SANITARY CONDITION OF THE STATE

There were 121,000 deaths reported during the year, making a death rate of 18.0 per 1000 of the reporting population. In 1897 the death-rate was 18.00; in 1896, 18.50.

The average longevity for the year indicated by the mortality was 55.3 years, against an average for 10 years past of 54.3.

There was an average during the year of 331 deaths daily; the average of a period of 10 years preceding was 325.

In the eight sanitary districts into which the State is divided

the death-rates per 1000 population were:

In the winter months the average daily mortality was 311; in the spring months, 326; in the summer months, 341, and in the autumn months, 328.

Of the deaths occurring in the four seasons, 25.0 per cent in the winter months were of subjects under five years of age; in the spring months, 27.7 per cent; in the summer months, 39.0 per cent, and in the autumn months, 30.7 per cent.

Zymotic diseases caused 9.5 per cent of the deaths occurring in the winter months; 9.4 per cent in the spring months; 22.2 per cent in the summer months, and 16.6 per cent in the autumn months; in the whole year 30.2 per cent.

Infectious diseases-The so-called zymotic diseases, which consist as classified of cerebro-spinal meningitis, typhoid fever, malarial diseases, smallpox, scarlet fever, measles, erysipelas, whooping cough, diphtheria and diarrheal diseases, caused 17,088 deaths during the year, or 14 per cent of the total deaths, a proportion the same as last year and smaller than in previous

years.

Smallpox, which the state at large has been free from for three years, developed this year an epidemic in the western part of the state remarkable for its wide-spread prevalence and for its extraordinary mildness, not a single death having occurred, although more than 200 persons were taken with it. It was introduced into the state in May by one individual, who himself had the disease so mildly that it escaped recognition, and being not long incapacitated from work, he continued his part as member of a traveling theatrical troupe which visited 22 localities before a second case developing among his associates, the nature of the disease was discovered. Prompt measures were taken to watch for and control it wherever there had been exposure, but in not a few places, nevertheless, it secured a foothold sometimes of weeks' duration before recognition, and reaching surrounding towns, has continued to exist through the year in various localities, 40 towns in all having had from one to 20 cases. Some of these still have it at the close of the year. Its mildness has caused a doubt as to its nature among many physicians in the rural parts of the state whither, by the nature of its introduction it for the most part appeared, who, by the protection which vaccination has afforded now seldom see this disease, but it has not eluded the diagnosis of well-informed observers, and there is no question of its being smallpox. We

have pursued some studies of it, by inoculation of calves with its virus and otherwise, which have as yet been attended with negative results. A full report upon this outbreak will appear in the appendix to this report.

Grippe recurred in milder form than in any of its annual reappearances which have followed the general outbreak in December, 1889. The number of deaths attributed to it, occurring in the early part of the year, is 2500, heretofore it having been estimated to have caused from 3000 to 8000 deaths each epidemic. It reappeared in December, however, with severity, the winter epidemic of 1898-9, having commenced earlier, with which may be noted the fact that severe winter weather set in unusu ally early in this state, having begun the last week in Novem ber, and 1800 deaths have been attributed to it in this last month of the year.

Typhoid fever caused 1810 deaths which is an unusually large number. It was severer than is customary in the early autumn. It was not limited to one locality but was generally more prevalent. This report does not include deaths from this or other diseases occurring at Camp Wykoff in the town of East Hampton on Long Island, during August, September and October. Returns of about 80 deaths from typhoid fever have been sent from there to this office.

Diphtheria is presenting a course of decreasing mortality now for three years. Thus our records are of 6616 deaths from this cause in 1894; 5696 in 1895; 4640 in 1896; 4117 in 1897; and 2612 in 1898. For 10 years prior to 1898 the average year's mortality from diphtheria was 5544. There has been an extraordinary decrease in the present year to less than half the customary mortality.

Scarlet fever for the past four years has had a low mortality amounting to 825 deaths a year, which is that of this year; while for the four years before there were each year more than 1800 deaths. During recent time the disease has been prevalent, often very extensively, but of very mild type and attended with few fatalities.

Measles caused fewer deaths than usual. It is a disease of variable prevalence, two to four years of low mortality being followed by a similar period of high, ranging from 800 deaths to more than 2000 in the year. This year there were 837 deaths from it.

Whooping cough is fourth of the zymotic diseases in the number of deaths, being exceeded by diarrheal diseases, diphtheria and typhoid fever. It seldom causes less than 1000 deaths a year, and during this year has caused 1155 deaths. It prevails and causes fatality in the more populous regions; in rural parts of the state it caused eight deaths to 100,000 population and in the rest of the state 20. Its fatality increases as the warmer weather. of summer approaches. These facts as to its distribution and time of prevalence have been heretofore noted every year.

Diarrheal diseases caused 8500 deaths, 8700 being the average of the past 10 years. This is 7.0 per cent of the total, and there is not much variation from this proportion year after year. In the rural parts of the state this cause of death operates later and increases the number of deaths in September, whilst the June increase is almost all from the large cities. This year the usual June increase was small, but the October mortality was excessive, and it came largely from rural parts of the state; the sanitary districts having small city population had unusually high diarrheal mortalities. For seven months in the year diarrhea is a

very small contributor to the death-rates, for it comes chiefly from June to October.

Malarial discases constitute an inconspicuous cause of our reported mortality, causing about 400 deaths a year. Three-fourths of these come this year from the Maritime district. Its reported mortality appears to be decreasing.

Cerebro-spinal meningitis has been more than usually prevalent this year and caused more deaths than any on our records, though without any reported epidemic occurrence. Of the 700 deaths, 400 came from the Maritime district and 92 each from the Hudson valley and Lake Ontario and Western districts.

Consumption is the largest single cause of death, and the one which is attended with the least variation, generally causing, as this year, about 13,000 deaths. Year after year it constitutes with uniformity from 10.5 to 11.0 per cent of the total mortality, and nearly two deaths per 1000 population. The number of deaths in the state would be less by one-tenth without it and the death-rate would be reduced to 16.00. The sanitary district. which always has the lowest mortality from consumption is the southern tier, where 7.5 per cent of the deaths were from it; in the Maritime district it is highest, 11.5 per cent. The larger the urban population the greater the relative number of deaths from consumption. This disease is accepted as one of the infec tious and preventable class and ultimately this will operate to control its spread and lessen its large ratio of mortality.

Acute respiratory diseases caused 16,350 deaths, the largest of any group in our series. From June to September the deaths each month were less than 1000, in all the other months more than 1000, and in December there were 2250, many of them being due to grippe. About 12.0 per cent of the deaths in the year were