CLOSING REMARKS.

Little more than a quarter of a century has elapsed since efforts have been made to improve the sanitary condition of the people. But short as the period has been, much good has been done. Many lives have been saved and much sickness and misery have been averted. Dr. Johnson says: "To preserve health is a moral and religious duty, for health is the basis of all social virtues." Indeed, it is only within the past ten years that sanitary science has made its way, in any important degree, outside of purely professional men and professional literature. There is a growing conviction that the necessity for such knowledge is not restricted to the physician; that it is essential also to the educator, the architect, the engineer, the mother, the nurse, and, indeed, to every one who would enjoy, together with the due development of his physical, intellectual and moral nature, the full boon of life. Happily, men, and women, too, are fast coming to realize the fact that humanity is responsible for much of its own sickness and premature death.

The main causes which shorten and embitter human life, as far as that unhappy result depends on the disturbance of health, are within our own control. There is the closest connection between the knowledge we have acquired of the physical conditions on which the life and health of individuals and communities depend, and our command over those conditions. Every fact we have learned respecting the great laws of nature, on our conformity to which our very existence depends, has taught us that the circumstances which produce excessive sickness and early death are preventable.

The character of pestilence which gave it its great power and terror-" that it walketh in darkness "-is its character no longer. Its veil has fallen and with it its strength. A clear and steady light now marks its course from its commencement to its end; and that light places in equally broad and strong relief its antagonist and conqueror, sanitary science, and through it the prompt adaptation and adoption of preventable means. The spread of epidemic disease is always the direct result of neglecting sanitary laws. There is now no mystery about the Plymouth fever, and many more epidemics we might mention. They are as plain and clear as the death of a man who has been seen to swallow a dose of strychnine. Now that we know the causes, such as overcrowding, for example, we can prevent the accumulation of filth in towns and houses. We can prevent the spread of conta

gious diseases. The supply of light, air, and pure water, together with several other appliances included in the all-comprehensive word cleanliness, we can secure. To the extent to which it is in our power to do this, it is in our power to prevent disease and epidemics. The human family have now lived together in communities for over six thousand years, and they have not yet learned to make their habitations clean. At last, however, we are beginning to learn the lesson. When we shall have mastered it we shall have conquered epidemics.

Let us, therefore, look hopefully forward for the time to arrive when we can show the ability of sanitary science to vastly reduce mortality from future epidemics.

English sanitarians claim that more lives have been saved in their army in ten years by better observance of sanitary laws than were lost at Waterloo.

The death-rate could certainly be reduced in every part of our nation by efficient national, State and local sanitary supervision. In the English official reports we find that such a system reduced the annual death-rate from 22.6, in 1872, to 18.9, in 1881; and that this reduction was not spasmodic, nor due to exceptional causes, but was steadily continued from year to year, and the reduction gradually accomplished during the ten years. In other words, thirty-seven persons in every thousand were saved from death each year during the period mentioned, who would most certainly have died had it not been for this careful sanitary oversight. This statement shows what has been accomplished there, and no reason exists why as good results may not be attained here. Taking our figures from our own annual reports for five years, from 1879 to 1883 inclusive, we find that 29,843 persons died in this State from causes that might have been avoided. This shows us that an average of 5,968 persons died in this State from preventable diseases each year during that period, many of whom might have been living to-day under a proper sanitary oversight at all equal to that now in practical operation in England. In other words, more than five people in every thousand die annually in this State from avoidable causes.

In closing this report we desire to call special attention to—

First. The importance assigned to hygiene and State medicine all over the State of New Jersey. The increasing interest and attention given to it, is an evidence at once of the advanced stage of civilization and of the dense and rapidly-growing population. It also indicates

that long occupancy of the land by successive generations has at length overtaxed the regenerative and self-purifying energies of the earth, and that extraordinary methods have now become necessary. Second. To the fact that preventive medicine has at last attained recognition as the highest aim of the physician's art. It has now more to do than in warding off epidemic visitations of great scourges. The late Dr. Samuel D. Gross, closed his oration delivered at the dedication of McDowell's Monument, in the following significant words:

grown

Young men of America: listen to the voice of one who has old in his profession, and who will probably never address you again, as he utters a parting word of advice.

