The Medical Profession-- "A wise physician skilled our wounds to heal, Quacks and Quackery "For the dull world most honor pays to those "I thought thee wise till I heard thee speak." The Ladies "If woman be there, there is happiness too." Dr. J. A. Dickson, Ashtabula, O. visiting, a game of base ball, etc. The afternoon was spent in A very enjoyable time was had. The next regular meeting will be held in Painesville the first Tuesday in November. NINTH ANNUAL MEETING OF THE TRI-STATE MEDICAL SOCIETY OF ALABAMA, GEORGIA AND TENNESSEE. You are invited with your friends to attend the ninth annual meeting of the Tri-State Medical Society of Alabama, Georgia and Tennessee, to be held in the Auditorium of the Tulane Hotel, corner Church and Spruce Sts., Nashville, Tenn., Tuesday, Wednesday and Thursday, October 12, 13 and 14, 1897. If you desire to read a paper, report a case or exhibit a specimen, notify the Secretary. Reduced railroad rates to the Tennessee Centennial. W. D. Haggard, Jr., M. D., Chairman Committee of Arrangements, Nashville, Tenn. PROGRAM. TUESDAY, OCTOBER 12, 1897-MORNING SESSION. Registration, Introductions, etc., 9 to 10 a. m. AFTERNOON SESSION 2 TO 5 P. M. Reading of Papers and Discussions. NIGHT, 7:45 P. M. Concert by Conterno's Band and Fireworks at Centennial Grounds. WEDNESDAY, OCTOBER 13-MORNING SESSION. 9 to 12 A. M. Reading of Papers and Discussions. AFTERNOON. Tri-State Medical Society Day at Tennessee Centennial. NIGHT SESSION 7:30 TO 9 P. M. Reading of Papers and Discussions. Exhibition of X Ray Apparatus. THURSDAY, OCTOBER 14-MORNING SESSION. Reading of Papers and Discussions. Election of Officers. AFTERNOON SESSION 2 TO 5 P. M. Reading of Papers and Discussions. NIGHT SESSION 7:30 TO 9 P. M. Reading of Papers and Discussions. AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS. TENTH ANNUAL MEETING, HELD AT NIAGARA FALLS, N. Y., AUGUST 17, 18, 19 AND 20, 1897. THE SOURCE OF PUERPERAL SEPSIS was the title of the next paper, which was read by Dr. John Milton Duff of Pittsburg. The essayist said that the exact source in any given case is not always easy to determine; in fact, in many instances, after the most patient and careful search one is unable to find even a probable source. In cases in which the source of infection is determined, however, it generally proves to be one which might have been avoided. Aseptic midwifery has done much to prevent the occurrence of puerperal sepsis, and, consequently, to lower the rate of mortality following childbirth. An accoucheur who attends a patient without observing the strictest posible aseptic and antiseptic precautions is guilty of nothing less than malpractice. Frequently, however, too great reliance is placed upon the use of antiseptics. A well-known member of the profession said recently in the hearing of the essayist, that he felt perfectly safe in attending a patient in labor after visiting one suffering from erysipelas or diphtheria if he washed his hands thoroughly in a strong solution of mercuric bichlorid prior to entering the lying-in chamber. Such a proceeding the essayist thought most reprehensible. The speaker then briefly reported the histories of 50 cases of puerperal sepsis which have come under his personal observation, and specified the source of infection, when discovered, in each. In 14 of these cases, the source of infection could be traced, although 2 were instances of placenta previa. Five of the patients were attended by a midwife, and no aseptic precautions were observed. The source of infection in the remaining 31 cases was as follows: Retained placental tissue, 5; placenta spuria, or succenturiata, I; attending physician had previously visited a patient ill with erysipelas, 1; putrid fetus, 4: physician had previously dressed an abscess in another patient, I; laceration of cervix and perineum, 3: putrid blood clots, 2; diphtheria case in same house, I; acute gonorrhea in husband, I; protracted labor, due to shoulder presentation, with sloughing of vaginal walls and cervix, 1; retained membranes, 1; tonsilitis in attending physician, 1; physician had previously dressed a case of gangrene of leg, 2; physician had opened suppurating finger, I; mother of patient had pelvic abscess at time of latter's confinement, both being attended by same nurse, I; decaying animal matter in cellar of house in which confinement occurred, 1; child of patient's sister had dysentery, 1: physician, a few hours previous to patient's confinement, had curretted a patient for incomplete abortion, I. Dr. A. Goldsphon of Chicago said: This paper is a most valuable one, as it calls attention to the fact that the principal source of