we desire to find the results of the latter confirmed by the former, and have the laboratory and the bedside agree. The conditions of experimentation must be the same as far as lies in our power to make them so. While experimenting with germs in a testtube the antiseptic bathes them on all sides, and the condition of further development of these germs are a priori brought down to a minimum; but, on the contrary, we know that even in an ulceration considered superficial, the tissue destroying germs have spread behind the granulation cells, out of the immediate reach of the antiseptic, are constantly fed by a fresh supply of blood from the capillary circulation, and are further favored by a suited degree of heat. All these conditions must be considered as militating against the direct action of the antiseptic, and we should therefore not be surprised if, with such a discrepancy of surroundings, these germs being submitted to the same destroying agent, should manifest more resistance in one case than in the other. Let no one, therefore, decry laboratory experimentation by heralding its want of accord with clinical evidence; but, on the contrary, whenever such is the case, the true investigator will seek to discover that which is the cause of this difference; for in medicine as elsewhere an immutable relation between cause and effect exists. Histology, the intelligent use of the microscope, will elucidate the question in most cases, as it has surely done in the present one; for as soon as a clear and unobstructed scope, by scraping, was given the acid sublimate solution to reach the pathogenic germs, whether these existed on an ulcerating surface of the human body, or in the test-tube of the laboratory experiment, they were effectually destroyed with equal ease. We should furthermore remember just what is to be expected of an antiseptic solution; it should sterilize the parts and nothing more. It contains no surgical principle other than this; it is not surgery. It will not fulfil the indication any further than destroy germs. It is a wonderful agent for destroying the surgeon's greatest enemy (infection), but that is all. The mind of the surgeon remains now, as before, master of the situation, and must guide the case as carefully as ever by the constant application of his whole knowledge and skill, if even with judicious antisepsis he wishes to maintain his position among the enlightened members of the medical profession. CONCLUSIONS. 1. Acid sublimate solution consists of the ordinary sublimate solution 1-1000, to which five parts of any acid are added, preferably hydrochloric, citric or tartaric acid. It is the acid condition which retains the albumen in solution. 2. Five parts of hydrochloric acid will dissolve one part of sublimate; hence this is a convenient form of keeping a concentrated solution. Tablets or powders may be made by combining one part of sublimate with five of citric or tartaric acid. This is a convenient form for ready use. With the above a 1-1000 sublimate solution is made by taking the relative amount of sublimate in the compound. 3. The acid sublimate solution is stronger and more effective than the simple sublimate solution; its strength is uniform, never deposits any precipitate, and retains all albumen in solution. 4. It has been advocated by Koch and is used in his laboratory (the Hygienic Institute) in Berlin; in Pasteur's laboratory in Paris, and the principal hospitals, as the best disinfectant. 5. In a word, it should be used wherever it is thought that sublimate is of service, being proved to have marked superiority over the simple sublimate solutions, without any of its disadvantages. 6. It has proved itself unexcelled in clinical experience, having been adopted by the "Academie de Médecine" of Paris to be used throughout France, this conclusion being the unanimous report of a commission named by the Minister of Commerce for the purpose of studying and reporting on the question of antisepsis applied to midwifery. 7. All risk of intoxication or irritation can be eliminated when we realize that the antiseptic value of the acid sublimate solution is retained when its strength is as reduced as 1-10,000. A CASE OF PUERPERAL SEPTICEMIA SIMULATING TYPHOID FEVER. BY CLARA MARSHALL, M.D. Abdominal surgery, with its increasingly wide range of applications, has, within late years, introduced new problems into the treatment of the puerperal state, of which the following case is an illustration: Mary F., æt. 20, white, domestic, was admitted to the gynææcological wards of the Philadelphia Hospital June 10, 1890. I am indebted to Dr. Louise G. Rabinovitch, under whose care the patient was delivered, and to Dr. Rothrock, resident physician, for notes of the case. The patient had a good family history; parents both alive and well, and no history of any family disease. She had had the ordinary diseases incident to childhood, also scarlatina at thirteen years of age, from which she made a good recovery and remained in good health. The patient was delivered by Dr. L. G. Rabinovitch at the Maternity Hospital January 11, 1890. The foetus was macerated and was presumed to have been dead in utero for about a week. The uterus was washed out with a 2 per cent. solution of creolin, as is the practice at the Maternity in all cases of this kind. About the third day after delivery the lochia began to be offensive, but without any special rise of temperature. Douches of creolin, 2 per cent., were given until the odor disappeared. The patient was getting along nicely after the first few days of her lying-in, when she was rather uncomfortable on account, it was presumed, of the abundance of milk in her breasts, notwithstanding the attempt made to dry up the secretion. The milk soon disappeared and she felt well, though she was exceedingly nervous because her parents did not know anything about her condition. For the first few days the uterus was soft and flabby, the os open and lips thin, though involution was thought to be proceeding fairly well. On the eleventh day of her lying-in she had an attack of facial erysipelas, from which she recovered sufficiently to leave the hospital. The temperature rose during the attack to 104.4° F. The patient stated that since leaving the hospital she never felt entirely well, but was compelled to spend the greater part of her time in bed. During this time her