The Medical World

C. F. TAYLOR, M.D., Editor and Publisher

A. L. RUSSELL, M.D., Assistant Editor

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Language is a growth rather than a creation. The growth of our vocabulary is seen in the vast increase in the size of our diction. aries during the past century. This growth is not only in amount, but among other elements of growth the written forms of words are becoming simpler and more uniform. For example, compare Eng. lish spelling of a centnry or two centuries ago with that of to-day! It is our duty to encourage and advance the movement toward simple, uniform and rational spelling. See the recommendations of the Philological Society of London, and of the American Philo logical Association, and list of amended spellings, publisht in the Century Dictionary (following the letter z) and also in the Standard Dictionary, Webster's Dictionary, and other authoritativ works on language. The tendency is to drop silent letters in some of the most flagrant instances, as ugh from though, etc., change ed to t in most places where so pronounced (where it does not affect the preceding sound), etc.

The National Educational Association, consisting of ten thous and teachers, recommends the following:

"At a meeting of the Board of Directors of the National Educational Association held in Washington, D. C., July 7, 1898, the action of the Department of Superintendence was approved, and the list of words with simplified spelling adopted for use in all publications of the National Educational Association as follows:

securing the general adoption of the suggested amendments-> IRVING SHEPARD, Secretary."

We feel it a duty to recognize the above tendency, and to adopt it in a reasonable degree. We are also disposed to add enuf (enough) to the above list, and to conservativly adopt the following rule recommended by the American Philological Association: Drop final "e" in such words as "definite," "infinite," "favorite," etc., when the preceding vowel is short. Thus, spell opposit,' preterit," "hypocrit," "requisit," etc. When the preceding vowel is long, as in "polite," finite," unite," etc., retain present forms unchanged, We simply wish to do our duty in aiding to simplify and rationalize our universal instrument-language.

Death of Dr. I. N. Love.

As we go to press we are startled and grieved to learn of the sudden death of Dr. Isaac Newton Love, of New York, formerly of St. Louis, the brilliant editor of the Medical Mirror. He was just returning from Paris, and died on the steamer while at quarantine just out of New York. Dr. Love had a remarkable personality-genial, sympathetic, and always interesting. Perhaps no medical man in the country was more widely known, personally, than he; and his death will be felt as a personal loss to more doctors than would be the death of perhaps any other medical man in the country. At medical meetings, no social circle was complete without Dr. Love. Very few men can go to New York City in middle life and build up a practise amid the keen competition of the leaders of the profession there, but Dr. Love was rapidly doing it. His untimely death while at the threshold of a lucrativ practise among New York's best people is very sad. Every door, whether of rich or poor, humble or aristocratic, opened gladly to Dr. Love's attractiv personality. He will be sadly missed. He leaves a widow, a beautiful daughter and an unusually promising son, Mr. Hodgen Love, who possesses his father's attractiv qualities in a high degree. While only eighteen years old, he seems like a man of twenty-five; and he is already business manager of The Medical Mirror.

Examinations of Children Should be Made Carefully and Completely.

It is a known fact that not only is the greater part of the general practician's work among children, but that his success in gaining and holding practise among adults depends in great

part on the methods he employs and the results which follow his treatment of children. Yet the infant and the young child are too frequently given only a cursory examination unless the severity or immediate danger of the case forces the physician to his immediate and complete duty. Even with only a minor complaint the examination of these little patients should be thoro and painstaking, for frequently unsuspected complications or aggravating influences will be thus discovered which would otherwise have been overlookt.

When possible, always examin a child when sleeping, as far as you can proceed without awakening it. In this way you get its actual pulse and respiration before the child becomes alarmed or excited by your presence. The position assumed in sleep, and the expression of the face, as well as the position and actual state of quietness of the extremities often yield information of diagnostic value. While sleeping, the eyes and mouth should be closed. Existing pallor or flushing of the face and lips can be noted, and the condition of the skin ascertained better in sleep. If the child be very young, note the condition of the fontanelles.

