us. a very healthy one; no epidemic of severity has prevailed among Scarlatina of a mild form has prevailed since the first of January, but has been sporadic rather than epidemic in character." He has known no death to occur from it in regular practice. Bilious and typhoid fevers have been almost entirely unknown for the past year. Operations in surgery have been less frequent than commonly. He has amputated one leg, and had quite a number of cases of necrosis; of minor operations he had about the usual number. He says: "One or two cases are perhaps worthy of a more extended notice, as I believe they are of rare occurrence. I saw W. C., of Smithfield, on the 3d of January, 1868. He had served two terms of enlistment in the army, and up to September, 1864, was in good health, and was a good soldier. About that time he was taken with a chill, which was followed by considerable febrile action and diarrhoea. The fever continued for two weeks only, but the diarrhoea remained. For a time he was in a division hospital in the field, thence taken to a general hospital at City Point, from thence to Washington, and finally to Satterlee Hospital, Philadelphia, where he was discharged at the close of the war. During all of this time the diarrhoea had continued, and a portion of the time he was very low, his friends almost despairing of his recovery. In the winter of 1864 and 1865 he was troubled with what he supposed to be piles, as when he went to stool there seemed to be some impediment to the passage of the feces, and a good deal of tenesmus-it seemed as if something had fallen into and closed the passage. At times no effort of which he was capable was sufficient to expel the feces; at others the evacuation would commence freely, and suddenly be arrested. After reaching home he gained somewhat in flesh and strength, but the diarrhoea and obstruction continued. For the past few months he had suffered very much from dyspepsia, and grown very feeble; the obstruction in the bowels seemed to be increasing. At this time he could eat but little, and had no control of the bowels; the stools were liquid, and passed from him without his being able to prevent it-sometimes even being ejected with great force. The patient was anæmic, with considerable anasarca. Diagnosis: Stricture of the rectum. Examination disclosed a stricture about an inch and a half from the sphincter ani. The sphincter was normal and the rectum healthy until I reached the band which surrounded it. The stricture was formed by a membranous partition thrown across the bowel, with an opening in the centre not exceeding one-fourth of an inch in diameter, and I was unable to pass my smallest finger through it until I had used a dilator several times. Six weeks after using the dilator he had gained complete control of the evacuations, and his appetite and strength had improved somewhat; but he was troubled with flatulence, and the anasarca was still apparent, as well as some ascites. This state of things still continues, though to a less extent than formerly. The index finger is now easily passed through the opening. The patient thinks there is still another stricture above the point to which the dilator extends; I am not satisfied in regard to this. The medical treatment was directed to improving digestion, supporting the system, allaying nervous irritation, and exciting the action of the kidneys. To accomplish these objects I made use of quinia, iron, dwarf elder, buchu, and uva ursi. He has been a great sufferer, and I think he would have lived but a short time had he not found relief. I now think he may get well, though he will be obliged to use the dilator as long as he lives. "The dilator made use of in this case is a new instrument, and never before used, to my knowledge. It was invented by a physician of Berlin, and presented to me by George Tieman & Co., of New York. The name of the inventor, I am sorry to say, I have forgotten. At a future time I will give a cut and a full history of this instrument. At present I will briefly describe it. It is made of hard rubber, and is about seven inches in length, three-fourths of an inch in diameter, and has a hole extending through its entire length about one-half inch in diameter. Six or seven arms are made, commencing at about one half inch from the end, and are brought down to a point. A sheath of corrugated rubber is pressed over the dilator, which is then passed into the stricture; a conical ball is passed into the ring below, and any amount of pressure made that may be desirable. This case is the only one of the kind that I have ever treated, and from the ease with which the instrument was used, and the success attending its use, I am led to think very favorably of it. While dilatation may be the safest course to pursue in cases like this, it seemed to me while treating this case that I might have shortened it very much by dividing the stricture in several places, and then used the dilator while the process of healing was going on. I think there would have been no danger from hemorrhage or inflammation. "I will report one case of retroversion of the uterus, in which I felt considerable interest, not on account of its rarity, as I had seen similar cases, but as it shows what intense suffering a lady may pass through without having a miscarriage. About the middle of February last I was consulted by Mrs. - who stated she was about five months pregnant-that up to the end of the first three months she experienced no particular inconvenience. About that time, after riding in a carriage over a rough road, she began to suffer from strangury and tenesmus, accompanied by a feeling of fulness in the rectum, which she attributed to hæmorrhoids. Her sufferings at each evacuation of the bladder or bowels were intense. She had taken laxatives and diuretics without experiencing any relief. I suspected displacement was the cause of her