surgeons' reports KENTUCKY SECOND DISTRICT. 365 



chrouic portal congestion of that organ, with the blood both in the liver and general circulation laden 

 with vitiated elements of bile and other impure particles, and where remittent fever, whether sligiit 

 or considerable in degree, is added to make up the sum of the disease. This, in the absence of all 

 the characteristics of typhoid fever, is taken for the latter disease. Tlie blood in typhoid fever is 

 also perverted; but it is of a diss^olved character, and does not admit of speedy depuration, as in 

 the above-mentioned condition. The humoral element in the example given is ignored, as well as 

 the diseased state of the liver, which constitutes its main part. Often in such cases, after quantities 

 of quinine have been given without the fever being conquered or the condition otherwise inqiroved, 

 a rash and heroic mode of reasoning is instituted. It begins and is stated in this way : it is obsti- 

 nate like typhoid ; it will not yield to quinine ; therefore it must be typhoid. The extent to which 

 this has been carried, I think, has never been fully comprehended. 



This mode of reasoning is only one instance out of many of a kindred nature that might be 

 cited. The disease has a treatment tliat is appropriate to it to shorten its duration and hasten a 

 return to health; a treatment that will siniply put all in order that is out of order: a chronically- 

 engorged liver, which nearly always has coupled with it sluggish action, is to be put in order ; the 

 same must be done for the vitiated blood circulating in the whole vascular system— it is to be put 

 in order through depuration as far as practicable. But when the rule of exploration is passed by 

 in silence, and the expectant plan resorted to, which leaves all of this diseased state unrecognized 

 and unattended to, what is there left of medical .science ? Pathologists look upon and use this 

 rule as a primary one in their researches for disease to yield them perspicuous results, and give 

 them more of certainty in its treatment than from any other. It is unquestionable that the French 

 pathologists, through Louis and others, have made many advances in medical science : they have 

 discriminated between typhus and typhoid fevers, and between the latter and symptomatic typhoid, 

 and between tyidioid pneumonia and the three former, by which developments all four of them 

 stand out in classification as belonging, through a principle upon which the classification is founded, 

 to the same family, and, save symptomatic typhoid, were shown to be in reality separate and dis- 

 tinct diseases. The latter is equally distinct, but dependent upon a previously-diseased .state. It 

 requires but a moment's reflection to be assured that the advance did not end here, but that 

 another group— that of the malarial class— through them and others have been equally explored 

 and comprehended. # * # 



J. M. BEST, 

 Surgeon Board of Enrollment First District of Kentucky 

 PaducAH, Ky., Juhj G, 1865. 



KENTUCKY— SECOND DISTEICT. 

 Extracts from report of Dr. J. W. Compton. 



* * * I ]jad previous to this time some twelve months' experience in the field in 



performing the active duties of surgeon of a volunteer regiment. 



The number of men physically examined by me from the 15th day of September, 18G3, to the 

 20th day of May, 1865, was about eight thousand five hundred. 



The geographical features of this district are diversified. The eastern third, embracing Breck- 

 enridge, Grayson, Hancock, Butler, and Edmonson Counties, is broken and hilly, almost mount- 

 ainous. Although no great elevations are attained, the country has a rugged, mountainous appear- 

 ance. The geological formation is principally limestone. Bold, running springs, of clear, excellent 

 water, are very abundant; and the numerous large creeks furnish excellent water-power for mills 

 and manufactories. The vales between the hills and the sides of the hills liave rich, productive 

 soil ; and the bottoms bordering each side of the streams through these counties have a dark, allu- 

 vial soil of exceeding richness, which produces the most luxuriant vegetation. 



The remaining portion of the district is not so rough and hilly, but is undulating, with large 

 tractsof flat land, having rather a marshy aspect until cleared, when it becomes the most pro- 

 ductive farming-land. Although well watered by streams navigable for steamboats, and others 