Now have the nurse gently waken the child, placing yourself in a position where you can observe its expression on awakening. Note if the expression denotes apathy, anxiety, undue excitement, or other abnormality. Note the changes in pulse, respiration, flushing of the face, etc. Examin the tongue and gums. Auscult the chest from the rear; you can get just as much information as in front, and you frighten the child less. Percussion nearly always frightens a child, and should be the last method employed.

Next have the child stript of all clothing, and placed in a good light, and away from any draught. The temperature may be taken in the groin while proceeding with the examination, and the child's attention is thus distracted from the presence of the thermometer. Inquire if there has been chill, cyanosis, convulsion, or vomiting; any of these may have been the initial symptom, and yet have been so slight that no mention will be made of the matter unless the direct question is askt. Pain in various parts of the body is often manifested by rapid or moaning respiration, without any involvement of the respiratory apparatus. If there has been vomiting, examin the vomitus, if possible; if none has been preserved, get as accurate a description as possible of its character, including frequency, amount, constituents, color, odor, etc. Examin the abdomen for tenderness and distention, and percuss the bladder gently for the presence of urin. Inquire as to color and odor of urin and the fre

quency of its passage. Look at the anus to exclude irritation, rhagades, prolapse, etc. Examin the prepuce or clitoris, and the vaginal introitus or scrotum. See that there is absence of skin eruption on all parts of the body, and if any be found, be cautious in expressing an opinion too hastily. Flex and extend the joints, and note carefully if pain is elicited by such motion. See if undue flaccidity of any muscle or group of muscles be present. Have the child laid down and raised up, and make sure that there is no spinal tenderness.

Such an examination will give the nurse confidence in your ability and will reinforce your diagnosis in your own opinion. Numerous other points will occur to you as soon as you become accustomed to making all your examinations of children in this thoro manner, and you will become a better diagnostician and a better practician because of it. The wide spread carelessness with which children. are examined is due, not to ignorance on the part of the profession, but to the simple fact that they have never really considered what an actual examination of a child involves and implies.

Caution in Diagnosis Desirable in Cases of Unconsciousness, without History.

In such cases the examiner must often think quickly and act with celerity; yet he should never become so confused as to be led into a rash diagnosis. The consequences of error in such cases are grave and far reaching. Not only may a mistake result in chagrin to the physician, but it may directly contribute to the death of the patient.

Not every man found unconscious on the street is intoxicated, even tho his breath may be loaded with the fumes of liquor or his pocket contain a partially emptied flask. Even drunken men are subject to disease and accident just as sober men. The first passer-by who finds an unconscious man is apt to try to pour whiskey into him in efforts to revive him. It is no uncommon thing that whiskey is used as a vehicle for poisonous or narcotic drugs. A man may have taken liquor and have been injured or become ill afterward, and yet not have been even slightly intoxicated. For these reasons it is plain that a diagnosis of intoxication is all but impossible, and should rarely be made without extraneous evidence. Newspaper accounts of men being pickt up unconscious on the street and consigned to a cell to "sleep off their load," and being found dead in the morning, and the autopsy revealing a meningeal hemorrhage from traumatism or disease, are becoming all too common.

Among the things of which every physician should think immediately on being sum

moned to an unconscious man found in any public or unfrequented place, are (1) fracture of the skull from accidental or purposeful traumatism; (2) opium poisoning, accidental or intentional, suicidal or homicidal; (3) coma, diabetic or uremic; (4) apoplexy; (5) concussion of the brain from fall or blow; (6) alcoholism; (7) epilepsy.

In the hyperemia from injury at the base of the brain it is often impossible to exclude opium poisoning, for in both cases we find the patient in a stupor, with contracted pupils, yet who can be temporarily aroused, and whose symptoms are not confined to one side. Given such a case, it is best to be on the safe side, and wash out the stomach. It is best to wash out the stomach even if the pupils are dilated, since atropin is frequently mixt with morphin. in quantity sufficient to inhibit the contraction of the pupils from the morphin.

