for examination. Three are purely starch foods; two malted ones, and three are milk foods, which most resemble human milk and are much the best to properly nutrify all the tissues.

STARCH FOODS.

Ridge's Food contains, of the albuminoids or nitrogenous matter, 8.76 per cent.; cellulose (which is indigestible) 0.73 per cent.; lime salts, 0.48; phosphoric acid, o. 260; and ease of digestion, 7.97. Wells, Richardson & Co.'s albuminoids are 9.05; cellulose, 1.54; lime salts, 2.26; phosphoric acid, 0.688; and digestion, 8.35. Imperial Granum's albuminoids are 10.73; cellulose, 0.97; lime salts, 0.37 (very low); phosphoric acid, (ditto) 0.167; digestion, 9.55.

MALT FOODS.

Mellin's" albuminoids are 8.34; cellulose, 0.58; lime salts, 3.53; phosphoric acid, 0.583; digestion, very low, being 7.38. "Horlick's" albuminoids, 11.30; cellulose, 0.55; lime salts, 2.76; phosphoric acid, 0.421; and ease of digestion, 10.85.

MILK FOODS.

"Nestle's" albuminoids are 11.46; cellulose, o.10; lime salts, 1.75; phosphoric acid, 0.630; digestion, 11.09. "Anglo-Swiss" albuminoids are 12.38; cellulose, 1.09; lime salts, 1.95; phosphoric acid, 0.800; and ease of digesiton quite high, being 11.20.

"Carnrick's Soluble Food" contains of the albuminoids 18.22 per cent. and Woman's, 17.08 per cent. Cellulose, none. Lime salts, 2.991; and phosphoric acid, 0.874; these two are the petrous tissue builders. Ease of digestion, similar to human milk, and is 16.45.

Carnrick's Soluble Food is certainly best adapted as a general tissue-builder, and will produce teeth, with ability to resist attrition and decay, much better than foods that are deficient in inorganic constituents.

The starches are very difficult for young children to dispose of. These hydro-carbons are dissolved by the amylytic ferment found in the saliva, pancreatic and intetsinal secretions. Young children do not secrete this ferment in sufficient quantities to dispose of the starches. Hence, crackers, dried and softened bread, farina, corn starch and foods that are composed largely of starch are largely indigestible.

If the wheat starch in an infant food is converted into dextrine, by baking the wheat for eight or nine hours at a temperature of 350° F., then when the artificial food is ingested, all that is required to complete the hydro-carbon digestion is for the dextrine to receive one molecule of water, which converts it into soluble sugar, which is ready for immediate absorption, and the child's digestive apparatus has not been taxed beyond its feeble powers.

The enamel of the teeth should contain 98 per cent. of calcareous matter, dentine 80 and cementum 70 per cent. The pregnant woman and she who nurses ought to eat bread constructed out of the whole of the wheat, or corn, or rye, and not the bolted product of the grain. The tegumentary coats of all of our grains should be finely ground aud then eaten ! As we live to-day, we are starving out the petrous tissues, because we deny to them their necessary amount of pabulum.

Send the lime salts through the umbilical cord and mammary glands when the teeth are forming, for they, unlike other tissues of the body, are built up once, forever!

There is no form of food that contains so rich a deposit of lime salts, that has been put together in such a simple form, as to be easily digested, absorbed and appropriated, as has been in the immediate outside coats of all of our cereal foods.

INFLAMMATION: SOME OF ITS FORMS, AND TREATMENT.

BY C. M. HOLCOMB, M. D., WINFIELD, KANSAS.

Inflammation is defined as that nutritive disturbance which is characteriz ed by active hyperemia and active proliferation of the cells of a tissue or an organ. Tissues are nourished by nutritive products passing out of the vessels and into the cells of the various tissues. This nutritive product, or material, is contained in the liquor sanguinis. In inflammation this process is disturbed; the lymph containing more albumin and salts, is rendered more coagulable. This liquor sanguinis passes out of the vessels into the tissues, is absorbed by the cells, hence the cells undergo great proliferation; 'tis hyper-nutrition—or a perversion of nutrition. The capillary vessels are engorged with blood, hence the active hyperæmia. If active hyperæmia exists without cellproliferation, 'tis of little importance, as disease is not likely to follow; so active hyperæmia and active cell-proliferation are both necessary to inflammation. This cell-proliferation gives rise to tissue metamorphosis. This lymph, or liquor sanguinis, is blood deprived of its red blood corpuscles, a tissue comprising one-third of the entire body. Cut off this supply of lymph and death is the result, hence it is one of the most important constituents of the body. Two kinds of corpuscles exist, red and white, in the proportion of I white to 1250 red. They take up everything within their reach.

