nant form! The whooping cough is not so dangerous, but it is a most troublesome disease, sometimes a terrible siege to go through with, and very serious in its results.

Now if all these diseases can be prevented, and their dangers and bad results avoided just as well as not, is it not duty to do it? Will not every family and individual unite in helping to do it? Suppose there should be some exposure in making the case known, some inconvenience, some trouble; but does not the public good require it? May not every family and individual be benefited, either directly or indirectly, by such a course? There can be but one opinion, one universal testimony, on this matter. Some inconvenience, some sacrifice, must be made for the general good. What, then, are the means necessary to use in preventing these diseases?

The first step is isolation in every case. Let there be no exposure, no chance to communicate the germs of the disease to other persons. It is on this account that the law stipulates that every physician shall report cases of scarlet fever and diphtheria to the Board of Health. In certain forms this latter disease, diphtheria, is considered contagious and very dangerous. For two or three years this course has been pursued in our city, and, as a consequence, these diseases during this time have had a very slight run, and few deaths have occurred from them, compared with some former years. Scarlet fever and diphtheria have been singled out because they are more dangerous. Let the same course be pursued with reference to measles and whooping cough, and they would also subside from our midst.

SMALL POX.

Of all the contagious diseases most dreaded, is small pox. At no time for many years has it been so prevalent as the present winter. In some places where it has broken out the disease has been immediately checked and confined to one or a few individuals, while in others its ravages have extended, and may be still spreading. In New York and Chicago small pox has got a strong hold, and will prove very difficult to eradicate. In consequence of the great number of persons travelling, and the large emigration from across the waters, and especially from the Canadas and the Provinces, we are very much exposed to this disease. Lowell is peculiarly exposed to emigrants, constantly arriving here, and from the fact that great numbers, especially children, have never been vaccinated.

In 1871, when the small pox broke out here, vaccination had been greatly neglected. The disease had been spreading several months before decided and earnest efforts were made to suppress it. But when general vaccination was enforced, when every case was isolated, and disinfectants were thoroughly used, the disease subsided in a few weeks. In the meantime our city had had over five hundred cases of varioloid and small pox, attended with 173 deaths. The suffering, trouble, and anxiety attending the epidemic cannot be described; nor can the expenses and losses, private and public, be easily estimated. Such another epidemic in Lowell we should not care to encounter. The only means of prevention are vaccination. Every child and adult who never had this done successfully, should at once be vaccinated. We are liable any day to have the small pox here, and no one knows where it may first make its appearance.

That there may be no excuse, even among the poor, the Board of Health have made provision whereby this can be done free of expense. The City Physician will attend at the Dispensary, in the Market House, daily (Sundays excepted), from 12 to 1 o'clock, to vaccinate all who desire it. Others can call in their family physician, or go to the office of some physician and have it done. So important did our legislature some years ago deem this act, that it framed a law commanding the operation, and attached a penalty to its neglect. In 1871, when this epidemic prevailed here, several parties refusing vaccination were complained of, brought before the courts, and fined. At this time health and life were in immediate danger, and resort to law seemed absolutely necessary. Now is the time to comply with the law and avoid all danger from this terrible disease, which is far worse than the penalty fixed by law.

BULLETIN NO. 2.

OFFICE OF Board of Health, City Hall,
LOWELL, MASS., March 1, 1882.

SANITARY SCIENCE.

This is comparatively a new science. The word sanitary, by itself, refers simply to health; but when combined with science, is far more expressive. It means the application of laws or principles for preserving health. It is the union of the two words that is new,

implying that there are certain agencies or laws in nature which can be employed to preserve health or prevent disease. To such an extent have these laws or principles been discovered and applied, and so surely and certainly have the same results followed, that they may be said to constitute a science, the science of health. It is not necessary that these laws should be understood by everybody, and admitted as true, that they be considered a science; but that if they have been extensively applied by a large number of persons, and the same results never fail, they constitute, when combined, to all intents and purposes, a science.

