the family intrusted to his care. When this obtains, his moral obligation will impel him to promptly do his full duty, by giving adequate instruction concerning the ill effects of improper posture, dress, food, drink and erroneous habits of living, including the non-forbearance of indiscriminate, excessive and impure sensual indulgences. Then it will come to pass that the wholesome forbearance of coitus during the entire period of gestation, the puerperium, and three months thereafter, will be insisted on." Landis (Compend of Obstetrics, page 42, Pregnancy), says: "Locally, the hyperemia of the pelvic organs will cause, at first, an increase in the sexual desire." Page 40 (Causes of Abortion): "Hyperemia of the pelvic organs from over-exercise, coitus, lifting, etc." "Lusk (Management of Pregnancy, page 113): "Marital relations, though not absolutely to be prohibited, should be of infrequent occurrence.

Ex

cesses in the newly married are a common cause of abortion." Page 317 (Prophylaxis of Abortion): Rapid succession. In such cases, curetting is often of service, and a six weeks' abstention from sexual intercourse may be usefully enjoined.

Palmer (American Text-book of Obstetrics, 1895, page 181): "Sexual intercourse is to be regulated carefully, for very often it is found to be injurious to pregnant women. While especially enjoyed by some pregnant women, coitus is distasteful to most women at this period, and it becomes the source of much pelvic discomfort to not a few; it may create an abortion. Even uncivilized nations have condemned the privilege of sexual intercourse during the period of pregnancy, and have visited punishment on the offender. During the first months, when so many abortions occur, and toward the last of pregnancy, it is best for husband and wife to occupy separate beds."

In regard to the effects, Palmer also says that it is aggravated by unpalatable food, by sexual excitement, and by emotional excitement. Playfair, Churchill, Cazeaux and Tarnier, Baudelocque, Dewees and John Burns agree as to both abortion and vomiting. Lusk says that coitus often increases the sickness.

Garrigues (American Text-book, page 693): "When we take into consideration that at least the staphylococcus pyogenes abounds on human hands, it can hardly be doubted that it is found also on the skin of

the penis. Since women often have sexual intercourse up to the day of their confinement, there is no difficulty in supposing that they have, at the time of their confinement, such cocci in the vagina, and that, in a certain sense, they may infect themselves, not only with saprophytes, but also with pathogenic cocci.'

William E. Ground ("Times and Register." Philadelphia, 1896), in the Transactions of the Medical Society of the State of Wisconsin, criticises, among other things, the condition surrounding the women of the middle and lower classes. He states that the husband, as a factor in the production of puerperal sepsis, has not received. the consideration he deserves. Gonococcus has been talked of; when she is near the end of pregnancy, he comes home with a soft chancre and continues his septic and sexual relations with her. However dirty his occupation may be, he handles the penis in urinating, but never thinks of bathing before copulation. before copulation. Men sometimes have sexual relations with their wives within a week or two after confinement; the woman develops symptoms of puerperal fever, and the doctor is puzzled to explain the cause, and perhaps lays it to the breasts, or to catching cold, or to auto-infection. During lactation I find that Galen, quoted by Bouchut, says: "I order all women who are nursing children to abstain from sexual relations." Further, he says, "If mother begins to menstruate from the possibility of conception she should refrain from sexual intercourse."

Out of about two hundred journal articles and of 125 authorities examined, I found but little on the subject of the effect of coitus upon lactation. It is a subject fraught with great importance to-day, and I was surprised to find such a paucity of literature on the subject. I believe this matter will be forced upon our attention more and more every day until we make it our business to inquire into the disorders of infancy, and to know what the sexual relations of the nurse may be. Platner, quoted by Bouchut, says that "Certain it is that unsatified desires are worse and more harmful than a rare and moderate use."

Routh (Treatment of Defective Lactation) refers to great sympathy between breasts and genitalia, and states that proper functional use of the one will influence the other, and advises occasional reunion to

improve and excite the flow of milk. Hartman says that "Sexual intercourse may be allowed the mothers. in moderation." Trousseau remarks that "conjugal intercourse is not injurious to nurse or nursling, provided it is regulated by great moderation.”

Some four or five other authorities, consulted by me, counsel moderation in sexual intercourse between the husband and the nursing mother. Some go to the lower animals for the purpose of citing an analogy and quote the practice of some dealers in cattle, especially in milch cows and goats in the southern part of Europe, where it is customary to gently irritate the genitals of the female in order to stimulate the secretion of milk, and place the animals on the market in order that they may find ready purchasers.

