DEPARTMENT OF HEALTH. Report for Week Ending March 1, 1913. MILK BOTTLE ORDINANCE SUSTAINED BY APPELLATE DIVISION. In November, 1912, the Court of Special Sessions affirmed a conviction which was of the greatest importance to the Department of Health. The defendant, a driver for a milk company, had been charged upon information with having in his possession and having received milk bottles which had not been washed after holding milk and were therefore unclean. He was prosecuted under section 183 of the Sanitary Code (cited below) and was convicted. The case was discussed at length in the Monthly Bulletin for December. The defendant appealed and the decision of the Appellate Division of the Supreme Court affirming the conviction has just been announced. The opinion handed down was written by Justice Francis M. Scott, the other justices concurring, and was as follows: "The evidence would support a finding that defendant had collected a large number of used milk bottles, some of which had not been washed; that he had taken them to a railway station at Park avenue and 164th street and unloaded them upon the platform where they were stacked up. About two hours later the bottles, includ ing the unclean ones, were loaded on cars. "The milk company had a cleaning plant at Manhattan street, and the reason why the defendant did not take the bottles there, was that it was out of the way. "The defendant makes no question as to the facts, contenting himself with attacking the constitutionality of the ordinance, which reads as follows; the part attacked being the last sentence: 'Sec. 183. It shall be the duty of all persons having in their possession bottles, cans or other receptacles containing milk or cream, which are used in the transportation and delivery of milk or cream, to clean or cause them to be cleaned immediately upon emptying. No person shall use or cause or allow to be used any receptacle which is used in the transportation and delivery of milk or cream, for any purpose whatsoever other than the holding of milk or cream, nor shall any person receive or have in his possession any such receptacle which has not been washed after holding milk or cream or which is unclean in any way.' "The defendant urges that upon a strict construction of the section, and both sides agree it should be so construed, it is unreasonable in that it makes it an offense for the milk company to reclaim or retake its own property, if someone else has violated a duty with regard to it. "I have no doubt that this strict construction is precisely what was intended by the Board of Health, and it fits perfectly with the Agricultural Law, to which it is merely supplementary. * * "Sec. 47 of that law as amended by L. 1911, Ch. 608, provides that: 'Whenever any can or receptacle is used for transporting * milk to the market for the purpose of selling or furnishing the same for consumption as human food, which can or receptacle, when emptied, is returned or intended to be returned to the person so selling, furnishing or shipping such substance to be again thus used, or which is liable to continued use in so transporting * * * the consumer, dealer or consignee using. selling or receiving the milk, cream or curd from such can or receptacle, shall before so returning such can or receptacle remove all substances foreign to milk therefrom by rinsing with water or otherwise?' "The appellant concedes that there is no constitutional objection to either the Statute or Ordinance except the last sentence of the Ordinance under which defendant was convicted. "We are of opinion that the sentence objected to is not unreasonable and is within the police power of the State. It does not deprive the milk company, appellant's employee, of its property, but merely requires it, before accepting a bottle or other receptacle from a customer, to insist that that customer shall observe the law and wash out the receptacle. This can be done either by ceasing to deliver milk to a customer who refuses to obey the law or by lodging an information against the persistent law breaker. "That the company had provided a sterilizing plant to clean bottles and receptacles does not seem to meet the requirements of law, especially when the bottles are not taken to the plant, but are shipped away in an unclean condition. "Both the Statute and the Ordinance are undoubtedly drastic, but the danger to be apprehended from the use of unclean receptacles for milk intended for human food is too obvious and so well known that drastic measures to prevent the possibility of such use are reasonable and justifiable. 'The judgment is affirmed." DUTIES OF INSPECTORS AND VETERINARIANS IN SLAUGHTER-HOUSES. At the last meeting of the Board of Health new rules and regulations were adopted relating to the duties of inspectors and veterinarians in slaughter-houses, and since their duties have thereby been considerably augmented, it is well that the proprietors of slaughter-houses, and the public in general, should know exactly what these duties are in order that unnecessary friction may be avoided. The following are the new rules which are to govern their actions: 1. At all times when on duty the badge of the Department of Health must be worn on the outer clothing, conspicuously displayed. 2. Inspectors and veterinarians assigned to abattoirs must at all times, so far as lies in their power, enforce the rules and regulations for the conduct of such premises adopted by the Board of Health on January 21, 1913. 3. Inspectors shall not leave the floor or the premises while killing or dressing is in progress unless relieved by another inspector or the veterinarian in charge, except on urgent or unusual business of the department. 4. Inspectors will state on their daily report card, in addition to the time at which they arrived and departed from the premises, the time at which operations began and the time at which the operations were suspended for the day and the premises thoroughly cleaned. 5. Upon completion of the day's work, both inspectors and veterinarians will report the fact to the department either by telephone or in person. 6. Upon the completion of the day's work the inspector and veterinarian will ascertain from the manager or owner of the abattoir to which they have been assigned, the hour at which slaughtering will be resumed on the following day. 7. If upon arrival at their posts it is discovered that there will be no killing on that day, the inspector will communicate immediately with the office of the chief of the Division of Food Inspection, by telephone, for instructions. 