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DIPHTHERIA EPIDEMIC

AT

MIDDLETOWN.

BY JOHN T. SUTPHEN, M. D., H. O.

DIPHTHERIA EPIDEMIC AT MIDDLETOWN.

JOHN T. SUTPHEN, M. D. H. 0.

C. O. PROBST, M. D., Secretary State Board of Health, Columbus, Ohio: SIR: In reply to your request to give a history of the epidemic of diphtheia in this city, I would say that Middletown is a city of 8,400 people situated upon the bank of the Great Miami river. Underlying the town is a drift of gravel and sand. which is very porous with a soil of loam overlying it, with an average thickness of three and one half feet. The sub-soil drainage, by investigation, is west 26 degrees south. The drainage of the city is comparatively good. At one place east of the Bee Line Railroad there is a low, flat place where the drainage from the hills east of the city have settled for years past. That is now provided with sewerage for surface drainage only. We have a system of sewerage for drainage, but none of the sewers are trapped or used for sanitary purposes. We have the open vault system, which permits drainage into the porous soil, except that part of the city north of First street, where a cistern system is in vogue. Very few open wells are used in the city; the water used for domestic purposes. is taken mostly from the water-works system, which water is drawn from an open well, and on the line of sub-soil drainage; to that well nothing but cistern vaults are permitted. Many driven wells are used. The water used is pronounced by analytic chemists as being remarkably good. A complete analysis of the water used for domestic purposes can be found in my fourth annual report. Great care has been taken in regard to cleanliness of the city. In fact, when compared with other cities of the same class, which I have visited, we have the cleanest of them all. Isolation was inaugurated by action of the board of health on February 4, 1889, after which time every house in the city in which a case of diphtheria existed was placarded, visitors prohibited and schools notified of the fact, and they ordered to prohibit children attending school from those houses until it had been certified that danger from contagion had passed, which fact was obtained by the health officer from the physician in charge of the case. Whenever a placard was ordered on a house, the sanitary inspector was nstructed to furnish the occupants with o e of your circulars on diphtheria,

The

care was taken to thoroughly disinfect the premises and vaults. observation and opinion of the board of health is that this epidemic of diphtheria does not result from any local causes, but its spread is strictly due to contagion. At this time of writing there exists in the city only -one (1) case of diphtheria. The first case developed was on May 9, 1888, which case occurred in a house situated upon one of the raises in the soil, being about twenty (20) feet higher than the major portion of the city, with no houses nearer than 500 feet, well ventilated and apparently danger of contagion avoided, there being but one (1) member of the family affected; but at that time visitation by neighbors was not prohibited; no public funerals have been permitted since October 1888. The enumeration of school children between the ages of six (6) and twenty-one (21) years in August of 1889 was 2157.

And of this number 1,157 are enrolled in the public schools, and 216 are enrolled in the parochial school. On September 17, 1888, occurred the first death from diphtheria. The last death occurred on the 20th of August, 1889. During the time of the epidemic 413 cases have been reported to the health department; out of this number 55 have died, being a percentage of 13.31 to the number of cases. Of the deaths there have been males, 22; females, 33; white, 54; colored, 1. One year old and under, 7; two years old and under, 8; three years old, 13; four years old, 3; five years old and under ten, 16; ten years old and over, 8. The oldest person dying from diphtheria was 21 years old, the youngest, 9 months old. The number of cases were distributed as follows:

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In families where diphtheria existed, it has been the experience of our physicians that many cases in the same families where diphtheria existed were of the character to be diagnosed follicular tonsilitis and catarrhal angina. They were of such a type, that to be called diphtheria would have been a false diagnosis, yet the excessive number of such cases indicated that the diphtheretic epidemic had considerable bearing. During the month of March, with one exception, the cases were laryngeal; since May the cases have been free of any complication; as to treatment of cases it is beyond my province as health officer.

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