During the night of the 22d she was nursed twice, and vomited after each nursing; stools good and temperature normal. It was again put on malted milk for twenty-four hours after stomach-washing, the nursing then being gradually resumed. The child made a good re covery, and had no more vomiting.

The best results in stomach-washing are seen in cases of acute dyspepsia in the initial stage with or without diarrhea and with no fever. Rarely more than one lavage is required.

It is indicated in acute gastro-interic catarrhs with vomiting and fever. Usually two washings are necessary, but rarely more than three or four. It improves the tone of the stomach and diminishes the number of stools.

It is a valuable and effectual means of combatting a troublesome symptom in gastro-intestinal diseases, as it mechanically rids the stomach of milk and curds which accumulate there, and which, unless removed, would pass into the intestines and produce irritation.

It is of use in those cases which have vom. ited from birth or have had continual regurgitation of food, as it removes curds and thick mucus, which is nearly always present with disordered digestion. In some cases it may be found necessary to continue the lavage for perhaps two weeks, at first washing once each day, then every other day, and so on as required; but in the majority of cases vomiting is relieved in from one to three washings repeated on successive days.

It

Stomach-washing is by no means a panacea, in controlling this oftentimes troublesome symtom, nor does it preclude other treatment. is far better than emetics, the disadvantage of which has long been recognized in the treatment of indigestion of infants, and if properly done is a simple, effective, and thorough mechanical procedure, and, so far as I have seen in a rather extensive experience with it here, is entirely without danger.

Perhaps in private practice there may be some objections raised to its use, as to all new measures; but these, I am sure, will not be offered when once the great benefits derived from its application are seen.-The American Practitioner and News.

Rules for the Management of Infants During the Hot Season.

Recommended by the Obstetrical Society of Philadel phia, and printed by the Board of Health, with slight modifications.

[WE republish these most excellent rules for those physicians who wish to instruct the families under their care.]

RULE 1.-Bathe the child once a day in lukewarm water. If it is feeble, sponge it all

over twice a day with lukewarm water, or with lukewarm water and vinegar. The health of a child depends much upon its cleanliness.

RULE 2.-Avoid all tight bandaging. Have light flannel as the inner garment, and the rest of the clothing light and cool, and so oose that the child may have free play for its limbs. At night undress it, sponge it, and put on a slip. In the morning remove the slip, bathe the child, and dress it in clean clothes. If this cannot be afforded, thoroughly air the dayclothing by hanging it up during the night. Use clean diapers, and change them often. Never dry a soiled one in the room in which the child is, and never use one for the second time without first washing it.

RULE 3 -The child should sleep by itself in a cot or a cradle. It should be pu: to bed at regular hours, and be early taught to go to sleep without being nursed in the arms. With out the advice of a physician never give it any Spirits, Cordials, Carminatives, Soothing Syr. ups, or Sleeping Drops. Thousands of chil dren die every year from the use of these poisons. If the child frets and does not sleep, it is either hungry or else ill. If ill, it needs a physician. Never quiet it by candy or by cake; they are the common causes of diarrhea and of other troubles.

RULE 4.-Give the child plenty of fresh air. In the cool of the morning and early evening, have it out of doors for a little; take it to the shady side of broad streets, to the public squares, to the Park, or make frequent excursions to the rivers. Whenever it seems to suffer from the heat, let it drink freely of water which has been boiled and cooled by ice. Keep it out of the room in which washing or cocking is going on. It is excessive heat that destroys the lives of young infa

RULE 5. Keep your house sweet and clean, cool, and well aired. In very hot weather let the windows be open day and night Do your cooking in the yard, in a shed, in the garret, or in an upper room. Whitewash the walls every spring, and see that the cellar is clear of all rubbish. Let no slops collect to poison the air. Correct all foul smell by pouring chloride of lime into the sinks and privies. This article can be got from the nearest druggist, who will give the needed directions for its use. Make every effort yourself, and urge your neighbors to keep the gutters of your street or of your court clean.

RULE 6 - Breast milk is the only proper food for infants. If the supply is ample, and the child thrives on it, no other kind of food should be given while the hot weather lasts. If the mother has not enough, she must not wean the child, but give it, besides the breast goat's or cow's milk, as prepared under Rule 8. Nurse

the child once in two or three hours during the day, and as seldom as possible during the night. Always remove the child from the breast as soon as it has fallen asleep. Avoid giving the breast when you are over-fatigued or overheated.

