The child of rapid growth usually fails of symmetric development in several directions. Disease processes, infections, accidents of nutrition, 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 disproportionately 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 functions, 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 functionation; 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
