— 27,815 U.S. Census Office. Compendium of the Eleventh Census: 1890, Part II. 1894, p. 6.

Alabama ( 80) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 26.

Arizona ( 16) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 34.

Arkansas ( 64) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 42.

California ( 339) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 50.

Colorado ( 294) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 58.

–146 Denver U.S. Census. Abstract…Eleventh Census… 1896, p. 271.^[1]

Connecticut ( 574) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 66.

Delaware ( 83) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 74.

District of Columbia ( 147) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 82.

Florida ( 14) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 90.

Georgia ( 152) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 98.

Idaho ( 30) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 106.

Illinois (2,604) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 114.

— 1,124 Chicago U.S. Census. Abstract…Eleventh Census… 1896, p. 271.^[2]

Indiana ( 594) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 122.

Iowa (1,212) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 138.

Kansas ( 385) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 146.

Kentucky ( 544) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 154.

Louisiana ( 187) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 162.

–115 New Orleans. U.S. Census. Abstract…Eleventh Census: 1890… 1896, 271.^[3]

Maine ( 206) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 170.

Maryland ( 293) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 178.

— 113 Baltimore U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 271.^[4]

Massachusetts (1,774) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 186.

— 545 Boston U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 268.^[5]

— 156 Lawrence U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 268.^[6]

Michigan (1,189) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 194.

— 237 Detroit U.S. Census. Abstract…Eleventh Census: 1890…. 1896, p. 271.^[7]

Minnesota ( 933) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 202.

–154 Minneapolis U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 271.^[8]

— 94 St. Paul U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 271.^[9]

Mississippi ( 89) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 210.

Missouri ( 708) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 218.

— 44 Kansas City. U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 271.^[10]

–223 St. Louis. U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 271.^[11]

Montana ( 41) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 226.

Nebraska ( 615) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 234.

Nevada ( 10) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 242.

New Hampshire ( 230) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 250.

New Jersey (1,067) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 258.

–255 Newark. U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 269.^[12]

New Mexico ( 773) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 266.

New York (4,085) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 274.

— 100 Albany U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 270.^[13]

— 53 Elmira. U.S. Census. Abstract…Eleventh Census: 1890… 1896p. 270.^[14]

–1,021 Brooklyn U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 269.^[15]

–1,337 New York. U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 269.^[16]

— 22 Rochester U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 270.^[17]

North Carolina ( 309) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 282.

North Dakota ( 133) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 290.

Ohio (1,828) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 298.

–407 Cincinnati U.S. Census. Abstract…Eleventh Census: 1890… 1896, 271.^[18]

–327 Toledo U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 271.^[19]

Oklahoma ( 9) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 306.

Oregon ( 97) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 314.

Pennsylvania (2,976) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 322.

— 98 Allegheny U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 271.^[20]

–483 Philadelphia U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 272.^[21]

–315 Pittsburgh U.S. Census. Abstract…Eleventh Census: 1890… 1896, p. 272.^[22]

Rhode Island ( 203) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 330.

South Carolina ( 161) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 338.

South Dakota ( 229) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 346.

Tennessee ( 169) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 354.

Texas ( 165) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 362.

Utah ( 212) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 370.

Vermont ( 224) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 378.

Virginia ( 488) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 386.

Washington ( 129) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 394.

West Virginia ( 118) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 402.

Wisconsin ( 949) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 410.

Wyoming ( 27) U.S. Census. Report on Vital Statistics…Deaths, Part III, p. 418.

Narrative Information

Census: “The total number of deaths reported as due to diphtheria is 27,815, giving a proportion of 33.06 per 1,000 of all deaths in which the causes are reported, which is decidedly lower than the figures of 1880, which gave a proportion of 52.32 per 1,000. To these figures, however, should be added the greater part of the deaths caused by croup, numbering 13,862, which would make the combined ration of the two diseases 49.54 per 1,000.” (p. 6.)

“For some of the states and cities the proportion of deaths from diphtheria per 1,000 of all deaths of known causes was as follows: [We reorder original paragraph into lines raked by death rate.]

