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attenuant of the curd. These digested gruels render the milk curds porous and also provoke the secretion of the digested juices. As diluents, they are a very great improvement on water. Most of the thick malt extracts are sufficiently active in diastase to produce the desired effect. I, however, prefer the employment of diastase itself without any of the other malt ingredients, as being both speedy and efficient. It can either be produced cheaply at home or purchased at the nearest drug store. A simple decoction of diastase may be made as follows: A tablespoonful of malted barley grain put in a cup and enough cold water added to cover it, usually two tablespoonfuls, as the malt quickly absorbs some of the water. This is prepared in the evening and placed in the refrigerator over night. In the morning the water, looking like thin tea, is removed by a spoon or strained off, and is ready for use. About a tablespoonful of this solution can be thus procured and is very active in diastase. It is sufficient to dextrinize a pint of gruel in ten to fifteen minutes. Preparations of diastase are made by a number of chemists, Parke, Davis & Co., Forbs, Horlick and others.

There are cases constantly arising where milk must be withheld for a time or given only in small quantities. Here is where the judgment of the physician is put to a test. The symptoms that call for modification or change of diet are loss in weight, vomiting, colic and unnatural stools. A brief glance at these conditions may be helpful to some in applying dietetic remedies.

Weight. The weight of the infant is the best means we have to measure its nutrition. It is as valuable a guide to the physician in infant feeding as is the temperature in a case of continued fever. Although the weight is not to be taken as the only guide to the child's condition, it is of such importance that we can not afford to dispense with it during the first two years. It is a great advantage to keep up regular observations during childhood. A child may not always gain rapidly, but it should gain steadily, and if it does not, something is wrong. All the conditions surrounding the infant should be investigated, but especially the food. One should

not be satisfied unless the average weekly gain during the first six months is at least four ounces.

Vomiting. When vomiting occurs immediately after feeding, it is probably caused by simple distension of the stomach, and less bulk of food is accordingly indicated. The vomiting that occurs some time after feeding is apt to be caused by undigested food, the rejections are frequently highly acid, and there may be curds and mucus present. Projectile vomiting, where food is rejected with force, is an indication of brain irritation.

Colic.-Colic may be caused by cold, but is more frequently induced by the fermentation of indigestible food.

Conditions of the Stool.-Much may be learned by a careful inspection of the stool with reference to increasing or diminishing the various kinds of food. The normal stool is smooth, yellow, homogeneous, and about the consistency of thin mush. The following may be considered abnormal types:

Green Stools.-Stools can only be considered green when that condition is evidenced immediately upon their passage. They are due to fermentation, which is doubtless a bacterial action. All stools become green a certain time after passage, caused by oxidation of the air.

Curdy Stools.-Curdy lumps may be procured by undigested casein or fat. The former are hard and yellowish, while the latter are soft and smooth, like butter.

Slimy Stools.-These are the result of catarrhal inflammation. When the mucus is mixed with the fecal matter, the irritation is high up in the bowels, but when flakes or masses of mucus are passed, the trouble is near the outlet.

Yellow, Watery Stools.-These are seen in depressed nervous conditions, especially in the hot days of summer, when the bowel is relaxed and the inhibitory fibers of the splanchnic nerve do not act to advantage.

Very Foul Stools.-These are caused by decomposition of the albuminoid principles of the food.

Profuse, Colorless, Watery Stools-With a little fecal matter, are

doubtless caused by an infective germ akin to Asiatic cholera. This is known as cholera infantum. It is rare to see one of these types by itself, with the exception of the last; they may be seen in all combinations.

In slight forms of unnatural stools, increase the dilution of the top milk and reduce the quantity of sugar a little. If large lumps of fat are in the stools, use milk containing less fat for diluting. This can be obtained by taking more top milk out of the quart bottle. Where lumps of casein are apparent, the diluent must be increased. If increasing the dilution and reducing the fat and sugar does not overcome the trouble, stop the milk and feed dextrinized gruel for a day, gradually adding a little milk, which is increased in amount as fast as the infant can digest it.

There are times when infants can not digest milk in any form, no matter how much it may be diluted nor what diluent is employed. They may be given mutton broth, from which the fat has been removed, extracted beef blood and water, dextrinized wheat or barley gruel, or dextrinized gruel, to which either the white or yolk of an egg has been added.




Without going into a discussion of any of the causes or supposed causes of labor, or why pregnancy should end at or near the end of the tenth lunar month, it is my desire to present a few thoughts that seem to me to be worthy of our careful attention.

When called to see a patient who thinks she is in labor the first duty of the accoucheur is to find whether or not this is true. This is not always easy, and can not be accomplished in every case by a hasty examination of the mouth of the womb through the vagina.

The first thing to be done is to gain the confidence of the patient and convince her that you have a deep interest in her case. Get a history of her case from the beginning of the pregnancy; let her tell you the exact date of her last menstrual period, if she can remember it. Count the time and see if it is time for normal labor to come on. The best rule for me to remember is to take the date of the beginning of the last menstruation, count back three months, then add seven days and you have her exact time to be confined.

The obstetrician should now wash his hands and the vulva of the patient with soap and hot water, rinse them with listerine or a solution of bichloride of mercury-1-2000-and then make a digital examination of the mouth of the womb to see if she is really in labor; if so, how far advanced the dilatation is. At this examination he should determine, if possible, the exact presentation and position of the child so that it will not be necessary to examine again until the membranes rupture.

At this visit the abdomen should be palpated externally, the fœtal heart listened for, and everything possible found out that would be of advantage in her delivery. If she is yet to be several hours in

this stage, the bowels should be moved by an enema, and if not convenient to a bath tub at least a hip bath should be given, after which an antiseptic dressing should be applied to the vulva, held in place by a T bandage.

If the pain is severe, ten grains of chloral hydrate should be given, and another dose of five grains in thirty minutes if the first dose does not procure sleep and relief for the patient. After watching for the effects of the medicine, if the relief is sufficient, the physician may go on making his other calls, instructing the patient to empty the bladder when she desires, that she may sit up or walk about the room if she feels like it, always leaving word where he can be found when wanted on short notice. Instruct the patient that she shall not bear down with the abdominal muscles during the first stage of labor; that it does not hasten the termination of the labor, and may do a great deal of damage to the neck of the womb by jamming it down into the bony pelvis before it is sufficiently dilated.

What I have detailed above is necessary in a perfectly normal case of labor if found before the second stage has been reached. If there are abnormalities, the earlier they are discoverd and properly cared for the better for all concerned. It is in the first stage that version should be practiced if necessary; in fact, if the second stage has set in before it is attempted, it will be found very difficult to perform and much more hazardous, both to mother and child. During this stage all the preparations should be made for the second and third stages, from the proper arrangement of the instruments to be used, bed for the patient, anesthetic and even the making of a string to tie the cord with.

While I have not tried to mention all that might be said or done during the first stage of labor, I have tried to show that there is plenty to be done to show a proper interest in any case without making frequent digital examinations of the womb, a practice that can not be too strongly condemned.

The real object of this paper is to call attention to what I consider one of the most pernicious practices that a physician could be guilty of that of hurrying a patient into the second stage of labor

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