however, in favor of the activity of minute medicinal doses. For when the one thousand-millionth part of a grain is sufficient to produce such visible results as the solidification of a solution by the formation of crystals, we can hardly say that the ninth trituration contains no more of the active substance. [Ztschr. 1. Phys, Chemie 22, p. 289.]Pharmaceutical Review.

AFTER CARE OF THE PARTURIENT.

EMMA F. A. DRAKE, M. D.,

PROF. OF OBSTETRICS, DENVER HOMEOPATHIC HOSPITAL AND COLLEGE. DENVER, COLORADO.

Had we to deal with labor in its simplicity as a physiological act natural and unmolested, the accoucher's duties in the days immediately following, labor could be expressed in a few words; but owing to the results of our boasted civilization, which too often in its mad rush has robbed womankind of the sturdy physique and sound brawn so much needed in the every day emergencies of life, she comes to the ordeal of maternity illy fitted for its strain, and with little or no reserve power, either to carry her through the hours of incomparable pain, or to aid in her restoration in the days following.

Whole volumes have been written, if collected from our journals, on this subject, dealing with all its phases, and the wise accoucheur reading and digesting all he can find on the subject will select from this knowledge and his own common sense, the best method of dealing with the individual cases as they occur in his practice; and from his experience write new and better articles each succeeding year.

That great changes have been made in the past thirty year, since the promulgation of the germ theory of disease, in the management of the lying in room, is unquestioned, the patient is no longer left alone to the recuperative forces of nature but is aided as well by every wise provision of art

-and as a consequence the mortality rate of paturients has been reduced to a minimum.

When death enters the lying in room, in any guise, inquiry is at once made as to what carelessness or indiscretion the attendant or physician has been guilty of, and the taking off is not always adjudged to be a decree of Providence to which we must patiently submit.

Now what, in the light of present knowledge, are the best methods of management during the two weeks of lying in, is the question under discussion.

First, I think all will agree that an ounce of prophylaxis is better than ten pounds of cure, and the physician is wisest whose armamentarium is bulwarked with this truth. We will suppose that our patient has been wisely and well delivered, that all possible injuries so far as feasible have been repaired and that she has fallen into our hands for after care. It is first important that we guard well the approaches of disease. See surely that the room and all necessaries to be used about the patient and the attendants be not only aseptic, but, if you please, antiseptic as a double guard.

And right here the question will arise, what antiseptic? Avoid odorous disinfectants, carbolic acid, iodoform, kreosote and others of pungent odors may (?) be useful but they certainly cannot be pleasant and are, we believe, many times possitively injurious. Dr. Geo. Wm. Winterburn says relative to Sloan's Maternity Hospital, which has a wide reputation as a clean place, that the babies all have a gray, unnatural look owing, he thinks, to their constantly breathing the air impregnated with this triad of disagreeable germ killers mentioned above; which prove as well, we think, baby killers as one in nine of the infants of this institution die. Bi-chloride of merc. has been passed upon as of doubt. ful efficacy as it must be used in a strength which is poisonous and harmful to be of even a little good. The hands immersed for five minutes in a solution of one part to fivehundred leaves the germs resting about tne finger nails and in other hiding places unharmed; when one quarter this

strength is recommeded for external cleansing of the genitalia and douching, and one tenth as strong, or one part to five-thousand only is allowed for intra-uterine washing, we can see easily how powerless for good the bi-chloride becomes. Especially are we warned when we read of fatal cases resulting from intra-uterine douching with solutions of bichloride one part to two thousand or two thousand five hundred.

On the other hand we have a host of odorless and pleasant anti-septics from which we may choose, listerine, permanganate of potash, borolyptol and several others bearing a close relationship to these, and last, but by no means least, calendula. Again, we must not place too great stress upon any anti-septic. One after another has been taken up, its praises sung for a varying time, only to be dropped as dangerous or useless, while another comes to the front.

