and incidentally to the fact that yellow fever is never epidemic in such localities. The Druggists' Circular, in referring to these experiments of Dr. Waggener, makes the following sensible suggestions: "That these experiments suggest a highly-important possibility is obvious. It is well known to chemists that lime dissolves in water to a very limited extent, so that a small quantity of lime will furnish a very large quantity of lime water, and it may be that this when much diluted by admixture with the water of the ponds would still prove efficient." A Damage Suit for Malpractice End ing Favorable to the Doctor. Dr. J. W. Perkins, of Kansas City, sued a patient, C. R. Rockwell, for $489 for medical services, resulting in a counter claim by Rockwell for $25,000 damages for malpractice. The case was won by Dr. Perkins only because he had kept a daily record of this, an unusual one, by means of which he was able to prove painstaking care and unusual skill in the treatment of his patient. In this he was also sustained by the various nurses and consultants who had been associated with him. This shows the importance of keeping notes of cases from at least one important point of view. It also emphasizes the value to the physician of consultations with other physicians as a protective measure in all cases that might develop into a suit for malpractice. The Kansas City Medical Index-Lancet, in referring to this case, very properly speaks disparagingly of those physicians who encourage the instigation of damage suits against other doctors, particularly without a substantial basis; and suggests that such individuals should be properly disciplined by any medical society in which they hold membership. Our con temporary also suggests that such cases should be thoroughly investigated by the proper county medical society of the district in which the defendant physician resides, with a view to bearing the burden of the expense of his defence, if worthy. Our contemporary concludes with "We predict that there would soon be an end of all needless damage suits," to all of which we say, Amen. To Mask the Bitterness of Nux The Medical Gleaner is authority for the claim that two drachms of chloroform mixed with enough alcohol to make one ounce, and well mixed and then emptied with water, a thorough mixture of all into a five-pint bottle, which is then filled three results, especially after a very little almost cover up the bitterness of nux shaking. This preparation is said to vomica. Chloroform Water in Thirst, Nausea and Vomiting. Dr. S. I. Dibailoff, in Vratchelnaya Gazeta (St. Petersburg), calls attention to the efficacy of chloroform water in relieving thirst, stomach pains, nausea, and vomiting, especially when these conditions are symptomatic or of a reflex or nervous nature, rather than due to local inflammation. He finds it useless in typhoid fever, thus contradicting the assertion of others. We respectfully solicit from our readers reports from experiences, either favorable or not, on the following subjects brought out in recent years: Permanganate of Potassium in Opium and Other Narcotic Poisoning. Lard Freely Administered in Strychnine Poison ing. Free Saline Purgation in Peritonitis. Original Articles. The following articles have been written exclusively to the editor and readers of this journal. Other journals republishing any of these articles will, as a matter of professional courtesy, kindly give credit as follows:-Medical Council, Philadelphia. tion, there is left in the stomach and intestines, food which readily undergoes decomposition; and, at the same time there are furnished conditions in which bacteria may develop, which, though previously present, are unable to gain a foothold, or bacteria may be introduced The Etiology of Infantile Diarrhea. in such numbers, and of such virulence, By A. E. SNYDER, M. D. New Milford, Pa. The term Infantile Diarrhea is applicable to all forms of diseases of the bowels in infants which are accompanied by frequent and loose passages. It is my purpose to treat only of the most prominent causes of infantile diarrhea, such as we meet frequently. The etiologic factors common to all forms of infantile diarrhea are age, season, surroundings, constitution, dentition, food, and feeding. Some of the different forms are: 4. Nervous, caused by cold, heat, fatigue, fright. 5. Acute gastro-enteric infection, which will comprise gastro-intestinal catarrh, gastro-enteritis, cholera infantum, and mycotic diarrhea-the last named being the form of diarrhea most prevalent during the summer months. The view now generally held is that it is of infectious origin. 6. Entero-colitis and colitis. Most of the etiologic factors already mentioned will apply with equal force to ileo-colitis, and it may also be secondary to the infectious diseases. In general, this depends upon the cause of the diarrhea and upon our ability to remove it. It is worse when the symptoms have lasted some time and when The predisposition to attacks of summer diarrhea is partly general and partly local. The general influences-age, im- they are continuous; better when they proper food, etc., have already been mentioned. The most important of the local causes is chronic derangement of digestion, usually the result of improper feeding. In addition, there may be present a low grade of catarrhal inflammation. The exciting cause may be acute indigestion. In consequence of the arrest of diges *This and the following articles on this subject were read before