lowing cleansing with soap and water, immersion in 1-5000 bichloride solution and the use of rubber gloves. He states that the examinations were negative and that very few instances of infection occurred in the whole series. I quote some of his conclusions:

(1) That washing of the hands and arms should not be too violent, and that the use of a scrub brush should be confined to the hands. (2) The arms should be washed by rubbing with gauze or a towel. (3) The use of the nail cleaner about the base of the nails was unnecessary. (4) Alcohol was not adequate as a germicide, when used upon the hands. (5) That a solution of 1-5000 bichloride of mercury, used after washing, to disinfect the hands and arms, and then used in the rubber gloves, was thoroughly satisfactory in protecting against the development of bacteria within the gloves during operation. (6) That the rubber glove was a guarantee of safety, not only to the patient, but to the operator himself, when operating upon infected wounds. (7) That the mask over the face was not necessary.

In the last few years there have been quite a number of articles in the journals advocating coverings of the hands with various kinds of varnish as a substitute of the rubber glove. These have not proven practical.

The suggestion of Allen's that the skin of hands and arms should not be harshly treated is a good one, and applies as well to the wound area. An occasional operator may use the scrub brush vigorously to advantage, but its daily use will soon put the skin. in a state of irritation and roughness that almost precludes sterilization. The smoother and more pliable the skin can be kept, the easier it is made clean and kept clean. The nails should be carefully manicured and care taken that the attachment of the skin and nails is not disturbed too much. Examine the nails of nurses in the operating room, where they are constantly using the nail file and you will note in many of them a retraction of the attached surface that is way beyond normal. The numerous antiseptic washes advocated and used so extensively are referred to only to be condemned. I might mention permanganate of potash to be followed by oxalic acid to remove the stain, or the Harrington solution, consisting of a 1-5000 solution of bichloride of mercury and alcohol, or sulphate of soda and chloride of lime or turpentine. Others might be mentioned, but none to be recommended.

Senn, in a recent article, extols the antiseptic and germicidal properties of iodine very highly, and suggests as a prevention against infection, the finger tips may be dipped in tincture of iodine.

After a careful study of the different methods of sterilization of hands and wound area I have come to the conclusion that a strict aseptic method is the only one upon which the surgeon can depend primarily, followed by the use of chemical agents for their inhibitory action. This method consists in thoroughly washing in pure soap and sterile water, treating the nails, rinsing the surface with clean water to remove the soap, then the hands and arms may be submerged in a 1-3000 bichloride solution or a 1% carbolic acid solution. The management of the wound area is along the same lines.

The principle governing the use of antiseptics obtain everywhere, whether in the operating room of a modern hospital or in general practice. All that is necessary is to remember that chemical agents, like heat, if used to germicidal strength will destroy living tissues; if used in the presence of oil, blood and general debris, ordinary cleanliness cannot be obtained, let alone inhibition or destruction of bacteria. Then of what use are antiseptics? In solutions that are not injurious to the tissues they are protective alone. They inhibit the growth of bacteria that may be present and protect from further invasion. In my judgment much harm arises from the indiscriminate use of antiseptics about the body. How often do we meet with the local effects of carbolic acid and mercury? How often do we meet with the constructional effect of these and other powerful antiseptics used to wash out natural cavities, such as the bladder, vagina, endometrium, rectum, mouth, ctc., and the same may be said of artificial cavities.

CONCLUSIONS.

(1) Aseptic methods, whether in special or general practice, are the only practical ones for sterilizing living tissues.

(2) Antiseptics should be used alone for the purpose of inhibiting the growth of bacteria and protecting from invasion from without.

(3) Owing to a chemical action of antiseptic agents with oil, blood or general debris ordinary cleanliness cannot be obtained with these agents alone.

THE PREDISPOSING AND ACQUIRED CHARACTERISTICS OF THE ALCOHOL AND DRUG HABITUE.*

BY C. D. MILLS, M. D.,

Superintendent Marysville Sanatorium, Marysville, Ohio.

Our subject limits us to the personality of the habit former, and yet it will not be a serious digression if we incidentally refer to some of the environmental influences that are constantly operating upon susceptible individuals.

That the laity should manifest a seeming and probably a real indifference about this subject is not so amazing as is the attitude of the medical profession toward a malady more serious than pneumonia, tuberculosis or any other of the fatal infections. The average physician and the average layman, strange to say, think very much alike about the drunkard, considering him a willful and vicious violator of civic, physical and moral law who deserves contempt and prompt and severe punishment. The readiness with which they answer the question as to why some men are abstainers, some men moderate drinkers and others excessive drinkers, to be simply a matter of will power, is in inverse proportion to their knowledge of a very intricate and difficult problem.

