First-William R. Spalding, of Texas.
Second-J. Owen Rice, of Kentucky.
Third-Thomas Stamps, of North Carolina.
Fourth-Frederick P. White, of Kentucky.
Fifth-Floyd Kinsolving, of Missouri.
Sixth-George R. Turner, of Kentucky.
Seventh-John H. Gautier, of Georgia.
Eighth-Richard D. King, of Texas.
Ninth.-Ottis Bodine Scott, of Kentucky.
Tenth-Joseph W. Largent, of Texas.

PRIZES.

Graduates' Contest. The Yandell gold medal for the highest class standing was awarded to William R. Spalding. The second prize, a gold medal, was awarded to J. Owen Rice, and the third prize, a gold medal to Thomas Stamps.

Under-graduate Contest. The prizes won by under-graduates for the highest average attained in anatomy, physiology, materia medica, and chemistry were distributed as follows:

To Achilles E. Davis, of Kentucky, the first, a copy of Wyeth's Surgery.

To George E. Davis, of Kentucky, the second, a pocket case of instruments.

To Frank M. Stites, of Kentucky, the third, a pocket case of instruments.

FREE SCHOLARSHIPS

for the session of 1888-89, offered by the Board of Trustees to the two under-graduates who should pass the best examination in all the branches taught in the school, were won by Achilles E. Davis, and George E. Davis.*

INDIVIDUAL PRIZES.

Prof. Bodine's prize, a gold medal, for the student passing the best examination in anatomy, was awarded to George E. Davis, of Kentucky.

Prof. Palmer's prize, a gold medal, for the student passing the best examination in physiology, to Thomas Stamps, of North Carolina.

Profs. Yandell and Roberts' prize, a gold medal, for the best in surgery, to J. Owen Rice, of Kentucky.

As these gentlemen have attended two courses of lectures in the school, they are entitled to attend, free of charge, all succeeding sessions. Since they can not get the benefit intended, the scholarships were given to the two gentlemen standing next highest in the examination, Frank M. Stites, of Kentucky, and B. Logan Holmes, of Kentucky.

Prof. Ouchterlony's prize, a gold medal, for the best report of his clinical lectures delivered at the Louisville City Hospital, to Robert J. Huston, of Kentucky. Honorable mention: J. Harry Wilson.

Prof. Cottell's prize, a gold medal, for the best collection of microscopic specimens in normal or pathological histology, to William R. Blue, of Tennessee. Honorable mention: James B. Bullitt, of Kentucky.

Prof. Anderson's prize, a case of obstetrical instruments, for the student passing the best examination in obstetrics and diseases of women and children, to William R. Spalding, of Texas.

Prof. Bailey's prize a gold medal, for the best in materia medica, therapeutics, and public hygiene, to William R. Spalding, of Texas.

The gold medal for the best thesis, offered by Prof. W. H. Whitsitt, D. D., LL. D., of the Southern Baptist Theological Seminary, was awarded to Charles M. Rosser, of Texas. Subject: The Alvine Fluxes of Children.*

The awards were made by the President, Hon. Jas. S. Pirtle, who took leave of the graduates in a happy extempore address.

The Faculty Valedictory was delivered by Prof. William Bailey. (See p. 129.)

The Class Valedictory was delivered by August Schenk, of Texas.

HEALTH OF THE CROWN PRINCE.-The London Lancet, February 1, 1888, received the following telegram from San Remo:

"Separation of slough has greatly improved the left side of the larynx, but there is a slight extension of thickening at the anterior commissure to the right side. A portion of the large slough from beneath the left vocal cord has been sent to Professor Virchow. Limited disease of cartilage is present, but there is no exposure of cartilage or exfoliation."

The editor states, on the authority of the Vossische Zeitung, that Professor Virchow, after the most careful and minute investigation, is unable to discover in the portion of slough submitted to him any thing of a really

serious nature.

*This paper will be published in the next issue of the AMERICAN PRACTITIONER AND NEWS.

COMPRESSED TABLETS.-We take pleasure in calling the attention of our readers to the advertisement of Messrs. John Wyeth & Bro., in this issue. The new remedies they bring forward in the form of their compressed tablets will be of interest to every physician. The circular matter they offer to supply is very concise, collated with much. acumen, and shows an evident thorough knowledge of the therapeutic worth of these recent antipyretics, analgesics, and antiseptics.

