The disease has been confined almost exclusively to the white population, 161 out of the total of 168 cases reported being among the whites. Of the total number of cases reported during the year, 2 resulted fatally, both being white. The percentage of deaths to cases being 1.2 for the whites and 0.0 for the colored and 1.1 for all. In comparing these figures with those of 1906, it will be observed that the total mortality was reduced from 3.9 to 1.1 for 1907. It is gratifying to note this reduction in mortality and would indicate that the type of disease was very mild. The disease prevailed among the white population in the proportion of 69, and among the colored 7.1, per 100,000 of population and for the total population it was 51.0 per 100,000.

The white population furnished 95.83 and the colored 4.17 per cent of all the cases reported.

Since January 1, 1908, the number of cases of scarlet fever has considerably increased. From January 1 to June 30, 1908, 178 cases have been reported, 164 white and 14 colored, with 4 fatalities, all white. The corresponding period of 1907 gave a total of 107 cases, 102 white and 5 colored, and 1 death. The indications about the end of June were, however, that the rate of increase would not continue during the year. I am unable to assign any cause for this increase in the number of cases reported unless it be due, in part at least, to several undiagnosed cases of the disease which were permitted to go at large while desquamating, and were only discovered by the medical inspector of schools when these children applied for readmission to school. In several other instances the early diagnosis was incorrect and consequently no precautions were taken by the family to prevent the spread of the disease.

TYPHOID FEVER.

Typhoid fever continues to be present in the District, not, however, to so great an extent as during the year 1906. During the calendar year 1907, 945 cases were reported, 735 white and 210 colored. In 17 of these cases the diagnosis was subsequently changed as follows:

Deducting these 17 cases from the 945 cases reported leaves a total of 928 cases to be accounted for. Of these 725 were white and 203 colored. Seventy-seven of the white and 37 of the colored cases terminated fatally. The percentage of deaths to cases was, therefore, 10.6 for the white, 18.2 for the colored, and 12.3 for all. In comparing these figures with those of 1906, it will be noticed that there was a decrease of 198 cases. The total number of cases reported during 1907 was the smallest of any year since 1902, the time the act requiring cases of typhoid fever to be reported was put in operation. The figures

also show a reduction in the mortality over the year 1906. The white death rate remains practically the same; the colored rate, however, was reduced from 24.2 to 18.2, while the general rate was diminished from 14.4 in 1906 to 12.3 in the year just closed. The disease prevailed among the white population in the proportion of 311, the colored 211, and the total 282 for each 100,000 of population. Seventyeight and twelve one-hundredths per cent of the cases were furnished by the white and 21.88 per cent by the colored population.

The first six months of the calendar year 1908 furnished a somewhat larger number of cases than for the same period of 1907. From January 1 to June 30, 1908, 221 cases were reported, 167 white and 54 colored, as against 212 cases for the same period of 1907. Sixteen white and 8 colored cases, of the 221 reported, died. While there was a greater number of cases reported during the period, the mortality, on the other hand, was greatly reduced.

The cause of the continued prevalence of typhoid fever in the District is a mystery which, up to the present time, remains unsolved. The distribution of the cases, as in the past, is general all over the district and is not confined to any particular locality.

In 924 of the cases reported, the following information was obtained; in the remaining 4 cases no information was obtainable.

Cases contracted out of the District of Columbia...

Cases contracted from others...

Cases contracted from milk..

Cases using Potomac water alone..

Cases using Potomac and other waters

Cases using well water....
Cases using spring water.

Cases using bottled water.

Total.......

191

64

27

533

67

35

3

4

924

The percentage of persons using Potomac water exclusively was practically the same as in the cases investigated in the preceding year. In 1906, 60.4 per cent, and in 1907, 57.7 per cent of the cases reported used Potomac water exclusively.

The following table shows the occupation of those affected:

During the calendar year 1907 the District was practically free from smallpox. There were only 7 cases reported during the entire year, 3 white and 4 colored, with no fatalities. Of these 7 patients treated during the year, 4 had never been vaccinated and the remaining 3 unsuccessfully vaccinated. The disease prevailed among the white population in the proportion of 1.3 and the colored 4.2 for each 100,000 of the population and for the total population it was 2.1 for each 100,000.

Between January 1 and June 30, 1908, 180 cases of smallpox were reported, 22 being white and 158 colored. This outbreak, which for some time assumed rather serious proportions, seemed to have had its origin in the southwest section of the city some time during the latter part of September or the first part of October, 1907. In the early part of December 2 cases of the disease were found in the northwest section of the city. For some time it was impossible to trace the source of infection. While these patients (colored) were confined in the smallpox hospital, it was learned that a friend had visited their home about the 20th of November and that this friend was covered

with "bumps.' An investigation which was started at once finally located this man in one of the alleys in the southwest section of the city. Upon examination he was found to have had smallpox and still had some scabs on his body. In carrying the investigation further, it was discovered that in the latter part of September or the early part of October a colored man who is said to have come from Virginia was a roomer in the house in the alley referred to, and that when he arrived in the city he was covered with an eruption. This man, after staying at this house for about two or three weeks left, his room being shortly thereafter occupied by the patient above referred to. This patient slept on the same lounge that the stranger had slept on, and in about two weeks time was taken sick with smallpox. These patients, of course, with the eruption on them, went about the city and were in contact with a great many persons. After this the disease began to spread. Many of the cases were in the advanced stages of the disease at the time of their discovery. The outbreak was confined almost exclusively to the colored population.

