retransferred to beef bouillon; and that, while inoculation with the most virulent form caused poisoning without suppuration, inoculation with the attenuated form (that prepared from chicken bouillon) produced slow changes ending in abscess formation. The discrepant results of inoculating animals with pure cultivations may be due to the fact that the change of media necessary to obtain a pure cultivation has altered the properties of the microbe. Further, there remains the curious and interesting fact that the tissues of certain animals will not allow certain microorganisms to flourish in them: Chauveau and Fraenkel found the guinea-pig to be proof against inoculation with the virus of puerperal septicemia.

These scientific facts give us a basis for this proposition thatThe condition of a patient has a leading role in the development of septic poisoning: the nearer the patient's health approaches the normal standard the less is the need of antiseptics. This is a trite. fact in regard to the development of morbid processes generally; but its significance in the case of septic infection has not been sufficiently insisted on. The more nearly the patient's condition approaches that of normal health the greater is the germ resisting power of the tissues, or, in more scientific phraseology, the less favourable are the media which they afford for the growth of microbes. In gynecological operations, especially where the patient's general health is approximately normal (where it has not been seriously affected by the local condition calling for operative treatment), cold water is all very well; but the puerperal patient is so much below par that we cannot trust to cold water or Condy's fluid, but must use the most reliable antiseptic.

2. Microorganisms require the condition of rest for their development; they will not multiply in the circulating blood. Doléris calls attention to this fact as explaining why, in cases recorded by himself, Pasteur, and others, micro-organisms were not obtained from cultivation of the blood during life, but were readily prepared from cultivations of the blood and other fluids. post-mortem; and were likewise found in the tissues, so as to leave no doubt of their having been present before death.

We are not yet in a position to say whether in cases of puerperal septicemia we have to do with septic infection alone, or whether septic intoxication may not also occur. In the majority of cases which have ended fatally, and in which the organs have been examined, micro-organisms have been found-pointing towards the existence of a virus which multiplies in the body, like that of a specific fever. That this virus is specific there is no proof. Lomer points out that similar chain-like micrococci have been described in scarlet fever, erysipelas, and pyæmia. The fact that they do not multiply in the circulating blood explains, I think, why the washing out of the uterus is followed by such good results; for one's first doubt naturally is how the washing out of

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the uterus can prove beneficial, if rapidly-multiplying microbes, producing symptoms of septicemia, have already passed into the system. The answer to this question is, I think, that in these cases the toxic material does not multiply in the blood, but is generated in the uterus alone, from which it is served out into the system, and eliminated by the excretory organs. The relation might be illustrated from the gas supply of a city; in which the gas is, of course, produced in the retorts at the central work, and is simply served through the pipes and eliminated at the burners. By washing out the uterus we put out the retorts and stop further production; and, in a healthy constitution, the elimination of the poison is only a question of time.

There are, of course, cases in which the local process has gone beyond the uterus, e.g., where we have septic thrombosis in the veins of the broad ligament; in this case the production of toxic material may not be limited to the uterine cavity, and therefore the washing out of the uterus will not cut off all the supply of the poison. Or again, we may have the micrococci multiplying in the lymphatic system or in the Fallopian tubes. In these cases, also, washing out the uterus will do no good.

3. The microbes described in septicemia differ from those characteristic of putrefaction. In the great majority of cases of puerperal septicemia, the micro-organism found has been the chain-like micrococcus; the rod-shaped bacteria, common in putrefying matter, has rarely been found in the blood and tissues of the body, although it is not uncommon in the lochia. May we not draw this practical inference, that we may have in the uterus septic matter which is not putrid, and therefore showing no fœtor; and formulate the proposition that while all putrefaction within the uterus after delivery may cause septic poisoning, not all septic poisoning implies putrefaction. We merely throw out this possible explanation of those cases in which we have septicemia without foetid lochia, and ask whether we are not bound in those cases also to give the patient the chance of washing out the uterus.

