Hysteria.—Although hysteria has not the same gravity, it is no less advisable that cases should be tracked out. This neurosis is being discussed to-day as never before. Without setting forth at length what we think should be included under this term, let us point out a characteristic of hysteria which is commonly recognised, and which is of such importance that it indicates the line of treatment to be followed. The two principal manifestations of the affection, hysterical fits and the recital of lying tales, require for their complete development the presence of a public, of a gallery. Inversely, their disappearance is assured by isolation or apparent inattention.
The discovery of such tendencies before entrance to the school will allow the doctor to forewarn the teacher, and point out to him the best way of dealing with such children.
There are still three affections about which we must say a few words—rickets, adenoid vegetations, and scrofula.
Rickets.—The chief characteristic of this condition is defective ossification. Instead of possessing their usual rigidity, the bones become curved, and multiple deformities result. The legs become bowed, and the knees cannot be brought into contact when the feet are placed together; the thorax becomes constricted or gibbous, etc. In addition to the nutritive disturbance, which appears to be at the root of all these disorders, there may be, according to some authors, an affection of the entire system, and especially of the nervous centres. Unfortunately, as rickets is a disease of the earliest years of life, one often finds oneself in the presence of the sequelæ which have been left, and which simply must be made the best of.
Adenoid Vegetations.—Everyone has now heard of cases of this kind where the appearance is so characteristic. The lips are always half open, the appearance is sleepy-looking, the respiration is difficult. If one looks at the throat, or if one introduces the finger into the child's mouth in order to explore the pharynx behind the soft palate, one will see or feel the large tonsils or the fleshy masses which obstruct the posterior orifice of the nasal fossa. One would like to find in these vegetations the cause of the habitual torpor of the children, and of their want of progress. It is true that there is a connection between mental backwardness and adenoids. The removal of the swellings by a surgical operation will make more free the respiration, whose obstruction prevented sustained attention, and will also frequently cure the deafness, which was due to an obstruction of the Eustachian tubes. The operation may therefore result in a marked amelioration of the mental condition as well as of the general health. If the amelioration is sufficient, the child can be sent back to the ordinary school.
Scrofula, Tuberculosis.—A child with a lymphatic appearance, whose tissues are infiltrated with serum, and whose glands readily become enlarged, requires plenty of country air and a nutritious diet. If he is admitted to the special school, it will be advisable to attend to his health before subjecting him to any particular educational methods.
The doctor, then, will notice in passing the existence of such conditions as rickets, adenoids, and scrofula in the children who are submitted to him. Affections of the lungs and tuberculosis of the bones will also attract his attention. But such affections in abnormal children have no other significance than in the case of children of average intelligence. They furnish no special indication regarding the admission or non-admission of the child into a special class. Their severity alone determines the course to follow with respect to their treatment.
We shall, however, say a few words about another infirmity—incontinence of urine. If there is presented for a class for defectives a subject, eleven years of age, who cannot control himself in this respect, the course to follow is: submit the child to examination by a specialist, who will decide the nature of the incontinence. If it is curable, give the condition the necessary attention, or give instructions at the school for training the child properly; but if there is an incurable weakness of the sphincters, supply the child with the same kind of apparatus as is used in such cases by ordinary people.