TABLE 41.-SHOWING DEATHS IN NEW JERSEY FROM SMALL-POX FOR TWENTYSEVEN YEARS.

Cerebro-spinal Meningitis.-The mystery which has attended the spread of this disease has been removed in great degree by the knowledge that the meningococcus is carried in the nose and throat in the case of healthy persons, and the dissemination of the infection may therefore be through the agency of individuals who are not suspected to be affected with the disease. The infectious organisms are probably distributed as in diphtheria by kissing, by suspended droplets of moisture which are liberated in the acts of speaking, coughing, sneezing, &c., and, therefore, isolation of the patient is of first importance, and no one except the necessary attendants should be admitted to the sick room. It has been found that the infectious organisms die out quickly when they are deposited upon clothing, bedding, furniture, &c., and the spread of the disease is doubtless mainly due to the direct exposure of susceptible persons to contact with an individual who is carrying the cocci upon the mucous surfaces of the throat or nose.

Notifiable Diseases.-The law requires that the following diseases shall be reported to the local board of health within twelve hours after they are discovered: Diphtheria, membranous croup, scarlet fever, typhoid fever, small-pox, varioloid, chicken-pox, tuberculosis, hydrophobia, trachoma, glanders, anthrax, cholera, yellow fever, typhus fever, leprosy, plague, trichinosis, malaria.

For the convenience of physicians local boards in some districts have furnished blanks printed on postal cards somewhat like the following:

Report all cases, not only first cases, but also all

subsequent

NOTIFIABLE DISEASES.

Cholera, yellow fever, typhus fever, leprosy, plague, trichinosis, small-pox, typhoid fever, malaria, tuberculosis, trachoma, hydrophobia, glanders, anthrax, chicken-pox, diphtheria, membranous croup, scarlet fever, varioloid.

Verbal notice from the attending physician does not give to the health board a legal basis for the enforcement of isolation restrictions and other precautionary measures, and the notice should, in every instance, be in writing. Valuable time is often gained by sending the information by telephone, but the written notice should follow as soon as possible, for it is upon the written statement that the health board depends for its action, and without the written notice there would be no record of the report of the case. The language of the law is that the report "shall be in writing, signed by such physician, and shall set forth the name, age, and precise location of the person suffering from such disease."

TABLE 42.-INFECTIOUS DISEASES REPORTED FOR EACH QUARTER DURING THE YEAR ENDING JUNE 30, 1906.

TABLE 42.-INFECTIOUS DISEASES REPORTED FOR EACH QUARTER DURING THE YEAR ENDING JUNE 30, 1906-Con inued.

Creameries.-The act approved April 20th, 1906, was rendered necessary because some of the establishments where milk is received for distribution have been conducted without due regard for cleanliness, and additional legislation was required to bring the construction and management of all creameries up to the sanitary standard which has voluntarily been reached by the proprietors of many of them, and which is essential for the protection of the milk from contamination while it is passing through these buildings. Inspections have been made of all premises in the State where milk is sold to dealers or persons who buy to sell it again, and 108 licenses to conduct creameries have thus far been issued. The law defines the word "creamery," as used in the act, to mean establishments where milk is sold at wholesale, and the reports on file in the office of the board show that there are numerous repositories for milk in cities, which are unmis-. takably classed as creameries in the law, where the conditions are altogether unsuitable for handling milk.

The record shows that not less than 132 establishments in which the law is violated have been inspected, and notices have been sent to the owners informing them that they are conducting creameries in violation of the law. Suits have also been ordered against some of these parties. Since the passage of the act 349 letters and notices have been forwarded to the owners of creameries, and important improvements have been made on about sixty per cent. of these premises. Broken and leaky floors have been replaced by water-tight constructions, and in several instances wooden floors have been replaced with concrete. Side walls and ceilings have been made smooth, and dust and cobwebs have disappeared. The water-supply has been inquired into in every doubtful case, and every creamery which has been licensed is provided with wholesome water. Screening against the entrance of flies is not so general in creameries as it should be, but before the beginning of another season this precaution will doubtless be applied in every creamery building. The results already obtained under the provisions of the creamery act are highly gratifying, but vast improvements are still required in conducting the business of distributing milk, and substantial progress will have been made when every creamery, milk depot and milk shop shall be conducted in a cleanly manner. The chart on page 32, showing the diminishing mortality among children, should encourage health officers to continue and increase their efforts to secure the marketing of clean milk.