uterus and have been clean in all respects. Give a good bath, under cover, having a rubber bed pad under the mother before delivery. Change the bed and clothing of your patient yourself, and if you don't know how to do this with ease and without worry to your patient, you should learn. Don't leave this to the chance neighbor or hanger on; do it yourself. If there has been a tear of the perineum repair it at once, observing as strict technique as you would in any other surgical procedure. See that your patient gets the much needed rest after her labor by keeping away the morbidly curious who must just step in and see the baby, when they have not probably visited the family for twelve months, but whose curiosity must be appeased. If you have been clean in every respect you need not be especially concerned with what form of bacteria you may have to deal. The so-called "milk-fever" is a misnomer and simply an excuse upon the part of the attendant to hide some negligence.

As this paper is intended to deal more especially with the protective method, I will not go into the pathology of the many troubles that sometimes confront us.

Look well to those measures which are protective; as good midwifery requires a just appreciation of all the resources at our command, and a careful study of the circumstances which render them severally appropriate. Pathologists have done much to prevent many of the troubles that threaten at this period, and we know better than ever before how to prevent many of the troubles that have caused the death of thousands.

With the proper care upon the part of the attendant to the mothers among whom he practices, the thorough and competent physician can make himself no small factor in shaping the destiny of his community and be a benefactor to the nation. May there never be any cause for such lamentations as were uttered by the prophet of old: "Is there no balm in Gilead, is there no physician there?" "Is there no physician for the daughter of my people?"

May there never be any more cause for such lamentations than has the altruistic guardian of our people; and I can but feel assured that with this day of scientific medicine, and with the proper understanding of duty with reference to the great work expected of us as guardians of the nations in all things that pertains to their physical and moral welfare, that we can not be derelict in the discharge of obligations. Social and educational demands multiply the organic strain; hence the

physician should recognize the broad field of useful and essential teaching that unfolds itself before him, and prepare the mothers for the great physiological crisis of their lives; for a disregard of the fundamental law makes the change in a single generation almost inconceivable. Prepare the soil that the harvest may be of the full ear; that the gathering may be of the best fruits. Lose no opportunity to give to the mothers and to their offspring the advantages vouchsafed to them by all the laws of hygiene and preventive medicine.

To recapitulate: the duties and responsibilities that devolve upon us as physicians are of such magnitude as to make it imperative for us to prepare ourselves to meet these obligations in a manner befitting representatives of a scientific profession.

The influence of the accidents of pregnancy and of puerperal morbidity, of course, are well understood. The relationIship and responsibility of the physician relating thereto is well recognized, but probably not to the extent that its importance demands.

The enormity of the results which a failure upon our part to recognize these facts entail is responsible for many of the dire consequences that follow.

I believe that many of the accidents of pregnancy, the nausea, headaches, general lassitude, ptyalism, and even eclampsias, are due to sepsis, to auto-intoxication, to defective metabolism, to failure of elimination to inactive emunctories; for they invariably correspond with hepatic and renal insufficiency. We must not forget that the physiological products of the liver augment digestion and absorption and prevent intestinal putrefaction, and much of the morbidity and toxemia that results can be directly attributed to hepatic insufficiency. Gestatory toxemia is evidently the basis for many of the accidents of pregnancy.

Hence the pregnant woman should be constantly under the supervision of her physician, and he should be ever conscious. of the many evils that might befall her and take such careful supervision of her as to safeguard against these many acci

dents.

DISCUSSION.

Dr. LeGrand: "I did not expect to discuss this paper, al though I have been much interested in it. It treats perhaps of the most important subject in surgery or medicine. The doctor has covered the ground fully, in a general way. just make one point, which I desire to emphasize, and that is I think the greatest trouble following unsuccessful obstetrical work is that of sepsis. We cannot, in my opinion, emphasize too much the importance of having the patient thoroughly prepared, thoroughly clean-and the doctor himself. It is my opinion that the physician who practices the ideal will have him a sterilized suit of clothes for every case, a clean sterilized duck suit to wear when he visits a case of obstetrics. I think, further, the patient should be prepared; it is advisable to have a well trained nurse to see that she is thoroughly bathed and cleaned. We all know that it is best not to make too many examinations. The doctor should be clean, scrubbing the hands thoroughly; and I want to say in my opinion it takes quite a good deal of time to thoroughly cleanse the hands, and hence the importance of the rubber glove. I believe that every physician practicing obstetrics ought to provide himself with the rubber gloves, and see they are thoroughly sterilized, and use them, because of the fact that the active practitioner is exposed in such a way, doing so much work, that he is liable to infect the patient though he may scrub his hands. Edgar, in his most excellent work, insists that you may be clean yourself, that your patient may be clean, but that you ought to have such an obstetrical bag as that you can sterilize the bag and instruments and everything you use. I hardly think that is practicable in general work, but it is worthy of consideration."

