grimed by smoke and age, so domiciled are families with all the dignity of tenants having rent to pay." This description, given thirty-one years ago, fits many of the habitations in this city today, and the influence of such homes upon death rates is shown by the fact that in 1906 the death rate among alley residents was 26.96 as compared with 18.75 among the residents of streets.

It is known that 90.54 per cent of our alley population are colored. It is not surprising, therefore, that during the past 12 years they have contributed 5,268 out of the 9,534 deaths from consumption.

Infantile diarrhea, for reasons given,* is also more prevalent in insanitary dwellings.

Here, again, the colored population, obliged as they are to find shelter in houses unfit for human habitation, contributed in the last six years 1,202 out of the 2,003 deaths from diarrhea and enteritis under two years of age. The mortality of children under one year of age is 115.50 per 1,000 among the white, and 334.86 among the colored. The white infantile death rate of 115.50 per 1,000 is lower than that of any of the 106 American cities, and also lower than that of 42 German cities tabulated by Professor Harrington, while the rate for colored infants is appalling.

It is likewise a noteworthy fact that, out of the 1,672 deaths from typhoid fever during the last ten years, 698 were colored and 974 white. The rate per 100,000 of population was 47.4 for the whites and 76.4 for the colored. Both rates are excessive, to be sure, but the factor of environment and other predisposing causes is plainly revealed by the undue fatality in the colored population.

Sufficient reference has been made to the influence of insanitary homes, but the mortality rate is especially excessive when combined with overcrowding. Hand in hand, and not infrequently as a result of such conditions, we also observe a greater amount of abject want, of filth, of crime, licentiousness and other excesses which predispose to disease and even affect the unborn offspring.

I am not disposed to attribute all this and the general excessive mortality rate in the colored race to racial degeneracy, because many of the factors are sociological and to be found among the poor and ignorant everywhere. The colored element in Washington represents to a large extent those engaged in laborious work, probably the most exposed to hardship and inclement weather. Some allowance must be made for this in computation of the comparative death rates. The broad fact remains, however, that the average mortality rate in the seven cities

*Kober's "Industrial Hygiene," p. 99.

which I selected, on account of similarity of climate, is 18.01 in the white population, and 27.12 for the colored element, and we may conclude that, while uplifting influences and higher standards of living are necessary among the least resourceful classes, regardless of race, they are especially imperative for the Afro-American. That his physical welfare responds promptly to improved environment is strikingly illustrated by a decrease in his general death rate from 42.86 in 1875 to 28.21 per 1,000 in 1907, and in the rate from consumption from 6.9 in 1878 to 4.5 in 1907.

REGENERATION OF HOUSING CONDITIONS.

The regeneration of the housing conditions and removal of slums does not concern a few well-meaning citizens alone, for the germs of typhoid fever may be carried by flies from a patient inhabiting one of the alley houses, often situated in the interior of a fine residence block, and contaminate the food and drink of neighboring homes. The contagion of diphtheria, scarlet fever and tuberculosis may be spread by servants from these plague spots to the very best families.

The question involves both money and education; those who can not invest in sanitary homes can at least contribute their mite to the employment of trained agents engaged in the prevention of sickness and distress, or render, what is far better, some personal service in this uplifting work. Who can deny the influence of a friendly visitor in teaching his fellow-man the value of a clean home, proper food and cooking and sober habits, in the preservation of health and morals?

It is a lamentable fact that only about 1,500 of our residents are engaged in charitable and uplifting influences. The same men and women who subscribe to the Associated Charities, social settlements, playgrounds, summer outings, prevention of tuberculosis, day nurseries, visiting nurses to the poor and other philanthropic agencies, have so far furnished the means for the erection of 240 buildings which provide clean, healthful homes for 480 families. The wealthy men are not adequately represented, nor are the rank and file of our citizens.

THE PRESENT SITUATION.

It is not difficult to conceive that health officials appointed for a brief period, and clothed with limited authority, are decidedly handicapped in the conduct of their office, and as a result two such officers were found wanting in the control of the sanitary affairs of this city.

In 1895 our present health officer came into office, and it is due to his intelligent appreciation of the needs of the city that a number of sanitary laws and regulations have been framed and enacted. In fact, his efforts

for the control of scarlet fever and diphtheria and for a more rigid system. of food inspection, with special reference to the milk supply, with corresponding reduction in death rates, will stand out pre-eminently in the sanitary history of the city.

If it is deemed desirable that such important duties and responsibilities should devolve upon one man, he should be sustained by the strong arm of the law. This, however, in the very nature of our government, can not be, and the result is that the health office is not in a position to render the most efficient service. A health officer or board should be invested with full power, from Congress, to declare what shall be deemed nuisances injurious to health and to provide for the removal thereof, to make and enforce health ordinances, etc., subject to the approval of the District Commissioners, and the appointments should be made, as in the case of the assessor or chief of police, during good behavior.

