which fewer inspectors were employed, but they were requird to do much more than make a routine call at a school for fifteen minutes a day, and so were put on the same basis as medical inspectors, thereby becoming available not only for school duty, but for any emergency duty required by the Department. To each was assigned a school which he was required to visit before 10 A. M. each school day. Beside the daily examination of pupils suspected of having contagious disease, they were ordered to examine, at stated intervals, generally from a week to ten days, every child in the school, taking cognizance not only with regard to the ordinary contagious diseases, such as measles, scarlet fever, whooping-cough and the like, but also any affections of the eyes, nose, throat or skin, excluding any pupils whose condition warranted the belief that its presence in a class-room might result in transmitting contagion of any kind to other children. With the co-operation of the Board of Education, this system has resulted in a very decided diminution of the number of cases of contagious disease common to children of school age. The system as thus outlined has been considered with interest by the health officers of other cities and adopted with certain modifications by several of them.

Following are some statistics of the work performed by Medical School Inspectors:

Rigid inspection of the eyes of school children, undertaken at the suggestion of Richard H. Derby, M. D., a member of the Medical Advisory Board of this Department, disclosed the fact that trachoma had been for several years largely on the increase, especially among children of the East Side. When children were excluded for this cause they sought treatment from private practitioners or in dispensaries in order that they might be allowed to return to school as soon as possible. The dispensaries, however, appeared to be unable to handle all the cases which came to them without securing extra grants from the City for that purpose.

With a view to relieving them of this undue pressure, and of

securing early treatment for children excluded from school, an eye hospital and clinic were established in the autumn of 1902, with the assistance of the trustees of Bellevue and Allied Hospitals, in one of the old Gouverneur Hospital buildings, and in this, under the charge of physicians of this Department, treatment has since proceeded at the rate of about 15,000 cases per month. A detailed report of this ophthalmological work and of plans for its extension will be found appended.

SCHOOL NURSES.

With the increase of exclusions from school as a result of more rigid examination by the Medical School Inspectors, it was seen that in many cases children excluded were not securing prompt and satisfactory treatmentthe result either of ignorance or inability on the part of the parents. A nurse was accordingly employed to follow up the excluded children after they had been absent unduly long and to treat them or see that they secured treatment in minor cases, notably of eye disease and pediculosis. The operations of this nurse proved to be so successful that additional ones were appointed, and their work has now developed into a nursing corps of fair size, which, in the opinion of this Board, should be extended until every school in the tenement districts has a nurse attendant upon it. This work has met with marked favor from the Department of Education and, latterly, from the parents of the children who come under treatment.

CONTAGIOUS DISEASE HOSPITALS.

The condition of the City's contagious disease hospitals at the beginning of the year 1902 was found to be such that immediate and radical measures were necessary to bring the plant up to any state of efficiency. The hospitals were utterly inadequate to supply the City's needs. Many of the buildings in use were sadly out of repair, without adequate toilet and sanitary facilities; in fact, almost entirely unsuited for the work. It is difficult to see how physicians who were cognizant of these conditions could have failed to arouse public opinion and demand immediate improvement.

Passing by matters of faulty administration, nursing and supplies, remedies for which were quickly found, the fact remained that the aggregate of hospital accommodations was miserably deficient, most continental cities, for example, being able to accommodate in their contagious disease hospitals from two to four times the number of persons per unit of population that New York could accommodate. Application was immediately made to the Board of Estimate and Apportionment for an appropriation for new con

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struction and repairs, and $500,000 was thus obtained, of which $75,000 was for repairs to existing plant. With this appropriation Riverside and Kingston Avenue Hospitals were repaired and fitted with proper sanitary accommodations, the steamboat Franklin Edson" was rebuilt, and the chief new construction work of the year, a six-story pavilion for scarlet fever patients, was begun on the Willard Parker Hospital grounds at the foot of East Sixteenth street. This new pavilion will hold 250 patients and will cost from $375,000 to $400,000. The work is in charge of W. Wheeler Smith, Esq., a specialist in hospital architecture, who has embodied in the building what are believed to be the best and most modern ideas upon the subject. With this fine building under way, and existing buildings put into thorough repair, a good beginning has been made in the work of reconstructing and enlarging the City's contagious disease hospital facilities.

