DIPHTHERIA 
IN THE 
CITY OF KALAMAZOO, MICHIGAN, IN 1884. 
BY 
H. B. HEMENWAY, A.M., M.D. 
I.ATF. HEALTH OFFICER OF KALAMAZOO. 
Reprinted from the Journal of the American Medical Association, February 27, 1886. 
CHICAGO: 
PRINTED AT THE OFFICE OF THE ASSOCIATION. 
1886. DIPHTHERIA 
IN THE 
CITY OF KALAMAZOO, MICHIGAN, IN 1884 
BY 
H. B. HEMENWAY, A.M., M.D. 
LATE HEALTH OFFICER OF KALAMAZOO 
Reprinted from the Journal of the American Medical Association, February 27, j8S6. 
CHICAGO: 
PRINTED AT THE OFFICE OF THE ASSOCIATION. 
1886. DIPHTHERIA IN THE CITY OF KALAMAZOO, MICHIGAN, 
IN 1884. 
To the physician three fields of work present them 
selves, in which he may spend his time and strength. 
He may devote himself to the study of the normal 
and morbid conditions of the human system, simply 
for the satisfaction received in learning; he may di- 
rect his attention to the cure of diseased bodies; or, 
his thought maybe occupied in discovering and mak- 
ing known the causes of sickness. 
There is, perhaps, no other one disease about which 
there is so much disagreement among doctors, as 
diphtheria. It is not my intention here to discuss 
especially the identity or non-identity of diphtheria, 
and membranous croup. Neither do I propose to 
look for those minute forms of life, which one sees 
so clearly, and another observer says do not exist, 
save in the mind of the enthusiast. Nor shall I ask 
the reader to investigate with me, at present, whether 
we should give to the patient brandy or quinine, tur- 
pentine or calomel, ice in the throat or hot applica- 
tions. I shall endeavor to give facts as they were, 
uncolored by any pet theory or idea. When an 
opinion is stated I shall seek to so express it that the 
reader will at once be able to separate the true from 
the possibly false. 
During the latter part of the year 1884, there oc- 
curred in the city of Kalamazoo, Michigan, a large 
number of cases of diphtheria. At first they seemed 
to be to a degree sporadic. Though in some localities 
several persons were ill, yet no connection could be 
found between the disease in one section and that in 
another. Before proceeding, however, to give a 
history of the epidemic, perhaps a general view of 
the city would not be unprofitable. 
Kalamazoo is a beautiful little city of about 15,000 
inhabitants, located in the midst of a rich farming 
region. It nestles in a hollow, with hills nearly sur- 
rounding it. The river, from which the place took 
its name, runs into the city from the east, twice turns 
back upon its course and then runs northward until 
beyond the limits of the corporation. Though hills 
have been mentioned, there is no marked elevation 
of the earth’s surface. The river flows silently, and 
the wind may easily sweep any street in town. Two 
creeks join the river within the city walls. At the 
“Ox-bow” an old settler cut a canal across a narrow 
neck of land, and located a flour-mill, using his canal 
for a race. He needed no pond as the river furnishes 
all the power needed without any special storage of 
the water. Just south of the city the stream is di- 
vided. A portion flows on in its natural channel; 
the remainder is conducted along higher land to run 
another mill. Before it gets to this mill the race 
expands into a storage pond. Along this larger creek, 
and around the “Ox-bow” of the river, the land is low, 
, and in the springtime it is often covered with water. 
' North of the city the valley spreads out to the width 
of three-quarters of a mile. The soil of most of this 
low land is a rich alluvium. Mixed with the mould is 
more or less sand, and an occasional bowlder is to be 
seen. Here, too, are peat beds, which furnish a good 
grade of that fuel. The centre of the city is built 
upon higher ground, which, like the surrounding hills. 
! is composed largely of sand. In some places so much 
clay is mixed with the sand that the earth is very 
firm. In others, the sand may be found in a pure 
state. Under the whole city, from six to twenty-five 
feet below the surface, there is a bed of clay. This 
is not very thick in any place, though its thickness 
varies greatly. At the paper-mill, a short distance 
south of the city, an attempt has been made to get 
an artesian well. The drill went down between 750 
and 760 feet below the surface. For about 200 feet 
the workmen bored through all kinds of drift material, 
mingled sand, gravel, clay, and bowlders. At that 
depth a small stream was struck, but it did not flow 
with sufficient force to answer the purpose. The 
water had a decided taste and smell of coal oil. A 
j little more than 200 feet from the surface shale was 
reached. As far as the drill went below that point 
nothing but shale was found, and at last the enterprise 
was abandoned. 
