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child, general nervousness comes higher than backwardness and acidosis, but the symptoms
of parental mismanagement (spoiling, disobedience, etc.) are equally prominent. This is the only
group amongst the groups considered (apart from the only children over 3) where what might
be called gross mismanagement comes in as a serious factor, and certain inferences will almost
inevitably be drawn from this. In the "replacement" cases, reactions typified in the form of
"acidosis" are very noticeable, closely followed by frank symptoms of misery and
by nocturnal enuresis, a sequence that will have significance for any one familiar with
neurological events. The rationale of the acidosis in these cases and in that of the "only
children" should perhaps be considered. In the general group, i.e., families where the interval
between the children is small, nervousness, backwardness, and acidosis appear again in that
order, but enuresis once more appears high on the list. Here the factor of replacement, as has
already been suggested, must very often come in, though it cannot be observed very directly,
and there are also the difficulties of training in the larger family where the children are all
young at once. The occurrence of sleep difficulties, again, is much commoner amongst the only
children, in proportion, than in the other groups (as Freud would say, " the eternal triangle.")
A survey of symptoms taken now in relation to their incidence rate in different districts
bears out the importance of general " nervousness " as the most frequent type of symptom
in all districts. There is no outstanding indication of any direct relation between the type of
district and the occurrence of any special type of symptoms, apart from the question of the
type of family occurring in different districts, but confirmatory observations may be made on
this point by further reference to Table IV.
1. The Only Child.
The type of symptoms commonest in the only child under and over 3 years of age has
already been observed. What is the incidence rate of nervous symptoms in only children as
compared with the rest of the community of pre-school age ? The following figures show the
evidence amongst these cases for or against special difficulties attaching to the only child family.
(a) Only Child under 3 Years.
The percentage total of only children under 3 showing nervous symptoms equals 57.
Percentage of total other children examined showing nervous symptoms equals 45.
But, excluding the only and big interval children special groups, the percentage of total cases
showing nervous symptoms equals 40: and, excluding all the special groups, the percentage
equals 30, so that the incidence rate of symptoms in the only children under 3 as compared with
the " ordinary " child is, approximately, double.
(b) Only Children over 3 Years.
Percentage of only children over 3 with nervous symptoms equals 57'5.
Percentage of total other children examined showing nervous symptoms equals 46. But,
comparing the only child with the " ordinary " child, the incidence rate of symptoms is again
as 57 5 to 30—again approximately double.
(c) Only Children over and under the age of 3 compared.
57% only children under 3 showed nervous symptoms.
57-5% only children over 3 showed nervous symptoms.
Therefore, the risk of nervous difficulties with the only child shows no increase after the
age of 3, amongst the cases examined up to school age.
2. The Big Interval Child.
(a) Nervous symptoms incidence.
The percentage of " big interval " children showing nervous symptoms equals 63.3.
Percentage of all other children examined showing nervous symptoms equals 45.6. But
the percentage of " ordinary " children (c.f. above) showing nervous symptoms equals only
therefore the incidence rate amongst the big interval group is, again, more than doubled as
compared with the " ordinary " family; or, compared with all other groups, 1½ times as great,