occur a considerable loss of weight. An exclusive milk diet far from meets the demands. There must be supplied to the child food which will give enough energy and allow of sufficient variety to aid in keeping him in good resistant condition. The most satisfactory method is to remove the top pint from a quart bottle of milk and dilute it with one pint or less of boiled water. In children under five years the dilution of pint and pint is best, but in older children it is better to allow the cream to remain concentrated and dilute the pint with eight ounces of water. To each ounce of the milk so treated there is added from one-half to one dram of sugar of milk. This latter is a most valuable addition to the diet. In the administration of food regularity must be the keynote. It is not sufficient that we prescribe a certain amount of nourishment every so often, but there should be some definite idea of the needs of the child. For practical purposes this may be best calculated by the weight of the child. We may proceed somewhat as follows: There should be provided such an amount of food as approximates the caloric need of a child at rest with a further addition to prevent as well as limit protein loss. For every five pounds of the child's weight, we should provide in each twenty-four hours approximately: Milk (treated as suggested) 21⁄2 ounces. Cereal gruels I to 14 ounces. To illustrate a child of fifty pounds would be given (in twenty-four hours) milk, 25 ounces; sugar of milk, 122 to 25 drams; eggs, two to three; cereal gruels, 10 ounces. But to add to the variety of this as well as adding an extra amount of nourishment which is easily and usually eagerly taken, I am in the habit of using vegetable purees in the milk. The puree is made from any fresh vegetable which is cleaned and cut fine, and covered completely with cold water. This is boiled for from four to six hours and strained. Then the clear liquid is reboiled for five minutes, restrained, seasoned and thickened with arrow root. This is used as a stock, and is added to the milk in about the proportion of two ounces to eight. By varying the vegetable the appetite is appealed to. Water should be given somewhat freely and at stated intervals, although it needs to be remembered that with the milk treated as suggested, there is considerable amount of water added to the diet. As soon as the temperature has remained normal for five to seven days solid food may be added in the form of stale bread, zwieback, toast, or a well-cooked cereal. The return to a full diet can be made more rapidly than in adult cases. The return to a whole milk in the dietary should be made with considerable caution because there persists for a long time an intolerance to it. GENERAL TOPICS. Relation of the Nose to Digestion.1 The digestion may be influenced by the olfactories in several ways-directly, reflexly through idiosyncrasy, or by some complex psychic process hard to analyze. It is estimated that it requires about 2,000 cubic feet of air to pass daily through the lungs of an adult in order to furnish enough. oxygen to maintain good digestion, and, as the greater part of this air passes over the olfactory region, the content of odorous. substances it contains may exert a marked effect on the alimentary tract. That appetizing odors may make the mouth "water" by stimulating the salivary glands is well known, and Pawlow has shown that the gastric juices are fully as susceptible to the gentle suggestions of the olfactory organs. Every one who reads. these lines can doubtless remember a past experience, when fragrant odors wafted by friendly breezes from some near-by kitchen not only whetted the appetite, but also brought about in the stomach that gnawing sensation which only a bountiful flow of the digestive juices can produce. On the other hand, no one factor can exercise a more malign influence over the appetite, and with it the digestion, than foul or repulsive smells; for we must admit that, as Bassler well says, "viewing the body as a whole, a marked disturbance in any organ outside of the digestive canal acts as a chestnut-burr irritation in upsetting the normal nervous balance of the neurologic system, and that these abnormal stimuli , 1910 , Vol. V., manifest their effects most easily on the digestive organs, which, through abundant sympathetic supply, are most sensitively balanced." As some loathsome sight or a disgusting mental picture may kill the appetite and "turn" the stomach, so a foul odor, through its reflex action, may just as effectually dry up the "appetite juices." Even after digestion has normally begun, the presence of a disagreeable odor may retard its progress, and, by inhibiting the secretion of gastric juice, and checking the motor waves of the stomach, may allow stagnation, bacterial fermentation, and the formation of gases and irritant decomposition products. The influence of odors and perfumes on many people is exceedingly marked. Some there are who can not remain where lilacs are in full bloom, or bear the odor of jasmin; others are given a headache or are nauseated by heliotrope or tuberose, while the smell of cantharides often causes vertigo and a sinking sensation in the epigastrium. Even the fragrance of roses has an irritating and nauseating effect on some. Attacks of real illness, with long trains of digestive disorders following in their wake, may be brought on by odors. are Superstitions of Childbirth. There many superstitions connected with childbirth, says Pickin, who has at different times been made acquainted with the following simple methods of foretelling the sex of the child during pregnancy: I. If the chief prominence of the abdomen is high towards the end of pregnancy, the child is a male; if low, a female. 