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All communications relating to the publications of the Department of Health should be

addressed to the Commissioner of Health, 149 Centre Street, New York

Entered as second-class matter May 7, 1913, at the post office at New York, N. Y.,

under the Act of August 24, 1912.

NEW SERIES. VOL. II.

OCTOBER 25, 1913.

No. 43

A DIPLOMA NOW REQUIRED OF MIDWIVES. While it is undoubtedly true that the standard required of midwives is higher at present than it was several years ago, before the Department of Health took an active interest in its elevation, it must be confessed that the standard in this city left a good deal to be desired, and was much lower than that in many European countries. With the object of remedying this deficiency, the department has decided that in future it will require the presentation of a diploma or certificate showing that the prospective midwife is a graduate of a midwifery school before a permit to practice will be issued to her. The resolution embodying this intention was passed at a meeting of the Board of Health on the 14th day of October, 1913, and reads as follows:

Resolved, That the rules governing the practice of midwifery in The City of New York adopted by the Board of Health November 8, 1907, be and the same hereby are amended, so as to read as follows; the same to take effect on and after the 1st day of January, 1914:

Rule 3. The applicant must be twenty-one years of age or upwards, of good moral character, and able to read and write. She must be clean and constantly show evidence in general appearance, of habits of cleanliness.

The applicant must also present a diploma or certificate showing that she is a graduate of a school for midwives registered by the Board of Health of The City of New York as maintaining a satisfactory standard of preparation, instruction and course of study, but the requirement of a diploma shall not apply to any person who is now or heretofore has been authorized to practice midwifery by the said Board.

SEGREGATION OF TUBERCULOUS VISITORS AT OTISVILLE.

In the past it has occasionally happened that a visitor to the Otisville sanatorium for tuberculosis has been a sufferer from this disease, and while these instances have been very infrequent, the propriety of lodging such visitors in the Administration Building has been recently questioned. It was therefore decided at a meeting of the Board of Health of the Department of Health held October 14, as stated in full in the resolution that follows, that in future when it shall be necessary for tuberculous visitors to remain over night, they shall be housed at the Male or Female Unit. The following is the resolution:

Resolved, That the following rules and regulations for the protection of nontuberculous employees at the Municipal Sanatorium, located at Otisville, N. Y., be and the same are hereby adopted:

Whereas, The Administration Building at Otisville is occupied by non-tuberculous employees and is used for the accommodation of official visitors and others having business at the Sanatorium, and,

Whereas, Facilities for the proper care of tuberculous individuals do not exist at the Administration Building, but are provided at the East and West Units of the Sanatorium, and

Whereas, It is imperative that all non-tuberculous employees and inspectors be carefully protected against tuberculous infection, and,

Whereas, Many tuberculous persons visit the Sanatorium in an official capacity or on other busines; be it, therefore,

Resolved, For the protection of other employees and inspectors visiting Otisville, it is directed that hereafter whenever City employees or other persons suffering from pulmonary tuberculosis visit the institution, either in an official or unofficial capacity, that they be provided with accommodations at the Male or Female Units. Under no conditions will such persons be cared for at the Administration Building or elsewhere on the plant.

THE "BETTER BABIES'” CONTESTS. Since July 1, 1912, some twelve better babies' contests have been held in the Greater City by the various social service organizations, most of which are connected with the Babies' Welfare Association. This association is composed of some eighty separate organizations, and works in close co-operation with the Department of Health, through the latter's Division of Child Hygiene.

In every case the physicians and nurses of the Division of Child Hygiene and those connected with the Infants' Milk Stations have co-operated fully by canvassing the immediate neighborhood and by informing mothers as to the nature of these contests and their locations. They also assisted in the registration of the babies at the various milk stations, public schools and social centres where the contests were held.

The physicians have conducted the mental and physical examinations and measurements, and have recorded on the standard score cards the various points to which each child is entitled.