INSERTION OF THE URETERS INTO THE RECTUM.-(El Siglo Medico, Deutsche Mediz. Zeit., February 9, 1888). Novaro was the first to succeed in transplanting the ureters from the bladder to the rectum in dogs. The operation succeeded perfectly, and the sphincter ani sufficed to retain the urine for some time.

A dog operated upon by him in January, 1887, is still alive, and in excellent condition. Novaro thinks the operation of great value,and intends employing it in a case of total extirpation of the bladder.

No. 6.

VOL. V. [NEW SERIES.]

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

ALVINE FLUXES OF INFANTS.* (Prize Thesis.)

BY CHARLES M. ROSSER.

That the "young may die; and the old must die," is most certainly true; but, as if to reverse the observation, statisticians have discovered that of those that are born the larger per cent do not survive the period of infancy and early childhood.

During this period the functional activities of life are greatest, therefore the especial attention of physiologists should be directed to the phenomena presented during a state of health; and because the young are very liable to disease and death, the diseases to them peculiarly incident should be carefully studied by those who would be their physicians.

Unfortunately, the little sufferers are not able to make plain the subjective evidence of disease, and for this cause some have thought it a necessity to base their management upon a species of "scientific guessing;" but since the introduction of those valuable diagnostic instruments, the thermometer and the microscope, such, happily, need not be the case under the light of modern medical teaching. Indeed, I have thought that for the thoroughly equipped and properly educated practitioner, it is more possible to avoid errors in diagnosis under circum

The Whitsitt gold medal for the best thesis written by any student of the Medical Department, University of Louisville, session of 1887-88, was awarded the author.

stances to which I have referred than when given a patient of maturer years, because adults may, either by willful or ignorant misrepresentations, influence erroneous conclusions, while infants can have neither cause nor capability for the accomplishment of this very undesirable result.

The morbific manifestations of an infantile disease are undisguised, and the patient may be questioned by a thorough investigation and study of the symptoms presented, which rarely fail to reveal the truth. Several distinct diseases are embraced by the title of this paper. the title of this paper. They have been variously classified by authors, and more variously by practitioners. A review of scholastic teaching is at this time beyond my power, and, hoping that practical papers are not undesirable, I have chosen to base what I may say largely upon actual bedside observations, rather than theories derived solely from text-books, which are the common property of each of us.

I purpose noticing only three of the alvine fluxes, and they will be considered in the following order:

1. Cholera infantum.
2. Infantile diarrhea.
3. Infantile dysentery.

The first is, fortunately, of rare occurrence, although the name has been applied by the laity to every alvine flux of infancy, from the most conservative diarrhea following an acute indigestion to the gravest form of the fearful malady properly coming under that heading.

"Family doctors" are commonly responsible for these errors; but whether they be due to want of exactness in differential diagnosis, or desire for unmerited fame if recovery takes place, and leniency if the issue be fatal, I

can not say. Possibly one or both of these suggestions may serve to explain some points that otherwise might be difficult of understanding.

I think it was Professor Smith, of New York, who wrote: "The 1,500 fatal cases of so-called cholera infantum reported every summer in this city, are, with now and then an exception, cases of gastro-intestinal catarrh, inflammation generally protracted."

Thus it will be seen that statistics concerning the mortality and frequency of this disease can not be relied upon.

During three years of active private prac tice in Texas, I have seen but two typical cases of cholera infantum. These I will briefly report:

CASE 1. Was called August 3, 1887, to see an infant of Mr. George Mc-, aged eight months. Arriving five or six hours after first symptom was noticed, I found patient in a state of collapse. Sunken eyes, great emaciation, extreme pallor, and anxious countenance were the points attracting attention. The history was that of almost incessant vomiting and purging from the beginning, and at that time the discharges from both stomach and bowels were thin and watery in appearance. The stools consisted of a serous fluid, which scarcely stained the linen, and which gave an odor which, if once known, is never to be forgotten. The temperature was subnormal and the radial pulsation could not be detected.

Dispatching a messenger for the best available counsel, I addressed my attention to the patient, bathed body with solution of whisky and quinine, and applied stimulating sinapism to spine. The various medicines commonly used for the control of vomiting and purging were given per os. Among these I mention bismuth, ingluvin, minute doses of calomel, carbolic acid, etc. Evidences of a reaction were at no time manifested, and the termination was by death, in less than twenty-four hours from the initial symptom.

