A fc R1 E F BIOGRAPHICAL SKETCH OF THE- MEDICAL PROFESSION OF- INDIANA COUNTY, PENN’A, AND The First and Second Sanitary Reports, and Papers on Sclerosis of the Nerve Centres, Pyemia, Nervous Diseases, Bacteria, Tobacco and Hygiene. WILLIAM ANDERSON, M. D., Member of The Indiana County Medical Society, permanent member of Medical Society of the State of Pennsylvania, per- manent member of The American Medical Association, member of the Inter-National Medical Congress, and member of The Inter-Continental Amer- iean Medical Congress. TIMES STEAM PR,NT, Indiana, Pa, PREFACE. At a. meeting of The Indiana County Medical Society in May, 1890, 1 was appointed to prepare and read a brief bio- graphical sketch of the Medical Profession of Indiana County, Pa., at the meeting in September. When the Society heard my sketch a number of the members expressed a desire to have mv paper published, I solicited a short delay for the purpose of cor- recting the original manuscript, and now it is offered to the profession;, aware of many imperfections. It is well known that accurate records are seldom kept in any department of society in the United States. In some parts of the world you will find records of all the transactions of churches, schools and families, but it is not so in this country. The American people as a rule are not recorders, are not historians. This state of society is so well known at the present day that it is not necessary for me to point it out. In 1880 I hastily collected a sketch of the Medical Profession for Captain Amies for his history of Indiana County, and now 1 offer the members of the Medical Profession a more accurate sketch. My present history covers ninty years, and as tar as I know, I am the only person that has been pressed into such an unpleasant task. And now my retrospect is fin- ished, and in closing the work assigned me, I am conscious of the anxiety of many of the younger members of the profession to learn something about the organization of the County Medical Society, and also the publication of some of the papers read at an earlier date than their entrance into the profession. To gratify them I have added a few papers on medical subjects, hoping my associates will contribute similar papers. , W. A, BIOGRAPHICAL SKETCH OF THE MEDICAL PROFESSION OF INDIANA COUNTY WILLIAM ANDERSON, M. D. BY At a meeting of the Indiana County Medical Society I was appointed to prepare a biographical sketch of the Medical Pro- fession of Indiana county. As many of you are aware Indiana county was formed from W estmoreland and Lycoming counties by Act of Assembly, passed March 30, 1803, and the county seat located in 1805, and the first county officers were elected in 1800. I am aware of the many difficulties connected with the work assigned me, when 1 know that for a period of near eighty years, the Medical Profession of Indiana county was without a history ; or any permanent record of their names; and many of them were not permanently settled. Under such circumstances, I am conscious; that with all the care and caution I can take, to do justice to all, I will be severely criticised and censured. In summing up' the history of the Medical Profession of Indiana county, 1 observed that a number of them practiced their pro- fession in different parts of the country. In order to make my sketch more convenient, 1 will give every physician’s history, principally at his first place of settlement in the county, and as I pass on through the towns and villages alphabetically, will only mention date and period of location at that place. Dr. Saw ad To Image was the first physician of whom we have any history, to practice medicine in the territory that now belongs to Indiana county. He was born in Massachusetts and educated there. He had training in a Medical College as he frequently mentioned to his family, that an epidemic of yellow 4 SAMUEL TALMAGE. fever prevailed in a hospital, where he prosecuted his studies, and his experience with that disease. Before 1800 there were only four Medical Colleges in the United States; the University of Pennsylvania, at Philadelphia; Columbia College, New York; Harvard, Mass., and Dartmouth, New Hampshire. There was an epidemic of yellow fever along the Atlantic coast in 1798, and another epidemic of the same disease in 1797 and 1798. We are not able to tell which of these epidemics he referred to when speaking of his experience with yellow fever. He undoubtedly came to Pennsylvania soon after he served in the hospital, for he practiced medicine east of the Allegheny mountains before he came to Newport. Was married to a widow lady whose maiden name was Ann Fry, of Dauphin county, Pa. He moved to Newport, Indiana county, about 1800, (at that time Westmoreland county.) His practice extended over a large field on both sides ot the Conernaugh river. Some- times he visited the scattered families that lived near where the town of Indiana now stands, before the county was organized or the county seat located. When Dr. Talmage settled at Newport, the surrounding country was full of howling wolves, which made night travel dangerous. He made several narrow escapes re- turning from professional calls. About 1810 he moved to the west side of the Conernaugh river opposite the Broad Fording. Here he kept tavern and practiced medicine. Shortly after he located here, he discovered a salt spring in the middle-of the river. When the river was low, cattle and deer would go in and drink, and lick the boulders, where the water oozed up. The doctor sank a vessel, the shape of a barrel and puddled it, to shut off the river water and dipped up the water and ran it out in wooden spouts, and boiled it in large iron kettles, and made the first salt on the Conernaugh river. Salt at that time was selling for five dollars per bushel. Dr. Talmage moved from Broad Fording in 1826 or 1827 to Bogg’s Salt Works, one and one-half miles above Apollo, on the West- moreland side of the Kiskiminetas river. Then moved to Old- town, at the mouth of Pine Run in the same county. Here he ARMAGH. 5 lived and practiced his profession until 1847. Always had an interest in salt works from the time he discovered the salt water in the middle of the river, until he moved from the State, and practiced medicine at the same time. He had gained a good reputation in Obstetrical practice, and was frequently called a considerable distance from home in difficult cases. His wife died in 1844. In 1847 he went to Fishing Creek, Tyler county, West Virginia, and lived with his son-in-law, William Robison, until his death in 1853, aged 88 years. William Johnston sank a well by boring for salt water in 1813. He reached salt water at the depth of 450 feet. This was the first salt well above Saltsburg. Dr. Reed, a Westmoreland county physician, occasionally visited families on the north side of the Conemaugh river before there were permanently settled physicians in the county. His visits were mostly in the neighborhood where Blairsville now stands. Dr. George Hay«, a native of one of the New England States, where lie received his education, literary and medical, located in the county of Indiana, about the time of its organiza- tion. He boarded with Gen. Campbell, near Campbell’s Mills, on Blacklick creek, for a number of years, and with a Mr. Repine of the same neighborhood, and at a latter date with Joseph Turner, one mile east of Jacksonville. His practice extended over a large and sparsely settled territory, from Cambria county on the southeast to Armstrong county on the west. After spend- ing a number of years in Indiana county he moved to the neigh- borhood of Westmoreland county, and practiced his profession there until his death. Armagh is the oldest living town in Indiana county at present. It was laid out in September, 1792, on a road that led from Frankstown, on the Juniata river, to Pittsburgh, Pa. It is 18 miles west ofEbensburg, Pa., and 14 miles east of Blairsville, Pa., we have very little history of the first physicians in Armagh. Dr. John Young was the first. Dr. Vanhorn succeeded Young, ARMAGH. and Dr. Andrew (.Jetty was the next physician. As to their early history or date of location we hn.ve no data. Dr. Robert K. Scott, came from flic eastern part of the State in 1 , M. Winds. Remarks. 1 D ofM, 5 a.m. 12 M. 6 P. M. 9 P. M Winds | Remarks. 1 67° 68° 72° 68° E Thunder shower 1 25° 40° 39° 32° W Cloudy E Clear, pleasant 2 65 83 78 69 S E Thunder shower 2 28 40 49 35 3 4 5 6 67 77 67 53 90 82 80 81 81 75 76 75 72 68 68 66 S E S E S E s w Thunder shower Heavy rain Heavy rain Clear, pleasant 3 4 5 6 27 53 57 39 60 74 72 60 49 65 66 58 52 61 57 42 E Clear, pleasant S Clear, pleasant 8 Clear, pleasant W Clear, pleasant / 60 86 75 68 w Clear, pleasant 7 33 59 59 45 E Claer, pleasant 8 58 83 78 75 S E Clear, pleasant 8 41 60 59 53 E Clear, pleasant 9 62 90 84 78 S E Very warm 9 43 70 , 59 52 S E Clear, pleasant 10 78 93 86 79 E Wry warm 10 50 70 60 53 S Part of the day clear N W Flying clouds 11 69 95 79 73 E Cloudy 11 35 56 46 39 12 67 80 75 70 E Heavy rain 12 35 46 49 52 E Heavy raiu 13 66 80 79 69 E Cloudy and cool 13 36 25 25 81 N W Snow storm 14 62 87 81 78 E Clear and warm 14 18 29 27 21 N Clear, cold 15 63 93 79 69 V’i’le Raiu P. M. 15 36 45 36 33 E Clear, cold 16 63 83 72 68 E Distant thunder 16 39 58 45 44 8 E Clear, pleasant 1 7 61 77 69 62 E Clear 17 39 72 49 50 S E Clear, pleasant 18 52 83 75 62 E W Clear 18 40 70 40 49 E Clear, pleasant .1 9 61 76 69 53 Rain and sunshine 19 44 48 41 39 E Heavy raiu E Clear afternoon 20 52 80 70 60 W Clear, cool 20 34 48 34 29 21 49 80 69 60 E Clear, cool 21 30 40 53 42 N E Heavy rain 22 59 80 75 70 E Clear, cool 22 45 56 78 48 E . i Clear, cool 23 62 80 74 70 E Clear part of day 23 37 48 36 29 E Clear, cool 24 68 83 76 67 E Rain 24 36 48 35 27 E Clear, cool 25 66 79 70 67 S E Flying clouds 25 36 35 35 41 E | Rain 26 62 68 67- 63 E Heavy rain 26 45 54 43 41 E Clear, pleasant 27 62 78 69 63 W Cloudy 27 30 45 35 35 E Clear A. M. 28 55 71 60 53 N W Clear, cool 28 27 50 33 27 E Pleasant 29 39 69 61 55 N W Frost. Clear, cool 29 20 45 37 40 N W Clear 30 43 73 69 60 E Clear, pleasant 30 37 65 73 55 S Clear A. M. 31 55 77 67 60 E Cl’rA.M., cl’dyP.M. Tkermometrical Observations.—Continued. SANITARY REPORT. DECEMBER, * 1859. *Mean temperature 25 °. JANUARY, i860. D.ofM. 0 A, M. 12 M. 6 P. M. 9 P. M. Winds. Remarks. D.ofM. 5 A. M. 12 M. 6 P. M. 9 P. M. Av’ge. Winds. Remarks. 1 60° 69 62 50° s Heavy rain 1 10° 14° —3° —5 8° W Clear 2 51 49 35 22 s Heavy rain 2 —3 11 3 0 4 w Clear in part 3 18 21 19 17 N W Snow and sleet 3 2 21 21 22 16 S E Snowing 4 35 40 37 34 N E Wet and cool 4 21 28 15 9 18 S E Heavy storm 5 34 49 35 36 S E Warm 5 5 28 30 28 15 S E Clear, cool 6 41 45 51 50 S E Rain 6 12 23 42 40 23 S Snow. East rain 7 26 21 23 11 E Snow and cold 7 35 43 38 38 40 E East rain 8 9 16 8 4 E Snow and cold 8 28 42 42 42 36 S E Cloudy 9 7 23 35 23 E Snow and cold 9 35 48 48 51 42 S E Clear, warm 10 23 23 19 14 E Snow and cold 10 50 42 30 29 48 S Cloudy, warm 11 22 34 33 22 W Snow and cold 11 51 34 21 21 36 N E Heavy rain 12 27 33 14 9 N W Cloudy 12 20 32 29 28 23 E Cloudy 13 20 24 20 22 W Cloudy 13 19 34 35 34 27 E Clear 14 26 34 26 21 s w Heavy snow storm 14 31 34 34 34 33 E Cold, rain 35 17 22 17 11 w Clear, cool 15 30 33 37 35 32 E Snow 16 17 43 30 25 N Clear, cool 16 36 36 28 26 36 S Soft, cloudy 17 28 35 34 37 E Heavy sleet storm 17 32 32 28 27 30 S Soft, cloudy 18 32 36 32 32 W Snow 18 36 36 27 25 30 s Rain and snow 19 30 36 31 31 N Snow 19 21 28 45 46 25 E Part of day cloudy 20 36 37 28 24 S E Snow 20 30 47 45 41 42 E Clear, pleasant 21 20 21 15 14 E Cold 21 40 59 34 31 48 E Clear, pleasant 22 10 19 14 14 S E Snow, cold 22 32 43 33 33 35 E Clear, pleasant 23 12 14 9 11 W Cold 23 25 40 56 55 32 W Clear, pleasant 24 9 11 9 8 N W Stinging cold 24 38 60 36 32 52 S E Cloudy 25 7 33 30 40 S Clear, pleasant 25 27 40 36 32 38 W Clear 26 40 42 37 30 s Clear, pleasant 26 24 27 22 22 23 E Heavy snow 27 25 33 27 21 N E Cloudy 27 27 28 20 21 24 E Snow 28 17 21 11 10 E Cloudy 28 20 28 25 24 24 W Snow 29 13 20 12 28 E Snow and sleet 29 10 41 37 41 32 W Clear 30 25 30 23 20 S W Flying clouds 30 43 40 39 36 39 N W i Clear 31 1 8 3 4 W Clear 31 37 30 14 10 22 W Snow storm Thermometrical Observations—Continued. SANITARY REPORT. FKBRUAKV, 1890. 1 MARCH, 18H0. D.ofM. 5 a. m. 12 M. 6 P.M. 9 P, M. Av’ge. Winds. Remarks. D.ofM. 5 A. M. 12 M. 6 P.M . 9 P. M. Ay’ge Winds. Remarks. 1 0° 9° 3° —3° 4° N W Clear 1 53° 50° 49° 43° 48° S E Rain 2 3 19 3 19 11 EtoW Suow 2 37 53 51 46 46 s w Clear 3 2 19 16 15 13 E Clear 3 51 53 51 53 52 S E Rain 4 19 41 20 21 25 E Clear 4 32 48 37 32 37 s w Clear 5 20 25 25 27 24 E Sleet and snow 5 31 65 55 51 50 S E Clear 6 42 45 41 24 40 S E Rain 6 49 67 56 25 56 s Clear 7 30 35 27 22 28 S Suow 7 58 72 60 56 61 s w Showery 8 22 60 32 32 36 3 Clear 8 51 55 48 43 48 N Cloudy 9 30 48 45 28 37 S W Pretty clear 9 30 40 28 23 30 w Snow 10 9 26 15 10 15 w Clear 10 18 24 23 22 21 w Suow 11 13 26 25 17 20 w Clear 11 25 48 37 38 36 N W Smoky 12 14 28 20 24 21 w Rain P M. 12 34 33 24 22 28 N W Clear 13 32 58 44 40 43 w R iiu P M. 13 12 32 25 22 23 W Clear 14 40 39 36 32 36 w Cloudy 14 14 45 30 24 28 S E Clear 15 2" 26 29 32 28 N E Snow 15 25 55 51 42 43 S E Clear 16 20 20 19 9 17 N W Cloudy 16 36 62 53 43 48 S E Clear 17 3 22 15 15 13 E Clear 17 37 71 58 50 54 S E Cloudy 18 20 26 28 19 23 StoSW Snow 18 45 58 58 51 50 S E Rain 19 10 14 11 8 10 E Cloudy 19 45 52 48 48 48 W Snow 20 15 48 34 37 33 E Clear 20 38 40 31 32 35 N W Clear 21 35 59 47 46 47 E Clear 21 31 36 29 28 31 N W Clear 22 39 62 64 61 31 E Rain 22 20 52 37 32 32 N W Cloudy 23 45 55 43 39 45 E Cloudy 23 35 47 40 37 39 N VV Suow 24 27 30 26 25 27 N W Snow 24 32 35 30 28 31 N W Showery 25 19 26 24 24 23 E Snow 25 20 35 24 22 25 W Showery 26 15 47 35 34 32 E Clear 26 21 36 31 29 29 w Clear 27 40 62 55 51 52 S Clear 27 15 43 35 33 31 w Cloudy 28 40 63 55 54 53 S E Clear 28 30 52 32 36 37 w Clear 29 50 66 55 58 57 S E Clear 29 82 57 48 45 45 w Clear 30 41 68 59 55 56 w Clear 1 1 31 52 78 65 60 63 w Clear Themnometrical Observations.—Continued 96 SAMTARY REPORT. A PHIL, I860. D.OfM. •5 A. M. 1 2 M G P. M. 9 P. M. Av’ge. Winds. Remarks. 1 56° 45° 34° 31° 41° N W Rain and snow 2 22 38 32 27 29 N Clear *> 31 58 50 48 46 S E Snow three in. 4 40 60 58 55 53 8 E Rain & thunder 5 40 5B 43 35 43 W Light snow 6 32 49 36 34 37 W Clear 7 30 63 55 53 50 E Pretty clear 8 40 80 70 68 64 E Thunder storm 9 57 72 55 57 60 W Thunder & rain 10 48 60 52 48 54 E Cloudy 11 45 55 40 35 44 N E Rain 12 30 55 50 46 45 S W Thunder & rain 13 38 55 49 47 47 N W Clear 14 45 37 33 25 35 N W Snow 15 18 52 50 43 41 W Freezing 16 40 48 54 53 48 E Cloudy 17 64 73 56 44 59 E Clear & 29 56 52 48 46 W Clear 19 38 G5 52 50 51 E Threatening 20 53 66 68 65 63 E Rain 21 63 66 69 60 63 W Rain 22 50 64 57 52 55 s Rain 23 42 48 43 41 42 S E Clear 24 29 44 34 33 35 E Snow 25 32 38 33 31 33 N Cold 26 28 49 38 35 37 N Mild 27 28 54 47 40 42 N Clear and warm 28 37 60 55 47 49 E Clear 1-9 4(3 65 60 55 56 W Clear 30 42 67 64 58 ' 58 E Clear Thermom-etrical Observations.—Continued SANITARY REPORT. 97 JANUARY, I860. FEBRUARY , I860. MARCH, I860. APRIL, 1H60. D.OfM. j A. M. | M. P. M. M. H. D.OfM.] A.M. M. P. M. M. H. D.OfM.i A.M : M 1 P. M. M. H. D.OfM. A. M. | M. j P. M. M. H. 1 — — — — 1 29 34 29 51 29 50 29 45 1 29 06 29 0629 20 29 11 1 28 76|28 74 28 66128 72 2 29 50 29 50 29 55 29 45 2 29 50 29 50 29 60 29 53 2 29 30 29 30 29 40 >9 33 2 28 77128 82 28 81 28 82 3 29 52 29 50 29 50 29 51 3 29 53 29 45 29 38 29 45 3 29 23 29 19!29 03 29 15 3 28 82'28 83 28 74 28 77 4 29 50 29 45 29 45129 47 4 29 40 29 45 29 44 29 44 4 29 24:29 24:29 24 29 24 4 28 72 28 69 28 55 28 65 5 29 55 29 65129 65 29 62 5 29 4129 47i29 14 29 31 5 29 10 29 00 29 00 29 03 5 28 72128 73 28 70 28 71 6 29 55 29 60 29 50 29 57 6 29 00 29 99129 98 28 99 6 29 00 29 08:29 98 29 02 6 28 92 28 01 28 82 28 98 7 29 30 29 10 29 10!29 17 7 29 03 29 19,29 24 29 15 7 28 85 28 86 29 88 28 86 i 29 02:29 07 29 06 29 05 8 1 29 10 29 10:29 25 29 15 8 29 22 29 18,29 14 29 18 8 29 00 29 98 29 94 28 97 8 29 06 29 04 29 05 29 05 9 29 30129 30 29 30 29 30 9 29 03 29 91 29 93 28 96 9 28 90 28 88:29 90 28 89 9 29 02 29 04 29 03 29 03 10 29 30 29 30 29 36 29 29 10 29 30 29 40 29 40 29 33 10 28 90 28 00 29 10 29 00 10 29 02 29 00 29 04 29 03 11 1 29 14 29 10 29 34 29 21 11 29 13 29 93 29 98 29 O' 11 29 13 29 14 29 00 29 09 11 29 03 29 02129 09 29 04 12 29 25 29 30 29 42'29 34 12 29 32 29 36 29 28 29 32 12 ,28 70 28 88 29 10 28 89 12 29 12 29 IS 29 19 29 16 13 29 40 29 48 29 42 29 45 13 29 25 29 18:29 10 29 18 13 29 22 29 22 29 22 29 22 13 29 18 29 14 29 17 29 18 14 29 23 29 05 29 88; 29 05 14 29 12 29 15 29 15 29 14 14 29 22 29 22 29 24 29 22 14 29 16 29 16 29 16 29 10 15 28 94 5 9 94 29 97 29 95 15 28 97 29 85 29 85 28 89 15 29 28:29 33 29 36 29 32 15 29 24!29 22 29 20 29 22 16 28 97,29 98 29 98!28 98 16 28 91 29 96 29 02 28 96 16 29 36129 36 29 36,29 36 16 29 20 29 25 29 29 29 24 17 28 98'29 98 29 98 28 98 17 29 10 29 10 29 90 29 03 17 29 34 29 38 29 38 29 37 17 29 02 29 09 29 32 29 14 18 28 98 29 99129 97 28 98 18 28 42 29 24 29 49 28 38 18 29 40 29 38:29 35 29 38 18 29 40:29 49 29 45 29 41 19 29 1329 15'29 15 29 15 19 28 90 29 04 29 20 29 05 19 29 20 29 15 29 15 29 17 19 29 43 29 48129 40 29 43 20 29 20 29 22 29 20!29 21 20 29 18 29 18 29 18 29 18 2q 29 00: — — — 20 29 22 29 25*29 19 29 22 21 29 18 29 18129 18129 18 21 29 21 29 26 29 17 29 29 21 29 03 29 03j29 50 29 04 21 29 19129 04 29 04 29 07 22 29 18 29 19 29 22 29 20 22 28 91 29 88 29 80 28 86 22 29 05 29 07j29 00 29 06 22 29 00 29 02 29 01 29 01 23 29 37 29 49:29 49 29 42 23 28 80 29 01 29 83 28 88 23 29 06 29 05129 87 29 99 23 29 00129 03 29 00 29 01 24 29 38 29 36 9 3,0 29 35 i 24 29 02 29 08 29 28 29 04 24 28 88:28 87129 86 29 87 24 25 29 28 29 28129 38 29 31 ! 25 29 12 29 34 29 50 29 23 25 28 86 28 86129 86 29 86 25 , — 26 29 25 29 2f 29 03 29 21 1 26 29 50 29 41 29 44 29 47 26 28 86:28 06j29 13!29 01 26 1 1 — 27 29 19 29 19 29 20 29 19 27 29 41 29 44 29 50 29 43 27 29 1329 1329 13:29 13 27 1 — 28 28 91 29 92,29 30 29 07 28 29 44 29 50 29 38 29 48 28 29 03 29 05 29 06 29 04 28 — i — 29 29 30 29 25 29 10 29 22 29 1,29 40 29 23 29 36 29 33 29 29 00 29 04 29 83 29 95 29 30 29 07 29 09 29 14 29 10 30 29 92 29 83 29 93 29 93 30 31 29 17 29 17 29 22 29 19 1 i 1 j 31 29 92 29 92 29 80j 29 88 : 1 1 Barometrical Table—Highest at Morning, Noon and Evening. Sanitary report. from reporting the mortality of the diseases met with in this county. lam not aware that any mortuary tables have been Mortality.—The absence of a registration law prevents nS kept by any physician in the county. The following will approximate very closely to the mortal- ity of the different diseases:— In Typhoid fever . . . . lin 15 cases. “ Eemittent . . . 1 in 40 “ Smallpox . . . . lin 20 “ Varioloid none. “ Measles . . . . 1 in 50 “ Pneumonia . . . . 1 in 20 “ Pleurisy 1 in 20 forms of disease of organs of nutrition, lin 15; in diseases of In different forms of nervous diseases, lin 50; in different urino-genital organs, 1 in 8. from epidemics and endemics during the past year. Scarlatina, Rubeola and Pertussis were met with in a few localities; but, Prevalent Diseases.—Our county has been remarkably exempt most cases were mild. few cases occur which have been contracted abroad. They gen- Fevers.—Intermittent Fever is rarely met with. Sometimes a erally yield to appropriate treatment. years; it is mostly confined to a few localities. Some cases are severe, and occasionally fatal; but few are troublesome when Remittent Fever has been more prevalent than in former promptly treated. Typhus Fever is not met with. Typhoid Fever is a common disease in this county; it pre- vails, more or less every year, commencing generally in the early part of summer, and continues during the fall, and sometimes into the winter. It is not considered contagions, nor is'it very fatal. I have observed the first cases in the season to com- mence on the east side of streams, and occasionally where there was but a small quantity of pure fresh water, but moisture, more or less, on the wTest side of the residences. In a few local- SANITARY REPORT, 99 ities in the comity, contiguous to mill-dams and other ponds of water, it frequently assumes remissions simulating remittent fever. At Greenville and Dimondsville this form prevailed, and many of the cases were fatal. Dr. W. B. Stewart of Greenville, informs me that during an epidemic in that place, in the best marked cases of typhoid, with all the general and local symp- toms of the disease, a few doses of sulphate of quinine would give it a remittent form. The treatment pursued by most physicians in the county is such as is laid down in the text books. I have administered quin. snip, in small doses (one grain) about every three or four hours, in connection with such reme- dies as are required to control the local and general disturbances with the happiest effects. I frequently commence the quinine at my first visit, and have never seen cause to regret it. I be- lieve quinine lias very much the same specific influence on the peculiar poison in the blood of a typhoid patient, that it has in intermittent and remittent diseases. I think the great error of many is in the administration of large doses;—large doses never succeeded well in my practice. The doses should he small and well-timed, so that it will be taken up in the circulation with- out making a strong impression on the nervous system. Since I adopted this course of treatment, in good constitutions, with- out any complication, I seldom lose a case, or have erysipelas or abscess in the last stage of the disease. In May, 1858, there Avere a feAV cases of typhoid fever on a branch of the Mahoning Creek, that assumed a very malignant form. About a Aveek from the commencement of the attack, on some part of the surface a severe burning sensation Avould be felt, very painful to the touch; in a feAV hours it Avould become red, then purple, and shortly after, black; generally, not more than twelve hours from the time the pain Avas first felt, the part Avould begin to slough, and even the bones Avould exfoliate, most of the cases died. A great many remedies Avere tried; but 100 SANITARY REPORT. the treatment that appeared to mitigate the symptoms most was quinia and spirits turpentine, pushed as far as the patients would bear, with anodynes sufficient to allay pain and procure rest. Some of them lived until portions of the body sloughed and dropped off. It may be proper to remark here that no mercurial was used in any of the cases. Smallpox is not often met with. Sometimes vaccination is neglected for a year or two, and a few cases may be contracted before it can be accomplished for protection. The members of the profession generally concur in attesting the value and , , , 0 power ot vaccination. Measles.—-IThere are generally cases of measles every year; they are but seldom fatal, unless there is some complication. The antiphlogistic treatment is sometimes necessary; but, gen- erally, an expectant one is all that is required. Scarlatina.—Almost every year it is seen, but not generally of a virulent character. It has prevailed epidemically every six or seven years, when it is more malignant, and frequently very fatal. No disease has been treated in a greater variety of forms than this. Some have tried the stimulating plan of treatment, by administering alcoholic preparations throughout the course of the disease; but I believe this mode of treatment has but few advocates in this part of the country at present. Most practi- tioners pursue a cautious antiphlogistic treatment. The verat- rum viride has been extolled by some. Others depend on cold ablutions; while others again prefer to treat with chloride of potassa. Chloride of sodium, in solution with capsicum, is fre- quently used for a gargle. Other Diseases.—Pneumonia occurs in all parts of the coun- ty during the winter and spring; it is generally of a sthenic character. Active antiphlogistic treatment is required in most cases. But one communication has been received on this dis- ease. Dr. Anthony, of Marion, writes: “In November and De- cember I had a number of cases of pneumonia, all of whom re- SANITARY REPORT. 101 covered. The treatment in all the cases was phlebotomy, cup- ping, antimony and morphia, to act as a sedative and expector- ant; and in some, mercurials were pushed till the gums were slightly affected. Also, counter-irritation, with blisters six by eight inches.” Pleurisy is very common in this part of the country. It generally yields to prompt antiphlogistic treatment. Heart Diseases.—During the past year there were more heart affections than has been known before. Many of them proved fatal. Some very suddenly. There was one peculiarity about most of the cases—a large number of them were among those in comfortable circumstances; that lived well, the most indus- trious, and generally of regular and temperate habits. Inflammatory Rheumatism is very common in our county. It appears to be on the increase; it is not generally manageable by the treatment recommended in most of the text books. Many physicians have varied their mode of treatment in this disease very much. I have not been favored with any com- munications on this subject. From what intercourse I have had with other members of the profession, I learn that many depend much on iodide of potassium after the acute inflammatory period is passed. I have used, sometimes with decided benefit, something like the following: “Bichloride of mercury 10 or 12 grains, muriate of ammonia 1 drachm, iodide of potassium II ozs., water 1 pint; dose from 40 to 60 drops three or four times a day.” Within the last few months I treated a few cases with tar- trate of soda and potassa and veratrum viride, Avith anodynes at night sufficient to procure rest and allay pain. lam free to say that I never had rheumatic cases to do as Aveil as those under this mode of treatment. Consumption has been increasing rapidly during the last few years; it forms a very large space in the mortuary list of our county. Most cases are hereditary, a feAAr can be traced to ne- glected colds, &c.; but the gradual increased hereditary ten- 102 SANITARY REPORT. dency is truly alarming to the sanitary observer. It is not nec- essary to speak of the treatment or the result of the treatment, it is here the same as in all other places. Scrofula is frequently met with; a large portion of the cases are hereditary, and generally terminate in phthisis. Miscellaneous.— Veratrum Viride may properly be consid- ered a new remedy amongst our physicians, and has generally been satisfactory; in many cases it is spoken of in the highest terms as to its controlling influences over the heart and arteries. As far as I have tried it I have been pleased with its effects; when used for a length of time, diarrhoea generally sets in. Yellow Jessamime (Gelseminum sempervirens) has been tried in gonorrhoea, without producing any decided change. The Hypophosphates have been tried by a few physicians without giving satisfaction. Surgery.—The surgical cases during the past year have not been numerous, occasionally an amputation; a few cases of the extirpation of the mammary glands, with fractures of the ex- tremities and clavicle are the principal. In fractures of the femur, Dessault’s apparatus is generally used. In fractures of the leg, the fracture box is used by some, others prefer a modification of Dessault’s apparatus. In frac- tures of the clavicle, Fox’s apparatus with a shoulder-brace. May 4th, I was called to see a boy aged 6 years and 1 month; he had received the contents of a double-barrelled shotgun load- ed with buckshot, over the left eye, sweeping away part of the frontal, and a greater part of the temporal bone, with integu- ment and part of the brain, back as far as the ear; some par- ticles of brain were carried through a tin vessel several feet from the boy. He lived 23 hours; he appeared unconscious nearly all the time; never spoke; sometimes moaned like a person in sleep. Obstetrical.—Of 404 births reported, 214 were males, and 190 females; no communications furnished by the members of society, SANITARY REPORT. 