THE CAUSATION OF INTERMITTENT EE VER; INCLUDING A Record of 118 Cases of Intermittent Fever and of Coincident METEOR- OLOGICAL AND OTHER CONDITIONS. Bv A. W. NICHOLSON, M. L>., OF OTISVILLE, GENESEE CO., MICHIGAN. [Reprinted from the Annual Report of the Michigan State Board of Health, for the year 1880. | Reprint No. 70. CAUSATION OF INTERMITTENT FEVER. HOW METEOROLOGICAL CONDITIONS MAY CAUSE SICKNESS; AND METEOROLOGICAL AND OTHER CONDITIONS INFLUENCING THE PRODUCTION OF INTERMITTENT FEVER. BY A. W. NICHOLSON, M. D., OF OTISVILLE, MICH. All investigators after scientific truths, and especially those working in the field of pathological research, must entertain respect for the recent systematic efforts of Prof. Klebs, and of Dr. Tommasi-Orudetf to discover the nature of the causation of periodic fevers in certain organisms existing in the soil, and in the atmosphere above the ill-famed Roman Campagna and Pontine Marshes. Yet the wavering conclusions arrived at by these earnest workers as a sequence of their labors, and the absence of positive knowledge as to the nature of the causa sine qua non of the development of the so-called malarial disorders, still leaves open the opportunity for further earnest work in this direction, further labor for the microscopist, and further labor upon the part of those other investigators who doubt the constant presence of a definite organism in the soil, to propagate and diffuse itself in the atmosphere, where that alone would be sufficient to produce the phenomena of periodic fever. The sanitarian is still unable to point out, and adopt determinate means to exorcise this ignis fatuus and thereby offer a blessing to the State and to man- kind, though great are the results consummated by him in the removal of many conditions that often appear to perform the parts of elements of causation. Whatever channel of research the etiologist or pathologist may pursue, his exertions ought to be influenced by a thorough knowledge of all those common circumstances liable to cause a disturbance of a physiological state. He should not ignore the apparent relations that alterations in atmospheric pres- sure, that hygrometric changes, that temperature, and other meteorological conditions bear to these disturbances. The existence of the phenomena of fever needs not always be accounted for through a co-existence of a specific poison. Nor has the periodicity of fevers been explained by the presence of a "bacillus malar ice." I would not wish to offer any theory of my own to supplant the theories that have arisen as results of the admirable speculations of the many who have tried to fathom the nature of the cause of these fevers; but several years' observations of these fevers, with an effort to be systematic in a careful analy- sis of individual cases, as to their relations to immediate meteorological condi- 193 194 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. tions and sanitary surroundings, may justify me in presenting the results of these observations. The study of the relation of meteorology to pathology is every day assuming greater importance. That there are some factors that meteorology already has demonstrated bear a truthful relation of cause and effect in regard to sick- ness, does not justify one in anticipating that to atmospheric changes may sometime be traced the causation of all diseases. Yet we cannot but conceive that the conditions of the air exert an influence on all sicknesses and all physio- logical conditions. The prevalence of periodic fevers in this region, especially during the Summer months, induced me to prepare a schedule of inquiries bearing upon the subjects of sanitation and meteorology in their relations to these fevers. I therefore commenced a history of these cases, as they occurred in my prac- tice, on the 1st day of May, 1877, and according to the requirements of the schedule. At this date I did not have a complete meteorological equipment, but one including ozonometry. Upon the 18th of the succeeding month my apparatus accorded with the requirements adopted by the State Board of Health. The plan was to ascertain the date of attack, and consider each case in its relation to every meteorological fact possible pertaining to the forty- eight hours preceding the attack, and for the day of the attack. Also to secure facts relating to sanitary surroundings, to the health of the individual imme- diately preceding his present sickness, and facts relating to all exposures, excesses, and deprivations. Such a record, when tabulated, might enable me to arrive at some valuable conclusions. In examining the facts recorded in the table one is impressed with the apparent relation of causation some of these facts bear to the individual cases. Temperature, moisture, barometric pressure, and other atmospheric condi- tions assist in sustaining or occasioning perturbations in the physiological equilibrium of every individual. Yet, each state of the air never can exhibit its own influence separable from the combined influence of other atmospheric conditions, and our study of their relations to organic life should be governed by a knowledge of this fact. If humidity modifies the effects of temperature it also modifies the influence of barometric pressure, and of the wind. In speaking of the separate effects of temperature, the late Geo. B. Wood says:- " The effect of heat is to excite its own peculiar sensation in the seat of application. In a moder- ate degree this may not be displeasing; indeed, when the temperature has been depressed below the normal standard, it is often highly grateful; but, if increased it begins at length to become painful, and in the highest degrees is often extremely so. "The secretions are promoted, all of them probably at first, under a gentle operation of the stimulant; but when the heat is considerable and continued, the mucous membranes and the kid- neys appear to be irritated beyond the point of free secretion, as indicated by a dryish state of the mouth and diminished discharge of urine; while the secretory function of the liver and skin are augmented so that there is usually a freer flow of bile and a greater or less increase of perspi- ration. " Along with the exaltation of the organic functions the nervous also becomes excited. A mode- rate influence of the cause is usually attended with agreeable effects. But these functions under a higher degree of excitation become deranged, and at a still higher are impaired. This result is simply in conformity with the general law that, by moderate over-excitation or irritation, the functions are increased in a normal direction, by a greater amount of it are deranged, and by a still greater are diminished or suppressed." In a recent work on "Sanitary Examination of Water, Air, and Food," by Cornelius B. Fox, he writes of moisture:- "An excess of aqueous vapor in the atmosphere has not only a depressing effect on the nervous system, but it interferes with the cutaneous and pulmonary exhalations. If the temperature is high (65° to 80° Fahr.), saturated air is sultry and offensive; if low (e. g., a Scotch mist of 36° Fahr.), its chilling influence penetrates all clothing. Above 80° Fahr, air of excessive humidity becomes injurious, and it has been doubted as to whether life can be prolonged in such air at a temperature of between 90° and 100° Fahr." The practical researches of Dr. Bowditch, and of Dr. Baker of our own CAUSATION OF INTERMITTENT FEVER. 195 State Board of Health, clearly demonstrate a marked relation between mois- ture and temperature and pulmonary affections. The 19th of July of the year 1878 may well be remembered by the working population in this State, and especially by those at that time living in this vicinity. The morning opened with a temperature of nearly 70° Fahr, and the atmosphere saturated with humidity. At 2 o'clock P. M. the thermometer read 93° in the shade with a relative humidity amounting to eighty-five per cent. The highest temperature amounted to 96.5° Fahr, in the shade. The air was quiet, or moving at the rate of from two to four miles per hour. The record of atmospheric pressure was one of the highest during the month. The per cent of clouds was not sufficient to protect the laborer from the torrid heat of the sun. In the test for ozone for the preceding night there was but a trace, though this circumstance might have been due to decolorization by excess of moisture. The rate of ozone was, during the day, a discoloration of three degrees, on a scale of ten, according to Schonbein's test. The great majority of the laborers working in the harvest-field during the most oppressive portion of the day, wisely, or instinctively, left the field, while among those who injudicously disregarded the warning the oppressive air gave to all, some were seized with sudden and excessive nausea and depression, others