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probably apparent rather than real. Such deaths do not become known to the health department until the presentation of the death certificate, which is delayed in many cases until immediately before the funeral. It is, therefore, frequently impossible to make an investigation such as is necessary to determine the true nature of the disease, without interfering with the funeral, and the department limits its action to an effort to secure the disinfection of the premises. The coincidence of an increased mortality from croup with an increased mortality from diphtheria is only one of many occurrences tending to prove the relation between these diseases.

Smallpox.-Owing to the mild type of smallpox which prevailed, the mortality does not represent the extent to which the District suffered from that disease. The only death which occurred was that of a colored woman, and happened almost at the close of the year.

Yellow fever. The death which was charged to yellow fever on November 18, represented the first case of that disease which is known to have occurred in this District. The deceased, a civil engineer, apparently contracted the malady in Costa Rica.

Measles.-Whites: Deaths, 13; death rate, 0.06. Colored: Deaths, 14; death rate, 0.16. All: Deaths, 27; death rate, 0.09.

The mortality from measles increased from 10 to 27. The number is not large when compared with those of some previous years, but is slightly in excess of the average for the past five years. The average number of deaths from measles per month was 2.25. The largest number in any one month, 7, occurred in July. The number which occurred during each of five months was above the average, and during the remainder of the year it was below. During October and November there were no deaths. Here, as elsewhere in the zymotic mortality table, the death rate for the colored people far exceeds that for the whites-0.16 per thousand, as compared with 0.06. All of the decedents were less than 10 years of age, and 24 had not yet completed their fifth year of life.

Whooping cough.-Whites: Deaths, 6; death rate, 0.03. Colored: Deaths, 6; death rate, 0.07. All: Deaths, 12; death rate, 0.04.

Colored:

The mortality from whooping cough decreased from $4 to 12. It represents merely one of those fluctuations in the prevalence of this disease which occur without let or hindrance on the part of the medical profession, and, in this District, without any control on the part of the sanitary authorities. The death rate among the colored people exceeded that among the whites-0.07 per 1,000, as compared with 0.03. Scarlet fever.-Whites: Deaths, 18; death rate, 0.09. Deaths, 1; death rate, 0.01. All: Deaths, 19; death rate, 0.06. The number of deaths from scarlet fever during the past year shows an increase over that for 1897-98, from 13 to 19. Differing from most of the zymotic diseases, deaths from scarlet fever were much less frequent among the colored people than among the whites-0.01 per 1,000, as compared with 0.09. For detailed information relative to this disease, attention is invited to the statement relative to the work of the scarlet fever and diphtheria service, and to the report of Dr. John E. Walsh, medical sanitary inspector, which appears in the appendix.

Mumps.-The single death from mumps which appears in the mortality record for the past year is the seventh death from this disease which has been reported during the past twenty-five years, during which period the number of deaths from all causes was 121,970. The deceased in the present instance was a white girl 17 years old. The immediate cause of death was certified to as "Congestion of the abdominal viscera and brain, the result of metastasis."

Time will not permit a detailed analysis of each of the remaining classes of deaths, viz: Those due to constitutional, to local, and to developmental diseases, and those due to violence. Any information which is desired can be obtained, it is believed, from the tables which appear in the appendix. A brief statement must, therefore, suffice.

CONSTITUTIONAL DISEASES.

Whites: Deaths, 652; death rate, 3.29. Colored: Deaths, 627; death rate, 7.04. All: Deaths, 1,279; death rate, 4.45.

Registered in this class there were 1,279 deaths. The death rate among the colored people was more than twice as great as that among the whites-7.04 per thousand, as compared with 3.29. Of the total number of deaths from constitutional diseases, 217 were classed as diathetic and 1,062 as tubercular. Of the former, 20 were due to rheumatism and 177 to cancerous growths of various sorts. Of the decedents who succumbed to tubercular diseases, 498 were whites (death rate, 2.51) and 564 colored (death rate, 6.33).

LOCAL DISEASES.

Whites: Deaths, 1,670; death rate, 8.41. Colored: Deaths, 1,260; death rate, 14.17. All: Deaths, 2,930; death rate, 10.19.

