of Rhodes. Spurious works Andronicus.

The American journal of obstetrics and diseases of women and children online

. (page 104 of 109)
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such half-way measures as are now tried here were attempted,
show that nothing really efficient and of universal benefit can
be gained in this direction, unless it is undertaken and carried
out by its "natural guardian" — the State! Therefore at the
sixtieth annual session of the American Medical Association in
June, 1909, during a discussion,* in the Section on Stomatology,
I emphasized the importance of instituting and maintaining
dental clinics by the states or cities, appointing dentists at suf-
ficiently high salaries and with prospects of becoming pensioned,

♦Published in the/. A, M. A., of July, 1909, p. 53.

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zentler: proper development of children. 1009

so that, serving in clinics, they shall refrain from private practice
and give their entire time to this work. I am glad to say that
enough interest was stimulated among the members of the
Section for a resolution to be proposed and carried, that the
house of delegates of the A. M. A. be requested to recommend
this measure to the legislature. I earnestly hope that the house
of delegates of the A. M. A. will favorably act upon it and that
finally it will be taken up by the state, who, asserting itself in
modem society as its guardian, thereby assumes responsibility
for its welfare.

Each newborn child becomes a prospective member of society,
and according as to how his or her faculties will develop it will
become a useful or a useless member, a "help" or a "burden,"
to society. If by means which, for the great masses of the people,
the state alone can employ, some children may be changed from
useless into useful members, it is plain that it is the state's duty
to undertake this task.

The very fact that the state asserts itself as guardian of
society by assuming the privilege of regulating and governing
society implies the obligation — no privilege without obligation —
that the state be watchful that such rules and regulations which it
imposes upon society may comfortably and profitably, both
to society and the state, be carried out. When the state ordains
that all parents must send their children to school, the state
takes the obligation: first, toward the child, that it be placed and
kept in such physical comfort that its mental faculties may
develop to their highest possibility, thereby not needing to
spend more than the officially acknowledged necessary time for
going through the school grades; second, the state takes the
obligation toward society, who contributes to the state's budget,
that it may not be burdened any more than necessary, as it
would with children with uncorrected physical defects impeding
their mental faculties and placing them in the position to need
the attention of teachers and to use the space in schools reserved
to them for longer periods of time, thus burdening the state

That such oral defects as malformed jaws and arches with their
bad influence upon the development of other organs indirectly
retard mental development, I believe, was clearly explained
early in this paper, and what mother does not know of the
debilitating influence upon her children of the other defect,
the common "tooth decay"; how many sleepless nights passed

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1010 zentler: proper development of children.

in agonies of pain, resulting in the physical inability of regular
school attendance, were the consequence of " tooth decay"?

If the parent is not financially in a position to have the oral
defects of the child properly attended to, or if for lack of better
knowledge the parent neglects this needed attention to the child,
and as a result, regular school attendance is interfered with on
account of physical debility, is not thereby mental development
impeded? Will the child not lose his time and will not the state
spend more for educating this child? It is therefore to the
interest both of the child and the state that the state undertake
the correcting of oral defects in children, beginning at the earliest
age possible, with a view rather of prophylaxis than cure.

In order to waive the possibility of a doubt as to the fact
that the expense to the state to maintain school dental clin-
ics is not greater than the schooling of children with uncor-
rected oral defects, I will mention that in Germany where this
experiment has been carried on for over five years, statistics
show that the former proposition costs a great deal less than the
latter. It costs the city of Strassburg about twelve cents
yearly per child to correct and maintain in good condition its
oral cavity.

It is hard to lay down rules as to how the condition relating to
oral defects should be met.

It may be expedient to begin by introducing in the curricu-
lum of the schools for kindergarten and public school teachers
enough of oral hygiene to enable the teachers to intelligently
explain and inculcate to their classes the need and method of
oral cleanliness, as a precursor to better oral development.
Further, to arrange for systematic periodical conferences, given
by dentists to pupils of all the public schools, inviting to such
conferences the parents of pupils, and in connection with the
lecture to illustrate the normally developed mouth, the defective
mouth, the result of early corrected defects and the sad con-
sequences of neglected oral defects. To illustrate how home
hygiene ought to be carried out and to lay great emphasis upon
proper infant diet, and, above all, not to forget to preach that
true maxim which is printed in all the German dental clinics:
" A clean tooth surface does not decay."

Such measures if carried out universally will have the effect
that when the state will take the next absolutely necessary step
in order to accomplish results — when it will institute and main*
tain the public school dental clinic and make it a rule for every

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pupil to pass through it for thorough periodical oral examinations
by dentists paid by the state and giving their time exclusively to
the clinic — the parents and pupils will not look upon this rule
as arbitrary or despotic, but will gladly obey it. Of course, the
school dental clinic, after establishing the needs of each individual
child, is not to force the children to have their defects corrected
by the state, if their parents are willing to have private practi-
tioners do it for them, but in the interest of general hygiene of
society and state such children who cannot seek paid services
shall be cared for by the state.
265 Central Park, West.


AnntuU Meeting held in Washington, Z>. C, May 3, 4, and 5.
The President, David L. Edsall, M. D., in the Chair.

president's address.

David L. Edsall, M. D., Philadelphia, said that the honor of
serving for a year as the president of a group of men who are
the highest representatives of their type of work in this country
imposed upon one the duty not merely of giving expression to
complacent satisfaction, but also of devoting serious thought to
the activities that may be open to the members of the Society,
as individuals or as a group of men, by which they might still
further advance the honorable standing of the work that is their
chief concern in life. He recognized that the things he desired
to say could not be considered exactly as advice, as they were
not his own thoughts alone, but in more or less the same form
were uppermost in the minds of others. He felt that proper
dignity and regard were not yet accredited in this country to a
subject which had proved to him unquestionably the broadest,
most complex, and the most important division of general medi-
cine and that proper standing would not be generally given to
pediatrics in this country until better things were demanded
for it by concerted action and until better things were demanded
for it by a large group of those who are the recognized leaders.
The dignity of the intellectual pursuits was determined by two
things: first, by the opportunities offered those who teach the
subject and by the manner in which these opportunities are made
use of; second, by the extent to which those who follow that
pursuit engage in matters that vitally affect the welfare not

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only of those individuals with whom they come in immediate
contact, but rather of the public at large. He thought there
were ways in which great usefulness could be secured for pedia-
trics in both of these directions and believed that the Society
could rapidly, by the strength of carefully planned concerted
action, greatly benefit the position of the work which it repre-
sents. The methods pursued by the teachers determined the
standards demanded in the subject and the quality of the future
exponents of the subject. Among the teachers of this subject
there were men who have in certain ways no superiors in any
part of the world. Concerning the provisions made for their
teaching, however, there were points which might be justly
commented upon and not wholly favorably. Pediatrics was
probably more inadequately provided for in most medical
schools than any other important subject. This criticism was
of the general group of schools, not of individual schools. In
some the system of teaching was relatively excellent. But
nowhere is provision made for the subject as good as that which
is made for general medicine, surgery, and obstetrics. Neu-
rology, he thought, had much more actual standing and recog-
nition in the general group of our best medical schools than
has pediatrics. Yet he thought that the problems of infancy
and early childhood were much more distinct from general
medicine than were the problems of neurology and more properly
demanded generous provision for instruction. At the present
time there were in this country at least twice the number of
men of recognized distinction in neurology than there were in
pediatrics. The explanation he thought a patent one and that
while the responsibility might be properly thrown in part upon
the shoulders of the administrators of medical schools it could
not be wholly upon them, but must be shouldered by pediatrists
themselves. It was a common and seemingly just statement
that the clinical branches have in this country in the past gener-
ation by no means kept pace with the medical sciences in methods
of teaching and investigation. He made a strong plea for
better general conditions in teaching and said that it was a
well-recognized fact among educators that unless a man does
some kind of research, more or less continuously, he does not
make, or at any rate does not long remain, a sound teacher,
simply because the teacher must, in order to make the student
search for knowledge, search continuously and diligently him-
self. The kind of research work done in any particular depart-
ment is commonly accepted, and rightly so, as the best criterion
of the character that the teaching in that department will
exhibit. The chief essentials for making well-trained men and
for attracting first-class men into a subject were that the men
shall do most of the work themselves and not be merely told
about it; that they shall be made precise and critical in their
methods and that the craving for a sound understanding for
the reason of things be satisfied by having them clearly corn-

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prebend the relation between tbe fundamental and tbe practical
tbings. In tbese ways general medicine and general surgery
badjbeen quite transformed witbin two decades, and now students
do most of tbe work in tbe wards and dispensaries. In pedi-
atrics tbe cbanges bad been mucb less distinctive. Cases were
less frequently seen as problems to be worked out by tbe student
bimself. Of course that was less attractive to the best men.
Healthy minded persons enjoyed eating more than being fed.
Tbe propriety of studying pediatrics as a special subject rather
than as a mere part of general medicine was based essentially
upon tbe fact that tbe infant and young child differ from adults
enormously in degree and almost equally in kind, in suscepti-
bility to infections and especially in liability to derangements
of nutrition. This be thought gave a greater justification for
specialization than any based upon difference in the organs of
the body and demanded of those who would enter into pedi-
atrics a very wide and subtle knowledge of the two types of
work that are now and probably will be for years to come the
most progressive and most productive lines of work in'^medicine
and at tbe same time the most complex and difficult: infection,
immunity, and hygiene, with the physiology and pathology of
nutrition. Tbe difficulty in regard to the studying of cases
could be overcome only by demanding that tbe clinic^ work in
pediatrics shall be put on tbe same basis as that which is being
struggled for and increasingly secured in medicine and surgery.
He thought that the Society could wisely take upon itself a
serious consideration of the manner in which teaching and in-
vestigation in this branch may be benefited and by individual
and concerted action further whatever appears to be wise.
In this way be thought results could be rapidly accomplished.
Among other ways in which be thought tbe Society could take a
useful part was a study of school conditions and tbe industrial
conditions among children, which should be studied by persons
of calm and judicial temperament so that we might be in-
formed upon tbe actual state of affairs by those whose opinion
would be more reliable than that of perhaps overenthusiastic


