cover the similarities and differences between the normal adult mind, for example, and the mind of the child, or of the insane, or of the genius, or the criminal, or even of lower animals.

The Four Stages in Mental Development.

These four points of view may be taken, of course, with special regard to the period of most intense mental development, which begins immediately after birth and comes to a certain conclusion at about the age of twenty-five. This period is usually divided into four stages, during which mental development follows certain definite lines. The first stage is that of infancy, and it is mainly devoted to the development of the senses and motor capacities. It is followed by the years of childhood, in which the imaginal and ideational life awakens to full activity, and which leads to the stage of adolescence, when the emotional powers assume the leadership. The last stage is one of struggle, in which the young mind is trying to find itself, in which the various conflicting factors are seeking a compromise upon which to base character and personality. It is of little use to determin the number of years for these different stages, because they vary a great deal from individual to individual; but, on the whole, they correspond roughly to the main divisions in our educational system, the kindergarten, primary grades, high school, college and university course. As it is impossible within the present limits to discuss these four stages at some length, we shall confine ourselves here to the psychology of infancy.

The Stage of Infancy.

Just as the infant's body is not like an adult's body on a smaller scale, so the infant's mind is not a miniature of the adult mind. The fundamental principle which makes a scientific study of the infantile mind possible is that all impressions tend to express themselves, and that the younger or less developt the mind, the more simple, immediate, and naive are its expressiv movements. Consequently their interpretation is the more appropriate, the fewer and the simpler mental phenomena it involves. To ascribe, for example, to a baby a few months old the emotion of fear or a strong will of its own is entirely unscientific. Such experiences require an elaborate system of ideas and involve a complex mental attitude toward a complex physical situation. A careful analysis of such experiences in the

infant's mind reveal, however, not much more than a single vivid sensory impression with a strong feeling of unpleasantness, and a reflex-like, or an instinctiv, or an habitual motor reaction of particular suddenness and energy. In order to have a will of its own the child must first develop an idea of its own self, which again requires that the child must have recognized the various parts of its body as its own and be able to distinguish them as a whole from the bodies of other people. In addition to this the child must have acquired some notion of property of mine and thine. What is usually spoken of as the baby's will is, as a rule, nothing but a strong habit which the parents more or less unthinkingly have allowed to grow up and which at special occasions they suddenly realize to be in conflict with other and perhaps more desirable actions. For example, the motion of sucking is a reflex, but the act of nursing, either regularly at certain hours or irregularly whenever the baby cries, is a strongly establisht habit that has to be broken up at the period of weaning. To be sure, the substitution of artificial food makes an entirely new and usually unpleasant impression upon the baby's mind; but there is nothing right or wrong in it as far as the baby is concerned. The idea or notion of deception does not arise in his mind for several years to come; it exists only in the interpreting observer of the child's behavior. If it were reasonable to assume that a bad impression of lasting moral effect could be made upon so young a child, it would be also correct to hold that babies who are suddenly weaned would therefore be inclined to mistrust their mothers more than their fathers or other members of their families; for at the normal age of weaning the infant, as a rule, does no longer look to anybody for food but only to its mother. In this question of right and wrong as well as in the previous one of will, a complex system of associated ideas is involved for the presence of which in the infant's mind there is absolutely no evidence. Even the old Romans knew that nihil est in intellectu nisi quod in sensu; that is, there is nothing in the intellect that did not enter thru the senses. If, then, psychology is to be a science on the same level as the natural and biologic sciences and is to be free from philosophic reflections, it must rest on the same general scientific principle of parsimony and simplicity in attempting to

describe and explain its own peculiar phenomena.

With this principle in view we may ask now: How does psychology study the mind of the infant? Certainly we cannot use the direct method of introspection except as an ultimate standard of analogy. For the infant under one year of age there is practically only one method at our disposal, namely the accurate, systematic, and unbiased observation of the infant's behavior and utterances. The first baby-record dates back to the last quarter of the 18th century. Later, Darwin incorporated many incidental notes on babies' behavior in his "Expressions of Emotions." In 1881 Preyer publisht a kind of model record which stimulated many mothers to similar observations. Since then

a number of books and scientific monografs by psychologic experts and psychologically trained parents have appeared.

