DIFFICULT BOYS 343 



The child of rapid growth usually fails of symmetric development 

 in several directions. Disease processes, infections, accidents of nutri- 

 tion, environment, emotional influences, etc., all tend to initiate and 

 emphasize minor deformities. Overgrowth usually leads, for instance, 

 to poor thoracic capacity. If the thorax is for any reason dispropor- 

 tionately small and narrow a variety of special predispositions are 

 encountered. 



If as physicians we fail to devote sufficient attention to morbid 

 phenomena of the mind and morals, we perform less than half our 

 duty. Disorders of the mind are dependent upon one of two factors: 

 either defects of development in the brain, or diseased processes of the 

 brain, or retroactively. The purpose and aim of diagnosis rest upon 

 the concept that by the early recognition of manifestations of morbid 

 physiology, we shall find means to check the changes which would 

 otherwise pass on to destructive alterations. 



If this proposition obtains for the disorders of the physical func- 

 tions, how much more must it fulfill a valuable service for those of the 

 brain, which is a far more sensitive structure and especially liable to 

 permanent damage from relatively slight irritations. It is a great 

 privilege to mitigate bodily suffering, to limit the progress of structural 

 degenerations, to prevent disablement and save life, but how vastly 

 higher is the prerogative to turn aside those perils which jeopardize the 

 budding intellect and rescue a tottering moral nature. Yet how little 

 of this subject is the medical student taught, or again how much interest 

 does the average practitioner display in this incomparably higher phase 

 of his duties? 



It should be the aim of the clinical teacher to emphasize unceasingly 

 the urgency of obtaining the earliest possible indications, omens or 

 prefigurements of departure from normal f unctionation ; especially in 

 children. When this is accomplished the greatest economy is effected; 

 first in the limiting of suffering and the progress of disease, and second, 

 in forefending the organism from developmental defects. All life is a 

 process of development, but the effects of interferences are vastly more 

 forceful and significant in the young. M. W. Barr points out a fact, 

 especialty obvious in children of impaired mentality, which, however, 

 obtains to a certain extent in all. There are at any one period, three 

 ages which must be estimated: (1) the actual age in years, etc.; (2) 

 the psychologic age, the degree of mental development or retardation; 

 (3) the physiologic age, the status of conformation and function. 



Diagnosis of the morbid conditions of childhood involves something 

 more than a mere search for evidences of disease. During the period 

 of plasticity numerous influences prevail in all ranks of life to alter 

 normal growth and organic development by which the foundations of 

 constitutional weakness are often laid. These are in a great measure 



