R. M., aged 17 years, was returning home in a wagon when the horse began to kick, and in doing so struck a board in the hands of the driver, which was driven backward, striking the lad on the bridge of the nose. On examination a severe tear of the nasal septum was discovered. The mucous membrane of the nose was actually stripped up for at least one-half inch.

After not a little effort we succeeded in drawing the displaced Schneiderian membrane downward in apposition with the raw surface below. Having succeeded in this, the question naturally arose, How can it be best held in that position? Suturing was first thought of, but the displaced mem

brane was entirely too frail to hope for success by this procedure. Not having access to an instrument shop where we could procure ivory or vulcanite plugs as retentive apparatus, we decided to utilize a large size rubber catheter. Two plugs, about two inches in length, were accordingly cut off and sterilized for introduction.

We experienced much difficulty in introducing them through the posterior nares, but when once introduced answered the purpose admirably.

A suture was passed through their ends, which were allowed to project about one-half inch from the nasal openings; we then passed it up on the forehead, where it was firmly bound down by adhesive plaster.

The case, in every way, seems to be doing well.

I was rendered valuable service by Dr. H. T. Bahnson, of Salem.

Although there are several matters connected with the hygiene of infancy to which I wish to refer, the principal one among them relates to the preparation of the infant's food, and, being chief, may be considered first.

*Read before the College of Physicians, Philadelphia, February 6, 1895.

It is admitted by nearly all writers that the object aimed at in the feeding of infants upon artificially prepared food should be to produce a milk which resembles human milk chemically, as far as it is possible to attain. this end. With this in view, analyses of various milks have repeatedly been

made in order to determine the relative proportions of the chief constituents albuminoids, fat, sugar, water and salts. Analyses of human milk are somewhat at variance. Those of Leeds would give the albuminoids as equalling 2 per cent. Those of Meigs, Harrington and Biedert, on the other hand, place it at 1 per cent. Adopting the latter percentage as the result of the more recent investigations, and as sustained by the greater number of authorities we may formulate the composition of woman's milk as follows (Rotch):

herd milk.

Certain breeds of cows,

and, still more, individual cows give a milk which varies from the standard. It is the albuminoids of cow's milk, and especially the caseine constituting the greatest proportion of these, which give the baby so much trouble to digest. There are undoubted chemical differences in the caseine of the two sorts of milk, and these often cause difficulties which we are unable to overcome by any method of dilution or preparation. The mere matter of quantity of the different ingredients, however, we are able to manage. If we compare the two tables given we notice that cow's milk, as contrasted with woman's milk, is much too rich in albuminoids, contains the same percentage of fat, has nearly twice as much sugar and is slightly richer in ash. It is evident that by diluting cow's milk sufficiently we can reduce the albuminoids to the proper amount. It is also evident, however, that in so doing we diminish too greatly the amount of sugar and of fat. Our work, therefore, is clearly cut out for us, and consists in diluting cow's milk sufficiently to reduce the albuminoids to the proper percentage when the preparation is completed, and then in adding cream and sugar in sufficient amount to make up for the loss of these ingredients.

As regards the sort of sugar to be used, milk-sugar is that naturally. present in milk, and it certainly seems rational, therefore, to employ it. It is possible that cane-sugar may answer just as well; and, indeed, in the case of some children, it seems to agree better; but these are only the excep tions. We should certainly try by the use of milk-sugar to approach as nearly as possible to the character of human

milk. With regard to cream, it is evident that its richness must determine the amount to be employed. Ordinary skimmed cream consists of 16 per cent. fat, while the thinner centrifugal cream contains about 20 per cent. fat. In constructing any milk mixture the character of the cream must be borne in mind, and the proportion varied accordingly. Finally, cow's milk, as it reaches the consumer, is very commonly acid, and contains bacteria, while human milk is alkaline and is free, or practically free, from bacteria. The destruction of the bacteria is to be accomplished by sterilizing or some similar process. For the removal of the acidity the addition of lime-water is very commonly employed, but a solution of soda is greatly to be preferred for several reasons. There are several objections to lime-water, and it is on account of these that, with these introductory remarks, I wish to recommend the following formula, which gives a milk corresponding, as far as possible, to human milk:

As the author himself admits, this solution has to be made fresh every few days, since it will not keep. To obviate this difficulty Dr. Rotch used a little measure, and measured out the amount of sugar-three and threeeights drachms-required for each eight ounces of milk mixture.

The soda solution is made of the strength of one grain of bicarbonate of soda to the one-half ounce of water. Analyses kindly made for me under the supervision of Dr. Marshall, of the University of Pennsylvania, show that the amount of this salt of soda, equivalent in alkalinity to a half-ounce of ordinary lime-water, equals very nearly one grain. A dozen packages of bicarbonate of soda, each containing one drachm, may be obtained from the druggist at very slight cost. One of these dissolved in a quart of water makes a solution of the proper strength. As the dozen packages are sufficient to alkaline 768 eight-ounce bottles of the milk-mixture, and as the soda solution will keep indefinitely, it is readily seen that the use of the solution is both cheap and simple.

