GENERAL REPORT.

To His Excellency the Governor and the Honorable Council:

Herewith is presented the fifth annual report of the State Board of Health, for the year ending April 30, 1886. Like the preceding reports issued by the board, it is made up chiefly for the purpose of giving information to the people of the state upon various subjects regarding and associated with the ever important question of health. The matter which comprises this volume is given in plain language. Scientific abstractions and technical. terms are avoided as far as possible. The work is for the people, to convey knowledge that may be understood by all.

A comparatively small part of the executive work of the board is represented, because the space that would be taken up by such a recital is of more value for other subjects. In most cases such work has been of a local nature and not interesting to the general public; there have been, however, occasional exceptions to this rule.

TYPHOID FEVER.

In another place will be found a report upon this disease from the physicians in different parts of the state. The disease has gradually diminished during the last three years, and several physicians have expressed the conviction that it is due entirely to an increased knowledge among the people of the various causes of typhoid, and a correspondingly better understanding of some of the means of avoiding it. An intelligent physician in the western part of the state, who has been in active practice for many years, in writing to the board concerning sanitary work,

says: "In the last three years typhoid fever has become almost extinct. I do not have one case now in the time I used to have five cases four or five years ago. I firmly believe that these results can be mainly attributed to the improved sanitary conditions which have taken place in all parts of the state. The money expended by our legislature has been well invested, and the people who pay the taxes have received fully fifty per cent upon the money invested. But to us physicians, financially, it is like the old adage: 'What was fun for the boys was death to the frogs; so in this case, what is a famished pocket-book to the doctors is health and comfort to the people." This quotation shows very pointedly to what extent many physicians labor daily for the public good against their own financial interests, as has the writer of the above. Increased attention has been given the subject of drinking-water, as it has been shown each year that polluted water and filth of all kinds are a prolific source of this and kindred diseases. As one of the fruits of this information, local boards of health have been created and more or less sanitary work has been done in towns that have never before taken any official action in this direction. The water supply has been examined, or analyzed, in hundreds of individual cases during the past three years, and those shown to be contaminated have been abandoned, the latter being mostly from wells polluted from privies, cesspools, sink-drains, barnyards, etc.

The gratifying results that have been accomplished in this direction may be still further increased by vigilant attention to the evils that are already positively known to be productive of this filthy disease, which annually destroys so many valuable lives.

DIPHTHERIA.

This erratic disease has existed in several localities in the state during the year. Reference to the secretary's report will show quite fully its prevalence, as well as the causes, or supposed causes, in many instances. It has long been classed among the filth diseases. In this state as well as elsewhere it is more generally found among the poorer class and in the more unsanitary parts of towns and villages. Like typhoid, it prevails to a greater extent in small villages and at isolated farmhouses than

in the cities or larger towns. That telluric and atmospheric conditions have, in connection with other causes, a marked effect upon this disease is evident from its history, and when the spark has been ignited, assists in fanning it into an epidemic. That it is both infectious and contagious is a fact no longer open to discussion. To limit its spread, after it has appeared in a locality, as much care should be exercised as in any other contagious disease.

No epidemics of any considerable extent have occurred during the year; that at Newmarket was the severest. The disease has been reported as existing in many localities of this and foreign countries during the present year, evidently in excess of the preceding. Whether there are some general influences springing up to favor its reappearance in the form of epidemics we are not able to say; there are some evidences, however, to indicate it, hence a special effort should be made by every family to avoid those conditions of sanitary neglect, which extend to this and other diseases a most cordial welcome.

SCARLET FEVER.

The prevalence of this disease has been somewhat less than for the year 1884, although its ratio of fatality is somewhat larger. It has generally existed in a very mild form, yet each year it is a dreaded destroyer among us, against which isolation, disinfection, and all other available precautions should be employed. The percentage of its fatality, however small, cannot indicate from what household its victims may be called; its mildness should not cause any relaxation in restrictive measures, for it often appears in malignant form where least expected. It should be guarded against by every family with as much vigor as would be exercised against the most dreaded disease.

A report from seventy-six towns, giving some idea of the extent to which it has prevailed and the ratio of mortality, will be found elsewhere.

SMALL-POX.

The epidemic of small-pox in Montreal called upon the board to exercise its powers and functions to an extent not before demanded since the creation of the department, and in this one

time of needed protection the value of the department was most vividly apparent to the people of the state. Indeed, the absence of any national health organization, in which local or state authorities can place confidence, makes it incumbent upon the latter to use the utmost vigilance in their respective jurisdictions to prevent the invasion of epidemics.

The United States Marine Hospital Service undertook, on behalf of the government, to restrict the importation of smallpox into the states by placing inspectors upon all the trains coming from Montreal. For several weeks after the inauguration of this inspection service, the work was so inefficiently performed that we, unwilling to jeopardize the interests of our state, especially of the manufacturing centers, established an inspection serIvice in behalf of the state. Not only this, but we used every effort possible to secure a better government service, that we might be able to withdraw our own and obtain better protection for all New England.

While we were, at least, exceedingly fortunate in the results, it is no less to be regretted that the national government should place interests so important as the restriction of epidemics in the hands of a bureau possessing so few of the requisites for guarding the public health as, in our judgment, belongs to the Marine Hospital Service.

But six cases of small-pox occurred in this state, and those were in one family, three fatal. A more complete account of this work will be found in the report of the secretary.

CHOLERA.

The country was exceedingly fortunate during the year to escape a visitation of this dreaded disease, which was expected by many. The disease was restricted only through the intelligent, determined, and systematic work done by the health authorities of foreign ports and places. The number of cases officially reported in Spain up to the first of November last, was 273,808; the number of deaths 101,448. This, although enormous, is believed to be below the actual number. Had it not been for intelligent sanitation and other protective measures, such an epi