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N.I. C. VITAL STAT,
ANNUAL REPORT. DLPT. OF HEALTH;
1919
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Digitized by the Internet Archive
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ANNUAL REPORT
OF THE
DEPARTMENT OF HEALTH
OF
THE CITY OF NEW YORK
FOR THE
CALENDAR YEAR 1919
NEW YORK CITY
1920
M. B. Brown Printing & Binding Co.
25-5007-2 l-B
TABLE OF CONTENTS
PAGE
Board of Health. 9
Directory of the Board of Health 10
Letter of Transmittal 13
Bureau of General Administration —
New Sections and Amendments to the Sanitary Code 15
Personal Service 16
Appropriation for the Year 1919 . . • • 16
Statement of Cash Receipts Turned Over to the General Fund of the City.... 17
Laboratory Products 17
Purchase and Storage of Supplies 17
Division of Complaints 18
Division of Construction and Repairs 18
Welfare Division 19
Law Division 20
Sanitary Bureau —
Various Activities 25
Stables 25
Refuse Removal • • 26
Heating and Dwellings 26
Vessels from Plague Infected Ports 28
Mosquitoes 28
Prevention of Rabies 28
Prevention of Glanders 29
Preventing Waste of Food 29
Assembly Halls 29
Barber Shops 29
Stores for Birds and Small Animals 30
Comfort Stations 30
Permits for Chickens and Pigeons 30
Bathing Establishments 31
Horse Shoeing Establishments 31
Ice Plants 31
Laundries ^2
Lodging Houses ^2
Vacant Lots 32
Parades • - ^2
Clothing Trade Survey ^2
Unmuzzled Dogs ^^
Drinking Water ^^
Lack of Heat ^^
Pratiques 34
Railroads 34
Ventilating Openings of Subways 34
Ventilation of Railroad Cars.
Refuse Material
35
3
TABLE OF CONTENTS— Con/mu^d
pagb
Schools ■ ■ - ,
Stables
Spitting • •
Temporary Privies '
Division of Food and Drug Inspection ^^
Terminals
37
Factory Inspection
Milk Inspection
Meat Inspection
38
Drug Inspection °
Miscellaneous Inspection Work ^^
General Scope of Work of the Division • • 38
Terminal Inspection and Wholesale Markets 39
40
Factory Inspection • • ^"
Bakery Inspection • • ^^
Restaurant Inspection
Retail Establishment Inspection 42
Milk Inspection ^'
X • 44
Meat Inspection • • ^
Drug Inspection _
Food Adulteration "^^
Exposure of Food on Streets ^^
Cleansing of Utensils ^^
^ • 47
Prosecutions
Co-operation with Other Agencies 47
Wood Alcohol in Food Products 48
Health Squad • • 50
Division of Institutional Inspection 52
Staff =-
Functions ^-
Institutions for Children 54
Summary of Monthly Medical Reports, 1919 54
Bureau of Preventable Diseases —
Pulmonary Tuberculosis • • 58
The Health Department's Tuberculosis Clinics 63
Communicable Diseases ^^
Scarlet Fever ' ''
Epidemic Cerebro-spinal Meningitis 85
Poliomyelitis °^
Measles ^
Encephalitis Lethargica 91
Major and Unusual Infectious Diseases 98
Smallpox 98
Anthrax 98
Rabies 98
Tetanus 98
Typhus 99
Venereal Diseases 99
Detention and Release of Court Cases 103
Occupational Clinic • • 114
4
TABLE OF COXTEXTS—Coniinucd
PAGE
Bureau of Laboratories —
The Division of Administration 118
Concentration of Antitoxic Plasma US
Distribution of Living Organisms 119
Division of Media and Sterilization 1 19
Division of Microbal Sanitary Examinations 122
Water Examinations 122
Examination of Oysters 123
Division of Diagnosis 123
Cowpox Vaccines ■ ■ 123
Work on Rabies 124
Statistics of Patients Receiving Pasteur Antirabic Treatment 126
Division of Applied Therapy 127
Division of Special Investigations 127
Incidence of Common Colds 128
Culture Media for the Diagnosis of Diphtheria 128
Active Immunization Against Diphtheria 128
Bureau of Child Hygiene —
Baby Welfare Work During 1919 130
Instruction and Supervision of Expectant Mothers 131
Supervision of the Care and Feeding of Babies under Two Years of Age.... 133
Encouraj:ement of Maternal Nursing 143
Eflforts to Secure Enrollment of Babies as soon after Birth as possible 143
Age of Infants Admitted to Baby Health Stations 144
Milk sold (Quarts) at Baby Health Stations 146
Studies, Surveys, Exhibits 151
Infant Mortality Rates, Diarrhoeal Disease, N. Y. City 152
General Cooperation in the Work 156
Little Mothers' Leagues 1 59
District Home Visiting Control of Infant Mortality 160
Physical Examination of Children of Pre-School Age 161
School Medical Inspection 162
General Contagious Diseases Found in Schools and Excluded 163
Contagious Eye and Skin Diseases Found in Schools 164
Vaccinations 165
Examinations for Physical Defects 165
Cases Terminated 166
Health Leagues 166
Miscellaneous School Activities 166
Little Mothers' Leagues 169
Cooperation of the Department of Education 169
General Impressions of the Year's Work 170
Other Work by School Medical Inspection Personnel 171
Ej-e Clinics 171
Dental Clinics 173
Dental Work During 1919 174
Special Nursing Features 1 75
Issuance of Employment Certificates 175
Open-air Classes I77
Work in the Open Air Classes of the Public Schools of New York City 185
S
TABLE OF CONTENTS— Con/mw^d
PAGE
Open-Air Scholarship Record 186
Results of Work in Open-Air Classes 187
Cases Discharged from Open-Air Classes 187
Number of Permits in Force December 31, 1911, to 1919, inclusive 188
Routine Procedure in the Licensing and Supervision of Homes 188
