the latter part of 1832 we had intermittent and remittent fevers, the latter commonly but erroneously called bilious, for it was only a lesion produced from malaria, and intermittents were equally so. Malignant intermittents and remittents were frequent in some seasons, called cold plague. At that period these diseases were treated by the heroic administration of sixty grains calomel with gills of Cook's pills, the results of the teachings of the school at Lexington, Ky. Quinine was but little used, and then only in the form of Sappington's pills, and a host of similar ones followed, all having for their base quinine. I believe I was the first person using quinine itself alone in the remittent forms of fever at that early day. Dr. Thomas Fearne was the first to use it in twenty grain doses in a form of pneumonia with perfect success. The pathology of the so-called malarial fevers is but little understood, and I am inclined to the opinion that those diseases are the products of what might be termed entozoic corpuscles in the blood, produced by the inhalation of microscopic fomites, which formations are absolutely neutralized by quinine. It may be said, then, how do you account for the recurrence of intermittents? By the impressions produced upon the nervous centres, from fibres conveying to the brain a sense of general sensation, independent of the sense of touch, which after the cause is removed is kept up from habit, as in the loss of a limb, yet the missing member can still be felt. All of our exanthems could be attributed to the same diseased state of the blood-enteric fever, cholera, small pox, &c., &c., produced by different forms of microscopic fomites. The time will come when these causes can be demonstrated, and consequently the pests of the profession made to succumb to enlightened and successful prophylaxy and treatment.

Follicular enteritis, commonly called typhoid fever, first made its appearance (so far as my observation extended) in the fall of 1842, and its type was of the heretofore prevailing fevers, and was treated as such with quinine, but without any effect; and consequently the quinine was said to be adulterated; and the usual treatment of calomel and Cook's pills proved very fatal, and many died before the disease was fully understood. Typhoid pneumonia was also prevalent during the progress of the disease, and proved fatal in many cases. Dysentery in epidemic form prevailed in 1856-57very fatal.

The various diseases incident to childhood prevailed extensively, such as mumps, scarlatina, measles, whooping cough.

In some years diptheria was very fatal; all treatment seemed useless, and many lives were lost.

A few cases of cholera appeared in 1851. It was not endemic, but came from Tennessee.

Small pox first appeared in 1863–64, brought into the county by negroes who came from the Federal army; also in 1866. One case was of the melanotic form, in an aged lady-fatal. In eighty cases

in 1863-64 only four died from the disease; in 1866 none. Most of the cases were of the confluent form, and were severe but amenable to treatment-no doubt from the isolation of the patients and our pure air, aided by the paucity of diet at that time from the scarceness of food.

There was one remarkable fact exhibited during the progress of this disease. In one family where it prevailed extensively it was remarkably mild, said to be so from the constant use of an infusion of black snakeroot, rattleweed, or more properly, Cimicifuga. In the same family were several children (whose fathers were in the army), whom I attempted to vaccinate, but was unsuccessful, and was told the reason-because they made constant use of the infusion of Cimicifuga. They did not take the small pox, and after some months, when all symptoms of small pox had ceased, and the children had quit using the infusion, I vaccinated them with perfect success. These were the only cases observed, but would undoubtedly use the infusion of Cimicifuga should small pox prevail again. Epidemic erysipelas was very prevalent in some years, but yielded

to treatment.

In 1832 the free use of the lancet was the rule and not the exception. In 1842 it was dropped, and this great remedy is now almost forgotten. About 1832 Thompsonianism was rife in the land, then gradually was absorbed in Eclecticism, and now Homœopathy sways the multitude with its infinitesimals. What will come next I know not, but no doubt some new form of cure, while the drug stores and newspapers (secular and religious) teem with nostrums for the cure of every ailment man is heir to. The silent, painstaking regular plods along his way, doing all the good he can from an enlightened and philosophical standpoint, unheeded, unnoticed and unknown, struggling for a mere subsistence, yet proudly conscious of right, while the multitude heaps up riches upon the Northern vender.

The lancet came into disuse because the type of fever was changed. The Thompsonian, with his axiom, "Heat is life, and cold is death," put a stop to the excessive use of mercury, while the Eclectics use concentrated essences, and the Homœopathists, with their dilutions attenuated to non-comprehension, gave an impulse to minute doses of remedies. These checks were necessary to a healthful appreciation of the difficulties attending the knowledge of such an intricate structure as man, with his protean diseases, appetites and habits, until at length we are taught that the more we study and practice, the more sensible we become of our ignorance,

REPORT ON THE SURGERY OF MADISON COUNTY.

BY J. J. DEMENT, M. D., OF HUNTSVILLE.

Having accepted the appointment from the President of the Medical Association of the State of Alabama to report on Surgery from Madison county to its next annual session, I herewith respectfully beg leave to submit the following cases:

Compound Dislocation of Elbow-Necrosis of Humerus-Excision— Recovery.-By FLEMING JORDAN, M. D., of Maysville.-Miss Catharine C., aged eight years, was thrown from her horse on the 2d of December, 1869, producing dislocation of the elbow joint. The inferior extremity of the humerus was forced obliquely downwards through the integuments, and through her dress. A physician was called immediately. Before he arrived, the uncle of the girl had, by extension and counter-extension, reduced the dislocated bone to its normal position. The physician, on his arrival, did not make any special examination of the case, but pronounced the reduction and dressings proper. The splints were applied with the arm in an extended position, and being very thin and flexible, gave way to the weight of the arm. On the 20th December the inferior extremity of the humerus made its appearance through the integuments, two inches above the first opening. At this stage of the case I was called in, on the 24th of December, to amputate the arm. On careful examination of the case, I found the inferior extremity of the humerus of the left arm projecting through the integuments at the opening last made and extending one inch above the surface of the arm, and of a dark brown color, and destitute of any periosteum. The patient, in other respects, was in good health. In place of amputating the arm, I determined to perform the operation of resecting the end of the humerus, and to establish, if possible, an artificial joint. The patient was placed upon the table and properly anæsthetized. By a free incision both of the openings were laid into one, and with a fine saw I removed one inch of the lower extremity of the humerus, with the condyles. The arm was then placed in an angular splint and the dressings applied. At the end of three weeks I removed the splints. The wound had nearly

