even moderate daily drinking. Our young men generally have fair education, are studious, bear themselves honorably, subscribe for medical journals, buy the recent publications issued by our leading writers on medical subjects, and keep themselves well abreast of the improvements of the age. This is as it should be.

In order that our report should be of value, every member was personally addressed by letter, and urged to bring his contributions to a special meeting, called for the purpose of receiving them. But I regret to say that while all our members bring cases of deep interest before the Society and ably discuss them, and are men of extensive practice, daily brought face to face with disease in its manifold forms, only a few of them have furnished anything for this communication. Many of those who have failed to comply with our request have often, in our meetings, brought forward cases and their treatment, accompanied by observations and conclusions which prove that they possess a readiness of diagnosis, and a knowledge of the value and power of remedies, which would enable them to send us most valuable reports; and yet they decline to send anything, through fear that they might be troubling us with "just ordinary cases." The ordinary cases, those which occur frequently every year, are those with which we make battle. One case of pneumonia, or scarlet fever, or diphtheria, or smallpox, carefully observed and reported, together with a true and detailed history of its treatment, is of far more value than the reports of a dozen twoheaded or four-legged children. No one has greater opportunities for becoming acquainted with acute diseases and the value and powers of remedies than the country doctor; no one has greater facilities for the study of diseases of women and children, and, if he be a student as well as a practitioner, no one is more competent to meet every emergency of those cases. In cities and small towns, if the case show an unfavorable symptom, aid is called in-one, perhaps two physicians are summoned, and thus the responsibility is so divided as not to be felt, or even much cared for, by any of them. In country places the physician is relied upon to carry the whole case through, whatever phase it may assume. How intensely does this responsibility stimulate him in his work! With what interest he scans every symptom! How carefully he graduates his remedies! With what anxiety he waits for results! With what promptness he meets and overcomes emergencies! If a new remedy should come to him bearing the award of merit from high authority, who has more frequent and varied opportunities to test its qualities, and decide on its value than the man who, feeling his great responsibility, is every day, every hour, at the bedside of the sick? The medical

teacher in the various colleges catalogues every new remedy reported by the chemist, the botanist, the pharmaceutist, and the practitioner, and proclaims to his classes the reputed qualities as reported by its discoverers or admirers-and then comes the test; thousands of doctors, spread all over the country, day after day prescribe it and patiently await results. From these persons, then, should come up reports of the degree of value of those remedies, and of their proper adaptation to the relief of diseased conditions. The profession has a right to expect this. There is a world of knowledge and of skill hidden in, and unheard of beyond, the small circle in which many an intelligent and skilled doctor moves. I was forcibly reminded of this fact, last year, at our Pottsville meeting, when a physician from one of the mining districts exhibited a large number (forty, I think) of calculi, which he had extracted from the human bladder by nearly as many operations, and with only two deaths-both of which he charged to the patient's imprudence. It was a surprising exhibition, and, truly, a surprising fact. A man hidden away in the mountains, a man scarcely arrived at middle age, had performed successfully, nearly forty times, an operation which a few years since ranked as one of the greatest achievements of surgery. But few surgeons in any city can show so large a number of successful operations in that line-And yet we have not a written line on the subject.

Truthful and accurate reports can only be made by him who makes daily records of his cases. The physician who takes careful notes is well paid for his trouble, in the habit which he acquires of close observation and connected thought, by which he can trace results back to causes. A great fault with many of us is our loose careless way of examining patients, and prescribing for them. Pleurisy, bronchitis, and pneumonia are rarely distinguished from each other with any accuracy; with many, every sore throat is a diphtheria, every cough a pneumonia, and the per cent. of cures by some trifling remedy is heralded as the result of its astonishing power, too often leading others to rely on a worthless article in dangerous cases of those diseases. During last spring, when bronchial disease was so very prevalent, physicians not a few spoke of the great number of cases of pneumonia which they had treated, and all successfully, by means of aconite or veratria to depress action, and a little carbonate of ammonia to stimulate action, a mush poultice all over the chest to keep it warm, and whiskey and quinine internally to keep it cool. The mere announcement of their treatment and its success in so many cases was proof of the

inaccuracy of the diagnosis. The following brief papers have been prepared by our members.

Dr. SAMUEL WOLF, who practises at Skippackville, writes :Being entirely without notes on my cases, the following report is based wholy on the recollection of a few scattered facts connected with them, together with such data as could be obtained by reference to my visiting list.

