CEREBROSPINAL MENINGITIS 
IN 
MASSACHUSETTS 
IN 
1873. 
With some Inquiry into the Circumstances Attending its 
Origin or Supposed Cause. 
J BAXTER UP HAM, M. D. 
HBOSTQIfrr 
WRIGHT & POTTER, STATE PRINTERS, 
Corner of Milk and Federal Streets. 
1874- €ereko--fpitial Heninsjiti© 
IN 
MASSACHUSETTS ; 
BEING A 
Succinct History of the Epidemic of 1873, 
WITH AN ANALYSIS OF UPWARDS OF 500 CASES, COLLECTED 
FROM EVERY PART OF THE STATE. 
J. BAXTER UPHAM, A.M., M.D., 
Late Physician to the Boston City Hospital, Member of the Massachusetts Medical 
Society and of the Boston Society for Medical Improvement, Bellow 
of the American Academy of Arts and Sciences, 
<Sr’c., &*C. 
[Reprinted from the Fifth Annual Report of the State Board 
of Health of : 
WRIGHT & POTTER, STATE PRINTERS, 
BOSTON: 
Corner of Milk and Federal Streets. 
1874. CEREBROSPINAL MENINGITIS IN MASSACHUSETTS. 
The disease now denominated cerebro-spinal meningitis has 
long been known to the medical profession in the various 
countries of the civilized world. It has existed as an epidemic, 
at stated times, in Russia, Holland, France, Germany, Spain, 
Portugal, Sweden and Great Britain. It has occurred also, 
from time to time, under various names and divers forms and 
phases of development, in many parts of our own land. 
During the war of the rebellion it was seen in marked and 
fatal form in some of the important military posts both West 
and South. It was the fortune of the writer to observe the 
disease in its epidemic character as it occurred in the camps 
in and about the town of Newbern, in North Carolina, in the 
winter and spring of 1862-63. This was one of the first 
among its recent visitations as an epidemic in the United 
States. So long, indeed, had the affection been dropped from 
the catalogue of our prevailing diseases that, at first, the 
whole medical force in that Department were at a loss to 
know with what they had to deal. Coming, as it did, sud- 
denly and without warning, it early arrested attention by the 
abruptness and intensity of the attack, the peculiarity of its 
symptoms, its protean developments, its oftentimes rapid 
course and fearfully fatal results. By some it was taken to 
be a new and unusual phase of intermittent fever; by others 
a severe malarial fever of the bilious remittent type ; by 
others still, a malignant typhus, identical in its essential 
elements with the endemic fever of Great Britain, and which, 
under the various titles of hospital, jail or camp fever, putrid 
malignant fever, petechial fever, maculated typhus or ship 
fever, and other ill-favored names, "is known to lurk in the 
track of armies, and is familiar in the hovels and ill-drained 
and ill-ventilated houses of the poor and wretched”—with each 
and all which affections it seemed to present many symptoms 4 
Cerebro-Spinal Meningitis in Massachusetts. 
in common. It was not, indeed, till repeated post-mortem 
investigations revealed the unmistakable and striking lesions 
which belong to the disease in question, that its true character 
was recognized and established. 
To give, in briefest form, a portraiture of the disease as it 
is now understood by the medical profession, I quote the fol- 
lowing definition from a recent admirable monograph on this 
subject by Dr. Meredith Clymer,* as follows, viz.: "An acute 
specific disorder, commonly happening in an epidemic, general 
or limited, and, rarely, sporadically,—caused by some un- 
known external influence,—of sudden onset, rapid course and 
very fatal; its chief symptoms, referable to the cerebrospinal 
axis, are great prostration of the vital powers, severe pain in 
the head and along the spinal column, delirium, tetanic and, 
occasionally, clonic spasms and cutaneous hyperoesthesia, with, 
in some cases, stupor, coma and motor paralysis, attended fre- 
quently with cutaneous Jimmie spots; the morbid anatomical 
characters being congestion and inflammation of the membranes 
of the brain and spinal cord, particularly the pia mater, 
although there is reason to believe that the evidence of these 
changes may be wanting, even in cases of long duration.” 
To this succinct and comprehensive, but purely technical, 
definition, it may not be out of place to add here some account 
of the essential characteristics of the disease, its habits, symp- 
toms, progress and pathology, as seen in its epidemic and 
most prevalent form in this country. In its mode of attack 
it is commonly sudden and without premonition, the patient, 
for the most part, continuing about his ordinary duties and 
making no complaint till the very day of his seizure. The 
subjects of the disease, in most cases, among adults, and 
males especially, are those who have previously been in the 
enjoyment of sound and robust health, and have endured hard- 
ship and exposure with impunity. The symptoms at the first 
are headache, referred mostly to the back part of the head, of 
a severe, oftentimes excruciating, character; conjoined with 
this, or soon following, are violent pains in the nape of the 
* Epidemic Cbrebro-spinal Meningitis, with an Appendix on some points on 
the Causes of the Disease, as shown by the History of the recent Epidemic in the 
city of New York. By Meredith Clymer, M.D. (Univ. Penti.y, etc., etc. Phila- 
delphia : Lindsay & Blakiston. 1872. The Epidemic of 1873. 
5 
neck, extending down the spine, accompanied with a peculiar 
sense of stiffness in the muscles of the neck and lower part of 
the face. There is chilliness rather than a well-defined chill. 
Nausea and vomiting, in children especially, is mi early symp- 
tom. There is generally soreness and tenderness at the back 
of the neck and along the spine. Sudden and acute pains in 
the joints is a not infrequent concomitant. As the disease 
advances there is great exhaustion; the breathing becomes 
irregular and labored. Delirium is frequently present, often 
of a violent kind, but differing from the delirium of typhoid 
and typhus fever in that the patient can easily be aroused so 
as to answer questions intelligently. There may be, at some 
stage of the affection, an eruption of a dark-red or purplish 
hue, of a hsemic character, not raised but apparently imbedded 
in the substance of the skin. This eruption is by no means a 
constant phenomenon, nor is it confined to any particular por- 
tion of the body. There is usually much nervous agitation, 
manifested by a constant restlessness and jactitation. The 
muscles of the neck become rigid and contracted, drawing 
the head backward to almost a right angle with the thorax; 
this, although not a constant symptom, is mostly seen, or at 
least a tendency to this condition is noticed, at some period of 
the disease. There may be also tetanic and clonic spasms. 
The action of the heart is irregular and tumultuous, so as 
often to simulate valvular disease of that organ. An inflam- 
matory condition of the iris, or of the synovial membrane of the 
larger joints is often an accompaniment. Such are among the 
more prominent and constant symptoms. But there is a con- 
siderable diversity in these manifestations during the progress 
of the disease, whether towards a favorable or fatal result; in 
no individual case can it be expected that all, or even a 
majority, of those above enumerated will be present. 
The duration of the disease is very uncertain. It may last 
less than twelve hours, or it may extend, with its complica- 
tions and sequelae, to as many weeks, or, perhaps months ; 
the greater number of fatal cases terminate on or before the 
seventh day. Cases are on record in which death has occurred 
within two or three hours from the time of seizure. 
No age is exempt; nor would there seem to be any preference 
of sex. Children are, perhaps, more commonly subjects of 6 
Cerebro-Spinal Meningitis in Massachusetts. 
the disease. Statistics show that more cases occur under than 
over the age of ten years. 
The mortality is very great, averaging in many well-marked 
epidemics of which we have record fully 67 per cent. ,In 
the visitation at Newbern, before alluded to, the mortality 
of all the recorded cases was 73 per cent. ; in the city of 
New Tork, in 1872, it was 75 per cent.; in the epidemic 
that occurred in this State, in 1866, it was 61 per cent. 
The prognosis must be regarded as doubtful from the first; 
of no disease is it more hazardous to base upon existing favor- 
able or unfavorable symptoms a positive prediction as to the 
result. Convalescence is usually slow and relapses not infre- 
quent. 
As to the season of the year when epidemics of this affection 
are most apt to prevail, not much that is satisfactory can be 
learned. Dr. Simon has stated that, of 182 European epidem- 
ics, 24 were in October and November, 46 in December and 
January, 48 in February and March, 30 in April and May, 24 in 
June and July, and 10 in August and September. Dr. Cly- 
mer, who has collected the statistics of many epidemics, says 
that, in Sweden, of 417 local outbreaks, 311 were in winter 
and 106 in summer; that, of epidemics in Europe and the 
United States, noted by Hirsch, 33 prevailed in winter, 24 
in winter and spring, 11 in spring, one in spring and summer, 
two in summer, one in summer and autumn, one in autumn, 
one in autumn and winter, three in autumn, winter and spring, 
and six throughout the whole year. Pleiffer says "it prefers 
winter, soldiers and children.” 
It would be out of place here to enter largely into the con- 
sideration of the nature and pathology of the disease. Suffice 
it to say that the weight of evidence is in favor of placing it 
in the category of those diseases which are engendered by the 
existence of a morbid poison acting primarily upon the vital 
fluid, and secondarily affecting more especially the meninges 
of the base of the brain and spinal cord, where, upon dissec- 
tion, its material lesions can most often be found. 
The etiology, or cause of the disease, is still involved in 
doubt. It will be our aim to consider, with minuteness and 
impartiality, the mass of evidence collected from the many The Epidemic of 1873. 
7 
intelligent observers of the present epidemic, and to deduce, 
if we can, something that may prove of use in the prevention 
or management of future visitations of a like nature. 
Before entering upon a discussion of the existing epidemic, 
let us glance at the past history of the affection within the 
limits of our own State. The first reliable record of it, as 
seen in the epidemic form in Massachusetts, dates back to 
1806, when it appeared in the town of Medfield. Nine cases 
occurred in that town, all of which proved fatal. This was 
in the month of March. From that time until 1816 it ap- 
peared, at intervals, at various points within the State, and 
was more or less epidemic in its character. It prevailed quite 
extensively in 1810. In that year a most interesting report 
upon this then mysterious and obscure affection was drawn 
up and published by Drs. James Jackson and John C. War- 
ren. It first appeared, as stated in that report, in the town 
of Dana, about the beginning of the year, "but not in any 
considerable number of instances until the cold weather of 
the middle of January.” In the latter part of February it 
was heard of at Petersham, and at Barre, Oakham, Rutland, 
Paxton, Hardwick, New Braintree, Brookfield, Spencer, Stur- 
bridge, Winchendon, Athol, Gerry, Leicester and Worcester, 
in the course of the month of March, " mostly about the 
third week in that month.” It will be seen that all the above- 
named towns are in the county of Worcester. It was seen at 
Cambridgeport in the latter part of March, and at Lancaster 
in April. In the course of April and May a few cases oc- 
curred at Boston, and again in the counties of Worcester 
and Middlesex. During May it presented itself in Spring- 
field, and had not subsided in the second week in June.* 
We hear little or nothing more of the disease till 1849, when 
Dr. Joseph Sargent, of Worcester, called the attention of the 
profession to its existence in the towns of Millbury and Sutton 
during the month of March of that year. Not many cases 
were seen, however, and if the disease could then be called 
epidemic at all, it was limited both in quantity and extent. 
Dr. S., in this memoir, first suggested the analogy of the 
* See Report of the Committee of the Mass. Med, Soc’y, May, 1866, Luther Parks, 
M. D., Chairman. 8 
Cerebro-Spinal Meningitis in Massachusetts. 
disease with the so-called "spotted fever” of a former day.* 
It appeared again, to a limited extent, in April, 1857, in the 
town of Becket, in Berkshire County. Dr. Jackson stated 
that he had occasionally met with sporadic (isolated) cases 
of the disease in later years, or since the epidemic of 1806-16.f 
Since about the time of the outbreak of the disease among 
our soldiers during the war, it has made its appearance at 
various points in this State. Five cases came under the 
observation of the writer, in the Boston City Hospital, in 
1865-6. Some of these cases originated in the hospital. Dr. 
Pasfe saw a considerable number of cases, near the close of 
O 7 
the war, at Gallop’s Island, a military post in Boston Harbor. 
The report of the committee from the Massachusetts Medi- 
cal Society, in 1866, covers all the cases which could be col- 
lected in the State from 1857 to 1865 inclusive,—280 
in all. These were distributed over the different years as 
follows : 
In 1857 there were 
3 
cases. 
1858 “ 
4 4 
27 
4 4 
1859 “ 
4 4 
3 
4 4 
1861 “ 
4 4 
5 
4 4 
1862 “ 
4 4 
5 
4 4 
1863 “ 
4 4 
7 
4 4 
1864 “ 
4 4 
. 88 
4 4 
1865 “ 
4 4 
. 116 
44 
Years not designated, . 
. 26 
44 
Making a 
total of 
# 
. 280 cases. 
From the above it appears that instances of the disease 
have occurred in this State in each year from 1857 to 1865, 
inclusive, with the exception of 1860. Doubtless a con- 
siderable number of cases might have been chronicled in 
1866, but the report did not include the record of that 
year, other than the mention of seven cases in Brookline, in 
January. 
* Records of the Boston Society for Medical Improvement, 1849. 
f Extract of a letter from the late Dr. James Jackson to Dr. L. Parks, in 1866. 
See report of the Committee of the Massachusetts Medical Society for that year. The Epidemic of 1873. 
9 
We are not able to find any reliable account of the number of 
cases of this affection which have occurred from 1866 to 1871, 
inclusive. Neither the state or city registration reports 
render much assistance in this investigation. In the former, 
the nosological term, cerebro-spinal meningitis, does not ap- 
pear. We have the right to infer, however, from an actual 
knowledge of the existence of the disease, to a greater or 
less extent, in these years, that it may be embraced within 
the term "cephalitis,” under which all the inflammatory affec- 
tions of the brain and its coverings seem to have been classed. 
Among the causes of death for the years below stated, the 
number attributed to " cephalitis ” stands as follows : 
In 1863, 
524 
1864, 
728 
1865, 
669 
• 1866, 
595 
1867, 
* 
525 
1868, 
577 
1869, 
572 
1870, 
601 
1871, 
620 
We would call attention to the fact that in the years 1864 
and 1865 the disease was known to be epidemic in many por- 
tions of the State; and the greater number of deaths attrib- 
uted to " cephalitis ” in these epidemic years tends to confirm 
our opinion that the disease existed, and was reported under 
the above title. In 1872 it appears for the first time in 
the state nosological records under its true name, 157 
deaths being returned as occurring from cerebro-spinal me- 
ningitis, 16 from spotted fever, and two from black fever, 
all which were supposed to be cases of the affection now 
under consideration. In his annual report for 1872, the 
city registrar states that the whole number of deaths 
in Boston from this cause in that year was 60, of which 
number 34 were males and 26 were females. He further 
says that in 1867, when this disease was first distinctively 
reported to him, under its present name, there were seven Cerebro-Spinal Meningitis in Massachusetts. 
deaths; in 1868, eight; in 1869, seven; in 1870, five; and 
in 1871, three.* 
During the early months of the present year it became evi- 
dent that the disease had again assumed an epidemic form, 
and was prevailing to an unusual extent, in the eastern por- 
tions of the State especially. In the month of May a notice 
was inserted in the Boston Medical and Surgical Journal, call- 
ing the attention of physicians to this fact, and asking their aid 
and co-operation in collecting statistics. Subsequently a cir- 
cular was issued by the Secretary of the State Board of Health, 
and distributed to his regular correspondents throughout the 
State. This circular contained the following questions : 
1. How many cases of this disease have come within your knowledge or 
observation within the present year ? 
