* The number of registered births in Chicago is estimated as 95 per cent. of the returns from Cook County. (See Bulletin 112 of Bureau of the Census, Mortality Statistics for 1911, p. 24, footnote 4.)

§ April to April.

† Stillbirths included.

THE WORK OF GOVERNMENTAL AUTHORITIES FOR THE CONTROL

AND PREVENTION OF INFANTILE PARALYSIS

STATEMENT BY THE CHAIRMAN:

The acute problem before the government and people today in relation to infant welfare is a problem of the prevention of infantile paralysis. Our attention has been recently drawn to the fact that more children die from diphtheria and scarlet fever it may be, year in and year out, than are now dying from infantile paralysis; and the deduction is sought to be drawn that we are paying too much attention to infantile paralysis; as though a man suffering from a chronic disease should ignore a minor incident, such as a broken bone or a dislocated joint until he is cured of cancer or arterio-sclerosis.

The logical demand on the community today is not to ignore scarlet fever, or diphtheria, or measles, or whooping cough, or infantile paralysis, but to attack them all.

Infantile paralysis has been attacked by the Federal Government, and this seems to be an opportune time for determining how far we have moved in the line of prevention. Probably the most important element in preventing the spread of infantile paralysis is the control of the disease so as to confine it within a limited area, if it be possible. To confine it within a limited area in the state is a state function, to confine it within the area of a particular state or territory is a federal function, which the United States Public Health Service backed up by a modest appropriation by Congress, sought to discharge. Through the courtesy of Surgeon General Blue, of the Public Health Service, we have two of the officers who were actively engaged in the effort to control infantile paralysis at the very center of the outbreak of last summer, that is, in the territory about New York City and in the city itself. They will tell us what the Public Health Service has done and will do to endeavor to relieve this country of the present panic and it is neither more nor less than a panic.

I take pleasure in introducing Dr. Charles E. Banks, Senior Surgeon, United States Public Health Service, Milwaukee, Wis.

GOVERNMENT MEASURES TO PREVENT SPREAD OF

POLIOMYELITIS

Epidemic of 1916 in New York City

CHARLES E. BANKS, Senior Surgeon, U. S. Public Health Service, in Charge of Detail

During the summer of the present year the greatest epidemic of poliomyelitis known to the present generation, or at least of record for professional study, occurred in the municipality of Greater New York, and extended for a radius of one hundred miles in every direction from the first development at this focus, until there was a total of approximately 19,000 cases. Of this number about 9,000 occurred within the five boroughs of Greater New York. The remainder of these cases were to be found in Northern New Jersey, Western Long Island in the southern tier of counties in New York State, and in Western Connecticut, affording an excellent example of the spread of this disease by propinquity and contact.

This epidemic began late in May, grew to considerable proportions in the month of June, and by the middle of July had reached an incidence of 120 cases daily. The highest daily record was 217 cases on August 3, 1916. This was the crest of the wave, and from that time forward until the first of October the subsidence was continual, and consistently rapid.

The steady increase in the numerical strength of this epidemic alarmed communities in centers of population all over the country, and as a consequence there were demands for restrictive measures running all the way from inspection of travelers from New York City, to shotgun quarantine. The Surgeon-General was frequently importuned for assistance in controlling its spread.

The Secretary of the Treasury who, under the law, has supervision of the activities of the United States Public Health Service, early in July offered the Mayor of New York City the co-operation of the medical officers of this corps in the execution of any measures which would be of local assistance in the management of the epidemic, or would tend to prevent the spread of the disease to other communities. This offer was accepted, and the Service Board in Washington considered the

situation with a view to applying such measures under the Interstate Quarantine Law as seemed to be applicable to the situation; in addition a field party was detailed with headquarters in New York City, to cooperate with the local health authorities in a limited epidemiological study under charge of Surgeon C. H. Lavinder. This phase of government work will be related by others.

On July 13 I was summoned by telegraph to Washington to a conference on this situation and after arrival was detailed as chief of the party which should be chosen to carry out measures tending to the prevention of the spread of the epidemic. Upon arrival in New York City on the morning of July 15, after making a careful examination of the situation in regard to the questions of quarantine and restrictions of travel for safeguarding other states, being assured of the co-operation of the Health Commissioner of the City of New York, and requiring of the transportation managers of the great railroad and steamboat systems entering into New York City their aid in executing the plan which was obligatory on them under the Interstate Quarantine Act of February 15, 1893, the following plan of operation was devised:

First it was determined that children 16 years of age or under should be put in a restricted class of travel, and that whenever such children were to be taken out of New York City, by rail, boat or other means, their parent, or guardian, must first obtain a certificate that the premises occupied by them were free from and had been free from poliomyelitis since January 1, 1916, and that this certificate must be obtained on the day of travel, or at the farthest it should not be over twenty-four (24) hours old at the time of entraining or embarking.

Second. Medical inspection of such travel was to be maintained at every avenue of exit from New York City by rail or boat, exclusive of a few trolley lines. Automobile traffic was equally guarded by the same means with the exception of a few roads at the extreme northerly limit of the Borough of the Bronx leading into New York State, and thence, by connecting highways to Connecticut and Massachusetts.

The examination of this vast volume of travel was accomplished at twenty (20) different stations and took place under the personal supervision of thirty-six (36) medical officers. This examination consisted of as careful and accurate inspection of each child as the rapidity of movement of travel and the exigencies of the situation permitted. Naturally, there could be no elaborate clinical observations taken.

It is to be presumed that few, if any persons, except under great stress would attempt to move a child in the acute stage of poliomyelitis from a city where every facility under their family physician was afforded for treatment, to outside towns where conditions were less favorable for care of the sick.

The number of actual rejections for suspected poliomyelitis was small, but as an example of the work, one of our surgeons told me of such a rejection and the removal of the child to the City Hospital immediately, and four days later the father passing through the same depot informed the officer that his child had died that day of the dis

ease.

The City Board of Health in its work of certification of premises rejected about five hundred (500) applications for certificates of freedom of such premises from this disease.

Third. As a part of this system of restriction of travel, all railroad and steamboat lines were required, under my directions, to refuse entrance through their gates to all children under 16 years of age leaving New York City whenever the travelers were not provided with certificates of identification issued by the officers of the United States Public Health Service, and all such persons presenting themselves for passage were denied entrance until they had so provided themselves. This constituted a very efficient check on unauthorized travel, and from personal observation of its administration at all hours of the day and night, I am satisfied that but few sifted through the net.

Fourth. The card of identification issued by our officers enabled the traveler to pass the gateman and enter upon his journey. At the same time it was punched as a ticket would be to prevent subsequent use by others.

A duplicate of this card was immediately mailed to the health officer of the locality to which the traveler was destined, informing the officer of the expected arrival of the traveler, giving the street and house address in the town or city to which he was bound, and the number of children 16 years of age or under accompanying him. These were mailed hourly by railway postal trains and reached the health officials a short time after the arrival of the travelers.

A complication in the supervision of the vast volume of travel in and out of the city of New York, estimated at over a million people a day, was the problem of commuters, 16 years of age, or under; office