epitomized a code of ethics worthy of any

man.

He did not miss suffering. Malignity welled from its deepest and darkest pits to villify him; no accusation was too low or too mean but what was hurled against him; insult upon insult was heaped upon him mountain high, Ossa on Pelia; personal malice and spite were vented upon him as rank and poisonous as the deadly cobra, until Honor blushed and Truth. hid its head to think that he must suffer so. But he remained unmoved. Like some tall mountain of granite upon whose serried sides the wintry storms have beat until the polished rock shines and glistens, so he stood amid the storms of hatred and passion, undaunted, untouched, unflinching. Vengeance is mine saith the Lord of Hosts; this Lincoln remembered, and all through the hatred, pettinesses and even treachery of those around him, he went his way rugged, strong, unswerving. He sought no vengeance but forgave; practiced patience and fortitude at all times, and ever listened to the dictates of a heart that beat synchronously and sympathetically with all human suffering. Slow, honest, temperate in body, thought, word and deed, he bore without complaint the sorrows of a Nation, ever teaching us by personal precept and action. We appreciate Lincoln's heroic qualities as a great President, as the Saviour and Preserver of a now United Nation, as a martyr, but we love and revere his memory because he was at all times Lincoln, the man, a human, sentient being like ourselves. We love him because his life, character and achievements are possible to any man, in any line of occupation for in all lines the elements of success are built upon the fundamental principles upon which he conducted his life.

This lank loose limbed man never knew, never sought, never wanted rest. Melancholy brooded over him from birth to a piteons death closed by tragedy. But when the recording Angels trace with blazing stilus upon the golden tablets of Immortality the records of deeds well done, how small, how eeld, will seem those of militay conquerers beside this humble, lowly, simple, plain, poverty stricken and clumsy backwoodsman, who left a memory so noble so high, so holy that all men, of every political creed, revere and cherish it claiming it as a birth-right and so deep has it been engraven into the public conscience, and so majestic have grown its true proportions that it has become a basic part of our American Institutions. To-day his memory rises like the sun to illuminate and strengthen men's lives, to shed a radiance of holy sympathy over their deeds, and to warm the hearts of his fellow creatures.

God seemingly took from the sterile clay of this inviting farm enough to make a mould

wherein He created a man, the like of whom has rarely been equalled, destined him to suffer and bear the pangs of sorrow and hu miliation and as did His only begotten Son, die an ignominious death.

Only by standing at this humble spot, only by contemplation of his still humbler home can we realize how the light of his life was shed, how it spread and grew until the whole Nation was basked in its effulgence.

Only by standing here and realizing that he was the friend of the Nation do we understand and appreciate how cruel and foul was the assassin shot that struck him down, yet in that tragic passing men saw his life illumined in its true radiance, and awoke to a full realization of the truth of Stanton's words "He belongs to the immortals."

""Tis the wink of an eye, 'tis the draught

of a breath;

From the blossom of health to the paleness of death,

From the guilded saloon, to the bier and the shroud,

Oh, why should the spirit of Mortal be proud?"

THE RELATIONSHIP OF FEEDING IN
INFANTILE ECZEMA.*

By M. L. RAVITCH and S. A. STEINBERG,
Louisville.

Infantile eczema usually makes its appearance first on the face; afterwards, through irritation, infection and sensitization of the skin it may spread to other parts of the body. Irritation in some form or other seems to be the main etiological factor in this type of eczema, whether irritation from without or irritation from within. As the face in the infant is the part which is usually subjected to less external irritation than any other part of the body we naturally look rather to internal irritation as the cause, and especially do we look to the diet, since infantile eczema usually appears in babies who have shown in other ways that they are on an improper or insufficient diet.

