NEWMARKET’S EPIDEMIC OF DIPHTHERIA IN 1885-86
Presented to the New Hampshire Medical Societry
BY CHARLES A MORSE MD, NEWMARKET
Mr President and Fellows In presenting this paper for your consideration I shall not attempt to give anything new in regard to the etiology diagnosis prognosis or treatment of the disease but shall confine myself to the epidemic as seen by myself and to such information as I was able to obtain from my brother practitioners.
The town of Newmarket on the line of the Boston & Maine Railroad one and one half miles east of South Newmarket Junction is situated upon the west bank of the Lamprey River which flows into what is known as Great Bay. The tides rise and fall about ten feet. The soil of Newmarket is sandy with a substratum of clay. The main portion of the town being higher than the river and tide water and sloping in that direction gives us an excellent opportunity for drainage were it improved. But the main sewer running along a portion of the main street is higher than the cellar bottoms. These cellars have thus ample opportunity to become filled with water in the spring and fall and a majority of them contain more or less stagnant water during the year. More than once has the question of sewerage been agitated but we have always failed to get an appropriation of the town’s money for that purpose.
The population is of a mixed character and numbers about two thousand three hundred people at least one thousand of whom are French Canadians. Having such a class to deal with it is surprising that the mortality from the epidemic was not greater for when a dozen or more persons live in one room it is almost impossible to obtain any satisfactory results from medical treatment. I know of one house where twenty seven human beings ate and slept in one room which was by actual measurement fifteen by nineteen feet.
The first case of diphtheria noticed in the epidemic of which I speak occurred about the first of October 1885. A boy about twelve years of age son of one of the best families in town was suddenly stricken down while attending school in what is known as the primary school building . This was the only known case in town at the time . For days and weeks his life was despaired of but in time he made a complete recovery and is now strong and well. From that time on until about the first of May 1886 one hundred and twenty three cases were treated by the resident physicians with a total of twenty seven deaths. The youngest patient whom I saw was eleven months old, the oldest was forty four years of age. By far the larger number were children between the ages of four and twelve years. Whole families were taken down, and in one instance I had a mother, her nursing child, and five other children of her family all sick at the same time. All were in beds upon bedsteads or upon the floor — no two patients being in the same bed. In every case isolation was demanded and enforced as far as possible but you are all well aware that the population usually found in a manufacturing town is unreliable and that it is almost impossible to do with them as we are able to do with a more intelligent class of patients. Taking these facts into account I think that our per cent of recoveries will compare favorably with those of epidemics in other places.
You may ask ”What was the probable starting point and cause of this epidemic?”. There have been quite a number of theories advanced but to positively prove them we have been unable. As the first patient was attending school in our primary school building this structure has received more or less criticism whether justly or unjustly I know not; but I do know that a majority of the cases occurred in children who attended that school or who were members of families having children attending the school. Out of a school of forty six children twenty eight suffered from the disease and fifteen died. Also a young lady who was substituting for the regular teacher was taken sick and died in about five days. The local board of health made a thorough examination of the building and out buildings but could not give us a satisfactory explanation of the probable cause . The school was closed and the buildings were subjected to a thorough cleaning in the line of scrubbing painting and whitewashing . A goodly amount of sulphur was burned in the cellar and since then no cases have been noticed as coming from that vicinity.
A case here and there has been seen and from May 1 1886 to June 1 1887 five deaths from diphtheria have been recorded. Our treatment in these cases was that laid down in the latest textbooks changing from time to time as each individual case might require . I used in all my cases local applications to the throat with a good amount of gargles and washes and for young patients the spray from a hand or steam atomizer was the local application. I am a firm believer with my limited experience in the use of plenty of water water containing a weak solution of carbolic acid or of chlorate of potassium to be used about the patient. If common sulphur cost $10 per pound ten times as much of it would be used for disinfecting purposes. I believe it to be one of the best medicines that we have.
Iron quinine and many other remedies all have their places but good care good nourishment in the smallest possible volume are the things to be relied upon. Diphtheria being a constitutional disease, it behooves us to keep up the strength of our patients. Great care should be used in regard to the surroundings of the patient. Only necessaries should be allowed in the room. Better have too little furniture in the room than too much. I generally have a large pail for the reception of all sputa and cloths from the patient and I insist that boiling water with a strong solution of carbolic acid shall be added to this waste before it is disposed of, and too much care cannot be taken in this direction. Members of the family whose services are not required in caring for the patients should in no case be allowed to visit those sick with this disease. In fatal cases burial should be insisted upon as soon after death as possible - no public funeral being allowed. When the minds of the people at large have been brought to realize the contagiousness and severity of the disease then shall we more fully be able to cope with it, and until then we may expect that a large per cent of our cases will prove fatal.
