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REPORT OF THE LYCOMING COUNTY MEDICAL SOCIETY.

OBSTETRICS.-- With the exception of a few cases, nothing particularly unusual occurred in my obstetrical practice during the last year. I have had a number of cases where it became necessary to turn the child, and in no instance was it attended with any injury to the mother or child. I have also been obliged frequently to resort to the use of instruments, and so far with equally good results.

I will relate one case which I consider somewhat novel. Mrs. B. has given birth to six children, and all, with the exception of one, which was a twin, have been breech-presentations. The first was still-born, and one of the twins also. I have attended her through all of her confinements, except the twins.

Mrs. M., aged 42, is the mother of eleven children. The last birth, Nov. Sth, 1875, was premature, being confined at the seventh month; hip-presentation. The child was almost decomposed. She states that she was confident that she was pregnant in April, 1875, and that in June of the same year, about two months afterwards, was taken with uterine hemorrhage, which continued every few days, alternated with copious discharges of water, up to the time of labor. At times the discharges were very offensive. About two weeks before her confinement, she stated she had a very severe chill (and had had two or three slight ones previous); at the time of the hard chill she thought she lost at least one quart of blood. The death of the child she dated from this chill. November 18th, 1875, she had entirely recovered from her confinement.

Her husband consulted me some months since relative to her condition, but as she was opposed to having any examination made, it was deferred until the hemorrhage occurred, which was about two weeks before delivery, and did not throw any light upon it. The uterus was up too high, and the membranes still, as far as could be ascertained by digital examination, were not ruptured. The case was an abnormal one, and one eliciting some interest.

Query. How could a child survive even to seven months, after the loss of so much blood, and other discharges?

SURGERY.-I was called March 22, 1876, in consultation with Dr. Rittenhouse to visit a little girl aged about six years, and diagnosed a dislocation of the hip joint down into the foramen ovale or sciatic notch (right leg). It had been dislocated then five days. On the following day, being the sixth from the time of receiving the injury, I visited her again, accompanied by Dr. R., my son, Dr. Edward Lyon, and Dr. Rittenhouse's student, Mr. D. Hughes, and after putting her under the influence of chloroform succeeded in reducing it.

I would here state that we first tried the old method, and did not succeed, and then Reed's mode of manipulating as recommended by Smith in his Surgery was put into operation, and succeeded without any difficulty. The limbs were then fastened at the knees and feet or ankles, to prevent redislocation. She was visited daily by Dr. R., her father's family physician, and she is now walking about as usual, and free from any rigidity of the joint.

The accident was caused by her slipping upon the ice coming from school.

Nov. 23d, 1875, E. W., female, aged 46, fractured the tubercle and the internal condyle of the bumerus, together with dislocation of the head of the radius, caused by a fall, and striking her elbow on the pavement. The pain was very severe in the joint, with complete inability to move it. Effusion rapidly followed, accompanied by swelling and ecchymosis.

After reducing the luxation and adjusting the fractures, it was dressed with a rectangular case, leaving an opening opposite the internal condyle to prevent pressure; the limb was then carefully bandaged, and the epicondyle kept in position with adhesive strips and compresses.

The local applications consisted principally of diluted alcohol, with the addition of a little tincture of opium. As soon as the swelling had subsided, and the pain removed, I made use of passive motion daily until the joint resumed almost its former action.

She had now almost entirely recovered, with but a very slight rigidity of the joint.

WHOOPING-COUGH.-I was called to visit a little child aged sixteen months, with whooping-cough, May 17, 1876, complicated with diarrhæa and bronchitis, with manifestations of brain disease. After checking the diarrhea, I gave the usual remedies for whooping-cough and bronchitis with very little success for one week. I then tried quinia as recommended in an article published in the Medical and

Surgical Reporter, No. 1003, May 20, 1876, being considered as a specific by Mr. John Reynolds, of England, and first published in the Lancet. He enumerates one case that yielded in a few days after its administration, and adds, three others were equally favorable. I prescribed it for four days as recommended, without any manifest change whatever. On the 25th I resorted to the belladonna treatment as recommended by Dr. Corson, and the change was really wonderful. The second dose produced a decided effect, and the child improved rapidly daily until the 30th, when it was completely out of danger. The mother observed a change after the second dose, and now, June 6, the child has so far convalesced, that I do not deem it necessary to continue my visits. I have used the belladonna treatment for years, and always with good results.

