Between the inhaling-valve and the exhaling-valve there is a circular valve arranged so that the administrator can begin by giving all air, gradually turning the valve until the required amount of anesthetic is being given. All the air required can be supplied from this source, and the unpleasant strangling process in the usual method of giving ether is obviated, and sudden shock from a too rapid administration of chloroform is also avoided. Another valuable consideration is the cleanliness of the method, no anæsthetic coming in contact with the face in liquid form.

With nitrous oxide my custom is to give a few whiffs of it pure, and then adjust the sliding-valve according to the needs of the patient; this, I have found, as before stated, will be from one-quarter to one-fifth atmospheric air, a little more or less. It is absolutely necessary that the administrator give his undivided attention to his work. In nitrousoxide anæsthesia he should observe carefully the respirations of his patient; as long as these are continued he need have no concern. pulse is the last to give way.

The

It remains for me to add a few words upon those cases not adapted to nitrous-oxide anæsthesia. I have found a few that could not be anesthetized with it at all. In one case I gave twenty five gallons of the gas, and then the patient was just as conscious as when he began its inhalation.

Occasionally there will be a case where the admixture of the required amount of air for safety will dissipate the anesthetic condition; and, again, especially those of an alcoholic habit will become boisterous or rigid, so that it will be impossible to proceed. These cases are, however, the rare exception; but, as they do occur, mention should be made of them, and it is well to be prepared for them, and substitute ether or chloroform if required. I therefore make it a rule always to carry with me to a case these three anæsthetics, viz., nitrous oxide, ether, and chloroform, and use them in the order named. In order that I might the more readily substitute the one for the other, I had constructed the inhaling-apparatus herein described. It can be made with or without the nitrous-oxide attachment, and is convenient, cleanly, and safe.

While there is occasionally a case where nitrous oxide is unsuitable or ineffective, there is a still larger class of cases where, owing to the weak and debilitated condition of the patient, ether or chloroform add materially to the probability of a fatal issue; and it is especially in this class of cases that nitrous oxide would supply a want long felt in the profession.

DISEASE GERMS AND DISINFECTANTS.

BY JOHN G. JOHNSON, M. D.

Read before the Medical Society of the County of Kings, December 17, 1889.

[CONTINUED.]

Next in frequency to cancer of the stomach comes cancer of those portions of the intestine where its contents are obstructed, especially the rectum. When you consider that persons of sedentary habits are usually constipated, and that straining at stool easily causes a fissure of the rectum, opening up the absorbents for the cancer-germ to travel along the absorbents to the neighboring organs, it is difficult to understand why cancer of the uterus is so common among our wealthy women who eat much rare meat and take but little exercise.

Next to cancer of the rectum comes cancer of the bends of the intestines, where the contents are impeded in their progress; next comes cancer of the throat and mouth. There are more cancers of the throat than all external cancers put together.

In 1887, there died in the City of New York 780 persons of cancer; enough to make a good sized town.

Dr. Tracy, Registrar of the New York Health Board, in his report shows that in 1888 there died of cancer, in the City of New York, 870 persons, of which number 284 were men and 586 were women, or nearly twice as many women as men.

In Brooklyn, 111 males and 214 females died in 1888 of cancer. Nearly twice as many women as men.

8

In Brooklyn the death-rate from cancer was 3% to the 10,000 population, while in New York 5.5 to the 10,000 of the population. Brooklyn is composed mostly of the middle classes of society, where everybody works. New York has the extreme rich and extremely poor. Is there any probability from these figures of more luxury,

more cancer.

Compare this with the fact that in the Highlands of Scotland, where the peasantry live on oatmeal porridge, cancer is almost

unknown.

There is another animal disease that almost every physician has introduced into the human system, and yet no one can tell what it is or how it acts. I mean vaccine. Probably no one subject has been more studied than the fluid that comes from cow-pock. No one has found a germ or a germinating principle there, yet everybody knows that if you abrade the surface of the body anywhere, and plant this

vaccine upon it, it will grow. You can dry it on a quill, and keep that quill a week. Then if you moisten that quill and rub it on to the abrasion on the arm of the unvaccinated child, you introduce the same disease into the child. Is it unreasonable to suppose that the cancer-cell, which has been shown to propagate a week after it has been removed from the animal, may take a foothold on a raw spot in the stomach or intestine in the same way? Recall Strumpfell's statement of cancer of the stomach. They "take their origin on an old ulcer of the stomach as if they were planted on it. The cancer-growth forms around this ulcer as a nucleus. The great bulk of the meat consumed in this city is slaughtered abroad, and only the marketable portions shipped to the city. Can any one tell from what he sees in the market what disease that animal may have had? Remember that the cancer-cell is migatory. Virchow says it is first local and then constitutional. Remember that of all cancers are internal. In view of the alarming increase of cancer among our wealthy classes, can any one say that rare meat and blood gravy of an animal that is subject to cancer--if those cancer-cells are introduced alive into the human stomach-has nothing to do with this enormous increase of cancer in this community.

Great as has been the advance towards accurate knowledge in these diseases furnished by bacteriology, it has been surpassed by the infor mation obtained in regard to diphtheria and scarlet fever, to which I invite your attention to-night.

