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        CENTENNIAL BOARD OF FINANCE,
 In the Office of the Librarian of Congress at Washington. 
 
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GROUND-PLAN  OF  HOSPITAL. 
 

iWttlAM  Pt
BUREAU  OF  MEDICAL  SERVICE.
                ffntetttatiottal   JjUljiHtion,
                           —1876—
UNITED  STATES  CENTENNIAL COMMISSION.
Bureaus of Adminisiraft
 Medical Service.
on.
iyntta.aewiA<.a, Q/anua-iu -/, VS1/"/.
  A. T. GOSHORN, Esq.,
               Director- General.
  Dear Sir,—I have the honor to herewith submit the report of the Medical Bureau ot
the International Exhibition.
                               Very respectfully yours,
                                      WILLIAM PEPPER, M.D.,
                                                   Medical Director.
 
REPORT  OF   THE  DIRECTOR
OF THE
BUREAU   OF  MEDICAL  SERVICE.
Bureau of
Medical
Service.
Organization
of Medical
Bureau.
  The functions of the Medical Department were to supply medical
and surgical assistance within the Exhibition grounds ; to advise with
reference to sanitary questions; and to issue in authoritative form
such information on the sanitary condition of Philadelphia and of the
Exhibition as  might  be  desirable.  The important subjects of the
drainage and water supply of the Exhibition grounds  were placed
entirely under the control of the Chief Engineer of the grounds.
  The Medical Department was organized in the early part of 1876,
by the appointment of a Medical Director, a staff composed of six
Medical Officers, and a Secretary, who was also the Resident Physician
at the Hospital in the Exhibition grounds.
MEDICAL DEPARTMENT.

       MEDICAL DIRECTOR,
    WILLIAM PEPPER, M.D.
OFFICERS OF MEDICAL STAFF,
JACOB ROBERTS, M.D.,
S. W. GROSS, M.D.,
H. C. WOOD, Jr., M.D.,
ROLAND G. CURTIN, M.D.,
HAMILTON OSGOOD, M.D.,
DE FOREST WILLARD, M.D.
                RESIDENT PHYSICIAN AND SECRETARY,
                  THEODORE HERBERT, M.D.

  [There were also employed a nurse, two apothecaries, and four attendants and clerical
assistants.]
  The Hospital  was  centrally located in Landsdowne  Ravine, on
Landsdowne Avenue, between Agricultural and Belmont Avenues.
Its position was  retired, well shaded, and quite  picturesque.  The 
REPORT OF THE DIRECTOR-GENERAL.
3
building was a one-storied frame structure, 64 feet by 32  feet, well Bureau of
lighted and ventilated, and conveniently arranged,  having a large Se^v|^
waiting-room, No. 1, 19 feet 6 inches by 19 feet 6 inches ; the office of
the Medical Staff and of the Apothecary, No. 2, 19 feet 6 inches by 12
feet 6 inches ; the office of the Director and Secretary, No. 3 ; the pri- Description
vate room of the  Resident Physician, No. 4;  two wards, Nos. 5 and 6, ° Hospita
for male and female patients, each 16 feet by 20 feet; two bath-rooms,
and  a  private room for  the  nurse.  It was furnished  with  every
necessary convenience and comfort, and  in  every  way answered the
purposes for which it was intended.
   The  Hospital was first occupied on the opening day of the Exhibi-
tion, May  10, and from that time until November 15, when the Ex-
hibition was finally closed to the public, the above organization was
maintained in efficient operation.
   The  experience of previous International Exhibitions has been that
exaggerated statements are circulated as to the bad sanitary condi-
tion of the cities in which they have been held ;  and a circular (No.  1) Circular No. r
was accordingly  issued, April 15, 1876, in which the sanitary condi-
tion of Philadelphia was fairly represented.*   This circular was widely
distributed, and was extensively reprinted at home  and abroad.
   Prior to the opening of  the Exhibition the duties of the Medical
Department were chiefly limited to the care of the employees engaged
in the construction of the various buildings or in the preparation of the
grounds, and of  the attaches of the Foreign Commissions, who early Casualties
began to take up their residence within the grounds.  It is a gratify- amo"s
   or                          o               o    j  employees.
ing fact that although many thousands of workmen were engaged for
eighteen months in the construction of the buildings, the number of
casualties  was very small.   In  order  to provide fully for these, Dr.
Herbert was  at an early  day stationed in a convenient office on the
grounds, so that all  such  cases might receive immediate  attention.
As there was telegraphic  communication with  the  nearest general
hospital, that connected  with  the  University of Pennsylvania, there
was no delay in having any serious case transferred in an ambulance
to its wards.
   With the opening of the Exhibition began the active work of the
Medical Department, but for the first  few weeks the public evidently
were not fully aware of its existence.   It is probable that  from  this
cause  many cases of sickness, occurring during this  time, did not
come to the Hospital for  relief.   This was remedied by an announce-
* See Exhibit A, Circular Xo. i, p. 29. 
4
INTERNATIONAL EXHIBITION, 1876.
Bureau of     ment, which  was  posted  throughout the Exhibition Buildings and
Medical            .   *
Service.      grounds.*
             Owing: to the great number and size of the buildings, and the dis-
Stretchers and        o       o
ambulance,    tances between them, it was necessary to place stretchers at numerous
           points in each of the principal buildings and about <the grounds.  The
           guards were especially instructed to promptly convey to the hospital
           any person requiring medical relief.   In addition to this an ambulance
           was  kept standing in constant  readiness to be dispatched to any part
           of the grounds for cases  of  a more serious  character.   The  ambu-
           lance was  also  used in exceptional  cases for conveying patients  to
           their  residences in the city,  or to one of the neighboring  hospitals,
           after the hours of  the  Exhibition.
             For the  efficient and satisfactory working of  the Hospital Depart-
           ment the following rules were issued :

Rules of the      1.  The Hospital building does not contain any exhibit; it is intended solely for medical
Bureau.      purposes, and, as its wards are always occupied, visitors will  not be admitted.  Informa-
           tion concerning the Department can be obtained from the Resident Medical Officer.
              2.  All medical relief furnished  at the Hospital building being gratuitous, under no circum-
           stances will any remuneration be received for services rendered. No medicines will be sold,
           nor will any be dispensed excepting upon the prescription of the officers of the  Department.
              3.  In order to avoid undue publicity of personal details, the record of the daily work
           of the  Hospital furnished to the agents of the public press will embrace only the number
           and general character of the cases treated.
              4.  No patient will be permitted to remain in the Hospital  building over night.  All
           patients remaining in its wards at  the hour of closing the Exhibition will be transported to
           their residence by the ambulance  or by private conveyance.
              5.  All employees of the Board  of Finance, of the Centennial Commission, and of Foreign
           Commissions requiring medical treatment, shall report daily to the Resident Medical Officer,
           at such an  hour previous to the opening of the Exhibition as he shall designate.
              6.  Any case of  serious sickness  occurring among  the employees must  be  reported
           without delay to  the Resident Medical Officer, who shall immediately have the patient
           removed to his own residence or to one of the neighboring civil hospitals.

Health of       In proceeding to the consideration of the medical statistics of the
population.    Exhibition, it will  be convenient to  allude first  to the sickness occur-
           ring among the population resident within the grounds.   In this con-
           nection it is important to  determine what was the  average  extent of
           this population during the period of the Exhibition, though it  is im-
           possible to do  this with entire accuracy, on account of  the constant
           changes in the number  of  persons  domiciled at the  several State
           headquarters.  It  may, however, be estimated  that the average daily
           population for the twenty-seven weeks was 1568.   The highest daily
           average was  1817, during the week ending May 27, and the lowest
           daily average was 1382, during the week ending November 10.
* See Exhibit A, Circular No. 2, p. 30. 
REPORT OF THE DIRECTOR-GENERAL.
5
The population was distributed as follows:                         BureauPf
                                                                  Medical
 Residing at the several restaurants, daily average.....256
 Residing at the buildings of the several foreign Commissions, daily average   103
 Residing at the several State buildings, daily average   .
In the employ of the United States Government, daily average
   "   "    "   Board of Finance:
                              Centennial Guard, daily average
                              Firemen, daily average
                              Janitors and others, daily average
Total
Service.
Resident
.     population.
 802
 175
  53

1568
   Before considering the amount of sickness  occurring among  this
population, attention is due to the peculiar conditions involved. In the
first place, among the numerous  representatives of  foreign countries
quartered within the grounds, most of whom  were sufficiently well
housed and provided for, there were not a few who suffered severely
from the exceptional weather of 1876—the keen  cold of the early
months of the year, as well as the intense  heat of the summer.   Un-
fortunately, too, some of those whose native climate would render
them most susceptible to these extremes were  not  suitably provided
for, in either lodging or food.  This was particularly the case with the
Japanese, who numbered about fifty; and whose dwelling, although a
beautiful model of Oriental taste and workmanship, was barely suitable
as a  residence during the cool weather of an  ordinary Philadelphia
spring or fall.  It was a frame structure of the lightest description, with Peculiarities
no provision for heating excepting a small shallow box, filled with sand, dwei^""6
placed in the centre of each room, upon which were kept burning a few house.
small pieces of charcoal.   It may be  imagined, therefore, how  ill fitted
this was as a residence, not only during the severe winter months, but
even during April, May,  September, and October.  It is to be noted, in
connection with  this mode of heating the apartments of the Japanese
dwelling, that, as there was no outlet for  the fumes  of the burning
charcoal, nor indeed any aperture whatever  for ventilation when the
rooms were closed, as they constantly were during  cool weather, the
inmates were subjected to a most unwholesome atmosphere.   These
depressing  influences, in  connection with  their meagre diet, caused
considerable sickness among the Japanese.   The chief forms of indis-
position were diarrhceal  affections, attended with an unusual degree
of general prostration, which yielded readily to treatment, but were
apt to recur.  In addition to this, the want of acclimation and  the
depressing influences just mentioned, strongly predisposed them to
contract febrile affections of typhoid type.  Thus,  out of about 50
individuals, including the members of the  Japanese Commission and 
6
INTERNATIONAL  EXHIBITION,  1876.
Bureau of
Medical
Service.
Health of
English
residents.
Composition
of Centennial
Guard.
the Japanese exhibitors, there were  9 cases of typhoid and typho-
malarial  fever.   These cases were all treated at the  University  Hos-
pital, and all recovered.  They were  of a  rather  mild type, with a
peculiar  absence of diarrhoea and of symptoms of nervous  disturb-
ance.  Although the cases were not severe, it was  further noted that
the convalescence was unusually slow and protracted.
  Among the  English residents, of whom there were 36,—next in
number to the Japanese,—there was a moderate amount of diarrhoea,
but only two cases of typhoid fever, both of which recovered.  In
marked contrast to the unhealthfulness of the  Japanese colony  is to
be placed the  excellent  sanitary conditions of the cottages for the
employees of the British Commission.
  The most important question in  connection with this  part of our
subject concerns the health of the Centennial  Guard.  This body,
which originally consisted of 1176 men, was selected with great care
as to their physical fitness.  It comprised representatives  of twenty-
five States; the largest number from any one being 608  from Penn-
sylvania, of whom only 197 were from  Philadelphia, so that over 80
per cent, of all  were from country districts.  This  fact  has an impor-
tant bearing upon the liability to continued febrile affections conspicu-
ously displayed by the members of this force.  In regard to occupation,
about 50 per cent, of all  had been engaged, prior to  their enrolment,
in in-door  pursuits  (as  clerks, store-keepers, printers, shoemakers,
etc.), which gave the worst possible preparation for the  very exposing
and trying duties assigned to them as members of the Guard.  Indeed,
of the 50 per cent, who had previously been engaged  in what we  have
classed as out-door pursuits, as distinguished from those which  were
purely sedentary and in-door, there were several large groups  (such as
sailors, machinists,  blacksmiths, etc.) who were not  especially well-
fitted to bear protracted exposure to intense summer-heat. An exam-
ination of the ages of  the men enrolled, shows that  every year  from
21  to  53 inclusive was  represented.   The following table shows
the relative  number enrolled for each period of five  years  from 21
onwards:
Age of the
Guard.
From 21 to 25 years inclusive .......   223 men.
    26 to 30
    31 to 35
    36 to 40
    41 to 45
    46 to 50
Over 50 years of age
340
288
211
 95
 12
  7
Total
1176 
REPORT OF THE DIRECTOR-GENERAL.
7
Although the number  of men actually enrolled in the Guard was Bureau of
                                                               Medical
                                                               Service.
1176, the daily average during the entire period of the Exhibition was
only 802.   The  reduction in numbers was a gradual one, and, so far
as is known, does not impair the general accuracy of the proportions
we have given.  Attention has been called to the above details about
the composition of the Guard, because it is evident that they exerted
a large influence upon  the  high rate of sickness which afterwards
prevailed among them.
   Owing to the unusual  heat of the season, the uniform which was Uniform and
adopted proved  to be much too heavy and oppressive.   It must also  arrac s
be observed  that, in  the  construction of the barracks in which the
Guard were quartered, sufficient  attention was not  paid to  securing
free ventilation or sufficient  cubic feet of breathing space.  It is prob-
able that both the health and comfort of the Guard  would have been
better served by requiring the men to be within the  grounds only
while on duty and allowing them to quarter themselves outside.
   It was inevitable, in consideration of the composition of the Guard, Sickness
 ...               ,              ,          i-ii             among the
their arduous duty, and  the extreme heat  to  which they were ex- Guard.
posed, that a considerable amount of sickness should  have  occurred
among them.  This  showed itself  chiefly in the forms of diarrhceal
and febrile affections and of solar exhaustion.  The  diarrhoea was
of a  simple  character and  amenable to treatment, so that  it rarely
necessitated the patient's  being off duty.  The forms of fever which
presented themselves were  simple  intermittent,  typho-malarial, and
typhoid.  Nearly all cases of intermittent fever occurred among those
who had suffered previously with the same  affection within eighteen
months.  In no instance did it appear that the disease was contracted
for the first time upon the  Exhibition grounds.  It is a well-known
fact that, in those who have once suffered from malaria, any cause of
nervous exhaustion, such as exposure to extremes of temperature or
excessive exertion, may reproduce the symptoms of fever without there
having been any fresh exposure to malarial miasm.   When  it is fur-
ther noted that nine-tenths of the  cases of intermittent fever among
the Guard and other residents within the grounds occurred during the
months of June, July, and August, it is clear that  there cannot be said
to have been any marked degree of malaria about this locality.  During Absence of
these three months, which  were  characterized by extreme and dry malaria
heat, the climatic conditions were very unfavorable to the development
of the malarial poison;  while during the later months of the Exhibi-
tion, including the period when malaria is usually most prevalent, it
was found that not more than three or four mild cases occurred.
   Of the other forms of fever mentioned, typho-malarial and typhoid, 
INTERNATIONAL  EXHIBITION, 1876.
Bureau of
Medical
Service.
Typhoid fever
among the
Guard.
Mortality
among the
Guard.
it is important to speak more at length, since the attention not only
of the medical profession but of the public was prominently directed
to this subject.   As, however, its chief interest concerned the health
of the public at  large more than that of the Guard, its consideration
will be found in  a later part of this report.   (See pages 22-27.)
  It is difficult to determine accurately the number of cases of typhoid
fever  occurring  among the Guard.  This is chiefly because, on  the
development of  any symptoms of a suspicious character, the patients
were in most instances removed to their homes, and all future record
of the cases was lost.   It is certain, however, from the observation of
cases of this character  sent to  Philadelphia hospitals, that many of
them proved to be simple  diarrhoea, with unusual  prostration.  On
the whole, it may be said that not more than from  25  to 30 cases
of true  typhoid or typho-malarial fever occurred ambng the Guard,
whose average  number during the months of May,  June, July,  and
August, during which time all of the cases of fever originated, was 870.
When we recall the conditions  upon which we have dwelt as render-
ing the members of the Centennial Guard  unusually liable to these
febrile affections, it becomes evident that the specific causes of typhoid
and typho-malarial fevers did not exist in any high degree of intensity
at the Exhibition grounds.
   The total  number of deaths known  to have occurred  among  the
Guard is 8, from the following causes:

