cord was very much hypertrophied, and I found it extremely difficult to separate the vessels. The mass removed was about six inches in length and ten in circumference. I opened into its interior, and found that it was rapidly undergoing disorganization; quite a large quantity of bloody pus exuded. For the first four days after the operation everything seemed favorable; the wound was granulating finely, and patient very much encouraged. From this time until his death the parts became erysipelatous, and extended to the surrounding parts. He sank, and died on the tenth day after the operation. L. DARLING, JR., M.D. REPORT OF THE WASHINGTON COUNTY MEDICAL SOCIETY. THE Committee appointed to prepare the annual report of the Washington County Medical Society have met with the usual difficulty in obtaining material upon which to base their report. Many of the most interesting facts and cases brought to the notice of the Society at its various meetings, not being committed to paper, are virtually lost, when it is desired to make a report of them. The health of the community has been generally better during the past year than the average. The only epidemic that prevailed to any extent was one of diphtheria that visited the town of Washington, in the latter part of the fall and early winter, and proved the most fatal form of that disease ever visiting the county. The mortality during the early part of the epidemic was truly alarming, defying every plan of treatment, and demonstrating most clearly the inefficiency of all plans yet used in the severe form of the disease. The disease prevailed in various parts of the town, from the highest point to the lowest, manifesting itself most severely in the families of the better class of the people. No age from eight or nine months to forty years was exempt from its ravages. Dr. McKennan reported a case of camphor poisoning, and, on account of its rarity, I speak of it in this connection. The poisonous dose taken was thought not to have been over fifteen grains, yet the complete toxical effects of the drug were manifested. I herewith submit the report of a case presented to the Society by Judge T. W. Bradly M.D., of Burgettstown. Some time in September a man about 75 years old, from Beaver County, called at my office, and his son, who was with him, informed me that more than a year before, he noticed a fulness in the back part of the throat, which gradually increased, until at this time. he could neither speak, swallow, nor breathe without effort, and then very imperfectly. His son informed me that all the sleep he had got for some weeks was what he could get between breaths (or spells of breathing). He said he thought he slept about a minute at a time, then would wake up struggling for breath, and in the effort would throw the bedclothes in every direction, then again go to sleep as before. I examined and found a tumor, nearly flat on its surface, smooth and glossy, burrowing under and distending the pharyngeal muscles, obliterating or incorporating in itself the pterygoid muscles, and pressing down upon the larynx and base of the tongue, so that it required quite an effort to get to see them; ulceration had commenced at the base of the tumor, and the parts on which it pressed. This I looked upon as an effort of nature to remove the intruder. He was of course very anxious to be relieved. I told him nothing short of an operation would relieve him, that it would be difficult, and attended with a good deal of danger; suggested to him to go Pittsburg, as there were several surgeons there of merited repute, and if no one else would operate I would, rather than he should die without an effort at least to relieve him for a time. He went to the city, came back and informed me that none he had seen save one would dare to operate. I told him to go back to that one and let him do it. He left and in a few days sent an urgent request that I should come and operate, as he felt that he could not live longer without it. Having some instruments that I had made for the removal of uterine tumors, which I thought would answer, I resolved to try, but how was I to proceed? If he was erect when I cut, the blood would strangle him; if he was inverted the tongue would be in the road. Still another difficulty presented: as he could only breathe by a voluntary effort, dare we use anæsthesia? If we did not, could he resist the disposition to struggle when the tumor was taken hold of with the volsellum ? Having everything in readiness, and assisted by Drs. Graham, McCoy, and Ramsey, we laid him on his back across a bed, his head hanging down, used about equal parts of ether and chloroform until we thought him near the point of insensibility. Dr. Graham held the tongue well up with a compressor; I grasped the tumor with the curved volsellum, the covering membrane gave way and revealed a cerebriform tumor, which I removed in about half a minute with the curved instrument. Some redundant membrane that hung around I removed with a common volsellum and a rude cutting instrument of home manufacture. The hemorrhage was enormous during about a minute, but yielded soon to the tinct. ferri chlor., which is my favorite styptic. We were prepared to burn if found necessary. I had an iron rod bent at right angles, with a bulb on the end just large enough to pass readily through a rude speculum I made from a piece of sheet-iron, which I fancy would have answered the purpose had we been required to use it. We left him very much relieved, although with a sore throat, and he seemed much delighted in that he was able to talk and eat bread. I have not seen him since the operation, but learn that he is getting along well. Although his general appearance is healthy, yet I suppose he will again be troubled. May 13, 1876, operated second time; tumor small as compared with the first, occupying the middle of the back part of the pharynx, immediately above the commencement of the oesophagus, in appearance like a wart or excrescence, central portion medullary as before, the sides more fleshy. The central part easily removed with a dull curved instrument, the outer parts were removed with curved scissors. The pterygoid muscles (which on the former occasion seemed obliterated) were again visible, at least in a rudimentary state. The hemorrhage during this operation was but slight, probably not more than one or two ounces. The old man's health had continued good since the previous operation, had slept well, and until recently could swallow quite well. Accompanying the report the doctor also presented the various instruments used in the operation, constructed under his supervision by his blacksmith. Respectfully submitted, JNO. A. M'KEAN, |