In European cities, hospitals for contagious diseases are almost invariably situated, if not in congested districts, at least without any regard to the possible or rather impossible dissemination of contagion. In our own country, the Boston Hospital for Contagious Diseases, the Philadelphia Hospital for Contagious Diseases, and, in New York City, the Willard Parker Hospital, are so situated. The advantages of such an arrangement are only too obvious. We have long passed the age when children desperately ill with scarlet fever, diphtheria or membranous croup, shall be moved it intensely cold weather seven or eight miles to a water-front, transferred to a boat, carried across the river or bay, and transferred again to a ward, the whole process occupying, perhaps, three or four hours, an experience for which any child perfectly well might pay a severe penalty. To refer again to the supposed danger to the surrounding community, it can be affirmed most positively that when the hospital is once established and in operation no one will for a moment give it a second thought, any more than now those who protested against its establishment consider themselves in any way endangered by the presence of a case of scarlet fever or diphtheria in the next house. Effect on Property Values. In regard to the possible depreciation of property, the department is by no means prepared to admit that this depreciation would take place. This has not been the experience of other cities, and the parking of the surrounding area which has been suggested by the Board of Health would not only remove the sentimental objections and prejudices of the surrounding property owners, but would probably result ultimately in a greatly increased value of the surrounding property. In order to care properly for cases of contagious disease, The City of New York seriously needs additional hospitals located in the areas of developing population, and the fundamental need of more numerous and scattered contagious disease hospitals is a matter of such demand and importance that it would seem to be unwise to allow sentimental reasons or dubious property considerations to stand in their way. THE NEW SEA VIEW HOSPITAL. As a location for a hospital to care for the tuberculosis cases which must be treated in New York City, no finer site could have been chosen than that on Manor Road. Staten Island, where the great Sea View Hospital of the Department of Public Charities, with over one thousand beds, is soon to be opened. This project was conceived and undertaken several years ago. The acquirement of the property, planning and erection of so large a hospital, with the delays attendant on the provision of funds, have naturally consumed much time; but at last the City has ready for use probably the finest, and certainly the most beautiful plant in this country, and one of the finest in the world. Although no definite policy can be outlined now as to the class of cases which will be received, it is planned at first to take patients in not later than the second stage. A requirement, however, which will be strictly enforced is that patients shall be of the respectable, self-supporting class, not vagrants nor alcoholics, and preference will be given to those with families, who might become infected by their continued stay at home. It is hoped to make every day a visiting day at Sea View, if possible. so as to give ample opportunity for the patients to see their friends, and for every member of a patient's family to get to know this great institution, which the City has erected at a cost of $3,500,000, so as to give every one with tuberculosis in New York City an opportunity to get well in beautiful and comfortable surroundings, where everything which science has evolved has been provided to hasten their recovery. E. S. McSweeny, M. D., formerly Resident Physician at the Otisville Sanatorium of the Department of Health, is the Medical Superintendent. THE VON PIRQUET TEST FOR TUBERCULOSIS. Unless especially contraindicated, the Von Pirquet tuberculin test is performed on every child attending the children's classes of the tuberculosis clinics of the Department of Health. This test, when positive, in the absence of a localized reaction, is of little if any service in adults, for it has been shown that about 90 per cent. of all adult bodies coming to autopsy present lesions of either