Fatigue is easily induced and is exhibited in all varieties of activity—­mental, physical, or visceral.  Mental work may produce fatigue with extreme readiness even although the quality of the work may remain of a high standard.  To Darwin and to Zola work for more than three hours daily was an impossibility, and yet their work done under these restrictions excites all men’s admiration.  The palpitation and breathlessness which follows upon trivial exertion, such as climbing a flight of stairs, is a good example of visceral fatigue.

Among adult neuropaths we recognise the harm which may be done by unwise speeches on the part of relatives, or still more on the part of doctors.  A chance word from a doctor or nurse off their guard for the moment will implant in the minds of many such a person the unyielding conviction that he or she is suffering from some gastric complaint, from some cardiac affection, or from some constriction of the bowel.  It may take the united force of many doctors to uproot this pathological doubt which was implanted so easily and so carelessly.  The medical student is notoriously prone to recognise in himself the symptoms of ailments which he hears discussed.  Little children, too, are apt to suffer in the same way.  How much illness could be avoided if mothers would cease to erect some single manifestation of insufficient nervous control into a local disorder which becomes an object of anxiety to the child and to the whole household.

Undue liability to fatigue, irritability, instability, lack of control over the emotions, extreme suggestibility, prompt and exaggerated reactions to toxins of all sorts, excessive vasomotor reactions and anomalies of secretion, weakness of the gastro-intestinal apparatus—­these, and many other symptoms, are of everyday occurrence in the nervous child.  To discuss them more fully would be to pass too far from our nursery studies into a consideration of psychological medicine.

CHAPTER XI

NERVOUSNESS AND PHYSIQUE

It has already been said that symptoms of nervousness are often accompanied by faults in the physical development of the child.  The defects may assume so many forms as to make any attempt at description very difficult.  Nevertheless, certain types of physical defect present themselves with sufficient frequency, in combination with neurosis, to merit a detailed description.  For example, we recognise a type of nervous child which is marked by a persistence into later childhood of certain infantile characteristics of the build and shape of body.  Further, we meet with a group characterised by a special want of tone in the skeletal muscles, by lordosis, by postural albuminuria, and by abdominal and intestinal disturbances of various sorts.  We recognise also the rheumatic type of child with a tendency to chorea, and in contrast to this a type with listlessness, immobility, and katatonia.  Lastly, in a few children, in boys as well as in girls, we may meet with cases of hysteria.[3]