cases of typhoid fever were reported, but these were few. In addition to the catarrhal and pulmonary diseases, an innocent class of eruptive complaints were very common, as urticaria and roseola, the latter frequently being so severe as to occasion several days of confinement to bed, and in some instances the accompanying fever was of such extent that it was only by the absence of the facial symptoms, and by the varying, irregular duration of the fever, that it could be distinguished from scarlet fever, some cases of which did occur, as did also enough to be noticeable of erysipelas. These diseases were generally mild and manageable, no death being reported from them. February had a milder temperature, 59° 20′ F. Rain fall, 3.03 inches. Prevailing wind, south. The general classes of disease unchanged, but the type of catarrhal and pulmonary complaints milder. Eleven deaths occurred from pneumonia and pleurisy, six of which were among negroes. A case declared to be typhoid fever, and one of hæmorrhagic malarial fever, were reported at the meetings of the Medical Society. In both instances recovery followed. The chief diseases reported as general were congestion of brain and lungs, to which your attention will be further directed. March-Mean temperature, 63° 56′ F. Amount of rain, 9.79 inches. Prevailing wind, southeast. Although the temperature was approaching that of summer, the month was a wet one, accompanied by southeasterly winds, loaded with moisture, the catarrhal diseases were increased over those of the previous month, and we note thirteen deaths from acute pulmonary complaints, including one from croup, two from diptheria, three from cerebro-spinal fever, besides which there were reported twelve deaths by phthisis pulmonalis, and three from hæmoptysis. During the latter part of the month bowel complaints began to be common. In April, with a mean temperature of 68° 85 F., rain fall 2.92 inches, and south winds, acute pulmonary diseases almost disappeared, and in their place we had a large number of cases of dysentery (none fatal), and diseases generally began to assume the malarial form. Many cases of cerebro-spinal fever were reported, which with meningitis, cerebritis, convulsions, and congestion of brain were the accredited causes of death in sixteen instances. Parotitis was epidemic, and many cases of mild erythemata continued during this and the ensuing month. May and June were wet months, the amount of rain fall respectively being 6.18 and 5.18 inches, mean temperature 73° 81' and 81° 86' F., and the prevailing winds south and southwest. The general character of diseases was mild and manageable, consisting largely during May of dysentery and vernal fevers. The marked peculiarity of diseases when severe was a hæmorrhagic tendency, which was noticeable particularly after surgical operations and parturition. A few cases of diarrhoea in children occurred during May, which became prevalent in June, along with a marked number of cases of bronchial and laryngeal cases, with some of rheumatism. The cases of cholera infantum occurring now were generally accused of being obstinate in resisting remedies, and sixteen deaths occurred from this class of diseases. This is, as a rule, our month of professional vacation, the amount of sickness being reduced to the minimum, and although I think there was this season a greater amount of sickness than is ordinary for the month, its fatality was small, deaths numbering but eighty-four, total. [Up to this date no reliable data as to localities of or local causes for disease are available, nor is the registration of causes of death other than inexcusably and shamefully imperfect, often grossly incorrect, and very frequently not stated at all. During June the newly adopted laws in relation to registration of deaths, sanitary inspection, and all matters in relation to public health, were put in force under direction of the Board of Health, and a gradual improvement is perceptible as regards the information obtainable. This note is made to explain the nomenclature of the causes of death, and the large number of deaths from unknown, debility, &c.] In July we had our hottest weather nearly, the mean thermometrical range being 83° 26' F. Amount of rain, 4.24 inches. Prevailing wind, west. During the first third of the month there was but little sickness, and that of a mild type of fever, along with some bowel complaints, these having diminished very much. (At this time, too, our citizens, at least those who can afford it, make their loyal hegira northward, very many scattering among the mountains of Virginia to enjoy for a season the bracing atmosphere of those regions in crowded hotels, while they improve the physique by active exercise-in ball rooms.) At this time the gutters and large drains of the city were in the worst condition, which was occasionally improved temporarily by a flushing shower of rain. The