Professor Simpson said: No subject can occupy more profitably the time of the Society than a consideration of the genesis of septicæmia, and I am glad to see Dr Hare here, who will be able to give us further information on the scientific side of the question. I should like to ask Dr Hare to give his opinion as to the following points-Whether we are to look for the cause of septicemia as being always a specific germ which had to be somehow introduced into the mother's genitals, or whether we are now to admit that other poisons, such as that of diphtheria, erysipelas, etc., if introduced into these passages, may cause a similar condition. Gusserow has, of course, shown that a woman exposed to these poisons may be the subject of attacks quite different from anything we can call septicemia, but would these poisons, if introduced into the genital canals, give rise to such attacks, or to

the more definite symptoms of what we call septicæmia? Such considerations are interesting in relation to such cases as those recorded by Dr Hunter, who had a series of septicæmias after having attended a patient suffering from erysipelas on the hand. Did these cases run a course similar to a typical septicemia? Again, it is important to determine whether the poison is introduced only by means of fingers, instruments, apparatus, etc., or if the introduction may not sometimes depend on the germladen atmosphere. In the latter case there would be danger whenever a genital wound was exposed; or the microbes might be introduced through the lungs or stomach, and exert their deleterious influence when they came upon the uterine surface or on tissues of lowered vitality. It is well to bear in mind that easy labours are, as a rule, seldom followed by septicemia; and Winckel has shown that it is exceedingly rare in precipitate labours. This is a point of much interest. Possibly it may be that the suitable media for the cultivation and development of the poison is absent in these cases. We will all agree with Dr Barbour, that we should have early recourse to washing out the uterus in all cases where we find signs of the disease. I agree further with him that corrosive sublimate is the best solution for this purpose. I cannot be deceived at the same time into supposing that the use of this substance is entirely devoid of risk. Thus, in the Maternity Hospital during the present quarter, a patient who showed marked signs of septicemia improved rapidly under regular uterine douching with corrosive, but on the fourth day had bloody stools, owing undoubtedly to the absorption of the mercury. But we must be content to know this; and we will best avoid it by douching the uterus with plain hot water after the antiseptic has been applied.

Dr Angus Macdonald doubted if he could add much to what had been so well put by Dr Barbour. He admitted that the subject was one of the highest importance. He handed round a drawing of the lochial discharge as seen under the microscope, which had some bearing on auto-infection. He made a series of observations on the condition of the lochia with reference to micro-organisms some time ago. He took great precautions in collecting the fluid so as to prevent the contamination of it by germs floating in the air. The specimens for examination were collected under the spray with every care, and in every case it was found that the cultivations gave an abundance of micrococcus, and that in fluid. removed even from the cervix. He was of opinion that the ordinary lochia might itself provide the poison, a view which was held by the old Greek physicians. He certainly agreed with Dr Simpson in thinking erysipelas might give rise to a condition in all respects identical with that of ordinary septicemia. He recollected a case in which a patient was seized with erysipelas post-partum. The mischief began in the head, and extended downwards over the body. No symptoms of septicemia whatever were to be found until the disease reached the vulva, when a fatal

result occurred with great rapidity, and with all the signs of acute septicemia. He heartily concurred with the latter part of Dr Barbour's paper-that bearing on the practical questions between micro-organisms and the use of antiseptics. The relation of these organisms to the production of puerperal fever had been clearly established, and, moreover, we could completely destroy them with corrosive sublimate. In this way we could be sure that we were not carrying them from one patient to another. We might not be able to abolish the disease entirely, as it was likely sporadic cases would occur in spite of all precautions, but we could be quite sure of not infecting our patients. Thus in the Maternity Hospital he (Dr Macdonald) had attended during four tremestres, and had had no case of death from this cause, and, indeed, only one death from any other cause. This result had followed the careful adoption of antiseptic precautions in this Hospital, and was a condition which compared with the most favourable of private practice. He quite agreed with the importance and value of washing out the uterus with corrosive sublimate solution, but reserved this where real danger was threatened, as evidenced by the gravity of the constitutional symptoms. In simple cases he merely washed out the vagina. He was exceedingly pleased with Dr Barbour's paper. He was convinced that a conscientious man had now the means at his command of obtaining an assurance of safety against conveying this disease from patient to patient.

