SECRETARY'S REPORT.

To His Excellency Leon Abbett:

GOVERNOR-The State Board of Health herewith has the honor to present to your Excellency and the Legislature its fourteenth report, and with it the twelfth report of the Bureau of Vital Statistics.

It was in 1866 that the first Sanitary Commission made report, so that a quarter of a century will have elapsed when this report is in print. While the first action was prompted by the threatenings of cholera, a still wider scope was in the mind of those who initiated the movement, but the time for a sustaining public opinion had not yet arrived. A fuller report made in 1874 drew more widespread attention to the subject, and in 1877 a State Board of Health was formed. The advance which the retrospect shows is highly encouraging. Public and municipal sanitation began as a defense of the industrial classes against the oppression of disease induced by improper dwellings and surroundings. The interest has extended to those in all conditions of life. The security to the public health and the defense against epidemics is much greater than twenty-five years ago. Popular information as to the care of physical life has greatly increased. At that time we were without such legislation as rendered sanitary administration possible. To-day the State has a code of sanitary laws not excelled by that of any other State. Modes of administration are direct and competent, and Local Boards are on the increase. The relations between sanitary inspection or care and the duties of citizens are better understood. Organization is the first step toward effective administration, and this has been fully secured. The great defects which still exist in some localities as to administration, can only be removed by greater intelligence and by thorough efficiency on the part of Health Boards and their inspectors. The progress of knowledge has been such, and specimens of successful service and adequate results in the protection of life and health are so numerous, that we are no longer without a science to guide us, or

models after which to pattern. Here, for instance, is an example which, while it may show our own shortcomings, also serves to show the method and the value of effective regulation:

"At the International Congress of Hygiene, when Dr. Martin described the wonderful saving of human life achieved by the Sanitary Bureau of Brussels, an ovation was given in honor of its chief director, Dr. Janssens. The death-rate of Brussels has been reduced in a manner that is admirably illustrated by charts recently published. On examining these charts it will be seen that the average death-rate of Brussels from the years 1868 to 1873 was 29.3 per 1,000 of the population, and the zymotic death-rate 4.60 per 1,000. From 1874 to 1876 the Bureau d'Hygiène dealt with an annual average of 757 cases relating to sanitation; 237 insalubrious houses were improved, and 399 premises were disinfected. From 1874 to 1878 the average death-rate fell to 25.7 per 1,000 and the zymotic death-rate to 2.02. From 1877 to 1879 the sanitary authorities had to deal with, on an average, 801 cases. They improved 325 dwellings and disinfected 243 premises, From 1879 to 1883 the average death-rate was 25.3, and the zymotic death-rate 1.58. The average sanitary works from 1883 to 1885 were 1,916; no less than 1,155 dwellings had to carry out sanitary improvements, and 491 premises were disinfected. Finally, from 1886 to 1888 the average number of cases that came under the notice of the Bureau d'Hygiène annually, rose to 2,146. Sanitary works were executed in 1,241 houses, and 367 premises were disinfected. As the work of the sanitary authorities increases, we note a corresponding decrease in the death-rate, and what is still more significant, in the death-rate from zymotic diseases. Thus the average death-rate from 1884 to 1887 was 23.9 per 1,000, and the zymotic rate 1.66; while the death-rate in 1888 was 22.9, and the zymotic rate 1.31. The zymotic death-rate has, therefore, fallen from 4.60 (average of the years 1868-73) to 1.31 in 1888, and the general death-rate from 29.1 to 22.9 in the same period. On the other hand, the number of cases of insalubrity coming under the notice of the sanitary authorities, nuisances removed, sanitary improvements accomplished, or premises disinfected, has increased from the annual average of 757 to 2,146. The Brussels Sanitary Bureau costs 48,000 francs per annum; and if we estimate every life saved at only £40, this outlay in sanitary administration is equal to an investment bringing in an annual interest of 1,400 per cent.

"These excellent results have been achieved by a strict enforcement of the French law of December 14th, 1789, and that of August 16th and 24th, 1790-laws that came into force in Belgium when the French Republican army had triumphed at Jemmapes and Fleurus. The town of Brussels, basing its action on the legislation just mentioned, has drawn up by-laws containing the following clauses:

"Art. 120. The College of the Bourgmester and Sheriffs is authorized to prohibit the habitation of houses, tenements, &c., that are unclean, where there is not sufficient ventilation, and where the drainage is such as to compromise, in a permanent manner, the public health.'

