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Frontmatter
Human development
A cultural approach
2nd Australian and New Zealand edition
Copyright © Pearson Australia (a division of Pearson Australia Group

Pty Ltd) 2023
Pearson Australia
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Richmond Victoria 3121
www.pearson.com.au
Authorised adaptation from the United States edition entitled Human

Development: A Cultural Approach, 3rd edition, ISBN
9780134641348 by Arnett, Jeffrey J. & Arnett Jensen, Lene,
published by Pearson Education, Copyright © 2019.
Second adaptation edition published by Pearson Australia Group Pty

Ltd, Copyright © 2023.
The Copyright Act 1968 of Australia allows a maximum of one

chapter or 10% of this book, whichever is the greater, to be copied by
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ISBN 9780655704447
1 2 3 4 5 27 26 25 24 23
Pearson Australia Group Pty Ltd ABN 40 004 245 943
Human development
A cultural approach
2nd Australian and New Zealand edition
Arnett
Jensen
Chapin
Brownlow
Machin
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Brief contents
Chapter 1 A cultural approach to human development 1
Chapter 2 Genetics and prenatal development 44
Chapter 3 Birth and the newborn child 81
Chapter 4 Infancy 124
Chapter 5 Toddlerhood 173
Chapter 6 Early childhood 222
Chapter 7 Middle childhood 277
Chapter 8 Adolescence 331
Chapter 9 Emerging adulthood 388
Chapter 10 Young adulthood 438
Chapter 11 Middle adulthood 482
Chapter 12 Late adulthood 528
Chapter 13 Death and afterlife beliefs 578
Answers 612
Glossary 614
References 624
Name index 710
Subject index 740

Contents
Preface x
Features xii
Acknowledgements xv
About the authors xvi
Educator resources xviii
Chapter 1 A cultural approach to human development 1

Section 1: Human development today and its origins 2
A demographic profile of humanity today 2
Cultural Focus: Niger and the Netherlands: an up-close

look at the demographic divide 4
Human origins: the rise of a cultural and global species 10
Summary: Human development today and its origins 16
Section 2: Theories of human development 17

Ancient conceptions 17
Scientific conceptions 20
Summary: Theories of human development 27
Section 3: How we study human development 29

The scientific method 29
Research methods and designs 33
Research Focus: Darwin’s diary—a case study 36
Summary: How we study human development 42

Apply your knowledge as a professional 42
Chapter quiz 42
Chapter 2 Genetics and prenatal development 44

Section 1: Genetic influences on development 45
Genetic basics 45
Genes and the environment 50
Research Focus: Twin studies: the story of Oskar and

Jack 54
Genes and individual development 56
Summary: Genetic influences on development 60
Section 2: Prenatal development and prenatal care 61

Prenatal development 61
Prenatal care 64
Cultural Focus: Pregnancy and prenatal care across

cultures 65
Summary: Prenatal development and prenatal care 71
Section 3: Pregnancy problems 72

Prenatal problems 72
Infertility 75
Summary: Pregnancy problems 79

Chapter quiz 79
Chapter 3 Birth and the newborn child 81

Section 1: Birth and its cultural context 82
The birth process 82
Historical and cultural variations 86
Summary: Birth and its cultural context 96
Section 2: The neonate 97

The neonate’s health 97
Physical functioning of the neonate 102
Summary: The neonate 107
Section 3: Caring for the neonate 108

Nutrition: is breast best? 108
Cultural Focus: Breastfeeding practices across cultures

110
Research Focus: Preterm births declined during COVID-19

lockdowns: Why? 113
Caring for the neonate: social and emotional aspects of

neonatal care 114
Summary: Caring for the neonate 121
Chapter quiz 121
Chapter 4 Infancy 124

Section 1: Physical development 125
Growth and change in infancy 125
Infant health 135
Motor and sensory development 139
Summary: Physical development 143
Section 2: Cognitive development 145

Piaget’s theory of cognitive development 145
Cultural Focus: Object permanence across cultures 148
Information processing in infancy 150
Assessing infant development 153
The beginnings of language 155
Summary: Cognitive development 159
Section 3: Emotional and social development 160

Temperament 160
Research Focus: Measuring temperament 161
Infants’ emotions 163

The social world of the infant 167
Summary: Emotional and social development 170

Chapter quiz 171
Chapter 5 Toddlerhood 173

Growth and change in years 2 and 3 174
Cultural Focus: Gross motor development across cultures

180
Socialising physical functions: toilet training and weaning

181

Cognitive development theories 184
Language development 188
Cultural Focus: Language development across cultures

194

Emotional development in toddlerhood 197
Attachment theory and research 203

Cultural Focus: Stranger anxiety across cultures 205
Research Focus: Can a therapeutic intervention change

attachment? 207
The social world of the toddler 211

Chapter quiz 219
Chapter 6 Early childhood 222

Growth from age 3 to 6 224
Motor development 230

Theories of cognitive development 234
Cultural Focus: Theory of mind across cultures 237

Emotional regulation and gender socialisation 243
Early childhood education 249
Parenting 253
The child’s expanding social world 263
Research Focus: Play groups as early childhood

interventions 267

Chapter quiz 274
Chapter 7 Middle childhood 277

Growth in middle childhood 278
Health issues 282

Theories of cognitive development 287
School in middle childhood 301
Cultural Focus: School and education in middle childhood

across cultures 303

Emotional and self-development 308
The social and cultural contexts of middle childhood 314

Research Focus: TV or not TV? 326

Chapter quiz 329
Chapter 8 Adolescence 331

The metamorphosis: biological changes of puberty 332
Health issues in adolescence 340

Adolescent cognition 345
Education and work 350

Cultural beliefs: morality and religion 363
The social and cultural contexts of adolescence 367
Research Focus: The daily rhythms of adolescents’ family

lives 368
Cultural Focus: Adolescent conflict with parents 369

Chapter quiz 385
Chapter 9 Emerging adulthood 388

The emergence of emerging adulthood 389
Cultural Focus: The features of emerging adulthood 394
Physical changes of emerging adulthood 395
Risk behaviour and health issues 398
Research Focus: Graduated driver licensing 400

Education and work 406
Cultural Focus: Tertiary education across cultures 406

Cultural beliefs and stereotypes 420
Cultural beliefs 422
The social and cultural contexts of emerging adulthood

425
Cultural Focus: Media use in emerging adulthood across
culture 434

Chapter quiz 436
Chapter 10 Young adulthood 438

The transition to adulthood 439
Physical health 443
Research Focus: What is ‘overweight’? What is ‘obesity’?

