DISINFECTANTS, Isolation and disinfection continue to be our chief means for preventing the spread of contagious diseases. It is important to remember always that cleanliness in all its details is the one essential before and beyond all else, and that nothing can take its place. We have heretofore in circulars and reports so fully treated of disinfectants, that it is only necessary here to add a few words because of some more recent investigations. The value of fresh-slaked lime and of milk of lime or lime-wash, as noticed in the last report, has been sustained. Heretofore these have been regarded too much as favoring cleanliness without having any special power over lower forms of life or the chemical changes occurring in filth. Sulphate of iron hardly maintains its former asserted value and is being replaced more by sulphate of copper. Carbolic acid, which for a time was partially supplanted by corrosive sublimate, has resumed its former place. A five per cent. solution is an effective disinfectant agent, and it even destroys spores after an exposure of twenty-four hours. Corrosive sublimate, while of great value, is not of so universal application as was at one time contended. By reason of the fact that it coagulates albumen rapidly, it often does not reach a mass of matter, but forms an outer coating. It also suffers decomposition into inert compounds, when mixed with organic acid. It is not as good as chloride of lime for the disinfection of excreta or sputa. As it corrodes metals or amalgamates with them, it cannot long be used in metallic vessels or poured often into lead or other plumbing-pipes. Its effect is much increased by adding to the solution 1 to 1,000, five per cent. of hydrochloric acid, or a little more than its own weight of common salt. If kept long in solution it is decomposed. Its chief use is for application to all floors furniture and clothing, for the disinfection of the hands or to immerse clothing in, which cannot be boiled. Or if soiled clothing has to be retained awhile in the sick room, it can be immersed for one or two hours in a solution of 1 to 1,000. Remember always that it is a poisonous solution, and so never to be in common pitchers, bowls or pails. In Germany, and to some extent in this country, rubbing the walls with pieces from a bread loaf, not too fresh or stale, has been found to remove bacterial germs with much success. The plan is to take, for instance, the end of a loaf just large enough to be conveniently held and rub the cut surface along the wall, the crumbs being caught on a paper spread on the floor and then burned. By paring the crust from time to time a small half loaf will cleanse quite a surface of wall. Chloride of lime fully retains its value as a disinfectant, but small packages are often adulterated. SCHOOL HYGIENE. There has been throughout the State an increase of interest in all that relates to the sanitary care of children in our public schools. Teachers are studying the great sanitary problems involved in education, both in respect to the child in his physical and mental training and the conditions and circumstances by which he is surrounded. One after another, poor school-houses are being replaced by better ones and more care is being exercised in the choice of locality and the control of adjacent buildings. The State Superintendent of Schools is alive to all these interests and has done and is doing much in this department of educational progress. The systematic teaching of hygiene in the higher schools and the frequent instructions of teachers as to it, are having good results. As we have given large space in recent reports to this subject, we only allude to it in our present report, but shall probably, in connection with the State Superintendent of Schools, ere long conduct anew a systematized inquiry into the details of sanitary conditions in the school buildings of the State. HOSPITALS. In a previous report we had occasion to note the need of hospitals in general and of cottage hospitals in our smaller cities, both as a means of isolating communicable diseases and to meet the emergencies of accidents. Long Branch, Plainfield, Mt. Holly and Asbury Park illustrate the feasibility of these smaller hospitals, and cities like Montclair, Bloomfield, &c., are considering their needs. The time has come when a hospital means far more than it once did. Models of plainness and sanitary completeness, with the best of attendance and discipline, with regulated out-door relief, with temporary provision for maternity to those whose home care cannot be adequate, and with a widespread influence as to health and sickness, thrift and morals; such a hospital comes to be a real Hotel Dieu, a bond of hope, a center of consolation, a viaduct between the poor and the rich, a grand heart exchange in which there is practical demonstration that each is and means to be his brother's keeper to that extent which duty and kindliness prompt. It solves many a question as between capital and labor, wealth and want, recklessness and morality. It is said in England that many a cloud is lifted because every Englishman knows that there is a hospital bed ready for him and hospital relief at hand when income fails and when poverty threatens. How beautifully this was recently shown when the collection of Hospital Sunday in London amounted to over $100,000. On the Friday previous, Jonathan Hutchinson, the distinguished President