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Typhoid Fever. In consequence of the intimate connection of this disease with sewage-polluted water supplies, the Board has made it the subject of observation and experiment, and will report upon the results of observations in a later report. Special attention has been paid to the investigation of the conditions under which the disease has prevailed in those cities and towns which had an unusually high death rate from this cause.
The following table, published also in the report of 1890, presents the numbers of deaths from typhoid fever in the cities of Massachusetts for the twenty years 1871-90, together with the average annual death rate per 10,000 in each city from this cause. This table contains the same data for the added year 1890, which does not materially change the figures of the former period.
The following affords an illustration of probable infection through the domestic water supply:
Great Barrington. — The Board was requested to investigate certain cases of typhoid fever which occurred in Great Barrington in the fall of 1891. In August, 1891, a case occurred in the family of Mr. Hirsch, living near the village, in which one death occurred. It appeared that a drain leading from the kitchen sink past the well used by the family had been broken, allowing the discharge from the sink to soak into the soil near the well, with the probability of polluting the water. Other cases not fatal were said to have followed in the same family. The Board of Health requested the family to discontinue the use of the water of this well, and they complied, and soon moved out of the house. The sink drain was repaired very soon afterward, and while it was being repaired a boy from a neighboring family came and played about the drain ; whether he drank of the water of the well could not be learned. This lad was taken ill with typhoid fever September 7, and died October 18. His illness was followed by five other cases in the same family, the disease having a continuous run in this family of three months. The persons attacked were the mother, four sons and a daughter aged six. Of these six, four died. In this house there was no drainage whatever. The kitchen sink bad no outlet, and all sink water, as well as some of the excreta of the sick, were thrown out upon the ground about the well. The privy vault was situated across the yard, at a distance of about seventy-five to one hundred feet from the house, and a cow stable was somewhat nearer.
The water supply of this household was obtained from two sources, — from a cistern which was supplied from the roof, and from a well situated just outside the kitchen door. Both were provided with chain pumps. The well was mainly used for drinking water.
An analysis of the water of this well was made by the State Board, with the following result :
Analysis of Sample of Water from Well in Great Barrington.
[Parts per 100,000.)
Sample collected Jan. 2, 1892.
Slight. Free ammonia,
.006 8.77 7.00 45.72
The chlorine in this analysis should be compared with the normal chlorine of the waters of this region, which is about .10 per 100,000.
This analysis shows that the water was very much polluted at the time the sample was taken.
The origin of the first case of typhoid which occurred in August is unknown, but it appears probable that the cases in the second family originated in the visit of the little boy to the first house. He was the first to be taken ill, and the other cases followed, probably through infection of the drinking water of the well.
Diphtheria. Several local epidemics of this disease were investigated by the Board during the year, the circumstances and conditions of which differed but little from those which have been detailed in former reports of the Board.
Hydrophobia. During the year 1891 hydrophobia has gradually abated, until at the close of the year cases were reported very rarely. The number of deaths during the past decade has been as follows:
The following case is so fully confirmed and the account so carefully detailed by Dr. G. C. Pierce of Ashland as to be worthy of special notice :
On July 14, three young children of Mr. C. Adams of Ashland were bitten by a dog supposed to be suffering from rabies. On the following day they were admitted to the Pasteur Institute in New York, under the charge of Dr. Gibier. On July 30, sixteen days after admission and treatment, they were discharged, and went home to Ashland, after having been pronounced to he out of danger from hydrophobia. On August 6, a week later, the boy, five years old, was taken ill with symptoms of hydrophobia, and died three days later, several physicians agreeing in the diagnosis of hydrophobia.
The circumstances of the infection were as follows: At 5 A.M., July 14, a shepherd dog ran madly through the streets of South Framingham, where he sprang upon a man and bit him in several places. A little daughter of Mr. Adams, aged seven, had started from home to pick berries. The dog rushed upon her, and inflicted twenty-one wounds with his teeth. He then attacked an older sister, aged eleven, and bit her hand. Next he attacked the little boy, and inflicted nineteen wounds upon him, and was then killed. The wounds were cauterized by a surgeon very soon afterward, and on the following day the children were sent to New York, in company with Mr. Dill of South Framingham, for treatment at the Pasteur Institute.
After returning home, the boy appeared well till Thursday afternoon, August 6. He was first attacked with nausea and vomiting. On the following day he had signs of fever. His face became alternately flushed and pale. On Saturday morning the temperature was 100° and the pulse slightly above normal. Pupil of left eye slightly dilated; constant twitching of angles of mouth ; spasmodic action of muscles of forearms. Tongue slightly coated. No headache. By Saturday afternoon he was delirious, and refused food of all kinds. Difficulty in swallowing water. Eyes at times bright and glistening, and occasionally dull. Sunday morning he was worse. toms increased in intensity. Temperature, 1021° ; pulse, 130. An eruption appeared on chest and left cheek. Occasionally talked rationally; restless. Skin hyperæsthetic. A breath of air caused distress. He became emaciated for thirty-six hours