We may now consider some of the reasons why a soda solution is deci dedly to be preferred to lime-water. In the first place, it is a mistaken idea that lime must be added to the food for the sake of the lime salts required for the baby. Cow's milk, as the tables show, is decidedly richer than woman's milk in mineral matter, including lime, and its dilution does not reduce the salts below the proper amount. The sole object of the limewater is to render the mixture alkaline, and soda does this just as well. hasten to say that the use of soda is in no way original with me. Dr. Jacobi,

for one, long ago sanctioned it. Another objection to the lime-water is, that when added to milk in the quantity sometimes advised, its taste is quite evident and may be unpleasant to the baby. Another count against it is that when the milk mixture is heated a chemical reaction takes place between the sugar and the lime and a brownish color is produced. This is perhaps only an objection on an esthetic ground, but there seems no good reason for producing the offending color unless it is necessary. A fourth and more vital objection is that when the milk mixture is sterilized lime-water has been added, the lime is precipitated in large measure, and the desired alkalinity is reduced or destroyed.

after

Finally, in the effort to overcome the latter objection, the difficulties of sterilizing are largely increased.

has been proposed, for instance, that the milk, water, sugar and cream be mixed in the proper proportions and sterilized, and that the lime-water then be added. We can only do this with safety however, just before the mixture is to be used, since an earlier removal of the cotton plug allows germs to enter. Consequently, the proper amount of lime-water must be added to each bottle when the child is

about to be fed. With the varying

amounts of nourishment which the baby takes at different. ages it is evident that the calculation of just how much lime-water is to be added on each occasion is a matter not altogether simple. It will certainly seem to the mother to add greatly to the trouble in using sterilized milk; and it must be our object to make the process as easy as possible.

With regard to the amount of cream to be employed, the formula given allows a certain latitude, since the cream is a variable substance. In using the mixture the whole amount needed for the twenty-four hours should be prepared in the morning when the milk arrives, the proper amount placed in each bottle according to the age of the child, and the bottles placed in the sterilizer and heated to the degree of temperature desired.

With regard to the practice of sterilizing, it is undoubtedly true that the process often in some way makes the caseine more difficult to digest. On this account Pasteurizing has been proposed to take its place, as it does not materially alter the digestibility. The studies of Koplit and others show, however, that Pasteurizing, in the strict sense of the term, i. e., heating to 75° C. (167° F.), is not a safe method to be intrusted to mothers, since it does not satisfactorily kill the germs, which will develop in less than twentyfour hours. On this account a modified sterilizing is to be preferred. If the sterilizer is employed with the hood removed and the lid set slightly ajar and a brisk but not too hot fire is employed for about forty-five minutes, the temperature of the milk does not go above 80° or 90° C.-a temperature which does not materially affect the digestibility of the milk, yet which is sufficient to render the milk practically safe for twenty-four hours. I have myself tested the milk with the thermometer while it was being heated in this way.

Where predigestion of the food is to be combined with sterilizing, as is very often necessary in cases of illness, we may employ the following formula:

Water enough to make 8 ounces.
Sterilize as already described.

This formula contains the same proportions as the preceding one, with the exception of the soda, which is increased in amount. No soda solution need be added, since the soda in the peptonizing powders or tablets more than takes its place.

In concluding my remarks upon feeding, I beg leave to exhibit this food-warmer, which will be found very convenient, and which is not as widely known as it deserves. When a baby wakes in the night crying for its bottle, the tedious warming of the milk to the proper temperature is, to say the least, a dreary process. This foodwarmer, called the Penniston, consists practically of a hot-water bag with an outside pocket. One or more bottles of prepared milk, sterilized and corked, may be placed in the pocket on retiring, the compartment for water filled, and the whole covered with a woollen cloth.

The bottles are thus kept ready for immediate use.-University Medical Magazine.

A HINT IN PRESCRIBING.—Now that the price of empty capsules has become so greatly reduced that they are within the reach of all, even the country prac

titioner, they should, seemingly, form as much a part of the armamentarium therapeuticum of the physician as the pocket-case or hypodermic syringe. Why cause patients to swallow a bitter pill in the form of a compressed tablet or tablet triturate, when the taste of such may be effectually masked by enclosing in the popular gelatin capsule? The disguising of the taste, moreover, entails no sacrifice of speedy efficacy, as the gelatin dissolves quickly and exposes its contents to the action of the stomach.-Therapeutic Notes.

USTILAGO MAYDIS DURING LABOR.Excellent results are obtained by the administration of the fluid extract Ustilago maydis in cases of primitive. inertia of the uterus. The contractions appear twenty-five to thirty minutes, forty at the most, after the drug has been ingested, and are physiological, there being no convulsive or tetanic character about them. There is no contraction of the cervix, and the drug can be given without danger at no matter what time during labor, acting even better when dilatation is already obtained at the time of inertia. Delivery and the expulsion of the placenta are in no way delayed or prevented. No bad results accrue either to mother child. This drug has been employed in Germany and America for twenty years, and in obstetrical practice is far superior to ergot. -DR. V. S. GROMSDEFF, in Vratch.

or.

VALERIANATE OF AMYL.-A writer in the Med. Record says that in 21⁄2 grain capsules every half hour, up to 5 or 6 doses, this agent will relieve the pain of nephritic colic or of cystitis, though it has no influence on the calculus.