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DEPARTMENT OF HEALTH

Report for Week Ending January 25, 1913

THE PUBLIC AND THE NEw MILK REGULATIONS. A circular which has recently been issued by the department calls attention to the different grades of milk which are permitted to be sold in New York City and describes the purposes for which the various grades may properly be used. The importance of obtaining a pure milk supply for a large city can hardly be overestimated, not only from the viewpoint of the nutritive value of the milk, but also on account of the danger of transmission of a number of diseases through this medium. The circular which follows will be supplied in quantity to associations or individuals volunteering to assist in its distribution. The Department wishes to disseminate this information as widely as possible in order that all citizens may avail themselves to the fullest possible extent of the protection afforded by the recent improvements in the official control of New York's milk supply.

“ADVICE TO THE PUBLIC ON THE USE OF MILK. “The rules and regulations of the Department of Health require that all milk, whether in bottles or cans, shall be labeled with the grade for which a permit has been issued.

"The rules and regulations relating to the sale of milk will be sent to anyone on application. By calling at the Department any person may obtain information as to the grade of milk each dealer in the City is permitted to sell.

"The Department should be informed whenever these regulations are not complied with.

Plan for Milk Grading. “Grade A. Suitable for infants and children—This grade of milk is sold only in bottles, the caps of which must be marked "Grade A.' This grade comprises certified milk, guaranteed milk, inspected milk raw and selected milk pasteurized.

"Grade B. Suitable for adults—This grade may be sold in bottles or cans, caps and tags of which must be marked "Grade B.' in large, green letters on a white ground. This grade comprises pasteurized milk and selected milk raw.

“Grade C. Suitable for cooking purposes only-Must be plainly marked in red letters 'Grade C. for cooking. From the sanitary standpoint, this is the poorest grade of milk that is permitted to be sold and should never be used for babies or children. All milk stores selling Grade C. will be required to display a placard so stating.

"Pasteurized milk of either grade must be plainly labeled 'pasteurized. Pasteurized milk is considered by the Department safer than raw milk of the same grade.

"Whenever milk is sold for immediate use by adults, as in restaurants, hotels, clubs, bakeries, lunch counters, dairies, it must be either Grade A or Grade B quality.

"Whenever possible, bottled milk should be purchased so that the quality may be known from the label. This holds true when milk is bought for the family or when used at the table in hotels, restaurants or similar places.

"Advice to Mothers. "It is advised that Grade A milk only be used for infants. In case Grade B milk must be used, the pasteurized is the safer. If Grade B raw milk must be used, it should be first pasteurized or boiled in the household.

“Grade C milk should never be used for infants. If you cannot obtain Grade A milk from your dealer, apply to the nearest infant's milk station, a list of which is published.

"This information is promulgated by order of the Board of Health.” APPLICATION OF OSTEOPATHS FOR AMENDMENT OF SECTION 163a, SANITARY CODE.

A hearing was held before the Board of Health at its meeting on Tuesday, the 21st inst., upon the application of Guy Wendell Burns, Chairman, Board of Directors, Osteopathic Society of The City of New York, on behalf of the practicing osteopaths of the City, for the amendment of the Sanitary Code, whereby certificates of death signed by osteopaths might be accepted and burial or transit permits granted thereon. The New York Osteopathic Society, the New York County Medical Society, the Kings County Medical Society, and the Queens-Nassau County Medical Society were represented. Arguments pro and con were heard from 3:30 until 6 p. m. Commissioner Lederle announced that a decision would be given in two weeks.

Previous to the passage of chapter 344 of the Laws of 1907, the practice of oesteopathy was not recognized in this State. By the passage of this law, it was so recognized, and subsequent to the refusal of the Department of Health to register signatures of osteopaths with it, a writ of mandamus was issued by Justice Aspinall, compelling the Department of Health to register their signatures in accordance with the provisions of that act, and that the word "osteopath" be included in such registration. On March 31, 1909, the Board of Health amended the Sanitary Code by the addition of the following sub-section, known as section 163a :

"Sec. 163a. No transit permit shall be granted for the removal or burial of the remains of any person who may have died in The City of New York, unless a certificate of death, made out upon a blank form furnished by this Department, and signed by a physician upon whom has been conferred the degree of Doctor of Medicine, be filed in the Bureau of Records of this Department."

