ty.

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 c