as the result of the use of beer have diarrhoea, or if the stool of the child is too loose, I stop it; while if the excrements of the child are normal the beer has done the child no harm, and the milk is all right and, as far as we know, the mother has received no harm. This milk business is a most serious thing. You cannot trust the

dairy men, as they feed these same brewery slops to the cows. I have to give the babies artificial food or condensed milk, because I cannot rely upon cows' milk.

Dr. Sanders criticized the treatment of the case. If the doctor will allow me, we had no trouble in stopping the hæmorrhage. My method, when it becomes necessary to wean the child, is never to use any Camphor preparations, but use the breast-pump to take off the excess, believing that any breast, with few exceptions, will stop secreting milk after the mouth of the suckling is withdrawn. The breast-pump never excites the gland to its full powers, and as in this case the reason we used the breast-pump was to draw off the excess, and the reason we used fomentations was to stop the inflammation, the result of suppressed secretions. The hæmorrhage stopped when the excitement of the child's mouth was withdrawn.

THE IMPORTANCE OF MORE THOROUGH AFTERCARE OF THE PARTURIENT WOMAN.

BY SARAH J. MILLSOP, M.D., BOWLING GREEN, KY.

I SEEM to have selected a very long title for a very small but the subject is an important one.

paper,

It was suggested to me as a fruitful theme by a wise and conscientious physician who has had a long and successful obstetric experience.

Then, too, the importance of the subject was impressed upon me anew recently by a patient who, though several years married, had never conceived. She gave, as her reason for this, that she had always been delicate, and did not wish to break herself wholly down by giving birth to children. To convince me of her superior wisdom, she said: "On looking around among all the mothers of my acquaintance-many of whom I knew as robust girls-there is not one who is not a faded, broken down or a confirmed invalid."

I assured her that I knew many mothers, some of whom had reared even old-fashioned families, and, besides, had accomplished much good for humanity in general, and they were still in fine physical and mental condition.

I further tried to make clear to her that child-bearing was a natural and physiological process, and that when women suffered afterward it was usually the result of the transgression of simple hygienic laws, but might be due to the lack of common sense on the part of the patient or the lack of after-care on the part of her physician.

However, it is a lamentable fact, as proved by the numerous cases in our note-books, that a large percentage of the ailing women who come to us for treatment date their bad health from a poor "getting up" after child-birth. Especially do we find this to be the case with women who have had abortions, either accidental or produced. So it is for these reasons that I write upon this subject, and not

that I have an especial grudge against the good-looking groups of men whose faces have adorned the frontispiece of recent issues of The Medical Century.

It is not that I wish to take from these eminent gynecologists any legitimate practice. On the contrary, I have a laudable ambition that they should do more and better work than do the surgeons of any other school.

But to repeat what we all so well know, and what has been affirmed again and again, when obstetricians do their work better, there will be less of a certain kind of work for gynæcologists to do.

In truth, one of the greatest evils from which the parturient woman suffers, by the neglect of her physician, does not come within the province of the gynecologist. This is the mammary abscess, the suffering of which exceeds beyond all comparison the pains of labor.

Many physicians of my acquaintance leave the entire care of the breasts to ignorant, untaught nurses, not even making an effort to relieve the engorged or "caked" glands when notified that such condition exists. They simply do the lancing after the nurses have worked faithfully and applied various greasy, dirty-looking applications in the vain hope of aborting the dreaded abscess, or "rising," as it is always called. Could a name be more appropriate?

I find it to be the exception in my vicinity for a woman not to have had trouble with her breasts. One, who had given birth to eleven children, told me her "breasts rose" after every labor, and so familiar did she become with this condition that she borrowed a lancet and opened the abscess herself. Yet some there are who persist in saying that women have "no nerve," and that they never can make surgeons.

One case that made a lasting impression upon me in the earlier days of my practice, and to which I referred in a paper read before our Southern Association, was that of a primipara who was attended by a doctor of the Old School in fairly good standing in the profession. He did not make his "party call" until three days after labor, when he was sent for. There was some trouble with the nipples; the baby either refused to nurse or the pain of the suckling could not be tolerated. At any rate, the inevitable mammary abscesses resulted. The breasts were lanced again and again, suppuration keeping up until the entire glands had disappeared. When

I saw the patient, three months after labor, there was not a vestige of either mamma. With the exception of a few scars, there was flatness and smoothness of the entire chest.