The nurses have been of special service in registering the babies, in assisting at the recording of results of the preliminary examinations, in dressing and undressing the children, and in eliminating cases in which contagious diseases are suspected.

During the month of October, three contests were held in the district of the Chelsea Dav Nursery Association, at the Nazareth Day Nursery. 216 West 15th street, at the Northwestern Dispensarv. 403 West 36th street, and at the Infants' Milk Station of the Department of Health, 289 Tenth avenue.

It is hoped, and confidently expected, that these better babies' contests will prove an important addition to the methods already employed by the Department of Health in the reduction of infant mortalitv. and by which the infant death rate has been reduced from 181 in 1902 to 105 in 1912.

APPOINTMENT OF MEDICAL ADVISER TO VENEREAL CLINICS.

The following, in the form of a letter, has been sent to all physicians in the City, and it is hoped that it will receive their approval and insure their further co-operation in the campaign against venereal diseases.

In accordance with the policy announced some time ago, the Department of Health of New York City has for some months conducted two diagnostic clinics for venereal diseases, where physicians may send patients for Wassermann tests for syphilis, for the complement deviation test for gonococcus infection, microscopical examination for treponema pallida in fresh specimens and gonococci. Under no circumstances are the results of these examinations communicated to anyone_but the physician sending the case. All the examinations are made free of charge. That the diagnostic aid thus afforded practicing physicians is appreciated, is evident from the rapid increase in the number of cases examined since the inauguration of this work. About 200 examinations a day are now being made.

In order to extend the usefulness of these clinics in combating the spread of the venereal diseases, a specially trained physician has been appointed to act as "Medical Adviser” to the patients attending the clinic. Under no circumstances will he treat cases. His duties consist in advising patients as to the nature of the disease, the necessity of proper medical care, the dangers of self-treatment, and the importance of obeying the directions of their physicians. Upon request, the "Medical Adviser" will also instruct the patient regarding the nature of venereal infections, their mode of spread, ordinary course, complications and far-reaching effects and in various questions of sexual hygiene.

The establishment of these venereal clinics has been disapproved by some physicians on the ground that ample facilities for the free treatment of venereal diseases now exist. It is apparent that this objection is based on a complete misunderstanding of the diagnostic function of the clinic, and the duties of the "Medical Adviser." From what has been said it will be clear that not only will the medical advice given in no way interfere with the legitimate work of private physicians and dispensaries, but that it will materially aid them in successfully treating their patients.

DEATH RATE FOR THE WEEK. There were 1,160 deaths and a rate of 11.26 per 1,000 reported during the past week, as compared with 1,238 deaths and a rate of 12.48 for the corresponding week of 1912, a decrease of 1.32 points in the rate, and a relative decrease of 126 deaths. The rate of the week ending October 18, 1913, was 11.20 per 1,000, and was the lowest weekly mortality that has ever been recorded in the history of the department. The mortality of the week just past stands as the second lowest death rate since the organization of the department in 1866.

The combined deaths from measles and scarlet fever numbered 6 against 3 during the corresponding week of 1912. The death rates from diphtheria and croup, typhoid fever and diarrhoeal diseases were approximately the same, while that from whooping cough increased considerably. The greatest decrease was among the deaths from lobar pneunionia, the figures for the past week being 51 against 89 deaths. Organic heart disease and Bright's disease of the kidneys showed a slightly decreased mortality. The only cause showing a considerable increase was pulmonary tuberculosis, there being 138 deaths recorded as against 122 deaths for the corresponding week in 1912.

Viewed from the standpoint of age groupings, the mortality under five years was approximately the same, while that among adults and old people was considerably below the mortality of the corresponding week of 1912.

The death rate for the first forty-three weeks of the year was 13.93 per 1,000 of the population as against 14.24 per 1,000 during the corresponding period of 1912, a decrease of .31 of a point.

VITAL STATISTICS
Summary for Week Ending Saturday, 12 M., October 25, 1913.

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*Corrected, 1913

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