previous labors. Since this death there has not been a case of puerperal septicemia in the institution. The great success attending the work of this Maternity is due to the strict enforcement of the law of cleanliness. Everything and everybody in the house is clean and jealously kept so. This system was enforced by Dr. Goodell, and has been carried out on the lines laid down by him. The routine treatment of patients is as follows: the patient on entering the house is given a hot soap bath, dressed in clean underclothing, and given a clean bed in the waiting ward. If necessary, a laxative is given and the bowels kept soluble during her waiting period. Thereafter, until her confinement, she is obliged to take at least two hot soap baths per week and to wear clean clothes. She is allowed to do such light work about the house as the physician may deem advisable, and is encouraged to take as much open-air exercise as circumstances will permit. Every effort is made by the officers and employes of the institution to make it as cheerful and homelike as possible. When ready for the delivery room the patient is again given a hot soap bath and an anæma and a vaginal injection of 1 to 2000 bichloride of mercury solution. She is clothed in a clean nightrobe and drawers and placed upon a new, clean delivery bed. Scrupulous cleanliness is observed in all manipulations of the patient, and after delivery a second vaginal injection is given, and a vaginal suppository of iodoform is introduced. The patient's person is carefully cleaned and all soiled clothing removed, the binder applied, a clean set of night clothes put on, and the patient placed in a new, clean bed in the ward. All of the soiled articles are immediately removed from the delivery room and a new bed made up for the next patient. The patients in the ward are carefully observed by the nurses, but no unnecessary handling or interference indulged in. The patients remain in the ward until they are able to be up, when they are removed to the convalescent ward. As the ward is emptied, the beds are burned and all the bedding most carefully cleansed. No soiled linen (as draw-sheets, diapers, napkins or other articles of clothing) is allowed to remain in the ward, but when soiled is immediately placed in a covered receptacle and removed from the ward and building. No sponges, wash-rags or absorbent cotton are used in the house. Corrosive jute supplies the place of these articles, being clean, soft, remarkably absorbent and cheap;

it is destroyed immediately after use. The pads used to absorb the lochia are also composed of jute and are likewise destroyed after use. The beds in the wards are of new straw. All discharges from the delivery room are immediately burned. All bedding soiled beyond cleansing or contaminated by purulent or specific discharges is likewise burned. In short, every effort is made to keep the house perfectly pure and sweet. The arrangement of the house permits of rotation in the use of the wards, so that a ward, once emptied, is not again used until three others have been filled. In the meantime it is most carefully and scrupulously cleaned and thrown open to the atmosphere. A similar system is pursued in the convalescent wards and delivery room. A few alterations in the building have very markedly increased the effectiveness of the institution and the comfort of its inmates. In the first place, the bathroom and water-closets have been removed from the building proper and placed in the towers in the rear. The plumbing is as near perfect as modern sanitary science can make it. The verandas have been enclosed in glass, forming large, light, airy corridors about the rear of the building, and furnishing a distinct circulating atmosphere between the house proper and the wards and the waterclosets. The ventilation of the entire building is simply perfect. The capacity of the house at present is about fifty patients per month, and, when a few contemplated changes are made, the capacity will be doubled and the institution rendered as nearly an ideal maternity hospital as is practicable.

Dr. William Goodell said it had always been a matter of great regret to him that he did not adopt this system a year or a year and a half before he did. He supposed it was partly due to the conservatism of old age and partly to a series of some forty deaths from bichl. poisoning he had collected. Tarnier's report of the results following the use of this agent so impressed him, that he was led to make the change. Before he adopted the system which had just been detailed by Dr. Price, he had once as many as five deaths in about 150 cases, four of these due to septicemia. Latterly hardly a year would elapse without the occurrence of one or two deaths. When he first started everything about the institution was new and clean, and for several years he had the best record of any maternity hospital in the world. After the building and articles had become

old, deaths began to occur. He tried carbolic acid, but it proved of little value. After beginning the use of corrosive sublimate injections, iodoform suppositories and antiseptic pads, he did not have a death from septicemia. The only death was one from Bright's disease of the kidneys. During this time he had been consulted perhaps a dozen times in the course of a year to see women dying from puerperal septicemia. He thought that, in private practice, it would not be needful to follow out so strictly the details of the method as it is practiced at the Preston Retreat. For instance, the antiseptic pad and the iodoform suppositories might be done away with. He believed, however, that every practitioner should syringe out the vagina both before the birth of the child and after complete delivery, with a bichloride solution of 1-2,000. The hands should also be disinfected. He was called in consultation by a physician in the country who had had four or five deaths from sepsis in a short time. He found he had been treating a case of phlegmonous erysipelas. He knew of another physician who had lost, he thought, seven cases -certainly five, from dressing a sloughing case of erysipelas. Antiseptic measures would probably have saved all these

cases.

