to the absence of any legal standard of attainment necessary to entitle one to register as an undertaker; and in view of the sanitary importance of the proper care of the dead, it is respectfully recommended that steps be taken to secure the passage of a law to regulate the practice of this art.

PRIVATE HOSPITALS.

Application has been received for the maintenance of one new private hospital, and one such institution, for the maintenance of which a permit has been asked, has ceased to exist. No formal permits have yet been issued, owing to the vagueness of the law as to the conditions under which such issue should be made. It is hoped that some action may be taken during the coming year to secure such modifications of the present law as are necessary for its intelligent enforcement.

CEMETERIES.

There has been no change in the number or location of cemeteries in this District during the past year.

A bill prepared by this department for the regulation of cemeteries and the disposal of dead bodies was passed by both Houses of Congress, but failed to become a law by reason of the failure of the President to sign it, owing, it is believed, merely to the extremely late hour of his official life at which it was presented to him for that purpose. The same bill was introduced at the subsequent extraordinary session, passed the Senate, and is now on the House Calendar.

The recommendation made in the two preceding reports of this department that a crematory be erected as an adjunct to potter's field is respectfully renewed. If all bodies to be interred in this tract of land be cremated before interment, it will last for an indefinite period; but unless some such provision be made, additional land must soon be purchased or the present site will be so overcrowded as to become a nuisance and a menace to the health of the unfortunate inmates of those institutions located in its immediate vicinity. Such a crematory, if erected, will be of service, from a sanitary standpoint also, for the destruction of the remains of those dying of the graver contagious diseases.

The need of a municipal crematory was recognized by the grand jury of New Orleans in 1883, and the establishment of a crematory for the incineration of the bodies of those dying of contagious diseases recommended. In 1888 the New York State legislature, acting upon a recommendation of a committee of the Society of Medical Jurisprudence and State Medicine, required the commissioners of quarantine to erect and establish a crematory for the destruction of the bodies of persons dying at the contagious hospital from contagious diseases. The recommendation of this committee was accompanied by a draft of a bill which provided not only for the incineration of the remains of persons dying of contagious diseases, but also of the remains of paupers and unidentified persons. And the health department of the city of Phila

ANATOMICAL MATERIAL.

During the past year bodies to be used for scientific purposes have been offered for distribution by the various hospitals, and have been distributed to the various medical colleges, as shown in the following table:

a By an agreement between representatives of all medical schools Georgetown University received all bodies offered for distribution during the summer of 1895; hence the large number delivered to this institution in excess of its regular quota.

The total number of bodies so distributed has been but 47, of which 7 had been subjected to post-mortem examinations prior to delivery. The plan of distribution has been the same as was described in the preceding report of this department, but the supply of material has been too small to meet the requirements of those engaged in medical education. As the Government, which in the interest of public health very properly makes certain educational requirements of those desiring to practice medicine, should properly be interested in securing for students of that art means whereby they can prepare themselves to meet those requirements, it 18 recommended that the law under which these bodies are distributed be so amended as to make it mandatory

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upon those in charge of hospitals and asylums to deliver for scientific purposes such bodies as they are now permitted to deliver if they be so inclined. The care and distribution of such bodies might, with advantage, be intrusted to a commission created for that purpose, as is done in Pennsylvania.

RELIEF OF THE POOR.

The work done by the physicians to the poor is shown by the following table:

To the cost of medicines given in column above must be added, in order to give correct amount expended for medicines during fiscal year, tablet triturates, $199.42; antitoxic serum, $59.50; for supplies furnished homeopathic physicians to the poor for April, May, and June, 1897, $48; making total cost of medicines for fiscal year 1897, $2,355,42. TABLE F.-The sick poor for fifteen years.

From the above table it appears that the number of patients treated during the past year, either taken as a whole or with reference to the white and colored elements, has been smaller than at any time since 1893. It should be borne in mind, however, that the tigures given to show the number of patients treated are absolutely worthless except

even for this, since they merely indicate the sum of the patients reported each week as being under treatment, so that a single patient, if he happens to be under treatment during a portion of two weeks, will appear as two patients. An effort will be made to correct this method of keeping the records prior to the issue of another report.

More accurate information as to the amount of work done may be gathered from the number of visits and office consultations. These amounted to 28,052, while during the preceding year there were 28,028. The average cost of each patient has been 52 cents for medical attendance and 17 cents for medical supplies, making a total cost of 69 cents per "patient," using the term in the manner previously explained. The amount received by each physician for each visit or consultation has been, approximately, 26 cents.

Attention is invited to the recommendations of this department of June 17, 1897, in reply to a letter from the Congressional Joint Select Committee to Investigate Charities and Reformatory Institutions in the District of Columbia, which has been printed in the hearings before that committee. (See Senate Doc. No. 185, Fifty-fifth Congress, first session.) These recommendations are, in so far as they relate to the physicians to the poor, respectfully renewed.

CONTAGIOUS DISEASES.

SCARLET FEVER AND DIPHTHERIA SERVICE.

Scarlet fever.-There were reported during the past year 160 cases of scarlet fever, of which 148 were white and 12 colored. The incidence per 10,000 of the population was, therefore, 7.84 among the whites, 1.36 among the colored, and 5.74 among the population as a whole. These figures show a marked diminution in the prevalence of this disease during the year. That the type of the disease which has occurred has been exceedingly mild is shown by the occurrence of but a single death, a fatality of but 0.6 per cent.

The extent to which scarlet fever has prevailed in the various parts of the United States during the year is indicated in the following statement. While the figures given can not be accepted as mathematically accurate, they are subject only to the same sources of error as other vital statistics. So far as is known there is no reason to believe that the amount of such error is greater in one place than another, so that for purposes of comparison they may be accepted as substantially correct.

Incidence of scarlet fever in fifteen cities in the United States during the year ended June 30, 1897.

Diphtheria.-During the year there has been reported among the white portion of the population 494 cases of diphtheria, 78 of which terminated fatally, and among the colored 126 cases, of which 32 were fatal. The incidence of this disease per 10,000 of the population was among the whites 26.16, among the colored 14.29, and among the entire population 22.38, showing a marked increase in prevalence during the past year, as shown in Table H.

The cause of this increase it has not been possible to determine, but there is no reason to believe that it was in any way due to local conditions, as a similar increase was noted in many places situated in widely separated parts of the United States. The actual extent to which this disease prevailed in the various places during the period covered by this report is fairly shown in the following statement:

Incidence of diphtheria in fifteen cities in the United States during the year ended June 30, 1897.