MINUTES OF THE SECTION

ON

DISEASES OF CHILDREN.

WEDNESDAY, May 4, 1881.

THE Section on Diseases of Children was called to order by the Chairman, Dr. A. JACOBI, of New York. Secretary, Dr. T. M. ROTCH, of Massachusetts.

Dr. H. P. BOWDITCH, of Massachusetts, presented a paper entitled The Relations between Growth and Disease.

Dr. J. S. BILLINGS, U. S. A., spoke of the value of Dr. Bowditch's paper, and presented to the Section the statistical cards intended for circulation by the National Board of Health.

Dr. WM. LEE, of Maryland, remarked that he had paid especial attention to this subject, and that he had noticed that a female child could lose more in proportion to its weight, without detriment to its health, than the male child of the same age. He also said that if the loss of weight preceding the eruptive disease was excessive, the case was so much the more grave in its prognosis, and that this loss of weight preceded the eruption. by from four to five days.

Dr. S. C. BUSEY, of District of Columbia, read a paper entitled The Relation of Meteorological Conditions to the Diarrhoeal Diseases of Children.

Dr. JAMES C. WHITE, of Massachusetts, presented a paper entitled Some of the Causes of Infantile Eczema, and the Importance of Mechanical Restraint in its Treatment.

Dr. L. DUNCAN BULKLEY, of New York, regretted criticizing the paper as he felt obliged to do, in the absence of his friend Dr. White, but the views presented differed so radically from those which he had formed from experience that he could not help so doing, because he felt that the subject demanded it. For those who did not know of his acquaintance with the dis

ease, he would state that he had recently made analyses of 2500 personal cases of eczema, and of these nearly 700 had occurred at an age which classed them as infantile eczema; he therefore believed that he could speak with authority on the subject. Dr. White had, it is true, treated of only one feature in the management of the disease, namely, physical restraint, but he believed criticism to be called for because of the principles which underlie, or which call for this element of treatment; the premises being wrong, what follows must of necessity be wrong.

The speaker believed that Dr. White here, as elsewhere, laid far too great stress upon local causes of eczema, and ignored entirely the influence of internal, general, dietary, and hygienic causes; if these are not recognized and managed, the results of local treatment are imperfect and uncertain. He did not believe that the children with infantile eczema were really in perfect health, but that always the evidences of imperfect assimilation could be discovered; the evacuations from the bowels were faulty, the urine constantly presented evidences of mal-assimilation, and searching investigation would always demonstrate imperfect health in the child. In nursing children, the mother should always receive very careful attention, as very commonly she would exhibit dyspepsia, or constipation, or perhaps was taking ale, beer, much tea, etc., which disagree and cause trouble in the child; or perhaps she was very much debilitated, etc.

This subject could not be fully entered into here; the speaker expected to read a paper on Diet and Hygiene of Eczema, before another Section at the present meeting. He was, however, absolutely convinced of the importance of this matter, and that if attention was thoroughly paid to it much less would be required locally, and what was used would be more rapidly and completely successful.

Internal treatment to a certain degree was also absolutely necessary, and without it, physical restraint, as any local treatment, would be comparatively ineffective. This could not be discussed here, but he would only mention in illustration the internal use of small purgative doses of calomel, every other day, and a mild alkali, as acetate of potassa in the liquor ammoniæ acetatis, with a little nitre and perhaps aconite. Individual cases required very different management.

In regard to the method of restraint proposed in the paper, he would say that he had never employed such restraint, simply

because he had never found it necessary. If the itching was relieved, the restraint was not required, because the habit of scratching was soon overcome when the infant found that a proper application gave relief. If the itching is not relieved, such confinement was torture beyond any description, judging from the statements of older patients, who cannot abstain from it by any force of will, and who assert that they would scratch even if they died from it. The agony of little ones mechanically restrained was fearful to see.

In the paper the writer had mentioned the use of diachylon ointment. This the speaker very rarely employed in infantile eczema, as he belived it very inefficient in arresting itching. Tar in some form was far more efficacious; indeed, the speaker said that he had little to desire in the way of an application to infantile eczema beyond the following ointment: Recipe, unguenti picis, one ounce; zinc. oxid., two drachms; unguenti aquæ rosa, three ounces. Mix. This should be very carefully prepared and very thoroughly and abundantly applied. If it appears stimulating, less of the tar ointment may be used. He laid great stress upon employing the rose ointment, and not simple cerate, or lard, or vaseline, or petroleum. The ointment should be made of a consistency to spread easily and yet not to all melt away after application.

