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During the first six months of 1908, 30 cases were reported, 14 white and 16 colored. Nineteen of these cases terminated fatally, 9 white and 10 colored, the percentage of deaths to cases being 63.6 for the white, 62.5 for the colored, and 63.3 for all.

In studying the age tables of the various diseases, we find that in the case of diphtheria, while 45.26 per cent of the cases reported occurred between the ages of 6 and 12 years, the mortality for the age was only 4.3 per cent. The same tables show that as the

age diminished, the mortality increased. Those cases occurring in patients under 1 year of age give a mortality of 33.3 per cent.

In the case of scarlet fever, the greatest number of cases again occurred between the ages of 6 and 12 years, those ages furnishing 41.07 per cent of all cases reported.

Typhoid fever prevailed to a greater extent among persons between the ages of 20 and 30, this age furnishing 32.95 per cent of all cases. In contrast with the preceding diseases, the mortality in typhoid increases with the age of the patient.

Most of the patients who suffered from smallpox during the past year were between the ages of 20 and 30 years, these ages furnishing 57.14 per cent of all cases.

When measles, whooping cough, chickenpox, and epidemic cerebrospinal meningitis are considered, we find that in measles 40.97 per cent of the cases occurred between the ages of 5 and 10 years; in whooping cough 60.62 per cent were in children between the ages of 1 and 5 years; in chickenpox 49.87 per cent occurred between 5 and 10 years of age, and in epidemic cerebro-spinal meningitis 50 per cent were in

persons between the ages of 10 and 20 years. I am of the opinion that many cases of measles, whooping cough, and chickenpox occurred during the year just closed that were not reported to the health department as the law requires, in a good many instances the failure to report the case being due to ignorance of the law on the part of those having charge of such children. A large number of children suffering from these diseases are not seen by physicians, but such patients are given home remedies by the parents. I believe that the public are now better informed as to their responsibility under the law, and that the record for the year 1908 will show more accurately the actual number of cases of these diseases in this District.

An act to provide for the registration of all cases of tuberculosis in the District of Columbia, for the free examination of sputum in suspected cases, and for preventing the spread of tuberculosis in said District, was approved May 13, 1908. The active enforcement of this act has been delayed by reason of the absence of the bacteriological laboratory equipment necessary to perform the work required and the several blank forms, record books, etc., necessary to enable the department to carry out the provisions of the act. Steps have been taken to procure the necessary equipment, blanks, etc., and it is expected that active work under this law will be begun in a very short time.

ISOLATING WARDS.

No unusual conditions have prevailed during the year at the isolation wards of the Garfield Memorial and Providence hospitals. The following tables show the number of patients treated and the diseases for which said patients were treated, the total number of patient days, and the average number of days per patient, during the fiscal year 1907-8.

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This service has continued as usual, nothing of an unusual nature occurring during the year.

From January 1, to December 31, 1907, 907 premises were disinfected as follows: Diphtheria.

374 | Syphilis... Scarlet fever. 141 | Septicemia.

1 Smallpox... 7 Croup..

1 Measles..

74 Typhoid fever. Epidemic cerebro-spinal menin

Tuberculosis.

291 gitis....

10 Glanders.

2
Total...

907 Erysipelas.

1 It is not the usual custom to disinfect rooms because of erysipelas, syphilis, septicemia, or croup, but in each of the cases above mentioned, the circumstances were such that disinfection was deemed advisable and was therefore accordingly done. The above figures show that 51 more premises were disinfected because of tuberculosis

77

38 325 156

6

51 564

during the year 1907 than during the preceding year. From January 1, to June 30, 1908, 172 premises were disinfected on account of tuberculosis. The act relating to tuberculosis in the District of Columbia, approved May 13, 1908, requires that after removal or death of any person suffering from tuberculosis the room occupied by said patient must be disinfected before being again occupied. During the year 873 test cultures were examined to determine the efficiency of the disinfection. In 755, or 86.5 per cent, of the cultures

, examined the organisms were killed, while in 118, or 13.5 per cent, they were not.

The following articles were disinfected at the disinfecting station: Mattresses..

462 Mattings. Feather beds.

Rugs. Bolsters..

174 Cushions. Pillows.

1,214 Couches.. Carpets. Quilts.

Total.....

3, 731 Blankets.

664 The work of improving the roadways to the smallpox hospital and quarantine station was completed during the year. While these roadways render travel to and from these institutions safer and more comfortable than heretofore, the roads are not as well drained as in my judgment they should be. I therefore recommend that an effort be made to secure additional funds to enable the department to make the needed improvements.