{lf no cases have been observed, please give a negative reply.) 
2. State the sex, nationality, age, and occupation of the patients. 
3. Character of the attack, whether sudden or otherwise. 
* The distribution of deaths attributed to this disease in 1872 will appear from the 
following table. 
COUNTY. 
Town. 
Deaths. 
COUNTY. 
Town. 
Deaths. 
Barnstable, 
Orleans, . 
1 
Plymouth, 
Abington, 
1 
r 
Adams, . 
Gt. Barrington, 
Lenox, 
5 
Mattapoisett, . 
1 
Berkshire, 
2 
1 
Suffolk, . 
Boston, . - . 
Chelsea, . 
Ashburnham, . 
63 
1 
Williamstown, 
1 
r 
1 
Bristol, . 
Fall River, 
Amesbury, 
Danvers, . 
2i 
2 
2 
Berlin, 
Clinton, . 
Grafton, . 
1 
1 
4 
Essex, . 
Essex, 
Salem, 
Topsfield, 
1 
1 
1 
Hardwick, 
Holden, . 
Hubbardston, . 
I 
1 
1 
Franklin, 
Warwick, 
1 
Lancaster, 
1 
Chicopee, 
1 
Mendon, . 
Milford, . 
2 
Hampden, 
Holyoke,. 
3 
5 
Springfield, 
Enfield, . 
5 
1 
Worcester, .< 
Northbridge, . 
N. Brookfield,. 
1 
1 
Hampshire, . 
Hadley, . 
1 
Oxford, . 
1 
Southampton,. 
1 
Royalston, 
2 
' 
Littleton,. 
Lowell, . 
2 
1 
Southboro’, 
Sterling, . 
2 
1 
Marlborough, . 
18 
Sutton, 
Upton, 
Webster, . 
Winchendon. . 
1 
Middlesex, 
Melrose, . 
Natick, . 
Somerville, 
1 
7 
1 
6 
2 
1 
Tewksbury, . 
1 
Worcester, 
5 
Norfolk, . 
Hyde Park, 
Quincy, . 
WestRoxbury, 
1 
1 
1 
175 
1 Black fever. The Epidemic of 1873. 
11 
4. Stage of the disease when the patient was first seen. 
5. The earlier and later symptoms. 
6. The duration of the disease. 
7. The treatment. 
8, The result. 
9. The post-mortem developments, when obtained. 
10. Name of the attending physician. 
11. Has the disease prevailed among animals,—horses, cows, hens, etc. ? If 
so, please state the symptoms and pathological appearances when possible. 
12. General remarks upon the case, with especial reference to its supposed ori- 
gin or cause. In this connection a detailed account of the locality, hygienic 
conditions and circumstances of the patient,—his home and home surround- 
ings, living-rooms, cellar, sinks and privies, nature of the soil, drainage, 
character of the water used for drinking and culinary purposes, etc., etc., 
is especially desired. 
And for the greater convenience of record, when a consid- 
erable number of cases had been observed, a tabular form, 
with headings indicating the desired points of information, 
was added. 
Eeplies have been received from 199 physicians, represent- 
ing 77 towns and cities, who have furnished the statistics, 
more or less complete, of 517 cases of the disease. In this 
enumeration we have retained only those instances which we 
believe to be genuine and authentic. The following will 
serve as examples of these tabular returns received from 
various parts of the State:— Cerebro-Spinal Meningitis in Massachusetts. 
12 
Tabular Statement of Cases of Cerebro-Spinal Meningitis 
[ No. of Case, j 
Name of City 
ok Town. 
Name, Nation- 
ality, and Oc- 
cupation. 
Age. 
Condition— 
Easy or 
otherwise. 
Date of 
Attack. 
Onset— 
Sudden or 
otherwise. 
No. of 
Hours or 
Days ill be- 
fore Seen. 
1 
Boston, 
M. L. C., 
Domestic, 
Canada. 
18 
Comforta- 
ble. 
Mar. 15, 
Sudden, 
One day. 
2 
Fitchburg, . 
W. F.,. 
13 
Easy, 
May 16, 
Sudden, 
16 hours. 
3 
Haverhill, . 
Mrs. S., 
American. 
27 
Good, 
Apr. 15, 
Sudden, 
Seen at 
once. 
> 
4 
4 
Leominster. 
S. W., Amer- 
ican. 
60 
Not desti- 
tute, but 
with lim- 
ited and 
gradually 
diminish- 
ing means. 
July 28, 
Sudden, 
16 hours. 
5 
Worcester, . 
G. M., Amer- 
ican. 
5 
Easy, 
Apr. 14. 
Sudden, 
2 days. The Epidemic of 1873. 
occurring in Massachusetts during the Epidemic of 1873. 
Symptoms. 
Early. 
.Advanced. 
Vomiting of bilious matter. Severe 
headache; pain in back, and stiffness 
of right leg. Delirium at night. Pain 
of head referred to forehead; and of 
back in upper cervical and lower dor- 
sal vertebrae, where she is tender on 
pressure. Slight deafness. Temper- 
ature, 102°. 
Pain as at first. Delirium at times. 
Pulse, 72-140; small, weak. Hearing 
good at times. Temperature, 101°-104°. 
Patient failed rapidly on fifth day. No 
convulsions. No eruption. 
Vomiting. Pain in head, and general 
febrile symptoms. Severe pain in back 
of head and neck. Appetite continued 
good until a few hours before death. 
Rapid pulse, pain in head; stiffness, of 
spine, and tenderness, especially in cer- 
vical region. Sank rapidly and died, 
without premonition, apparently from 
paralysis of respiratory muscles. At 
death, pulse at wrist full, strong—130 
per minute; heart continued to beat 
for two or three minutes after respira- 
tion had ceased, wrhen the action be- 
came slower, feebler, and ceased en- 
tirely. I was present at death. 
Violent pain in back; spasms. Uncon- 
sciousness. 
Symptoms continued in modified form for 
two weeks. 
Intense pain in head, with rapid pulse 
and high fever; dry skin; bilious vom- 
iting, with remissions of pain in head 
transferred to back, particularly lower 
part of back. This, at times, intense, 
with paralysis of bladder for eight 
days in second and third weeks, re- 
quiring use of catheter twice a day; 
after that the bladder resumed its 
action. 
Paroxysms of pain in head and back grad- 
ually subsiding; stiffness of muscles of 
neck and lower jaw, with difficult deglu- 
tition; no appetite; gradual failing of 
vital powers. 
No marked rigor. Pain in head and 
back of neck ; vomiting; convulsions ; 
fever; delirium; retraction of head; 
tenderness along cervical portion of 
spine; large herpetic cluster upon back 
of left hand; no other eruption. 
Profound insensibility; pallor, alternating 
with flushings of the face; slow, feeble 
pulse; strabismus, with dilated and in- 
sensible pupils; complete hemiplegia of 
right side, lasting for two weeks; con- 
stant jactitation of left arm and leg; 
great emaciation. 14 
CerebroSpinal Meningitis in Massachusetts. 
Tabular Statement of Cases of Cerebro-Spinal Meningitis 
J No. of Case. 
Relapses, or 
Decided Re- 
missions. 
Duration, till 
Convalescence 
or Death. 
Treatment. 
Result. 
1 
Some relief 
to pain 
under 
treatment. 
Five days. 
Morph. Sulph. at first for pain and rest- 
lessness. 
Second day, FI. Extract Ergot, m. xx. 
Potass. Bromid. gr. v. 2d h. 
Third day, Ergot omitted, and Potass. 
Br. increased to gr. xx. with Extract 
Cannabis Ind. gr. j 2d h. 
Fourth day, pain much relieved. 
Death. 
/ 
2 
Quite a 
marked 
remission 
after 12 
hours. 
48 hours 
from first 
attack. 
First saw the patient at evening; gave 
morphia until sleep, quiet and refresh- 
ing, ensued. Morning found apparent 
convalescence; pulse 80, and nearly 
normal. Directed quiet, stimulants 
to spine with diuretics. At 4, p. m., 
patient suddenly grew worse, became 
unconscious, and died at 10, i>. m. 
Death. 
3 
Severe re- 
lapse May 
4th. 
Five weeks. 
Counterirritation vigorously applied. 
Bromide Potass. Hyd. chloral. Sulph. 
Quinite. 
Recovery. 
4 
None, 
7 weeks and 
2 days. 
At onset emetic—cathartics—then cold 
to head; counterirritants to spine; 
blisters to nuchoe, temples, back of 
ears, &c. Paroxysms of pain sub- 
dued by sub-cutaneous injection of 
morphine—sleep induced by choral. 
After the acute stage—2 weeks—beef- 
tea, broth, milk-punch, &c., all the 
patient would take, which was not 
much, and only at our earnest solici- 
tation. He gradually sank from ex- 
haustion. 
Death. 
5 
None, 
Duration, 
to complete 
convales- 
cence,about 
3 months. 
Under treat- 
ment, seven 
weeks. 
Early: cold applications to head and 
spine; evacuation of bowels. Potass. 
Bromid. ev. 4 hours, and Chloral and 
Opium p. r. n. Advanced: nourish- 
ment, Potass. lod., Hydrarg. Bi- 
chlorid., and as convalescence be- 
came established, Iron. 
Recovery 
complete. The Epidemic of 1873. 
Post-Mortem 
Developments. 
Locality — High 
or Low, Damp 
or Dry. 
Name of At- 
tending Phy- 
sician. 
Remarks, with especial reference to Origin or 
Supposed Cause. 
No autopsy. 
Residence not 
known. 
Dr. Abbot. 
This was a patient in the Massachusetts 
General Hospital, where she entered 
on the second day of her sickness, and 
remained until her death. 
No post- 
mortem. 
House situ- 
ated on the 
bank of 
an artificial 
reservoir, 
into which 
a sewer is 
drained. 
Dr. Jewett. 
The home of this patient is at the lowest 
part of a valley. House stands on the 
shore of an artificial reservoir, which 
is used almost daily for a mill; surface 
of the pond is constantly" changing, 
leaving the bottom frequently exposed 
to the sun and air. Into this pond sev- 
eral privies and a sewer are emptied. 
My opinion is, that both the air and 
drinking-water are poisoned, and that 
to these sources we may look for cause 
of the disease. 
Street well 
drained. 
Clay bot- 
tom ; cellar 
damp. 
Dr. Crowell. 
New house with modern conveniences. 
Tenement on north side. Good family. 
The street sloped abruptly toward the 
river, on the south. Surface-drainage 
good. Pure aqueduct water used. 
No autopsy. 
Low and 
damp. 
Dr. Field, . 
I consider the proximate cause to be 
this—the falling asleep on the ground 
after a hard day’s work. A life of 
hard work and gradually diminishing 
pecuniary means may be considered 
as remote causes. Perhaps the water 
used by the family, taken from a 
neighboring pond, may have had some- 
thing to do in causing the disease. 
High, dry, 
sandy soil. 
Dr. Gage. 
This case was isolated. There were no 
others in the family or neighborhood. 
The house was apart from others, upon 
high ground, and surrounded by trees, 
and the surroundings appeared to be 
every way of the most favorable char- 
acter. Convalescence was very slow. 
Intellect for a long time very weak, but 
finally fully restored. Command of 
lower limbs was very slowly regained. 
Strabismus continued for three months, 
but at last entirely disappeared. 
occurring in Massachusetts during 1873—Concluded, Cerebro-Spinal Meningitis in Massachusetts. 
The following table will show the towns from which affirmative replies 
have been received, and the number of cases reported in each, with 
the popidation in 1870. 
CITIES AND TOWNS. 
Population 
in 1870. 
No. of 
Cases. 
CITIES AND TOWNS. 
Population 
in 1870. 
No. of 
Cases. 
Abington, 
9,308 
9 
Lowell,. 
40,928 
48 
Amherst, 
4,035 
3 
Lynn, . 
28,233 
48 
Andover, 
4,873 
4 
Marblehead,. 
7,703 
8 
Ashland, 
2,186 
2 
Methuen, 
2,959 
1 
Attleborough, 
6,769 
1 
Mattapoisett, 
1,361 
1 
Belchertown, 
2,428 
3 
Millbury, 
4,397 
5 
Beverly, 
6,507 
3 
Milford, 
9,890 
9 
Boston, 
250,526 
50 
Newburyport, 
12,595 
2 
“ CityHospit’l, 
- 
16 
New Bedford, 
21,320 
1 
“ Mass. Gen. H. 
- 
2 
N ewMarlborough, 
1,855 
1 
“ Dorch. Dist., 
- 
2 
New Salem, . 
987 
2 
“ Roxbury “ 
- 
7 
Newton, 
12,825 
4 
—77 
N. Bridgewater, . 
8,007 
4 
Braintree, 
3,948 
7 
Northampton, 
10,160 
3 
Bradford, 
2,014 
1 
North Brookfield,. 
3,343 
3 
Brighton, 
4,967 
6 
Palmer, 
3,631 
1 
Brookfield, . 
2,627 
2 
Peabody, 
7,343 
3 
Brookline, . 
6,650 
8 
Prescott, 
541 
1 
Cambridge, . 
39,634 
17 
“ North, . 
3 
“ East, . 
- 
1 
— 4 
“ North, 
- 
1 
Quincy (Point), . 
7,442 
1 
—19 
West Brookfield, . 
1.842 
1 
Cambridgeport, . 
- 
7 
West Roxbury, 
8,683 
2 
Charlestown, 
28,323 
28 
Salem, . 
24,117 
5 
Chelsea, 
18,547 
11 
Salisbury, 
3,776 
3 
Chicopee, 
9,607 
10 
Sandwich, . 
3,694 
1 
Clinton, 
5,429 
2 
Saugus, 
2,247 
1 
Dedham, 
7,342 
8 
Shrewsbury,. 
1,610 
2 
Dudley, 
2,388 
1 
Somerville, . 
14,685 
6 
Everett, 
2,220 
7 
South Hadley, 
2,840 
1 
Fall River, . 
26,766 
6 
Springfield, . 
26,703 
12 
Fitchburg, . 
11,260 
2 
Stoughton, . 
4,914 
7 
Great Barrington, 
4,320 
1 
Swampscott,. 
1,846 
2 
Hadley, 
2,301 
1 
Tyngsborough, 
629 
3 
Haverhill, 
13,092 
18 
W atertown, . 
4,820 
6 
Hingham, 
4,422 
2 
Webstei', 
4,763 
5 
Holyoke, 
10,733 
5 
Westfield, 
6,519 
• 1 
Hubbardston, 
1,654 
2 
Weymouth, . 
9,010 
9 
Lawrence, 
28,921 
15 
Winchester, . 
2,645 
1 
Leicester, 
2,768 
2 
Wi nchen don, 
3,398 
6 
Leominster, . 
3,894 
20 
Woburn, 
8,560 
4 
Leverett, 
877 
1 
Worcester, 
41,105 
7 
Lexington, . 
2,277 
o The Epidemic of 1873. 
The following are the towns from which negative replies 
have been received : 
Ashby, Barre, Berlin, Billerica, South Boston (Hospital), 
Bridgewater, Enfield, Essex, Fairhaven, Falmouth, Granby, 
Halifax, Hopkinton, Hyde Park, Ipswich, Jamaica Plain, 
Kingston, Lougmeadow, Manchester, Marlborough, Monta- 
gue, Nantucket, North Andover, North Brookfield, Orleans, 
Plymouth, Reading, Rowe, Sharon, Sherborn, Shirley, Stock- 
bridge, Stoneham, Wakefield, Walpole, Waltham, Ware, 
Wareham, Weuham, West Boylstou, West Springfield and 
Williamstown. 
The period embraced in this investigation covers only the 
year 1878, and relates mainly to the first ten months of 
the year, since the time did not allow us to keep the record 
open longer. Such cases, however, as could be collected in 
November and December are included in our count. 
We do not presume to have presented a full return of all 
the cases which have occurred within the limits of the State 
during this period. A considerable number of physicians, 
to whom circulars were sent, failed to reply either affirma- 
tively or negatively. In many instances it was stated that 
the disease existed, but "no notes of the cases had been pre- 
served.” In many instances also the record of such as were 
given was insufficient to warrant an opinion of the true char- 
acter of the affection. It will be seen, however, that with all 
these limitations the aggregate of cases far exceeds the num- 
ber adduced in any former epidemic of which we have record 
in the State. 
In elucidation of the character of the present epidemic, and 
as having a possible bearing upon its origin or supposed cause, 
we make the following extracts from the tabular returns and 
medical correspondence called forth by the circulars :—■ 
Abington.—Dr. Gleason reports nine cases, the location of which is said to 
he “good” in six, “low or damp” in three. Two of these patients, aged 7 
and 11, were pnpils in a day-school. 
Amherst.—Three cases reported. In two there was “no appreciable cause. 
Hygienic conditions excellent in every respect.” In one, “hygienic condi- 
tion very unhealthy; the house low and damp, situated in a hollow; the 
yard, at the time, filled with the wash of the surrounding nastiness; and the 
drinking-water coming from a well in the middle of the yard.” Dr. D. B. N. 
Fish writes from this place as follows:—“ In the spring many diseases took Cerebro-Spinal Meningitis in Massachusetts. 
on a condition of great depression, with slow pulse, much restlessness, sigh- 
ing, respiration, etc., resembling that of epidemic cerehro-spinal meningitis, 
of which disease there were several cases in this vicinity at that time.” 
Ashland.—“Two cases reported. Cause not appreciable. Sanitary sur- 
roundings of the patients good: the soil a deep, heavy, sandy loam with a 
gravelly subsoil; natural drainage good; the cellars a little damp.” 
Andover.—Dr. Kimball reports four cases. In one case the location was 
dry; in two cases it was dry, but near a pond or running stream ; in one it 
was “rather damp.” Nothing definite is stated as to origin or supposed 
cause; two of the cases followed exposure to wet and cold after very violent 
exercise. 
Attleborough.—Dr. Sanford reports a single case. “ Patient was robust, ac- 
tive and athletic. Of origin or supposed cause,” ho says, “nothing can be 
stated.” 
Belehertoivn.—Three cases reported. In two, “locality low, the patients 
being occupants of an Irish shanty on the bank of a river so swollen at 
the time as almost to reach the threshold of the house; no conveniences of 
any kind.” In one case the disease supervened upon typhoid fever. This 
patient “ was from a good family, but had been overworked, both physi- 
cally and mentally,—was away from home at school when seized with the 
fever, and living in a very damp location.” 
Beverly.—Three oases are reported by Dr. Haddock. In one instance the 
locality was high; in two it was low. 
Boston.—The records of the city registrar show that 216 deaths were at- 
tributed to this disease in 1873. Of this number, 100 were males and 104 
females; in 12 the sex was not stated. The first case was recorded on the 
11th day of January. I have been able, through the courtesy of Mr. Appol- 
lonio, to obtain the dates and fix upon the exact locality of 204 of these 
reported cases, as will appear in the following table:— The Epidemic of 1873. 
Table showing the Deaths attributed to Cerebro-Spinal Meningitis in Bos 
ton in 1873—Taken from Books of the City Registrar. 
Street and Number. 
Street and Number. 
* 
c 
M 
a 
CO 
% 
m 
£ 
F. 
9 Oxford Place, . 
V. 
r 
M. 
City Hospital. 
F. 
70 Warren Street, . 
XIV. 
M. 
Franklin Street, 
XVI. 
rtK^ 
M. 
144 Portland Street, 
IV. 
F. 
138 Mt. "V ernon St., 
VI. 
Not stated. 
F. 
39 Ellery Street,. . 
XII. 
•-a 
M. 
Bowdoin Sq., . 
XVI. 
M. 
12 Hollis Place, 
VIII. 
F. 
45 Athens Street, . 
VII. 
5 g 
M. 
44 Parkman St., 
III. 
M. 
7 Travers Court, . 
XL 
F. 
Tremont. Street, 
XV. 
F. 
100 Hudson Street, 
VIII. 
Ci 1 
M. 
Deer Island. 
F. 
Fellows Street,. 
XIII. 
M. 
35 Adams Street, . 
XIII. 
i 
Not stated. 
M. 
22 Liverpool St., . 
I. 
£ 
M. 
23 Maverick Sq., . 
I. 
F. 
11 Franks Street, . 
IV. 
o 
F. 
F. 
Dorchester Av., 
11 Riverside St., . 
XVI. 
XV. 
M. 
22 Ferry Street, 
II. 
.3 
F. 
15 Gouch Street, . 
IV. 
F. 
18 Norfolk Place, . 
V. 
£ 
M. 
42 Tileston Street, 
II. 
F. 
57 Anderson St., . 
VI. 
M. 
Deer Island. 
F. 
Fulton Street, . 
XVI. 
F. 
3 Wadleigh PL, . 
XII. 
c3 
M. 
17 Rochester St., . 
VII. 
F. 
693 Washington St., 
VIII. 
.fc 
M. 
40 Billerica Street, 
III. 
p* 
F. 
Tremont House, 
IV. 
s 
M. 
17 Maverick St., . 
I. 
M. 
3 Rutland Place, 
XL 
'o 
F. 
65 Brighton St., 
III. 
-2 
F. 
1094 Shawmut Av., . 
XIV. 
M. 
90 Fiftlx Street, ‘ 
VII. 
rg 
M. 
Broadway Ct., . 
VII. 
•a 
F. 
100 Kendall Street, 
XI. 
F. 
47 Oswego Street,. 
VII. 
M. 
155 Saratoga Street, 
I. 
rd 
F. 
183 Endicott Street, 
II. 
M. 
98 Brookline St., . 
X. 
p 
F. 
352 Third Street, 
XII. 
O 
F. 
36 Lampson St., 
IX. 
F. 
42 Y eoman Street, 
XIII. 
F. 
57 Williams St., 
XIV. 
M. 
31 North Square, . 
11. 
s 
M. 
234 Hanover St., 
II. 
F. 
46 Piedmont St., . 
IX. 
q 
M. 
61 Bower Street, 
XIV. 
F; 
2059 Washington St., 
XV. 
r=! 
M. 
453 Shawmut Av., . 
XI. 
M. 
239 Trenton Street, 
I. 
o 
M. 
Rogers Av., 
XV. 
M. 
122 Sumner Street,. 
I. 
M. 
199 Silver Street, 
VII. 
M. 
10 Bridge Street, . 
III. 
K*% 
Not stated. 
M. 
31 Billerica Street, 
III. 
3 
M. 
Mass. Genl. H. 
F. 
10 Genessee St., 
VII. 
' 
M. 
36 Cottage Street,. 
I. 
{^ 
F. 
6 Lark Street, 
XII. 
F. 
39 E. Dedham St., 
X. 
F. 
2 Clifford Place, . 
II. 
M. 
Harrison Sq., . 
XVI. 
F. 
29 Cove Place, 
VII. 
F. 
59 Endicott Street, 
II. 
M. 
160 Chelsea Street, . 
I. 
M. 
4 Buttrick Place, 
II. 
F. 
91 Charter Street, . 
II. 
o3 
M. 
16 B Street, . 
VII. 
M. 
5 Maverick St., . 
I. 
r 
M. 
89 Sixth Street, 
XII. 
F. 
City Hospital. 
c5 
> 
F. 
58 Baxter Street, . 
VII. 
M. 
3 Watts Coux-t, . 
XII. 
F. 
Mass. Genl. H. 
p 
M. 
9 Meander Street, 
X. 
M. 
Heath Street, 
XV. 
- 
F. 
Moini Court, . 
XII. 
F. 
124 Mt. Vernon St., 
VI. 
M. 
City Hospital. 
II. 
P 
M. 
6 Lark Sti’eet, 
XII. 
F. 
Mass. Hotel, 
A 
M. 
18 Minot Street, 
III. 
J 
M. 
41 Haynes Street . 
I. 
M. 
19 Margaret Street, 
II. 
s 
F. 
120 Havre Stx-eet, . 
I. 
*-* 
F. 
City Hospital. 
o 
F. 
2 Carver Place, . 
VIII. 
*3 
F. 
3 Irving Place, 
VI. 
F. 
200 Marion Street, . 
I. 
Ph^ 
F. 
45 Sharon Street, . 
XI. 
F. 
141 Eighth Street, . 
XII. 
F. 
987 Tx-emont St., 
XV. 
2 
M. 
20 Havre Stx-eet, . 
I. 
F. 
144 Third Street, 
VII. 
7p 
M. 
48 Williams Street, 
XIV. 
£ 
M. 
21 Hanson Street, . 
X. 
Pt 
M. 
Neponset Av., . 
XVI. 
00 
F. 
Shamrock St., . 
XVI. 
M. 
145 Harrison Av., . 
VIII. 
M. 
City Hospital. 
M. 
City Hospital. 
q 
F. 
320 Sumner Street, . 
I. 
M. 
39 Gooch Street, . 
IV. 
c3 
F. 
6 Gold Stx-eet, 
VII. 
M. 
10 Cottage Place, . 
XV. 
M. 
28 Y eoman St., 
XIII. 
F. 
581 Shawmut Av., . 
XL 
Not stated. 
F. 
5 K Street, . 
XII. 20 
Cerehro-Spinal Meningitis in Massachusetts. 
Deaths by Cerebro-Spinal Meningitis—Concluded. 
Street and Number. 
• 
Street and Number. 
a 
m 
g 
m 
£ 
m 
£ 
r 
M. 
26 Grenville Street, 
IX. 
f- 
M. 
47 Vale Street, 
XV. 
F. 
12 Beacon Street, . 
IV. 
c3 
p 
M. 
35 Rochester St., . 
VII. 
M. 
270 Athens Street, . 
VII. 
F. 
119 Charlestown St., 
II. 
F. 
3 Texas Court, . 
XV. 
M. 
15 Bennet Street, . 
II. 
M. 
49 Cedar Street, 
XVI. 
F. 
635 Harrison Av., . 
X. 
M. 
4 Hope Street, 
III. 
M. 
3 Meridian Place, 
I, 
F. 
26 Traverse Street, 
IV. 
13 
M. 
7 Quincy Street, . 
XIV. 
1 
o 
> 
F. 
101 Norfolk Av., 
XIII. 
M. 
17 Dale Avenue, . 
XV. 
M. 
976 Harrison Av., . 
XIII. 
■S 
F. 
126 Broadway, 
VII. 
tc 
F. 
986 Harrison Av., . 
X. 
CD 
M. 
14 Burroughs St., . 
City Hospital. 
VIII. 
"a 
M. 
249 Shawmut Av., . 
X. 
CD 
M. 
M. 
609 Harrison Av., . 
X. 
p 
F. 
980 Harrison Av., . 
XIII. 
•g 
M. 
246 Shawmut Av., . 
X. 
1-3 
F. 
2 Utica Place, 
VII. 
F. 
284 Federal Street, . 
V. 
Not stated. 
r-i 
M. 
90 Fifth Street, 
15 Clark Street, 
VII. 
M. 
II. 
F. 
Rockingham PL, 
XIV. 
. 
M. 
Breed’s Island, . 
11 Stillman Street, 
I. 
o 
F. 
Swett Street, 
XIII. 
F. 
II. 
F. 
291 Fourth Street, . 
VII. 
< 
F. 
28 King Street, 
XV. 
F. 
27 Billerica Street,. 
III. 
s 
F. 
238 Harrison Av., . 
VIII. 
rH 
M. 
45 Sharon Street, . 
XI. 
CD 
M. 
139 Hampden St., . 
XIII. 
rp 
M. 
5 Saxon Court, 
I. 
{>% 
Not stated. 
Pm 
M. 
5 River Street, 
VI. 
M. 
154 Bremen Street, . 
I. 
<! 
F. 
37 Merrimack St., . 
IV. 
F. 
M. 
M. 
F. 
49 Pitts Street, 
237 Federal Street, . 
396 Harrison Av., . 
10 Bonnot Avenue, 
IV. 
V. 
VII. 
II. 
. 6 to 29. 
r 
M. 
F. 
M. 
F. 
City Hospital. 
40 Webster Av., . 
525 Chelsea Street, . 
1102 Tremont Street, 
II. 
I. 
XIV. 
f 
F. 
54 Chadwick St., . 
Prince Street, . 
XIII. 
F. 
20 Seneca Street, . 
VII. 
F. 
II. 
fee 
F. 
59 Dove Street, 
XII. 
M. 
11 Malden Street, . 
X. 
< 
F. 
70 Charter Street, . 
II. 
F. 
7 Tremont Place, . 
XV. 
g5 
> 
F. 
F. 
F, 
M. 
St. Ann’s Inf. Assn., 
4 Percival Street,. 
Forest Hill Av., 
5 Myrtle Place, . 
XII. 
I. 
XVI. 
XIV. 
g. 29 to 
pt. 26. 
r 
M. 
M. 
42 Snowhill Street, 
Not stated. 
243 Federal Street, . 
II. 
V. 
'd 
F. 
30 Allen Street, 
III. 
•3* 
M. 
City Hospital. 
*s 
F. 
1494 Washington St., 
XL 
CD 
g- 
£ 
O 
M. 
F. 
