Treatment of diseases in infancy and childhood

Front matter

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IN PREPARATION.

Preface

In this volume the author has essayed to give a thoroughly practical, and at the same time concise, resume of the treatment of the various diseases incident to childhood. His apology for the work must rest upon the very large number of requests from subscribers to the previous volume on Treatment of Heart and Lung Diseases.

From the numerous investigations that have recently been made in infantile diseases, and the light that has been thrown upon them, great improvement has developed in the methods of treatment. It is these recent and morS advanced practical therapeutical views of the several leading medical authorities of New York City, and which in their experiences are the most approved and the most successful, that the author has endeavored to place before the general practitioner, fully and in the minutest detail and yet with the most careful discrimination.

Among medical publications the author knows of none similar in character to this, and it is earnestly hoped that the work will prove a useful one to the profession.

Part I. General Diseases

Treatment by Dr. A. Jacobi, (9); by Dr. W. A. Hammond, (13); by Dr. T. Gaillard Thomas, (13); by Dr. J. Lewis Smith, (14); by Dr. A. H. Smith, (17); by Dr. Alonzo Clark, (17); by Dr. Beverly Robinson, (18).

Rachitis ig

Treatment by Dr. A. Jacobi, (19); by Dr. W. H. Thomson,

Treatment by Dr. J. Lewis Smith, (24); by Dr. A. Jacobi, (26); by Dr. F. N. Otis, (26).

Treatment by Dr. W. H. Draper, (27); at New York Hospital, (30); by Dr. A- Jacobi, (30); by Dr. J. H. Ripley, (30); by Dr. Alonzo Clark, (30); by Dr. W. H. Thomson, (31); by Dr. Austin Flint, (31); at Hart's Island Hospital, (33); at Bellevue Hospital, (33); at Roosevelt Hospital, (34); at Charity Hospital, (34).

Treatment by Dr. J. Lewis Smith, (35); by Dr. F. N. Otis, 36); at Charity Hospital, (37); by Dr. R. W. Taylor, (37); by Dr. G.H. Fox, (38); at Bellevue Hospital, (40); by Dr. W. H. Draper, (40); at New York Hospital, (41); at Roosevelt Hospital, (41).

Part II

diseases of the air-passages.

Treatment by Dr. J. Lewis Smith, (42); by Dr. A. Jacobi, (45); by Dr. C. Billington, (51); by Dr. A. A. Smith, (54); by Dr. F. Delafield, (54); by Dr. Beverly Robinson, (55); by Dr. J. H. Ripley, (56); by Dr. Alonzo Clark, (56); by Dr. L. Elsberg, (56); by Dr. J. R. Learning, (56); by Dr. E. C.Wendt, (57); the Alcohol or "Brooklyn," treatment, (57).

IV CONTENTS.

CORYZA 60

Treatment by Dr. J. Lewis Smith, (60); by Dr. A. A. Smith, (62); by Dr. J. R. Learning, (63).

True Croup (Acute Croupous Laryngitis) 63

Treatment by Dr. J. H. Ripley, (63); by Dr. J. R. Learning. (67); hyDr. J. Lewis Smith, (68); by Dr. F. Delafield, (69); by Dr. A. Hadden, (70); by Dr. A. L. Loomis, (73); by Dr. Austin Flint, (74).

Spurious or Catarrhal Croup (Acute Catarrhal Laryngitis.) 74 Treatment by Dr. J. Lewis Smith, (74); by Dr. F. Delafield, (75); by Dr. A. L. Loomis, (76).

Laryngismus Stridulus (Spasmodic Croup) 78

Treatment by Dr. J. Lewis Smith, (78); by Dr. A. L. Loomis, (79); by Dr. W. H. Thomson, (79); by Dr. A. A. Smith, (79); by Dr. F. Delafield. (80).

Hooping Cough , 81

Treatment by Dr. J. Lewis Smith, (81); by Dr. A. Jacobi, (82); by Dr. J. R. Learning, (82); by Dr. H. S. Dessau, (82); by Dr. A. L. Loomis, (83); at Beilevue Hospital, (83); at the Infants' Hospital, (84).

Treatment by Dr. A. Jacobi, (S4); by Dr. G. M. Lefferts, (85); by Dr. W. H. Draper, (85); by Dr. Alonzo Clark, (85).

Part III

diseases of the digestive organs.

