PIGMENTATION-A RARE DISEASE AMONG INFANTS.

By M. B. WRIGHT, M.D.

EARLY in 1873, several deaths occurred among the infants born in the Cincinnati Hospital. They sickened and died soon after birth, and from the discoloration of the face, the only prominent symptom, it seemed to justify the inference that there was imperfect lung structure, and deficient oxygenation of the blood. The cases. increasing, and other symptoms unusual in character appearing, a demand came pressing for more critical examinations. They were carefully made, and the results, with an outline history of the symptoms of each case, are as follows.

Case 1.-Infant (male) of Emma R., born January 5, 1874.

Jan. 15. At times during the last few days respiration has been irregular. Now the surface has a dusky hue. There is languor, with disinclination to nurse. Occasionally, there is twitching of the hands. The eyes are turned upwards-the feces are dark, and the urine leaves a coffee-ground stain on the diapers.

17th. With a dusky, there is a slight yellow tinge of surface. The tunics of the eye present a greenish hue.

20th. The skin is more natural, and there is a manifest desire for the breast.

30th. Is feeble, but the general condition indicates convalescence. Taken from the hospital.

A month later, the little one was reported to be in a tolerably healthy condition.

Case 2.-Infant (female) of Eliza W., born January 30, 1874.

Feb. 13. Has been losing flesh, seemingly from deficient nourishment. Scattered over the mouth is a curdy exudation. The skin has a dark yellow color-there is some cough, and drowsiness is constant. Urine dark brown, and intestinal discharges resemble meconium.

18th. Bowels inactive, and vitality feeble. Died on 19th at 12 M. Autopsy. Lower lobes of both lungs imperfectly dilated-readily

filled with blowpipe-foramen ovale pervious. Pelves of kidneys full of a dark substance, the consistence of clay.

Case 3.-Infant (female) of Martha M., born February 3, 1874. Feb. 16. Is deeply jaundiced-nurses poorly-is very feeble. 18th. Died at 3 P. M.

Autopsy. All the tissues normal.

Case 4.-Infant (male) of Sarah H., born February 5, 1874. 22d. Is small and feeble-has cough and coryza. Color of skin dark yellow.

23d. Discoloration increased.

27th. Urine and feces dark. Has been sinking slowly, and died to-day.

Autopsy. Lungs healthy-right auricle contains a light-colored, firm clot. Pelves of kidneys filled with a dark-colored and firmly moulded substance. Over the right parietal bone is a considerable swelling (cephalæmatomia) 2 in. by 3 in. in size, filled with a muddy-like fluid. This fluid was beneath the pericranium. The outer table of bone to the extent of the tumor was absent. A bony ridge, seemingly elevated, encircled the excavation, and defined the boundary of the imperfect bone structure.

Case 5.-Infant (female) of Mary D., born February 8, 1874. The entire surface of the body presented a bluish tinge. The child was feeble, and died on the fourth day.

Autopsy-Lungs not expanded, sink in water, and are dark

colored.

Case 6.-Infant of Mary C., born February 16, 1874.

25th. The mouth has been aphthous for a few days, and to-day there has been vomiting. The skin is dark yellow, also the eyes. Urine darkens the napkins like strong coffee; feces greenish. 26th. Died at noon.

Autopsy. Lungs healthy;

heart filled with tough coagula; foramen ovale open and large. Pelves of kidneys filled with slatecolored, thick substance.

Case 7.-L. S. was delivered of a male child October 15, 1874. It was well developed, and there was no evidence of unnatural function, except in the feeble cry. In three or four days, a curdy exudation was scattered over the mouth.

26th. The surface generally has a dull waxen appearance, with a dusky hue about the mouth and forehead.

29th. The latter is deeper and more diffused. Intestinal discharges dark green; urine natural in color and quantity; vomits

occasionally; hands and feet cold. Evening visit. Has been passing urine chocolate color. Temperature 95.

31st. Urine scanty; muscles of the neck rigid; head drawn backwards. Died at 5 A. M., November 1.

Autopsy. No organic disease; the kidneys were filled with a black granular substance. The testicles had not entered the scrotum. Case 8.-Infant of S. S., born March 5, 1875.

25th. Is feeble; refuses the nipple; screams often as if in pain, especially when moved; over the sacrum and on the left wrist, it is swollen, red, and tender.

26th. There is febrile action; pulse 150 to 160; breathing frequent, some cough; temperature 1041.

27th. Has had slight spasms. Pulse, temperature, and respiration increased. Tumefaction over sacrum more prominent and fluctuating. Increased redness and swelling of wrist. Swelling and redness have appeared over the left internal malleolus.

28th. The right internal malleolus and right olecranon are swollen. The skin is dull yellow, and the stools are curdy. 29th. Is in strong convulsions. A rose rash covers the body; breathing alternately slow and rapid; eyes injected. Died at 11

A. M.

Autopsy. Portions of right lung are in a state of atelectasis, but are easily dilated. Foramen ovale closed. Kidneys, with other abdominal organs, healthy. All the swellings contained pus.

