•actical Points in the Management of Some of the 
 Diseases of Children. 
 
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 UNITED STATES OF AMERICA. 
 
PRACTICAL POINTS 
 
 Management of Some of the 
 Diseases of Children. 
 
 I. N. LOVE, M. D., 
 
 President American Medical Editors' Association (1890'); President 
 
 Pediatric Section of American Medical Association (1890'); 
 
 President Mississippi Valley Medical Association (1887); 
 
 Secretary Pediatric Section Ninth International 
 
 Medical Congress ; Member American 
 
 Pediatric Society; 
 
 Member Board of Trustees of American Medical Association Journal ; 
 
 Professor Diseases of Children, Clinical Medicine and Hygiene, 
 
 Marion-Sims College of Medicine, St. Louis ; Consulting 
 
 Physician City Hospital, St. Louis; Resident 
 
 Assistant Physician City Hospital (in 
 
 1872-73-7U), St. Louis; Editor 
 
 Medical Mirror, St. Louis. 
 
 1891 
 GEORGE S. 
 
 DAVIS, 
 
 DETROIT, MICH. 
 
Copyrighted by 
 GEORGE S. DAVIS. 
 
 1891. 
 
 X— Co 
 
 V 
 
THIS LITTLE VOLUME IS DEDICATED 
 
 To one of the most earnest, enthusiastic and honest workers that the 
 American Medical Profession ever possessed, 
 
 JOHN T. HODGEN, 
 
 Whose life was the personification of Purity, a crystallization of Chastity 
 and Charity; a constant inspiration to others to work and win— whose 
 every act pronounced him the unselfish friend of humanity— the Young 
 Doctor's Guide, Counsellor and Ardent Helper; whose every thought was 
 to help others to help themselves, and keep all knowledge of his help 
 from the beneficiary. 
 
 Full many a year will come and go ere the Medical Profession of 
 America has another more lofty and commanding figure. Those who 
 knew him intimately and well were fortunate. There cluster about 
 his personality, that was at times seemingly severe, though in fact 
 ever calm, patient, strong, benignly firm, gentle and genial, many of 
 the most tender and blessed memories connected with the life of 
 THE AUTHOR. 
 
INDEX. 
 
 Page 
 
 Absorption of medicaments 52-53 
 
 of quinine, mode of administration 52 
 
 Administration of drugs to child, care in 41 
 
 of teeth making materials 34 
 
 Advantages of boiled milk 21 
 
 ^Esthetic medication 46-47 
 
 Alcohol as a food 65 
 
 how to administer 65 
 
 in diphtheria 94 
 
 Alimentary canal, clearing of 42-43 
 
 Analysis of mother's milk 15 
 
 Animal broths, value of 24-25 
 
 Antipyretics in continued fevers 125-126 
 
 Appearance of teeth, order of 33 
 
 Arrangement and quality of utensils in sick-room 67 
 
 Avoidance of cholera infantum 21 
 
 B 
 
 Baths, value of 7 
 
 in typhoid fever 134-135 
 
 Bathing, a treatment for fevers 43 
 
 of children 7 
 
 value of 43 
 
 Beef cacao (Mosquera's) 66 
 
 in typhoid fever 137 
 
 Beef meal (Mosquera's) 25-66 
 
 how to prepare for food 67 
 
 palatibility of 66 
 
 Benzoate of soda, a stimulant to secretions 74 
 
 in diphtheria 95 
 
 in tonsillitis 78-79 
 
 Bichloride of mercury in diphtheria 95 
 
— VI — 
 
 Page 
 
 Boiled milk, advantages of 21 
 
 value of as child's food 21 
 
 Bromoform in whooping cough 116 
 
 Broths, (animal,) value of 24-25 
 
 C 
 
 Care in diagnosis 42 
 
 in selection and preparation of foods 55 
 
 in selecting wet-nurse 17-18 
 
 in selecting soaps 39 
 
 of child during dentition 32 
 
 of cord 28 
 
 of nursing bottle 17 
 
 of skin 40 
 
 of wounds 29 
 
 Catarrh, diagnosis and treatment of 70 
 
 intestinal 69 
 
 laryngeal 74 
 
 prevalence of 69 
 
 of respiratory tract 69 
 
 Catarrhal fevers 69 
 
 Calomel and ipecac in treatment of colds 72 
 
 Cascara cordial in constipation 49 
 
 Causes of cholera infantum 20 
 
 of tetanus „. 27 
 
 Chicken pox, diagnosis and treatment of . . , 112 
 
 Child, care in administration of drugs to 41 
 
 care of teeth in 55 
 
 confidence of, to gain 3-4 
 
 hygienic care of 56 
 
 newborn, the 11 
 
 food for 16 
 
 liver of 13 
 
 mouth of 12 
 
 nourishment of 13 
 
 toilet of 11 
 
 treatment of mouth of 12 
 
 susceptibility to opiates and quinine 41 
 
 thirst in 15 
 
 Children, bathing of. 7 
 
 clothing of. 7 
 
— VII — 
 
 Page 
 
 Children, confidence of, to gain 2 
 
 nursing of 14 
 
 Child's doctor, the 2 
 
 food, boiled milk as 21 
 
 Chill, prevention of 7-8 
 
 Chloroform, inhalation of in whooping-cough 115 
 
 Cholera infantum, avoidance of 21 
 
 causes of 20 
 
 produced by cow's milk 19 
 
 Clearing of alimentary canal 42^3 
 
 Clothing of children 7 
 
 Cold, calomel and ipecac in treatment of 72 
 
 muriate of ammonia in 72 
 
 necessity for prompt treatment of 71-72 
 
 sequela? of 73 
 
 taking 8-9 
 
 treatment of 71 
 
 Cold driEks, value of in measles 109 
 
 Complications of scarlet fever 102 
 
 Condom, use of in controlling epistaxis 141 
 
 Confidence, of children, to gain 2 
 
 Constipation, cascara cordial in 49 
 
 Contamination of cow's milk 19 
 
 Continued fevers 119 
 
 antipyretics in 125-126 
 
 care of glandular organs in 127 
 
 control of temperature in 123 
 
 diagnosis of 119 
 
 Dover's powder in 128 
 
 necessity for quiet in 128 
 
 for sleep in 127 
 
 pepsin cordiaHn 125 
 
 tablet triturates of morphine in 128 
 
 temperature in 122 
 
 tranquillization of patient in 127 
 
 treatment of 121 
 
 varieties of 119 
 
 Cord, care of 28 
 
 management of 12 
 
 Cow's milk, cholera infantum produced by 19 
 
 contamination of 19 
 
 use of sterilized 18 
 
 Croup, membranous, diagnosis of 75 
 
— VIII — 
 
 Page 
 
 Croup, membranous, tartar emetic in 75 
 
 treatment of 75 
 
 necessity for keeping air moist in 76 
 
 spasmodic, treatment of 74 
 
 turpeth mineral (sub-sulphate of mercury) in . . 74 
 
 Curative aid of Nature 41-42 
 
 D 
 
 Deficiency of mother's milk 14-15 
 
 Dentition 31 
 
 care of child during 32 
 
 disturbances of 31 
 
 order of appearance of teeth in 33 
 
 treatment of eczema in 37 
 
 Diagnosis and treatment of catarrh 70 
 
 care in 42 
 
 excretions in 5 
 
 napkin in 5 
 
 of chicken pox 112 
 
 of continued fevers 119-120 
 
 of diphtheria 86 
 
 of German measles 110 
 
 of measles 108 
 
 of scarlet fever 101 
 
 skin in 6 
 
 tongue in .„ 5-6 
 
 of tonsillitis 77 
 
 of typhoid fever 131 
 
 urine in 5 
 
 of whooping cough 114 
 
 Dietetic points 55 
 
 Diphtheria 85 
 
 as an accompaniment of scarlet fever 104 
 
 alcohol in 94 
 
 benzoate of soda in 95 
 
 bichloride of mercury in 95 
 
 deductions 97 
 
 diagnosis of 86 
 
 disinfection in 92 
 
 history of 85 
 
 nutrition in 92 
 
 precautions against 91 
 
— IX — 
 
 Page 
 
 Diphtheria, stimulants in 93 
 
 theories regarding 87-90 
 
 treatment of 90-91 
 
 turpentine in 97 
 
 Disinfection in diphtheria 92 
 
 Disturbances of dentition 31 
 
 Doctor, the child's 2 
 
 Dover's powder in continued fevers 128 
 
 E 
 
 Eczema, Hebra's ointment in 38 
 
 importance of bathing in 39 
 
 ointment of oxide of zinc in 38 
 
 relief of itching in 38 
 
 treatment of in dentition 37 
 
 Elegance in medication 45 
 
 Emesis, value of 43 
 
 Enlarged tonsils 82 
 
 hydriodic acid in 82 
 
 removal of 83 
 
 sequelae of 83 
 
 Epistaxis 139 
 
 causes of 139 
 
 how to control 140 
 
 use of condom in controlling 141 
 
 Exanthematous fevers 99 
 
 diagnosis and treatment of 99 
 
 Excretions, value of in diagnosis 5 
 
 Exercise, open air, necessity for 57 
 
 F 
 
 Feeding, regulation of 26 
 
 Fever, scarlet 101 
 
 complications of 102 
 
 diagnosis of 101 
 
 necessity for isolation in 102-103 
 
 nephritis a complication of 103 
 
 treatment of by bathing 43 
 
 typhoid 130 
 
 diagnosis of 131 
 
 history of 130 
 
— X — 
 
 Page 
 
 Fever, typhoid, treatment of 133 
 
 value of baths in 134-135 
 
 Fevers, catarrhal 69 
 
 continued 119 
 
 antipyretics in 125-126 
 
 care of glandular organs in 127 
 
 control of temperature in 123 
 
 diagnosis of 119-120 
 
 - Dover's powder in 128 
 
 necessity for quiet in 128 
 
 sleep in 127 
 
 pepsin cordial in 125 
 
 tablet triturates morphine in 128 
 
 temperature in 122 
 
 tranquillization of patient in 127 
 
 treatment of 121 
 
 varieties of 119 
 
 exanthematous 99 
 
 cooling drinks and baths in 100 
 
 diagnosis and treatment of 99 
 
 Flowers in sick-room 67-68 
 
 Fluid medicines, superiority of. 44 
 
 Food, alcohol as a 65 
 
 care in selection and preparation of 55 
 
 child's, boiled milk as 21 
 
 for newborn child 16 
 
 malt liquors as .* 65 
 
 selection of 59-60-61-62-63-64 
 
 how to prepare 67 
 
 G 
 
 German measles 110 
 
 Germicides, necessity for, in throat affections 80 
 
 Glandular organs, care of, in continued fevers 127 
 
 sympathy of 6 
 
 H 
 
 Hamamelis, extract of, in measles 109 
 
 in scarlet fever 104 
 
 in tonsillitis 81 
 
 Hebra's ointment, in eczema 38 
 
Page 
 
 History of diphtheria 85 
 
 of typhoid fever 130 
 
 How to administer alcohol 65 
 
 quinine 50 
 
 to control epistaxis 140 
 
 to prepare beef meal (Mosquera's) for food 67 
 
 foods 67 
 
 Hot drinks inhibited in measles 108 
 
 water as a therapeutic agent 45 
 
 Hydriodic acid in enlarged tonsils 82 
 
 Hygienic care of child 56 
 
 measures ' 1 
 
 precautions 58 
 
 I 
 
 Importance of bathing in eczema 39 
 
 Infant, (See Child.) 
 
 Infantile therapeutics 41 
 
 Intestinal catarrh 69 
 
 Introduction, general 1 
 
 Irritation of skin in teething 36 
 
 Isolation in scarlet fever, necessity for 102-103 
 
 Itching in eczema, relief of 38 
 
 L 
 
 Laryngeal catarrh 74 
 
 Liver of newborn child 13 
 
 treatment of 13 
 
 M 
 
 Malnutrition, caused by bad hygiene 57 
 
 Malt liquors as food 65 
 
 Management of cord 12 
 
 Measles . 108 
 
 diagnosis and treatment of ." 108 
 
 extract hamamelis in 109 
 
 German, diagnosis and treatment of 110 
 
 hot drinks inhibited in 108 
 
 necessity for allaying skin irritation 109 
 
 value of cold drinks in 109 
 
— XII — 
 
 Page 
 
 Medication by absorption 52-53 
 
 elegance in 45 
 
 Membranous croup 75 
 
 tartar emetic in 75 
 
 treatment of 75 
 
 Milk as food, necessity for withholding 24 
 
 boiled, advantages of 21 
 
 cow's, contamination of 19 
 
 producing cholera infantum 19 
 
 sterilized 18 
 
 mother's, analysis of 15 
 
 deficiency of 14-15 
 
 substitutes for 17 
 
 peptonizing of 23 
 
 sterilizing of 22 
 
 Mineral salts, value of 25 
 
 Moist air, necessity for, in treatment of croup 76 
 
 Moral character of wet-nurse 17-18 
 
 Morphine in continued fevers 128 
 
 Mosquera's beef cacao 66 
 
 beef meal 25-26 
 
 Mother's milk, analysis of 15 
 
 deficiency of 14-15 
 
 substitutes for 17 
 
 Muriate of ammonia, in colds 72 
 
 N 
 
 Napkin in diagnosis 5 
 
 Nature's curative aid 41-42 
 
 Nauseous medication to be avoided 48 
 
 Necessity for germicides in throat affections 80 
 
 for open-air exercise 57 
 
 for withholding milk as food 24 
 
 Nephritis, a complication in scarlet fever 103 
 
 treatment of 103 
 
 Newborn child, the 11 
 
 food for 16 
 
 liver of 13 
 
 mouth of 12 
 
 nourishment of 13 
 
 toilet of 11 
 
 treatment of mouth of 12 
 
Page 
 
 Nose-bleed 139 
 
 causes of 139 
 
 how to control 140 
 
 Nourishment of newborn child 13 
 
 Nursing bottle, care of 17 
 
 of children 14 
 
 Nutrition in diphtheria 92 
 
 Open-air exercise, necessity for 57 
 
 Opiates, susceptibility of child to 41 
 
 Order of appearance of teeth 33 
 
 Oxide of zinc ointment in eczema 38 
 
 Palatibility of beef meal (Mosquera's) 66 
 
 Pancreatic extract 24 
 
 Pathological condition during teething 35 
 
 Pepsin cordial, an adjunct to quinine 51 
 
 in continued fevers 125 
 
 in scarlet fever 104 
 
 Peptonizing of milk 23 
 
 Personal disinfection in scarlet fever 105 
 
 Physical condition of wet nurse 17-18 
 
 Precautions against diphtheria 91 
 
 Prevalence of catarrh 69 
 
 Prevention of chill 7-8 
 
 of tetanus 27 
 
 Q 
 
 Quiet, necessity for, in continued fevers 128 
 
 Quinine, external application for absorption 52 
 
 formulae for administration of 51 
 
 how to administer 50 
 
 susceptibility of child to 41 
 
 R 
 
 Regulation of feeding 26 
 
 Relief of itching in eczema 38 
 
 Removal of too early appearing teeth 35 
 
 Respiratory tract, catarrh of 69 
 
S Page 
 
 Scarlet fever 101 
 
 complications of 102 
 
 diagnosis of 101 
 
 diphtheria an accompaniment of 104 
 
 extract hamamelis in 104 
 
 necessity for isolation in 102-103 
 
 nephritis a complication of 108 
 
 pepsin cordial in 104 
 
 personal disinfection in 105 
 
 treatment of 106 
 
 Sequelae of cold 73 
 
 Sick room, arrangement of utensils in 67 
 
 flowers in 67-68 
 
 Simple sterilizer 22 
 
 Skin, the 36 
 
 care of 40 
 
 in diagnosis 6 
 
 irritation, necessity for allaying 109 
 
 of in teething 36 
 
 Sleep, necessity for in continued fevers 127 
 
 Soaps, care in selecting 39 
 
 Spasmodic croup, treatment of 74 
 
 Sterilized cow's milk 18 
 
 Sterilizer, simple 22 
 
 Sterilizing of milk 22 
 
 Stimulants in diphtheria * 93 
 
 Substitutes for mother's milk 17 
 
 Superiority of fluid medicines 44 
 
 Susceptibility of child to opiates 41 
 
 to quinine 41 
 
 Sympathy of glandular organs 6 
 
 T 
 
 Tablets of tartar emetic 76 
 
 Tablet triturates morphine in continued fevers 128 
 
 Taking cold 8-9 
 
 Tartar emetic in membranous croup 75 
 
 tablets of 76 
 
 Teeth, care of in child 55 
 
 too early appearance of 35 
 
 making materials, administration of 34 
 
Page 
 
 Teething, pathological conditions during 35 
 
 Temperature, control of in continued fevers 123 
 
 in continued fevers 122 
 
 Tetanus, causes of 27 
 
 neonatorum 27 
 
 prevention of 27 
 
 Theories regarding diphtheria 87-90 
 
 Thirst in child. . . 15 
 
 Throat affections, germicides in 80 
 
 Tongue in diagnosis 5-6 
 
 Tonsils, enlarged 82 
 
 diagnosis and treatment of 82 
 
 hydriodic acid in 82 
 
 "removal of 83 
 
 sequelae of 83 
 
 Tonsillitis 77 
 
 diagnosis of 77 
 
 extract hamamelis in 81 
 
 treatment of 78 
 
 Too early appearance of teeth 35 
 
 Tranquillization in continued fevers 127 
 
 Treatment of chicken pox 112 
 
 of cold 71 
 
 of continued fevers 121 
 
 of diphtheria 90-91 
 
 of eczema in dentition 37 
 
 of German measles * 110 
 
 of liver 13 
 
 of measles 108 
 
 of nephritis 103 
 
 of scarlet fever 106 
 
 of spasmodic croup 74 
 
 of tonsillitis 78 
 
 of typhoid fever 133 
 
 of whooping cough 114-115 
 
 Trismus 27 
 
 Turpentine in diphtheria 97 
 
 Turpeth mineral (sub-sulphate of mercury) in croup . . 74 
 
 Typhoid fever 130 
 
 beef cacao (Mosquera's) in 137 
 
 diagnosis of 131 
 
 history of 130 
 
 treatment of 133 
 
— XVI — 
 
 Page 
 
 Typhoid fever, value of baths in 134-135 
 
 Tyrotoxicon in cow's milk 19 
 
 producing cholera infantum 19 
 
 U 
 
 Urine, in diagnosis 5 
 
 Utensils, arrangement of in sick-room 67 
 
 Vaccination 117 
 
 care after 118 
 
 procedure in 117 
 
 time for 117 
 
 Value of animal broths 24-25 
 
 of baths 7 
 
 of emesis 43 
 
 of mineral salts . . 25 
 
 Varieties of continued fevers 119 
 
 W 
 
 Water, hot, as a therapeutic agent 45 
 
 value of drinking ^ 44-45 
 
 warm, as nourishment 14 
 
 "Wet nurses 17 
 
 care in selecting 17 
 
 moral character of ' 17-18 
 
 physical condition of 17-18 
 
 Whooping cough 113 
 
 bromoform in 116 
 
 diagnosis of 113 
 
 inhalation of chloroform in ' 115 
 
 seriousness of 114 
 
 treatment of 114-115 
 
 Witch hazel in tonsillitis 78 
 
 Wounds, care of 29 
 
PREFACE. 
 
 Never in the history of the world has there been as much 
 brain-work upon the part of every class and condition of men 
 in behalf of children as now. This is, indeed, the children's 
 age. 
 
 Art, literature, mechanical ingenuity, and every possible 
 field of work have been directed toward the improvement, the 
 amusement, and the comfort of the children, and it is high time 
 for doctors to be aroused to a keener interest in them. 
 
 The object of this little volume is simply to group together 
 a number of practical points pertaining to various disturbances 
 of childhood which have come under the direct observation of 
 the writer. That which is said here is a mingling of facts 
 gleaned from the works of other men, and bedside observation, 
 both in pri rate practice, hospital and dispensary work. During 
 the past twenty years the writer has had a field of work in the 
 City of St. Louis, which has been at least a varied one, the 
 first five years being connected with the City Hospital, City 
 Dispensary, and other institutions. The chief and last part of 
 this period has been devoted to private practice. 
 
 There is much difference in the character of the diseases 
 which are observed among the poorer classes of a large city 
 and among the well-to-do. In the former instance, the chief 
 troubles are those dependent upon bad air, bad food and 
 insufficient clothing. Among the latter, the variations from 
 the standard of health are largely due to improperly selected 
 food, over-feeding, and congestive troubles dependent upon 
 taking cold, being caused in the majority of cases by over- 
 heated homes, insufficient clothing and careless exposure to 
 the elements. The exanthematous diseases affect all classes, 
 
but they are more serious and more fatal among the unfor- 
 tunate poor. The opinions of every writer should be carefully 
 considered, for it would add much to the correctness of our 
 conclusions, if we could determine the particular field of 
 work in which the writer has been engaged. Views which are 
 based entirely upon a hospital experience, or upon a work 
 among the pauper element, necessarily vary much from those 
 of an observer whose work is among the upper "400" of a 
 great city; or from the opinions of him whose parish happens 
 to be out in a section of country far removed from the city, 
 where every breeze that comes from the various points of the 
 compass carries with it health, life, and force, and where the 
 facilities for good food are in abundance. 
 
 The writer trusts that the views herein presented will at 
 least be accepted in the spirit in which they are given. He is 
 conscientiously anxious to advance the interests and arouse 
 the thought of the profession in the direction of the importance 
 of pediatrics. If this little book, intended for the "leisure 
 hour," aids in the accomplishment of this end, it will not have 
 been written in vain. 
 
GEN ERAL. 
 
 In managing the diseases of children, we shall have 
 gained much if we recall the fact that we can cure 
 the diseases of babyhood better by preventing them 
 than in any other way. 
 
 We should make it the object of our lives to teach 
 the parents of the children under our care that an 
 indefinite amount of prevention is worth more than 
 an indefinite amount of cure. Every day's sickness 
 checks the proper development of the child, aiding 
 in the direction of a delicate organization rather than 
 a strong one. 
 
 There can be no wound without a subsequent scar, 
 nor can there be a day's illness without its effect 
 upon the child. 
 
 This being so, we should emphasize to the mother, 
 in tones of thunder, the thought that nothing which 
 will tend in the direction of preventing disease is 
 trivial. We should run the risk of being charged 
 with being cranks and riding hobbies if need be, 
 rather than become neglectful or allow the parent to 
 be neglectful of the health of the child. In a general 
 way we are safe in saying that nearly all the diseases 
 of early life may be avoided if constant, unremitting 
 care be given the child. Proper hygienic measures ; 
 cleanliness, keeping open the secretions, the anatom- 
 1 
 
ical sewers so to speak of the little bodies, from the 
 very day of their birth on through each and every 
 day of their lives ; selection of diet, proper instruc- 
 tion as to the time of eating, protection against chill- 
 ing of the surfaces, clothes proper for each and every 
 season, all are of vital importance. 
 
 If we have faith that religious care in these direc- 
 tions will be followed by success and the health of 
 the children, and if we infect the parents under our 
 care with our belief, much will have been accom- 
 plished. 
 
 One of the first essentials to the proper manage- 
 ment of the diseases of children is to have the com- 
 plete confidence of the children themselves. If we 
 have their confidence, our presence does not disturb 
 them, but has the opposite effect, and we are better 
 able to secure a full knowledge of their case. Every 
 possible effort should be made to so influence them 
 as to reach their tender side and thus have presented 
 to us a clear undisturbed picture. 
 
 We should establish the habit of mingling with 
 children, and if we do not possess a natural fondness 
 for them, we should endeavor to develop it. We 
 should constantly study children, their habits, tastes 
 and peculiarities in health if we hope to cope with 
 them in disease. I am strong in the belief that 
 (other things being equal) a man's interest in chil- 
 dren is greatly increased by his possession of them. 
 The child's doctor as a rule, should be a father. 
 
— 3 — 
 
 By taking this position, I do not mean to oppose 
 the treatment of children by bachelor doctors or 
 childless fathers, for often I have seen these latter 
 much fonder of children than many parents of my 
 acquaintance, yet the fact remains that constant asso- 
 ciation with children develops a knowledge of them. 
 
 Having learned to know children in health, being 
 familiar with their peculiarities and idiosyncrasies 
 when well, we are the better able to judge of them 
 when they become the victims of disease. 
 
 In making our examinations of a child, if not 
 already acquainted with him, we should be particu- 
 larly careful to make our approaches gently, in fact 
 if there is one word that I would emphasize in con- 
 nection with managing children, it is "gentleness," 
 and if you couple with that word another one, viz : 
 " firmness," equally important, we have a pair which 
 will enable us to accomplish much. 
 
 A "gentle firmness" is one of the first requisites 
 of a good parent, so also it is of a good child's doctor. 
 A never varying patience, a persistent perseverance, 
 a loving interest in the child, an ability to impress it 
 with the fact that you are its friend are the first 
 essentials. 
 
 Children, like dogs, intuitively know their friends, 
 and if a physician has not and cannot cultivate love 
 for children, he ought to be honest enough to refuse 
 to attend them. 
 
 Of course I would not make the point that these 
 
— 4 — 
 
 qualifications referred to are superior to a scientific 
 knowledge of the etiology, pathology and proper 
 treatment of the diseases of children, but I do believe 
 that the possession of these latter qualifications will 
 not bring success if the others be absent. 
 
 I recall a case which came under my observation 
 some years ago, where a harsh, rough, uncouth, un 
 kind physician was called to see a fretful, peevish 
 child and instructed the mother, in spite of the con- 
 ditions present, to punish the child for his ugliness of 
 disposition. The child was thrown into convulsions 
 later and the surprising part of it is that the result 
 was not fatal. The doctor in the case should have 
 been put under treatment himself and another atten- 
 dant should have been called. Suppose we are called 
 to a child with fever, a disturbed nervous system, a 
 rapid pulse, a heart acting tumultuously, if we are 
 not able to command the confidence of the child, we 
 are certainly at a great disadvantage. Our presence 
 annoys and antagonizes him and .aggravates all of 
 the symptoms present; if, however, we can reach 
 the better side of the child, if our knowledge of baby 
 nature be sufficient, we can soon have an opportunity 
 for studying the case perfectly. Take for instance 
 the question of securing the temperature by means of 
 the fever thermometer, if we approach a child abruptly 
 or awkwardly before we have secured a proper know- 
 ledge of the degree of fever in the case, we will have 
 thoroughly " rattled " the little patient. If we under- 
 
— 5 — 
 
 stand him however, and approach him correctly, hav- 
 ing his confidence, we will soon secure not only the 
 temperature but many points valuable in the making 
 up of our diagnosis. 
 