RULE 7.—If, unfortunately, the child must be brought up by hand, it should be fed on a milkdiet alone-that is, warm milk out of a nursing bottle, as directed under Rule 8. Goat's milk is the best, and next to it, cow's milk. If the child thrives on this diet, no other kind of food whatever should be given while the hot weather lasts. At all seasons of the year, but especially in summer, there is no safe substitute for milk if the infant has not cut its front teeth. Sago, arrow-root, potatoes, corn-flour, crackers, bread, every patent food, and every article of diet containing starch, cannot and must not be depended on as food for very young infants. Creeping or walking children must not be allowed to pick up unwholesome food.

Milk careroom soon

RULE 8.-Each bottleful of milk should be sweetened by a small lump of loaf-sugar, or by half a teaspoonful of crushed sugar. If the milk is known to be pure, it may have cnefourth part of hot water added to it; but if it is not known to be pure, no water need be added. When the heat of the weather is great, the milk may be given quite cold. Be sure the milk is skimmed; have it as fresh as possible, and brought very early in the morning. Before using the pans into which it is to be poured, always scald them with boiling suds. In very hot weather, scald the milk as soon as it comes, and at once put away the vessels holding it in the coolest place in the house—upon ice if it can be afforded, or down a well. les ly allowed to stand in a warm spoils and becomes unfit for food. RULE 9.-If the milk should disagree, a tablespoonful of limewater may be added to each bottleful. Whenever pure milk cannot be got, try the condensed milk, which often answers admirably. It is sold by all the leading druggists and grocers, and may be prepared by adding to six tablespoonfuls of boiling water without sugar one tablespoonful or more of the milk, according to the age of the child. Should this disagree, a teaspoonful of arrow root, of sago, or of corn-starch to the pint of milk may be cautiously tried. If the milk in any shape cannot be digested, try, for a few days, pure cream diluted with three-fourths or four-fifths of water-returning to the milk as soon as possible.

RULE 10. The nursing-bottle must be kept perfectly clean; otherwise the milk will turn sour, and the child will be made ill. After each meal it should be emptied, rinsed out, taken apart, and the nipple and bottle placed in clean

water, or in water to which a little soda has been added. It is a good plan to have two nursing-bottles, and to use them by turns. The best kind is the plain bottle with a rubber nipple and no tube.

RULE 11. Do not wean the child just before or during the hot weather; nor, as a rule, until after its second summer. If suckling disagrees with the mother she must not wean the child, but feed it in part, out of a nursing-bottle, on such food as has been directed. However small the supply of breast-milk, provided it agrees with the child, the mother should carefully keep it up against sickness; it alone will often save the life of a child when everything else fails. When the child is over six months old the mother may save her strength by giving it one or two meals a day of stale bread and milk; which should be pressed through a sieve and put into a nursing bottle. When from eight months to a year old it may have also one meal a day of the yolk of a fresh and rareboiled egg, or one of beef or mutton broth, into which stale bread has been crumbed. When older than this it can have a little meat finely minced; but even then milk should be its principal food, and not such food as grown. up people eat.

BRIEF RULES FOR CASES OF EMERGENCY.

RULE 1.-If the child is suddenly attacked with vomiting, purging, and prostration, send for a doctor at once. In the meantime put the child for a few minutes in a hot bath, then carefully wipe it dry with a warm towel, and wrap it in warm blankets. If its hands and feet are cold bottles filled with hot water and wrapped in flannel should be laid against them.

RULE 2.-A mush poultice, or one made of flax-seed meal, to which one quarter part of mustard flour has been added; or flannels wrung out of hot vinegar and water, should be placed over the belly.

RULE 3.-Five drops of brandy in a teaspoonful of water may be given every ten or fifteen minutes; but if the vomiting persists. give this brandy in equal parts of milk and lime water.

RULE 4.—If the diarrhea has just begun, or if it is caused by improper food, a teaspoonful of castor-oil, or of the spiced syrup of rhubarb, should be given.

RULE 5.-If the child has been fed partly on the breast and partly on other food, the mother's milk alone must now be used. If the child has been weaned it should have pure milk with lime water, or weak beef tea, or chicken water.