Vermont, 42.62;

Connecticut, 39.97;

Massachusetts, 38.66;

New Jersey, 35.38;

New Hampshire, 33.52;

New York, 33.40;

Delaware, 27.72;

Rhode Island, 27.37;

District of Columbia, 24.40;

Alabama, 4.27;

Toledo, Ohio, 197.73;

Dover, New Hampshire, 137.55;

Lawrence, Massachusetts, 121.00;

Elmira, New York, 96.36;

Hartford, Connecticut, 65.97;

Minneapolis, Minnesota, 63.22;

Cincinnati, Ohio, 61.35;

Pittsburg, Pennsylvania, 60.60;

Denver, Colorado, 56.57;

Detroit, Michigan, 56.53;

Jersey City, New Jersey, 55.03;

New Haven, Connecticut, 50.12;

Brooklyn, New York, 49.58;

Boston, Massachusetts, 49.05;

Chicago, Illinois, 48.67; Newark,

New Jersey, 48.39;

Bridgeport, Connecticut, 47.95;

Allegheny, Pennsylvania, 46.23;

St. Paul, Minnesota, 42.15;

Albany, New York, 41.41;

Providence, Rhode Island, 34.12;

New York city, 30.83;

Indianapolis, Indiana, 30.18;

St. Louis Missouri, 25.86;

Troy, New York, 24.43;

Burlington, Vermont, 22.90;

Trenton, New Jersey, 22.22;

Philadelphia, Pennsylvania, 20.35;

Kansas City, Missouri, 17.48;

Louisville, Kentucky, 17.43;

New Orleans, Louisiana, 16.73;

Memphis, Tennessee, 14.42;

San Francisco, California, 14.00;

Baltimore, Maryland, 10.54;

Richmond, Virginia, 10.00;

Rochester, New York, 9.51;

San Antonio, Texas, 6.63;

Wilmington, Delaware, 6.37;

Concord, New Hampshire, 5.93;

Chattanooga, Tennessee, 5.18;

Galveston, Texas, 4.32; Mobile, Alabama, 3.86; Atlanta, Georgia, 3.80; Savannah, GA, 3.63; Nashville, Tennessee, 2.97; Charleston, SC, 0.44.”

“As in 1880, therefore, diphtheria is much more prevalent in the northern part of the country than in the south, but its relative prevalence in the cities appears to have greatly increased since the last census, at which time it was slightly more prevalent in the rural districts than in the cities, whereas in 1890 the reverse appears to have been the case.” (US Census Office, Interior Dept. Compendium of the Eleventh Census: 1890, Part II: Vital and Social Statistics…., 1894, 7.)

On Diphtheria

CDC: “Diphtheria is a serious disease caused by a toxin (poison) made by bacteria. It causes a thick coating in the back of the nose or throat that makes it hard to breathe or swallow. It can be deadly. The DTaP vaccine protects against diphtheria…. Diphtheria starts like a cold, with sore throat, mild fever (101 degrees or less), and chills. Next, the diphtheria toxin makes a thick coating on the back of the nose or throat. It may be blue or grayish green. The coating makes it hard to breathe or swallow… The coating on the throat can get so thick that it blocks the airway, so the person can’t breathe.

“The diphtheria toxin can attack the heart, causing abnormal heart rhythms and even heart failure. It can also attack the nerves, which leads to paralysis (unable to move parts of the body).

About 1 out of 10 people who get diphtheria dies. In children younger than 5 years, as many as 1 out of 5 children who get diphtheria dies.

“How does diphtheria spread? Diphtheria spreads when an infected person coughs or sneezes. A person can spread the disease for up to 2 weeks after infection.

“What is the DTaP vaccine? The DTaP vaccine is a shot that combines the vaccines for diphtheria and two other serious diseases: tetanus and whooping cough (pertussis). The vaccine helps the body to build up protection against the diphtheria toxin. Most children (about 97 children out of 100) who get all doses of the vaccine will be protected against diphtheria….” (CDC. Vaccines and Immunizations. “Diphtheria – Fact Sheet for Parents.” 7-8-2013 update.)

Guilfoile: “Origin of the Term ‘Diphtheria.’ The French physician Pierre Bretonneau performed autopsies on many people who had died of what we now call diphtheria. He noted that a common feature of these victims was that they all had a growth, called a pseudomembrane, in their upper respiratory tract. In 1826, he first used the term ‘diphtherite,’ after the Greek word meaning ‘leather or hide,’ based on the leather-like appearance of the pseudomembrane. The term was subsequently modified to ‘diphtheria’ in the 1850s.” (p. 11)

“In contrast with nasal diphtheria, respiratory diphtheria is a very serious disease. Prior to the development of effective medical treatments, about half the people who developed symptoms of respiratory diphtheria died. In children who have diphtheria, the bacteria grow primarily in the upper and lower throat.” (p. 14.) (Guilfoile, Patrick G. Diphtheria (Deadly Diseases and Epidemics series). NY: Chelsea House, an imprint of Infobase Publishing, 2009. )

