JUNE, 1903]

ities of the larger communities, in which the so-called dairy milk is used, should have a watchful eye. Many of the dairies of larger cities are not sanitary. The animals are kept in dark, narrow, unclean quarters; their food and drink are not the best; and is it any wonder that the milk becomes contaminated right from the beginning?

If the infant is bottle-fed, the proper modification of cow's milk is of importance. It should be changed very carefully in its composition to suit the age, strength and other requirements of the child. Cow's milk improperly modified will interfere much with the general welfare of the infant. The digestiv organs are very apt to suffer on account of it, and different forms of gastric and intestinal indigestion are the consequence. A weak digestion very much predisposes to the infections of the alimentary canal. I will not here describe rules how to modify cow's milk for infant feeding. That would take too much time and space. Nevertheless, every physician who treats these little ones should make a close study of that point. There is abundant good literature on the subject, which is indeed a good and profitable investment for the physician.

Supposing, now, that the milk is properly. modified, then comes the all-important point, namely, to keep the milk free from contamination. The mothers and nurses should be instructed to keep the milk in air-tight containers. These, of course, should have been rendered carefully clean. The milk should be kept in a cool place, preferably an ice box. The nursing bottles, the rubber nipples, all should be cared for with the utmost diligence. The nursing-bottle containing milk should not be allowed to stand around the room or lie within the crib while the baby is not using it, possibly or probably to be stuck right back into that little mouth at the first outcry. There should never be more milk put into the bottle than the child can take at a single meal. soon as that meal is finisht, the bottle and nipple should be thoroly cleansed and scalded, which should be repeated just before both are used again. We must impress these mothers and nurses with all means in our command that it takes but little carelessness to render the milk absolutely unfit, yes poisonous, for the child. The mouth of the baby, be it bottle-fed or breast fed, should be kept carefully clean. The strict cleanliness of the mother's breast is a thing of much importance; and yet how many mothers can be found that neglect this precaution! The baby's hands should receive proper attention as to cleanliness, for these little members are often put on or into things neither clean nor sanitary, and

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247

from these directly into the mouth. The diet of the child during the first two years of its life should be mainly a milk diet, especially so if the baby is not overly strong, so that the stomach and intestins may properly dispose of all food. People, as a rule, are too apt to overtax the stomach of the infant. With a faulty digestion once set up, inflammatory and infectious conditions are very apt to follow. It is needless to say that milk should be heated to the boiling point and then cooled to the necessary degree before it is given to the baby.

So much for the prevention. What measures should we employ for the cure? Supposing we are face to face with a serious case of milk infection. The patient before us is suffering under severe systemic infection. His little body is simply overpowered by the poison within. Here are the frequent discharges from the bowels, which, by the way, is a universal symptom in all alimentary infections of infanthood. We find, perhaps, high fever, or possibly a temperature subnormal, which indicates collapse, frequent vomiting, pincht expression and markt pallor of the face, restless tossing, or possibly coma, and markt emaciation. In short, we find the little body overwhelmed by the deadly toxins peculiar to these diseases. Let us treat such a case on the same principle as we would treat any other case of poisoning. First, let us remove as much of the toxic material within the stomach and bowels as is possible. Nothing is so efficient. as the prompt use of the stomach-tube to cleanse that organ thoroly, and the high enema to empty the colon and rectum of these irritating contents. A No. 14 male soft rubber catheter is an admirable instrument as a stomach-tube for ir fants. By attaching to the catheter a short piece of rubber tube and a small funnel one can easily improvise a perfect instrument with which to practise lavage in the infant. The operation is easy; anybody can do it. It is next to impossible to place the catheter anywhere but into the esophagus. The washing of the stomach can be repeated severa! times in twenty-four hours should the vomiting persist. The fluid to be used is warm water at a temperature of about 70° to 85° F., to which I usually add 20 gr. of boric acid to the quart. I use from one to two quarts for each lavage, according to age and according to the amount of material to be removed. One should keep

on washing out until the water returns clear. The child seems to have but little discomfort during this procedure. The colon should be well washt out with warm water, or with cool water, if the temperature requires speedy reduction. The stomach ard lower bowel once carefully emptied of all irritating and fermenting material, broken doses of calomel should

be given by mouth until 1⁄2 gr. to 12 gr. is given altogether. Calomel given that way seems to quiet the stomach and will free that portion of the gut of its contents which cannot be reacht by the enemas.

