your magnifying glass and examine the nipple carefully, and if you find a single abraded point don't permit the baby to nurse except over a shield, and you will have no mastitis. What is to be done? If the shield is unusable, until the abrasion is healed, take the baby from the breast. Feed it artificially in one way or another, but until that soreness of the nipple is mastered, I repeat with emphasis, keep the baby away from the breast. That brings up another proposition. I do not believe that we ever have such a thing as mastitis resulting simply from accumulation of milk in the breast. When the breast becomes full and hard this popular massage of the breast, this rubbing of the breast, is entirely unnecessary and harmful by stimulating added secretion. All we have to do is to let that breast alone. Cover it carefully with clean, pure absorbent batting and give it proper compression and support, and put a restriction upon the food of the patient, put her on dry food until we have mastered the topical soreness, and, besides, we should use the proper indicated remedy bearing upon the healing of this nipple, and as soon as this nipple is healthy and all these abrasions are controlled, then the baby can go upon the breast again. I have another point to which I would like to ask your attention, and this is regarding the food of the lying-in woman. It is wise not to carry this diminished amount of her food too far, for we are liable to lose sight of the fact of the blood condition of the mother incident to the completion of her labor. What is this condition? It is now a conceded proposition that the blood state of the mother in the latter months of gestation is a condition of blood closely approaching anæmia, and therefore this lightening of the lying-in food should be cautiously done, and as soon as all threat of fever and peril has passed by, then there should be a gradual increase in the nutritious elements and in the quantity of the food furnished.

DR. ERWIN: How does Prof. Sanders account for inflammation in the case that Dr. Custis spoke of, and in a case where the child had never been even brought to the nipple?

DR. SANDERS: The case cited by Dr. Custis was caused by traumatism. In the other case mentioned there was probably an unrecognized traumatism.

A MEMBER: I say the mother who has a sore nipple should not permit the baby to nurse. I advise these patients to take care of their breasts and nipples prior to confinement, and it is an extraordinary thing for me to find an inflamed breast if this is done. The treatment I adopt is this: to have the breasts massaged twice a day carefully, without necessarily any medication, without anything except this embrocation. If that is done during the latter months of gestation, why we will have no such thing as sore nipple, on the ground that this nipple has been accustomed to all the pressure that it has to stand afterwards between the jaws of the infant. There is

often a stupendous blunder on the part of the nurses, and sometimes of the physician, in the permission of the nursing of the breast before the milk is in the breast, and the result is that really by the time lactation is established, that breast is in a condition of soreness, excoriated, sometimes ulcerated, and sometimes one-third of the nipple has been actually mummered off by the little jaw of the infant. Do not let the child be applied to any one nipple oftener than every six hours.

P. DIEDERICH, M.D.: In regard to the prevention of mastitis, I wish to mention Phytol. dec. in the mother-tincture or the first decimal dilution as a remedy par excellence. As soon as pain and a lumpy hardness of the breast appears, Phytol. should be gently rubbed on, and relief sets in almost immediately. In many years' practice it has never disappointed me, and therefore I feel safe in recommending it.

Mention is made in the paper of those unfortunate women who do not want to bear children, and I want to say a few words in regard to their treatment. Generally their minds are morbid, and it is the duty of the physician to change it, if possible. Many have great fear of death, because their former physician told them that another pregnancy would mean certain death. Here we have a good indication for Acon., and I believe Acon. does good to them. But how shall we, in a general way, proceed in these cases? Will a kind, instructive lecture be enough to change their minds, and will they leave your office satisfied? Hardly ever, and probably they go immediately to somebody else, who does that which you won't do, and abortion will be procured. Generally I proceed in this manner: I ask whether they are sure of being pregnant, and usually they say, No. Well, if you are not sure of being pregnant, perhaps a simple, harmless remedy is all you need to come around all right at your next period. This proposition mostly satisfies, and they are willing to try the remedy. And what remedy shall it be? Sac. lac., in fivegrain doses, daily four times; Spirit. vini, in five-drop doses, daily four times, or any non-medicated tablets or globules will do. They all serve the same purpose; that is, to gain time. But, as I said already, Acon. in some cases may dispel the fear of death, and other medicines may be indicated in other cases and improve the general health of the woman. I always prescribe a remedy with the request to report later on. And later on I talk to them and perhaps make another prescription of the same character as the first one, and so time passes, and finally the woman is afraid of doing anything unnatural, and the pregnancy ends at full term in the usual manner.

DR. COGGSWELL: I wish to take issue with Dr. Grosvenor as to the cause of mammary abscesses. Manipulation comes before congestion in the formation of mammary abscesses.

