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DEPARTMENT OF HEALTH.

Report for Week Ending January 18, 1913.

THE PRESENT ATTITUDE OF THE DEPARTMENT OF HEALTH IN

REGARD TO DIPHTHERIA AND MEASLES. Following a report made by Dr. Hermann M. Biggs, General Medical Officer of the department, the Board of Health has made important modifications in its policy in regard to disinfection in diphtheria and measles. In considering this matter with special reference to terminal disinfection in these diseases, and from the point of view of bringing the practice of the department more into harmony with present scientific thought, several phases of the subject must be kept in mind.

There is no doubt that the isolation which is nominally enforced in tenement houses in the various infectious diseases, is really wholly ineffective so far as the liability of spreading the infection to other members of the household is concerned. At most, it results only in restricting somewhat the intercourse between the patient and the rest of the family, and this chiefly only during the period of acute illness; after this and during convalescence intercourse is usually free. It is possible, however, that the isolation and especially the placarding now practised by the Department of Health with certain infectious diseases, does really tend to prevent the spread of infections in that it restricts the intercourse between the patient and persons not members of the infected household. It is the restriction of intercourse with persons not members of the family which chiefly renders of value the fixing of a definite period of isolation which is finally terminated by disinfection. If the practice of terminal disinfection were entirely abandoned, it seems likely that the enforced isolation of patients during convalescence would be more difficult and less effectual. This applies especially to scarlet fever and diphtheria.

Some distinction should be made, however, between the infectious diseases to be dealt with. In diphtheria it seems rather absurd to insist on terminal disinfection when we know that the danger is far greater from bacillus carriers than from the room.

In measles, the danger of infection is undoubtedly greatest in the very beginning of the disease, usually before the diagnosis is made. The exposure during this period is usually free. There is little evidence to show that measles is often transmitted by fomites or by any one occupying a room in which a case of measles has been ill shortly before. The value of terminal disinfection in this disease must be extremely small.

In scarlet fever, the same consideration probably held good, but perhaps there is somewhat greater danger in this disease than in the case of measles and diphtheria.

In accordance with these statements, therefore, the Department of Health now adopts the following procedures in cases of diphtheria and measles :

In diphtheria, experience has shown that diphtheria bacilli, as a rule, die out in a short time after drying and exposure to light, and that when a person suffering from diphtheria has completely convalesced, and the throat is free from diphtheria bacilli there is little likelihood of any infection from the sick room. Conditions, however, are quite different when the patient is removed from the sick room at the height of the illness, or when death occurs at this time. Under these conditions, it is probable that fresh discharges are present, and that these contain living diphtheria bacilli.

The action of the department, therefore, depends on the manner and the time when the case is terminated.

(1). If the patient completely convalesced in the sick room, the department does not perform disinfection, but insists that the apartment be thoroughly cleaned and aired. After recovery of the patient at home, the woodwork of the room in which the patient has been isolated must be thoroughly scrubbed with hot soda solution (one-half pound to three gallons) and the room thoroughly aired for at least twentyfour hours before being again occupied. Goods will be removed to the Department of Health Disinfection Station, for sterilization, and will then be returned.

(2) If the patient is removed from the sick room during the height of the illness or dies at this period, the room with its contents will be disinfected, and all goods exposed to the contagion will be removed to the Department of Health Disinfection Station, and returned after disinfection by steam. Bedding or other infected goods from such infected rooms must not be taken from the house or thrown into the street by the owner. After the goods have been removed, and the premises reinspected, if conditions are found satisfactory, the inspector will issue the necessary school permits. Children in the family are not allowed to attend school until they have received a certificate from the Department of Health.

In measles, also, experience has shown that there is little likelihood of any infection from the sick room or when the person suffering from measles has completely convalesced. The main danger is from fresh discharges. So far as disinfection is concerned, therefore, the action of the department depends upon the manner and time when the case is terminated,

The method of procedure adopted by the department is, therefore, similar to that in the case of diphtheria, with the exception that goods are not removed for disinfection after the death or recovery of cases of measles.

