and transitory.
Many studies have lately been made of the forms of scoliosis, or spinal curvature, peculiar to adolescents. Eulen- burg had found that of 300 cases of scoliosis, most occurred be- tween six and fourteen, and of these 53 per cent between seven and ten, 23 per cent between six and seven, and 12 per cent be- tween ten and fourteen. Krug found that of 181 cases, most or 35 per cent occurred between thirteen and thirteen and three- quarters years; that next to most, or 28 per cent, occurred from eleven to eleven and three-quarters years; that 27.5 per cent oc- curred between twelve and twelve and three-quarters years; and that 5 per cent of the rest occurred between fourteen and sixteen and three-quarters years of age. Its advent is so slow and insidious that it is often unnoticed for years, or it is thought to be merely a bad habit of posture. The same leg is crossed over the other instead of reversing the position. In standing DISEASES OF BODY AND MIND 257 the weight is chiefly on one foot and perhaps always the same, rather than equally divided or alternating. One elbow is leaned on, the head is tipped to one side, vicious attitudes are assumed in writing, studying, etc. Heiser ^ recommends the use of the scoliometer at this age to detect the beginnings of asymmetry of function. Most frequent is right dorsal, and next comes left lumbar curvature. Both may be either cause or effect of habit- ually sitting with more pressure on one flank than on the other. Whether the various scolioses, including cyphosis and lordosis, are primitive and purely hereditary, still admits of some doubt. The deformity of the thorax is often attended by and perhaps causes irregularities of heart beat, respiration, and digestion. More or less torsion of the spine and muscular insufficiency are often causes, and osseous theories alone are at least inadequate to explain most cases, as are the muscular, nervous, or ligamen- tary theories so often exploited in connection with orthopedic methods. Most of the latter now agree in disapproving of corsets and all constant physical restraints of the freedom of motion, save in extreme cases, because immobility enfeebles. The accentuation of these asymmetries at adolescence is to be expected from the rapidity of growth under unfavorable condi- tions of heredity, environment, or habit, for one side of the body develops more nervous innervation and muscular tension, or more rapid metabolism, than the other, and the equilibrium which characterizes perfect normality and health is upset.' Finer modern measurements show that nearly all persons are more or less unsymmetrical.
The great work of Alexander James ^ shows that the great- est mortality for consumption occurs from the ages of twenty- five to thirty. If we assume with Clouston that infection with this disease began on the average five years earlier, we could in- fer that consumption begins under twenty-five, and this would agree with James's law that " tubercular deposit tends to occur in various tissues at periods when the excessive nutritive power required for growth is becoming or has become exhausted." Clouston^ adds that ''lung tubercle first shows itself in any de- * La Scoliose Essentielle des Adolescentes. Paris, 1897. ' Pulmonary Phthisis. •The Neurosis of Development, p. 91. 18 THE PSYCHOLOGY OF ADOLESCENCE gree in 14 per cent of persons living near the beginning of re* productive power, viz., fifteen years of age. It doubles its viru- lence about twenty, reaching 34 per cent, and gets to 38 per cent at twenty-five and to 40 per cent at thirty, thus killing most of its victims during the developmental ages and reaching its maximum just at the age of completed development." Clous- ton has described a special kind of mental disease, which he calls phthisical insanity, beginning during or just after adolescence, when he thinks the body is in a state of reduced nutritive con- dition favorable to tubercular infection. This innutrition he deems one form of trophic neurosis, and thinks the special pul- monary innutrition, that admits of the tubercle bacillus finding a nidus in the lungs, results in a developmental failure in the epithelium of their alveoli. He bases this inference very largely upon the coincidence of the maximal age of infection for both. Suggestive in this regard are the mortality tables for tubercu- losis for the different ages and sexes in Prussia calculated in percentages on a basis of 10,000 inhabitants, as follows: ^ Age.
Age.
ao-25 Stuttering is a spastic disorder of coordination in the muscles of speech and is most liable to occur at pauses or initial consonants, especially if they are explosive. The three factors of expiration and vowel production by action of the vocal cords and consonantal activity of lips and tongue, which are involved in articulation, are not harmonized, and tonic or clonic cramps occur. The impediments may sometimes all remit and speech be normal for a time, but they are aggravated or often caused by mental tension and bad training. Stammering differs from stuttering in lacking the spontaneous by-movements and in being a failure of pronunciation rather than of speech, while the latter is a kind of chorea of the muscles of utterance, and breathing is usually at fault. It is especially liable to occur at the age when mechanical reading is taught, and the speech * Jahresbericht auf die Fortschritte u. Leistungen auf dem Gebiete der Hygiene, DISEASES OF BODY AND MIND 259 processes long circuited from ear and mouth to eye and hand. It is favored by shyness and fatigue in the child, and by too great urgency on the part of the teacher, so that the child ac- quires a speech consciousness. Both are very contagious and with proper initial training could probably be very greatly re- duced. Hartwell's valuable table ^ shows that averaging the six best German studies of 252,312 children, in all 1.12 per cent were stutterers, as against 0.77 per cent among Boston children and 1.57 per cent among Russians. Next to the age of second dentition, the onset of puberty is most susceptible to this form of nervous disturbance. He found the largest per- centages in girls at seven, twelve, and sixteen, and in boys at eight, thirteen, and sixteen; and finding that these ages nearly corresponded with those of the highest specific intensity of life or immunity from death, he concluded that the irritability of the nervous system of which stuttering is an expression was bound up with the nutritive activity, which resisted lethal in- fluences. He advocates special breathing exercises at this age.
