518 PEDIATRICS 



ascribed to them; proximal malformations, such as auricular 

 appendices, harelip, anencephalia, cyclopia, flattening of the face, 

 anophthalmia, hereditary polydactylia (Ahlfeldt and Zander, Vir- 

 chow's Archiv, 1891), and lymphangioma of the neck, have been 

 found to be caused by amniotic attachments or filaments. Is it 

 too much to believe that the uterus, whose internal changes, syph- 

 ilitic or others, are known to be very accessible to local and gen- 

 eral medication, should be so influenced by previous treatment 

 that malformations and fetal deaths will become less and less 

 frequent ? 



The problem of the health and hygiene mainly of the older child 

 refers to more than its food. The school question is in the fore- 

 ground of the study of sanitarians, health departments, physi- 

 cians, and pedagogues. Its importance is best illustrated by the 

 large convention which was organized in Stuttgart, April, 1904, 

 as an International Congress for School Hygiene. Podiatrists, 

 pedagogues, and statesmen formulated their demands and mapped 

 out future discussions. Rational pediatrics would consider the 

 following questions: Is it reasonable to have the same rule and the 

 same daily sessions for children of eight and perhaps of fifteen years, 

 and for adolescents? Certainly not. The younger the child the shorter 

 should be the session, the longer and more frequent the recesses. 

 There should be no lessons in the afternoon, or only mechanical 

 occupations, such as copying, or light gymnastics. There should 

 be no home lessons. 



The problem of overburdening was carefully considered by 

 Lorinser in 1836, and by many since. It deals with the number 

 of subjects taught, the strictness and frequency of official examin- 

 ations, and should consider the overcrowding of school-rooms. We 

 should try to answer the question whether neuroses are more 

 the result of faulty schooling or of original debility, heredity, 

 underfeeding, lack of sleep, bad domestic conditions, or all these 

 combined. In Berlin schools they have begun to feed the hungry 

 ones regularly with milk and bread. No compulsory education 

 will educate the starving. The child that showed his first symp- 

 tom of nervousness when a nursling, the child with pavor nocturnus, 

 or that gets up tired in the morning, or suffers from motor hyperes- 

 thesia, pointing or amounting to chorea, unless relieved instead 

 of being punished by an uninformed or misanthropic or hysterical 

 teacher, gets old or breaks down before the termination of the 

 school term or of school age. There should be separate classes for 

 the feeble, for those who are mentally strong or weak, or of medium 

 capacity. All of such questions belong to the domain of the child's 

 physician, the physician in general. The office of school physician 

 is relatively new. Whatever we have done in establishing it in 