Case of S. H., single lady; aged 77. First visit October 11, 1874. Complained of severe burning pain in left foot, with shooting pains through corresponding limb. The first uneasiness in the limb had manifested itself about three days previously, after a long walk. On examining the foot, it was of a shining, reddish, or rather livid appearance, and, despite the burning sensation experienced by the patient, was cold to the touch. Inquiring into the previous history of the woman, I was told she had at different times suffered from rheumatism, though never severely. Had also, shortly before the occurrence of this attack, been under my treatment for a squamous eruption on the hands from which she had suffered at intervals for many years; otherwise the health had been remarkably good. The appetite now suffered, and the bowels were confined. My prescription was an aperient for the bowels, followed by a tonic. Locally, I applied a stimulating lotion, and ordered the limb to be well wrapped in flannel. During the course of the next few weeks, there was very little change in the appearance of the foot, except that the redness diminished somewhat, as did also the swelling. At about the end of this period, several small black spots appeared on the great toe, sensibility in the toe being almost entirely absent while the pain was undiminished, and could only be controlled by opiates. I had substituted hot linseed poultices for the lotion originally used, which had been rather grateful to the patient. My diagnosis from the beginning had been senile gangrene, and the appearance of the spots, as above mentioned, satisfied me of its correctness. The disease, in spite of local applications of various kinds and constitutional treatment mostly of a tonic and stimulating character, slowly advanced, involving one toe after the other, extending up the foot, until it had advanced about half way to the instep, when an apparent line of demarcation began to form. This, however, never extended completely round the foot, but, after a stand-still of probably a month, the line was overleaped and the mortification extended rather more rapidly than previously, until it reached the ankle. During this time, the affected limb became œdematous, being swollen to its utmost, to some distance

beyond the knee. The sound limb was also affected, but to a less degree. The patient was also suffering from irritative fever, and the violent pain required that she be kept almost contínually under the influence of morphia, of which she took grain doses two, three, or four times within the twenty-four hours. The constipation was obstinate, and seemed to resist all measures, until finally I hit on podophyllum peltatum, or, to be more correct, podophyllin, which I gave with the expectation of relieving the dropsy as well as the constipation. The patient seemed to be rapidly sinking, and I was expecting the fatal termination of the case almost daily. Under the above-mentioned treatment, combined with the use of chlorate of potassa and bark, the dropsy diminished, the appetite increased, and the general health of the patient was very materially improved. The line of demarcation was now completely formed at the ankle, and the process of natural or spontaneus amputation was steadily going on. I placed the limb, at this juncture, in a box similar to a fracture-box, but more roomy, packed bran around it, into which I poured, so as to run into the ulcer, Labarraque's disinfecting solution. Visited the patient every other day, and changed the bran, cleansed the sore and the box. As nearly all pain ceased after the ulceration had extended through the skin, and the general health of the patient was good, I suggested amputation. This the patient stoutly refused to consent to. At this time I had a consultation with Dr. Keelor of Harleysville, who discountenanced the idea of amputating, on the ground that there would be likely to be troublesome sloughing of the stump, and probably fatal secondary hemorrhage. I now gave over this course, and contented myself with watching nature, in this case a great surgeon, engaged in amputation. The entire foot was a hard, dry, black mass, retaining its original shape and symmetry. The ulceration gradually extended down through fascia, muscles, tendon, artery, nerve, bone, and all the tissues, until on May 18, 1875, the mass was spontaneously removed. This was seven months after the commencement of the trouble.

Shortly prior to this termination in the one limb, the same symptoms manifested themselves in the right foot, following the same succession, but rather less rapidly and with much less constitutional disturbance. This terminated in spontaneous amputation through the metatarso-phalangeal joints of the great and the second toe, the line of amputation, extending longitudinally through the third toe, leaving behind the two last and about half of the third toe perfectly intact, with the exception of the nail and its matrix, which sloughed from the fourth toe. This was February, 1876.

During the progress of the disease in this foot, I was, of course, directing treatment to the stump on the left leg. In this stump,

at the time of the amputation, were exposed the distal ends of the bones, the internal and external malleoli extending beyond the surface of the ulcer. These exposed portions of bone were black. I ventured no operative interference here, but resolved to rest content, for the time being, with the work of nature. I simply dressed the stump with antiseptic and astringent solutions and ointments, substituting one article for another occasionally, and had the satisfaction to see the suppuration decrease, the epidermis extending itself gradually over the uncovered surface, and, as far as was possible, the promise of a favorable termination of the case. The internal malleolus was, however, being so slowly removed by the process of nature, which was an ulceration through it, on a level with the soft tissue, that I became impatient, and nipped it off with the bone pliers. I was soon satisfied that this had been an unwise proceeding, the sore becoming irritated, and the tendency to heal lessened. However, after some time, the ulcer again became more tractable. On the right foot, there was considerable redundant skin in the stump, which I was anxious to utilize; therefore applied adhesive strips, bringing the edges as far over the denuded surface as possible. Under this treatment, the ulcer rapidly became smaller.

The general health of the patient seemed still to be improving. The appetite was good, the bowels less costive, the power of the pulse increased, and I was beginning to look for recovery in the case. In the last week in February, an attack of idiopathic erysipelas attacked her. From this she made a good recovery, under the use of tr. ferri chlor., in a week. On Sunday, March 5, I was called, having seen her on Friday previous. At that time, she had a coryza, but no other symptoms requiring attention. On Sunday, I found, on examining the chest, that there was pneumonia of both lungs, and of the lower lobes at that, suggesting the hopelessness of the case, which I explained to the friends. She steadily sank. in spite of stimulants, till the following Sunday morning at 1 o'clock A. M., when she died. The foot is still in my possession, and I would take great pleasure in showing it to any of the members of the Society who may give me the pleasure of a call. I am only sorry that I have no notes on this case, so that I might give you a more complete history of it. I, however, forgot to mention that I tried the effect of camphor internally, which is said to have specific virtues in this disease, but without the least benefit.

On the Use of Ferri Subcarbonas in Neuralgia.-Without