moderate and proportionately equal extent during the first year of life. Both, to about double the extent from the first to the fifth year that they do in the first. Both diminish rapidly from the fifth to the tenth croup, it is true more rapidly than diphtheria-while diphtheria continues to be accredited with an occasional victim up to years of maturity, and croup only with an exceptional one. prevail during the winter months more especially, and their fluctuations are very nearly simultaneous. The deaths from CEREBRO-SPINAL MENINGITIS amounted to 73, a decrease of nine from those of the year before. WHOOPING-COUGH carried off 125 children, two-thirds of whom were under one year of age, and three-fifths females. This was an excess of 51 over the year previous, but this disease was then much less fatal than usual. We record with great satisfaction a falling off in the mortality from TYPHOID FEVER of fifty-two, the entire number of deaths being 419, exactly divided between the two sexes. The coincidence of this diminution, with the fact of the completion of the new main sewer along the western bank of the Schuylkill, which conveys below the dam at Fairmount immense quantities of filth which formerly discharged themselves directly into the reservoir from which our drinking water was drawn-this coincidence, we say, must be regarded as something more than a mere accident. If we are right in attributing this beneficent result to the cause suggested, we have here a hint of a necessary improvement in our system of sewerage, which will become inevitable at no distant day. This consists in the establishment of grand trunk sewers parallel to and near the banks of both the rivers which receive the filth of the city, which shall carry it so far down the Delaware, before allowing a particle of it to mingle with the water of the stream, that no considerable portion of it shall reach the populous portion of the city again by the flood tide. At.present, nearly every street running from river to river opens its yawning mouth in the free air, and vomits its noisome contents from a height which at low tide is very considerable, directly into the water, thus poisoning both elements at once. As a temporary expedient for improving the quality of our water, Dr. Turnbull suggests that "There should be employed in the spring, filters, so as to mechanically cleanse the water, and that masses of ice should be prevented from entering the reservoir, unless clear and free from impurities." "A second remedy," he continues, "would be required, in the event of a very dry summer, and a small supply of water—a calamity which has happened several times already, and may happen again when we have half a million of people beyond our present population of over eight hundred thousand. "A chemical examination of the amount of pollution should be made by competent officers, and if it be found that more than the allowable percentage of foreign organic matter exists, the supply at that point should be cut off, for drinking purposes, and the water only employed for washing. "Again, in the Delaware River this pollution is produced by sewerage and refuse matters thrown into it at all points during the rise and fall of the tide. Our water supply from that source may be considered as sewage simply of different degrees of dilution. "If it is very much diluted-as when the water supply is abundant-not much harm may be produced in healthy persons; but should the person be of a delicate temperament, or the stomach and bowels in a diseased condition, evil results are sure to follow. "There is no want of proof that, in a large number of instances sporadic cholera, dysentery, and typhoid fever have originated in the drinking of water containing excremental discharges of persons sick of those diseases, and even of the apparently healthy, when concentrated. It is a well-known fact that an immense number of the rural population of this country habitually consume water strongly impregnated with animal and human excremental discharges, and yet maintain a tolerable degree of health; but mark, if the supply becomes scant, it shows its effects at once upon the health of those who drink it, producing diarrhoea in children and invalids, cholera morbus, sporadic cholera and dysentery, and, through the blood, diphtheritic inflammation of the bowels, throat, and other mucous membranes, which effects are manifested during the spring, autumnal, and winter months." At the suggestion of the most distinguished sanitarian our Society or city can boast, Prof. Henry Hartshorne, of the University, a member of your committee undertook to determine whether typhoid fever was equally distributed throughout the city, or confined more particularly to certain districts. The results, for which the materials were found in the Report of the Board of Health for 1873, are succinctly given in the following table. They show conclusively that there are portions of the city which are habitually almost free from it, at least in a fatal form, and others where it prevails constantly, sometimes to a very considerable extent. The years 1862-3-4, and 5 have been omitted in this analysis, for the reason that the large number of military hospitals established here at that time, crowded with broken-down and wounded soldiers, swelled the typhoid death-rate far beyond its true limit. MORTUARY TABLE NO. 4. Wards of Philadelphia in the order of leas. mortality from Typhoid Fever for a period of ten years, from 181 to 1874 inclusive, omitting 1862 to 1865 inclusive. No. of 23d 22d Annual deaths to 10,000 persons living. Annual deaths to 10,000 persons living. No. of 2.99 3.39 3.46 3.54 8th 24th 10th 9th 13th за 15th 20th 1st We are authorized from the above figures to assert, first, that there is a belt of territory lying along the Delaware River, and extending back for a few squares, running the whole distance of the built-up river front