From Seventh Report of the Massachusetts State Board of Health. 
REPORT 
ON THE 
REGISTRATION OF Pill! IBM 
By F. W. DRAPER, M. D. 
Of BostcJW. 
BOSTON: 
WEIGHT &, POTTER, STATE PRINTERS, 
79 Milk Street (corner of Federal). 
1876. With the Compliments of 
Dr. F. W. DRAPER, REPORT 
ON THE 
REGISTRATION OF PREVALENT DISEASES. 
By F. W. DRAPER, M. D., 
Op Boston-. REPORT ON REGISTRATION OF PREVALENT DISEASES. 
The desirability of a trustworthy method for the registration 
of prevalent diseases is undisputed. Sanitarians have repeat- 
edly expressed the want, but have failed hitherto to realize its 
fulfilment. They know how much greater would be their 
power to protect the public health, if data of the local develop- 
ment and progress of disease were promptly afforded to them. 
They recognize the fact that the utility of such a registration 
is amply illustrated in the control which boards of health 
exercise during invasions of small-pox prompt measures of 
prevention by isolation being thereby made possible for the 
defence of the entire community. In a still broader sense, 
they see the great advantage which would result from the 
opportunity to study the rise and fall of epidemics, and the 
development of diseases whose cause lies in local and prevent- 
able conditions. 
Hitherto health authorities have relied on the registration 
of deaths as affording a basis for their active operations in 
behalf of the public welfare, as well as for generalizations in 
sanitary science. A persistently high rate of mortality is an 
indication that something is wrong in the sanitary condition of 
the community reporting it; it is a signal that so far as that 
region is concerned, influences are at work which demand 
speedy investigation and, if it be possible, prompt removal. 
Therefore the registration of mortality has always been ac- 
knowledged as an invaluable adjuvant to sanitary adminis- 
tration. 
But it is obvious that the death-rate does not represent the 
actual state of the public health, the real amount of sickness, 
or its real character at any given time in any community. 478 
STATE BOARD OF HEALTH. 
[Jan. 
An entire hamlet may be smitten by an epidemic which 
makes no impression on the bills of mortality. The schools 
of a township may be forced to take an unseasonable vacation 
by a general invasion of whooping-cough, which may cause a 
comparatively small number of deaths. Mild scarlatina, or 
diphtheria, or even small-pox may sweep through a village 
and be the occasion of only a few funerals. On the other 
hand, an exceptionally severe outbreak of infectious disease 
may be attended with a fatality out of all proportion to the 
number sick, and thus become the source of erroneous 
inferences. So that it seems eminently desirable that a regis- 
tration of diseases should in some way be put into operation, 
not to take the place of mortality-registration, but to supple- 
ment it. 
To the public, as well as to the health-authorities, an accu- 
rate knowledge of the prevailing diseases is of evident value. 
An official bulletin, issued at stated intervals, declaring 
what acute diseases are present in a specified section, and in 
what part of that section they are most rife, has a double 
usefulness : it warns well people to avoid the risk of exposure 
in any specially infected locality, while it prevents the ill 
effect of sensational items, which are ever on the alert to 
startle newspaper readers by their alarming assertion that 
this or that dreaded and dangerous malady is " raging ” in 
some community which is only measurably affected, or, it may 
be, is wholly exempt. If it were possible to publish daily 
records of the relative prevalence of the more important acute 
diseases, and of their comparative gravity, from returns 
gathered and compiled upon authority, the people might 
escape the apprehension and the alarm fostered by paragraphs 
for which nobody is responsible. 
The analogy between such a scheme and the already estab- 
lished system of weather-reports will at once occur. The 
eminent usefulness of the work done by the Signal Service 
cannot be gainsaid. Its value to commerce, to agriculture, 
and to the conduct of ordinary affairs, has been fully tested. 
The " weather probabilities ” have become an important 
feature of the daily news, and thousands of people are accus- 
tomed to shape their plans according to the prognostications 
of the chief of the bureau. Already we have intimations of 1876.] 
REGISTRATION OF DISEASES. 
479 
a greatly extended operation of the system of weather-reports 
begun so successfully in this country; the time will presently 
come, when an international bulletin of meteorological obser- 
vations, taken simultaneously at many stations in the north- 
ern hemisphere, will furnish special means for the develop- 
ment of this department of scientific study. 
