has a speaking acquaintance with one or more of our legislators, and if our legislative committee should draft and present a bill abolishing the tax we would experience little trouble in securing its passage. Aside from exploiting the material advantages to be derived from this Association the present officers have endeavored to elevate its scientific work to the highest possible standard, and in so doing have deemed it advisable that this work be divided into appropriate sections, with a chairman and secretary for each. This plan was submitted to the Board of Council and the House of Delegates and met with their entire approval, and I recommend its continuance; in fact, we have grown so large that it has become a necessity. I recommend also the establishment by this Association of an official journal. At present there is but one medical journal published in Georgia, and it seems that the times are propitious for the launching of an official organ of this Association.

I can not close this address, gentlemen, without some expression of my appreciation of the great honor you have conferred upon me. The honor of having been the official head of the medical profession in this great State is one of which any man may be proud, no matter to what height he may have attained in his profession.

ENTEROCOLITIS IN CHILDREN.

BY THOS. J. M'ARTHUR, M.D., CORDELE.

When we consider how many little lives are destroyed by this disease we can realize something of the importance of this subject. In some of the large cities statistics show that thirty-three per cent. of the deaths from all causes is due to diarrheal affections, and of these deaths ninety-five per cent. occurs in children less than five years old, ninetytwo per cent. in children less than two years old, and sixty-seven per cent. in children less than one year old. A disease with such mortality, and which claims for its victims such a large number of innocent, helpless children should receive no small amount of consideration from the medical profession.

ETIOLOGY.

The most frequent causes of this disease are cold and improper feeding. Infants insufficiently protected by clothing and exposed to sudden changes of temperature or to currents of air, or exposed outdoors by careless nurses, frequently become affected with diarrhea from taking cold, just as other children contract coryza or bronchitis from the same cause. But the most frequent cause of this disease is improper feeding, the use of food which is unsuitable for infantile digestion, and which therefore acts as an irritant. Then, too, the food may be of good quality, but improperly administered, being given too frequently or in too great quantity, and as a consequence is not all digested. This undigested food in consequence of fermentative change stimulates the intestinal

follicles to excessive secretion, and increases the peristaltic movements by its irritating action, thus producing frequent and unhealthy evacuations. The experiments of Booker & Vaughn have given us strong evidence that bacteria are the chief casual agents of those forms of diarrhea which originate from foul air and unwholesome and indigestible food. These toxines occasion the most profound disturbances, and the invasion of other organs is not unusual. Under the influence of this intoxication from the intestinal tract the resistance of the whole organism is diminished, as is manifested by numerous complications. It is the experience of every physician that the number of cases of severe diarrhea or enterocolitis is small among breast-fed children, but in children who are artificially fed we find a great many cases. Holt emphasizes this when he says that of 1,943 fatal cases of which he has collected the records, only three per cent. was breast-fed exclusively. The season plays an important part in this disease. We see very few cases in the winter, but when warm weather appears it becomes frequent and acquires considerable prominence, owing to its severity and large mortality. This is evidenced by the statistics of all cities in temperate climates. Cases become more and more numerous and severe as the weather grows warmer, until July and August, when it obtains its maximum prevalence and severity. In these two months it is the most frequent and fatal of all diseases in cities. In September it is not so frequent and new cases are not so numerous. The fact is therefore undisputed, and is universally admitted, that this is a disease of the summer season. It is much more prevalent in cities than in rural districts for the reason that a greater number of city children are artificially fed, the air has more impurities which lowers the vitality of the child and pure milk is more difficult to ob

SYMPTOMS.

The onset is usually gradual. The child is dull and languid, or is irritable, and there is a slight rise in temperature. Nourishment is either refused or taken in small quantity. There may or may not be nausea and vomiting with flatulence and colic, which usually disappears after the first copious liquid stool. The colic and pain return, however, upon the administration of more indigestible food, and the diarrhea becomes more and more profound. The color of the discharge is at first normal, but they gradually change to a rice-waterlike fluid, without odor. A return to a darker color with odor to the feces may be looked upon as a favorable sign. There is a great thirst, and while the diarrhea is severe, the child will drink eagerly of cold water or any liquid, but when the diarrhea ceases, it refuses water and will return to the breast or bottle as formerly. At the beginning of the attack there is usually some fever, but when the diarrhea becomes profuse the fever subsides, extremities become cold, lips pale and bluish and the features are pinched. But after the diarrhea is checked the fever returns, and when this reactionary fever is of short duration, a rapid recovery will ensue. On the other hand, if the fever lasts long, recovery will be retarded and there will be rapid emaciation and atrophy. At first the stools are liquid, but later contains mucous which is sometimes streaked with blood. There may be great tenesmus, especially if the lower portion of the colon is involved. Protracted diarrhea frequently causes erythema over the perineum and sometimes as far as the thighs, due to irritation from the acid stools.. Vomiting is a very distressing symptom, if the gastric mucous membrane is involved, and the patient loses strength very rapidly owing to failure to retain sufficient nourishment and to the lack of rest. Bronchitis is

a frequent complication of enterocolitis, and sometimes gives us considerable trouble. When these little patients have been sick for sometime, become weak and have been constantly in the recumbent posture, hypostatic congestion of the lungs results from lack of heart force and feeble pulmonary circulation. This congestion, continuing, soon results in pneumonia of a low grade, which is a serious complication. Another serious complication, which is likely to occur when the loss of flesh and strength have continued for several weeks is spurious hydrocephalus, which is announced by drowsiness or vomiting and rolling of head. This, if mild, may be recovered from by stimulation, but if it is profound the usual result is death. In cases of moderate severity the duration of acute symptoms is usually about a week, and after this recovery may be slow and relapses frequent in cases previously in good condition and properly treated. In those cases which are more severe or in which relapses have been frequent, convalescence is slow and it may be months before the child fully recovers, indeed, the child may never regain its former vigor.

PROGNOSIS.

The prognosis is not good in infants and in those children whose power of resistance has been diminished by former illness, and when complicated with broncho-pneumonia or hydrocephalous. Cases which occur in the summer are in danger of relapses or recurrent attacks until cool weather appears. Persistent vomiting, continued high temperature, rapid wasting, nervousness and rapid pulse are some of the serious symptoms. Simple cases, unless the patient is weak to begin with, need not be regarded as very serious if the proper treatment is given in time. The danger lies in neglect and injudicious feeding.