A representative osteopath sought to enjoin the enforcement of this section of the Sanitary Code. The Corporation Counsel of the City entered a demurrer, which was sustained. Hon. Justice Putnam handed down a decision from which the following may be quoted :

“While the State has wisely allowed the practice of osteopathy, it does not follow that it thereby holds out one without any practice in surgery or experience in prescribing drugs as fully qualified to certify the cause of death. Indeed, it is not certain that a board of health would be compelled to take the certificate of death of all licensed physicians in the event of an epidemic or the spread of some new and mysterious disease. Granted that the theoretical education of the osteopath is of a standard equal to that of a doctor of medicine, after he enters on his profession his practice is restricted, so that it does not appear that he can make the tests by examination of blood and tissues by which alone many diseases can be certainly detected. The Sanitary Code is discriminatory, but the discrimination is not personal and arbitrary. It is based on a limitation which the osteopath may be said to make for himself, and deprives him of no rights which he ought to exercise, consistent with the public safety."

Death FOLLOWING THE REMOVAL OF TONSILS AND ADENOIDS. On January 23d, an article appeared in the “New York World” describing the death of Julius Reif, thirteen years of age, of 493 Wendover ave., a pupil of Public School No. 42, and stating that his death, which occurred on January 16, was the result of an operation for the removal of enlarged tonsils and adenoids, the operation having been advised by the representatives of the Department of Health. The death of a child in consequence of such an operation, which is usually regarded as trivial and involving no especial danger, is regrettable enough, and especially so in the case of a boy 13 years of age who, as described by the “World,” had evinced such creditable evidences of good scholarship. Some of the statements, however, in the article referred to, are inaccurate in so far at least as the Department of Health was concerned. The facts are as follows:

The boy was examined on the 12th of November in Public School No. 42 by a medical inspector of the Department, and it may be mentioned that the Inspector in question is considered one of the best and most conservative men on the staff. The Inspector noted that the boy was suffering from defective nasal breathing, and stated, as his records of the case show, that the obstruction was due to a deviated septum, that is to say, to a malposition of the partition which separates one nostril from the other. He did not note the occurrence of adenoids or hypertrophied tonsils, and his case record makes no mention of their existence. Following this diagnosis, a Nurse from the Department called at the home of the parents November 23d and advised that the boy be taken to the family physician for advice and treatment. She said nothing about operative procedures for, as the result of her past experience in such cases, she did not believe that a boy of this age would be operated upon for the correction of a deviated septum. She called again November 30th, but made no reference to any operation, and at neither of these two visits was anything said about enlarged tonsils or adenoids. Her third and last visit was made on the 27th of December, when she was told that the boy had been operated upon in the Fordham Hospital for adenoids and hypertrophied tonsils. On the 2d and 13th of January, a Nurse from the Department visited the boy's home in order to make inquiries in regard to his condition. He was finally taken to the Harmoriah Hospital, where he is said to have died on the 16th of January, twenty days after the operation, the cause of his death being meningitis or inflammation of the brain. It will thus be seen that, so far as the operative procedures in this case are concerned, the Department of Health did not urge their performance, was not officially cognizant of the conditions for which they were undertaken, and cannot, therefore, be held in any way responsible for the unfortunate result. A New REGULATION RELATING TO THE REMOVAL TO PUBLIC INSTITUTIONS OF SURGICAL

Cases SUFFERING FROM CONTAGIOUS DISEASES. Until quite recently, there has been no rule rigidly adhered to by the Department in its attitude towards surgical cases in public institutions when the patient, after being admitted to these institutions, is attacked by some one of the contagious diseases. When the surgical affection has been trivial in character, the Department has usually removed the case to one of its own hospitals, and the treatment, both of the surgical condition and the contagious disease, from that time onward, has been conducted by the physicians of the Department. When the surgical affection has been of a more serious nature or one requiring special surgical skill, it has been the practice to obtain from the superintendent of the institution his verbal promise to maintain supervision of the surgical character of the case after its removal. As a rule, this rather indefinite arrangement has worked fairly well. Recently, however, the right of the Department to demand such cooperation on the part of the institution from which a case is removed has been seriously questioned, and the Department has decided, therefore, to assume complete charge of these surgical cases, at least, in so far as those removed to the Willard Parker Hospital, in Manhattan, are concerned. For this purpose, four Assistant Attending Surgeons have recently been appointed to the staff of Willard Parker Hospital, and the following circular letter will shortly be mailed to the superintendents of all hospitals and dispensaries :