In like manner, the prevalence of endemic and epidemic 
diseases may be registered. Large areas of territory may be 
included in the field of observation, and bulletins issued by 
a central authority may give timely warning of the rise and 
spread of zymotic affections. Just as the "cautionary signal” 
now tells the mariner or the traveller that a storm is coming, 
so in the future will the official word of the registrar tell the 
public of the existence of infectious and contagious diseases, 
their gravity, and their progress. Indeed, it is not too much 
to predict that "probabilities ” may yet be cast with some 
degree of precision, as we advance in our knowledge concern- 
ing epidemics. The manifold directions in which such a 
system may prove useful in gathering facts concerning epi- 
demiology, in staying groundless alarm, in pointing out 
localities to be avoided, in indicating specially threatened 
places, need hardly be mentioned farther. 
Yet it must be confessed, that there are many and serious 
difficulties at present in the way of a practical realization of 
such a plan. Some of these obstacles are inevitable ; others 
would disappear as time introduced more perfect methods of 
registration, and diminished the friction of new machinery. 
It is proper to allude briefly to some of these hindrances. 
It is obvious that the registrar of prevalent diseases is 
obliged to depend for his working material upon the medical 
profession; his information must come from physicians upon 
whose punctuality and uniform fidelity the success of the entire 
business relies. The law is not his ally in this matter, as in 
the case of the kindred registration of mortality; the labor 
attending the gathering of the preliminary facts must, there- 
fore, be entirely voluntary and public-spirited. But it is im- 
possible that the entire medical profession, including all 
persons styling themselves " doctors,” could be enrolled in' 
the serv ce; and on many accounts it is well that it is so, 
because, as is amply illustrated in mortality registration, the 480 
STATE BOARD OF HEALTH. 
[Jan. 
certificates furnished by the numerous company of pretenders, 
to whose ministrations a pretty large minority of the people 
submit themselves in times of sickness, are of doubtful value, 
and do not supply reliable data for sound reasoning. A 
purely ideal system for registering prevalent sickness would 
involve the recording of every case of acute disease, whether it 
were under the care of persons representing one or another 
degree of medical skill, or indeed of those without any degree 
at all. Such a comprehensive plan, even supposing it to be 
desirable, is not practicable. Reliance must therefore be 
placed upon a selected number of observers, who will regu- 
larly return the required facts. The registrar will aim to 
secure the cooperation of the best physicians, those at once 
the most accomplished and the most busily engaged in their 
art. He will be fortunate if those of his first choice do not 
decline his overtures, through reluctance to accept another 
draft upon their professional charity and good-nature. Any 
scheme of this sort will be strong, and its results valid in 
proportion to the trustworthiness of those who are its practical 
supporters; success depends more on the character of the 
observers, than upon their number. The first difficulty, there- 
fore, in the way of this registration, is the selection of men 
best fitted to perform the primary service; the second and 
greater difficulty is to enlist these volunteers in the corps of 
observation. 
But supposing the corps to be sufficiently and satisfactorily 
filled, the physicians composing it representing the best pos- 
sible quality as regards medical intelligence, extent of observa- 
tion, fidelity, the next obstacle 1 es in the fact that the mat- 
ters to be reported upon are not of an absolute character. 
The meteorological observer is sure of his weather record ; 
his thermometer, and barometer, and anemometer indicate to 
him positive conditions, about which there can be no mistake, 
the proper precaution being taken, of course, concerning the 
accuracy of the instruments. But the clinical observer deals 
with matters far more subtle and difficult; the reliability of 
his record of observations depends upon his own acuteness 
and judgment. He reports the presence or absence of dis- 
eases whose diagnosis is not always easy. His opinion of the 
nature or gravity of any case or series of cases may be quite 1876.] 
REGISTRATION OF DISEASES. 
481 
different from that of his neighbor. What is diphtheria to 
one observer, is croup or simple sore throat to another; what 
is febricula to one, is typhoid fever to another; what is 
cholera infantum to one, is infantile diarrhoea to another; 
what is influenza to one, is bronchitis or severe catarrh to an- 
other. For this diversity there is no radical remedy. It is 
the source of a considerable margin of error in the registra- 
tion of mortality, affecting the causes of death; it is the pos- 
sible origin of a still wider range of uncertainty in the results 
of any scheme for registering diseases which do not afford, in 
their fatal termination, an additional indication for diagnosis. 