2. If the abdomen is more prominent when viewed from the side, there is a boy; but if more prominent when viewed from the front, a girl. 3. If, when a woman has given birth to a sequence of boys (or girls), there is a change in the usual course of events during her pregnancy (i. e., if she suffers from vomiting when she has not done so before, etc., etc.) it forebodes a change of birth and the child will be a girl (or boy). 1 F. H. Pickin, M. R. C. S., The Practitioner, Oct., 1909. 4. If towards the end of pregnancy a drop of secretion is squeezed from the breast into a glass of water and it sinks, there will be a boy; but if it spreads out and floats upon the water, there will be a girl. "The last method," continues the author, "was told me by an ancient midwife in Somersetshire, who assured me she had never known it to fail. I am also indebted to the same good lady, Mrs. A. for some interesting facts relating to the caul. She informed me that her sister was born with a veil or mask over the face, which was carefully removed and put aside by those present, special care being taken to prevent it coming in contact with the ground because of the bad luck which would follow. Later the 'veil' was spread out to dry, then it was wrapt in tissue paper, labelled, and kept until the child was grown up, when it was given into her charge. She still had it in her possession when 76 years of age (1907), although it was reduced to dust and so small in amount that it could be placed upon a sixpenny piece. She would not have parted with it on any consideration because it would bring her bad luck to do so. Mrs. A. also told me that if the 'mask' is neglected at birth and thrown away, the child when grown up could see visions, foretell death, and have the power of 'overlooking' people. She stated that her own nephew was known to have these powers for this reason. Sea captains used to purchase these 'cauls' because it was believed that no vessel with one on board could be lost, and it is said lawyers also used to buy them in order to attain eloquence, but the owner of a caul would have to be hard very before up parting with it because of the ill-luck that might ensue. Mrs. A. knew of five pounds. being offered for one and refused. I know of a woman who recently sold a caul to a sailor for thirty shillings. The following advertisements, copies of which I found in Brand's Popular Antiquities, prove the value that once attached to these charms :— "To the gentlemen of the Navy and others going long voyages to sea. To be disposed of, a child's caul. Enquire at the Bartlet Buildings Coffee House in Holborn. N. B. To avoid unnecessary trouble, the price is twenty guineas.' Morning Post, August 21st, 1779. A Child's Caul. Price Six guineas. Apply at the Bar of the Town Shades, corner of Tower Street. The above article, for which fifteen pounds was orginally paid, was afloat with its late owner thirty years in all the perils of a seaman's life, and the owner died at last at the place of his birth.' Times, May 8th, 1848. In Bristol I have seen the placenta of a primipara placed upon the fire in the lyingin room and have watched the young mother counting the big "pops" to ascertain the number of children she was to be blessed with. These "pops" or "crackers" are caused by the bursting of any blebs that may arise owing to gas formation. It is commonly believed among husbands that, in order to safeguard the child, the wives during pregnancy must be supplied with anything they have a great longing for. Some wives are not above longing for new hats." THE ANNOTATOR. Sanitary Condition of New York Harbor. The Metropolitan Sewerage Commission of New York City has published a "Digest of Data" collected before the year 1908, and the matter deserves far more comment than it has so far received for it is of the utmost importance. Unfortunately, a broad interpretation of the data is merely that the harbor of New York City is filthy with sewage-a fact we all know and one which did not need laborious bacteriological confirmation. We also knew that on account of the slowness of the tides, practically none of our filth reaches the sea but that some of it is destroyed as in a septic tank, the balance of the precipitated materials being deposited mostly along the shores. The scouring action of tidal currents, of course, prevents deposition in the channels to more or less extent, though not entirely, for colon bacilli were found "at the surface of the bottom of the harbor at all points in the upper and lower bays, including the rivers and canals." Some of this sediment undergoes chemical changes until it becomes offensive black mud and even colon bacilli are found in it to considerable depths. Long before septic tanks were dreamed of, Waring had called attention to the slow diminution of the material in cesspools, and showed that where the daily deposits are not too great the vaults have been known to have not necessitated excavation for many years-the state of affairs in our own harbor when the city had a small population. When the deposits are introduced faster than the old ones decay, then occasional excavation became necessary, and when our city became congested with people, we began dredging around the docks for the same purpose. It is therefore somewhat surprising that the Commission concludes that "the harbor is not like a cesspool in which bacterial multiplication is a leading feature. Either the sewage in the harbor is disposed of in other ways than by bacterial action or the bacterial action is very rapid." It is shown that sewage floats on the colder heavier sea water brought in by the tides, and that the currents are exceedingly variable. It is also shown that the bacteria, as a rule, are more numerous in winter, as would be expected from the destructive effects of the summer sunlight. is not generally known, by the way, that minute forms of life are far more numerous in northern waters than in the tropical, probably for the same reason. It The most amazing part of the report is a synopsis of investigations of the sanitary condition of Gowanus Canal, made by Charles F. Breitzke (Technology Quarterly, Sept., 1908). It is a revelation of a state of affairs so foul as to be a blot upon our boasted civilization-an open septic tank 100 feet wide and two miles long whose odors are noticeable for several hundred feet and it could all be remedied at an expense which would enhance the value of the adjacent property much more than the outlay-not to speak of the improvement of health. The condition of the Passaic River shows the utmost need of a radical change in our methods of dealing with domestic and industrial wastes. It is regrettable that this preliminary report does not mention the remedial measures now under discussion, for the public are keenly alive to the conditions and are sure to demand suggestions for early relief. The data are now sufficiently voluminous, and though some of the investigations were of no particular use, a few being considered even inaccurate, yet as a whole, the report is a splendid beginning for future reforms. Now let practicable schemes be worked out without delay. Every now and then the world is given. some book that marks an epoch of thought, a book that so arranges old facts, or so garbs them in new apparel that they appear new and altogether startling. Such a book is Major Woodruff's "Expansion of Races." Few there are who can read this notable contribution to ethnologic study without being impressed by the way the author has taken established facts, and put them to work proving his contentions. As one reads, therefore, one's interest is bound to grow, for the ideas and opinions of the writer are expressed in familiar terms and based on phenomena generally known if not generally understood. No novel or tale of adventure was ever more interesting. Dr. Woodruff is a splendid writer. His pen is most facile and his diction is delightful. With the skill of the true artist he takes the most prosaic facts and with a deft touch gives them a new and distinct personality. Indeed he unfolds the story of racial growth and progress in such a way, that his book has all the fascination of romance and fiction. People, even of marked intelligence may be slow in taking up Dr. Woodruff's book, but, when they do, they are sure to read it with an application that is given to few scientific works. Antagonisms will be created and many of his deductions will be questioned and denied. But the stimulation of thought and the broadening of opinion cannot fail to repay the reader many times over the time required for perusal. In every way this book serves to broaden the mental vision. It establishes a better perspective and gives a truer balance between the multiple details of human living. Space prevents considering its many topics and sub-topics, but no physician or intelligent layman should fail to read. and ponder this really masterful book. Next to Darwin's "Origin of Species," Woodruff's "Expansion of Races" should EXPANSION OF RACES. By Charles E. Woodruff, A. M., M. D., U. S. Army Medical Corps. be found in every library. To some this may sound like fulsome praise, but those who once fall under the spell of Major Woodruff's book, will understand and grasp our meaning. The excellent opportunities of studying races and peoples, that Major Woodruff has enjoyed, have given him a practical viewpoint that is of infinite value to a really scientific mind. The combination of opportunity to observe and capacity to understand and classify, rarely occurs. It has, however, in the instance of Major Woodruff, and the world is the richer for it. Valuable and intensely interesting_as every intelligent person will find the "Expansion of Races" we venture to believe that ten years from now it will just begin to be appreciated. The reading public will be better able then to grasp its teachings and absorb its lesson. In the meantime it will do a splendid work in diverting thought from acquired grooves and directing it into unknown but perhaps more productive fields of activity. What greater success could an author wish? SOCIETY PROCEEDINGS. EASTERN MEDICAL SOCIETY OF THE CITY OF NEW YORK. STATED MEETING, FRIDAY, DEC. 10, 1909. 1. Presentation of Specimens and Report of Cases. (1). The Urticaria of Infancy, by Dr. Udo J. Wile. (See page 42). DISCUSSION. Dr. H. Schwartz said he had been very much interested in Dr. Wile's paper, especially that portion of the subject referring to infants, and breast-fed infants in particular. He thought urticaria, as is usual with all diseases that have been ascribed to so many different causes, had no specific cause. He had recently had the opportunity of investigating some causes of urticaria in the breast-fed. He had found in these cases that the fat content of the milk taken by the child usually had been very high, and in one case where the urine had been examined the ammonia excretion was high and there was an increase in the fatty acids in the stool, showing that evidently there was an intoxication, with an increased elimination of alkali. That this is not the only cause had Series