are used as nursing bottles. These bottles are graduated and should have cotton wool for stoppers. Then a woolen wrap or cosy for the sterilizer and an ordinary 8 oz. apothecary's glass divided into half drams. Milk, sugar and limewater. A measure holding 333 of sugar of milk; a siphon to separate the cream from the milk. To operate the siphon, fill it with boiled water; never use your lips to start it. The mother or nurse should be told to follow your directions exactly, or a uniformly correct result will not be obtained. Care should be used that the source of the milk be clean and the animals properly fed. The milk should come from a herd, the cows of a common breed. The milk should be carefully strained. After straining, it should be poured into a glass quart jar, placed in ice water and covered over with a boiled cloth. Let it stand 15 or 20 minutes until the animal heat is exhausted, then seal it tightly as for preserving and allow it to stand in the ice water for six hours, using care not to let the water fall below 35° F. At the end of six hours siphon off 24 oz. of the milk, and you have all your materials ready for any combination you may wish to make. You have the milk that has been siphoned off, containing a large percentage of the proteids, the cream containing 10 per cent. of fat; the milk sugar and some fresh lime-water and some pure drinking-water that has been boiled five minutes. You can recombine these various materials into any proportions that you may require and place the requisite quantity in each tube and they are ready for the sterilizer. Rotch then advises heating to 177° F. with the cover off and then to remove the heat, replace the cover and wrap the sterilizer in its woolen covering. My own experience has been that it is better to simply sterilize at a temperature of 2129 F. I have found that there is less liability to a flocculent sediment. After sterilizing the tubes are removed and kept in a cool place until needed. As they are used they should be warmed to blood heat and a clean nipple attached. The ease and accuracy with which we can change the different combinations in modified milk makes it particularly desirable in feeding children who are ill from some of the different bowel troubles. It is my custom in most cases of summer diarrhea or diarrhea of teething children to reduce the amount of fat, with a slight reduction of the proteids in their food. Such reduction of the fat alone in the great majority of cases you find to be all the treatment needed. In that most obstinate and discouraging diarrhea of children, fermentative diarrhea, the changing of one constituent part or the other will do much toward a recovery. As a rule the reduction of the sugar will prevent the fermentative bacteria from thriving. In some cases, however, I have found it necessary to change the other ingredients. The treatment of these cases by such modification I have found extremely satisfactory, the only drug I am in the habit of using being large doses of bismuth, opium being of course contraindicated. In the Infant Hospital in Boston the death-rate has been largely reduced since the introduction of modified milk food in this class of cases.

In weakening digestions, too, a great deal can be accomplished by changing the percentages toward helping the infant retain its food. In a short paper of this kind the many therapeutic values of changing the percentages in food can only be touched upon.

The proper suggestions for infant-feeding and the rules governing substitute food should emanate from the medical profession rather than from the non-medical proprietors of commercial foods. The position occupied by the physician in comparison with that of the venders of patent foods is a very humiliating one and should no longer exist. I would not condemn all use of commercial foods, some of them are useful for children who have passed their first year, but what I would condemn is the pernicious use of these foods by the profession simply because they may have agreed with some individual children, or because some old nurse advises it. The statements of non-medical food proprietors who would tell us how to feed our young charges must be lost sight of in our own scientific knowledge of the subject and the physician must stand in the same attitude in this that he now does, in all other lines of his profession.

The commercial foods are far from being reliable, and all of them, even when containing the percentages of fats and proteids claimed for them by their owners, may have these constituents reduced below the limits of nutrition when properly diluted for the infant's feeding.

I have endeavored to make clear to you how cow's milk can be so modified as to closely resemble mother's milk. Let us refuse to be dictated to by proprietors of so-called infant foods or by old nurses, but let us think for ourselves, prepare our foods scientifically, be on the watch for improvement, and above all, hold our self-respect. I have no fear of the result when modified milk is used with care and accuracy.

SEVEN CASES OF DIPHTHERITIC CROUP-TWO ABORTED BY ANTITOXIN AND FIVE CURED BY ANTITOXIN AND INTUBATION.

BY R. M. HARBIN, M.D, ROME, GA.

Case 1. Dewey F-, aged ten months, a well nourished boy, was taken on September 15th, 1898, with symptoms of an ordinary cold and difficulty in swallowing. There was considerable hyperemia of the pharyngeal vault with some deposit of membrane on each tonsil. Two days later hoarseness began and the next day dyspnea was well marked and the temperature ranged from 101 to 103 F. I was asked to see the child by Dr. W. D. Hoyt on the 19th, at 9 a. m., and found an abundant deposit of grayish membrane on the tonsils and uvula and a great amount of swelling of the lymphatic glands of the neck; breathing was very labored and urine normal in quantity. This case furnished a perfect clinical picture of diphtheria. The usual remedies had been given and at 12 o'clock 1500 units of antitoxin was given and preparation was made for intubation. The throat was mopped with Loeffler's solution. The dyspnea remained about the same for six hours, and in twenty-four hours the breathing became normal, the deposit on the tonsils having cleared away. No other treatment was given and the patient made a good recovery.

Case 2. Annie T-, aged one year and one month, had sore throat on January 16th, 1898. I saw her on the 19th, and found an intense hyperemia of the pharynx and tonsils with a grayish deposition, each tonsil with considerable swelling of the lymphatic glands of the neck. Temperature was 102 and pulse 130. A clinical diagnosis of diphtheria was made. There was some hoarseness and on the 20th there was slight dyspnea, indicating an invasion of the larynx. The usual remedies had been given and the room was vaporized from a kettle containing lime and turpentine. There being no abatement of symptoms 1500 units antidiphtheritic serum was injected in the thigh and no other remedies were then given. In twentyfour hours the croup symptoms had disappeared and recovery was uneventful.

Case 3. Adeline B-, aged three years eleven months and previous good health, had an attack of acute indigestion on November 2d, 1898, with temperature 101 1-5 degrees and pulse 122. There was some hyperemia of the pharynx and tonsils, which later became more suspicious. During the two days following the temperature ranged from 99 degrees to 102 degrees, and pulse from 106 to 122. On November 4th I was asked to see the case with Dr. Battey and found the tonsils swollen and red with a slight deposit on the right tonsil resembling coagulated mucus, and the glands of the neck were very much enlarged. The temperature was 101 degrees and pulse 119 and urinalysis showed the absence of albumen. The patient was put upon a liquid diet and throat sprayed every four hours. For two days about the same set of symptoms continued and a clinical diagnosis of diphtheria was made. On the 6th hoarseness began and the next day at 4 p. m. a severe paroxysm of dyspnea occurred. On the 8th at 1 a. m., 1500 units of antitoxin was given, and six hours later nine ounces of urine was passed, having sp. gr. 1020, acid reaction and no albumen. At 12 a. m., there being no improvement of the symptoms, 1500 more units of the