Remote Antecedents.—These include an investigation regarding the ancestors, the brothers and sisters, and the collateral relations. The age of the parents (since we know that too immature or too advanced an age, or a disparity in age between the parents may result in the birth of weak children). Degree of relationship between the parents (since we know that the offspring of parents related to each other may be weak). Maladies incurred by them or prevalent in their families, incidental vices of the parent (since we know that constitutional maladies, such as syphilis, tuberculosis, gout, pellagra, malaria, mental and nervous diseases, etc., alcoholism or an irregular life of excesses, may lead to the procreation of degenerates). Furthermore, since it is known that according to the laws of collateral heredity, maladies may reappear in nephews which previously occurred in uncles and not in the parents, information should be sought, so far as possible, from all members of the family. Information regarding the brothers of the subject offers an interest of a very particular kind, because this gives us an insight into the generative capacity of the parents: for instance, if there were abortions, children who died at an early age of convulsions, meningitis, etc., this argues unfavourably for the normality of the subject.
Near Biopathological Antecedents: Mother, Child.—Our inquiries should centre first of all upon the mother, in order to know the conditions of conception, pregnancy, delivery and lactation, in the case of the child under examination, because we know that frequently an error at the time of conception may produce a degenerate or a weakling. For example, a child generated in a state of physical or mental exhaustion—e.g., after a long trip on a bicycle, or after passing an examination—may be born feeble, predisposed to nervous diseases (idiocy, meningitis), just as he may be born abnormal (epilepsy, anomalies of character, criminal tendencies) if generated by the father during an alcoholic excess, or by the mother while suffering from hypochondria, illness, etc. The history of the pregnancy is also of interest: whether it proceeded regularly to the close of the nine months, whether the mother suffered especially from mental anxiety, illness or received any blow on the abdomen.
Other causes which may affect the health of the child have reference to birth and to lactation. If the delivery requires an operation, it may, for instance, deform the skull; while a hired wet-nurse, or artificial feeding are more or less apt to cause deterioration in the child.
Having completed this first enquiry, we pass on to consider the child itself, from the time of birth onward, lingering especially over its early development and more particularly over the cutting of the teeth, learning to walk and learning to speak, which are the three first obstacles to infantile development. The healthy child overcomes them according to normal laws, while the child of tardy development shows the first characteristic anomaly in these three fundamental points of its early existence (tardiness of development, incomplete and defective development, development accompanied by diseases, etc.).
Usually a tardiness in the development of the teeth denotes general weakness and more especially skeletal weakness (rachitis, syphilis); tardiness in learning to walk may occur in connection with the above-named causes (weakness of the lower limbs); or with difficulty in attaining an equilibrium (of cerebral origin; witness the case of idiots who, without being paralytic, cannot walk, because they cannot learn how to walk); or with paresis, more or less partial or diffused, of the muscles controlling the act of walking (infantile paralysis, Little's disease, etc.). A tardy development of speech is sometimes found together with a notable intellectual development and the child will not begin to speak until he can express thoughts and speak well; but more frequently such delayed development is due to partial deafness; or it originates in the association centres of the brain (the idiot child cannot learn to speak).
It will also be helpful to know whether the child was ever ill. It is very important in this connection to find out whether the child ever suffered from infantile eclampsia in early life (convulsions, or "fits" as the mothers of the lower classes call them). This is an indication of a cerebral malady which leaves behind it permanent alterations of the brain and of its functions. The child may be an idiot, or may belong to one of the various catagories of children who go under the name of defectives; or he may be abnormal in character (cerebroplegic forms). Another important fact to record is nocturnal enuresis (loss of urine during sleep subsequent to the normal age); this is considered by some authorities as a pre-epileptic state—that is, a child that suffers such losses may in the future become subject to epilepsy, and quite probably, if studied, will show various anomalies of the nervous system, such, for example, as too deep sleep, slowness of intelligence, etc. Repeated attacks of infective diseases, even though they are survived, also denote organic weakness, with facile predisposition to infective agencies—in other words, deficient powers of immunity.
Prolonged intestinal maladies or typhus in the early months (denutrition from pathological causes, exhaustive diseases) may, in themselves, be the cause of the child's enfeeblement and its consequent arrest in development.
But in the interpretation of such observations, the physician should be the guide and the direct judge.
The most salient symptoms in regard to the child—intelligence, conduct, character, endurance, etc.—are, for the most part, expressed with great clearness by the mothers. Prof. De Sanctis, for example, has noted that the mother's first words might serve the purpose of a diagnosis; for instance, the mother says of an idiot child: "he doesn't understand," of a child retarded in development, "he is stupid," of an abnormal child, "he understands but he is bad." Accordingly, Prof. De Sanctis begins his diagnostic researches by registering the maternal judgments, because the mother is struck by the salient characteristics of her child; and even if she is uneducated she always finds concise and effective phrases to express her judgment.
To the end of rendering the research into antecedents surer and more complete so far as regards the personal antecedents of the child, certain anthropological tablets are being introduced to serve as maternal diaries. In this way the mothers have a guide for studying their children, and this forms one of the first practical attempts toward the "education of the mothers."