444

Adult intelligence 449
Cognitive advances in young adulthood 451

Emotional development in young adulthood 455
The social and cultural contexts of young adulthood 458
Cultural Focus: Marriage and love relationships across

cultures 461
Chapter quiz 480
Chapter 11 Middle adulthood 482

Physical changes in middle adulthood 483
Health and disease 487

Intelligence, expertise and career development 494
Research Focus: Intelligence in middle adulthood: two

research approaches 495
Information processing in middle adulthood 502

Emotional and social development: emotional and self-
development 505
Emotional and social development: the social and cultural

contexts of middle adulthood 512
Cultural Focus: Family relationships in middle adulthood

across cultures 516

Chapter quiz 526
Chapter 12 Late adulthood 528

Cultural beliefs about late adulthood 529
Physical changes 535
Health in late adulthood 540
Cultural Focus: Physical health in First Nations

Australians 542

Cognitive changes and decline 548
Alternative views of cognitive changes 554

The social and cultural contexts of late adulthood 562
Research Focus: Do North Americans become more

religious with age? 571

Chapter quiz 576
Chapter 13 Death and afterlife beliefs 578

Section 1: Physical aspects of death 579
The biological processes of death and ageing 579
Research Focus: Growing telomeres 584
The sociocultural contexts of death 587
Summary: Physical aspects of death 592
Section 2: Emotional responses to death 593

Bereavement and grief 593
Confronting death 596
Summary: Emotional responses to death 598
Section 3: Beliefs about death and the afterlife 599

Beliefs about death throughout the life span 599
Afterlife beliefs and mourning rituals 601
Cultural Focus: Mourning the dead across cultures 608
Summary: Beliefs about death and the afterlife 609
Chapter quiz 610

Answers 612
Glossary 614
References 624
Name index 710
Subject index 740
Preface
Welcome to the second edition of Human Development: A Cultural
Approach, Australian and New Zealand Edition.
This edition features current research, with particular attention to

Australia and New Zealand, as well as a focus on the cultural
diversity that exists around the world more broadly. We have worked
closely with the Pearson team to develop a wide range of features
that make the content and cultural approach engaging. However,
what sets this text apart, more than anything else, is that it presents a
portrayal of development that covers the whole amazing range of
human cultural diversity. As individuals who have taught human
development in higher education for years, and being familiar with
the available texts, we were struck by how narrow they all seemed to
be. Many texts focus on human development in the United States as
if it were the typical pattern for people everywhere, with only the
occasional mention of people in other parts of the world. With this
adapted text, we have carefully scrutinised the applicability of the
mainstream American model for students in Australia and New
Zealand. In some cases, the research is similar; sometimes, the
content is very different; and sometimes American research serves
as an interesting contrast for development patterns in New Zealand
and Australia.
So, in writing and adapting this text for an Australian and New
Zealand audience, we decided to take a cultural approach, and one
that pays close attention to development in our own part of the world
as well as beyond. We set out to portray human development as it
takes place across all the different varieties of cultural patterns that
people have devised in response to their local conditions and the
creative inspiration of their imaginations. Our goal was to teach
students to think culturally, so that when they apply human
development to the work they do or to their own lives, they
understand that there is, always and everywhere, a cultural basis to
development. The cultural approach also includes learning how to
critique research for the extent to which it does or does not consider
the cultural basis of development. We provide this kind of critique at
numerous points throughout the text, with the intent that students will
learn how to do it themselves by the time they reach the end. By
exploring a balance of examples of research from Australia, New
Zealand, the United States and throughout the world, students
studying with this text will learn how culture shapes human
development at all stages of the life span.
We know from our experiences as university lecturers that students

find it fascinating to learn about the different forms that human
development takes in various cultures, but there are also practical
benefits to the cultural approach. It is more important than ever for
students to have knowledge of the wider world because of the
increasingly globalised economy and because so many problems,
such as disease and climate change, cross borders. Whether they
travel the globe or remain in their hometowns, in a culturally diverse
and globalised world, students will benefit from being able to apply
the cultural approach and think culturally about development,
whether in social interactions with friends and neighbours, or in their
careers, as they may have patients, students or co-workers who
come from different cultures.
Did you notice that the front cover is a woven mat? We have taken as
inspiration the whāriki from Māori culture. Whāriki are usually the
result of many people working together who are valued for their
artistry. There is also a symbolic meaning. The individual strands of
the whāriki represent the aspects of life that describe and support
human development, and the completed whāriki represents ‘a woven
mat for all to stand on’ (Ministry of Education1, p. 10). The weaving
metaphor is also present in other cultures. There is a Tongan saying
that ‘society is like a mat being woven’, and the Malagasy from
Madagascar have a proverb that says, ‘All who live under the sky are
woven together like one big mat’. The cover image captures the
interwoven nature of culture, experiences and historical context for
individuals in their development, as well as biological, cognitive and
psychosocial aspects of development. As individuals, we need to look
beyond our own experiences and not assume that what is true for
ourselves is true for others. We have grown up in a certain cultural
context. We have learned to think about life in a certain way. Most of
us do not realise how broad and diverse our world really is. Our hope
is that this text will help more students identify the strands of the
weaving that represent an individual’s development and appreciate
the wonderful diversity within this.
1 Ministry of Education. (2017). Te Whāriki He whāriki mātauranga mōngā

