bacillus botulinus may not be made sterile by ordinary methods of sterilization, and the public canneries must be more thorough in the application of heat to preserve their canned goods, and home canning should be most carefully done.

The working rule of the kitchen of the household should be that any canned food of disagreeable smell or of unusual appearance should be destroyed; that as far as possible canned foods. should be washed, especially if they are to be served without heating; and that food should not remain in the can after it has been opened. Canned foods that are to be served hot should be boiled, if possible without destroying the character of the food, for at least ten minutes. Food that is to be served cold direct from the can, and food that would be destroyed or made unpalatable by such boiling, must be more carefully inspected than the food that can be boiled.

It should be noted that the bacillus botulinus is anæærobic; therefore it may not be found on the surface of the jar, while below the surface the contents may be loaded with this germ. This germ is not frequent in animal food.

Symptoms of Poisoning. The first symptoms of poisoning are likely to be nausea, vomiting and prostration, soon followed by signs of paralysis. Early in the poisoning there is often disturbed vision, disturbed speech, and inability to walk. The paralysis proceeds, in serious cases, to affect the eye-lids in some instances, then the arms, then speech becomes almost impossible, swallowing difficult, and finally paralysis of the respiratory muscles and death.

Treatment. The treatment is to quickly cause vomiting by some rapidly acting emetic and then to cause catharsis by large. doses of castor oil.

An antitoxin has been produced, and Dickson and Howitt1 present their conclusions concerning it as follows: "A true antitoxin may be prepared from the toxin of bacillus botulinus." There are at least two types of this bacillus which are distinct as far as their toxin-antitoxin relationships are concerned. In the laboratory they find that "the antitoxin may protect against the action of the toxin for at least twenty-four hours after the 1 Journal A. M. A., March 13, 1920, p. 718.

administration of one test dose of toxin, but that the effectiveness is, to a certain extent at least, dependent on the amount of toxin injected. For therapeutic administration a polyvalent antitoxin should be employed, and it should be given in large amounts and intravenously."

TOADSTOOL (MUSCARINE) POISONING

Muscarine is an alkaloid found in some of the poisonous mushrooms, and not infrequently the poisonous mushrooms are mistaken for the food mushrooms.

The symptoms of poisoning are somewhat similar to those caused by the over-action of pilocarpine. There is likely to be vomiting and abdominal pain, sometimes watery evacuations, an increased secretion of saliva, and an increased flow of tears. The pupils are generally contracted; there is sometimes dizziness and tremors. There may be mucous rales in the chest, and dyspnea. If death occurs, it seems to be from prostration and from respiratory failure.

The treatment is to quickly evacuate the stomach and bowels, surround the patient with dry heat, and give atropine hypodermatically, strong coffee by the mouth if the patient is not vomiting, and hypodermic injections of either post-pituitary extract or of an epinephrine solution.

CONVULSIONS OF YOUNG CHILDREN

Young children have convulsions very easily, as their nervous systems are not well balanced, especially if they have inherited a neurotic taint. If an acute disease is ushered in by a chill or by high fever, the young child is likely to have a convulsion. At other times convulsions are due to digestive disturbances, probably to some protein poison. Various endocrine gland disturbances may allow convulsions to more readily occur, and especially in parathyroid insufficiency and in disturbances of calcium metabolism. Mild acidosis conditions undoubtedly predispose to convulsions.

The causes of convulsions may be divided into: (1) Those due to cerebral irritation from any disease or from a disturbed metabolism. These are spasmophilic in type. (2) Those due to actual inflammation of the meninges. (3) Those due to epilepsy.

1. Convulsions of the spasmophilic type are the most frequent, and may occur from anything that disturbs or irritates the central nervous system; and meningismus readily occurs in all acute conditions in children. Focal infections may be a cause of some protein poisoning or of some metabolic disturbance that allows convulsions to occur in children, and focal infection is more frequently present in children than is supposed. Tonsillar and nasopharyngeal inflammations may be a cause of such disturbances. Also, since it has been learned that the pituitary gland frequently changes its size and the amount of its secretion, and that the thyroid and parathyroids, even in children, are often disturbed, it is not surprising that, with their not well balanced nervous systems, children have convulsions with apparently a slight amount of irritation. In spasmophilic conditions there is always more or less sleeplessness and increased reflex irritability.

A careful study of the calcium metabolism and of the endocrine gland sufficiency or insufficiency may disclose the cause of neurotic, irritable, bad tempered children.