The registered mortality from diseases classed as local was 2,930. Of the total number of deaths 759 were due to diseases of the brain and nervous system. The death rate from such diseases was, among the whites, 2.54 per 1,000, and among the colored 3.16. The diseases appearing most frequently on the death record were apoplexy and meningitis. From diseases of the circulatory organs there were 510 deaths, the death rate for the whites being 1.49 per 1,000, and that for the colored 2.40. Most of these deaths were due to valvular heart disease and to fatty degeneration. Diseases of the respiratory organs, excluding pulmonary tuberculosis, caused 758 deaths, the death rate for the whites being 1.77 per 1,000, and that for the colored 4.56. From pneumonia alone there were 508 deaths; bronchitis was responsible for 144; and pulmonary congestion for 54. The mortality from diseases of the digestive organs, excluding diarrheal diseases classed as zymotic, represented 401 deaths; the death rate for the whites was 1.16 per 1,000, and that for the colored, 1.93. Diseases of the intestines alone were the most frequent cause of deaths of this variety. Next in order were diseases of the stomach; then gastro-intestinal diseases; and, finally, diseases of the liver. Diseases of the kidneys caused 380 deaths, the death rate for the whites being 1.24 per 1,000, and that for the colored 1.49. Of these deaths, 234 were due to the various forms of nephritis, not including 45 which were charged to Bright's disease. From diseases of the generative organs there were 22 deaths, all females. Eight were due to fibroid tumors of the uterus and 6 to pyosalpiux. From diseases of the osseous and locomotory organs there were 19 deaths, and from integumentary diseases 8 deaths.

DEVELOPMENTAL DISEASES.

Whites: Deaths, 313; death rate, 1.58. Colored: Deaths, 234; death rate, 2.62. All: Deaths, 547; death rate, 1.90.

This class of diseases is divided into diseases of children, diseases of women, diseases of old age, and diseases affecting general nutrition. Diseases of children, so called, caused 251 deaths, all during the first year of life. The death rate for the whites was 0.69 per thousand, and

that for the colored, 1.28. Of these deaths, 110 were due to premature birth, 80 to congenital debility, and 12 to patent foramen ovale. Diseases of women other than those pertaining to the generative organs were responsible for 67 deaths. The most frequent diseases of this class were puerperal septicæmia, which caused 12 deaths; puerperal convulsions, which caused 9; and puerperal peritonitis, which caused 8. From diseases attributable to old age, or from old age itself, there were 218 deaths. Two hundred and eight deaths were reported as being due simply to old age, 7 to senile gangrene, and 3 to senile dementia.

VIOLENCE.

Whites: Deaths, 159; death rate, 0.80. Colored: Deaths, 74; death rate, 0.83. All: Deaths, 233; death rate, 0.81.

From violence in various forms there were 233 deaths. One hundred and ninety were due to accidents, 25 were suicidal, 15 homicidal, and 3 by judicial execution. Of the accidental deaths, 35 were from scalds and burns, 28 from falls, 21 from drowning, 20 from steam railways, 7 from street railways, and 12 from illuminating gas. There was a large increase in the number of deaths due to steam railways, from 12 to 20, and a slight increase in those due to street railways, from 5 to 7. Deaths from accidental inhalation of illuminating gas increased from 2 to 12. Of the homicidal deaths there were 3 due to stabs, 5 to gunshot wounds, and 1 to incised wound of the throat. The number of suicides shows a very material decrease, from 50 to 25.

BIRTH RETURNS

The number of births reported during the past year was 4,757; the number reported during 1897-98 was 4,709. Of the birth returns for the past year, 2,866 had reference to whites, and 1,891 to colored. Five hundred and forty-five of the births certified to were reported as illegitimate, whites 66, colored 479. Two thousand eight hundred and thirty-one certificates were received from physicians, and 1,926 from midwives. Of the children born, 2,487 were males and 2,270 females. There were 72 twin births reported, 40 white and 32 colored, and in one instance the record shows the birth of triplets.

RETURNS OF STILLBIRTHS.

The number of stillbirths reported was 513. Of these 193 were said to be illegitimate; 24 were white and 169 colored. Of the total number of stillbirths, 172 occurrea among the whites, and 341 among the colored. Those reported by physicians amounted to 384, and those by the coroner to 129. These figures correspond very closely with those of the preceding year. The cause of stillbirth was reported as unknown in 370 cases.

MARRIAGES.