mokopuna o Aotearoa early childhood curriculum. Wellington, New Zealand:
Ministry of Education.
[Return to reference]
The cultural approach makes this text different from other life span
texts, but there are other features that make this text distinct. This
text is also alone among major texts in dividing the adult life span into
stages of emerging adulthood, young adulthood, middle adulthood
and late adulthood. Emerging adulthood, roughly ages 18–29, is a
new life stage that has arisen in developed countries over the past 50
years, as people have entered later into the commitments that
structure adult life in most cultures: marriage, parenthood and stable
work. Other texts either call the whole period from ages 18 to 40
‘Young adulthood ’ (which makes little sense, in that for most
people in developed countries ages 18–29 are vastly different from
ages 30–40) or they have an emerging adulthood chapter and then
lump young and middle adulthood together as ‘adulthood’ (which also
makes little sense, given that it means applying one life-stage term to
ages 25–60). Arnett originally proposed the theory of emerging
adulthood in 2000, and it has now become widely used in the social
sciences. We think it is a fascinating and dynamic time of life, and we
know students enjoy learning about it, as many of them are in that life
stage or have recently passed through it.
This text is somewhat shorter than most other texts on human
development. There is one chapter devoted to each phase of life, for
a total of 13 chapters. Each chapter is divided into three main
sections, which correspond to the physical, the cognitive and the
emotional and social domains of development. This is an introductory
text, and the goal is not to teach students everything there is to know
about every aspect of human development, but rather to provide
them with a foundation of knowledge on human development that
hopefully will inspire them to learn more, in other courses and
throughout life.
Features
Opening vignettes begin each chapter and provide an overview of
the developmental stage being covered. The vignettes feature people
from diverse backgrounds and discuss their lives, experiences and
the role that culture has played in their development.
QR codes appear throughout the text in opening vignettes, feature

boxes and the margins beside relevant text. The content can be
brought to life by scanning the QR codes and watching videos
relating to the text.
Research and artwork have been incorporated to help students
appreciate the diversity that exists within countries and to understand
the role of culture, ethnicity, socioeconomic status and other factors
in human development.
Research Focus features offer a detailed description of a research
study, including its premises, methods, results and limitations.
Multiple-choice review questions at the end of the feature ensure that
students have a solid understanding of the research study and
methodology.
Cultural Focus features highlight how culture impacts various
aspects of development, such as breastfeeding practices, gross
motor development, marriage and family relationships, and work and
retirement. Students read an overview of the topic and then answer a
review question.
Critical-thinking questions encourage students to think more
deeply and critically about a developmental topic. These questions
appear in every main section and often focus on the role of culture in
human development.
Practice quizzes appear at the end of each section within the
chapter to test knowledge gained during the topic.
Summary boxes at the end each section cover the key points
associated with each learning objective within the section.
Apply your knowledge as a professional videos at the end of each
chapter show career professionals who describe their jobs and
explain how a knowledge of human development and culture
influence their work on a daily basis. They help students apply
chapter content to their own lives and future careers.
Chapter quizzes at the end of each chapter consist of multiple-
choice questions covering topics raised in all sections of the chapter
to ensure good knowledge of content.
Acknowledgements
We are grateful to all of the talented and dedicated people who have
contributed to this second edition. Anna Carter, Development Editor
at Pearson Australia, deserves a massive thank you for her support
and encouragement throughout the writing process. Anna has
worked with each of the authors to keep us on track and focused
during what has been an unpredictable time for people across the
globe. Another big thank you to Stephen Heasley, Senior Portfolio
Manager, who initiated this project and supported the team
throughout.
We would like also to thank the reviewers who reviewed chapters,

sections and other material during the development of the text. We
benefited greatly from their suggestions and corrections, and now
instructors and students reading the text will benefit too.
Reviewers include:
Laura McLaughlin Engfors—University of South Australia
Carolina Gonzalez—The University of Queensland
Danielle Davidson—Queensland University of Technology
Nenagh Kemp—University of Tasmania
Ryan Balzan—Flinders University
Katherine Johnson—University of Melbourne
Finally, we thank everyone who participated in ways great and small,

and hope that you are as pleased with the finished product as we
are!
Laurie Chapin
Charlotte Brownlow
Tanya Machin
About the authors
Jeffrey Jensen Arnett
Authors Jeffrey and Lene with their twins, on the cusp of emerging
adulthood.
Jeffrey Jensen Arnett is a Research Professor in the Department of

Psychology at Clark University in Worcester, Massachusetts. He
received his PhD in developmental psychology in 1986 from the
University of Virginia and did 3 years of postdoctoral work at the
University of Chicago. From 1992 to 1998 he was Associate
Professor in the Department of Human Development and Family
Studies at the University of Missouri, where he taught a 300-student
life span development course every semester. In the autumn of 2005,
he was a Fulbright Scholar at the University of Copenhagen in
Denmark; in 2010–2011 he was the Nehru Chair at Maharaja
Sayajirao University in India; and in 2017–2018 he was a Visiting
Professor at the University of Bordeaux in France.
His primary scholarly interest for the past 20 years has been in
emerging adulthood. He coined the term, and he has conducted
research on emerging adults concerning a wide variety of topics,
involving several different ethnic groups in American society. He is
the Founding President and Executive Director of the Society for the
Study of Emerging Adulthood (SSEA; www.ssea.org). From 2005 to
2014, he was the editor of the Journal of Adolescent Research (JAR),
and currently he is on the Editorial Board of JAR and five other
journals. He has published many theoretical and research papers on
emerging adulthood in peer-reviewed journals, as well as the books
Adolescence and Emerging Adulthood: A Cultural Approach (2015,
6th edition, Pearson) and Emerging Adulthood: The Winding Road
from the Late Teens Through the Twenties (2015, 2nd edition, Oxford
University Press).
He lives in Worcester, Massachusetts, with his wife Lene Jensen and