with vertigo, and many by attacks of typical periodic fevers whose par- oxysms were repeated for several days. In two instances of insolation (sun- stroke) occurring among those cases coming under my own observation, a lingering illness was followed by insanity terminating in death. What was the cause of these differing disturbances when all were subjected to selfsame atmospheric conditions? While in the same field one was the prey of abdominal spasms with fluxes and nausea, another of ague, and another the victim of a coup-de-soleil (sunstroke), can we, when we know of the varying susceptibility of the nervous system of differing individuals to the influences of external impressions, and the ease with which discomfort overbalances a phys- iological condition, expect to discover the presence of one individual, septic, or cryptogarnic element that alone will produce one of these sicknesses while the others are produced by known, obtaining atmospheric states, all being sub- servient to the same apparent causes ? It is difficult to declare what influence each meteorological element exerted upon those placed in relation to it. The most marked, probably, was the combined influence of temperature and moisture. Evaporation of the per- spiration from the skin was almost absolutely prevented, and it was rendered impossible for the body to sustain the temperature of health. Disturbances in the digestive and circulatory and other functions were the result. Another illustration of the apparent effects of elevated temperature and excess of moisture, came under my observation in the Summer of the year 1876. The locality was in a pioneer settlement and adjoining a pine forest. The floor of the house where the subjects resided was constructed of rough, boards which were movable. The rooms of the house were practically as one. Beneath the house was stagnant water to the depth of two feet. A hot fire in a large stove was a frequent necessity, and the artificially heated atmosphere greatly served to attract the moisture from below. This humid air, subject to sudden fluctuations of temperature, was the apparent cause of the extreme sickness that followed. One of the inmates of this habitation died of colliq- uative diarrhea, and four others, after removal, slowly recovered from fevers of a periodic and a typhus type. 196 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. Experiments made with the psychrometer by the writer since the occurrence of the instance recorded last, demonstrate that where conditions exist to freely admit moisture where the air is artificially heated, as with stove above men- tioned, there is excess of moisture in the air thus heated over that in the air not immediately subjected to such heat. Experiments conducted over a swamp with the view of ascertaining the varying amount of moisture in different situ- ations, discovered that where there was free circulation of the air or a rapid motion the temperature and moisture were less than in situations where the air was more confined and the temperature higher. The influence of barometric pressure on the phenomena of life is not yet well known. It is stated that a man of ordinary stature, subjected to a normal pressure of fourteen tons, suffers no great inconvenience, as the body, being- permeable to the atmosphere, is subjected to equal pressure in all directions. Yet, the aeronaut, as he ascends into rarer atmosphere, experiences hemor- rhages from nose, lips, and eyes, a fact ascribable to the absence of the cus- tomary atmospheric pressure exerted upon the blood-vessels. Although the change is sudden in these instances producing these effects, it is not improba- ble that the barometric fluctuations in the lower stratum of the atmosphere when associated with other favorable conditions, effect changes in the circula- tory system and in the nervous system, that may excite discomfort and disease. What the exact relations may be between the weight of the atmosphere and co-inciding sickness, only multiplied observations in this direction can demon- strate. Other co-existing factors must be considered at the same time. Strict accuracy in this relation requires that the observer should not wholly rely upon averages of months in regions isolated from the case of sickness, but that he should make the time of his observation correspond simultaneously with the date of attack, and that the observations should be in close proximity to the location of the case. The same accuracy should be observed in respect to every other meteorological condition when studied in relation to prevailing disease. The effects of the prevalence of clear or cloudy skies as factors in the pre- vention oi' production of disease is little studied and, perhaps, too greatly disregarded. It is generally believed that sunshine is conducive to the per- petuity of a healthy state of the body and mind. Although this proposition is generally true, an exception often occurs when, after rains, the effects of high temperature and a humid air are ameliorated by an over-clouded sky. The invigorating influence of showers, increasing, as it usually does, the quan- tity of active oxygen, and washing impurities from the air, more than equals the evil a cloudy sky would cause. If ozone is the "scavenger" of the atmosphere, it has an ally in the wind that dilutes the air containing local impurities with fresh supplements of purer air, thus enabling this great disinfectant to better seize upon its poisonous particles. Although the wind often is the agent that transports the contagia of virulent disease, it often acts as a factor to prevent disease. High temper- ature and extreme humidity of the air, with a still circulation, prevent cutan- eous and pulmonary exhalations to such an extent as to occasion diarrhea and other disorders, especially those apt to occur where nervous depression already obtains. A change happens when a breeze puts into circulation the motionless air. Then the surface of the body experiences cooler and more agreeable sen- sations by an augmented evaporation from the skin, and its salutary influence is reflected to the nerve-centers. CAUSATION OF INTERMITTENT FEVER. 197 How great may be the influence of active oxygen upon the animal economy is, also, yet a question for extensive observation and speculations. Notwith- standing so little positive information has been obtained relating to its agency in preventing or producing disease since its discovery in 1839 by Prof. Schbn- bein, and so discouraging have been the results arrived at by most observers, the present unabating enthusiasm exhibited by many investigators in relation to this subject renders an eventual solution of the problem probable. The State Board of Health of Michigan considered the subject worthy of study, and has adopted a systematic course of investigation in regard to it. In a communication to the writer, the Secretary of the Board emphasized the importance he placed upon the study of the etiological relations of ozone. The following table exhibits the monthly averages of the principal meteoro- logical data. It is inserted to assist in the study of the cases recorded in the table succeeding it. MONTHS, 1877. Temp. Degrees r.* Grains of Vapor in Cubic Foot of Air.* Atmos- pheric Pressure. Inches.* Velocity of Wind. Miles per Hour.* f Ozone. Rainfall. Inches. Per Cent of Cloud- iness.* Day. 7 A. m. to 2 P. M. Night. 9 P. m. to 7 A. M. May 57.8 .... 4.4 3.5 2.7 1.75 33.6 June 67.0 5.62 29.068 6.5 3.0 2.7 3.77 37.5 July 72.5 6.03 29.084 3.5 3.0 1.9 1.97 32.1 August 69.9 5.99 29.066 2.2 3.4 1.8 3.58 32.9 September . 62.5 5.56 29.153 2.7 3.1 1.9 2.59 24.7 October 50.7 5.11 29.114 2.9 3.4 3.2 4.33 80.1 November 33.9 2.53 29.143 3.9 4.6 5.2 3.03 65.0 December 36.0 2.60 29.221 6.0 3.4 3.9 1.68 68.0 * Average of observations, at 7 A. M., 2 P. M., and 9 P. M. daily, t Estimated. The altitude of the place where these observations were taken is 820 feet above the level of the sea; the latitude, 43° 13', and longitude, 83°31'. Topo- graphically the country consists of level tracts succeeded by sandy elevations, and abounds in small lakes. The soil varies greatly in short distances, con- sisting of clay, clay loam, sand and sandy loam. 198 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. TABLE.-Record of 118 Cases of Intermittent Fever Jack. Date of first Visit. Date of Meteoro- logical Observa- tion. Temp. Grains of vapor IN A CUBIC FOOT OF AIR. Barometric Pressure. Reduced to 32° F. Per Cent of Cloudiness. Prevailing Direc- tion and Veloc- ity of Wind. to ◄ O Date of A 3 3 JU Ci a 4 C5 s OS g pl Cl s Ch' G aS g g 3 cu (N g Ci Direction. Miles per Hour. « o *•* Qg s; O 1877 31 40 37 100 100 100 N. W. 4-2 1 May 2 May J 51 " 2 30 49 41 00 5 00 N. W. 4-2 ' 2 1 Mnv 1 31 40 37 100 100 100 N. W. 4-2 " 5 46 60 47 20 75 5 E. 4 3 7 7 j " 6 . 