sufferings, and requested an examination. I found the walls of the vagina pressed together so firmly that it required considerable force to pass my finger up sufficiently to learn the real nature of the difficulty. The fundus of the uterus was pressing firmly against the perineum, producing considerable distension. The cervix was drawn so far above the pubes that I could scarcely reach its lower margin, and could not reach the os. There was life and motion in the fœtus, and its extremities were easily felt through the walls of the vagina and uterus. I attempted to replace the uterus by carrying my finger under it, but the organ was so firmly fixed in its position that no effort of mine, aided by the posture of my patient, was sufficient to dislodge it. The patient's sufferings were so great by this time that I decided to administer chloroform, hoping while she was under its influence to succeed in restoring the womb to its normal position. At this time I called in Dr. Holmes, who assented to my plan of treatment, and administered the anaesthetic. As soon as she was fully under its influence I passed my hand into the vagina and raised the fundus above the promontory of the sacrum, but it fell back very readily. I then held it up for about twenty minutes, when it seemed slightly fixed-the hips of the patient being elevated considerably, I withdrew my hand. During this operation there was considerable hemorrhage, and I supposed an abortion would be the result. One week after this I saw the patient again, and learned the hemorrhage had continued but a short time, and all her unpleasant symptoms had returned, and on examination found the fundus down as before. Chloroform was again administered, when I found I could raise the fundus above the promontory, that it would not remain there, and I could not bring down the cervix. By the advice of Dr. Holmes I now abandoned the idea of saving the child, and by a protracted effort succeeded in bringing the cervix low enough to introduce a sound, rupturing the membranes and permitting the liquor amnii to escape. I left the sound in the uterus three days, the patient remaining on her back, before laborpains were felt. After they had continued three hours I removed the sound, the cervix remaining high up behind the pubes, and dilatation proceeding slowly. When the pains were on, the pressure was against the pubes. After three days of severe labor she was delivered of a five-and-a-half-months fœtus. The lady was much exhausted, but made a good recovery. This was her first pregnancy. The foetus was a good deal deformed. I made no postmortem examination, but the right leg was much shorter than the other. I think there was an arrest of development in that part of the fœtus which was pressed into the pelvis. "This is the only case of retroversion of the uterus in which I have found any serious difficulty in restoring the organ to its normal position." Dr. E. G. Tracy, of Sylvania, reports that nothing new or particularly interesting has occurred in his practice during the past year, which has, in the absence of disease in an epidemic form, been one of more than ordinary good health. The mortality among old people has been greater than usual. He has treated about four hundred cases of disease of all kinds, of which eleven terminated fatally; of these, two were seventy-nine, four between sixty and seventy, one fifty-four, one forty, and one twenty-four years of age; the other two were under one year. He has treated six cases of "enteric or typhoid" fever, one of which came into his hands after having been treated some three weeks by a neighboring physician. This case proved fatal. Another case was very much protracted, continuing over eight weeks, but finally made a good recovery. In the treatment of this disease he uses mercurials very sparingly, ol. terebinth. moderately, and tonics abundantly. In the early stage of the attack he uses digitalis as an arterial sedative, and prefers it to any other article. During the past month (May) he has treated seven cases of scarlatina, some mild and some severe, but they have all recovered except one little girl of five years who is now, June 5th, in the third week of her sickness, and very much emaciated. "I think her case doubtful." There is a large swelling under her left ear from which pus is discharging through the external meatus. "My general plan of treating this disease is to do nothing for the mild cases;" to those of a severe character he administers tincture of the chloride of iron, chlorate of potassa, and when the strength begins to fail he adds quinia. In some cases, he directs the patient to hold ice in the mouth, and to swallow ice water. In conclusion, I am happy to report that the interest manifested by the members of our Society in its meetings seems to be on the increase. While this is an encouraging evidence of progress and improvement, the fact that so many of our members either neglect or refuse to contribute to the report for the State Society is a matter of painful regret. It is to be hoped this may be speedily corrected. At the meeting of our Society, held in September, 1867, the reso lution, offered by Dr. Mowry at Wilkesbarre in 1866, in relation to the recognition of female physicians, was adopted. RUFUS C. ROCKWELL, M. D., OFFICERS AND MEMBERS. Chairman. President.-BENJAMIN DEWITT. Vice-Presidents.-GUSTAVUS CONKLIN, S. L. CHILSON, H. M. MOODY, and S. P. TRACY. Corresponding Secretary.-E. P. ALLEN. Secretary.-L. D. MONTANYE. Treasurer.-G. F. HORTON. Censors. RUFUS C. ROCKWELL, A. J. COLE, V. HOMET, and E. G. TRACY. MEMBERS. Drs. E. P. ALLEN, POST-OFFICE. Athens. A. K. AXTELL, STEPHEN L. CHILSON, A. J. COLE, GUSTAVUS CONKLIN, C. K. LADD, RUFUS C. ROCKWELL, E. G. TRACY, G. P. TRACY, C. M. TURNER, J. D. UNDERWOOD, 66 Standing Stone. 66 Burlington. Towanda. 66 Ulster. Towanda. Troy. Sylvania. Monroeton. Towanda. E. Smithfield. |