Stomatitis 87

Treatment by Dr. J. Lewis Smith, (87) ; by Dr. J. H. Ripley, (88); at the Nursery and Child's Hospital, (89).

Treatment by Dr. A. Jacobi, (90); by Dr. J. R. Learning, (91); by Dr. F. Delafield, (91); by Dr. F. H. Bosworth, (93); by Dr. W. H. Draper, (93); at New York Hospital, (93); by Dr. F. A. Burrall, (94); by Dr. G. M. Lefferts, (94); by Dr. Beverly Robinson, (97); by Dr. F. H. Hamilton, (97).

Pharyngitis 98

Treatment by Dr. A. Jacobi, (98); by Dr. A. H. Smith, (100); by Dr. F. H. Bosworth, (100); by Dr. A. A. Smith, (101); by Dr. F. Delafield, (101); by Dr. G. M. Lefferts, (102).

Treatment by Dr. J. Lewis Smith, (102); at the Infants' Hospital, (103); by Dr. A. H. Smith, (103); by Dr. A. A. Smith, (104); by Dr. W, A. Hammond, (105); by Dr. F. Delafield, (106).

CONTEXTS. V

Gastritis 106

Treatment by Dr. F. Delafield, (106). Enteralgia (Colic) — Enteritis 10S

Treatment by Dr. J. W. McLane, (108); by Dr. F. A.

Bunall, (ioS); by Dr. Austin Flint, (log); by Dr. A. A. Smith, (109): by Dr. F. H. Hamilton, (109); at the Infants' Hospital, (no); at New York Hospital, (no); by Dr. F. Delafield, (in).

DlARRHCEA 112

Treatment by Dr. J. Lewis Smith, (112); by Dr. E. G. Janeway, (113); by Dr. A. A. Smith, (114); by Dr. F. Delafield, (115); at the Infants' Hospital, (116); at Hart's Island Hospital, (116); at Bellevue Hospital, (117).

Intestinal Catarrh nS

Treatment by Dr. A. Jacobi, (11S); by Dr. J. Lewis Smith, (121); by Dr. F. Delafield, (122); by Dr. A. A. Smith, (125); at Bellevue Hospital, (126).

Treatment by Dr. F. Delafield, (126); by Dr. J. Lewis Smith, (12S); by Dr. G. B. Fowler, (129); by Dr. Alonzo Clark, (129); at Bellevue Hospital, (130).

Cholera Infantum (Spurious Hydrocephalus) 130

Treatment by Dr. J. Lewis Smith, (130); at New York Foundling Asylum, (131); by Dr. F. Delafield, (133).

Treatment by Dr. A. Jacobi, (134); by Dr. A. A. Smith, (137).

Treatment by Dr. J. Lewis Smith, (137); by Dr. A. Jacobi, (13S); by Dr. Yan Giesen, (139).

Incontinence of Urine 140

Treatment at Bellevue Hospital, (140).

Infantile Leucorrhcea 141

Treatment by Dr. T. Gaillard Thomas, (141); by Dr. J. B. Hunter, (142); by Dr. V. P. Gibney, (143); by Dr. Beverly Robinson, (143); at New York Hospital, (143).

Part IV

diseases of the brain and nervous system.

Treatment by Dr. J. Lewis Smith, (144); by Dr. A. Jacobi, (146); by Dr. A. A. Smith, (147); by Dr. E. C. Seguin, (152).

VI CONTENTS.

Treatment by Dr. J. Lewis Smith, (153); by Dr. A. Jacobi, (154); by Dr. W. A. Hammond, (155); by Dr. E. C. Seguin, (156); by Dr. W. H. Thomson, (157); by Dr. E. G. Janeway, (157); at New York Hospital, (158).

Treatment by Dr. W. A. Hammond, (,158); by Dr. J. Lewis Smith, (163); by Dr. E. C. Seguin, (163).

Treatment by Dr. A. Jacobi, (167); by Dr. F. Delafield, (169) ; by Dr. W. A. Hammond, (169) ; by Dr. E. C. Seguin, (170); at Bellevue Hospital, (173); at Charity Hospital, (173).

Treatment by Dr. F. Delafield, (173); by Dr. E. C. Seguin, (175); by Dr. W. A. Hammond, (175).

Acute Hydrocephalus (Tubercular Meningitis) 176

Treatment by Dr. F. Delafield, (176); by Dr. J. Lewis Smith, (177).

