for the modification of fresh cows' milk, would be more in accord with physiological principles than are the dried milk foods.

Under the first class I will mention Nestle's Food, which is said to be made from the richest and purest cows' milk, the crust of whitened bread and cane sugar. According to directions for preparing this food for infants, it is found compared with womans' milk, to be deficient in salts, proteids, fat and milk-sugar, while there is an excess of water.

Horlick's Malted Milk, also of the first class, is claimed to be made of pure rich cows' milk, combined with an extract of malted grain. Its makers claim that by special treatment with plant pepsin the caseine is kept from forming in large and irritating curds on the stomach.

According to directions given for preparing this food for the infant, it is also found deficient in proteids, fat and milk. sugar, with an excess of water. This about corresponds to a dilution of one part of good cows' milk with four parts of water.

Under class two, Imperial Granum, a farinaceous food to be used as an adjunct to cows' milk. It is said to be a solid extract derived from very superior growths of wheat. When ready for the infant it corresponds more closely with womans' milk than do the foods under class one. Yet it is deficient in proteids, fats and milk sugar. This deficiency can be removed to some extent by using more milk and less water.

Mellin's Food under class second is stated to be a soluble dry extract from wheat and malt, for the modification of fresh cows' milk. When ready for use by the infant, this food differs but slightly from womans' milk, and in the constituents its similitude to womans' milk is remarkably close.

Of all the necessities of an infant, water stands out most prominently. It aids materially in cleaning the mouth and gums, and in quenching thirst. It is certainly diuretic, and water given regularly is an excellent laxative. Instruct every mother and nurse, that a child young or old requires water.

An infant up the first month, should have several teaspoonfuls of plain boiled water, which has been allowed to cool, but by no means ice water. This water is best given immediately after feeding or as soon thereafter as possible.

If it is not time for feeding, and the infant is restless, a spoonful of cool water will frequently comfort it. Water is very important when large cheesy curds are found in the stools If the child refuses the water then the addition of a very few grains of cane sugar will be an advantage. The free dilution of childrens' nourishment with water will aid digestion, as only to a certain limit will pepsin be furnished for digestive pur. poses. In artificial digestion albumen often remains unchanged until large quantities of acidulated matter are supplied.

Many disturbances of digestion are doubtless due to a deficiency of water, certainly many more than are due to an excess, as it is quickly absorbed. In the management of summer complaint of children affecting the stomach and bowels, feeding properly is the most important part of the treatment. When dietetic errors are committed, the child will suffer with gastro-intestinal disorders.

A baby fed exclusively from the breast is usually exempt from summer complaint, unless it is irregularly fed, or if the milk is of an improper quality. Tbus milk containing large quantities of colostrum-corpuscles has a decided laxative effect.

The depressing effect of extreme heat in midsummer naturally tends to lower the vitality af the infant. Therefore we should not be surprised to find that an appetite which has been unusually good heretofore, suddenly diminishes.

When the infant shows a loss of appetite nothing will tone up the stomach and bowels more than a sudden change of air from one locality to another. If in spite of this change the infant continues to vomit, or to have loose greenish stools, the breast feeding should be stopped and the stomach given complete rest for twenty-four or forty-eight hours after which substitute food such as barley water, rice water or albumen water which can be given in teaspoonful doses. In this manner we remove milk from our dietary for the time being and give the above liquids, which are easily absorbed. If severe vomiting persists in spite of this change of food, then absolute rest of the stomach is necessary and rectal feeding should be resorted to.

If the infant has been artificially fed, discontinue all kinds of food which were given previous to the summer complaint.

If the food has been milk, stop it and give such foods as barley water, rice water or arrowroot-water. These can easily be made by adding a tablespoonful of either of the above mentioned cereals to a pint of water and boiling for half an hour, strain through a cheese-cloth and then add enough boiled water to make a pint. In feeding use from three to six ounces, to which a pinch of salt and some sugar have been added, and warm the same to body heat, just before feeding. It is a good plan to allow a larger feeding interval during an attack of summer complaint, thus giving the stomach and bowels less work.

Thirst requires careful management. If the child is thirsty give plain boiled water or add the white of an egg making albumen water. When the child's condition becomes normal, return gradually to natures food, milk.

Unless conditions are such that milk, fresh from the cow can be obtained for each feeding, it is advisable to pasteurize or sterilize the milk for about 20 to 30 minutes, and then keep it on ice until time for feeding.

