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REPORT OF THE HEALTH OFFICER.

GENTLEMEN: I have the honor to submit herewith the following report upon the work of the health department and the condition of the public health in the District of Columbia during the year ended June 30, 1908. Embodied in this report and appended thereto are figures with reference to deaths, to certain classes of diseases, and to births. Other figures are given, showing, so far as figures can show, the kind and amount of work done by the health department. Unfortunately, however, there is nowhere a statement correlating or undertaking to correlate these factors. No such statement could be prepared without a careful analysis of sociological and meteorological conditions, as well as a detailed study of sanitary conditions in the District, by locality and otherwise; and with the force now at the command of the health department any such study has been impossible. But until such a study and correlation can be made year after year, no satisfactory idea can be obtained of the relative efficiency and importance of measures designed to protect and to improve public health. There has been in the past, however, and is even now, a tendency to regard public health administration as purely in the nature of police duty. Certain misdemeanors are created by statutes and ordinances having some supposed relation to public health, and these the health department is expected to enforce. Whether these statutes and ordinances do or do not accomplish wholly or in part the purpose for which they are intended, and if they do so, whether they accomplish it or any of it in the most economical and speedy manner, are questions that are left to private enterprise to be solved, or else are not solved at all.

As a simple business proposition, and even without any reference whatsoever to the protection of human life, means should be provided for determining the effect on public health of such protective measures as are adopted and for determining the form and extent

any new activity designed to conserve and improve the health of the community. It is folly to spend money in controlling and auditing the expenditures of public funds in order to see that services and supplies of proper quality and amount are obtained therefor, and yet to provide no efficient means for seeing that the very services and supplies which the funds purchase are expended so as to bring about the desired results. The services and supplies are mere incidents to the real purpose of the appropriation, and if they are misspent or spent unwisely the money itself might as well have gone astray in the first instance, and the money that has been expended for auditing and safeguarding the accounts is merely added to the loss.

So far as relates to the work of the health department, it is impossible now to keep any efficient oversight of the net results which it

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accomplishes toward the end for which it was created, that is, toward the protection of public health. In the first place, the number of clerks and inspectors in the service of the department is not sufficiently great; in the second place, the salaries paid are insufficient; and in the third place, the tenure offered employees is not such as to invite the best men into public health work. Employees now in the service, clerks and inspectors, are so burdened with routine, more or less mechanical duties, that anything like a scientific study, even by a single clerk or inspector, of the purpose and effect of his own duties can not be expected, and there is no one who has the time and force at his command to investigate and report regularly upon the whole situation. The salaries paid in the health department are no better than, in fact are hardly as good as, those paid in other offices, where the work is of a simpler character. The average man coming into the service of the department must expect, if he remains in the service, to live out the balance of his days on a salary not in excess of $1,200 per annum. There is no increase by reason of longevity. There is no pension even though disease or death may result from the discharge of official duty. His tenure of office is not safeguarded by law, and he is not guaranteed by law even a hearing before dismissal. It is not to the point to say that dismissals except for cause have, for some years past, been unheard of; a man entering the department with the expectation of spending thirty or forty years in its service desires something a little more definite to rely upon than an office custom of a few years standing. Under the circumstances pointed out above, the health department does not, and can not, obtain men who have fitted themselves for its work and who, abandoning all hope of private income, are ready to enter its service for the balance of their days. Until a broader conception of the nature of the work of the health department exists in the minds of the public and of those who alone have the power to mold its policies and to shape its future, and until better provision is made for the discharge of that work by providing a sufficient force with sufficient remuneration, with tenure of office established by law, the present state of affairs must continue.

POPULATION.

The following statement shows the general results of the police census of April 8, 1908, in comparison with the corresponding figures for 1907.

Statement showing general returns of police censuses of 1907 and 1908.

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On March 1, 1907, Congress enacted a law relating to the registration of births in the District, to become effective six months thereafter. It became operative so late in 1907 that it could not reasonably be expected to produce any considerable effect on the number of returns received during the year. Whether such increase as appears was due in any way to the enactment of this law, or to the operation of the same causes that for some years past have brought about each year an increase in the number of births reported, can not be determined. There were registered, however, during the calendar year 1907, 6,873 live births and 570 stillbirths, a total of 7,443, representing an increase of 344 in the number of reported births, a decrease of 68 in the number of reported stillbirths, and a net increase in births and stillbirths together of 276. The diminution in the number of reported stillbirths was probably due in part at least to the operation of the new law. Prior to its enactment there had been no authoritative determination of the earliest period of gestation at which a stillbirth or abortion became reportable. As a consequence, some physicians reported as stillbirths abortions occurring even during the earliest months of pregnancy, while others made no reports of cases occurring during that period unless it became necessary to obtain a burial permit for the remains in order to satisfy the desires of the parents with respect to the disposal of the body, in which case a formal report became necessary. The act of March 1, 1907, however, definitely provided that no report need be made of a stillbirth when the fetus delivered has apparently not passed the fifth month of uterogestation, and there is, therefore, no reason for believing, because of the falling off in the returns of stillbirths, that there was a diminution in the number that actually occurred.

The following statement shows the relative number of births and stillbirths among white and colored people during the calendar year 1907.

Statement showing recorded births and stillbirths, by race, during calendar year 1907.

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It is difficult to estimate accurately the percentage of births that is never recorded. This department originated several years ago the method of checking against the birth records the returns of the deaths of locally born infants in order to determine the accuracy of the registration of births. Through the courtesy of Dr. Cressy L. Wilbur, Chief of the Division of Vital Statistics, Bureau of the Census, a careful study has recently been made to determine in this way the accuracy of such registration in this District, with the results as shown on the following page.

a See Report of Health Officer, 1907, p. 100.

Statement showing the number of apparently unrecorded births in the District of Columbia.

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These figures probably overestimate the percentage of births that is not recorded. In the first place, it is not unlikely that in some instances the place of birth was erroneously stated in the death certificates from which information as to the supposed occurrence of the birth in the District was obtained, and that the decedent was not born in the District; in which event, of course, no record would or should exist on the records of this department. And in the second place, since deaths are almost always reported by name of decedent only, and births until recently were recorded and indexed only by names of parents, it is not unlikely that birth records existed in some cases in which it was impossible to identify them. That the registration of births is better than would appear from the figures given above appears from a comparison of the number of births recorded and the results of the police census. The police census of 1907 showed that in April of that year there were in the District 6,258 children less than 1 year old. If to that number we add 1,125, the number of children under 1 year of age who died during the year named, the result, 7,383, is approximately the number of children born during the year. And this being the case, the number of births recorded during 1907 was 93.09 per cent of all that occurred. While this showing is better than that made by the other method, yet it is not what it should be. For so long as a single birth escapes registration the records of the health department, and of the District itself, are not complete, and until they are they can not be regarded as satisfactory.

INFANT MORTALITY.

Race suicide is a matter serious enough in itself. It assumes, however, an even more serious aspect when viewed in connection with infant mortality. During the calendar year 1907 there occurred in the District of Columbia 1,125 deaths of infants less than 1 year of age. This represents approximately 16 per cent of all recorded births, and over 15 per cent of the number of all births, whether recorded or unrecorded, as estimated by the method described in the preceding paragraph. A certain part of this mortality is not preventable by any known method, but some is even now known to be in whole or in part preventable, as is shown by the following statement:

a Theoretically the number of deaths added should be only the number of dead District-born children, but as some District-born children have doubtless died outside of the District, the deaths of children born elsewhere who have died in this District may be allowed to offset this number.

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