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Entered according to the Act of Congress in the year 1889 by

LEA BROTHERS & CO.,

In the Office of the Librarian of Congress at Washington. All rights reserved.

PHILADELPHIA

DORNAN, PRINTER,
N. W. cor. Seventh and Arch Sts.

CONTRIBUTORS

ΤΟ

VOLUME FIFTY-FIVE.

LEWIS H. ADLER, M.D., of Philadelphia.
DUDLEY P. ALLEN, M.D., of Cleveland, Ohio.
HENRY C. ALLEN, M.D., of Los Angelos, Cal.
JOHN ASHHURST, JR., M.D., of Philadelphia.
JOHN AULDE, M.D., of Philadelphia.

J. M. BALDY, M.D., of Philadelphia.

ROBERTS BARTHOLOW, M.D., LL.D., of Philadelphia.

A. N. BELL, M.D., of Brooklyn, N. Y.

G. M. GARLAND, M.D., of Boston.
ALBERT L. GIHON, M.D., of Washington, D. C.
S. P. GLOVER, A. M., M.D., of Beyrout, Syria.
WILLIAM GOODELL, M.D, of Philadelphia.
WALTER D. GREEN, M. D., of Philadelphia.
H. A. HARE, M.D., of Philadelphia.
FREDERICK P. HENRY, M.D., of Philadelphia.
J. F. HEUSTIS, A.M., M.D., of Alabama.

HENRY G. BEYER, M.D., Ph.D., M.R.S.C., of G. C. HUBER, M.D., of Ann Arbor.
Washington, D. C.

FRANK BILLINGS, M.D., of Chicago.

JOHN S. BILLINGS, M.D., of Washington, D. C.
JOHN J. BLACK, M.D., of New Castle, Delaware.
HENRY R. BOWDITCH, M.D., of Boston.
VINCENT Y. BOWDITCH, M.D., of Boston.
A. V. L. BROKAW, M.D., of St. Louis.
DANIEL R. BROWER, M.D., of Chicago.
CHARLES H. BURNETT, M.D., of Philadelphia.
SWAN M. BURNETT, M.D., of Washington.
JAMES R. CHADWICK, M.D., of Boston.
S. H. CHAPMAN, M.D., of New Haven.
N. E. CHARLTON, of Trinidad, Colorado.
WALTER CHRYSTIE, M.D., of Philadelphia.
SOLOMON SOLIS-COHEN, M.D., of Philadelphia.
A. COOLIDGE, JR., M.D., of Boston.

JAMES M. CRAIGHILL, M.D., of Baltimore, Md.
ANDREW F. Currier, M.D., of New York.
ROLAND G. CURTIN, M.D., of Philadelphia.
J. M. DACOSTA, M.D., of Philadelphia.

J. CHALMERS DACOSTA, M.D., of Philadelphia.
J. HERBERT DAREY, M.A., M.D., of Granger, Minn.
EDWARD P. DAVIS, M.D., of Philadelphia.
JOHN B. DEAVER, M.D., of Philadelphia.
CHARLES DENISON, M.D., of Denver, Colorado.
F. X. DERCUM, M.D., of Philadelphia.
GEORGE E. DE SCHWEINITZ, M.D., of Philadelphia.
ROBERT T. EDES, M.D., of Washinton, D. C.
CHARLES SETH EVANS, B. S., M.D., of Cincinnati.
EDWARD EVANS, M.D., of La Crosse, Wis.
A. M. FIELDE, M.D., of Swatow, China.
F. FORCHHEIMER, M.D., of Cincinnati.

M. H. FUSSELL, M.D., of Philadelphia.

E. FLETCHER INGALS, A.M., M.D., of Chicago.
EDWARD JACKSON, M.D., of Philadelphia.
W..W. JAGGARD, M.D., of Chicago.
JOHN A. JEFFRIES, M.D., of Boston.

