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child caring institutions of the City the same system of physical examination of children as was provided for in the public and parochial schools.

Five Medical Inspectors were assigned to this duty, under the direction of a Chief Inspector.

For many years, under the State Public Health Law, the Department of Health, through the Division of Child Hygiene, has made monthly visits to all child-caring institutions, in order to ascertain whether the sanitary and hygienic conditions necessary for the welfare of the children were maintained. The children, themselves, however, had received no direct attention and this special appropriation made this extension of the work possible.

There are sixty-three of these institutions in New York City, divided as follows: Manhattan, 16; The Bronx, 14; Brooklyn, 25; Queens, 4, and Richmond, 4. Work under this special appropriation was begun in March. The institution managers were notified of the department's desire to give each child a physical examination with the idea of furnishing the institution with a health record of each child, so that appropriate treatment, when indicated, might be obtained for it.

In all except one instance the most cordial co-operation was met with. In the instance referred to the lack of co-operation was not on the part of the institution authorities, but was due to the objection of the attending physician.

From March 29 to October 18, 14,697 children were examined. Of these 6,486 were found to be normal, 8,211 suffering from one or more physical defects. The total number of defects found was 10,884, divided as follows: Defective vision

1,888 Defective hearing

91 Defective primary teeth

3,730 Defective permanent teeth

1,987 Defective nasal breathing

1,109 Hypertrophied tonsils

969 Defective nutrition

212 Cardiac disease

259 Pulmonary disease

363 Orthopedic defects

204 Nervous diseases

76 In general, the percentage of defects noted is about the same as that found among children in the public and parochial schools, an exception being noted in the case of defective teeth. This defect was found among the institution children in only 38 per cent of the cases, while among the children in the public and parochial schools 49 per cent, were found to have defective teeth. This condition is undoubtedly due to the greater attention paid by the institutions to defects of this nature.

After each examination the institution authorities were furnished with a record showing the physical status of the child and its need of treatment. The Medical Inspector co-operated with the institution in obtaining assistance required by the attending physician, if such were needed. In this way much volunteer corrective work has been done by the physicians of the City and appropriate treatment has been obtained at an early date.

In October these children were all re-examined to determine whether or not the treatment provided had had the desired result. It was found at that time that 2,730 or 44 per cent of the children were entirely cured: 1.868 or 30 per cent. were improved, while 1.593 or 25 per cent. remained unimproved. Considering the brief time elapsing between the original examination and the re-examination, the percentage of children cured is remarkable and indicative of what may be accomplished in safeguarding the health of children when it is possible to apply direct and prompt attention to their needs.

There can be no question whatever but that the City owes to these dependent children the same supervision over their health that it owes to the other children of the City, and even the brief time that this work has been in operation has shown the need for such supervision and the beneficial results that may be obtained.

THE STORY OF AN UNREPORTED BIRTH. Not long since application was made to this department by a father for the record of his child's birth in order that the child might gain admission to school. No record of the birth could be found, and the applicant was advised to secure a certificate of birth from the attending physician. He returned several weeks later and reported that he had made several unsuccessful attempts to secure a certificate from the physician. The doctor was then sent for and the following is his story:

A number of years ago he was called from his breakfast to attend a woman in labor; upon arriving at the house he found the child already born; in a half hour he had completed his duties and left the mother and infant in good condition. He was paid the usual house fee by the father (one fact which is indelibly impressed on the doctor's mind) and was told he need not call again as arrangements had been made to have the physicians from the Lying-In Hospital take charge of the case; that they had already been sent for and were expected any minute. Under the circumstances the doctor felt that as he had not been present at the birth, and as the case was under the care of the staff of the Lying-In Hospital before and after the confinement that it would be the duty of the hospital to report the birth. He returned to his cold breakfast and proceeded to forget the case.

Seven years later a man called at the doctor's office and demanded a certificate of birth of his child; the doctor had no recollection of the man or his wife, or of having attended at the birth of the child, and after a diligent search of his books could find no record of having patients of that name. The man left dissatisfied and returning on several occasions each time demanded a certificate of his child's birth. Finally the doctor recalled the case of his interrupted breakfast many years before; he could not, however, identify the man or his wife.

He communicated with the Hospital of the Lying-In Society, a search of their books revealed the fact that they had had such a case. The doctor then advised the father to apply to the hospital for a birth certificate, which the hospital evidently refused to supply, and the father returned and roundly abused the doctor in the presence of an office full of patients. The doctor escorted the father to his front door, gently he assures us, the father stood outside and shouted a few unpleasant epithets to the doctor, much to the doctor's chagrin and the neighbors' enjoyment.

The doctor was next served with a subpoena to appear in the Municipal Court to show why he had failed to file a certificate of birth; he was ordered by the Justice to produce his books; he did so, but neither the father not his attorney could find any record of the birth. Three days later he was served with a summons and complaint in an action to recover $2,000 damage for the bodily injury the father sustained at the time the doctor escorted him to the front door, gently as he tells us.

It is very questionable if, under the law, the doctor in this case could be held responsible for not reporting the birth.

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DEATH RATE FOR WEEK ENDING DECEMBER 27, 1913. There were 1,357 deaths and a death rate of 13.18 per 1,000 of the population reported during the past week as against 1,403 deaths and a rate of 14.15 during the corresponding week in 1912, an absolute decrease of 46 deaths, equivalent to a relative decrease of 100 deaths, and a decrease in the rate of 97 of a point.

