to the extent of one inch. Hemorrhage was considerable, and continued for several hours, though cold water, alum-water, and Mononsel's solution were freely used. Torsion was finally applied to two vessels, which promptly arrested the bleeding. The mucous membrane was then brought over the stump with four silver sutures, a point being left open, corresponding with the cervical canal. On the seventh day the sutures were removed, and the parts were found to have united. Examination one month afterward, the sound passed two and a half inches. The fundus was in its normal position. She had menstruated once, easily, and she expressed herself as feeling better than she had for several years.

Case VI.-Mrs. B, aged twenty-six years, in giving birth to her first child, had a rupture of the perineum, down to but not involving the sphincter ani. Four hours after the accident, she was placed in the position for lithrotomy. The raw surfaces were carefully cleansed of blood and brought together with three silver sutures. Her nurse was directed to inject the vagina twice a day with tepid water. The catheter was used as often as required, and the patient enjoined to lie on her side. The sutures were removed on the eighth day, and union found to be perfect.

Case VII.-Mrs. H, aged nineteen years, in giving birth to her first child, also had rupture of the perineum, to about the same extent as the above case. The same treatment was instituted, except the introduction of the catheter; she living several miles in the country, I was unable to attend to it in person; the use of the instrument was entrusted to the nurse, who I found on my return had been unable to introduce it. On the ninth day the sutures were removed, and the parts were found to be completely united.

Case VIII. On the 4th March, 1871, my friend, Dr. J. S. Macon, of this county, brought to my office J. R., a youth of sixteen years of age, with epuloid tumor, involving the gums of six teeth of the right superior maxilla. It was near the size of a hen's egg, and presented a dark, purplish appearance. We requested several medical gentlemen to see it, who agreed with us that an operation for its removal should be performed, as it had continued to increase rapidly, after Dr. Macon had extracted three teeth, two weeks before. An incision was made through the lip to the nasal septum, thence along the base of the nose to its side, thence up the side to near the inner canthus of the eye. The flap thus made was freely dissected up, laying the tumor bare. A small saw was passed through the bone, up to the lower margin of the molar bone, then with the use of bone forceps, the attachments in the median line to its fellow, and the nasal process were each divided, when the tumor was easily removed, all the diseased bone was then carefully removed with gnawing forceps, and the lips of the wound brought together with eight twisted sutures. The chasm in the bone was filled with lint, saturated with a solution of carbolic acid. The pins were removed on the third day, leaving the thread of silk, which had been passed

around them, supporting the lips of the wound. The parts united by first intention throughout their whole extent. There was considerable sinking in of the lip over the site of the tumor, which has since been effectually relieved by his dentists. I was kindly assisted in the operation by Drs. Carter, Bassett and Pynchon; chloroform was not used; no vessels required ligatures.

W

Case IX.-M. W—, aged four years, daughter of a minister, was attacked with croup on the night of March 10th, 1871. The usual remedies in such cases were used by Dr. Binford and myself without affording any relief for six days, when it became obvious that unless she was soon relieved she would become asphyxiated. After consultation with Dr. M. C. Baldridge, of this city, tracheotomy was determined upon, chloroform was administered, and the operation performed, and a double trachea tube inserted; constitutional symptoms ran very high for two days afterwards, when they began to subside; several pieces of false membrane were expelled through the tube with powful paroxysms of coughing. The dissolving membrane was so tenacious and abundant, that the inner tube was frequently obstructed by it, and had to be removed. Great relief was afforded the little sufferer by the use of the atomizer; the atomized fluid, half grain permanganate potassa to an ounce of water being directed on the mouth of the tube. On the seventh day after the operation the inner tube was removed, and a cork inserted in the outer, and the patient allowed to breathe through the natural passages for several hours. On the ninth day both tubes were removed and respiration was performed regularly. The wound gradually filled by granulations, and the fifth day after the removal of the tubes was entirely closed.

TOPOGRAPHY, DISEASES, OBSTETRICS AND SURGERY OF SPRING HILL, MARENGO COUNTY.

BY GEORGE WHITFIELD, M. D.

Prefatory Remarks.-The writer craves the clemency of the critics, and throws himself upon their generosity by confessing that he is unable to write elegant English. He would explain the dryness of this report by stating that he has had nothing but dry facts upon which to base it. It will be a plain, simple, unvarnished statement of facts.

Topography.-The "Spring Hill neighborhood" may be described as a territory eight miles square, which may be divided into three parts, according to the nature of the soil, viz.: The "Canebrake," the Post-oak," or "Flat-woods," and the "Sand Hills." The "Canebrake" lies on the north, and includes more than half of this territory; the soil stiff and clayey, and varying in depth from a few inches to many feet, and in color from a dark ash to deep black; the general outline rolling; before the war well drained by large canals and ditches, but now, in many places, in a sad state of neglect, containing no perrennial springs, and its water-courses ceasing to flow in summer; formerly heavily timbered and interspersed with canebrakes-hence the name-but now nearly all cleared, presenting large open plantations of great fertility, and before the war, by far the healthiest portion of our neighborhood. The draining canals and ditches carry large volumes of water after the heavy rains at all seasons of the year, but in summer are either nearly dry or contain stagnant water in the lowest places. The now badly drained fields are in many places quagmires, overgrown in summer with rank vegetation, and emitting noxious exhalations. Underlying all this district, and at various depths, in many places coming to the surface, is soft, bluish limestone, which becomes white on long exposure to the air. This limestone has myriads of shells embedded in its substance, and sparingly sulphuret of iron in lumps, some of them beautifully chrystalized. From underneath this stratum when bored through, spouts the water, which supplies the artesian wells.

