fullness to the touch. Dr. H. prescribed ice, allowed to dissolve in mouth, and one-quarter doses sulph. morph. every three or four hours. Gave one-eighth grain morph. hypodermically over the abdoContinued supporting enemas, and applied turpentine stupes

men.

and hot water dressing to the abdomen.

14th. Patient remained much in the same condition, and received the same treatment-hypodermic injections of morphia being given morning and evening, that controlling the pain better than the morphia by the mouth.

15th. At 8 A. M. and 7.30 P. M., condition same, and same treatment continued, including hypodermic injections. At 11.30 P. M. was called in haste, with message that "patient was worse than ever, and wouldn't live till morning." Owing to extreme darkness and bad condition of road, it was 12.30 A. M. of the 16th by time I saw him; when found, his condition about same as on night of 13th, except that there was no vomiting, though some nausea and very severe abdominal pain. Injected three-sixteenth grain morphia hypodermically, and in an hour one-eighth grain more, when he soon fell asleep and slept until 6 A.M. At 7 A. M. administered purgative enema, which acted promptly, producing free evacuations of the bowels (two in number), the appearance and smell being the same as that of the matter vomited the 13th, and having, in addition, numerous long, flattened, soapy-looking masses of feces.

Repeated three-sixteenth grain morphia hypodermically at 7.30 A. M. and left him pretty comfortable. Saw him again at 7 P. M. same day, when I was informed he had had a hemorrhage from the bowels of bright red blood, perhaps a fluidounce in quantity. Repeated three-sixteenth grain hypodermic injection of morphia.

17th. Patient slept well all night, as he expressed it," the first night's sleep since sick." From this time on there was no further return of severe pain, and he gradually improved, taking his medicine entirely by the mouth, and taking one-quarter grain morphia every four hours, then every six hours until the 23d, when I stopped the opiate. The evening of 17th began the use of iced milk by the mouth, this being the first nourishment introduced into the stomach since the 11th. To this was gradually added soft boiled eggs, milk punch, and Colden's liquid extract of beef, and similar nourishing diet, discontinuing the rectal supporting enemas the 18th.

23d. Tongue clean and moist; pulse 86; respiration normal; temperature same; no pain, tympanites, nor abdominal distension; bowels regular; tumor still perceptible and hard, but gradually reducing; cheerful, feels well, moves about his room, and is fairly convalescent.

Duration of illness six weeks.

The case in many respects was a rare one, and the cause producing it is not satisfactorily known.

First, there was typhlitis (whether confined to the cæcum, or to its vermiform appendix, or involving both, is a matter of doubt), then abscess, with perforative ulceration of intestine and discharge of pus from the bowels, then peritonitis. The length of time from date of ulceration of bowels and discharge of pus until the supervention of peritonitis, was such as to preclude the idea that it was produced by the perforation of the intestine, nine days having elapsed between the two occurrences.

Dr. H. has suggested that the peritonitis may have been produced by the breaking up of recent adhesions, in the straining and retching accompanying the acts of vomiting, which is very probably the correct theory. The subcutaneous administration of morphia controlled the severity of the pain much more promptly and satisfactorily than when given by the mouth, and its influence was felt for a much longer time than when four times the quantity was taken into the stomach. The injection of morphia into the abdominal surface, though very near the seat of pain, failed to produce much effect in subduing pain, while those injected into the arm always gave prompt relief.

Observation of cases of this kind, while leaving us in doubt as to the etiology of the disease, show the beneficial therapeutic effects of the opium treatment in this class of diseases. All species of mammalia, except the "ourang-outang" and the "wombat," are created with the "appendix vermiformis" as a portion of their anatomical structure; in them the useless constricted portion of cæcum, so named, is wanting, in which respect they are ahead of Darwin himself.

R. B. ELDERDICE.

MCKNIGHTSTOWN, PA., January 1, 1877.

REPORT OF THE ALLEGHENY COUNTY MEDICAL SOCIETY.

As will be seen by the Report of the Board of Health (liberal extracts from which are herewith appended), the city of Pittsburg, during the year 1876, exhibited a decreased death-rate as compared with the previous three years. No disease prevailed to an extent which could be considered epidemic, although smallpox, with the advent of low temperature toward the close of the year, greatly increased in prevalence. Scarlet fever, typhoid fever, and hoopingcough, all exhibited greatly reduced death-rates. The total mortality from zymotic or infectious diseases was much below that of the previous three years.

The disastrous effects of long-continued high temperature upon the mortality of the city was strikingly exhibited during the three weeks ending July 15. During the year, the average weekly mortality was 56. For the week ending July 1, it was 72. For the week ending July 8, it was 79; and for the week ending July 15, it was 121. With the fall of temperature, it dropped in the week following to 70.

There being no data attainable from the city of Allegheny, or from that portion of the county outside of the city of Pittsburg, the following extracts from the Report of the Board of Health of the latter city are respectfully submitted without further comment:

VOL. XI.

Mortality of the Winter Quarter. The deaths during these three months amounted to 630, exceeding those of the previous quarter by 66, and being less by 154 than the average for the corresponding quarter of the previous three years. The mortality of children from pneumonia, congestion of the lungs, and the different forms of bronchitis, aggregated but little more than one-half that of former years.

There were 277 deaths of children under five years of age, making 43.97 per cent. of the total mortality for the quarter, against an average of 47.49 per cent. for the corresponding quarter of the previous three years.

During this quarter 126 cases of smallpox and varioloid were. reported, with 20 deaths; 66 cases of scarlet fever were reported and 30 deaths; 37 cases of typhoid fever were reported and 19 deaths, and 19 cases of diphtheria and 15 deaths.