REPORT ON THE ZYMOSES OF 1857, 
AS THEY OCCURRED IN THE 
MIDDLESEX EAST DISTRICT MEDICAL SOCIETY. 
BY EPHRAIM CUTTER, M.D. 
OF WOBURN. 
The report embraces the towns of Melrose, Reading, 
Stoneham, West Cambridge, Wilmington, Winchester, 
Woburn and Burlington. The physical characters of this 
portion of Middlesex County are not peculiar. Based on 
a formation of syenite, hornblende slate, gneiss, green- 
stone and trap rock, the surface is uneven and considera- 
bly diversified with the usual share of New England hills 
and valleys. This area is well watered by ponds and 
perennial streams. These collections of water are not 
generally stagnant. 
A considerable portion is cultivated. Not a small frac- 
tion is covered with forests, while some rocky and barren 
tracts are not wanting. 
The population, in 1855, was about 18,000. The occu- 
pation is mainly the manufacture of shoes and leather, and 
agriculture. Some of the population may be termed 
semi-urban residents-those who spend their business 
hours in the city and their nights in the country. Since 
the introduction of railways this class has increased very 
rapidly, and their families afford many cases of disease. 
The general condition of the people is good. For the 
1 2 
REPORT ON ZYMOTIC DISEASES 
most part they have a moderate competence, are tolerably 
well educated, and perhaps have a higher morale than the 
neighboring urban population. 
This report includes only the Zymotics, which consti- 
tute about one-tenth of all diseases. The term is derived 
from the Greek, and signifies a leaven or ferment. It is 
applied generally to diseases 11 induced by some specific 
body, by the want of proper nourishment or by the bad 
quality of food "-thus including Epidemic, Endemic and 
Contagious complaints. The Zymoses are a very nume- 
rous class of fatal agents, producing about 29 per cent, of 
all the deaths in Massachusetts.* For this reason, and 
because of their amenability to treatment, prophylactic 
and curative, they were selected for the present report. 
The following items only, are particularized-namely, the 
number of cases as mild, severe, and fatal, and the time 
when they occurred. 
A practising physician cares more to know cases and 
their characters, than any other particulars. Age and sex 
were not enumerated, though of great importance, for 
fear of embarrassing the notation. To multiply particu- 
lars in blank forms for registration, is to diminish its ac- 
ceptability by making it a matter of too much trouble to 
fill it out. Perhaps the reason why registration efforts 
have so often failed, is that the blanks have been over- 
loaded with details, and thus physicians, especially those 
in full practice, whose returns are most desirable, have 
dropped the whole matter, as requiring more time than 
could be spared. The blanks in the present case may 
appear meagre, but they had the advantage of being 
readily filled, the particulars being natural and easy to be 
remembered. 
Several causes mar the correctness of the report, but 
* 15th Registration Report of Mass., p, 232. IN THE MIDDLESEX EAST DISTRICT. 
3 
they occur in any like registration. (1) All cases are not 
reported. This happens from the remissness of physi- 
cians, from the patients being treated by irregular practi- 
tioners, and from no doctor at all being called-as occurs 
often in scarlatina, rubeola, varicella, &c. (2) Mistakes 
of diagnosis-the want of calling things by their right 
names. This trouble is found in all departments of soci- 
ety. (3) Reporting of consultation cases-one patient 
thus counting two or more. These are the chief sources 
of error in the present instance. 
Some of the gentlemen have stated that their returns 
were not full, from the fact that a patient's name was in- 
sufficient to recall his disease. The Physician's Visiting 
List, of Lindsay and Blakiston, furnishes an opportunity 
of easy registration, which would remedy this difficulty, if 
the column intended for the Amount of Bill at the week's 
end be used for noting down the disease. 
Two tables are appended. Table I. is a summary of 
the returns, with the percentages of Mild (M.), Severe 
(S.), and Fatal (F.), for each disease. Table II. is in- 
tended to show at a glance the variations in the preva- 
lence of certain of the Zymoses. The points, on the right 
of the spaces, headed Jan., Feb., &c., which on the scales 
placed to the left, give the number of cases for the months, 
are connected by lines of different characters. A distinct 
line and a distinct scale is appropriated to each disease. 
