lowing the use of arsenic for chorea. Inasmuch as probably not more than five cases of this condition have been published during the last few years, the fact that two of them have been reported at our meetings is a matter of interest.

The discussions upon the papers contributed have, for the most part, been lively and interesting. There has scarcely been an article read or case reported which has not awakened some discussion. This is an important matter, since free discussion is both pleasing to the reader of the paper, and generally instructive to the listeners.

With the attendance upon our meetings we have every reason to be gratified. The largest recorded attendance, except upon the night of organization, has been 73; the smallest, 24; the av erage, 50. The actual attendance has, however, been decidedly larger than this, owing to the presence of visitors, and especially owing to the fact that many members neglect the recording of their names as they enter the room. I would urge that this signing of the names be not neglected, as without it the secretary can have no accurate record of those present.

Finally, as to our plans for the future, and our prospects. We have already several papers promised for coming meetings. I am glad to be able to announce also that Professor Osler has promised me to come to us early in the year and to read us a paper. Everything, in fact, is pointing toward a long period of interesting, useful work. The Philadelphia Pediatric Society is an assured It has passed long since the stage of experiment. Nev ertheless, there is reason to remember that we are still in the “new broom" stage, and that, while suffering ourselves to join in selfas we have been doing, we must not presume too

success.

congratulation,

much upon our strength. A considerable number of our initial members are likely, in the natural course of things, to drop away Others, who attended frequently at first, will cease to There is always danger that the initial enthusiasm may I would like to impress upon you, as I tried to do at the

from us.

do so.

wane.

beginning of my presidency, that this is the individual society of

each one of us.

We owe to it the duty of our support, both by Our scientific contributions and by our faithful attendance. Without both of these the organization cannot accomplish the good which is to be expected of it, and of which it has given such prom

ise.

Without a good audience, good papers must not be looked

for. Without intelligent discussion of papers there is no stimu lus for members to present them. Without an abundance of interesting scientific material presented, a good audience cannot be gathered together. I would like to see every member on the qui vive in his or her search for cases and contributions which may prove of interest. There is no necessity that the paper be long. In fact, to have many such is not to be desired; and their length should be restricted by legislation by the society. But our programme has always had a distinct portion set apart for the presen tation of cases with only verbal remarks, it may be; and for the brief, even verbal, reports of cases, although they be not exhibited.

Again, this society was not intended to be one in which only specialists take part. There should be continued, as in the year past, the freedom which every one of us, I hope, feels of joining in the scientific proceedings. This should be preeminently the society for the young practitioner, for it is upon the interest and enthusiasm of the younger members that its ultimate success will depend.

Neither has it been the policy of the society to limit its proceedings to the study of medical pediatrics only; anything bearing upon the diseases of children in any branch-surgical, medical, or in the special departments, has a place.

Of myself, I hope you will let me say that the evident success which you have made of this organization has made my term as its first president a great pleasure to me. To see it prosper has lain nearer to my heart than almost anything else during the past year. I feel sure that you know this, and that this has made you show me such uniform courtesy, and such tolerance of my presidential faults, of many of which I am well conscious.

DR. E. E. GRAHAM exhibited an ABDOMINAL TUMOR IN A CHILD OF THREE YEARS.

DISCUSSION.

DR. F. A. PACKARD.-It seems to me that this tumor is rather too superficial and too much to the left side for a retro-peritoneal tumor. There is also no swelling of the feet, although of course this sign is not necessarily present in that condition, as it depends upon the chief direction of growth. It seems to me on superficial

!

examination that there are two notches to be quite plainly made out on the inner edge of the mass. Of course that does not absolutely prove its splenic origin; but to my mind it is a quite valuable sign in differential diagnosis.

DR. ALFRED STENGEL.-In feeling this mass it struck me that the edge of the organ or tumor is very sharp, and I felt almost tempted to think that it is the spleen on that account. At the same time the case that Dr. Hamill refers to and one other case of a tumor involving the liver, were so deceptive in this very respect that I know that caution is very wise. The growth of nodules on the surface of the organ in Dr. Hamill's case and the similar growth of nodules in other cases I have seen, was such that one could readily get the feeling of a sharp edge and a notch. The greater degree of frequency of sarcoma of the kidney as compared with sarcoma of the spleen of this size is a point which substantiates Dr. Graham's diagnosis of sarcoma of kidney, and in addition to points referred to in his clinical notes, the presence of blood in the urine is a point of some importance. While blood may occur in the urine in marked anæmic conditions, according to the blood examination made a week ago this child is not very anæmic in the sense of having great reduction of the number of red corpuscles and it would be most unusual to find blood in urine from that alone. Of course, there is another factor to be thought of: pressure upon the renal vein and escape of blood in consequence.