F. 
F. 
F. 
194 Prince Street, . 
374 Meridian Street, 
41 N. Margin St., . 
2 Vincent Court, . 
98 Revere Street, . 
II. 
I. 
II. 
VIII. 
VI. 
Sept. 26 to 
Oct. 28. 
' 
M. 
M. 
F. 
F. 
70 Nashua Street, . 
1981 Washington St., 
16 Simmons Street, 
63 Albany Street, . 
III. 
XIV. 
XV. 
VIII. 
M. 
4t) Union Park, 
X. 
>> 
s 
M. 
F. 
F. 
250 Harrison Av., . 
Ill Worcester St., , 
45 Warren Street, . 
VIII. 
XL 
XIII. 
Oct. 28 
to 
No. 27. 
M. 
F. 
60 Cabot Street, 
8 Lothrop Place, . 
XV. 
II. 
Not stated. 
F. 
74 Fifth Street, 
VII. 
d C 
M. 
63 Athens Street, . 
VII. 
F. 
21 Meander Street, 
X. 
>D< 
gQ 
F. 
102 Portland Street, 
IV. 
M. 
183 Friend Street, . 
IV. 
F. 
7 Holden Place, . 
VI. 
M. 
372 Hanover Street,. 
II. 
A o 
L 
F. 
91 Chelsea Street, . 
I. The Epidemic of 1873. 
21 
The percentage of Deaths in each Ward may he shown by the following 
Table. 
Ward. 
Population 
in 1870. 
rS 
c3 
s 
Ratio per 
thousand. 
. 
Ward. 
Population 
i in 1870. 
Deaths. 
Ratio per 
thousand. 
XIII., . . 
8,.536 
11 
1.288+ 
XI, . . . 
14,617 
9 
.616— 
II., . . 
24,912 
27 
1.083+ 
XII, . 
19,880 
12 
.604— 
IV., 
10,216 
11 
1.077— 
VI, . . . 
11,792 
7 
.594— 
XV., . . 
14,851 
14 
.942+ 
V, . . 
14,166 
5 
.353— 
X., . . 
13,097 
12 
.916+ 
IX, . . . 
14,142 
3 
.212+ 
XIV., 
11,38-5 
10 
.878+ 
Deer Island, 
1,660 
2 
- 
I., . . 
23,824 
20 
.839+ 
City Hospital, . 
9 
VIII., 
11,278 
9 
.798+ 
Mass. Genl. H, 
- 
2 
- 
VII., . . 
28,921 
22 
.761— 
Not stated, 
- 
8 
- 
XVI., 
12,259 
9 
.734+ 
Ill, . . 
14,990 
10 
.666+ 
Total, . 
250,526 
212 
It may be proper to give in this connection the general 
locality and extent of the wards which, according to this table, 
have furnished the largest ratio of deaths per thousand of 
inhabitants, in order, as follows, viz. : Ward XIII.—By 
inspecting a recent map of the city, we shall see that this 
ward is situated in the south-easterly part of the old city 
proper, spreading out along the waters of the South Bay 
and intersected with tidal streams. It comprises the " Swett 
Street District,” lies low, and has for the most part no proper 
drainage. The raising of a considerable portion of this ter- 
ritory is now being mooted by the city authorities. The con- 
templated route for the extension of East Chester Park to 
Dorchester nearly bisects this ward. Ward II comprises a 
segment of the No th End, so called, the oldest part of the 
city; its serai-lunar outline bordering upon the Charles 
River and the harbor. Many portions of this ward have a 
densely crowded population. Ward IV is centrally situated, 
occupying very nearly a circle whose centre is in Scollay 
Square. It includes Portland Street, with the numerous 
courts and alleys adjacent, which can hardly be said to revel 
in favorable hygienic surroundings; eastward it reaches to 
the harbor and includes some of the most active business 
parts of the city. Ward XV is included in the extensive 
and sparsety settled district in the south-westerly part of the 
city. It lies low, and is in considerable part a marsh. It is 
largely intersected by tidal inlets. Ward X extends from 22 
Cerebro-Spinal Meningitis in Massachusetts. 
the South Bay, by which it is bounded for a considerable 
part of its extent on the east, to Warren Avenue and the 
Providence Railroad on the west. Washington Street, 
which formerly connected Boston with Roxbury as a narrow 
neck, passes through it lengthwise and nearly midway with 
made lands on either side. Ward XIV comprises the pict- 
uresque and elevated portion of the city-—Roxbury High- 
lands, formerly so called—and extends in a somewhat nar- 
row strip northerly as far as Tremont Street. Ward I 
comprises the whole of East Boston and the islands in the 
harbor, and is sometimes called the "Island Ward.” Ward 
VIII is small in extent, stretching from the Common east- 
ward to Ward YU. It is bounded by Albany Street on the 
east, and is intersected by Harrison Avenue, Washington and 
Tremont Streets. 
Beginning now with those wards which are said to have 
furnished the least number of victims in proportion to their 
population:—Ward IX is situated between the Common and 
Public Garden and the remotest portions of the Back Bay 
lands in the one direction, and between Commonwealth Ave- 
nue and Ward X in the other. It is largely bottomed on 
made lands, but lately reclaimed from the sea, and com- 
prises some of the finest streets of the city. It embraces 
also the recently raised Church Street District. The artifi- 
cially made portion of this ward was originally a dry gravelly 
bank in Newton. Ward V extends from the Common east- 
ward to the harbor, and includes the greater part of the 
burnt district, so called. Ward VI covers the more ele- 
vated part of the city north of the Common, extending thence 
along the Charles River to Brookline. Ward XII com- 
prises the greater part of the peninsular of South Boston. 
Ward XI is similarly situated with* Ward X, adjoining it 
upon the south. Chester Park, and Franklin and Blackstone 
Squares are in this ward. Ward 111 is bounded by Cam- 
bridge Street on the south, and extends along the borders of 
the Charles River as far as Warren Bridge. Most of the 
northern and eastern railway freight and passenger depots 
are in this ward. 
It is not possible to predicate upon the meagre skeleton of 
facts here given, any positive opinion as to the conditions The Epidemic of 1873. 
23 
which are most likely to give rise to the disease. This can 
only be done by a patient investigation of the premises in 
each individual case, and it offers an interesting field for 
future research. 
Dr. S. L. Abbot has given a careful resume of eleven cases 
which came under his observation. In three cases the hygienic 
conditions of residence were unknown; in three cases they 
were pronounced "good”; four cases occurred in narrow and 
crowded streets or courts; in one case the location was "as 
bad as could be,—low and damp, within fifty feet of the 
marsh on Parker Street, and quite near the large open sewer 
of that district; in addition to these appointments a cow-yard 
for the accommodation of a dozen cows adjoined the house on 
the east.” In regard to one of the cases referred to above 
as living in a narrow and crowded street, he says : "A cess- 
pool in the yard had been full to overflowing for a year or 
more, and at full tide there was a foul stench in the house 
daily. The nuisance was rectified on complaint to the Board 
of Health, who discovered that the privy also overflowed into 
the drain. A case of cerebro-spinal meningitis was said to 
have occurred in the same house a few weeks previously.” 
And of another case in the same category, he says: "The 
place is so shut in as to be wanting in good ventilation, and 
has stables for cart-horses in the rear,” 
Sixteen cases are reported, mostty in the months of March, 
April and May, from the Boston City Hospital, of which nine 
died and six recovered. Careful autopsies were made in five 
cases, showing the usual characteristic manifestations of con- 
gestion and effusion about the base of the brain and medulla 
oblongata, extending sometimes a considerable distance down 
the cord. No opinion is expressed as to the causation of the 
disease in these places. 
Dr. Read furnishes the statistics of twelve cases which 
occurred in his private practice. This series of cases is espe- 
cially interesting as presenting eleven recoveries and one 
death. Dr. Read attributes his great success to the adminis- 
tration of a combination of ergotine and extract of belladonna 
in proportion of one grain of the former to one-tenth of a 
grain of the latter for adults, which dose was administered 
every three or four hours during the acute stage of the dis- 24 
Cerebro-Spinal Meningitis in Massachusetts. 
ease, conjoined with other local and general remedies as symp- 
toms seemed to demand. We understand that Dr. Bead in- 
tends to give to the profession a resume of all the cases which 
have come under his observation in which these remedies have 
been tried, and we therefore forbear to express any opinion on 
the subject here. Dr. 11. makes a particular point of the 
irregularity of the heart’s action in the diagnosis of this dis- 
ease. In one case he speaks as follows : " The peculiarity most 
noticeable was the persistent irregularity of the pulse, kept 
up till after the patient became convalescent, and re-appearing 
on the least overexertion.” Of another case he says : " The 
pulse was peculiar, consisting of one strong beat, then several 
feeble, ineffectual beats,—as if a clock should tick once and 
then the pendulum should swing several times without com- 
pleting the ticks,—then go regularly for a while, and repeat 
the process indefinitely.” 
Dr. Ayer reports four cases, three of which were negroes. 
He says : " I consider the disease to be epidemic, and can 
form no conjecture as to its origin and cause.” 
Dr. Lyman says: "It is impossible, in my experience, to 
trace the disease to any supposed cause.” 
Dr. Morland, remarking upon the single case which came 
under his observation, says: "The previous health of the 
patient had been delicate ; she had suffered from a change of 
former better circumstances, had endured much care and anxi- 
ety, been indifferently nourished and irregular in the times 
of taking food ; she had a lodging-room at the top of the 
house, dry and well ventilated.” 
Two cases are reported by Dr. Fitz. Of one he says : 
" Patient lived in an old house ; the nature of soil such that 
thorough drainage might be questioned ; house not opened to 
sun and light.” Of the other he says : " House recently re- 
modelled, soil excellent, drainage good, plenty of sun and 
fresh air.” Dr. Fifield reports three cases, about which he 
says: "They all lived in unhealthy localities, and the cause 
seemed to be exposure to cold and wet.” Dr. J. Homans 
reports one case, of which he remarks; "The sanitary con- 
ditions, of the locality showed nothing remarkable.” Dr. 
Ellis reports a case, of which he says : "No assignable cause ; 
patient was healthy and living under the best hygienic con- The Epidemic of 1873. 
25 
ditions.” Dr. C. D. Homans says, of two cases reported by 
him: "One was a robust boy; the other an ambitious girl, 
but not robust, who had generally resided in the country. 
She had studied hard.” Dr. Palmer reports three cases, in 
one of which he attributes the immediate cause to " anxiety in 
consequence of the sickness of her husband, and damp feet 
apd clothing from exposure to snow.” Dr. Fisher writes, 
under date of July 16, as follows; "The late epidemic was 
mild in comparison with the one I witnessed at Newbern, I 
think. Deaths, so far as I can learn, were less sudden and 
frequent, and the signs of disorganization of the blood less 
prominent.” Dr. Gavin reports seven cases. "In none of 
those cases,” he writes, "have I been able to detect a want of 
proper hygienic or sanitary conditions. The disease was 
singularly tedious in its course,—twelve or more weeks pass- 
ing by with very little improvement in the symptoms. In 
only one of my cases did any eruption show itself, and then 
it was of the vesicular order.” Two cases are reported by 
Dr. Swan. Of one he says : "Locality low, damp and filthy. 
Patient’s mother is said to have died with similar symptoms, 
in the same house, four months previously.” Dr. E. T. 
Williams presents a group of sixteen cases, which he re- 
gards as genuine specimens of the disease, and an analysis 
of which seems to him to favor the existence of contagion as 
a means of extension. 
It will be seen that a considerable number of cases came 
under treatment in the hospitals, the origin of which, as is 
mostly the fact with severe diseases brought into hospital, 
could not be satisfactorily traced. 
Braintree.—Dr. Torrey reports seven cases, five of which occurred in one 
family, all being children, varying in age from four months to eleven years. 
The locality is said to he damp and near a pond. “ All these patients were 
of Irish descent, living in a low, damp place, their houses filthy, with nine 
or ten persons crowded into two rooms.” 
Brighton.—Of six cases reported, one, that of a stone-cutter, aged twenty- 
one years, “ followed exhaustive labor at his trade during the very warm 
days of June.” In another, “ the surroundings were most unhealthy,—the 
patient being sick in the kitchen, on four chairs used as a bed.” Another, a 
girl of eleven, was a close student, as well as a brilliant one.” 
Brookline.—'Two cases reported. In one, “ could be traced to no cause except 
exhausting work as book-keeper.” In the other, “ could be traced only to a 
crowded household, if that can be considered a cause.” Dr. Salisbury has 26 
Cerehro-Spinal Meningitis in Massachusetts. 
detailed a single case, which manifestly falls into the category of the disease 
in question. He states, however, that he has had twelve or fifteen cases 
within a period of two months, varying in severity, and all going through 
their course without alarming symptoms, bnt with characteristics so similar 
in kind with the case he has reported, as to leave in his own mind no doubt 
as to their identity. In addition to these, three undoubted and fatal cases 
have occurred in his practice. 
Cambridge.—Dr. Wellington speaks of the disease as occurring, for the most 
part, without premonitory symptoms, coming on suddenly with chills, vomit- 
ing, violent headache, soon followed with pain at the nuchse and spine, etc., 
etc. He noticed in some of his cases a marked and sudden variation in the 
temperature of the surface, changing two or three degrees in the space of 
twenty-four hours or less, and that, for the most part, the temperature was 
from one to two degrees higher at night than in the morning. The pulse 
varied from 90 to 120. There was usually moisture rather than dryness of the 
skin, great sensitiveness to the touch, and marked exhaustion from the first. 
Stiffness of the muscles of the neck was common, opisthotonos not unusual. 
In a majority of his cases the decubitus was on the side. He notes a busy, 
talking delirium, the patient’s mind running upon his occupations. This 
delirium was superficial, so to speak, the patient being easily roused to 
answer questions logically. He marked this peculiarity in even his worst 
cases. Dr. W. had noticed, during the spring months, that other diseases 
simulated the prevailing epidemic in their early symptoms. He had a case 
of acute rheumatism which began in this way. “ I can say but little with 
regard to origin or supposed cause. In one case the surroundings were all 
favorable. In two cases the patients were in easy circumstances and, in the 
main, Avell provided for; but the cellars were damp and drainage was defect- 
ive.” In Dr. Webber’s three cases, the locality was “ low and dry, with a 
sandy soil,” in one case; “low and damp in another; ” “ high and damp, with 
clayey soil, but excellent drainage,” in the third. In six cases reported by 
Dr. Hildreth, it was “ low and damp ” in three cases; “ moderately favor- 
able” in the others. In Dr. Hooker’s “ twelve or fifteen cases” no origin or 
cause of the disease could be traced. The most aggravated cases were those 
living in healthy localities, patients cleanly, occupations light. In Dr. 
Massey’s eleven cases, the ground was “low and underdrained” in six cases ; 
filled land and badly drained in one case; healthy location in four cases. 
