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WEEKLY BULLETIN

OF THE

Department of Health of the City of New York

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BOARD OF HEALTH

ERNST J. LEDERLE, Ph.D...
JOSEPH J. O'CONNELL, M.D.
RHINELANDER WALDO..

Commissioner of Health, President
Health Officer of the Port
Police Commissioner

HERMANN M. BIGGS, M.D..
EUGENE W. SCHEFFER..

.General Medical Officer .. Secretary

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.

DECEMBER 20, 1913.

No. 51

RETIREMENT OF DR. HERMANN M. BIGGS. On December 9th, in a communication to the Commissioner, dealing shortly with the advances made in sanitation in this City during the last twenty years, Dr. Hermann M. Biggs, General Medical Officer, severed his connection with the Department of Health. An abstract of Dr. Biggs' letter follows, certain parts of which will be of interest to the thoughtful citizen alive to "the irresponsible public criticism so much in vogue and not always free from the bias of interest."

Dr. Biggs states that during the twenty-six years of his connection with the department “a complete and remarkable transformation has taken place in the sanitary administration of The City of New York. No one twenty-five years ago could have anticipated the wonderful progress which has been made in preventive medicine."

“This progress has been possible only through the scientific developments oí this period, especially in bacteriology and in the discovery of new curative and protective methods.

"But the Department of Health of New York City has set the pace, for this and other countries, in the prompt practical application of the new achievements of science and the lessons of experience.

"I do not believe that the citizens of New York fully realize how far in advance of most of the great cities of the world our administration of the health service has been. During frequent visits to Europe in the last twenty years, I have made a careful study of the work of the health authorities in Great Britain, France and Germany, and have been greatly impressed with the fact that they were but slowly, and often very incompletely, adopting the measures which had proved most successful here. This fact has been long recognized in Europe and the authorities there constantly look to New York for suggestions and directions in new methods in sanitary work.

"Vany years ago Robert Koch, the most eminent bacteriologist of his generation, referred to the campaign for the prevention of tuberculosis which was being waged by the Department of Health as constituting a model which the authorities of every German city could imitate. Sir Robert Philip, of Edinburgh; Doctor Newsholme, Chief Medical Officer of the Local Government Board of England; Professor Gaertner, Professor of Hygiene in the University of Jena; Professor Loeffler, of the University of Greifswald, and many others, after a careful study of the methods employed here, have spoken most enthusiastically of the work that was being done by the Department of Health of New York City.

"I refer to this fact because in the irresponsible public criticism, which is so much in vogue in these days, and is not always free from the bias of a limited interest, there is a risk that the real facts in the situation may be obscured, and that the confidence and pride in the work of the Department which the people of The City of New York have had and should have, may be disturbed or destroyed. Such a condition would affect most unfavorably the authority, influence, and effective work which the Department is doing.

"A glance backward over this quarter of a century shows a prompt and complete readjustment of the administration of the Department to meet the new and more precise conception of the infectious diseases which the new bacteriology created.

“An effective laboratory section has been organized which has steadily kept pace with the advancements of science to which it has in many noteworthy ways contributed. It has won general recognition, in this and other countries for its early practical application of new methods of diagnosis to the needs of the citizens of all classes, in the preparation and in improving the efficiency of curative sera and other protective agents.

"Step by step, and often in the face of serious obstacles, the Department has proceeded in the education of the people in the ways of safeguarding themselves against infection and in minimizing its occasional occurrence. Thus the ravages of tuberculosis, diphtheria, smallpox, scarlatina, typhoid fever, and other infective maladies, have been largely limited. And the way has been recently opened for a more effective crusade against the venereal diseases.

"The construction and administration of hospitals for the contagious and communicable diseases have been revolutionized within this period, and with the most gratifying results.

"The Department was the pioneer in the establishment of a municipal Visiting Nurse service, which promises to be one of the most distinctive marks of the period. in linking medical to social service, for the welfare of the poor.

"The physical handicaps of many children in the schools have been greatly reduced through the medical inspection service which is wholly the growth of these later years.

“In the face of enormous complexities and baffling numerical limitations of the inspection service, the milk and food supplies of the City have been in tlie fullest practicable degree safeguarded against the ever threatened forces of ignorance, indifference, cupidity and fraud.

“The work for the prevention of infant mortality has been attended with an ever increasing and really remarkable success.

