ing case from my record book as a typical case of glioma, or glio-sar

coma.

CASE.-E. A., age 3 years, white, male. This little fellow was brought to my office to see me in regard to his eye. A few months after birth it was discovered that he did not see with his left eye; he was very fretful and showed by his appearance that he was an unhealthy child. A few months later his parents noticed that the left eye was slightly enlarged and had a great resemblance to a "cat's eye in the dark," as the parents admirably described it. The eye has continued to enlarge until now, (that is, two years and a half after the first enlargement was noticed) it protrudes far out between the lids which cannot be closed over the protruding ball. He has suffered all the time, more or less, and at this time his suffering is very severe. The eye-ball is hard and indicates great intra-ocular tension, is not very tender to touch, conjunctiva highly inflamed. No other organ of body affected.

etc.

With the assistance of Dr. Robertson, jr., of Hutchinson, Kansas, I removed the eye by dividing the conjunctiva at the sclero-corneal junction, superior and inferior oblique, internal and external recti muscles, Dissected back on the optic nerve and divided it near its entrance into the orbit. United conjunctiva with interrupted sutures. The bleeding was slight. The patient rallied well and was free from pain until he died. One month after the operation the soft parts of the orbit commenced to protrude and take on unhealthy action. At expiration of another month the growth was protruding from between the greatly swollen and everted eye-lids. It had a dusky, red, fleshy and vascular appearance, secreting or exuding a sanious fluid which, becoming dried on its surface, often cracked and bled profusely.

Dr. W. S. Harvey, of McPherson, assisting, the growth was removed, by dividing the outer canthus down to the malar bone. The mass was then dissected out with curved scissors, cleaning everything out of the orbital cavity, but the periosteum. The hæmorrhage was. profuse and it was with much difficulty that the little patient was made to rally. He got along very nicely for a few weeks, when cerebral symptoms appeared, indicating an extension of the disease along the optic nerve, or encephalitis which lasted a few days and ended in death. From date of first operation he had no pain, as before the eye was removed. The growth weighed three and one-half ounces and was undoubtedly a true glioma retina. I operated only with expectation of relieving the severe pain and possibly (?) lengthening life.

THE PROPER CARE OF CHILDREN.

BY BENJAMIN LEE, M. D., PHILADELPHIA, PENN.

To infants, cleanliness is life, filth is death. The child, to retain health must be clean, and its surroundings must be clean. It needs a clean skin, clean clothes, clean water, clean food and clean air. It should be bathed night and morning in a warm room, away from any draught, and in water from which the chill has been taken. As the child grows older, and in the summer time, cooler water may be used. The body should be cleansed from head to foot, with a soft sponge or a piece of fine flannel; using only a little pure soap, and keeping it way from

The Proper Care of Children.-Lee.

411

the eyes. The whole body must be dried with a dry, warm towel, using but little friction, for active rubbing and strong soaps are injurious to the skin of babies. In the summer time, the child may be left in the cold bath 10 or 15 minutes, but it should never become chilled while bathing. The napkins should be changed as soon as soiled, and never used a second time until they have been washed, and if possible they should not be dried in the same room in which the child lives.

Let babies and young children sleep all they will, for sleep is an absolute necessity for their vigorous development. They should regularly be laid to rest at stated times, away from the noise and light. The child from the very first should be taught to go to sleep in a cot, without being rocked, nursed or carried about. No kind of cordial, spirits, syrups, sleeping or soothing drops, or any other remedies should ever be given, by the nurse or mother to make a child sleep. If the young child is sleepless. it is ill, and medical attendance should be summoned. It is a bad habit for mother and child to go to sleep while the child is nursing in bed. Children from two to six years of age are often cross and ill-natured for want of sufficient sleep.

For

As

A very frequent cause of the early death of young children is improper feeding. The natural food for babies is the breast milk of its own mother, next that of a wet nurse; lastly unskimmed cow's milk or goat's milk; the latter is very nourishing and easily digested. young babies remember that milk and milk only, should be used as food. They need no gruel, butter, honey or castor oil; these things are all worse than useless-they are dangerous. Too much care cannot be exercised to secure pure milk. It is now believed that milk derived from a number of cows is better than that from one cow. If from one cow, care should be taken not to get it from a cow which has been milking too long, since milk frequently deteriorates from this cause; also, when the milk disagrees with the child, it will be well to change the cow. soon as the milk is received, it should be placed on the stove and brought to a boil, then placed in the coolest place-on ice or in a well. The vessel in which the milk is kept should daily be scalded out with boiling water and cleaned with soap, being kept perfectly pure and sweet. Earthen or glass or stoneware vessels are preferable to tin ones for keeping milk in. Never give a baby sour or musty milk; it must always be sweet and pure, and freshly prepared each time; if sour, throw it away and get some fresh it cannot be safely sweetened. When fed to the child, the milk should be diluted with one-fourth or less water, and a little sugar added; but before you add the water, be sure that the milkman has not previously added it. It the undiluted milk agrees with the child, use it. Use" condensed milk" if the fresh cannot be had pure. Under six months, children can be stuffed with. but not nourished by, corn, flour, arrowroot, baked flour and other kinds of starchy foods. These are of no value at all to children under six months, and they may be, and often are starved to death on these things.