RULE 6-The child should be allowed to drink cold water freely.

RULE 7-The soiled diapers or the dis.

charges should be at once removed from the room, but saved for the physician to examine at his visit.

FOR THE CONVENIENCE OF MOTHERS THE FOL LOWING RECIPES FOR SPECIAL FORMS

OF DIET ARE GIVEN.

BOILED FLOUR OR FLOUR BALL.

Take one quart of good flour; tie it up in a pudding bag so tightly as to make a firm, solid mass; put it into a pot of boiling water early in the morning, and let it boil until bed-time. Then take it out and let it dry. In the morning peel off from the surface and throw away the thin rind of dough, and, with a nutmeggrater, grate down the hard dry mass into a powder. Of this from one to three teaspoonsful may be used by first rubbing it into a paste with a little milk, then adding it to about a pint of milk, and, finally, by bringing the whole to just the boiling point. It must be given through a nursing bottle.

An excellent food for children who are costive may be made by usirg bran meal or unbolted four instead of the white flour, preparir g it as above directed.

RICE WATER, BARLEY WATER, ETC. Wash four tablespoonfuls of rice; put it into two quarts of water, with a little salt, and boil down to one quart, and then add sugar and a little nutmeg. This makes a pleasant drink.

A pint or half pint of milk added to the rice water, before it is taken from the fire, gives a nourishing food suitable for cases of diarrhea. Barley, sago, tapioca, or cracked corn can be prepared in the same manner.

BEEF TEA.

Take one pound of juicy lean beef-say a piece from the shoulder or the round-and mince it. Put it with its juice into an earthen vessel containing a pint of tepid water, and let the whole stand for one hour. Then slowly heat it to the boiling point, and let it boil for three minutes. Strain the liquid through a cullen 'er, and stir in a little salt. If preferred, a little pepper or allspice may be added.

Mutton Tea may be prepared in the same way. It makes an agreeable change when the patient has become tired of Beef Tea.

RAW BEEF FOR CHILDREN.

Take half a pound of juicy beef, free from any fat; mince it very finely; then rub it into a smooth pulp either in a mortar or with an ordinary pota o masher, and press it through a fine sieve. Spread a 1.ttle out upon a plate and sprinkle over it some salt, or some sugar if the child prefers it. Give it alone or spread upon a buttered slice of stale bread. It makes an excellent food for children with dysentery.

Common Errors and Fallacies in the Treatment of Children.

Feeding of Infants.-No mistakes in treatment are more pregnant of mischief than those connected with the feeding of infants. No mistakes are more common.

1. The Sudden Weaning of Infants on to Fresh Cow's Milk and Water. This is a frequent source of disaster. The massive curds which distinguish cow's milk when brought into contact with the acids of the stomach are

frequently beyond the feeble digestive powers of an infant; dilution only diminishes the quantity of the casein, it does not alter its character; and the undissolved clots under the favoring conditions of heat and moisture ferment, and set up colic, vomiting, diarrhea. Unboiled milk readily becomes sour, and affords a favorable soil for putrefactive bacteria and disease germs. Both clinical experience and actual experiments show that boiling milk sterilises it as far as the putrefactive bacteria and disease germs are concerned. And yet, as has been well remarked by Dr. Jeffries, while older people are fed almost entirely upon sterilised, i. e. cooked, food, infants are fed on an unsterilized food pecul arly adapted to serve as a cultivative medium for bacteria. Boiled milk, moreover, clots less firmly and massively thin raw milk-hence is more digestible. Children should be weaned on to boiled milk, with barley water, which appears to separate the curd atoms, and hinders massive coagulation. In the case of very young or very delicate children, however, the milk should always be peptonised at first, the degree of peptonisation being gradually reduced. Whatever form of milk is used, the solution should be sufficient y dilute to begin with, the strength being gradually increased.

2. The Feeding of Children on a diet which is excessive or deficient, either in gross quantity, or in certain essential ingredients.-The following are the chief errors in this respect.