Dr. Henry Leaman would call the attention of those who have the opportunity of observing the physiological processes of labor to one point, viz.: presentation. It is very difficult to accurately determine the presentation. particularly of the face, brow, and posterior presentations. These observations should be verified by examination of the abdomen previous to labor and the locatior of the foetal heart sounds. They should also be confirmed by observation of the position of the head in the act of delivery. A mistake is readily made in posterior presentation. Posterior presentations are, he thinks, more common than we are in the habit of considering them. His object in speaking was to say that every case of labor was a case for the minutest observation. There was another point which he thought should be observed, that was the hour of the day at which labor occurs. There is, he thought, probably some connection between arterial pressure and the time of delivery. In recording the hour there would be an allowance to be observed in cases where the forceps were used. There was another point not mentioned, and that was the position of the succedancum

and its extent. These have to do with the natural process of labor and aid in determining the presentation.

Dr. J. Price said he was as anxious about a labor as he was about a section, when he read reports of maternity hospitals with a mortality of from 2 to 27 per cent. This troubled him not a little now that he controlled a large maternity hospital, one in which Dr. Goodell had left a record of 275 cases without a death. He sees a labor case as frequently as he does a drainage after abdominal section. When this hospital was new, Dr. Goodell had a run of 250 cases without a death from any cause. This was the longAfter this deaths

The

est run of any institution at that time. began to occur. Later he adopted the gospel of cleanliness, and with what results he has just told you; the results are now precisely the same as he left them. In regard to Dr. Hirst's question as to whether the same results might not be obtained by simpler methods, Dr. Price said that they did not differ much in regard to the use of solutions and that part of the treatment. toilet of the house was perhaps just as systematically carried out at the Philadelphia Hospital as at other institutions. The pad which he had shown would hold a pint of fluid. It saved an immense amount of laundry work. It was now coming into use as a menstrual pad, and was very convenient for ladies traveling. In private practice the mortality was greater among the rich than the poor. Among the poor he had had 700 deliveries without a death. He thought the difference was in the water-closets which the better classes had in their houses. The mor

tality throughout the country was large. In a small town in Ohio, with a high elevation and beautifully located, he had recently known of two deaths from septicemia. Last summer he had been called to see puerperal cases nine times, and all died.

Selections.

The Cure for Bacillary Phthisis.

The Med. News has the following from the Internat. Klein. Rundschau, by Louis Weigert:

Two years ago I recommended a work concerning the therapy of diseases of bacterial origin. For reasons which

I can not now particularly enumerate I discontinued it in order that I might restrict my attention to a part of the work, viz.: the tuberculosis. Theoretically I made the following deductions:

All attempts hitherto made to destroy the tubercle-bacilli in a body infected by them failed, for the reason that they possess a greater power of resistance against anti-parasitic agencies, than do the cells of the animal organism themselves.

Just as resistant as the tubercle-bacilli are against such remedies, just so susceptible are they to the influence of temperatures, be they either higher or lower than their optimum temperature.

All varieties of microbes, as was first proven by Pasteur, by reducing the virulence of the bacillus of chicken cholera, and as taught later by Toussaint and Pasteur by their protective anthrax inoculation, are thus reduced by the action of increased temperatures.

The temperature limits within which the tubercle bacilli can flourish are particularly narrow. Were it possible now, by means of a discontinuous sterilized process, to hinder the tubercle-bacilli in their development and thus to diminish their virulence, and were it possible for the human organism to bear the inhalation of highly heated air without detriment, then we would have obtained a means in such inhalations of combating bacillary phthisis.

Thus reasoning, I instituted experiments in various directions, with the following results:

1. The correctness of the announcements made by other investigators concerning the temperature limits, and the effects of various degrees of temperature upon the tuberclebacilli.

2. The possibility of lowering their developmental and procreating capacity by means of discontinuous sterilization.

3. That dry air heated to 150°—180° C. (302°—356° F.) may be inhaled by man without difficulty for several hours, and that such inhalations produce a hurrying of the pulse only during the first few minutes; a diminution in the frequency of respiration, with at the same time a deepening of the inspirations; an elevation of the general temperature of the body by 1⁄2-1° C.; the expired air shows a temperature of at least 45° C.; within an hour after completing an inhalation the temperature of the body returns to normal, and the general well-being remains undisturbed.