under treatment and improving. It will be fully reported on a future occasion.

In none of these cases did auto-intoxication present any difficulty. The healthy tissues in all possessed a remarkable degree of resistance to the destructive action of the rays. In all of them X-Rays irritation. was difficult to produce and being produced they reacted promptly. They tolerated large doses of radiation for a protracted period of time. High expectation of success was not looked for by either the patients or myself. The patients, however, were favorable ones, inasmuch as they gave implicit obedience to all requirements. These cases are presented because they naturally fall into a class which shows the fullest degree of affirmative evidence of the X-Ray when properly and persistently administered in recurrent sarcoma. These cases were undoubtedly sarcoma of the most malignant type. Both clinically and histologically they showed this.

While the toxines were used in some of the cases towards the end of recovery, there is complete evidence that the results obtained were due to the X-Radiations. It seems to me, therefore, from the treatment of these cases that we are justified in believing that in this agent, when intelligently applied, we have a curative measure that is entitled to the respectful at tention of the medical world. They demonstrate that the emanations from a properly excited crooks tube in such intervals and quantities constitute a therapeutic agent in the most desperate cases known to the profession. The report of the fifth case will be given more fully at some future time and it is more remarkable than any of the above.

SOME POINTS IN THE ADMINISTRATION OF ANAESTHETICS. By GEO. H. CARVETH, B.A., M.D., Anaesthetist, Toronto Western Hospital.

AFTER an experience of twenty years in the administration of anaes

thetics, I offer these suggestions in the hope that some few of them may be valuable to beginners in this important branch of medical work. During that time no patient has been refused and no death has taken. place, either at the time of administration or afterwards from the effects of the anaesthetic.

Choice of Anaesthetic. On account of the nervous temperament of patients in this country and the safety with which ethyl chloride and nitrous oxide are administered, local anaesthetics are not generally used, but short operations are sometimes done under ether or ethyl chloride spray or cocaine injections. A few major operations, such as the removal of the thyroid, etc., have been done under injections of weak solutions of cocaine and morphia.

As to general anaesthetics, nitrous oxide followed by ether is made use of in most cases. except when bronchial irritation is present, when chloroform is used. Chloroform is made use of in the extremes of life, say under six and over sixty years. When the patient is doing badly under the first anaesthetic chosen, whether that is ether or chloroform, a change is made to another and generally with success.

Preparation of the Patient.-Rest in bed for some days before time of operation is advised, the last two days of which light diet is given and one meal is withheld just before operation. A laxative should be given two days before operation, but no strong purgative at any time is allowed.

The operation should be done in the morning if possible, the earlier in the day the better. The patient should be encouraged and cheered up in every way possible before commencing the administration of the anaesthetic; and no patient should be anaesthetized who greatly fears the results, rather another time should be chosen.

Water (hot or cold), as the patient wishes, should be given in large quantity before and after an operation, and in some cases washing out the stomach before hand has been of great service.

The anaesthetic should be commenced and gone on with in the place in which the operation is to be performed, and as little movement of the patient as possible should be permitted after the administration of the anaesthetic is stopped. Quick and gentle removal back to bed seems to be the best plan.

Management of the patient during time of administration.—The temperature of the surroundings should be between 65 degrees and 70 degrees. The anaesthetist should devote his whole time and energy to the administration, keeping one finger on the patient's pulse all the time and closely watching the patient's breathing, eyes, lips and general appearance. A clean and disinfected inhaler should be maue use of.

Chloroform should be given drop by drop by means of a towel or piece of lint, leaving the eyes uncovered; ether by means of a cotton covered cone, the face being protected from chloroform by vaseline and from ether by a face piece of gauze. If available, Barth's instrument for nitrous oxide-ether will be found very satisfactory.

A trained nurse should remain with the patient at least two hours after the anaesthetic is stopped. Keep the patient on his side or nearly in this position when the nature of the operation will permit of it, to allow mucous to come out of his mouth easily till consciousness is complete.

When water is given in quantity beforehand, and afterwards, the patient is kept in the open air or practically so, and the patient disturbed

very little after the anaesthetic is stopped, nausea and vomiting are almost unknown and the usual remedies to stop sickness are not required.

Fees. Considering the risks of administration, the time and energy. required, the anaesthetist should receive at least an amount equal to onethird of the sum charged by the operator.

Use of Drugs.-Morphia given beforehand is seldom or never necessary, and strychnine should only be given when called for by the weak condition of the patient, and not as a routine practice.

ERYSIPELAS COMPLICATING LABOR TREATED BY ANTISTREPLOCOCCIC SERUM WITH RECOVERY.

THER

By A. R. HANKS, M.D., Blenheim, Ontario.

'HE case I herewith report has been of such intense interest to me that I publish it with the hope that my experience in this case will encourage some brother practitioner in the hour of dire necessity when he feels the battle is against him.

Mrs. W. H. E., aged 28 years, multipara, eight months pregnant, on the evening of December 24th, presented a well marked erysipelas of nose and left side of the face, the left eye being swollen nearly shut, the rash extending from ala of nose on left side over the left face and cheek nearly to the ear, across the root of nose beneath the right eye, blebs on the left side of the nose and eye-lid. She gave a history of not having felt well for some months, complained of aphthous sore mouth, had chilly sensations for the past three days alternating with fever, a feeling of fulness and burning in the face at the seat of the fiery rash which was very tender to touch. She had headache, pain in the back and limbs, coated tongue, temperature 102 1-2 degrees, pulse 120.

