The masseuse has to do with paralysis, atrophy of muscles, and deformities that result from this disease, but it is interesting to know a little about the disease itself. The paralysis is caused by the destruction of the nerve cells in the anterior horns of the spinal cord, chiefly in the cervical and lumbar regions.

During dentition, or after influenza or chill, or over-fatigue, the child has a rise of temperature, is languid and fretful, and develops paralysis of one or more limbs. This first stage is sometimes so little out of the ordinary that it is scarcely noticed till it is seen that the child drags a leg (if it walks or crawls), or does not move an arm.

In a short time there is partial recovery of the limb or limbs.

After this atrophy of the paralyzed muscles sets in, and deformity results.

In the first stage there is inflammation of the anterior horns of the cervical and lumbar portions of the spinal cord, with effusion of blood.

In the second stage there is absorption of the blood and products of inflammation, and some repair of damage by the formation of new nerve-cells.

Lastly, there is permanent paralysis of muscles which are supplied by the nerve centre which has been destroyed. The bones also atrophy and become short.

Greenstick Fracture.—The principal movement is effleurage, the splints to be gently removed and carefully readjusted.

Separation of Epiphysis.—Massage is given after the parts are replaced. The treatment is the same as the foregoing.

Talipes (Club-Foot).—All movements for the foot and leg are given, and a continual moulding kept up, a gentle and gradual pulling of the foot into correct position. There are many varieties of club-foot, and the exercises given are those which are suitable to each individual case. The condition is due to contraction of certain muscles or tendons. In slight cases massage and exercises are relied on to bring about improvement. In severe cases they are given after operation.

In talipes calcaneus, the tendo-Achilles is too long ; there is contraction in the sole of the foot, and the toes do not come to the ground at the same time as the heel.

Treatment.—The muscles of the calf are well manipulated, and the foot is extended.

Talipes Equino-Varus.—The toes come to the ground, the heel is drawn up, and the foot is inverted.

Treatment.—The muscles on the front and outer aspect of the leg are especially worked up; the foot is flexed, abducted, and everted.

Talipes Equine Valgus.—The toes come to the ground, the heel is drawn up, and the foot is everted.

Treatment.—Muscles on the front and outer aspect of the leg to be especially worked, the foot to be adducted and inverted.

In each case all the foot movements are useful, especially friction with thumb over tarsal-bones and round ankle-joints.

In giving exercises when the foot is flexed, extended, etc., it is held for two or three minutes in position, then the exercise is repeated.

If a retentive apparatus is used it must be applied carefully after treatment, care being taken that it is properly strapped.

Intussusception.—The movements over the tumour are made in a backward and forward direction—that is, the kneading is done from right to left in the ordinary way, then from left to right, passing and repassing over the invaginated part ; one portion of the intestine has slipped over another. The idea of the double movement is to straighten out the bowel and push on the contents.

In spinal curvature, wry-neck and chorea, the treatment is the same as described in Chapters IX., X., and XII.

Delicacy of touch, cheerfulness of manner, and unbounded sympathy are essential qualifications in the masseuse who undertakes the treatment of the little ones.