great many people think there is altogether too large an emigration of an undesirable class, and that greater restrictions should be placed on the emigrant being allowed to land. Certain it is that, practically, there are but few restrictions, and but a very small per cent. are sent back to their own country. Paupers, criminals, insane, pregnant unmarried females, and persons likely to become a burden on this country, are supposed to be sent back, but only a percentage of these are, owing to the difficulty in detecting them. I will say nothing further of that, but devote the remainder of this letter to showing how the sick and destitute emigrant is treated when he lands here. First of all, the steamship companies pay a tax of 50c. per capita on all foreigners they land, they in turn receiving this from the emigrant in selling him his ticket. This fund is used in maintaining Castle Garden and the State Emigrant Hospital and Refuge. So that the emigrant supports these institutions, and does not become a charge upon the country. Emigrants entering the port of New York, go to Castle Garden, where they are either allowed to land, or are detained on account of sickness, or for the purpose of being sent back. The "detained" are sent to the Hospital and Refuge on Ward's Island, where those sick are treated, and those to be returned are kept until the ship on which they came over, sails back. Emigrants having landed, and being in this country less than a year, are sent to this hospital if they become sick during the year after their landing.

It will be seen that the field from which the State Emigrant Hospital draws its patients is a large one-the whole world. There were represented, in the wards of the hospital last year, twenty-nine nationalities. There were 2,705 patients treated last year, of whom the largest number were German, Irish, Italian, then Russian, English, Swedish, and more or less of each of the other nationalities. Not over twenty-five per cent. can speak English. When I first came here in May, I expected to be very much handicapped in arriving at a diagnosis, on account of this difficulty in speaking to the patients, but have since learned to appreciate the fact that the patient being unable to describe his symptoms is not an unmitigated evil, as he is, at the same time, prevented from misrepresenting or magnifying them. It simply makes a person pay more attention to physical

signs, and look more closely for positive symptoms, than depending too much on the patient's own de scription.

With a little knowledge of German, and occasionally the aid of an interpreter, one gets along very well. The class of diseases is as varied as are the patients themselves, but there is, of course, a very large preponderance of acute over chronic cases.

The main hospital is a large, red brick building, and is an ideal hospital, both in the way in which it is built, and in the way in which it is conducted, there being no hospital in New York which is cleaner and better kept. There are ten wards of thirty beds each, the wards being entirely isolated from one another. During the summer months the male patients are removed from the main building to four wards, entirely separate from the main building, and built for this purpose. This allows a thorough disinfection of the hospital every summer. In another large building, of ten wards, and beds for 100 patients, the contagious and infectious diseases are quarantined. There are usually from forty to sixty patients in quarantine. A large proportion of measles that come here is complicated by broncho-pneumonia, and a great many by diphtheria. This is accounted for by the fact that the patients take sick on board ship, are exposed to the weather, and to contagious diseases on the vessel, have been poorly fed and clad, and, by the time they reach here, a large number are pretty sure to get up broncho-pneumonia, and are fortunate if diphtheria does not still further complicate the measles.

In the Insane Asylum there are forty patients. Last year the 2,705 patients were distributed into medical wards, 1,122, surgical 579, children 257, quarantine 427, obstetrical 131, insane 188. The mortality rate (exclusive of insane) of hospital proper was 5.2 per cent., which is unusually low, as low if not lower than that of any other hospital in the city. This is particularly good when the class of patients, and the large number of acute cases are taken into consideration. Doubtless the situation of the hospital on Ward's Island, where there is plenty of fresh air, and where the hygienic surroundings are good, has much to do with it. There is a resident staff of four physicians, and a Consulting Board of seven. There are in addition to the hospital, other buildings for the destitute and de

tained people, and altogether accommodation for over 1,500 persons, and which can be made use of should an emergency arise or an epidemic break out. Two years ago there were 2,000 people here, some patients, others quarantined on accouut of small-pox on the vessels they came over on. Smallpox is now taken to the small-pox hospital on North Brothers' Island.

In another letter I will give in detail the man agement of obstetrical cases, and the lying-in-ward. CANUCK.

Selected Articles.

ON THE TREATMENT OF HABITUAL CONSTIPATION IN INFANTS.

