sicians; also, to health officers for annual returns of duties attended to and work accomplished.

Other circulars are written and distributed to various town officials and other parties, having duties under the laws in relation to public health and the vital statistics of the State, reminding them of those duties, suggesting methods of performance and urging their prompt discharge.

Distribution is made, when occasion requires, of the tracts for the "Prevention of Typhoid Fever" and "Prevention of Scarlet Fever," the "Manual" prepared for the use of health officers, the "Nomenclature" of diseases for the use of physicians, and the posters, "Treatment of the Drowned," when called for.

A record of the investigations of cases of contagious diseases of domestic animals, the date, the name of the owner, the location, the characteristics of the disease and other notes. (See Report of the Cattle Commission department.)

Twelve hundred and fourteen letters were written by the Secretary during the year, not a few of which were to prominent public men and government officials in European countries, making inquiries in regard to sanitary measures adopted and results of the same, and asking for data in detail regarding important facts in the various relations of vital statistics.

THE "MONTHLY BULLETIN."

The publication of the Monthly Bulletin has been continued through the year, for which the Secretary has written 88 articles, long and short; has prepared 12 summaries of deaths, with sex, parentage and ages; 24 pages of causes of deaths and number, with comments and percentages; and 24 pages of meteorological observations and summaries. Supervision is also given to printing, correcting proofs, addressing, wrapping, mailing and other methods of distribution of copies.

It has been regularly mailed or otherwise placed in the hands of 1056 of the teachers in the public schools of the State. The index, which would take up too much space in this report will be sent to any party making application therefor.

HEALTH OF THE STATE, 1890.

In the pages following, an account will be found of the prevalence of diseases of the various kinds and forms as they occurred in the different towns during 1890. The State was unusually exempt from epidemics of the contagious or infectious diseases during the year.

Three only of ordinary occurrence, that is diphtheria, measles and typhoid fever, had such prevalence. Diphtheria was epidemic in a part of the town of Smithfield, and was rather largely prevalent in two other towns for a short period.

Measles had epidemic prevalence in Bristol, East Providence, Warwick, Hopkinton, North Kingstown and Westerly.

Typhoid fever had epidemic prevalence in Burrillville only.

If the influenza or "la grippe" be included with the contagious and infectious diseases, and it is infectious surely, though doubtful if communicated from one person to another by contact, then it should be said that every town and even every hamlet in the State was visited by an epidemic disease.

EPIDEMIC INFLUENZA (LA GRIPPE).

Commencing about the 20th of December, 1889, and continuing through January aud a considerable part of February, 1890, there occurred one of the most remarkable epidemics of modern times, considering the number of its victims, the rapidity of transit, and the extent of territory over which it traversed. Originating in Russia, it spread over the larger part of Europe between the forty-second and sixtieth degrees of latitude, and covering the entire territory in North America between the thirty-second and fiftieth degrees of latitude. In this connection a very brief account only will be admissable.

In Rhode Island not less than thirty-three per cent. of the entire population was, sooner or later, during the winter of 1889 and 1890, attacked with the disease.

Usually there were few, if any, premonitory symptoms foretelling the onset of the malady, it being ushered in suddenly with chills, followed by headache, pains in the limbs and back, more or less fever, dryness and heat of the linings of the nostrils and throat, and general nervous disturbance with a sense of weariness and dejection or depression of spirits, hardly to be accounted for by the amount or severity of the other symptoms.

Other and numerous derangements of function were attendant, as loss of appetite, nausea, indigestion, catarrh of the nostrils and respiratory passages, and not infrequently of the alimentary canal. The acute attack lasted in a majority of instances from three to five days and was followed by cough and expectoration for an indefinite length of time, lack of energy, muscular weakness, and other functional or organic derangements or positive lesions and impairment of tissue.

The tendency was greatest toward inflammation of the bronchial and pneumonic tissues. Bronchitis and pneumonia were frequent

sequelæ and in many instances with fatal results.

In a very considerable proportion of the cases, convalescence was very tardy, and complete restoration to health in many instances was so long delayed and through so much general malaise, that the results seemed to bear but little relation to the conditions during the first week of sickness.

The number of cases of death reported during the first three months of the year, as having been caused by the influenza primarily, and secondarily by inflammation or congestion of the respiratory organs, were as follows:

It will be seen by the above that the mortality from pneumonia and bronchitis in January, 1890, was caused primarily in considerably more than one-half of the cases by the influenza, and during the first quarter of the year, by about thirty-six per cent. of the cases.

This epidemic influenza of the winter of 1889 and 1890, differed from the sporadic and sometimes epidemic influenza of other years; first, by the intensity of functional disturbance; and second, by the tendency to dangerous organic complications.

There is also a difference of opinion among medical men as to its contagiousness. This difference I think is more in words than in conception or judgment. No one questions the fact that it comes

from a living specific agent, or poisonous substances, or particles in the atmosphere which is, or are, too infinitesimal and volatile to be discovered by the naked eye, and, as yet, too subtle and elusive to be caught for microscopic or biological investigation. It is evident that it may be transported by persons, or by clothing or merchandise, or in currents of the air. It would seem that it must have vitality, and be capable of exceedingly rapid propagation, or the production of multiple fermentative or putrefactive products.

The question of infection is not doubted. But is the poison generated in the atmosphere, and only where the free atmospheric air is present, or may it be generated in animal bodies, and exhaled in the breath, or discharged in the secretions, or in the effluvia of human bodies, and so communicated from one person to another by contact and thus constitute contagion proper?

The principal work of the Board will be presented in larger detail, though necessarily epitomized, in the report of the Secretary, which will be found in the following pages.

Respectfully submitted for the Board.

CHAS. H. FISHER,

Secretary.