but little can be done to make the patient's thoroughly annointed with this, covered with brief existence at all bearable. absorbent cotton, the cotton kept in position

The treatment of burns and scalds will vary by a roller bandage. with the severity of the injury. The first indications, are to relieve pain and overcome shock, later to guard against congestions and that the burned places are relieved of pres

inflammation of internal organs; and still later to counteract exhaustion, to support the patient by the use of nourishing food. by quinine, iron and the mineral acids.

The treatment of shock should be conduct ed as in other cases of shock, by artificial warmth, and by enforced rest. In severe cases a hypodermic injection of morphine and atropine should be given at once. These can be repeated until pain is controlled. If an anæsthetic is necessary great care should be

taken in its administration.

Hot coffee, beef tea and milk punch, should

It is often very difficult to so lay the patient

sure, and it is frequently necessary to allow him to remain in the sitting posture, sometimes for several days, with support for chin, by suspending him by means of wide strips of muslin passing under the chest or abdomen, the strip being fastened above. Dr. Fuller of Neukinchof, recommends that the patient first be treated to a warm bath. The burnt surfaces are then washed with an aqueous solution of thymol, 1 to 1,000 followed by the application of a thymol spray for several minutes. The blisters are not disturbed, but handled with extreme care. The raw surfaces then

be given when reaction has commenced. Also painted with a one per cent. thymolized lin

lime water if the stomach is irritable. Thirst

seed oil. The patient is then laid on a waterwarm. The application of thymol should be proof mattress and the room kept comfortably repeated at first, less frequently later, every ten minutes, using large, soft haired paint. brushes, and as it relieves pain very remarkably the patients themselves call for it.

Since the sad accident which occured last

which is usually intense, should be allayed by small pieces of ice, or small quantities of champagne, or carbonated water. Great care should be used in dressing, to avoid unnecessary exposure of injured parts, and consequent chilling. Saline laxatives or mild aperients should be used as indicated. Cerebral hyperæmia, tetanus, gastro-intestinal irritation, bron-month at the refinery of N. K. Fairbanks & chitis and pneumonia, should be treated as in Co., doubtless many of you have asked as to ordinary cases. Vesicles should not be broken the cause of death from burns and scalds. but punctured at their lowest point. In the Various theories have been advanced from flexures of the joints, between the fingers, time to time in answer to this question. about the face and neck, great care should be taken to prevent adhesions. Time would fail to tell of the innumerable number of remedies that have been employed in the treatment of burns and scalds. Flour and

Dupuytren thought that immediate death was often caused by excessive pain, the irritation of the nerve terminations inducing a paralysis

of the centres.

Others have regarded it as due to an arrest soda are the chief remedies, that are always at of the cutaneous perspiration, consequent uphand, and for temporary use, much might be on the destruction of a large extent of integsaid in their favor. Then there is the water ument. Others again have maintained the dressing, white lead, castor oil, and the old so-called "mechanical hypothesis," according time carron oil. The latter is a very efficient to which there is a dilatation of the cutaneous dressing, but the offensive odor, the unsightly appearance of the patient, and the destruction of clothing and bedding make it very objectionable. Much has been said in favor of Sonnenburg claims that instead of the asthymol, and iodoform, but my preference is sumed loss of heat there is an increased temdecidedly in favor of carbolized cosmoline. perature, even during the period of capillary Cosmoline with fifty per cent. of crystalized dilatation, and further, that this dilatation corbolic acid. The injured part should be was rapidly succeeded by a contraction of the

capillaries and a consequent loss of heat, leading to vaso-motor paralysis which extends to the great vessels and the heart itself.

vessels when the burning was long continued or of great intensity.

Alimentation in Adynamic Conditions.

BY H. O. BEESON, M. D., BIRMINGHAM, MO.

Tappeiner found a notable diminution of the watery constituents of the blood, with an increase of hæmoglobin and red corpuscles. In the matter of dealing with infectious and He found no changes in the red corpuscles. contagious fevers and other diseases, the first L. Van Lesser, was led by his investigations place in point of importance is conceded to to results differing from both Sonnenburg and prevention. However, the usual duty of the Tappeiner. The latest and most ingenious physician is to treat the malady after its detheory is that of Catians of Berlin, who be velopment, and he has often to do this in the lieves the symptoms all point to an affection presence of the conditions which produced it. of the cerebro-spinal centres, especially of the In the case of fevers we have long been medulla oblongata. He also says that the taught the theory of self-limitation, and that sweat is normally of acid reaction by reason to preserve the strength was the true principle of the formic acid which it contains and which of rational practice. To accomplish this deis neutralized on the skin by ammonia, form- sirable result, we are told to feed the patient, ing the voluble formate of ammonium, NH4 thus supplying the place of matter which is CHO2. This salt becoming quickly heated gives up its water and becomes hydrocyanic supposed to be destroyed by the pyrexial con

acid. He claims that the symptoms following extensive burns and scalds are the same as

those of prussic acid poisoning. Lesser rejects the views of Sonnenburg, Billroth and Lücke,

and claims that death after extensive burns is

caused by a reflected dimunition of vascular tonicity. Basing his views on a large number of carefully conducted experiments upon animals, he is convinced that the sudden death after burns is produced by a relative anæmia, or rather an acute oligocythæmia.

After careful study of the various theories advanced by as many observers, we are forced to the conclusion that nothing definite is known, that a theory only confronts us, and that in replying to the question, what is the cause of death in burns and scalds? truth compells us, as in answering many other questions to say we do not know.

Undoubtedley however, the chief factors in the cause of death are the cessation of the functions of the skin as an eliminator, its failure to throw off carbonic acid with the general emanations, the interference with cutaneous respiration and with perspiration, the loss of the natural protection, and heat regulator of the body, and (as a natural result,) internal congestions.

It is claimed that atropia hypodermically injected before the administration of chloroform sustains the heart's action.

dition.

It has been the practice to employ antipyretic agents to reduce high temperature, in order to avoid as much of such waste as possible. It has not been satisfactorily demonstrated, however, that either waste of tissue or

loss of strength is prevented by forcing the

temperature down.

However that mooted question may be in fact, it is acknowledged that we are unable to materially contract or shorten the duration of an attack of specific fever, and are content to treat it entirely upon the expectant plan, relying upon light medication and good nursing to carry the patient through. In our text-books and medical journals much importance is given to the matter of nourishment, all advising liberal allowances of milk, soup, broth. egg-nog, etc. In the light of our present knowledge, this is undoubtedly the correct treatment, but we are not furnished with a dietary adequate to the demands. Our bill of fare is too limited to enable us to suit the taste of the patient, and our knowledge of how to select is not equal to the task. Much attention has been given to the observation of the physiological action of remedial agents, but little is ever said about the selection of food. We can certainly improve our practice by a closer attention to the details of the preparation and selection of food for fever patients.

The primary cause of a specific fever is the entrance into the blood of a materies morbi.

And every case tends to recovery, if not com- tion of the various aliments at his command.

plicated, and would manifest the same tendency without medicine.

We have been urged to believe that milk furnished all the elements needed. And have we It is usually a complication that causes an not fallen into the error of taking it for exacerbation of fever, and probably 90 per granted, without pausing to consider whether cent. of such complications are referable to or not it practically supplies those needs, in the alimentary tract. This state of affairs form suitable to the requirements and capacipoints out the importance of avoiding all pos- ties of, the body, regardless of the needs sible sources of irritation of that capal. In of the system and the composition of food? The all cases of fever of a specific nature of what proposition is true that the best food for an ever type; the alimentary tract is supposed. to infant or an invalid is the food that agrees be in a condition very similar to that, of the best. A food which meets all of the requiretongue, viz., hyperæmic or anæmic, sluggish ments of theory, may be not only useless, but from enervation and exudative thickening Harmful, practically. We are governed largely the natural secretions perverted, acrid and of- by fashion, and may have gone to the extreme fensive, becoming a foreign factor, productive, in our substitution of milk for almost all other by absorption as well as local irritation, of ag- foods. Perhaps we are too hard on beef-teagravation of the original disorder. Each type following the fashion. At all events, we can of fever presents its own peculiar local lesion, not speak too confidently of the composition but for all practical purposes the same general of milk, for it is unknown to-day. What conline of treatment is to be observed in all, and stitutes normal milk can not be told, hence the same necessity exists for proper selection our theory will not stand the test of analysis, of food. and we have at last to resort to empiricism. Often we make our morning call and find Practitioners of thirty years ago condemned the patient has passed a restless night; per. the use of milk in fever. They also conhaps has had troublesome diarrhoea, nausea, demned cold water. The latter was a theoretvomiting etc.; bowels tympanitic, tongue heavily coated and tremulous; the mind unsettled by dreams and hallucinations; we look at the patient and say this is a very bad case, the malady has appeared in an aggravated form, and it will require an iron constitution to outlive it. We seldom pause to determine what part our treatment has played in producing this turn for the worse. Perhaps we have been following the rut as laid down for our guidance in the text-books and journals, giving milk till the alimentary tract is a stream of festering milk clots, mucus and ammoniaca]

matter.

We tell the friends the patient is much worse, and must be fed without fail, Give four tablespoonfuls of milk and whisky every hour. The symptoms grow worse and the sufferer is relieved by death.

It is my purpose to call attention to some articles of diet, to the end that good may result. To intelligently select and apply suitable nutriment the physician must first realize the state of the digestive apparatus as well as indi. vidual idiosyncrasy. He must also know the requirements of the system and the composi

ical objection, while the former was based upon the observation that the ingestion of milk was often followed by an exacerbation of fever, hence they argued that milk produced fever, while, in fact, such was only the case when the digestive apparatus was unable to digest the milk, and it became a foreign substance, creating the irritation by its presence, and not by its absorption into the system. I speak of milk first because it is the best of the convenient articles to be had in a family, and should always be tried first; but the mistake should be avoided of supposing it the only diet at our command. If it disagrees, try the following, which has stood the tests of analysis, theory and practice: equal parts of milk, cream, lime water and weak arrow-root water. This mixture will frequently be well borne, when milk alone is inadmissible. Eggs, variously prepared, meat soups, broils, etc., belong to the list of albuminous foods, and the physician should be able to direct their preparation, and make them acceptable to the taste and stomach of the patient.

Heretofore but little attention has been

given, in this connection, to other than this class belong Mellin's, Hawley's, Horlick's, class of foods. It is manifestly irrational to Hasby & Mattison's and Moore's Foods, and assume that a diet chiefly nitrogenous can sup- Baby Sup, numbers one and two. The first ply the needs of an impoverished system. three are dried foods, in brown or granular Physiology teaches us that our principle diet masses, very sweet, resembling powdered canconsists of carbo-hydrates, starch, sugar and dy. Mellin's has an acid reaction, while Horoil. It shows us that without these we can lick's and Hawley's are alkaline. The process not live. Then why not observe the same of manufacture is approximately as follows:

precept in sickness, and supply such FATIGNE Ot flour and barley malt are macerated,

of food as the system demands,

its mode of preparation and for case in hand.

There are now to be found twenty or more manufactured to

MEDICA

changing wit heat bran, in an alkaline solution until to suit the the starch is all converted. It is then strained MAR 2 and the liquor evaporated in vacuo, the residue the messiated and reduced to powder. The other SA this class contain some unconverted

These foods may be divided into three classes 1st, Farinaceous Foods; 2d, Liebig's Foods; 3d, Milk Foods.

which are scientifically prepared with arch. Baby Sup No. I consists of malted oats, to meet the requirements of an infantile or and contains a comparatively small amount. enervated digestive apparatus. Physicians of starch. It requires cooking, but is very have had little opportunity of becoming ac- palatable without, and is very soluble in the quainted with these preparations. Their use saliva. Baby Sup No. 2 consists of malted has, for the most part, been the result of ad- barley and wheat flour. It requires a little vertising. I propose to give an approximate more cooking, and contains a little more unoutline of the principle components of the converted starch. Hasby & Mattison's food is leading ones, and feel confident that they can a thick syrupy liquid, and is probably a neuoften be used to great advantage, both in in- tralized extract of malted barley. It is a very fants and adults. palatable food and its usefulness has been amply demonstrated. Class 3, milk foods, differs from the Liebig's foods in containing a much smaller quantity of grape sugar and less The predominating ingredient of the first soluble carbo-hydrates, and a greater per centclass is starch, somewhat changed by thorough age of cane sugar and starch. The albuminbaking. Well selected barley and wheat are oids are also more abundant. To this class ground to a flour, mixed in various prepara- belong Nestle's, Gerber's, Anglo-Swiss and tions, made into a dough and thoroughly American-Swiss foods. baked; then it is dessicated and ground into a foods consist of cereals powder, which usually keeps well, aided by combination with milk. the addition of sugar. In the baking process er percentage of albuminoids, fats and salts a considerable portion of the starch is converted into soluble carbo-hydrates. This class contains from five to ten per cent. of albuminous, and a small percentage of grape sugar. In this class belong Blair's Prepared Wheat Food, Hubbell's Prepared Wheat Food, Imperial Granum and Ridge's Food, A. B. C. Cereal Cream, A. B. C. Cereal Milk, and Robinson's Patent Barley, are mixtures of wheat and barley but little changed by cooking, to which are added sugar and albuminoids.