(a) Insufficient gross amount of Nutritive Material. For instance, a child is found un able to digest any mixture of cow's milk stronger than I in 4, and it is kept upon this. But the capacity of the stomach is limited, and it is impossible for it to ake a sufficient quantity of this mixture to supply the material required for growth and full nutrition. Thus I found the other day an ill nourished child of five months old, kept by medical advice upon a mixture of milk and water which afforded twelve ounces of milk only in twenty-four hours. It was impossible for a child of this age to grow and thrive upon this gross amount. It was unable to digest a stronger mixture. The difficulty was easily overcome by the addition of so ne Valentine's meat juice and cream,

pending a slow and gradual increase in milk as the child's digestive power developed.

(b) Food Deficient in Fat.-This elemen: is of especial importance in the food of children. And yet they are constantly brought up on a diet sadly wanting in it-as for instance most of the artificial foods, whether purely farinaceous or contaning dessicated animal matter. Some con lensed milks are deficient in cream, while skim milk, upon which I have known children to be fed, is practically destitute of fat.

(c) Food Deficient in Proteid. The same thing may be said with regard to deficiency in proteid. Children, especially those with whom cows' milk does not agree, are frequently placed solely upon some artificial food, which does not supply the necessary quantity of nitroge 1ous matter without the id lition of milk.

The removal of a portion of casein by rennet in "artificial human" milk is sometimes carried to excess, and continued too long I have just been consulted about a child fourteen months old, who has become soft, sweats abou: the head, has attacks of laryngismus, and has had two attacks of general convulsions. It is rickety, and has been fed to this age solely upon humanised" milk, from which one half of the casein has been removed. Children starved of these two elements are often large and fat, but flabby, anemic, and rachitic. In deed, this defect in food is cne of the chief causes of rickets.

(d) Prolonged use of Artificially-digested Foods.-Another error, now growing common has arisen from the discovery of th: value of predigested foods-I refer to the practice of maintaining children on peptonised or pancreatised foods for too long a time. These prep. arations do excellent service in the case of children just weaned, or with small power of diges:ing cow's milk. If however, these predigested foods are continued for months nutrition falls off, the child becomes flabby, soft in bone, and in the end strikingly anemic. Moreover, the pover of digesting curd is seriously impaired, so that there is often great difficulty in changing afterwards to ordinary milk foods.

I have now urder care three children, of from ten to fourteen months, brought up entirely on pancreatised food. In condition they bear a singular resemblance to each other. They are all full-sized, plump, but soft and white, and show signs of commencing ricket. One has profuse sweatings, and has had repeated convulsions during teething. In all the anemia is marked. In all the improvement on raw meat juice and fresh milk has been immediate and decided. And further, I have noted three cases of scurvy arising on a sole diet of

peptonised condensed milk. This diet should be gradually replaced by ordinary milk.

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The Treatment of Infantile Diarrhea.There is a belief current amongst mothers and nurses, and held also by many medical practitioners, that a moderate amount of diarrhea is rather beneficial to a child than otherwise, especially during the time of teething. pears to be regarded as a means of dis harge for various undefined and "peccant humors" of evil tendency, escaping, as by an open safetyvalve, to the great relief and advantage of the patient, and especially useful as a safeguard against convulsions. Upon this assum ɔti ›n, a looseness of the bowel: is often allowed to run on unchecked until it has assumed dangerous proportions. I believe that this view of infantine diarrhea is entirely erroneous, and I am sure that the practice based upon it is most mischievous, often disastrous.

The diarrhea of young children is most commonly due to the irritation of the mucous lining of the intestine by undigested and decomposing articles of food, aided, perhaps, by the influence of ptomaine poisons in causing paresis of the splanchnic nerves, undue stim 1lation of the vagus, or derangement of secretion of digestive juices. It is also caused apparently by irritation reflected from the dental nerves in teething, setting up increased peristalsis in the same way.

Now in the first case, it cannot be wise to acquiesce in the condition by which nutriment is passed out, some of partially digested, and what is digested hurried on too rapidly to permit of absorption. There can be nothing curative or beneficial in the process.

In the second case, when the flix is due to reflected irritation in teething, there can be no advantage in the nutrient drain which the increased peristalsis involves. Many, although not all, of these attacks of diarrhea during the period of teething, and attributed to reflex dental irritation, are in reality due to direct irritation of the alimentary canal, the dentition being merely a coincic ence, or only subsidiary by rendering the mucous membrane more excitable. So far from diarrhea being a safeguard against convulsions, it is precisely those children who have been drained by diarrhea and vomiting who are most liable to them.

