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57
of the Nose and Throat. 38 were referred for treatment, 75 for
observation, and in 4 no treatment was prescribed. In addition to
the Routine Cases, there were 63 " Specials '' referred for treatment.
Of the total 101 cases referred for treatment, 20 were
operated on and 69 carried out a course of Breathing Exercises.
A large number of children have been included in this Group
who presented a moderate degree of enlargement of one or both
tonsils, and they have been referred as a rule for observation, and
at the same time a leaflet of instructions on Breathing Exercises
has been given to the Parents. At the time of examination there
were no signs of obstruction, but any condition producing congestion
of the nose and throat, such as head cold, leads at once to obstructive
symptoms in these children. I have formed the opinion that
breathing exercises regularly and properly carried out leads to a
great improvement in the condition. This applies not only to the
milder cases, but also to those with well-marked signs of obstruction.
I now rarely recommend operation in any case of obstruction due to
Tonsils and Adenoids without first trying the effect of a course of
Breathing Exercises.
Heart and Circulation.—Fourteen children were fpund with
Valvular Disease of the Heart, and 13 showed variations from the
normal, which were regarded as functional. All children with
organic disease of the Heart are inspected at intervals and advice
as to exercises, attending the Swimming Baths, etc., is given.
The more closely one follows up this condition in children the
more evident it becomes that the great majority of these damaged
hearts are due to the poison of rheumatic fever. Chorea is
responsible for a few, and the poisons of the Specific Fevers,
especially Scarlet Fever and Pneumonia, may also be responsible,
but it is difficult to trace with certainty Valvular trouble to the
Specific Fevers. Diphtheria, although it profoundly affects the
heart muscle during the disease, can I think as a cause of subsequent
valvular trouble, be ruled out. The poison of rheumatic fever is
the outstanding causative agent, and this fact emphasises the gravity
of this disease in children, and the need for great care and precau-