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Amherst — J. B. PETTINGILL, M. D. Typhoid Fever. — Three cases, two in town; one in Mont Vernon, fatal. In the two cases in town the drinking-water was polluted ; in the other case was uncertain. It has been my experience that unsanitary conditions are almost always the cause of the disease.

Diphtheria. — None in my practice during the year. Basing my opinion upon my past experience, unsanitary conditions, except in cases of contagion, are the cause of all cases.

Amherst — H. D. Hicks, M. D. Typhoid Fever. - One case. The patient was taken ill while away from home. He lived and slept in a store in which he was employed, and which during the day was filled with people (it was an auction store). The place was poorly ventilated, and the patient was without the ordinary comforts of life. He also took his meals irregularly, and was generally under unsanitary conditions. Undoubtedly the germ of typhoid fever is conveyed by defiled water courses.

I will mention one rather interesting case, which I have not reported as typhoid fever. Early last summer a man came to me with fever and looking so b:id that I sent him home to bed, and followed him there to examine and care for him. On questioning the family about the water used at the house, I found they complained of the well, and I examined the premises as best I could.

The house was a large, old-fashioned one, consisting of the main house and an L. It was occupied by two families, the sink of one being at the back of the house and that of the other at the back of the L. Both families complained of the character of the water, saying it had a greasy feeling, and left a greasy surface on everything washed in it.

The well was under the L part of the house, entirely closed in, and not easily accessible. As far as known it had not been cleaned out for very many years. An old lady who formerly lived in the house, told me that the well had been condemned by its owner in her youth (at least forty years since). It was of the ordinary type, being closed up from bottom to top by loose stone walling. The water was obtained from it by pumps and piping.

Each sink discharged its waste through a pipe in the side of the house, and by a wooden trough to a spot on the ground about twenty feet from each wall of house and L. The grass and weeds grew luxuriantly about the spot. This spot was not more than twenty or twenty-five feet from the well. These sinks, either one or both, had been in use for several generations, and had discharged their waste water at this place during that time.

On examination of the well water, I found it to be clear and sparkling in appearance, with some bubbles adhering to the sides of the bottle which held it. It was without any distinctive smell or taste. On adding to it some crystals of nitrate of silver, a cloud of white precipitate was developed, which increased on agitation. I made no other tests, on account of lack of facilities; but clearly the water was unfit for use.

The owner of the estate was exceedingly wroth that any stain should be cast on his well, and would not admit that a pool of sink drainings of more than forty years' duration could, by any possibility, find its way into a well twenty-five feet distant. The water was his favorite drink, he said, and must be pure on that account. I warned the tenants of the danger of using the water. As the case of illness terminated so soon, and there was considerable doubt as to its being typhoid, it was not reported except informally. Nothing was done about the well except, I believe, the owner cleaned it out, and reported the existence of elm tree roots in it. One tenant moved elsewhere, one still remains; but the house is on my mental black list as an undesirable place of residence and as a possible source of infection.

Diphtheria. — None observed during the year. Unsanitary conditions are undoubtedly a powerful factor in fostering the germs of diphtheria.

Antrim I. G. ANTHOINE, M. D. Typhoid Fever. — Three cases, none fatal. Could not trace the cause in any case. Have generally found unsanitary conditions in cases of typhoid fever.

Diphtheria. — Five cases, none fatal. Have not been able to

discover the cause in these cases. Believe unsanitary conditions to be the chief cause of diphtheria.

Antrim MORRIS CHRISTIE, M. D. Typhoid Fever. - One case. In my experience, unsanitary conditions have often been the cause of the disease.

Diphtheria. — Not a case during the year. Believe that unsanitary conditions and diphtheria bear the relation of cause and effect.

Barrington (East) — G. E. OSGOOD, M. D. Typhoid Fever. — Two cases, neither fatal. In one case low, swampy land surrounded the dwelling; the other was contracted in Dover. We believe that unsanitary conditions are the cause of the disease.

Diphtheria. — Seven cases, none fatal. Could not demonstrate cause in any case. Two cases were in the vicinity of low, swampy land, and these were more severe than the others. Have observed that filth is a good culture ground for the disease. Care, good ventilation, and disinfectants modify cases.

