reports are hereto appended as a body of evidence in which the connected points of review and suggestions, as here submitted by the Board. will be fully sustained:

I. Prevalent Diseases.-Small-pox, Diphtheria, Scarlet Fever, Typhus and Typhoid Fevers.

II. Distribution and Local Government of the Population.- Local Boards of Health.

III. The New Sanitary Laws.- Chapters 407 and 431 of 1881.
IV. Reports of the Committees.

V. Investigation and Prevention of Stench Nuisances.

VI. Procedures under the eighth section of the State Board of Health Act.

VII. Laws and Sanitary Provisions relating to Small-pox and Vaccination.

VIII. Impure Water Supplies. Pollution of Wells and Streams.Water Analysis.

IX. The General Drainage Laws.

X. Sanitary Drainage of Villages, and the Treatment of Drainage areas in populous districts. Disposal of Domestic Waste Matters. XI. Public obstructions to Natural Drainage. Sanitary questions connected with the Abandoned Canals, and the Malarial Grounds near the Erie canal.

XII. The extent of Preventable Causes of Malaria in the State.
XIII. Sanitary Inquiry relating to Prevalent Acute Diseases.

XIV. The State System of Registration of Births, Deaths and Marriages.

XV. Expert Services.

XVI. Health in the Schools.

XVII. Tenements. - - Protection of Health and Life of Tenants.

I. PREVALENT DISEASES.

Healthful and prosperous as the past year has been in the State of New York, those acute contagions which are the enemies of child-life, have prevailed in a great many localities, and, as usual, have desolated. thousands of homes. Scarlet fever, diphtheria, small-pox, the most conspicuous of these enemies, have not limited their prevalence to the crowded cities, and the poorer classes in villages; but they have been especially malignant and fatal in rural neighborhoods, and even in the remotest districts. As the year is now closing, diphtheria and smallpox are being reported as in progress in remote hill districts where sanitary safe-guards against such evils have been least thought of hitherto. The more we know of the places and habits of these contagious maladies the more conclusive is the evidence that whatever may

be the importance of local conditions that promote their propagation, the contagia or communicable poisons which they produce and spread abroad, must be controlled and "stamped out," as the very first sanitary duty by public health authorities.

The conditions under which contagious and other fatal diseases become localized are well understood, and the diseases themselves which depend upon these conditions for their persistency and greatest public harm are now justly termed filth diseases, foul-air diseases, and the endemic, epidemic and contagious kinds of disease.

Endemic and epidemic fevers, which have for ages had a written. history, still prevail under conditions not unlike those that have found their record in ancient story and in the annals of the districts where marshes, neglect of drainage and sewerage, sodden grounds and predominating uncleanliness have propagated miasmatic and filth diseases.

The increasing prevalence of miasmatic diseases during the past few years in New York, and other States in our latitude, is receiving careful attention from this Board, and from some other State Boards of Health.

The frequent recurrence of small-pox in communities that were presumed to be as well protected as others against it; the outbreak of diphtheria in widely separated towns and villages; its fatal persistence in several of the cities through the last fifteen years, and its recurrence again and again in the same towns, in the same valleys, and upon the same hillsides, or in particular neighborhoods, where, within the last twenty years, it appeared for the first time in the present century, are supplying facts which seem to show either that the sanitary measures hitherto adopted were not in any sense adequate to the extermination of the causes of this disease, or that it prevails so capriciously that ordinary sanitary measures may not reach its causes.

The appearance of scarlet fever in every county in the State, and its varying but always terrible fatality and dreaded consequences, and the frequent prevalence of measles and whooping-cough which destroy a vast number of children's lives annually in the State, by the fatal effects they produce upon the respiratory organs; these, when counted together, are found to be charged with a very large percentage of the total mortality, year by year. The diseases here enumerated are not altogether to be accredited to filth and foul air; they are contagious diseases, and spread by their own specific poisons. Hence, they will all admit of a certain degree of definite sanitary control; and as hygiene and medical philosophy, founded on exact experimentation and research, now teach, there may be no plainer or imperative sanitary duty imposed on health boards, physicians and householders than correctly to understand, and promptly to apply, the known resources of

hygiene to the control and extinction of the contagious elements upon which these harmful diseases so largely depend. As regards small-pox, diphtheria, scarlet fever, and the typhus and typhoid fevers, these are plain sanitary duties; and in this report we summarize them under the heads: (1.) Isolation and Quarantine. (2.) Cleansing, Disinfection and Extinction. The reports of the standing committees on Vital Statistics and on Quarantine present certain public aspects and results of these duties.

This Board has thus far rarely had difficulty in its efforts to induce local boards of health to make it an invariable duty to enforce all needed obligations for the domestic or local quarantine, disinfection and cleansing which are adapted to and necessary for protection against each of the contagious diseases.

The amended general law prescribing the organization and powers of local boards of health (chapter 431 of 1881), confers on every local board adequate authority, and prescribes the necessary safeguards, for the exercise of such powers, for the suppression and extermination of sources of contagion. The circulars of information prepared and issued by this Board, supplying to all health officers and boards of health having need of sanitary information and advice in regard to the acute kinds of contagious diseases, and the treatment of infected persons, places and things, have been sought after and made practically available in the warfare against these enemies of households and communities. The first issued relates to diphtheria, and, though designed for communities that were in great alarm and peril, remote from physicians, and without the jurisdiction of any local board of health, has become the most useful and necessary of all in this list of circulars of information and advice. This, as well as the others six in number will be found hereto appended.

