ants upon certain definite morbid states, we still lack confirmation that they are causative rather than accompanying factors of such states. It is not at all inconceivable to my mind that the generative conditions of the minute bodies are less certainly known than supposed. Fission, sporulation, etc., may not be the ultimate processes, but yet more indefinite changes may be produced among them, which our present facilities cannot handle. I am also quite of an idea that the germs, as we know them, are not in themselves the causes of the specific symptoms of diseases, as we know them; but that these germs may develop poisonous bodies, just as plants develop poisonous principles in their juices, which bodies are the real causes of the symptoms observed.

It fell to me last summer to witness an actual illustration of the contagiousness of dysentery; and the spread of this contagion was contrary to my preconceived opinions thereof. Mr. R., a healthy mechanic of 62, dwelt in an isolated farm-house, one mile from Bristol Centre. The situation of his house along under a hill of volcanic rock is such that contamination of his well or premises by his neighbors is impossible. No form of intestinal disease had ever been known in his house, or among his family. In the midsummer his wife's sister was taken with dysentery at a house some miles away, and brought to his house, where she died in less than a week. All the family were in good health at this time. So far as I could learn the attending physician ordered no disinfection beyond burying the stools away from all danger of contaminating the well. About a week after the woman's death, I was called to attend the man, who had been sick three days, and who died five days later of collapse from ulceration, in the same manner that the woman died. I found this man sleeping upon the ground floor, immediately above him was a bedroom occupied by two girl boarders. Forward of that were two chambers occupied by his three daughters. His wife slept below in a room, two rooms away. There was no communication between his room and the chambers except by going through another room to the stairs. When first called, I began to disinfect the stools with sublimate, burnt all the soiled cloths, boiled all the well water and milk that was used, and overlooked the preparation and storage of food. I also attempted to anticipate infection by the internal use of Asepsin to modify the intestinal contents. Despite all precautions, every one in the house had the disease. First the oldest daughter, next the

two boarders, then the other daughter and last of all the widow. The widow, who had been the most exposed to contagion, was the least sick of all, only four or five days. The two boarders, who were only in the house nights, and who were not near the sick man, were very sick. One of them was given up several times, but made a full recovery in about seven weeks.

Now here was a case in which all such causes as bad weather, malaria, bad water, epidemic influence and the like must give way to the one cause of personal infection.

The absolute presence of some sort of a germ or contagion would seem beyond dispute. If this contagious principle were a bacillus it should have been spread by personal contact as through food or drink; but those who were in constant contact suffered the least, while those whose only contact was in sleeping above the room suffered the most severe attacks. The infecting principle must have been mobile enough to have penetrated into the upper chambers and infected the girls in some other way than by the mouth in food or drink. There must have been a genuine conta

gious virus, as in scarlatina or rubeola.

Shortly after I was called to a case nearly four miles from the first. It was upon a flat sand-bank along the shore of the old canal basin, where there are about six houses upon a road bending upon itself at a right angle, thus fetching the houses all within a few rods of one another. At the fourth house, where I was called, one child lay dead, and another was in a collapse, cold and pulseless. Two other children were beginning to vomit and purge. The other five houses each had one or more sick. Three other cases died in the five houses within a few days. I disinfected stools with sublimate, and burnt sulphur all over the house and cellar (the preceding doctor had used no disinfection). Three more bad cases and two light ones developed in the house, all making good recoveries except the one in collapse.

The second day of attendance the Board of Health met there, and upon being asked, I advised the burning of two barrels of concrete tar, which was done, the locality being kept full of the dense smoke one whole afternoon; no more fatal cases arose after the use of the tar.

Now, I think these two illustrations go to prove the contagious nature of these severe dysenteries, as opposed to the idea of their telluric origin, and point to infection by contact rather than by food

and drink. They certainly point to the advisability of fumigations in serious epidemics.

Were the presence of bacilli of specific nature the sole cause of dysentery, it is difficult to see why some cases should be so much more malignant than others. The germs of anthrax generally produce severe results when one is infected with them, as is also malignant pustule. But if the virus is in the excretion or secretion of the bacilli, we could understand how that a concentrated potion would be more terrifying to the economy than a diluted one.

Perhaps, after all, the contagion does lie in the secretions or exhalations, and that bacilli, amoebæ, or cocci flock to and appear upon the diseased membranes; not because they are per se the morbific agent, but because they are attracted to a congenial ground.

In the same manner little flies are attracted to decaying apples by the acetous fermentation, and breed therein, intensifying the rapidity of the decay by their presence. There seems no doubt to my mind that contagions and viri have selective affinities for certain organs, the same as the juices of plants have, and, therefore, whatever may be their mode of entrance into the economy, they produce their disturbances upon their selected locations.

