From the above figures it will be readily seen that a remarkable decrease in the rate has taken place within the past forty years, a decrease comparing each decennial rate with the one immediately preceding represented by seven, seven and eighteen per cent. respectively, and comparing that of the first decennium with the individual year under review, a decrease of forty-seven per cent.

The following diseases and causes of death are those which have been the targets against which the bolts of sanitary science have been hurled, and with what effect the following comparisons, based upon the previous table, will show:

1. Typhus Fever.-This dreaded disease has entirely disappeared from the causes of death since the years of its importation, 1892 and 1893.

2. Asiatic Cholera. In the year 1849 this disease carried off 5,071 inhabitants of the city; in 1854 there were 2,509 deaths reported, and in 1866-the year of the organization of the Board of Health—1,137 deaths; in the decennium, 1868-1877, 30 deaths; in that of 1878-1887, no deaths; in that of 1888-1897, 9 deaths; since 1892 the City has not suffered the loss of one inhabitant from this cause.

3. Smallpox.-Out of every 100,000 of the population 48 died in the decennium 1868-1877, 7 in that of 1878-1887, 3 in that of 1888-1897, and 2 in that of 1897, comparing the latter decennium with that of 1868-1877, a reduction of 95 per cent.

4. Typhoid Fever.-The rate per 100,000 in the decennium 18681877 was 31, and in the subsequent decennia fell to 28, 20 and 18; the rate fell to 12 in 1908, a decrease of 61 per cent. compared with that of the first decennium, a reduction which falls far short of the actual condition, for if we consider the immense strides made in medical diagnosis as to this disease, we can not but realize that in earlier decades many deaths that should have been reported under this heading found place under indefinite titles, for example, under the heading of typhoid fever 4.445 deaths were enumerated in the first decennium, and 3,626 under that of malarial fevers, while under the same headings in the decennium 1898-1907 the figures were 6,349 and 1,112 respectively, the ratio of typhoid to malarial deaths in the first decennium being one and one-quarter deaths to one, and in the last six to one; undoubtedly there

has been an immense transference from the malarial death column to that of typhoid; it is very evident that deaths from malarial fever originating in this climate are seldom fatal, most of those that are reported being probably of a pernicious type having origin in southern latitudes. It is only fair to assume that the death rates from typhoid fever in remote years did not reflect the true index of mortality from this disease. If we add the number of deaths in the first decennium from malarial fevers to those from typhoid fever, the result is a total of 8,071 deaths with a rate of 57 per 100,000, against 7,461 deaths and a rate of 21 per 100,000 during the last decennium, a decrease of 63 per

cent.

5. Malarial Fevers.-In the decennium 1868-1877 the rate per 100,000 was 26, which rose to 30 in the succeeding one, then fell to 18, and finally to 3 in the last decennium; if we compare the latter rate with the first, a decrease of almost 90 per cent. will be shown.

6. Measles. The mortality from this cause rose from 28 in the ten years, 1868-1877, to 37 in the next decennium, fell to 31 in the next, and then to 20 in the last.

7. Scarlet Fever.-The decrease in the mortality from this cause has been a tremendous one, reaching 78 per cent. comparing the rates of the decennium 1898-1907 with that of 1868-1877; the number of deaths in the latter ten years reached 12,978, while in the former only 6,864 were reported.

8. Diphtheria and Croup gave a death rate of 153 per 100,000 in the decennium 1868-1877, and 53 in that of 1898-1907, a decrease of 66 per cent., that is, where three children died from this cause in the former, only one died in the latter decennium; in 1894 the rate was 163 per 100,000; in 1895-the year of the introduction of diphtheria antitoxin-the rate was 127, and in the following year fell to 86, since which year it has not reached 60, and in 1907 and 1908 fell to 40.

9. Whooping Cough.-Under this head 5,212 deaths and a rate of 37 per 100,000 were recorded in the decennium 1868-1877, and 4,124 deaths and a rate of 12 in that of 1898-1907, a decrease of 68 per cent., that is, three children succumbed from this disease in the former to one in the latter decennium.

