within recent years great progress has been made in regard to this problem. Beginning with the nursing infant, its first supply of nourishment is that of the colostrum, which continues until the flow of milk is established. We find, however, that later this same condition may obtain, that is, we may have a colostrum period in which colostrum corpuscles may appear, and during that period we frequently find indigestion. The time to apply the child, as the gentleman just remarked, is after the mother has had proper rest, perhaps about four hours, and then every four hours until the flow of milk is properly established.

Now the principal progress in infant feeding is in the line of the chemical analysis of milk. It has been determined that in the feeding of infants any disturbance that arises during nursing comes chiefly from the proteids or from the fats. We have, in other words, proteid or fat indigestion. There are many conditions that may bring about this alteration in the percentage of fats and proteids, and any physician can readily estimate the amount of proteids and the amount of fats. The method adopted by Prof. Holt is by using a graduated tube and estimating the percentage of cream. The ratio of fat to cream is as 3 to 5; the specific gravity of milk varies from 1,029 to 1,031; cream being of low specific gravity, will lower the specific gravity of milk, while proteids, being of high specific gravity, would increase the specific gravity of milk. Taking this relationship and knowing the specific gravity of the milk, you can readily estimate approximately the percentage of fats and proteids.

The method of changing the percentage of these elements should be studied. It is well known that a nitrogenous diet will increase the percentage of fats; consequently giving meat or a nitrogenous diet to a nursing woman will increase the percentage of fats in her milk. The percentage of the different ingredients of milk varies, chiefly, in those two, that is the proteids and fats. The carbo-hydrates vary but slightly

under any condition, remaining at about 7 per cent. The matter of reducing the percentage of proteids is more difficult. In order to do that it is necessary to increase the amount of exercise; where there is disturbance of digestion it will usually be found to be due either to an increase of proteids or a diminution of the percentage of the fats.

The subject of bathing has been gone over, and I fully concur with the other gentlemen that have spoken before me that many children are bathed to death. I do not believe that it is necessary to give a child a full bath oftener than two or three times during the week. I believe that many feeble children's vital powers are exhausted or reduced by this process of bathing.

Substitute feeding.

One gentleman spoke of giving cow's milk as a substitute food. I believe it is the only substitute food that should be given, but it requires a great deal of care and study in properly adjusting the percentage of the ingredients to the ability of the child to digest; in other words, we should as nearly as possible prepare the milk with the percentage of ingredients-that is, the percentage of proteids, fat and carbo-hydrates--as near that of the mother's milk as possible. One great difficulty in the digestion of cow's milk is the large percentage of proteids (about 4 per cent.), while human milk contains only about one and a half per cent. In order to reduce the proteids it is necessary to dilute the milk; in doing that we dilute the carbo-hydrates, the percentage of which is smaller than that of mother's milk; consequently in diluting proteids we dilute the carbo-hydrates and it is necessary to add carbo-hydrates of milk-sugar to make up for this deficiency. Cow's milk is acid; human milk It

is alkaline. To obviate this difficulty we add lime-water. is found that 5 per cent. of lime-water is sufficient to render the milk alkaline.

In regard to sterilizing food, a gentleman remarked that it was difficult to sterilize the food, and he preferred, therefore,

boiled milk. I think it is generally conceded that Pasteurized milk is preferable to the boiled. This can be very readily done. All that is required is the tin can and the bottles. The amount of food required for twenty-four hours should be sterilized at once and placed in a cool place.

Dr. Helm: The first thing a new father does when he finds the mother has no milk is to go to the drug store to get the nursing bottle. For some reason the druggist is nearly always sure to give him one of these abominations with a tube about six inches long and a brush with which to wash it out. I have often wished the druggists and manufacturers could take their food for life through such tubes.

Very well; but

Somebody spoke about sterilizing bottles. you can not sterilize those tubes, and the tubes are nearly always sold; and if proper I would like to make a motion that this Society condemn most emphatically all those tubes, and that nothing but a pure nipple be used.

Dr. Dougherty: I am an advocate of the common sense ounce bottle and nipple, but no rubber tube, because I think the milk can be more contaminated with germs through the long rubber tube than where they are not used, and I second the motion.

HYGIENE OF OBSTETRICS: THE PUERPERIUM.

BY A. J. PULS, M. D., OF MILWAUKEE.

Nature herself is a most faithful and active prophylactic agent to the human being and especially to the puerpera. She produces by means unknown to us some remedy more potent and less toxic than any antiseptic discovered by man. On the other hand, she creates within the genital tract of the confined, under favorable circumstances, a toxine whose effects upon the human system prove fatal in spite of the untiring efforts of the obstetrician.

Not until puerperal septicemia was considered to be the result of the invasion of microbes into the birth-channel of the parturient was there any scientific advance made for its correct treatment, and at present bacteriology and pathological chemistry are leading us on in the right direction to combat its evil. effects.

In a preliminary report, published a month ago, Dr. J. Hofbauer1 from Prof. Fried. Schauta's Vienna clinic, gives the result of his experience in seven cases producing an artificial leucocytosis in puerperal septicemia by the use of nuclein hoping that antitoxics are freed in the body which can overcome the influence of the virus produced by the microbes present in the system.

To-day our object will be to decide upon the best methods of preventing infection in obstetric cases.

J. P. Semmelweis2 may be properly termed the father of prophylaxis of child-bed fever. In 1846, just fifty years ago, he first demonstrated his theory by using antiseptics in the lying-in hospital of the University of Pesth, since he insisted. on cleansing the hands with chlorine water before attempting an examination of the parturient.

Subjective antisepsis still prevails. Although the theory of self-infection had many supporters, the tendency now is in

the opposite direction and the law is almost universally accepted, "To consider the obstetrician septic and the healthy parturient aseptic."

The virus which produces puerperal septicemia is, as a rule, introduced from without. The infection can in most instances, as we shall see, be traced to direct contact,

First, during parturition;

Second, during delivery of the placenta and membranes; Third, during the lying-in period.

The general practitioner who is well aware of the dangers of sepsis can only practice subjective antisepsis and very seldom follow out aseptic principles in the lying-in chamber. How often is he called to an emergency obstetric case when he is least prepared to meet the required rules of asepsis. How often does it happen that he is called away from the bedside of a patient, dying from puerperal sepsis, to attend at once a case of labor where he has been the family physician for many years, and no one else would be entrusted with such a serious case no matter how simple the delivery may be. Can he refuse? How often has he no more than a few minutes to prepare himself, and no time whatever to arrange the bed and surroundings necessary to meet the requirements of asepsis. But, on the other hand, does it ever happen that a practitioner can become careless respecting subjective antisepsis? Credit must be given our older physicians, although they studied and practiced medicine before the days of antisepsis, inasmuch as they practice asepsis with more care than the younger physician, who, probably conscious of and elated over his former successes, becomes indifferent regarding asepsis. The young practitioner's busy life stimulates him to do the greatest amount of work in the shortest possible time.

In a normal birth, time is the greatest safeguard both for mother and child. It means a leaning hand to the natural forces, and is for this reason the greatest of all prophylactics. To give time is to say, "Let nature care for herself."