toxic symptoms. The gas after being absorbed traverses the portal system, and consequently the liver, the first emunctory for the elimination of poisons; then it reaches the lungs, where the greater part passes through the parenchyma and escapes by exhalation.

The quantity of gas administered (or the dose, if I may so call it) must not be too large, for you would run the risk of an incomplete elimination, and a part, passing into the arterial system, might determine symptoms of poisoning. Moreover, the sulphuretted hydrogen, which is so toxic, cannot be used in a state of purity; it must be diluted with some other gas. Air being too irritating, Bergeon made his choice of carbon dioxide, which is not irritant, is readily eliminated by the respiratory passages, and, besides, possesses anæsthetic properties well known to you.

He thus exhumed from the past, as Maurice Dupont has shown,* a method counselled at the close of the last century by Priestley, who recommended to the physicians of the period to employ fixed air-i.e., carbonic acid-in lavement in the treatment of certain diseases. The method of Bergeon became known by the various communications made by him to the Academy of Sciences and the Academy of Medicine. I immediately made application of it in my hospital service, and one of my pupils, Dr. Lecomte, has analyzed the results obtained, and made this the subject of his inaugural thesis.†

the pressure of the carbonic acid which penetrates the rectum.

In the apparatus of Morel, the carbonic acid is generated by pouring sulphuric acid on bicarbonate of sodium in a flask. The complete apparatus consists of a flask in which the carbonic acid is generated, of a rubber bag capable of holding six litres of carbonic acid, of a large, wide-mouthed bottle to contain the medicinal substance, and of a rubber-ball injector, which acts the part of a suction- and force-pump. The rubber bag having been filled with carbon dioxide, is adapted to the bottle, which is itself connected with the injector. It is necessary to take care before introducing the canula into the rectum to get rid of all the air contained in the apparatus by making a few pressures on the rubber ball.

This apparatus presents certain inconveniences: first, the use of sulphuric acid is an objection, for some of it is sure to come over with the carbonic acid during the effervescence and vitiate the result by the irritation which its presence causes. Then again, it is too cumbersome, and is not sufficiently portable, which is a serious inconvenience in private practice; therefore, at my request, Dr. Bardet has constructed another model in which all the parts are brought together in a convenient, portable box, and in which the carbonic acid is produced by the action of tartaric acid on the sodium bicarbonate.

The apparatus (Fig. 1) is composed of a box with compartments occupied by (1) a carbonic acid generator, A; a wide-mouthed bottle resembling a wash-bottle, B (the barbo

a pear-shaped rubber ball, P, and a canula, C, etc. The canula C, with its tube, are the only parts which are outside of the box during the working of the apparatus. The injector I, whose operation depends on a play of valves,

* Maurice Dupont, “On Inhalations and Injections of Carbonic Acid" (Bull. de Thérap., 1887, t. cxii. p. 24). † See and compare Bergeon, Acad. des Sciences, July 12, 1886; Congress of the French Association for the Advancement of Sciences, Nancy, August 20, 1886; Acad. de Méd., November 2, 1886; Cornil, Acad. de Med., October 19, 1886; Morel, "New Treatment of Affections of the Respiratory Passages and of BloodPoisonings by Rectal Injections, Cure," Paris, 1886; Dujardin-Beaumetz, "The Gazo-Rectal Injector of Dr. Bardet," Acad. de Méd., November 9, 1886; also the Treatment of Pulmonary Affections by Gaseous Rectal Injections," Bull. de Thérap, t. cxi. p. 449.

"On

nected with all parts of the apparatus by means of tubes, r, t', t, with their faucets and stop-cocks.

The gas furnished by the generator A escapes by the tube a, which is connected by the faucet with the central metallic piece I, whence it issues by the tube to enter the reservoir R. Here it is retained by the resistance of the liquid in the wash-bottle B. When once the bag R is filled, the apparatus is ready to work. The operator squeezes the ball P, forcing out the air which it contains, and which escapes by the valve i' and canula. Then the ball expands by its elasticity, exercises its suction-power, and fills

itself with gas from the reservoir R. This gas first passes out of the reservoir and under suction influence enters the receptacle B by the tube v, which dips down to the bottom of the vessel, where it becomes charged with medicinal vapors; then it escapes by the exitpipe to enter the injector, which it then fills, as well as the rubber ball P; the operator now presses the ball and forces the gas out through the valve and the canula C, and continues so to do till the rubber bag, which holds just four litres, is emptied, which event makes itself known by the rubber ball remaining collapsed after being squeezed. To prepare the apparatus for use, you proceed in the following way:

1. Pour into the receptacle B enough to fill it half full of the medicinal solution which you propose to use (sulphur waters, carbon bisulphide water, warm water holding in suspension iodoform, terpinol, eucalyptol), then put in the stopper.