Our chief safe-guard is again to be found in the known skill 
and reputation of the observers. 
The liberality of the State Board of Health permitted dur- 
ing the year 1875 a plan for registering prevalent diseases in 
Massachusetts to be subjected to a practical test. The plan 
was not a pretentious one : it was offered as an initiatory ex- 
periment in a field of sanitary statistics hitherto unproductive. 
The purpose was to break the ground, in the hope that other 
workers might be tempted to carry forward and perfect a 
project believed to contain undeveloped elements of value and 
importance to the public welfare. It is the main object of 
this paper to report what has been done, the methods, and the 
results. 
For the purposes of the plan devised, the State of Massa- 
chusetts was divided into seven sections of unequal size, but 
of distinctive topographical characters. The hill country of 
Berkshire formed one section. The second region comprised 
the counties of Franklin, Hampshire, and Hampden, the 
"valley” section, traversed and drained by the Connecticut 
River. The county of Worcester constituted the third or 
"midland ” section. The "north-eastern ” section included all 
of Essex County, and all of Middlesex County except eleven 
towns and cities embraced in the fifth section. This latter, 
the " metropolitan,” contained Boston and its suburbs, the 
northern boundary being the valley of the Mystic River, and 
the southern the Neponset River. In this section were 
included, besides the city proper, with its recently acquired 
outlying territory, the following: Hyde Park, Brookline, 
Newton, Watertown, Belmont, Cambridge, Arlington, Som- 482 
STATE BOARD OF HEALTH. 
[Jan. 
erville, Melrose, Medford, Malden, Everett, Winthrop, and 
Chelsea. The "south-eastern” section, the largest in area, 
consisted of the counties of Norfolk (the towns of Hyde 
Park and Brookline excepted), Bristol, Plymouth, and 
Barnstable. The islands of Martha’s Vineyard and Nan- 
tucket constituted the seventh, or "island” section. These 
several territorial divisions were made without regard to their 
extent, or to the distribution of their population, but solely 
with reference to their general characters, as regards situation 
and surface. 
The field of observation having thus been divided, the phy- 
sicians were selected in each district to perform the part of 
observers. The principle of the choice has been intimated. 
The aim was to secure the cooperation of regularly educated, 
intelligent medical men, whose field of practice was so dis- 
tributed as to enable them in the aggregate to give a compre- 
hensive and accurate weekly conspectus of the diseases preva- 
lent in the entire State. In cities whose sick poor were 
attended to by means of an organized gratuitous dispensary 
service, the physicians of the yisiting staff were regarded as 
particularly desirable reporters, for the reason that the pa- 
tients under daily observation were so numerous, and of such 
a character, as to have considerable influence in determining 
the relative prevalence of acute diseases in their localities. 
The project was introduced to the attention of the profes- 
sion in November, 1874, the following circular being mailed 
to one hundred and sixty-eight regular physicians :— 
COMMONWEALTH OF MASSACHUSETTS. 
State Board of Health, 
Boston, Nov. 1, 1874. 
Dear Sir :—The State Board of Health is very desirous of get- 
ting weekly information of the diseases prevalent in all parts of 
Massachusetts. The object is certainly one of great importance,— 
positive knowledge of the health of the people, as well as of the dis- 
eases which, at any time and place, are present, or which threaten 
to extend as epidemics. 
In order, however, to attain this end, the board will need the 
cooperation of a large and select number of physicians, in full 
general practice, in various parts of the State. We therefore take 
the liberty of asking whether you will consent to be one of this 1876.] 
REGISTRATION OF DISEASES. 
483 
number,—to report weekly, during the next year (1875), the 
diseases prevalent in your vicing. The inclosed sample postal 
card will indicate the proposed method ; it will be observed that an 
endeavor has been made to reduce to the minimum the expendi- 
ture of time and trouble incident to the service asked of busy 
medical men. 