Speaking of the uncertainty of effects, Vogel states that "Whether a coitus upon which no gestation follows is in itself injurious, I am unable to say, but it does not seem probable, however." Bouchut states. that "Nothing positive is known concerning the influence of coitus." He relates the case of a young woman whose child fell into violent convulsions each time she gave herself up to coitus. "But numerous examples, on the other hand, demonstrate that the influence is not always so injurious." Routh, in an article on galactorrhea, says that "There can be no doubt that irritation of the womb itself, or its immediate appendages, causes profuse secretion. Undue excitement has been known to produce a jet of milk from both breasts, which has only subsided with the cessation of the stimulus."

Busey of Washington, D. C., says that "Excessive sexual indulgence during the period of lactation seriously deteriorates the nutritive qualities of the milk. The unwholesome and and sometimes pernicious changes produced in the mother's milk are too well established by clinical observations, if not by chemical analysis, to be considered mere coincidences unworthy of the attention and careful scrutiny of the scientific physician. Woman is the highest type of the breeding female, yet she is the only one not exempt from the approach of the male by a natural periodic interval of aestus. It is a law of the physical economy that excessive indulgence of any animal passion, or the overwork of any func

tion or organ, is detrimental to the whole organism."

Among the legendary and ethnological examples, Engelmann furnishes the greatest number, and states that the negroes of Loango of Central Africa are a fair type of the black race. With them women are prohibited from sexual indulgence during lactation, which averages from twelve to fourteen months. Among the Northern tribes of Russia the mothers dwell apart for several months after confinement. On the slave coast, when women become mothers they are sent away for three years to nurse their infants and to prevent cohabitation. If the act should be accomplished, they believe the evil spirit takes away the milk and the child dies. In several of these cases the wife selects a substitute for her husband, and in Japan they are called or known as "by wives." Natives of Africa, Asia and many of our western territories are not only kept apart from husbands during confinement, but for weeks afterward. With them, as with Hebrews, there is the idea of uncleanliness, but by this isolation, rest and non-exposure, the women escape numerous uterine troubles. Arabs do not deprive themselves of sexual intercourse during the course of lactation. The prophet, however, without expressly forbidding this practice, lets it be understood that it must not be an injury to the nursling.

Dr. G. J. Witkowski, in "Curiosities of Breast and Lactation," says that "It is a law of nature that the woman who is nursing ought rarely to become pregnant. One can compare the uterus to the earth. As the lands which are not allowed to rest become exhausted and produce little, even so the women who are pregnant all the years without interruption, the uterus nourishes poorly its fruit." Jacobi (Transactions New York Obstetrical Society, 1876-78) states that "As early as 1758 a law was passed in France, according to which wet nurses had to inform employers of the occurrence of another conception. Not very rarely will the uterus not be able to resist the persistent mammary irritation kept up by nursing, and the fetus is expelled." Sometime ago Robertson remarked that one-half of the nursing working women of Manchester, England, conceived during lactation. Dr. Barnes ("London Lancet," 1852) has written an able paper on this subject, and has shown that in a given number of instances

abortion occurred in 17 per cent of cases in which the female became fecundated during lactation, and in only 10 per cent when impregnation occurred at other times.

In regard to idiocy and imbecility, Dr. C. K. Mills (American Text-book of Diseases of Children, page 673) writes, in speaking of etiology, of "Bad health in the mother and impressions made on her during pregnancy, the father's health or condition at the time of procreation." Sach (Nervous Diseases of Children, page 632) states that "The alcoholic habits of the father at the time of procreation are surely a potent factor of congenital idiocy." On page 683 he remarks that "Traumatism during pregnancy is another factor in the development of idiocy in the child. As the influences brought to bear are prenatal in origin, these cases may be included under the heading of hereditary idiocy, and there is all the more reason to do this, as such traumatic injuries are all the more likely to be harmful to the normal development of a child's brain in families with neurotic taint than in families whose histories are entirely negative." Taylor and Wells (Cerebral Palsies, page 516), in speaking of etiology, allude to trauma to the mother during gestation, and intimate that coitus is one of the causes of trauma. Psychic and emotional shocks, nervous and other strains, result in retardation of fetal brain development.

