is a résumé, was undertaken primarily for personal information. The results obtained from year to year amply repaid all expenditures of time and money. The criticisms of extremists on both sides, convinced me I was pursuing the proper course. Besides it speedily became apparent that any fifty returns taken in the order or reception agreed in essentials with any other fifty and differed not materially from what I had been led to expect by my reading and by my observation of neighbors. I have then absolute confidence in their accuracy. If anyone takes exception to the nomenclature employed, let lim remember that there are fashions in names as well as in all things else, and that if it were not for the remarkable gift, known as memory, the text-books of one decade would be unintelligible jargon to the next.

All that is necessary is cognizance of the phenomena included in a certain label at a given time. Facts are everything, titles nothing. Governed by law, our patients, as well as ourselves escape the dire effects of the diverting fantasies that have hitherto and necessarily ever will mark the course of the old school. What we build is permanent. Meet it is that we as a school no less than as individuals, pause from time to time and consider where we stand and how we stand. If a man knows not that, he merits commiseration and contempt. It is conceded this paper has exceeded its logical limitations but thus a more complete delineation of the present condition of the art has been secured.

ANTE-PARTUM CARE.*

BY REBECCA ROGERS GEORGE, M. D.

At the beginning of this new century, when the prevention of disease is looked upon as a greater triumph than its cure, it is but in keeping with the general tenor of the times, that such precautionary care be given each case of pregnancy, as will give a reasonable assurance of a normal and safe delivery.

Not so many years ago, a physician called to a case of confinement could only guess at what conditions he would be called upon to meet, for with no previous knowledge of the patient's physical condition, habits of life, or position of the child in utero, he was indeed a mariner without a compass, possessed of no knowledge to warn him of impending disaster.

With women who are well developed physically, and who have kept their muscular, circulatory, and nervous system in good condition by approximately normal habits of life, parturition is usually normal and recovery rapid. But with the advance of mental and social requirements among the women of the present generation, the perils of maternity are manifold.

Fortunately many of these perils may be obviated by intelligent care and proper methods of living during the period of pregnancy, and the modern physician is indeed loath to undertake a case of confinement which has not been under his constant surveillance for at least three months prior to the day of delivery.

It is far safer, however, for a patient to be under a competent physician's care from the time a pregnancy is known to exist, for there are many symptoms attending the pregnant state, formerly supposed to be a necessary accompaniment which are now known to be pathological and demanding relief, for the best interest of mother and child.

Of these symptoms, the first in importance, because usually

Read before the Indiana Institute of Homeopathy.

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the first to cause annoyance, is of course the so-called morning sickness," or nausea of pregnancy. The doctrine so long taught and still deeply planted in the minds of the laity, that this distressing symptom is a necessary preliminary to motherhood, seems to the medical mind of to-day as much a relic of past ages, as does the doctrine of infant damnation to the modern Presbyterian.

The progressive physician of this twentieth century who examines his cases of intractable nausea and vomiting, finds either a loaded rectum pressing on the growing uterus, an eroded cervix, or a fundus looking back and crowded under the sacral promontory, or possibly all these conditions in the same

case.

While nux is the remedy par excellence for correcting interrupted or impaired peristalsis, and sepia is indispensable in that lazy portal circulation which results in pelvic congestion, and puls. is a faithful friend in the catarrhal condition of stomach, bowels, and uterus, which give us persistent nausea, yet we have all met cases where the medicinal remedy alone was not sufficient to give relief. Nor is it wise to wait for the actions of our medicine until the strength and vitality of our patient is well-nigh exhausted. Far better flush out the colon of its hardened contents, examine the uterus and if the cervix is eroded as it usually is, treat it tropically, as you would treat any other solution of continuity and continue to treat it until healed thoroughly. This not only results in relieving the nausea but does away with the exhausting leucorrhoea common to such cases, and puts the cervix in a normal condition for the peculiar part it has to play in the process of delivery.

