usually less even than in the adult. The swelling of the
joints in particular is less considerable, and both the pain and the
swelling are apt to wander from one to another joint, or to a different
limb, instead of remaining fixed as they do in the grown person for
several days in the same joint, even though fresh joints may be
implicated in the course of the disease.

These circumstances tend to make people look on rheumatic fever in the
child too often as a comparatively trivial ailment; and this not only
because the suffering which attends the disease is slighter, but because
its duration is also shorter. But there is one fact which forbids this
low estimate of its importance, and that is the great tendency to
affection of the heart even in cases of comparatively mild rheumatism in
the child; while in the grown person there is a direct relation between
the general severity of the rheumatic symptoms and the liability of the
heart to be involved. I have already stated that nine out of ten of all
cases of heart disease in early life, not due to original malformation,
are of rheumatic origin, and further that heart disease comes on in the
course of four out of five cases of rheumatic fever in the child, slight
as well as severe. It seldom occurs before the third or fourth day of
the illness, so that if parents take the alarm at the very outset, it is
usually though not invariably possible for the doctor by judicious
treatment to anticipate and to prevent its occurrence, or at any rate
greatly to control its progress.

Every threatening of rheumatism, therefore, is to be watched with the
most anxious care, since so serious a complication as disease of the
heart may accompany extremely slight general symptoms. It is wise too,
to place any child in whom general feverish symptoms come on at once
under medical observation, for though it does not usually happen, yet it
does sometimes occur, that rheumatic inflammation attacks the heart
before any other local signs of the malady have manifested themselves.
It is scarcely necessary to add that tenfold precautions are needed when
rheumatism has once occurred, since the liability to its return is very
great, and the heart which escaped in the first attack may suffer in the
second; or the comparatively small mischief done the first time may
become an incurable disorder.

=Ague.=--_Intermittent fever_ or _ague_ is very rare in childhood in
London; or at any rate it is very rare am