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63
The twenty-four deaths due to Diphtheria were however not
fairly representative of the number of cases, which probably
occurred in the district, for there is reason to believe a high
rate of mortality prevailed among the persons affected.
From careful investigation I found that the number of cases
very largely decreased from an early period in the year,
and in point of numbers the disease was very much less
extensive than it was during the latter end of 1882.
Indeed after the end of April Diphtheria could in no
sense be called epidemic in the district, and I can only
account for the large number of deaths which occurred by the
fact that the disease was of an unusually severe type.
Another noteworthy fact in relation to this outbreak is,
that it occurred in distinct groups, separated not only by
intervals of time, but by distinctions of locality and by the
ages and social status ot the victims. This points to
a separate set of causes leading to these outbreaks.
The year 1882 had ended with a heavy mortality from
Diphtheria. This was continued in January 1883, by five
deaths, then the fatal cases declined to two in February and
one in March. After an interval of six weeks (towards the
end of April) six cases suddenly occurred, five of them within
a week. Another month elapsed and one case appeared,
and next month another, showing a subsidence of the disease.
With the exception of two cases in August the disease seemed
to disappear till the end of the year, when six more deaths
occurred during the last three months. The isolation of the
outbreak in April was very marked, six weeks preceding
and four succeeding the group of cases among which the
deaths occurred. Besides an entirely different locality was
affected from that ot the previous and the subsequent outbreaks,
and also older persons and those of a superior class were
attacked. These facts attracted my special attention and
led to a patient investigation, but it only resulted, as is so
frequently the case in tracing out the etiology of disease, in
failure to demonstrate the connection of the outbreak with