among the very fatal diseases, the number of persons attacked within the infected area is unusually great, and fatal or even severe cases are agonizing and terrible. It is therefore our duty to prevent, by every means in our power, any locality from becoming infected.

The sources of infection to this State are pointed out as follows: So careful is our present system of seaboard quarantine that in our latitude there is scarcely a possibility of the introduction of the disease through our ports. Especially is this true of the Delaware river, with its triple line of defences. The danger will be of the conveyance of the infection in the clothing or other effects of soldiers, especially if sent home from infected places by express or surreptitiously. Hence we may look for its appearance in some inland town, rather than in Philadelphia.

This prediction has been liberally fulfilled. Not a single case has passed the Delaware cordons. A very suspicious case, however, did make its appearance at Pekiomen Junction, Montgomery county, in the person of a member of Battery "C," recently returned from Ponce, Porto Rico. He was taken sick October 6, and died October 12. Dr. J. G. Shoemaker, county medical inspector to the State Board of Health, who was present at the autopsy, while venturing the opinion that the case may have been one of undeveloped typhoid fever, yet states that "most if not all the characteristic symptoms of the yellow fever were present excepting jaundice," that all the morbid anatomy of yellow fever was noted except in the liver, and acknowledges that the characteristic post-mortem lesions of typhoid were conspicuously absent. Whatever his theoretical views of the case, however, he took no chances. Precautions were taken during the progress of the case to prevent infection, the funeral was strictly private, and everything which had been used about the patient was burned. While the case occurred so late in the season that there was no reason to apprehend any considerable spread of the infection, yet the inspector's prompt and vigorous action cannot be too strongly commended.

It is the belief of your Secretary that this was a genuine case of yellow fever. The appearance of two cases more recently in the city of New York demonstrates the reality of the danger apprehended by the Board. One of these, as is well known, terminated the life of one of America's most prominent sanitary engineers, Col. George C. Waring, to whose skill we owe many important works of a sanitary nature in this State. But for the admirable choice of Montauk Point as a camp of detention for troops returning from Santiago and Porto Rico, by the authorities of the army and the United States Marine Hospital Service, and the strict quarantines observed, it can scarcely be doubted that, with the intense and protracted heat of the past season, an epidemic of formidable proportions would have occurred in our northern cities.

Leprosy.

Cases of this most loathsome of all infections still remain in this State, one at the Delaware County Almshouse, where it is carefully isolated; the other in the leper house of the city of Pittsburgh. Of the latter an interesting description has been published by Dr. W. T. English, of that city, which will be produced with illustrations in the appendix to this report. In strong contrast to the let-alone policy, which so many of our purely theoretical specialists advocate with regard to this disease, Dr. English closes his account of the case in the following words: "To-day leprosy is more promising of its harvest of death in America than at any previous point in its history. Statistics prove that our own countrymen have ceased to show the immunity from attacks of leprosy that they could once claim."

In all the above outbreaks of communicable diseases, the State Board, having been appealed to for assistance through the local boards, wherever such existed, and through its own inspectors where they did not exist, by advice in the former, and by direct exercise of its authority in the latter conditions, contributed largely toward the control of the contagion.

Pollution of Streams and Water Supplies.

Complaints of the pollution of streams and other water supplies have been received as follows:

Of Codorus creek, York county.

Of the water supply of New Brighton, Beaver county.

Of a well at Stanton's Mill, Somerset county.

Of a stream at Shippensburg, Cumberland county.

Of a stream at York Haven, Schuylkill county.

Of the water supply at Scranton, Lackawanna county.

Of Cowanesque river, at Nelson, Tioga county.

Of Cedar Creek, at Allentown, Lehigh county.

Of wells at Allentown, Lehigh county.

Of Harvey's Lake, Luzerne county.

Of the Schuylkill river near Norristown, Montgomery county.
Of a stream at Beck's run, Allegheny county.
Of a well at Hampton, Adams county.
Of a stream at Ambler, Montgomery county.
Of a stream at Falls Creek, Clearfield county.
Of a stream at Hollidaysburg, Blair county.
Of a well at Mount Union, Huntingdon county.

Of a stream at Reynoldsville, Jefferson county.

Of wells and springs at Brookville, Jefferson county.

Of a stream at Millvale, Allegheny county.

Of a pond at Lakeside, Susquehanna county.

INSPECTIONS.

Inspections have been made by the Secretary, of

The Schuylkill river and canal.

Hanover, York county, diphtheria.

Pocono Biological Laboratories at Swiftwater, Monroe county.

By Medical Inspectors, at

Milroy, Mifflin county, diphtheria.
Woodvale, Berks county, diphtheria.
Proctor, Lycoming county, anthrax.
Smith's Station, York county, diphtheria.
Nesquehoning, Carbon county, diphtheria.
Essington, Delaware county, diphtheria.
l'enllyn, Montgomery county, scarlet fever.
Hanover, York county, diphtheria.
Laporte, Sullivan county, anthrax.

York, York county, typhoid fever.

