should never be allowed to overshadow the irritated gastro-intestinal mucous membrane. real point at issue. The term "inward convulsion," so common among the laity, is acknowledged as correct by Koplik, who says: "The symptoms of convulsions are sometimes so very slight as to be scarcely noticeable. Only a very observant mother will see a slight twitching of the lips and eyelids, a momentary turning of the eye and cessation of breathing, or a momentary spasm of the whole trunk." The convulsion occurring a few days after birth may be due to cerebral hemorrhage, and will be followed in such case by paralysis, contractures, difficult swallowing, and prolonged coma. Congenital atelectasis will cause convulsions, in which case there is cyanosis of varying degree during the attack, and signs of bronchitis and collapse of the lung are elicited in the intervals. In older children, drugs and poisons may cause convulsions, and the history of a few preceding hours should be carefully investigated. If tetany or tetanus be develop ing, the spasm is tonic as distinguisht from the clonic spasm of the ordinary convulsion. In meningitis, other symptoms of the disease will be found on examination. In tumor or abscess, or in injury of the brain, the convulsions will be limited to the port supplied by the nerves extending from the site of the lesion. If no fever be present, and the patient be safely tided over the first convulsion, the prog nosis is generally good; in presence of fever, prognosis and diagnosis are best withheld temporarily. In the attack, place the patient with the head low, the hips elevated, and all clothing loosened. If the convulsion has passed away before the physician arrives, and the child is in a stupor, it should not be disturbed unless a history would point to poisoning or the ingestion of some unsuitable food, or unless fever be present. If the child be in convulsions on the physician's arrival, it should be placed in warm water to which a little mustard has been added, and a cold cloth placed to the back of the head; the limbs and body being briskly rubbed while in the bath. At the first sign of relaxation, the child is removed from the water and quickly wrapt (without waiting to dry the body) in a warmed flannel. A few drops of chloroform may be administered to hold recurrent convulsions in abeyance, and such administration may need to be continued for some time. The bowels should be immediately emptied by a high rectal enema containing glycerin or castor oil. Calomel or castor oil should be given as soon as consciousness returns sufficiently to admit of swallowing; the latter is preferable on account of its quick action and its soothing effect on the If some time has elapst since the last convulsion, and the child be restless and twitching, it is well to give a few generous doses of the bromids combined with chloral, remembering that children bear large doses of chloral. No case of convulsions should be carelessly handled or neglected, and the practician should not abandon his investigations till he learns the true cause of the trouble. The Employment of a Woolen Abdominal Protector in Prophylaxis and Treatment of Summer Diseases. Among many things which the practician of today could learn from the ancient predecessors whom he ridicules, is the fact that the woolen abdominal protector is a valuable aid in the treatment of various summer complaints in children and adults. This is generally lookt upon as "an old granny notion" by those who give it little thought, but if one reflects on the thinness of the abdominal wall and the extent of peritoneal surface which must be affected by sudden climatic changes, he will not smile so broadly. Recent army experience shows that regiments doing tropical service which were equipt with woolen abdominal protectors and required to wear them, suffered less from stomachic and intestinal derangements than regiments doing the same service, and similarly fed and equipt, but without the abdominal covering. The physician who uses his eye and brain, and who learns from experience, knows that many of his stomach and bowel cases relapse on taking the slightest cold; and, if he be unusually astute, he may observe that many cases have their origin from simply taking cold. It is not necessary that the protector be heavy or uncomfortable. A piece of light flannel really gives a sense of coolness and support. ry advising the use of such a protector, and you will find that your patient will quickly learn the comfort and advantages to be derived from the constant wearing of such a protector. Were small children commonly so protected, there would be much of the terror removed from the mind of the mother regarding the "second summer," and diarrheal troubles and cholera infantum would be less frequent. Treatment of Constipation in Infants and Children. This trouble is always a difficult one to treat successfully at best, and when one reflects that nearly every case which the physician sees has been "treated" (?) and drugged by the mother or grandmother with castor oil, cascara, salts, etc., which they know so well how to abuse, and further has probably been subjected to a misguided use of the rectal injec JUNE, 1903] Editorial tion until the bowels will scarcely respond to even that stimulus, then, indeed, we realize the obstinacy of the affection. All cases may not have become so aggravated; yet some are even worse, with fissured anus or prolapst rectum, so that the condition of the little sufferer is pitiable in the extreme. Such a condition finds the child ripe for diarrheal troubles, toxemias, and a host of reflex disorders. It is not well to dismiss such a case carelessly, perhaps only giving a stronger cathartic to add to the already existing evil. Drugs will be required in almost every case, but a cure will never be effected with drugs unaided by hygiene. If the child be an artificially fed infant, modification of the milk may do much toward overcoming the habit. Castor oil may be rubbed into the abdomen twice daily. The juice of stewed prunes will be taken greedily and is a great aid. Glycerin suppositories, used regularly at stated intervals for some time, A teaspoonful of often accomplish wonders. cream given before each nursing will often correct the trouble to a certain degree. If the babe is over a year of age, it should be gradually and carefully weaned to a mixt diet. A child over a year of age may be fed a teaspoonful of unmelted butter twice daily until the stools become softened, and then gradually reduce the quantity, and give it only on alternate days. Fresh vegetables may be given in the form of soups, and well selected raw fruit may be allowed. Orange juice is obtainable the year round, as is also the juice of stewed dried peaches, apricots, and prunes; all of these may be given freely. Oatmeal, barley, and other cereals, thoroly cookt, are a valuable addition to the dietary. The abdomen may be massaged along the line of the colon for a few moments once a day, either with or without the employment of castor, olive, or codliver oil. When drugs must be employed, fractional doses of podophyllin or generous doses of some of the rhubarb preparations do well. Calomel is not to be used too frequently. The bitter tonics may be given, as strychnin, and often accomplish unlookt for results. Patience, and a careful study of each individual case will often bring about a solution, in time, of this vexing problem. Treatment of Tumors by Caustics. The actual cautery is now seldom used in the treatment of tumors, altho it is quite efficient in skin cancers, and is also an excellent hemostatic. It destroys small cancers quickly and prevents dreaded hemorrhage. It is a valuable adjunct to the knife in destroying small bits of 243 cancerous tissue left after operation, thus sav- be used more frequently by the general prac- The chemical caustics are likewise valuable agents, and it is deplorable that they have been almost exclusivly relegated to the realm of the charlatan and quack. Nevertheless, the laity will always fear the knife, and will continue to flock to the man who uses the caustics, and with historic perversity will generally prefer the quack, and the more blatant he is the better it pleases them. Those who use caustics in selected cases are able to show results which The quack has are not eclipst by the knife. been heralding the fact (?) that the knife is no longer required, and that any tumor can be removed by caustics. The general practician cannot afford to do this, but he can well afford to use the caustics honestly and intelligently, and when so used they will not disappoint him. It is both useless and unnecessary to enter into explanation about the "roots of the cancer," because the patient "knows all about them' (?), and you may as well save your time. The fallacious and false claim of the quack that the caustic only attacks abnormal tissue may likewise be ignored. Merely tell the patient that you will remove every vestige of the tumor as well as any one can do it, and that the boasted secrets of the quack are common knowledge to the medical profession, and they will generally allow you to do the operation. The selection of the caustic must be governed somewhat by the location and character of the tumor; the characteristics of the patient; and a certain regard to the dangers of Small benign tumors gensubsequent hemorrhage from corrosiv action on large blood vessels. erally yield readily to caustics and give a per- due to the first application. Pain is relieved by hypodermic injections of morphin and application of the ice-bag to the seat of cauterization. Caustic potash is one of the most activ caustics, liquefying rapidly in contact with the tissues, and consequently must be guarded from too great spreading on sound tissue. It should not be employed in cavities, nor can it be depended upon as a hemostatic. It is often blended with caustic lime, and is then known as Vienna paste; this makes it easier handled and