healed. I used gentle extension and flexion, and placed the arm in a sling, with instructions to the nurse to use gentle motion daily. I discovered that flexion and extension improved at every examination. I then commenced pronation and supination, which gradually improved. This patient regained the use of her arm much more rapidly than I expected, and in six months the artificial joint was fully established. She has now flexion and extension, pronation and supination, as perfectly as in the right arm, and has equal strength and use of the left as the right. The left arm is shorter than the right, but not to be noticed or known only by measurement. This case is reported to show that artificial joints can, and ought to be established when the surgeon can accomplish so important and so desirable an object to the unfortunate sufferer.

Incised Wound of Abdomen-Protrusion of Intestines-Recovery.— By GEO. D. NORRIS, M. D., of New Market.-William Hamilton was cut with a knife in the hypogastric region, right side, incision about an inch, letting out almost all the small intestines. Found great difficulty in replacing them. Enlarged incision half an inch, and returned them after considerable difficulty by gentle taxis. No injury to bowels, but much hæmorrhage. Secured wound by four interrupted sutures; dressed with thin plate of lead and usual bandage. On the tenth day removed sutures. Wound healed by first intention. For the first few days there was much hæmorrhage, mostly venous. A small branch of the epigastric was cut, but required no ligature. Cold water, with tincture of arnica, was used constantly. His bowels were not moved for ten days, after which he had abundant discharges.

Was also cut in the back about three inches, completely severing inferior angle of scapula from the body, upward and underneath. Secured by several sutures. Venous hæmorrhage. He was also wounded in left knee, almost opening the joint. This man was large and fleshy, and in perfect health; was well in thirty days. Dr. E. T. Taliaferro afforded valuable assistance in this case.

The following are reported by L. D. Carter, M. D., of Huntsville: Case I.-Comminution of Hand and Forearm-Amputation-Recovery.—Frank Robinson, negro, aged eighteen years, well grown, stout, muscular, and full habit. Was brought to my office at ten o'clock, A. M., June 28th, 1871, with left hand and forearm completely comminuted to within three inches of elbow-crushed under the trucks of a locomotive at Huntsville. Hæmorrhage had ceased. Slight reaction from shock. Ordered a mixture of one grain of sulphate of morphia and two ounces of spirits to be taken at once. Supported the limb by a loose bandage from the shoulder, and sent him to his quarters, telling him I would amputate some time during the morning.

Six, A. M.-Had reacted, and went kindly under chloroform. Circular amputation two and a half inches below elbow. As many as six arteries were ligated and parts closed by sutures and adhesive

strips. Was summoned to see him at eight, A. M. Found the stump bleeding freely. Opened it and secured an additional artery. Redressed as before, supporting it by roller bandage, applied loosely. Ordered cold water dressings. Rested well at night without anodyne.

June 29th, at ten, A. M., he was doing well. Ordered the stump to be kept well moistened with a solution of carbolic acid and water. July 1st. He was able to come to my office. The stump had united to within an inch of its entire extent. Removed adhesive

strips. Dressing continued.

July 7th. He was sent to county poorhouse, under charge of Dr. Frank Rice. Saw him a few days afterwards; the stump was entirely healed.

I was assisted by Drs. J. D. Carter and J. D. Humphrey.

Case II.-Extensive Wound of Face.-Jack Kelly, colored, aged forty years, field hand, was accidentally wounded March 9th, 1872, in the following manner: A negro man, engaged in a street fight, struck at his antagonist with two sections of a stove pipe; the distal section was thrown off by the force of the blow, passing over the head of his antagonist, and striking Kelly in the face endwise, inflicting an ugly and extensive wound, cutting the integuments of the face on the upper margin of the cheek bone from about an inch below the outer canthus of the right eye to the bridge of the nose. The lateral fibro-cartilage, the cartilage of the nasal septum down through the upper lip by the margin of the left ala and through the lower lip about one inch. The wound extended through the nasal fossa, fracturing the hard palate and dividing the soft parts of the roof of the mouth. The tissues and alveola process were divided between the first and second bicuspid above, and the crown of the second bicuspid below was broken off. The skin was brought together by sutures and adhesive strips, taking the precaution to engage the mucus membrane just below and at the margin of the left ala. March 14th, eleven, A. M., bowels confined, slight traumatic fever. Ordered one ounce castor oil. March 16th, eleven A. M., free catharsis from castor oil. No fever; some fetor from excretions from mouth. Ordered a solution of carbolic acid and water, to be used as a mouth wash every three hours. March 18th, wound completely united; removed sutures, and discharged patient.

The following are reported by H. W. Bassett, M. D., of Huntsville: Case I.-Comminution of Foot and Leg-Amputation-Recovery.On the 26th September, 1869, was called to see Solomon Combs, a brakesman in the employment of the Memphis and Charleston Railroad. Found him suffering very much with his leg and foot, which had been crushed by the wheel of a car, which he had attempted to enter while in motion. The whole foot and leg was mashed into a jelly. He had not recovered from the shock at eleven, A. M. I administered half grain sulphate morphia, and sent for a consulting physician and my instruments. In about half hour Dr. A. R.