REPORT 
ON THE 
TOPOGRAPHY AND EPIDEMIC DISEASES 
OF 
NEW JERSEY, 
AND THE 
TREATMENT THEREOF. 
BY 
LYNDON A. SMITH, M. I). 
EXTRACTED FROM TIIE 
t , 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 LODGE ALLEY. 
1858. REPORT 
ON THE 
TOPOGRAPHY AND EPIDEMIC DISEASES 
OF 
NEW JERSEY, 
AND THE 
TREATMENT THEREOF. 
BY 
LYNDON A. SMITH, M.D. 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 105 LODGE ALLEY. 
1858. It E P 0 It T. 
The undersigned, appointed bj this Association, in 1855, to 
report “On the Medical Topography and Epidemic Diseases of 
New Jersey, and the Best Method of Treatment,” respectfully 
represents:— 
That immediately after his appointment, he addressed a circular 
letter, through the newspapers and the Medical Reporter, to the 
physicians of New Jersey, stating that such a committee had been 
appointed, as well as the object in view, and asking from them such 
information as might enable him to make a full and satisfactory 
report. He also made application to the New Jersey Medical 
Society for assistance, but up to the present moment has received 
no response to his appeals, and is, therefore, dependent upon his 
own limited observation, and the annual reports of the Standing 
Committee of the New Jersey Medical Society, as published in the 
Medical Reporter, together with the Report of the Geological Survey, 
under Dr. Kitchell, and also Gordon's Gazetteer. To these sources 
he hereby acknowledges himself indebted for the facts embodied in 
this report. 
Topography.—The State of New Jersey lies between the paral- 
lels of 40° 20' and 88° 55' north latitude, and meridians 73° 54' 
and 75° 84' west longitude from Greenwich. 
It occupies a position peninsulated, with respect to New York, 
which bounds it on the north, and from which it is separated by an 
imaginary line running nearly on the 41st parallel of north lati- 
tude to the Delaware Biver. On the east, the boundary line fol- 
lows the Hudson Biver until it empties into the Bay of New York, 
thence it follows the strait which separates the State from Staten 
Island. The remainder of the eastern and southeastern boundaries 4 
REPORT ON 
is formed by the Atlantic Ocean. The Delaware River forms the 
western and southwestern boundary, separating the State from 
Pennsylvania and Delaware. 
The total area is 7,750 square miles, being 4,960,595 acres, of 
which only 1,767,991 are improved, leaving entirely uncultivated 
3,192,604. And yet there are no deserts, nor dismal swamps, 
where the labor of man would not receive an adequate reward. 
The inhabitants of the State are settled principally in valleys, on 
the rivers and brooks, where the land is rich and easily cultivated. 
Hence it happens, that the most prevalent diseases are of malarious 
origin. As the land is drained and cultivated, the country gradu- 
ally becomes more healthy, so that our bills of mortality compare 
very favorably with those of any of the United States. 
The area of the State is naturally divided into three strongly 
marked sections. The first division, the alluvial, between Delaware 
Bay and the Ocean, includes the marl region, and is almost a level 
plane, much of it dense forest, and, where cultivated, is devoted to 
the raising of the grasses, grains, and fruits, which are produced in 
great abundance. The climate is so mild near the sea-coast, that 
cattle often subsist upon the meadows and in the neighboring 
woods, through the winter, without being sheltered or fed. 
The streams, of which there are a great number, have so slight 
a descent, that in many places they may almost be regarded as a 
succession of swamps and ponds, forming a striking contrast to 
other portions of the State. The section comprises the counties 
of Monmouth, Burlington, Gloucester, Salem, Cumberland, Cape 
May, and Atlantic, and it has evidently been reclaimed from the 
Ocean. 
The second division, the hilly, is included by a line drawn from 
Hoboken, south, to Trenton, and another drawn from the Ramapo 
Mountains, curving by the Pompton Mountain to Delaware River, 
between Alexandria and Milford, and affords a considerable variety 
of soil and surface, the geological formation being secondary, or 
chiefly red sandstone. This division includes a large part of 
Bergen, Hudson, and Passaic counties, all of Essex, part of Morris, 
Somerset, Hunterdon, and Middlesex. This is the most populous, 
and probably most wealthy portion of the State. While the soil 
is not so productive as in the primitive and transition regions, 
there being less of it waste, and divided as it is into small farms, 
and more assiduously cultivated under the stimulus of convenient 
markets, the returns are very abundant. The manufacturing in- THE EPIDEMIC DISEASES OF NEW JERSEY. 
