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ORIGINAL COMMUNICATIONS.

SOME ACCOUNT OF AN ENDEMIC FEVER AMONG THE COLORED POPULATION OF PHILADELPHIA.

BY SILAS S. BROOKS, M. D.

In the capacity of Physician to one of the Charitable Institutions of our city, I have witnessed during the past winter, an endemic fever which prevailed to a considerable extent among the most degraded portion of our colored population, residing principally in the narrow streets and courts of Moyamensing.

The greatest number of cases occurred in the early part of the season, and were the most malignant and rapid in their progress. At present few cases are met with, and these are commonly mild, and terminate favorably.

During a period of four months and a half, I saw 55 cases, 14 of which terminated fatally. Its general type was similar to that of typhus, attended with great hepatic derangement.

The premonitory symptoms were similar to those marking a case of common bilious derangement, succeeded in a few days, by considerable febrile excitement; and this, after a longer or shorter time, by general prostration. In fatal cases this was followed by coma, involuntary stools, &c. which usually terminated in death on the 5th or 12th day.

There was generally more or less abdominal tenderness, especially over the epigastric region; and in many, great pain was felt in this region. Throughout the whole muscular system, much complaint was made of soreness, and in many instances of pain. The bowels were generally constipated; yet in many they were preternaturally loose, and attended with vomiting. Urine scanty and highly colored. The skin was unusually moist at the begining, cool and dry in the latter stages. The pulse at first, was

from 80 to 100 per minute, but in fatal cases it often became as high as 140. Headache was common, and sometimes intense. The tongue, in the early stage of the disease, was moist, and covered by a white, thick, and pasty furr; afterwards it became brown, dry, swollen and tremulous; and was with difficulty protruded. Thirst was excessive. Conjunctiva in most cases very decidedly yellow. Mental derangement frequently occurred, which sometimes amounted to wild and furious delirium; morbid vigilance was common. The coma, and prostration, with involuntary stools, always proved grave symptoms.

Only one post mortem examination was made by myself, and that was of a boy 7 years old. No lesion was detected; but in the small intestines thirty-eight lunibricoides were found, mostly of full grown size, and some were at least ten inches in length. When the treatment was commenced within the first few days, it was generally successful. The most efficient agents at any stage, appeared to be the blue mass, castor oil, and quinia. Dover's powder or opium, was often combined with the blue mass, on account of the abdominal pain, nausea, and vomiting. As adjuvants and palliatives, sinapisms, cold ablutions, warm fomentations, &c., were employed. As a general rule, the prostration, dry and brown tongue, sordes, and other symptoms that mark a grave case of typhus, did not supervene where the above remedies were early and freely used.

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The first alvine dejections after the administration of the medicine, were thin, and of a light color; but after four or five doses of the blue mass and oil, they became dark-almost black, and of greater consistence. From this moment, improvement generally became evident, and a speedy convalescence ensued. It appeared as if there had been an accumulation of focal matter in the alimentary canal, which acted as a local irritant-an incubus, that held the patient down; and so soon as it could be removed, the oppression ceased, and health and strength returned. The treatment was unsuccessful when the patient became in the least comatose, with prostration and great abdominal pain; notwithstanding recourse was had to cups and blisters, freely applied, over the seat of local congestion, and to wine, quinia, carbonate of ammonia, internally administered. Bleeding from the arm was

practised several times during the prevalence of the fever; but in general, its effect was to hasten the stage of prostration and its accompaniments. This complaint seemed to commence with the cold weather of last fall, from the same causes apparently, that produce typhus fever; viz: want, and hardships of all kinds, neglect of cleanliness, impure air, &c.

It is well known that these people are peculiarly sensible to the influence of cold; and they are found thrown together in small and illy-ventilated apartments, with but little fire, and provisions the most scanty and poor. Their bedding consists in many instances, of almost nothing; rags, old and filthy carpeting, worn out clothing, and such like, thrown upon the floor of a garret, and sometimes upon the ground of the cellar. Their clothing is of course, insufficient, and their habits altogether loathsome, and calculated to engender disease. The only occupation of many of them is, what they call "ragging and boneing." Numbers of them are seen daily, picking from the gutters and sewers of the city, such fragments of clothing, and bones, as they may find, which serve to make up their wardrobes and supply their tables. The marvel is, that there is not more disease and mortality among them.