  Typhoid and typho-malarial fevers, after removal to their homes in other States  .   3
  Typhoid and typho-malarial fevers, after removal to hospital    ...   .3
  Organic disease of the heart, with rupture, after removal to hospital  .    .   .1
  Variola, after removal to hospital.    .   .   .    .    .    ...   .1
Isolated cases
of smallpox
and measles,
  In connection with this latter case, it is interesting to observe that
it was developed in one of the Guard who was quartered in a crowded
barrack,  and that it  was the only  case of smallpox that occurred.
In like manner, a single isolated case of severe measles  presented
itself in a different barrack.
  In further confirmation of the view that the causes of the typhoid
fever which occurred were general in their character, and connected with
peculiar atmospheric conditions and with the peculiar composition of
the population resident within the grounds, there should be mentioned,
first, that the cases all occurred during the months of May, June, July,
and  August; and, secondly, that they  were quite  evenly distributed
over the extensive grounds; thus there were cases among  the Guard
at the barracks on George's  Hill, among the Japanese and  English at
their quarters on the Hill, among the guard at the Fifty-second Street 
REPORT OF THE DIRECTOR-GENERAL.
9
barracks, among those at the barracks at the eastern end of the Main Bureau of
Building,  among those at the barracks at the northeastern extremity SerV|ce.
of the grounds, and among those at the barracks immediately in front
of the Hospital, which was almost in the centre of the inclosure.   It
seems  remarkable  that  at the barracks of Company G, which was
situated in  Belmont  Ravine, between the  Kansas  and  Colorado
Building  and Agricultural  Hall, there was  not a single case, as this
location seemed to present the  least favorable hygienic  conditions
qT oil                                                             General health
                                                                  of Guard good.
   Apart from the  diarrhoea and fevers which have been spoken of,
the  general  health of the Guard was good, the only ailments  being
of a very trivial character.
   It may be stated, in conclusion, that, considering the great exposure
of the Guard, of the employees, and of the attaches of Foreign Com-
missions during the cold inclement weather of March and April, and
later during the unprecedented heat of June, July, and August, their
health was better than could have  been anticipated.                 Sanitary
   As  yet there  have been considered only those sanitary questions Visitors "to the
connected with the population resident within  the grounds.   It now Exhibition.
remains to examine the interesting questions which concern the  ex-
traordinary  number of  visitors who thronged the Exhibition during
the twenty-seven weeks of its continuance.
   As  already stated, during the first few weeks it was not generally
known to visitors  that  provision for  medical relief had been  made. Medical
In view of the frequent calls subsequently made upon the  Depart- ^ureau should
                   x                                               be organized
ment,  and the valuable assistance rendered in many cases, it seems early.
desirable that hereafter in similar Exhibitions the Medical Bureau
should be organized  at a very early date, and that the  attention  of the
public should be called to it in the clearest possible manner.
   On  the opening  day,  May 10, although there were 186,672 visitors,
there would seem to  have been no serious accidents, since but 5 cases Totalnumber
applied at the Medical Department, 3 of which were  slight injuries of cases
and 2 were  cases of exhaustion.   It is probable, however, that there Hospital
were many other similar cases which were removed directly to their
homes, and of which consequently no record has  been kept.   From
that date to  the closing day (159 days in all), 6463 cases were treated,
making a daily average of about 41.
   The following analysis of the actual residences of the cases, although
of course not in any way proving  that the same proportions held in
regard to the entire number of visitors, is of interest: 
10
INTERNATIONAL EXHIBITION, 1876.
Bureau of
Medical
Service.
Residences of
patients.
Sex of
patients.
Ages of
patients.
Austria			2
Bavaria			1
Belgium			4
Bohemia			1
Brazil .			• 3
Canada			68
Cuba .			1
England			55
France.			23
Germany			21
Ireland			11
Italy .			4
Japan .			32
Jerusalem			1
Norway			1
Nova Scotia			11
Poland			1
Portugal			1
Prussia.			4
Russia .			13
Syria .			2
Scotland			2
Sweden			12
Turkey			7
I.—RESIDENCES OF
     West Indies
     Alabama
     Arkansas
     California  .
     Colorado
     Connecticut
     District of Columbia
     Delaware  .
     Florida
     Georgia
     Illinois'
     Indiana
     Iowa .
     Kansas
     Kentucky  .
     Louisiana  .
     Massachusetts
     Maryland  .
     Maine
     Michigan   .
     Minnesota  .
     Mississippi  .
     Missouri
     Montana
PATIENTS.
        Nebraska
  1
 14
  7
 32
  8
292
 65
 42
  9
 18
116
 97
 64
 21
 20
  6
495
139
 42
163
  7
 16
 33
  1
Nevada
North Carolina
New Hampshire
New Jersey
New York
Ohio
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Vermont .
Virginia  .
Wisconsin
Not known

  Total  .

United States
Foreign countries
Not known

  Total  .
   7
   2
  14
  66
 249
1268
 3i8
   1
2104
  58
  11
  15
  n
  79
  58
  48
 165
6463
6016
 282
 165
6463
   It  is seen  from  the above table that 93  per cent, of all persons
treated were residents of  the United States, representing 39 States and
Territories; while but 4.36 per cent, of all were from foreign countries.
Of those from the United States, 35 per cent, were from Pennsylvania,
21  per cent,  from  New  York, 7.6 per  cent, from  Massachusetts, 4.9
per cent,  from Ohio,  4.5 per cent, from  Connecticut, and 3.8 per cent.
from  New Jersey.   Of those from foreign  countries,  55 were from
England, 32 from Japan,  23 from  France,  and 21 from Germany.
   Of the total number of cases (6463), 1799 .were females and 4664
were  males.
                       II.—AGES OF PATIENTS.
Ages.		
Under 1 year		
1 to 5 years		
5 to 10 "		
10 to 20 "		
20 to 40 "		
40 to 60 "		
60 to 80 "		
80 to 100 "		
Not given .		
Total .		
The oldest patiei	its i	ncluded
Males.	Females
5	I
17	9
51	26
449	222
2348	759
88S	285
*45	38
1	2
763	457
4664
1799
                                in the above table were one man aged
81, and two women aged respectively 95 and 96 years; while, on the
other hand, the youngest patients were 2 and 4 weeks respectively. 
REPORT OF THE DIRECTOR-GENERAL.
II
  The following tables present a summary of the principal causes of Bureau of
sickness among the visitors to the Exhibition during the twenty-seven Servicei
weeks of its continuance :
III.—MEDICAL CASES.
Respiratory and Circulatory Diseases.		Vertigo .....	55 Analysis of
Asthma ......	9	Meniere's disease	I medical and
Hay asthma ..... Bronchitis ..... ILvmoptvsis .....	2 135 '3	Miscellaneous .... Total.....	7 surgical cases ____ treated at the 865 Hospital.
Organic disease of heart .	8	Fevers.	
Palpitation of heart .... Miscellaneous .....	13 66	Simple fever .... Intermittent fever	27 212
Total......	246	Remittent "...	5
Digestive Diseases.		Typhoid "...	6
Cholera infantum	1	Total.....	• 250
Cholera morbus ....	151		
Diarrhoea.....	1686	Effects of Heat.	
Dysentery ....	19	Heat exhaustion	29
Indigestion ....	499	Thermal fever ....	10
Cramps .....	487	Sun-stroke ....	2
Constipation .... Miscellaneous ....	215 141	Total.....	41
Total.....	3199	Effects of Over-exertion.	
Nervous Diseases.		Debility and exhaustion .	. 266
Apoplexy.....	2	Faintness and syncope	44
Headache .... Neuralgia (including toothache anc	356 I	Total.....	. 310
earache) .... Epilepsy ..... Hysteria ..... Insanity .....	• 364 28 5o 2	Intemperance .... Miscellaneous medical cases Total medical cases	10 • 596 • 55'9
IV.—	SURGICAL CASES.		
■Wounds.		Fractured larynx	1
Bites and stings	25	Concussions ....	4
Contused wounds	• 56	Foreign body in eye .	192
Incised wounds	73	Foreign body in ear .	1
Lacerated wounds .	100	Foreign body in throat	4
Gunshot wounds	3	Hernia .....	4
Punctured wounds .	11	Hernia (strangulated)	6
Total.....	. 268	Total.....	• 414
Accidents and Injuries.		Miscellaneous surgical cases	262
Scalds.....	14	Total surgical cases	• 944
Burns ..... Contusions .... Dislocations ....	12 . 96 4	Medical cases .... Surgical cases ....	■ 5519 ■ 944
Sprains..... Fractures.....	. 64 12	Total.....	. 6463
 
          I2              INTERNATIONAL EXHIBITION, 1876.