CASE 2. Only a few weeks later, while resting one warm afternoon, I was roused by

the statement that my own baby (boy aged eighteen months) "seemed to be sick." A few hours before he was exceedingly playful, but at the moment of which I am writing he was dull and stupid. He was pale, and seemed to be nauseated extremely. My first impression was that he had, during sleep, swallowed an insect, probably a house-fly; and desiring to relieve his stomach of the offending substance, mattering not what, I gave him some pulverized alum. Emesis was very prompt, and in the vomited matters I found quite a quantity of unripe fruit, peaches, which had been eaten during the forenoon. Contrary to my expectation the vomiting continued, and to my horror I noticed that purging had supervened. The discharges from both stomach and bowels resembled to some extent those of the previous case in both appearance and odor. Reeognizing an emergency, I administered hypodermically at once:

Morphiæ sulphatis...........gr.
Atropiæ sulphatis..... .gr. obo
Aquæ.....

......gtt. xx.

In less than thirty minutes the vomiting and purging ceased. I then gave minute doses of calomel combined with oxalate of cerium. Careful attention was paid to his diet, and lactopeptin was administered after meals. The recovery was immediate, and no untoward after effect was observed.

By permission of Prof. Wm. Bailey, I mention instances cited by him in the course of his lecture on belladonna and its preparations, present session.

(Case a.) He was called to see an infant five weeks old. Diagnosis: cholera infantum. Patient was in a state of collapse. He administered morphia and atropia hypodermically. The result was in every way most gratifying.

(Case b.) Two years later he was called to see same child, to find it in the same condition as before. Relying upon same treatment used in former attack, a favorable result was again speedily obtained.

Dr. Bailey advises, under these circumstances, the employment of small doses of morphiæ, combined with proportionately large

(a) Authorities have agreed that the alvine fluxes are more often met during the heat of summer than at other seasons; that deficient ventilation and bad hygienic surroundings are predisposing causes; that improper feeding and sometimes dentition are exciting causes.

(6) Experience has demonstrated that the weak and feeble seem no more liable to the malady now under consideration than the healthy and robust.

(c) Recovery or death soon takes place, and there are consequently no cases of chronic cholera infantum.

(4) Autopsies do not discover any intestinal lesions, and the softened condition of the stomach, often noticed, has been attributed to the post-mortem action of the gastric juice.

(e) Cholera infantum bears a striking resemblance in many, if not all, particulars to the cholera morbus of adult life. The treatment that has appeared to be most successful in both diseases is the same, varying only to suit age and condition of patient. Therefore,

(f) The conclusion that to me has seemed legitimate is, that cholera morbus and cholera infantum are in etiology identical.

Diarrheas of infancy are of two types, the "simple" and the "inflammatory;" but, since the causes, symptoms, and rational treatment are so little different, they will be considered as differing in degree rather than in kind.

As has been intimated, the causes of cholera infantum, both predisposing and exciting, are equally operative for the development of the diarrheas and dysentery as well. Dentition is thought by some to be the most important factor in the causation.

of the diarrheas, but many cases have been observed in patients so young that dentition was necessarily excluded. In these cases, pregnancy on the part of the mother, or the feeding of improper artificial diet, insalubrious environment and the like, must be examined for explanation.*

Diarrhea comes on as a gastro-intestinal disturbance, and is very seldom abrupt in its onset.

If apprehended early, little or no medication is required, the tendency being toward a normal condition on removal of the cause or causes. Very often removal from city to the purer atmosphere of rural districts has been quite sufficient.

If, however, a favorable termination is not obtained after the lapse of a few days, the child becomes more fretful, and the appetite is either measurably impaired or becomes morbid. Nausea and vomiting, more distressing than previously, and a rise in the temperature to 101° to 102° or 103° F. announce an inflammatory gastro-intestinal action. The increased temperature is more or less persistent, bearing close relation to the inflammatory process. Food is either rejected by stomach, or passed undigested by bowels, soon after it is taken.

The stools, which at first were abundant, quite thin, and light colored, are now of greenish color, and somewhat scanty; the passages, which are frequent, being preceded by colicky pains about the abdomen. At this time the stools are often found to be streaked by a bloody mucus.

Diarrhea, known in domestic practice as summer complaint, is usually protracted; the unfavorable course being that of progressive emaciation, and when death takes place it is usually by asthenia through inanition. If the case recovers, convalescence is generally slow.

The treatment which in my limited experience has given the most satisfactory results will be referred to presently.

The writer wishes it understood that he has refrained from the discussion of the "germ theory" as it relates to the "alvine fluxes," not because he is entirely ignorant of it, nor because he does not believe it true, but for the reason that, in a paper proposing to be practical, matters purely theoretical are thought to be inadmissible.