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properties is undisputed. We can understand how carbolic or salicylic acids arrest fermentation, but to be convinced that five-grain doses of salol or sulphocarbolate of zinc-both feeble germicides and hardly sufficient to sterilize an external ulcer-after running the gauntlet of the digestive fluids including an acid and an alkaline secretion, and after passing over twelve or more feet of intestine and many square feet of mucous surface and escaping absorption, will find their way to the lower third of the small intestine, and promptly disinfect the secretions of twenty or more Peyer's patches, demands that truly sublime confidence in the efficacy of drugs which we have not yet been able to acquire."

If the disinfection of the intestinal contents be the

object of the so-called antiseptic treatment of typhoid fever, even this object must fail of accomplishment by the usual remedies. In a disease like the summer diarrhoeas of infants, in which bacteria have been shown to play an important role, and in which they are really more accessible than in any other disease, much may be accomplished by attacking these organisms. But surely no rational therapy would countenance the pouring of parasiticidal solutions into the gastro-intestinal tract. Recognizing the fact that food containing bacilli is one of the chief etiological factors, its sterilization is resorted to as a prophylactic agent. Should bacteria, however, accumulate in the intestinal canal, they may be attacked by irrigation. Inasmuch as the lesions are usually found in the large intestine this may be done with some show of success. But clinical experience has demonstrated here, as it has so often done elsewhere, that the more simply we treat these conditions the greater will be the success. Just as boiling water has been proven to be the best disinfecting agent for the surgeon's instruments, and boiled water the best disinfecting agent for fresh wounds (Schimmelbusch), so has the pædriatric physician discovered that plain boiled water is the most useful agent for intestinal irrigation, after adopting it to the sensitive mucous membrane by the addition of a little chloride of sodium. Just as in the pursuit of surgical asepsis, the mechanical element of the agent is regarded as more important than the chemical, so does the intelligent physician regard the simple washing of the diseased surfaces in the bowel superior to any germicidal action of chemical agents.

The lesson we would endeavor to enforce by the presentation of these facts, is the import of simplification in therapeutics, to which we have referred in previous issues.

Since the prevalent fallacious ideas on internal antisepsis may retard the progress of simplified therapeusis, we direct the reader's careful attention to the study of this important question of the day, in the light of the facts here presented.

SUCCESS OF THE PEOPLE'S BATH.

The recent Annual Report of the Association for Improving the Condition of the Poor of this city, publishes some statistics which must gladden every philanthropic heart.

As has been stated in the "Plea for Public Baths," published in the May, 1891, issue of the GAZETTE, this Association went energetically to work to carry into execution the plans presented to them by the author of this paper. The latter said:

"It is a rare experience to discover, in a society of lofty aims, such practical energy in the application of its principles. In the cause of hygiene I would express my highest appreciation of the prompt action of this benevolent association, and to hope that philanthropic people will contribute freely to an enterprise whose import to all classes of society cannot be over

estimated."

Their efforts have been crowned with success. The

number of baths taken during the past year were 61,226. Of this number there were 40,455 men, 7,575 women, 6,203 boys, 2,043 girls, and 4,950 small children.

In all cases except those of small children there was a charge of five cents for each bath, and with this was given a piece of soap and a towel. The receipts from this source was $2,813.80.

When it is considered that these 61,000 people were bathed in a building covering an area of 67 x 21 feet, the economical advantages of the rain bath adopted by the association (and described in the issue of May, 1891), becomes at once apparent.

It would seem that since the prophecy of the author of the "Plea for Public Baths" has been fulfilled, his appeal for the further development of this great benefaction, contained in the subjoined extract, is entitled to immediate recognition :

"While I have no doubt that this association will

successfully establish a good 'People's Bath,' the enterprise to furnish all that are needed in this great city, so over-crowded with the poor and needy, is too vast to be left to one benevolent body.

66 DUTY OF THE CITY AUTHORITIES.

"Being a subject intimately connected with the public weal, it comes within the legitimate province of the authorities of this city.

