Dr. Imlach and some others say that as soon as we have diagnosed the condition the operation is indicated, and in this they are supported by the fact, as they claim it to be, that we rarely see such cases until there are evidences of rupture. What are these evidences of rupture? The pain and collapse. The advocates of electricity say the pain and collapse in its mildest form is not due to rupture, but to contractions of the dilated tube. On the other hand it is asserted, and with perfect justice, as there are many sad cases on record, that the first symptoms demanding medical aid may be those of fatal rupture, and as Dr. Herman, of London, says in a very thoughtful and temperate paper which has just appeared in the London Lancet, if we judged of the fatality of extra-uterine fœtation, by the results of abdominal section cases and of post mortems, we should regard it as one of the most fatal conditions we know of. But this is misleading. Some very high authorities regard extra-uterine fœtation as far more common than is generally supposed, that rupture often takes place with hæmorrhage into the peritoneal cavity, and that the bleeding ceases spontaneously. The fœtus may escape and be absorbed or may die and be retained in its sac and be dissolved in the liquor amnii and absorbed. A remarkable instance of the possibility of the absorption of the fœtus is the case of Dr. Petch, in which a fœtus so advanced that the heart sounds could be heard, died and was almost completely absorbed. Experiments on animals. (rabbits) by Leopold have demonstrated such a fact beyond doubt. Hence the explanation why as in many cases, no fœtus has been found either unfortunate, for she immediately began to suffer at autopsy or on section during life. And all such cases cannot be accounted for by the operator having over-looked the remains of the foetus; a thing easily understood by anyone who has done the operation and removed the clots, etc., by a process of scooping and washing out. These facts with reference to the solubility and capacity of the fœtus for being readily absorbed lend support to the opinions of certain authorities, notably Veit, Leopold and Lesonej, to the effect that most, if not all, pelvic, especially retro-uterine hæma toceles, are the result of ruptured extra-uterine fœtation (tubal). If this be true then extrauterine fœtation is by no means so fatal as it has been hitherto supposed, and the practice of opening

the abdomen to remove a tubal gestation sac directly we have diagnosed it, is to needlessly expose many women to the dangers of a serious operation. I speak of it as a serious operation. It is not so in the hands of experienced abdominal surgeons, as Mr. Lawson Tait; but such men cannot always be had to operate in an emergency. In competent hands this is one of the most brilliant of the life-saving operations of surgery. But if all the cases on record were available for statistics the showing would by no means be so good. Notwithstanding what I have just said, I desire to appear on record as holding that in all cases in which the diagnosis having been made with reasonable certainty, there are serious symptoms of loss of blood, or of the peritonitis which may be set up, if the patient survive the hæmorrhage, and also in all cases of urgent pelvic or abdominal symptoms of doubtful character, this grand life-saving operation must be promptly done, and it will be done with the assurance that there is no state of the patient, however low, in which it may not be successful. That abdominal section may be necessary, after electricity has killed the fœtus, must I think be admitted. Serious symptoms have arisen at a variable interval after all activity about the gestation sac has subsided. know of no case in which this has already been done, but my own case is an illustration of the fact. I quote from the report of that case (Canada Medical and Surgical Journal, August, 1885):

I

"After this she improved so much that I ventured to consent to her leaving her bed and going to a couch in the same room, but this proved

from what we took to be symptoms of inflammation
and suppuration of the tumor.
It became very
painful, tender and swollen, and presently a red blush
with slight oedema of the surface appeared, Tem-
perature rose three or four degrees, and altogether
her condition gave us much anxiety for a week or
two. These symptoms occurred on the closing
days of March and first week of April. During
this period, while I was absent in New York, she
was seen by my friend and colleague, Dr. Shepherd.
The question of incision and drainage of the
supposed abscess cavity was seriously considered,
but unexpectedly she began to improve in every
respect, and a few weeks afterwards was able to
leave her bed.

of death without ample opportunity of consulting jurisprudence, as will make him a reliable witness authorities of refreshing his memory, or of decid- in any and every case requiring investigation. I ing intricate problems. Now bearing in mind the hold that within the limits of the time allotted to fact that at any time a case may arise requiring medical studies all that an ordinary medical man most profound knowledge, and involving issues of can do is to fit himself for the ordinary duties immense importance, I leave it to the individual which will devolve upon him in the discharge of opinion of each one present, whether he is compe- his harrassing practice. To spend the time necestent to decide such momentous questions on the sary to perfect himself as a medical jurist would spur of the moment. Even cases which superfici- be wasting his energies-the knowledge so acquired ally seem to be simple and uncomplicated, may on could only be called into requisition at long interreflection become serious and difficult, and there vals. The remuneration he would receive throughmay arise a failure of justice by forming a hasty out a long practice could not be adequate to the opinion. time and labor expended, and the knowledge would inevitably evaporate through years of ordinary practice. Moreover, skill as a medical jurist can only be acquired by experience. Mere book knowledge cannot compare with practical knowledge. The judgment needs to be perfected by application. For these reasons it seems to me unreasonable to expect, however well grounded by study, any medical man whose constant attention is occupied by the ordinary duties of his profession, that he can retain such an accurate acquaintance with each and every subject embraced in the limits of forensic medicine, as to be ready to form an opinion on any case of disputed or doubtful cause of death which would not be liable to be called in question.