As to the paper, I commend it very highly, because the doctor

has taken up points that ought to be thoroughly understood by the members of the profession, and I am sorry to see that many of them are not here.

Dr. S. J. MILLSOP: Those who heard my paper will remember that I said an eroded nipple is the "usual cause" of a mammary abscess; but this is not always the cause. The worst case of double mastitis coming under my observation was before the birth of the child and during an attack of typhoid fever. There had been no irritation of the nipple whatever.

After labor, which occurred on the tenth day of the fever, the mamma were of enormous size and the pain almost beyond endurance. All who saw the patient at this time said the lancet would prove the only means of relief. The babe could draw nothing from the glands. The nurse tried with her own mouth and with various breast-pumps, but only a few drops of thick yellowish fluid rewarded her efforts. Two vigorous pups succeeded in emptying the glands, and although there was at that time an excoriated condition of the nipples, with bleeding, at every suckling, no abscess formed. While I dislike to differ from a man of Dr. Sanders' learning and experience, it is my belief that where the occluded ducts can be emptied, an abscess will not form, even though the microbes in large numbers are frolicking around the eroded nipples.

When I advocate a light diet, I mean also a nourishing diet, as found in milk, buttermilk, eggs, oatmeal or the entire wheat in some form.

DROPSY OF THE AMNION AND ITS RELATION TO

DEFORMITIES.

BY L. C. GROSVENOR, M.D., CHICAGO, ILL.

In my early practice I delivered a young primipara at full term, of a child without a brain, the eye and the ear being the highest part of the head. The top of the head was flat and unfinished, there being no integumental or scalp covering.

Novice as I was, this was a case of peculiar interest to me, and I made a plaster cast of the same, which was placed in the museum of one of our large colleges.

Later, while visiting a medical museum at Washington, I saw an exact counterpart of my cast. Two years later I had another case exactly like the first.

These specimens were spoken of as acephalous, but a better term is acranial, as indicating that part of the head which is wanting.

Each of these cases was accompanied by an unusual amount of amniotic fluid, but in my inexperience, I did not suspect that this might have any relation to the deformities.

Later still, I attended a young Swedish primipara at full term. When the os was fully dilated and the sac of waters fully formed, I seated her upon a jar and ruptured the membrane, when there was a discharge of five quarts of amniotic fluid.

Labor progressed, and she gave birth to a remarkable phenomenon-a child with six striking deformities, viz.: acrania (just like the three I have mentioned), hare-lip, cleft palate, spina bifida and double talipes, the feet turning inward, and the plantar surface of the feet pointing upwards.

I tried to get a cast or photo of this remarkable case, but the parents were sensitive.

Three years after this I delivered a child perfect and beautiful in form save that there was upon the back a tumor. It differed from any case of spina bifida I had ever seen in this; it was less soft and

fluctuating, had a much thicker and firmer integumental covering and was marked like the posterior aspect of a fat hog.

There were the two hams, a rudimental caudal appendage, with a cul-de-sac beneath.

There was fluctuation upon pressure, and two of the lumbar vertebræ were imperfect. I had no means of judging of the amount of amniotic fluid in this case, for the waters had broken some days before.

The mother accounted for the peculiar marking of the tumor in this way. She was out walking one cold morning, when on turning the corner by the market she came suddenly upon a frozen porker standing on all fours; she was shocked and much disturbed by the impression it made upon her, and when the baby was born immediately inquired if it was perfect.

The little one lived three weeks and died in convulsions, as cases of spina bifida are apt to do.

In case No. 80 of my last year's obstetrical record, a large and beautiful girl was born but with three fingers of one hand missingthe thumb and little finger only being present.

No. 173 of last year's record. An Allopathic brother called me in a difficult case, which he called ascites-complicated with a seven months' pregnancy.

The lady was immense in size and in a condition of peril from difficult respiration and cardiac weakness due to pressure. She and her family as well as her doctor had little hope. She was having occasional labor pains, and during these I could clearly outline the distended uterus.

I told the doctor I regarded the case as one of dropsy of the chorion instead of ascites, and gave him my reason in the clear outline of the distended uterus during each pain. I advised prompt termination of gestation to save her life. To this he agreed; so seating the lady upon a commode I ruptured the sac, when she discharged six quarts of the amniotic fluid, greatly to the relief of the patient.

Labor progressed rapidly and in a little time the child was bornstill-and with a tumor, weighing perhaps one pound, growing from a small pedicle at the end of the spine.

This tumor was remarkable in that it contained fragmentary portions of another foetus; two feet and one arm were distinctly dis