of the treatment above described, I have yet to see a work upon diseases of children which contains any allusion to it. J. A. LARRABEE.

703 E. Broadway, Louisville, Ky.

Clinical Remarks on Hot-Weather Diarrheas in Infancy.

By Frank Woodbury, A. M., M. D., Professor of Clin cal Medicine in the Medico-Chirurgical College of Phila., Fellow of the College of Physi cians, Chairman of Section on Materia Medica and Therapeutics in the American Medical Association, &c.

EDITOR MEDICAL WORLD:-Diarrheal disorders are acknowledged by all to constitute the great bane of infantile existence, especially during the hot weather of the second summer, and more especially among infants who are so unfortunate as to be deprived of wholesome breast milk. It was the first span of the bridge of life that, according to Addison, had the greatest number of pit falls, and through these the bottle fed babies annually slip in large numbers, the mortality, indeed, being so great as to constitute a reproach to modern therapeutics. In foundling asylums, where children are of necessity artificially fed, the records of this country, until recently, showed a mortality of nearly one hundred per cent. In some of them it was a rule, with rare exceptions, that all such infants died before reaching the first year. In private practice it is true that the mortality is considerably less than this, but parents as well as physicians have learned to dread the perils of the midsummer heat for infants.

There are several popular errors with reference to hot-weather diarrheas in infants, with regard to their causation, pathology and treatment. As our ideas of the cause and nature of a disease necessarily guide the therapeutics, it may be well to briefly consider these before discussing the merits of different methods of treatment.

1st Error. It is a common but erroneous belief that summer complaint, as it is called, is due directly to increased atmospheric temperature, and is peculiarly and exclusively a hotweather disease.

2nd Error. The assumption that towel dis order occurring in infants during hot weather is due to a single cause, or always to the same combination of causes, is not warranted by experience.

3rd Error. The idea that infantile diarrhea is a disease of closely-built cities and of crowded communities, and does not exist in suburban or rural life is a common mistake. The readers of the autobiography of J. Marion Sims will recall his graphic description of an

Those in which the nervous system is implicated:- Reflex irritation from teething, habitual indigestion, marasmus. (Sunstroke may be mistaken for cholera infantum.)

T'he above is not intended as a complete classification of the forms of diarrhea which prevail among infants, nor is it supposed that any one will infer that the enumerated causes are only active during hot weather; but they occur most frequently and most fatally among infants, and especially during the heat of summer, when the vitality of the little patient is at a low ebb, and when the contributing causes, such as bad ventilation, spoiled ford and special poisons are most active and prevalent.

The treatment, as previously intimated, is not a treatment for diarrhea, for cholera infan. tum, or for summer complaint. The mistake is frequently made of simply prescribir g sedatives and astringents as in the functional diarrhea of adults. This treatment in infants yields the worst results and is generally followed by the death of the patient. Both opium and vegetable astringents are highly dangerous in the treatment of young infants with diarrhea. A general outline of treatment can only be ventured upon here. In the first place the child should be comfortably clad in clean rather loose garments, and should be protected from not only extreme heat but from chilling by draughts, night-air, &c. The child does not suffer directly from the effects of the heat but it directly, and chilling of the surface is more to be feared than an external temperature of from 98° to 100°, which, by the way, is the temperature normal to the infant when folded in its mother's arms with its head upon her

breast. The children of tropical countries survive summers in which the temperature is much higher than any that infants are liable to experience in our northern cities. As a measure of safety, the baby should wear a flannel bandage covering its stomach and protecting from sudden chill. If there is a dry hot skin, the child may be put in a tepid bath, or simply sponged with warm water, once or several times daily. Its food for the bottle should be carefully and uniformly prepared, always the same proportions, always at the same temperature, and about the same quantity. Some knowledge of infant foods and infant feeding is necessary, in order that too much time be not lost in discovering the kind of food best suited to the individual case. The feeding is of the highest importance. To some infants, a teaspoonful only of sterilized milk may be given every quarter or half an hour, others will bear larger quantities at regular intervals of from two to six hours. In this connection it should be borne in mind that summer diarrhea is often due to over-feeding, and especially too-frequent feeding. During the attack, it is of service to restrict the quantity of milk, or to suspend it altogether for a time and simply administer albumen of egg diffused in water and slightly sweetened with white sugar. Arrow.root or ice-water may be given; but no water unless previously sterilized by boiling. If the patient is very restless, and there are frequent passages, enemata of boiled starch, of about the consistency of syrup, may be used, containing a few grains of chloral and bromide of potassium or of sodium. Large enemata of warm water (irrigation of the bowel) are signally useful; good results have also been reported from washing out the stomach with warm sterilized water. The medicinal treatment proper, or the treatment by drugs, occupies a place secondary to the hygienic treatment. Where there is distinctly a cause of irritation in the contents of the bowel, or there is poisoning by tyrotoxicon, the administration of castor oil or a saline purge is the first step. If there is only indigestible food, the syrup of rhubarb is a safe and efficient remedy. The bowels being clear, due attention should be paid to the diet in order to keep them so. Carnrick's soluble food is not a medicine, but under its use the vomiting often ceases and the irritability of the bowels passes away. Where