10. Pulmonary Tuberculosis.-There were 5,374 deaths reported under this heading in the decennium 1868-1877, with a mortality of 376 dying out of every 100,000 of the population; this high mortality rate fell gradually until in the decennium 1898-1907 it reached the comparatively low figure of 224, a decrease of 40 per cent. During the past ten years the number of deaths certified from this cause was 79,637.

II. Diarrhoeal Diseases.-The mortality rate of 30.3 per 1,000 children under the age of five years in the decennium 1868-1877 fell to 23.4, then to 19.7, and finally to 13.5 during the subsequent decennia. The rate from this cause has always been considered a reliable standard whereby to judge the sanitary conditions of a locality, and from the above decline in the mortality, especially when the following facts are considered, first, the extremely high temperature occurring during the summer months, and second, the high birth-rate among the foreignborn non-English-speaking population in the community, it is fair to assume that the efforts of this Department supplemented by those of the various charitable organizations have been productive of this encouraging result.

The rate per 100,000 of deaths from violence increased from 108 to 119 between the decennia 1868-1877 and 1898-1907, an increase of 10 per cent.

In contrast to the reduced mortality in the causes mentioned previously, that of the causes not amenable to sanitary intervention has increased considerably; the rate from the acute respiratory diseases, bronchitis and pneumonia, has increased 8 per cent., the rate of 291 per 100,000 in the decennium 1868-1877 increasing to 315 in that of 1898-1907. The mortality from cancer and sarcoma has increased at an enormous pace; in the decennium 1868-1877 the number of deaths reported was 5,556 and the rate 39 per 100,000, and in that of 18981907 the deaths numbered 23,648, and the rate reached the high figure of 67 per 100,000, an increase of 72 per cent. in the rate. While there is no doubt as to the more accurate certification of causes of death contributing to this increase, still it must be admitted that this explanation does not explain, save in part, the increased mortality recorded (see page 242, Annual Report of year 1902). The rate per 100,000

from organic diseases of the kidneys increased from 67 in the decennium 1868-1877 to 1.39 in that of 1898-1907, an increase of 107 per cent.; the rate from organic heart disease increased, comparing that of 1878-1887 with 1898-1907, from 111 to 138 per 100,000, an increase of 20 per cent.

12. Death Rate of Children Under Five Years of Age.-This is considered one of the most reliable tests of the sanitary condition of a community and the following short table shows in what proportion the decrease in mortality at this group of ages has taken place, in the present Boroughs of Manhattan, Brooklyn and The Bronx, which house about 93 per cent. of the population of the entire City:

It is evident that this decrease in the mortality at this age-group has been a considerable one, greater, in fact, than at any other agegroup, according to tables recently compiled, and we are not surprised. at this when we consider the reduced mortality previously spoken of in discussing the rates from individual causes of death, such as measles, scarlet fever, diphtheria and croup, whooping-cough, diarrhoea, and to a limited extent, smallpox and tuberculosis.

INFANTILE MORTALITY.

In other countries than this where the returns of birth are fairly complete this term is used to express the proportional number of deaths of infants under one year of age to every thousand births reported during the same year; the returns of births in this City are not complete, nevertheless the infantile mortality is such that it compares favorably with nearly all the largest cities of the world, as shown in the following table, notwithstanding our hot summers and consequent heavy mortality among infants from diarrhoeal diseases; a truer comparison

would follow the juxtaposition of quinquennial or decennial rates, but the absence of anything like complete returns of births in this City in previous years prevents the preparation of a table possessing rates other than annual rates:

In the City of New York during 1908 there were reported 16,231 deaths of infants under one year of age, 8,818 of which were males and 7,413 females; the great majority of these deaths were certified as having been due to the following specified diseases, arranged in order of numerical preponderance and of percentage of all deaths occurring at the age-group: