THE INFLUENCE OF SURGERY ON MODERN OBSTETRICS.

1142 wished a great deal of the morphine" (8ic). Now we get a hint of the nature of her malady. "Her bowels never acted unless she took salts or oil ; she had no appetite, was having severe uterine hæmorrhage daily, was so weak she could scarcely speak above a whisper, was greatly emaciated, and dead in every respect," whatever that may mean. Still, nearly I time rolled on" and"her condition continued to grow worse, " even though she was so "nearly dead in every respect" before. Of course, in the moderate language of the narrator, ’’ she beoame disgusted with the infernal ignorance and malpractice of the attending quacks," and then, providentially, "hearing that -Thad just returned from college, 1 was called in." We must not disclose the nature of the remedies employed, or we may be charged with advertising I I eclectic remedies." It must suffice to say that though "I, of course, couldn’t promise a ’cure,’ I gave " three separate bottles of medicine, one for the haemorrhage every three or four hours," another for constitutional treatment "before each meal," the third for her nervous spells "every hour." No wonder that on the third day (was this in compliment to the three bottles?) "she showed convalescence in every respect." "Z saw her yesterday and she looks as if she might last for several years to come." This interesting account finishes with the following modest flourish: "My practice is good. I haven’t lost a patient, and don’t ask the allopaths any odds. We have eleven of them here, and no eclectic except Dr. -; but we don’t take any back seat because they are in the majority." Truly the writer must be a pleasant man for the " majority " to have in their neighbourhood.

FAILURE TO CONVICT UNDER THE POISONS ACT.

there was present, say, half the fatal dose - it is obvious that a person intent on procuring a dangerous quantity could do so by purchasing an unlimited number of samples. As a matter of fact, in the case above mentioned the preparation was labelled "poison" admittedly to "ensure its careful use," and subsequent analysis disclosed the preThe total quantity, sence of the scheduled poison morphine. however, was not stated, being presumably less than a poisonous dose, whence it was inferred that the preparation We as generally sold could not be productive of harm. repeat that the mere presence of a poison in a preparation should for many reasons be a bar to its indiscriminate sale, or else the provisions of the Act will to some extent be paralysed and the mischief against which its provisions were intended to operate will be increased. It is difficult to draw a sharp line distinguishing between quantities which are fatal and not fatal, and to insert a section in the Act making a provision of this kind would be utterly impracticable.

ACETANILIDE AS A SURGICAL DRESSING. IN the Philadelphia Medical News Dr. Francis W. Harrell calls attention to the excellent results which he has obtained from using acetanilide as a dressing for wounds. He was led to try it first from a consideration of the fact that several of the coal-tar products are of the nature of good antiseptics. The first case in which it was tried was an extensive laceration of the skin and muscles of the lower part of the arm and forearm in a lad aged nineteen. The surfaces were first carefully washed with warm water and then powdered with acetanilide. There was at first a very slight degree of irritation, which disappeared in a few minutes, and this Dr. Harrell has found to be the usual effect. At subsequent dressings no pus was observed, and the wounds gradually became smaller and ultimately completely disappeared. In other cases similar success has attended his use of this substance, and it is to be hoped that the experience of others will confirm these results. There seems to be no danger from absorption, and large quantities may it is said, be used locally without any risk.

