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This has been the first Malt Extract made in Europe or America (1847), and has been constantly improved in conformicy with the advance of science.

No preparation of " MALT" has been so long and so extensively

employed as a

Medical Food and Nutrient.

“As a large number of patients lack the necessary power to digest solid food, and would through the use of stimulants be merely excited and weakened, therefore I regard it of immense value to the practitioner to bring to his aid a nutritious tonic and remedy like the Johann Hoff's Malt Extract, which will act not only as a tonic but as a nutrient as well, and which is less exciting than wine, ale or porter as a stimulant."

-PROF, PIETRA SANTA, Paris. “I have used Johann Hoff's Malt Extract for the past five years in my private practice, and have found it to be the best health-restoring beverage and tonic nutritive known. I have found it especially good for persons convalescing from fever in cases of dyspepsia, for nursing mothers, and in cases of weakly children, and also in lung troubles. My attention was drawn by the immense importation semi-monthly, and about i million of bottles imported by you have passed my inspection in the Custom House satisfactorily for the past five years."

W. W. LAMB, M.D., AREA Chief Drug Inspector, U. S. Port, Philadelphia.



A preparation BOTTLED IN NEW YORK is being sold as “ Hoff's” Malt Extract. To obtain

the genuine, original article, please specify " JOHANN HOFF'S MALT EXTRACT, imported by EISNER,” which will prevent substitution of immitations,


Office, 6 Barclay Street, New York,

The Dietetic Gazette .


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By R. O. BEARD, M. D.,

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of Minnesota.

Original Articles.

profession and among the public at large stands in the

way. These laissez-faire philosophers admit the fact

of an excessive mortality in infancy, but they hold

THE CAUSES AND PREVENTION OF INFANT lightly the value of infant-life; they give to the loss a


Malthusian meaning and profess to regard it as one

among the many evidences of superfluous generation.

But the analogy is not well taken. Nature is prodi-

Professor of Physiology in the Departmeni of Medicine of the University gal of her growth in the germ-but she is not wanton

of her finished work. She scatters seeds by the mil-

Read before the American Public Health Association, Brooklyn, Nov. 1884). lion to the wind, where but a thousand take root and

germinate. She hatches out one fish where the

HE most exalted function of the physician is to possibilities of hundreds have been spawned. She

maintain health rather than to remedy disease. matures a score of Graafian follicles in the human

That chair which, in the curricula of the colleges, is ovary for every ovum that is fructified and fully

most deserving of dignity and, still is most commonly developed. But at that point-the point of birth-

conspicuous by its absence, is the chair of Preventive the parallel stops. With the appearance of the indi-

Medicine. The business of our profession is the con- vidual existence, the worth of life begins and reaches

servation of human life, and yet upon the very its highest standard in the human. Endangered it is

threshold of the task we encounter one of the most from “foes without and foes within,” but Nature

perplexing of vital problems—the fact of infant immediately strives to throw around her completed


product every protective influence. From birth, the

Few of us, I fancy, appreciate to their full, the ex- vis medicatrix naturæ become not merely a latent

tent and meaning of this fact. We entertain a general but an actual force. Thereafter every new life, with

idea that infancy is hedged about with seemingly in- its freight of possibilities, has an economic value ;

evitable dangers, while we have but a vague notion every sacrifice of it is an economic loss.

of the relative activity and the ultimate origin of those But a still more serious obstacle bars the progress

influences which determine the fatal results. And if of the inquirer into the causation of infant mortality,

we seek to prosecute anything like an analytic inquiry viz.; the poverty of our vital statistics. In this re-

into the causation of infant death, we find the effort gard the Old World is immeasurably in advance of

impeded by obstacles very difficult to overcome.

Our records of birth are altogether imperfect.

The indifferentism of a certain class in the medical Our nomenclature, our classification, our methods of


