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cal profession who are interested I would be pleased to place in communication with them. These men are all at the present time able to work, but their work is not the pleasure it should be. I can add but little more. I have stated a problem to the physicians of Erie County. Will the honor belong to one of us of discovering the remedy? What that remedy will be I cannot say. It may be some sort of a grounding of this wasted fluid that now fills the rooms of the power houses. It may be some neutralising ray, or some form of insulation which can be applied. It may be any one of many things, but which one, none of us is at present prepared to state. It may be some great electrician like the immortal Edison who will find the remedy, instead of one of our profession. For when I had the pleasure of an intensely interesting visit with Mr. Edison in his laboratory last month, I found him as deeply absorbed with things new and marvelous as he ever was in the whole of his marvelous lifetime. I shall shortly submit this problem to him, for my own personal satisfaction, even if without the hope of any solution.

What does this mean to the men engaged in this business? First, it means personal discomfort and distress, which alone would make it enough of a problem to engage our serious attention. Then, again, it means that these men will be put in substandard lists for purposes of life insurance. It means, possibly, deterioration more or less permanent to the individual and to his children. It should be of sufficient interest to our profession to warrant further study and investigation. If my paper has the effect of awakening an interest in this problem, it will have served its purpose.

139 N. PEARL STREET.

Brief Considerations Relating to Convalescence.

BY E. E. ROWELL, M. D., Stamford, Conn.

HE care of patients during the period of convalescence from

plished than is generally the case. At the beginning the attending physician exercises his best efforts in observation to make a correct diagnosis and, if accomplished, seeks to adopt a line of treatment which will avoid entirely or prevent the pitfalls which his experience tells him are possibly or probably in his patients' way. If, in spite of his care, the patient becomes progressively worse, or an unexpected serious crisis occurs, his activity necessarily redoubles, but once the crisis is passed and convalescence

commences, it is too often the case that interest in the patient slackens and the doctor's treatment becomes more and more perfunctory and routine-like, everything being left to the recuperative powers of nature. In many cases this blind confidence may be justified by the outcome and the patient goes on to make a recovery. Too frequently, however, many patients are less fortunate and the tissue wastes caused by disease are slowly replaced or not at all, while the various organs of the body resume their interrupted functions only partially or imperfectly.

In convalescents, in whom nature takes up again the task of building up, not merely replacing tissue, the appetite is poor and the digestive process inadequate, so that the food usually taken in these cases is not correctly prepared for assimilation and nutrition. The mental status of a patient is abnormal; he takes no interest in his surroundings and there is no sharp rebound upwards, such as we may observe where proper nourishment is supplied from the first. The organs of elimination are also inactive and incompetent to perform their functions, increased as the demand is by the excessive oxidation and accumulation of waste products which attend at this stage in most diseased conditions. The nervous system also plays an important part in the establishment of a complete convalescence. Perfect performnace of its function by an organ depends upon the proper nutrition of the brain and spinal cord. Given a state of low vitality as in these cases of delayed convalescence, and all the organs of the body will suffer, whether their function be secretion or elimination, and their cells themselves, lack the requisite energy for taking up from the blood the materials necessary to their maintenance and to the development and formation of similar cells.

In all such cases, these several organs, the stomach and the intestines, the liver and the kidneys, the blood-making tissues, and finally, the brain and the spinal cord need a complete and perfect nutrition associated with mild stimulation. These wants I have found ideally combined in bovinine. It is a tonic and food par excellence and I have found it generally indicated in convalescence from most forms of acute disease.

EMERGENCY SUTURES.-If you have to tie a bloodvessel in an emergency, and you have no sterilised sutures, it will always be best to tie one end of the thread short and bring out the other end at one of the angles of the wound; allowing it to remain there. It will promote drainage, may be easily removed when it becomes loosened, and will diminish the chances of abscess formation.International Journal Surgery.

SOCIETY PROCEEDINGS.

T

Buffalo Academy of Medicine

Section on Medicine, April 11, 1905.

REPORTED BY FRANKLIN W. BARROWS, M. D., Secretary.

HE regular meeting of the medical section was held Tuesday evening, April 11, 1905, at the academy rooms in the Public Library building. The meeting was called to order at 9 o'clock by the chairman, Dr. Allen A. Jones. The minutes of the last meeting were read and approved.

DR. HENRY DWIGHT CHAPIN, professor of the diseases of children, in the Post-Graduate Medical School, New York, presented a paper entitled,

THE FUTURE VIEWPOINT AND PRACTICE OF INFANT FEEDING.

Author's Abstract.