103 April 30, 1860, I was called to attend Mrs. 1., set. 36, her fifth pregnancy. She informed me that she had had symptoms of labor for more than two weeks, had been wasting a great deal during that time, and the last ten days compelled to keep her bed all the time on account of the loss of blood, whenever she would move or get up. At this time she was very weak. I made an examination and felt the placenta through the os uteri, which was dilated about an inch in diameter. I administered a large dose and immediately after, carefully intro- duced my hand into the vagina, passing my fingers gradually into the os uteri. About the time I was able to pass my hand into the womb her pains commenced to bear down, I separated the placenta on one side by sweeping the fingers along the inner surface of the organ, passing up the hand as soon as possible, brought down a foot, and with the aid of the bearing down pains she Avas delivered of the child in a short time. I discovered she Avas wasting profusely, the placenta was torn across. I immedi- ately introduced my hand and removed the part that was re- maining in the Avomb; this being done, the womb contracted Avel; she Avas very much prostrated; the pilloAvs Avere removed, the foot of the bed elevated from eight to ten inches, and by the administration of mild restoratives she soon rallied, and moth- er and child are doing Avell. January 30, 1860, Mrs. M., aged 19, felt very unwell Avith pain in her stomach; by advice of a lady friend, took camphor and laudanum for the pain; Avas about eight months advanced in her second pregnancy; she had a miscarriage of four months’ advance, 24th of February, 1859; her husband was absent from home, and no one to stay Avith her but a young girl. She re- tired about her usual time, the girl in another part of the house; next morning Avhen the girl had breakfast ready, she Avent to her room and found her in convulsions. I Avas called in, bled her very largely, applied ice and snoAV to her head, ordered mustard and friction to the loAver extremities, cupped her freely along the spine, applied a blister to the nape of the neck, en- SANITARY REPORT; deavored td get her to swallow, but failed; the convulsions con- tinued every half hour until between 4 and 5 o’clock P. M. About 2 o’clock the os uteri commenced to dilate, and continued dilating slowly, and with the struggling and convulsive efforts the head descended far enough at 4 o’clock in the afternoon to be reached by the forceps, which I applied and delivered her, the placenta soon following; the convulsions now ceased, she swallowed a little wine and water, never spoke, lay in a coma- tose condition till 8 o'clock P. M., when she expired. There were two women delivered in the county, where the placenta was full of chalky concretions; the uterine surface of one of them was very rough. Dr. Anthony reports a case as follows: “I attended a lady at her confinement; the child’s health was good until the third day, when it gave evidence of being unwell; the nurse observed a red spot on the centre of the occipital region about the size of a dime. I was called in that evening. When I reached the place, the inflammation and swelling had extended over all the occipital region, and partly over the top of the head. The red spot which was observed first had become gangrenous, and the following morning sloughed and separated from the adjacent tissues, leaving the cranium exposed about three-fourths of an inch in diameter. The superficial fascia sloughed out about the size of a dollar. The opening in the skin enlarged but little more than the fascia. The discharge from the surface was very offensive. I gave laxatives sufficient to insure an evacuation from the bowels daily, also iodide potassa 1-5 grain four times a day. Applied to the slough a decoction of black oak bark three times a day, and over the inflamed surface unguent, plumb, acetas three times a day, with a poultice of bread and milk coated over with the mucilage of slippery elm over all the affected surface, renewed frequently. The sloughing of the superficial fascia ceased in two or three days, and the child gradually convalesced. SANITARY REPORT. 105 The space left by the slough gradually healed over. The child at present appears healthy.” Tobacco.—Most persons are satisfied that many of the hered- itary diseases are increasing among us, with fearful rapidity. We cannot help pausing at times, and ask ourselves the ques- tion, Why is this so ? What is the cause or causes of this change in the human family ? No one will doubt that there are many causes for it; but, by examining one by one, the supposed or real causes,-carefully and impartially, we must say that the ex- cessive use of tobacco, so common in our country for many years past, is the principal. No article so injurious to the hu- man economy is in so general use—we might say universal use. The habit is so common, that persons not addicted to it might be termed exceptions. Wood & Bache, in the United States Dispensatory, speaking of the effects of tobacco, say, that “To- bacco, when used in excess, enfeebles digestion, produces emaci- ation, and general debility; and lays the foundation of serious nervous disorders—sometimes mental disorder, closely resem- bling delirium tremens.” It is liable to disorder the digestive organs, and produce general debility. Can the blood be in a healthy state during the use of an accumulative toxic principle? I think not. If the blood is not affected, why the emaciation and serious nervous derangement? Is not the blood the source from which the component parts of every tissue derives its ma- terial? The modification of its elements must then modify the secretory—the nutrient, as well as the nervous action. Are not hereditary diseases produced by some primary modification in the constitution or elements of the blood ? It is well known that this agent will affect the system, applied local- ly, taken into the mouth, or inhaled into the lungs. It has proved fatal in many cases, administered in different forms. In all the defects and changes in the blood, each particle must participate, and the solids suffer in proportion to their physio- logical relation; hence the corresponding changes in the secre- tions. 106 SANITARY REPORT. The nervous derangement is another evidence of its de- structive property, as the nervous system is subject to influences through the blood, and is deeply implicated in all the pheno- mena of the living being, in health and disease. I think it will not be disputed that the system of the tobacco chewer and smoker becomes saturated with the substance; for instance, subject one of them to a process, like what thehydropa- thist calls packing, and then examine the linen. I need not offer more. Now, the main question may be put; Can an unhealthy be- ing, diseased, poisoned, and emaciated, beget the reverse? We all know that there are certain tendencies and predispositions; and these are generally inherited. Will not everything that impairs health and depresses the vital organism favor the nat- ural tendency? We have the law that the “parents eat sour grapes, and the children’s teeth are set on edge.” We have no evidence that the persons eating the grapes suffered like the children. We may venture one step farther. Is not this habit the foundation of drunkenness in our land? By an impartial in- vestigation, we not only find disease produced, but morbid appetites. It is not often that we see a person fond of strong drink, that is not a slave to tobacco in some form. In most of our villages and towns, we see boys from seven to ten years of age, chewing and smoking. If we watch their course, the ma- jority of them will be drunkards at twenty-five. Many are of opinion that it is the tasting of intoxicating drinks that makes the drunkard; close investigation will not sustain this opinion. Many years ago these western counties were studded with small distilleries, and the young men that were raised up about them are among the most temperate in their neighborhood; many of them not tasting a drop. Occa- sionally you will meet with one addicted to strong drink; in these instances }rou generally find that they spent much time in idleness, and used tobacco in some form; and had compan- ions with the same habits. REPORT. 107 I have neither time nor ability to do justice to this subject, nor in a report of this kind is it expected; but I wished to notice it merely, that the subject may be taken up by those avlio are able to do justice to one of so much magnitude. It is Avith regret that a report so unsatisfactory is submitted; but, circumstances prevent anything better at this time. It was late in the season when the committee Avas appoint- ed, and unfortunately, I have had no opportunity of meeting the other members of the committee, for the purpose of prepar- ing a report; and received only two communications, one on Pneumonia, and the other on Infantile Erysipelas. The Avork Avas delayed to the latest period, and I have been compelled to report Avhat If am in possession of, aAvare that it presents little worthy of consideration. Respectfully submitted, WM. ANDERSON. REPORT OF THE INDIANA COUNTY MEDICAL SOCIETY. The.locality, hydrography, topography, and geology of our county were given in the report of 1860. Meteorology and Mortality no data—As the county lies be- tween the Appalachian chain of mountains and the Lakes, we are subjected to frequent, sudden, and severe changes of weather. During the winter months, we have seldom a week of settled weather at any one time. Most generally, there occurs a change of the atmosphere every twenty-four hours, during that season. Our people are very subject to severe colds, and most of our pre- valent diseases during the winter have an intlammatory tendency. During the summer of 1863, we had no fall of rain between May and November; there was, in consequence, a great scarcity of Avater during the fall and early part of Avinter. In our towns and villages, the water of many Avells became offensiA’c and un- 108 REPORT. fit for use. In these localities we had a large number of cases of Remittent Fever. Many cases were severe and protracted, the patients generally complained of pain or uneasiness in the stomach, loss of appetite, headache, and general languor for several days before they were compelled to go to bed. These symptoms were followed by chills, alternating with flushes of heat; nausea, frequently vomiting; severe pain in the head; pain in the back and loins; soreness over the entire body, at- tended with muscular weakness. In the larger number of cases, there were two remissions every twenty-four hours, in the fore part of the day, and fore part of the night. The pulse at first was full, but soon became more slow and feeble. The gastric disturbance continued throughout the disease. After the first week,.many of the cases exhibited a typhoid tendency, with pain in the back, more par- ticularly at the cervical and dorsal regions. The duration of the attack was usually from two to four weeks. Treatment—In a few cases venesection was required An emetic of ipecac, gave great relief in most cases. This was fol- lowed by calomel, rhubarb and ginger, sufficient to move the bowels freely; then calomel, opium, and ipecac., in alterative doses, until a slight mercurial impression was produced. After this, small doses of quinise sulphas and chlorate of potassa were found to be valuable remedies. A dose of Dover’s powder was given at night, when the stomach would bear it; in other cases, the sulphate of morphia, opium, or laudanum. Sinapisms were applied along the spine and over the stomach. Cold applica- tions were made to the head, and warm applications to the ex- tremities. Where the pain was constant and severe in the head and back, blisters were invaluable remedies. Abscesses were very common in the last stages of the disease; most generally on the back and about the neck. When the pulse continued frequent, veratrum viride was found to be useful. Most of the cases recovered. Rheumatism has been more frequently met with last year SANITARY REPORT. 109 than formerly; the acute inflammatory form was the most com- mon; all ages were attacked, and almost all the cases ran a pro- tracted course. Treatment.—The iodide of potassium, chlorate of potassa, bicarbonate of soda, citrate of potassa, Rochelle salts, guaiacum and colchicum, have all been tried. The course of treatment found most beneficial in my practice was, evacuating the bowels freely at the commencement of the attack with calomel, podophyllin, and extract colocynth; then the administration of calomel, opium and ipecac., in alterative doses, until a slight mercurial impression was apparent. This was followed by bicarbonate of soda, or Rochelle salt, in full doses, every three or four hours. Dover’s powder, or morphia sulphas, sufficient to allay pain, was given, and the veratrum viride to control the heart’s action. In obstinate cases, the following preparation has had good effect:— Bichloride of mercury, 10 grains, Muriate ol ammonia, 1 drachm, lodide of potassium, 1J oz. To be dissolved in a pint of water. Dose,'-from 30 to 60’ drops 3 times a day, in hop-tea or sweetened water. Cupping the spine was found beneficial in some cases. Bleeding and blistering were not esteemed advisable, unless the disease assumed an irregular form. Pneumonia prevailed more generally last winter than was ever known to be the cascjbefore in our county. All ages were attacked; persons advanced in life were mostly affected with regular pneumonia, and the middle aged and young, with bron- cho and pleuro-pneumonia. At first there were generally chills, a flushed face and headache, with some fever; hurried respira- tion; a feeling of weight or oppression in the chest; constipation; in many of the cases there was very little thirst. The duration of the disease was from eight to twelve days. If the case became protracted, cerebral disturbance would often occur. Treatment.—The majority of our physicians treated_the dis- REPORT. ease by venesection, purgatives, expectorants, cupping and blistering. But more cases have been treated lately without the lancet than formerly; the veratrum viride being chiefly depend- ed on to control the action of the heart. Mercury to affect the system; antimonials and blisters. The course I found most successful in the cases that came under my care was—if my patient was an adult and plethoric— to bleed, then purge, mostly with calomel, followed with black draught. After this I gave alterative doses of calomel, opium, ipecac., and digitalis, three hours till the gums were af- fected; Dover’s powder or morphia at night, to procure rest; blistered freely. If this course did not control the fever, I used veratrum viride to keep the pulse natural. I gave my patients tartar emetic and morphia in solution, for the cough; two parts of the former to one of the latter, regulated according to age and condition, every one, two, or three hours. Venesection in robust, plethoric persons, will cut short the disease several days. Measles.—During the last two years, we have had severe epidemics of this disease; it affected persons of all ages, from infancy to sixty years. The symptoms, at the commencement of the attack, were feeble pulse, difficulty in breathing, oppres- sion at the epigastric region. In some cases there were delirium and other nervous disturbances, with a strong tendency to in- flammation of the lungs, and sometimes of the stomach and the brain; severe pain in the.head and back, with continued vomit- ing, was also observed. In the most severe cases the eruption did not appear until the fifth or sixth day. It was mostly irregular and of a livid hue. Many of the cases proved fatal. Treatment.—The most successful treatment was by calomel, opium, and ipecac., in alterative doses, followed by full doses of chlorate of potassa, with tepid drinks, low diet, laxatives, vera- trum to allay fever; tartrate of antimony and morphia in solu- tion to allay cough and difficulty of breathing; opium and acetate of lead in cases attended with diarrhoea. After the dis- REPORT, 111 appearance of the eruption, if any congestion or inflammation remained, local depletion and blisters, with the cautious use of stimulants and tonics, were necessary. Scarlatina prevailed in many parts of the' eounty last year; most of the cases commenced with sickness of stomach, vomit- ing, sore throat, fever, and quick pulse. The disease was of a favorable type. In some families, during last winter, scarlatina and measles prevailed at the same time, or, as soon as the one had run its course, the other commencing. Treatment.—Laxatives, chlorate of potassa internally; tepid drinks; veratrum to allay fever; cold applications to the head; sinapisms to the spine; opium and acetate of lead to arrest diarrhoea; tartar emetic and morphia in solution to allay bron- chial or pulmonary disturbance. Sponging the surface with tepid water and soap was found to he very soothing to the patient. Diphtheria has prevailed in our county for the last four years, in all localities, town and country, low and elevated, dry and moist, and during both summer and winter. The mortality lias been the same, or nearly so, in every locality. Sometimes the disease would assume a mild form for a few weeks, almost every case terminating favorably, then it would become more fatal. In general, new cases were observed to appear about two days after heavy rains, during the winter season. In cases where there was much swelling of the glands of the neck, with rapid formation of deposit on the tonsils and uvula, the disease was of a grave form; few cases recovered when the deposit extended to the larynx—I believe only two in my practice. In such cases death seemed to be gradually approaching for some thirty-six hours before the deposit became detached and thrown off. I had many cases where the deposit was thrown off, but soon re-formed, and the patients sank. I found that many of the cases in which emetics and purgatives produced little effect, and where there was a refusal to partake of a reasonable amount of nourishment, proved fatal. My opinion is, that diphtheria 112 REPORT:; is a blood disease, non-contagious, and distinct from all others, though, perhaps, closely allied to scarlatina; the sequela? of the two diseases are, however, very different. In diphtheria the tendency is to paralysis; in scarlatina to dropsy and abscess. Scarlatina is seldom met with more than once in the same indi- vidual. In diphtheria, frequently several attacks may occur in the same individual. I have had persons under my care that had had four attacks within twelve months. Occasionally scar- latina and diphtheria prevailed in the same families, when one run its course, the other commencing. Treatment.—It is very seldom that we meet with as much difference of sentiment in respect to treatment as we do in this disease. After many trials the treatment that has been found most successful in our county, as far as I can ascertain, con- sists in the application of soothing remedies to the throat, and the administration internally of such as are adapted to change the condition of tire blood as quickly as possible. Local Treatment.—Warm poultices to the neck, if there is much swelling. A poultice of hops and vinegar, thickened with bran, applied warm and frequently changed, wTas found bene- ficial. The fatty portion of old bacon, sliced thin and applied around the neck, was also esteemed a good application, as was also the camphor liniment. A gargle of vinegar, pepper, and salt, used every hour or two, as strong as the patient can bear it, is one of the best remedies I ever tried. Where there is much tenderness in the throat a strong decoction of the quercus alba will be found useful. In some cases the camphor liniment is soothing to. the tonsils. General Treatment—An active purgative at first, followed by full doses of chlorate of potassa in solution, every three or four hours, throughout the course of the disease, with a moderately good diet, such as the patient can swallow. In cases of great debility, hot toddy or other alcoholic stimulant, to be taken warm and administered liberally. Emetics should always be at hand. Should there be any REPORT. 113 tightness about the throat or chest, an emetic should be ad- ministered immediately. I prefer ipecac., or ipecac, and alum mixed. If fever should be present after an active purgative, veratrum viride should be used to control the morbid action of the heart. Chlorate of potassa given alone has been more beneficial as an internal remedy in this disease than any other I have tried. lodide of potassium has proved beneficial in some cases, but disturbed the stomach in many others, keeping up nausea, with loss of appetite. Muriated tincture of iron had a great reputa- tion at one time—both administered internally and applied to the tonsils. It was very frequently added to a saturated solu- tion of chlorate of potassa; but I have failed to see any decided benefit from it in this disease, though prescribed in over two hundred cases. Quinhe sulphas has been frequently tried; but few cases have been benefited by it. Where it disagreed with the patient, as it did in very many cases, it produced spasmodic disturbance, and in a few cases convulsions. The same effects resulted from Peruvian bark and Fowler’s solution. Veratrum viride is useful in allaying excitement of the arterial system; but I never saw any other good effect from its use in this dis- ease. Mercury has proved useful in a few cases where there was a strong tendency to inflammation, but not in others. Guaiacum and colchicum have little or no influence over the disease. Alum was useful in a few cases where there was pro- fuse hemorrhage from the nose, internally administered. Blis- ters to the neck, or in the vicinity of the neck, are positively injurious. lam free to sa}r that injury was inflicted upon every patient I blistered in diphtheria. It had the effect to increase the extent of the disease in the very part which it is so import- ant to protect. Croton oil and all irritants to the neck proved injurious, just in proportion to their strength. Tincture of iodine has been used by many physicians, applied to the cervical glands and to the tonsils with a brush; but it is now pretty generally abandoned as useless, if not injurious. In the hands 114 hepor'J. of our physicians, hydrochloric acid diluted has been tried, but has failed to give satisfaction. I have given the nitrate of silver frequent and fair trials, both in the form of pencil and in solu- tion, and never saw any benefit from its use; but believe it was injurious in many cases. Swabbing the throat and forcibly detaching the deposit is highly injurious. Everything irritat- ing to the throat should be avoided. Such is my experience in at least six hundred cases. The mortality in my practice was as follows: In* the year 1860, lin 43; 1861, lin 10; 1862, lin 15; 1863, 1 in 20. Cerebro-Spinal Meningitis.—We have had a number of cases of this form of disease within the last eighteen months in our county. It commenced in two forms—in the greater number of cases without any premonitory symptoms. The patient was suddenly attacked with pain in the head and vomiting. Some had a strong desire for food immediatel}1, before vomiting com- menced. There soon folloAved pain in the back, difficulty in breathing, distressed appearance of the countenance, and delir- ium. In the majority of cases the pulse was small and frequent at first; in others it was not much changed. In severe attacks the surface is generally cold at first. Delirium commences early, with agitation of the muscles, fol- lowed by moaning. The eyes are generally affected; sometimes the pupil is contracted; in others dilated. There is often in- flammation of the eyes, with intolerance of light, as well as of sound. In a few cases there is insensibility to light, with deaf- ness. There is great thirst, constipation, and suspension of the secretions generally. Early in the disease the muscles of the neck become contracted, drawing the head mostly backwards; in other cases a little to one side. Occasionally the spinal muscles are rigid, even to the lower extremities. Many attacked in this way die in from twelve to thirty-six hours. In the other form of attack the patient complains for several days of lightness of head, weakness, loss of appetite, general soreness of the body, with occasional sharp pain at some par- REPORT. 115 ticular part. Occasionally symptoms of pneumonia or pleurisy present themselves for a few hoUrs; then there takes place a sudden transition of symptoms to the bowels, peritoneum, kidneys, or brain. The disturbance may continue in this way for several days, often deceiving superficial observers as to the true seat of disease, until the period when relief may be ren- dered has passed. In this form the symptoms are generally periodical. When suffering, the patient has a wild, vacant stare, and answers questions incoherently, most generally saying he is much better, and thinks he will be well soon. Pressure along the spine will lead to tender spots, of which the patient Avas not before con- scious. After a few days of periodical and shifting disturbance the patient presents a distressed and delirious aspect, stupor gradually becoming more and more intense. There is generally moaning, with restlessness. The lightest touch will frequently cause complaint. If this comatose condition lasts long the patient is sure to die. Relapses are generally fatal. All ages are liable to be attacked. I have seen it in persons two years old, and of all ages up to seventy. Both sexes are liable; but the larger num- ber attacked are females, between sixteen and twenty-five years of age, and unmarried. I never saw a married lady suffering from the disease. Abscess is occasionally met with in the ad- vanced stages of the disease; but it is not of frequent occurrence. In some cases petechise and rose-colored spots make their ap- pearance. Recovery is very slow, even when the stomach will bear a good deal of nourishment, and the bowels are at the same time regular. The patient becomes more and more emaciated, until he becomes wasted to the condition of a living skeleton. In these cases the appearance of the face is deceptive. I have seen the face full and the features natural when the patient was on the verge of dissolution. I supposed this disparity between the condition of the features and of the frame to result from the 116 REPORT. seat of the disease, in consequence of which the important line of communication between the brain and the digestive organs is interrupted, the recuperative powers of the system being thereby impaired or destroyed. Treatment.—Few diseases require more active treatment. If the patient is robust, I bleed freely at first. After venesection, if performed early in the attack, the pulse frequently becomes more full. Large doses of calomel, followed by black draught, should then be given until the bowels are freely moved;- then alterative doses of calomel, opium, ipecac, and digitalis, until the gums are affected. The hair should be thinned, and cold applications made to the head, with blisters to the nape of the neck. Sinapisms along the spine, over the stomach, and to the lower extremities. If fever supervenes, veratrum viride will be proper in sufficient doses to keep the pulse regular. After the mercurial has made an impression on the system, iodide of potassium is the best remedy that I have tried. I believe blisters will prove the most useful agent in this disease, if commenced with early and followed up. When I commence to blister in this disease I put the first on the nape of the neck, and as soon as it commences to dry I put another on between the shoulders; when it commences to dry I put an- other again on the nape of the neck, and so change them alter- nately throughout the course of the disease. I have used chlorate of potassa after a mercurial impression is made; but believe it is not of much account in bad cases. Quiniae sulphas I believe is injurious. I have tried it, and have seen other cases where it was used, and it seemed to me to pro- duce disturbance in nearly all the cases in which it was tried. I have used Fowler’s solution, and arsenious acid and iron in the advanced stages of the disease. Neither of these remedies was beneficial; but their effects were most generally injurious. Opiates usually agree well with the patients, and are useful in procuring rest. I have found that those patients did the best who were kept calm by means of opiates. ADDRESS. 