           About one-fourth of these cases were of such severity as to require
          admission to the  Hospital wards, while the remainder  were capable
          of being immediately relieved.  In the vast majority of  cases the pa-
          tients admitted  to the wards  recovered  so  speedily as to be able to
          return home without aid.   In not more than 35 instances during the
          entire season did  the patients continue so ill as to make it necessary
          to have them conveyed to  their homes in  the ambulance  when the
          Hospital was closed at  nightfall.  In no instance was it necessary to
          deviate from the  rule of the Department,  that no case of sickness
          should remain in the Hospital building over night.
            It will be observed that 3199, or more than  one-half the entire
          number of medical cases, were  connected with the digestive organs.
          Although the majority of these originated  at  the  Exhibition, a  con-
          siderable number were cases of longer standing.   It is  important to
chronic cafes. note this, not  only in  connection with this class of affections,  but
          with all the other classes, since, in reality, a considerable proportion
          of the cases were in no way chargeable to the visit to the Exhibition.
          Thus, so soon as it became  generally known that gratuitous medical
          advice could be had, a large number of persons with chronic affections
          of  a  medical or  surgical character  applied at the  Department for
          relief.   It was  thought expedient not to  refuse  such applications,
          although they were recognized as an  abuse of the  Medical Depart-
          ment, which was intended solely for the relief of cases of emergency.
Causes of    The great majority of the cases  of digestive disturbance  were directly
diseases of    traceable to excesses  or  indiscretions in  eating; and, when  it is
organs^     remembered that such vast numbers of persons,  collected from  all
          classes of society and accustomed to all varieties of occupation  and
          climate, were exposed to the  combined influence of excessive  fatigue
          and excitement, of extreme heat and of irregular  diet  and  hours of
          eating, it is truly remarkable that sickness from these causes was not
          vastly more common.  It should also be observed that in  supplying
          the enormous demand for certain articles of food it must occasionally
          have happened  that supplies of  inferior quality were used.   This was
          particularly the  case with regard to articles of such perishable character
          and of such general consumption as milk, meat, eggs, etc.  A forcible
          illustration of this was given on the  nth of July, when  no less than
          26 patients with severe cholera  morbus were admitted to the hospital
          in the course of an hour and a-half, all of whom  had been  taken ill soon
          after partaking of a lunch of pie and milk  at  one of the restaurants.
          It cannot be doubted that this violent outbreak was dependent  upon
          some  subtle organic change in one of the articles mentioned, prob-
          ably the milk, by which it acquired highly irritant poisonous qualities.
Bureau of
Medical
Service. 
REPORT OF THE DIRECTOR-GENERAL.
13
Probably, however, sickness was less frequently caused by such spoiled Bureau of
or tainted provisions than by excessive fatigue in very hot weather, sJv|ce-
by the copious  use  of iced drinks of all kinds while  the body was
greatly overheated, and by the consumption of indigestible articles of
food when in a state of great physical exhaustion.  Vast numbers of
those who visited  the Exhibition did  so at great personal and pecu-
niary sacrifice.   Every effort was made, therefore, to condense  their Conditions
visit to all parts  of the Exhibition into the shortest  possible  time, s*ckne"son
and it is difficult to conceive of the excessive fatigue and exhaustion part of visitors.
involved in this attempt.   A large proportion of the visitors  were
women or young persons entirely unfitted for enduring the physical
fatigue of a succession of long days, spent on foot, in constant motion,
in the midst of  vast throngs of  people, and with the mind overtaxed
with the ever-changing novelties and attractions of the scene.   Very
many of the visitors came from  localities  whose climates differed
widely from that  which they here found.   They  abruptly changed
all their habits of living,  and,  in too many instances, neglected the
hygienic rules which are essential to  health.
   During the later months of the  Exhibition, there were unfavorable Drinking-
reports circulated in regard to  the purity of the drinking-water sup- ****any™ay
plied  to  the  Exhibition grounds  and  the  neighboring portion of as a cause of
West  Philadelphia; but careful investigation  showed that they were
unfounded.  The water was drawn   from  the Schuylkill River at
a point  opposite  the Exhibition grounds.   It  is true that, in the
extreme haste  with which many of the small  buildings within the
inclosure were  erected, the rules  issued on this subject were dis-
obeyed in a few  instances, and wells were constructed having con-
nection with one or the other of the two small streams which flowed
through the grounds and emptied into  the  river not far from the
above point.  In  every case, however, this was  soon detected and
instantly  corrected.  Any contamination of  the water supply  from
such a source could only have occurred during  the first few days of
the Exhibition.   As a  matter  of  fact, no sickness occurred  during
this period.  Careful analyses were made at short intervals  by Dr.
C. M.  Cresson, which showed that the purity of the water taken from
this point of the Schuylkill was fully up to  the  standard of previous
years  as well as  to that of the water supply of  neighboring cities.
The most conclusive evidence, however, on  this point is to be drawn
from the actual  experience of the large number of persons who drank
the water freely during the entire period of  the Exhibition, but who
were not exposed  to the various causes of sickness which  influenced
the Guard and visitors.  In no  single instance did any sickness of a 
14
INTERNATIONAL  EXHIBITION, 1876.
Bureau of
Medical
Service.
Exhibition
grounds and
vicinity free
from any
special cause
of disease.
Conclusions as
to sanitary
conditions of
grounds.
 typhoid or  diarrhoeal  character occur.  We  have already seen that
 the amount  of typhoid fever among the Guard was small, taking into
 consideration the peculiar composition of that body, and, further, that
 the cases which  occurred took place within a limited period, marked
 by  unusual  meteorological conditions,  while the water supply re-
 mained unchanged.  Finally, we have seen that the cases of diarrhcea
 occurring among the Guard were light in character and  readily amen-
 able to treatment, though all the time the patients were using large
 quantities of this drinking-water.
   As a further evidence of the fact that  no special cause of typhoid
 fever existed at the Exhibition grounds or in their vicinity, it may be
 stated  that in the Twenty-fourth Ward, which embraces almost the
 whole of Fairmount Park and all of the adjoining  portion of the city,
 the  total number of deaths from typhoid fever  for the entire year was
 44,  of which 30 occurred between May 10 and November 10.  The
 population of this ward in 1875 was 41,310, but during the Exhibition
 period it may be safely estimated—in  consideration of the large tem-
 porary hotels, all of which were.included in this ward, and the enor-
 mous number of boarding-houses and private  residences which were
 constructed for the occasion—that the population was at least 75,000,
 which gives a rate of  mortality per 1000 from typhoid  fever during ■
 this period of only .4.
   In conclusion,  we may state, as the  result of careful  study of this
 question of the  sanitary condition of  the Exhibition  grounds,  in re-
 gard to which so much was said at the time:
   First, that there is no evidence to-show that any special cause of
 sickness existed  there.
   Second.  That with regard to  the  supply of  drinking-water in par-
 ticular, there is no evidence to show that its use predisposed either to
 typhoid fever or  to diarrhoeal affections.
   Third. That the sickness occurring among the Guard and employees
 resident within the grounds was due  to peculiar  causes above con-
 sidered, which were in no way connected  with  the  sanitary condition
 of the grounds.
   Fourth.  That the sickness occurring among  the visitors, which was
 actually dependent upon their visit to the  Exhibition, was due exclu-
 sively to the  effects of over-fatigue, indiscretions in eating and drink-
 ing,  undue exposure to great heat or to inclement weather, etc.
   It remains  now in connection with  the record of sickness  amono-
 ...                                                         t>
the visitors to allude to a few peculiarities.
  A considerable number  of cases showed, as would have been ex-
pected,  the injurious effects of  the  extreme  heat.  Douhtless, this 
REPORT OF THE DIRECTOR-GENERAL.
15
cause aided in producing many of the cases classed as simple exhaus- Bureau of
tion.  The cases, however, in which sickness  was directly traced  to Serv|ce.
the effect of heat were 41  in number, of which 32 occurred between
the 25th of June and the  22d of July, during which four weeks the
average  temperature  was  81 ^°F.   The majority of cases, 29  in
number, presented the ordinary symptoms of nervous exhaustion fol- Direct effects
lowing  upon exposure either to the direct rays of the sun  or to a
very high  degree of temperature within-doors.  In the 10 cases  re-
corded as thermal fever, the symptoms were much more severe.  The
patients were still conscious, or in some cases delirious;  there was
intense heat of surface, congestion of the  eyes, deep flushing of the
face, and great  rapidity of the  pulse.   These  cases were treated by
immersion in baths of ice-water,  and  promptly  recovered.  The 2
cases recorded as sun-stroke were characterized by sudden and alarm-
ing development of temperature, the patients almost instantly passing
into a state of coma with stertorous respiration, with livid congestion
of the face and surface, and with extremely small and rapid pulse.
They were stripped and were then vigorously rubbed  with pieces  of
ice until  a marked reduction of temperature took  place.   As this
occurred, consciousness returned, followed in both cases by  rapid
recovery.
   In regard to the class of nervous diseases, there are  several points Nervous
of interest to be noted.  Thus, there were but  two cases of apoplexy,
one of which occurred in an intemperate  man, and proved almost
immediately fatal,  while the other was  a mild attack, probably  of
localized apoplectiform congestion of the brain, occurring in a young
man  engaged as a chair-pusher, an occupation which involved ex-
hausting effort and prolonged exposure to the  sun.  There were only
28 cases of epilepsy treated at the hospital among 9,910,966 visitors
to the Exhibition.   It is of course highly probable  that very many
more epileptics  were included in this number who were not so unfor-
tunate as to have  an accession of their terrible malady while within
the grounds.  The  cases recorded as vertigo were almost exclusively
dependent upon indigestion.  As  a matter of purely medical interest,
it may be mentioned that a single case of that rare affection, Meniere's
disease or labyrinthine vertigo, presented itself at the Department.
  The only remark to be made in connection with the  class of respi- Respiratory
ratory and circulatory diseases is to call  attention to the very small circulatory
number of cases, only 21,  who were attacked with disturbance of the diseases-
heart, either due to functional or  organic  disease; as well as to the
very small number  of cases of haemoptysis, only 13, which occurred
among  the  enormous  number  of visitors.   We have already re- 
6             INTERNATIONAL EXHIBITION, 1876.
Medical
Service
Bureau of    marked  that the large number of cases of digestive disorders, 3199,
          were nearly all attributable to excesses  or indiscretions in eating or
          drinking, with  the exception of cases of  a chronic character.
Absence of     In illustration of the class of persons who visited the Exhibition, it
.ntoxicanon.   .g tQ ^e observed  tnat ^ut IO cases  0f intoxication were brought to
          the  hospital for treatment.  It was anticipated  that a  considerable
          number  of cases of abortion  or miscarriage would occur in conse-
          quence of  the excessive exertions  and fatigue incurred by many
          visitors to the Exhibition.  In but  one  case, however,  did abortion
          result; and in one other miscarriage was threatened, but was averted
          by rest and the use of opium. .
Deaths within    There were  but 4  deaths  within the grounds during  the  entire
          period of the Exhibition.  Of these, 2 occurred from organic disease
          of the heart and 2 from apoplexy.
surgical cases.    ^he surgiCal cases, 944 in number, were for the most part of minor
          severity.  It is a striking illustration of the good order which prevailed
          among the vast crowds which daily assembled in the grounds that there
          was  not a single case of injury resulting from personal violence. This
          was  especially remarkable on those days when some particular attrac-
          tion drew unusually large numbers of visitors.   Yet even on " Penn-
          sylvania day," when over a quarter of a million persons were gathered
          within the grounds, most of whom remained until long after nightfall,
          so perfect was the good temper of the crowd, so entirely capable were
          they of taking care of themselves, and so careful to respect each other,
          that, although no special precautions were taken and no additional con-
          stabulary was employed, the occasion was entirely unmarked by any
          unusual  accident.   No quarrel occurred, and no woman  or child was
Remarkable   crushed  or trampled upon.  The passenger railway which traversed
          the  grounds carried 68,273 persons  on  that day; and, although the
          crowded trains frequently seemed to literally plow their way through
          the dense masses which  lined the tracks, there was not a single acci-
          dent.  It may be questioned whether any festival, equally remarkable
          in all  respects, has ever  occurred.  It  is also noteworthy, when  the
          enormous amount of machinery in motion, and the throngs of curious
          visitors constantly surrounding each  machine are considered, that not
          a single accident happened, with the exception of a few trifling contu-
          sions and  lacerations  occurring among  the workmen.  There were
          3,784,142 passengers in all carried  by the Narrow-Gauge Railway
          Company, without the occurrence of any accidents.
            For the entire period of the Exhibition the ratio of cases of sick-
          ness among the visitors was  1  in every 1533.   The  greatest number
          of patients treated in one  day was 114, on  September 28, " Pennsyl-
absence of
accidents 
REPORT OF THE DIRECTOR-GENERAL.
17
vania Day," when there were 274,919 visitors, thus  giving  1  patient Bureau of
in every 2411 ;  while on the 20th  of July there were only 25,936 s^e.
visitors, and  58  cases of sickness, or 1 in every 447, the highest per-
centage occurring during the Exhibition.
  The following table shows the number of patients treated at the
Hospital, and the proportion borne to the total number of visitors on
the days when the attendance at the Exhibition was  greatest.  The
mean temperature has also been placed in connection with  the other
data:
TABLE V.						Amount of
						sickness in
	Number of Visitors to	dumber of Pa tients treatee			Mean	proportion to
	the Exhi-	at the Hos-	Ratio.		Tempera-	number of
	bition.	pital.			ture, Fah.	visitors.
May 10, Opening Day	186,672	5	1 in	37,334	56-7	
July 4.....	56,494^	48	I in	i,i77	82.5	
August 24, New Jersey Day	67,052	60	I in	1,117	73-7	
September 7, Connecticut Day .	75.044	59	1 in	1,272	63.0	
September 14, Massachusetts Day	97,868	80	1 in	1,222	68.2	
September 21, New York Day .	134,588	60	I in	2,243	61.7	
September 28, Pennsylvania Day	274,919	114	1 in	2,411	56.2	
October 5, Rhode Island Day .	10x3,946	48	I in	2,103	58.5	
October 12, New Hampshire Day	. 115,422	53	1 in	2,177	45-o	
October 19, Delaware and Marylanc	I					
	. 176,407	7i	1 in	2,484	53-7	
October 26, Ohio Day	■ i35>6°i	73	1 in	1,852	45-5	
October 27, Vermont Day .	. 108,080	53	I in	2,039	43-7	
November 10, Closing Day	. 121,721	31	I in	3,926	39-7	
  The opening day maybe disregarded in this respect for the reasons
already given.  With reference to the  other days, it will be observed
that so long as the average temperature was  moderate, say between
400 and 6o°, the  sickness among the visitors was apparently not in-
fluenced by it, but  varied within certain  limits from  other causes.
When, however, the average temperature was materially above 6o°,
it was found that the proportion  of sickness increased  considerably.
As the temperature was the chief agent in influencing public health
during  the  Exhibition, it will  be interesting to  subject it  to a more
     0                             .                              Influence
careful study.  In order to facilitate this, Charts Nos. I and 2 have been of high
prepared.  The first feature which is apparent from these is the exces- temPerature-
sive temperature that prevailed during the thirteen weeks of June, July,
and August.  During  this entire  period the average weekly tempera-
ture  was continuously above 700, and  during  the  four weeks ending
July 22, the  average weekly temperature was 81 }(0 Fah.  The effects
of this protracted  heat were aggravated by the  dry character of the
season.  The influence of the  elevated temperature upon the amount 
i8
INTERNATIONAL EXHIBITION, 1876.
Bureau of   and character of mortality in the city at large  is very apparent, and
service     w^ be carefully discussed  later on.   We would now ask attention
         to  its influence upon the admissions  to  the  Exhibition  and  upon
         the  amount  of  sickness among the  visitors.   It will be  seen  that
         during the first 5 weeks of  the  Exhibition, up to June IO, there was
         a steady increase in the total weekly  admissions to the grounds, so
         that for the week ending with the above date they numbered 233,406.
         At this time it was confidently expected that, as the traveling season
         was about to begin, there would  be a rapid rise in the attendance.
         Unfortunately, however, the  heated term, which was destined to be
influence    so long and so intense, began at that date.  In consequence, undoubt-
of high
temperature  edly, of the  reports concerning the heat which were  quickly circu-
on amissions \a^e^  the attendance, instead of  increasing, immediately  showed a
and on amount                                        °            '
of sickness,  falling off.   In  the  week ending July I the number had fallen to
         210,108; average weekly temperature, 81 °.  The total for the week
         ensuing, average temperature being 8o°, was brought  up to  315,853
         by the large number of visitors attracted  by the ceremonies of the
         4th of July; but in  the following  week, with an average  temperature
         of  830, the total fell to 174.792^; and in  the week after, with an
         average temperature of 8o°, it continued to fall, and reached the num-
         ber  166,744.   At this point a break in the continued  heat occurred,
         and the attendance  instantly began to rise, but it was not until the
          15th week of the Exhibition that  the number of visitors  had attained
         the point where it stood in the 5th week. From  this point the  attend-
         ance rapidly rose, and was no longer  influenced  by the temperature,
         which continued moderate  until  the close of  the  Exhibition.  The
         irregularities  in the curve  showing admissions (represented  by the
         dotted black  line) were chiefly, if not entirely, dependent upon the
         occurrence of certain days of  particular interest.  While undoubt-
         edly the total admissions to the Exhibition were seriously dimin-
         ished in  consequence of the extreme heat which raged during the
         month of July and parts of June  and  August, it is a  matter of con-
         gratulation that large numbers of  strangers did  not visit  Philadelphia
         during that time.  It would have been impossible for the  vast throngs
         which crowded the grounds during the latter  part of the season to
         have visited  them  during  the heated  term  without a lamentable
         amount of sickness resulting.   The  effects of the heat  upon  the
         general  attendance  at  the Hospital are clearly shown by following
         the dotted red  line  in Chart No. 2.  The fact  that after the  marked
         fall  in this attendance which followed the break in the heated term
         the number of cases again  began to increase  in  the  15th week, and
          continued quite large  during the  rest  of the season, was entirely due 
REPORT OF THE DIRECTOR-GENERAL.
19
to the great and progressive increase in the general admissions to the Bureau of
grounds, which began at that date.   Although this effect is shown in S*TV'^
the general attendance at the Hospital, it is far more clearly displayed
in regard to diarrhoeal affections (see dotted yellow line in Chart No.
3) and  the class of cases showing exhaustion in its various forms.
(See dotted yellow line in Chart No. 2.)
   We invite attention, in the next place, to the sanitary statistics of the Sanitary
city of  Philadelphia at large during the period of the Exhibition.  In Philadelphia.
endeavoring to estimate the effect produced upon the health of the  com-
munity by the sudden  introduction of vast numbers of unacclimated
strangers, it is necessary to bear in mind the peculiarities of the season
and the very great differences which occur, without appreciable cause,
in  the  mortality from  some  of the principal diseases in different
years.
   It is also highly important to determine as  closely as possible the Estimated
movement of the population of the city during this period.  It is need- p°PuIattonof
                 11                j      0     l                  citv during
less to  say that, for the following reasons, this can be done with only Exhibition
approximative accuracy.   In  the  first place, the floating portion of Penod-
the population was directly absorbed into and blended with the resi-
dent population  in a most remarkable manner.   In other cities, when
an occasion draws a large concourse of visitors,  the additional num-
bers are  accommodated  chiefly in  hotels and boarding-houses.  Of
course a considerable number would also be  received as  guests  into
private families,  but these would form but a very small proportion of
the whole.  On the other hand, although the hotel accommodation
in  Philadelphia was very largely increased in anticipation of the Ex-
hibition, and although many additional boarding-houses were opened,
the great bulk  of the floating population was  quartered in private
houses.  This was partly the  result of the operations of the Centen-
nial Boarding-House Agency, which enabled all housekeepers, who
so desired, to receive as many lodgers as they could accommodate;
but it was chiefly due to a system  of hospitality so lavish and so uni-
versal that it has  probably never  before been equaled.  The  almost
unlimited extent to which this reception of guests and lodgers was
carried can only be understood by recalling the fact that Philadelphia,
with a population  estimated  in the early part  of 1876 at 817,488,
contained, in addition to other kinds of buildings,  over 143,000 houses
occupied by families, thus giving an average of less  than  six persons
to each residence.   The  second source of difficulty in  estimating the
total population of the city lay in the frequent and  extreme fluctua-
tions which occurred in it.  In the following statements, the ordinary
floating population necessarily incident  to the  daily life of a great 
20
INTERNATIONAL EXHIBITION, 1876.
Bureau of
Medical
Service.
Fluctuations
in number of
strangers in
city.
Sources of
difficulty in
estimating
health of city.
Sickness
among
visitors to
Exhibition
after their
return home.
city is of course excluded.  Bearing in mind the result of the census
above given, it may be  safely estimated  that from May 10 to June
25, the beginning of the period of intense heat, the daily number of
strangers in  the  city was from 30,000 to 50,000.  From June 25 to
August 10 the number  must have  fallen off considerably, and prob-
ably ranged from  15,000 to 25,000 per diem.  After  August 1 the
number steadily and  rapidly increased, so that during the last three
months of the Exhibition it ranged from 50,000 to 200,000.  It will
be seen later that these fluctuations in the population bear an interest-
ing relation to the variation in the amount of certain diseases.   In
order to serve as  a  basis  of calculation it  is necessary  to  decide
upon a figure as representing the average population during the entire
Exhibition period.  After much reflection it appears proper to adopt
the figure 900,000 as being unquestionably a safe and rather low esti-
mate, and we shall accordingly use this as our basis in computing and
comparing all ratios of sickness, mortality, etc.  There are, however,
two sources of difficulty met with in attempting to give  any definite
idea of the health of Philadelphia during this particular period.  The
first of these is incidental to all such calculations, and depends upon
the fact that the records of the Board of Health give only the number
of cases of death from various causes, and  that no  means  exist for
obtaining the actual  number of cases of  such sickness  which have
occurred.   In regard  to dangerous  affections, where the rate of mor-
tality is considerable and more or less definite, it is possible to make
an approximative calculation of the total number of cases which have
occurred, based upon the number  of deaths.  But in  the case of
comparatively non-fatal affections, it -is obviously impossible to apply
any such  rule.  The other source  of difficulty lies  in the  fact  that
much of the sickness which  occurred was  among visitors, who in
many instances, as soon  as attacked,  returned to their  homes.   It
is of course impossible to estimate what  amount  of  mortality may
have  thus  occurred in different  parts of the country from sickness
actually contracted  in Philadelphia.  So much  discussion of  this
question has  taken place in many quarters, both at the time  and
since the close of the  Exhibition, and  so many statements  were
made which we are compelled to regard as greatly exaggerated,  that
it seems necessary to  consider it somewhat  in detail.  It  cannot be
doubted that, owing to the  unusually  severe  character of the  season,
and perhaps to peculiar  atmospheric conditions which we cannot ap-
preciate, there existed a  strong tendency to diarrhoeal  and typhoid
affections over a large section of the country.  During  the six months
with which  we are chiefly concerned the above diseases are the  only 
REPORT OF THE DIRECTOR-GENERAL.
21
ones which caused any considerable amount of mortality, and we Bureau of
shall  therefore  devote particular  care  to their  consideration.  In SerVlce.
speaking of the sickness among the  visitors to the Exhibition, we
have already alluded to the numerous  causes which predisposed them
to diarrhoeal and febrile affections.  We beg here to refer to what was
said at that point (see pages 12, 13), because we are convinced, from
careful observation and reflection, that there existed no special condi-
tions in the city, either at the Exhibition grounds or elsewhere,'whether
in the form of imperfect drainage, impure drinking-water, or any other
special local feature, which were calculated to induce sickness.  We sickness
have endeavored to show that, on the contrary, the great proportion citcumsuncTs
of sickness which did occur among the visitors to the Exhibition was under which
 ,     ,           ,    .               -....,.        , Exhibition
dependent upon the  circumstances of their visit,  such as long and was visited.
hurried journeys, excessive fatigue while at the grounds, indiscretions
in eating and drinking, etc.
   Not only indeed did large numbers of persons arrive in the city
thus predisposed to contract sickness from any cause, but we became
acquainted  with the  fact that in  many  cases  sickness was  actually
contracted and had even developed itself before their arrival here. It
is of course impossible to estimate the  number of such cases, but from
our personal knowledge of several deaths and of not a few cases of
serious sickness, occurring in this  manner, we  infer that the total
must have been large.  Indeed, when we consider the full force of
these influences, and the vast numbers upon whom they operated, it
appears remarkable that the mortality statistics were not more seriously
affected than  they were.   Thus, we find that out of 10,294 deaths in
Philadelphia from  all causes during the six months from May 10 to
November 10, only 1333, or 11.8 per cent., were from diarrhoeal affec-
tions.   Of  this number no less than 1232  deaths occurred  among
children under 5 years of age, leaving only 101 deaths from all diar-
rhoeal  affections during the entire Exhibition period among  adults
and children above 5  years of age.
   In comparing this with the mortality from the same causes during No excessive
the corresponding period of previous years, it is found that it is even diarrhoea in
below the average. Thus, while during the hot months of 1876, from the city.
May to November inclusive, the mortality from diarrhoeal affections
among children under 5 years of age was  1.38 per  1000 of the total
living population, during the 7 years from 1862 to  1868 inclusive the
rate was 1.78 per IOOO.  In regard to  diarrhoeal  affections occurring
among adults, the record of 1876  shows no less  favorable results in
comparison  with previous years.  To show how entirely these dis-
eases were under the influence of high temperature, we refer to Chart 
22
INTERNATIONAL  EXHIBITION, 1876.
Bureau of
Medical
Service.