Fermented drinks have been used from as remote a period as five thousand B. C., while the pleasurable sensations of wine drinking were discovered thus early, and its evil consequences were soon determined and restraining measures by moral suasion and punishment were early instituted.

Heroditus tells of the feasts in honor of Diana, where more wine was consumed than in all the rest of the earth. When he visited Egypt in four hundred and fifty-four B. C., he relates that at their conventional banquets among the wealthy classes when they had finished supper a man carried around in a coffin the image of a dead body, carved in wood, and showing this to each of the company he said, "look upon this, then drink and enjoy yourselves, for when dead you will be like this."

In Sir J. Gardener Wilkenson's Popular Accounts of the Ancient Egyptians is figured women at a feast drunk and vomit

* Read before the Tenth District Medical Association, October 5, 1905.

ing. These are copied from Theban tombs, 1500 to 1000 years B. C. Without going into further detail, on nearly every page of history is the story of drunkenness and the record of innumerable ineffectual efforts to arrest it. A special research committee, appointed by the English Society for the Study of Inebriety, made the following report in April, 1901:

1. The genesis of inebriety in the individual depends on three essential factors, of which one is inborn and the others acquired.

2. The inborn factor is a capacity for enjoying the sensations evoked by indulgence in alcohol, without it men would not drink for they would not enjoy drinking.

3. The acquired factors are a personal experience of the sensations evoked by alcohol; without this acquired knowledge, this memory, no man would crave for the sensations in the sense the inebriate craves and the increased delight in drink which continued indulgence in drink confers.

4. The inborn capacity for enjoying alcohol like other inborn traits is certainly heritable.

Now let us briefly consider the inborn factor. Patton, in his recent work on psychiatry, defines the addiction as a symptom of a functionally unstable nervous system; keeping in mind this definition and conforming ourselves to the personal equasion, I insist that contrary to the generally accepted view, drinking is not a question of morals, only so far as the first indulgences are a violation of the code of ethics of many people. How unreasonable that anyone should maliciously and with malice aforethought do the thing that he knows is bringing to himself irrevokable ruin. The so-called immoralities are the certain sequences of chronic alcoholism and are the symptoms of functional and structional changes due to the toxic effects of a poison upon the nerve centres. Craving for alcohol has nothing to do with strength and vigor of character; neither has education anything to do with appetite. No degree of ecclesiasticism or erudition can change a pleasant sensation into an unpleasant one. Either may create an abhorrence for alcoholic excess, but neither can alter a nervous organization that responds with emotions of delight to an alcoholic indulgence. We cannot substitute a delight in Shakespeare or Paderewski for a craving for alcohol.

You recall Lydston's illustration in his Diseases of Society, where he says "that certain moralists claim that inasmuch as the inebriate willfully took his first drink, the question is of moral significance only. This is as logical as that typhoid is to be cured by moral suasion because the victim voluntarily drank water containing the germs of disease.".

Noah is represented as being righteous before the Lord, and yet we read of his becoming so thoroughly intoxicated that he lost all sense of modesty and was found going about his tent without any clothing.

We are told that Lot was permitted to leave the wicked cities of Sodom and Gomorrah on account of his righteousness, and yet he became so beastly drunk that he did not recognize his own daughter, and while in this condition both the daughters of Lot became with child by their father.

We read with abhorrence and just indignation of the atrocities of the Moslems and yet in obedience to the teachings of the Koren, one hundred and eighty millions of Mohammedans have been abstainers for thirteen hundred years.

This inborn susceptibility may remain latent for many years and even through the entire life, particularly in women, who, although possessing an unstable nervous organization, have also an innate spirit of idealism, and further they are more securely entrenched behind the protecting influences of home than their exposed brothers. This statement with reference to women needs particular emphasis, as the frequency with which we are confronted with homes where the boys are dissipated and the girls total abstainers is urged as an argument against the hereditary tendency to alcoholism.

Referring again to the question of latency I have had many patients who had remained abstainers until they were twenty or thirty years of age tell me that their first drink had brought to them a sense of repose and well being entirely new in their experience. There had come into their lives a temporary restfulness to their unstable nervous systems so that they were willing to take chances on subsequent disaster in order to renew again. and again their first experience.

Within the past six months a very intelligent man of thirty was brought to us for treatment who, after he was perfectly sober, gave this history: He had a decidedly neurotic temperament.