117 Attention should be paid to the patient’s skin and secre- tions generally, throughout the whole course of treatment. Some amount of nourishment ought to be insisted upon after three or four days, and if symptoms of debility approach rapid- ly, diffusible stimulants used cautiously will be indispensable. In 1865 Dr. Anderson was elected president of the Medical Society of the State of Pennsylvania, and was conducted to the chair by Drs. King, of Pittsburg, and Zeigler, of Lancaster. On taking chair he made the following remarks: Gentlemen:—l tender you my thanks for the partiality you have shown in selecting me to preside over the deliberations of this Society, among whose members so many are my superiors in medical knowledge as well as in parliamentary experience. I cannot think that this honor is to me alone, but also to the Society I represent. Since I first held a seat in the State Society, I have felt a deep interest in its success, and have endeavored, to the extent of my ability, to promote the great object of its organization. It is true, the profession throughout the State have not respond- ed to the frequent appeals made to them by this Society in the manner that many of us desired. But we should not despair. There is certainly a brighter day approaching. We are firmly of opinion that much of the opposition and influence against us from irregular practitioners and quacks must soon yield. Had it not been for our domestic difficulties during the last four years, I believe much of our desired work would have been done ere this. But view our situation, weigh our surroundings, take into careful consideration the great struggle that has been going on to preserve the life of our nation, and see how it has affected every district, and family, I might say, in our land. The physician, whose mission it is to go about doing good, has performed his full share in the camp, in the field, and at home. These duties resting on him unavoidably, will account for what some might construe as indifference. Our profession, as well as the enlightened portion of every community, have learned by 118 ADDRESS. fearful experience the consequences of tolerating an institution in direct opposition to light and knowledge. We should profit by the fearful lesson we have had, and take advantage of the educated sentiment in the masses of mankind, with renewed assurances that the worthy objects of our noble profession shall not fail. Knowing well that quackery soon begins to reel and stagger in the presence of well-regulated medical organizations, it behooves every member of our State and local societies in the commonwealth to be alive to the work of organization, until our annual meetings will be composed of delegates from every county and city of the glorious old Keystone, making her truly the keystone of medical science as well as she is of our repub- lican institutions. Gentlemen, I again thank you for the honor conferred upon me, and ask your aid and indulgence in the performance of the duties of my official station. ADDRESS OF THE PRESIDENT, WM, ANDERSON, M. D. Gentlemen of the Medical Society of the State of Pennsylvania: In obedience to the Constitution I come before you to fulfil a duty required of the presiding officer, and, in performing the duty assigned me, I am at a loss to find language adequate to express the happiness I feel in renewing with many of you the pleasant associations of former years, and of greeting those who are present for the first time, to promote our honorable interests, and to contribute their well-earned knowledge for the benefit of our profession and the good of mankind. With the return of another (the seventeenth) anniversary of the Medical Society of the State of Pennsylvania, we cannot but experience some feelings of regret that the profession has not been sufficiently awake to the importance of a thorough medical organization throughout our State: especially when we view the delegates in attendance, and find so many counties in ADDRESS. 119 the State are without medical organizations, and consequently without representation. But the consciousness of doing good and of belonging to that brotherhood of science which has achieved so much for humanity, and is destined to achieve still more, and a desire to be co-workers in the great study of nature and man, have brought a goodly number here to-day. These annual meetings may relieve us for a short period from the ac- tive labors of professional life; but they cannot relieve us from the responsibility of our calling, which inspires to higher and nobler thoughts than the outbursts of popular pleasure; and all of us who have the privilege of mutually congratulating each other on this occasion, should determine anew, individual- ly and collectively, to do our duty, so as to make ourselves more useful, to elevate the profession, and advance the science of medicine. Every physician should recollect the obligation he is under to his profession. It is not sufficient that he appro- priates all the wisdom and learning accumulated by medical organization, and disseminated by publication, to himself, but it is his imperative duty to give to others the result of his wis- dom and experience. This mental attrition sharpens the facul- ties, and cultivates a spirit of investigation, which is a feature of medical organization. We should also bear in mind that, within the borders of Pennsylvania, the first regular medical school was established on this continent, and from that day to the present the students of her medical colleges have been re- spectable in numbers, as well as in character; and wherever met are considered worthy members of their honorable and honor- ed class. In consideration that the interests of the profession, the increase of medical science, in this age of discoveries in physi- ology, chemistry, meteria medica, surgery, and the practice of medicine, could be better promoted by well-regulated medical organizations; a respectable number of the profession met, eigh- teen years ago, and formed our present Society, and declared the following basis to be its object. 120 AfffiRESS. “The objects of this Society shall be the advancement of medical knowledge, the elevation of professional character, the protection of the interests of its members, the extension of the bounds of medical science, and the promotion of all measures adapted to the relief of suffering, and to improve the health and protect the lives of the community.” These objects and principles appeal at once to the best in- terests of every regular member of the profession, to promote his education, enhance his professional pride, enlarge good feel- ing with his professional brethren, and give him a proper sense of the duties belonging to the profession and the public. The medical man needs advancement in the general knowledge of the duties, the rights, and the privileges that surround him while occupying so imporant a position. The man of public and pro- fessional pretensions is measured by a rigid and exact rule, and if he fails to give good measure, he stands disgraced and his professional brethren around him. Every member should con- sider that the weight of good character, professional reputation, position, and influence in his profession, is beyond estimation. The whole community looks to medical men for the solu- tion of all dark and difficult problems of a scientific and med- ical nature. These questions are unliminated in their range, taking in the character of diseases and similations, questions of a sexual bearing, the sanitar}r condition of cities and towns, identity, legitimacy, death, real or apparent, homicide; poisons, the various kinds and how used; business transactions, civil and criminal; the highest interests of individuals, families, and society, frequently rest on medical men, not only of property and life, but that which is equally dearer, character and reputa- tion. These things should induce us to search after knowledge and truth all our days, and when found apply it for the good of mankind. “Our work is great, self-sacrificing, and a benevolent one; but it is sublime, even God-like, dealing with disease, pain, life and death.” It is pleasant to know that the members of this Society AfcDftESS, 121 have been ever faithful in their duties; but still, events are before; the interests of humanity are here; the hopes of the profession of our State are in this Society; may we act well our part under such circumstances! We should think of the centuries that have elapsed, since the records began, of the thoughts, the experience, and the re- searches of so many men, as to medicine and their uses, that are preserved for us. By organization wre are encouraged to wrest something daily from science, literature and art to increase our stores of knowledge. Attachment to this course of life will soon determine the question as to our success and our influence in the world for good. Knowledge has no limit, because the Great Author is with- out limit in knowledge and power. During all the past ages of the world, as man progressed, the various arts and sciences with which he was connected, yielded to the same omnipotent influ- ence. In no age of the world’s history have there been present- ed more evidence of the develojjment of this law than at present. Indeed all animate nature, as well as man, the last and greatest of God’s works, obeyed this law with precision and fidelity from age to age. Discoveries already made can in no way lessen the domain of new discoveries, auntil time shall be no longer;” nay, the discovery of new knowledge is a productive parent of new acquisitions; and a new era of science, but the precursor of another, more lofty and beautiful, to be gained step by step. With all our attainments in knowledge, as to forms and substances or material knowledge, there is still much to learn. Physiology has been re-created, and pathology born, again. We may say the same of chemistry, therapeutics, anatomy, obstet- rics, the science and juactice of medicine and surgery. The whole wide circle lies open before us, and the acquisition of all these is important to the physician to enable him to do good to others, and adorn his professional character. This knowledge can only be secured by cumulative labors in the departments of generalization, induction, and experiments. Let us trace the 122 ADDRESS. history of any one department of science, and mark the primary germs of it; we must acknowledge that it is the fruit of a vine- yard cultivated by many laborers; a superstructure of fixed principles of truth, added gradually by different minds. No one with whom we are acquainted could have attained his pres- ent perfection and magnitude by the efforts and labors of a single intelligence; therefore, the more laborers and the more thorough the devotion, the more perfect the knowledge and the more successful the practical application of the principles estab- lished by such means. If we examine carefully the science and the art, the study and practice of medicine, as it is at the present day, we will see the importance of every one who assumes the responsibility of dealing Avith the liAns and the happiness of his fellow-creatures, of seeking that association AAdiere he will receive light to guide him in searching after knowledge and truth. It is with deep regret that Ave see our noble profession suf- fer by the partial and superficial education of many Avho enter the ranks. This can only he avoided by a careful inquiry into the preliminary studies and intellect of the student, by the private preceptors and medical faculties, before admission, as Avell as making the course of study more exact and more thorough. The student should possess transcendent merit, great devotion to study, and love for the profession, Avith pro- found judgment. These are the prerequisites to success, and feAV fail Avho possess these qualifications. This is the only Avay to elevate professional character, and meet the folloAving require- ments of the American Medical Association, that “every individ- ual, on entering the profession, as he becomes thereby entitled to all its privileges and immunities, incurs an obligation to exert his best abilities to maintain its dignity and honor, and to exalt its standing.” Physicians should always feel that their profession requires a high toned, dignified and honorable course of conduct with their professional brethren, Avith their patients and Avith the ADDRESS, 123 world. They should be intelligent and courteous gentlemen, generous and warm-hearted friends, trustworthy and public spirited citizens, kind and accommodating neighbors, whole- souled philanthropists, earnest, sincere and steadfast Christians, ardent lovers of their country, thoroughly devoted to every moral and benevolent movement, always endeavoring to be an ornament in all things amongst the great and good, observing strictly the laws which are instituted for the government of the profession, and follow the golden rule, “Do to others as you would wish they should do to you.” The importance of these high qualifications in the physician will be seen when we inves- tigate his surroundings. “He must necessarily see and hear a great deal that none should ever see or know, save the family where the matter occurs.” He sees much that glitters before the world, become the merest dross in the sick chamber. He sees, too, the gold shining bright in the crucible of affliction. He sees human passion in every form and condition; implacable hatred, and love as strong as death; fallen virtue, and virtue tried and proved; mental and moral strength, and childish im- becility in the once mighty and great; hope beaming bright with heavenly lustre, and ghastly fear, and black despair; unbounded power of endurance, and the broken spirit; with these scenes before him, and conscious of the responsibility and confidence reposed in him, he should maintain the honor of his profession and a dignified course in the community. In endeav- oring to fulfil this duty, he must protect the interests of his med- ical compeers; for a physician, writhing under the pinching pangs of poverty, cannot successfully prosecute scientific or lit- erary investigations; nor can he, with pleasure to himself, nor with success to his patients, prosecute the practice of his profes- sion. Self-preservation is the first and paramount law of nature, and I know of nothing that is more preservative in its character than the means by which our physical wants are to be supplied. To provide for one’s self and his household is a divine law: and he is pronounced worse than an infidel who does not do it. 124 ADDRESS, Our wants and those of our families must, in some degree, be met, before the rugged cliffs of science can be surmounted, or the open fields of literature surveyed. A physician does nothing by proxy, and therefore derives no gains but from his own individual efforts; a faithful attem tion to business is not sufficient alone, but an arrangement should be made for the prompt collection of fees. A man feels some gratitude immediately after he recovers from disease, but he will soon forget the means that were used for his recovery, It is better to have no business than one which does not pay, Again, the expertness and excellence attained by practice and experience, should never be used to the injury of the timid and less experienced in practice or surgery. It is' often difficult to establish professional fame, hut its worth is in proportion to its cost. To elevate an edifice of re- nown requires both time and labor; but in an effort to do it every false means and every course should be avoided which is calculated to detract from the reputation of a brother practi- tioner, and we should observe under all circumstances the most honorable course of medical ethics. This course gives all who are well qualified for their profession, the power to be useful and happy, with habits and manners of gentlemen—earnest in the work of extending the bounds of medical science, picking up the ablest and best material, to advance their own interests, and to know how fearfully and wonderfully man is made, which is the command of religion and of science as A ell as the dictates of reason. The application of the mind with diligence is necessary, not only for acquiring knowledge, but for securing the honors and emoluments which are its rewards. As we cast our eyes back over the important events of the past ages of the world, we see the gradual, but steady, develop- ment of the healing art. The master stream having been formed by the coalescing and union of the best minds in every age, gathering the results of experiments and researches along the ADDRESS. 125 declivities of time down to the present day. But all the discov- eries and improvements of preceding generations have been surpassed by the achievements of the present age. And with all the attainments made in medical knowledge, there is still much to All things earthly have a great influence on man’s physical as well as his intellectual and moral usefulness. We should hasten then to gather into the treasury of our minds every solid ore and every previous gem that will increase our power to do good; this will protect us against idleness, routinism, and self-conceit, and encourage us to know medicine from foundation to coping-stone. Let us look at these consequences of routinism and self-conceit. “The routinist practices without any philosophical principle or foun- dation to guide him, reasoning solely on the perception of his senses; he is aged in his ideas, regardless of the progress of science, and obstinately confines himself within a limited circle of certain actions. All his knowledge and ability consist in lay- ing hold of the first appearance of things, and in prescribing certain formulfe. He also becomes indolent and indisposed to everything that requires labor; his intellect is never applied to reflection, and as to observation and deduction from every-day occurrences in his practice, he is a perfect stranger. He declaims against all investigation and improvement in medical science, and is too stupid and proud to recognize anything valuable in the profession around him. Blind to every principle of pathol- ogy and therapeutics, he approaches the bedside of his patient, with ignorance and death standing by his side whispering, all chance. These physicians pretend to diagnose disease at a single glance; they hasten to the bedside of their patient, and ask a few questions for form’s sake, and make the same prescription perhaps a score of times in a day, no difference what disease they meet with.” Again, we see the self-conceited, equally contemptible and degrading to the profession. He has a blind headstrong confi- dence in his own qualifications; he scoffs at medical associations 126 ADDRESS. of every kind, discards the idea of improvement there. “He is wiser than his teachers,” and every other person he has knowledge of. He pretends to have read everything, has seen everything, is the most scientific and successful practitioner in the land; “The most difficult surgical operations are to him mere pastime;” constantly speaking of himself and his mighty achievements; nothing to him is obscure-—all the secrets of na- ture are to him easily discovered; for no veil hides from his far-seeing eye the mysteries of our organization; new discoveries to him are worthless, for already he knows everything that does or can afflict the human frame. If he is met in consultation, he has impudence enough to disregard the laws of etiquette, pretend to detect at once the most delicate lesions, and vauntingly puff the unequalled pre- scriptions secreted from his own brain. Such is the material that opposes medical organizations. These degrading presump- tions can only he effectively avoided by mutual and daily inter- course and investigation with high-minded and scientific men of our calling; men of transcendant merit, always respecting the laws of the profession. The natural roughness of our nature will be polished by this kind of social intercourse; this, rightly understood and practiced, makes physicians taste the pleasures of their profession truly. See that isolated physician who knows no place but his office, and no companions but his books. He goes into the sick room awkward and ignorant; his demeanor manifests his quali- ties at once; his patients lose confidence in him; he always ap- pears to disadvantage, and is not likely to be a successful prac- titioner. He may have good talents and profound knowledge, but is not likely to occupy a high position in the profession. If he possesses the qualities that make a gentleman, and pursues this course of life, he is sure to become timid and unhappy in the practice of his profession; the most simple cases will alarm him; he will always act in fear, never satisfied with his prescrip- tions, constantly changing them; he will rarely attack disease ADDRESS, 127 at the right time, or with the proper remedies. His timidity causes him to withhold his treatment until the period of recovery is frequently passed. Such men do not kill their patients, but they let them die. If they would join their brethren in medical organization and labor with them diligently in the good work, they would undoubtedly get rid of much of their timidity. This course with attention to the study and practice of their profession would give the communities, where they reside, an opportunity to appreciate their worth. No physician should be content with the general intelligence of the masses, but should endeavor to bring forth additional information regard- ing the laws of hygiene and the curative processes, embracing, within the expansive folds of science, every known thing that is useful; and to establish at every point a fresh, able and de- termined advocate and defender of the noble profession of med- icine—a profession, so often traduced, has done more to render life long and happy than any other. To sustain such a profession in obedience to the great law of progress, and to contribute to its usefulness in the right direc- tion, should be our constant aim and effort. Our science alone discloses the truth of those mysterious processes and forces, as well as the physical and intellectual constitution of man, both as a creature perfect in structure and attributes, and as a moral and physical ruin. Therefore the practical result of our skill is to inform the human family as to the best mode of preserving their health in natural perfection, and giving counsel as to the physical training and education of the youth, according to the necessities of society; controlling disease in all its dangerous forms, that threaten the domestic altar. This is a great estate, the riches grasped out of fleeting centuries, and the most valuable of possessions. With the riches and power of this estate, it gives adminis. trative and executive power over the whole human family; and what gives additional honor to the physician, is, that he is the protector and friend of the poor and the distressed in every rank ; 128 ADDRESS. and by precept and example raising them up to the level of his own excellency, wealth and power which it creates and main- tains. Take from the physician the motive that should actuate his course, a desire to benefit his fellow creatures, and you crumble to atoms the foundation of his profession. It is that elevating principle that induces him to risk his own life, if nec- essary, to save that of his patient. It has been done on the field of battle to save the wounded—it has been done where the most virulent, contagious and malignant diseases were sweeping entire districts—it has been done in the prosecution of the studies essential to the performance of the duties of an enlight- ened physician. Many never think, that in their calling, they exhibit virtues that in other positions would crown them with laurels and draw the admiration of the world. Others, conscious of their good traits, shun admiration, and quietly seek the good of their fellow-beings. The value of the skill and motives of a physician will be more intelligible, when we consider the generally received prin- ciple of law as connected with the liberty and usefulness of the members of every community—“that each person naturally has a legal right to the enjoyment of his life, limbs, property and reputation.” As this right is natural and inherent, it cannot be destroyed or disabled without a manifest breach of civil liberty. For the preservation of these rights, the law requires the thor- ough education of those whose talents and time are to be devoted to this end—securing them a just remuneration in return. If a person professes to possess certain qualifications and expresses a readiness to perform them, he is justly liable to the law if he fails to perform them; and that he shall exhibit continuous study and an accurate knowledge of the improve- ments of the day, with a proper regard for the responsible posi- tion, embracing all that is essential in preserving the health and protecting the lives of the community where he labors. Here we see combined obligations—destroy these, and we would have something like the savage tortures practiced in the dark ages, ADDRESS. 129 rendering the practitioner unfit to associate with refined and polished society. The profession must fully comprehend its duties and responsibilities, and proper and special qualifications for the practice of medicine, before any attempt can succeed to get the public to appreciate what these are, or to acknowledge the impropriety of using secret remedies. If we make no dis- tinction between the regular and irregular practitioner, between the physician and the proprietoi of a nostrum, we are censurable that two such characters are confounded by the community. Until the profession is united, and honestly cultivate a proper spirit in our calling, it is vain to expect a change of public opinion regarding medical science. To prevent disease, and treat those that are diseased, is a benevolent and honorable vocation, and to conceal for selfish purposes a valuable remedy, displays a dishonest principle, void of philanthropy, placing a moneyed valuation upon pain and life. Such an individual may profess what he pleases, but a fact is established, that with him the almighty dollar is above the physical sufferings of his fellow beings; his piety is not divine—for that teaches us to eschew evil, and love our neigh- bor as ourselves. Another cause of the unjust reproach and odium that the ignorant and degraded in almost every commu- nity cast against the medical profession, is from want of interest and zeal in members of medical organizations. Let all who are indifferent, or opposed in any way to the united action of the profession, examine their position, and they will find that they are encouraging quackery of every color. This Society asks nothing but what is strictly just, and what every regular mem- ber owes to it. To stand separate from medical organizations is opposing the better elements of the means that dignify and adorn our calling; it is giving encouragement to quacks and all kinds of quackery; it is standing on the side of ignorance and against improvement, a mere mercenary machine, ready to grovel in the pit of infamy, for selfish purposes. Opposition to this best means of increasing our knowledge and usefulness is on an equality with the so-called D. D.’s, M. D.’s and LL. D.’s, who lend themselves and their influence to promote the sale of various nostrums—attesting falsehoods of the baser sort for the benefit of impostors and humbugs. These, in connection with that portion of the press which has no higher object than filthy lucre, feed tire weak minded with the most miserable trash, in the form of demoralizing books and advertisements in the public journals, appending high-sounding titles and false statements to the articles offered. This infamous practice is carried ty such an extent at the present day, as to poison both mind and con- science, destroying the morality of both sexes of the rising gen- eration. Such persons giving their influence in connection with and through the press, become willing criminals for the sacri- fice of human life. And I may mention one more of like char- acter, and cheerfully would I pass by this disgraceful field and save the feelings of this intelligent audience around me, but the bold and unprincipled efforts to give notoriety to this imposition during the last few years, requires a passing notice. Aft&RBMI. The efforts to impose on our brave and patriotic soldiers with the “like cure like” system is still fresh in our memories. Think of a brave soldier defending the cause of his country, carried off the field of battle wounded with a deadly missile; another is bleeding to death from a severed artery; the “like cure like” surgeon comes along—would he, or dare he apply, or resort to the treatment they proclaim to the world? If he resorts to proper measures under such circumstances, and closes the gaping wound and ligates the wounded artery, he thereby declares to the world that their principles of treatment are false, that the system they represent is the basest humbug the world has ever seen, a disgrace to manhood, repugnant to common sense, opposed to every principle of science, and contrary to all reliable experience in the physical, mental and moral world. It is shocking to the better feelings of our nature, when we hear professors of religion—and doubly so, when we hear teachers in the Christian Church—speak favorably or advocate the “like Aftpftm 131 cure like’* system. This accounts for the want of confidence placed in many divines, because they disgrace their sacred call- ing by neglecting the doctrines of the bible and lend their aid and influence to impostors. When the Physician of souls visit- ed the earth, He treated the body also. We are bound to