Marked
influence of
heat on
mortality from
diarrhoea.
No. 3.  By following the yellow line it will be seen that, after the tem-
perature had  continued above 700 for a  short time, the  mortality
from  diarrhoeal affections began to increase;  and that, from the close
of June, when the mean weekly temperature reached 8o°, it continued
to increase with frightful rapidity for 3 weeks, when a decrease in tem-
perature was accompanied by a fall in  the mortality; and finally that,
during the last week of July and the first week of August,  when the
mean temperature was 710 and 700, this fall continued at a rapid rate.
A rise in weekly temperature to 780 and y6°, during  the  middle of
August, was accompanied with a moderate rise in the mortality from
diarrhoeal affections, quickly followed, however, by a  still  more de-
cided and  persistent fall, so that after the  first  of  September  the
number of deaths from that cause was comparatively small.  It  has
already been shown that scarcely any  part of this mortality was con-
nected with the  influx of visitors to the  city; and this  is  further
proved by the fact  that from the very time, September I, when  the
mortality  rapidly and  finally fell,  the  attendance  at  the Exhibition
grounds rapidly and steadily rose.   The number of cases of diarrhoeal
affections treated  at the Medical Department, and due exclusively to
such  causes as indiscretions in eating and drinking,  followed with
considerable closeness the fluctuations in  the weekly attendance at
the Exhibition.   As corroborating the truth  of what has  more than
once been stated  with regard to the sanitary advantages of  Philadel-
phia we ask attention to the following  table, which shows the relative
mortality from diarrhoeal affections during  1876  in Philadelphia and
some  other large  American  cities:
Mortality from
diarrhoea in
large cities.
1876.	Philadelphia.	New York.	Brooklyn.	Baltimore.	Chicago.
	825,594 1,417 i.66	1,054,000 3,732 3-5o	506,233 1,542 3-°4	355,ooo 866 2.44	420,000 954 2.28
Mortality from diarrhoeal affections. Death-rate from diarrhoeal affections					
					
