Typhoid Fever at the Massachusetts General Hospital 
During the past Seventy-eight Years 
Mortality; Intestinal Hemorrhage; Perforation; 
Relapse 
BY 
REGINALD H. FITZ, M.D. 
BOSTON, MASS, 
Reprinted from the Boston Medical and Surgical Journal of 
November 23, iBgg 
BOSTON 
DAMRELL & UPHAM, PUBLISHERS 
No. 283 Washington Street 
1899 TYPHOID FEVER AT THE MASSACHUSETTS GENERAL 
HOSPITAL DURING THE PAST SEVENTY-EIGHT YEARS. 
MORTALITY; INTESTINAL HEMORRHAGE; PERFORA 
TION; RELAPSE.1 
REGINALD H. FITZ., M.D., BOSTON. 
The recognition in this country of typhoid fever as an inde- 
pendent disease and its identification with the typhoid fever of 
Paris were the outcome of investigations carried on at the Penn- 
sylvania Hospital in Philadelphia and at the Massachusetts Gen- 
eral Hospital in Boston. The discoveries in the first quarter of 
this century of the French pathologists, above all, of Louis, re- 
ceived but little attention from the American physicians of that 
period. In fact, the observations on typhoid fever of this emi- 
nent physician were known to James Jackson, professor of the 
theory and practice of physic in Harvard University, only through 
a review in the Edinburgh Medical and Surgical Journal tor 1830, 
until the return from Paris, three years later, of his son, James 
Jackson, Jr. This gifted young physician, in the words of Dr. Os- 
ier, “ the young Marcellus among the physicians of the country,” 
between 1831 and 1833 was a fellow-student in Paris of William 
W. Gerhard, and Casper W. Pennock, both of Philadelphia. 
These young men became devoted followers and admirers of Louis. 
Jackson, in particular, came into such intimate personal relations 
with him as to look upon him as a second father. Louis has 
placed on record the warmth of his friendship for the younger 
Jackson and his thorough appreciation of his exceptional talent 
for the observation of disease. Dr. Gerhard, soon after his re- 
turn to Philadelphia in 1833, received the appointment of resi- 
dent physician in the Pennsylvania Hospital, occupying this sub- 
ordinate position for the purpose of devoting himself for a while 
to medical research. The results of his study of typhoid fever 
were published in the following year.2 James Jackson, Jr,, 
within two weeks after his return from Paris, closely examined the 
cases of disease in the Massachusetts General Hospital (both in 
the wards and in the autopsy-room) until he was taken sick with 
typhoid fever. Soon after recovery from this disease he died of 
dysentery, early in 1834, just as he was about to begin the prac- 
tice of medicine in Boston. Although his opportunity of active 
research at the hospital was limited to a few weeks only, his influ- 
ence seems to have been the most powerful factor in bringing 
1 Read before the New York State Medical Association, October 25, 1899. 
2 American Journal Medical Sciences 2 
about, both in the hospital and in New England, the more exact 
knowledge of the nature of typhoid fever. Until his return the 
examination of the intestines in this disease was not properly 
conducted; indeed they were most frequently left unopened. 
Within six weeks after his investigations were begun the evidence 
obtained with regard to typhoid fever was strongly corroborative 
of the observations of Louis. “He found that this disease exhib- 
ited in the living and in the dead the same characters which his 
master had so accurately delineated.” 3 
The names of two other Bostonians, Drs. Bowditch and Shat- 
tuck, also pupils of Louis, and who eventually became physicians 
to the Massachusetts General Hospital, likewise were intimately 
connected with the early history of typhoid fever. Henry I. 
Bowditch in 1832 was a fellow student in Paris of the younger 
Jackson and shared in his enthusiastic admiration for Louis. He 
translated the “ Recherches Anatomiques ” of this author,4 and 
thus in 1836 opened to most of the practitioners of the United 
States and of the British Kingdom what hitherto had been a sealed 
book. Geo. C. Shattuck, Jr., was sent to England by Louis in 
1838 to observe the cases of continued fever in that country, 
all of which were then regarded as the one affection, typhus, 
with the view of determining to what extent they resembled and 
differed from those occurring in Paris. He found examples of 
both typhus and of typhoid fever and reported that the latter dis- 
ease in England was identical with the one observed by Louis in 
France. His investigations were communicated to the Society for 
Medical Observation in Paris and were published subsequently in 
Philadelphia.6 
The influence of James Jackson, Jr.’s, work at the hospital was 
first made evident in June, 1838, when his father presented to 
the Massachusetts Medical Society a “ Report founded on the 
Cases of Typhoid Fever, or the Common Continued Fever of New 
England, which occurred in the Massachusetts General Hospital 
from the Opening of that Institution in September, 1821, to the 
End of 1835.”6 
The number of cases serving as the basis of this report was 
303, but reference to the records of the hospital during this period 
shows that they were entered as typhus, enecia, enecia typhus, 
enecia synochus and enecia cauma. These diagnoses at some 
later period were overwritten by the term typhoid fever. Dr. 
