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DEPARTMENT OF HEALTH

Report for Week Ending February 1, 1913

RESEARCH WORK IN RELATION TO TRACHOMA, For the past two years a special study of the various forms of conjunctivitis occurring among school children has been undertaken by the Research Laboratory of this Department in order to ascertain, if possible, what relation existed between the various forms, what proportion of such cases should be classified as trachoma, and the etiological importance of the so-called trachoma bodies discovered by Halberstadter and Prowazek. Within the past year these studies have been conducted principally in two clinics, over which the laboratory has had complete control. One of these is located in Public School 21, and to it are sent the children from sixteen schools, The second clinic, to which the severer cases are sent, is located in Public School 14, at the corner of Hester and Allen sts., and is connected with an ophthalmia school, in which the more severe and more chronic cases receive their education while treatment is in progress. This second clinic receives children from forty-two schools. To these two clinics the Medical Inspectors detailed to the public schools are supposed to send all children with “sore eyes," and the Physician in charge of the clinics is assisted by a Nurse and Laboratory Assistant and, the second clinic, by the Matron of the Ophthalmia School. All cases are visited at their homes and explicit instructions are given to the families in regard to the care of the eyes, and any cases of sore eye's found are sent to the clinics. Minute records are kept of each case. At present there are comparatively few bad eyes in these schools, and for several months past there have been no new cases showing thickening of the lids. Many cases, however, present follicles scattered over an otherwise normal conjunctiva. The latter are all under observation, under the same system that is used for the others. As a result of these studies, clinical and microscopical, some very definite conclusions have been reached in regard to certain classes of conjunctivitis occurring in children. These conclusions will shortly be published in full, after having first been presented before cither the County Medical Society or the Ophthalmological Section of the New York Academy of Medicine. For the present, suffice it to say that while they may, perhaps, not prove conclusively what class of cases should be called trachoma, they do illustrate very forcibly what class of cases should not, that is to say, what cases of conjunetivitis in children do not terminate in cicatrization and involvement of the cornea. AN OBJECTION TO THE DISCONTINUANCE OF THE FREE ADMINISTRATION OF DIPHTHERLA

ANTITOXIN. Under date of January 28, Commissioner Lederle received a communication from Dr. B. J. Beck of this City in regard to the discontinuance by the Department of the free administration of diphtheria antitoxin by its Inspectors.

Dr. Beck calls attention to the fact that in certain parts of the City the antitoxin stations located in drug stores are frequently closed at 11 p. m., and in almost all instances by 1 a. m., and, in general, are not reopened until 8 o'clock in the morning. During this period of from seven to nine hours free antitoxin cannot be obtained by a physician when its use might be sorely needed, and the only alternative to waiting until morning would be to send the case to the hospital, which might be strongly against the wishes of the parents. For the benefit of Dr. Beck and fellow physicians, to whom the same objection to the Department's recent action may have suggestel itself, it is here stated that free antitoxin can be obtained by a physician at any hour of the night at the Central Office of the Department, 149 Centre st. During the hours that the sub-stations are open, physicians will be able to obtain free antitoxin in all parts of the City for those unable to pay for its use. Immunization will be performed by Inspectors of the Department as hitherto. In those cases in which intubation is imperative, the physician must either perform intubation himself or call in some one to perform it for him. In case he is not able to intubate, and the patient is unable to afford a consultation, the Department's aid can always be summoned, but after an Inspector from the Department has performed intubation the case will be removed to the hospital.

RECENT RESOLUTIONS OF THE BOARD OF HEALTH OF INTEREST TO PHYSICIANS.

At a meeting of the Board of Health held January 21, 1913, several resolutions of interest to physicians were adopted. All these resolutions are to take effect immediately. The following new rules and regulations relate to the reporting of deaths and cases of contagious disease :

1. Reports of cases of contagious disease, of births, still-births and deaths must be written with black ink, upon blank forms provided by the Department, which will be furnished upon application, personally or by mail.

2. Certificates of death will be returned for additional information, which give any of the following diseases, without explanation as to the sole cause of death :

Abortion, cellulitis, childbirth, convulsions, erysipelas, gangrene, gastritis, hemorrhage, meningitis, metritis, miscarriage, peritonitis, phlebitis, pyæmia, septicæmia, tetanus.

(Any of these may be the result of an injury, and thus be subject for investigation by a Coroner. If it is not, the certificate should make that fact plain.)

3. No certificate will be accepted which gives a mere symptom as the sole cause of death (such as “asphyxia,” “debility," "dropsy," "heart failure," etc.), unless accompanied by a satisfactory written explanation.

4. Certificate containing palpable errors or alterations of name, date, etc., or which are illegible, will be returned, and a new certificate required, as no corrections, erasures or interlineations will be permitted.

The following resolution relating to the duties of undertakers, but which is of interest to physicians and others, was also adopted :

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Burial Permits. 1. No burial permit for a person deceased in The City of New York will be issued except in exchange for a proper certificate of death.

(If a permit already issued has been lost or mislaid, a duplicate will be issued only in exchange for an affidavit of the undertaker that the first one has been lost, and that, if found, it will be returned to the Department of Health.)