Charlestown.—The epidemic was rife here during the early months of the 
year. Dr. Forster reports as follows: “In its attack the disease was sud- 
den and severe, and attended with a large mortality. There ay as great 
variety in the modes of treatment adopted, as well as great uncertainty as 
to the result.” He alludes to the existence of spurious or abortive cases 
of the disease,—cases having all the early symptoms of the genuine affec- 
tion, oftentimes very marked, but lasting two or three days and then sub- 
siding. 
Chelsea.—Dr. Wheeler reports having observed many undoubted cases of 
the disease in his own practice and in that of his brother physicians. “ The 
disease commonly came on suddenly with chills, severe headache and pain 
in the back, especially along the nuchse, with sometimes symptoms of a 
violent cold, occasionally with vomiting, and almost invariably with great 
nervous excitement. There was generally great sensitiveness of the surface, 
restlessness and jactitation;—spots not constant, though frequently seen. The Epidemic of 1873. 
27 
In most of the cases there was retraction of the cervical muscles, causing 
the head to he thrown backward.” He had noticed in two or three cases an 
excessive tenderness of the posterior muscles of the legs and thighs, which 
preceded the retraction of the head and neck. He had seen one post-mortem 
examination, which showed extravasation of lymph about the base of the 
brain and spinal cord. He had remarked the existence of what he calls 
“ spurious cases” of the disease in several instances, in his own practice and 
that of others, i. e., instances where the patient was attacked suddenly and 
violently with chills, headache, pain in the back and joints, and great ner- 
vous disturbance, giving reason to fear the access of this disease—all sym- 
toms, however, subsiding and merging, after a few days, into a somewhat 
slow convalescence and perfect recovery. He recalls two such instances in 
one family, a father and son, who were attacked about the same time with 
the symptoms above stated, conjoined with vomiting, feverishness, and se- 
vere pain in the head and back, and accompanied in each case with pain 
along the line of the fibula, giving promise of an attack of acute rheuma- 
tism. Both patients Avere confined to their bed, had distinct remissions 
every morning and exacerbations in the afternoon. After a period of from 
four to six days, such cases generally cleared up or resolved themselves into 
an attack of bronchitis, catarrh, or some other mild affection. At a later 
date he says: “ The disease suddenly subsided as the dry Aveather of early 
summer came in. I think many of the cases Avere traceable to bad location, 
cesspools, privy-vaults of cellars poorly ventilated, or some deficient drain- 
age about the premises.” 
Chicopee.—Hr. Abell makes the following statement: “ From my observa- 
tion of the cases which occurred in my oavu practice and elseAArhere, I came 
to regard the disease as more like a rheumatic inflammation of the meninges 
of the brain and spinal envelope than anything else; that the proximate 
cause is atmospheric; that the exciting causes may be various, as a blow on 
the head, exposure to the sun’s rays, cerebral excitement from fear, over- 
exertion at study, Avork, etc.; and I could not but think that the pesti- 
lential vapors arising from foul pools in the immediate vicinity of many of 
the cases had a decided influence.” In another communication he writes as 
follows: “ I have had some thirteen or fourteen cases of the disease. They 
all had many symptoms in common, while each had some peculiar to itself. 
Nearly all Avere children, betAveen tAvo and ten years of age. All occurred 
betAveen the last of May and the fifteenth of June. The longest duration of 
the disease proper Avas from five to six Aveeks, the shortest three or four 
days. In all the cases where I was able to get at an intelligent history, the 
disease commenced Avith a decided rigor, or chilliness, followed by great 
heat of the head, Avith severe pain, particnlaidy in the back of the head, 
with at first full and hard pulse, sometimes irregular, hurried and notice- 
ably panting respiration, pain and stiffness in the muscles of the back of 
the neck, with retraction of the head, in some cases almost to a right angle 
with the body, accompanied Avith extraordinary rigidity. Nearly all the 
cases had pains in the joints, either of the knees, elboAvs or ankles, usually 
of an intermittent character. Nearly all had distinct remissions or relapses. 
The temperature did not exceed 100° in the axilla.” “ Several of the chil- 
dren had been exposed bareheaded to the rays of the sun not long before the 
attack. Three had met Avith a fall Avithin the preceding forty-eight hours. 
Two were taken doAvn at school, Avhere their brains had evidently been 
much exercised by study and religious catechizing,—as they were continu- 28 
Cerebro-Spinal Meningitis in Massachusetts. 
ally conning over their lessons in their delirium, and seemed terribly afraid 
the priest would punish them. Five cases occurred in the immediate neigh- 
borhood of a pool of standing water, the refuse of several blocks of houses 
crowded with Irish tenants.” In conclusion, Dr. Abell records the following 
interesting fact: “ During the past year, several cases of the head affection 
among small children, which occurs in connection with dentition usually, 
have proved fatal after a prolonged coma and, often, convulsions,—which a 
post-mortem examination showed to he pure cerehro-spinal meningitis,— 
i. e., the brain itself seemed normal, hut the membranes were congested and 
more or less inflamed, and suppuration, to a greater or less extent, had 
taken place. These children died with symptoms often ascribed to hydro- 
cephalus, but no serum was found.” 
Dedham.—Of three cases reported by Dr. Maynard, “No palpable cause. 
The locality was in all the cases good.” Of four cases sent by other physicians 
of that town it is remarked: “ All these cases seemed to arise from over- 
heating, followed by exposure when the patients were fatigued to exhaus- 
tion.” 
Everett.—Dr. Wakefield says of the lour cases he sends from tins town: 
“My cases seemed to depend upon over mental and physical exertion, 
though in all these cases the land where the patient resided was low, 
marshy and damp.” 
Fall Fiver.—Dr. Eddy, who reports six cases, says ; “ I have observed 
nothing worthy of special remark in regard to the home surroundings, drain- 
age, water, etc., unless it be that their condition has been exceptiouably 
good.” 
Fitchburg.—Dr. Hitchcock says; “My belief is, from professional obser- 
vation and inquiry, that stiff neck, muscular lameness «and soreness, head- 
ache and backache, were more frequent accompaniments or concomitants of 
both zymotic and climatic diseases in this city last winter and spring than 
usual.” 
Great Barrington.—Dr. Foster says, in connection with the single case 
which came under his care (a girl of fourteen years): “ There was no cellar 
under that part of the house occupied by the patient; the house itself was 
damp; surroundings not good; privy too near; drinking-water obtained 
from a well near by. The patient had been closely confined to school.” 
Hadley.—Dr. Bigelow, referring to a case occurring in his practice, writes ; 
“ The home of this patient is on the bank of the Connecticut Eiver, along the 
eastern side of which, in the town of Hadley, most diseases have, for several 
years, shown the influence of some epidemic depressing power. Soil, a sandy 
loam. Hygienic, conditions good, except that the sink might possibly be con- 
sidered in bad order for hot weather.” Dr. Bonney writes, Deo. 8, as follows : 
“The disease has not presented itself to any extent in anything that could 
be called an epidemic form ; indeed, there has been less of meningeal form of 
disease this year than usual. For the last ten or twelve years I have had to 
contend with secondary forms of the disease. If the system of the patient 
got lowered to any extent this condition has frequently been developed. 
This has been in past years so frequent, that one’s anxieties were greatly in- 
creased respecting the termination of what might seem to be mild disease. 
The accession would be sudden, and either rapidly fatal or there would be a The Epidemic of 1873. 
29 
lingering convalescence with great prostration. In 1863 diphtheria was very 
prevalent in this town, and its accession was very violent. It was attended 
with considerable fatality. Ever since that date there has been more of the 
meningeal difficulty. I cannot disabuse myself of the inference, that the 
proximity of diphtheria frequently is the indication of the origin of the 
brain disease,—i. e., that the poison which produces the former may also 
allow of the development of the latter. I have also thought that typhoid 
fever stood sometimes in essentially the same relation.” 
Haverhill.—In six cases reported by Dr. Cheney, the locality is stated to he 
either “ low or damp ” or “ low and damp ” in all. In one case the patient 
was a shoe-fitter, and had worked in a damp shop, and his house was situated 
in a swampy locality, on new-made land, with damp cellar and poor drain- 
age,—“ all which circumstances combined promoted the disease.” Of another 
case he writes: “ Patient’s house in a damp locality,—being a tenement over 
a shop where shoe-stock is prepared, from which a constant dampness rises 
and fills the rooms above; drainage imperfect; the air filled with impurity 
from surrounding buildings.” Of another (a child) he says: “ She had been 
permitted to play outside the house in April, sitting on the ground; the soil 
wet; drainage poor; cellar damp.” Of the next he says : “ Patient lives 
near the river, in the midst of a foreign population ; cellar damp ; drainage 
poor.” And of the remaining two cases: “ They lived in a damp, undrained 
locality ,* no sewerage; cellar damp; air and water impure.” Dr. Fernald, 
in reporting a single case which came under his observation, says, “ The 
locality is near a lake, where typhoid fever prevails when the pond is low. 
There are twelve or fifteen families in this locality, and two years ago there 
wore measles and typhoid fever in every household.” Dr. Crowell reports 
three cases, in two of which “ the soil was clayey, and the cellars damp; 
in one, high and sandy.” 
Hingham.—In two cases reported the locality was “ high, hut near a slug- 
gish tidal stream.” 
Holyoke.—Of the five cases reported, Dr. Hummiston writes as follows: 
“ The surroundings, in a majority of instances, were such as to invite typhoid 
fever. In fact, it had prevailed to a considerable extent in the same locality 
only a few weeks before; and while I was attending upon case 1, in this series,, 
it was alleged a patient died of typhoid fever in the same square. No. 2 
occurred in the same section of the city. But the characteristic marks were 
the same in all. What should cause them, however, is as much a puzzle to 
me as to any one else who has sought for the origin of this terrible disease.” 
Lancaster.—Dr. Thompson writes: “ Have seen no well-marked case of this 
disease in this vicinity, hut still have observed a peculiar influence in other 
diseases,—more pain in hack of head and upper spine than usual, not very 
marked or lasting, yet sufficiently prominent to he noted.” 
Lawrence.—Dr. Chamberlain confirms the fact, so often stated, of the dis- 
position on the part of physicians and others to exaggerate the extent of the 
disease by including in its category very mild cases resembling it in some of 
their features, but passing off spontaneously in a short time and without 
treatment,—showing, as we have stated elsewhere, the existence of an epi- 
demic influence which gave a coloring, so to speak, of cerehro-spinal symp- 
toms in divers insignificant ailments. “ There have been many cases of 
pain,” he says, “ often severe, in the head and neck, with little and, in some Cerebro-Spinal Meningitis in Massachusetts. 
instances, no constitutional derangement, which, I have no doubt, were tire 
result of the specific influence which caused the cerebro-spinal disease.” 
“ I am unable,” he continues, “to say anything satisfactory in regard to 
origin or cause. It did not appear to depend, either for its remote or excit- 
ing causes, upon any influences arising from locality,—although a few cases 
were developed amidst surroundings which more than suggested that the 
vitiated air of ill-ventilated houses was instrumental in determining the 
disease.” 
Levereti.—Of a single case reported, Dr. Fish writes: “No appreciable 
cause; soil a gravelly loam; cellar dry and clean; sink and spring well 
cared for; drinking-water excellent.” 
Leominster.—A comparatively large number of cases have been reported 
from this town. Dr. Pierce, who gives the data of twenty cases, writes, in 
regard to the disease : “It seemed to be rather dependent upon epidemic in- 
fluences than upon any local cause,—most of my patients having their houses 
on a light gravelly or sandy soil, with no fault of drainage, so far as I could 
ascertain. In some cases several members of the same household had the 
disease.” He further says : “It seemed to select neighborhoods for its centres, 
thereby, indeed, indicating a local cause, yet what I could not satisfactorily 
ascertain. The patients were mostly healthy, robust, laboring people, in easy 
circumstances.” Nearly all of these cases recovered; in regard to which, Dr. 
P. writes : “ This unusual result is, I think, due more to the mildness of the 
attack than to the special mode of treatment.” He further says :“ A singu- 
lar fact connected with these cases is this,—they were all Americans, with 
one exception, and that one was native-born, though we have a large per- 
centage of foreign population.” Dr. Field, who reports four cases, writes of 
one of these cases as follows : “ The locality was low and damp. I consider 
the proximate cause to have been sleeping on the ground after a hard day’s 
work; and among the remote causes may be named a life of hard work and 
gradually diminishing pecuniary means. Perhaps the water used by the 
family, taken from a neighboring pond, may have had something to do in 
causing the disease.” He further reports, under date of Nov. 1, that, within 
a few weeks, he has seen and examined several supposed cases of the disease 
in patients who had the attack months ago and were not yet fully recovered. 
“We know,” ho adds, “that in all epidemics a good many forms of disease 
will, in a greater or less degree, simulate the epidemical affection and still 
not be genuine.” And he presumes that some of the cases which came under 
his observation, in his own and others’ practice, may have been of this 
character. 
Lowell.—Under date of August 30, 1873, Dr. Nickerson writes as follows: 
“Nineteen out of thirty physicians consulted have had cases of the disease. 
Five others, not consulted, have recorded deaths.” * * * “ The epidemic has 
not been confined to any particular quarter of the city, but has been gener- 
ally most severe in the more thickly settled parts of the town. The heights 
of the city, e.g., Dracut Heights, Belvidere and the higher portion of Chapel 
Hill, have furnished but very few cases and only two deaths.” * * * “The 
attack was almost always sudden, and, when sudden, began with headache 
and vomiting and prostration.” Among the symptoms he enumerates head- 
ache as existing in every case, generally of a peculiarly intense character, 
delirium, tenderness over the spine, retraction of the head in a vast majority 
of cases, oxnsthotonos only occasionally, tonic and clonic convulsions of local The Epidemic of 1873. 
31 
muscles not uncommonly, petechi® in a few instances, hypersesthesia of the 
skin in a goodly number of cases, a variable pulse, accelerated respiration, 
restlessness and jactitation. In regard to tlie severity of the present epi- 
demic, he says: “On the whole, I should think that the epidemic had been a 
mild oue.” On the subject of causation he continues as follows: “After 
careful inquiry I get no light as to the cause of the disease. As in most of the 
epidemics in this country of which I have any knowledge, a majority of the 
cases occurred in the period between December and July; there were only 
a few scattering cases after that time. The only circumstance that has 
pointed to contagion was the occurrence of two fatal cases in one house, 
two sisters being attacked within two weeks of each other. While on the 
subject of causation it may be well to say that our system of sewerage is 
quite defective, and that the recent introduction of city water renders it rela- 
tively more so, though improvements are now in progress in this direction.” 
“ In comparing the rainfall and temperature of the epidemic season of this 
year with those of the same period in previous years I find nothing worthy 
of remark.” • 
Under date of December 19, he writes: “ Out of thirty-seven deaths from 
this disease, twenty-seven occurred between February aud the last of July. 