D. M. CowiE, M. D., Ann Arbor, Mich., and Wm. D. Lyons,
Ann Arbor, Mich., because of tbe many discordant views as to
disturbances of infant digestion, endeavored to ascertain how
food reactions in tbe infant stomach compare with those in vitro.
They determined, first, the stimulating effect of normal food ; how
altered by certain chemical substances, and bow that compared
with results obtained in test-tubes. They determined that the
stomach is capable of stimulation from tbe first day of life; that
all tbe ferments are secreted at that time. Tbe secretion of

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acid was represented by curves which gradually rise. Taking
samples of stomach contents from time to time, a curve charac-
teristic of the majority of infants was obtained. They made
from a hundred and fifty to two hundred anal3rses on twenty-
eight or twenty-nine infants and rarely found free hydrochloric
acid present in the stomach. It is not necessary in order for
the stomach to perform all its physiological functions. After
fasting for six or eight hours they found hydrochloric add, but
at the end of the feeding period or in the middle they rarely got
free hydrochloric acid. They determined that the basic condi-
tion of calcium casein must be overcome before the rennin pre-
cipitates rennin curds. Conditions are different from those in
test-tubes. The statement that basic calcium chloride hastens
evacuation of the stomach was not true. Taking out fats and
anything that would inhibit motility of the stomach, they found
that in forty-five minutes the change had taken place, producing
the ordinary curd. Basic calcium chloride did not prevent for-
mation of curds in the stomach in majority of cases. They also
showed that acidity hastened the opening of the pylorus. They
believed this had more to do with the evacuation of the stomach
than the curds. The curds were easily crushed and large curds
did not occur in normal conditions of the stomach. Calcium-
chloride curds were easily precipitated. They concluded that it
was not necessary to produce a perfectly soft curd, but to learn
what chemical changes actually go on in the stomach. They
considered the acid control of the pylorus of great importance.


A. H. Wentworth, M. D., Boston, presented this paper which
was a continuation of work alluded to in a pre\dous article, the
principle of the research being the discovery that hydrochloric
acid is diminished in the stomach contents of atrophic infants.
The secreting power in cases of infantile atrophy was much
diminished. It was thought that the stomach of atrophic
infants fails to secrete sufficient hydrochloric acid to stimtdate
the duodenum. In the first series of cases the stomach contents
were obtained one hour after eating and determination was made.
Results showed diminished secretion of hydrochloric acid in
every case. The same experiment was made with healthy infants
with variable results; in four cases it was greater and in three
cases it approximated that of the atrophic infants. The results
were not conclusive and a second series of observations were
made. This article gives the results of the second series and
certain conclusions that may be drawn from them. Unfiltered
stomach contents were used in every case; soft-rubber No. 19
French catheters were used; contents obtained with infant lying
on side. The essential data were arranged in the form of tables.
The diagnosis of infantile atrophy was made from clinical evidence

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alone. The possible relation of stomach contents to degree of
acidity appeared not to be present in this series. A few cases
showed marked gain in weight with only a trace of hydrochloric
acid in the gastric juice. There was rarely more than a trace of
hydrochloric acid from the stomach of atrophic infants fed on
cow's milk. The results correspond closely with those of the
experiments previously made. The stomach contents of well-
nourished infants fed on cow's milk showed diminished amount
of hydrochloric acid, corresponding closely to about one-half of
the atrophic infants. Although the diminution was marked, it
was never so extreme as in the atrophic infants. The results
tend to prove that marked diminution of hydrochloric acid oc-
curs in infantile atrophy. It was also shown that these infants
can gain markedly in weight without hydrochloric acid in the
gastric juice, and that there is greater variation in hydrochloric
acid in the stomach contents of these infants than in normal