In observing a baby's movements one notices at once that certain of them are made entirely unconsciously, while others. just as obviously involve some consciousness, and others again seem to belong in the doubtful group. The important question is then what sort of mental life do these movements manifest? Is the baby born in the full possession of all its senses? If not, at what age does it acquire the lacking ones? Does the infant know what is pleasant and unpleasant? When does it begin to notice differences of quality, intensity, duration, extent, etc.? Can it pay attention? When do signs of recognition and memory first appear, etc., etc.? To many of these questions it is at present impossible to give definite answers. We know, however, a good deal concerning the senses and the rise of the instincts.

Early Developmental Psychology. To give a single example, let us trace roughly and briefly the earliest development of the sense of vision. A 3-week-old baby will gaze at light surfaces when contrasted with dark ones. At 6 weeks it can fixate dark or light objects and follow bright moving lights. After 10 weeks it makes. head-movements and can follow any moving object. At the age of 3 months there is some visual recognition of familiar persons standing close by, fixation of any near objects is now perfect, and there seems to be greater attraction by colored than by colorless objects. During the 5th month the baby begins to watch the actions of other people, to drop articles and watch them fall,

and to show preference for at least one color. A 6-months-old baby begins to observe flying birds and insects and notices people over one hundred feet away, but it does not understand the pointing of a finger until several months later, when it also begins to show more decided color preferences for objects otherwise the same in size and form. One might summarize these observations by saying that up thru the 4th or 5th month the baby's greatest interest is in looking, after that time in grasping, until still later the activities become too complex to reveal any decided preference.

The gradual rise of the various experiences becomes ever so much more significant by reason of the fact that they call our attention to the many other experiences which the young mind is still lacking. To an adult the perception of a picture, for example, seems a very simple matter; but let us recall for once what complicated activities it really involves: discrimination of light and dark and of colors, perception of form, size, distance, direction, interpretation of shades and tints as indicative of plane and solid or far and near objects, realization of the general spatial relations of the various objects to each other, suggestions of action and motion, and finally the esthetic and ethical appreciation of the artist's motives, etc. It is only when we become aware of the complexity of such a seemingly simple matter as the study of a picture that we learn to realize how little a picture means to a child less than 2 years old. And not only does the picture mean so much less, it means something quite different to him; it means an object to be played with, to be graspt, handled, moved about, turned over and upside down, thrown on the floor, torn up, etc.; in other words, it is a stimulus calling forth all kinds of reflexes and instincts, instead of moods of intellectual reflection and esthetic contemplation. The pleasure which the child experiences in the presence of a picture is probably aroused much more by its own motor reactions than by the mere sight of bright colors. Just let me remind you of the extreme joy which a little baby finds in pounding the keys of a piano, as compared with the faint smile on hearing somebody else play a regular tune. The same is true of his early utterances, squeals, cooings, etc., which he makes merely because he enjoys these vocal exercises. Of course, in so doing he unintentionally prepares him

self for speech, but he does not purposely imitate adult sounds until perhaps toward the end of the first year.

The older the infant, the more ways of expressing his mental life he will acquire and hence the more ways of studying his mind. In connection with the development of speech the method of making indexes of the child's store of words is applied. Here the difficulty arises of knowing what words the baby can understand without being able to say them, what words he can say without understanding them, and what words he can say and also understand. The solution lies again in observing the behavior, especially gestures and responses to such phrases as: what is this? where is so-andso? show me this or that; or bring me such and such, etc. Still later the constructive activities of child-play can be used for psychologic studies and result in most instructiv collections of forms, figures, and objects made with building blocks, or sticks, or cardboard, of dolls' dresses, and especially of drawn pictures. The interpretation of the latter kind of material is not always easy. It must consider not only the baby's vision in general, but also his knowledge of the object thru other experiences; it must consider whether the drawing is a copy from an actual object or from another drawing, or whether it was done from memory, whether it was made intentionally or accidentally and afterward named by the child, and it must not overlook the stage of fatigue or practise. In copying models we must not forget that they are frequently imperfect and that the average adult cannot, as a rule, draw perfect copies even of such simple pictures and objects as are presented to the child. Finally, toward the close of infancy, when speech has advanced to sentence construction, it is possible to make statistical collections of such sayings of children as indicate the awakening of the other mental powers, such as reasoning, the use of analogy and symbols, standards of morals, religious ideas and ideals, occurrence of illusions and dreams, and the influence of suggestion, etc.