the Susquehanna Co. (Pa.) Med. Society. are intermittent. If there is some evident cause which can be removed, the prognosis is much better than when no cause is discoverable except the child's delicate constitution. It is worse when there is rickets, syphilis or other constitutional vice. The existence of diar rhea increases the danger from any acute of this form of disease has again and disease. Every physician who sees much and again met with cases so weak, so wasted, and so anemic, that recovery seemed out of the question; and yet, after a few weeks, under favorable circumstances, they have begun to improve little by little, and finally have gone on to complete recovery. Statistics compiled by observers in New York, Baltimore, Boston and Berlin say that the mortality varies but little from January to May, then rises rapidly to its highest point in the middle of July, to fall rapidly until October, after which it varies little until the end of December. There are very few cases of infantile diarrhea that prove fatal, except among children already suffering from athrepsia. It is not uncommon among such children to have fatal cases of diarrhea which have never presented any choleraic symptoms. It is a surprise to see with how few symptoms such children succumb. In cases suffering from athrepsia, any diarrheal attack may prove fatal, and a guarded prognosis must be given. I will now say something about Cholera Infantum. Cholera infantum can scarcely be misCholera infantum can scarcely be mistaken for any other form of intestinal disease if its chief symptoms are kept in mind. The constant vomiting, the profuse serous stools, the great thirst, dry tongue, high temperature, and great restlessness, followed by rapidly developing collapse, sunken fontanelle, pinched, anxious face, cool extremities, weak puise, dyspnea, cyanosis, stupor, coma, convulsions, and death, all occurring in the course of one or two days, are unmistakable. Prognosis. The prognosis is worse in a young infant; worse in one who has been badly fed and poorly cared for; worse when all the surroundings are unfavorable; worse when the patient has suffered from antecedent intestinal disease; and worse in midsummer. Yet almost every year are seen stout, well nourished infants of 10 or 12 months, who have been tolerably well cared for, die from this disease. There are certain cases in which it is evident, from the first few hours of their sickness, that death will be the issue. In 237 cian to intimate to the parents that the such cases it is simply cruel for the physibeen called in time. result might have been different if he had No matter what the treatment employed, and no matter how early it is begun, the vast majority of the ever, no case, no matter how severe, very severe cases terminate fatally. Howshould ever be despaired of. They constitute not more than 2 per cent. of the cases of infantile diarrhea. Infantile Diarrhea-Pathology. By S. BIRDSALL, M. D. In considering or discussing any disliterature of the subject makes this diffiease, a good classification is a great help to both teacher and learner, but the cult. It is evident that authors do not find it easy to agree. Professor Vaughn says that a classification based on pathology or anatomic lesions is impracticable, or words to that effect. Were it otherwise, the task assigned me would be less difficult. I cannot claim originality in describing the pathology of infantile diarrhea, and, after consulting several better than adopt the classification found authors, have concluded that I cannot do Theory and Practice of Medicine," which is as follows: Pepper's American Text-book of in (" 1. Acute dyspeptic diarrhea. As well-chosen synonyms often throw light even on a difficult subject like the special pathology of diarrheal diseases, I have selected some from other authors. Acute Dyspeptic Diarrhea. Synonyms.-Acute intestinal indigestion, simple diarrhea, irritative diarrhea. of diarrhea do not pass beyond the stage Pathology. The lesions of this form of catarrh. There is redness, swelling, lesions of the intestine do not take place." and increased secretion, but destructive reference to intestinal diseases that I The term catarrh is so frequently used in thought a comprehensive definition from so good an authority as "Foster's Ency clopædic Medical Dictionary" might be of service: "Catarrh: A simple inflammation of any mucous membrane, in which the blood vessels become engorged, and swelling takes place from exudation of serum." Cholera Infantum. Synonyms. Acute milk infection. Choleraic diarrhea. Pathology." Few or no lesions of the intestine are found post-mortem, and never any of an ulcerative nature. The gravity of the affection seems to be due rather to the associated paralysis of the vaso-motor nerves of the intestine, with a resulting profuse discharge of serum, than to any violent enteritis even of a catarrhal form." The past few years have added much. to our knowledge of cholera infantum. It is now generally regarded as due to poisons taken in the food, or developed in the intestinal tract from germs contained in the food. This being the case, we would not expect to find marked anatomic lesions, especially when the disease is of such short duration. It is not like a corrosive poison, carbolic acid, or a concentrated mineral acid that speedily disorganizes the mucous membrane, but, nevertheless, is capable of causing the most profound functional disturbances. If the poison is speedily eliminated, recovery is rapid, and the mucous membranes scarcely show a trace of its effects. Just as a person breathing an irritating gas, like chlorine, soon develops the subjective symptoms of severe bronchitis, and if this is continued but a short time, the person returning to a pure atmosphere, the cough ceases and the bronchial mucous membrane presents no characteristic inflammatory appearances, so in cholera infantum-the cause removed, no lesion is found. Acute Entero-Colitis. Synonyms.