year after the patient was subject to severe attacks of hysteria, and, it was feared, would be a chronic invalid. One child nearly lost its eyesight from the terrible convulsions, and if there had not been much vitality would not have recovered." 2. Dr. Wood next read a very interesting and practical paper on "Extracranial Convulsions."

Dr. Moore: "There is a regulation in that remarkable institution, the Bank of England, that prohibits its employees from making intricate calculations when the temperature is at a certain point. This is not a philanthropic movement on the part of the bank officers, but because the calculations. made at those times were found to be wrong. Dr. Wood has excellently covered this subject, and I especially like his two main divisions of the extracranial convulsions: toxic influences which act directly on the nerve centres and those which act indirectly or reflexively.

"Now as regards the toxic influences. Among those he has enumerated I would like to lay a special emphasis on one which he did not, perhaps, bring out as fully as he might, and that is the subject of auto-toxic conditions. I remember one of the first cases I was called to; I could find no cause. The child was only a few months old, and care was used in its food. While I was there he vomited up quite a large mass of cold spinach, which he had taken off a table and swallowed while his mother was out of the room, and that had brought on convulsions by irritation of the stomach. Convulsions of children and adults are due to improper food, not to the bulk of food taken, but to poisonous toxines. I think most of the cases we see are of the extracranial, and not intracranial type. When we consider those which act indirectly, their name is legion. In one thing, and that is the only thing, I must disagree with Dr. Wood, and that is dentition. I believe at the present time the pendulum is swinging the other side, and convulsions may be due to teething, especially when the eye and stomach teeth are coming.

"Then we also hear a good deal about convulsions caused by parasites in the intestinal canal. Their presence alone

does not produce convulsions, but the condition of the mucous membrane, acting in a reflex way, produces convulsions."

Dr. Batchelder: "I have been very much interested in this paper and the discussion of it. There are some things that have impressed me very forcibly this evening. When we come to analyze the daily operations of life organic, and also those of the highest sphere - I think we can trace nine tenths of them to an ultimate outside origin. These we class as reflex. If we analyze these still further they fall into two groups. Those processes or operations which are comparatively simple are reflex. Those which are of outside origin, as fright, are an operative cause of producing a condition in which convulsions are the symptoms more or less lasting. The pathways of the impulses are more or less complex. We do not call them reflex.

In

"Another thing that has impressed me. It grows out of the error of using many terms in a very loose way, and we may well ask the question, What's in a name?' regard to this matter which has been referred to by Dr. Wood as toxic poison, let me say that we can find in normal phenomena pictures that will express many of these evidences. Those who have been studying this from the chemical standpoint find that we have invariably certain productions that have been referred to. It is possible to produce fatigue in a rested animal. Similar relations exist in our bodies. Dam up, close the doors of these waste products, and it is easy to see that the nerve centres are overloaded. "Another point Dr. Moore referred to is toxine as a result of poisonous material, which may or may not be caused by unsuitable food. I think we can see in a lesser degree the influence of this ptomaine in toxic-albumen, which we know as rattlesnake venom. The protoplasmic cells are the original producers of waste products."

3. Dr. Colby, in opening the discussion of Dr. Townsend's paper, said in part: "Although I have heard but a small portion of this paper, the essayist kindly furnished me a copy, and therefore I know something of its contents.

"The treatment of the whole subject of convulsions in infancy is one of such extreme importance that I wish I had more experience than I have had and better capacity for discussing the subject; but there are some points in the course of years that must impress themselves upon our minds with regard to this disease.

I agree most cordially with his paper, in a measure. Of course there are some points with which we must all of us disagree, and in such discussion will recognize the value of each other's opinion. But one particular point that he has called attention to is that something must be done. That is true, something must be done in infantile convulsions. There are younger physicians here; some may in listening to the essay be too strongly impressed with the idea of protecting themselves. While I agree totally that something must be done, I hold that something must be done that will work for the good of the patient, and in doing that the physician makes what is for his own good. If everything that is done in that direction ignores every other object except the good of the patient, that means that something is being done for the patient. My observation has shown that the preserving of a calm demeanor does much more good to the patient and friends than a bustling way. This is a very small schooner that we are handling here, and the tiller does not require very much sweep, otherwise injury may result to the physician and possibly to the patient.