5 
terests in the State are principally confined to this section, and add 
greatly to its wealth and importance. 
The third, or mountainous division, which is from ten to forty 
miles in breadth, extends from the northwest boundary of the 
State, in a southwesterly division to the Delaware Water Gap; 
where it passes into Pennsylvania. This district is very interest- 
ing and varied in its geological formation, surface, soil, mineral, 
and vegetable productions. The primitive ridges contain rocks of 
a pretty uniform character, as quartz, feldspar, &c. 
In the transition section, grauwacke and grauwacke slate are the 
most common rocks. Extensive beds of magnetic iron ore, and 
also zinc and copper are found. 
The most remarkable mountain range, in this division, is that 
called the Blue Mountains. This range is from 800 to 1500 feet 
in height, and from three to six miles in width at the base. Be- 
tween the western slope and the Delaware Biver is a valley averag- 
ing one mile in width, drained by the Elatkill and its branches. 
East of the Blue Mountains lies a broad and fertile valley, called 
the Kittating, and extending, through the counties of Sussex and 
Warren, forty miles to the Delaware River. It is broken by a 
succession of rounded hills, which cause the drainage of the north- 
ern portion to pass through the Wallkill northerly towards the 
Hudson, while the southern portion is drained by the Paulins Kill 
into the Delaware. Both streams are fed by small lakes and 
ponds, which are so numerous that they often cause the Wallkill 
to overflow its banks, destroying the fertility of a large tract of 
country, and rendering it unhealthy. 
The next remarkable range in this section is a continuation of 
the Highlands of New York, which take the same general direction 
as the Blue Mountains. They are not as continuous as the latter, 
and as they are made up of parallel ridges, intersected by occa- 
sional valleys, have different names in different localities. 
Within this range are several large and beautiful lakes, and 
many small ponds, affording the waters which make up many of 
our principal rivers, as the Raritan, which runs easterly for seventy- 
two miles, and empties into the Bay of the same name. The Pas- 
saic, which, after running about seventy miles, empties into Newark 
Bay. The Hackensack, forty miles in length, also empties into 
Newark Bay. The Pequest, thirty miles in length, empties into 
the Delaware. This is a bold and rapid stream, affording abund- 
ance of water power, and draining a very fine valley. 6 
REPORT ON 
The Musconetcong is the outlet of Lake Hopatcong, and runs 
forty miles, in a southerly direction, through a deep and narrow 
valley, and empties into the Delaware. Lake Hopatcong is five 
and a half miles in length, and one and a half wide, and is the 
feeder of the Morris Canal, containing nearly four and a half square 
miles of water. 
There are many other streams draining smaller valleys, between 
mountain ridges, and forming branches of the Raritan or the Pas- 
saic, which time will not allow me to particularize. 
The mountains in this section, with some exceptions, are gene- 
rally in a state of nature, while the valleys, based on limestone, 
form the most fertile portions of the State, and are generally in a 
high state of cultivation, and thickly inhabited. 
Epidemic Diseases.—During the three years of the existence of 
this commission, it will be seen by the following extracts from the 
Reports of the Standing Committee of the New Jersey Medical 
Society, that the State has been remarkably healthy. The Com- 
mittee for the year 1855 say, in their Report to the Society m Jan- 
uary, 1856, as published in the New Jersey Reporter:— J 
“No epidemic has prevailed, to any extent, in our State during 
the past year; such as approached that character were generally 
limited to small portions of the State. Among these, scarlatina, 
whooping-cough, measles, diarrhoea, dysentery, mumps, and bilious 
fever have had a share; also a very troublesome disease of the skin.” 
The Committee for the year 1856, say:— 
“The general prevalence of health throughout the State, and its 
immunity from extended epidemics, affords but little material upon 
which to report in this department of medical research.” The dis- 
eases mentioned as prevailing are nearly the same as during the 
last year. 
The Committee for the year 1857, say:— 
“ In presenting their annual Report, your Committee feel great 
gratification in being able to announce that the citizens of our 
State have, during the past year, enjoyed an unusual exemption 
from the various ills that flesh is heir to. We have been spared 
from any of those pestilential epidemics which, at times, have swept 
over our land, destroying our fellow beings by scores and hundreds, 
and desolating hearth-stones. 