Classitication of Homes 188
Co-operation with Other Agencies 189
Registry Kept by Foundling Keepers 189
Inter-Departmental Co-operation 189
Study of Permits to Board and Case of Children 189
Delinquencies of Foundling Keepers 190
Supervision of Midwives 190
Suppurative Eye Cases 191
Puerperal Sepsis Cases 192
Stillbirths 192
Delinquencies of Midwives ♦ 192
Bureau of Food and Drugs —
Drug Addiction 193
" Milk:
Cost of Milk 195
Amendments to the Sanitary Code 195
Poultry Slaughter Houses 196
Shellfish 196
Staff of Bureau 196
Executive Office 196
General Scope of Work of the Bureau 197
Food Standards 197
Milk Inspection 198
Reconstituted Milk and Cream 199
Checking Work of Veterinarians 199
Country Milk Efficiency and Economy 199
Milk Surveys 199
Milk Temperatures 199
Milk Exposition 200
Efficiency of Pasteurizers and Flash Pasteurization 200
City Pasteurizing Plants 201
Prosecutions • • 201
Miscellaneous 201
Oysters and Other Shellfish 201
Jamaica Bay 201
Raritan Bay 202
Out of Town Oysters , 203
Adulteration of Oysters by the Addition of Water 203
Quantity of Oysters Marketed 203
Clams, Mussels, Scallops 203
Terminal Inspections and Wholesale Markets :
Borough of Manhattan 204
Borough of Brooklyn 205
Factory Inspection 206
Bakery Inspection ^ 207
6
TABLE OF CONTENTS— Continued
PAGE
Restaurant Inspection 208
Meat Inspection 210
Food Adulteration 211
Exposure of Foods on Streets • • 212
Cleansing of Utensils 212
Prosecutions 213
Co-operation 213
Other Items of Interest 214
Chemical Laboratory 215
Analytical Work of Chemical Laboratory 217
Drug Analyses 218
General Summary 221
Bureau of Hospitals —
Venereal Disease Service 222
Drug Addiction 222
Medical Education 224
New Ward Buildings 224
Improvements in the Service 225
Co-operation with Other City Departments 226
Bureau of Public Health Education —
Publications 234
Motion Pictures 234
Information Bureau 235
Lunch Room 235
Miscellaneous 235
Venereal Diseases 23o
Division of Lectures 2I^S
Exhibits 236
Division of Industrial Hygiene 237
Occupational Diseases 238
Illuminating Gas Poisoning 238
Lectures 239
Physical Examinations 239
Distribution of Placards 240
Narcotic Drug Clinic 241
Borough of Brooklyn :
Sanitary Division 242
Sanitary Engineer 243
Division of Preventable Diseases 243
Veterinarian Division 245
Division of Child Hygiene 245
Division of Food and Drugs 245
Sanitary Division 246
Borough of The Bronx :
Sanitary Engineer 248
Division of Preventable Diseases 249
Incidence of Communicable Diseases 249
Tuberculosis Clinic Report 249
Occupational Clinic 249
Venereal Disease Clinic 249
7
TABLE OF CO'^TENTS— Continued
PAGE
Anti-rabic Clinic 250
Veterinarian Division 250
Division of Child Hygiene 250
Statistical Summary of School Work, Bronx Borough, 1919 251
Statistical Report of Baby Welfare Work, Bronx Borough, 1919 252
Midwives and Foundlings 252
Statistical Data of Midwife and Foundling Work, Bronx, 1919 253
Employment Certificate Work 254
Division of Food and Drugs 255
Borough of Queens :
Sanitary Division 259
Division of Institutional Inspection 259
Division of Sanitary Inspection 259
Sanitary Engineer 261
Division of Preventable Diseases 260
Visits by Staff Compared to Previous Year 261
Occupational Clinic Work , 262
Veterinarian Division 263
Division of Child Hygiene 263
Work of Eye Clinic at Public School No. 81 265
Borough of Richmond :
Sanitary Division 266
Sanitary Engineer 267
Division of Preventable Diseases 267
Veterinarian Division 269
Division of Child Hygiene 269
Examinations for Physical Defects 270
Division of Food and Drugs 272
Summary of Veterinarian Activities 273
Bureau of Records —
Vital Statistics 274
Deaths from Principal Causes 274
BOARD OF HEALTH
Commissioner of Health and President of the Boon
Royal S. Copeland^ M.D.
Health Officer of the Port
Leland E. Cofer, M.D.
Police Commissioner
Richard E. Enright
Secretary to the Board
Charij:s L. Kohler
DIRECTORY OF DEPARTMENT OF HEALTH.
OFFICES.
Headquarters: 505 Pearl Street, Manhattan Telephone, 9400 Worth.
Borough of The Bron.K, 3731 Third Avenue Telephone, 1975 Tremont.
Borough of Brooklyn, Flatbush Avenue and Willoughby Street Telephone, 4720 Main.
Borough of Queens, 372-374 Fulton Street, Jamaica, L. I Telephone, 1200 Jamaica.
Borough of Richmond, 514-516 Bay Street, Stapleton, S. I Telephone, 440 Tompkinsville.
Office Hours — 9 a. m. to 5 p. m.; Saturdays, 9 a. m. to 12 ra.
HOSPITALS FOR CONTAGIOUS DISEASES.
Manhattan — Willard Parker Hospital, foot of East 16th Street. Telephone. 1600 Stuyvesant.
The Bronx — Riverside Hospital, North Brother Island. Teleplione, 4000 Melrose.
Brooklyn — Kingston Avenue Hospital, Kingston Ave, and Fennimore St, Telephone, 4400 Flatbush.
Queens — Queensboro Hospital, Flushing Avenue and Letts Lane. Telephone, 2600 Jamaica.
LABORATORIES.
Diagnosis Laboratory, Serological Laboratory, 505 Pearl Street. Telephone, 9400 Worth.
Research Laboratory, Chemical Laboratory, Vaccine Laboratory, foot of East Sixteenth Street.
phone, 1600 Stuyvesant.
Antitoxin Farm and Laboratory, Otisville, N. Y.
Tele-
172 East 3d St.
513 East nth St.
306 Avenue A.
443 1st Ave.
225 East 107th St.
241 East 40th St.
174 Eldridge St.
BABY HEALTH STATIONS.
Manhattan.
8 224 West 63d St.
9. 326 East 11th St.
10. 114 Thompson St.
11. 315 East 112th St.
12. 244 Mulberry St.
13. 508 West 47th St,
14. 78 Ninth Ave.
IS.
348 East 74th St.
22.
73 Cannon St.
16.
205 East 96th St.
23.
95 Suffolk St.
17.
209 Stanton St.
24.
206 Madison St.
18.
343 Pleasant Ave.
25.
214 Monroe St.
19.
108 Cherry St.
26.
289 Tenth Ave.
20.
197 Hester St.
27.
95 Forsyth St.
21.
27 Suffolk St.
28.
2155 Fifth Ave.
Brooklyn.
1.
268 South 2d St.
7.
359 Manhattan Ave.
13,
604 Manhattan Ave.
19.
698 Henry St.
2.
621 Fourth Ave.
8.
49 Carroll St.
14.
179 Bedford Ave.
20.
594 Sutter Ave.
3.
208 Hoyt St.
9.
76 Johnson Ave.
15.
296 Bushwick Ave.
21.
167 Hopkins St.
4.
144 Navy St.
10.
233 Suydam St.
16.
994 Flushing Ave.
22.
592 Park Ave.
5.
2346 Pacific St.
11.
323 Osborn St.
17.
176 Nassau St.
23.
165 Ten Eyck St,
6.
184 Fourth Ave.
12.
107 Dupont St.
18.
129 Osborn St.
24.
49 Amboy St.
1. 511 East 149th St.
The Bronx.
2. 428 East 133d St. 3. 354 Webster Ave.
4. 2380 Hughes Ave.
Queens.
1. 114 Fulton Ave., Astoria. 2. 22 Maspeth Ave., Maspeth. 3. 753 Onderdonk .Ave., Ridgewood.
Richmond.
689 Bay Street, Stapleton, S. I.
CLINICS FOR VENEREAL DISEASES.
ADVISORY CLINICS.
Manhattan.
Main Clinic, 505 Pearl Street Week days, 9 a. m. to 12 m.
Brooklyn.
n . /^r • ui .. J fi»-ii uu c-x i /Daily except Sunday, 9 a, m, to 12 noon.
Prospect Chnic, Fleet and Willoughby Streets [Monday and Friday. 8 p. m. to 9 p. m.
10
CLINICS FOR VENEREAL DISEASES— ADVISORY CLINICS— Coatiaued.
TREATMENT CLINICS.
Manhattan.
Chelsea Clinic. 307 West 33d Street l^r^'H'^^^A^'"^ ^S^^^^ ' *V ™- '° V ?n°"-
\Weanesday and Friday. 7 p. m. to 10 p. m.
Brooklyn.
Prospect Clinic. Fleet and VViUoughby Streets f pa-'v except Sunday. <) a. m. to 12 a. ra.
\ Monday and Friday. 8 p. tn. to 9 p. m.
ANTI-RABIC CLINICS.
Manhattan— 505 Pearl Street. Telephone. 9400 Worth. Week days. 1 to 4 p. m.
Brooklyn— Fleet and Willoughby Streets. Telephone. 4720 Main. Week days. 10 a. m. to 1 p. m •
Sundays and holidays. 10 a. m. to 12 m.
The Bronx— Third Avenue and St. Paul's Place. Tel.. 1975 Tremont. Week days. II a. m. to 1 p. m.
Queens — Patients attend Brooklyn or Manhattan Clinic.
Richmond — Patients attend Manhattan Clinic.
On Sundays and holidays patients of all Boroughs attend Brooklyn Clinics. Hours on these daya*
10 a. m. to 12 noon.
Immunization against typhoid fever will be given on request at these clinics.
OCCUPATIONAL CLINICS.
Manhattan — 128 Prince Street. Week days, 9 a. m. to noon. Telephone. 9586 Spring.
The Bronx— 493 East 139th Street. Week days, 2 to 4 p. m. Telephone. 6399 Melrose.
Brooklyn — Fleet and Willoughby Streets. Week days, 2 to 4 p. m. Telephone. Main 4720.
Queens — Jamaica, 372-374 Fulton Street, Jamaica, 2 to 4 p. m.; Saturday, 9 to 12 noon. Telephone
1200 Jamaica.
Corona, 127 46th Street (near Alburtis Avenue "L" Station). 2 to 4 p. m.; Saturday, 9 to 12
noon. Telephone. 3255 Newtown.
Ridgewood, 753 Onderdonk Avenue, Ridgewood, 2 to 4 p. m.; Saturday. 9 to 12 noon. Tele-
phone, 3624 Evergreen.
Queens Plaza, 138 Hunter Avenue. Telephone, 2589 .Astoria.
Richmond — Richmond Bay and Elizabeth Street, Stapleton, 2 to 4 p. m.; Saturday. 9 to 12 noon. Tele-
phone, 1558 Tompkinsville.
DIVISION OF NARCOTIC REGISTRATION AND NARCOTIC RELIEF STATION.
Manhattan — 145 Worth Street. 2 to 8 p. m. daily except Sunday and holidays.
BRANCH OFFICES AND TUBERCULOSIS CLINICS.
Manhattan — Corlears, 331 Broome Street. Telephone, 7914 Orchard.
Stuyvesant, 540 East 13th Street. Telephone, 2859 Orchard.
Yorkville, 439 East 57th Street. Telephone. 2526 Plaza.
Jeflferson, 341 Pleasant Avenue. Telephone, 2375 and 828 Harlem.
Riverside, 481 West 145th Street. Telephone. 9068 Audubon.
Chelsea, 307 West 33d Street. Telephone. 3471 Greeley.
Washington, 130 Prince Street. Telephone, 9586 Spring.
Day Camp, Ferryboat "Manhattan." foot East 90th Street. Telephone, 1581 Lenox.
The Bronx — Tremont. St. Paul's Place and Third Avenue. Telephone. 1975 Tremont.
Mott Haven, 493 East 139th Street. Telephone. 5702 Melrose.