been shown by the fact that in one case the fat content was low in the milk. The speaker thought there evidently was some poison circulating in the blood of such children, which with an added trauma to the skin-either heat, light or cold-produced a local irritation and the characteristic wheal. He cited a case of scarlet fever where the administration of large doses of quinine had produced urticaria. The local condition had been the previous trauma to the skin from the scarlet fever, while the primary condition had been the circulation of the quinine. Dr. Ludwig Weiss said that urticaria was the bane of dermatologists, pediatrists and the general practitioner, inasmuch as while the symptoms were easily recognized, it was very difficult to cure. To not one, but to several causes is it attributable. Generally it is caused by intestinal auto-intoxication, but usually it is difficult to find any shortcoming in the digestive system. While dilatation of the stomach is said to be a constant feature, in this dermatologists do not agree. That auto-intoxication is the main factor in producing it is almost a certainty, but the way in which the auto-toxic substances are carried from the intestinal tract to the skin is as yet an undecided question. In speaking of the different etiological factors, the speaker cited an instance which he said had not been touched upon during the evening, the contention of Hutchinson who called attention to the frequency of this affection after eruptive fevers. Like urticartia it sometimes occurs after measles and then assumes a papular type, and when it appears after chicken-pox it appears in the vesico-papular type. So it would seem that there is a consequence between the original disease and the consequent urticaria. It is known that the auto-toxic substances may act as irritants either to the nerve centers or terminals and thereby provoke pruritus, disturbing the lability of the skin, causing as it were an abnormal reaction, in consequence of which the circulation becomes impaired and may lead to an urticarial condition. The eruption consists of a papule or papulo-vesicle, around which is a hyperaemic border, the urticarial part of the eruption. This is evanescent, making its appearance mostly at night or after the ingestion of food, while the papules remain sometimes for weeks and months. This disease has also been known by some of the older writers as "gum-rash," as it sometimes accompanies dentition. It was Bateman who first recognized the relation of the papule to the wheal, calling it urticaria, while to Colcott Fox is due the fact that it is regarded as a morbid entity. In the pathology of exudative erythemas their vasomotor origin and angioneurotic character usually are emphasized. But it is equally true that the metastatic theory offers a more natural and tangible explanation. This is, under certain restrictions, true. It is the transmission of irritant substances to the skin, the alterations in the walls of the vessels that cause the erythema lesions. , 1910 , Vol. V., The irritative substance on its way from the blood to the surface undergoes certain alterations, satisfies certain affinities, is attenuated, as it were. The process will first invade the deeper strata of the skin and, expending its force, the main lesions will be found there. The angioneurotic alterations of the skin are nothing else than the reactive irritation phenomena of the vessels. Erythema or urticaria papulosa is the simplest kind of inflammation, an inflammation of a very mild type, a metastasis caused by the alterations of the walls of the vessels, of short duration. As to internal treatment diet is of the utmost importance. Next in importance is environment-cleanliness of body and surroundings, as the extremely tender skin of infants and children is peculiarly susceptible to urticarial lesions, especially after insect bites, etc. Dyspepsia, obstipation and anemia must be relieved, and particular care exerted in the selection of food. Internal medication consists of antifermentatives, Beta-naphthol and saline purgatives, or salol in small doses. The speaker said he had been quite chary of giving atropine to very young children. He mentioned tincture of colchicum as a remedy not heretofore employed in the disease under discussion. Because of the fact that in rheumatism as well as in urticaria there is a deficiency of urea, it had occurred to him that the employment of this drug, of signal effect in gout and rheumatism, would augment the internal armamentarium in combating the condition. To very small children it is given in the dosage of 1 drop to 2 teaspoons of water, every 2 hours, and to larger children in 1 drop doses three or four times a day. A very essential part of the treatment consists of the relief of the pruritus. Warm baths with the admixture of borax or oatmeal to soften the water are of value. Because of their warmth and moisture causing itching, salves are of little value. A soothing lotion consists of lime water, zinc oxide, and a little alcohol. It is a good policy never to tell a nervous woman that she has a floating kidney, unless the trouble of which she complains is directly attributable to it. If her mind is once drawn to this condition she is likely to ascribe all her symptoms to its presence and develop a neurasthenic state, from which nothing short of an operation will rescue her. As suggested by Dr. E. P. Davis, discomfort from silk or catgut ligatures in perineal operations may be prevented by bringing the ends of the suture within the vagina. The stitches can be gathered and held in place by a superficial stitch. |