knowledge of many sorts. He must be prepared to make a thorough and
complete physical examination, sufficient to exclude the presence of
organic disease. If no organic disease is found, he must explore the
whole environment of the child, and seek to determine whether the
exciting cause is to be found in the reaction of the child to some
form of faulty management.

For example, a child of two or three years of age may be brought to
the doctor with the complaint that defæcation is painful, and that
there has existed for some time a most distressing constipation which
has resisted a large number of purgatives of increasing strength.
Whenever the child is placed upon the stool, his crying at once
begins, and no attempts to soothe or console him have been successful.
It is not sufficient for the doctor in such a case to make an
examination which convinces him that there is no fissure at the anus
and no fistula or thrombosed pile, and to confine himself to saying
that he can find nothing the matter. The crying and refusal to go to
stool will continue after the visit as before, and the mother will be
apt to conclude that her doctor, though she has the greatest
confidence in him for the ailments of grown-up persons, is unskilled
in, or at least not interested in, the diseases of little children.
If, on the other hand, the doctor pursues his inquiries into the
management of the child in the home, and if, for example, he finds
that the crying and resistance is not confined to going to stool, but
also takes place when the child is put to bed, and very often at
meal-times as well, then it will be safe for him to conclude that all
the symptoms are due to the same cause--a sort of "negativism" which
is apt to appear in all children who are directed and urged too much,
and whose parents are not careful to hide from them the anxiety and
distress which their conduct occasions.