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considered in connection with facts gathered in other cases similarly investigated. It would, moreover, result in an official statement of all of the facts of the case which would be equally available to all parties, to aid them in adjusting any claim for damages that might arise. If the investigation of all injuries might prove too great an undertaking, at least those that are the result
of operations of public service corporations might well be made the subject of official scrutiny. It is recommended that action now be taken toward that end, leaving the larger question as to the causes of injuries generally for future consideration.
CONTAGIOUS DISEASE SERVICE.
Typhoid fever.—There were reported during 1907, 928 cases of typhoid fever, 725 among the whites and 203 among the colored people. The figures represent case rates per 100,000 as follows: Whites, 311; colored, 211; entire population, 282. These figures are the lowest that have been recorded since the reporting of cases of typhoid fever was made compulsory. Deaths from this disease numbered 114, equal to 12.3 per cent of all reported cases.
Of cases among white people, 10.6 per cent proved fatal, and of those among colored people 18.2 per cent.
Although the investigation by this department and by the Public Health and Marine-Hospital Service into the causes of the undue prevalence of typhoid fever in the District of Columbia has been kept up, and although there has been a diminution in the prevalence of typhoid fever in the District, as is shown by the foregoing figures, yet no satisfactory answer to the riddle has yet been found. For detailed figures relating to typhoid fever and other communicable diseases during 1907 and during the first half of 1908, reference should be made to the report of the inspector in charge of the contagious disease service, in the appendix.
Diphtheria.--Four hundred and eleven cases of diphtheria were reported during 1907, equivalent to a case rate of 125 per 100,000. Of these cases 28, or 6.8 per cent, died. The case rate among white people was 161, and the percentage of fatalities 5.6, while the corresponding figures for the colored population were 35 and 20.6. The comparison suggests very strongly that among colored people a relatively large number of mild cases occur that are never reported. This disease was somewhat less prevalent than during recently preceding years.
Scarlet fever.-Of this disease, 168 cases were reported during 1907, with 2 deaths. The case rate per 100,000 was, therefore, 51, and the percentage of fatal cases 1.1. The case raté among white people was 69, and among colored 7. The percentage of fatal cases among the former was 1.2. Of the colored cases none terminated fatally. This disease was much less prevalent than it has been of recent years, the average annual case rate from 1901 to 1905, inclusive, having been 107, and the case rate for 1906 having been 71.
Smallpox.—Only 7 cases of smallpox were reported during 1907, none of which ended fatally.
Measles, whooping cough, chicken pox, and epidemic cerebro-spinal meningitis.—The act requiring the reporting of cases of these diseases
was not passed until February 9, 1907, and did not become operative until sixty days after its passage. The reporting of such cases during 1907 was, therefore, necessarily incomplete and imperfect. Figures relating thereto are not reproduced here, but can be found in the report of the inspector in charge of the contagious disease service, in the appendix.
Isolating wards.-In the isolating wards at Garfield Memorial Hospital during the fiscal year ending June 30, 1908, 138 patients received treatment, the total service rendered amounting to 3,589 hospital days. Of these patients, 100 were treated wholly at public expense, service rendered amounting to 2,865 hospital days, and 38 paid in whole or in part for the cost of treatment, service amounting to 724 days. The patients treated in these wards suffered from scarlet fever, erysipelas, measles, German measles, whooping cough, chickenpox, epidemic cerebro-spinal meningitis, and mumps, or were held pending diagnosis, as being suspected of suffering from one or the other of these diseases. The cost to the Government for the service that it received from these wards was $6,000. These wards are not suitable for the treatment of such a variety of communicable diseases, and yet by force of necessity they must be used for that purpose. A better understanding of the cost of operating these wards would be obtained if weekly reports of receipts and disbursements on account of private patients were required and all money collected from such patients paid over to the collector of taxes, the cost of operating being provided for by direct appropriation.
The isolating ward at Providence Hospital is reserved exclusively for cases of diphtheria, and for patients suspected of suffering from that disease, who must be isolated until a diagnosis can be made. The total number of patients treated during the year was 102, of whom 83 were treated at public expense and the remainder paid in whole or in part for treatment. Service rendered amounted to 1,104 hospital days, 876 for free patients and 228 for pay patients. The Government paid $4,000 for the service rendered in this ward on its account. What has been said with respect to the financing of the isolating wards at Garfield Memorial Hospital applies with equal force to this institution. A better understanding of the cost of operating and of the money received and expended on account thereof could be had if weekly reports of receipts and disbursements on account of private patients were required and money received from such patients paid to the collector of taxes, to be deposited in the United States Treasury.
During the calendar year 1907, 907 premises were disinfected, and during the first six months of 1908, such premises numbered' 696. The enactment, on May 13, 1908, of the act to prevent the spread of tuberculosis will very materially increase the amount of work required of the disinfecting service, making compulsory, as it does, disinfection of all rooms vacated by consumptives, whether by reason of death or otherwise.
71552-D C 1908—VOL 3- -2
MEDICAL INSPECTION OF SCHOOLS.
The value of the medical inspection of schools has been amply demonstrated during the past year, and the need for strengthening the service has been equally apparent. The 12 medical inspectors now in the service made 9,535 visits to schools and 73 to the homes of pupils. Twelve thousand and twenty-nine examinations of pupils were made, and in 1,169 cases the pupils examined were excluded for cause. Physical examinations were made of 154 candidates for admission to the normal school. For a detailed statement of the results of the medical inspection service, reference should be made to the report of the inspector in charge of the contagious disease service, in the appendix.