49 60 48 00 00 N. E. 12-4 4 « 7 47 61 47 75 50 00 N. E. 12-4 4 " 10.. " 11 45 51 47 90 90 90 N. & E. 2-4 2 4 12 57 62 44 90 90 00 S. E. & N. E. 2 3 " 12.. " 16 50 67 52 00 25 00 N. E. & S. E. 4-2 3 69 72 60 50 20 00 S. E.& S. W. 2-12 2 5 18 20 j " 17 62 72 69 100 75 00 S. E.&S. W. 2-4 1 " IS 69 82 70 50 50 5 S. W. 4-2 2 " 16 69 72 60 50 20 00 S. E. & S. W. 2-12 2 6 18 20-j " 17 62 72 69 100 75 00 S. E. & S. W. 2-4 1 " 18.. " 17 69 82 70 50 50 5 S. W. 4-2 2 62 72 69 100 75 00 S. E. & S. W. 2-4 1 7 19 21 j " 18 69 82 70 50 50 5 S. W. 4-2 2 " 19.. 15 69 88 67 50 25 10 S. W. 12-2 50 72 59 100 75 5 E. 4-2 3 8 17 " 16 69 72 60 50 20 00 S. E. &S. W. 19.2 2 " 17 62 72 69 100 75 00 S. E.& S. W. 2-4 1 " 9 46 50 43 75 75 10 N. W. & N. 4-2 3 9 11 " 10 45 57 47 90 90 90 N. & E. 2-4 2 " 11 57 62 44 90 90 00 S. E. & N. E. 2 3 " 18 69 82 70 50 50 5 s. w. 4-2 2 10 20 215 " 19 69 88 67 50 25 10 8. W. 12-2 1 " 20 72 88 72 50 50 100 S. E. & E. 2-4 1 " 1 31 40 37 100 100 100 N. W. 4-2 11 3 " 2 30 49 41 00 00 00 N. W. 4-2 " 3 39 57 47 00 10 5 S. W.&N.W. 2-4 " 18.. 69 82 70 50 50 5 s. w. 4-2 2 12 20 Jn?4 " 19 69 88 67 50 50 10 s. w. 12-2 1 " 20. 72 88 72 50 50 100 S. E. & E. 2-4 1 J'ne 1 " 30 66 80 63 25 25 00 s. w. 4-2 3 13 47 " 31 71 81 67 10 5 10 s. w. & s. 12-4 3 f June 1. . 72 83 69 5 75 5 S. E. 12-4 3 I Mav 31 71 81 67 10 5 10 s. w. & s. 12-4 3 14 2 72 83 69 5 75 5 S. E. 12-4 3 4 j " 2 69 80 61 00 00 5 N.W. &S.W. 12-4 4 " 2 69 80 61 00 00 5 N.W.&S.W. 12-4 4 15 4 " 3 . 69 80 61 75 10 10 N. W. & W. 25-2 3 " 4... 69 75 59 5 25 haze W. & E. 4 3 " 9.. 69 67 58 100 100 100 S.W. &N.W. 12-4 4 16 11 " 10 50 58 50 100 75 10 w. 12-2 3 " 11 53 59 52 10 95 75 E. S. W. 12-2 4 " 5 55 71 59 100 95 100 N. E. 4 4 17 7 14 •• 6 59 74 61 10 00 N. E. 4-2 1 « 7 64 79 65 5 25 00 N. E. & S. E. 2-12 2 * Estimated, by observations at 7 A. M., 2 P. M„ and 9 P. M. The figures separated by hyphens denote the greatest and the least velocity; in some cases the velocity is given for the three observations, thus, 2-12-4. CAUSATION OF INTERMITTENT FEVER. 199 and Coincident Meteorological and other Conditions. Ozone, Day, 7 A, 1 M. to 2 P. M. Rainfall, Inches. Character of Surrounding Country, and Nature of Soil. Sanitary Surroundings of Habitation. | Age, in Years. 1 Sex and Social Condition.* Recent Exposures, Excesses, and Deprivations. Type of Disorder. ..... Light Snow. 1 Village. Low lands part- l ly drained. Forests % ) mile distant Soil sandy. House in village,low on ground. Ground cold and wet at this time. Well 27 ft. deep; iron pipe. Water becomes yellow on 27 Fe. M. Patient says cause of her sick- ness might be due to her having taken off under- clothing. Only such exposures as work- ing hard in field would oc- casion. Tertian. .... Light Snow. \ Level well cultivated V {arming country. Soil standing; has bad taste. Ground cold and wet on May 1. Sanitary surroundings fair. 23 Ma. M. Tertian. ) clay and sandy loam. Well-water good. 1 4 1 Level and well cultivat'd. > Soil sand, clay and loam. ) Soil dry at this time. House low on ground. No cel- lar. Good water. 83 Ma. M. Deprived of rest by taking care of sick wife. Tertian. 4 House, rough boards. No cellar. Has a very impressionable 4 i Land'rolling. Ponds and > marshes near. Soil mix* Stagnant pond near. House in settlement with population of 75. No other case near. Water nervous system and is sub- ject to convulsions; no ap- parent unusual cause why sickness should occur. Quotid- ian. 3 10 Ma. 3 ) ed and dry. good. 3 3 2 .77 {Slight elevations s u r. > rounded by swamps. El- 1 evations sandy. ) Elevated farm'g country. J- Small lake 100 rods from ) house. Soil sandy. Low, filthy, unfinished house. Well-water good. 77 Fe. M. No unusual exposures, etc. Tertian. 3 3 2 .08 .77 Low, small house; no cellar. Water good. Soil wet from rain of previous day. 1 & Ma. No unusual exposures, etc., excepting the air was nearly saturated with moisture. Quotid- ian. .77 Went bare-footed on the 17th Quotid- 2 1 Same as in case 1 Same as in case 1_ Ma. and 18th, for first time this ian. 2 3 year. .46 .08 . .77 Low board house; ground wet. Fe. Went bare-footed on 17th, / Soil sandy. Woods. Low No cellar under house. Spring- and had then first marked Tertian. 3 (lands and swamps near. water; Some organic matter in it. 1 chill. 4 4 3 .01 ) Woods. Low lands and £ swamplands. Soil sandy. Low log house. Use spring, water containing organic mat- ter. Bad taste to water. 1 & Ma. Child's health affected by period of dentition. Tertian. 2 /In village of Otisville. C Soil sandy. Land rolling. 1 Land rolling. Swamp and V low land 40 rods from ) house. Soil sandy. Open rolling farm'g coun- / try. Low swamp land Small house with no cellar. Occupation, blacksmithing. Lett shop and went fishing, remaining out until 2 A. M. of 19th. Been working unusually hard and exposed to all kinds of weather up to date of first visit. 2 3 2 .24 Light Snow. Well 15 feet deep, containing surface water. House low and uncleanly; no cellar. Well 44 ft. deep; met- allic taste. Ground moist. House in good condition; rath- 39 43 Ma. Fe. M. Tertian. Tertian, Quotid- ian, Double Quoti'dn 2 11 Fe. No unusual exposures Tertian. 3 .24 t 40 rd. frm house. Sandy ' loam. er low. Water good. 3 /Country level. Soil sandy f and sandy loam. Log house completely inclosed with trees and shrubs. Great amount of moisture about house. Well-water good. 3 30 Fe. Much worn from caring for sick in her own house. Quotid. 3 M. ian. 3 3 /Rolling farming country, f Soil sandy. Cellar damp. Much decaying vegetable debris about house. Well-water good. 70 Ma. Childish, and subjects himself to all kinds of exposures without reason. Tertian. 4 M. Good house, but 2 ft. of water in the cellar. Been water in the cellar for 2 months. Well- water good. Fe. M. / Rolling farm'g lands. Soil ( clay and clay loam. 4 4 .10 40 No unusual exposures, etc.... Tertian. 3 3 .89 Same as in case 10. Ground wet. Very wet unfin- ished cellar. Well-water good. 32 Fe. M. No unusual exposures, etc.... Tertian. 4 .11 .11 Ground damp. House low on 3 Sarne as incase 10 ground; no cellar; bad air. Water not good; used contin- ually. 10 Ma. No unusual exposures, etc. .. Tertian. 3 * Ma.-Male. Fe.-Female. M.-Married. 200 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. a oo O Date of Attack. Date of first Visit. Date of Meteoro- logical Observa- 1 tion. Temp. Grains of vapor IN A CUBIC FOOT OF AIR. Barometric Pressure. Reduced to 32° F. Per Cert of Cloudiness. Prevailing Direc- tion and Veloc- ity of Wind. 0 2 2 d Ci s Cl os 7 A. M. s Ph* Cl X Ck 05 G cs S Cl c-' Direction. Miles per flour. ♦ J'ne 60 76 69 50 20 25 W. & S. 2-4 2 18 16 17 ) " 15. 76 75 70 25 100 10 8. w. 2-25-2 3 " 16. 65 76 67 100 20 10 8. W. & E. 4-2 1 " 13. 67 73 61 50 75 25 8. & S. W. 12-4 3 19 15 I?' " 14. 50 76 19 50 20 25 w. & s. 2-3 2 ( " 15. 76 75 70 25 100 10 8. W. 2-25-2 3 " 13. 67 73 61 50 75 25 s. & s. w. 12-4 3 20 15 18 j " 14. 60 76 69 50 20 25 s. w. 2-3 2 " 15. 76 75 70 25 100 10 S. & 8. W. 2-25-2 3 67 80 63 25 25 00 8. W. & S. 4-2 3 21 1 19 j « 31. 71 81 67 10 5 10 8. W. & S. 2-12-4 3 72 83 69 5 75 5 8. E. 4-12-4 3 " 3.. 69 75 61 75 10 10 N. W. & W. 4-25-2 3 22 5 19 j « 4.. 62 73 59 5 25 haze W. & E. 4. 3 " 5.. 55 71 59 100 95 100 N. E. 4. 4 " 16. 65 76 67 100 20 10 8. W. & E. 4-2 1 23 18 22 j " 17. 79 81 59 00 10 10 E. 1-4 3 " 18. 68 85 72 5.77 6.73 6.33 29.10 28.95 28.98 29.01 10 75 10 S. & 8. W. 12. 3 " 21. 64 76 55 6.28 6.81 4.18 28.99 28.93 29.08 29.00 100 30 00 S. & W. 2-12 3 24 23 « 22. 55 68 51 4.18 3.94 3.30 29.22 29.26 29.26 29.25 30 20 00 N. E. 12-4 2 " 23. 52 77 57 3.23 4.50 1.05 29.25 29.20 29.00 29.15 00 20 00 S. W. & S. 2-4 2. 3 « 2'2 55 68 51 4.18 3.94 3.30 29.22 29.26 29.26 29.25 30 20 00 N. E. 12-4 2 25 24 24 < " 23. 52 77 57 3.23 4.50 1.05 29.25 29.20 29.00 29.15 00 20 00 S. W. & S. 2-4-2 3 •• 24. 62 85 65 4.98 6.07 6.87 28.91 28.82 28.88 28.87 5 40 20 8. AS. W. 2-4-2 2 « 22. 55 68 51 4.18 3.94 3.30 29 22 29.26 29.26 29.25 30 20 00 N. E. 12-4 2 26 24 30 " 23. 52 77 57 3.23 4.50 1.05 29.25 29.20 29.00 29.15 00 20 00 S. W. & 8. 2-4-2 3 " 24. 62 85 65 4.98 6.07 6.87 28.91 28.82 28.88 28.87 5 40 20 S. & 8. W. 2-4-2 2 " 23. 52 77 57 3.25 4.50 1.05 29.25 29.20 29.00 29.15 00 20 00 8. W. * 8. 2-4-2. 3 27 25 30 " 24. 62 85 65 4.98 6.07 6.87 28.91 28.82 28.88 28.87 5 40 20 S. & S. W. 2-4-2 2 25. 65 86 60 6.68 6.25 4.90 29.00 29.02 28.97 29.00 00 15 100 8. W. AS. E. 2-12. 3 " 18. 68 85 72 5.77 6.73 6.33 29.10 28.95 28.98 29.01 10 75 10 8. & S. W. 12 3 28 20 J 1 " 19. 67 76 53 5.30 5.08 3.58 29.14 29.22 29.32 29.33 10 25 10 N.E. & N.W. 12-4 3 " 20. 56 80 69 4.02 6.02 6.25 29.31 29.19 29.04 29.18 20 30 75 8. W. 4-12 2 " 23. 52 77 57 3.25 4.50 1.05 29.25 29.20 29.00 29.15 00 20 00 S. W. & 8. 2-4-2 3 29 25 10 " 24. 62 85 65 4.98 6.07 6.87 28.91 28.82 28.88 28.87 5 40 20 1 8. & S. W. 2-4-2 2 ( " 25. 65 8b 60 6.68 6.25 4.90 29.00 29.02 28.97 29.00 00 15 100 8. W. & S. E. 2-12. 3 J'ly (July 4.. 