said to be equally as great. The following is a diet list given by some writers: Milk should be taken in considerable quantities; may be mixed with vichy or other carbonated waters. Meat should not be taken more than once a day; lamb, mutton, fish and oysters are best for them, with raw or cooked food, and with the lighter fresh vegetables in moderation. Graham and whole wheat bread and all cereals are also helpful. All spirits should be interdicted. Coffee and tea check excretion and their use in any quantity should be discouraged. At least one quart of water should be taken a day internally; externally, a cool sponge bath in the morning, and a warm bath at night. For nervousness, restlessness and insomnia there is nothing more soothing. Plenty of fresh air is demanded. Costumes-We hear of the vigor of the savage woman and of her capacity for work, her ability to follow her tribe on the march, and why is this? It is plausible at least to say that it is due to her hygienic costume and rational habits and it is a fact that the Indian women are singularly free from derangements of the female generative organs and from difficulties of parturition, and a still more startling fact is, that the women of the more civilized tribes who have learned to follow closely their white sisters in dress and habits of life suffer more frequent complications of parturition than are common among the uncivilized tribes. It is easily seen that much of the suffering and many of the complications of parturition are due to our present mode of dress. How often we hear a woman say that she can go to her sixth or seventh month of pregnancy without detection, by the use of of her tight-fitting corset and garments, little realizing the danger to which she is subjecting her uterus, kidneys and other organs, to say nothing of the influence it must have upon the growth and formation of her offspring. The clothing should be mainly of woolen garments, for while they may be light in weight, they give much greater protection against sudden changes of temperature to which the pregnant woman is particularly susceptible. The clothing should be suspended from the shoulders and hang loose around the body, and anything which produces pressure upon the kidneys or uterus, should not be worn. The Care of the Breasts.-The mother's breasts and nipples often require attention. Drawing out of the nipples, cleaning their surfaces and healing of cracks and fissures in their epithelium. Congenital fissures of the nipples and uncleanliness expose the patient to danger of infection, as bacteria have a direct route to depth of breast through lymphatics. Authorities claim that abscess of the breast is caused by infection through lymphatics rather than through milk ducts, as is generally supposed. An eminent physician has made the statement that any physician who had a mammary abscess in his practice ought to be liable for malpractice. During the latter weeks of pregnancy the nipples should be cleansed with boracic acid solution, bismuth subnit and castor oil, boracic acid ointment, etc., and during the first week of lactation boracic acid solution should be used after each nursing. At the first indication of congestion of the breast, strict antisepsis should be used with the application of a firm binder and administration of free doses of salines. Child should be taken from the breast and only sufficient milk removed by pump to relieve discomfort of patient. Under this treatment, ninety cases out of every hundred of threatened abscesses will be aborted. Traumatism. In the prevention and cure of injury due to child-birth, the family physician has an even more important function in preventive medicine than any other branch of general practice. The lacerations of the birth canal are due either to an abnormal relation between foetus and birth canal or when the relation is normal, too long and tedious labors resulting in oedema of the soft parts. While on the other hand, it is often due to too rapid delivery, either natural or artificial, through the undilated soft parts. That it is impossible for a physician to prevent lacerations is well known to everyone, as they are inevitable and it has been said that a physician who does not have lacerations can be put in one of three classes: Those who never had a labor case. Those who never look for them. I. 2. It is true, however, that the intelligent physician can restrict lacerations within their present limits if a more watchful care is taken during the birth of the head and shoulders. This is accomplished by lessening the severity of the pains, with the use of an anaesthetic, thus relaxing the perineum; by pressure upon the descending head to obtain as great flection as possible, thus presenting the head in its smallest diameter and finally to deliver the head between and not during the labor pains. No physician can always prevent lacerations, but all physicians can repair them, and here is where many are guilty of negligence, as is proven by the great number of women suffering from prolapsus, uteri, retrodisplacements, rectocele, cystocele and later endometritis, salpingitis, and a life of invalidism, all being due to a neglected lacerated perineum and cervix. A short