believe that His whole course of life.was strictly consistent. Who dare say when He met the blasphemer, the Sabbath break- er, the covetous, the drunkard, the extortioner, or any and all the corrupt wretches met with in His journeyings, that he ever gave the least evidence of the “like cure like” system ? To argue such doctrine is in opposition to every principle of truth, light, and knowledge. The pure Homoeopathist may safely stretch himself erect and defy the cold-hearted atheist to go far beyond him in slandering the King of Glory. For the self-same principle must and will come out the same. If the principle is right in regard to the body, it will apply to the immortal part of man. Such doctrine is wanton blasphemy, and cannot be tolerated by persons possessed of common-sense views of things sacred and divine. We still remember the disgrace our nation suffered by the calling of such creatures to see a member of the Cabinet, in the capital of our country. But, by the mysterious workings of Divine Providence, the assassin’s work opened the way to save his life, and save the nation from part of the disgrace. The profession, as we represent it, has lived and flourished from the early ages. Charlatanism and quackery have endeav- ored to destroy true medicine with as much zeal as infidelity labored to destroy Christianity. But these cancroid and cor- roding enemies have been sloughed off in their fetid shape, and true medical science remains unmoved. None but an honest and pure profession could have resisted the impediments that ours has done, and lived. Then may we not be justly proud when we feel that our best efforts arc used to sustain such a profession and contribute to its usefulness? Some may be dis- couraged when they consider the magnitude of the work, and 132 ADDRESS. look at their surroundings. None should despair, for a real love of learning and true ambition to he excellent in the pro- fession will surely succeed. True greatness will always be acknowledged sooner or later. Sometimes it is late, because an opportunity is wanting for its conspicuous development; but during a lifetime that opportunity will occur. To the physician, as to all others, if he is qualified for his duties, truly representing his noble profession—if lie possesses the real element of solid knowledge and worth—there is a time when these qualifications will be proclaimed and acknowledged. Physicians should begin their task understandingiy, with a firm resolve to do their part in relieving the distressed, and maintaining the dignity and usefulness of the profession. Then nothing can hinder them from giving to the possession of learn- ing, the practice of virtue, the attainment of public esteem and confidence. This is a sure foundation for happiness, built on an immovable rock. Without this all their enterprises are vain, and they shall be pointed at as persons of no judgment, no industry, no talents, no use in society, fit only to be cast aside, neglected,, and despised by mankind. It may be truthfully said that a great physician is among the first of great men. Ho makes himself great by the improvements with which he per- fects the healing art, and thus becomes the benefactor of humanity; by the power which he exercises over disease, and by the zeal which lie manifests in his attempts to remove it, Every physician should appreciate these obligations in the practice of his profession. If our calling is full of bitterness, the sweet pleasures of it, and its aims and hopes, banish and transcend the pain. The elevation and union of the profession are the best means of obtaining our desired object, and its growth will be increasing evidence of a check on imposition. Labor unseals the blind natural eye of man, and fills it with the light of knowledge. This, with the indomitable will, the prolonged search, the un- tiring patience, invigorates and strengthens persistency in the Address. cause of knowledge and usefulness. The inattentive man may overlook it, the careless man undervalue it, or the indolent man neglect it. But in our profession the man of ability, prudence, and diligence will surely succeed. Sick people are so desirous of life and health, that the ignorant physician will stand the least chance of being thought of. This important truth should ever be kept in mind, that “merit is sure of its reward in this world.” This should induce “every member of the profession who would defend its claims to honor and usefulness, and win for himself a. distinguished position in its ranks, to assist, by every legitimate means, the organization of our noble profession for- the advancement of medical knowledge,” and assist each other to bear the sacrifice and endure the labor which its successful prosecution demands. This is no trifling work; it is not a short work, nor an easy work. We should make no calculation to reach our aim short of a lifetime spent in earnest, honest, and self-sacrificing work. For the enemies of light and truth are always busy, and will always be busy. They are united, and will be united. The innumerable hosts of pathies and isms are all combined against true medicine and are endeavoring to add to their number, and will add to their number daily, while the practitioner of true medicine looks on with indifference. We may well say to those without organization: Why stand by idle ? There is a day coming when you must give an account of your stewardship, and what did you do with your talents ? Our work is dignified, it is noble, it is honorable. That man must be a fool who refuses to enlist in a cause that benefits the human race, and there is no fool on earth equal to the pro- fessional fool: he dwarfs his manhood and insults common sense. Every physician should consider the good he is capable of doing, by proper application and by continued endeavors to relieve suffering and sorrowing humanity, and bearing an hon- orable part in the constant conflict between truth and error, 134 SCLEROSIS. between right and wrong. What cause is better than an honest desire to restore fallen manhood, alleviate suffering, and correct the evils that distress and destroy the human race? The soul of man is, in this world, like the dove on the wide waters of the flood, without a resting place. There is no point of repose, and the surest way to escape sorrow and trouble is to labor assiduously in the path of knowledge with an earnestness for future good. Man, goverened and influenced by this principle, will surely obey the eternal law, to become dignified, and elevate himself in the scale of creation, physically, mentally and morally, to the end of his days, feeling that when released from the affairs and circumstances of time, he is still destined to a spiritual elevation throughout all eternity. SCLEROSIS OF THE NERVE CENTRES. Sclerosis of the Nerve Centres is a condition of the structure and cause of various forms of diseases that has been taxing the best efforts of the Pathological Anatomist and Physiologist in all parts of the medical world for several years. Although much has been discovered, and many former mysteries connected .with the symptoms and cause of many nervous affections have been accounted for and explained, yet the morbid conditions which relate specially to this subject and positive knowledge of all changes and phenomena brought about by induration of the nerve centres are comparatively incomplete. The term* Sclerosis, in a limited sense meaning hard, and nerve centres, a restricted field, will necessarily bring me within the range of diseases affecting the nervous system connected with the brain and spinal cord. As all the normal phenom- ena of the living organism are known to occur under the in- fluence of the nervous system, and are controlled by it, so it is but reasonable to regard all morbid actions as being more or less ADDRESS* 135 influenced by diseased nervous action. We might here state that the actions of the cerebro-spinal system are subject to cessation and interruption, while those of the ganglionic system are of a continuous and uninterrupted character. Let us look briefly at the two grand divisions of the nervou system; the cerebro-spinal system embracing all the aesthetics, intellectual and senso-motory phenomena, and the ganglionic, governing the circulatory, secretory and nutritive acts in their widest sense; the sensory element of the cerebro-spinal system by an intimate and active reflex relation; under certain influences and circumstances; con- trols the ganglionic even to the complete subversion of its health- ful reign in the animal economy. This nervous system, thus constituted with all its delicate and well appointed arrangements; its inherent powers, and its reflex susceptibilities is subjected constantly to aggressions from the external world; its thermal, luminous, electric hygrometric, and toxic conditions; all more or less coming in relation with it, to depress, or to exalt, to paralyze or disturb both its direct and indirect energies. But beside being subjected to the external world, it is subjected to an internal world, whose in- fluences are equally powerful—that vast and all pervading domain, the blood. Now it is my desire to point out the char- acteristics of the disease under consideration and the peculiar effects on the healthy economy, as far as we find it located in the nerve centres. Sclerosis corresponds to affections in other parts called by different names, but always meaning hard or indurated. It is characterized by the hyperaplasia of the interstitial nerve cement or connective tissue. The increased density of the structure, sometimes the consistence does not exceed concrete albumen, in others the consistence of cheese, and in a few of a cartilaginous character, these forms are generally found in spots. The proximate cause is undoubtably a deposition of lymph into the connecting tissue by which the inter-moleculor intervals are 136 SCLEROSIS. filled up and cemented together, supposed to result from chronic inflammation. When it effects the brain, as a general title it is found in the white or medullary substance of the brain; not often in the cortical substance, with greyish white nodules and a fibrillated appearance showing fragments of new fibres—granular masses -—nucleated cells, such as are seen in atrophied nerve structure- most generally the disease is found in scattered patches through the brain in nodules from the size of a pea to that of an almond. Sometimes sclerosis and softening of the brain are associated together, and patches of grey induration and grey degeneration blended with inflammatory products, as to make the mass like a new growth. Occasionally a case is found where the disease extends over an entire lobe or an entire hemisphere. The dis. ease may be limited to the' brain, but often the brain and spinal cord at the same time. Then there is an occasional [sclerosis of the whole brain as described by Bright in his Medical Report. In a little girl that lay perfectly motionless and senseless for a year before her deatln with her limbs stiffly extended and without the possibility of her making the slightest movement the white substance of the brain was found after death as hard as soft cartilage, so that the grey substance could be peeled off it, leaving the mould of the convolutions in the white substance. A stream of water washed off the grey matter leaving the convolutions below on the hard white substance, giving it the appearance of a wax model of a brain. The ventricles looked'as if they had been modeled in wax. The ivhite passed in streaks into the grey convolutions around. The cord was also hardened. Symptoms ot the brain trouble are generally manifested in the mutual condition; the faculties of the brain arc more or less enfeebled, the memory generally fails, headache, vertigo and melancholy are prominent features, and like other lesions of the substances of the brain, give rise to paralysis. When paralysis takes place from this cause the muscles are effected gradually SCLEROSIS, 137 by the dissemination of the lesion which causes the paralysis, and by the successive occurance of sclerosed nodules. Generally at first the paralysis is confined to certain of the muscles of one of the lower limbs, then certain musics of an upper limb, or of a corresponding muscle of the opposite side. Paralysis may extend to the trunk. Strabismus may occur. The muscles involved in speech, in deglutition and respiration may become implicated. The cutaneous sensibility may be but little affected. Defective vision and deafness are occasional effects. Muscular tremor is a very contstant symptom. It pre- cedes and accompanies paralytic effects. During the progress of the disease, convulsive movements are observed and co-ordi- nating powers frequently become defective. Nutrition of the body may continue and even grow fat. In this connection I will refer to a case reported in the Epileptic Hospital, New York. The patient had been an Epileptic from youth, and for months before his death had a feeling of dizziness in his head. The brain tissue was in a general state of sclerosis; under the mi- croscope the nervous elements appeared deficient, and replaced by connective cells and fibres. More particularly in the med- ulla oblongata. The anterior and lateral columns were partial- ly degenerated. Now we may consider the same kind of lesions taking place within the spinal cord. Corresponding to those we were con- sidering as taking place within the cranium. Sclerosis of the spinal cord is supposed to proceed from chronic inflammation— a specific diathesis or peculiar constitutional defect, and consists in an abnormal production of the connective tissue of the nerve substance involving more or less atrophy and other degenera- tive changes in the nervous structure; these altertaions are of a notable hardness and of a greyish color. The sclerosis may be limited to a single segment of the cord. Existing in isolated patches more or less numerous and deficeincy in size in different cases—distinguished as irregular, diffused or multiple sclerosis. Again we find sclerosis in the anterior portion of the cord, some- 138 SCLEROSIS. times io the lateral portions of the cord, and the sclerosis may be seated exclusively in the posterior columns. Each column affected extending over a greater or less space. When limited in extent, the lumber section is most generally affected. Again the lesion may exist in the anterior and lateral portions at the same time. Although the tendency of sclerosis of the cord is to progress in a given anatomical tract, yet the disease may be of a coarser kind and attack several parts of the cord at the same time; and sclerosis of the spinal cord and brain are not infre- quently associated. Sclerosis of the antero-lateral portions of the cord give rise to general paralysis and paraplegia; these portions contain the fibres which transmit volitions to the muscles of the extremities. It would seem that the disease in this part of the cord interferes with the motor function in such a way that the forces are trans- mitted in an irregular manner to the muscle. This form of dis- ease has long been conformed with paralysis agitans; but is now known to he a distinct affection, both in its pathology and symptoms. It is now believed that paralysis agitans depends on a want of innervation, and sclerosis in a change of tissue with rhythmical movements, and has a more rapid course and ter- minates by spasm and contraction of the limbs. The disease differs from paralysis agitans in being observed most frequently in young people,it commences by feebleness in walking as in some forms of paraplegia, but there is no loss of power over the rectum and bladder; nor is there any loss of sensibility as generally met with in ataxia.- After some months the tottering gait and feebleness increase until the energies of the patient are altogether impaired and the disease is fully developed. When this has oc- cured, we are struck with the remarkable regular or rhythmical movements of the body and limbs. At night jerking and dart- ing pains running up and down the legs; sometimes a feeling of compression about the abdomen as if a cord were drawn around it. This disease in the motor tracts often extends upwards into the cranium and even reaches the brain proper; then the muscles of the face become affected and the ordinary expression is lost. Tins will be readily seen in the action of the arms. If the arm is attempted to be held out, it moves slowly and in an orderly manner, so that if the patient be told for example to put’a'spoon to his mouth, the arm will ascend in regular stages, until the mouth is reached, when if the spoon is put in, it will clatter against the teeth. The movements are best observed during the action of the muscles of speech; the words are brought out one by one, or syllable by syllable as a child learning to read. This interrupted or jerking mode of talking is characteristic of this affection. If the patient lie sitting up, his head also may be seen moving in a regular manner. The eyes are also constantly rolling from side to side. If the head is supported and the body is at rest there is no movement; but in a case of paralysis agitans the movements cease only during sleep. SCLEROSIS. 139 In the sclerosis of which. I am speaking, it is only when the patient rises from bed that his head and shoulders undergo an oscillatory motion. There is a difference in the intellect: In sclerosis it is simply impaired without any of the positive delu- sions which exist in general paralysis; the patient is not always depressed; frequently happy; generally emotional and ready to laugh or cry when spoken to. After the continuance of these symptoms for sometime, the next stage commences, the legs become stiff and the patient is unable to walk; he takes to his bed, the legs are stretched out and absolutely rigid; sometimes the legs are bent up and stiff, but more generally they are stretched out straight; there is no weakness of the bladder or rectum, as in paraplegia, nor do bed sores appear; there is no loss of sensation; this form of the disease generally lasts from two to three years. Dr. S. Weir Mitchell describes anterior or lateral sclerosis as having little or no tremor when at rest; the few vibrations are rapid and short; but are intensified when the patient attempts to carry a cup to the lips in the act of drinking, or any other volitional act. In summing up these symptoms it may be as 140 SCLEROSIS. well to state in this connexion what the scalpel and microscope has revealed after these symptoms were witnessed. There was found after death a chronic myelitis or hyperplasia of the nerve substance—sclerosed masses of connective tissue scattered through the anterior or motor columns of the cord, often reach- ing as high as the corpora striata, -and passing into the brain itself; these were mostly of a pinkish grey color, not well defined from the surrounding tissue, into which they gradually pass. A section of the cord will display these grey patches of various shapes and sizes; and in sections of the cerebral hemis- pheres they become web marked in contrast with the white medullary matters. We may now look at sclerosis of the posterior columns of the cord. According to our present knowledge, the posterior column is intimately related to the cerebellum, and by means of short fibres connect one portion of the grey centres with an- other; it also propagates the influence of that part of the encephalon, which combines with the nerves of volition to regu- late the locomotive powers and serve to harmonize the actions of the several segments of the cord; and as pathological changes correspond very often to distinct anatomical regions, and as these changes are accompanied by special characteristic symp- toms in chronic myelitis, grey degeneration or sclerosis of the posterior columns of the spinal cord, we have a want of co-ordi- nation, and by the loss of this regulating power of the body wTe witness the complaint known as locomotor ataxy. Sir William Gull describes patients laboring with this disease that they could not walk in a straight line; they threw their limbs for- ward and had great difficulty in turning round; there was often a numbness of common sensation, so that the patient could not direct the muscles, and considered it an actual weakness in their contraction. Dr. Chenne designated the disease as a progressive abolition of co-ordination of the movement and integrity of the muscular force. The same facts apply to -the arms; the patient cannot SCLEROSIS. 141 make a straight-forward thrust, for the arms will strike from side to side; they are deep seated aching pains; to use the common expression of patients, they were seated in the bones; sometimes instead of being constant or enduring like those of rheumatism they resemble electric shocks, darting through the limbs or muscles. Charcot considers the degeneration or sclerotic change mostly limited to the outer portions of the posterior columns, avoiding the tracts next to the lateral fissure. In a few cases the posterior roots of the nerves have been found involved in the disease. The membranes, too, may be thickened and adherent. Vulpian speaks of four autopsies. That in all these cases the sensitive nerves were found completely normal, also the posterior roots between the ganglia and point of junction with the anterior; but between the ganglion and the spinal cord, these same roots were atrophied invariably, when the posterior col- umns of the cord were sclerosed. It would seem that the ganglion interposed a barrier to the progress of the disease along the spinal roots. Had the disease affected the anterior roots, destitute of a ganglion we might suppose that it would have extended to the periphery. Now I have described to you the effects of this disease in its pure and simple form. It is not to be understood as designating ataxy to every form of spinal affection, for you may easily suppose that if this disease is due to the changes described, such morbid changes may affect other portions of the cord and produce a complex case; but the most recent investigation in pathological anatomy has shown that a large proportion of the cases of locomotor ataxy results from grey degeneration or sclerosis of the posterion columns of the spinal cord. No doubt many might think these views more positive than our present knowledge of sclerosis will justify, for it has been well established that paralysis, anaesthesia, amaurosis, aphasia, chorea and epilepsy have resulted from hemorrhage by the rupture of arterial branches in the nerve structure by new for- 142 Sclerosis. mations, tumors, malignant and benign; softening of the brain or spinal cord, or both, as well as by sclerosis; but in a large proportion of such cases they are accompanying symptoms and circumstances that will throw light on the cause of change in the nerve centres. And now to consider the indirect effect of this disease viz: The changes that may take place in the organs controlled mostly by the ganglionic system. The ophthalmic ganglion is connected with branches of the third and fifth pairs of nerves; the spheno-palatine ganglion with branches of the fifth and seventh pairs of nerves; the. sub-maxillary ganglion with the fifth and seventh pairs of nerves; the otic ganglion with the fifth and seventh pair; the cervical ganglions with the cervical spinal nerves, and all the ganglia in the chest and abdomen are connected with the cerebro-spinal nerves, and as this great sympathetic system is distributed to organs over which the consciousness and the will have no immediate con- trol. The liver, spleen, kidneys, supra renal, capsules, large and small intestines, obtain their nervous supply mostly from the ganglionic system, but the roots of their sympathetic branches uniting with the cerebro-spinal centres by numerous attach- ments so that mechanical or altered nerve structures in the cerebro-spinal nerve centres, will influence these various organs in the same manner as in local irritation, give rise to altered circulation, nutrition and secretion; to chemical change in the fluids and tissues, and of temperature, and the constitution of the blood. Amongst the most important causes may be consid- ered the partial loss of the vital force and thereby a general impairment of the functions of the different organs. Take, for example, the effects that result from division of the pneumo- gastric nerves; this experiment is invariably followed by a sus- pension of the arterializing process; the same effect has been observed by merely tying these nerves. If you open the carotid artery after ligating the phrenic nerves, the blood that flows has a dark color; take away the nervous influence from the blood 80M5tlCSIS. and it will become darker and darker, until at length the Inngß are rendered utterly incompetent to make any salutary impres- sion upon it. The inflammations and ulcerations in the kid- ney, and the mucous membrane of the bladder after injuries of the medulla spinalis; the extensive abdominal inflammations after sections of the thalamus opticus; peritonitis and nephritis connected with inflammation of the spinal cord; gastro enteritis in inflammation or softening of the brain, and softening of the stomach in meningitis of the base of the brain. These all go to show the intimate, and to a great extent dependent relation the various organs hold to the cerebro-spinal system. And now a few words about this communicating link: Our modern physiologists tell us that the different forms of disturb- ance referred fo are due to irritation, and not cessation in the function of the various parts of the brain; for irritation of parts around the portion impaired or destroyed by disease causes certain sensations, not that the part destroyed causes them, but because an irritation starting from the place around influences cells, some near, some at a considerable distance from the local- ity of the lesion; believing therefore that certain functions of the brain instead of being localized in clusters of cells are on the contrary spread over the greater part, if not the entire brain. This theory explains a very large number of the cases of disease referred to, which would otherwise be very difficult to under- stand. Parts in the brain supposed to be endowed with special functions can be destroyed without any loss of function; so that it follows that any part of the 1 train can produce loss of power and parts supposed to contain special functions can be destroy- ed without loss of power. It makes no difference whatever, whether the distance be small or much greater, as in either ease their communications with each other must take place by nerve fibres, the length of which is unable to interfere with the function. Each half of the brain is a complete brain originally, and possesses an aptitude 144 PYEMIA. to be developed as a centre for the two sides of body in volition- al movements, as well as in all other cerebral functions. Communication between the body and the brain can be more or less fully accomplished by means of a very much small- er number of conductors than are generally supposed. We know that the will gives an order and as we know by clinical facts that any part of the medulla oblongata can be destroyed without paralysis, and that in some cases a very small portion of it has proved sufficient for the persistence of voluntary move- ments; it would seem that the order may be transmitted as well by one fibre as by another, and that it is necessary to recognize the existence of faculties of a much higher order in the nerve cells of the spinal cord, than those that are admitted to exist there. Many facts and similar reasoning tend also to show that the nerve cells of the spinal cord possess as regards sensibility; faculties of a higher order than those which physiologists ad- mitted a few years ago. PYEMIA. Pyemia is generally understood as a mixture of pus in the blood—giving rise to septicemia or blood poison. Pus is the direct cause of the affection we are now considering, and it is altogether proper, that we should examine some of the causes of this product. • It is a well settled belief at the present day that pus is the result of the inflammatory action; either acute or chronic, simple or specifi c. The causes are very numerous and no period of life is exempt from it. The infant at the breast and the advanced in years have suffered with inflammatory disturbance followed by suppuration. Pus is composed of serum fibrin and the globules of the blood changed by inflammation—the fluid part of pus has properties not found in serum. The gastric juice ot PYEMIA. 