Toxic Goitre

history of excessive perspiration three months previously, followed two weeks later by a "sweat rash." She became very fretful, refused her food, and did not sleep. There was marked photophobia. She was admitted to hospital, and kept on sedatives to procure sleep. She took her feeds better, but began to have a temperature; loose motions followed, and eventually she died of gastro-enteritis. In a few cases the body rash may become infected with staphylococci and give rise either to localized impetigo or furunculosis. The disease lasts from six to nine months, with the prospect of a slow but gradual improvement and complete recovery in those cases which are not fatal in the early stages. The treatment is most difficult. The anorexia requires careful nursing, and it requires a good mother or nurse to persuade the infant to take sufficient nourishment. Variety in the dietary is essential, and spoon-feeding or even the stomach tube may have to be resorted to. The insomnia is very intractable, and the common hypnotics may be ineffectual, but bromide, chloral, medinal, trional, and luminal should be tried. Recently the intraperitoneal injection of 10 c.c. of four per cent. sodium citrate has been advised, and I have found this to give valuable immediate but temporary relief, and so procure sleep. This may be repeated daily.. Light socks and gloves should be worn to protect the hands and feet from injury. The body should be covered with cellular linen or cotton garments, and then woollen clothing sufficient to keep the child warm without the use of bedclothes, which are always thrown to one side. The sides of the cot should be padded with pillows to allow the child to move as much as it wishes without the risk of injury. Vitamines have been recommended, on the assumption that the disease is a deficiency one, but for this there is no support. Braithwaite recommends filtering the rays from the violet end of the spectrum by means of ruby glass, in the belief that ultra-violet radiation actually aggravates the condition. A Sollux lamp with ruby glass inserted is a valuable means of administering infra-red rays, and in my experience has been beneficial in procuring sleep without drugs.