Essential facts relating to these diseases. Important progress is being made in the knowledge of causation of the destructive contagious and infectious maladies. The wonderful disclosures in inoculation, as practiced in the time of Lady Wortley Montague, and by vaccination, the great discovery of Jenner, seem to have been but preludes to the discovery of certain fundamental facts relating to the means by which diseases most fatal and obstinate are rendered controllable. In respect to this matter, however, we may reasonably believe that sanitary and medical science is only upon the verge of great discoveries and definite rules of sanitary practice by which the human family shall be adequately guarded against the most destructive maladies. The National Board of Health is attempting to subordinate to the demands of sanitary science numerous expert investigators who already report conclusively practical results concerning the causes and spread of diphtheria.

Small-pox.- This disease, which marks its victim for life, is at last so well understood as an unmasked destroyer that its contagion is readily controlled and extinguished by definite rules of disinfection, and by enforcing the absolute isolation or quarantine which the local and State sanitary codes now require; vaccination, at the same time, presenting the boon of protection with as much claim to efficiency as it ever had. In special reports appended will be found practical illustrations of these subjects which all people should understand. It is for this reason they are introduced as a body of evidence. Small-pox continues to be a curse and a terror to the communities in which it appears, where neither vaccination nor adequate sanitary regulations are already in the line of defense against it. Perhaps nothing has occurred in the history of small-pox that is more instructive than the protection which the towns of Kingsbury, Fort Edward, Argyle and Caldwell obtained by means of sanitary organization, domestic and local quarantine, and, chiefly, by the complete defense which vaccination and revaccination secured. As the reports show, the Board of Health in the village of Sandy Hill (in the town of Kingsbury) called for, and gratuitously used, 1,250 vaccinal points, immediately upon notice of danger, in time to confront the peril from the nearest neighboring village-only three or four miles away while the next contiguous and populous towns and villages secured immunity by the same means. The five towns which were most exposed to the contagion, that was rife in the populous village in their midst, as is shown by the reports, secured their immunity by promptly applying vaccination to several thousand persons, at a cost which is but a small fraction of the sum that was expended by the single rural town of Salem, in December and January last, in the attempt to control an outbreak of small-pox in the little hamlet of Shushan. The total cost of "stamping out" small-pox that was stealthily introduced into the town of Queensbury, and its chief village, Glens Falls, amounts to nearly $8,000, while the entire expenditures upon the thorough vaccination and revaccination that protected the towns of Fort Edward and Kingsbury, and the village of Sandy Hill, amounted to but a few hundred dollars. The total and detailed results of vaccination, as studied by the officers of this Board, and now attested in every locality where this protective agency has been seasonably resorted to, seem to confirm all that Jenner and all enlightened physicians, from his day till now, have claimed for the place which vaccination holds in well regulated public health service.

Pure and trustworthy virus.-This Board directed three of its standing committees, as shown in the appended abstract of proceedings, to prepare a report upon suitable State supervision and sup

plies of necessary vaccinal virus from inoculated calves; in other words, upon the subject of a "bovine or vaccine farm." Such a report will be expected from those committees early in the winter. It is deemed of the utmost importance that there should be the most trustworthy and ample supply, and the best methods of distributing it to local health officers, and for the gratuitous offering of it to the needy in the community, under suitable sanction. Precisely these duties are what is implied by this Board's action on the subject. It is simply renewing the memorable methods of the discoverer of vaccination in the careful culture and preservation of the full virtues of the vaccinal virus. Therefore, we respectfully commend the subject. to your attention and to that of the legislature. A "bovine or vaccinal farm" consists of an organized arrangement for skillful selection, keeping and inoculation of heifers, the vaccinal vesicles upon the tender skin of their loins, being produced, at a great number of inoculated places, precisely as in the arm of an infant. Fortunately, there are several private establishments of this kind in the United States, but there is none in New York. The State of Maryland has, for several years past, maintained such an institution, and paid the expense for supplying pure virus gratuitously to all who will accept it in the State. The cost is not great, but the skill and precision required in the service should be perfect.

The Board mentions, with much satisfaction, that out of the several thousand supplies (points), of vaccinal virus for which it temporarily guaranteed the payment, wherever purchased (for bovine virus has been obtained at great disadvantage from several States to meet urgent demands) only a few dollars worth has, thus far, been required to be paid for from its funds. The largest amount so guaranteed for any one health board was for 1,250 points in a single town. The fact that health boards of towns and villages have no available funds of their own, but must await an auditing at some distant time, has rendered this mode of assistance to them quite important in the effort to afford general public protection against small-pox.

Diphtheria. It is now twenty-three years since diphtheria appeared in a malignant form in the city of Albany and desolated an extensive district south of State street, in the old quarter of the city. It raged fatally for several months in that district, and had nearly disappeared before it was announced as prevailing elsewhere in the State. More than sixty years had then elapsed since it had prevailed in any part of the State, and then it was under the name of malignant sore throat, etc.; and it appears to have been perfectly described by the physicians. of that period. Now it is known by the name given it in France in later times, Diphtheria; but, as a terrible domestic pestilence, no