"Under a new regulation, surgical cases developing scarlet fever or diphtheria in general hospitals, will be admitted to the Willard Parker Hospital, and will be cared for by Surgeons attached to the Medical Board of the Willard Parker Hospital, instead, as was formerly the case, by representatives of the Surgeons previously having charge of these cases.' It is obvious that under these circumstances, the Surgeons of the Department of Health should possess a complete history of the case previous to its admission to the Willard Parker Hospital and such cases will, therefore, only be received by the Ambulance Surgeon if a complete medical history or a complete history with a copy of the X-ray findings (if such an examination has been made) accompanies the patient. Furthermore, in cases having a plaster of Paris cast, such a cast must have been previously properly trimmed and cut so as to permit a quick and satisfactory examination of the parts."

At the Kingston Avenue Hospital, the hospital for contagious diseases in the Borough of Brooklyn, no visiting surgical staff exists at the present time, and in this hospital, therefore, the Department has no facilities for the care of_surgical cases. The same is true at the Riverside Hospital, on North Brother Island. For the present, therefore, surgical cases suffering from contagious diseases will not be admitted to these hospitals unless they are accompanied by a signed agreement stating that their surgical treatment will be continued by the institution from which they are removed. As soon as possible, however, visiting surgical staffs will be appointed at Kingston Avenue and Riverside Hospitals, after which the Department will undertake complete charge of all such cases.

MORTALITY OF THE WEEK, There were 1.461 deaths reported during the week ending January 25th, with a rate of 14.19 per 1,000, as against 1,564 deaths, and a rate of 15.77 during the corresponding week of 1912, a decrease of 1.58 of a point corresponding to a decrease of 163 deaths.

The most notable decrease was that from typhoid fever, the number of deaths reported during the week fell to the extraordinarily low number of 2, probably the lowest number of deaths from this cause reported weekly during a great many years. The acute respiratory diseases, notwithstanding the peculiar atmospheric conditions, showed a decrease of 42 deaths, heart diseases a decrease of 45 deaths, tuberculosis a decrease of 15 deaths. On the other hand, the deaths from measles and scarlet fever, especially the latter, were augmented considerably.

The mortality from the first of January, 1913, is almost one-half a point below that of the mortality of the corresponding period in 1912.

VITAL STATISTICS

Summary for Week Ending Saturday, 12 m., January 25, 1913.

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Corrected according to borough of residence.

t. 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.

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Cases of Infectious and Contagious Diseases Reported.

Week Ending

Oct. Noy Nov. Nov. Nov. Nov. Dec. Dec.
26.1 2. 9. 16. 23. 30. 7. 14.

Dec.
21,

Dec. Jan. Jan. Jan. Jan.

1
28.
4. II. 18.

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311

452

394

296

332 338

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Tuberculosis... 398

452
364
402
485

365

295
497 483

+56 Diphtheria and Croup.. 272 305 292 332 293 317 309 318

3381 280 397 363 Measles 104 91 128 175 211 223

276 274 412

298 / 393 551 463 472 Scarlet Fever.. 93 102 II 118 167 182 197 232 259 283 30+

338

301 333 Smallpox...... Chickenpox.... 43

68
95
86
107
116
170 204 185 133 149

268 214 278 Typhoid Fever II2

52
62 61 52 56 49 52 21

36

23 19 Whooping

24 19 22 Cough....

30 32 32
31 45 25 12 26

50 63 Cer. Spinals

6

5 3 II 5 Meningitis.)

4 4

9
6
4

6 6 6 Total...... 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 1,991

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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 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 past 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 ai 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 61/2 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.

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