the task of preparing the address, so that the manuscript was found among his papers. That it will be read with interest by not only the British association, but by all members of the medical profession who love their calling, is a self-evident statement. His son has seen the manuscript properly published, and with a fine engraving of the lamented author, it is now before the medical public. We have but space to refer to a few points in it.

"Long before the expiration of the next half century no practitioner of medicine will be without a lancet at hand for immediate use."

He regards it merely a question of time when there be discovered specific organisms for all the infectious diseases.

As there has been discovered a remedy for malarial fever, so will there be discovered a remedy for each of the fevers.

Then, in connection with the progress of bacterial etiology, etc., will come the study of the conditions needful for the development of these diseases. He thinks it not improbable that the discovery of these conditions will be even more important than the discovery of agents which will destroy the diseased organisms. His remarks respecting medical literature and specialties we shall call attention to in other pages.

Abstracts from Exchanges.

Prepared by A. B. Lyons, M. D., Walter P. Manton, M. D., and W. R. Chittick. M. D.

PHYSIOLOGY.

A NEW CONSTITUENT OF THE BLOOD.-Mr. L. C. Wooldrudge describes, in the Proceedings of the Royal Society, his method of obtaining "a new constituent of the blood," which he has lately discovered, and dwells upon its physiological import. The plasma of a peptonized dog, having been completely freed from all corpuscular elements by means of the centrifuge, is cooled down to zero, when the plasma rapidly becomes turbid, and a decided flocculent precipitate is formed. This is the body that gives rise to the fibrin ferment, and if examined microscopically the precipitate is found to consist of a number of minute transparent bodies, nearly circular in shape, but much smaller than the red corpuscle, and having a great tendency to run together into granular masses. These peculiar bodies may, perhaps, explain the granules, blood-plates, and hæmatoblasts of Osler, Bizzozero, and Hayem.-Med. Record.

OTOLOGY.

SCHWARTZE'S METHOD OF TREATING SUBACUTE AND CHRONIC MIDDLE-EAR INFLAMMATION. This method is for the treatment of such cases as contain

fluid in the middle-ears. If there be not perforation of the membrana tympani, a large paracentesis is made in the lower and posterior quadrant. This being done, a warm three-fourths-per-cent. solution of table salt is forced through the Eustachian tube till the thick mucopus is seen in the external auditory canal.

When but one ear is affected the catheter is used, when both ears it is dispensed witn.

The patient is directed (correspondence of the Va. Med. Monthly) to cleanse the nasal passages by blowing the nose gently; a basin is placed under his mouth and one under each ear. The mouth remains open and the beak of a blunt-pointed syringe, large enough to completely occlude the anterior nasal orifice and containing the same solution is placed in one side of the nose and a stream of water is sent in, which returns through the other side and through the mouth. After having in this manner cleansed the nasal cavity, the same manœuvre is repeated, except the other side of the nose is closed tight by the fingers, and sufficient force is used to drive the water in a gentle stream through the two Eustachian tubes and thence through the middle-ears into the basins. This is done four or five times, when, if the manœuvre is properly performed, the contents of the middle-ears are found in the basins under the ears.

If paracentesis has been performed the manoeuvre is repeated after four or five days, but in chronic purulent inflammation it must be done daily. The strictest antiseptic precautions are observed, and a protective bandage worn over the ear until the opening has healed.

OPHTHALMOLOGY.

REMOVAL OF EPITHELIOMA OF THE EYE LID BY APPLICATIONS OF BENZOLE AND CALOMEL.-At the last annual meeting of the American Ophthalmological Society Dr. A. Matthewson, of Brooklyn, N. Y., reported a case successfully treated as above. The patient, a laborer, aged fifty years, was seen October 3, 1881, with tumor on right lower lid. This first appeared as a warty growth three years previously. Of late it had been rapidly growing, and presented a raw granulation surface. Careful examination by an expert showed it to be undoubted epithelioma. It was treated by frequent dustings of calomel, after brushing the surface with benzole. The tumor entirely disappeared until a few months ago, when a granular spot appeared at one edge. of the site of the former growth. This disappeared under a renewal of the same treatment.-Med. Record.

OLIVE OIL AS A MENSTRUUM FOR DISSOLVING COCAINE FOR APPLICATION TO THE EYE.-At the last meeting of the American Ophthalmological Society, Dr. J. A. Andrews, of New York, read a paper on the above subject. Olive oil will not dissolve any of the salts of cocaine or atropine but, when these remedies are needed,

their alkaloids can easily be dissolved in the oil by thoroughly mixing them and subjecting the mixture to a gentle heat. This solution does not cause the irritation that oleate of cocaine or cocaine dissolved in castor oil does. C.