-Gastro-intestinal catarrh. Summer diarrhea. Sub-acute milk infection. Pathology.-"The pathologic lesions are situated principally in the ilium and colon, although there may be hyperemia of the rest of the intestinal tract. The disease might, with good reason, be called ilio-colitis. It has sometimes been termed follicular enteritis, since ulceration of the follicles is present in most cases. During the first week of the disease the lesions are those of acute enteritis of moderate severity in adults. "The mucous membrane of the affected region is swollen and softened, and the epithelium appears to have been shed in some places. The solitary and agminated glands are enlarged and prominent. After a week the solitary glands, particularly in the colon, exhibit ulceration, as do Peyer's patches to some extent. "These ulcers rapidly enlarge and deepen, forming a central slough, and penetrate to the muscular layer of the bowel. In some cases, instead of this change, there is a diphtheritic or pseudo membranous inflammation. This renders the intestinal wall firm, stiff, destitute of folds, and of three or four times its normal thickness. The glandular structure is indistinct, but there is no deep sloughing. The wall of the intestine has been rapidly infiltrated with small cells and fibrin in this variety of the disease." Chronic Diarrhea. Synonyms. -Chronic entero-colitis, chronic intestinal catarrh, chronic intestinal indigestion. Pathology." Even in the cases which severity during life, and which have been present symptoms of only moderate chronic from the outset, there is found post-mortem distinct hyperplasia of the lymphatic follicles, especially the solitary glands of the colon. These are swollen glands of the colon. and projecting, reach or exceed the size of a mustard seed, and are surrounded by a small red zone. In more severe cases, especially where acute diarrhea has preceded the chronic form, there is noticed, under the microscope, some loss of villi and a decided disappearance of many of the tubular glands. There is a great proliferation of lymph-cells in the mucous layer, with some new formation of connective tissue in cases in which the disease has persisted a sufficiently long time. In the worst cases, those following Infants should be protected, by proper clothing, from extremes of heat and cold, and from dampness. They should be taken away from crowded or unclean districts in cities and towns during the hot weather, and have fresh country or sea air, and good hygienic surroundings. The quality and quantity of food should be regulated; the milk and water pure and sterile; and, in very hot weather, an extra amount of water allowed, and solid food diminished in amount. No uncooked fruit or foods should be permitted in very hot weather. Infant-feeding in all its modifications would be interesting, but necessarily too copious to include in this paper, so I will only outline a general plan. Clinical experience has proven that the average infant in the early months of its life does not digest unmodified cows' milk, demonstrating that the best results are obtained when the chemistry of the food more nearly approximates the chemistry of human milk. Hence cows' milk should be made to suit the conditions of the digestive tract at this time. The following formula will suffice for an infant of four months, and averaging fourteen pounds in weight. Number of feedings, 7. Amount, 41⁄2 ounces. The water used should have been boiled for five minutes, and the milk sugar dissolved in the water previous to adding the other ingredients. The materials required are a sterilizer, thermometer, tubes, stoppers of cotton wool, cozy graduate, milk sugar and sugar measure holding 33% drachms, siphon, and a 1-quart jar. The milk should be kept from impurities by covering the jar with a clean cotton cloth until the animal heat is disposed of (fifteen miuutes); then place the sealed jar in ice water for six hours at a temperature of 35° F., when it can be siphoned or use. In presenting a line of treatment for infantile diarrheas, I shall follow a plan which, while it includes prophylactic, internal and external medication, will also vary in accordance with the cause and seat of the disease producing the sympton of diarrhea. The papers preceding this have brought to your notice the causes, symptoms, and general characteristics, and I shall take up these several forms in order of their nature and severity. First. Functional, Non-inflammatory. Which, being due to increase in peristalsis and secretion from irritants and other causes mentioned, we find, no doubt, that the diarrhea has removed the irritant, and all we will have to do is to secure absolute rest to the alimentary canal for from twelve to twenty-four hours, giving small quantities of sterile water as frequently as desired. After twelve hours have passed we may give a thin rice or barley water containing a small amount of milk sugar. If much prostration is present, whiskey or brandy If artificial food is used, may be added. |