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set them floating again in the air, besides permitting the entrance of common air from with

out.

The dry filtration by means of cotton or other substances to entangle and arrest the particulate material floating in the air is not practicable, on account of the rapidity necessary in the entrance and exit of the air in order to displace the agents entering from without during the progress of an operation, and those emanating from the occupants of the room. If, however, we can cause the air entering the room to pass through several showers of water, we have an expedient which may entangle these objects and carry them to the ground.

The following is a description of such a device:

1. Basement. On the floor at the right hand is seen a pot (3) for burning sulphur. It has under ita Bunsen burner; though for quick use, in order to purify the room before an operation, the sulphur is usually made inflammable by mixing alcohol with it. On the right hand, in the wall, is an entrance ventilator or window, before which a steam jet is made to play in order to infiltrate the entering air with very fine globules of water (2).

2. The air thus moistened passes in the direction of the arrows, under a curtain or diaphragin reaching within fifteen inches of the floor. Under this curtain lies an iron pipe with numerous small holes drilled in the upper side, furnishing streams of water which strike the underside of a plank fifteen inches wide, and fall back in a shower of drops. The upper side of the plank is the lower limit of the screen or curtain which divides this apartment from the next. It is thus necessary for all the moving air to pass through this artificial shower near to the floor and into the next room, warmed by the stove seen on the left hand of the diaphragm or screen (5).

3. The air thus warmed ascends to the ceiling, passing over the screen (6), and then descends near to the floor, and passing under the screen (7) ascends as it passes back and forth under the shelves dripping with water, and finally through the spray which supplies this water (8).

Thus there are three filtrations of the air, one by steam and two by water.

4. The air thus filtered three times, emerges through an opening in the floor and goes to the top of the operating room above.

5. Operating-Room. The exit ventilation is seen on the opposite, or right-hand side of the room, in the direction of the arrows. This is effected by a movable shaft or box, made by tacking muslin upon a frame, with a stove inside the inclosure, and the arrow shows the progress of the air next the floor, which has been longest in the room, in its progress toward the stove behind the screen, by the heat of which its escape upward and out of the room is hastened. Fig. 10 is upon the body of the screen, and Fig. 11 is upon the upper portion, which swings upon the ceiling so as to take a horizontal position and close the exit shaft when the apparatus described is not in operation.

Fig. 13 shows the opening for the sky

light. The arrangement thus far is to get an atmosphere more pure than that outside, and, through the frequent change of the air in the operating-room, to get rid, to the greatest possible degree, of the contamination of the air (during the progress of an operation) produced by the emanations from surgeons, assistants, spectators, and the patient himself. This change is secured by the entrance of filtered air from the basement, and the exit, from the floor of the operating-room, of the air which has been the longest in the room, having descended gradually from the ceiling where the air is hottest, after having entered from the warming-chamber below.

6. The floor of the operating-room is made of yellow pine, and filled with paraffine to as great a depth as heated smoothing irons can drive it. By this means, all cracks are filled so as to be non absorbing. Under this, lies a layer of tarred paper upon a common floor upon the joists. Between the joists lies a layer of tarred paper upon the ceiling, the under side of which ceiling is painted, and lined with muslin while the paint is fresh. The muslin is again painted on the under side. The floor thus has seven layers, including the joists.

7. The operating-room is free from closets where any thing unclean can be hidden, and

all the wood-work of the room is either paraffined or painted.

8. There is no opening into any other room; about six feet of space intervening between the door of entrance and the nearest wall of the main building.

9. Before the use of the room for an operation involving the opening of a joint or the peritoneal cavity, it is intended that the rooms above and below shall be fumigated by sulphur burning in the basement. This is to be done for the destruction of any floating material of an organic character which may have gained entrance while the room may have been out of use. Among the disinfectants, Dr. Miller, of Dundee, Scotland, in The London Practitioner for 1884, in an article upon contagion, considers sulphurous acid (from burning sulphur) the most valuable of all disinfectants. Its vapor destroys every microbe, whether zymotic, septic, or pathogenic. Its gas permeates every crack in the walls of a room, and its solution is easily applicable to the surfaces of solid bodies. Its only objectionable feature is the difficulty of using it in rooms while people are in them.

10. This building is the execution of a theory of combining the best known expedients for securing the best possible atmosphere for surgical operations, by excluding noxious. agents and by destroying or expelling those which may have stolen in, or which may be introduced by the patients, or by the surgeon and his assistants and guests. It is supposed that enough air will enter and escape to change the whole volume of air once in fifteen minutes. The exit draft coming from the floor will carry away most of the floating material.

11. The employment of a spray or douche of carbolic acid of the strength of 4 to 100, or of mercuric bichloride of 1 to 10,000, or other antiseptics, locally applied, though less necessary than in an ordinary room, may yet be resorted to in order not to omit useful any precaution.

12. The employment of solutions of carbolic acid, mercuric bichloride or permanganate of potash with the nail-brush for cleaning the hands, should be supplemental to the fixed provisions against septic and pathogenic particulate infection.

