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bleeding. No case can be pointed out, in a range of many miles around this place, that proved fatal after a free and early bleeding. What we need in the treatment of pneumonia is to see the patient early, while there is yet only distension of the bloodvessels, and commencing “inflammation of the alveoli and bronchioles,” and then to bleed promptly-copiously-so that we shall drain the blood, so to speak, from the capillaries of the lungs, as Professor Gross drains it froin the minute vessels of the eye. This done, and the stomach not poisoned and sickened by veratria, the brain not made to reel and hum with quinine, or be stupefied with whiskey, and the case will, in the hands of even a skilled nurse, rarely prove fatal.
I may mention another incident. At the discussion in Easton already referred to, after Professor Gross, the two Atlees, and other eminent practitioners who had hundreds of times tested the value of blood-letting in inflammatory diseases, had spoken of their great confidence in it, a physician of Perry County rose under much emotion, and said that he was very glad that he was present to hear such testimony; that years ago, he used to bleed his patients who had pneumonia, and nearly always with success; but that for the last eight years he had been afraid to use it. Several young doctors, and some Homeopathists had settled in the county, and all denounced bleeding as being no better than murder. They talked about a change in the type of disease which had taken place within a few years, and which rendered bleeding inadmissible, even dangerous, and he had therefore yielded to the prevalent sentiment and had given up the lancet, " and now,” said he,“ within a few weeks I have lost five healthy, strong persons, with pneumonia. But I will never treat another case of it without bleeding, if I should be driven out of the country for it."
As everything which can throw light on this subject is of importance, I am impelled to relate an incident which may add strength to what has been written. At a recent meeting of the Montgomery County Medical Society, a young man who has a very large practice, and who has been strongly impressed with the value of aconite as a substitute for venesection in inflammatory affections, reported that he had been sent for to see a woman who had then been confined two days, had had no physician, and he had been sent for because she seemed to have contracted a pneumonia. He found her quite ill, but by the use of aconite he had reduced her pulse from 160 beats to 80 per minute, and she was convalescing rapidly. I could not forbear to speak on the subject, and to urge on the society, to look at what was going on around us, in our region
persons dying one after another of pneumonia, in the hands of those who use veratria, or aconite, or digitalis to the exclusion of general and local bleeding, while those who bleed freely save their patients. After my young and able friend got home that night, he was sent for to see his patient, and found all her symptoms aggravated, and the pulse again at 160. The next day but one, he called to ask me to see her with him, though he confidently believed she would die. It did not suit me to go then; he went back, bled her nearly or quite a quart, and when I saw him two days afterward, he said she was, he thought, out of danger. She was soon well. Let us think a moment longer of this case: a woman who had lost the usual amount of blood after a labor, bled a quart by the doctor, and without “supporting treatment,” strengthened, and saved from impending death. I am greatly humiliated to feel that it has become necessary to thus present testimony to prove, to our young physicians, the utility of a measure which until within a few years had no superior in the estimate of our best practitioners, but which now finds no place in the confidence of some of our present teachers.
If any reader of the Transactions should think we have occupied too much space on these few diseases, I can only say in our defence that country doctors do not expect to occupy space with physiology, minute anatomy, or the discoveries in chemistry, or the revelations of the microscope, or on specialties so called. Our work is in practical medicine, and surgery, and obstetrics. Here, never losing a single day, we labor on; and if the aurist, or oculist, the orthopædist, or the chemist be authority in his specialty, we should be so too, in our wider field of labor, our greater specialty. They deal with the dull ear, the dim eye, the deformed or anchylosed joint; we confront Death himself, and if any of us have discovered a new or better mode of arresting his advances, or parrying his blows, or antidoting his poisons, it is our duty to make prompt and full report to our fellows.
Chairman of Committee.
REPORT OF THE NORTHAMPTON COUNTY MEDICAL SOCIETY.
NORTHAMPTON County in the past year has had little of medical interest but the usual routine of practice, and even that modified by the very limited amount of sickness, and the entire absence of any epidemics, whooping-cough perhaps excepted, of which there was a considerable amount reported.
Physicians interviewed throughout the county, universally testify to extraordinary healthfulness during the year, and a limited amount of practice consequently. A few sporadic cases of typhoid fever were reported in Easton and vicinity in the early fall months. The type of diseases was, as a rule, mild, seldom proving fatal except in the debilitated and weakly, almost always sthenic. The unusual absence of asthenic forms of disease was so marked as to cause general comment among medical men.
