unless we had previously given a test meal and withdrawn the contents at the proper time. If we have reason to believe that we are dealing with a disease in which the laboratory evidence is not uniformly present, we should not be contented with one negative examination, it matters not how painstaking we may have been in our efforts to make it a success, but should repeat the procedure until proof of the suspected pathology is found or until we are reasonably certain of its absence, by so doing we will often be able to satisfy ourselves as to the diagnosis instead of being left in doubt. In many conditions more than one examination is often necessary before we can form any definite conclusion, for example, in pulmonary tuberculosis where the finding of the causative organism is often difficult, one negative examination of the sputum means but little, while on the other hand the finding of the tubercle bacillus means a positive diagnosis. E. W. JACKSON. TREATMENT OF CONSEQUENCES OF CONCUSSION OF THE BRAIN. In a recent article published in the Mediziniche Klinik, April 25. 1914, xi, No. 17, page 480, Weber and Neubert call attention to their experiences in the treatment of the sequelae of concussion from whatever source. The seriousness of the after effects is such as to justify the widest dissemination of their experiments and results of treatment. The cases studied were all serious ones, that is to say, there has been a somewhat prolonged period of total unconsciousness after the accident or injury, usually a blow or fall upon the head, a wound from a bullet or scrap of shell or shrapnel, but of such a character as to produce a generalized condition, without evidence of any destruction localized or actual organic lesions of the brain structure. While we will not take issue at the present time with the use of the old word "concussion," preferring, as we do, a more definite term, and while we believe there are small organic changes, due to laceration and punetate hemorrhages, still the injury may not produce such gross pathological changes as to localize symptoms, but rather a generalized effect embraced under the older and generalized term "concussion." The main and essential features, however, is to bear in mind that though we have these changes, restoration can, as a rule, be brought about by proper remedial measures. A very close analogy could here be drawn between post concussion and post insolation (thermic fever) effects. The writer has frequently been much impressed by the close resemblance between the after effects of heat and sun effects and so-called concussion. In each of these cases, I have for years maintained that in certain physio-therapeutic remedies, we have the best means at our command for a seeming or at least functional restoration of cases of concussion and insolation and some twelve years or there about ago, in discussing before the Jefferson County Medical Society. a paper on Concussion by Dr. Chenoweth, I dwelt on the value of hydrotherapy. Several years later, in an article on insolation, published in the Journal of Advanced Therapeutics, I outlined in detail, the same methods now prominently brought to the notice of the medical profession by Weber and Neubert. With the pardon of the reader for this personal digression and self laudation, we call attention to the fact that the disturbances that follow are generally headache, restless sleep. dizziness in climbing stairs or walking fast, and inability to do any muscular work, sweating and having to give up when such is attempted. He has found that in such persons, the distribution of blood during muscular exertion differs from the distribution under normal conditions. The concussion injures the central mechanism for the innervation of the blood vessels; both the peripheral and the cerebral blood vessels are involved. It seems plausible to assume that this is the cause of low and persist after concussion of the brain. the headache and other symptoms which fol The headache and dizziness are connected with the damaged central mechanism for the innervation of the vessels, as also the weakness and inability to do muscular work. In treatment, drugs give no relief. I wish here to again insist that drugs give little or no help save in certain conditions, have little or no bearing on the concussion itself, but the continued existence of which may cause additional discomfort, viz: digestive disturbances, toxemias and stases, arising from the gastro-intestinal tract. To hydrotherapy, we must turn for relief. Those who would like to investigate the physiological actions underlying this measure should consult one of the few really good text books on the market, and read carefully the action of water on the vascular system, especially the vasomotors. These authors remarked: "surprising benefit was realized from alternating hot and cold douches. At first the relief is transient, but the improvement becomes permanent under a course of the alternating douches. The relief is striking within half an hour, even after one alternating douche and in two or three weeks, the improvement becomes a complete cure. The douches are given with hot and cold water for half a minute each (14 and 45 C. or 59 and 113 F.) applying the cold jet a trifle longer than the hot, and ending always with the cold. The cold seems to be the active factor; its effect is merely enhanced by