This view is rendered more rational by the discovery that nearly all sorts of germs may be found in out of the way places, ready to aggregate and work mischief if opportunity presents itself. Thus the Frænkels pneumonia bacillus, with other so-called specific germs, is found in the discharges of otorrhoea and ozæna. A whole line of specific germs may be dug out from under the finger nails or between the teeth. The micrococci of diphtheria are found in the mouths of healthy people. Now and then some person offers a favorable condition for the sudden multiplication of these organisms, they put on activity as the grass does when winter's cold withers under the eye of the vernal sun; they become full of juices and develop poisonous bodies. The lonely bacillus becomes multiplied into a ravaging army. He poisons the air with his exhalation, his virus smites the vital powers of those exposed to it, alters their chemical conditions, depresses excretory energies the system--and the accumulation of morbific materials offers a nucleus wherein the bacillus develops its specific qualities. Then the erstwhile harmless bacillus, representing erstwhile but a potency for evil, passes in a ravaging power, coursing through a career of

destruction, till science smites, or no more suitable pasture offers for his nourishment.

Such is about my present idea of poisonous germs and infections, and points with an inflexible finger towards the continuous, untiring, scientific use of preventive disinfection.

Bristol, Conn.

F. H. WILLIAMS, M.D.

RECENT PROGRESS IN MEDICINE.*

Infantile Diarrhoea.—At a recent meeting of the Harveian Society, Dr. Luff read a paper on the antiseptic treatment of infantile diarrhoea. He spoke highly of Dr. Illingworth's treatment, which consists in the administration of 1-50th of a grain dose of the biniodide of mercury dissolved in iodide of potassium, combined with one-grain doses of chloral hydrate. The biniodide possesses the property of combining with, and rendering the milk ptomaine, tyrotoxicon, insoluble. Of eighty cases of infantile diarrhoea treated by this method, the diarrhoea ceased within two days in seventy-two of the cases, in five out of the remaining eight cases it ceased within four days, and in no instance did it last over seven days. Med. and Surg. Reporter, Jan., 90.

The Mental and Physical Training of Children.—In an article by Mrs. Waller in a recent number of the Nineteenth Century, upon "The Mental and Physical Training of Children," she recommends that two of the best rooms in the house should be set apart for day and night nursery respectively, and that the importance of sunshine and the evils of overcrowding should be recognized in all the nursery arrangements. She advises that the nursery walls should be painted rather than papered, paint being easily washed and disinfected after the attacks of infectious disease, which in every large family are only too likely to occur. As regards clothing, it is pointed out that in spite of modern improvements in this matter, it is still too much the custom to leave the upper part of the chest and the lower part of the abdomen exposed, and that hence come pulmonary affections on the one hand and bowel complaints on the other. "It is a fact that not only has the *A Monthly Review of Practice, edited by ROBERT SAfford Newton, M.D.

child less power of generating heat than the adult, but that it has also a much larger surface in proportion to the mass of its body, and will consequently be far more susceptible to cold. Cold feet cause a large amount of indigestion, and exposure of the large blood-vessels of the thigh during childhood frequently sows the seed of kidney-diseases to develop in after life."-Lancet, Oct. 12, 1889.

Methods of Craniotomy.-There are undoubtedly cases in which this operation is indicated, hence its technique should be perfected to the highest possible degree. The following are some of the indications:

1. Unsuccessful use of the forceps, or version cases in which the head cannot be extracted.

2. The certainty that the foetus is no longer living.

3. Such a condition of the mother that Cæsarean section would almost certainly be followed by death.

4. Certain deformities of the fœtus.

The operation will vary according as there is a greater or lesser degree of pelvic deformity. In the latter case the choice of methods will be governed by the steps which have already been taken. If the forceps has been used unsuccessfully upon the presenting head, the latter should be perforated and the forceps used as a tractor. In the higher degrees of pelvic deformity the method will consist: First, In podalic version and extraction of the body; Second, Perforation through the palatal process; Third, Cephalotripsy; Fourth, Extraction of the body with the cephalotribe or by means of traction upon the body and the inferior maxilla, combined with pressure above the pubes.

The advantages of this method are as follows:

1. The base of the cranium is more effectually destroyed.

2. The head is firmly fixed during perforation and removal of the brain.

3. It admits of variation in the position of the head, the cephalotribe being applied in different directions so as to adapt the smallest diameter of the crushed skull to the proper diameters of the pelvis.

4. The head having been crushed it will be more easy to exert traction upon the jaw and the body of the fœtus, combining suprapubic pressure therewith.

In the discussion of the foregoing paper, Dr. Champneys re