USA > Georgia > Memoirs of Georgia; containing historical accounts of the state's civil, military, industrial and professional interests, and personal sketches of many of its people. Vol. II > Part 14
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MEMOIRS OF GEORGIA.
monia, contracted elsewhere and neglected; one from congestion of the brain, one ascites, one tuberculous phthisis, developed elsewhere. During the prevalence of that fatal epidemic, the yellow fever of 1854, which infested our coast towns and even penetrated to villages which had before escaped its ravages, it finally made its appearance in the city of Augusta. Although an easterly wind prevailed for sixty days, before and during the epidemic, and consequently blowing directly to the hill across the city, there is no reason to suppose the atmosphere of Sum- merville was at all contaminated with the poison of this pernicious fever, as no case occurred here other than those contracted in the city, or by close confinement with those cases which were developed in the village. The residence of Col. John Milledge, which stands upon the most prominent situation due west of Augusta, and nearer to the city than any other in the village, was crowded with refugees from Savannah and Augusta who, including their servants and the family, nun- bered about sixty persons, yet among these not a single case of sickness of any kind occurred.
The same exemption from causes of disease claimed for other portions of this region applies to this village, and though malarial fevers exist in the valley and close upon its borders to some extent, yet the hill proper, upon which most of the village stands, is entirely exempt from this influence, being in every respect as healthful as Aiken, Columbia and Camden, in South Carolina, and Belair, Berzelia, Bath, and other sand hill villages in this state. To the lovers of the picturesque, the views from the various prominent points of the village are beau- tiful in the extreme, and so distant is the horizon as to require very little exercise of the imagination to fancy the wide expanse of the ocean spread out before the eye, while the broad valley upon which stands the city of Augusta, bounded by undulating hills, gives a charm and variety to the landscape seldom found even in mountain scenery. This village, being connected with the beautiful and growing city of Augusta, by a street railroad, the cars of which run at frequent and regular intervals between the two places, the time occupied being about thirty minutes, affords the residents of Summerville all the advantages of the city market, together with the quiet and beauty of a suburban residence. A good turnpike also offers inducements for pleasant drives to those who keep their equipages. To the pedes- trian the fragrant pine woods in close proximity to the village not only afford protection from the winds, but also opportunities of agreeable recreation and healthful exercise. These advantages in connection with others which will readily suggest themselves, make this a most desirable residence for those who may wish to avail themselves of the remedial influences of the climate, as presented for their consideration in the preceding pages.
The meteorological register kept by the United States arsenal at Summerville for twenty years-1849 to 1869-daily thermometric observations at the hours of sunrise; 9 o'clock a. m .; 3 o'clock p. m., and 9 o'clock p. m. show the mean average temperature as follows: January, 46.7 degrees; February, 50.7; March, 58.8; April, 65.1; May, 72.2; June, 80.9; August, 79.7; September, 72.8; Oc- tober, 63.5; November, 53.8; December, 46.3. Mean temperature of spring, 65.3; summer, 79.9; autumn, 63.4; winter, 47.9, Fahrenheit. The mean annual rainfall for the period of twenty years was 37.17 inches. Spring, 10.16 inches; summer, 14.14 inches; autumn, 6.95 inches; winter, 5.92 inches. Mean num- ber fair days per year, 238; cloudy days, 70; snow about two days to every three years. Prevailing winds-Spring, northwest and southwest; summer, south and southwest, varying to south; autumn, north, northwest and southwest; winter, south, southwest, west, northwest and north. Unfortunately the meteorological register fails to show the atmospheric humidity of Summerville. Inasmuch as
103
MEDICAL HISTORY.
Summervillle is located upon the same sand ridge as Aiken, I am satisfied that the humidity is practically the same if not identical in both places."
CLIMATIC TREATMENT OF PULMONARY TUBERCULOSIS.