I have further to recommend that fire hydrants and the necessary equipment in the way of hose, etc., be provided for the protection of the smallpox hospital, the quarantine station, and the crematorium from fire. I again earnestly recommend that renewed efforts be made to secure an appropriation for constructing a stable at the smallpox hospital. The present structure is an old frame building which is not in keeping with the surroundings, and furthermore is not suitable for storing the valuable property belonging to the service which is now required to be stored therein. I desire to express my appreciation of the services rendered by the employees of the smallpox hospital and the quarantine station and respectfully recommend that they be granted an increase of compensation, fully believing that they are deserving of the same.

MEDICAL INSPECTION OF SCHOOLS.

During the school term an outbreak of smallpox occurred among the pupils attending the colored schools in the southwest section of the city. Several children suffering from very mild forms of the disease were in attendance at school with the eruption on them. Before the outbreak subsided 18 colored school children contracted the disease. None of these children had ever been successfully vaccinated; 10 of this number attended school at the same building.

It is believed that if more care had been exercised by the teachers in ascertaining if the pupils were successfully vaccinated before being permitted to enter school, much, if not all, of the trouble would have been avoided. As a result of this outbreak it was found necessary to disinfect 31 school rooms.

In addition to the disinfection because of smallpox it was also found necessary during the school terms to disinfect' 30 schoolrooms for other diseases, as follows: Diphtheria, 13; scarlet fever, 11; measles, 4; chickenpox, 2; total, 30.

In the early part of November, 1907, a small outbreak of diphtheria occurred in one of the white schools located in the county in the northeast section of the District. On investigation 2 or 3 school children were discovered in the class room with the diphtheria bacilli in their throats. Before the outbreak ceased 8 cases of the disease developed among the pupils. These outbreaks of smallpox and diphtheria were closely watched by the department and school inspectors and it was only by close attention, together with the cooperation of the school authorities, that more cases of the disease did not develop.

A study of the following table of exclusions from school shows that the greatest number was for the following diseases, and in the order named, to wit: Pediculosis, 342; chickenpox, 119; mumps, 113. It will be noticed that in the case of pediculosis capitis 337 were white pupils and only 5 colored. It seems hardly possible that these figures show the actual condition existing with respect to the disease. The excessive number of white pupils as compared with the number of colored can only be accounted for in my judgment by a closer inspection of the pupils in the white schools than of those in the colored. When compared with the exclusions in the preceding year, the year just closed shows marked increase in the following diseases, to wit: Chickenpox, contagious conjunctivitis, measles, German measles, scabies, and tinea circinata. The total number of pupils excluded in the year just closed was 1,169, as against 975 for the year previous. The following statement shows the work done by the medical inspectors of schools during the year:

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Statement showing the number and causes of exclusions from school on account of the

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White. Colored. White., Colored. White. Colored. White. Colored.

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Statement showing the number and causes of exclusions from school on account of the

health of the pupil-Continued.

1904-5.

1905-6.

1906–7.

1907-8.

Cause.

White. Colored. White. Colored. White. Colored. White. Colored.

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Echthyma.
Eczema..
Enuresis.
Eruptive disease.
Erysipelas, facial.
Erythema
Eye strain.
Enteritis.
Febricula.
Fracture.
Gastralgia..
Gastritis, acute.
Grippe..
Headache.
Herpes.
Heart (irritable)
Hysteria
Icterus.
Imbecility.
Impetigo..

Contagious.
Indigestion..
Infection of thumb
Intestinal colic.
Iritis...
Keratitis.
Laryngitis.
Malaria.
Mastoiditis.
Measles.

Exposure to.
Measles, German.
Mumps.
Myalgia.
Myopia.
Narcotism.
Nasal catarrh
Otitis:

Acute...
Suppurative.
Media..
Media suppurative..
Media and pediculosis

capitis.
Otorrhea.
Osena...
Pediculosis.

Capitis.
Capitis, with eczema

Corporis.
Pharyngitis.
Phlegmon.
Pleurisy.
Pleurodynia.
Potts diseases.
Refused examination
Rhinitis.
Rhus poisoning.
Ringworm.
Ringworm and eczema.
Ringworm and pediculosis

capitis.
Scabies..
Scabies and pediculosis.
Scarlatina...

Exposed to..
Suspected, and whoop-

ing cough. Smallpox..

Exposed to.
Sore neck.
Stomatitis.
Stye.
Syncope.
Syphilis, second eruption.
Tonsilitis.

Shown by culture (diph-
theria suspected)...

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