the hot jet. Seven cases are described to illustrate the prompt and reliable curative action of the procedure in these conditions. They comment upon the ergographic and other changes studied experimentally in these cases and how there is registered a dilatation of the vessels in the hand or forearm during some strictly localized muscular exertion, such as dorsal and plantar flexion of the foot hanging free. After concussion of the brain, the vessels shrink, instead of becoming distended, during this muscular exertion. Of the value of this post-treatment of concussion, the writer has this to say, (Pope, Practical Hydrotherapy, 1909 p. 413) "The after treatment is important, and should consist of daily graduated cold applications, care being taken to thoroughly cool the head before each treatment. As a result of the heatstroke, the patient's nervous system and vasomotor mechanism have received a severe shock, and we often find traces of injury to nerve functions, such as headache, vertigo, insomnia, nervous irritability, altered disposition, tender spine, indigestion, anemia, irregularity of respiration and heart action, morbid dreads, mental excitability, or an incapacity to stand heat or the sun's rays. In the after treatment, it is essential therefore, and advisable that the patient be put upon a light diet; that he refrain from the eating of meat during the warm weather; that he be compell. ed to drink daily at least one-half gallon of water: that all digestive conditions and constipation be corrected; and that ali measures be continued which will stimulate and regulate the nerve functions and place him physically and nervously in prime condition. For this purpose, institutional treatment should be commenced immediately after the attack and continued during the period of hot weather and long into the fall and winter. Nothing is superior in these cases to the careful and persistent use of the electric light bath for several minutes, keeping the ice-helmet on the head, followed by the horizontal rain bath at 100 F. for one minute, reduced to 65 F. for one-fourth minute. As soon as reaction is well established and resistance increased, we may add the cold jet douche at 60 degrees F. up and down the spine, paying especial care to the cervical region. In very sensitive cases the electric light bath may be omitted and the treatment given as outlined, the patient wearing the ice-helmet during the rain bath. The author has had the pleasure of seeing a number of cases entirely freed from unpleasant sequelae by the adoption of these methods. The Scottish or alternate douche, a stronger and more stimulating procedure, can be used as soon as the patient stands the plain douche well. The temperature, alternations, and duration are detailed above. The pressure should range from fifteen pounds at the start to fifty or even higher if the patient desires and stands well the force of the stream. We believe, that in the near future the realm of hydrotherapy will be more appreciated. CURRAN POPE. THE PREVENTION OF DIARRHEAL DISORDERS IN CHILDREN In no domain of preventative medicine has there been more gratifying success than in the prevention of the common bowel diseases of summer time in children. Statistics obtained from the various Milk Fund Commissions and the experience of physicians in general show that there is far less bowel disorder among children that there was formerly. Perhaps the most important factor in this result is the securing of pure milk, free in a large measure from bacterial contamination. Even where certified milk of a high grade is not obtainable proper sterilization of the milk reduces greatly the frequency of the bowel infection. When however, there has occurred some infection of the intestinal contents experience has shown that milk is one of the worst foods that can be administered. Every type of bacterium apparently finds a good culture medium in milk. The general classes of putrefactive and fermentative bacteria can grow in milk and produce irritating and toxic products. In the cases of diarrhea in infants and children, it is important immediately to stop milk feeding and substitute starvation or semi-starvation by administering such foods as are not good culture medium for the types of organism present. Particularly in the case of offensive stools is it important to keep the child upon a very thin non-albuminous diet. The thorough purging with oil to remove all decomposing food in the intestines will frequently stop short an attack of diarrhea, and if the starvation is maintained for a few days there will usually be a great amelioration if not an entire cure of the attack. The use of buttermilk is becoming more general and is based upon the sound principle that the strongest types of lactic acid bacilli will prevent the development of other types of pathogenic bacteria. It is important, therefore, as milk constitutes a large part of the food of the infant that it be as free from contamination as possible. It is possible, however, that bacteria may be carried into the bowel by the use of other foods and it is by no means uncommon that the infant or young child gets hold of fruits and vegetables in the summer time which have begun to rot. Over-ripe fruit has been an exciting cause of diarrhea. Overfeeding or the taking of foods that are too hot or too cold may lessen the resisting power of the system so