The treatment of these cases may be summed up as follows: 

(a) We must search for any source of infection, a source which is often to be found in the condition of the tonsils.  Enucleation may then be indicated as the first step in treatment.

(b) Massage and gymnastic exercises calculated to improve the muscular tone, while every effort is made to secure for the child as perfect hygiene in the environment as possible.

(c) The stimulating effect of cold douches is often very evident in improving the vasomotor tone.  These children, however, will not stand well the abstraction of heat from their thin and chilly little bodies, so that it is a good plan before the colder douche to immerse the child in a hot bath and to return again to the bath momentarily afterwards.  With these precautions children will often enjoy a cold spray, the temperature of which may be constantly lowered as they become used to it.  Prolonged hot bathing has a correspondingly prejudicial effect.

(d) We must be on the watch to prevent the development of further postural deformities, such as scoliosis.  If a child of strong muscular tone and good physique habitually adopts some posture, curled up, it may be, in some favourite easy-chair, there is little likelihood that its constant assumption will produce deformity.  When the muscular system is lax and weak, on the other hand, deformity such as scoliosis is very readily caused.  It is important, for example, to see that the child does not habitually incline to one side in reading or writing.  When there is little energy for free and energetic play the children are apt to become great bookworms.  If there is shortsightedness, the dangers are correspondingly increased.  A special chair may be made with a well-fitting back and the seat a little tilted upwards so as to throw the child’s trunk on to the support of the back.  Lastly, a desk, the height of which can be regulated at will, can be swung into the proper position.  The child, sitting straight and square, with the weight supported by the foot-rest and back as well as by the seat of the chair, should be taught to write with an upright hand, avoiding the slope which leads to sitting sideways with the left shoulder lowered.

(e) Malt extract, cod liver oil, Parrish’s food, and other tonics may be of undoubted service.

(3) RHEUMATISM AND CHOREA

It is certain that there is a close association between rheumatism in childhood and the common nervous affection known as chorea.  We are still ignorant of the precise nature of the infection which we know as rheumatism.  There is much to suggest that in rheumatism we have to deal only with a further stage in those catarrhal infections to which so much infantile ill-health is to be attributed, and that endocarditis and arthritis, when they arise, signalise the entry of these catarrhal, non-pyogenic organisms into the blood stream, overcoming