their twins, Miles and Paris. For more information on Dr Arnett and
his research, see www.jeffreyarnett.com.
Another random document with
no related content on Scribd:
Fig. 249 Osteomas.period
Myxomas. of life is,
Sarcoma. however
, exempt.
Tumors attain
sometimes enormous
size. Marsh has
recently described
such a tumor
weighing thirty-three
pounds.
Microscopically these
tumors may assume
any of the varieties,
endothelioma,
angiosarcoma, etc.,
those of the most
rapid growth being
found rather of the
round-cell type, while
those of slow growth
are usually myeloid or
contain giant cells.
Sarcomas
frequently arise from
the periosteum.
Commencing in the
interior of a bone,
they develop for the
most part very slowly,
and expand the bone
more or less
symmetrically, in
Exostosis bursata. (Orlow.) distinction to those
growths of external
origin which are in evidence on one or another aspect of the bone
involved (Figs. 247 and 248).
Sarcoma not infrequently has its origin from the callus of a delayed
bone union, and I have had repeatedly to amputate for this sequel of
fracture. (See Fig. 252.)
As the disease advances there is increase of pain, usually with
increasing cachexia, while augmentation in size of such a tumor may
make a limb not only useless, but the source of greatest annoyance
and difficulty in management of the case.
Treatment.—There is but one treatment in cases which will permit it
—amputation of limbs, extirpation of tumors from certain bones, or
excision of entire bones. Thus for sarcoma of the scapula we
extirpate the entire bone; for sarcoma of the skull we make extensive
resections of the same, removing the underlying dura when involved;
for sarcoma of the lower or upper jaw we remove it in whole or in
part. Sarcoma of the spine is inoperable, that of the pelvis almost
equally so. In absolutely inoperable cases treatment by the toxins of
erysipelas may be tested. In all cases where pain is severe opiates
should be administered, which under these circumstances are
anodyne, stimulant, and almost nutritive. Patients in this condition
should not be allowed to suffer, and opium in assimilable form should
always be administered to any amount necessary.
Fig. 250 Fig. 251
Sarcoma of periosteum of humerus. Bone cyst of tibia. (Buffalo Clinic.)

(Pemberton.)
Myeloma (Kahler’s Disease).—Collins[36] reports the tenth

recorded case in this country. The
disease was first described by Bence Jones in connection with a
peculiar proteid found in the urine. It is characterized by changes in
the bones, with pain in the chest, back, and loins. In the urine
albumose appears, which seems to be pathognomonic when taken
in connection with such symptoms as those above. On section
numerous small tumors are seen in the bones. The disease has
hitherto been regarded as an expression of osteomalacia. All the
bones of the skeleton may be involved without any tendency to
metastasis in other tissues. On minute examination the myelomatous
tumors met with seem to be found alike in the bone substance and
the marrow, and to be cell proliferations of myeloid tissue. The
matter is still left somewhat in doubt as to what should be meant by
the term myeloma, this being a feature to be cleared up later. It is
seen more often in males than in females, and in the later part of life.
Aside from constant malaise, with pain in the back and side, there
occur progressive weakness, with anemia, and such final softening
and fragility of bones as to lead to spontaneous fractures, or to the
projection of tumors, which may be especially noted about the ribs,
with deformity of the vertebræ. On close inspection the urine will be
found turbid and albumose is detected. The disease is usually
regarded as hopeless; there is no information regarding its
successful treatment.
[36] Medical Record, April 29, 1905.
Fig. 252
Sarcoma developing in callus. (Haberen.)

CHAPTER XXXIII.
DEFORMITIES DUE TO CONGENITAL DEFECTS
OR ACQUIRED DISEASES OF THE LOCOMOTOR
APPARATUS; ORTHOPEDICS.
In previous chapters have been considered the various morbid
conditions of bones, joints, muscles, and tissues which help to form
the locomotor apparatus of the body. It would seem then quite proper
in this place to insert the chapter usually relegated to the end of text-
books on surgery where it stands by itself, i. e., the chapter on
Orthopedics. As a subject orthopedics deals with the causation and
the treatment of deformity, whether inherited or caused by disease.
The term is used in a more or less elastic sense, and is made by
some to cover a larger field than others would accord it. The subject
divides itself into two parts:
1. The consideration of deformities produced by tuberculous or
other infectious disease, and
2. Non-carious, congenital, and acquired deformities.
Tuberculous lesions do not differ in pathology or other respects
from the tuberculous diseases of bones and joints described in
earlier chapters of this work. Inasmuch, however, as some of them
form distinct and clinical types of deformity they assume an
importance which justifies reasonable consideration by themselves.
Of these we shall consider spinal caries, sacro-iliac disease, hip
disease, and tumor albus.
SPINAL CARIES, SPONDYLITIS, KYPHOSIS, POTT’S DISEASE.

