SICKNESS STATISTICS. Beport of the Committee on Vital Statistics to the National Conference of State Boards of Health, at Lansing, Michigan, June 6, 1892. BY HENRY B. BAKER, M. D., Secretary of the Michigan. State Board of Health, Lansing. 1 Reprinted from the Annual Report of the Michigan State Board of Health for the fiscal year 1892.] [Reprint No. 414.] SICKNESS STATISTICS. REPORT OF THE COMMITTEE STATISTICS.* ON VITAL BY HENRY B. BAKER, M. D., SECRETARY OF THE MICHIGAN STATE BOARD OF HEALTH, LANSING. For many years, leading statisticians lamented the absence of, hoped for, commended, and labored for the creation of statistics of sickness. Statis¬ tics relative to mortality are useful, and have supplied important bases for sanitary work and progress; but mortality statistics come too late for the greatest immediate usefulness by practical sanitarians engaged in restrict¬ ing dangerous diseases. They are also too distant from the conditions which caused the disease to be most useful in studying the causation of diseases. The exceeding great expense attending the reporting of all sick¬ ness has, always, thus far, prevented the attempt, except in the case of armies, navies, etc., where such requirements can be enforced. ^ T o Benjamin Ward Kichardson, M. D., LL. D., one of the leading Medi- hfcnd Sanitary minds in Great Britain, should be given the credit for the >ad before the National Conference of State Boards of Health, at Lansing, Jane 6, 1892. SICKNESS STATISTICS.—MICHIGAN SYSTEM. cxxxv invention of a method of obtaining valuable sickness statistics without the immense expense involved in collecting records of all sickness. His plan was to have a considerable number of representative medical practitioners in active general practice report regularly to a central office, the reports to be there compiled. He inaugurated this system, and maintained it long- enough to prove its usefulness, when the expense, even of this system, was too great to be carried on by private enterprise; he tried to have the gene¬ ral government of Great Britain take it off his hands; but, failing in that, the undertaking was abandoned. To the Massachusetts State Board of Health belongs the honor of being the first governmental officers, aside from those of armies and navies, to establish a system of sickness statistics. That Board adopted substantially the system inaugurated by Dr. Benjamin Ward Richardson, and maintained it very successfully for one year; the published results yielding information of exceedingly great interest and value. But the Massachusetts State Board of Health changed Secretaries, and, apparently, the new officer did not appreciate the important work of his predecessor; at any rate, the valuable sickness statistics then ceased. To Michigan, after all, must be given the greatest credit for having adopted, perfected, and successfully maintained, through a series of years, the most satisfactory system of sickness statistics the world has yet seen. It commenced in 1876, and adopted, at first, very much the same system as had been proved to yield such valuable data in Massachusetts; but, from time to time, improvements have been made. The most important change was made in May, 1885, since which time the representative physicians in active general practice who report regularly each week, are asked to report only the sickness which occurs under their own observation. The system is thus on a more accurate scientific basis than when the reports included sickness which occurred in the vicinity, under the observation of other physicians; because the opportunities for conferring with other physicians vary greatly, and thus cause in the reports variations which are eliminated by confining the reports to answers to direct questions, relative to each important disease,—Did you or did you not, during the given week, see a case of that disease? How many cases did you see? This system of sickness statistics rests upon the “law of averages,” in accordance with the “law of probabilities,” which makes it probable that a considerable number of representative physicians in active general practice, in localities distributed fairly well about a State, will see an average of the sickness which occurs. Theoretically, this was true before the system was inaugurated. Practically, it has been demonstrated to be true, by the several combinations of the sickness statistics which have been made in Michigan. For instance,—it was questioned whether the small number of reports received in time for the weekly bulletin, being about fifty, were sufficient to supply a fair statement of the sickness in Michigan, throughout the State. The question seems to have been answered in the affirmative as follows:—when the fifty reports are com¬ piled, and afterwards fifty more reports are received and compiled, it is generally found that the results of the two compilations are practically the same; indicating that both results are correct. Again, speaking now of the whole number of reports received and compiled in the Annual Report, although during the years 1877-1884 the system was not as perfect as since May, 1885, yet such diagrams as that on page 255 of the Annual Report cxxxvi STATE BOARD OP HEALTH.