Fresh air is also a vital point to be considered, in the management of summer complaint, coming next to diet. Unless the child can have the benefit of fresh out door air and can be removed from unsanitary and improper hygienic surroundings, our prognosis should be guarded.

THE EARLY DIAGNOSIS OF SMALL-POX, AND ITS IMPORTANCE TO THE PHYSICIAN AND

TO THE PUBLIC GENERALLY.*

By Julius Jones, M. D., Rockford, Ala.

The recent development of small-pox in some portions of the county, and a mistaken diagnosis in some instances, have led me to pen a few thoughts for the society upon the importance of an early and proper diagnosis of small-pox from other exanthemata, ("To be a skilled diagnostician is a consummation devoutly to be wished"). The application of a knowledge of symptoms and of the history and all the circumstances of the patient, and to distinguish the existence of the diseases,

* Read before the Coosa County Medical Society, April 7, 1903.

and their special characters and varieties is an art not always possessed by many practitioners of medicine. In my opinion the first and oftentimes the most difficult part of the phy. sicians' duty in undertaking a case, is to make an accurate diagnosis

It often requires much knowledge, skill and judgment, and I fear many times we are prone to treat symptoms and await further developments, and mistakes are frequently made, with consequences deplorable to society and hurtful to professional reputation, hence the practitioner should at least possess a reasonable amount of the knowledge of the history, symptoms, etc., and hold himself ready at all times to make a differential diagnosis of these affections.

It goes without saying that the small-pox of a century ago, and that of to-day is vastly different in many respects; and I may say that one quarter of a century ago the affection was much more virulent in many cases from various causes, than those cases met with in our practice at the present time. When we take up our recently published text books and read the violent symptoms, and the large mortality percentage, the unfavorable prognosis in many of these cases we are led to believe that we have no small-pox in our country, and are often times confronted with an active opposition in our diagnosis from the laity, and some times also from our brethren.

In the large metropolitan hospitals of the United States, and in foreign hospitals, the conditions, circumstances and environment of the patients are entirely different, from those met with in the ordinary practice in this country. Those affected with the acute diseases are almost exclusively negroes and the destitute and starved, and many from the intemperate classes, who live for the most part, in narrow filthy places and tenement houses with insufficient food, etc., and it is this type of the disease I think that is usually described so graphically by our authorities.

It seems that most writers picture this loathsome form which is usually well developed, and as a rule not difficult to differentiate, whereas, in our country those severe cases never occur, but it is of a milder form, and the diagnosis more difficult to make, hence, the necessity of a careful study of the

situation, and a hearty co-operation and concert of action among ourselves.

The history of this remarkable disease seems to be clothed in considerable obscurity, and its existence may have been coeval with the existence of man. There is no evidence, however, that it was known earlier than the ninth century, as the first accurate description of it, is that of Rhazes, an Arabian physician who lived in the ninth century. It was brought to America by the Spaniards early in the sixteenth century, and has existed in some portions of our country ever since. The nature of the contagion is still in doubt. It is an acute, specific and highly infectious disease, characterized by a typical range of temperature, and a specific inflammation of the skin, culminating on the third day in a papular eruption, which becomes vesicular and finally pustular It passes through the successive stages of papular, vesicular, pustular, desiccation and desquamation.

The clinical history of small-pox may be divided into four stages, viz: Invasion, eruption, secondary fever, and desiccation or decline.

There are three distinct forms described: viz:

First: Variola Vera. "A" discrete, "B" confluent.
Second: Variola Hemorrahagica-black small-pox.

Third: Varioloid, modified by vaccination.

Most all cases at the present time especially in our country are of the first type: that is the discrete and confluent, and a majority are semi-confluent, beginning with a discrete form and usually come together as it were.

The period of incubation is from 10 to 15 days, average 12 days. Invasion, is usually ushered in abruptly; there is a chill or chillness or a distinct rigor, followed by high fever head ache, sick stomach and back ache, and in children often times the symptoms are more severe, greater prostration and convulsions mark the onset of the disease; the skin is dry and the tongue is coated, with red edges; abdominal pains and tenderness are frequent, respiration rapid.

The average duration of the stage of invasion is three days; in grave cases it is often shortened to two, while in varioloid it is often prolonged to four days.