ble and endeavors made to expectorate with every effort. A dry, irritable cough, without expectoration, should be held in check by proper remedies.

The spute should be received in a cup containing a quantity of moist absorbent and antiseptic material. The contents should be removed once or twice daily and the cup cleansed. Moist antiseptic cloths may be substituted for the cup. The cloths and the contents of the cup should be burned. Catarrhal colds should be avoided by every known means, and if they occur they should be treated with the utmost care and the treatment continued until the disappearance of every trace. The patient should consult his physician at once upon the appearance of new symptoms, the significance of which may be unknown to him.

The patient should observe and record carefully his condition from day to day upon suitable blanks; such records afford information of the greatest value in formulating prognoses and lines of treatment. He should bring them along when he consults his physician. "With careful instruction an intelligent patient may become," to a limited extent, "his own observer and, to a certain extent, his own medical attendant" and to his advantage.-J. Am. Med. Assoc.

Artificial Feeding of Infants.-By W. B. Cheadle, MA., M.D. Cantab., F.R. C.P.-Difficulties connected with the question of the feeding of infants are amongst the most common of the many troubles which beset the ordinary practitioner, and are constant sources of worry, of anxiety, and not unfrequently of discredit.

A large proportion of the diseases of early life, some of the most fatal, and some of the most lasting in their influence, have their origin in errors of diet. It is, therefore, of immense practical importance as a matter of national hygiene.

Of the four great external con litions which influence the development of the young organism-food, air, heat and sunlight-food is one of the most potent. Of course the intrinsic condition, original constitution, played upon by these external conditions, is the other great and prime factor. The feeble and imperfect body, which under adverse conditions would fall still lower, or dwindle and die, may, by favorable conditions, be fostered into some degree of vigor and stability; the well-made body of rich possibilities may under evil conditions be degraded, and grow stunted and deformed, while under favorable surrounding influences it will develop into the highest perfection.

There is a lack of correct and precise knowledge on this subject, not only amongst students, but amongst medical men in active practice also; and even more than this, a great deal of positive errone

ous belief, and of mistaken practice founded upon it. The main cause of this serious deficiency is to be found in the fact that the subject is neglected in our medical schools. It is either not taught there, or only in vague generalities and in desultory fashion. No accurate and scientific exposition of it is to be found in the ordinary text-books, and thus, when the student enters upon the actual work of his profession, he has no certain data to guide him. He lacks accurate knowledge of the physiological laws which govern the needs and powers of an infant, and of the exact nutritive value of the various materials adapted for artificial feeding. And so the method followed is too often routine and mere rule of thumb. If one food does not agree, another is substituted haphazard, because some other child appears to have done well on it, possibly under quite different conditions-with a different constitution and digestive power, different age and state of health. I have seen a delicate little infant, with a stomach whose powers were utterly unequal to digesting the coarse, heavy curd of cow's milk, which set up vomiting and purging, forthwith put on goat's milk. But the caseine of goat's milk coagulates in equally heavy masses, and the change, instead of doing good, made matters worse than before. Again, I have seen too frequently-the most common mistake of all, perhaps-a puny, bloodless child, with incipient rickets, evidently suffering from want of animal proteid and fat, owing to its inability to digest cow's milk, placed upon a purely farinaceous diet, with the result of causing still further deterioration, and inducing scurvy in addition to rickets. Such instances I might multiply almost indefinitely.

Human milk may be taken as the type-food for an infant, and the proportions of the different ingredients found to be contained in it may be taken as the standard of an infant's food when artificially made.

Taking the mean between the two analyses of milk, Payen and Gorup Besanez, as the final standard, we find the proportions of different elements are, for the infant:

Milk is a rich emulsion of fat, yet little children are constantly placed on artificial foods which are almost destitute of this vital element.

Another quality in food essential to the healthy nutrition in infants, in addition to the due proportion of the different elements, is the anti-scorbutic property. In the case of adults, every dietary must contain a certain amount of fresh vegetable food, or scurvy follows. The exact nature of the ingredient which confers the anti-scorbutic power has not been ascertained with certainty, but it is known to be contained especially and abundantly in fresh vegetable juices, and has been inferred to consist in a combination of organic acids with potash.