infection in puerperal sepsis is from without, and not necessarily from the unclean surroundings of the patient, as a woman may be confined in a stable by a competent and cleanly attendant without bad results, whereas another may be delivered amid the best surroundings and may develop sepsis if the physician or other attendants do not observe aseptic precautions. The most dangerous form of infection is that by streptococci, but, fortunately, this occurs only in about four per cent. of cases. Infection by the colon bacillus and other micro-organisms is more frequent, but less dangerous. The presence of sewer gas undoubtedly is often an important factor. Many obstetricians advocate giving a vaginal douche before labor, but this should not be done if the attendant has reason to suppose that the vaginal secretions are healthy. Nature has provided a puerperal woman with copious vaginal secretions, and the one per cent. of lactic acid contained in this secretion is sufficient to kill pathologic germs in a great majority of instances. If, for any reason, this secretion is not of a healthy nature previous to labor, a douche of a 1-2000 mercuric bichlorid solution is indicated. Dr. Samuel McMurtry of Louisville, Ky., said that the number of deaths from puerperal sepsis continued to be so large that the subject should continue to be discussed in all its bearings until the importance of the possibility of its being prevented should be impressed upon the mind of every practitioner. He agreed with the first speaker that the condition is not a pathologic entity, but is a mixed infection, and should be treated as such. Milk fever, socalled, is a mild degree of sepsis, and its symptoms are liable to be overlooked, and its importance as part of a general pathologic condition underestimated. Dr. C. G. Cumston of Boston said that gonorrhea in the female is as difficult to cure as when occurring in the male, and that in the case of a pregnant woman in whom former infection is suspected cultures from peri-urethral glands should be made in order that this source of sepsis might be eliminated if found to be presHe referred, also, to the numerous cases of puerperal sepsis in which the bacterium coli has been demonstrated in the uterine mucous membrane. Dr. J. F. Baldwin of Columbus, Ohio, said that the worst cases of puerperal sepsis which had ever come under his observation presented no clinical symptoms whatever in the vagina. In three instances of sepsis during the puerperium the source had been traced to the appendix. These probably were due to the presence of the bacterium coli. The speaker then related the histories of several cases in which every possible precaution against sepsis had been observed, yet the patients died, no cause for infection being ascertainable. He said that the practice of merely dipping the hands into a mercuric bichlorid solution previous to examining a woman in labor was a reprehensible one, and could not be too strongly condemned. Thorough application of soap and hot water, with vigorous and long-continued use of a nail-brush would produce far better results, although thorough soaking of the hands afterward in the bichlorid solution would make assurance doubly sure. With reference to the paper read by Dr. Longyear, the speaker thought a valuable and as yet uninvestigated field had been opened. The possibility of sepsis during the puerperium being due to infection by the Klebs-Loeffler bacillus must set every obstetrician to thinking, and the strides taken during the past two years in the serum-therapy of diphtheria made it reasonably certain that by the early use of antitoxin the condition might be easily arrested and cured. If subsequent bacteriologic examination proved the infection to be due to another cause no harm would have been done by the employment of the remedy. He said that Jacobi of New York has claimed that peroxid of hydrogen in full strength is too irritating for application to the throat, and he questioned if the same is not true in the case of the vagina, especially when the canal is inflamed. Dr. Potter said the recognition of the fact that puerperal sepsis was not an entity, but a complex pathologic condition, had led to the great improvement in methods of treatment which now prevail. While a maternity hospital formerly was looked upon by the laity and general practitioner as the most dangerous place in which a woman could be confined, such an institution now is considered the safest on account of the rigid adherence by the attendants to aseptic principles. Dr. Wright of Toronto agreed with Dr. Baldwin in the importance of the use of hot water, nail-brush, and soap by the ob |