243 alleys, each having a population not exceeding 100, the death rate was 18.47; in 43 alleys, with populations between 101 and 200, the death rate was 21.08; in 13 alleys, having between 201 and 300 inhabitants, the death rate was 22.78, and in 2 alleys, with populations between 301 and 400, the death rate was 35.70. But in the single alley having a population in excess of 400-that is, 422-there was not a single death reported. So that while the general death rate in the alleys does not bear out preconceived ideas, the death rates as given above indicate, in a general way, that the danger of these places increases with the increase in the number of inhabitants.

Classifying the mortality according to causation we find an increase since last year in the deaths from constitutional and developmental diseases, and a decrease in the number from zymotic and local causes and from violence. From the standpoint of public health, the most important of these classes is, of course, the zymotic, which includes most of those diseases which may be regarded as preventable. Some special importance attaches, however, to the constitutional class, owing to the presence in it of the tubercular diseases, having been inserted in this class before definite knowledge was acquired as to their causation, and being allowed to remain until some general plan for the classification of vital statistics can be adopted throughout the country. Deaths from violence are of interest chiefly from a sociological standpoint.

Deaths by classes, arranged by sex and color, with percentages and annual death rates for year 1897, and 1896.

Zymotic diseases.-The entire number of deaths from zymotic diseases was 1,027, being 220 less than during the preceding year, and forming 17.90 per cent of the deaths from all causes. Of this number 577 were whites and 450 colored; 577 were children under 5 years old.

In certain diseases of this class the number of fatal cases shows an increase; thus the deaths from diphtheria increased from 75 to 110; from whooping cough, from 22 to 65, and from grippe, from 53 to 118. But the fatal cases of measles diminished from 70 to 3; from scarlet fever, from 13 to 1; from croup, so-called, from 9 to 6; from typhoid fever, including so-called typho-malarial fever, from 240 to 153; from malarial fever, from 72 to 51, and from diarrheal diseases, from 468 to 358. The number of deaths from diphtheria is not excessive, as, except during the year immediately preceding, it has not fallen so low since 1889. The mortality from this disease is further discussed in connection with the consideration of the operations of the department under the scarlet fever and diphtheria law.

The number of deaths from whooping cough indicates a marked increase in the prevalence of this disease, but in the absence of any law requiring the report of cases the extent of such increase can not be ascertained with any degree of accuracy.

Grippe first appeared upon the mortality tables during the latter part of December. In January it caused 21 deaths, in February 52 deaths, and in March 24 deaths. From that time it declined, but a single death being reported during June. It prevailed mostly among persons of advanced age, 74 of those who died being over 50 years of age. Seven of the deaths occurred among children under 5 years old.

There is no record of a year passing prior to that now under consideration with but a single death from scarlet fever. A statement as to the mortality from this disease in other places is made in connection with the consideration of the operations of the department under the scarlet fever and diphtheria law.

The most important feature in the decrease in the number of deaths from zymotic diseases is the diminution in the number of fatal cases of typhoid fever and diarrheal diseases. And while malarial fever itself can not be properly classed with such diseases, the extreme rarity of fatal cases of this disease in this climate, in the practice of many of the best informed physicians, renders it not unlikely that many of the deaths reported as due to it were in reality due to typhoid fever. So that the apparent decrease in malarial fever may be considered in this connection. The decrease was as follows:

While it is not safe to base conclusions upon this improvement in the death rate for a single year, yet its coincidence with the closing of a very considerable number of surface wells; with the replacement of a very considerable number of box privies with running closets, and the proper drainage of the premises; and with a closer supervision of the milk supply, is very suggestive of some relation of cause and effect, and possibly justifies us in expecting further improvement in the future.

satisfactory, as it had increased continuously since 1887. The death rate from this disease during the past year (0.53 per 1,000) is the lowest since 1884, and is considerably lower than the average for the past twenty-two years (0.64).

