13. Congestive Fever. Syn. Pernicious fever. Typhus petechialis—Spotte fever. Cerebro-spinal meningitis —Brain fever. By T. II. Squire, M. D. Communicated to the Society by the Secretary. During the winter and spring of 1857, an epidemic, commonly called the spotted fever, prevailed in the villages of Elmira and Hoiseheads, and, to some extent, in other parts of Chemung county. The newness of the disease in this locality, and the fact that other portions of the State and country suffered more or less from its visitation during the same period, are a sufficient apology for the following list of cases and subsequent remarks: Case 1. Lafayette Tillotson, a healthy boy, fourteen years of age, living on Lake street, Elmira, after retiring to bed on the 23d December, 1856, was seized with prfin in his head and neck, with chills and vomiting. These symptoms continued through the night, and the next morning he had also severe pain in his arms and legs. At night he was delirious, and the power of speech was gone. He was not able to protrude his tongue, his jaw was set, and his face was dark red in color. He grew very restless; often tried to raise himself up in bed; tossed to and fro; struck with his arms, and kicked with his feet; groaned, but uttered nothing, save, now and then, '• oh dear." At length, after violent jactitation and overwhelming distress, he sank into profound como, and died 28th of December, after a sickness of only four days. Case 2. On the 1st of January, 1S57, a boy by the name of Walker, thirteen years of age, residing in the village of Elmira, was in the possession of perfect health; he spent most of the day (New Years) away from home; at night he returned to his father's house, and partook of a hearty supper. Durinsr the evening he was playful, and, at the usual hour, he went to bed. 156 [Assembly In the middle of the night he was taken with sickness of the stomach, vomiting, severe head-ache, and soreness of the whole muscular system. Domestic treatment was relied upon till the evening of the second, when Dr. J. F. Hart was called in. At this time there was a feverish condition of the skin and pulse, a slightly furred tongue, congested and watery eyes, with in- creased sensibility to light, difficult articulation, complete de- rangement of mind, and great prostration of muscular power. A cathartic was administered which operated favorably. On the morning of the third, Dr. Hart observed "large circular stains, of a mulberry color, scattered here and there, at wide intervals, over the lower extremities; the skin was so morbidly sensitive to the touch, that even gentle sponging of the surface was dis- agreeable to the patient, and any attempt to move the body from one side of t e bed to the other caused excruciating pain." Nearly the same symptoms continued till the morning of the 6th, when death closed the scene. Case 3. Reported by Dr. Wey. On the 13th of February, at 10 o'clock, P. M., I was called to visit an infant, aged eight months, at the Seely creek railroad bridge, in the town of South- port, two miles from the village of Elmira. It was attacked suddenly, so the father informed me; and just before leaving the house, and not more than an hour or two from the commence- ment of the sickness of the stomach, he observed an eruption of cherry-colored spots on its face and neck, and immediately on observing this appearance, he started on a hand car tor a physi- cian. Forty-eight hours before, during the evening of the 11th of February, a sister of the infant, aged seven years, apparently in perfect health, was attacked in the same manner, and in a few hours, nearly its whole body, but more particularly its arms and legs, became covered with an eruption, or spotted discoloration, at first cherry-colored, but finally changing to a much darker color, and varying in size from the minutest speck, to the extent of a two-shilling piece, and even larger. Dr. Jewell, of Wellsburgh, had seen and prescribed for this child several times, and at the time its father came for me, he stated that it could not possibly survive, and might die before No. 85.J 157 morning. His attention seemed to be continually occupied in concern for his infant son, whom he thought, by speedy atten- tion, would be spared the probable fate of his daughter. On reaching the house, not more than an hour and a half from the time Mr. Parkinson started for me, we found that the infant had been dead an hour, and the other child was rapidly failing. The body of the younger one was yet quite warm and flexible, and was extensively covered with spots, not in the least elevated above the skin, varying in size from a pin's head to a mx pence, and very irregular in shape. They were of a light purple color, and were the largest and most distinct on the neck and chest. The statement of the child's mother, and of the other persons present, confirmed what Mr. Parkinson had mentioned respect- ing its seizure. In three hours from the time it first manifested symptoms of being ill, and while the attendants were engaged in watching the development and extension of the eruptions, it suddenly, to their great astonishment, died. There was nothing peculiar in the act of dying, more than that it ceased to breathe, wThen its mother, and others, least expected such an occurrence. Its body gave evidence, by inspection, that it had been a healthy child. Cose 4. The other child exhibited the following symptoms: the skin was neither hot nor cold, but under rather than above the natural heat; pulse feeble, small and frequent, the uneasy and disturbed state of the child preventing my counting them; she was wildly delirious, crying out that some one was hurting her, that she was drowning, and at times her language was inco- herent; her complexion was of a dull, sodden, or bronzed hue; the nose pinched, cheeks collapsed, eyes sunken, pupils con- tracted, conjunctional membrane congested, and sight certainly lost, a bright light brought down suddenly before the eyes fail- ing to make any impression. She was sensitive to a slight touch over the whole surface of the body, and especially was this sensitiveness remarked when any point of the eruption was even delicately impressed with the finger. Taking hold t>f the hand for the purpose of drawing the arm from under the bed clothes, to feel the pulse, produced a loud cry of pain, and the same 158 [Assembly experiment was repeated with the same result, on attempting to separate the feet from each other. Pressure on the