145 animals will not coagulate pus. Muriate of ammonia will coag- ulate tire fluid part of pus: but not other secretions or natural fluid. There is some" difference'in the products from serous and mucous surfaces, and also from the various morbid condi- tions which surround the tissue. It is also modified by the presence of extraneous substances—grumous blood fibrin, cholestein, or the debris of organs and textures. It is heavier than water;t about as heavy as blood; it is susceptible of ab- sorption, and is frequently removed by the absorbent vessels, supposed to undergo a species of disintegration, and is carried off by the liver, kidneys and other channels. Prior to the for- mation of pus, we have effusion'of serum, effusion of lymhp, adhesion, hardening, with undue heat,‘swelling, pain, perverted secretion and sensibility, and finally suppuration; and these with the constitutional and local causes are further modified by many specific impressions, ?giving rise to the primary inflamma- tion. During these changes, sometimes the parts around be- come organized into a sac, lined by a membrane called pyogenic membrane; this' membrane may secrete more pus, or absorb some ot it. Pus diffused through the natural textures, tends to soften and separate them and break them down. For conven- ience I will divide pus into healthy and unhealthy. Healthy pus contains albumen, extractive matter, fatty matter, salts of lime and soda; the globules are a little larger than the red corpuscles of blood; there are several kinds of unhealthy pus: the ichorous, sanious, curdy, slimy, serous malignant and con- tagious pus. Connected with the diffusion and absorption of some form of unhealthy pus lies the great danger to health and life. When disease attacks either the suppurating surface or the constitution, the character of the pus generally changes, often becoming putrid. Poisonous principles may be incorpor- ated in the pus without detection, for chemistry has failed to detect or show any difference between pus of gonorrhoea, syphilis, malignant pustule, glanders and small pox, and pus from a common abscess. I will not discuss the theories under 146 PYEMIA. investigation at the present day such as bacteria, micrococci, microgerms, the microsporina supposed to produce diphtheria, or the monadina that brings on inflammation, but for conven- ience will consider pyemia connected with the practice of medi- cine, and next in surgery, and lastly in the parturient patients. Pus frequently follows inflammation of the brain and membranes, and clinical experience has shown that abscess of the liver often follows with a large mortality. Pyemia follows many cases of pneumonia, pleurisy, typhoid fever, scarlet fever, dysentery, erysipelas, phlebitis, angriolucitis, small pox and carbuncle. In pneumonia the capillary vessels .in the lungs give way sufficient to take up pus. In pleurisy the serous exu- dation is capable of resorption, but pus is not. In typhoid fever and dysentery the open ulcers in the alimentary canal take up pus rapidly. In erysipelas, phlebitis, angeiolucitis, scarlet fever and small pox the capillary vessels are largely de- stroyed, leaving open mouths for the reception of pus or other putrid substances. When inflammation takes place in the coats of the veins and capillary vessels, a watery, ichorous or sanious fluid mixes with the blood, the lining coat of the vessel is soon poisoned, and purulent collections soon follow and extend to the cellular tissue around, and in this way multiple abscesses form through the system, most common in the in- ternal viscera. Prognosis very unfavorable. Symptoms generally are chills, headache, low fever, fre- quent pulse, languor, thirst, confusion of thought, prostration, swelling of the joints, night sweats, edema of the lower extremi- ties; the chilliness often amounts to shivering; heat in the palms of the hands and soles of the feet; pain in different parts of the body; skin sallow, sometimes jaundiced; indifference; in the advanced stage with cold extremities. A well marked change in the manner and appearance of the patient; the sore- ness often mistaken for rheumatism; if serous structure is affected the pain is generally severe; erysipelatous patches fre- quently appear on the surface. In the advanced stages of the PYEMIA. 147 diseases referred to, if the patient has chills irregularly, followed by profuse sweats, rapid and feeble pulse, low, persistent fever, sallowness of the skin, prostration, shifting pains, swelling of the joints and glands, cold abscessess and suppuration, the practitioner may conclude that pus is forming very rapidly in the deep seated viscera. Treatment.•—Much will depend on the primary cause and the general condition of the patient—but cleanliness, pure air and good nourishment will be proper in all cases. It is important to keep up the vital forces by nutriment and stimu- lants. Beef tea, good fresh milk, sometimes lime-water added, cream, eggs, oysters, wine, or what I consider better, pure rye whiskey, will be required in all bad cases, along with such medicinal agents to meet the condition of each patient accord- ing to the different changes that the patient may undergo. In cases following lyphoid fever, sulphate of quinia and spirits of turpentine will be needed, and perhaps acetate of lead, opium and ipecac, will be necessary to control the complications; sul- phite of soda with quinia will agree in a few cases; muriate and carbonate of ammonia will be useful when general alteratives are required; nitrate of silver introduced by Prof. Mitchell many years ago, and recently revived by Pepper, where ulcers were suspected in the bowels in the latest stages of typhoid fever and dysentery, has not been satisfactory in my hands. The same remedies will be useful in cases following dysen- tery; after erysipelas muriate tincture of iron, chlorate of potash, muriate of ammonia and iodide of potassium arc good remedies. Following scarlet fever, chlorine in some form is necessary; if the case becomes chronic, bichloride of mercury, muriate tinc- ture of iron and Fowler’s solution in combination is a good tonic and alterative compound. The same remedies with blis- ters will effect as much in phlebitis and angeiolucitis as any other course of tieatment. Particular attention should be paid to the liver, kidneys, bowels and skin throughout the entire course of treatment—such remedies should be used as will keep 148 PYEMIA. them as near a healthy condition as possible. As the secretions almost always become vitiated, the food is seldom well digested. Pepsin or lactopeptine should he administered immediately after eating; this is a very important part of tiie treatment and should not be neglected. Surgery.—ln surgical cases we find many of the general symptoms the same—but modified by complications arising from other causes. Pyemia may follow any severe shock, or anything that suddenly depresses the vital powers, profuse hemorrhage, severe injuries of the head, gun-shot wounds, compound-comminuted and impacted fractures, injuries of the Joints, dislocations, trephining, amputations, lithotomy, lithotrity, perineal section, operations for aneurism, hemor- rhoids, extirpation of tumours of every kind, particularly where veins are wounded, and all extensive lacerations and contusions. Prognosis unfavorable. Treatment.—All irritating causes should be removed as far as possible, and the system be well supported with tonics and stimulants. If there is an open-suppurating surface, free drain- age should be established and fomenations applied; if drain- age should fail, the pyogenic membrane should be treated either with a solution of chlorinate of soda, dilute acid nitrate of mer- cury, tincture of iodine, balsam of Peru, or carbolized dressing. In compound fractures and all extensive wounds communicat- ing with bones, balsam of Peru is generally the most satisfac- tory; all abscesses in reach should be opened, and soothing treatment to all inflamed parts not matured. Quinia is of more benefit in cases where septicemia follows a severe shock than in any other form; ammonia, iron, wine, whiskey, milk and animal broths in full quantities; opiates to relieve pain and procure sleep. If nausea is troublesome use ice and aromatic spirits of ammonia. If the stomach rejects opiates, the hypo- dermic use of morphia will be proper, and all the secretions should be cautiously guarded; tendencies to internal organs should be counteracted by dry cupping and counter irritation. PYEMIA. 149 if hemorrhage takes place, ligatures, compression torsion, ferric alum, gallic acid and the astringent preparations of iron should be used to suit each individual case. In all cases where the surgeon is called immediately to see a patient injured by accident, or where capital or severe opera- tions are performed, he his patient much suffering and pain, and the risk of the dangers of septicemia, by the use of small doses of quinia, and alteratives to support the system and to keep the different organs healthy from the first treatment of the case. There is no doubt but much can be done to prevent septicemia by early attention to the symptoms leading to that result. In many cases quinia, opium and good nourishment will protect the patient. When the head is injured there is a strong tendency to disease of the liver; it is important to try and prevent abscess in that organ. Some of our modern sur- geons are in favor of rectal alimentation when the stomach fails to bear food—-it is ivell to try it; but experienced surgeons look upon all cases where the stomach rebels as exceedingly doubt- ful for recovery. As in general practice, lactopeptine should not be forgotten. Parturient patients are different in many, particulars from the cases met with in practice and surgery. The practitioner generally has the advantage of treating his patients before septi- cemia commences, and in a large proportion of his cases the patient had good health prior to the disease that laid the foun- dation for the blood-poison, and the symptoms during the course of the primary trouble, and the effects produced by the remedies administered, will assist in the management of the sequella. The surgeon meets with many patients that were healthy up to the day of the accident or the operation, and by commencing at the beginning of the case to protect his patient against all serioussequences, if not able to succeed successfully, he can certainly do more for his patient than where the system is saturated with pus before the patient is visited. Let us begin with our patient at conception and we find an inflammatory 150 PYEMIA. tendency during the whole period of pregnancy, and during this course, changes take place in the cavity of the abdomen; the blood is changed by the formation of keisteine, the secretion of milk, the. fluid circulating through the foetus, and perhaps some of the excretions of the embryo entering the blood of the mother, produces a tendency in the fluids to become acrid and putrid. Then the mental excitement, exhaustion of the brain or spinal cord, or both at the same time. Pressure on the renal veins and internal iliac causing exosmosis into the cellular tissues of the pelvis; the retention of urea, which a process of ferment produces carbonate of ammonia in the blood. This pressure and disturbance of the pelvic textures certainly inter- feres with the functions of assimilation, secretion and absorp- tion, making a pathological condition in some of the parts; then old lesions only partially restored ready to start up again and increase the trouble and danger, such as cellulitis, granular disease of the mucous membrane, chronic metritis, scurvy, scrofula, tuberculosis; old dispacements such as prolapsis, ■anteversion, retroversion, retroflexion, hypertrophy, neuralgia, rheumatism, induration or ulceration; these conditions assist with atmospheric and toxic influences to lay the foundation for pyemia in parturient patients, either in miscarriage, abortion or labor at full term. When multiple abscesses are formed the contents seldom have pure pus, but the consistence of dirty grey plastic lymph mixed with grumous blood and flakes of fibrin; the parts around engorged with blood and frequently softened, but in some cases, and even fatal cases, the only changes discoverable are in the blood. After delivery at full term, the fatigue of gestation, the efforts of labor, the altered condition of all the structure within the pelvis and abdomen, the womb relieved of its weight and tension, and a large pla- cental surface communicating by many orificies with the uterine sinuses and filled with plugs of coagula, the gravid organ returning to a non-gravid condition, the lining membrane to undergo fatty degeneration, the muscular tissue is to be reduced PYEMIA. 151 to small size, and the surplus fluids which pregnancy called into existence with the vessels and nerves are to be reduced by a process of absorption and exosmose to a normal condition. In some cases we have retained coagula or portions of retained placenta in different stages of decomposition, together with the pressed tissues, contusions, lacerations, ruptures and abraded surfaces; it is not at all strange that very slight morbid influ- ences will lay the foundation for such inflammatory action as will result in blood poison. The whole course of a parturient case is more rapid and deceptive. There is no power left in the system to resist the decomposition and diffusion of the poison- ous principles through every organ in the body, until the vital powers become so low that in a short time the mortal part is changed and wasted away. How deceptive are some of the symptoms: the tongue will some times be clean and moist until near the close; the bowels are generally at first costive till the vital force is low, then a profuse diarrhoea sets in, and is often uncontrollable; respiration rapid and short, pulse frequent and small, chills generally twice a day followed by heat and profuse perspiration; sometimes husky cough, glassy eye, dusky skin, coma, suppressed lochia and milk, urine scanty and often sup- pressed are the most prominent symptoms in this dread disease that prepares the victim for the change so unexpected to them. The experienced practitioner seldom meets with any form of disease where life and death are so strangely blended—where death takes the glow and hue of life—and life the distressed and grissly form of death. Prognosis—unfavorable. Treatment.—Rest* good nursing, eliminatives, tonics, stimu- lants and nourishment covers the course of treatment. A pa- tient saturated with poison and almost always brought low, from slow progressive changes in the system, needs all the rest and all the care possible to protect and preserve the small amount of vitality left—then to get rid of the putrid fluid that has poisoned and threatens to destroy the patient, has been a subject that has worried many practitioners. All will agree 152 PYEMIA. that it is right and proper to make an effort to remove the cause, but the course to pursue is not always clear. Good nursing with knowledge sufficient to administer the remedies prescribed as often as the patient can bear, is of the first importance. There are no class of patients cared for, that need experienced and good nursing more; everything used ought to be administered at the right time and. in the right way—even minutes are important, and neglect for a very short time or imprudence on the part of the nurse may sacrifice a life. The knowledge to administer the remedies —to give stimulants and nourishment in proper quantities is of as much value as the services of the physician. Quinia-sul- phite of soda, chlorate of potash, iodide of potassium, muriate of ammonia, spirits of turpentine, carbolic acid, salicine, salicy- lic acid, salicyllate of soda, sulpho-carbolate of soda and of zinc, have had their advocates. I have no doubt that in the great variety of cases met with, they may be all used to advantage, but when I speak for myself, quinia and chlorate of potash has been more satisfactory in my own experience than the other agents mentioned. I have not used all, nor have I visited pa- tients where all were tried but have had reports from them. Muriate of ammonia is a good remedy, but I think a little slow— too slow I judge in the majority of cases. Spirits of turpentine is useful, and where it agrees with the patient will be of great service. Quinia administered in doses of two or three grains every two or three hours has been more effective and satisfactory in my practice than larger doses. I am of opinion that larger doses produce a kind of rigidity that interferes with the ab- sorption of the agent, and consequently not so beneficial. Chlo- rate of potash in solution largely diluted, given alternately with quinia every one, two or three hours is a valuable agent. From one to two drams should lie given daily—few remedies are better borne, and few restores the healthy hue of the blood as soon. Oxygen in these cases counts all the time; but the patients are almost always better after that. If these agents should disagree I would take the next best, and that would be the PYEMIA. 153 remedy or remedies that would agree best with the patient and accomplish the most for her benefit. If the patient improves and the unfavorble symptoms gradually yield, tonics will be proper. The elixir of calisaya, iron and bismuth is a favorite of mine, and has generally been satisfactory. Muriate tincture of iron, Fowlers solution and bichloride of mercury is another, but generally later in the course of treatment. Emulsion of cod liver oil is good. Cleanliness is important. Vaginal injections of tepid water will be proper, occasionally, but should in no way disturb the patient. Careful sponging the surface with tepid water or spirits and water, and as frequent changes of linen as the patient will bear are useful. The liver, kidneys and bowels need watching during the whole course of treatment, and such agents used as will keep the natural action in the dif- ferent organs as near a healthy condition as possible. The bowels particularly should be regular. Coma is generally re- lieved by purgatives, stimulating applications along the spine and blisters to the nape of the neck. Stimulants are generally required during the whole course of treatment,and should be used at such times and in such quantities as each individual case requires; wine, whiskey and brandy have their advocates. Whiskey I think best diluted with water or given in milk; others like wine or brandy. Which ever agent is used should be regulated to the condition of the patient; some require much more than others; there may be days or parts of days when stimulants will be all you have to depend upon; the amount required will depend on circumstances; from Bto 50 ozs. daily; occasionally one will reject stimulants; gen- erally there is not much hope for those cases; persons accus- tomed to their use in health will require heroic doses, but time and quantity must always be arranged to suit the patient and stage of the disease. Good nourishment well prepared and ad- ministered with prudence sums up the last point in the man- agement of these kind of cases; bread is not always agreeable at first; milk, beef-tea, oysters, chicken broth, soup prepared from 154 NERVOUS DISEASES. wild game if it can be procured, oat meal, farina, corn starch and perhaps eggs, coffee and tea if agreeable. While we are on the subject of nourishment, we should not forget that the digestive powers are defective from vitiated gastric secretion; administering nutriment alone will not build up and nourish a patient without agents to assist digestion; there is no class of patients more in need of pepsin or lactopeptine than the class we are now considering; one of these agents should always be administered after the food; this should never be forgotten. Thomas More Madden, M. D. F. R. C. S. of the National Lying in Hospital, Dublin, Vol. 2, page 395, Ninth Internation- al Medical Congress, speaks of puerperal hygiene as an obvious method of diminishing puerperal septicaemia as follows. “For the prevention of puerperal septicaemia, the preparatory treat- ment of the patient before delivery by suitable nourishment, fresh air and appropriate tonics, is of primary importance. With this latter in view, I generally direct a mixture containing the chlorate of potash, iron and quinine, to betaken during a couple of months of gestation prior to her confinement, and I have never seen puerperal septi ca?mia in a patient who had been thus treated before her confinement,” NERVOUS DISEASES. There is no branch in the whole field of medical science and practice more extensive and complicated than diseases of the nervous system. When we examine the brain and spinal cord, the nervous system of animal life and the ganglionic or sympathetic the system of organic life, we can account for some of the phenomena in nervous affections. There we find the nervous system composed of two different substances, which differ from each other in density, color, in their minute structure and in their chemical composition. They are called the vesicu- lar nervous matter and the fibrous nervous matter. The former NERVOUS DISEASES. 155 is called the gray or eineritious substance, and the latter the white or medullary. The fibrous nervous matter is most ex- tensively diffused throughout the body. It forms a large portion of the nervous centres, either alone or mixed with vesicular matter, and is the principle constituent of the nerves which connect them with the various tissues and organs. The vesicular matter is usually known by its soft consistence and dark reddish gray color; it is generally collected in masses inter- mingled with the fibrous structure in various parts of the brain and spinal cord, and in the several ganglia. The fibrous nerv- ous matter consists of two different kinds of nerve fibres which are distinguished as the tubular fibre and the gelatinous fibre. In most nerves these two kinds 'are intermingled—the tubular fibres being more numerous in the nerves of the cerebro-spinal system; the gelatinous predominating in the nerves of the sym- pathetic system. The vesicular nervous substance is distin- guished b}r its dark reddish gray color and soft consistence; it is found in the brain, spinal cord, and various ganglia inter- mingled with the fibrous nervous substance, but is never found in the nerves. The ganglia may be regarded as separate and independent nervous centres of smaller size and less complex structure than the brain; connected with each other, with the cerebro-spinal axis, and with nerves in various situations. The ganglia consist of the same elements as the other nerve centres: vesicular nervous matter, traversed by tubular and gelatinous nerve fibres. The corticle substance or gray matter is so thor- oughly blended with the white matter, and the white fibres with the gray, that the combined influence of both are complete in all parts of the brain. In addition to the complete arrange- ment of the substance of the brain acting in harmony, we have a spinal cord closely connected with the brain and nervous system, and by these combined influences, through the nerves, will the organs of the body act in harmony. In the gray mat- ter of the cord are cells with long processes; the origin of nerve roots. They are ganglionic in their nature and have the power 156 NERVOtfs DISEASES. of exciting motion and giving nutrition to the muscles. When disease attacks these ganglionic cells, paralysis of the muscles ensues, and wasting of the nerves. Placed laterally to the gray matter are the lateral columns: masses of nerve fibres passing along the cord, constantly receiving accessions from nerve roots, and in the upper part of medulla oblongata becomes the pyramidal tracts crossing over the opposite side and passing through the pons varoli into the peduncle, then upward direct with the cerebral tracts. In the extreme borders of the anterior fissure in the white matter of the cord. They are white nerve fibres passing upward to the brain to conduct impressions from the brain. The differ- ence between these nerve fibres is that the gray masses of nerve fibres cross over to the opposite brain hemisphere, and the white run direct to their own hemisphere. The anterior and posterior nerve roots pass out from the gray matter of the cord. The white matter in the region of the posterior roots is connected with sensation and co-ordination so that disease in this portion of the cord, their functions will be affected. There are nerve fibres passing out from the spinal cord into the sympathetic ganglia. Some of these fibres pass up from the cervical ganglia into the cranial cavity and to the vaso-motor nerves of the brain; others reach the eye and also to the heart and all tin- organs essential to life. The conducting nerve fibres, both in the brain and in the spinal cord, and in the nerves themselves appear to have their nutrition regulated by certain ganglionic cells with which they are connected, so that when isolated from such cells they un- dergo degeneration. All functional acts are accompanied by or dependent upon nutritive changes. It matters not whether the functional act is connected with thought, consciousness or secretion, the generation of nerve force by the ganglionic cell and its transmission by the nerve fibre is accompanied by these nutritive changes in the body. A nutritive act has a tendency to make an impression on NERVOUS DISEASES. 157 nerve tissue, and all nerve tissue is liable to be affected by its own functional actions. This applies equally to normal and to pathological actions; owing to this action, habits may be formed and become permanently impressed on the nervous system. The nutrition of the body depends upon the nutrition of the individual cells of which it is made up. Each cell has the pow- er of appropriating from the blood such substances as will pre- serve its existence; enable it to perform its functions, and pro- duce a successor; the cell is controlled by nerve power—even the nutrition of bone is influenced by the nervous system. When a bone is developing, a lesion of the nerve to it, or of the deeper portion of the spinal cord from which these nerves arise, will modify and partly arrest its growth. Each nerve has a connection with nerve cells from which it arises, and destruc- tion of the cell, or division of its cylinder will produce degener- ation of the nerve, and death of the part. Nerves do not coalesce, but pursue an uninterrupted course from the centre to the periphery; but do not pursue a perfectly insulated course, but occasionally join at a very acute angle with other branches running in the same direction, and from these branches others are given off, and this arrangement may extend for a consider- able distance, and in no instance do they unite; but several branches may come together and form a plexus, and then increase their varied extensions. This arrangement gives the practitioner more trouble to find the true seat of disturbance. A plexus is the communication between two or more nerves in their formation; the nerves may divide and join and subdivide. The branches passing off generally have more ex- tensive connection with the spinal cord. Location of lesions is to be arrived at by a knowledge of anatomy and physiology of the nervous system. In many cases under examination it is necessary for the physician to travel back from the symptoms to the cause of the disease, and study the family history—trace out predispositions, study the various causes of disease that the patient has been exposed to. In NERVOUS DISEASE. many cases the diagnosis may be found in causes outside of the nervous system, such as nodes, cicatrices, hemorrhage, renal disease, increased arterial tension, cerebral tuberculosis, pul- monary lesions, personal habits, over-work, self-abuse, tobacco, alcoholic beverages, injudicious diet, injurious employment, uraemia, anemia, malaria, punctured wounds, neuritis, brights disease, chronic diarrhoea, lithemia, heat; the altered condition of the nerves and organs after severe attacks of malignant fevers .that pervert the functional activity of the nerve centres, and sometimes exist without the presence of any definite disease. Nerve exhaustion frequently takes place from the sedative effects of cold—slow, progressive sedation from cold will inter- fere Avith the reparative poAver of the system, and the cells will break doAvn faster than neAV cells are formed. This condition of the system has confused and Avorried many physicians and families. Many physicians aa-ill imagine and guess at a variety of supposed causes, such as internal abscesses, tumors, brain disease, Avasting of certain nerves, embolism, thrombosis and other conditions, before the true cause is discovered; and even a number of physicians are not Avilling to accept the true condi- tion of the system Avhen pointed out. This condition of the system, if fairly started, almost ahvays ends fatally; the length of time depends largely on the original constitution and age of of the patient. Cold Avill bring on tetanus after Avounds—even slight Avounds that would not be troublesome if the patient Avas protected from the influence of cold. Excessive heat produces serious disturbance by its depressing influence in producing putrefactive changes in the fluids, and arrests respiration by paralyzing the respiratory centres. Dr. John Guituras recently in the navy reports a form of thermic fever in India and sub- tropical America almost identical in symptoms Avith the typhoid fever of the United States. Fever is a disease that effects the Avhole system—it effects the head, trunk and extremities; it effects the circulation, absorption and the nervous system; it effects the skin, fibres, Nervous diseases. 