detracts but slightly from the intensity of its action. Chlorid of zinc is used in the form of a paste made by mixing the chlorid with flour and water; it is then called Canquoin's paste. It is necessary that it be applied beneath the skin, or that the skin be macerated for a time with dilute caustic potash or opened by incisions. It is the most reliable of the hemostatics, and is consequently the caustic to be selected in vascular tumors. The eschar it produces is dry and hard, and corresponds in size to the cubic volume of the mass of paste inserted. In a few days the eschar is removed and another application made. Arsenic is not so much used as formerly. It is a slow caustic, and has no special advantage over others, altho some observers claim it has a peculiar potency in small epiblastic carcinoma about the face and lip. It is not by any means specific, as once claimed, and the benefits derived depend solely, as with other caustics, to the depth to which the cauterization penetrates. Chromic acid is less painful than any other liquid caustic. It may be used in concentrated solution or in the crystals. It acts best in small superficial tumors. It Nitric acid is the most popular liquid caustic on account of its leaving only a small scar. has valuable hemostatic properties. French surgeons use the caustics more frequently than do our American practicians. A favorit plan there is to form the caustic into small arrows, make a deep incision and insert an arrow. Such arrows are made of flour three parts, chlorid of zinc one part, with sufficient water. The technic has been described by Maissoneuve, and may be executed in three different ways: (1) The arrows are introduced in a circle on the same level so that their points converge in the centre of the tumor; (2) the arrows are inserted at right angles to the surface; (3) a single large point is inserted in the centre, so that cauterization proceeds from the centre towards the periphery of the tumor. For small tumors surface cauterization is better, even if the procedure has to be repeated. In large tumors in close proximity to blood vessels of any considerable size, the method is not devoid of danger, on account of the action taking place at a depth hard to estimate accurately. The use of caustics requires only ordinary care and skill, and in careful hands will yield satisfactory results. Naturally such an operation requires attention; it does not do to spread on the caustic and leave the case to its misery. Given a suitable case, care in selection of an agent, and reasonable attention afterward, and cases of cauterization do well. The Discovery of the Germ of Smallpox. The germ of smallpox has been isolated, and the discoverers, Drs. Councilman, McGrath and Brinckenhoff, have announced the fact to the world. It is a protozoan, with the cycles of development common to that type of microorganisms. organisms. It has been named Cytoryctes vaccinia. The corneas of rabbits were inoculated with the contents of the pustules of smallpox, and the development studied in this way. Micro-photographs have been taken of each stage in the development. The sporozoa appear in sixteen hours in the epithelial cells, and by the third day every cell displays them. The micro-organism causing vaccinia and that causing variola are declared identical. It is indeed gratifying that after centuries of study, we now really know what smallpox really is, and what causes it. It is now in order for the investigators to go a step further and tell us how to combat the germ other than by vaccination. As in the case of tuberculosis, a long time may elapse before decisiv results are attained, but a distinct advance has been made after many years of stagnation, and it is to be hoped that the dawn of a complete victory over the pest is now close at hand. Examination of Urin by the General Practician.-Fourth Paper. Acetone is a volatil compound frequently present in urin in diseased conditions; it is yet undecided whether traces may not be present in health. The peculiar "fruity" odor of the urin in diabetes mellitus is due to the presence of acetone. Acetone arises from decomposition of proteid material, either that of the body tissues or of food ingested by the patient. Acetonuria is classified by v. Jaksch according to cause, as: 1. Febril, as found in scarlet fever, typhoid fever, measles, pneumonia, small-pox, etc. 2. Diabetic. 3. Cancers, in certain forms independent of inanition. Starvation. 5. In psychoses. 6. In autointoxication. 7. In disordered digestion. 