A study of the geology of this section of the State 
shows that Kalamazoo is situated nearly in the centre 
of a large depression in the rock. This basin, about 
seventy-five miles in diameter, and nearly round, is 
filled, as has already been mentioned, with gravel, 
sand, and other drift material. Reference to the cut 
may aid the reader to understand the elements of 
the water supply of the city. This figure is of course 
schematic, and drawn without reference to propor- 
tion, as the ratio of the diameter of the basin to the 
depth of the same is many times greater than one 
might infer from the diagram. Imagine, then, AA 
to represent the bed rock, and MM the surface of 
the ground. BCB would then represent the drift 
material. The water level would be practically the 
same (DDD) for the whole basin, with an outlet (at 
E) in the Kalamazoo river. At the depth of C there 
would be little to produce motion in the water; it 
would be without special current. More water, there- 
fore, coming into the basin in the form of rain or 
sewage would, as soon as it reached the water level, 
tend to flow out towards E. Theoretically, therefore, 
and actual tests show it to be a fact, the water at the 4 
water level would not be as pure as that from a greater 
depth. There are three sources or modes of water 
supply for the citizens: Open, or dug wells, drive 
wells, and the city pumping works. This last water 
is commonly known by the name of the first pumps 
used at the works—Holly. The source of this water 
pumped by the city engines is a deep well (figure, F), 
so constructed that the water only enters from the 
bottom. This well is 32 feet deep with a diameter 
of 24 feet at the bottom; depth of water to overflow, 
21 feet; average depth of water, 18 feet; capacity, 
3,500,000 gallons per diem. An analysis of the 
water shows less than 20 grs. of mineral water per 
pound, consisting mostly of carbonate of lime, car- 
bonate of magnesia, and alkaline chlorides. There 
is (but a very faint trace of organic matter. This 
analysis by Prof. Kedzie, of Pansing, made in Janu- 
on low land, and here they settle where most people 
would not think of locating their houses. All around 
on the flats one may see their little huts and cottages. 
Some of these are kept as clean as any house could 
be; many are less wholesome, and others decidedly 
filthy. The Dutch are to a lamentable degree fatalists. 
When the attention of a mother was called to the filthy 
water drank, as the cause of her child’s diphtheria, she 
replied, “No water! It comes from Himmel.” Their 
children are put to work almost as soon as they can 
walk. The soil where they live is well fitted for cel- 
ery raising. The shipping season lasts about six 
months. To give a little idea of the amount of that 
article raised one need only state that it is not an 
unusual thing to ship forty or more tons of celery in 
a single day; sending it to the Atlantic and Pacific 
Oceans and to the Gulf of Mexico. The women 
ary, 1885, varies but slightly from the original analy- 
sis in 1871. Among the dug wells I included what 
many call spring water. For example, in case 130, 
to get drinking water a barrel was sunk in the ground 
by the side of a ditch. Strange to say, at the level 
of the water in the ditch the aqueous fluid was to be 
found in the barrel. To make the work as easy as 
possible, the point selected for lowering the barrel 
was where the surface came nearest to the water 
level. The water to be had from wells on the hill 
in the northwest corner of the city is purely surface 
water, as it comes from above the clay stratum al- 
ready mentioned. Many of the drive wells do not 
go down deep enough to gain the advantage of drive 
wells, as they only give surface water. 
The present system of sewage was adopted in De- 
cember, 1880. The first sewers put down were laid 
the next summer. During the summer of 1884 the 
work of laying the lateral sewers was pushed vigor- 
ously, and at the close of the season about twelve 
miles of pipe had been laid. In 1885 the work was 
again pushed forward. The system adopted is essen- 
tially that of Col. Waring. Only a very small per 
centage of the residences had been connected with 
the public sewers at the time of the outbreak of 
diphtheria. The Arcadia creek, which flows through 
the centre of the city, was an open sewer. An or- 
dinance was passed during the year forbidding its 
use as such. In the older portion of the city the 
ground is full of cesspools, many of them long since 
forgotten. 
There is a large Dutch population in the city. In 
their native country they were accustomed to live 
and children do much of the washing and preparing 
for shipment. They will often stand all day with 
their hands in cold water at this labor. In more than 
one instance children have been sent out to this work 
before they were entirely well. 
