REPORT OF THE SCHUYLKILL COUNTY MEDICAL SOCIETY.

Dr. D. W. BLAND, of Pottsville, reports:

As a few items of interest I desire to contribute the following for the county report: In obstetrics, one case of complete prolapse of the vagina. I first examined this patient when she was in the throes of labor. The vagina was filled with an elastic body that I at once decided was the distended bladder. I introduced the catheter, emptied the virus, but the tumor remained the same. Upon a second examination I found the os dilating and a presentation of the vertex. By careful manipulation I managed to partially place the prolapse above the vertex and behind the pubes. I then applied the forceps, guarding the prolapse with my left hand, and making gentle traction with the forceps. I succeeded in delivering my patient. The prolapse was treated with the globe pessary and perfect rest.

One case of double varus, for which I operated when the child was six weeks old. The result was entirely satisfactory. I used adhesive strips as dressings for two weeks, when the shoes were adjusted.

One case of double congenital hare-lip, with double palatine fissures; child was six months old.

One case of urethral fistule, or rather malposition of opening in male child. The urine escapes under the scrotum in the line of the raphé; patient has control over the bladder. There is no opening in the penis, no evidence of an opening in the glans; the organ is oval, symmetrical, and resembles the condition after the operation of circumcision.

One case of rapid ovarian disease, ending fatally. That of Mrs. D., aged 32 years, of nervous sanguine temperament, came under my care sometime in Feb. 1871. She was then menstruating regularly; complained of an acute pain in the left iliac region, had no external evidence of tumor, or any decided symptoms, aside from the pain that pointed to disease of the ovaries. I placed her upon tonics and alteratives with counter-irritation, also a laxative pill.

The case continued in a fluctuating condition for several months. In the month of April her menses ceased, her strength began to fail, while at the same time there was evident hardness, and a rigid feeling in the iliac region, with most decided increase in the size of the abdomen. From this time forward the case progressed regularly, increased suffering, irregular action of the kidneys, condition of ascites, complete shrinkage of the mammæ, and retraction of the nipple, flattening of the chest. The face assumed a cadaveric appearance, eyes sunken, countenance anxious, respiration labored, complete loss of appetite. Her abdomen was distended to its utmost capacity. The wave on palpation was decided; two distinct, firm, and unyielding masses could be felt through the integuments. Her condition was fast becoming critical. Upon consulting with Dr. J. T. Carpenter, we decided to remove the fluid with the aspirator, hoping by relieving the pressure of the fluid to contribute to her comfort. In this we were not very successful, the canula becoming blocked with floating shreds of lymph. The amount thus removed was about fifty ounces. A drainage-tube was introduced, and the flow encouraged. The rough outlines of the mass could now be distinctly felt.

The patient was placed upon beef essence, egg-nog, narcotic doses of opium, and quiet. For three days the case progressed favorably. On the fourth day decided evidences of trouble were manifested, in the rapid pulse, increased heat, tympanitic condition of the abdomen, and vomiting of a dark, glairy, offensive mucus. The case went on to a fatal termination one week from the day of aspiration.

Post-mortem examination was made sixteen hours after death. Peritoneal inflammation general; the entire left side of the abdomen was filled with an ovarian tumor, multilocular in its composition. The walls of the tumor varied in thickness; at some points very thin, almost diaphanous, at other places, more than two inches in thickness. The cavities varied in size, and in the quantity of their contents; fluid in sacs, thick, gelatinous. The tumor was firmly adherent to the descending colon, to the left side of the uterus and pelvic fascia; the pedicle was thick and strong. The operation of removal would have been a severe reflection upon the hard-earned reputation of ovarian surgery.

The uterus was normal. The tumor, without the fluid, weighed twelve pounds; the entire mass and fluid contents would probably weigh thirty pounds.

Two very interesting cases of "Purpura Hemorrhagica," following simple attacks of diphtheria came under my care. One child under two years had fever with slight patches in fauces; on second day

an eruption closely resembling scarlatina appeared; on the third day throat symptoms were worse, eruption had disappeared, fever subsided, and the eruption of purpuric spots, with profuse and exhaustive hemorrhage from the kidneys appeared. The discharges were excessively offensive, the napkins requiring a strong solution of carbolic acid to be used. Seven discharges of blood in the twenty-four hours. Under the liberal use of fld. ext. ergot and tinct. ferri chl. in alternate doses, counter-irritation over the loins with lin. terebinth., and beef-tea, and egg-nog internally, the patient made an excellent recovery.

A case of protracted hæmoptysis that resisted the effect of the generally accepted remedies is deserving of notice. The subject was Henry M., aged 36 years, has had repeated attacks of bleeding from the lungs during the past four years. During the past two months has had severe attacks, sometimes three and four in one day, averaging from four to ten ounces of blood. The blood was a bright scarlet color. I prescribed the various preparations of iron, with ergot, turpentine, ol. erigeron, saturated sol. of tannic acid, ice, salt, counter-irritation, each in their order, some in combination, but the bleeding was stubborn and persistent. I then resorted to the employment of a remedy that had operated successfully in the same person in one of his former attacks. The dose seemed bordering on the decimal, or even less. I directed forty drops of the wine of ipecac. in five ounces of water; a teaspoonful to be given every half hour, the use of the remedy to be persisted in without regard to any bleeding. After the use of the above remedy for twenty-four hours, the bleeding ceased. Up to the present, now five weeks since the use of the medicine, there has been no evidence of bleeding. The patient is walking about his room, goes down stairs, and out into. the garden.