13. The bathing of the instruments in carbolized water; while this proceeding is incapable of disinfecting or destroying any germs which may adhere to them, may yet be useful in an antiseptic sense, that is, by destroying microbes in a developed state or freeing them from the supposed secretion by which they may be surrounded, and which may serve as their weapon of attack by which they digest or destroy the surfaces with which they come directly in contact.

14. A useful precaution on the part of the operator may be a bath, shaving the hair off the back of the hands and off the fore arms, and a change of clothing; the hair and beard being dampened so that dust will not escape from them; and yet another precaution may be the wearing of gowns which will oblige all dust escaping from the clothing of the operator and his assistants to fall to the floor whence it may escape with the draft which carries out the lowest stratum of the air.

The construction of an operating-room on the principles here explained in a hospital already built, without erecting a detached building, would require that two rooms should be taken, one above the other, and if the upper one can have a skylight it will be of great advantage. The lower room might be in the basement, with a shaft not less than three (3) feet in diameter extending to the upper room, which might be under the roof for the advantage of a skylight. All communications must be closed by brick and mortar, and an entrance opening made in the outer wall, the approach being secured by means of a platform on the outside of the building, so that it must be unavoidable to go into the open air for entrance and exit. The lower room should be equally shut off from communication with other rooms of the building.

TESTS OF THE PURITY OF THE AIR OF THE ROOM.

The first proceeding for a test, or for a use of the room for opening a joint or the peritoneal or the pleural cavity, is to burn a few ounces of sulphur in the basement. Afterward the steam is turned on, and the two sprays of water are set in operation.

The fire in the two stoves, one above and the

other below, produces the increased lightness of the air necessary to make it rise.

June 28, 1885, ten slices of freshly boiled potato were put upon small plates, covered with small tumblers and sealed with a mixture of wax and paraffine. The plates, the covers, and the knife with which the potato was cut, were made aseptic by boiling.

Ten sealed flasks of culture liquid, kept since the cold weather, were opened, permitting the entrance of air to equalize the density of the

inner and the outer air, kept open a few minutes, and sealed up again by melting the tips.

A bottle of culture liquid, kept since cold weather by a cotton seal, was opened five minutes and sealed again with the same kind of cotton stopper. Ten test-tubes containing culture liquid, and sealed with cotton since last winter, were opened five minutes, and the cotton stoppers replaced.

One of the ten potato slices showed mold in a very few days, and two more later; of

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Window admitting outside air.

Fig. 2. Steam for moistening all floating particles.

Fig. 1.

Fig. 3.

Sulphur pot, with Bunsen burner under it, for slow combustion. A more rapid combustion is secured by mixing alcohol with the sulphur. Fig. 4. Spray of water through which the air must pass in going to the next apartment.

Fig. 5. Stove for heating the air which has been once washed.

Fig. 6.

Screen for forcing the air to pass from near the ceiling through the next washer.

Fig. 7. Shelves of thin muslin through which water drips from the spray in the opening in the floor above.

Fig. 9. Entrance of the air of the room into the draught heated to hasten the rapidity of the escape.

Fig. 10. Stationary partition.

Fig. 11. Movable portion hinged above, and taking a horizontal position under 12, to close the exit through the roof, when the room is used without running the ventilating system.

Fig. 13. Sky-light.

An arrangement, not shown in the cut, secures a flow of warm moist air upon any part under operation. This air is washed by passing through a spray of water holding a solution of mercuric bichloride.

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the latter one was yellow and the other brown. The remaining seven were free from change at the end of thirteen weeks. They all went into decomposition in four months, probably from the loosening of the wax and paraffine seal.

One of the flasks showed mold upon its surface in a few days, while the body of the liquid remained clear. The remaining nine of the flasks were clear at the end of four months. None of the test-tubes became subject to decomposition. The bottle of culture liquid (about 60 c. c. m.) did not go into decomposition. August 16th. Seven weeks from the time of the preceding observation, the room was sulphurized and the motion of the air secured by a fan or Sturtevant blower run by a gas engine. The ten test-tubes exposed seven weeks before were re-opened, and kept open for half an hour, and closed again in the same way without subsequent decomposition or mold.

Ten slices of potato were put up in the same manner as before.

Five slices of gelatine culture were prepared and put into test-tubes sealed with cotton. The gelatine placed upon the slides was made by taking of fish glue, 20 parts; sugar, 13 parts; water, 78 parts; making a total of 100 parts. All the five slides took on mold, which appears to be the sacchromyces mycoderma.

Five potato slices showed discoloration, and five remained unaltered at the end of the third week, but all went into decomposition in three months. The test-tubes, which had been reopened and closed again, remained without alteration as noticed at the end of three months.

A speck of mold started upon the bottle containing the unused portion of gelatine, sealed with cotton, but this was sterilized by boiling, and remained without change as long as the cotton seal remained undisturbed.

It appears from these observations, that the spores of mold are the most difficult to eradicate, while they are the most innocent of all as to surgical considerations.

Several operations involving the opening of joints have been made in this room, without any septic or erysipelatous sequel, and the peritoneal cavity has, up to the time of writing, January 1st, been opened six times.

[TO BE CONTINUED.]

JACKSONVILLE, İLL.

