unobtrusive member; and the community at large a most worthy and valuable citizen. Resolved,-That we, the members of the Galveston Medical Society, do offer, by these resolutions, a final testimonial of the high esteem in which we held the deceased, both as a physician and a private citizen. Resolved,--That a copy of these resolutions be sent to the family of the deceased, be furnished the city papers for publication, and that they be entered on the minutes of the society. S. M. WELCH, M.D., M. CAMPBELL, M.D., Committee. 1 Diptheria---Dr. T. J. Heard. ESSAY READ BEFORE THE GALVESTON MEDICAL SOCIETY, JAN. 3, 1867. MR. PRESIDENt and GentlEMEN: The subject of diptheria has engaged the best of pens for years, hence, it is hardly to be expected of men from my humble stand-point to offer or put forth anything original. But, notwithstanding my observations have been limited, when compared with thousands of others, they have been sufficient to enable me to form some opinions as respects the nature and the point especially of greatest interest-the treatment of this affection. My attention was first called to the importance of this subject by Prof. Jas. Jones, of New Orleans, in the winter of 1844 and 1845. Notwithstanding the impressiveness of his lecture on the subject, in which he very fully portrayed the fearful ravages of the disease in Europe, I could not bring my mind to the realization of the fearfulness of the disorder until I encountered it in this place in the winter of 1859 and 1860. The affection presented in the main the same features the occasional cases we now meet with do. The more I have seen of this disease the more I have been persuaded of its zymotic nature, and I risk nothing when I say that such as suffer of this disorder have not been in a good state as regards their general health for some time previous to the attack. Diptheria may be divided into three stages:-the first I will call the pyrexial stage; the second, the stage of exudation; the third, that of collapse. And, as a digression, I will remark that I think other clearly zymotic affections will be found interrigating nature, so far as regards the stages as above stated, to leave a strong analogy to diptheria, to wit, yellow fever, cholera, &c. The pyrexial state or stage of diptheria may be of two or three days duration. By friends it is usually regarded as a catarrheal form. Some complaint may be made of soreness of the throat, but it is not usual during the first day or two of the illness to find any well marked dlptherial exudation. But so soon as complaint is made, and even in some cases before, an erythematic condition of the parts may be found, which is but too often, in a day or two, found dotted here and there with the white exudation beneath the epithelium, which is distinctive of this disease. The second stage is marked by the subsidence of the form and by the rapid extension of the diptheritic exudation. During this stage the sub-maxillary glands and the adjacent parts become very much swollen independent of the diptherial exudation so as to render respiration and deglutation very difficult. The third stage is not one simply of collapse in the common acceptation of the term, but is a condition which I have not witnessed in any other disease. In the early part of this stage, or even before this stage is fully established, the patient may be suffocated from occlusion of the air passage. In cases where there is no interruption to the ingress of air to the lungs, but in which the gastric intestinal mucous surfaces mainly suffer, in such cases I have seen the disease fully set forth. For days I have seen the poor little sufferer wear on, with the smallest thread of pulse, not unfrequently very slow, without the least evidence of warmth about them, the tongue cold and palid yet with the rest, but any kind of ingesta was vomited at once. It is strange but true; I have seen some of these poor little doomed children, so far from giving any evidence of pain or distress, taking interest in the plays and toys of their littie friends to almost their last moments. If time, and the necessity justified, I could elaborate this paper, and say much on the subject of blood poisoning; but I will dismiss the subject for the present by making a few remarks on the treatment of the disorder. TREATMENT. If the patient is seen in the first stage of the disease, the indications are two-fold-1st to abort the form; and, 2d, to correct the abnormal state of the blood. I have used the following with unvarying success : Take, for a child, say five years old, the following:-Quinine, 3 grs. ; cholorate potass., 3 j.; hydrachloric acid, 3 js.; water, ii drachs--mix. Take a tea-spoonful in a wine-glass of water every two hours. As the patient improves the remedy may be used at longer intervals, but should in all cases be continued in small doses for a month at least. If the bowels are confined, I find nothing better than castor oil and oil of turpentine. But all lowering treatment should be scrupulously avoided. The warm bath has a very happy effect during the first stage, and the free incrustation all over of camphorated oil