 Remember, if we frighten and demoralize our 
 patient, all symptoms are intensified. 
 
 We should secure a knowledge of the excretions ; 
 one of our first inquiries should be as to the nature 
 of the evacuation from the bowels. If the napkin 
 has not been preserved, we should impress upon the 
 parent the importance of saving the last action from 
 the child and the napkin before our next visit. Noth- 
 ing will so clearly indicate the condition of the ali- 
 mentary canal as the evacuation from the same. If 
 the discharges from the bowel be frequent and unsat- 
 isfactory, with straining efforts, local irritation, par- 
 ticularly of the lower bowel, is indicated. If the urine 
 be high colored, the napkin darkly stained by it, it is 
 suggestive of fever. The appearance of the tongue 
 is of vital importance. If the tongue be broad, too 
 large for the cavity which contains it ; if there are 
 indentations upon the sides occasioned by the teeth 
 pressing upon the same, with more or less pain over 
 the right hypogastrium, we have evidence of an inac- 
 tive liver. If there be on the tongue a heavy coat- 
 ing with red points and edges, we have evidence of 
 an inactive state of all the secretions and marked 
 gastro-intestinal disturbance, or else, if a continued 
 fever be present, we have symptoms pointing towards 
 
— 6 — 
 
 typhoid fever. We should bear in mind that the 
 tongue is expressive of the conditions of the alimen- 
 tary tract in its entirety, the mouth being the " port 
 of entry " to the great gastro-intestinal canal. If 
 we have an active secretion upon the part of the 
 stomach and the rest of the glands of the intestinal 
 canal, the tongue will indicate it; if, however, the 
 tongue be heavy, swollen and gorged, it is typical of 
 the same condition beyond. We are safe in judging 
 a "road-way" by the appearance of the "gate-way" 
 to the same. 
 
 Another point: If the skin be dry, inactive, 
 shrunken, it is in itself expressive of the condition 
 of the system at large; indeed, we should remember 
 that the skin and the alimentary canal are each a 
 continuation of the other. The entire tissues of the 
 body are contained within a closed sac, the outer 
 portion of which is skin, the inner layer of which is 
 the mucous lining of the alimentary canal. The 
 only difference between the lining membrane of the 
 alimentary canal and the cutaneous covering of the 
 body is one of degree, the epithelial layer of the skin 
 being thicker and heavier. 
 
 Not only do the skin and the lining of the alimen- 
 tary tract sympathize one with the other, but the 
 entire glandular system of the body acts in harmony. 
 The liver, the spleen, and the various glandular 
 organs are active or inactive just in proportion as 
 the skin and its appendages and the internal lining 
 
of the body, as expressed by the tongue, are active 
 or the reverse. An important thing we should bear 
 in mind in connection with babyhood is the proper 
 clearing out every day of the bowels, as well as see- 
 ing to it that the skin is carefully washed. We 
 should instruct the parent of the child to protect the 
 surface against sudden or excessive chilling by a 
 lighter or heavier grade of flannel, according to the 
 season, the year through. Fortunately now the 
 manufacturing guild has directed its attention to- 
 wards the furnishing of all-wool, regular made, soft, 
 elegant grades of flannel, suited to the season. 
 Three grades are presented: the heavier for mid- 
 winter, the medium for spring and fall, and the 
 lighter grade for summer. There can be no doubt 
 nature intended that a non-conducting covering 
 should be furnished all animals. Particularly the 
 chest and bowels of the child should be protected at 
 all times. I feel that we are neglectful of our duty 
 if we fail to impress upon parents the necessity of 
 the child wearing not only an all-wool undershirt 
 summer and winter, but also to direct that it should 
 have the bowels covered with a flannel bandage, by 
 which precaution we assist in the prevention of the 
 chilling of the abdominal surf aces by which the blood 
 is driven to the internal organs, causing impaired 
 digestion, congestion or inflammation. If we remem- 
 ber that a very large percentage o.f the deaths in the 
 earlier years of life are caused by diseases of the 
 
respiratory system, due to the so-called colds, depend- 
 ent upon the chilling of the surface, the importance 
 of this course can be appreciated. In addition to the 
 great mortality occasioned by diseases of the respira- 
 tory system, dependent upon taking cold in early life, 
 numerous deaths result from the same cause affecting 
 the abdominal organs. 
 
 I know I am safe in saying that ninety per cent, 
 of all the children who die under three years of age, 
 die from disturbances of the alimentary canal, the 
 digestive system, or respiratory apparatus, dependent 
 in the majority of cases upon the chilling of the sur- 
 faces. 
 
 It is a popular idea that the chief danger to chil- 
 dren during the summer months is the excessive 
 heat; that the various diseases of the alimentary 
 canal are dependent upon the effects of the heat. 
 This is certainly true to a very considerable extent, 
 the heat producing that general depression conducive 
 to sensitive nerve centers which superinduces internal 
 congestions, disturbed digestion, etc. At the same 
 time there is danger of the child taking cold even in 
 the hottest weather. 
 
 In midsummer instructions are often given mothers 
 to place the child, with only the lightest slip of mus- 
 lin upon it, in a position where it can get fresh air. 
 Time and again I have found these little sensitive 
 plants in the hot days of July and August with 
 nothing on them except the little slip referred to, in 
 
some shady place where a strong draft would blow 
 upon them. I have even found them placed in the 
 cellar on account of the coolness there, the whole 
 thought seeming to be to keep the child cool. I 
 wonder that some of the ignorant mothers have not, 
 as a result of the constant preaching which they 
 have received upon this subject, placed the little 
 ones in the refrigerator. 
 
 I have found children dangerously ill with conges- 
 tion of the stomach and bowels dependent upon cold 
 received in the manner suggested. There is almost 
 as much danger to the little one from "taking cold" 
 in hot weather as there is from "taking heat." We 
 should provide for a uniform temperature, and impress 
 upon the parents the absolute necessity of the child 
 being guarded against a draft. 
 
 The thought has been thrown out that in treating 
 children we labor at a disadvantage, our hands being 
 tied on account of the fact that the child cannot give 
 us a history of his case, and that there is much light 
 which we lose in consequence of this. But, take it 
 all in all, I am strong in the belief that we have a 
 decided advantage in the managing of the diseases 
 of children over and above those of adult life. 
 
 Though the child may not be able to verbally pre- 
 sent to us much in the way of information, probably 
 we are better off for that, for many times the phy- 
 sician is misled by the remarks of the patient. 
 A child never pretends (except in rare instances 
 
— 10 — 
 
 during school life possibly). So in earlier childhood, 
 in infantile life, we generally have presented to us a 
 correct picture, the true story. Nothing is withheld, 
 nothing exaggerated, things are exactly as they seem, 
 and the gravity of the case is unaffected by over- 
 anxiety on the part of the child, by worrying, by the 
 indulgence of gloomy anticipations, by the burdens 
 which naturally belong to adult life. If we cultivate 
 the habit of carefully studying the symptoms as they 
 are presented to us, we will soon find ourselves more 
 promptly able to make a diagnosis than when called 
 to an adult. 
 
THE CHILD IMMEDIATELY AFTER BIRTH. 
 
 It is too frequently the custom for the newborn 
 infant to be turned over promptly to the tender 
 mercies of the "Sairey Gamp" of the sick room, and 
 all the energies of the medical attendant to be 
 directed to the mother. 
 
 This is a mistake; in the first place the watchful, 
 thoughtful mother can but feel that the dearest object 
 of her life is being neglected and this in itself is de- 
 pressing to her, so for the good of the mother the 
 physician should pay due attention, at every visit, to 
 the child, but primarily, for the good of the child, the 
 doctor should give it careful attention from the very 
 moment of its birth. 
 
 I should not think of giving instructions as to the 
 toilet of the newborn child for the reason that this 
 little work could not properly take up that subject. 
 The text books on Obstetrics all have instructions 
 upon this point, yet, at the same time, they do not 
 sufficiently impress upon the reader the fact that he 
 should give scrupulous attention to the babe. 
 
 We all know the importance of placing the child 
 upon its right side immediately after birth with a 
 view of favoring the closure of the foramen ovale; of 
 the proper cleansing of the child; of the proper dress- 
 ing of the cord. In this latter connection I would 
 
— 12 — 
 
 suggest that we emphasize in our minds the import- 
 ance of dressing the cord antiseptically, the same as 
 we would make any surgical dressing; the bathing of 
 the same in corrosive sublimate solution, one part to 
 a thousand would be in order, followed by wrapping 
 in corrosive sublimate lint. With such dressing sup- 
 puration can be completely ruled out, and we all 
 know that by these precautions (since the demon- 
 stration of the bacillus tetanus) tetanus neonatorum 
 is also ruled out. 
 
 The nurse should be instructed carefully as to the 
 proper manner of washing the little one's mouth. 
 Coarse, rough cloths have frequently been used and 
 too much muscular effort directed to the delicate 
 mucous lining of the mouth and tongue and denuda- 
 tions of the mucous membrane have frequently been 
 produced. 
 
 A soft rag or a small piece of absorbent cotton 
 wrapped about the finger answers well, and a mild 
 antacid lotion should be used, nothing being better 
 than the following: 
 
 3. 
 
 Sodii Biboratis, 
 
 3ii. 
 
 Fl. Ext. Pinus Canadensis, 
 
 5ss. 
 
 Glycerin, 
 
 5ss. 
 
 Aquae Rosse, 
 
 |iii. 
 
 M. Sig. : Use as a mouth wash night and morning. 
 
 The nurse should use no force in the process. 
 Immediately after birth the child should be given 
 for twenty-four hours the following: 
 
— 13 — 
 
 I£. Hydrarg Chi or. Mit. gr. i. 
 
 Sodii Bicarb., 
 
 Sacch. Lac, aa grs. x. 
 
 M. ft. ch. No. xx. 
 Sig. : One powder every two hours. 
 
 By this powder we gently stimulate the secretions 
 of the alimentary canal, the activity of the liver is 
 aroused, fermentation in the stomach and bowels is 
 prevented and an antiseptic condition therein is pro- 
 duced. 
 
 When we remember that in the newborn child the 
 liver is larger, in proportion to the body, than it will 
 ever be again, that there is an engorged condition of 
 the excretory organs and that the alimentary canal is 
 filled with accumulated secretions, we can appreciate 
 the importance of a remedy which will at once clear 
 out the system and make way for the proper reception 
 of food on the part of the food tract. 
 
 I am sure that this course not only favors the 
 cleansing out of the alimentary canal, but tends to 
 the prevention of jaundice, and arouses activity in 
 the entire glandular system of the child. 
 
 It helps in the direction of better digestion, of 
 better rest, inasmuch as the fermentative condition 
 of the alimentary canal is largely productive of the 
 colics so frequent in the newborn. 
 
 We should now turn our attention to the proper 
 nourishment of the child. 
 
 First of all we should instruct the nurse to give 
 freely of warm water, two or three or four teaspoon- 
 
— 14 — 
 
 fuls at a time for the first few hours. This form of 
 nourishment (and warm water is a nourishment) 
 will probably be sufficient for the first twelve hours, 
 but in some cases we need to give more. 
 
 Of course it goes without saying that the child 
 should immediately after birth be placed to the 
 mother's breast, as her best interest is thus subserved, 
 as well as that of the child. 
 
 The withdrawal of the accumulation within the 
 breast stimulates a more active contraction of the 
 uterus, and the secretion of the breast taken by the 
 child aids in clearing out its alimentary canal. 
 
 We hear much regarding the duty of mothers in 
 nursing their own children. I have rarely found, be 
 it said to the credit of maternity, a mother who was 
 not anxious to nourish her child. During the past 
 twelve years I have been fortunate in having a prac- 
 tice among the very best element of a large city. 
 Many society women, many women who might be 
 considered light and frivolous, and yet with one 
 exception I have found them all anxious to do their 
 duty to their child, so that I feel that as a rule we 
 shall have the earnest co-operation of the mothers in 
 nursing their children. 
 
 If the mother seems short of milk, we should not 
 be too easily discouraged, and should persistently 
 feed her with a view to the developing of her milk- 
 giving powers. At the same time we must remember 
 that under the existing conditions of society and 
 
— lo- 
 calization there are many women who are congenit- 
 ally imperfect in this direction, and we should not 
 fail to promptly make up all deficiency upon the part 
 of the mother. 
 
 Scores and scores of times I have had children 
 come under my observation who had been practically 
 starved to death the first three or four months of 
 their lives by earnest, anxious mothers, who thought 
 they were nursing their children and giving proper 
 nourishment to them. 
 
 The little one may work earnestly, energetically 
 and persistently and get but little. He cries ever and 
 anon and at once is dosed by the nurse, or possibly 
 by the anxious mother, who is ignorant of the fact 
 that her child is hungry. Among the ignorant, un- 
 fortunately, some "soothing syrup" is apt to be 
 brought into requisition. 
 
 The baby is frequently thirsty, and should be given 
 freely of water instead of being placed at the breast; 
 but if there be a dearth of secretion in the breast, the 
 child is probably kept at the same a considerable 
 part of the time pulling away for dear life for what 
 he does not get, his mother weary and worn out, and 
 he vexed and irritated, and righteously so, too, for 
 the reason that he is w r orking for a living and not 
 getting it. All these things should impress upon us 
 the importance of now and then making more careful 
 investigations. Analyze the mother's milk, and make 
 frequent examinations of the condition of the breast. 
 
— 16 — 
 
 Have the child refrain from nursing for a given 
 length of time, and observe if there is any accumula- 
 tion. Insist upon regularity in feeding but there is 
 no particular harm done if the child be changed from 
 his food. 
 
 We are safe in taking the position that as long as 
 there is nothing in the composition of the food in it- 
 self objectionable, and if the food be in a form digest- 
 ible it is safe to be used. We need not fear chang- 
 ing from one food to another that is we need not fear 
 the result if we take a child from the mother's breast, 
 say for half a day or a day, and give it temporarily 
 some substitute for its natural food. 
 
SUBSTITUTES FOR MOTHER'S MILK. 
 
 On substituting some other food for the mother's 
 milk it may be necessary to give the artificial food 
 every alternate feeding; in other words it may be only 
 a partial substitution. 
 
 Let us save the mother's breast milk and encourage 
 her milk-giving powers, for in case of illness on the 
 part of the child when light diet is allowable this 
 supply is a Godsend. The child is soothed and com- 
 forted, and there is much in that. 
 
 For the first month or two the child should not be 
 fed oftener than once in two hours, the interval may 
 then be lengthened to two hours and a half. 
 
 Do not forget that the nursing bottle should be 
 plain and simple, — it is easier to clean. For the same 
 reason the nipple should be the block rubber variety. 
 No tubular affair should be allowed. 
 
 The use of several bottles, ample cleaning, airing 
 and sunning should be insisted upon. 
 
 Wet-Nurses. — Of course it goes without saying 
 that as a substitute for mother's milk, some other 
 mother's milk is preferable; in other words a wet- 
 nurse should be engaged, if one can be secured whom 
 we know to be in good physical condition, with no 
 taint upon either physical or moral character. Bet- 
 ter by far that the child should run the gauntlet of 
 
— 18 — 
 
 some other forms of food, or even die, than that a wet- 
 nurse be brought in the family whose qualifications 
 render her somewhat of the nature of a moral leper. 
 
 Parents have a divided duty, a duty to the home in 
 its completeness, a duty to their other children as 
 well as to the infant. 
 
 Taking one consideration with another, in the 
 majority of instances we are safe in ruling out of the 
 family the wet-nurse; besides many families cannot 
 aiford the luxury. 
 
 In the selection of a wet-nurse invariably insist 
 that a clear bill of health be presented and also evi- 
 dence of the possession of a good moral character 
 and a reasonably kind disposition. 
 
 Impress upon the mother, however, in employing a 
 wet-nurse the thought that there need be no special 
 fear in the matter of changing foods, or changing wet- 
 nurses. Indicate at once to the nurse employed com- 
 plete independence of her. If the reverse course be 
 pursued the naturally tyrannical nature of the brood 
 will be apt to manifest itself. Details as to the quali- 
 fications of the wet-nurse need not be presented. 
 
 I maintain that the little one can have a change of 
 food without running any very great risk, if the 
 severest care be exercised. 
 
 If a wet-nurse is not available (other things being 
 equal), the milk from a good, healthy cow is to be 
 preferred s and before being used it should be com- 
 pletely sterilized. 
 
— 19 — 
 
 There are many writers who take the position that 
 cow's milk is the only food for infants where wet- 
 nurses are not available, but the same objections some- 
 times apply to cow's milk as to wet-nurses. 
 
 The difficulty of knowing the condition of the cow 
 from whom the milk is taken, as to the cleanliness of 
 those who have cared for the milk, and the difficulty 
 also of impressing upon the members of the house- 
 hold the fact that milk is more readily polluted by 
 its environment than any other article of diet, pre- 
 sents many objections to its use, as also the addi- 
 tional facts that it absorbs atmospheric impurities; 
 that it readily ferments and sometimes develops with- 
 in itself poisonous properties. 
 
 In 1884 Prof. Victor C. Vaughan, of the University 
 of Michigan, isolated an active principle from poison- 
 ous cheese, which he named tyrotoxicon. Later he 
 found the same principle in impure milk, ice-cream, 
 and other articles of food in which such milk formed 
 a part. In experimenting with the poison, it was 
 found that its action on the lower animals produced 
 the phenomena of cholera infantum. The symptoms 
 and the post-mortem appearances were identical. 
 From this it is easy to understand the prevalence of 
 cholera infantum among the very poor, where fresh, 
 wholesome milk is almost unknown. 
 
 We have in this discovery an explanation of the 
 many so called obscure cases of poisoning from pic-' 
 nic ice-cream. In many of these parties there have 
 
— 20 — 
 
 been large numbers taken down suddenly with all 
 the symptoms of acute poisoning from arsenic or 
 other active irritants. 
 
 There can be no doubt that the tyrotoxicon of 
 Vaughan is the casus belli in the majority of these 
 cases. Dr. Vaughan, after a long series of laboratory 
 experiments, demonstrated that normal milk infected 
 with a small portion of poisoned milk and kept a few 
 hours at the temperature of the body, rapidly be- 
 comes poisonous in its entirety. 
 
 Dr. W. D. Booker, of Johns Hopkins University, 
 has done much active work in the laboratory in the 
 direction of demonstrating the micro-organisms which 
 are at the bottom of much of the trouble of the ali- 
 mentary canal of infants suffering from " summer 
 diseases." 
 
 There never was yet a case of cholera infantum 
 that had not a preliminary history of gastro-intestinal 
 disturbance of a mild character, usually lasting from 
 two to three days prior to the acute attack. Of 
 course, exceptionally, there can be sudden attacks of 
 cholera infantum just as there may be of cholera- 
 morbus in adults, produced by an excessive amount 
 of undigested food, but the majority of cases present 
 a preliminary history of a mild intestinal war prior 
 to the more acute attack. Observers who have had 
 an opportunity of studying the subject know that 
 when cholera is present there is generally a history 
 
— 21 — 
 
 of choleraic diarrhoea preceding the acute attack of 
 cholera. 
 
 If the proper diet be selected in these cases during 
 the cholera times and if the proper check be placed 
 upon the disturbance in the alimentary canal, the 
 majority of cases of cholera would be avoided. For 
 the same reason, we would impress upon the mothers 
 and the attendants of the children under our care 
 the fact that in summer or winter if the mild dis- 
 turbances of the bowels of the child be properly 
 cared for, cholera infantum will in the majority of 
 cases be ruled out altogether. 
 
 In the managing of these disturbed digestions and 
 more serious intestinal riots, we should bear in mind 
 Taughan's tyrotoxicon, and we will often find it best 
 to withdraw all milk diet for a time. 
 
 We have for centuries rapidly advanced in our 
 development of proper food for adult life, and the ad- 
 vancement of civilization has demonstrated to us that 
 nearly all food which is properly prepared is cooked, 
 and yet not until recently did we realize that milk 
 should be no exception to the rule. There can be no 
 doubt but that the boiling process renders the milk 
 more digestible. The curd of the milk which is 
 formed in the stomach after drinking appears in finer 
 particles, is more broken up, and is of course more 
 approachable by the gastric juice. 
 
 The boiling of milk also has an additional advan- 
 tage, in that it destroys the possibility of tubercular 
 
— 22 — 
 
 infection, it having been demonstrated that the milk 
 of cows suffering from tuberculosis may transmit 
 that disease to those who partake of it. As has been 
 suggested when citing the cases of acute gastroin- 
 testinal disturbances aroused by picnic ice-cream, 
 dependent upon the presence of the cheese poison in 
 the milk, freezing does not destroy micro-organisms 
 of any kind, in fact, all organic matter is preserved 
 by the freezing process, and when received into the 
 alimentary canal is as virulent as before; but a tem- 
 perature of 212° is destructive to it, so that in boiling 
 the milk we purify it as well as render it more diges- 
 tible. There are in the shops sterilizing apparatus, 
 which are convenient, but for all practical purposes 
 the smallest size Mason fruit jar will answer every 
 purpose. The milk may be placed within the jar, 
 and the same, without its cover, set in a vessel of 
 cold water, which being put upon the stove and 
 brought to the boiling point, will have reached that 
 degree of heat which is sufficient. After standing a 
 moment or two upon being removed from the stove, 
 the top of the jar may be screwed on, and then it is 
 practically hermetically sealed. The advantage of 
 the small jars is that they will hold a quantity suffi- 
 cient for use each time, while if the larger ones be 
 used, the milk has to be disturbed and runs the risk 
 of pollution. 
 
 There may occur cases where even sterilized milk 
 will not be digested, and then it may become neces- 
 
— 23 — 
 
 sary to modify the milk by the addition of barley 
 water or some farinaceous article. Some form of 
 malt is an admirable addition in these cases. I have 
 found no better agent for the purpose than Mellin's 
 Food, a teaspoonful or two to one portion of milk 
 for a feeding. By its presence in the milk, it being- 
 rich in hydrocarbons and dextrose, we have not only 
 an aid to digestion, but additional elements of food, 
 so that nutrition is better accomplished. Maltine, 
 a very attractive form of malt, is also many times 
 well received when added to sterilized milk. 
 
 The digestive powers of the infant often are so 
 impaired that it becomes necessary to predigest the 
 milk, by adding the following formula: 
 
 1$. Piilv. Pancreatic Extract. gr. v 
 
 Sodii Bicarb.. gr. xv 
 
 Saccli. Lac, gr. xv 
 
 M. Ft, ch.,No. I. 
 
 Mix this powder in a gill of warm water and stir it into the 
 amount of milk necessary to fill a nursing bottle, then place the 
 bottle in a vessel of water at a temperature a little above 100° F. 
 
 By keeping the milk at a temperature of 100° for 
 twenty minutes, it will be sufficiently peptonized to 
 be well received by the child. If, as sometimes hap- 
 pens, a bitter taste is developed, we may know at 
 once that we have heated the milk too much or too 
 long. Commerce has fortunately provided for us 
 peptonizing materials, which are always available 
 and very convenient. Fairchild Bros. & Foster's 
 
— 24 — 
 
 peptogenic milk powder answers an admirable pur- 
 pose, and full instructions are given with it, so that 
 he who runs may read and use. Parke, Davis & Co., 
 with their pancreatic extract, have also furnished us 
 that which we can lean upon as a reed unbroken. I 
 often find observers object to peptonizing materials, 
 because the attendants of the sick room have not 
 sufficient intelligence or understanding to properly 
 carry out the instructions given. I think, however, 
 that we shall find, if we are patient, and make a prac- 
 tical demonstration ourselves to the nurse or the 
 mother as the case may be, she will readily learn; 
 yet in these matters we must ever bear in mind that 
 we should have patience to go into every detail, and 
 give as perfect a demonstration in as practical a way 
 as possible to those who are to carry out our instruc- 
 tions. We should take nothing for granted, and we 
 should have positive evidence that those who are to 
 execute our orders understand them. 
 
 As previously stated, it frequently becomes neces- 
 sary for us in the management of-a case of indiges- 
 tion in a child to stop all milk food, and we find 
 advantage in so doing; in such cases the administra- 
 tion of the animal broths is indicated. The expressed 
 juice of a rare and tender steak, warm and gently 
 salted, will many times be retained and assimilated 
 when other food is rejected. We have all observed 
 that not only artificially fed babies, but those which 
 have been most carefully and completely nourished by 
 
— 25 — 
 
 their mothers, will, at times, at the table grasp greed- 
 ily for the salt cellar and eat heartily of its contents. 
 In this we have given us a cue, and we should be 
 prompt in reading the lines which follow after, and 
 learn that even in the very young there is often a 
 demand for the mineral salts. It is needless to refer 
 to the physiological necessity of these salines in the 
 animal economy, but I fear that we too often fail 
 to appreciate their importance, since many times 
 these animal broths to which I have referred, rich as 
 they are in salts, meet a necessity. I have found 
 clam juice of great value, either given warm or cold. 
 If the child be feverish, and the weather warm, it 
 may be given almost ice-cold. 
 
 There has been recently been presented to the pro- 
 fession an admirable product known as Mosquera's 
 Beef Meal, a perfectly pure, predigested meat, con- 
 taining all the constituents of lean beef, half of which 
 are in soluble form ready for assimilation, the other 
 half easily digestible by the gastric and pancreatic 
 juices. The entire preparation is composed of nutrient 
 matter, containing about 40 per cent, of soluble pep- 
 tone and albuminose. It is claimed that it represents 
 about six times its weight of lean beef. It is quite 
 valuable, and is tolerated with ease by the most deli- 
 cate stomach. I have found in a number of instances 
 that if given in a more or less thick soup, it will be 
 taken by the child with avidity, even if quite young. 
 Of course, the quantity should be regulated, accord- 
 
— 26 — 
 
 ing to the delicacy of the stomach. In children of 
 larger growth, it may be mixed with porridge, or 
 even given in chocolate, or when made into a paste 
 may be given in the form of a sandwich. There are 
 often times when a rich, rare steak, scraped and thor- 
 oughly macerated, from which every shred of con- 
 nective tissue has been removed, and the completely 
 softened fibre, warmed and salted, is in good form 
 for administration, even to very young infants, .par- 
 ticularly in those cases where all forms of milk food 
 are not tolerated. We must always bear in mind 
 that every baby, like every other individual, is a law 
 unto itself, and there can be no stereotyped rule for 
 the artificial feeding of infants. Regularity, a proper 
 regard for the component parts of the food, which 
 should meet the necessities of tissue-building, a due 
 respect for the palate of the child, and the administra- 
 tion of liberal quantities of liquids, will in the major- 
 ity of instances completely nourish even the most 
 delicate child. 
 
