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feebly constituted, and was an easy victim to disease. There was a wooden sink in the kitchen, and from it a wooden spout discharged the waste directly under the window; it had been in position for several years. The ground within a radius of ten feet was completely saturated with the drainage. From repeated usage the earth has been washed so as to form a cesspool, and I was informed that it had remained in that condition for three years. The case was unusually profound, terminating fatally in seventy-two hours.

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Typhoid Fever. Five cases, none fatal; four in town, one in an adjacent town. It is not probable that the drinking-water was polluted in any case. I did not find that unsanitary conditions had any connection with these cases, and I have no more cases of the disease than I did fifty years ago, when I first commenced practice. Nearly every case I have had in all my practice has occurred among the better classes of the people, and those who take the most care to keep their surroundings neat and clean. Had typhoid fever occurred in destitute families and among the foreign people, I should have a very different opinion, for they are generally filthy, and usually live in the poorest quarters of a town, where houses are huddled close together, drainage poor, and the rudest of outhouses, with wells in close proximity frequently. This may not prove true in cities, but my experience leads me to believe that it comes where it will.

Diphtheria. One case.

Unsanitary conditions had no part in causing this case. In some cases, if the condition of the patient had become very weak before the disease developed, unsanitary conditions would affect it, but generally the disease has been carried by others, more like contagion.

Winchester GEORGE W. PEIRCE, M. D.

Believe

Typhoid Fever. None observed during the year. unsanitary conditions to be the predisposing but not the specific cause of the disease.

Diphtheria. — Five cases, none fatal. No unsanitary conditions. Believe unsanitary conditions to be predisposing causes of diphtheria.

Walpole-N. H. SCOTT, M. D.

Typhoid Fever. - Three cases, none fatal; two in town, one in Tuftonborough. Know of no cause in any case.

Diphtheria. Three cases, none fatal. In all these cases there were unsanitary surroundings.

Woodsville C. R. GIBSON, M. D.

Typhoid Fever. — Five cases, two fatal; four in town, one in Bath. In all these cases the drainage was bad, and in one fatal case a neighbor's vault was within twelve feet of the patient's sleeping-room. I think unsanitary conditions are the exciting cause, while any condition that depresses the system, as overwork, insufficient or poorly prepared food, worry, etc., may be called the predisposing causes. Diphtheria.

One case, not fatal.

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TYPHOID FEVER.

Of the physicians reporting cases of typhoid fever in their practice during the year 1888, forty-two traced the source of one or more cases to drinking-water polluted by cesspools, sink-drains, privy-vaults, etc.,; seven reported cases under unsanitary conditions generally; two found drainage conducted into cellars; two, decaying vegetables in cellars; two, bad drainage; three reported cases in filthy families; five had cases which resulted from contagion; thirteen had imported cases, consequently there was no opportunity to study the cause; overwork in two cases. One or more cases were reported as occurring under the following conditions, by one physician each: Impure milk, exhausted vitality, cesspool close to door of dwelling, privy-vault close to sleeping-room window, sink-drain. Twenty-two reported as having failed in their efforts to discover the cause of the disease in their cases, while eighteen made no mention of having attempted to do so. One hundred and nine physicians reported four hundred and seventy-four cases under the above attributed causes. One hundred physicians express the opinion, as the result of their experience with the disease, that unsanitary conditions are always present in cases of typhoid fever, either as the direct cause of the disease, or as a means of developing the germ or specific

poison which causes the disease. To the question, Basing your opinion upon your experience as a practitioner, what relation do unsanitary conditions bear to typhoid fever? eleven physicians returned the answer, "cause and effect." Seven express the opinion that the disease may always be traced to polluted water; four firmly believe that unsanitary conditions have no connection whatever with the disease; six have as yet had a too limited experience to have arrived at any conclusion, while thirty-eight make no reply to the question as to what they believe may be the relations of unsanitary conditions and typhoid fever.

DIPHTHERIA.

Sixty-eight physicians reported two hundred and eighty-two cases of diphtheria in their practice during the year 1888. Of these, ninety-two cases were attributed to unsanitary surroundings, sixteen to polluted drinking-water, twelve to contagion, thirteen to defective drainage, six to emanations from cesspools, four to filth, three to damp cellars, two each to swampy land about buildings, decaying vegetable matter in cellar, sink-drain discharging into cellar, and filthy pig-sty, and one each to eating decayed grapes, defective sink-drain, and improperly constructed vault. Four of the reported cases were imported, consequently no investigation of the surroundings could be made. Fifteen physicians reported that in seventy-four cases they could discover no cause, while in the remaining cases no mention of cause is made.

In reporting upon the disease in general, seventy-five physicians express the opinion that unsanitary conditions have a decided influence upon the disease, either as the direct cause or as the means of developing the specific germ or poison; nine believe the relation of unsanitary conditions and diphtheria to be that of cause and effect; three assign filth as the cause; four attribute it to a specific germ or poison; four believe that unsanitary conditions have little or no connection with the disease, while two are undecided in the matter, and two attribute the cause to cold and impure air.

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