there is collapse or great feebleness, some stimulant is necessary, and old brandy or whiskey is very useful if carefully administered in ten or fifteen drop doses. Bovinine, which contains ten per cent. of old Bourbon whiskey, is especially serviceable in treating infants with summer diarrhea or so-called cholera infantum. A good wine of coca is often very

happy in its effects on young children, as in adults, suffering with disordered digestion. Pepsin acts as a sedative to the stomach and aids in nourishing the child by facilitating digestion. Pepsin and bismuth, in small doses, control vomiting. Where the diet is milk (properly diluted and always sterilized), calf pepsin in the form of glycerite of calf pepsin is highly valuable; it should be administered immediately after the bottle has been taken. Where there is intestinal indigestion and irritation, with green slimy stools, papoid with bicarbonate of soda has a prompt effect. This as prepared by Johnson & Johnson, is in tablets, each containing grains jss of papoid, with bica bonate of sodium and peppermint. One of the table's may be dissolved in two tablespoonfuls of boiled water, and a teaspoonful administered every fifteen minutes. order to prevent fermentation of the contents of the gastro intestinal tract, salol is used with advantage in minute doses, or salicylic acid with the addition of sodium bicarbonate and bismuth, if desired. The addition of a very

In

small amount of aromatic powder as a carminative is useful.

With regard to arsenic or arsenite of copper, corrosive sublimate, calomel, and other remedies of this class, while admitting the fact that they have been reported to be curative in skillful hands, the occasion rarely arises in my opinion where it is prudent or safe to use them. In fact, as already intimated in this brief paper, the chief idea in treating cases of so called cholera infantum, should te the prophylactic and hygienic management-pure air, properly prepared food, attention to the skin, avoiding extremes of temperature or sudden changes from heat to cold-rather than any reliance upon any drug or combination of drugs.

When the source of the attack clearly resides in a polluted atmosphere, it is scarcely neces sary to add that it is of primary importance to substitute for it the purer air of the country, the mountains or the seashore. If this is out of the question, we may, at least, give the little patients a chance for life by taking them out frequently on the river or to the various parks. Philadelphia, Pa. FRANK WOODBURY.

Cholera Infantum,

EDITOR MEDICAL WORLD:-This disease attacks children of every age, but is far most common in the first and second years, at which period it exercises its most destructive influences. This very fact shows that the manner of nourishment, especially the artificial, or the transmission from the breast to weaning, plays an important part, as infants who receive good mother's or nurse's milk, are much more rarely affected than others. Mothers who have not

reached the age of eighteen should not be allowed to nurse their children in cholera in. fantum, as the milk they give is not fit for patients with this d sease, but should procure a strong healthy nurse.

The

This disease usually occurs in June, July and August, and especially in the large cities. Every physician knows that with the first warm days of summer that this disease makes its appearance. Cases of it increase in frequency until it becomes epidemic, and finally almost disappear in September, although there are some cases that hold on until late in the autumn. This disease is usually the result of some irritant, as from some unwholesome food, drink or poison, or a cold, and takes the form of an acute catarrhal inflammation of the mucous membrane of the stomach, extending into the intestines, attended with nausea, retching and vomiting, followed by watery diarrhea, consisting of profuse transudations of fluid, containing little albumen. whole system is generally affected. The dis ease is apt to become epidemic in the summer, towards its close, or in the beginning of autumn. Injurious food causes an irritated condition of the gastric and intestinal mucous membrane, with profuse production of mu cus. Digestive disorders, therefore, result naturally, both from food unsuitable in quality and quantity and gastric impairment, or in. capacity; or to summarize, to a want of relation between the food to be digested and the organism, owing to which the latter finds itself unduly embarrased in its duties, or entirely incompetent to perform them. The sequel is, in the infant, diarrhea. This disease sometimes attacks the patient very abruptly. The attacks generally commence with nausea, vomiting and purging, and sometimes with great. tenderness on pressure in the abdomen. No appetite, intense thirst, and an enormous quantity of undigested food is evacuated. Vomiting and purging, once commenced, recur in rapid succession, sometimes simultaneously. There may also be spasms and cramps. There are sometimes fifteen to twenty evacuations of either a greenish yellow or entirely green color in the course of the twenty-four hours. Tongue is sometimes clean, but more often coated grayish white, and urine scanty due to the large amount of water in the diarrheal discharges. There are at times great cerebral disturbances. Prolapsis of the rectum occurs, occasionally absent. Sometimes mucous and blood are found in the feces, which have generally a bad odor. Death generally

