There are observations on record which indicate that the secretion of milk may be influenced by a contemporaneous diuresis. Precisely what changes in the composition of the milk may be initiated in this way had not been determined until recently, when the question of the influence of specific diuretics on milk flow was investigated by Steenbock at the University of Wisconsin. He remarks that in view of the importance which heretofore unknown constituents of diets and rations have lately assumed, it is of the greatest interest to dissect the various factors normally operative in the body under ordinary conditions of diet. Steenbock found that urea, for example, administered in a diuretic dose, is able to decrease temporarily the flow of milk. On repeated administration, however, the increased intake of water which follows the impoverishment of the tissues with respect to water content balances the draft for water imposed by the diuretic, and the milk secretion comes back to normal. Other diuretic salts, like sodium chloride, may be entirely unable to depress the milk secretion under normal circumstances, because they call forth a compensating thirst which simultaneously increases the water intake. In cases in which diuresis does lead to temporarily decreased flow of milk, the percentage of solids in the secretion is ordinarily increased, the fat being the principal variable. In ordinary experience, however, the composition of the milk may be regarded asessentially unaltered by slight variations in renal activity.—The Journal of the American Med. Asso.
Dr. Ross McPherson (Provid. Med. Jour.) summarizes his views in the following conclusions: First. Cesarean section is a very useful operation for removing the child from a pregnant woman at or near term in cases: (a) where there is a relative disproportion between the birth canal and the fetus, sufficiently large to make the birth difficult or impossible; (b) in cases of serious obstruction due to tumors, or deformities congential or acquired; (c) a certain number of cases of placenta previa, convulsive toxemia, or occasionally organic disease. Second. The operation should not be decided upon except by a person whose training and experience in pelvic and abdominal examination is sufficiently large to warrant the acceptance of his judgment. Third. The operation should not be performed by anyone unless he be a skillful abdominal surgeon, preferably one who has given particular thought and attention to this subject. Fourth. A long labor, much handling and manipulation, especially in the presence of ruptured membranes, predispose the patient to infection of the peritoneal cavity, and fifth, therefore, intraperitoneal abdominal Cesarean section should not be undertaken under those conditions, with one exception, namely when the religious prejudices of the family demand the saving of the child at the expense of the mother, and then only in the presence of and with the advice of a consultant and a clergyman, after carefully explaining the situation to the family and obtaining their written consent to the procedure. Sixth. If the above demands and conditions are fulfilled the maternal mortality should be practically nothing, the morbidity negligible, the end result perfect, and with the exception of those cases undertaken solely in the interest of the mother, every child should be born alive.—Medical Progress.
Treatment of Ophthalmia Neonatorum.
G. A. Neuffer, in theJournal of the South Carolina Medical Associationfor February, 1915, states that he has met with universal success in this condition by means of the following treatment: A sixty-grain (4 gram) to the ounce (30 c.c.) solution of silver nitrate is at once applied to the conjunctiva and immediately precipitated with a solution of sodium chloride made by dissolving one teaspoonful of the salt in a glassful of water. This application is repeated once every twenty-four hours, until one is satisfied that the disease has been controlled. Only in extreme cases are more than two applications necessary, and often one proves sufficient. In addition, an ounce (30 grams) of boric acid is ordered dissolved in a quart (litre) of hot water and the solution kept constantly warm. With this the nurse or mother is instructed to wash out the eyes as often as any pus collects, even if this is required a hundred times a day. One drop of a one per cent solution of an organic silver preparation is dropped into each eye three times a day as long as there is any pus; after this an astringent lotion is substituted. The author also has squares of lint kept on a block of ice and applied constantly, with frequent renewals, for forty minutes in each hour. The treatment described should be applied both day and night until the condition has been mastered.—New York Medical Journal.