ommon nervous affection known as chorea. We are
still ignorant of the precise nature of the infection which we know as
rheumatism. There is much to suggest that in rheumatism we have to
deal only with a further stage in those catarrhal infections to which
so much infantile ill-health is to be attributed, and that
endocarditis and arthritis, when they arise, signalise the entry of
these catarrhal, non-pyogenic organisms into the blood stream,
overcoming at last the barrier of lymphoid tissue which has
hypertrophied to oppose their passage. Certainly the connection of
rheumatism with catarrhal infections of the mucous membranes and
adenoid enlargements of all sorts is a close one. Whatever its
nature, the rheumatic infection in childhood is more lasting and
chronic than in adult life. Rheumatism in childhood is not manifested
by acute and short-lived attacks of great severity so much as by a
long-continued succession of symptoms of a subacute nature, a
transient arthritis, perhaps, succeeding an attack of sore throat with
torticollis, to be followed by carditis, to be followed again by
another attack of tonsillitis. And so the cycle of symptoms revolves.
In most cases the child grows thin and weak; in most cases he becomes
restless, irritable, and unhappy; often there is definite chorea. Of
this cerebral irritability chorea is the expression. In adults, chorea
is perhaps more obviously associated with mental stress of all sorts
and with states of excitement and agitation. In the case of little
children it is often only the mother who really appreciates how
radical an alteration the child's whole nature has undergone, and how
great the element of nervous overstrain has been before the chorea has
appeared.

Of the treatment of chorea there is no need to speak. It is purely
symptomatic. Isolation, best perhaps away from home, as might be
expected, gives the best results. If there are pronounced rheumatic
symptoms, the salicylates will be needed; if there is anaemia, arsenic
and iron; if there is sleeplessness and great restlessness, bromides
or chloral. Hypnotism is often almost instantly successful, but, apart
from hypnosis, curative suggestions proceeding from the attendants
form the principal means at our disposal.

(4) EXHAUSTION AND KATATONIA

A large number of children, in convalescence from infective disorders,
when the nutrition of the body has fallen to a low ebb, show as
evidence of cerebral exhaustion a grou