Vacancies at Otisville (except young children) will always be filled first from cases already under observation at the Riverside Sanatorium. They will be sent to Otisville direct on Thursday of each week, from the Reception Pavilions in the Riverside Sanatorium. Ample opportunity will be given to patients in the Reception Pavilions, when necessary, to visit their homes and arrange their affairs before their departure for Otisville.

TYPHOID FEVER IN SEPTEMBER. The epidemic of typhoid fever from which the eastern and lower sections of the city have suffered since the early part of the month has apparently reached its maximum and its gradual decline may now be expected to take place. In relation to its causation and aspects, Commissioner Lederle issued on September 25 the following statement to the public:

"In order to emphasize to the citizens of New York the lesson involved in the present localized outbreak of typhoid fever and to correct possible misapprehensions and uncertainty arising from unauthorized statements which have been published in this connection, I wish to make public the following facts as to the recent cases and the action taken by the Department of Health.

"Until the beginning of the present outbreak, the record of typhoid fever in New York City, in 1912 and 1913, had been the lowest in the history of the city. On September 3, 1913, several unreported cases of typhoid fever in East 21st street, were discovered by Inspectors of the Department. Other foci of the disease developed in the middle eastern section of Manhattan below 40th street and also on the lower east side. Up to 5 p. m. Wednesday, September 24, 271 cases have been reported to the Department from the east side, between 40th street and the Battery. Following its usual methods, the special staff of the Department of Health which is assigned to the continuous observation of typhoid fever in New York, began a special investigation of these cases and in two days the evidence against certain milk supply in the class known as 'Grade B Raw' had become so strong, that the Department excluded from the City the milk from this particular source until it could be pasteurized. Since that date, September 5. no raw milk from the source suspected has been allowed to enter the City. The entire course of the subsequent investigation has tended to strengthen the suspicion that the cause of this outbreak was an infection transmitted through raw milk In over 60 per cent, of the cases investigated to date the families are found to have been supplied with milk of the same company. It is considered that most of these cases which have been reported to date, were infected prior to September 5 although clue allowance should be made for other cases which may have been infected by direct contact with patients who had contracted the clisease previous to September 5 from the source suspected. Every possible precaution is being taken by the Department in accordance with established methods of administrative supervision to prevent the further spread of the disease. While all danger from the original source was removed by the pasteurization of the milk beginning September 5, the Department is continuing its investigation in order to determine the ultimate source of the original infection hoping to find conlirmation of the present hypothesis in some care or typhoid carrier in the region from which this particular milk supply was drawn. So far this investigation has not warranted a definite conclusion.

“The present outbreak serves as one more emphatic warning to the public of the risk that accompanies the drinking, in New York, of any raw milk except that in 'Grade A. For the past four years the Department of Health has incessantly urged the necessity of pasteurization. By increasingly stringent regulations, the Board of Health has raised the proportion of pasteurized milk to the total supply, from about 7 per cent. in 1910 to over 50 per cent. at the present time. The main object of the grading system which the Department has put in force was to extend the scope of pa' teurization with due consideration of economic conditions and the need of keeping the price of milk within the reach of the poor. This made necessary, at least, temporary provision for a class of raw milk in Grade B. The standard for this raw milk, however, was set much higher than that which was in vogue for the general milk supply, previous to 1910. It has been the definite purpose of the Board to bring about as rapidly a possible the pasteurization of all but a small fraction of the milk supply of New York City and to eliminate the class of raw milk in Grade B. If observations thus far made, with reference to the present outbreak, should be confirmed on subsequent investigations, sufficient evidence would then be provided to justify the Department in insisting at the earliest possible date on pasteurization of the class of

milk now designated as 'Grade-B-Raw. The adoption of such a requirement would mean that all milk sold in New York, excepting Grade A milk, would require to be pasteurized.

"In the meantime the advice to the public which the Department has given on so many occasions, is again repeated, and all citizens of New York should realize that the only way to be insured against disease transmitted through milk, is, to use only Grade A milk, or milk which has been pasteurized, or brought to the boiling point.”

DEATH RATE FOR WEEK ENDING SEPTEMBER 27, 1913. There were 1,237 deaths and a rate of 12.01 per 1,000 population reported during the week just past, as against 1,194 deaths and a rate of 12.04 during the corresponding week of 1912, an increase of 43 deaths and a decrease of .03 of a point in the rate, which is equivalent to an actual decrease of 3 deaths, if the increase in population be taken into consideration.

The number of deaths from measles and scarlet fever was so small as to be almost negligible. There were 14 deaths reported from diphtheria, an increase of 2, and 11 deaths from whooping cough, an increase of 4 over the figures of last year. The typhoid fever mortality showed an increase from 7 deaths in the week ending September 28, 1912, to 14 deaths in the week just past. On the other hand, the Borough of Brooklyn showed a decrease from 12 deaths to 2 deaths, more than offsetting the increased mortality in the Borough of Manhattan. The number of deaths from this cause reported in the entire City during the week was 20 as against 22 in the corresponding week of last year. The mortality from the diarrhoeal diseases was considerably below that of last year, the deaths reported numbering 109 under five years of age as against 169, a decrease of 55 per cent. Organic heart diseases showed an increase of 33 deaths, pneumonia 26 deaths, Bright's disease and nephritis 18 deaths, pulmonary tuberculosis 6 deaths.