Barrington WILLIAM WATERHOUSE, M. D. Typhoid Fever. — None observed during the year. Diphtheria. — None in my practice.

Bartlett EDWIN M. GROUND, M. D. Typhoid Fever. — Fifteen cases, none fatal; ten cases in Bartlett, four in Livermore, and one in Jackson Polluted drinking-water in every case but one. My opinion in regard to the relation of unsanitary conditions to typhoid fever is very emphatic. I believe that unsanitary conditions are necessary for the growth and development of the typhoid germ, and are consequently responsible for the spread of the disease. Fourteen of my cases could be traced to a contamination of the water supply. I will cite Livermore as a fair example of the source of all cases coming to my knowledge during the past season. In the first place, it must be remembered that Livermore is situated on the side of a mountain, and that the inclination toward Sawyer river is very abrupt. We begin at the river. Running parallel with the river is situated a row of dwellings, numbering ten or twelve, then the street, and another row of dwellings. Each dwelling has a privy located at variable distances of a few feet in the rear. X marks the house where the disease first originated. O, in the rear, and just by the side of the river, marks the location of the spring (cesspool would be more appropriate) which furnished the water for all the dwellings marked ; P, the privy, and C represents several feet of surface upon which the kitchen waste was thrown, and this amounted to a great quantity, as the building was used for a boarding-house. Across the street, directly opposite, are two stables, with manure heaps three feet high. When we take into consideration the abrupt inclination of the ground toward the spring, the relative location of the stables — the refuse from which has been accumulating for years — not more than 100 feet away, the privy, which had probably not been cleaned out since it was built, located not 20 feet from the source of water supply, and finally, the several feet square of surface, deluged

Sawyer's River.

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[] Dwellings. Stables. [x] House where first case appeared. O, Spring, the water supply of the village. P, Privy. C, where kitchen waste is thrown. almost hourly with kitchen refuse and slops from a saw-mill boarding-house kitchen, passing its putridity by almost imperceptible gradations into the pool of water used by the occupants for cooking and drinking, can we conceive of anything more impure and filthy? Is it to be wondered at that typhoid fever, so clearly traceable to unsanitary surroundings, should develop ? My other cases were just as clearly traced to unsanitary conditions as those originating at Livermore.

The cases in Bartlett all developed in persons who used the water from a well in close proximity to a manufacturing establishment. The water for the boiler was taken from this well, pumping it empty several times a day. The well is surrounded by privies used by the help, nearly fifty in number, and by decomposing bark and sawdust. I consider that pumping the well empty so often makes the current into the well more active and direct.

My case at Jackson was the second of a series of four. The first case that developed here I saw in consultation with the regular attendant. This lad was engaged in taking the kitchen waste away from a summer hotel. The second case (my case) developed in a family that took their water supply from a spring which received drainage from a hillside upon which was thrown the kitchen refuse from the summer hotel referred to. Two other cases occurred among the help in this hotel, one proving fatal.

I do not pretend to say, neither do I believe, that typhoid fever can originate from filth or unsanitary conditions alone, but I do say that these conditions are necessary for the growth and propagation of the typhoid bacillus. I do not believe in the sporadic or spontaneous origin of typhoid fever, or any other germ disease. Such a supposition is unphilosophical and unscientific. So called sporadic cases are so either from lack of inquiry or lack of information. It is no more possible for the germ of a particular disease to originate de novo, than it is for animal life of a higher order to originate spontaneously. We all know the story concerning the spontaneous production of mice, and the quicker the people fully appreciate the importance of putting and keeping their premises in a good sanitary condition, the sooner will we realize a diminution in the prevalence of typhoid fever and other preventable diseases. Typhoid fever is as preventable as smallpox, and should, in fact, be as largely prevented.

Bath G. B. EMERSON, M. D. Typhoid Fever. — Three cases, none fatal ; one in Bath, one in Haverhill, and one in Benton.

Belmont — S. A. MERRILL, M. D. Typhoid fever. — None in my practice during the past year.

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