of the Royal College of Surgeons, in a remarkable address, treated both of the value of the hospitals and the remedies now in use to prevent them from such a promiscuous charity as would encourage dependency. He claimed that they constitute at once the right hand of science exerted for the good of man and the most beneficent department of Christian civilization. We have space only to quote as follows: "Many definitions may be devised for the word 'hospital.' The one which I like best to keep constantly in mind is that of an institution for the prevention of orphanage.' Not that all, or nearly all, the maladies treated entail danger to life, nor that all the patients are parents. A large proportion, however, of hospital practice does concern those who have others dependent upon them, and we may suitably recognize degrees of incapacity short of actual death. The loss of a limb or an eye, or a permanent impairment in health, may easily entail on a man's family calamities little short of what would. have followed his death. Such a definition helps us, I think, to some adequate conception of the real value of these institutions, and places medical charity in the position which it ought really to occupy-that of the foremost of all forms of beneficence. In no other sphere can so much good be done at so little cost. What is wanted is that medical skill should be well developed, and next, that it should be made accessible to all. Now the good which our hospitals effect is far from being restricted to their own patients. There are the schools in which medical science is cultivated, and from which those go forth who spread its benefits all over the world. We claim that within recent years some diseases have been nearly exterminated, that the ratio of mortality for nearly all has been greatly diminished, and the average duration of human life definitely increased. Let it be clearly understood that we wage no fruitless war with the divine ordinance of death, but rather accept it thankfully, as one which favors the progress of our race and the perennial rejuvenescence of mankind. We are at war, however, with death in its premature and irregular forms; we do wish to prevent and remedy, as far as possible, the disabilities of life, the disqualifications for usefulness in its duties and enjoyment of its happiness; we do wish to prevent orphanhood in all forms and degrees, and to accomplish as far as we may be permitted what has been so beautifully expressed by our poet : 666 'To sweep destruction from the day, And make the chalice of the big round year The larger hospitals at Jersey City, Newark, Camden, Orange, and the recent new General Hospital at Paterson, are of great service to the public health. There should be an increase of these facilities in other cities. The following is a list of those at present in New Jersey: It has long been a dicussion in the medical profession how far it is the duty of physicians to notify Local Health Boards of the existence of cases of communicable disease. In no regard has the growth of medical opinion as related to the care of public health been more marked. It is now so far conceded, that most physicians respond with readiness, and law is definite and decisive in its penalty for those that neglect. It is enough that if there is a case of small-pox or scarlet fever or diphtheria in a house, sanitary administration and the safety of the people require that the Health Inspector should, early in the case, be made aware of the fact by the physician in attendance. There may be differences of opinion as to what diseases are to be notified, who is to be notified, whether the physician is to be paid for the notification and what is to be done by the health officer thus notified. But these are details which must be settled by law and ordinance. Disapproval of some detail does not affect the necessity of the law. Such has been the progress in this direction in England and Wales, that Parliament in 1889 extended the Infectious Disease Notification act. It is now enforced (March, 1890) in 56 large towns, in 436 urban, 311 rural and 17 port sanitary districts, which represent about three-fourths of the entire population, and is constantly being extended as an indispensable sanitary measure. In many of our American cities similar progress is made, but very much still remains to be done. Notification is of little value unless there is prompt and efficient action by the sanitary authority in preventing spread of the disease. This means the details of sanitary administration, in which so many of our cities are deficient. Our own laws are excellent and recognize it as a special service to be promptly done and to be followed by prompt sanitary methods. We must still urge this as one of the most important methods for preventing the spread of communicable diseases. The recent decision of the Supreme Court of Errors of Connecticut, in the case of the State vs. Nathaniel P. Warden (see report of its State Board, 1889), fully presents the grounds of such laws and confirms their constitutionality. PROPRIETARY MEDICINES. From time to time our attention as a Board is drawn to the evils arising from the extensive use of patent medicines. While physicians probably gain some pecuniary advantage from the evils resulting from their use, the general public suffers both as to money and health. It is doubtful whether any such combinations have any right to be |