Gambar halaman
PDF
ePub

REPORT OF THE CUMBERLAND COUNTY MEDICAL SOCIETY.

As instructed, I submit the following report, which, however, as designed, shall touch simply on the character of the diseases, as found to prevail within the geographical limits under our observation.

Cumberland County is situated in the southern latitude of Pennsylvania, adjoining the border counties, and is bounded by the Susquehanna River on the east, a range of the Blue Ridge on the north, the South Mountain on the south, and by Franklin County on the west.

It would be interesting, in this connection, to present a geological description of the Cumberland Valley, with its mountain skirts, but, reserving this for the pleasure of the Society, I will only state, that three prominent formations characterize the district, viz., the northern slope or mountain, composed of secondary rocks, without any mineral deposits, and skirted by a range of several miles in width, of clay and black slate, which extend along its entire range, except for several miles at the eastern extremity, where an admixture of alluvium and peat soil takes its place.

The centre of the valley is essentially of the limestone formation, and this crops out prominently at almost every point, imbedded, however, in a rich clay soil.

The South Mountain, and a belt ranging, probably, from half to two and a half miles, is of the tertiary formation, composed of silicious sandstone, and is deeply impregnated with rich iron ore.

The water and streams of these districts are also peculiar and characteristic; those of the northern district being soft, in some instances brackish, with here and there a sulphur spring. The waters of the central district are impregnated with lime, and are denominated hard. Those flowing from the mountain gorges of the south are slightly tinged with a yellowish-brown color. They contain some iron, and have other peculiarities; but we are not acquainted with their chemical analysis.

The diseases, as they prevail in the county, are generally of the same character throughout, though, in their peculiar type, they

seem, in many instances, to have been modified by the geological districts. In the one assuming the sthenic, and in the other the asthenic type, as has been observed by those whose duties have led them into those sections. This is especially so of diseases of an inflammatory character, as also of the zymotic diseases. They, however, frequently to a definite extent coalesce; yet they are often so marked up to the very lines of these transitions as to make them peculiar.

It has been the subject of remark, that climate, temperature, and latitude, alike, have had their influence, not only on vegetable and animal organic life, but also on the moral, psychological, and physical character of man. Here, though within a range of but a few miles, to the close observer these peculiarities are apparent. Without making any comparison, and consequently, without disparagement to either, it is proper to state that the physical and dynamic constitutional forces vary greatly in these respective regions. Whether such is the result of atmospheric causes, of organic vegetable life, of the influences of water and of gases, or of geological conformations, or of all these combined, they are such as to condition. the type of diseases.

The prevailing type or character of our diseases, as already intimated, is almost uniformly of the asthenic, order, and consequently, though prevailingly mild, they border more on the nervous than the bilious and congestive forms. This is especially so in the limestone region, except when modified by malaria and other local causes. This remark is true also, to some extent, of the diseases as they occur in the silicious sandstone region, where they border a little more, however, on the inflammatory, while in the slate or soft water region, instead of assuming the nervous form, they are more likely to develop into the subacute inflammatory or passive congestion, on the one hand, or the lingering though mild typhoid on the other.

In all this, it is observed that while the general type of disease is prevailingly the same within our entire county, there are dynamic and adynamic forces and habits, conditioned by causes, though natural, very peculiar; and these, again, so condition the physical economy, that, in the operation of morbid forces, and in the progress of their development, whilst the type remains the same, their phenomena and details are peculiar and special.

The treatment of our diseases, therefore, in order to be rational, will also be somewhat peculiar. The lancet is rarely used, and it is probable that many of our physicians do not practise venesection once in a year. Too active purgation is also contraindicated. In

the use of purgatives, recourse is usually had to those of a mild character, and these are frequently combined with nerve stimulants and tonics. The mercurials, though indispensable, are administered in small doses and with caution. In many of our diseases, little or no interference is called for on the part of the physician, beyond his hygienic and disciplinary skill, if I may so speak, which is, however, of vast importance. Under these circumstances, so far, we may be regarded as having returned to the "expectant" plan of treatment.

On the other hand, many of our diseases require the most prompt and energetic attention at the hands of the physician, and unless he is prompt in his support, they readily assume that low, irritable, and asthenic character, indicative of constitutional forces purely adynamic. Under these circumstances, recourse is usually had, at an early stage, to tonics and stimulants, and these last, in connection with suitable diet, constitute our chief refuge. Besides this general type of disease, we have also sporadic cases of every other type, which can only be properly managed and treated according to their indications.

The tables of mortality in this district, we regret, have never been regularly computed, yet, in our judgment, they are very low. Among children especially, from the ages of one to sixteen years, inclusive, we think they would not average two (2) per cent.