The diet may figure as a primary cause of infantile eczema in the following ways:

(1). There may be an insufficiency of proteid, fat, carbohydrates or salts in the diet. This is rarely so in the breast-fed babies since human milk is naturally the most nearly perfect food for the human infant, the result of thousands of generations of adaptation of each of the other. However, there are cases where the mother does not produce sufficient milk for the infant's nutrition or the milk is too low in some ingredient, and then it is nec

*Read before the Muldraugh Hill Medical Society.

essary to supplement the breast feeding with a few bottles feedings daily or even to put the baby on bottle feeding altogether. There are certain constitutional conditions in the in the mother which may make her milk poor in salts, especially lime, so that while the baby may be fat and seem well-nourished there is poor bone formation and obscure changes in the blood, with diminished coagulability and tendency to exudative eczema. With artificial feedings, whether modified cow's milk, mixtures of dried milk and cereal solids, or condensed milk, there is often a deficiency in assimilable nourishment. This may be due to improper mixtures, as when a physician gives a suitable formula for a month old baby and the same formula is used when the baby is six months old; it may be due to too small and too few feedings. The result will be that there will not be the proper rate of growth; there may even be loss of weight and frank malnutrition. Before a breast-fed baby is placed on the bottle, every effort should be made to determine first whether the breast-milk is insuf-. ficient; an examination of the milk and quantitative estimation of the fat, sugar and proteid should be made; then if the milk is low in quality or quantity an effort should be made to correct this by increasing the mother's diet and correcting her habits. Finally, if the milk can not be brought up to the proper figures, one should try first to get pure, rich cow's milk and modify it to the infant's needs, changing the formula until one dose strikes the proper mixture and then adapting that mixture from time to time to the growing infant.

(2). The diet may be liberal enough, but owing to the inability of the infant to digest certain ingredients, it may prove insufficient. This applies especially to babies on artificial feedings; a baby who has had no trouble in digesting human milk-fat may have trouble in digesting the fats of cow's milk; or the larger, tougher curd of cow's milk may interfere with digestion of the proteid; or in the mixtures of cow's milk and cereals much of the carbohydrate may be present as starch, which is indigestible by young infants. The stools in these cases will give valuable information and an examination of the feces should not be neglected, both macroscopical and microscopical. When there is protein-or casein-indigestion the stools may contain curds or clots of undigested casein; owing to putrefaction there will be a strong odor of indol and skatole, almost nauseating, as a rule. In fat-indigestion the excess of fat appears in the stool as globules of fat or soapy curds, while microscopically crystals of the fatty acids will be found. In starch-indigestion the feces will be full of undigested or only partly digested starch granules, readily identified un

der the microscope by their reaction with iodine; the inability to digest sugars is less easily determined, but such a stool will usually contain a great deal of lactic acid. Fat and starch indigestion cause many cases of infantile eczema; where the fat is at fault the eczema is most apt to be of the moist exudative type, while starch causes the dry, scaly type. The offending substance should be removed from the diet entirely for a short time, whereupon improvement will nearly always follow promptly; restoration of the diet to the usual figures should be slow and cautious, while substitutions should be made when possible. Thus, in starch indigestion lactose or sucrose should replace the starch; in proteid indigestion the feeding of whey instead of whole milk will often furnish an easily digested albumen; in fat-indigestion olive oil or cod-liver oil may sometimes be better borne than butter-fats, and small, frequent feedings better than the larger feedings at greater intervals.

(3). Improper articles, such as should not be given to an infant of that age. Before the baby is old enough to digest starches he should not be given bread crusts to suck on, as is often done. Meat-gravy is another thing that is often given much too soon. Beer, pickles, diluted whiskey, it would seem unnecessary to warn against such things, yet they are too often given to babies by ignorant mothers or nurses. They are nearly certain to produce indigestion.

(4). Toxic substances in the food. They may appear in mother's milk as a result of tuberculosis, syphilis, septic infections, nephritis, convulsions, and various chronic constitutional conditions. The milk of women with hyperthyroidism is often toxic. Where there is a mastitis, the affected breast, at least, should not be nursed from, but should be emptied and kept from going dry by means of the breast pump until normal again. In cow's milk toxic substances may appear as a result of tuberculosis, infections of the udder, improper feeding (distillery slop) or stabling in dirty, ill-ventilated and dark stalls, or they may be due to changes in the milk from bacterial contamination. Where the best of care is not taken to keep the milk clean and chill it immediately after the milking sufficient bacterial growth may take place in it to make it unsuited for consumption in a few hours. Pasteurization has but little effect on such milk as far as destroying the toxins already formed is concerned. In this regard it should be remembered, too, that a pasteurized milk may become quite toxic and yet show no visible changes nor be sour to the taste. Unpasteurized milk always contains some lactic acid forming organisms whose growth not

