The following table shows the day of the disease on which the cases were injected :

The following table shows the cases receiving two or more injections, the day the first injection was given, and the deaths:

ANNUAL REPORT

OF THE

PHYSICIAN-IN-CHARGE

OF THE

MUNICIPAL HOSPITAL

For the year 1897,

GENTLEMEN:-In accordance with custom and a rule of the hospital, I take pleasure in presenting the annual report for 1897, detailing the work performed during the year.

For several years past the number of admissions to the hospital has increased year after year, until it has now reached a proportion unparalleled in the history of the institution. In the years 1871-1872, when the great epidemic of small-pox prevailed, the admissions were greater than in any year before, or since that time, until the two years 1896-1897-during which the number of admissions so greatly increased as to attain pre-eminence. While the increase was very great in 1896 over previous years, it was far greater in 1897. It cannot be said that the increase is due to unusual prevalence of such infections diseases as are usually treated in the hospital, for, on the contrary, these diseases have been more prevalent in the city in previous year. I believe the increase is due, first, to a more rigid enforcement by the Board of Health of the Act of Assembly of 1895, which requires that all houses in which infectious diseases exist shall be placarded, or the patients removed to the hospital, by force, if necessary, when they cannot be properly cared for at their homes; and, secondly,

to the greater popularity of the hospital. It is now quite generally known in the city that the hospital is provided with competent resident physicians, and with an efficient corps of trained nurses, who constantly care for the patients from the time they are received into the ambulance to be conveyed to the hospital until they have recovered and are ready to be returned to their homes. In employing nurses great care is taken to ascertain their standing and general reputation, and only those are accepted who, besides being well recommended, have received their diplomas from a reputable training school. I do not believe that a more comptent corps of nurses can be found in any hospital here or elsewhere. A number of those on duty at present have served for several years, and consequently have become quite skilled in the management of patients suffering from infectious diseases.

It is due the institution to say that the present resident physicians (only two in number) have served for nearly three years, by which long and constant service they have acquired not only much valuable experience in the treatment of infectious diseases, but have become remarkably skillful in the operation known as intubation for the relief of membraneous croup. A resident physician and a trained nurse invariably go with the ambulance when a call is made for a patient, and if the case be one of membraneous croup with very difficult breathing, the physician, with the assistance of the nurse, immediately performs intubation at the residence, after which the patient is carried to the ambulance by the nurse and conveyed to the hospital with much less suffering than if the operation had not been performed. This operation has even been performed in the ambulance on its way to the hospital in order to save the life of the child:

In answering an ambulance call it not infrequently happens on reaching the house the resident physician discovers

that the case, though reported as diphtheria, is actually scarlet fever; in such case the ambulance returns to the hospital empty, and another ambulance, physician and nurse are sent for the patient. The hospital is provided with three ambulances with modern improvements: one is used for conveying diphtheria patients, another scarlet fever patients, and the third small-pox, when that disease prevails. Fortunately, no case of the latter disease has been admitted to the hospital for over two years. The last case was received in the latter part of October, 1895; since that time, it is worthy of remark, the city has been wholly exempt from small-pox. No like period of exemption from that dread diseases can be found in the records of the Health Department of Philadelphia; and this speaks volumes for the service of sanitary workers.

The diseases diphtheria and scarlet fever have, for several years past, been responsible for the vast majority of the admissions to the hospital; and this is true notwithstanding the fact that these diseases have not prevailed in the city in epidemic form. As already stated, the increase of admissions has steadily progressed year after year. This may be seen by the following table, which shows the number of patients admitted annually since 1890:

The following table shows the number of patients remaining in the hospital January 1, 1897, the number admitted during the year, the total number treated during the year, the number discharged cured, the number that. died, and the number remaining under treatment December 31st, 1897:

NOTE. Twelve (12) of the deaths recorded in this table occurred among the two hundred and eighteen (218) patients remaining over from the year 1896.

Out of the twelve hundred and fifty (1,250) patients admitted in the year 1896, two hundred and eighteen (218), as the table shows, remained over into 1897. Adding this number (218) to the number admitted during the year (2,179), gives the total number treated in the hospital in 1897, which amounts to two thousand three hundred and seventy-nine (2,379). When small-pox prevailed in the years 1871-1872, one hundred and eighty-seven (187) cases remained over from the former year into the beginning of the latter, and as the admissions in the latter year amounted to twelve hundred and nine (1,209), it shows that the total number treated in 1872 was one thousand four hundred and sixty-nine (1,469). This was the largest number of patients ever treated in the hospital in any single year, before or since, until 1897, when, as just stated, it reached 2,379, which is 910 patients in excess of the next highest annual number. The year 1897 has therefore acquired considerable pre-eminence as to the number of admissions, over any previous year in the history of the institution.

The following table shows the number of admissions and deaths during each month of the year: