the long fixation, had we not used it. Our greatest help in stimulating nutrition and getting relief from the deepseated soreness in the joint came from the use of the thick static spark, obtained from a large Holtz machine. It required nearly two years of treatment to get the joint in such condition that the patient could do without crutch or

cane.

This case is one that should have had fixation and rest immediately after the injury, and had it been treated in this way, a great amount of time and suffering could have been saved. It is another illustration of the proneness of our profession to make mistakes in the care of cases of traumatism about joints. It is far better to let a joint suffering from traumatism rest a little longer than is really required than it is to have it put into use too soon, and perhaps do it irreparable injury.

CONVULSIONS OF CHILDREN.

By W. Hoyt, M. D., Hillsboro, Ohio.

Convulsions may be divided into clonic and tonic, but for the purpose of this paper such a division is unnecessary, although we most frequently meet the clonic variety, where we see frequent relaxations, and contractions of the muscles, producing rapid jerking of the whole body and extremitites and even to the eyelids, instead of the tonic variety where the rigidity of the muscles continues for, to what appears to the anxious watchers, a long time.

Convulsions are very alarming to parents and friends, but usually not dangerous unless they come on late in a disease or are caused by some disease of the brain or spinal cord, although they are much to be dreaded; not so much for the danger of death as if often repeated, there is a possibility of them becoming a habit, so in time we have that terrible

disease Epilepsy, a condition more to be dreaded than death.

Convulsions may occur at any time in childhood but less frequently after the age of five or six years. Many times they are preceded by some premonitory symptoms which an experienced physician can detect, so as to be prepared when they do come, or by proper measures ward off the attack entirely.

Drowsiness is one of the first symptoms, or the eyes may have a fixed appearance for a moment without any indication that the child realizes what it sees. Some times there is an unusual heat about the head, jerking of the muscles, delirium, etc., all of which should be sufficient cause to excite alarm with the physician and friends.

The causes are many and varied in character and with some children even the law of heredity may have its influence. Perhaps a majority of the children afflicted with convulsions are predisposed to such ailments on account of their delicate and sensitive nervous system. With such it takes very little to precipitate an attack.

The great majority of convulsions that physicians meet in every-day prac tice is undoubtedly caused by some irritation of the gastro-intestinal tract.

Sometimes some indigestible substance may have been lodged at some point in the intestinal tract, and relief cannot be given until the offending substance, whatever it may be, has been removed.

I have known of cases where such offending substance has remained in the stomach or bowels many days and immediate recovery follow the expulsion of apple skin or the seeds of fruit or berries.

Almost any disease or irritation may be an exciting cause, particularly exanthematic fever, such as small-pox, scarlet fever, and measles about in the

order mentioned, and if the diseases are very violent the child may die before the eruption appears.

If convulsions come on after scarlet fever eruption appears the case may be considered extremely grave and in all probability the patient will die.

Convulsions appear to attack boys much more frequently than girls, although I fail to see any good reason for it except the tight fore-skin, and the accumulation of smegma; such conditions no doubt act as an exciting cause in spasms as well as other nervous troubles.

Undue excitement of a nursing mother may precipitate an attack of convulsions. Hence it is very important that she should avoid worry, anger or great excitement of any kind, and if such conditions should unavoidably occur, the breast pump should be used before the breast is given to the child.

It is also important that with babies fed on cows' milk the cows should be cared for by gentle hands and not worried by dogs or be driven fast by thoughtless persons. Poisonous ptomains or toxines may come from milk as well as various nitrogenous foods, and the alimentary canal is a good place to develop such poison germs. And except for the action of the liver in destroying such germs it is probable toxine poisoning would occur much more frequently than it does at the present time. In proof of this it is a fact that some poisons may be swallowed with impunity which if injected under the skin would be highly poisonous.

For instance, the poison of dissecting wounds which are so much feared by students and physician, yet they never hesitate to suck poison into their mouths where it is possible some of it may find its way into the stomach.

Also some snake poisons may be taken into the stomach with impunity, that would cause immediate death if administered hypodermically.

All children should be fed with regularity if they appear to be hungry, but if a child is unwilling to eat do not insist, for the demands of nature are the best guides, and I would emphasize this point, for ten times as many children are killed by overfeeding than by underfeeding. Another point should be burned deep into the brain of every one that has the care of infants and children, and that is that every child of every age should have a chance to drink water ad libitum.

Many children take food with avidity, not because they are hungry, but because they are thirsty; so under no circumstances should water be forgotten. Many times where a child has had convulsions or is threatened with them, the restlessness may be greatly relieved by feeding it water a few drops at a time, and if given in that way it will be tolerated a long time, while if given in large quantities it is likely to be thrown up. Even if it is thrown up, as long as the thirst is great I would continue to give water, in very small quantities and frequently repeating until the little patient is sat

isfied.

Many attacks of convulsions are preceded by or accompanied with high fever, and a high elevation of temperature in a nervous child should always excite alarm.

As to treatment I believe the bowels should be evacuated freely and as quickly as possible. An enema will do good, but some thing will be needed that will pass through the bowels and dislodge any offending accumulation.

Castor oil will probably do the work as quickly and thoroughly as any rem

edy. The homeopathic remedy should never be overlooked, but very few would expect good results from a well-selected remedy in case of poisoning until all the poison possible had been removed from the stomach.

In cases of convulsions usually there is a local irritation or poisoning of some kind and the more of that that can be eliminated from the system the better results we will get from the well-selected Homeopathic remedy, which can be found by consulting any one of our good Materia Medicas.

DIET IN NEUROSES.

By J. H. Cook, M. D., New Carlisle, Ohio. What to eat, when to eat, and how much to eat, are questions very frequently asked and quite as frequently they are either entirely evaded or answered in such a general way as to be practically valueless to the patient. The special form of nervous trouble will in a measure determine the kind of foods to be taken, but when to urge food and when to withhold it requires much study. Dr. J. Torrington Black in an able article calls our attention to the fact that in nervous dyspepsia dieting often does much harm. It is well known that such patients are too explicit in following the physician's inexplicit directions. If told that too much meat will aggravate their trouble they abstain from meat entirely. If their attention is called to milk being constipating they avoid milk without seeking to overcome this trouble by malting, shaking or peptonizing. Goodno also calls attention to the fact that strict dietary precautions are often more harmful than beneficial, causing the patient often to worry constantly over what to eat and what to avoid, thereby intensifying their introspectiveness. But is not this due more to the fact that certain articles of diet

are recommended or forbidden in place of the appropriate food being selected, its manner of preparation being desig nated, the quantity to be consumed being measured and the time for its digestion being recorded. That what we do eat has a material bearing upon what we are is easily demonstrated. For instance, I have one patient mentally unsound, who stands between gluttony and starvation. When eating gluttonously she is boisterous, talkative, overbearing and extremely troublesome and difficult to live with, while during her periods of starvation she is quiet, silent, undemonstrative, requires nothing and seeks only to be let alone and remain peaceably in bed.

The ancients were nearly all vegetarians, acorns and fruits being among the most commonly used, and it is said that nervous diseases, especially epilepsy, were almost unknown among them. Certain it is that the early settlers who. lived on coarse corn bread and unbolted flour, with much wild game for meats, were not as nervous as the present generation. The Germans, with their rye bread, frankfurter sausages, sauer kraut and beer are much slower and more plodding in their methods. The English with their roast beef, plum pudding and ale are more irascible, contentious and tenacious. The French with their highly spiced dishes and light wines are more frivolous and excitable, while the Americans, who are cosmopolitan in their dishes and tastes are also cosmopolitan in their diseases and require cosmopolitan directions in their diet and treatment.

The first thing in feeding is to see that food is properly digested. No matter how nutritious it may be nor what elements it may contain, unless it is digested it will not be assimilated, and

unassimilated food is foreign matter with which to tax the system by its elimination. One of the most glaring American evils is our constant hurry and efforts to save time. This is evidenced by bolting our meals and starting our food wrong at the first step of digestion. One reason why zwieback and dextrinized foods are more easily digested is because they are difficult to swallow without first being thoroughly insalivated and digestion started before they even reach the stomach.

Meats, the great bone and sinew of the working man's diet, should be sparingly used by those afflicted with nervous troubles. Not only is uric acid found in the meat but its formation in the system is encouraged by the use of a meat diet, and neurasthenia, headaches and nervous irritability are engendered and encouraged thereby. Highly seasoned foods of all kind are to be avoided, both on account of their stimulating qualities and also because of their tendency to produce and perpetuate gastric and gastro-intestinal catarrhs. Tea, coffee and spirituous liquors for like reasons need to be carefully looked after by the physician and their use forbidden or strictly regulated. Hot water is the best drink for general purposes at mealtime, but owing to its insipidity I find it frequently necessary to tax my ingenuity in suggesting various innocent flavorings, like ground ivy, and mints of different kinds, often suggesting several and using them in rotation so as to prevent palling the appetite. Malted milk when the taste is acceptable and cocoa, especially Phillip's Digestible Cocoa, are urged upon my patients where it becomes necessary to lunch between meals. Of all the liquid articles of diet none seem to me so generally useful as good buttermilk. Even babies can take

it and thrive, but it often requires much persuasion and firmness to have it taken regularly and in quantities sufficient to obviate the necessity of resorting to more objectionable aliment. Next to buttermilk come the various preparations of sweet milk, but no hand-made article equals the laboratory product of nature. Following in the descending scale of usefulness come the liquid peptonoids, under various names and manufactures. If as much attention was given to the making of raw eggs palatable as is used in the preparation of milk and meats we would have a veritable storehouse upon which to draw, but I have never succeeded in persuading patients that from one to two dozen raw eggs every day were just what they needed.

The food value of nuts is just beginning to be appreciated. Pecans have been recently highly praised in hyperacidity. Malted nuts, nut butter and creams are now being placed upon the market and are both exceedingly palatable and highly nutritious and aid us very much where we desire to use highly concentrated food of easy digestion. The many new breakfast foods placed upon the market are but finger boards pointing out the way to a better mode of eating than is furnished by the frying-pan and grease-soaked contents of the skillet. We can use them to much better advantage if we require them to be used without the accessories of cream and sugar. A dry teaspoonful of maple flake or its equivalent in shredded wheat biscuit can not be swallowed until thoroughly masticated and we enforce our precepts to eat slowly by making it physically impossible to do otherwise. A little tact is necessary even to have success in eating. The manner of preparing and the choice of cereals has undergone a marked change in the past

few years.

Oatmeal, which formerly was held in such high esteem, is now relegated to the rear and assigned its proper place as food for horses. Wheat, which contains all the elements which enter into the composition of the body, is now riding the top crest of the wave of popularity, and dextrinization by means of dry heat now takes the place of sodden porridges. These changes, unlike some others, have all been in line with the most advanced views of physiology. Add to these fruits in season and eaten during the early hours of the day, and we have a line of diet from which it is not so hard to select something both agreeable to the most fastidious taste and suitable to the crying needs of the most delicate invalid.

A CASE OF CEREBRAL IRRITATION. By Arthur C. Roll, M. D., Toledo, Ohio.

I will only claim your attention for a few moments while I go briefly over the symptoms of a case which to me was somewhat peculiar. Mr. A., age 52. Married about thirty years, two children, a son and daughter, both enjoying good health, both mentally and physically, and giving no history of inherited insanity. Always has enjoyed good health until six years ago, when he had a severe attack of typhoid-pneumonia, has for many years been a steady drinker and to a great extent since his illness, but rarely to the point of intoxication.

Dec. 13th I was called to his home, finding him in a peculiar state of bewilderment of mind and suffering from muscular incoordination. I prescribed and left the house, thinking nothing serious would result, but before driving away was recalled to find him apparently suffering from a stroke of apoplexy.

He remained in a comatose condition for perhaps one hour, then in a semi

comatose condition for two days, after which he had convulsions of an opisthotonos variety at irregular intervals for four days. After the convulsions ceased he began readily to recognize members of his family and those few who were in attendance upon him, but his mind was confused and his memory was a total blank for a period of six years. His physical condition began now to improve quite rapidly but his mental confusion increased from day to day.

As soon as he was able to move about he would insist on keeping business appointments with different men, some of whom had been dead for several years. From the beginning of his illness he had no liquor and seemed to have very little desire for it. He did not seem to recognize that he had been ill and constantly insisted that he was able to go down to his office, and persisted in speaking of work which he had completed years before. We treated him at his home for almost six weeks, hoping that his mind would clear up, but as he grew stronger he became unmanageable at home and we finally sent him to a State hospital, where he has been up to the present time.

About one month ago his memory began to return and since that time there has been steady improvement, but he acts in many respects just as a little child. He is allowed to visit his family quite often, coming to and fro without attendance, and the most noticeable symptoms now are those of childishness and at times melancholia. In the beginning of the trouble I gave him Belladonna and later Hyoscyamus. Since being at the hospital I think his treatment has consisted of the Bromides.

I present this case to you for discussion, hoping thereby to get some new light on the diagnosis and prognosis.