Kalamazoo is not a very unhealthy place. The 
estimated number of deaths for the year 1884-85 
was about per thousand. Omitting the deaths 
from diphtheria and other so-called preventable dis- 
eases, the rate would have been 8 per 1000. In 
1884, from the 7th day of May to the 21st of June, 
there was no grave opened in the Protestant por- 
tion of the city cemetery; and from May 26th to 
June 21 st there was no interment in the whole cem- 
etery. In June, 1885, there were only ten burials in 
the city. 
We are now prepared to study the earlier cases of 
the epidemic, and then study the outbreak as a whole. 
Case /.—F., aged 3 years, only child. Parents 
both deaf mutes. Family live on the upper floor of 
a frame house. The Arcadia creek, above mentioned, 
Hows through the back yard. The creek is higher 
than the cellar floor. The little girl was reported ill 
with scarlatina about the last of April. As health 
officer I visited the place and confirmed the diagno- 
sis. Ordered the father, who was a mechanic em- 
ployed in a furniture factory, to remain at home. I 
ordered them to keep the child as perfectly isolated 
as possible. The house was in a good condition 
generally. The cellar was damp, and the mother 
informed me that, a day or two before, the baby 
played down cellar for some time. She attributed 
her sickness to that. She was quite sure the child 5 
had not played with other children. A few days 
later, on April 29, the attending physician reported 
that the scarlatinal symptoms had nearly left, but 
that he had a clear case of diphtheria just developed 
that day. There had been no known case of diph- 
theria in the city for several months. The family 
could not conceive of any means by which they 
might have come in contact with that disease. The 
case progressed favorably and in two weeks was re-! 
ported recovered; but on May 20 the doctor was 
sent for in haste, and when he reached the house the 
child was dead, probably from cardiac paralysis. The 
family used water from a dug well, and there was no 
sewage for the house. A baby under one year old 
in the same house did not get sick. 
Cases 2, j, a?id 4.—F., F., and M., aged 10, 
and 2, living about six blocks from case r, all came 
down with diphtheria on July 20. The house inside 
was in good sanitary condition. The sink-pipe emp- 
tied upon the surface of the ground near the house, 
and the filthy stood there until absorbed by 
the ground. Six feet from where the water struck 
the earth a drive well entered the ground. A micro- 
scopical examination of the water from this well 
showed large quantities of organic matter. A former 
occupant of the house “could not live in Kalamazoo 
on account of her health.” On July 25 the mother 
of these children was taken with diphtheria. 'The 
use of the well water was stopped, and all except 
case 3, which died of septicaemia, recovered. I could 
not trace these cases to a previous case. 
Cases 6 and 3 lived just around the corner from 
the preceding, and .had played with them before they 
were taken sick. They were taken sick on July 26 
and 30 respectively. Case 6, F., aged 8 years, lived 
in an old house, which sat down on the ground, with- 
out cellar wall, and which showed marked signs of 
decay. Both these families used dug wells, and 
neither place had sewage. 
Case 8.—Colored, M., aged 12 years, was taken 
sick August 1 st. Lived in an old house without 
sewage. Used dug well. Could not trace this to 
any preceding case. 
Case p.—M., 15 years old, lived in the south-east- 
ern portion of the city. (The others were all north 
of Main street.) Could not trace the case to pre- 
ceding cases. House near marsh land, and no ven- 
tilation under the rooms where he lived. Taken sick 
August 5. Died August 24 of cardiac paralysis. 
Case jo.—M., aged 3, taken sick August 16th, and 
Case ij.—F.,aged 7, taken sick August 17th, lived 
in the north-eastern portion of the city in an old 
house without other foundation than the earth. A 
hole in the ground was called a cellar, and there the 
winter’s wood was kept, and the bark and sawdust 
accumulated. Could not trace to other cases. 
Cases 12 to //, inclusive, were colored children, in 
two houses, and though I could not trace them to 
case 8, yet they may have taken the disease from 
him. The sanitary condition of their homes was 
very poor. 'Three of these cases died. 
Case 18.—M., 12 years old, was taken sick Sep- 
tember 28. He had always been sickly. The family 
lived on the third floor of a tobacco store. Used 
Holly water and city sewage. Traps imperfect; al- 
ley in the rear not in good condition. Died sudden- 
! ly from rupture of an abscess in the pharynx. Could 
| not trace to previous case. 
