PRACTICAL NOTES

TREATMENT OF ARTHRITIC ECZEMA IN CHILDREN.

Leullier (Journal des Praticiens, August 31, 1901) claims that in children eczema is one of the most frequent manifestations of the arthritic diathesis. Treatment should consist in: (1) Prophylaxis, which consists in having the child breast-fed, allowing it to nurse for a short time at frequent intervals and forbidding the nurse to take alcohol, fermented beverages, spiced foods, or food too rich in nitrogenous elements. (2) General measures: the avoidance of overfeeding. If the child is weaned it should not have much nitrogenous food. Meats, especially red meats, should be given sparingly, and no wine, alcoholic beverages, tea or coffee used. The bowels should be kept regular; green vegetables, cooked fruits, bananas, prunes, marmalade of apples and of pears may be given. Graham bread is the most suitable bread. Hydrotherapy, massage,

physical exercise and life in the open air are essential. Alkalines may be given in moderate doses for ten days during a month. Comby often prescribes:

For one powder; to be taken before meals in a spoonful of sweetened milk.

(2) Local treatment should consist in the application of zinc oxid ointment, to which menthol or salicylic acid may be added in small quantity. Vaselin is often badly borne and may be replaced by benzoated lard, as:

The following powder may then be dusted over the part:

MUNICIPAL INFANT-FEEDING BOTTLES.

Municipalties in different parts of the world are taking paternal care of those who are so fortunate as to live under their control. The city fathers in many large centers of population supply the inhabitants with gas, water, means of locomotion and even with dwellings at a cheap rate, and, in addition to these material benefits, provide instruction and amusement for the mind.

Battersea, a large district of London, chiefly populated by the laboring classes, and which was a pioneer in this new movement, has recently decided to make another innovation, and to supply nursing bottles to those persons who apply for them. The infant mortality there has been greatly on the increase within the past few years, due, it was believed, to impure milk and unclean bottles. Having arrived at this conclusion, the municipal council of Battersea at once resolved to take steps to meet the situation, and, according to the New York Press, are about to open a station at which the best cow's milk obtainable will be bottled and distributed among the poor of the locality. Nine hermatically sealed nursing bottles of sterilized milk will be supplied daily to each customer at a charge of a little over 30 cents a week, and the station will collect the used bottles every day and supply clean ones in their place. The nine bottles for each day will be packed in a basket, six for use in the day, and three in the night.

Undoubtedly, there is "method in the madness" of Battersea and although the scheme savors more of maternalism than of paternalism, yet if carried out efficiently it will be the means of checking the infant deathrate to a very appreciable degree. Contaminated milk is the cause of more deaths among infants than perhaps any other one cause.

It may be said that the plan just adopted in Battersea has been tried in Fécamp, France, with conspicuous success, the deathrate among infants being reduced in one year from 157 to 103 per thousand.-Med, Record.

FURTHER TESTIMONY AS TO THE VALUE OF VACCINATION,

If more was needed, or would be heeded by the antivaccinationists is given by that veteran observer, Dr. William M.

Welch, who recently stated before the Philadelphia County Medical Society in reference to the recent epidemic:

"Not one thus far who has been vaccinated previous to exposure has contracted smallpox. About fifty individuals, including physicians, nurses and attendants, have been continuously and freely exposed to the disease.

"We have, from time to time, received in the hospital persons with well-marked and even fatal smallpox in whom vaccination some weeks before had failed.

"Many physicians hesitate about vaccinating individuals who are suffering from some other disease. At the Municipal Hospital recently scores of patients suffering from diphtheria and scarlet fever were vaccinated as a precautionary measure. The vaccination did not unfavorably influence the original disease, and, on the other hand, the course of the vaccinia was in no case unusual.

"Since the beginning of the present year, about 300 cases of smallpox have been treated at the hospital. Of this number not a single patient had been recently successfully vaccinated. The shortest period elapsing between a successful vaccination and the contraction of the disease was five years. Whilst the majority of the patients admitted were unvaccinated, a very large number had been vaccinated in infancy.

"I believe that it may be laid down as a rule that if a child is successfully vaccinated in infancy, and again at the age of puberty, the protection will be permanent. The exceptions to this rule, however, may be sufficiently frequent to warrant a repetition of the vaccination whenever there is exposure to smallpox."-American Medicine.

TREATMENT OF INTUBATION ULCERS.

Johann Bokay reports the successful treatment of five cases after the method of O'Dwyer. This consists in the employment of tubes provided with a narrow neck and coated with a layer of gelatine and alum. In all cases in which intubation has lasted over 100 hours, ulceration is liable to occur and the employment of these tubes is then to be recommended. The gelatinized tube is left in the larynx for five days, at the end of which time it is removed and replaced by a similar tube. This process is repeated three times, at the end of which the ulcer will usually be found to be completely healed.-Medical Record.