As illustrative of the above, I here present a few statements, furnished by my venerable friend, Dr. William Rankin, of Shippensburg, and by others. "We have had a pretty severe epidemic of measles. In the forming stage the symptoms, in some instances, were pretty highly inflammatory; and, in a number of cases, the convalescence was complicated with bronchitis, or pneumonia; destroying life in a few instances."

"Catarrhal affections, during the winter and spring, have been very general, yielding, however, to mild treatment, or to the efforts of nature alone."

"Typhoid fever, to a limited extent, has occurred during the year; commencing with symptoms of a bilious, intermittent form, which yielded, in most instances, very readily to purgatives and quinine; after the intermittent paroxysms gave way, the typhoid symptoms made their appearance. For this stage of the disease a very mild treatment, mostly, succeeded." Laxatives, compound solution of chlorate of potassa with muriated tincture of iron, neutral mixture, warm fomentations over the abdomen, and quinine, were occasionally demanded.

"We have had a few cases of scarlet fever, of the anginose form;

all recovered, I believe, by means of the ordinary treatment, viz., laxatives, sponging with tepid and sometimes cold water, ice to the fauces, and diaphoretics, nitrate of silver (10 grs. to f3j of water) to the throat, and a saturated solution of chlorate of potassa with tincture of the chloride of iron, using the latter combination internally, often through the whole of the disease; and quinine as a tonic when indicated. This region," he adds, "is well watered with pure limestone water;" the surface of the country is rolling, and in a pretty high state of cultivation, and is quite productive.

Dr. David Ahl, of Newville, mentions the prevalence in that locality of measles, characterized, in many instances, by a peculiar congestion of the lungs, involving also the larynx and trachea; while resisting almost everything else, these cases readily yielded to cerebral and nervous stimulants, as, for example, elixir of opium, and tr. of valerian, freely administered.

Several cases of corresponding character, though not connected with measles, but apparently formidable, under my own observation, yielded readily to bromide of potassium and whisky.

In this particular latitude, where the nervous diseases, and those also of the subacute and passive congestive forms, especially of the throat and chest, so frequently prevail, it may yet remain a question how far they may not be the result of cerebro-spinal irritability.

Dr. George Grove, of Big Spring, in the northwestern portion of the country, informs me that he noticed the most marked change in the general type of diseases, as they have prevailed in that particular region for the last year or more; instead of sthenic and actively inflammatory and congestive, they are every day assuming more and more the asthenic form, and so readily do they fall into the nervous, the subacute, or the typhoid character, that they require not only great caution in the use of depletory and antiphlogistic means, but the most prompt and energetic support from the very

start.

In that particular region the measles have also prevailed in a peculiarly malignant form, showing, it is true, nothing unusual during the early stages; but at the time when the rash began to fade, a condition of general enervation supervened with a rapid tendency of the morbid forces upon the respiratory organs. In some cases these morbid forces determined upon the fauces, larynx, and trachea only, resulting in a few hours in a superficial membraneous deposit; beneath which, deep-seated ulceration was formed, with a rapid tendency to degeneration which was treated successfully by means of solid nitrate of silver to the parts, with the very free use of quinine and brandy internally.

Dr. S. P. Zeigler, of Carlisle, reports an exceedingly interesting case of subacute inflammatory (arthritic) rheumatism, in the person of a young girl, aged about twelve years. With more than ordinary severity, it continued a little more than two weeks without much impression from medicine; when, all at once, the rheumatic affection was supplanted by a correspondingly severe attack of chorea. The rheumatism involved the joints of the upper extremities especially, and was characterized with considerable fever. Immediately, on the supervention of the chorea, there was marked tenderness of the cervical and upper dorsal vertebra. Finally, she recovered, under the use of tonics and stimulants.

Having had no reports from my professional brethren in the eastern part of the country, this report, however incomplete in itself, must, on that account, remain the more so.

Our Medical Society now numbers forty-three members, embracing four-fifths of all the regular physicians in the county. Its meetings have been well attended, and have been characterized with an honest spirit of inquiry, while the ethical relations of its members have been uniformly honorable and pleasant.

S. B. KIEFFER, M. D.

OFFICERS.

President.-WILLIAM RANKIN, M. D.

Vice-Presidents.-IRA DAY, M. D., GEORGE GROVE, M. D.
Corresponding Secretary.-S. B. KIEFFER, M. D.

Recording Secretary.-RICHARD CRAIN, M. D.

Treasurer.-S. H. BREHM, M. D.

Censors. Drs. J. W. C. CUDDY, W. H. LONGSDORFF, R. C. HAYES.

« SebelumnyaLanjutkan »