The board has appointed Dr. F. W. Draper, of Boston, to be the 
registrar of this new Bureau of Health Correspondence. He will com- 
pile from the returns received a concise weekly bulletin of prevalent 
diseases, to be reported to the secretary of the board, and pub- 
lished, with appropriate comments, for the information o£ the 
people. At the end of the year, a summary of the accumulated 
observations will be prepared for publication in the annual report 
of the board. 
If the board is successful in securing the cooperation of physi- 
cians in the accomplishment of this plan, the practical results will 
be of essential value, not only to the State at large, but to private 
individuals. To medical men, in particular, such a weekly synopsis 
of prevalent diseases would be possessed of obvious interest. It is 
not out of place to remark, also, that the present scheme is the first 
practical attempt in any part of the world to make a systematic 
weekly registration of diseases. It is hoped that you will consent 
to assist the board in executing a purpose which is capable of being 
developed to very useful ends. If you will please to signify your 
willingness to undertake the service alluded to, the proper blanks 
will be forwarded. 
We have the honor to be, very respectfully, yours, 
Henry I. Bowditch, 
David L. Webster, 
J. C. Hoadley, 
Richard Frothingham, 
T. B. Newhall, 
R. T. Davis, 
Chas. F. Folsom, 
Members of the State Board of Health. 
To this preliminary request for cooperation, one hundred 
and fifteen physicians responded affirmatively. In March, 
1875, this number was increased by the enlistment of the aid 
of seventy-nine additional physicians. These one hundred 
and ninety-four medical men were supplied from time to time 
with postal-card blanks, to be filled and forwarded to the 484 
STATE BOARD OF HEALTH. 
[Jan. 
registrar. This blank form, of which a copy is here given, 
was intended to procure the maximum of information with 
the least amount of machinery and detail. 
Report of Diseases prevalent 
during tlie Week ending 
• Saturday, 1875. 
Please erase the names of Diseases not prevalent, and indicate 
the relative gravity of prevalent diseases by a cross (X) under 
“Mild” or “Severe,” as the case maybe; basing the Report, not 
alone on the actual cases in the reporter’s practice, but also on a 
general knowledge concerning his vicinity. Please mail the card 
as soon after Friday of each week as is convenient. 
Bronchitis 
Cholera Infantum . 
Cholera Morbus. . 
Croup (Membraneous) . 
Diphtheria .... 
Diarrhoea 
Dysentery 
Influenza 
Measles 
Pneumonia .... 
Rheumatism.... 
Scarlatina .... 
Small-pox .... 
Typhoid Fever . . 
Whooping-cough . 
Mild. 
Severe. 
Remarks. 
M. D. 
If more particulars had been called for, necessitating an 
additional outlay of time and thought on the part of the active 
practitioner, much less would have been gained in the end. 
The form has served admirably throughout the year. Future 
experience may indicate the time when more elaborate data can 
be asked for and obtained ; the point has not yet been reached 
when a state commission can draw from an overworked pro- 
fession long-continued gratuitous service, unless that service 1876.] 
REGISTRATION OF DISEASES. 
485 
be of the simplest nature, and to secure most useful ends. It 
is a pleasure in this connection to testify to the faithfulness and 
uniformity with which the physicians have discharged their 
promise to cooperate in this work. It was to be expected that 
some would fail and drop out of the ranks before the year was 
ended; but to the large majority, the registrar feels indebted 
for well-sustained assistance. Without this aid, the plan would 
have come to naught; to it the experiment owes nearly the 
whole of its success. If one would seek for some sign that the 
registration of diseases is a desideratum, and that the present 
method has in it some quality of favor, he might find such evi- 
dence in this ready response and long-sustained support on 
the part of many of the best representative physicians of the 
State. 
The reports returned at the end of each week were assorted 
by districts, the initial letter at the left upper corner of each 
card being designed to facilitate that work. The diseases 
reported by each section were then compiled from the cards, 
and a percentage computed between the number reporting 
each disease and the whole number reporting for that week 
for that district; thus, if from the midland section, in a given 
week, twenty-five (25) cards were received, of which eigh- 
teen (18) returned pneumonia as prevalent, the percentage 
for pneumonia for that week and that section would be sev- 
enty-two ( 72). Inasmuch as the number reporting from week 
to week necessarily varied somewhat, this computation of the 
percentage would appear to show better than any other way 
the relative changes in the prevalence of diseases. All the 
sections having been analyzed in this way, the summary for 
the State at large was obtained in a similar manner by aggre- 
gating the returns. The results of the analysis for each sec- 
tion and for the State were transferred to charts, which pre- 
sented to the eye a graphic picture of the prevalence from 
week to week of acute diseases, the regular curves giving a 
satisfactory notion of their development and decline. 