It is not much more than thirty years since this subject began to attract general attention. The inquiry formerly among physicians, and all others, was how to cure diseases. The idea of how to prevent them, in single cases or on a large scale, was scarcely ever entertained. About half a century ago a few sagacious medical men, living in advance of their times, began to cherish some ideas on this subject. Among these was Dr. Elisha Bartlett, one of the earliest physicians in Lowell, and its first mayor, in 1836. In 1832, just fifty years ago, Dr. Bartlett started the publication of a monthly medical journal in Lowell, which was afterwards transferred to Boston. In urging upon the profession a more thorough knowledge of the causes of disease, he said: "The next thing to be done is to find out the best methods of modifying and preventing diseases. This is the great mission that lies immediately before us; this is to constitute the great work of the next and succeeding generations.” About the same time, in Great Britain, Dr. John Forbes urged upon the profession special attention to hygiene, with the view of preventing diseases on a large scale, and individually, in their sphere of medical practice. "Here," says he, "the surest and most glorious triumphs of medicine are to be achieved."

The predictions of these two men are beginning to be verified, especially in Great Britain, where sanitary improvements are far more advanced than in the United States. The last Government Report on Health (1880-81), represents a steady decline in the death-rate, and estimates that from 1870 to 1880 “about a quarter of a million of persons were saved from death, and three millions have been saved from a sick bed," by these improvements. The death-rate for 1880-81, in England and Wales, was lower than it has been any year since 1837, when the registration report of deaths first commenced.

78

The number of deaths for February is rather small (78). The mortality for the same month in 1881 was 103, and the average for five years was 86. It is very evident there was no epidemic or prevailing sickness in the city. More than half the deaths occurred from chronic diseases. With the week closing February 25th, there were only fourteen deaths; during one week last year (in May) only, was the mortality so small. There were twenty deaths in February of infants under one year, and only one death from old age (87), against eleven in January. The number of deaths from typhoid fever (53), last year, was twice as large as it has been for many years. The report commencing January with six, and February, seven, looks as though for this year the mortality from this source was to increase. We would call the attention of physicians to a careful scrutiny whether the causes of this fever are local, or can be traced to any unsanitary conditions of the residence or surroundings where patients are found.

DEATHS IN LOWELL, 1881.

These

The city physician reports 1,287 deaths in Lowell in 1881. deaths were the results of some sixty distinct diseases or causes, which are divided into five classes, viz.: Zymotic, 380; constitutional, 345; local, 431; developmental, 66; and accidental or violent, 65. This classification was made by the registrar general of Great Britain, from forty years' experience in reporting many millions of deaths, and is now generally adopted, both in Europe and in this country. This classification is a matter of great convenience, especially in discussing the causes of death and the prevention of

disease. The name of each class explains in part the character of its diseases.

The class designated zymotic attracts far more attention than either of the others, from the fact that its diseases are preventable,are controlled by sanitary agencies. The term zymotic means ferment, or the germs of diseases that originate in fermentation, and are epidemic or contagious. This class embraces seven diseases, viz. : Small pox, scarlet fever, measles, diphtheria, whooping cough, enteric or typhoid fever, and diarrhoea or bowel complaints. These diseases prevail, sometimes in an epidemic or malignant form, and make a great amount of sickness. In most of these cases the germs of disease are communicated from one to another, and, when a few cases are once started, these diseases spread with great rapidity. The true course is to prevent the first entrance, and, if one case is started, use effectual means to stop it, isolate it, and cut off all com'munication with it.

The second class, constitutional, numbering 345 deaths, are considered rather hereditary in their origin, generally of a scrofulous or tubercular character, of which consumption takes the lead. The third class, designated local diseases, numbering 431, include diseases of the brain, of the nerves, and of individual organs. The fourth class, called developmental, numbered last year only 66, and embraces those diseases immediately connected with the birth and growth of the body. The fifth class is generally small,-only 65 last year,— and includes those deaths only caused by accident or violence. In these four last-named classes many deaths occur which might be prevented by seasonable care and observance of sanitary laws. By including these, and most of the first class-the zymoticwhich are considered preventable, we have fully one third of all the diseases prevalent every year, which should and might be prevented, together with one third of the mortality. This would make a vast difference in the amount of suffering, expense, and loss of human life.

DIPHTHERIA AND SCARLET FEVER.

These diseases are more to be dreaded among children than any others. For the last two months only one death has occurred from scarlet fever and two from diphtheria. In 1881 there were twentyseven deaths from the latter and nine from the former. The greatest possible pains should be employed by all concerned to prevent these