62 84 65 5.27 6.55 6.07 29.28 29.22 29.19 29.23 15 50 10 8. E. * 8. W. 2. 2 30 6. 8. < " 5. 67 87 66 6.93 7.48 5.42 29.16 29.08 29.09 29.12 11 30 9( S. & N. W. 2-4 1 ( " 6.. 65 82 59 3.79 5.52 4.79 29.20 29.19 29.21 29.20 5 5 00 E. & N. E. 3 ( " 8.. 73 87 72 7.57 7.85 7.00 29.04 28.97 28.95 28.99 10 20 25 s. w. 4-2. 3 31 1( 15 7 « 9.. 71 84 7: 7.86 6.18 5.01 28.90 28.85 28.90 28.88 10c 51 35 W. N. W. 2-4, 2 ( " 10. 62 73 5! 5.27 4.84 4.2t 28.99 29.00 29.07 29.02 00 90 5 N. W. 2. 2 1 " 16. 75 88 68 6.62 8.50 5.4' 28.95 28.87 28.97 28.93 100 50 90 8. 2-4 2 32 It 1 19 7 " 17. 66 86 7. 5.73 5.38 5.0; 29.01 28.96 28.93 28.96 10( 60 50 S. W. 2-4-2 3 ( " 18. 68 83 63 6.10 5.15 6.45 28.88 28.75 28.74 28.79 90 80 100 S. & E. 2-12-2 3 ( " 18. 68 83 63 6.10 5.15 6.45 28.88 28.75 28.74 28.79 90 80 100 8. & E. 2-12-2 3 33 2( 1 21 7 " 19. 61 69 60 5.40 5.37 4.95 28.78 28.81 28.87 28.81 50 50 75 W. & N. W. 2 ( " 20. 58 67 59 4.64 5.04 5.0t 28.93 28.98 29.09 29.00 40 90 50 S.W. & N.W. 2. 2 ( " 19. 61 61 60 5.40 5.37 4.95 28.78 28.80 28.87 28.81 50 50 75 W. & N. W. 2. 2 34 2 27 ( " 20. 58 67 5! 4.6- 5.01 5. Of 28.93 28.98 29.0! 29.01 41 91 5( S.W. & N.W. 2 2 | " 21. 58 81 68 4.64 5.92 5.20 29.20 29.19 29.23 29.21 01 5 50 N. W. 1-4 1 ( " 23. 67 86 68 6.55 6.58 5.7t 29.44 29.40 29.41 29.42 5 5 5 N. W. & E. 2. 2 35 21 27 7 " 24. 77 89 67 6.7: 5.35 5.60 29.42 29.2! 29.2< 29.32 5 10 5 E. A 8. 2. 2 ( " 25. 71 84 75 6.14 7.17 8.05 29.20 29.09 29.05 29.11 50 50 90 8. E. 1-4 2 TABLE.-Continued.-Cases of Intermittent * Explained in foot-note on page 198. CAUSATION OF INTERMITTENT FEVER. 201 lever and Coincident Conditions. Day, 7 A. 2 P. M. Rainfall, Inches. Character of Surrounding Country, and Nature of Soil. Sanitary Surroundings of Habitation. 1 Age, in Years. 7s Type of Disorder. Sex and Soc Condition Recent Exposures, Excesses, and Deprivations. I Ozone, 3 S 3 (Rolling farming country, f Soil clay and clay loam. Ground damp. Well-water good. Sanitary surroundings fair. Tonsilitis preceded attack a few days. 2 3 .39 6 Fe. Tertian. 3 (Level farming country, f Soil sandy loam. Log house; no cellar. Well- water not good, but used by all continually. Fe. M. Been about, but troubled with Remit- 3 22 tent. 2 .39 diarrhea for two weeks. 3 ( Hilly farming land. Soil ( sandy loam. Sanitary surroundings fair. Well-water good. 12 Ma. Been ailing for some time. Chills appeared first on 15th. Tertian. 3 2 .39 3 1 Rolling farming countiy. > Small stream near house. House poor and low on ground. 3 Well contains mostly surface- 7 Fe. No unusual exposures, etc.... Tertian. 3 ) Sandy soil. water. Water used by whole family. 4 .10 4 as 21.. Same as 21 9 Ma. Nounusual exposures, etc.... Had been living in another county until a few days pre- ceding attack. Was well when he arrived here. Tertian. 4 3 .11 2 Same as case 10 Same as case 10 16 Ma. Tertian. 3 House of rough boards built in 3 .12 (Wild rolling land. Soil ( sandy. In forest. opening in a forest. Coal pits Fe. Girl of dissolute habits. No Tertian. 4 near for making charcoal. Water used mostly surface- 16 known unusual exposure, etc. 4 .. water. 4 Low board house on border of Congest- 4 as case 10.... small lake. Cleanliness disre- 2 Fe. Nothing unusual ...... 3 .56 garded. Water not good. ive chill. 4 ( Good rolling farm'g coun- ( try. Soil sandy loam. House low on ground. Water 2 Ma. Nothing unusual - Tertian. generally good. Ground wet on day of attack. 3 4 .56 3 .56 as case 26 Same as case 26 - 4 Ma. Nothing unusual Tertian. 3 .21 3 (Roll'gland near swamps. ( Soil sandy loam. House a low log. Damp dug- Fe. Nothing unusual Tertian. out under house. Well-water, 4 good. 4 3 .56 as case 10. House on low land. Water good. 4 Fe. Nothing unusual Tertian. 3 .21 3 House low on ground. Water in cellar. House surrounded with thickly standing trees and shrubs. Well-water good. 1 Had diarrhea for 2 weeks pre- vious to attack. 2 Same as case 10 & Fe. Tertian. 4 % Been troubled with tooth- 2 3 4 ".02 (Level farming land. Soil ( sand and clay loam. Old house low on ground. Well water not good. 14 Fe. ache for some time, and was sick from being up nights and from the pain from tooth. Worked harder than usual, and has been reduced by Leucorrhea. Quotid- ian. 3 3 .10 (Level farming lands. Soil ( clay loam. Sanitary surroundings fair. Well-water good. 29 Fe. M. Remit- tent. 4 1.19 4 2 3 1.19 .05 (Good farming country.- ( Soil sandy loam. Unfinished house resting on blocks of wood. Well-water good. 24 Fe. M. Been bilious, and has suffered with headache for some time. Tertian. 2 3 .05 Hilly country, soil sandy. House rests on slope of sandy hili. Water good. 60 Fe. M. Been subjected to unusual labor within a few days. Tertian. 3 3 (Fine open farming coun- f try. Soil sandy loam. Ma, M. Been accustomed to work in a saw mill. Was taken sick immediately on going into 4 Surroundings good. ...... 37 Tertian. the harvest field. * Ma.-Male. Fe.-Female. M.-Married. 202 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. TABLE.-Continued.-Cases of Intermittent ttack. 6 ce o C <X> <X> Temp. Grains of vapor IN A CVBTC FOOT OF AIR. Barometric Pressure. Reduced to 32° F. Per Cent of Cloudiness. Prevailing Direc- tion and Veloc- ity of Wind. ght,9P. A. M. 8 A Miles Case. *© ce A o ® s A © ® ce A i a bo o s A ©i C5 7 A. 51 2 P. M. 8 cu a 7 A. M s ©1 A* Oi G 08 ® S s* d s a' cj Direction. Per Hour. ® C • gs o July July ( Tub 23. 67 86 68 6.55 6.58 5.78 29.44 29.40 29 40 29.42 10 5 50 N. w. & E. 2. 2 36 25 27-j 24. 77 89 67 6.71 5.35 5.60 29 42 29.29 29.24 29.32 5 10 5 E. & S. 2. 2 « 25. 71 84 75 6.14 7.17 8.05 29.20 29.09 29.05 29.11 50 50 90 8. E. 1-4 2 ( (( 22. 66 86 68 5 72 6.26 5.20 29.31 29.31 29.40 29.34 00 30 95 N. W. 1-4 1 37 24 29-J << 23. 67 86 68 6.55 6.58 5.78 29.44 29.40 29.40 29.42 10 5 50 N. W. & E. 2. 2 1 24. 77 89 67 6.71 5.35 5.60 29.42 29.29 29.24 29.32 5 10 5 E. & S. 2. 2 28. 72 90 76 8.10 8.20 7.90 29.08 29.00 28.96 29.02 90 40 90 8. 2. 1 38 30 4( 29. 73 91 71 7.57 6.29 6.14 29.04 29.03 29.05 29.04 90 25 20 N. 2-4 4 << 30. 69 90 69 5.97 5.25 5.80 29.14 29.12 29.17 29.14 00 5 00 N. 2. 1 (( 26. 77 92 73 8.57 7.90 8.35 29 07 29.02 29.05 29.05 30 80 90 8. W. 2. 2 39 28 (C 27. 72 86 72 8.10 6.58 8.00 29.08 29.06 29.09 29.08 90 90 50 8. 2-4-2 2 28. 72 90 76 8.10 8.20 7.90 29.08 29.00 28.96 29.02 90 40 90 8. 2. 1 <4 27. 72 86 72 8.10 6.58 8.00 29.08 29 06 29.09 29.08 90 90 50 8. 2. 2 40 29 31 j << 28. 72 90 76 8.10 8.20 7.90 29.08 29.00 28.96 29.02 90 40 90 8. 2. 1 29. 73 91 71 7.57 6.29 6.14 29.04 29.03 29.05 29.04 90 25 20 N. 2-4 4 u 31. 72 87 73 6 66 6.14 5.92 29.22 29.19 29.18 29.20 5 30 00 E. 4-2 1 41 Aug .g-<Aug. 1.. 70 91 75 6.25 5.99 6.30 29.22 29.17 29.17 29.19 25 80 20 8. E. & S. W. 2. 2 2.. 75 92 68 6.95 6.79 5.78 29.16 29.10 29.12 29.13 50 10 00 w. 1-4 1 U 2.. 75 92 68 6.95 6.79 5.78 29.16 29.10 29.12 29.13 50 10 00 w. 1-4 1 42 4 6 J 44 3.. 66 82 60 5 72 4.99 4.68 29.20 29.14 29.18 29.18 00 10 00 N. W. 1 *< 4.. 57 81 56 4.76 4.60 4.11 29.26 29.22 29.20 29.23 00 25 00 W. & N. - 00 44 7.. 68 85 73 5.11 6.37 6.87 28.89 28.84 28.85 28.86 100 75 10 w. 2-4 2 43 9 <4 8.. 64 88 66 5.61 4.47 4.28 28.9] 28.82 28.86 28.87 5 50 00 s. w. 2-12-2 3 9.. 61 81 61 4.83 5.31 5.72 28.88 28.84 28.92 28.88 90 90 00 w. 2. 2 44 10. 61 82 61 5.24 4.51 5.11 29.00 28.99 29.08 29.02 00 90 00 N. W. 1-4 3 44 12 44 11. 59 83 74 5.08 4.66 5.24 29.15 29.11 29.06 29.10 00 30 90 N. & 8. 2. 00 «« 12. 66 87 70 6.72 5.56 5.66 29.00 28.98 28.95 28.98 80 15 00 W. & N. 3. 4 44 10. 61 82 61 5.24 4.51 5.11 29.00 28.99 29.07 29.02 60 90 00 N. W. 4-2 3 45 12 44 11. 59 83 74 5.08 4.66 5.24 29.14 29.11 29.05 29.10 00 30 90 N. & W. & 8. 2. 0 14-j << 12. 66 87 70 6.72 5.56 5.66 29.00 28.97 28.95 28.97 80 15 00 W. & N. 2. 3 44 5.. 59 86 71 4.53 5.95 4.78 29.19 29.12 29.08 29.13 10 00 10 N. W. 1. 1 46 7. 44 6.. 63 82 63 5.15 5.35 6.10 29.05 29.06 28.94 29.02 5 90 00 w. 2. 4 << 7.. 68 85 73 5.11 6.37 6.87 29.88 28.84 28.84 28.86 100 75 10 w. 2. 2 ( 44 8.. 64 88 66 5.61 4.47 4.28 28.91 28.82 28.86 28.87 5 50 00 w. 2-12-2 3 47 10 44 9.. 61 81 61 4.83 5.31 5.72 28.89 28.84 28.91 28.88 90 90 00 w. 2 « 10. 61 82 61 5.24 4.51 5.11 29.00 28.99 29.07 29.02 00 90 00 N. 2-4-2 3 44 13. 65 65 62 6.51 6.51 5.91 28.98 28.95 28.92 28.95 60 100 95 N. E. 2. 3 48 15 44 14. 62 70 62 6.25 6.25 5.91 28.8S 28.85 29.00 28.90 100 95 40 N. W. 2. 2 << 15. 61 66 63 6.06 6.72 6.10 28.98 28.98 28.99 28.98 100 100 100 N. E. * 3 44 13. 65 65 82 6.51 6.51 5.91 28.98 28.95 28.92 28.95 60 100 95 N. E. i2. 3 49 15 18-j 44 14. 62 70 62 6.25 6.25 5.91 28.88 28.85 29.00 28.90 100 95 40 N. W. 2. 2 « 15. 61 66 63 6.06 6.72 6.10 28.98 28.98 28.99 28.98 100 100 100 N. E. 2. 3 44 14. 62 70 62 6.25 6.25 5.91 28.88 28.85 29.00 28.90 100 95 40 N. W. 2. 2 50 16 44 15. 61 66 63 6.06 6.72 6.10 28.98 28.98 28.99 28.98 100 100 100 N. E. 2. 3 «• 16. 62 73 61 5.91 6.87 6.06 29.00 28.99 29.01 28.99 100 100 20 N. W. 2. 1 44 14. 