REPORTS FROM SOUTH CAROLINA. ARTICLE I AN ACCOUNT OF THE EPIDEMIC FEVER ON SULLIVAN'S ISLAND IN THE SUMMER OF 1850. By JOHN B. PORTER, M.D., Surgeon U.S. A. SULLIVAN'S Island is so well known, that but a brief description is required. It is a sand island at the mouth of Charleston Harbor, elevated only a few feet above the level of the sea. The drainage is bad; percolation rapid, excepting after frequent and heavy rains. In all seasons, and on almost every part of the island, water is found three or four feet beneath the surface. On the rear, or northernmost part, on the main land, are large marshes, from which, as some say, no deleterious effects arise; but others, including intelligent physicians, assert that, in years past, when northerly winds prevailed, (sweeping over the marshes to the island,) severe fever was known to occur in the street most exposed-the one in rear, or on the back beach, in the town of Moultrieville. By many, including physicians, Sullivan's Island is considered one of the most salubrious spots on the face of the earth for summer residence, for all sorts of persons, in all diseases, and in all stages of disease; others, including intelligent medical gentlemen, are of opinion that, for some persons, and in some complaints, the damp and chilling atmosphere is positively insalubrious and injurious. Fort Moultrie is on the south side of the island, on the main channel or entrance into Charleston Harbor, about four miles from the city. Charleston (St. Michael's Church) is in latitude 32° 46' 33" north; longitude 79° 57' 27" west. The fort is in latitude 32° 42′ north; longitude 79° 56' west. (Vide Army Statistical Report, 1840.) By the observations of the Coast Survey, if I am not mistaken, Fort Moultrie is situated in latitude 32° 46' north; longitude 79° 46' west. It is surrounded on three sides by the village of Moultrieville-a resort in the summer season. METEOROLOGICAL REGISTER OF FORT MOULTRIE, for the Summers of 1849 and 1850. Thermometer detached from Barometer, and Quantity of Rain. 1849. Sunrise. May 69.48 74.19 81.77 71.74 72.37 84 54 30° 79° 61° 4.60 June 73.36 80.40 83.16 79.33 79.13 88 72 16 86 74 2.60 July 75.89 79.80 81.99 78.58 78.87 88 66 22 85 71 7.50 August 78.35 82.80 83.58 80.58 80.80 88 73 15 85 75 10.80 September 72.16 75.83 78.16 75.03 75.16 86 64 22 81 69 4.70 Total number of inches 1850. of Summer Rain 25.60 May 66.38 73.61 76.83 70.22 71.61 84 56 28° 78.0 61.5 4.10 71. 79.66 81.46 75.23 76.23 93 55 38 83.0 63.0 0.78 July 79.3 85.70 88.19 81.12 83.61 95 74 21 90,0 78.5 2.32 August 79. 85. 87.29 81.93 83.14 94 73 21 87.5 77.5 4.03 September 73.1 78.9 82.76 77.5 77.93 91 60 31 84.0 68.0 2.68 From the foregoing tables, it will be perceived that the summer of 1849 was comparatively cool and wet; and that the summer of 1850 was hot and dry; but no one can form an idea of the continued and intense heat in the months of July, August, and part of September, 1850, unless he had been a resident, or has an opportunity to study the daily meteorological observations of that period. There was only one day in July when the daily mean of the thermometer was not 80°, and above; there were only five days in August in which the daily mean was not 80°, and above; and there were twelve days in September in which the daily mean was 80°, and above. In July, the thermometer ranged as follows:- S.R., from 74° to 86°; 9 A.M., from 80° to 89°; 3 P.M., from 81° to 95°; 9 P.M., from 77° to 86°. In Augusts.R., from 73° to 84°; 9 A.M., 79° to 90°; 3 P.M., 78° to 94°; 9 P.M., 77° to 86°. September — S.R., from 60° to 80°; 9 A.M., 65° to 88°; 3 P.M., 76° to 91°; 9 P.M., 67° to 85°. Health of Charleston previous to the Epidemic.-Yellow fever in the autumn of 1819; scarlatina, more or less, during the winter following, and in the spring of 1850. Health of Sullivan's Island.-In the summer of 1819, bowel affections, especially among children. No yellow fever in the fall of 1849, and but few cases of fever of any kind. In the winter following, catarrhal affections, and diarrhea among children. Pertussis common. In April, 1850, scarlatina was introduced from Charleston, and several severe cases, of the anginose and malignant varieties, occurred in the months of April and May, many of them proving fatal. Very few of these cases were S. simplex, and there was dropsical effusion in every case, mild or severe. In June and July, bowel affections, including cholera infantum, were common among children. Prickly heat [lichen tropicus] was universal,-- from infants, to three score and ten; lichen urticatus common; herpes frequent; boils were almost universal, and carbuncles were com mon. We now come to the epidemic in question. It commenced in the city of Charleston in July, but was later in its