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Headquarters: S. W. Corner Centre and Walker Streets, Borough of Manhattan

Telephone, 6280 Franklin.
Borough of The Bronx, 3731 Third Avenue.

Telephone, 1975 Tremont. Borough of Brooklyn, Flatbush Avenue and Willoughby Street. Telephone, 4720 Main. Borough of Queens, 372-374 Fulton Street, Jamaica, L. I..

Telephone, 1200 Jarnaica. Borough of Richmond, 514-516 Bay Street, Stapleton, S. I..

Telephone, 440 Tompkinsville Office Hours--9 a.m. to 5 p.m.; Saturdays, 9 a.m. to 12 m.

Manhattan-Willard Parker Hospital, foot of East 16th Street. Telephone, 1600 Stuyvesant.
The Bronx-Riverside Hospital, North Brother Island. Telephone, 4000 Melrose.
Brooklyn-Kingston Avenue Hospital, Kingston Avenue and Fenimore Street. Telephone, 4400 Flatbush.

Diagnosis Laboratory, Centre and Walker Streets. Telephone, 6280 Franklin.
Serological Laboratory, Centre and Walker Streets. Telephone, 6280 Franklin.
Research Laboratory.

Chemical Laboratory, Vaccine Laboratory. Drug Laboratory.
Foot of East Sixteenth Street. Telephone, 1600 Stuyvesant.


Manhattan 1. 172 East 3d St.

8. Vanderbilt Clinic

421 East 74th St.

73 Cannon St. 2. 513 East 11th St.

9. 326 East 11th St. 16. 205 East 96th St. 23. 110 Sufiolk St. 3. 281 Avenue A

10. 114 Thompson St. 17. 209 Stanton St. 24. 96 Monroe St. 4. 210 East 28th St.

11. 315 East 112th St. 18. 2257 First Ave. 25. 251 Monroe St. 5. 225 East 107th St. 12. 244 Mulberry St.


108 Cherry St. 26. 289 Tenth Ave. 6. 241 East 40th St.

13. 508 West 47th St. 20. 122 Mulberry St. 27. 74 Allen St. 7. 174 Eldridge St.

14. 78 Ninth Ave.

21. 207 Division St.

Brooklyn 1. 268 South 2d St.

7. 359 Manhattan Ave. 13. 651 Manhattan Ave. 19. 698 Henry St. 2. 660 Fourth Ave.

8. 49 Carroll St.

14. 185 Bedford Ave. 20. 552 Sutter Ave. 3. 208 Hoyt St.

9. 69 Johnson Av. 15. 296 Bushwick Ave. 21. 167 Hopkins St. 4. 176 Hudson Ave.

233 Suydam St. 16.

994 Flushing Ave. 22. 604 Park Ave. 5. 2346 Pacific St.

11. 329 Osborne St. 17. 176 Nassau St. 23. 239 Graham Ave. 6. 184 Fourth Ave.

12. 126 Dupont St. 18. 129 Osborn St. 24. 49 Amboy St. The Bronx-1. 511 East 149th Street. 2. 1354 Webster Avenue. Queens-1. 114 Fulton Avenue, Astoria, L. I. Richmond-1. 689 Bay Street, Stapleton, S. I.


Hours: 2-5 p. m. Saturdays, 9-12 m.
Manhattan-Gouverneur Slip. Telephone, 2916 Orchard.

Pleasant Avenue and 118th Street. Telephone, 972 Harlem.
164 Second Avenue. Telephone, 2081 Orchard.
449 East 121st Street. Telephone, 3230 Harlem.

P. S. 144 Hester and Allen Streets. Telephone, 5960 Orchard.
Brooklyn-330 Throop Avenue. Telephone, 5379 Williamsburg.

124 Lawrence Street. Telephone, 5623 Main.

1219 Herkimer Street. Telephone, 2684 East New York. The Bronx-580 East 169th Street. Telephone, 2558 Tremont. Richmond-689 Bay Street. (Dental only). Telephone, 686 W. Tompkinsville.

Manhattan-Centre and Walker Streets. Week days, 9 to 10 a.m.
307 West 33d Street Wednesdays, 8 to 9 p.m.

Manhattan-West Side Clinic, 307 West 33d Street. Telephone, 3171 Murray Hill.

East Side Clinic, 81 Second Street. Telephone, 5586 Orchard.
Harlem Italian Clinic, 420 East 116th Street. Telephone, 2375 Harlem.
Southern Italian Clinic, 22 Van Dam Street. Telephone, 412 Spring.

Day Camp, Ferryboat “Middletown," foot of East 91st Street. Telephone, 2957 Lenox.
The Bronx-Northern Clinic, St. Pauls Place and Third Avenue. Telephone, 1975 Tremont.

