should produce two kinds of secretions, one an internal, that should prove so toxic to the mother and to guinea pigs and not to the nursing infant, another, an external secretion for the nourishment of the young. In following out in my mind the various phenomena of pregnancy, it was forced on the writer that there must be some reason why the mammary glands should begin to develop at the very beginning of pregnancy, and to continue developing gradually until parturition. Then in one or two days after parturition enlarges considerably more. If it were the purpose of nature to simply develop these glands to secrete milk after the birth of the baby, why is not the development complete at the time of birth? The only reasonable explanation is that the function of the mammary gland is to furnish an internal secretion for the nourishment of the foetus, the increase in size of the foetus demanding a corresponding increase in size and output of the gland.

"Miss Lane Claypon and Starling found that injections of aqueous extracts of rabbit foetuses into a virgin rabbit, every one to three days over a period of three weeks, led the glands which were at first almost invisible, to become markedly hypertrophied, with enlargements of the ducts and to the discharge of a thin fluid, and in multiparous rabbits to the discharge of true milk.'

After parturition this internal secretion becomes an external secretion to which is added the butterfat, carbohydrates, water, etc., accompanied with an increase in size and output of the gland after the second or third day. It is a well known fact that in the opossum and kangaroo owing to the smallness of the maternal pelvic orifice, the young are born much less mature than the young of other animals, yet when they attach themselves to the nipples of the mammary glands in the pouch of the mother, they are nourished to maturity. The nature of the nourishment received from the mammary glands must be very similar to the nourishment received in utero. It has never seemed reasonable to the writer that the digestive organs of the infant could possibly be sufficiently developed at birth to begin functioning from the first day, and be able to sustain the life of the infant.

There must be some part of the secretion of the gland that does not need digesting, need digesting, similar to the nourishment received in utero. The slight loss in weight of the infant for the first week may be due to the fact that while in utero the nourishment went directly into the blood of the foetus without loss, but after birth it passes through the alimentary canal where waste occurs, which is only overcome when the digestive organs begin to digest the

fats, carbohydrates, etc., in the added secretion of the mammary gland.

Now what is the nature of this secretion? When health departments first began the examination of the sediments of milk, they found in some cases large numbers of so-called pus cells. These milks were accordingly condemned as unfit for use, the excessive number of leucocytes being attributed to a local inflammation of the udder or mammitis.

Boston went so far as to establish a standard of 500,000 leucocytes per cubic centimeter, above which milk was condemned. About four years ago. Dr. Vernon Robins reported the milk from 55 herds as having an excessive number of leucocytes. Examinations nade of the herds, and in only one herd was mammitis found to exist. Hastings and Hoffman of the University of Wisconsin found leucocytes in every cow's milk in the herd examined. They found no existing cases of acute mammitis, but stated that from the history of the herd there may have been associated in a considerable number of cases a previous slight inflammatory disturbance. They concluded that milk from these cows should not be condemned as injurious.

Cary in a paper before the A. V. M. Association claimed that boric acid solution injected into the udder produced a milk free from bacteria and leucocytes. Hoffman proved that injections of solutions of boric acid, normal salt, and sterile water decreased the bacteria but increased the leucocytes. He explained the decrease of the bacteria to the action of the leucocytes and the increase of the leucocytes to the mechanical irritation of the udder.. All the investigators have heretofore believed the leucocytes to be present in milk as the result of a present or past mammitis, irritation of the udder, or to be attracted there by the presence of batceria.

Reviewing the work of these investigators and remembering our own findings, it did not seem reasonable that there should be such a waste of leucocytes just because of an old mammitis or other cause, equally as unreasonable.

It appeared to the writer that the leucocyte must be a normal constituent of milk, and that it had a definite physiological function to perform, that the vital portion of milk referred to . by chemists as vitamines, was due to the presence of these leucocytes.

It was shown by the Department of Agriculture in 1909 that milk had agglutinating power over bacteria similar to blood in typhoid agglutination. This power with the occurrence of the leucocytes and the fact it was intended for the nourishment of the young, led the writer to believe that this was the explanation of the nature of the internal secre

tion, and also why mother's milk gave infants greater vitality and immunity from contag ious diseases than did condensed milk or other prepared foods having practically the same chemical constituency.