healed or active tuberculosis. In children under five years of age, however, a positive reaction is of considerable diagnostic importance in a case presenting doubtful clinical symptoms. It may be said, in addition, that the test is of value when negative, both in adults and children. Von Pirquet's test, in so far as a reaction denotes the presence of tuberculosis somewhere in the body, appears to be exceedingly reliable, and from the ease of its performance and the practical absence of constitutional reaction, is to be preferred in dispensary practice to the test by subcutaneous injection. The diagnosis of tuberculosis in children is frequently so difficult that no means should be neglected which promises to assist the examiner. Von Pirquet's test is best performed as follows: Three points of scarification are made upon the upper part of the left arm and separated from each other vertically by about 3 or 4 c. m. The scarification should be small and should not draw blood in any considerable quantity. The uppermost scarification serves as a control. Into the second is inoculated a 25 per cent. solution of crude tuberculin, while the third or lowest scarification receives an inoculation of 50 per cent. tuberculin. The inoculation may be made in a number of ways. One, which is simple and satisfactory in its results, consists in placing a drop or two of the solution upon the skin and then performing light scarification through it. It is necessary to dilute the tuberculin. The crude tuberculin, as furnished by the department, is a glycerine extract and contains no water. In consequence, when placed upon a scarified surface, absorption may fail to occur and disappointment result. It is true that the scarification may liberate enough blood serum in certain cases to make a solution which will be satisfactorily absorbed, but this is not to be relied upon. A successful "take" manifests itself in from twenty-four to forty-eight hours. At the point of control there will be no reaction, whereas at the two points of inoculation a zone of inflammation more marked at the lowest point of scarification will be evident. The "takes" are slightly elevated and light pink or red in color and are sometimes accompanied by swelling of the surrounding tissues. In a few days all signs disappear save except some temporary discoloration of the skin. The reactions at the points of inoculation vary considerably in severity, from slight redness and superficial infiltration, to a lesion somewhat resembling the earlier stages of a smallpox vaccination. VITAL STATISTICS Summary for Week Ending Saturday, 12 M., April 5, 1913. Corrected according to borough of residence. The presence of several 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. II. 18. 25. I. Cases of Infectious and Contagious Diseases Reported. Week Ending. Jan. Jan. Jan. Jan. Feb. Feb Feb. Feb. Mar. Mar. Mar. Mar. Mar. Apr. Tuberculosis... 4. 5. 8. 15. 22. I. 8. 15. 22. 29. 363 470 338 369 539 526 561 355 367 472 454 333 402 278 245 20 Whooping 12 26 Cough.. 19 Cer.-Spinalį Meningitis..} Total...... 1,534 1,991 1,933 1,991 2,127 1,790 1.773 2,090 2,462 2,509 2,610 2,634 2,674 2,508 Deaths According to Cause, Age and Sex. 9. Influenza... 12. Other Epidemic) Diseases....... 13. Tuberculosis Pul 14. Tuberculous Men 15. Other forms of Tuberculosis... 23. Other *If the deaths under one month, numbering 88, be deducted from the total deaths under one year the resultant rate will be 62 per 1,000 births, weekly average of 1912. Corrected Mortality Among Children, Week Ending April 5, 1913. Includes Small Pox, Measles, Scarlet Fever, Diphtheria and Whooping Cough. Deaths According to Cause, Annual Rate per 1,000 and Age, with Meteorology and Number of Deaths in Public Institutions for 14 Weeks. Feb. Week Ending - Jan. Jan. Jan. Jan. Feb. Feb. Feb. 8. 15. 22. 4. II. 18. 25 I. 1. Mar. Mar. Mar Mar. Mar. Apr. 8. 15 22. 29. 5. Total deaths... 1,519 1,512 1,546 1,461 1,440 1,568 1,732 1,836 1,699 1,723 1,848 1,685 1,660 1,512 Annual death14.75 14.68 15.01 14.19 13.98 15.23 16.82 17.83 16.50 16.73 17.94 16.36 16.12 rate........ 14.68 12 24 12 19 20 22 3 II 38 21 2 I 193 39 39 36 35 38 12 Mean barometer. 29.69 30.16 30.19 30.04 29.84 29.91 30.01 29.89 29.81 29.95 29.93 30.18 30.05 29.83 or snow.... Mean tempera 1 ture (Fahr-43.6° 39.9° 41.9 41.° 39.4 25.6° 27.° 40. 33.7° 32.3° 48.6' 46.4° 50.9 50.3° |