Our city, during the winter of 1875–76, has been visited by that awful scourge, scarlatina. Assuming in the majority of the cases the malignant form, consequently the percentage of deaths was large; in several families there would be as high as three and four deaths, and in some instances whole families of children were carried off by the disease. The sequelæ of the disease were also very fatal. After it had yielded to treatment, and the patients were convalescing, they would frequently be seized with acute rheumatism, and followed often by dropsy, the result of disease of the kidneys which very often proved fatal.

My treatment in the first stage was mildly antiphlogistic, never administering more than one small dose of cathartic medicine, ard frequently none at all, and particularly where typloid symptoms were developed. When the temperature of the skin exceeded the natural standard, I frequently bad the patient sponged with tepid water or wrapped in a blanket wrung out of the same. Directed a gargle (when old enough) with chlorate of potassa, and to take it internally at the same time; when too young to gargle, to swallow it. If the ulcerations of the throat became offensive, ordered a solution of argenti nitratis to be applied three times a day, or carbolic acid in solution, either applied with camel-hair pencil, or to be used as a gargle—the supporting plan of treatment was carried out from the beginning. To the indurated and enlarged glands I frequently used, with good success, equal parts of tinct. of iodine and glycerine. When suppuration had commenced some warm poultices were applied.

Out of some thirty cases which came under my care I lost three, two from the sequela of the disease, viz., Bright's disease of the kidneys. The other one was in a dying condition when called,

taking on typhoid symptoms, and the throat so much ulcerated as to preclude all nourishment and medicines.

Among the most efficient remedies for dropsy in my practice was supertart. of potassa, given in sufficient quantity to act mildly upon the bowels, and at the same time to increase the secretion from the kidneys. Acetate of potassium with spts. nitrici dulcis acted very well; and, in addition to the above, I frequently gave an infusion of watermelon seeds, pumpkin seeds, and parsley root. Where there was an entire suppression of urine I could always arouse the secretion of the kidneys by friction over them with spirits of terebinthinum.

Mrs. N., aged 34 years, the mother of five children, was seized with an attack of pleuro-pneumonia, of a typhoid type, on the 30th of January, 1876. She, having naturally a weak and feeble constitution, was rendered more so, at the time the disease developed itself, from having attended her father as a nurse for some weeks with the same disease. The treatment, in consequence of her feeble condition, was of a supporting character from the first, the nourishment consisting of the essence of beef, egg-nog, milk punch, alternating with chicken, oyster soup, etc. Notwithstanding the above nutritious treatment, she took quinia and other tonic remedies from almost the first stage of the disease, and after some ten days elapsed, diphtheria in its worst form made its appearance which almost closed her throat and air-passages, and it was with great difficulty that she could take sufficient nourishment to support life. But by continuing the above treatment, together with a local application of a solution of argenti nitratis 20 grs. to the ounce of water, and carbolic acid 15 grs. to the ounce, applied with a camel-hair pencil, she made a good recovery, being perfectly convalesced on the 22d of February, 1876. Counter-irritations were applied over the chest and side from the first, which afforded great relief.

REPORT OF THE MERCER COUNTY MEDICAL SOCIETY.

Chloral Hydrate in the Treatment of Intermittent Fever.-Intermittent fever is the most common disease which prevails in the Shenango Valley, and in a practice of twelve years I have treated a large number of cases. The treatment has been confined principally to the administration of quinia, which will in almost every case, effect a cure if properly given. But as you all well know, it has to be given during the intermission, and continued until constitutional effects are produced before it will control the paroxysms; very frequently this cannot be accomplished in one day nor two, and several days will pass, during which time the patient has to suffer the return of the paroxysms at regular intervals. During the past summer, I made some experiments with chloral hydrate in the treatment of intermittent, which proved slightly satisfactory, and although I did not carry my experiments to such an extent as to establish for it a reputation which will place it among the antiperiodics to be administered in the cure of this disease, I most certainly did establish the fact in my mind that it will very easily, quietly, and completely dispose of an intermittent paroxysm, when given in full doses immediately before the time for its return. As I do not intend to enter into any details, I will give the history of a few cases which I have treated.

Case I. Aug. 6th, Solomon B - a strong, muscular blacksmith, presented himself at my office to be treated for quotidian intermittent. He had had the disease six weeks. Used quinine freely, looked pale and emaciated, and for the last two weeks had been unable to work. The paroxysms were violent, and he seemed to stand in great dread of their return. While talking to me he stated that he would have an attack in a short time, expected it inside of the next hour, and begged of me to give him something which would prevent it coming on; I knew that quinine would not accomplish what he greatly desired, but I told him I would try to prevent its return, if he desired it. I therefore administered 40 grs. of chloral hydrate and sent him home, which was but a short distance. In five days he returned, and stated

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