"It is a well-recognized axiom in political economy that the most important function of government is to protect the lives, liberties and property of its people. Since health is the most important of all its possessions, it becomes the duty of the government to guard and foster the latter at any cost. The vast sums expended for quarantine, for health boards, good water and food supply, etc., are expressions of this idea, that the preservation of the public health, which is

the aggregate of the health of the individual, is an important function. Health may be defined as the harmonious action of all the organs of the body and their normal relation to its environment. Whatever contributes to these ends is the lawful province of the government to consider. Every intelligent layman knows as well as the physician that cleanliness of the person is an important element in the problem of health maintenance.

"It requires no argument to prove that every consideration of law, propriety and sanitation demands. that our city authorities take immediate steps to secure to our laboring population near their dwellings, and in the school buildings, the houses, etc., the means of cleanliness and refreshment, health preservation and moral improvement, which the public bath is more capable of furnishing than any other more costly investment, and to sustain all benevolent societies who are striving in the same direction.

"It strikes me that the administration which will inaugurate such a simple system of public bathing, without the erection of costly buildings in the beginning, will write its record in the hearts of a grateful constituency, and thus erect for itself a monument more enduring than brass."

In response to this appeal Alderman Flegenheimer has induced the Board of Aldermen of this city to appropriate, last winter, the sum of $25,000 for the purpose of erecting one or more public baths, for use at all seasons of the year. For some unfathomable reason no practical result has been attained.

It is to be hoped that the incoming administration will signalize its advent by more energetic compliance with the wishes of the Board and the needs of the people. The recent cholera scare, which has left as an indelible lesson the imperative need of affording the poor better opportunities for cultivating cleanliness is "the writing upon the wall" whose warning must now be regarded.

Annotations.

THE ARTIFICIAL FEEDING OF INFANTS.

BY CHARLES S. SHAW, M. D., PITTSBURG, PA. There is a vast improvement in the artificial feeding of infants in the last two years; and the improvement is due, like most recent advances in medicine, to a recognition of the all pervading influence of bacterial life.

The investigations of the bacteriologist, which have so enlarged the power and scope of surgery which promise so much in the treatment of disease, have also had a most salutary effect upon the subject

under consideration.

Practically, we have but one substitute for the mother's milk, that is the milk of the cow. The

fresher and purer the milk the better, but with the modern method of treatment, the milk in the hands of the dealer is sufficient, so that the care and expense with which the anxious parent used to seek out peculiar excellences in the milk for the child are now largely removed. The endeavor is to make a food of this milk that will resemble the mother's milk as closely as possible.

The average of the analysis of human milk, taken from Rotch's article in the Cyclopedia of Diseases of Children is water, 86-89 parts; solids, 12-13 parts. These solids are: fat, 4 parts; albuminoids, 1 part; milk sugar, 7 parts; ash, 2 parts. Cow's milk shows, by the same authority, practically the same proportion of water and solids, but the solids are: fat, 4 parts; albuminoids, 4 parts; milk sugar, 4 parts; ash, 7 parts. Here we see the same amount of fat in each, but the cow's milk contains four times as much albuminoids, a little more than one-half as much sugar milk and more than three times as much ash. Evidently if we dilute the cow's milk with water till the albuminoids are the same in each, we will have only one-fourth as much fat, a little more than half as much sugar, while the ash will be nearly the same. Then by the addition of fat and milk sugar in the proper quantity to the diluted cow's milk, we make a mixture very closely resembling the mother's milk. But the cow's milk, as we find it in the market, is acid, while woman's milk is invariably alkaline. To remedy this we add lime water to the mixture, and the result is a compound that seems to be almost identical chemically with human milk.

For the preparation of 8 oz. of the mixture, as given by Rotch, take water, 3 oz. ; cream, 2 oz.; milk, 1 oz. ; lime water, one-fourth strength, 2 oz. ; milk sugar, 3 3.8 drams. One of the essential differences between cow's milk and woman's milk, that is removed by this dilution is the character of the curd. Undiluted cow's milk coagulates in hard and large curds, while the curd in woman's milk is very light and fine. The dilution of cow's milk with four parts of water, reduces the curd to about the same as that of woman's milk. This mixture resembles closely the old Meigs mixture that was so popular in Philadelphia a generation ago. In composition, appearance, taste and reaction it is almost a perfect imitation of human milk, but there is still a most important difference-the mother's milk is sterile; the mixture is not. It is the sterilization of the artificial food that is the great advance in modern infant feeding. The experience of the nursery long ago. taught that boiling the milk made it "keep better," and rendered it more acceptable to the infant's stomach. Reason would suggest that raw milk is the more natural, and therefore the better food for the child; and Raudnitz has demonstrated that boiling