But

After that is done, our next step is to allay the terrible irritation within stomach and bowels, to allay the existing inflammatory conditions, to check the frequent watery, mucous or bloody discharges. Bismuth is here doubtlessly a drug of value. Its action is slightly astringent. Its main good is done by the mechanical protection it renders the inflamed mucous membrane. It covers the mucous membrane with a fine, film like coating, and thereby more or less prevents the toxic irritants coming in contact with it. in order to have this effect it wants to be given fearlessly in large doses. Fifteen to twenty grs. repeated every two or three hours to an infant a year old is not too much. A chemically pure subnit. of bismuth can do no harm, even in much larger doses. I like to add to the bismuth small doses of carbolic acid, m. to 1⁄2, on account of its quieting effect on the stomach, as well as on account of its antiseptic action; tho I personally believe that the theory of the so-called intestinal antiseptics is rather far fetcht, as we dare not give any of them in sufficient quantities to do much good as an antiseptic. All opium preparations should be avoided as much as possible. They usually do much more harm than good. If on account of very severe pain and tenesmus an opiate must be given, the hypodermic use of morphin or the rectal use of tr. op. deod. is to be preferred. Generally, tho, warm flushing of the lower bowel to which some cornstarch may be added for its soothing effect, and hot external applications, especially in the form of turpentine stupes, will be found sufficient to allay pain and tenesmus in most cases. If there is fever, higher than permissible for the safety of the patient, it should not be reduced by coal tar preparations or other motor depressants. These drugs will only temporarily reduce the temperature, while the true causes for the fever, namely, the toxic condition of the blood, the poisonous material within the body, is not influenced by the fever reducing agent. Remove the cause, and the fever will leave by itself. Not alone do the coal tar preparations and other antifebril agents do no good, but they do positiv harm, by still further depressing an already deprest system; and by still further oppressing an already opprest heart. Here we need stimulation, not depression. The rational way of reducing high temperature is by the bath; either tub-bath or sponge-bath. The temperature of the water should not be low enuf to

cause a shock to the child. The preference of the writer is the lukewarm sponge-bath with the addition of vinegar, followed by the rubbing of the body with pure alcohol. Alcohol used thus does not alone reduce temperature; but to some extent acts as a tonic and stimulant. The sponge-bath and alcohol rub can be repeated every fifteen to thirty minutes when necessary. when necessary. Besides the application of water to the skin, the introduction of water of moderately low temperature into the bowel is an excellent measure with which to reduce the fever in these cases. In this connection we should not lose sight of the great susceptibility of the nervous system of the child. The most sensitiv part of a child's body is its nervous system. It therefore does not take much irritation to produce convulsions in the infant. Consequently we must guard against this occurrence by keeping the little brain cool and free from hyperemia until the other methods employed have freed the system of those elements instrumental in causing convulsiv seizures. The ice-bag to the head and heat to the extremities are in order in those cases with high temperature. This, along with bathing, will offer a fair chance for the prevention of convulsions and the possible occurrence of a cerebral meningitis, a complication which is by no means so very uncommon in these diseases.

