nights, and frequent changes to wet and cold. And even the indigestion which has been so generally suggested as a cause of "summer complaint" is itself the result of the impairment of natural gastric and intestinal secretions and the increase of mere serous exudation; the primary fault not being so much in the quality and quantity of the food, as in the morbidly sensitive and relaxed condition of the whole inner surface of the digestive canal. The reasons why the children under two years are affected so much more severely than older persons, are, the less mature development and greater sensitiveness of their gastric and intestinal mucous membranes and glandular structures, and their much more constant confinement indoors.

If the foregoing views are correct, they indicate clearly that our efforts to lessen infant mortality from serous diarrhoea and cholera morbus must embrace such measures as will secure for young children a better supply of fresh, pure air, for increasing the oxygenation and decarbonization of the blood, and maintaining the activity of the vaso-motor nervous system, and as will counteract the effects of high temperature by increasing the general tonicity and lessening the excitability of the tissues generally. Measures for the first object must consist in securing better ventilation of dwellings, and especially of nurseries and sleeping-rooms during the warmest part of the summer; the sending of young children, with their mothers and nurses, from cities and densely populated districts, to moderately elevated healthy locations, or to floating hospitals or receiving ships on large bodies of water during the special periods of continuous high temperature. For accomplishing the second purpose, I know of no measures that are so efficient, and, at the same time, within the reach of the poorest part of the population, as the judicious use of the sponge bath. Whenever the human system is relaxed, and rendered morbidly sensitive by continuous high heat, causing the infant to be languid, restless, and sometimes pale, a free, bathing or sponging of the whole surface with water simply, as cool as is comfortable, always produces a refreshing and invigorating influence, which continues from six to twelve hours. Consequently, if mothers and nurses could be so instructed by their family physician that during every wave or period of high atmospheric temperature, in which the mercury did not fall below 70° F. during the nights, they regularly gave each child under two years of age

a full sponge bath in the evening as well as in the morning, and kept their sleeping-rooms as well ventilated as possible, it would diminish the number of attacks of serous diarrhoea and cholera infantum one-half, and consequently very greatly lessen the infant mortality from these affections.

It is well known to every careful observer, that a large majority of all the attacks of this form of disease show their first beginning during the last half of the night or early in the morning, owing to the long continuance of the high temperature, coupled with the more still and confined air of the night. The increased tone of the whole vascular system produced by the stimulant and tonic effect of a comfortably cool sponge bath on the function of the vaso-motor nerves, applied in the evening, would enable thousands of these little, restless sufferers to pass the whole night unharmed, when without it the dreaded sickness would begin. The views I have presented in regard to the causes and nature of the affections called " summer complaint," and cholera infantum, also offered clear indications for the most rational and successful application of remedial agents in the treatment of those affections in all their grades of activity. But my time will not allow me to pursue the subject farther at this time.

SOME OBSERVATIONS MADE DURING THE

TREATMENT OF RICKETS.

BY WILLIAM LEE, M.D.,

MARYLAND.

Believing that some careful observations made while treating six cases of rickets, seen from its earliest symptoms, would be interesting to this Association, I venture to submit them to you in this short but I hope not uninteresting paper.

Indeed, when I bear in mind how almost singularly deficient the medical literature of our country has been on this subject, since the years of 1870 and 1872, notwithstanding the able articles published during those years by Dr. Jacobi, of New York, and our late gifted and highly esteemed friend John S. Parry, of Philadelphia,* I feel as if it was my duty to impress upon you the importance, not only of our recognizing this disease in its early stage, but to appreciate the fact, for it is a fact, that many, nay, the majority, in my opinion, of deformities in the young, have their origin from this disease.

Whilst writing thus far, I received Meigs' and Pepper's last edition of their very interesting work on diseases of children, and am glad to see that they admit rickets to be not so rare as was formerly supposed, and in this connection use the following language: "Of late years the attention of observers in this country has been more forcibly attracted to this subject."

Rickets seems to be at first a general disease, associated with which is a special form of debility, the bone lesions being but a part, and not always very prominent, so that he who looks only for the latter signs of the disease will often fail to recognize some of the most severe cases. Then again I fear many do not fully discriminate between this disease and mollities ossium.

* American Journal Medical Science, January and April, 1872.

VOL. XXXIII.-29.

In rickets a defective assimilation arises in an infant, and produces failure in the process of ossification, which, if our patient survives, is rectified, for re-ossification or hardening of the bones is certain to take place. Now, on the other hand, whilst in mollities ossium we have a similar ailment arising in the adult up to a certain point, the bones not only never re-ossify, but become, later on in the disease, brittle.

These six cases, three of American and three of foreign parents, were seen by me during the first stage of the disease— such as profuse perspiration of the head and upper part of the chest, a desire and effort to be cool, particularly at night, with loss of energy and unwillingness to be moved about,—complaining of pain when circumstances required it. For a detailed description of the many symptoms seen during the progress of rickets, I must refer my friends to the valuable articles which have been written by Sir William Jenner, Aitken, and others, it being my purpose only to make observations on what seemed of most interest during a study of the disease at the bedside.

Age and History.-It is said that the second year is that period of life when rickets becomes most frequent, on account of the abrupt changes at that time in the child's diet. My cases first began to show signs of this disease at the following ages: two before nine, three at sixteen months, and one at two years of age.

Four had been artificially fed, had bad hygienic surroundings and constitutional predispositions; two had been nourished in part by their mothers, and had good surroundings.

No syphilitic history or evidence of the same could, after very careful examination, be detected. This was made a very important matter with me, as much has been written of late with an effort to show a connection between rickets and syphilis.

Upon this subject Sir William Jenner says he does not believe that syphilis produces the condition seen in rickets, and sustains such a statement by arguing thus: "If a person is syphilitic the first child often escapes that disease from the continuance of the influence of antisyphilitic remedies in the parents; but still it is the early children who suffer syphilis, while in rickets, on the contrary, it is the later ones that suffer; and, among poor people, if one child has rickets all the later ones are rickety."