"The great question of the day is not this operation or that, not ovariotomy or lithotomy, or a hip-joint amputation, which have reflected so much glory upon American medicine-but preventive medicine, the hygiene of our persons, our dwellings, our streets-in a word, our surroundings, whatever or wherever they may be, whether in city, town, hamlet or country, and the establishment of efficient town and State Boards of Health, through whose agency we shall be more able to prevent the origin and fatal effects of what are known as the zymotic or preventable diseases, which carry so much woe and sorrow into our families, and often sweep like hurricanes over the earth, destroying millions of human lives in an incredibly short time.

"The day has arrived when the people must be roused to a deeper and more earnest sense of the people's welfare, and suitable measures adopted for the protection, as well as for the better development, of their physical, moral and intellectual powers.

"This is the great problem of the day, the question which you, as the representatives of the rising generation of physicians, should urge, in season and out of season, upon the attention of your fellow-citizens, the question which above and beyond all others should engage your most serious thoughts, and elicit your most earnest co-operation.

"When this great object shall be attained; when man shall be able to prevent disease, and to reach, with little or no suffering, his three score years and ten, so graphically described by the Psalmist, then, and not until then, will the world be a paradise.'

LOCAL OUTBREAKS OF TYPHOID FEVER

AT CAPE MAY COUNTY AND THE MORRIS PLAINS ASYLUM.

THE SEWER SYSTEM OF THE ASYLUM.

Besides the cases of typhoid fever which have occurred in various parts of the State, there have been two local outbreaks, the history of which it is important to record. Our attention was called to the first in April, 1885, on account of its spread in the small neighborhood of Swainstown, in Cape May county. The following is its brief history, as obtained from Drs. Mecray and Marcy, of Cape May, and as confirmed by my own visit and examination :

The first case occurred on the 11th of September, 1884, in the family of Mr. N., at Holly Beach. The child recovered. The B. family were living in the adjoining house, and frequent visitors to the sick child. Both families used the same surface well, which had been filled up before the visit of a sanitary inspector. Mrs. B. was taken about the 18th of October, and some days after removed to Swainstown, several miles distant, where she died the next day after arrival, from severe intestinal hemorrhage.

There were two other cases at Holly Beach, both of which recovered. Holly Beach is low and quite level, and water, after rains, stands in pools. The springs are near the top of the ground, and you can dip water out of most of the wells. Water in the wells often becomes unfit for use, and persons are changing wells continually. All the privies are simply deposits upon the ground, and so these may easily find their way into the water. Since these cases, a Health Board has gone vigorously to work to correct evils. About ten days after the death of Mrs. B., who had been brought from Holly Beach to Swainstown, her husband was taken sick. . He had a severe attack. His attack lasted about four weeks.

During his sickness a little girl of a neighbor was sent daily to the

house to inquire after him, and always, childlike, went up to the sickroom, remaining from half an hour to two hours. In about nine days the child sickened, and after about two weeks more, died, with some brain complication. This brought it up to about the last of December. It then remained quiescent until some time in February, when a Mr. I. took his little son, about nine or ten years of age, and went with him to Holly Beach, and remained there two days and one night in the immediate vicinity, if not in the house where the first case originated. In about nine days after their return home the child sickened, and ran through a tolerably severe course and recovered. In about a week the mother of the child sickened, and during the third week died. This case occurred in the midst of the cluster of houses visited. Mrs. I. was the daughter of Capt. E. B., and a very intimate friend of the H. family. Of course, the whole B. family were more or less with the sick ones, and the H. family, also. Special sanitary precautions were not used in these two cases, and the cases that you saw, and that were on hand at that time, were infected so that I soon had eight of them, all down at one time. The fever was plainly typhoid, as you saw. Their temperatures ranging from 102° to 104°; part of them (four) had the typhoid eruption; six of them had bad diarrhea; five of them dry, dark tongues; six of them deafness, and a pulse-rate with them all, from ninety-six to one hundred and twenty. Those that had the eruption had some soreness over the right iliac region; six had delirium, more or less. Four have died; one from perforation of bowels, as you know. The Miss H. that suffered the relapse, died from exhaustion, at the end of the sixth week, and the second week of the relapse; the other one, with epistaxis, with hemorrhage from stomach and bowels. The remaining four of them are fairly convalescent. I have no doubt now, but that the outburst that fell to my hands was caused by infection, and for the want of proper use of disinfectants in the case of the child mentioned."

Two other cases have since occurred which can probably be traced to the same source, although one of them was full three weeks after nursing in one of the families.

The Secretary of the State Board made a thorough examination for local causes of the disease at Swainstown. Although the wells were not deep, there seemed to be unusual care as to them. The testimony was decided on the part of physicians and nurses and