8. Inspectors are required to correct all unsanitary conditions which exist in the abattoirs under their charge. If they fail to improve conditions by verbal notice to the owner of manager, they shall immediately report the fact to the veterinarian and to the office of the chief of the Division of Food Inspection, by telephone, from which office they will receive instructions as to their subsequent conduct. 9. Upon the carcasses of animals slaughtered in abattoirs which are under the supervision of the Department of Health, the inspectors assigned thereto shall place suitable tags or stamps, as prescribed by the Department of Health. If the tag used is a retaining tag, then the inspector shall cause the carcass to be placed in some room set aside for the purpose until after examination by the veterinarian. 10. When any carcass, organ or part of an animal becomes unfit for food for any reason other than that caused by disease, the inspector shall immediately cause the same to be destroyed. 11. When any carcass, organ or part of any animal has been condemned as unfit for food purposes, it shall be the duty of the inspector to cause such carcass, organ or part to be denatured and removed by the offal contractor, or to some approved rendering plant for destruction. 12. It shall be the duty of the inspectors when the carcass of an animal suffering with an infectious disease, or the carcass of an animal which dies suffering with an infectious disease, has been skinned, split or dressed, that he require all persons who have handled said carcass, and all implements which have been used in the handling of said carcass, to be disinfected to the approval of the Department of Health before another carcass is handled. 13. Inspectors, on Saturday of each week, will report to the department the number of animals killed, and the weight of meat produced therefrom, in the abattours under their charge. 14. Any violation of these rules may lead to the presentation of charges of neglect of duty to the Board of Health. WHY PHYSICIANS SOMETIMES FAIL TO APPRECIATE THE WORK OF THE DIAGNOSIS LABORATORY. It is the aim of the Department of Health to make the Diagnosis Laboratory of as much real assistance to practising physicians as possible. But there are physicians who are not fully benefited by the examinations performed for them, and the Laboratory is often called upon for services which it was never intended to perform. This occasionally leads to unjust criticism and is due entirely to a lack of understanding as to the position that laboratory diagnoses should occupy in the daily work of the physician. Although the laboratory facilities offered by the Department of Health are intended to aid the physician in every possible way, he must not expect the entire burden of responsibility in making a diagnosis, to be removed from his shoulders. In order to get results which are of value from the Diagnosis Laboratory, it is absolutely necessary for all specimens to be obtained exactly as described on the slips accompanying the several outfits. No amount of care on the part of a laboratory worker will produce satisfactory results if the specimen has been carelessly prepared and therefore does not represent the true condition of the patient. It is not an uncommon occurrence for two cultures from the same case of diphtheria, taken within an hour of each other by different physicians, to be positive and negative respectively; and furthermore, it is usually the careless physician of the two, who complains that the laboratory findings do not agree with his clinical diagnosis. It should be constantly borne in mind that the possibility of making a correct or incorrect diagnosis as to the nature of a patient's illness, begins the moment it is decided to submit a specimen for examination and does not end until the results have been received and interpreted; the interpretation of results is second in importance only to the results per se. Only specimens are examined, not patients; and while laboratory findings indicate the nature of the trouble, they should not be construed as being an index to the severity of the patient's illness. If a specimen contains diphtheria bacilli, it does not mean that the patient must necessarily be very ill nor, if it does not contain them, that he is normal in every respect. The absence of tubercle bacilli in a specimen of sputum which consists of saliva only, is of no significance, and cultures with the swab pushed through the medium or with the medium macerated to a pulp do not afford a fair test. A negative result from a specimen of blood sent in for examination for malaria is of little value if large doses of quinine have been given to the patient. Time is often wasted in examining specimens which should not have been sent in at all; e. g., cultures submitted every day throughout the entire course of a case of diphtheria; specimens of blood for the Widal reaction, sent once a week after positive reaction has been obtained, and gonorrheal specimens at short intervals. Numerous instances could be given showing a lack of knowledge as to the location of the dividing line between laboratory diagnosis and clinical diagnosis and also the tendency to draw false conclusions from the result of the examination of a single specimen. The physician who personally superintends the collection and forwarding of all specimens from his patients is in a much more favorable position as regards interpretation of results, than he who allows some one else to perform these services for him. In Occasionally attempt is made to deceive, by sending specimens under improper conditions in order to receive false results, and thereby cause embarrassment. regard to such cases, it can be truly said that whether apparently successful or not. such persons really deceive only themselves, for it is always assumed in the Diagnosis Laboratory that all specimens are obtained and prepared under standard conditions, and the results reported apply only when such is the case. If specimens are obtained with as much care as is used in making the physical examination of the case and the results received properly interpreted, the Diagnosis Laboratory will be of great assistance to physicians; but otherwise the time spent in forwarding and examining specimens may be largely wasted. VITAL STATISTICS Summary for Week Ending Saturday, 12 M., March 1, 1913. ↑ 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. Total...... 1,213 1,482 1,495 1,636 1,436 1,534 1,991 1,933 1,991 2,127 1,790, 1,773 2,090 2,462 Death-rate. 1912. 1913. *Cor rected, 1913. |