occurs from exhaustion or cerebral disturb. ances, more frequently from exhaustion. The symptoms of collapse are, cold extremities, with warm trunk, eyes sunken, deep wrinkles

in the face, difficult breathing, fontanelles depressed; a dark shadow is found almost constantly around the sunken eyes, especially on the lower lids, which is caused by the projection of the edges of the orbit beyond the sunken globe. sunken globe. The prognosis is always seri

ous.

I shall briefly here state my line of treatment. The mother who is nursing her infant, especi ally if she nurses over the second summer, should be compelled to avoid vegetables and acids. The thighs and arms of the infant must be kept clean, and not be allowed to be. come stained with feces. If allowed to become so, it will sometimes produce eczema, or intestrigo. All fever should be kept under control as much as possible. I generally order the patient to be sponged twice daily with vinegar and warm water, care being taken that the patient does not catch cold. Internally I give in fever:

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R Sub-nitrate of bismuth Paregoric ....

......

..scruples ii

.drams ii

Parish camphor mixture ......drams ii Syrup acacia Mix and label "shake." Dose half to one teaspoonul every hour or two. This is not unpalatable and is eldom refused.

When the odor of the stools is very oppresive give three grain doses of salicylate of soda Every hour or two, which quickly arrests it. It is a valuable remedy for checking diarrhea, but in large doses nauseates.

For thirst, give a mixture of port wine and vater to drink.

If the infant is very hot, have the face, ead, neck and forearms sponged frequently with tepid water.

Cumberland, M. D.

W. J. CRAIGEN, M. D.

Antiseptic Treatment of Summer Complaint of Children.

EDITOR MEDICAL WORLD:-But few physiians have escaped contact with this one of he most fatal diseases of childhood, and not me who has watched the anxious look, and bserved the pinched features and knitted Tow, will likely witness the approach of sumer without looking about for some untried medy for this great enemy of infantile life. The causes of this disease are as varied as are e surroundings of the people or children who ffer from its ravages. One of the most mmon causes, either in the crowded city, or arsely settled country, is poor nutrition. anty, food does not, of itself, give rise to the Duble, but to the reverse if properly cooked, will prove more or less a preventive of the sease. Overfeeding, as well as highly seased and indigestible food, give rise to a

larger per cent of the cases met with in the wealthier classes, while in the poorer classes, there is usually quite sufficient quantity and variety, but it is prepared in a way that renders it indigestible and irritating.

I believe that any physician of experience can, at the bedside of his patient, by observation and history, arrive at or very near the true cause of the trouble before him. I therefore urge that every sense be exercised in making these deductions. Now let me call your attention to a fact in this disease, that the profession has passed without due consideration, namely, that the disease is of septic origin. You will observe that the discharges are foamy and emit a sour odor at the outset of the trouble; as the disease progresses the discharges become green and very offensive, till the poison invades the system, and when the third stage is reached the evacuations may be almost clear and watery, or, as I have observed in many cases, the actions of the bowels which have been every few hours may now cease entirely. The fever is of a remitting and hectic type, usually the highest in the evening, accompanied with the hectic flush of the cheeks. The tongue, which was whitish or yellowish, coated at first, is now red and glassy, while the gums and lips show a tendency to ulcers. The sudden cries and tossing of the little sufferer evidence the spasmodic nature of this disease.

Treatment. This should aim at antisepsis, first of all, then the system should have a liberal supply of nourishment, previously rendered aseptic. The old treatment with calomel and astringents is not only useless but hurtful. When a purgative is indicated I use castor oil, in one-half to one teaspoonful doses, in which there is dissolved one-fourth to onehalf drop of carbolic acid, given as hot as can be taken. It does much to allay the distressing nausea, which is always present in these cases. Still acting upon this fact of antiseptic, you will have the best results from food in which the bichloride of mercury enters, in proportion of one in five thousand, either in the food direct, or given just before the food.