Since August Ist, there has been a material decline iu the number of 
cases.” * * * “As to the matter of location: I thought of water-courses and 
damp soil in my earlier perambulations, but could not establish any law in 
this particular. Out of forty-eight cases which I have recently examined I 
find that only sixteen can be fairly placed iu damp regions or in the line of 
water-courses.” 
Lynn.— Dr. Webster gives a detailed account of the character and habits 
of the epidemic as observed by him iu Lynn, where the disease prevailed 
quite extensively. The attack, as a general rule, came on suddenly with 
severe headache, especially posteriorly, pain soon extending to the neck and 
back. Vomiting was oftentimes an early symptom. Retraction of the head 
was a common occurrence. All ages were attacked. Dr. W. likewise refers 
to the prevalence of spurious cases, so called, where the patients had the 
early symptoms of cerebro-spinal meningitis, but which, in three or four 
days, recovered or lapsed into some other and milder affection. The first 
death resulting from this disease which appeared upon the records at the 
city hall in Lynn dates back to March. Dr. W. thinks a few patients were 
attacked as early as February. He gives the record of four cases which 
occurred in his practice, in two of which the locality is stated to have been 
“ dry ” aud in two “ low and undrained.” Both of the former were on the 
borders of a lake, where also several other cases occurred. In regard to the 
two last named of his cases the sanitary conditions are stated to have been 
exceedingly poor. Dr. Cahill says, of four cases reported by him, that the 
locality was “low or damp” in three aud “ fair” in one. Dr. Galloupe says, 
of nine cases which he reports ; “ I have been unable to find any cause, 
proximate or remote. The disease has appeared under every variety of con- 
dition, among old and young, rich and poor.” Three out of live cases 
reported by Dr. Drew are supposed to have had for their proximate cause 
“ over-exertion,” Dr. Goodell says, of three out of seven cases reported by 
him, that the locality was near a pond. In one other, the sanitary condi- 
tions Avere “very poor,” in the rest, “fair.” Dr. Newhall, who reports six 
cases, writes: “Iu no instance could I discover any cause, either iu the 
locality or condition of the patieut, Avhich could iu any manner predispose 32 
Cerebro-Spinal Meningitis in Massachusetts. 
to the disease.” Out of four oases reported hy Dr. Kilham, the locality in 
three was “ low and damp.” 
Manchester.—Dr. Priest reports no cases, hut says that he has had several 
which seemed to simulate the disease, with pain on the hack of the head 
and neck and muscular contractions. 
Marblehead.—Dr. Eveleth reports four cases, and refers to “an impure 
atmosphere, especially in a damp district,” as, in Ms opinion, a cause of the 
disease. Dr. Neil son, who gives four cases, reports the locality to have been 
“ low and dry” in two, “low and damp ” in one, and in one, “high and dry.” 
Methuen.—Dr. Chamberlain reports a single case, of which he says : “ The 
patient lived in a tenement boarding-house, on a dry soil, hut close upon a 
hank bordering a sluggish stream. The house was crowded and the air 
impure.” 
MilTbury.—Dr. Lincoln gives the details of five cases, of which he says ; 
“I know of no cause other than epidemic influence. In 1872, there were 
some fifteen or twenty cases of the disease in this town, and then a much 
larger per cent, were fatal.” 
Milford.—Dr. Barns gives the details of nine cases which came under his 
care. In regard to them he says : “ Nearly all the cases which have come 
under my care the present year, and in previous ones, have been those whose 
physical and mental powers had been more or less overtaxed or whose 
general health had been somewhat impaired hy some previous disease. This 
being the fact the question with me is, Is this one of the causes of the 
disease, and is the tendency to it transmissible ? 
New Bedford.—Dr. Prescott sends the details of a single case, in regard to 
which he says ; “ The house was situated on low made land. Walls of bed- 
room constantly moist; no cellar; privy in rear, and drainage flowing 
from the house.” 
North Bridgewater.—Dr. Bordeu gives the details of four cases which 
occurred in his practice. He can find no special cause for the disease. The 
locality was damp in one, low and damp in one, and good in two cases. 
Northampton.—Dr. Fiske reports that eight cases had “come under his 
observation at some stage of their progress. Of these, six were American, 
two were of Irish parentage; three were adults, five were children ; seven 
wore of the female, one of the male sex. Six recovered and two died.” 
North Adams.—Dr. Babbitt, in a recent communication, writes as follows: 
“In the spring of 1871, cases of cerebral meningitis were by no means infre- 
quent in this locality. They were of a marked character and plainly 
diagnosed,—continuing with decreasing severity till autumn,” * * * 
u What I would especially remark is, that since that period we have had no 
distinct typhoid fever. I have been in this locality more than twenty-five 
years, and have never passed an autumn without cases of typhoid fever till 
the seasons of 1872 and 1873; since which I have had no well-marked case of 
that disease. The Epidemic of 1873, 
33 
“ Pharyngitis, pneumonia and other febrile diseases have, in almost every 
instance, taken on cerehro-spinal symptoms; and it is common for the 
patient to say, if his head is raised for any purpose,—‘ yon hurt my neck! ’— 
so that it is difficult to tell which is the disease,—the pneumonia, etc., or the 
cerehro-spinal meningitis. This general observation has struck me forcibly 
in connection with disease in this locality.” 
Palmer.—Dr. Holbrook had a single case about which he says, “Water 
and drainage good; no traceable cause of the disease.” 
Peabody.—Three cases are reported. In one— “ the location is a level area 
of ground, nearly circular and surrounded by hills and farms,—a sort of am- 
phitheatre, as it were, perhaps three-fourths of a mile in diameter; the soil, 
dry. Hot far from the house a field is used for the purpose of drying glue- 
stock, and from this the smell is sometimes very offensive. The drains of 
the house were in a slovenly condition, discharging within fifteen feet of the 
well.” In the second, the house stands “on loav made land; a tannery on 
one side and a morocco manufactory on the other. The smell is offensive, 
and the air must be very impure.” The third was in a healthy locality. 
The patient (a young woman) “had been at work at Lynn for some time, at 
a shoe establishment, using a sewing-machine and confining herself very 
closely, working, at times, sixteen hours a day; she had been for years 
subject to bilious attacks.” 
Quincy Point—A single case. The house of the patient “stands on a low, 
porous soil, and within an eighth of a mile of tide-water. His sloeping- 
room is large and well ventilated; cellar, dry; sink empties into the privy, 
which is about a foot from the houge. Half a dozen other persons live there, 
and are all in good health.” 
Poxbury Highlands.—Dr, Flint gives a report of two cases, of which h© 
says : “ I cannot think either case referable to bad drainage or impure water. 
The first was in St. James Street; drainage, good; water, Cochituate. The 
second was at the Simmons estate, Highland Street, with which locality 
Dr. Derby is probably familiar. The water, I presume, is well-water. I 
made no inquiries in regard to drainage.” Dr. Streeter also reports two 
cases which he could not trace to any special cause. He had also “seen 
many cases accompanied with cephalalgia and rachialgia, requiring a few 
days’release from business; no special treatment; others did not give up 
business or occupation. Evidently a strong epidemic influence prevailed 
throughout the winter and spring.” 
Salem.—Dr. Johnson writes: “We have not seen much of cerehro-spinal 
meningitis in Salem. There have come under my own observation several 
cases of intense and uncontrollable headache, affecting chiefly the back of 
the head, with muscular pains and slight stiffness of the neck, suggesting 
for several days the commencement of an attack of cerehro-spinal meningitis. 
But, without further development of symptoms, the pains would slowly 
decline and cease. These cases seemed to me peculiar, and in conversation 
with Dr. Kemble, I found he had met with several cases in which there 
seemed to be but little lacking to constitute the initial symptoms of the 
disease. The quiet departure of the symptoms suggested to me an abortive 
cerebro-spinal meningitis; yet, the cases were too ill-defined to be satisfac- 
torily classified. Of the few genuine cases which have occurred, the locali- Cerebro-Spinal Meningitis in Massachusetts. 
34 
ties have not heen peculiarly damp, some of these cases occurring in the 
drier portions of our city.” 
In a letter of later date, Dr. J. gives an account of a large number of 
typhoid fever cases, which occurred during the summer and autumn, and 
sketches the localities in which this disease especially prevailed. Bad air 
and water, insufficient drainage and unsanitary surroundings made up, as 
usual, the prevailing elements attendant upon the advent of the fever. But 
oerehro-spinal meningitis did not, as we have seen, particularly flourish in 
these localities, although the predisposing cause was imminent during the 
earlier part of the year. 
Sandwich.—One case reported: “Can give no cause; the locality is at 
least thirty feet in altitude above sea-level; plenty of air and light; no 
miasm.” 
Somerville.—Of six cases reported, the locality in five Avas found to be 
“low and damp.” Dr. Knight gave the details of two cases only, though he 
“had seen many more.” “Locality,” he says, “seems to have had no marked 
influence. In none of my cases can I refer to any origin or cause.” 
Springfield.—Twelve cases are reported. The locality was “low,” or “low 
and damp,” in nine cases, “damp” in one, “high” in two. 
Stoughton.—Dr. Tucker reports seven cases, and says, “I could not dis- 
cover that locality, whether high or loav, damp or dry, had any influence.” 
Swampscott.—Dr. Chase says of a case reported by him: “He was as healthy 
a young man as Ave have in town, of good habits, etc. I know of no cause 
why he Avas attacked with this disease.” 
Tyngshorough.—Dr. Dutton had two cases, “five miles apart.” Of one of 
them he says, “Her earliest symptoms date sharply from exposure in a 
damp night, with wet feet.” 
Ware.—Dr. Minor says: “ I have neither seen nor heard of any cases of 
cerebro-spinal meningitis in this region. We have had a feAV cases in which 
there were complaints of pain in the neck and back, but not sufficiently 
severe for treatment, or to warrant us in calling it the genuine disease, 
though there Avas evidently a tendency that Avay.” 
Watertown—Dr. Hosmer relates the folloAving someAvhat curious circum- 
stance in regard to three cases of the disease Avhich came under his obser- 
vation, the patients being two brothers and a sister: “ Their home AAras in 
the village of Watertown, in the second story of a house Avith fair surround- 
ings. The eldest (a boy), fifteen years of age, was living on a farm two 
miles away, visiting his family every Sunday. Ho Avas seized with the dis- 
ease, while away from home, at the same time that his brother and sister 
were ill with it at his father’s house.” 
Webster.—Dr. Brown gives five cases. He says: “I am unable to state any 
specific cause for the occurrence of the cases aside from the supposed epi- 
demic influences, as the circumstances of these patients, with the exception 
of two which occurred In same family, were very unlike in almost every par- 
ticular ; and I saw no especial reason for the attack.” The Epidemic of 1873. 
35 
West Roxbury.—ln three cases reported hy Dr. Maynard, he finds “no ap- 
parent cause.” 
Weymouth.—Dr. Forsaith reports a single case, which, he says, occurred in 
the vicinity of other families and among a healthy population. 
Williamstown.—Dr. Smith writes, in regard to his experience in this disease, 
as follows : “I have not been able to discover the cause; I once attributed it 
to the water ; and my conviction now is, that to that source, combined with 
local causes, as previously set forth, is to be ascribed the disease.” 
Winehendon.—Dr. Ira Eussell states that six cases of cerebro-spinal menin- 
gitis had come under his observation and treatment during the past summer. 
He also states that he had been familiar with the disease in the winter of 
1863-64, during his army life. He says the disease was “ almost invariably 
ushered in by a chill, great prostration, nausea, vomiting, severe pain in the 
head, neck and back, delirium, sometimes wild, but more commonly moder- 
ate, the patient being easily roused to answer questions, but immediately 
relapsing into his former condition, with contraction of the muscles of the 
neck and back, rigidity of the extremities and great restlessness. Degluti- 
tion was commonly difficult, often impossible. The patient would commonly 
remain in this condition from twelve to thirty-six hours, when re-action would 
come on, followed by fever, usually of a typhoid type, lasting from one to six 
weeks,, sometimes ending in recovery, oftener in death.” In regard to causa- 
tion, he believes the disease to be undoubtedly due to an epidemic influence, 
“ an influence more nearly allied to that which produces influenza, peritonitis 
and pneumonia rather than to the idiopathic fevers, like typhus and 
typhoid.” 
Winchester.—Dr. Winsor could find “no assignable cause” for the few cases 
which came under his observation. 
Woburn.—Dr. Cutter reports four cases. In two the locality was “ unfa- 
vorable ” ; in two it was “ fair.” Dr. C. says : “Itis my opinion that cases of 
cerebro-spinal meningitis occur in Massachusetts, which, from their mildness, 
are sometimes overlooked and mistaken. There is a mild form of the disease 
which may be thought rheumatic.” 
Worcester.—Twelve cases are reported. Of these Dr. Clark reports seven, 
and says that three cases occurred in one family and two in another. Of the 
former group he says: “ The house is in a generally healthy location; it 
stands, however, upon a bank, sloping towards the street, so that the land in 
the rear is considerably higher than the front. Two families occupy the 
house. The sink-drains Open at the side of the L part, and the drainage 
flows in a superficial gutter, by its side, to the front, and from thence, under 
the sidewalk, into the street sewer. The well is outside and a little below 
where the sink-spout debouches.” Of the latter group he remarks: “ The 
location of the street is high, upon a hill sloping to the north ; soil wet, with 
hard-pan beneath; hygienic surroundings very unfavorable.” Dr. Clark 
states that there were fifteen cases in that city, and one in Millbury, in the 
seven months from December, 1871, to July, 1872, inclusive.” 
Having thus quoted largely from the correspondence of 
medical gentlemen, in various parts of the State, as to the 
locality and other circumstances connected with the origin of 36 
Cerebro-Spinal Meningitis in Massachusetts. 
the disease, I will add the results of my own personal investi- 
gation in several towns and cities where the epidemic has 
more extensively prevailed. 
Charlestown.—ln company with Dr. Forster, I personally 
inspected the following localities : 
Case I. A child, 24 Henley Place.—One in a row of tene- 
ment-houses, each floor of which is usually occupied by two 
families. The living-rooms were, in this case, on the second 
story, back, and consisted of a kitchen and sleeping-room, the 
latter about 7 x 10 feet in dimensions, opening out from the 
kitchen, and having one small window looking into the back 
yard. These houses were on made land. Cellar in fair con- 
dition. 
Case 11. Adult mole, 108 Water St.—Old house, near 
the navy-yard gate. Kitchen opens out upon the back yard. 
Sleeping-room of the patient 12 x 14 feet, without windows. 
Back yard filthy; privy-vault full and overflowing. Tide- 
water flows at times into cellar. No drainage. 
Case 111. A child, 12 Thorndike St.—A few rods from 
mill-pond,—the receptacle of Miller’s Eiver; land low; no 
drainage; privy in back yard. Water flows into the cellar. 
Contents of two Sinks empty upon the ground cellar-floor. 
