gaining obedience by threats of impending harm from policemen, bogey men, animals and so forth. Bravery is an instinct which should be encouraged and developed, and the utmost precaution should be taken not to arouse unnatural fears. All children are easily frightened, and the child who is predisposed to nervousness may be so terrified that lasting harm may be done. Fear of the dark or of being alone very often may be traced to an early threat or scare, unwise conversation or an ill-chosen story which imprinted on the plastic mind memory pictures so vivid that they persist for years and may cause incalculable suffering and distress.

In education these children should not be sent too early to school; neither should they be pushed ahead faster than they can comfortably go, nor urged into contests and competitions, nor led into experiences which are beyond their age and which they have no capacity either to appreciate or enjoy.

Play, work and study with other children rather than alone or with adults should be encouraged. Play is the natural employment of children and provides an outlet for emotions which crave expression and a healthful means of getting rid of impulses and instinctive tendencies in a relatively harmless way. To learn to act with others as follower or leader, to serve, to coöperate, to resent and maybe occasionally to fight represent natural healthy attitudes which are fundamental in the development of self-control and self-reliance, resources of inestimable value in the larger experiences of later life. It is, furthermore, during play that the most effective moral lessons may be taught. Truthfulness, honesty, unselfishness, generosity, patience, gentleness and courtesy are most easily acquired and cultivated by suggestion and example during play, while efforts directed through abstract teaching prove futile and unproductive. For older boys and girls attendance at playgrounds and membership in boys' clubs and the boy and girl scout organizations should be encouraged, for these agencies have proven a valuable means of controlling and directing the instinctive tendencies.

Children and youths whose mental strength has thus been conserved and cultivated will more easily meet and efficiently overcome the difficulties presented by the changes and readjustments which inevitably are a part of every life, and which too often prove to be factors which contribute to upset and impair the mental health. Correct mental habits formed in early years provide an asset of immeasurable value in the prevention of the functional mental diseases.

Work, the daily performance of some appointed task or duty which engages the time and the attention, is one of the most valuable means for the preservation and promotion of mental health, for " Education to idleness means education to nervousness." It is obvious that the work must be adapted to the ability of the worker, that its demands both for physical and mental strength must not be so high as to cause undue fatigue, worry or strain, nor so low as to cause dissatisfaction and humiliation, that it should be under healthful conditions and that the relations with the employer and workers should be congenial and pleasant. To feel the dignity of labor, to find the "joy in work," to receive its rewards both in satisfaction and material remuneration, to gain through daily association the comradeship of others who work, and to share in the loyalty which is fostered by common interests and ambitions, increases self-reliance and courage, and furnishes a valuable stimulus to healthful endeavor and activity. Nor should the effects of uncongenial work be overlooked or minimized, for feelings of bitterness, antagonism and rebellion are often created which tend to warp the ideas, crush initiative and ambition and paralyze energy and activity.

Industry is to-day recognizing the tremendous importance of having the work adapted to the worker, and medical examiners, psychologists and efficiency experts have set themselves the task of "fitting the man to the job," and thereby not only increasing production, but eliminating sickness, accidents and discontent by avoiding the occupational misfits and maladjustments of former years. More

and more it is being recognized also that hard work fits for play as well as rest, and more time and many more opportunities are being provided for recreation, amusement and diversion.

In the prevention of mental deficiency, segregation is recognized as a most important measure, for these individuals have not the mental qualities which make them valuable to society, and economically they are a partial or total loss, but especially because it is an established fact that this type of defective family increases at about double the rate of the general population, and feeblemindedness is inherited, for parents cannot transmit to their children nervous and mental strength which is not theirs to give. Some states already have enacted laws which provide for the sterilization of the socially unfit, the criminal, the feebleminded and the incurably insane.

Compulsory education and medical inspection in the schools have brought to light the astounding fact that nearly 70 per cent. of the children of school age are physically defective and in need of medical and surgical treatment. Of this number it is estimated that about 4 per cent. are mentally retarded or defective, and for these special classes and schools must be provided where special training can be given to fit them for life. The psychometric tests have been a valuable means of disclosing the subnormal child.

It has been demonstrated that children who may be retarded one, two or three years can by special training and instruction become practically normal, although they will always be a little slow. Those who show a retardation of more than three years can with proper supervision become manual workers and therefore partially or wholly self supporting. Too often because of pride parents will not acknowledge this condition and refuse to allow or provide the special training until it is too late. No group in society stands more sorely in need of preventive measures, for statistics prove that these subnormal individuals are unable to control those inherent tendencies which lead them in so great num

bers to become confirmed alcoholics, drug addicts, prostitutes and perverts, delinquents and criminals.

Mental hygiene does not limit its activities to the care of those who are sick and the prevention of disease in those who are threatened, but it has also the broader function of increasing the mental health of those who are neither already ill nor threatened with illness. One of the most important and forceful agents in this field is the well-trained nurse. Her training enables her to discover slight deviations from the normal in behavior and personality and to know that seemingly insignificant peculiarities may be the forerunner of grave mental disturbance. She knows, also, how to call attention to these matters without giving offence, and cognizant of the value of early treatment, can urge consultation with a physician skilled in disorders of the mind or a visit to hospital or clinic where advice may be obtained. She may also be able to discover difficulties in the patient's home, in his work, his associations and recreations which contribute to bring about and prolong his illness, and she may be able to make changes and readjustments which will remove and eliminate the disturbing factor.

She is also frequently in a peculiarly advantageous position to do good to the whole family. She can make suggestions as to improvements in hygienic conditions, about the food, about the clothing, the education of the children, and changes in the environment which may be advisable or necessary, and what she says is invariably respected. Parental difficulties and conflicts are frequently first disclosed to her, and she may be able to make suggestions for readjustments which will relieve the stress and strain and promote the health and happiness of the whole household. Her circle of usefulness is ever widening for neighbors hear of her helpfulness and they too desire the beneficial effects of her visits and ministrations.

CHAPTER VI

QUALIFICATIONS FOR MENTAL NURSING - SYMPTOMS OF MENTAL DISEASE

The successful treatment of mental illness depends so much on good nursing, and so much of the nursing is the ready and prompt application of measures which the symptoms make evident, that it is obvious that mental nursing demands special qualifications and fitness, special training and experience. The nurse who will be most successful in understanding these patients and in dealing with them will be the one who brings to her service not merely the special knowledge and skill acquired by training but also the education, culture and social accomplishments which have been acquired in school and college, by reading, study and travel, and in the broader school of life. She must be intelligent, for no form of nursing makes such constant appeals to the intellect, or demands closer observation, more accurate reasoning, prompter decision or quicker judgment. She must have acquired full mastery of her own emotions if she would most effectively strengthen those with weaker wills and reënforce their efforts of self-control. She must be more than ordinarily capable, versatile and resourceful if she would lead and direct the activity of those whose minds are weakened and distorted by disease.

Mental nursing is far more difficult and exhausting than general sick nursing, arduous as that may be, for the nurse must spend long hours intimately and constantly in the presence of the patient who may be in the very depths of despair, or whose mind is filled with sordid and unwholesome thoughts, or whose behavior is perverted in strenuous and many times unpleasant ways, and out of her experience and training she