TREASURER'S REPORT. Benjamin Lee, Treasurer, in account with the Medical Society of the State of Pennsylvania. 22." cash received from Indiana Co. Med. Soc. in full for 1872 from Washington Co. Med. Soc. on account Luzerne Co. Med. Soc. on account Cumberland Co. Med. Soc. on account for 1874 May 13. To balance for 1874 for 1874 66 Crawford Co. Med. Soc. for 1874 from Cumberland Co. Med. Soc. in full for $1110 52 18 75 1.00 90 40.00 29 00 40.00 22 50 30.00 270 00 36.00 174 00 1 25 21.00 5.00 10 50 1.00 15.00 51 50 1 62 Luzerne Co. Med. Soc. in full for 1874 28 00 55 50 28.50 May 4. To cash received from Clearfield Co. Med. Soc. on account Huntingdon Co. Med. Soc. for 1874. 13 50 15 00 Bradford Co. Med. Soc. for 1874 from Berks Co. Med. Soc. for 1874 33 00 60 00 31.50 38 80 24 47 43 50 May 15. By cash paid for stationery, etc., at Easton . 82 20 12.00 60.00 ADDRESS IN MEDICINE. BY WILLIAM PEPPER, A.M., M.D., PROFESSOR OF CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA, PHYSICIAN TO THE PHILADELPHIA HOSPITAL AND THE CHILDREN'S HOSPITAL; ETC. ETC. PERHAPS no more difficult question could be submitted for any one's decision than the choice of a subject for such an address as I have the honor of being appointed to deliver before this Society. This difficulty springs from two sources. The usage which formerly rendered such discourses not so much addresses in medicine as Reports on the Progress of Medical Science, would seem to a great extent to be superseded by the ever-increasing number and comprehensiveness of the abstracts, summaries, and year-books which preserve in a most convenient form every new fact or theory in connection with medical science. And it might therefore appear more appropriate to select as a theme for the remarks I shall have the honor of making here, some one important topic, were it not for the fact that so long a time has elapsed since any similar address in medicine has been delivered before this Society, that I find it difficult to select any one from the group of immensely important medical questions which have occupied the attention of the profession during that period. It has therefore appeared to me that it might be as well to avoid either of these courses—and, without attempting to give even the barest epitome of all that has been added of importance to medical science during the past five or ten years, or without selecting any one topic for exhaustive treatment, to touch briefly upon a few of the leading questions of the past decade, which are distinguished either for their newness and originality, or for their general and comprehensive character. It would be difficult to select any phrase to characterize the activity of thought, observation, and investigation of the past few years in regard to questions purely medical. If many advances of great importance have been secured, and many brilliant results achieved by the labors of the laboratory, no less illustrious progress has been made in the field of pure clinical study. Apart from the great advances which have been made in the exact knowledge of the clinical history and pathology of many diseases-especially in the affections of the nervous system, and the specific chronic blood diseases, there have been several brilliant discoveries of diseases hitherto unrecognized. It is not at all probable that any of these diseases are really of recent occurrence only; but the truth would rather seem to be that with our advance in the knowledge of pathology, and the significance of symptoms, minds capable of embracing in a comprehensive view complex groups of facts, from time to time arrive at new generalizations, by which certain special symptoms, previously included in vague and incoherent accounts of some disease, and regarded as mere anomalies, are seen to pertain to certain special cases, which are really distinguished from all others by their possession, and thus constitute a distinct and independent morbid entity. Among the more important of these recent additions to our nosology, a few may be taken for special mention. And first I will allude to a form of disease long ago well described, but recently announced as a new affection. As long ago as 1855, Dr. Addison' sketched with the hand of a master the symptoms and course of certain cases of progressive "idiopathic anæmia” which advanced resistlessly to a fatal issue, and in which after death no adequate lesion to explain the symptoms was discovered, the only change detected being fatty degeneration of the heart. And I doubt not that in the experience of many of us there have occurred cases of apparently causeless intense anæmia, advancing, despite all treatment, to a fatal result. But recently a number of such cases have been recorded, as by Dr. Luigi Corrazza (Bologna, 1869); and especially by Biermer3 of Zurich in 1872, who published a valuable and original memoir, under the title of Progressive Pernicious Anæmia, based on a careful study of 15 cases, chiefly in pregnant women. Somewhat in advance of the date of this, is an interesting article by Gusserow in 1871 containing the histories of 5 similar cases, also in pregnant women. Further cases have also been published by Immermann,5 by Zenker, and by Gfrorer. It was supposed by 6 Syd. Soc. Ed. of his works; Art. on Disease of Supra-renal Capsules, p. 212. 2 Storia di un caso di oligoemia con riflessioni su quest' affezione, sulla clorosi e sulla degenerazione grassosa degli organi. Bologna, 1869. 3 Vortrag, gehalten in den ärztlichen Gesellschaft des canton Zurich. Correspondenzblatt für Schweizerische Aertze. Jahrgang, ii. 1872, No. 1. U. hochgradigste anämie Schwangerer. Arch. f. Gynækologie, 1871; Heft 2, p. 218. 5 Deut. Arch. f. Klin. Med. 13ten Bd. 3tes Heft. 1874, p. 209. 6 Deut. Arch. f. Klin. Med. 13ten Bd. 3tes Heft. 1874, p. 348. 7 Med. Times and Gazette, Nov. 21, 1874, p. 582. some of these writers that this affection was specially developed under the peculiar geographical influences of Switzerland. But, besides the fact already stated, that the disease was long ago clearly referred to in England, I may add that, in an article to appear in the October number of the American Journal of the Medical Sciences, I propose giving the full account of three cases of this peculiar disease which have come under my observation in the past three years. The peculiar feature of the disease is an intense anæmia without special cause, so far as yet known, which steadily progresses to a fatal result, often accompanied during the later stages by oedema, serous effusions, petechiæ, passive hemorrhages, and a tendency to syncope; and characterized anatomically by an extreme diminution in the proportion of the red blood globules with no increase in the white cells, and by advanced fatty degeneration of the heart, liver, and kidneys, but with little or no enlargement of the spleen or lymphatic glands. Ponfick' has also described undoubted cases of this affection from the anatomical standpoint under the name of the "Anæmic Form of Fatty Degeneration of the Heart." It is not desirable, at this time, to enter into the discussion of the differences which exist between this singular and fatal affection and any of the more familiar analogous conditions-such as chlorosis or leukæmia. Its pathology cannot be regarded as established, but I may refer to the fact that my own examinations render it probable that one of the essential features is an alteration of the marrow of the bones similar to that which has now been repeatedly observed in some forms of leukæmia. It is, however, in connection with the diseases of the nervous system that many of the most brilliant advances in knowledge have been made. Here, too, there have been additions to the list of diseases, one of the most interesting of which is Ménière's disease, so called after the acute discoverer of this strange affection (also called "labyrinthine vertigo" "aural vertigo," or "auditory vertigo," "vertigo ab aure læso," etc.), who described it in a communication addressed to the French Academy of Medicine, in June, 1861. The disease thus brought to the notice of the profession can neither be a new one nor a very rare one, since I have met in the past three or four years with four or five well-marked instances of it, and. already the literature of the subject is quite copious. The group of symptoms which characterize this affection is so distinct as to render its recognition easy. Perhaps in no way can. I more concisely state them than by sketching the course of an Uber Fettherz. Berl. Klin. Wochenschr., 1873, Nos. 1 and 2. |