Mr. F. W. Kurk, my laboratory associate, and I, carried out the following lines of investigations: One hundred and forty-nine samples of breast milk, colostrum, goat milk, dog milk and asses milk have been analyzed and a leucocyte count made. The method used in counting leucocytes, differed slightly from the Buckley and Doane method and was as follows. We centrifiuged 10 c.c. of milk for 10 minutes, finding that fewer leucocytes were held by the butterfat when centrifuged at such low rate of speed. After centrifuging, the top portion was siphoned off, all except about 2 c.c. The butterfat was removed from the tube with a cotton swab. Then Loeffler's alkaline methylene blue was added to stain the cells and water to make 10

c.c. This was thoroughly mixed and a drop placed on a Thoma-Zeiss counting plate, allowed time to settle and counted. The counts were estimated per cubic centimeter instead of per cubic millimeter, as is the case with blood counts.

In colostrum having large number of leucocytes, dilutions of 1-5 or 1-10 were made before centrifuging.

The results of these counts showed that in all colostrums examined within 24 hours after birth the leucocytes numbered from 3,120,000 to 5,560,000 except two, one of which ran 45,000,000 and another where a severe postpartum hemorrhage occurred, ran only 62,000,

Breast milks after the first two weeks showed a leucocyte content ranging from 212,000 to 483,000 per c.c. A few cases after five or six months lactation showed only from 50,000 to 70,000 per c.c., and artificial feeding had already been resorted to, to aid the supply of nourishment to the infant.

Bitch milk early in lactation showed 780,000 leucocytes per c.c. Goats milk in one case late in lactation 62,400, in another case, period of lactation unknown 140,400; asses milk late in lactation showed 78,000 per c.c. Two typical interesting cases in women where counts were made daily showed leucocyte contents as follows:

Case No. 1, was normal in every way, but in case No. 2, the baby died at birth and no attempt was made to establish secretion. In both cases the number of leucocytes increased on the second day, decreasing on the third and fourth day, due to the beginning secretion of milk on the third day and the consequent dilution due to increase in fluid. No. 1 decreased considerably by the sixth day as full secretion of milk was established by that time. Case No. 2 had its heaviest secretion on the fourth day and only a few cubic centimeters a day from the sixth day until the patient left. the hospital. All other cases examined have run a similar course to No. 1, where the baby nursed, and to No. 2 where the baby died and secretion was not encouraged. The results of these examinations of milk proved conclusively that there existed in milk as a normal constituent thereof in considerable numbers, mononuclear and polymorphonuclear leucocytes.

VITALITY OF MILK.

It has long been known that heating milk to 80 degrees or 85 centigrade, destroys its digestibility and otherwise changes its nature. It has been explained that, heating destroys the enzymes, known as peroxidase, galactase, and lipase found in milk. The tests to differentiate raw milk from heated milk as used by Leach, Storch, Kastle and Porch, and other authorities are based on the fact that peroxidase is present in raw milk but absent in heated milk.

Kurk and I found that the addition of centrifuged leucocytes to milk that had been heated to 90 C. gave the peroxidase reaction after incubating two hours, but to less degree than raw milk.

We also found, however, that a stronger reaction occurred when the leucocytes used were from milk freshly drawn from the cow instead of several hours old. The test used was the one recommended by Leach, known as Storch's test and consisted of the addition of 2 drops of hydrogen peroxide and two drops of a two per cent solution of paraphenelenediamine, to about 10 e.c. of milk. The tests made were as follows:

No. 1, raw, whole milk; No. 2, raw milk with leucocytes removed by centrifuging; No. 3, heated milk; No. 4, heated milk plus leucocy

tes; No. 5, heated milk plus leucocytes from urine of a pregnant woman.

No. 1, became blue promptly, after 24 hours turned pink, and coagulated.

No. 2, became blue promptly, did not turn pink, and did not coagulate.

No. 3, did not turn blue until after 24 hours, did not turn pink or coagulate.

No. 4, became blue, slowly, after 24 hours became pink, and coagulated.

No. 5, became blue slowly, after 24 hours became pink and coagulated.

The results in these tests show that the leucocyte has the power to regenerate the peroxidase reaction in heated milk, and led us to conclude that the peroxidase reaction was due in both raw and heated milk plus leucocytes, to the activities of the leucocytes. The secondary reaction and the coagulation of all milk except the centrifuged and heated milk, are further proof of the activity of the leucocyte. The leucocyte from milk and from urine of a pregnant woman gave the same reactions. The failure of the heated milk and the milk without leucocytes to coagulate, shows that the leucocyte plays a part in the coagulation of milk, and that it is a similar process to the coagulation of blood.

A series of tests was made similar to the above without the addition of hydrogen peroxide, which prevents the growth of bacteria. The results showed that the milks to which leucocytes from milk and urine had been added, coagulated in about one-half the time it. took the raw and centrifuged milk to coagulate, proving conclusively that the leucocyte is active and plays a part in the coagulation.

