certain percentage of these cases will still show a favorable response after the entire failure of the slow vibrations to produce the desired effect. The explanation of this I can not offer; I can only vouch for the fact and make the recommendation that in cases like the above the rapid vibrations be tried experimentally before the change. to treatments less promising be made. A word of caution is necessary in this connection. I believe that in all such cases the first treatment should be applied with extreme care, for only five or ten seconds at most, upon only one side at a time, allowing the patient to hold the ear-piece in the ear himself and impressing it upon him that upon the slightest pain it is to be instantly removed. Careful tests of the hearing distance for watch and voice should be made both before. and after the experiment and inquiry made as to its effect upon any form of tinnitus which may be present, or in regard to the development of subjective sensations of any sort. The first trial being free from any unfavorable indications repetition may be made once or twice a week, with an increase of five seconds in the duration of each treatment, until a full minute has been reached. Beyond this point I have never gone nor felt the necessity of going. Finally, an injunction is necessary in relation to cases in which any involvement of the labyrinth or auditory nerve is found by preliminary testing to be present. In all such cases, in my opinion, this method of treatment by rapid vibration should never be employed, even though a catarrhal condition of the middle ear itself might indicate its use.

In illustration of the foregoing let me adduce the following case in brief outline. The patient, a young man, twenty-six years of age, with good general health, showed upon examination a moderate degree of postnasal catarrh of some years' standing and a typical condition of chronic catarrh of the middle ears, also of several years' standing, with thickened drum-heads, loss in the lower tone limit, etc., but without tinnitus. My testing watch, which should be heard normally at a distance of forty inches, was heard only on contact on the right side and light pressure on the left. The loudest whisper was heard at a distance of six feet on the right side and five feet on the left. That was in October, 1901. Treatments were given once a week with almost perfect regularity. At the end of the first month, after ordinary inflations and vibratory massage of slow and medium frequency, absolutely no change was visible. Inflations were then discontinued and very rabid vibration applied by means of the Wappler Electric Controller Company's masseur, the in-and-out movement, 15 seconds at a time, followed by the high-frequency current for two minutes at each treatment. At the end of the second month the watch could be heard at a distance of nearly an inch on

both sides. At the end of the third month of treatment the masseur was used 30 seconds each time and the watch was heard two inches on the right side and nearly as far on the left. At the end of the fourth month each treatment lasted 45 seconds and the watch was heard six inches on the right and three on the left. During the fifth month treatments lasted sixty seconds each, followed by the highfrequency current for two minutes, and were so maintained afterwards, the hearing rising to eleven inches right and nine left. From that time on the increase has been very steady and the treatments continued on the same line, with the occasional substitution of the Faradic for the high-frequency current, the hearing at the beginning of the last treatment, April 14, 1903, being for the watch 36 inches on the right side and 32 on the left, while the medium whisper was heard without difficulty 20 feet on both sides.

THE CARE OF THE BREASTS IN OBSTETRIC CASES.

(An Illustrated Lecture Delivered before the Alumni Association of the New York Homeopathic Medical College and Hospital, at the College in New York City, on Alumni Day, May 7th, 1903.)

BY EDWIN H. WOLCOTT, M.D.,

Obstetrician to the Rochester Homeopathic Hospital,

Rochester, N. Y.

In appearing before you I may not inappropriately remind you that I am not a medical professor, nor a medical specialist. I am simply a general practitioner who has had such opportunities to supplement the knowledge acquired in a medical college as are afforded in a tolerably large practice, supplemented by such facilities for special investigation as my connection with the Rochester Homeopathic Hospital affords.

In speaking to you of the care of the breasts before and after childbirth, and of the diseases to which they are liable, my point of view will be practical rather than theoretical, though I trust what I say may be found to rest on a sufficiently sound scientific basis.

I. THE NIPPLE.

First of all, let me speak of the nipple, since the nature of the orifice through which the milk-secreting glands discharge the lacteal

fluid varies greatly, and malformation of the nipple often leads to serious complications. Out of 97 cases of puerperal mastitis, Birket found that the nipples were imperfectly developed in 48.

Varieties. The accompanying chart (reproduced from The American Text Book of Obstetrics, 1902, Vol. II, p. 272) gives the different varieties of nipples which the obstetrician is compelled to recognize. Of these the most important are: (1) the normal nipple,

Mushroom.

which need not detain us long, because it is normal. (2) the hollow nipple, which is a frequent cause of trouble, since it requires an extra amount of suction to properly empty the lacteal glands, and milk acumulates and sours in the depressed portion of the apex, causing irritation which often extends to the adjacent glands. (3) the mushroom nipple, in which the base is so narrow that the free flow of milk is prevented by the grasp of the child's gums-the result be

Normal.

ing insufficient nutrition for the child and the possibility of serious complications for the mother. (4) The stunted nipple, which differs from those already mentioned in that there is no adequate elevation of the nipple above the surface of the breast; but sometimes a positive depression. In either case it is impossible for the child to nurse, and the stunted (or depressed) nipple should be securely bandaged on the day after confinement, to arrest the secretion of milk. When the nipples are misshapen or stunted the infant is unable to grasp them,

and his efforts to do so becoming more violent, traumatism of the nipple frequently takes place.

2. Liability to Soreness and Irritation.-The nipple, even if of the normal type, is peculiarly liable to soreness and irritation, and this must, of course, be carefully guarded against. (1) The nipples should

Fissured.

have proper care before confinement. Pressure upon them by the clothing, and especially by the corsets, should be carefully avoided. They should be washed night and morning, during the months im- . mediately preceding childbirth, with a mild solution of soap and water, followed by massage and the application of cacao-butter, sweet oil, or some other inunction-the object being to develop and toughen the nipple. (2) The breasts should be carefully watched during the first few days after the birth of the child. Irritation of the nipples is generally detected at once, but it often happens that en

gorgement and caked breasts have developed before the nurse, or the doctor is aware of the fact.

Whether in regard to the irritation of the nipples or the inflammation of the mammary glands an ounce of prevention is worth a pound of cure.

When irritation of the nipples is once established it is very difficult to treat, for no sooner are the nipples a little better than irr:tation is again induced by the grasp of the child's gums. When the