159 muscles and membranes; it effects the body, it effects the mind; it is therfeore a disease of the whole system in the fullest sense of the word. This explains why so many persons are nervous after attacks of fever, as all normal phenomena of the living organism are known to occur under the superintending influ- ence of the nervous system, and are controlled by it; so it is but rational to regard all morbid actions as being more or less under the influence of the nervous system. Congestion is certainly the result of a peculiar disturbance in the nervous action. The nervous system is so delicate in its susceptibilities, and to the influences of the external world such as light, heat, moisture, electrical and toxic conditions, that changes are frequent and sometimes distressing; neither the strongest lenses of the micro- scope, nor the nicest analysis of chemistry have succeeded in discovering the faintest traces of the composition and character of these mysterious and stupendous agencies. We have no power over these agencies, but can try to fortify against their effects. There are reflexes of two kinds—superficial and deep; the first from nervous disturbance, from external irritations; the deep reflexes are from altered nerve structure beyond the surface, such as perforating ulcers, sphacelus, gangrene, even changes in the bones and joints, eye strain, diabetis, uramia, gastric, gouty, or other local troubles. In considering palsies, it will be more satisfactory to divide the different kinds. First, general palsy, in which the whole muscular system is involved. It is of brain origin, and asso- ciated with symptoms of alteration of brain function. The lesion which produces it must affect both hemispheres of the brain; hemorrhage into both sides of the pons varoli will develope general palsy and severe apoplectic symptom. Hemiplegia in which palsy affects”one side of the body or at least the arm and leg of one side; this form of palsy is gen- erally from a local brain lesion; sometimes, however, they may be of spinal origin, due to pressure of a tumor or wound in the upper section of the cord. If the attack comes on sud- 160 NERVOUS DISEASE. denly, it is generally by an embolus or thrombus, an abscess or tumor. If hemiplegia comes on slow, it is the result of an ab- scess localized cerebral softening of focal brain degeneration including tumors. Paraplegia may come on in the course of two or three days, and when not connected with injury is due either to hemorrhage into the cord, or a hemorrhage into the vertebral canal outside of the cord; there are cases where injury is the cause of paraly- sis. In cases of gradual paraplegia with pain, they are disease of the vertebra or a growth usually sarcomatous or cancerous, situated to involve the nerves, or an aneurism pressing on the vertebra and nerves, may cause the trouble. Monoplegia in which one member of the body is effected in the greater part of its muscular structure, and may be due to a lesion of the nerve or of the large multipolar cells in the anterior cornua of the spinal cord or of the brain cortex. In making the diagnosis in any case the general situation of the lesion is first to be determined. Multiple palsies in which two or more disconnected district groups of muscles are paralyzed. The symptoms vary accord- ing to seat and nature of the lesion, and may be cerebral or periphery origin. There is one form of peripheral multiple palsy in which, although the muscle wastes, the reactions of degeneration do not appear. Local palsy in which a single muscle or a single group of muscles tributary to a single nerve is affected, and may be either centric or peripheral. The diag- nosis of the nature of local palsy is to be made the same way of multiple palsies. Then we observe diseases in the brain and spine the very opposite of palsies—convulsions, chorea, spasms and tremors. In the convulsive form, we generally find divi- sions such as epilepsy, hysteria and tetanus. Epilepsy is a disease from organic disease of the brain, and the disease may be from different causes affecting the integrity of the brain and spinal cord; but the disease is more severe when the upper part of the brain is effected. Epilepsy may come on from poisons, NERVOUS DISEASES. 161 toxaemia, uraemia or irritation transmitted to the brain to such a degree as to change the normal action of the organ. The hysteroidal form is not generally so severe as to destroy life or impair the healthy action of the different organs, and in many cases will yield to treatment. Tetanus frequently starts from punctured wounds and peripheral- irritation, and may be classed in the most severe and fatal forms of disease that the practitioner is called to treat. Chorea starts from a diseased condition of the ganglionic structures of the cerebro-spinal axis and may exist without al- teration of structure; sufficient to be~determined by the micro- scope and if it continues long will generally be marked by structural changes; they are generally a lower tone of the ner- vous system than healthy nerve power, seldom met with in persons of robust nerve power. Spasms, the reverse of paralysis, generally start from irri- tative lesions in the muscles and nerves. Tremors are involuntary movements of the muscles and produced by different causes; in some cases they come on after excessive mental or physical work; in others from the excessive use .of tobacco, coffee, tea or strong drink; then others from lead or mercurial poisoning, then the tremors of old age; and from multiple sclerosis of the brain. Tremors from sclerosis are sus- pended during sleep and repose. Charcot says that three- fourths of the cases of cerebro-spinal sclerosis, vertigo is present, and a whirling or revolving sensation is experienced. Severe nerve trouble has occassionally followed blows and falls—the pia mater has been known to suffer after very slight injury and the small vessels in the corticle substance of the brain are frequently changed and in many cases microscopic ex- aminations have revealed morbid changes scattered in different parts of the brain that was not visible to the eye. The gray substance is not fashioned in all parts of the encephalon upon the same model; there is a marked difference in different parts of the brain; and vascular ruptures thrombosis and emboli; NERVOUS DISEASE. find even partial softening are sometimes found when they were not suspected. Prof. Sam’l Jackson was accustomed to say in his lectures at the University of Pennsylvania: “Whenever the ex- penditure of nerve force is greater than the daily income, phy- sical bankruptcy sooner or later results.” It is to he remembered that the nerve capital of persons differs almost as widely as does their moneyed capital. There are numerous families with very little nerve power from birth. Are born with less power of creating nervous energy than is necessary to meet the require- ments of the ordinary duties of life. There is every grade of natural nerve power; many persons are born with very little more nerve power than is necessary for breathing, eating and drinkink; and others have nerve power sufficient to enable them to bear incessant toil. This is frequently observed in the loss of life from very slight causes and indifferent wounds, and others would pass through the most malignant #forms of disease and recover; and in many eases where they were riddled with bullets or terribly lacerated, would partially recover and live several years. In proportion to the supply of good healthy nerve power will the individual be able to perform the ordinary duties of life. Not one organ alone, but every organ of the body needs it, and must have healthy nerve influ- ence or disease will be the result; and this supply must be reg- ular night and day. Among civilized nations a perfectly healthy individual seems to be the exception rather than the rule. It is rare to meet a person at the age of thirty years who will not admit that at various times in their lives they have suffered from derangements of health in some form that the skillful physician can trace to disturbed action of the nervous system. It is not my intention to touch on the special senses such as sight, hearing, smell, taste and touch, or the mental and intellectual faculties generally. That would lead entirely beyond an ordinary paper. Each special sense would require a separate paper, and the same might be said of every organ in the body. I merely wished to examine a few forms of disease, feACTERIA. 163 that the general practitioner meets with in regular practice, associated more or less with the nervous system. We have diseases of every kind and in every climate, many of them peculiar to certain localities and countries. But take the twenty-four hundred diseases mentioned, as found in the world, and a large proportion of them are of a nervous charac- ter; and let any disease exist in the human system long—the nervous system will be affected more or less, and when we take a grand survey of the world and all that effects man physically and mentally, we are ready then to acknowledge that he is fear- fully and wonderfully made. BACTERIA. Bacteriology is occupying the attention of a great many scientific men on both continents, at the present time. Bacteria are defined at present to belong to the lowest organism of the vegetable kingdom, but their persistence and universality raised the question as to their origin and object. Investigation and observation led to the belief that they were capable of spontan- eous generation and of fermentations, and a large number of virulent and contagious affections. The question as to the origin of life has been much disputed. The long ages of the past show the universality of the law of life, that like produces like. The germ theory asserts that no life has been evolved other than from a living parent or a living germ. Then again we find it disputed as whether bacteria ever occur in an animal in a perfectly healthy state. Some bacteria have only power of existence in tissue where vitality has entirely ceased, while others have power of existence in the presence of animal cells. There are now over two hundred varieties known. I will not take the time necessary, at present, to refer to the different kinds mentioned by investigators, for there is a great discrep- ancy in the experiments made in different countries and by 164 BACTERIA. different persons. Many learned men claim that there are a specific bacilla that will always appear in a particular disease, and in no other, and that inoculations with pure cultures will always produce that disease. Others equally well qualified to test the effect of micro organisms on man, claim that the popu- lar fear of bacteria is based on a misapprehension that the great mass of bacteria are innocent little bodies. They are known to exist in every country and climate, and almost every creature with life is loaded more or less with bacteria of some kind, without feeling any inconvenience when they are in a healthy condition. Mequel found that the ordinary atmosphere of a large city contains over 2000 bacteria per cubic yard, and the air of a room of an old house in winter will show 4500 bacteria per cubic yard; the wards of a long used hospital as many as 90,000 germs in the same space; but all these germs must have soil for their de- velopment, and many of them powerless after one attack. When placed in a favorable condition they will double their numbers every hour. One bacterium will fill a half-pint measure in 48 hours, measuring 1-150000 of an inch each. They are found in water—the water may appear clear, yet swarm with bacteria; nor does freezing lessen the danger of water; many bacteria are not affected by freezing. Nor do mineral springs remain free. A number of mineral springs in Europe have been examined and bacteria found in all of them. Dr. Minges of Dubuque, lowa, examined water taken from 19 mineral springs in the United States, and found bacteria more or less in all of them. Nor does elevation save mankind from bacteria. Culture mediums have been used to test locali- ties; sterilized culture tubes have been prepared from blood serum. Agar, agar gelatine, meat infusion, peptone agar, liquid blood serum, veal broth, all sterilized by heat with cotton over the mouths of the tubes, and continued under the high temper- ature until every germ and spore was completely destroyed; then sealed over the cotton and taken carefully, carried to the BACTERIA. Alps, 7000 feet above sea level and opened, and in three days a number of them were swarming with bacteria; and the same tests have been used in our own country; they are found in the water at Fort Lewis in Southwest Colorado, 8000 feet above sea level, and in Montana at different places, ranging from 3,000 to 6,500 feet above sea level. From the time of the first discovery of bacteria by Leewen- hoeck, during his examination of saliva in 1675, bacteriology made no progress until about the middle of the present century, when Ehrenberg described several varieties, and Cohn classified them into bacilla micro cocci and spirilla; and in 1849Pollender described rod like formations; and in 1863 Davainc undertook to prove a connection between bacteria and disease. Pasteur claimed some advances, and then Koch came forward and claimed to prove that wherever there is decomposition, bacteria are found; but in dry gangrene they are not found. Cutter speaks of Koch’s bacilla as known thirty years ago; they were found in lager beer drips and in bread. Green’s Pathology, page 41—“In necrosis, if the limb is much swollen, of a purplish color, and studded with bulla or blood stained fluid, and the part exposed to warm, moist air, septic bacteria will quickly enter through the skin and multiply rapidly.” S. Weir Mitch- ell and Prof. Reichart experimented with rattlesnake poison, and found within an hour or two after an animal was bitten, the poison rots the vessels, and makes the blood fluid; then the system swarms with bacteria, connected with the putrefaction. If the venom is mixed with a strong solution of potassa or soda its power is killed; permanganate of potash is tire best agent. There are certain localities where many of the severe forms of disease are not found although Koch, Tyndell, Atkin and Mequel have proved to the world the existence of microbes in houses, and in the open air. Dengue seldom spreads in locali- ties over 2000 feet above sea level. Savannah, Georgia, with surroundings.similar to other southern cities; the water supply is from surface wells, river water, driven wells and artesian 166 BACTERIA. wells, and hydrophobia, puerperal fever, typhus fever and vesical calculous diseases are unknown. Typhoid fever, cholera and cerebro-spinal meningitis has died out. Erysipelas, sun- stroke, croup and renal calculi are rarely met with; diphtheria and cholera infantum and exanthematus diseases very mild; yellow fever and dengue at long intervals; malarial diseases very much modified. Gastro-intestinal disorders and diseases of the lungs are the common diseases met with, and are very frequent. Surgeon Sternberg, after a stay of six months in Cuba studying the cause of yellow fever, has failed to find a specific microbe described by Dr. Friere of Brazil, or the microbe of Koch in cholera, not even in the cadaver. In the year 1873 cholera, cerebro-spinal meningitis, small pox, yellow fever, bilious fever, congestive fever, dengue, gastric fever, intermittent, malarial, remittent, nervous fever, puerperal fever, scarlet fever, typhoid and typhus fevers all prevailed at the same time in New Orleans. And in 1887 typhoid fever and diphtheria pre- vailed at the same time in the same city. In the cases of diph- theria the bacilla found in the false membranes were not dis- coverable in the lymphatic glands, in the blood or the viscera. The bacilla in many cases produced the disease in guinea pigs and rabbits, but not in rats or mice. In all cases the cultures lost their toxic powers when boiled. Flugge states that his experiments with both the dejections and inoculations Avith pure cultures of the typhoid bacilla was always successful. Vaughan, Eberth, Koch, Gaffky, Frank el, Simonds, Seits and others Avho investigated typhoid fever patients for the typhoid bacilla, failed in many cases. All the experiments made by Murchison, Klein and Bahredt Avith typhoid stools and Avith the blood of typhoid patients by inocu- lation Avere without success. Novy experimented Avith the drinking water of the Iron mountain, Michigan, Avhere there Avas a severe epidemic of typhoid fever with negative results. From all Ave can obtain Ave have good reason for regarding bacteria. 167 typhoid fever as due to mixed infection, as the majority of in- vestigators in search of the typhoid bacilla are compelled to give the so-called germ a secondary role in the greater number of their cases in that disease. Profs. Wood and Flint taught that well-marked cases of typhoid fever rarely exist where malarial fevers prevail. The antagonism between the malarial poison and the cause of typhoid has been observed for many years. Malarial poison rapidly destroyes the colored corpuscles of the blood. This di- rect solution of the problem of the poisonous properties of the stagncnt waters of the swamps, marshes and rice fields intro- duced into the blood of the inhabitants explains the origin of intermittent, remittent, congestive and pernicious fevers, and other forms of malignant diseases. When the water was boiled or distilled for domestic use the malarial diseases diminished. The blood was always diseased first. A number of recent ex- perimenters are of opinion that the bacilla of tuberculosis is of the nature of a fungous, and requires for its growth a soil in which organic decay is taking place in tissue of very low vitality prone to break down. The ptomaines are artificial alkaloids found in decompos- ing animal matter when dead. Leucomaines are artificial alkaloids in living matter; in healthy conditions they do no harm, but in disease they may enter the morbid structure and increase the virulence of the disease in the modified animal tissue in many cases. The best treatment is change of climate, hygiene and good nutrition. Dr. Pepper believes that in all infectious diseases from scarlet fever to tuberculosis it is a ques- tion both of the soil and specific poison; and the symptoms and course of the disease, and not simply the life history of the microbe; but they are the expression of the reaction of the system and of the secondary disturbances of function. Dr. Richardson of London, thinks it a great mistake to assume the infective action of a microbe in consumption. He repeats, con- sumption seems to indicate an hereditary diathesis; an heredi- 168 BACTERIA. tary failure of nutrition, and upon this the bacilla tuoerculosis becomes engrafted. The experiments of Dr. Cutter led him to believe that consumption was brought on from the spores of vinegar yeast in the blood, which by their size and chemical action produced tubercle. He found in tuberculosis the blood was sticky and ropy masses of red corpuscles saturated with spores of vinegar yeast, and also vinegar yeast spores in the serum, and when vinegar yeast was detained in the lungs, tubercle was formed. This yeast comes from the bowels and is produced by the fermentation of starches and sugar; and so long as there are masses of vinegar yeast in the blood the patient is in danger of lung necrosis. When the blood becomes healthy, then nature has a chance to heal the lung. The bacteriologists of the present day are willing to admit that there are only a few specific bacteria that are to be dreaded, and that the human organism is not affected by the larger num- ber of the microbes, for they are satisfied that a large portion of our food is filled with microbes—particularly milk. There have been 18 different varieties of bacilla found in the alimen- tary canal of milk fed infants, without impairing the health, and that the bacilla found in one form of disease destroys the bacilla in other forms of disease; and in many diseases there are no bacilla found. Doctors Hunt of New Jersey, Plater of Canada and Kretch- man of Brooklyn, on the indiscriminate and promiscuous expectoration of ithe victims of consumption on the floor or pavement, that when the expectoration has dried by the atmos- phere, some individuals will present a suitable soil for its devel- opment. They believe the best means of protection against germ diseases is to be found in so maintaining the general con- dition of the body, that it will resist the action of the germs, even should they find access thereto. That where there is a tendency in an individual to pulmonary disease, they should never engage in any indooi*occupation, and should exercise the lungs frequently by deep and prolonged inspirations and expi- rations in the open air. BACTERIA. 169 In all their investigations connected with pulmonary dis- ease, where germs were found, they found a soil congenial for thpir development. They have shown that in many cases of tuberculosis, bacteria disappeared entirely from the lungs; yet the disease progressed and resulted in death. Rossi of Rome, found bacteria in the follicles of the tonsils in healthy men and in the saliva, and caused no harm. Doctors Straus and Murtz experimented with gastric juice on the hacilla of tubercle, charbon, typhoid fever and cholera morbus. The gastric juice of man, of dogs and of sheep were selected for the experiment. They found that for a lew hours digestion at a temperature of 100 degrees destroyed all the germs. The hacilla of anthrax was killed in half an hour; the hacilla of typhoid and cholera in less than three hours; hut the hacilla of tubercle bore digestion for six hours, and in some cases up to 12 hours—over 12 hours digestion destroyed it com- pletely; they believed it was the acid that was the true germi- cide, for they found hydro-chloric acid diluted with water in the same proportion as it is in the gastric juice proved as active a destroyer of the hacilla. Pepsin had no influence on the germs. They are of opinion that the germs taken into the stomach during ordinary nutrition are not exposed to the acid constitu- ents of the gastric juice so direct and prolonged action as in the experiments. Very thorough experiments have been carried on with germides, with a view to ascertaining the smallest quantity of any antiseptic substance which is capable of preventing the development of the hacilla of typhoid fever, cholera and tuber- culosis. The culture of the typhoid hacilla was prevented by one part of corrosive sublimate on 20,000 parts of culture medium; one part of sulphate of quinia on 800 parts of culture medium, and one part of carbolic acid on 200; one part of hydro- chloric acid on 105 parts; and one part of chloride of lime on 100 parts of culture medium. Koch tells us that the cholera hacilla will not develop in an acid medium; one drop of a 1 170 BACTERIA. per cent. solution of hydro-chloric acid prevents it. The cholera bacilla is prevented by one part of corrosive sublimate on 100,000 parts of culture medium; one part of sulphate of quinia on 5000, one part of sulphate of copper on 500 parts, and one part of carbolic acid on 400 parts of culture medium. And silicate of soda, polysulphide of potassium, fluo silicate of iron, salycilic acid and ammonia will sterilize the culture me- diums of tubercular bacilla. A temperature of 132 degrees will destroy the bacilla of anthrax, typhoid fever, glanders, cholera, erysipelas, vaccinia, rinderpest and sheep pox. The cholera germ yellow fever germs, scarlet fever and small pox germs do not form spores. A temperature of 212 degress for one and a half hours will destroy bacteria without spores; a temperature of 284 degrees F. will destroy spores in 3 hours. Dr. A. M. Bell, of New York, has tested steam lie says steam at a temperature of 220° F for ten minutes or 145° for two hours is fatal to all known germs of disease. Mercuric chloride 1 part in 1000 will destroy all spores in a few minutes; it is better than carbolic acid. It is generally agreed that bacteria belongs to the vegetable kingdom, and if these microbes were capable of producing their special form of disease every time we are brought in contact with them there would be no chance for any of us to live. Now we will very briefly show that the opinions of the bacteriologists at the present day will not bear them out, when compared with the wisdom and experience of the best men in the medical profession in all ages and in all countries. Take for example the microbes found in osteo myelitis and inject them into another person- -you will not find the same disease produced. And the same way with endo-carditis. Take a case of small pox, and the individual may he young when the disease was contracted, and after recovery may be surrounded with variola microbes tor three score years and no more disease of that kind. Why is it so? If these bacilla are so dangerous, and there are many instances where persons come in contact BACTERIA. 171 with variola many times during life and never had the disease, there was no soil there for the hacilla. Take yellow fever, and very few have second attacks; and many not at all; there is no diseased tissue there. Take typhoid fever, scarlet fever, cholera and let us go down along the line of tho diseases supposed to be brought about by bacteria, and we find them living and en- joying good health for three score years and ten, surrounded by millions of microbes supposed to be generators of diseases, all the days of their lives. Very frequently persons are taken away with pulmonary consumption without any microbes about the system. The parasitical experience comes from the laboratory, and are very different from the living organism. We are told that bichloride of mercury will kill all forms of parasites. Why not. cure pulmonary consumption and all forms of con- tagious and dangerous diseases with the remedy. How can the bacteriologist assert that there are certain microbes that will kill a human being in a short time, and then acknowledge that there are several kinds in many diseases, and cannot possibly tell which one is really the most dangerous in certain diseases; and where there is a well developed disease in the system, to kill the microbes would kill the patient, and with the next breath acknowledge that we ordinarily take in mil- lions in a few hours in the water we drink, the bread we eat and the air we breathe, and still continue in the best of health? We see from all the progress made in the different experiment- al methods that they are nothing less than hypothesis and systematic tendencies—they are very far from perfection. Many physicians when blinded by a hobby try to find good reasons to console themselves for their non-success. The existence of some of the recent ideas have wrought a condition in their brains as disastrous as the bacilla in the lungs of their patients. Within a few years we had Bergeon’s gas treatment, Pasteurism, then came Brown Seguard’s elixir of life; they have gone the way of all the earth. I hope they are happy. And last but not least, Koch’s lymph. If we look straight forward we can see the hand writing on the wall in different languages, giving all na- tions, kindreds and tongues warning that the same host is hastening back to remove the last great failure from the face of the earth. There is an harmonious agreement between ancient and modern observers that hereditary predispositions exist; and they also agree that good hygienic conditions—pure air, good nourishment and everything that will augment the vitality of the cells and invigorate the whole system—will cripple the tendency to disease, and defy microbes. What we have said concerning hereditary diseases will hold good in many other diseases. If the soil is wanting, the disease will not be modi- fied by microbes. The true physician must drop experimental empiricism and follow the great truths of clinical observations and scientific medicine furnished by the bright lamp of physics, of chemistry, of physiology and of pathological anatomy. TOBACCO. TOBACCO. Tobacco is an annual plant with a large fibrous root, rising from three to six feet high; the lower leaves are often two feet long and six inches broad. The original locality of tobacco is not well settled. The Spaniards found it in tropical America; the Chinese claim that it was cultivated in Asia, before Colum- bus discovered America. In the early writings of Dr. Benja- min Franklin lie refers to Indian traditions, claiming that tobacco was given to the six nations; and central Pennsylvania near the Susquehanna river was the place the first tobacco grew, and that the Spaniards obtained it from the American Indians, and introduced it into their country in 1518. History mentions the introduction of tobacco into France in 1560, into Holland in 1615, into England in 1665, and into China about the same time. After its introduction into Europe there were efforts TOBACCO. 