finely divided; 100 grams mashed potatoes; 100 grams toasted bread; 30 grams of butter; 300 c. c. hot, rich milk, which was first coagulated with rennet, in order that it might not be coagulated in the stomach, then shaken back to liquid and heated. Meat, macerated in water, then pressed for its extracts, crushed crackers, hard boiled eggs, and a bit of bran or ballast was another favorite form of diet for a change. If there was persistent anorexia the patient would lie on the right side for two hours following the meal.

In connection with the diet, certain mechanical methods were employed, most of which he had found to be fruitful of harm rather than good in these cases. Lavage, galvanic and faradic electricity, exercise, and the more or less systematic bathings and drugs were some of the means which Dr. Turck failed to appreciate. The high frequency current with Oudin resonator he had found sometimes of advantage as an adjuvant.

FOOD ADULTERATION IN TENNESSEE.

Mr. Lucius Brown, Chemist, of Nashville, in a paper on this subject said that milk was peculiarly liable to sophistication on account of its perishable nature and the readiness with which it could be adulterated. This took the form of watering, thereby reducing the quality, and the addition of preservatives to conceal or prevent decay. There was no form of food adulteration which was meaner than this. Milk was the standard food of young children, and was largely used for invalids, and the addition to it of such materials, which had a directly injurious effect on the digestion, and usually only took down the danger signal without removing the danger, should be relentlessly and severely punished. An examination of pure food legislation showed that twenty-two States had a regularly organized food inspection department. It was significant that Kentucky had just increased its appropriation for this purpose from $7.500 to $10,500. For the proper enforcement of pure food laws a qualified analytical chemist was an absolute necessity. Not less necessary was a wise and active pure food commissioner. There need be, on the part

of the retailer, no fear of a hardship being worked on him by a proper enforcement of food legislation. He was always given an opportunity to put himself right, if he desired to do so, under any food laws. But in order to reassure him, most States allow the retailer to be exempt from conviction if he produced a written guarantee from the wholesaler or his agent resident within the State.

EARLY DIAGNOSIS AND EARLY TREATMENT OF OTITIS MEDIA.

Dr. N. C. Steele, of Chattanooga, said that careful observers knew there was a large number of adults who were permanently deaf in one or both ears. Of every one thousand seriously deaf ears, perhaps in 999 the disease was otitis media, and every aurist knew that chronic otitis media was generally incurable. He pointed out the general management and treatment of these cases, and closed by saying that the physician who looked carefully and intelligently after the patient's general health, as well as the local treatment, would have the greatest success in otitis media, just as he would in other local diseases.

TUBERCULOSIS CUTIS.

Dr. J. M. King, of Nashville, discussed this subject. He pointed out how the initial skin lesion was formed, and discussed the differentiation of lupus from rosacea, eczema, and blastomycosis, which he said was rarely necessary. Radiotherapy, Finsen light, and violet rays were at present considered the most acceptable method of treatment, and should always be used if the patient was in reach of it. The X-rays and Finsen light were both satisfactory, but the ideal treatment was the combined use of X-rays and Finsen light.

GASTRO-INTESTINAL DISEASES OF CHILDREN IN SUMMER.

Dr. Zeb. L. Shipley, of Cookeville, divided the acute diarrheas of infancy on the basis of their etiology into two main classes, namely, those due to nervous origin, and those due to infection. Simple diarrhea was of nervous origin, manifested by an increased peristalsis. This increased peristalsis might be caused by various conditions acting through the central nervous

system or by the mechanical action of undigested food. Among the most important factors acting through the central nervous system were sudden changes in temperature, prolonged exposure to heat or cold, fright and fatigue. Food might fail of digestion from being unsuitable, or from the digestive organs being functionally weak. In either case the food became a foreign body. In this form of diarrhea the intestinal mucous membrane showed no pathological lesion unless it be a slight hyperemia. The stools were increased in number and fluidity, and usually contained particles of undigested food. The chief factor in the treatment of this form of diarrhea was the removal of the cause. If the alimentary canal contained undigested food, this could best. be eliminated by giving fractional doses of calomel and sodium bicarbonate, often repeated, until one or two grains had been given, or castor oil given in teaspoonful doses acted admirably. The cause having been removed, the diarrhea usually ceased. But should it continue, the treatment should be directed to the control of the excessive peristalsis. The author next devoted considerable attention to infective diarrhea, and said in the prophylactic treatment of it the infant should have the best possible hygienic surroundings, be given plenty of fresh air and bathed. frequently. Care should be taken not to overfeed the infant, as less food was needed in warm weather than in cool, and owing to the depression produced by the heat the child was less liable to digest its food. The infant should be kept as quiet as possible. It should be lightly clothed and frequently bathed.