Case jp.—Could not be traced to previous cases. 
; Used water from dug well. Sewage of place nil. 
House old and decaying. 
Case 20.—Mild case. Lived in second story of a 
| store building. Private drain; Holly water; private 
alley in rear in very bad condition just before the 
boy was taken sick; slops were thrown out into that 
alley by neighbors and allowed to stand upon the 
ground until dried up. 
Of the next two cases I simply recorded “ bad 
surroundings.” Though I could find no communi- 
cation with case 19, yet they may have taken the 
disease from him. More likely they might have all 
three taken the disease from case 25, though I think 
they did not do so. 
Cases 23 to 23, inclusive, and 35, ages 5, 
and 7; sex, F., F., M., M.; taken sick September 
18, 18, 15, and 22. The house was a small frame 
structure of one story. The cellar walls were made 
of two layers of boards, between which sawdust 
was packed. In the spring the cellar floor was 
covered with water. No attempt had been made to 
ventilate the place. The sawdust was moldy and 
mushy, in the cellar were the remains of vegetables 
not less than a year old. The boards around the 
door-way were quite rotten. There was no provi- 
sion for the care of slops, but the tidy housewife 
stepped upon the back porch and threw her dishwater, 
etc., upon the surface of the ground. The dug well 
had partially caved in, on account of the giving away 
of its wooden walls, and consequently the surface of 
the ground sloped towards the well. The water from 
the well was used for cooking and drinking. All the 
children in this house were sick. The boys, who 
were away from home more or less, were but slightly 
affected. The girls, who had been in the house 
much, were very sick, and the older one died. Next 
door to this family lived another, whose sink-pipe 
opened upon the surface of the ground among a lot 
of weeds. From the street both of these places 
looked very neat and clean. I examined the weeds 
and found that the ground was a soft slime several 
inches deep. 'There was a window over these weeds 
about five feet from the ground. By this window a 
child slept. She had diphtheria. The family used 
a dug well under the house. 
Not to be burdensome I will only make a few 
more selections. 
In Case 40 the drinking water used was very bad. 
Cases ss, 36, 38, sp, 60, F., M., F., F., F„ aged 
3 years, 15 months, 12, 14 and 15 years. First three 
fatal. 1 aken sick October 6, 8, 6, r, and 2, respect- 
ively. The three older children were sent out ped- 
dling vegetables after they were taken sick. No 
physician was called until the night before the first 
child died. Upon examination I found a dug well 
close by the back door. The kitchen had no floor 
but the ground. On two sides of this kitchen was a 
ditch, eight inches deep, which served to receive and 
hold the family slops. It did not conduct them away. 6 
When I reached the house this ditch was full of black 
water. The well was not six feet from this ditch, and 
yet the mother wondered that the health officer 
would not allow her a couple of weeks before having 
that ditch filled up. 
In another house upon the marsh, with ditches 
around, and those ditches dammed to help the cel- 
ery, there were four children, the oldest 11 years old, 
and the youngest 18 months. All died except the 
baby. The baby was not sick. In this case a dug 
well was used, and I found the women standing upon 
the well platform pouring their slops off from its edge. 
In Case 163 a young lady fell into the fire and was 
very seriously burned. One of the attending sur- 
geons was at that time attending a case of diphtheria. 
The general sanitary condition of the house was good. 
In one house, old and without sewage, dug well, and 
no cellar or chance to ventilate under the house, 
there were eleven cases and seven deaths. 
Case 213.—A beautiful little cottage was built on 
ground that had been used for a long time as a dairy- 
man’s cow yard. A well was dug not more than 
fifteen feet from the privy. Soon after the family 
moved into the cottage the little girl was taken sick. 
In a few cases I could find nothing about the 
premises in a bad sanitary condition. That, how- 
ever, was no proof that the disease might not have 
arisen from filth. The physician reporting case 69 
recorded as the source of contagion “unknown.” 
The patient was a butcher, 36 years old. His chil- 
dren were playing with him and even kissing him 
after the disease was clearly defined, and yet he was 
the only member of the family attacked. The neigh- 
bors had complained of his barn-yard, but the health 
officer did not think it probable that Mr. F. had taken 
the disease there. Examination of the meat market 
showed that right under where Mr. F. stood at his 
work, there was a water-closet in the cellar. The 
sewer-pipe was broken and leaked both water and 
gas. In another instance (from my own practice) 
a family lived in a new brick block of four houses. 