Mortality from   Next to diarrhoeal affections, which caused a mortality of 1333 out
typhoid fever,  of 2485 deaths from all zymotic diseases during the Exhibition period,
          typhoid fever was more fatal than any other disease of this class. No
          less than  450 deaths are recorded  as having occurred during the six
          months from  this affection; and  taking the entire  year 1876, the
          total number of deaths from this cause was 761.
            We have already expressed our belief that in a not inconsiderable
          portion of these  cases,  inflammatory  diarrhoeas of  a typhoid type
          were reported as cases of  true typhoid  fever.   But this does  not in- 
REPORT  OF THE  DIRECTOR-GENERAL.
23
terfere with  the fact that during the entire  year 1876  there was a Bureau of
                                                                    Medical
much larger amount of typhoid fever  in this city than is usual.   In
order to clearly show this it is only necessary to  give the following
table of the annual mortality from typhoid fever for the past  16 years,
with the annual death-rate per 1000 living:
Service.
Year...........................
Population in  thou-
 sands........................
Total  mortality from
 typhoid fever.............
Annual death-rate per
 1000 living.................
1863[1864
565

773
1.36
1865 1866
1867
1870
674
409
.60
1872
1873 1874
1876

825
760

.91
Excessive
mortality from
typhoid fever
in 1876.
   During the Exhibition period the population may be estimated at
900,000, and this, with  a  mortality during  those  six months of 450
from typhoid fever, gives a rate of annual mortality from this  cause
of 1  per  1000.   It  will be seen, on  examining this table, that  the
annual death-rate per 1000 from typhoid fever during last year was
exceeded during the  years 1862, 1864, and  1865, white  it was very
closely approached  in 1863.  In considering the causes which led to
the  high  rate of mortality from this  disease during the  latter years,
it will be  found that it was connected with the large number of sol-
diers who were quartered  in and around the city.   So, too, in con-
sidering the sudden  increase in typhoid fever that occurred during the
year 1876, the most important cause which suggests itself is the enor-
mous influx of unacclimated visitors during the Exhibition period.  It
has  long  been known, in connection with typhoid fever, that none are
so likely  to be attacked as the residents of small towns or rural dis-
tricts, when visiting large  cities to whose climate  and conditions of
life they are unaccustomed.  This is undoubtedly because such persons
are much more susceptible than the permanent residents to the causes
of typhoid  fever, even though existing only in the moderate degree
which is  too often found  in large cities.  The truth of this  may  be
realized from the fact  that during the  Exhibition period  in 1876 the
number of deaths from typhoid fever was 450, as contrasted with 207
deaths from this cause during  the corresponding period of 1875.
  That this increase was due to the vast influx of  unacclimated visi-
tors, and  not to any special prevalence of the causes of typhoid fever
during that period, may be inferred from the fact that in those hospi-
tals which received almost exclusively patients from among the poorer
classes resident  in the  city, the number of cases of typhoid and typho-
malarial fevers treated  between May 1 and November 15, 1875, was 49,
while during the corresponding months of 1876 the number was only
This excess
due to influx of
unacclimated
visitors.
Cases of fever
treated at
hospitals. 
24
INTERNATIONAL  EXHIBITION, 1876.
Bureau of
Medical
Service.
Ratio of deaths
from typhoid
fever to
number of
visitors.
28.  On the other hand, in those  hospitals which  receive  patients
chiefly of a better class, and to which, consequently, strangers who
may be taken sick while on  a visit to the city are frequently admitted,
the number of cases of typhoid and typho-malarial fevers treated during
the Exhibition period of 1876 was about double that treated during
the corresponding period of 1875.
   Still more convincing evidence in favor of this view is to be found
in an examination of the relation borne by the number of deaths from
typhoid fever to the number  of visitors to the Exhibition grounds. (See
Chart No. 4.)  It will be seen by the course of the solid blue line, in-
dicating the mortality from  typhoid fever, that there was no  marked
increase beyond the ordinary mortality from this affection from May I
to the last week of July, during  which  time the number  of visitors in
attendance at the Exhibition was low, as is  shown by following  the
dotted  black line  which indicates the weekly attendance. (See  also
tabulated statement at foot of page.)
   During this time, also, the number of strangers arriving in  the city
was especially small, the attendance at the Exhibition  being chiefly of
		Mortality from		
Table showing Week ending		Typhoid Fever	Admission of Visitors	Attendance at the Centennial
ratio 0		in Philadelphia	to the Exhibition.	Hospital.
mortality May	13 •	7	235.251^	14
from typhoid «<	20	10	"5.236	19
fever to (< admissions	27 .	12	155.724	51
and attendance J	3 .	10	204,704^	62
at Hospital. "	10	10	233,406	69
"	17	12	216,536	117
"	24	12	232,535	159
July	1	10	2IO,Io8	204
"	8 .	9	315.853	30I
"	15 •	10	174,792 %.	3°i
"	22	13	166,744	252
"	29 .	18	185,464^	259
August	5 • -	22	196,277	205
"	12	23	210,075	282
"	19 .	26	241,078	276
U	26	3*	347,082	334
Septembei	2	29	321,997	348
u	9	24	446,032	347
a	16	12	495,694	359
tt	23 •	3i	624,372	359
"	30 .	15	758,160	349
October	7	29	551,669	398
n	'4	21	584,011	3°7
"	21	10	700,600	322
a	28 .	13	641,021	336
Novembei	4	15	628,348	322
a	10	16	596,102	211
 
REPORT OF THE DIRECTOR-GENERAL.
25
the residents of Philadelphia.  The large number of visitors attracted to Bureau of
the city by the ceremonies of the 4th of July, remained for so brief a Se*vjc*
time that they exerted no influence upon'the mortality from this cause.
After the week ending July 29, a steady rise in the weekly attendance
occurred, which continued to  progressively increase, with occasional
fluctuations due to  special  causes, until the close of the  Exhibition. Ratio of
With this there was noticed a rise in the weekly mortality from typhoid mortality
-                                                                  from typhoid
lever, which continued until  the  weeks ending August 26 and  Sep-feverand
tember 2,  when, with a  weekly attendance of 347,082 and  321,997 adraissions-
respectively, the mortality from typhoid fever was 31 and 29.  After
the latter date, although there is a still further marked increase in the
weekly attendance at the grounds, the deaths from fever never exceeded
the figures  above given; but, on  the contrary, after October  10 there
was a  very marked  reduction  in  the weekly mortality from this
cause.  The marked  effect of the intense heat  upon  the mortality
from diarrhoeal affections, not only in Philadelphia but elsewhere, has
already been shown (see pages 21, 22); and it is interesting to observe
that no  similar effect was produced  upon the mortality  from febrile
diseases.
   The  amount of  typhoid  fever in  neighboring cities  during the No excess of
Exhibition period was not more than usual during the correspond- ^phoidfeveT
ing months of other years, and this fact is interesting when  we bear in other cities.
in  mind the statements  which were widely circulated at the time,
that very numerous cases of  typhoid fever occurred  among  persons
who  had returned  home from their visit to  the Exhibition.   It is
difficult to conceive how this could have been so to any extent with-
out influencing perceptibly the mortality from the febrile affections
during that period.  It may therefore be stated, in conclusion, that Conclusions as
                                                                   to prevalence
during the six months of 1876, from  May 10  to  November 10, there of typhoid
occurred  in Philadelphia an unusual number of deaths  from  typhoid fever'
fever; that this excess over the  usual mortality amounted  to about
200 deaths; that the occurrence of this unusual mortality from typhoid
fever was not due to the  existence of any special cause of that disease
in connection with the Exhibition, or to the prevalence  in an  unusual
degree throughout the city at large of its ordinary causes; but that it
was due to the enormous influx of unacclimated visitors, who  were
rendered additionally liable to the action of morbid influences  of every
kind by their mode of life while in this city.
   Having thus spoken of the statistics of typhoid fever during 1876, Definition of
both  in this city and elsewhere, a few words only upon  its character ^ho'-maiariai
are called for in this report.  It will have  been observed  that the fever-
terms typhoid and typho-malarial fever have been used.  The first of 
26
INTERNATIONAL  EXHIBITION, 1876.
Bureau of
Medical
Service.

Definition of
terms.
Characters of
typhoid fever
of 1876.
Ratio of
mortality.
these is employed, as is well known, to designate a specific febrile affec-
tion, characterized by a peculiar form of ulceration of the intestines,
and caused, so  far as is  yet known, by the emanations from decom-
posing animal  matter, and especially by those from  the  evacuations
of patients having this same disease.  The term typho-malarial fever
has been introduced of late years to designate a disease in which it is
believed the specific poison of typhoid fever exists, complicated with
malarial poison.  Medical opinion is  still somewhat  divided with re-
gard to the latter affection, although it is generally acknowledged that
such a disease,  due  to the combined  action of the two poisons, does
actually exist.   It  seems probable,  however, that the term typho-
malarial fever has often been used inaccurately, so as  to include cases
of irregular typhoid fever, and probably  also cases  of simple  intes-
tinal catarrh with marked typhoid prostration  and  irregular febrile
action.
  We believe that the typhoid fever which occurred during 1876 was
not much  modified, at least  here and  in neighboring localities, by
the admixture  of a malarial  element.    This  opinion is  based not
only on the characters of the  disease as it  came under  our notice,
but also  on the small amount of malarial  fever of any form which
occurred here during that season.  It is true that, in a considerable
number of instances, the cases were termed typho-malarial fever in the
returns to the Board of Health, but we are convinced that the large
majority  of such cases were either uncomplicated typhoid  fever of ir-
regular or abortive type, or else catarrhal diarrhoea with marked typhoid
prostration of system.  Indeed, we have more than once expressed our
belief that a considerable proportion of the deaths recorded as from
typhoid fever were in reality due to this latter condition. The typhoid
fever itself was very irregular.   In many  cases it ran a much shorter
course than in the  usual typical  form, not exceeding 15 to 18 days.
Another  marked peculiarity was  the frequent occurrence  of hemor-
rhage  from the bowels,  which took place in a larger  proportion of
cases than usual.
  It is, of course, difficult to estimate the ratio of mortality of  a dis-
ease occurring under such circumstances, but from  the  data in our
possession it may be  stated as about  18 per cent.  As an  illustration
of the extent to which typhoid fever is influenced both in its degree
of prevalence as well as  in its mortality by epidemic  causes, which it
is difficult to appreciate, it may be stated that in Paris (where the mor-
tality during the previous three years was as follows: in  1873, 1007;
in 1874,  846; in 1875, 1001) the number of deaths from  this disease
during the year 1876 amounted to 2073, and so  severe was  the type 
REPORT OF THE  DIRECTOR-GENERAL.
27
that the  rate of mortality rose as high as 35  per cent, of all  cases Bureau of
treated.                                                                 *IecHcal
                                                                        Service.
   We have entered thus at length into the discussion of the typhoid
fever of 1876 on account of the large amount of public interest which
this disease attracted during the Exhibition period.   In summing up
our remarks upon the  sanitary condition of Philadelphia during this
interesting time, it will be  seen that the general results do not differ Circular No. 3,
materially  from those  stated in our circular issued  in the latter part September.
of September.   (See Exhibit A, Circular No. 3.)
   At  that  time the data in our possession did not enable us to dis-
tinguish  between the  different  classes  of diseases  with  as much
accuracy as we have done in the following table, which embraces the
entire Exhibition  period:
London.......
Philadelphia
Baltimore....
Chicago......
Boston........
Brooklyn___
Paris...........
New York...
Berlin.........
3489
 900
 35o
 420
 342
 506
1851
1054
37,592
10,294
 4,020
 4,927
 4,144
 6,453
23,735
I5.492
16,407
«8
0 8
21.54
22.77
22.97
23.46
24-33
25-49
25.63
29.40
33-S6
J 5
< g#