62 70 62 6.25 6.25 5.91 28.88 28.85 29.00 28.90 100 95 40 N. W. 2. 2 51 16 18 44 15. 61 66 63 6.06 6 72 6.10 28.98 28.98 28.99 28.98 100 100 100 N. E. 2. 3 •• 16. 62 73 61 5.91 6.87 6.06 29.00 28.99 29.01 28.99 100 100 20 N. W. 2. 1 <4 9.. 61 81 61 4.83 5.31 5.72 28.89 28.84 28.91 28.88 90 90 00 W. 2. 2 52 11 17 j <4 10. 61 82 61 5.24 4.51 5.11 29.00 28.99 29.07 29.02 00 90 00 N. 2-4-2 3 <« 11. 59 83 74 5.08 4.66 5.24 29.14 29.11 29.05 29.10 00 30 90 N. & W. * S. 2. 0 44 16. 62 73 61 5.91 6.87 6.06 29.00 28.99 29.01 28.99 100 100 20 N. W. 2. 1 53 18 23 j 44 17. 58 84 64 5.21 4.81 5.94 29.08 29.05 29.10 29.07 25 30 00 N. & E. 2. 1 44 18. 60 82 63 5.54 5.81 6.10 29.14 29.11 29.14 29.13 00 50 10 N. W. 2. 0 * Explained in foot-note on page 198. CAUSATION OF INTERMITTENT FEVER. 203 1 Ozone, Day, 7. A. M. to 2. P. M. Rainfall, Inches. Character of Surrounding Country, and Natnre of Soil. Sanitary Surroundings of Habitation. | Age, in Years. 1 Sex and Social Condition.* Recent Exposures, Excesses, and Deprivations. Type of Disorder. 3 4 Same as 35 Same as 35. 12 Fe. Has had a hard cold for two weeks. Tertian. 4 -- 3 .18 4 4 as 33... Same as 33 ... 4 Fe. Nothing unusual Tertian. 2 3 3 .05 as case 10 Much woods about house. House poor. Water fair. 14 Fe. Has had diarrhea for 2 weeks Tertian. 2 3 2 .05 tsameascase 33. Good house and good surround- ings. 26 Ma. Nothing known Tertian. 2 3 .05 and good farming j country. Soil sandy loam House low on ground and open. Well-water good. .8 Fe. Child teething. Changed long clothes for short one week ago. Quotid- ian. 4 4 2 (New land near ponds. ( Soil sandy. House situated among other houses built for mill hands. Houses of rough boards. Water good. 11 Fe. Not used to being in sunshine. Went berrying and was tak- en sick. Remit- tent. 2 4 3 as case 10 House low on ground. Well- water good. 34 Fe. M. Out all the night previous and became exhausted, and was exposed to night air. Tertian. 3 3 4 | Surroundings fair. Well-water good. 27 Ma. Nothing unusual Quotid- ian. 4 .04 (Rolling farming country. House low on ground. Well- 26 Fe. Worked hard at moving. Tertian. 00 ( Soil sandy loam. water bad. M. Nursing babe at same time. House placed recently on site of 4 ) Level farm land. Soil old house torn down. Present No unusual exposure, etc., Quotid- 3 .04 V clay loam. Small swamp house on blocks of wood. Well 38 M. unless to those referring to ian. 4 ) near. 15 ft. deep, contains surface habitation. water. 4 4 3 | Same as case 45 Same as case 45 29 Fe. M. Reduced by nursing child. Otherwise same as case 45. Tertian. 3 4 £same as case 45... ) Same as case 45 10 Ma. Same as case 45 Tertian. 4 4 4 4 .87 .06 .23 1 Rolling farm'g land. Soil > sandy. Large swamp X ) mile from house. House on blocks of wood. No cellar. Well recipient of sur- face water. 2 Ma. Been having diarrhea for some time. Other members of family had been having ague and diarrhea. Quotid- ian. 4 4 4 .87 .06 .231 Same as case 1 House low on ground. Well recipient of surface water. 26 Ma. M. Been ailing all summer...... Tertian. 4 4 2 .06' .23 ( Farming land. Land roll- j ing. Soil sandy. House old and built of logs. Small swamp near. Water good. 27 Ma. M. Been ailing all summer. Re- sided in Ohio until the pre- ceding May. Tertian. 4 .06 ( Rolling farm'g land. Soil ( sandy. House, on border of pond of still Ma. M. Been used to mill work and 4 .23 water, is a rough board house. 25 went into the harvest field Tertian. 2 Well-water good. to work. Worked in rain. 4 4 3 .04 as case 1 House low and sanitary sur- roundings not good. Well- water not good. Ma. Mother not well. Child re- cently had diarrhea. Tertian. House an old log house with a Ma. Been at work on marsh. Had as case 48 damp cellar beneath. Every 33 been exposed to night air a Tertian. .22 thing about the house damp. good deal. Surface water in well. Fever, and Coincident Conditions, * Ma.-Male. Fe.-Female. M.-Married. 204 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. w co O | Date of Attack. Date of first Visit Date of Meteoro- logical Observa- tion. Temp. Grains of vapor IN A CUBIC FOOT OF AIR. Barometric Pressure. Reduced to 32° F. Per Cent of Cloudiness. Prevailing Direc- tion AND VELOC. ity of Wind. I Ozone, Night, 9 P. | M. to 7 A. M. 1 | 7 A.M. 8 ft e. 8 CL os 3 Ph' 8 8 Ct* e» 0 s cS O) 8 3 ft cc 8 ft 0 Direction. Miles per Hour. * Aug Augf (Vug. 18. 60 82 63 5.54 5.81 6.10 29.14 29.11 29.14 29.13 00 50 10 N. W. 2. 0 51 20 23 < " 19. 64 87 71 6.29 5.85 6 45 29.17 29.14 29.14 29.15 00 30 25 N. W. & E. 2. 1 " 20. 62 84 69 5.91 6.50 7.37 29.18 29.12 29.12 29.14 2,5 50 20 S. E. 2. 1 " 18. 60 82 63 5.54 5.81 6.10 29.14 29.11 29.14 29.13 00 50 10 N. W. 2. 0 55 20 " 19. 64 87 71 6.29 5.85 6.45 29.17 29.14 29.14 29.15 00 30 25 N. W. & E. 2. 1 " 20. 62 84 69 5.91 6.50 7.37 29.18 29.12 29.12 29.14 25 50 20 8. E. 2. 1 " 19. 64 87 71 6.29 5.85 6.45 29.17 29.14 29.14 29.15 00 30 25 N. W. & E. 2. 1 56 21 " 20 62 84 69 5.91 6.50 7.37 29,18 29.12 29.12 29.14 25 50 20 S. E. 2. 1 " 21. 70 87 72 6.91 5.85 6.03 29.10 29.02 29.04 29.05 15 60 25 8. E. 2. 2 « 22 70 85 67 7.26 5.77 7.30 28.98 28.93 29.06 28.99 100 95 100 8. 2. 3 57 24 " 23. 66 69 67 6.72 7.00 7.30 29.03 28.98 28.96 28.99 100 100 100 N. & S. E. 2. 1 " 24. 63 68 63 6.45 6.77 6.45 28.98 29.02 29.07 29.03 100 95 100 N. W. 2. 3 " 19. 64 87 71 6.29 5.85 6.45 29.17 29.14 29 14 29.15 00 30 25 N. W. & E. 2. 1 58 21 " 20. 62 84 69 5.91 6.50 7.37 29.18 29.12 251.12 29.14 25 50 20 8. E. 2. 1 " 21. 70 87 72 6.91 5.85 6.03 29.10 29.02 29.04 29.05 15 60 25 S. E. 2. 2 " 17. 58 84 64 5.21 4.81 5.94 29.08 29.05 29.10 29.07 25 30 00 N. & S. 2. 1 59 19 " 18. 60 82 63 5.54 5.81 6.10 29.14 29.11 29.14 29.13 00 50 10 N. W. 2 0 " 19. 64 87 71 6.29 5.85 6.45 29.17 29.14 29.14 29.15 00 30 25 N. W. & E. a 1 " 21. 70 87 72 6.91 5.85 6.03 29.10 29.02 29.04 29.05 15 60 25 8. E. 2, 2 60 23 26 j " 22. 70 85 67 7.26 5.77 7.30 28.98 28.93 29.06 28.99 100 95 100 8. 2. 3 " 23. 66 69 67 6.72 7.00 7.30 29.03 28.98 28.96 28.99 100 100 100 N. & S. E. 2. 1 " 23. 66 69 67 6.72 7.00 7.30 29.03 28.98 28.96 28.99 100 100 100 N. & S. E. 2. 1 61 25 " 24. 63 68 63 6.45 6.77 6.45 28.98 29.02 29.07 29.03 100 95 100 N. W. 3 " 25. 64 81 69 5.61 6.22 6.29 29.10 29.03 29.06 29.06 15 50 5 N. W. &S.W. 2-4 3 ( " 24. 63 68 63 6.45 6.77 6.45 28.98 29.02 29.07 29.03 100 95 100 N. W. 2. 3 62 26 267 " 25. 64 81 69 5.61 6.22 6.29 29.10 29.03 29.06 29.06 15 50 5 N. W.&S.W. 2-4 3 I <• 26. 63 83 67 5.76 6.29 6.55 29.16 29.08 29.19 29.15 5 50 00 8. W. 2. 1 " 22. 70 85 67 7.26 5.77 7.30 28.98 28.93 29.06 28.99 100 95 100 8. 2. 3 63 24 21 { " 23. 66 69 67 6.72 7.00 7.30 29.03 28.98 28.96 28.99 100 100 100 N. & S. E. 2. 1 " 24. 63 68 63 6.45 6.77 6.45 28.98 29.02 29.07 29.03 100 95 100 N. W. 2. 3 Sept Sept ( " 30. 56 72 61 4.89 4.68 5.72 29.27 29.23 29.15 99 99 40 100 90 W. & S. E. 2. 1 64 1. 3 J " 31. 66 71 66 6.35 7.48 6.72 28.97 28.92 28.98 28.95 100 100 100 E. & W. 2-4 3 ( Sept. 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 2. 4 « 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 2. 4 65 3. 3. j " 2.. 53 63 51 3.74 4.18 3.61 29.00 28.96 29.04 29.00 95 90 40 N. W. 2. 3 " 3.. 51 71 57 3.74 5.18 3.88 29.08 29.02 29.04 29.04 95 80 20 8. W. 4-12-2 3 " 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 2. 4 66 3. 3. j " 2.. 53 63 51 3.74 4.18 3.61 29.00 28.96 29.04 29.00 95 90 40 N. W. 2. 3 " 3.. 51 71 57 3.74 5.18 3.88 29.08 29.02 29.04 29.04 95 80 20 8. W. 4-12-2 3 " 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 2. 4 67 3. 4. j " 2.. 53 63 51 3.74 4.18 3.61 29.00 28.96 29.04 29.00 95 90 40 N. W. 2. 3 " 3.. 51 71 57 3.74 5.18 3.88 29.08 29.02 29.04 29.04 95 80 20 8. W. 4-12-2 3 4ug. 31. 66 71 66 6.35 7.48 6.72 28.97 28.92 28.98 28.95 100 100 100 E. & W. 2-4 3 €8 2. 4.< Sept. 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 2. 4 " 2.. 53 63 51 3.74 4.18 3.61 29.00 28.96 29.04 29.00 95 90 40 N. W. 9. 3 4J \ug. 30. 56 72 61 4.89 4.68 5.72 29.27 29.23 29.15 29.22 40 100 90 W. & 8. E. 2. 1 •69 1. " 31. 66 71 66 6.35 7.48 6.72 28.97 28.92 28.98 28.95 100 100 100 E. & W. 2.4 3 ( Sept. l._ 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 0 4 I lug. 30. 56 72 61 4.89 4.68 5.72 29.27 29.23 29.15 29.22 40 100 90 W. & 8. E. 2. 1 70 1. 4.7 " 31. 66 71 66 6.35 7.48 6.72 28.97 28.92 28.98 28.95 100 100 100 E. & W. 2-4 3 ( Sept. 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 2. 4 ( Aug. 30. 56 1'1 61 4.89 4.68 5.72 29.27 29.23 29.15 29.22 40 100 90 W. & 8. E. 2. 1 71 1. 5.7 " 31. 66 T1 66 6.35 7.48 6.72 28.97 28.92 28.98 28.95 100 100 100 E. & W. 2-4 3 ( Sept. 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 10 N. W. 2 4 TABLE.-Continued.-Cases of Intermittent * Explained in foot-note on page 198. CAUSATION OF INTERMITTENT FEVER. 205 Fever, and Coincident Conditions. I Ozone, Day, 7 A. i M. to 2 P. M. Rainfall, Inches. Character of Surrounding Country, and Nature of Soil. Sanitary Surroundings of Habitation. | Age, in Years. 