back, abdo- men, or chest, gave the same evidence of distress. She moved her body constantly in bed, throwing her arms about in every direction, and made an unceasing effort to get up. She reached after imaginary objects in the air, and, when, for a moment, her arms were restrained by her side, decided subsultus of the ten- dons at the wrist was tbserved. The mouth was partly open when, for a moment, she appeared at rest, and offered the only opportunity to notice the tongue, which was dry, contract- ed, and covered with a dark fur; the ti.tth were covered with sordes, not as distinct as is sometimes observed in bili- ous fever, and the breath was peculiarly sickening and disa- greeable. Her bowels had been freely moved by cathartics the day before, and the abdominal surface was rather concave than distended. Her arms, legs, and body were occupied by an eruption of spo's, from the size of a cent downwards, irregular in shape, of a strikingly livid color, unaffected by pressure, a slight touch of the finger, as before mentioned, upon any of the spots, was immediately noticed by the patient. Five hours after I left the house, her delirium and restlessness having in the meantime become subdued, she died. Parkinson's family lived in a common board shanty, on the bank of Seely creek, and the appearance of the tenement indicated a very careless and untidy mode of housekeeping. Case 5. A girl, five years old, daughter of Cornelius Powell, living on South Lake-st., Elmira, was taken suddenly ill, during the night of the 21st of February, and died seven hours after- wards, without being seen by a physician. In this case there were sickness at the stomach, vomiting, headache, great rest- lessness, convulsions, and other symptoms, which, together with their speedy termination in death, warrant the opinion that she died of the prevailing epidemic. Case 6. Andrew Clark, a lad twelve years of age, residing on Caroll street, was well and attended Sabbath school on the 24th of February. At 11 o'clock P. M. he awoke from sleep with a heavy chill, severe pain in his head, back and limbs, and soon afterwards, sickness of the stomach and vomiting came on. Dr. No. 85.] 159 Gregg, being hastily summoned, was soon in attendance. He found the patient in great distress, with all the symptoms of col- lapse. This cold stage continued several hours, when violent reaction came on. It was evident that the boy was alarmingly sick. The pain in the head was intense, the joints were painful and tender, and the whole surface of the body was morbidly sen- sitive to the touch. The vomiting did not cease till the next day noon. About this time, twelve hours after the seizure, an eruption showed itself. In this case the spots were, many of them, as large as a dollar, of a dark livid color, and painful when pressed upon. They were the most conspicuous upon the trunk and thighs. The tongue was not materially altered in ap- pearance, the pulse was characterized by feebleness and com- pressibility, the eyes were congested, and every symptom indi- cated a powerful impression upon the nervous centres. At seven o'clock Monday evening there was no pulse at the wrist, the patient was passing into a comatose state, and at two horns past midnight the heart ceased to beat. The eruption remained, and grew darker after death. This boy, previous to his sick- ness, had been subject to many of the hardships and privations of poverty. He was doubtless compelled to work beyond his strength. His food and clothing may have been unsuitable and insufficient, and his sleeping apartment certainly wanted proper ventilation. Case 7. A child, son of Peter Bien,aged sixteen months, living in the eastern suburbs of the village of Elmira, died suddenly on the 4th of March, after an illness of only a few hours. It was not seen by a physician, but I have information which satis- fies me that the case is properly enumerated in this report. Case 8.—Reported by Dr. Tenney.—Child of John Curley, aged six years, living in the Third ward, Elmira. I was called at ten o'clock A. M.; of the 7th of March, and found the boy with dilated pupils, sterterous breathing, and no pulse at the wrist. Death took place half an hour afterwards. The child went to bed as well as usual the night before; at ten o'clock in the evening it made complaint of pain in the legs and back; in the morning those complaints were renewed, and the child cried with violent headache; but the parents, Irish, suffered the 160 [Assembly child's distress to pass unheeded till it was in a dying condition. There was no eruption on the skin. Case 9. Reported by Dr J. F. Hart. Son of James Powell, aged ten years, living on Railroad street, Second ward, Elmira. This boy, having till then, enjoyed good health, was taken sick on the ninth of March. Quite late in the evening I was called to see him; found he had suffered a severe chill; his whole body was cold, and there was feeble pulse, with frequent vomiting and great prostration of the muscular system. By appropriate remedies, reaction was established; but, the disease continuing, the above symptoms were followed by delirium, convulsions and coma, and the patient died on the evening of the 12th March, sixty hours from the commencement of the disease. No erup- tion of the surface appeared. Case 10. Reported by Dr. Tenney. A second child of John Curley, aged five years, was taken with pain in his limbs, at ten o'clock, P. M., tenth of March. Mustard applications were made to the feet, and the child was put to bed. It rested but poorly through the night, and in the morning it began to vomit and to complain of headache. I was called at nine o'clock, A. M. The child was then rational, but very much prostrated, having a small and feeble pulse. Energetic measures were re- sorted to to save the patient's life, but they were of no avail; death took place at five o'clock, P. M., eight hours from the time of my first visit. No eruption. Case 11. Reported by Dr. Chubbuck. At eight o'clock Tues- day morning, March tenth, I was called to see James Dalley, an Irish laborer, thirty years of age, residing in the town of South- port, about one mile from my office. On my arrival, I found him in bed, complaining of some headache, the pain being most severe in the top of the head. His pulse was pretty full and strong, almost to a bleeding point; bowels were constipated, skin dry arid hot, and the patient was inclined to be stupid. On inquiry, I learned that he had been dissipating to excess for two days and nights previously; had attended an Irish wake, where a child had died of the spotted fever; had drunk and danced No. 85.] 