The

griping and burning in the lower bowels is easily overcome with injections of warm water, in which carbolic acid one drop, and tinct. of henbane five drops, to the pint, has been dissolved, and repeated every four hours. These injections do much to relieve the inability to take medicine by the mouth. Elm bark, and willow charcoal, placed in a cup and covered with water in which two grains of chlorate of potash to the ounce has been dissolved, will speedily assuage the thirst, and restore the mucous membranes of the esophagus and stomach. The restlessness is banished and sleep insured by the use of tinct. of aconite,

one-fourth to a half drop, and tinct. of gelsemimium one drop, every two hours. The use of quinine is always indicated, but it is rare indeed that it can be given by the mouth. Not caring to risk disturbing the stomach, I mix twenty grains of quinine with an ounce of lard and apply every four hours under the arms. When you see the bowels swell and become tender, and the little patient cries every time you make pressure over the lower portion, think of turpentine. Grease a flannel cloth with castor oil, then apply fifty drops of turpentine, and cover the bowels with it. Turpentine is a reliable germicide, and should never be overlooked in the treatment of bowel troubles in children.

It has its specific germ, and may or may not ally itself with those of malaria or like diseases. Any treatment that does not destroy these germs is unsuccessful in curing the patient.

The alimentary tract should be cleansed and rendered aseptic. Castor oil, carbolic acid and corrosive sublimate can be relied upon to do this. I have just completed notes of one hundred cases treated in this way, with the loss of two.

WM. T. COGGIN. M. A., M. D., Ph. D., etc. Keener, Ala.

Infant Feeding.

EDITOR MEDICAL WORLD:-The best food for an infant is mother's milk if the mother is in good health. If she is not, or for some reason has not the requisite amount of lacteal fluid necessary to nourish her baby, the next best thing to do is to employ a healthy wet nurse. In selecting such a nurse the family physician should be consulted. One should be engaged whose baby is about the same age as the baby she is to nurse. Her personal and family history should be inquired into, so as to know whether at any time she ever suffered from syphilis or any hereditary or transmissible disease. A child may live on a certain kind of food but may not grow well, and may become poorly developed.

An infant has so many different tissues to build up that a healthy kind of food is required. One child may not thrive on the same food that suits another one. If for any reason a suitable wet nurse cannot be obtained the next best food for an infant is cow's milk. Cow's milk is deficient in sugar, also contains too much casein; hence it should be diluted or it will form large curds. In woman's milk the curd is

crystal-like and unirritating and easily di gested. Do not give starchy foods, as the child is not capable, at so early an age, of changing it into grape sugar. A small portion of starchy matter is often given in cow's milk to prevent it curdling. Oatmeal water is often added to cow's milk. This has a laxative effect. Barley and arrow-root water are also often added. They have a constipating effect. You must be ex tremely careful in your selection of the correct one of these cereals to be added to the milk, as some babies are naturally constipated, while others have a tendency to diarrhea. The cow's milk does not want to be too rich-that is, not to contain too much cream; also not to be too poor; but it is better to be lacking in cream than to be too rich. It is best to keep one cow's milk. Milk from a good common dairy is good, though, as you get a general average by having several cows' milk. Milk must not be placed where there is any decomposition of animal matter going on. As regards quantity of food, a child two months old should have two ounces of food every three hours, given slowly. Lime water added to milk as a general thing is, I believe, more injurious than bene-i ficial; pure cow's milk does not need it. In stead of lime water, add a pinch of soda phos phate.

The baby foods in the market under certain brands are sometimes good and, under some circumstances, preferable to some of the milk sold in large cities.

The different brands have each their admirers. I have found Wagner's preferable to all others, and have raised partially on it a chid of my own, in whose case food of all brands did not agree nearly so well. Condensed milk for hospital use is better than cow's milk, as the latter would absorb the impurities. But a child brought up on condensed milk has a lack of firmness of muscle, and the least ailment wil pull it down. A little oil in condensed milk is very essential-cod-liver, cocoa or castor oil Milton, Del. JAS. S. GILLESPIE, M.D.

Hickory Leaves for Cholera Infantum. EDITOR MEDICAL WORLD:--Here is my mite on this subject: Bathe and swathe the little sufferers in a strong decoction of hickory leaves, which are not hard to find in any part of the country. Whatever other remedies may be used, this is a valuable help, and often when no other medicine or food, liquid or solid, could be retained in the stomach, I have found that the patient would have a nice sleep after being bathed and swathed, waking much refreshed, and able to take and retai both medicine and nourishment. I do not fully understand, nor shall I undertake to ex