IT has been repeatedly demonstrated in the Babies' Hospital, that tenement house babies vomit less, have better stools and gain more rapidly in weight when they are taking formulas which contain a moderately low percentage of fat and when the ratio of fat and proteids are about equal, than when they are being fed on a high per cent. of fat or "cream mixtures" where there is a very marked difference in the ratio of fat and proteids.

The objection that has been made to these low fat mixtures is that in some cases constipation develops. If lime water is dispensed with and bicarbonate of soda used instead to make the food alkaline, there is very little danger of this trouble occurring, and even when it does occur it is very easily remedied by making up the food with oatmeal gruel instead of barley, or by using malt sugar in the form of one of the malted foods instead of cane or milk sugar.

When feeding babies of the poor, another point in favor of low fat mixtures, or those that can be made up from four per cent. or plain milk, is that the excellent free milk from the New York Diet Kitchen Association can be utilized. Very few parents of tenement house babies can afford to buy really good bottled milk, and without this, "cream mixtures" cannot be prepared at home.

The following cases treated in the Babies' Clinic of this institution are illustrations of the above statements:

Case I: Edward R., age three weeks, brought to the Clinic Oct. 13th, 1903. The patient is a fairly well nourished child, weighing 8 pounds 8 ozs. The mother is unable to nurse her baby, so a formula consisting of-Fat, 1.20; Sugar, 6.20; Proteids, 1.05, using barley water as the diluent, and given III. ozs. q. 2 h. is prescribed.

Oct. 27th-Weight of patient 9 pounds 12 ozs. ; quantity of food increased to IV. ozs.

Nov. 3d-Weight 10 pounds 1 oz. Formula changed to Fat, 2; Sugar, 7.10; Proteids, 1.75; IV. ozs., q. 2-1-2 h.

Nov. 17th-Weight 10 pounds 9 ozs. Formula changed to Fat, 2.40; Sugar, 7.60; Proteids, 2.10; IVss ozs., q. 3 h.

Dec. 1st-Weight 12 pounds 2 ozs. Child slightly

constipated, so food diluted with oatmeal gruel instead of barley.

Dec. 29th-Weight 13 pounds 8 ozs. Stools now normal; no vomiting: child in excellent condition. Quantity of food increased to V. ozs.

This case shows a gain in weight of five pounds in eleven weeks.

Case II: William G., age two and a half months; brought to Clinic Dec. 22d, 1903. Weight, 13 pounds 12 ozs. Nursed up to present time, but for past two weeks has been losing weight and vomiting after every meal. Mother ill and milk very scanty, so patient put on milk formula, consisting of Fat, 1.20; Sugar, 6.20; Proteids, 1.05, IV. ozs, q. 2-1-2 h.

Dec. 29th-Patient has ceased vomiting entirely, stools normal, weight 14 pounds 2 ozs. Formula increased to Fat, 1.60; Sugar, 6.70; Proteids, 1.40.

Jan. 12th-Weight 14 pounds 12 ozs. Formula changed to Fat, 2; Sugar, 7.10; Proteids, 1.75, IVss OzS., q. 3 h.

Feb. 5th-Weight 15 pounds 8 ozs. food increased to V. ozs., q. 3 h.

Quantity of

Feb. 12th-Weight 15 pounds 12 ozs. Child has cut two lower central incisors, stools normal, no vomiting. Formula increased to Fat, 2.40; Sugar, 7.60; Proteids, 2.10.

This patient shows a gain in weight of two pounds in about seven weeks.

Case III: Teddie B., age nine weeks, brought to the Clinic Jan. 26th, 1904. Patient has been nursed up to date, but mother's supply of milk is very scanty and of poor quality; she must now work out and wishes to wean the child. The baby has had green stools with curds for several weeks and cries from colic and hunger the greater part of time.

Weight of baby 10 pounds 10 ozs. Formula ordered: Fat, 1.60; Sugar; 6.70; Proteids, 1.40, using barley water as the diluent, and giving IIIss ozs., q. 2 h.

Feb. 2d-Weight 11 pounds 8 ozs. Stools now normal; child appears much more satisfied; no colic. Formula increased to Fat, 2; Sugar, 7.10; Proteids, 1.75, IV. czs., q. 2-1-2 h.

Patient per

Feb. 23d-Weight 12 pounds 2 ozs. fectly normal in all respects, quantity of food in

creased to V. ozs., q. 3 h.

This patient shows a gain in weight of a pound and a half in four weeks.

In all the formulas used for the above cases the ratio of the fat to the proteids is 8-7, Dr. L. Emmett Holt's method of milk modification being employed, taking a twenty ounce mixture as a basis and using

plain or four per cent. milk when making up these formulas.

The cases cited are only three of many similar ones treated at the Clinic. The same method of modifying the milk has been tried in the wards and with nearly as good results.

In issuing the first number of the present volume, the Medical Board of the Lying-In Hospital desire to make the following announcement: A vast amount of clinical material is constantly under observation by the various members of the Attending Staff, which, properly presented should prove of great interest and value to the medical profession. Aside from the immediate benefit which hospitals confer on their patients, they must be viewed as centers of instruction, not only for those who are fortunate enough to be directly connected with them, but also for the profession at large,

tion either in its wards or at their homes (about 38,000 during the past 14 years) and the careful records kept of each case, warrants the belief that the resulting statistical information may be looked upon as bearing the stamp of truth and accuracy.