Constitutional diseases.-There were 1,247 deaths from diseases of this class, being 21.73 per cent of the mortality from all causes. number 632 were white and 615 colored.

Of this

The greater part of the deaths in this class were due to the various forms of tuberculosis, the deaths from this cause numbering 1,053, of which 776 were from pulmonary phthisis. These diseases have been, as usual, much more prevalent among the colored than among the whites, the death rate for the former being from the pulmonary variety alone 4.67, while that for the latter was but 1.94.

Local diseases.-In this class there were 2,643 deaths, being 46.05 per cent of the total mortality. Of these 1,512 were white and 1,131 colored. From diseases of the nervous system 685 deaths occurred, 11.94 per cent of the total mortality. Of these 437 were white and 248 colored. Cerebral hemorrhage caused 205 deaths; convulsions (mainly infantile), 108 deaths; meningitis, 69 deaths; epilepsy and insanity, 82 deaths, and heat stroke, 43 deaths.

Diseases of the circulatory organs caused 423 deaths, 7.37 per cent of all, 244 being white and 179 colored. Of this number 308 were valvular diseases of the heart and 15 were reported as due to angina pectoris.

From diseases of the organs of respiration, except pulmonary tuberculosis, there were 764 deaths-386 white and 378 colored. Of these 509 were from pneumonia and 193 from bronchitis and congestion of the lungs. The largest mortality occurred during the months of January, February, and March. Forty-five per cent of deaths in this class occurred in children under 5 years of age.

Diseases of the digestive organs caused 408 deaths, the principal causes being gastric and enteric catarrhs, cirrhosis of the liver, and peritonitis. Of the decedents 225 were white, 183 colored, and 183 children under 5 years of age.

From diseases of the urinary organs 306 deaths occurred, of which 185 were from nephritis. Bright's disease was reported as causing 52 deaths; enlarged prostate 10, and cystitis 11.

Diseases of the generative organs were charged with 27 deaths-13 white and 14 colored; all females. Of these, 11 were due to fibroids of the uterus and 10 to pyosalpinx and salpingitis. Certain diseases of these organs are charged among the developmental diseases, the above figures being susceptible of misinterpretation unless this be borne in mind.

Diseases of the osseous and locomotary systems caused 22 deaths, principally gangrenes and osseous necroses. Integumentary affections caused 8 deaths, of which 7 were from sarcomatous formations.

Developmental.-In this class, which includes diseases incident to childbirth, infancy, and old age, not otherwise classified, there were 593 deaths, of which 277 were infants, 68 women in the puerperal state, and 248 the aged. There were 34 deaths reported as due to puerperal infections, 7 to abortions, and 4 to umbilical hemorrhage.

Violence.-There were 227 deaths from violence during the year, of which 168 were accidental, 11 homicidal, and 47 suicidal.

Of the accidental deaths 101 were of whites and 67 of colored. In 29 cases death resulted from drowning; in 28 from falls; in 22 from burns and scalds; in 15 from injuries received from steam railways; in 9 from

injuries received from street cars; in 5 from gunshot wounds; in 9 from poisons, and 7 from traumatic tetanus. The number of deaths from injuries from steam railways is, of course, in excess of the number of fatal accidents from such conveyances in the District of Columbia, as not infrequently persons who have been seriously injured in adjoining States are brought here for treatment, while the reverse seldom occurs. Of the homicidal deaths, 5 resulted from gunshot wounds, 3 from stabs, and 2 from blows on the head.

Of the suicidal deaths, 17 resulted from pistol shots, 10 from the inhalation of illuminating gas, 13 by poison, and 2 by hanging.

The number of deaths from suicide shows an increase of 9 over the corresponding figures for the preceding year, and an increase of 6, or almost 15 per cent, over the highest number previously recorded. The average number of suicides per annum during the past twenty-two years has been 17.20; during the five years' period, 1878 to 1882, it was 12; from 1883 to 1887, it rose to 17.40; during the following five years, 1888 to 1892, it was 23.20, and during the period just ended, 1893 to 1897, it was 39.40. The population has not doubled, but the number of suicides has increased more than threefold.

