"The Board will throw every necessary sanitary safeguard around those communicable diseases now reportable to the health authorities. It will also endeavor to limit the spread of tuberculosis, a disease which destroys annually over a thousand lives, furnishing nearly one-sixth of the total mortality. This the Board hopes to accomplish, in noticeable measure, by a thorough campaign of education of the masses regarding the communicability of the disease and the easier methods of prevention; by the ready assistance of the medical profession, which has generally awakened to the importance of the subject and can materially help in more ways than one, and by the stricter enforcement of those laws and ordinances calculated to diminish the dissemination of germs generally.

"The Board wishes to announce in no uncertain tone its unqualified belief in the importance and propriety of early reporting and early announcing first cases of quarantinable diseases. Upon such information and action depends the success of measures looking to the rapid control of infection. The Board realizes in this connection that it will be crippled in its best efforts if it lacks the support and co-operation of the medical profession, and with a view to secure such co-operation and assistance and in order that even the most timid may not be deterred from doing their duty, the Board, while favoring a policy of absolute non-secrecy, would gladly welcome and favor any concerted plan of action whereby conscientious physicians reporting early doubtful cases of fever in their practice could be shielded from that uncharitable and at times decidedly injurious criticism which so often follows the heralding of their names in the public press. The announcement of the two essential facts, the existence of a suspicious case and the final verdict or diagnosis upon investigation, is all-sufficient and should satisfy all but the morbidly curious.

"The Board affirms its belief in the mosquito doctrine of yellowfever transmission, and will continue to operate those preventive measures calculated to stay the rapid breeding and multiplication of the insect in the city. This will include oiling of cisterns in case of drought.

"Not only will the Board endeavor to discharge, in a commende manner, those duties specifically imposed upon it by law, but erever a doubt may exist as to whose duty it is to enforce a sanitary statute or ordinance, it shall assume this to be part of its alfunctions. The proper care and disposition of lepers may an instance.

"Nothing will be neglected, nothing considered too arduous or too menial, which may result in public good, in the reduction of the mortality rate, or in bringing about those conditions which tend to enhance the average of life-expectancy.

"The Board will freely avail itself of its general supervisory and advisory authority in all matters liable to affect the public health, making such recommendations or interposing such objections as may be deemed advantageous or conducive to public safety.

"In the discharge of their duties the executive officers of the Board will endeavor to be firm without being harsh, or conciliatory without being remiss, as the occasion may require, with the one object in view, at all times, of the most good to the greatest number.

"The Board looks for and confidently hopes to win and enlist the ready co-operation of those whom it must constantly strive to benefit, the people, and for proper financial support by the constituted representatives of the people-the Mayor and City Council."

It was found advisable from time to time to modify and rearrange the service in the several departments of the Board. The present lines of organization show under the appropriate heads.

In the main the changes effected consisted in the employment of larger and adequate forces in the sanitary and food inspection departments, commensurate with the needs of these services; in the imposition of specific, instead of fluctuating duties, with direct responsibility for correct performance; in the institution of tenement-house inspection; in the creation of a special dairy inspection service; in making provision for the better surveillance of public and private. markets, bakeries, confectioneries, groceries, etc., and the collection. of milk samples on a larger scale; and in the remodeling and reorganization of the special anti-mosquito service, changing the working system of this department in its entirety.

The Board has three departments-Vital Statistics, Food Inspection, and Sanitary. It employs a chemist and a bacteriologist, who have the use of the well-equipped laboratories of Tulane University. Each employs an assistant, and a clerk and messenger.

A special fund for anti-mosquito work is provided by the City.

SANITARY DEPARTMENT.

Aside from the medical officers in the employ of the Board, this service consists of a superintendent, a general clerk, a permit. clerk, a notice clerk, a tabulation clerk, ten house-to-house inspectors (delegated on anti-mosquito work while this lasts), four tenementhouse inspectors, two laundry inspectors, two inspectors for the sulveillance of the nuisance-boats, two on carding houses and getting histories of communicable diseases, two on investigations of complaints, four disinfectors, one general utility man (in office), one in charge of chemicals and apparatus, ladders, oil, etc., at the warehouse.

Guards and extra fumigators and vaccinators are employed as needed.

