On motion of Dr. Washburn, Resolved, that the thanks of this society are tendered to the members of the profession in Charleston for their generous accommodation and kind attentions during their present session.

Resolved, that at each annual meeting this society may elect two honorary members who shall not reside within its territorial limits at the time of the election.

On motion of Dr. Washburn, Dr. Clippinger, of Terre Haute, Indiana, was unanimously elected an honorary member of this society.

On motion of Dr. Davis, Dr. E. Reed, of Terre Haute, was unanimously elected an honorary member of this society.

On motion of Dr. Banks, Resolved, that the thanks of this society are due to Dr. T. D. Washburn for the able and impartial manner in which he has discharged the duties of President, during the last year.

On motion, the Secretary was instructed to forward a copy of the proceedings of this meeting for publication in the N. W. Medical and Surgical Journal. Also, that he furnish a copy to the editor of the Charleston Courier, requesting the editors of the Paris and Marshall papers, Greenup Tribune, and Vincennes Gazette, and all papers desirous of promoting the interests of our society, to publish the same.

On motion, society adjourned to meet at York, Clark Co., on the last Wednesday of May next.

S. YORK, M. D., President.

C. M. HAMILTON, M. D., Secretary.

SELECTIONS.

Milk Sickness, Poison, Tires, &c. By W. H. BYFORD, M. D., of Evansville, Indiana.

All the above synonyms are used to designate a well-marked and distinct disease which prevails over a large district of the U. S. A., but which is ignored by every systematic writer on medicine that I have ever examined. Its very existence is denied by many eminent and influential men in the profession. These circumstances serve to exclude it from the approved works on the practice of medicine. Hence all young practitioners are deprived of the proper source of information on the subject. These considerations, I think, justify journalists in occasionally admitting to their pages even rigidly systematic essays upon it, for the benefit of the junior members of the profession, provided that such is the result of the experience of the authors. This preliminary will sufficiently indicate my purpose, Mr. Editor, in offering you the following paper for publication.

Very generally there is a preliminary stage, marked by obvious symptoms. Less frequently the access is sudden, and not preceded by prodromic phenomena. Under the former condition of things, we may expect a more protracted but less severe case; while from the latter circumstance, more gravity in its symptoms and effects and shortness of duration are to be apprehended. The nervous system and digestive organs are the more prominent subjects of premonitory derangement. Lassitude, muscular debility, trembling of the extremities, uncertainty and unsteadiness of gait, easily induced fatigue, shortness of breath, and palpitation of the heart, often present in the precursory stage, make up that ensemble of symptoms known by the name of tires. Connected with these symptoms, we have loss of natural appetite, craving for ardent spirits, nausea, and, upon much exertion, vomiting, sense of oppression in the epigastric region, constipation, and that general but vague uneasiness which renders the patient restless and sleepless. Sometimes, however, he is dull, stupid, and indifferent to surrounding circumstances.

After the continuance of the above symptoms for a longer or shorter time, or in cases where they are not present, in consequence of the application of some exciting cause, the disease commences to manifest itself in a decided me

when the

following state of things may be observed: urgent thirst, vomiting every few moments, with distressing nausea between times, loathing of food, burning sensation and feeling of weight or load on the stomach, and obstinate costiveness, which, when we first see the patient, has probably lasted for several days. The substance ejected from the stomach may be the ingesta merely as water or food with a little mucous, but nearly always it is colored, light green, blue, indigo, or so very dark as to seem black. Upon examination of the ejected material, it will be found composed of two parts, which separate soon after it is discharged into a transparent liquid, nearly or quite colorless, and a more solid collection of coagula (probably the mucous secretion of the stomach) floating in it. The different color of the solid portion causes the various shades of color above mentioned. The taste of this ejected substance is sour, acrid, and sometimes, in the latter stages, otherwise offensive. It generally effervesces with the sup. carb. soda. Often, in the latter stages, it is so very dark as almost precisely to resemble black vomit. The alvine discharges which take place spontaneously, are very dry, scanty, and difficult to extrude, often assuming the shape of small, hardened balls, not generally altered much in color or other properties, except in respect of moisture. The abdominal parieties are retracted and hard, and the pulsations of the abdominal aorta are visible, and perceptible to the touch from the epigastrium to its division. This phenomenon, no doubt, results from the dryness of the fæces and lack of fluid and gas in the bowels, thus rendering their contents better conductors of motion. The surface is generally dry, but not more commonly elevated in temperature, and is usually of a dingy or dirty color. The tongue is almost always coated with a white, brown or yellow layer. The pulse, in the majority of cases, early in the disease, is not much or remarkably altered, perhaps not at all. The breathing is generally more or less embarrassed by a sense of oppression or weight on the chest, interrupted and sighing. This oppression is often a prominent and distressing symptom. A peculiar fetor emanates from the lungs and mouth, which may be regarded as characteristic, and, when once observed, will be readily recog nized by even a superficial observer. This smell is so remarkable, and sometimes so strong, as to be perceptible anywhere in the room, adjoining rooms, or even several yards from the house. Experienced practitioners might, in many instances, form their diagnosis before entering the house, from the peculiar odor on the premises. It is not uncommon, in bad cases, for delicate and sensitive persons to be so much affected by this oppressive and disagreeable smell, as to render them incapable of remain

