REPORT OF THE NORTHAMPTON COUNTY MEDICAL SOCIETY.

THE County of Northampton, one of the oldest in the State, was separated from Bucks by act of Assembly of March 11, 1752. It originally included Wayne, Pike, Monroe, Lehigh, and Carbon; the latter having been established in 1843. That portion which remains of the original county lies almost entirely within the fertile and beautiful Kittatinny Valley, and bounded by the Blue or Kittatinny Mountain on the north; by the South (or Lehigh) Mountain on the southeast, with the Delaware River flowing along the eastern, and the Lehigh River along the western boundary. The entire county is rolling. The superior agricultural soil is well drained by numerous tributaries of the Martin's and Bushkill Creeks, emptying into the Delaware, and by the Saucon, Monocacy, and Hockendaqua Creeks, emptying into the Lehigh River, which flows into the Delaware at Easton.

In the northern and part of the middle portion of the county, extensive slate-beds abound, extending from the Lehigh to the Delaware River, whilst the more central and southern portion is a fertile limestone bottom, rich in deposits of iron ore. The rich yield of this valuable metal, in connection with the extensive slate developments, have occasioned of late years large investments by enterprising capitalists.

As regards the sanitary report of this county, I regret to announce the indisposition of members to communicate their observations and results of their practice. This fact entirely precludes such a report as is desired by the State Society; and as to the mortality report, it is impossible even to approximate, there being no statistics of deaths or births kept in the county.

The past year has been a comparatively healthy one in the southern part of the county; only a very few cases of diarrhea occurred during the summer of 1867, and less pneumonia during the winter and spring months than in former years. Scarlatina was treated during the month of February in two cases, and in March in one case. Rubeola prevailed in seven cases during March,

all belonging to one family. The Easton and Bethlehem physicians report the disease as having prevailed in an epidemic form during January, and as the family above mentioned lives some six miles from either place, it seems somewhat remarkable that the disease should have been confined to them.

Pneumonia being complicated with one case three years old, the patient died.

Typhoid Fever.-A sporadic case was treated in November, and one in December. During January and February of the present year no case occurred. In March it again made its appearance in one case; in April, five cases; in May, eight cases; and at the present writing the disease is on the decline, no new cases having occurred since the 1st of this month. The disposition of the disease is to keep closely confined to the base of the South Mountain.

In eight of the foregoing cases mentioned as having been treated, the disease appeared in a very malignant form; of these, one is yet quite sick; three convalescing; two quite well; and two died.

Mr. Z., æt. 44, died on the 26th day of his illness, in consequence of exhausting diarrhoea, accompanied with profuse hemor rhagic discharges, which commenced in the second week of his sickness, and which nothing seemed to control.

Mr. R., æt. 56, who died on the 12th day of his illness, rested well at 2 o'clock P. M., with a pulse of 85 beats to the minute. He was rational, and apparently doing well, but died at 11 o'clock P. M. the same day. His wife stated that towards the latter part of the day he had occasion to use the chamber, and soon after his return to bed was attacked with a chill. The patient threw himself several times around in bed, when his breathing became laborious, and apparently, from the description of his widow, sank into complete collapse.

During life this patient was suffering with a large inguinal hernia, and was obliged to wear a truss, which he was in the habit of wearing in bed, as well as out of it, up to the day of his death; on that day, however, he removed it from his person. From the fact of his resting apparently well when visited at 2 o'clock P. M., the cause of death was assigned to the internal lesion.

The treatment of typhoid fever pursued in our practice, varies with the cases, expectant with early support to the vital powers in the milder form, counteracting as much as may be any mischievous tendency in the more aggravated forms of the disease.

Dr. A. J. HARRIS, of Hellertown, reports:

"Mrs. K., æt. 23, primipara. I was called to deliver on the 25th

day of February. I found, upon examination, the position of the head of the child normal; duration of labor, four hours; placenta easily delivered, and whole. On the third day after delivery I made the second, and only customary visit in these parts, on such occasions.

"I was called on the tenth day after delivery, at which time she had been out of bed, but was attacked with profuse secondary hemorrhage of quite red blood. On examination, no clot was found to interfere in the closure of the mouth of the womb.

"Ergot, in combination with opium and plumbi acetas, was prescribed internally, and cold applications locally, which only partially arrested the hemorrhage, when, at the end of the fourth day of this treatment, the hemorrhage became alarming. At the recommendation of Dr. P. B. Breinig, of this town, cold injections per rectum were made use of, frequently repeated, and continued for thirteen days, with ice-cold topical applications, and internal treatment, which finally had the desired effect in relieving her from an otherwise certain death. She slowly convalesced, and is now quite well."