Brooklyn — Prospect, Fleet and Willoughby Streets. Telephone, 4720 Main.
Eastern District, 306 South 5th Street, Williamsburg. Telephone, 1982 Stagg.
Bedford, 420 Herkimer Street. Telephone, 2220 Decatur.
Brownsville, 64 Pennsylvania Avenue. Telephone, 2732 East New York.
Bay Ridge, 215 60th Street. Telephone, 2434 Sunset.
Day Camp, Ferryboat "Rutherford." foot of Broadway. Telephone, Williamsburg, 5223.
Queens — Jamaica, 372-374 Fulton Street. Jamaica. Telephone. 1200 Jamaica.
Corona, 127 46th Street (near Alburtis -Avenue "L" Station). Telephone, 3255 Newtown.
Ridgewood, 753 Onderdonk Avenue, Ridgewood. Telephone. 3624 Evergreen.
Queens Plaza, 138 Hunter Avenue. Telephone. 2589 Astoria.
Richmond — Richmond, Bay and Elizabeth Streets, Stapleton. Telephone, 1558 Tompkinsville.
HOSPITAL DIAGNOSIS STATION.
Manhattan — 128 Prince Street. Hours. 2 to 4 p. m., Tuesday, Thursday, Saturday.
SANATORIUM FOR TUBERCULOSIS.
Otisville, Orange County, N. Y. (via Erie Railroad from Jersey City). Telephone, 13 F 1 Otisvilk.
11
DEPARTMENT OF HEALTH,
CITY OF NEW YORK,
505 Pearl Street, Borough of Manhattan.
New York. October 30, 1920.
To His Honor
The Mayor of the City of New York:
Sir — On behalf ot the Board of Health I have the honor to transmit
herewith, as required by Section 1168 of the Charter of the City of New
York, a report of all the operations of the Department of Health of the
City of New York for the year ending December 31. 1919.
Very respectfully,
ROYAL S. COPELAND,
Commissioner of Health.
13
REPORT OF THE DEPARTMENT OF HEALTH
CITY OF NEW YORK, FOR THE YEAR 1919
BUREAU OF GENERAL ADMINISTRATION
During the year 1919, in addition to the transaction of routine business
required by the Charter, the Board of Health inaugurated a campaign
against Drug Addiction, with a course of control and treatment; and, in
cooperation with the Federal and State Governments, extended the care
and treatment of venereal diseases in the various boroughs of the City.
Numerous amendments to the Sanitary Code were made, the most
prominent of which was the Hcensing of undertakers.
New Sections and Amendments to the Sanitary Code.
Sec. 117 Proprietary medicines. Amended Feb. 25, 1919.
Sec. 171 Sale of oysters. Amended April 29, 1919.
Sec. 1 Definition 47 — Pestilential Disease (Drug Addiction).
Adopted June 22, 1919.
Sec. 142 Protection of food, amended July 24, 1919.
Sec. 228 Noise from bells, gongs, etc. prohibited. Adopted Aug. 20, 1919.
Sec. 225 Heating of occupied buildings. Amended Dec. 11, 1919.
Sec. 229 Loud noises from automobiles prohibited. Adopted Dec. 17, 1919.
Sec. 43 Sextons; to register with the Department of Health. Adopted
Dec. 11, 1919.
Sec. 46 Business of undertaking regulated ; permit required. Adopted
Dec. 11, 1919.
Sec. 106 Wood alcohol poisoning to be reported. Adopted Dec. 31 ,1919.
Regulations governing the conduct of poultry slaughter houses. (Reg. 1).
Amended February 4, 1919.
Regulations governing transportation of ofifal, butchers' refust, etc.
Amended February 25, 1919.
Regulations governing the removal and disposal of dead bodies of human
beings. (Reg. 15). Amended March 27, 1919.
Regulations governing the handling, storing, offering for sale, etc. of food
and drink in retail stores. (Reg. 28). Amended June 24, 1919.
Regulations governing the conduct of poultry slaughter houses. (Reg. 1).
Amended July 24, 1919.
Regulations governing docking of vessels arriving from an infected port.
Amended Dec. 17, 1919.
Regulations governing the business of undertaking. .Adopted Dec. 31. 1919.
Regulations governing the disposal of dead bodies. Amended Dec. 31, 1919.
15
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Regulations governing the isolation of persons affected with an infectious
disease. (Reg. 5). Amended Dec. 31, 1919.
Personal Service.
During the year many of our employes who were in the military and
naval service of the United States returned to duty, which placed the
department on a more efficient basis, their positions having been filled by
temporary war substitutes.
DISTRIBUTION OF EMPLOYES.
BUEEAU.
Physi-
cians.
Nurses.
Labora-
torians.
Inspect-
ors.
Clerks.
Others.
Total.
General administration ....
Sanitary
Records
Child hygiene
36
7
6
143
161
33
2
6
326
194
176
2
l.j
2
91
9
67
25
117
1
1
145
6
34
18
45
18
24
3
12
212
73
26
76
43
18
559
3
67
404
153
66
563
Preventable
Food and drugs
468
168
Hospitals
Public health education . . .
Laboratory
795
8
177
Total
394
696
110
220
305
1,077
2,802
During the year a new system of keeping the personnel records of the
employes of the entire department was inaugurated. Heretofore, the
records were kept on cards and in books, and to get a complete record it
was necessary to resort to both sources and then perhaps to the Auditor's
records for a correct and complete one. The system which has been started,
and which is progressing rapidly, eliminates the objectionable and irksome
task of going from one place to another for the desired information, in so
far as it contains the employes' complete record. In this connection, the
various bureaus of the department were requested to furnish the employes'
correct addresses, which are an important part of this record. To accom-
plish the task of changing the personnel system, it being a large and impor-
tant one, a force of clerks have been assigned, and when completed it will
be a valuable asset to the records of this ofBce and the department.
Appropriation for the Year 1919.