tabulating death-causes are in most chaotic state. These cities are sufficiently varient in size, climate There is no uniformity among them. We permit and geographical situation to afford a fair average in ignorance to hide behind such unscientific terms as death-rate and to establish, beyond a question, inanition, infantile debility, marasmus, asthenia, denti- the truth that modern preventive medicine has not tion, indigestion, scrofula, heart-failure and the like. reached a remedy for the excessive loss of infant-life. We confound methods of dying with causes of death. This fact duly recognized, the more difficult task We commonly overstep the physiological bounds of awaits us of determining the immediate and ultimate infancy-limited naturally, by the complete evolution causation of this mortality. of the deciduous teeth, to three years and include It will not be enough to discover the names and children up to the age of five in the records of infant- relative fatality of the diseases which destroy the mortality. In fact, only thirty American cities pay human race in iis earliest years. This is a comparaany attention even to this artificial boundary line of ively simple thing to do, even in the face of our years in making up the sum-totals of death ; while statistical failures. But the weightier question reonly nine cities consider the element of the.age of the mains and hides the solution of the whole problem of decedents in tabulating the returns of individual infant mortality. Why is infancy peculiarly liable to death-causes. The American Public Health Associa- the destructive influence of these immediate deathtion would do a signal service to the public if it

causes ? should appoint a Committee to frame a satisfactory in the correct reply to this important query rests table of mortuary statistics and to secure the adop- the final recognition of the ultimate causation of indion of the same by State and Local Boards of fant-death in its present overwhelming excess. Health.

The road to the last analysis of the problem must, It goes without saying that accuracy, in such an of course, lie through a primary analysis of the iminquiry as this, is thwarted by these failures in the mediate causes. The nine cities, whose published reofficial returns of death. We are confined, of neces. ports enable us to determine the classified age of their sity, to the larger group of statistics I have noted, for decedents in each individual death-dealing disease, a discovery of the percentage of infant mortality in

are New York, Baltimore, Boston, San Francisco, the gross and are forced, even, then, to accept the Cincinnati, St. Louis, Newark, Hartford and Minreturns for the first five years of life instead of for the neapolis. In the year ending October ist, 1889, the first three, while, in the endeavor to determine the combined statistics of these cities give a death-total of individual diseases which result fatally in infancy, we 22,092 infants under one year and of 12,883 children are restricted to the smaller group of nine cities. In between the ages of one and five. The sum of these a recent address, which he had the honor to deliver figures gives 34,975 so-called infants who have died before the Minnesota Academy of Medicine, the within one year. writer succeeded in approximating some degree of The diseases which have induced these fatal results accuracy in the returns from twelve American cities,

are as follows: but, in order to secure an absolutely correct estimate, Diphtheria...

..2,653 it has proved necessary to narrow down the present Membranous Croup...

974 summary still more.

Scarlet Fever ....

1,257 While it is measurably true that the death-rate of Measles ..

752 cities is modified to some extent by that of the Whooping Cough

. 1,004 country-districts, yet population is concentrating Bronchitis...

.2,380 itself so rapidly in great centres, that this is less true Pneumonia..

.2,974 than in earlier times, and, for all practical purposes, Pleurisy

7 the urban statistics are a safe index to the facts.

Cholera Infantum and Diarrhoea......5,214 A study of these statistics in the thirty selected Gastro-entero-colitis.

..2,510 cities to which I have referred, shows that, during the Marasmus, etc,

....12,998 year 1888, 155,208 deaths occurred in these places. Convulsions..

1,929 Of this number 40,715 or over 26 per cent. were Meningitis...

1,685 under one year of age, while 33,776 more, or over 15 Cerebral Congestion..

736 per cent. were under the age of five, making a total Phthisis..

300 of 64,491. or 41.5 per cent. After a fair estimated Tubercular Meningitis. subtraction for the number of decedents, who ranged General Tuberculosis..

26 between three and five years of age, we can safely Tabes Mesenterica...

56 estimate that 35 per cent of this sum total come with- Hydrocephalus.

274 in the physiological limits of infancy. This figure Syphilis....

81 accords very closely with the reckoning of a number Congenital Malformations etc.

772 of other statisticians and coincides curiously with the Miscellaneous Causes...

.6,280 calculation that nearly thirty-five, out of every hundred babies born, die in infancy.

Total, ...

. 34.975


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This general statement demands a brief analysis This classification puts us in a position to discuss and these causes a general classification.

these groups of diseases in their relation both to the Under “Miscellaneous Causes" we find a variety immediate and remote causation of infant mortality. of diseases which seldom appear, and more seldom re- And, first, the Contagious Diseases, which represent sult fatally, in true infancy, while probably two-thirds about 16 per cent of the entire death-rate of infancy. of this total, in which these rarer death-causes are in- Over one-half of the fatalities in this group are cluded, is made up of still-births and premature chargeable to diphtheria and membranous croup, births, which should not be, but almost always are which may safely be regarded, so far as the statistireckoned as actual deaths.