The frequent discharges from the bowels. drain the system of its fluids. We must endeavor to substitute this loss by introducing into the body by mechanical means as much fluid as possible. Plenty of good water by the mouth, if the stomach will tolerate it, is essential. The normal salt solution, either per rectum or subcutaneously, is a thing of the highest value. We should introduce this solution into the rectum as high as possible and try to retain it there until absorption has occurred, if necessary with the help of a few drops of tr. op. deod. But where, on account of extreme irritation or inflammation of the gut, this cannot be done, the subcutaneous method should promptly be practised in all critical cases. I am so convinced of its true value, not alone in supplying the body with much wanted fluids but also as a heart stimulant, that I firmly believe that a physician has no right to allow the little patient to succumb without having employed the salt solution in the given way. If used subcutaneously, the salt solution should not be cooler than 100° F., and as the fluid always loses some of its warmth passing thru the tubes of the transfusion apparatus, the solution with a temperature of 110° F. would not be too high. Much depends upon the proper temperature of the transfusion fluid. One of a temperature below

It is needless to say that these patients need stimulants, and some of them plenty of them. The heart in these cases is bound to be opprest, and it easily succumbs under the great amount of poison circulating thru it. Alcohol in the form of good brandy or whiskey should be here the main standby, either given in small, frequent well diluted doses by the mouth, rectum, or hypodermically. Strychnin, ether or camphor hypodermically is also to be recommended in extreme cases. As I mentioned before, I believe that the thoro rubbing of the skin with pure alcohol is of some value as a stimulant. If the temperature is subnormal, the skin cold and clammy, in short, symptoms of collapse apparent, the little patient should be wrapt in a warm woolen blanket and should be surrounded by hot water bottles. All means commonly used in collapse should be promptly employed, most of which have been mentioned in this paper.

In conclusion, I will say a few words in regard to the diet of these patients. This is indeed a very important factor and deserves a place at the head rather than at the end of this piper.

Milk, be it mother's or cow's milk, should be promptly stopt as soon as the child shows symptoms of any of these conditions. Milk is a fertil culture medium for the bacteria responsible for the trouble. We should no more think of feeding these patients with milk than we should try to extinguish fire with oil. By giving milk we add that which we should endeavor to take away. Milk should be omitted for at least from one to three days or longer, until the frequency and character of the intestinal discharges show that the natural digestiv forces are being reestablisht, and the pathological condition of the gut have changed. for the better. Then the milk diet should be resumed carefully and gradually, and stopt again with the first apparent sign of possible mischief. In most cases the artificial peptonizing of the milk is a thing of great value. Barley water, rice water and oatmeal water, reinforced by a few drops of brandy, are proper means of supporting the child while milk is omitted. Of these, barley water is doubtlessly the best, especially as it is slightly astringent. Oatmeal and rice water are less to be recommended because they are rather laxativ. Beef-juice can safely be given in most cases, and is an excellent supporter of the vitality of the child.

During convalescence we should endeavor to supply the child with blood and fat-producing tonics. Plenty of outdoor air and sunlight are most essential. In fact, it is a good thing to

even during the course of the disease, if the weather permits. I find that strips of good breakfast bacon heated thru on the spider but not enuf to deprive it of its fat, is eagerly suckt by the infant, and it supplies its body with much-wanted fat. It agrees with the digestion in nearly every case. Good, pure cream, somewhat diluted, is another good fat-producer. The addition of lime water to the latter, in fact to all milk given, is of value, as it counteracts the formation of acids within the stomach.

We should not forget that the frequent irritant acid discharges from the bowels will readily set up a painful cor dition about the genitalia. Frequent bathing with an alkalin solution and the use of a soothing ointment will save much suffering for the patient.

This paper has described a line of treatment when confronted with a serious case of summer complaint. In the milder forms, of course, the methods to be employed need not be as radical in every point; nevertheless, the principles as laid down I think hold good in all EUGEN COHN, M.D.

cases.

This makes a thick mixture which is not unpleasant to take. If syrup be not desired, use tincture of ginger with water or mucilage of acacia. The salicylate or the subgallate of bismuth is a good substitute for the subnitrate.

Dr. Thos. H. Hammond, of Wildwood, Fla., suggests that a small amount of powdered ginger be substituted for the syrup of ginger, so that it can be carried by the physician and given in powder.

Diarrhea and Dysentery.

Editor MEDICAL WORLD:-Pursuant to your request, I inclose formulæ of the remedies which have proven in my experience well nigh specific for the class of diseases with which we will be deluged in the next few months.

of infants and young children. In every case reduce patient to liquid diet; if weaned, milk and lime water and egg (white) or albumin water; keep perfectly cool and quiet.