—REPORT OP SECRETARY, 1892. of the Michigan State Board of Health for the year 1886, (reproduced on page cxxxvii in this article) prove that the results of the compilation of the weekly reports of sickness then yielded statistics of very great value, and statistics which bore on their face the evidences of reliability, being con¬ sistent from month to month, and from year to year. Not only that, but when placed beside the results of tri-daily observations of such “ instru¬ ments of precision” as the standard thermometers in use by the regular meteorological observers in Michigan, these sickness statistics relating to a prominent disease bore an astonishingly close resemblance to the statistics of the observations of the thermometer. The similarity of the two curves, representing the two sets of observations—of the sickness and of the instruments, is such as to lead to the conviction that both sets of observa¬ tions are true, and that there is accessary relation between the sickness and the atmospheric temperature. Until the sickness statistics in Michi¬ gan supplied the scientific basis for such studies, such knowledge as that to which I have just referred was not in existence, as a scientific induction; it rested upon the insecure foundation of dogmatic assertions, not sup¬ ported, as it now is, by large numbers of facts classified and tabulated. Again, diagrams have been constructed containing curves representing the sickness reported from several important diseases, and these curves have been compared with curves representing the mortality from those diseases during the same time, in Michigan. These comparisons have demon¬ strated that both kinds of statistics are valuable; although it showed, as was known before, that the mortality statistics in Michigan are not as com¬ plete during the earlier as they are during the later months in each year, for reasons which have been published, and have long been well known to those who understand the vital statistics of Michigan.* It is to be hoped that the legislature will be induced to give this subject attention, and will so amend the law for the collection of the mortality statistics as to require that each death shall be immediately recorded, as the sickness now is,, within a week of its occurrence, and not be as the deaths are now,— neglected for a year or so before being placed on record. It is apparent, to whoever will take the trouble to investigate the subject,, that the sickness statistics of Michigan are extremely valuable. The vast mine of valuable information has been only very slightly worked as yet, for the reason that few private individuals can find the time to do such careful, painstaking work for such long-continued researches as are required to so marshal the vast numbers of facts as to bear upon a question in the causa¬ tion of disease. Such work, for the benefit of all, should be done once for all by some one representing the whole people. Enough has been done by the Secretary of the State Board of Health to> prove that the sickness statistics of Michigan are a mine of wealth which will richly repay the work of developing. The part which has been developed is that relating to the diseases of the throat, lungs and air- passages, and those dangerous communicable diseases which enter the body by way of the throat and air-passages. It has been demonstrated that tho causes which increase these diseases are associated with coldness of the atmos¬ phere, and that the relation is not only qualitative but quantitative. This information alone is of sufficient value to repay all and more than has been expended for the statistics. But the “cold-weather diseases” are only one * Explained on pages 3-12 and 158-167, Vital Statistics of Michigan, 1871. Temperature , and Sickness from Pneumonia in Michigan, in each month during eight years. SICKNESS STATISTICS.—MICHIGAN SYSTEM CXXXVll R Which stated that Pneumonia, was under the observation of the fbyjicienj who made reports, Prteumon t a. . Jhicraye Jemjteroture cxxxviii STATE BOARD OP HEALTH.—REPORT OF SECRETARY, 1892. part of all,—there remain to be studied the great classes of diseases which prevail most under opposite conditions. There remain also the studies into the exact conditions which are causative of each disease, and those which are only accidental. And, after all the factors shall have been worked out, there will remain the study of the rate of decline of each dis¬ ease under the influence of the appropriate measures which shall be inau¬ gurated for the prevention or restriction of each disease. Consequently,, it should be a long time before the collection, compilation, and utilization of sickness statistics should cease. Should such work ever cease? It would seem not; because even if the causation of all the prominent dis¬ eases shall become known, the preventive and restrictive measures thor¬ oughly applied, and the diminution of all preventable diseases shall reach its maximum, there should still be constant surveillance of such sickness, as shall remain, in order to be prepared to enter at once upon measures, which may at any time be indicated as necessary. There is another reason than the one already stated why we may not expect the sickness statistics to be immediately used by people generally,, but only by statisticians or persons who are willing to work hard and