One feature of the work, and that by which the public has 
known of its progress, has been the weekly bulletins. From 
the cards, and from the charts, was readily made a brief sum- 
mary, setting forth the diseases prevalent in the various parts 
of the State, with a comparative record giving the increase or 486 
STATE BOARD OF HEALTH. 
[Jan. 
decline of the more dreaded affections. This weekly bulletin 
was published simultaneously on Thursday mornings through- 
out the year in the "Boston Medical and Surgical Journal,” 
and in the Boston "Morning Journal.” A single specimen 
will suffice to show the general character of these announce- 
ments :— 
“ The following is a bulletin of the diseases prevalent in Massa- 
chusetts during the week ending January 16, 1875, compiled under 
the authority of the State Board of Health, from the returns of phy- 
sicians representing all sections of the State: 
“ In Berkshire, pneumonia, rheumatism, bronchitis, and typhoid 
fever. Diphtheria and croup are less prevalent. 
“ In the Connecticut Valley, bronchitis, influenza, rheumatism, 
diphtheria, pneumonia, whooping-cough, and croup ; scarlatina is 
less prevalent. One physician in Springfield reports meningitis. 
“In the midland section, mild bronchitis, severe pneumonia, in- 
fluenza, rheumatism, whooping-cough, scarlatina, and diphtheria. 
Erysipelas is reported as ‘ epidemic’ in the northern part of Worces- 
ter County. 
“ In Middlesex and Essex counties, influenza, bronchitis, scarla- 
tina, rheumatism, pneumonia, and whooping-cough. Measles and 
diphtheria are subsiding. 
“In the metropolitan section (Boston and its suburbs), bron- 
chitis, pneumonia (not fatal), rheumatism (sub-acute), measles, 
scarlatina, influenza, and whooping-cough. Diphtheria and tonsil- 
litis appear to be subsiding together. 
“ In the south-eastern counties, mild bronchitis, influenza, pneu- 
monia, rheumatism, whooping-cough, and croup. Scarlatina is less 
prevalent. 
“ It appears that bronchitis, pneumonia and rheumatism prevail 
in all parts ; croup and diphtheria are most prevalent in the Con- 
necticut Valley ; scarlatina is in the midland, north-eastern and 
metropolitan sections, its type being generally mild ; whooping- 
cough prevails mostly in the rural sections. 
“ Since last week there has been a decline in the following : Mea- 
sles, diphtheria, and tonsillitis. Bronchitis, influenza, pneumonia, 
rheumatism, scarlatina, and erysipelas show an increased prevalence. 
Croup and whooping-cough are the same as at last report. 
“ F. W. Draper, M. D., Registrar.” 
But the weekly statements do not exhaust the account of 
the fruits which the scheme has made apparent; the bulle- Jan. JJcir. Apr. .Jay Jicrte JitCy A ar/. Sept. Oct. «/Vbr. Dec. 
2 I 9 i6| 23I30 6 i3 2o 27 6 13I20 27 3 I 10I 17124 1 8 t5 22 29 5 i2 19 26 3 10117 24I31 7 14 2i 28 4 j u j iT 23 2 1 9 tb 6 13 20I27 .4 1 i» i8:23~ 
Note.—This chart is to be read as follows: “ For the week ending January 2, 1875, 84 per cent, of the observers returned bronchitis as prevalent; 65 per cent, 
lcported pneumonia; 57 per cent, reported influenza; 32 per cent, reported diphtheria, &c.” 
CHART N? I. 
REFERENCES. 
/. Broar/ulus. 
2. BncumcrUas. 
3. /n/luenzw. 
■4. BipZu/ieriu. 
5. Croup. 
6. Chotera, Afcrbu*. 
7. Chctcra InVuntu/n. ,/ff/r. Feb. *Afar. Apr. *Mciy *Ju,ne '/it/cV uluf/. *Sep(. Oct, J)er. 
2 I 9 116 23I30 6 113 2oj27 6 13 2o 27 3 10 17 34 1 8 i5 22 29 3 i2 19 26 3 to 17 24 31 7 14 2i 28 4 11 18 23 2 9 t6 2330 6 U3 20127 4 »« l8j25 
CHART N? 2. 