condition seems to have been variable, better at times for a few days, succeeded by a relapse into her former condition. For three weeks previous to admission to the hospital she suffered from pain in the lower part of her abdomen. On March 30, three days before admission, she was seized with violent headache, while the abdominal pain grew worse; she experienced no chill but felt "feverish." Her condition must have continued much the same until her admission April 2, at 3 P. M. She then had a temperature of 101°; pulse 136, and weak. She was restless; complained of pain in lower part of abdomen; and over the whole of the same region there was marked tenderness upon pressure. At 10 P. M. the temperature reached 104°, and at 6 A. M. the following day it reached the same point. April 3, very restless and still complains of pain. Examination of urine reveals the presence of albumen and casts (granular and hyaline). During the day she vomited greenish matter resembling grass. The stools, two in number, were watery, yellowish, and contained some mucus. During the night she was slightly delirious; pulse 150 to 160, weak, irregular; respirations regular. April 4, weaker, very restless, suffered from pain, which was so intense as to cause her to cry out occasionally; easily aroused and seemed rational. The treatment up to this time consisted mainly in the administration of liquid food, quinine, whiskey and digitalis, and in the external use of turpentine in the form of stupes. With the history of a macerated fœtus, foul lochia, and erysipelas; with removal to unfavorable surroundings while not feeling entirely strong; with failure of return to usual health; with the subsequent development of acute abdominal symptoms ; with such a clinical history as this, the question of surgical interference arose. After consultation with my colleague, Dr. Edward P. Davis, it was decided to make an exploratory incision; this was done April 3, at 4 P. M. Upon reaching the peritoneal cavity a digital exploration of the pelvis and lower abdomen did not reveal the necessity for further surgical interference. A portion of the intestines was drawn out of the abdomen with a view to ascertaining if adhesions were present; none were found, although that portion of the intestine which was seen was deeply congested, giving the appearance of inflammatory action. The abdomen was flushed with hot distilled water and closed with interrupted silk sutures without drainage. The patient was very weak during the operation and was supported by hypodermic injections of ether, whiskey, atropine, nitro-glycerine, and heat to the epigastrium. The pulse after the operation was 136 and weak, but soon grew stronger, and the patient's condition was apparently no worse than before the operation. 8 P. M. the pulse began to fail, circulation more feeble; extremities cold and clammy; temperature 104°. At 9 P. M. temperature 105°; pulse weak and rapid, and could not be counted at the wrist; respirations 56; very restless and growing rapidly weaker. At 11 P. M. temperature 106°; respirations 60. Patient died at 11.50 P. M. AUTOPSY. Thorax.-No pleural adhesions; the posterior portion of the lungs was the seat of hypostatic congestion. Heart.-Normal in size, pale; muscle soft and flabby; no valvular lesions; no heart clots; blood dark, liquid. Heart muscle showed evidence of acute fatty degeneration. Abdomen. The peritoneal cavity contained a small quantity of dark red fluid; some extravasation of blood into the sub-peritoneal fat of abdominal wall just below lower edge of wound. That portion of intestine occupying the pelvic cavity was deeply congested, the remainder light pink in color and distended with gas. Pelvic peritoneum covered with small flakes of lymph, as was that portion of intestine occupying it. Mesenteric glands enlarged, especially about the lower portion of the ileum, where they were congested (dark red in color), and some of them had attained the size of filberts; on section they were soft, dark red, some of them showing a tendency to break down. Spleen.- Much enlarged (weight, 13 ounces), soft, friable, dark red, pulpy. Kidneys. Slightly enlarged, capsules stripped easily; on section cortex rather pale and streaked; medullary portion also pale. Liver.-Rather soft in consistence, otherwise presented nothing unusual. gangrenous spot upon the fundus. Ovaries.—Ovaries and tubes freely movable; ovaries perhaps slightly enlarged. Stomach.-Anæmic, slightly dilated; no lesions. Small intestine.-Examined throughout its extent; about four feet above ilorcæcal valve, Peyer's patches were noticed to be slightly infiltrated; as the cæcum was approached the infiltration became more marked. About two feet above the valve was found a patch much more infiltrated than the rest, the surrounding intestine deeply congested, and the peritoneal surface of intestine opposite well covered with lymph; as the valve was approached the whole intestine was infiltrated and ulcerated, giving an appearance somewhat resembling chronic enteritis; ilor-cæcal valve involved in like manner. Cæcum.-The solitary glands of the cæcum and upper part of colon, for about one foot from the valve, were indurated and ulcerated. Brain and cord.-Not examined. The organs and tissues throughout the body generally showed evidence of acute fatty degeneration. The post-mortem appearances so closely resembled those of typhoid fever that such a diagnosis might readily have been made by one not having had an opportunity to study the case in connection with its clinical history during life. My colleague, Dr. Edward P. Davis, was of the opinion that the case was one of puerperal septicemia; and Dr. Ernest Laplace, who saw the specimens almost immediately after the autopsy, placed especial stress upon the gangrenous spot near the fundus uteri, a spot in which a putrefactive and infectious condition existed, as an explanation of the mode of infection. Passing this case in review, it is possible that had the patient been placed under more favorable conditions as to surroundings and treatment in the beginning of the acute attack, she might have recovered; also, that surgical interference would not have been of avail at any period of the attack, since there were no pus tubes to be removed, no abscess cavity to be drained, no adhesions to be broken up, etc. Suppose, then, one were confronted with a |