The number of marriages recorded in the health department during the past year was 1,733; of whites 1,142 and of colored 541. The number of marriage licenses issued by the clerk of the supreme court during the year was 2,897. The number of marriages not reported was, approximately, 1,164, or 40 per cent of the entire number. Of reported marriages, in 1,569 cases both of the parties entered into the married state for the first time; in 158 cases at least one of the parties had been married once before; and in 6 cases at least one of the parties had been married twice.

MORBIDITY RETURNS.

In view of the entire absence of data relative to the prevalence of sickness in this District, independently of fatal cases, an attempt was made to secure the cooperation of the medical profession in an effort to collect and to collate such statistics. To this end a circular letter was addressed to each registered practicing physician, except such as were known to so limit their work as to render the inquiry irrelevant, requesting them to report from month to month, on blanks furnished by the health department, data relative to certain specified diseases. The scope of the undertaking is indicated by the following copies of one of the circular letters and one of the cards for returns:

HEALTH DEPARTMENT, DISTRICT OF COLUMBIA,

Washington, D. C., March 31, 1899.

DEAR DOCTOR: The inclosed blank is forwarded to you in connection with the scheme for the collection and tabulation of data relative to the prevalence of certain diseases in this District during the current year. The death certificates, which the law requires to be issued by the attending physician in all cases which terminate fatally, afford an index to the causes of death, etc.; but, aside from the possible results of the present undertaking, no accurate information exists, or is likely soon to exist, relative to the prevalence of the various diseases specified in the inclosed blank, or, in fact, of any other diseases except scarlet fever, diphtheria, smallpox, etc. The continuance of your cooperation in this undertaking is respectfully requested to the extent of furnishing information as to the number of cases of each of the specified diseases which have occurred in your practice during March,

1899.

This blank need not be signed by you; it can be identified by the health department, if necessary, by the number which appears upon it. Similar blanks will be forwarded to you at the close of each month.

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The responses for the first months, January and February, 1899, were by no means complete, but if those subsequently received had been even as full as these they would, taken altogether, have formed sufficient basis for an interesting and valuable statistical inquiry. But the D C 99-VOL III—2

responses for March were so incomplete as to render it apparent that no information of value would be derived from the continuance of the work, and it was therefore abandoned.

RECORDS AND TRANSCRIPTS.

The records of the health department of births, deaths, and marriages were augmented by 12,897 entries. The record of births includes from its beginning more than 100,000 entries; that from deaths approxi mately 127,000, and that from marriages almost 29,000. Attention is again invited to the necessity for fireproof vaults for the proper preservation of these records. It is evident that it would be impossible to replace them if they should be destroyed. That they are of no inconsiderable value is demonstrated by the issue during the year of 530 transcripts, showing records of births, deaths, and marriages, and 5 certificates showing that no such record existed.

OFFICIAL REGISTERS.

Under the act to regulate the practice of medicine 54 physicians have registered at the health office during the past year. Of this number, 13 have been licensed by the board of medical supervisors by reason of having registered at the health department prior to the passage of the statute now in force, and 41 were licensed by reason of having passed successfully examinations held under the supervision of that board. Three medical officers in the United States Army, 4 in the United States Navy, and 3 in the United States Marine-Hospital Service registered under the provisions of the eighth section of the regulations to secure a full and correct record of vital statistics, promulgated by the late board of health August 1, 1874, and subsequently legalized by Congress. Five midwives registered who had received licenses from the board of medical supervisors by reason of having passed examinations, and 13 who had been licensed because they had registered at the health department prior to the passage of the medical practice act now in force.

Thirty-eight certificates issued by the board of dental examiners were presented for record.

The register of undertakers shows an increase of 1.

PRIVATE HOSPITALS.

There has been no change during the past year in either the number, location, or character of the private hospitals in this District. Previ ous recommendations for the amendment of the law governing such institutions are respectfully renewed.

CEMETERIES.

There has been no change during the year in the number of cemeteries and crematories in this District. The need of a crematory to replace, or as an auxiliary to, potter's field becomes more urgent each year.

ANATOMICAL MATERIAL.

Seventy-four bodies were offered during the year for use under the provisions of the act of February 26, 1895. The apportionment of such bodies among the medical colleges is shown in the accompanying table. This apportionment has been affected by the same factors which have modified it heretofore, viz, differences in the periods during which the

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