child, and is now a strong healthy boy of fourteen years. And here I desire to notice a fact, in relation to feeding children, which is worthy your attention. Look at young mothers feeding children by the spoon, and observe how very slowly they dribble in the milk, or gruel. They will place the spoon on the lip and then pour it in, almost by drops; and if the child be very hungry, it will cry nearly all the time it is being fed. The food comes too slowly; it becomes impatient; it is annoyed by having to hold its mouth open so long before it gets enough to swallow. A child of two weeks of age can take milk as fast as you can dip it from a cup and put it into its mouth by a teaspoon.

I feel quite certain that it is almost as easy to raise children by hand, if they have an abundant supply of good undiluted cow's milk, as it is by the breast. But the bottle should always be used instead of the spoon. My plan is to direct as much milk as the child can take, and as often as it wants it; but always of the temperature nearly of the mother's milk. In winter time, or when milk is kept in a deep cave, or in a spring-house, I direct that as much boiling water be added to it as will bring it to that temperature. It takes but very little water, and is more convenient than heating it over the fire. To a pint of cool milk two tablespoonfuls of boiling water should be added-the whole then well sweetened. A healthy child of one month will take that much twice in the twenty-four hours. Some children at one month, or between one and two months, will take more than a quart daily; and a few can scarcely take so much. If then you are called to such cases as I have described, or to those milder cases where the child is fed half enough, or even a little more than that, place no reliance on the word of the nurse, or mother, "that she feeds it plenty, or that it will not suck or eat, or cannot keep it down." I have frequently seen a mother let the little hungry creature tug and pull at her flaccid, milkless breast, without being aware that the child got nothing from it; and yet she thought "it was getting suck." In those cases hold back the medicine for a few days and try the milk. Those children who have been nursed, and fed a little by the spoon, will sometimes wholly refuse to take the bottle in lieu of the breast, and the mother takes it for evidence that they do not like the cow's milk, and will therefore attempt to raise them on some one of the many farinaceous articles recommended, and in this she will be likely to fail. A little perseverance will generally induce them to take the bottle; and when once used to it, so that they can steady it in their own hands, they will rarely take too much.

I sincerely hope that our graduates, hereafter, will not go forth

to practice, believing that the proper substitute for the mother's milk is a mixture of two-thirds water and one-third cow's milk. Rather let them be instructed that the higher the organization of the animal, the more abundant will be the nutritive constituents of the milk, and as man is at the head of the animal creation, human milk is more highly organized than that of any other animal. If then you wish to use any other milk as a substitute for the mother's, instead of diluting it with water, it would seem to be more appropriate to add to it some nutritive substance. I have never used for infants any other milk than that of cows; asses' and goats' milk is not easily procured. Baron Liebig's soup is probably very good, for, to five ounces of good milk he adds half an ounce of wheaten flour, half an ounce of malt flour, and seven grains and a quarter of cream of tartar, dissolved in one ounce of water. This is to be put on a gentle fire, and when it begins to thicken it is removed from the fire, stirred for five minutes, heated and stirred again until it becomes quite fluid, and finally made to boil. Separate the bran by a sieve, and it is fit to use. But how inconvenient for the poor to procure those ingredients and prepare them for the child every time that it needs food! Where milk cannot be procured, farinaceous substances may be used; but milk is better and more convenient. I feel that some physicians who practice among the higher classes of society will regard these observations as having no reference to their patients, but refer wholly to the neglected children of the poor. It would be fortunate if it were so; but who has not seen the poor, little, emaciated child of rich parents, dragged about in its little coach by the nurse, or lying on her lap on a cushion, as the large carriage rolled along to give it an airing, by direction of the physician, whose very precise directions had been to feed it every four hours, two-thirds water and onethird milk? Day after day, week after week, has he not visited and prescribed (not for the starvation), but to improve its nutrition, to relieve its colics, to correct its sourness of stomach, to regulate its bowels, or, to sum it all up in one common phrase, "to build it up?" Did he succeed? No. Under the impression that the child's stomach was weak, not able to take much food, the quantity of food was diminished, a little lime-water, mint-water, or some other "corrective" added, and the little starving sufferer, never ceasing its low and plaintive moan, gradually passed away for ever. This is starvation in the midst of plenty. Starvation by prescription. There is little difficulty in raising children by hand, if they are allowed a full supply of good milk. A great many struggle along on even half the proper quantity. But they are weak, thin, and of

small growth. Children who are fed on the water and milk mixture are sometimes saved by a habit which prevails among the poor, of giving it, while the mother is eating, small bits of bread or biscuit soaked in coffee, or with molasses or sugar on it. Thus, very soon, the little hungry thing becomes clamorous for it, and the mother, in order to keep it quiet, will soon give it quite a slice of bread, or a small biscuit to suck at. Children of a few months will sometimes thus be saved.