Appropriation and Special Funds, Including Transfers :
Personal Service $2,885,269.57
Other than Personal Service 1.206,994.28
Revenue Bond Funds:
Miscellaneous • 30,608.07
$4,122,871.92
16
BUREAU OF GENERAL ADMINISTRATION
Expenditures, including unliquidated obligations:
Personal Service $2,854,194.41
Other than Personal Service 1,181,462.28
Misc. Revenue Bond 29,957.62
$4,065,614.31
Statement of Cash Receipts Turned Over to the General Fund of the City.
Sales of Antitoxins 76,579 . 42
Sales of Virus 13,643.24
Pay patients, U. S. Government 158,156.00
Pay patients, City Hospitals 5.900. 50
Pay patients, Sanatorium, Otisville 616.00
Transcripts 49,590. 50
Bulletin subscriptions 61 .92
Waste paper 393.09
Auction Fat 223 . 70
Miscellaneous Refunds 330.64
$305,495.01
Laboratory Products.
Cash receipts from sales of antitoxins and virus 90,222.66
Distributed free — antitoxins and virus 127,512. 15
$217,734.81
Purchase and Storage of Supplies.
Requisitions approved for purchase of supplies and
equipment 3,603
Contracts for supplies, equipment and repairs
executed— 270 $684,204.41
Orders issued for purchase of supplies, equipment, etc.
Open market and contract — 8217 $1,235,041 .91
Due to the strict economy exercised by the department in the purchase
of supplies, materials and equipment, the department managed to carry on
its increased activities within the appropriation, without the issuance of
revenue bonds to augment the department's appropriation.
By strict supervision in the distribution of postage, the savings for the
year 1919 shows a large increase over that of 1918 and 1917, as noted
below :
1917 1918 1919
Amount of postage distributed $39,652.82 $39,573.74 $28,125.35
a saving of $11,527.47 over 1917, and of $11,448.39 over 1918, notwith-
17
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
standing that there was a greater amount of mai' distributed during 1919
than during any previous year.
Division of Complaints
SCHEDULE OF COMPLAINTS RECEIVED, RECORDED AND DISPOSED OF
DURING THE YEAR 1919.
New York
City.
Complaints pending December
31, 1918
Complaints received (citizens) .
Complaints received (original) .
Nocauseforaction (complaints)
Abated by personal effort (com-
plaints)
References
Returned for notice or order
Complaints pending December
31, 1919
Notices and orders pending De-
cember 31, 1919.
Notices and orders issued
Man-
Rich-
hattan.
Bronx.
Brooklyn.
Queens.
mond.
588
255
91
100
13
22,341
7,417
11,171
3,687
1,045
3,340
726
2,653
2,047
505
10,898
3,769
4,310
1,544
271
2.903.
1,357
3,893
1,452
382
7,334
1,552
2,363
560
183
3,686
1,154
3,229
1,870
710
1,448
566
120
308
17
462
352
672
448
159
3,686
1,154
3,189
1,870
703
1,047
45,661
9,271
20,792
9,987
11,992
10,649
2,459
2,093
10,602
Division of Construction and Repairs
Notwithstanding the excessive cost of labor and the vast increase in the
cost of materials, the appropriations for maintenance and repairs to De-
partment Buildings, by careful consideration, was kept within the amount
allowed. This was principally accomplished by department laborers mak-
ing all minor repairs and replacements wherever possible, and by careful
inspection and elimination of all unnecessary improvements.
During the year, four milk stations and one tuberculosis clinic were
removed to more desirable locations, and where the greater need existed
for such stations and clinic — in some instances at reduced rentals.
The following new hospital buildings were completed and occupied dur-
ing the year:
Helps' Dormitory Building — North Brother Island.
Venereal Building — Riverdale Hospital, North Brother Island.
Helps' Dormitory and Kitchen Building — Kingston Avenue
Hospital, Brooklyn.
Diphtheria Pavilion — Kingston Avenue Hospital, Brooklyn.
The entire construction of these buildings was supervised by employes
of this division, to see to it that all plans and specifications were complied
with, and that materials as required were used in construction.
In the spring, specifications w^ere prepared for decorating and painting
thirty-three Baby Health Stations. Contracts were awarded, and interior
and exterior of stations were painted, where necessary.
18
BUREAU OF GENERAL ADMINISTRATION
Lease of the Department Headquarters' Building, at 139 Centre street,
expired on September 30, 1919, and the Sinking Fund Commission, on
recommendation of the Board of Heahh, wisely refused to approve the new
lease at a greatly increased rental. The Department moved to the Hallen-
beck Building, owned by the City, on the Court House site, thus saving a
rental of at least $60,000 per annum.
WELFARE DIVISION.
Examinations and Re-examinalions of Employees Made During (he year
Examinations 287
Re-examinations 665
Men examined 68
Men re-examined 61
Women examined 219
Women re-examined 604
Defects or Impairments Found.
Cardiac impairment
Pulmonary impairment
Overweight
Underweight
Indigestion
Constipation
Naso-pharyngeal impairments, including enlarged tonsils and deflected
and perforated nasal septa ,
Defective vision
Hearing
Defective teeth, including pyorrhoea
Enlarged thyroid
Flat or weak feet
Tenderness found over region of liver and gall bladder
Possible gastric ulcer
Hernia
Gastroptosis
Movable kidney
Tenderness found in right iliac region
Menstrual disorders
Hypotension
Hypertension
Anaemia
Minor skin affections, including psoriasis, chromophytosis, eczema, etc..
Found suffering from petit mal
Bone deformities
Unclassified affections
No evident physical impairment
Number needing advice
Number referred to physician or institution
Number ordered to report for observation until physical condition had
improved
Number who reported regularly until physical condition had improved
Emergencies treated during morning office hours
Men.
Women.
3 45
3 37
2 28
48
17
1 46
2 43
2 89
26
15 97
14
23
4
2
2
5
3
8
25
2 87
3 49
34
15
2
4 6
2 12
14 64
? 675
100
75
6S
73
19
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
LAW DIVISION
A comparison of the legal work performed in the courts, for the years
1918 and 1919, shows a material increase in the number of actions instituted
and disposed of, as well as the amount of fines imposed by the Criminal
Courts of the City, during the year 1919.