TETANUS NEONATORUM. 
 
 Tetanus of the newborn is decidedly a preventable 
 disease. Recent investigations of bacteriologists 
 have demonstrated almost beyond question that teta- 
 nus is a disease of the nervous system, dependent 
 upon a specific bacilli. The disease is a motor-neuro- 
 sis, which shows itself in tonic contractions, some- 
 times of the entire muscular system, and sometimes 
 of individual muscles. It sometimes is confined to 
 the muscles of the jaw, and is then known as trismus. 
 Tetanus general is always accompanied by trismus, 
 but the latter is not necessarily accompanied by the 
 general motor-neurosis. On post-mortem there have 
 not as yet been discovered any special lesions. Con- 
 gestion of the brain and spinal cord have been 
 observed, and some effusion in the arachnoid sac, but 
 these are more likely to be results than causes of the 
 disease. The most satisfactory explanation of the 
 disease, taking into consideration the fact that it is 
 an accompaniment of a septic condition, is the bac- 
 teriological idea. Tetanus of the newborn has been 
 observed for years, more particularly among the lower 
 classes and those whose hygienic surroundings were 
 the most unfavorable. Among the colored people 
 who are crowded together in large numbers, and 
 have little appreciation of the importance of cleanli- 
 
— 28 — 
 
 ness, and who have children pretty much as rabbits, 
 tetanus was formerly a cause of great mortality. 
 Physicians who practiced before the war among the 
 slave population reported enormous numbers of 
 deaths from tetanus among the infant class. Since 
 there has been an appreciation on the part of the 
 profession of the importance of cleanliness in con- 
 nection with all surgical procedures, and this thought 
 has been applied to the toilet of the umbilicus, there 
 has been a great decrease in the number of cases. 
 We should realize that every umbilical cord should 
 be removed with instruments properly sterilized, 
 and that the dressing should be antiseptic, the parts 
 having been bathed with a solution of corrosive sub- 
 limate, 1 part to 1000. The best dressing for the 
 cord is the salicylated absorbent cotton. No grease 
 should be permitted, as germs increase and multiply 
 in the presence of oleaginous environment. The 
 proper treatment of the disease is anti-spasmodic, 
 whether it affect the newborn child and be dependent 
 upon or independent of irritation about the navel, or 
 whether it follow a traumatism. In every case of 
 tetanus following an injury we should investigate 
 thoroughly our wound, and if possible should open 
 up and cleanse the same completely. If it be a mem- 
 ber, we should favor amputation. The administration 
 of bromide and chloral in ten grain doses of the for- 
 mer and two grains of the latter, often enough to 
 produce the complete physiological effect, is indicated. 
 
— 29 — 
 
 Fowler's Solution, pushed to its full toxic effect, has 
 been commended. The late Dr. John T. Hodgen, 
 for many years a leading surgeon of St. Louis, was 
 a strong believer in the value of Fowler's solution in 
 heroic doses in tetanus. He reported during his life 
 several cases successfully treated in this manner. In 
 consideration of the fact that children are very prone 
 to injury, we should be ever on the alert as to the 
 possibilities of tetanus "as a complication following 
 these injuries; even the simplest wound should be 
 treated in the completed antiseptic manner. I should 
 be inclined to advise that the innermost recesses of 
 every part should be washed out thoroughly with 
 Marchand's peroxide of hydrogen first, and sub- 
 sequently, after being cleansed with pure water, 
 thoroughly submerged in a bichloride solution 1 part 
 to 2000 of water, and then as completely closed as 
 possible — hermetically sealed. 
 
 Fortunately the commercial end of the medical 
 profession has furnished us with antiseptic gauzes, 
 absorbent cotton and various dressings that can be 
 gotten in any well-stocked drug store. Wherever 
 possible in the closing of wounds with sutures we 
 should use the antiseptic cat-gut suture, for in this 
 case the suture is absorbed, and we do not have to 
 disturb our wound to remove the same. If the 
 wound be deep and cannot be completely closed from 
 the bottom, a drainage tube, properly washed out 
 from time to time with an antiseptic solution, should 
 
— 30 — 
 
 be used, and at as early a date as possible we should 
 remove the same and apply pressure, with a view to 
 closing the cavity. 
 
 These few points regarding the dressing of wounds 
 are given simply as prophylactic measures against 
 the possible development of tetanus, following simple 
 accidents. 
 
DENTITION. 
 
 There are writers, and good ones, too, who take 
 the position that dentition, being entirely a physio- 
 logical process, should not be considered under the 
 head of disease. They claim that many children 
 have been permitted to suffer needlessly with diseases 
 that should have been relieved, which were charged 
 up to the teething process. Unquestionably to a 
 degree they are right. For instance, the thought 
 that children during the period of dentition should 
 be permitted to have intestinal irritation, and many 
 other diseases, and the same be ignored, on the ground 
 that it was necessary to the teething process, has 
 been responsible for the death of many children. 
 But the fact that the profession and the public went 
 too far in the direction of justifying many diseased 
 conditions on the ground of teething, does not justify 
 our going to the other extreme, and saying that den- 
 tition or the disturbances incident or necessary to 
 dentition are a myth. The time was when during 
 the teething process, if children had convulsions, 
 disturbed digestion, long continued irritation of the 
 bowels, sore eyes, sore mouth, sometimes of a very 
 serious character, enlargement of the glands, febrile 
 symptoms, at times of a very pronounced nature, 
 they were all ignored, and simply charged up to 
 
teething. This was all wrong, and yet we should 
 not say, as some have said, that there is nothing 
 involved in the teething process; that it is entirely 
 physiological, the same as growths, the same as eat- 
 ing a particular meal and the digestion of the same. 
 There are certain things that it is necessary for us to 
 remember in connection with the teething process. 
 I am sure We are not safe in ignoring them. It is true 
 that dentition, like all other physiological processes, 
 may go on uninterruptedly, without any disturbance 
 at all; with very little, at least, though in some cases 
 its effect upon the constitution at. large is very 
 serious, and may even destroy life in children of a 
 very nervous organization. We should teach the 
 mothers of the children under our care that during 
 the teething process the child is more than usually 
 susceptible to disturbances of its health, and for this 
 reason deviations should be all the more promptly 
 checked. The child in teething, we might almost 
 say, is going through its first climateric, and 
 needs to be guarded carefully. The thought that it 
 is a physiological process, and requires no attention, 
 in the light of careful observation, is absurd. We 
 may as well say that the bearing of children on the 
 part of mothers is completely physiological, quite as 
 much so as eating dinner and digesting the same, and 
 probably in the early days, in the primitive state of 
 society, before the enervating effects of civilization 
 had a chance to completely overcome the women 
 
— 33 — 
 
 of the world, it was so; but in this last decade 
 of the nineteenth century, and for the many that 
 preceded it, we know fall well that the fruit-bear- 
 ers of the animal world, particularly the most per- 
 fect specimens of it, those of the highest grade of 
 society, give evidence that their work is more patho- 
 logical in many instances than physiological, and 
 requires the aid of science and the art of the skilled 
 physician. If under these latter-day conditions par- 
 turition has become, we may say, an almost unnatural 
 thing, surely this is justification of the thought 
 that the teething process, which is under proper 
 conditions thoroughly natural and easy, may become 
 the reverse. But leaving all theorizing aside, the 
 observation of the careful physician who has had 
 many years of practice, is strongly in favor of th 
 thought that dentition is not without its dangers. 
 There are many pathological conditions which are 
 intimately associated with teething, if not as a direct 
 cause, at least as a superinducing cause. We are 
 safe in saying that the teething process puts the 
 nervous-system on edge, renders it hypersensitive, so 
 to speak, easily upset, readily demoralized, and pre- 
 siding, as it does, over the various functions of the 
 body; the equilibrium being interrupted, the result- 
 ing condition is a standing invitation to disease. 
 
 I will simply recall to the mind of my reader the 
 order in which the teeth usually present themselves: 
 From the fifth to the seventh month, the two central 
 
— 34 — 
 
 lower incisors; from the ninth to the eleventh month, 
 the four upper incisors, the two central appearing 
 first; from the thirteenth to the fifteenth month, the 
 two lower lateral incisors and the four first premolars; 
 from the sixteenth to the twentieth month, the 
 canines, those in the upper jaw generally preceding 
 the lower; from the twentieth to the thirtieth month, 
 the second premolars. There of course are variations 
 from this rule; the teeth may appear earlier than the 
 various orders I have, named, the order may be inter- 
 rupted, or ttoey may appear very late. I have ob- 
 served several cases where no teeth appeared before 
 the child was two years old, and these children 
 developed later well, werehealthy, strong and hearty. 
 While I would allay the anxieties of a parent where 
 there was great delay in the development of the 
 teeth, I would at the same time encourage their 
 development by the administration of the best form 
 of nutrient and tooth-making materials, such as 
 cereals and phosphate of lime and soda. Unques- 
 tionably a long delay in the appearance of the teeth 
 is an expression of a rachitic tendency; that is, that 
 the child is short on its mineral supply, and we 
 should make up the deficiency. There are cases on 
 record of a child being born with one or more of its 
 teeth already cut. This in the early times was 
 considered to be expressive of a strong, heroic, ag- 
 gressive disposition, but I think we are justified in 
 looking upon it as a pathological condition. While 
 
— 35 — 
 
 no case of this kind has come under my observation, 
 authors have recorded numbers of cases of children 
 born with one, two, or three of their teeth already cut. 
 They favored their prompt removal. Usually there 
 is an absence of enamel, and sometimes the develop- 
 ment of the protruding teeth is only superficial, and 
 may be readily removed. Various authors suggest 
 that there is always as a cause of the too early ap- 
 pearance of the teeth some irritation of the periosteum 
 of the alveolar process, and that this irritation has 
 advanced the development. They urge removal of 
 the appearing tooth, as it favors the relief of the 
 generally accompanying periostitis of the alveolar 
 process. The condition is a rare one, but when it 
 presents itself we should look closely to the local 
 conditions. 
 
 The thought that there should necessarily be a di- 
 arrhoea or a pronounced bowel trouble with teething, 
 or that a teething cough, or a rash upon the skin, 
 during the teething process, should be ignored, is all 
 wrong; in fact we should remember that whatever 
 pathological condition presents itself during the 
 teething process, should be promptly relieved, with 
 this thought well in mind: that during the teething 
 time the bowels should be kept in a thoroughly open 
 condition, and should present no appearance of irri- 
 tation. Beyond that, a too frequent opening of the 
 bowels should be relieved. There is no excuse for 
 any cough or disturbance of the bronchial tubes 
 
— 36 — 
 
 being permitted to continue. It is true that among 
 the other conditions that are most apt to occur dur- 
 ing dentition is an irritation of the bronchial mucous 
 membranes, the little patient being more susceptible 
 to " taking cold," and inasmuch as the very young 
 when they take cold are very liable to bronchitis, 
 the teething child is prone to bronchial irritation. 
 It should be promptly relieved, because the condi- 
 tions are such that if neglected serious trouble may 
 readily develop. 
 
 The Skin. — All skin disturbances should be 
 promptly relieved. In the early days there were ob- 
 jections, and even yet many of the "good old grand- 
 mothers in Israel " oppose the interfering with any 
 irritations which may appear upon the skin of the 
 teething child. The old-time milk crust was looked 
 upon as a dispensation of Providence, as a "blessing 
 in disguise," and the one who was indiscreet enough 
 to interfere with or heal that rash was in disgrace. 
 We should be positive in favoring the earliest possi- 
 ble relief to all irritations of the skin. We should 
 impress the parents of the child primarily that the 
 epithelial or cutaneous disturbances are a reflex from 
 a disturbed condition of the alimentary canal, and 
 evidence impaired digestion. We should direct our 
 attention to a removal of the cause and relieve all 
 fermentative conditions of the digestive tube and 
 aid digestion in so far as possible. Usually by re- 
 moving the cause we cure the cutaneous disturbance; 
 
but there are times when we need to make applications 
 directly to the skin. 
 
 It is well to bear in mind in connection with these 
 disturbances of the skin, (which may generally, par- 
 ticularly in teething children, be classed under the 
 head of Eczema), that in so far as possible all wet 
 applications should be avoided. There are many 
 varieties of eczema referred to by dermatologists, 
 such as E. simplex, E. vesiculosum, E. papillosum, 
 E. impetiginote, E. squamosum, E. rubrum, E. uni- 
 versale, E. partiale, and so on, ad infinitum, accord- 
 ing to special peculiarities or special fondness of der- 
 matologists to multiply names. The disease, of 
 course, as represented by all these different terms 
 varies; in fact the varieties of eczema are as numer- 
 ous almost as the individuals. The history of the 
 case, the general conditions, and the special condition 
 dependent upon the special cause, will enable us to 
 make our diagnosis readily. In cases of chronic 
 eczema which have continued for a long time the skin 
 becomes thickened, rough and fissured with papillary 
 hypertrophy and cellular infiltration of the deepest 
 layers of the coriurn. In many cases the removal of 
 watery applications, the interference with frequent 
 washing, and the protection of the skin from the at- 
 mosphere, with some soothing, emollient ointment, 
 will be all sufficient, if we guard the alimentary 
 canal against irritation and properly select the diet. 
 In the majority of cases it is well to scrupulously 
 
— 38 — 
 
 avoid all farinaceous foods. We should also lay 
 special stress upon the matter of preventing the 
 patient from scratching the itching part, for many 
 times the itching is of so pronounced a character, and 
 the temptation to scratch so great, that here we will 
 have our greatest difficulty. As a means of relieving 
 the intolerable itching which sometimes accompanies 
 eczema, I have found the following, if applied once 
 or twice daily, to be all-sufficient: 
 
 1$. Acid carbolic, 3 ii. 
 
 Glycerin, 3 iv. 
 
 M. 
 
 This is a strong solution, but if properly applied it 
 is much less irritating than the too-frequent scratch- 
 ing. I have in some cases made it stronger, even 
 to the extent of doubling the strength. To pro- 
 tect the surfaces against scratching, in the case of 
 small children it may often become necessary to glove 
 the hands and tie them. On some cases it is neces- 
 sary to make a mask which will cover all of the ex- 
 posed parts, leaving only a space for the mouth, the 
 nostrils and the eyes. Often the plain ointment 
 (laying special stress upon the "care of its prepara- 
 tion "), of the benzoated oxide of zinc is of great 
 value. The best all-round application for eczema, 
 however, is the unguentum diachylon albi of Hebra, 
 which consists of equal parts of linseed oil and 
 diachylon plaster, to be applied on soft linen rags, 
 and changed every twelve hour?. There are times, 
 
— 39 — 
 
 particularly in the flexures of the skin, when a dry- 
 ing powder, such as the impure carbonate of zinc, 
 is of service. 
 
 I have referred more particularly to eczema for the 
 reason that it is the disturbance of the skin most fre- 
 quently met with in young children. 
 • Let us not forget that in guarding the skin of chil- 
 dren as well as adults, we should keep in proper con- 
 dition the alimentary canal primarily, and urge upon 
 those under our care the importance of the hygiene 
 of the skin, bathing at least once a day with tepid 
 water and a proper kind of soap. Dr. Merrill Rick- 
 etts, of Cincinnati, at a recent meeting of the Mis- 
 sissippi Valley Medical Association, presented h 
 paper upon skin diseases resulting from the abuse of 
 soaps wherein he made very strong points. Undoubt- 
 edly there is not proper discretion exercised on the 
 part of the household in the selection of soaps for 
 domestic use. White castile soap is good all-around 
 soap, but one of the best soaps for use in the nursery 
 is Pears' soap, and in spite of the fact that somebody 
 may benefit by this special commendation, I am ready 
 to maintain the position and present in justification 
 the fact that probably the highest authority in the 
 world upon the skin, Sir Erasmus Wilson, has publicly 
 taken the same position. We should impress the par- 
 ents of the children under our care from the day of 
 birth with the thought that cleanliness is godliness, 
 not only cleanliness of the skin, but cleanliness of the 
 
— 40 — 
 
 inner skin, remembering, as remarked elsewhere, that 
 the alimentary canal and the external covering of 
 the body are each continuous with the other, of simi- 
 lar anatomical structure, varying only in the fact 
 that the skin has a thicker layer of epithelial cells as 
 a protective ; irritation of the one is reflected to the 
 other. Keep, then, the alimentary canal free from 
 irritation; keep also the skin in good shape, if you 
 would have both healthful, but, mind you, cleansing 
 the skin does not mean scrubbing it as you would 
 scrub a kitchen floor, with soap equal almost to the 
 concentrated lye used on the same. 
 
INFANTILE THERAPEUTICS. 
 
 In considering " Infantile therapeutics,'' first of all 
 I would make the point that Ave must bear in mind 
 the delicate organization of a child, the fact that in 
 consideration of its incomplete development there is 
 much more likely to be an idiosyncrasy against cer- 
 tain remedies, and for this reason we need to move 
 very carefully in our administration of drugs. We 
 should give small doses on general principles, and 
 repeat them often, rather than large doses at longer 
 intervals. The child is specially susceptible to opi- 
 ates and quinine. It bears well such drugs as calo- 
 mel, the bichloride of mercury, in fact mercury in 
 any form; but of course even these should always be 
 given carefully. We should resolve early in our 
 management of the diseases of children to form a 
 partnership, and throw upon our partner the chief 
 work, and this partner should be Nature. The com- 
 bination of a careful, conservative, alert, observing 
 physician with Dame Nature, and the latter the chief 
 member of the firm, will most generally be successful 
 in the management of the diseases of children. How- 
 ever, we must not trust too much to nature. I have 
 no patience with the doctor who is called to a child 
 ill and who carelessly says to the parent, " I don't 
 believe in giving medicine to children ; open its 
 
— 42 — 
 
 bowels, and it will be all right in the morning." 
 The most careful examination should be made in 
 every case, for, while it is true that nature is of 
 great value in recuperating and rebuilding the child, 
 we must bear in mind that we have a sensitive plant 
 to deal with, an undeveloped organism, a creature 
 which is made up largely of nervous system, more 
 than usually sensitive, and easily agitated, altogether 
 presenting great susceptibility to irritation, distur- 
 bance, and attack by the various germs and deleteri- 
 ous influences which surround it. 
 
 Another point. The child has great elasticity, and 
 will not yield to disease until forced to do so, and for 
 this reason many times the true condition is masked; 
 an ambition to play, an indisposition to yield, will 
 many times deceive us. We should be scrupulously, 
 religiously careful to investigate every organ, every 
 point, connected with the child to which we are 
 called; interrogate the parents as to possible expo- 
 sure to various diseases incident to childhood; de- 
 velop completely all the knowledge that we can with 
 regard to heredity, at the same time scanning care- 
 fully all the evidence given. We are always safe in 
 clearing out the alimentary canal of the child. 
 The chances are that there is some error in the major- 
 ity of cases; that there is some offending article of 
 food in the alimentary canal. The opening up of the 
 secretions is important. 
 
 In the olden days, nearly every one, when a phy- 
 
— 43 — 
 
 sician was called, was promptly vomited. The eme- 
 tic has almost become a lost art, and I question 
 whether it is sufficiently appreciated. There are 
 many conditions which call not only for a complete 
 clearing out of the alimentary canal from above 
 downwards, but also the beneficial effects of a com- 
 plete emptying of the stomach from below upwards. 
 The relaxation produced by emesis is of value. It 
 has a pronounced derivative effect. It is anti- 
 phlogistic. As a prompt emetic in children, the old- 
 fashioned ipecac stands pre-eminent. There are 
 many conditions, however, which tend in the direc- 
 tion of inflammatory troubles, such as pneumonia 
 and bronchitis, where in my judgment tartar emetic 
 in very small doses — the y^-g- of a grain — every fif- 
 teen or twenty minutes, until emesis occurs, is of 
 great value. It should not be continued long. 
 
 I have referred elsewhere to the value of water as 
 a remedial agent, more particularly externally, in the 
 form of the bath. In high-grade fevers the cooling 
 bath is the best agent we have for the prompt reduc- 
 tion of temperature. It is also a cleanser, and an 
 opener of the cutaneous secretions. In chill or inter- 
 nal congestion, when accompanied by high fever, the 
 hot bath is of great value. In restless, irritable con- 
 ditions of the nervous system it is an admirable seda- 
 tive. I do not believe, however, that water as an in- 
 ternal remedy is sufficiently appreciated. Children 
 should be taught to drink freely of water in health. 
 
_44 — 
 
 It is an aid to digestion, if taken between meals, 
 cleansing as it does the stomach and aiding in the di- 
 rection of an activity of secretion of the intestinal 
 glands. It also encourages the renal work and 
 washes out many of the excretory products which 
 otherwise might not be removed. There can be no 
 doubt that the water-drinker, whether child or adult, 
 has a more active tissue change; the food which is 
 taken into the alimentary canal finds more active 
 secretion, and is therefore sooner put into condition 
 to be absorbed, and in addition finds more active 
 absorbents and is more promptly taken into the cir- 
 culation. In water drinkers there is unquestionably 
 a more energetic endosmosis and exosmosis, in fact, 
 water, in health and disease, is an energizer to all 
 physiological functions. All remedies, whether ad- 
 ministered to children or adults, but more particu- 
 larly to the former, should be given if possible in the 
 fluid form. For the reasons given above, they are 
 more promptly taken into the circulation, and the 
 greater amount of water they possess, the more 
 promptly they are given out of the circulation. 
 Probably the chief advantage possessed by the won- 
 derful Hot Springs of Arkansas rests less in the 
 chemical constituents of the waters of the springs 
 than in the fact that the individuals who go there be- 
 come great consumers of water, their chief occupation 
 being the drinking of large quantities of water, and 
 hot water at that, and as we all know, hot water is 
 
— 45 — 
 
 promptly taken up and given out of the system. 
 They who go to Hot Springs as a rule have not been 
 water-drinkers. The chances are that many of them 
 have been excessive partakers of alcohol, and all the 
 tissues of the body are more or less saturated with 
 the same, or else they are the victims of venereal dis- 
 eases, or possibly rheumatism. In any case, the 
 chances are that they are completely saturated with 
 medicine and disease. On going to Hot Springs, par- 
 taking as they do of such volumes of hot water, 
 there is a complete cleansing of the system, a carry- 
 ing out by the hot water (which is rapidly thrown 
 through them, as through a sewer), of the accumu- 
 lated alcohol, venereal poison, rheumatic germs (if 
 such things there be), and various forms of medicine 
 which have been administered and accumulating for 
 months past. The drinking of the hot water, coupled 
 with the frequent baths, produces a flow inwardly and 
 outwardly, from every direction, flushing and sluicing 
 all the tissues and organs of the body. Possibly the 
 same process of drinking pure hot water in the same 
 large quantities, coupled with similar bathing, at 
 home, would possess similar virtues. The only ad- 
 vantage of going to Hot Springs is the fact that the 
 individual secures a rest from business, pays proper 
 attention to the diet, and these are of vital import- 
 ance. This diversion was only intended to emphasize 
 the value of water as a therapeutic agent. 
 
 Elegance in Medication. — We are neglectful of 
 
— 46 — 
 
 the interests of our patient, of our profession, of 
 humanity, and of ourselves, if we do not pay special 
 regard to the palate of our patient in the administra- 
 tion of medicine. We have no right to ignore the 
 sensitive feelings of our patients in any direction. 
 Neglect of the aesthetic side of medicine on the part 
 of the early fathers, too great a disposition to feel 
 that physical delinquents should be treated by 
 heroic measures, should be scourged and have poured 
 into them hot-shot, early and often, were largely re- 
 sponsible for the development of one of the most 
 prominent, irregular branches of the profession. 
 Orthodoxy in the early days, unfortunately, both in 
 medicine and theology, meant an active, living hell, 
 as a punishment of disease, physical and moral. I 
 do not believe that we can safely elimininate Hades 
 from the treatment of moral evils any more than we 
 can completely from the treatment of physical ills. 
 However, as the curtain rises higher and higher on 
 the panorama which presents itself to us, we are fur- 
 nished more and more a scheme of managing chil- 
 dren, physically and morally, in a pleasant, cheerful, 
 kindly way. 
 