Jackson, in the paper now under consideration, was led, “after 
much hesitation,” to use the term typhoid fever through the in- 
3 Memoir of James Jackson, Jr., M.D., 1835, p. 40 
4 Anatomical, Pathological and Therapeutic Researches on Gastroenterite. Putrid, 
Adynamic, Ataxic or Typhoid Fever. By P. Ch. A. Louis. Translated by Henry I. 
Bowditch, M. D. Two vols., 1836. 
B Medical Examiner, 1840, iii, 133. 
e Medical Communications, Massachusetts Medical Society, 1841, vi,79. 3 
fluence of Dr. Gerhard, although he had recognized in 1833 the 
identity of the continued fever of Boston with that described by 
Louis. 
During the earlier part of the period covered by the report Dr. 
Jackson thought that in most cases the early use of active reme- 
dies, especially of antimony, would diminish the violence of the 
fever and, in many instances, would arrest it.7 In almost all the 
patients, therefore, “vomiting or full purging or both, were in- 
duced by medicine, in the first or second week of the disease.” 8 
After 1831 emetics were used much less frequently than before, 
although hut few patients were allowed to go without a cathartic, 
and between 1833 and 1835 cathartics were not used as often after 
the first day in a large proportion of the cases. Mercurials, al- 
most exclusively calomel, were employed during the first or second 
week until the mouth was made sore, hut after 1830 their use 
almost entirely ceased. 
In 1833, however, doubts arose, especially in the mind of one 
of his colleagues, as to the benefit of any continued active treat- 
ment. Notwithstanding these doubts, Dr. Jackson, from 1833 to 
1835, during the first week of the disease, usually prescribed tar- 
tar emetic every two hours in constantly increasing quantity, until 
it was ascertained how large a dose the patient could bear. It was 
found that from one-half a grain to four grains thus could he taken 
without any important effect upon the stomach or bowels. Bleed- 
ing was used in one-fifth of the cases, not as a remedy for the 
disease, but always with reference to particular symptoms, and 
opium was given to check diarrhea and cough, to procure sleep, 
and to alleviate pain. 
Dr. Jackson concluded, apparently by deduction according to 
the numerical method of Louis, that at the onset of typhoid fever 
the patient should receive an emetic, followed by a cathartic, or 
the two should he given in combination. If the vomiting and purg- 
ing were not followed by great relief, venesection was to be prac- 
tised on the following day unless the patient’s constitution was 
very feeble or the attack mild. If the disease did not subside after 
the evacuations, tartar emetic was to he given every two hours in 
increasing doses, the bowels being kept open in the meantime. It 
was advised that calomel should enter into the medicines used for 
this purpose. Evacuations, at least vomiting and purging, might 
he resorted to in the second week, and some benefit might be ob- 
tained if the use of small doses of antimony was begun in this 
week. After the second week no active treatment was to be em- 
ployed, at all events none which would cause any serious inconven- 
ience to the patient. 
7 Memoir, p. 41. 
8 Medical Communications, Massachusetts Medical Society, 1811, vi, 91. As a result of Dr. Jackson’s experience, but not capable of 
being demonstrated by the numerical method, was his adherence to 
the mildest articles of liquid diet until the patient was “ fully rein- 
stated.” Then extra food was allowed cautiously, the caution 
being the more necessary the earlier the return of the appetite. 
Vinous liquors might be tried if desired by the patient when greatly 
enfeebled at a late stage of the disease. 
