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December 1916


Author Affiliations

Phipps Psychiatric Clinic, Johns Hopkins University, Medical Department BALTIMORE

Am J Dis Child. 1916;XII(6):618-625. doi:10.1001/archpedi.1916.04110180080008

Failure to control the bodily functions of excretion constitutes a breach of conduct so offensive to civilized society that its origin as a social refinement is apt to be obscured. Although it is "only necessary to scratch civilization to find savagery," there is a tendency to forget the influence of traditional associations on civilized activities.1 Primitive impulses, the utility reactions of a simple environment, still survive. Their readjusted nervous mechanisms are generally less stable than the reflexes of instincts subject to less direct social scrutiny. All the newer requirements of civilization call on the organism to develop self-control. Consequently many customary actions of frequent repetition speedily become unconscious mechanisms. Hand in hand with this automatic activity goes an increase in the emotional value of its omission, still more of the performance of such activities contrary to custom.2 In the mature individual lapses in control of the urinary bladder

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