ing at the bedside, or in the room of the patient. Its almost corrosive pungency would convince an unbiased observer, through one of the senses at least, that there was a peculiarity in it. Comparison being one of the best means of acquainting a person with an unfamiliar subject, I have sought and found one which I think will be regarded as appropriate.

It resembles, almost exactly, a strong odor of chloroform, mingled with the smell of animal secretions. Say a smell of chloroform and the breath of a patient salivated, and we would have it almost precisely. The kidneys secrete scantily, and the urine, though not altered in color or appearance, emits the same odor of the breath. The spirits are dejected, and the patient is despondent. Should no relief be afforded, and the disease continue to advance, the respiration is more embarrassed, and accompanied by a sense of sinking, or as of a void which the patient is unable to fill by the most strenuous efforts at inhalation. The irritability of the stomach increases. The ejected matter, if not dark before, now becomes very dark and scanty, having the appearance of coffee-grounds, and is thrown about without any regard to cleanliness, and with very little effort, the patient either being listless and apathetic, or employed absorbingly with the respiratory efforts. The surface becomes cold, the pulse is small, frequent, and finally fails, which often occurs several hours before death. Not unfrequently, some time before death, while the pulse is small, frequent and weak, the respiration is slow and irregular, to such a degree as to lead the bystander to believe that it is entirely suspended; coma supervenes, which gradually deepens into death. Again, in some cases, after the lapse of several days or a week from the commencement, the bowels either act spontaneously, or having been moved by cathartic medicine, become swollen, tympanitic, irritable, and painful, the discharges are watery, with mucous floculi floating in them, tinged with blood, or scybalous and foetid. The tongue is dry, red and chapped, or coated with a dark, dry fur, teeth covered with sordes, the fauces dry, red, stiff and sore, deglutition difficult, regurgitating emesis of the dark fluid above described, dorsal decubitus, with knees drawn up, retained urine, (often,) coma, small, frequent and weak pulse, hot abdomen, and cool or cold extremities. The inferior maxillary falls, the eyes become suffused with mucous and tears, and injected, and death, after a period varying from several hours to several days, gradually steals upon the patient. If, however, the case is to terminate favorably, after a few copious alvine discharges, the burning sensation at the stomach with the nausea becomes less, the vomiting gradually subsides, mus

cular debility becomes less, the tongue cleans off, the patient experiences a returning but capricious appetite, desiring apparently the most inappropriate diet. The smell of the room is more tolerable, and a protracted convalescence ensues, attended, unless carefully guarded, with many of the symptoms detailed as sometimes promonitory, and not unfrequently their chronic continuance encourages the popular opinion that it never can be entirely eradicated from the system. Occasionally, though not usually, in slight cases, the convalescence is more rapid and complete in a few days, leaving the patient in the enjoyment of good health.

The above is a description of what may be called the simple variety, in contradistinction to two other forms which it sometimes. assumes. It is by far the most common met with in this vicinity at the present time. The two varieties alluded to may be termed, according to the nomenclature in vogue, congestive and inflammatory, according as the attending phenomena indi-, cate the presence of either of these general conditions of the system. The congestive variety is very rapid in its progress, and among the most fatal diseases, equalling, in mortality, (according to the number of cases,) the most fearful varieties of congestive miasmatic fevers of the same regions. This is probably the character which the disease more commonly assumed in the earlier periods of this country's history, as it was then considered the most surely fatal of diseases, in which death usually ensued in a very few days. After suffering from the premonitory symptoms some time, or, otherwise, violent vomiting and incessant retching, a sense of impending suffocation, extreme anxiety, insatiable thirst for water, and often for alcoholic liquors, coldness of the extremities, a profuse, watery perspiration, small, weak and frequent pulse, a glassy appearance of the eyes, great prostration of strength, restlessness, jactitation, suppressed urine, and a wandering condition of the intellect, soon convince us of the great danger of our patient. And the peculiar smell, the condition and appearance of the abdomen and bowels, the almost insatiable thirst for alcohol, and other characteristic symptoms, plainly indicate to the experienced the true nature of the disease. Often this catalogue of symptoms continues without much change, except in intensity, for from twelve hours to two or three days, when, if relief is not afforded, death closes the scene. In other instances,

and they are not unfrequent, coma supervenes upon these symp toms, or without much coldness or change in the pulse, and continues to the end. This form of the disease has never, in my experience, presented itself in any other class of patients