Family recently from Devonshire, England, and much dis- 
gusted with their present home. Much complaint of the bad 
air coming up the stairway from cellar. 
Case IV. Adult female, 41 Chestnut Street.—A cheerful 
and pleasant street; high and dry; sanitary conditions ap- 
parently all right; cellar said to be dry and drainage good. 
I learned that this patient, the day before her attack, attended 
a funeral, went down into the vault, where she remained some 
minutes,— that the tomb was cold and damp, and she felt 
chilly while there. 
Case V. A child, 39 Henley Street.—On low ground; 
floor of cellar covered with boards, partially decayed; house 
drain said to be connected with the street sewer. The Epidemic of 1873. 
37 
Case YI. Adult female, 44 Henley Street.—Tenement- 
house ; surroundings poor, hut not of the worst; living- 
rooms a kitchen and bedroom adjoining, on ground floor, 
back; bedroom small, immediately over cellar, which is not 
wet, but in a slipshod state generally ; bad smells complained 
of. 
Case YIL Adult male, Allston Street.—A pleasant, cheer- 
ful-looking street; locality high and dry. This man worked 
in a furniture factory on " the point,” so called, close to the 
water. 
Case YIII. Adult male, Mount Vernon Street.—Locality 
apparently dry and pleasant. This man was a rigger, and 
employed much about ships and docks. 
In addition to the above localities, which were personally 
visited, the exact position of a great many other cases which 
occurred in this city was obtained by our medical correspond- 
ent and marked down upon a map. They were in the main 
low and damp, were mostly upon made land and near the 
water, with marked exceptions, however, as in the list above 
given. On consulting this map, I find the locality of 49 cases 
thus designated. 
Chelsea.—The following places in which the disease had 
occurred were visited in company with Dr. Wheeler:— 
Case I. A child, Williams Street.—A double house. The 
locality of the street itself is good. The foundation of the 
house, however, is four feet below the level of the street, 
with kitchen and cellar on the same level, i. e., a basement 
kitchen, where the family principally live. Drains connected 
with the main sewer, but were without traps. This house 
has been complained of to the authorities for its unsanitary 
condition. Dr. W. says he never knew a family to live there 
six months without cases of illness or death. Since the occur- 
rence of the present disease the drains have been repaired 
and a trap affixed. 38 
Cerebro-Spinal Meningitis in Massachusetts. 
Cases II and 111. Marginal Street.—Two cases occurred 
here,—one a child, the other an adult male. The house hacks 
immediately upon the water, and is too low to allow of drain- 
age. The living-rooms are on the ground floor, and consist 
of a kitchen and sleeping-room. 
Case IY. A child, Middlesex Street, lower end.—Living- 
rooms on a level with street; basement or cellar falls off in 
rear, which is used as a cow-yard, and is foul and filthy ; sur- 
roundings also bad. A pool of stagnant water stands within 
two or three rods of the house. 
Case Y. A child, Maverick Street.—Living-room on first 
floor, level with the street, with basement or cellar falling otf 
in rear. In this basement was a bar-room where liquors 
were sold. A foul smell noticeable; land low, about one 
hundred yards from the water; drain said to enter the street 
sewer. 
Case YI. A child, Maverick Street.—House small; situa- 
tion low; surroundings bad; cow-yard twelve or fourteen feet 
from the house, foul and in bad condition; no cellar; no 
drainage possible. 
Case YII. A child. Central Avenue.—The house was shut 
and the family absent. Surroundings apparently good. Could 
learn nothing definite about the drainage. 
Case YIII. Adult male, corner of Central Avenue and 
Lynn Street.—Locality good; ground rather high; house 
new; surroundings apparently good. . Did not enter and 
inspect the premises for domestic reasons. 
Case IX. Adult male, Middlesex Street.—To a casual ob- 
server this house would seem to be well situated, with fair sur- 
roundings ; but on examining the premises it appeared there 
was a cellar, perhaps twelve or fourteen feet square, under 
the rear of the house, directly beneath the kitchen. The 
drainage from the sink of said kitchen passed into an open, 
Y-shaped wooden trough, and was thence conveyed across The Epidemic of 1873. 
39 
the cellar to the opening of a pipe three or four inches in 
diameter, not trapped, which conducts presumably to the 
street sewer. At the junction of the trough with this pipe 
the connection was so loose that the greater portion of the 
slops emptied directly upon the cellar floor, which was of 
boards laid upon the ground. A foul, strong and constant 
stench pervaded the cellar, which had no connection with the 
outer world other than by means of the stairway and door 
through the kitchen. It was stated that this patient was in 
the habit of rising early (4 to 5 A. m.), making arousing 
fire in the kitchen, and there reading his paper, etc., till he 
went to his work. To make clear the description above 
given, a diagram of these premises is subjoined. 
Section of Kitchen akq Cellar Case IX 
KITCHEN 
SINK 
STOVE 
STAIRWAY 
GROUND LEVEL 
CELLAR 
LEAK 
NO TRAP 
Case X. A child, Pratt’s Block, off Second Street.—This 
is in a row of wooden houses, of a mean class, in dilapidated 
condition, without cellars, and having their ground floor four 
feet below the level of the street; living-rooms on ground 
floor, comprising kitchen and sleeping-room, of eight-feet 
stud, dark and ill-ventilated; sink foul, its contents empty- 
ing directly upon the ground, A marsh comes up to within 
a few rods of the house. Yard uncleanly; the whole place 
redolent of bad smells. 
Case XI. A child, Auburn Street.—House old, dilapidated; 
basement-cellar flooded at times, and always foul and damp; 
no drainage. Twenty feet from house is a large pond of 
greenish water, into which flows the refuse from the Chelsea 
Laundry. A great mortality of children from cholera-infan- 40 
Cerelro-Spinal Meningitis in Massachusetts. 
turn and like diseases is reported in this locality in the hot 
months. 
I have given on a previous page the report of Dr. Wheeler, 
in which he states that all, or nearly all, the cases which have 
come to his knowledge, have occurred on the low, marginal 
lands, where the soil is to a greater or less extent saturated 
with moisture. " The same localities,” he says, "where they 
usually expect to find the majority of their cases in epidem- 
ics of typhoid, diarrhoea, etc.” 
Cambridge.—Accompanied by Dr. Wellington, I inspected 
the locality of such cases as he had been cognizant of in that 
city. 
Case I. A child, Somerset Street.—Surroundings bad; 
land loav and marshy; water at high tide comes up very 
near the house ; no cellar; no drainage. 
Case 11. Adult male, Webster Street.—House on a dry 
and sandy soil; surroundings fair; in the yard is a cesspool 
not connected with the street sewer. This patient was 
employed in a druggist’s store, under the Revere House, in 
Boston, and was seized suddenly while about his work and 
taken home for treatment. 
Case HI. Adult male.—House in near vicinity of the 
marsh; living-rooms on the ground floor; kitchen immedi- 
ately over a cellar which is very damp and foul. The patient 
was an old man, and spent much of his time in this kitchen. 
The house had been much complained of for its bad smells. 
Quite recently the house drain had been connected with the 
street sewer. 
Case IY. River Street.—Locality apparently all right. 
Premises not entered, but Dr. Wellington reports that to 
his knowledge no sanitary defects exist. 
Case Y. A child.—Locality, an Irish settlement on low 
land; a sort of hollow in which water collects after rain; 
no cellar; surroundings poor. The Epidemic of 1873. 
Case YI. Adult, Bigelow Street.—High and dry ; drainage 
good; to outside apjjearances everything all right; premises 
not entered. 
Case YII. A child, Austin Street.—Soil dry; drainage 
good; at very high tides water hacks up aud enters the cellar; 
this has not happened the last year. 
Case YIII. A child, Street.—Situation of house 
low; water comes into the cellar in winter aud spring after 
rains and thaws ; the occupants think it was more than usually 
wet last season; cellar floor covered with hoards partly 
decayed. 
Case IX. A child, Tremont Street.—House one story; 
surroundings had ; no drainage ; large pool of stagnant water 
about two rods distant. 
Case X. A child, Cambridge Street.—Land is low in rear; 
water from the sink empties into back yard direct; no drain- 
age ; cellar said to be dry. 
Case XI. A child, Rideout Street.—An Irish settlement; 
land low; soil heavy ; stagnant water in immediate vicinity; 
no cellar; no drainage. 
Case XII. A child, Cambridge Street.—Surroundings poor ; 
tide-water comes into the cellar at times. 
Case XIII. A child, Cambridge Street.—Locality some- 
what low ; living-rooms on second floor ; surroundings fair. 
Haverhill.—Dr. Crowell made with me a tour of inspection 
covering the undoubted cases which had come within his 
knowledge. 
Case I. Young man, Spring Court.—This case occurred 
in a row of tenement-houses of a good class, newly built, 
standing on rising ground, with good chance for drainage. Soil 
heavy; cellar damp, the water percolating through the walls 42 
Cerebro-Spinal Meningitis in Massachusetts. 
from the higher grounds beyond, and at times standing upon 
the floor of the cellar. At the time of our visit the moisture 
had been absorbed by a layer of gravel put upon the floor for 
this purpose; general aspect of the house cheerful and pleas- 
ant. 
Case 11. Adult male, Spring Place.—Kitchen and cellar in 
basement, the floor of which is a little below the general sur- 
face. An exceedingly offensive odor exhales from the sink- 
opening, filling the kitchen with a sickening stench. This 
kitchen connects by a stairway with the sitting-room where 
the patient had been accustomed to pass his evenings. 
Adjoining privies and sink-drains likewise in bad condition. 
Case 111. Adult male.—House of average quality, with 
cellar-kitchen; no noticeable odor about the house itself; 
cellar close and ill-ventilated; apparently not damp. A 
stable adjoins the house in rear, on land a little higher, the 
drainage from which must by gravity tend towards, if not 
enter, the cellar; privy of an adjoining house overflowing 
and producing an offensive odor. 
Case IY. A child, Mount Washington.—House about one 
hundred and fifty feet above the river, and some fifty rods 
distant; apparently dry and sandy surface; family lived in 
second story; there was a cistern in the cellar; the cellar 
itself in fair condition. 
Case Y. A child.—Locality about a mile from the town, 
elevated two hundred and fifty feet above the river; soil rich 
and loamy, with clayey substratum ; cellar very damp a great 
part of the time, water standing there sometimes to the depth 
of two inches or more. The family have sometimes fancied 
they perceived a foul odor and damp air coming up from the 
cellar, through the register-openings, into their sleeping- 
rooms; a bad smell from the privy, in close vicinity to the 
kitchen complained of. 
Case YL A child, rear of Primrose Street.—A crowded 
colony, of French mostly; surroundings bad; soil clayey; 
water stands after a rain ; no drainage. The Epidemic of 1873, 
43 
Case VII. Chestnut Street, off Water Street.—House on a 
declivity, perhaps forty feet above the river, and twenty rods 
from its northern bank; surroundings good; the water, how- 
ever, from the higher ground flows into the cellar, making it 
wet and foul, and often necessary to " put down boards ” ; had 
been very wet and damp just before patient was attacked; 
there was a disused well in the cellar, and an offensive odor 
in the sitting-room immediately over it; the drainage from 
the sink is carried into the garden a few feet from the house. 
Case VIII. Adult female, Green Street.—House appeared 
all right; cellar a trifle damp, but not wet; the flowage from 
the sink of the next house above is seen upon the surface 
about ten or twelve feet distant, and has been "complained 
of.” 
Case IX. Adult female, Auburn Street.—House small; 
soil clayey and damp; no drainage; cellar very damp ; two 
or three inches of water stands there, the exit of which has 
become stopped up; an offensive smell comes up the cellar 
stairway into the sitting-room immediately above; sink emp- 
ties into a hogshead set in the ground. 
Case X. A child, in " Portland Extension.”—House stands 
high; cellar in fair condition; the locality of this house is 
good; the sink-drainage stands where it is poured out, quite 
near the house ; but on the whole the hygienic conditions are 
favorable. 
Lynn.—ln company with Dr. Webster, I visited and exam- 
ined the localities and habitations where a majority of the 
well-authenticated cases of the disease had occurred. 
Case I. Oxford Street, between Willow and Ahnont,. right 
side.—Land low; surroundings poor. 
Case 11, A child, Willow Street, between Oxford and Lib- 
erty, left side.—The family occupied the upper story of an old 
house; shop underneath; land low; surroundings bad; the 
surface bestrewed with manure and garbage; a pool of stag- 
nant water near. 44 
Cerehro-Spinal Meningitis in Massachusetts. 
Case 111. Central Street, north side, near City Hall 
House surroundings fair. 
Case IV. A child, G Street, water side, in near vicinity of 
lumber yards This street skirts the harbor, is muddy, 
almost impassable in spring; soil saturated with moisture. 
Case V. Adult male, Pleasant Street, foot of Harbor Street. 
—Soil low and damp ; surroundings bad ; cellar always wet. 
The tide-water backs up through the drain, standing some- 
times a foot or more in depth; sink empties into hack yard 
direct; a pool of stagnant water near. There has been much 
sickness in this house during the past year, typhoid fever or 
rheumatism being almost constantly present. 
Case VI. A child, on the same street, and near the above.— 
House similarly situated ; cellar damp and uncleanly ; appar- 
ently no drainage ; bad smells. 
Case VII. A child, Tyrrell's Block, on Pleasant Street.— 
This block consists of several rows of wooden houses, all of 
the same build. The street, in this part, is "very muddy, 
and difficult to drive through in spring.” Land low ; surface- 
water runs readily into the cellar. It has water supplied from 
the water-works, and each tenement is furnished with a water- 
closet in the cellar. I learn that a fatal case of the disease 
occurred in this block six mouths previously. 
Case VIII. A child, Bond Street, west side.—General situa- 
tion and construction of tenement similar to that in preced- 
ing case. Land low, but the soil drier; cellar damp ; sur- 
face-water sometimes flows into it. 
Case IX. A child, Church Street, south side, quite near 
Lynn common.—Land somewhat low, but not damp; sur- 
roundings good; aspect of house and street cheerful and 
pleasant; no sanitary defects. 
Case X. A child, Emerson Street, west side.—Land low 
and flat; it is, however, dry and pleasant. Sanitary surround- 
ings good ; cellar in fair condition. The Epidemic of 1873. 
45 
Case XI. North Common Street, north side.—Surround- 
ings good ; premises not examined. 
Case XII. A child, Water-Hill Street.—lrish settlement; 
poor class of dwellings ; very near the mill-pond, formed by 
a sluggish stream which connects Flax Pond, or Wyoma Lake, 
with Saugus River. 
Case XIII. A child, Boston Street, north side, near Rad- 
din Court and near the Saugus River.—Ground marshy in 
near vicinity; surroundings generally poor. 
Case XIY. Raddin Court, north side, near the last case.— 
Position higher; soil apparently dry. 
Case XV. Winter Street, south side, midway between 
Stony and Strawberry Brooks.—House small and poor; land 
wet; drainage bad. 