If dysentery, use same formula, after initial dose of calomel in dose suitable to age, and wash out bowel after each evacuation with euthymol, listerine or glyco-thymolin, an ounce (3) to the pint. The formula of these alkalin antiseptics being similar and their results, in my experience, being the same, I employ them. without distinction.

M. Sig.-Teaspoonful in water every two hours until stools clear of blood. Irrigate bowels after each evacuation with saturated boric acid solution or alkalin antiseptics mentioned above.

Should this fail, suspect the presence of the amœbæ coli and use injections of quinin sor to . This failing, the best procedure with which I am acquainted is the injection of solution nitrate of silver twenty grains to pint of warm water. A cocain suppository or a small injection of starch water and laudanum should always precede the silver injection on account of the pain it otherwise might occasion.

The most important factor in the treatment of all these cases is undoubtedly that of diet. Fresh air and daily bathing should also be insisted upon.

I would suggest to Dr. Davis, page 225, May WORLD, that he bleed his patient and give her a thoro course of depletion.

I wish to thank the Editor of THE WORLD for the excellent showing up of the St. Louis editor in the "Talk" in May WORLD. This has been sorely needed for a long time, and since the initiativ has been taken, it is to be hoped that other legitimate medical journalists will take some interest in airing the selfish methods so long and cunningly followed. Missionary work is sadly needed among the class of doctors who would follow a leader calling bacteriology "bugology," and the serums "horse-juice,' and, worse still, he is an anti-vaccinationist. Such doctrins are impediments to progress and a menace to public safety. Alpine, Ala.

CHARLES T. ACKER.

Never neglect to ascertain the cause of post-climacteric hemorrhage.

Never neglect the treatment of acute or chronic otitis media.

Don't use aloes in hepatic congestion, pregnancy nor proctitis.

Remember that ex: thyroid, altho contraindicated, may do good in Graves' disease.

Purdy's Test for Sugar.

Editor MEDICAL WORLD:--In testing for sugar I have used Purdy's test for years and find it reliable, easily applied and it will keep for months. It is in one solution and is a modification of Fehling's test.

R

Cupri sulf.

Potass. caust.
Lig. ammon. fort.
Glycerini

Aq. dest., ad

3xx Dissolve the copper and glycerin in giv of water by heat; dissolve the potassa in iv; mix, and when cold add the ammonia; afterwards water to twenty ounces.

In using this I vary Purdy's method, but it is in reality the same. Boil one dram of the test in a test-tube and add the urin, drop by drop, boiling after each addition. Stop as soon as the blue color of the test solution is discharged. Divide 16 by the number of drops of urin required, and the quotient will be the number of grains of sugar to the ounce. For instance, it takes 16 drops of urin to decolorize the test fluid; 16 16 gives 1, showing 1 grain of sugar to the ounce. Should 8 drops decolorize it will show 2 grains to the ounce. require 40 drops, it will show two-fifths of a grain. Any quantity can be immediately calculated in the head, as well as the percentage. Should there be a large quantity of sugar (in 1894 I was passing 10 percent by my own calculations and by those of Professor P. B. Wilson and another well-known chemist; now I pass merely a fraction of a grain and eat all kinds of food) add 4 parts of water and multiply the result by 5.

Should it

Here is a modification of Purdy, but I find it not superior, yet as good and is used in the

Safety-pin Lodged in Posterior Nares. Editor MEDICAL WORLD:-Ralph D. was born December 23, 1901. January 11, 1903, he swallowed (?) a closed, medium-sized safety-pin. He was very nervous, crying frantically, nose bleeding a little, everybody excited. His aunt

came very near getting it as it passed down his throat." I advised them to give no cathartics, and to watch for the pin. After relating a similar case or two, as reported in THE WORLD, I left them resting easier but more or less apprehensiv of future danger. Ralph was soon cheerful as ever. Days, weeks, and months passed, but no pin. Notwithstanding Ralph's good health his parents became restless. About April 27 I advised Mr. D. to take Ralph to my friend, Dr. S., specialist, and have him examin the posterior nares, stating that it was possible, but not probable, the pin could be above the palate and cause no trouble. He took him to Dr. S., April 30, who, after a casual examination, was about to send them away with the assurance that nothing could be wrong with Ralph. Mr. D., however, insisted on a more thoro examination, which resulted in the removal of an open safety-pin, one and onehalf inches wide and one inch from point to shield, from above the palate. There were no symptoms to indicate the location of the pin. Chattanooga, Tenn. JOHN B. LEE, M.D.