In the following year, 1839, Enoch Hale, attending physician of 
the hospital, also addressed the Massachusetts Medical Society on 
the subject of typhoid fever.9 His paper was based chiefly upon 
his experience at the hospital from October 1833 to 1839, during 
which years 197 cases had been admitted. The former date was 
selected since it represented the time at which especial attention 
began to be directed to the study of the symptoms and lesions of 
this affection. He stated that the knowledge of the disease of 
Peyer’s glands in typhoid fever “ serves to guard us especially 
against inappropriate, irritating medicines, such as were formerly 
in use, in the expectation of arresting the progress of the 
fever. . . . Up to a very recent period, if it be not so in some 
places even now, it was a common practice to give not only anti- 
monials, but irritating cathartics, not only occasionally to evacuate 
the intestines, but daily, and several times a day, to ‘ break up ’ or 
arrest the progress of the disease, or to cure diarrhea by removing 
the supposed cause of irritation.10 ‘ Hence the necessity of a mild 
and unstimulating diet during convalescence as well as during the 
more active period of the disease,’ and most important . . . to 
abstain from attempting too much by active treatment. . . . Vio- 
lent, persevering efforts to arrest the disease, after it has fairly 
begun its course, cannot be successful. They may do much harm 
by increasing the irritation and inflammation; but it is scarcely 
possible that they can do good. We may allay the general irrita- 
bility of the system, we may watch against the attack of unfavor- 
able symptoms, we may soothe the irritated state of the intestinal 
canal, and, sometimes, perhaps moderate the severity of its local 
inflammation, and thus contribute greatly both to the comfort and 
the restoration of our patient. In the beginning of disease, before 
the process of inflammation is fully established, we may, perhaps, 
do more, and by early removing the causes of irritation, prevent 
its formation, and cut short its course. It is only then that active 
remedies can be used with benefit, or even with safety. If perse- 
vered in at a later period, they may exhaust the patient, but they 
will not subdue the disease.” 11 
'■> Remarks on the Pathology of the Typhoid Fever of Kew England as exhibited in 
its Physical Signs, and its Anatomical Appearances. Medical Communications, 
Massachusetts Medical Society, 1811, vi, p. 183. 
10 IjOc. cit ,p. 253 
11 Medical Communications, Massachusetts Medical Society, 1841, vi, p. 255. During the past sixty years the treatment of typhoid fever at 
the hospital has not varied materially from the plan pursued by 
Dr. Hale and his colleagues. For the purpose of more exact in- 
formation with regard to the modifications in carrying out this plan 
and their results, my former assistant, Dr. Louis W. Gilbert, has 
undertaken the laborious task of examining the original records. 
He has prepared a table ( see pages 10 and 11 ), which shows the 
mortality in successive years and the frequency of intestinal 
hemorrhage, perforation and relapse. The results of this inves- 
tigation are presented for your consideration. 
For the entire period of seventy-eight years but one volume of 
the clinical records of the medical cases is missing, namely, Volume 
CCCI, covering a part of the year 1871. The number of patients 
with typhoid fever assigned to this year, therefore, is probably 
somewhat smaller than was actually the fact, and the data obtained 
for 1871 are less valuable for purposes of comparison than would 
have been the case were the missing volume at hand. The table 
includes only those cases of typhoid fever which were treated in 
the hospital for a longer period than two days. Convalescents 
from typhoid, admitted for the purpose of recovery from the effects 
of the disease, are not entered in the lists. With these exceptions 
the total number of patients included is 3,127 from 1839 to 1899, 
and 3,538 from the admission of the first patient in 1821 to the 
year 1899. The average mortality for the seventy-eight years 
from the opening of the hospital is 14.3 per cent., and for the past 
sixty years it is 14.7 per cent. The percentage of mortality in 
successive decades does not differ widely from the above figures, 
as appears from the following statement: 
Decade. Mortality. 
1829 to 1839 11.8% 
1839 “ 1849 11.1 “ 
1849 “ 1859 16 “ 
1859 “ 1869 15.9 “ 
1869 “ 1879 16.6“ 
1879 “ 1889 14.7 “ 
1889 “ 1899 13.5“ 
The years of low mortality were, 1837, no deaths; 1835, 2.8 
per cent. ; 1846, 3.4 per cent., and 1877, 4.2 per cent. On the 
other hand, years of unusually high mortality were, 1843, 26.6 per 
cent.; 1857, 27.2 per cent.; 1878, 31.2 per cent, and 1868, 40 
per cent. That these variations were independent of any sudden 
changes in treatment will appear from contrasting them with the 
mortality in contiguous years. Although in 1855 the mortality 
was only 2.8 per cent., in 1854 it was 12.5 per cent., and in 1856 
it was 13.6 per cent., while in 1857 it was 27.2 per cent. In 1877 
the mortality was 4.2 per cent, and in 1878 it was 31.2 per cent. 