time ago a woman came under my care who for thirty years has had a constant dribbling of urine from her bladder, through a tear which occurred during child-birth. Who can imagine the misery she has endured? And yet she was relieved by a simple operation, which should have been done thirty years ago. Another woman who has had involuntary movements of her bowels for six years and during all this time has hardly been able to leave the house, the result of a neglected tear of sphincters during child-birth. These are only examples of the many cases which come under the care of the gynecologist every day and the family physician must answer for them. Every woman should be examined within twenty-four hours after labor and any laceration of the perineum should be immediately repaired, and some physicians insist that lacerations of the cervix should also be repaired at this time, but to do that requires more skill, better appliances and more numerous assistants than the general practitioner usually has at his command and for these reasons it is inadvisable for general adoption. The Puerperium.-The most remarkable and important, and often the most dangerous period of a woman's life, certainly so of her sexual period. The changes accompanying the entire organism to a condition of normal are among the most aston ishing phenomena in physiology and with these changes occur the greatest dangers to which the puerperal woman is exposed. Involution, creating an endosmotic flow which tends to favor invasion of bacteria; retention of blood-clots and placenta ; traumatism, lowered vitality due to strain of pregnancy and labor, all favor infection and the puerperal woman needs the care of an intelligent physician until involution is completed and all organs have returned to their normal condition. How many lives of invalidism would be saved if the medical care of women would continue for six weeks after labor instead of three to ten days, as is the usual custom. Some authorities claim that a woman should get out of bed on the third or fifth day. Thereby they obtain better drainage, stronger uterine contractions and more complete involution; but I believe the majority of physicians try to have their patients remain in bed until the tenth or fourteenth day, although this is not always carried out by the patient. Less than one month ago I delivered a primipara and when I called the next morning found her walking around the room, and the same day she walked over a mile to visit a friend. I would not like to be held responsible for her condition five years hence. If every woman would receive the proper care during the six weeks following labor, and at the end of that time if an examination is made of her pelvic organs and all abnormalities rectified, I am sure the lives of many women would be saved the suffering they are often compelled to endure and we would have much less use for major and abdominal surgery. In conclusion, I wish to say that it has not been my intention to present anything new but to call your attention to a few facts in preventive medicine as it is presented to the general practitioner, that we may look forward toward the golden future, when we shall not only be able to meet and cure diseases, but when we shall forsee and prevent them. "Then indeed will our art become a science, and our power be god-like." TWO CASES ILLUSTRATING THE SUBJECT OF THE BLOOD COUNT AS A GUIDE TO DIAGNOSIS AND TREATMENT IN ABDOM INAL SURGERY. BY DR. WM. G. WEAVER, WILKES-BARRE, PA. The exact scope, as well as the limitations of the blood count as an aid to diagnosis and a guide to surgical operations, cannot be said to be definitely settled. On the one hand we have the broad claims and positive statements of Brown of Baltimore, and of Wilson of Philadelphia. As opposed to these observers, with their enthusiastic claims concerning the advantages to be gained by a blood count, we have the demurrer of Deaver and of Baldy. I have not had the pleasure of reading Dr. Deaver's original paper entitled, "The examination of the Blood in Relation to Surgery of Scientific, but often of no practical Value, and may Misguide the Surgeon." Dr. Baldy makes the title of Dr. Deaver's paper his (American Practitioner, March 12, 1902), and proceeds to convict the leucocytes of unreliability and want of attention to business. I think a careful consideration of the cases cited by Dr. Baldy will suggest in several instances a satisfactory explanation; especially when it is borne in mind that all that is claimed for leucocyte-count is that it is an aid to clinical study. In the second case cited by Dr. Baldy the complaint is made that the blood count corroborated the clinical diagnosis, and that both were wrong. And yet it does not occur to Dr. B. to attack the unreliability of clinical evidence. In my opinion enough has been proven by those who have made a careful study of the subject to render it the duty of every surgeon, having the opportunity, to make his own observations and faithfully report the result. In this manner so many cases will be reported that the true value of this procedure will finally be arrived at. Dr. Brown, of Baltimore, says: "Regarding the value of leucocyte counting in surgery, I |