How common it is to hear a mother say, "My child is getting very hearty now; but until it was nearly a year old it was very puny; I thought I would lose it." It was puny for want of food; it was starved on water and milk; but, when it got old enough "to sit up at the table, and get a little of anything," it began to improve, and yet the mother did not perceive the cause of the change.

I do not know that I can illustrate this subject better than by showing the effects of different amounts of food on young brute animals. Observe a litter of pigs when only two days old, and you will be surprised to see how closely they resemble each other in size. But look at them again in ten days. There are ten of them -all the nipples are occupied. The four which are at the front and back teats, but especially those at the back teats, are decidedly smaller than those broad-backed, plump fellows which are gorging themselves at the middle ones; and one of these is less than the others; he is, indeed, already called "the runt." See him in two weeks more, or when they are four weeks old, the common time for selling them; while the others will bring five dollars apiece, he will not bring two; indeed, it is common to give him to some poor man who hopes, by great care, to make something out of him. In another month see him again. He has been well fed on milk, or milk and bran, as much as he could eat, and now you would not recognize, in the clean, comfortable, lazy shoat, with his white skin and well curled tail, the yellow-haired, scurfy, puny, thick-legged, stifftailed runt of a month ago. An abundant supply of food, though it was not the mother's milk, has "built him up," even without the aid of whiskey, the now highly lauded nutriment.

Now mark the terms I have used in describing the half-fed pig— yellow-haired, scurfy, thick-legged, stiff-tailed. The other pigs are white and clean; their tails are limber and curled, and their legs smooth and supple; but he is yellow as though the hair were dirty, his skin is covered with a dark scurf, which reaches to the very feet, and, thickly covering the tail to its very extremity, causes it to stand out almost in a straight line with his backbone. Νο washing will have much effect upon him until you increase his food.

If you give him plenty of food, he will get well, even without washing; if you do not, he will struggle on like a starving, half-fed child, and die. If, then, in the country, where the milk is good, a child of a month needs nearly a quart daily, without dilution, how very important that no water shall be added to the milk brought to the city by milk-men! It is not too much to say that before it reaches the citizen's door it is only two-thirds milk. Now, should the doctor direct that the milk should be diluted by adding one-half water you can see that the food of the child will be four parts milk and five parts water-a starving mixture even if given in full quantity. Add to this the fact that much of the milk taken to the cities is of indifferent quality, and the difficulty of rearing children there, by hand, will be apparent. But much of the danger may be averted by giving the milk without the addition of any diluent, and by adding, when the child's age will allow it, some farinaceous substance. I have just heard of a case in a rich, fashionable family, the recording of which may be instructive. The child is fed on

what may be called corn meal tea, or soup. The corn meal is boiled very thoroughly; the water then strained off, and a little milk or cream added, about as people use it in tea or coffee; and this is all the poor child gets. It is now a year old, weak, pale, fretful, unable, even when held up, to stand on its limbs, presenting a pitiable picture of suffering caused by want of food, under the physician's direction.

I have but merely glanced at this subject. My object has been simply to call attention to the fact that many thousands of the children who annually die prematurely, die from want of food. They are starved to death, and we are not blameless.

THE DIAGNOSIS,

POSITIVE AND DIFFERENTIAL,

OF

SPINAL ARTHRO-CHONDRITIS.

BY BENJAMIN LEE, M. D.,

OF PHILADELPHIA.

THE elements which enter into an inflammation of the bodies of the vertebræ are singularly simple. Neither synovial membrane nor periosteum (or its analogue, perichondrium) being present, we are thus enabled to eliminate at once the symptoms arising from synovitis and periostitis, which so complicate the study of inflammations of the diarthrodial joints. In point of fact, the intervertebral fibro-cartilage, closely adherent both above and below to the surfaces of the bones, itself constitutes the joint. All the motion takes place by means of an interstitial movement between its cells and fibres, and none whatever between itself and the articulating surfaces of the vertebræ.' The signs of inflammation in such a joint will therefore simply be those of inflammation of an articular cartilage and of osteitis, simple or ulcerative, having its seat in the vertebral surfaces immediately in contact with the cartilage.

To an inflammation involving these anatomical elements in this region, never before specifically described, so far as I know, I consider that I am authorized in applying the designation, SPINAL ARTHRO-CHONDRITIS-signifying an inflammation of a vertebral articulation, involving the intervertebral fibro-cartilage as an essential component.

This affection derives its importance, in a pathognomonic point of view, from the fact that it is almost invariably associated, either

To what an astonishing extent this motion may be carried without destroying the integrity of the joints, we have recently had a striking instance in the persons of the younger members of the company of Japanese acrobats and contortionists, now performing in our large cities.