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., uuder the Act of August 24, 1912. NEW SERIES. VOL. II. MAY 31, 1913. No. 22 OFFICIAL SUPERVISION OF IMMUNIZATION WITH LIVING BACTERIA. When the exploitation of the so-called Friedmann cure for tuberculosis in this country was imminent, in the early part of this year, the Board of Health of this City became convinced, after due investigation of the story and claims and promises of the discoverer, that, while the presumption and the existing evidence were largely against the fulfillment of the claims which were so freely made for it, it was still not wise or practicable, in view of the widespread hope of benefit which had been aroused among the victims of this disease, to interfere at the moment with the use of the remedy, provided no evidence was to be adduced of the harmfulness of the living cultures which it was proposed to administer. Such evidence was not at the time at hand, and, while the testimony as to the efficiency of the remedy from German observers was not at all encouraging, it was felt that a fair scientific test might wisely be given to the method. Under these conditions, although the Board of Health felt that it would not be wise or practicable for it to assume the supervision of such a series of tests, it welcomed the assumption of this task by the Federal authorities who had placed the matter in the hands of accomplished and experienced medical officials. The unusual publicity which has accompanied the introduction of this particular remedy and the large number of patients who applied for treatment threatened to bring about a general pilgrimage of sufferers from tuberculosis to New York City, and thus presented a new and acute problem to the Board of Health which already had grave doubts whether the department charged with the protection of public health should permit the general use of treatments by new and untried vaccines until evidence of their entire harmlessness had been produced. The progress of the study of this remedy by the Government physicians was followed with interest, and the Board of Health finally drafted a general regulation providing for official supervision of such methods of treatment in the future. The entire subject was then presented to the Medical Advisory Board of the Department of Health at a meeting held Wednesday, May 28, 1913, at which the following members were present: Dr. Joseph D. Bryant, Chairman; Dr. T. Mitchell Prudden, Secretary; Dr. Abraham Jacobi, Dr. Simon Flexner, Dr. A. Alexander Smith, Dr. John Winters Brannan, Dr. L. Emmett Holt, Dr. Walter B. James. The following officials of the Department of Health were also present: Ernest J. Lederle, Ph.D., Commissioner; Dr. Joseph J. O'Connell, Health Officer of the Port; Dr. Hermann M. Biggs, General Medical Officer; Dr. William H. Park, Director of Laboratories; Dr. Charles B. Slade and Dr. Luther B. MacKenzie. Other physicians present by special invitation were: Dr. James Alexander Miller of Bellevue Hospital, Dr. Maurice Fischberg of the Montefiore Home, Dr. Alfred Meyer of Mt. Sinai Hospital, Dr. Alfred G. Gerster of Mt. Sinai Hospital, Dr. N. E. Brill of Mt. Sinai Hospital, and Dr. Livingston Farrand, executive secretary, National Association for the Study and Prevention of Tuberculosis. On May 29, 1913, the Board of Health adopted the following resolution in the form approved by the Medical Advisory Board: Whereas, In the judgment of the Board of Health, the use of living cultures of bacteria in the inoculation of human beings, for the prevention or the treamtent of disease, may be fraught with serious danger to the individuals and to the public health, and Whereas, The necessity and the harmlessness of such a procedure can be safely determined only by carefully planned and controlled and unbiased scientific measures and observations, and Whereas, Certain tests of the efficiency and safety of an alleged cure for tuberculosis now being made in this City are being rendered unsatisfactory, unscientific and practically futile through the insistence of the originator of the alleged remedy, on conditions which involve inadequate observation, inaccurate methods of administration and the insistence on secrecy regarding the substance employed in some phases of the treatment, and Whereas, Evidence is already at hand to show that the so-called remedy not only does not fulfill the promises of efficiency and safety under which its use was at first permitted in this City, but, on the contrary, during its administration many patients have suffered serious and unduly rapid progress of their diseases; therefore, be it Resolved, That the use of living bacterial organisms in the inoculation of human beings for the prevention or treatment of disease shall be and is hereby prohibited in New York City, until after full and complete data regarding the method of use. including a specimen of the culture and other agents employed therewith, and a full account of the details of preparation, dosage and administration shall have been submitted to the Board of Health, and until permission shall have been granted in writing by the Board for the use of the same. This resolution was embodied in the Sanitary Code as section 148a, the exact reading of which is as follows: Section 148a. The use of living bacterial organisms in the inoculation of human beings for the prevention or treatment of disease is hereby prohibited until after full and complete data regarding the method of use, including a specimen of the culture and other agents employed therewith, and a full account of the details of