Now, children fed on fresh milk never get scurvy, except in the very rare instances when the mother who is suckliug her child becomes scorbutic. This shows that where the anti-scorbutic element is present in the food of the milk-producer it is transferred with other properties to the milk. Nursing mothers who get scurvy from the lack of anti-scorbutic food cannot transfer the essential element to the milk, and their infants may become scorbutic. Fresh milk therefore possesses, in addition to the other essential elements, this mysterious anti-scorbutic element which in an ordinary diet is supplied by fresh vegetables. Thus milk becomes an absolute and complete compendium of all essential food. It is perfect in all points. The next question to be dealt with is, How much food altogether must be given combined in these proportions?

It has been calculated that a mother's breasts yield one pint of milk during twenty-four hours for the first few weeks, and that this quantity gradually increases until in the later months it reaches three

pints. This, then, may be taken as the standard of quantity.

There is no doubt considerable variation in the amount which is essential according to the size and vigor of the child and the nutritive richness of the milk, and judgment must be used in individual cases. But we may take it as a general rule that anything materially under one pint of human milk, or its equivalent, would be insufficient for full nutrition, even for the first month of life, and we may safely say that for the first month the child should have the equivalent of 16 to 24 ozs. of human milk, in the second month the equivalent of 20 to 26 ozs., in the third month the equivalent of 24 to 30 ozs., in the fourth month 30 to 35 ozs., and later 35 to 45 ozs. or more.

These quantities are not to be taken as absolutely and arbitrarily fixed. They will require to be varied within the limits named according to the capacity of the child and its peculiarities, but will serve as a starting-point and safe guide at the outset. The child's stomach acts in some degree as an indicator of quan

tity, too. If overfilled the excess is readily rejected. If after the meal craving still remains, the child cries for more, sucks its fingers, is restless and complaining.

With the data I have given, and a watchful observation of the child's condition, aided by a regular record of weight (the increase should be 2 or 4 ozs. per week, or more), the necessary quantity will be estimated with sufficient exactness.-The (London) Herald of Health.

Some of the Medical Uses of Fruits.--It should not be understood that edible fruits exert direct medicinal effects. They simply encourage the natural processes by which the aids are brought about. Under the category of laxatives, oranges, figs, tamarinds, prunes, mulberries, dates, nectarines and plums may be included; pomegranates, cranberries, blackberries, sumach-berries, dewberries, raspberries, barberries, quinces, pears, wild cherries and medlars are astringent; grapes, peaches, strawberries, whortleberries, prickly pears, black currants and melon seeds are diuretics; gooseberries, red and white currants, pumpkins and melons are refrigerants, and lemons, limes and apples are refrigerants and stomachic sedatives. Taken in the early morning, an orange acts very decidedly as a laxative, sometimes amounting to a purgative, and may generally be relied on. Pomegranates are very astringent, and relieve relaxed throat and uvula. The bark of the root, in the form of a decoction, is a good anthelmintic, especially obnoxious to tapeworm. Figs, split open, form excellent poultices for boils and small abscesses. Strawberries and lemons, locally applied, are of some service in the removal of tartar from teeth. Apples are correctives useful in nausea, and even seasickness, and the vomiting of pregnancy. They immediately relieve the nausea due to smoking. Bitter almonds contain hydrocyanic acid, and are useful in simple cough; but they frequently produce a sort of urticaria, or nettlerash. The persimmon, or diospyros, is palatable when ripe; but the green fruit is highly astringent, containing much tannin, and is used in diarrhoea and incipient dysentery. The oil of the co

coanut has been recommended as a substitute for codliver oil, and is much used in Germany for phthisis. Barberries are very agreeable to fever patients in the form of a drink. Dutch medlars are astringent and not very palatable. Grapes and raisins are nutritive and demulcent, and very grateful in the sick chamber. A so-called "grape cure" has been much lauded for the treatment of congestions of the liver and stomach, enlarged spleen, scrofula, tuberculosis, etc. Nothing is allowed but water and bread and several pounds of grapes per diem. Quince seeds are demulcent and astringent; boiled in water they make an excellent soothing and sedative lotion in inflammatory diseases of the eyes and eyelids.--Ecchange.

