DR. A. E. NAISH'S PAPER 321 



before in its life. If this amelioration of symptoms 

 were purchased at the expense of the child's 

 ultimate good nutrition, a great mistake would be 

 made. It thus behoves the medical man to proceed 

 with great caution until he is sure that it has no 

 tendency to produce rickets or scurvy. Taking 

 rickets first, since it is possible in some cases to 

 cure the disease by a change on to a dried milk 

 diet, it is obvious that in these cases the necessary 

 nutritional elements are capable of absorption and 

 assimilation. This, however, is not proof that in 

 other cases rickets may not develop or even be a 

 fairly common consequence of taking this food, for 

 there is great variability in infantile powers of 

 absorption and assimilation. The point can only be 

 settled by direct observation, and here it is that the 

 observer must be sure that he has a clear mental 

 picture of what is known as rickets. Bony defor- 

 mities, though striking in appearance, are among the 

 less important signs of the disease, since the earlier 

 and more severe cases show comparatively little out- 

 ward bony deformity. Unfortunately most of the 

 other signs are not so capable of accurate registration. 

 The time, however, when independent walking is first 

 accomplished can be registered exactly, and I regard 

 this as excellent evidence of the presence or absence 

 of early rickets, since this disease profoundly affects 

 the tone of the muscles and prevents the infant 

 standing or walking till long after the normal time. 

 I have followed up considerable numbers of those 

 fed on dried milk, and noted the time at which 

 independent walking commences ; this I have found 

 to be usually within fourteen months, except where 

 the infant has been very far from the normal at the 

 time of its first attendance or has suffered subse- 

 quently from measles, whooping cough or other bac- 

 terial infection ; in not a few cases the child has 

 walked before the end of the first year, and in 



