good color. First child alive, healthy, two years of age, both nursed two to three weeks, then put on to condensed milk. No teeth, but both were backwards, no mouth symptoms, no rise of temperature. Mother had noticed that the child was peevish and fretful, without much appetite, and showed a disinclination to be handled before the fall, but much more so after. I told her that I thought that some other cause would account for the trouble rather than the fall, and suggested changing the food, but the mother informed me that the first child had done well enough on the same food, and insisted that there was some trouble in the joint. I then asked Dr. Cook to see the case with me, who, after his usual careful and thorough examination, informed the mother that there was no trouble in the joint. On the way down to the station, Dr. Cook characteristically remarked, "if you will put that child on to diluted milk, and give it the juice of one orange every day, the Lord will do the rest, and the child will be well in a short time." He was a good prophet.

The second and most severe case I have to report has the following history: Female child sixteen months old. Had been failing for some time, no particular cause as far as the mother knew. The child then became peevish and fretful, perspired freely about the head, sleep broken, and appetite gone. Cried every time she was moved and refused to move the legs or attempt to walk; as the mother explained it she was too weak. The child, so it is claimed, weighed eleven and three quarter pounds at birth, but at four months had only gained one pound and a quarter. Nursed one week, then all the different proprietary foods were tried, until condensed milk, which seemed to agree with her better than anything else, and this had been her diet for a year. The family history was negative and the surroundings good. The child seemed to have no trouble until a month or six weeks before I was called, and then the parents did not think much of

it, laying the condition to its being housed up during the winter. The physical examination of the child showed it to be a typical case of well-advanced Scurvy, with the swellings of the ankle and thigh; also one, which was new to me, which was on the bottom of the foot, under the heel, the same fusiform, tense, non-fluctuating swelling, without redness or pain or palpation. Pain on movement of the legs, and the pseudo-paralysis were well marked, and the legs were also thin and flabby. The mouth showed the scorbutic stomatitis, with sordes on the lips, which bled easily, and the breath was very offensive. There had been "pistaxis, and the urine showed some blood-corpuscles, a trace of albumin, mucus, uric acid, etc. Fever occurred at irregular intervals. The child was very pale and anemic, with a very decided cachectic appearance.

Placed on milk, orange-juice, potatoe with gravy, and iron, she made a very prompt and satisfactory recovery.

ACUTE NEPHRITIS IN INFANCY.

WALTER G. MURPHY, M.D.,

EAST HARTFORD,

At one time Nephritis was considered a very rare discase in infancy. To-day, with the more careful attention given to the study of children's diseases, many cases are reported which formerly were not recognized. Nephritis is not, however, an everyday occurrence in practice, and its course, when present, is entirely different from the disease as commonly observed in older children and adults. The diagnosis is often very difficult, particularly in the early stages, and unless carefully sought for the disease is not easily recognized.

Holt says the onset is generally abrupt, with high fever and vomiting; dropsy is exceptional early in the disease but present towards the close; anemia is a prominent and valuable symptom. At times there is dyspnea, without pulmonary disease. Nervous symptoms are common; dullness and apathy are usual, convulsions rare. The urine is not often scanty until the close and sometimes not then; suppression of urine is not common. Albumen is frequently absent early in the attack but invariably present at a later period, rarely in large amounts. Casts can be found, by centrifuge, and are of the hyaline, granular and epithelial varieties; bloodcasts rare. Pus cells, renal epithelial cells and red blood-cells are found.

Considering the difficulty in diagnosis, the liability to confuse this disease with other conditions, and the rela tive infrequency of nephritis in little children, the writer hopes the Society will be interested in the report of two cases he has recently encountered.

Case 1. D. B., female, age seven months.

Family history negative, except mother who suffered from acute nephritis of pregnancy with the premature birth of the baby as a result; otherwise there is no disease or tendency on either side.

Personal history: Born January eighth, 1903; weight at birth, six pounds. She was fed artificially on a milk and cream mixture. Initial loss in weight, one pound, after which she gained steadily until the third month when her weight was seven pounds one ounce. At three months her diet was increased and she was given, in addition to her milk mixture, one-half teaspoonful of fresh beef-juice twice daily. At three and a half months there was a sharp attack of indigestion lasting three or four days. Bowels generally in good condition, at times constipation alternating with diarrhea. After the third month she gained slowly, sometimes only a quarter of a pound a week, other weeks not any. At five months food increased in quantity and strength and beef-juice was given, one teaspoonful three times daily, and then every other feeding. Was anemic, and attacks of indigestion, with vomiting and diarrhea, were more frequent. At such times barley-water was substituted for the milk. Weight at five months nine and one-eighth pounds. Appetite capricious and she did not sleep well at night; suffered frequently from colic, the movements often contained curd, were green in color and generally offensive; vomited easily. Weight at seven months ten and onehalf pounds, a total gain of only four and one-half pounds since birth. At this time she was taking milk diluted one-half, in combination with a prepared food with beefjuice. Seemed in fair condition up to August second when she had a sharp attack of gastro-enteritis with vomiting, diarrhea and fever. I saw her for the first time August fifth.

General examination: Anemia marked; temperature 104° per rectum; cried very little; listless and rather

stupid in facial expression and attitude; muscles relaxed; abdomen distended. The most noticeable symptom was a general anasarca which pitted deeply upon pressure and involved principally the face, neck and extremities. This was first noticed as a slight puffiness about the eyes three days before I saw her.

Physical examination: Fontanelles open and not depressed, head rather large with craniotabes; no teeth; tongue coated, lips and mucous membrane of the mouth red and dry. Throat normal; eyes partly closed, pupils normal in size and reaction; facial expression dull. No superficial glandular enlargement; well marked rosary. Lungs negative except over lower posterior portion there were a few coarse râles, bronchial in character; respiratory sounds not increased. Heart area normal, no valvular disease evident, second sound apparently accentuated. Stomach area enlarged; intestines considerably distended with gas. Liver dullness normal. Spleen apparently enlarged. Respirations rapid and somewhat labored, pulse rapid but regular with some increased tension. No muscular twitchings. General attitude sug gested meningitis. Koenig's sign and Babinski's sign absent. Quantity of urine normal. Diarrhea; movements greenish, containing curd and odor markedly foul --much more so than usual in these cases. Vomiting occasionally, mucus and some curdled milk. Examination of urine showed albumen one-third by volume, acid in reaction, no sugar, a well-marked reaction of diacetic acid. After precipitation by centrifuge, microscopical examination showed granular and hyaline casts with renal epithelium.

No blood examination made.

Diagnosis acute nephritis.

Treatment: All milk was stopped and no food given; boiled water only for ten hours and then barley-water. A high rectal enema of salt and water was given and the