Published weekly by the Department of Health, City of New York, 189 Centre St., New York, N. Y. Entered as Second-Class matter October 16, 1917, at the Postoffice at New York, N. Y. Under Act of March 3, 1879. Subscription, 10 cents per annum. APRIL 20, 1918. No. 16 NEW SERIES, VOL. VII. ENFORCEMENT OF THE SANITARY CODE. One of the great achievements of the Citizens Committee, whose investigations established the present organization of the Department of Health in 1866, was the delegation to the Board of Health by the Legislature, of power to enact and enforce a sanitary code. It is safe to say that very few, except those in direct contact with the Health Department's activities realize how important a part the sanitary code plays in public health administration in the city. A brief summary of the work of enforcing the provisions of the Sanitary Code may, therefore, be of interest. In its present form the code consists of 18 Articles, each subdivided into sections, all the sections being designated numerically and numbering about 350. The scope of the laws embodied in the code is well shown by the following list of titles of the eighteen articles: Article 1. Definitions.. Article 2. Animals. Article 11. Midwifery; care of children. Article 3. Births, marriages and deaths. Article 13. Offensive materials. Article 4. Buildings. Article 5. Medical examiners. Article 7. Diseases. Article 8. Drugs and medicines. Article 14. Plumbing, drainage, and sewerage. Article 15. Passenger cars. Article 16. Street conditions. Article 18. Vessels and seamen. During the year 1917 over 12,641 court prosecutions were conducted by representatives of the Department of Health for violations of the Sanitary Code. That they were justified is indicated by the fact that of this large number only 363 were acquitted by the court. To handle this large number of cases the Department of Health has a legal division which consists of a counsellor, one junior law clerk, two other clerks and two stenographers. It may be objected that most of the cases prosecuted represent merely minor violations of law and were prosecuted by inspectors and sanitary police of the Department of Health without imposing any burden whatever on the legal division. As a matter of fact, however, after deducting all the cases of minor violations, there were still left 3137 cases whose preparation for prosecution demanded careful attention at the hands of the legal division. AY Of the 9504 minor prosecutions the larger number were for violation of the law against spitting in public places, the exposure to dust and dirt of foodstuffs and the muzzling of dogs. Of the 3137 more important prosecutions, 2975 were conducted in the Municipal Term of the Magistrates Court. These were largely cases involving the sale of unwholesome, deleterious, adulterated or misbranded food, including milk, meats, fish, vegetables, eggs and beverages. These, together with prosecutions of nuisances such as discharge of dense smoke, noxious gases and vapors into the air, violations of sanitary regulations in factories, prosecutions for dirty milk cans and other food receptacles, and for conducting offensive trades in violation of the law, constituted the bulk of the cases prosecuted in these courts. Finally 162 cases were prosecuted in the Courts of Special Sessions, the defendant exercising his privilege to be tried before three justices. Of these cases only 17 were acquitted. Of the defendants found guilty, eighteen were sentenced to jail, and those fined were required to pay an average fine of over $100. In addition to the criminal prosecutions already mentioned, the Department of Health institutes civil actions to impose a penalty on those who have failed to comply with the provisions of the Sanitary Code. Among such cases may be mentioned actions against physicians for failure to report births, deaths or cases of infectious diseases; against midwives for failure to report births or to comply with the rules and regulations governing the practice of midwives; against undertakers, and cemetery keepers for non-compliance with regulations regarding the disposal of the dead. Before any legal action, criminal or civil, is instituted by the Department of Health against an alleged offender, the facts and circumstances surrounding each particular case are carefully reviewed both by the administrative officers of the bureau involved and by the legal division to the end that unnecessary recourse to the courts is avoided and that the alleged offender receives the benefit of any doubt as to his guilt. The volume of legal business as above outlined, large as it is, gives only a faint reflection of the vast amount of work being done in the Department of Health, especially by the bureaus dealing with sanitary matters, food and drugs, records, child hygiene and preventable diseases. It serves to explain, however, why, in general, the people in this city regard health regulations seriously-they realize that the Department of Health enforces these laws. OLEOMARGARINE IN PUBLIC INSTITUTIONS. In a letter to the City's legislative representative at Albany, the Commissioner of Health advocates the passage of a bill now before the legislature removing the restrictions which now prohibit the use of oleomargarine in institutions maintained wholly or in part by public moneys. "The Department of Health wishes to express its approval of the proposed measure on the ground that the excessive price which the City of New York has to pay for butter places an undue burden upon the taxpayers by prohibiting the City authorities from purchasing