2. Certificates of death must be filled out with black ink.

3. No certificate will be accepted which has been corrected, interlined or altered in any way so as to change its meaning.

4. No certificate will be accepted which is imperfectly filled out (except for foundlings or the unknown dead), or which is illegible.

5. No earth burials are allowed below 130th st. No vault below that street shall be opened for the deposit of a body, without the approval of the Sanitary Superintendent or Assistant Sanitary Superintendent.

6. If a permit is issued for burial in the City Cemetery. the coupons are removed and retained by the Bureau of Records. If a change in the place of burial renders it necessary to use the coupons, they can be procured at the Permit Office on showing the original permit and making a written statement of the change,

(Every change in the place of burial from that originally given when the permit is issued must be reported at the Burial Permit Oifice and the permit exchanged for a new one.)

Transit Permits. 1. Transit permits will be issued for the burial in or passage through the City of bodies of persons who died outside of The City of New York oniy in exchange for the papers and evidences of identity and of the cause of death which have accompanied the body from the place of death, and upon a written statement (on blanks furnished by the Department) of the persons applying for such permits.

2. Such permits will be required in every case, excepting wlien the body is accompanied by a permit issued by the proper health officer, under the laws of the State of New York, New Jersey or Connecticut, a transit permit issued in either of those States having the same effect in The City of New York as one issued by this Department.

3. Transit permits will not, in any case, be issued in advance of the arrival of the body, whether by ship, boat or railroad, nor will such perinit be issued when the death was due to yellow fever, Asiatic cholera or smallpox, excepting by express permission of the President of the Department, on personal application to him.

4. Transit permits will be issued for the removal of a dead body from one portion of the City to another, for the convenience of the family or the undertaker. Such permit will have no coupons, and must be returned to the Department of Health when the burial permit is applied for.

Disinterment Permits. 1. Permits for the disinterment of bodies already buried within the limits of The City of New York will be issued upon written application (on blanks furnished by the Department of Health) of relatives of the deceased, or other persons who furnishi sworn evidence from such relatives that they have been authorized by them to apply for such permit.

2. Permits for disinterment must be countersigned by the Sanitary Superintendent or the Assistant Sanitary Superintendent.

3. Bodies which are disinterred must be placed in hermetically sealed caskets or coffins, unless otherwise ordered by the Sanitary Superintendent or Assistant Sanitary Superintendent.

Cemeteries. Superintendents and keepers of crematories or cemeteries must not receive permits upon which alterations have been made as to the name, age, place and cause of death, or place of burial.

Midwives.
The following resolutions relating to midwives were also adopted :

Resolved, That rule 6 of the rules and regulations governing the practice of midwifery, adopted by the Board of Health November 6, 1907, be and the same is hereby amended so as to read as follows:

6. No permit shall be granted to an applicant who has been convicted of criminal practice or "of practicing medicine illegally," and any such conviction shall be sufficient cause for revocation of the permit.

Resolved, That the following rules and regulations relating to the legal duties of midwives be and the same are hereby adopted :

Reports of births and still-births must be written with black ink upon forms provided by the Department, which will be furnished upon application, personally or by mail.

Certificates containing errors of name, date, etc., will be returned and a new certificate required.

MORTALITY OF THE WEEK ENDING FEBRUARY 1, 1913. There were 1,440 deaths reported during the week with a rate of 13.98 per 1,000 as against 1,593 deaths and a rate of 16.06 during the corresponding week of 1912, a decrease in the death rate of 2.08 points, which corresponds to a decrease of 214 deaths.

The principal causes showing decreases were the organic heart diseases, of which 69 fewer deaths were reported; pneumonias, of which 65 fewer deaths were reported; pulmonary tuberculosis, 12 fewer deaths; diseases of the nervous system, 37 fewer deaths, and violence, 17 fewer deaths. Those causes showing increases were diphtheria, 11 more deaths being reported than in the corresponding week of last year; digestive diseases, 24 more deaths; influenza, 7 more, and Bright's disease and nephritis, 9 more. Viewed from the standpoint of the age-grouping, deaths of children under five showed a decrease of 32 deaths, five to sixty-five a decrease of 21, and above sixty-five years of age a decrease of 60 deaths.

The death rate of the first five weeks of this year stands at eight-tenths of a point less than that of the corresponding weeks in 1912.

VITAL STATISTICS

Summary for Week Ending Saturday, 12 m., February 1, 1913.

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Corrected according to borough of residence.

1. 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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Tuberculosis... 452 364 402 485 311 +52 394 365 332 295 497
Diphtheria

483
+56

465 and Croup.. } 305 292 296 332 293 317 309 318 338 | 338

280

397 363 470 Measles

91
128
175
211 223 276 274 412

2981
395
551

472 454 Scarlet Fever 102 114

118

167 182 127 232 Smallpox.....

259
304

301 333 402 Chicken pox...

68
95

107
116 170 204 185 133 149

268

214 278 215 Typhoid Fever 50 52 62 61

52 56 49 52

36 23 19 Whooping

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

50 63 63 Cer-Spinali

5 Meningitis.. )

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5 4 4

2 9

6
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6 6 6

9 Total...... 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 2,127

21

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