The highest mortality in any one year was 40 per cent, in 1868, 
but in 1867 it was 18.9 per cent, and in 1869 it was 12,9 per cent. 6 
Such variations in mortality and an appreciable prolongation of 
the period of convalescence led Dr. Jackson, in 1838, to question 
whether the increased fatality and the prolonged convalescence 
during the period of radical changes in the treatment from 1833 to 
1835, inclusive, were due to the greater severity of the disease or 
to the less active treatment during this period. It would appear 
from his concluding advice that he preferred to return to the 
more active treatment to which he had long been accustomed than 
to recommend the blander methods preferred by some of his col- 
leagues, and of which he had made a trial for a number of years. 
Dr. Hale,12 on the contrary, in the following year answered Dr. 
Jackson’s query by stating that during the three years subsequent 
to the period included in Dr. Jackson’s report the treatment was 
perhaps even milder than ever before. Although the mortality 
from 1833 to 1835, inclusive, was from 16 per cent, to 17 per cent., 
it fell to 10 per cent, in 1836. In 1837 there were no deaths ; in 
1838 the mortality was 5 per cent, and the average mortality for 
the three years was in the vicinity of 6 per cent. The higher 
mortality of the earlier years was attributed, therefore, by Dr, 
Hale to the difference in the severity of the disease at different 
periods. 
Although the study of the above table makes it doubtful if 
modifications of treatment carried on at the hospital have produced 
any essential change in the death-rate, it is desirable to consider 
this question from the other side and inquire what changes, if any, 
have followed alterations of treatment. 
For the thirty years after the publication of Dr. Hale’s paper, 
namely, from 1839 to 1869, the diet of the patients was liquid, 
the fluids often containing some farinaceous ingi’edient. From 
1869 to 1879 beef tea and beef juice were largely used in addition 
to the milk, and from 1879 to 1899 the liquid portion of the diet 
has been chiefly milk. Between 1893 and 1898 the patients under 
the care of Dr. F. C. Shattuck have received, in addition to the 
milk, minced meat, raw and soft-boiled eggs, macaroni, soft crack- 
ers, toast and puddings. Patients under the care of Dr. E. G. 
Cutler during a like period have been fed on skim milk, butter- 
milk, eggs and milk, albumin water, chicken broth, and beef juice 
with barley water. The mixed foods were so strained as to be 
freed from solid particles. 
During the thirty years of liquid, farinaceous diet, the average 
mortality was 14.1 per cent. In the milk and beef tea decade it was 
16.6 per cent., although in the immediately preceding liquid, far- 
inaceous decade it was 15.9 per cent. From 1879 to 1899, among 
those patients using milk as the principal article of food, the mor- 
tality was 14.6 per cent., which was about the same as during the 
12 Medical Communications, Massachusetts Medical Society, 1841, vi, p, 254. 7 
period of liquid, farinaceous diet. The,mortality was only 11.3 
per cent., however, among the patients between 1893 and 1898 who 
were fed upon the liquid and soft-solid diet prescribed by Dr. Shat- 
tuck. This mortality compares very favorably with that of 15.1 
per cent, noted among the patients using a largely milk diet, and 
with the 16.6 per cent, mortality occurring among patients taking 
strained, starchy and proteid fluids. 
Since 1839 emetics and purgatives have no longer been in use 
and antimony has been discontinued. Calomel has been employed 
only occasionally in the decade following 1838, and again in 1887, 
when ten grains of calomel were given as a matter of routine to 
about one-half of the patients when they entered the hospital. The 
treatment in general use consisted of an alkaline fever mixture, 
mild laxatives or chalk mixture and laudanum, as the condition of 
the bowels might demand. After 1868 rectal enemata instead of 
laxatives by the mouth were used when a movement of the bowels 
was desired. In 1878 quinine and other antipyretic drugs were 
added to or substituted for the alkaline fever mixtures, and were 
used with greater or less frequency during the subsequent ten 
years. The external use of water in the treatment was begun in 
1873. At first some of the patients were sponged with tepid 
water two or three times daily. From 1878 to 1888, however, 
the frequency of the sponging was increased to six or eight times 
a day, and the temperature of the water was often as low as 65° 
F. Since 1888 sponge baths and tub baths, at a temperature of 
65° F. and upwards, have been in constant use as often as every 
four hours when the temperature of the patient was 102.5° F. As 
the average mortality from 1878 to 1888 was 16 per cent., and 
that from 1888 to 1898 was 13.5 per cent., it is evident that a defi- 
nite lowering of the rate has taken place during this period of cold- 
water treatment. It does not follow, however, that this change 
for the better was due to the use of cold water, since a lowering 
of the mortality of even 5 per cent, in successive decades took 
place between 1839 and 1859, wholly independent of any obvious 
modification of treatment. It remains to be learned whether the 
external use of cold water and the changes in diet have been at- 
tended with variations in the occurrence of such complications of 
typhoid fever as intestinal hemorrhage, perforation and relapse. 