 A Sunday school superintendent called upon a vis- 
 iting brother to address his school; the gentleman 
 arose and opened his remarks by saying, " Children, 
 love one another, confound you." History does not 
 relate the subsequent proceedings, but if the children 
 had risen en masse and thrown the visitor out of the 
 
— 47 — 
 
 window, he would have been treated correctly. We 
 have presented to us now, by nearly all of the most 
 advanced theologians, the thought that the good 
 Father thinks of us always affectionately, kindly, 
 tenderly, and not specially with a desire to crush and 
 condemn us. We are not now told that He created 
 us for the specific purpose of damning us. AJ1 of 
 the preceding leads to the thought that we are neg- 
 lectful of our duty in the management of physical 
 ills if we do not study them with a view of relieving 
 them in the kindliest, gentlest, most humane way. 
 The surgeon who would present himself to a child, 
 or even an adult, whose limb was crushed, or whose 
 tissues were throbbing with pain, dependent upon a 
 local inflammation, and rudely and harshly proceed 
 to relieve it without a single tender word, a single 
 soothing touch, or the application of some obtunder 
 to the shrieking, sensitive nerves, would be a brute. 
 The kind, the humane, the thoughtful surgeon knows 
 that in the nervous system is where his patient lives, 
 and that if he would have prompt healing, a ready 
 response after his work is done on the part of his 
 patient, he must husband all the nerve force of his 
 patient, and for this reason he should save him every 
 single pain possible. In as great a degree it is the 
 duty of the physician called to the bedside of a 
 patient suffering with disease which can only be re- 
 lieved by medicine and general treatment, to bear in 
 mind also the nervous system of his patient. He 
 
— 4S — 
 
 should be easy in his approaches, gentle and tendei 
 in his movements, kindly of word, thoughtful and 
 considerate in the expression of his opinions; with a 
 view to what? To save the delicate feeling of his 
 patient, not to depress him, even though a child. If 
 he enters and finds scarlet fever or diphtheria, and 
 rudely and abruptly says: "This child has scarlet 
 fever," "This child has diphtheria," he may produce 
 a shock injurious to the child, which has possibly 
 (from a knowledge of the experience of some play- 
 mate), a great dread of the particular disease men. 
 tioned. The result produced by the blunderer called 
 to relieve him may be a lasting one.* So, then, as the 
 physician should be thoughtful of his every word 
 spoken in the presence of a child, after having thor- 
 oughly interrogated every organ, developed every 
 point possible, in his efforts to relieve the conditions, 
 he should have sensitive regard for the every comfort 
 of the patient. If he administers a remedy which is 
 disgusting and revolting and demoralizing to the 
 child's stomach, wdiich raises a riot in its administra- 
 tion, the question is whether he has done good or 
 evil; and the ignoring of these things on the part of 
 members of our profession has been largely responsi- 
 ble, as before remarked, for the development and the 
 growth of one of the special branches of the medical 
 profession, whose chief merit lay in the direction of 
 an appreciation of the importance of pleasantness 
 and elegance in medication (even though the medica- 
 
— 49 — 
 
 tion was almost nil), coupled with a special regard 
 for sanitary points, hygienic surroundings, and a con- 
 fidence in the vis meclicatrix natures. It is not 
 necessary to go to the extreme of administering in- 
 finitesimal nothings in order to give pleasant medi- 
 cine. If it be our desire to open up the bowels of 
 our patient, we might at first thought feel that a good 
 old-fashioned dose of castor oil was the thing, and in 
 the majority of instances, if it could be taken pleas- 
 antly and easily, it would be a good thing. In this 
 connection I will say that castor oil can be given so 
 as to be reasonably pleasant, by coupling it with 
 lemon juice, or a modicum of whiskey and a little 
 sugar sprinkled over it, or in the froth of beer, or 
 even in hot milk, flavored with a small amount of 
 nutmeg. But if the oil raises a riot, if it arouse 
 trouble and resentment, let us give something pleas- 
 anter. Fortunately the confections of senna are 
 nearly all pleasant to children. The compound licor- 
 ice powder will many times be taken by children. 
 The Cascara Cordial of P., D. & Co. is agreeable, and 
 is a good opener of the bowels, besides it possesses 
 the virtue of not only opening the bowels, but serv- 
 ing as a tonic to the muscular coat of the same, and 
 if continued it will eventually relieve constipation, 
 both in infants and adults. However, in the major- 
 ity of cases of children whose bowels require open- 
 ing we find a perverted secretion and coated tongue, 
 and then the little tablet triturates that are manufac- 
 
— 50 — 
 
 tured now (composed of the tenth or the twentieth 
 of a grain of calomel, one-half grain of bicarbon- 
 ate of soda and the grain of sugar of milk), are 
 readily soluble, and are tasteless, and nearly all chil- 
 dren eat them with avidity. 
 
 In the administration of quinine we have had many 
 difficulties to contend with in the past. However, 
 latterly I feel that the problem of administering qui- 
 nine to children has been solved. We find in the 
 drug stores the small chocolate tablets containing one 
 grain of quinine mingled with a modicum of tannin 
 and chocolate, in such form that the quinine is com- 
 pletely covered in its taste, and all the children under 
 my observation for several years, readily eat the same 
 as they would bonbons. I believe, however, that 
 some menstruum that holds it in suspension in a form 
 to disguise the taste, and at the same time render it 
 readily soluble in the stomach, is the most desirable 
 way to administer it. Pills and powders are not 
 always as well received, at least not always as read- 
 ily digested and assimilated by the stomach, as we 
 could wish. I have time and again found capsules, 
 particularly the gelatin-coated ones, pass through 
 the bowel exactly as they entered it; in fact I would 
 say that quinine should be administered the same as 
 all other medicines, as nearly as possible in a fluid 
 form. The following is a good formula, viz.: 
 
51 — 
 
 3 
 
 Quin. Sulph., 
 
 gr. xxxii. 
 
 
 Pulr. Tannici, 
 
 gr. x. 
 
 
 Syr. Rhei. Aromat., 
 
 lii. 
 
 
 Syr. Tolu, 
 
 ?ii. 
 
 Sig. : One or two teaspoonfuls, every two to four hours. 
 
 The following is also an excellent way of adminis- 
 tering quinine : viz. — 
 
 R Quin. Sulph., 3 ss. 
 
 Cascara Cordial (P., D. & Co.) | jss. 
 
 Syr. Tolu. fss. 
 
 M. Sig. : Teaspoonful every two hours or as may be desired. 
 
 An advantage of this combination is that the cas- 
 cara has a mildly laxative effect in addition to being 
 a pleasant vehicle for the quinine. 
 
 When I administer quinine by the stomach, 
 whether to children or adults, I always order the fol- 
 lowing : viz. — 
 
 ^ Pepsin Cordial (P., D. & Co.) I iv. 
 
 Sig. : Teaspoonful with food. 
 
 Quinine disturbs digestion and the pepsine cordial 
 given with food, makes up the deficiency of digest- 
 ive power. There are times, however, when the 
 stomach will not receive quinine to good advantage 
 at all. In young infants I rarely have occasion to 
 administer it internally, but have great satisfaction 
 in applying it in the following : 
 
 3 Quiniae Sulph., fj. 
 
 Sachet Pulvis, q. s. 
 
 M. Ft. Chart Xo. I. 
 
— 52 — 
 
 Take two layers of flannel six inches square and 
 sprinkle the powder uniformly between the same. 
 Bind the edges, and having evenly spread the 
 quinine between the two layers of flannel, quilt the 
 same backwards and forwards and crossways until 
 the powder is uniformly held between the meshes of 
 the same. Then cover one side of the pad with oil 
 silk, moisten the flannel surface with hot whiskey, 
 and apply the same directly over the pit of the 
 stomach, holdiug it in position with a flannel band- 
 age snugly pinned with safety pins. Just in propor ; 
 tion as we desire a more complete absorption we will 
 renew the application of whiskey to the flannel sur- 
 face of the pad, using just enough to moisten the 
 same, and not enough to make it soggy and wet. 
 Occasionally it may be desirable to use hot vinegar 
 in moistening the pad. There is considerable absorp- 
 tion of quinine through the skin. Of course, where 
 we desire a more pronounced effect we can make a 
 larger pad and have it extend over the entire stomach 
 and bowels, warning the attendant, however, not to 
 make it too large, as it will not fit closely to the 
 abdominal wall. I have even in adults produced 
 ringing of the ears and other characteristic effects of 
 quinine simply by this means. It is much to be pre- 
 ferred to the administration of quinine by means of 
 ointments. However, there are times when ointments 
 may be brought into requisition. Again recalling the 
 fact that the skin is only a modified mucous mem- 
 
— 53 — 
 
 brane, with just a little thicker layer of epithelial 
 cells, we can readily understand that absorption is 
 sure. We have only to test the absorptive powers of 
 the skin by the application of belladonna to a suffi- 
 ciently large surface ; we will readily secure pro- 
 nounced dilatation of the pupils, and we have all 
 seen ptyalism produced by a too liberal supply of 
 mercurial ointment to the skin. If we give a suffi- 
 cient amount of thought to each prescription that 
 we write, and to each case, we can in nearly all in- 
 stances give our remedy in a pleasant form. I feel 
 that I would be leaving out a very important for- 
 mula if I did not present that which I have found 
 of great value as an all-round domestic cough mix- 
 ture for many years. I think the majority of fami- 
 lies under my care in the City of St. Louis keep the 
 following formula on hand, particularly during the 
 winter months : 
 
 Best Whiskey, 6 ozs. 
 
 Maltine, 1 pt. 
 
 Best Glycerin, 6 ozs. 
 
 Juice of 6 lemons, 
 Six tablespoonf uls of sugar, 
 
 Mix and boil fifteen minutes. Dose, a teaspoonful to a table- 
 spoonful, according to age, every one, two or three hours, as may 
 be indicated. 
 
 This combination is a good expectorant, and is 
 valuable in the majority of colds accompanied by 
 cough in children, and for that matter in adults as 
 well. The' majority of cough mixtures secured by 
 
— 54 — 
 
 our patients in the shops unfortunately contain ipecac 
 and opium, and these disturb digestion and pervert 
 secretion. The advantage of the mixture given is 
 that there is nothing in it which will impair diges- 
 tion, if given within proper limits, and nearly all of 
 the component parts are in themselves nutritious, 
 and by their presence stimulate and favor nutrition. 
 
DIETETIC POINTS. 
 
 Just in so far as the family physician impresses 
 upon the parent of the child the importance of care- 
 fully guarding the general health through the medium 
 of its diet, in keeping it in the best possible condi- 
 tion, just in so far is he in advance managing his 
 cases well from the dietetic stand-point. The ali- 
 mentary canal of the child from birth should receive 
 the most thoughtful attention of the mother. That 
 which goes into it should be most carefully selected 
 and prepared, and that which goes from it should be 
 closely observed from time to time, and at frequent 
 intervals the child should be "weighed in the bal- 
 ance " and if " found wanting " more scrupulous care 
 should be given than before, with a view of making 
 up the deficiency. The mother should know that in 
 the case of the child, it not only eats to live but should 
 eat to grow. The best and most nutritious food 
 should be selected and it should be given at regular 
 and proper intervals, and the child should be taught 
 to eat carefully and slowly; but, from the beginning 
 of the teething process, the family dentist should be 
 visited at regular intervals that he may care for the 
 teeth, which are of greater importance to the well- 
 being of the child than is appreciated by the laity. 
 The child should be taught how to masticate for it 
 
— 56 — 
 
 needs to be taught. We help them in learning to 
 walk; we aid them in learning to talk, and we cer- 
 tainly should assist them in learning to properly pre- 
 pare and^grind their food. Lessons in mastication 
 should be a part^of the training of the infant. 
 Mothers should study not only how to please 
 the palate, but to familiarize themselves with the pri- 
 mary principles of physiology to the extent that 
 proper selection of food be made in order to accom- 
 plish the completest nutrition. Variety is the spice 
 of diet. Not only does the palate demand variety, 
 but the^tissues as well. Let us not forget to remind 
 the mothers'that'the five digestive fluids, are from the 
 beginning, dependent upon the proper secretion and 
 activityofjthe digestive glands which are a part of 
 the glandular^system, and that the entire system must 
 be doing proper work or else the individual glandular 
 organs^will become crippled. Reasonable muscular 
 exercise should be insisted upon, and if the child be 
 too } T oung or too delicate to exercise himself, he 
 should be given the benefit of massage with lots of 
 fresh air from^the very earliest weeks of infantile life. 
 There isjar less danger of taking cold in the winter 
 time, than there is of being poisoned from breathing 
 bad air in close, ill-ventilated rooms. With the sur- 
 face properlyjprotected, there is no danger from cold 
 air. In many homes there is more sewer gas than 
 oxygen, and much of the loss of appetite and im- 
 paired nutrition in the child world is due to a neglect 
 
— 57 — 
 
 of general and personal hygiene. The child that is 
 properly clothed can, from the very first month of 
 its existence almost, live outdoors the greater part of 
 the day-time, winter and summer. There can be no 
 demand for fuel in any furnace unless there be drafts; 
 there can be no consumption of fuel unless there be 
 plenty of oxygen. Much impairment of physique 
 and perverted nutrition is due to the neglect of these 
 directions. It goes without saying that the well- 
 nourished, well cared for tree or plant can withstand 
 the ravages of the elements better than the stunted 
 one. The uttering or repetition of truisms empha- 
 sizes them, and for this reason I feel willing to present 
 that which "goes without saying." The well-fed 
 child, the child that has a clamorous appetite, whose 
 diet is well selected, whose digestion is well per- 
 formed, who takes plenty of physical exercise, who 
 lives outdoors, and is well clothed, breathes plenty 
 of oxygen, rarely takes disease and when he does, 
 unless there has been dire neglect of the preliminary 
 announcements of the disease, the case can probably 
 be successfully managed, at least in the majority of 
 cases. Of course the consideration of all these hy- 
 gienic points of early life, does good only in the di- 
 rection of equipping the child in a manner to resist 
 disease; but when we are brought face to face with 
 a case of bona fide well-developed illness, happy are 
 we if the child has had proper management from 
 birth; if it has not, we have all the more reason for 
 
— 58 — 
 
 availing ourselves of the opportunity for good which 
 lies in the direction of nourishing the afflicted one in 
 a manner to give it the power of wrestling with its 
 enemy. I claim that we are neglectful of our duty 
 if we do not preach, yea, if we do not almost fanat- 
 ically announce in season and out of season, to the 
 parent of the child who is under our care, the im- 
 portance of oxygen and exercise and fresh air and 
 diet easy of assimilation and of excretion as well. 
 As previously remarked, we should teach the mothers 
 to know not only what goes into the child, but also 
 to carefully observe what comes out of it, and to train 
 them in the direction of recognizing variations from 
 the normal of the various excretions of the body. 
 The child not only runs the risk of poisoning from 
 the sewers within our homes, but there is danger of 
 sewerage poisoning from its own sewerage system, 
 particularly if it be permitted to become clogged and 
 engorged. Food means force; the manifestations of 
 life are due to the reaction of food with the deriva- 
 tives from it and the oxygen upon each other. Dis- 
 ease which attacks the blood should, most unquestion- 
 ably, be constantly antagonized by that which sustains 
 and supports the blood. In our selection of diet, we 
 should bear in mind the importance of meeting the 
 demand in the direction of furnishing the three 
 varieties of food; at least the foods which present 
 the elements that go to make up the body and supply 
 the blood. The mineral, the vegetable and the ani- 
 
— 59 — 
 
 mal kingdom should never be lost sight of, and in 
 speaking of food, we necessarily include drink. In 
 this connection, within reasonable bounds, the more 
 liquid there can be given the individual with the 
 food, the more ready its assimilation. The nitroge- 
 nous articles of food, such as albumen, caseine, etc., 
 should be supplied in abundance, and the hydrocar- 
 bons, such as sugars and fats should be drawn upon 
 liberally and the inorganic as represented by the 
 various salts should not be ignored. The food par 
 excellence and which should be insisted upon and 
 given almost constantly during the progress of 
 exhaustive disease, is Nature's ideal nutrition, milk. 
 Milk is surely a typical illustration of natural food. 
 In its caseine we have the nitrogenous matter; in the 
 butter the fatty matter; and in the sugar of milk, 
 the additional hydrocarbons, together with the proper 
 salines and water, all forming a combination upon 
 which one can live indefinitely. In the egg, we 
 have an admirable natural food, except that unless it 
 be eaten in its entirety, shell and all, it is lacking in 
 the salts. But in the egg and milk together, we have 
 all the necessary elements of nourishment. Surely 
 in milk we have the staff of life, " a nectar for the 
 gods." A better nerve builder never was devised. 
 Of course, it should be sterilized; it is safer, and be- 
 sides after being boiled, it is more digestible. Given 
 in peptonized form, it is readily assimilated and if 
 this be done carefully, the taste is not affected. I 
 
— 60 — 
 
 would suggest that many times where the milk has 
 been peptonized and the bitter taste developed, we 
 may be sure that the milk has been heated too much. 
 In the majority of instances, a slight heating of the 
 same is 'all that is necessary, and often we need 
 not warm it at all, but stir the peptogenic powder 
 into the milk and the digestion goes on after it 
 reaches the stomach. The point may be made 
 many times, that the child will not take the milk; 
 that it either does not like it on general principles or 
 that it has formed an aversion to it. Diplomacy will 
 generally overcome this. If the child be not under 
 (as unfortunately is often the case) the complete con- 
 trol of the parent; if it be a spoiled, petted, capri- 
 cious darling, we will have many difficulties. The 
 little fellow may be hired by one means or another 
 to take his milk and other articles of diet as a matter 
 of duty and for the reward which he will receive; 
 and we should carefully study the individuality of 
 each little one, win his confidence and love and get 
 him to do as we wish for our sake and the sake of 
 those who love him. Beef fibre in the form of rare 
 steak properly prepared, is acceptable to the palate 
 and is the most nutritious of all the animal foods, 
 although well ripened mutton is a shade more diges- 
 tible. The young green fleshes, such as veal and 
 lamb should be tabooed. The soft part of raw 
 oysters is nourishing; with a little lemon juice over 
 them and salted well, they would many times be 
 
— 61 — 
 
 eaten by the child who has not yet cultivated the 
 taste for oysters; and they possess the advantage of 
 almost digesting themselves. Clam juice and beef 
 juice, domestic and commercial, in the form of 
 bouillon or bovinine are admirable. The domestic 
 beef tea has been supposed to be of no value as a 
 nourishment. Of course, it is lacking in the stronger 
 elements of nutrition, but the salts which it contains 
 are gently stimulating and besides they are of value 
 as pleasers of the palate, so it may be given freely. 
 The advantage of beef peptones and bovinine is that 
 they contain large quantities of albuminous matter 
 and well digested excellent beef fibre. They may be 
 given in teaspoonful doses every two or three hours, 
 exactly as you would give medicine. If a few drops 
 of brandy be added to it or good Tokay wine, 
 the combination is even better. Sweet-breads, if 
 stewed and delicately cooked, without the addition 
 of the stimulating condiments which usually accom- 
 pany them, are very nutritious and digestible and 
 will many times be found very acceptable. In the 
 selection of sweet-breads, we should confine ourselves 
 to the use of the pancreas and exclude the thymus 
 gland. Venison, when in season, and the various 
 game, such as quail, prairie chicken, wood duck, etc., 
 if selection be made from the breast of the birds and 
 the loin of the venison, are most palatable, and if 
 properly cooked, are digestible and nutritious. 
 Vegetables are of great value as they contain a great 
 
— 62 — 
 
 deal of starch and saccharine matter. Simply from 
 the stand-point of variety they are of advantage. 
 The cereals, such as wheat flour, oat-meal and corn- 
 meal may all be utilized and be of excellent advan- 
 tage. Puddings made of corn starch with milk are 
 nutritious and in many cases, very pleasant to the 
 palate of the child. Rice is one of the most valu- 
 able, farinaceous articles of diet, and if properly 
 cooked, it is very digestible and seems especially 
 acceptable to the alimentary canal, often when the 
 same is irritated. Potato is a very nutritious form 
 of starchy food, and should be thoroughly ripe and 
 well cooked. The best way of cooking them is either 
 steaming them or baking with the peeling on. The 
 cauliflower is delicate, and when well cooked is rea- 
 sonably digestible. Belonging as it does to the cab- 
 bage tribe, however, it should only be eaten in small 
 quantities. The tomato is a very agreeable acid 
 food but is more valuable as a relish than for its 
 nutritive properties. It is a good addition to soups 
 as it adds attractiveness and pleases the palate. It 
 is an excellent antiscorbutic. Well selected and 
 properly cooked asparagus, the tender portion of it 
 in particular, is delicate and enjoyable and is a most 
 excellent stimulant to the urinary apparatus. Spin- 
 ach, thoroughly cooked is not only enjoyable but it 
 serves an admirable purpose in the direction of relax- 
 ing the bowels, and of course, should be carefully 
 given for this reason. It has been declared by author- 
 
— 63 — 
 
 ities on dietetics, to be wholesome and if given cau- 
 tiously, it aids digestion in that it stimulates secretion 
 by its presence in the alimentary canal. I have fre- 
 quently found the stalks of rhubarb or pie plant when 
 well stewed, to be very acceptable to children, partic- 
 ularly those craving acids, and if given in reasonable 
 quantities, of value to the appetite. 
 
 Fruit is of great value not only in health but in 
 sickness, and properly prepared fruit will be of ser- 
 vice, but it must not be over ripe or green. It is 
 an agreeable and refreshing kind of food, and eaten 
 in moderate quantities exercises a favorable influence 
 as an article of diet. It is chiefly of service, looking' 
 at the actual material afforded, for the carbohydrates, 
 vegetable acids and salts it contains. It is decidedly 
 antiscorbutic. When we are in doubt about the 
 digestive powers, it is well for the fruit to be cooked. 
 The effect of fruit is to diminish the acidity of the 
 urine. The alkaline vegetable salts which are con- 
 tained in fruits, become decomposed in the system, 
 change into the carbonate of the alkali and are elimin- 
 ated with the urine ; for that reason it is likely to 
 prove favorable in gout and the rheumatic diathesis, 
 wherein the urine shows a tendency to throw down a 
 deposit of lithic acid. There having been recently 
 established, clinically at least, a very close relation- 
 ship between the gouty and rheumatic diatheses and 
 the inflammatory diseases of the throat, particularly of 
 the tonsils, for the reason just given, the fruit diet is 
 
— 64 — 
 
 specially indicated in all troubles affecting the throat 
 and glandular system. The various fruits which are 
 particularly valuable as articles of diet, are accessi- 
 ble and freely grown in America; among them the 
 pomaceous group stands first. Of this group, the 
 apple and pear are easily obtained and are fortunately 
 of the greatest value. In the raw state, the apple is 
 not considered easy of digestion ; but when carefully 
 selected and well ripened, there are many times when 
 a scraped apple may be given to advantage, with- 
 out burdening the digestive powers, and there is 
 nothing more grateful to the palate of the child. 
 The apple if cooked however, is light and digestible, 
 and no better laxative for the bowels can be given 
 than roasted apples. The best variety of pears is a 
 very delicate fruit. If well ripened before plucking 
 and reasonably fresh, a soft luscious pear is more 
 digestible than the apple. Unless very ripe and 
 very soft, the pear should be cooked. Oranges, par- 
 ticularly from the southern part gf America, are abun- 
 dant and even the imported oranges are so easily 
 grown and cheap, that they are, when in season, very 
 available. The orange is exceedingly grateful and 
 cheering to the palate, and if thoroughly ripe and 
 reasonably fresh, it is very seldom liable to create 
 disturbance in the alimentary canal ; and it may be 
 admitted under almost all conditions either of health 
 or disease. Lemon juice in the form of lemonade is 
 an agreeable beverage in all feverish conditions and 
 
— 05 — 
 
 it is rarely objectionable unless given in excess. As 
 a food, I cannot pass over the importance of alcohol 
 and the malt en liquors. Whatever the dictum of 
 the schools may be with reference to alcohol in rela- 
 tion to its food powers, clinically, it is of unquestion- 
 able value. In the form of brandy of the best qual- 
 ity and good Tokay wine it is nearly always ac- 
 ceptable to children, and we have that upon which 
 I believe we can safely lean. It should be given 
 carefully and with proper discrimination, but aside 
 from being of value as a nourishment and as a stimu- 
 lator of the flagging energies, it is also to a certain 
 extent a local and general antiseptic. Malt is a bev- 
 erage which many times will serve us well. It is not 
 only nutritious in itself, but it aids by its presence in 
 the stomach in the digestion of farinaceous foods. 
 A special malt known as " Maltine " is very attractive 
 to children. Ice cream, if properly made, or frozen 
 custard is, in small quantities at a time, very pleas- 
 ing to the heated and parched mouth and throat and 
 is very nutritious. Nearly all children are delighted 
 with the promise of such morsels and we may many 
 times by this means not only aid in feeding satisfac- 
 torily but by giving such things as a reward for taking 
 medicine, we the more gracefully accomplish our 
 desires, in other matters. 
 
 A new food has been under my observation for 
 several months and hardly a day has passed that I 
 have not prescribed it liberally. It is known as 
 
 5 
 
— m — 
 
 Mosquera's Beet' Cacao, and as nearly all children are 
 fond of chocolate, they will readily partake of it, 
 Mosquera's Beef Cacao consists of equal parts of beef 
 meal, sugar, and a superior article of Dutch Cacao. 
 It does not require cooking but may be mixed with 
 warm milk exactly like ordinary chocolate and so 
 completely is the taste of the beef disguised that it 
 cannot be detected. Requiring therefore no previous 
 preparation, it ,is most conveniently administered. 
 Another excellent condensed food in the shops, of 
 great value, under the name of Mosquera's Beef Meal, 
 contains all the inorganic salts and stimulating prin- 
 ciples of the extracts of meat and in addition the 
 nutritive principles which the extracts lack ; all the 
 albumen of meat juices without their weakness ; all 
 the extracts of powdered meats without their ran- 
 cidity or insolubility; all the peptone of the pepton- 
 ized meats without their bitterness. " Mosquera's Beef 
 Meal is a perfectly pure predigested meat, containing 
 all the nutritious constituents of lean beef, half of 
 which are in a soluble form ready for assimilation ; 
 the other half easily digestible by the gastric and 
 pancreatic juices. The entire preparation is com- 
 posed of nutritive matter, containing about 40 per 
 cent, of soluble peptone and albuminose. Mosquera's 
 Beef Meal represents in actual nutritive value at 
 least six times its weight of lean beef. " It is per- 
 fectly palatable and will be tolerated with ease by 
 the most delicate stomach. It admits of being 
 
— 67 — 
 
 administered in a variety of forms, thus avoiding 
 monotony in the food. It may be given in any thick 
 soup, condimented to suit the taste of the patient, or 
 also mixed with biscuit powder, oatmeal, porridge 
 and milk and sugar. Again it may be mixed with 
 chocolate, which makes a delicious beverage, or 
 given in the form of a sandwich, and, finally, as a 
 plain beef tea, simply dissolving it in hot water, add- 
 ing salt. 
 
 To sum up : — Food which is rich in the elements 
 of nutrition should be constantly presented to the 
 children suffering with disease. In order not to sur- 
 feit the stomach, it should be given carefully and at 
 proper intervals and in proper variety. The matter 
 of nutrition should never be lost sight of in the prep- 
 aration of the food, but due regard for the palate 
 and the digestive powers should always be had. In 
 the presenting of food, the attendants of the sick 
 room should be impressed with the importance of not 
 only having it properly prepared, but of presenting 
 it in an attractive way. The little ones have their 
 esthetic tastes the same as we have ; and the china 
 should be well selected and all the utensils in which 
 delicate morsels are placed before the sufferer, should 
 be scrupulously neat and clean. Care should be 
 taken in the linen; the little attractive waiters upon 
 which the food rests should be well kept and everv- 
 thing pleasantly arranged for the sensitive feelings 
 of the invalid. A bunch of flowers placed in proper 
 
— 68 — 
 
 position upon the little sick one's table will often do 
 much to brighten an otherwise unattractive spread. 
 We cannot be too careful in all the various details 
 that go to make up the necessities of the sick room. 
 As physicians, we can often help out the digestion of 
 the little one under our care by thoughtfully study- 
 ing the artistic side of alimentation and giving 
 pointers to those who are helping us in our work. 
 