Sluggishness of the bowels in infants is a common source of trouble in the nursery, and the derangement is one which it is not always found easy to overcome. Occasionally aperients in such a case give only passing relief. The bowels, indeed, are unloaded for the time, but when the action of the aperient is at an end, they are left no less sluggish than before. Habitual constipation is very common in infants who have been brought up by hand; and on inquiry, the trouble will often be found to date from the time at which bottle feeding was begun. Still, infants at the breast are not exempt from this annoying derangement. A deficiency of sugar in the breast-milk, or, as is sometimes seen, a milk the curd of which makes a firmer clot than is common in human milk, will often cause habitual torpor of the bowels which resists treatment with some obstinacy.

It is, no doubt, to improper, or at any rate inappropriate, feeding that the bowel trouble is usually to be referred. An excess of starch in the diet, or any food which overtaxes the child's digestive power and thus burdens the alimentary canal with a large undigested residue, may set up the costive habit. By such means a mild catarrh of the intestinal mucous membrane is excited and maintained. There is excess of mucus, and the fæcal masses, rendered slimy by the secretion, afford no sufficient resistance to the contractions of the muscular coat of the intestine, so that this slips ineffectually over their surface.

Another cause of constipation is dryness of the stools. Even in the youngest infants the evacuations may sometimes be seen to consist of little round hard balls, often the size of sheep droppings, which are passed with difficulty every second or third day. This form of costiveness is generally due to insufficiency of fluid taken. The food is made too thick, or the needs of the system in the

matter of water are in some way overlooked. But whether the constipation be due originally to excess of mucus or deficiency of fluid, it cannot continue long without affecting injuriously the peristaltic movement of the bowels. As the colon grows accustomed to be over-loaded, the intestinal contents can no longer exert a sufficiently stimulating influence upon the lining membrane, and the muscular contractions begin to flag. If the infant be poorly fed and badly nourished, this languor of muscular contraction may be aggravated by actual weakness of the muscular walls; and as under these conditions the bowel is apt to be overdistended by accumulation of its fæcal contents, the expulsive force at the disposal of the patient is seriously impaired. Constipation, resulting from the above causes, is often made more obstinate by the infant's own efforts to delay relief. A baby whose motions are habitually costive knows well the suffering which undue distension of the sphincter will entail, and often yields to the desire to go to stool only when it is no longer possible for him to resist it. The pain is sometimes aggravated by the formation of little fissures about the anus, and the violent contraction of the sphincter set up by the presence of those fissures forms an additional impediment to free evacuation.

There is another form of constipation in infants which we should be always vigilant to detect. This is the torpidity of the bowels induced by opium. In well-to-do families the use of soothing syrups and other narcotic preparations is now less common than was at one time the case; but now and then we find a baby drugged for reasons of her own by an unscrupulous nurse, and showing the earlier symptoms of narcotic poisoning. So long as the sedative continues to be given the bowels are costive, the child often vomits, his relish for food in great part disappears, and he lies with pupils firmly contracted in a dull, heavy state from which he cannot easily be roused. In young babies the use of opium seems to lessen the action of the kidneys, the urine is scanty, and on examination of the surface of the body the healthy elasticity of the skin will be found to be seriously impaired. When pinched up between the finger and thumb the skin lies in loose folds on the abdomen or only slowly recovers its smoothness. If this inelasticity of skin be noticed in a baby whose pupils are closely contracted, and who seems habitually heavy and drowsy, with little relish for his food, it is well to remember that these symp toms may possibly be due to the action of a narcotic.

An infant whose bowels are habitually costive is not necessarily injured by the want of a daily relief. Often the child seems perfectly well in health, and, except for occasional local discomfort when he gets rid of an unusually large or hard mass, may appear to suffer no inconvenience at

all, In other cases there is flatulent distension or frequent colicky pain, the child sleeps badly, has a furred tongue, and cares little for his food; the motions are often light colored from undigested curd, and are passed with violent straining efforts, during which the bowel may prolapse or the navel start. This straining is a not uncommon cause of hernia.

