seventeen pounds of blood in the average human subject to disinfect. We must also consider that the alimentary canal is a colossal organ, the length of which is about thirty feet, and in its largest portion has a diameter of twelve inches. While its chief function is that of digestion, it is also the great excretory organ of the body. One-fifth of its length is a common receptacle for the excrements of the animal economy, the sole province of which is to subserve the purpose of a sewer to eliminate the waste material from the organism.

We can accept the teachings of Oppler and other bacteriologists that the stomach and bowels are never free from micro-organisms. Indeed, it does not seem that our Maker designed that this canal should be rendered sweet and aseptic, and I regard it a physical impossibility to accomplish this without destroying its functions.

But without going further into the details of this treatment, I unhesitatingly declare the doctrine to abort every case of typhoid fever by the methods proposed, having subjects visit the physician in his office and placing no restriction upon diet, is chimerical, fallacious and pernicious.

DISCUSSION ON DR. RICHARDSON'S PAPER.

Dr. DeSaussure Ford, of Augusta, was called upon to open the discussion. He said:

Mr. President-I have only just come in, and have only heard a portion of the doctor's paper. I can say, that I have seen such cases as the doctor describes, and have had just the same experience as he has had. More recently positive diagnoses have been made by bacteriological examinations of the blood of typhoid fever patients to determine whether it is typhoid or not. These atypical and typical cases of fever we are all acquainted with. In one of his cases Dr. Richardson said, and it was an atypical case, that for the first twenty-four or forty-eight hours he gave qui

nine, and his opinion was that within five or six days relief was very positive, although he does not give credit for the possibility of the medicine bringing about that result, quinine being both antiseptic and antipyretic.

Dr. R. R. Kime, Atlanta: It might be of interest in the line of obstetrical work to report a case I had some time ago. The patient was taken with typhoid fever at her confinement. The course of the fever was scarcely that of typical typhoid, but in the main this was so. At the end of the second week there were evidences of some uterine disturbance in connection with the typhoid condition, and I deemed it necessary to investigate the cavity of the uterus, the patient having had increased hemorrhage. It is my rule in those cases where we have evidence of uterine disturbance to investigate the uterine cavity and find out what the difficulty is. In this case I held the cervix open and irrigated with water. Understand, three days previously there was an increased flow amounting to a hemorrhage almost. As soon as I commenced to wash out the uterus the hemorrhage began. Before I tamponed the uterus the patient had almost become pulseless. The tampon was left in forty-eight hours. I might say here that Dr. Hardon was called in consultation and agreed with me that the case was one of typhoid fever with hemorrhage from the uterus. On removing the tampon at the end of the time mentioned, a stream of hemorrhage the size of a lead pencil began to issue again. We simply retamponed the uterus with iodoform gauze which was allowed to remain for thirty-six to forty-eight hours. In renewing it, the patient became pulseless again, and the indications were that she would almost die before we succeeded in retamponing the uterus. The tamponing of the uterus had to be repeated and kept up for three weeks before finally removing the last tampon to prevent the patient from bleeding to death.

Dr. Richardson (closing the discussion): There is very little for me to say in my closing remarks, as I have nothing to refute. I was not permitted to complete the read

ing of my paper, and therefore could not bring out the culminating facts of my thesis, namely: That these cases terminated spontaneously, regardless of treatment. The other point I wished to make was that the administration of quinine to differentiate malarial from typhoid fever was better than any revelations of the microscope. A third point was the impossibility of rendering thirty feet of the prima via and seventeen pounds of blood and internal viscera aseptie by the administration of any known medicine. Those were the points I desired to emphasize.

MEDDLESOME INSTRUMENTATION IN URE

THRAL DISEASES.

BY W. L. CHAMPION, M.D., ATLANTA, Ga.

The ugly train of symptoms that follow in the wake of bad urethral surgery, and the results obtained from such instrumentation, is frequently a monument as lasting to the surgeon as a fracture improperly treated. It seems the impression is prevalent in the minds of some, that the urethra has no function at all, but was made for the surgeon's use to demonstrate his skill in the use of instruments.

Considering the teachings of to-day and our knowledge of the importance of cleanliness in surgery, it is a puzzle to know why physicians continue to thrust dirty instruments, made sleek with rancid grease, into the urethra and bladder, producing untoward results and not knowing the source of infection. If the instruments are clean, it frequently happens that they are passed into the bladder, carrying purulent material retained within the urethra. While a diseased urethra is as a rule an unclean canal, it frequently happens that the deep urethra and bladder are in a healthy state, so there is no common sense in “adding fuel to the fire" by using unclean instruments or forcing poisonous material into uninfected areas.

The close observer rarely overlooks the origin of urethral fever, swelled testicle, cystitis, prostatitis, damaged kidneys and many serious conditions directly due to the meddlesome use of instruments. Not to be a meddler in the treatment of genito-urinary diseases, it is essential to

be familiar with the use of instruments; to know when to use them, and what kind of instruments to use.

The use of small steel instruments, below 18 or 20 French cannot be too strongly condemned. With our knowledge of the anatomy of the urethra, and of the dangers of passing small steel instruments, false passages should be a thing of the past. The soft bougies, though not as durable as the steel sounds, accomplish the same results, and should always be used when a small instrument is called for; and even the larger ones are just as serviceable and produce less pain on introduction.

The routine practice of passing sounds into the bladder in treating strictures in the penile portion of the urethra, is not only useless but bad surgery. There is always a liability of infecting the bladder, and producing irritation. of the prostatic urethra. The short, straight sound passed through the stricture accomplishes the same result as the curved instrument, and the danger of producing complications is lessened.

An important point that should never be overlooked, is the necessity of having instruments perfectly clean that are to be introduced into the bladders of old men with enlarged prostate; and this point should always be impressed upon the patient when he is given a catheter to use.

The carelessness with which instruments are thrust into the urethra frequently results in permanent injury to the tissues. "It is a very easy thing to force a catheter or sound through the urethral walls, or to produce sufficient injury by bruising and laceration to result in cicatricial deposit and consequent stricture." This is especially true when the canal is highly inflamed; and probably many of you have had cases of cystitis, and later organic stricture to treat due to meddlesome surgery of this kind.

The custom of many physicians of using the steel sound for exploring the urethra, to determine whether stricture