Management of Functional Neuroses. --Against the perils of auto-infection the system is provided with a variety of safeguards. One of the most efficient seems to be the antiseptic properties of the digestive secretions which keep the putrefactive processes in the alimentary canal in check. The liver also subserves, a preservative function against autoinfection. But the complex chemistry of these secretions is liable to numerous disturbing influences notably nervous irritations. If nervous influences are capable of deranging the chemistry of the body, why may not such perturbances of nervous origin, occurring now and then, as nervous actions characteristically do, suffice to produce either increased amounts of alkaloidal poisons or else to diminish the effectiveness of the normal antidotal processes? These considerations seem to offer us a hint of the explanation of the intermittency in functional neuroses.

The bearing of this view of functional neuroses on treatment is as follows: First, instead of vaguely expecting help from structural anatomy to show us the pathology and then the treatment of this difficult class of diseases, and meanwhile choosing our remedies according to the old empirical methods, the physician should look for aid to advance in the knowledge of the chemistry of diet. Second, gastro intestinal antisepsis should be studied as a particular branch of therapeutics. (The value of a certain class of purgatives, conjoined with the administration of antiseptics, has been particularly impressed upon the author's mind in the treatment of migrine, of hysteria and of melancholia with quickened pulse.) Lastly, the investigation of leucomaines, of which lithæmic states are an example, is of equal importance in a great variety of morbid states, with functional disturbances.

Directed by these three principles, suggested by the progress of organic chemistry, I think that our treatment of functional diseases would be much more effective than if we continue to seek for mere drugs with specific properties or fruitlessly to wait the verdict of pathological anatomy.-Dr. W. H. Runson.

Treatment of Typhoid Fever.-The attempt to manage or cure the disease by remedies destructive of the bacilli is futile.

Active medication is forbidden by men of much clinical observation.

The main points in the therapy are to lessen the fever by the application of water to the surface, and cold water by enema, and to support the failing heart by stimulants, alcoholic in character, and by liquid food. At what temperature the water shall be applied, either by sponging, the pack, or the bath, is a matter of great judgment.

The coal tar antipyretics, antipyrin, antifebrine,

and phenacetin, are depressants to the heart and should rarely be used.

Since the clinical thermometer has come into general use, and the danger of high temperature has been so strongly insisted on, there is reason to think that the use of antifebrifuges and antipyretics have done much harm, even to the production of death in cases otherwise, mild, and which might have gotten well by the efforts of nature and abundance of liquid food. Certainly the large doses of quinine so much in vogue a few years ago did great harm.

Finally, in view of the possibility of a reinfection of additional glands taking place from ulcers slow in healing and open at the end of four weeks from the beginning of convalescence, it is well to insist on quietude and liquid diet for that time.-Cincinnati Lancet-Clinic.

The Sense of Taste.-Physiology has not as yet determined the existence of a taste center or the particular nerves that transmit gustatory sensations; and while the latter have been divided into sweet, bitter, acid, and saline, the researches of Camerer, von Vintschgau, Shirmer, Aducco, and others, have not done more than add to our knowledge of certain features regarding these sensations. In a recent contribution to the Journal of Physiology, Dr. L. E. Shore adds to this knowledge by narrating the outcome of certain experiments made with a substance obtained from the leaves of the Gymnema silvestre, an asclepiadaceous plant occurring in India and Africa. The leaves of the plant when chewed, as well as a derivative obtained from them, have a paralyzing influence on the nerves that convey sweet and bitter tastes. The first thing determined was the normal taste recognition of different localities of the tongue. The taste for sweet and acid substances was most acute at the tip, least so at the back; that for bitter substances was most acute at the back, least acute at the tip; and that for both bitter and acid substances was more acute on the left than on the right edge. Saline substances were recognized equally in each locality and there was no taste on the dorsum. The gymnema decoction pevented a sweet taste in all regions.-N. Y. Medical Journal.

How Jewish Meat is Killed.-One of the largest abattoirs in the city, covering an ample block, owned and operated by men of Jewish race and faith, is remarkable for its smooth and effective working and admirable distribution of parts. An average of eight hundred cattle, between three and five years old, pass through it in each of the business days of the year. Arriving from the West at the river-front, they ascend one by one to the fateful inclosure, where an adept employee fastens a chain around the hind