6 
REFERENCES. 
/. RheunvcUisnv. 
2. ffhecpinff Ccufffv. 
3. Mecusles. 
4. ScarlrUinor,. 
5. Typhoid Fever. 
6. Diarrhoea. 
7. Dysentery. 1876.] 
REGISTRATION OF DISEASES. 
487 
tins served their purpose, and fulfilled their end, as soon as 
they were published ; they were essentially ephemeral. It is 
possible to gather from the returns some results of a more 
permanent value. The geographical distribution of non- 
fatal diseases, their development considered with relation to 
the changes of the seasons, their more or less distinctly defined 
local manifestation, their relation to meteorological variations, 
are all capable of being demonstrated. The accompanying 
charts are intended to show the relative prevalence of acute 
diseases in the State at large during the year. It will be use- 
ful to add a few notes concerning the different sections whose 
charts are not introduced. 
Berkshire.—During January, croup and diphtheria were quite 
prevalent; but they subsided as the spring advanced, and 
remained absent until October, when a slight accession oc- 
curred. Influenza and bronchitis were present throughout 
the winter and spring months, but they disappeared before 
the first of June, to reappear in late autumn; pneumonia and 
rheumatism followed a similar course. There was some 
typhoid fever in the first three months of the year; it disap- 
peared in April, to return in September, and continue through 
the autumn. The diarrhceal diseases of summer began their 
invasion at about the first of August, considerably later than 
in some of the more populous sections; they subsided in the 
second week of October. Whooping-cough was never entirely 
absent. Measles htid a very limited course during February, 
March, and April, and it reappeared in some parts in Decem- 
ber. Scarlatina was present (but not prevalent) during 
April, May, and June. In April, the town of Lee reported 
the presence of small-pox. 
The. Valley of„ the Connecticut.—This section began the 
year with bronchitis, diphtheria, pneumonia, and rheumatism 
as its prevailing diseases. In February, bronchitis was joined 
by influenza, and both held sway till the middle of March, 
when they subsided together, reaching their point of least 
prevalence in midsummer, but returning with October, and 
continuing to prevail quite generally during the rest of the 
year. Diphtheria was at no time wholly absent; it was most 
prevalent in January, least prevalent in August; from the 
first of October to the close of the year it was again quite rife, 488 
STATE BOARD OF HEALTH. 
[Jan. 
especially in the cities and larger towns. Pneumonia and 
rheumatism kept their course together from January to June, 
when the former subsided while the latter continued; after 
the first of October both diseases increased in prevalence till 
the end of the year. Measles had a limited course in January 
and February, and again in May and June, but it was never 
epidemic, as in some of the more eastern parts ; in the late 
autumn, the town of South Hadley suffered from the combined 
presence of measles and diphtheria. Scarlatina maintained 
its hold throughout the year, but it was only moderately 
prevalent. Small-pox was reported in the spring by a few 
towns (Holyoke, Easthampton, Wilbraham, Huntington), but 
the disease did not extend. The summer diseases (diarrhoea, 
dysentery, cholera infantum, and cholera morbus) first ap- 
peared in the last week in June, reaching their maximum 
prevalence in August, and disappearing in October, diarrhoea 
being the first to enter and the last to leave the stage. Ty- 
phoid fever was first reported in the last week of July; it 
steadily advanced till the last week of September, and thence- 
forward it declined ; in the towns along the banks of the river 
a remittent type of fever was observed. Cases of cerebro- 
spinal meningitis were reported in the earlier months of the 
year as present in the northern parts of this section (Shel- 
burne, Ashfield, etc.). 
Midland ( Worcester County).—Bronchitis, influenza, pneu- 
monia, and rheumatism held the highest place in the scale 
from January to June ; measles and scarlatina came next in 
the list, the former reaching its highest point in February, 
and continuing till August, the latter having its maximum in 
March, but prevailing to a limited extent throughout the year. 