only shows when the milk is unfit for food by the souring and curdling caused by the lactic acid, but also checks the growth of pathogenic and putrefactive bacteria. When these acidforming organisms have been destroyed by pasteurization any putrefactive forms that gain entrance to the milk can grow unchecked, and they may develop highly toxic substances without affecting the appearance or taste of the milk. A pasteurized milk with a bacterial content of 100,000 per c.c. should be regarded with more suspicion than a raw milk with a count of 500,000. The greatest of care should be taken to have a clean milk; where there are municipal examinations of the milk the reports should be obtained and studied. Where modified milk is being used it does not matter so much if the milk is somewhat low in butter-fats, so long as it is clean and pure. since less water can be added in the modification.

(5). Lack of vitamines in the diet. Our knowledge of these all-important substances is as yet too slight for us to make any positive statement regarding their relationship to eczema, yet we do believe that eventually certain cases of eczema will be found to be due to a lack of vitamines. Those who have seen the changes which occur in beri-beri, scurvy, pellagra and the experimental polyneuritis of pigeons will not find it hard to believe that a deficiency in some vitamine can cause eczema. We have at present under treatment an adult whose eczema we believe to be due to a deficiency of vitamines; changing the diet to one rich in these substances has resulted in prompt and rapid improvement. As the vitamines are destroyed by heat such foods as milk and cereal powders, condensed milk and even boiled milk may contain too small an amount of vitamines. Raw milk, whether human or bovine, would hardly be low enough in vitamines to be insufficient for the infant's needs.

(6). Anaphylaxis. We now come to a new and most interesting field, the effect of foreign proteids when introduced into the body parenterally, that is, without having been previously broken down or digested. Nearly every proteid, when brought directly into contact with certain cells of the body that if the same proteid is brought into contact with these cells a second time a reaction will take place, which we call an anaphylactic reaction. As a rule, when proteids are ingested as food by mouth, the digestive fluids break these proteids down before they are absorbed to a point where they are no longer proteids and thereafter unable to cause either sensitization or reaction However, it is possible for proteids ingested as food by apparently normal individuals to cause sensitization or anaphylaxis, and this is probably due

to minute abrasions of the mucosa of the stomach or intestine allowing unchanged protein to leak through the wall-lining into the blood-stream. As the proteids of the food are changed to a non-proteid condition fairly rapidly and as the rate of absorption through slight abrasions must be slow it is probably extremely seldom that sufficient protein leaks through to be dangerous to life. However, from clinical evidence, it would appear that the frequent repetition of even slight anaphylactic shocks is sufficient to cause skin-eruptions in certain individuals. When a person is sensitive to a proteid either he should be desensitized or that proteid should be omitted from the diet. In order to find out whether anyone is sensitive to certain proteids we may make use of the local reaction of the skin, since the skin of an individual who is sensitive to a certain proteid will give a pronounced local reaction to the injection or inoculation of that proteid into the skin. The test is similar to the Von Pirquet test. For each proteid to be tested for two abrasions are made in the patient's skin, using a knife, chisel, or, as Dr. White of Boston suggests, a dental burr. The instrument should remove shining, slightly moist surface; the abrasion should never be deep enough to cause bleeding or even much serous exudate. Each pair of abrasions-when testing for more than one proteid at a time-should be a couple of inches from any other pair, and separated from each other at least an inch. One is covered with a suspension or solution of the proteid to be tested for in physiological saline; the other is covered with saline alone as a control. The control should develop only an erythema. The test abrasion, if positive, will develop a well-defined papule, usually most marked 30 minutes after the inoculation; if negative, it should show only the same erythema as the control abrasion. both abrasions are positive, the skin is so senstive to injury as to render the tests of no value so far as determining proteid sensitization. Some individuals will be sensitive to several proteids. As far as is known only proteids are capable of causing anaphylaxis, and in those cases reported of positive skintests to lactose, butter-fat, and other non-proteid substances we can only suppose that the test-substances were not sufficiently purified, but contained traces of proteid clinging to them. In infants on a milk diet the only proteid which they receive and therefore the only ones which need to be tested for are casein and lactalbumen; if on a mixed diet it such as those of beef, mutton, pork, wheat, may be necessary to test for other proteids, corn, etc. Where an individual is sensitive to a protein he may be desensitized by inject

