inently before the eye of the public, in other words, that it is the best kind of an advertisement to have the title "Professor" prefixed to his name, and if he has not the "pull" that will secure a place in one of the schools already existing, he gets together a set of those who are out and they set up another "muchneeded" school. A school without clinical material is "not in it," so they must needs get a dispensary and hospital under their control. The great need of such an institution in a certain locality is brought to the attention of the mung ipal authorities pecuniary aid secured, and the dispensary established. The supply of those patients for whom such institutions are properly intended is not sufficient for the needs of the school, so those are admitted who are able to, and should, pay for the services of their medical attendant. This is unjust to the tax payers, unjust to those physicians who depend upon their practice for their support, and harmful to the people at large, in that it stimulates a spirit of pauperism. However, it is a difficult matter to decide just where the line should be drawn that shall divide the two classes. We do not think that this aid should be extended only to those who are destitute. There is a worthy and most useful class of citizens, who by their honesty, frugality and industry manage to keep out of debt and supply their families with the ordinary comforts of life while they are in health, but who in case of sickness, have their income cut off as well as their expenses increased. This class should be favored and not required to start out again burdened with a heavy debt and in many cases out of a job which has beer forfeited during their illness. Such a condition would greatly discourage them and in many instances would probably prove the beginning of a downward tendency that would finally result in absolute poverty and crime.

While the north is suffering from an exess of this kind of charity this section is suffering the other extreme. In only three or four of the larger towns is there any effort being made to dispense medical aid to the poor from the public funds. This burden is thrown entirely upon the medical profession as though it were a part of their natural duty, and we may say accepted by them in much the same spirit. Now there is no more reason that the medical profession should bear this burden alone than that it

should be imposed upon the legal profession, or any other individual class. Doctors have to pay their pro rata of the public tax, and are now even subjected to a special tax for the privilege of practicing; they have to pay full price for all the commodities of life and for the drugs which they are expected to furnish when they give their services.

The care of the poor clearly devolves upon the county authorities and each county should provide hospital accommodation for those of its citizens who are sick and unable to pay for their medical attention. If a county is sufficiently populous it should have its own hospital centrally located; otherwise, two or three counties might have a joint hospital. These hospitals need not be expensive structures, but should be provided with the necessary paraphernalia, and be under fhe charge of some intelligent person. Some physician near by, could always be engaged for a nominal sum to visit the hospital every day, or two days, at farthest,and give his directions to the attendant. The expense of such an institution would not be great and would fall very lightly upon the individual tax-payers, whereas the burden falls quite heavily when concentrated upon the twenty-five or thirty doctors in the county. These institutions should be in no wise connected with the county poor houses, for there is a stigma attached to the fact that one has been an inmate of the poor house which would deter many of the very persons who most deserve the aid.

Some people think that it is no expense for a doctor to attend the poor, but it is an expense. He is not only called upon in many instances to furnish medicines and surgical dressings, but there is the wear and tear on his horse and buggy and upon himself, and the frequent loss of a case that would pay him well; and the intelligent physician is always able to employ his spare time usefully. We believe this is a matter worthy of the attention of the county medical societies, and we see no reason why something on this line cannot be done that will prove greatly beneficial to the people as well as to the profession.

Abstracts.

THE CLINICAL SIGNIFICANCE OF THE DISCHARGES IN INFANTILE DIARRHEA.-Dr. W. E. Darnall (Prac. Med.) suggests the following classification of the bowel discharges in infantile diarrhoea Mucous, serous, the pasty white, or musty, and the dyspeptic, the last subdivided into (1) acid and (2) alkaline.

(a) The mucous stool, whose appearance is familiar to every practitioner, presents a discharge usually small in amount, frequent, and characterized by whitish, ropy mucus of a gelatinous consistence. It may be faintly streaked with blood or stained with feces. While some authors have attributed the presence of this stool entirely to nervous disturbance of the secretive functions, it is equally true that this stool in a large number of cases is the result of errors in diet, and where no neurotic tendency can be made out.

In dysenteric states, where the colon is affected, there may be quite a bloody stool, and sometimes a stool known as hemorrhagic, which consists almost entirely of blood. There are also much tormina and tenesmus, and the pain rapidly exhausts the little patient if it is not relieved.

Should ulceration be present, it may be determined by the occurrence in the discharges of pus and shreds of necrosed mucous membrane, in addition to blood and mucus.