2. Place in the generator A the contents of a package consisting of sixteen grammes of tartaric acid with twenty grammes of bicarbonate of sodium,-a quantity necessary to generate four litres of carbon dioxide. the generator half full of water by means of the funnel e, and shake the flask.

Fill

3. Have care to drive all the air out of the apparatus by four or five squeezes of the rubber ball before introducing the canula.

4. The injection should be made slowly and without force; there ought to be an interval of from ten to fifteen seconds between the successive pressures made on the injector, and the entire operation should last from twenty minutes to half an hour.

As for the apparatus of Faucher, it is com

posed (1) of a flask, A (see Fig. 2), which receives the sulphuretted water and a package of sodium bicarbonate; (2) of a reservoir, B, which is filled with bisulphate of sodium; this reservoir is connected with an escapepipe, which traverses the rubber cork which closes the flask; (3) of a rubber tube ending in a canula.

To work the apparatus you plunge the lower part of the reservoir B into the alkaline water by pressing on the, pipe T. The

not to cause distention; the quantity is regulated by the amount of salts employed, and patients can manage this apparatus very well themselves.

Whatever be the apparatus or method employed the principle is the same, and it now remains for us to study the application and uses of the various substances introduced into the economy by the means above described.

Bergeon, in a recent communication to the Academy of Sciences (June 25, 1887), insists on the necessity of operating with carbonic acid gas which is absolutely pure; for if it is impure, or if it has remained a long time in the rubber bag, it loses the property of passing out by the lungs, and, accumulating in the intestine, causes meteorism and colic. As it is very difficult to purify carbonic acid, it is desirable to contrive some

way of obtaining it pure at first by making way of obtaining it pure at first by making use only of substances that will produce gas of a good quality.

I have already referred to sulphuretted hydrogen, and told you that since Claude Bernard's discovery we find ourselves able with

impunity to introduce quite large quantities of this gas per rectum without determining toxic symptoms; we have just repeated Bernard's experiment in our laboratory in the following way:

Taking a middling-sized dog, we injected one hundred and thirty cubic centimetres of the gas by the rectum. Test-1 t-paper moistened with acetate of lead and placed before the nostrils of the animal blackened at the end of fifty seconds, and the dog, which was not muzzled or tied, remained quiet without appearing to be at all incommoded. The sulphuretted hydrogen, then, seems to have been promptly eliminated, for a few minutes only after the end of the injection the animal's breath no longer blackened the testpaper. It is by such experiments that we have been convinced that we may without danger apply to man the injections of sulphuretted hydrogen, but with the condition that the gas shall be free from air, and that the injection shall be made slowly. Dr. Bergeon advises the use of the natural sulphur waters only, having observed that the artificial sulphur solutions are often irritant. This, however, is not necessarily the case, and the main thing is to see that the sulphuretted hydrogen is pure.

In our hospital service we use the following solutions, and according to the process given below:

Distilled water, q. s. to make 100 cub. cent. M.

We introduce into the glass mixing-bottle. of our apparatus five cubic centimetres of each solution, a mixture capable of setting free fifty cubic centimetres of perfectly pure hydrogen sulphide; this is dissolved in two hundred and fifty cubic centimetres of pure water, and it is through this mixture that the carbonic acid is made to pass.

I have employed the bisulphide of carbon in the form of carbon bisulphide water, whose preparation and uses I have pointed out to you in previous lectures, and especi

ally under the head of intestinal antisepsis ;* this water may be put just as it is into the

mixing-bottle.

You see that we may vary almost to an unlimited extent the number of substances capable of being absorbed by this process, have, for instance, employed eucalyptol, terbut I will indicate only the principal: we have, for instance, employed eucalyptol, terpinol, iodoform, this last substance being solid was held in suspension in warm water; lastly, we have made use of carbonic acid alone.

How has this mode of treatment been borne by our patients? In a certain number of cases we have seen the cough diminish, the expectoration modified, and the respiratory distress abated; some have recovered their ability to sleep and their appetite. These happy results, whenever we have obtained them, were due to the union of carbonic acid gas with sulphuretted hydrogen.