Next day the eyes were both swollen completely shut, Could not see at all. Disease extending up the forehead, its margin being marked by a distinct ridge which advanced as the disease spread. It also extended over the right side of face and possessed a brawny feel, tongue dry and brown in middle, very delirious, urine frequent and scanty, no albumen, pulse 120, temperature 104 degrees.

December 26. The disease extended up the forehead and to the right ear, but not involving the ear. Symptoms in no way ameliorated, temperature 105 degrees, when during the night she was taken in labor, the baby being born about 7 a.m. on the 27th. At this time her temperature was 103 1-2 degrees, pulse 110.

December 27. The erysipelas extended to and beyond the roots of hair on the forehead, and the whole face from ear to ear and above the lips was extensively involved, the swelling of the parts first involved showing signs of subsiding though extending at the margins. The tongue

was very dry and brown, the bowels loose and the patient very delirious. December 29. Can open left eye a little. Erysipelas had extended to left of mouth and the lower lip involved. Right ear and right side of head were involved and much swollen. The tongue still dry and brown, delirium less.

December 30. The right ear enormously swollen, no fresh involvement, tongue cleaning and becoming moist, delirium gone, appetite returning.

ing.

December 31. Restlessness gone, urine abundant, disease not spread

January 1, 1905. Left ear involved and left side of head, which assumed normal three days later, urine scant.

January 2. Retention of urine, which was abundant when drawn off by catheter, a process we were compelled to continue for three days. Tongue clean and moist, appetite good, face, lips and ears much swollen.

January 5. The right ear somewhat swollen still, and eye lids show ulceration from superficial abscesses. Patient feels well, except for sore mouth, and urinates voluntarily again.

We have been taught that the streptococcus which produces erysipelas is the same germ that commonly causes septicæmia after labor; and that the germs cling to your clothing and hands with such tenacity that, as Osler puts it, you should never attend a case of confinement while treating a case of erysipelas.

Here our patient, already three or four days ill with a severe facial erysipelas, dry, brown tongue, active delirium and enormous swelling of face, with a temperature of 105 degrees, pulse 120, is taken in labor and must be protected from streptococcic infection.

How to accomplish the task in a house, already germ laden, and from which the patient's mother, her servant and her nurse had, during her illness, to be sent to their respective homes, cach suffering from a follicular tonsillitis due to unsanitary surroundings, was a question the favorable solution of which was of vital importance to the patient.

Aseptic mid-wifery is an ideal we all worship, but, under circumstances such as these, to rest content with the strictest asepticism would probably have been followed by the death of the patient a few days later from septicæmia.

When the labor was well advanced, but previous to delivery, the thighs, buttocks and vulva were given a good anti-septic scrubbing, and a large sterilized pad placed over the vulva, no vaginal examination having been made at any time. The patient was completely disrobed and carried to a bed farthest removed from the room in which she lay, while fresh clothing and bedding were used, and a large wad of sterilized cotton was kept constantly applied over the vulva, the nurse using sterilized rubber

gloves to change the dressings and sponge the vulva with anti-septic washes.

Then anti-streptococcic serum was used liberally for the double purpose of protecting the patient against infection, and arresting the progress of the erysipelas, both of which it accomplished admirably.

The temperature chart showed that within twenty-four hours of beginning the administration, there was a decided effect upon the pulse first, then on the temperature, tongue and delirium. The baby was born on the 27th, and three doses of serum were given on the 28th, when the pulse and temperature both went down; at this time, the serum was being given every six hours on the 29th, three more doses were given every six hours, and, as the delirium and temperature were declining, the interval was lengthened to eight and then twelve hours, so that in four days after twelve doses of serum the temperature was subnormal never to rise above normal.

The only unpleasant symptom attributable to the serum was retention of urine, which lasted three days, and the sub-normal temperature for a few days.

The erysipelas continued to spread for four days after the first administration of the serum, even though the constitutional symptoms showed an improvement, and I am not prepared to say the erysipelas would not have pursued as favorable a course if serum had not been used; but I think from previous experience it would not, and I certainly will use it in my next severe case of erysipelas. But it is of its protective influence I wish especially to speak.

This patient was debilitated to such an extent that she was suffering from aphthous sore mouth. She was surrounded by such unhygienic in. fluences as to develop a severe erysipelas de novo. Three inmates of the house contracted follicular tonsillitis-a streptococcic attection-though there were no other cases in the section; so that one would expect little resisting power in the patient at the time of labor, even without the proximity of so contagious a disease as erysipelas. While due precaution was adopted to prevent germs finding entrance to the vagina, I can not think the parts escaped contamination under all the circumstances. There was no pelvic involvement, thanks to the serum, and the patient made an excellent recovery.

This is an example of serum conferring immunity against infection, and of its value in this field I cannot speak too highly.

As a curative agent in infection following labor, the results have been variable in different experimenter's hands, which may be because of delay in administration, or it may be due to insufficient persistency in its use; but, as a prophylactic, there can be no doubt of its efficacy. Vaccination.