MATERIA MEDICA.

THE PEPTONIZING FERMENT IN FIGS.-Dr. A. Hansen (Phar. Jour. and Trans.) has been investigating the digestive properties of the common fig, and finds that the statements made by others, concerning a peptonizing ferment in this article of food, are correct. It acts also on starch and sugar. A syrup of the dried figs is active. It is suggested that a syrup be made of this fruit, to be administered to children along with starchy foods so much in vogue.

PATHOLOGY.

C.

ON TUBERCULAR MILK. Dr. Bang, of Copenhagen, expressed the opinion, at the last International Medical Congress meeting in that city, that milk taken from a tubercular cow is probably a fruitful cause of tuberculosis in children. (Heitler's Centralblatt, July,

1885.) He was led to this belief by the fact that milk is the principal food of young infants, and that this disease prevails to a great extent among them.

Bang declares that tuberculosis of the udder of milch-cows is by no means a rare affection, and is characterized by diffused, painless swelling of one, rarely of two portions of the udder, proceeding without any constitutional implication. A gland thus affected furnishes in the beginning an apparently perfectly normal milk, while in a simple non-tubercular inflammation the milk is at once materially and conspicuously altered. The diagnosis is corroborated by the swelling of the supra-mammary lymphatic gland. This milk, according to Bang, contains a large number of tubercle-bacilli. Experiments resulted in the infection of several animals. Boiling he found would destroy the bacillus, hence it is but prudent to resort to this process in every doubtful sample of milk. -Therapeutic Gazette.

A CAST OF THE BLADDER.— Dr. H. J. Boldt recently exhibited before the New York Pathological Society the cast of the bladder of a woman, aged 18 years, who had recently given birth to her first child. Delivery was normal. Soon after, Sept. 21, she complained of pain in the hypogastric and lumbar regions. There was tenderness on pressure; but micturition caused no pain. The urine contained albumin, blood casts, and a small quantity of pus; and a diagnosis of calantial nephritis was made.

The temperature at this time was 102.6°, but some days later it rose to 106°. The patient felt something in the urethra while urinating, and, on examination, what

was thought to be a portion of the inverted bladder was found. This occurred several times, the part being replaced. It was finally expelled, and appeared to be the mucous membrane of the bladder, with some submucous tissue and perhaps some of the muscular fibres. After its expulsion the bladder-walls seemed to be entirely denuded of their lining membrane, and became thickened, the cavity greatly decreasing in size. During the 24 hours a large quantity of urine was passed. The patient died Oct. 10th, with cerebral symptoms, probably of a septic nature.-N. Y. Med. Journal, Oct. 1885. M.

SURGERY.

THE EFFECT OF COCAINE UPON THE HEALING OF WOUNDS. Dr. Lucien Howe, from his experiments upon the eyes of animals, concludes that:

I. In lesions of the conjunctiva, perfect solutions of the hydrochlorate of cocaine have no appreciable effect, beneficial or otherwise, upon the healing process. When the solution is imperfect, a slight additional hyperæmia is produced, which persists longer than in the other eye, but this is ordinarily of no practical importance.

2. In lesions of the cornea it has a beneficial effect, like other mydriatics, but inferior to that of atropine. In imperfect solutions, a perceptible abrasion of the epithelium is produced, and, though this is quickly renewed the healing is thereby delayed by the cocaine.

3. In wounds of the iris the mydriatic action of cocaine is evident; but here again it is inferior to atropine, and is of little value in detatching fine synechiæ. Imperfect solutions, however, do not appear to hinder the healing process any more than when applied to the conjunctiva or cornea.

Indeed, as strong mixtures possess decided antiseptic properties, they would seem to exert a favorable effect in this respect.-New York Medical Journal, Aug., 1885.

M.

EXENTERATION FOR ENUCLEATION OF THE EYE.— Dr. Middleton Michel recommends "exenteration of the eye as a substitute for enucleation."

"This simple method," he says, "consists in opening the eye just beyond the sclero-corneal border, as in the operation for staphyloma, finishing the abscission of the anterior segment of the bulb with scissors, then with scoop or curette, introduced between choroid and sclera, enucleating the contents of the globe, eviscerating the organ so as to destroy completely ciliary and optic connection with the sclerotic, arresting hemorrhage, and cleansing the sense-capsule with cotton compresses dipped in a weak solution of corrosive sublimate, then suturing the scleral cup with two or three catgut ligatures, all of which is conducted under a continued antiseptic spray of corrosive sublimate."-Medical News, July, 1885.

