is known that we used about $5.00 worth of sterilized gauze daily just to make napkins it will be seen what expense is found in such an institution. In no case was it permissible to change the diaper of one baby for that of another when slightly wet and then dried.

FIG. 7.-The first clothes of a Premature Infant, consisting of a flannel shirt, flannel band, diaper of cotton and gauze, and cotton and gauze envelop.

LIGHT.

Ballentine (British Medical Journal, May 17, 1902), Rotch and others declare that premature babies should be kept in darkness. On the contrary, our babies were kept constantly in the light; for, as mentioned, light was necessary to show the incubators and at night it was necessary to permit of their While the light was much subdued after II p.m. the infants were never in darkness. I was unable to discover any harmful effect of this light.

care.

EXERCISE.

Even the youngest infants should have their arms out so that it can move them; this permits a little motion and assists the respiration and circulation.

The question of bathing like so many questions concerning premature infants is considered from a different standpoint by each author. Some interdict bathing for the first week or ten days, while others recommend its daily use. Rotch says that the premature infant should not be bathed but should be rapidly covered with warm sweet oil and wrapped up in ab. sorbent cotton; this is changed only every forty-eight hours, when the infant is again covered with oil. Voorhees gives very similar directions. Monti recommends that premature infants be bathed at once after birth in water at a temperature of 29 to 30°R. (about 98°F.). He furthermore believes that sponging the baby once or twice daily is very advantageous as a circulatory stimulant. Parts of the infant are successively exposed and washed with sterilized cotton dipped in warm water; a mild soap can be used. This stimulates the function of the skin and prevents infection. Blair also finds daily repeated baths helpful to stimulate the circulation and the skin. Budin is an ardent advocate of daily bathing in warm water, but he finds it especially of service in those infants whose

temperature remains below normal.

corroborated the value of bathing.

Finkelstein has likewise

For the purpose of increasing the rectal temperature Budin advises two procedures: Where a rapid elevation of the temperature is desired the infant is plunged into a bath at a temperature of 37°C. and remains there until its temperature is normal. However, he finds that if the infant is placed in the bath at a temperature of 1° above the infant's rectal temperature and then gradually raised during fifteen or twenty minutes until it reaches 37°C. the infant's rectal temperature will remain normal much longer than it will when raised rapidly by the former method. The temperature of the water is elevated by the addition of warm water which should be poured into a funnel to which a tube is attached which reaches. below the surface of the water in the bath tub. If the water is gently poured into the tub the warmer water has a tendency to float on top and does not mix with the cooler water.

We followed Rotch's directions in the main. The infant was rubbed with oil and placed at once in the incubator. The baby was not bathed for several days, when a daily sponge was begun; this was done with sterilized cotton, one part after another being exposed; after this it was given an oil rub. In several instances a warm bath was given when the infant's temperature fell below 96°F. For rapid elevation of the rectal temperature the warm bath is the ideal method and should. always be resorted to.

I shall have to obtain more evidence than I possess at present to believe that this frequent bathing is necessary. Of course, when the temperature of the incubator is kept too high, as Blair's figures evidently are, or if the incubator temperature is kept too low as Budin evidently does, at least for infants weighing less than 1200 grams, these baths must be absolutely necessary; in the one case to cool the infant and in the other case to heat the infant. But if the infant's rectal temperature is maintained between 97 and 98°F., bathing will be found unnecessary. A daily sponge and afterward a good rub with oil will usually be found sufficient. If the baby's temperature is below 96.5° or above 100°F., the bath should be given.

There is, however, one possible advantage of frequent bathing during the first few days of life and that is that the skin has an opportunity to imbibe water, for usually an insuffic

ient supply of water is given during the first few days. Still, as it will be found easier to give the same amount of water by the stomach or rectum this advantage is not worth considering.

THE OIL RUB.

Many authors do not mention the oil rub. Some seem to think it unnecessary, others believe it is a mistake to use it, still others recommend it. It is difficult to conceive any serious objections to it. As massage is so helpful it is really necessary to have some emollient for massage on the dry tender skin. Furthermore it protects the sensitive skin somewhat from irritation, and as a means of cleansing it should by no means be dispised. Then there are two specific reasons which, therapeutically at least, should be given due consideration:

First, the oiled skin prevents a too rapid heat loss, the oil acting as a non-conductor, and, finally, the oil prevents to some extent the evaporation of water, which in a warm incubator should always receive attention. In fact, the rapid loss in water is one of the most serious menaces to the life of the infant.

Just what oil should be used is somewhat indefinite. Probably any non-irritating oil will answer. We used olive oil, Rotch recommends sweet oil. An animal fat would seem to be preferable, so that fresh lard or fresh butter might be used; the tendency of the latter to become rancid will, no doubt, be a serious objection. Cocoanut butter should also be permissible. The odor of cod-liver oil makes it objectionable. The oil should be sterilized by heating for several minutes and placed in sterilized bottles; it should be applied with sterilized cotton or a thoroughly disinfected hand.

EXERCISE-MASSAGE.

All authorities agree that massage and passive movements are beneficial. The infant's limbs should be free so that movements are possible. Complete swaddling, therefore, is unwise. It was our custom to massage the infant every morning after the bath. The loose clothing permitted active moveA good cry several times a day is helpful in that it removes atelectasis and increases oxygenation.

ment.

(To be Continued.)

I

Electricity as a Curative Agency in
Gynecology and Oncology.

By G. BETTON MASSEY, M.D.,

PHILADELPHIA, PA.

SHOULD probably preface these remarks with the explanation that the little used word, "Oncology," is defined by Foster as descriptive of the science of tumors, and is used in this paper to refer broadly to the science of benign and malignant growths.

The progress of electrotherapeutics in displacing various less useful and harmful procedures in gynecology can only be appreciated by those who are in touch with the many hundreds of physicians throughout the country who are using it, and who report highly satisfactory results from its use. There are some who decry the results to be obtained from it, it is true, but an analysis of the personnelle of its opponents will invariably disclose two strong reasons for their opposition, either of which disqualifies them for the expression of a truly scientfic opinion; one condition invariably present, in my experience, amongst those opposed to electricity is an absolute ignorance of the remedy and its practical application. I do not for a moment say that the eminent surgeons who may be placed in this classification are ignorant men, in the ordinary sense; but I do say that a man trained to the performance of major operations, and necessarily occupied in this work alone if great skill has been acquired, is no more fitted to give a useful opinion on the subject at issue than he would be to draw the plans for an electric power plant, or to compute the orbit of a new planet. And, moreover, the work in which he is most interested differs so completely from gynecologic electrotherapeutics that we should not expect him to develop his crude ideas into an expert knowledge in a work so entirely different from his chosen path.

The second condition characterizing the opponent of electrogynecology is that natural state of mind attending all rivalry amongst human beings. As long as we have a proper devotion to our work we will look askance at the claims of others to better results by the pursuance of different methods.

Read before the Medical Society of City Hospital Alumni, September 15, 1904.