MINUTES OF THE SECTION

ON

DISEASES OF CHILDREN.

WEDNESDAY, June 7, 1882.

SECTION On Diseases of Children met at Druid's Hall, 3 P.M. Dr. S. C. BUSEY, President, absent.

On motion of Dr. N. S. DAVIS, of Illinois, Dr. WILLIAM LEE, of Maryland, Secretary of the Section, was elected President, and Dr. E. C. MILLER, of Iowa, Secretary.

Dr. DAVIS read a paper on the Means for Lessening the Mortality of Infants from Bowel Affections.

Dr. LEE, after stating that the paper was calculated to do much good, and the thanks of the Section should be extended to Dr. Davis, said whilst he could add nothing to the first part of it, in regard to treatment of diarrhoea, he was satisfied, in order to meet with success, we should be careful in every case to have for our object the immediate removal of the exciting causes, and that when due (as in nearly every case at first they were), to acid fermentation of the food, alkalies are useful, and their beneficial effects could not be overrated. The doctor then alluded to the advantage of always carrying litmus paper, and using it to see if the discharges were alkaline or acid.

On motion the paper of Dr. Davis was referred to the Committee on Publication.

Dr. LEE read a paper on Some Observations made during the Treatment of Rickets.

Dr. DAVIS had met with three cases of well-marked rickets in five years; he believed, however, it was on the increase, and that many cases of deformities were due to the disease.

Dr. WARDEN, of New York, generally found the disease among foreigners; considered it the result of faulty habits of life and improper food.

Dr. CHARLES W. EARLE, of Illinois, had seen several cases of rickets lately, and believed with the Chairman that it was on the increase; his cases made excellent recoveries, without much medicine, under proper hygienic measures and good nourish

ment.

Had not observed craniotabes in any of his cases, probably from the fact that he did not make very careful examination of the patient's head.

In many cases the pigeon-shaped breast seen in adults, could be traced to rickets in early life.

Dr. LEE thought the too general use of artificial preparations of infants' food, over-crowded and badly ventilated tenement houses, were prolific causes of this disease.

There being no further discussion, on motion Dr. Lee's paper was referred to the Committee on Publication.

THURSDAY, June 8.

Section met at Druid's Hall, 3 P. M., but as the gentlemen who were to read papers did not put in an appearance, and as nothing was before the Section, Dr. LEE opened a debate on headaches of children, and said that, in his opinion, they were not fully appreciated; he had seen many cases in which children suffered from headaches almost constantly, and he was satisfied they meant more than the profession were willing to admit. He then cited the cases of two children, who, after suffering from attacks of headaches for three months (the pain being confined to the right side), began to show signs of chorea; and that as soon as the choreic movements became fully established the headaches stopped,—showing, in his opinion, a direct connection between the two affections.

Dr. MILLER, of Iowa, said he had no doubt that the Chairman's interesting statements were true; he had seen quite a number of school children who suffered from headaches brought on from over-study and bad ventilation.

OBSERVATIONS ON THE EFFICIENT CAUSES OF SEROUS DIARRHOEA AND CHOLERA MORBUS IN INFANCY AND EARLY CHILDHOOD, AND THE BEST MEANS FOR LESSENING THE MORTALITY FROM THOSE AFFECTIONS. By N. S. DAVIS, M. D,

CHICAGO, ILL.

WHEN it is remembered that one-third of the human race perish before they reach five years of age, and that a large percentage of these early deaths are the direct result of attacks of serous diarrhoea and cholera morbus in infancy, it will be conceded that no subject is more worthy of careful study than the etiology and prophylaxis of these affections. I mention etiology and prophylaxis together, because all measures designed to prevent diseases must be intelligently adjusted either to the removal of the efficient causes or to a neutralization of their effects, else they will fail to accomplish any useful purpose. Nearly all the public sanitary and hygienic measures which characterize the present stage of civilization, are aimed at the removal or prevention of the causes of disease, both predisposing and exciting. But there are many etiological influences of great potency in either predisposing to or exciting attacks of disease, which are not under human control. The problem presented for consideration concerning these, is not how to prevent or destroy them, but how best to shield the human system from their injurious effects. For instance, bad food may be destroyed and that which is good substituted in its place; bad and impure air in dwellings may be displaced by ventilation; soils wet and impregnated with decomposable vegetable and animal matter may be improved by drainage and cultivation; but the meteorological conditions of the atmosphere, whether they relate to

impurities, sudden and extreme changes, or waves of continuous high or low temperature, are not amenable to our control, and yet much can be done to mitigate or prevent their injurious effects. Nearly all the recent writers on practical medicine and on diseases of children class the cases of serous diarrhoea and cholera morbus in children under two years of age, usually called "summer complaint" and "cholera infantum," with the local inflammations under the general name of catarrhal gastro-enteritis. And while they all assert that these forms of diseases are most prevalent and fatal during the warmest months of summer, they set forth as the chief causes improper feeding, impure and changed milk, impure and confined air, the progress of dentition or " teething," and overworked, badly fed, and unhealthy mothers and nurses. All these causes are represented as producing either gastric or intestinal indigestion or both, which so increases the irritation of the mucous membranes as to cause a more or less rapid serous exudation into the gastric and intestinal canal with excessive evacuations. It will be noted that indigestion is very generally alleged as the immediate cause of the so-called catarrhal irritation and excessive discharges; while the indigestion is in turn regarded as the result of bad feeding, impure air, teething, and unhealthy mothers or nurses. Dr. Flint and others have placed much emphasis on the influence of the adulterated and poor quality of milk distributed in our large cities. That the milk so distributed is often of poor quality, and is productive of gastric and intestinal derangements, and that all the other causes enumerated are often the occasion of similar derangements, I freely admit. But I am quite certain that a more careful and extended clinical study will show that none of the causes usually enumerated really exert more than a minor influence over the production of the so-called summer complaint and cholera infantum that prove so destructive to infantile life in many of our cities and populous towns every summer. For instance, a moderate degree of attention will show that the errors in feeding infants, the adulterations of milk and impurities of other food, and the unsanitary condition of dwellings, are quite as prevalent in all communities during the winter as the summer. It is quite certain that in every community there are, on the average, as many children cutting their teeth in December and January as in July and August; and I have been wholly unable