LECTURE COURSE FOR Nurses On Public Health and Social Service, The growing interest in public health matters, the important part taken in them by the various departments of the City government, and the essential cooperation therein of social service workers, rendered advisable a systematic authoritative course of instruction for the Nurses of the Department of Health. The department, therefore, in cooperation with the Nurses' Settlement, Teachers'. College, and the Charity Organization Society, the latter through the Sage Foundation and the Committee on Cooperation, made arrangements for a series of lectures to be given by its officers and by representatives of the above organizations upon the activities and methods of the City in dealing with public health matters, home nursing, social service work and charitable aid. The introductory lecture was given by Dr. Hermann M. Biggs, General Medical Officer, June 7, 1912, and following this, the work of the various divisions of the department was presented. This occupied the entire summer. In the fall, other subjects were taken up by the cooperating organizations. The lectures were given on Wednesdays at 5 p. m., at first in the Assembly Hall of the United Charities Building, 105 E. 22d st., and later, through the courtesy of the Metropolitan Life Insurance Co., in the assembly room of their building, at 9.15 a. m. Each Nurse was required to report personally to her supervisor in the assembly room, and to take careful notes in order to equip herself for the quizzes which were held later. This part of the course, consisting of lectures on the work of the various divisions of the Department of Health by officers of the divisions, was completed October 2, and was followed by a course of lectures at Teachers' College on the methods and principles of public health nursing.

A KINDLY REMEMBRANCE FROM GERMANY. The Congress of Hygiene and Demography, which was held at Washington in September, 1912, was attended by a large number of eminent sanitarians from various parts of the world. Many of these made more or less comprehensive tours during their visit studying various sanitary problems as they are presented in our large cities. Thus it was the good fortune of the officials of the New York Department of Health to become personally acquainted with a number of the foreign delegates and to extend to them such courtesies as were possible. Some weeks after the termination of the Congress, the Commissioner of Health was agreeably surprised by the receipt of a joint letter from two of the delegates who had visited New York, Dr. Aug. Gartner, of Jena, and Dr. Aug. Weber, of Berlin. Translated it reads as follows:

“Department of Health of the City of New York.
"Dr. Ernst J. Lederle,
"Commissioner of Health,

"Corner of Centre and Walker Sts., New York City :

"During our visit to The City of New York, you yourself as well as the officials of the Department of Health, Dr. Biggs, Dr. Bolduan, and Dr. Park, with the members of his laboratory, and Dr. Wilson, exhibited towards us so much courtesy and consideration that we feel it our duty to extend to you all our deepest gratitude. We have to thank the untiring advice of yourself and the gentlemen mentioned for the fact that our visit to New York was so successful and full of information,

“As a token of our gratitude, we beg you to accept and to place in the Department of Health, or in your Research Laboratory, the bust of Robert Koch, wbich we have this day sent to your address, and in whose memory you have been so very successful in combatting epidemics. With professional greetings to yourself and to those who were so courteous to us, we remain, yours, etc.,

“DR. AUG. GARTNER.

"DR. AUG. WEBER." Shortly after the receipt of this letter the bust arrived. It is about two and a half feet tall, and is an excellent likeness of the great bateriologist. It at present adorns the meeting room of the Board, and as a work of art and a token of appre. ciation, it is very highly valued.

EXHIBIT OF THE WORK OF THE DEPARTMENT. An exhibit, in which the various activities and resources of the department are illustrated by means of charts, diagrams and models, is at present in course of establishment on the fifth floor of the department headquarters, No. 149 Centre street, and will be open for public inspection on or about February 1st. Parts of this exhibit have been displayed in the pasi on various occasions, in Chicago, at Atlantic City and, more recently, at the Congress on Hygiene and Demography in Washington, D. C., but up to the present time it has never had permanent installation. The exhibit contains many interesting features, conspicuous among which is an extensive model of the grounds and buildings of the Tuberculosis Sanatorium at Otisville. This model was made by a patient of the institution and its entire cost is represented by the materials used in its construction. Two larger models, representing the style of pavilion occupied by patients at the sanatorium, are also to be seen. The work of the Research Laboratory is represented in part by cases containing specimens of the substances employed in determining various chemical biological reactions. The death rate of different years is definitely shown by means of various charts, while the increasing population of the city from 1800 to 1910 is strikingly shown by means of plaster cubes of increasing sizes. The face of the cube representing the year 1800 is 6/2 inches square, that of 1910, 28 inches square. An interesting feature is an illuminated chart which contains the number of persons living at the end of various years from the first to the ninety-fourth, starting on the basis of 100 children born. Numerous charts and tables are also on view.