161 freely, and in this way was evidently much fatigued. 11is wife informed me that he had been in bed all day, and that she could not induce him to leave it. I gave him a cathartic dose of calo- mel, ordered sinapisms to the nape of the neck, and also to the feet, and directed the friends to let me kn v if he was not better in the morning. Wednesday morning, a little after daylight, a messenger came for me in great haste, saying that the }>atient was worse, and that Drs. Purdy and Flood bad been i< oik -ted to meet me at his bedside immediately. On reaching the house, I found Dr. Flood already in attendance, and Dr. Purdy arrived about the same time with myself. We found the man quite cold, especially thf no pain in the back or bone*;, from the first; urine was of the natural color and quan- tity, no thirst; would never call for water nor drink it unless request. ,\ to do so. There seemed to be a total indifference to things around him; not a question asked from the beginning in regard to the nature of his disease, or its probable termination. 24th. No abatement of the symptoms, nor any perceivable alteration, with the exception of suffusion of the eyes, and an inability to control the lid of the left eye, which had fallen down over the globe, and he was unable to raise it. Pulse sixty-eight per minute, and in other particulars natural; the disease seemed t<» make no impression upon the circulation, unless is was to make it more torpid; the heart did not seem to beat with that degree of force and frequency as in health; and if you were to found your prognosis upon the circulation, the tongue, the secre- tions and excretions, you would be led astray, not anticipating a fatal termination so soon. 25th. His symptoms beginning *o assume a more formidable aspect; the tongue slightlv furred and dry in the middle; when asked to show his tongue, he fumbles it around his mouth, runs the end of it against the cheek, < r up into the roof of his mouth, and takes a long time in getting It out of the mouth. 26th. His head now inclined to the right side and slightly drawn backwards; the conjunction considera- bly injected, and the pupil dilated; a greater degree of stupor, and an increased motion of the right arm; bowels move daily, aided by medicine, and the discharges healthy in color, consis- tence and smell; when aroused, complains of no pain, and be- comes stupid again when left to himself. 27th. Much weaker; impossible to arouse him; his head turned still more to the right and drawn further backwards; the pulse beginning to flag, de- glutition difficult; respiration natural till to-day; now more frequent. 28th. Two involuntary movements from the bowels; urine passed in the same way; eyes intensely injected, and mat- ter floating about beneath the lids. An attempt was made to move him from his apparently uncomfortable \position, by plac- ing him upon his back, and a pillow under his head, but the 166 [AsSEMFLT attempt was immediately abandoned, as it seemed to give him the utmost distress; in fact the head could not be bent forward, or the face turned into a line with the body; he seemed to suf- fer very much till he was put in his former position again. 29th. His head drawn back to an angle of forty-five degrees, and still more inclined to the right; breathing laborious and irregu- lar; pulse feeble, but distinctly felt; extremities warm, and skin natural to the touch. He continued gradually to fail, and died at four o'clock, A. M. March 30th. No eruption or discolora- tion was seen upon him, until after his death, when, a few min- utes afterwards, his body was found to be completely covered with slate colored spots, from the size of a pin's head to that of a shilling piece. The margin of these spots was regular, and they reminded me very much of blood blisters, although they were not elevated above the surface. Case 19. Reported by Dr. Wey. Mr. Scudder, aged thirty-nine years, a healthy, temperate man, by trade a coppersmith, worked in the shop of Horton & Smith, Carroll street, and resided on South Lake street. On Monday, March 23, during a severe storm of snow and rain, in the morning while going to his work, he wet his feet, and remained till noon in wet stockings and boots. The following day his head, back and joints ached, and he was sic,k at the stomach, throwing up yellow matter closely resembling yolk of egg. He passed a restless night, during which the bowels moved twice, from mandrake root, which he was in the habit of taking as physic, and the pain in his head increased as morning approached. At seven o'clock, A. M., of Wednesday, March 25, a neighbor stepped in to see him, and after conversing with him a little while, was so much surprised at observing the change that had taken place in him since the previous evening, that he insisted on going for a physician, and the patient, yielding to his counsel, remarked, " Perhaps it will be as well to do so." The messenger ran over the bridge, and in ten minutes I reached the house. His skin was cool, hands and feet cold, pulse 80, weak and tremulous, respiration gasp- ing, and very rapid. His eyes were closed, and he was already quite insensible. By calling his name in a loud voice, he would for a moment open his eyes, and relapse again into insensibility. No. 85. J 167 Hecoujd not speak, n-.r ronld the least impression be made upon his mind. His eyes were sunken, his features collapsed, and his complexion of a dull ashy color. It was impossible to observe ihe tongue, for he could not be made to respond to my request that he should put it out. He appeared like a dying man. Brandy and water put in his mouth he could not swallow, and we resorted to hot bricks, bottles of hot water, and friction applied to the whole surface of the body. In an hour, after faithfully continuing the heating measures, he was enabled to swallow, with evident difficulty, what was put in his mouth, yet he was as stupid as before. At night, on being asked in a loud voice if he had pain in his head, he opened his < yes and nodded his head, and once or twice, in moving from side t» side, for he had become restless, he said "oh dear,'' but without be- traying consciousness. On the 20th March he was yet unable to speak,and occasionally sank away as if about to die; stimu- lants were given and he revived. His eyes were congested, and he scowled continually. Alternating in this way