Spurious Hydrocephalus — See Cholera Infantum.

Chronic Hydrocephalus 17S

Treatment by Dr. F. Delafield, (178); by Dr. E. C. Seguin, (178).

Treatment by Dr. F. Delafield, (179); by Dr. J. Lewis Smith, (181); by Dr. F. A. Burrall, (182); by Dr. W. H. Draper, (183).

Spina Bifida 184

Treatment by Dr. L. A. Sayre, (184); by Dr. A. Jacobi, (185); by Dr. H. B. Sands, (185); by Lister, (185).

Part V. Fevers

Treatment by Dr. W. H. Draper, ^186); by Dr. Beverly Robinson, (192); by Dr. F. Delafield, (193); by Dr. W. H. Thomson, (194); by Dr. A. H. Smith, (195); by Dr. Austin Flint, (196) ; at Bellevue Hospital, (196) ; by Dr. A. L. Loomis, (198).

Scarlet Fever 20s

Treatment by Dr. Alonzo Clark, (202); by Dr. J. Lewis Smith, (204); by Dr. A. L. Loomis, (205); by Dr. G. M. •Lefferts, (207) ; by Dr. F. A. Burrall, (207) ; by Dr. D.

CONTENTS. Vll

Lewis, (207); by Dr. A. Jacobi, (209); by Dr. J. H. Ripley, (210).

Measles 216

Treatment by Dr. Alonzo Clark, (216); by* Dr. A. L.

Loomis, (217).

Variola (Small Pox) 219

Treatment by Dr. J. N. McChesney, (219); by Dr. Alonzo

Clark, (225); by Dr. A. L. Loomis, (227); by Dr. \V. H.

Thomson, (223).

Intermittent Fever 228

Treatment by Dr. Austin Flint, (228) by Dr. Alonzo Clark,

(229); by Dr. F. A. Burrall, (230) ; by Dr. J. C. Peters,

(231); at New York Hospital, (231); by Dr. A. L. Loomis,

(232); at Bellevue Hospital, (234). Typhus Fever 235

Treatment by Dr. Austin Flint, (235) ; by Dr. A. L.

Loomis, (23S).

Otitis (Ear-Ache) 241

Treatment by Dr. O. D. Pomeroy, (241); by Dr. A. Jacobi, by Dr. Beverly Robinson, (244); by Dr. C. R. Agnew, (244);

by Dr. S. Sexton, (245).

Ophthalmia 248

Treatment by Dr. C. R. Agnew, (248) ; by Dr. J. Lewis

PART VI. SKIN diseases

Treatment by Dr. L. Duncan Bulkley, (251); by Dr. A. Jacobi, (258); at Bellevue Hospital, (259); by Dr. G. H. Fox, (259); by Dr. W. H. Draper, (263); by Dr. R. W. Taylor, (264); at New York Hospital, (264).

Herpes 265

Erysipelas 267

Treatment by Dr. A. Jacobi, (267); by Dr. V. P. Gibney, (268); at Bellevue Hospital, (268); at Presbyterian Hospital, (268).

Erythema 269

Treatment by Dr. L. D. Bulkley, (269); by Dr. G. H. Fox,

Vlll CONTENTS.

Urticaria 270

Treatment by Dr. L. D. Bulkley, (270); by Dr. G. H. Fox,

Scabies (Itch) 272

(273); by Dr. L. D. Bulkley, (273); at Bellevue Hospital,

(274).

Phthiriasis (Lousiness) 274

Treatment by Dr. G. Ff. Fox, (274). Tinea Favosa (Favus) 276

.Treatment by Dr. L. D. Bulkley, (276). Tinea Tonsurans (Ringworm) 278

Treatment by Dr. G. H. Fox, (278); at Bellevue Hospital,

(278).

Alopecia Areata (Tinea Decalvans) 279

Treatment by Dr. G. H. Fox, (279). Psoriasis 281

Treatment by Dr. G. H. Fox, (281). Pityriasis 282

Treatment by Dr. G. H. Fox, (282). Purpura Hemorrhagica) (Morbus Maculosus) 283

Treatment by Dr. A. Jacobi, (283).

Part I. General Diseases

ANEMIA.