The non-coagulation of the milk in two and three of the first series was due to the absence of leucocytes, or to the killing of the leucocytes by heating and to the prevention of bacterial action by the hydrogen peroxide. In the second series bacterial action was not hindered and coagulation occurred, but 24 hours later in the centrifuged and heated milk than it occurred in the milk to which leucocytes were added.

Tschernowzski found peroxidase in leucocytes. It also has been found in the mammary gland and according to Hilderbrandt occurs to much greater extent in the active gland as compared with the inactive one. In view of our findings, together with those of other observers, it would appear that the active principle of milk, that which is destroyed by heat, is the leucocyte and that the so-called enzymes, such as peroxidase, etc., are very probably byproducts resulting from the leucocyte activity.

Microscopical findings in examination of from 450 to 500 specimens of urine from

pregnant women showed leucocytes in practically every case. Nearly every case of pregnancy showed a large number of leucocytes in the last few weeks, some showing as high as 12 to 14 per field in a drop of unsedimented urine using a 1-6 objective. Every case of albuminuria of pregnancy not complicated with a previous nephritis, contained large quantities of leucocytes and no casts at first. Casts appeared later in some cases. One case a patient of Dr. Tuley's, Mrs. A., showed one gram per liter of albumin in a catheterized specimen with a heavy sediment of leucocytes. Blood count showed 12,812 white cells. There were some slight secretion from the mammary gland. A breast pump was used three times a day until delivery three weeks later. The colostrum thus secured showed 3,774,000 leucocytes per c.c. Two days after this treatment was instituted, albumin disappeared from the urine and did not appear again. A blood count four days after beginning treatment showed 11,250 leucocytes.

Another case, patient of Dr. Leo Bloch's, with this history furnished by Dr. Bloch, had eclamptic convulsions, with four per cent albuminuria, gave birth to a dead macerated child. Elimination was practiced together with the withdrawal of one pint of blood and the injection of normal saline.

With Dr. Bloch I saw her 12 days later. Patient was able to be about, but complained of dizziness. Albumin in urine, .7 grams per liter, with large amount of leucocytes in sediment. Blood count 12,600. No secretion of mammary gland had been noticed. A breast pump was used every two hours and the secretion thus collected showed 936,000 leucocytes per c.c. Urine on the next day showed .6 grams of albumin per liter; third day, .3 grams; 4th day, .5 grams, no treatment for 24 hours previous; fifth day, .3 grams; sixth day, trace; seventh day .5 grams, no treatment for 24 hours previous.

Treatment was not carried out on third day giving rise to an increase of albumin on the morning of the fourth. Patient refused treatment after the sixth day. This case showed very plainly the influence of elimination through the mammary glands on the amount of albumin in the urine.

In three other cases in which this treatment bad been used the albumin disappeared. In another showing 1.5 grams albumin, albumin decreased to 4 grams in four days, but remained about that point to present time, a period of two weeks. This patient had albuminuria of 1.5 grams for six weeks before beginning treatment, history prior to that unknown. The urine now shows few leucocytes, but a good many casts and it is very evident, there is a true kidney lesion present. In four

teen cases of pregnancy about full term the blood count showed a leucocytoses with an increase of lymphocytes.

Kirke's and Howell's Physiologies state that the leucocyte count of blood is increased in pregnancy after the third month, and is most marked in the latter stages, coming back to normal a fortnight after parturition, attributing it probably to the general stimulation of the maternal organism. To determine whether or not these leucocytes had any connection with the nourishment of the foetus, Kurk and I made examinations in a number of cases of the leucocytes in the blood from the cord of the infant, the finger of the mother and the colostrum and could find no microscopical difference in size or appearance. We took a human placenta, washed it for several hours thoroughly in salt solution and then in .3 per cent acetic acid. Normal saline was then filtered through it until no leucocytes could be found in the centrifuged filtrate. Then a solution containing leucocytes from cows milk was filtered through, obtaining leucocytes in large number in the filtrate. There is an objection to this test in that we cannot be sure no small blood vessel was ruptured in the washing process. That the leucocyte pass through the placental membrane and carry proteid material to the foetus, there is no doubt in the mind of the writer whatever. The foetus obtains proteids from some source. They are not dializable and can only pass through animal membrane by being car ried by a cell having amoeboid movement. That the leucocyte passes through adult tissue is easily demonstrated and it does not seem possible to prevent its passage through the embryonic tissue of the placenta.