In the District Magistrates' Courts, where minor violations are con-
sidered, particularly those relating to spitting in public places, smoking in
subways, the use of unclean glasses in serving and dispensing drinks, the
use of common drinking and eating utensils in the preparation and dis-
pensing of food and drink, the maintenance of minor and aggravating
nuisances, etc., this increase was very marked. In 1918, a total of 4.894
cases were disposed of, and $6,853 in fines imposed ; while in the year 1919,
10.424 cases were disposed of, and $15,645 collected in fines.
A comparison of the results obtained in the Municipal Term Courts,
which try and dispose of complaints involving the more serious violations
of the health law, establishes the fact that a marked increase occurred dur-
ing the last mentioned year. \\'hile the total number of cases only increased
from 2.299 cases disposed of. in the year 1918, to 2,613, in the year 1919,
the fines imposed by the courts amounted to $39,626, from $21,950 in 1918.
It will be noted, further, from this brief summary, that the activities
of the department in the enforcement of the health laws, during the year
1919, have received the approval of the courts, as evidenced by the results
obtained.
It might be mentioned that, before a criminal or civil action is insti-
tuted against any person, firm or corporation, the evidence obtained by the
representative of the Department is carefully reviewed, both by the ad-
ministrative official of the branch of the Department charged with the en-
forcement of the provision of law alleged to have been violated, and by the
Law Division so that trivial, technical, and unnecessary violations would
not be presented to the court, where results could be obtained through the
machinery of the Department. This procedure has proven beneficial to the
Department, as well as to those against whom complaints have been filed.
The interests of persons so complained of are fully protected, because no
complaint is submitted to the courts until it has beeen thoroughly con-
sidered.
It must, also, be borne in mind that the results obtained through the
courts reflect in a great measure the activities of the Department. The en-
forcement of the food. drug, and sanitary laws of this City, as embodied in
the Sanitary Code establish the effectiveness of the administration of the
Department of Health. Constant vigilance must be exercised in detecting
the unscrupulous in the nefarious traft'ic of selling, or using unwholesome,
deleterious, and fraudulent foods and drugs. The convictions obtained, as
disclosed in the attached tables, furnish adequate evidence that the Depart-
20
BUREAU OF GENERAL ADMINISTRATION
ment is effectively prosecuting such individuals. This conclusion is equally
supported in the enforcement of the Sanitary Laws, particularly those relat-
ing to the conditions under which the residents of New York City live.
The Heat Ordinance may be particularly mentioned as having afforded
relief to thousands who, without its aid and support by the courts, woula
have suffered grave inconvenience, and possible danger to their lives and
health. The enactment of this Ordinance, the courts held, is within the
powers vested in the Board of Health, and tended to accomplish the pur-
pose of its enactment.
It might be mentioned, that no landlord of a building was summoned
to court until all other means were exhausted by the Department, in its
endeavor to have heat supplied to tenants, and it was only as a last resort
that landlords were charged with violating the provisions of this Ordinance.
In nearly every instance where a criminal complaint was presented to the
courts, a conviction was obtained and heavy fines imposed.
The particular bureau or division of the department charged with the
enforcement of particular sections of the Sanitary Code will refer to more
important prosecutions in their respective reports.
DISTRICT MAGISTRATES' COURTS.
REPORT OF DISPOSITION OF CASES FOR THE YEAR
ENDING DECEMBER 31st, 1919.
To Municipal Term
To Special Sessions
Fined
Sentence suspended
Prison sentences
Acquittals
Dismissals
Total ca.ses
Total amount of fines
2
33
7,786
2,311
18
54
220
10,424
$15,64.5
21
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
MUNICIPAL TERM COURTS.
REPORT OF DISPOSITION OF CASES FOR THE YEAR
ENDING DECEMBER 31st, 1919.
Dismissed (nuisance abated or complaint withdrawn
before trial)
Held for Special Sessions
Fined
Sentence suspended
Jail sentence
Acquitted
Total prosecutions instituted
Amount of fines imposed
Part I.
Manhattan
and
The Bronx.
116
17
1,200
362
46
1,741
$25,281
Part II.
Brooklyn.
48
7
573
235
872
S14,345
Total.
164
24
1,773
597
55
2,613
$39,626
COURT OF SPECIAL SESSIONS.
REPORT OF DISPOSITION OF CASES FOR THE YEAR
ENDING DECEMBER 31st, 1919.
Man-
hattan.
Bronx.
Brook-
lyn.
Queens.
Rich-
mond.
Total.
Dismissed (nuisance abated or com-
plaint withdrawn before trial)
Acquitted
8
10
5
1
• ■
2
5
1
1
2
1
3
8
9
o
Jail sentence
Sentence suspended
16
Fined
20
Total prosecutions instituted. . . .
23
8
2
2
12
47
Amount of fines imposed
$775
$475
$150
$325
$1,725
Section of Code
Concerned.
116.
122.
139.
144.
151.
152.
159.
163.
170.
225.
Total.
Fined
Sentence suspended ....
Prison sentence
Dismissed
Acquitted
'2
1
2
2
'4
1
2
'2
3
'2
4
3
'2
11
1
2
1
1
1
20
16
"9
2
Total
2
1
4
4
5
5
9
14
1
2
47
$300
$25
$400
$725
$25
$250
$1,725
22
BUREAU OF GENERAL ADMINISTRATION
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23
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
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24
SANITARY BUREAU
The Executive Office maintains a supervision over the work performed
by the Division of Sanitary Inspections, and the Division of Food and
Drug Inspections, Manhattan.
Various Activities.
The 34 lodging houses maintained for soldiers and sailors during the
war, were discontinued during the early months of the year.
Many inspections were made of the large number of private stands
erected along FiftH Avenue, from which were viewed the parades of
the U. S. A. Divisions returned from the late war, as many of those built
on vacant lots had toilet facilities (latrines) installed for each sex, and those
in charge were directed to have lime on hand to sprinkle over the contents.
The city built public stands, covering the entire sidewalk on the east side
of Central Park, from West 60th to West 110th Streets. The day following
each parade, inspectors were detailed to see that all comfort stations, and
the spaces beneath all the stands along the entire route of the parade, were
thoroughly cleaned. The Mayor's Committee sent 25 laborers to thoroughly
clean spaces beneath the stands on Central Park sidewalk.
Stables.
During the latter part of March, a complete census of the stables in
the borough was made, and it showed a decrease of 17,828 horses, since
1917. Whenever horses are destroyed at a stable fire, a patrolman of the
Health Squad is detailed to the premises until all dead animals have been
removed to the offal dock and all offensive material (burned hay, straw,
etc.) removed from premises.
The stables have been kept under close surveillance to prevent fly
breeding and insure sanitary conditions.
Labor strikes, at various times during the year, made it difficult for the
manure dealers to ship manure from the city, or to obtain an adequate
supply of scows or cars on which to load same. This office maintains an
alphabetical street list of all stables in the borough, and also a list of the
manure dealers, and these lists show from which stables each dealer re-
moves manure. Each dealer was notified that manure could not be allowed
to accumulate in stables, but must be removed at least twice each week,
even if necessary to store temporarily on scows or cars or on their docks.
At various times, labor conditions compelled temporary storage on docks.
25
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Refuse Removal.
Labor strikes prevented, at times, the prompt removal of ashes and
garbage by the Department of Street Cleaning, and nuisances developed
when ashes containing considerable putrescent material were used to fill on
the river front, from W. 87 to W. 93 Sts. and when flat scows loaded with
garbage were held many days on the waterfront, before same was re-
layed to bottom-dumper scows, and taken to sea. As a result of these
conditions many complaints were received by this division.
Heating and Dzvellings.
During several winters the Department of Health was besieged with
persons, who lived in so-called steam heated apartment houses, whose own
apartment had no means of providing a reasonable temperature within the
rooms when, for any cause, the central heating plant had ceased to func-
tion or was inadequate.
As the question involved seemed to bear directly on public health and
comfort, and was a subject to be considered under the police powers
devolving upon the Department of Health, the Board of Health, at its
meeting of October 17, 1918, passed a resolution, which became Section
225 of the Sanitary Code :
Section 225. Heating of Occupied Buildings. It shall be the duty of
every person who shall have contracted or undertaken, or shall be bound to
heat, or to furnish heat for any building, or portion thereof, occupied as a
home or place of residence of one or more persons, or as a business establish-
ment where one or more persons are employed, to heat or to furnish heat
for every occupied room in such building, or portion thereof, so that a
minimum temperature of sixty-eight (68) degrees Fahrenheit may be main-
tained therein at all times. Provided, however, the provisions of this
section shall not apply to buildings, or portions thereof, used and occupied
for trades, businesses, or occupations where high or low temperatures are
essential or unavoidable.
Under this section is was made a misdemeanor for anyone who had
contracted to furnish heat, for any residential premises, to fail to maintain
a temperature of 68 degrees F. in the occupied living rooms thereof.
As an immediate result of the adoption of this section the Sanitary
Bureau of the Department received thousands of complaints, although the
winter of 1918-19 was not a severe one. The ordinance was fruitful of
good results during this time, and was upheld by the lower courts as
reasonable.
To meet the legal technicalities advanced by owners of houses com-
plained of, the sanitary inspectors were provided with thermometers, whicK
had been tested in our laboratory in comparison with a U. G. Government
26
SANITARY BUREAU
tested and sealed thermometer. These thermometers were found to be not
only serviceable but reasonably accurate (within 1 or 2 degrees F. ) for the
purpose required.
It was found, after a year's trial of this ordinance, that there were
several instances in which no expressed contract could be established re-
quiring the heating of the premises. Landlords were quick to take ad-
vantage of this defect and plead it, when summoned to provide heat. Again,
the tenant in many instances became unreasonable and attempted to compel
the owner to provide heat during all hours of the twenty-four.
In view of these, and of other defects within the knowledge of our
legal department, the Board of Health at the meeting of December 11. 1919,
amended Section 225 of the Sanitary Code to read as follows :
"Section 225. Heating of Occupied Buildings. — It shall be the duty of
every person who shall have contracted or undertaken, or shall be bound to
heat, or to furnish heat for any building, or portion thereof, occupied as a
home or place of residence of one or more persons, or as a business estab-
lishment where one or more persons are employed, to heat, or to furnish
heat for every occupied room in such building, or portion thereof, so that
a minimum temperature of sixty-eight (68) degrees Fahrenheit may be
maintained therein at all such times. Provided, however, the provisions of
this section shall not apply to buildings, or portions thereof, used and oc-
cupied for trades, business, or occupations where high or low temperatures
are essential and unavoidable.
"For the purpose of this section, wherever a building is heated by
means of a furnace, boiler, or other apparatus under the control of the
owner, agent, or lessee of such building, such owner, agent, or lessee,
in the absence of a contract or agreement to the contrary, shall be deemed
to have contracted, undertaken, or bound himself or herself to furnish heat
m accordance with the provisions of this section.
"The term 'at all such times' as used in this section, unless otherwise
provided by a contract or agreement, shall include the time between the
hours of 6 a. m. and 10 p. m. in a building, or portion thereof, occupied as a
home or place of residence, and during the usual working hours established
and maintained in a building, or portion thereof, occupied as a business
establishment, of each day wherever the outer or street temperature shall
fall below (50) degrees Fahrenheit.
The term 'contract' as used in this section shall be taken to mean and
include a written or verbal contract."
During the winter months, over 49(X) complaints were received in re-
lation to "lack of heat" and these were investigated by the regular field
force.
27
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Vessels from Plague Infected Ports.
Lists of vessels arriving from infected ports (bubonic plague) were re-
ceived daily from the Health Officer of the Port of New York, and a patrol-
man of the Health Squad was sent to enforce official regulations on all
vessels that had not been fumigated, and these vessels were kept under
observation while moored to dock or pier to insure compliance with regula-
tions.