between sink- ing and rising he lingered till ten o'clock Friday morning when he died, having never regained full, or even partial conscious- ness, since Wednesday morning at seven o'clock. The eruption first appeared on Wednesday soon after noon, when he began to perspire. It appeared on the neck, arms, forearms, thighs, legs, back and groins; was dark like the stains of raspberry juice, was irregular in shape, not elevated above the skin, not removed by pressure, and gradually grew darker as the case advanced. The spots were still darker after death. Case 20. Reported by Dr. Wey. Mrs. John Mathews, aged twenty-three years, was confined on the 21st February. Her recovery was speedy. On the night of the 23d March, she re- tired to bed as well as usual; at midnight a chill seized her, and at three o'clock on Tuesday morning, March 24th, I was called to see her. She was yet cold and complaining of excruciating pain in the head over the eyes, and pain in the back and joints; face red; eyes congested as in measles; tongue pasty and cover- ed with a grayish white fur; stomach quiet; abdominal surface natural; urine scanty. In the middle of the afternoon an erup- 168 | Assembly tion appeared, first on the face, and rapidly spread over the neck, arms and legs; and with its appearance she begun rapidly to sink. The spots were livid in color, more like a blood blister than any I had seen, not raised, irregular in outline, and in size from a three cent piece downwards. She was inclined to insen- sibility, rendered incoherent replies to questions, and breathed heavily and laboriously. Stimulants were used unsparingly, both externally and internally, but without success. The pulse constantly ilagged, and after throwing the body violently about for an hour, and at times screaming loudly as if in pain, she died at eight o'clock in the evening. She lived on Dewitt street, and her husband was employed in the same shop with Mr. Scud- der, whose case is given above. Case 21. Reported by Dr. Flood. Boy five years old, son of Joseph Allen, residing on Hudson street,in the Third ward, was suddenly attacked on the 25th of March, and died the next day. Case 2-2. Reported by Dr. Flood. McNerny left his residence in the Third ward, and moved to the upper end of High street, on the 24th of March. On the 25th, a son, two years of age, was taken sick, and survived only two days. Case 23. Reported by Dr. Wey. Daniel Hawkins, aged thirty- six years, a healthy man, has worked for ten years in the woolen factory. At noon of Thursday, March 26, while at work he ex- perienced a severe pain in the head, over the right eye, but con- tinued to labor during the balance of the day. His back was sore, and he felt that he had taken cold. I saw him Friday af- ternoon, March 27, at four o'clock His skin was decidedly cool to the touch, pulse not above eighty, soft and yielding, breathing unembarrassed; pain in the head so severe that he could not lie still, but threw himself about the bed; pain in the back and limbs; mind clear, countenance pale as if he was faint; eyes brilliant and watery, tongue not dry but thickly covered with a white coat; appetite wholly gone, stomach quiet, bowels natu- ral, urine scanty. Hot drinks were given, hot applications made to the surface, and in two hours perspiration was established. The pulse remaining feeble stimulants were used. The pain in the head constantly increased, and at three o'clock A. M., March No. 50.] 169 28th, it was so intense, though the pulse did not warrant it, that I ventured to take from a vein half a pint of blood. After the bleeding, so exceedingly full and irregular appeared to be the ac- tion of the heart, I was obliged to resort to cordials to sustain him. The pain in the head diminished from the time he was bled, and he ascribes his relief entirely to the venesection. At the time blood was drawn, his pulse ranged at seventy; after the bleeding it fell to sixty, and for two days did not advance be- yond that point, and beat in the following manner: taking its pulsations for a minute, while the second hand of the watch was traversing the dial, the first quarter counted twelve, the second eighteen, the third ten, the fourth twenty. Shortly after, to show its 'irregularity, the first quarter gave fifteen, the second twenty, the third twelve, the fourth thirteen. During conva- lescence Hawkins has been very much troubled with rheuma- tism, with which for years he has been for intervals afflicted.' In relation to the case of Daniel Hawkins, I wish to add some particulars. I visited him daily for twelve weeks. The hast appearance of improvement was not manifested before the ninth week. For about six weeks the symptoms were from day to day nearly the same. He lay upon his back, with his limbs fully extended, denoting great prostration. His tongue was never dry, and much of the time was not even pasty; he required but litt'e drink. Delirium of a harmless, busy kind, indicated by imaginary conversations, by being engaged in labor, by disputa- tions and discussions, persisted in until after he was able to leave his bed, and sit up every day. lie partook of food in quanti- ties greater than seemed good for him, through the whole of his sickness, and after the third week, and until nearly the time of resuming work in the factory, his movements from the bowels, as well as the urinary discharge, took place involuntarily. But once during the twelve weeks, and then only for two days, did the focal discharges differ in consistence, color and smell from natural and healthy evacuations. On that occasion they were loosened by partaking of corn-meal porridge. His strength wasted with the visible waste of his physical I can hear you." 1 he next morning he did not say much, nearly still. It hurt him to move his neck; he died at two o'clock, A. M. thirtieth March. ('asr 25. The following imperfect history of this protracted case was obtained from the child's parents. Eliza Fairman, aged eleven years, living in the third ward; on the 27th of March, the day before her seizure, was unusually playful, sing- ing and dancing with her school mates in a very lively and happy mood. Before going to bed that evening she remarked that her throat was sore. A younger sister slept with her, who, when she came down stairs in the morning, March 28th, said to her mother, "Eliza is sick; she has been vomiting on the carpet."' The mother went up and s eingthat she wa< very pale, and that she had vomited several times, raised her up in