C. W. KAVANAUGH, M.D., of Gainesville, Texas.
CLARENCE KING, M.D., of Machias, N. Y.
E. H. KING, of West Liberty, Iowa.
FREDERICK I. KNIGHT, M.D., of Boston.
Paul H. KRETZSCHMAR, M.D., of Brooklyn, N. Y.
Ernest LaPLACE, A. M., M.D., of Philadelphia.
GEORGE M. LEFFERTS, A. M., M.D., of New York.
MORRIS J. LEWIS, M.D., of Philadelphia.
JAMES HENDRIE LLOYD M.D., of Philadelphia.
ALFRED LOOMIS, M.D., LL.D., of New York.
HENRY M. LYMAN, M.D., of Chicago.

RICHARD LEA MACDONNELL, B. A., M.D., of Montreal, Canada.

E. M. MAGRUDER, M.D., of Virginia.
THOMAS H. MANLEY, M.D., of New York.

MATTHEW D. MANN, M.D., of Buffalo, N. Y.

EDWARD MARTIN, M.D., of Philadelphia.
JOHN MARTIN, Ph.M., M.D., of Ann Arbor, Mich.
Arthur V. MEIGS, M.D., of Philadelphia.
W. M. MEMMINGER, M.D., of Charleston, S. C.
O. H. MERRILL, M.D., of Corinna, Maine.
S. WEIR MITCHELL, M.D., of Philadelphia.
ROBERT B. MORRISON, M.D., of Baltimore, Md.
THOMAS S. K. MORTON, M.D., of Philadelphia.
JOHN C. MUNRO, M.D., of Boston,
J. H. MUSSER, M.D., of Philadelphia.
THOMAS R. NEILSON, M.D., of Philadelphia
WILLIAM OSLER, M.D., of Baltimore, Md.
EDWARD O. Otis, A. B., M.D, of Boston.

ROSWELL PARK, M.D., of Buffalo.
CHARLES T. PARKES, M.D., of Chicago.
THEOPHILUS PARVIN, M.D., of Philadelphia.
GEORGE L. PEABODY, M.D., of New York.
CHARLES B. PENROSE, M.D., of Philadelphia.
WILLIAM PEPPER, M.D., of Philadelphia.
E. B. PLATT, M.D., of Baltimore, Md.
J. J. PUTNAM, M.D., of Boston.

B. K. RACHFORD, M.D., of Cincinnati, Ohio.
B. Alex. RandALL, A.M., M.D., of Philadelphia.

W. O. ROBERTS, M.D., of Louisville.
BEVERLEY ROBINSON, M.D., of New York.

L. V. RONING, M.D., of Rogers Park, Ill.

H L. RUSSELL, M.D., of Poynette, Wisconsin.

RALPH W. SEISS, M.D., of Philadelphia.

Lawson Tait, F.R.C.S., of Birmingham, Eng.
R. W. TAYLOR, M.D., of New York.

T. GAILLARD THOMAS, M.D., of New York.
W. W. TOMPKINS, M.D., of Charleston, West
Virginia.

C. W. TOWNSEND, M.D., of Boston.

E. L. TRUDEAU, M.D., of Saranac Lake, N. Y.
S. S. TURNER, M.D., Surgeon U. S. Army.
JAMES TYSON, M.D., of Philadelphia.
JAMES B. WALKER, M.D., of Philadelphia.

J. HOWELL WAY, M.D., of Waynesville, N. C.
ROBERT F. WEIR, M.D., of New York.
WILLIAM H. WELCH, M.D., of Baltimore.

J. WILLIAM WHITE, M.D., of Philadelphia.

W. R. WHITEHEAD, M.D., of Denver, Colorado.

NICHOLAS SENN, M.D., Ph.D., of Milwaukee, Wis. RICHARD WILSON, Student of Medicine, University

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THE MEDICAL NEWS.

A WEEKLY JOURNAL OF MEDICAL SCIENCE.

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motor centres. And the severity of a given attack of this disease will depend upon the presence and potency of the active cause in addition to the predisposing causes. An infant exposed to a sudden cool change in summer may suffer from congestion of the digestive organs, with transudation of serum and hypersecretion of the mucous membrane of the digestive tract; if the child's food be

A Clinical Lecture delivered at the Woman's Medical College of lessened and be free from fermentation and irritating

Philadelphia.

