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108
necessity of obtaining a thorough examination of the back
of the child's nose. I attach great importance to the breathing
exercises, which are in vogue at all the schools, and much
good is done by this means. The importance, from the point
of view of bodily and mental development, of proper nasal
breathing is gradually becoming more recognised by parents,
and one has much less difficulty than formerly in persuading
them to overcome the natural reluctance to a. surgical operation
which the removal of these obstructive post-nasal growths
(adenoids) entails. It cannot be too strongly insisted upon
that, in the interest of the child, mentally and physically, to
say nothing of the increased liability to contract serious attacks
of Scarlet Fever and Diphtheria, it is the undoubted
duty of the parent to obtain the requisite treatment if there
is any obstruction to the entry of air through the normal
passage, namely, the nose.
Organic Heart Disease.
8 children were found to have definite disease of the
valves of the heart. In each instance it was the Mitral valve
which wa6 the valve affected. Nearly all these children appeared
to be in good health, and the disease was unsuspected in the
majority of them. Rheumatism, St. Vitus's Dance, and
Scarlet Fever are the commonest causes. The existence of
heart disease has a very important bearing upon both the
school life and the choice of a suitable occupation. In all
cases these matters were discussed with the parents and the
necessary instructions given to the teachers where a modification
of school regime seemed desirable.
Functional Heart Disease.
This was found in 19 instances, 12 boys and 7 girls. By
this term is meant some alteration in the action of the heart
which is not apparently due to organic disease of that organ;
for instanoe, irregularity or undue rapidity of the heart-beat.
It is not infrequently due to a temporary disturbance of the
nervous mechanism of the heart caused by an attack of acute