In remedying this condition attention to the feeding and clothing of the baby is of little less moment than the use of drugs. When the infant is at the breast a teaspoonful of syrup given three or four times a day before a meal will often quickly restore the normal regularity of the bowels. If the stools are habitually dry and hard, we should see that the child takes a sufficiency of liquid with his food. In addition, it is useful now and then to make him drink some plain filtered water. In the case of a baby in arms, the possibility that the child may be thirsty and not hungry seems rarely to be entertained; but in warm weather, when the skin is acting freely, the suffering amongst young babies from want of water must often be acute. At such times the urine is apt to be scanty and high-colored, and may deposit a streak of uric acid on the diaper. When fluid is supplied, the secretion both from the bowels and the kidneys quickly becomes more healthy; and a desert-spoonful of some natural saline aperient water, given at night, aids the return of their natural consistence to the stools.

The form of constipation which is due to mild intestinal catarrh is common enough in young babies. This is owing, no doubt, in great measure to over-abundant feeding with starchy matters, or to the giving of cow's milk without taking due precautions to ensure a fine division of the curd. Still it cannot be denied that we sometimes find the same derangement in infants whose diet is regulated with proper care and judgment. In them the intestinal catarrh is frequently the consequence of exposure, for the sudden withdrawal of all protection from the lower limbs and belly which the process known as "short-coating" too commonly involves is a fruitful cause of chill. In children so denuded, the feet and even the legs as high as the knees may be quite clammy to the touch. Under such conditions the susceptibility of the patient to alternations of temperature must be extreme, and the bowels are, no doubt, often kept in a state of continued catarrh from rapidly recurring impressions of cold.

Where the constipation is due to this cause our first care must be to protect the infant's sensitive body so as to put a stop to the series of catarrhs. To do this it will not be sufficient to swathe the belly in flannel. The legs and thighs must also be covered, for a lengthened experience of these cases has convinced me that so long as a square inch of surface is left bare the protection of the child is incomplete.

We should next see that the infant's dietary is regulated with due regard to his powers of digestion. Excess of starch must be corrected, and it is best to have recourse to one of the malted foods. Mellin's food is especially valuable in cases where there is this tendency to constipation, as is in many children the food has a very gentle laxative effect; but as Mellin's food contains no unconverted starch, and can do nothing to prevent the formation of a dense clot when the curd of milk coagulates in the child's stomach, it is advisable, when giving it with milk, to ensure a fine division of the curd by the addition of some thickening material such as barley water. A child of six months old will usually digest well a good dessertspoonful of Mellin's food, dissolved in milk, diluted with a third part of barley water. A certain variety in the diet is of importance in all cases where the digestive power of the infant is temporarily impaired. Therefore, it is advisable to order an additional food to be given alternately with the Mellin and milk. Benger's "self-digesting food " is useful for this purpose, and rarely disagrees. It must be given, like the Mellin, with cow's milk, but without the barley water, for the pancreatine it contains has a digestive action upon the curd, and removes the tendency of the latter to firm coagulation. In addition to the above, if the child has reached the age of ten months, he may take a meal of veal broth or beef tea once in the day, and with this it is advisable to give some vegetable, such as broccoli or asparagus, thoroughly well boiled. At this age, too, the milk for the morning meal may be thickened with a teaspoonful of fine oatmeal, and sweetened with a teaspoonful of malt extract. In the case of many infants suffering from habitual constipation, the appetite is very poor, and great difficulty is found in persuading them to take a sufficient quantity of nourishment. This indifference to food is almost invariably associated with coldness of the extremities, and usually disappears when measures are taken to supply necessary warmth to the feet and legs.

In all cases where an infant's bowels are habitually costive, it is of the first importance to enter thoroughly into these questions of clothing and diet. In addition, care should be taken that the bowels are regularly stimulated by manipulations from without. The sluggishness of peristaltic action which forms a part of every case of habitual constipation may be very materially quickened by judiciously applied frictions. The nurse should be directed to rub the child's belly every morning after the bath. She should use the palm of the hand and ball of the thumb, and, pressing gently down upon the right side of the abdomen, carry the hand slowly round in a circular direction following the course of the colon. The frictions may be continued for five minutes. In obstinate cases the child may be laid down upon the bed, and the