Fashion has held high court in climatic treatment of pulmonary tuberculosis. Thirty years ago a warm, moist climate was regarded as best suited to this class of patients. Experience having demonstrated the fallacy of this opinion, the profession went to the other extreme and sent their patients to the frigid climate of Canada and Minnesota. This was found baneful and after the advent of listerism came the idea that altitude was the important factor in climatic treatment of phthisis. Investigators demonstratcd that while the atmosphere of some cities contains 5.500 germs to every cubic meter, the number of germs constantly decreased with altitude until when 13,000 feet was attained no germs could be detected in the atmosphere. Then temperature, humidity, etc., were no longer considered in estimating the suitableness of climate to pulmonary diseases, the sole question was altitude sufficient to insure freedom from disease germs. Altitude was everything in the climato-therapy of these affections. The profession accepted the theory and for years adopted it. The claim was boldly made that the dwellers on high mountains were free from pulmonary phthisis. Kutchin- meister showed that these mountaineers lost their immunity immediately that they exchanged a pastoral life for that of the workshop, as had been found to be the case in the Erz and Riesen Gebirge. Dr. German See combating the altitude theory said: "The best proof that altitude exercises only a questionable influence is that among the inhabitants of elevated regions, when crowded together in confined localities, as is the case in workshops like those at Joux and Chaux-de- Fond, in the Swiss Jura, at an elevation of 3,609 feet, one finds as many consumptives as in the city of Berlin." Investigation also discloses the fact that consumption was as rare at Madras, a seaport town, and in the Kirghiz steppes, which are below the sea level, as among the inhabitants of certain elevated regions. Several of the advocates of altitude in climato-therapy of pulmonary tuberculosis at the present day are among the ablest men of the profession of medicine. A greater number of the profession, however, contend that the beneficial effect of climato-therapy is dependent upon purity of atmosphere-not upon altitude. I believe with Loomis that high altitude of itself is not of the slightest importance in the climato-therapy. of pulmonary phthisis; yet, if it really be an important factor, Georgia offers abundant facilities in this respect, in the mountainous regions of Towns, Rabun, Habersham, Fannin, Pickens, White and Lumpkin counties. If a warm, moist atmosphere be deemed serviceable in pulmonary affections it can be found in abundance in the low-lying sections of the state near the seacoast. If sea air be wanted it is to be had on the islands and in seacoast cities of Georgia. If a markedly dry, pure atmosphere be the desideratum, it exists in great abundance at Atlanta, at Thomasville, and at Summerville and Grovetown adjacent to Augusta, and in the thousands and ten thousands of acres of land in the pine-woods region of this state. The Sand Hill region of South Carolina and Georgia extends through the central portions of the two states. It begins in Chesterfield county, S. C., running in a southwestern direction until it reaches the Savannah river at the western side of Augusta. On the Georgia side it re-appears at the "Sand Hills," known as Summerville, a suburb of Augusta, extends through Georgia, and terminates in its southwestern border. The aver- age width of this tract of Sand Hill region in South Carolina and Georgia is twenty miles. The maximum elevation is at Aiken, S. C., 565 feet above the sea
104
MEMOIRS OF GEORGIA.
level, and at Summerville, adjoining the western border of Augusta, 463 feet above the sea level. This sand hill region lies between the primary and tertiary regions, distinctly separating them. The soil of this region, as implied by its name, is made of fine, loose sand. It is known as the "pine barrens," because of the poverty of the soil in its natural condition for agricultural purposes. The sub-soil is extremely porous. The writer has repeatedly witnessed the following demonstration of porosity of the sub-soil of Summerville. At the residence of Mr. a barrel with both ends knocked out was sunk in the ground so that the top of the barrel was a few inches below the surface of the ground. The excavation after receiving the barrel was then filled with brick-bats. The gutter, three inches in diameter, conveying the storm water from the roof of one-half of this large dwelling house, discharges directly over this barrel filled with brick. I have seen this solid stream of water three inches in diameter discharged into this pit for an hour or more, and so porous is the sand beneath I have never seen it overflow. I do not know the depth of the sand, but the fact above cited shows that it must extend many feet beneath the surface. Another evidence of the porosity of the soil is the fact that in this sand hill region water is rarely found nearer than eighty feet from the surface, and not infrequently it is 150 feet. The porosity of the soil is such that within a few hours after a heavy rain the ground is so free from dampness that one who had not known that it had rained heavily would scarcely believe it. Within a few hours after the heaviest rains in the winter season invalids can take outdoor exercise with perfect impunity. The sand hill section, or as it is sometimes called, "the hilly pine region of Georgia," is covered with pine forests of long-leafed or yellow pine (pinus Australis) and Black Jack (Quercus Nigra), a small-sized oak. The exact influence which pine forests exert in pulmonary affections is unknown. By some observers it is claimed that these trees, by generating ozone or per-oxide of hydrogen, add to the purity of the atmosphere. Elliott and Storer, in their book on organic chemistry, say: "the disinfecting power of ozone produced by the action of the atmosphere on turpentine is interesting in connection with the observed facts that ozone is abundant in the air of pine forests where turpentine abounds, and that pine forests are remarkably free from malaria." Be the ex- planation of the beneficial effects of pine forests on pulmonary affections what it may, the fact remains that this class of invalids are impressed from personal experience that the terebinthinate exhalations of pine forests is beneficial to them, wc are, therefore, justified in claiming that extensive pine forests add markedly to the climate of a locality. Extensive pine forests not only protect a locality against winds, but it is a fact that the atmosphere thereof is warmer than one of oak and other trees. Weber cites, in substantiation of this proposition, the fact that he has often known tender exotics growing in a forest of firs to remain uninjured by the severe cold of winter when those in the more open situations in the same neighborhood were killed. Again, humidity is markedly less in a forest of pine trees, whose foliage is more dense. Forests also show absence of dust, which is so injurious to patients with pulmonary complaints.
