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Influenza, or a form of catarrhal fever, records a very few deaths in the State. But associate evidence from reports, and from medical practitioners, show that it prevailed very extensively in the State last winter and spring. It was especially prevalent in Atlantic, Burlington, Camden, Cumberland, Mercer, Hunterdon and Morris counties. In Middle Valley, Morris county, it affected nearly the whole population ; and, in general, through the parts of the State affected, showed a progress, an extent, and a universality that easily identified it as being of the climatological form of that disease which, under various names, has traveled over States and continents, and subjected multitudes to its influence. It is especially worthy of note as interfering with labor, as sometimes affecting all mucous membranes, and as to be mitigated and even sometimes prevented by remaining indoors until the influence has passed by. So far as known it does not, like many of the zymotic diseases, depend much on local conditions. Yet, as the very young or the old frequently succumb to it, it needs much earlier attention than is usually given to catarrhs.

Croup and Diphtheria. We had occasion in the last report to trace an increase from 1873, in 1879–80, to 1,728, in 1880–81, and to 1,472, in 1881–82. The record for the year is 1,146. In the Town of Union, Hudson county, in a population of 5,849, it caused this year 52 deaths, and the year before 47.

While a majority of the cases occur in the city, it is also a disease very common in rural districts. Unlike small-pox, or measles, or scarlet fever, it seems to arise without antecedent cases from favoring local conditions. It is now believed that it is sometimes conveyed by water and by milk kept in improper milk cellars. Stagnant dampness in confined places and some forms of vegetable decay have in many cases been closely associated with it. Parents are becoming better informed as to the need of early medical advice, and as to the necessity of constant dilution of the impure air in rooms where children are sick therefrom. It is chiefly in confined localities that it takes on a virulent form.

Diarrheal Diseases. The connection of these with wrong food, bad air, impure water and poor milk is fully certified.

Young children that are allowed, in summer, to eat of all table dishes and of various kinds of fruit and confectionery at unseasonable times, are frequently its victims. In cities it is often desirable to use

water that has first been boiled and then poured from one pitcher to another for aeration, and made moderately cool with ice. In the country, wells are apt to become low in summer, and the quality of the water is such as to need similar treatment. Our last report contained a valuable paper on the various forms of artificial food. Some of these are valuable, but others directly injurious to young children. It is often, too, the case that children are overfed, and so an irritable condition of the mucous membrane is produced. The necessity of second summer sickness is taken entirely too much for granted. Where the transition from milk diet is to plain, well-cooked food in moderate supply, we rarely find this effort of nature to rid itself of unwholesome foods or drinks.

Consumption and Acute Lung Diseases. The study of pulmonary diseases can never diminish in importance so long as many thousands die each year therefrom. It is easy to see from our records the effects of such occupations as those of the potter, the hatter, etc. Also, that most of the dust trades and occupations count many victims. Nor is it surprising that many die therefrom in the open country, and especially females. Indoors work in damp houses, or the steam of the laundry and the kitchen, and the chill of the cellar, too often give sudden alternations of temperature. In many of our farm houses there is need of consulting more closely the health of those who labor indoors, and of providing the best and easiest methods of work. We look with much expectation to the diminution of this disease in the State, because the advantages of change of climate within our own borders are coming to be understood.

Brain and Nervous Diseases. These, both in the young and adult life, cause a great mortality. But there is a marked contrast between the brain and nervous diseases of adults and those of children. With adults, many result from excessive toil, and from an overstrain of the heart and circulatory system. With children, bad modes of sleeping, exposure to great heat, and especially the direct rays of the sun, and irritation of the stomach and bowels often are declared in this way. Forced study, or worry over books, is sometimes a cause. The little nervous ailments of children are too often overlooked. Many a convulsion is followed by no subsequent treatment. A single attack, or a few attacks, can often be prevented from becoming habitual or resulting in epilepsy or idiocy, when it is afterward difficult or impossible to interrupt the tendency. Many cases, functional at first, thus become organic and incurable, and add to our dependent and afflicted population. There is great need that physicians be more impressed with the necessity of attending to children after a convulsion, and of cautioning the parents not to allow repetitions to take place, but to keep the child under medical supervision and treatment.

Diseases of the Heart and Circulation are not only common in old age or with those exposed through life to great business excitements, but occur also in the young, or as a result of such exposures as induce rheumatism. By early and active treatment, and by the use of salicylic acid and alkalies, many cases of rheumatism are prevented from seizing upon the valvular structure of the heart. It is a fact that heart diseases are prevented or ameliorated by care and hygienic conditions more than formerly, and thus many lives are prolonged.

Urinary Diseases. These, while grouped together, are distinguished in office tables. A large proportion of them are such as affect the kidney as a secreting and separating organ. Alcohol, the use of sharp condiments and other errors of alimentation and digestion, record their effects upon this excretory apparatus. Disease attacks its structure with comparative rareness, unless it has been subjected to very unfavorable conditions.

Adult Brain and Spinal Diseases seem to be on the increase. Whenever the nervous system is subjected to early irregularities or is overtaxed in middle life, it is apt to show itself in an early embarrassment of some part of this intricate structure. The number of imperfect or shortened lives past middle life are thus multiplied and much power abstracted from the years which would otherwise give both comfort and vigor for labor.

Erysipelas is becoming more and more an important study. Many facts seem to classify it as a specific disease of a zymotic character and to show that it frequently takes on the virulence of an infectious disease. There are so many evidences that it is inoculable and is apparently carried by contagion that great care is to be exercised as to it.

Its undoubted relation as a conveyor or excitant to puerperal fever makes it very certain that the medical practitioner or the nurse may

not pass from cases of this disease to those in child-bed, without the most precise and cleanly precautions. Since so much of this attendance is rendered by women, they need to know how precious lives are endangered unless all precautions are taken.

Puerperal conditions and diseases need the most careful guard. The loss of mothers, and especially if dependent children are left, means more to the State than is generally supposed. It is for this reason that some governments provide maternities, in order that the risks of loss may be diminished and that the poorer classes may be assured of skilled attendance.

Cancer, as a disease, seems on the increase. The returns for this year show 461 cases. While certain organs are especially prone to this degeneration, it is probable that some small and benign tumors or some forms of localized skin fissures and irritations are forced into a malignant type. The disease is being made more and more a subject of close investigation, and it is to be hoped that preventive care will accomplish more than has yet been accomplished by medicinal means.

Accidents. The constant increase of accidents should attract public attention. Drowning, accidents by fire-arms, by railroads and by machinery are more often the result of carelessness than of some unavoidable catastrophe.

There should be laws of prohibition as to bathing and fire-arms, applicable to minors. Machinery in factories should be more fully protected and strict inquiries be made into all other forms of accident. This very watchfulness is a great preventive.

The space at command has required brevity in this summary, but as the record of this year will form a part of the quinquennial record just tabulated, to be more fully analyzed in the next report, there is not so much need of details here. As the tables advance in number of years and in completeness, they lead us to important facts as to localities and greatly aid in the estimates of methods for the promotion of public and private hygiene. This means better and stronger lives, which add alike to the comfort of the citizens and the capital of the State.

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