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

infancy increased from 83 to 130; those from trismus nascentium decreased from 24 to 11. An examination of the mortality tables shows a decrease in the number of deaths from organic brain diseases from 61 to 33. This decrease, however, is believed to be apparent rather than real and to be the result of changed methods of classification, as the number of deaths which have occurred in the Government Hospital for the Insane during the past year remains practically the same as during the year preceding.

Diseases of the circulatory system have been responsible for 565 deaths. The principal cause of deaths of this class has been valvular heart disease, 450 deaths, an increase of 76 since last year. The largest number of fatal cases from this affection occurred among persons between the sixty-first and the seventieth years of life, inclusive.

In considering diseases of the respiratory system, it is important to have in mind the fact that pulmonary tuberculosis is not classed with them, being regarded as one of the general diseases. With this understanding, diseases of the respiratory system caused 712 deaths. The principal factor in such morality has been pneumonia, 462 deaths. The greater part of these occurred between December and April, inclusive, the average mortality during these months being 58.2, while the average mortality during the remainder of the year was 18.43. Acute bronchitis caused 82 deaths, chiefly among children in the first five years of life. Chronic bronchitis caused 46 deaths, and, as distinguished from the acute form of this disease, prevailed chiefly among years of age.

persons more than 50

Seven hundred and thirty-six deaths were charged to diseases of the digestive system, of which 451 occurred among children less than 5 years old. There were no material variations in the number of deaths occurring from the individual diseases which go to make up this mortality. Diseases of the genito-urinary system were responsible for 365 deaths. Acute nephritis, reported as such, caused 47 deaths, and chronic nephritis 168, while Bright's disease was certified to under that name as the primary cause of death in 52 instances.

Pathological conditions incident to the puerperal state caused 48 deaths, diseases of the skin and cellular tissue 20, diseases of the organs of locomotion 14, and malformations 19. Four hundred and forty-one deaths were charged to conditions peculiar to infancy, premature births in 141 instances, marasmus in 98, and simple congenital debility in 71. Senile debility was recorded as the cause of 149 deaths, a decrease of 59; senile dementia as the cause of 12, an increase of 9. There have been during the year 189 deaths due to other than natural causes. Of these, 29 were suicidal, 143 accidental, 15 due to criminal homicide, and 2 due to legal execution. Of the decedents from these causes, 119 were white and 70 colored, 133 male and 50 female. There is the usual marked disproportion between the number of suicidal deaths which have occurred in the white and in the colored races, the former showing 25 and the latter but 4. The prevailing mode of self-destruction has been by poison, 9 having taken substances of this character by the mouth and 6 having inhaled illuminating gas. Suicidal gunshot wounds were responsible for 6 deaths, and hanging for 4. Two of those who committed suicide during the last year were between 10 and 20 years of age, both of whom died by poison. Among the accidental deaths, in 34 instances the cause was falls, in 34 burns or scalds, and in 20 drowning. The number of accidental deaths from

inhalation of illuminating gas decreased from 12 in 1898-99 to 3 during the past year. Street railways have caused 8 deaths, and steam railways 19.

RETURNS OF BIRTHS.

The number of births reported during the past year was 4,641, showing a slight decrease since last year. Of the children born, 2,790 were white, and 1,851 colored. In 75 instances twins were born of white parents, and in 41 of colored. Four hundred and seventy-seven illegitimate births of colored children were recorded, and 90 illegitigitimate births of white parents.

RETURNS OF STILLBIRTHS.

The number of stillbirths reported was 536-336 legitimate and 200 illegitimate. One hundred and sixty-two returns of stillbirths were received from the coroner, representing, ordinarily, bodies which have been deposited in the street. In a majority of all cases the causes of stillbirths were reported as unknown.

RETURNS OF MARRIAGES.

The number of marriages recorded in the health department during the past year was 1,828, white 1,251 and colored 577. The number of marriage licenses issued by the clerk of the court during the corresponding period was 3,181, showing, therefore, that approximately 42.53 per cent of the total number of marriages have not been reported. There appears, however, to be no way in which an improvement can be effected in the matter of marriage returns except that already suggested by this department-that is, the issue of licenses directed to specified ministers rather than "to any minister of the gospel authorized to solemnize marriages," as at present.

RECORDS AND TRANSCRIPTS.

During the past year 505 transcripts from the records of births, deaths, and marriages have been issued, and 6 certificates have been given showing that no record existed. Attention is again invited to the necessity for fireproof vaults for the safe-keeping of such records. If destroyed, they could not be replaced.

OFFICIAL REGISTERS.

Under the act to regulate the practice of medicine, 46 physicians have been registered, 36 by virtue of licenses issued by the board of medical supervisors as the result of examinations and 10 on the basis of similar licenses based merely on the registration of the licentiates. at the health department prior to June 3, 1896. So far as is known to this office, 15 registered physicians have died during the past year. Under the provisions of the same act, 15 midwives were registered, 2 of whom had been licensed by reason of having passed examinations and 13 by reason of prior registration by this department.

Fifty-three licentiates of the board of dental examiners were regis

tered.

The register of undertakers shows an increase of 4.

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. Previous recommendations for the amendment of the law governing such institutions are respectfully renewed.

CEMETERIES.

There has been no change in the number of cemeteries or crematories. Attention is again invited to the need of a crematory to replace, or as an auxilliary to, Potter's field.

ANATOMICAL MATERIAL.

The number of cases in which material was offered for use under the provisions of the act for the promotion of anatomical science decreased from 74 to 53. The sources from which material was derived and its distribution among the medical and dental colleges are shown in the following table. In order to advance the position of this city as a center of medical education, it is desirable that the law governing the supply of cadavers for scientific purposes should be amended so as to increase the amount.

TABLE C.-Distribution of cadavers under anatomical act during year ended June 30, 1900.

The work done by physicians to the poor during the past year shows a marked decrease. Whether this has been due to prevailing prosperity or to other causes it is impossible to say, but as there has been no complaint of the failure of such physicians to give proper service to all worthy applicants, any decrease in interest or industry on their part can not have been responsible for the change. The number of visits made by physicians to the poor was 15,831, and the number of office consultations was 396.

January.

February.

March.

April.

May.

June.

Total.

During the year 4,452 families have sought medical relief through physicians to the poor, a decrease of 1,523 since last year. Of such families 1,067 were white, a decrease of 437, and 3,385 were colored, a decrease of 1,086. The entire number of individuals treated was 5,642, of which 1,512 were white and 4,130 were colored, the decrease generally corresponding, to a certain extent, to the decrease of the number of families. On the basis of the recent United States census, 20.25 out of every 1,000 inhabitants received medical relief at public expense through the agency of the health department.

The total cost of the service has been $9,690.75, of which $7,891.40 was for the services of physicians to the poor, and the remainder for drugs and incidental expenses. The average cost of treating each patient during the year has been $1.40 for services and 32 cents for drugs, etc., a total of $1.72. The average amount received by each physician for each visit and office consultation has been 48 cents. The average cost of drugs, etc., supplied or used in connection with each such visit or consultation has been 11 cents. In view of the foregoing figures it is unnecessary to call attention to the inadequacy of the compensation of the physicians to the poor. They are required to be on duty twenty-four hours each day, and for such service receive $1. They are entitled to no leave, either by reason of sickness or otherwise. It is respectfully recommended that the compensation of these physicians be increased to $480 per annum.

Detailed statements relative to the work done in this service during the past year, and a comparison of the amount of such work with the amount done in previous years, are set forth in the following tables:

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