By following a line from one month to another, an idea 
is easily gained of the prevalence of the disease indicated 
by the line. ZYMOSES, 1857. 
1 J AX. 
Feb. 
March 
April 
May 
June 
July 
Aug. 
Sept. 
Oct. 
Nov. 
Dec. 
TOTALS. 
SUM. 
Percentages. 
Characters. 
M S F 
M S F 
M S F 
m|.S | F 
MS F 
M S F 
M S F 
M S |f 
M S F 
M S j F 
M S F 
m| 8|f 1 
M S F 
M | S F 
Carbuncle 
1 2 
1 
fl 
1 1 
2 
2 1 
2 
1 
7 8 
15 
47 53 
Cholera Asiatica .... 
" Infantum .... 
1 1 
6 7 
11 6 3 
25 17 7 
9 4 1 
2 
4 4 1 
56 41 12 
109 
51 38 11 
" Morbus .... 
1 
1 2 
1 
2 1 
1 1 
5 4 
813 
26 20 
2112 
13 2 
2 
5 
84 57 
141 
59-5 40 
Croup, Pseudo-Membranous 
4 
2 
1 1 
1 
1 1 
1 1 
1 1 2 
1 
4 4 10 
18 
22 22 55-5* 
" Catarrhal .... 
3 2 
10 1 
5 1 
6 
1 2 
1 
2 
3 
2 2 
7 1 
16 9 1 
54 20 1 
75 
72 27 1 
Dysenteria 
1 
11 
2 
6 5 1 
8 8 
4218 3 
30 8 4 
1 
88 42 8 
138 
64 30 6 
Diarrhoea 
1 
1 
9 4 
12 2 
19 
13 
27 25 
33 13 
15 6 
3 
7 
140 50 
190 
74 26 
Erysipelas 
3 2 
3 
12 1 
2 
2 
3 
1 1 
5 1 
1 4 
21 9 2 
32 
66 28 6 
Febris Intermittens . . . 
1 1 
1 1 
2 
1 
2 4 1 
7 
29 57 14 
" Puerperalis .... 
1 
2 1 
1 
1 
3 
. 1 
2 1 
10 2 1 
13 
77 15 8 
" Typhoides .... 
! 5 2 
1 
2 1 
1 2 
1 
112 
9 4 
7 11 
21 5 
13 8 
7 2 
5 
71 27 4 
102 
70 26 4 
" Typhus 
1 
1 
2 
2 
100- 
Influenza 
15 8 
17 22 
11 6 
9 18 1 
17 9 2 
6 4 
3 2 
3 4 
5 7 
44 16 2 
30 15 1 
23 8 
183 119 6 
308 
60 38 2 
Parotitis 
2 1 
3 4 
1 
5 6 
11 
45 54'5 
Pertussis 
2 
1 
3 1 
2 8 1 
1 2 
1 5 
16 1 
7 5 2 
33 13 
49 42 4 
95 
51 44 4 
Rheumatismus 
! 5 7 
3 1 
3 3 
3 6 
2! 5 
3 
1 
1 
5 
2 2 
5 4 1 
32 34 1 
67 
55 43 1 
Rubeola 
3 
1 3 
1 
4j 1 
1 
5 4 
9 
55'5 44 
Scarlatina 
23 17 3 
32 4 2 
18 8 5 
14 7 2 
9 6 3 
7 110 2 
3 5 
3 
13 1 
8 
18 6 2 
15 4 
163 68 19 
250 
65 27 8 
Varicella 
2 
1 
4 
4 
9 2 
11 
82 18 
Variola 
Varioloid 
Characters. 
M | 8 F 
1 
M S F 
M| S | F 
m[s|f 
m| s |f 
m| s |f 
m|s|f 
M S F 
M S F 
M 8 F 
M S F 
M S |f 
M | S F 
M S | F 
ZYMOSES, 1857. 
Jan. 
Feb. 
March 
April 
May 
June 
July 
Aug. 
Sept. 
Oct. 
Nov. 
Dec. 
Totals. 
Sum. 
M - mild. 
6o'38! 7 
69 | 4 
53|31|9 
34[36 3 
531281 6 
5o'29| 4 
52 46 4 
03j71| 4 
171|82|11 
141]60 10 
88 36 6 
119[47| 3 
983 539| 71 
1593 
'62 33-51 4 
S - severe. 