173 made to suppress its use. Physicians declared it hurtful to health, the priests denounced its use as sinful; snuff was pro- hibited in churches; the Sultan of Turkey was in favor of mak- ing the use a capital offense; jn Russia the nose was to he mutilated if used. James lof England declared it loathsome to the eye, hurtful to the nose, hurtful to the brain and danger- ous to the lungs; but still the habit in all its vile forms went on, destroying body and mind. Let us look at the authorities as recorded in the United States Dispensatory and the National Dispensatory, the precipitate of the wisdom of all observers, of all experimenters of all ages, in all countries, giving the properties and the effects of tobacco. These statements are made as follows: “Tobacco is a powerful sedative poison, and locally irritant and hostile to all forms of life. Plants confined in rooms where snuff is manufactured soon lose their foliage; nearly all insects shun tobacco. Tobacco owes its poisonous properties to the presence of a liquid volatile, alkaloid, nicotine or nicotina; this is a deadly poison, and like prussic acid de- stroys life in small doses with great rapidity.'” A child three years of age died from using an old wooden pipe to blow soap bubbles. “There is 4 per cent, of nicotine in tobacco smoke. Nico- tine acts poisonously upon all animals, even on frogs and snakes. The blood of a person during life, if examined when under the full influence of tobacco, presents a striking disintegration of the red corpuscles of the blood, which are less regularly circular than natural. It lessens the natural appetite, and more or less impairs digestion and induces constipation; irritates the mouth and throat, rendering regular congestion, and destroying the purity of tire voice. It induces an habitual sense of uneasiness and nervousness, with epigastric sinking or tension-palpitation and neuralgia. Chewing and snuffing cause gastralgia, and smoking neuralgia of the fifth' pair of nerves. It renders the vision weak and uncertain and sometimes amaurosis; also the hearing suffers with ringing and buzzing in the ears. It im- 174 TOBACCO. pairs muscular power, nutrition and sleep, and also the nerve force. A few may not expeiience the general effects above men- tioned, but the greater number addicted to the habit will ex- perience the injurious effects, and in a certain number of cases it acts in almost all doses as a poison.” Let us look at the testimony we have from facts laid before the International Medical Congress in 1887, Vol. 4, page 101: “Chronic pharyngitis is one of the common results from chew- ing and smoking tobacco, and many , cases of the so-called clergyman’s sore throat is nothing more nor less than a tobacco throat. Smoking tobacco is a great injury to the air passages, producing irritation of the mucous membrane lining tire trachea and larger bronchial tubes, which finally results in chronic in- flammation of the parts irritated. In many cases the nasal mucous membrane, the epiglottis and true vocal cords are kept in a highly congested state. Throats in this condition are always aggravated by exercise and prolonged use of the voice. Persons suffering with the irritation produced by tobacco are always slow in recovering from acute inflammatory diseases of the air passages. The practice called dipping is the very worst form to use tobacco; it is inhaled in a finely comminuted state; where there is a tendency to pulmonary disease, it will hasten a fatal termination, and the eyes are known to be effected by the habit; more particularly amblyopia and diseases of the cheeks.” Let us look into Taylor’s Medical Jurisprudence, page 253. This work is a standard authority on poisons, recognized by our courts and medical profession throughout the United States and England: “The effects of tobacco when taken in large doses either in powder or infusion, are as follows: The symptoms are faint- ness, nausea, vomiting, giddiness, delirium, loss of power in the limbs, general relaxation of the muscular system, trembling, complete prostration of strength, coldness of surface, with cold, clammy perspiration, convulsive movements, paralysis and death.” In some cases, violent pain in the abdomen; in others TOBACCO. ' 175 sinking or depression in the region of the heart. Tobacco operates as a poison when applied externally A woman aged 40. suffering from varicose veins, struck her leg accidently against a sewing machine; severe hemorrhage followed; to stop tins she applied tobacco to the wounds. In g short time there were alarming symptoms; a physician was called in, the tobacco was removed, and stimulants administered, and the woman recovered. When wo study the effects of tobacco and fail to discover any benefit in any part of the world or for any useful purpose whatever, we have the right to ask the question: What is it raised for? The annual production of tobacco in all countries is about 3,000,000 tons. In 1875 there were 559,000 acres planted in the United States, yielding 367,000,000 pounds of tobacco. Only two reasons can be given for this immense pro- duction; the first is the revenue—the internal revenue from the sale of tobacco in every form in the United States, for the }7ear 1890, was $33,958,991; and the other is to dwarf the human family in body, mind and soul—to destroy one-tenth of their •happiness and one-fifth of their lives. Many will tell you “I don’t use much, I can quit it any time,” but the experience of the world proves that the use of narcotics and stimulants con- tinued for a time leads to habit, and when habit is formed it is .seldom, or with great difficulty, overcome. It is not doubted that tobacco contains poisonous princi- ples which possess the power of arresting the oxidation of living tissues, most deleterious to the young, causing in them impair- ment of growth, premature manhood and physical degredation. The cigarette is a small cigar wrapped in paper; the best wrappers are made in Switzerland, from rice straw. Their man- ufacture is nearly new in the United States; the extensive use of the article is recent here. Cigar stumps are frequently used along with leaves to manufacture them. A cigarette is so small that it looks harmless, hut it contains more poison than a cigar; the smoke from the paper wrappings sends more poisonous 176 ' TOBACCO. fumes into the lungs than a pipe or a cigar. An ordinary cigar- ette contains nicotine enough to kill two men if taken pure. There is all the way from three to seven pounds of nicotine in a hundred pounds of tobacco—One drop of nicotine placed on the tongue of a dog will instantly kill the animal. The use ol cigarettes brings on tremor, palpitation, and tendency to paraly- sis and many seriousTorms of disease. Another effect of tobacco in the world is the intemperate use of spiritous, vinous, brewed and malt liquors. It is the forerunner of drunkenness. Let us take the drunkard’s infancy, early life, youth, manhood and old age in all its horrors, with every link and step, and the tobacco evil shows its hideous face all along the line. Take the sons of the chewer and smoker, and you see the effects of indigestion, depressed nerve power, vitiated secretion, insensibility to all the higher and nobler feel- ings of humanity transmitted to their offspring. These unfor- tunates seek something at an early age to gratify and satisfy their tainted organisms. What do they seek? Whiskey, opium, chloral or coca. Many years ago I was requested by an aged gentleman ol more than ordinary qualifications and opportunities to observe and study the families of Indiana county. (Dr. James M. Stewart.) He remarked to me “I have watched the rising gen- eration in our country around us for 40 years, and in almost every case where I saw a boy using tobacco at 10 years of age, I saw a drunkard at 25, and since that time I have observed many so-called temperance men in our county, activfe in tem- perance societies, who would not touch strong drink nor permit it to he kept about their houses, but at the same time were slaves to the tobacco habit; and their children were nearly all fond of strong drink. At an early period in our county there were a great many small distilleries. I can take you to places where 40 different distilleries stood in Indiana county, and very little drunkenness at that period; and what appears remarkable, the boys raised TOBACCO. 177 where whiskey was manufactured, were generally the most temperate men in our county—very few exceptions. At a later date, many years after they left the distilleries and commenced to use tobacco, some of these persons became intemperate. When we are on the subject of intoxicating drinks we may as well give the true cause of so much intemperance, with the hor- rid degradation and all accompanying evils connected with the traffic. First, the hereditary appetite. Second, patent medicines in the form of cordials and soothing syrups poured into child- ren when they are young, and in some cases for many years; and I have several times noticed two or three old pipes started in rooms where there were infants not more than one hour old. After they are smoked, and dosed on patent medicine for a few years, they are ready for something stronger. These patent remedies prepared for children are composed largely of seda- tives and narcotics; then candy and all the truck sold at such places—the morbid taste cultivated by the use of the confection- ery stock, prepares them in a short time for tobacco, then whis- key, then the drunkard preceding the drunkard’s grave, with all its consequences. The whiskey vender does not make the drunkard. He sells to the drunkard after he is a drunkard. The tobacconist and whiskey vender will look at you with a saintly countenance and say: “I ask no one to buy.” But there are purchasers all the same when the articles are before the public, and advertised for sale. If the young were protected and properly trained and all the old sinners were led into a decent form of living, and treated tobacco as the greatest curse visible on the face of the earth, then the fearful consequences would he avoided. Go back and read its properties and effects as I have shown you from the highest authorities, and you will see that it curses everything it touches. Take the animal that walks on all four—even the swine that the evil spirits chose to ride into the sea, will not degrade 178 HYGIENE. themselves with the weed; and the serpents, the copperhead and rattlesnake, will not chew nor suck the weed. Now I will refer very briefly to two important duties de- volving on every human being. After God had made all other creatures he said let us make man in our image, after our like- ness; and requires all lawful endeavors to preserve our own lives and the lives of others, and forbiddeth the taking away of our own lives or the life of our neighbor, or whatsoever tendeth thereunto. The first duty may be considered under the head of hygiene. Hygiene is the art of preserving health; that is, of obtain- ing the most action of body and mind during as long a period as is consistent with the laws of life. In other words, it aims at rendering growth more perfect, decay less rapid, life more vigorous and death more remote. The use of tobacco is posi- tively in opposition to hygiene. If no one would touch tobacco how long would it be raised and offered for sale? If no one would use intoxicating drinks as a beverage, how many saloons and licensed bars would be in the land. In the second duty we are bound to the following applica- tions: We are commanded to “be pure in body and mind,” and as we have opportunity we ought to “do good to all men,” and “train up children in the way they should go, and when they are old they will not depart from it;” and to “love thy neigh- bor as thyself,” for “what a man soweth, that shall he also reap;” “he that is filthy shall be filthy still.” And when the second division of the great and innumerable host appears at the resur- rection, it will be found that tobacco and patent medicines are not the least offenses charged against their friends in this life. HYGIENE. [Thesis submitted to the faculty of the Jefferson Medical College, Philadelphia, Pa., December, 1851:] For the support and nourishment of the system of man, it HYGIENE. 179 is necessary for the different organs to be in a healthy condi- tion; without this, no one can enjoy the rich blessings of health for a great length of time. When disease attacks the different organs of the body, though small at the commencement, it will eventually break in on the various connections in the human system, still opening a wider road for the ravages of the morbid condition, until at last it deranges that beautiful structure in its wondrous forms. For the proper performance of Hygiene, many points pre- sent themselves for consideration. We have nothings of more importance in the protection of health, than the inhalation of pure air into the lungs. A well ventilated apartment is a useful adjuvant to the remedies we apply in the treatment of disease. As soon as the infant enters the world, the air rushes into its lungs, the circulation of the blood through that organ commences, and from that moment life depends very much on the air that is inhaled into the nostrils, which is incessantly taken in and thrown out of the lungs, hence the necessity of having constant- ly a renewed supply of pure atmosphere. As a portion of the atmospheric air is frequently corrupted by the respiration of men and animals, by the burning of so many natural and arti- ficial fires, by the dissolution and putrefaction of innumerable substances, which if inhaled for a length of time, renders the system unfit for its many duties. This property so important to life, is much improved by light and heat from the sun, which has a very efficacious ten- dency in counteracting the baneful effects of corruption and putrefaction. This we believe to be the cause of many of the diseases existing throughout the land, appearing in various forms in different localities, commencing in the most fertile plains, finding its way over mountains and through valleys, carrying with it the features of a malarious disease in one place, in another appearing in a modified form; but still growing suffi- ciently to convince us of its nature; and we are unable to form a correct knowledge of the manner in which it attacks the sys- 180 HYGIENE. tem of many. Nothing has been discovered to satisfy as to its peculiar nature—creeping in as it were by magic, until it pros- trates the whole structure; sometimes the seeds lying dormant in the system for weeks or months, until they are roused by some indisposition, when they spring forth with as much force as if sown recently. No doubt the surface is often affected by miasmatic influ- ences, especially where we are under an unfavorable atmosphere. The numerous contaminations acting as foreign substances on the body, checking the free, full and healthful condition of the surface, causing determinations to internal organs, keeping up local congestions, acute and chronic inflammations, producing many irregularities and obstructions, between the various organs on which our health depends, and disease is the result. To remedy this cause, wo must protect ourselves against the changes of the seasons, and ward off whatever presents itself in the form of miasm. If we are not able to protect ourselves against such attacks, by our remedial agents, we must change our location, where the atmosphere will be more favorable to the circulation, keeping up the vital force in every organ, secur- ing the necessary stimulus to the endangium for the support and nourishment of the blood, enabling every organ to perform its function—preventing the decomposition of the material so essential to life; this keeps the nervous power in operation, and by it every tissue is sustained with power sufficient to perform its duty, driving the consumed particles into the pores, where they are conveyed out of the body, through the different chan- nels, when in a healthy condition. When this process is re- tarded, the system is changed in some part, a laxity of the tis- sues is brought on, which leads to weakness or perversion of function, so that instead of a sufficient quantity of well elab- orated material, for the purposes of nutrition, there is separated from the blood a peculiar product of the loAvest grade of vital force, with a tendency to degeneration fixed upon it, which exists as & foreign matter in the midst of living structures, per- HYGIENE. 181 verting the vital forces below the healthy standard, sometimes even to extreme debility. Amongst the many points of consideration for the judicious course in preserving health, is proper attention to food. The first of our articles of diet is that food which we receive from our mother’s bosom. Nature is furnished with aliment to sat- isfy the hunger and thirst of the infant. When taken into the stomach in large quantities, it is too much distended, and by degrees acquires an unnatural craving for food, which must be satisfied whatever be the consequence. These excessive supplies not only produce serious and fatal disorders, but also retard the growth, and eventually diminish the digestive power of the stomach. If we use for some tune a good selection of articles, the stomach becomes so habituated to them that we feel indis- posed as soon as we transgress, and the digestive power soon becomes impaired. People in health require no excitement to relish good and wholesome food—the simple dish is the most palatable. Attention is necessary to peculiar constitutions. Such a selection of animal and vegetable food as proves to be nourish- ing and easy of digestion is the proper regimen for the healthy economy. Regular periods, as well as the food being received gradually into the stomach, as it is duly prepared by mastica- tion. The mode of preparation is often the cause of disease; if this department was carefully attended to, health would be promoted—at least better prepared for the toils and changes of life. When food is properly masticated and has received a suffi- cient quantity of saliva, it is prepared for passing into the stom- ach, where it is acted on by the gastric juice as well as the churning action of that organ. If there is too great a quantity of fluids taken into the stomach, it prevents the ordinary course of digestion by causing the organ to perform a greater amount of labor than it is accustomed to, though a proper share of fluid is necessary for the performance of digestion. 182 HYGIENE. Drinks ought always to he taken in moderate quantities; these should he pure and of the most simple kind—an undue proportion of drink renders the mass of the blood too thin, and occasions a general debility of constitution. Stimulating fluids should be avoided, as they are apt to bring on an unusual de- gree of excitement—affect the nerves and leave a state of depres- sion which weakens the digestive powers. The process of mas- tication, insalivation, and deglutition are important, not only for preparing the food for the gastric juice, but allowing proper time for the stomach to act on a mere morsel as it passes into it, and by this course it is not injured by too rapid distention. After this gradual and moderate action, the chyme is pure, and all the secretions • are sufficient to meet the demands of the various organs of the body. If the bulk and quality in the articles of diet contain suffi- cient aliment, the sensibility and muscular contractions are directed to the process of digestion; when the chyme is formed it passes into the duodenum, where it receives the different secretions, preparing chyle to be taken up through the proper channel for the nourishment and support of the various organs of the body, after which separation the healthy condition of the body requires an evacuation of all the excrementitious matter remaining in the bowels. If the individual is enjoying good health there is generally no difficulty produced in the course of nature. Should there be any failure in regular evacuations, the system is likely to suffer; remedies for this object should bo resorted to, and the individual instructed as to the best articles of regimen, and the formation of regular habits. Some atten- tion should be paid to animal and vegetable substances, as digestion is very much facilitated by tenderness of fibre and minute divisions of the various substances. The structure of the system is calculated for the perform- ance of a great amount of exercise. It is necessary for every able bodied person to be engaged in some employment, for the preservation of health, as inactivity never fails to induce a.re- HYGIENE. 183 laxation of the contractile fibres, and when the fibres are relaxed, neither digestion nor circulation can be duly per- formed, though sedentary employments may be mixed with a due quantity of exercise and not injure health. The exercise should be daily and regular, and by all means in the open air, that the human frame may receive that bracing and strength- ening power designed for it by the Creator, to ward off disease. If the different emunctories are obstructed and the many crude and acrid substances retained, nature must suffer in pro- portion to the malignity and duration of the offending matter. Frequently nature is compelled to relieve herself by more unusual channels, such as bleeding at the nose in plethoric young people; hemorrhoids in others (generally in those more advanced in life;) sometimes ulcers arise in those individuals whose fluids are in an impure state. The saliva may become very profuse, and great mischief may be done to individuals by these conditions. Proper attention to cleanliness is one of the safest remedies to counteract fatal effects; it may be considered the grand secret of preserving beauty, as well as promoting health. All ages and sexes are alike applicable to its benefits; the softness of the skin is maintained, the limbs are pliant, the complexion gives evidence of purity; the whole constitution is kept bright and in full vigor. By frequent ablutions impurities are thrown off, cutaneous obstructions removed, and the surface is preserved and many threatening disorders are prevented. It soon at- tracts our regard and becomes agreeable to our nature. It does not only adorn us with a virtue, that we can go into company without giving offense, but preserves many of the higher pas- sions of the mind, not only making us agreeable to others, but easy to ourselves; promoting health of body and mind, so that pure and unsullied thoughts are naturally suggested to the mind by those objects that perpetually encompass us, when they are beautiful and elegant in their kind. Our senses are governed more by refined feelings, and inlets made to reason. 184 HYGIENE. We may now with propriety notice the effects of intemper- ance. The mind that is fortified by temperance leads to health and happiness. If anything is used in excess, pain and misery is the result; it is necessary in all things to be cautious, especially in our meat and drink. If we destroy a healthy con- stitution by intemperance, knowingly, we do as manifestly kill ourselves as though we were to hang ourselves with a rope, or to take poison sufficient to put an end to our existence. Our desires should he regulated, so that we may enjoy every pleas- ure with moderation. Voluptuousness should never be suffered to overcome us. Our relish is much diminished by excesses. The intoxicating draught is undoubtedly the most miserable refuge for misfortune; the result of it is short life, sinking spirits; one dose opening the way for another, until the miserable man falls a slave to the draught and becomes a sottish sacrifice. Let those who taste, remember that custom changes into habit, and habit soon becomes a second nature, very difficult to be subdued. Little unsuspecting beginnings generally contract vice, and sel- dom terminate but with life. Every pleasure that is pursued to excess converts itself into destruction. If the monuments of death were read, we would have a more instructive lecture on moderation than any of the most eloquent writers can give. Behold tire graves peopled with the victims of intemperance; view the chambers of darkness hung round on every side with the trophies of luxury, drunkenness and sensuality. As it has been asserted, “Where war or pesti- lence have slain their thousands, intemperate pleasure has slain its ten thousands. The healthy economy may be much assisted by clothing. Wc must dress according to our situations. The great object of clothing of different kinds is to keep the body warm and uni- form. This valuable shield to the comfort of mankind is often abused by the imprudent. There appears to be a transcendant faculty of reason, wisely left with man to accommodate himself with clothing to suit the different climates and seasons. Cloth- HYGIENE. 185 ing alone will not entirely protect us from the fatal clfects occasioned by the sudden changes of our climate, yet by a good selection we may avoid much danger. Such clothing should be worn as will maintain a comfortable temperature of the sur- face, so as to prevent a profuse perspiration and bring on debility. The surface should be clean and dry, the clothing frequently changed, and above all precautions the clothing ought to be dry; this applies to our couch as well as our every day garment. We should not be overloaded with clothes so as to heat the blood more than is consistent with health, producing copious exhalations which weaken the organs relaxed by sleep. This rest is the great restorer of nature, introduced as-a welcome vacation for both the body and soul. The health and happiness of mankind depends greatly on a due amount of sleep; without this accustomed repose the whole frame is in a short time thrown into disorder, the appetite is impaired, the mind is par- tially abridged and the spirits dejected; the body sinks gradu- ally into a state of inactivity; the blood circulates slowly, per- spiration is disordered; the memory becomes feeble, and sensi- bility is in a great measure destroyed; but where a proper share of this reviving rest is obtained, the feeble brain and hands repair their exhausted vigor, many of the pensive thoughts drop their load of sorrows, and the busy ones rest from the fatigue of application. The great Author of nature draws around us the curtain of darkness, which conceals everything that disturbs the senses and favors the inclination to drowsiness and repose, which rouses the weary frame from its exhaustion, and prepares us for the many arduous duties of life; for the mind needs to be refreshed constantly. If the mind should be agitated it has a tendency to diminish the powers of the body, enfeebling the nervous system and opening the way for many complaints. It is of the highest importance to avoid all rigorous excitement; we are too apt to yield to slight provocations, which produces a nervous tremor, increases the circulation; every nerve and 186 HYGIENE. muscle is brought into action, and often over-exerted by vio- lence, and is compelled to give way sooner or later, leaving a state of depression, very uncomfortable, and frequently danger- ous. Local disorders may arise from the extreme exertion oc- casioned by the excitement, and if exposed to contagion, the virus may enter the system, seize the opportunity of developing itself in the different organs during the depressed condition, making inroads to the very centre, exposing the system to all the of disease. A little caution would no doubt save many dangerous and fatal disorders. Distress brought on by envy or malice gener- ally rivets on the mind a.corrosive poison, which frequently destroys all rest and torments until all the more agreeable feel- ings are corrupted, imbibing prejudice and envy until the ma- licious intention is heightened in its malignancy; breaking down all pure and refined feelings, leaving the person an enemy to all around him; a disgrace to his friends; restless and full of terror to himself, his mind leading onward and downward until his days are days of trouble, and his existence difficult to be borne. We should be careful to avoid violent passions, attended with so much evil, causing us to be unpleasant to our compan- ions and uncomfortable to ourselves. It destroys many of the powers of doing good, injures our health and plunges us into disgrace. A little well directed prudence would no doubt keep us in the limits of moderation, and have the confidence of all around. We would not be likely to neglect our business, destroy our health and bring on poverty and disgrace. The evil does not stop here. It is truly lamentable that we live in an age in which many of the qualities and conditions are exces- sively addicted to vice, and it must be fresh in the memory that many of the most atrocious deeds have been committed, whilst under the influence of a violent passion. We are flat- tered by the subtle invader until we are tarnished with disgrace and compelled to blush at our actions. HYGIENE. 