I had been taught that it was the doctor's fault if her lying-in patients suffered from mastitis; and that it was her duty to examine the breasts at every visit, not trusting to the reports of the nurse. This I had always done, and had rather prided myself on the fact of never having had a case of mammary abscess in my own practice, although I have cared for a good many, coming from the hands of other doctors. Indeed, I intimated rather plainly that such cases need not occur in the practice of a pains-taking physician, especially if he were a disciple of Hahnemann.

It has been wisely said that "Pride goeth before a fall,” and I have since had the unpleasant experience of a bad case of glandular mastitis in one of my own patients.

I usually watch my parturient patients carefully, and make many more visits than is customary in my part of the country, but in this instance the nurse had been dismissed on the tenth day, and as all had gone well with the healthy mother, whom I had cared for in a previous confinement, I gave the case no further thought. On receiving word that one breast was "caked" I sent remedies, with directions that the gland should be emptied; but this was not done. A tender nipple, the usual cause, was the excuse for not allowing the baby to nurse; the breast pump did not do the work; the old colored Auntie, who had been recalled, did not carry out my directions for softening the gland; but resorted to her own poultices instead. The result was weeks of suffering, the greatest ever experienced, by this most patient patient, who could ill afford the time from the cares of her little family, to be sick. The lesson then learned has not been lost upon me, for I thereupon resolved that I would not, in future, lose sight of my patients even at the tenth day; neither will I, however busy, again trust to the manipulations of an ignorant nurse to remove milk from the obstructed ducts. If the infant is not given "teas," or any artificial food, but is taught to nurse not too frequently and with regularity, it is conducive not only to the peace and comfort of both mother and child, but is an important factor in the prevention of mastitis. I do not have the trouble, doubtless encountered by some doctors with a more fashionable clientele, of having mothers refuse to suckle their babes for other

than unavoidable causes. The greatest difficulty I find is in getting mothers to stop nursing their babes when they are old enough to be weaned, and after the menses have returned, thus overtaxing the mother, and doing a positive injustice to her child. We are all familiar with the true reason for this prolonged nursing; but some give as the reason fear of bowel troubles incident to the second summer; while others wish to continue the nursing until all the teeth have come through. If we could spare a little time to teach these mothers that this drain is injurious both to themselves and to their offspring, and help them to find a suitable food to take the place of breast milk, it would come under the head of very good after-care.

I need not dwell at length on the importance of the repair of a lacerated perinæum, as one of the most important measures in the after-care of the parturient woman. I think but few physicians now advocate leaving the repair of a bad laceration to nature; or deny the importance of an entire or restored perinæum in preventing that "let down" feeling complained of by so many patients.

Whether the operation shall be primary or deferred to "a more convenient season," each obstetrician must decide for himself, accordto the condition of the patient, the needs of the case, the help to be obtained, etc. No one can complain of a lack of light on this subject, even though the "lack of illumination" proves a bar to the immediate operation; for the subject has been ably and fully discussed in our medical journals.

The bulk of surgical opinion seems to favor the immediate operation; but, on the other hand, many good and sensible reasons are given for the secondary operation.

Some of the bolder operators are advocating an immediate repair of cervical tears as well; but my judgment would counsel the deferring of this operation until after the weaning of the child. I'm sure nature heals many slight rents in the cervix; and just here let me ask why it is that surgeons who forbid the giving of vaginal douches after trachelorrhaphy lest the office of nature's kindly lymph be interfered with, will advise the giving of antiseptic washes after labor, while there is a possibility of nature doing all the work? I no longer give the douches except for cause, as foetid lochia, rise in temperature, etc., until from three to five days after labor, wheu I follow the cleansing wash of simple boiled water with another, containing Hydrastis, Calendula or Hamamelis, the latter if the sanguineous flow keeps up.