“It is our pleasing duty to report that, while seed-time and har- 
vest have prospered, Hygeia’s sway is now, and has been during THE EPIDEMIC DISEASES OF NEW JERSEY. 
7 
the past year, more than usually absolute, and that we are at pre- 
sent in a remarkably happy condition of health and prosperity.” 
The Committee allude to the remarkable financial epidemic which 
lately visited our country, as having had a peculiarly debilitating 
effect upon the medical profession, causing long faces and lank 
purses. 
The diseases mentioned as epidemics, during the year, are the 
same as those reported for the two preceding years. Erysipelas 
alone is particularized as having been “wide spread, insidious, and 
fatal” in our locality, Gloucester County. 
The Committee present the following conclusions of Dr. Yan 
Doren, relating to the diseases of Somerset County, and probably 
equally well applied to some other portions of the State. 
“True sthenic inflammation is becoming more rare yearly, and 
the cases which do occur are of a milder grade.” 
“ The phlegmasia are replaced to a considerable degree by dis- 
eases of irritation, viz., neuralgia, nervous gout, and subacute 
rheumatism.” 
“Inflammatory action is attended with less symptomatic fever 
than formerly; thus we often see (latent) pleuritis, pneumonia, &c.” 
“ The cause of these peculiarities is doubtless that our population 
have their vascular and muscular systems less, and their nervous 
systems more developed, than their ancestors, and the cause of this 
difference is to be found in their habits of life.” 
“ In relation to fevers the following facts appear. Intermittents 
have been increasing for the past ten years, and are in some locali- 
ties very annoying.” 
“ At the same time, bilious remittent (also, they say, miasmatic) 
has dwindled and almost disappeared, and intermittent fevers often 
ally themselves with and run into typhoid (the enteric fever of 
Wood).” 
“ Typhoid fever has become endemic among us, and typhus, i. e., 
typhus gravior, has almost if not quite disappeared.” 
“Irritative fever, the febris ephemera of Goode, is often met 
with in children, and is almost the only form of remittent fever 
commonly encountered.” 
“In relation to the treatment of typhoid fever, an expectant 
practice, with careful control of the local complications, as they 
arise, has generally proved successful. The turpentine emulsion 
of Dr. Wood is most efficient in controlling the abdominal symp- 
toms.” 8 
REPORT ON 
Scarlatina has prevailed more extensively in the State than 
any other epidemic, in all its forms, from the mildest to the most 
malignant. Great difference of opinion prevails respecting its 
treatment in the severer forms, while all agree that in its simplest, 
little more is required than confinement to the house, and regula- 
tion of the diet and bowels. 
In the anginose variety of this disease, the best practice seems 
to be that suited to many cases of continued fever at their com- 
mencement, the antiphlogistic. Where there is heat of skin, cold 
affusion, or at least cold sponging, is very advantageous. When 
the tonsils become inflamed and swollen, and the cerebral circula- 
tion is disturbed, as indicated by delirium, the application of cold 
to the head, and leeches to the throat, is found to be useful. But 
great care is necessary not to do too much. 
In the malignant form of this disease, all agree that every method 
of treatment too often fails, and that almost the only chance for the 
patient, is in the use of tonics and stimulants, occasionally pencil- 
ling the gangrenous ulcerations of the throat with nitrate of silver 
and detergent gargles. 
At the suggestion of Dr. lSTebinger, of Philadelphia, in the New 
Jersey Med. Reporter for Dec., 1857,1 have recently tried, in several 
cases of this disease, with pleasing effect, chlorine, prepared after 
the following formula. Dissolve two drachms of chlorate of potash, 
in a mixture of two ounces each, of hydrochloric acid and pure 
water. The water absorbs the chlorine which is generated, and 
becomes highly charged with it. The mixture must be made in a 
close-stoppered bottle, and kept from the light. Of this, half a 
drachm is mixed with four ounces of syrup and water, and a table- 
spoonful or less, according to age, is given every hour or two, 
according to the urgency of the symptoms. 
After clearing the primse viae, this remedy, with the use of 
detergent gargles and nitrate of silver to the tonsils, has done in 
my hands better than any other, and I would respectfully urge the 
profession to give it a fair trial. 