cian is concerned, as identical diseases. The signifiUnder the term “Congenital Malformations, etc.," cance of this percentage is enhanced when we obare included cyanosis, atelectasis, trismus nascentium, serve that these are preeminently the fatal members umbilical hæmorrhage, malæna, spina bifida, deformi- of this group so far as true infancy is concerned and ties and other conditions which terminate life within a that scarlet fever, measles and whooping-cough find few hours or days of birth. This class should prob- the vast majority of their victims in children between ably be increased by some further contribution from the ages of three and five. Of this remaining trio, it the "miscellaneous causes. "

might be something of a surprise to the casual student The small number of infant-deaths charged up to of vital statistics, to find whooping-cough playing so syphilis would excite surprise were it not for the well | large a part and really destroying a greater number recognized fact that physicians habitually save the of actual infants than scarlatina and rubeola. That feelings of their patients' families by concealing the measles, too, a disease ordinarily regarded in so innature of this disease, as a death-cause, under the nocent a light and rarely quarantined, should yield guise of some local disturbance incident thereto. It

so large a number of fatalities as it does, deserves is a misfortune to the public that a cause so unques- emphasis. Doubly true is this when we remember tionably potent and so frequently occurrent should be how common a sequel or concomitant of measles is thus obscurely hidden.

capillary bronchitis and give due weight to the fact With the deaths attributed to hydrocephalus and that a large part of the numerous deaths debited to to tabes mesenterica are inextricably grouped, by some the bronchial disease should be charged to this primstatisticians, many cases of so-called marasmus, while

ary cause. with the latter disease are included similarly a few And this naturally leads us on to the reflection that deaths from tabes and hydrocephalus. Admitting our second group-the Respiratory Diseases—are that it is difficult to classify these conditions and that very definitely related as sequelae in infancy to the they sometimes interact upon each other, that it is exanthemata. This conclusion is borne out by the nowtrue that hydrocephalus'has a syphilitic origin and fact that where the latter thrive, the former are again that it has a tubercular character, it is never always prevalent; and that, whenever the one group theless improper to place that large variety of condi

assumes a marked degree of statistical importance, tions, which we conveniently term marasmus, in asso- the other group keeps pace with it. And, let us mark ciation with either the one or the other of these two very carefully, that of both classes is it true that they well defined diseases.

appear and multiply, in occurrence and fatality, not For convenience of future criticism, it will be well merely in direct ratio to the increase of the populato resolve these diseases into several well defined tion, but in direct proportion to the massing of the groups, as follows:

population within a given area. This is due not only

to the opportunity which close crowding of the people (1) Contagious DISEASES, including diphtheria, gives for the spread of contagion, but also to the cor

membranous croup, scarlet fever, measles relative truth, applicable to all diseases alike, that reand whooping cough. Total

6,640 duced cubic space per capita, involving the worst of (2) RESPIRATORY Diseases, including bronchitis, insanitary consequences, means a reduction in the pneumonia and pleurisy. Total

5,361 powers of resistance in the people and particularly in (3) TUBERCULAR DISEASES, including phthisis, the infant so 'environed. tuberculosis, tubercular meningitis, tabes mes.

And here we touch the first key-note in this social enterica and hydrocephalus. Total

769 discord of infant-death-the first suggestion of its (4) CONGENITAL DISEASES, etc., including syph- ultimate causation. It is not true that infant-life

ilis, malformations, etc., still-births and other under favorable averages of environment, is unequal miscellaneous causes.


7,133 to the task of maintaining itself against disease ; but (5) NUTRITIONAL Diseases, including cholera in- it is true that infancy, prejudiced in the unequal fantum, diarrhea, gastro-entero-colitis and struggle with insufficient air-space and sunshine,


10,722 easily goes down under the attack of disease. (6) Nervous Diseases, including convulsions, The remarkable number of deaths assigned to meningitis and cerebral congestion.

pneumonia, coupled with the fact that this malady, Total

4,350 | in its true form, is not ordinarily considered a foe to


infancy, gives rise to a suspicion of carelessness in this fatality. The introduction of mechanical aids, diagnosis and of a probability that a large part of by means of the operation known as intubation of the this total should be added to that essentially infantile larynx, to which Dr. O'Dwyer, of New York, and Dr. disease--capillary bronchitis. It is also certainly Waxham, of Chicago, have contributed so ably, marks. true that a considerable share of cases reported as I believe, an era in the treatment of the diphtheria pneumonia are in children between three and five and croup of infancy. It cannot be practised too years, when the advancing age renders the diagnosis early after the invasion of the larynx by the disease if more probably correct, but carries the disease it is to avail in averting the dangers of death by suffurther outside the proper limits of the causation of focation. truly infantile mortality.