Oxidases were found in the placenta by Etti and Preyer; and since they occur in the mammary gland, in milk, and in the leucocytes found in these organs as shown above, it is safe to conclude that leucocytes do pass through the placenta. The similarity of the nature of the nourishment of uterine and extra uterine life is thus explained. In view of these findings, the findings of Hoffman, that injection of boric acid, sterile water and normal saline increased the leucocytes; and the history of the development of the treatment of milk-fever, by the use first, of injections of a solution of iodide of potash to disinfeet the udder, later injections of boric acid solution, then oxygen, and finally plain air, it was thought possible the explanation of the cure of milk-fever was due to the establishment of the secretion of leucocytes. Accord

ingly a cow was selected and leucocyte counts made of samples from two quarters, night and morning for six days. On the sixth day these quarters were injected with air and counts

The highest count before injection in the front quarter was 94,000, and in the back quarter 286,000. The highest count after injection in the front quarter was 5,937,000, 24 hours after injection and in the back quarter 12,750,000, 24 hours after injection. After injection the count ran very much the same course as it does in the beginning secretion after birth.

From these experiments it was concluded that milk-fever is a toxemia arising from the accumulation of the leucocytes in the body due to the suppression of the secretion of the mammary glands and that air pumped into

the mammary gland relieved this suppression and thereby affected a cure. Now since our experiments have shown that the secretion of leucocytes in the human to be similar to that in the cow and since albuminuria of pregnancy can be relieved by elimination through the mammary gland it is not unreasonable to conclude that milk-fever and eclampsia are the same thing and should be relieved by the same treatment.

Through the kindness of Dr. Tuley and Dr. Schacklett, I had occasion to try this treatment on a case of post-partum eclampsia on November 1st. The patient was delivered of a live child at 10 p. m., on October 31st, by Dr. Shacklett. She had a convulsion and became unconscious at 11 p. m., never regain ing consciousness. Dr. Tuley saw her in consultation on November 1st, and had her removed to Norton Infirmary where I first saw her November 1st, at 4:30 p. m. Patient was cyanotic with oedema of lungs, Cheyne Stokes' respiration and having convulsions every ten or fifteen minutes lasting from one to two minutes, albumin in urine 15 grams per liter, with leucocytes and casts, blood count 14,910 white blood cells. There was no secretion from

the mammary gland which felt hard and contracted. An effort was made to start secretion with a breast pump and by massage without success. Air was pumped into the glands at 6:30 p. m., using this instrument, consisting of a hand-pump connected by tubing to a cylinder containing sterile gauze to filter the air through. This cylinder was connected by tubing to a blunt needle about the size of a

No. 21 hypodermic needle with openings on side.

The needle was introduced into the opening of the lacteal duct in the nipple of the gland. At 7:30 p. m., she had had two more convulsions and all the air had escaped from the glands. Air was again pumped into the glands, inflating them much more than at first.

A gauge bandage was tied around the nipple and adhesive placed over the openings. The patient relaxed and had no more convulsions, never became conscious however, and died at 10 a. m. on the third of Novemher from oedema of the lungs. Had this patient received this at first instead of 20 hours after the onset of the convulsions, there is no doubt in the mind of the writer the result would have ben different. It has been found in cows that 99 per cent of cases get well where treatment is given in time. Delayed treatment does no good. The cessation of convulsions in this case showed that the further accumulation of toxines had evidently ceased.

Case No. 2. At the City Hospital. Pauline Bell, age 17 years, primipara, on November 25th. Vomited all morning; blood pressure 170, blood count 14,700, albumin in urine 10 grams per liter with a heavy sediment of leucocytes, no casts, Wassermann positive plus four. Patient was delivered of an eight months living child at 9:30 p. m. Blood pressure began to fall at 8:30 reaching 130 at 6 a. m. November 26th. There was no secretion from the mammary glands and none could be secured by use of the Breast pump. Hot baths, calomel and magnesium sulphate were given. Patient put on buttermilk diet. Blood pressure reached 150 on 26th, and 174 on 27th, remaining near that point until November 29th, the fifth day after delivery. Blood count on 27th, 15,200 leucocytes. No secretions of the breasts could be secured by breast pump to this date. Glands were inflated but not quite to full capacity on 29th. Blood count 14.200 leucocytes. Free secretion of colostrum showing 3,496,000 leucocytes per e.c. and 2,106,000 colostrum corpuscles were present six hours later. Blood pressure had fallen to 136, remaining at this point for 24 hours and then falling to 120. Blood count on December 2nd, showed 9,000 leucocytes. Breasts were pumped out regularly until December 3rd, when baby was allowed to nurse, the milk flow being sufficient to nourish it. The following is a chart of the blood pressure and also showing the kind, and the time of treatment given, prepared for me by Dr. Beeler.