O  <r,
S J <
6905
2485
1524
2277
1422
2583
5884
< >
2SN
QC5
3 & 2
z a S
z b<
<
 3-99
 5-5
 9.2
10.8
 8-3
£2
o c
606
450
 53
1122
 168
 393
S S «
h o >
< X «
QoQ
z °<
<
>• J
h <
S^
3M9
1333
 652
 918
 772
1485
3527
< <
as
o*|
5 os a
z a a
3-72
4 37
4-5
5.86
6.69
Results
brought up
to close of
Exhibition.
   It will be seen from this that of the nine large cities from which we Favorable
have been able to secure returns, Philadelphia was second to London poTidol of
alone in point of average total  mortality.  It will also  be seen  that Philadelphia
while  the annual death-rate  from  typhoid fever per 1000  living  in
Philadelphia was higher than in any other of these cities excepting
Paris, the annual death-rate per  1000 from all zymotic diseases, which
include diarrhoeal affections, continued and eruptive fevers, etc., was
relatively smaller  in this city than  in any other save London.  This
result is chiefly  due to the  relatively  small mortality from diarrhoeal
affections, which gave an annual death-rate per 1000 of only 2.96,  as
contrasted with  6.69 in New York,  or 5.86 in Brooklyn.
   If we have been  correct in our  conclusions previously stated (see
pages  14, 25), it  may therefore be confidently asserted  that  Phila-

  * By zymotic diseases are to be understood all diarrhoeal affections; eruptive fevers, such
as smallpox, measles, scarlatina, etc.; typhoid and malarial fevers; diphtheria, etc. 
28
INTERNATIONAL  EXHIBITION 1876.
Bureau of    delphia  has  again vindicated her claim  to be regarded  as  the  most
Service      healthy  city in the world, with a population of over 500,000, with the
          single exception of London.
            Some of the causes of this are stated in the circulars alluded to (see
          Exhibit  A), and it is owing to the nature of these causes that the un-
          precedented risks of a sanitary nature connected with so vast an influx
          of strangers to the city were met with such signal success.

Acknowiedg-    It is proper to state that in the establishment of the Hospital a full
          supply of medicines was presented, with great liberality, by the follow-
          ing  well-known  firms: Messrs. Powers & Weightman, Rosengarten
          & Sons, Hance, Brothers, & White, and  Bullock & Crenshaw, all  of
          Philadelphia. 
BUREAU  OF MEDICAL SERVICE-EXHIBIT  A.
                           OFFICIAL  CIRCULARS.

          UNITED  STATES  CENTENNIAL COMMISSION.

                  INTERNATIONAL EXHIBITION,  1876,
                                                                               Bureau of
                               PHILADELPHIA.                               ^edical
                                                                               Service.

                    BUREAU OF MEDICAL  SERVICE.

                                CIRCULAR NO. I.
  Owing to the very large number of persons who contemplate a visit to Philadelphia Circular No. 1.
during the coming summer, it seems important that the utmost publicity should be given
to all facts bearing on the sanitary condition of the city.
  The following statistics, which  have been obtained from the  most authentic sources ac-
cessible, represent the mortality in some  of the  chief cities of  the world during the past
four or five years:
	Number of Years.	Average Population.	Average Total Mortality.	Average Dbath-Rate PER IOOO.
	5 5 4 5 4 5	648,560 994,458 950,000 3,284,488 1,851,792 744,831	20,424 29,601 28,420 76,741 42,724 16,573	31.42 29.93 29.91 23-33 23.00 22.27
				
Berlin....................				
				
				
Philadeplhia..........				
				
  While thus showing an average rate of mortality more favorable than that found in any
other city containing over 500,000 inhabitants, Philadelphia has recently (1874) attained
a degree of healthfulness almost unparalleled, viz.: with a population at that time of 775,000,
the number  of deaths was  but 14,966, giving a death-rate  of only 19.3  per  thousand.
These very favorable results are largely due to the abundant and cheap water supply, and
to the opportunities given, even to the poorest citizen, for the enjoyment of pure country
air in the great Fairmount  Park, which  contains 2991 acres.  The extent to which this
is valued by  the citizens may be inferred from the fact that during the year 1875  the Park
was visited by over eleven million persons.
  The  most  powerful influence of all, however,  is  the absence of that overcrowding of
the population, which is the most fruitful  source of  sickness and death in  many quarters
of nearly all other large cities.  This will be  more clearly comprehended when it is
remembered  that the 817,488 inhabitants of Philadelphia are spread over an area of 129^
square miles, which are traversed by more than one thousand miles of streets and roads;
and that the  city contains, in addition to other kinds of buildings, 143,000 dwelling-houses
occupied  by families, — a number exceeding  by  over 40,000 that  of  any  other city in
America.
  The climate of Philadelphia is also, on the whole, a favorable one, although presenting
many of the peculiarities common to inland localities.  The mean annual temperature of
the  last ten  years is 53.730 Fahrenheit;  the average annual rain-fall is about forty-five
inches.
                                                                      29 
30
INTERNATIONAL  EXHIBITION, 1876.
Bureau of
Medical
Service.
Circular No. 1.
Circular No. 2.
. 32.720 F.	July . . .	• 78-74° F.
. 33.12 "	August	• 75-92 "
• 39-io «	September	. 67.72 "
• 53-36 "	October .	• 56-°3 "
• 63.24 "	November	• 43-34 "
• 73-54 "	December	. 33.92 "
  The following table exhibits the mean temperature of each month for the past ten years,
showing that the  range is far  less extreme than  is found in many other  less favorably-
situated localities:

 MEAN TEMPERATURE  (FAHRENHEIT) OF  EACH  MONTH  DURING  THE PAST TEN' YEARS.
January  .
February .
March
April
May
June

  It is thus seen that only during the months of June, July, and August does the mean
temperature rise to a high point.  During this period there are very rarely any prevailing
epidemic diseases; and the  chief mortality occurs among children, especially among the
poorer classes.
  The health of Philadelphia at present is unusually good.  Timely efforts have been made
to secure an abundant water supply to meet the great  increase in  the demand which must
be  expected this  summer, as compared with previous years.  Constant watchfulness will
be  exercised by the authorities to  maintain cleanliness, and to avoid  or remove every
possible cause of  disease.
  Within the Exhibition grounds a rigid sanitary  inspection will be maintained, under the
control of the Bureau of Medical Service; and thus a guarantee will  be afforded that no
cause of infection or disease will be allowed to occur through neglect  of this important
duty.
  The object of this circular has been to call attention to the unusual sanitary advantages
of  Philadelphia, and to the preparations which have been made to insure the highest pos-
sible  degree of healthfulness during the  approaching Exhibition  season.  It is proposed
to issue at certain intervals other circulars, announcing in an official and  accurate manner
the sanitary condition of the city, so that entire security may be felt by  all who desire to
visit the Centennial International Exhibition.
                                    WILLIAM  PEPPER, M.D., Medical  Director.
  15th April, 1876.

                                  CIRCULAR NO. 2.
                  rPOSTER  USED IN  THE BUILDINGS AND GROUNDS.]
                    THE BUREAU OF MEDICAL SERVICE
has been organized for the purpose of rendering immediate gratuitous aid in  all cases of
sudden illness or injury occurring to visitors and others within the Exhibition grounds.
  The Medical Director has  secured the services of a  staff of six well-known and  able
physicians, who will be on duty from 9 a.m. to 6 p.m., at the Hospital building, which is
centrally situated in Landsdowne Ravirte, in the  rear of  the Judges' Hall,  and is comfort-
ably and suitably arranged for temporary relief and comfort of all in need.
    In connection with the Hospital service, stretchers are placed  at many points, by which
such cases may be immediately carried to  the Hospital, and an ambulance by which, when
necessary, they can be removed to their residences.   Any person needing medical aid may
apply to the Guard, who are instructed to  assist them to the Hospital without delay.
    The Hospital may be recognized by its flags,  one being the United States  flag, having
the words Centennial Medical Department printed across the centre;  the other, a white
flag,  with  a large red  Geneva cross in  the centre.   The officers  will  be recognized by
the badge,  a white shield, with red Geneva cross, above which  is a blue enameled bar,
surmounted by the American eagle.
    May 10,1876.                      WILLIAM PEPPER, M.D.,  Medical Director. 
REPORT OF  THE DIRECTOR-GENERAL.
31
                                  CIRCULAR  NO. 3.                                    Bureau of
                       BUREAU  OF  MEDICAL  SERVICE.                        Medical
                                                                                      Service.
   In a former circular issued from this Department, the exceptionally favorable  position circular No. 3.
which is occupied by Philadelphia, in comparison with the other great cities of the world
[i.e., cities containing over 500,000 inhabitants), in regard to its sanitary advantages and
average  rate of mortality, was  shown by carefully-prepared statistics.   In  anticipation  of
the unusually large number of visitors who would undoubtedly be present in the city during
the continuance of the International  Exhibition, great efforts were made by the municipal
authorities, as well as by those in charge of the Exhibition grounds, to obviate every cause
of disease.   The details of these arrangements will be published in the official  reports of
the various departments, which will appear after the close of the Exhibition.
    It is owing to their thoroughness that, despite the very severe and prolonged heat of
June and July, and the vast number of unacclimated strangers constantly present in Phila-
delphia since the 10th of May, the general health of the city has been remarkably favor-
able.  With the exception of the four weeks ending July 22, the range of temperature  for
the past five months  has been about the average.  Thus, for the entire period of twenty
weeks since May 10, the mean daily temperature has been 71.300 Fah., while the average for
the same months during the past ten years has been 71.820 Fah.  The mean temperature of
the  four weeks referred to (ending July 22), on the other hand, was 8o°, 830, 830, and 8i°
respectively, giving an average for the month of 81.750 against 75.50 Fah., the mean temper-
ature of the corresponding period of  the previous year.
   The  following table, showing the  relative mortality of  Philadelphia and some of the
larger American and  European cities, has been prepared with strict care from the official
records.  The periods selected for comparison correspond as closely  as possible.  It will
be seen, on careful examination, that the past season has not been an unfavorable one :
			x a j	x .},	« Ml		" S	
	Z	z	"• x e	B.Q	g S		p. g	
	<	" a * <	~^H X			< * 5 x		5*
	3	go		2 2		" a < 0	«i2	*3
CITIES.	0 Ph Q	^ z h < 0 „	* s * is		x < 2 0	EAT II -ING W Fever FFECTl		Hi
	< S	7 S	■< 0	X m n. 0 < M m		" * a< J a S J < 1 <	<"5	j a <
	w	£°	AVER Wei-Fevi Aff			§8 i3		*8d 3S<
	3,254,260	26 weeks, including the	105.5	291	1467.4	1.66	4.62	23.40
		quarters ending June 19						
		and Sept. 26, 1875.						
Philadelphia..	900,000	20 weeks, from week ending May 13 to week ending Sept. 23, 1876.	83.8	112	406.5	4.84	6.47	23.48
	420,000	18 weeks, from week ending May 13 to week ending Sept. 9. 1876.	52	80	196	6.44	9-9	24.27
	342,000		36-7		161	5-56	8-73	24.48
		May 13 to week ending						
		Sept. 9, 1876.						
	360,000	19 weeks, from week end-ing May 13 to week ending Sept. 16, 1876.	48-9	58.1	172.36	6.91	8-37	24.80
	1,851,792	26 weeks, including the quarters ending June 25	64		896	1.76		25.16
								
		and Sept. 24, 1875.						
	506,223	20 weeks, from week ending May 13 to week ending Sept. 23, 1876.	75-7	"5	262	7-74	11.81	26.91
	1,064,236	iq weeks, from week ending May 13 to week ending	'74-9	262	629.7	8.52	12.79	30-73
								
		Sept. 16, 1876.						
Berlin...........	950,000				626	10.92		34-32
		quarters ending June 30						
		and Sept. 30, 1873.						
 