M.

NEW SERIES, VOL. X, No. 8. WHOLE NO. 245

Original Communications.

THE VALUE AND DANGERS OF ANTISEPTIC METHODS.

N°

BY A. R. SMART, M. D., HUDSON, MICH.*

O ONE will, I think, dispute the wonderful advance made in surgical practice since the introduction of antiseptic methods. Compound fractures have lost. much of their dangers. Cases formerly doomed to amputation go on under antiseptic management to a speedy and safe recovery. Excisions of joints, ligation of large vessels, opening of chronic abscesses, especially those connected with bone, are all freed from much of the dangers which formerly attended them. Joints are opened and foreign bodies removed with safety; the knee joint, in cases of fracture of the patella, is opened, the fragments adjusted and wired, with rapid and complete recovery. The long exhausting suppurations from wounds both operative and accidental are, under the influence of "Listerism," unknown.

These results are secured by perfect cleanliness in the operator and his attendants, perfect cleanliness of the wound or diseased tissues, secured by free drainage and the complete removal of foreign or effete substances and as complete rest to the parts as possible.

Upon these points all are agreed. The advocates of Listerism or the so-called antiseptic management go farther than this and insist upon the use of agents which shall destroy disease-producing germs and prevent their entrance into wounds. Others, prominent among whom is Dr. Frank Hamilton, of New York, repudiate the germ theory and the necessity for strict antiseptic precautions to prevent the entrance of micro-organisms to wounds.

While the weight of evidence is in favor of the important part these agents play in exciting suppuration, septicemia and ill-conditioned wounds, yet it must still be regarded as an open question. Want of time forbids an inquiry into the evidence to be offered pro and con on this question, and we will briefly notice some points

*Read before the Southern Michigan Medical Society.

$2.00 a year. Single copies, 30 cents.

connected with it in a practical light. The microorganisms which are asserted to do the mischief in the surgical world are micrococci and bacilli; both of these require albuminous material to develop in. Bacteria are found in the cavities of the body but do not attack or develop in living tissues: they are found constantly in ill-smelling discharges, while micrococci occur in such decomposing material as is without odor.

According to the adherents of the germ theory common air teems with the spores of these living organisms, which need only the conditions to germinate and multiply with great rapidity.

In this connection we note, ist: These germs will not develop in perfectly healthy wounds. Union by first intention often occurs, even when unprotected from contact with air if the surfaces are accurately adjusted and kept quiet. 2d. A most potent agency in development of these germs is retained decomposing secretions; they afford a hot-bed for their culture. It is, therefore, of great importance that wounds should be thoroughly cleansed, and then by free and perfect drainage be kept in that state; all wounds are much more readily kept aseptic if clean. 3d. An important item in the treatment of wounds is perfect rest. Under the old style of daily syringing and washing this was impossible. No small share of the success of antiseptic methods comes from the fact that with it wounds are disturbed but little, and are kept at rest. All surfaces in process of

healing should be kept free from irritation, because it not only retards repair, but favors the development of septic germs. With this in view, ligatures are rendered aseptic, or animal ligatures are used which will not. excite irritation and suppuration.

May it not be that the antiseptics used act, not by destroying septic germs, but by hindering the decomposition in the wound of its secretions? Dr. Hamilton asserts that the solutions of carbolic acid, corrosive sublimate, etc., with which wounds are deluged does not act by destroying germs, but by preventing the decomposition of blood, serum, or pus, and by contracting the capillaries, and arresting oozing. Some surgeons have adopted other means than the use of antiseptic agents to prevent germ infection. Dr. Varick, of New Jersey, uses for this purpose hot water, a little below the boiling point,

and applied with a sponge; this he claims closes the capillaries, coagulates the albuminoids and thus bars the entrance of germs. The use of cotton-wool for this purpose, was a favorite practice of Gamgee and Guerin, the treatment adopted by these surgeons clearly demonstrated the value of cleanliness and rest in the repair of wounds. If the wound surfaces are well and thoroughly freed from extraneous matters and put at rest with ample protection from external influences, repair goes on without interruption; under the protection of gauze, antiseptic cotton-wool, tow, lint, peat, etc., the repair goes on without disturbance. When we consider that the catgut used for ligatures and the peat used for dressing have often been found teeming with bacteria, that after being successfully used for years it was found that the carbolic acid in the dressings used had evaporated and left them without sufficient strength to destroy germs, that carbolized oil upon which we so often depended is not antiseptic, we must believe that there is some other factor besides the antiseptic agent that makes the antiseptic treatment a success. Dr. Stimson aptly suggests that if exclusion of germs is all that is needed, why use drainage at all? Many surgeons of eminence have discarded the teaching of Mr. Lister, among others Messrs. Lawson Tait, Callender, Keith, Savory, Bryant, and Drs. Hamilton, Stimson and others in our own country. The antiseptic method must be judged by its merits. It must stand or fall by the standard of results. Viewed from this standpoint the verdict must be overwhelmingly in its favor. Still, the essential relation of the germ theory is not wholly established beyond controversy; the intricate complicated methods of Listerism have not been generally sustained, and that there is danger in the use of some of them has been proven. Yet the principles of entire scrupulous cleanliness, of rest, of free drainage, and of the value of antiseptic agents remains established.

A word regarding the agents used, their value and dangers. For a long time carbolic acid was "the antiseptic," but later many aspirants presented themselves to claim the crown, or at least to share it. Iodoform, used in powder, dusted over surfaces of wounds, or in gauze impregnated by it, was at one time very popular. It is not free from danger; if too freely used it causes a peculiar species of intoxication, or delirium, with marked constitutional disturbance. The quantity that can be safely used at once on an open surface is 45 grains. Carbolic acid is open to the same objection; used too freely it produces serious disturbances in the kidneys, and signs of systemic poisoning; both agents are offensive to the smell. Bichloride of mercury is one of the most effective germicides, and is very much used now as an antiseptic, it will destroy bacilli of anthrax in solutions of 1-20,000; it is used in solutions of from 1-1,000 to 1-5,000. It is said to be open to the objection of being an unstable compound, forming calomel; to prevent this it has been suggested to add five to 1,000 parts of common salt.

Prof. Lister says that the sublimate forms with the serum of the blood an albuminate which is not irritating to the skin, as the drug was rendered milder by the combination. In these solutions of sublimate or carbolic acid are soaked the ligatures used and the cotton-wool or gauze to be used in the dressing; also the drainage tubes used. The greatest pains are taken with sponges, first cleaning them with solution permanganate potassium 1 to 1,000, in which they remain twenty-four hours, then bleaching in solution of sulphite of sodium, with a little hydrochloric acid. They are then kept in solution of 1 to 20 or 40 of carbolic acid. Sublimate is superior to carbolic acid in this particular, solutions of carbolic acid excite an oozing of bloody serum which is disagreeable, soiling the dressings, etc., while sublimate dries the wound, doubtless, by the method suggested above by Prof. Lister. The bichloride should be used with caution. A number of cases have been reported where serious results, and death, even, have followed its use. It has caused enteritis and salivation. It is especially dangerous, when any renal impairment exists, to interfere with elimination. Dr. Hunter has seen three cases of salivation occurring from its use as a vaginal wash of ordinary strength. It is, however, a valuable antiseptic agent, because of the weak solution necessary to use. It has been ascertained that a three-per-cent. solution of carbolic acid is necessary to destroy the spores with which the surgeon has to deal, while solutions of 1 to 1,000, and weaker, are sufficient of corrosive sublimate. Of lesser value, or at least less frequently used, are bismuth, potassium permanganate, boracic and salicylic acid, thymol, chlorinated soda, and numbers of lesser agents.

Many vegetable acids possess antiseptic value, of which oxalic ranks first. In abdominal surgery the antiseptic treatment in all its details, especially the use of the spray, has not maintained the place it once occupied. Dr. Lawson Tait has, after faithfully trying the antiseptic plan in all its phases, declared his conviction that its only tendency was to mar his success; that his patients were oftimes poisoned by the agents used, and he has recently declared that after a thorough trial in ovariotomy, he has abandoned forever the antiseptic plan. It is urged that the use of the spray produces by evaporation a chilling of the peritoneum, and there is constantly great danger of absorption from its surface.

Not long since I saw a report of a case of ovariotomy made by a prominent operator, in which he says the cleansing of the peritoneum was made with care by sponges moistened with 1 to 1,000 solution bichloride of mercury. Examination of the urine previous to opera tion gave no evidence of renal disease. Albumen with casts appeared at end of second day, suppression of urine followed, and death ensued three or four days after. The fatal result was ascribed to septicemia from the cyst, which was found to contain micrococci. In my