Apart, however, from this tendency to convulsive seizures the nervous system of these children is abnormal.  As a rule they are excitable, and develop late the power to control their emotions.  Lagging behind in physical development and in the capacity to interest themselves in the pursuits of normal children, their emotional state remains that of a much younger child.  In the infant classes at schools they are recognised as dullards, learning slowly, speaking badly, and lacking co-ordination in all muscular movements.

The clinical picture so depicted is encountered with extreme frequency among the children of the poor in our large cities.  To find a name for the condition is no easy matter.  To call it “rickets” is to place an undue emphasis upon the bony changes which, though common, are by no means invariable.  Elsewhere I have suggested the name status catarrhalis, on an analogy with the name status lymphaticus, which in the post-mortem room is used to describe the secondary overgrowth of lymphatic tissue which is found in these catarrhal children.  In the present connection it is of interest to us to note how commonly the nervous system is involved in the general picture and the frequency both of convulsive disorders and of neuropathy.

The nervous symptoms of both sorts are to be allayed only by improving the general hygiene of the child and raising its resistance against infection.  A sufficiency of fresh air and of sunlight, and a management which encourages independence of action in the child, are both necessary.  The diet is of the first importance.  It should be sufficient, and no more than sufficient, to cover the physiological needs of the child for food.  The majority of these children have enormous appetites, and excess of food, and especially of carbohydrate food, plays some part in the production of the disturbance.  We must guard against overfeeding, against want of air and want of exercise, and against those errors of management described in previous chapters, which produce the maximum of disturbance in this type of child.

(2) A GROUP WITH MUSCULAR ATROPHY, LORDOSIS, AND POSTURAL ALBUMINURIA

At an older age, in children from the fifth year onwards, a second type of physical defect associated with pronounced nervous disturbance presents itself with some frequency.  The body is thin and badly nourished, and the muscular system especially poorly developed and very lax in tone.  The most striking feature is the extreme lordosis, accompanied usually by a secondary and compensatory curve in the cervico-dorsal region, so that the shoulders are rounded, with the head poked forward.  Viewed from in front the abdomen is seen to be prominent, overhanging the symphysis pubis, while the shoulders have receded far backwards.  The scapulae have been dragged apart, as though by the weight of the dependent arms, with eversion of their vertebral borders and lowering of the points of the shoulders.  The position which they adopt is that into which the body falls when it ceases to be braced by strong muscular support.  The muscular system is here so weakly developed and so toneless that the posture is determined by the bony structure and its ligamentous attachments.