Staples: “The history of diphtheria is not confined to modern times. According to Dr. Greenhow, of London, whose excellent monograph on this disease appeared in 1861, diphtheria prevailed in Spain, Italy, Sicily and other European countries, in the sixteenth and seventeenth centuries. It visited England, France, Italy, Sweden, Holland, Germany, and North America, about the middle of the last century. Oertel writes in Ziemssen’s Cyclopedia: ‘Diphtheria is one of the oldest epidemic diseases of the human race. Even Homer and Hippocrates advanced views from which Bretonneau first sought to prove that the disease was known in those times under the name ‘Malum Ægyptiacum,’ as a disease greatly to be feared.’ According to the same author, Aretaeus, writing at the close of the first and the beginning of the second century after Christ, accurately describes the Malum Ægyptiacum, specially emphasizing the fact that in the disease the tonsils are covered with a certain dense white ‘humore’ which spreads over the tongue and gums. Writers in the later centuries give the disease under various names, and evidently confounded it with other malignant affections of the throat; yet the description of the character and situation of the local disease given by the older writers – the white, ashy and putrid exudation, in fatal cases so loathsome that even the patients themselves can not endure it; the disease often extending to the air tubes and causing death by suffocation; the class of persons most liable to the disease, children who have not yet reached the age of puberty; its uncertain attack and advance – all this affords abundant evidence that the disease of the ancients was identical with the diphtheria of our own time..

“The name diphtheria was first given by Bretonneau, of Tours, France, in 1821. This distinguished Frenchman first made accurate investigations into the nature of the disease, and, because of its essential characteristic, the exudation, he gave it the name, in French, diphtherite, from the Greek diphtheria, a pellicle.^[23]

“The investigations and views of Bretonneau were first published in the form of two treatises presented to the French Academy of Medicine. He at first insisted that diphtheria must be considered as wholly a local disease^[24]. He was obliged at a later period to concede that a blood poisoning is one of its essential characteristics – (Oertel.).

“In 1820, Dr. Thomas Brown presented a paper on diphtheria to the Glasgow Medical Society, and in 1825, Dr. McKenzie published two papers in the Edinburgh Medical and Surgical Journal, in which views were expressed similar to what Bretonneau published the year following. It is true, however, that the medical profession at large, at this time and for many years afterward, had little knowledge and less practical interest in the disease, whose existence and character was known only in a few scientific essays.

“Almost all knowledge of the Malum Ægyptiacum of Aretaeus of the first century, of the Garrotillo or Morbus Suffocans of Villa Real, Foutecha and Herrera of Spain, in the seventeenth century, the sore throat described by Chomel of France, and by Fothergil, Starr and Huxham of England, and by Samuel Bard in North America, in the middle of the eighteenth century, and even the diphtherite of M. Bretonneau, early in the present century, had passed from the memory of man, and the world for several generations had known little of diphtheria, when the great outbreak of the disease occurred at Boulogne in 1855. In this beginning of epidemic diphtheria of our own time, according to Dr. Greenhow, there were in Boulogne in the months of January, February and March, 366 deaths; 341 of which were of children under ten years of age. During the year, the disease appeared in various parts of France.

“The epidemic first appeared in England in the early autumn of 1856. The first cases were in the town of Spaulding, in Lincolnshire. In 1857 the disease was in London. Concerning the method of the progress of the epidemic, Dr. Greenhow remarks: ‘It is at least an important point in the history of the epidemic, to have ascertained that it began, to all appearances, spontaneously in several centers, sufficiently remote from one another to prove their complete independence. Another feature noticeable in the spread of the epidemic n London, as well as in other parts of England and on the continent, that has peculiar interest is, that the epidemic influence often produced its effect in various ways short of causing the complete and malignant forms of the disease. There was for some months previous to the introduction of what was regarded as true diphtheria, a peculiar sore throat prevalent, unattended either by ulceration or exudation, and scarlet fever prevailing about that time had unusual features as regards the character of the throat disease; there was an unusual depression of the vital powers. An epidemic of catarrhal fever^[25] prevailed in the autumn of the same year, almost exclusively limited to children; and this also was attended and followed by an unusual amount of depression….

“In closing this outline sketch of the history of diphtheria, I desire to quote briefly from a lecture by Dr. Alonzo Clark in the College of Physicians and Surgeons, New York, published in 1861, giving the opinion of the author concerning the future of the disease. Dr. Clark says: “I must now add that diphtheria, though an epidemic affection, is not, like cholera or yellow fever, a disease of a single season, at least so far as relates to a state or country. It often has a limited duration in villages and among a scattered population, but in large towns, and in the country at large, there is much reason to apprehend that, once established, it will continue for years.” (Staples. “Report on Diphtheria,” pp. 27-29 in Minnesota State Board of Health. Seventh Annual Report of the State Board of Health of Minnesota, January 1879. Minneapolis: Johnson, Smith & Harrison, 1879.)