Dr. A. JacOBI believes the occurrence of anaemia in infancy and childhood, to be a circumstance of vital importance. He, moreover, directs especial attention to the fact, that although this condition is so frequently observed and so dangerous, and one which ought to be treated of by the best of practitioners and writers, yet there is no text-book in which a comprehensive study of the subject can be found.

In all cases, he advises that plenty of out-door exercise be taken, and if necessary this should be enforced. Crowded school-rooms, and excessive lessons, should be particularly avoided. Regarding the diet, irregular and fast eating is prohibited as bad habits. For infants, he directs that, in the main, solid food be withheld. Barley-water and cow's milk, in his opinion, will make far better muscle than poor mother's milk. Cow's milk, either undiluted or diluted with water only, is also prohibited. The same restrictions are insisted upon regarding condensed milk. In fact, Dr. JACOBI advises that no milk whatever should be used, without the addition of some gelatinous or farinaceous decoction, such as barley-water, etc. ; and particularly in anaemia beefsoup should be added. At the end of the first year solid food may be given, and such articles be gradually included in the diet as physiology and experience permits.

Regarding the use of remedial agents, he finds that although iron has long been resorted to in the treatment of anaemia and chlorosis, yet a great many children recover in consequence of the change of diet, together with rest and an improved general nutrition, and without the use of any iron whatever. Besides, he frequently meets with cases in which the administration of iron is absolutely unavailing. In using this remedy, however, the preparations which, in his experience, are most beneficial, are the lactate, the tincture of the pomate, the pyrophosphate, the subcarbonate, and the tincture of the chloride, or muriated tincture. They should not, however, be given in the inflammatory fevers, although they may be in the septic type. Where, in addition, an absorbent is indicated, as in slow convalescence after inflam-

ANEMIA. I I

mations resulting in exudation, and especially in diseases of the glands and lungs, the syrup of the iodide is used, thus :

5 • Sy rupi ferri iodid. . . gtt.x.

Aquae ..... q. s.

M. Sig. Dose, thrice daily, to a child of two years.

The iodide, he advises, meets two indications, and,

moreover, the iodine is set free in the stomach and

interferes with decomposition. When gastric catarrh

is present and hinders the general improvement in

progressive anaemia, or during slow convalescence, he

finds the following combination especially beneficial :

E. Ferri subcarbon.

Bismuth, subcarbon.

Sodii bicarb. . . gr. xvi-xxx.

M.*Sig. This amount daily, to a child of two years.

When the action of the heart is lowered and the blood-pressure diminished. Dr. Jacobi gives the tincture of the chloride (being a vascular irritant » with greatest sen-ice. In cases of anaemia associated with gastric catarrh, and catarrh of the upper portion of the small intestine, he considers the pyrophosphate the more desirable preparation. He also uses the hypophosphites and the phosphates with good results. In chronic anaemia he finds they are all valuable. In these chronic cases, also, and especially where there

12 ANAEMIA.

is a peculiar torpid condition of the stomach, much benefit is frequently derived by him from the administration of arsenic, in minute doses, daily, well diluted with water ; he gives it thus :

5- Liq. potass, arsenit. . . . m. i-ii.

Aquae q. s.

M. Sig. Dose, after meals.

Or, he often prescribes it with iron, and with or without stomachics. By this means, he finds that marked results obtain from improving the general nutrition, and this is particularly so in cases where there is also nervous trouble. He has also found strychnia sulphate, in doses of gr. T V daily, to a child of two years, very serviceable as an adjuvant to either arsenic or iron, its use being continued for a long period of time, combined with proper food. In some instances phosphorus is employed by him with much benefit, and in cases associated with caries, etc., he often obtains very favorable results. The following is the formula for the tincture of phosphorus used at BELLEVUE HOSPITAL:

1$. Phosphori . . . . gr. xxxii.

Alcohol, absol. . . . gxlvi.

Tinct. vanillse . . . . § i.

01. aurant. cort. ... 3 iii-

Alcohol. absol. q. s. ad . 5 xlviii.

ANAEMIA. 13

* M. Sig. Twenty minims contain gr. ^ of phosphorus.

Concerning the benefit derived from the use of cod liver oil, Dr. Jacobi finds that although frequently of great service, yet in his experience the contra-indications are often overlooked. Most children, he advises, do not bear it well in the summer time, and some not at all. In all cases, moreover, he cautions that whenever digestion is impaired, and gastric catarrh present, preliminary treatment is required before the administration of either cod liver oil or iron.