These various terms have reference to deformities of the spine of
similar type, but with considerable variations, produced by caries
(tuberculosis) of the vertebral column. Where osseous structures are
separated by cartilaginous or more or less complete joint cavities the
primary focus may form within the spongy structures of the vertebral
bodies or in the softer tissues of the intervertebral joints. In other
words, it is caries of the ordinary type which assumes special
significance only because of the accident of its location. The entire
vertebral column should be regarded as the main support of the
body, while to it is due the maintenance of the erect position which
raises man above the animal. When diseased and softened it yields
to pressure, the result being exaggeration or distortion of its natural
curves. As the instinctive tendency of the human being is to maintain
the head in the line of the centre of gravity above the pelvis, any
marked degree of curvature in one direction brings about, by natural
causes, a compensatory curve in its opposite direction. A well-
marked case of kyphosis, then, is characterized by more than one
exaggerated curvature or protuberance, one being due to disease,
the other to compensation.
While there may be several foci of active tuberculous disease,
even in one vertebra, there may be found pronounced forms of
angular curvature as the result of destruction occurring in but one or
two of them. The carious process once begun may be checked at
any point in its course, or it may proceed to complete softening and
destruction, with formation of cold abscess. The tuberculous process
once begun spares no tissue, and thus bone and intervertebral
cartilage melt and disappear in the same manner. There may be a
possible danger from spreading of tuberculous disease to the spinal
meninges or to the cord, or of its being generalized. In the former
case there is pachymeningitis and myelitis with paralysis; in the latter
case it causes more or less rapid, acute general tuberculosis.
Paralysis is more often induced, however, by actual compression
than by mere tuberculous involvement, although the disease
products which cause this pressure are likely to come from a
caseous pachymeningitis.
The disease is most common in childhood, about 80 per cent. of
cases occurring before puberty. Of the three regions of the spine the
thoracic is the one most often involved, next the lumbar, and lastly
the cervical. The most common site of all is in the lower dorsal
region. Deformity once established as the result of this disease
cannot be expected to spontaneously disappear.
Causes.
—Slight injuries occurring in those of tuberculous diathesis, by which
there is produced a focus of least resistance, or secondary infections
following upon such conditions as scarlatina and typhoid, constitute
the most frequent recognizable causes. There can usually be
obtained a history of some injury in about half of the cases. The
disease once established may assume either an acute or chronic
type.
Symptoms.—As indicated when discussing caries in joints the
principal signs and symptoms are pain, muscle
spasm, muscle atrophy, tenderness, deformity, and impairment of
function. These are all present in Pott’s disease, to which they give
that distinct clinical picture which Pott so graphically described about
a century ago.
Pain.—Pain is rarely absent. It may be misleading, but is usually
referred to the terminal distribution of the intercostal nerves, and thus
may be complained of in the chest, the abdomen, or the legs. Many
a “stomach-ache” in children is of this character and origin, and a
complaint of frequent “growing pains” should be carefully
investigated. Even in sleep these pains are characteristic, and have
been previously described as “starting pains.” Children cry out with
them in the night. They tire easily and tend to seek rest instinctively.
Pain is always aggravated by excessive pressure upon the upper
spine or by jars, such as may be received in jumping. It is not
necessarily constant. Vertebral tenderness may sometimes be
detected by pressing upon the ribs. This will especially aggravate
symptoms when respiration is of a groaning character or when there
is any expression of dyspnea. There may be vomiting or dysuria. A
sudden increase of these painful features means a fresh focus of
infection, impending abscess, or a danger of paralysis.
Muscle Spasm.—It is by muscle spasm that we account for the
attitudes and postures of Pott’s disease. It is a constant feature, but
will vary in its expressions with the location of the disease. In caries
of the cervical spine the chin is raised, the head is balanced
somewhat backward, while the lower spine is straightened and given
a backward curve. In the stooping posture the head is supported by
the patient’s hands in the instinctive effort to protect it. In caries of
the mid-dorsal region there is elevation of the shoulder, with marked
tendency to support the weight of the upper part of the body by
placing the hands upon the knees or thighs. Lumbar caries often
produces perceptible backward curve in the lower portion of the
spine.
In all cases there are stiffness and rigidity of the spine, and
patients resort to all sorts of instinctive expedients to avoid motion in
the affected area. When that part of the spine which is in relation
with the psoas muscle is involved there is more or less psoas
contraction, with characteristic flexor deformity at the hip, which is
usually bilateral. This will give a peculiarity to the gait and cause it to
be not only stiff in appearance, but it will be seen that the patient
walks more upon the toes and with slightly bent knees, which are
thus made to act as springs. An attitude assumed in stooping or in
the effort to lean over as if to pick up an object from the floor is
characteristic; the spine will not be curved forward and the patient
will not stoop as usual for the purpose, but the spine will be more or
less erect and stiff and lowered to the floor by flexing both knees and
hips until the squatting position is assumed. In rising the same effort
will be made to protect the spine from any motion between its
component parts. (See Figs. 253 and 254.)
During sleep this muscle stiffness becomes even more
pronounced, so that in the morning patients are “stiffer” than later in
the day. The existence of muscle spasm can often be detected by
palpation of the spinal lesion. Some lateral deviation or asymmetry of
signs may often be noted, according as the muscles of one side are
more pronouncedly influenced by the location of the disease focus,
and it is the more common in proportion to the greater severity of the
case.
The confinement caused by the disease will naturally be followed
by more or less atrophy of the body muscles, but, in addition to that,
those immediately involved about the centre of the disease undergo
an atrophy due to it and often apparent on inspection.
Tenderness.—In numerous distinctive ways the patient constantly
evinces tenderness and makes invariable efforts to protect against
movement or even jar. Tenderness can also be evoked by pressure
upon the head or shoulders, which will cause severe pain, or by
causing the patient to jump down a step or to rise upon the toes and
then come down abruptly upon the heel. Pressure upon the spines of
the affected vertebræ or upon the ribs which connect with them will
also cause complaint of pain.
Deformity.—This is the most striking objective feature of well-
marked Pott’s disease. It is practically a backward projection known
as kyphosis, the vertebra first affected being usually the first to yield,
the others following or changing in shape as the disease spreads or
as the growth of the individual permits accommodation and
necessitates rearrangement. The more acute the disease the
sharper the projection. Old and mild cases cause an abrupt
curvature rather than a protuberance.
Fig. 253 Fig. 254
Typical postures of the spinal muscle spasm of spondylitis. (Bryant.)
It is well to keep a record of the deformity in cases under