bed, but the child was unable to support herself. The fatlier then took her in his arms and carried her down stairs, and placed her in an easy (hair; she appeared drowsy and stupid all day; said her head ached, her faced ached and her neck ached. To- wards evening she grew feverish, and was delirious all night. The next forenoon she seemed a little better, but as ni-ht came on she became very restless and suffered severe pain. Being asked where she felt pain, she replied, " my head aches, my back aches, my legs ache and one arm aches.'' Afterwards she had extreme pain in her limbs, sometimes one limb and some- times another, like inflammatory rheumatism, could not bear to be touched; could not be moved without screaming. For the last two months of her sickness she was helpless, lying just as she was placed in bed, with no movement, from morning till night. The intellectual powers were also prostrated. She be- came very much emaciated, although for a few weeks before she died she took considerable food. Her feet bloated some before the close. Her pupils were, much of the time, widely dilated. She died on the 31st of July, having lingered and suffered through four months. 174 [Assembly Case 26. Reported by Dr. Wey. On Monday, March 30th, I first saw an infant son, aged eight months, of Thomas Mack, living on Fox street. Early in"the morning, suddenly, while being nursed by its mother, it was observed to wilt down, as if it had lost its muscular strength. It becoming pale and sick at the stomach, she concluded at once, that it was attacked with the fever, of which she had heard so much, and she made use of proper measures to induce perspiration. It was generally moist when I saw it, pulse small and exceedingly weak, respi- ration gasping, crying out violently, at short intervals, and re- lapsing into a partially stupid state; complexion very pale; lips without color; tongue covered with white fur; stomach occa- sionally turning; bowels had moved in the morning. Stimulants were given freely; mustard was applied to the feet, ankles, legs and bowels, and the arms were thoroughly rubbed. At dark the eruption showed itself on the neck, chest and legs; at ten o'clock in the evening, the spots were larger and extended more thickly on the surface, and at 12 o'clock the child died in a semi-comatose state. Case 27. Son of James O'Brian, aged four years, living on Water street, was taken April 2d, with vomiting and head ache, and died in three days. Case 28. Miss Sally Hovencamp, aged seventeen years, having no settled habitation, was taken on the 5th of April, at the house of Ira Clark, Carroll street, with chills, headache, pain in the limbs, and vomiting. She was conveyed, through rain and snow, at ten o'clock, of the sixth, to the miserable hovel of her brother-in-law, in the second ward, where with little or no atten- tion, she continued vomiting, and tossing to and fro, in violent pain of the head and extremities, till the energies of her system were exhausted. Her.head was rigidly drawn backwards; she had a cutaneous eruption, distinct and characteristic; she had no congestion of the eyes; she died, neglected of every one save her medical attendant, at four o'clock, P. M., 11th of April. Case 29. Reported by Dr. Chubbuck. Monday, April 6th, at nine o'clock in the morning, I was called to visit Mrs. Sweet, No. 85.] 175 aged forty-one years, living on William street. I found her in a very hard chill, which lasted two hours; severe pain in the fore- head, in the top of the head, the back, legs and arms; the flesh exceedingly tender to the tuuch, especially about the joints, and one of the fingers of the left hand particularly so. During the night she had not rested very well, but in the morning she arose. as usual, and prepared breakfast for the family, but ate nothing herself; and soon after breakfast, she was attacked with the chill, as above.stated. I gave a large dose of quinine and mor- phine, in hot brandy sling; got her in bed and placed hot bricks saturated in warm water, about her, and she was soon in a pro- fuse perspiration. Her pains continued through the day; pulse small, soft and slow; tongue not much coate1; at ten o'clock at night, the stomach was so unsettled, that medicine could not be given. At six o'clock, next morning, I was called in haste to see her; found the circulation almost gone at the wrist; counte- nance haggard; extremities cold; inciting to be comatose; little pain in the head; made free use of stimulants and outward warmth. At nine o'clock, A. M., at my request, Dr. E. L. Hunt was called in. At this time the surface was covered with spots, or petetia, from the size of a pin's head, to that of a three cent piece. Dr. Hunt and myself staid with her most of the day, and we did every thing in our power to sustain the powers of life; but the pulse did not come up at all; she became fully comatose, and at ten minutes before nine o'clock, P. M., she expired, thirty-eight hours from the commencement of the attack. Case 30. This very interesting case was under the care of Dr. E. L. Hart, whose skill and unremitting attention to the patient. through his long illness, are worthy of great commendation. The following imperfect history of the case, however, was ob- tained in part lrom the friends of the patient, and in part from my own observation, as I was kindly permitted to see the young man, on two occasions, during his sickness. David Wilmot Vander Cook,aged seventeen years, residing on Clinton street, was in the enjoyment of perfect health at noon of April 7th. At three o'clock P. M. of that day, being in school. 