In the earlier years of the hospital, patients with typhoid fever 
were allowed to walk to the closets for the purpose of emptying 
the bowels; hence, presumably, the occurrence of hemorrhage 
from the intestine was often overlooked. Notwithstanding this 
fact, Dr. Jackson 13 notes 10 per cent, of hemorrhage from the 
bowels in his series of 303 cases. 
From 1849 to 1899 the occurrence of intestinal hemorrhage is 
18 Medical Communications, Massachusetts Medical Society, 1841, vi, 117 i 8 
recorded in 159 cases out of 2,767 patients, a ratio of 5.7 per cent. 
The extremes in the decades here included are 2.3 per cent, from 
1859 to 1869 and 9 per cent, from 1889 to 1899. The table 
shows that during the last twenty years, and especially during the 
past ten years, hemorrhage from the bowels has been much more 
frequent than during the previous twenty years. Indeed, the aver- 
age occurrence has been nearly as high in the past ten years as 
during the days of emetics and the active use of purgatives. That 
this is not a question of consistence of food appears probable from 
the study of the records between 1893 and 1899. In this period 
the frequency of intestinal hemorrhage among patients living 
chiefly on a milk diet was 10.6 per cent.; among those fed upon 
strained proteid and amylaceous fluids it was 16 per cent., while it 
was only 9 per cent, among the patients living upon fluids and soft 
solids. The inference from this comparison is: A diet of soft 
solids not only does not provoke intestinal hemorrhage, but also 
rather lessens the tendency to this complication. On the other 
hand, a strained mixed diet may increase somewhat the frequency 
of hemorrhage. 
In like manner the question of perforation of the intestine has 
been investigated. The difficulties in the way of determining the 
occurrence of this complication of typhoid fever are obvious to all 
physicians. Its presence is suggested by the onset of symptoms 
of peritonitis, and is made apparent by the discovery of the per- 
foration after a laparotomy or at a post-mortem examination. The 
symptoms of perforation may exist, however, and no perforation 
be found at a laparotomy or after death. Perforation, indeed, 
may have taken place and no characteristic symptoms have an- 
nounced its occurrence. Bearing in mind these difficulties, all 
the cases of suspected perforation have carefully been scrutinized, 
and those instances only admitted to the table in which the per- 
foration was demonstrated, or the clinical evidence was of the 
strongest possible nature. It is only within the past thirty years 
that the data were considered sufficient to permit comparisons to 
be made. From 1869 to 1879 the average frequency of perfora- 
tions was 1.1 per cent., from 1879 to 1889 it was 0.3 per cent., and 
from 1889 to 1899 it was 1.6 per cent. These differences are so 
slight as to make it doubtful if diet or treatment has had any 
effect in modifying the tendency to this grave complication of 
typhoid fever. Of 10 patients with perforation between 1893 and 
1897, five, or 2.8 per cent., were using a largely milk diet; two, 
or 1.8 per cent., strained liquid diet, and three, or 3.4 per cent., 
were fed upon liquid and soft-solid diet. 
Any accurate observation concerning the frequency of relapse 
has been made trustworthy only since the introduction of the ther- 
mometer in the study of disease. Careful thermometric records 9 
have been made at the hospital since 18,69. From 1869 to 1879 
the average frequency of relapse was 8:7 per cent. ; from 1879 to 
1889 it was 13.6 per cent., and from 1889 to 1899 it was 11.3 per 
cent. The average for the thirty years is 11.2 per cent. It may 
be that the increased frequency during the past twenty years is due 
largely, as has frequently been maintained, to the hydriatric treat- 
ment of the disease. 
The possible influence of diet has also been considered. Under 
the largely milk diet the ratio of relapse was 13.1 per cent. It 
was 11.1 per cent, among patients living upon the strained proteid 
and amylaceous diet, and 10.2 per cent, among patients fed on 
fluids and soft solids. Relapses thus were rather more frequent 
among patients living upon a largely milk diet. 