ABSTRACTS

ESOPHAGOTOMY IN A CHILD OF SIXTEEN MONTHS.

WM, J. TAYLOR (Therapeutic Gazette, Oct. 15, 1901) reports this case: A little boy, aged 16 months, on March 18, 1900, swallowed a metal clasp known as a drawers holder." Immediately after the accident his father tried to remove it, and told me that he was able to touch the upper end with his finger passed well down the throat, but in his effort to extract it without forceps he pushed it farther away from his finger and out of his reach. The baby was fretful for three days and three nights, but was able to nurse, and had no special attacks of dyspnea or pain, although immediately after the clasp was swallowed he was unable to cry out, probably from pressure on the recurrent laryngeal nerve. At no time since then could one hear his cry further than across the room.

On April 5th he was brought to Philadelphia and taken to a hospital, where a fluoroscope was used and an unsuccessful attempt made to take a skiagraph. The child's parents were told at that time by the surgeon who saw him that no foreign body was present. At no time did he vomit blood, and only once was there any bloody mucus discharged, and that was immediately after swallowing the clasp, This was possibly due, in part at least, to the efforts of the father at its extraction. There was no special cough or difficulty in breathing, but there was a great deal of rattling and many rales in the chest. He always nursed well, but had been unable to swallow any form of solid food.

At my request Dr, Leonard etherized the child and made a very careful skiagraph. This when developed showed absolutely the position of the foreign body and also that the clip on the end of the clasp was open. The tip of the clasp was directly on a line with the sternoclavicular articulation.

On October 27th ether was given him at the Orthopedic Hospital and an attempt made to reach the clamp by forceps passed down the esophagus. In this I was unsuccessful, as the distance was too great and it was considered unwise to make a prolonged search. The position of the clasp as afterwards shown would have made an attempt at extraction through the mouth particularly dangerous, and in any subsequent case of the kind I should make no effort whatever to do this if a similar foreign body had been swallowed longer than a few hours.

I then immediately opened the left side of the neck and worked down until I found the esophagus, and through its walls I could feel the sharp points of the clasp. This I did without passing any sound or metal probe down through the mouth to act as a guide. I then opened the esophagus, and here my difficulties began. The large hook in the clasp had evidently ulcerated at least partly through the wall of the esophagus, and in attempting to withdraw it I hooked up and pulled upon probably the bifur

cation of the bronchus, and the child nearly died in consequence; and it was only with the greatest care and after considerable manipulation that I was able to get the clasp out. The clasp when swallowed was nickelplated, clean and bright, as it was new, but when it was removed all of the nickel-plating had been cleaned of, evidently by the action of the tissues, not a particle of it remaining. As the opening was made in the esophagus bubbles of air welled up from the lowest and deepest part of the wound, which made me fear for a moment that the wall of the trachea had been ulcerated through, but upon closer inspection it was seen that this was air which had been imprisoned by a valvular flap of soft parts. There was so much ulceration and the tissues were so lacerated that I did not think we could possibly get primary union in the wound, and I therefore drew the edges of the wound in the esophagus together as closely as possible with a few catgut sutures, then closed the upper portion of the external wound with two sutures, and packed the lower portion down to the esophagus with iodoform gauze. The baby was so young that I was afraid not to give it some nourishment by the mouth, and therefore allowed it to nurse, but each time the milk would all run out of the hole in the neck. We kept this up for about forty-eight hours, using in addition nutritive enemata, until I thought it imperative that we get some food into his stomach. I tried to put a catheter down the mouth into the stomach, but could not get past the point in the esophagus from which the clasp was removed without using unjustifiable violence. I then packed

the wound in the neck with cotton and made pressure with my finger while the child nursed, and in this way we were able to give it a considerable amount of nourishment, although a great deal escaped from the edges of the wound. During the night the child nursed every four hours, and we soon got the hang of matters so that quite a considerable amount passed into the stomach. Indeed, the stomach was appreciably distended after the nursing. Each time that he was nursed the dressing was removed and a pad of cotton pushed into the wound and held there by firm pressure.

His convalescence was uneventful; the wound closed by granulation and no fluids whatever passed out of the wound after November 16thtwenty days after the operation-and by December 1st the wound was entirely closed. The last heard of the child was on March 25, 1901, when he was reported as being perfectly well and strong and able to eat solid food without any difficulty, Thus far it would seem there is no stricture

of the esophagus.

THE SEARCH FOR THE PARASITE OF CANCER.

The problem of the discovery of the parasite of cancer has occupied so much attention lately that there has been danger of forgetting the results obtained by accurate observers. It must not be forgotten that this problem, in spite of the work of Gaylord and Schuler, is perhaps not now much nearer elucidation than it has ever been. Parasites of cancer have been discovered so often by men who are apparently convinced of their absolute authenticity, that the modern sceptical medical man will require the strong