INQUIRY FOR THE PRESIDENT'S HOMES COMMISSION MEDICAL INSPECTION OF PUBLIC SCHOOL

CHILDREN, WASHINGTON, D. C.

In speaking of the health of a given locality it has always been deemed necessary that the climatic and telluric conditions should be considered. For the purpose of a comparative study I requested Prof. Willis L. Moore and Prof. A. J. Henry, of the United States Weather Bureau, to furnish me with meteorological data covering a period of thirty years for the city of Washington and six other cities where the climatic conditions are quite similar to those which obtain in this city. A careful analysis of these data and a study of the comparative mortality statistics justify the conclusion that there is absolutely nothing inimical to health in the

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climate of Washington. It was found, however, that although the city enjoys practically the same climate as Cincinnati, Indianapolis, Detroit, Philadelphia, Springfield and Kansas City, it has the highest death-rate* -22.8 per 1,000, Philadelphia coming next with a rate of 21.2 per mille, while Detroit, Kansas City, Indianapolis and Springfield have an average of 17.5 per 1,000.†

As a matter of record, Dr. Busey, in one of his addresses, quotes the "Washington Gazette" of 1797, that "during that year, in a population of two thousand, but seven deaths occurred in this city." If, then, during succeeding decades, "fatal epidemics of bilious fever, intermittent bilious fever and bilious dysentery" and typhoid fever occurred, and the reputation of the National Capital as regards health conditions has suffered, it cannot be the effect of climate, but of something added to the climate, and students of the subject have long since recognized that, apart from temperature, humidity, atmospheric pressure, winds, sunshine and other meterological conditions, there are many factors such as soil, water, impure air, the presence of insects, social and racial problems -which play an important role in the healthfulness of a given locality.

It can be safely asserted that a number of causes have operated in the production of unsanitary factors in the National Capital.

The topography of the basin in which the city is located was undulating, interspersed with small valleys, ravines, morasses and lowlands subject to periodical overflows. The lowlands, according to Dr. Busey, "spread south of the F street ridge to the river shore, including a greater part of the White Lot and the Mall, and in the section known as 'the slashes,' lying along the northern boundary from the Tiber to Rock Creek, and dipping in many places far into the interior of the basin. When the city was first platted there were no Potomac and Anacostia river flats; the formation of the Potomac marshes is attributed to the construction of the Anacostia causeway in 1805 and the building of the Long bridge in 1808, and the Anacostia river flats to the construction of the Kentucky avenue bridge in 1795 and the Bennings bridge in 1797." Whatever their cause may have been, they increased from year to year by continuous depositions and soon became notorious breeding grounds for mosquitoes and the chief source for the propagation of malaria. The Potomac flats have been reclaimed since 1882, adding about 621 acres to

*Of these seven cities Washington had the highest death rates from malarial, diarrheal diseases, typhoid and consumption (Philadelphia exceeding in pneumonia).

+Considerably less than the general death-rate in the registration area in the United States, representing 10,000,000 inhabitants. For the census year 1900 this was 18.6 per 1,000.

our parking system, but the Anacostia river flats, which cover an area of over 1,000 acres, the title to which is vested in the United States, still continue to be a menace to the health of our inhabitants. The reclamation of the Potomac flats has greatly reduced the prevalence of malaria, as shown by the statistics of the health department, and it is reasonably and scientifically correct to maintain that similar results would follow the reclamation of the Anacostia flats. Take away the mosquito breeding places of every description and there will be no extra-corporal habitat for the germs of malaria. It is a deplorable fact that, although this measure has been urged by the Commissioners since 1894, no legislative action has yet been taken.

RELATIONS OF WATER SUPPLY AND SEWERS TO HEALTH.

Prior to the introduction of Potomac water in 1859 the inhabitants had to depend upon springs, pumps, wells and cisterns subject to pollution from the sewage of cesspools, vaults and box privies. It was the old story of wells and privies being dangerous neighbors and failure to recognize the necessity that a system of public sewerage must go hand in hand with the public water supply, the neglect of which compels recourse to various makeshifts and must inevitably lead to pollution of soi!, water and air. There can be no question that these factors have played an important role in the causation and spread of typhoid fever, dysentery, diarrhea and other intestinal infections and have served to swell the general mortality rates. Many of these conditions have been improved, a comprehensive system of sewerage disposal has been adopted within the city limits, and the number of public pumps has been reduced from 171 in 1895 to 42 in 1908. The number of private wells, however, is a matter of conjecture.

It may be urged that with the introduction of a purer water supply in 1859, health conditions, especially as regards the so-called water-borne diseases, should have improved, but it is a long and tedious matter to convince the average man that a clear, sparkling and very palatable pumpwater in cities may be, and very frequently is, liable to the grossest forms of pollution. He knows from observation that hydrant water is at times absolutely filthy from suspended matter, and that it reaches in summer a temperature which is far from palatable. But he does not know that the well water in its passage may have simply been deprived of the suspended matter, without losing some of the most dangerous forms of disease germs. It involves, therefore, many years of education to impress the public with the dangers of pumps, and, by the time this was fairly