from all causes of women of childbearing age, namely women from 15 to 45 years old. In the second decennial period there were ninety-seven deaths, and in the last period seventy-three deaths. The rate based on the number of confinements shows about the same rate of decline. In the three periods, for every 1000 confinements the rate was 7.6, 5.5, and 4.1 respectively. These figures show indeed a decline, and so far are encouraging. The decline corresponds in time to the spread of the teachings of Lister, and is no doubt due to the excellent teaching of asepsis and antisepsis in our medical schools. The fact remains, however, that the mortality rate from puerperal infection is still very much too high, and indeed has increased during the last four years. In 1891 it was 62 per 1,000 deaths of women of childbearing age, in 1892 it was 60 per cent., in 1893 65 per cent., in 1894 71 per cent., and in 1895, 69 per cent. In other words, puerperal infection still kills more women in the prime of life, women of the greatest worth to their families and to the State, than any other cause except consumption.

Who is responsible for this large continuing mortality, physicians or midwives? While it is impossible to answer this question from the imperfect records of the Registrar's office, it seems very certain that the improvement for the last decades is due to the better training of medical students, and that the bad results of the last few years are largely due to midwife practice, which has not made corresponding advance.

Hence I claim justification in presenting to this Staff the subject announced on the program. The scope of our duties is yet to a certain extent indefinite and will be left to natural development. We are called on by midwives to treat childbed fever. Is it not reasonable that we should try to prevent its development? I look forward to the growth of our organization in such a way that each member of the Štaff shall have practical charge of the midwives in his district. Like the commander of a company in an army, he shall inspect the records and outfits of the members of his division, and he shall come to feel so far responsible for the practice in his district that he will try to keep the mortality and morbidity records as low as possible. This is the condition in some of the German provinces where the best obstetric results are obtained. It is impossible for us at present to exercise such control. As Dr. REILLY pointed out at the last meeting, it is important that we go slowly at first in order not to wreck the movement at the start by over-zeal. The first thing to do is to secure a complete registration of midwives. So long as a certain number defy the authority of

the City Board and the State Board of Health they would defy us and we would accomplish nothing. It will probably take some weeks or months longer to bring the defiant midwives to terms or to revoke their licenses to practice, and until then we must confine our efforts to advice to those who

call on us. Yet, in this way we can, if we will, accomplish very much of value, and for this reason, it seems to me timely that we begin to study the mistakes and failures of midwives and consider the means to correct and prevent them.*

* The remainder of Dr. BACON's address, which is published in full in the Journal of the American Medical Association, Vol. XXVIII, No. 6, deals with the subject-matter in the title: "Failures of Midwives in Asepsis."

Reports and Recommendations of the Chief of Bureau of Sanitary

Inspection for the Years 1895-6.

HON. WILLIAM R. KERR,

Commissioner of Health:

He

DEAR SIR: The citizen who makes a complaint of the unsanitary condition, either at his house or in his immediate neighborhood, demands prompt attention at our hands. is aware of the fact that provision is made for an inspector for each Ward, and acting on this knowledge he can see no reason why action on his complaint is not prompt and effective. He is not aware of the fact that of the thirty-four inspectors provided for sanitary work and charged on the rolls to the sanitary division of the DEPARTMENT—

Six are detailed as smoke inspectors;

One as milk inspector;

One as clerk to Registrar of Vital Statistics;

Two as clerks in office;.

Twelve tenement inspectors, two in office;

Twelve plumbing inspectors, one in office;

That

leaving ten sanitary inspectors for the entire city. the immense amount of work enumerated herein has been accomplished by this small and inadequate force bears testimony to efficient direction and untiring, faithful work on the part of the inspectors.

For the past two years increased demands have been made upon this Bureau by reason of new methods inaugurated in the DEPARTMENT called for inspection of premises where contagious diseases are located, and the enforcement of the ordinance so as to bring about proper sanitary conditions in such localities. This work emphasizes the

necessity of an increase of the force in the direction of inspection. There should be a tenement inspector for each ward exclusive of the fifteen plumbers, and four clerks for office work, and a stenographer. This would enable us to make what has been too long neglected-a periodical houseto-house inspection enabling us to forestall the unsanitary conditions in any part of the city.

The entire force deserves commendation for the amount of work accomplished. The lady inspectors particularly in regard to the inspection of workshops and the improvements effected by and through their efforts.

Some provision should be made in regard to cheap car rates for the force. It is too great a burden to exact from their salary.

An ordinance passed in 1895 provided for the examination of all men engaged in the business of plumbing, Chief Inspector being made Examiner. These examinations, the questions asked and answers given should have been a matter of record. This could not be done in the absence of a stenographer, no provision whatever being made in the ordinance for such. I therefore urge in order that the work of this Bureau may be successfully carried out that a stenographer be provided for the coming year.

Notwithstanding the good work accomplished I must confess that much remains undone by reason of the inadequacy of the force and the vast territory to be covered. The majority of complaints entered at this office come from the best parts of the city and from the better class of our citizens. There are homes and surroundings in good and wholesome condition whose owners are quick to resent the shortcoming of their neighbors, and demand, and justly so, that the ordinances be rigidly enforced upon others in the vicinity. Unfortunately the poorer quarters of our city, by reason of the inadequacy of our force, do not receive that

attention so much needed. Here is where our best efforts should be concentrated among those whose ignorance and indifference to sanitary surroundings are a constant menace to the entire community. These conditions could be improved by frequent inspection and conversations with them. I would suggest that inspectors with a knowledge of their customs, habits and language should be placed in charge and held responsible for the sanitary conditions of such localities. This would be of great benefit during epidemics of disease and enable our medical force, by reason of our thorough knowledge of existing conditions, to apply the proper remedies without loss of time, making the work in such directions doubly effective.

The inspection of new buildings as to plumbing and drainage has been productive of the best results. Our citizens building homes fully appreciate the benefits accruing to them through the thorough methods of this DEPARTMENT in this most important adjunct of a healthy home. I am pleased to say that the health and comfort of the occupants of the county building have been subserved through our efforts, the plumbing and drainage having been remodeled and placed in good sanitary condition. Our theaters, public halls, schools, etc., are being inspected and their sanitary condition noted, while necessary improvements are ordered wherever necessary. One of the greatest improvements of the year in connection with the DEPARTMENT was the order requiring the inspectors to wear the uniform prescribed and adopted for the DEPARTMENT. It has enhanced the value of the officer in the eyes of those he comes in contact with in the performance of his duties, while the officer, knowing the good name of the DEPARTMENT is in his keeping, has been careful as to his conduct and appearance in the discharge of his duties.

In the event of an increase of the inspection force so as to permanently place an inspector in each ward, I would