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and transports to the city, as express matter, this fresh milking. It is thus possible to get fresh milk. As to its cleanliness, precautions are taken so that the hands be clean, the udders clean, and the receptacle clean — in this case a specially constructed glass jar is used. The modifier at the laboratory has, then, for recom- posing milk on the breast-milk type, i, a cream of stable percentage; 2, a clean separated milk without fat; 3, twenty per cent, milk sugar solution ; 4, distilled water; 5, lime-water. All of these ingredients are freshly prepared dail}-. Nature does not seem to run in routine milks. Breast milks differ in all constituents in a remarkable manner, especially in polite modern society. Yet it may be price of lamisil affirmed from e.xperience that all infants can be satisfied upon a limited range of variations. Practical Workings of this System. — At the Presby- terian Hospital and outside, I have had what is lamisil under observation something over twenty cases, and as result of this experi- ence I may attempt some suggestions to those for the first time prescribing. Our daily rounds are made at a definite time. The babies who have been sunning in lamisil lotion the glass roof-house are returned to their cribs, have taken their feedings, are in their best moods. The daily notes lamisil 250 of the nurse, with temperature chart and milk prescription, hang at the foot of the bed. Upon a glass topped table is a collection of diapers labelled with the baby's names. As the rounds progress each case is considered with all the data at hand — child, history, chart, notes of successive days, prescriptions, passages. We have agreed upon cer- tain forms of description so that we may understand each other. Dr. Rotch has put into our hands a good working basis for recomposing milk on the breast type. In round numbers it may be stated as follows : Good breast milk in a multitude of cases has been found to vary within certain lamisil online high and low averages. For instance : Fat 4 per cent. Sugar 7 " Albuminoids 2 " represents a high order of breast milk, and Fat 3 per cent. Sugar 6 " Albuminoids i " represents a hght breast milk, but still a breast milk upon which infants were thriving when the examinations were made. In lamisil 250 mg round numbers, then, consider cow's milk to be : Fat 4 per cent . Sugar 4 " Albuminoids 4 " The last ingredient is four times the amount of the weaker breast milk albuminoids. Very well, suppose we say we will divide it by four distilled water ; we then have made our albuminoids i per cent, as desired, but where is the fat and where the sugar? Each will be i — 1 — I, and the lightest good breast milk is 3 — 6 — i. Now, with our prescription blank in hand and a lamisil gel well-equipped laboratory near by, we may go to work in somewhat exact methods, and subsequent experience will enlighten us still further. Whatever we do with it, the milk is a good article to begin with. When an infant comes into the baby ward of a lamisil tablet hos- pital it is sure to be a pretty poor thing. It comes from poverty ; its mother must go out to work ; its care and feeding are problematical. Suppose it is four months old, and it has been fed on condensed milk. It is desirable to begin feeding on a good milk of about the same propor- tions that it has been accustomed to. If condensed milk, the albuminoids will be about one, with the ordinary dilu- tion. This ingredient is fair, but the fats are very low. So let the prescription for our poorly-fed, marasmus baby of four months read : Fat 2.50 per cent. Sugar 5 Albuminoids I ' Lime-water i^o by bulk. Heat to 167° F. Feedings 10 Amounts 3 iv. The passages will, no doubt, furnish abundant reasons for modifying the milk later, but at first it is desirable to change the proportions slowly. One baby was brought to the ward because its mother was a patient in the medi- cal ward above. It had been fed on cow's milk diluted. Its passages were curdy, mucus in strings and masses abundant, the whole colored as though a solution of Paris green had been poured over it. Here was a baby lamisil at gel but temporarily disturbed, age about six months. Prescrip- tion : Fat 4 per cent. Sugar 6 " Albuminoids .... i " Lime water "iV by bulk. Heat to r67° F. For convenience we often speak of the above prescrip- tions as 2.50 — 5 — I and 4 — 6 — i, the fat, sugar, and albuminoids being always enumerated in the same order. Two days later the ingredients were increased to 4 — 7 — 2 ; for the moment you can get a baby on the maximum average of lamisil at cream good breast milk it will thrive quickly. The passages will become smooth and homogeneous, yellow will crowd away the green, and at length a yellow pasty stool will show that the infant has come to take his own food. In modifying milk for a child new-born, the problem is not so cornplicated. Begin with a light lamisil spray breast milk, 3 — 6 — I, gradually increasing. Here the indications are fairly leading. On the other hand, when an old-fashioned nurse has exploited her time-honored fads, from rum and molasses to good old-fashioned cow's milk, such as the pilgrim fathers and her sire were fed upon as babies, when the baby has begun to have frequent explosive watery passages, Paris green in color, with curds and mu- cus, then you come to a baby that will tax your judg- ment to prescribe milk for. How shall you hitch it on to the previous series of feedings ? The aim is still to make the junction as smooth as may be. Begin lamisil one with a light breast type. If six months old, say: Fat 3 per cent. Sugar 5 ■' Albuminoids 0.45 Feedings 8 Amount § vi. lamisil purchase It is well regularly to order modified milk heated to 167° F. (Pasteurized) after the handling and exposure required. AH babies, as you know, are liable to have dilated stom- achs from over-feeding. The quantity of modified milk, needed to sustain a baby is probably a trifle more than natural breast milk, but in cases of dilatation the quality may be so modified as to regularly diminish the quantity and restore the viscus. So, in ordering an increased quantity, reflect if it will not be better to lamisil at spray increase the (juality instead. To such lamisil terbinafine cases of green mucus and curd passages we have usually given calomel, one-tenth grain triturates every hour till freely purged. Thereafter Squibb's bis- muth subnitrate, ten grains every two hours, or oftener. We use no form of opium. As to Weaning. — Then again, it is desirable to try and ascertain what the quality of the breast milk is and order the substitute feeding to correspond. Remember that you 554 MEDICAL RECORD. [October 28, i! are to modify from 4 — 7 — 2, the average high-grade breast- milk, to 4 — 4 — 4, the cow's milk. Start with 4 — 7 — 2, two days later drop the sugars one-half per cent, and raise the albuminoids one-half, or 4 — 6.50 — 2.50. Three days later make the proportions 4 — 6 — 3 and have two of the feedings contain one-half oatmeal jelly, or other cereal preparation. So continue, dropping the sugar per cent, and raising the albuminoids, so that in ten days, without the baby's stomach being surprised, it will come to take full cow's milk, bread and milk and is weaned. Breast milk is very fiat to taste. Babies that once get any other food prefer it to the breast milk. They like the cane- sugar sweet. As to my results, my answer is the number of cases is too small thus far. I have seen two wretched marasmus babies restored to good vitality by this feeding. They were emaciated, rickety, big-bellied, greedily filling them- selves with any fluid food, and having numerous watery, explosive green passages. It was nearly impossible to keep them warm, they passed urine in large quantities, and were always wet. These two seem the best triumphs. An adult patient in a private hospital room had not been able to keep on his stomach lamisil oral any food for ten days before coming to the hospital. A little iced champagne was his sole nourishment, so he said. He was put upon a full cow's milk which had been passed through the separator. His feeding was a lamisil at fresh milk to begin with, a clean milk (its impurities having been left in the machine), and upon milk lamisil cream in divided quantities and regularly administered. In one week he took beefsteak, and is now walking daily in the roof promenade and sleeping the entire night. I have known the insipid taste of modified milk to in- terfere with the thorough trial of feeding. If a child cost of lamisil has been fed on a sweetened condensed milk it does not pre- fer to take a tasteless article. If the mother will not be firm and starve it to the new food, there is but little hope of success. Finally, it is possible now to obtain in New York a fresh milk and a clean milk. As the digestive capabilities of infants differ, no routine mixture can prove successful, and a variety in percentages of the constituents of milk must be employed to compass perfect nutrition. Among the reports of progress in medicine, it may be asserted that in the modifying of milk by exact methods a right step has been taken. LESIONS OF THE SPINAL CORD WITH AND WITHOUT FRACTURE— AN EXPERIMENTAL AND CLINICAL STUDY.i By THOMAS H. MANLEY, M.D.,

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