treatment. This may be graphically preserved by putting the patient
flat upon the abdomen upon a straight surface and bending a strip of
lead so that it shall fit the contour of the spinous processes. After it
has been made to fit it may be removed and a tracing of the curve
made upon a sheet of paper. Comparison of tracings thus made at
intervals will afford a graphic record of the progress of the disease or
of the improvement made. Kyphotic deformities lead to a shortening
of the spine, so that growth is stunted and patients become dwarfed
in appearance. Secondary curvatures are produced above and
below the primary projection. Gradually as the shape of the vertebral
bodies and of the entire spinal column changes the ribs are pressed
more or less together, often being made to overlap, the shape of the
chest undergoes alterations, the sternum sometimes being
depressed and sometimes protruded, giving the chest, in the latter
case, the so-called “pigeon-breast” appearance.
Loss of Function.—There are but few disorders which produce more
pronounced and widespread accompaniments than spinal caries. As
change in the shape of the spine occurs and assumes a marked type
we see changes occurring through the body, not only in the direction
of anemia with general impairment of function, mental irritability, and
cachexia, but there occur trophic alterations as well. The shape of
the face changes, the expression assumed is one of anxiety, and the
features become less mobile.
Complications and Sequels.—Tuberculous meningitis, cerebral
or spinal, is the most dangerous and
acute condition, while other tuberculous complications may occur in
various regions of the body. In fatal cases meningitis, in
consequence of acute or mixed septic and terminal infection,
furnishes the explanation for the great majority. Paralysis is not
infrequent as a sequel, assuming the type of paraplegia and
developing slowly. Motion is first impaired and a considerable
interval may elapse before sensation is affected. Motor impairment
varies from mere mild paresis to complete paralysis, beginning as
fatigue, loss of strength, and inability to stand. Unless the disease be
located in the lumbar region the reflexes are exaggerated and
muscle spasm is easily provoked or occurs without perceptible
cause. As above noted the muscles become atrophied, and when
the cord is seriously compromised are rigid in chronic spasm. The
rectum and the bladder suffer finally, especially in disease of the
lower segments. Occasionally in cases of high dorsal disease the
arms will suffer more or less motor impairment. Sensory paralysis
begins usually as paresthesia. In merely bedridden but not actually
paralyzed individuals the reflexes should be normal. Of the muscle
contractures, those of the psoas are the most common and
distinctive. Paralysis follows rather than precedes deformity, and is
noted in perhaps 20 per cent. of advanced cases. It should rarely
occur if effectual treatment has been begun.
Abscess.—Abscess is usually of the “cold” type. Its general
character has been previously described. It may be of the purely
tuberculous type, but is not infrequently the result of a secondary
pyogenic infection. It is a consequence of neglect, but cannot always
be prevented. Signs, both local and general, of the presence of pus
or of pyoid are noted here, as under other circumstances. There is
exaggeration of local tenderness, with development of tumor, which
fluctuates as it approaches the surface. General septic features,
proportional to the activity of the process and its location,
accompany the local indications. Sometimes it occurs insidiously and
with but few evidences.
Pus travels here in the direction of least resistance. The fascial
planes of the body are mostly so placed as to protect important body
cavities, consequently pus will travel usually around them and
toward the surface, burrowing long distances, for instance, from the
lower dorsal region to the groin along the psoas muscle. Cervical
abscesses usually spread anteriorly toward the pharynx
(postpharyngeal) and deeply into the thorax (mediastinal); they may
open into the trachea or esophagus or externally through an
intercostal space; or they may burrow laterally, opening behind the
sternomastoid muscle. Dorsal abscesses usually travel posteriorly,
opening not far from the spine, or they burrow downward and
forward along the psoas so as to appear beneath Poupart’s
ligament. Lumbar abscesses escape through the psoas sheath as
psoas abscesses, so called, or between the fasciæ of the spinal
muscles and those of the abdomen to appear upon the side; they
may extend downward beneath the iliacus, escaping over the brim
and into the pelvis and then out through the sacrosciatic notch. Of all
these the psoas abscess, opening in the groin, is the most common.
This will in time destroy the muscle fibers of the psoas, but it leaves
the vessels and nerves intact, whose sheaths are much more
resistant, and which can be found passing through such a cavity like
cords through a chamber. This form of cold abscess, with its
consequent bulging and final escape in the groin, has been mistaken
for hernia as well as for abscess due to perinephritis and
appendicitis. The most serious mistake would be to take it for a
femoral hernia. The customary routes of all these collections of pyoid
have been thus indicated. Nevertheless abscesses may burrow and
appear almost anywhere. They will give rise to varying and to
superadded symptoms, according to their location. For example,
retropharyngeal abscess may seriously threaten respiration by
pressure upon the upper air passages, while a collection of pus in
the mediastinum might cause serious respiratory difficulty of another
character.
Cold abscesses of spinal origin may remain stationary, the fluid
portion of the pyoid material may even absorb, while the balance
undergoes more or less degeneration and conversion into inert
material, or they may slowly or rapidly increase in size. The best that
can be hoped in such cases is absorption, with encapsulation of the
solid residue. Even this may be a source of danger, as it is a focus of
lessened resistance, in or about which subsequent trouble may
result. Those abscesses which seem to remain stationary would best
be let alone, hoping for subsidence under good treatment. Those
which open spontaneously leave tuberculous fistulas behind them,
which may possibly close in time, but which lead often to subsequent
acute infection, and which are the bête noir of surgeons, for it is
often impossible to heal them. The best that can be done in such
instances is to wash them out, keep them clean, and guard them
from infection from without. It is often possible to pass a tube along
the sinus and through this to irrigate with a solution of iodine, of
formalin, or of any other antiseptic which may be preferred. If
anything be done with them in the operative way it should be as
radical as possible, seeking the original lesion, thoroughly curetting
its site and the whole interior of the cavity, and making ample
opening so as to provide for effective drainage.
Retropharyngeal abscesses usually necessitate evacuation
because of the obstruction which they cause within the pharynx.
Lumbar and psoas abscesses may be let alone. When this is not
practicable, then choice should be made between simple aspiration,
aspiration with washing or injection of some antiseptic fluid, and free
opening with radical treatment. In these cases we are to be guided
by the peculiar features and surroundings of each, and by our own
facilities for such work and for subsequent care of the case. An
abscess which will soon rupture should be opened and
counterdrained; but in one where this is not impending, and where
home features are such that the patient can receive no adequate or
prolonged care, it would be wiser to abstain. Under the best of
circumstances in these cases it is always a difficult problem to
decide. Even aspiration leaves at least a needle track to be
subsequently infected, while the contents may be too thick to flow
through a small trocar. Aspiration with thorough washing out and
then with injection of emulsions of iodoform or of other irritating
antiseptics have found favor with only a part of the profession. If any
radical measure is to be adopted the greatest care should be given
to carry out the principles expressed in the general consideration of
cold abscesses. (See p. 114.)
Diagnosis.—Intelligent comprehension of signs and symptoms
should enable one to make a diagnosis in most cases.
Nevertheless the surgeon is occasionally in doubt and has to
distinguish, for example, as between Pott’s disease and sprain,
lateral curvature, hysterical spine, cancer, cord tumors, rheumatic
arthritis, rickets, syphilis, actinomycosis, hydatid disease, acute
osteomyelitis, i. e., non-tuberculous diseases, and certain abdominal
affections followed by suppuration, such, for example, as peri-
appendicular abscess. Moreover, spondylitis may be simulated in the
course or as a complication of typhoid, scarlatina, gonorrhea, and
other acute infections. Psoas abscess should be distinguished from
perinephritic abscess as well as from acute appendicitis, which often
causes psoas contraction, especially when the appendix is
posteriorly placed and left in contact with that muscle. We may also
have to distinguish this condition from sacro-iliac disease and from
ordinary hip disease.
Prognosis.—In some degree prognosis depends on what is
meant by a cure. Absolute cure, with restoration to the
original condition, is exceedingly rare. Arrest of disease, with
improvement of deformity, is possible in cases seen early. Even
considerable motion may be restored under suitable treatment. In
late cases hectic, amyloid degeneration, and dissemination of the
disease make the outlook very discouraging. At best its relief is slow
and in time it is always chronic, no matter how rapid the onset,
except in those instances where dissemination occurs early and
rapidly, in which case there is little or no hope. In ordinary cases
there is a certain tendency to spontaneous recovery, but not without
deformity and impairment of function, while obviously the occurrence
of abscess prolongs a case to a considerable degree.
Treatment.—Those general measures so necessary for the
treatment of any tuberculous lesion, namely,
hypernutrition, fresh air, and general constitutional measures, are
needed here as in any other such disease. Physiological rest, i. e.,
absolute rest in a bed without springs, the patient lying flat on the
back or on the face, and not on the side, and lying quietly,
constitutes the best part of local treatment. In the case of children it
is best to have a gaspipe frame, across which cloth may be
stretched, on which a fretful child can be secured by straps across
the shoulders, pelvis, and knees. This frame may be laid upon the
bed and lifted from it while a cross-piece is removed for toilet
purposes, or a suitable opening may be left if a single piece of cloth
be stretched across it. If the patient can be made to submit to this
repose, then a pad may be placed under the projection. After a
sufficient length of time, with the desired improvement, a plaster
shield may be molded to the back, with the patient lying upon his
face; and then, after removing and suitably trimming and lining this
mold, the patient can be returned in it to the previous position in bed,
from which he may gradually be raised. This is the best method to
follow in acute or severe cases, or when the disease is higher up in
the spine. It will also best serve the purpose when the case is
complicated by abscess. To it may be added, if necessary, traction
upon the head (Fig. 255).
Fig. 255
Child in bed-frame, with head traction. (Lovett.)
—The simplest of all apparatus is the plaster jacket, or corset, which