I have preferred to give here the most important guiding principles and methods for the study of the infant mind rather than a number of arbitrarily selected results, because the latter would be misleading without a detailed description of the conditions under which they were obtained and under which alone they would hold, and because

I believe that in this way the reader is helped more in gaining for himself a better understanding of the workings of the infantile mind. L. R. GEISSLER, PH.D.,

Professor of Psychology, University of Georgia. Athens, Ga.

of infantile life by Professor Geissler is a [This excellent description of psychology result of the discussion by Drs. Cohen, Seilikovitch and the Editor in the August WORLD, page 340. We have been in communication with Dr. Geissler and have had him write this article for us. This description should be written into every book on infancy and the care of infants for the guidance of physicians and the laity alike. We expect Dr. Geissler to follow this paper with several others.-ED.]

Some Practical Methods of Treatment. EDITOR MEDICAL WORD: In a letter to the Amer. Jour. Clin. Med. I askt of my brother physicians who, like myself, are dependent on their resources in a country practise, of their experiences with ethyl chlorid. Some five years ago, at a meeting of our county medical society, when there was a good attendance, I askt each member present what he knew of it, and each one said he had never used it.

Uses of Ethyl Chlorid.

I had been using it at that time for previous five years, and I found it a very useful thing to "have in the family" even then, but the expense was almost prohibitiv, not on account of first cost, but on account of leakage or evaporation from defectiv spray vent. Until I got hold of the Gebauer Chemical Company's make (of Cleveland, Ohio) I was constantly being disappointed by finding my ethyl chlorid tube empty. Since learning of this company's container, I have used no other. Levy, of New York, imports ethyl chlorid in a metal container that at first sight appears to be good, but the liquid will escape somehow. This variety is made in Switzerland at the city of Brugg by Brugg Chemical Company.

The different uses to which I put this preparation are to reduce an incarcerated gut in hernia. When trying to put the intestin back where I have failed to do so with safe taxis, I spray the hernia until the skin freezes white and many times the gut will slide back without any manipulation. Refrigeration by use of salt and

ice in strangulated hernia is much less convenient than by ethyl chlorid.

A child that will go into spasms from needle prick of a hypodermic syringe will submit to it peacefully if a white spot is made with the ethyl chlorid spray. Gebauer's container can be regulated so that it can be controlled, run out in a stream size of a broomstraw or in a hissing spray that can be heard across a room. This spraying on is the only way to get perfect anesthesia with this agent. I know no better way to get rid of a crop of venereal warts, or where a chancroid has become phagedenic. These growths can be easily removed under this anesthesia.

I find many uses for it. The technic, like the technic of everything else, must be learnt, no matter how simple. Giving chloroform with a drop bottle and Esmarch's face mask, simple as it is, has to be explained to a man who never gave chloroform that way. Lately I had a young doctor give it for me to reduce a dislocated shoulder, and it was amusing to watch him pat the bottle with his fingers, but he got the hang of it finally.

Carbolic Acid for Carbuncle.

An article in one of my journals tells how to handle carbuncles. The writer makes a hypodermic syringe and ethyl chlorid tube necessary. For twenty-five years I have been curing these pets, and I need nothing except a match and crystals of carbolic acid. His method is all right and, as he says, will break up the "buncle" in short order. My way is to sharpen the match, dip in acid and at each point of carbuncle (hair follicle, for these troublesome things always start to take on infection at that point), after covering sound or surrounding skin with vaselin or lard, bore in as deep as needed, dipping in acid as needed. As the induration is broken up wrap cotton on match or probe. If not in a hurry two hours will practically cure any carbuncle, so that a patient will not suffer, and some simple dressing to cover the hole is all that is needed. There is sufficient anesthesia from the acid. The sting from first application is the only pain.

Chloroform to Kill Maggots.

Does every physician know that chloroform is an unfailing agent to get maggots out of stock when the green fly has gotten to some wound? So far as I know, I in

troduced this remedy to my neighbors thirty years ago, tho I got it from a brother physician.

Concentrated Sunlight.

