of the cases occurred between the third and ninth month and his youngest patient was ten days old. The prognosis in all cases is rather bad, the high mortality (from 50 to 80 per cent) being due to the youth of the patients and the fact that the diagnosis is usually delayed. The chance for recovery from operation decreases rapidly with each day and unless the diagnosis can be made early there is very little hope for the child. In a very young baby this is attended with peculiar difficulties. REPORT OF THE WORK DONE IN THE BABIES' CLASS From October 1st, 1915 to September 30th, 1916. BY EMELYN LINCOLN COOLIDGE, M.D. DURING the past year 1542 new patients were admitted to the Class, the total number of visits made was 5098. The number of new patients admitted is quite a little in excess of those admitted for the same length of time during the year previous but the total number of visits made is a little less than the previous year. We attribute this slight decrease to two causes. First, our Class is no longer a free one, since last November patients have been required to pay a small sum for all medicines received. This is quite as it should be but it inevitably caused a slight falling off of patients. Second, the epidemic of poliomyelitis during the summer months kept many patients away from the clinic during the season when we usually have the largest attendance. The mothers were afraid to bring their babies to clinics for if there was evidence of slight illness they feared the babies might be developing infantile paralysis and thought if they came to a clinic the babies would be taken away from them and forcibly sent to an isolation hospital. Other mothers were afraid to bring their babies to any place where large numbers of children were congregated because they had all been warned to keep by themselves and avoid crowds as far as possible. Our nurse spent an exceedingly busy summer visiting the homes of patients whose mothers could not be persuaded to come to the Class. During the year she made 1432 calls. With the emergency fund which is provided by the Ladies'Auxiliary for needy patients, the nurse bought mosquito netting, fly paper and disinfectants wherever she found it was impossible for the parents to afford these articles, to protect their babies from flies and mosquitoes. She gave much good advice regarding cleanliness of homes and general care and hygiene of the babies. She saw that every suspicious case of an infectious disease was immediately reported to the Health Department and proper isolation maintained whenever this seemed necessary. In this way we feel that the Class did its full share in helping to fight the epidemic of poliomyelitis that invaded the City during the summer months. For the last three months we have been trying a new method of feeding delicate babies and while we are not yet ready to give very large statistics as to the results of this method we have thus far met with very excellent gains. The method has been tried usually after our ordinary formulas have been used with more or less unsatisfactory results. We have many babies who are especially difficult to feed. They have poor vitality to begin with and the digestive organs have often been almost ruined by ignorant feeding attempted by the mothers before applying to the Class for help. The general principle of this method is as follows: A comparatively large amount of a finely prepared and sterilized cereal flour is mixed with a small amount of a dextrinizing fluid, and the amount of water and milk needed in a given formula; all these ingredients are then brought to a point just below boiling, then at once removed from the fire and quickly cooled and bottled. No sugar and no antacid as lime water or soda bicarbonate, is needed with this method. Either whole milk or top milk formulas may be used according as the special baby needs more or less fat. The nurse has always given each mother an object lesson in preparing this food but when once shown how to do this, even the very ignorant mothers do not make mistakes. It is really very much more simple than the usual method of first preparing the cereal gruel and then adding the milk, sugar, lime water, etc. The stools of the babies taking this new set of formulas were very carefully watched and almost from the start showed a marked improvement, very soon being absolutely normal in appearance. After this took place the gain in weight would begin and continue to increase steadily from four to eight ounces weekly. This method also worked well in cases of marked vomiting, in this group of cases we used either whole milk or else skimmed milk with the dextrinized gruel, until the stomach was strong enough to bear higher percentages of fat. The dextrinized gruel in itself, is not at all a new idea but the special method of using it and mixing it with the other ingredients in the formulas is quite new. Any one of the cereal flours may be used in this way but we had better results during the past summer with wheat flour than with any one of the others. A new cereal flour made from corn has also been tried in some cases as it is especially easy to assimilate when dextrinized by this special method. Altogether we have had an unusually successful and interesting summer with our large number of feeding cases, many of whom seemed almost hopeless when they were admitted to the Class. The premature babies have done well at home when we were able to get in touch with them early. Fourteen of these babies weighing from two pounds fifteen ounces to four pounds have been closely followed up. The little cotton suits have been worn by them, careful warm oil baths given by the nurse and the food regulated with special care. We are glad to report that they are all gaining well. In several cases where breast milk could not be obtained for these premature babies, the new method of modifying milk has been used and with very marked success. One almost hopeless baby weighing only two pounds and fifteen ounces, made a gain of nine ounces in one week after being changed to the new method of feeding! During the epidemic of influenza last winter we had a number of very interesting cases in the Babies Class. The most frequent complications that we found were bronchitis, otitis media and cervical adenitis. Many cases of the latter progressed to suppuration, it being necessary to incise the glands but when this was once done, the recovery was very prompt. MEDICAL STATISTICS OF THE LYING-IN HOSPITAL BY ROSS MCPHERSON, M.D., Number of confinements.. Number of births... .6,266 .6,337 In the 6,337 births it was possible to observe the presentations in 5,621 instances (88.70 per cent). Of the above 578 (9.12 per cent) were brought in by the ambulance as emergency cases. |