HYDROGEN PEROXIDE IN THE TREATMEnt of PuerpeRA

SEPSIS. Two principles of fundamental importance concer ing puerperal sepsis are, first, that in these days of advanced asepsis puerperal sepsis should not ordinarily occur, and, second if it does occur, it should be treated aseptically rather than anti – septically. An exception to the first principle is found in such cases as are autogenetic-a class of cases which, although their existence is denied by competent authority, the writer is convinced are sometimes encountered. These unpreventable on es are exemplified by instances of putrefaction and subsequent se psis occurring in women, in whose products of conception life has been extinct for several weeks.

When sepsis results from external causes, it is because the accoucheur or nurse has failed to secure surgical cleanliness. This, in most instances, is highly reprehensible. It is true that in the humble walks of life poverty, filth and ignorance are pow erful factors in the causation of sepsis, and frequently triumph in spite of the physician's most watchful care. Elevation of temperature, not dependent upon some easily removable or transient causes, such as constipation or the first secretion of milk, but associated with scanty, offensive or absent lochia, is the invariable indication that infection has taken place, and that prompt clearing of the uterine cavity is imperative.

The writer's method of treatment in these cases is to first irrigate the interior of the uterus with a normal salt solution, remove secundines or other retained foreign materials by means of the sharp curette, then again irrigate freely with salt solution After thoroughly drying with aseptic cotton or gauze, hydrogen peroxide is applied to the uterine cavity by means of a small intra-uterine syringe, or an applicator upon which is wound a piece of aseptic gauze or absorbent cotton saturated with the agent. The foam should be removed and fresh applications made until the cessation of foaming gives positive evidence that the uterine cavity has been thoroughly cleansed. This procedure should be practiced daily until the temperature falls to normal and remains at that point. This, in the writer's experi

[*If you want definite and reliable results, do not fail to use Marchand's preparation.-ED. S. P.]

ence, always occurs within a week. The following cases are illustrative of the efficacy of this mode of treatment:

Case I.-Mrs. H., aged 40, in her seventh labor, as the result of rigid cervix and violent uterine contractions, had rupture of the uterus in its long diameter, involving four-fifths of the thickness of the wall. Mural abscess and sepsis followed, associated with profuse, offensive lochia, the color of dirty dishwater. On the fifth day the uterus was above the pubis and spongy. The ordinarily recommended treatment was practised without improvement, but on the eighth day the method above detailed, with hydrogen peroxide, etc., was instituted, with the result that the temperature immediately fell to the normal point and the patient made a good recovery.

Case II.-Mrs. D., delivered of her third child two months prematurely. Baby much emaciated in consequence of interference with nutrition from placental degeneration, lived twelve hours. Within the first five days the temperature ranged from 101° to 105° F., and the usual concomitant symptoms of sepsis were present. On the sixth day after delivery, curettage, with free douchings of hot salt solution, was practiced, and the usual application of hydrogen peroxide was made. Temperature taken half-hour after treatment showed a fall of 1°, while on the seventh day it was normal. From this date on convalescence was uninterrupted, and the patient was out of bed as early as though no complication had occurred.

Case III.-Mrs. S., after rapid delivery, did well for nine days, when the usual symptoms of puerperal sepsis appeared, due in all probability to her wretched surroundings, lack of proper nursing, etc. The treatment above detailed was exhibited, the temperature promptly returned to normal, and there was speedy and satisfactory convalescence.

The rationale of the treatment by bydrogen peroxide is that this agent causes a rapid oxidation or super-oxidation of effete organic matter, thus completing in a very short time what it takes the unassisted process of nature a dangerously long period to accomplish. It initiates, but infinitely improves and accelerates, the efforts of the human organism to remove offending foreign materials. The advantage of this agent over mercuric chloride, carbolic acid and other agents that act chemically, is

that it is non-corrosive and non-destructive of healthy tissue. Furthermore, the results obtained from the use of hydrogen peroxide are vastly superior to those obtained by the use of any other agent, so that the writer now approaches the treatment of puerperal sepsis with less fear of unfortunate results than he has ever before experienced.-Jno. N. Upshur, M.D., in Va. Med. Semi-Monthly.

SIR WILLIAM GULL'S DIRECTIONS CONCERNING TYPHOID FEVER.—The Albany Medical Annals for October quotes the following directions of Sir William Gull to the attendants of the Prince of Wales when suffering from typhoid more than twentyfive years ago, as being as applicable to-day as then, and says that they cannot be too often reiterated: 1. Typhoid is a dis.

ease which runs a more or less definite course.