This statement is true, and I feel that to ignore the truth, or fail to report this result, would evince a failure in doing a professional duty. Our mission is to cure disease and alleviate suffering. To the means we employ, and the remedies we administer, so long as they are legitimate, no professional brother can urge an objection. The remedy must have some therapeutic action, or how could the result prove the fact? The teachings of Ringer, of Wood, the chair of "Symptomology" (recently introduced into some of our medical schools) must certainly have more than ordinary significance.

If we are justified in using wine of ipecac. in one-drop doses every hour or two in the protracted nausea and vomiting of pregnancy (and this remedy certainly affords relief), most undoubtedly should the use of any remedy be approved of whenever it does good and

cures disease. The maxim of Asclepiades, "Curare cito tuto et jucunde," doubtless meant to have just such means employed as would accomplish the purpose.

The profession of medicine is a liberal one. Indulgent to all when no one especial "hobby" is assailed. The profession are not a unit on the interpretation of the code of ethics as they are now recognized by the American Medical Association. Many able and prominent members of the profession are more charitable in their views than the code prescribes they should be. The result is a species of electicism in the practice of medicine, "proving that which is true, and holding on to that which is good." Disease is tested with a greater variety of remedies, and the best are selected. The rationale of a drug and disease in their results and application is only proven by experience. We know that digitalis will reduce the action of the heart, and that is all we do know; why it does it, and how, we leave to the theorist, who may flood the profession with pamphlet after pamphlet, and still the mystery will remain a mystery still.

I applied the jacket casing for a case of posterior lateral curvature of the spine. The subject was a young lady aged twenty-two years, who had been a great sufferer for several years. She was treated for a great variety of troubles, more especially for dyspepsia. At the time I examined her the trouble was most marked; decided lateral with posterior projection of the dorsal vertebra. I sug gested the spinal casing. To this she assented. With the pulleys, cross-bar, chin, occiput, and arm sling I drew her up to the height of allowing her toes to touch the floor. Owing to her extreme anæmic condition, she was unable to endure the position sufficiently long to admit the application of proper casing. Having adjusted a close-fitting merino-shirt, I applied the rollers in regular turn, beginning at the hips, an assistant covering the roller with a solution of salicylate of soda. The roller was continued well up under the axilla. When several layers of bandage had been applied, and well saturated with the solution, the patient was gently and carefully taken down and placed on the bed, keeping up as much as possible her extended position. The patient wore the jacket for several weeks with the greatest relief and comfort. In a very short time the casing was firm and hard. In the mean time I procured a sheet of perforated felt to be used in improving the casing jacket. This perforated felt was cut into strips of the required length, two for the chest anteriorly, two for the back, either side of the spinal column, with two each side of the chest extending from the ilium to the axilla.

After the lapse of three weeks I removed the first dressing. The patient having been under the use of iron and quinine, her general condition was greatly improved. When making the second application of the jacket I used the perforated felt splints as described. After encasing the chest with one thickness of muslin, I placed the splints into hot water, then applied them in their proper position and proceeded to secure them with additional turns of the roller, keeping the roller well saturated with the solution of salicylate of soda. This dressing made a splendid casing jacket, and was worn by the patient for nearly five months without removal. Her condition was so much improved that she was able to walk several miles without resting, could work for hours at the sewing machine, do general housework, and in fact perform any duties she might be called upon to do. The lateral curvature was arrested, the posterior projection lessened, and entirely relieved. Some two years ago, when the perforated felt was first brought to my notice, I wrote to Prof. Sayre suggesting its use for the jacket instead of the plaster, or to combine them. As I never received any reply, I presumed the letter was not received, or the suggestion was nil. However I am happy to see its recognition in the hands of reputable specialists and used with perfect success.

MARY ALICE SWAYZE, M.D., of Pottsville, reports a Case of Extraordinary Cancerous Tumor of Left Kidney in a Child.

The case of Bessie W., aged a little over three years, was one of unusual interest. In April, 1878, a small enlargement in the child's left side was observed. My attention being called to the case by the mother, after a careful examination, I expressed the opinion that, without doubt, the enlargement was the result of a tumor situated inside the abdominal walls.

The child's health previous to this time had been uniformly good. As the abnormal development was then comparatively small, I felt warranted in trying at least some remedies to relieve my little patient carefully watching the progress of the case, and making repeated measurements of the abdomen from time to time. Towards the end of May the enlargement was rapidly increasing, was oblong in shape, and seemed to rise from near the spine under the region of the lower ribs. It seemed firm and devoid of fluid. Its location naturally suggested either a tumor of the spleen or left kidney. Taking into consideration the rapidity of the growth of this mass, the absence of any discoverable cause for its presentation, and the very tender age of the child, I was disposed to regard it as cancerous in nature.