This case, as well as 3 and 5, is not an instance of decided pigmentation, but the probabilities are that it was produced by the same local poison.

Case 9.-Infant (male) of Mary F., born April 5, 1875. Well developed, and to appearance healthy. Nursed well from the bottle, and continued in good condition until the 12th. Then the skin became dull yellow, and the eyes greenish. In a few hours. the skin became dusky, the hands, feet, and lips quite dark. In the right axilla is a hard and large ecchymosed spot. Intestinal discharges curdy and green.

13th. Urine coffee color, and containing a dark substance easily collected on napkins. The urine has just been discharged, and, in the end of the urethra, is a mass of black, clay-like substance.

14th. External appearances the same; urine discharged with large quantities of dark sediment.

15th. Skin not so dark; urine as yesterday; feeds well; heat 981. 16th. Vomits a green mixture; skin lighter; urine the same.

17th. Still vomiting; general conditions same.

18th. The skin has the dull grayish color of death.

19th. Skin a more natural appearance, and at an early visit, symptoms seemed better. Died at 11 A. M.

Autopsy. Body much wasted. Heart and lungs normal.

small quantity of yellowish, slightly turbid fluid was found in the abdominal cavity. There were soft adhesions at different points between peritoneal surfaces. Connective tissue about kidneys infiltrated. Kidneys soft and dark; apices of pyramids black; black substance easily pressed out of tubes. Liver normal; spleen very dark.

Case 10.-Infant (male) of M. D., born April 6, 1875.

17th. Dark surface; eyes yellow-green. Temperature 100. From this date to 20th the skin, urine, and feces presented appearances thoroughly characteristic.

20th. Skin paler; and black deposit absent from the urine. Takes its food readily, but has difficulty in swallowing.

21st. Symptoms less prominent, and, as a whole, indicate continued improvement. Notwithstanding the prognosis was favorable, death occurred at 10 A. M.

On post-mortem examination all the organs were found healthy except the kidneys, which contained the usual black substance. Case 11.-Infant (male) of E. R., born April 24, 1875.

May 2. Had a yellowish tinge from birth. It is becoming dingy; surface cool; feces and urine dark, the latter without pigment deposit; temperature of mouth 98. Later in the day, urine had a black deposit; temperature slightly increased. Died at 7 P. M. Usual symptoms, except aphthæ; lasting only twelve hours.

Autopsy. The body of this infant was submitted for inspection to the Obstetrical Section of the American Association. After opening the abdominal cavity, the intestines and kidneys were the only viscera examined. The former were dark, and the tubes of the latter were filled with pigment. No loose substance was found in the pelves.

Case 12.-Infant (male) of M. R., born April 19, 1875.

May 4. Whole surface jaundiced; eyes green; restless during night; aphtha. Urine black with deposit; feces dark green; temperature 983 5 P. M. Dark color increasing; exhaustion great; died at 11 P. M.

Autopsy. Kidneys filled with dark substance.

Case 13.-M. C. was delivered of a female child, April 24, 1875. May 10. The face of the child has a dirty-yellow appearance;

dark around the mouth; curdy exudation on the tongue, lips, and cheeks; pupils sluggish; nurses tolerably well.

11th. Stools dark green; urine normal in quantity, but dark. 13th. Face more dusky; eyes greenish; semi-comatose; dark deposit in urine. Temperature 981.

17th. Condition about the same; still nurses.

18th. Surface dull white; is restless and constantly moaning. 19th. Died this morning.

Autopsy. Well nourished and fat. Lungs unusually pale; heart normal; right ventricle contained a whitish clot, which extended into the pulmonary artery; the left auricle contained a firm clot; right auricle pervious; intestines unusually white; liver and spleen normal. The pelves of the kidneys contained a brown. consistent substance; the pyramids were of dark slate color; on section, the dark substance followed the direction of the tubes and radiated towards the periphery. The cortical substance of the kidney was lighter colored than usual, and seemed fatty. Brain healthy; the sinuses at the base contained clots, partly white, partly colored.

Statement of Dr. Dandridge, Pathologist.

Post-mortem Examination of Infants with Brown Skin and Peculiar Deposit in the Kidneys.-The description here given of the autopsies held on these children, is the result obtained from a number of examinations, the constant and characteristic lesion in all cases being the peculiar deposit in the kidneys.

The bodies appeared badly nourished, and the integuments were of a dark dusky hue, this disappearing somewhat if the examination was made long after death.

In one case there were pyæmic abscesses in the neighborhood of several joints-both ankles and one elbow-these abscesses, however, did not seem to be connected with the cavity of the joints. The lungs were generally perfectly normal, and they could be easily and completely inflated.

Heart normal.

The peritoneum, both on the intestines and parietes, had lost its normal glistening appearance, and was of a dusky hue.

The intestines were empty, and they presented nothing abnormal.

Liver and spleen normal.

Kidneys slightly increased in size; the surface appeared perfectly normal. The pelvis was filled with a substance resembling