was brought into favor in this country by Sayre, although not
invented by him. It is usually applied in suspension, i. e., with the
patient in the erect position beneath the frame, from which hangs a
support by which firm traction can be made, both upon the head and
the arms or the shoulders. The intent of such a jacket is to apply it
with the patient so stretched out that a certain degree of the
projection will at least be eliminated and the back made more nearly
straight than it otherwise would be. In cases where this is impossible
it at least affords better expansion of the thorax and supports the ribs
in better relation to the spine, affording more chest room. The plaster
is not applied next to the skin, but a thin undershirt or its equivalent
of woven materials should be applied, care being taken to see that it
fits snugly and is not allowed to fold in ridges. After the patient is
completely suspended to a degree where discomfort begins, then a
small “stomach pad” is slipped beneath the under-jacket, in front, in
order that more room may be given for enlargement of the abdomen
Fig. 256 after a full meal.
Finally with the first
turns of the plaster a
strip of tin or a couple
of strips of moistened
pasteboard should be
applied directly over
the middle line in front
and incorporated in
the successive turns
of bandage, in order
that there may be
material there which
may be cut down in
removing the jacket.
Small pads should be
placed over the iliac
crests and over the
protrusion if it be at all
marked or tender.
Now by the use of a
series of bandages of
gauze, in which
reliable plaster of
Paris has been
incorporated, the
entire trunk is
enclosed within a
corset, which will
quickly harden as the
plaster becomes firm.
It should extend well
Jury-mast for high dorsal and cervical caries. (Lovett.) down over the pelvis
and nearly to the
Treatment by Apparatus.
trochanters, since from this portion it takes
its fixed support. It should then be extended as high as can be
permitted under the arms and higher yet over the chest and back.
Enough material should be used along with the plaster-of-Paris
cream, as the former is applied, to ensure sufficient firmness and
strength. If the plaster be reliable it will not be necessary to keep the
patient suspended more than a few moments after the completion of
the jacket. The finishing touches may be given it after he has been
taken from the frame and placed again upon a soft surface.
Another method of application is to have the patient recumbent
and properly supported, and this is particularly necessary in acute
cases, where suspension is likely to cause faintness or unpleasant
symptoms. In this attitude the spine is really put in better position.
The method is not at all available in those few cases of lateral
curvature which demand jackets (Fig. 256).
Substitutes for these jackets are made of various materials, such
as leather, rawhide, aluminum, thin strips of veneering, celluloid,
paper, glue, etc. These have to be constructed over a mold which is
taken from a plaster jacket. When the disease extends above the
level of the fifth dorsal vertebra there should be incorporated within
the jacket a support for the head, known since Sayre’s time as a
“jury-mast.” This consists of a metal upright, with cross-pieces, which
are incorporated with the jacket and which is curved up behind and
over the head and made to carry the frame from which the leather
straps and supports pass beneath the occiput and the chin, and thus
give to the head a certain amount of fixation. The support is so
arranged as to permit of sliding and of sufficient expansion so that
traction upon the head can be made effective.
Fig. 257
Frame for application of plaster jackets in recumbent position. (Lovett.)
Fig. 255 shows the application of traction to the head, while Fig.
256 illustrates one form of apparatus by which the jury-mast is made
effective in producing traction on the head in the upright position.
Figs. 257 and 258 show a convenient frame and method for making
plaster-of-Paris corsets with the patient in the recumbent position.
Figs. 259 and 260 show another form of apparatus intended for the
same purpose.
Fig. 258
Application of a plaster jacket in the recumbent position. (Lovett.)
The variety of apparatus which has been devised for the