thus grasp the principles of statistical methods. That reason is found in the- fact that the sickness statistics do not impress the average person,, especially not the casual observer, as being sufficiently reliable upon which to base questions involving human life on a grand scale as is demanded by public sanitation. To some of the physicians who contribute the weekly reports, it seems almost or quite incredible that from the experience of one person like himself in a place, and comparatively few places in Michigan, can be built up statistics which shall enable one to know the- exact relations of all the most important and common diseases to the vary¬ ing conditions of the atmosphere. Perhaps as useful a service as can be done, at the present time, is to point out how it is that the fifteen years experience with the sickness sta¬ tistics of Michigan has resulted in the development of statistics which are not only the best that the world has ever seen, but that can be demonstrated to be perfectly reliable.* Some such demonstration here follows: The Statistical Method , Essential in the Sciences. It is extremely difficult for any person to master the subject of vital sta¬ tistics. This should not be wondered at, because all questions relating to the life of man—the most complex of all organized beings—are complex; and the laws or principles of even ordinary statistics are not generally understood. To hear statistics spoken of as unreliable, is a very common occurrence: but it is true, and ought to be generally known, that no general fact is established or can be established except by the statistical method. One experience or one observation of a fact does not establish anything; a few experiences or observations may lead to a belief; but it is only by the grouping together of oft-repeated experiences or observations of facts that a general fact is established, and the grouping together of experiences and observations of facts, is the essential part of statistics. Therefore there is no higher method, no more reliable method, than the statistical method. That method is the one employed in every science. For instance, the chemist makes an experiment, and observes a result. In order to reach a * The confident tone in some portions of this report may be accounted for by the fact that the mem -. ber of this committee was. for a few years, engaged in compiling and studying general statistics, and for twenty-one years has been continuously engaged in compiling and studying several kipds of vital statis tics. Accordingly, it is assumed that this long experience and study of statistical science and practice- especially of vital statistics, enables him to teet, and judge of, the reliability of such statistics. SICKNESS STATISTICS.—MICHIGAN SYSTEM. cxxxix conclusion, however, he must repeatedly observe the same result to follow repetitions of the same experiment. If, because of the imperfections of all manipulations, he does not always reach precisely the same result, he con¬ tinues, by the statistical method, to learn the amount of the probable error, and, if that is within the limits of variation warranted by the nature of the manipulation, he uses the average result, and if the observations are suffi¬ ciently numerous, he relies upon that result; that is to say, if he has (what is really, although he may not so consider it) a statistical basis for his con¬ clusion he is satisfied. Not only the science of chemistry, but all sciences rest upon similar foundations. One of the most common fallacies in the minds of intelligent people is, that statistics are not reliable unless all the facts on the given subject are collected. Concerning vital statistics, this false idea is extremely common, even among scientific men who in their own science never seem to think of the comparative paucity of the facts upon which their own conclusions are based. A chemist, for instance, will base conclusions on less than a hundred experiments, sometimes less than a dozen; yet, in vital statistics, he would be likely to question results of observations of many times that number of experiences; and very likely demand that records be used of all the possible experiences. For Reliable Statistics, not All the Facts are Needed. Few people realize how perfect is the knowledge which may be gained by statistics which embrace only a small fraction of the great mass of facts which might be collected on the same subject. Take, for instance, in the science of meteorology, the statistics of temperature: It is well known that thermometers hung on the different sides of any building will rarely exactly agree. But it is not so well known that if one intelligent and reli¬ able observer take tri-daily observations of a thermometer, placed under proper conditions, in a central location, as, for instance, in Lansing, the results of his observations supply a reliable basis for conclusions concern¬ ing the entire State of Michigan, as to the comparative temperature in each month of every year. This is susceptible of demonstration, so that any intelligent person can appreciate the result; and a demonstration for a single year is given on page 27 of the Annual Report of the Michigan State Board of Health for the year 1886, and a similar demonstration is in nearly every Annual