* Decimals over .5 are 
F- fatal. 
105 
108 
93 
73 
87 
83 
102 ; 
168 
264 
211 
130 
169 
1593 
called the next numb.; 
below .5, no account is 
made of them. 
Table I. ZYMOSES IN THE MIDDLESEX DISTRICT. 
5 
It is hoped that this report, however meagre, may be 
the beginning of a registration of all diseases by the Fel- 
lows of the Massachusetts Medical Society, certainly 
throughout Middlesex County if not the State. Such a 
registration, besides being a valuable contribution to hu- 
man knowledge, would form a new bond of union among 
physicians. It would improve them in diagnosis, and it 
would combat quackery by showing that the regular pro- 
fession is hard at work in careful observation of the march 
of disease. 
We now proceed to remark upon some of the facts 
found. 
Zymoses. - These amounted to 1593 cases. 62 
per cent, were mild, 33-5 per cent, severe, and 4 per 
cent, fatal. On the whole, for the first seven months of 
the year, the number reported was much the same-the 
highest being 105 in January, and the lowest 73 in April. 
The healthiest months were April, May and June. These 
months, it will be recollected, were very wet. In fact; 
such was the case during the whole spring. Does not this 
confirm a statement made by Dr. John Ware, in a lecture 
at the Massachusetts Medical College in 1855-6, that 
wet weather is the healthiest ?* From 102 cases in July, 
the Zymoses ran rapidly up to 264 cases in September. 
In October, they descended to 211 cases, and continued 
to go down the next month to 130, finally ending the year 
with a slight rise, 169 cases. September was the sickliest 
month. The diseases which prevailed then, taken in order 
according to number, were dysenteria, cholera infantum, 
diarrhoea, cholera morbus, typhoid fever and scarlatina. 
Now this month was a very pleasant, dry, and cool 
month. The sun rose for days in a clear sky, and set 
* Dr. Ware has since remarked that this assertion was broader than the 
one he avowed. It must be remembered that the expression here is applied 
only to the Zymoses. 6 
REPORT ON ZYMOTIC DISEASES 
without a cloud. Fires were almost needed in houses. 
Still this dryness, coolness and pleasantness did not ex- 
empt September from furnishing, in this district at least, 
the largest number of cases of the Zymoses. This would 
also support Dr. John Ware's assertion. Will the mild- 
ness, that was so unusual, of the weather in the latter 
part of autumn and the commencement of winter, explain 
the less amount of disease which happened then ? (Vide 
Table II.) 
Carbuncle.-The propriety of placing this disease in 
the present list, may be doubted. Still, Erasmus Wilson, 
in his late work on Diseases of the Skin, speaks of its 
prevalence as an epidemic in London during 1852 to 1856, 
and a writer in a late number of the Lancet alludes to its 
prevalence there still. Number reported here, 15; 7 
mild, 8 severe-the latter exceeding the former, which is 
unusual in this report. 
Cholera Infantum.-(Vide Table II.) The number of 
reported cases of this disease, which from its commonness, 
obscurity and fatality, challenges the interested attention 
of every physician, was 109; 51 per cent, mild, 38 per 
cent, severe, and 11 per cent, fatal. For the first five 
months there was no case reported. It commenced with 
two cases in June. The largest number occurred in 
September, August next, and October next. Those 
months were the most fatal in Massachusetts for the past 
eight years. In 1856, 118 deaths from cholera infantum 
were reported in Middlesex County, or one death in about 
every 1644 of population. In the present instance the 
deaths were about one in every 1500. The cases were 
about one in every 165 of population. The prevalence 
in localities cannot be estimated with accuracy; still an 
approximation, in proportion to the population, is as fol- 
lows:- Stoneham, Winchester and Woburn. The first 
town had one case in every 81 of population; the second, IN THE MIDDLESEX EAST DISTRICT. 
7 
one in 82; the third, one in 116. These estimates arc 
only approximatively true. Stoneham is higher and drier 
than Winchester. Woburn is more elevated than Win- 
chester. It is very well watered. Winchester is unusu- 
ally supplied with ponds, and has a large quota of semi- 
urban residents and well-to-do farmers. 