All the well water in this region, with this exception, is unwholesome, being strongly impregnated with the earthy salts and sulphuret of iron, and tainted with decayed organic matters from surface drainage. Cisterns dug in the solid rock and supplied with rain-water caught in the winter from the housetops-furnish excellent water, cold, clear, wholesome, and pure, except slightly impregnated with lime. That caught in warm weather, abounds in animalcules, and is thought to be unwholesome.

The Post-oak" lies on the southeast and south, stretching round towards the west, so as to enclose the sand hills between itself and the canebrake, and embraces almost as much territory as the latter, differing from it in being, perhaps, a little more level, stiffer, and more clayey in soil, having its limestone foundation deeper, and its chief growth post-oak. Irregularly scattered over it are spots of that singular formation called "hog-wallow" land, the surface presenting a series of little elevations or hillocks, a few yards apart, with little depressions or basins between, which hold water in their clay bottoms like a bowl, none of it being absorbed, but disappearing only by evaporation; these little basins always containing drifted vegetable matter and moisture, await only the action of the hot summer sun to generate miasin of a malignant character. The well-water of this region is abominable, being a vile compound of sulphuret of iron, lime, mud, rotten vegetable matter, and perhaps some sulphate of magnesia. Some few streaks of sandy land in this region occasionally afford tolerable water. Malarial fevers of

all grades are rife; none of the inhabitants escape, and the writer has never yet examined a white person from this district without finding an enlarged spleen, and their complexions indicate the depraved state of their health.

The "Sand-hills" lie near the centre of the neighborhood, between the Cane-brake and Post-oak, and consist of a series of irregular elevations or hills, somewhat higher than the surrounding country, many of them having steep sides, with damp and shady valleys or "hollows," as they are called, between, along the bottom of which run in wet weather small streams, many of which uniting, make creeks, which, ceasing to run in summer, become a chain of lagoons of stagnant, foul water. At the heads of these valleys, and under the steep hill sides are small, perpetual springs, the waters from which are, in summer, drunk up by the sands below. As the name would indicate, the soil is sand, overlying a substratum of reddish clay and sand mixed. The blueish limestone, doubtless, underlies this substratum, as it occasionally crops out on the hillsides, and spots of cane-brake and post-oak land, which always overlie this stone, are found in the hills. Wells in this region afford pure, clear, free-stone water, unless dug in these spots of canebrake, or post-oak. This region is, for the most part, heavily wooded, principally with oak, which furnishes abundance of vegetable material to rot in the damp ravines and valleys. These valleys,

or hollows, as they are called, have an important influence on the hygiene of the community. It has been noticed for many years that families living on the hills near the heads of these ravines, suffer much more from malarial fevers than others, a distance of even a few hundred feet making a great difference. This has been theoretically explained by the resident physicians, on the supposition that the miasm generated in the valleys is drifted up, so to speak, when the winds happen to blow from that direction, and passes into the houses, being concentrated to one point by the sides of the hills as by a funnel. Whether the theory be correct or false, the fact attempted to be explained is indisputable.

Population. The population of our neighborhood is almost entirely agricultural, numerically, perhaps about 2,500 of whites and negroes-the latter outnumbering the former about twenty to one. The whites are nearly all intelligent farmers, and their families in comfortable circumstances, generally of good habits, some of them laboring in the fields, and all the males much exposed to the open air, attending to their farming operations. Nearly all the blacks are tenants, occupying and cultivating the lands of the whites. Their habits and morals are about the same as everywhere else, and too well known to need description here. Suffice it to say, however, that although all are ignorant and superstitious, many set an example of industry and good behavior worthy of imitation by their more intelligent white neighbors.

Diseases.-The topography of this neighborhood would indicate that diseases of miasmatic origin prevails. Such is preeminently the fact, more than eighty per cent. of all cases coming within the practice of the writer, being malarial fevers in their various forms. In short, marsh miasm is the scourge of this county, and makes its impressions on nearly all ailments, rendering the use of quinine appropriate in nearly all of them. No portion of the above described region is exempt from it, but the "Post-oak" is by far the worst afflicted.

These miasmatic fevers usually make their appearance during the first hot weather in June, and prevail with varying intensity until the first cool weather in October, from which time they gradually diminish numerically and in intensity, until winter, some cases, however, of intermittent, and even pernicious fever, occurring as late as February. Calomel, the opiates, quinine, blisters, and rubefacients combined, according to the symptoms, have been the usual treatment. A liberal use of cold water and ice in the hot stage, has seemed very beneficial. Morphine administered hypodermically, has proved to be an admirable adjuvant in bringing about reäction from the cold stage. The writer has very rarely found it necessary to resort to venesection in any of these cases. Chronic intermittents are very common among the whites and mulattoes-never among the negroes of pure, unmixed blood. The difference between the constitutions of the two races in this