Better by far trust to cleanliness alone than to antiseptics of any kind while careless of cleanliness. One writer will tell you that asepsis includes anti-sepsis, while another will say as emphatically-asepsis is sufficient alone and productive of no evil results. Says one writer "as to anti-septics—why they should be used after labor any more than in gynæcological work in the non-pregnant state is the matter that those in favor of such treatment should explain."

"If abrasion of the genitalia be the plea, then why not use them in every case of erosion of the os uteri, or after curetting where some of our best homeopathic surgeons never use or think of using such treatment, and whose success is never excelled, if ever equalled."

This is the other side of the question and has many advocates among our best physicians. However, it is safe to be sure of asepsis if you can get it, and proceed. If you cannot be sure of it without anti-septics, then use the reasonable ones, and you will feel safer at all events.

While we do believe, as many affirm, that septicemia is always heterogenetic, and that puerperal sepsis invariably

means faulty technique; yet we surely cannot be too careful in our demands for cleanliness. Listerism has certainly made important this factor of cleanliness and for this, we thank it. The questions asked by the physician on his first visit after delivery are in regard to the quantity and quality of the lochia, whether urine has been voided, whether after pains have been troublesome. The pulse and temperature will be carefully watched less they steal a march on him.

The patient should be seen within twelve hours after delivery and careful note taken of all these items.

Should the patient from semi-paralysis of the parts, be unable to void urine, the catheter must be used-but its use should not be encouraged beyond the first day unless positively necessary. Weakness of the sphincter has often been fostered by overuse of the catheter.

When a few doses of arnica are given immediately following delivery, or it may be stramonium, the physician is rarely ever forced to use the catheter.

Very much can be done with the indicated remedy in the after care of the lying in. Right here is the ground for the homeopathist to boast, and he has double standing room if he has had opportunity to care for his patient in the months preceding parturition. In the thorough cleansing and building up of the woman no weak or diseased ground is left for a resting place for disaster or disease.

Should after pains be troublesome, rhus, arnica, bry. or sepia will, in the majority of cases, cover the symptoms; if not, you will rarely fail with ignatia, ferrum, bell, nux. or cof. or, the indicated remedy.

The administration of nitrite of amyl is recommended. Saturate a tissue paper with five or six drops, crowd into a two dram vial and when the pain approaches, instruct your patient to remove the cork and inhale. It is said to work with magic celerity.

As to diet, it is my rule to keep the patient on a light diet until after the third day, then follow with a generous diet of nourishing food. Each patient's peculiarities must determine what and how much. Immediately after de

livery and the toilet, to patients who can stand it, I recommend a cup of hot milk. To others a cup of beef tea-made from Armour's Beef Extract, a bottle of which can be carried by the physician as a part of his armamentanium if he choose--is more acceptable than the milk.

Mixing one of the effervescing salts congress, vichy, seltzer, or kissingen in a tumblerful of milk is very grateful.

The douche in the after care of the parturient has been variously discussed. A hot douche immediately following delivery, to thoroughly cleanse the uterus of any clots or bits of membrane that may be hiding there, is, we believe, productive of no harm and may obviate much trouble thereafter, while a daily douche of hot water containing a little calendula or listerine is cleansing and very grateful to the patient In many of our maternity hospitals a douche is given for the first few days once in eight hours, then once in twelve, and finally once daily until the patient leaves the hospital.

The bowels need little attention. When nature calls for an evacuation, a very warm enema is all that is required.

Should the nipples give trouble from sensitiveness of fissures, after trying the simple external remedies, together with the indicated internal, and failing in all these, look to the uterus for the cause. You will sometimes find a curettement followed by a soothing treatment will relieve the breast of all trouble. Washing off the nipple after each nursing and dusting with calendulated boracic acid, or simply bathing with calendula, may heal them very quickly. If this alone fails, after nursing apply a piece of gold beaters skin, first puncturing with several openings to allow the milk to pass through. Make a fresh application each time, and by thus persistently keeping the lips of the child from the sensitive surface they are enabled to heal,

If all goes well, you may, on the sixth day allow your patient to sit up in bed to eat her meals. On the eighth and ninth days she may slip out to a chair while her bed is being freshened and on the tenth day she may be dressed in a