Status of legislation relating to public health in the District of Columbia ..... APPENDIX F. Laws relating to public health in District of Columbia. APPENDIX G. List of physicians entitled to practice medicine in the District of Columbia....... 68 70-133 335 134 142 144 147 147 164 166 167 172-310 311 364 HEALTH DEPARTMENT, DISTRICT OF COLUMBIA. MEMORANDA OF INTEREST TO PHYSICIANS. MINOR CONTAGIOUS DISEASES. The Health Department of the District of Columbia maintains an ambulance solely for the purpose of transporting patients suffering from minor contagious diseases. All cases of diphtheria, scarlet fever, measles, erysipelas, and diseases of like character requiring hospital treatment should be sent to the hospital in this conveyance. It is at the service of any physician at call. One of the physicians connected with the Health Department accompanies the ambulance on each trip and arranges for the disinfecting of apartments, etc. The ambulance will respond to telephone messages from physicians. Physicians are required, however, to leave either at the Health Office or at the residence of the patient, prior to the removal of the patient, a certificate stating the nature of the disease, and that the patient can be moved without danger or with less danger than he or she can be allowed to remain at home. Where the diagnosis cannot be positively made, a certificate to the effect that the patient is suffering from a case suspected of being some given contagious disease is, of course, sufficient; the patient can then be taken to the hospital and kept in rooms which have been constructed specially for such patients until the diagnosis can be made. CHLORIDE OF LIME AND CHLORINATED LIME. Physicians are cautioned as to the use of so-called " chloride of lime" for disinfecting and deodorizing purposes. The term is popularly supposed to mean the calx chlorata or chlorinated lime of the United States Pharmacopoeia. Recent examinations by this Department have shown that in not a single instance did the commercial “chloride of lime" conform to the standards prescribed by the Pharmacopoeia for calx chlorata, the samples analyzed containing from 5 to 16.8 per cent. of chlorine.* while the officinal preparation contains 35 per cent. In view of the fact that the chlorine is the active disinfecting and deodorizing element, and as formulæ in which chlorinated lime is to be used are based on the supposed presence of 35 per cent. of available chlorine, the substitution of chloride of lime" will generally result in a failure to secure the desired results. It is suggested that physicians desiring this substance for disinfecting use the officinal term, calx chlorata, or particularly instruct their patients to call for chlorinated lime. 66 REPORTS OF BIRTHS AND STILLBIRTHS. The cooperation of physicians in the matter of reporting births and stillbirths is respectfully requested. The law requires these reports to be made within six days after the event, under penalty of not less than $25 nor more than $200. WM. C. WOODWARD, M. D., Since these analyses were made, a sample of "chloride of lime has been submitted containing 34.5 per cent, of available chlorine. fore 21.37 per thousand, a decrease of 0.28. The average annual death rate during the past five years has been 20.95. Of the decedents 3,325 were white and 2,628 colored, the decrease in the former being 47 and in the latter 26. The population, number of deaths, and death rates in this District during the past quarter of a century are shown in the following table: TABLE A.-Population, deaths, and death rates for the twenty-five years ended June 30, 1900, based upon results of police censuses, and of the United States census of June, 1900. NOTE. This table is corrected to date. The returns of the Federal census of June, 1900, relating to the distribution of population by color, have not been received and the death rate by races can not be calculated at the present time, October 10, 1900. Classifying by sex we find 3,056 of the deceased were males, a decrease of 148 since last year, and 2,897 were females, an increase of 75. years Distributed by age, 1,843, or 30.96 per cent of the total mortality, occurred during the first five years of life and 1,314, or 22.08 per cent, during the first year. Of all white decedents 795, or 23.90 per cent, were less than 5 years old, and 560, or 16.84 per cent, were less than 1 year of age. In the colored race the deaths of children under 5 of age amounted to 1,048, or 39.88 per cent of the total colored mortality, and those of children in the first year of life numbered 752, or 28.61 per cent. The average age of all decedents was 32 years, 2 months, and 24 days; of the whites alone, 39 years, 2 months, and 11 days, and of the colored, 25 years, 3 months, and 6 days. These figures do not vary materially from those of last year. Five persons were reported to have passed the century mark, 44 were over 90 years old, and 762 had lived beyond the allotted three score and ten. The average number of deaths per week has been 114.02. During each of twenty-five weeks the number of deaths exceeded the average, and during each of twenty-seven weeks it was below. The largest number which occurred in any one week was 169, recorded during the week ended April 7, 1900. The average daily mortality for each month was as follows: Full information as to the number of deaths which occurred each day, a general summary as to the daily character of such mortality with reference to disease and color, and a statement of the prevailing meteorological conditions, appear in the appendix. So also do data as to the distribution of mortality by locality. TABLE B.