monia, with bronchitis. The type of disease here is inflammatory, and bears depletion well. In the successful treatment of pneumonia, I have been for many years in the habit of bleeding, when called early. And in this connection I would especially mention digitalis as having been in my hands a most potent and reliable agent in the treatment of pneumonia. I give the tincture in such doses as may be required to impress and control the pulse.

In obstetrics and surgery I have nothing to communicate of importance, unless it is to say that in a long practice I have become convinced that the use of the forceps, in all suitable cases, will shorten the sufferings of the patient, and is not hazardous to either mother or child.

Dr. MILLER, of Huntingdon, writes:

"Last summer during the warm months had considerable diarrhoea, chiefly among children, and caused mostly by malarial poison; mortality very small; duration of disease brief, excepting in two cases. Treatment consisted in small doses of calomel combined with plumbi acet. and bismuth subnit. After checking the bowels, gave quinia and bismuth, with proper attention to diet. Had but four cases of dysentery; the tendency of intestinal trouble was to the small intestines. Later in the fall had a number of cases of typhoid fever, more than I have met with any year for the past eight. The disease run from two to three weeks, and in no case were there any sequela left. The cases were treated chiefly on the expectant plan, with the most gratifying results. During the months of December, January, and February, we had but little sickness, and no tendency to pneumonia or bronchitis. In March and April had a number of cases of pneumonia, principally in children; treatment consisted of calomel and ipecac. and veratrum viride, together with stimulants and beef-tea, when required. Have had considerable whooping-cough; treatment most successful in my hands was bromide of potassium in combination with hydrate of chloral."

Dr. G..W. C. JAMES, of Orbisonia, writes:

"The past year has been one remarkably free from any prevailing or malignant disease in this locality. The principal cases I was called to treat were, during the summer months, of simple diarrhoea. My usual course of treatment was calomel, bismuth, and morphia, alternated with syrup of rhubarb; and I had the satisfaction of seeing every case recover. During the last few months pleurisy and pneumonia have been the only diseases I have been called on to treat, only one case of this proved fatal. Bleeding

freely in the congestive stage of this case, I believe, would have saved the life. In all of the other cases where venesection was resorted to they recovered in a very short time. Some fifteen years ago it was my usual custom to bleed my patients freely when called in the early stages of pneumonia and pleurisy; and generally had the satisfaction of seeing the result of this plan of treatment crowned with success. In the advanced stages of pneumonia my favorite expectorants are carbonate of ammonia and syrup of senega."

Dr. BRUMBAUGH, of Huntingdon, writes:

"I have noticed for several years a growing tendency to nervous affections and mental disorders. Partial paralysis, in which the integrity of a portion of the sympathetic or ganglionic system of nerves is involved, has been quite common in my practice. From observations carefully made I am constrained to attribute this tendency to the effects of the use of tobacco, as it is largely associated with the tobacco habit. Mental derangements from dyspepsia, which is attributable to the same cause, are also largely

on the increase.

"No epidemics have prevailed here since the meeting of the Society, one year ago, save that during the early part of the past winter was a general typhoid tendency, with a few cases of wellmarked typhoid fever.'

"During the winter of 1867-68, we had in this community a limited epidemic of cerebro-spinal meningitis, and again in February and March of 1873. All the cases of the first epidemic were characterized by a profuse petechial eruption, becoming ecchymotic, and giving a dark, dusky hue to the body. The cases were generally severe, and a majority proved fatal; but the eruption was found on the milder as well as the severe cases. In the late epidemic the eruption was visible only to a very limited extent in a very few cases. The attacks were severe, but yielded more readily to treatment, only about one in six proving fatal."

J. A. SHADE, Chairman of Committee.

REPORT OF THE LANCASTER COUNTY MEDICAL SOCIETY.

DR. M. L. HERR reports as follows:

The late epidemic of "cerebro-spinal meningitis," which so seriously and fatally invaded this locality during the past year, seemed to fall more severely on the southern and western sections of our city. The first cases I observed occurred in the early part of February, 1873; the epidemic continuing throughout the year.

I treated from the invasion of the disease up to the present time sixty-three (63) cases; of these, twenty-eight (28) died, which seems a high rate of mortality; of these, eleven (11) died early in the disease; some, before any treatment could be instituted; whilst several died after a lingering debility.

I saw many cases during the epidemic which simulated the disease, but which I had not included in the report, because the prominent distinctive features, retraction of the head, tetanoid spasms, and general rigidity of the muscular system, were absent; whilst the vomiting, violent pain in the head, back, and limbs, would seem to be pathognomonic of a mild or modified type of the disease; I have no doubt that they were produced by the same morbific agent, just as diarrhoea and vomiting may be prevalent during an epidemic of cholera.

All of the cases here reported, so far as I could observe, were preceded by a chill, followed by intense febrile excitement and obstinate vomiting; headache being violent from the first, with severe pain down the back and limbs; the pupils of the eyes were generally dilated, but in several cases they were in opposite states, one dilated and the other contracted; convergent strabismus was present in fully one-half of the cases; there was generally great restlessness, the patient moaning and uttering plaintive screams; the breathing slow and oppressed, sometimes stertorous; speech inarticulate and rumbling; tetanoid spasms made their appearance soon after the attack, with great muscular rigidity.

Opisthotonos was present in every instance; I did not meet with one case of emprosthotonos or pleurosthotonos. Palsy of the

bladder, as well as palsy of the extremities of one side, occurred in six cases. Petechiae were not universally present, and in some of the most violent cases they were totally absent.

The prognosis is always to be regarded as unfavorable. The treatment with which I succeeded best was quinia in large and frequent doses, persistently continued until the retraction of the head yielded, and after that such tonics and stimulants as were best borne. I, however, did not confine myself to the quinia treatment, but in some cases pursued others, and regretted it in every instance.

The following is a tabular statement of the methods pursued :—

It will be perceived that the percentage of recovery is altogether in favor of the quinine treatment. The manner of treatment can be best illustrated by giving the history of one case.

Annie B., æt. 6, was taken sick 10th of June, 1873. I was called to see her on the evening of that day; found her pulse full and frequent; complained of pain in the head and back; tongue red and slightly furred. I ordered ol. ricini, 3ss, with potass. nitratis. On the next day I was called early. The parents much alarmed; child screaming with pain, and throwing itself violently about the bed. Head thrown back in the pillow, with occasional vomiting. I gave a hypodermic injection of morphia, with the view of quieting the child, and relieving the vomiting; and ordered 3j quinia in eight powders, one to be given every two hours; after taking the third powder, vomiting ceased, and the child rested; the next day she could answer my questions. I now ordered sod. hyposulphite in 10 gr. doses every three hours. During that night the paroxysms became as violent as ever, and the parent, not being able to find me, had the quinia prescription renewed without authority, and the child was more comfortable the following day. I then continued this for four days, during which time the child took 3v. She was conscious, but the retraction of the head had not yielded. I ordered one-half the quantity, which was continued one week longer. In all, the child took 3j of the drug. I then put her on wine and beef-tea, and by the 28th day she was out of bed, and is now fully recovered, so far as I know.

I have frequently used tincture verat. viride to restrain the heart's action.

Constipation is most generally present, but I studiously avoid all cathartic medicines.

There occurred total loss of hearing in two of the cases; further than this there was no serious accident among those recovering. I did not have the time or the facility for investigating the pathology of this disease.