Whooping-cough was reported through January, February, 
and March. Typhoid began in the last week of July, and 
was most abundant in October; it held the highest place in 
the list in that month. Diarrhoea led the van of the summer 
maladies, beginning in June, and followed a fortnight later 
by dysentery, cholera morbus, and cholera infantum, their 
maximum prevalence being in August and September. In 
October, bronchitis and influenza reappeared coincidently 
with the occurrence of epizootic catarrh. Several towns in 
the Blackstoue Valley reported small-pox at the close of win- 1876.] 
REGISTRATION OF DISEASES. 
489 
ter, and in the spring. Millbury reported an unusual number 
of puerperal fever cases in May. " German measles ” (rotheln) 
was frequently observed in the spring. 
North-eastern.—The diseases of the respiratory organs 
(bronchitis, pneumonia, and influenza) held sway till June, 
when they subsided, to return in October, and continue to the 
end of the year. Measles and scarlatina were very general 
throughout the earlier half of the year, and the autumn wit- 
nessed their revival. " German measles ” was frequently 
reported in the spring. Whooping-cough was prevalent dur- 
ing the first six months, but it disappeared in midsummer. 
Rheumatism kept its hold throughout the year. Diphtheria 
was more common during the last three months than at any 
other time; it Avas not as rife in this section as in some other 
parts of the State. The last week in July Avas the time at 
which the diseases of summer began; their highest point was 
reached in September; their disappearance occurred in the 
last Aveek of October. Typhoid fever commenced in August, 
Avas most prevalent in September, and declined in October. 
In the spring, isolated cases of cerebro-spinal meningitis were 
reported as present in certain toAvns in Essex County. The 
year has not been an unhealthy one in this section ; influenza, 
measles, and scarlatina have been the only diseases Avhich had 
a prolonged or very general prevalence. 
Metropolitan.—The first returns of the year indicated the 
prevalence of bronchitis, measles, pneumonia, rheumatism 
and scarlatina. These diseases kept their place at the head 
of the list until June. In February they Avere augmented by 
an epidemic of influenza, Avhich continued till the middle of 
May. Scarlatina reached a high point in March, then sub- 
sided during the summer months, to return in October, and 
to 'become more prevalent in December than at any time 
during the year. Diphtheria secured a hold early in the year, 
declined somewhat in the spring and summer, but reappeared 
in September, and was quite rife from that time until the end 
of December. Tonsillitis Avas common during the first 
quarter. Whooping-cough prevailed to a limited extent 
during the first four mouths. The group of summer affec- 
tions began to develop in the last week of June, Avas most rife 
in August, and subsided in the early part of October. 490 
STATE BOARD OF HEALTH. 
[Jan. 
Typhoid was never absent during the year ; its increase began 
in the middle week of August, the highest place being reached 
in the middle of October; it was not as prevalent here as in 
some of the rural sections. At the close of the year, bron- 
chitis and pneumonia headed the list of prevalent diseases, 
and diphtheria and scarlatina came next in order. Rotheln 
prevailed quite generally in the spring, accompanying the 
epidemic of measles, and appearing in this section before 
developing elsewhere. Epidemic catarrh occurred in October, 
coincidently with the epizootic disease. 
South-eastern.—Bronchitis and influenza were rife from 
January till June. Pneumonia and whooping-cough prevailed 
extensively from February to April. • Diphtheria was present 
from January to April, and again in the autumn, its maxi- 
mum being in October; it was less prevalent than in most 
other parts of the State. Measles prevailed in March, but 
not at any time so extensively as in the metropolitan and 
north-eastern sections. Scarlatina was present during the first 
six months, and again in the last quarter, but not extensively. 
July witnessed the accession of the diarrhceal diseases, August 
their maximum prevalence, and October their decline. Sep- 
tember and October were the months in which typhoid fever 
was the most rife. In March and April, small-pox was in 
Fall River, but it did not extend. 
The towns upon the islands in Martha’s Vineyard have 
been comparatively exempt from acute diseases throughout 
the year. 
The charts of the various sections enable us to trace the 
wavelike progress of contagious diseases. It is made appar- 
ent that the strictly contagious affections do not assail large 
areas of territory coincidently, but that their invasion is pro- 
gressive. Thus, measles was epidemic in Boston in January, 
February, and March ; it was hardly mentioned in the returns 
from the north-eastern and the south-eastern section before 
March, and while it was subsiding in Boston, it was most 
abundant to the north and the south of that city. March, 
April, and May found it in the midland section, while May 
and June were the months in which it was most prevalent in 
the valley of the Connecticut. 
