When all these measures had been finished the sanitary inspectors declared, under oath, that disinfection was complete. A general bath was then ordered for the whole populace, after which they were obliged to use oil on all hairy portions of the body; then 150 rounds were fired from the cannon, in order to procure concussion of the atmosphere; then the barriers were all removed. of individual families, and if persons | gave the reasons for the closure of the were noticed to be sick such were trans- sacred places. The streets were swept, ferred to hospitals as soon as possible; as well as alley and public places, and the remainder of families, in cases where the dust burned or buried. sick were removed, were placed in observation hospitals, their houses closed, after all suspected articles capable of transmitting contagion had been destroyed. The committees were obliged to furnish such families anything they wanted. Reports were prepared addressed to an outside sanitary commission, over the quarantine line; such committees kept all streets and houses clean, too, and sought for suspected individuals and effects supposed to contain any congion; finally, the committees obliged a strict observation of established rules. These measures were continued up to the 13th of June, an epoch when no more plague patients were in the hospitals and the disease seemed extinct. Before opening the town to the outside world again the place was subjected to another triple quarantine. The first was destined for a general visit of the inhabitants, in order to be assured that plague no longer existed. The second had for its object the general disinfection of dwellings and other places. It lasted forty days, and all furnishings were burned, as well as suspected household effects, in such places as the disease had been manifest. All metal objects were thoroughly washed with soap and water; doors; windows, walls, ceilings and floors were cleansed with muriatic acid and water; they rubbed the latter with sand and wood sawdust mixed with water; afterwards fnmigations with oxygenated muriatic acid gas were made. All win dows were kept open for fifteen days, and all house walls and ceilings were then whitewashed with lime, after all crevices and holes had been sealed up with cement. All clothing was fumigated with flowers of sulphur. After all this the inhabitants were permitted to return home. All church edifices were submitted to the same precautions, and those in which infected or suspected bodies had been interred were sealed up, and an inscription placed on a marble tablet The third quarantine commenced at this epoch, and was not marked by any injurious accidents; only some mild forms of intermittent fever were noticed. On November 1 the quarantine was raised, communication established with the outside world, and religious celebration occurred. The government, on its part, had executed the most rigorous measures to prevent all communication by land or sea upon the coast of the province of Bari; sanitary cruising vessels prevented the entrance and departure of all boats, and all merchandise arriving by sea from the parts of the realm was submitted to a most rigorous examination. A second quarantine line was established two miles from Nola; All merchandise coming from the province Bari and Nola, en route for Naples, was stopped at the places where it was found; all goods capable of carrying contagion were destroyed as soon as captured. The crews were submitted to quarantine before being permitted to depart again. All the cotton going from Nola to Naples was housed up to the month of December, and wire seals marked all that held in store-houses, which was purified. All letters were plunged into strong vinegar and then fumigated. No person from Bari could travel without a health certificate, and all things capable of holding contagion had to be reported to the public authorities and were cleansed. It was the death penalty for any one to introduce anything from Nola without official notification. Finally, thanks to such rigorous measures, the disease was limited to the single town of Nola, and was extinguished there. We have mentioned before the medical treatment of this epidemic. Almost 950 persons were attacked by the malady, of whom 728 died. A singular thing is remarked. A learned French missionary, who had resided in the Levant for a long time, assures us that when an individual has had one or two buboes passing on to suppuration he is no more liable to contract the plague. Such were the measures, full of wisdom and foresight, that the government of Naples took on this occasion. (It is doubtful whether moderns could do as well). It would be well to follow the example set on this occasion in case of similar calamities. We have also seen that the vigorous measures adopted at Moscow relative to isolation of hospitals, and particularly of orphan asylums, where, thanks to the active care and vigilance of Dr. Mertens, who was physician in charge, the contagion never penetrated. [TO BE CONTINUED.] Trephining. My experience, as well as that of other surgeons accustomed to operate for head injuries, suggests the "bull" that in "trephining" for depressed compound comminuted fractures, never use a trephine. The instruments usually necessary are a knife, a pair of bluntpointed scissors, a chisel, a good, sharp, Hopkins rongeur, two or three bone forceps with different curves, an elevatorium, two thumb forceps, one "rattoothed," a half dozen hemostatic forceps, small and medium-sized curved needles, and a good needle holder, small and medium silk, silkgut and catgut for sutures and ligatures. The small needles should be previously threaded and ready for instant use.