REPORT OF THE LEHIGH COUNTY MEDICAL SOCIETY. THOUGH free from serious epidemics, with the single exception of scarlatina, the past year has had several periods when some special form of disease was quite prominent, and the death-rate has been larger than the average for a number of years past. Scarlatina made its appearance in the fall, and continued during the winter and early spring. It was at no time especially virulent in its epidemic character, though all degrees of severity were manifested in individual cases and sometimes in the same family. One fact in connection with it was especially remarked by all our phy sicians, viz., that those cases occurring during the early part of the winter were almost invariably followed by albuminuria and anasarca. The latter cases have generally been free from this sequel. The total number of deaths from scarlatina, in Allentown, during the year ending April 30th, 1876, is thirty-seven, the proportion of fatal cases not being above the usual average. It is impossible to ascertain the precise number of deaths in the county outside of Allentown, but the ratio is thought to be about the same. On the 1st of May a few cases still remained under treatment, but the epidemic was practically about at an end. A few sporadic cases of typhoid fever have occurred during the year, and last fall a considerable number of cases of this disease appeared within a circumscribed district of very limited extent on the eastern bank of the Lehigh River, directly opposite the city of Allentown. It did not spread from that centre, and it was noticeable that the western bank of the river, at that point thickly popu lated with the poorer class of people, presented not a single case at that time. The disease was not traced to any known cause. Following a summer of unusual drought, malarial affections were more than ordinarily prevalent during the fall and early winter. Well-marked idiopathic intermittent has at all times been comparatively rare in Allentown and the vicinity, though it is the united. testimony of those who have been long in practice here, that the last twenty years have shown a steadily progressive tendency to affec tions of this class. This tendency is more marked in some localities than in others where the obvious surroundings would suggest no cause for the difference. It is largely manifested in complications of nervous and digestive disorders, often quite obscure in character, but almost invariably benefited by the use of quinine in antiperiodic doses. It may be pertinent to remark in relation to this gradual increase of malarial disease among us, that though the place is noted for cleanliness, the water supply (from a carefully managed reservoir) abundant and pure, the natural surface drainage excellent, and there is almost a total absence of those natural conditions generally supposed to be productive of malaria, yet there is no adequate system of sewerage. The immediately subjacent rock is a cavernous limestone, and advantage is taken of this fact to avoid the construction of proper sewers or cesspools by sinking shafts close to the houses until a seam or cavity in the rock is struck, and then lining the shaft with brick and covering it, to allow all the refuse from sinks, waterclosets, etc., to flow therein. These seams and cavities run in all directions, and many of them have natural streams of water flowing through them. Where the outlet of any particular rift may be, is not generally known, nor is any effort usually made to ascertain that, but it is not unreasonable to suppose that there must be some place of escape, and the uneven surface of the ground affords abundant opportunity for the outpouring of these streams of pollution upon it at very many points. A large number of cases of cholera infantum occurred during the latter part of the summer in Allentown. While no part of the city was in any measure free from it, only in those wards chiefly inhabited by the laboring classes was it especially fatal. Most of these people live in a district lying between the Lehigh and a small tributary known as the Jordan, considerably below the level of the rest of the city. Many of them have had little or no work for the last year or two, and consequently their food has been insufficient in quality and quantity. In many families, fresh meat is not seen for weeks together. Here the disease assumed for a short time almost an endemic form. The total number of deaths from this cause is twenty-two. Pulmonary affections were more than usually common during the winter, both in the city and throughout the county. It will be remembered that the winter was what is commonly known as a very open one. Pneumonia was unusually fatal, many cases assuming a typhoid form. In obstetrics, there has been throughout the year a marked tendency to puerperal fever. Some practitioners have observed symptoms of this condition in nearly every case they were called to attend, and this without any such thing as an epidemic, and with few if any deaths from this cause. A number of our physicians have met with great success in the treatment of febrile conditions in which exhaustion was very great, as manifested by high temperature, frequent pulse, restlessness, and sometimes delirium, as, for example, in typhoid fever, typhoid pneumonia, puerperal fever,, etc., by the exhibition of quinine in doses of from four to eight grains repeated every half hour until twenty grains or more have been taken. All who have tried this plan report, in every instance, great amelioration of symptoms following the treatment, the pulse becoming less frequent and stronger, the temperature lower, and the restlessness and delirium abating. No evil effects have been observed where the treatment has been continued day after day, but in some cases in which it was used on alternate days, the febrile symptoms have returned in their full intensity on those days when it was omitted, and have been almost entirely absent on the days when it was used, the abatement commencing soon after the administration of the quinine, without any intervening period of excitement, and continuing until the next morning. In all those cases in which it was used continuously during the height of the fever, it seemed to hasten recovery, as well as to add materially to the comfort of the patient. The accompanying mortuary tables relate only to the city of Allentown. They are compiled from the carefully kept records of the Health Officer. Where the cause of death was too vaguely expressed to be intelligible, or where the assigned cause was obviously not in itself fatal, it has been classed in the table as "unknown." It will be seen that the deaths of children under one year of age are within a small fraction of twenty-five per cent. of the entire mortality. Even after making due allowance for the various causes mentioned as having during the last year specially tended to this result, the proportion is much larger than should exist. Ignorance and neglect are certainly responsible in a vast degree for the fatality among infants. It is much to be regretted that no vital statistics are kept in the county outside of Allentown. IRENEUS P. DAVIS, |