Liebig's Foods, the second class, are almost free from starch, and contain a larger percent age of grape sugar and soluble carbo-hydrates: while that of fats is extremely low. In this

All of these milk specially prepared in They possess a high

than the previous classes. This is a highly serviceable class, especially when prepared with condensed milk, by which troublesome coagulation is avoided.

Condensed milk differs in composition from the milk foods in containing a greater percentage of fats, milk sugar and albuminoids, and a lower per centage of soluble carbo-hydrates. Cane sugar is added in abundance for its preservative effect.

Preserved milk contains no cane sugar. Decomposition is prevented by the addition of burnt wheat or barley flour.

Thus we have at our command, in fact, a quite extensive dietary, while in practice but

one class, the albuminoids' is drawn upon, and ber that about a month ago I removed an enthe unfortunate patient must get well on milk larged gland from the inguinal region in your or not at all. We must bend to the require- presence. Before then and since, he has sufments of fashion, and not fashion to the needs fered from pain referred to in thetesticle which of his condition. It is absurd to assume that gland I hesitated to remove because the diagthe digestive organs of a fever patient are like nosis was imperfect and incomplete. Since those of an infant, or are in a condition in any the time above referred to I have examined respect similar, and therefore the infant's nat- the removed gland under the microscope, and ural diet, milk, is most appropriate. Two find the morbid condition to be epithelioma, things could scarcely be more unlike. And that is to say the patient's original trouble again, milk does not contain the nutritive re- was epithelial cancer, and the glandular enquirements of the adult, for physiology and largement is secondary. I now feel that I every-day observation teach us that we live should remove the testicle that he may have mostly upon starch, sugar and oil, with a com- his life prolonged, and possibly the last deparatively small per centage of nitrogenous posit of this morbid material extirpated.

matter.

He is an American, 40 years old, unmarried, One or more of these foods can always be and (as far as I can determine) of good family found on sale, even in small country drug history. He has been in the hands of several stores, and the cost is such as to be within the doctors, who have treated him as progressive reach of every one. The manufactured article surgery directs. He states that Dr. Bibbe, of possesses the decided advantage of being more this city, operated on him for local trouble on palatable than the home-made preparations of penis, September 9, 1887; that Dr. Briggs, the sort. And they are otherwise more to the of St. Louis, operated on him for like trouble, purpose than anything the average family December 23, 1887; that on March 6, 1888, cook can or will prepare. With attention on Dr. Avery, of Troy, Mo., operated on him the part of the medical attendant as to the needs of the patient, few cases will be found in which benefit can not be obtained by selection from prepared foods to be found in the

market.

about the same as the others named; that on May 23, 1888, Dr. Purdy, of this city, amputated the penis; that on October 12th, 1888, Dr. Jackson, of Kansas City, removed a number of enclosed glands in the inguinal region; And further, a knowledge of the manner of that on March 17, 1889, Dr. Mudd, of St. preparing these foods and of their composi-Louis, repeated the operation of Dr. Jackson. tion, will enable the physician to direct the On November 23, 1889, the operation first preparation of many a dish pleasing to the referred to in this lecture was made in the palate and strengthening in its effect.

For much of the information as to the composition and preparation of manufactured foods herein contained, I am indebted to the

Medical News.

Antiseptic Surgery.

Synopsis of a Lecture delivered at St. Francis

Hospital, Wichita, December 7, 1889.

BY W. A. JORDON, M. D., PROFESSOR OF OPERA

TIVE AND CLINICAL SURGERY IN WICHITA
MEDICAL COLLEGE.

GENTLEMEN :-The patient now before you is one you have met before. You will remem

presence of this class, and to-day I propose to remove both testicles, and as you will see, I shall make the first incision from the lower margin of the external abdominal ring, and with one sweep of the knife divide the integument to the dependant part of the scrotum, to the end that drainage may be perfect. I shall now expose and tie the cord by transfixing it, not with cat-gut as most of the books direct, but with antiseptic silk, for reasons that I tried to make plain to you in a previous lecture. You will observe the removal of the gland from the scrotum and the great care maintained in cleansing the wound. The drainage tubes, which are thoroughly aseptic, will now be inserted, the wound stitched with cat-gut and dressed antiseptically, and the un