Where the child has cut its front teeth, it should have some light food, as bread, baked flour or milk biscuits added to its milk. Once a day, it may have meat broth or beef tea, with bread or biscuits soaked in it or the yolk of an egg lightly boiled. When it is a year and a half oid, it may have some fine chopped meat, but milk should still be its principal food. At two years, it may eat of corn-meal mush, rolled wheat, oat grits, etc., but such food as solid meat and potatoes, fat pork and fish, which form the food of adults, should on no account be given

to babies. Creeping and crawling children must not be permitted to pick up unwholesome food.

The nursing bottle needs special attention. It should be oval, with no corners or rough places in which the milk may lodge and become sour. A plain black rubber nipple to slip over the mouth of the bottle is the best pattern. Never use the elaborate and complex nipples with glass and rubber tubes attached, because they cannot be readily cleansed; and they also invite in the baby the habit of sleeping with the nipple in the mouth, a thing which should never happen. Both bottle and nipple should be thoroughly cleansed in boiling water after each using, and then kept in cold water to which a little baking soda has been added, until used again.

July, August and September are the worst months, and the "second year the dreaded period of the child's life. As preventative measures, are recommended: 1. The nursing of the child over the second summer, when this can be properly done, it her milk agrees with the child, and the mother is not exhausted. 2. The wearing of a thin flannel shirt by the child all through the summer. It should be thin, and in hot weather very thin. 3. Feeding only milk or other food known to be fresh and absolutely pure. 4. Whenever possible, babies should spend the summer months in the country. If the above precautions could always be carried out, summer complaint would be almost unknown. With care, the disease can be greatly diminished. At all events, during the summer months, give the child pure water to drink at frequent intervals, for it needs water to supply that lost by the perspiration. Bathe it in cool or tepid water twice a day. Keep it in the open air as much as possible, and where the air is pure. Don't permit it to have any sour, unripe, over-ripe, or half decayed fruits. Even ripe fruit may cause injury if the child be allowed to indulge at will. If the dejections are very offensive and the bowels tight, give a dose of castor oil, or of spiced syrup of rhubarb, on retiring at night. For pain in the bowels, give a few drops of essence of peppermint in sweetened water. Ten drops may be given and repeated as often as required, for this drug produces no bad results. Give no laudanum, no soothing syrups, no paregoric, no teas, or any other drugs, medicines, or remedies, unless urgently indicated.

It is the common belief that measles, scarlet fever, whooping cough, mumps, diphtheria, and the other diseases of childhood are necessarily contracted by every child. This is a mistake, These diseases are all contagious, and pass from person to person, by actual contact. By great care, their spread may be much restricted and the lives of many children saved. When these diseases prevail in a community, it is best to withdraw the children for a time from the day and Sunday schools, and so far as possible, to isolate them from other children. In no case should they attend the funeral of a person dead from any of the above diseases, and in case of scarlet fever and diphtheria, it is best for parents to remain away as much as possible from houses where they prevail, no matter in how light a form.

Aromatic spirits of ammonia will act as a solvent for antifebrine. where the latter cannot be given in capsules. It makes a very nasty mixture, however, and is better given in pure, undiluted glycerene.

Joplin Letter.

413

CORRESPONDENCE.

JOPLIN LETTER.

ED. INDEX:-It seems that Joplin is not represented among your contributors, and although I believe that nothing tends more to the advancement of medical science than an interchange through medical journals of the opinions and experiences of the professional brethren, I have been deterred from offering my mite from the fact that your pages are so well filled, I feared I could add nothing to their interest. With the thermometer every day among the nineties, and my time well filled with professional duties, I shall prefer to write a rambling letter rather than confine myself to a single subject.

COCAINE IN MINOR SURGERY.