Little children bear continued purging badly. Metabolism is active, and the loss of nutrient material tells heavily upon them. The mere drain of fluid is in itself alone a grave mat er, Look how, in choleraic diarrhea, they dwindle and wither rapidly, and, with pinched face and sunken eyes, shrink to half their former size almost. Although the diarrhea may not be severe-three or four loose stools a day only

perhaps the risk of permitting such flux to run on uncontrolled in a young child is a serious one. A diarrhea which begins moderately, and which excites no apprehension, but is viewed perhaps with satisfaction, is apt to develop dangerous proportions within a very short period, and to reach a point beyond the control of medicine. It is easy to keep it within limits if it is held in check from the first. But when it rages with full violence drugs may have little or no effect. I have, in many instances, seen fatal consequences result from neglect of this precaution, from a fatuous inaction in the early stages until the disorder passes beyond control, and leads to profound collapse beyond the influence of remedies.

In every case of diarrhea in a young child, however slight, it is wise to get it under control at once. It is not necessary to induce absolute constipation, but to bring the action of the bowels to natural limits. The younger the child, the more important this beccmes, the risk being in inverse proportion to age. An infant is very easily killed by vomiting and diarrhea during the first few months of life.

Having drawn your attention to the mischievous practice of letting this disorder run on unchecked, I have a word to say upon certain common mistakes made in treating the condition by drugs and diet.

In the first place as to food. Usually, if the child is on cow's milk it is stopped absolutely -so far so good. If milk is given at all it should be peptonised, and diluted with a little barley water. Give nothing which is nct sterilised, nothing but what is pre digested or easily digested.

Liquor opii se dativus, according to age, are the most efficient remedies.

Chronic Constipation.-Every medical man, I imagine, thinks he knows how to treat constipation; but my experience hardly warrants the assumption. I have been surprised to find what a narrow routine practice prevails. Three devices only appear to be adopted as a rule.

(1) The administration of more or less active purgatives from time to time, sometimes once or twice a week, the remedy being repeated as often as the bowels become confined again.

(2) The use of enemata, sometimes regularly every few days for lengthened periods.

(3) The inclusion in the diet of coarse foods and fruits, oatmeal, cabbage, prunes, figs and

the like.

Adults are generally treated more sensibly than children; they are given, perhaps, a daily dinner pill, or sent to drink laxative waters at some spa. But with children treatment is almost invariably limited to the three stock measures I have named.

Now if the constipation is only occasional, an exceptional difficulty, a free purge or enema may end the trouble, and cure the complaint. And if the constipation is slight only, the use of stimulating foods containing insoluble de bris may be sufficient to keep the bowels act ing. But if they are not successful, remember they do positive harm by favoring tard accu

mulations and excretions.

If, however, the constipation is recurrent or habitual, and obstinate-chronic, in a word— none of these measures will be adequate to

The relief given by a brisk purgative, if frequently repeated, tends to defeat its own end, and to retard, not hasten, the ultimate cure.

treatment.

I have a word to say with regard to the use of drugs. As a rule astringents are given and opium carefully avoided, as being dangerous in the case of little children. In my experience astringents such as hematoxylum or catechu a: e useless in the acute stage, and opium in some form essential in anything like a severe case. Grey powder with Dover's powder in small and frequently repeated doses should be given if there is much vomiting. Bismuth, the inBismuth, the insoluble nitrate, in doses of five to ten grains with chalk, and % or 4 or 1⁄2 a minim of

The purgatives lose their effect after a time; the frequent stimulation of the bcwel renders it less and less sensitive. Stronger and stronger purgatives are required, the constipation grows more and more difficult to overcome; at last the bowels, rendered callous to stimuli, refuse to act, except in response to powerful irritant purgatives or enema ta. The colon, its muscular wall in a condition of atony from overstimulation, habitually distended by fecal accumulation and evolved gases, and not unfre quently by repeated copious enemata, becomes largely dilated, and utterly inert. The last state of the patient is apt to be worse than the first. The attempts to cure have in reality aggravated the condition.

Now this state of chronic constipation in children requires treatment-and treatment by drugs. Treatment to be effective must be continuous-not intermittent. The constant