Within the last month, scarlet fever has become epidemic in the neighboring town of South Easton. At this writing, the epidemic is rapidly spreading; numerous cases are reported; a few cases have proved fatal. In Allentown, in the neighboring county of Lehigh, and along the Lehigh valley generally, this disease had been prevailing epidemically all winter, and now it has gravitated by its laws of contagion and infection to South Easton and Easton, which might be called the outlet of the Lehigh valley. It remains to be seen whether it will cross the Delaware River and invade our neighboring town of Phillipsburg in New Jersey.
The Medical Society met four times during the year. By vote of the Society six meetings a year will be the rule in future-one meeting every two months. The interest manifested is praiseworthy, and there is a steady gain in point of numbers and popularity. The younger members of the profession generally enroll themselves as they locate in the county.
A committee called "the Committee on Medical Intelligence," was created during the year, each member appointed presenting a short resumé on one or more subjects of leading medical interest. These papers were well received by the Society, and the subjects treated upon were ably presented. This feature of our association
will undoubtedly aid in bringing the Society up to the standard of what it should be, viz., a scientific body, and foreshadows a broader and more liberal medical culture aside from this; one special paper is presented and read in the order of seniority, by each member, commencing with the oldest. This may properly be called the "Paper" of the meeting. Usually it is followed by general discussion.
Special cases of medical and surgical interest are constantly presented to the Society. New methods of treatment discussed and new appliance in mechanical surgery proposed and presented.
The following case of obstetrical interest was reported to the Society at the January meeting by one of the members. Mrs. S. was taken with supposed labor-pains on the evening of January 14, about 8 o'clock. At 9 o'clock I was summoned, with the intelligence that she was losing a great deal of blood. Found her sitting on a common chair, and all the pains gone; hemorrhage also almost ceased ; after placing her in position in bed, he made an exploration : the vagina was narrow and contracted; os uteri dilated fully, but no presenting part came in contact with the hand. Supposing at first that I had a case of placenta prævia to deal with, the examination causing more hemorrhage, further effort was not made, and as professional engagements called me elsewhere, Dr. J. M. Junkin was requested, by consent of patient, to take my place at the bedside, and attend to her case. After having been gone probably two hours, Dr. Junkin sent for me. When I reached him, he informed me that there was still no presenting part, and no pain, although he had given several doses of ergot in the mean time, but that there was considerable loss of blood. We now concluded to make a thorough investigation, and with this in view, I prepared to enter the womb with my hand. After some difficulties were overcome, I passed my right hand slowly to the fundus, which I touched with the index and middle fingers. Nothing obstructed my course excepting fragments of placental tissue. The fætus was evidently not in the womb, neither was the placenta entire, nor the cord. There were not the usual history and symptoms of rupture of the womb, and this was not thought of as a possible occurrence, owing to the almost complete absence of pain, collapse, etc. The woman was bright and moderately cheerful, and complained of nothing, except the presence of my hand in the vagina and womb. I now slowly withdrew my hand, searching along the walls of the uterus for fissure, when the joint of the second finger came in contact with a foot of the child, in what felt like a deep fissure. I secured this with one finger, and soon felt and secured the remaining foot with the
other fingers of my hand, and, announcing the result to Dr. Junkin, began cautious traction, and soon brought the entire child back into the womb, through the opening, from among the intestines, where it had escaped to; and, continuing traction, the child was soon delivered, excepting the head, to which Dr. Junkin applied the forceps and effected delivery at once. By following the cord the placenta was also safely dragged into the womb, and soon delivered. The child was of average size and well formed.
Little remains to be said. No contractile pains followed the delivery, but death occurred on the morning of the fourth day, probably from absorption of septic matter, as there was no general peritonitis, and not even acute metritis, except immediately around the rupture.
Post-mortem twelve hours after death.–Rigor mortis complete. Body baving been in ice for six hours, upon opening the abdominal cavity there was an escape of gaseous matter, so penetrating and offensive as to drive all from the room.
Cutting down to the womb, found that organ in an uncontracted condition, and upon removing it entire, a transverse rupture, midway between the fundus and neck, was found upon the posterior aspect.
As to the causes leading to this result—the special point of interest in the case-it was the opinion of the medical attendants that it was only explicable by supposing a preëxisting state of chronic interstitial metritis of long standing.
The rupture had undoubtedly occurred before medical attendance had been secured, and was painless or almost so; as the lady had had little pain, and only concluded labor was about to occur, by the blood lost.
The long standing inflammation of the walls of the womb probably left the muscular striæ so softened that, at the first effort at contraction, the longitudinal fibres gave way, the transverse separating, thus completing the fissure through which the child escaped. The case is unique, owing to the absence of the usual history of rupture. Neither of the medical gentlemen in attendance had ever before attended her, and consequently knew nothing of her previous history.
A. K. SEEM,
We have the following report of an attack of vertigo in a member of the medical profession reported by himself.