Cholera Morbus.-141 cases; 59-5 per cent, mild, and 
40 per cent, severe. It is reported in every month, but 
prevailed in the warm months. In July, the severe cases 
predominated. The largest number of cases occurred in 
September. 
Pseudo-Membranous Croup. - 4 mild, 4 severe, and 
10 fatal cases reported. This is the only Zymotic, in 
the present report, in which the deaths exceeded the 
mild and severe, singly and collectively. 
Spasmodic Croup.-Out of 75 cases, one was fatal. 
This shows the comparative innocuousness of the common 
croup, about which anxious parents are so much alarmed 
-as every practitioner knows. 
Dysenteria.-(Vide Table II.) 138 cases; 64 per 
cent, mild, 30 per cent, severe, and 6 per cent, fatal. It 
prevailed in July, August, September and November. 
Nearly one half of the cases occurred in September-that 
clear, cool, dry and pleasant month. 3 cases were fatal in 
September. In October, one-tenth of the cases were fatal. 
Puerperal Fever.-13 cases; 10 mild, 2 severe, and 1 
fatal. If our data are correct, we might argue against 
the contagiousness of this fever, as it is reported in iso- 
lated periods--viz., January, March, April, July, August, 
October and November. Still, 4 of these happened to the 
practitioners of one town, and 4 to one physician (1 in 
March, 1 in April, and 2 in August). So that the report 
might be turned to either side of the question. One gen- 
tleman who reported three cases, stated that they all had 
metritis. 8 
REPORT ON ZYMOTIC DISEASES 
Erysipelas.-32 cases, of which 2 were fatal. It was 
most prevalent at the beginning and close of the year. 
The deaths occurred in March and November. Cases of 
erysipelas and puerperal fever did not occur contempora- 
neously in one man's practice. 
Typhoid Fever.-(Vide Table II.) 102 cases; 70 per 
cent, mild, 26 per cent, severe, and 4 per cent, fatal. 
Thus there was one death in 25 1-2 cases. " Out of 140 
cases observed by Louis, 52, more than 1-3, were fatal; 
while in 134 treated by M. Piedaguel, there were 19 
deaths, or about 1-7. In the Massachusetts General Hos- 
pital, in the year 1830, the deaths were one in three and 
a half; in 1831, one in fourteen and a half; and in 
1827, one in twenty-five. From November 1836, to 
November 1838, there were 55 cases without a death."* 
September furnished 26 cases-the largest number for 
one month. October reported 21. There was no month 
without a case. A physician writes-" In regard to the 
two cases of typhoid fever reported, I consider them both 
the consequence of solitary vice-both occurred in young 
men of 18 and 22 years." 
Influenza.-(Vide Table II.) This furnished the larg- 
est number of the Zymoses-308; 60 per cent, mild, 38 
per cent, severe, and 2 per cent, fatal. It was most pre- 
valent in October. 
Pertussis.-49 mild, 42 severe, and 4 fatal cases. The 
last quarter of the year had more than two-thirds of the 
whole. Of these, 46 occurred in December, none of which 
were fatal; while in November, out of 14 cases, 2 were 
fatal. With the exception of two cases in February, and 
one in March, the whooping cough did not occur till June. 
After this, it is found in every month. Dr. Condie (Dis. 
of Children, 4th ed., p. 366) writes, " it is most common 
* Wood's Practice of Med., Vol. I., p. 342, 4th Edition. TABLE II.BEPRESENT1NG THE PREV.UEXCEAS REPORTED P.Y THE MIDDLESEX EAST DISTRICT AIEDTCAL SOCIETY, DURING1857.UF 
theZymoses i Cholera Infantum, Dysenteria , Influenza > Typhoid Fever.-i-i->-I-i-»Scarlatinao-c^e^^-e^^-Q^^e-©-©^-0^ ♦ and Fatals » » J* >♦ • 
Zymoses 
Cholera 
Infantum 
Dys- 
entetia 
In- 
fluenza 
Typhoid 
Fever 
Scan- 
latina 
Fatals 
Jan . 
Feb. 
March 
April 
May 
J une 
July 
J 
Aug. 
Sept. 
Oct. 
Nov. 
Dec. 
