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thunder, after the equilibrium of different states of electricity was restored, we seldom had a new case until the atmosphere became rarefied again.


Newton HAMILTON, Pa., May 15, 1876. A. H. SHEAFFER, M.D.

DEAR SIR: Your postal requesting me to make" a report of my professional work during the past year” was received a few days ago; you also wished an early answer. Not anticipating such a call I have taken no notes, or in any other manner kept any record from which I could draw facts or incidents that would be interesting to the Society; my memory fails to recall any special peculiarity in the diseases incident to this locality. I have had during the months of October, November, and December five cases of well-marked typhoid fever. These are the first cases that have occurred for at least two years. Two of these cases were of an aggravated character. My plan of treatment was expectant, under which they have all made good recoveries. There has been an increased amount of disease here during the past year, but nothing of an epidemic character. I think diseases of the air passages are more prevalent than any other. Phthisis in my observation is more rapidly fatal and less amenable to treatment in the valley of the Juniata than in many other localities in the State with which I am familiar. I have observed more intermittent fever than in former years. There has been a gradual annual increase.

I have had quite a number of amputations of the forearm and leg, the result of railroad injuries. After injuries of this kind there is little opportunity for conservative surgery, as the damage in all such cases is of a very aggravated nature; the bones and muscles are crushed. The shock to the nervous system after injuries of this kind is much greater, and reaction more difficult to bring about than injuries of the same severity from other causes. In all instances this year I have performed the ordinary circular amputation, and, so far as I could keep trace of the cases, with good results. I am now treating a case of “inter-capsular fracture of the cervix femoris” in a lady aged about sixty years, the result of a fall. There is evidently pretty solid ligamentous union, but of what strength I am as yet unable to say. I have not yet allowed my patient to bear any weight on the limb. The injury occurred about two months ago. I feel considerable anxiety to see the result. I am satisfied if the union is sufficiently strong to support the weight of the body, that there will be but little lameness. All authors I have consulted are extremely doubtful if any bony union takes place in fractures of this kind.

Within the past few months I have had some few cases of diphtheria, which I have not met with for some time, our neighborhood having been remarkably free from it for two years. The cases were mild and yielded soon to treatment. I have observed an increased number of sudden deaths from brain affections diagnosed active congestion.

Have had no puerperal fever, and nothing worthy of note in my obstetrical business except one case of puerperal convulsions, which yielded to copious venesection followed with full doses of bromide of potassium.

Doctor, I have had so short notice and in the midst of business, I must apologize for my brief, imperfect, and unsatisfactory response to your request. Hoping I have met the demands of the Society,

I am yours, fraternally,



Keshacoquillas Valley, a portion of the county of Mifflin, bas been the theatre of my professional labor for the last forty-one years, and was somewhat adverted to in the last annual report of the President of our county association to the State Medical Society.

The valley is almost exclusively an agricultural region, with the exception of about three woollen manufactories situated in the western part of it, propelled by water-power. Near its summit the west branch of the Keshacoquillas Creek has its origin, from several large springs of water, strongly calcareous in quality, flowing east, mostly along the base of Jack's Mountain to the village of Reedsville, it then intersects with the waters flowing from the east end known as "Honey Creek" and "Tea Creek,” flowing west and south, consti'tuting the Keshacoquillas Creek proper, and passes through a gorge in Jack's Mountain, and empties into the Juniata River at Lewistown. In this gorge in the mountain is the celebrated “Mann's Axe Factory," as well as many flouring mills. Before it empties into the Juniata, and from its precipitous and rapid current, and being spring water, it is considered a most valuable water-power. The valley is separated from the Juniata basin by “ Jack's Mountain," which bounds it on the east and south and southwest. Jack's Mountain has an altitude of about 1400 feet. It is bounded on the north and northeast by Stone Mountain, and a chain of broken spurs or knobs of Stone and Tussey Mountains, known as the “Seven Mountains." It is about forty miles in length from its southwestern terminus at “ Mill Creek,” in Huntingdon County, on the Juniata River and. Canal, to its eastern boundary by the knobs of mountains before spoken of, and familiarly known as “ Beaty's Knobs.” The mean

width is from three to five miles, of a heavy limestone soil, with an occasional admixture of flint and clay. When viewed from its summit, near the village of Allenville, where it attains the elevation of about 500 feet above the Juniata River, there is spread out to the view of the beholder one of the most beautiful and highly cultivated agricultural plains to be seen anywhere in Central Pennsylvania.

The geology of the valley is easily understood. The basis or bed rock is that of limestone, both blue and gray, taking its dip of syn. clinal axis at the base of Jack's Mountain, becoming more perpendicular as it approaches Stone Mountain. About the centre from east to west, and near Keshaquillas Seminary, is to be found the anticlinal axis or the lying perfectly level the limestone rock, and nowhere else, to my knowledge, is the same thing noticed. The gray limestone is burnt into a cement or water lime in many places, while the other (the blue) is used after burning as a land fertilizer. The only mineral found to any extent has been iron ore, of a very rich and valuable quality, near the village of Belleville, and was formerly known as the Greenwood ore. These mines have not been operated for some years, owing to the difliculty of contending with the water, making the expense such as to be unremunerative to the parties owning them; they still belong to the Logan Iron and Steel Company.

