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I believe that unsanitary conditions aggravate and multiply the specific germ of the disease, which I believe to be the cause of typhoid fever in all cases.
Diphtheria. — Have seen none during the year. Think unsanitary conditions bear a very direct relation to the disease. In my opinion, diphtheria is pre-eminently a “filth" disease.
Belmont — G. H. INGALLS, M. D. Typhoid Fever. — Five cases, none fatal ; four in town, one in Canterbury. Attribute the cause of the disease to impure drinking-water. Diphtheria. — None observed during the year.
Berlin Falls — FRANK A. COLBY, M. D. Typhoid Fever. — Forty-eight cases marked with typhoid symptoms, many of light character, three fatal ; all in town. The drinking-water was polluted in all cases. Eleven cases in one house (tenement), with the well in the cellar, and nearly all drain pipes emptying into the same cellar, furnished decided proof of cause of the fever and propagation of the same. In my experience as a practitioner, nearly all cases have been directly traceable to unsanitary conditions.
Diphtheria. — Ten cases, one fatal. The disease has been of a mild type ; few malignant cases in town, to my knowledge. My cases were due to bad surroundings, poor diet, filth, and indifference to contagion. In my practice, 90 per cent of cases are traceable to unsanitary conditions.
Boscawen — E. E. Graves, M. D. Typhoid Fever. — Eight cases, none fatal ; one in Boscawen, seven in Penacook. Seven cases used water from same well ; but dozens of others used the same water and escaped. It has been my experience that unsanitary conditions are the predisposing, if not the exciting, cause.
Diphtheria. — Five cases, none fatal. Four cases were, in my opinion, due to bad sanitary conditions. In two cases the sink-drain was so situated that it must have polluted the water of the well which supplied the family — a leaky sink, situated directly over a well in the cellar.
Bradford — W. F. WALLACE, M. D. Typhoid fever. — Eight cases, one fatal; three in Bradford, four tn Newbury, one in Sutton. The drinking-water was polluted in all cases, with one exception, and in this latter case the cellar was full of rotting vegetables, and rotting wood at back door. It has been my experience that unsanitary conditions and typhoid fever are in the relation of cause to effect.
Diphtheria. — One case, recovered. In my opinion filth was the sole cause of the disease. Basing my opinion upon my experience, unsanitary conditions and diphtheria bear the relation of cause to effect.
Brentwood — Moses W. CAVERLY, M. D. Typhoid Fever. — Have not seen a well-marked case during the year.
Diphtheria. – Two cases, neither fatal. Could not refer the above cases to any particular cause, but, basing my opinion upon my past experience, I have no doubt that unsanitary conditions have much to do with the cause of the disease, even if in some cases it is difficult to discover them.
Brookline — C. H. HOLCOMBE, M. D. Typhoid Fever. — Three cases, none fatal. Two cases originated in Townsend pupils from same school building; other case in town. Drinking-water was polluted in one case. It has been my experience that unsanitary conditions and typhoid fever bear the relation of cause to effect.
Diphtheria. — Ten cases, none fatal. Three of the above cases were in Townsend, Mass.; no cause discovered. A few years previous there had been an outbreak of diphtheria in the same locality.
In the cases in Brookline the cause was more apparent. In a large family there were several cases of suspicious sore throat, and after these had disappeared diphtheria broke out in a son's family across the way, the wife being first attacked and then the husband, the child escaping. The disease afterward appeared in four families situated in different parts of the town. In the first instance, the well was situated about mid-way between the
sinkspout and privy, and only a few feet from each. Often the water could not be used in the spring. The following analysis of the water, made by Prof. Angell, shows its character :
SANITARY ANALYSIS OF WATER.
C. H. HOLCOMBE, M. D.,
BROOKLINE, N. H. Odorless. Color . . . . . . . . . . Yellowish tint Evaporation . . . . . . . . . . Quiet Residue . . . .
Uniform and grayish to brownish Total solids, grains per gallon.
. . . 25.7 Ignition of residue . . .
It blackens intensely Volatile and combustible matter Hardness, degrees . . . . . . . . . . 5.5 Alkalinity . . . . . . . . . . . Chlorine, grains per gallon Ammonia, parts per million : Free ammonia . .