Henry Heiman, M. D., New York, exhibited charts showing
the experiments that were conducted in the children's ward at
Mount Sinai Hospital, the study having been for the purpose of
adding to the data on the subject of gastric digestion in infants.
The first group consisted of twenty normal infants from three to
seven days old; the second group, thirteen artificially fed infants
three weeks to seven months old. In all the temperature normal
for at least a week and condition good. The method of procedure
was, with the new-born, to weigh the baby before and after nursing.
At the end of one hour stomach contents removed with French
catheter. No preliminary lavage was performed. In the
second group four examinations were made for each case. Con-
tents received in glass jar and measured in graduate, then filtered
and the filtrate used for the tests. In the first group thirty speci-
mens were examined. Quantity of milk consumed at each feed-
ing from 30 to 200 grm. — considerably above the figures usually
assumed at that time of life. In general the peptic action* was
more at the end of one hour than at the end of a half-hour. The
work showed in new-bom infants the large amount of milk taken
at one nursing; that practically the same quantity was obtained
at the end of one hour as at the end of one-half hour; that total
acidity was practically the same at the end of one hour as at the
end of a half -hour; absence of free hydrochloric acid in all cases;
presence of rennin in two- thirds; presence of lactic acid in one-
half of the cases. In the second group pepsin present in only six
cases; rennin in but two. The writer thought it remained for
future study to place the matter of gastric analysis of infants on
as firm a basis as that of adults.

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Charles F. Fife, M. D., Philadelphia, and B.S., Veeder, M. D.,
Philadelphia, had undertaken the studies to determine the
absorption of fat in cases of chronic intestinal disease in infants.
The infants were placed on definite formulae for some days and the
urine and feces completely collected. Case I, infant nine months,
weight lo pounds 9 ounces. Case II, age ten months, weight 11
pounds 10 ounces. Tables and charts were exhibited to show the
varying formulae. As to fat absorption the work showed in both
cases that fat absorption is below that of healthy infants. The
total amount is less the less fat is ingested. Where little fat is
given the percentage of absorption is much less. The amount
of carbohydrate present had no influence upon fat absorption.
Evidence pointed to the necessity of the splitting of fats before
digestion. They found that in the low fat periods the actual
amount of soaps in the feces was higher than in the high fat
periods. The lower the fat ingestion the higher the amount of
soaps. The work showed lowered fat absorption in these two
cases of chronic intestinal disease while most writers claim that
there is not much diflference. They did not find any definite
relation between the calcium, in the fat, the calcium in relation
to the total amount of fat, or relation to the soaps in the feces.


Maynard Ladd, M. D., Boston, concludes from a stuy ofd
125 cases of infants, in which the total mortality was 65.6, no
infant under six months surviving, that modified milk must be
considered as unsatisfactory food for premature infants and
should be used only when breast milk cannot be obtained.
Incubators were not employed.


John Rowland, M. D., New York, and Robert A. Cooke,
M. D., New York, presented the results obtained with three in-
fants put in a metabolic apparatus. On a fat-free diet they deter-
mined that all the calories could not be supplied. On a high
fat diet the caloric value rises. The protein given represented
6/10 gm. nitrogen per kilo. The first boy began with practi-
cally fat-free diet which was increased gradually until he was
taking 76 gms. a day of food containing over 7 per cent, of fat;
he was kept on this two and one-half months, then reduced to
fat-free diet. When on fat-free diet his stools were brownish,
frequent, and thin; as it increased they became light, and on
high fat diet whitish. A second child, boy of six months, badly
nourished, with ischiorectal abscess, had stools brownish and
very foul odor, as the fat intake was increased they became

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light and finally white and almost dry. The ammonium out-
put was relatively high throughout. On medium fat diet child
did best. Case III, small, badly nourished infant of five months,
investigation lasting three weeks. At first he took fat-free food,
then it was increased rapidly. Never did well at any time;
showed definite reaction to all fat feeding. The first child
showed only benefit; the second with excessive amount of fat
showed disturbance, and the last child was upset by a moderate
intake of fat. The results showed the danger of trying to draw
definite conclusions from limited material. They do not advise
the use of too much fat, but the individual tolerance of some
infants is so great that the greatest variation may not produce
any harmful results. They conclude that the best diet is un-
doubtedly one containing both fat and sugar in moderation.


stomach; (b) results of a trial of
finkelstein's method.

Henry D. Chapin, M. D., New York, said the proper nourish-
ment of feeble infants is a problem that taxes the resources of
the most skillful pediatrist. That digestion and assimilation
may be poor, either by inheritance or from faulty feeding, and
when from any cause the general vitality of the infant is lowered,
the digestive tract is usually the first to suffer and the last to

Online Libraryof Rhodes. Spurious works AndronicusThe American journal of obstetrics and diseases of women and children → online text (page 104 of 109)