the milk lessens its nutritive value, but in spite of these objections the boiled milk was preferred. The reason for this preference is that boiled milk is sterilized, and sterilization is of more importance than comparative nutritive value or digestibility. The reason for the well-merited popularity of condensed milk may be found in the same fact. Condensed milk, though a very imperfect food, chemically, is more or less sterile, and this compensates for all its shortcomings. Now, if we sterilize the mixture above described, we have counterfeited the mother's milk in every essential particular, and have, if not the ideal food, at least a very satisfactory one, and the best at present attainable.

This is done by heat. The most convenient way is by subjecting the mixture to a steam bath for twenty or thirty minutes, though any other method of thorough heating will answer. The only requisite is that the mixture shall be heated to a temperature of at least 212 degrees, and kept at that heat for twenty minutes or more. The vessel containing the mixture may be placed in a water bath and heated, or a steam sterilizer may be improvised with the kitchen utensil known as a colander, and a pot of boiling water. is, however, better both for efficiency and convenience to use some apparatus designed for the purpose. Various forms of sterilizers are on the market, and they may be equally good, but my experience has been limited to that known as the Arnold Steam Sterilizer, with which you may be familiar. It consists of an evaporating pan surmounted by a steam chamber, which holds a rack containing a number of 7 oz. graduated bottles. It is made of tin and is inexpensive. In using this apparatus the child's food for the day is prepared when the milk arrives in the morning. When making the mixture the lime water should not be added until after heating. Otherwise the food will have a straw yellow color and the taste will not be as pleasant, though the nutritive value and wholesomeness are not impaired. Sufficient of the mixture, without the lime water, for each nursing is put into each bottle, and the whole sterilized by thirty minutes steaming. The proper quantity of lime water is then added to each bottle, the neck of each is stopped by a plug of clean cotton, and as required they are used. In this apparatus the sterilizing bottles are used as nursing bottles, and very excellent ones they make. The plug of cotton is removed, the rubber nipple adjusted, and the mixture heated to about 100° in warm water. Any food remaining in the bottle after the infant has satisfied its appetite, is thrown out. This use of the bottle is not only a great convenience, but it also removes all necessity for disturbing or handling the mixture after sterilizing, and renders subsequent contamination of the food improbable.

to the child at each feeding depends of course on the size and vigor of the infant, and its digestive capacity. Biedert's law is two and a half ounces of the food to every pound weight of the child in 24 hours. During the first three months the babe may be fed every two hours during the day, and every four hours during the night. This would make ten feedings in the twenty-four hours, and, allowing one and a half or two ounces at each feeding, would amount to a pint or a little more of the mixture. There is always more likelihood of over-feeding than under-feeding. As the child grows the quantity of the food should be increased, and the intervals between the feeding lengthened. At six months the child may be taking four or four and a half ounces of food at each feeding, and a total of two and a half pints in the twenty-four hours. If the sterilizing bottle is not used in feeding the child, the best substitute is the ordinary nursing bottle, or a common prescription vial of four or six-ounce capacity. This bottle is surmounted by the common rubber nipple or teat. As found in the shops the perforations in this rubber nipple are frequently too minute, and should be enlarged. In the selection of the nipple care should be taken that it is neither too hard and unyielding, a common fault with those made of white rubber, nor so soft and flaccid that it will collapse, as some of the black rubber and red rubber ones do. The worst apparatus is probably that arrangement with the long rubber tube, so popular with lazy and ignorant nurses, and to be had at all drug stores. It is a device worthy of the invention of a Herod, and its sale should be prohibited by law. When feeding, the infant should always be held in the nurse's arms in a semi-upright position, and the bottle should be held by the nurse, and the flow of food regulated by tilting the bottle. There are several designs in nursing bottles for the admission of air through a valve, but none of them are satisfactory, and all are objectionable, because of the difficulty of keeping them clean. The nursing bottle and teat should be thoroughly cleansed after each feeding, and when not in use should be kept in a weak solution of soda or borax.