HOW SHALL WE FEED AND TREAT THE BABY?

Dr. Hermon Hawkins, of Jackson, in a paper with this title, laid down three cardinal rules: (1) A food should be given the baby which could be assimilated and given at regular intervals. (2) One should obtain the best possible hygiene of person and surroundings. (3) As little medicine as possible should be given. Each rule was discussed at considerable length, and several cases were reported.

AMYLOID DEGENERATION.

Dr. C. P. Mc Nabb, of Knoxville, defined this disease and then discussed its etiology, pathological anatomy, symptoms, diagnosis, differential diagnosis and treatment. Treatment consisted of removal of the cause. If syphilis or chronic malarial cachexia was present, the patient should receive proper medication. If there was a chronic suppuration, the surgeon should be called early and the pus evacuated. The physician should be very watchful in cases of hip joint disease, old pyosalpinx, and ileorectal abscesses.

THE MORE SERIOUS COMPLICATIONS OF LA GRIPPE.

Dr. E. A. Cobleigh, of Chattanooga, said that one of the primal results of influenza which was impressed upon him early was not simply the usual debility which accompanied most of the cases, and seemed out of all reasonable proportion to the appreciable conditions presented, but its indefinite persistence and extreme degree in quite good many cases. These patients, wholly without regard to age or previous vigor, were too feeble for any movement or exercise beyond the minimum of vitality required to stay alive. This one element of debility-passive existence alone — was profound, and the sole cause for uneasiness. Instead of recovering within ten days or a fortnight, most of these sufferers lingered for weeks, sometimes even for months, and not a few dwindled on for a year or two, to die of sheer exhaustion at last. Cases were cited in point.

The next condition, often occurring by itself, was marked by extreme nervousness. A third condition, not very frequent, but seen often enough to impress the clinician, was marked by mental involvement, occasionally amounting to prolonged delirium, to stupor little short of coma, to hallucinations during or even after convalescence from the real attack; and rarely to mania or continuing insanity.

One of the most impressive and rare complications of la grippe which he recalled ever having seen consisted in extreme clonic spasmodic seizures, particularly involving the heart, the

diaphragm, and the muscles of respiration, with perfect mentality during it all, but giving rise to the most pitiable agony of fear of impending death.

The writer discussed several other complications of influenza, and closed by saying that his object was to sound a note of danger and to awaken physicians to the frequency of complications, and insisting on their prompt recognition.

THE CLINICAL SIGNIFICANCE OF ASCITES.

Dr. Raymond Wallace, of Chattanooga, discussed this subject and reported two instructive cases. One case illustrated unusual difficulty of making an accurate diagnosis. The unusually pronounced alcoholic history in this case with excessive peripheral arterio-sclerosis, taken with the gastric symptoms and the presence of ascites, naturally led to a diagnosis of atrophic cirrhosis; and the absolute absence of any cirrhotic changes in the liver was a point of interest. The disappearance of the miliary carcinosis of the peritoneum after scrubbing and exposure to the air presented a phase analogous to the operative cure of miliary tubercle of the peritoneum.

ACUTE SEPTIC OSTEITIS.

Dr. Jere A. Crook, of Jackson, stated that his experience in the treatment of this disease comprised only a few cases, and the greater number of them did not come under his treatment until they had become chronic. He presented a specimen of a tubular sequestrum that he removed from the femur of a ten-yearold boy. This was a case of chronic osteomyelitis that had been discharging freely for several months. Upon cutting down upon the femur a large cloaca was found, and a freely movable sequestrum. The opening was enlarged with a chisel, the sequestrum removed, and almost the entire cavity of the shaft was curetted. It was irrigated and packed with gauze and allowed to granulate from the bottom.

Another case was one that he saw in connection with his father. This was a case of a chronic osteomyelitis of the femur in a ten-year-old boy. The disease had existed for a year,