a wholesome and nutritious substitute therefor. "The repeal of the prohibition against purchasing butterine and oleomargarine will vest discretionary power in the officials in charge of institutions to determine whether or not it would be advisable to supply the inmates of public institutions with butter or a wholesome, nutritious substitute. Public officials should have such discretionary power and the repeal of the present law would accrue to the benefit of the taxpayers without detriment to inmates of public institutions." THE SANITARY DANGERS FROM DOMESTIC PETS. A report on an epidemic of virulent smallpox in one of the southwestern states, submitted to the Surgeon General of the Public Health Service by one of the officers of that corps, sets forth with renewed emphasis the role that domestic pets may play in the transmission of disease, especially among children. The instance cited was that of a fatal case of smallpox in an infant in arms. The nearest case of the disease was in a house a block or so distant, and although the two families had no social relations, this apparently did not deter a dog belonging to the infected family from dividing his attention impartially between the two homes, eating at one place and sleeping at the other. In no other way could the source of the infection of the baby be explained, than that the dog fondled by the children of the smallpox family carried the virus of the disease to the neighbor's baby. Similar instances have been noted before in connection with smallpox transmission, and cats and dogs both have been incriminated as carriers of plague infected fleas-cases of bubonic plague so contracted having been observed by Public Health Service officers working in recent plague epidemics. The same household pets also have been charged in certain instances with the responsibility of carrying the infection of diphtheria, scarlet fever and other communicable diseases of children, as well as various intestinal parasites. A disease that annually causes more than 100 deaths in this country is rabies, and the role of domestic animals in spreading this disease is definitely proven, speculation or circumstantial evidence being discarded. Altogether, therefore, it is perfectly evident that the citizen who keeps domestic pets maintains at the same time a very potential source of danger; a sanitary menace to his own household and to that of his neighbor. While this aspect of the subject applies year in and year out, it may well behoove the city dweller in these times of urgent demand for food conservation to seriously take counsel with himself as to whether he is justified in continuing to keep his dog or his cat, both of which are casual sources of mental annoyance to neighbors, as well as agents for graver potentialities. POSTER COMPETITIONS FOR HIGH SCHOOL STUDENTS. Committee Offers Valuable Prizes for Fresh Air Posters. During the next three weeks students in the art departments of the various high schools in this city will be busily engaged in drawing posters designed to teach the general public the most effective method of preventing the spread of pneumonia, tuberculosis and other respiratory diseases. They will be stimulated in their efforts by the hope of winning one of the cash prizes and medals offered, in Manhattan and the Bronx by the Tuberculosis Committee of the Charity Organization Society, and in Brooklyn and Queens by the Tuberculosis Committee of the Brooklyn Bureau of Charities. The poster contest, under the immediate direction of Dr. James P. Haney, Director of Art in High Schools, is a cooperative effort in which the two local tuberculosis committees, the art departments of the high schools, and the Department of Health have joined hands in order to combat the marked increase in respiratory diseases in the past few months, and especially the rising death rate from tuberculosis. Each high school in the city has been asked to hold a poster competition, the best poster to receive a prize of five dollars in gold, the second best a silver medal, and the third best a bronze medal. After the award of these prizes, the posters of all the prize-winning contestants, will be assembled in one place and special purchase price of $25 will be awarded to the best poster from Manhattan and Bronx, and another $25 will be awarded to the best poster from Brooklyn and Queens. The general public probably does not realize what good poster work the stu dents of our high schools can do. The Bureau of Public Health Education, which has repeatedly made use of health posters drawn by these students, finds that they not only draw exceedingly well, but know how to give effective pictorial expression to our health maxims. The present poster competition will afford an excellent opportunity for the people of this city to learn how thoroughly practical is the art instruction in our high schools. One of the school posters recently sent to the U. S. Food Administration elicited the statement it was "the best we have seen in a long time." In a communication to the instructors in the art departments of the high schools, Director Haney sets forth the following conditions to govern the con test: "1. Each school competing will announce the competition on or about Monday, March 18th, and will organize its own exhibition on or about Wednesday, May 1st. There must be at least twelve pupils competing in a school to warrant the award of the prizes. Any pupil in any class may enter the competition. "2. The motifs of the competing posters may be derived from various sources, but their combination must be original