(To be continued.)

CARLISLE MEDICAL SOCIETY.

SESSION II.-MEETING II.

Thursday, December 10, 1885.-Dr LOCKIE in the Chair.

Dr Lockie read a PRESIDENTIAL ADDRESS.-After thanking the members for the honour they had conferred upon him, and paying a tribute to his predecessor in the Chair, he glanced briefly at a few of the changes which had occurred in the conditions of medical life and practice during the last twenty-seven years. Having passed in review some matters of local interest, he noticed a number of pathological conditions with which the profession at large had become acquainted within the time named, also a number of new remedies which had been introduced into general use, and which were likely to remain of permanent value. He then proceeded to speak of new instruments for attaining precision in diagnosis and for treatment, with which we had been furnished during the same period, mentioning the clinical thermometer, concerning which it might not be strictly accurate to speak of its introduction as being recent, it having been actually employed in measuring the height of fever by De Haen and Currie at the end of the last century, and by Christison in the epidemic of relapsing fever of 1817-19 in Edinburgh. Indeed, Sanctorius (1561-1636) "had

had the idea of investigating the temperature of the human body in health and disease" by means of the thermometer. Its employment did not, however, become general until recent years. Among the other instruments named were the laryngoscope, the ophthalmoscope, the pneumatic aspirator, the sphygmograph, the hemacytometer, and the hæmaglobinometer. The President then went on to say, "In no department of medicine have there been greater and more striking changes than in the realm of pathology, and in this domain nothing more noteworthy than the rise and development of the germ theory of disease, taking this term in the restricted sense that many diseases are associated with, and probably caused by, the introduction into, and development and reproduction in, the blood and tissues, one or both, of microscopic organisms. To this doctrine we owe the antiseptic system of surgery, which, whatever be its ultimate outcome, has beyond all question had a mightily beneficial influence in the treatment of wounds, and has immortalized the name of its illustrious founder. . To this germ theory we owe the introduction into general use of many antiseptic remedies of which physicians have not been slow to avail themselves, though, it must be confessed, with, as yet, a very imperfect result. But further, may it not be maintained that not only has this doctrine furnished us with new remedies, but it has thrown a ray of light upon the action of old and well-established ones. Physicians have been using antiseptic remedies with success without being aware of their antiseptic properties. Is anything better established than the value of mercury in syphilis? Is not syphilis associated with a microbe? Does not the syphilitic poison in all probability either consist of this microbe, or of something produced by it in the course of its life history? Is not mercury one of the best, if not the very best antiseptic known? There is a remarkable consensus of opinion upon this point. Sir Joseph Lister found a solution of the perchloride one of the best antiseptics. The most advanced accoucheurs use it constantly. Sormani and Brugnatelli, in the course of their experiments, found it, amongst thirty-six substances, the most destructive of tubercle bacilli in phthisical sputum. Miquel, who has made the most extensive observations on micro-organisms, places the biniodide of mercury at the very head of the list of antiseptics, numbering ninety-one, whilst the perchloride is fourth on the list. He found that 0025 gramme (about three-eighths of a grain) of the biniodide was sufficient to prevent putrefaction in a litre of neutralized bouillon, and that 0.070 gramme of the perchloride effected the same object. Can anything be more reasonable than the assumption that when mercury benefits syphilis, it does so in virtue of its antiseptic qualities? May not the same be said of iodide of potassium, which, though an antiseptic, is many times more feeble as such than mercury, and which, though effectual against some of the manifestations of syphilis, has long been thought powerless thoroughly to eradicate the syphilitic poison?