This is apparently a purely dietetic disorder occurring during the first two years of life, and most frequently during the middle and latter part of the first year. The etiology is not as yet wholly clear, but the following factors seem most important:

(1) A dead food, such as condensed milk, malted milk, boiled or pasteurized milk given for a long time.

(2) A predisposition on the part of the child that may be inherited.

(3) A food lacking in proper proportions of food elements, perhaps too little protein.

Environment plays no part. The essential lesions are in the blood and blood-vessels, causing hemorrhages under the periosteum, especially near the ends of the long bones, tibia, femur, etc., from the gums, and more rarely from the bladder, in the orbit of the eye, and in other places. We have, then, extremely painful swellings over the bones and purple and spongy, bleeding gums about the teeth. Often the only evident symptom is tenderness about the knee or ankle, so that the child screams when it is moved, and even when approached. This alone is usually diagnostic in an infant.

Treatment

The treatment is purely dietetic and most gratifying. Raw milk is substituted for its former food, or, if necessary, pasteurized or very slightly boiled milk, and orange or other fruit juices given freely from one to four ounces a day. Human milk is highly antiscorbutic, and so always acts favorably. If the child has developed it on the breast alone, that breast is no longer to be used without other food.