32
INTERNA T10NAL  EXHIBITION, 1876.
Bureau of         It will be further observed that, as in the table published in the former circular, Phila-
Medical      delphia occupies an exceptionally favorable position.   With the exception of London,
Service.      whose rate of  mortality is nearly identical, Philadelphia presents a considerably lower rate
 ireu ar  o. 3. tkan anv o^g,- 0f the great cities, while in comparison with its nearest neighbors, New York
            and Brooklyn, its superiority is both striking and suggestive.
                In calculating the rate of mortality in Philadelphia during  the past twenty weeks, the
            population has been estimated  at 900,000.   Those who have carefully studied the  move-
            ment of its  population think, however, that in consequence of  the large influx of visitors,
            this estimate is  below rather .than  above the mean daily population.   It must further be
            borne in mind that, while a considerable portion of its more favored classes were as usual
            absent from Philadelphia during the summer months, the lower classes, among whom the
            mortality is always greater at this season of the year, were largely reinforced.  If in addi-
            tion to this it is considered that a comparatively large amount of sickness might have been
            expected among the vast throngs of unacclimated visitors reaching the city after  long  and
            hurried journeys, and exposed to excitement  and excessive fatigue, the full significance of
            the remarkable  table above given will, it is hoped, be appreciated by  all.   As one of the
            most  important factors in the maintenance of public health is the purity of the water supply,
            it is with great satisfaction that we learn from the official report furnished by Dr. Charles
            M. Cresson, the distinguished analytical chemist, that the purity of the water supplied from
            the Schuylkill  River to  the Exhibition grounds and the neighborhood is fully up  to the
            standard of the  past four years.
                As the summer months, during which time alone any fears could be entertained for the
            development of widespread disease, have passed with such  gratifying results,  it  is  not
            premature to express the feeling of thankfulness and congratulation that during this  im-
            portant year Philadelphia has been favored with the same  exceptionally low rate of mor-
            tality she has so long enjoyed.
                                                WILLIAM  PEPPER, M.D., Medical Director.
               September 26,  1876. 
 llfu.slrtttiiiff thrUnji/vPopulation. Rfynlnd upon theKrluhilion lUYiut/tly.theA'iiiu/iirii/YuArso/^uhv/ex^t/ir.i^                                                                      Weekuiuiwi/■ Rfjii/lenls
upon the f.rhthi/iii/i (irowitJs.nitfi the llreh/i• Mortnlitv from nil iii/is<y/u /hcfilriifP/it/ittf/p/iui ttrtt/ ]/rttmt>/opittil (^
																																																															
' Chart I -J!v -1 i:)lh\Wth\\'?fb.												III III' /At:/hi							y/o		/„/>■		AuquM /."//,/, y.'/i/,' i/ti r.'U,' n't/.										?m.		September										October 1 November														'				
									Jir/.\tlU						?//'//.		t.s	/■I			/.,	II:													Zmt\f)fh.				tai/i.		.'■Jill		niii/i.		il	1	/////		■fixi\-t/nh. ■ , ■				Hli 10th.										
				1 1				1 1 1 1 1										, ~						i ' i !				'1					■Hlf.												1								■ , ■				llcqrees FoJtreiilteit		o.oo ^\				
								1 | | 1 |																																					"															25 -			
																																												V 1													93'			SO -			
																																																									97"			76 -			
																I																																	-								'S°	/		OO -			
^i ■				1												. 1						i																																			9<t"	/		23 -			
													/																																												91°	/		SO -	^		
													■					'		\l																	—																					t		73 -			
																						\		r 1																																	87°	2		00 -		S-	
'"""			_-,.-----------														-											r					-																									2		23 -			
""																		-^																																								2		SO -	vv S		
txzoA 7-													, #							1				/\								L																									S1°	2		73 -			
tsoo J 7 ^°-— '\ '																								\ - / v,										"		-						s															79°	3		OO -	-S-		
<?*«_ ! <• ,•" N '										/ /																																															77°		■3	23 -			
i-r.,' i ^ '"''•'																												Y																														3		30-			
it iv [ 5 '■> <-■								^																							' \		~	__.	~-				L___		-.																7J°	3		73 -			
																/ \ '																																										4		00 -			
. ixsn. : % " '" _^_				1																																																											
																													\ /									i																			G9°	4		23 -			
																																																									97° V		4	30 -			
IK,:.. \ •'■•■' =			^	/		f										' l'~~'^ J s^~\																																											4	73 -			
; 16-to § J4° ~ ^				\						V				i .\ r... a_									A "										X ►—			y				■j ■"				1 V ' /													04 °	3					
1 IS2 0	^ 320 -											* '. . ^ /. 7~.																																t\ r													01 °						
ISOO	^ soo —	i^ too -								\ / ^																																															19 °						
	S~ 4l.fl -	% s«								k\ /,											,«-																																				S7°	—	30.25 m.\				
		~r-				/-																																																									
	^ .,-,0 - v^>- ** s			A		'															/ \				=?**=^																																	3IJ00				"' "3....."	
				/											-N													**											_j\																						-		
_ 4_3oo_	& -">«-	x-'"-															r K		\ i								~~.																														49°						
		h ,-,,	~										•^						w										"^-•^													<;—'	"" ~~												\		47°		2.9				
	iy. '«» -	-^ --j -	3:	_3,																			y								"■•-.																	~~-			*				^		43 °						
1 440	5~ 340 —	^ «* -	<r		\								/,										\								--		^Li^,																	-v							43"						---
	s.- *« -	.y "'j	%		\																				\			-	—																						"}J								( a3				
'•■ noo	^ *»» -	s^ ">- 1			V.		"^.						•—		-										y.								i														i ^					*"^i 30°						!_...._	29			5	
		I* «- Ml																											.«•**		" '.																										S7°			"~		S	
	3 *«« -	£s " - K-A																									V																														S3"					??■	
	& '*o-	>§» /--	(^	—							,'																						t----								--													\				29. 01) „				i	
	Sj- 2JO -	§~ j<																													~																										y						
	ZOO _	r- to -	S																																												/•										Jletirees of Humidity						
y mo -		3G -	=r				.-																										\								/^.																Stiiuralwn. 100 -		2S.73 „				
7KO -		32	|				/																																								-.										y						
HO -		28 -	fc-																												._.						.*..												,				A										- :
120 -		24	?■																																»■*										'4				\ •		, ■' ''•												
IOO -		zo -	«S	•—																											t																				/												
!	*« -	IK	s~																										m.																				' V.					-	-v-								
	«fl - , ,;																		..*.																		..-«-.																										
40 -		1 -	^	•^-													■ -•■				"••---		■-■*..				.-•-'						^ *		---•-						'"*"'						^						..-•-.										T_j
	JO -	4																																											'»-																		
	-i • , fc			---			-—--				'-""																																						~~«—		—i"'												
Total Weeklv Rain Fall.				ITSin	Jtfin.		/«Tm		.3.5in		.52 in		.SSOi		.Win		63in.		.03 in		I.SSin		1.16 in		.ZSin		■l.Xu		.OOin.		.elin		.^2in		.jrin		.59m		l.3hn		4.90in		/««in,		J(7in		.OOin		.Kin.		.61 in.		.Ztin		l.49in								«J
Number of clear days.				1	.}		4		.1		.}		1		S		.1		4		2		.7		Z		0		2		z		2		/		2		1		0		2		J		4		4		1		5		z								
Number of cloudy days.				6	4		J		4		Z		6		::		2		3		.5		4		•5		y		.!		J		■5		ff		5		6		7		J		,f		.1		3		6		i		5								
Number of days with East wind.				1	■1		1		i		1		I		0		0		t		3		I		/		6		4		s		.'(		0		?,		s		-J		2		/		1		3		4		3		4								
Number of days with.West, wind!				6	4		6		.5		6		.3		r		7		6		4		3		6		1		3		z		/		7		■'		2		Z		•>"		«		6		4		3		4		Z								
Mean Thermometer WeeWv.				6Z°	SI'		64"		07'		71'		n.		rz-		SI"		m-		/a-		w		71"		W		-g"		76°				73'		07°		03°		or		.M"		«•		50"		43°		50°		53°		46'								
:[ Mean Barometer Weekly.				29.93	.10.20		■10.04		Z9.W		10.04		.10.14		X)!)4		2.9.00		2H.91		i»90		311.0.1		30111		30.0S		30.14		SOM		W.0-#		■ami		30. OZ		30.07		w.yr		?A«?		:';/»/		30 OH		30.04		29. OS		30.0t		30.01								
Weekly MurlnlUv from. aJl (auses in f'liUadftpluti
January /S7F.
_____, Wff/clyAuni/ii'/o/'/'erson.y•ir.ir.ditu/ upon flit Krfti/iifimt ft row ids.
........ WcMvrtut'So/'Si/hie.w>rmwtitf/uiw(fiit.iitp^^                (hounds.
       KrA/y (axr.sat?liiarrfurrtluiiorii) A'esulr/tf.Yuf/on.thr ELrlubituiit (nounfl.v.
     ^ WaMy Ca.sr.s-ofDefii.ljIviiiiuiiii/ Ke.sutriil.fiif/on thr KvAit/itiDii Grounds.
    HrMvavmuje Maximum arid Mwwuuu 'lini/Hiv/ntr.

-^Meau Ith'AtvHumidity-Poutl of Saturation, f(70.

—•  Menu Weekly Thermometer.
—x  Mean H'rrfdr Reading of 'Barometer.
fliekiy F/iin Fail in ituJies 
 
 Wnytw/iiN/ the Hedh. -/(///t/.wion.v to flic (irtfrrtttin/ /tt/emtttwiiei/ /u/iihiiftiti. the. Xumher of Patients ttea tee/ at t/ie llos/ttttt/ o/'f/te Btttr/ttt ofJ/ee/ieu/ ■ Serine, tfie NuniierofPatitnis
ttm/ed'/or£iJiaMtion.,/tttdE/Ieiisofl/itrfj/ieXitftifMro/Ihtieidsfivatee/fbrtSafi At/nh,^th the tota/ /fet'h'/y .//otfet/t/y /tottta// ^                                                        Sun Stroke
in f/ttli/ef/t/dt/a a/ief . ileteeitvtiupi				at	t/t	mrrti		///	on	s ton		'tie	,Wlt<		'/	it-ton		■/	Iff	fit.	*//M	' t	<V	t/r	*	/ '	■V.	\ ri/ttai			' L	If/	ire																											
| Chart II			May									In lie >/iTt,~			Uth.		July .hli/i'-l																	.('nil.		.01	September						III.	//	October						III.	Nervember				~........."" 1				
			t.Jth.		20th\ ?/!//.				:int\tc					>h\			/.v/7] sue				l.ilii.	i'^'/ai		29Ui\ .HO				r.J	ill ■■ inn.			'.'01 ti.					/>.	fGth,		H3rd\3ii					h\t40i			?tst:		r,s		■Ht,.		tilth.						
■ ,.				1				'IN |																1								I I				1			-		j			■ _ ..				m		Ii'						OeiireesFtihrcnJwil. o.oo y				
																											1 ";■																	1		--									'	IOI°\	.25 -			
																																																									.SO -.73 -	—		
																																																												
												... .. ._																																												93°	too -			
----i"l K																																																								03"	1.2S -1.30 -	5; - " "		
										-																	i																													oi"				
__________-»•».] *												-												- ;																																80°	1.73			
																						_. __																												-						97°	2.O0			
~N - r«a		5;																																																							2.23 -			
- noJmo 1 ~r7~io~									--						__.					I\																												--									2.SO ^			
																				/I						/\l			\																		-											3'		
■ - loo.ooo	;f". - 700		"" "t"																~		\																														-■						3.00 ~			
- 7SO.OOO	~. - OHO	--&-							i				_l		-										■ ! / V /						\									y	V											-		~		77°	3- ZS -	_jL		
- 760.000 ^ - 660		|																																				r"			\															73'	■?.,50 -			
| - UO.OOO	^ - 640	S	T 1																	"	\						/i\											1																			3.75 -			
1 — 720.000	~ - 620	4-															m																					/				\~^								^—				~		71°	4.00 -			
-^li^l^iE"		__£..		1																—																						' \						!*•					-			69°	4.25 -			
										/;											■>A'						! \														/							I* \								67° V ■,S°-				
				/f									,		\ •													i\													;	\						l'		\						63" ( 1-73-				
-------eio^otTo^	^- — 540	fc	-	^				S^s				/,		\																											r"					i				■«..						63 '	3.O0 -j			
	■^ - 320	£																		/ V Ii																								5_f \		/										01°				
- eon.oon	>• - soo	1"	-							\										/ \ J I																								\		xJ								"--.		39"				
;___~-°—-	5 — 411) ^ - 460	-4>		-\»						I \ ./.										7-	t\! ui : i-																	I						T		3	L									37°	— 30.2S in.\			
		^r																																										^J .'																
- HO.OOV	- ^ ««v^j																																					—\l							>	:;:	!						\			33°	30.00 .			
j - 120000		f~tr																		—			A *~-^								: p*^					\ l >																				________SI. ' .				
1 - 300.000																	--					" -		—					1							• \ jf													1											
- 4SO.OOO ^ Z. ~ 3*0 - 160.000 [ ^ ~ 360		8''																											—	—[V,						--Y-- i [.-															\						i-.'/Z-.r „			
		<*b																																																						43 '				
- 4IO.OOO 5 ~ .74 0																					■-—			-					-	»■				"~		"f 1								'*-.			•_.,		--* .							4.1"	29. SO \ -^			— 1
- 420 IMO	^ - J Z V																																			/•"^																^__.				4 1"	( 5			
- 4IIO.OOO		"5s																	?—		•-•.,																									—»-^->j										.19°			<3	
- .1*0.000	i" - 2*0	_^									■											'-.														1										-"'' '4-'										37 °	- 29.23 „		S	
.16- <«-0 _	> — 26 0																						»--	■--•«																																33°			^-	i
																								—:								r-.		,'															_' ! i											H
																	t.		*,							\ /						/		v-«																						y				
------IOO.OOO—	g" " 2*0 ^																/																																							lle/iirys ofBumidiiy				
	-v. - '*» ^																										__				.'																									■ SntiimHnn 100 23.73 „				
																	,		\																																						y			
- '--v^oiTo-													'•->				i									---		——■		.	i												-									—-								-■■ - ■■]
														%'■	--		.^ /																																											
																										_jr-		""																																
	-1 -::■ t _y:-- -											/												^,*--																																				
																																																												