I have recently been testing cocaine in small surgical operations, and except upon the eye where its anæsthetic powers are truly wonderful, I find it unreliable, if not altogether worthless. The following will serve as a typical case: Miss C. in putting down carpet kneeled upon a needle that was sticking in the carpet, with the point down. It pierced the interosseous ligament just below the head of the fibula, the point breaking off. I injected a half drachm of 4 per ct. solution of hydrochlo rate of cocaine into the areolar and muscular tissue, moving the point1 of the syringe from place to place, waited ten minutes and then began the operation for the removal of the needle. Immediately on making à small incision, she became so nervous that I had to administer chloroform to complete the operation.

ANTIPYRINE AND ANTIFEBRINE.

I have been using antipyrine and antifebrine in malarial and other fevers when reduction of bodily temperature seemed indicated, and so far with excellent results. In no case have I had to give more than two doses of either to produce a fall in temperature of from two to six degrees. Have often seen a fall of several degrees from one dose, during my stay of perhaps an hour. Usual doses have been from twelve to fifteen grains of antipyrine, and about four of antifebrine. Have had equally good results with each, but commonly use the latter on account of its smaller dose and less cost. They seem to have no effect on the duration of the disease, yet I think I never lost a case of either malarial or typhoid fever, where I could keep the temperature below 102. far, in probably forty cases, mostly malarial, 1 have had no difficulty in reducing it to that point or below, and holding it there with two or three doses per day.

FOREIGN BODY IN THE AIR PASSAGES.

So

The following case of foreign body in the air passage may be of interest, not only on account of its termination but on account of the rarity of such cases in medical literature.

M

May 29, was called to see Charles M—, age nine years. His symptoms were those of pneumonia of the right lung, except that the cough was more paroxyzmal and pain greater. Three days before, he. with other boys, had been playing with heads of awned wheat grass (Triticum Caninum) specimens of which they showed me. By putting the grass-head in the mouth with the awns outward, they found that an

effort to push it out of the mouth with the tongue caused it to move rapidly down the throat. In this case it had entered the larnyx and followed the most natural course to the right lung. I treated the case much as an ordinary pneumonia for two or three days, when there supervened a most violent pleuritis, the pain of which called for sedatives in full doses. As a febrifuge I used antipyrine with admirable results. In about ten days the violence of the symptoms subsided, but as there was still considerable cough, pain and anæmia, I continued my calls at intervals of two or three days to watch for symptoms of empyema.

June 13, I discovered a circumscribed tumor about two inches in diameter with its center near the angle of the eighth rib.

June 15, tumor assuming form of an abscess. Some fluctuation. No symptoms of pleuritic effusion. Opened abscess which discharged a small quantity of pus. Continued elm poultices which had been previously ordered.

June 19, abscess discharging more freely; has opened spontaneously three-fourths of an inch below first opening.

June 24, abscess extending downward. There was another spontaneous opening half an inch below the last. First opening closed.

June 27, point of grass head can be seen in last opening.

June 29, grass-head one and one-fourth inch long discharged, having made its entire journey in just five weeks. Its point of exit was opposite intercostal space of 10th and 11th ribs, though I think it passed between the 8th and 9th ribs.

After the first two weeks the boy had some appetite and really gained some in strength, but the paroxysins of coughing were very distressing. There was at no time any evidence of effusion into the pleural cavity, the two walls of the pleura having evidently been glued together by plastic lymph at the point of the passage of the grass head. After its expulsion the patient gained rapidly, and is now in perfect health. R. S. KELSO, M. D.

Joplin, Mo., Aug. 18, 1887.

ST. LOUIS LETTER.

The summer is gone, and with the return of autumn comes the doctor who has been passing the heated term at the seaside, in Europe in quest of knowledge, (or recreation) or in the quiet summer resorts of the North. These are the specialists-the men who "sow the wind and reap the whirlwind "-of cash. It is said that one man-Dr. Spencer, an eminent aurist of this city, actually has an income of more than twenty-five thousand dollars per annum from his practice; it is also said that he will seldom look into a patient's ear for less than five dollars! Such is specialism-financially speaking. The specialist is like the wind in that he goeth when and where he "listeth, " and no remarks are made as to his absence from his post of duty during the hot and dusty summer months. But the general practitioner, he who belongs, to use the words of Dr. Dudley Reynolds, of Louisville, himself a specialist, to a class of "ignoramuses, "("it is the specialist who does all the original work in the profession, and you must not forget that the treatment of general systemic diseases is a specialty adopted by a world of ignoramuses called general practitioners. "-Louisville Progress.) has