is very good. The sick should be well clad and be kept warm and comfortable. After the febrile stage has passed, I have found nothing better to advise than the hydrochloric acid and the chlorate of potassa with infusion of geantian often repeated, the bathing and the incrustation, &c.,as above suggested to be kept up. From first to last the sick is to have as much good food as they can bear; and, after the first stage has passed, good brandy, wine, or porter, in such quantities as we have good reason to think they can bear. I use no caustics or gargles, from the fact I have not found any need of them when the above plan has been pursued. I formerly used such means, greatly to the torture of the patient, without experiencing any benefit from them. To the neck I have used of late nothing except raw cotton, after rubbing the neck well with camphorated oil. This may be repeated every hour or two. Report of Case of Retained Placenta. BY S. M. WELCH. READ BEFORE GALVESTON MEDICAL SOCIETY, JAN. 8, 1867. As one of the objects of our Medical Society is to stimulate its members to observe and report interesting and instructive cases, and, by an interchange of facts and observations, to render our proceedings a source of improvement, I ask leave to submit the following cases :- I have to report a case of retained placenta in labor at full term, where the os uteri, though in a dilated condition, was so extremely irritable that all efforts at extraction were found useless, or worse than useless. The patient was a good deal exhausted, the tediousness of the labor and hemorrhage, and the placenta retained its position from want of power in the body of the uterus to expel it. After administering ergot in large and repeated doses without producing any effect, though the medicine, Battley's Liq. Ergotæ, was pure and active. It occurred to me to try the biborate of soda. It was resorted to, and after the second dose of 15 grs. the placenta was expelled by the strong uterine contractions produced. The property possessed by this remedy of exciting the contractive power of the womb, though known to the medical profession, for it is mentioned by most authors in materia medica and therapeutics, as Pareira, Wood and others alluded to in the Dispensatory, is, I believe, less often had recourse to by the physician, at least in this country, for remedial objects then by the professed abortionist to accomplish his base purposes. If the bi-borate of soda exercises this specific influence on the womb, may we not oftener employ it with advantage in cases similar to the above; and in cases of flooding after labor, when it is desirable to produce a tense contraction of the womb? Certainly it deserves a place on the list with ergot, savine and kindred remedial agents. URTICARIA FROM THE USE OF QUININE. I may also mention here the case of a lady, from New Orleans, very recently under my professional care, which exhibited some unusual effects, at least to me, from the administration of quinine. She was suffering from intermittent fever and had taken 5 grs. of quinine, on two occasions, before I saw her. Each time a red eruption resembling urtecaria or nettle-rash had appeared over the entire surface of the body and disappeared again on the disappearance of the effects of the quinine. On the following day she took one grain and the eruption ap peared. She then thought it time to send for a physician, her fears having become aroused. I ordered for her a purgative, and in a few hours followed it by 5 grs. quinine associated with comp. ext. colocynth and ext. hyaciamus. None of the unpleasant symptoms before mentioned followed. In a few hours I gave her five grains more of the quinine and repeated the dose twice afterwards without again noticing the eruption. I am of the opinion that the purgative I had premised had removed the cause, probably some digestive derangement, which proproduced the eruption. GALVESTON, FEB. 20, 1867. By a resolution of the Galveston Medical Society the undersigned committee were appointed to address a circular letter to the medical profession throughout the country, urging the necessity of establishing county medical societies, in every part of the State, for mutual improvement and the promotion of a spirit of concord and professional courtesy among the entire medical brotherhood, and for the still higher purpose of advancing medical knowledge, enlarging the field of inquiry, and, at the same time, diffusing a large amount of practical information now lying dormant for want of some convenient mode of communication and interchange of opinion. These primary organizations will lead the way to the establishment of a State Medical Association, a thing greatly to be desired and much needed. In every State where such an organization exists (and it is believed to exist in all the other States) much good has been the result, a great stimulous has been given to medical inquiry and a large increase in the number of the laborers in the broad field before us, with corresponding elevation and usefulness of the profession. Very respectfully, D. PQRT. SMYTHE, M.D., GREEENSVILLE DOWELL, M.D., Committee. |