andstill. Between this and the
slightest cases there are all shades of difference, till, in the latter,
a smaller power to maintain warmth, a less rapid growth, a smaller
muscular development, a feebler power, a hurry of breathing on exertion,
or in ascending a hill, or in going up a staircase, are all, except the
sounds which the educated ear detects of the blood passing through its
devious course, that tell of nature having, in this instance, ill done
her handiwork.

The one most natural question to which, in every instance, the doctor
has to reply is this: 'Will he or she outgrow it?' To this the answer
is, '_Yes_,' and '_No_.' In the worst cases the answer is obviously
_no_; and in none does _yes_ imply a recovery so complete as to leave no
trace behind, and to make the child heartwhole. But short of this, in
many instances much may be hoped for. There is, as I shall have occasion
again to repeat, a power in the growing heart to adapt itself in large
measure to conditions other than those of perfect health. The channels,
through which the blood ought not to flow, may shrink though they may
not entirely close; the valve may shut more completely than at first the
opening between the two sides of the heart; all inconveniences may
lessen, and the child may at last become scarcely aware of the
difference between himself and others. But for any such result, or for
anything approaching it to be attained, certain conditions are
absolutely essential which it is seldom easy to induce parents to
observe. Whatever can hurry the circulation is most carefully to be
avoided. The child must be kept strictly out of the way of
hooping-cough, measles, or any other fever; must be shielded from every
risk of catching cold, and having smaller power of maintaining its
warmth than others have, must be specially warmly clad, and must live in
rooms at a temperature of 60 deg. Fahr., all the year round. Great
attention must be paid to the state of the bowels, so that constipation
may not necessitate violent efforts to relieve them.

Moreover, for years the child must be carried upstairs; when old enough
to take part in games, it must not be allowed to join in any which call
for violent exertion, such as cricket, or lawn tennis, nor ride any
other than a quiet pony at a gentle pace.

It depends entirely on the parents whether, for the sake of a very great
but far-off good, they will strictly observe these rules. The difficulty
will not aris