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cases the disease was noticed within a few days of birth. In

half of the cases a statement was made as to the familyhistory. In 3 it was good throughout, in 3 a grand-parent or great aunt had diabetes. In 6 cases the disease

seemed to have followed an injury to the nervous system. In

2 of these the infants sustained a severe fall on the

head. In 2 other cases the symptoms may have beenassociated with injury at birth, as the labours were difficult.In 3 cases there was increased cerebral pressure from hydro-cephalus, and in 1 malformation of the brain (anencephalus).In 3 cases the disease began after the giving of an unusualamount of sugar. One baby was fed on condensed milk;another was given 150 grammes of sugar and a litre of

milk daily; and in the present case a litre of milk was

given containing 10 per cent. of malt infusion. The

majority of the cases showed the following symptoms incommon. At first restlessness was noticed. This wasfollowed by increased thirst, hunger, and secretion of urine.Loss of weight was a prominent symptom. Multipleabscesses were present in 2 cases, gangrene of the lung in 1,and a sore over the sacrum in another. At least 3 casesended in coma. Three of the patients recovered. The

majority of the more rapid cases terminated in three weeks.The prognosis is grave but not hopeless, unless the conditionis present in a severe form. Treatment should be begunearly and follow the lines of the treatment in adults. The

carbohydrate tolerance should be determined and the sugar-content of the diet correspondingly reduced. An ’’ oatmeal

day " or days should be given at frequent intervals.

THE SANITARY INSTRUCTION OF THE PUBLIC.

ACCORDING to Dr. James Kerr, whose report as the MedicalOfficer for Education of the London County Council waspublished in our columns on April 12th, schools play only aminor part under present conditions in the dissemination ofinfectious diseases. Nevertheless, it must be recognisedthat children coming from infected homes are possiblebearers of infection, even although they themselves may notbe ill. The desirability of complete cooperation of parentsand teachers, as well as of the general profession, with theschool medical officers, therefore, is undoubtedly to bedesired. But to attain this end the dissemination of know-

ledge is necessary, and in this we may learn something,perhaps, from Transatlantic methods. The Departmentof Health of Chicago distributes weekly a circular leafletentitled the BtÛZetin of the Chicago Sohool of Sanitary Instruc-tion, which deals with such sanitary and hygienic mattersas are for the time being of pressing import, the wording beingbrief, plain, forcible, and to the point, as is fitting in circularsintended for public reading. In the B1ÛZetin for August 30thnow before us the approaching reopening of the schoolsafter the summer vacation has directed the attention of theHealth Department to the importance of safeguarding thehealth of the children against infectious diseases when

they reassemble, and the advice given seems sane and

sound. The active assistance of all school principalsand teachers is called for in the work of segregatingpossible infection bearers, and it is suggested thatthis should be the first and all-important work of the

first school day. Principals are therefore recommendedto see that, prior to the assembling of classes, the

rooms are well aired, every window throughout the

building being thrown wide open for hours before thechildren enter it. Reference to the health department’srecords of contagious diseases, which are kept on file in

Chicago in the office of every school principal, is recom-

mended, with a view to ascertaining whether any familiesfrom which pupils come have had recently reported cases ofinfectious disease. It is further recommended that the teacher

should carefully observe each child, and should order allsuspicious cases at once to an isolation room or out of doors?to await inspection by the school doctor, all cases of sorer

throat, eruptions of any kind, desquamation, congestedwatery eyes, snuffies, visibly enlarged glands or coughs beingreckoned as suspicious. As an additional precaution, whenthe pupils have taken their seats, all those who now have, orhave recently had, any sickness in their homes should ber

asked to stand up, when a little judicious questioning willprobably - make it clear whether any suspicion attaches tothem as possibly coming from infected places. The coöpera.tion of the medical profession in immediately reporting allsuspicious cases, and insisting upon strict isolation until

absolutely sure that all danger of infection is past, is calledfor ; while parents are urged to comply strictly with therequirements of the sanitary authority by never sending anailing child to school or permitting even healthy children froman infected house to mingle with other children, inasmuch as,even though themselves well, they may carry infection toothers. " If," says the circular, " there be a proper measureof cooperation between the medical profession and thehealth department, there will be fewer small coffins to buythis fall and winter." Such circulars may indeed prove afruitful source of public education in hygienic and sanitarymatters, and in the last resort the people must be their ownsaviours in these matters, and to act intelligently it ieessential that they should be instructed in what they oughtto do. The Bulletin does not in its instructions fit in with

any possible routine in our schools, but the principles whichit has in view are those upon which our system of schoolinspection relies.

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THE EMETIC ACTION OF DIGITALIS.

t, MucH of the recent research into the action of digitalis’ and allied bodies has been provoked by the fact that the[ emetic action of the former has appeared to constitute a! serious obstacle to its continued use, and many have sought, diligently for some preparation of the drug which might be

innocent of those baneful effects, or for an alternative medidcament possessing all the virtues of digitalis but none ofits vices. Most of these investigators have accepted with-out question the belief that digitalis is a gastric irritant,and therefore an emetic. One of the most interesting andvaluable of the data revealed by the researches of Dr. R. A.Hatcher, of New York, and his colleagues was that experi-mental administration of the drug to animals by theintravenous method provoked vomiting, and that thiseffect of the drug was due to its action on the medulla,not to any direct irritation of the gastric mucosa. Oneof Dr. Hatcher’s fellow workers, Dr. Cory Eggleston, hasinvestigated the same matter from a clinical standpoint.Eleven cases of cardiac disease exhibiting auricular fibrilla-tion, and four cases of chronic valvular disease with regularrhythm, received digitalis either as a tincture or as an

infusion, and its emetic action was carefully studied withespecial reference to its connexion with the cardiac effectsof the drug (slowing of the pulse, alteration of the rhythm,and definite clinical improvement). Case records from the

literature were examined along the same lines. The result

of these observations is remarkably uniform. In 106 courses

of digitalis treatment marked by nausea or vomiting therewas clear evidence in 100, or 94 per cent., that the drug hadbeen absorbed in quantities sufficient to produce a definitecardiac action before vomiting occurred. Another fact which

is strongly antagonistic to the gastric irritant theory is broughtforward by Dr. Eggleston ; he quotes a number of cases inwhich very large single doses of digitalis (in one case2 drachms of the tincture) were given without provokingany gastric. symptoms whatever. In view of these facts he