THE ZYMOTIC CAUSES OF DEATH.

Small-pox.-This contagion killed only thirty-five persons in New York, and one in Brooklyn during the second and third quarters of the year. The total quantity of it in these two cities in that period, is believed to have been less than for any similar period for many years. We always may safely estimate that there are from twelve to fifteen persons ill with this malady to every one that dies.

The epidemic prevalence of this malady during the winter of 1864-65 swept through the city in such manner as to induce a healthful mental determination of nearly the entire population to be vaccinated. In the several chartered medical Dispensaries for the poor in New York that season, there were nearly seventy thousand vaccinations. Every physician in his private practice found himself surrounded daily by applicants for the then much prized boon of JENNER. The past year, the city has experienced the excellent result of that faithful effort of the people to obtain immediate protection from the dreaded contagion. And now that lesson will yield permanent and greater results if, by any means, it should lead to the adoption of systematic methods for the vaccination of all children and unprotected persons.

Vaccine Virus and Vaccination.-The Dispensaries of the city, by virtue of their recognized responsibility for the medical care of the indigent classes, have been almost the sole conservatories of vaccine virus, not only for the Metropolitan District but for the State. Admirably has that duty been performed by them, in the main; but there is such importance to be attached to the quality and constancy of the supply of this prophylactic germ, that it must not be left to chance, nor to even the best charity alone. Great progress has been made in the kind of knowledge that is requisite to insure the scrupulous care and testing of the virus, which is necessary to its perpetuity and its individual effect in full power. At the best, as vaccination is now managed among the people, much is spurious or needlessly untrustworthy. And as compulsory vaccination has been proved to be impossible, except under an imperial government, the sooner the Metropolitan District of this State provides for the systematic conservation of virus in full power, and for the more general application of it, the better it will be for life and welfare in the community.

Scarlatina. This domestic pestilence destroyed five hundred and sixty-four lives during the first nine months of the year. The abstract of zymotics for this period presents facts relating to its distribution in wards. But while it holds true that this malady is most prevalent, as it is also most infectious, among the tenant-house and cellar populations, it is also painfully true that both its communicability and its malignancy is increased by the foul local atmosphere of such domiciles.

So enduring and diffusible a contagion naturally enough has been very generally regarded as one of the inevitable afflictions of childhood, and, like measles, it has, by some families, been invited rather than avoided. But the

duty, to the physician, is plainly to use every effectual means to prevent the distribution of this insidious poison. From the first organization of the Board of Health this Bureau has made it a duty to forward to the family where scarlatina is reported fatal, plain advice to gather up and boil for an hour all the infected clothing of the patients, or to immerse the things in dilute chlorinated soda, or in a well-colored solution of permanganate of potassa ;* and to ventilate the sick-room, &c., for days very thoroughly. Prompt action recently taken by the Sanitary Superintendent in regard to scarlatina in tenant-houses will save many lives.

The epidemic movements of this malady are specially interesting in connection with the progress of cholera in different countries, but, in some degree, like cholera, the special excremental resultant of the infection unquestionably gives us the surest point of attack upon the epidemic itself.

In a recent report by the Registrar-General of England, that observing officer remarks, "it should not be overlooked that prophylactic measures are available against scarlatina as well as small-pox."

Diphtheria.-This disease destroyed 334 lives during the nine months. Its favorite localities were nearly identical with those of scarlatina. And the fact that a very large number of the deaths from reported scarlatina certify to the Bureau that a diphtheritic membrane became a complicating cause of death, warrants us in suggesting that these uncertainties concerning the real cause of death in the two diseases, when one supervenes upon the other, requires that we should urge the same sanitary care for diphtheria as for scarlatina. Though neither of them limits its ravages to the poor or to particular localities, the danger from each of them increases as the local causes of general ill-health increase, and this appears to be especially true in regard to humid, unventilated and crowded habitations. Counted together, the two diseases, diphthe ria and scarlatina, have destroyed too much precious young life the past nine months to be lightly regarded. In the coming year we shall preserve special records of their operations throughout the Metropolitan District.

Typhus Fever. This well-known disease of famine and overcrowding has, for the past forty years in this metropolis, fluctuated in its prevalence in periods corresponding closely with those of its greatest prevalence in the British islands at the time of greatest emigration to us from them. And, until the Commissioners of Public Charities, and the Emigration Commission, had prepared their new and excellent hospitals for the reception of fever patients, the entire Metropolitan District was exposed to fearful perils from typhus that was allowed to hibernate in the tenements and lodging-houses of the city. To the prompt action of the Commissioners above-named in removing the destitute poor fever patients to the fever hospitals on the islands,

We have the pleasure of knowing that this advice is gratefully accepted, and that it produces good results, partial as our knowledge of the sick must be, for less than one in twenty cases of this disease proves immediately fatal, and all of them are infectious, and probably in proportion to the degree of malignancy.

and to the active measures of the Board of Health, we attribute the rapid decline of typhus in New York.

The subjoined schedule of inquiries and returns is constantly bringing to the Board a kind of information that points out some of the lurking places of both forms of typhous disease.

Return of Cases of Typhus Fever and Typhoid Fever admitted to.

Island, in the

days ending

1866.

Hospital,

Typhoid Fever.-Having killed 362 persons in New York the first nine months of the year, it seemed to be a well-considered decision of the Board to order this malady to be reported as one that is "contagious and dangerous to public health." Its localization, and, probably, its production by foul sewers and filth-sodden ground, and the infective quality of the excremental matter in this enteric fever, are now admitted facts that make it a duty of the sanitary officers to cleanse and disinfect the privies, drains, and premises where it occurs. Whoever will examine the evidence regarding the perpetuating and infectious causes of this septic poison will rejoice that the Board of Health, without waiting the settlement of mooted questions in pyretology, has acted upon the facts which are known, and which have revealed the controlling causes of this fever, which, during the war, was enormously augmented in crowded camps, and which has since become more wide-spread than ever before in our chief cities.

The foul sewers, privies, and filth-soaked earth of the crowded city, is ever a ready soil for the deadly germs of this enteric fever. In a recent note upon this malady, Dr. Wм. FARR says, as regards their experience in England, "The impurities of the seeds of the disease can only be eventually got rid of by a vigilant sanitary police and by effectual destruction of its exciting leaven." This vitally important view of sanitary duty has, from the first, been taken by the medical officers and fully sustained by the Board of Health.

Erysipelas and Puerperal Fever.-The deaths from erysipelas and the deaths from puerperal fever in New York, though comparatively small in number, are classed with the domestic foes that menace the lives of mothers in such manner as to elicit constant surveillance over the hygienic condition of lying in wards. It will be observed that in Brooklyn there were but five

deaths from puerperal fever against 102 in New York.

The relative difference is mainly accounted for in the hospital wards and the crowded tenements of the city that has this excess.

Diarrhea. In the subjoined table we read a few of the facts relating to the persons who lost their lives by common flux of the bowels. The succeeding abstract of the records of "cholera infantum" adds the facts and a greater number of deaths by the most fatal form of diarrhoea, and in the most fatal period of life.