Quarterly bulletin (New York (N.Y.). Dept. of Health). 1913

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DEPARTMENT OF HEALTH.

Report for the Week Ending May 3, 1913.

ESTABLISHMENT OF RESEARCH LABORATORY AT OTISVILLE. SANATORIUM.

At a meeting of the Board of Health of the Department of Health, held January 31, 1913, a resolution was adopted requesting the consent of the Board of Estimate and Apportionment to the expenditure by the Board of Health of a sum not exceeding $16,000 from funds at the disposal of the Board of Health and received from the sale of vaccine virus and surplus bacteriological products, to enable the Department of Health to establish a branch of its present Research Laboratory on the grounds of the Municipal Sanatorium for Tuberculosis, and adjacent to the antitoxin plant at Otisville, Orange County, New York. The objects sought by the establishment of this laboratory were as follows: First, the routine pathological and bacteriological investigation incident to the administration of the institution, which was soon to care for over 600 patients suffering from pulmonary tuberculosis. Secondly, the pursuit of special studies having as their object the discovery of new and better bacteriological methods for the diagnosis, prevention and treatment of pulmonary tuberculosis. Thirdly, routine pathological and bacteriological work in connection with the production of vaccine and anti-toxic sera, and the study of the diseases of animals used in this connection and affecting these products. Fourthly, investigations having in view the more economical production of the various bacteriological products and their wider and more practical utilization in the prevention and treatment of contagious diseases. At a meeting of the Board of Estimate, held April 24, the Board of Health was empowered to expend for this purpose a sum not exceeding $12,757.70 during nine months, commencing April 1. The facilities for such a laboratory at Otisville are excellent, and the supply of clinical material is unlimited, while the opportunities for the use of this material are exceptional. As the City has nearly 4,000 cases of tuberculosis in its institutions, it would seem that no matter could be of greater interest or importance than the study of its specific treatment through research work.

PULMONARY TUBERCULOSIS IN NEW YORK CITY DURING 1912.

While universally approved from the viewpoint of duty and on the ground of humanity, the campaign against tuberculosis, at present in active progress in many countries and nowhere more energetically prosecuted than in New York City, has been regarded rather dubiously by many, in so far as its capability of securing positive results was concerned. In fact, the attitude, not only of many members of the medical profession, but also of many laymen much interested in the subject, has been one of quiet and respectful doubt. It may be said that, up to the present time, judgment in this connection has been suspended, and indeed properly so. The Division of Communicable Diseases of the Department of Health publishes some figures and statements in relation to the anti-tuberculosis campaign which are of considerable interest, and although the statistics, like all statistics relating to medical subjects, are necessarily liable to error and are capable of slightly different interpretations, they certainly are encouraging in so far as they can be relied upon.

The registration of cases of pulmonary tuberculosis in New York City by the Department of Health began in 1894, when 4,166 cases, chiefly from institutions, were reported in the Boroughs of Manhattan and The Bronx. The number of new cases reported increased steadily year by year until the maximum for the two boroughs. 21,331 new cases, was reached in 1910. In 1911 the number fell to 17,360, and in 1912 to 15,929. In 1910, when the figures for Greater New York first became available. 11.977 new cases were reported for the five boroughs. There was a steady increase to 32,065 in 1910 and a subsequent decline to 24,513 in 1911, and 22.752 in 1912. Does the apparent decrease during the past two years mean that the anti-tuberculosis campaign in New York City has begun to bear fruit? The mortality figures would seem to support an affirmative answer, the death rate from pulmonary tuberculosis in Manhattan and The Bronx having fallen steadily from 4.27 per 1,000 of population in 1881, to 1.9 in 1912, a reduction of 55 per cent., and the death rate of the Greater City from

pulmonary tuberculosis has fallen from 2.25 in 1898 to 1.66 in 1912. In other words, although the population has increased in Greater New York from 3,272,418 in 1898 to 5,173,064 in 1912, the deaths from pulmonary tuberculosis in the latter year were 8,591, as compared with 7,724 in 1898. However, before relying on these statistics as proof of the good accomplished, certain facts must be borne in mind. In 1910 when the highest record of cases was reached, the Department of Health, thanks to a very large appropriation for tuberculosis work, was able to open a number of new tuberculosis clinics, and to increase considerably the staff of clinic physicians and tuberculosis nurses. This meant greatly increased activity in referring suspected cases of tuberculosis to the clinics, and, although most of the clinic physicians were new to the work, their diagnoses were accepted without question. The case figures for 1910 are, therefore, in all probability, too high. Since that year, however, confirmatory re-examinations of all cases failing to show tubercle bacilli in the sputum have undoubtedly greatly lessened the number of incorrect diagnoses, and it may therefore be assumed with fairness that the lower figures of 1912 do represent a decreased prevalence of the disease. In regard to the mortality statistics we must take into consideration the decrease in the prevalence and mortality of all infectious diseases, consequent upon the steady betterment of social conditions throughout the civilized world, and further, Lecause of the steadily increasing tendency of consumptives to leave the city and seek the country, the annual number of deaths from pulmonary tuberculosis in New York City fails to include many cases in which the disease was contracted in the city, but death took place elsewhere. Nevertheless, although extremely difficult to prove by statistics to which no exception can be taken, there can be no doubt in the mind of any one familiar with the tuberculosis situation in New York City that the disease is year by year steadily becoming less prevalent and less fatal, and that the antituberculosis campaign has played a large part in bringing about this encouraging result.