Southern Clinic, 493 East 139th Street. Telephone, 5702 Melrose.
Brooklyn-Main Clinic, Fleet and Willoughby Streets. Telephone, 4720 Main.

Germantown Clinic, 55 Sumner Avenue. Telephone, 3228 Williamsburg.
Brownsville Clinic, 64 Pennsylvania Avenue. Telephone, 2732 East New York.
Eastern District Clinic, 306 South 5th Street, Williamsburg. Telephone, 1293 Williamsburg.

Day Camp, Ferryboat “Rutherford," foot of Fulton St. Tel., 1530 Main.
Queens- Jamaica Clinic, 10 Union Avenue, Jamaica. Telephone, 1386 Jamaica.
Richmond-Richmond ( linic, Bay and Elizabeth Streets, Stapleton. Telephone, 1558 Tompkinsville.

SANATORIUM FOR TUBERCULOSIS Otisville, Orange County, N. Y. (via Erie Railroad from Jersey City). Telephone, 13 Otisville.

TUBERCULOSIS HOSPITAL ADMISSION BUREAU Maintained by the Department of Health, the Department of Public Charities, and Bellevue and Allied

Hospitals, 426 First Avenue. Telephone, 8667 Madison Square. Hours 9 a.m. to 5 p.m.



3.22-K-13 (B) 200

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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.

NOVEMBER 29, 1913.

No. 48


GRADING OF MILK SUPPLY IN SOUTH AFRICA. Under date of September 12, 1913, Commissioner Lederle received a communication from Charles Porter, M. D., D. P. H., Medical Officer of Health of the City of Johannesburg, British South Africa, enclosing a report entitled “On the Circumstances of Milk Production in and Around Johannesburg," which is of considerable interest to the Department of Health of The City of New York. Dr. Porter writes "you will observe that we have quoted your regulations in regard to the use of ‘milk coolers,' and also your practice in regard to 'card inspection of dairies' and 'classification of market milks. He also states that the projected milk reform is meeting with much opposition and difticulty, principally on account of the fact that Johannesburg is a very cosmopolitan community and the milk trade has fallen largely into the hands of the uncleanly portion of the population. As an instance, he cites a case in which a dead fowl, and in yet another, a dead rat, were observed in the source of the dairy supply. He calls attention to the fact that "In Washington and New York, * * * the Board of Health has undertaken, both for the protection of the public and of the honest up-to-date dairyman, a system of classification of milk under the headings of 'certified milk'‘inspected milk' and 'pasteurized milk.' In America, this classification is largely based upon the results of a system of periodical "card-inspection of dairies (vide p. 20), wherein marks are assigned for each of the various attributes of a well-ordered dairy, e. g., structure, cleanliness, water supply, etc.” Dr. Porter then recommends that the inspection of milk at its source be made as thorough as possible, and that the classifications employed in New York City and Washington be adopted by the City of Johannesburg.

PHOTOGRAPHIC REPRODUCTION OF RECORDS. For some time past the Manhattan office of the Bureau of Records has been experimenting with the issuing of photographic copies of records in lieu of written or typewritten transcripts, and it is felt that while there may be a few minor difficulties to be overcome the process on the whole has proven its practicability. It is hoped that in the near future the bureau will be able to install two machines that will be able to perform most of the transcribing work of the bureau,

The certificate to be photographed is placed in a holding frame, an exposure is made of from five to twelve seconds, the photograph being made directly upon the paper without the use of a negative. The box of the camera contains a large roll of this specially prepared paper, the desired amount of which is unrolled, exposed, passed on to the developing tank, automatically cut and thrown into the fixing bath from which it is withdrawn completed save the washing process.

The advantages of the photographic copies over those written or typewritten are many, perhaps the most important being the absolute accuracy of the copy, and the next most important, the amount of time the process saves.

The method is found to be a great time saver in making copies of foreign permits for burial which accompany the remains of persons who die abroad. These permits consist usually of five or six official documents, written in a foreign language, usually illegibly, and ornamented with a great number of seals and signatures. The task of copying such documents in longhand is most tedious, and a thorough knowledge of the language is necessary in order to decipher them. By the photographic method, however, the sheets may be copied at the rate of two per minute and an exact reproduction of the original papers secured.

Aside from making photographic copies of births, marriages and deaths, the machines have many other uses that can and will be developed from time to time.


A communication recently received from Miss F. Elizabeth Crowell, Executive Secretary of the Association of Tuberculosis Clinics, contained a statement that at the last meeting of the Directors of the Association, the adoption of a new classification of cases and results of treatment, as recommended by the National Association for the Study and Prevention of Tuberculosis at its annual meeting, was brought up for discussion.

