"The child should be led from the education of the muscular system to that of the nervous end sensory systems; from the education of the senses to concepts; from concepts to general ideas; from general ideas to morality. This is the educational method of Séguin."
However, before we begin education, we must prepare the child to receive it by another education which is to-day regarded as of the very first importance. This preparatory education is the foundation on which all subsequent education must be based, and the success we obtain in it will determine the success of our subsequent efforts. by preparatory education I here mean hygienic education, which in defective children sometimes includes medical treatment. That is why the educational method for defectives is sometimes described as medico-pedagogical.
Those who realize that importance of feeling and internal sensation in education will understand that the bodily organism must function properly in order to respond to our educational efforts. We must preserve good health where good health exists: we must restore it where it is lacking.
We are therefore under strict obligation to pay close attention to nutrition and to the condition of the vital organs. Every one is aware of the close relation existing between general sensibility and morality. Criminals and prostitutes show very scant sensitiveness to pain and to tactile stimuli. The same situation is frequently apparent in defectives; hence the necessity of restoring the tactile sense with adequate attention to hygiene.
We cannot educate the muscles to perform a given coordinate movement if they have lost their power of functioning (as in paresis, etc.). Education, properly so-called, must be preceded by a medical treatment to restore the muscles, if possible, to good health.
It will be impossible to educate, for example, the sense of hearing, if some pathological situation has produced partial deafness. We cannot educate the sense of smell if the excessive excretion of mucus prevents external stimuli from acting on the ends of the sensory nerves. Obviously, we need a medical treatment to remove these diseased conditions.
MEDICAL EDUCATION
General baths: When not too prolonged they develop the sensibility of the nervous papillæ. They give tone to the cellular and muscular tissues, especially to the skin.
Hot and cold baths given alternately are a powerful educational instrument in attracting the attention of a child to his external environment.
Local hot baths may be given to areas deficient in sensibility. For instance, try bathing the hands if tactile education proves impossible, or bathe the feet if the defect in standing upright or in walking comes from the insensitiveness of the soles.
Local cold baths: Given to the head while the patient is entirely covered in warm water are a tonic to the scalp; they facilitate the knitting of the bones of the skull and the formation of wormian bones, preventing also cerebral congestion. They stimulate and regularize the cerebral circulation. Such baths are particularly useful for hydro-cephalics and micro-cephalics, but all patients are benefited by such baths, which are the most generally useful of all.
Steam baths develop perspiration which at times is completely absent or partial in defectives, causing serious physical disturbances. These baths, furthermore, predispose the nerve ends to the most intense sensitiveness.
Such baths are, however, not to be used on epileptics or on children suffering from rickets, weak circulation or general debility.
In general, local steam baths are used especially for hands and feet, and also for the tongue.
General cold baths are used in cases of super-excitation, motor-hyperactivity, excessive sensitiveness to pain and touch. These baths must be accompanied by constant cold lotions on the head.
Baths may be accompanied, with good results, by massage and rubbing.
Rubbings may be given dry or with water, alcohol, aromatic creams or ointments.
Local rubbings may be applied: (a) To the spine, carefully avoiding the lumbar region so as not to excite the sexual sensibilities. Dry rubbings should be made with a piece of flannel and continued until the skin reddens. They are especially useful after hot baths followed by cold douches. (b) To the chest to stimulate respiration. (c) To the abdomen to correct various internal disorders (here, however, massage is more efficacious). (d) To the joints (rubbings with aromatic creams and with alcohol are very effective).
A brief rubbing with alcohol or creams can be followed with good effect by massage in the case of abdomen and joints. Massage on the abdomen stimulates circulation in the intestines and intensifies and regularizes the movements of the muscular walls.
Massage has a surprising effect on the muscles of the joints; it shocks the muscular fibers in their innermost parts and sets them in motion; it regularizes the functioning of the muscles by reducing excessive contraction and restoring deficient contractibility. Emaciated muscles are regenerated, the muscular bulk is vigorously augmented, while the fat tissues are absorbed.