The writer had spoken of removing the restraining bands in order to wash the surface. The speaker was very positive in the directions given in regard to the use of water to eczematous surfaces in children; they were only to be washed according to direction, and that very rarely, often only at intervals of several days; moreover, it was all-important that the protective ointment should be replaced immediately after the surface is dried, and renewed sufficiently often to keep the parts completely protected, even twenty or more times the first day. On covered parts the ointment may be thickly spread on the woolly side of sheet lint and bound on. Among hundreds of cases the speaker had never covered the face with a mask, and had rarely been obliged to restrain the infant much after the first day or so. The only restraint he had ever practised was putting on muslin mittens, tied around the wrist, and then tapes from these passed behind the back or beneath one leg.

Under the management thus briefly indicated, if every point could be carried out, there was but one result, arrest of the VOL. XXXII.-23

eruption, and, if dietary and hygienic elements were persisted in, a cure of the disease. The attention to the mothers of nursing children he considered most important.

Dr. W. B. ULRICH, of Pennsylvania, in discussing the paper, said that he fully agreed with Dr. Bulkley, and that he entirely opposed Dr. White's treatment. In a long professional career he had never used a system of restraint in these cases, and that he would prefer to knock the little patient on the head at once rather than submit it to the tortures of Dr. White's strait-jacket.

Dr. JACOBI said, in regard to the discussion on eczema, that there did not appear to him to be such a great difference between Dr. White's and Dr. Bulkley's views concerning restraint. For Dr. Bulkley admitted that the tying of the wrists was sometimes necessary. He (Dr. J.) had sometimes resorted to it, and also to the use of the mask. The local treatment of chronic cases consisted, first, in the removal of the scabs. Poultice, oil, soap sufficed in mild cases; bad ones required the application, two to four times a day, of one part of liquor of caustic potash in eight to twelve parts of olive oil or cod-liver oil. In a few days the scabs can then be removed. Second, the soaking up of the oozing serum. Third, the use of astringents. The best of these is Hebra's diachylon ointment. Water is to be avoided, according to Hebra. As to constitutional treatment directed against the eczema proper, he knows of none, except arsenic in protracted cases sometimes. Ill health has its own general indications.

Dr. D. H. GOODWILLIE, of New York, read a paper on Thumbsucking, which he illustrated by the report of a case and exhibition of a wax model.

THURSDAY, May 5, 1881.

Dr. R. J. NUNN, of Georgia, presented a paper entitled Suggestions Touching the Treatment of Diphtheria.

Dr.LATHROP, of New Hampshire, said he had experimented with chloroform largely, and found it a highly useful agent. He used it in diphtheria and other throat affections on a piece of cotton attached to a tube or pen-holder. The cases usually required visiting no longer than four days, but the cases were not so malignant as had been reported in other localities.

Dr. Lathrop stated that no unpleasant effects had ever followed this plan of treatment, and that the child, in true diph

theria, would not complain of smarting from the application of chloroform.

Dr. E. H. BRADFORD, of Massachusetts, presented a paper entitled Resection of the Tarsus in Severe Cases of Club-foot.

Dr. JACOBI remarked that Dr. Bradford's cases were exceedingly interesting and instructive, and said that, as shown by the casts, they could not have been successfully treated without just such a procedure as Dr. Bradford had adopted.

FRIDAY, May 6, 1881.

Dr. C. J. BLAKE, of Massachusetts, presented a paper entitled Middle-Ear Disease in Children in the Course of the Acute Exanthemata.

Dr. JACOBI remarked that closing the mouths of infants and children, and simply blowing into the nose, is often a very valuable method of relieving severe earache, and that in a number of cases he had obtained most excellent results from this procedure, the cause of the trouble probably being a catarrhal affection of the Eustachian tube.

Dr. A. JACOBI, of New York, read a paper entitled Progress in the Knowledge of the Acute Contagious Diseases and Infections.

Dr. LEIGH, of Virginia, reported two fatal cases of poisoning from chlorate of potash. The first was the case of a child three years of age with diphtheria. The mother gave the child onehalf ounce of chlorate of potash, and the child died within twenty-four hours. The second case was a child five years of age with croup. It took six drachms of chlorate of potash in twenty-four hours; cyanosis appeared in six hours; hæmaturia and death in forty-eight hours.

Dr. POTTER remarked that in quite a large number of cases in his practice he had met rubeola and diphtheria occurring together.

Dr. JACOBI said that he had no doubt but that a number of deaths had occurred from chlorate of potash. When the blood is examined the corpuscles are broken up and irregular, and there is a conglomeration of hæmatin scattered about. There is no positive poisonous dose: three and a half drachms given for five or six days killed a robust boy of fourteen years. Dr. Jacobi had taken himself half an ounce, and this dose was followed by frequent micturition. Dr. Fontaine, a friend of his, however, took one ounce with fatal result.