A POINT of extreme importance in connexion with the section of the Pharmacy Act dealing with the sale of poisons was decided in the Court of Appeal on Tuesday last. Some time ago an action was brought by the Pharmaceutical Society against a seller, who is not a qualified chemist, for penalties for keeping open a shop for the retailing, dispensing, or compounding of poisons-to wit, a preparation of morphine called licoricine. The defendant keeps a shop classed as a drug store in Manchester, where a bottle of licoricine was asked for and bought THE INFLUENCE OF SURGERY ON MODERN by an officer acting under the instructions of the PharmaOBSTETRICS. ceutical Society. On the bottle was a notice to the followA this PAPER on contains the "This of subject appears in the September number properties preparation ing effect : of the Joitrnal to its and ensure careful use licorice root, chlorodyne, &c., of Surgery, Gynæcology, and Obstetrics by Dr. Thomas the the directions to Opie of Baltimore. He is of opinion that Pharmacy Act, 1868, printed according On from the earliest times there has always been a close be ’Poison.’" it to labelled analysis morphine requires relation between midwifery and surgery. The department was detected, but the actual quantity was not estimated, the analyst stating that there was more than a mere trace ; there of midwifery was then entirely in the hands of women, might have been from gr. to 3/30 gr. per ounce in the bottle. and it was only when the lying-in woman was in a desperate He was not prepared to say whether the taking of the whole condition that male assistance, generally of a more or contents of the bottle would do an adult any harm. The less directly surgical nature, was called in. The invencounty court judge gave judgment for the defendant. as he tion of the midwifery forceps in the seventeenth century did not consider that the evidence as to quantity was sufficient marked an epoch in the history of obstetrics, and at the to justify judgment for the plaintiff. A case which was same time enormously increased the number of cases in decided recently was cited, in which, however, there was which the use of instruments-that is to say, assistance evidence that there was sufficient morphine in the bottle sold of a surgical nature-was indicated. The field of to kill an adult. The court dismissed the appeal, Mr. Justice obstetric surgery has similarly been widened in our own Wright remarking that there was no evidence as to quantity time by the success of the modern Cassarean section and and that it would be an abuse of language to say that the of modern symphysiotomy, a success largely due to strict licoricine was shown to be a preparation of morphine. Mr. adherence to antiseptic principles. In this connexion we Justice Charles concluded in similar terms, observing that, may recall the testimony of the late Dr. Matthews Duncan, who dedicated one of his books to Sir Joseph Lister because on the evidence before them, they could only agree with the the This of court we venture decision, by his work on antiseptics he had " done more for lying-in opinion judge. county to think, is unfortunate, since it will probably lead to in- women than any obstetrician." Dr. Opie recognises three tricacies and tend to hinder the beneficial working of the periods in tracing the relation between obstetrics and surgery. Act. The Act, it is true, stipulates nothing about quantity, The first was the destructive epoch, when craniotomywas but the fact of a preparation containing a poison at all the chief operation for which instrumental assistance was should afford abundant ground surely for the preven- employed ; the second was the reactionary period, when If a preparation con- the pendulum swung too far in the other direction and tion of its indiscriminate sale. tained arsenic-e.g., in such proportion that in a bottle obstetric surgery was almost obsolete; and the third period

1143 was marked by the introduction of the forceps. We may, perhaps, be allowed to add a fourth period, which may be called "the antiseptic period, " being characterised, not only by the greatly increased success of the old operations when performed in accordance with antiseptic principles, but also by the increased safety with which a woman may pass through a normal labour if those principles are faithfully and intelli-

gently adhered to. Just as the surgeon has to consider and provide for the absolute cleanliness of himself, his patient, his Dr.

instruments, and his assistants, so in a case of labour, as Opie very rightly insists, it ought to be the first practical

consideration to secure the absolute cleanliness of all those concerned in the case, as well as of all instruments and The need for asepsis concerns the monthly nearly, if not quite, as much as the obstetrician. Weobserve one reason here given for the fact that so many nurses fail in their appreciation of the importance of antisepsis which is often lost sight of. It is that it often happens that a particular nurse works with many practitioners whose methods may vary widely. Somewe trust a vanishing minority-ignore the use of antiseptics

appliances. nurse

antiseptic, others another ; after delivery, while others do wondered at that an imperfectly

altogether ; some, again, use some use antiseptic douches

one

It is not to be educated woman under these circumstances should at times be led to conclude that the whole business is only so much fuss and worry, and may be safely disregarded in the spirit, if not in the letter. Much of Dr. Opie’s paper is taken up with the precautions to be taken and rules to be observed in the application of the forceps, and especially he gives a note of warning against the use of the forceps when the cervix is rot fully or at least sufficiently dilated-a fertile source of serious danger both immediately, as well as during the lying-in period and afterwards. As Dr. Opie says, "it is a great gift in an obstetrician to be able to wait and do nothing. The obstetrician who is inappreciative of nature’s power and ingenuity, and will not give her time in labour, has great need for the surgeon and the undertaker." not.