Some years ago I had an article in THE WORLD in 1905, I think-and in September, 1911, WORLD, page 374, telling. of using concentrated solar heat for cauterizing suspicious growths. Many letters came to me in regard to it, all of which I answered. In Amer. Jour. Clin. Med., in 1911, I told of using it. Again the letters came from almost every state. One letter I received from Dr. A. B. Hollman, of Mexico, the land of mysteries. I answered the letters. In every instance except Dr. Hollman no one ever wrote to tell me whether he tried it. Dr. Hollman did. He wrote me that he had utilized it in a case of gangrene, with perfect success. Dr. Hollman is connected with the Sanitary Commission of the republic. Extra-Intestinal Causes of Bowel Obstruction.

Some younger brother may profit by a mistake which I and Dr. J. R. J. Sims made soon after we began the practise of medicin, thirty-six years ago. At the time each of us learnt a lesson that stood us in

good stead ever after. That is, we saw the point after Dr. W. T. Maclin had shown us.

A husky fellow employed as a kind of foreman by Captain Epporon contracted gonorrhea. He was one of the kind that preferred a case of clap to a bad cold. Being at work with a crew of negroes doing heavy work in rail-splitting, sawing and chopping, he rather took pride in letting others know that he had been to see old Zilla Carter, a filthy old strumpet of ebony hue. After he got the disease he kept at work for a week or two, when orchitis got in its work and he had to go to bed and relieve the weight of his testes.

Sending for me, I, of course, was ready to tell him all I knew, and how easy it was to cure him. So in the first place I must give him a purgativ, which consisted of calomel, podophyllin and leptandrin, "dose, enuf." But it failed to go thru. Then I gave Epsom salt, lots of it, and waited. Then I wanted counsel. So Dr. Sims was called. He said oil, he thought, would do the work. So Bob got oil until he had over a pint in his belly. Then we pumpt soapsuds into him; we consulted, pumpt in more suds, then con

sulted some more. We kept up "proctoclysis" until the fellow was ready to burst almost. The urin was retained until bladder was as large as a man's head, and it lookt like Mr. Bob might find a case of clap plus two young doctors harder to stand than a bad cold.

We decided that Dr. Maclin might possibly be able to help us. So we sent for him. When he came, the first thing he said after each of us had told him all we knew and more perhaps, "Gentlemen, from what you tell me I rather expect your trouble comes from a gravid bladder; the reason may be purely mechanical-pressure against rectum from full bladder." when we were shown we were able to see as well as anybody.

And

Dr. Maclin took out a silver catheter, joined it and, introducing, puncht the pus out of the urethra, like punching pith out of a cob. The urin started and the relief to our patient was great. He had taken a sitting position on side of bed, and was using a large porcelain bowl to catch the urin. Every now and then Dr. Maclin would say, "I think his bowels will move when bladder is empty."

The commode was not near the bed, but on opposite side of the room. After one of Dr. Maclin's assurances Mr. Bob jumpt up and with an oath, "I've got to 'go' right now," started across the room. He left a streak of fecal material the whole way across.

A negro, Andy, was helping to nurse Mr. Bob, and they were great cronies in their drinking bouts. Andy exclaimed: "Oh, Mr. Bob, you are the same as dead man now, for you have done mortified!"

a

An old friend of mine, John Lyon, used to laugh about this case, and jolly me a great deal. Dr. Sims and Dr. Maclin have both crost over the river, both of them having moved from this state to Du Quoin, Ill., where they died, Dr. Maclin from car

buncle and Dr. Sims from blood poison after doing a surgical operation.

I learnt to look for gravid bladder when the bowels refused to move, and also for a retroverted or enlarged uterus when the bowels will not act after having given a saline.

Now, Mr. Editor, for me to go on and tell how much I prize THE WORLD like some of the family, would be in order; but I will praise in a little different style, that is to say, the length of time I have been a

Still another method followed by the Bohemians, somewhat similar to this, is to place the knee against the back of a patient seated upon a stool, and, grasping the hands behind the hand-locked neck of the patient. a forward and upward thrust is made by the knee in the region just posterior to the "dinner basket." This proves the equal of the after-dinner digestiv tablet, and ought to be "tried out" by those here prone to

linger too long with "kindred spirits"

around the dinner table.

Great Value of General Massage.

The second method of spinal therapy that we shall notice is that of general massage applied to the back. The advantages of this therapeutic procedure are too wellknown to be discust at any length here.

*Read before the First Annual Convention of the American Association for the Study of Spondylotherapy. at Chicago, November 14, 1912.