1 Sex and Social Condition.* Recent Exposures, Excesses, and Deprivations. Type of Disorder. 4 .22 Tertian, 4 4 .05 Same as case 53 Same as case 53 . 12 Fe. Had been over worked. Ex- posed to air of dwelling. then Quotid- ian. 4 .22 Fe. 4 4 .05 as case 53 Same as case 53 -. 4 That pertaining to house.... Tertian. 4 4 .05 as case 53 Same as case 53 34 Fe. M. Been subjected to hard work. Nursing babe. Exposed to Quotid- ian. 4 - damp air of house. 4 .83 Ma. 2 - as case 53 Same as case 53. 7 Exposed to damp air of house. Tertian. 3 - 4 - as case 51 Same as case 51 Fe. Accustomed to house work. Quotid- ian. 4 4 .05 21 M. Had been out in the field all day picking berries on 21st. House low and built of rough Been working unusually hard Quotid- 3 .22 (Rolling farm'g land. Soil boards. Water fair. Country Ma. f sandy. new. Coal pits near for the in woods. ian. - manufacture of charcoal. 4 4 2 .83 (New farm'g lands. Land f rolling. Soil sandy. House new. Sanitary surround- ings fair. Water good. 9 Fe. No known exposure Quotid- ian. 2 as case 51 Same as case 51 Ma. No known exposure. Been Remit- 3 3 ailing for week previous. tent. 4 3 4 4 as case 1 House good and on border of lake. Water good. 21 Ma. Been ailing for week Tertian. 4 2 3 .83 / Hilly farming land, f sandy. Soil Sanitary surroundings fair 20 Ma. Overworked in field on day of attack. Tertian. 2 4 .77 Same as case 48 Same as case 48 9 Fe. Been ailing for some time. Quotid- ian. 3 - 3 3 |same as case 48 Same as case 48 1 Ma. Nothing unusual Tertian. 4 - Is generally an invalid. 3 Same as case 1 Sanitary surroundings good.... 33 Ma. Worked unusually hard in Tertian. 3 M. store on day and night of 4 - ) the 1st inst. • 3 3 4 (Low farming land, f clay loam. Soil House comfortable. Well water not generally good, low at time of attack. 31 Ma. Clearing land and working hard in night air. Tertian. .77 Worked in a damp room one 4 ) Rolling farm'g land. Soil House low on ground. Well 35 32 Fe. week before attack and had Tertian. 3 - sandy. ft. deep. Water good. M. been ailing until day of at- tack. 2 .77 pSame as case 59 Same as case 59 Ma. Been working in a swamp for Quotid. 4 44 M. some time previous to attack. ian. 3 2 4 .77 Same as case 59 Same as case 59 ...... 16 Fe. Been ailing all summer. Remit- tent. 3 2 4 .77 as case 59 Same as case 59 19 Fe. No known unusual exposure. Tertian. 3 * Ma.-Male. Fe.-Female. M.-Married. 206 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. TABLE-Continued-Cases of Intermittent w tn •*1 O Date of Attack. Date of first Visit. Date of Meteoro- logical Observa- tion. Temp. Grains of vapor Barometric Pressure. Keduced to 32° F. Per Cent of Cloudiness. Prevailing Direc- tion and Veloc- ity of Wind. 1 Ozone, Night, 9 P. | M. to 7 A. M. IN A CUBIC FOOT DF AIR. g < E ft 0, g ft g <4 3 Cl g ft Ci g <4 g ft Cl g Ct Ci a Q g s <4 g ft <N g It cs Direction. Miles per. Hour. * Sept Sept ( Sept 3.. 51 71 57 3.74 5.18 3.88 29.08 29.02 29.04 29.04 95 80 40 S. w. 4-12-2 3 72 5. 6-J " 4.. 55 76 60 4.46 5.06 5.24 29.06 29.02 29.08 29.05 00 80 10 s. w. 2-4-2 3 " 5.. 57 66 58 4.76 5.42 4.92 29.16 29.23 29.30 29.23 95 100 80 N. E. 2. 2 " 4.. 55 76 60 4.46 5.06 5.24 29.06 29.02 29.08 29.05 00 80 10 S. W. 2-4-2 3 73 6. " 5.. 57 66 58 4.76 5.42 4.92 29.16 29.23 29.30 29.23 95 100 80 N. E. 2. 2 " 6.. 56 66 50 4.61 4.37 3.73 29.36 29.35 29.40 29.37 75 100 00 N. & E. 2. 3 ( Aug. 31. 66 71 66 6.35 7.48 6.72 28.97 28.92 28.98 28.95 100 100 100 E. & W. 2-4 3 74 2. 8.< Sept. 1.. 53 54 52 4.11 4.86 3.58 29.08 29.05 29.05 29.06 100 100 JO N. W. 4 " 2.. 53 63 51 3.74 4.18 3.61 29.00 28.96 29.04 29.00 95 90 40 N. W. 2. 3 " 5.. 57 66 58 4.76 5.42 4.92 29.16 29.23 29.30 29.23 95 100 80 N. E. 2. 2 75 7. 10 j " 6.. 56 66 50 4.61 4 37 3.73 29.36 29.35 29.40 29.37 75 100 00 N. & E. 2. 3 " 7.. 51 69 56 4.12 4.09 4.89 29.26 29.31 29.30 29.29 5 90 10 N. E. 2. 1 " 6.. 56 66 50 4.61 4.37 3.73 29.36 29.35 29.40 29.37 75 100 00 N. & E. 2. 3 76 8. nj " 7.. 51 69 56 4.12 4.09 4.89 ■29.26 29.31 29.30 29.29 5 90 10 N. E. 1 " 8.. 58 75 54 5.21 4.66 4.51 29.33 29.25 29.26 29.28 5 10 00 N. E. & S. W. 2.' 1 " 6.. 56 66 50 4 61 4.37 3.73 29.36 29.35 29.40 29.37 75 100 00 N. & E. 2. 3 77 8. " 7.. 51 69 56 4.12 4.09 4.89 29.26 29.31 29.30 29.29 5 90 10 N. E. Q 1 12 ( " 8.. 58 75 54 5.21 4.66 4.54 29.33 29.25 29.26 29.28 5 10 00 N. E. & 8. W. 2. 1 " 8.. 58 75 54 5.21 4.66 4.54 29.33 29.25 29.26 29.28 5 10 00 N. E. & S. W. 2. 1 78 10 12 j " 9.. 57 72 61 5.05 5.18 5.40 29.20 29.12 29.09 29.14 30 100 10 S. E. 2. 1 " 10. 58 62 64 5.51 6.25 6.65 29.03 28.95 28.96 28.97 100 100 100 N. E. 2. 3 " 8.. 58 75 54 5.21 4.66 4.54 29.33 29.25 29.26 29.28 5 10 00 N. E. & S. W. 2. 1 79 10 12 j " 9.. 57 72 61 5.05 5.18 5.40 29.20 29.12 29.09 29.14 30 100 10 S. E. 2. 1 " 10. 58 62 64 5.51 6.25 6.65 29.03 28.95 28.96 28.97 100 100 100 N. E. 2. 3 " 10. 58 62 64 5.51 6.25 6.65 29.03 28.95 28.96 28.97 100 100 100 N. E. 2. 3 80 12 13 j " 11. 64 73 63 6.65 7.21 6.10 29.01 29.00 29.05 29.02 100 100 5 W. & S. E. 2. 1 " 12. 64 76 62 6.29 6.83 6.50 29 16 29.11 29.19 29.15 100 100 10 S. E. 2. 3 ( « 11. 64 73 63 6.65 7.21 6.10 29.01 29.00 29.05 29.02 100 100 5 W. & S. E. 2. 1 81 13 " 12. 64 76 62 6.29 6.83 6.50 29.16 29.11 29.19 29.15 100 100 10 S. E. 2. 3 ) " 13. 60 83 65 5.87 6.95 6.51 29.24 29.21 29.22 29.22 25 95 5 S. E. & 8. W. 0 " 12. 64 76 62 6.29 6.83 6.50 29.16 29.11 29.19 29.15 100 100 10 S. E. 2. 3 82 14 " 13. 60 83 65 5.87 6.95 6.51 29.24 29.21 29.22 29.22 25 95 5 S. E. & S. W. 2. 0 " 14. 61 82 68 6.06 6.10 6.43 29.24 29.05 29.14 00 40 00 S. E. 0 " 14. 61 82 68 6.06 6.10 6.43 29.24 29.12 29.05 29.14 00 40 00 S. E. 2. 0 83 16 is| " 15. 68 82 65 6.43 6.41 6.87 28 99 28.87 28.98 28.95 10 100 90 8. E. 2-4-2 2 " 16. 62 80 66 6.25 4.45 5.72 29.08 29.04 29.09 29.07 100 00 20 S. W. &N.W. 2-4 2 " 13. 60 83 65 5.87 6.95 6.51 29.24 29.21 29.22 29.22 25 95 5 S. E. & S. W. Q 0 84 15 " 14. 61 82 68 6.06 6.10 6.43 29.24 29.12 29.05 29.14 00 40 00 8. E. 2. 0 " 15. 68- 82 65 6.43 6.41 6.87 28.99 28.87 28.98 28.95 10 100 90 8. E. 2-4 -2 2 ( " 16. 62 80 66 6.25 4.45 5.72 29.08 29.04 29.09 29.07 100 00 20 S.W. &N. W. 2-4 2 85 18 19 i " 17. 55 65 43 4.74 6.17 3.16 29.11 29.05 29.16 29.11 100 15 5 N. W. 4-12-2 3 " 18. 13 64 44 3.16 2.96 3.52 29.20 29.16 29.17 29.18 00 5 00 W. 2-12-2 1 " 15. 68 82 65 6.43 6.41 6.87 28.99 28.87 28.98 28.95 10 100 90 S. E. 2-4-2 2 86 17 " 16. 62 80 66 6.25 4.45 5.72 29.08 29.04 29.09 29.07 100 00 20 S. W. &N.W. 2-4 2 " 17. 55 65 43 4.74 6.17 3.16 29.11 29.05 29.16 29.11 100 15 5 N. W. 4-12-2 3 " 12. 64 76 62 6.29 6.83 6.50 29.16 29.11 29.19 29.15 100 100 10 S. E. 2. 3 87 14 " 13. 60 83 65 5.87 6.95 6.51 29.24 29.21 29.22 29.22 25 95 5 S. E. & 8. W. Q 0 " 14. 61 82 68 6.06 6.10 6.43 29.24 29.12 29.05 29.14 00 40 00 8. E. 2. 0 " 8.. 58 75 54 5.21 4.66 4.54 29.33 29.25 29.26 29 28 5 10 00 N. E. & S. W. 2. 1 88 10 20 j " 9.. 57 72 61 5.05 5.18 5.40 29.20 29.12 29.09 29.14 30 100 10 S. E. 2. 1 " 10. 58 62 64 5.51 6.25 6.65 29.03 28.95 28.96 28.97 100 100 100 N. E. 2, 3 " 16. 62 80 66 6.25 4.45 5.72 29.08 29.04 29.09 29.07 100 00 20 S.W. &N. W. 2-4 2 89 18 20 j " 17. 55 65 43 4.74 6.17 3.16 29.11 29.05 29.16 29.11 100 15 5 N. W. 4-12-2 3 " 18. 43 64 44 3.16 2.96 3.52 29.20 29.16 29.17129.18 00 5 00 w. 2-12-2 1 * Explained in foot-note on page 198. CAUSATION' OF INTERMITTENT !' FEVER. 207 Fever, and Coincident Conditions. Ozone, Day, 7 A. I M. to 2 P. M. Rainfall, Inches. Character of Surrounding Country, and Nature of Soil. Sanitary Surroundings of Habitation. Age. in Years. 1 Sex and Social Condition.* Recent Exposures, Excesses, and Deprivations. Type of Disorder. 4 Remit- tent. 4 as case 51 Same as case 51 6 Ma. No known unusual exposure. 3 4 3 as case 68 Same as case 68 6 Ma. No known unusual exposure. Tertian. 4 4 3 .77 (same as case 51 Same as case 51 21 Fe. After working unusually hard on the 2d inst. was attacked, Remit, tent. 3 diarrhea, chill and fever. 3 /Level farming land. Soil House poor and near to woods. 4 1 Ma. No known exposure Tertian. 4 t sandy loam. Cellar wet. Water good. 4 Fe. M. Worked hard in taking care of sick. co - as case 51 Same as case 51. 45 Tertian. 4 / Land surrounded by i swamps. Soil sandy. House low on ground. Water Been ailing for 2 or 3 months. Has valvular disease of heart. 4 61 Fe. Tertian. 3 good. 3 Went hunting on the 10th and had a chill on return. 4 |same as case 1 Sanitary surroundings fair 19 Ma. Tertian. 3 .87 3 Been ailing for some time. First chill on the 10th inst. 4 as case 78 Same as case 78 10 Ma. Tertian. 3 .87 3 2 .87 /Good farming land. Soil f sandy loam ) House good. Well-water not good. House low. Sanitary surround- ings not good. Water fair. 6 Fe. Not been well for 3 weeks. First chill on 12th inst. Tertian. 3 2 3 12 Fe. No known exposure Tertian. 2 as case 1 3 2 as case 81. Same as case 81 5 Fe. No known exposure. . - Tertian. 