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December Ist, 1872, the epizootic, which had been spreading over the eastern part of the United States and gradually wending its way westward, put in an appearance in our vicinity; and almost all horses, good and bad, were more or less severely affected with it.

In a few weeks after this onset, cases of erysipelas began to be frequently met with, (usually beginning on the face ;) and by the first of February (two months), we found ourselves in the midst of an epidemic of erysipelas.

Simultaneously with the beginning of the erysipelas, many of our obstetric cases would have a "bad getting up"; and by February, cases of puerperal metro-peritonitis were met with, here and there. Soon after

this, cases of cerebro-spinal meningitis were heard of, and seen, in almost all localities of our county and vicinity; in some localities producing fearful havoc, being usually fatal; but in our own immediate precinct, it never became very abundant or virulent.

During all this time, there were no cases of scarlatina or diphtheria heard of in our neighborhood. This condition of things continued, more or less violent, until about the first of April; when with the approach of pleasant weather the epizootic, erysipelas, puerperal metro-peritonitis and cerebro-spinal meningitis had all gradually disappeared; and no more was heard of either until this winter (1873-74), there having been a few sporadic cases of the latter disease. the erysipelas patients, there were no fatal cases, that I heard of, although,

Of

on a rough counting up, I find there were fully 300 cases treated by the physicians of this place. The sheet anchor in all cases was: Mur. tinct. iron and quinine. Of the spotted fever cases, I treated but three, all of which recovered; the treatment employed was large doses of bromide of potassium, and a blister to the nape of the neck for the first 12-20 hours; then quinine and stimulants, with fl. ex. calabar bean and ergot; and in two, where there were symptoms of effusion into the cavities of the brain, blisters to all four extremities were resorted to.

Of the cases of puerperal metroperitonitis, all fully developed cases died; and in all cases the immediate cause appeared to be some injudiciousness on the part of the patient. But three cases occurred in my practice. The first was doing well until forty-eight hours after labor, when the disease was ushered in with a chill. I was called and, upon inquiry, found she had sat up in bed, talked and laughed a great deal during the first twentyfour hours, contrary to the most positive orders I had left in the morning; she died on the fifth day after accouchement, and third day of the disease. This was a large, rugged, but not very fleshy woman, aged thirty-four years; sixth accouchement; labor natural and easy.

The second was a large and fleshy person, in her fifteenth confinement, aged forty years. Had three convulsions before labor was terminated, and seven during the two days after, during most of which time she was very restless; the convulsions stopped after copious depletion and free use of diuretics. In this case, also, the

disease was ushered in with a chill, on the fourth day after labor; and in five days more she was a corpse.

The third case was a lean, weakly person, in her first confinement; was doing well until the fifth day after labor, when her parents made her a visit; she sat up' and talked with them, and made one trip to the kitchen; that evening metro-peritonitis was ushered in by a chill, and in four days she was dead.

The symptoms in the foregoing cases were very uniform; rigors at the outset exceedingly rapid and irregular pulse; hurried respiration; suppression of milk and lochia, vomiting and diarrhoea; abdominal tenderness and swelling; tongue coated and dry; delirium and death. The treatment employed was somewhat varied; veratrum and opium, fomentations and poultices were mainly relied on.

Of the eighteen other cases of labor that I attended from December 1, 1872, to April 1 following, all had a moderately good recovery; but in all cases, I have good reasons to believe, my directions were fully carried out, i. e., keep quiet, and in the recumbent position, and as free from all excitement as is possible. In addition to this, in most of the cases, an antiseptic was given, both before and during accouchement. Not being previously engaged in some cases, this rule was not strictly adhered to. The antiseptics used were soda sulphis or mur. tinct. iron, with bromochlorolum as a disinfectant. The conclusions that may be drawn from the foregoing imperfect history are:

(a) That, in the diseases above mentioned, including the epizootic,

there is an origin from similar causes, viz. Epidemic, (let the materies morbi be what it may.)

(b) Though scarlatina and diphtheria may appear, in some stances, to have acted the part of cause or effect to metro-peritonitis, in this instance no such cause or effect can be attributed to them.

(c) Our main reliance for saving

P. S.-We should be glad to hear from other parts of the State on this subject.

D

URING the recent visit of the

members of the State Med

ical Society to Mercy Hospital, Prof. E. Andrews brought be fore them a newly entered patient, suspected of having vesical calculus. He introduced a sound, and proved by the audible click that the suspicion was well founded. The sensation communicated by the instrument also proved that the case was multiple, and the stones of pretty large size. The patient was about fifty years of age, but in fair health, and the bladder not much inflamed. The large quantity of calculous material present, and the great apparent hardness of the stones, judged by the sharpness of the click elicited, when struck, determined the case to be suitable for lithotomy rather than lithotrity. The patient was then placed on a free use of tinct. of iron for a few days, to prepare his system for the operation, and assigned a wellventilated ward, where his portion of the air-space amounted to 3,000 cubic feet. He was placed on a new mattress and given a pillow, whose feathers had been renovated by hot steam, and the tick washed, that no pyæmic

or septicemic infection might lurk in the bedding, as it is too often the case in hospitals. The plan pursued by Dr. Andrews is to have the contents of every mattress burned as soon as the patient leaves it, while the tick is sent to the laundry. The feathers of the pillows are renovated by boiling hot steam, as above stated, and the pillow-ticks sent to the laundry with that of the mattress. this way every patient comes virtually upon a new mattress, and upon pillows as pure as new ones.