176 [Assfmbly he was seized with a chill; he looked blue, and, to use his own expression, he was "almost frozen." He went home, and sat by the warm stove till he became quite warm. He slept very well through the night. In the morning he got up and dressed himself, but appeared stiff, awkward, unable to bend; his face looked red, his head and back pained him severely, and before noon spots came out on his skin, by nine o'clock at night he was delirious, and the next morning he had a spell of vomit- ing. As days passed on, hopes began to be entertained of his recovery; but at the end of two weeks, other signs of cerebral oppression showed themselves. Before this, the pupils had been dilated, and now he became partially deaf, and completely lost the use of one arm; at this time also a scowl was frequently seen upon his brow. Without attempting to follow the case from day to day, we will now pass on to the 3'Jthof May, when I drop- ped in to see him. He was lying upon his back, inclining to the right side, with two pillows under his head and shoulders. He was greatly emaciated, his soft white hands delicate and mo- tionless; his eyes open and fixed steadily in one direction; his pupils dilated; his mouth drawn a little to the right side; his hearing, speech, and deglutition greatly impaired; his mental faculties gone, or extremely child-like; his left arm and leg en- tirely useless; his pulse 100, regular, small and rather tense; his bowels and bladder emptying themselves in bed. I staid in the room about twenty minutes, and as I was about to leave, I observed that the patient had closed his eyes, apparently in sleep. He died the 10th of June. Case 31. Saturday, April 11th, daughter of John McGill, (color- ed,) four years old, living on Dickinson St., healthy till Wednesday night, April 8th. After going to bed, begun to cry; complained of pain in the head and legs, and wanted to drink; said she could not get up; was restless and thirsty all night; Thursday morning she vomited, and Dr. Tenny was called in; head has been painful ever since; legs and whole surface tender. Yes- terday they gave her vermifuge, and five worms were expelled, one by the mouth. I have just seen the child with Dr. Tenny; lies on the right side, with the whole spine, and especially the head, firmly curved backwards; any effort to bring the head No. 85.] 177 forwards is forcibly resisted, and pain is produced; she cannot be placed in any other position; is restless, and moves the arms and legs more or less, ami sometimes throws the head still fur- ther backwards; the breathing is now, and has been, embar- rassed and irregular—a few insj.i rations too frequent, then as many either natural or too slow; tongue inclined to be dry. and furred in the middle; pulse 110, and otherwise not remarkable; no vomiting at present; eyes not congested; pupils natural; slight dulness of the eyes; semi-comatose; no appetite; n> thirst; had some chills yesterday; starts, as usual, with worms; skin natural ami dry; child cries as if in fear, especially when twitched, or moved in any direction. Put the child in a warm bath, wrapped it in flannel and put a blister along the spine. Six o'clock P. M., child lying on settee by the wall; wrapped in flannel and blankets; lies all the time on the right sjde; head thrown far backwards, and spine much curved; utters a cry of distress every few moments, and at the same time tries to throw the hips still further backwards towards the head; with each cry, also, the left arm is elevated and thrown back- wards; skin quite hot and dry; tongue nearly clean and slightly dry; eyes not congested—pupils natural; pulse frequent—arm not still quite long enough to count them—say 140; no spots; surface sensitive; turned the child upon the left side; cried much, and soon got back into the old position; respiration be- coming a little hoarse; does not talk; cannot swallow; the child must die soon. Sundav, six o'clock P.M.—The child main- tained the same symptoms all night, and died this morning at seven o'clock; body warm at death. Secfio Cadaver is.—The neck, which was so rigid yesterday. now perfectly flaccid, and the rigor mortis very slight in every other part of the body. Placed the body on the table; made an incision from ear to ear; turned back the scalp; sawed through the scull and removed the cap very carefully; nothing remark- able in the external appearance of the dura-mater; took the scissors and divided this membrane parallel with the course of the saw; with the forcep raised this membrane so as to expose the lett hemisphere of the brain; this revealed a striking patho- [Assembly, No. 85.J 12 178 | Assembly logical appearance; beneath the arachnoid membrane was a plentiful effusion of yellowish white lymph, filling up the in- terstices of the convolutions; this appearance we marked well; then in a similar manner the right hemisphere was uncovered, and a similar view was there exposed; next we divided the falx at its anterior extremity, and carefully removed the dura-mater; to effect this a little dissection was necessary, just at the sum- mit, where the membrane was slightly attached to either hemis- phere; this being done, we noticed that the effusion was most abundant over the anterior lobe of either hemisphere, and about the summit of the right. Next, with the scissors, we divided the first and second nerves, when the brain tipped back far enough to reveal much of the same fluid at the base of the brain; a perfect pool of sero-purulent fluid filled the foramen magnum; the fluid in the sub-arachnoidean spaces was abund- ant, and instead of being limpid, as in the healthy state, was thick and sero-purulent in character. The substance of the brain was injected with red blood, which exuded freely from the cut surface. The left cavities of the heart were empty; the right auricle was dilated by a large yellow coagula. The stomach was much softened at its greater cul-de-sac, so much so that it gave way on being elevated with the fingers, allowing its con- tents to escape into the abdominal cavity. Nothing else wor- thy of note. Case 32. Elijah Van Sickles, aged nineteen years, a common laborer, living two miles north of Elmira, was taken on the 13th of April with headache, backache and chills. For three days he was in the hands of a mountebank. On the 16th he was taken in charge by Drs. E. L Hart and Chubbuck, at which time his symp- toms were of the most threatening and violent character. The muscles of the neck and back were rigidly contracted, causing opisthotonos, which kept the patient continually in the prone posi- tion. In this unnatural decumbency, lying upon the stomach, with the head rising above the pillow, he remained for the last two days of his life, dying in this condition. The pupils were dilated, and an eruption existed, similar to that of many other like cases. He died on the morning of the 18th, after a sickness of five days. No. 85.] 