southern and southeastern portions of the city were particularly defective as to drainage, large pools and ponds of water standing in many places, and the point of land known as Choctaw Point swamp, in addition to its naturally bad condition of swamp, covered with vegetable debris, had been made a dumping ground for all species of refuse, from street garbage to dead animals and night soil. In this neighborhood now the malarial fevers began to increase in number and intensity, assuming the congestive type, and often associated with severe enteric complications. Very many, and the most fatal of these cases, occurred in laborers employed upon the railroads, in which instances the diseases were contracted beyond the city limits. The northwestern portion of the city (seventh ward) is bounded by another swamp or creek bottom, and here also many cases of severe malarial fever occurred, chiefly among negroes, the main population of that district. The total deaths from diseases of mala rial origin during the month was twenty-seven, besides four of acute meningitis, which was probably due to the same cause. August was ushered in with a decrease of temperature in the mornings, light northerly winds setting in before day and continuing until nine, A. M. From twelve, M., until after three, P. M., the heat was oppressive, after which it moderated, and the remainder of the afternoon and night was pleasant. The mean temperature for the month was 830 82′ F., amount of rain fall 2.71 inches, and the prevailing wind northwest-notably one of the dry months of the year, December being the only one with less rain. Remittent fevers, some of very protracted character, were the prevailing cases of sickness. These were all, or nearly all, marked by an unusual amount of jaundice, which also occurred even in mild attacks of intermittent. Early in the month the prevalent fevers became much disposed to produce intense cerebral and meningial congestion, which, if not terminating in a few hours either by death. or recovery, was followed by effusion. The cerebral complication was particularly observable in children, occurring generally on the second or third day in remittents, and on the advent of the second paroxysm in intermittents. Even when the above mentioned congestion was not present, the nervous system seemed to feel the full brunt of the illness and suffer great prostration, death occurring in adults usually by coma, in children by convulsions. Other instances occurred in which the attack approached without the symptoms incident to malarial fevers, and assumed somewhat those of cerebrospinal fever, commencing with mere sleepiness, increasing to stupor, retraction of the head to some extent, followed by coma-the base of the brain and medulla being the centres most affected. Mercurial purges, followed by the use of veratrum and quinine, were the remedies most relied on in the cases of fever, the quinine being administered in full doses and early-i. e., in remittents as soon as the bowels were moved, and in intermittents as the fever commenced to abate. Quinine being most serviceable and well borne as soon as the skin begins to moisten, the cutaneous function seems accelerated and increased by the drug. In the cases of meningial or cerebral hyperemia unpreceded by fever, the veratrum was given sufficiently to control the circulation, repeated in doses and at intervals p. r. n., in conjunction with leeches, cupping and cold to the head. Where a prompt impression was by these means made upon the disease the case usually recovered. Quinine was, I believe, invariably used to some extent during the convalescence. Your Reporter used it by enema, as soon as the bowels had been evacuated, being satisfied of its great efficacy in subduing hyperemia, as well as serving as an anti-toxic to malaria. Cases of bilious colic occurred during this month and last, resulting in death in one instance. This form of malarial sickness does not present itself so commonly as in former years it was reported to do. Dysentery was added to the list of complaints, while diarrhoea had almost disappeared. As a small but widely spread annoyance, we note an abundance of furunculi, singly and in crops; the number of persons applying for remedies and met on the streets, with fingers and hands in limbo on account of this Jobish visitation, was noticeable. Slight eruptive diseases were still met with, but not so frequently as two months before. September-Mean temperature, 75° 57'. 