The nervous reflexes should also be studied; namely, the eyes may be in trouble; there may be an elongated, adherent prepuce, or an irritated clitoris. There may be serious constipation; even if there are daily movements of the bowels they may be insufficient. The diet may be wrong, which is the most frequent cause of nervous disturbances in infants and young children; and in young infants vomiting and diarrhea more or less rapidly cause acidosis, and convulsions may result. The treatment of convulsions in such a patient is carbohydrate food.

Spasmophilic convulsions are not followed by sleep (as are epileptic convulsions), and a child who has this type of convulsions is also likely to have other signs of spasmodic conditions, as spasmodic croup, attacks of temper, holding-thebreath attacks, bowel cramps, etc., all showing a hyperirritability of the nervous system. Several convulsions of this type may occur at short intervals. However, it should always be borne in mind that young children can have true epileptic attacks, and the possibility of the convulsions being such, must always be considered.

The treatment of convulsions of the spasmophilic type is evacuation of the bowels; the administration of starchy foods, as barley water and thin oatmeal gruel; the administration of calcium, as lime water or as small doses of the glycerophosphate, unless the child can take milk, and best breast milk. Also an alkali, as potassium or sodium citrate, should be given, the dose depending upon the child's age.

The sedative required is a bromide, and a safe dose is about 0.065 Gm. (1 grain) for every year of the child's age, repeated every two hours, unless the child is asleep. If the convulsive conditions are so severe as to endanger life, a few whiffs of chloroform may be necessary.

It is always of advantage to hold such a child, sitting up, in a bath with the water a little warmer than his temperature. This takes the blood from the brain and distributes it over the body. It is also good treatment when the child is cold and good treatment if the child has a high temperature. If the child is cold when taken from the bath, he may be wrapped in warm blankets, not too tight, allowing his arms to move freely; also the extremities and body may be gently massaged. If the child is warm and feverish, after the bath he may be placed on a bed and covered lightly.

2. If it is decided that the convulsions are due to actual cerebral irritation, localization of serious conditions as in the ear, mouth, or throat should be excluded, and the spinal fluid should be examined to note what kind of meningeal infection is present. The treatment outlined above is good treatment for this condition, with perhaps the addition of an ice cap to the head for a short time. The high temperature should be treated as deemed advisable, depending upon its height and the condition of the patient.

3. As stated, true epilepsy can occur in infancy. It may be diagnosed by the type of the convulsion, the coma or sleep that follows, and by the bitten tongue; also a careful history may disclose petit mal attacks, especially if the child is several years old. The family history should be studied, to note the conditions that are likely to be inherited, a Wasserman test made, and all reflex disturbances of the child must be sought and

treated. It is needless to urge that an epileptic child should be individualized, as there is no one method of treatment that is advisable for all epileptic children.

SUNSTROKE-INSOLATION

Sunstroke is a very serious condition which may develop very rapidly, the patient becoming suddenly unconscious, and he may die within a few hours, or even within a few minutes. He may die comatose, or he may improve somewhat and die of heart weakness. If not comatose, he will complain of headache, have disturbed vision, be nauseated, dizzy, have a rapid pulse, and the temperature may be excessive.

A patient found comatose who has been exposed to intense sun rays or intense heat may not be suffering from insolation, and all other causes for the comatose condition must be excluded. On the other hand, convulsions followed by coma may be due to excessive heat. The various causes of coma and their diagnosis have been elsewhere discussed.

Disease, indulgence in alcohol, and previous attacks of insolation are predisposing causes. Exhaustion and weariness may precipitate a heat stroke, but are more likely to develop heat prostration. The excessive temperature of sunstroke may cause albumin and casts to appear in the urine.

Just what is the exact pathologic condition in insolation is doubtful except that excessive heat can cause changes in the body metabolism, and perhaps cause autointoxication. It has been suggested that heat stroke may be a form of uremia, and creatinin has been found in excessive amount in the blood.1 Post-mortem examinations have shown congestion of various organs, and edema of the lungs, brain and meninges.

Preventive treatment is a proper head protection (and that means the air-cooled, large hat), abstention from alcohol in any form, drinking of large amounts of cool, not iced, water, and a diet largely of carbohydrates, certainly without an excessive amount of meat. Patients who are diabetics and those who have damaged kidneys should be warned against over-heating and exposure to the sun.

1 Gradwohl and Schisler, Amer. Journ. Med. Sci., Sept., 1917, p. 407.