The severity of our epidemic may be judged by referring to some of the cases after convalescence had begun. Many of the patients suffered from partial or total paralysis; some children being obliged to learn again to walk, others to talk, and others still were more or less troubled by paralysis of the muscles deglutition. In one case a young man lost almost the whole control of the sphincter muscle of the bladder being unable to retain his urine, but his case yielded quickly to nux vomica and the battery. One other case of interest to me was that of a boy thirteen years of age who, with two other members of his family, had the disease quite severely. All had more or less hemorrhage but finally recovered. This boy suffered more or less from loss of vision being obliged to wear glasses. He was not able to see at all for months but gradually his sight returned and now after about one and one half years he is able to see quite well by the aid of glasses. I examined the eye as best I could but saw nothing abnormal.
Our townspeople having learned the lesson at the cost of the lives of some of their brightest children will see to it that in the future Newmarket’s sanitary condition shall be a very great improvement upon that of the past. To day we are in a better state of cleanliness than ever before, and we shall not remain quiet until we have obtained in the line of sewerage that which the signs of the times demand.
Dr Conn: It seemed to me in the reading of that paper the writer struck the key of his position in the last sentence almost of his paper that in the time of epidemics of diphtheria and those of a kindred nature we shall be obliged to rely upon prevention rather than cure. Wherever epidemics occur of a contagious infections or malignant nature like those of diphtheria and scarlet fever there will always be mortality attending a certain number of cases. And in our efforts to save life in epidemics of that nature we must rely upon prevention or rather stop the disease before it commences.
Dr Douglas: Unlike our great Teacher and great Physician I came not to minister but to be ministered unto. Yet this subject is one that interests me specially and I would like to say two or three words. In the treatment of diphtheria let your remedies be given very often. If there is any one thing that is of importance it is to give remedies very frequently not so strong as to be objectionable to the child but so frequently they can get the benefit of it. With reference to drugs probably we are all agreed as to what is best. While there is unanimity of opinion in regard to internal treatment there is great diversity in regard to local applications Some do not apply local applications at all, others believe they are of very great use. I have practised the use of local applications and particularly muriated tincture of iron and more especially subsulpnate of iron blown upon the throat. I think I have had better success with that treatment than with any other and I recommend it to the profession.
Dr Whittier : In the beginning of my treatment of diphtheria I always made local applications nitrate of silver at that time was popular a very good thing. I thought I did not suppose I could cure a case without the local application of nitrate of silver or some strong solution to get rid of the exudation. I practised that for years and I finally came to the conclusion that it did not amount to anything. I think the local applications could be as well applied by medicines which went down the throat and into the stomach as to make a local application with a sponge or brush or anything of the kind except perhaps in the few cases where the throat was filled up. Then as a matter of course the local application did good in this way that it cleared the throat for the time being of accumulation of matter. A tincture of chloride of iron will be applied to the throat by the process of swallowing it as a matter of course the gargle does not reach the posterior fauces at all. Subsulphate of iron is a good thing if you want to apply it to patches. It does no harm In fact it puckers them up and they fall off readily in a few days. But I have had as good success as any one could have in diphtheria. I do not think I have made a direct local application for five or six years; I do not know but it may be ten. I use chloride tincture of iron in large doses and I use it frequently I practically saturate the system with it and I believe that either combined or alternated with perhaps aromatic spirits of ammonia being a very pleasant preparation of ammonia is the best treatment you can adopt. I am satisfied that chloride of potash does very little good further than perhaps the process of gargling which clears the throat. During the last year before this from the 1st of January to the 1st of January, I had thirty six cases of diphtheria in which the throat was covered by the parchment patch. I do not consider any other cases of sore throat in that number of cases and in not a single case did I apply any local application than what went down into the stomach. They all lived and I submit that was the result of the treatment.
Dr Hill: I hope that the members of this Society will not dwell too much or attach too much importance to the contagiousness of diphtheria. For myself I do not believe it is as contagious as most people think. I think with proper precautions it may be avoided. The same cause which produced the first case may produce others but I do not believe that the second case often comes from the first . The common opinion occasions a great deal of alarm because the neighbors sometimes stay away from the disease and the family sometimes suffer from want of assistance in nursing etc.
Newmarket Charles A Morse : Typhoid Fever - None observed during 1888 Diphtheria Have not seen a well defined case during the year
BIO — Morse Charles A
Newmarket - Democrat, Baptist physician and surgeon. Married, age 33; born in Salisbury Sept 8 1857 the oldest of five children - three boys and two girls. In 1862 the family removed to Fisherville (now Penacook, NH) and he attended the public school and Penacook Academy. In 1875 he entered the employ of Cephas H Fowler of that place to learn the drug and medicine business and worked at it there in Boston and in Concord nearly five years when he began the study of medicine with Dr E.E. Graves of Boscawen. He graduated from Dartmouth Medical College Nov 15 1881 , located in Newmarket the following March and has since then resided there enjoying a large practice. He served as school superintendent three years and postmaster under the Cleveland administration Always a Democrat.