It must be borne in mind that subsequent correction of an erroneous opinion is almost impracticable. No opportunity for so doing may arise. If the matter should be made one of subsequent investigation it is of course possible that the medical witness may have a chance to correct himself, and should undoubtedly do so if mindful of his obligations; but consider what a fearful blow he would strike at his own reputation, how sadly he would be made to figure in court, and how much the ends of justice would be defeated. Surely when the reputation of the deceased and the feelings of surviving friends, or the liberty or even life of the accused, or grave financial issues, or the reputation of the medical witness hang in the balance, it is not too much to ask that ample time should in all cases be afforded the medical witness, for careful consideration of all the conditions and circumstances of the case, and for reference to authorities. There may possibly be some gifted individual, who really is possessed of such absolute and profound knowledge of all anatomical, medical, surgical, therapeutical, pharmaceutical, pathological, toxicological or other ogical branches embraced in medical jurisprudence, that he could unerringly avail himself of at a moment's notice, and it is more likely that there may be some one so vain as to believe himself so gifted, but assuredly he is not to be found amongst the ranks of ordinary medical men.

In what I have said in so far as to the medical witness, I think I may reasonably rely on your

Hitherto, in a scattered population the only available opinion has necessarily been drawn from the ranks of ordinary practitioners, but it is a question with me whether or not circumstances have so altered as to justify the requirement of more specially skilled witnesses, or at least of developing such, which may be available when required by progress of civilization. In all large, thickly populated centres there is a need of a division of labor to ensure perfect efficiency. In the medical world we need some who will devote themselves specially to different branches of medical and surgical practice.

Thoroughness can only be attained by such a division. We have long ago entrusted chemical examination in forensic matters to experts in chemistry. Why should we not have experts in medical jurisprudence as well. I should as soon trust ordinary medical practitioners to conduct chemical examinations in toxicological cases, as I would in other branches of forensic medicine.

So long as circumstances did not permit atten

tion to be limited to particular branches of medical science, we had to rely upon the material we possessed, but assuredly, perfection in any of them can only be attained by directing our energies and study to some one or other of them.

ANTISEPTIC TREATMENT OF WOUNDS
OF THE HAND.*

BY DR. OLMSTEAD, HAMILTON, ONT.

As to the coroners jury, I hardly feel enough | Mr. President and Gentlemen,– respect for it to give it serious attention. To suppose that a dozen men gathered up promiscuously from the streets, ignorant, as we know them by experience to be, and utterly unable to form a rational opinion as to the cause of death, could in any way advance the ends of justice, is to my mind egregiously absurd. The coroner's jury is always, if not a hindrance, at least a nullity, more frequently the former. In my opinion we might well dispense with the coroner's jury-if not indeed with all other juries.

The subject to which I have the honor of asking your attention, viz.: The aseptic and antiseptic treatment of injuries of the hand, is one which, at first glance, appears to be of rather trivial character, but I think you will all agree that it is one of very great practical importance both to the general practitioner and public at large. We all meet with such injuries almost daily in our practice, while but few are called on to remove renal calculi, cystic ovaries, or brain tumors; and though we have not the opportunity of transplanting a cornea, yet it is not uncommon for us to have fingers almost entirely removed by machinery, which it is in our power to replace and

You will naturally ask, What substitute do you propose, or what change do you think advisable to render coroner's inquests more satisfactory. I honestly confess that I have no matured scheme to lay before you. The matter requires consulta- Prof. Agnew says, "The importance of the tion and prolonged investigation. Briefly, how-hand as a prehensile, tactile and defensive mechanever, I may indicate the leading modifications ism is so great, that in no other part of the body

which seem to me desirable.

save.

does there exist so much necessity for conserva

1. Abolish the antiquated absurdity of coroner's tive surgery." Now the frequency with which jury.

2. Divest the coroner of all legal or judicial functions. Confine his duties entirely to the investigation of the case as a medical man.

fractures of the phalanges are treated by amputation is shown by Hamilton's figures, viz., 12 in 30, i.e., 40 per cent., but I feel confident from my observation of hospital cases during the past

3. In any case of difficulty, let him have the eighteen months that a great many more can be aid of one or more associated coroners.

4. Require more exactness in recording all the circumstances and conditions attendant on the

death of deceased.

5. Entrust the post mortem examination to those specially qualified to conduct them, or at least to those who have had frequent opportunities of conducting them, and not to one chosen at haphazard, or because of his accidental association with the case.

6. Give the medical expert ample opportunity to mature his opinion, by comparison, reading and

reflection.

7. And finally, require the coroner or associated coroners to present to a proper legal officer a reasoned opinion as to the cause of death, based upon a consideration of all the facts elicited in the course of the enquiry.

there.

saved than usually are. However, when it is found absolutely necessary to amputate, as much of the finger should be saved as possible, and we should always aim to get as useful a hand for our patient as circumstances will allow. Now it is as important to practice aseptic or antiseptic surgery in this class of injuries as it is in the major operations, and you all are aware of the necessity Here also should we perfect ourselves in the technique of ascepticism, for, as is well said by Gerster, of New York, "It is wicked to attempt to learn the first lessons of asceptic surgery in laparotomy, when, possibly, the surgeon's experience is bought with the life of his trusting patient." Of course we necessarily have to modify our means of ascepticism in emergencies, but never should we deviate from this principle.

* Read before the Ontario Med. Association, June, 1888.

The following is an outline of the method used demand of the kindly dame (by thoroughly cleansin my cases: ing the parts in the usual manner, checking all hæmorrhage, and bringing the several edges neatly into apposition and dressing as usual), and the result has been most satisfactory, showing her protest against the insatiate monster's machinery and heroic surgery.

5. If a finger is to be amputated, cocaine 3 ss. of 4 per cent. solution is injected, and the circulation arrested by a rubber band which has pre-informed me that two different physicians had seen viously been sterilized by a sublimate solution. During the operation the wound is frequently cleansed with 1.2000.