EPIDEMICS AND ENDEMIC DISEASES.
Dengue has prevailed as a general epidemic in the more populous communi- ties of the state in 1850 and 1880. While in the larger cities probably three-fourths of the inhabitants were attacked, it is doubtful if the mortality from both epidemics reached fifty. Smallpox has occasionally been imported into Georgia, and pre- vailed as an epidemic in various counties, but only once, 1865-66, did it prevail as an epidemic over a large part of the state. This resulted from being scattered from
105
MEDICAL HISTORY.
place to place by the Confederate and Federal armies. With the exception of the epidemic, 1865-66, the mortality from smallpox has been markedly light, inasmuch as it is one of the most manageable of diseases. It is readily jugulated by isolation of the sick, and disinfection of all the infected materials, together with vaccination of the public. Citizens are afraid of smallpox, and readily co-operate with the authorities in efforts to stamp it out. Measles, contrary to the public idea, is a disease attended by a large mortality. Few diseases show a larger mortality than measles. Not that the deaths per 1,000 cases are as numerous as in small- pox, scarlet fever, diphtheria, etc., but because the public regard it as a non-fatal affection, and make no effort to escape it. As a consequence an epidemic of measles generally attacks an entire community, the people seeming to force their children to take it by exposing them to it, under the idea that children stand the disease better than adults. No greater mistake has ever been made, for the mortuary statistics of every community demonstrate that but few diseases show a larger number of deaths than measles. The census of 1880 shows that it caused 496 deaths in Georgia. The census of 1890 shows 440 deaths from measles. These figures by no means represent the actual number of deaths from the disease. If the deaths from dropsy, diarrhoea, pneumonia, etc., directly caused by measles were added to the list it would show a mortality fully double that appearing in mortuary statistics as resulting from this malady. When it is remembered that almost the entire mortality from measles is confined to the helpless, innocent children, and that it is a wholly preventable disease, the responsibility for this slaughter of the innocents rests upon parents and the state. This shameful state of affairs will continue until public instruction and sanitary administration puts a stop to it.
Scarlet fever, although frequently prevailing as an epidemic over many of the northern and western states, has never, so far as I can ascertain, prevailed as an epi- demic over this state. Occasionally the disease is imported into one or more of our populous communities and becomes epidemic, yet the total mortality is extremely light. In proof of this statement I cite the mortality record of the three principal cities in Georgia: Augusta, 1880 to 1892 inclusive, deaths from scarlet fever, 19; Atlanta, 49; Savannah, 23. The population of these three cities is largely over 150,- 000. Total mortality for Georgia in 1880 from scarlet fever was 31, and in 1890 was 8.
Diphtheria is rarely met with as an epidemic except in the larger cities, and never as widespread and fatal as in cities of similar population in the north and west. Atlanta, with an estimated population of 75,000 shows a freedom from epidemics of diphtheria which is truly surprising. I have compiled the following table from the annual reports of the boards of health of Augusta, Atlanta and Savannah, show- ing the mortality from diphtheria for the 13 years, 1880 to 1892 inclusive.
City.
1880 '81 '82 '83 '84 '85
'88 '89 'go '91 '92
Augusta
0
12
0
4
5 I
5 6
4 7 5
II
5
2
IO IO
Atlanta
5
2
8
6
27
3 3 I I5 '86 '87
6
7 6
4 6 12
14 7
Savannahı
20 48 I5
44
19
Total mortality from diphtheria for the state, U. S. census 1880, 588; census 1890, mortality from diphtheria and croup in Georgia, 553.
Typhoid fever .- According to the U. S. census of 1880 the mortality from typhoid fever in the state was 986; census of 1890, mortality from typhoid fever, 1,000. In the latter year almost every county in the state is represented in the mortuary record from typhoid fever. The board of health reports from Augusta, Atlanta and Savan- nah show the number of deaths from this fever as follows:
I
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MEMOIRS OF GEORGIA.