If

ing the offending proteid under the skin, beginning with very minute doses and working up, the injections being given every three or four days, or by feeding the proteid by mouth in increasing quantities. However, this must be done with care, for a considerable degree of anaphylactic shock may be produced. It is hardly advisable to attempt desensitization in infants; but better to leave the offending proteid out of the diet. An infant who is sensitive to cow's milk may show no reaction to coat's milk, which has other advantages over cow's milk for the infant.

In conclusion, whenever there has been digestive disturbances the intestinal tract is usually swarming with bacteria, often of a harmful character, and a very restricted diet with intestinal antiseptics may be necessary for a few days to get rid of this excess. Moreover, even when the necessary corrections

have been made in the diet the

skin-lesions

may persist, the skin having gotten into the habit of catarrhal inflammation, just as an infection in a joint may persist after the focus in the tonsils or elsewhere has been removed. The external treatment should be carried out with due consideration for the delicacy of the skin in the infant. Zinc ointments, modi. fied Lassar's paste and protective and soothing powders should be used on the skin and any abrasion should be protected against secondary infection.

INFANTILE PARALYSIS.*

By JACOB GLAHN, Owensboro.

In presenting to this august nudience a thesis on "Infantile Paralysis" its technical name; "Poliomyelitis anterior acuta" I do so with some trepidation, as this whole country has been considerably aroused and justly so, not so much about the deadly effect of the disease in itself, but more on account of its destructive sequence, the after-effects, upon the different parts of the growing and expanding bodies, especially so of the young.

So much has been written about this fearful disease and one-sided theories have been advanced as to befog the minds of even our best medical authorities, and it seems to me, that too much stress has been laid upon the germ theory without paying any attention at all to Virchow's philosophy as to pathologic al conditions found in this disease; neither is there any attention paid upon the most magnificent deliberations of Trousseau and Pidou on the blood, etc.

Now any case in the court of medical science (or medical ingenuity) ought to be accorded the right, to have the evidence of both sides of the case in question, considered; in question, considered;

*Read before the Daviess County Medical Society.

thereby we might find the key to this terrible disease; anyway it will create a clearer understanding of the question at issue and medical treatment may become more effective at once and thereby obtain better results as to the destructive after effects.

BARTHOLDI'S DEFINITION.

By infantile paralysis is meant a peculiar form of spinal paralysis, occurring in children suddenly, and due to an inflammation of the anterior horns of gray matter. It is now known that the same form occurs in adults also, thought much less often.

CAUSE.

Infantile paralysis as the name implies, is a disease of early life, and occurs most frequently from six months to the fourth year; but precisely the same form of disease occasionally is encountered up to sixty years of age, so that the term proposed by Kussmaul— poliomyelitis anterior acuta is more appropri

ate.

Besides age little is known as to the causes producing this disease.

The influence of summer heat seems established by the observations of Sinkler, American Journal of the Medical Sciences, Vol. lxix. p. 348.

As cases frequently occur during the course of convalescence from the exanthemata, and other acute febrile affections, a causative relation is supposed to exist between them. The important negative fact, that the influence of heredity can not be traced.

Dr. T. S. Bell of blessed memory, Professor in the medical department of the University of Louisville, many of his students are still living and especially through the South, no doubt will remember his uncompormising attitude on the causation of periodical congestive fevers. He held to the opinion that moist summer heat for an indefinite length of time (he usually took 60 days as his standard of the length of time) will produce congestive fever in predisposed individuals; he meant of slight physical resistance. It is well to keep this “maxim" of our old Professor T. S. Bell in mind during the prosecution of our case, for a greater and deeper "Medical Philosopher" never lived in any country, and it is a pity, that he was so little understood, by his associates and students.