It is very popular to talk of microbes. We hear the term in almost every one's mouth, and yet of the many thousands who use the word so glibly, how few know its meaning or derivation. You will seek for it in vain in any dictionary or its definition in any medical book. For a long time there was a dispute as to whether these disease germs were animal or vegetable, and the word microbe was adopted as a common term which every one could use. It comes from mikros, small, and bios, life. These "little lives," as microbes mean, was a term that every one could use, whether he believed these "little lives" were animal or vegetable. Webster's definition of an animal as having sensation and motion had to be abandoned, because it was shown that there were vegetables that had both sensation and motion. Finally, Pasteur compounded a fluid entirely of minerals, furnishing C. H.O.N. in form, easily obtainable, and it was found that these microbes could subsist on this. A new distinction was made between animal and vegetable life-that is, that an animal must have some other animal or vegetable life to subsist on; while a vegetable can live on the mineral world. As it was found that these disease germs would subsist on either animal, vegetable, or mineral world, wherever they could easily obtain

C. H.O.N., all bacteriologists now class them as vegetable organisms. Of all germ diseases probably none have been fraught with more terror and less been known about them than diphtheria and scarlet fever. Diphtheria is as old as civilization. Homer mentions it as attacking the armies of Ulysses. Hippocrates, the father of medicine, Celsus, Sydenham and others, from the dawn of medical history, have described it under many different names. In the Middle Ages it was known as the Malum Egypticum. The earliest medical records of this country describe it as the putrid sore throat of New England. Yet during all these ages that it has prevailed, no one has known its cause. Like the pestilence that walks in darkness, no one knows how it came or how to stop its ravages. Chemistry cannot detect these diseasegerms. In water which stands the severest tests of chemical purity, typhoid bacilli have been found, enough to infect a whole village. No chemist with the finest reagents in his laboratory can show any difference in the pestilential air in the rice swamps around Tybee Light or the pure air from the top of Chimboraza Mountain. Chemistry can show no difference between an air laden with the yellow fever poison and the air you breathe. The microscope alone cannot tell diseasegerms, because in every mouth, on every tongue, and on every portion of the skin, are multitudes of germs. Which of these gérms are hurtful and which harmless the microscope cannot determine. An amusing instance of the mistakes made in relying on the microscope is seen in the fact that the Alumni Association of the Albany Medical College awarded their prize for the discovery of the cause of diphtheria to a microscopist who had found in the diphtheritic membrane and propagated an ordinary mold, which he named mucor malignans. It is not sufficient to find a germ in any disease-tissue and propagate it, to claim that it is the cause of that disease.

Four rules have been laid down by Koch and accepted by all bacteriologists:

1st. The micro-organism must be found in the blood, lymph, or diseased tissues of man or animal suffering or dead from the disease. 2d. The micro-organism must be isolated from every other organism and propagated outside the body in pure cultures.

3d. A pure cultivation when introduced into a healthy animal must produce the same disease.

4th. You must find the same organism in the inoculated animal. In diphtheria, for a long time after the probability of its being a germ disease, the difficulty of proving it so was found from the number of different germs that could be propagated from the false membrane, and particularly from a micrococcus that was invariably found in the membrane and that propagate so rapidly as to overshadow the

rest. Nearly twenty years ago Oertel announced this as the cause, and bacteriologists are yet found who maintain this micrococcus is the cause of diphtheria; but when the rigid rule of propagating this micrococcus in pure cultures and then inoculating an animal, it was found that this micrococcus would not produce diphtheria. What is now known as the Klebs-Loeffler bacillus has been shown to be the true cause of diphtheria. Loeffler not only isolated this bacillus, but after propagating this bacillus in pure cultures, produced the pseudomembrane in pigeons, fowls and guinea pigs. Paralysis also followed as in human beings. When the bacillus of Loeffler is injected into the windpipe of the rabbit it produces diphtheritic croup. The Loeffler bacillus fills the bill. It produces the membrane, causes the diphtheritic croup, and finally the paralysis and death by failure of the heart's action.

The next point of interest is that diphtheria is first a local disease, and later on becomes a constitutional one. Observation has shown this for many years. For instance, a physician has a hangnail on his finger; he bites it off. In examining a child's throat, the child coughs, and the expectoration comes upon the raw spot and causes diphtheria of the finger.

A mother, attending her diphtheritic child, puts a blister on her chest, thinking she is going to have pneumonia. The raw surface becomes covered with the diphtheritic exudation, and she dies from it -no false membrane having formed in the mouth or throat. A mother with cracked nipples nurses her diphtheritic baby, and has diphtheria of the breast. A patient, in the wards of a hospital where there is diphtheria, has leeches applied, and the diphtheritic membrane forms on the leech-bites.

The enormous number of cases like the above, which have been authenticated, produced the conviction that diphtheria was at first a local disease. Since the germ of diphtheria has been discovered, inoculation-experiments have been so frequently shown that it is first local and afterward constitutional. It may be laid down as thoroughly established, that on whatever part of the body diphtheria starts, that is the focus of infection. From that part of the body the poison radiates through the body until, by a general blood-poisoning, it renders the organism incapable of life.

Why diphtheria should attack the tonsils and mucous membrane of the pharynx is easily understood. The germs of diphtheria dry up and float around in the air. As they are breathed in they lodge on the tongue. This furnishes the moisture necessary to revive them and the heat at which they most readily propagate. If physicians would only spend a few minutes every day in examining their own saliva, they