appearance on Sullivan's Island; and it spread rapidly and universally, scarcely a single person in a family escaping. What was this disease? In Charleston, S. C., Dr. Dickson and others say that it was 'Dengue;' others termed it 'Breakbone fever,' meaning the same thing. On the other hand, several physicians of Charleston believe it to be a simple Bilious remittent fever. On Sullivan's Island, some physicians believed it to be dengue,' others thought differently. My own opinion will be stated hereafter. What is dengue? Dr. Thomas Lawson, now Surgeon-General of the U. S. Army, was the surgeon at Canton Clinch, near Pensacola, in 1828; he says:--Dengue has prevailed to a great extent in this section of our country. In Pensacola, scarcely a person of any age, sex or condition has escaped an attack. With us in the cantonment, however, its influence has been less generally felt. The disease was modified somewhat in its character and the intensity of its symptoms, by the peculiar constitution of the subjects attacked. Among the Americans, and other persons of vigorous health, the fever usually ran very high, and continued, without a remission, from twenty to thirty-six hours; after which it subsided, leaving the patient in a state of extreme debility, and laboring under an acute rheumatic affection of the muscular system generally. Among the Spaniards, who are generally less plethoric, the febrile manifestations were, on the contrary, much less intense; but the disease was of longer duration, and the pains throughout the fibrous tissues were infinitely more severe. 'As a general rule among the Americans, one or two efficient cathartics were administered in the early stage of the disease; after which the repeated use of the warm bath, and frequent draughts of lemonade, were sufficient to complete the cure. Among the Spaniards, no active medicines at all were taken; ptisons and the warm bath were the only remedies employed. A recurrence of the disease, particularly of the rheumatic affcetion, was very common among all classes, but the relapses, I believe, were much more frequent among those who resorted to no active remedial means. It was always most safe to administer an eflicient dose of medicine immediately on the attack; the disease was rendered more manageable, and its duration shortened. The period of its course varied from fortyeight hours to several weeks.' (Army Statistical Report, p. 64), Dr. Forry (Am. Jour. Med. Sciences, April, 1842) says:'From the various descriptions of this disease, it appears that it was generally ushered in by the usual manifestations of febrile diseases. Its accession was marked by a painful affection of the joints and muscles, attended by fever of the ordinary inflammatory type. The fever generally declined and disappeared on the second or third day, and the arthritic pains diminished in severity with the subsidence of the febrile exacerbation. The paroxysm terminated in an abundant perspiration, attended occasionally with a rash, or miliary eruption, which, however, was regarded as an incidental symptom. The local pains abated so considerably that the inexperienced were often induced to resume their occupations. This deceptive interval, however, was but the prelude to the second stage. On the third or fourth day—the fever having generally intermittedthe tongue began to show a yellowish fur, and the stomach manifested considerable oppression, with nausea, and sometimes vomiting. These annoying symptoms, on the fifth or sixth day, were relieved by a cutaneous eruption. It resembled scarlatina more than measles, but was less confluent than either. The eruption consisted of minute papulæ, of a florid red, slightly elevated, and distributed in irregularly-shaped patches. A second febrile exacerbation supervened, attended with severe arthritic and muscular pains, on the full development of this exanthem. After two or three days, the eruption gradually disappeared, with some desquamation of the cuticle. In the neck, groin and axilla, the lymphatic glands, in a good many cases, suffered inflammation and enlargement; and this condition of the glands, as well as the painful affection of the joints, often continued weeks after convalescence. Dr. Dumaresq, of New Orleans, observes-"This was a singular termination of the disease, leaving sufferers from the fever hardiy able to move about; and, indeed, the appearance of persons in the street must have been truly pitiable to a healthy strangerhere, one seen dragging his legs after him, supported on crutches; and there, another, with limping gait and various contortions of countenance, bespeaking that his tardy progress was made at the expense of his bodily feelings." As regards the pathology of dengue, it may be fairly classed |