In the same line of inquiry, I wish to present a brief abstract of some tabulated observations selected from records because of the known environment of the nurse in her sexual relations. I shall not go into any great detail, as time does not permit. In 51 cases of digestive disturbance in sucklings in which the breast milk showed colestrum characteristics, with greater or less increase in proteids, 24 were relieved with no treatment other than the discontinuance of coition; 13 received slight medical treatment, as a mild laxative, or a few doses of calomel and soda, or a little lime water; 11 proved more intractable and required treatment from one to four weeks; one was put upon modified milk after three months' ineffectual efforts at nursing; one was changed to wet nurse after two months; one died in convulsions apparently as a direct result of excessive coitus after long abstinence. The milk analysis in these

cases showed a specific gravity of 1032, fat 2, and proteids 3.8.

These cases are selected because of the apparent marked causative relation of coitus to the disturbed equilibrium of the milk; not that other examples are wanting in which this etiological factor appears equally prominent. But in the cases presented I feel morally certain that sexual indulgence was discontinued, hence the conclusion as to its etiological relationship, and the time limit is too brief to attempt an exposition of the various tests applied to this case, not to mention the many cases rejected as unworthy of classification as to proof of this one cause of disturbed lactation. That menstruation is equally a cause of disturbance I fully believe, and that as such it is much easier of demonstration.

I trust that these few carefully selected cases may stimulate other investigations in larger clinical fields, with the hope for more exact knowledge upon this important but neglected subject-the modification of breast milk.

To Remove from the Hands the Odor Acquired in Making a Post-Mortem.— Every physician who has had occasion to make a post-mortem examination is familiar with the peculiar cadaveric odor which clings so tenaciously to the hands. Those also who have treated uterine cancer know the sickening odor of the vaginal discharges, and how impossible it is to wash it from the hands. In such cases, the hands should be washed thoroughly with warm water and soap, and then listerine applied full strength.

A movement is on foot, inaugurated by Dr. E. Fletcher Ingals, to organize a Chicago Laryngological and Climatological Association. This is a most commendable move in the right direction, and one which, under such indorsement and prestige as its eminent sponsors give it, cannot help but be a success from the start. New York, St. Louis and other cities of less importance have for some time maintained flourishing organizations of this character, and Chicago should have had. Whether or not it will become a section of the Chicago Medical Society remains to be determined when the organization is completed.

THE CHICAGO CLINICAL SCHOOL.

The following operations were performed in the West Side Hospital, during the month of December, the students in attendance at the Chicago Clinical School being present. Compiled by Senior Interne Dr. Bebb:

I Ovarian Cyst.

4 Bassini Operation.

2 Kocher Operation.

2 Intestinal Resection-Murphy Button. 6 Appendicitis.

2 Extra-uterine Pregnancy.

I Right Inguinal Colotomy.

I Left Inguinal Colotomy.

2 Oophorectomy and Salpingectomy.

2 Amputation of Cervix.

3 Trachelorrhaphy.

9 Tonsillotomy.

4 Exostoses.

2 Deflected Septum.

2 Mastoid Operation.
3 Perineorraphy.
2 Cholocystostomy.

I Perinephritic Abscess.

I Osteo-myelitis.

2 Enucleation of Eye.

12 Adenoid Operation.

3 Polypi.

I Hydrocele.

2 Varicocele.

3 Circumcision.

2 Tubercular Testicle.

2 Joint Injection.

I Amputation of Forearm.

I Reduction of Dislocated Elbow of Long Standing.

1 Fracture of Leg-Reduction.

I Wiring of Ununited Fracture of Arm. I Sarcoma of Ribs.

3 Excision of Inguinal Glands.

Anatomy and Operative Surgery on the Cadaver.

The Clinical School has, since its organization, ever evidenced not only a will-ingness, but a determination to furnish for its students the best and most numerous advantages, both general and special. Among the recent improvements and additions made is the establishment of a special course as above indicated. These courses are conducted under the personal direction of Professors F. R. Sherwood and W. T. Eckley. Special work on any line desired may be obtained, as eye, ear, nose and throat, gynecology, abdominal surgery, etc., etc.

The following course will cover the needs of most of those who may contemplate work of this kind:

a. Dissection by the student, under the personal direction of Prof. Eckley.

b. Operative surgery by the student, under the personal direction of Prof. Sherwood.

The course offers the following advantages:

a. Classes limited to four members. b. Each class has the exclusive use of two full subjects; one for dissection, the other for operative surgery.

c. Special attention is given to the regional dissection of surgical areas; dissections are made on one of the subjects one night, and, with the anatomy fresh in mind. operative surgery is done on the same surgical area on the other cadaver the next night.

d. The anatomical course includes the dissection of the entire body.

