vomiting persists after twenty-four hours, gastric lavage is indicated; as a rule it ceases after one irrigation of the stomach.

The diarrhoea is controlled by irrigation of the lower intestinal tract. The rectum and lower bowel are irrigated in those cases in which diarrhoea is persistent and becomes progressively worse. By using normal saline solution the benefit is two-fold; it removes any residue of feces that may have collected in the rectum and lower intestine and stimulates peristalsis, thereby favoring evacuation from above; it also stimulates the heart and adds to the body an amount of fluid to compensate for the drain caused by the diarrhoea. The enemata are given under a pressure obtained by an elevation of at most two feet from the bed. A temperature of 107 degrees to 110 degrees Fahrenheit is the best and most stimulating. Fully a quart may be used in half pint portions, allowing the first to return with the intestinal contents. The water may sometimes escape alongside the tube; this is a rather favorable sign as it demonstrates the contractile power of intestine and the abdominal walls. Only two enemata daily. are necessary in severe cases. As the diarrhoea and other symptoms subside the number may be reduced to one, and finally be discontinued entirely as the infant further improves.

In exceptional cases rectal irrigations are followed after a few days' use by discharges of blood and mucus with aggravation of the tenesmus. Under such circumstances it is advisable to reduce the number to one every other day, or should the symptoms persist, to discontinue them entirely in order to determine whether the discharges are due to therapy or the disease. Hypodermoclysis is indicated only in those cases in which the course of the disease has been rapid and the prostration extreme.

In all cases with or without elevation of temperature, the benefit from warm baths cannot be overestimated. In case of great prostration a bath at temperature of 108 degrees Fahrenheit for five minutes is stimulating to the nerve centers and there is an apparent reduction in the effects of the toxemia. If the patient's temperature rises above 103 degrees Fahrenheit, sponging with water at about 80 degrees Fahrenheit is all that is needed, repeated not oftener than every three hours.

Alcohol is now prescribed less often than in former years, as experience has taught us that there is a special intolerance

of the stomach and of the economy to alcohol in these cases. Infants after taking it for twenty-four hours will become stupid, apathetic and exhibit a constant retching if they do not vomit. This appears to be due more to the effects of the alcohol locally (on the stomach) and systemically than to the toxemia of the disease. It is, therefore, only advisable in severe cases in small doses and at short intervals.

Strychnine is useful and may be given in doses of 1-300 grain to an infant of six months, or 1-200 to older children, every three hours. Atropine recently advised as a cardiac stimulant is of questionable value; 1-150 grain has given rise to convulsions and twitching. I do not employ it; camphor water has been more serviceable. If the vomiting is constant, resorcin, 1-8 grain every three hours, is a safe and useful remedy. Bismuth subcarbonate is the best drug to allay the vomiting and tenesmus of the bowel. Two or three grains can be given every two or three hours.

Opium in any form has fallen into disuse. In severe cases it may increase the prostration and is dangerous. In milder cases small doses of the camphorated tincture or wine may be used when necessary to control colicky pains. Salol in 1-2 grain doses every three hours in combination with bismuth usually controls pain and diarrhoea. Colic is often relieved by a small enema; passing of the rectal tube rarely benefits this condition.

As the symptoms improve care should be observed not to return to a milk diet too quickly. Diluted milk is advisable, as it is better borne by the enfeebled digestion of the infant at this time.

Whatever methods are employed in the treatment, it is necessary to avoid the error of over-treatment. It should be remembered that hours of rest do more good than hours of treatment. Three hour intervals between the application of remedial measures, fresh air in the room, and a few hours' sojourn in the open with absolute quietude, are of the greatest value in these cases

HYGIENE AND THE PREVENTION OF DEFECTS IN

CHILDREN BEFORE AND AFTER SCHOOL AGE

BY J. J. HANNA, M.D.

Quanah, Texas

Mr. Chairman and Gentlemen of the Panhandle District Medical Association:

During the last few years preventive medicine has been coming more and more to the attention of thinking people, being talked and written of both by the lay and medical world, but the subject is of so much importance and so large, that I have no apology for appearing before you with the above caption. Before coming to my subject, there are two or three things I want to mention, not directly connected with the subject as outlined, and still bearing in some measure upon it indirectly. The first of these is breast feeding of infants by their mothers

We, as physicians, know all too well how often a little one is put on artificial food, with the ostensible excuse that the mother's milk is not sufficient in quantity, or. does not agree with the baby, when the real reason is that it interferes with the mother's social affairs or she is afraid that, by nursing the baby her mammary glands will become atrophied, or offers some similar inadequate excuse. There is not the difference now in the artificial and the breast fed infants, that there was a few years ago, owing to our increased knowledge of feeding, but even now the difference is enormous, and the mothers need to be educated along this line. I have the confidence in our American women, to feel that when they get the proper conception of this question they will attend to the rest, and it is therefore up to the medical profession to see that they are educated.

