uterine injections those which consist of a soft rubber tube three feet long, one end attached to a metal or hard rubber tube half the length of the common stomach catheter, the other end communicating with a large funnel or a reservoir holding one gallon. By alternately rising or sinking this "irrigator" we may adjust the power of the stream to all demands. Thus we may

use great power to carry away placenta rests, less power for simply washing out blood clots.

These prophylactic measures are continued throughout the puerperium. After "physiological" accouchments, we perform vaginal injections twice a day for two weeks, by means of an ordinary syringe with a piece of soft rubber tube on its nozzle. When there are symptoms of accumulation or decomposition of the discharges, or when rests of the placenta or of the membranes have remained, we make every three to four hours the above mentioned intra-uterine injections of the same. (two to three per cent) solution of carbolic acid. Rarely a double-current catheter is necessary to secure the free exit of lochia and injected liquid. Tute, impregnated with carbolic acid, or wadding soaked with ten per cent carbol. oil, is always laid in the introitus vaginæ. Many obstetricians scatter a mixture of acid, salicyl. and amylum (1:5) on the inner side of the labia, and on all wounds and contusions. Whatever materials we use must often be renewed. When in puerperio the contraction of the womb lessens, secale may freely be given in combination with injections of cold water in the cavum uteri; the contraction of the uterine walls with its veins and vasa-lymphatica prevents any decomposed matter spreading in the serosa and parametrium. The general condition of the puerpera ought never to be neglected. I allow sufficient aliment, finding the commonly prescribed "waterporridge" not to afford nutrition; any intercurrent disease may be treated without regard to the local antisepsis. Great care must be taken that the bowels are regularly moved, as constipation in the puerperio increases the hyperemy of the pelvic organs; oleum ricini (15.0), tartarus natronatus (15.0: 50.0 aq), magnesia sulph. (30.0:90 aq.); acid, sulph. dilut. with water and sugar are such laxatives as may be used to assist the prophylaxis of the puerperal fever.

In hospitals the practice of puerperal antisepsis is somewhat different. Schede uses a self-holding drainage-tube for constant irrigation; Chamberlain, Schücking and others recommend more

or less complicated instruments for the same purpose; the practitioner prefers his syringe to costly irrigators.

To-day almost everywhere carbolic acid is used as the most. powerful antiseptic. The boracic acid is less irritating, but also less powerful; it is used in a four per cent solution; the hyposulphite of soda (five per cent) is a harmless, but often insufficient surrogate of carbolic acid. Salicylic acid is frequently used as a disinfectant in the proportion of 1 to 600-900 of water (salicylate of soda does neither prevent nor arrest putrefaction; it should be excluded from the list of antiseptics). "Sanitas," so boastfully recommended of late from the English markets, is, according to Dr. Glaser's investigations, even when strongly concentrated, not as powerful as a three per cent solution of carbolic acid. The almost obsolete thymol has lately been re-introduced into surgical practice, and is now claimed to be the best and most useful antiseptic, being ten times less detrimental to the organism than carbolic acid. In Volkman's clinic, at Halle, the following formula is used for external antiseptic purposes: thymol 1.0, alcohol 10.0, glycerine 20.0, aq. 1000.0.

1

Dr. Ranke, in Vol. 128 of Volkmann's Samlung Klinischer Vorträge, gives an account of the success of thymol, and his results encourage the introduction of this "antiseptic of the future" into the obstetrical practice. P. Bruns (Berliner Klinische Wockenschrift, 1878, Vol. 29) strongly recommends alumina acetica as an excellent antiseptic, well qualified for constant irrigation. Probably the disinfectant powers pertain to the acid, as a one to two per cent solution of acetic acid gives the same result as one of alumina acetica of the same strength.

All these surrogates of carbolic acid have been tried in order to find a substitute which might possess all the advantage of carbolic acid without having its detriments. It is well known that Lister's antiseptic method has many opponents;, who will be surprised if "Listern in midwifery" is assailed?

"Carbolic acid has a poisonous effect" is their war-cry, and Lister's adversaries gather scrupulously all cases where a patient died during or soon after the application of the antiseptic. Not wishing to deny a direct idiosyncrasy of certain persons against carbolic acid, I find, in examining the details of the reported cases, no proof for the absolute dangerousness of the anti

1. Correspondenzblatt für Schweizer Aerzte, 1878, No. 19.

septic method. Death during or immediately after the resection of the hip-joint, after the operation of strictura ani, after opening of a thorax empyem, has often occurred before Lister's method was known.

Individuals suffering from rupture of the cervix uteri, from pelvic peritonitis, from abscesses with discharge of pus through the bladder, from erysipelatous abscess of the gluteus muscle, and suppuration of the knee-joint, died suddenly under the application of the antiseptic. Are such fatal cases really due to carbolic poisoning? Is the bold conclusion, "post hoc ergo propter hoc," a just or even a logical one? Senfteleben thinks that carbolic poisoning is produced by the presence of phenol in the blood; he recommends in such cases as antidote a sulphuric acid mixture (acid sulph. 1.0, aq. gumos 200, syr. 30.0; one tablespoonful every hour), the produced sulpho-carbolic acid being innocuous.