"With regard to hot baths. Almost invariably the rule is to plunge the infant into a hot bath. Now this is not always convenient, and in my experience I have found quite as good results from a piece of flannel wrapped about the patient closely and sufficiently warm. Sufficiently warm does not mean painfully hot. In an infant the reflexes are remarkably active, and the whole organism is made up of superior reflexes. Moderate heat, a little over warm, but not over hot, will have a soothing as well as a derivative effect. It does not follow that derivative effects will produce relief. I believe in the same conservative notion with regard to the application of cold to the head. Cold applications are undoubt

edly a proper thing to do in the severest cases of cerebral convulsions, but I do not think it is the best thing to apply ice water, thus chilling the whole surface and producing paralysis of the scalp. For the last twenty years I have not even used cold water; I have applied tepid water, and not with a cloth, but by continual wetting; a little alcohol makes the evaporation more rapid, which will have the effect of cooling the surface without chilling or producing paralysis of the external vessels. "I think the doctor was a little heroic in his doses of ipecac and bromide; they were larger than necessary.

"I must also take issue with him a little upon following an enema with a tablespoonful of castor oil. I believe that an enema relieves the lower bowel, excites peristalsis, and you are likely to reach the upper bowel also. I know that castor oil has been used for a long time, but I think following one with the other would be heroic.

"I have my own peculiar ideas about lancing gums. I find but few instances in which the gum was so swollen or hard that the tooth would not push through, but sometimes it is necessary to lance the gum, but never over the point of the tooth. If the tissues are so thick that the tooth cannot get through they will come together after lancing. If the gum is lanced on the side it will relieve the congestion. It is not always the irritation of teething which causes the irritability. We are apt to forget that the irritation of teeth is only one thing in the development of the child; that at the same time as great, if not greater, changes are going on and increase the reflexes. I have seen excellent results in severe cases with chloral and bromides. If it is a tonic convulsion likely to last long enough to cause dissolution, we are warranted in using every means to ward off such disastrous results. The practice of several who have been successful has been to administer regularly doses of chloral and bromide; chloral is quicker, and when the reflex activity is diminished you can cure the disease. There is a difference between relieving and curing a disease.

"With regard to convulsions in childhood and future prospects. When a child, as an infant, has frequent convulsions

from what seems to be insufficient cause, then I think you can assume that there is danger ahead, and that unless the hygiene of that child's life is controlled, you are very likely to have during the period of adolescence an epileptic development. I have found in a large number of epileptic cases, when called to take the history, that the child had convulsions in early infancy, and as far as the parents could tell, by taking some little thing which caused indigestion. After many convulsions, look out for the development of epilepsy. If the child lives it should be absolutely controlled, and should be kept out of all kinds of excitement and over study.

"With regard to bromide. I believe the essayist included somewhat the subject of epilepsy. It is not a very common thing in childhood. Eclampsia and epilepsy are very near of kin; it is only a question of degree which leads us to decide. Bromides are of very little use in enabling us to control the condition except they be pushed to the extent of causing bromism, and to induce bromism in a child is to endanger its being. If you carry it to the extent of stupor, as you must, you are injuring the cortical cells and, I believe, in that way injuring your patient. I do not say that bromide should not be used, but I believe that too long a use of bromide in the case of an infant is likely to lay the foundation for insanity.

"As to convulsions in meningitis. There have been suggestions given which are good. Usually, in an attack of meningitis, convulsions develop after the disease has progressed most severely; the involved areas are threatening life, and I warn you from placing too much confidence in prognosis when the case has reached the state of convulsions. More than this, a large percentage are tubercular and practically hopeless.

"I wish again to make the suggestion that in every case of infant meningitis the family history should be most thoroughly studied out to ascertain if there is a tubercular history; and go through every organ which can show tuberculosis, because it is secondary to some tubercular deposit elsewhere." The meeting adjourned at 9.55.

FRANK E. ALLARD, Secretary.