University of Illinois at Chicago: “Diphtheria is a highly contagious disease caused by a bacillus (Corynebacterium diphtheriae). The disease is spread from person to person by coughing, breathing, direct contact, or through contaminated food. Upon infection, the ailment normally breaks out after a brief incubation period of two to four days. Symptoms of the illness include a sore throat, fever, hoarseness, swollen neck glands causing a “bull-neck” appearance, and difficulty in swallowing and breathing. A grayish membrane often forms in the throat and, if it continues to grow, can interfere with swallowing. If it extends to the windpipe, it can block air and cause suffocation.

“If untreated, the diphtheria bacteria produces a powerful poison, or toxin, that spreads throughout the body and can cause pneumonia, paralysis and heart failure. Treatment consists of immediate administration of diphtheria antitoxin and antibiotics. Antibiotic treatment usually renders the patient non-infectious within 24 hours. Even with treatment, however, the disease can be fatal, killing 5 percent to 10 percent of diphtheria patients. Untreated, the disease claims even more lives — 25 percent to 50 percent. Untreated patients are infectious for two to three weeks. Unless, immunized, children and adults may repeatedly be infected with the disease.

“Diphtheria is undoubtedly an old malady. In historical accounts, however, it is very difficult to separate the disease from other throat conditions, such as scarlet fever, which also had serious consequences. One of the earliest accounts of diphtheria is found in the Hippocratic work Epidemics III, which was written 2,500 years ago. Another early description of the disease was recorded about 1,900 years ago by Arateus of Cappadocia, a Greek physician, who practiced medicine in Rome. Arateus called the ailment ulcers of the tonsils. He observed that if the ulcers spread to the windpipe it resulted in suffocation. Arateus accurately observed, ‘the manner of death is most piteous; pain sharp and hot as from a carbuncle; respiration bad, for their breath smells strongly of putrefaction, as they inhale the same again into their chest; fever acute, thirst as if from fire, and yet they do not desire drink for fear of the pain it would occasion…’ During the Middle Ages, there was little written about the disease.

“The first recorded epidemic of diphtheria in America occurred in colonial New England in 1735. It lasted almost five years and caused the deaths of 5,000 persons, or 2.5 percent of the total population. In towns across western Massachusetts and New Hampshire many families lost all their children to this terrible sickness….

“Although diphtheria was primarily a disease of children, adults also suffered and died from it. The most famous adult of the 18th century to die from diphtheria was George Washington. The former president died at his Mount Vernon home in 1799 from asphyxia from a severely swollen

throat caused by the ailment….

“Between 1850 and 1860, for the first time in recorded history, there was a severe worldwide

epidemic, or pandemic, of diphtheria….

“Much of the confusion over the cause of the disease occurred because no one at the time [up to 1880s] recognized the existence of healthy diphtheria carriers, individuals who are apparently well but harbor the diphtheria bacillus in their nose and throat. These diphtheria carriers were a major source of the illness, accounting for as much as 75 percent of the cases of the disease.” (University of Illinois at Chicago. “4. Diphtheria,” pp. 49-60.)

Sources:

Centers for Disease Control and Prevention. Vaccines and Immunizations. “Diphtheria – Fact Sheet for Parents.” 7-8-2013 update. Accessed 8-27-2013 at: http://www.cdc.gov/vaccines/vpd-vac/diphtheria/fs-parents.html

Guilfoile, Patrick G. Diphtheria (Deadly Diseases and Epidemics series). NY: Chelsea House, an imprint of Infobase Publishing, 2009. Google digital preview at: http://books.google.com/books?id=tzVqM-JUnW8C&dq=diphtheria&source=gbs_navlinks_s

Staples, Franklin, M.D. “Report on Diphtheria,” pp. 27-29 in Minnesota State Board of Health. Seventh Annual Report of the State Board of Health of Minnesota, January 1879. Minneapolis: Johnson, Smith & Harrison, 1879. Google digitized at:

http://books.google.com/books?id=10VNAAAAMAAJ&printsec=frontcover#v=onepage&q&f=false )

United States Census Division, Department of Interior. Abstract of the Eleventh Census: 1890. Second Edition, Revised and Enlarged. Washington, DC: GPO, 1896. Google digitized at: http://books.google.com/books?id=1DUPAAAAYAAJ&printsec=frontcover#v=onepage&q&f=false