 The patient, be he ever so young, will suffer and 
 the result of our treatment is much less likely to be 
 favorable to us if we fail to appreciate the impor- 
 tance of catering to the " psychical satisfaction " of 
 the sufferer. 
 
 The nervous system is a very complex organization 
 and anything which rudely disturbs the palate, may 
 upset the whole system. That which is disagreeable 
 or unattractive to the eye, the nose and the palate, 
 may create a general disgust in the nervous ranks, 
 and indigestion, non-assimilation, irritation, restless- 
 ness, friction and a loss of force ba the result. 
 
 Let us husband every resource we possibly can for 
 the good of our patient, and never lose sight of the 
 thought that nothing which pertains to and assists in 
 the securement of a successful result, is trifling. 
 
CATARRHAL FEVERS. 
 
 As the term would indicate, catarrh means a flow, 
 and it is applied as expressing an inflammatory con- 
 dition of the mucous membranes, whether it affect 
 the alimentary canal or the air passages. As has 
 previously been stated, intestinal catarrh, either pro- 
 duced by errors in diet, weakened digestion or the 
 chilling of the surface, as commonly expressed in 
 "cold," is the most frequent disturbance of early 
 childhood, and next in order is a catarrh of the re- 
 spiratory mucous membranes. Steiner states that at 
 the Prague hospital for sick children, out of an annual 
 clientele of 9,000 patients there were on an average 
 1,300 children suffering from catarrh of the air pas- 
 sages. Of course, we may have either primary or 
 secondary, acute or chronic catarrh. The symptoms 
 and the suffering of the child vary according to the 
 particular part of the respiratory apparatus which 
 may be affected. If the congestive and inflammatory 
 disturbance be within the nasal passages, we may 
 simply have a mild case of snuffles. If it be in the 
 upper air passages, — the upper bronchial tubes, we 
 may have a mild case of bronchitis. But we must 
 always bear in mind that by continuity of surface, 
 and from the fact that the secretions of the irritated 
 surface cannot be readily expelled from the child, we 
 
— 70 — 
 
 are ever in danger of the inflammation extending into 
 the smaller bronchial tubes, and result in a capillary 
 bronchitis. If the mucous membrane is inflamed, we 
 will find that it is injected, either generally or in 
 patches, swollen, at times almost oedematus, with a 
 rich secretion of mucus, which sometimes may be 
 almost muco-purulent. If this condition of the 
 mucous membrane, or this catarrhal attack, be with- 
 in the larynx, we may have a case of acute laryngitis 
 or croup to contend with. The initiatory stage 
 of the disease is the dry stage, the parts being- 
 dry, gorged and painful. The secondary stage is 
 that of secretion. Of course, if the bronchial mu- 
 cous membranes be involved in the first stage, the 
 cough is hard, dry and painful, and sometimes very 
 tormenting. When the stage of secretion follows, 
 the cough becomes moister. The younger the child 
 the graver the danger, and in very young children a 
 dry, light cold affecting the air passage may prove 
 fatal in a very short time. A simple case of snuffles 
 should receive our promptest attention, for it means 
 obstruction to the breathing apparatus; it means 
 irritative catarrhal fever of a greater or less charac- 
 ter. But if there be evidence of bronchial irritation 
 or laryngeal distress, whether the child be young or 
 more advanced in years, we should bear in mind the 
 possibilities, and never ignore it. We should invari- 
 ably take the temperature, for we shall sometimes be 
 surprised to find how high the temperature will go, 
 
— 71 — 
 
 when the mother had thought that the child had only 
 a cold. 
 
 " Only a Cold " sometimes means a dangerous or 
 deadly capillary bronchitis within a few hours, or 
 pneumonia. Those of us who have had an acute 
 cold or influenza, with all the accompanying aching 
 of every muscle, soreness of chest, constant inclina- 
 tion to cough, which when responded to racks 
 every nerve in the body, accompanied by splitting 
 headache, may readily understand that when such an 
 attack rattles us so completely, and so nearly 
 "knocks us out," it is really dangerous to the young- 
 child. We shall be working in the direction of oar 
 duty if we impress upon mothers who employ us as 
 physicians the fact that their babies, even their chil- 
 dren of larger growth, can never have a cold without 
 being in danger of something worse, and every cold 
 needs prompt treatment; nursing, coddling, kindly 
 care. On general principles, the first indication in 
 these cases is to produce a complete relaxation, and 
 to this end nothing is better than a hot bath, unless 
 the temperature already be high, in which case the 
 bath should have a mild degree of warmth. A mild 
 remedy should then be given to open up and clear 
 out the alimentary canal. The good old-fashioned 
 dose of oil is well, but many times we shall find great 
 objections to the taking of the same, particularly on 
 the part of older children, and in addition an aversion 
 by the mother to the administration; but whether oil 
 
— 72 — 
 
 be given or not, the mild chloride and ipecac should 
 always be given, in the following formula: 
 
 5 Hydrarg. chlor. mitis, gr. 1. 
 
 Ipecacuanhas pulv., gr. ss. 
 
 Sacchari lact., gr. x. 
 
 Sacchari albi, gr. xx. 
 
 M. Ft. chart No. x. Sig. : One half or one full powder 
 every two hours, according to age. 
 
 This little stereotyped formula serves admirably as 
 a stimulator of the secretory systems of glands, not 
 only of the alimentary canal, but also of the mucous 
 glands of the air passages. One of the sheet anchors 
 in these cases is the muriate of ammonia, in doses of 
 from one to five grains (well diluted with water), 
 according to age, every one, two or three hours, as 
 may be indicated. It will soften up and loosen a 
 harsh, dry irritable condition of the air passages 
 more rapidly than any remedy within my knowledge. 
 If the catarrhal disturbance be located (and nearly 
 always there is some of it at least), within the nasal 
 passages, we should direct our -thoughts towards 
 soothing and opening up the same, with a view of 
 aiding respiration, and to this end the free floating 
 through the nostrils of melted vaseline or liquid albo- 
 line is good. We may often relieve as by magic the 
 discomforts of an almost frantic child by soothing 
 the irritated membrane, and secure a more prompt 
 resolution of the inflammation. The more promptly 
 we can relieve and remove entirely the morbid condi- 
 tions of these mucous membranes in the children 
 
— 73 — 
 
 under our care the better; because, aside from the 
 discomforts, aside from the dangers immediately in- 
 cident to the inflammatory disturbance, we must re- 
 member there is constantly a tendency towards a 
 chronic irritation in these parts if they are not 
 promptly relieved. The inflammation may be of 
 such a character as to denude the mucous membrane 
 in spots here and there, and whether denuded or 
 simply inflamed, if this condition is permitted to re- 
 main we have present in our little patient a constant 
 invitation to various germs which are ever present in 
 the atmosphere to enter and abide therein. In cities 
 more particularly, where diphtheria, scarlet fever and 
 various other germ diseases, like the poor, are always 
 with us, we should realize that the sooner we get our 
 little one in a perfectly healthy condition, particularly 
 in its mucous membranes, the less the liability to its 
 falling a victim to the disease mentioned. So even 
 a simple cold in the head if neglected may breed a 
 chronic nasal catarrh, or if continued, whether acute 
 or chronic, we must remember this particular child is 
 all the more susceptible to the contagion of diph- 
 theria and other diseases; and diphtheria which gains 
 entrance through the medium of the nasal passages is 
 a serious form, for the reason that it is frequently 
 overlooked, and thought to be nothing more than a 
 suppurating catarrh for days, until the patient falls a 
 victim to an overwhelming blood poisoning. When 
 we bear in mind the anatomical structure, and the 
 
— 74 — 
 
 free distribution of lymphatics in the nasal passages, 
 we understand why diphtheria gains such rapid en- 
 trance into the circulation, and causes such profound 
 systemic poisoning, when located in this region. 
 
 The benzoate of soda is an admirable remedy to 
 stimulate secretions and expectoration, so that it is 
 specially indicated in these troubles affecting the air 
 passages; besides it is known to be, as was established 
 by Salkowski in 1879, antagonistic to diphtheria. 
 
 Laryngeal Catarrh. — If the catarrhal inflamma- 
 tion attack the larynx, we may have almost danger- 
 ous symptoms developed rapidly. A harassing 
 laryngeal cough in a very young infant may soon be- 
 come dangerous. If the spasmodic feature be devel- 
 oped as it often is, we have the spasmodic croup, 
 which is so greatly dreaded by the mother. It usually 
 comes on suddenly, and our summons to these cases 
 is nearly always in the night, the entire household is 
 demoralized, and the child, particularly if it be young, 
 will at times seem almost suffocating. The indica- 
 tion here, of course, is prompt emesis, and the sim- 
 plest agent at hand is the syrup of ipecac. We will 
 usually find that this has already been given. For 
 children beyond six months of age, the turpeth min- 
 eral, in doses of one-half grain every hour, until free 
 vomiting occurs, is in my judgment one of the best 
 remedies we have. The emesis produced is an addi- 
 tional advantage in that it is antagonistic to inflam- 
 mation, as also is the mercurial effect. 
 
— 75 — 
 
 Croup. — The question of diagnosis between sim- 
 ple spasmodic croup or catarrh of the larynx with 
 spasmodic complications, and membranous croup 
 often presents itself, the difference being that the one 
 is mild and usually readily relieved, and the other, of 
 course, is deadly dangerous. The throwing out of 
 the pseudo-membrane upon the larynx, and upon the 
 trachea may soon endanger life by obstruction to 
 respiration. We are never safe in telling parents 
 positively when a child has been relieved by the 
 usual remedies of a case of spasmodic croup that 
 there may not be the membranous croup developing. 
 Of course there is always more or less fever with 
 simple croup, but if the fever be high and continuous, 
 even if the spasmodic fits be relieved, there is danger, 
 and we should be on the alert. I have found, not 
 only for the relief of the simple spasmodic croup, but 
 for the inflammatory condition of the larynx and the 
 parts adjacent, the administration of infinitesimal 
 doses of tartar emetic of great value. Some declare 
 antimony to be too powerful a remedy to be adminis- 
 tered to infants, the same as there are those who de- 
 cry against calomel ; but the old-time administration 
 of calomel and antimony differs very materially from 
 the manner in which it is given to-day. The practi- 
 tioner who gives large doses of calomel to infants or 
 parents is misdirecting his energy. Certainly I feel 
 justified in believing that large doses of antimony are 
 dangerous, but the lancet and the scalpel are both 
 
— 76 — 
 
 dangerous when handled unskillfully or in excess ; an 
 argument against their abuse and excessive use is no 
 argument against their proper use. A very conven- 
 ient method I have found to be to carry with me 
 little pellets or powders of tartar emetic, of about £ 
 grain each. I then dissolve one in a half glass of 
 water, and instruct them, according to the degree of 
 hoarseness and irritability in the larynx, to administer 
 a teaspoonful of the solution every ten minutes until 
 there is a soothing effect produced in the coughing, 
 or until emesis occurs. I very rarely fail to find 
 good results follow. One advantage of the adminis- 
 tration, or disadvantage, whichever we may consider 
 it, is that we are credited with being somewhat 
 homeopathic ; but, in any event, the result is satisfac- 
 tory. 
 
 The atmosphere of the child suffering with croup 
 should be made as moist as possible and this can be 
 accomplished by placing a small vessel of water over 
 an alcohol lamp in the room. If an ounce of car- 
 bolic acid is placed in a pint of hot water and kept 
 boiling every now and then for a few minutes, the 
 charging of the air with carbolic acid will soothe the 
 irritated mucous membrane of the air passages. Oc- 
 casionally an ounce each of turpentine and pine tar 
 in the water is preferable. 
 
TONSI LLITIS. 
 
 Tonsillitis is a disease peculiarly incident to chil- 
 dren. While fortunately very young babies are not 
 liable to it, yet occasionally it does occur, a case 
 being recorded of a tonsilar abscess in a child only 
 three weeks old. The cases may be ushered in with 
 a chill, followed by fever, vomiting, bleeding from 
 the nose, sneezing, etc., and in very young children 
 there may be high delirium from the start, though in 
 some cases there may be an active inflammation of 
 the tonsils, without any of these marked symptoms. 
 We are never safe in neglecting to examine the 
 throat of every child to which we are called. This 
 may be accomplished readily, no matter how young 
 the child, if we are careful, and I believe the most 
 satisfactory method is the use of the finger, the same 
 having been carefully and thoroughly cleansed with 
 soap and water. It is soft and pliable. We have 
 an additional advantage, if we use it deftly, that we 
 not only see the throat thoroughly well, with the 
 light properly directed, but at the same time, through 
 the medium of our third eye, which we should ever 
 carry in our index finger, we can determine much as 
 to the condition of the mucous membrane of the 
 tongue. If the child be old enough to express itself, 
 it will soon direct the attention of its mother to the 
 
— 78 — 
 
 fact that it has a burning and a dryness in the 
 throat, and difficulty in swallowing. If one or both 
 tonsils be involved, the accompanying symptoms 
 vary, of course, being the more severe with the 
 double tonsillitis. The glands are usually found 
 swollen and spotted with reddened patches, the honey- 
 comb structure of the tonsil can be readily observed, 
 an accumulation of whitened mucous being in posi- 
 tion corresponding to each follicle, and sometimes 
 pus is exuding from the follicular openings ; but in 
 the more violent cases the tonsils are so swollen, dark 
 and red in color as to be almost bursting, and nearly 
 touch one another, almost completely closing the 
 isthmus of the fauces. Fortunately inflammation of 
 the tonsils does not occur often in very young chil- 
 dren. 
 
 I consider that jDoulticing the neck in the neigh- 
 borhood of the angles of the jaw, with flannel cloths 
 rung out of hot water and arnica or witch hazel is 
 of service. The fomentations certainly are soothing. 
 Remedies which open the bowels promptly are indi- 
 cated. 
 
 In 1885 I published a paper wherein I favored the 
 administration of the benzoate of soda internally 
 freely, as being almost a specific for tonsillitis. The 
 paper was read before the St. Louis Medical Society 
 at that time, commending the benzoate of soda as a 
 remedy in diphtheria, on account of its stimulating 
 qualities upon the mucous glands. It has a tendency 
 
— 79 — 
 
 to soften the secretions and encourage exosmosis or a 
 current from the interior to the exterior and this flow 
 from within outward soon enables the parts to throw 
 off the deposited membrane in diphtheria, The soda 
 benzoate being in itself somewhat of a germicide, 
 was certainly desirable in diphtheria but on account of 
 its action alone referred to, I feel that it was also the 
 ideal treatment for simple tonsillitis. This treatment 
 was subsequently explained verbally to a staff of 
 physicians at the Mullanphy hospital, St. Louis, and 
 they later, chiefly through Dr. Boisliniere, treated 
 some 600 cases of tonsillitis, and found the benzoate 
 of soda the best remedy. If given to children in 5 to 
 10 grain doses every one or two hours, as the case 
 may demand, it rapidly causes a throwing off of se- 
 cretions from a previously dry, engorged, angry and 
 painful tonsil. The flow is upward and outward 
 through the mucous glands. Pus and various other 
 accumulations are thus thrown off, and I am sure that 
 the case terminates, if seen early, in one fourth of 
 the time usually required, and suppuration rarely 
 occurs. The accumulation of mucus and pus upon 
 the tonsils in a case of follicular tonsillitis may some- 
 times simulate the membrane of diphtheria, and no 
 doubt some cases have been declared diphtheria which 
 were only follicular tonsillitis; but we should always 
 bear in mind that now, particularly in cities, diph- 
 theria is an endemic disease, and that every case of 
 tonsillitis, or inflammation of the raucous membrane 
 
— 80 — 
 
 of the air passage, is a standing invitation to diph- 
 theria. A case of follicular tonslilitis may if we are 
 not upon the alert suddenly emerge from a pain- 
 ful but non-dangerous disease into the deadly, 
 treacherous, diphtheria. I feel that we are neglect- 
 ful of our duty if we do not constantly bear in mind 
 this fact in every simple case of sore throat which 
 we treat, and let all applications be in the nature of 
 germicides ; let our administrations of internal medi- 
 cine be supporting and strengthening, and antagon- 
 istic to germ diseases ; and to this end the bichloride 
 of mercury in -£-$ grain doses, well diluted, given in- 
 ternally, together with the benzoate of soda, are in 
 the right direction. Locally gargles or applications 
 which we may make either by means of the probang, 
 or better still, by the atomizer, should always, and 
 fortunately may now very readily be made antagon- 
 istic to the diphtheria poison, at the same time being 
 soothing and sedative to the inflamed surface. 
 
 I should treat no case of tonsillitis without occasion- 
 ally spraying the surface (simply for the sake of feel- 
 ing safer myself) of the inflamed tonsil occasionally 
 with Marchand's^ peroxide of hydrogen. This is a 
 rapid oxidizer of organic matter, and is unquestiona- 
 bly a germicide. It may be used in its purity or di- 
 luted with one-half of water. If the parts be sensi- 
 tive, a very excellent application to them is a spray 
 of the following : 
 
— SI — 
 
 B Tr. calendula, 3 j. 
 
 Fid. ext. hamamelis (P., D. & Co.), 3iij. 
 
 Soda biborate, 3 ij. 
 
 Glycerin, 5 ss. 
 
 Aquarosa, 3 iij. 
 M. 
 
 This may be used every hour or two, as the case 
 may be. If the parts are very painful, I have often 
 observed that a gargling or spraying of the surface 
 with hot milk to which a teaspoonful of baking soda 
 had been added to a glassful is very soothing. If 
 the child should swallow this particular gargle, it 
 will be an advantage. The cases usually terminate 
 favorably inside of 24 or 48 hours under this plan of 
 treatment. 
 
ENLARGED TONSILS. 
 
 The consideration of tonsillitis naturally brings 
 up the subject of enlarged tonsils. This hypertro- 
 phied condition of the tonsils does not usually follow 
 a single attack of tonsillitis, although it may do so, 
 but is much more apt to be the result of repeated at- 
 tacks. According to my observation, children who 
 are the product of strumous parentage, particularly 
 of a remote syphilis on the part of the parents, are 
 more prone to a chronic enlargement of the tonsils. 
 The inflammatory exudation is less liable to be 
 absorbed. The seriousness of the condition depends 
 very much upon the degree of the enlargement. 
 Sometimes, if it be not very extensive, mild astring- 
 ents persistently applied will reduce the size of the 
 tonsil, and I certainly think that alterative medicines 
 should be administered. The syrup of hydriodic acid 
 in teaspoonful doses, as a tonic, or the compound 
 syrup of hypophosphites, is of value. The building 
 up of the general health, the guarding against a re- 
 petition of colds, all favor the gradual absorption of 
 the inflammatory material. There may be cases, how- 
 ever, where the enlargement is very great, they being 
 even as large as pigeon eggs, nearly touching and 
 blocking up the fauces. Where this is the condition, 
 I believe the impairment of health, and obstruction 
 
— 83 — 
 
 to breathing is so pronounced as to render a removal 
 absolutely necessary. The general health is im- 
 paired, besides the child assumes a dull, heavy look, 
 goes about with its mouth open, breathing through 
 its nose, and, as is said to have been observed by the 
 savages of old, there is a disposition toward credit- 
 ing it with a stupidity which it does not possess. 
 The old Indian adage was, " fear not the man who 
 keeps his mouth open." Where the tonsil is so much 
 hypertrophied as to produce an obstruction to breath- 
 ing, or interference with the comfort of the individ- 
 ual, it should certainly be removed. A child is much 
 more liable to attacks of pharyngeal catarrh, is more 
 in danger of diphtheria and the other contagious dis- 
 eases; and where there has been so great a growth of 
 adventitious tissue, we cannot hope to secure its re- 
 duction by other means than removal. It has been 
 stated that towards puberty the affection will dis- 
 appear of itself. If the child be quite young, the 
 operation is not an easy one, and I believe in the 
 tentative methods until a child is advanced to the age 
 of four, five or six, yet, fortunately, the degree of en- 
 largement which requires removal does not occur 
 often in the very young. 
 
 In this connection, I think we should not fail to 
 impress upon the mothers of the little ones the im- 
 portance of early teaching them to gargle their 
 throats with cold water or salt and water. It is 
 cleansing, and besides the knowledge may be of value 
 
— 84 — 
 
 to us later if the child have trouble demanding it. 
 We should also early familiarize them with the atom- 
 izer. In. health train them and prepare them for the 
 necessary procedures of disease, as we would in peace 
 prepare for war. I think many a child's life has been 
 saved by having had this training from a thoughtful 
 mother, suggested by a thoughtful physician. 
 
 We are neglectful of our duty if we do not impress 
 upon parents the thought that they can never take 
 chances in these inflammatory disturbances of the 
 throat. They should not trust their diagnostic abili- 
 ties. I have repeatedly found supposed cases of sim- 
 ple sore throat, which had been under the care of the 
 mother, to be well-advanced cases of unsuspected 
 diphtheria. I recall an instance in my office, one 
 morning in the winter of 1888, when a mother pre- 
 sented herself with four of her children, all of whom 
 she said had a sore throat, like they had often had 
 before, and which she had always -been able to cope 
 with, but the trouble now did not seem to yield. I 
 examined them, and was horrified to find all of them 
 far advanced cases of diphtheria, and one already 
 presented the huskiness and hoarseness of a laryn- 
 geal complication, and died before night. The 
 mother could hardly realize that she had been during 
 all these days almost criminally neglectful of the in- 
 terests of her children. 
 
DIPHTH ERIA. 
 
 Diphtheria is a disease which under various names 
 has existed for many hundreds of years and being so 
 widely diffused and so destructive in its results, it 
 must always be of interest to the student of medi- 
 cine. The amount that has been written regarding 
 it during the past two hundred years would make 
 volumes sufficient to fill a library, and yet we are still 
 greatly at sea regarding its pathology, and, if the 
 testimony of many writers is to be accepted, we know 
 less of its proper treatment. The most important 
 monograph of the century upon this subject was that 
 of Bretonneau (1826) composed of a series of essays 
 read before the French Academy of Medicine, the 
 first essay presented to the Academy June 26, 1821, 
 from which may be dated the modern history of 
 diphtheria — the author creating the name diphtheria 
 and giving us the best insight into its pathology. 
 Not until 1859 did English medical literature adopt 
 the name when the Sydenham Society published a 
 volume of memoirs of the disease translated from the 
 French of Bretonneau and others. 
 
 A novice in the profession, as he reads the works 
 of the various authors and the testimony of observers 
 regarding general diseases, may at times feel that his 
 views are very clear, opinions well fixed and defined, 
 
— 86 — 
 
 and his plan of action in his work positive and well 
 decided; but he will not advance very far without 
 being convinced that "theories and the pen are 
 mightier than practice," and at no time will this con- 
 viction press itself upon him with greater force than 
 when wrestling with that most described and little 
 known, but ever treacherous disease, diphtheria. 
 
 Most authors agree that the disease is specific, in- 
 fectious and contagious, sometimes prevails as an 
 epidemic and is endemic in certain places, and that 
 it is characterized by the exudation in various situa- 
 tions, particularly on mucous membranes and the sur- 
 faces of wounds, of a pseudo-membrane composed of 
 exudated fibrin and epithelial cells, more or less or- 
 ganized; that it is usually constitutional and when so 
 more or less asthenic. 
 
 The question is often asked, is diphtheria primarily, 
 a local or constitutional disease? I believe that 
 the poison enters the system through the medium of 
 a denuded surface, and therefore, like syphilis there 
 must be a primary inoculation. 
 
 In the majority of cases which begin with more or 
 less fever, lassitude and general constitutional disturb- 
 ance lasting for several days without local symptoms, 
 we might incline to the opinion that the disease is 
 here primarily, constitutional. However, it is pro- 
 bable that some hidden part of a mucous surface was 
 the seat of the deposit and the " port of entry " for 
 the disease. The discussion on this point, like that 
 
regarding the local or constitutional origin of cancer, 
 will probably go on indefinitely, but it indicates to 
 us our duty in the matter of treatment, that is to in- 
 clude in our therapeutics both local and constitutional 
 measures. Much confusion obtains in the profession 
 in regard to the nomenclature of disease. This is 
 much to be regretted, but when we recall the fact of 
 color blindness and the number afflicted with it, and 
 their inability to appreciate the difference between 
 the well defined colors green and red, we are not sur- 
 prised that physicians vary in their interpretation of 
 the symptoms of disease. 
 
 This appreciation of the shades of color and symp- 
 toms of disease, as the case may be, enters largely 
 into the fitness of the worker in his particular field, 
 and suggests the propriety of the government pro- 
 tecting its people against the color-blind doctor, as 
 well as against the color-blind marine pilot or rail- 
 way engineer. 
 
 In consideration of the above thought, I would 
 advise against the multiplication of names of dis- 
 eases, as I would against the adoption of a great 
 variety of delicate colors for signal lights on account 
 of the resultant confusion. In this connection, I de- 
 sire to express my belief that the two affections 
 laryngeal diphtheria and membranous croup are 
 identical; the fact that such excellent observers as 
 Frank, of Germany; Dr. Hiller, Dr. George John- 
 son, Sir William Jenner and Morrell Mackenzie, of 
 
England, and our own Jacobi, of America, are of the 
 same opinion, strengthens me in my belief. It is to 
 be regretted that the term " diphtheritic sore throat" 
 was ever introduced; it is misleading and incorrect. 
 A disease is either diphtheria with which we have to 
 cope, or it is not. One objection to the use of the 
 term referred to, is the confusion it creates in the 
 minds of our patients and the tendency it produces 
 toward a contempt for the dangers of infection. 
 There can be no question that some practitioners are 
 either too liberal or too severe in their interpretation 
 of the symptoms of disease. If during a season 
 when our own knowledge and the records of the 
 health department as well, testify that diphtheria is 
 not prevalent in the community, we hear a physician 
 say " I have had fifty or a hundred cases of diphtheria 
 in the past month and have not lost a case," can we 
 not conclude that he is what we may term " a liberal 
 interpreter of the symptoms of disease," and possibly 
 honestly (?) so. 
 