If there is a retrodisplaced fundus, such dislocation must be reduced if possible, by placing patient in the knee-chest position and making the necessary manipulation. As this is not always followed by success, it is sometimes necessary to place medicated tampons in the posterior fornix and by such gentle and continued upward pressure, the uterus may be assisted to regain its normal position and relation to contiguous parts, thereby making possible the relief of a very intractable nausea.

The results of local treatment in cases of retrodisplacement and eroded cervical tisues, are so uniformly satisfactory and

free from danger, that such treatment should not be postponed after such a condition is discovered.

The topical medicines necessary in healing an eroded cervix, depend somewhat, of course, upon the case, but painting the diseased tissues with enzymol, or ichthyol and placing a tampon saturated with calendulated glycerine is my favorite application.

Constipation is often a most annoying and persistent accompaniment of pregnancy, but should not be looked upon as a natural condition during this period, for if unrelieved it may give rise to a chain of symptoms difficult to manage during the last months. Especially do we find that hemorrhoids are a frequent result of constipation, although too often their occurrence is attributed to pressure alone, during the pregnant

state.

In order to prevent constipation and consequent hemorrhoids during pregnancy, it has been my custom not to depend upon artificial laxation, which naturally tends toward engorgement of the hemorrhoidal veins, but to regulate bowel activity by proper diet and exercise.

Fortunately the diet indicated to overcome or avoid constipation is also the diet which tends towards the promotion of an easy delivery, for by the use of acid and sub-acid fruits and by avoiding those foods rich in bone forming elements, the cranial bones of the growing infant are not made so solid as to prevent easy molding, and unretarded progress, as the head passes through the maternal channels during the progress of labor.

Foods especially rich in bone-forming elements are lean meats, particularly the red meats, beans, rye, oats, and wheat, while corn contains but a small amount of mineral salt.

Therefore the pregnant woman does well to eat very sparingly of the red meats, shell fish, oatmeal, and all wheaten bread stuffs or breakfast foods. Eggs also should not be used in abundance.

On the other hand, such fruits as oranges, apples, peaches, and plums should be eaten freely and should constitute a large part of the daily bill of fare if a sluggish liver and constipation be avoided. While milk, vegetables, rice, corn, macaroni,

etc., are permissible and help furnish an abundant variety to the diet of pregnancy.

To the many physicians who smile in quiet derision at the possibility of easing and shortening the period of labor by looking after the diet of the expectant mother, I can only say that such skepticism is evidence of failure in thoroughly trying this method in a sufficient number of cases to warrant an opinion as to its efficacy.

For there is nothing more gratifying than the results obtained from proper diet and plenty of exercise during the last six months of pregnancy, and a fair trial will prove to anyone, that the majority of labors need not, and do not, exceed six to eight hours, even in primiparæ, and with a goodly number the time of travail is cut down to three or four hours.

However, I would not be misunderstood in claiming that diet alone is all that is needed toward accomplishing an easy delivery, for abundant exercise is also important, else the abdominal and uterine muscles will be too sluggish and inactive to do their part well, and uterine inertia may be the result, just when the expellant forces are most needed.

Perhaps there is no better form of indoor exercise for the pregnant woman than light housework, and such a patient is fortunate indeed, who can afford to keep enough servants to do all her bed-making, light sweeping, dusting, and the many household duties which make daily activity imperative. But the housework should not be so heavy as to prevent daily walks in the open air, for never is there greater need of fresh air and sunshine for both mother and child, than during this important period.

Nor should the matter of dress be neglected by the physician in his watchful care of his pregnant cases, for many times daily exercise is rendered almost impossible and indeed positively harmful, by the patient knowing no better than to crowd the growing child in utero, by tight, stiff corsets, and further impair her muscular development by heavy unsupported skirts, and high-heeled shoes. Perfect freedom of motion is necessary, and unrestricted muscle play, else the exercise we prescribe may do positive injury, instead of the good which we prophesy.