United States Census Office, Department of Interior. Compendium of the Eleventh Census: 1890, Part II: Vital and Social Statistics…. Washington: GPO, 1894. Google digitized at: http://books.google.com/books?id=T8frAAAAMAAJ&printsec=frontcover#v=onepage&q&f=false

United States Census Office, Department of Interior. Report on Vital and Social Statistics in the United States at the Eleventh Census: 1890. Part III. – Statistics of Deaths. Washington, DC: GPO, 1894. Google digitized at:

http://books.google.com/books?id=YfZYAAAAYAAJ&printsec=frontcover#v=onepage&q&f=false

United States Census Office, Department of Interior. Report on Vital and Social Statistics in the United States at the Eleventh Census: 1890. Part IV. – Statistics of Deaths. Washington, DC: GPO, 1895. At: http://www.cdc.gov/nchs/data/vsushistorical/vsush_1890_4.pdf

University of Illinois at Chicago. “4. Diphtheria,” pp. 49-60.

http://webcache.googleusercontent.com/search?q=cache:ALEJFHVbhcoJ:www.uic.edu/sph/prepare/courses/ph500/resources/diphtheria.pdf+&cd=1&hl=en&ct=clnk&gl=us

[1] Our calculation based on diphtheria death rate of 56.57 per 1,000 deaths and 2,584 Denver, CO deaths.

[2] Our calculation based on diphtheria death rate of 48.67 per 1,000 deaths and 23,102 Chicago, IL deaths.

[3] Our calculation based on diphtheria death rate of 16.73 per 1,000 deaths and 8,875 New Orleans, LA deaths.

[4] Our calculation based on diphtheria death rate of 10.54 per 1,000 deaths and 10,752 Baltimore, MD deaths.

[5] Our calculation based on diphtheria death rate of 49.05 per 1,000 deaths and 11,117 Boston, MA deaths.

[6] Our calculation based on diphtheria death rate of 121.00 per 1,000 deaths and 1,297 Lawrence, MA deaths.

[7] Our calculation based on diphtheria death rate of 56.53 per 1,000 deaths and 4,203 Detroit, MI deaths.

[8] Our calculation based on diphtheria death rate of 63.22 per 1,000 deaths and 2,440 Minneapolis, MN deaths.

[9] Our calculations is based on diphtheria death rate of 42.15 per 1,000 deaths and 2,240 St. Paul, MN deaths.

[10] Our calculation based on diphtheria death rate of 17.48 per 1,000 deaths and 2,553 Kansas City, MO deaths.

[11] Our calculation is based on diphtheria death rate of 25.86 per 1,000 deaths and 8,645St. Louis, MO deaths.

[12] Our calculation based on diphtheria death rate of 48.39 per 1,000 deaths and 5,280 Newark, NJ deaths.

[13] Our calculation based on diphtheria death rate of 41.41 per 1,000 deaths and 2,421 Albany, NY deaths.

[14] Our calculation based on diphtheria death rate of 96.36 per 1,000 deaths and 551 Elmira, NY deaths.

[15] Our calculation based on diphtheria death rate of 49.58 per 1,000 deaths and 20,593Brooklyn, NY deaths.

[16] Our calculation based on diphtheria death rate of 30.83 per 1,000 deaths and 43,378 NY, New York deaths.

[17] Our calculation is based on diphtheria death rate of 9.51 per 1,000 deaths and 2,323 Rochester, NY deaths.

[18] Our calculation based on diphtheria death rate of 61.35 per 1,000 deaths and 6,640 Cincinnati, OH deaths.

[19] Our calculation based on diphtheria death rate of 197.73 per 1,000 deaths and 1,656 Toledo, OH deaths.

[20] Our calculation based on diphtheria death rate of 46.23 per 1,000 deaths and 2,122 Allegheny, PA deaths.

[21] Our calculation is based on diphtheria death rate of 20.35 per 1,000 deaths and 23,738 Philadelphia, PA deaths.

[22] Our calculation is based on diphtheria death rate of 60.60 per 1,000 deaths and 5,206 Pittsburgh, PA deaths.

[23] “A thin skin or film on the surface of a liquid.” (American Heritage Medical Dictionary. Houghton Mifflin Co., 2004; quoted in TheFreeDictionary.com.

[24] Local, in the sense, we believe, of localized at a location in the body.

[25] “Old term for the group of respiratory tract diseases including common cold, influenza, and lobular and lobar pneumonia.” Farlex Partner Medical Dictionary, 2012; quoted in TheFreeDictionary.com.

1889-90, June-May, Diphtheria, 48 States & DC, esp. NY/4K, PA/2.9K, IL/2.6K, OH-27,815