In

While preliminarily taking the iron for a few days, the patient was ordered good nourishing diet, and directed to spend a considerable portion of his time out of doors, but not to undertake any violent exercises.

On May 25, he was placed on the table and anesthetized with sulphuric ether. Prof. Andrews then proceeded to perform lithotomy by the usual lateral method. The first introduction of the forceps brought away a smooth stone over an inch in diameter, with three large facets upon it, showing that there were other calculi present. The second trial drew out two smaller stones. The third

brought away another large one; the fourth, fifth, sixth, etc., had the same result until nine calculi had been extracted, six of which were over one inch each in diameter. The combined weight of the nine stones was five and a half avoirdupois ounces. They were all smoothed by attrition, and rendered somewhat triangular by the arrangement of the flattened faces, that rested against each other, so that the six larger ones fitted together in a sort of circle, as shown in the accom

panying engraving, which doubtless.

indicates the way they lay in the bladder. The three smaller stones were likewise more or less angular in form, and polished. The engraving is about two-thirds of the actual diameter.

Twenty-four hours after the operation, the patient (who had lived in a malarious district) had a severe chill, followed by some hours of fever, and closing with a copious sweat. Vigorous doses of quinine prevented any repetition of the chills, and tincture of iron was given in addition five times a day.

On the tenth day some enteric disturbance, resembling that of typhoid fever, occurred, and the treatment was changed to nitric acid and strychnia. At present (thirteenth day), this complication still exists, with a slight fever and some want of moisture on the tongue. The wound looks well, but the temperature of the body, tested in the axilla, is over 101 degrees. There are no pyæmic chills

nor sweats.

June 10th-Patient doing well.

PROF. NELSON, in his clinics,

this summer, selects a student and assigns him a patient, several days before the clinic, whose case he is to study, as best he can from books or other outside sources, and report the same in detail at the clinic, from written manuscript or otherwise-the class and Professor criticising, or adding to the report, as they may see

fit. The following is one of those clinics-J. R. Kewley being reporter for the day:

This young man was attacked, some seventeen months ago, with intermittent fever, or ague of an irregular triple-quotidian variety, previous to which time he had been strong, healthy and robust. After a few months of medication the paroxysms

disappeared, and he seemed to be nearly well. At this time, through

the advice of a companion, he took a very large dose of cantharides, which was speedily followed by the characteristic symptoms of poisoning by this agent-such as burning along the alimentary canal, with nausea, attempts at vomiting, constriction of throat, and difficult swallowing; pain in the kidneys and along the urinary passages, with violent burning during micturition, etc. He soon seemed to recover from these symptoms, but ever afterward he experienced a languor and dullness, or mental inactivity, at times. He passed but little urine, and that high-colored; tongue heavily coated; appetite, digestion and sleep, good; bowels, at times, regular; again irregular; fæces, of normal color; had no pain any place and, when at rest, seemed quite strong; but upon slight exertion would become much fatigued. He seemed to run on in this way until last July, when his troubles kept him to his bed for some time; since which time his symptoms have corresponded to those before it, with occasionally a chilly feeling in the morning, followed by slight fever in the afternoon. Not. improving any, and being unable to attend to business, he sold out and came to the city, in the hope of being cured. After trying quite a number of our city physicians without any beneficial effects, he entered the hospital, nearly three weeks ago. When I first saw him, his symptoms were those already enumerated, with the exception that he has not now any of the chilly mornings, followed by fever in the afternoon. In addition to these symptoms I noticed that, although the pulse was nearly normal

in frequency, about eighty, moderately large and full, the artery was quite easily compressed. On auscultation, the heart was found to contract rather quickly (not very strongly), and the interval of rest between the contractions was slightly prolonged. Upon testing the urine I found it normal in quality, except, perhaps, a slightly deficient amount. of urea; could not detect any other symptoms, except those of a negative character.

Our text-books, as far as I have examined, give but very little information regarding troubles of this nature.

My preceptor, Prof. N. S. Davis, says, "that in ague that continues to persist for many months, we have the ganglia of the great sympathetic at times affected. Those ganglia, situated in the abdominal region, being first impressed; then the cardiac plexus; and, finally, but rarely, the ganglia within the cranium itself." In these cases the exact nature of the change in the ganglia is not understood, the affection being marked more by the derangement or perversion of the organic functions than by any pathological condition or lesion of these numerous ganglia. We have no pain any place; the patient to his friends may seem well, and even to himself, while in a state of inactivity; but upon exertion of any kind, he finds he becomes wearied; has no strength, no endurance. There may be, as a result of this organic derangement, dullness or stupidity of the brain or mental functions; deficient power in the contractility of the heart, and, as in this case, a rather quick contraction with a prolonged interval of rest; the frequency of the pulse may be normal, but the artery is