The principal Physician to the Alms House, Dr. Benedict, appears to think the fever different from the ship or typhus of the emigrants, and is rather inclined to look for some local miasm as the cause. He says, that about two hundred and fifty cases have been brought to his notice at the Alms House, and that the greatest number came from a comparatively small locality, viz: that bounded by Delaware Fifth and Eighth streets, South and Fitzwater streets. The ground in this location is rather low, when compared with many other parts of the city, and is the very spot on which is found the greatest amount of degradation and wretchedness among the colored population.

Drs. Dunott and Ashton, each of whom had about the same number of cases as myself, give their testimony in favor of its being intimately connected with the ship fever of last summer; that it is the ship fever, modified by the peculiar habits and constitutions of the colored race. Indeed, Dr. Ashton informs me of several cases of ship fever that occurred in his practice last

summer, that strongly resembled the phenomena developed by the subsequent disease among this people.

The whole number of cases, so far as I can learn from various sources, was about five hundred. There appears great uniformity of testimony as to location of most of the cases-that mentioned by Dr. Benedict. The mortality, with my friends above named, does not appear to have been quite so great as my own; this I. attribute to their having had a better class of patients, and of course better nursing. At the Alms House, several post mortem examinations were made, but there was, in general, no particular or uniform lesion found. The solid viscera of the abdomen were frequently enlarged, or changed in structure. Philadelphia, 1848.

A CASE OF CONSTIPATION,
SUCCESSFULLY TREATED WITH CROTON OIL.

BY SILAS S. BROOKS, M. D.

Lucy aged 32 years; sent for the author at about 3 o'clock in the afternoon, of the 23d of 1st Month last-complained of pains, as she expressed it, "all over," and especially in the back; also nausea and occasional vomiting. Pulse was 83 per minute, and nearly natural in force and volume. Had considerable thirst, the tongue brown and slightly furred, the temperature of the skin nearly natural, but dry, some cough, a little soreness on pressure upon the parietes of the thorax, and great epigastric tenderness. Was restless and dispirited. The bowels had not been evacuated for a number of days, and when last open, were quite loose; yet nothing was done to check their action. Had taken several doses of salts, castor oil, injections, &c., without effect. Prescribed four drops of croton oil, made

into four pills with crumbs of bread ; one to be taken hourly, till they operate.

24th, 9 o'clock, A. M. No evacuation of the bowels, pains increased, was restless during the night. Prescribed two scruples of calomel, combined with two grains of opium, to be divided in equal parts, and taken, with an interval of two hours between them. At noon, the same day, no discharge had occurred; the pain somewhat relieved, otherwise about the same. Prescribed two ounces of epsom salts, with one of senna, to a pint of water; and directed a teacupful of the infusion to be taken every two hours. Also, large domestic enemata to be administered every two hours.

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6 o'clock, P. M. Same as at noon; the first two doses of salts and senna were retained, but the subsequent ones were rejected. The enemata quickly came away, nearly unchanged in appearPulse slightly quickened. Examined, to ascertain the presence of hernia, but none was found, nor any other cause to prevent the operation of the medicine. Ordered thirty grains of calomel in three powders, one to be taken every hour, also the warm hip bath.

25th, A. M. In the course of the night, a light colored mucous and watery discharge had occurred from the bowels, to the amount of about ten ounces, which seemed to afford partial relief. As she appeared very comfortable, it was thought best to trust to, and watch nature a short time.

5 o'clock, P. M. No more evacuations, the pains began to return, prostration to supervene, the pulse to quicken, and the mouth to exhibit signs of a mercurial influence. Ordered eight drops of croton oil in pills of one drop each; one to be taken every hour till they operate. Large flannel cloths to be wrung from hot water and laid around her body and extremities, and renewed once or twice as they became cool.

26th, A. M. Very much better; had three copious alvine discharges of a fœcal character, mixed with a good deal of mucous. Took five of the pills before the bowels moved, which was not till after midnight. Pulse was soft, slow, and weak, and she had some appetite. From this time she improved rapidly, and soon recovered her usual health.

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