It cannot be stopped or cured simply by medicine. 2. The chief thing to be done at the outset of an attack is to send the patient to bed so as to save strength from the beginning. No strong purgative medicines are desirable. 4. As the fever develops and the strength grows less, light food should be given at short intervals. This must be directed medically, but in general it may be said that the amount required is that which induces repose and sleep. 5. The bowels may be left to themselves. If unmoved for twenty-four or thirty-six hours, a lavement of warm water may be necessary. 6. The restlessness or wakefulness in fever is best remedied by the careful giving of wine or spirits with the food or in water. Sedatives such as opium are inadmissable-most injurious. 7. The bedroom should be kept at a temperature of 62° to 64°. 8. Great care is necessary to keep the bed clean and sweet. This is most easily done by having in the same room a second bed, to which the patient can be removed for two or three hours daily, while the other is thoroughly aired and the

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linen changed. 9. All fatigue is to be sedulously avoided. visitors should be admitted, and no other person than a nurse and one attendant to help her. 10. The patient should never be left unattended for a moment, as in the delirium of fever he might jump from bed and injure himself. 11. As to medicines and the treatment of complications, the immediate medical at

tendant must be responsible. 12. As the discharges from the bowels in typhoid fever are a source of contagion, it is desirable that before being thrown down the closet they should be largely mixed with some disinfectant. On the same principle the strictest cleanliness must be observed in the sick room. 13. There is no reason to believe that typhoid fever is contagious from individual to individual in the ordinary way. The largest experience shows that it does not extend like an ordinary contagious disease to nurses or others attending upon patients suffering under the disease.-New York Medical Journal.

THE DOCTOR.—A doctor should be a man of the widest culture, for no science is so deeply indebted to all sources of learning for its truths and forms of expressing them as is medicine. It draws its magic from the hidden mysteries of nature, simulates protean life, consorts death's phenomena familiarly; through metamorphosis with easy, royal, grace, it goes to share the triumphs of final forms. Reason and philosophy are its friends and counselors, experience and history its prophets, and antiquity opens her darkly clad bosom to reveal an imperial wardrobe for the priests, cup-bearers, and the whole retinue of this science. All nature is the realm of medicine. The doctor should know his realm; should know anatomy as the carpenter knows the timbers in a house he builds; he should know physiology as the engineer knows the machine he directs; he should know drugs, their chemistry, physiological action, etc., as the alchemist knows the reagents before him; be as ready in formu. lating as the pharmacist is supposed to be in compounding his prescriptions, or the housewife in preparing the simplest diet. He should be as acute in detecting pathology as the miller in detecting disease in grain. In a word, he should familiarize himself with medicine as a woman knows her domestic circle and its round of duties.

To do this he should be familiar wrth the terms of his profession, know every word, phase, theory-all facts. He must read, remember, think, know. Know man, Nature his mother, her laws, her rewards for obedience, her penalties for infraction; the sum of violations, in false customs, artificial habits,

and sham obedience, and their pernicious offspring, disease-the constant attendant of vice and ignorance, the arch-enemies of human physical ease, as sin is to spiritual ease; each begets dis. ease, chaos. Medicine comes as a mediator, and the doctor is her priest and interpreter; his end is amelioration, palliation, relief. By his knowledge many are to be healed. How tireless, then, ought the doctor to be! With ever relentless toil he should strive to master the whole realm of knowledge for the power it would give. The task means a lifetime of toil, but the end justifies the means. Every power of mind, every faculty, and conscience demand it! The days of the charlatan are num. bered and finished. Medicine is a learned science, and ignor. ance has no place beneath its mantle, nor elsewhere, ere long; for with our common schools, high schools, academies, colleges and universities, we should be a nation of savants; and the holiest fillets of learning, science and wisdom are to fall upon the shoulders of the doctors. He who "spoke as never man spoke" nearly twenty centuries since proclaimed in the parable of the Samaritan the principles of antiseptic medicine, and chose a man, a doctor who “had perfect knowledge of all things,' to teach it to the profession and the world. "And why should we be less than he?"-Ernest L. Stephens in Texas Courier-Record of Medicine.

"THE ABUSE OF ERGOT IN THE TREATMEnt of Hemorrн. AGE was the title of a paper read by Dr. Ferdinand A. Pack. ard at a meeting of the College of Physicians, held in Philadel. phia, Nov. 2d, ult. He contended that the administration of ergot being productive of an increase in blood-pressure, which it is desirable to avoid, the exhibition of the drug is contra. indicated in all varieties of hemorrhage, with the possible ex. ception of the postpartum variety. Attention should rather be directed toward the administration of remedies such as tend to favor coagulation of the blood, as calcium chlorid. etc., the me. chanical favoring of a clot and its non-disturbance, particularly by rest, etc. In the discussion, Dr. E. W. Watson coincided with Dr. Packard, particularly with respect to pulmonary hem. orrhages and hemorrhages from eroded vessels. He thought,