The repetition several times a day of bathing, rubbing and massage has produced real miracles of physical regeneration.
FEEDING
Intestinal disturbances have a direct influence on the functional power of the central nervous system. They merit, therefore, special consideration. For in defectives an intestinal inflammation may produce symptoms of meningitis, and a disorder in digestion even unattended by fever may occasionally give rise to convulsions.
The hygiene of feeding which is almost the same as that for normal children must therefore be rigorously observed.
The general rule is list the children should have regular meals and be allowed nothing whatever to eat between meals. It is commonly believed that a piece of candy or a bit of fruit given between meals has no bad effect. This is a common error of many mothers, who by allowing such slight irregularities in diet, become the unwitting cause of serious illnesses in their children. When we say that children should be fed at mealtimes, we mean that nothing should be given them except at meal times; nothing, not even the most innocent confection; not a crumb of bread, not a drop of milk. This severity has the quantity and quality of food allowed in each.
Number: For children between 2 and 7 years: 4 meals a day; for children between 8 and 14 years: 3 meals a day. These meals should be at regular hours, and followed without exception by a period of mental rest, which must be provided for in making up the daily program of lessons.
We need special researches as to what type of activity may be allowed children during digestion and what organs may be active without damage to the child while the stomach is taxed with the labor of digestion. A few things are clear. The children should be sent out of closed rooms where their play raises more or less dust, and kept in well-ventilated places, if possible, in a garden or in a woods well supplied with aromatic trees. The best thing a child can do immediately after a meal is to take a short walk in the open air without much exertion.
Quantity: In the case of children between 2 and 7 years of age, there should be two full meals and two luncheons. After the age of 7 there should be one lunch and two full meals. We cannot be more specific.
Quality: In the case of defectives it would be useful for the doctor to order a diet day by day after having examined the diaries of the nurses as is done in hospitals. For it may be possible to introduce into the food elements which constitute an actual cure for certain diseased conditions and preventives of certain kinds of attacks. In food we should realize the distinctions between the elements which build tissues—true food substances, and others whose function is purely stimulatory—alcohol, coffee, tea, etc., which should be used only occasionally.
Among the food substances properly so-called are the albuminoids (proteins), fats, and carbo-hydrates (sugars, starches, wheat and potato flours, etc.). The fats are the least digestible foods, but they produce the greatest number of calories.
The proportion of the different elements in the food should be determined by the amount of albumin, which constitutes the real food element. Albumin is of both vegetable and animal origin. Its animal forms are more nutritious, more easily digestible, and products more calories than the vegetable forms. The foods which produce animal-albumin are milk, eggs, and meats. Vegetables themselves furnish what is known as vegetable-albumin. Children up to 8 years of age are supplied usually with the following albuminous foods: eggs, milk and vegetables. For children between 6 and 8: eggs, milk, fish and vegetables may be provided. Older children may be given chicken, veal, and finally beef.
Though for normal children a restricted meat diet is desirable, in the case of defectives a rich supply of meat as well as of albuminoids in general is to be sought. Their treatment resembles that of weak convalescent patients whose strength is to be restored. The meats best adapted to such children are those containing large amounts of mucilaginous substances and sugar (veal, lamb and young animals in general). Vegetable purées, fat gravies, butter, etc., are to be recommended in these cases.
For nervous children, fats, oils, acids, and flours should be avoided.
For apathetic children, who experience difficulty in digestion, tonics and rich seasonings should be used, such as spices, which have come to be almost excluded from ordinary cooking, especially for children. Spices may well be restored to the diet of institutions for defectives, since they have the additional advantage of permitting mixture with irons, of which they neutralize the taste.
Questions of food depend largely upon the individual condition of the children. The important thing is to avoid "the school ration." This is all the more true of beverages.
Beverages: While stimulants are usually to be excluded from the diet of normal children of 7 or under, it is often desirable to introduce tea, coffee, etc., into the meals of defectives. This should be done, however, only in the daily diets ordered by the physician for individuals.