Cerebro-spinal meningitis occurred sporadically throughout 1876.] 
REGISTRATION OF DISEASES. 
491 
the year in all the sections ; but it did not have, at any time, 
or in any place, a very marked prevalence. Many of the 
observers noted its coincidence with bad drainage and other 
unsanitary conditions. 
The distinction of diseases, according to their type, as mild 
and severe, has been observed by those making the weekly 
returns. It is impossible in this summary to make use of 
this discrimination, but in the course of the year it has been 
very useful in determining the relative gravity of the various 
affections in regard to time and place. It may be stated in a 
general way, that in all parts of the State, the year through, 
the milder forms of acute diseases have predominated. 
The sensitiveness of the public health to weather-variations 
has been shown repeatedly by means of the weekly returns. 
A sudden change in temperature or in humidity, has again 
and again indicated its effect upon the amount and gravity of 
the prevailing diseases. A single instance, which many per- 
sons in Massachusetts will recall, may be cited as an example 
of this. The fourth week in April, the week in which the 
centennial celebrations at Concord and Lexington occurred, 
was marked by a severe cold snap after an interval of mild 
weather. The sickness returns for the week represented a 
very decided increase of acute diseases ; bronchitis, influenza, 
rheumatism, pneumonia, whooping-cough, measles, scarlatina, 
and sore throat were returned as being much more prevalent. 
It is one of the advantages of such a system of sickness- 
registration that it shows at any time, and without delay, the 
effect of weather-changes, making a far more prompt and 
satisfactory exhibition of the influence of such changes upon 
the public health, than is possible with the mortality-table 
which gathers the more distant, indirect, and partial results of 
the same phenomena. 
It is to be remarked, in conclusion, that the method of 
sickness-registration, tested in Massachusetts during the last 
year, has surpassed the expectations of many who were inter- 
ested in its trial.* Experience has discovered certain defects 
* When it is remembered that the State contains a population of 1,651,912 
persons, living in 19 cities and 322 towns; that the average weekly number 
of physicians who have reported in season for the published bulletin, con- 
cerning the prevalent sickness in all these cities and towns, and of all these 492 
STATE BOARD OF HEALTH. 
[Jan.’76. 
in it, which, in future, might be avoided. The year’s work 
has demonstrated the willingness of the medical profession 
to cooperate in such a registration, and this fact alone is a 
significant result of the trial. It is to be hoped that the 
recording of prevalent diseases may yet become as indispen- 
sable a department of the public service as is the registering 
of mortality at the present time. It matters little what the 
details of the method are, or who originates them, if only 
they are practicable, and their results are good. The need 
of such a record is undeniable ; its fulfilment is a question of 
time. In the words of a distinguished leader in sanitary 
reform, " Registration of deaths represents the wrecks which 
strew the shore, while that of sickness would tell us of the 
coming storms, and enable us to trim our vessels to meet 
them. Till we have such a system of disease-registration, 
public health cannot be administered with full intelligence.”* 
people, has scarcely reached six scores, and that these physicians have based 
their returns, not on data of absolute statistical accuracy, hut on their gen- 
eral knowledge of what was going on around them, the results of the year’s 
experiment may seem insignificant to the critical. It is frankly admitted 
that the results of this single year’s work are without much value in them- 
selves, hut it is insisted that the method of registration should not be judged 
according to the fruits of this short period of trial. Two measures at once 
suggest themselves for rendering the plan more effective in future, and both 
these measures are practicable: first, to enlarge the number of weekly medi- 
cal reporters; and, secondly, in proportion as that is accomplished within 
the limits already alluded to, to call for statements which shall more fully 
satisfy the requirements of statistical correctness. When the fact is recalled, 
that the registration of vital statistics has required more than a quarter of a 
century to attain its present place, it can scarcely he expected that any 
registration of sickness can come full panoplied into being, or that its first 
fruits will be entirely satisfactory. 
* Eight Hon. Lyon Playfair, F, K. S. Address on Sanitary Eeform. 1874.