Diphtheritic croup is very frequently an attendant on this dis- 
ease, and is generally fatal. When otherwise, the favorable issue is 
generally owing to the free use of nitrate of silver topically applied, 
according to the plan of Dr. Green, and the internal administration 
of calomel. THE EPIDEMIC DISEASES OF NEW JERSEY. 
9 
Intermittent, Eemittent, and Typhoid Fevers have prevailed 
to some extent in many localities as epidemics, and have greatly 
taxed the patience of both physician and subject. I am not aware 
that anything new has been discovered in the treatment of these 
diseases, or that the confidence of the faculty in the old methods is 
at all abated. 
Many physicians prefer quinoidine to quinine, in the treatment of 
intermittents, as being more permanent in its effects. My own 
practice is to combine carbonate of iron with quinine, and it 
seldom disappoints my expectations in making a radical cure. 
Some speak in high terms of the veratrum viride in those febrile 
affections characterized by excessive action of the heart and arteries. 
The method of using this article is to commence with six drops of 
Norwood’s tincture, for an adult, and increase one drop each dose, 
every three hours, till a decided effect is produced upon the system, 
evinced by diminution in the frequency of the pulse, or by nausea 
and vomiting, when the dose is reduced to six drops, and continued 
as before. 
I have prescribed this remedy with pleasing effects, and do not 
hesitate to recommend it as preferable to those usually resorted to 
for the same general purpose. 
I will here add, that Dr. Johnson, of Hunterdon County, who 
has had considerable experience in the use of veratrum, says: “ In 
all cases of exalted arterial action, and when the circulation needs 
bridling, we have in the veratrum viride a resource which puts the 
lancet, tartar emetic, and digitalis far in the background.” 
Dr. Gibbon, of Salem County, also speaks in commendation of 
the article, and says: “I am inclined to think that, in some in- 
stances at least, it may be used as an efficient substitute for the 
lancet.” 
Dysentery has not prevailed very extensively as an epidemic 
in the State, during the past three years, but has occurred in some 
localities with greater or less severity. 
Dr. Coleman, of Burlington County, says, “ that the cases of this 
disease in that region last year, were marked by early prostration 
and rapid tendency to dissolution.” lie does not mention the par- 
ticular method of treatment. 
Dr. Johnson, of Hunterdon, says “that, during the months of 
July and August, this disease prevailed so extensively in that 
county as to be an epidemic. The attacks were severe but amena- 10 
REPORT ON 
ble to medicine.” He commenced the treatment with castor oil, of 
which he seldom found it necessary to give more than one or two 
doses. “ The great principle kept in view in the treatment, was 
to maintain the bowels as much as possible at rest.” 
He used Dover’s powder in the usual doses, and, in many cases, 
added to each, say every three or four hours, a teaspoonful of the 
solution of plumb, acetatis, four grs. to the ounce of water. 
The opium suppository, two grs. for an adult, was used at bed- 
time, in cases of tenesmus. Poultices of mush, and bread and 
milk, to the abdomen, had a pleasing effect, as had also the sina- 
pism occasionally. The diet was liquid, consisting of soups, and 
sweet milk and bread. This treatment, he says, subdued the dis- 
ease in a brief period. 
Dysentery has prevailed also in this city and vicinity with some 
severity, but has been manageable under a treatment similar to the 
above. 
Measles has made its appearance in some portions of the 
State. 
Dr. J. C. Johnson, of Warren County, says, in his report to the 
Standing Committee, “ that this disease prevailed over a very large 
district of that county, in the winter and spring of 1856, and affected 
the greater portions of those who were unprotected by previous 
attacks. Their type was sthenic, devoid of malignancy, yet in most 
cases attended with bronchial and pulmonary complications.” 
Dr. Johnson found “that mild treatment, by demulcent drinks, 
rubefacients, and small doses of ipecac, removed all these diffi 
culties, without recourse to the lancet, blisters, or antimony.” 
Dr. Phillips, of Trenton, speaks of the disease as having pre- 
vailed there in Jan., 1857, and that it required strict antiphlogistic 
treatment. 
It also has prevailed to some extent in Essex County, existing 
in many instances in families where the scarlet fever was at the 
same time prevalent. It was not particularly fatal, generally giving 
way to the usual plan of treatment. 