Everything seemed to be in good condition until I 
asked the owner about the sewer-traps. I then found 
the following condition : There was a large and good 
cesspool of brick behind the house, and only twenty 
feet from the building. There was an opening at the 
surface of the ground for ventilation and cleaning. 
Four lead pipes connected this cesspool with the 
four kitchen sinks. There were no traps, but the 
pipes were as straight as possible. The pipe to No. 
3 was the shortest and straightest. Since the upper 
end of the pipe was several feet higher than the out- 
of-doors ventilator of the cesspool, very naturally in 
kitchen No. 3 there was frequently to be detected an 
odor of sewer gas. In this house, all three children 
had diphtheria without being exposed to any previous 
case so far as known. Traps were at once put into 
each sink-pipe. No other children in the block had 
the disease. 
In most families where the first cases were prompt- 
ly isolated other persons were not attacked. 
Table I gives a synopsis of the water supply and 
sewage of the first 292 cases. I may here express a 
regret that I did not keep a fuller account of all the 
cases. Whoever has attempted, however, to keep sta- 
tistics of this kind readily realizes how difficult it is 
to get accurate information, and how often the sta- 
tistician receives an intimation that the information 
sought is none of his business. 
TABLE I. 
TOTAL. 
FATAL. 
Num- 
Per- 
Num- 
Per- 
of Cases 
Water— 
ber. 
cent. 
ber. 
cent. 
Fatal. 
Holly 
53 
18 
13 
21 
24.53 
Drive Well 
IOI 
35 
10 
l6 
9-9° 
Dug Well 
137 
47 
39. 
63 
28.47 
Cistern 
I 
Cesspools 
33 
II 
5 
8 
15* 15 
City Sewers 
6 
2 
2 
3 
33-33 
No Sewage 
253 
87 
55 
89 
21.74 
1 OTAL 
292 
IOO 
62 
IOO 
21.23 
WATER SUPPLY AND SEWAGE, 
About twenty-five per cent, of the entire popula- 
tion of the city use the Holly water. Since only 
eighteen per cent, of the diphtheria patients used 
that water, it seems to indicate that they are less 
likely to take the disease on that account. Probably 
there are other reasons besides the kind of water 
drank why these citizens should be less prone to the 
disease. A very large proportion of the cases oc- 
curred among the poor population, especially among 
the Dutch. 
In regard to the portion relating to sewage, it must 
be noticed that the places where no provision had 
been made for the care of kitchen slops are decidedly 
the most prolific of cases, and fatal cases. The very 
small number of cases in which the premises are con- 
nected with the city sewers renders the last column 
of that line of little value. One of the two fatal 
cases was No. 163, already mentioned, in which the 
injuries received nearly took the patient’s life, before 
the diphtheria attacked her. As relating to the sub- 
ject of sewage, it may be noticed that no cases oc- 
curred upon the east side of the river until the dams 
on the river were fixed, and the water raised enough 
to overflow some low land there. After that there 
were nineteen cases, six of which were fatal. 
After a careful study of the epidemic, I came to 
the following conclusions: 
1. Diphtheria is essentially a filth disease. 
2. It may be produced without any relation to a 
former case. 
3. During the earlier stages it is but feebly 
contagious. 
4. A simple “ sore throat,” including under this 
head tonsillitis, pharyngitis and laryngitis, may de- 
velop into diphtheria, without receiving contagion 
from a previous case. 
5. Diphtheria, after being once produced, may be- 
come contagious and epidemic. 
6. Diphtheria and the proneness to the disease 
may be modified by the constitution of the person, 
and by atmospheric conditions. 
7. Diphtheria and membranous croup are the same 
disease. 
To what extent does one attack protect from future 
attacks? I regret to say that I have no accurate 
data on this subiect. Some persons were attacked a 7 
second time. On the other hand, in one family of 
four children all but one had the disease some years 
ago. This year this one had it and died. Those 
who had had it before escaped this year. 
What relation has age and sex to the disease? 
Table II gives the number of cases of males and 
females of each age from April 15, 1884, to July 1, 
1885. For study the cases are divided into four 
groups: Those under 6 years old; those from 6 to 
10 inclusive; those from 11 to 15 inclusive, and those 
over 15. It will be noticed that almost ninety-two 
per cent, of the males, eighty-five per cent, of the 
females, and eighty-eight per cent, of all cases were 
under 16 years old. 
having been severely burned. The man 33 years old 
had pneumonia. His four children had diphtheria, 
and three of them died. After the last death he 
caught cold, and at the same time diphtheria took 
hold of him, almost immediately extending through 
his entire lungs. It will also be noticed that more 
girls than boys were attacked during the first period. 