It was finally resolved that the Directors recommend to the Association the adoption of this new classification and the Secretary was directed to send this recommendation to the chief of each clinic requesting his opinion thereon. The Executive Secretary desired also to be informed whether the Department of Health would regard the adoption of this new classification as feasible for use in the clinics of the Department of Health. The new classification will be adopted by the Department of Health on January 1, 1914, and presents many advantages over the old. The differences are shown in the subjoined table.

Classification of Patients on Examination.

Neue. 1. Incipient (Favorable)--Slight initial 1. Incipient-Slight or no constitutional lesion in the form of infiltration limited' symptoms (including particulvly gastric to the apex of a small part of one lobe. or intestinal disturbances or rapid loss of

No tuberculous complications. Slight weight). or no constitutional symptoms (particular- Slight or no elevation of temperature ly including gastric or intestinal disturb- or acceleration of pulse at any time durances or rapid loss of weight).

ing the twenty-four hours. Slight or no elevation of temperature Expectoration usually small in amount or acceleration of pulse at any time dur- or absent. ing the twenty-four hours, especially after Tubercle bacilli may be present or abrest.

Expectoration usually small in amount Slight infiltration limited to the apex of or absent.

I one or both lungs, or a small part of one Tubercle bacilli may be present or ab-, lobe. sent.

i No tuberculous complications. 2. Moderately Advanced No marked 2. Moderately Advanced-No marked impairment of function either local or impairment of function, either local or constitutional

constitutional Localized consolidation moderate in ex- Marked infiltration more extensive than tent with little or no evidences of de- under incipient, with little or no evidence struction of tissue, or disseminated fibroid of cavity formation. deposits; no serious complications.

No serious tuberculous complications. 3. Far Advanced-Marked impairment 3. Far Advanced--Marked impairment of function, local and constitutional. of function, local and constitutional.

Localized consolidation intense, or dis- Extensive localized infiltration or conseminated areas of softening, or serious solidation in one or more lobes, or discomplications

seminated areas of cavity formation, or serious tuberculous complications.


Classification of Subsequent Observations.

New. Cured--All constitutional symptoms and Apparently Cured-All constitutional expectoration with bacilli absent for a symptoms and expectoration with bacilli period of two years under ordinary con- absent for a period of two years under ditions of life.

ordinary conditions of life. Apparently Cured-All constitutional Arrested-All constitutional symptoms symptoms and expectoration with bacilli and expectoration with bacilli absent for absent for a period of three months, the a period of six months; the physical signs physical signs to be those of a healed to be those of a healed lesion. lesion.

Apparently Arrested-All constitutional Arrested-Absence of all constitutional symptoms and expectoration with bacilli symptoms; expectoration and bacilli may absent for a period of three months, the or may not be present; physical signs sta- physical signs to be those of a healed tionary or retrogressive; the foregoing lesion. conditions to have existed for at least two Quiescent-Absence of all constitutional months.

symptoms; expectoration and bacilli may Improved-Constitutional symptoms les or may not be present; physical signs sened or entirely absent; physical signs stationary or retrogressive, the foregoing improved or unchanged; cough and ex-conditions to have existed for at least pectoration with bacilli usually present. two months.

Progressive (Unimproved)-A1l essen- Improved-Constitutional symptoms lestial symptoms and signs unabated or in- sened or entirely absent; physical signs creased.

improved or unchanged; cough and expectoration with bacilli usually present.

Unimproved-All essential symptoms and signs unabated or increased.

DEATH RATE FOR THE WEEK, There were 1,288 deaths and a death rate of 12.51 per 1,000 of the population reported during the past week as against 1,251 deaths and a rate of 12.62 for the corresponding week of 1912, an increase of 37 deaths—if the increase in population be taken into consideration, it is equivalent to a decrease of 11 deaths--and a decrease oi .11 of a point.

The following causes showed a decreased mortality, diphtheria and croup: pulmonary tuberculosis, other tuberculous diseases, Bright's disease and nephritis. Those causes showing an increased mortality were scarlet fever, whooping cougli

, typhoid fever (the increase in these three being very small), organic heart diseases, which showed an increase of 38 deaths, broncho pneumonia and violence. The figures for measles, bronchitis and lobar pneumonia were the same as those of last year.

Viewed from the point of age grouping, there were 11 more deaths of children under five years of age, 29 more deaths of people over sixty-five years of age, and 3 less deaths between the ages of five and sixty-five years.

The death rate for the first forty-eight weeks of 1913 was 13.77 per 1,000 oi the population as against 14.08 for the corresponding period of 1912.

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