 Again in a season when we know from evidence 
 that cannot be questioned, that diphtheria is around 
 us almost in an epidemic form, we hear a professional 
 brother say "diphtheria can not be prevalent, I 
 haven't a single case. These doctors who have them 
 in abundance, are making them by exaggerating their 
 tonsillitis and pharyngitis and ulcerated sore throat, 
 and beside the fact that their cases get well, is evidence 
 that they are not diphtheria, as that is a disease 
 
— 89 — 
 
 which generally kills." — What must we think? Are 
 we not justified in concluding that our brother is too 
 severe in his conception of the disease? Might he 
 not as well say that unless a case presents all of the 
 most violent features of malignant scarlet fever, it is 
 not that disease? All authorities and observers agree 
 that individual cases and particularly epidemics vary 
 in intensity and malignancy, but all are of sufficient 
 importance to receive prompt, efficient and constant 
 attention. No case of diphtheria, as well as no case 
 of scarlet fever, can be mild enough to be free from 
 danger, and all are treacherous. 
 
 Some authorities favor the parasitic theory of the 
 disease; others oppose it. We know this however, 
 that the exudation is capable of rapid extension, and 
 of infecting other surfaces, and that there are agents 
 which, if brought into contact with it, will render it 
 innocuous. This being the case, our duty is plain. 
 
 Henle, Schwann, Hueter, Tommasi, Oertel and 
 others have given strong proof in favor of diphtheria 
 being due to bacteria. Eberth made successful in- 
 oculation upon living tissues with bacteria which he 
 had isolated, and, in the pointed language of Jacobi, 
 " he asserts, with the positiveness of an evangelist, 
 that diphtheria cannot occur without bacteria." 
 
 As with all other questions, there are many who 
 take a negative position, among them being Billroth, 
 Hiller, Ehrlich, Curtis, Satterthwaite and H. C. 
 Wood. Some are inclined to look upon bacteria as 
 
— 90 — 
 
 an effect of the disease rather than the cause, among 
 them Burton Sanderson. These pathological conun- 
 drums, questions of identity or non-identity of 
 poisons, germs, theories, etc., are alluring, but that 
 which practically concerns us is the protection of the 
 community against the disease, and the successful 
 treatment of the same. Of nearly one hundred 
 medical journals both foreign and domestic, which 
 have come under my observation each month during 
 the past several years, there has hardly been an issue 
 which has not contained numerous suggestions regard- 
 ing the treatment of diphtheria. Even the secular 
 journals are not considered abreast of the times un- 
 less their various numbers present formulae for the 
 suppression of the disease. I believe the changes 
 are more frequently rung on sulphur than any other 
 one remedy by lay journals. An exhaustive reading 
 of the literature of the subject in text books and 
 journals for the past fifteen years, coupled with my 
 experience and application of ideas gleaned from all 
 sources, convinces me that the treatment should be 
 supporting, antiseptic and eliminative. We should 
 not forget that empty and hungry lymph vessels, 
 not furnished with nutritive fluids, will absorb 
 "locally-existing poisonous matters" as "a cat laps 
 milk." 
 
 Let us then make it our business, in each and every 
 suspected case, to furnish starving tissues and empty 
 lymphatic vessels with food that can be easily assimi- 
 
— 91 — 
 
 lated, at the same time, earnestly devote our time and 
 attention to the rendering of the " locally-existing 
 poisonous substances" as nearly inert as we can, 
 never forgetting that on general principles, and in 
 this condition particularly, effete matter, products of 
 diseases, the ashes of combustion, if you please, must 
 not be permitted to accumulate. The excretory sys- 
 tem must be stimulated, the animated system of 
 sewerage must be cleansed and kept open. I have 
 used the term " suspected case " advisedly, for, during 
 the time when diphtheria is at all prevalent, every 
 case of sore throat, in children particularly, should 
 be suspected, isolation insisted upon and the severest 
 precautionary measures adopted. We need not be 
 alarmists, but we should always be upon the safe side, 
 protecting our patients, anticipating dangers, and 
 never caught napping. Never more than in the prac- 
 tice of medicine is it true that " eternal vigilance is 
 the price of safety." The emphatic words of one of 
 our most earnest, energetic and efficient medical 
 writers, should never cease to ring in our ears " Only 
 the philosopher may be a passive spectator, the phy- 
 sician must be a guardian." We should advise our 
 patients, particularly during the prevalence of an 
 epidemic, of the importance of giving proper atten- 
 tion to all complaints on the part of the children, and 
 the frequent examination of the throat, even though 
 no trouble is complained of in that locality, should 
 be practiced. Treatment should be instituted at the 
 
— 92 — 
 
 earliest possible moment, and it should be positively 
 and radically antagonistic to diphtheria, even though 
 the symptoms be not well-defined; the patient should 
 receive the benefit of the doubt. 
 
 The isolation of our patient and his disinfection 
 and that of his surroundings should be complete. 
 The best disinfectant for soiled vessels and sewers, is 
 a solution of common copperas, one pound to the gal- 
 lon of water ; beside being efficient it is cheap. The 
 most desirable for clothing, bed-linen, etc., is four 
 ounces of sulphate of zinc and two ounces of common 
 salt to the gallon of water. Carbolic acid is objec- 
 tionable in that it must be used strong to be efficient, 
 and by its all-pervading odor, it gives a false sense 
 of security. For the purifications of the sick-rooms 
 nothing equals fresh air, cleanliness and sunshine. 
 For nutrition, peptonized milk alternated with beef 
 peptonoids and a solution of the white of an egg in a 
 half pint of water, are to be preferred. The milk in 
 this form, is well borne by the stomach, and readily 
 assimilated, and being alkaline it is very soothing to 
 the sensitive surfaces of the mouth and throat. In 
 fact, I find an occasional gargling of the throat with 
 equal parts of lime-water and milk, made comforta- 
 bly hot, or ice cold as the case may be, a good way 
 to relieve the pain of the inflamed surface. 
 
 The solution of albumen referred to, if carefully 
 prepared, can be given freely, and children will not 
 be able to distinguish it from plain cold water. In 
 
— 93 — 
 
 addition to nutrition, I would positively urge active 
 stimulation, and I consider alcohol the most desirable 
 of diffusible stimulants. I make it the rule to give 
 good brandy or whiskey liberally. Get the best 
 liquor obtainable, for there is great risk in freely 
 administering bad whiskey. I would fight the acute 
 and infectious diseases, much as I would snake-bite, 
 and it is astonishing what enormous quantities will 
 be well borne in these conditions. I cannot express 
 my convictions better than by quoting Jacobi who 
 says, in Pepper's System of Medicine : " In regard to 
 the dose of stimulants, it is a fact that there is more 
 danger in diphtheria from giving too little than too 
 much. When the pulse barely begins to be small 
 and frequent, stimulants must be administered at 
 once. A three year old child can comfortably take 
 one to five ounces of cognac, or fifteen to seventy -five 
 grains of carbonate of ammonia, or fifteen grains of 
 musk or camphor and more in twenty-four hours. 
 In the septic forms especially, the intoxicating ac- 
 tion of alcohol is out of the question; the pulse be- 
 comes stronger and slower, and the patient enjoys 
 rest. In those cases in which the pulse is slow r , 
 together with a weak heart's action the dose can 
 hardly be too large. The fear of a bold administra- 
 tion of stimulants will vanish, as does that of the use 
 of large doses of opium in peritonitis, of quinia in 
 pneumonia, or of iodide of potasium in meningitis or 
 syphilis. I know that cases of young children with 
 
— 94 — 
 
 general sepsis commenced immediately to improve 
 when their three fluid ounces of brandy were increased 
 to four times that amount in a day. " I have fre- 
 quently found puny children, when the septic con- 
 dition was excessive, the pulse almost imperceptible, 
 restlessness acute and painful, improve as by magic 
 under the administration of an ounce of whiskey 
 or good brandy every hour till an effect was pro- 
 duced. In this connection, I cannot refrain from 
 referring to the personal experience of a medical 
 friend in St. Louis, who contracted diphtheria 
 while in attendance upon a malignant case. He 
 stated that he applied local and general measures to 
 his case, but that he supplied himself with the best 
 whiskey that could be gotten and drank it in enor- 
 mous quantities, keeping himself saturated with it, 
 and the amount he took without producing intoxica- 
 tion, was marvellous. The effect and the result in- 
 creased his confidence in alcoholic stimulation. 
 
 In the matter of medicinal treatment I am much 
 inclined to germicidal and eliminative measures. 
 Locally we should endeavor to relieve irritation and 
 add to the comfort of our patients, at the same time, 
 endeavor to prevent the spread of the membrane and 
 render it innocuous while in situ or after exfoliation. 
 I am disposed to fear the possibility of the infectious 
 matter inoculating the alimentary canal if swallowed, 
 (doubting the statement that has been made that the 
 
— 95 — 
 
 gastric juice renders the membrane inert) and also 
 poisoning the blood by absorption. 
 
 The two remedies upon which I chiefly rely are 
 the bichloride of mercury and the benzoate of soda. 
 The mecurial treatment of diphtheria was practiced, 
 possibly empirically, many years ago, at least as 
 early as 179V, and from time to time since has been 
 prevalent, the usual form of administration being 
 calomel. For five years past, I have used the cor- 
 rosive sublimate in doses from the one-fiftieth to 
 the one-hundredth of a grain every hour or two, ac- 
 cording to age or condition, preceded by large quan- 
 tities of water ; I gave the mercury in this form for 
 the reason that it was easy of administration ; it 
 acted as a germicide locally and constitutionally, and 
 was a stimulant to the eliminative organs, as well as 
 a preventive of fibrinous exudations in that it defi- 
 brinated the blood. In addition, it has been my cus- 
 tom to give the benzoate of soda in doses of five, ten 
 or fifteen grains, every hour or two according to age 
 or condition. I cannot better present my reason for 
 the administration of this drug, than by quoting from 
 a paper read before the St. Louis Medical Society in 
 February, 1886, on scarlet fever, viz., "The remedy 
 upon which I chiefly rely in my infectious cases is 
 the benzoate of soda. I may safely say that I proba- 
 bly never prescribed for a case of scarlet fever dur- 
 ing the early stages, without giving this remedy. 
 In 1879 Salkowski showed that this drug largely in- 
 
— 90 — 
 
 creases the secretion of nitrogenous and sulphurous 
 compounds with the urine, and drew the conclusion 
 that it should be useful in diseases in which the blood 
 is overcharged with effete matters. 
 
 Salkowski, Fleck and Buckholtz discovered that 
 the benzoate of soda prevents the development of 
 bacteria in putrescible liquids, and Graham Brown 
 found that diphtheritic fluids lose their contagious 
 quality speedily in a solution of benzoate of soda. 
 The remedy also, in my judgment, reduces tempera- 
 ture. It may be given in from ten to fifteen grain 
 doses, in syrup and cinnamon water, every hour or 
 two, to a child from two to live years of age. The 
 mixture is a very pleasant one. " Dr. A. Broudel 
 writes, in the Bulletin General de Titer apeutique, 
 of November 15, 1886, concerning the treatment 
 of diphtheria by benzoate of soda, and asserts that 
 of two hundred consecutive cases he has not lost 
 a single one. He admits the possibility of a mistaken 
 diagnosis in some instances, and^ I am inclined to 
 think the admission a very proper one, but even ex- 
 cluding fifty per cent, on that account, he still has a 
 large number of cases without a death. Here, then, 
 we have two remedies, both of which act locally and 
 constitutionally as destroyers of bacteria and stimu- 
 lants to the excretory system, thus ridding the over- 
 charged blood of its effete matter. In mild cases, 
 with a limited patch of membrane, and severe cases 
 with an extensive deposit, the membrane will soften, 
 
liquefy, and gradually be thrown off, and be much 
 less disposed to spread or reform than under other 
 plans of treatment. I have, since November, 1884, 
 given no quinine and iron, except in the period of 
 convalescence, as a tonic; and absolutely no chlorate 
 of potash, believing that it is frequently productive 
 of harm, and of all remedies probably more abused 
 by the laity and the profession than any save quinine. 
 As a local application, Marchand's peroxide of hydro- 
 gen, full strength, either applied by means of an 
 atomizer or a swab, stands pre-eminent. If the child 
 is old enough he may use it as a gargle, or the part 
 may be flushed with a syringe. The peroxide is a 
 rapid oxidizer, and under its use a thick, tenacious 
 membrane of diphtheria will disintegrate, as melts 
 the snow under the warming rays of the noonday 
 sun. Now and then the local application of oil of 
 turpentine to the pharynygeal surface is indicated, 
 and a more healthful application to a mucous surface 
 was never made, and as a diffusible stimulant, and an 
 accelerator of the glandular system, nothing is bet- 
 ter. The bichloride and benzoate of soda, as admin- 
 istered above, are admirably successful in controlling 
 and relieving doubtful cases, which never advance 
 further than being tonsillitis or ulcerated sore throat. 
 
 I present the following conclusions: 
 
 1. In the management of diphtheria, nutrition, 
 stimulation, antisepsis and elimination are the most 
 potent means of antagonism. 
 
 7 
 
— 98 — 
 
 2. The nourishment should be of a character to be 
 readily assimilated, and in the majority of cases 
 should be peptonized. 
 
 3. Good whiskey or brandy as diffusible stimulants 
 are to be preferred. 
 
 4. The bichloride of mercury, in small doses, fre- 
 quently administered, accompanied with liberal quan- 
 tities of water, coupled with the benzoate of soda, 
 are the most reliable antiseptics and glandular stimu- 
 lants at our command. 
 
 5. Too great stress cannot be given to the sodium 
 benzoate as a local and constitutional measure. 
 
 6. As a local application, Marchand's peroxide of 
 hydrogen is as reliable in its destructiveness to the 
 membrane as is water to fire. It may be applied 
 freely, and if swallowed no barm is done. 
 
 7. As a disinfectant to the air of the room, and a 
 soother and softener of the dry and sensitive air pas- 
 sages, equal parts of tar and turpentine may be 
 boiled freely in the sick room, in proportion of two 
 ounces of each to a quart of hot water. 
 
EXANTHEMATOUS FEVERS. 
 
 There are certain general points which will apply- 
 to all of the fevers of this group. We must remem- 
 ber that we have a specific germ, which probably 
 enters the circulation, and in its efforts, or rather, in 
 the effort of nature to throw off the disease, we 
 have the rash developed upon the skin. We must re- 
 member that the skin is but a continuation of the lin- 
 ing membranes of the body, and that naturally we 
 have by a continuity of surface an irritation of all the 
 lining membranes, if not a perfect rash, in harmony 
 with that which is upon the surfaces. In a general way 
 our treatment should be directed towards maintain- 
 ing the equilibrium of all the secretions of the body. 
 If there be enough irritation connected with any par- 
 ticular part of the glandular system, we should re- 
 lieve the special organ and stimulate the activity of 
 the remaining ones. If, for instance, the skin be 
 greatly involved, and there be much inflammatory 
 action accompanying the rash, we should be all the 
 more active in keeping open the compensatory organs, 
 such as the bowels and the kidneys, or if the kidneys 
 be engorged, and their activities impaired, we should 
 stimulate the glandular attachments of the skin to 
 compensatory work. An open condition of the ex- 
 cretory organs should be maintained, with a view of 
 
— 100 — 
 
 aiding nature to eliminate the poison, and a counter 
 activity of certain other organs should be urged, 
 which will relieve those which are crippled. A part 
 of the expression of the disease is always more or 
 less irritation of the skin. Sometimes this is so pro- 
 nounced as to produce a marked irritative fever. 
 Our efforts should be turned towards soothing this 
 irritation. Time was when scarlet-fever patients and 
 the victims of measles were permitted not only to 
 almost burn up from thirst, but the burning process 
 was stimulated by the application of external warmth 
 and the maintenance of a heated condition of the air 
 in the room of the patient. Now ; however, we ap- 
 preciate the value of comforting our patient, while 
 guarding against any chilling of the surfaces, we 
 admit cooling drinks freely, and are even willing at 
 times to sponge off the surfaces of the body for the 
 cooling effect produced. We are all of us every now 
 and then called to victims of measles and scarlet 
 fever (with a temperature much beyond 105°, a burn- 
 ing thirst, a feeling all over the snrfaces as thou h 
 the parts were on tire), covered mountain-high with 
 bed clothing, and denied any form of drink whatso- 
 ever. The gratitude of the patient who is relieved 
 from such inhuman treatment can well be imagined. 
 The drinking of cold water under these conditions, 
 given in the name of humanity, the removal of all 
 excessive bed-clothing, and the administration of 
 
— 101 — 
 
 remedies which reduce the temperature, are surely 
 most grateful. 
 
 Scarlet Fever is a disease which is dreaded more, 
 and justly so, by the thoughtful mother than almost 
 any other disease upon the list, unless it be diphthe- 
 ria. It is the most uniformly uncertain and variable 
 in its expressions of any of the diseases of childhood. 
 It is as variable as the individual. No two cases 
 during any particular epidemic will pursue the same 
 course; no two epidemics will be alike. We may 
 pass through a series of years during which we will 
 have observed a large number of cases of scarlet 
 fever, all of which were amenable to treatment and 
 terminated favorably, without complications. ILour 
 experience be limited, we shall probably form the 
 opinion that scarlet fever is not much of a disease 
 after all, or else we are particularly skillful in its 
 management; but the truth is, before we have hardly 
 gotten through with the indulgence of this thought, 
 one or more cases will come under observation which 
 will demoralize us completely. In other words, the 
 expression of the disease seems to vary during differ- 
 ent seasons. Many epidemics are mild, while others 
 are malignant, but no case of scarlet fever, however 
 mild, should be looked upon as a trivial disease. The 
 simplest case, with the temperature but little above 
 the normal, with a rash that is hardly perceptible, 
 with a sore throat which it is almost impossible to 
 discover, the child disposed to play around the room 
 
— 102 — 
 
 and hardly realizing that it is sick, if neglected, 
 may suddenly develop symptoms most dangerous. 
 I have heard observers give expression to the thought 
 that the simplest and mildest cases of scarlet fever 
 Avere most liable to complications deadly and danger- 
 ous, the explanation being given that the disease not 
 having expressed itself in the most tangible way, was 
 indulging its deadly work in secret; yet I believe that 
 this is not the correct view to take. The more severe 
 the expression of a case of scarlet fever, the higher the 
 temperature, the greater the amount of local disturb- 
 ance upon the skin, as a rule, the greater the danger 
 of complications. The reason that the seemingly 
 mild case's are so frequently complicated with later 
 dangers is that they are neglected. Of several chil- 
 dren in the family taken down with scarlet fever, 
 the one which is seemingly the most seriously ill will 
 receive the most attention; the mild case will more 
 than likely be neglected. I have observed in St. 
 Louis, where the law, which is very explicit, requiring 
 that every house in which a case of scarlet fever oc- 
 curs shall be placarded, that many times the mild 
 case of scarlet fever is visited only for two or three 
 days, and the house is not placarded at all, and the 
 parents, in blissful ignorance, fail to guard the child 
 from danger. We should impress the parents of the 
 child with the fact that no matter how seemingly 
 mild a case of scarlet fever may be, it is in every de- 
 tail a serious and very dangerous disease. If a child 
 
— 103 — 
 
 has scarlet fever at all, mildly or severely, it is in for 
 a siege of not less than six weeks. As when called 
 to a broken leg, we should say " This case will re- 
 quire six or eight weeks of guarding and attention. 
 The most that we can do is to help nature to heal it- 
 self." We should call from time to time and guard the 
 patient from complications, but under no circum- 
 stances should the parent be led to believe that the 
 child is out of danger until at least six weeks have 
 elapsed from the time of the appearance of the rash. 
 One of the most frequent complications of scarlet 
 fever is nephritis, so we should be constantly on the 
 qui vive and watch closely the secretion from the 
 kidney and from time to time administer the appro- 
 priate remedies for flushing and washing out the 
 same, and to this end the administration now and 
 then of water-melon seed tea is of value. I consider 
 the benzoate of soda one of the most valuable reme- 
 dies to administer to scarlet fever patients; given 
 in ten-grain doses every one or two hours, as the case 
 may be, from the beginning, we shall secure an open 
 condition of the excretory organs. The temperature 
 sometimes goes very high, and in such conditions it 
 should be reduced. Acetanilid in three to five-grain 
 doses every two to four hours, given in the follow- 
 ing formula, is valuable: 
 
104 
 
 ft. 
 
 Acetanilid, 
 
 gr. xl. 
 
 
 Alcohol, 
 
 3iv. 
 
 
 Glycerin, 
 
 3iv. 
 
 
 Pepsin cordial (P., D. & Co.), 
 
 fiij. 
 
 M. Sig. : Dessertspoonful every two to four hours, with a 
 view to holding the temperature down to 102. 
 
 This formula is not only of service in reducing the 
 temperature, but secures tranquility to the nervous 
 system of the patient. 
 
 The sore throat in scarlet fever is sometimes quite 
 distressing, and remedies which sooth and are cleans- 
 ing should be used. The following gargle is of 
 value: 
 
 Fid. extract harnarnelis (P., D. & Co.), I i. 
 
 Tr. calendula, 3ij. 
 
 Boro-glycerid (50 per cent.), 3 vj. 
 
 Aqua rosa, 5 vi. 
 M. 
 
 The same may be used in the atomizer at least once 
 every two or three hours, and free flushing of the in- 
 flamed parts, either by gargling or by spraying, 
 should be made with Marchand's "peroxide of hydro- 
 gen. 
 
 While there is often a disposition to necrosis of 
 tissues in the sore throat of scarlet fever, producing 
 a condition simulating the membrane of diphtheria, 
 yet we frequently have diphtheria as a complication; 
 in fact whether there be any sympathetic relation- 
 ship existing between the germs of scarlet fever and 
 diphtheria or not, the fact remains that we often have 
 scarlet fever sore throat plus diphtheria. The condi- 
 
— 105 — 
 
 tions of system present in a case of scarlet fever, as 
 well as the local condition, all cordially invite the 
 visitation of the diphtheria germ. For this reason I 
 feel that we should be ever on the alert in guarding 
 against this possible complication. 
 
 Personal Disinfection ix Scarlet Fever. — 
 Since we know that scarlet fever is so actively con- 
 tagious, and that all of the discharges and materials 
 thrown off from the surface are active carriers of 
 the virus, we should be on the lookout, guarding 
 others against possible infection from the particular 
 individual under our care. All the vessels which are 
 used about the sick room should be disinfected, and 
 for this purpose we have nothing more convenient 
 or advantageous than Piatt's chlorides in varying 
 strength, or we may use the disinfectants suggested 
 for diphtheria. We can make such a solution as we 
 may wish, and wash out the various utensils used in 
 the sick room. Realizing that the desquamative 
 stage of the disease is the one when contagion is 
 most active, we should from the start sponge the sur- 
 face of our patient with antiseptic lotions. An anti- 
 septic cologne has been furnished, which is bichloride 
 of mercury one part to two thousand of cologne. 
 Freely sponging off with this is not only agreeable to 
 the patient, but tends in the direction of the destruc- 
 tion of the contagious element. Another application 
 which is also in the same direction, and at the same 
 time of excellent advantage in soothing the intense 
 
— 106 — 
 
 itching of the skin which is sometimes present, is 
 the following : 
 
 Acid Carbolic, gr. xxx. 
 
 Liquid Albolene, $ vi. 
 
 M. Sig. : Apply once or twice daily. 
 
 We are perfectly safe in commending a thorough 
 washing of the surfaces every second or third day 
 with hot water and castile soap. We will often find 
 the attendants very much averse to changing the 
 clothing or cleansing the surfaces. I have many times 
 seen a victim of scarlet fever in the third or fourth 
 week to whom a drop of water had hardly ever been 
 given internally, and none had been applied exter- 
 nally, and whose bed clothing had never been 
 changed ; burning with thirst, secretions all checked 
 by accumulated dried epithelium and general filth. 
 Here was a case indeed which called for sympathy 
 and sanitation. We are safe in informing the atten- 
 dants that not only in these cases, but in all other 
 cases of sickness, if there be no draft allowed or chill- 
 ing of the surface, that is if the room be kept prop- 
 erly warmed, and all openings guarded, any patient 
 may be safely washed ; in fact they are the better 
 for it. More than that, any patient, whether suffer- 
 ing from scarlet fever or what not, is the better for 
 drinking freely of good, pure water. Of course 
 there are times when the stomach will reject abun- 
 dant quantities of water, but with proper precaution 
 cool water, not too cold, but just cold enough, may 
 
— 107 — 
 
 safely be given to nearly all patients, and certainly 
 to none more than to the victims of scarlet fever. 
 There are many accumulated poisons in the system 
 which require a free flushing of water to carry them 
 out. The demands of a proper elimination, of a 
 proper cleansing of the alimentary canal, of a proper 
 assimilation of food, of a proper reconstruction of 
 tissue, are in the direction of a free supply of good, 
 pure water. 
 
MEASLES. 
 
 In measles the complications are more frequent in 
 the direction of the air passages, and in the later 
 stages sometimes toward the alimentary canal; for- 
 tunately the kidneys are not so frequently involved. 
 Conversation with those adults who have suffered 
 from measles convinces me that the discomforts of 
 the disease are much more severe than are generally 
 supposed. Too often the family rest under the im- 
 pression that measles is a trivial disease, and that 
 they can cope with, the majority of cases successfully 
 without the aid of a physician. I recall a case of a 
 little girl of twelve, the youngest child, reared in a 
 lap of luxury, who had been sick for a week with 
 measles, and the family physician had administered 
 the old-time hot drinks ad nauseum. The child was 
 almost frantic, had rested neither day or night for a 
 week, at least, only at intervals, and then only from 
 exhaustion. The thermometer indicated a tempera- 
 ture of nearly 106°, a persistent cough was present, 
 and every now and then an irritability of the stom- 
 ach, which was probably superinduced by the cough- 
 
 ng. 1 administered the following: 
 
 
 I£ Acetanilid, 
 
 gr. xl, 
 
 Alcohol, 
 
 3ij- 
 
 Glycerin, 
 
 3ij- 
 
 Aquae Cinnamoni, 
 
 5jss. 
 
 M. Sig.: Dessertspoonful every two hours. 
 
 
— 109 — 
 
 A sponging off of the surface, and to relieve the 
 intolerable itching the following: 
 
 5 Fid. ext. hamamelis (P., D. & Co.). 1J- 
 
 Acid boracic (impalpable powder), 3 iij. 
 
 Glycerin, lj. 
 