Case XVI. Washington Street, near Main, north side.— 
Land low; house better than ordinary; apparently no drain- 
age. 
Case XVII. A child, Laighton Street, south side.—House 
of one story, with cellar and attic; stands comparatively high ; 
cellar damp, and water backs in from drain. 
Case XVIII. Off Jenness Street.—North side of Wyoma 
Lake, and within three or four rods of its margin; behind is 
a rocky and fairly wooded hill; surroundings apparently 
good. 
Case XIX. On the same side of the pond and just upon its 
border; surroundings good. 
Case XX. Near Browne’s Pond, east side.—Surroundings 
good. 
Case XXI. A child, Browne’s Block ( Wyoma).—East side 
of Main Street ayd close to the westerly point of Flax Pond. 46 
Cerebro-Spinal Meningitis in Massachusetts. 
Locality bad ; marshy grounds, saturated with stagnant wa- 
ter, in rear; close by is a water-course connecting Wyoina 
and Wenuchus lakes. 
Case XXII. Boston Street, east side, near the lakes.— 
House small, of two stories ; in the lower is a barber’s shop ; 
ground in rear of house marshy and low. Two cases occurred 
in this house. 
Case XXIII. Adult male, Lake Street (Glenmere).—This 
was an old man who lived alone in a small tenement, with a 
wood-house or lumber-room beneath, twenty rods or so from 
Flax Pond; surroundings poor; no drainage. 
Case XXIY. Adult female, Lake Street, east side.—About 
the same distance from Flax Pond as the preceding case. 
Sanitary surroundings good; cellar in fair condition ; drinking- 
water obtained from a pump near by; drains apparently all 
right; vegetables stored in the cellar. 
Case XXY. A child, Maple Street, east side.—Distant one 
or two rods from Flax Pond. Premises not examined. 
Case XXYI. A child, Fayette Place, north side.—Small 
tenement; no drainage ; stagnant water after a rain. A few 
rods north of this house is a small pond. 
Case XXYII. A child, Fssex Street.—House has two 
stories and an attic ; in fair sanitary locality, airy and pleas- 
ant ; but there is a hollow in the near vicinity, on the west 
side and across the road, where the soil is wet and heavy and 
water stands after a rain. In other respects, surroundings 
good. 
Case XXYIII. Amity Street, lower part.—The locality is 
low, near the margin of salt water, with marshy grounds 
around. 
Four other localities were visited, but the premises were not 
examined. They all had apparently good hygienic surround- 
ings. The Epidemic of 1873. 
47 
Salem.—But comparatively few cases have occurred in this 
city. Early in the season, I examined, with Dr. Johnson, the 
following localities, where he had heard of the existence of 
the disease : 
Case I. Daniels Street, off Derby Street.—Now a dilapi- 
dated portion of the town; near the harbor; sanitary sur- 
roundings fair. 
Case 11. A child, Pratt Street, off High Street.—Surround- 
ings generally poor. This is a sort of court, near the mill- 
pond. 
Case 111. A child, Webb Street.—This street skirts Collins 
Cove ; land is low; hygienic conditions poor. 
Case IV. Adult female, South Prospect Street—This local- 
ity is almost on a point of land, having water on three sides. 
Sanitary surroundings fair. 
We now present, in briefest form, an analysis or resume, of 
the principal facts and circumstances received in answer to 
the series of questions before stated. 
The details, more or less complete, of five hundred and 
seventeen cases, are given. All ages, occupations and nation- 
alities were alike amenable to the disease. The age of the 
youngest patient on the record is five weeks, that of the old- 
est seventy years. Two hundred and thirty-one were males, 
and two hundred and eight were females; in seventy-eight 
the sex was not stated. The character of the attack in the 
large majority of instances was sudden, without premonition 
or previous noticeable illness. 
The earlier and later symptoms correspond very nearly 
with those I have named as belonging to the disease in a 
former part of this paper,—violent, often excruciating, pain, 
referred to the back part of the head and neck, with muscular 
stiffness and a tendency to retraction of the head, great sen- 
sitiveness of the surface, restlessness and jactitation, with irreg- 
ular panting respiration and delirium, mostly of a superficial 
character, were the prominent symptoms. 48 
CerebroSpinal Meningitis in Massachusetts. 
The condition or circumstances of the patients, whether easy 
or otherwise, were pretty evenly balanced. 
The disease prevailed most extensively during the spring 
months. Of three hundred and ninety-four cases in which 
the date of the attack is definitely stated, ten began in Janu- 
ary, twenty-five in February, eighty-four in March, one hun- 
dred and sixteen in April, ninety in May, thirty-seven in 
June, ten in July, eight in August, five in September, seven 
in October, one in November, and two in December. The 
first recorded case bears date January 6th. Relapses or de- 
cided remissions are referred to only in a minority of instances. 
The shortest recorded duration of the disease is two hours, 
the longest six months.* 
It would be out of place here to enter upon the question of 
treatment. From the evidence in hand, we feel bound to say 
that no line of therapeutical management can absolutely con- 
trol or cut short the disease, though much can be done to 
comfort and relieve the patient. The mortality in the five 
hundred and seventeen cases adduced was a little less than forty- 
four per cent. This goes to confirm the opinion expressed by 
many of our correspondents, that, compared with former epi- 
demics of which we have record, the present visitation must 
be considered a mild one. The post-mortem records of the 
epidemic are few and meagre; but the developments, so far 
as observed, tally with the already chronicled facts in the 
pathological history of the disease. 
The locality is stated in four hundred and forty-six cases. 
It is said to have been " low and damp ” in one hundred and 
thirty cases, "low and dry” in thirty-seven cases, "low” 
in eighteen cases, "damp” in twenty-one cases. It was 
" high and dry ” in eighty-nine cases, " high and damp ” in 
seven cases, "high” in twenty-two cases, "dry” in sixty- 
one cases. It was said to be "medium” in sixty-two cases, 
and in seventy-one cases the nature of the locality is not 
stated. By this it will be seen that the low or damp element 
is somewhat in the ascendant. 
* As a complication, or sequel, of this disease, ophthalmic affections are not unfre- 
quently observed. So also affections of the ear, resulting in deafness, are not un- 
common. We are permitted by Dr. Clarence J. Blake to refer to his private note- 
book for the year ending Oct. 1, 1873, from which we derive the following facts. The Epidemic of 18 73. 
49 
Has the disease prevailed among animals ? Returns from 
Boston, Brighton, Charlestown, Fall River, Lynn, Newton, 
Stockbridge, Wakefield and Worcester, all speak of the ex- 
istence of the disease, to a greater or less extent, among ani- 
mals. Horses and cows appear to have been most often 
affected; after that hens and chickens, and in some instances 
dogs and cats; so that the cognomen, "pandemic,” as ap- 
plied to this disease by a recent medical writer, is not wholly 
inapt, though of somewhat questionable etymology. The 
following account of the disease, as it appeared to a consider- 
able extent among horses in New Bedford, has been furnished 
by Dr. O. H. Flagg, a well-informed and reliable veterinary sur- 
geon of that city. Under date of July 9th, 1873, Dr. F. writes 
as follows ;—" Since the first of January, sixteen cases of the 
so-called cerebro-spiual meningitis have come under my ob- 
servation and treatment. Of these, fifteen were horses and 
one a calf four months old. The ages of the horses varied 
from five to sixteen years ; two only were over twelve years 
old; nine were males, six were females. Their symptoms 
were as follows ;—They were attacked with violent pain, fol- 
lowed, in most of the cases, with a rapid swelling of the 
lumbar and sacral muscles, which became as rigid and hard as 
iron. After the subsidence of this condition the muscles be- 
came exceedingly lax and flaccid, with more or less impaired 
contractile power, but without entire paralysis. In one case 
the muscles of only one side were affected; in others this af- 
fection showed itself more severely on one side than the other. 
The sensation continued intact. There was, in many cases, a 
Twenty-seven cases of deaf-mutism came under his observation in the time named, 
the origin of which he clearly refers to cerebro-spinal meningitis. Commenting upon 
these cases, he writes as follows :—“ The majority of the cases of deaf-mntism result- 
ing from cerebro-spinal meningitis, were presented for examination within four 
weeks from the time of the attack. In most of them the history was the same,—the 
child having heard well before the illness, and the deafness being first noticed when 
convalescence began. In a few cases the deafness was noticed early in the disease. 
In the majority of cases, moreover, the external and middle ears were in a compara- 
tively healthy condition, the exceptions being traces of slight catarrhal inflammation 
of the middle ear, not sufficient to account in any degree for the deafness, which was 
in all but two of the cases, so far as could be ascertained, total. In these two cases 
there was hearing for loud noises. It is probable that the sound of their own voices 
in speaking was heard by some of the remaining patients, but their age rendered it 
difficult to determine this point.” All the cases above referred to were children, the 
youngest being two and the oldest twelve years of age. 50 
Cerebro-Spinal Meningitis in Massachusetts. 
scanty secretion or complete suppression of urine; in others 
very high-colored urine, and great difficulty in evacuating the 
bladder. In eight of these cases opisthotonos was well 
marked; in three the muscles of the neck and fore extremi- 
ties became swollen like those of the lumbar region before 
described. There was partial coma in two cases, i. e., the 
calf and one horse. They could, however, be easily roused at 
any time. I saw no evidence of active delirium. In one 
case there was paralysis of the optic nerve of the left eye, 
commencing two days before death. My treatment consisted 
of fomentation of the affected parts with blankets dipped in 
hot water, which were covered with dry cloths to prevent 
evaporation; alternating with this the parts were bathed 
freely with ammonia and camphor-lotion, repeating the pro- 
cess until the pain subsided. Internally cathartics and diuret- 
ics were administered, followed, as improvement advanced, 
by nervous stimulants and tonics, along with good diet. Three 
of these animals died, and one other will probably succumb 
to the disease ; the other twelve are convalescent. The dura 
tion of the disease was from five to fifteen days. The condition 
and situation of these animals, as to place of abode, general 
care, usage, etc., were decidedly varied. The post-mortem 
appearances were a general congestion of the psoas and iliac 
muscles, and also of the external lumbar and sacral muscles. 
The meninges of the posterior part of the spinal cord were 
inflamed, with a quantity of colored fluid in the canal, the 
amount of which I was unable to measure. The vessels of 
the arachnoid were full to distention, and, in spots, this con- 
dition seemed to dip down into the cord itself. There were 
petechial spots extending over the dorsal portion of the cord. 
The kidneys were inflamed (or, perhaps more properly, con- 
gested) and enlarged.” 
It remains to see if, from all the evidence we have adduced, 
any reasonable deductions can be drawn which shall throw 
some light upon the vexed question of the etiology or cause 
of this affection. It is well known that during the autumn 
months of the preceding year a remarkable and wide-spread 
disease, of the influenza type, prevailed among horses. This 
State suffered among others, though not, as I am aware, with 
exceptional severity. It was a common prediction with some The Epidemic of 1873. 
of our most intelligent medical observers that an epidemic among 
human kind would probably follow. In this State such pre- 
diction was certainly verified. With the advent of cold 
weather came an unparalleled visitation of small-pox, the like 
of which, for its wide extent,—for virulence and fatality,—had 
not been known since the times of Jenner. This epidemic 
ran its course, and subsided with the disappearance of the ex- 
treme cold weather of midwinter. Co-incident with this 
subsidence arose the epidemic with which we have now to 
deal, and which has prevailed, as we have seen, to a greater 
extent than ever before in this State. These are curious facts, 
—perhaps nothing more. 
We have long been familiar with what is called, for want 
of more definite knowledge, a prevailing epidemic influence, 
—a certain something which pervades the air, and rests like a 
baleful shadow on the land. Its very mystery adds to its 
force, and tends to excite terror and dread among the people. 
This, in medical parlance, is called a remote or general cause 
of disease. It prevails in certain years, or at certain seasons 
of the year, and threatens all alike. But there are immediate 
or exciting causes which, at such times, determine the indi- 
vidual attacks. In some diseases these proximate causes are 
well known—e.g., in small-pox it is direct contagion ; in 
typhoid fever it is bad drainage or impurity of the air, or 
water, or food, or all together; in typhus, it is contagion and 
insanitary influences combined. 
But in the affection under consideration its origin or imme- 
diate cause is not so clear. We have seen that the condition 
in life and the nature of the locality do not seem to have ex- 
erted any positive controlling influence in the production of 
the disease; neither extreme cold nor heat seems especially 
to favor its propagation; nor do we find any just grounds 
for relief in contagion as a specific cause. 
The relation of insanitary conditions in and around the 
abode of the patient to its origin or supposed cause, demands 
the most careful consideration. In weighing the evidence 
contained in the returns, I find the scale to be pretty evenly 
balanced in this particular. The cases are distributed among 
all classes and grades of society,—the high and the low, the 
rich and the poor, locations unexceptionable for situation, 52 
Cerebro-Spinal Meningitis in Massachusetts. 
open to abundant light and air, and the pent-up hovels of the 
lowly and wretched, have all contributed to the material of the 
epidemic. We believe, therefore, that the primal origin of 
the disease is atmospheric, and, for the present, beyond our 
ken. 
It would seem, however, from the multitude of facts that 
have hitherto been collected, that, in times of epidemic influ- 
ence, in this as in other diseases of a kindred nature, any de- 
fect of known hygienic and sanitary conditions in and about 
the patients’ residence may, if his system be otherwise made 
ready or predisposed, through want, deprivation, mental or 
physical exhaustion, anxiety, or other depressing cause, tend 
to precipitate an attack, while under other circumstances he 
might be able to withstand the general epidemic tendency and 
ward off the disease. We need only refer to the mass of evi- 
dence contained in the communications of our correspondents, 
added to our own personal investigations, as detailed in the 
preceding pages of this report, for confirmation of this view. 
Our conclusions, therefore, while they must be, in the main, 
negative as to the existence of any definite exciting cause 
which, under all circumstances, will produce the disease, lead 
us to say with confidence that those communities, towns or 
cities whose sanitary regulations are strictest and best observed 
will be most likely to escape. Nor does it follow from the 
evidence adduced that any system of general municipal sur- 
veillance merely will suffice. It must be carried into the 
houses and daily resorts of the people. It rests equally upon 
the citizen as upon the city, to provide himself with all the 
means of safety in his power; to be vigilant to foresee and 
bar the approach of danger in the shape of houshold nuisances 
and impurities of every kind; to keep himself and his family 
from unnecessary exposure and excesses, and to govern wisely 
the walk and conduct of his daily life. While, therefore, we 
do not agree with some recent writers upon this subject, who 
boldly attribute the origin of the affection to these insanitary 
conditions themselves, we cannot resist the conviction that 
they are more than mere concomitants and accidents of the 
disease, and we must find in the lesson of the present epidemic 
the injunction of a stricter regard for the known requirements 
of hygiene in our habitations and our homes.