In the next the boys are most numerous. During 
the years when the maidens are preparing for woman- 
hood they are again more likely to be troubled by 
the disease. 
In the first year of life there were 13 cases—8 males 
and 5 females; at 2 years there were 16 cases—4 
males and 12 females; at 3 years there were 24cases 
—9 males and 15 females; at 4 years 26 cases—n 
males and 15 females; at 5 years 25 cases—13 males 
and 12 females; at 6 years 24 cases—14 males and 
10 females; at 7 years 34 cases, equally divided; at 
8 there were 21 cases—11 males and 10 females; at 
9 there were 26 cases—16 males and 10 females; 23 
cases in the 10th year included 11 males and 12 fe- 
males; 17 cases at 11 were divided among 8 males 
and 9 females; 15 cases at 12 included 5 males and 
10 females; 7 cases at 13 included 2 males and 5 
females; 9 cases at 14 showed 3 males and 6 females; 
12 cases at 15 give 4 males and 8 females; 5 at 16 
give 3 males and 2 females; 3 at 17 show 1 male and 
2 females; and at 18 there were 2 cases, both females. 
The age at which death took place in the fatal cases 
was as follows: At 1 year 3 males and 1 female; at 
2, 6 females; at 3 years 4 males and 4 females; 4 
males and 7 females at 4 years; 2 males and 4 females 
at 5; 4 males and 1 female at 6; 1 male and 3 fe- 
males at 7; 2 males and 4 females at 8; 1 each at 9; 
2 females at 10; 1 each at 11; 1 male and 2 females 
at 12; 2 females at 13; one each at 14; 1 male and 
2 females at 15; 1 male at 16; 1 female at 17; and 
1 female at 18. 
NUMBER OF CASES. 
TABLE II. 
MALES. 
FEMALES. 
TOTAL. 
A 
N 
M 
P 
N 
P 
TV 
M 
P 
I 
8 
5 
13 
2 
4 
12 
l6 
3 
9 
15 
24 
4 
II 
15 
26 
5 
13 
45 
3°-4i 
12 
59 
32 • 24 
25 
104 
3i-42 
6 
14 
IO 
24 
7 
17 
17 
34 
8 
II 
IO 
21 
9 
l6 
IO 
26 
IO 
II 
12 
23 
69 
46.62 
59 
32-24 
128 
38-67 
II 
8 
9 
17 
12 
5 
IO 
15 
13 
2 
5 
7 
14 
3 
6 
9 
IS 
4 
8 
12 
22 
14.86 
38 
20.77 
60 
18.13 
l6 
3 
2 
5 
• 7 
I 
2 
3 
18 
2 
2 
20 
I 
1 
21 
I 
1 
22 
I 
1 
23 
I 
1 
24 
I 
1 
25 
I 
1 
27 
I 
1 
29 
2 
2 
32 
I 
1 
33 
2 
3 
5 
35 
I 
2 
3 
36 
I 
1 
37 
I 
1 
39 
T 
2 
* 3 
45 
2 
2 
47 
I 
1 
49 
I 
1 
5° 
I 
1 
5i 
12 
8. ii 
I 
27 
14-75 
1 
39 
11.78 
Total.. 
148 
I48 
100 
183 
183 
IOO 
331 
33i 
IOO 
Average Age 
—Males 
9.03; 
Females, 10.67 
; Total, 9.94. 
,4, Age. A7, Number. M, Total Number. P, 
Percent of Cases. 
TABLE III. 
FATAL CASES. 
MALES. 
FEMALES. 
TOTAL. 
A 
N 
M 
P T 
N 
M\ P | T 
N 
M 
I T 
I 
3 
I 
4 
2 
6 
6 
3 
4 
4 
8 
4 
4 
7 
II 
5 
2 
4 
6 
— 
13 
48.15 28.89 
— 
22 51.17 27.29 
35 
5°- 33-63 
6 
4 
I 
5 
7 
I 
3 
4 
8 
2 
4 
6 
9 
I 
I 
2 
IO 
2 
2 
— 
8 
29.63 11.59 
11 25.58 18.64 
19 
27.14 14-84 
II 
I 
I 
2 
12 
I 
2 
3 
!3 
2 
2 
14 
I 
I 
2 
IS 
I 
2 
.3 
— 
4 
14.81 >8.18 
8 18.6021.05 
12 
I7.I4 20.00 
16 
I 
1 
17 
I 
1 
18 
I 
1 
33 
I 
2 
7.4116.67 
2 465 7-41 
1 
4 
5.72 10.26 
Total.. 