If

If the disturbance is neurotic in origin, with mucous stools, remedies designed to restore normal nervous tone may be employed, good hygiene being of first importance in all cases. the history points to the presence of local irritants from dietary imprudence, a full dose of a palatable preparation of castor oil sweeps clean the Augean stable of its offending matters and mucus. Bismuth then in large doses, held in suspension with mucilage of acacia, is valuable for its sedative, mildly astringent, and antiseptic action.

Should a dysenteric state be present, calomel and ipecac, internally, are of value. The more rational mode of treatment, however, would seem to be that of local applicatious to the diseased part by means of medicated enemata-silver nitrate solutions standing among the most valuable for this purpose. also among the best when ulceration is present,

It is

(b) Serous Diarrhea.-These stools are represented by copious watery discharges, which hardly stain the napkin. It is termed choleriform diarrhea, or cholera infantum. Associated with such stools may be severe vomiting, and usually a profound state of collapse. The severe shock under which the little pa tient labors is ascribed, on the one hand, to heat exhaustion; on the other, to a severe toxemia from infected food. The clinical picture in either case is the same. The vaso-motor system is profoundly depressed, and the abundant flow appears to be caused by the relaxation of the intestinal vessels supplied by the splanchnic nerves. Temporizing here means death to the child. If heat stroke is the cause, the same indications for treatment obtain as in the adult. Whether due to heat or poison, the point to be emphasized is that a dangerous condition confronts us a disorganized physiologic state is present. Unless this aspect of the case is recognized and the depressed state of the nervous system promptly restored to its normal tone, a few hours or a day may leak the reservoir of life so low that death sepervenes.

Abdominal counter-irritation is valuable and should not be forgotten. Morphin and atropin, for their stimulating effect, may be used hypodermatically in minute doses. Champagne and brandy are valuable. Lavage of the stomach may be employed to check vomiting. Rectal enemata of saline solutions also have their advantage, for by this means lost serum may be restored to the blood, while excessive purging may be allayed by rectal injections of starch water and laudanum.

(c) The Pasty White or Musty Stool.-The discharge is hardly visible on the napkin, and has the appearance of a paste made of water and chalk. The odor is musty or mousy, and is characteristic of this stool. The stool indicates a complete atony of the glands of digestion. Through the influence of micro-organisms every gland in the alimentary canal appears to be in

active.

Treatment here should be prompt, its object being to restore activity to the glandular functions. No agent is more effective for accomplishing this than the bile itself, for this, with its antiseptic action, is one of its most important natural functions. Podophyllin in one-twentieth-grain doses has been found very

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valuable in flooding the bowel with bile and bringing to terms the languid glands. So long as this pasty stool continues astringents are contraindicated. They will only lock every gland. tighter and tighter. When the stools become bilious, Nature usually accomplishes the rest. If a catarrhal condition should remain, however, then, and not till then, are astringents indicated.

In each of these three phases of diarrhea it is generally accepted as advisable to withhold all food for a short time. In the meantime thirst may be allayed by barley water, and the child usually does not suffer from want of nourishment for a day or two.

(d) In the next class of dyspeptic diarrhea, however, the whole management seems to be a question of artificial feeding rather than the administration of medicine. The trouble may last for months unless proper feeding be employed.

The stools may be divided into two varieties: The first of these is characterized by a discharge leaden in color, acid in reaction, and by the sour, disagreeable odor of fermentation. The second is characterized by a grass-green stool, alkaline in reaction, and of a most foul and offensive odor. Intermixed in

the discharges of both the acid leaden and the alkaline green stools may be seen curds of undigested food. The first is typical of the bacteria of fermentation; the second of the bacteria of decomposition, and the alimentary canal affords a splendid test tube for the cultivation of these organisms.

This disease is one of hot weather, the warmer temperature making the always easily infected milk still more congenial to the growth of the bacteria, which get into it through unclean nursing bottles, contaminated nipples, and in many other ways. The first indication is, of course, to free the bowel as completely as possible of its offending contents. The adjustment of a suitable diet may then be considered. This is frequently

a matter of much difficulty. Escherich, who has made much research in this field, advises, in the acid-fermented stool, the withdrawal of all carbohydrate foods, milk, etc., and the administration of beef juice, albumin water, and meat broths. If, on the other hand, the green alkaline stooi is present, these foods should be prohibited, and carbohydrates given. It is often nec