Up until the tenth month the best results will follow the use of this sterilized mixture to the exclusion of all other foods; but with the advent of dentition comes the ability to digest and assimilate other forms of food, and these may be judiciously added, keeping the original diet as the basis of nourishment. The common household preparation of flour, arrowroot, corn starch, etc., may come gradually into use, supplemented by meat juices and well cooked fruits. -Atlanta Med. Jr.

Treatment of Cholera.-Dr. Buxbaum, of The quantity of this sterilized mixture to be given Vienna, offers some statistics of Cholera Treatment,

whose good results demand careful attention at the present time, albeit it refers to a method which has been much neglected by the profession :

In 1832, Casper, of Berlin, seated the patient in a tub without water if patient was not perspiring, or filled partly with water at 90. Three to five buckets of ice-cold water were thrown upon the head, back and chest; alternating with this a stream of water was poured from some distance out of a pitcher upon the chest of the patient with some force. This was repeated every two to four hours. After the patient has been removed from the bath and placed into warm blankets, ice-cold damp compressers were placed upon the chest and abdomen. There is no fear of taking cold, as this is the best method of restoring warmth. Cold wet cloths were also placed upon the head, while the feet were wrapped in hot wet cloths. Internally, Casper gave all his patients cold water, ice and even cold beer. He also used cold enemata.

In Vienna, Guenther applied ablutions with cold water, combined with frictions with pieces of ice upon the entire body. The ablutions were made with sponges or cloths and they, together with frictions, were continued until warmth began to be restored, which occurred in five to six minutes. The patient was then dried quickly with moderately warm cloths and enveloped in warm flannels, when the surface usually began to grow warm. Internally, well-water was given in sips every two to three minutes, and pieces of ice every five to ten minutes.

Both of these methods found a large number of adherents and imitators, who employed them extensively. Guenther lost thirty-five out of one hundred, in one series of cases, and only eight out of forty-two in another.

Prof. Sachs, of Koenigsberg, says of this method : I regard its omission in the treatment of cholera, where it can be used, as a serious violation of duty.

Prof. Wagner said, in 1836, that these cold affusions, when the extremities are cold, pulse small and empty, and cramps frequent, were of the greatest service; their effect, if properly and timely used, are brilliant and scarce credible. The cold water awakens the peripheral nerve activity and relieves the leg

cramps.

Experience and statistics confirm the value of this treatment. Numerous reliable physicians testify to it being one of the most important means of treating cholera.-Blaetter J. Klin, Hydroth.

Medicinal Value of Fruits.-It should not be understood that edible fruits exert direct medicinal effects. They simply encourage the natural processes by which the acids are brought about. Under the category of laxatives, oranges, figs, tamarinds, prunes, mulberries, dates, nectarines and plums may be in

cluded; pomegranates, cranberries, blackberries, sumach berries, dewberries, raspberries, barberries, quinces, pears, wild cherries and medlars are astringent; grapes, peaches, strawberries, whortle berries, prickly pears, black currants and melon seeds are diu. retics; 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 authelmintic, 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 the teeth. Apples are correctives useful in nausea, and even sea-sickness, 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 uticaria, 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 incident dysentery. The oil of the cocoanut has been recommended as a substitute for cod-liver 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 demulcent.- Weekly Review.

Dangers of Washing out the Stomach. -Washing out the stomach is absolutely invaluable when employed in a rational way, but it is not altogether devoid of danger.

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1. The operation is sometimes followed by nerv ous symptoms of some severity. In cases of pronounced hysteria the passage of the tube may accompanied by an attack of convulsions. The most interesting nervous phenomena are those in which the symptoms resemble tetany. Bouveret and Devic have recently cited twenty-three cases, including two of their own. F. has found the records of two additional cases. There may be three distinct forms as regards clinical symptoms, simple rigidity of the muscles of the extremities, tetanic convulsions, or true

epileptic seizures. The three varieties may exist either separately or in combination, the more complex the case the greater being the danger of life. Death usually occurs either from coma or from failure of the respiratory centre, and may supervene within a few hours of the initial symptoms or be postponed for several days. Seventy-two per cent of the cases terminated fatally.