Philadelphia, Philadelphia county, typhoid fever.

Doylestown, Bucks county, bone-boiling.

Packerton, Carbon county, diphtheria.

New Brighton, Beaver county, polluted water supply.

Leiperville, Delaware county, diphtheria.

Wallingford, Delaware county, drainage.

Wayne township, Erie county, escape from quarantine.

Schuylkill river and canal, pollution of Philadelphia water supply. New Florence, Westmoreland county, insanitary conditions. Mohnsville, Berks county, bone-boiling.

York, York county, bone-boiling.

Allentown, Lehigh county, pollution of Cedar creek.

Antrim township, Franklin county, diphtheria.

Sharpsville, Allegheny county, proposed water supply.

Waynesboro, Franklin county, slaughter house.

Strode's Mill, Chester county, typhoid fever.

Nanticoke, Luzerne county, pollution of Harvey's Lake.
Hammersley Fork, Clinton county, typhoid fever.

Interstate Notification of Contagious Diseases.

Notification of the existence of contagious diseases has been given to and received from the secretaries of the boards of health and other states and provinces as follows:

Notifications Sent-Small-pox.

To all other State and provincial boards of health on eight occasions covering six outbreaks.

Notifications Received-Small-pox.

Indiana, on one occasion, covering one outbreak.
West Virginia, on two occasions, covering two outbreaks.
Illinois, on two occasions, covering two outbreaks.
South Carolina, on three occasions, covering six outbreaks.
Ontario, on three occasions, covering five outbreaks.
Montreal, on six occasions, covering four outbreaks.
North Carolina, on nine occasions, covering nine outbreaks.
New York, on three occasions, covering twelve outbreaks.
Michigan, on four occasions, covering four outbreaks.
Ohio, on seven occasions, covering fourteen outbreaks.
Wisconsin, on three occasions, covering three outbreaks.
Louisiana, on one occasion, covering one outbreak.
District of Columbia, on one occasion, covering one outbreak.

Boards of Health Established.

During the year ending November 1, 1898, boards of health have been established in Pennsylvania, in accordance with the act of May 11, 1893, as follows:

Target, Westmoreland county.

Clarksville (Clark P. O.), Mercer county.

Courtdale, Luzerne county.

Portland, Northampton county.

West Easton, Northampton county.

California, Washington county.

South Washington, Washington county.

Dunlo, Cambria county.

Mount Union, Huntingdon county.

Polk, Jefferson county.

Reports of Bureaus and Boards or Health.

Regular reports are received from the following named boards and

bureaus of health in the State, at the periods mentioned:

Philadelphia, weekly.

Pittsburgh, weekly.

Scranton, weekly.

Norristown, monthly.

Johnstown, monthly.

Williamsport, monthly.
Total, 6.

Appointments.

During the past year appointments have been made by the Board as follows:

County Medical Inspectors.

For Chester county, J. G. Shoemaker, M. D., vice Isaac Massey, M. D., deceased.

For Cameron county, E. O. Bardwell, M. D.

For Sullivan county, W. Pratt, M. D., Dushore.

For Warren county, W. M. Robertson, M. D., Warren.

For Venango county, J. P. Strayer, M. D., Oil City.

Deputy Inspectors.

Mr. Grant Dodds, Wilmerding, for the Wilmerding district, including the townships of North Versailles, Patton and Wilkins, in Allegheny county (subject to the orders of the Secretary).

Mr. Reed T. Lawson, Lawsonham; for the Lawsonham district, including the township of Madison, in Clarion county.

Dr. F. N. Irwin, Peale; for the Peale district, including the township of Cooper, in Clearfield county.

Dr. Ralph Lee Cooper (reappointed), Ogontz; for the Ogontz district, including the townships of Cheltenham and Abington, in Montgomery county.

Captain F. C. Flanegin, Butler; for the Butler district, including the townships of Adams, Centre, Clay, Clearfield, Concord, Jefferson, Mercer, Muddy Creek, Slippery Rock, Summit and Washington, in Butler county.

Dr. T. S. Lippincott, Hoppenville; for the Hoppenville district, including the townships of Marlsborough and Upper Hanover in Montgomery county, Rock Hill and Milford in Bucks county, and Lower Milford, in Lehigh county.

Mr. John B. Dunlevy, Darragh; for the Darragh district, including the township of Hempfield in Westmoreland county.

Dr. Jesse G. Shoemaker, Phoenixville; for the Phoenixville district, including the townships of Schuylkill, Charlestown, East and West Pikeland, East and West Vincent, East, South and North Coventry, in Chester county, and Upper and Lower Providence, in Montgomery county.

Dr. F. W. Winger, Bradford; for the Bradford district, including the townships of Bradford, Foster and Lafayette, in McKean county. Samuel Wallik, for the Codorus Creek district, including the banks of said creek and its tributaries, to their headquarters, York county. J. M. Cooley, M. D., Beachtree; for the Beachtree district, including the township of Washington, in Jefferson county.

3--19--98