The Government has now by law required that all children attend school for a certain time and has provided means whereby to enforce its mandate. The parent has, of course, the right to send his child to a private school, but many are not able to do so, and many who are able elect to send their children to the public schools realizing the many advantages that the latter possess. The public schools are in fact the schools of the District. The Government, however, so long as it maintains a public school system, can not escape the responsibility incident thereto. It is not sufficient, in order to meet that responsibility, to provide the means whereby the minds of the pupils can be trained to a greater or less extent, or even to provide means for a limited amount of manual training; it is essential that neither school attendance itself nor efforts to train the intellect or the senses retard physical development. We may go farther and say that school attendance should tend to promote physical development, and that efforts to train the intellect or the senses can be only partly successful so long as physical conditions are neglected. It must be frankly recognized that school attendance is but a form of graduated labor, intended to accomplish a particular purpose, and that it may be quite as harmful to the growing child as any other form of labor. And the same motives that have led to the enactment of a childlabor law for the protection of the child against the selfishness and cupidity of parents and employers should be sufficient to protect them against neglect on the part of the Government itself. A badly lighted, a badly heated, or å badly ventilated schoolroom is as injurious as a workshop, or store or office of the same type, and prolonged hours of school work may be effective for harm as prolonged hours of labor of any other kind.
And as in the issue of a certificate under the child-labor law it must be certified by a responsible officer of the Government that the child to whom the certificate relates has reached the normal development of a child of his age and is in sound health, and is physically able to perform the work which he or she intends to do, so in the issue of tickets of admission to school and in the transfer from one grade to another it would seem that some similar method should be adopted. In order, however, to adopt this plan it would be necessary to increase materially the number of medical inspectors of schools, and to provide for their better supervision and for the clerical work incident to the service. The school inspectors now employed are barely sufficient to guard the schools against outbreaks of contagious disease and to examine such supposedly ailing or defective children as are referred to them by teachers. Anything like the thorough and systematic examination of all school children for the purpose of determining whether they are of normal physical development and fit for the discharge of the duties that they are called upon to perform is entirely out of the question. Yet if physical development is to be regarded at all this is what must be done. Substantial beginnings are being made elsewhere and there seems to be no good reason why something should not be done here in Washington, which it is commonly admitted should be a model for all cities and not merely a follower in their footsteps. In the hope of being able to extend the medical inspection of schools along the lines laid down above, the health office recommended the appointment of a chief medical inspector of schools, 18 medical inspectors of schools, and of 6 school nurses, and in the general estimates for the expenses of the health department recommended such increases in the clerical force as would have provided for the clerical work incident to the medical-inspection service. It is regretted that it has been found impossible to approve the estimates of the health officer with respect to this matter. Such recommendations as have been made will, however, be renewed at the appropriate time, and it is hoped with better results.
While an act to regulate the employment of child labor in the District of Columbia, approved May 28, 1908, does not specifically impose any duty upon the health department, yet its operations have necessarily imposed a very considerable amount of labor upon it. The act provides that children of a certain prescribed class shall not be employed unless they have approved age and schooling certificates, and it provides further that no age and schooling certificate shall be approved unless satisfactory evidence is furnished by a duly attested transcript of birth, or by certain other specified evidence, showing the place and date of birth. The law provides further that the certificate referred to shall show that the child has reached the normal development of a child of his age, and is in sound health, and is physically able to perform the work which he intends to do. The health department has been called upon, therefore, to make many searches of its records, and to issue many certificates, to show the date and place of birth of children born in the District and applying for
age and schooling certificates. And since the superintendent of schools was not in a position to certify as to the development, healthiness, and working capacity of applicants for age and schooling certificates, the health department, through the medical inspectors of schools and through other physicians in its service, has undertaken to examine such applicants to determine whether the desired certifificates can be properly issued. While such work has materially interfered at times with the other work of the department, it has been looked upon as a legitimate function of the office and the burden has been assumed with the hope that sooner or later, when proper provision is made to provide for the increased demands upon the health department, the matter will be duly adjusted.
RECORDS AND TRANSCRIPTS.
Nine hundred and forty-nine transcripts of records of births, marriages, and deaths were issued during the fiscal year ended June 30, 1908, as shown by the following table:
The amount of fees collected for these transcripts for which charge was made was $438, deposited in the office of the collector of taxes.
Physicians.-Seventy-one physicians registered during the fiscal year 1907-8,66 having been licensed by the board of medical supervisors after examination, 4 by virtue of licenses from other jurisdictions, and 1 on the basis of registration prior to the enactment of the law regulating the practice of medicine in this District. The total number of deaths among physicians since the present register was opened, so far as this department is advised, is 172, and revoked licenses number 2, leaving 1,513 registered practitioners on the books of the health department.
Midwives.- No midwives have been registered during the year, the number registered remaining the same as on June 30, 1907, viz, 151.
Dentists.-Six hundred and thirty-nine names now appear on the register of dentists, 15 having been added during the year.
Undertakers.--Nine undertakers registered during the year, making the total 192. Attention is again called to the need for legislation defining what constitutes an undertaker for purposes of registration.
PRIVATE HOSPITALS AND ASYLUMS.
The passage of an act to regulate the establishment and maintenance of private hospitals and asylums in the District of Columbia, approved April 20, 1908, gives to the commissioners and the health officer needed authority for the control of such establishments. A copy of this law appears on page 194. A draft of such regulations as are authorized by this act will be submitted for consideration as soon as the other work of the office permits.
During the year 1907-8 two applications for permission to maintain private hospitals were filed, both antedating the passage of the law referred to Action on these and on all other applications has been indefinitely suspended, and pending the promulgation of the regulations to definitely control the matter, no licenses can be issued.