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in addition to these Horlick's Malted Milk, Bovinine or the various extracts of meat.

We have however, usually depended on milk administered as hot as the patient can sip it, and given as often as once in three or four hours, both day and night. Frequently patients will tell you that milk disagrees with them, which is sometimes true, and it will usually suffice to tell them that heated milk is different in its effects from that which has not been heated, and in that manner get them to begin the use of it. Others will protest that they cannot use milk but can take cream with impunity. We then give hot

water and cream instead. If the stomach persistently reject milk, we administer one of the above mentioned prepared foods instead. Hot toast water may be well borne in this condition of the stomach. At all events we must not lose sight of the fact that the system is being subjected to a great waste through the violence of the disease, and this improvement must be counteracted and impending bankruptcy to the vital forces averted by the constant and regular administration of proper alimentation. By pursuing this course in relation to the proper nourishment of the sick our patient's strength will not be so greatly reduced and our fatalities brought down to the minimum.

OBSTETRIC ASEPSIS AND ANTISEPSIS.*

BY WM. C. RICHARDSON, M. D.

RECENTLY, that is, within the

past year or so, there seems to have set in a sort of reaction in the matter of obstetrical antisepsis and asepsis, which was quite the rage up to that time. It has in fact been found that, like Listerism, it has its limitations and it is possible that many of the measures used are of questionable value, some of positively injurious character and others of so little value that it is not worth while to resort to them.

The mortality which prevailed under the old methods of carelessness in obstetrical practice, was deplorable; and it was high time that the profession should have something to arouse them to a realization of the dangers incident to the lack of cleanliness; and the anti-septic craze, which swept

*Read before the Missouri Institute of Homœopathy.

over the country accomplished that purpose quite thoroughly.

On the other hand, when it was carried to the extent of using dangerous chemicals and, as one author has recommended, of using a toothbrush to scrub out the vagina, it had grown to an extent that was utterly ridiculous and dangerous.

Grandin and Jarman in their recent work on obstetric surgery, have this to say: "Anti-sepsis is simply the means of certifying to asepsis (cleanliness.) The whole question has been needlessly complicated by the introduction of scores of chemical agents which possess, to a greater or less degree, the power of rendering inert, the micro-organisms which exist in, or may be conveyed to, the human body."

"It is possible to secure asepsis without resorting to antisepsis, but

in order to surround surgery with every possible safe-guard, these chemical agents must be looked upon as absolutely essential. The point to be remembered in obstetric surgery is, that too free indulgence in antisepsis may do harm, even while it aims at good. The nature of many of the antiseptic agents, on which we must needs rely, is poisonous to the human body. Therefore the corollary must be borne in mind, that overzealousness in matters of antisepsis may injure and kill, even as lack of asepsis may be followed by similar effects."

This quotation conveys an idea of all that is desired in the matter of obstetrical asepsis and antisepsis. In other words, it emphasizes the necessity of absolute and entire cleanliness in all manipulations incident to the obstetric art. As to methods in detail, we shall say but little; and that little, we hope will be so pointed, as to emphasize the matter in a way that will make it of value to the ordinary every-day practitioner, who, taken collectively, has more to do with obstetrical work than the specialist, by a large percentage.

First, let us say that it is almost an absolute impossibility in private practice, for the general practitioner to carry out the technique ordinarily observed in lying-in institutions, such as shaving the pubis, flushing and scrubbing the vulva and vagina with bichloride and other various chemical solutions. Even were it possible to gain consent of the patient in private practice, we hold that this is nearly always unnecessary and uncalled for. It must be remembered that the healthy partur

ient woman is ordinarily thoroughly aseptic herself, and the probabilities are, that when she is taken with any of the infectious puerperal diseases it is due to foreign and extraneous germs that are introduced to the parts, too frequently, by aseptic and antisepsis devotees, rather than to auto-infection.

The first thing to be observed, in treating a case of obstetrics, is absolute cleanliness of the hands and clothing of the physician in attendance. The ordinary practitioner is all too careless, perhaps, in this matter; frequently going from cases of infectious diseases to the lying-in chamber; and we have to say that it is absolutely criminal, for any one to enter the lying-in chamber, who has recently been to see a case of scarlet fever or erysipelas or other infectious diseases, or, who has been at a post-mortem examination or in the dissecting room.

Let the physician, who is engaged in general practice, always change his clothing, if possible, before answering an obstetrical call; and when he has attended infectious diseases invariably have everything he wears thoroughly disinfected, before going to the lying in chamber; and then, above all, let him be scruplously careful about the care of his hands. The hand of the general practitioner that has examined the pulse of a person afflicted with any infectious disease, is usually thrust into the driving or other glove, and the disease breeding germs are thus kept secure, in the place where they can do the most harm. Before making an examination, the hands of the physician should be thoroughly washed with soap and water and then dipped

into a saturated solution of permanganate of potash, allowed to dry a minute or two; and then the stain produced by the permanganate of potash may be removed by washing in a solution of citric or oxalic acid, made with boiling water. This will thoroughly and effectually aseptisize the hands, so that there will be no danger from that source. The nails should be kept close-trimmed, and thoroughly cleaned, before immersing the hands in the permanganate solution.

In the matter of lubricants, the ordinary vaseline jar or olive oil bottle, should be avoided, as they frequently contain infectious microbes of all kinds, being used commonly as an emoillient for all sorts of sores and eruptive diseases by the family and others; to say nothing of the questionable apothecary shop from which they were purchased. Perhaps the best, and most thoroughly aseptic lubricant, that can be found readily obtainable in nearly every family is ordinary lard, which has been purified in the rendering and heat incident thereto.

We should next carefully consider the bed and other appurtenances of the patient. It is of course desirable and preferable when the means of the patient will permit, to have accouchement sheets or pads of aseptic and absorbent material, such as wood-wool, etc., but this is not always possible; and we must content ourselves with insisting on absolutely pure linen, that which is new

ly laundried, being preferable, as the boiling incident to laundry-work has rendered the material germ-free.

The common and careless use of bichloride or other injections, after delivery, frequently seems to facilitate the carrying of germs that would not otherwise find their way into the parturient canal. The most scrupulous care must be observed as to the cleanliness and aseptic condition of all catheters, syringes and other appliances and absolutely pure water, sterilized by boiling, is, perhaps the best of all for injections. In case of the use of instruments, boiling or baking them in an oven is the best way of securing a perfect and harmless asepsis. The instruments may be lubricated with lard, or if the practitioner prefers it, creoline, which is a very good emoillient and thoroughly aseptic preparation.

The lying-in chamber should always be thoroughly provided with sterilized water; not merely hot water, but water that has been thoroughly boiled; as, in that way only, can we secure perfect sterilization for the purpose of injections, washing of intruments, hands, etc.

In conclusion, we will only say further that we wish to enter a general protest against the increasing use of all poisonous chemical solutions, such as bichloride of merc., and other similar preparations, which too frequently do much more harm than good. In In permanganate of potash, we possess a non-poisonous preparation that is perhaps the best all-around germicide known.

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