Boerhave holds that a fever is the endeavor of nature to boil up the abnormal chemical conditions and thereby bringing back the physical organization to normal again.

Pathological Anatomy. The naked eye-appearances furnish no exact information, and may be entirely negative on microscopic examination, important changes are found in the anterior horns of gray matter, in the

dorso-lumbar and cervical enlargements of the cord.

The change consists in an inflammatory softening; the nerve-elements are disassociated by an exudation containing numerous granulation corpuscles and free neuclei; the neuroglia undergoes hyperplasia, and the multipolar ganglion cells have wasted and blood-vessels are abnormally distended; the many disappeared, while those remaining are in various stages of atrophic degeneration. The softening extends a little posteriorly and latterly, and sclerotic degeneration also occurs in the adjacent anterio-lateral columns. Similar changes take place in the anterior roots. Extensive wasting atrophic degeneration, and sclerosis occur in all cases and after many years. The anterior nerve-roots are thin, atrophied, and translucent, and more or less degeneration takes place in the filiaments of the peripheral nerves.

The muscles to which the nerves are distributed undergo very serious alterations, which consist in an increase of the connective tissue, the formation of numerous fat-cells and granules, and the degeneration and disappearance of the muscular fibres.

The bones of the paralyzed members cease to grow, and degenerate more or less, the cancellated structures being relatively increased, and the fatty tissue also.

Important changes occur in the joints; the articular surfaces are atrophied and eroded, the ligaments thinned and stretched, the articulations relaxed. By reason of these atrophic changes great deformities, the worst forms of club-foot are produced. In this dissertation we must be mainly guided by first principles for its proper comprehension.

Physical life is a fermentation process, it is a chemical action of resolution (see Alexander von Humboldt's views and observations in Nature). It is accepted by all biologists to be a spontaneous synthetic evolution, of course normal cell-evolution must then be the sequence of aforestated maxim, "a spontaneous synthetic evolution."

Bartholow's delineation of the pathologic condition of this disease is exquisite.

We find a soft watery, edematous inflamed condition of the gray matter of the anterior horns and adnexing tissue, nervous as well as connective tissue.

This indicates an abnormal chemical, a depraved metabolic condition of all the fluids. and tissues of the body, they are subnormal.

The point of least resistance in infantile paralysis being the anterior horns of gray matter of the spinal cord and this is easily explainable, when we recall, that the nervous system in growing children is always more or less on the stretch, due to the expansion and growth of the human body, of

There can be no doubt, that the quality and quantity of the basic salts within the physical body are lacking in a decided degree in infantile paralysis; causing a primarily and persistant chemical deficiency in the fluids and cells substances of the body and organs a probable degree of status lymphaticus, roused into activity, now add adverse environment; telluric conditions, plus great atmospheric heat for an indefinite length of time; new chemical, fermentative synthetic changes will take place in an already abnormal soil.

An abnormal or better expressed subnormal fermentation must produce an abnormal, in this dissertation, synthetic product; the result of subnormal oxidation. What this peculiar abnormal synthetic product will do, to the fluids and tissues of the affected cord and nervous system, is evidenced by the just described pathological anatomy of this disease.

If this lowered oxidation produces a chemical synthetic condition in the affected parts, which acts in a destructive manner upon the fluids and tissues per se or if they produce new, not yet recognized bacilli in a spontaneous manner, or through the chemically changed disturbed soil, their previously natural habitat, bacilli naturally benign and harmless, now have become vicious and destructive, is the office of the biologist-chemist to solve, and ought to be now an easy matter to definitely prove the specific materies morbi.

But the physician, the clinician, the humble bedside practitioner, can now secundum artem readily and logically understand the vis medicatrix naturae, the way nature directs that it is his business to at once try to improve the blood with gentle alterative tonic restorative medication, which will at once bring about an improved synthetic change and reaction in the tissues and fluids affected; for it does not require a great deal of alterative medication to neutralize the infection of the anterior horns of gray matter, improve it and so guard against its destructive action.

SYMPTOMS.

The usual onset of this disease is a fever, which lasts a day or two, and on recovery from which it is observed with surprise that the child is paralyzed.

The fever may be accompanied with head