In deep drunkenness the pupils are widely dilated; the breathing is stertorous, with lips and cheeks "puffing" with each expiration; the extremities are as limp as if actually paralyzed; the face is pale, the pulse weak, and the patient in a practical coma. The odor of liquor may or may not be discernible.

Fracture at the base of the skull and cerebral hemorrhage are easily confused, especially if there be no external evidence of traumatism. It must also be recalled that syphilitics are subject to hemorrhage in the brain. Examin for syphilitic scars or other evidence of lues in all such patients.

When thinking of epilepsy examin the tongue for scars, the teeth for fractures, the inner side of the cheek for scars or fresh cuts from teeth, and scars or recent injuries about the front part of the head such as may have been produced in falling.

Every unconscious person found under unexplainable circumstances should be catheterized immediately and the urin searcht for evidence of albumin and sugar, and if possible for

urea.

Under no other circumstance is the physician so tempted to jump at conclusions; yet under no other condition is rashness less excusable.

Buttermilk as an Infant Food.

For some time past buttermilk has been used as an infant food in Germany and Holland with reputed good results. It is now attracting some attention in this country, and we may soon see lengthy articles concerning it from the pen of the man who knows nothing from clinical experience about handling either infants or infant foods.

The buttermilk is prepared from cream which has been passed thru a centrifugal ma

chine, and to which cultures of the lactic acid ferment have been added, eighteen hours before churning. When prepared, the food contains 34 percent of albumin, 2 percent of fat, 10.3 percent of carbohydrates, and 1⁄2 percent of lactic acid. It is prepared by taking I liter of the buttermilk and adding to it 35 to 55 grams of cane sugar and 15 to 25 grams of fine wheat or rice flour; the mixture is boiled for five minutes, strained thru a steril cloth and placed in steril bottles on ice to await the demand.

It is said to act nicely in fermentativ diarrheas and in intestinal disorders after the acute stage has passed. The resultant stools are smooth and pasty, of neutral or alkalin reaction, and contain very few proteolytic bacteria. The casein of the buttermilk exists as fine flocculi which are readily digestible. The high acidity retards the growth of bacteria.

So read the reports. We predict that this form of infant feeding will never become popular in America. Doubtless extremists will try it, and doubtless many little ones will suffer for it. The reports indicate that its field is limited and that many infants cannot take it, and the indications for its use are not clearly stated in the reports. Admitting that lactic acid is beneficial in some forms of diarrhea, we could not sanction its indiscriminate use as a food. Some practicians are preparing to test the method here, but the difficulty of obtaining the buttermilk from centrifuged cream, the expense of the method, and the popular prejudice sure to rise against a mixture of acidulated milk, flour, and sugar, will probably hold the experiment in check. We hope this notice will prevent a deluge of inquiries regarding the method, and we advise ultra conservatism concerning it, at least until much further work has been done and completer reports are made.

A Reminder Concerning Consumption.

Are you still prescribing tonics, close rooms, invalid diet, etc., for consumption? We have frequently mentioned and urged the open air treatment, but many cling tenaciously to antiquated ideas and cling, and cling, and cling! The tripod upon which the rational (and successful) treatment of "the great white plague' rests is composed of open air, food, and rest. "Open air" does not mean a walk or a ride of an hour or so per day, but it means living in the open air practically all the time, night and day, regardless of the weather or season. it can be done. If your delicate and sensitiv patient says "I can't," refer her (or him) to the splendidly illustrated series of articles on the subject in the June number of the American Monthly Review of Reviews (13 Astor place,

Yes,

New York City; $2.50 per year, or 25 cents per issue).

Here is the dietary of a recently establisht hospital for consumptivs. The patients eat nine times a day, as follows:

6 a.m.: A breakfast of cereals, bread and butter, coffee, and beefsteak or poacht eggs.

8 a.m.: Cod-liver oil, with whiskey or sherry. 10 a.m.: Eggnog.