No meteorological or mortuary tables have been kept.

Prevailing Diseases.- No malarious forms of disease prevail in this locality. During the summer months sometimes, a few cases of remittents and intermittents, with cholera morbus and cholera infantum, with an occasional case of typhoid fever of a mild type, occur. The prevailing diseases are mostly of the winter fevers, pneumonias, catarrhs, and influenza, or affections of the thoracic viscera, generally. During the last winter pneumonia (or pneumonitis) prevailed almost to the extent of an epidemic in the vicinity of Belleville, mostly lobular, involving but one, but in some instances both lungs.

In my practice, if called in the early stages, I used my lancet, followed with nitrous powders, calomel, and ipecacunanha, until the inflammatory action subsided, and sinapisms and blisters completed the treatment. The mortality, considering the number of cases, was very light. I treated a case, Mr. K., aged 73 years. The right lang was completely hepatized from its base to the clavicle, the respirations 40 in a minute, and the pulse 130, dyspnæa very great, and anxious expression of countenance. I ordered brandy and quinine alternately every four hours, and cups, sinapisms, and warm fomentations. In thirty-six or forty hours the symptoms improved, VOL. XI.


and continued improving to the end of four or five weeks, and the old gentleman got up and about. I observed that in almost all cases of pneumonia during the last winter, stimulants were well borne.

Obstetrics. A case of placenta prævia came under my notice. Mrs. Y., aged 29, in her fourth pregnancy, sent for me about 2 o'clock A. M., March 9th. On arriving at the house, the physician in attendance, a very intelligent young practitioner of the village, was there, and had employed the usual astringent remedies, with plugging the vagina, absolute rest, and elevating the hips. The subject was almost entirely pulseless. On inquiring of the doctor as to the nature of the case, he requested me to make an examination per vaginam, and say what I would diagnosticate in the case, reserving his opinion until I would speak. On removing the packing as gently as possible, lest I should provoke a sudden return of the hemorrhage, I found the os dilated about one and a half inches, and the placenta fairly covering it entire. I stated to the doctor my convictions that it was a case of placenta prævia, to which he replied that that was his opinion, but it was his first experience of such condition. This was the third attack of hemorrhage during this preg.. nancy, and she alleged she was at the end of the seventh month. The course to be pursued was plain, viz., that of turning and delivery, for nothing seemed to arrest the torrent of blood, and I, by request of Dr. H., proceeded to do so. I had no difficulty in introducing my left hand, rupturing the membranes high up, and seizing the feet. Version effected easily, and in bringing them down, to my dismay, I found the placenta completely detached, and obstructing delivery. I let go the feet, delivered the placenta, and then seized the feet and effected delivery in thirty or forty minutes. There was but little blood lost during the operation, the woman was well bandaged and given nourishment and stimulants, but sunk inside of twenty-four hours.

Was the cause of death owing to the complete draining of the blood vessels? Was not the operation of turning and delivery a little too late to succeed ?

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THROUGH the exceeding kindness and confidence of the members of our Society, it again becomes my pleasant privilege to report some of our year's work to the State Society. We have held seven meetings during the year, all of which have been well attended, and the improvements and progress of the profession in its varied departments have been promptly laid before the members. It is now twenty nine years since our Society originated, and there are still a few of the original members left with us, who have attended nearly every meeting during all those years. As this is the centennial year of our existence as a Nation, we thought it would be well to have the history of our Society placed in the hands of every member, so that it could be found in his library for future reference, as many interesting cases and facts are there recorded. To this end we have had our records somewhat abbreviated and published in book form. It is with real satisfaction we can report, that, in looking over this careful review of our proceedings, while there have often been marked differences of opinion in relation to medical subjects, they have not on a single occasion given rise to permanent ill-feelings of members towards each other. There has been a degree of harmony always prevailing which was pleasant to witness, and which placed the Society before the public, and the members of the profession who are not members of the Society, in a most honorable position. Two of our members have been appointed by the “ Board of Public Charities," members of the “ Board of Visitors to the Prison and Almshouse,” and most faithfully have they performed their duty, in the thorough inspections which they have made, and the reforms they have inaugurated in the institutions referred to. We are proud of the profession in our county: not only of our members, but also of those not associated with us. Before the organization of our Society, many members of the profession were intemperate; many took no journals, bought no new books-spent their leisure hours lounging at stores or taverns, and gave no attention to the advancement or honor of our calling. Now I do not know a drunkard in our ranks; and only a very few who indulge in

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