active. Near its border was another abscess, evidently joined with the first, for upon pressing it with the finger, pus flowed freely from the opening in the first abscess. During the whole of the month of June, the rabbit was sick and the abscesses suppurated, but less and less. In July they closed; the animal was well. There could only be felt some nodules under the skin of the abdomen.

What disturbances might not such an organism carry into the body of a parturient woman, after passing into the peritoneum, the lymphatics or the blood through the maternal placenta! Its presence is much more dangerous than that of the parasite arranged in chains. Furthermore, its development is always threatening, because, as said in the work already quoted (April, 1878) this organism can be easily recovered from many ordinary waters.

I may add that the organism in long chains, and that arranged in pairs are also extremely widespread, and that one of their habitats is the mucous surfaces of the genital tract.

Apparently there is no puerperal parasite, properly speaking. I have not encountered true septicemia in my experiments: but it ought to be among the puerperal affections.

Fourth observation.-On June fourteenth, at the Lariboisière, a woman was very ill following a recent confinement: she was at the point of death: in fact she did die on the fourteenth at midnight. Some hours before death pus was taken from an abscess on the arm, and blood from a puncture in a finger. Both were sowed. On the next day (the fifteenth) the flask containing the pus from the abscess was filled with long chains of granules. The flask containing the blood was sterile. The autopsy was at ten o'clock on the morning of the sixteenth. Blood from a vein of the arm, pus from the uterine walls and that from a collection in the synovial sac of the knee were all placed in culture media. All showed growth, even the blood, and they all contained the long strings of granules. The peritoneum contained no pus.

When, by the procedure I elsewhere described, urine is removed in a pure condition by the urethra from the bladder, if any chance growth occurs through some error of technic, it is the two organisms of which I have been speaking that are almost exclusively present.

Interpretation of the disease and of the death. The injury of the uterus during confinement as usual furnished pus, which gave a lodging place for the germs of the long chains of granules. These, probably through the lymphatics, passed to the joints and to some other places, thus being the origin of the metastic abscesses which produced death.

Fifth observation.-On June seventeenth, M. Doléris, a well-known hospital interne, brought to me some blood, removed with the necessary precautions, from a child dead immediately after birth, whose mother, before confinement had had febrile symptoms with chills. This blood, upon cultivation, gave an abundance of the pyogenic vibrio. On the other hand, blood taken from the mother on the morning of the eighteenth (she had died at one o'clock that morning) showed no development whatever, on the nineteenth nor on following days. The autopsy on the mother took place on the nineteenth. It is certainly worthy of note that the uterus, peritoneum and intestines showed nothing special, but the liver was full of metastatic abscesses. At the exit of the hepatic vein from the liver there was pus, and its walls were ulcerated at this place. The pus from the liver abscesses was filled with the pyogenic vibrio. Even the liver tissues, at a distance from the visible abscesses, gave abundant cultures of the same organism.

Interpretation of the disease and of the death.-The pyogenic vibrio, found in the uterus, or which was perhaps already in the body of the mother, since she suffered from chills before confinement, produced metastatic abscesses in the liver and, carried to the blood of the child, there induced one of the forms of infection called purulent, which caused its death.

Sixth observation. The eighteenth of June, 1879, M. Doléris informed me that a woman confined some days before at the Cochin Hospital, was very ill. On the twentieth of June, blood from a needle-prick in the finger was sowed; the culture was sterile. On July fifteenth, that is to say twenty-five days later, the blood was tried again. Still no growth. There was no organism distinctly recognizable in the lochia: the woman was nevertheless, they told me, dangerously ill and at the point of death. As a

matter of fact, she did die on the eighteenth of July at nine in the morning: as may be seen, after a very long illness, for the first observations were made over a month before the illness was also very painful, for the patient could make no movement without intense suffering.

An autopsy was made on the nineteenth at ten in the morning, and was of great interest. There was purulent pleurisy with a considerable pocket of pus, and purulent false membranes on the walls of the pleura. The liver was bleached, fatty, but of firm consistency, and with no apparent metastatic abscesses. The uterus, of small size, appeared healthy; but on the external surface whitish nodules filled with pus were found. There was nothing in the peritoneum, which was not inflamed; but there was much pus in the shoulder joints and the symphysis pubis.

The pus from the abscesses, upon cultivation, gave the long chains of granules-not only that of the pleura, but that from the shoulders and a lymphatic of the uterus as well. An interesting thing, but easily understood, was that the blood from a vein in the arm and taken threequarters of an hour after death was entirely sterile. Nothing grew from the Fallopian tubes nor the broad ligaments.

