Dr. McMurtrie read a paper on Antiseptics in Midwifery, also reported an interesting case of severe uterine hemorrhage followed by super-involution.

Dr. Latimer has used Bromo-Chloralum as an antiseptic with good results; thinks cleanliness especially needed. Dr. Tibbits said there had been cases of poisoning from Hyd. Bichlor. and called attention to the use of very weak solutions of Iod. Plumbi. Has liked carbolic acid and believes warm douches of simple water very useful.

He

Dr. Hawkins has for two years used water and Listerine. said Dr. Thomas lays great stress upon proper preparation of the room, removing furniture and carpets, disinfecting the floor and all that is left in the room. Dr. H. does not think this needed in all cases of private practice, certainly not to the extent which Dr. Thomas advocates. Does not use vaginal douches before the third day, except in cases of laceration etc. Thinks the danger from Bichloride to be in its imperfect solution. Does not like carbolic acid. Thinks it well to apply iodeform and collodien to abrasions. Uses the bichloride solution for intra uterine injections.

Dr. Russell referred to the fact that cases of labor do well in the midst of filth and without care, while others die where antisepsis has been carried out in detail, and asked whether the enemy existed within the body or gained access from without. Believes the plan of Dr. Thomas to be impracticable; that if accident occurs causing abrasions or any of the secundines or clots be retained that fever, if it occur, can be traced to these causes. and that the sloughing tissue and the bacteria are both together the causative agents. The removal of all sloughing tissue by washing out the cavity of the uterus is necessary, and although he has used carbolic acid and Bichlor. of Mercury because others did, thinks simple warm water would do as well.

Dr. Cory believes in perfect cleanliness and that labor should not be allowed to become tedious, using forceps when needed, also chloroform often relaxes the parts. All clots should be removed and ergot given to ensure contraction, repeating the doses. If septicemia occur he would use disinfectants and has used carbolic acid. He seldom finds their use called for.

Dr. Wood spoke of the rarity of the occurence of super-involution, as in the case reported. At a recent meeting of the American Medical Association, few of the Gynecologists then present had met with it and many doubted its existence.

Dr. Rothwell asked, "what is dirt ?"

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ON DEBOVE'S NEW TREATMENT OF GASTRIC ULCER.

Dr. Hawkins thinks Dr. Thomas' plan and rules for disinfection and perfect cleanliness, the most practicable, feasible and sensible that have ever been suggested or proposed. Dr. Thomas does not pretend for a moment to say that it is necessary in all cases to carry out the plan suggested in all its minutest details. It is mere cant to condemn antisepsis and ridicule Dr. Thomas' ideas of cleanliness and disinfection and then practice and advocate cleanliness as the surest means of preventing septicemia. Dr. H, said that Dr. Thomas does not believe in a specific puerperal fever, but believes puerperal troubles in all cases to be puerperal septiccmia, while Dr. Barker admits that we may have a puerperal septicemia but he believes in a puerperal fever separate and distinct from septic troubles. They are agreed as to the efficacy of proper antiseptic precautions.

Dr. Tibbits said the purification of bacteria destroyed their vitality.

Dr. Latimer said the usually used strength of carbolic acid does not destroy germs.

Dr. Davis spoke of the value of Bromo-Chloralum. Dr. McMurtrie uses it in strength of one drachm to two pints and has found strong solutions to cause some irritation. Attest.

L H. Wood, M. D.

Recording Secretary.

ON DEBOVE'S NEW TREATMENT OF GASTRIC ULCER-THE HABITAT AND TREATMENT OF THE OXYURIS OR ASCARIS VERMICULARIS.

BY HENRY B. MILLARD, A.M., M. D. N. Y.

In a communication made to the Societe Medicale des Hopitaux in April, 1884, and in the Progres Medical of July 12th of the same year, Dr. Debove promulgated a new treatment of a malady which may justly be termed the approbrium medicorum, namely, gastric ulcer, illustrating the practical view of his theory by presenting the records of four cases which he had cured. His idea is to spare the stomach the necessity and labor of excessive muscular action, and the stretching and pulling, as it were, of the new tissue necessary to the healing of the ulcer, giving it rest; and as the secretion of the gastric juice cannot be suppressed, to modify its acidity, which, though necessary to gastric digestion, is, nevertheless, to an ulcer, a caustic irritant; using such food as does not require peptonization by the stomach, and can be digested entirely in

the small intestines.

Under such favorable conditions the ulcer may

heal with comparative ease.

Dr. Debove showed me, in the summer of 1884, his method of treatment, and I saw and examined a number of patients cured or relieved by it. The lacteal diet usually employed, consisting in the administration of several quarts of milk daily, is sometimes provocative of hemorrhage from distention of the stomach, and not only that, it is usually inefficacious. Dr. Debove, after having used with advantage nutritive powders, condensed milk, etc., conceived the idea of relieving the stomach entirely of the chemical parts of digestion, and neutralizing the acidity of the gastric juice by administering the powder of beef and milk, or water mixed with the bicarbonate of soda. That the gastric juice does not act upon this mixture is shown by the fact that, upon removing a portion of it by the tube from the stomach after a certain time, it is found to contain no peptones. The work of converting albuminous substances into peptones is thus taken off the stomach, and the ingesta is passed unchanged into the duodenum, only in a more highly alkalized state, being thus all the more favorable for intestinal digestion. That peptonization by the stomach is not always necessary to digestion, is evident from the fact that the pancreatic juice liquifies the muscular and other tissues separated, but not dissolved, by the gastric juice, and that this latter, indeed, does little more than separate the elements of the food; and if certain forms of fatty matter and nitrogenous substances in divided particles, and free from fibre, tendon, etc., could be introduced directly into the duodenum, the stomach might to a considerable extent be dispensed with.

As to the "alkaline cachexia" being produced by the administration of an ounce of bicarbonate of soda daily, he cites Jaccoud, who gave, for a long time, twenty grammes, and Charcot, who had given forty grammes daily, without any ill effect, but admits that although the cachexia may not be established, the remedy may cause inconvenience: its taste is disagreeable, and it is somewhat irritating to the stomach, and its decomposition by the gastric juices gives rise sometimes to the formation of considerable quantities of carbonic acid gas, causing painful eructations. He advises its use. therefore when it does not agree, in smaller doses. On account of these objections he tried lime-water, calcined magnesia, saccharate of lime, etc., but abandoned them in favor of the soda. In employing this treatment the stomach is first washed with simple water to free it from acidity, using Debove's modification of Faucher's tube. (A full description of the method of lavage

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ON DEBOVE'S NEW TREATMENT OF GASTRIC ULCER.

by this tube was given in a paper by me in The New York Medical Fournal of April 19th and 26th, and May 10. 1884.) This operation should be performed by, or under the direction of, the physician himself, on account of a possibility of hemorrhage being produced. The operation should be suspended if the water is returned tinged with fresh blood, but otherwise continued until what comes from the stomach is quite clear. As to the danger of hemorrhage from lvagae it has never occurred in his cases, but he instances two (which have been published) where it occurred to a fatal extent, and was supposed to have been produced by the lavage. At all events, it is a danger that should not be overlooked. Debove usually gives twenty-five grammes of the poudre de viande with ten of the bicarbonate of soda, prepared with milk, so as to be of about the consistency of cream, administering it, when it cannot be taken otherwise, by the tube. That Dr. Debove's ideas are not chimerical is evident from some very remarkable cures which he has effected, three of which I will refer to, as I myself saw and questioned the patients, The most remarkable was that of Louise Davit, whom I saw at the Hospital des Tournelles, where Dr. Debove is at present physician-in-chief; she was thirty-nine years of age, and had had for twenty years a gastric ulcer, and during this period had suffered frequently from exhausting hemorrhages, and, as a matter of course, from severe gastric pains. So imperfectly had her system been nourished for many years that she looked a dried up woman of sixty-five. She was, when I saw her (last August), entirely cured, and serving as an assistant in the wards; and was able to digest ordinary food; she had been under treatment for nine months. At first, fifteen to twenty grammes of soda were given daily, the quantity being gradually increased to thirty-obout one ounce.

Hotel Dieu, August, 1884.--The patient was a man forty five years of age the gastric ulcer had existed nine or ten months; had been sub ject for three months to gastric pains and violent hemorrhages. Is now taking ninety grammes of the poudre de viande daily, and six grammes of the bicarbonate of soda immediately before the beef powder, in a little water. The hemorrhages have stopped and the pains entirely gone.

Hospital des Tournelles, August, 1884.-Patient a woman; the gastric ulcer had existed eight months, with severe vomiting and hemorrhages. Has been under treatment six weeks, and is now quite cured No restrictions now as to diet. The beef powder and soda were given mixed with milk at the commencement of the treatment.

I regret that I cannot supplement these cases by experiences of my own, but I have had no cases of gastric ulcer since becoming acquainted with this mode of treatment.

OXYURIDES, OR ASCARIDES VERMACULARES, THEIR HABITAT AND TREATMENT.

It is but little creditable to many, I may say most, writers on diseases of children, that they usually state that the ascaris oxyuris mostly infests the rectum, and the blind acceptance by me of this common statement, rendered the cure of two cases well-nigh impossible, To find out their habitat and character it is necessary to consult specialists in this department, and not rely upon works on general practice or on the diseases of children. Kuchenmeister1 states that they inhabit the large intestine, especially the cæcum and rectum; and Cobbold says: "It is an error to suppose that the lower bowel or rectum forms their especial habitat, nevertheless the most approved manuals, vade mecums, and general treatises have for a long time supported this general view."2 And according to the same author, "they commonly infest the terminal portions of the intestinal tube, being especially abundant in the sigmoid flexure of the colon."

"They are

Leuckart says: "Their only natural abode is the large intestine, the whole length of which is often inhabitated." also found in the cæcum and the small intestine."

With cases of ascarides, occurring so frequently as they do in children and adults, we are all familiar, and there are usually no insuperable difficulties in affording relief by the constitutional and local means of treatment usually employed, the latter being most generally used on the theory that the ascaris inhabits the rectum solely, and that this should be made the point of attack; still, many of these cases are very troublesome. The two cases to which I have referred, however, are as follows: Six years ago Miss X- then seventeen years of age, had a rectal abscess resulting in a fistula; this was successfully operated upon by Dr. J. C. Minor; it had been preceded by other abscesses. She had since infancy been troubled at various times by ascarides, and for two or three years they had been more intolerable than ever. Injections of nitrate of silver, strong infusions of the seeds of chenopodium, etc., always produced relief, but this was only momentary; internal remedies were also given, but as it proved, not enough reliance was placed upon them. I believe that the rectal abscesses, so severe and incessant almost was the itching, were caused by the parasites; they were so troublesome as to prevent sleep and were voided, according to the young lady's expression, "almost by the cupful," and she often found them on her clothing. The matter of diet was not overlooked. She was

1 Die Parisiten Leipsic, 1885.

2 Parasites. London. 1879.

3 Entozoa. London, 1874.