A Few Suggestions.

Editor MEDICAL WORLD:--In membranous croup try inhalations of steam impregnated with adrenalin, 3j; aq. calcis, 3j. Sig.: Use in a steam atomizer. Give internally half dram doses fl. ex. jaborandi, and cold compress on neck.

Pot. iodid and pilocarpin will aid your expectorant mixture in liquefying the secretions. I consider the first named remedy very valuable in one to three grain doses every two hours.

In gonorrheal ophthalmia in adults, try 50 per cent sol. of protargol once daily over eyelids.

In acute "weeping" eczema, try equal parts of formalin and glycerin applied once every two or three days. It will burn and smart at first, but soon stops.

In vomiting and sick stomach of pregnancy, one good remedy in a hundred indifferent ones is glycozone or equal parts glycerin and hydrogen dioxid, which is about the same thing. This also sweetens the breath in catarrhal condition of stomach.

I cured long standing tropical leg ulcer in the Philippines with big hot flaxseed poultices at night, and aristol and firm bandaging in daytime. If much induration and inflammation, soak entire limb in very hot boracic solu

tion for an hour daily, using a deep milk can to hold the solution. Follow this with a large cotton pad well soakt with glycerin and ichthyol (10 per cent). After a week or so and leg and ulcer look bleacht, use europhen or aristol, strap tightly and bandage with a web elastic bandage. If ulcer is very indolent, use bovinine instead of the powder on a gauze pad. Renew all dressings every other day.

Try ten to twenty grs. three times daily of ichthalbin in tablet form for your acne rosacea. Fl. ext. berberis aquifol in large doses will benefit your other kinds of acne wonderfully.

Just on my say so try an old fashioned and homely remedy for erysipelas for the local treatment, and I promise faithfully you will throw ichthyol to the dogs. Put one or two quarts, according to area involved, of uncookt cranberries into a linen bag and mash them up thoroly so the juice of the berry soaks thru. Apply this and change every six or eight hours. You will be astonisht at the results. I am speaking from an experience of seventeen years when I say I would not trade a half bushel of cranberries for a car load of ichthyol in erysipelas.

Don't overlook a valuable old friend in giving mercury-blue mass, ten to fifteen grs., followed in six or eight hours by a saline.

Wish I could hand out some bouquets to antiphlogistine, but I can't. Glycerin and ichthyol are ten times more effectiv, and I have repeatedly tested them both.

My gonorrheal cases all seem to do well on forty to fifty grains daily of salol and an injection of protargol and berberin sulfate, ten to twenty grs. of each to six ounces of water. I would lose many patients if it took me six to eight weeks to cure a specific urethritis, as many write about.

Give us more of homeopathy or any other pathy if they will only make good their promises. I've culled many useful remedies from the eclectics. Show me and I'm willing to learn and I don't care a snap what school they do or don't belong to.

Hanley Falls, Minn. W. M. BECK, M.D. Ohio Med. Col., '86; Jefferson Med. Col., '90; ex-Ass't Surg. 13th Minn., Army of the Philippines.

Removal of Tapeworm.

Editor MEDICAL WORLD:--During my early years of practise I met with many failures in the treatment of this affection. In my opinion, many of the prescriptions given in THE WORLD and other medical journals would prove very uncertain in expelling a tapeworm. Now, after years of experience, I know how to get rid of these parasites. "Who heeds not experience,

trust him not." In order to be successful in the treatment of all diseases one must have