2. It happens, not frequently, especially when the operation is performed for the first time, that the patient is seized with a sensation of giddiness, or faintness, and the tube has consequently to be withdrawn. Such symptoms are seldom of any moment, and probably arise either from simple nervous excitement or from the fear of being choked. But we may also observe during the later stages of the operation, that similar phenomena are apt to develop themselves as a direct result of any sudden alteration in the intra-abdominal pressure. The case of a gentleman, aged fifty-three, attacked with symptoms of organic affection of the stomach, is cited. The disease was accompanied by rapid loss of flesh and strength. For a short time the stomach was washed out daily. Several weeks later the tube was again introduced and about a pint and a half of sour fluid was rapidly withdrawn, when, without any warning, the patient fell backward dead. There was cancer of the stomach and the heart muscles showed marked signs of fatty degeneration.

3. It is generally admitted that acute gastric ulcer constitutes a contra-indication to the use of the stomach douche. But cases of latent gastric ulcer are by no means uncommon, and in these cases the adoption of lavage will be attended by great danger to life. The author describes a case which he believes to be unique. A female aged twenty-five had suffered several months with symptoms of ordinary atonic dyspepsia. After a while it was decided to wash out the stomach. Little fluid was employed and the stomach was not unduly distended. Toward the end of the operation, violent vomiting and increase of epigastric pain came on. Acute peritonitis developed. A gastric ulcer had perforated into the peritoneal cavity. The mere passage of a tube may prove dangerous, in such cases, from the readiness with which it excites the act of vomiting.

4. Hæmorrhage is apt to follow aspiration of the stomach by the stomach-pump, but dangerous bleeding accompanying the use of the siphon has never been recorded. The accident does, however, occur sometimes.

5. The use of the stomach-pumps and bougies is attended with considerable liability to injury of the mucous lining of the œsophagus and stomach. If the attempt to pass a pliable tube has failed, it is safer to desist.

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Therapeutic Hints in Psychoses.-In the second report of his private institution for diseases of the mind at Erdberg, near Vienna, Dr. Svetlin gives the following valuable hints:

For artificial nutrition (by the tube) of the insane, who resist feeding, S. gives the following bill of fare: For the morning 3-4 litre milk, coffee and milk, or chocolate kakao or malt extract (70 750); the yolk of four eggs rubbed up with sugar; followed by 250 grammes red wine, and finally 150-200 grammes fresh water. In very asthenic cases 25-30 grains good cognac is daily added. In the afternoon 3-4 litre soup with 4 eggs; 1-2 litre beer (for emaciated patients, malt beer with the usual admixture), and finally 1,571 grammes fresh water. The soups are all concentrated and changed from pure beef tea (at first in very reduced patients) strong beef soup cooked with diastised pea or beanmeal, oatmeal, sago, barley, liver, brain, meat or potato purée, thin fluid vegetables, spinach, etc. To all these soups is added a tablespoonful of Kemmerich's meat pep

tone.

Among medicinal agents, syrup of the hypophosphites is praised as a specific in sexual neurasthenia and in irritable feebleness of the brain in the form of ready fatigue after acute psychoses and in the treatment for morphine habit.

Orexin is well thought of as an appetizer in atonic conditions of the stomach and in chronic gastric catarrh; it produces candialgia and must then be stopped. In eight cases of anxious depression opium proved a specific (Ext. Opii. 1.0 Ext. Coloc. 0.2 Pulv. and Ext. Rhei. q. s. ut. ft. pil. 100) in gradually increasing doses up to 0.2 to 0.4 per die. Codeia proved itself a useful substitute for morphia in hemialgia and local spasms. Coca and cocaine acted badly. The effect of 1 gramme of sulfonal was enhanced by the addition of 0.03-0.05 codeia, especially in agrypnia on a neurasthenic basis.

Atropin cured one severe case of hystero-epilepsy. Chloral was usually combined with ext. ergot to prevent its vaso-paretic tendency.

The following hydrotherapeutic procedures were adapted to the psychoses: Prolonged lukewarm baths in condition of excitement not based upon exhaustion; wet packs (14 to 2 hours) in maniacal not too violent paralytics, and in conditions of depression. -Deutsch Med. Zeitung.

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