number of patients in the hospital was upwards of one thousand. Every variety of fever was to be seen prevailing together, but the predominant type was a remittent, attended by headache and great flushing of the face and redness of the skin generally, but easily controlable. This remittent was evidently more prevalent among females than males. By some physicians it was thought to proceed chiefly from exposure to the sun, but, if this were true, the laboring man should certainly have suffered most. This flushing of the skin was observed in all cases, whether in hospital or private practice. Hemorrhage from the nose was observed in many cases, and was generally followed by happy effects. Hemorrhage from the gums, and slight jaundice, were observed in a few cases. All this will be more fully noticed in my report on fevers.

The Board of Health report 995 deaths, for the five weeks ending on the 3d, 10th, 17th, 24th and 31st. Of these, there died of all fevers, 292; of yellow fever, 64; of affections of the brain, 210; of sun-stroke, included in the latter, 43; of cholera, 8. The week ending on the 3d was the only one that has yet passed without any death from cholera; that ending on the 10th contained 1; on the 17th, 2; on the 24th, 2; on the 31st, 3. I saw one case in private practice, which proceeded mildly, and ran into rice-water stools, when it was arrested and cured. Immediately after this the patient had intermittent fever.

Bilious colic has prevailed to a very considerable extent. I find two deaths from it reported by the Board, though there are twenty from enteritis, many of which, I have reason to believe, were consequences of this disease. Farther investigations have gone strongly to strengthen my former suspicions that this colic, and various affections of the brain and nervous system, which have been observed at the time, all proceed from lead poisoning. I have discovered that not only soda-water, but all the hydrant water used in this city, is more or less impregnated with lead. It is not generally known that various affections of the brain and nerves may proceed from lead, besides colic. I have said that there were 210 deaths this month from affections of the brain, including convulsions, congestion of the brain, cerebritis, menengitis, apoplexy, etc. Now, what proportion of these deaths

may be attributable to lead poisoning, can only be inferred from the extent of exposure. I shall show, in a special report, that the exposure in this city is far greater than ever was dreamed of.

I saw a man at the Charity Hospital who had passed through violent colic, rheumatic pains and convulsions, followed by paralysis of the arms: he was a hatter, and said he had not been exposed to lead or paint in any way that he knew of, except by cleaning a painter's hat occasionally. He was intemperate, and drank brandy freely, but no soda-water. He said he had been thirsty for a long time, and drank a great deal of water. He drank hydrant-water, and unless this contained lead, we could not discover how he had imbibed the poison. Ought not this to be pronounced a case of lead poisoning, whether the lead could be detected or not?

The number of deaths from coup de soleil, or sun-stroke, has been very large (43). These, I presume, may be chiefly attributable to the extraordinary heat. Strange to say, horses are liable to this complaint, as well as men. Dr. Elliott, an intelligent and educated farrier who stays at Tattersall's livery stables, told me, that on the 5th of August, an extremely hot day, he was called to eighteen horses that had been struck down by the sun: more than half of them died.

The Board of Health report thirteen deaths from apoplexy, 20 from convulsions, and 21 from sun-stroke, for the week ending the 10th. The fevers of the month have displayed head symptoms stronger than any others. Most of the fatal cases terminated in congestion of the brain. Intermittent and congestive fever, dysentery, diarrhoea, etc., have prevailed, as usual. So much for the principal diseases of the month. I shall dilate more fully on the fevers and lead diseases, in my special reports.

The fevers of the time have given rise to much inquiry and rumor among the editors of newspapers and citizens generally. Many inconsiderate persons take upon themselves to deny that there has been any yellow fever in the city during this month, notwithstanding cases have been reported by some of the most experienced and intelligent physicians of this city and Lafayette, such as Drs. Lambert, Lewis, Davizac, M. Dowler, and others. The fact is, the prevailing type of remittent fever

approaches as close as possible to yellow fever. The hemorrhagic tendency has not been strongly marked as yet, though it is evidently increasing as the season advances. After the occurrence of a few more cases of black vomit, many will be pronounced yellow fever which are not now recognised as such. All this confirms what I said in my report on fevers in my first volume, viz.: 'There are no indisputable diagnostic marks of yellow fever previous to the approach of the crisis.' Death is too often required to settle the question. Before yellow fever is declared to be epidemic, physicians are completely at a loss about the diagnosis of many fever cases. After that, everything among unacclimated subjects is yellow fever, down to the mildest remittent. Among acclimated subjects, again, they admit nothing to be yellow fever unless it terminate in black vomit, or other hemorrhage, and jaundice. Many cases of the present remittent fever have been seen in persons who have had the yellow fever.