THE UNIVERSALITY OF SCIENCE. LAST week the Societe de Chirurgie celebrated their j abilee with a dinner at the Grand Hotel, Paris, at which Sir Spencer Wells was a guest and in his character of English Corresponding Member was made the object of a flattering toast. In the course of his reply to this attention, he made use of the following expression : " Le nom d’etranger doit etre banni de la science, qui n’est etrangere à rien et ne connait pas de frontieres en ce qui concerne en particulier la chirurgie francaise et la chirurgie anglaise." This testimony to the fact that the laws of science can have no local limits may seem to be unnecessary, as bearing witness to what is generally acknowledged ; but in the case of surgery-the particular science to which reference is made-this universality is not so freely admitted. It is, of course, of the very essence of science that her principles should be universal in their application and independent of geographical or racial conditions. Art may be strongly influenced by national trend or political phase, as is manifest from the most superficial comparisons of the literary and artistic productions of different nations, and of these again at different epochs ; but over the truths of science these variations of physical and ethnological environment can have no influence. What is true because it can be verified by actual experiment or because it can be deduced directly from a verified fact by a logical process of analogy-these things make up science and are necessarily as true for one nation as another, as true for a republic as a monarchy, and for a black man as for a white. Yet while we all allow that chemical truths must be the same in Germany as in Japan, and that the laws of gravitation are identical in France and San Francisco, we still talk of this and that school

of surgery in a manner that might lead the unobservant to think that some fundamental differences existed in the principles of the various schools. This is the misconception that Sir Spencer Wells’s dictum should clear up. To Where nations and scientific facts there can be no variants. schools diverge, and can yet maintain an equal claim to be right, is in their deductions (when these have been made by methods open to human error) and in their consequent courses of procedure. In earlier times-when the proven facts were few and the deductions many, and, for that matter, flightythe teachings of different schools grew very far apart; but as more knowledge passes by experiment over to the region of fact the various systems of teaching approximate more and more, until geographical limitations to unanimity are seen to be wholly artificial. And at no time in the world’s history has this approximation taken place more rapidly than during the last twenty-five years, so numerous have been the facts that have been added to the science of surgery.

BACILLUS

PYOCYANEUS

PERICARDITIDIS.

IN the American .To2srnal of the Ifedical Sciences for October Dr. Harold C. Ernst, of Harvard University, publishes an account of a bacillus found in the fluid removed by Dr. Shattuck from a case of pericardial effusion. The clinical features of the case were very interesting, and this side of the case will be presented by Dr. Shattuck. The fluid was sent to Dr. Ernst for bacteriological examination, and he found in it a bacillus which he believes to be different from any hitherto described. It is found in the cells of the fluid. When cultivated it produces a bluish-green colour, which in old cultures changes almost to black ; acids turn it red, and alkalies change it to bright grass-green. Careful comparisons with Gessard’s bacillus pyocyaneus and with P. Ernst’s bacillus &bgr;showed it to differ from each of these so constantly as to justify its separation from them and its distinctive name.

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THE

DISINFECTION OF BALLAST.

DR COLLINGRIDGE, in his half-yearly report for the Port of London, refers to the very interesting but admittedly difficult question of the disinfection of sand or water taken in as ballast from infected sources-such, for instance, as the. River Elbe. That, theoretically, these materials may convey the comma bacillus would certainly appear to have been placed beyond the region of doubt, more especially as we are assured on reliable authority that this bacillus was found to survive in the water of Marseilles Harbour for eighty-one days. Up to the present, however, no orders have been issued by the central authority upon the subject, and it must be admitted that there are almost insuperable difficulties in the way ; especially is this so when a general view of the question is taken, and regulations have to be framed applicable to the varying conditions of the harbours, anchorage &c. to be found in the several ports throughout the kingdom. Although we believe that water ballast may, with the exercise of great care and the use of proper machinery, be gradually discharged and replaced, the same remark cannot be made as to sand ballast, and it would, we think, be a difficult matter to efficiently disinfect a large quantity of this material. In fact, we must confess ourselves to be a little sceptical as to the possibility of dealing with this subject by means of any general order as regards discharge or disinfection of ballast. This being so, we are the more inclined to agree with Dr. Collingridge that instructions might be given to our consuls and vice-consuls to inform the shipowners and masters that ballast taken from infected or suspected sources would be liable to be refused entry to our ports. This course, if it could be properly carried out at places where no official of the class referred to resides, would certainly do something to mitigate the