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Feeling the responsibility which devolved upon them, as the only representatives present from the American Medical Association, they at once proceeded to forward the measures which they had been appointed to advocate. They are not at the present time able to present the result of their efforts, owing to the fact that the transactions of the International Medical Congress have not yet reached this country. The serious illness of the Secretary-General, M. WARLOMONT, has also delayed that publication several months. They can, therefore, merely report progress. However, from conversations held with various distinguished gentlemen present on the occasion, they feel quite fully warranted in saying that their propositions in your behalf would be very favorably entertained.
Your delegates wish to express the great pleasure and gratification which they experienced in the manner of their reception by the Congress, by the city of Brussels-having been made its guests and by His Majesty, the King of Belgium, at the royal palace.
They desire also to acknowledge courtesies from Drs. EDWARD SEGUIN, of New York; HENRY COLLIGNON, of Brussels; and ALEXANDER OGISTON, Surgeon to the Aberdeen Royal Infirmary, Scotland.
They have referred to the fact that, owing to the illness of the Secretary-General of the International Congress, the publication of its Transactions, in extenso, has been delayed several months.
They are happy to say that they were fortunate enough to secure and bring with them an official copy of the Minutes of the Congress, published in a small pamphlet in the French language. From this document, through the courtesy of Dr. GEORGE W. WELLS, of New York City, a translation of the essential points of what transpired has been made and compiled, under the title, "Brief Résumé of the Proceedings of the International Medical Congress at Brussels, 1875," etc., a copy of which is herewith submitted as a portion of this report.
To the English reading portion of our profession this Résumé will be found of special interest; but the French reading physician is referred to the full Transactions, which may be
obtained from the Secretary-General at a cost in gold of about the same as our own Transactions.
All of which is respectfully submitted in behalf of the American Delegation to the International Medical Congress, Brussels.
EDWARD C. HARWOOD, M.D., of New York,
CLINICAL OBSERVATIONS ON INFLAMMATION
OF THE MASTOID CELLS.
Read before the Northwestern Medical and Surgical Society, November 15th, 1876.
Reprint from the Virginia Medical Monthly, Richmond.
Mr. President and Gentlemen: The paper as announced for this evening is founded upon one case, selected from several which have come under my observation.
It is not my purpose to enter into an elaborate and extended dissertation as to the nature and causation of the affection under consideration. Suffice it to say that the disease, in my experience, is more frequently the result of a strumous diathesis, cold, neglected otorrhoea following scarlatina and measles, etc. It is oftener observed in children than in adults; in the latter, it frequently results from traumatic causes and syphilis.
CASE. Julia Higgins, now before you, aged ten years, residing in this city, had, as I was informed, always up to this time (April, 1874,) been a healthy and active child, with the exception that at the age of six she suffered considerably from whooping cough and scarlet fever, which were both severe. During the paroxysm of coughing, the cerebral congestion was of a remarkable character. She often had bleeding from the nose and ears, accompanied by vomiting. On recovering from her attack of scarlet fever, there remained a discharge from the left ear, which continued until about the middle of September last without interfering with her general good health. A few days before I saw her, while at school, she was attacked with
ear and toothache, in consequence of which she was obliged to go home and remain there. So great was her suffering, that on the morning of April 18th, 1874, at two o'clock, her parents were obliged to seek the advice of a physician.
When I arrived at her bedside, I found her in convulsions. A hot water and mustard pediluvium was ordered, and dry cups were applied to the nape of the neck, but without the desired effect. I then administered chloroform by inhalation, which promptly arrested the convulsions.
I now discovered that her pupils were widely dilated, giving no response to light, and that there was complete paralysis of the right side the latter condition being first made manifest by the fact that when the bed covering was turned down from the chest, she would immediately put it up again with her left hand. The left side immediately responded to irritation; but over the entire right side there was no sensation. I therefore diagnosed compression of the brain, from an unknown cause, and regarded the case as a desperate one. The pulse at the time (three o'clock A. M.) was 160 per minute; temperature. 105°F. I administered* ol. tiglii, gtt. ij, placing it well back upon the tongue, together with an enema,† composed of ol. ricini, zss; ol. terebinth., zss; aq. bul., ziv. In twenty minutes the patient arose from her bed, and walked in a delirions manner about her room, moaning the while; then she evacuated freely both the rectum and bladder; after which she voluntarily assumed the recumbent position-still, however, manifesting traces of delirium. The pupils now appeared natural, and readily responded to a strong light. At five o'clock A. M., the pulse was down to 120; temperature, 102°. I then ordered:
Sig. A dessertspoonful every hour until my return, which was about 9.30 A. M.
On my return, I found her sufficiently conscious to recognize her friends, but some of those whom she knew most intimately she could not call by name. The treatment was continued with slight variation, administering the bromide mixture at longer intervals until the 22d, during which time I had ascertained that the cerebral trouble and hemiplegia were the result of inflammation of the mastoid cells. I determined to operate, and with that view I had this instrument (Fig. 1), made by C. E. Riker, 1227 Broadway, New York.
On the morning of November 23d, 1874, assisted by my friend, Dr. Charles A. Leale, having anæsthetized the patient with sulphuric ether, I made a crucial incision over the mastoid process, about one-half an inch posterior to the ear, down to the bone, which was found to be roughened. About two ounces of pus immediately made its exit. Then with a small trephine (7-16 of an inch, Fig. 1), I cut through the table of the bone, and the removal of a corresponding-sized button was followed by a small amount of pus. The wound was then closed by two sutures, with the exception of the lower portion, which was left open for the exit of pus, aud dressed with cold water.
One o'clock P. M. Patient comfortable, with the exception of slight pain in the region of the wound. Pulse, 106; temperature, 99.8°. Ordered tinct. opii, if necessary to procure
Five P. M. Temperature, 104°; pulse, 106°; tinct. opii given. Nov. 24. 10 A. M. Patient had a good night's rest-sleeping until 8 A. M., when bromide mixture was given, together with generous diet. Pulse, 100; temperature, 98.5°.
Three o'clock P. M., Pulse, 100; temperature, 99.5°. Sprayed the wound with carbolized soap and water, and dressed the same with carbolized tow moistened with warm water.