Erysipelas is one of the epidemics of the past three years. It 
prevailed extensively in Mercer County in 1857. In the report 
of the Standing Committee to the Medical Society, it is stated 
“ that the constitutional symptoms were very severe and distressing, 
and the disease attacked every age, sex, and condition. Many THE EPIDEMIC DISEASES OF NEW JERSEY. 
11 
deaths occurred among parturient females, the disease associating 
itself very insidiously with puerperal peritonitis, and proving 
extremely unmanageable.” The treatment consisted in the internal 
use of tonics (generally some preparation of Peruvian bark), and 
the external use of nitrate of silver and tincture of iodine. 
Dr. Graham, of Gloucester, says: “ The disease prevailed through- 
out that county, and many a memory will often, and with sadness, 
recall its ravages during the winter of 1856-7.” 
“Accompanying this epidemic, was an obscure form of inflam- 
mation, as to the exact character of which different opinions ob- 
tained among our most experienced practitioners.” 
“This disease was so similar to erysipelas as either to be the 
same, or, at least, its cousin-german.” Dr. G. asks, “ whether there 
is such a thing as internal erysipelas ? Is it or not a disease diag- 
nosed by cutaneous inflammation, and from which mucous tissues 
are exempt?” 
Dr. Newkirk, of Cumberland, reports to the Medical Society, 
1856, that an anomalous cutaneous affection had prevailed in 
that county, which was attended with intense itching and smarting, 
and when irritated by scratching, running into ulcerations, having 
been at first vesicular. It resembled scabies, and yielded at last, 
after running a long time, to remedies appropriate to that disease. 
It was seldom noticed on or between the fingers, but sometimes 
appeared on the forehead and face. It went through whole families 
often, but not always. Some thought it contagious, others not. 
Sarsaparilla, iodide of potash, and Fowler’s solution, were all used 
internally with benefit; externally, all the usual ointments and the 
laurel bath. 
Dr. Bateman, of Cedarville, mentions, in the A. J. Medical Re- 
porter, that the same disease has prevailed in his vicinity for seve- 
ral years. He thinks it evidently contagious, and says no grade or 
class of society, from the highest to the lowest, is exempt from its 
attacks. 
His description of the disease is similar to Dr. Newkirk’s, and 
he adds, that it often returns after the patient has seemed to be 
cured. Dr. B. says: “ After an experience of three years in the 
treatment of this disease, I find that the prescription which has 
been most efficacious, has been the internal use of the liquor po- 
tassae arsenitis, one to eight drops, three times a day, according to 
the age of the patient; and the external use of a wash of bichloride 12 
REPORT ON 
of mercury 3j; crude sal-ammoniac 3ij; water Ojss; dissolved, and 
applied morning and evening.” 
The same disease has prevailed in Essex County extensively, 
also in Warren, Sussex, and Somerset counties, and gave way 
under the use of Fowler’s solution, and the external application of 
a solution of sulphate of zinc, citron ointment, and a solution of 
the sulphuret of potash. 
Whooping-Cough has been epidemic in several sections of the 
State, but nothing new or interesting respecting the pathology or 
treatment of the disease has come to my knowledge. The same 
remark is applicable to the Mumps, Rheumatism, Diarrhcea, 
Cholera Infantum, and Influenza, which have all visited some 
portions of the State, though not extensively. 
Smallpox has been more than usually prevalent in many por- 
tions of the State, especially in Essex County, but the faith of the 
profession in the efficacy of vaccination, as a preventive, is in no 
sense weakened, but most of them believe that a perfect vaccination 
is a perfect protection. In my own experience this perfection is not 
always attained by one trial, but sometimes requires two or more; 
and my practice is to revaccinate, in all cases, so long as a vac- 
cinoid effect can be produced. 
That vaccination never wears out is my belief, as in my own 
case it has stood the test of forty-eight years, during which time I 
have repeatedly revaccinated myself without any other effect than 
a slight inflammatory action, and have very often been exposed to 
the most virulent forms of smallpox with impunity. 
The Board of Education in this city have adopted a resolution, 
that no child shall be admitted into our public schools, who has 
not been successfully vaccinated; and arrangements are made by 
the city for vaccinating the poor gratuitously. Were the same plan 
adopted throughout the State, smallpox would soon cease to exist 
in all our borders. 