I. Head and neck.

2. Axillary space.

3. Joints.

4. Inguinal.

5. Femoral. 6. Thoracic.

7. Abdominal.

8. Pelvic regions.

e. The operative course will include: 1. Ligation of the important arteries in continuity.

2. Amputations, exarticulations and resections.

3. Trephining for cerebral localization; ligation of middle meningeal; mastoid operation; removal of Gasserian ganglion.

4. Operations upon the thorax, tracheotomy, etc.

5. Operations upon the abdomen and pelvis; special attention is given to the different operations for hernia, varicocele, hemorrhoids, intestinal anastomosis, appendicitis, gastro-enterostomy, supra

pubic cystotomy, etc.

6. Gynecological and genito-urinary operations.

7. Aside from the above any operation that may be desired by the class will be demonstrated.

This course being given entirely in the evening, it does not in any way conflict with the other work of the class in the general course. It takes up four full evenings of each week; can be taken up at any time and finished in thirty days.

THE MEDICAL LIBRARY.

How to Examine for Life Insurance. By John M. Keating, M. D., Fellow of the College of Physicians and Surgeons of Philadelphia; Vice-President of the American Pædiatric Society; ex-President of the Association of Life Insurance Medical Directors. Royal 8vo, 211 pages, with two large half-tone illustrations, and a plate prepared by Dr. McClellan from special dissections; also numerous cuts to elucidate the text. Price, in cloth, $2.00 net.

The subject of life insurance has become of such general importance to almost every practitioner that anyone who attempts to serve any company in the capacity of examiner will welcome the appearance of this new edition of this excellent work by the late Dr. Keating. It is not to be presumed that the possession or perusal of the volume will make a painstaking and honest examiner out of a careless and unreliable one, but it will be a most effectual assistant to that one who has his own and his employer's interest in mind while making the examination.

Since it is the doubtful and abstruse points in the examination which will embarrass the medical director, it behooves the examiner to be prepared to clear up any such as may appear in the applicant before completing his report to the director. This work is so comprehensive and at the same time so complete in its intention, and is written in such a practical style as to quite captivate the reader by its interest.

A very fair idea of its scope may be gained by noting the various chapter heads, which are as follows: Special Duties of an Examiner; The Examination of the Applicant; Habits; Pulse; Height and Weight; Examination of the Heart; Chest and Lungs; Incipient Phthisis; Abdomen, Liver and Bowels; Examination of the Kidneys; Nervous System; Women.

To this is added in part eleven copies of the instructions which are issued to their examiners by twenty-five of the leading companies of this country. Thus the whole will give to anyone a very perfect and complete understanding of what is desired by the medical directors of all the prominent companies. The chapter on examination of the urine is itself worth the price of the book, if one intends to do even a limited

amount of this branch of practice; to others it is invaluable.

A Text-Book of Mechano-Therapy.

By Axel V. Grafstrom, M. D., late house physician Blackwell's Island. Especially prepared for the use of medical students and trained nurses; 139 pages, with eleven pen and ink sketches by the author. Published by W. B. Saunders, 925 Walnut street, Philadelphia. Price, $1.00 net.

The author's aim in the volume seems to be the production of an authority on the subject in the fewest possible pages. In this he has succeeded, so far as brevity is concerned, but we fear the real value of the book is thereby somewhat impaired; as, for instance, in the chapter on chronic constipation there is four pages of discussion; that on the use of mechanico-therapy in the treatment of nervous diseases we find reduced to three pages.

Some of the other subjects discussed are as follows: Medical Gymnastics; Massage; Diseases of the Respiratory Organs; Mechanico-therapy in Gout and Rheumatism; Obstetrics, and Diseases of Children.

It is an exposition of the principles of the so-called Swedish system of gymnastics, with such modifications as were deemed best by prominent teachers and authorities of the science in this country and abroad.

Fractures of the Elbow Joint.

I. All fractures of the lower end of the humerous, once in position, are held in place if the forearm is kept acutely flexed. 2. Such flexion can be used without danger to the limb or undue distress to the patient. 3. The only force required being one of flexion, no rigid apparatus is needed, it being sufficient to strap the forearm to the arm. One of the strong points of this treatment, therefore, is its perfect simplicity. 4. The points to emphasize are: Be sure to replace fragments as flexion is made, taking great care that the internal condyle is as low as possible and the joint not widened by effusion between fragments. If the condyle is kept down no gunstock deformity can occur. 5. In cases thus far treated the amount of motion gained has been slightly greater than after ordinary methods. The amount of deformity has been very much less. Med. Review.