City.
1880 '81 '82 '83
'84 '85
'86 '87 '88 '89 '90 '91 '92
Augusta
14
42
15
24
3 29
I8
20
26 I8
II
26 2I
Atlanta
25
68
53
79
51
4I
29
68 105
48 99
89 74
Savannah
I4
29
20
12
19
8
22
IO
I2
IO
26
17 32
This table shows a greater ratio of typhoid fever to total mortality in Atlanta than in any city in the state.
Malarial fever in its various types is the principal endemic disease of Georgia, as it is in almost all of the southern states, and several of the northwestern and western ones. The census of 1880 places the mortality from malarial fevers in this state at 1,060. The mortality from this class of fevers in 1890 was, according to the U. S. census, 937, which is one death from malarial fever to every 1,960 of the pop- ulation of the state. This is the ratio for the entire state. It varies markedly in the various counties. In some of the counties in the swamp regions the mortality from malaria reached I to every 422 of the population. In other counties, particularly in the sand hill region and the mountains, the mortality is as low as I to every 15, 186, while in other counties not a death is reported from malarial fever in 1880. Malaria is readily exterminated by thorough surface and sub-soil drainage. This dis- ease was once as prevalent in England as it is in America, but it has been almost wholly banished by thorough drainage. It is marvelous that counties in Georgia will annually suffer malarial fever to kill from I to every 500 to 1,000 of the popula- tion yet make no effort to destroy this monster. All types of malarial fever, inter- mittent, remittent, congestive, and hemorrhagic are encountered in our state. The latter, commonly called hemorrhagic malarial fever, occurs only in the most in- tensely malarial regions. By some writers it is claimed that hemorrhagic malarial fever is a disease first making its appearance in the south after the war, 1865. This, however, is a mistake. Dr. Joseph Jones, of New Orleans, Louisiana, in his work on fevers, published in 1887, page 578, says: "As far as my individual experience extends, on the coast of Georgia, in 1848, cases presenting all the marked char- acteristics of malarial haematuria, which proved rapidly fatal, occurred in the months of September and October." It would be instructive to examine the various endemic diseases of Georgia in detail, but the limits of this paper forbids. The following table, from the U. S. census, showing the principal diseases occur- ring in Georgia in 1880, fairly represents the diseases occurring annually in our state-the number of cases of each disease varying, of course, with different years. (I have already commented on consumption and acute lung diseases.)
Smallpox, 2; measles, 496; scarlet fever, 31; diphtheria, 588; whooping cough, 650; fever, 281 ; cerebro spinal fever, 30; typhoid fever, 986; diarrhoea, 350; dysen- tery, 543; cholera infantum, 585; malarial fever, 1,060; erysipelas, 60; septicaemia, 14; septicaemia puerperal, 134; rheumatism, 35; consumption, 1,707 ; hydrocephalus, 48; dropsy, 871. Nervous system-Brain, inflammation of, 248; meningitis, 138; apoplexy, 137; paralysis, 356; tetanus and trismus nasuntium, 60; epilepsy, 62; con- vulsions, 350; diseases of the brain, 352. Circulatory system-Diseases of the heart, 570. Respiratory system-Croup, 721; bronchitis, 174; pneumonia, 1,685; pleurisy, 91 ; asthma, 47; laryngitis, 10; others of this group, 123. Digestive sys- tem-Dentition, 450; angina, 57; gastritis, 41 ; jaundice, 49; inflammation and ab- scess of liver, 51; other diseases of the liver, 120; peritonitis, 17; ascites, 32; others of this group, 258. Urinary system-Bright's disease, 36.
HISTORY OF YELLOW FEVER IN GEORGIA.
Saint Mary's, Camden Co., Ga., was invaded by yellow fever the first and the only time in 1808. The summer season was unusually rainy, causing stagnant
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MEDICAL HISTORY.
pools of water to be formed about the town, and the water in the wells became offensive to smell and taste. Yet the health of the population was as good as usual until Sept. 5, when the schooner "Polly" arrived from Savannah with two men sick with yellow fever. These were allowed to be landed from the schooner and conveyed to a house in the center of the town. Both patients died. Two men who nursed the cases died, one on Sept. 9, the other on Sept. 10. Next every member of the household developed yellow fever, and from this focus the disease spread over the town. The total mortality was eighty-four. The total number of cases is not known. The epidemic extended from Sept. 5 into the month of October. I cannot obtain the exact date of cessation.
The first epidemic of yellow fever in Savannah was that of 1820. The record shows that quasi epidemics occurred in 1807, 1808, 1817, 1818, and 1819, but in neither of these years did the disease reach epidemic proportions. Dr. P. M. Kollock, of Savannah, a believer in the local origin theory, in 1857 wrote the fol- lowing account of the early history of the disease in Savannah: "The yellow fever was but little known until after the war of 1812. It was not until the winter of 1816 that foreign shipping began to resort to Savannah, and the next summer the harbor was crowded, no care to time the arrivals to the healthy months, and the seamen were strangers entirely unacclimated. In the month of August the yellow fever broke out. It was confined to the seamen, and continued until the shipping departed. There were not many cases. During 1818 there were, but few arrivals, and all (the shipping) had left port before summer had fairly set in, and there was but little sickness. In the year 1819 many ships arrived, bringing many strangers, totally unused to the climate and unacquainted with the disease to which they were exposed. Early in autumn the yellow fever commenced its ravages, and in less than a month the whole number of passengers who had been brought by one ship had fallen victims; the disease continued until cold weather and was confined entirely to strangers."
The epidemic of 1820 began in May. The mortality for each month was as follows: May, 3; June, 14; July, 39; August, III; September, 214; October, 196; November, 10; December, 3; total deaths from yellow fever from May 7 to De- cember, 590. The mortality resulting from this epidemic has scarcely ever been equaled by any epidemic of yellow fever known to medical history. Dr. William R. Waring, in his official report to the city council of Savannah, in 1820, says: "The population, therefore, of white inhabitants remaining in the city during the whole season may be fairly estimated at 3,000, which would constitute a mortality of one in five." This mortality is calculated upon the number of the white popu- lation remaining in Savannah during the epidemic, and the deaths from yellow fever among the whites. While yellow fever is contracted by the negro population in equal proportion with the whites, yet the history of American medicine clearly demonstrates that yellow fever among the negro population is practically a non- fatal disease.
What was the source of this epidemic? Dr. Waring in his report says: "It was said by some individuals to have been brought from the coast of Africa, in a brig called "Raminez," which had on board a cargo of new negroes. Unfor- tunately, however, for this hypothesis, the "Raminez" did not only arrive with a healthy crew and an entire freedom from any malignant disease, but she arrived some time after the fever had grown into considerable extent and severity. I have already stated that some rapid and insidious cases occurred in June, and that fourteen deaths took place in that month. I have stated that Mr. Patrick Stanton even died of black vomit on July 16. The "Raminez" came into port on July 22.
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MEMOIRS OF GEORGIA.
It was not, and could not be an African disease. From May 23 to July 20 there came five vessels from the West Indies and one from New Orleans. I have not been able to learn of any others. On May 23 the brig "Rover," Capt. James, from Havana; on June 2 the schooner "Phantom," Havana, and on June 13 the schooner "Charles," New Orleans; on June 24 the sloop "Darien," St. Do- mingo; on June 27 the schooner "Isabella," Matanzas, and on July 20 a vessel to Green & Lippit from St. Domingo. It appears from inquiry as to the state of these vessels that the crews were healthy and there was nothing in relation to them which could authorize a belief of their having either severe disease on board, or the power of propagating any disease whatever." Here we find what has been found in every epidemic of yellow fever in every seaport in Georgia, without a single exception to the present day, i. e., immediately previous to the appearance of yellow fever in Savannah vessels arrived at the wharves of that city from infected ports-in this instance from the West Indies, the habitat of yellow fever, where this disease is always in existence. Because no one was known to have yellow fever on board of these vessels from infected ports it was accepted as proof positive that these vessels and their contents were necessarily free from infection, and also free of power to infect the city of Savannah. The fallacy of this position is now admitted by every learned sanitarian in America. It has been indisputably proven by scores upon scores of instances that every member of a crew may be immune by reason of having previously had yellow fever, yet the vessel and textile fabrics may be literally full of yellow fever germs. In 1827 and 1828 there were a few cases of yellow fever among the residents of Savannah, but in neither year did the disease assume epidemic proportions. The next epidemic of yellow fever in Savannah was that of 1854. It has been stated that the disease was epidemic in Savannah in 1839. But this is a mistake. There were a few cases among the inhabitants, and as the citizens feared an epidemic, many of them fled the city, but it did not assume epidemic proportions.
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