3 3 ) Farm on high land be- (. tween two swamps. Soil ) sandy. / Rolling farming land. £ Soil sandy. Low log house in a dilapidated condition-damp. W ell- water good. 3 .46 % Fe. No known exposure. . - Tertian. 3 Tertian. 2 House and surroundings in fair sanitary condition. Water good. Recently came from Ohio in a debilitated condition from Quoti- dian, 3 ■23 Ma. then 3 3 .46 dissipation. Typo- malari- al. 4 11 Same as case S3 Same as case 83 15 Ma. No unusual exposures Tertian. 4 3 3 .46 /High farming land. Soil Low board house. Spring-water 36 Fe. M. Enciente ...... Tertian. 4 3 .11 r sandy. used. 2 ySame as case 83 Same as case 83 __ O'? Ma. No unusual exposure Tertian. 3 3 /Rolling farming land, f Soil sandy. Unusually exposed to damp weather. Remit- tent. 4 House low. Water good 9 Ma. 3 .87 3 Quoti- dian. 4 .11 as case 88.. Same as case 88 11 Fe. No unusual exposure. 4 * Ma.-Male. Fe.-Female. M.-Married. 208 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. w Cfi O | Date of Attack. I Date of first Visit. Date of Meteoro- logical Observa- tion. Temp. Grains of vapor IN A CUBIC FOOT OF AIR. Barometric Pressure. Reduced to 32° F. Per Cent of Cloudiness. Prevailing Direc- tion and Veloc- ity of Wind. 1 Ozone, Night, 9 P. | M. to 7 A. M. 1 g p4 ci s s ei ft! TO s si S TO c 03 G) a si si Cl si TO Direction. Miles per Hour. Sept Sept Sept. 19. 48 69 48 3.06 3.66 3.47 29.18 29.07 29.11 29.12 5 100 00 S. w. 2. 2 90 21 22 " 20. 46 55 50 3.70 4.74 3.99 29.13 29.06 29.18 29.13 90 100 90 S. E. 4B. E. 2. 1 " 21. 42 69 48 3.30 4.09 4.01 29.29 29.31 29.32 29.31 00 10 00 N. E. & S. E. 2. 1 " 16. 62 80 66 6.25 4.45 5.72 29.08 29.04 29.09 29.07 100 00 20 S. W.& N. W. 2-4. 2 91 18 21< " 17. 55 65 43 4.74 6.17 3.16 29.11 29.05 29.16 29.11 100 15 5 N. W. 4-12-2 3 " 18. 43 64 41 3.16 2.96 3.52 29.20 29.16 29.17 29.18 00 5 00 w. 2-12-2 1 " 20. 46 55 50 3.70 4.74 3.99 29.13 29.06 29.18 29.13 90 100 90 S. E. & N. E. 2. 1 92 22 23i " 21. 42 b9 48 3.30 4.09 4.01 29.29 29.31 29.32 29.31 00 10 00 N. E. & S. E. 2. 1 " 22. 46 71 54 3.50 7.13 3.70 29.36 29.28 29.26 29.30 00 5 00 S. E. 2. 0 " 17. 55 65 43 4.74 6.17 3.16 29.11 29.05 29.16 29.11 100 15 5 N. W. 4-12-2 3 93 19 24 ] " 18. 43 61 44 3.16 2.96 3.52 29.20 29.16 29.17 29.18 00 5 00 w. 2-12-2 1 " 19. 48 69 48 3.06 3.66 3.47 29.18 29.07 29.11 29.12 5 100 00 s. w. 2. 2 « 21 42 69 48 3.30 4.09 4.01 29.29 29.31 29.32 29.31 00 10 00 N. E. & S. E. 2. 1 94 23 25 < " 22. 46 71 54 3.50 7.13 3.70 29.36 29.28 29.26 29 30 00 5 00 S. E. 2. 0 " 23. 53 78 63 4.11 5.12 5.15 29.27 29.20 29.22 29.23 00 20 10 S. E. & S. W. 2-4-2 1 " 22. 46 71 54 3.50 7.13 3.70 29.36 29.28 29.26 29.30 00 5 00 S. E. 2. 0 95 24 284 " 23. 53 78 63 4.11 5.12 5.15 29.27 29.20 29.22 29.23 00 20 10 S. E. & S. W. 2-4-2 1 " 24. 62 84 67 5.27 6.18 6.23 29.23 29.17 29.17 29.19 10 30 00 8. W. 2-4. 3 " 26. 62 71 69 5.96 7.13 6.63 29.21 29.18 29.20 29.20 20 50 50 S. W.&N. E. 2-4. 1 96 28 28 < " 27. 62 74 67 5.91 7.08 6.55j 29.17 29.16 29.12 29.15 50 20 50 E. 4-2. 3 " 28. 62 69 55 6.25 5.97 4.74 29.24 29.26 29.28 29.26 75 90 00 S. E. & N. E. 2. 1 " 20. 46 55 50 3.70 4.74 3.99 29.13 29.06 29.18 29 13 90 100 90 S. E. & N. E. 2. 1 97 22 284 " 21. 42 69 48 3.30 4.09 4.01 29.29 29.31 29.32 29.31 00 10 00 N. E. &S. E. 2. 1 *• 22. 46 71 51 3.50 7.13 3.70 29.36 29.28 29.26 29.30 00 5 00 8. E. 2. 0 " 25. 65 80 65 6.17 6.03 6.17 29.22 29.15 29.14 29.17 50 90 00 S. W. 2-4-2 2 93 27 294 " 26. 62 71 69 5.91 7.13 6.63 29.21 29.18 29.20 29.20 20 50 50 S. W. & N. E. 2-4 i " 27. 62 74 6/ 5.91 7.08 6.55 29.17 29.16 29.12 29.15 50 20 50 E. 4-2 3 Oct. " 24. 62 84 67 5.27 6.18 6.23 29.23 29.17 29.17 29.19 10 30 00 S. W. 2-4 3 99 26 14 " 25. 65 80 65 6.17 6.03 6.17 29.22 29.15 29.14 29.17 50 90 00 8. W. 2-4-2 2 " 26. 62 71 69 5.91 7.13 6.63 29.21 29.18 29.20 29.20 20 50 50 8. W.&N. E. 2-4 1 " 26. 62 71 69 5.91 7.13 6.63 29.21 29.18 29,20 29.20 20 50 50 8. W.&N. E. 2-4 1 100 28 14 " 27. 62 74 67 5.91 7.08 6.55 29.17 29.16 29.12 29.15 50 20 50 E. 4-2 3 «• 28. 62 69 55 6.25 5.97 4.74 29.24 29.26 29.28 29.26 75 90 00 S. E. & N. E. 2. 1 " 27. 62 74 67 5.91 7.08 6.55 29.17 29.16 29.12 29.15 50 20 50 E. 4-2 3 101 29 24 " 28. 62 69 55 6.25 5.97 4.74 29.24 29.26 29.28 29.26 75 90 00 8. E. & N. E. 2. 1 " 29 55 80 66 4.74 6.99 6.35 29.24 29.24 29.10 29.19 15 10 00 E. & 8. 2-4-2 2 " 26. 62 71 69 5.91 7.13 6.63 29.21 29.18 29.20 29.20 20 50 50 8. W.&N. W. 2-4 1 102 28 54 " 27. 62 74 67 5.91 7.08 6.55 29.17 29.16 29.12 29.15 50 20 50 E. 4-2 3 « 28. 62 69 55 6.25 5.97 4.74 29.24 29.26 29.28 29.26 75 90 00 S. E. & N. E. 2. 1 Oct. Oct. 2.. 59 66 58 5.69 6.04 5.51 29.15 29.08 29.08 29.10 100 100 100 N. E. 2. 3 103 4 74 " 3.. 62 80 68 6.25 5.18 5.30 29.07 28.97 28.74 28.93 100 10 25 8. E. 2-4-2 1 " 4.. 50 54 41 3.48 3.06 2.74 28.80 2S.90 29.11 28.94 75 75 00 N. W. 4. 1 " 4.. 50 54 41 3.48 3.06 2.74 28.80 28.90 29.11 28.94 75 75 00 N. W. 4. 1 104 6 84 " 5.. 37 47 35 2.56 2.90 2.40 29.20 29.04 29.26 29.17 00 90 00 N. W. 2-12-2 4 " 6.. 33 59 38 2.22 3.01 2.65 29.41 29.39 29.45 29.42 00 10 00 w. 2-4-2 1 " 4.. 50 54 41 3.48 3.06 2.74 28.80 28.90 29.11 28.94 75 75 00 N. W. 4. 1 105 6 144 " 5.. 37 47 35 2.56 2.90 2.40 29.20 29.04 29.26 29.17 00 90 00 N. W. 2-12-2 4 " 6.. 33 59 38 2.22 3.01 2.65 29.41 29.39 29.45 29.42 00 10 00 W. 2-4-2 1 " 9.. 47 64 52 3.88 3.98 4.56 29.17 29.16 29.12 29.15 25 90 100 W. & E. 2. 4 106 11 16-< " 10. 4S 58 41 3.85 1.91 3.19 29.02 28.82 28.96,28.93 100 90 100 S. E. & W. 4. 4 " 11. 38 45 41 2.89 3.14 3.19 29.10 29.20 29.28 29.19 100 90 100 N. W. 4-2 3 " 17. 49 60 56 3.85 4.41 5.18 29.25 29.13 29.08 29.15 90 75 100 S. E. 2. 3 107 19 20 < " 18. 57 59 52 5.05 5.08 4.26 29.07 29.07 29.12 29.08 100 100 100 N. 2. 3 " 19. 50 51 47 4.28 4.12 3.62 29.09 29.12 29.14 29.12 100 100 100 N. 2-4-2 TABLE-Continued.-Cases of Intermittent * Explained in foot-note on page 198. CAUSATION OF INTERMITTENT FEVER. 209 Fever, and Coincident Conditions. 1 Ozone, Dav, 7. A. M. to 2 P. M. Rainfall, Inches. Character of Surrounding Country, and Nature of Soil. Sanitary Surroundings of Habitation. | Age in Years. Sex and Social Condition.* Recent Exposures, Excesses, and Deprivations. Type of Disorder. 4 House low. Well-water very poor. Over- exerted herself by a long 2 3 .16 as case 1 4 Fe. walk in night air on Wednes- day night, and was ailing Quotid- ian. 3 House low on ground. Barn until 21st inst., when chill and fever came on. 4 4 .11 as case 1 _ close to house. Unsanitary surroundings. Procured water 8 Ma. Been complaining for 2 weeks previous to attack. Remit- tent. 2 3 .16 as case 1 at different wells. House low on ground. Damp excavation beneath house for 1 Fe. No unusual exposures Tertian. 3 cellar. Well-water poor. 1-5 4 4 .11 /-Same as case 51 j .8 Ma. Attacked while away from Tertian. 4 home visiting. 3 House of rough boards. Low on ground. Well-water good. Worked unusually hard, and after excitement wore off be- gan to feel ill. Been subjected to excitement in moving and settling. Father a minister. Same as case 95 Quotid- ian. 3 3 as case 1 54 Ma. 3 Sanitary surroundings of house fair, although house had been uninhabited for two weeks. Same as case 95 - ... 3 as case 1 4 Fe. Tertian. 3 2 2 .99 as case 95.. 2 Ma. Tertian. 3 2 3 .16 House low on ground. Water 8 Fe. No unusual exposure Quotid- 3 not good. ian. 3 2 "".99 as case 95 Same as case 95 35 Fe. M. Same as case 95 - Tertian. 2 3 (Level farm land. Soil House low on ground and sani- Fe. Been ailing for two weeks. Tertian. 3 tary surroundings poor. Well- 10 others in same house not 2 .99 i sandy. water good. well. 2 2 .99 ( Low swampy farm lands, f Soil clay loam. House low on ground and poor- ly constructed. Well-water poor. 18 Fe. Been ailing for week before Tertian. 3 attack by chill. 2 1 New farm. Land rolling. Drank a good deal of water 3 House damp. Water in cellar. 4 Fe. Tertian. 4 [ Soil mixed. Water tastes bad. before attack. 2 2 .99 1 High farming country, j Soil sandy. Log house. Damp, unventilated cellar. Water tastes of organic matter. Board house. Spring water- 5 Fe. Nothing unusual- Tertian. 3 3 j- In pine woods. Soil sandy. Fe. Suffered from diarrhea for 4 37 one week before attacked by chill. Tertian. 4 .12 very poor. M. 4 4 .12 J Open farming country, j Soil sandy. 1 Rolling farming country. J Soil sandy. 1 Rolling farm land. Soil J sandy. Board house poorly constructed. 30 Fe. No unusual exposures Quotid- 4 Cellar dry. W ater good. ian. 4 4 .12 Sanitary surroundings fair. Water good. 22 Ma. Was out hunting in woods all night preceding day of attack. Tertian. 4 3 Caught cold four days before attack. Quotid- ian. 4 4 .64 t House poor. Water good 22 Ma. 2 3 .12 rSame as case 83 Same as case 83 22 Ma. Was sick with ague on Sept. 14th and 20th. See case 87. Tertian. 4 1.21 * Ma.-Male. Fe.-Female. M.-Married. t Not enough to measure. 210 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. TABLE.-Continued.