There were 10 fewer deaths reported of children under one year of age, and 22 fewer deaths of children between the ages of one and five years. To offset this decreased mortality there were 41 more deaths reported between the ages of five and sixty-five, and 34 more deaths at sixty-five years and over.

The causes showing increases were those found in adult and advanced life.

The death rate for the first thirty-nine weeks of the year 1913 was 14.15 per thousand as against 14.37 during the corresponding period of 1912, a decrease of 22 of a point.

VITAL STATISTICS

Summary for Week Ending Saturday, 12 M., September 27, 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.

Week Ending.

July July 'July Aug.' Aug. Aug. Aug. Aug. Sept. Sept.' Sept. Sept. 12. 19 26. 2. 9. 16. 23 30. 0. 13

27

20

495

175

154

359
128
IIS
4€

2191

l'uperculosis..

423
397 414 381
337 434 350 456 392

342 Diphtheria and Croup. 228 187 192 167

161

210
1
157 181

212 Measles ...

522 409 303

220
172

100
121

72 53 50 Scarlet Fever..

16 77 77 56 69 50

56
63 43

73 Smallpox...... Chicken pox...

32
22

7

10 10 TO 22 Typhoid fever..

47
68
73 65

116 145 206 Whooping Cough

54 72

37
49
35 40

52 72 Cerebro Spinal Meningitis..

10
5
7

6

8 Syphilis . 175 244 153 193 1 22 237

226 167 171 303 182 Gonorrhea 51 80 114 52 96

102
167 40 188

150 74 Chancroid

I
2
II 5, 13 11

9 7 27 19 9 Total

1,640 1,626 1,377 1,271 1,141 1,120 1,118 1,367
1

983 1,215 1,386 1,274
Infectious and Contagious Diseases in Hospital,
Willard Parker

Otisville
Riverside Hospital.
Hospital

Kingston Ave. Hospital. Sana

torium

..

Deaths According to Cause, Age and Sex.

5

..

8

64

6

1. Typhoid Fever.... 3. Malarial Fever... 4. Small-pox... 5. Measles.. 6. Scarlet Fever. 7. Whooping Cough, 8. Diphtheria and

Croup 9. Influenza... 12. Other Epidemic

3 Diseases.. 13. Tuberculosis Pul-/

132 monalis.... 14. Tuberculous Men15. Other forms of

6 Tuberculosis... 16. Cancer, Malignant 'Tumor.

95 17. Simple Meningitis 9

of which 172 Cerebro Spinal

6 Meningitis.... 18. Apoplexy, Soften

18 ing of the Brain 19 Organic Heart Diseases..

153 20. Acute Bronchitis..

7 21. Chronic Bronchitis, 22. Pneumonia (ex-) cluding Broncho

44 Pneumonia)... 22a. Broncho Pneumonia 63 23. Other Respira- 6

tory Diseases.. 24. Diseases of the

Stomach (Can- 5

cer excepted). 25. Diarrhæaldiseases

(under 5 years) 26. Appendicitis and

Typhilitis.... 27. Heensar Intestinal

6 Obstruction.... 28. Cirrhosis of Liver.. 29, Bright's Disease

103 and Ac.Nephritis 30. Diseases of Wom!

en (not Cancer) 31. Puerperal Septi

cæmia.. 32 Other Puerperal

8 Diseases. 33. Congenital

De-
bility and Mal-

109
formations.....
34. Old Age.....
35. Violent Deaths.

a. Effects of Heat
b. Other Accidents. 67
c. Homicide...

3
36. Suicide
37. All other causes.. 167
38. Ill-defined causes

* If the deaths under one month, numbering 109, from all causes, be deducted from the total deaths under one year, the resultant rate will be 73 deaths of infants per 1,000 births (weekly average July 1, 1912 to July 1, 1913)

Corrected Mortality Among Children, Week Ending September 27, 1913.

• Includes Spall 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.

Week Ending – June July | July | July July Aug. Aug. Aug. Aug. Aug. Sept. Sept. Sept. Sept.

30.

12.

19.

26.

2

9

16.

23

6.

13.

20

27

61.

62.7

167.6

or snow....

Mean barometer. 29.89 29.89 29.76 29.80 29.88 29.63 29.91 29.99 29.99 29.86 30.06 30.01 30.08 29.98 Mean humidity.. 73.7 65.4 60. 59.

71. 68 00 65 € 62. 09.3 83

72. Inches of rain

.08in .67in .63in .45 in. 1.17 in 3.64in 1.08 n 0.13in .49in 18in 4.15in .47in 1.18in 1.2oin Mean temperature (Fahr-73.44 79.0 73.60 75.9° 75.o

77.30 74.99 172.925.20 172 70 71.99.64.90 '01 - 63.70 )... Maximum temperature 87.095.

88.
95.' 90. 95.'

84.86. 77. 77. Fahrenheit)

1 Minimum tem

perature 62.o 66.° 58.° 62.9 60.9 64.0 63.o 60. 61.o 60.” 61.9 49.945."148.° (Fahrenheit)

91.9

90.