Dr. Cullack^ thinks many of the weaknesses and other eye troubles peculiar to puberty really originate in the sexual modi- fications of that period, especially in girls. Eye strain and re- tino-choroiditis, hemorrhage of the eye, etc., he describes as due to nature's seeking an outlet at this age which elsewhere is denied it or is found to be inadequate. These troubles he found are often removed when menstruation is normally established. Clouston, too, holds several visual neuroses to be essentially developmental neuroses.
The following table, adapted from Seggel,^ who tested two or three times a year for sixteen years, is perhaps the best for German schools, and shows clearly the increased rate of myopia during adolescent years. Key on the other hand found that at fourteen and again at seventeen the increase of myopia was lessened. Other tables have shown no difference, so that on the whole we must infer that if the influence of puberty on near- sightedness is not yet conclusively established, a rather steady increase through the period of sexual maturation is certain.
^ Rep. of Director of Physical Training. Boston, 1894, p. 69, et seq. ' The Eye at the Age of Puberty. Gaillard's Med. Jour., New York, beginning THE PSYCHOLOGY OF ADOLESCENCE Agb.
Class.
Per cent of short- sighted.
S-S ?
Both Bunge and Marro found a slight excess of iron in the blood during early pubescent years, which they conjectured was nature's way of providing against the special liability to chlorosis and to anemia at this age.
Among the many miscellaneous nosological peculiarities of adolescence we may probably reckon increased liability to typhoid fever, Ziemsen's percentage being as follows: Be- tween the ages of sixteen and twenty may be found 19 per cent of all cases; between twenty-one and thirty, 58 per cent; and between thirty-one and forty, 16 per cent. In malaria several writers have urged that tertian, quotidian, and other inter- mittent, periodic, and recurrent forms were more liable at and soon after puberty.
Berillon^ concludes that onychophagia, or nail-biting, reaches its maximum frequency at about the age of greatest danger of masturbation.
Both Ireland ^ and Kind think that if idiots can remain in * Monograph on the subject, 1894.
• Mental Affections of Childhood and Youth, 1898, p. 356 DISEASES OF BODY AND MIND 26 1 schools for their benefit only four to five years, they will receive most profit between the ages of twelve to sixteen.. Some writers think this age prone to a type of cataleptic lethargy/ to simulation of diseases, and to many psychic contagions. Partridge ^ found that morbid blushing was prone to begin or to become greatly intensified at this age.
Dermal eruptions and muddy complexions, characteristics of several of the many skin diseases, are now common, especially with abnormalities of menstruation during the years of its first establishment.
While the suicide curve rises, there is also a new and oflf- setting horror of death not felt before. Clouston's " barking cough of puberty " has been often recognized by subsequent writers.^ Troubles that seem minor now may become grave later, and it is probable that this is the sprouting garden of many more chronic and hereditary troubles that become fatal later than is recognized; so that the germs of death are now taking root like tares among the forces of the budding vernal life; all this makes adolescence a process of assay and ordeal for the alloy of morbid predisposition. Now the robust often become deli- cate, or vice versa.
Liveing thinks megrim in girls has three periods of onset, each about equally liable, from seven to thirteen, at the dawn of puberty, and during adolescence.
Warner, whose very suggestive studies were made with singular disregard of age, with little apparent consideration of the work of other writers on related lines, and, I think, with- out a single indication that he had considered any work not written in English, found that of 100,000 London school chil- dren,* 9,777 had defects in development of various kinds and 8,323 were otherwise defective or sick, leaving only 81,900 without visible defect or not reported dull. Of all 10,355 showed nerve signs.
* See a valuable characterization by Rothmann and Nathanson in the Arch. f.
^Blushing. Fed. Sem., Apr., 1897, vol. 4, pp. 387-394.
* Report on Scientific Study of Mental and Physical Conditions of Childhood. London, 1895.
262 THE PSYCHOLOGY OF ADOLESCENCE Warner found cases of developmental defect more frequent in males, but under the effects of their environment more apt to be harmful to girls than to boys. The former were more liable to acquire nerve disorders, mental dulness, and low nu- trition.