PUERPERAL ECLAMPSIA.*

BY D. T. SMITH, M. D.

My remarks in the present paper will be mainly addressed to the treatment of that form of convulsions occurring in pregnant and parturient women, and which are probably due to the accumulation of urinary elements in the blood. The rationale of the convulsions of uremic poisoning in the lying-in woman has been for years, among obstetricians, a matter of profound study and earnest debate; but it is now generally conceded that urea or its products retained in the blood is the active cause. A few authorities find the difficulties of this explanation too great, and add to this supposed cause other elements of retrograde tissue metamorphosis, which should have been excreted by the kidneys. The recent discovery of peptones in the urine may serve to show us how materials other than urea (the retention of which might be highly injurious) may fail of excretion and so constitute the determining, if not the essential, cause of convulsions. For our purpose it is sufficient to claim that the materies morbi consists of some form of poison retained in the blood which should have been removed by the kidneys. This conceded, we are now brought into one of the most trying experiences of practice. An attack of puerperal convulsions presents us with a therapeutic problem of overwhelming difficulty. In the belief that they may throw some light upon the question, the following cases are reported:

My first case of puerperal convulsions was in the person of a multipara who had been habitually the subject of sick-headache. For some time before the attack the patient had been dropsical, and showed several symptoms of uremic poisoning, which, if met with at this day, would put me upon my guard. I was called, however, to treat the cerebral trouble, and at the time gave nothing beyond a few doses of bromide of potassium. The patient got no better, and told me that it was useless. for her to take medicine, as she had tried every thing in previous attacks without the mitigation of any symptom. Marked cerebral vom

*Read before the Louisville Medical Society, February 25, 1886. For discussion see page 203.

iting developed in the case and continued for several hours, when she became alarmed and sent for a former family physician. He also gave bromide of potassium and withdrew. In a short time convulsions set in. The patient, as I was informed by her physician, was treated with chloroform, bromide and acetate of potash. The convulsions continued for eight days, when she gave birth to a child of about the same number of months, and shortly afterward died. I need not say that I found in this case a solemn and impressive lesson.

The next undoubted case I saw in company with Drs. William Lair and Joseph Greer, two competent and self-reliant physicians in the vicinity of Van Alstyne, Texas. This patient was a primipara and near the seventh month of pregnancy when I saw her. Chloroform had been freely used, and on consultation bleeding was resolved upon. Cyanosis was already so far advanced that not more than an ounce of blood could be made to flow from veins several times opened; edema was extreme, and in the interval between the rapidly recurring convulsions the patient was profoundly comatose. We then decided upon the induction of labor. Not the least dilatation of the os had taken place. A douche of hot water was used for a while, then a bougie was introduced, and lastly the fingers. At about 5 o'clock in the evening the forceps were applied and the child extracted.

It was, in the fullest sense, an accouchement force. I had made up my mind previously to resort freely to catharsis in my next case. But this patient was in so deep coma, when not in convulsions, from the time I saw her, at ten in the morning, until I left her, at six in the evening, that medication by mouth was out of the question. At 9 o'clock that night she died. In this I had had enough of delivery by force. Several times thereafter I had pregnant women under treatment for albuminuria, and, in each case, I gave the compound jalap powder in doses of one dram every two hours till catharsis followed, supplementing the treatment with large doses of bitartrate of potash until I considdered the blood freed from all results of defective kidney action. She was then treated with alkaline diuretics until the danger seemed past.

The next case of puerperal convulsions which came under my care enabled me to avail myself of the lessons learned through this experience. Mrs. William Martin, living near Farmington, Texas, was delivered at 10 o'clock, on a December morning of 1877, and immediately went into convulsions. Dr. William Collins had charge of the case, and he at once summoned Dr. James F. Bristow, of Farmington, and myself. I saw the patient at 3 o'clock P. M. Drs. Collins and Bristow had given her chloroform by inhalation, and calomel with soda by mouth. They had tried three times to bleed her, but the blood would not flow. They had also given her an enema, but, as it was not retained, they did not repeat it. I made a test of the little urine drawn from the bladder, and found it under heat to be nearly solid with albumen. In the consultation I got permission to make the freest use of purgation.

The convulsions were recurring at intervals. of a few minutes; cyanosis was deep and the pulse, now very rapid, at about 6 P. M. became imperceptible. Reflex sensibility remained. for a time, and the patient would at first swallow liquid substances put into the mouth, but some of the liquid failed of deglutition and was spurted out on the return of the convulsions.

I continued the chloroform in moderate amount during convulsions, and gave enemas of soap-suds containing an ounce of table salt to the pint. When one of these would come away, another was at once administered.

Four drops of croton oil were given in one dose. Without weighing or measuring, we made, or tried to make, the patient swallow all the compound jalap powders which our three medicine cases contained, and, when this supply was exhausted, we procured and administered two ounces more of jalap powder and six or eight ounces of cream of tartar. How much of this medicine found lodgment in the patient's stomach can not be stated; a good deal of it was wasted, since some of the doses were given at times when the coma was too deep to admit of swallowing, the medicine being spurted out of the mouth during the ensuing convulsion; but she certainly retained a large quantity. Bleeding was essayed three times

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