MEDICAL TOPOGRAPHY AND EPIDEMICS OF THE undersigned, appointed by the American Medical Association, at the session held in Philadelphia in the year 1855, to report on the Medical Topography and Epidemics of Maryland, and having associated with himself C. C. Cox, M.D., of Easton, and A. M. White, M. D., and Edmund G. Waters, M. D., of Baltimore, respectfully offers the following: In the section of Maryland lying on the east of the Chesapeake Bay, and in those parts of the western portion remote from the large cities, we are seldom visited by epidemics. With the exception, probably, of influenza, which pervades whole continents, other epidemics--as scarlatina, variola, rubeola, pertussis-are often limited to narrow bounds. From dysentery we receive sporadic visits every year, but many years sometimes pass before it appears as an epidemic. In this report I shall confine myself to brief notices of the most important. TYPHOID FEVER.-Many pages have been written for the purpose of settling the question as to the name which would most clearly designate the disease known as typhoid fever. It has been called nervous fever, typhus mitior, dothinenteritis, gastro-enteritis, continued fever, enteritis, &c. &c. To all of these some objections might be urged, but it is not my design to enter into the discussion. The term typhoid fever, not less objectionable than others, is that by which the disease is most generally known; and though I have seen it run its whole course without evident enteritis, rose spots on the abdomen or elsewhere, diarrhoea, or tympanitis, I retain the name for the peculiar affection which in many instances exhibits all these signs. This form of fever is said to prevail only in regions exempt from malarious influence. This is not always true; but it is true that in those parts of Maryland where the endemic bilious fever is known, typhoid fever is seldom seen in autumn. For some years past— 1854, 1855, and 1856—our bilious endemic has been of rare occurrence in Kent and the neighboring counties, and in these years typhoid fever has prevailed to an unusual extent, even in the autumnal season. Many more cases, however, occur in winter and spring; and the pneumonia and erysipelas of those seasons are accompanied by a typhous grade of fever. To what influence our comparative exemption from the annual visits of bilious fever and its sequelae is to be attributed, is a question which has not been satisfactorily answered. The average temperature of the summer and autumn of the years 1854, 1855, and 1856, has been about the same as in preceding years when the disease in question prevailed extensively; and the annual decomposition of vegetable growths has, in fact, been greater, in consequence of the great increase in the productiveness of the land. We must look, then, to some other source for the remote cause of bilious fever. The diagnosis of typhoid fever is not clearly marked in the first stage. The symptoms are almost identical, excepting in the graver cases, with those of the ordinary endemic remittent which prevails throughout the eastern portion of Maryland, and in the vicinity of the watercourses which empty into the Chesapeake on its western side. In a treatise on a disease so well known, and on which so many volumes have been written, it is deemed unnecessary to enumerate the symptoms. A few days will remove all doubt with regard to diagnosis. From the commencement, the physician will proceed cautiously in using his remedial agents. A mild cathartic, of which some preparation of mercury should constitute a part, should be administered; and if this should not remove or decidedly mitigate the usually attending cerebral distress, a few leeches may be applied to the temples, or cups to the back of the neck, near the base of the cranium, with much benefit. If pulmonary symptoms present themselves, cups to the thorax, or near the spine, as close to the part affected as possible, together with the ordinary mercurio-antimonial treatment, will be found not only useful, but indispensable. If there be much tenderness over the iliac region, indicating enteritis, leeches, associated with mild saline aperients, should be applied. Warm poultices over the abdomen, and mucilaginous drinks, are beneficial. If the tongue be red and dry, and especially if coexisting with tympanitis, much relief may be confidently expected from the use of the oil of turpentine in the form of emulsion, in doses of ten to twenty drops every two or three hours. It may be well here to remark that, though diarrhoea be absent, the stomach and bowels are unusually sensitive to the operation of cathartics, and, of course, much more readily acted upon than in other fevers. The mildest aperients, therefore, should be administered when required; and for this purpose a Seidlitz powder, emulsion of oleum ricini, or Rochelle salt, will be found sufficient. The existence of those morbid changes in the intestines, and especially in Peyer's patches and Brunner's glands, so much insisted on by authors, I have not been able to verify by post-mortem examinations. In country practice, death from this fever is rare, and permission to examine bodies after death is almost always refused. The existence of such changes is not disputed, and that in consequence of them there is danger to be apprehended from perforation of the intestine. This consequence, if not prevented by previous treatment, is, in a great majority of cases, surely fatal. Generally, there is more danger to be apprehended from pulmonic complication, especially when occurring in the second or third week. In the first week, such local complication is no more dangerous than in ordinary bronchitis or pneumonia unmixed with typhoid fever, but generally gives way to local bleedings by cups or leeches, the mercurio-antimonial treatment, and blistering. Uncomplicated by local derangements, typhoid fever, as seen in country practice, generally runs its course free from danger, if treated with due caution, without too much professional interference. A "masterly inactivity" is the better policy in such cases, but there must be an unceasing watch kept up for occasional complications. The medical attendant will always find more or less disturbance from defective or vitiated secretions. To correct these, small doses of calomel or of the blue pill, associated with bicarbonate of soda, chlorate or tartrate of potash, with gum-Arabic, will generally succeed. Blistering the extremities, so much practised many years ago in fevers of low grade, seldom does good, but, on the contrary, much mischief, by producing extensive sloughing. Quinine, now much employed by practitioners in large cities, in the vain effort to cut short the fever, has proved in my hands utterly useless during the first and second weeks of typhoid fever. In the last stage, when the disease in malarious districts sometimes takes on a remittent character, and may be supposed to partake somewhat |