AIMS OF MODERN PEDIATRICS 495 



These last factors are of special importance in the period of skeletal 

 development. Unhygienic conditions of the surroundings, insuffi- 

 cient ventilation, crowding together of persons, as occurs especially 

 among poor people and in cold weather, have, as Kassowitz has 

 shown, an undoubted influence on the origin and severity of rachitis. 

 Considering the great frequency and insidious beginning of this 

 disease, it is not unnecessary to mention that the severe forms and 

 deformities of this disease may at the proper time be prevented. 

 In a carefully regulated diet and the use of baths, air and exercise 

 cures, and secondarily in the administration of food preparations and 

 medicines (phosphorus, iron, arsenic), we possess powerful aids 

 against the development of this dyscrasia, which is so frequent at 

 this period. In view of the change of the skeleton from the infantile 

 to the adult type, which occurs at this time, one should also try to 

 influence this process favorably and to prevent for example the devel- 

 opment of the dreaded paralytic thorax by suitable means. The 

 dangers of dirt infections are to be avoided by careful avoidance of 

 opportunity for infection, and cleanliness; eventually, also by the 

 use of an inclosed protective pen (Feer). I have reached the opinion 

 that not a few of the cases of tuberculous meningitis, which is so 

 frequent at this age, are to be traced to infection from dust in the 

 dwelling. 



In the second period of childhood, which is devoted to functional 

 development, the task of the physician is on the one hand to bring 

 the powers and abilities of the child to harmonious perfection, on the 

 other hand, by an appropriate selection and direction of bodily 

 exercises and by the proper arrangement of hours of work, to pre- 

 vent exhaustion and harm. From which side the influence of the 

 physician must act depends on the peculiarities of the child and of 

 its guardians, and also on the customs and usages of the country. 

 In the Germanic and Latin countries the general striving toward a 

 better physical development does not begin until this period, while 

 among people under English influence this has started long before. 



A new factor comes into the life of the child with the school. The 

 modern method of teaching classes in closed rooms and with a com- 

 paratively large number of hours of instruction is, from the hygienic 

 standpoint, to be looked upon as a necessary evil. So much the more 

 we must endeavor to compensate for the unavoidable harm by im- 

 proving the school arrangements on the one hand, and by sufficient 

 time for rest on the other. From many sides the principal task of the 

 physician in this period is thought to be by rigorous isolation meas- 

 ures to guard the children against the acute exanthemas which 

 threaten them at school. I cannot agree with this point of view 

 under all circumstances and for all the diseases of this group. Even 

 though every appropriate measure, even prophylactic immunization 