that the bacteria which have been held quiescent are enabled to multiply and cause local infection. Ice cream is especially injurious to young children because the frigidity itself is hard upon the digestive tract and also on account of the fact that cream rising through milk will pick up most of the bacteria of the milk, so that cream as ordinarily served is far more infected with bacteria than average milk. Freezing such a mixture simply keeps the bacteria quiescent until the cold mass has been warmed up in the intestines and then the multiplication of these foreign bacteria proceeds almost unhindered. It is hardly necessary to dwell upon the relationship between flies and the infection of food. Essentially a filth conveying animal it infects all food with which it comes in contact. In houses that are not properly screened, or in which no attention is paid to the flies, it is difficult to prevent infection of the young child. Equally important is the reinfection of the child by flies getting into the stools and from thence infecting the food of the child. It is particularly important that the stools be sterilized as quickly as possible after passing. Various soft drinks which are given to very young children, apparently without any objection on the part of the parents, and the hokey-pokey gelatine compounds take their toll of children in the hot weather. One should begin in the spring to prepare for the hot weather and its unfortunate effects upon weak, debilitated children. It is wise to insist always upon the proper strengthening of these feeble children so that they come into the summer with their resistive powers at the highest point. Delicate and feeble children should be sent away to colder climates for if they do not succumb to intestinal disorders their resistance to various lung disorders is very much lower and broncho-pneumonia is frequently the terminal infection. When the hot weather has arrived it is well, as far as possible, to keep the child cool. Too warm clothing and all other agents which increase the heat of the child favor the infection by bacteria; on the other hand, keeping the child cool by any methods which are feasible not only lessens the frequency of attacks but also helps the child in its fight for life. PHILIP F. BARBOUR. SPECIAL ORDER AT 12 M. The Diseased Tonsils; What Shall We Do With Them? F. H. CLARK, Lexington W. W. ANDERSON, Newport HON. FRED FORCHT, Louisville Medico-Legal Paper .J. T. REDDICK, Paducah THURSDAY, SEPTEMBER 23-9 A. M. Therapeutic Measures Other Than Drugs CURRAN POPE, Louisville The Use of Iodine and the Iodides in Medicine.. Heart Complications in Infectious Diseases E. W. JACKSON, Paducah A. L. THOMPSON, Madisonville W. J. BOGGESS, Louisville J. R. MORRISON. Louisville .I. N. BLOOM, Louisville HERBERT BRONNER, Louisville Cardio-Vascular Disease GEO. H. DAY, Louisville PERMANENT COMMITTEES. SCIENTIFIC WORK-J. W. Kincaid. Chairman; John J. Moren, A. T. McCormack, Secretary. MEDICO-LEGAL J. J. Moren, Chairman; W. B. McClure, A. T. McCormack, Secretary. LEGISLATION AND PUBLIC POLICY--C. Z. Aud, D. M. Griffith and Milton Board. MEDICAL EDUCATION-W. W. Richmond, D. M. Griffith and C. A. Calvert. EXPERT TESTIMONY-J. N. McCormack, Curran Pope, J. L. Phythian. PREVENTABLE DISEASES OF THE EYE-J. A. Stucky, R. L. Collins Wm. Cheatham. CONSTITUTION AND BY-LAYS OF THE KENTUCKY STATE MEDICAL AS SOCIATION ADOPTED AT PA- CONSTITUTION. ARTICLE I.-NAME FO THE ASSOCIATION. The name and title of this organization shall be the Kentucky State Medical Association. ARTICLE I-NAME OF THE ASSOCIATION. The purpose of the Association shall be to federate and bring into one compact organization the entire medical profession of the State of Kentucky, and to unite with similar associations in other states to form the American Medical Association, with a view to the extension of medical knowledge, and to the advancement of medical science; to the elevation of the standard of medical education, and to the enactment and enforcement of just medical laws; to the promotion of friendly intercourse among physicians, and to the guarding and fostering of their material interests; and to the enlightenment and direction of public opinion in regard to the great problems of state medicine, so that the profession shall become more capable and honorable within itself, and more useful to the public in the prevention and cure of disease, and in prolonging and adding comfort to life. ARTICLE III.-COMPONENT SOCIETIES. Component Societies shall consist of those county medical societies which hold charters from this Association. ARTICLE IV.-COMPOSITION OF THE ASSOCIA TION. Section 1. This Association shall consist of Members, Delegates and Guests. Sec. 2. MEMBERS. The members of this Association shall be the members of the component county medical societies. Sec. 3. DELEGATES. Delegates shall be those members who are elected in accordance with this Constitution and By-Laws to represent their respective component county societies in the House of Delegates of this Association. Sec. 4. GUESTS. Any distinguished physician not a resident of this State may become a guest during any Annual Session upon invitation of the Association or its Council, and shall be accorded the privileges of participating in all of the scientific work of that Session. ARTICLE V.-HOUSE OF DELEGATES. The House of Delegates shall be the legis |