Dr. Fitts: This subject to the general practitioner is a very interesting one. The very able paper of Dr. Palmer leaves little for discussion, but it is, perhaps, just as well to emphasize some things, and I have jotted down a few of them as having been presented to me lately. In the first place as regards sterilization of the hands, a very important matter; the doctor has insisted upon cleanliness, and I think if more of us took particular pains to scrub well our hands with soap and bichloride, it would pay us for the trouble. The urine should be systematically examined, for it is our business to know

about it. I have been told by physicians it does not matter in the early months, and that they wait until later. It should be done both early and late. In this connection I might mention that in the last two months I have seen five cases of eclampsia. This week's Medical Record contains a number all over the country, and it ought to emphasize the importance of an early diagnosis and a careful urinary analysis. One thing I would emphasize is the care of the cord. I have found, in consultation work, that there is not very much care taken of it really, and that the material used in tying it is rarely sterilized. It is a very simple matter to pass it through bichloride to render it perfectly harmless and thus often avoid trouble. The method. of Crede, in Paris, in putting one or two drops of a 2 per cent. solution of nitrate of silver in the eyes is one generally neglected, but which is, I think, of vital importance. Another precaution which I always take myself, and which every doctor should take, is to carry in his obstetrical bag the necessary instruments for the repair of the perinæum. It is true that we do not have many tears or ruptures, but the most careful physician will get them, and it is not wise to go unprepared. I thank you kindly for your attention, and Dr. Palmer for his excellent paper.

Dr. Palmer: (In conclusion): I do not know that I have anything further to say. In writing this paper I purposely omitted referring to anything that pertained to delivery. There are many things in labor that might have to be overcome. The point which I did intend to bring out was the fact of the general disregard on the part of the medical profession of the many conditions that threaten our patients during their pregnancy and at the time of their delivery. I think this is the important time. I think that this is the time to prepare for successful delivery of any mother. I used the expression in my paper commencing twelve months before hand. I do not think it is a bad idea, for if the mother begins her pregnancy with her health run down, with the many cares and worries of home, it is a condition that will certainly be harmful during her pregnancy, and is bound to affect her at the time of delivery. I think a neglect of this feature brings a reproach upon the profession; I think it has a great deal to do with the future health of the child, as well as the future health of the. mother, and the thing that I did want to specially emphasize, and to awaken the most interest in on the part of the profes

sion, was the great and broad field of usefulness along these lines. I think it is a field negelected by a great many of the profession. Now the doctor alluded to the instillation of nitrate of silver into the eyes of the child. I have never seen the common sense of putting nitrate of silver into one hundred eyes, because one might have an inflammation of the eyes. I think in twenty-two years of experience in obstetrical work I have had five cases of opthalmia, and I would feel mighty bad tc have put nitrate of silver into the eyes of all the others. I do not think it is a good practice. I thank you very much, gentlemen.

IRITIS.

BY LEWIS GREEN WOODSON, M. D., OF BIRMINGHAM.
Professor of Ophthalmology, Birmingham Medical College.

In the preparation of this paper I have endeavored to present my subject in such a way as to be of some practical value to the general practitioner. Many of you have never had the opportunity of giving diseases of the eye special thought or study; but every intelligent physician should be able to make a diagnosis in those affections of the eye where the nature of the disease can be recognized by simple inspection. Many practitioners being remote from cities are frequently called upon to render first aid in ophthalmic cases. Errors in diagnosis and treatment in many diseases of the eye may, and frequently do, lead to disastrous results. Especially is this true of the disease, which is the subject of this paper.

From the standpoint of the general practitioner I regard iritis as one of the most important diseases of the eye, from the fact that it furnishes, according to competent authorities, from two and one-half to four per cent. of all ophthalmic cases. I do not know of any disease in which the signs and symptoms, both objective and subjective, are so well marked as in iritis. I do not know of any disease of the eye in which an error in diagnosis is more certain to be followed by partial or complete blindness. Nor do I know of any serious disease of the eye in which an early diagnosis and proper treatment give more brilliant results.