Two police officers are permanently detailed by the city to assist the board in its sanitary work.

TUBERCULOSIS.

On May 14, 1907, tuberculosis was included in the list of diseases to be reported to the Board of Health. The fact was given much publicity in the daily press, and a number of physicians began to report cases in their practice.

Official promulgation of the ordinance was made on June 4, at which time it was thought physicians would be prepared to fully conform with the new regulation.

On July 10, in view of the small number of reports coming to the office, the following circular-letter was issued to the medical. profession:

WILLIAM T. O'REILLY, M. D.,

Chairman and Health Officer.

OFFICE OF

SIDNEY L. THE ARD,

Secretary.

BOARD OF HEALTH OF THE CITY OF NEW ORLEANS,

CORA BUILDING, COMMON STREET AND VARIETIES ALLEY.

Dear Doctor:

July 10th, 1907.

Two months ago this board by resolution included tuberculosis in the list of diseases to be reported to the health authorities. This fact was much commented upon in the public press and the resolution itself promulgated in the official organ of the city, and it is hardly probable that any physician is ignorant to-day of the board's action and attitude in the matter.

The medical profession has been slow to respond, however, and, fearing that some misapprehension may exist as to the exact scope and purpose of the resolution, this circular letter is being sent to the physicians of this city.

Aside from statistical purposes, the board has no intent other that to practice disinfection in such cases at the proper time (as often as may be required or indicated), and to supply the household with educational literature of a character agreeable and acceptable to the medical attendant. Surely there can be nothing objectionable in this, but rather much that is commendable.

The public and the medical profession have clamored for some action by the health authorities tending to stay the progress of tuberculosis. We take it that there is a sentiment back of these utterances that they are not mere empty words, and we look to the medical pro. fession for support and encouragement.

We must begin somewhere, doctor, and the proper beginning, to our mind, is to establish the tubercular status, as it were, of the city, which can only be effected by a full and complete report of the cases of tuberculosis under medical care.

In this connection, we beg to inform you that, beginning July 15, the confidential relations formerly existing between the bacteriologist of the Board of Health and the medical attendant in suspected cases of tuberculosis will no longer obtain, and that duplicate reports will be sent to the sanitary department of the Board of Health for recordation and attention.

We know the influence which the medical attendant wields in the household. We know that Board of Health measures succeed or fail according to the amount of support which they receive from the profession.

We can not believe that, by its silence or apathy and the withholding of information now reportable, the profession will cripple the health service, at the very outset, in its best efforts in this new and most important field of activity.

We appeal to you, doctor, to report your cases without delay.

Respectfully,

W. T. O'REILLY, M. D.,

Chairman Board of Health
& Health Officer, City of N. O.

This direct appeal to the profession was productive of results. On August 20, however, it was found necessary to bring a recalcitrant to trial, a conviction being readily secured in the lower court, from which no appeal was taken.

A review and analysis of the facts and figures before us to-day, after seven months' experience with tuberculosis as a reportable disease, leads to the conclusion that all, save incipient, cases are being reported to the health office. There has apparently been no effort. to conceal the true cause of death, for the number of fatalities reported in 1907 is no smaller than for preceding years.

The attitude of the medical profession in the matter augurs well for the future.

YELLOW FEVER.

There is no yellow fever or yellow fever scare to report for the two years just ended.

An undoubted case of dengue from Texas was reported and investigated in the summer of 1907 and proper sanitary measures instituted, no secondary cases following.

LEPROSY.

Cases coming to the attention of the Board were promptly sent to the Leper Home in Iberville Parish.

In November, 1906, the Board prosecuted a physician for failure to report a case of the disease in his practice, a conviction being secured.

DIPHTHERIA AND SCARLATINA.

Our freedom from the severe types of these two diseases so prevalent in the East and West during the past two years is cause for gratification.

Diphtheria and scarlatina are endemic in New Orleans, as in all large cities, but never prevail to any marked extent, and the fatalities are few. The average number of deaths from diphtheria per year, for the past decade, has been thirty-six, and from scarlet fever thirteen-figures frequently reached in a week or in a day by other large cities.

TYPHOID FEVER.

Typhoid fever is reported to the Board of Health since August, 1901. The number of cases and of deaths since that time show in the following statement: