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
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
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
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
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.
Albuminoids I '
Lime-water i^o by bulk.
Heat to 167° F.
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-
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
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 ■'
Amount § vi. lamisil purchase
It is well regularly to order modified milk heated to
167° F. (Pasteurized) after the handling and exposure
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
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
[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-
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
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
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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