leg of each. Hoisted by machinery, the bovine falls gently upon one shoulder, and in most instances without a cry. Occasionally, however, some brute, maddened by sight and smell of blood, breaks out into the slaughter-house, and creates a disturbance that is speedily quelled by its own despatch. Submissive companions, with neck twisted to expose the throat, quickly feel the shochet's long and shining knife. The shochet himself is a stalwart fellow, cool and wary withal, who rarely makes a useless motion. He is a religious man and of good moral character, as his license from Rabbi Jacob Joseph, chief of certain orthodox congregations in the metropolis, avouches. The life-stream in torrents follows the movement of his blade. This is "shechita," the killing. It insures complete effusion of blood, in which may be germs of disease that otherwise might find entrance into human bodies. Next follows "bediqah," the examination of instrument and victim. If a nick appear on the keen edge of the knife, that by extremists is held to imply unnecessary suffering, injurious chemical change, and consequent unfitness of the carcass for market. If there be none, lungs, liver, and heart, the entire body indeed, are minutely inspected.-The Century Mag., Feb.

Oleomargarine.-A paper upon this subject, from the pen of G. C. Caldwell, B.S., Ph.D., Professor of Agricultural and Analytical Chemistry in Cornell University, appears in a late number of the Medical News.

This substance has become an important article of food, and its use is rapidly extending, so that it behooves physicians to acquaint themselves with its mode of manufacture, its dangers and its uses.

According to Professor Caldwell, caul fat is first cooled, and washed, and then rendered at a temperature of 120° to 150° F. The clear fat is then run into wooden tanks, and the greater part of the stearine, the hard fat contained in it, allowed to crystallize out. The liquid fat separated from the stearine is called "oleo oil." A similar product, prepared from lard, is allowed to retain its stearine, and is known by the trade name of "neutral." The "oleo oil" and " tral" are then mixed in certain proportions, and constitute "oleomargarine." This substance is free from flavor and color, and to become "butterine" is churned with milk or cream, by which a certain proportion of the flavoring elements of butter are mixed with it, and impart to it the taste and odor of natural butter.

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Physicians are not concerned with the effect which the manufacture of this article may have upon the butter trade, but are deeply interested in the wholesomeness and the nutritive value of this product.

It may be stated at once, that it has not yet been

shown to be a medium or fthe transmission of pathogenic germs, and there can be but little doubt but that it is much cleaner than the bulk of the butter put on the market.

Some laboratory experiments as to its digestibility have been made by Dr. R. D. Clark, chemist to the New York State Dairy Commissioner. Dr. Clark performed some emulsionizing experiments with different fats and pancreatic juice, and found that, next to cod-liver oil, butter gave the finest emulsion in twelve hours, while oleomargarine still had many large globules, left unchanged. Dr. Clark also proved that, while butter melts to a clear, limpid liquid in thirty-five minutes, at 100° F., oleomargarine was but slightly changed.

Treatment of Catarrhal Gastritis.-The term dyspepsia should be given up. It is a symptom and not a disease in itself. In chronic catarrhal gastritis we have too much mucus with a resulting impairment of digestive power. Out of 118 cases of gastric trouble, he had found 17 of uncomplicated gastritis (chronic) giving the usual symptoms in different combination and varing severity of epigastric pains, nausea and vomiting. Less common were fulness, coated tongue, eructations, anorexia, vomiting, constipation, etc. As to etiology, the trouble is more common in males and users of tobacco, alcohol, and excesses in iced drinks. The duration varies from months to years. The treatment is one of diet and but little medicine. Lavage had in his opinion but a limited value, because patients would not submit to it. He is in the habit of directing patients to drink from eight to sixteen ounces of very hot solution of bicarbonate of soda (ten grains to the pint) twenty minutes before eating. This removes the mucus and enables the food to come into direct contact with the mucous membrane of the stomach. Thereby normal peristalsis is set up. As to diet, a trial meal of lean meat and buttered bread should be given. As the patient improves, oysters, eggs, etc., can be added. Pastry should be avoided. Bismuth, cerum, nux vomica, and tonics can only be adjuvants; pepsin is good where there is atrophy of the gastric tubules or organic structural changes; also in anæmic cases.Dr. Harold N. Mayer.

The Defects of Wet Nursing.-The woman who lends herself to such services, if she is honest, has very frequently a heavy sorrow on her heart which is incompatible with the best nutrition and the secretion of the healthiest milk. If she is indifferent to her condition she may present dangerous constitutional defects produced by a life of shame or debauchery. There are always the dangers of occult tuberculosis, scrofulitic or syphilitic taints. Their