Combe thought girls more prone to eye defects than boys in the proportion of twenty-one to twenty-seven, and about seven per cent more so in the city than in the country.
Most determinations of the time either actually given or needed for sleep at different ages show, as we saw, a decline near puberty, and most of our returns show that for a time sleep was at first restless and perturbed and afterward settled into a state described as better or worse, as if there were a new adjustment or balance struck between the processes of restora- tion and of expenditure. The sexual organs now often make themselves felt in dreams of a new character, and the advent of this new function is sometimes first announced in sleep. Green- wood thinks the function of dreams is to enlarge our imagi- native knowledge of the fields of life, and Manaceine thinks that where mental development is not highly advanced dreams are more likely to be racial rather than personal. Spitta, Radi- stock, De Santis, and others have suggested that some diseases make their first symptomatic advent into consciousness in dream life, and many have held that some " nocturnal syndrome " may be the bud of a second personality; that dream life may en- force or check tendencies in the waking consciousness; that the latter is often brightened, darkened, predisposed, or ren- dered averse to many things by reason of the psychic activities of sleep; or that dreaming is, in Wundt's phrase, a " normal temporary insanity," and may even affect the form of perma- nent insanity if the latter come later. The spontaneous dreams not due to the momentum of waking life are often thought to have more or less value as a revelation of individual character.
However all this may be, I am convinced that the dawn of adolescence is marked by much emotional intensification of dream life, and that at no age is its influence so important upon the moods and dispositions of waking consciousness. Som- nambulism often first appears at this age and trancoidal states of inner absorption midway between sleeping and waking are DISEASES OF BODY AND MIND now most frequent. The new emotional life seems if not to create and project, at least to take command of mental imagery and association, and indeed this may be a part of nature's method of making the intellectual sphere better fit that of in- stincts. In some of our cases, dreams are so intense as to be one cause of the chronic fatigue and even morning tire common in the teens. Sometimes young people wake with the soul suffused with a sense of nameless and unaccountable rapture from nearly or quite forgotten dreams, or perhaps with a new and strong predisposition toward some person of the other sex unattractive before, which lingers hours and perhaps days before it fades. These presentiments and previsions of love, which often first arise spontaneously and naturally in sleep, seem to illustrate the old trope that the stars of other and larger systems come out best when the sun of our own personal consciousness has set. Indeed in the reverie and day dreaming common at this stage, when the soul transcends its individual limitations and ex- patiates over the whole field of humanity, past, present, or future, it is perhaps quite as near the" world of our habitual, but generally unremembered dreams, as it is to the waking world of memory. In the new horizon now opening to the mind, unconscious cerebration generally has a larger role and for a time is more uncontrolled by the consciousness, over into which it shades by imperceptible gradations. Many psychic processes are so absorbing as to be almost a narcosis akin to the dreamy states that Crichton-Browne characterizes, so that if at first the soul falls to sleep with a great drop from waking life, the two states are later brought into manifold rapport and perhaps linked into unity.
Warner thinks the hours of work and sleep should be as follows: Age.
Hours of work per week.
Hours of sleep per night.
Between 8- 9 15 12 20 ll'A 25 II 30 35 40 45 50 10 9 264 THE PSYCHOLOGY OF ADOLESCENCE Our returns show great reason for believing that near the dawn of sexual life there is not only a new balance struck be- tween the processes of repair and anabolism and those of kata- bolic expenditure of energy, but that there is a marked tendency to irregularities in sleep. Sometimes a sense of fatigue, lassi- tude, and sleepiness, rarely narcoleptic, may supervene, and the time of actual sleep for days, weeks, or greater periods be pro- longed, but wakeful tendencies and special aversions to re- tire and to sleep follow and alternate. Some rebel at this period against the necessity of losing so much time from the life of active consciousness, dread night, and rejoice every morning on waking up that they have a long day before sleep is again im- perative. There are almost always spells of sitting up late and sometimes, though far more rarely, of preposterously early rising to utilize the maximum of time. Normal adolescent boys especially wish to explore night out-of-doors, to rove about perhaps with adventurous or romantic thoughts, and on moon- light nights particularly there is a pathos about the necessity of rest. A part of this suggests an atavistic recrudescence of what may have been in primitive man the need of watchfulness, the custom of predatory adventures or amatory excursions of an- cient courtships by night, still reverberating in the attenuated form of periods of nocturnal restlessness. The child's fever of early candle-light is metamorphosed by puberty into the youth's impulse to use darkness as a motive of abandon and license, as if the responsibilities of the day could be dispensed with by night in roving nocturns of riotous freedom analogous to the start on falling to sleep, due to the sudden removal of the habitual cerebral repression upon the lower spinal and midbrain centers. This passion to occasionally be out or to work late nights shades down the psycho-physical scale into increased dream activity and power to work evenings. The wonted irregularity of the diurnal rhythm, no matter how well estab- lished before, is now like every other function for a time dis- turbed.^ Passing now to the mental and nervous troubles, the pro- found effect of adolescence in producing disturbances of the * See Reactions to Light and Darkness, by G. S. Hall and T. Smith. Am. Jour, of Psy., Jan. 1903, pp. 21-83.