As usual, there have been all sorts of predictions in regard to the coming epidemic. We have had just such weather as was thought would certainly bring it about, but as yet it is deferred, though it is by no means too late; severe epidemies have broken out in this city at a later period.

In pursuance of their duty, the Board of Health have had the streets kept cleaner this summer than has been done for years. The health-wardens have been vigilant and attentive in having all filth promptly removed.

The river has fallen to a low stage.

SEPTEMBER.

The weather during this month has been, for the most part, dry, fair and warm. The autumn was ushered in with a very cool spell, and the nights were generally cool and pleasant, but the sun was generally oppressively hot. The winds have been mostly from the north, and generally fresh and strong. There was rain only upon two days, viz., the 7th and 28th, and on both these occasions it fell during the night. There were heavy threats upon several occasions, lowering clouds and distant flashes of lightning foreboding an impending storm; but it all passed with but little rain. We had nothing like an equinoctial blow. The

general aspect of the weather was precisely such as had commonly been supposed to bring about an epidemic of yellow fever, viz., cool nights, hot days and north winds. All agreed that it was real yellow fever weather; but the predictions of the wisest were falsified in regard to a severe epidemic. Nevertheless, there was more sickness, especially in the second municipality, than during the month previous; but yet the mortality, as reported by the Board of Health, was about one-third less. There were 633* interments in the cemeteries of this city and Lafayette, of which there died, of all fevers, 178; of yellow fever, 33; of various affections of the brain, 79, and of cholera, 44. The greatest mortality occurred during the week ending the 21st, and amounted to 181; the smallest was for the week ending the 7th-137. Every cool change of weather was followed by an immediate diminution of sickness.

The following is a list of the various types of fever, and the number of deaths from each, as specified in the cemetery reports, viz.: fever, 11; f. congestive, 33; f. bilious, 16; f. intermittent, 4; f. pernicious, 18; f. remittent, 26; f. typhoid, 13; f. typhus, 14; f. yellow, 33; f. malignant, 3; f. puerperal, 2; f. putrid, 1; f. continued, 1; f. cerebral, 1; f. algid, 1; f. uncertain, 1. From this it will be seen, that the types causing the greatest mortality were congestive and yellow fever; but whilst there may be a reasonable doubt whether all the deaths attributed to yellow fever were of an unquestionable character, there is good reason for believing that many charged to other types might have been more properly set down to yellow fever.

Upon no previous occasion, perhaps, has there existed so much difference of opinion in regard to the prevailing fevers of the time, as during this summer. Whilst some of the most intelligent and experienced physicians asserted that they met with genuine yellow fever, and the weekly bills of mortality reported a number of deaths from this type, the editors of our city newspapers, instructed by the physicians whom they consulted, boldly proclaimed the belief that not a case of yellow fever had been seen. Such is the prejudice that has recently sprung up in our city against the very name 'yellow fever,' that unless an epidemic be Weekly reports of the Board of Health.

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generally recognised as prevailing, no case will be admitted to be entirely free from doubt, without presenting all the symptoms and marks of the most malignant type. On the other hand, when an epidemic of yellow fever is conceded to be prevailing, everything, even to the mildest type, among unacclimated subjects, is called yellow fever. Does not this show, most distinctly, our want of definite precision in regard to the diagnostic marks of yellow fever? Without further discussing this point at present, I will proceed with a more general account of the prevalent fevers, and reserve what I have to say specially for my report on fevers.

I stated in my report for the last month, that fever was prevailing chiefly in the first and third municipalities. During this month it gradually spread upwards, and overran the second municipality and Lafayette. The most ordinary type was a mild remittent, attended with pains in the head, back and limbs, and in many cases with marked flushing of the face, neck and arms. The last-mentioned symptom was observed, to a great extent, at the Charity Hospital, and more especially among the females. By some physicians, it was attributed to the direct influence of the sun, and was therefore called 'solar fever;' but it appears to me that if there really were a type of fever worthy of such distinction and arising from such a cause, it would certainly be seen chiefly amongst that class of persons who are mostly exposed to the sun, such as laborers on the streets and levee; but this was not the case, as has just been observed.

To be brief, and not anticipate what will be more fully discussed in the special report on fevers, I will remark, as the result of my observation, and that of many physicians with whom I have conversed, that the prevalent fever was, for the most part, of a very mild type, and yielded readily to judicious treatment; that many cases, in the earlier stages, presented the usual symptoms of yellow fever, such as severe pains in the head, back and limbs, and suffusion of the countenance; and that many cases were attended by hemorrhage. The hemorrhage most commonly observed was epistaxis, and this was uniformly followed by happy effects, removing the pain and fullness of the head, and proving critical to the fever. Hemorrhage from the mouth was also seen, but less frequently. Women laboring