3.95 inches. Prevailing wind, northeast. Amount of rain fall, After the first third of the month general sickness was diminished, especially among the whites, and the fevers assumed a milder type, accompanied less frequently by cerebral complications, the chief peculiarity of the malarial fevers being the constant occurrence of acute abdominal pains, often of great intensity, probably the combined result of portal congestion and malarial neuralgia. The first indication in the severe cases was to relieve the pain, for which purpose I found hypodermic use of atropia and morphia most efficient, after which quinine in decided doses to prevent recurrence, which was inevitable without it. Where the pain was not so intense as to require the use of anodynes for its immediate relief, quinine alone was the most effective agent. The doses required were larger than in fevers, cinchonism being the point to be attained and sustained for thirty-six or forty-eight hours, any disagreeable effects of which are promptly subdued by an occasional draught of solution of bromide of potassium. In these cases cathartics would often fail to act until the system felt the effects of quinine, when efficient alvine evacuations promptly followed. The fevers of this period were followed by prostration of very marked character, conjoined with jaundice, before observed; in many cases active stimulants, as carbonate of ammonia and brandy, being demanded for several hours. Several cases of malarial hæmorrhagic fever were reported, in one of which I examined the urine, containing blood and granular casts. This was a case occurring in a pregnant woman, terminating fatally. About the fifteenth of the month, heavy rains occurred for several successive days, followed by a decrease in the number of cases of fever. After the 25th the bulk of sickness was among negroes living in those portions of the seventh ward near the swamp. Catarrhal affections began to occur, fevers continuing, but without the severity of the cases described. October was a continuation of September, except that there were fewer cases of hæmorrhagic malarial fever and more of dysentery. Mean temperature, 70°. Amount of rain, 5.33 inches. Prevailing wind, northeast. November, mean temperature 59°; amount of rain 6.48 inches; prevailing wind north; generally healthy; a few cases of scarlet fever occurred, some from pleurisy, croup, and light catarrhal affections. One death occurred from yellow fever. The patient arrived from Natchez via New Orleans-a stranger-employed by the North western Railroad Company; was taken sick the day of his arrival in the city, dying on the fifth day. December was likewise healthy, bronchitis and pneumonia occurring in persons necessarily exposed to the weather, but there cannot be said to have been any prevalent disease important enough to be observed. By reference to the accompanying table of mortuary statistics, it will be seen the great destroyer of mankind, and saddest of all diseases, phthisis pulmonalis, even in our land of sunshine and seabreezes, carries off the largest proportion of those whose days have been numbered, those of negro and mixed blood being the greatest sufferers. The per centage of deaths from this cause being among whites 13.52 per cent, of deaths from all causes, excluding stillbirths; among negroes 15.26 per cent. Total per centage of all colors 14.4. Negroes lose very many infants by tetanus neonatorum, the per centage being 8.133 of deaths from all causes, while among the whites the per centage is but 1.31. The per centage of deaths from malarial fevers is considerably less than that of either of the above mentioned diseases. Owing to the imperfect registration of deaths prior to June, the calculation in this class of cases can only be made approximately, and for the last seven months of the year, at the season when the diseases generally considered due to the influence of malaria are prevailing, the estimation for the entire year would reduce even this per centage, which is, excluding deaths arising from attacks of malarial fever not contracted in the city, but on the river or in the marshes where railroad employees were engaged, 4.5, including the exceptions made, 6.31 per cent. The death rate, including all causes of death, per one thousand of population is as follows: Whites,- -20.22 per 1,000, (excluding still-births.) Negroes, &c.--40.84" Total population, 26.94 66 Many patent reasons account for the large negro mortality. First. Their universal carelessness of themselves in health, even where circumstances permit or even encourage the reverse. Second.-Dilatoriness in seeking medical aid, (very many dying without such attention,) and neglect in obeying the directions of physicians when called. Third.--Intemperance and licentiousness in both sexes. Fourth.--Those who do not live as hired servants, but either rent or own residences, live in those portions of the city which are notoriously unhealthy. Fifth.--Despondency when sick, and lack of mental as well as physical vitality to resist serious illness, pulmonary diseases either acute or chronic, being extremely fatal among them. Reference to the accompanying meteorological tables, (for which valuable addition to my report, I am under obligations to the courtesy of the officers of the U. S. signal service,) exhibits the fact |