-ESTES. Mellin's Food Prepared with Fresh Cow's Milk as Directed. RICH RED BLOOD OR BLOOD RICHNESS Is the main desideratum in many cases. Richness of the circulating fluid in those important basic elements of vitality-hæmoglobin and oxygen. "Pepto-Mangan ("Gude") INFUSES THIS DESIRABLE RICHNESS IN CASES OF ANÆMIA, CHLOROSIS, AMENORRHOEA, DYSMENORRHOEA, RICKETS, By furnishing these necessary hæmoglobin-making and oxygen-carrying elements - Iron and Manganese-in a form for almost immediate absorption. Both repeated "blood counts and clinical experience go to prove this statement. PEPTO-MANGAN "GUDE" is put up only in bottles holding 3 xi. Prescribe original packages, Doctor, and thus avoid substitution. NEVER SOLD IN BULK. Samples and literature upon application. M. J. BREITENBACH COMPANY, Sole Agents for U. S. and Canada. "WELL PREPARED!! NUTRITIOUS!! EASILY DIGESTED!!" THE WORLD'S COLUMBIAN IMPERIAL GRANUM STANDARD PREPARED FOOD S EARNESTLY RECOMMENDED as a most reliable FOOD for INFANTS, CHILDREN and Nursing-Mothers; -for INVALIDS and Convalescents;- for Delicate and Aged persons. It is not a stimulant nor a chemical preparation; but a PURE, unsweetened FOOD carefully prepared from the finest growths of wheat, ON WHICH PHYSICIANS CAN DEPEND in FEVERS and in all gastric and enteric diseases. It is easily digested, nourishing and strengthening, assists nature, never interferes with the action of the medicines prescribed, and IS OFTEN THE ONLY FOOD THE STOMACH CAN RETAIN. SEEMS TO HOLD FIRST PLACE IN THE ESTIMATION OF MEDICAL OBSERVERS.-"The Feeding of Infants," in the New York Medical Record. A good and well made powder of pleasant flavour. CONTAINS NO TRACE OF ANY IMPURITY.-The Lancet, London, Eng. A valuable aid to the physician in the treatment of all the graver forms of gastric and enteric diseases.-The Prescription. As a food for patients recovering from shock attending surgical operations IMPERIAL GRANUM stands pre-eminent.-The International Journal of Surgery, New York. Not only palatable, but very easily assimilated.-The Trained Nurse, New York. IMPERIAL GRANUM is acceptable to the palate and also to the most delicate stomach at all periods of life.-Annual of the Universal Medical Sciences, Philadelphia, Penna. Highly recommended and endorsed by the best medical authorities in this country.-North American Practitioner, Chicago, Ills. It has acquired a high reputation, and is adapted to children as well as adults-in fact, we have used it successfully with children from birth.-The Post Graduate Journal. The results attending its use have been very satisfactory. York State Medical Reporter. * * * M.D., in New Especially valuable in fevers, and often the only food the stomach will tolerate in many gastric and enteric diseases.-Dominion Medical Monthly, Toronto. IMPERIAL GRANUM has stood the test of many years, while many competing foods have come and gone, and have been missed by few or none. But it will have satisfactory results in nutrition far into the future, because it is based on merit and proven success in the past.— The Pharmaceutical Record, N. Y. ★ Physician's-samples' sent free, post-paid, to any physician-or as he may direct. ★ JOHN CARLE & SONS, Wholesale Druggists, 153 Water Street, NEW YORK CITY, N. Y. THE Cincinnati Lancet-Clinic: New Series Vol. XXXVIII. A WEEKLY JOURNAL OF CINCINNATI, MARCH 27, 1897. Original Articles. NOTES ON OBSTETRICS AND BY F. O. MARSH, M D, Some experience as instructor in one of the medical schools of this city has convinced me that one of the best ways for a teacher to accomplish his function is to occasionally expose his own ignorance. As a method of eliciting discussion it may also serve as an apology for invading a field of medicine so distinctly relegated to a special department. With a fair average practice, extending over twelve years, the essayist feels that, nevertheless, his experience in obstetrics and gynecology has been limited. Whether this has been due to a state of celibacy or the lack of a disposition to cultivate the study I am not prepared to state. But of a number of points which have a bearing on the subject I have become fairly convinced: Whole Volume LXXVII. difference what we do so long as it is done aseptically. Outside the field of gynecology I will venture the assertion that more people have been killed through a misplaced confidence in antiseptics than will ever be heard of. Furthermore, if the benefits of antisepsis are to be obtained at the sacrifice of all the other elements of good sense and good surgery, it may well be a question whether we are not as well off without it. It is certainly to be regretted that the sense of security afforded through asepsis does so often obscure the need of attention to such factors as the preliminary building up of the patient, the duration and severity of the operation and the consequent degree of shock, drainage, coaptation and care as to pressure by the dressings, together with careful after-treatment. parative neglect through the predominance of the germ theory. The study of temperament and individual constitution, careful, philosophical consideration of the necessity or advisability of operation, the important question whether at times it is not even our duty to abstain from saving life unless we can at the same time confer First and most generally of a certain a reasonable degree of health and comfort detrimental influence which the modern-all these considerations fall into comantiseptic or aseptic craze has had upon the judgment at large, not only of the gynecologist, but of the general surgeon and physician. By "antiseptic craze" I do not mean the doctrine of the practice of antisepsis in its best sense. I think I may say that it has been my privilege to help promulgate and defend such doctrine and such practice at a time when they were not so universally accepted. But I believe that too much cannot be said at the present time against the idea so prevalent that it makes no 1 Read before the Academy of Medicine of Cincinnati, February 15, 1897. It is not alone in the field of surgery that this modern one-sidedness is felt. To see a family doctor assiduously sprinkle a dilute solution of carbolic acid over the carpet of a sick-room, and at the same time use his lead pencil as a tongue depressor in a suspected case of diphtheria, complaining the while that the great trouble is to teach people to disinfect thoroughly, is a spectacle rather disturbing than amusing. To find gastro-intestinal disturbances treated by antiseptics long after there is nothing left to contend with but the |