"If the owner of a property refuses to carry out the sanitary improvements demanded by the Bureau d'Hygiène a report is drawn up by the Local Medical Commission and, after due notice to the inhabitants, the police compel them to evacuate the premises. The legal proceedings that lead to these extreme measures are simple, and rapidly executed. They can give rise to no wearisome contentions, to no expensive litigation. The tenants who are driven out have a right to prosecute their landlord for the inconvenience and disturbance. They demand, and generally obtain, very heavy damages. Consequently, when the landlord sees, after a little resistance, that the sanitary authorities are in earnest, he almost invariably does all that is required. The by-laws relating to the construction of houses clearly describe what should be done by every house-owner. Art. 79 stipulates that every building serving as a place of habitation or of meeting should be provided with closets that have a door or a window opening on to the outer air, and that are so constructed as to in no wise endanger public health. A great number of regulations have been drawn up with regard to the construction, fall, diameter, &c., of the soil and drain-pipes. These coincide with our English principles of domestic drainage. Art. 91 enforces the principle that every drain-pipe must be trapped. The soil-pipe traps or syphons placed within the houses must (Art. 92) have a dip equal to six centimeters (about two inches and a half). But the traps or gullies placed in yards or gardens must have a smaller dip. Consequently, if pressure from the sewers forces the gases through these traps, those in the open air will be the first to yield. If more than one closet communicate with a soil-pipe, to prevent syphonage the soil-pipe must be prolonged to the roof of the house and there left open for ventilation purposes. If any house in Brussels does not conform to these stipulations, an anonymous communication may be addressed to the Bureau d'Hygiène. This will lead to an inquiry and the prompt. adoption of the measures necessary to have all defects removed.

"Such, briefly, are the sanitary enactments with regard to the con-struction of dwellings which have been enforced of late years with much rigor and very excellent results. But this alone has not sufficed to bring about the notable decrease in the death-rate demonstrated by Dr. Janssens' charts. Vaccination (from the calf) has been employed with ever-increasing zeal; and very noteworthy improvements have followed the gratuitous administration of preventive medicine in primary schools. All the children are carefully and medically examined; the feeble are supplied, at public expense, with cod-liver oil and other suitable medicaments.

"Dr. Janssens has also introduced an excellent measure to render disinfection more effective and practical. He has succceded in obtaining possession of an old Octroi or Customs Post, situated in the center of the broad Boulevard du Midi. This building occupies, at some distance from the busiest part of the town, and yet not too far away, a comparatively isolated position. The public disinfector and his wife live on the premises. On the first floor there are dormitories, carefully ventilated and kept scrupulously clean. Here are conveyed, free of all cost, the families from tenements undergoing the process of disinfection. A good warm bath is given them on admittance, and an excellent breakfast of milk and coffee and bread. They remain in this sanitarium twenty-four or forty-eight hours, according to the time it may take to thoroughly disinfect their homes. The accommodation is generally superior to that afforded in their own dwellings; the beds are beautifully clean and very comfortable, the caretaker kind and sympathetic. The building has a dignified official look; it stands out well in the midst of trees, and seems like a little mansion. Therefore there is no prejudice against the institution. The poor people go there willingly. Care is taken that they should not imagine that they are receiving any charity, but on the contrary they are taught that, by thus facilitating the work of the sanitary authorities, they are performing a duty for the benefit of the public. By methods such as these, by a humane policy which is at once wise and just, the work of sanitation is rendered popular even among the most ignorant."

Just such results are obtainable in all our cities, if proper sanitary government is secured. This State has been fortunate in that it began to give orderly attention to health matters at the time when the great principles of hygiene were asserting their vital relations to the welfare of the citizen, and the necessity for legislative jurisdiction was coming to be realized. In the Departments of Health and Vital Statistics, it has been our aim to keep pace with the advance of the age. While there are yet some great failures in effective local service, it is not because methods have not been well defined, or laws well provided. We still believe that the chief power should be vested in the Local Boards. The State Board centralizes and diffuses knowledge, studies the various problems presented, and by the force of argument, by details of facts and by pointing out failures, aids the local authorities to effective service. As our reports have, from year to year, so fully considered the various facts in evidence, the time has come when it is unnecessary to treat of each sanitary subject separately or in detail. After a brief review of general conditions, we