512 GOATS’ MILK FOR INFANTS.

sensitive. The dura mater has a fair nerve-supply from the

trigeminal, and when the dura mater is divided a slightlydeeper anaesthesia, is needed. That accomplished however,less than 0’5 5 per cent. will be amply sufficient for most

operations on the brain substance, for the encephalon is forthe most part little sensitive. Sometimes, indeed, the chloroform may be entirely cut off for 10 or 15 minutes, and in onecase Sir VICTOR HoRSLEY was able to operate for 20 minuteswithout chloroform on a child with a cerebellar tumour.

In all intracranial operations it is of the first import-ance to arrest hemorrhage, but the oft-tried expedientof tying a main artery such as a carotid does not meetwith Sir VICTOR HORSLEY’S approval. For the capillaryand arteriole oozing he finds nothing better than hot irriga-tion, and for this purpose the temperature of the lotion

should not be allowed to fall below 110° F., while it

should not exceed 115°. Another expedient of value

in the arrest of venous and capillary oozing is the in-

halation of oxygen, for this lowers immediately the

pressure in the veins, the bleeding ceasing rapidly as thedark purple of the oozing blood changes to bright scarlet.Much of the danger from shock in these operations can beavoided by dividing the operation into two stages with aninterval of some five days ; for it is certain that it is the

opening of the skull which causes most shock by producinggeneral depression of nerve energy and alteration in the

circulation. If we may judge by statistics, the danger inthese operations varies greatly with the region involved, mostdeaths occurring when the cerebellar region is dealt with andleast when the motor area is affected. It is, moreover, clearthat in operations designed to remove an excess of intra-

cranial tension shock is least fatal when, a correct diagnosishaving been made, the skull has been opened immediatelyover the affected part, and the tumour has been easilyremoved. Conversely when an incorrect diagnosis has beenmade and the skull has been opened at a distance from thetumour, which was therefore not removed, a much higherrate of mortality has occurred.Of the danger of sepsis in operations on the contents of

the skull no difference of opinion can exist, bat especialprecautions should be taken in these cases, and Sir VICTORHORSLEY points out that a weak antiseptic lotion is

desirable for the irrigation fluid ; that the subsequent dress-

ing should be antiseptic (some mercurial salt being em-

ployed) and not merely a-eptic ; and lastly, that drainageshould be employed as little as possible, for every drainforms a probable channel for the admission of germs. It

is important to displace as slightly as possible the cerebraltissues, for even if they have not been visibly damagedpermanent harm appears to result from displacing portionsof the brain ; and all pressure exerted on brain substance, asin raising the frontal lobe, must be of the utmost gentlene.s sand applied slowly. It has been suggested that a laterallobe of the cerebellum may be removed without dangerfor the purpose of reaching deeply seated tumours,

and so far as experience goes very little harm seems

to result, but it is an unnecessary mutilation and

should therefore be avoided, even though we are

unable to trace to it any harmful results. Finally,in many c3.ses it appears to be sufficient for removingthe effects of pressure to open the skull, though it is generally

necessary to divide the dura mater also, and this may be

effective in relieving symptoms even though it may not be

possible to remove the tumour causing the increased pressure,In several cases Si.r VICTOR HORSLEY has laid bare gliomataand having found them inoperable he has closed the wound.

From the date of the operation the symptoms have steadilydiminished and ultimately disappeared. Without venturingto suggest any adequate explanation of the facts, it cannotbe doubted that complete or almost complete recovery doesfollow in many of these cases.I The conclusions to be drawn are that in the last 20 years

great progress has been made in this the youngest, or

almost the youngest, branch of surgery ; we have learnedto avoid or to counteract many of the dangers which

beset the path of the operator on the brain and the fieldof utility has been widely extended. Much has, indeed,been done, much still remains to do, and as in the past nosmall share of the achievements already gained are due toSir VICTOR HORSLEY, so in the future we may with con-

fidence expect that he will be one of our forerunners alongthis most difficult yet most encouraging branch of surgery.

Annotations."Ne quid nimis."

GOATS’ MILK FOR INFANTS.

IN a letter which appears in our correspondence columnsthis week an interesting point is raised by the writer in

regard to the suitability of goats’ milk for infant feeding.There is evidently a wide diversity of opinion on this

question judging from the totally opposite views taken bydifferent authorities on dietetics in general. One writer,indeed, on one page of his book regards goats’ milk withfavour in infant feeding, while on another page he refersto its indigestibility. Thus, he says, "it [i.e,, goats’milk] is the most highly nutritious of these milks butit is the least digestible." In the same book it is

written in another place : I The reason why the milkof the ass and even that of the goat will agree withthe human infant when cow’s milk disagrees would appearto be owing to their different manner of clotting whenthey come into contact with the gastric juice. Cow’s milkhas a tendency to coagulate in the infant’s stomach intolarge, firm, cheese-like masses which are apt to cause muchgastro intestinal irritation, whereas ass’s and goat’s milk forma loose flocculent curd like human milk." Another authoritywrites: "Goats’ milk is a strong milk, stronger even thancows’, and in no way suited for use in infancy," and anotherthat " the coagulation [of goats’ milk] obtained by acid orrennet is more solid and is harder than that from cow’s milk."As to the chemical composition of goats’ milk in its relationto human or cows’ milk there ought not to be, of course, twoopinions and yet one authority writes, "The milk of thegoat, as a rule, contains more cream than that of the cowandrather less albuminous matter," while another says, "goats’milk is richer in albuminates and fats than human milk andeven than cows’ milk." The latter writer is correct judgingfrom the average figures given in a number of analyses byvarious authoritative observers. The composition of a milkwould appear to depend upon the rate of growth of theanimal for which it is intended, and the variations occurchiefly in regard to the proteids and mineral constituents.Heubner, for instance, showed that as the proportion togetherof proteid and mineral matter increased in milk, so the timetaken to double the weight of the animal was diminished.

513FLY LIFE AND INFECTIVE DISEASE.

Thus the milk of the rabbit contains 10’ 4 per cent. of proteidand 2’ 4 per cent. of ash and the weight of the babyrabbit is doubled in about seven days. The human animal

is at the other end of the scale, for human milk showsonly 1-0 0 per cent. of proteid and 0 - 2 per cent. of mineral

matter, and accordingly the human baby’s weight takesas many as 180 days to double. The kid’s weight isdoubled in 19 days and goats’ milk contains 4’ 3 percent. of proteid and 0-8 per cent. of mineral matter.There can be no excuse for mis-stating the composition ofgoats’ milk as appears to have been done in the case quotedby our correspondent, and it is certainly a misrepresenta-tion of fact to state (if it was so stated) that" goats’ milkwas worse than skimmed milk and did not contain sufficientfat or sugar." As a matter of fact, goats’ milk is richer inproteids and mineral salts than genuine cows’ milk andcontains usually as much sugar and rather more fat. Goats’milk therefore as a substitute for cows’ milk or human milkcannot be condemned on the grounds of its chemical com-position, but its adaptability for the human infant’s needs isanother matter.

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FLY LIFE AND INFECTIVE DISEASE.

THE fly, like the worm, has its place and function in theeconomy of nature both for good and for evil. What theworm is to the soil the fly is to the air, exercising a depura-tive influence by its absorption of effluvia which, directlyinhaled, would be mischievous, even fatal, to man. On theother hand, the fly may be the carrier and transmitter ofpathogenic organisms which, introduced by puncture or evensimple contact into the human subject, are the proximatecause of infective disease. In 1888 Professor Angelo Celliof Rome observed that flies nourished on the typhoidbacillus transmit, by the medium of their fasces, the

same malady in all its virulence-an observation amply con-firmed just ten years later, in 1898, in the Americanconcentration camps in Cuba during the war. Even priorto this a similar observation, experimentally confirmed, hadbeen made in Hamburg in the case of cholera. Flies, duringthe necropsy of a victim to that disease, having alighted onthe intestine, were inclosed in a glass receptacle so that theair and the movement might desiccate and neutralise theparticles of choleraic virus adhering to their wings andextremities, and were thereafter placed in a tube con-

taining liquid gelatine. In 48 hours all the plaques werecovered with colonies of the bacillus virgula. More

recently, in Paris, it was shown that flies are the principalagents in diffusing cholera at short distances, thus explain-ing the fact that chelera epidemics diminish in intensityduring winter when fly life is arrested by the cold. A stillmore recent study in this field is that of Professor SaverioSantori of the bacteriological laboratory of the Roman

commune, by which he demonstrates the fly as causing thedissemination of "infective intestinal maladies," particularlythe summer gastro-enteritis of children in its acute form.

Examining the statistics of the Italian death-rate, he foundthat while in the last 23 years well-nigh all infectivediseases are on the wane some, and these the intestinal,show little or no tendency to decrease. Inferring that theseailments must be propagated by other than the usual agents,against which we neglect to guard ourselves, ProfessorSantori bethought him of the flies. He thereupon made astudy of the flora bacterica " contained in their digestivetube, on the tracks they left on the places over which

they crawled, and on all their corporeal superficies, takingspecial care that the said flies came from the most

frequented localities, especially from the neighbourhoodof market places and hospitals. The results were sur-

prising even to himself. He found that on the walkingapparatus, the wings, the proboscides, and, in general,

all over the bodies of the flies there were pathogenicbacilli not only in vast quantities but of the most variedforms, the latter observation seeming natural enoughwhen we think of the infinity of soiled substances uponwhich the fly alights. At the same time, this variety ofform in the bacilli was much less in the digestive tube,one form so preponderating as to make all the others

practically non-existent. Professor Santori, in fact, fromcultures derived from flies frequenting a Roman market

place succeeded in isolating a bacillus which under the

microscope appeared mobile, short and stunted, its charac-teristics, morphological, cultural, and biological, and its

pathological features corresponding exactly to that " specialemicro-organismo " which Dr. G. Volpino described somemonths ago in the " Archivio per le Scienze Mediche " as the

"pathogenic agent " of the infezioni viscerali affectinginfants in summer. The importance of this identification ismanifest. It may explain the enormous diffusion of thisgastro-intestinal malady, particularly in the summer, and italso throws light on the fact that in these later years themalady, unlike other infective diseases, shows little or nosigns of decrease. The practical, hygienic, corollary thencearising is, according to Professor Santori, to take specialmeasures for lessening in our habitations the excessivenumber of flies and for the prompt and thorough removal ofthe soiled or putrescent substances from which these flies

transport and diffuse, in myriads, the pathogenic germs.

ŒSOPHAGEAL SYMPTOMS IN AORTICANEURYSM.

AT a meeting of the Société Medicale des H6pitaux ofParis held on May 4th M. Edgard Hirtz and M. HenriLemaire reported an important case of aortic aneurysmwith oesophageal symptoms. Rupture of an aortic aneurysminto the digestive tract is rare. In a period of 72 years142 cases of ruptured aneurysm were reported to the

Société Anatomique of Paris. In 79 of these ruptureoccurred into the air passages and in only six into the

digestive tract, once into the duodenum, once into the

stomach, and four times into the oesophagus. A man, aged55 years, was admitted into hospital on March 3rd, 1905. It

could not be ascertained whether he had had syphilis or not.For six months he hai suffered from digestive troubles.At the beginning there was a little diarrhoea, but inthe last few weeks this had given place to constipa-tion. For two months vomiting had followed nearly everymeal. At first the vomiting occurred about an hour aftermeals, then it occurred earlier, and finally it took the formof regurgitation. After taking a few mouthfuls of food thepatient had to get up in order to eject what he hadswallowed. This always occurred in the case of liquids butsolids were often retained. Deglutition was not painful anddid not appear to be difficult. For four months the patienthad been losing flesh and strength. On admission he lookedcachectic and the conjunctivse and face had a sub-icterictinge. There was myosis without inequality of pupils. In

the upper part of the epigastiium home deep and painfullumps were felt. On taking a glass of milk the patientvomited it after some seconds and in the meantime abundantsalivation occurred. The urine was increased in quantityand contained a trace of albumin. The area of cardiacdulness was increased, especially to the left. The apexbeat was in the fifth space outside the nipple line.Auscultation showed a " bruit de galop" on the left sideand a resounding second sound at the base. The arterieswere atheromatous; the radial and femoral pulses were equal.Abundant salivation always followed the taking of food but

occurred at no other time. The patient complained of greatthirst which he could not quench. The existence of painlesoesophageal vomiting with abundant salivation led to the