12 m.: Dinner, consisting of soup, beef or mutton, potatoes, another vegetable, and bread.

2 p.m.: Cod-liver oil and plenty of sherry.

3 p.m.: Beef tea.

4 p.m.: Eggnog.

5 p.m.: Supper of pudding, a soft-boiled egg, bread and butter, and tea.

8 p.m.: Hot or cold milk.

Open air life increases the appetite; oxidation is increast, hence metabolism is stimulated and nutrition improved. While camp life in the country is preferred, it is possible on a city lawn, and open air life is also possible on open porches in a city. The difference in the open air in country and in city is really not as great as one would think.

Nine hours sleep is prescribed, and most of the day is spent sitting or reclining out in the open air, with wraps according to the weather. Of course, patients should be kept warm, day and night, but this can be done with wraps in all kinds of weather, a hot water bag to the feet being useful occasionally. It is well to begin open air life at this season of the year and extend it into or perhaps thru the winter rather than to begin it in cold weather. It is scarcely necessary to say that the patient should be tranquil in mind, and "at peace with all the world."

Normal, freshly voided urin of acid reaction, contains no sediment except a trace of flocculent mucus which may include a few epithelial cells or mucus corpuscles. If the urin be alkalin, as it generally is in three or four hours after a meal, it may be cloudy when passed and quickly deposit a considerable bulk of earthy phosfates, which will immediately disappear on addition of acetic acid. If normal urin is allowed to stand in a cool place, it will deposit a pinkish or colorless sediment of amorphous urates which disappear immediately when the urin is warmed; such a deposit may contain crystals of uric acid, octahedral crystals of calcium oxalate, bacteria from the air or other source, and spores of the yeast fungi. When a urin becomes alkalin thru decomposition, hosts of bacteria are present, and there is a deposit of phosfates, both amorphous and crystallin. Urinary sediments are examined chemically and by the microscope; the microscope often failing to reveal the exact nature of

certain sediments. The sediment is obtained for examination by the method of allowing to settle, or by the centrifuge; the latter is speedy and more reliable. If allowed to settle, the glass should have parallel sides and a concave bottom, with a smooth top which will admit of closely covering with paper or glass to exclude dust or other foreign material. Twelve to twenty-four hours are required for the settling, and if no preservativ be added the urin may undergo alkalin decomposition before the sediment settles. Thirty cubic centimeters of a saturated boric acid solution to each glass will preserve urin during sedimentation, and does not in any way interfere with any examination. Formaldehyd, chloral, chloroform, salicylic acid, etc., are all open to objections as preservativs. The greatest objection to the centrifuge is that because of the great concentration of which it is capable it may deceive the investigator as to the relativ amounts of sediment present in a certain quantity, or it may so condense the sediment that the discovery of casts is almost impossible.

The pipette, slides and cover-glasses, and settling glass should be of good clear glass, and always kept perfectly clean and free from dust, ready for immediate use. The pipette is closed at the upper end with the tip of the index finger and the point lowered into the sediment. The finger is then slightly raised and the sediment enters the pipette unmixt with urin. Withdraw the pipette and wipe dry from end to point. By slightly moving the index finger a drop at a time may be obtained, and a drop should be placed on several slides and covered at once with the coverglasses. Examin first with a low power and then with the higher. If the sediment be bulky, it is well to take a few drops from the upper layer, and then to make another examination from the bottom of the sediment, so that both the lighter casts and the heavier crystals may be obtained. Sometimes the casts and cells are too light to settle, but remain as a cloud at the upper surface of the urin; in such a case, examin a few drops of such cloud.

Urinary sediments are either anatomic, or organized; or chemic, or non-organized. The organized elements are:

1. Epithelium.

2. Nucleo-albumin (mucin). 3. Blood.

4. Pus.

5. Casts.

6. Spermatozoa. 7. Fat.

8. Fibrin.

9. Fungi and infusoria.

10. Particles of morbid growths. II. Parasites.