lected in the pelvis, to prevent septic symptoms, and adds: "Of course no one would think of performing this operation until septic fever is evident."

Another writer says: "If a drainage tube has been used it should be well corked (italics mine) until symptoms of blood poisoning arise, when is it to be opened frequently to admit of the escape of any fluid that may be in the cavity....and a hard rubber syringe passed to the bottom of the tube to remove what has not run out."

A noted German author and operator writes: "After a vaginal and supra-vaginal hysterectomy I continue to use drainage of the pouch of Douglas, in spite of various publications which state that the omission of this is not injurious. I attribute my success essentially to this treatment in connection with two observations that I have made. One case perished from septic. peritonitis in which the tube was allowed to escape and a collection of secretions formed at the bottom of Douglas' pouch. In the second.case I was induced by the publication of successful cases without drainage to omit the latter, which I otherwise employed. The patient recovered well from the shock of the operation; in the course of the second day, however, an extremely threatening collapse occurred, with pallor of countenance, and increased frequency of pulse. The symptoms disappeared at once as I had the patient sit up, and separated the sides of the opening in the vault of the vagina by passing my fingers into it.. A large amount of sticky and foul fluid was discharged. From this moment the patient got better."

He says on the indication when he removed the drainage tube: "Usually between the third and fourth day a peculiar period of drawing is experienced in the umbilical region. I then remove the tube. Since I have employed this method of treatment the results of supra-vaginal amputation have become essentially better and surer." This great operator lets the great lesson from nature in drainage teach him nothing. In 77 salpingectomies this same operator had 14 deaths, with no history of drainage. Of this number 10 died of sepsis, or the result may be traced to this source as a cause.

One aspirant to operative fame, when discussing drainage with a professional brother, said: "I do not see how you can drain the pelvis with the tube standing straight up." His wise senior replied: "Turn the patient on her side and let it run out."

i

I have seen a drainage tube pushed down into the pelvis and the dressings and bandage applied over its outer extremity, and that, too, by a teacher before his class, at the same time remarking that he had had a number of fecal fistulæ following the use of the tube, and that it was very troublesome to keep the dressings clean and dry.

Hydrostatic pressure on the diaphragm has been advanced as a counter indication to the use of the irrigator. An outward flow during your irrigation is obtained if used properly; you rarely wash the diaphragm unless you have been using the Trendelenburg position and had your patient's diaphragm and liver flushed with pus or other septic fluids during the operation. You do not use water hot enough to paralyze the solar plexus, as some apprehend.

The general surgeon long since called attention to the fact that old abscesses with a limiting wall, if disturbed, in many cases lead to systemic infection by changing the character of this breastwork to one with absorbing functions. While this fact was long since recognized, it was not suspected that the changes wrought in the surrounding tissues by a surgical interference lead to a secondary infection by the admission of new agents into the abscess cavity, yet every effort was made to keep an outward flow of the discharges by drainage, through counter openings, vapor baths, cathartics, diuretics, etc., all drainage agents.

If we accept or reject the germ theory of the suppurative process and its prevention by antiseptic or aseptic methods, the truth remains unaffected that it has been through this channel of purification that we have learned that cleanliness in surgery is next to godliness. If germicides are or are not used while operating, the diluent acts as an absolvent to the dirt, or as a destructive agent to the pathogenic bacteria, and the same end is obtained provided both methods are carried out with equal care and diligence, although possibly by a different process-one by washing away the dirt or germs present, and the other by destroying or inhibiting those not destroyed. The object in either method is to reduce to a minimum the amount of chemical substances or number of germs, so that the functions of absorption, destruction and elimination are not overtaxed, at the same time reducing to the lowest ebb the fermentative fever tendency by removing at the time of the operation as much of the fever-producing agent as possible by

irrigation and by keeping the locality clean by thorough drainage afterwards. There are localities in the body where germicides cannot be used in strength sufficient to have the action desired without producing toxic effects. Fortunately, it is in this same locality that we have the greatest absorptive and eliminative function developed.

The same principles hold good in draining the peritoneal cavity that are applicable to other parts of the body. No surgeon, with all the antiseptic precautions possible to be used in opening a diffused abscess of the thigh or other parts of the body would think of such a thing as at once closing the wound hermetically, leaving many broken-down shreds of diseased tissue dangling in the abscess cavity. He may have irrigated the cavity thoroughly with a "1 to 1,000," yet he would not feel it safe to close the wound until after he had made counter openings and introduced the drainage tubes, this being as near ideal surgery as it is possible to obtain in these cases. The presence of the tube does not have special healing virtues, only in as far as it keeps the parts free from the poisonous discharges, and permits the structures to come in contact and heal in their normal relations, and at the same time, by this system of draining, avoid the absorption of septic and putrid material.

(Concluded in July number.)

DEPARTMENT OF PEDIATRY.

CONDUCTED BY ROBERT W. HASTINGS, A.M., M.D.

ORIGINAL COMMUNICATIONS.

THE X-RAY DIAGNOSIS IN CHILDREN.

A. V. L. BROKAW, M.D..

THE science of radiography and fluorescopy in its application to children is of extraordinary value; the scope, utility and application being as wide as in the adult. By reason of the alleged harmful effects, and believing the more delicate organism of the child to be susceptible to a greater degree to the untoward influence of the new form of radiation, many surgeons have been deterred from the frequent use of the X-ray in children. That such is the opinion of many is a matter of regret. I feel quite confident that this reasoning will not be sustained after a further consideration of the subject. After large experience, I can but come to the conclusion that the adaptation of this discovery merits a wider application and more general use than is at present in evidence. The danger of burns and deep-seated tissue degeneration has been reduced to a factor so slight that it does not merit the dignity of very serious consideration. In the early experimental stage of the development of this new diagnostic aid, burns of varying intensity occurred with a frequency sufficient to arouse general attention, especially as the daily press found these accidents news items worthy of publication. Happily, such accidents are rare in comparison with the thousands of exposures being made the world over. The destructive effects, the accidents, it will be noted, have followed where the operator used a coil apparatus. As far as I am aware no serious effects have presented themselves when the source of generation of the rays has been effected by static machines. This source for generation of the rays, I believe, to be the best, and undoubtedly the safest in the examination of children, and it is therefore recommended. By the ex