BY EDWARD P. DAVIS, M.D.,

OBSTETRICIAN TO THE PHILADELPHIA HOSPITAL, ETC

FROM the many terms employed to designate a disease characterized in infants by inflammation of the digestive tract, with diarrhoea, fever, and exhaustion often resulting fatally, the name gastro-intestinal catarrh has been chosen as best describing the pathology of the affection and embracing all grades of its severity. Cholera infantum may fairly designate cases not frequent in which the severity of the affection and rapidly fatal result closely simulate Asiatic cholera.

We shall obtain a better understanding of the pathology of this disease if we first consider some points regarding normal digestion in infants. It has been shown by Koch that lactic acid is wanting in the gastro-intestinal tract of patients dying with Asiatic cholera, and it might reasonably be inferred that lactic fermentation is part of the processes of normal digestion. Recent studies by Baginsky and Leo have confirmed this inference so far as the digestion of infants is concerned. The stomach of the newborn child does not contain pepsin as an active ferment, but digests by the action of lab ferment and zymogen, and when cow's milk is taken hydrochloric acid is secreted in excess. The lactic fermentation or hydro-lactic acid digestion is present normally, and it is not this process, but a further acid fermentation resulting in the change of the neutral lactates to butyric acid, with the formation of acetic acid and acetone, which is pathological; the digestion of starch, casein, and albumin is checked simultaneously with the formation of the acetic compounds.

The bacteria, whose presence accompanies the lactic fermentation, are adjuvants in normal digestion, and their activity is not to be checked; it is the excessive formation of bacteria arising through failure of the inhibitory function of the lactic bacteria which is to be combated. Examination of the adult stomach reveals the presence of bacteria in abundance, whose function in normal digestion is to aid in splitting up ingested foods. There are, then, bacteria and bacteria, some benign and adjuvant, others malignant and destructive, according to the part they bear in aiding or hindering digestion.

Regarding the causation of gastro-intestinal catarrh, its active cause is most often irritating food; its predisposing causes are those which favor vaso-motor paralysis and blood-stasis in the digestive organs, as exposure to cold and the depressing effect of heat on the vaso

matter, nature soon cures the case with a few loose stools which relieve congestion and cause the gastrointestinal catarrh to cease. If, however, upon this condition of blood-stasis and hypersecretion the acetic bacteria and irritating products of their activity be grafted, a general gastro-intestinal catarrh results attended by the rapid growth of bacteria and structural lesions of a grave

nature.

Distinguishing, therefore, between the predisposing and active causes of the disease in question, we find that the most important factor in producing active causes is heat. When the average temperature for twenty-four hours is so high as to favor the decomposition of the albuminoid envelope of the fat drop which forms the milk globule, milk ceases to be an unirritating food and becomes an active irritant and conveyer of pathogenic bacteria. Milk is ordinarily taken from the cow early in the morning, and delivered to the consumer before 9 or IO A.M. When the night temperature rises disease caused by irritating milk increases; in early autumn it is less frequent so soon as the nights become cool although the days are warm. Not only Not only is milk affected by heat, but the water of ponds, lakes, and rivers contains an increased quantity of fermented material and bacteria so soon as the night temperature permits the continuous decomposition of vegetable and animal albuminoids contained in leaves and twigs, and in the bodies of birds and fish. Milk and water under certain average temperatures are very liable to become active causes of gastro-intestinal catarrh.

The pathology of these cases varies from that of simple blood-stasis and transient hypersecretion to the development of well-marked ulceration of the large intestine with profound anæmia of vital organs and passive congestion in the cerebral sinuses. In cases which seem to survive the disease only to perish later in collapse, no gross lesion is found sufficient to explain the fatal issue, and marasmus expresses our ignorance of the pathology of these cases. It is not improbable that atrophy of the gastric tubules resembling that found in adults in pernicious anæmia is present in such cases. Examination of the stools in cases attended by intestinal lesions reveals undigested food, pus, and bacteria in abundance; when chemically examined fat is present in increased quantities, showing failure of pancreatic digestion.

The symptoms of a compensatory catarrh following simple congestion are moderate fever, restlessness, thirst, and frequent liquid-yellow stools often containing mucus. In severe cases fever becomes high, restlessness is well

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