Nervous children should be restricted to milk and water for their meals with some moderately sweet drink (orange juice, weak lemonade, etc.) after eating.
Apathetics, showing atonic digestion, may have coffee either before eating or during their meals.
Special education is necessary to accustom the children to complete mastication. Such practice in the use of the organs of mastication assists also in the later development of speech.
EXCRETION
Among the physiological irregularities that appear among children special importance attaches to excretions.
Defecation: Among defectives especially, so-called "dirty children" are often so numerous that special sections have to be made for them in institutions. Such children show involuntary losses of fæces and urine, as in the case of infants. Most frequently the defecations are of liquid consistency though sometimes the reverse is true. Our remedial effort should be in two directions: we should try to regularize the operation of the intestines by giving solidity to the excretions; secondly, we should endeavor to strengthen the sphincter muscles.
A strict observance of the diet hygiene outlined above, especially as concerns regularity of meals and mastication of food, will assist in the attainment of the first object. We should try in addition to regularize defecation by stimulating it at regular intervals (to be gradually increased in length) through light massages and hot rubbings on the abdomen.
To strengthen the sphincters general tonics (iron, strychnine), and local tonics (such as cold "sitz-baths," cold showers and electric baths) may be used. Suppositories may also be used to advantage in stimulating sphincter contractions and accustoming the muscles to constrictive action.
Urine: some defectives show involuntary loss of urine, especially at night, up to very advanced ages. Epileptics are particularly predisposed to this. The treatment is analogous to that just described. Beverages should be carefully supervised. Diuretics and excessive drinking in general should be avoided.
General recommendations: Local baths, and rigorous cleanliness to avoid any stimulus to onanism.
Education can do much in the treatment of this situation. Urination should be regularly suggested to the child before he goes to bed and when he wakes in the morning. In special cases it might be well to waken the child once or twice during the night for the same purpose. This defect is often associated in a child with some abnormality in the phenomena of perspiration.
Perspiration: The sweat has almost the same composition as urine, and perspiration is a process supplementary to the action of the kidneys. It has been observed that often in defective children perspiration is either entirely lacking or limited to certain areas (the palms of the hands, the nose, etc.). It is absolutely necessary to stimulate and regularize perspiration over the whole surface of the body. This may be done by hot and steam baths, by dry rubs with flannels (long sustained if necessary), by woolen garments constantly worn next to the skin, and other similar mechanical devices. We must, however, absolutely avoid the use of special diaphoretic drugs, which often bring about a fatal weakening of the organs of perspiration. The treatments we have suggested above are, first of all, harmless, but besides they contribute to the general toning and sensitizing of the skin.
Nasal mucus and tears: Tears are often lacking in defectives. On the other hand nasal excretion is very abundant and replaces the tears, which are often so rare that some children reach a relatively advanced age without having wept. In such cases there is a predisposition to certain diseases of the eyes; and excessive nasal excretion prevents the functioning of the olfactory organs.
For this we recommend inhaling of hot vapors and of fragrant irritants, which correct the excessive excretion of mucus and exercise the olfactory sense. Usually the regular secretion of tears follows as a matter of course.
Saliva: One of the most unpleasant abnormalities in defectives is the continuous loss of saliva from "hanging lips." But the effects are not only unesthetic. The continuous over-excretion of saliva makes the inner organs of the mouth flabby and swollen. The tongue and the organs of speech in general gradually lose their contractive power, and articulation is ultimately rendered impossible. Taste and tactile ability often disappear altogether. Mastication becomes difficult and deglutition irregular. The secondary effects on the digestive organs are bad. We possess a variety of efficient curatives and educational treatments for this defect: first, general tonics; second, local cold douches on the lip muscles, electric massage of the lips; third, the use of licorice sticks, large at first but gradually reducing in diameter, to be introduced between the lips to stimulate the sucking activity and the exercise of the contractive muscles. This will ultimately give the necessary muscular tone. The lips of the child should be closed mechanically from time to time to force him to swallow the saliva and to create the habit of deglutition.