179 Case 33. Reported by Dr. Stanch lie Id. Julia Whiting, aged eleven years, of good constitution, living on Cross street, was at- tacked on the evening of the 28th of April. She had invited a few of her schoolmates into the house to spend the evening, and, at nine o'clock, while they were dancing, she suddenlv became dizzy and dropped upon the lounge, saying to her mother that there was a strange feeding in her head. She slept well till the latter part of the night, when she awoke with a severe pain in her head. At four o'clock A. M., April 29, she had a hard chill, and vomited three or four times, after which she sank into " a sweet sleep," as her mother described it. At eight o'clock she was moved from the bed to the lounge. In putting on her clothes they discovered an eruption upon her back, and her mo- ther remarked that she had been exposed to the measles, and that they were coming out beautifully. She remained in this comatose condition—"sweet sleep"—until three o'clock P. M., when they thought, from her peculiar breathing, advisable to call in a physician; remarking at the same time that they could not make her know them. I arrived at the house at half-past three o'clock, and found her nearly pulseless, breathing heavily, extremities cold, pupils dilated, and the eyes of a glassy appear- ance; drawing back of the head, and constant sighing; would scream out when touched, or when an attempt was made to move her; she could not bear to have a finger moved. I examined the eruption upon the back; it consisted of small spots, upon each side of the spine, from the upper part of the neck to the sacrum; they were very uniform and of the size of a pins head; the skin was completely covered with them; there were none upon the extremities or other parts of the body; they were of a raisin color. She was immediately put upon the free u*e of stimulants, placed in bed, and hot applications applied to her till profuse perspiration was obtained. The head continued to fall backwards and to incline to the left side, as in the case al- ready described, (IS) and notwithstanding the most energetic measures, she continued rapidly to sink; the sighing became more distressing, and led me to think the influence of the respi- ratory nerves was partially suspended. She laid perfectly quiet during the night, and died on the morning of the 30th, at five o'clock. 180 |Assemblt Post Mortem.—A post mortem examination was made nine hours after death. On removing the clothes from the body, it was found to be covered with purple spots, as before described. The scull cap was removed in the usual manner, and on separa- ting the dura-mater from the membranes beneath, there were slight adhesions near the longitudinal fissures, and upon the anterior portion of the cerebrum; there was no unnatural ap- pearance of this membrane. The pia-mater covering the hemis- pheres of the brain, was congested, and the large veins in their way to the several sinuses, appeared remarkably turgid. The serous membrane covering the brain and upper part of the spi- nal marrow, were found to be the seat of extensive inflammation. The substance of the brain and spinal marrow appeared per- fectly free from any lesion; there was no unusual vascularity indicated, or softening apparent; nor did the ventircles betray disease. The membranes of the spinal marrow were congested as low as examined, and bore the marks of severe inflammation; on cutting into the medullary portion of the brain, blood was seen to ooze out of the small vessels; no other parts of the body were examined. Case 34. Reported by Dr. Chubbuck. Sunday, May 5th, I was visiting a patient with billions fever, at Horse Heads, a small village six miles north of Elmira, and on arriving at the house of my patient, a Mr. Simmons, aged twenty-three years, was lying on the lounge near the stove, in a semi-comatose state. On inquiry, I learned that he was attacked with a chill about four o'clock in the morning; when I saw him it was about ten o'clock, A. M. The chill lasted about one hour, when slight reaction came up. When I saw him he was warm, and had severe pain in the head and back and some pain in the limbs. He was placed in bed as soon as possible, and quinine and brandy, and infusion of serpentaria, were given freely; hot bricks, quenched in water were put in bed with him, and he was soon in perspiration. This course of treat- ment was continued, under the supervision of Dr. Greenman, of Horse-Heads, as long as medicine could be given. I left him at twelve o'clock, and was sent for again at five P. M. I did not arrive until eight o'clock, and then found the patient had been No. 85.] isi dead two hours. A short time before death, spots of a raisin color, from the size of a six-pence downwards, appeared over the surface of the body. He was sick about fourteen hours. Case 35. Reported by Dr. Stanchfield. A female child of Michael Moore aged four years, livingon High street, complained of being unwell, early in the morning of the sixth of May. Her mother paid but little attention to it, as the child had been exposed to measles only a few days previously. She continued to grow worse, became stupid and wanted to go to sleep. At (deven o'clock they became somewhat alarmed, on account of her having a chill, and sent immediately for a physician. I arrived at the house a few minutes before twelve o'clock; found her on the bed, with a shawl thrown loosely over her; respira- tion hurried, and louder than natural; pulse rather slow and very feeble; took no notice of any thing around her, no erup- tion to be seen by the most careful examination. I caused her to be put in bed, gave stimulants, and had hot bricks placed around her; called again in an hour and a half and found her in a profuse perspiration; the whole surface was sparingly covered with dark colored spots, not elevated nor regular in outline; would not disappear under pressure, nor did they in- crease or diminish in size during her illness; she continued to breathe harder, and became more comatose, and died at half past three o'clock, P. M. Case 36. Child of John Conolly, three months old, living in the third ward, was taken suddenly sick, on the 19th of May, and died in two hours; not seen by a physician. Case 37. Son of Win. O'Kief, aged two years, living in the third ward, was taken on the 19th May, with symptoms pecu- liar to the disease, and only survived six hours. Case 38 Female child of Dennis Finnegan, aged fourteen months, was taken with the disease May 21st. and died in twelve hours; the characteristic eruption appeared, and the head was firmly retracted. Case 39. Porter Breese, living at Horse-Heads, aged forty years, while seated in church, Sunday, May 24th, was seized with chills and violent head ache. He was taken out of church 182 [Assembly and conveyed to his home, where, through the following night, he was exceedingly restless, turning and writhing in bed, in in- describable distress. The next morning he was