We will not close this paper without referring to the position of the midwife in cases of puerperal fever, and its prevention. In the country these women attend to almost all accouchments, and there is probably no practitioner who has not been inconvenienced by want of knowledge and by stubbornness of the midwife. Protracted labors, dangerous operations, might often be avoided through a more rational and natural action of the attendant.

In some places of Germany, all midwives who attend women suffering from puerperal fever are prohibited by law from the practice of midwifery for a certain period. Such bold infractions upon individual rights and freedom can exist wherever a strong police is supported by the nature of governmental institutions. Simpler and less shocking sanitary measures are those which interdict the obstetrical practice to every person (either physician or midwife) who is not fully acquainted with the principles and practice of every day midwifery, and who does not know how to prevent infectious diseases in puerperio. A better scientific instruction of all obstetricians, stricter and exacter examinations of the candidates for the practice of midwifery will answer the demands of modern medical science better than prohibitory laws. Why continue to expose patients to an increased chance of death from diseases that are preventable? Why sacrifice so many lives through neglect or indolence? To realize the principles of obstetrical antisepsis in private practice and in the country is

less difficult than in overcrowded hospitals and dirty tenement houses.

Spencer Wells, Tarnier and others have obtained satisfactory results without antiseptic treatment and prophylaxis, by scrupulous cleanliness alone; for most private practitioners an absolute cleanliness is, and will always be a vain wish, as they cannot enforce such sanitary precautions as prevail in the private hospital of Wells, and in the Paris maternity.

ARTICLE XVI.

WHOOPING COUGH; A NEUROSES, PATHOLOGY AND TREATMENT. By J. J. CALDWELL, M. D., of Baltimore, Md.

Being impressed with the apparent truth of Niemeyer's views of the pathology of this disease, viz: "That whoopingcough is a catarrh of the respiratory mucous membrane, combined with intense hyperæsthesia of the air passages;" this, together with the various other excitable or nervous demonstrations, etc.; the periodic and very rapid and jactitating cough, and temporary brain and spinal demonstrations, and the cerebral and facial arterial injection, followed by the apparent utter intermediate immunity-all pointing to the fact that this was but a periodic seizure of the peripheral nerves distributed to the mucous membrane of the air passages.

The investigation of this subject was forced upon my observation during the summer of 1870, in Brooklyn, N. Y., where this disease was epidemic. My own children suffering terribly, induced me to search in every direction for a more ready method than the time honored-of several months duration. I found that there was but little unity in its pathology or treatment, some advocating quinine for its antiperiodicity, and others the light carburetted hydrogen emanating from the gas factories as acting successfully through the nervous system, etc.

My conclusion was this: If Niemeyer's ideas are correct, whooping-cough has its origin in a local nerve lesion of the mu

cous membranes of the air-passages with excessive catarrh. "Ubi irriatio ibi affluxus." Ergo: A topical application of anæsthetics with gentle astringents, would be the treatment indicated.. It seems strange to my mind that this famous master did not fall into the same reasoning. Therefore I adopted the following treatment with my little ones, as well as a dozen other cases, with most happy results. (Reported in Boston. Med. and Surg. Jour., April, 1871.) Also a report of several cases with like results in a late number (1875) of the same journal, by Dr. Winthrop Spooner.

My mode of treating in these cases was very simple and ready, viz.: to place Codman & Shurtleff's steam atomizer in position on a table before the patient, charged with—

B. Fl. ext. belladonna......

Ammon. brom........

Pot. brom.......

Aqua dist.........

..gtt vj-xij.

......ǝj.

.....Jij,

..f Zij.

This spray is rapidly carried over into the face, mouth, and lungs of the child, and applied ten to fifteen minutes, until the pupils are dilated by the effects of the belladonna mixture ;. this application to be made morning, noon and bedtime. This has so far cut short the spasmodic cough within two or three days uniformly, and almost to a certainty. More recently we note reports of cases of pertussis successfully treated (almost instantly) by the inhalation of sulph. ether, in this instance discovered by Dr., while dressing a fracture of a child suffering from whooping-cough. The first administration cut short the malady then and there. The Doctor followed up this experience with the happiest success, the history of which he has given to the medical journals, thus again sustaining my theory of its neurosis and the good effects of anæsthetic treatment.

Again, during this discussion1 (before the section) my views were maintained; although the treatments differed, still they all pointed to the nerve origin. The beneficial effects of vaccination, on this affection, as ably demonstrated by Dr. W. B. Ulrich,, Chester Pa, and strongly indorsed by several leading physicians present, though the modus operandi of course is obscure, still to my mind maintain its nervous lesion. The argument, that because whooping-cough is contagious and constitutional, it could

Amer. Med. Ass.