Those causes showing material decreases were scarlet fever, diphtheria, whooping cough, organic heart diseases, lobar pneumonia and violence; those causes showing increases were measles: broncho-pneumonia, pulmonary tuberculosis, other forms of tuberculosis, Bright's disease and nephritis.

Viewed from the standpoint of age grouping there was an increased mortality of infants under one year and a diminished mortality between one and five years of age and at sixty-five years and over.

The death rate for the first fifty-two weeks of the year was 13.75, as against a rate of 14.08 during the corresponding period of 1912, a decrease of .33 of a point.

VITAL STATISTICS

Summary for Week Ending Saturday, 12 M., December 27, 1913.

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rected,

1913

49 14 C6 23.76 | 13.72 51463 12.68 12.06 42 14.12 12.38 12.64 17 1295 12.32 13.05

18.58 19.59 16.87 113 14.15 13.18

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*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.

5-65 Years.

and Over. | 65 Years

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Cases of Infectious and Contagious Diseases Reported.

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18.

Oct., Nov. Nov. Nov
25. 1. 8. 15.

Nov. Nov. Dec. Dec. Dec.

29. 6. 13

Dec 27.

22

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1,349 1,254 1,199 1,686 1,236 1,496 1,744 1,356 , 1,628 1,949 1,757 1,391

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A number of years ago he was called from his breakfast to attend a woman in labor; upon arriving at the house he found the child already born; in a half hour he had completed his duties and left the mother and infant in good condition. He was paid the usual house fee by the father (one fact which is indelibly impressed on the doctor's mind) and was told he need not call again as arrangements had been made to have the physicians from the Lying-In Hospital take charge of the case; that they had already been sent for and were expected any minute. Under the circumstances the doctor felt that as he had not been present at the birth, and as the case was under the care of the staff of the Lying-In Hospital before and after the confinement that it would be the duty of the hospital to report the birth. He returned to his cold breakfast and proceeded to forget the case,

Seven years later a man called at the doctor's office and demanded a certificate of birth of his child; the doctor had no recollection of the man or his wife, or of having attended at the birth of the child, and after a diligent search of his books could find no record of having patients of that name. The man left dissatisfied and returning on several occasions each time demanded a certificate of his child's birth. Finally the doctor recalled the case of his interrupted breakfast many years before; he could not, however, identify the man or his wife.

He communicated with the Hospital of the Lying-In Society, a search of their books revealed the fact that they had had such a case. The doctor then advised the father to apply to the hospital for a birth certificate, which the hospital evidently refused to supply, and the father returned and roundly abused the doctor in the presence of an office full of patients. The doctor escorted the father to his front door, gently he assures us, the father stood outside and shouted a few unpleasant epithets to the doctor, much to the doctor's chagrin and the neighbors' enjoyment.

The doctor was next served with a subpoena to appear in the Municipal Court to show why he had failed to file a certificate of birth; he was ordered by the Justice to produce his books; he did so, but neither the father not his attorney could find any record of the birth. Three days later he was served with a summons and complaint in an action to recover $2.000 damage for the bodily injury the father sustained at the time the doctor escorted him to the front door, gently as he tells us.

It is very questionable if, under the law, the doctor in this case could be held responsible for not reporting the birth.

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DEATH RATE FOR WEEK ENDING DECEMBER 27, 1913. There were 1,357 deaths and a death rate of 13.18 per 1.000 of the population reported during the past week as against 1.403 deaths and a rate of 14.15 during the corresponding week in 1912, an absolute decrease of 46 deaths, equivalent to a relative decrease of 100 deaths, and a decrease in the rate of 97 of a point.

Those causes showing material decreases were scarlet fever, diphtheria, whooping cough, organic heart diseases, lobar pneumonia and violence; those causes showing increases were measles, broncho-pneumonia, pulmonary tuberculosis, other forms of tuberculosis, Bright's disease and nephritis.

Viewed from the standpoint of age grouping there was an increased mortality of infants under one year and a diminished mortality between one and five years of age and at sixty-five years and over.

The death rate for the first fifty-two weeks of the year was 13.75, as against a rate of 14.08 during the corresponding period of 1912, a decrease of .33 oí a point.

VITAL STATISTICS
Summary for Week Ending Saturday, 12 M., December 27, 1913.

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*Corrected according to borough of residence.

t. 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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Cases of Infectious and Contagious Diseases Reported.

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Week Ending,
Oct. Oct. Oct. Nov. Nov. Nov

Nov. Nov. Dec. Dec.' Dec. Dec
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15.
29. 6. 13

27.

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Tuberculosis.
Diphtheria and Croup.
Measles
Scarlet Fever..
Smallpox......
Chickenpox..
Typhoid Fever.
Whooping Cough.
Cerebro Spinal Meningitis..
Syphilis .
Gonorrhea
Chancroid

Total....

12

58

36 41

99
88
52

5
244
120

4

269
50
30

1
206

180 23 43

6 153

2031

165

4 1j6 50 IT

187 138 12

1 335 155 10

300 339 43

118

15

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1,349 1,254 1,199 1,686 1,236 1,490 1,744 1,356 1,628 1,949 1,757 1,391

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