It is proposed to publish the Bulletin at convenient intervals, four or more times a year, the volume consisting of about 200 pages and liberally illustrated. The subscription has been fixed at the nominal price of One Dollar per annum. No advertisements are to be published. In addition to the original articles on obstetrical topics, it is believed that a department of book reviews and a classified bibliography of obstetrical literature will add to the value of the Bulletin.

Communications may be addressed to the Editor of the Bulletin, Lying-In Hospital, Second Ave. and 17th St., New York City.

Mrs. M. D. was admitted to the Indoor Service of the Lying-In Hospital, January 13th, 1905 (C. N. I., 5378). She stated that she had had colic-like pain, severe and cutting in character, in the right hypochondrium and radiating to the right shoulder. This pain had been followed recently by nausea and vomiting and she had had one decided chill which continued for five minutes. Pain had been constant for the past seven days, although at times it was dull in character. Her skin had been yellow, urine high colored and passed in large quantities, bowels were constipated, though the color of the stools had not been noted. Upon admission she was fairly well nourished. No jaundice present. The tongue was Her heart and lungs moist and heavily coated. Pulse 108. were negative. Temperature 102.2. Liver dullness extended from the Respiration 26. sixth rib to the free border. The liver was not pal

hypodermatically in quantity and frequency sufficient to control the pain. The intestinal tract was cleared by divided doses of calomel and a high ox gall enema. A hot pack was given. The temperature was normal within the first twenty-four hours and remained there-while the other physical signs and symptoms of the attack disappeared progressively and the patient was up and about the ward in twelve days, practically well without nausea and vomiting-and apparently gaining flesh. The previous history as given was: age 29, native of United States, always a sickly child, readily nauseated and vomiting frequently. Has had all of the usual diseases of childhood-Measles, Scarlet Fever, Diphtheria, Varicella, etc., without leaving evident trace. Menstruation beginning in the twelfth year, was irregular, scanty, painful and of three to four days' duration,-until after the birth of the first child, when it became regular and without noteworthy character. She was pregnant for the fifth time. There had been no abortion-the first two children were delivered at term, instrumentally, and are still living. The third was delivered instrumentally in the ninth month-during an attack of colic with convulsions. It died after six months, from summer complaint and "enlargement of the liver." The first attack of colic occurred in 1893-three years previous to the birth of her first child. The pain at that time was so great that she had convulsions with loss of consciousness, and was taken to a hospital, where she was obliged to remain two weeks, having had considerable fever. Occasional severe attacks with nausea and vomiting had occurred until after the birth of the third child since which time they were absent altogether for a period of nearly four years, until a few months before the birth of her fourth child, when the attacks occurred again with greater or less severity at intervals of about one month.

February 27, 1904, this patient made application at the Lying-In Hospital, and the regular ante-partum examination was made by the writer. She was then about six and a half month pregnant with her fourth child. It was her first appearance at this hospital. Her general good condition was the only noteworthy observation. No history of pains or nausea was revealed. On April 10th she was ad

mitted to the In-Door Service (C. N. I. 3863), saying that she was suddenly attacked with pain in the right lumbar region, radiating to the lower part of the abdomen and right side. This pain had persisted for twenty-four hours. The pain was that of renal colic. There was no tenderness over the gall bladder. Pulse and temperature normal. She was slightly emaciated-very slightly jaundiced. The urine showed a trace of albumen a few haline casts-no leucin, tyrosin or bile-although it was of a golden brown color-nausea and vomiting were persistent in spite af lavage-and various combinations of drugs, Bismuth, Cocaine, Cerium Oxalate, etc., everything taken into the stomach was promptly rejected. Nutrient enemas were tried and promptly expelled as often as tried. On April 12th, the cervix and vagina were tightly packed with sterile gauze. Uterine contractions began in about four hours, pains were fairly forcible. The gauze was expelled the following day and contractions ceased. The cervix was then soft and three fingers dilated. April 14. Nausea and vomiting persisting,-chloroform to surgical degree given,-manual dilitation was done and the child delivered by podalic version. Hemorrhage was profuse. The placenta was implanted only about 6 cm. above the internal os, was adherent and required manual extraction. A hot intra uterine douche given and the uterus packed with iodoform gauze. Two interrupted chromic gut sutures were placed in either side of the cervix to control hemorrhage where laceration had taken place. A wound in the perineum was also repaired. Vomiting ceased within the next fortyeight hours. More or less deep-seated pain in region of right kidney was complained of, otherwise recovery was rapid. Temperature reaching 99 degrees or above but twice. She was discharged in good condition with her child gaining in weight, on the 13th day post partum.

August 11th, 1904, patient again admitted to the hospital (G. H. N. 595) complaining of pain in lumbar region, radiating forward to right iliac and hypochondriac regions-no rigidity or tenderness found-temperature and pulse normal-consider able nausea and vomiting. Nothing very definite made out. She was discharged at her own request August 18, 1904.