Interpretation of the disease and of the death-The pus found in the uterus after confinement became infected with germs of microscopic organisms which grew there, then passed into the uterine lymphatics, and from there went on to produce pus in the pleura and in the articulations.

Seventh observation.-On June eighteenth, M. Doléris informed me that a woman had been confined at the Cochin Hospital five days before and that fears were entertained as to the results of an operation that had been performed, it having been necessary to do an embryotomy. The lochia were sowed on the 18th; there was not the slightest trace of growth the next day nor the day after. Without the least knowledge of this woman since the eighteenth, on the twentieth I ventured to assert that she would get well. I sent to inquire about her. This is the text of the report: "The woman is doing extremely well; she goes out tomorrow."

Interpretation of the facts.-The pus naturally formed on the surface of the injured parts did not become contaminated with organisms brought from without. Natura medicatrix carried it off, that is to say the vitality of the mucous surfaces prevented the development of foreign germs. The pus was easily resorbed, and recovery took place.

I beg the Academy to permit me, in closing, to submit certain definite views, which I am strongly inclined to consider as legitimate conclusions from the facts I have had the honor to communicate to it.

Under the expression puerperal fever are grouped very different diseases,' but all appearing to be the result of the growth of common organisms which by their presence infect the pus naturally formed on injured surfaces, which spread by one means or another, by the blood or the lymphatics, to one or another part of the body, and there induce morbid changes varying with the condition of the parts, the nature of the parasite, and the general constitution of the subject.

Whatever this constitution, does it not seem that by taking measures opposing the production of these common parasitic organisms recovery would usually occur, except perhaps when the body contains, before confinement, microscopic organisms, in contaminated internal or external abscesses, as was seen in one striking example (fifth observation). The antiseptic method I believe likely to be sovereign in the vast majority of cases. It seems to me that immediately after confinement the application of antiseptics should be begun. Carbolic acid can render great service, but there is another antiseptic, the use of which I am strongly inclined to advise, this is boric acid in concentrated solution, that is, four per cent. at the ordinary temperature. This acid, whose singular influence on cell life has been shown by M. Dumas, is so slightly acid that it is alkaline to certain test papers, as was long ago shown by M. Chevreul, besides this it has no odor like carbolic acid, which odor often disturbs the sick. Lastly, its lack of hurtful effects on mucous membranes, notably of the bladder, has been and is daily demon

'Interesting as the starting point of the conception of diseases according to the etiological factor, not by groups of symptoms.-Translator.

strated in the hospitals of Paris. The following is the occasion upon which it was first used. The Academy may remember that I stated before it, and the fact has never been denied, that ammoniacal urine is always produced by a microscopic organism, entirely similar in many respects to the organism of furuncles. Later, in a joint investigation with M. Joubert, we found that a solution of boric acid was easily fatal to these organisms. After that, in 1877, I induced Dr. Guyon, in charge of the genito-urinary clinic at the Necker hospital, to try injections of a solution of boric acid in affections of the bladder. I am informed by this skilful practitioner that he has done so, and daily observes good results from it. He also tells me that he performs no operation of lithotrity without the use of similar injections. I recall these facts to show that a solution of boric acid is entirely harmless to an extremely delicate mucous membrane, that of the bladder, and that it is possible to fill the bladder with a warm solution of boric acid without even inconvenience.

To return to the confinement cases. Would it not be of great service to place a warm concentrated solution of boric acid, and compresses, at the bedside of each patient; which she could renew frequently after saturating with the solution, and this also after confinement. It would also be acting the part of prudence to place the compresses, before using, in a hot air oven at 150° C., more than enough to kill the germs of the common organisms.

8

Was I justified in calling this communication "On the extension of the germ theory to the etiology of certain common diseases?" I have detailed the facts as they have appeared to me and I have mentioned interpretations of them: but I do not conceal from myself that, in medical territory, it is difficult to support one's self wholly on subjective foundations. I do not forget that Medicine and Veterinary practice are foreign to me. I desire judgment and criticism upon all my contributions. Little tolerant of frivolous or prejudiced contradiction, contemptuous of that ignorant criticism which doubts on principle, I welcome with open arms.

8 The adoption of precautions, similar to those here suggested, has resulted in the practically complete disappearance of puerperal fever.-Translator.