The following is Dr. W. A. HAMMOND'S mixture : 9- Ferri pyrophosphat. . . . 3 i.

Quiniae sulph 3 i.

Strychniae . . . . gr. i.

Acid, phosphor, dil. . . 3 ii.

Syrup, zingib § ii.

• Aquae ad .... g iv.

M. Dose : A teaspoonful or less, according to age. Dr. T. GAILLARD THOMAS prescribes the following with excellent effect for the anaemia of chlorosis,

* The phosphorus is digested with absolute alcohol, with exclusion of air, until dissolved ; then the flavoring ingredients are added, and finally the bulk is made up with absolute alcohol to fl. ? xlviii.

occurring in young girls at about the age of puberty:

9- Ferri vini amari . . . § viiss.

Tinct. nucis vomicae . . . 3 iv.

Liq. potass, arsenit. . . . 3 ii.

M. Sig. A dessertspoonful in a glassful of water, just after each meal.

In addition to this, Dr. THOMAS, regarding the indications as being to remove the cause, cure the neurosis, and repair the damages, advises general tonic treatment and the observance of good hygiene.

Dr. J. LEWIS SMITH aims to improve and build up the general health of the child by the administration of the ferruginous and vegetable tonics, and by suitable hygienic measures. The following is one of Dr. Smith's favorite tonic formulas :

5. Ferri et ammon. cit.

Ammon. carbon. . . aa gr. xxxii.

Syrupi ......

Aquae anisi ■ . . . . aa§ii.

M. Sig. A teaspoonful.

In cases of anaemic neuralgia occurring in children of from eight to twelve years — neuralgia dependent upon and associated with anaemia — and which he finds is due chiefly to a condition of debility, he places the child upon a most nutritious diet, consisting largely of milk and beef, and directs that it be kept away from school for a season, as the study and strict discipline exacted, together with the necessary confinement and long hours, always aggravate this malady. He also advises that plenty of out-door exercise be taken, and residence in the country secured if possible ; together with regularity in the meals, the full amount of sleep, and the avoidance of constipation.

As regards medicinal measures, he orders a moderate amount of alcoholic stimulant, as a teaspoonful of brandy in milk, taken at meals, with considerable satisfaction. In addition to this, his treatment consists in the administration of any of the vegetable bitters with iron. The following combination is a favorite with him in these cases, and from its use he has often obtained marked and usually prompt benefit ; this formula is also very extensively used at Bellevue Hospital :

5- Ferri et potass, tart. . . . 3i. Tinct. cinchonae co. . . . § iv.

M. Sig. A teaspoonful in a little water, four times daily.

In some instances, under this treatment, the headache, even of months standing, has ceased in less than two weeks.

Dr. Smith also derives much good from stint-

1 6 ANAEMIA.

ulating and irritating applications along the spine. When the pain is in the trunk, he never employs a lengthened blister, or any blister over the spine, as recommended by some, but usually prefers a stimulating application, as an ammoniacal mixture ; or the following is much relied upon by him for this purpose :

^. Olei terebinthinae ....

Linim. saponis camphorat. . . e. p. M. Sig. To be applied with brisk friction, several times daily.

Or he frequently obtains considerable temporary relief from the use of dry cups, applied in three or four places over the spine, and along its side opposite the seat of pain. But for permanent good, he places the greatest reliance upon constitutional remedies.

In some instances, he advises, there is also more or less palpitation, and frequently anaemic heart murmurs are heard ; or sometimes an occasional ^hort and painless cough, without expectoration, is present. In such cases, he has found the following prescription of most valuable service :

^. Ferri sulphat 3 ss.

Acid nitric. . . . . fl. 3 ss.

Aquae destill. . . . § ss.

M. Sig. Four drops, four times daily, in sweetened water.

This cough, he finds, may also be relieved by the use of belladonna and the bromides, but at the same time advises that iron, tonics, and careful attention to hygiene, must constitute the chief means of treatment.

In anaemic girls at the age of puberty, and especially if chlorotic, Dr. A. H. Smith prescribes the following tonic mixture, from the use of which he has obtained the most gratifying results :

9- Hydrarg. chlorid. corros. . . gr. i-ii. Liq. arsenici chloridi . . . fl. 3 i. Tinct. ferri chloridi Acid, hydrochlor. dil. . aa fl. 3 iv.