-Cases of Intermittent s 2 § g £ « 5 £ o § § Case. to 5 J 12 8 8 £ 83 § g Date of Attack. g J2_ £ 03 Date of first Visit. 222 2 2 2 2 2 2 2 2 : : : is: £ • • o • * < 2 2 2 2 2 2 =.:£ Date of Meteoro- logical Jbserva- £85 CO ~ l OS TO g§£ g§!2 £55 855 §§£ 855 855 tion. £5S ssg 8§?£ 558? 5££ £££ £32 888 3££ £83 £83 7 A.M. 258 882 «e« 8t8 285 £g* £S2 £33 S88 £23 £28 2P. M. g £52 533 §5*8 £g£ £53 £&5 823 £88 833 533 9 P. M. gsg j-ioro 833 582 K.WIO §£8 523 SSs 583 «££ S2S 858 8S8 7 A. M. 5§" <,►£ rf- tO .4- !«JSP ">«P COtOK) fops*. jspt-1 2P. M. &£Jg £88 882 8§8 3S£ 835 £85 §58 858 £5 ".« *. W SO t« tO OC *-*' cata.w 03 4" OS ggg r»t-!- s£S japcju 9 P. M. li 8Sfe 8§g ££3 388 82" ssgg 888 83S 8S8 §§s sss SgS §88 TO 888 §§§ gg.S §ss SSS 7 A. M. 2£S £8£ 333 g§8 258 835 £88 £83 £83 8£S §§£ W 83g £££ 28.90 28 66 28.37 SiSsS 28.97 29.17 28.94 g.gg 588 29.00 28.96 29.18 §§§ 3E3S 29.07 29.12 29.17 2P. M. iff 29.31 1 29.49 29.52 §8'8 SSS §8'8 TO 558 §§§ ggtg ggg §§.§ §§§ ggg 9 P. M. ££§ 588 3zS §82 5X5 5X5 8S8 S8S TO TO §§§ §§§ §§§ sss §§§ Mean. S5S 8SS §85 533 £33 £58 888 £8.8 558 ££§ 001 001 06 888 §85 888 §§§ 888 585 §85 888 888 888 7 A. M. ?? o.8o? §88 888 §88 888 888 §88 8§8 858 §88 g§8 2 P. M. 100 100 25 §88 888 888 §88 888 588 u>8o> 858 S§§ 888 9P. M. 17 r/1 m P»« 00« 03 6! a> on 3il ■ ■ 3 MB. M ? ft- ««« "m- K =?.»« ??? ??? « tott *2 FF to 5t£ to 1 Fi f PJO t® *!«P jo :r H ?f to to to Iff- to IO IF •hi ?l| C 4" 03 4* 4" Oi C/S 4-. Ci 4* MM MM Qt co a to w Ozone, Night, 9 P. M.to7A. M. * Explained in foot-note on page 198. As recorded in the table, of the one hundred and eighteen cases, seventy-two persons were either reduced by previous sickness, or subjected to unusual ex- posures just previously to the attack. In forty-six cases no such relation of causation could be traced. That exposures and previous sickness increase the liability to attack the record seems to prove. Sex.-Fifty-eight of the cases were males and sixty were females. Of those who were attacked after unusual exposures, thirteen were males and twelve females. Of those who were ill previously to attack, twenty were males and twenty-seven females. This difference was no doubt due partly to the greater liability of the female to disease or physical depression from many conditions characteristic of the female. Age.-Thirty-one of those cases attacked were under five years of age; 33 between the ages of 5 years and 20 years; 47 between the ages of 20 years and 50 years; while of those over 50 years of age only seven were attacked. Esti- mating the susceptibility to attack according to the age, the record declares the period of infancy to be the time when attacks are most liable to occur. CAUSATION OF INTERMITTENT FEVER. 211 Fever and Coincident Conditions. 1 Ozone, Day, 7 A. M. to 2 P. M. Rainfall, Inches. Character of Surrounding Country, and Nature of Soil. Sanitary Surroundings of Habitation. | Age, in Years. 1 Sex and Social Condition.* Recent Exposures, Excesses, and Deprivations. Type of Disorder. 3 Farm in border of village. Low lands near. Water good. 4 1.21 as case 1.... 30 Ma. No unusual exposures Tertian. 4 3 (Swamps and ponds near, f Sandy soil. 1 Quotid- ian. 4 4 1.21 House poor. Well-water fair.. & % Ma. Had a cold for some time.... 3 .18 Same as case 61 Same as case 61 23 Been ailing for a week before Quotid- 4 attacked by chill. ian. 4 4 y Pine woods. Soil sandy.. House poor. Water not good 25 Ma. No known exposures Tertian. 8 3 4 .27 as case 109 Same as case 109 2 Ma. No known exposure ,. Quotid- 4 ian. 7 /Low farm lands. Soil 4 mixed. Ma. M. 3 .44 House of logs. Water good..,. 74 No known exposure Tertian. 4 7 Mist. Was sick the last of Septem- 3 .44 j-Same as case 95. Same as case 95 4 Fe. Tertian. 4 Mist. her. See case 95. 4 4 .20 j-Same as case 59 Same as case 59 28 Ma. No unusual exposure Tertian. 4 4 4 3 ""'*09 .23 > Same as case 59 ) Same as case 59 2 Ma. No unusual exposure Tertian. 4 as case 59 Same as case 59 16 Ma. No unusual exposure Quotid- 4 .70 ian. 3 3 3 .13 .19 /Same as case 1 ... Same as case 90 4 Fe. Been ailing for some time. See case 90. Quotid- ian. * Ma.-Male. Fe.-Female. M.- Married. This may be accounted for when we consider the physical tenderness of this age and the many exposures to which such cases are subjected by the thought- lessness of parents and guardians. Type of Disease.-Of the 118 cases 25 were quotidian, 80 tertian, and 9 re- mittent. One case was first tertian, then quotidian, then typho-malarial. One case was first tertian, then quotidian, then double quotidian. There was also one case of congestive chill among the number. Water.-In 37 of the cases the water used for drinking and culinary pur- poses was unfit for use, being mostly surface water. Sanitary Surroundings.-A large proportion of cases were related to bad sanitary surroundings. The houses in many instances were low on the ground and poorly constructed. In some instances there was standing water beneath the floor. Swamps.-Twenty-seven cases were attacked while living near to marshes, although 91 cases occurred at a distance from any such influence. Soil.-The greatest number of cases occurred where the soil was sandy. 212 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1880. The porous condition of such soil giving a large surface for the evaporation of moisture, where rains are frequent, may partly account for the large number of cases occurring where they were subjected to such possible influences. It is certain that fewer cases of intermittent fever appear in this vicinity where there is a clay soil. Temperature and Moisture.-The greatest number of cases occurred when the temperature was higher than the average for the month, and there was a correspondingly greater humidity. Sudden decrease in tempera- ture with excess of moisture, exerting a chilling influence, would sometimes be followed by increase in the number of cases. Atmospheric Pressure exceeded the average for the month, as a general rule, when there was an increase in the number of cases, and most generally with any of the cases. The exceptions were mostly after a rainfall when there was an increase in temperature and excess of moisture. Clouds.-A marked relation seems to exist between the average per cent of clouds and the prevalence of intermittent fever. The least per cent of clouds occurred in the month of September, when there was by far the greatest number of cases recorded. The per cent of clouds influencing the radiation of heat may bear no small relation to the appearance of disease. Direction and Velocity of Winds.-The prevailing direction of winds during the prevalence of this disease was west and south, and particularly dur- ing the month of September. The velocity of the wind was least in those months when there was the greatest prevalence of fevers, as in the months of August and September. Ozone.-There was much less than the average of ozone at night, as indi- cated by Schbnbein's test, when the greatest number of cases occurred. The same conditions obtain in regard to the amount of ozone by day. During the months of October, November, and December, when fevers were least preva- lent, there was much more than the average of ozone. If we may believe that other meteorological conditions affect the presence or scarcity of the type of disease under consideration, understanding as we do the important relation oxygen bears to animal life, can we assume that an increase or decrease in the quantity of such an important element of the atmosphere as oxygen in a state of activity can itself exert no modifying influence upon this disease? Bainfall.-Seventy-one of the cases recorded in the table occurred imme- diately after rains. Four-fifths of these cases occurred after rainfalls exceed- ing .20 of an inch. In the month of June 4 cases occurred immediately after a rainfall of .56 of an inch. Of seven cases about the first of September all were immediately after a fall of .77 of an inch. Later in the month five cases were after a fall of .99 of an inch, and five others after a fall of .11 of an inch. Four other cases in this month occurred immediately after a rainfall of .87 of an inch. Under no other conditions were the meteorological data re- peated so often. With these cases there usually occurred an increase of tem- perature and a much greater absolute humidity than the average. In summing up the meteorological and other conditions with which fevers may be associated, as exhibited in this record, is it not possible to discover sufficient causes for a disturbance of the system to produce the phenomena of disordered functions of digestion, and fevers with periodicity, without ascribing them to some particular, poisonous entity? If there is a particular cause, it is evident that many disturbing elements, rendering the system susceptible to attack, may be removed by attention to matters of sanitation and personal comfort.