REPLIES OF L. C. WAILES, M. D., OF PLANO, APPANOOSE COUNTY.

* The figures beginning each paragraph, refer to questions in Circular 23B, on page 152.

NORTHWESTERN DIVISION.*

REPLIES OF PAUL L. BRICK, M. D., OF LE MARS, PLYMOUTH COUNTY.

There are many circumstances combining to increase the difficulty of obtaining satisfactory statistics of our part of the State. Plymouth county has been only lately settled, and Le Márs has been so rapidly increasing in population. Our physicians are most all new comers here. I have been here but two years and a half.

All these causes will aid in excusing my slim report.

8. Lung diseases.

9. To the increased prevalence of the diseases named in No. 6. It seems to have been my experience that during an epidemic all other diseases are pushed into the background.

10. Diphtheria, variola, malaria. 11. Diphtheria was present in a more violent form; variola made her first visit; malaria had never been known here before in a fatal form. 12. Rubeola.

13. Had no severe cases; weather was warm and dry, favorable to treatment.

14. Diphtheria, January to May, mortality high, mostly malignant form (pyæmia); mortality from malaria was high all through the year, I think.

15-16. Had variola in December, with one death, a child, 5 months old.

17. Small.pox, 3 cases; no cases. of cholera; no scarlatina (authenticated), that I know of in 1881. Typhoid fever or typho-malaria of the typhoid type has een plenty here, but I would not attempt to set any figure as to how many cases. Had no unusual amount of measles; some cases of whooping cough with a few deaths. I treated perhaps a hundred cases of diphtheria myself, and think perhaps three fourths of all cases we had.

18. Cholera, scarlatina, cerebrospinal meningitis.

19.

*For counties in this division, see map, page 156.

+ The figures beginning each paragraph refer to questions in Circular 23B, on page 152.

The squares represent sections, the number of which is marked in the center with figures. The heavy line is the county line between Sioux on the north and Plymouth on the south. [] represents houses that have been infected with diphtheria, while the figures show the routine of the course of the disease. S denotes school houses, while the squares with a cross represent churches. A postoffice on the northwest corner is marked P. O.; the name is Corn Valley. + represents houses of customers of mine living in the close neighborhood of the line of the disease, but who escaped its ravages in their families. My first diptheria patient was in the family of C. French, section 24, 94, 47. Two cases, both croupous, both fatal. Mr. French is a son-in-law of Mr. Burket (Place I), communication kept up, the disease was carried to place II, where four cases resulted-one death among them. Mr. Kluter (place III) persisted in visiting No. 2, carried diphtheria home, had one case not fatal. Will speak of this case hereafter. Mrs. Ferris (place IV) had daily communication with No. III through Mr. C. Burket (No. V), a son of No. II and nephew of No. IV; he carried the disease to No. IV and then home (No. V.) At No. IV they had six cases, with two deaths. Mrs. Evans (No. VI) is a sister of Mrs. Ferris (No. V), and helped to nurse the patients of No. V, being very careful, however, in changing her garments before entering her own house. Mrs. Evans, though, had a slight attack of diphtheria herself, and from that communicated it to her children. They had four cases, with two deaths. From here it was taken into the family of Mr. Rolston, some three weeks after all signs of the disease had disappeared from the house of No. VI. It was transmitted by a child of No. VI sleeping at the house (No. VIII.) Here we had six cases, no deaths. About the same time Mrs. Edwards (No. VII), visiting her sister, Mrs. Evans, carried the disease home; had four cases, with two deaths. From Rolston's (No. VIII), it was carried across the road to Corbin's (No. IX), where six cases all recovered. Next, diphtheria appears at the home of Mr. Montag (No. X), he being an old-time friend of Mr. Rolston, went there frequently, taking his family along. Here we had six cases, two of which proved fatal. Lastly, from here it was through carelessness carried to N. Sherman's (No. XI) by himself, where one case of two fatal. From Mr. Albers' (XII), it was taken to J. Huron's (No. XIV), but there could no clue be traced of any connection between No. XII and any of the previous cases.

From this chain, as well as other experiences that I have had, I conclude beyond a reasonable doubt that diphtheria is a highly contagious and infectious disease. That the infection can be carried in clothing for weeks, and that great care should be exercised on part of the physicians to prevent any spread of the disease. I had advised Mr. Kluter (No. III) to isolate at once the case in his house from the rest of the children-he has five-and give them plenty of whisky. The poor fellow was so badly scared that he kept the family half intoxicated for weeks by the influence of whisky. He had no other case in his house. At Mr. Evans' house one of the children had diphtheria two years previous. I told the family that she would not be apt

to have another attack of it. She showed symptoms of sore throat soon after the first case appeared at the house. She was put to bed with the patient, but was finally by my request permitted to leave the bed, and she was the only one in the family who did not take the disease, and the only one of the children who survived. This, as well as many other cases that I have had opportunity to watch, proves that an attack of the disease is a perfect immunity against a second attack, at least for a certain time, in fact as much so as it is the case in variola. (I have treated this year four cases of variola who had that disease years ago.)

One other point. In section 18, township 93, range 46, we have three farms on a space of half a mile. Two of these places were infected, while the one between them remained intact. Mr. Cox, the owner of the place, was a careiul man. Although he himself rendered all the aid possible at the neighbors' houses, he never allowed any of his eight children or his wife to go there. As a prophylaxis, the children were using whisky, chlorate of potash, iron, etc. I have a great deal of faith in chlorate of potash as a preventive for diphtheria. In the cure of the disease ice is one of my stand-by remedies, when there is swelling of the glands of the throat with high local pyrexia. Families accustomed to filth, if kept clean during the ravage of diphtheria, seem to escape better than those accustomed to perfect cleanliness. Disinfectants do not check the progress of infection or kill the germ, in my experience. Jaborandi is a reliable remedy in diphtheria and pseudomembranous croup. The following is a record of one hundred cases of diphtheria treated by me:

32. No accidents from petroleum that I can think of in 1881.

Le Mars, August 3, 1882.

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Respectfully yours,

PAUL L. BRICK, M. D.