DISEASES OF BODY AND MIND 265 nervous system and of the mind is recognized in many a custom and belief of savages, and has been recorded through the entire history of medicine. Hippocrates describes a girl who at the dawn of pubescence saw a vision, leaped and tried to throw her- self into a well and then to hang herself, deeming death more desirable than life. Such cases in his day dedicated fine articles of cloth to the goddess Diana, usually on the advice of sooth- sayers. The Arab physicians noted the predisposition of pu- ^ bescents to fall into religious melancholy. The Middle Ages abounded in ecstatics and convulsionaires, which religious leaders honored and knew well how to utilize, so great was the popular superstition and reverence for them. In the great de- lusions which Hecker, McKay, and others have described, in the children's crusade in witchcraft, stigmatization, animal mag- netism, the dancing and sweating manias, trance, lycanthropy, demonology, and especially in revivals and other great re- ligious movements, and in the general conceptions of insanity down into the present century, we detect disposition, humors, enthusiasm, and fanaticism, St. Medardisms, frenzies, and calentures, and sometimes somatic symptoms which were clearly marked with pubic and adolescent features, without the need of assuming that the world was in a more juvenile stage than now. It was, however, reserved for recent decennia to make these phenomena objects of scientific investigation, and al- though great progress has been made there are still many obser- vations that will grow clear only with advancing knowledge of the more nearly normal metamorphoses of this stage of life. It is striking to note the cases where the predispositions peculiar to this age exist in greatly magnified form. Many of the most successful malingerers, simulators, and even dissimula- tors, that often defy both judicial and medical experts; the most preposterous impostors famous in history, from Alex- ander of Abonuteichos ^ to modern spirit mediums; the great seeresses from Joan of Arc to Katherine Emreich, who was spontaneously marked with the sacred stigmata of the cross, if we may accept the medical opinion on which Gabriel Max based his idealization of her in a painting as the " ecstatic virgin "; telepathic girls, like the Creery sisters, who for years misled the best members of the English Society of Psychic » Zeller. Vortr. u. Abh. II., pp. 154-188.
266 THE PSYCHOLOGY OF ADOLESCENCE Research; the most dithyrambic of the boy preachers; the visionaries who communicate most famiUarly with the other world and its denizens; patients that puzzle the doctors with weird new symptoms and often victimize them, as the recent history of hypnotism and hystero-epilepsy illustrates in an anthology of striking cases — all these have been adolescents in whom the tendencies and characteristics normal to this age are here seen only in persistent or exaggerated forms. ^ Rich as is the story of many of the early religious sects and of the great delusions and superstitions of the Middle Ages, fascinating as are several periods and departments of the history of medicine as told in Sprengel's monumental volumes, and copious as are the illustrations of these phenomena in a great science yet to be developed which I may call the pathology of religion, the careful and fruitful study of ephebic psychosis is of recent date.
Psychoses and neuroses abound in early adolescent years more than at any other period of life. This causes great emo- tional strain, which some have described as a kind of repressed insanity that is nevertheless normal at this period. To keep down morbid impulses is often a very difBcult matter in this age of stress. There is an intense antagonism betwen egoistic and racial motives. One writer ^ would almost have us believe that the relative reduction of the individual involves a latentiz- ing of energy which builds up the great organs involved in reproduction which are not now used but only prepared for the future. This expenditure of energy is not immediate, but the race ought to carry the day and accumulate energy not imme- diately spent. On this view pubescence to-day probably in- volves great waste of energy that should be stored up into active channels, and hence a tendency toward slow progressive race failure. This is also the most plastic period of life as seen in the very wide differentiation of size, brightness, dulness, etc. Thus in a sense the child is not completely born until he has * Sorcellerie, Magndtisme, etc., par Paul Regnard. Paris, 1887. Das Wahn- sinn in den vier letzen Jahrhunderten. Tr. from Calmeil by Dr. R. Leusbuscher. Halle, 1898. See also Gurney's Phantasms of the Living. Early Proceedings of the English Psychic Research Society. Lourdes, Anon. Paris, 1894. Delbriick: Pathologische Liige und Schwindler. 1891. Hecker: Epidemics of the Middle Ages.
' W. S. Christopher: Adolescence from the Physical Standpoint. Trans, of the 111. Soc. for Child Study. July, 1902, p. 196 et seq.
DISEASES OF BODY AND MIND 267 achieved this great revolution and established a law of division between stored and used energy.