264 
SCALES 
Graduated to 
260 
-250- 
40 
EACH DISEASE 
240 
45 
I the hues 
endon the 
-230 - 
46 ~ 
-11 
right af the 
| spaces headed. 
-220 - 
- 44 
43 
<ooo oo oo e-o-en 
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\Jan.Feb&C'. 
i at the pair it 
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the number 
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63 
£2 
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-60- 
60- 
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- io 
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-38- 
-57 - 
57 
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/ / 
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S 1 
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36 
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-/70 - 
-34 ~ 
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-150 - 
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45 
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on the scales 
; is marked 
43. So there 
were 43cases 
• of Scarlet 
Fever ui Jan 
/4O - 
-28- 
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- 42- 
L8 ~ 
- 7 - 
X 
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The same 
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1 were 8cases 
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- 
Zymoses 
Cholera 
Inlhnluin 
Dys- 
enteria 
In- 
fluenza 
lyphoid 
Fever 
Scar- 
latina 
Kitais 
Jan . 
Feb. 
March 
April 
May 
June 
July 
Aujr. 
Sept. 
Oct. 
Nov. 
Dec. 
S. (fritter Jies 
Cc-f ZiCft - ■ IN THE MIDDLESEX EAST DISTRICT. 
9 
in spring and autumn, especially when cold and damp. It 
has been found frequently to prevail most extensively be- 
fore, during or after the occurrence of epidemic measles." 
This statement is supported, as since December the 
measles have prevailed here to an extent hitherto almost 
unknown. 
Rheumatism.-32 mild, and 34 severe cases. The 
predominance of the severe over the mild, is unusual in 
this return. 41 cases happened in the first half of the 
year. The months taken in order, according to the larg- 
est number of cases, are January, December, April, May, 
March, September, October, February, November, June, 
July and August. There were 7 deaths from rheumatism, 
in Middlesex County, in 1856. 
Scarlatina.-(Vide Table II.) 250 cases; 65 per 
cent, mild, 27 per cent, severe, and 8 per cent, fatal. In 
the first six months, 172 cases were reported, against 
78 in the latter six. There were 17 deaths in the first 
six months, or one in ten cases. In the latter six, there 
were two deaths, or one in 39 cases. March was the 
month of greatest fatality-5 deaths being reported, 
or one in six and one-fifth cases. May had one death 
in six cases, June one in nine and a half, April one in 
eleven and a half, January one in fourteen and one third 
and February one in nineteen. The two fatals of the 
latter half of the year came in November, or one death 
in 13 cases. 
Scarlet fever, as a cause of death, stands the third 
on the list in Massachusetts. 
Stoneham reported the largest number of cases, Win- 
chester next, and Woburn next. Average to the popu- 
lation-Stoneham, one case to every 23 1-2 of inhabi- 
tants; Winchester, one to about every 28; Woburn, one 
to about every 117. This must be received "cum grano 
salis." 10 
REPORT ON ZYMOTIC DISEASES. 
It is interesting to observe the parallelism between 
scarlatina and cholera infantum, as regards their preva- 
lence in towns. (Vide Choi. Inf., supra.') One gentle- 
man thus writes: "The case of'scarlatina in December, 
was sporadic; a boy from Portland, Me., who came 
here in the cars, the disease prevailing there extensive- 
ly." Another states that " the scarlatina here has been 
mild, and the case herewith reported as fatal was render- 
ed so, more by a feeble, scrofulous constitution, than by 
the severity of the malady." 
Intermittent Fever.-2 mild, 4 severe, and 1 fatal. 
These were all imported,. it is believed. The severe 
were double the mild. This is unusual in the present 
return. 
Fatals.-(Vide Table II.) Out of a total of 1593 
cases embraced in this report, 71, or about 4 per cent., 
were fatal. September had the largest number of deaths. 
The following table represents the fatality of each month, 
proportioned to the number of cases: 
January, one death in 15 cases. 
February, " 11 "27 " 
March, " " "10 1-3 " 
April, " " " 24 1-3 " 
May, " " " 14 1-2 " 
June, " " " 20 3-4 " 
July, « " " 25 1-2 " 
August, " " " 42 " 
September, " " " 24 " 
October, " " " 21 1-10 " 
November, " " "21 2-3 " 
December, " " "56 1-3 "