A health officer with an advisory board of health, with the supervising general of the Public Health Service as a member ex officio, would offer many advantages. The personal element would be entirely eliminated in the exercise of discretionary power and the health officer relieved from grave responsibilities in passing upon important problems and in the settlement of vexatious questions relating to the employment and discharge of subordinates and in the rigid enforcement of existing laws and ordinances.

Moreover, municipal hygiene is a progressive science, and the Commissioners and congressional committees would be relieved from the consideration of details in the formulation of sanitary legislation if these were acted upon by a board of experts. We do need more deliberative bodies, like the Board of Education and the Board of Charities, competent and willing to give to the Commissioners and the public the benefits of expert knowledge without regard to compensation.

Congress and the Health of the District.

The advocates of sanitary reforms and the improvement of housing conditions gratefully acknowledge the important services rendered by Senators McMillan and Gallinger, and other distinguished members of both houses, in the cause of sanitation of the National Capital. Much has been accomplished, but more remains to be done before we can hope to place the healthfulness of this city on a par with some of the European capitals.

Congress, in the administration of the affairs of the District, has a sacred duty to perform. The general government owns more than onehalf of the property in the city, contributes more than one-fourth of the

population in the way of officials and employees, not to mention the immense number of American citizens who annually visit the seat of government. In addition, Congress has permitted, during and after the war, 40,000 negro refugees to find shelter as best they could in our midst. For all this the United States simply pays one-half of the taxes; no more; and not infrequently has paid less.

As sanitarians, we contend that in building a city, the capital of a gigantic nation, the first care should be the protection of the health of its people. Its beautifying is essential, but of secondary importance. Economy, however laudable its general purpose, should never be exercised at the expense of public health.

SEXUAL AND MORAL PROPHYLAXIS.

The morbid habits connected with the generative organs may be acquired under a variety of circumstances. First in very young children, a local irritation, due to some abnormal condition of the genitals, may lead to manipulation of the parts and to consequent pleasurable excitement, which is continually renewed, with an entire unconsciousness of the meaning of the practice. The second class includes cases which have reached or are near the period of puberty and have accidentally learned or been taught this habit, which they are able, if so disposed, to successfully combat. In the third class of subjects the habit has a central origin, as in some forms of insanity and idiocy. When we consider that the highest degree of organic power is necessary for the elaboration of the spermatic fluid, we can appreciate how severely the body is taxed if the emission of the seminal fluid becomes a drain on the system. Excessive, premature and illegitimate sexual intercourse is injurious, and the injury is especially great when excited by unnatural means, because the imagination is. brought into action to produce the mental impression.

The effects are anemia, disordered digestion, general loss of health and strength, with feeble, rapid and irregular heart action and a greater tendency to sickness and incapacity for mental and physical work. Indeed, anyone familiar with the subject realizes that those morbid habits are a frequent cause of breakdowns, and contribute greatly to the number of defectives in charitable and reformatory institutions. A special investigation, conducted by Dr. Paul B. Johnson for the Committee on Social Betterment, shows that the majority of the inmates of the workhouse have been addicted to the habit, and it is one of the greatest evils which the authorities of industrial and reform schools have to contend with.

According to Hammond: "The countenance parts with its natural hue, the eyes lose their luster, the skin becomes dry and harsh, and the hair is deprived of its natural moisture and falls out. The mental faculties become more or less affected and often great despondency, apathy for society and all kinds of amusements, with loss of memory and irritability of temper, is evinced. The effects on the generative system are also marked. There is irritability of the neck of the bladder, accompanied by discharge of mucus and prostatic fluid often mistaken for semen. At the same time seminal emissions are prone to occur upon the least provocation, sometimes without any manual interference, but solely through mental impressions, derived through the imagination at the sight of some lascivious picture or scene, and nocturnal emissions are quite frequent."

This is an extreme picture of the unfortunate victims, but it is well to remember that there is a difference in degree commensurate with the extent of the habit.

In the correction of the habit, should any local source of irritation, malformation or disease exist, it should be removed.

In many instances the moral sense must be acted upon to break up the habit. As Professor Dana puts it: "Man is distinguished from the brute by his self-control. Let him bear this fact in mind and raise himself by a determined effort of the will. Pure thoughts and chaste associations, vigorous physical exercise and a resolute effort to act the manly part will always be successful."

By way of prevention it has been suggested that judicious advice may with advantage be given before even a knowledge of the habit is acquired. and no one is more competent to do this than the father, the family physician or teacher. Cold baths and a well regulated system of gymnastics are of importance, since bodily exercise works off the exuberant animal spirits and indisposes to venereal desires, while idleness is a great incentive.

One of the most difficult problems is to keep young men, frightened by the shameful advertisements and literature, from consulting designing quacks. Many a young man has been driven to insanity or suicide by attributing an occasional nocturnal emission to his former habit, however rarely practiced, when in reality it may be only Nature's safety valve in a continent and otherwise healthy subject, or the emission may be a symptom of a disease for which he is in no way responsible.

If the proprietors of our newspapers could but witness the physical and mental wrecks produced by mountebanks, such harmful matter would not be tolerated in their advertising columns. It seems difficult to con