of the rarity of the disease and the consequent infrequency of autopsies. Dercum says it is usually due either to a blood poison, like rheumatism, or the absorption of septic material, or it may occur in connection with pregnancy. Several cases have been recorded as the result of fright. The autopsies which have been made have shown meningitis, or vascular changes in the brain, or endocarditis. DISCUSSION. DR. MILLER-In the treatment of chorea, I consider that rest is more important than any drug we can give. I have in mind a case of a little girl in the county hospital at Laramie. She had choreic movements of a very violent character. I gave antipyrine as mentioned by Dr. Hopkins, also Fowler's solution, without any benefit; and I gave bromides without benefit; also gave gelsemium without benefit. I ordered her put to bed and while in bed the bowels to be kept regular and withdrew all medicine, and within a week there was marked improvement, and she has continued to improve until to-day she is practically well. I consider that the benefit was due entirely to the rest in bed. I think that is the most important part of the treatment of chorea. DR. JOHNSTON-It has always seemed to me in these cases that the treatment should be directed, if possible, toward the causation of it. In a great many instances, especially in anaemic and rapidly growing children, any treatment that will correct or act as an intestinal antiseptic should be adopted, and it seems to me in this use of antipyrine, which is probable to some extent an intestinal antiseptic, is correct. Creosote will do the same thing, and it is probable that Fowler's solution acts in the same way. I have used creosote in some of these cases with very good effect. In that class of cases intestinal antiseptics together with tonics of iron seem to have been the most effective treatment that I have found. Of course there are other cases, cases arising from amenorrhea and disturbances of that sort need the treatment indicated in those lines. Again there are cases that are purely of a hysterical nature. I have seen in a number of cases nerve remedies and organic treatment act as a remedy. Discussion closed by DR. HOPKINS-In answer to Dr Work's remarks, I refer him to the duration of the case reported in my paper. I have treated cases with antipyrine after they had been under the arsenic and iron treatment without any improvement with beneficial results and a duration of three to six weeks. In my paper I have called attention to the precaution necessary to follow the use of this drug and do not advocate it in every case of chorea. TREATMENT FOR WOUND INFECTIONS.* By F. H. MCNAUGHT, M.D., Those of us that do emergency surgery must admit that while the principles of aseptic surgery seem almost perfect, the application of this principle is not rigidly enforced and in many cases cannot be complied with. In the surgery of choice, with a clean field for operation, infection can be held in abeyance, or entirely prevented. Not so with our emergency work where the wound is often infected at the time of injury, yet, even in our emergency cases, I am led to the belief that much of the infection we have to contend with might be prevented, if the principles of asepsis were more rigidly carried out at the time of the accident. The recognition of the cause of infection is not so old but what many here can recall when the true principle of treatment was first given to the world, yet, 100 years prior to Listerism, clinical observers used the same principle of treatment without recognizing the true cause of the condition. The treatment for cure of this condition extends back hundreds of years, and the principles evolved in the year 1500 are being brought forward to-day as the best treatment for infection. Paracelsus in 1493 stated that nature, without assistance, was competent to repair wounds and that non-interference was the best policy. In 1706 Parmanus speaks of a lotion which he applied to wounds to prevent putrefaction. In 1753 Heister is reported to have used certain balsams because they prevented and retarded putrefaction. In 1785 Lumbard and Percy learned that *Read before the Rocky Mountain Interstate Medical Society, Cheyenne, Wyo., Sept. 9th, 1902. a noted Alastian had an infallible remedy for the cure of infected wounds, and on trial of the remedy they are said to have praised it highly, but upon investigation, it proved to be pure water. Lemaire in 1863 made a very complete study of wound infection in which he recognized the germ theory of disease and first inaugurated the principle of antiseptics through the use of carbolic acid. A little later Lister published his first paper showing the effects of microorganisms in the production of wound infection. While to Lemaire must be given the honor of discovering the cause and originating the antiseptic treatment of infection, to Lister must be given the honor of elaborating this principle and bringing it before the world in all its perfection. The same principle that was applied for treatment of infected wounds 40 years ago is to be applied to-day, also the same antiseptic. The use of antiseptics presupposes infection. While this should be held as a truth, I am inclined to the belief that it is often overlooked and through force of habit antiseptics are applied to wounds where no infection has occurred or is liable to occur. Even in our modern and well equipped hospitals, antiseptic solutions are usually prepared for each and every operation without taking into consideration the question of infection. Habit is a strong factor in our daily vocation, and habit in the surgeon, as well as in the artisan, often leads up to many forms of abuse. As we understand asepsis to-day the preventive treatment for infection should be of greater value and its principles more thoroughly applied than is usual. The late wars throughout the world have done much to bring out this principle and its application. It is only when we compare the mortality rate in gun shot wounds and amputations of the Colonial, Civil, and late wars, that we recognize what the prophylactic treatment for infection means. Practically the only advance that has been made in prophylactic surgery is along the line of infection, and yet, while the government in the conduct and care of their army have given their men the best and latest treatment for the prevention of infection, many of the corporations who employ large bodies of men, that are subject to many forms of injury, have not taken necessary precautions to prevent infection in the newly made wound. Wyoming, Utah and Colorado have many mines, large smelting interests, railroad corporations, iron and coal industries that employ many thousands of men daily, yet, I question whether any of these corporations or the surgeons who have charge of the medical department for them, have properly equipped their local representatives with first aid dressing packages, whose sole function it is to prevent infection. I recognize that it is a difficult matter in many cases in the mines, on the railroad, in the smelters or amongst the iron and coal employees, tɔ properly handle and use these dressings, yet, I am not obtuse to the fact, that one man could spend a period of 12 to 15 days in any corporation, even on the railroad, and instruct the proper persons in the proper use of these dressings. If a simple protective dressing was applied immeditely upon the receipt of an injury our results in our many emergency cases would be much improved. The question of infection is now so paramount that nearly every household discusses it with some degree of knowledge, and if a man has been in the hospital of late, goes out, and is again injured, he is very quick to note whether proper precaution has been given him to prevent infection. Humanity demands that preventive infection be considered in every injury, and medico-legal questions are now arising that make it imperative, that every case of emergency surgery receives special care that infection does not take place. Although surgical cleanliness is what we desire in all of our cases, yet we are brought in daily contact with unclean wounds, and demands are made upon us for their cure. A treatment which is used daily, the principle of which I do not recall as being suggested in any text book, modern or otherwise, is what might be denominated the mechanical treatment for infection. By this I wish to be understood the mechanical removal of any infection or tissues that invite infection. Sterile gauze, sterile water, gauze sponge, brush, curette, scissors and proper drainage, I believe, to be more efficacious in the treatment of wound infection than any form of antiseptics known. I am prepared to have this expression criticized and yet am a convert to the principle, after having treated a great number of infected wounds invading every structure of the body, I am led from this personal experience to recognize in this mechanical treatment the one most effectual. The method of this treatment must be at times heroic and at other times very mild. In many cases of early infection a stream of sterile water thrown against the infected parts will wash away any microorganisms, or their products, found on the surface. To ac complish this some force must be given the water on its application. If the infection has become more tenacious and adherent, rubbing the parts with sterile gauze sponges often clears up the field of infection, leaving us practically a clean surface. In other cases where foreign substances, infected or non-infected, are carried into the wound, a stiff brush may be required in removal of them. Again, where the parts are mutilated and tissue structure is so destroyed as to act as foreign substances, the use of currette, scissors or a scalpel may be required. The weaker the tissue vitality the greater likelihood to infection, so that in cleansing these wounds all tissues that are bruised and mutilated so as to be liable to necrosis are to be removed. This mechanical manner of rendering wounds surgically clean is, in my estimation, of very great value. In the few cases where the mechanical treatment cannot be applied through inability to reach the infected parts I use carbolic acid. Over a third of a century ago this remedy was brought out and used for a time, then fell into disrepute; to-day it is being brought forward as one of the best remedies that we have for the cure of infection. To show you that our many antiseptics are not satisfactory I have only to remind you of the great number that have been brought to our attention. George N. Sternberg has reported 65 substances having antiseptic qualities, very many of which have been used in surgery for a time and then dropped. When we consider this great number that has been given us it would indicate, at least, that very few stand the test of time for surgical uses. My experience and reading leads me to the belief that the remedy given us by Lister is still the remedy that gives us the best results. Here again history is repeating itself, as over a century ago the coal tar preparations were found to be of great value in the cure of wounds. While the technique in antiseptic surgery has been only slightly advanced since the time of Lister, the proper use and control of phenol solutions seems to have been recognized only of very late. While doing post graduate work under John Wyeth of New York City, I learned much regarding the use of this very valuable antiseptic, and during the last three years I have used it in a large number of cases of surgery where the mechanical treatment could not be applied, and my experience, coupled with the reports of others regarding the use of this drug in the treatment of infec |