Report. Page 27 of the Report for 1886 is here reproduced,—Diagram I, on page cxl. By that diagram, it may be seen that a curve, accurately drawn to scale, representing the exact average daily temperature at Lansing (the line-ox) is very nearly the same as the curve representing the average for 21 stations in Michigan (in the line xxxxxx). For most purposes, the curve representing the results of the observations of one thermometer by a single person, in a central location, are sufficiently accurate and reliable upon which to base conclusions for the entire State of Michigan. Yet this person is only one of two millions of inhabitants of Michigan, probably half of whom might make observations of the atmospheric temperature, each under conditions slightly different from those of any other person. Why is it that the results of observations by the six persons whose work is represented in Diagram I, prove to be so accurate that each curve is substantially the same as the others? It is because they all use reliable “instruments of precision,” because they are careful observers, and because for each significant point in Diagram I, there were a sufficient number of observations to secure the true average. This last reason is one which should be understood, because it is an impor- DIAGRAM I.-AVERAGE TEMPERATURE, BY MOS., IN 1885. 'Scale, 10° F. to»92In. Vertically. H. B. T., Del. Des. by H. B. B. SICKNESS STATISTICS.—MICHIGAN SYSTEM. cxli tant subject in all statistics. It is a fact, that in grouping together results of large numbers of observations, minor variations tend to neutralize each other so that the average of a large number of observations exhibits the general truth which pervades them all. How a Statistician may Know whether he has Sufficient Data. Frequently it is perfectly easy for a statistician to learn whether or not he has a sufficient number of observations to yield the general truth for which he seeks. All that is necessary is to compile a number of the obser¬ vations, and from the results make a curve, such as is shown in Diagram I. Then compile another group of observations on the same subject, and from those results make another curve; then compare the two curves; if they agree, it proves that either one of the curves is as good as both,—that the general truth has probably been reached by the number of observations used in either of the experiments. This test has been applied to the sick¬ ness statistics of Michigan, by taking about one-half of the weekly reports of sickness, and then the other half; and it has been found that fifty weekly reports of sickness supply a sufficient number to give a fairly accurate statement of the sickness in Michigan. Generally that number of reports are received in time for the Weekly Bulletin; the average for the three years, 1889-91, was 58.- But for the tables, diagrams, and studies of the sickness statistics in the Annual Report of the State Board of Health, a much larger number is secured, the average for 1889-90 being 98 per week. A few facts on this subject are shown, in tabular form, as follows: Weekly Reports Received. For the Weekly Balletins. For the Annual Reports. Year. Least. Most. Average. Average per Week. 1889... 42 73 58% 96 1890. 44 76 62)4 100 1891. 44 74 59 83 Averages... 43 74 58* 93* * The average number of weekly reports received per week for the Annual Report was 60 per cent more than those received in time for the Weekly Bulletin. Then the probable least number received per week for the Annual Report would be 60 per cent more than 43 (the average least number received in time for the Weekly Bulletin) or 69. In the Annual Report, no attempt is made to study the subject by weeks, but the lowest unit is by months; so that, for each significant statement in a table or diagram, about four hundred observations are grouped to learn the average statement. But even the evidence of four hundred reports is not relied upon to finally decide the exact relation which a given disease sustains to atmospheric temperature, or other causative condition of sickness, although frequently it might safely be relied upon, as is proved by the diagram on page 255 of the Annual Report of the Michigan State Board of Health for the year 1886, which diagram is here reproduced on page cxxxvii. The custom of the writer has been to still further multiply the evidence by grouping it by months for a series of years. Thus, in Diagram No. l,page 252, Report SICKNESS STATISTICS.—MICHIGAN SYSTEM. cxliii of Michigan State Board of Health for the year 1886, corrected* and reproduced here (page cxlii), over 30,000 weekly reports of sickness, and over 150.000 observations of the atmospheric temperature are represented. The result is, that there is such a scientific demonstration of the relation of those two phenomena as to carry conviction to the mind of any sane, intelligent person who will take the trouble to study the subject. No such person can have a “reasonable doubt” of the truth of both sets of obser¬ vations there delineated. The tables and that diagram demonstrate com¬ pletely, and settle the question for all time, as to the relation of sickness from pneumonia to atmospheric temperature in Michigan during those years,—the sickness decreases as the temperature rises, and increases as- the temperature falls, and the relation is almost exactly quantitative. Mathematical Demonstration that the Relation of Pneumonia to Tem¬ perature is Quantitative. To demonstrate the fact that the relation is very nearly quantitative, it is only necessary to make a few simple computations, and to graphically picture to the eye the results of those computations, as follows: A table exhibiting the average temperature and the average per cent of the weekly reports which stated the presence of pneumonia, as graphically represented in the diagram (No. 1), is as follows: TABLE 1 .