DR. S. M. HAMILL.-Dr. Stengel's remark recalls a case of mine which he saw, and in which, as he has just said, he felt a distinct notch. From this and other reasons he concluded that the case was one of enlarged spleen. In fact there were a number of different diagnoses made in this case, but that of sarcoma of the kidney was never made. The case was thought to be possibly one of sarcoma of the retro-peritoneal glands. This diagnosis was reached because it was thought that there were two masses, the one occupying the left lower quadrant and extending into the right lower quadrant, the other being in the upper left quadrant. Between these masses there was a broad area of tympany, and it was in this area that the very distinct notch was felt, which led to a diagnosis of enlargement of the spleen. The presence of this area of tympany, and what seemed to be a very evident separation of the two masses, led to the exclusion of sarcoma of the kidney. When the case came to autopsy, it was found

that the descending colon crossed the hilus of the kidney, extending from the umbilical region in the direction of the anterior su perior spine of the ilium, and this descending colon was what had given rise to the area of tympany and led to all the errors in diagnosis. The kidney shape was perfectly retained.

DR. E. E. GRAHAM.-I think the rapid growth of this tumor is an argument in favor of its being sarcoma of the kidney, and the fact that there is no history of syphilis would, perhaps, be somewhat against it being an enlarged spleen. The fact that the blood changes are not sufficient in themselves to give rise to the effect, and the absence of corresponding enlargement of the liver, are, perhaps, rather against this being splenic. Yet, after all these points have been gone over, there remains always in the mind of every one, a question whether or not it might be spleen. To my mind, however, everything points to the diagnosis of sarcoma of the kidney.

DR. ALFRED STENGEL read a paper upon PSEUDO-LEUKEMIA IN

FANTUM.

DISCUSSION.

DR. ALFRED HAND.-Dr. Stengel has taught us a good deal about this subject in his paper, so that there is very little left for us to say. The point that he made about the ease with which children reacted to the different causes of leukocytosis I think is borne out by many of the other clinical features of disease in children, not only in the onset of the symptoms of disease, but also in their frequently rapid recovery, especially in those diseases which affect the blood. I remember one instance of profound anæmia in a child, following intestinal hemorrhage. Two hemorrhages occurred, and the hæmoglobin sank to 48 per cent, but within a few weeks the blood had returned almost to normal.

DR. W. REYNOLDS WILSON.-I think it is interesting to note what might be called the want of balance in the blood of early life. I have been much interested in studying the blood of the newborn, which presents a characteristic of white cells. The excessive hæmoglobin, the poikilocytosis and the usual presence of great numbers of nucleated red cells are also very important differences from adult blood and show probably a want of balance in the blood of early life, which perhaps lasts over into the period in which this disease may develop.

Dr. Griffith asked Dr. Stengel to give his views on the subject of splenic anæmia.

DR. STENGEL.--I do not think there is any definite disease, splenic anæmia. I do not present this as a specimen of the blood of infantile pseudo-leukemia or even as corresponding to von Jaksch's description of that. I merely show it to illustrate the condition of the leukocytes in the leukocytosis of infancy. The very marked differences between leukocytosis of infantile blood and the leukocytosis of adult blood is the thing which has impressed me; given a case with marked anæmia, splenic enlargement and leukocytosis, I would say that the blood should take on characteristics von Jaksch has described.

In regard to splenic anæmia I have not the slightest idea how you would classify such a disease. I know many cases which have been described as splenic anæmia have been secondary anæmia with enlargement of the spleen; some are syphilitic, others Hodgkin's disease, but no one has proved that there is a definite disease, splenic anæmia.

DR. W. REYNOLDS WILSON read a paper upon POST-MORTEM LESIONS FOUND IN TWO INSTANCES OF DEATH IN THE NEW-BORN; ONE DUE TO ASPHYXIA, THE OTHER TO MAL-NUTRITION IN A PREMATURE INFANT. See page 456.

D. L. Edsall, Recorder,

330 South Sixteenth Street, Philadelphia, Pa.