to all of these mixtures, and besides, this assists in the digestion of the casein.

Hoping that I may have said something which will create more interest in the feeding of infants and thanking you for your time and attention, I will leave the subject with you.

DISCUSSION ON DR. BOYNTON'S PAPER.

Dr. M. A. Clark, of Macon: This is a very important and to me an interesting paper. As you all know, the only successful way to treat children is by paying attention to their diet. It is simply impossible to treat them successfully in any other way.

Several years ago, when the matter of percentage feeding came up, and I looked at the percentages, it seemed so much like a mathematical proposition it almost staggered me. The charts the doctor showed this morning were all good; but when he gives you a problem as “10 is to 3, and 20 is to r," you say at once, I can not bother myself with these figures, and you do not pay the attention to this subject that you should. The rules he gave are good.

If you will look in Holt's last edition, I believe you will find he gives you a good guide. He calls the first series the series of fat; proteids three to one for infants from birth up to two or three months old. He uses ten per cent. cream, and does not make the proteids stronger than 1-16 per cent. up to the fourth month.

Not wishing to trust to memory, I make a copy of the formulae I use for future reference. Holt says that a child at the beginning should take one ounce of sugar, one ounce of lime water, two ounces of ten per cent. cream, and enough water for twenty ounces. That gives one per cent. sugar, five per cent. lime water, and one hundred per cent. proteids. If you have an infant that is

normally developed and healthy and put him on the bottle, that is a good start. If that infant is not well developed, or if he shows any weakness, or the family history impresses you that there is a suspicion of weakened digestion, begin with a weaker per cent. than that. I have adopted the rule of beginning with this, instructing the mother to weigh the baby at least once a week. If the child is gaining and digesting this, at the end of one week I advise her to give one or two ounces more. If, at the end of another week, the child is doing well I usually increase the amount one ounce and a half, and at the end of another week add one ounce of cream and take out one ounce of water, etc. After the child is six months old I use seven per cent. cream, giving it two to one. I use granulated sugar, ordinary cane sugar, instead of sugar of milk. I believe it was first suggested by Dr. Jacobi, of New York, some years ago. If we could get pure, unadulterated milk sugar, it would be very desirable, and all agree that milk sugar is the sugar. But it is difficult to do that, and after the use of milk sugar, if we get fermentation, disturbance of digestion, we are apt to attribute it to the formula of food. Cane sugar is always convenient. I make it a rule to estimate how much milk I want to have used during the day. I give a formula to the mother for the amount, instructing her to prepare the whole amount, pasteurizing it, keeping it in a cold place, and during the summer on ice. I instruct her to observe the directions as to cleanliness, etc. By that method I have had very little trouble. Occasionally I forget, but we should remember that for a child two or three weeks old we should add one more ounce of cream to the proportion, which makes it strong enough; that for a child a little older we should add another ounce, and so on, until we get to the fourth month, then gradually increase

the proportions. It is a little trouble to remember the formulae, but sitting down and writing out a formula for each infant is like sitting down and writing out a prescription for each patient. This is what we should do, as it is much more satisfactory than to use the elixirs fixed up by the pharmaceutical houses so elegantly and palatably, and give the same dose to every patient regardless of temperament, build, or individual characteristics or idiosyncrasies. (Laughter.)

Dr. Boynton (in closing): I have only a word or two to say in closing the discussion on my paper. The principal object of this paper is to get physicians all over Georgia to use proper artificial feeding. Every now and then I have a baby brought into my office that is very much emaciated-in fact, starved to death, not because he is not getting food, but because that baby has been started incorrectly. For instance, take a baby at eight or nine months old that is going to be weaned, instead of starting it on artificial food at about six or seven weeks, or two months, and gradually going up, practitioners will go to work, if they use these formulas at all, and put such babies on nine months artificial feeding. The baby's stomach is not accustomed to casein, and it will be upset every time, and it is much easier to carry these babies along all right if you start them so that their digestion will keep right than it is to correct the digestive trouble you have caused by imperfect methods of feeding. I have done the same thing myself, have found out my mistake, and I simply wished to call your attention to that subject.

THE PROGNOSIS IN CHRONIC NEPHRITIS.

BY CLAUDE A. SMITH, M.D., ATLANTA.

To give a prognosis in diseases of the kidney is undoubtedly one of the most difficult tasks which the physician is called upon to perform.

In the post-mortem room and in the laboratory we may describe the condition of the kidney, and gain some idea of the amount of involvement, but clinically it is a difficult task indeed to say to what extent the kidneys may be affected.

From the time of the recognition of diseases of the kidney by Richard Bright, in 1827, different writers, such as Christison, Rokitansky, Frerichs, Virchow, and others, have given various classifications to the different diseases of the kidneys. Virchow called attention to the fact that we may have parenchymatous nephritis, an interstitial nephritis, or an amyloid degeneration. Even with as simple a classification as this, the physician is often puzzled to know which he has to deal with.

In this brief paper my remarks will be directed more to the consideration of the chronic forms of nephritis. Chronic nephritis often develops from the acute attacks, but in many instances we find that the chronic inflammation comes on insidiously, and it is not possible to say just how long the kidneys have been affected. The condition may develop so gradually as not to produce any appreciable symptoms for considerable periods, and the

condition only be brought to the notice of the physician by an acute exacerbation of the chronic condition.

We can recognize the involvement of the kidneys, in addition to the general symptoms produced, by the elements contained in the urine. This is shown by the production of albumin, casts of all kinds, blood, pus, etc., and we may have one or all of these present in the urine, depending upon the character and severity of the attack.

After finding that there is an inflammation of the kidneys, the next point is to determine as near as possible to what extent the function of the kidneys is involved. As we know, the kidneys have the ability to do a great deal more work than they are ordinarily called upon to perform, but as a result of impairment of function the entire reserve power is called upon, and as long as this is able to throw off the toxic products the vitality of the organism is preserved; but when the point is reached where these toxic products are retained in the system, and the kidneys with the assistance of the other emunctories are unable to eliminate them, then we begin to get the effect of their poisonous influence. This point of lack of elimination may be reached early, or it may come on gradually.

The physician may be called to a case where the kidneys have the ability, with the assistance of the other emunctories, to keep the body in fairly good condition, but if the other emunctories are sluggish and not doing their full duty, then the kidneys are called upon to do more than they are able to accomplish in their crippled condition, and as a result serious symptoms begin to appear.

In severe irritations the point of lack of elimination is reached early, and the condition is then spoken of as acute nephritis, or acute Bright's disease. When the irritation is of a mild type and continues day after day, month after