maintenance of rigidity and correction of deformity, and, in suitable
cases, traction upon the head, is to be measured almost by the
number of orthopedic specialists, nearly every surgeon inclining to
some device or at least modification of his own. Judson probably has
formulated the best rule covering the entire matter when he says:
“The apparatus may be considered as having reached the limit of its
efficiency if it makes the greatest possible pressure upon the
projection compatible with the comfort and integrity of the skin. It is
essential that the brace is efficient; second, that it is one that can be
constantly worn, if necessary, or can be easily detached from the
body if not to be worn at night.” Certain ambulant cases can be
treated by an effective brace through the day, and rest at night upon
a reasonably hard mattress, with traction upon the head. Concerning
the multitude of these special aids to treatment it hardly seems worth
while to go into any elaborate description in this place, inasmuch as
one who is incompetent to judge as to what is best should not retain
the management of such a case, while one who is really competent
will probably desire to make his own selection, and the writer’s
recommendation would count for but little. Every case must be a law
to itself, and every special brace must be constructed especially for
the individual for whom it is meant; otherwise it loses all its
serviceability.
Forcible Reduction.—The feasibility and propriety of forcibly reducing
the deformities due to spinal caries was first suggested by Chipault,
of Paris, who suggested wiring the spinous processes of the affected
vertebra, and then, by Calot, who, in 1896, described a method of
forcible reduction under an anesthetic. The first to actually wire the
spine under these circumstances was Hadra, of Texas, who had
actually done the operation four years before Chipault. The method
has probably less to commend it in actual practice than in theory,
and, attractive as it may be in respect to time and completeness of
reduction, it is often followed by serious accidents, such as
hemorrhage, rupture of abscess, fracture of the spine, etc. Bradford,
in 1899, collected 610 cases performed by 29 different operators,
with a record of 21 immediate deaths from local trauma and 15
cases in which there were at least alarming immediate symptoms. Of
229 of these cases complete correction was effected in 119,
incomplete in 94, while no gain whatever was made in 16. Of results
reported later, 66 showed some gain, there was no relapse in 17,
while 49 showed more or less return of deformity. The claim has
been made that the more or less wide gaps or bony defects which

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Chapter 2 Genetics and prenatal development 44

Chapter 3 Birth and the newborn child 81

Chapter 4 Infancy 124

Chapter 5 Toddlerhood 173

Chapter 6 Early childhood 222

Chapter 7 Middle childhood 277

Chapter 8 Adolescence 331

Chapter 9 Emerging adulthood 388

Chapter 10 Young adulthood 438

Chapter 11 Middle adulthood 482

Chapter 12 Late adulthood 528

Chapter 13 Death and afterlife beliefs 578

Name index 710

Subject index 740

About the authors xvi

Educator resources xviii﻿﻿

Chapter 1 A cultural approach to human development 1﻿﻿

Cultural Focus: Niger and the Netherlands: an up-close

Human origins: the rise of a cultural and global species 10﻿﻿

Summary: Human development today and its origins 16﻿﻿

Educator resources xviii

Chapter 1 A cultural approach to human development 1

Human origins: the rise of a cultural and global species 10

Summary: Human development today and its origins 16

Section 2: Theories of human development 17

Scientific conceptions 20

Summary: Theories of human development 27

Section 3: How we study human development 29

Research Focus: Darwin’s diary—a case study 36

Summary: How we study human development 42

Chapter quiz 42

Chapter 2 Genetics and prenatal development 44

Genes and the environment 50

Genes and individual development 56

Summary: Genetic influences on development 60

Section 2: Prenatal development and prenatal care 61

Prenatal care 64

Summary: Prenatal development and prenatal care 71

Section 3: Pregnancy problems 72

Summary: Pregnancy problems 79

Chapter quiz 79

Chapter 3 Birth and the newborn child 81

Historical and cultural variations 86

Summary: Birth and its cultural context 96

Section 2: The neonate 97

Physical functioning of the neonate 102

Summary: The neonate 107

Section 3: Caring for the neonate 108

Chapter quiz 121

Chapter 4 Infancy 124

Infant health 135

Motor and sensory development 139

Summary: Physical development 143

Section 2: Cognitive development 145

Cultural Focus: Object permanence across cultures 148

Information processing in infancy 150

Assessing infant development 153

The beginnings of language 155

Summary: Cognitive development 159

Section 3: Emotional and social development 160

Research Focus: Measuring temperament 161

Infants’ emotions 163

Summary: Emotional and social development 170

Chapter quiz 171

Chapter 5 Toddlerhood 173

Summary: Physical development 183

Section 2: Cognitive development 184

Language development 188

Summary: Cognitive development 196

Section 3: Emotional and social development 197

Attachment theory and research 203

The social world of the toddler 211

Summary: Emotional and social development 218

Chapter quiz 219

Chapter 6 Early childhood 222

Motor development 230

Summary: Physical development 233

Section 2: Cognitive development 234

Cultural Focus: Theory of mind across cultures 237

Language development 239

Summary: Cognitive development 242

Section 3: Emotional and social development 243

Early childhood education 249

Summary: Emotional and social development 273