This material forms the nucleus of a permanent exhibit at the headquarters building, which will be added to from time to time and will become, it is hoped, an important feature of the educational work of the Department of Health.

MORTALITY OF THE WEEK ENDING JANUARY 18, 1913. There were 1,546 deaths reported during the week with a rate of 15.01 per 1,000 of the population, as against 1,578 deaths and a rate of 15.91 during the corresponding week of the previous year. This difference of nine-tenths of a point corresponds to a weekly decrease of 93 deaths.

Diphtheria and croup, the acute respiratory diseases and the heart diseases showed a decreased mortality compared with the corresponding week of 1912, while scarlet fever, influenza, Bright's disease and nephritis, and the digestive diseases, showed an increased mortality; that of measles, diarrhoeal diseases and pulmonary tuberculosis remained about the same. Considered from the viewpoint of age-grouping, the mortality was slightly decreased at all the age-groupings, no particular age-grouping showing a greater decrease than the others.

The mortality so far for the year is a shade lower than that of the corresponding period of 1912.

VITAL STATISTICS

Summary for Week Ending Saturday, 12 m., January 18, 1913.

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Corrected according to borough of residence.

l'he presence of severai large institutions, the great majority of whose inmates are non-residents of the city, increases considerably the death-rate of this Borough.

Deaths by Principal Causes, According to Locality and Age.

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452

311

332

338

187

338

T

I uberculosis
Pulmonalis.
388 398
361 402 +85

+52
394 365

295 497

483 Diphtheria

307 272 and Croup..)

305 292
296 332 293 317 309 318

338
280

397 Measles.

64 104
91 128 175
211 223 276
274 412 298

395 551

463 Scarlet Fever .. 85 93 102 114

118
167 182
232 259 283 304

301 Small-pox....

2 Varicella

43
68

107
116
170 204 185

133 149 268
Typhoid Fever
II2 50 52 62 61 52 56 49 52

36 23 19 Whooping

39 24 Cough.... 19 22 30 32 32 20 31 45 25 12 26

50 Cerebro-Spi. nal Meningi- 4

6
5 3 II 5 4 4

9 6

6 6 tis......

Total....... 1,010 1,052 1,092 1,071 1,181 1,400 1,213 1,482 1,495 1,636 1,436 1,534 1,991 1,933

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1. Typhoid fever... 3. Malarial Fever.. 4. Small-box....

Measles.. 6. Scarlet Fever. 3. Whooping Cough. Croup.

25 31 9. Influenza... 12. Other Epidemic Diseases...

7 13. Tuberculosis Pul

171 171 monalis.... 14. Tuberculous Men

12 | 13 ingitis.... 15. Other forms of

16 Tuberculosis..

13 16. Cancer, Malig

86

84 nant Tumor...) 11 Simple Meningitis. 9

Of which 17a. Cerebro Spinal

6 Meningitis..

4 18. Apoplexy. Soften

19 ing of the Brain

40 19. Organic Heart

218 Diseases... 20. Acute Bronchitis.. 18

29 21. Chronic Bronchitis.

3 22. Pneumonia (excluding Broncho 162 166

1 Pneumonia)..... 2za Broncho Pneumonia 123 23. Other Respira

8

9 tory Diseases.. 24. Diseases of the Stomach (Can

5 cer excepted).. 25. Diarrhoeal diseases (under 5 years)

30 30 26. Appendicitis and 8

1 27. Hernia. Intestinal

16 Obstruction....

13 28. Cirrhosis of Liver.. 23 19 29. Bright's Disease and Ac. Nephritis

122 110 30. Diseases of Wom

6 en (not Cancer)

5 31. Puerperal Septicæmia..

5 34. Other Puerperal

Diseases.. 33. Congenital Debility and Mal

79 102 formations... 34. Old Age...

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17 35. Violent Death,

74 79 a. Efects of leat b. Other Accidents. 69 75 C. Homicide...

4 35. Suicide 37 All other causes... 233 219 38. Ill-defined causes..

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If the deaths under one month, numbering 97 from all causes, be deducted from the total deaths under one year, the resultant rate will be 58 deaths of infants per 1,000 weekly average births of 1912.

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