Another question demanding the attention of our people and in which the doctors must take the lead, is consanguineous marriages. If each of you gentlemen present will for a moment cast your minds back over the feeble-minded, the idiots and imbeciles met with during your practice, coming about as results of such unions, you will realize the need of some action along this line. As the matter now stands, even first cousins are not prohibited from marrying in Texas. If

*Read before the Panhandle District Medical Society at Amarillo,

Texas.

the contracting parties to a marriage of this kind could realize the danger they are in, of being the parents of an idiot or hopeless imbecile, I think it would deter them from mating. This is another question needing education and also legislation. While on this train of thought, I desire to say that I think we owe it to our clientele to teach them that a healthy, well developed mate, is more apt to be a congeniel partner, and to be the parent of healthy, robust children. I think there is a tendency now to over develop the mind, at the expense of the physical part. I am sure that a woman who can, and does, prepare palatable meals, bears and takes care of healthy children and who is physically able to mutually indulge in and enjoy, with her husband, a reasonable amount of sexual activity though she may have only a moderate education is a more satisfactory life partner and worth more to the family and community, than an over-educated, physically under-developed woman; and the same may be said of the man.

Again, Mr. Babcock, registrar of vital statistics, writes. me that there was reported in 1912 in Texas 28,638 deaths; of this number perhaps twenty per cent. were really preventable. In this number, of course, would be placed tuberculosis, typhoid fever, the infectious diseases, errors from feeding, etc. For the two years ending August 31, 1912, the State Board of Health reported about 11,000 deaths of infants less than one year old. This is a sad commentary on our general hygienic conditions, and the medical profession in particular. The next four years contributed 5,000 deaths reported, and this, too, when a great many physicians do not report their vital statisties. This shows us what a field the student of preventive medicine has! Coming directly to our subject we will pass over the first three years of child life, (expecting this time to put us past the teething period), and come to the stage in child life when digestion for ordinary food is fairly well established. From this time on till the child is old enough to start to school the most frequent cause of ailment and hence things demanding our attention most, is largely due to errors of diet and infectious diseases. This is the classification of Bendix, of Berlin, in Pfaundler and Schlossman's new work on diseases of children. Perhaps the defect most common among young children is trouble with the teeth. There is an idea prevalent among the laity and to some extent among ourselves, that the milk teeth will be shed in a few years any

way, and that a child need not really begin to care for its teeth until later. This is the reason the habit of cleaning the teeth properly shoud be acquired the first few years of life so that the habit will be established before the permanent teeth come in. The milk teeth play quite an important role in the development of permanent teeth, as well as having their own function to perform-hence the double necessity of caring for them. The teeth should have careful inspection at least twice a year and any beginning defect should be corrected in time. Most all of the hideous, irregular teeth we sometimes see, eculd have been prevented by a capable man, if taken in time. As the permanent teeth are cut they should be watched, and if necessary, one or more of them extracted so that the remaining ones may have room to enter. This plan is much better in every way than an ugly, crowded set of teeth. Of the front teeth, the eye teeth should be especially conserved for attaching bridge work to later, if needed. If the milk teeth are pulled too early the dental arches do not expand sufficiently for the permanent teeth, then we have crowding. My dentist friends tell me that the sixth molar is the one most often sacrificed of any of the permanent teeth, for the reason that it appears before the milk teeth are shed and is frequently thought to be one of the deciduous teeth, and therefore allowed to become decayed; or is extracted for some trifling . trouble, under the impression that it will be replaced later on. The teeth play an important part in digestion, and upon. the proper digestion. and assimilation of our food hinge our general nutrition, hence the importance of close supervision. over any process that enters into digestion. Right here I want to get this thought forcibly impressed on our minds-that any deviation from the normal standard is to be looked on as a defect, whether it manifests itself a blindness, deafness, deformity, or merely as flabbiness, or that indefinite condition summed up as a delicate child. I want us to realize that the best guarantee against any one, or all of these conditions combined, is in keeping the general health of the child up to par. Pfaundler and Schlossman comment on the lowered nutrition found in children during the school age, and emphasize the necessity of close supevision by the family physician, as the start for the day's duties. The Germans segregate their weakly, anemie and poorly developed, and by more exercise, feeding, sunshine, and outdoor life, bring them to a better