Of the 180 cases, all but 7 were treated at the smallpox hospital. The exceptions noted were as follows: 3 were permitted to remain at home because of the fact that some of the other members of the family were just recovering from measles and in the other 4 instances the patients had recovered from smallpox, and they were therefore given a disinfecting bath and permitted to go at large. Five of the cases treated at the hospital were complicated with other diseases, as follows: 2 with chickenpox, 1 syphilis, 1 whooping-cough, 1 typhoid fever. This outbreak of smallpox showed very clearly that a great many children attending the public schools had never been successfully vaccinated. Eighteen of those who developed smallpox were children attending the public schools, none of which had been successfully vaccinated. Ten of these pupils attended schools in the same building.

While the number of cases occurring between January 1 and June 30, 1908, was quite large, there were no fatalities, all patients making a good recovery. The youngest patient in the hospital being 13 days old and the oldest 57 years.

The new ambulance purchased by the department last year was used during the outbreak and rendered good service; the patients being very much better protected from the weather than they could possibly have been in the ambulance formerly in use.

The smallpox hospital was open 66 days between January 1 and December 31, 1907. The total number of patients being 7 and the total number of patient days being 104. The average number of days per patient was 14.8, and the average number of patients per day was 0.11, during the time the hospital was open.

The quarantine station was open 51 days between January 1 to December 31, 1907. During this period 24 persons were admitted, the total number of inmate days being 149. The average number of days for each inmate was 6.2, and the average number of inmates per day was 0.47 during the time the quarantine station was open.

MEASLES.

The act requiring cases of measles to be reported to the health department was put in operation April 9, 1907. From that date to December 31, 1907, 493 cases were reported, 440 being white and 53

colored. Of this number 4 died, 2 white and 2 colored. The disease prevailed to a greater extent among the white than among the colored population. In the case of the white, the proportion was 188 and the colored 55, for each 100,000 of population, while for all it was 150 for each 100,000 of population. The percentage of deaths to cases for the white was 0.4, for the colored 3.8, and for all 0.8. From these figures it will readily be seen that the colored mortality was much higher than the white. The white race furnished 89.25 and the colored 10.75 per cent of the cases. I am of the opinion that a great many cases of eruptive diseases occur among the colored race which are never reported as the law requires. This failure to comply with the law is, I believe, due in part to the difficulty of making diagnoses in these cases, and to the fact that many of the colored children suffering from the milder forms of these diseases have no medical attention.

From January 1 to June 30, 1908, 777 cases of measles were reported, 616 white and 161 colored. None of these cases terminated fatally.

WHOOPING COUGH.

From April 9, 1907, the time cases of whooping cough were required to be reported, until December 31, 1907, 259 cases were reported. Of this number 198 were white and 61 colored. Sixteen of these cases died, 7 being white and 9 colored. The percentage of deaths to cases was 3 for the white, 16.4 for the colored, and 6.2 for all. It will again be observed that the colored mortality is much higher than the white. The disease prevailed among the white population in the proportion of 85, the colored 63, and for all 79, for each 100,000 of population. Of the cases, 76.45 per cent were furnished by the white and 23.55 per cent by the colored population.

From January 1 to June 30, 1908, 314 cases were reported, 246 white and 68 colored; of this number 7 white and 11 colored died.

CHICKENPOX.

From April 9 to December 31, 1907, 385 cases of chickenpox were reported, 302 white and 83 colored, with no deaths. The disease prevailed among the whites in the proportion of 129, the colored 86, and for all 117, for each 100,000 of population. Of the cases, 78.44 per cent was furnished by the white and 21.56 per cent by the colored population.

From January 1 to June 30, 1908, 314 white and 66 colored cases of this disease were reported, making a total for that period of 380. No deaths occurred.

EPIDEMIC CEREBRO-SPINAL MENINGITIS.

Between April 9 and December 31, 1907, 10 cases of this disease were reported. In 8 instances death resulted, 3 of the deceased being white and 5 colored, the percentage of deaths to cases being 60 for the white and 100 for the colored and 80 for all. The disease prevailed in the proportion of 2 for the white, and 5 for the colored for each 100,000 of population, the total for all being 3 for each 100,000 of population. The white and colored races each furnished 50 per cent of the cases.