187 Our minds should be cultivated so as not to be led into ex- tremes. It appears that people possessed of great fortitude are not so readily infected by contagious disorders, as those more timid. Many persons under a violent tit of fear contract disease on entering the chamber of the sick once or twice. The mind should be preserved so as not to be suddenly surprised when calamities and afflictions befall us; it should be preserved in ease and serenity. The best remedy against a torturing state of the mind is a good conscience, which is to the soul what health is to the body. It is this that keeps our hearts from bursting under the pressure of evils and calamities; it caresses us in all extremes and gives the unhappy an expectation of happiness in the bosom of futurity. The mind has a great influence on the state and disorders'of the body; if we can call to our assist- ance the strong powers of the mind, it proves of great service to the mechanical operation of drugs; if we can obtain the desired imagination, it presently makes some impression in the brain, whence proceeds a motion of the sensitive soul and of the spirits that excite the passion of hope. By it, the activity of the whole machine is enlivened, the action of the heart and arteries is in- creased, the circulation of all the fluids is more vigorous and uniform, preventing the formation of disease, and facilitating the cure of such as are formed. The body should he prepared to gradually undergo the emotion connected with it. We must be fortified with a necessary share of firmness to meet joyful tidings, as well as disastrous. If we can only con- duce a grateful passion of the heart, it contributes greatly to the health and happiness of every society. We should learn such lessons as would kindle in ourselves the promotion of good morals, both private and public; hence amongst the innumer- able blessings, health would be much promoted by the con- sciousness of doing our duty, and would diffuse through the heart that habitual complacency and joy most friendly to health. No one will doubt that health is the result of nicely balanced appetites and passions. 188 HYGIENE. Harmony is one of the great powers that wards off disease, both mental and corporal; without it, imperceptible strokes are given to those delicate fibres of which avc are composed, until we are insensibly injured. On the other hand we are presented with all the innocent pleasures of human life, that purifies our enjoyments and renders them more grateful and generous, thus making us habitually cheerful. Cheerfulness promotes happi- ness and banishes many discontentments and hears the same friendly regard to the mind as to the body. Then we can look around on this vast world, where beauty and goodness is reflect- ed from every object, where every heart glows and every com- fort is sweetened by the same indulgent hand. Thus it is that gratitude prepares a good man for the enjoy- ment of prosperity; for not only has he as full a relish as others, in all the innocent pleasures of life, but moreover, in these he holds communion with God. In all that is good or fair, he • * traces his hand. From the beauties of nature, from the im- provements of art, from the blessings of public or private life, lie raises his affections to the great Fountain of all happiness, which surrounds him and this widens the sphere of his enjoy- ments by adding to the pleasures of sense the far more exqui- site joys of the heart. This nourishes that fervent love of God and man, consti- tuting the heart, gladdening the religion of Christ. This teaches us to deny ourselves and follow in the exercise of all virtue, wherein consists the life of religion, laying aside all idle quarrels, self-interest and needless debates about circumstantials, for this religion is not in words but in works; not in opinions but in as- surances; not in speculation but in practice. It is this religion all men ought to love for their own sakes, because a holy life which it teaches gives a comfortable death and happy eternity. CONSTITUTION. Constitution and By-Law of the Indiana County Medical Constitution. 189 Society, as revised and amended September 9, 1890, and ap- proved by the Censors of the Seventh Censorial District, October 21, 1890. Title of Society—Article i.—The name and title of this society shall be The Indiana Comity Medical Society. Objects of This Society—Article it.—The objects of this society shall be the advancement of medical knowledge, the promotion of harmony, union and friendly intercourse amongst its members, the protection of the interests, honor and useful- ness of the profession, and to preserve the health and protect the lives of the community Article hi.—This society shall be subject to the rules and regulations laid down in the Sixth Article of the Constitution of The Medical Society of the State of Pennsylvania. Organization—Section 1.—The members of the profession in any county in this State, who desire so to do, may form them- selves into a county society—Provided—that the public notice of the proposed meeting for that purpose be given, and that all the regular members of the profession in the county be invited to join therein; and said Society may adopt rules for their gov- ernment—Provided—the same do not contravene those of the State Society; may elect officers and do such other matters as may be necessary to carry out the objects of their Association. Qualifications of Members—Sec. 2.—No one shall be admitted as a member of this Society unless he is either a graduate in medicine of some medical school considered respectable by this Society, or who is known by the members of this Society to have been a good respectable practitioner for twenty years, and who is known by this Society to be a regular practitioner. Patent Medicines and Instruments—Sec. 3.—Any physician who shall procure a patent for a remedy or instrument of sur- gery, or who sells or deals in patent remedies or nostrums, or who prescribes a remedy without knowing its composition, or who shall hereafter give a certificate in favor of a,patent remedy or instrument of surgery, or who enters into a collusive agree- 190 CONSTITUTION, ment with an apothecary to receive pecuniary compensation or patronage for sending his prescription to said apothecary, shall be disqualified from becoming or remaining a member of this Society. Approval of Censors—Sec. 4.—As soon as a County Society is organized the Secretary thereof shall transmit to the Censors of the district two copies of their rules and regulations, with the names of their officers and members, and as soon as one of said copies is returned with the approval of the said Censors or a majority of them, they shall be authorized to elect one delegate to the State Society for every five of its members, and one dele- gate where the Society does not.consist of five members, and one delegate to the American Medical Association for every ten resident members, and one additional delegate for an addition- al fraction of more than half that number. 'Code of Ethics—Sec. s.—Every County Society shall enforce the observance by its members the Code of Ethics adopted by the State Society, and they shall be authorized to censure or expel any member convicted of violating its provisions. Expulsion—Sec. 6.—Any member of a County Society who is censured or expelled shall have the right to appeal to the Censors of the district any time within three months after the Society notifies him of their decision. Rights of Consultation Suspended—Sec. 7.—Any member who is expelled shall be debarred from the rights of consultation or the privileges of professional intercourse with any member of the State Society. Annual Reports—Sec. 8.—The County Societies shall report annually to the State Society a list of their officers and members, any new rules they may adopt and such other matter as they deem interesting. Fee Bills—Sec. 9.—Each County Society shall have a right to fix a fee bill for regulating charges of its members for profes- sional services* Meetings—Sec. 10.—County Societies shall hold at least two Constitution. 191 meetings in each year, but have the privilege of holding ns many meetings as they see proper. Mutual Improvements—Sec. 11.—Each Society shall have full authority to adopt such measures as they may deem most effi- cient for mutual improvement, for exciting a spirit of emulation, for facilitating a dissemination of useful information, for pro- moting friendly intercourse amongst its members, and for the advancement of medical science. Neglect of Duty—Sec. 12.—If any County Medical Society shall neglect to perform all such acts as may he required to he done by the laws of the State Society or which may be consid- ered derogatory to the honor of the medical profession, or who shall oppose or neglect to comply with the laws of the State So- ciety, such County Society, during such delinquency shall have their privileges as a portion of the State Society suspended and their delegates shall not be entitled to a seat in the State So- ciety. Honorary Members—Article iv.—Sec. 1.—Honorary members may be admitted by a vote of two-thirds of the mem- bers present, who shall have a right to speak on any subject before the Society, but not to vote. Sec. 2.—Honorary members engaged in the practice of medicine shall be required to pay the initiation fee. Officers of the Society—Art. v.—Sec. 1.—The officers of this Society shall be a President, Vice President, Secretary, Treasurer, three Medical Examiners and three Censors. Each officer to be elected annually by a majority vote to serve for one year or until another is elected to succeed him. Sec. 2.—At the first election for Censors and Examiners one person shall be elected for one year, one person for two years and one person for three years for each of the offices, viz: Cen- sors and Examiners, and one person shall be elected annually thereafter to serve for three years in the offices of Censor and Examiner. 192 CONSTITUTION. Day of Election—Bee. 3.—A1l officers shall be elected by bal- lot and a majority vote at the regular meeting in May. Delegates—Sec. 4.—Delegates to the Medical Society of the State of Pennsylvania and American Medical Association shall be elected annually according to the Constitution and By-Laws of those societies. Duties of Members—Art. vi.—Attendance—Sec. I.—Any member of this Society living in the boroughs of Indiana, who fails to attend lavo regular meetings consecutively, and mem- bers outside the boroughs of Indiana who fail to attend three regular meetings of the Society consecutively shall be dropped from the list of members unless they give the Society satisfac- tory reasons for their absence. Duties of Members—Sec. 2.—Any member Avho fails to per- form any duty assigned by the Society in proportion to the duties expected and performed by the members of County Medical Societies, such as preparing and reading papers or essays on medical or surgical subjects; or attending meetings of the Medical Society of the State of Pennsylvania or American Medical Association, shall bo dropped from the list of members unless they give the Society satisfactory reasons for their ab- sence. Candida,tes—Sec. 3.—Every candidate for membership shall be proposed at a regular meeting, referred to tire board of Cen- sors, who shall report at the next meeting, Avhen a ballot may be taken. Art. yii.—Code of Ethics.—This Society adopts as part of its regulations the Code of Ethics of the American Medical Asso- ciation. Amendments—Art. yii.—No addition, alteration or amend- ment can be made to this Constitution without the unanimous vote of the members present, but if objections be made, the ad- ''dition, alteration or amendment shall lie over to the next regu- lar meeting; when if two-thirds of the members present vote for it, it shall be adopted. BY-LAWS. 193 BY-LAWS. Meetings—Article i.—Sec. 1.—The regular meetings of this Society shall be held in the boroughs of Indiana, on the second Tuesdays of January, May and September. Sec. 2.—The Society may hold as many special meetings as they see proper. Sec. 3.—The President shall call a special meeting at any time, when requested in writing by members of Society. Sec. 4.—Five members shall always constitute a quorum. Duties of Officers.—Art. ii.—President—Sec. 1.—It shall be the duty of the President to preside at all meetings, enforce a due observance of the Constitution and By-Laws, appoint all committees, give the casting vote and perform all other duties, which by usage and custom belong to that office. Vice President- Sec. 2.—The Vice President shall assist the President when necessary, and preside in his absence, and in the absence of both President and Vice President, the Society shall appoint a President pro tern. Secretary—-Sec. 3.—The Secretary shall keep the minutes of the proceedings of all meetings, insert the same in a book kept for that purpose when adopted, and perform such other duties asusually appertain to that office. Treasurer—Sec. 4.—The Treasurer shall receive all monies due the Society, disburse the same as directed by vote of So- ciety, and make a full and true report of the same at the annual meeting in May. Duties of Censors—Sec. 5.—It shall be the duty of the Censors to inquire into the character and standing of all candidates for membership, and report on their eligibility at the next meeting of the Society, to investigate any disagreement which may occur between members, and endeavor to restore harmony if possible. When a member is charged with an infringement on the laws of the Society it shall be the duty of the Censors fully and impartially to investigate the same, and if they deem it BV-Uwa, well founded, to report the case to the Society at the next meet- ing with their decision.. Duties of Medical Examiners—Sec. 6.—It shall be the duty of the Medical Examiners to examine all applicants for admis- sion as students of Medicine, under the tuition of members of this Society, and said Committee of Examiners shall withhold its Certificate from any applicant unless he is of good moral character, possesses the preparatory education required by the American Medical Association, viz; A good English education, a knowledge of Natural Philosophy and the Elementary Math- ematical Sciences, including Geometry and Algebra, and such an acquaintance at least with the Latin and Greek languages as will enable them to appreciate the technical language of Medi- cine, and read and write prescriptions correctly, and no mem- ber of this Society shall receive a student who fails to procure a certificate from the Examiners, or a diploma from a College legally entitled to confer degrees. Election of Members—Art. hi.—Sec. 1.—Application for membership shall be made to the Society at least two months before they are voted for, and if the Censors report favorably, they may be elected by a two-third vote of the members present, and on admission shall pay the sum of one dollar as an initia- tion fee and sign the Constitution and By-Laws. An applicant being rejected for membership, cannot apply again for the period of one year. / Offenses, Trials—Sec. 2.—If any member violates the laws and regulations of this Society: upon a charge in writing, to the Censors, it shall be their duty to notify the accused member of the same and, if after due investigation they consider the charge in writing sustained, they shall report the case to the Society at its next meeting. Notifying the accused of the same, if he fails to come forward and give the Society satisfaction, the Society shall take such action as they consider right and proper, and either suspend or expel the member according to the nature of the offense. BY-LAWS. Expulsion requires a two-third vote. Art. iv.—Funds—Funds for defraying the expenses of the Society may lie raised by assessment. Art. v.—Papers Read—Sec. 1,—The President shall appoint at least two essayists at each meeting of Society to prepare and read papers at the next meeting of Society, on any medical or surgical subject they may see proper to select. Members failing to comply with their appointments shall be dealt with accord- ing to the second Section of Article 6 of the Constitution. Auditors—Sec. 2.—The President shall appoint three Audit- ors annually to examine and audit the Treasurer’s report in May, and also appoint special committees when required. Sec. 3.—Any rule or By-Law not covered by this list shall be regulated by Cushing’s Manual of Parliamentary Practice. Order of Business—Article vi.—The following order of business shall govern the Society: 1. Calling the roll. 2. Reading the minutes of last meeting of Society. ■3. Report of special committees. 4. Any business requiring early considerations. 5. Report of the Censors. <6. Election of new members. 7. Rejiort of the Medical Examiners. 8. Report of the Delegates to the State Medical Society. 9. Report of the Delegates to American Medical Associa- tion. 10. Written communications—Papers read and discussed. 11. Oral communications—Shall be received and discussed. 12. New members proposed. 13. Any new business may be brought forward. 14. Election of officers. 15. Unfinished and miscellaneous business. 16. Adjournment. Amendment—Art.—These By-Laws may be suspended, altered or amended by a vote of two-thirds of the members pres- ent at any regular meeting. 196 FEE BILL. PHYSICIANS’ FEE BILL. Fee Bill adopted by the Indiana County Medical Society, September 7, 1867. PRACTICE. Fore-anu 3500 Wrist 30 00 Fingers, eacli 5 00 Hip joint.: .. 100 00 Femur 75 00 Teg........ ' 50 00 F'oot 50 00 Dressing Wounds Simple incised $ 2 00 All sutures 1 00 Operation for Trephining 50 00 Cataract 25 00 Strabismus i 25 00 Pterygium 35 00 Kntropion 20 00 Ectropion 20 00 Fistula lachrymalis 25 00 Abscess of antrum 15 00 Extirpation of eye 50 00 Hair lip—single 2500 Hair lip—double 50 00 Epulis 25 00 Enlarged tonsils 5 00 Staphy loraphy .. 100 00 Taryngotomy 100 00 Tracheotomy 100 00 Extirpation of mammary gland.. 50 00 Paracentesis thoracis 25 00 Paracentesis abdominis 15 00 Strangulated hernia, femoral 75 00 Strangulated hernia, inguinal 50 00 Artificial anus 25 00 Hemorrhoids 50 00 Fistula in auo 50 00 Ifithatrity 100 00 Tithotomy „ 200 00 Castration 50 00 Hydrocele . 15 00 Varicocele 50 00 Phymosis 15 00 Paraphymosis 15 00 Epispadias 25 00 Hypospadias 25 00 \lrethral catheterism 2 50 Gonorrhoea 20 00 Syphlis, (one-half in adv.) 50 00 Club foot 100 00 Tumors. Operations for scirrhus, calloid, encephaloid, melanosis, and all other raaglignant tumors, in proportion to location, &c,, &c. minimum fee 25 00 Eigation of Arteries. Carotid $lOO 00 Facial 25 00 Subclavian 75 00 Axillary 50 00 Brachial 25 00 Radial 20 00 Ulnar 20 00 Iliac 100 00 Femoral 100 00 Day visit in town $ 1 00 Night visit in town 2 00 RATES OF MILEAGE. A visit of one mile 2 co “ two miles 3 00 three “ 3 50 “ four ", 4 OO : five ,*’ 450 1 “ six “ 5 00 “ seven “ - 550 “ eight “ 600 “ • nine “ 650 | “ ten “ ..... 700 Over ten miles, per mile 1 00 Consultation, in addition to milage, optiona 5 00 i Mileage for night visits 50 per cent. over day visits When the first visit is made to a case on Sunday, 50 per cent, addi- tional to regular fees shall be charged, optional Natural labor 10 00 j Tabor by turning ~..$l5 00 to 25 00 : Tabor by forceps 15 00 : Craniotomy 5° 00 1 Adherent placenta.- 1000 j Placenta Brevia 50 00 j Abortion 10 00 : ,Uterine polypus.. 5° 00 i Imperforate hymen 25 00 : Examination by vaginal speculum 250 | Reducing ante-version of uterus 5 00 | Reducing retroversion of uterus 5 00 SURGERY. Reducing Tuxations of Inferior maxilla 5 00 1 Clavicle 15 00 Shoulder 20 00 Elbow v. 15 00 i Head of radius 10 00 Wrist 15 00 Femur 75 00 Knee 25 00 Patella 15 00 Head of fibula 10 00 Ankle 25 00 Ankle with fracture 30 00 Reducing Fracture op Femur 20 00 Teg 15 00 Humerus 15 00 Radius 10 00 Ulna 10 00 Ribs 10 00 All other fractures of limbs 5 00 Amputation of Arm 30 00 Shoulder joint 50 00 Elbew 50 00 OBSTETRICS, &c. FEE Bltt. 197 Popliteal 100 00 Posterior tibial 50 00 Anterior 30 00 Peroneal 50 00 All necessary after treatment in obstet- rical and surgical cases to be charged for at the usual rates. Cupping in office $ 2 00 Bleeding in office 1 00 Extracting teeth, each 50 Administering ether 1 00 Vaccination, for one in a family 100 Vaccination for each additional person, in a family 50 Advice in office from $1 to $5. MISCELLANEOUS. POST MORTEM EXAMINATIONS. Post mortem examination before a coroner or a magistrate, where no evidence is to be given in court...s 50 00 Post mortem examination where evidence is to be given in c0urt...,100 00 Post mortem examination when exhumed 150 00 Post mortem examination with chemical analysis 250 00 Regular mileage to be charged in addition, to the above. Regular and honorary members of this society, engaged in the practice of medi- cine, are required to make their charges conform to the foregoing fee bill. When possible, all accounts are to be settled semi-annually. Where a number of visits are made at the same time in a neighborhood, full mileage shall be charged in each case; provided that the services of a physicians cannot be dispensed with. APPENDIX. 198 INDEX INDEX. Adair, James T 20 Adair, Hugh 43 Allison, David R 56 Allison, Samuel C 45 Allison, Alex. H 23 Altman, William 6 Anawalt, J. W 14 Anderson, William 36 Andrews, Dr 12 Ake, Joseph H 19 Ansley, Wm.B 54 Ansley, Joseph M 54 Anthony, William 47 Armstrong, A. H 46 Arney, George F 33 Bain, Dr 59 Bair, John 46 j Barr, Robert 8 Baldwin, James D 24 Barker, John A 60 Barclay, Wm. F 58 Barrett, Henry S 63 Barrett, Elisha D... 61 Barrett, Samuel D 62 Berryhill, Samuel G 53 Bingell, Ferdinand F 48 Bishop, J. J. J 45 Bell, James H 21 Blose, Joseph U 20 Bolinger, Dr 22 Brallier, Emanuel 20 Brown, Samuel P 12 Bryson, James A 51 Buchanan, John J 25 Burrell, D. Dr 33 Caldwell, William 18 I Calhoun, Bruce L 22 Calvin, Hugh A 63 j Campbell, Dr 14 ; Cameron, Norris 21 Campbell, J. Gilbert 33 | Cass, John T 45 Carson, Thomas 58 Carson, John B 17 Claggett, Luther 5..... 15 Cantwell, Terrence J 14 Clark, A. Jackson 7 Cleis, George 29 , Crawford, Dr 9 | Craighead, Dr 12 Craig, William 43 Crawford, James L .. 58 Crawford, David R 62 Crawford, W. T 63 Crooks, Joseph 35 Crooks. John W 28 Cunningham, Wm. N 38 Davis, Thomas E 66 Davis, James G 42 Davis, John A 33 Davison, John B 47 Davison, Thomas J 67 Devlin, Samuel F 6 Devoe, Arthur 39 Devoe.i Marmora 39 Dickie, Edward H 28 Dickeson, Henry 65 Dodson, Wm. E 48 Duffield, Saunuel 12 Dunwoodie, John W 52 Flarhart, Elias B 60 Edgar, J. C 43 Ehrenfedt, N. F 3S FJder, Samuel M 41 Emerson, Edward P 11 Evans, John 32 Evans, John N 23 Ewing, C. M 29 Ewing, James R 27 Falconer, Archibald 16 Faulk, Henry 49 French, Jonathan 33 Frederick, William 10 Fundenberg, Dr 13 Gamble, George M 9 Gamble, Thoedore B 50 Getty, Dr 5 George, Wm. J 49 George, M. R 59 Gemmill, Dr 13 Gettys, George W 6 Glasgow, George M 26 Gilpin, John 12 Gillespie, Dr 12 Golden, Joseph C 24 Goodhart, George 52 Green, John B 25 Gross, Augustus H 40 Hadden, John H 30 Hamill, Dr 13 Hamilton, Andrew A 66 Hay, John 6 Hays, George 5 Harding, James L 18 Hartwell, Dr 30 Henry. Thomas J 31 Hildebrand, |Dr 48 Householder, M. C 60 Hosack, William 20 Hufeland, Dr 36 Hughes, John W 15 Hunter, William 16 Hunter, George 17 Irwin, Crawford 7 Irwin, George ... 40 Irwin, Benjamin C 45 Jack, William 40 Jackson, David P n Jackson, Robert M. S 12 Johnston, William W 60 Johnston, Andrew 9 iVw*. jahnston, Andrew A n Jones, Dr 54 | Kelly, Janies 20 ; Kerr, Joseph M 11 Klages, Theodore F... . 9 Kier, Janies A 56 Klingensmith, I. P 16 Krebs, A. Bryan 26 Taney, Thomas M 14 Larimer, William T 44 Leyda, Isaac N 16 Lewis, George R 43 Liggett, Robert 18 Livingston, Dr 48 Lomison, Henry~G 57 bowman, Alonza 50 Loughry, James N 45 Lovelace, R. A,... 19 Luke, J. B 51 Lydick, Joseph W 65 Mabon, Thomas 40 Mabon, James* 32 Marlin, Thomas J 22 Marshall,' Robert J . 12 Martin, George 21 Mardis, Joseph 67 Marshall, David M 24 Marshall, Dr 30 McAdoo, ElmerjE 65 McAdoo, John 52 McAfoos, Harvey E 51 Mcßryar, William 58 McChesney, Robert 64 McChesney, Win. A 64 McCrea, Chalmers S 50 McCartney, James S.. 37 McCullough, Herman L 23 McClure, James D 8 McClure, A. S 25 McCune, J 30 McCurdy, J 9 Mcßeth, Joseph 18 McConnaughy, Robert 57 McConnaughy, Frank 14 McEwen, William 53 McEwen, Christopher 53 McEwen, Joseph W 34 McEwen, Charles M 55 McFarland, John 56 McHenry, E. Q 65 McHenry, George J 47 ■ McKee, Samuel 26 McKim, Dr 13 McGowan, William D 7 McMillen, John C 25 McMullen, James 49 McMullen, Thomas 10 McNutt, John S 22 Miller, G. W 50 Miller, Samuel G 68 Miller, Christopher C 41 Miller, J. Sloan 29 Miller, James Calvin 21 Miller. Martin L— 13 Meeker, Dr 60 Morgan, James 57 Morrow, J. Wilson 46 Morrow, James 27 Morrow, Wm. L 27 Morrison, John C 32 Moorhead, Thomas 35 Mitchell, Robert 34 Murray, Thomas 56 Myers, Ambrose H 25 Ogden, Samuel M 21 Orr, R. M ~.. 22 Palmer, Dr 44 Parker, Wm. C 41 Patton, James M 62 Pratt, William A iq Pitman, H. B 28 Powell, William 1... 26 Purriugton, Augustus F ... 37 Rankin, D. Carson 64 Rea, Alexander M 22 Redick, Samuel T 57 Reed, William 37 Reed, Wm. L 33 Reed, Dr 5 Reese, George J 66 Rich, P. P 26 Ross, Janies 61 Row, Herman ; 37 Rutledge, S. R 15 Rutledge, Albert T 17 Shaeffer, Samuel A... 55 Scheffer, J 24 Shields, J. Milton 24 Shields, Winfield S 24 Shields, James 32 Shields, Wm. Lincoln 42 Short, James C 25 Shook, James C 21 Simpson, T. P 10 Simmons, Dr 12 Sims, William N 60 Scott, Robert K 6 'Smith, C. B 52 Smith, John W 30 Smith, Joseph H 50 Souther, A. J 9 Snowden, D. Harrold 47 Snowden, H. S 57 Spear, William R 14 Sterrett, Benjamin 55 Stewart, Joseph F 40 Stewart, James M 34 Stewart, Orlando C 23 Stewart, Wm. G 6 Stewart, Samuel F 7 Stewart, Wallace B ... 9 St.Clair, Thomas ;. 35 St.Clair, Charles M 38 St.Clair, John M 39 Sturgeon, David P 39 Swan, Samuel M 36 Swift, Elisha P 17 Sweeny, Barnabas 61 Talmage, Samuel 3 Taylor, Janies 18 Taylor, James M 35 Taylor, William S 59 Thomas, Shadrach H 33 Thompson John K. 37 Tomb, Robert J 8 Tomb, Benjamin F 9 Torrence, James M 38 Tussey, A. Fjdgar 16 i Van Antwep, Eugene H 50 200 INDEX Vanhorn. Dr r Virtue, Samuel W 44 Wakefield, J.C ’ ,Q Walker, Wm,. B ?2 Wassam, Adam C 20 Wiggins, Samuel L 10 Wiley, Isaac W 13 Young, John g Young, Frank 5 Resolution and Memoirs. Stewart, James M 7I Stewart, Joseph F 72 Adair, James T 72 Barr, Robert " 7Z Elder, Samuel M | 7t McMullen. Thomas 7/i McHenry, George 7^ Indiana County Medical Society 76 Report of Indiana County Medical Society 10-, Address of Wm. Anderson in accept ing Presidency of the Medical Society of State of Pennsylvadia 117 Address of Wm. Anderson before the annual meeting of the Med- ical Society of the State of Penn- sylvania ug I Sclerosis of the Nerve Centres.. i-m I Pyemia | G’l Nervous Disease Bacteria Tobacco Hygiene 178 Constitution and By-Laws of tlte Indiana County Medical Society igg Physicians’ Fee Bill I9g Towns and Townships. Armagh - 1 Avonmore to I Bells mills Tn i Blairsville l: Centerville is Cherrytree.. m Clarksburg.. 2i Cookport" .... | 2” Covode 24 Diamondville 24 Dixonville ’ 2- Georgeville .... 26 Glenn Campbell.. 26 Gettysburg 2g Greenville , 2q Homer City Indiana S-, Jacksonville .'.40 Kimmell 42 West Lebanon ~ M archand It Marion • '“‘.‘V" Ig Mechanicsburg 4s Newville cQ Nolo si Pine Flats 51 Plumville Shelocta g, Smicksburg go Smithport gs Strongstown gg Taylorsville 57 Wheatfield Township 68 ERRATA. Page 21.—Dr. James Curry Shook graduated in 1891. “ 28.—Dr. Joseph H. Ake located at Gettysburg in 1850. “ 29.—Dr. Wallace B. Stewart spent the summer of 1858 in Nebraska. “ 32.—Homer City was laid out in 1854. “ 37.—Dr. W. B. Stewart returned to Greenville in 1856. “ “ —Dr. Reed practiced with Dr. St.Clair until 1859. “ 66.—Dr. Joseph R. Golden. “ 67.—Dr. Jasper Mardis. “ 146.—Tenth line “Angeiolucitis.”