The conclusions reached from this study of the records of the 
Massachusetts General Hospital for the past seventy-eight years 
are as follows: 
(1) The treatment of typhoid fever does not differ in essentials 
from the principles laid down in 1839. 
(2) The average mortality from this disease has not materially 
changed from the days of active treatment with emetics, purgatives, 
venesection, antimony and calomel down to the present time. 
(3) Intestinal hemorrhage, perforation and relapse, upon the 
whole, are quite as frequent now as at any period in the history of 
the disease. 
(4) A considerable variety in diet may be permitted not only 
without detriment, but also with possible benefit to the patient. 10 
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Per cent.  
Year. 
No. cases. 
Deaths. 
Mortality 
Per cent. 
Hemorrhage 
Per cent. 
Perforation. 
I Per cent. 
Relapse. 
Per cent. 
1859 
55 
5 
9 
1 
1.9 
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28 
4 
14.3 
1 
3.5 
1861 
41 
4 
9.7 
1862 
19 
4 
21.5 
1 
5.2 
1863 
42 
9 
21.4 
3 
7.1 
1864 
33 
3 
9 
1 
3.3 
1865 
24 
6 
25 
1866 
23 
2 
8.7 
1867 
16 
3 
18.9 
1 
6.2 
1868 
20 
8 
40 
1 
5 
1859-1869 
301 
48 
15.9 
7 
2.3 
1 
.3 
1869 
31 
4 
12.9 
1 
3.2 
1870 
50 
7 
14 
1 
2 
3 
6 
1871 
41 
13 
31.7 
2 
4.8 
2 
4.8 
1872 
45 
5 
11.1 
1 
22 
1 
2.2 
2 
4.4 
1873 
37 
9 
24.3 
1 
2.7 
2 
5.4 
1874 
27 
3 
11.1 
1 
3.7 
2 
7.4 
1875 
46 
5 
10.9 
1 
2.2 
6 
13.2 
1876 
39 
6 
15.4 
4 
10.2 
1 
2.5 
6 
15.4 
1877 
23 
1 
4,2 
1 
4,2 
4 
16.8 
1878 
16 
5 
31.2 
5 
31.2 
1869-1879 
355 
58 
16.6 
12 
3.4 
4 
1.1 
31 
8.7 
1879 
23 
5 
21.7 
1 
4.3 
1 
4.3 
1880 
52 
4 
7.7 
2 
3.8 
7 
13.4 
1881 
75 
17 
22.7 
2 
2.4 
9 
12 
1-82 
56 
10 
17.8 
5 
8.9 
4 
7.1 
1883 
63 
13 
20.1 
4 
6.3 
1 
1.5 
8 
12.7 
1884 
74 
17 
22.9 
4 
5.4 
14 
18.9 
1885 
90 
12 
14.2 
3 
3.3 
10 
11.1 
1886 
84 
12 
14.3 
2 
2.3 
1 
1.1 
16 
25 
1887 
161 
20 
12.3 
6 
3.7 
23 
14.3 
1888 
115 
17 
14.7 
11 
9.5 
1 
1.1 
16 
13,9 
1879-1889 
793 
127 
16 
40 
5 
3 
.3 
108 
13.6 
1889 
119 
13 
10.9 
11 
9.1 
4 
3.3 
17 
14.2 
1890 
68 
6 
8.8 
6 
8.8 
8 
11.7 
1891 
98 
16 
16.3 
8 
8.1 
2 
2 
8 
8.1 
1892 
92 
13 
14.1 
5 
5.4 
7 
7.6 
1893 
81 
9 
11.1 
4 
4.9 
2 
2.4 
9 
11.1 
1894 
89 
16 
17.9 
14 
15.9 
4 
4.4 
8 
6.9 
1895 
88 
16 
18.1 
12 
13 6 
1 
l.l 
10 
11.4 
1896 
120 
13 
10.8 
7 
10.8 
1 
1.5 
23 
19.1 
1897 
86 
11 
12.8 
11 
12.8 
2 
2.3 
4 
4.6 
1898 
159 
22 
13.2 
12 
7.5 
19 
11.9 
1889-1899 
1,000 
135 
13.5 
90 
9 
16 
1.6 
113 
11.3 
Totals, 1821-1899: Number of cases 3,538; deaths 509; mortality 
per cent. 14.3.