-Deaths by classes, arranged by sex and color, with percentages and annual death rates, for the year ended June 30, 1900. The Bertillon system of classifying causes of death has been adopted during the past year, the chief reasons for doing so being the adoption of the system in many other places, and a desire on the part of this department to assist as much as possible in bringing about uniformity in vital statistics. It is recognized, however, that this classification is by no means perfect in its present form. The official classification as approved by the American Public Health Association, and an index thereto, are printed as an appendix to this report. The first general subdivision of the Bertillon classification of causes of death is epidemic diseases, and includes typhoid fever, smallpox, measles, scarlet fever, whooping cough, diphtheria, and influenza (grippe). The total number of deaths due to diseases of this type was 667. There was an increased mortality from typhoid fever, measles, whooping cough, and diphtheria, and a decreased mortality from influenza. There were 221 deaths from typhoid fever (including so-called typho-malarial fever), equivalent to a death rate of 0.79 per thousand. This is an extremely unsatisfactory showing when compared with 0.65, the death rate last year, or 0.49, the death rate for 1897-98. In the absence, however, of reports of all cases of this disease, so that their number and location may be considered, the cause of this increased mortality can not be determined. Of the decedents, 118 were white and 103 colored; 131 male and 90 female. Thirty-three per cent of the mortality from typhoid fever occurred among persons from 20 to 29 years of age, inclusive. The mortality by months was as follows: July, 10; August, 39; September, 30; October, 28; November, 29; December, 26; January, 17; February, 6; March, 8; April, 10; May, 6; and June 12. The increased mortality from diphtheria seems to have been due partly to the increased prevalence of the disease and partly to the occurrence of a severer type. The cause or causes of such increased prevalence and the greater severity of the prevailing type, if any, is unknown. Detailed information relative to this disease appears in the synopsis of the work of the scarlet fever and diphtheria service, and more particularly in the report of the medical sanitary inspector (Appendix A). In the absence of knowledge as to the number of cases of measles and of whooping cough which occurred during the year, it is impossible to say whether the increased number of deaths was due to the occurrence of a larger number of cases or to the occurrence of these diseases in a more malignant form. This holds true, too, with the necessary qualifications, with reference to the decreased mortality from grippe. That portion of the mortality included under the term "general diseases," but not classed as "epidemic," presents the following points of interest: There is a noticeable, but not marked, decrease in the number of deaths from malarial infection, from 53 to 45. Tubercular diseases show an increased mortality, from 797 to 859, an increase in the death rate from 2.86 to 3.08 per 1,000. Tuberculosis of the lungs was responsible for 742 deaths, that is, for 86 per cent of all deaths from tuberculosis. Of the decedents, 386 were white and 473 colored. Four hundred and forty-one were males and 418 females. The largest number of deaths occurred among persons from 20 to 29 years of age, inclusive, the total number in this class being 245. Deaths from malignant tumors increased from 177 to 204. This, considered in connection with the corresponding figures for recent years, appears to bear out the widely prevailing opinion that such growths are becoming more common, but such a conclusion can be supported, if at all, only after a careful study of the many factors involved, which would require more time than is at present at the disposal of the health department. Of those who died from malignant tumors during the past year, 145 were white, and 60 colored; 71 were male, and 134 female. The total number of deaths from diseases of the nervous system and organs of sense was 735. Cerebral hemorrhage sustains its usual position as the chief causative factor of this mortality, and, moreover, shows a considerable increase in the actual number of deaths which have resulted from it, from 256 to 285. Deaths from convulsions of |