by it, has taken over the management of the child.  To this mother the explanation must be extended to fit these observations, of the accuracy of which there need be no doubt.  Fretfulness and negativism with all children whose management is at fault come in waves and cycles.  The child, naughty and almost unmanageable one week, may behave as a model of propriety the next.  The negativism and refusal to go to stool are the outcome of the nervous unrest, not its cause.  Again, the nervous child, like the adult neuropath, very often improves for the time being with every change of scene and surroundings.  It is the ennui and monotony of daily existence, in contact with the same restricted circle, that becomes insupportable and brings into prominence the lack of moral discipline, the fretfulness, and spirit of opposition.  Lastly, the conduct of the nervous child is determined to a great extent by suggestions derived from the grown-up people around him.  Refusal of food, refusal of sleep, refusal to go to stool, as we shall see later, only become frequent or habitual when the child’s conduct visibly distresses the nurse or mother, and when the child fully appreciates the stir which he is creating.  The mother will readily understand that in such a case, where constipation varies in degree according as different persons take charge of the child, the explanation offered is that which alone fits with the observed facts.  A full and free discussion between mother and doctor, repeated it may be more than once, may be necessary before the truth is arrived at, and a line of action decided upon.  Only so can the doctor, remote as he is from the environment of the child, intervene to mould its nature and shape its conduct.

If the doctor is to fit himself to give advice of this sort, he must be a close observer of little children.  He must not consider it beneath his dignity to study nursery life and nursery ways.  There he will find the very beginnings of things, the growing point, as it were, of all neuropathy.  A man of fifty, who in many other ways showed evidence of a highly nervous temperament, had especially one well-marked phobia, the fear of falling downstairs.  It had never been absent all his life, and he had grown used to making the descent of the stairs clinging firmly to the stair-rail.  Family tradition assigned this infirmity to a fall downstairs in early childhood.  But all children fall downstairs and are none the worse.  The persistence of the fear was due, I make no doubt, to the attitude of the parents or nurse, who made much of the accident, impressed the occasion strongly on the child’s memory, and surrounded him thereafter with precautions which sapped his confidence and fanned his fears.