26. "Dermoid Cyst of the Bladder, with the Report of Case," by Dr. W. A. Crowe, of Atlanta.

27. "Hemorrhagic Fever," by Dr. L. P. Hudson, of Coch

ran.

28. "Acranial Monster, with Specimen and Report of Case," Dr. W. P. Williams, of Blackshear.

29. "Quinine Blindness," by Dr. A. W. Calhoun, of Atlanta.

30. "Infant Mortality," by Dr. E. Van Goidtsnoven of Atlanta.

31. "LaGrippe," by Dr. W. C. Lyle, of Augusta.

32. "History of Epidemics," by Dr. Marcus F. Carson, of Griffin.

There being no further business, the Association, on motion, adjourned to meet on Cumberland Island, the third Wednesday in April, 1897.

ENTERO-COLITIS OF INFANCY.

BY M. A. CLARK, A.M., M.D., MACON, GA.

When we consider how many little lives are sacrificed by this dread disease, we are impressed that it cannot be too often discussed. Hence, if I do no more than emphasize what has already been taught in regard to it, I shall not have imposed upon the time of this Association.

It is my purpose to give you my views as the result of a careful study of numerous cases. I shall devote the most of my time to the treatment, it being the most important part of the disease.

I prefer the term entero-colitis to intestinal catarrh, because it more fully conveys what the pathology of the disease is. While in adults and children we recognize enteritis and colitis as separate and distinct diseases, yet in infants the symptoms are not sufficiently well marked to enable us to differentiate them. In fact, as J. Lewis Smith says, "In the majority of instances there exists an inflammation of both the small and large intestines, the one rarely existing without the other."

This inflammation may be ulcerative, membranous, or, as is more frequently the case, a simple inflammation of the mucous and submucous linings of the intestines.

Causation.-Cold is often the cause of intero-colitis, and, in a majority of the severer cases, it plays an important part. The most important factors, however, in the causation of this disease are temperature and diet.

The summer heat without doubt influences very mark

edly the cause of this disease, as it invariably occurs in its intensity during the summer months. It is most fatal during July and August, and abates as cooler weather comes on. It is, however, not so much the heat itself as the effect. it has upon the atmosphere and the diet.

After all, it is the diet that is the most important cause. This is proven by the fact that the majority of fatal cases are bottle-fed infants. Of 1,943 fatal cases reported by Holt, only three per cent. were wholly breast-fed. All writers agree that outside of the cities, especially in the rural districts, it is of far less severity. Some seem to think

We will all readily

it of little importance in these districts. agree that it is far more fatal in cities, but we must insist that its gravity is such as to cause us deep concern in our towns and villages. In this fast age of ours so many mothers are unable to nurse their babies, that artificial feeding must be relied upon. Consequently entero-colitis is now a disease that demands careful thought and attention, even by the country practitioner.

Age is a predisposing cause. The greatest number of cases occur between six and eighteen months. It is less frequent up to the third year, after which it is rare.

Teething is usually given as a predisposing cause. Some authors even go so far as to explain that the excess of salts in the saliva produces a diarrhea that is beneficial to the patient. How often it has been said that the baby is sick with teething. Even the physician, in answer to the question of the anxious mother as to what is the matter with the baby, replies, "teething." It is proverbial with the laity that the second summer is very trying with infants, because they are cutting teeth. I wish to say most emphatically teething is wholly a physiological process, and has nothing to do with the cause of this disease.

During the process of dentition, nature is preparing the alimentary canal for the important functions of digestion,

and because of this evolutionary process, the whole mucous membrane is susceptible to the slightest irritant. The teeth have absolutely nothing to do with this process, and if kept clean and sound have nothing to do with the bowel troubles of infancy. Let us use every available opportunity to eradicate such ideas from the minds of the laity. Many little lives have been allowed to languish and die because their mothers thought they had to be sick while teething.

According to Booker and Vaughan, bacteria are found in the stools. Hence there is no doubt that bacteria play an important part in the cause of the bowel diseases of infancy.

Symptoms.-Onset is usually gradual, languor, fretfulness, and slight rise of temperature. The diarrhea is so mild at first, that it is considered of no importance, so thoroughly prevalent is that erroneous idea that the bowels must be loose during dentition. Let us impress upon all mothers that any diarrhea, however slight, during teething is a symptom of disease, and should have the attention of the physician. By thus acting, we will save ourselves many anxious moments, and relieve many little sufferers before it is too late.

The stools are variable, at first yellow, then brown, then green, or they may be green from the onset. At first there may be considerable fecal matter, then stools become small with mucous and blood, sometimes pus and shreds of membrane. The blood is usually from congestion of blood-vessels and straining. In mild cases from five to six stools in twenty-four hours; in severe cases from twenty to thirty.

If inflammation extends to the rectum, there is pain and burning before and after stools.

Temperature is usually slight, but frequently runs up to 102 or 103 degrees Fah. After a prolonged attack, it may be sub-normal.

The tongue is first moist and covered by a brownish or

grayish fur, then becomes dry, and in severe cases red and swollen.

Vomiting is not apt to occur until after the first week, unless the stomach is involved. Persistent vomiting is

usually a grave symptom.

The skin is dry and cool, except over the bowels, where it is hot. It is always cool in the stage of collapse.

Thirst is usually marked, especially when stools are very frequent and fever high.

Pulse varies with the intensity of the disease. Boils and erythema are frequent complications.

Hypostatic congestion of the lungs, with cough, may result from prolonged recumbency and enfeebled heart's

action.

Spurious hydrocephalus is ushered in with vomiting, rolling of eyes, tossing of head, mouth open, eager to drink anything offered, even nauseous doses, drowsiness, stupor, pulse frequent and feeble, usually followed by death.

If case is mild, recovery results in two or three weeks. Severe cases may run on five or six weeks, as subacute or chronic.

Diagnosis. By careful attention to the symptoms and history of the case, diagnosis is usually easy.

Prognosis.-Mild cases tend to recovery.

When complicated by bronchitis, hypostatic pneumonia or gastritis, the prognosis is grave. Spurious hydrocephalus is always

very grave.

Treatment. The first and most important duty of the physician is to prevent disease. So in this disease, as well as all others, we must first consider preventive treatment.

Clothing. I wish to emphasize this proposition—every infant should wear throughout all seasons flannel next to the body until the period of infancy is past and childhood well established. Indeed, I would hardly go wrong to say