27 
27 
38.57 18.24 
43 
43 '61-4323-49 
7° 
70 
IOO 21.15 
Ase 
A7', Number. M. 
Total Number. P, Percent of Fata! Cases. 
T, Percent of all Cases. 
Table III shows that ninety-three per cent, of the 
males, ninety-five per cent, of the females, ninety- 
four per cent, of all cases proving fatal were under 
16 years of age. Of the cases over 23 years old, all 
but four occurred in families where there had been- 
previous cases among the children. Among the four 
is the butcher mentioned as Case 69. One was an old 
colored woman who had not had any child sick with 
it so far as known, but she lived in the neighborhood 
of cases among the negroes. Of the fatal cases over 
15 years old, the boy of 16 was an unusually well 
developed lad. The girl of 17 was also well devel- 
oped. So far as could be seen there was no special 
reason why they should either of them die. The 
girl of 18 was the one already twice referred to as 
It will be noticed that 7 seems to be the favorite 
age for patients. It will also be noticed that boys 
reached their highest mortality for any age at the 8 
years 3, 4 and 6, losing four at each of those ages. 
The girls lost seven at the age of 4. Table III 
shows that the mortality of females was greater than 
that of males. 
What is the influence of weather upon diph- 
theria? 'Fable IV gives the weather report, and 
number of new cases of diphtheria in each week 
for the last six months of 1884. I often noticed 
that when the amount of ozone dropped to one 
or two for two or three days, new cases would be 
reported, and old ones were likely to be worse. At 
Christmas time there was considerable snow upon 
the ground, and there were but two or three cases of 
diphtheria. The snow melted quite suddenly during 
the next few days, and within two weeks there were 
twenty-five new cases reported. When the ground 
had been frozen a short time the number of cases 
was small. 
did not recommend it. but I became thoroughly con- 
vinced that the practice did much harm. 
Though, as before stated, I do not propose to dis- 
cuss the subject of therapeutics, yet it may not be 
out of place here to say that I think, with only one 
exception, all the physicians here use some prepara- 
tion of mercury in the treatment of this disease. Some 
prefer as a general thing the iodides, others the chlo- 
rides. Especially in robust children, my own prefer- 
ence is for the mild chloride, given in 2-grain doses, 
every two or three hours until six powders have been 
taken for a child 5 years old. The one physician 
above mentioned depends largely upon whisky and 
quinine. His success certainly is not better than the 
average. Within the last year various papers have 
recommended the burning of tar and turpentine. I 
think those who have tried it here will not try it 
again. For laryngeal trouble, however, some have 
thought they were aided by the vapor of turpentine. 
I used it in one case with good results. The turpen- 
tine was put into boiling water, and the patient in- 
haled the steam. Noticing the tendency towards 
cardiac paralysis, from the first I gave all my cases 
digitalis, and after the fever began to subside I ad- 
ministered tr. nucis vomicae. Locally I used a solu- 
tion of carbolic acid or permanganate of potassium. 
Though I did not try it, I think the mixture of solu- 
tions of corrosive sublimate and permanganate of 
potash would do good; better, indeed, than any other 
application I have seen suggested. Personally I am 
convinced that ice applications are detrimental, but 
I allow the patients to drink water freely. Alcohol 
is good, but it must be used with caution. I am 
convinced that we must study to prescribe such med- 
icines as will not disgust the patients, as not infre- 
quently serious results have followed the resistance 
of the patient against taking the drug prescribed. 
The patient’s strength must be kept up, not by 
stimulants, but by food. When all else fails I depend 
on milk, given, if necessary, in dram doses every half 
hour. Since most of the cases occurred among the 
poor and more ignorant population, where they did 
not receive, and could not get competent nursing, it 
was the opinion of the attending physicians that if 
we had had a city hospital where such patients could 
be cared for, from forty to fifty per cent, of the fatal 
cases would have been saved, and the whole number 
of cases would have been diminished. 
