One point in the history of the case after the operation deserves mention as bearing upon the question of vaginal drainage in ovariotomy. For four days after the operation there was an abundant, watery, dark-colored, very fetid discharge per vaginam, sufficient to saturate completely three or four times a day a folded sheet placed under her. The question arises, had this discharge had no outlet, would it not have produced either peritonitis or septicæmia, or both? The tumor was composed of a single cyst of the right ovary, and weighed, with its contents, about nine pounds. The fluid removed at the first tapping was clear, limpid, and only slightly albuminous. At the time of operation, it was turbid, viscid, albuminous, and of a dark color.

This is the only instance of vaginal ovariotomy on record, with the exception of the one by Dr. Thomas before spoken of, and that can hardly be called an exception, as the tumor in his case weighed only twelve ounces, and the patient did not yet suffer sufficient inconvenience from the tumor to make surgical interference a necessity, while in mine, that necessity had already become imperative.

I think it must be conceded that this case proves that vaginal ovariotomy is possible in a larger proportion of cases than has hitherto been supposed, and Dr. Peaslee's conclusion that "it is practicable only in case of a very small cyst, and while it gives no special inconvenience, to justify surgical interference in any other way," must now be modified. Whether it will ever become a recognized operation in surgery or not, others must decide; but I am free to confess, that, should a similar case again present itself to me, I should certainly be inclined to repeat the operation, confident that the dangers to the patient would be lessened thereby.

REPORTS

FROM

COUNTY MEDICAL SOCIETIES.

FORM OF COUNTY REPORTS TO THE MEDICAL SOCIETY OF THE STATE OF PENNSYLVANIA."

I.-CAUSES WHICH MODIFY THE HEALTH OF THE COUNTY.

1. LOCALITY:

Boundaries of County, and its situation in the State.

Its proximity to large rivers and the lakes; to mountain ranges; their direction and extent.

2. HYDROGRAPHY OR DRAINAGE:

Size and direction of watercourses, and of the dividing ridges, or water-sheds.

Extent of river bottom.

Power and rapidity of streams; danger and frequency of inundation.

Quantity of marshy or springy soil.

Artificial water channels and reservoirs; amount of lockage.

3. TOPOGRAPHY:

Area and mean altitude of County.

Population and their lineage; chief avocations.

Location and size of principal towns.

General character of surface; principal valleys and eminences. Nature and extent of surface destitute of vegetation, tilled, covered with forest, or in grass.

Agricultural produce; kinds of timber; effects of clearing and of drainage on climate; extent of artificial irrigation.

4. GEOLOGY:

Geological position, actual location, dip, direction, and extent of the different formations.

Character of soil, subsoil, and subjacent rock.

Source and nature of water used for domestic purposes.
Supply of water to towns; kind of pipes used as conduits.
Map with geological features named, and colored agreeably to
the order adopted by the State Geologist."

5. METEOROLOGY:3

Latitude, longitude, and altitude of observer.

I See printed Transactions, vol. v. p. 52.

2 Inclose, by dotted lines with proper marginal references, those sections of the county in which epidemics have prevailed.

Observers for the Franklin Institute, Philadelphia, as well as for the Smithsonian Institution, Washington, reside in a number of the counties, and would furnish all the meteorological information required. See page 16, Part iii. 1858.

Barometric, thermometric, and hygrometric states of the atmosphere for every day in the year, indicating, in columns, the amount in inches, of rain, hail, and snow.

1. MORTALITY:

II.-MORTUARY TABLES.'

From fevers; from measles, smallpox, and varioloid.
From diseases of the lungs and air-passages.

From diseases of the nervous system.

From diseases of the organs of nutrition.

From diseases of the urino-genital organs.

2. CAUSES assigned for death where the number exceeds 10 per cent. of the whole.

3. QUARTERLY TABLES, showing the whole number of deaths of white and of colored persons under 1 year, from 1 to 2, from 2 to 5, from 5 to 10, from 10 to 15, from 15 to 20, and for every decennial period over 20.

III.-PREVALENT DISEASES.2

1. EPIDEMICS AND ENDEMICS OF THE YEAR:

Their origin and march; apparently contagious or not; how affected by race, age, sex, temperament, avocation, circumfusa, ingesta, and the density of population.

2. FEVERS:

Intermittent and remittent; their frequency as compared with that of former years.

Typhus and typhoid fevers; smallpox; benefits of vaccination; measles; scarlatina.

3. OTHER DISEASES:

Observations on their etiology, pathology, and therapeutics.
Peculiarity of type or tendency.

Number of cases, and a comparison of it with that of other
years.

4. MISCELLANEOUS:

Medical effects of indigenous plants, and of new remedies.
Facts of interest in surgery and obstetrics.

Notices of members deceased during the year.

List of officers and members.

If, as is to be feared in many counties, the materials for this classification cannot be obtained, the reporter is requested to approximate as closely to it as his means of information will admit.

2 In describing cases, give the age, sex, condition, and location of patient, season of year, treatment, and termination.