HISTORY OF PEDIATRICS 523 



born. Two I have seen myself. There are those which have been 

 observed at 6 months (Friedel), 9 months (De France), at 15 months 

 (Bjering), at 18 months (Dick). In the year 1889 Morgan collected 

 93 cases, 13 of which occurred from the second to the fifth, 11 

 between the fifth and tenth, and 15 between the tenth and twen- 

 tieth years. Amongst the 168 cases collected by Cassirer, 20 occurred 

 below the fifth, 8 between the fifth and tenth, and 25 between the 

 tenth and twentieth years of life. Like most nervous diseases, these 

 cases had either congenital or acquired causes, amongst which a 

 general neuropathic constitution, and the hereditary influence of 

 alcohol, chlorosis, and anemia are considered prominent. Of acute 

 circumscribed edema, 28 cases are found below nine years of age 

 in Cassirer's collection of 160 cases, one of which at the age of one 

 and a half months is reported by Crozer Griffith, one at three months 

 by Dinckelacker. Again hereditary influence is found powerful. 

 Osier could trace the disease through five generations. 



The connection of pediatrics with psychiatry is very intimate. 

 Insane children are much more numerous than the statistics of 

 lunatic asylums appear to prove, for there are, for obvious rea- 

 sons, but few insane children in general institutions. It is only 

 those cases which become absolutely unmanageable at home that 

 are intrusted to or forced upon an asylum. The example of the 

 French, who more than fifty years ago had a division in the Bicetre 

 for mentally disturbed children, has seldom or not at all been imi- 

 tated. Thus it happens that though not even a minority of the 

 cases of idiocy become known, its statistics is more readily obtained 

 than that of dementia of early life. Some of its physical causes or 

 accompaniments have been mentioned asphyxia with its conse- 

 quences, ossification and asymmetrical shape of the cranium, acci- 

 dents during infancy and childhood, and neuroses that may be the 

 beginning or proximate causes of graver trouble. Infectious diseases 

 play an important part in the etiology of intellectual disorders. 

 Althaus collected 400 such cases. They were mainly, influenza 

 113, rheumatism 96, typhoid fever 87, pneumonia 43, variola 41, 

 cholera 19, scarlatina 16, erysipelas 11. In most of the cases there 

 were predisposing elements, such as heredity and previous dis- 

 eases, or over-exertion of long duration. The overworked brains 

 of school-children were complained of as adjuvant causes of lunacy 

 by Peter Frank as early as 1804. We are as badly off, or worse, a 

 hundred years later. 



There is one ailment, however, that appears to hurt children 

 less than it does adolescents or adults, that is masturbation. There 

 are those cases, fortunately few, which depend on cerebral disease, 

 and original degeneracy, but in the large majority of instances 

 masturbation, frequent though it be, has not in the very young the 