Syrupi fl. § iii.

Aquae ad fl. § vi.

M. Sig. One to two teaspoonfuls in a wineglassful of water, after each meal.

This should not, however, be continued for more than two weeks at a time.

Dr. Alonzo Clark varies his treatment somewhat according to the associated condition. Besides the use of constitutional remedies, where there is also anorexia, nausea and vomiting, and constipation, he causes a free movement of the bowels, and directs that they be kept in an active condition. He then endeavors to aid digestion and to improve the general health by the administration of medicinal remedies, such as pepsin and nitro-muriatic acid, together with good, nutritious food, and by the maintenance of good hygiene. If head symptoms are present, these, he finds, also disappear as the patient improves.

Dr. Beverly Robinson prescribes the following with great satisfaction, in those cases of progressive pernicious anaemia occurring in young girls at or about the time of puberty :

9- Ext. cascarae sagradae fl. . 3 ss.

Aquae § ss.

M. Sig. Dose, at bedtime.

This is also to be repeated in the morning if required. In conjunction with the above he then administers :

5. Pil. ferri carbon. (Vallet) . No. x.

Sig. One three times daily, with meals.

Under this treatment benefit has followed in a very short time.

RACHITIS.

In treating these cases in infants, Dr. A. JACOBI first advises keeping the child in as uniform a temperature as possible, not allowing the room to get too hot, but maintaining an even temperature of about 70 , with a slight degree of moisture in the air by means of steam. An abundance of fresh air is also secured through proper ventilation ; this, he finds, is worthy of the highest consideration, and its importance cannot be over-estimated. He further directs that the child be bathed regularly and at more frequent intervals than usual, at least every morning and night. For this purpose the cold water bath, with perhaps a little salt in it, is used, and the child warmly clothed afterward.

Where a baby of one year is still at the breast, as is often the case, he insists that it be weaned at once, as the rachitis is probably more or less dependent upon the character of the mother's milk. In doing this, farinaceous foods, such as barley and oat-meal mixed with boiled cow's-milk, are gradually substituted for the breast-milk. He advises discrimination, however, in the use of barley and oat-meal, according to the condition of the bowels. If the bowels incline to be constipated, oat-meal is preferred ; but where diarrhoea is present, barley is used because of its tendency to constipation. Besides these, beef-tea or soup are also added to the diet. In older children, that is to say, of two or three years of age, he directs that plenty of beef and eggs be given in addition ; but where the general illnutrition is very marked, with a flabby condition of the muscles, and constipation, Dr. JACOBI places the child on a diet consisting of a few teaspoonfuls of raw meat and one egg in the twenty-four hours, together with plenty of oat-meal with cow's-milk. Moreover, too much milk, he advises, may prove injurious by forming a superabundance of lactic acid in the stomach and intestines.

Regarding direct treatment, it is questionable with him whether any is necessary, in a great many cases. He does not generally care to give much medicine directly, provided he can harden and toughen the child by cold water bathing and proper food. When there is much cough present, opium is occasionally required. As a rule, however, and especially where there is more or less glandular enlargement, he gives the iodides, preferring the following as one of the best preparations :

]pfc. Syrupi ferri iodidi . . gtt. viii-x. Aquae . . . . . . q. s.

M. Sig. Dose, three times daily.

In addition the salts of sodium and calcium are usually given in fair quantity. In many cases he also combines the above with cod liver oil, in doses of 3 i, three times daily. The following emulsion is very much used at Bellevue Hospital :

5- Olei morrhuae

Aquae calcis . . . aafl. § viii.

Olei cinnamomi . . . gtt. x.

M.

In cases where the child is also subject to the frequent occurrence of convulsions, or even with symptoms of meningitis present, Dr. JacOBI considers it vastly more important to improve the general condition, to insure good hygiene, fresh air, and nourishing food, than to treat the convulsions, which are but manifestations of the constitutional condition. In these children, he often finds that if plenty of oxygen, in the shape of fresh air, is obtained, the convulsions cease of themselves without any medicinal resort. This abundance of air, he advises, must also be secured during the night, as well as the day, by means of proper and thorough ventilation.