The attempts at placing infant feeding on a scientific basis during the past twenty years have been devoted principally to altering cow's milk so that it should resemble human milk in its chemical properties. Peptonising milk, diluting it and adding cream, sugar and some alkali, sterilisation and pasteurisation have been advocated, but the problem of making human milk has not yet been solved. It is now recognised that studies must be made in other directions. The mother supplies the fetus and infant with food in six different forms from conception to weaning, and milk is one of these forms. The object of changing the form of the food, is to make it suitable for the infant as it develops. The infant at birth is not completely formed, and while supplied with milk its digestive apparatus undergoes a transformation that fits it for solid food. Mother's milk is an elastic food, in that when it comes in contact with the infant's gastric secretions it is built up into solid compounds before diges tion proceeds, which increase in density as the infant's secretions become stronger. Milk of all animals has this property and gradually strengthens the digestion of the young and fits it for its future work. It is because animals digest food in different ways and have different kinds of digestive tracts that milks are not alike. Alkalies added to cow's milk prevent the gastric secretion forming solid compounds with it and allow the milk to remain fluid in the stomach and readily to pass into the intestine. Gruel diluents allow the stomach to perform its function, but

soften the solid curds so as to make them easily digested. Dextrinised or digested gruel diluents put the starch in a soluble condition and add to the proteid value of the food. The object of the present paper is to bring out and emphasise the biologic aspect of infant feeding which has heretofore been overlooked.

DISCUSSION.

Dr. IRVING M. SNOW: The members of the Academy have reason to feel well acquainted with Dr. Chapin. His book has been widely read and his methods are much employed by Buffalo physicians. He has given us this evening a very original presentation of his subject. There are many problems in the nutrition of the infant that are still unsolved. It seems that a baby cannot thrive without first receiving colostrum milk. Again, many babies are entirely unable to digest cow's milk. I do not understand why this is true. We have all noticed that children who have been fed on malted milk or condensed milk, if they survive to the age of three or four years, are often as well and strong as those who have been nursed by the mother. I am unable to account for this fact, also. On the other hand, it is quite true that the introduction of better methods of infant feeding has greatly reduced the death rate of infants in our cities. For this result, Dr. Chapin and other workers in this field of medicine. deserve hearty thanks.

Dr. DEWITT H. SHERMAN: Dr. Chapin's plan is easily followed by those who have his ladle for measuring the milk. Unless the mother has some such instrument, I find that she is often in doubt as to the amount of milk to remove from the bottle. I have succeeded in simplifying this matter very much by asking the mother to remove the upper half when she wants to obtain an 8 per cent. of milk. The upper one-third of the bottle contains 12 per cent. milk, and, as a matter of convenience, I call the upper one-fourth of the bottle a 16 per cent. milk. In this manner, taking one-half, one-third or one quarter of the bottle and adding the proper diluents, the home modification of the milk is greatly simplified. Formulas are hard to remember, but if we remember the strength wanted in our combination, and the figures given above the problem is easier. It is not necessary to attempt to be more exact than is possible under the plan just outlined; we remember that the actual percentage formulas in vogue a few years ago did not give the satisfactory results that were theoretically called for.

Dr. W. G. TAYLOR: Some of my cases have apparently flourished on cow's milk, but have suffered severely from constipation. How would the doctor treat such cases?

Dr. G. H. A. CLOWES: From the standpoint of the chemist, the laboratory is very unreliable for arriving at the proper mode

of feeding children. I have never seen a better presentation of this question than that which Dr. Chapin has just given us. I wish to ask the doctor how we are to harmonise the statements in his table to the effect that increase of proteids in the diet of young animals leads to an increase in growth and strength, with the facts brought out in some of the recent experiments of Professor Chittenden in which he reduced the amount of proteid food and obtained a corresponding increase of strength in the subjects of his research. That portion of the proteid food which, instead of being utilised for the formation of tissue, is oxidised and goes to form heat energy is likely to produce an excess of amido bodies, and the like, which exert a detrimental action on nutrition. Can we not, therefore, use less proteid for children and get a stronger race? Another question relates to the proper amount of salt and other salines to be added to milk in order to bring it up to the normal percentage existing in the food of adults. How much salt should be given the infant, and how does it affect the production of hydrochloric acid in the stomach? The wide range in the ability of different children to assimilate the casein of cow's milk may be explained by the biologic reactions of different individuals toward the same proteid. We know that two carbohydrates, as cellulose and starch, can be easily dif ferentiated by chemical tests. The various caseins, on the other hand, vary in their biologic rather than their chemical reactions.

When the proteids present in the serum of one animal are injected into an animal of another species, in the course of time the serum of this second animal is capable of precipitating the serum of the animal first employed and of all other animals of the same species, whilst animals of other species are only affected in a lesser degree. This differentiating reaction may frequently be effected when it is entirely impossible to show any chemical difference between the bodies in question.

Does Dr. Chapin think that this property of the proteids accounts for the variation in the ability of different children to assimilate certain proteids?

have

Dr. CHAPIN, in closing: Constipation is hard to correct, cially in bottle-fed infants. In my experience rolled oats proven helpful in such cases. In reply to Dr. Clowes I would say, first, that Dr. Chittenden's experiments were on adults, the question before us is how much proteid to give the babymust refer back to the composition of woman's milk and we

while

We

find

that it contains from 1 to 2 per cent. of proteid. It is a biologic fact that we cannot essentially alter the percentage of ingredients in the milk of a given animal, no matter what change we produce in its quantity. This is practically true of woman, although if higher and become harder to digest. This condition is improved a nursing woman is nervous the proteids may run some what by rest. The baby grows very rapidly. Growing bone and usIcle require a considerable amount of proteid. During the entire

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