The essential elements of active hyperæmia are, first, dilatation of the blood vessels with primary acceleration; secondarily, stagnation or retardation of the flow of blood, followed by the escape of liquor sanguinis and next by white blood corpuscles into the perivascular blood spaces. The rapidity of flow alluded to lasts only about an hour, when it is followed by retardation. This dilatation of blood vessels and retardation of the flow of blood are necessary elements of inflammation in the blood vessels. The escaping fluid gives nourishment to the cells it comes in contact with; the white corpuscles are found to be adhering to the walls of the blood vessels, the red corpuscles in the center of the current. The white corpuscles have amoeboid movements, reaching out feelers and finally penetrating the vascular walls and escaping into the surrounding tissues. They mingle with the proliferating cells in the tissues, which proliferating cells have been caused by the lymph which first escaped into the tissues. The red blood corpuscles also pass out through the vessel walls, but in a manner different from that of the leucocytes.

(Con

In the third stage of inflammation we find the circulation in the capillary vessels is arrested altogether; the red corpuscles being in balls, like coins one on another, in great numbers. If this condition is not remedied, the tissue dies from being deprived of its nourishment.

The changes, then, to be observed in inflammation are :

I.

2.

puscles.

Disordered circulation and expansion of vessels.

Damaged condition of vessel walls, exudation of lymph and of cor

3. Capillary stasis or retardation.

4. Formation of coagulating lymph or embryotic tissue.

The question may arise, What becomes of this inflammatory exudate ? · A number of these cells reënter the circulation through the lymphatics; a number atrophy, and the remainder enter into the formation of tissue-causing permanent thickening of the tissue. If the inflammation is of a higher degree, and micrococci exist, pus will be formed, laudable pus, the cells not forming into tissue. The essence of the inflammatory process resides in the vessels themselves, and in the perivascular tissues, there being no action by the nerves whatever. We do have reflex disturbances of the circulation, but they do not cause inflammation, hence inflammation is not a nervous affection. Cutting off the nervous supply simply predisposes to inflammation, for we know the cornea will perish if we cut the ophthalmic branch of fifth nerve; but it is due to loss of functions of the tears and eyelids and foreign bodies in the atmosphere. If the pneumo-gastric nerve is divided, a broncho-pneumonia results from a similar cause, as a paralysis ensues of the upper air passages and the larynx. In as brief a manner as possible, let us enumerate the types of inflammation, then pass on to an outline of treatment.

The types presented are: Traumatic, due to injury; idiopathic or spontaneous; healthy and unhealthy (the former having a tendency to repair, the latter a tendency to destruction and death of the parts); irritable inflammation, as in keratitis or syphilitic rupia. We have also infective inflammation latent inflammation, as seen in pneumonia, typhoid fever, etc, very few symp. toms being manifssted. Acute, sub-acute and chronic inflammation, acute being rapid with well-marked symptoms; chronic with slow, poorly-marked symptoms; sub acute between the two. We have also serous, fibrinous, plastic, or adhesive, purulent, croupous or diphtheritic inflammation, hæmorrhagic inflammation, as in acute local pneumonia; ulcerative and gangrenous inflammation, superficial and deep-seated, interstitial and parenchymatous inflammaion, phlegmonous inflammation of connective tissues and the skin itself, destruction of the tissues involved generally.

TREATMENT.

Passing by the terminations and ætiology of inflammation, let us pass cursorily over the treatment. The indications for treatment are:

I.

2.

Removal of exciting cause.

Establishment of resolution.

The remedies are divided into local and constitutional, the general agents employed in all inflammations being rest, elevation and relaxation of the inflamed parts. Rest is of paramount importance in all cases, and the patient

will voluntarily obtain rest during the day, but when sleeping we must resort to splints and bandages, and where the inflammation is confined to internal parts, as in peritonitis, pleuritis, etc., we must resort to such remedies as opium for our splints. By elevation of the parts the suffering is very much lessened, as the arterial blood and lymph in the part are diminished. Relaxation of the parts is obtained by flexing the limbs, thus preventing the muscles from contracting.

Local remedies to be used in first stage of inflammation are :

3.

Cutting off the supply of blood to the part.