In what proportion of the cases did paralytic 
symptoms develop? I could not tell exactly, as 
physicians made no report of paralysis except inci- 
cidentally. I knew, however, of a dozen cases out 
of the 33 r. There probably were more. One of 
these was almost entirely paralyzed, and afterwards 
recovered. In two cases at least, the paralysis de- 
veloped certainly a month after apparent recovery 
took place. One of these proved fatal. 
I am under obligations to Mr. A. M. Munn, of the 
Michigan Asylum for the Insane, for kindly giving 
me free access to his weather record. The observa- 
tions were made by Mr. Munn at the Asylum, which 
is situated upon the hill in the southwest portion of 
the city. 
Kalamazoo, January 10, 1886. 
TABLE IV. 
| New 
Week ending Cases 
Bar. 
Ther. 
Wind. 
Cloud. 
Ozone. 
Rain. 
July (fraction) 
5 
29.091 
70.25 
3-85 
5.08 
2.00 
0.22 
12 
29-I75 
68.14 
5-00 
6.05 
2.14 
O. l6 
iq 
29-I99 
64.65 
5-04 
4.06 
i-57 
0.07 
26 
5 
29.215 
72.78 
5.06 
6.00 
2.05 
1.78 
August 
2 
2 
29. I 17 
72 43 
5.00 
7.00 
2.00 
0.26 
9 
1 
29.257 
Co-57 
S.OQ 
7.06 
2.06 
0-33 
l6 
1 
29.366 
72-53 
4-00 
4.00 
I.06 
0.12 
23 
1 
29.278 
72. II 
6r*o 
4.00 
2.00 
O. 52 
so 
3 
29. 108 
64.89 
5 03 
7.06 
2.06 
0.76 
September.... 
6 
3 
29.292 
72.78 
4.06 
5.00 
1.05 
0.48 
13 
'1 
29 376 
70.22 
503 
4.02 
I.08 
20 
9 
29.365 
63.43 
6.08 
403 
I.07 
O. l8 
27 
9 
29.216 
64.OO 
6.03 
7.00 
2.05 
i-54 
October 
4 
IS 
29.266 
68.24 
5.01 
8.00 
2.02 
O. 2-4 
11 
27 
29.381 
59.76 
6.02 
5-00 
2.00 
O.96 
l8 
46 
29.399 
55-57 
503 
5.00 
2.04 
0.18 
25 
24 
29.497 
49.09 
6.04 
5.00 
2.03 
O.98 
November.... 
I 
23 
29.361 
42-57 
5.00 
9-°5 
2.01 
0.82 
8 
27 
29-439 
38.48 
5.02 
6.00 
2.07 
0.85 
15 
27 
29.389 
45-24 
4.07 
503 
I.07 
22 
20 
29.316 
36.76 
5.09 
7.00 
3.00 
0.12 
29 
is 
20.063 , 
27.62 
6.06 
10.00 ( 
3.00 
0.87 
December 
6 
5 
29-153 1 
40.86 
4.07 
7.00 
3.06 
0.83 
13 
4 
29-335 
31-33 
7.01 
9.00 
I.09 
1.02 
20 
2 
29.326 
I3.8l 
5.02 
9-°4 
2.07 
I.98 
fraction) 
27 
I 
29.379 
15-33 
5-05 
9.03 
3-°4 
1.34 
31 
12 
29.255 
39-75 
6.00 
10.00 
3.02 
2-°i. 
Table giving for each week the number of new cases of diphtheria in the 
city, the average barometric pressure, thermometer (F.), velocity of wind, 
amount of cloud, ozone, and rainfall. (Cloud and ozone marked on scale 
of io.) 
Of the fatal cases, the modes or causes of death 
were as follows: 
Cardiac paralysis 8 cases. 
Laryngeal stenosis 29 “ 
Septicaemia 27 “ 
Laryngeal stenosis and septicaemia .... 4 “ 
Rupture of abscess 1 case. 
Haemorrhage (from bowels) 1 “ 
Total 70 cases. 
So far as known, of the cases reported one had the 
membrane only in the larynx. Three or four females 
had the membranes over the genitals. Several had 
the membrane upon abrasions of the skin. I think 
that, without exception, cases in which blisters had 
been raised progressed towards recovery more slowly, 
and were more liable to septicaemia than those not so 
treated. In several cases the parents had applied 
kerosene oil to the neck externally, before the physi- 
cian was called. At first, knowing that some good 
authorities had recommended that vesicants be used, 
I permitted my patients to be so treated, though I