Under this plan of treatment the results, in his experience, have been very favorable. And even in cases where there is softening of the costal ends of the ribs, with a tendency to fractures of the bones of the arms, leg, and thigh — or rather infractures — he finds this general anti-rachitic treatment very beneficial. The fractures heal and general improvement in the condition of the child takes place. Later on, when the health is greatly improved, he remedies whatever defect may have taken place in the union of the bones, by refracturing them and permitting them to unite in a better position. Before this period, however, he often observes that all that is necessary is to bend the bones back again and retain them in their normal position.

In the treatment of all cases, moreover, caution is advised in distinguishing between rachitis due to syphilis, and those which are not ; as in the latter mercurials would never be employed, while in the former they are necessary to the cure.

In treating the seqaelce of rachitis, found in older children, where the pigeon breast, etc., is prominent, Dr. JacOBI's main object is to expand the lungs and to change the shape of the chest. Even where the disease is of long standing, he advises that it is possible, though not very probable, that the administration of potassium iodide will assist somewhat in causing a resolution of the induration in the lungs, which is not infrequently present. Where, however, the lung tissues have undergone constant changes, he thinks it will prove of little value. But since similar conditions are sometimes benefited by this remedy, he recommends that it be, at least, tried in these cases ; it will also act beneficially on the chronic bronchitis, which is often a troublesome feature. In administering the drug, he sometimes gives it in combination with the iodide of iron, for a time, with great benefit. The following method is much used at BELLEVUE HOSPITAL :

9- Potassii iodidi . . . 3iv.

Syrupi ferri iodidi . . . 5 i.

Tinct. calumbse q. s. ad. . § iv.

M. Sig. Half- to a teaspoonful.

Dr. JACOBI also directs that a good, nourishing and mixed diet be administered, such as beef, eggs, milk, farina, oatmeal, etc.; but coffee, tea, and stimulants are strictly prohibited. Open air exercise, play out of doors, gymnastics, the use of dumb-bells, etc., are also required, together with cold bathing; and during the winter cod liver oil should be taken to increase nutrition.

The following is the formula for the emulsion of cod-liver oil used at ROOSEVELT HOSPITAL : 5- Olei morrhuae . . . . 3 ii-

Spts. lavandulae co.

Spts. vini gall aa 3 i.

M.

Dr. W. H. Thomson finds that the best time to give cod-liver oil, when regarded as a food, is about one and one-half hours after a meal, as then the stomach is acting rapidly, and the oil is passed directly into the duodenum, where it can be readily emulsified by the pancreatic and intestinal juices.

SCROFULOSIS.

Of all the remedies employed in the treatment of the strumous diathesis of young children, Dr. J. Lewis Smith believes that the oxide of iron is apparently the best. This he gives in doses of gtt. i. for each year in the age of the child. In many cases of marked strumous aspect, he gives the following with great benefit :

IpL Syrupi ferri iodidi . . . gtt. iii. Aquae q. s.

M. Sig. Dose, thrice daily, to a child of one year.

In conjunction with this he also administers cod-liver oil. Where from the presence of an inflamed condition of the nostrils, fissures of the lips, etc., the suspicion exists that a syphilitic cachexia lies at the bottom of the case, he resorts to the application of the mercurial ointment, as follows :

9. Pulv. zinci oxidi . . . 3i.

Ung. hydrarg. nitrat. . . 3 ii-

Oleo-paraffini (Vaseline) . . § i. M. Sig. To be applied four or five times daily. If stomatitis is also present, he makes use of the following with much satisfaction :

9. Potass, chlorat. . . . 3 i.

Tinct. ferri chlor 3 i.

Glycerinae . . . . § ss.

M. Sig. A teaspoonful every three hours. In cases of scrofulous glandular enlargements, and particularly where there is also much itching present, Dr. SMITH finds the following ointment very efficacious :

9 • Ung. hydrarg. nitratis . . 3 ii.

Pulv. zinci oxidi . . . 3 ii.

Acid, carbol. . . . . gr. xiv.

Oleo-paraffini (Vaseline) . . § iss.

M. Sig. Apply by inunction.

The carbolic acid, he advises, is usually of excellent service in allaying the itching in these cases. Or, in certain instances, he uses iodine with good effect on the adenitis, thus :

9. Sol. iodinii co

Glycerinae . . . . aa§i.

M. Sig. To be applied by inunction.

Dr. A. Jacobi advises that in cases of strumous abscesses about the neck, after opening the abscess and evacuating its contents, he finds it an excellent plan to keep the opening patent by means of lint soaked in a two per cent, solution of carbolic acid.