We can procure the abstraction of blood by means of leeches, scarification, general bleeding, puncture, incision and wet cups. As the effect of the local extraction of blood is but temporary, we must apply cold to keep the vessels from becoming distended again. It not only prevents the distension of vessels, but it relieves pain, heat, swelling and tissue change. The application of cold can be made by means of cold cloths, by irrigation, and if dry cold is desired, by means of rubber tubing or rubber ice-bags. In the application of dry cold, however, we must have a piece of flannel cloth interposed between the rubber tubing or bags and the skin.

To cut off the supply of blood to the part, we can resort to a digital compression by means of a bandage, tourniquet or by forced flexion. As a dernier resort, ligation of the main artery may be resorted to, but, as gangrene may and often does result from this, it is not often done.

In the second stage of inflammation, i. e., stage of serous effusion and plastic exudation, we have compression as one of our most valuable and useful remedies, as it affords support to the dilated vessels, thus preventing further effusion, and causing absorption of the effused fluids; and it also controls spasm of the muscles of the inflamed area. We can obtain compression by means of an ordinary roller bandage, Martin's bandage, compressed sponge, adhesive strips, collodion, etc. Astringents and sorbifacients are also applicable to the second stage.

Our local remedies for the third stage of inflammation, i. e., stage where suppuration has occurred or threatens to occur, are heat and moisture, as obtained by hot fomentations and poultices. By means of these we relax the blood vessels, thus accelerating the movements and escape of the white blood corpuscles, overcoming the stasis, relieving pain, assisting in the process of granulation and casting off small sloughs. The poultices can be made antiseptic by means of the bichloride of mercury in solution; can also medicate them as by opium, or acetate of lead, etc.

As we have in so brief a manner mentioned the local remedies for the three first stages of inflammation, let us conclude by merely mentioning our armamentarium of constitutional remedies: We have (1) blood-letting; (2) depressents, or arterial sedatives. (3) cathartics, or purgatives; (4) diaphoretics and diuretics; (5) antipyretics for high temperature; (6) anodynes to relieve pain; (7) hypnotics to produce sleep; (8) emetics to unload the stomach; (9) mercurials; (10) tonics in later stages, and finally, our antiphlogistic

regimen, as diet, hygiene and care of the patient. By antiseptic processes we can now generally prevent high grades of inflammation, hence these remedies are passing out of use.

REPORTS FROM PRACTICE.

A FATAL CASE OF LABOR.*

BY J. L. WARDEN, M. D., PLEASANT HILL, MO.

One bitter-cold night in January, some years ago, with the ground so slippery that a horse could scarcely stand, I was called to the country about eight miles from town to attend a case of confinement. While getting ready to go sent the messenger to my partner for ou obstetrical forceps and chloroform; the former he obtained, the latter not, as the doctor had none at his house, but not waiting to so inform me the man hastened homeward to avoid an approaching storm. Upon reaching the house I found that the woman had been in labor for some hours, but the os was dilated only to the size of a silver dolla and was rigid. She had been in severe labor about four hours, and even longer in puerperal convulsions.

The situation was an apalling one : A woman in convulsions for hours, the os undilated, forceps at hand but no chloroform to relax the unyielding os. Nor was this the worst-outside the storm had burst in all its fury; it was intensely cold, and the house in which the patient lay was of the kind known as a "box house," unplastered, great cracks through which one could run one's hand, into which poured the snow and sleet, and no fuel except a few sticks of green wood covered with ice. The woman's limbs were almost frozen, and the whole surface temperature extremely low. The convulsions appeared to grow worse with each moment's delay, so after looking the situation over carefully I despatched the messenger for help and for chloroform, but (as I subsequently learned) he only succeeded in reaching the next farm-house.

I first gave the woman a hypodermic injection of morphine and then bled her to the full extent I dared to. I then attempted to dilate the os with my fingers, hoping to get my hand into the uterus and perform version. This, however, I could not do, the os remaining hard and unyielding. Along toward morning, finding that no assistance was probable, I attempted to use my forceps with the rigid os. I had been from time to time attempting to dilate with the fingers, and at last succeeded in pushing one blade of the forceps through the os; but though I tried for an hour or more to introduce the other I did not succeed, and could scarcely withdraw the one already inside. Thus in futile endeavors the night wore away, and at day-break the woman died undelivered and partially frozen.

The repeated injections of morphine appeared to have no relaxing effect whatever, and the bleeding seemed to exert not even the slightest influence upon the eclampsia. My object in reporting this case is to ask: What more could have been done in such an emergency?

Reported to the Tri-County Medical Association.

E. L.