f the child and raising its resistance against
infection. A sufficiency of fresh air and of sunlight, and a
management which encourages independence of action in the child, are
both necessary. The diet is of the first importance. It should be
sufficient, and no more than sufficient, to cover the physiological
needs of the child for food. The majority of these children have
enormous appetites, and excess of food, and especially of carbohydrate
food, plays some part in the production of the disturbance. We must
guard against overfeeding, against want of air and want of exercise,
and against those errors of management described in previous chapters,
which produce the maximum of disturbance in this type of child.

(2) A GROUP WITH MUSCULAR ATROPHY, LORDOSIS, AND POSTURAL ALBUMINURIA

At an older age, in children from the fifth year onwards, a second
type of physical defect associated with pronounced nervous disturbance
presents itself with some frequency. The body is thin and badly
nourished, and the muscular system especially poorly developed and
very lax in tone. The most striking feature is the extreme lordosis,
accompanied usually by a secondary and compensatory curve in the
cervico-dorsal region, so that the shoulders are rounded, with the
head poked forward. Viewed from in front the abdomen is seen to be
prominent, overhanging the symphysis pubis, while the shoulders have
receded far backwards. The scapulae have been dragged apart, as though
by the weight of the dependent arms, with eversion of their vertebral
borders and lowering of the points of the shoulders. The position
which they adopt is that into which the body falls when it ceases to
be braced by strong muscular support. The muscular system is here so
weakly developed and so toneless that the posture is determined by the
bony structure and its ligamentous attachments.

The lordosis resembles the similar deformity which develops in cases
of primary myopathy, when the spinal muscles have undergone complete
atrophy. As in myopathy the movements are very uncertain. The
children are apt to fall heavily when the centre of gravity is
suddenly displaced, because their upright posture is maintained by
balancing the trunk upon the support of the pelvis. The frequency and
severity of the falls which these children suffer is a common
complaint of the mother. The faulty posture is often associated with
slight albuminuria. Its appearance is very capricious, but it is