regard to feeding of infants, and ever since then, at my first visit after confinement, I have given the mother one of these little pamphlets. Attached to it is a weight table. I request the mothers to weigh their babies once a week, and make a record on this table. As long as the child is improving, or as long as there is a normal increase, I consider the child is getting sufficient nourishment. As soon as the breast begins to fail, you begin to get either no increase in weight, or perhaps a loss in weight. It does not make any difference what age the child may have reached at that time. If I can not improve the mother's condition in a short time, and get another increase in the weight of the child, I put the child on modified milk. I look upon the weight chart as one of the most important things connected with the feeding of children, because it will always give you an indication as to whether the baby is thriving or not. As a rule, if you go to a case a day or two after confinement, and there is no milk, there is some reason for using artificial food. The ordinary instructions are to give milk and water. The feeding of children in this country is absolutely horrible. There is scarcely a city of any size in this State but what, during the next ninety days, if you took up the morning's paper you will see anywhere from four to fifteen deaths of children of three months to one year of age, when practically all of these deaths are due to improper feeding.

Dr. St. Joseph B. Graham, of Savannah: I agree with Dr. McHatton that a weight chart is one of the most important things we can use in connection with infant feeding. During my term at Heidelberg, at the Louisien Heilanstadt, under Professor Vierholdt, professor of diseases of children, he relied more on the weight chart than on anything else. He also took into consideration the stools of the infant. The Germans are very particular in regard

to the matter of examination of the stools to find out whether the baby is passing too much fat or not. They take fat in the milk, but it comes through in the form of a fatty stool, and they dissolve that out with potassium and such things, making a soup of it, and finding out exactly what the stools amount to, how much fecal matter there is, and how much fat. A baby of my own was born in Heidelberg, and was under the care of Professor Vierholdt. That baby did badly on all sort of milk, but after sending it to the Louisien Heilanstadt it soon gained a pound a day on modified milk.

Dr. Visanska (closing the discussion): There is nothing I can add to what I have already said. I have taken up too much of the time of the Association, but simply wish to thank the gentlemen who discussed the paper.

SOME CASES OF ABDOMINAL PAINS.

BY DR. LOUIS C. ROUGLIN, ATLANTA.

The abdominal and pelvic cavities containing but comparatively few organs, the location of each in health varying but slightly from a relative fixed position, the function, pathology and symptoms arising of those that are most often subject to acute and inflammatory diseases being rather well defined and known, it would seem that there should be but very little difficulty in recognizing these lesions and making an early and correct diagnosis. Pain is the chief symptom which first attracts the patient's attention, and for the relief of which the physician is consulted. Now, by general consent, the laity has divided abdominal pains to belong to three classes of disease, namely, colic, indigestion and appendicitis, and frequently a careless physician, making a flashlight diagnosis, helps to confirm this belief and gives it the stamp of authority.

There is, perhaps, in the whole domain of medicine, no part in which an early and exact diagnosis is more important, and yet more difficult to make, than that in which abdominal pains is a prominent symptom, and the physician can less afford to commit himself until he has at least made a thorough physical examination, and in some cases a microscopical and chemical examination is necessary before one can reach a conclusion as to what would be the rational method to pursue in a case of abdominal disease.

The symptom of pain, when it can be traced to its incipiency and not aggravated by misapplied efforts, or soothed and masked by opiates, may serve as a guide upon

which as a basis a correct diagnosis can be made; but this is, in a majority of cases, not attainable, and we must also remember that the absence of pain in abdominal disease is often fraught with grave consequences; and I need not emphasize that in connection with the pain all physical, subjective and objective, and all rational signs must be considered before a proper conclusion can be reached.

Disease, in which abdominal pains play an important role, may be divided into two great classes:

1. Those which are entirely medical.

2. Those which are entirely surgical,

and an intermediate class, which may gradually or rapidly drift from one into the other, or which may at all times. belong to both branches.

Abdominal pains belonging to the first class are characterized that in, but few exceptions and except under special conditions the manifestation of the systemic phenomena of shock is wanting; as in acute and chronic constipation, ordinary colic, mild cases of dysentery, typhoid fever, non-perforating ulcers, syphilis, gastralgia, the excessive peristaltic action incident to the administration of purgatives and other drugs, notably arsenic, ipecac, etc. The second class may be subdivided into these: 1. Pain, and shock developing later, peritonitis either never present or developing slowly, as in tuberculosis.

2. Pain and shock appearing simultaneously, but without peritonitis, as in abortions, miscarriages, or in torsion of pedicle of an ovarian cyst.

3. Pain and peritonitis occurring together without shock, as in inflammation of the appendix.

4. Pain, shock and peritonitis occurring simultaneously, as in gangrene of the gut.

The symptoms, history and physical examination can

not always be depended upon as a true guide as to what class a case may belong, for often the true condition of a case can not be determined until the abdominal cavity is opened. The following cases occurring in my practice will serve to illustrate the difficulty of determining the true pathological condition with pain as a prominent factor:

Case No. 1.-M. G., male, age ninteen years, clerk in a store. Does not drink or chew, smokes moderately; had diseases of childhood, otherwise negative; denies all venereal diseases; family history negative. First presented himself July 26, 1904, suffering from constipation and obstruction of the bowels, due to impacted feces. From these conditions he was relieved under the usual treatment, and his bowels regulated by diet and occasional olive oil enema.

On October 1st he came to the office complaining of pain in the left hypochondrium; his bowels were regular, had good appetite, and no temperature-on account of the pain he had to quit work, and could not sleep. He described the pain as sharp and cutting, which would strike him all of a sudden and "double him up;" this. would last from fifteen to twenty minutes, would disappear to reappear again at a varying interval.

On

On examination the whole abdomen was found to be extremely hyperesthetic, palpation was impossible. the patient's refusal to be anesthetized I sent him home and endeavored to examine him while seated in a hot water bath; from this I derived but little satisfaction, and again made an examination on the next day, but could find no physical sign of any pathological condition. Examination of urine and feces was negative; his stools were normal, and he had regular actions. I diagnosed the case as one of nervous enteralgia, and put him on a pill of arsenic sumbul and iron.