in whose district the death occurred is notified; then it becomes his duty to visit the particular locality, to inspect the sanitary conditions of the surroundings, to put in force all necessary precautions so far as preventing the spread of contagion is concerned, and more especially, in case of typhoid fever, to look after infection sources, as, for instance, the water or milk supply. It early became apparent that both the water and milk supplies were potent factors in spreading infection. In both these articles the chemical and bacteriological researches of the DEPARTMENT were very thorough. Traders were given to understand that the legal standard must be maintained, and public and private warnings were sent out at such times when the examinations of the drinking water showed it not to be safe for internal use. Each Inspector is supplied with printed pamphlets prepared by the ASSISTANT COMMISSIONER concerning the restriction and prevention of consumption and other preventable diseases, the care of infants and young children in hot weather, etc. These are gratuitously distributed, and have become very popular, as evidenced by the fact that numerous requests have been made for supplies of copies.

The third subdivision of the work of the Staff of Medical Inspectors is the examination of areas and sections of the city in which the death rate has been found too high, to examine into the cause or causes thereof, to make house-tohouse canvasses, and to abate or correct, as far as practicable, all unsanitary conditions. An example of this work is to be noted in connection with the 33rd and 34th wards in the southeast section of the city. On examining the state of affairs, it was found that large numbers of poor people had settled in localities near the seat of their employment, and that the houses were built on stilts. There were in many places no sewers, or where the sewer pipes had been put in a connection between the water-closets and the sewer had

not been established. and there, and the hygienic environments were the worst possible. So urgent was the state of affairs that the Department of Public Works was called upon for aid. and immediately prompt measures were enforced with the result that in about two months a sanitary revolution was effected. Drainage was accomplished by establishing connections between the pools of stagnant water and the city sewer system; lime was freely scattered around in the places where the pools had been, and also in the gutters. Wherever sewers had been built, the privy-vaults were abolished and water closets were ordered put in houses, and then connected with the drain pipes in the street, so that the flushings of the privy vaults could be properly removed, instead of as formerly permitted to flow into the streets. A complete census was taken, and diagrams made of each house, and the surrounding out-houses, and full information obtained including the names of owners and tenants of houses. Considering the enormous number of abatements secured by us, and the necessary extra expenses forced upon the small land and home owners, the number of law suits that have accrued is astonishingly small. Explaining that our services were being rendered in the interest of all concerned, that our intention primarily was the saving of life, we gained the confidence and active co-operation of the populace.

There were foul pools of water here

During the past year family physicians have been allowed, under certain conditions, to be responsible for contagious diseases, delegating to them the authority to decide whether or not the houses shall be placarded. This has undoubtedly brought the DEPARTMENT into closer touch with the practitioners, and has caused them to more freely report their cases. During the past year the total number of cases reported, while markedly less than the previous year, does not sufficiently reflect the great amount of prophylactic work

done by the DEPARTMENT unless we consider this point: that, relative to the total number of cases occurring, the proportion reported was greater than ever before; and considering the number of cases, the low mortality, especially of diphtheria, reflects great credit upon the prevention endeavors of the BOARD OF HEALTH.

The fourth subdivision of the work allotted to the Medical Inspector's Staff, consists of duties in connection with the occurrence of cases of infectious or contagious diseases among school children, or those who might be liable to spread contagion. The mode of operation is as follows: Each day as reports come in from different medical practitioners in the city, lists are sent out according to topographical subdivisions to the Medical Inspectors. A Medical Inspector at once visits the house in which a case has occurred, and obtains the name of the sick child, the school it attended (if any), the. number of children in the house and the schools they attend. If the case has been reported by a physician the Medical Inspector does nothing further than has been outlined. Should, however, the child belong to a poor family, where proper care cannot be had, it becomes the Inspector's duty to attend the patient, or to see that proper medical aid, nursing, food and medicines are furnished. He then visits the principal of the school in which the child had been a pupil and leaves with him a printed card of notification as to the disease, the name of the suffering child and its address. On receiving such notification, the principal is required, on a card furnished for that purpose, to inform the contagiousdisease clerk of the HEALTH DEPARTMENT, that he has been notified as to the condition in question. When the Division of Contagious Diseases receives from any physician a report of a contagious or infectious case, the clerk forwards. to this physician's address a "reply" postal card. This when returned serves as notice that the case has terminated.

A postal card is then mailed to the principals of the schools, both public and parochial, in the vicinity of which the case had been found, informing them that the case has terminated, that the premises have been disinfected, and that all members of the family, including the school children, if any, are relieved from further restriction. These precautions are not only enforced when the disease has attacked a pupil or its family, but also when a case has been discovered in the vicinity or neighborhood of a school. If a case is found in a pupil, or in a family to which the pupil belonged, the school itself is visited and examined by a Medical Inspector who also looks into the health of the pupils in the room in which the sick child had last been enrolled, and inquires as to whether any other pupils have shown signs of illness. The general sanitary condition and surroundings of the school and of the house in which the patient lives are also given attention. Each Saturday morning, the Medical Inspectors meet the Chief Medical Inspector in the City Hall and submit reports to him of the entire sanitary work done during the week, which reports are summarized and forwarded to the ASSISTANT COMMISSIONER OF HEALTH.

One of the most valuable and important aims of a Municipal Health Department is prophylaxis. It is a well known adage that an ounce of prevention is worth a pound of cure, and I cannot think of any service ever rendered to the city by the DEPARTMENT OF HEALTH that has had such beneficial effect as the notices that have been given to the daily press warning the citizens of Chicago of the condition of the drinking water. It is a well-accepted fact in connection with disease etiology, that very many pathogenic micro-organisms can be transmitted by drinking water, and at times when the state of the lake water rendered it unfit for consumption, the alarm has been sounded and the people notified to take such steps as might be considered best to purify the water.

Your

I need only mention the destruction of the contagionsoaked old smallpox hospital, which had long survived its usefulness, and the completion of the new Isolation Hospital, one of the most perfect of its kind in the world. retention of the good Sisters in charge of the Hospital was a recognition of the efficiency of their services, their heroism and faithfulness in the past, and a guarantee of the care which will be given to all patients sent to the institution.

In conclusion, I submit to you certain statistical information which appears in the appendices hereunto attached, and also append copies of circulars, letters of instruction, etc.

Very respectfully,

ERASMUS GARROTT, M. D.,

751 WASHINGTON BOULEVARD.

Chief Medical Inspector.