of the city, some nine miles, with a single limited exception, which is the favorite and principal haunt of this fever; secondly, that there is a narrow stretch of territory running at right angles to this, through the oldest and most densely populated portion of the city directly across to the Schuylkill which comes next as a fever-nest; and, thirdly, that the manufacturing villages along the Schuylkill, within the city, also contribute a large share of the mortality from this affection. We have roughly tinted the accompanying map of the city in order to bring at once before the eye the regions indicated, and the degree to which the disease is fatal in them. The inference seems unavoidable that those who live near enough to the Delaware to breathe the emanations from the sewers are very liable to the disease; that those who, in addition, drink its polluted waters are so to a much greater extent; that those who dwell in filth, misery, and degradation, herded together in crowded quarters, while suffering seriously, do not do so to as high a degree as those who are using impure drinking water; that the inhabitants of suburbs not as yet supplied by the city water-works, and dependent on wells and springs for their water supply, if careless of the purity of their wells and filthy in their habits, as in factory villages, afford a large percentage of the typhoid mortality; but if intelligent and educated, with some knowledge of sanitary laws and requirements, 20 VOL. XI. as in such suburban districts as Germantown and Chestnut Hill, enjoy comparative immunity. The freedom of the sixth ward is readily accounted for by the fact that it is almost wholly given up to business purposes, leaving little food for fever within its solidly built area; but that of the eighth, ninth, and tenth wards can only be attributed to the general well-being and careful attention to sanitary precautions of their inhabitants. With a population of 74,000 to an area of but little over a square mile, they exhibited, during the past year, an aggregate of but eighteen deaths from this cause, a ratio of 2.4 deaths to every 10,000 persons living, a better showing than the average of most favored suburban wards. These latter, indeed, have, during the same interval failed to maintain their usual high standard of health in this particular. The nineteenth, with a population of 69,000 to an area of nearly one and a half square miles, contributed 74 fatal cases of typhoid and 8 of the 12 fatal cases of typhus. This is a mortality of upwards of 10 in 10,000, more than four times that of the wards above alluded to. MEASLES was extremely light, and not very prevalent, but twelve deaths being recorded from it. None of these were of persons of color. We have in previous reports taken occasion to remark the somewhat singular immunity of the African race from this disease. We say immunity from the disease, because we think that a comparatively small number of deaths indicates a still greater disproportion in the number of cases, and for this reason. The poison of measles expends itself principally upon the mucous membrane of the lungs. The deaths which take place from it are usually from bronchitis and pneumonia. Now, in our climate, the vital point of the African and mulatto is the lung. We are justified, then, in assuming that the same number of cases would result in a higher mortality among blacks than among whites. Five per cent. of the total mortality of the city is accredited to this portion of our popu lation. Of that from the more important diseases of the lungs, about seven per cent. They are, therefore, entitled to rather more than five per cent. of the deaths from the disease under consideration. Instead of this, we find that, in 1872, when it prevailed extensively, causing 143 deaths, but one colored person is reported as having died from it; and in 1874, when it was again epidemic, causing 117 deaths, but three are so returned; the percentage even in the latter instance amounting to but two and a half. There is but one other mode of accounting for this disproportion, and that is the supposition that the eruption is so masked by the color of the skin as to escape detection; but certainly there are other diag nostic marks which ought to render the disease recognizable to a practised eye. The deaths from VARIOLA, although not sufficiently numerous to be startling, were greatly in excess of those of the year previous54 as compared with 16-and tell a story of culpable neglect and criminal prejudice. In conclusion, your committee find it a grateful task to be able to call attention to the great improvement noticeable in the reports of the Board of Health of this city during the past two or three years. Instead of being chiefly devoted, as in former years, to proving the smallness of its expenditures in cleaning the streets of the city, they now contain a mass of valuable information, carefully analyzed and digested, with rigorous deductions from the statistical results so arrived at. In addition to the Alphabetical Mortuary Tables of the Registrar, which, complete and admirable as they are in their way, demand an immense amount of labor to glean from them any reliable data for discussion, we now find a complete Nosological Report in which the diseases are arranged according to groups and orders on a strictly scientific basis. The value of the last published report, that for 1874, has been freely recognized by medical reviewers abroad. For this marked elevation of the scientific tone and standard of the reports, the thanks of the society and of the city are due principally to its able and pains-taking secretary, Dr. William H. Ford, to whom, as to the registrar, Mr. Geo. H. Chambers, the Committee desire to express their acknowledgments for their courtesy in furnishing them. with material in advance of publication. BENJAMIN LEE, Chairman. J. R. WELLS, R. BURNS, L. TURNBULL. |