8. in chloroform narcosis. Acetone does not appear in diabetes till the disease is well advanced. An excess of nitrogenous food tends to the production of acetone; hence it is augmented in amount in diabetes when starches and sugars are taken from the diet and the food is mainly nitrogenous. Acetonuria uncomplicated tends to recovery. When acetone is found in large quantity where there are symptoms of cerebral irritation, the prognosis is unfavorable. Legal's test is crude, but easily performed. Fill a test-tube one-fourth full of urin and add a few drops of freshly prepared concentrated solution of sodium nitroprussid, and afterward a few drops of acetic acid, and alkalinize with ammonic or sodic hydrate. If acetone be present the mixture turns red and then deep purple red. A more accurate test is that of Lieben. Add a gram of phosforic acid to a liter of urin and distill enuf to obtain about 30 cubic centimeters; to a few cubic centimeters of the distillate add several drops of iodopotassic iodid and sodic hydrate; in even a trace of acetone, crystals of iodoform are precipitated which are easily recognized by their odor. Diacetic acid is never found in normal urin, and its presence is always an omen of grave import. Urin containing diacetic acid is always rich in acetone, with which it must not be confused. Diacetic acid is found in the urin of diabetes mellitus, in fevers, and in autointoxication. Diaceturia is most common in advanced cases of diabetes mellitus, particularly in children and adults under the age of 30. When so noted, it is frequently the warning of diabetic coma and speedy death. When noted in auto-intoxication the disease is usually rapidly fatal. Add perchlorid of iron to the urin, and if a phosfatic precipitate forms it is removed by filtration, and the addition of the perchlorid continued; if a Bordeaux-red color appears one portion of urin is boiled and the other treated with sulfuric acid and extracted with ether. If the first portion gives no reaction with the perchlorid solution after boiling, while the ethereal extract shows a claret-red color with the perchlorid solution, diacetic acid is probably present. The urin must be tested when fresh. Bile. Urin containing bile is always abnormally colored and on vigorous shaking carries an unusually persistent foam, which has a yellowish or greenish tinge. If a piece of white filter paper or cloth be wetted with urin containing bile, when dried the yellowish or greenish stain persists. Urin containing bile always contains albumin. Bile is found in urin whenever there is obstruction of the bile ducts; hence almost any hepatic affection may produce it. Bile pigment often appears in the urin before there is much discoloration of skin or conjunctiva. Marechalt's test is the most accurate. Place a half inch of alcoholic tinc ture of iodin in a test-tube, and underlie with urin by allowing the urin to flow gently from a pipette touching the inner side of the inclined test tube just above the level of the iodin; if bile be present a green color appears at the point of the two fluids and persists for perhaps 24 hours. Another easy and accurate test consists in placing a few drops of urin on a porcelain plate; adjacent to it place a few drops of fuming nitric acid, and allow the two fluids to come in contact by gently tilting the plate; if bile be present there is a brilliant play of colors: reen, blue, violet, red, and yellow. The Erlich Diazo Reaction.-This reaction depends upon a color produced in urin and its form by the action of diazo-benzol sulfonic acid on unknown substances in the presence of an excess of ammonic hydrate. The reaction is generally present in typhoid fever, but is also found in a variety of other diseases, such as pulmonary phthisis, pneumonia, pleurisy, scarlet fever, diphtheria, measles, erysipelas, acute miliary tuberculosis, syphilis, carcinoma, puerperal septicemia, rheumatism, etc. Two solutions are prepared: (A) Saturated aqueous solution of sulfanilic acid, 200 cubic centimeters, with concentrated hydrochloric acid 10 cubic centimeters; and (B) sodium nitrite, 1 cubic centimeter, and distilled water 200 cubic centimeters. The solutions are kept in separate, well corkt bottles in a dark place. Take 40 parts of solution and I part of solution B ; add an equal volume of urin in a test-tube; shake thoroly; add excess of ammonic hydrate by allowing to run slowly down the side of the tube. If the diazo reaction be present, the foam will be colored pink and the part acted upon by the ammonic hydrate will be crimson; invert the test-tube, and the entire fluid will become crimson, but the foam remains pink. Dr. Greene advises 100 parts of solution A and I part of solution B, and reports the result of 315 tests as follows: "Characteristic diazo reaction in 95 per cent of typhoid cases. In only five other diseases was the reaction found, namely: pneumonia, 9 per cent; carcinoma, 50 per cent; pulmonary phthisis, 122 per cent; septicemia, 75 per cent. All cases of severe typhoid will show a diazo reaction if the test is properly applied during the height of the disease-that is, between the tenth and eighteenth days." Never overlook the diet in the treatment of constipation of childhood. Never neglect to test the patellar reflex in all nervous manifestations. Never give strychnin nor cascara for an indefinit period. Don't cauterize any suspicious looking genital lesion. Remember that no other diseases are so productiv of rapid emaciation as tuberculosis, diabetes and cancer. ORIGINAL COMMUNICATIONS Short articles of practical help to the profession are solicited for this department. Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. COMPARE RECORD READ REFLECT The Prevention and Cure of Infantil Summer Complaints Due to Food Infection. Editor MEDICAL WORLD:-The hot season will soon be here, and again the general practician is confronted with the difficult problem, how best to battle against those dangerous and deadly foes of infanthood, namely, the infections of the alimentary canal. How shall we best protect and save the little ones from the ravishes of these diseases? We all know that many happy homes are robbed of their little sunshines every year. Many proud parents are forced to consign their little treasures to that narrow, quiet resting place called the grave. We ask ourselves the question, Is the medical profession doing all it can toward saving these little sufferers? Does the general practician really know everything he should necessary to the successful prevention and cure of the various summer complaints of infants? Does he go into battle against these foes properly armed? Does he understand the true nature of the disease, its causes, its pathology? There is no doubt in my mind that the conscientious physician has at all times the interest of his patient at heart. He will strive with all means at his command to help and save his patient. He will rejoice with the friends of the patient when the battle against death is won, and again he will feel sorrow and disappointment when his efforts have been in vain. But here another question arises: Does the physician always know all he should in this connection? I am afraid many of them do not. They have either forgotten or have never known the true causes, the true pathology of these diseases; and accordingly the treatment, tho well meant, is often not rational or logical. This paper is not intended to discuss the etiology and pathology of the various summer complaints. It is a paper on the prevention and treatment. Nevertheless the writer firmly believes that unless a physician has a fair idea about the etiology and pathology, his treatment can not be scientific. The research of the bacteriologist and pathologist of the present tract. age has thrown much light upon the causes of many diseases and the pathological changes produced by them. The gastric and intestinal diseases of children belong to this category. We have found with the aid of the microscope that germ infection plays not a small role in the most dangerous forms of summer complaints. We have learned that these infections cause certain changes within the alimentary We know that local inflammatory conditions and toxic changes of the blood are the consequence. It is true these pathological changes vary greatly. They may be slight or severe. They may be localized within a small area, or distributed thruout a large portion of the alimentary canal. The general infection, especially that of the blood, may be very slight or extremely severe. Their symptoms may be somewhat different; we know them by dif ferent names; yet as a whole all these complaints are very much related; their prevention and treatment consists of much the same, and therefore the giving of a general rule for the prevention and treatment of all the summer complaints of infants due to infection, be it one form or the other, would not be out of place, and would in my mind be quite logical. Prevention, prophylaxis, is here the one great factor in the successful battle against death. What is our duty? I firmly believe that probably the most important duty of the physician in this connection lies in the enlightenment, the education, of those who have the little ones under their care. We should teach them the general laws of hygiene. We should instruct them what is meant by strict cleanliness in connection with the preparing of infant food. We should show them that the introduction of food which is impure, unclean or unsanitary, is the all important cause for the prevalence of summer complaints. The guardians of the children should know that cow's milk, which is, beside mother's milk, the main nourishment of the child, if not handled most carefully from the time it leaves the udder of the cow until it enters the stomach of the child, is the most fertil medium in which to introduce poisonous and death dealing germs into the system. Cow's milk should be closely guarded from the time it is drawn from the cow until it is consumed by the little one. The animals used should be above reproach regarding health; their food and drink should be clean and wholesome; the stables should be airy, light, and kept in a sanitary condition. The containers into which the milk is drawn must be scrupulously clean. The hands of the person doing the milking should be absolutely free from uncleanliness. The udder of the cow should be kept clean. These last are points where the health author |