preparation, dosage and administration shall have been submitted to the board of health of the city of New York, and until permission shall have been granted in writing by the said board for the use of the same. A LIFE TABLE FOR THE CITY OF NEW YORK. For the first time in its history, the Department of Health has prepared a life table. It is based upon the mortality statistics of the City during the triennium, 1909-1911, and permits of comparison with the results of the life table of New York City prepared under the direction of the late Dr. John S. Billings in 1882 for the authorities of the Federal census and based upon the mortality statistics for the triennium, 1879-1881. A life table is the most accurate means of measuring the health conditions prevailing in a city and shows the expectancy of life at stated ages for males and females. The table, which is too extensive for the present issue of the bulletin, will later be published in full, and it must suffice for the present to call attention to some of its most interesting features. Thirty years ago a child under 5 years of age had an expectancy of 41 years, while a child of that age at the present day may look forward to an additional 52 years, an increase of 11 years. The life of a child between 5 and 10 years has been prolonged more than 5 years. A person from 25 to 30 years of age had an expectancy 30 years ago of about 32.6 years, while at the present time his expectancy is 34.3 years, an increase of 1.7 years. Persons between 40 and 45 years had an expectancy of 23.9 years a generation and a half ago, and at the present time one of 23.4 years, a decreased expectancy of six months. The table further shows that there is a constant diminution of the duration of life from the fortieth year onward. varying from six months, at 40 years of age, to 3 years and 3 months at 85 years of age. On the whole the expectancy of life is greater among females than among males before 40 years of age. After 40 the reverse is true. Among males at all ages the increased expectancy up to 40 years amounts to almost 25 years and among females to 29 years, while after 40 years the diminished expectancy among -males is 15 years and among females 18 years. In other words, 89 per cent. of the saving of like takes place before the twentieth year and this is especially noticeable before the fifth year, where the increased expectancy amounts to 40 per cent, of the entire life increase. The increased mortality in recent years, after the fourth decade, is ascribed to the greater prevalence of cancer and diseases of the heart and kidneys, an increase in the consumption of spirituous liquors and nitrogeneous articles of diet and the wear and tear caused by the exactions of modern existence associated with insufficient physical exercise in the open air. DEATH RATE FOR THE WEEK. There were 1,323 deaths reported during the past week, with a rate of 12.85 per 1,000, as against 1.275 deaths and a rate of 12.86 during the corresponding week of 1912, an increase in the absolute number of deaths of 48, and a decrease of 0.01 in the rate, which is equivalent to one less death. The mortality from measles, diphtheria and whooping cough was considerably above that of the corresponding week in 1912, as was also the mortality from organic heart diseases, pulmonary tuberculosis and Bright's disease of the kidneys. On the other hand, the scarlet fever, typhoid fever and the diarrhoeal diseases showed decreased mortalities. The number of deaths of children under five years of age was almost the same, between five and sixty-five exactly the same, and at sixty-five and over it was greater by 51 deaths. The death rate for the first twenty-two weeks of this year was 15.43 per 1,000, as against a rate of 15.51 during the corresponding period of 1912, a decrease of .08 of a point. VITAL STATISTICS Summary for Week Ending Saturday, 12 M., May 31, 1913. Population Estimated U.S.Census Population 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. 1. 8. 15. 22. 29. 5. Queens. Richmond.... Total.... 83 20 34 32 Cases of Infectious and Contagious Diseases Reported. Week Ending. Mar. Mar. Mar. Mar. Mar. Apr. Apr. Apr. Apr. May May May May May Tuberculosis... 355 Measles. 777 833 971 Scarlet Fever.. 443 450 236 Typhoid Fever 28 Whooping Cough. 78 Cer.-Spinalį 6 Meningitis.. 976 560 387 532 525 499 507 525 511 477 374 337 337 332 326 368 314 328 366 350 307 1,197 1,087 1,128 1,170 1,359 1,353 1,533 1,283 1,480 394 338 300 294 1,323 292 224 Total..... 2,462 2,509 2,610 2,634 2,674 2,508 2,671 2,738 2,837 2,874 3,029 2,769 2,904 2,517 Croup 9. Influenza... 12. Other Epidemic) Diseases... 13. Tuberculosis Pulmonalis..... 14. Tuberculous Meningitis...... 15. Other forms of Tuberculosis.... 16. Cancer, Malignant Tumor... 17 Simple Meningitis. Of which 172. Cerebro Spinal Meningitis..... 18. Apoplexy, Softening of the Brain 19. Organic Heart Diseases.... 20. Acute Bronchitis.. 21. Chronic Bronchitis. 22. Pneumonia (ex-) cluding Broncho Pneumonia).... 22a. Broncho Pneumonia 23. Other Respira-1 27. Hernia. Intestinal 28. Cirrhosis of Liver.. 29. Bright's Disease) and Ac.Nephritis ( 30. Diseases of Wom en (not Cancer) 31. Puerperal Septi cæmia.. .... 3 32 9 10 29 6 536 222 84 77 383 3 10 24 4 3 2 26 12 182 146 92 90 2 : - 2: 7 : 2: 6 29 59 75 17 I 2 1 4 28 25 15 84 2 6 2 69 6 12 100 9 2 8 : : 02:02 10 : :: wiwi : .00 :: 5 5 2 3 33 6 37 : 20 *If the deaths under one month, numbering 88, from all causes, be deducted from the total deaths under one year, the resultant rate will be 52 deaths of Infants per 1 000 births, (weekly average of 1912). |