 Aquserosae, ^ 5 V J- 
 
 M. Sig. : Apply every four to six hours. 
 
 Directed that cooling drinks be given in small 
 quantities ad libitum. After sponging of the surfaces 
 and the second dose of the medicine the child went 
 to sleep, and slept all night, the first night since the 
 beginning of the attack. She called for the sponging 
 off in the morning, and stated after receiving it that 
 she for the first time felt that she was not in a bake 
 oven being blistered. A little bland soup was given 
 in the morning, and a few hours later she was de- 
 lighted by being informed that she could have a little 
 ice cream. At no time later was her temperature 
 permitted to go above 102. The cough almost 
 entirely disappeared with the subsidence of the 
 fever. She remained in a thoroughly comfortably 
 condition, and inside of three or four days was 
 convalescing. The point I would make in this 
 case is that many times, with a sensitive skin, 
 and a correspondingly sensitive mucous membrane, a 
 case of measles may cause intolerable anguish, and 
 even great danger, and we have the means at our 
 command for reducing the discomforts and mitigat- 
 ing the danger, and should avail ourselves of them. 
 
— 110 — 
 
 In the several coal tar products we have the means of 
 rendering our cases of measles all more mild; of soft- 
 ening the asperities of the situation. 
 
 German Measles has received more attention 
 during the past ten years than previously in this coun- 
 try. It is a a distinct disease in itself. No doubt 
 many times it has been mistaken for scarlet fever 
 in some cases, and in others for rubeola. It resem- 
 bles scarlet fever, in that there is some soreness of 
 the fauces generally present. The rash is less soli- 
 tary in its character, and less bluish, than in measles, 
 being in some cases more disposed to simulate the 
 rash of scarlet fever. We should never be too posi- 
 tive in our diagnosis. If we be in doubt as to the 
 character of the rash, we should not hesitate to say 
 so. Let us frankly tell our patient that the case is 
 not completely developed; that it presents certain 
 symptoms which point in a certain direction, and as 
 the picture more completely unfolds itself, we shall 
 announce it. We are always safe in giving the other 
 members of the family the benefit of the doubt. If 
 we have a case which tends in the direction of any of 
 the contagious diseases, we should insist upon isola- 
 tion, and if the case should not develop in any par- 
 ticular direction, there is no harm done. There are 
 certain general principles which will apply to the 
 management of these eruptive fevers. We are safe 
 always in holding down the temperature, comforting 
 our patient and keeping open the secretions, and 
 
— Ill — 
 
 whether the case be German measles, rubeola, or scar- 
 let fever, matters not, if we are attentive and watch- 
 ful and have our patient isolated. I believe that 
 physicians frequently err in the direction of making 
 too hasty a diagnosis, and then hate to change it. 
 They do not mean to be dishonest, in fact they pro- 
 bably are not; they try to believe that they were 
 right. We are always safe in pursuing a careful and 
 conservative course; let us do always with the patient 
 as we should wish a member of our own family 
 treated. If we pursue this course we are safe. We 
 need not be afraid to tell the family that we have 
 not surely made the diagnosis, and that we are simply 
 watching the case, and as it develops will announce 
 our opinion. Let us ask their co-operation in the di- 
 rection of observing symptoms. We shall often get 
 good service from a mother if we suggest that she 
 take a sheet of paper and note down from time to 
 time with pencil the symptoms as observed. 
 
CHICKEN POX. 
 
 Chicken pox is a disease to which the physician is 
 rarely called. The majority of cases are carried 
 through by the home circle, without our help. Some- 
 times, however, there is some special condition of the 
 system which tends in the direction of aggravating 
 the disease and producing a suppurative disposition 
 upon the part of the papules, and we are then sum- 
 moned. An open condition of the alimentary canal 
 should be insisted upon in this disease, and a mild 
 diet directed, as anything which causes irritation of 
 the alimentary canal is reflected by an increased irri- 
 tation in the irritated parts of the skin. If there be 
 any itching, a sponging off with the lotion mentioned 
 in the remarks upon measles will be of value. If 
 the pustules are indisposed to heal immediately, the 
 application of the standard benzoated oxide of zinc 
 ointment, to which five grains of carbolic acid may 
 be added, will be beneficial. 
 
WHOOPING COUGH. 
 
 Whooping cough is a disease which has been sup- 
 posed to be trivial in its character by the laity, and 
 to rarely require medical aid, but in my judgment 
 this is a great mistake. Whooping cough is a very 
 serious disease. Anything which produces the 
 amount of local irritation that whooping cough does, 
 together with the serious demoralization of the nerv- 
 ous system, the impairment of nutrition, the loss of 
 weight, is dangerous; besides, statistics will prove 
 that if many cases are not directly fatal, they are in- 
 directly so from the complications which may follow. 
 If we have the opportunity to influence the parent of 
 the child, we should impress her with the fact that 
 whooping cough is a serious disease; that the general 
 impression which has obtained that it is not ame- 
 nable to treatment is a mistake, but that it may be 
 very materially mitigated in its severity, the discom- 
 forts greatly relieved, and the length of the attack 
 shortened. There is nearly always a preliminary 
 period of bronchial irritation, with some fever, before 
 the paroxysms or spasms become fully initiated. If 
 the child be well advanced in years, it can wrestle 
 with these paroxysms to fairly good advantage, but 
 if it is young, they are indeed distressing. Recent 
 developments tend to establish the thought that there 
 
— 114 — 
 
 is some specific germ causing pertussis, which enters 
 through the air passages, chiefly the nose. This be- 
 ing so, it has been positively demonstrated that 
 remedies in the nature of germicides applied to the 
 nasal passages seemingly have an effect in reducing 
 the number of paroxysms. I have had a number of 
 cases in which I have used three and four times a day 
 a liberal spray of Marchand's peroxide of hydrogen 
 through the nasal passages. In older children I did 
 not hesitate to use the syringe, and in them the 
 strength used was the undiluted; for smaller children 
 it should be diluted to about one part to three of 
 water. When we recall the number of cases of par- 
 oxysmal laryngeal cough, spasmodic asthma, which 
 have been relieved by the application of remedies 
 applied to the posterior nares, we can appreciate the 
 relations between these parts and these spasmodic 
 seizures in whooping cough. My attention was first 
 directed to the value of local ^applications such as 
 have been mentioned in the treatment of whooping 
 cough by a sufferer from apparent laryngeal irritation, 
 the victim having attacks every half hour or hour, 
 which were almost uncontrollable, and which were 
 at times almost suggestive of spasmodic asthma. 
 These were relieved almost entirely by the applica- 
 tion to the posterior nares of ten grains of nitrate of 
 silver in an ounce of glycerin, applied with a brush. 
 For days previously the victim had had applied di- 
 rectly to his larynx a series of applications which 
 
— 115 — 
 
 were absolutely without service. His trouble was a 
 reflex asthma, the primary irritation being in the pos- 
 terior nares. Such cases also as pass under the name 
 of hay fever, which are similar in their character, 
 and are relieved sometimes by local applications in 
 the nose, are a full justification for the treatment of 
 whooping cough through the same channel. As a 
 controller of the paroxysms, we have in acetanilid 
 (two and one-half to five grains every two to four 
 hours), a good remedy. The paroxysms can be re- 
 duced at least threefold, and a comparative degree 
 of comfort can be maintained. Not only so, but the 
 length of the attacks is abbreviated in many cases. 
 The repeated paroxysms in whooping cough result in 
 vomiting— complete loss of the contents of the stomach. 
 I should, however, insist upon the child eating right 
 along, of course of the most digestible food; there is 
 a satisfaction to the palate which accompanies eating, 
 and a modicum of the food, at least, is retained 
 and assimilated. I am satisfied that the individual is 
 benefited who has his palate pleased by food at 
 proper intervals, even if the same be rejected soon 
 after. The psychical satisfaction produced by the 
 meal is in itself of service to the patient. 
 
 Inhalations of chloroform (fifteen or twenty drops 
 poured upon a handkerchief and the child permitted 
 to breathe it carefully) will sometimes mitigate the 
 severity of paroxysms. I believe the mitigation of 
 severity diminishes frequency. Prof. Hobart A. 
 
— 116 — 
 
 Hare suggests in the severest cases the use very 
 guardedly of inhalations of nitrite of amyl, two or 
 three drops upon the hand or handkerchief of the at- 
 tendant, placed in position to be breathed with an 
 admixture of air. JBromoform, an agent compara- 
 tively new, from a therapeutic standpoint, has been 
 suggested for whooping cough. 
 
 Dr. Krieger has recently reported in the Texas 
 Courier of 31edicine (Jan., 1891), a number of cases 
 successfully treated by this remedy. His method of 
 administration has been to prescribe " one or two 
 drachms pure, and give one to four drops in a tea- 
 spoonful of milk three to five times a day, according 
 to age and severity of disease, and, moreover, to give 
 special instructions that the last remnant be given 
 from the spoon, as bromoform does not mix, but sinks 
 to the bottom. A happy feature is its sweetness." 
 
 He claims that a majority of his cases were 
 promptly controlled from the beginning and termin- 
 ated favorably in from five to ten days. 
 
VACCINATION. 
 
 If the child he reasonably healthy, vaccination 
 should be performed when it is about three or four 
 months old. It is better at this age than later, for 
 it is more quiescent and passive, and less likely to 
 irritate the " sore " by over-exertion. Fortunately 
 for the benefit of humanity and the convenience of 
 the profession, bovine virus is now cultivated in large 
 quantities all over the country, and this is the only 
 kind we should ever use. Under no circumstances 
 should we take virus even one remove from the cow, 
 as the possibilities of infection of other diseases from 
 individual to individual should not be despised. The 
 physician is remiss in his duty, if he does not urge 
 upon the parent the importance of vaccination, and 
 he should be willing at all times to take the respon- 
 sibility of administering it. Unless there is some in- 
 herent weakness in the blood of the child, there need 
 be no fear indulged in connection with the procedure. 
 My usual plan in vaccinating is to take the point of 
 a dull knife and scrape rapidly the outer layer of the 
 skin until the glistening, denuded surface appears. 
 Blood will not usually follow. The quill upon which 
 the virus has been deposited should then be mois- 
 tened in a little water and briskly rubbed over the 
 surface, and the part be allowed to completely dry. 
 
— 118 — 
 
 Direct the mother to sew on the inside of the sleeve, 
 particularly if it is flannel, a piece of soft linen, as it 
 is more cooling to the part. No adhesive plaster nor 
 other application should be made to the inoculated 
 point. We should direct that the part be protected 
 in every way possible, and the scab not allowed to 
 be broken, as the breaking of the same extends the 
 inoculation and increases the sore, without adding to 
 its efficiency. Select a point upon the remote side 
 of the arm about three inches below the insertion of 
 the joint. Under no circumstances, even if the vic- 
 tim be a girl, should we allow the leg to be chosen. 
 The muscles of the leg are brought more freely into 
 play, and the sore is likely to be much greater. Ma- 
 ternal vanity should not fear the effect of a mild scar 
 produced by the inoculation upon the arm. Even if 
 the demands of society later in life require the expos- 
 ure of the arm, the appearance there of a delicate 
 white scar cannot be other than decorative, and to 
 the medical mind it should be particularly gratify- 
 ing as it stands out prominently as a tribute of so- 
 ciety to science and the great Jenner. 
 
CONTI N UED FEVERS. 
 
 There are various kinds of fevers among children, 
 and whatever the cause, the disposition is to a contin- 
 ued form of fever rather than to that which takes 
 upon itself the intermittent character. 
 
 Even if malaria be the exciting cause we do not 
 have, so frequently as in adults, a well defined chill 
 followed by fever of a very high grade and then an 
 intermission, but are ranch more apt to have a mild 
 expression of fever continuous in character. 
 
 A heavy cold in the child, checking the secre- 
 tions, directing the blood inwardly and congesting 
 the internal organs, will develop a fever which may 
 last for a number of days, and may even be so pro- 
 nounced and dangerous as to cause death early. 
 
 In such cases our diagnosis could probably be 
 safely made, " Congestive fever." 
 
 The one element that is to be always considered in 
 childhood, is the nervous system. From infancy up 
 to the complete development the nerve centers are 
 more or less delicate and susceptible to external in- 
 fluences. 
 
 This fact it is which gives many infantile diseases 
 which would otherwise be trivial in character a seri- 
 ous aspect. 
 
 Delicate nerve centers, a soft and pliable brain, it is 
 
— 120 — 
 
 true may at times bear injury produced by external 
 violence wonderfully well, and yet that same brain, 
 in consideration of its unorganized, uncertain sus- 
 ceptibilities may be completely demoralized and de- 
 stroyed by a congestion which adults would bear 
 easily and well. 
 
 There are certain general principles to be observed 
 in the management of the fevers of children which 
 will apply in all cases no matter what the cause, 
 whether it be congestion or so-called malaria. 
 
 In this connection I would say that I believe 
 seventy-five per cent, of the so-called malarial fevers 
 are not such, but only a disturbed condition of the 
 circulatory apparatus and nerve centers, with an ac- 
 companying accumulation of excretory matter that 
 should have been eliminated, caused by chilling of 
 the surface from insufficient clothing and exjiosure 
 to variations of temperature. 
 
 There may be a malarial germ which is at the bot- 
 tom of the so-called malarial feve,r, but so far as my 
 observation extends, I believe that the sufferers in 
 the greater bulk of the so-called malarial cases are 
 simply the victims of taking cold. 
 
 There is an exposed surface, the blood is driven 
 inwardly toward the liver, the lungs, the spleen and 
 the digestive apparatus ; a general riot results, fever 
 is developed and we term it "Malaria." 
 
 It matters not, however, what term we apply; we 
 have a condition to meet and the best way in which 
 
— 121 — 
 
 to meet it is to produce upon the part of the body 
 affected a reverse tendency; to open up all the secre- 
 tions as far as possible; to bring the blood to the 
 surface; and to tranquilize the disturbed nerve cen- 
 ters. 
 
 The only indication which justifies the thought in 
 the direction of some special malarial germ is the 
 feature of periodicity. In children this periodicity 
 is not so marked. 
 
 If called to a case of fever in a child, we shall gen- 
 erally find a coated tongue and evidence of impaired 
 digestion, with more or less tenderness over the 
 stomach and bowels. 
 
 We find frequently in infants, that bronchitis is 
 present. The first important thing to do is to arouse 
 all the excretory organs. The bowels may be thor- 
 oughly open, and yet the various excretory glands 
 connected with the intestinal canal may not be active. 
 
 To simply ask the parent if the child's bowels are 
 open is not sufficient. The evacuation should be seen 
 and closely scrutinized and the doctor should not 
 hesitate to use his nose as well as his eyes. 
 
 The odor very often determines the condition of 
 the alimentary canal. There is nearly always a per- 
 verted secretion ; a disposition to decomposition 
 evinced by the odor, or else a thoroughly torpid, in- 
 active state evinced by the absence of odor. 
 
 A thorough cleaning out of the alimentary canal 
 by means of one grain doses of mild chloride, re- 
 
— 122 — 
 
 peated every two hours, until a complete response is 
 secured, should be followed by broken doses for a 
 day or two to keep up the activity of glandular 
 action, the one-tenth to the one-eighth of a grain of 
 of the same drug being given every two to four 
 hours. 
 
 Of course the temperature should be determined 
 promptly and if high it should be immediately re- 
 duced, because high temperatures long continued are 
 dangerous; the most prompt means of reducing a 
 dangerously high temperature is the cooling bath. 
 
 A visit should be made within twelve hours to de- 
 termine whether the fever is still present or not. 
 Cases of cold and acute indigestion, produced by 
 improper food, or a cold received immediately after 
 eating, creating a congestion in the neighborhood 
 of the stomach and an interference with digestion 
 may oftentimes be relieved by a simple clearing out 
 of the alimentary canal. 
 
 The subsequent treatment requisite in such cases is 
 a proper selection of a mild diet for several days and 
 protection against chilling of the surfaces. 
 
 If we discover, however, that in spite of the efforts 
 made to remove the cause, we still have a fever 
 present and that it is disposed to continue, we should 
 provide for a gentle siege of longer or shorter dura- 
 tion as the case may be. 
 
 Of course we shall keep ever in mind the possibili- 
 ties of malaria and the administration of quinine 
 
— 123 — 
 
 should be early instituted, after the conditions shall 
 have been made favorable to its reception. 
 
 It goes without saying that any remedy which it 
 is desired should be thoroughly absorbed, should not 
 be given until the stomach and alimentary canal are 
 in proper shape for its reception. 
 
 On general principles, therefore, the clearing out 
 of the stomach and bowels, placing the absorbents in 
 a receptive attitude should be accomplished, before 
 exhibiting quinine. 
 
 Controlling Temperature. — It should not be 
 our desire to reduce the temperature of a fever pa- 
 tient too rapidly or too constantly, or to too great a 
 degree. 
 
 A temperature of 102 is not dangerous. If it goes 
 higher, however, means should be instituted by 
 which a reduction of one or two degrees may be 
 secured. 
 
 Of course, if the temperature runs up rapidly to 
 104° or 105° or higher we should reduce it promptly, 
 and the best means to this end is a cooling bath. 
 
 Some writers favor a sudden immersion in very 
 cold water. This is in the majority of cases, I think, 
 unnecessarily severe, in fact considering the shock 
 to an already demoralized nervous system, I think 
 that a much more humane way for the administra- 
 tion of the cooling bath is to immerse the child in 
 water the temperature of the body, or even warmer, 
 and then permit the heat to be gently reduced until 
 
— 124 — 
 
 a proper degree of coolness is secured. It should be 
 kept in the bath sufficiently long to bring the tem- 
 perature down to a reasonable degree. 
 
 In order to hold the temperature down for any pro- 
 longed time it is questionable whether we should re- 
 peat the bath often. 
 
 To some patients the bath is grateful and conduc- 
 ive only to good. To others the bath is demoralizing, 
 a riot is created every time it is administered, and 
 when such is the case, I am strong in the conviction 
 that other means should be used. 
 
 Many times the administration internally of febri- 
 fuges may be alternated with the bath, and in this 
 way the temperature may be much more easily con- 
 trolled. 
 
 I have under my care at this moment a child of 
 seven, naturally amiable, a well controlled, well man- 
 aged little girl, in health fond of her bath, but the 
 very suggestion of a cooling bath or even of spong- 
 ing of the surfaces arouses a cycjone of irritability, 
 screaming, kicking and struggling to such a degree 
 that the bath cannot be given. 
 
 Unquestionably a hypersensitive nervous system, 
 resulting from a high degree of fever, lias developed 
 a special aversion to all form of water, applied 
 locally; even a cold cloth to the head creates worry 
 and annoyance. In this case, as in many others that 
 have come under my observation, I have been forced 
 to apply other means for reducing the temperature. 
 
— 125 — 
 
 I am already on record as favoring the use of acet- 
 anilid, in a paper read before the American Medical 
 Association, at Newport, in June, 1889. 
 
 I have not changed my views regarding the drug. 
 
 To a child I administer a dose ranging from one to 
 five grains, according to the age, using the following 
 formula: 
 
 3 Acetanilid, ^ dram. 
 
 Vin Tokay (Calvico), J^ ounce. 
 
 Pepsin Cordial (P., D. & Co.). 1^ ounces. 
 
 M. Sig.: One to two teaspoonsful, every tvro to four hours 
 according to age and intensity of fever. 
 
 I prefer in the use of this drug, as in the use of all 
 other agents for reducing temperature, to give an 
 average dose and maintain the effect secured by a 
 repetition of dose. 
 
 I am not in favor of large antipyretic doses. 
 
 Where too great a reduction is produced the reac- 
 tion is all the greater and the depression is objection- 
 able. 
 
 As will be observed in the formula as given, I 
 nearly always accompany the antipyretics with a 
 small amount of alcoholic stimulation in order to 
 overcome any possible depression. 
 
 Some writers use analgesin in place of acetanilid. 
 
 I am inclined to believe that analgesin is more 
 depressing and that there is greater danger to the 
 heart. 
 
 I have had most excellent results in a small num- 
 
— 126 — 
 
 ber of cases in the use of phenacetin in the place of 
 acetanilid, as a reducer of temperature. 
 
 The advantage of the coal tar products is that 
 they, while reducing the temperature also tranquilize 
 the nervous system and tend in the direction of rest 
 and sleep, and at the same time they are undoubt- 
 edly, to a degree, antiseptic to the alimentary canal. 
 
 The position may be taken by some that fever is 
 only a symptom of a condition and that by reducing 
 the temperature we simply mask the condition. 
 
 We might also say that pain in the stomach or 
 bowels, or anywhere else is only a symptom indicat- 
 ing a condition. 
 
 None the less, we should relieve it, as the symptom, 
 by effects produced, if long continued, may be de- 
 moralizing and dangerous. 
 
 High temperature long continued is dangerous. 
 For these reasons I am strongly in favor of holding 
 down the temperature. 
 
 In all these continued fevers I believe that it should 
 be our effort to manage our fever cases, rather than 
 to medicate, and yet there are times when medicine 
 serves us well. 
 
 As a means of controlling temperature we have 
 had added to our armamentarium valuable remedies 
 in the coal tar series. With their aid, coupled with 
 judicious bathing and proper efforts toward meeting 
 the symptoms as they arise, these fevers have been 
 robbed of many of their terrors. 
 
— 127 — 
 
 There are three very important features which re. 
 quire attention in fever cases: 
 
 First; the keeping actively engaged the glandular 
 system of the body, by which the waste products, 
 resulting from combustion expressed by the fever, 
 are carried away: 
 
 Second; the proper tranquillization of the patient: 
 
 Third; correct nutrition, tranquillity is largely 
 assisted by measures which are applied for the reduc- 
 tion of temperature, but in many cases additional 
 efforts will be required. 
 
 An abundance of sleep should be secured, and if it 
 is not accomplished by remedies which have been 
 given to reduce temperature there should be given, as 
 may be indicated, small doses of chloral hydrate, 
 from one to five grains, coupled with bromide of soda, 
 five to fifteen grains, according to age. 
 
 The best means of administering the combination is 
 the following: 
 
 5 Chloral Hydratis., 3 ss. 
 
 Sod. Bromicl., 3 jss. 
 
 Syr. Tolu, jy. 
 
 M. Sig.: One or two teaspoonsful according to age or 
 requirements until rest is secured. 
 
 In certain conditions complete rest cannot be 
 secured, except under the administration of mild opi- 
 ates. These are as a rule objectionable on account of 
 the fact that they have a tendency to check the secre- 
 tions. 
 
— 128 — 
 
 The best of the class, however (as there is less in- 
 terference with the glandular action by the opiate in 
 this form), is the Dover's powder, and the best form 
 in which to administer the latter is the syrup-doveri 
 (Gregory) in doses ranging from one-half to one tea- 
 spoonful every two hours as may be required. This 
 combination is pleasant and attractive to most chil- 
 dren. 
 
 There are times, however, when we can administer 
 to good advantage infinitesimal doses of morphine, and 
 the soluble triturates that have been prepared by the 
 firm of Parke, Davis & Co. (Detroit), are very con- 
 venient. 
 
 We may take, for instance, a tablet of the one- 
 eighth of a grain of morphine and dissolve it in twelve 
 teaspoonfuls of water in a glass and we have there 
 represented one-ninety-sixth of a grain of morphine 
 to the teaspoonful. 
 
 Instructions may be given to administer one tea- 
 spoonful of this every half hour or every hour, as re- 
 quired to secure rest. 
 
 We should impress upon the attendants in the sick 
 room the importance of guarding our patient against 
 the meddlesome visiting and attention of over zeal- 
 ous friends. 
 
 The sick may well call out, "Save me from my 
 friends." The attentions of the latter are well meant, 
 but misdirected. 
 
 A case of fever, as in fact any other disease, should 
 
— 129 — 
 
 be managed on strictly business principles and a 
 period of serious illness is no time for social visits, 
 as they disturb, arouse and excite a sensitive patient, 
 and interfere with the smooth running of the house- 
 hold so essential to the comfort of the sufferer. 
 
 Among the more intelligent class the securing of 
 our wishes is easy, but the trouble comes in when we 
 have our cases among the great numbers in the lower 
 segment of the social circle. 
 
 There the sick room is frequently crowded night 
 and day, and it is important that we should be firm 
 in our instructions, in fact, we should take a decided 
 stand, informing the family that unless our instruc- 
 tions are executed to the letter, we will retire from 
 the case. 
 
 Positiveness usually carries conviction, and a gene- 
 ral commanding an army should never hesitate in his 
 commands. Under such conditions suggestions are 
 not in order. The thing to do is to command, and 
 see that the command is obeyed. 
 
TYPHOID FEVER. 
 
 Through the researches of Koch, Eberth, Meyer, 
 Friedlaender, Gaffky, and later, of Fraenkel and 
 Simonds, the typhoid bacillus has become an entity 
 that must not (and cannot safely) be lost sight of 
 during the progress of a case of typhoid fever and 
 after its termination. 
 
 We are too much inclined to be on the lookout for 
 classical representations of this disease, as of many 
 others. 
 
 I have had a number that I placidly considered 
 simple continued fever, temperature not ranging 
 higher than from 101° to 103°, no rose spots, no 
 tympanites, no special evidence of intestinal irrita- 
 tion, nothing leading me to suspect typhoid fever, 
 until suddenly aroused to an appreciation of the fact 
 by dangerous and repeated hemorrhages from the 
 bowel, and in one instance (in 1877) the bleeding con- 
 tinued until it proved fatal. 
 
 This occurred in a boy of six, and was convincing 
 proof to me of the fallaciousness of the idea that 
 formerly obtained that young children are not sus- 
 ceptible to the malady. 
 
 In this connection I recall the circumstance of a 
 consultation upon a youth who had been ailing for 
 some weeks, though he was up and about until a few 
 
— 131 — 
 
 minutes before the family physician was summoned 
 and found him in great agony. 
 
 An investigation developed an intestinal perforation 
 which caused death in a short time. 
 
 The clinical history and the post-mortem revel- 
 ations evidenced an illustration of "walking typhoid 
 fever." 
 
 We know that we frequently have scarlet fever so 
 mild as to be entirely overlooked until the attention 
 is aroused by grave nephritic trouble; and so in all 
 diseases, the artistically perfect specimen is the excep- 
 tion and not the rule. 
 
 It has no doubt been the observation of all, that 
 the course and complications of typhoid fever are as 
 varied as the individual victims, but it was not re- 
 cognized until lately (by Griesinger) that numerous 
 light and rudimentary attacks (typhus levissimus) 
 belonged to typhoid fever at all. 
 