It is matter for regret that the seat of the lesion in True pneumonia--unquestionably a germ disease capillary bronchitis does not permit of any hope that is, so far as it affects true infancy, most prevalent in similar means will prevail to lessen also the mortality closely crowded communities and the fact re-emphas- of this disease. But, nevertheless, the point of relaizes what we have already said upon this subject. tionship in the mode of death suggests new possibiliEuropean cities are taking long strides in the direc- ties of adaptation of the old methods of treatment. tion of providing better houses and more cubic space No case, however desperate, should be readily abanfor their less fortunate inhabitants and the great doned to its fate. By the brief but timely aid of an cities of the United States must, sooner or later, emetic, by the careful use of diluted oxygen, by the grapple with the same necessity.

admission, in the neighborhood of the child of curOf design, the writer has recorded the fact that in rents of fresh air, by the stimulating effect of dashes the statistics of the nine cities under discussion, only of hot and cold water upon the chest and by the use seven cases of pleurisy, occurring and terminating of other agents which will promote the temporary fatally in infancy, are recorded within the past year. 'clearance of the tubes, the mechanical obstruction Now pleurisy is a disease to which infancy would which is fast destroying life, by cutting off the airmuch more probably be prone than to pneumonia, and, supply from the lung-cells, may be overcome and the without doubt, it occurs with some degree of fre- infant-lite, rapidly being choked out, may be saved. quency. Dr. C. D. Conkey, of Larimore, Dakota, The next class of death-causes which claim attenhas, in a recent and timely paper, drawn attention to tion in the order in which we have arranged them, is the somewhat frequent errors in the non-diagnosis of the group of tubercular diseases. the disease alike in its acute and chronic form. The Phthisis pulmonalis does not often develop in insuggestion is, at least, worthy the attention of the fancy and we frequently hear the idea of its occurprofession.

rence in that period scoffed at by medical men. So far, then, we have noted three diseases which Other forms of tubercular disease, meningitis, tabes, are peculiarly fatal to infancy-diphtheria (including and hydrocephalus, more commonly attack the inmembranous croup) whooping-cough and capillary fant. There is no apparent reason why the bacillus bronchitis.

tuberculosis should not find its way into the system of Between the two latter a natural relationship exists, the young child as easily as it does into that of the for in whooping-cough death usually results from adult. Doubtless it does, perhaps remaining in a complicating bronchitis. At first sight, no pathologi- quiescent state for years, and again making its ravacal connection of these maladies with diphtheria is ges upon meninges, or mesentery, where in infancy a apparent, but, if we pause to consider the usual mode more favorable nidus for the germ seems to exist and of death in all of these conditions, as affecting in- where the presence of tubercle quickly kills. fancy, we find a suggestive link which may, to a great Happily we are living in an age of wonderful prodegree, account for their common fatality and give gress in pathology and we have clearly established, us a clue to another ultimate agency in the mortality among other things, the contagious quality of these of this period.

diseases. Heredity, in their causation, is seen to be Death usually occurs in all of them by suffocation, | limited to predisposition or tendency; the actual rather than from exhaustion or blood-poisoning. It disease is traced to the entry of the germs through is in older years that the latter modes of death the media of air and meat and milk. We class the more frequently prevail. It is suffocation, incident tuberculoses among the preventable diseases and the to the blocking of the larynx or trachea in diphtheria, fact bespeaks hope for infancy as well as for adult of the capillary tubes in bronchitis, with or without life. Fresh air and an abundance of it, the increased whooping-cough, which commonly destroys the in- capacity of the chest, the disinfection of the products fant. The narrow lumen of the air-passages and the of the disease thrown off by its victims, the inspecinability of the babe to keep them free of obstruction, tion of animals and of meat, the application of suffiare the main factors in this result. If these points cient heat to all infant-foods—these are the preventare well taken, they are valuable, because while able agencies which will, eventually, lessen the ravaaffording another primary reason for the excessive ges of “the bacillus tuberculosis of Koch." mortality of infancy, they offer a hope of lessening For the arrest of congenital syphilitic disease and

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