It is the settled belief of the present Board of Health that each borough should have its own contagious disease hospital plant. Many American cities having far less population than our smaller boroughs are, nevertheless, far better prepared to treat contagious disease. To remedy this defect the Board has taken steps to acquire land in Queens and Richmond boroughs for the erection there not only of isolation hospitals, but of ambulance stations and disinfecting plants. The practice of carrying contagious disease patients from outlying portions of Queens and Richmond boroughs to North Brother Island has been little short of barbarous.

SANITARY WORK.

For some time prior to January, 1902, the sanitary inspection work of the Department had been in charge of the Division of Inspections, while the Division of Offensive Trades and Food Inspection was separately administered. It was deemed wise to consolidate these three divisions under one head, both in Manhattan and Brooklyn. This obviated any confusion which might arise in inspections as to the proper assignment of complaints to the sanitary or to the Offensive Trades Division, and also permitted the division. of the larger boroughs into districts, each in charge of a Sanitary Inspector, whereas formerly they had been an inspector of each of these divisions in a district. An efficient Sanitary Inspector is capable of attending not only to sanitary complaints, but to interest himself and gain experience in such questions as the conditions surrounding the storage and sale of food products and the like, thus broadening the field and increasing the scope of the individual inspector's work and his understanding of general questions. Up to September 1, 1902, the work of the Tenement House Department was carried on by this Department, and as the Department force had been very decidedly

reduced in January, 1902 (15% of the 1,000 employees having been dropped in order to keep within the salary fund), the Division of Inspections was severely tried in attempting to handle the Tenement House Department and general inspection work at the same time. Its efficiency, however, had been much increased by the consolidation of divisions, so that the Department was able to handle quickly and effectively all sanitary matters brought to its attention.

The work of the Division of Inspections may be classified in more important items as follows:

One of the main causes of failure in efficiency in this Department has been that mere issuing and filing of orders for the improvement of sanitary conditions, the abating of nuisances and the stoppage of the sale of adulterated milk and food products has been regarded as sufficient performance of its duty by the Department. Efficient co-operation upon the part of the Law Department is necessary in many cases in order to secure any remedial action. It is gratifying, therefore, to be able to report the highly efficient work done by the officers of the Bureau of Penalties attached to the office of the Corporation Counsel. Evidence of this efficiency may be

gained from the following table showing the amount of fines imposed by the Courts of Special Sessions and City Magistrates upon conviction:

It was the view of your Board that the Health Department's effi ciency should not be measured merely by the manner in which it handled citizens' complaints, but that in order properly to supervise the health of the city it should examine particularly into the sanitary conditions of all premises where a large number of people are wont to congregate. To that end special attention was given to the condition of lodging-houses, public markets, police stations, churches and theatres; the result being a large number of orders which were carried through and resulted in remedial action. The number of lodging-houses in this city is not unusually large, but the lodging-house population of Manhattan Borough alone is estimated to exceed 17,000 persons, or an average of 172 for each lodging-house. Their population is a floating one whose mode of living. has led to careless habits, so that considerable inspection work was needed to bring the tenants and proprietors to a proper comprehension of the standard of living demanded of them by the officers of this Department. Violations of the law as to overcrowding were also corrected.

Action was taken by the Department looking to the improvement in sanitary conditions in public markets, and when the results of inspections were obtained the Board notified the Borough President and Comptroller that these markets must either be repaired or closed. Most of the buildings had been erected in a time when little attention was paid to sanitary requirements, and their drainage systems were in most cases extremely unsanitary. Drainage from ice-boxes, fish-stands and floors were discharged into drains through untrapped waste pipes, so that the food