of the department where technical knowledge is required by law. (Veterinary inspectors in other branches of the Government service are paid from $1,400 to $1,800 a year.)

That a public horse and wagon be furnished in the inspection of dairy farms and abattoirs.

That the force be increased for the proper performance of this work. At least four veterinarians will be required to give this office a proper force if the inspection of dairy farms is made general and meat inspection at abattoirs introduced.

It is believed that such an increase is due dairy farmers of Virginia and Maryland in order that the cost of the production of milk be equalized. We visit the adjacent parts of these States and require the owners to comply with the law. We order the remodeling of barns and dairies to meet the requirements of the law, and condemn their diseased cows, all of which causes them a great expense and makes the cost of production of milk greater to them than their more fortunate neighbors, who are so far removed from the District that we can not reach them with only such transportation as a horse and buggy.

That the contingent fund of this office be so increased as to permit of a thorough inspection of all farms of importers.

That the act to regulate the sale of milk be so amended as to meet such important measures as the testing of all cows with tuberculin, the ear-marking or tagging and branding of such animals. This would prevent the sale of condemned cows to other dairy farmers unknowingly. We often condemn the same cow several times on as many different farms, causing a loss to each owner and the continued sale of such diseased milk in the city.

Most condemned cows are sold to dealers who, in turn, sell the fat cows to butchers and put young calves by the side of those which are giving milk, and ship them into the country to some point not inspected by this department, thus making the act of condemnation almost farcical, inasmuch as the milk continues to poison the children of this city.

That the milk act be so amended as to require the cooling of milk by some proper patent milk cooler to a certain degree, say 60° F., immediately after being drawn from the cow, and then reduced to 50° F. and maintained at such a temperature until it reaches the consumer. This would eventually require the railroad companies to put a refrigerator car on the milk trains during the warm weather.

That a law be passed providing a series of contiguous public abattoirs or the licensing of the existing abattoirs if they comply with the law.

That all meat sold in the District bear the brand of the Bureau of Animal Industry or the District health department.

That the unloading of Southern cattle in the District be prohibited, except they are for immediate slaughter at the point unloaded, save during the open season as prescribed by the Bureau of Animal Industry.

Respectfully submitted,

JOHN P. TURNER, V. M. D., Inspector of Live Stock and Dairy Farms.

W. C. WOODWARD, M. D.,

Health Officer.

APPENDIX D.

REPORT OF THE SPECIAL MEDICAL SANITARY INSPECTOR APPOINTED TO INVESTIGATE THE CAUSES OF THE PREVALENCE OF EPIDEMIC CEREBRO-SPINAL MENINGITIS.

WASHINGTON, D. C., June 30, 1899.

DEAR SIR: In accordance with your instructions of April 1, 1899, a study has been made of the then prevailing outbreak of epidemic cerebro-spinal meningitis in the District. Beginning with December 25, 1898, a list of deaths from that disease was furnished from the records of the health department, and subsequent cases have been reported from time to time as they have occurred. The medical fraternity of the city was requested to lend its cooperation in this work by furnishing histories of cases in its practice, as set forth in the folowing circular distributed in April, 1899:

HEALTH DEPARTMENT, DISTRICT OF COLUMBIA,

Washington.

DEAR DOCTOR: Dr. William B. French has been appointed special medical sanitary inspector to investigate the prevalence of cerebro-spinal meningitis in this District, to ascertain, if possible, such facts as may be of service in leading to the discovery of the cause, and in suggesting means for the prevention of the further spread of this disease. In order that his efforts may meet with success it will be necessary to secure the cooperation of the medical profession. Such cooperation on your part is, of course, purely voluntary; but in the interest of medical science the health department asks that it be granted.

Cards are inclosed on which such cases of cerebro-spinal meningitis as occur in your practice may be reported. Dr. French will not investigate any case which you may report, without your consent; but it will be esteemed as a special favor if you will afford him an opportunity of visiting the patient and examining the premises with you, or alone, as may best meet your wishes.

The department will be glad to receive from you such suggestions and information relative to this disease as may occur to you, or come under your observation from time to time, so that the records of the present outbreak may be as nearly complete as possible. The health department will be glad to receive now reports of such cases of epidemic cerebro-spinal meningitis as have already occurred in your practice during the current calendar year.

Respectfully,

WM. C. WOODWARD, M. D.,
Health Officer.

An endeavor was made to visit each physician reporting a case and to learn its history. Without exception the writer was courteously received and supplied with such information, and desires to express here his grateful acknowledgments.

In the beginning some difficulty was encountered in obtaining histories in detail, by reason of the long interval which had elapsed between the interview and the date of the case, and in some instances because of the absence of notes. Later in the work, when the writer could call more promptly for accounts of cases, the histories will be found to include most of the symptoms.

Whenever obtainable autopsies were made, generally by the writer, but it is much to be regretted that the public has such an aversion to

56 1

that kind of work being carried on as a matter of scientific study. The number of autopsies held were 17, with few exceptions in private houses and at times under the most embarrassing conditions; still, in all cases the purpose of the autopsy was attained, cultures made, and specimens of tissues saved. In the better class of houses no attempt was made to open the spinal canal in its entire length for obvious reasons, yet enough specimens of cords were obtained to permit a study of pathological changes.

In many instances examination of the thoracic and abdominal cavities had to be omitted, except in the hospital cases. The work was usually done on short notice and sometimes by artificial light.

I desire to call your attention to the courtesy of Dr. Walter Wyman, Supervising Surgeon-General of the Marine-Hospital Service, and of Surg. J. J. Kinyoun, then director of the Hygienic Laboratory of that Service, who kindly placed the facilities of such laboratory at my disposal and who furnished a very complete autopsy equipment, including materials and apparatus for bacteriological work and collection of specimens. This courtesy was, on the detail of Dr. Kinyoun to other duty, continued by his successor, Dr. M. J. Rosenau, of the same Service, and by Dr. E. K. Sprague, who subsequently at times had charge of the laboratory. These gentlemen took an active interest in the work, and to them are due the thanks of the department, to which the writer wishes to add his own.

While appreciating that the close observation and study of a case which is practicable in a hospital is entirely out of the question in an investigation of this kind, it is hoped that this study will present the disease as seen by the general practitioner in his every-day work. The conditions under which the investigations were made were the only ones available, and the writer has tried to make the most of them. His sources of information have been extremely varied, having called upon more than a hundred physicians, and through the courtesy of many of them he has been able to add his own personal observation. A majority of the cases occurred among the very poorest classes, where a close study of the conditions from day to day could not be made; yet a number of hospital cases, together with a number of autopsies in private cases, give positive results as to the character of the outbreak and removes the question of diagnosis beyond dispute.

In a certain small proportion of histories recorded the correctness of the diagnosis of epidemic cerebro-spinal meningitis may fairly be questioned, especially in the absence of autopsies, but in the immense majority the histories as furnished, together with data obtained clinically by the attending physician, were considered conclusive evidence. In sixteen of the autopsies the diagnosis of the epidemic type was confirmed by finding the diplococcus intracellularis, either in the cerebro-spinal fluid from cord or brain or in the exudate, and in other cases the organism was obtained by lumbar puncture.

The total number of cases plotted on the accompanying map of the city will be found to exceed those of which histories are given and is explained by the statement that a sufficient number of histories had been obtained to show the essential features of the disease.

Cases are plotted as far as possible in the houses in which they originated and not in the hospitals to which they may have been subsequently sent.

By the term "epidemic cerebro-spinal meningitis" is meant that form of inflammation of the brain, cord, and their envelopes, occurring in outbreaks and attacking a larger or smaller proportion of the com