—By months, for a period of eight years , 1877-84, the relation between Sickness from Pneumonia and the average temperature of the atmosphere in Michigan. {A fraction of .5 or more is called 1, of less than .5 is disregarded.) Eight years, 1877-1884. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Av. temperature, deg. F,... 21.43 25.60 31.04 44.48 56.60 65.54 70.68 68.85 62.05 51.34 35.99 27.25 Av. percent of reports of sickness.. 62 66 62 56 42 27 17 14 18 23 36 48 It may be seen that the difference between the lowest temperature (21.43})* in January and the highest temperature (70.68) in July, is 49.25° F. It may be seen that the difference between the least sickness (14 per cent of reports) in August, and the most sickness (66 per cent of reports) in Feb¬ ruary was 52. If we assume that a change in atmospheric temperature equal to 49.25° F. causes a change in the sickness equal to 52 (per cent of reports), what change in the sickness should follow a change in tempera¬ ture of 4.17° Fah., as occurred between January and February? (The average during the eight years embraced in the diagram.) As 49.25 is to 52, so is 4.17 to the answer sought. The answer is 4.42. Then, inasmuch as it is plain, by the diagram, that the sickness changes follow a month later than the temperature changes, and inversely to the temperature, and' the temperature change was a rise , there should have been a fall in the- sickness equal to 4.4, from what it was in February. In February the per cent of reports was 66; 66 —4.4 = 61.6, which is the computed sickness for March. Similarly, as 49.25 is to 52, so is 5.44 (the temperature rise between) February and March) to the fall in the sickness in April. Continuing this process through the several months, we compute a table exhibiting the sickness as it would be if exactly quantitative relations hold throughout. (Practically, the computations are more quickly made by obtaining a unit of measurement, which may be done by dividing the total range of per cent * The need for correction was discovered by comparing the diagram of compnted results (Diagram 2,. p. cxliv) with original diagram in the Report for 1886. NO. 2.—TEMPERATURE. AND COMPUTED SICKNESS FROM PNEUMONIA. Sh/eracje Stm^ercdune^^ _ Sickness Jrom 'Pneumonia SICKNESS STATISTICS.—MICHIGAN SYSTEM. cxlv of sickness (52) by the total range of temperature (49.25); when the quo¬ tient (1.06) will be the unit of variation in per cent of sickness equal to a variation of one degree of temperature.) The computed table is as follows: TABLE 2 .—By months , for a period of eight years, 1877-84, the relation between Sickness in Michigan from Pneumonia, to the atmospheric temperature; the sickness {except in February ) being computed, assuming that , in each month, the rise or fall of the sickness sustains the same relation to the rise or fall of the atmospheric temperature in the preceding month, as the total range of sickness sustains to the total range of monthly averages of temperature for the year. (A fraction of .5 or more is called 1, of less than .5 is disregarded.) Eight years, 1877-1884. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Av. temperature, deg. F— 21.43 25.60 31.04 44.48 56.60 65.54 70.68 68.85 62.05 51.34 35.99 27.25 Av. per cent of reports of Sickness (com puted) _ _ _ _ 60 66 62 56 42 29 19 14 16 23 34 51 This table may be compared with Table No. 1, which exhibits the actual statistics as compiled from the reports. This computed table is graphically represented in Diagram No. 2, p. cxliv which can be compared with Diagram No. 1, which represents the actual statistics, as compiled from the reports. By comparing the two tables (on pages cxliii and cxlv) it will be seen that in six of the months the figures are the same in each; in the other months they are nearly the same, the greatest difference being in December, for which month the actual figures fall short of the computed ones by 3. The comparisons are best made by means of the two diagrams, 1 and 2. But before or after comparing the two diagrams, it seems marvelous that accu¬ rate curves representing two such different phenomena as atmospheric temperature and sickness from pneumonia, observed and reported by entirely different classes of persons, should be found to run so almost exactly parallel as do the two lines in Diagram 1. That twelve successive changes in atmospheric temperature should be followed by twelve succes¬ sive changes in the amount of sickness, so almost exactly in proportion to the temperature changes can be accounted for only by the belief that there is a necessary relation between those two phenomena. If there is a neces¬ sary relation, it should be quantitative, unless other