nearly exhausted, pulse scarcely perceptible at the wrist, and respiration labori- ous. Stimulents, warmth and friction induced partial reaction; the skin grew moist, and raised colored spots soon showed them- selves; he said nothing; (it is a characteristic of this disease that patients afflicted with it, no matter how intense their agony, seldom make known their suffering by means of speech;) ap- peared very indifferent to all that was going on about him; pulse very slow even to forty-five per minute; head retracted. This case proved fatal after a period of five days. Case 40. Reported by Dr. Chubbuck. I was called to visit, at Horse-Heads, 27th of May, a boy by the name of Ward, aged seven-years. He had been well all day, and played as usual, until 5 o'clock, P. M., when he came into the house in a chill, and with severe pain in the head and back. His mother, hav- ing hot water on the stove immediately put him into a warm bath, where he remained eight or ten minutes, and was then taken out, wrapped in flannel blankets and put in bed; hot bricks were placed by his side, a cup of warm ginger with brandy was administered, and a messenger was dispatched for me. I arrived at eight o'clock, and found the boy perspiring freely, perfectly insensible to what was passing, and had been vomiting, at intervals, for about an hour. The pulse was soft, small and easily compressed. I gave a dose of quinine and mor - phine, but in five minutes time the stomach rejected it, with a quantity of bilious matter; and I was not able to get him to swallow any more of the medicine; and at 9 o'clock he was re- lieved from his sufferings, having been sick only four hours. Case 41. Reported by Dr. Wey. Mrs. Asa Sweet, aged thirty- two, living in the third ward, was seized with chills and violent pain in the head on Wednesday, May 27. She was seen by a homoeopathic practitioner, who administered for her relief, but did not visit her again, in consequence of his own sickness. From Wednesday until Friday morning, at 10 o'clock, when I first saw her, she had not taken any medicine, except cathartic No. 85.] 183 pilb, which had operated violently, and of course injuriously; experience has taught physicians, in this epidemic, that all such measures have a direct tendency to depress the vital functions, thereby lessening the prospect of recovery. She was lying on a bed, throwing her arms violently about, groaning and talking incoherently. Her eyes had a wild expression, and the pupils were neither contracted nor dilated, but seemed fixed and im- movable. She could not understand me, when I directed her to show her tongue, and this failure of her mental faculties had taken place within a short time. I could not feel the pulse at the wrist, as it was impossible to hold the arm still for a length of time sufficient, even to count two or three. The entire sur- face of the b dy was sensitive to the touch, and any effort to move the joints, produced an outcry of pain. The neck was stretched back and the head pressed forcibly down in the pillow, and her spine was so rigid that a strong man, or to speak more properly, two strong men, could not raise her up in bed without lifting the whole body. Towards night she became more quiet, a few spots of eruption appeared on the cheek and arms, and at 2 o'clock on the morning of Saturday, May 30th, she died in a comotose s!ate. At the time she was attacked, her son, aged between four and five years, had been sick with the same disease nearly two months, and was then paralysed in his lower extremities. He required constant care, night and day, and the physical powers of the mother had been nearly spent when she yielded to the epidemic influence of the disease, and became a speedy prey to it. Case 42. July 4th.—John Casey, (colored,) aged twenty-three vears, was taken about two weeks ago, with pain in his head and extremities, with chills and prostration. After a few days' continuance, these symptoms became so augmented that he was obliged to take the bed for a part of each day. The pain in his head, especially the posterior part of it, was very severe; there was no vomiting. My first visit to him was on the first day of July, when his symptoms were as above described. His mind was rather obtuse; uttered his words with hesitancy; appeared quite impatient whenever his wife attempted to answer ques- 184 [Assembly tions addressed to him; persisted in telling the story himself, but always took his own time in doing so, and generally stopped before he got through at that. At my visit in the evening he was wild, desiring all the while to have some one near him, and in his embrace; as I was about to leave, he repeatedly called me back, seized my hand and endeavored to restrain; he was extremely restless through the night. Yesterday, in the after- noon, when I called to see him, his brow and face were covered with large drops of perspiration, a kind of sweat which others have remarked in this disease; he exhibited his tongue in an awkward, faltering, ineffectual manner; he spoke but little; could not, or would not open his jaws to take medicine; diffi- cult to raise him up in bed, on account of the stiffness of his joints. The most striking feature of his condition to-day was a corpse- like rigidity of the whole body. This, I was informed, had ex- isted since three o'clock in the morning. At three o'clock in the afternoon, when I visited him, he was lying on his back, with the head turned to the right side; eyes closed and lids tremulous, and when they were forcibly opened, the globe was found to be turned upwards, so as to obscure the pupil; brow and face bathed in sweat; arms nearly extended; fingers semi- clinched; hands and feet tremulous; rigidity well marked throughout the whole muscular system; sub-sultus; made water in bed; bowels not moved in several days; regardless of ques- tions. July 6th, 11 o'clock A. M.—I saw Casey at six o'clock of the 4th, with Drs. Hart, Chubbuck and Stanchfield. He was not quite as rigid as at the previons note; Dr. Chubbuck placed his hands under the patient's head, and by main strength lifted the whole body, the heels alone touching the bed; afterwards I raised him in like manner by the feet, when the occiput only rested on the bed. By considerable force Dr. Chubbuck flexed the left arm, also the left leg and thigh; there was a general re- sistance to all efforts to move the limbs, which appeared so much like volition, that it was long before Dr. Chubbuck and the rest No. 85.] 185 ofus