REGULATIONS REGARDING "LOOSE" OR "DIPPED" MILK.

In view of recent misunderstandings of the proposed action of the Board of Health in regard to the sale of "loose" or "dipped" milk, a resume of the matter may be of service at this time.

On September 17, 1912, the following resolution, effective on June 1, 1913, was adopted by the Board of Health:

"Whereas, The interest of the public health requires that milk should be protected from contamination by human agencies and by dust, dirt and flies, and, "Whereas, Many of the premises in the City of New York where milk is sold by dipping from cans are grocery stores in which foods and food products and other commodities not in sealed packages are sold in a manner which causes much dust, and,

"Whereas, The facilities for proper icing, the proper cleansing of utensils, and the proper protection from flies are often inadequate in such stores, many of which are so arranged that the living rooms open directly into the store, therefore, be it

"Resolved, That after June 1, 1913, the sale of milk dipped from cans will be permitted only in milk stores approved by this department, and for which a permit has been issued, or in places in which foodstuffs, other than milk products, are sold in original packages only."

Subsequently, a draft of special rules and regulations, taking up in detail the requirements of this order, was prepared and sent out by the Commissioner to a number of associations and individuals particularly interested in this question, with request for consideration and criticism. It should be noted that these rules and regulations were issued only in a tentative form and are still under consideration by the Board. Recently there has been considerable discussion of the matter in the newspapers, and no little misapprehension has resulted, some of the papers making the misstatement that these rules and regulations had been actually adopted. This is not the case, and the Commissioner intends that the matter shall have full and fair discussion before the new rules are finally formulated and put in force.

PROSECUTION OF PHYSICIANS AND MIDWIVES FOR FAILURE TO REPORT BIRTHS. Section 161 of the Sanitary Code provides that physicians and midwives must report births occurring in their practice within ten days, and upon failure to do so, they are liable to prosecution and fine. The enforcement of this section has always been attended with difficulties and, in the past, failures to comply with it have been frequent,

due, generally speaking, to simple forgetfulness on the part of the medical attendant. The importance of the registration of births is increasing yearly. As a matter of routine practice, transcripts of certificates of birth have been issued for many years, for use in the Surrogate's and in the criminal courts. It is now necessary for a child wishing to obtain admission to the public schools to furnish a certificate of his birth, and if between the ages of fourteen and sixteen years he desires to go to work a certificate of birth must also be produced in order to obtain the necessary employment certificate. Candidates for examination for the positions of Patrolman, Fireman, Inspector, etc., must furnish a certified copy of their birth certificates to the Civil Service Commission. Natives of this country, who desire to marry in Europe and to reside abroad, must also furnish certificates, otherwise a marriage license will not be granted in certain countries. When a certificate of birth is not filed within a certain specified time, it becomes impossible under the law to have it placed on file later.

During 1912 there were 312 instances of failure to report births. In 300 cases the delinquents were physicians and in six midwives. In six cases excuses were accepted, the remaining 300 were fined in amounts ranging from $10 to $100. Since the first of January, 1913, the relative number of failures to report births has been less, amounting only to 50, and three physicians have been fined amounts ranging from $10 to $50. It is the intention of the department to prosecute to the fullest extent all present and future violations of the law, and a circular letter to this effect was forwarded to all physicians in New York City during December, 1912. It should not escape attention that violations of this section of the Sanitary Code are much more frequent among physicians than among midwives.

DEATH RATE FOR THE WEEK.

There were 1,532 deaths and a rate of 14.88 per 1,000 reported during the week just ended as against 1,542 deaths, and a death rate of 15.55 during the corresponding week of 1912, a decrease of 10 deaths and of 0.67 of a point. The mortality from infectious diseases, measles and scarlet fever, diarrhoeal diseases under five years of age, broncho pneumonia and pulmonary tuberculosis was considerably lower than during the corresponding week of last year, while deaths from organic heart diseases and lobar pneumonia were somewhat higher.

Viewed from the point of age grouping there were 27 fewer deaths under one year of age, and over the age of sixty-five years 30 fewer deaths. The age group between one and five showed six more deaths; between five and sixty-five years 51 more deaths.

The death rate for the first eighteen weeks of 1913 was 15.64, as against 15.79 per 1,000 during the corresponding week of last year.

Boroughs.

VITAL STATISTICS

Summary for Week Ending Saturday, 12 M., May 3, 1913.

Boroughs.

1912. 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.