“Notwithstanding the enormous difficulties which exist in the sanitary admin istration of a city like New York, because of the density of population, and its cosmopolitan character; and notwithstanding the hundreds of thousands of foreign. ers, who are yearly added to its population for a longer or shorter period, the death rate of the City has gradually but steadily declined, until it is now lower than the death rate for the remainder of the State, and lower even than that of the rural population of the State. All of the enormous advantages which the rural districts naturally possess have been more than counterbalanced in a denseli crowded city by the application of scientific measures for the prevention of disease.

"The death rate of New York City now compares favorably with that of the most healthy of the great cities of the world, where the conditions are naturally much better and in which a dense population of different nationalities is lacking. and in which the difficulties of administration are infinitely less.

“Twenty-five years ago the death rate of the old City of New York was about 26 per thousand of the population. In the present vear, unless some unforeseen conditions arise, it will be about 13.8. a reduction of almost 50 per cent. If the death rate in 1913 should be what it was in 1888. there would have been nearly 65,000 more deatlıs in the City than actually occurred.

"While I would not intimate that this reduction has been wholly due to the activities of the Department of Health-on the contrary, the work of many departments and the influence of many factors, have contributed greatly to the result-yet, by far the largest single factor, and, in my judgment, more influential than all the others combined, has been the work of this Department,

"This decrease in the death rate signifies that a number of years has been added to the mean lifetime of every citizen of the City, and that there has been an enormous decrease in the amount of sickness.

“It has been estimated that, at least, ten cases of somewhat serious illness occur in a community for every death. In other words, there will have been in 1913 650,000 less cases of serious illness in the City than would have occurred had the sanitary conditions of 1888 still obtained. It would be quite impossible accurately to estimate the enormous economic saving which this change has brough, about. The value of the lives saved the decrease in expenditure for physicians, nurses and medicines, the decrease in the wages lost because of illness—to say nothing of the impaired efficiency, physical suffering and mental distress averted-would amount to an enormous sum.

"Several years ago the Board of Health adopted the motto— Public Health is purchasable. Within natural limitations every community can determine its own death rate.' The officers responsible for the financial allotments of the City for a long time have accepted, in part at least, this dictum and have been usually generous in their appropriations to the Department. They have appreciated the large returns which the City receives for expenditures for health purposes and the Department has been able to show that in the long run additional appropriations have brought substantial results.

“I have been particularly interested in these recent years in the Municipal Tuberculosis Sanatorium at Otisville, for the direction and developinent of which I have been responsible. This institution is in many respects unique and, while in has already a capacity of six hundred patients, it promises great possibilities for future development and still greater usefulness. The Board has especially em phasized in the construction and maintenance of this institution its policy of making only the minimum expenditure in hospital construction which is necessary for the physical welfare of the patients.

“It has been a source of profound gratification to me to have taken part in the work of the Department of Health during these years and to have contributed in some small measure to the results which have been secured. And it has been a great pleasure, Mr. Commissioner, to have had the privilege of association with you during your two terms of service, in your wise, conscientious and efficient administration of the affairs of the Department.

"If, in the judgment of the Board, i can be useful in the future to the Depariment of Health in any capacity as a volunteer, I shall esteem it both a pleasure and a privilege."

DEATH RATE FOR WEEK ENDING DECEMBER 20, 1913. There were 1,439 deaths, and a death rate of 13.97 per 1,000 of the population during the past week, as against 1,481 deaths, and a rate of 14.93 for the corresponding week in 1912, a decrease of 42 deaths—if the increase in population be taken into consideration, the decrease is equivalent to 99 deaths and of 96 of a point in the rate.

The following causes show material decreases: Scarlet fever, lobar and bronchen pneumonia, pulmonary tuberculosis, Bright's disease and nephritis, and diseases of the nervous system. Those causes showing an increased mortality were measles, diphtheria and croup, typhoid fever, diarrhoeal diseases under five years, organic heari diseases and tuberculous diseases other than pulmonary tuberculosis.

Viewed from the point of age grouping, there was an increase in the numlier ni deaths under one year of age from 204 to 233, and an increase of one death of children at ages one to four years, inclusive. There was also an increase noted in deaths of persons between five and sixty-five years of age, the only age group showing a decrease being that of sixty-five years and over, at which the decrease amounted to 18 deaths.

The death rate for the first fifty-one weeks of the year 1913 was 13.78 per 1.000 of the population as against a rate of 14.10 for the corresponding period in 1912, a decrease of .32 of a point. The death rate for the entire year bids fair to be the lowest in the history of the City, and will probably not go higher than 13.80.

VITAL STATISTICS
Summary for Week Ending Saturday, 12 M., December 20, 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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