phenomena cause variation. The variation thus far apparent is so small as to indicate that it may be due to very slight imperfections in the observations. To which set of observations the slight variation is chargeable—whether of the tem¬ perature, by the meteorologists, or of the sickness, by the physicians,— remains to be ascertained; because, although the temperature is learned by the use of “instruments of precision,” the observations are not made every hour of the day and night, but only three times a day, and this may not, in every month, give us the exact average temperature, while the sick¬ ness reports represent all the time, day and night. On the other hand, during the years represented in the diagrams, the sickness reports were on the old plan, including all sickness believed to occur, even if not under the actual observation of the physician who reported. The subject can be further studied, and the exact truth can be ascertained. But these refine¬ ments in statistics are for the expert statistician. That they exist in sick¬ ness statistics of Michigan is conclusive evidence that these statistics are cxlvi STATE BOARD OP HEALTH.—REPORT OF SECRETARY, 1892. exceedingly accurate. And it is gratifying to know that by means of the sickness statistics of Michigan the essential facts as to the causal relation of pneumonia to atmospheric temperature has already been learned. It remains for pathologists and sanitarians to utilize that knowledge and finally to point out to the people how to take advantage of that knowledge, and use it for the lessening of sickness and deaths from pneumonia. Causal Relations of Meteorological Conditions to Diseases have been Established. A Plea for the Continuance of the Work. What has been done relative to pneumonia has been done for several other very important diseases, including the most important one of all— consumption. The fact is that the work with sickness statistics in Michigan is now in .advance of some of the other lines of scientific research; and before reaping the full benefit of the statistics we must wait for other sciences, but that is not a valid reason for stopping the important work of collecting facts with which to still further advance the work with sickness statistics. So important are the scientific results, concerning the causation of dis¬ ease, already obtained by the present Michigan system of sickness statistics, and so promising are the results yet to be worked out, that I am constrained to most earnestly plead with other State Boards of Health to take up and carry forward this system of sickness statistics. If the several State Boards will do this, it will then be much easier than otherwise it would be for a national public-health service to constantly have such knowledge of the actual state and condition of health in every part of the United States as it should have to enable it to best guard, from time to time, the highest interests of the people of this great country. Such a system of sickness statistics for the United States will be essential before it can be known what, on the whole, are the conditions which tend to the most perfect health, and what are the conditions most important to be avoided or guarded against. The Michigan statistics indicate that atmospheric conditions are the controlling causes of most of the important diseases,—those which cause most deaths. It is a fact that the migratory birds have, and act upon, such knowledge. Man’s control over nature is increasing, and will increase much more rapidly if preventable sickness and premature deaths are stopped. This country is being traversed by intricate net-works of railroads. Through increasing prosperity, because of lessened burdens on account of the prevention of sickness and deaths, the people are becoming able to travel, whereas formerly it would have been impossible. It should soon be practicable for man to approach in wisdom and in practices the migratory birds. A long step in that direction will have been taken when a good system of sickness statistics has been established throughout the country. SICKNESS STATISTICS.—MICHIGAN SYSTEM. cxlvii Note.—A sample of the postal-card report mailed weekly by the physicians in Michigan to the Secre¬ tary of the State Board of Health, is as follows: Diseases in _ ^“Please Date. week ending Sat.,. and vicinity. _, 189.... 5^3 poo C32 j) >«! CG 2.0 88 (J? "1 O gs N s. a ® s C.M C 3 ai & 3 s ® I p-cr Ed. 38. ft g!' 10 « P o §=. g O^Ol ‘B 5-2.' '§«$'! oSa! si|i igsi IJl! So P j o or? O <-t I ^,18! < S | a® < *»- C - : o' § c J go o- ® PVr—i ® 3 ^ “ S: p 2 ® P a|> 2 S tn co 03 C 1 ; 33 g3 ft ft *p£§ 3 §. P GO s?il = s il B,oS c 2 a »3c H! ft OO O p © H ft ft O 3-g a® DISEASES, CASES OBSERVED. Brain, Inflammation of_ Preval’nce Order.See a No. Of Cases. Bowels, Inflammation of... * _ Bronchitis ___ Cerebro-spinal Meningitis.. Cholera Infantum. .. .. Cholera Morbus Consumption, Pulmonary.. Croup, Membranous.. Diphtheria__ Diarrhea. • _ Dysentery.. .. _ Erysipelas__ Fever, Intermittent.. Fever, Remittent.. Fever, Typhoid (Enteric).. Fever, Typho-malarial_ Influenza... Kidney, Inflammation of. . Measles ... Neuralgia..... . Pleuritis.... Pneumonia__ Puerperal Fever.... Rheumatism___ Scarlatina_ Small-pox_ Tonsillitis_ Whooping-cough. If. D. 2105540352