0.08 Albuminoid ammonia
0.19 Nitric acid
Much Nitrous acid . . .
Trace Lead . . . . . . . . . . . . Trace Iron . . . . . . . . . . . . Trace Sediment . . ..
. Little Microscopic Examination . . . . . Few infusoria and bacteria
This water is badly polluted and wholly unfit for drinking purposes.
EDMUND R. ANGELL. Derry, N. H., April 5, 1888.
In the second case the drinking-water was found to be good ; in other cases the water was not analyzed.
Basing my opinion upon my experience as a practitioner, think unsanitary conditions act as a prominent factor in causing diphtheria.
Canaan — E. M. TUCKER, M. D. Typhoid Fever. - One case, in Grafton. Running water from a spring was used, and the surroundings appeared to be good. While I believe in a specific germ that we shall sometime in the future know more about, still I believe unsanitary conditions may favor contagion.
Diphtheria. — None observed.
Canaan — ARA WHEAT, M. D. Diphtheria. — None observed during the past year. Have no doubt but typhoid fever and diphtheria owe their origin to much the same causes — unsanitary conditions.
Candia — A. M. FOSTER, M. D.
Typhoid Fever. – Two cases, neither fatal. The first case was due to overwork; the second case was certainly caused by bad drinking-water, an old privy being within a few feet of the well, as was also a filthy pig-sty. There was also a foul cellar. In both cases there was quite severe chronic gastritis, in addition to the usual symptoms, and I attribute it to the same cause, namely, filthy surroundings. I consider unsanitary conditions to be a frequent cause of typhoid fever, and especially so when worry and overwork are added.
Diphtheria. — Three cases. One case, a child two years old, was complicated with membranous croup, and proved fatal. I think all the cases were due to, or at least rendered more severe by, improper drainage and lack of proper hygienic surroundings. I think unsanitary conditions constitute the most frequent cause of diphtheria.
This town has but very few wells of good water, and nearly all the drinking-water is badly contaminated by sewage or proximity to barnyards or other sources of filth, and all new comers here suffer from the effects of it. Most of the old residents seem to be acclimated to it, or else are perfectly case-hardened.
Charlestown— J. M. WHITAKER, M. D.
Typhoid fever. - There has been no case of typhoid fever in town during the year, to my knowledge. My past experience leads me to believe that unsanitary condition are a factor, more or less potent, in nearly all cases of well-defined typhoid fever.
Diphtheria. — None observed. Think unsanitary conditions. are to diphtheria as cause to effect.
Chester — ARTHUR L. EMERSON, M. D.
Chesterfield — JOHN F. BUTLER, M. D.
Typhoid Fever. — Four cases, one fatal. One case was contracted while nursing a typhoid patient in Vermont. Believe filth to be the primary cause.
Diphtheria. — None during the year. From past experience, think unsanitary conditions a prominent factor in spreading the disease.
Claremont — OSMON B. WAY, M. D. Typhoid fever. - Eight or ten cases, none fatal. Am not able to give cause.
Diphtheria. — Six cases, no deaths. Difficult to ascertain the cause.
Claremont — T. E. PARKER, M. D. Typhoid fever. — Two cases, neither fatal. Traced cause to drinking-water taken from an unclean cistern. I believe it is always traceable to some unsanitary condition.
Diphtheria. — One case. Decaying vegetable matter in the cellar. Believe true diphtheria may always be traced to unsani. tary conditions.
Claremont — A. R. CUMMINGS, M. D.
Concord — D. E. SULLIVAN, M. D. Typhoid fever. — Seven cases, one fatal. I believe that typhoid produces typhoid, and nothing else can, though the source is oftentimes obscure.
Diphtheria. — Two cases, one fatal. Both cases were from contagion. Think unsanitary conditions have a very decided relation to diphtheria.
Concord — F. A. STILLINGS, M. D. Typhoid Fever. — Seven cases, two fatal. Two more of the seven cases were taken to the hospital and died there. Five of the cases were in one family where, it is said, the drainage was found to be very defective, the drain, which was entered by two or three other soil pipes, being without any ventilation, and