dependent to a great extent upon the assumption of the erect posture.
There has been much discussion as to its explanation. It has been
argued that the lordosis itself produces the albuminuria by mechanical
compression of the renal vein, and it is said that albuminuria can be
produced, even in the prone position, by placing the child in a
plaster jacket applied so as to maintain the position of lordosis.
Other observers, however, have not obtained this result. It seems most
likely that the albuminuria is due to defective tone in the vasomotor
musculature, comparable in every way to the defective tone in the
muscles of the skeleton. We have often further evidence of vasomotor
weakness. Fainting attacks are so common as to be the rule rather than
the exception. Again, mothers are likely to complain of the child's
pallor and of dark lines under the eyes, especially after exertion or
in the reaction which follows excitement of any sort. As a rule a
blood count will not show any very striking evidence of true anaemia.
The pallor is of vasomotor origin, determined by faults in the
distribution of the blood from vasomotor weakness and not by deficient
blood formation. Circulatory and vasomotor disturbance probably also
accounts for the dyspeptic pains and vomiting which commonly accompany
any emotional excitement, or follow any unusual exertion or fatiguing
experience. Constipation is a common, and mucous diarrhoea an
occasional, symptom. The abdomen is often pigmented. The hands and
feet are usually cold and cyanosed.

The extreme nervousness of the children is the point upon which most
stress may be laid in the present connection. The association of
albuminuria with neurosis in childhood has been noticed by many
observers. The gastric and intestinal symptoms are especially
characteristic. If the condition of the children is not materially
improved, and if the symptoms, both of the physical defect and of the
nervous disturbance, are not cut short, we may predict that in adult
age their lives will be made miserable by a variety of abdominal
symptoms dependent both on the vasomotor disturbance and upon the
accompanying neurosis. Now that surgery forms so large a part of our
therapeutic proceedings, they may not reach middle life without being
submitted to one or more surgical operations. With good management
both on the physical side and on the moral or psychological side they
can be made into strong and useful members of socie