students of the various colleges dissect, and in the facilities possessed by such institutions for caring for material received when dissection is not in progress.

Previous recommendations for the amendment of the existing statute for the promotion of anatomical science, so as to secure a more abundant supply of such material as is necessary for this purpose, are respectfully renewed.

TABLE D.-Distribution of cadavers under anatomical act during year ended June 30, 1899.

MEDICAL RELIEF OF THE POOR.

The 30th of June, 1899, marks the end of the first fiscal year, during all of which the system of receiving calls for the service of physicians to the poor at the police station houses has been in operation. During this period there has been no complaint of the method on the part of those seeking medical aid or on the part of the physicians. On the contrary, so far as the latter are concerned, all seem to prefer the new system to that which formerly prevailed. Experience has demonstrated the correctness of the opinion expressed in the preceding report, that so long as calls are left at the police station houses it will be possible to secure for the poor the services of physicians who could not afford to be associated with the work if the patients came to their offices.

New methods of recording the amount and character of work done render possible a more accurate statement relative to the proportion of the public which has received medical relief at the hands of physicians than heretofore. The number of white persons who have been thus treated was 2,028, or 10.22 out of every 1,000 of the white population. Among the colored, 5,555 have been treated, or 62.39 out of every 1,000. Of the entire population, therefore, 7,583 persons have received medical aid at the expense of the public, or 26.38 out of every 1,000. The number of families represented by these patients was as follows: White, 1,504; colored, 4,471; and total, 5,975. The treatment of these people required 20,025 visits by the physicians, and 531 office consultations.

Each person treated has cost the Government during the year an average of $1.31; of this amount $1.04 has gone toward paying the salaries of the physicians, and 27 cents has been paid for medicines and sundries. The average amount which has been received by each physician for each visit and office consultation has been 38 cents, and the average cost of drugs and sundries has been 10 cents. Recommendations which have been made heretofore for the increase of the salaries of the physicians to the poor from $30 per month to $40 per month are respectfully renewed.

TABLE E.-Statement of work done by physicians to the poor during the year ended June 30, 1899.

Scarlet fever was much more prevalent during the past year than at any time during at least five preceding years. The number of reported cases in 1897-98 was 437; in 1898-99 it was 994. The increase affected both white and colored. Among the former the rise was from 403 to 890; among the latter it was from 34 to 104. As will be noted, the disease was much less prevalent among the colored people than among the whites, the ratio to the white population being 4.48 per thousand, and among the colored, 1.17. The disease was somewhat milder in type than it has been of recent years, except in 1896–97, the per cent of fatal cases being but 2.11; among the whites, 2.13, and among the colored, 1.92. Comparative data for the past six years appear in the following table:

TABLE G.-Reported cases of scarlet fever for six years ended June 30, 1899.

The increase in the prevalence of diphtheria, while not so marked as in the case of scarlet fever, was unfortunately of considerable magnitude. The number of cases rose from 700 to 1,059; among the colored from 206 to 304, and among the whites from 494 to 755. Its prevalence with reference to the population was as follows: Among the whites, 3.80 per thousand; among the colored, 3.41; and among the entire population, 3.68. The per cent of fatal cases among the entire number of patients fell from 18.71 to 16.43. The fatality among the whites rose from 13.56 to 14.30, while among the colored it fell from 31.06 to 21.71. Data for purposes of comparison appear in the following table:

1893-94..

1894-95.

1895-96.

1896-97. 1897-98.

1898-99.

TABLE H.-Reported cases of diphtheria for six years ended June 30, 1899.

Examinations of cultures submitted by physicians, to determine the presence or absence of diphtheria bacilli have been made in 2,930 instances. Of such cultures 1,312 were primary cultures—that is, were submitted for diagnostic purposes-an increase of 29 per cent. Of all primary cultures, only 562, or 42.84 per cent, contained diphtheria bacilli.

Attention is again invited to the fact that the law under which the health department is operating with reference to scarlet fever and diphtheria does not afford the public that degree of protection which it is desirable that it should, and which the public generally expects. The most that it accomplishes is the notification to the public that one of these diseases exists in any house which is placarded, so as to enable them to keep out; so far as keeping the inmates of the infected dwelling upon the premises, or requiring them to use definite and sufficient precautions, it is worthless except as it applies to the patient. It is recommended that it be so amended as to conform to modern legislation such as exists in other localities.

A beginning will be made during the year 1899-1900 toward the establishment of the general disinfecting service which has been so often asked for. It is true that the amount appropriated is not sufficient to accomplish what it was hoped to accomplish, and that the proviso that no part of it may be used for additional employees will interfere with its use in the manner desired, but in some cases at least the health department will be able to see that the infected premises are so treated as to prevent them from being continued sources of danger to the community, which it has not been able to do heretofore.

The buildings for the accommodation of patients suffering from minor contagious diseases, which were provided for during 1897-98, have not been completed at the close of the current year. Providence Hospital has, however, as heretofore, consented to treat such cases in a building which was fitted up at its own expense for the accomodation of such patients temporarily. During the year 55 cases of diphtheria and of scarlet fever have been treated in the free ward through the generosity of this institution. As such work has been entirely voluntary on the part of those in charge of Providence Hospital, and especially as it has been done without compensation from the Government or other source, and without any prospect of compensation, it is deserving of official recognition.

More detailed information relative to the operations under the provisions of the act to prevent the spread of scarlet fever and diphtheria may be found in the report of the medical sanitary inspector, which appears in the appendix.

EPIDEMIC CEREBRO-SPINAL MENINGITIS.

Epidemic cerebro-spinal meningitis, which had not been present in the District for some time, appeared during the past year. In the absence of any legal requirement by which physicians were obliged to report cases, the exact degree to which it prevailed can only be approximated through the voluntary returns which were made, and by the returns of fatal cases. The entire number of cases of which the health department obtained knowledge in this way was 105. Of these, 73 were fatal. The disease seemed to prevail chiefly among the poorer classes of the people, and in those parts of the city in which they resided. In view, however, of the careful study of this disease which was made by Dr. William B. French, who was appointed special medical inspector of the health department for that purpose, a full report of which appears in the appendix, it does not appear to be desirable to make any more detailed statement relative to it in the present place.

YELLOW FEVER.

The only case of yellow fever which, so far as I have been able to ascertain, ever occurred in this District was reported November 18, 1898. The patient, a civil engineer, had arrived in Washington the preceding day from Nicaragua, via the port of New York, and apparently contracted the disease at Port Limon, Costa Rica. Although, as was learned later, he had been ill while on shipboard, he had managed to evade the quarantine authorities. But his condition when he reached Washington was apparently such that he became unconscious soon after reaching his room, for nothing is known of him between the time when he registered at the hotel and when he was found in his bed, comatose, some hours later. He died at 2 o'clock p. m. on the day after his arrival, without having recovered consciousness. The real nature of the case was demonstrated by the post-mortem examination.

SMALLPOX.

The first case of smallpox during the year appeared in August, 1898. The patient applied at the Central Dispensary and Emergency Hospital for treatment, but the nature of his illness was promptly recognized, the patient removed to the smallpox hospital, and steps taken to prevent the spread of the disease. The origin of this case was never discovered, nor did any other cases appear at that time.

The next official information as to the presence of smallpox was received January 20, 1899, although subsequent developments showed that the disease had probably existed in at least one family since the latter part of December. Before the outbreak had been checked there had been 98 cases, 6 white and 92 colored, and one death. The type of disease which prevailed was exceedingly mild, so much so as to render diagnosis difficult and even to raise a doubt in the minds of some of the more skeptical of the laity as to its correctness; but the occurrence of occasional typical cases would have served to set all doubts at rest, even if the nature of the disease had not been already sufficiently certain to those who were familiar with smallpox. During the progress of the outbreak at least eight cases developed in Washington from exposure to infection in Alexandria and Portsmouth, Va. The ease with which the disease could be acquired in these and other places in Virginia and brought to this city rendered its suppression here more difficult. Local hospitals were prompt in the recognition of suspicious symptoms