From an experience of thirty-seven years, during which time I 
have been a very careful observer, the following opinions are ad- 
vanced with great confidence. They were originally published in 
the New Jersey Medical Reporter, vol. x., and are here reproduced. 
1st. That a perfect vaccination affords a perfect protection from 
smallpox during life, and that, if this is done in all instances soon THE EPIDEMIC DISEASES OF NEW JERSEY. 
13 
after birth, smallpox may, as Dr. Jenner supposed it would, be 
eradicated. 
2d. That in some subjects one vaccination is sufficient to destroy 
the susceptibility to smallpox, while in others two, and sometimes 
more, are required, and, therefore, it is important to revaccinate as 
long as an impression can be made. 
3d. That vaccination will protect the life, and greatly mitigate 
the distress of 'a patient, who has already taken the smallpox, if 
done in time to allow the first disease to pervade the system. 
4th. That the common idea, that the sorer the arm from vaccina- 
tion the better the protection, is a mistake, and that a very small 
pustule, which goes through the regular stages and produces a con- 
stitutional effect about the ninth day, is more generally 'perfect than 
one that produces great inflammation, pain, and swelling, and 
affects the glands. Indeed, I am always suspicious of a case 
when this has occurred, and take an early opportunity to revacci- 
nate, and have often had my suspicions verified by a good pus- 
tule. 
5th. That the virus should always be taken before the areola 
forms, if taken from the pustule, and with great caution, lest it in- 
terfere with its progress. My own practice is, to save the scab and 
insert it in a pulverized form by means of Faucher’s vaccinator, 
which is a very simple and convenient instrument, and saves much 
time, and never produces unnecessary inflammation. 
6th. That the virus should never be taken from any but a healthy 
infant of healthy parents, and then there is little or no danger of 
propagating any other disease, as many think may be and often is 
done. 
7th. That eruptions often occur after the most careful vaccina- 
tion, and are owing to some peculiar idiosyncrasy, although the 
friends of the patient attribute it to the virus. Hence the import- 
ance of the last observation, which may save the physician from 
blame. 
8th. That a small scar with pits, or indentations around its bor- 
der, is a much better evidence of the perfectness of vaccination 
than a large, smooth, and glossy one, though many think that the 
bigger the scar the better the vaccination. 
9th. In vaccinating a patient who has a good scar, if the virus 
produce redness and itching for a few days, and then dries up, I 
infer that the first vaccination was perfect. If it produce no other 
effect than is common to a slight puncture of the skin, I infer that 14 
REPORT ON THE EPIDEMIC DISEASES OF NEW JERSEY. 
the virus is not good, and immediately make another attempt with 
a new supply. 
In conclusion, I will allude to only one other epidemic which 
has visited us, and this is mentioned by Dr. Butler, of Burlington, 
in his report to the Standing Committee for 1856, and will, in some 
measure, excuse the meagreness of the paper 1 here present, as it 
shows that New Jersey has been blessed with a great share of im- 
munity from disease for the past few years. 
Dr. Butler says, in January, 1857: “So far as I am aware, the 
only general epidemic that has prevailed in this county the past 
year, was confined to the medical profession. This disease, which 
has of late been made the subject of study by certain enthusiastic 
Southern pathologists, is known by the name of Drapetomania, a 
disposition to run away from home. I shall not at this time go into 
a lengthened disquisition on the causes, nature, results, pathology, 
course, and treatment of this disease, but will refer you for further 
facts, in regard to it, to elaborate essays to be found in the pages 
of some of our Southern journals. Suffice it to say, that the epi- 
demic prevailed here throughout the entire season, and was cha- 
racterized by its ordinary symptom, a strong desire to leave home. 
The cause of the disease was, in this instance, a uniform one, viz: 
Little or nothing to do at home. The treatment was emphatically 
‘expectant,’ and the termination ‘favorable,’ for when allowed ‘to 
run its course’ it left the patient where it found him, at home. 
The most serious ‘ result’ of this epidemic, and of the cause which 
has given rise to it, is the emptiness of a certain sack or pouch, in 
the right inguinal region. This result, however, it is hoped may 
be obviated by time.” 
Respectfully submitted, 
LYNDON A. SMITH, M.D. 
Newark, N. J., April 10,1858.