with the maker. "3. The prizes in the several schools will be made by a committee of three judges invited by the school's art department to make the awards. It shall rest with, the art department as to whether its teachers are represented on this committee. In making awards, preference will be given to posters of large and simple design and effective and harmonious color, which bear short and striking phrases in well-lettered lines. "4.. The posters shall deal with one or other of the following: (a) or (b) preferred: (a) Fresh air as a preventive and cure of Tuberculosis. (b) Medical examination as a preventive of Tuberculosis. (c) Filth as a causative agent of Tuberculosis. (d) Bad ventilation as a causative agent of Tuberculosis. (e) Good feeding as a preventive of Tuberculosis. (f) Cleanliness as a preventive of Tuberculosis. "Every chairman is urged to aid in this competition. It is especially desired that the art department of the high schools participate in the movement to arouse the city to a sense of the necessity of combating the White Plague through proper feeding, medical examination, and fresh air. "With intention, the subject matter of the posters has been limited to phases which will permit simple and striking illustration. As subject matter, this can be as well prepared by boy students as by girl students. It is hoped therefore that every art department will participate." DISPENSARIES AND OCCUPATIONAL DISEASES. Health officials everywhere welcome the growing public interest in industrial hygiene and occupational diseases, an interest greatly stimulated by the industrial expansion caused by the war. Last week we called attention to the resolu tions adopted by the New York Academy of Medicine urging greater interest on the part of the medical profession in occupational diseases. The Academy's action has apparently borne fruit, for we find the Associated Out Patient Clinics endorsing the recommendations in the following resolutions: "Whereas, There exists a great deal of 'Occupational Disease,' and "Whereas, Cases of occupational disease are oftentimes not properly diagnosed in the out-patient clinics, and peter "Whereas, It is the duty of the clinics to help in providing the sick with comial advice, "Therefore, be it Resolved, That in the interest of the sick and the industrial efficiency of the workers, the attention of the boards of trustees of dispensaries situated in the industrial sections of the city, be called to the need of the early recognition of occupational disease, and that in order to facilitate the work of the physicians in this task, detailed records should be taken as to the occupation of all patients; "That adequate facilities be provided for the treatment of occupational and industrial poisonings; and "That an interest in the study of occupational diseases should be stimulated among the physicians connected with the dispensaries.” A CASE FOR DIAGNOSIS. From time to time the Chief Diagnostician of the Department of Health, who is attached to the Bureau of Preventable Diseases, encounters cases of more than usual interest from the standpoint of differential diagnosis. For the benefit of our physician readers we shall publish brief notes concerning these cases in the WEEKLY BULLETIN. Case II. "A patient, colored, adult male, was reported to the Department of Health as suffering from smallpox. He had fever and complained of 'misery' everywhere,-head, back, and extremities,-but thought he felt rather better since the 'bumps' came out the day before. "These 'bumps'-as colored people invariably refer to the lesions of any elevated eruption-were present in abundance and consisted of papules, uniform in size, deep seated in the skin, painless, and firm to the touch. On first inspection, the distribution of the eruption appeared to be general, being distributed on the face, scalp, trunk and extremities. The lesions were closely set on the face-some of them very near to muco-cutaneous junctions. They were fully as numerous on the forearms as on the arms, on the shins as on the thighs. So far, I think, no one would venture to rule out variola. However, below the wrists and ankles, not a lesion! The skin of hands and feet, both front and back, was smooth and normal in every way. “Experienced clinicians know that varioloid-if the term is permissible-is certainly getting more and more irregular as the years go by, and its positive diagnosis more and more difficult; but its irregularities have their limitations and one is not yet, at any rate, prepared to admit that smallpox can produce numerous lesions on the forearms and legs while leaving the hands and feet completely free. "This patient gave a 4+ Wassermann reaction and the eruption cleared up quickly under antisyphilitic treatment without any scab formation whatever.-W. L. SOMERSET, M.D.” DUTY OF PHYSICIANS WITH RESPECT TO ABORTIONS AND HOMICIDES. The Chief Medical Examiner calls attention to a matter of grave importance in the medico-legal and criminal investigation of cases of abortion and suspected abortion dying in city and private hospitals and more especially in the various private sanitaria in the City of New York. The attending gynaecologists and surgeons and their respective staffs of internes appear to be singularly unaware of their responsibility to the prosecuting authorities (the district attorneys of the counties and the medical examiner's office), in regard to the preservation of the pathological material of such abortions, namely, the curettings and, in some cases, the uterus removed by hysterectomy. The Chief Medical Examiner is cer |