sor Syme uttered the words which I have just quoted? When full and fair credit is given to the other aids which have come to the profession as a whole, through increase of knowledge and enlargement of experience during the period of wonderful surgical activity from 1865 to 1888, how much room is left for credit on behalf of antiseptics? In our reflections and calculations on this point it is only just to note the remarkable fact that among the most eminently successful of the abdominal surgeons of to-day we find men like Tait, Bantock and others, who claim that, so far as their experience in abdominal surgery goes, antiseptics have been weighed in the balances and found wanting, and by whom they have been denounced as a delusion and a snare. It has been customary of late years, when a successful operation of a new or exceptional nature, such as resection of intestine, cholecystotomy, splenectomy, etc., is recorded, to claim the result as another argument or fact in support of antiseptic surgery. And it may be that the belief in the marvelous advantages of such safeguards as it is supposed to furnish has inspired confidence beyond that which our increased knowledge of pathology, our improved dexterity in manipulation and our faith in the generally recognized and approved principles of surgery independently of antiseptics can afford us. But is it not just possible that too much value has been attached to the influence of antiseptics and too little to the numerous other factors which enter into this complex and many-sided problem? Is it not just possible that even if Listerism had never been heard of, surgeons would by this time or, at all events, sooner or later, have come to appreciate the immense value of perfect surgical cleanliness and conceded to it its true position in relation to all the other essential requisites of successful operating, such as tenderness of manipulation, efficient drainage, healthy surroundings, judicious dieting, conservation of blood, prevention of shock, wise and skilful nursing, etc.? All honor to Lister as the great apostle of surgical cleanliness, no matter what the ultimate fate of his theoretical views may be. The germ theory of disease as applied to surgery may be materially modified, or even proved to be in certain important respects erroneous; the use of carbolic acid, bichloride of mercury and the other germicides may ultimately come to be regarded as worse than useless, and all the complicated paraphernalia which constitutes antiseptic surgery declared unnecessary and absurd; and still the fact must remain that, whether right or wrong as a matter of abstract scientific truth, the theories and the methods

of Lister have done much to encourage the progressive modern surgeon in his righteous ambition to carry his beneficent labors to the furthest limit of possible usefulness. The simplest and most obvious truths are often the most difficult of apprehension and application by those most interested in their effects. It will be a most striking and wonderful exemplification of this old and true saying if it should ultimately appear that the sum and substance of the life work of this great surgical prophet and his disciples is comprehended in the ancient scriptural admonition, “Wash you, make you clean," Whatever the ultimate fate of the germ theory in surgery may be; whatever the fate of the so-called germicides like carbolic acid, bichloride of mercury, etc., may be, one thing is certain: that anything like a return to the old, loose and careless methods, as regards cleanliness, of conducting surgical operations and of dressing surgical patients is absolutely impossible; and for this the world will always feel grateful to Joseph Lister.

ANESTHETICS.

There are few subjects of surgical interest that have been so freely written about and discussed in our day as anæsthetics. Even the briefest review of this vast field of surgical literature would lead me far beyond the scope of this address. I merely refer to it for the purpose of declaring that, after very careful and respectful consideration of the views of those who have written and spoken on the subject, and after impartially testing the different substances recommended, I find myself irresistibly forced to the conclusion that, upon the whole, for all general purposes, chloroform posses superior advantages. My own experience with it induces me to believe that, when carefully administered in suitable cases, it is little if at all more dangerous than other anaesthetics, and its advantages in other respects are too well known to require further illustration on the present occasion. Death under anæsthetics is in every case a great and shocking catastrophe; but when it occurs during some comparatively trivial procedure the circumstance is appalling. Fortunately, in the progress of surgery of late years, local anæsthesia by ether spray, cocaine, etc., has been found to constitute an efficient and altogether safe substitute in a large field of minor though painful operations. That in the near future other and better general anesthetics than any yet known may be discovered, is surely not an unreasonable expectation, when we consider the ceaseless energy of earnest and brilliant students

experimenters in this as in all other departments of medical science. As a justification for my own faith in the safety and general efficacy of chloroform, perhaps I may be allowed to state that it is very nearly thirty years since I commenced using it, and so far no accident that could in any way be attributed to its use has occurred to disturb the early impressions as to its trustworthiness made upon my mind by the eloquent teachings of James Young Simpson and the no less powerful utterances and example of James Syme. To the use of the simple little apparatus which I here present, I have come of late years to attach great value in the administration of chloroform.

THE MICROSCOPE IN SURGERY.

Who of us is unable to recall the time when great things were hoped for by surgeons from this truly wonderful instrument, which has done so much in other departments of science? Who does not recall the confident predictions indulged in as to what would be accomplised by its means in the diagnosis and classification of tumors, in the diagnosis of the different morbid fluids, and so on? Can it be claimed to-day that these hopes have been realized, these predictions fulfilled? I fear not. How much has it done to enlarge our knowledge of the essential characteristics of different kinds of pus? Can we by its means distinguish with perfect certainty between the pus of gonorrhoea and the pus from a chancre or any other source? In short, has the microscope added anything to our powers as practical surgeons so far as this and other common surgical fluids are concerned? In the diagnosis and classification of tumors great things were expected of it, and it was also expected that by its means the prognosis of morbid growths would become a matter of actual and unmistakable demonstration. That much information interesting to the scientific surgeon has been obtained as the result of vast efforts in the investigation of the origin and the essential nature of morbid growths no one can deny; but for the practical purpose of deciding whether or not a given tumor should be removed by operation, or for the purpose of determining the prognosis in relation to the question of return or the danger of general infection of the system, I have not been able to persuade myself that the microscope has added much if anything to our resources. We must still depend upon the ordinary clinical signs and symptoms, the anatomical relations, and the facts of its history in determining our views as to the true nature and the best treatment of a morbid growth.

In certain departments of practical medicine nearly related to surgery, such as the examination of urine, etc., the microscope is valuable; but to the ordinary practical surgeon its usefulness has not equalled the expectations of its early enthusiastic advocates.

TO BE CONTINUED].

NOTES AND FORMULÆ.

DR. STEPHEN, of the Cyprus Medical Service, has found. antipyrine of incalculable value in epidemic cerebro-spinal meningitis. He advises it in three to fifteen grain doses given in the course of an evening and night.

CARBOLIC ACID IN SICK-HEADACHE.-Dr. Love says that when sich-headache and vertigo are due to the fermentation of the contents of the stomach occasionally attended by vomiting, relief can be afforded by two-drop doses of carbolic acid well diluted.

INFANTILE DYSPEPSIA.-Of mucilage of gum acacia, eightyfive grammes; bicarbonate of sodium, sixty-five centigrammes; chloroform, ten drops; essence of verbena, three and one-half grammes. One teaspoonful of this mixture every two or three hours for a six months' baby.

A DANGEROUS COMBINATION.-When antipyrine is dissolved in sweet spirits of nitre, the resulting solution will assume a rich green color. A new substance possessing highly poisonous qualities is formed. Care should be taken that they are not. administered in the same solution.

SALICYLATE OF SODIUM FOR GONORRHOEAL EPIDIDYMITIS.Dr. Henderson reports the successful use of salicylate of sodium in three cases of gonorrhoeal epididymitis. "The dose of the salt should not be less than twenty grains, and should be repeated hourly until at least three doses are taken, afterwards. the same dose may be continued at longer intervals.”

GLYCERINE FOR HABITUAL CONSTIPATION.-Dr. J. Athaus. says that the injection into the rectum, by means of an ordinary glass syringe, of a teaspoonful to a tablespoonful of glycerine, is an effectual way of inducing peristaltic action of the bowels.

The larger the amount of fæces, the greater is the effect. There is no discomfort or pain; sometimes a little throbbing is felt in the rectum for a few minutes.

COCAINE IN ZOSTER AND PRURITUS ANI.-Dr. Bianchi recommends a three per cent. solution of cocaine to be painted on to relieve the itching in these troublesome affections.

SODIUM PHOSPHATE IN INFANTILE DIARRHOEA.-Dr. H. C. Wood says that in cases of infantile diarrhoea, attended by claycolored stools, sodium phosphate in repeated small doses given in milk is of great value. In the types attended by alternate diarrhoea and constipation, it is especially indicated.

OINTMENT FOR SYPHILITIC RASHES.-Diday recommends the following ointment for syphilitic rashes on the face and exposed surfaces:

M.

R. Biniodide of mercury.
Prepared lard....

80 centigrammes. 30 grammes.

CHLORATE OF POTASH POISONING.-The Medical Press says that it is evident that if five-grain pellets of chlorate of potash be thoughtlessly sucked at intervals throughout the day a very considerable and certainly injurious quantity will ultimately be absorbed. In children it produces cerebral symptoms, especially "night terrors," with more or less intense prostration.

SORE NIPPLES.-Dr. J. F. Scarff gets better results from the following application than any other:

A RELIABLE LIQUID PEPSIN.-I have used Lilly's liquid pepsin for the last ten years with remarkable success and do highly recommend it to the profession.-Thompkins E. Taggart, M. D., Fairmount, Cincinnati, Ohio.

THE attention of our readers is called to the advertisement of Messrs. R. A. Robinson & Company, which appears on page