Fraentzel, of Berlin, and Statz have published through the Medical Society of Berlin the results of their observations on the efficacy of the method of gaseous rectal injections, and their results agree completely with those which I have observed.

The discussion which took place recently in New York on Bergeon's method, on the occasion when Kinnicut, Bruen, Shattuck, Pepper, Wood, Beverly Robinson, etc., gave an account of the results which they had witnessed from these gaseous injections, eventuated in conclusions which are in harmony with those which I had adopted from trials which I had personally made, and show

* THERAPEUTIC GAZETTE, Vol. I. (Third Series), page 165.

the superiority of the combination of carbonic acid with sulphide of hydrogen over all other antiseptic bodies.

Eucalyptol, on the contrary, has given me nothing but bad results in these rectal injections. I have always seen patients grow worse after its employment; there has been an increase of the irritation under which they were suffering, and lessening, if not complete disappearance, of appetite. Terpinol has seemed to me superior to eucalyptol, but yet inferior to hydrogen sulphide.

It has seemed to me, in the conditions in which my trials with this agent were made, that iodoform did not amount to anything, and I judge that it is absorbed in too feeble quantity to have any real antiseptic effect.

You know, moreover, that if the antiseptic action of iodoform is incontestable, its antituberculous action is, on the contrary, disputed by some authorities, and especially by Rovsing, of Copenhagen, who has shown that in giving experimental tuberculosis to animals by intraocular inoculation, the course of the disease is not at all hindered by the combination of considerable quantities of iodoform along with the inoculation material. At the same time these facts have been contested by Bruns, who, in a recent communication to the Congress of German Surgeons, endeavors to show by direct experiments made on tuberculous abscesses that the action of iodoform is both specific and antibacillary. This is, however, a question still unsettled, and to be decided by future study. With regard to the action of carbonic acid when used alone, it has seemed to me to play the part of a sedative of the nervous system.

But before concluding this topic I wish to call your attention to a fact noticed by my colleague, Chantemesse, and which we have verified many times in our practice. Even in patients that manifested a marked improvement, we have not been able to note any change in the approximate number of tuberclebacilli in the sputum. This is a fact to be remembered, showing, as it does, that if by the employment of gaseous rectal injections we may be able to improve the condition of our patients, the cause and the germ of the disease have escaped the action of the medicament.

It remains for me, gentlemen, before finishing this lecture, to speak to you of a new and very interesting method, which was first employed in pulmonary antisepsis. I refer to hypodermic injections with a mineral-oil basis. I speak of this method here because its first applications were made with a reference to the

subject which especially occupies us at this moment; but it is, as you know, of much more general application, and which has given to hypodermic medication a surprising and unlooked-for extension. One drawback of the hypodermic method, in fact, was its inapplicability the moment we wished to utilize substances little soluble or at all irritant, hence the desideratum of some such vehicle as we have now found; and, thanks to the employment of liquid vaseline, we may now inject under the skin substances which are highly irritant, such as eucalyptol, sulphide of carbon, and iodoform.

First pointed out by Pierre Vigier as applicable to hypodermic injections, it was my colleague, Balzer, who, in his service at the hospital Lourcine, was the first to utilize liquid vaseline as an excipient for subcutaneous injections of the salts of mercury, both soluble and insoluble. Shortly afterwards Dr. Albin Meunier, of Lyons, published a series of formulæ for hypodermic injections with a basis of liquid vaseline holding in solution various antiseptic substances, and he announced that these solutions might with impunity be injected under the skin, and without provoking any inflammatory accidents. At my request Dr. Albin Meunier sent me his products, and I was able to note in my practice the reality of his assertions. At the present time this method is actually in vogue, and is a part of current practice. It has already been in my hospital the subject of interesting researches, among which I may cite the studies of De Ley,* and of my pupil Caravais, who has made it the theme of his inaugural thesis.t

Let us inquire into this subject of liquid vaseline, for it is important to have a clear idea of what, in medical usage, we are to understand by the term. The petroleums have a variable composition according to their origin, and those of America are not comparable with those of Caucasus, or even those obtained from Europe. This variable composition explains why the petroleums do not furnish identical products on distillation. In distilling petroleum you obtain, between the temperature of 40° and 200° C., and even higher, variable bodies which are utilized in the arts. At first the petroleum ethers come over, which are so much employed to-day in our laboratories, then the illuminating oils,

* Ley, "On Antiseptic Hypodermic Injections with a Basis of Mineral and Vegetal Oil in the Treatment of Pulmonary Complaints" (Bull. de Thér., t. cxii. p. 246). † Caravais, "A Study of Liquid Vaseline as a Vehicle in Hypodermic Medicine" (Thèse de Paris, 1887).

and lastly, towards the end of the operation, we obtain paraffine and a liquid substance which is employed in the arts for machine oiling. It is this substance, purified and decolorized, which Albin Meunier has employed for subcutaneous injections, and which, according to the quantity of paraffine it contains, has a density between 0.810 and 0.870. This substance, which is liquid, of thin, syrupy consistence, ought, for officinal uses, to be absolutely neutral in order to be readily tolerated by the tissues. It dissolves a great number of bodies, and in particular, chloroform, bromine, iodine, iodoform, sulphide of carbon, myrthol, eucalyptol, terpinol, hydrogen-sulphide, etc. Bocquillon, moreover, has given us a very complete list of formulæ for hypodermic injections having for their vehicle liquid vaseline, a list which I have reproduced in my "Formulary."*

It was important, for the benefit of medical practice, to decide on a name for this new substance. While recognizing the fact that the word liquid vaseline is improper, since the substance recommended under this name by Albin Meunier is not vaseline, it has seemed to me to be best to keep this name, which was given by the discoverer; and if you say in your prescriptions medicinal liquid vaseline, you will sufficiently indicate the conditions. of purity and of neutrality which the product ought to have. It was necessary to decide this point, for there exist in commerce certain so-called "liquid vaselines" which are only mixtures of petroleum and of vaseline, and which, even when tolerably pure, may give rise to very serious inflammatory accidents, as we have had occasion to find out.

The mineral oils do not alone possess the property of dissolving the different substances of which I have just spoken, and you can use in the same way the oils of earth-almond (Arachis hypogaa), and even olive and linseed oils, taking pains first to sterilize them by heating.

It remains now to state the results obtained by means of these new methods of injection in pulmonary antisepsis. I should have told you before that these liquids are admirably borne by the economy, and rapidly diffuse themselves through the organism.

Sulphuretted hydrogen and bisulphide of carbon seemed at first to produce good effects, but this salutary action did not long continue,

* Bocquillon, Mem. et Bull. de la Soc. de Thér., 1887; Dujardin-Beaumetz, "Formulaire de Thérapeutique,"

1887.

and these medicinal agents give much less favorable results when administered in this way than when given in the form of gaseous rectal injections.

Iodine works well in the forms of tuberculosis with abundant bronchial secretion; it rapidly diminishes the cough, expectoration, and oppression. It is especially in the employment of eucalyptol that this method has rendered us real service. This is the formula proposed by Albin Meunier:

Pure eucalyptol, 5 parts;

Medicinal liquid vaseline, 20 parts. M.

I have modified this formula, and now make use of solutions of equal parts. When the eucalyptol is perfectly pure, injections of a solution of equal parts of eucalyptol in vaseline, in the dose of a syringeful (one cubic centimetre), and repeated night and morning, never cause any local irritation.

Roussel, of Geneva, who is the most ardent advocate of injections of eucalyptol in the treatment of tuberculosis, and Professor Ball, in a communication made this year to the Academy of Medicine, have reported the results of trials made in their respective hospitals with eucalyptol injections. In one case, the bacilli had disappeared from the sputa of a phthisical patient. In the reply which I made to the communication of Professor Ball I showed in this connection that eucalyptol acts only on the bronchial element, and that in certain cases of phthisis, attended by much fever, it is rather dangerous than useful. This view has been confirmed by a great number of my confrères, and in particular by Bouveret and Péchadre, of Lyons, Laplane, of Marseilles, and Biot, of Macon, who have come to conclusions absolutely conformable to those which I had laid down, and of which the following is a résumé :

Eucalyptol is generally well borne by patients; at the same time it presents certain disadvantages. Some complain of the disagreeable and persistent odor of the breath, a result of the exhalation of eucalyptol by the lungs; in others, the diminution of expectoration brings on dyspnoea. Eucalyptol is, then, chiefly a modifier of the bronchial secretions, and is in no sense a specific against tuberculosis; in fact, in all the researches which we have made, we have never seen disappear from the products of expectoration the characteristic bacilli, and if injections of eucalyptol give relief to patients, they do not cure the disease.

Nevertheless, this way of administering