further understanding that it is not necessary to bring the germ from another person to produce bacteria, as the germ is always present, and bacteria can always be detected in the lochia as well as in any other decomposing animal tissue; and bearing in mind that puerperal bacteremia is more frequently sporadic than otherwise, I have no doubt that all such must eventually change their views. Those who advance the theory of contagiousness admit the disease to be bacteremia when they advise accouchers to avoid dissections, for no poison will be conveyed on the dissector's hand but bacteria and bacterian germs, and therefore nothing will be added to that which will surely exist in every case. It is not an uncommon occurrence that a portion, or even the whole, of a placenta is retained, and in every such case decomposition commences in a few hours, and myriads of bacteria are therefore encompassed within the uterine walls. These are entirely harmless if the circulation is protected by intact membrane, but they make sad havoc if an opportunity is afforded of immigration to the circulatory system. It is a noticeable fact, as we might expect, that the uterus in the earlier months of pregnancy offers less of this opportunity than it does at full term. Puerperal bacteremia is often traced to a retained placenta or a portion of it; open blood vessels are just as often traced to the same cause.

Let it be understood that we may have puerperal metritis and peritonitis without bacteremia, and it should be further understood that these diseases ought to be designated by their proper names, as their pathology and prognosis are very different than are those of the terrible disease which is the subject of this paper.

I have little to add to the therapeutics of puerperal bacteremia. I believe that up to date medication has not had much to do with the recovery of this class of patients. The rationale of all treatment must depend upon our knowledge of etiology and pathology, hence the practical importance of establishing

these questions, if possible, in the disease under consideration. If I am correct in the position I have taken, the treatment indicated will obviously be very different than that usually practiced.

An attempt should certainly be made to prevent the sapping of the vital powers with the hope that the onslaught may not prove to be one of the most virulent. The rational treatment would undoubtedly consist in introducing into the circulation a drug capable of destroying bacteria, and if possible to prevent the admission of the animalcule. There are many medicines capable of accomplishing the first object named, but it is questionable if they can be carried into the circulation by way of the stomach in sufficient quantity to attain this end. Experiment has shown that very dilute solutions are not fatal to most of the forms of microscopical life. For instance, to produce their death by charging the air of a room with chlorine, sulphurous acid, carbolic acid, or any other of this class of drugs, it must be carried to an extent that will render the air irrespirable to human beings. Hence the uselessness of the usual methods of using disinfectants in the sick room.

Probably those that are at once the most efficient, and the least innocuous to the human system, are sulphurous acid and its salts, and salicylic acid. The latter is but slightly soluble, and its absorption is consequently slow. When given in solution in the presence of an alkaline salt, it is at once precipitated by the acid juices of the stomach, and is hence in its original condition. I once gave a grain of quinine and five grains of salicylic acid every half hour in a case of puerperal bacteremia, without obtaining the slightest perceptible effect. I have doubts if the medicine in such a depressed condition was absorbed at all.

Experiments have been made upon the lower animals of following the injection into the circulation of septic material with a solution of hyposulphite of soda, with astonishingly

favorable results. I am aware that I am open to the accusation of boldness when I predict that the time is near at hand when nothing but dereliction of duty will prevent the injection into the circulation of a sufficient quantity of anti-ferments to destroy the animalcule in all cases of bacteremia. May we not hope then that in the near future we will have at hand a means of arresting this dreaded disease? The time has already arrived when serious diseases are most successfully treated by those who are most scientific and skillful, and I have no regrets that the requirements of the day demand of the healer a high order of talent, both natural and acquired. I do not believe, with our present knowledge, it is possible, by local applications or by any other plan, to prevent the development of bacteria within the uterus of a puerperal woman, and we can therefore only content ourselves with securing a firmly contracted organ for the purpose of preventing bacteremia. I have nothing new to offer as to the means of accomplishing this object, but I desire to call your attention to the fact that to thoroughly evacuate the uterus of its contents, and to secure proper drainage afterwards by the erect position in bed being often assumed, should never be omitted,-not with the hope that decomposition may be prevented, for this is impossible, but to lessen the likelihood of the uterine walls remaining or becoming relaxed.

The disease is sometimes considered epidemic. Now, is it a coincidence that consecutive cases should occur, or are there zymotic influences that produce a greater number of cases of open sinuses than usual? As for me, when I become apprehensive of this kind of danger in my practice, I intend to commence the use of ergot before the second stage of labor is completed, and continue it until I consider all danger past, thus adding to those methods that are with me an every day custom another shield,—not against contagiousness, not against a new poison, but to controvert a prevailing tendency to subinvolution.

Although in this paper I have quoted very little from authorities, the principles as herein presented are founded on the published researches of the most noted scientists of the present day.

HOLLY, Mich., May 3, 1877.

VISUAL TROUBLES DURING PREG

NANCY AND PARTURITION.

BY EUGENE SMITH, M. D., 95 FORT STREET, WEST, DETROIT, MICH.

Preparing a paper on some subject connected with a specialty which shall be of such a character as to enlist the attention and interest of a large association of medical gentlemen, with but few exceptions general practitioners, is an unenviable undertaking. To do this necessitates, to a great extent, the omission of technicalities, the choice of a subject which is of more than passing interest, and which is of sufficiently frequent occurrence that a majority may have seen or are liable at any time to meet with examples.

I am well aware of the uninteresting character of purely technical papers, such as are apt to spring from an exclusive specialist like myself, and also of the fact that long ones are tedious, and I shall endeavor in the present instance, as in the past, to be as brief as consistency will permit.

The subject which I have chosen for your consideration to-day, and which, though belonging to the department of the ophthalmic specialist, is to fill the indications as above expressed, is one which is entirely ignored in many text books, and but briefly mentioned in any. I refer to visual troubles during pregnancy and parturition, and I have given to my paper this title.

It is, I believe, a very generally accepted fact that gestation develops a temporary albumenuria, in a large number of cases, which may disappear during or soon after puerperal conva