department to invite attention at the present time to the necessity therefor. But while the system has been studied and plans for its improvement have been carefully prepared, the labor thus expended will not bear fruit within the lifetime of the present generation if the present piecemeal policy of construction be followed. In order to realize the rate of progress toward the completion of such improvements as have been pointed out as necessary, we must consider the length of time which has been consumed in bringing the work to its present stage. The present agitation may be said to have had its starting point June 13, 1878, when the Senate authorized a committee to sit during the recess of Congress "to consider and examine into various plans for the improvement of the system of sewerage and the sanitary condition of the District of Columbia." The appointment of this com mittee seems to have terminated in the publication of several rather elaborate reports upon the sewerage of European cities, with numerous plans for the improvement of the sewerage of Washington (see Mis. Docs. Nos. 13, 17, 19, and 25, Forty-fifth Congress, third session), but no practical results were accomplished. Eleven years passed before the next step was taken. Then the District appropriation act, approved March 2, 1889, provided for the appointment by the President of the United States of three competent sanitary engineers to examine and report upon the system of sewerage existing in the District of Columbia, together with such suggestions and recommendations as might to them seem necessary and desirable for the modification and extension of the same. The report of the committee appointed under this act was published during the following year, 1890 (see Ex. Doc. 445, Fifty-first Congress, first session). The disposal of the city's sewage by the system of drainage in operation at the time of the investigations of this committee, which is practically that now in use, was found defective. At fourteen points along the Potomac and at eight on the Eastern Branch sewers of various sizes discharged their contents; and because of the relation existing between the tides and the current this discharge was frequently not carried off, but oscillated along the river front, settling along the shores, on the bottom, and on the flats; there it formed a breeding place for various forms of micro-organisms and gradually underwent decomposition, with the usual accompaniments in the way of deleterious and foul gases. This condition was much worse in the Eastern Branch than on the Potomac because of the relatively small volume of the stream and the presence of so much shallow water and swamp. In addition to this improper disposal of sewage after its discharge, certain points of the sewer system within the city itself were found to be sources of nuisances, viz, the B street outlet canal, the James Creek Canal, and the lower portion of Rock Creek. In the presence of such conditions the board of sanitary engineers found it necessary to devise a plan whereby all sewage of the city would be disposed of in such a manner as to prevent its deposit within the immediate vicinity of the city, and by which the open sewers above referred to would be closed and other existing defects of more or less importance corrected. To this end it recommended the establishment of pumping stations, and the discharge of the entire output of the Potomac River at a point some distance below Giesboro, with numerous changes in the present sewer system. Practically this plan has been adopted by Congress, and appropriations have been made for the construction of portions of the proposed work. But by this piecemeal method of construction it is to be feared that the population will outgrow the plans before the work is completed; so that the present generation after paying the cost will not have the use or benefit of the sewers, and the next generation will have to devise and pay for a sewage-disposal scheme of its own. In view of the fact, therefore, that more than fifteen years have already elapsed since the need of improving the sewer system of this District was first realized, and so little progress has been made toward the completion of the work which has been outlined for that purpose, steps should be taken to hasten that end. Respectfully submitted. WM. C. WOODWARD, M. D., The COMMISSIONERS OF THE DISTRICT OF COLUMBIA. APPENDIX A. REPORT OF MEDICAL SANITARY INSPECTOR. SIR: I have the honor to submit the following report of work done in the scarlet fever and diphtheria service during the fiscal year ended June 30, 1897: Of diphtheria there have been reported 620 cases, an increase of 294 over the number reported last year, and the largest number that has come to the knowledge of this department since the passage of the act to prevent the spread of scartlet fever and diphtheria December 20, 1890. This apparent increase in the prevalence of this disease is not, however, peculiar to the District of Columbia, but has been noted over the northern, central, and eastern parts of the country, as appears from Table I. In this table is shown the number of cases of diphtheria, population, etc., of 15 large cities, selected as representatives of the sections in which they are situated. An examination of it shows that the District of Columbia (Washington) stands ninth in the list as regards the number of cases per each 10,000 of population, eleventh according to the death rate, and eleventh in the number of deaths per 10,000. Those places which had a smaller number of cases per 10,000, viz, San Francisco, Atlanta, and New Orleans, are situated in warm localities and not subject to sudden and marked variations in temperature, etc. TABLE I.-Number of reported cases and deaths from diphtheria, together with ratio per 10,000 of population, in 15 representative cities during the year ending June 30, 1897. Reported cases. Deaths. Cities. Popula Boston.. New York. Detroit Buffalo Milwaukee 22 April. 508, 694 300 256 296 461 498 481 368 338 366 340 366 4, 536 89.1 10.4 1,962, 319 854 626 522 849 828 1, 011 1,372 757 878 897 1, 430 1, 044 11, 068 56. 41, 477 7.5 13.3 47 1, 227 45.8 301 11. 2 24.5 89 1,330 38.0 265 7.6 19.9 49 904 33.8 175 6.5 19.3 390 3,998 33. 21, 003 8.3 25. 1 651 22.7 167 5.8 25.6 159 106 139 75 70 286, 250 14 32 70 130 112 34 33 24 19 34 277, 782 28 23 48 59 110 116 Chicago A large number of the cases brought to the attention of the office, belong to that class not heretofore reported by physicians, and in which a positive diagnosis was only possible by bacteriological examination. |