BIRTHS.

The total number of births reported was 4,573, of which 2,761 were of whites and 1,812 of colored. If, however, we accept the estimated population below 1 year of age as correct, 816 births occurred which were not reported. The birth rate, even when based upon the estimated number of births and not upon those of which official returns were made, falls below the death rate for the colored, being 21.39; and for the entire population being 19.46.

In the case of whites the balance is slightly in favor of the birth rate, being 18.03.

The births reported as illegitimate numbered 573, of which 96 were white and 477 colored. During the preceding year the number of such births reported was 617.

Of the entire number of birth returns, 2,466 were received from physicians and 2,107 from midwives.

STILLBIRTHS.

The returns of stillbirths amounted to 487-187 whites and 300 colored-while during the preceding year returns were received in 520 cases. Of this number 153 were illegitimate-33 white and 120 colored. The returns were made by the coroner in 118 cases, which usually had reference to bodies which had been abandoned in public places. The number that went to full term was 197, and in three instances pregnancy was reported as having proceeded to the tenth month. The chief causes alleged were difficult labor in 24 cases, falls by mother in 14, overexertion by mother in 21, placenta previa in 9, and syphilis in 11.

MARRIAGES,

Returns were received from 1,519 marriages-between whites 984, and between colored 535.

The number of marriage licenses issued by the clerk of the court during the fiscal year 1896 was 3,618, while during the past year it was but 2,476. As it is a reasonable presumption that each such license

return required by law was 957, or 39 per cent of the entire number of marriages.

The only remedy for this condition is the issue of these licenses to particular persons, with the right of assignment if they be unavoidably prevented from performing the ceremony, instead of the issue, as at present, "to any minister or person authorized to solemnize marriages." If such a plan were adopted, it would be possible to require the proper return to be made in each case, as the name of the person who celebrated the marriage would be known. Moreover, the liability for the performance of the marriage ceremony by unauthorized persons, as has been occasionally done in the past, either through ignorance or willful wrong, would be very much diminished. The fact that the adoption of this plan would necessitate the selection of the person who is to perform the ceremony before the license could be secured would not seriously interfere with any well-considered marriage, and the interference with others would probably be beneficial rather than otherwise.

TRANSCRIPTS FROM RECORDS.

The recommendation contained in the preceding report of this department, that a fee be charged for transcripts from the records, was put into effect by the passage of an act authorizing the Commissioners of the District of Columbia to charge a fee for the issuance of transcripts from the records of the health department, approved March 3, 1897, which took effect thirty days after its passage. Between that time and

the end of the fiscal year there was collected the sum of $54.

As the records from which such transcripts are made cost approximately $3,000 per annum, it is evident that the fees collected will not begin to pay the cost. But the establishment of this fee has answered the purpose for which it was mainly intended-that is, it has diminished the number of applications for transcripts without any real need therefor on the part of the applicant, as will appear from the fact that the average number of transcripts issued during each working day prior to the passage of the act was 3.55, while after the act went into effect it diminished to 1.57. The total number of transcripts issued during the year was 957.

OFFICIAL REGISTERS.

Under the act to regulate the practice of medicine, approved June 3, 1896, 966 physicians have been registered at the health department. Of this number 961 have held licenses issued by virtue of registration at the health office at the time of the passage of the present law, and five licenses issued by reason of the licentiates having successfully passed examinations.

No midwives have been registered, no licenses of this class having as yet been issued by the board of medical supervisors, and, under the act above referred to, registration only being granted to holders of such licenses.

The register of dentists shows an increase of twelve during the year. Under the act for the regulation of the practice of dentistry, approved June 6, 1892, licenses from the board of dental examiners are necessary in order to secure such registration.

The register of undertakers, under the regulations to secure a full and correct record of vital statistics, promulgated by the late board of health, shows the total number to be 106. Attention is again invited