Dr. Green, of Easton, reports that the only epidemic which occurred in Easton during the year was one of measles. The first cases were of a sporadic character, two occurring in his practice in the month of September, eight in October, one in November, twentyfive in January, when the disease assumed the epidemic form. He reports forty-two cases for the month of February, eighteen for March, four for April, and two for May, when the disease ceased to prevail. Cases occurred during nine successive months of the year. This epidemic did not present any malignant symptoms as it occurred in Easton, though some of the cases were of a grave form. A mild antiphlogistic or cooling treatment, now so generally employed by the profession, was very successful. Of more than a hundred cases so treated by him, Dr. Green reports no instance of death, and says parents and nurses have lost much of the fear of this system of treatment which once prevailed. The catarrhal symptoms yielded to simple expectorant remedies. As in the epidemic of 1864, cases of a second attack in the same person were not uncommon.

The health of Easton was good, with the exception of the epidemic referred to above. The diseases of summer were not so prevalent as in some of the former years. In the month of June he prescribed for seven cases of diarrhoea in the adult, and for nine among children. In July he had twenty cases in adults, and eighteen in children. In August, forty-seven in adults, and twenty

three in children; a season when children are usually attacked by this disease in greater numbers than adults.

The mild temperature of the summer months was favorable to health, especially to that of infants. The hottest day of the season was the 23d of July; mercury at 92° F.

Dr. Green reports a case of tetanus which followed the operation, by ligature, for hæmorrhoids. It is not known that any case of this kind has occurred in the practice of American surgeons. Dr. Green reports the case, that the profession may judge how far the disease may be considered due to the operation, and whether such a result should enter into the account of probable results after the operation.

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The patient was a young man in good health and of vigorous frame, and although he had suffered for a considerable time from the pain which attends the protrusion of piles, his general health had not suffered. He had been an active soldier during the last He was prepared for the operation by purgative medicine and diet, and, being in good health, two ligatures were applied by Dr. Green, assisted by one of his pupils, Mr. James W. Moore. The patient was placed on a light diet, directed to remain at rest, apply cold water to the parts if hot and painful, and on the fifth day to use a gentle purgative. The patient was under the care of the physician of his family, and on the sixth day after the operation slight symptoms of tetanus were observed, which soon became more marked, and Dr. Green was sent for. As he was unable to visit the patient, Dr. John M. Junkin, of Easton, visited him, and makes the following report of his condition:—

"On the 19th day of August, 1867, in consultation with the family physician of Mr. A. B., I visited him, and found him suffering with well-marked tetanus; jaws almost set, head drawn back, slight tremors, pulse not excited, skin in a natural condition. About a week before, he had two piles ligated; no unfavorable symptoms had taken place until the morning of the day I was called. A purgative had been given, but the bowels had not been moved since the ligation of the piles. There was so much tenderness, that an examination of the rectum could not be made. I advised an injection of warm water and soap, which soon produced a full evacuation of the bowels, and protruded the parts so that the surface from which the piles had separated was visible, presenting a clean, healthy appearance. I applied sulphate of morphia freely, and returned the bowel, with the hope of producing insensibility in the parts, and thus allay the irritation of the nervous system. I advised the use of chloroform if the symptoms should increase, which was afterwards

tried, but without any beneficial effects. I did not see the patient again, but heard from the attending physician the next morning that the symptoms were more favorable, but he died on the third day. There was evidently a peculiar nervous susceptibility in this person. About two years before he had some slight symptoms of tetanus, from a small wound, I think, on his hand."

The profession have the facts in this case, and can decide how far the result is due to the operation, whether there was a peculiar susceptibility to tetanus in the patient, and whether such results may be feared in all cases when treated in this way.

In the recent edition of Prof. Gross's System of Surgery, vol. ii. p. 584, we find this remark: "The ligation of hæmorrhoidal tumors is occasionally followed by tetanus."

Mr. James Law, of London, reported in 1861 not less than four fatal cases of this disease consequent upon this operation, two of these having occurred in his own practice, and two in that of Mr. Gowllard. It is proper, however, to add that tetanus was remarkably prevalent at the time in some of the metropolitan hospitals. P. B. BREINIG, Chairman.

OFFICERS AND MEMBERS.

President.-Dr. EDWARD SWIFT.

Vice-Presidents.-Drs. AMOS SEIP and JOHN A. RAUB.

Secretary. Dr. JOHN M. JUNKIN.