 They used to have all sorts of names applied to 
 them, as suggested by Struempel, the favorite being 
 "gastric fever." 
 
 The diagnosis is of course difficult in proportion to 
 the scanty development of typhoid symptoms, and 
 it is best established by demonstrating an etiological 
 relation between them and others that are plainly 
 typhoid fever. 
 
 Apropos to this middle class of cases, I remember 
 a case that came under my observation some years 
 ago; a five-year-old boy in a family where three 
 
— 132 — 
 
 other cases developed (one fatal) of a violent charac- 
 ter; the child was sick only about twenty-one days, 
 and under ordinary circumstances his case would have 
 been diagnosticated simple continued or remittent 
 fever. 
 
 As the individual manifestations vary, so too do 
 entire epidemics. 
 
 One season the type is violent, and in another mild. 
 
 There are those who believe that by active inter- 
 ference, typhoid fever may be aborted; though I am 
 not ready to endorse this proposition, I am sure that 
 it may be modified and abbreviated. 
 
 I cite briefly the following as an illustration: 
 
 July 21, 1887, J. T. C, taken with violent vomiting 
 and intense abdominal pain; examination revealed a 
 lusty plethoric boy, red tongue, heavily coated, pulse 
 140 to the minute and full, temperature 105.5°, acute 
 tenderness over abdomen with constipation. Reme- 
 dies were ordered for opening the bowels, soothing 
 the stomach, and reducing the temperature. 
 
 After the lapse of twelve hours an action of the 
 bowels had been secured, but there was no improve- 
 ment in the general condition. 
 
 One grain of calomel to be taken every hour, was 
 ordered at once with the application of ten leeches 
 over the stomach and ileo-coecal region at point of 
 greatest tenderness, followed by hot fomentations. 
 
 The leeches abstracted three or four ounces of 
 blood, giving marked relief; at the end of ten hours 
 
— 133 — 
 
 the ten grains of calomel had produced active purga- 
 tion, and this together with, the local abstraction of 
 blood, had mitigated all the symptoms; the temper- 
 ature was down to 102°, the pain was almost gone 
 no nausea, no vomiting. 
 
 The patient was in every way more comfortable, 
 and jogged along for four weeks with a mild form of 
 typhoid fever instead of dying during the first five 
 days, as I believe he would have done had a tempor- 
 izing course been pursued. 
 
 Recognizing the disease as an infectious one, de- 
 pendent upon a specific virus, it behooves us to treat 
 it upon the antiseptic plan, aiding elimination by 
 stimulating the excretory organs, sustaining the 
 strength by diffuse stimulation at the proper time, 
 and the furnishing of an abundance of nutrition in a 
 form for prompt assimilation. 
 
 As previously remarked since the introduction of 
 the coal tar products the dangers of high tempera- 
 ture are much less than formerly, as we certainly can 
 control that feature; however, I favor their very 
 careful administration, until full opportunity is given 
 for the ascertainment of the degree of susceptibility. 
 There has been recorded already, a number of un- 
 favorable results; even death has occurred owing 
 probably to some peculiar idiosyncracy. I prefer 
 small doses at short intervals, keeping up the effect 
 continuously, rather than large doses which produce 
 sudden and excessive falling of temperature. I think 
 
— 134 — 
 
 a sudden reduction no matter bow attained, is not so 
 likely to be maintained; large doses are depressing 
 and endanger beart-failure. While tbe coal tar series 
 are of great value as febrifuges and tranquilizers of 
 the nervous system and at the same time diaphoretic, 
 in the cooling bath we have an agent equally valu- 
 able. I do not mean the sudden immersion in cold 
 water; that is uncalled for, undesirable and brutal. 
 The temperature of the water at first should be about 
 the same as that of the patient, and may be gradually 
 reduced to 85° to 80°. The bath may be prolonged 
 five or ten minutes. Often, patients wildly delirious, 
 go calmly to sleep during the progress of the bathing. 
 The advantages of the bath I take it are: 
 
 1. The reduction of temperature is accomplished 
 gradually and comfortably to the patient in accord- 
 ance with nature's plan of putting out fire with 
 water: 
 
 2. The water acts primarily as a soother of the 
 peripheral nerves, and secondarilycalms the disturbed 
 nerve centers: 
 
 3. It stimulates the secretory glands, allays thirst 
 by being directly absorbed into the heated and dry 
 tissues; encourages diaphoresis as well as diuresis: 
 
 4. It influences favorably the respiratory organs by 
 energizing inspiration; and thus aids in the secur- 
 ing of expectoration, and as a result bronchial com- 
 plications are less frequent: 
 
 5. The hygienic effect upon the skin is of great 
 
— 135 — 
 
 value, removing as it does the foul smelling products 
 of the sweat and sebaceous glands, aiding the pro- 
 curement of strength and elasticity in the cutaneous 
 and adjacent tissues, conditions antagonistic to bed- 
 sores. 
 
 The bath should be administered with due regard 
 to the comfort of the patient; drafts should be avoided, 
 and immediately following the bath a thorough dry- 
 ing and brisk rubbing of the surface should be insti- 
 tuted, and warm covering with hot water bag to the 
 feet, if need be, and a nice cup of hot broth or a little 
 wine or toddy would be in order. 
 
 Acetanilid or phenacetin and bathing or sponging 
 may be used conjointly to good advantage. . 
 
 As an antipyretic, quinine should be ruled out alto- 
 gether. In doses sufficiently large to reduce tem- 
 perature, it is demoralizing to the nervous system as 
 well as to the digestive tract, and when we recall the 
 fact that the sheet anchor of hope in typhoid fever 
 consists in good digestion and nutrition, and tranquil 
 nerves, we can see that the objection to quinine is 
 well founded. 
 
 If well-defined malarial symptoms present them- 
 selves as a complication, an antiperiodic is of course 
 indicated, and quinine should be given, but very care- 
 fully. 
 
 In this connection permit me to express the opin- 
 ion that the so-called typho-malarial fever of Wood- 
 ward is a misnomer, being probably nothing more 
 
— 136 — 
 
 than a modified expression of typhoid fever plus mal- 
 aria. 
 
 Certainly the coining of a new name for every 
 modification of the disease is confusing, and the 
 practice should receive no encouragement. 
 
 What has been said above need not be interpreted 
 as an objection to tonic doses of quinine during the 
 period of convalescence, but as against the administra- 
 tion of quinine to a well-defined case of typhoid fever. 
 
 In the earlier, middle or later stages of the disease, 
 there may come a time when the necessity of the 
 situation demands the removal of the patient from 
 one section of the country to another. 
 
 I desire to place myself on record as being strongly 
 of the opinion, that the danger of removing a person 
 seriously sick has been greatly overrated ; that with 
 due care, and guarding against the chilling of the 
 surfaces and interruption of the proper amount of 
 sleep, typhoid fever and other dangerous cases may 
 be safely transported hundreds of miles. 
 
 I have a record of four cases, successfully and ad- 
 vantageously removed from one hundred to one thou- 
 sand miles on sleeping cars, which justify this con- 
 clusion. 
 
 As the administration of the calomel purge in the 
 beginning is satisfactory, so the renewal of one-eighth 
 grain doses every other day to the number of half a 
 dozen, is an advantage in the direction of keeping 
 the bowels open, as well as serving as an intestinal 
 antiseptic. 
 
— 137 — 
 
 If an additional aid is required to evacuate the 
 bowels an enema of a teaspoonful of glycerin (as 
 suggested by Anacker) or the glycerin suppository is 
 a ready means of securing a prompt evacuation. 
 
 Permit me to emphasize the most salient points I 
 desire to make: 
 
 1. Typhoid fever varies in intensity, severity and 
 length of attack, as do other infectious diseases, and 
 while it has not yet been established that any of this 
 class can be aborted, yet typhoid with all the others, 
 may be mitigated and abbreviated, and unfortunate 
 complications are sequelae often preventable: 
 
 2. To the securing of this end that which is of 
 paramount importance, is management rather than 
 medication, though there are many dangers that can 
 only be tided over by the prompt and proper exhibi- 
 tion of drugs: 
 
 3. The administration of remedies that are anti- 
 septic and stimulate the excretory organs is impor- 
 tant, and for this purpose small doses (1-50 gr.) of 
 bichloride, or the mild chloride (1-8 to 1-4 gr.) as 
 often as is necessary to produce the desired effect are 
 of value: 
 
 4. Nutrition, by the administration of food in a 
 form for prompt assimilation, is a necessity, and to 
 this end the diet should be limited to peptonized 
 milk, beef peptones (Mosquero's Beef Cacoa) bovin- 
 ine (Bush) etc., bearing in mind that the stereotyped 
 home-made beef tea is of no more value as a food 
 
— 138 — 
 
 than a weak toddy, being a mild stimulant and noth- 
 ing more: 
 
 5. Agreeable alcoholic stimulation furnishes food 
 and force: 
 
 6. Freedom from pain, tranquillity and perfect rest 
 should be insisted upon, remembering that this dis- 
 ease of all others has a wrecking effect upon the ner- 
 vous system (it having been called by some German 
 writers "fieber nervoese" or nervous fever) we 
 should see to it that our patient obtains no less than 
 twelve or sixteen hours sleep out of the twenty-four, 
 and the remainder of the time be saved from the 
 meddling, misdirected kindness of overzealous friends: 
 
 7. For the obtaining of sleep and the relief of ner- 
 vousness, the administration of acetanilide, phenace- 
 tine, chloral, paraldehyde, urethan, and the bromides, 
 is preferable to opiates, though occasionally the lat- 
 ter are demanded: 
 
 8. When the conditions surrounding a patient are 
 unfavorable and a change is desirable, sometimes 
 even to a distant point, the removal under proper 
 precautions against chilling and unrest, may be per- 
 mitted or even preferred, the danger of the same not 
 being as great as it is generally considered to be: 
 
 9. As a rule a patient with typhoid fever, or any 
 other wasting disease, should not be permitted to 
 have bed-sores, which are an expression of starved 
 tissue and neglected skin, and are preventable, the 
 means of their prevention being proper nutrition and 
 bathing 1 . 
 
EPISTAXIS. 
 
 Nose-bleed is a common occurrence among chil- 
 dren. • It may be due to accident, by directly falling 
 upon the nose, a denudation of the mucous membrane 
 lining the nasal cavity, or the cause may be a general 
 one, dependent upon blood pressure. To this class 
 belongs the bleeding of the nose sometimes seen in 
 the outset of active fevers. A special case of long 
 continued bleeding from the nose is sometimes met 
 with, but fortunately rarely, known as haemophilia, 
 or the hemorrhagic diathesis, known among the 
 laity as " bleeders ;" or the condition may be a con- 
 stitutional one, a temporary tendency to ready haem- 
 orrhage, due to some organic lesion of the blood. 
 Under this head we have "purpura simple" "pur- 
 pura hcemorrhagica " anaemia, chlorosis and the stru- 
 mous diathesis. The bleeding from the nose of a 
 child may be of very slight import, or it may indicate 
 a serious condition. In the early stages of some of 
 the acute diseases it may have a beneficial effect, but 
 in all anaemic or weakened conditions of the blood, 
 or in any case where it is prolonged, it bodes no good. 
 We are frequently called to a sudden case of haemor- 
 rhage from the nose in active and full-blooded chil- 
 dren. In such cases generally we are safe in assur- 
 ing the patient and the family that the bleeding 
 will be beneficial rather than otherwise. If it does 
 
— 140 — 
 
 not stop spontaneously, the application of ice-cold 
 cloths over the nose and the frontal region of the 
 head may be sufficient. If not, the introduction into 
 the nares of small pledgets of ice and the snuffling 
 up of ice- water, will serve the purpose. It may be 
 desirable to saturate the same with alum. If the 
 conditions be such as to demand a prompt checking 
 of the haemorrhage, the introduction into the inte- 
 rior part of the nose by means of a long slender probe, 
 of small pledgets of absorbent lint, tied at intervals 
 of two or three inches upon oiled silk thread, the 
 pledgets being about half an inch square, and satu- 
 rated with a strong solution of alum, or smeared with 
 pulverized tannin, and the same packed firmly, 
 though gently, into the entire anterior nasal space, 
 may be all sufficient. Sometimes, however, the 
 bleeding may be active, and be in the direction of 
 the back part of the nose, and require a plugging of 
 the posterior nares. In this case there are instru- 
 ments which have been devised, to the point of which 
 may be applied, attached to a string, sponges satu- 
 rated with astringents, such as the sesqui-chloride 
 of iron, tannin or alum. A most valuable means 
 which I have applied during the past twenty years to 
 the posterior nares, suggested to me when a student 
 by my esteemed teacher and friend, the late Prof. 
 Jno. J. McDowell of St Louis, and which I have 
 never seen recorded, is the use of the condom, which 
 is made from the animal membrane known as the 
 
— 141 — 
 
 " vermiform appendix " of the sheep, and sold in the 
 majority of drug stores ; or, has been presented to us 
 in these latter days, in the form of the delicate, 
 finest quality of soft india rubber. The sizes vary. 
 I would select one in accordance with the age. For 
 a child the smallest size would be valuable. By 
 means of a long and delicate probe introduced within 
 the condom, it can be pushed gently upward and 
 backward through whichever nostril seems to be the 
 most open ; and in this connection we must remem- 
 ber that in nearly all cases there is a deviation of the 
 septum, so that one nostril or the other is the smaller. 
 By gently pushing the probe, which is embraced by 
 the condom, upward and backward, the probe being a 
 pliable one, which can be bent in accordance with the 
 necessities, we soon have it reaching well back in the 
 naso-pharyngeal space. The condom can then be read- 
 ily filled with ice-water, and we can have a ligature at 
 the external opening, which can be closed at will. 
 By this means we have a cold mass and pressure in 
 back part of the nose, which in the majority of cases 
 promptly checks the haemorrhage. I have rarely 
 found this procedure fail, and it is unquestionably 
 easier of application than the average "plugger," 
 and is much more portable, as the condom can be 
 carried in the purse easily. When one succeeds in 
 checking the haemorrhage, as I believe he will, he 
 may felicitate himself that he has done the work "se- 
 cundum artem." 
 
Pepsin in Infantile Diarrhoea. 
 
 Statistics show that the mortality rate of infantile diar- 
 rhoea, as it manifests itself in the summer months, is higher 
 than that of any other disease. 
 
 How shall the conditions present best be met? To answer 
 this query has inspired exhaustive contributions from the pens 
 of our most learned medical writers. It is admitted by all 
 that one of the causes which incites and perpetuates the gas- 
 tric and intestinal inflammation is undigested, or partly di- 
 gested, fermenting milk or other food, the decomposition of 
 which is accompanied by the development of ptomaines and 
 other toxic principles. It is as an aid to the removal of this 
 cause, both in predigesting milk or other food before it is 
 given, and in digesting fermented undigested food in the 
 stomach, that pepsin is indicated in infantile diarrhoea, and its 
 efficacy has been attested by many well-known medical writers. 
 (See /. Lewis Smith, M. D., Archives of Pediatrics, Sept., '86, 
 p. 518; Nov., '86, p. 639; Nov., '64, p. 424. Prof. Vocher, of 
 Berlin Archiv. f. Kinder h, vol. p, p. 3. Dr. I. N. Love, St. 
 Louis Weekly Medical Review, Aug., '88. T. Lauder Brunton, 
 Diseases of Digestion, p. 2pi. A. Holt, N. Y. Archiv. Pedia- 
 trics, 1886, p. 732. A. G. Bigelow, Archiv. Pediatrics, 1884, p 
 430. Discussion at German Medical Congress, at Salzburg, 1881, 
 by Biedert, Gerhart, Henoch, Steffen, Thomas, Soltman, Pfeiffer. 
 Prof. Leeds, Archiv. Ped., 1884, p. 421, etc.) 
 
 We supply pepsin in the following forms: 
 
 Pepsinum Purum in Lamellis ; Pepsinum Purum 
 Pulvis; Pepsin, Saccharated, U. S. P., 1880; Pepsin, 
 Glycerole, Concentrated ; Pepsin, Lactated ; Pepsin 
 Liquid, U. S. P., 1880 ; Pepsinum Purum Tablets, 1 
 gr., Sugar-Coated ; Pepsin Cordial. 
 
 All information desired by physicians as to our pepsin 
 products, our general line of standard medicinal preparations, 
 pharmaceutical specialties, and latest therapeutic novelties and 
 improvements in methods of medication, will be promptly fur- 
 nished on request. 
 
 PARKE, DAVIS & CO., 
 
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 A MONTHLY EPITOME OF MEDICAL PROGRESS. 
 
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 New subscribers taking more than one journal, and accompanying subscription 
 by remittance, are entitled to the following special rates. 
 
 GAZETTE and AGE, $2.50 ; GAZETTE, AGE and LANCET. $4.00 ; LANCET 
 and AGE, $2.50 ; WESTERN MEDICAL REPORTER or BULLETIN with any of 
 the above at 20 per cent, less than regular rates. 
 
 Combined, these journals furnish a complete working library of current medi- 
 cal literature. All the medical news, and full reports of medical progress. 
 
 GEO. S. DAYIS, Publisher, Detroit, Mich, 
 
IN EXPLANATION 
 
 OF 
 
 Tie Physicians' Leisure Library. 
 
 We have made a new departure in the publication of medical books. As you 
 no doubt know, many of the large treatises published, which sell for four or five or 
 more dollars, contain much irrelevant matter of no practical value to the physi- 
 cian, and their high price makes it often impossible for the average practitioner to 
 purchase anything like a complete library. 
 
 Behoving that short practical treatises, prepared by well known authors, con- 
 taining the gist of what they had to say regarding the treatment of diseases com- 
 monly met with, and of which they had made a special study, sold at a small price, 
 would be welcomed by the majority of the profession, we have arranged for the 
 publication of such a series, calling it The Physicians' Leisure Library. 
 
 This series has met with the approval and appreciation of the medical profes- 
 sion, and we shall continue to issue in it books by eminent authors of this country 
 and Europe, covering the best modern treatment of prevalent diseases. 
 
 The series will certainly afford practitioners and students an opportunity 
 never before presented for obtaining a working library of books by the best authors 
 at a price which places them within the reach of all. The books are amply illus- 
 trated, and issued in attractive form. 
 
 They may be had bound, either in durable paper covers at 25 Cts. per copy, 
 or in cloth at 50 Cts. per copy. Complete series of 12 books in sets as announced, 
 at $2.50, in paper, or cloth at $5.00, postage prepaid. See complete list. 
 
 PHYSICIANS' LEISURE LIBRARY 
 
 PRICE: PAPER, 25 CTS. PER COPY, $2.50 PER SET; CLOTH, 50 CTS. PER COPY, 
 $5.00 PER SET. 
 
 SERIES I. 
 
 Inhalersi Inhalations and Inhalants. 
 By Beverley Robinson, M. D. 
 
 The Use of Electricity in the Removal of 
 Superfluous Hair and the Treatment of 
 Various Facial Blemishes. 
 By Geo. Henry Fox, M. D. 
 
 New Medications, Vol. I. 
 
 By Dujardin-Beaumetz, M. D. 
 
 New Medicationsi Vol. II. 
 
 By Dujardin-Beaumetz, M. D. 
 
 The Modern Treatment of Ear Diseases. 
 By Samuel Sexton, M. D. 
 
 The Modern Treatment of Eczema. 
 By Henry G. Piffard, M. D. 
 
 Antiseptic Midwifery. 
 
 By Henry J. Garrigues, M. D. 
 On the Determination of the Necessity for 
 Wearing Glasses. 
 
 By D. B. St. John Roosa, M. D. 
 The Physiological, Pathological and Ther- 
 apeutic Effects of Compressed Air. 
 
 By Andrew H . Smith, M. D. 
 GranularLids and ContagiousOphthalmia. 
 
 By W. F. Mittendorf, M. D. 
 Practical Bacteriology. 
 
 ByThomas E. Satterthwaite, M D. 
 Pregnancy, Parturition, the Puerperal 
 State and their Complications. 
 
 By Paul F. Munde, M. D. 
 
SERIES II. 
 
 The Diagnosis and Treatment of Haem- 
 orrhoids 
 
 By Chas. B. Kelsey, M. D. 
 Diseases of the Heart, Vol. I. 
 
 By Dujardin-Beaumetz, M. D. 
 Diseases of the Heart, Vol. II. 
 
 By Dujardin-Beaumetz M. D. 
 The Modern Treatment of Diarrhoea and 
 Dysentery. 
 
 By A. B. Palmer, M. D. 
 Intestinal Diseases of Children, Vol. I. 
 
 By A. Jacobi, M. D. 
 Intestinal Diseases of Children, Vol. II. 
 
 By A. Jacobi, M. D. 
 
 The Modern Treatment of Headaches. 
 By Allan McLane Hamilton, M. D. 
 
 The Modern Treatment of Pleurisy and 
 Pneumonia. 
 
 By G. M. Garland, M. D. 
 Diseases of the Male Urethra. 
 
 By Fessenden N. Otis, M. D. 
 The Disorders of Menstruation. 
 
 By Edward W. Jenks, M. D. 
 The Infectious Diseases, Vol. I. 
 
 By Karl Liebermeister. 
 
 The Infectious Diseases, Vol. II. 
 By Karl Liebermeister. 
 
 SERIES III. 
 
 Abdominal Surgery. 
 
 By Hal C. Wyman, M. D. 
 
 Diseases of the Liver- 
 
 By Dujardin-Beaumetz, M. 
 
 Hysteria and Epilepsy. 
 
 By J. Leonard Corning, M. 
 
 Diseases of the Kidney. 
 
 By Dujardin-Beaumetz, M. 
 
 D. 
 
 The Theory and Practice of the Ophthal- 
 moscope. 
 
 By J. Herbert Claiborne, Jr., M. D. 
 
 Modern Treatment of Bright's Disease. 
 By Alfred L. Loomis, M. D. 
 
 Clinical Lectures on Certain Diseases of 
 Nervous System. 
 
 By Prof. J. M. Charcot, M. D. 
 The Radical Cure of Hernia. 
 
 By Henry O. Marcy, A. M., M. D., 
 
 Spinal Irritation. 
 
 By William A. Hammond, M. D. 
 Dyspepsia. 
 
 By Frank Woodbury, M. D. 
 The Treatment of the Morphia Habit. 
 
 By Erlenmeyer. 
 The Etiology, Diagnosis and Therapy of 
 Tuberculosis. 
 
 By Prof. H. von Ziemssen. 
 
 SERIES rtf. 
 
 Nervous Syphilis. 
 
 By H. C. Wood, M. D. 
 
 Education and Culture as correlatedHo 
 the Health and Diseases of Women. 
 By A. J. C. Skene, M. D. 
 
 Diabetes. _ 
 
 By A. H. Smith, M. D. 
 
 A Treatise on Fractures. 
 
 By Armand Despres, M. D. 
 Some Major and Minor Fallacies concern- 
 ingSyphilis. 
 
 By E. L. Keyes, M .D. 
 Hypodermic Medication. 
 
 By Bourneville and Bricon. 
 
 Practical Points in the Management of 
 Diseases of Children. 
 By I. N. Love, M. D. 
 
 Neuralgia. 
 
 By E. P. Hurd, M. D. 
 
 Rheumatism and Gout. 
 
 By F. Le Roy Satterlee, M. D. 
 Electricity, Its Application in Med'cinei 
 
 By Wellington Adams, M.D. [Vol.1] 
 Electricity, Its Application In Medicine. 
 
 By Wellington Adams, M.D. [Vol.II] 
 Auscultation and Percussion. 
 
 Ky Frederick C. Shattuck, M. D. 
 
SERIES IT. 
 
 Taking Cold. 
 
 By F. W. Bosworth, M. D. 
 
 Practical Notes on Urinary Analy- 
 sis. 
 
 By William B. Canfield, M. D. 
 
 Practical Intestinal Surgery. Voi.i. 
 Practical Intestinal Surgery. Voi.il. 
 
 By F. B. Robinson, M. D. 
 Lectures on Tumors. 
 
 By John B. Hamilton, M. D., LL. D. 
 
 Pulmonary Consumption, a Ner- 
 vous Disease. 
 
 By Thomas J . Mays, M . D . 
 
 Lessons In the Diagnosis and 
 Treatment of Eye Diseases. 
 By Casey A. Wood, M. D. 
 
 Diseases of the Bladder and Pros- 
 tate. 
 
 By Hal C. Wyman, M. D. 
 
 Artificial Anaesthesia and Anaes- 
 thetics. 
 
 By DeForest Willard, M. D., and Dr. 
 Lewis H. Adler, Jr. 
 
 Cancer. 
 
 By Daniel Lewis, M. D. 
 
 The Modern Treatment of Hip Dis- 
 ease. 
 
 By Charles F. Stillman, M. D. 
 
 Insomnia and Hypnotics. 
 
 By Germain See. 
 
 Translated by E. P. Hurd, M. D. 
 
 BOOKS BT LEADING AUTHORS. 
 
 SEXUAL IMPOTENCE IN MALE AND FEMALE $3.00 
 
 By Wm. A. Hammond, M. D. 
 PHYSICIANS' PERFECT VISITING LIST 1.50 
 
 By G. Archie Stockwell, M. D. 
 A NEW TREATMENT OF CHRONIC METRITIS 50 
 
 By Dr. Georges Apostoli. 
 CLINICAL THERAPEUTICS 4.00 
 
 By Dujardin-Beaumetz, M. D. 
 MICROSCOPICAL DIAGNOSIS 4.00 
 
 By Prof. Chas. H. Stowell, M. S. 
 PALATABLE PRESCRIBING 1.00 
 
 By B. W. Palmer, A. M., M. D. 
 UNTOWARD EFFECTS OF DRUGS 2.00 
 
 By L. Lewin, M. D. 
 SANITARY SUGGESTIONS (Paper) 25 
 
 By B. W. Palmer, M. D. 
 SELECT EXTRA-TROPICAL PLANTS 3-o© 
 
 By Baron Ferd. von Mueller, 
 TABLES FOR DOCTOR AND DRUGGIST 2.00 
 
 By Eli H. Long, M. D. 
 
 GEORGE S. DAVIS, Publisher, 
 
 O. B022: 470 Detroit, ^CIcl^ 
 
LIBRARY OF CONGRESS 
 
 022 169 352 8 
 
 
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