140 000	?- - •»!>	^ y																	-			:^																																				----		-■ —
- I20.OO0	- 20	i ■-. **-			r—<	V									..-■■		-----							v				»....		--^---		...»—		■■--		■--•■—		■■'■—				—•—						-—..		■--•----		•■*"-		— .						
J ' "J			*								''-—				~~*—				—*—		—•—	■ ■				~" "		— -				'																												
Total WVcklv Rain Fall.			/..Zfira		J6in		l.97in		.35 in		.5Zin		.55 in		.48in		.B3in		.0.1 in		I.SSin	I.l6in		.Z5in		Z.5Zin		.OOin		.67in		.Kin		.37in		59,n		1.31 in		4.90in		IMin		..Witt		.OOin		./Sin		.61 in		.Itin.		1.49m						ii
Number of clear cj.ivs.			/		J		4		3		.5		1		5		■1		4		^	3		2		0		2		2		2		1		2		1		0		l		•>-		4		1		1		5		I						
Number <	>f cloudy davs.		e		4		3		4		2		Ii		Z		2		3		5	4		5		7		o		.;		5		(1		5		6		7		5		-'		3		3		0		Z		5						
' Number of i	avs with F.ast wind		i		3		1		Z		1		2		0		0		1		3	4		1		6		4		5		:s		0		3		5		5		2		;		1		3		4		3		4						
' Number of (lavs with We.'		t wind. ^			1			6	5		6		■3		7		7		e,		4	3		6		1		3		Z		1		7		4		2		1>		•'		0		6		4		3		4		2						
Mean Thermo muter W		•ekK «- 5 1 f						4°	67°		7Z°		72"		72°		31"		S3°		*3°	30°		71"		70°		~g°		76°		74°		73°		07°		63°		64°		58"		51"		50°		43"		SO'		53"		46"						
j_Mran Bar	under We,	jdy._	\l	.93	H	■ill	"	III	z'/'/y .w.04				30.14		20..'M		2!).HI/\ Villi				Z9.96	30.05		3001		30.08		30.14		SUM		30.04		13.96		30.02		30.07		29.77		19.93		VJ.'JI		30.08		30.04		29.95		30.07		30.01						
M7e.
JC      ,___
 Mieldv Mortidity fieitrt a/t (meiesin PhUt/delpttiei
 HerMy .Vo/4/ttity from Suti.t/iohe in Hie (ifyof/'/idndcf/diiei.
 Itiridy 'fidatof It/en/fana: at'.ffosptitdtit Krfubdion fitonnds.
Wrt&lyVitaloftii/iti.vaffretfd fy'/frsti'tmd KvJiaurfimiamoiiqlM^
Weehiy 'fatal fdfr.fof'Si/.nsl/r,Ai' rimom) ii.vilors treat/da Ithe Ifospitat.
... Ilirtdi ■siti-hiisvwmdotheteid/'imuil/raern/tfw
   HieJdyavmnje Maximum and tfiniitmiii Tanperature.    ■
-^ Mean H'eeklvMwnidUv.- Poinl of Safurafwn, tOO.    I fVeekly ha/li tirtlm indies.
— Mean Weekly Thermometer.
-* Man Weekly J&aeliruf of Barometer. 
 
/t/ie.simtuii/ me Weehk.l<!ini,sswii.sUothf                                       the. Yumherof'Patientstimietle,trh  tn-rkultlirJkspiMoftkBiimut-ofJIetlieatSenw^
Jh'ittrhiriif'Affe/ioiiseneh Hid. wi/i the Hee/iiJ/orter/tir from all (im.ies in the (itvofPhtfietelphui, the Weekly Mortality, front Diarrhiral JJe.sea.sesm Ph
PhiJ/nlfJphteiand Mrtromloi/i/id Ohsenrdions forms
some Perioi J furnished fw Hie I.			S.SifjnaliJffue																																						
Chart III			May			June				July							.Allans/ September														October			Novem.ber							j
			f.ith.	20th.„	7ft,.	;'irl.\fflff,.\		t;tt,\ -ftuA		t.st. 1 Sill.		r, to.		:':'m/.		■.'.'llll.	.ill,		t:'iti\ t/tit,.\ :'i;i/,.\ 4?/„/.\ niti.					ffjth		ZJtrt		■jOI/,\ fit,.			14th	2i.s-i. y.itti.		4th. 10th.							
■\__			1		m	II				I ' "						1			1 ■ 1 1									• a								DegreesFoJirenheit 0.00 ^\					
					1 1 1 1 1																				~~	-			\ 1				' : 1			101 ° \		23 -			
					1 ■ 1													-i i ' 1 ! i '																		99°		SO -			
																																				«7°		7S -			
																	-																			93°	1	OO -			
}. . _ y.'l'L		^v							_			i		-				! ! ! .														-—	1			93°	t	23 -	-!:-:~		-
					■ -																										--				--	91°	I	30 ■			
	- 300	*v				H												1										--								69°	1	73 -			
										--		1 \						, . ;													—	—				87"	2	00 -		-j- -	
N, - 760																						.														S3'	2	23 -			
~ 840.000 1 -7IO		-1' ■ - --			--				._..															...							..._..		" —	—	—-		2	so V^			
	I'—			---		--	- —	T\		L__	-"/										-	_	-													31'	2	7S -	3'		
- rooooo 1												—				\\ \																					K	OO -	5J-		
	** - 660																							-													3	23 -	i		
- 760.000		f																										,								73'	3	30 -	°°		
| - 140 OOO		s						\			.1			\					\ "1									. / '•								73 °	3	7-5 -			
- 720.000	& ~ *">	47					/--	M								T-				A	--	_.\			-			X '								7r°	4	OO -			
- 700.000	"^ -sol						/	1																				' >l'				ff				69"	4	23 -			
- 6KOOOO						7		f	\								— -										;					if \				67° \ 4		SO -			
- 66O.0O0						y			\												\						!					•	\			63° (		73 -			
, " 040.000	i 4>6	&							\												\												v___				3	OO -J			
				Vs^			VP		S^								.._				\					,» \				\ \											
					--	:-:-		-^*v																		/				'.	1 n				*•.»	39 '	^				
- S6OO0O																										'				',						37°	— 30.2S in..\				
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																								\												31 °					
- soo.000 -. - - 40O		?			—■—	.......																		.'												49°					
- 4JIO.OOO ^ - .ISO																																				47 •	- 29.73 «				
- 46O.0O0 i - 360 j .5; \																								.-♦■"		--♦--										43°					
- 410.000 ^ ^ 340		- ; \ - -\—																					..y.					""»								43°	29. SO .. V K				-
- 420 OOO	X -320	r ~ \			'																											<^~'		^i^-r--		4,°				f »	
- 400.000						—	—				»—-	■~«,											!							»—■				*\		19°				=5	
- 330.000 1 ;> - 260 ^								■-				\								—4													■ !■ \			37 °	- 29.23 „			3	
- 360.000	> - 260 5										1			'"v-		_,						/														33°				f?-	
— 340.000	3 - 240 ->-																				''	!															29	011 .,		^	
	~ - 220 5' - 206	4 •								/												"*rf													_ S	y					
-300.000										,.'		a\											--	^		--										fh-iirrrs of Huniidiiy				---	---
■ 2in.i)'>ii ' i mo									.	<	•/ V																								! Saturation 100 23.73 .,						
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- 240.000	§* '"'-'	.^ , ...		--																J. ■		-				— '				._._	—	--	»-..					—			
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- IOO.OOO	■ $; -'0	f										v..				.•'"	'C*													*'								-			
- ISO OOO	£ -60													-■r																					*						
---------720 000~	- . 2„			X				^r ~y				-											^^															--			
		$	»-;*	-♦•^	j~^-				—																																
J "J				\--\-f'	rr~ ~*--ir-~																										'										
Tot al Weekly Rain Fall.			I.Zfin	J6in 197 in .15 in			.52 in.	.55 in	.48 in	.63in	.03in	I.83in		1.16 in		,Z5in	■>..52in		.OOin	.67 in.	.^2('n,	.37in	.59 in	Ulin		4.90in		l.60in		■loin	.OOin	.15 vn	.Olin	.11 in	l.49in						* |
Number of clear days.			1	J \ 4		3	5	1	5	.5	4	z		3		I	0		2	2	2	1	*	1		0		i		■»	4	4	1	5	I						
Number <	>f cloudy davs.		6	1	3	4	2	6	■■'	z	3	5		4		5	7		s	J	■>	6	5	6		7		5		I	3	3	fi	2	5						
Number of c	avs with Fast wind.		1	3	1	1	1	I	0	0	1	3		4		1	6		4	5	3	0	3	■5		5		2		1	1	.1	4	.?	4						
Number of days withWest wind.			0	4	fi	■-•	IS	.3	7	7	6	4		3		6	I		3	Z	1	■ 7	4	2		2		5		6	0	4	3	4	Z						
Mean Thermometer Weekly.			6Z'	SI" 1 64"		67°	72'	72°	72°	SI"	3.1°	33°		30°		71"	70°		~S°	76°	74°	73°	67"	63"		64°		f-	8°	54°	50°	43°	50°	51°	46°						
Mean Baromet it Weekly.			29.93	30.H0	30.04	to. 97	■ 10.04	30.14	29.94	291)0	29.94	29.90		30.05		3001	30.08		30.14	29.96	30.04	29.96	30.01	30.07				1993		29.91	.100/1	30.04	29.96	30.07	30.01	---'..					
WF.
DC
___, Weekly Miirtidily from,dt (7m.se.s-in  t'hiladetph in.

   t  Weekly Mortality from /Jiarrha-id fji.sea.ie.s in I'lnliulelphia.    \t~

...,  WeeklyAdnu.s-sion.s-t/i t/w f/ntetuiia/ JnUrnatiotad Kxtnlidivn   •-

___% Weet/ytula/ Jlleiidanrr al llos/iitalin Kxliibiiion Grounds.   »-
.., Weekly-Attendant* ut Hospital thorn fliairhaeeil Affectix>7is.

-f^Menii lieekly Humidity- Point of Satwiitiou. fttfl.

—• Mean Weekly Therniemieter.

—x Meem lliek/yJieadiiuj of Baronuler.
Weekly Rain Hitl in inches. 
 
  IBasbuUruf the llcehty Jbpulittiotitmidnil'upon thr /■.Whihifion fiivitndr, the  llrrk/yMrkiirxv/iotti oftYott.sr.s; the llrrkfi til.srsof'd/l'Pdrite Mmm\t/ieWrA/>diismoffn/ermi/fcMFrm: the Weddv
 lusrsol hphmdFeirr (itidndme/ 'fipho  J/idiiniit' Ihrr) airtoMf /tie fir.wleiil.rupon the Frhi/ttiron fowtinf-. nrfh ffir IlirldiJfortidtlrfnm fyph/tiel'fiverin the iityof/jhifadetph//it47idlfeleor
f>/expettl' Obserwtimv for the  sums period hiini.shrd by the P., S'.Siipuil Oftirr.
■lajiunry IStf.
    DC
— Weekly Aiwiltrr of Persons resitltni/ upon die Krtnfiitiini fimundt
... Wrrkly-fates of"Sieitnrssa/nntia fi'esnlentsiipon the KrhitUian drounrts
_, Weekly 'Ibteil of fasesofall feints diseases twi/aig JtciOlsjit.iuponExh1,'Grvuruis.
., Week!) • Ir/ses nfIntermittent fern iwwnif Kesu/etits upon the Frhdiitian (iroumf
   Weekly Uses of Ty/ihnid FevcrtvirlutUtuiJyplaiMa/mal'lemiong(liefirs^'ii/itm-Ed''Or'.
_ Weekly Mortality I nun all fetuses in I'hd/iMphja
,___   _^  Weekly Morhilttr trom Typhoid. Fever in I he f'ifi affhilatte/p/n.
.______«. Weekly. liimis°ion.vtottu• feiifeiuiial'International' KvliM/ion
      I  It'eekli fain Fa//in inr/ies
_______, Mean Weekhlfurnidf/r-Pointof Sa/arnfean. loV
._______. Mean H'erk/r'Thermometer
._______„./lean lieekly Aenefuiij ofh'arartwter.