The clerical force of the Sanitary Division was reduced by sickness,
special details, and vacancies, to a point where it was necessary to keep
several of the field force in tne office almost continuously; there was also a
vacancy in the district force, and thus depleted, the field force performed
the extra work, caused by the unusual conditions noted above, and made
66,626 inspections during the year.
Mosquitoes.
In the Borough of Manhattan, no citizen's complaints were received
in relation to mosquitoes, although climatic conditions were unfavorable.
Inspection, following complaint, showed that decaying vegetable mat-
ter was causing offensive odors in Loch Pool in Central Park, and refer-
ence was made to the Park Department and nuisance abated.
All possible breeding places in Central Park were kept under observa-
tion, and measures taken to eliminate breeding of mosquitoes when found,
as at Duck Pond, where steps are being taken to make a permanent im-
provement.
Prevention of Rabies.
To assist in preventing spread of rabies, there were printed far the
Department, during March, 100,000 copies of a folder containing informa-
tion for dog owners, such as, " licenses required for all dogs in cities hav-
ing population over 800,000 "— " sections of Sanitary Code relating to
rabid and vicious animals, and the proper muzzling of dogs," and " how
enforcement of same would prevent spread of rabies." Of these, 70,000
copies were sent to A. S. P. C. A., to give a copy with each new license,
or renewal of license, during 1919 (68,500 last year) ; 20,000 copies to
veterinarians in Greater New York ; 500 copies to stores selling dogs ; 2,000
copies to shops selling dog collars, etc.
The Veterinary Division reported: 1,037 dog bites; 114 persons
treated therefor in clinic; 1,452 Pasteur anti-rabies injections given; 595
persons bitten by dogs advised in clinic ; 974 dogs suspected of rabies exam-
ined ; 227 vicious dogs destroyed; 6 cases of rabies (dogs), no cases of
rabies in man.
28
SANITARY BUREAU
Prevention of Glanders.
Special efforts were made during the year to lower the number of
glanders cases, acting under the belief that Section 21 of the Sanitary Code
gave authority to enforce testing, branding, and tagging of horses.
In this work, 24,282 horses were examined ; 393 horses tested for
glanders ; 91 glandered horses were destroyed ; and 12.246 horses tagged.
Preventing Waste of Food.
Labor unrest since the war, and the many labor strikes that have oc-
curred during the year on the waterfront, in the adjoining harbor, and in
the New Jersey terminals, menaced to a marked degree, the food supply of
the city, and required the best efforts of the field force of the Division of
Food Inspections, to prevent waste and loss of perishable materials.
Waste was frequently prevented by having sound material removed
from shipments of partly decomposed or spoiled foods, under official super-
vision, and abandoned shipments of spoiled fruits were diverted to hospitals
and institutions, and the sound portions used.
DIVISION OF SANITARY INSPECTION.
Assembly Halls.
Inspections were made of all theatres, relative to ventilation, unclean-
liness, and general sanitary conditions, from time to time during the year.
Inspectors were especially detailed to ascertain if drinking utensils were
used in common. All of the theatres in the Borough of Manhattan were
visited, within a few days, and where it was found that the drinking uten-
sils were used without having been thoroughly cleansed by an attendant,
the practise was discontinued.
The following was the result of these inspections :
Violations abated by personal effort 12
No cause for action 107
Total Theatres inspected 119
This survey did not include motion picture theatres.
Barber Shops.
All barber shops were inspected by the district inspectors, from time to
time. The number of times that each one was inspected during the year
depended upon the character of the shop. Those located in neighborhoods
where the main portion of the population is not particular in habits, and
would not insist upon the use of sterilized implements, were kept under
strict observation, and the regulations rigidly enforced.
29
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
A survey of all barber shops during the year, as to violation of regula-
tions, showed :
Violations abated as result of notice 146
Violations abated by personal effort of inspectors 472
No cause for action 1 ,546
Total Barber Shops 2,164
Stores for Birds and Small Animals.
There are 123 establishments in the Borough of Manhattan under per-
mit from this Department, in which birds and small animals are kept for
sale. These birds and small animals are sold for pets, and for medical re-
search work. The places in which they are kept are under the observation
of the district inspectors, and are frequently visited by them to insure clean-
liness.
Comfort Stations.
In nearly all railroad terminals, ferry houses, elevated and subway sta-
tions, and in a few public squares, and in the parks, there are comfort sta-
tions that afford water-closet and washing facilities for the public.
This Division is charged with the responsibility of keeping these com-
fort stations in a clean and ."sanitary condition, by compelling those in charge
to make necessary repairs, from time to time, and cleaning them.
The comfort stations in the subways are the cause of mare difficulty
than any other set. They are located below sewer grade, the sewage that
accumulates in the sumps used in connection with them has to be pumped
up to the public sewers, and the mechanism of the ejectors used for the
purpose is delicate and easily put out of order. Failure to operate, results in
the sewage flowing on to the station platform and tracks. The subway com-
fort stations are more frequently inspected than any others.
There are about 800 comfort stations in the "L" and subway stations
of the Borough accessible to the general public, and those are about divided
equally for males and females.
Permits for Chickens and Pigeons.
There are 84 permits in force for keeping chickens, and 79 for keeping
pigeons. These permits only cover the keeping of these animals as pets and
for domestic use.
The places in which they are located are frequently inspected by the
district inspector, to assure cleanliness, and to ascertain if the number
allowed by the permit is exceeded.
Bathing Establishments.
There are no beach baths in the Borough of Manhattan. During the
summer the City of New York conducts six free floating baths along the
30
SANITARY BUREAU
river front, and five baths, in which river water is used, are conducted for
profit, by corporations and individuals.
The city, also, conducts five interior baths where there are pools ; and
there are 83 interior baths with pools, conducted by individuals or cor-
porations.
Samples of water are taken from the pools of all these baths, during
the year, and are submitted for bacteriological examination, and the river
front baths are closely watched and samples of the water from them are
frequently taken, during the bathing season.
The water used in the pools of all baths along the shore, and in the
interior baths conducted by the city, is filtered and treated with chlorite of
lime. All of the baths that float in the waters of the bay or rivers are tight,
so as to prevent the polluted water outside from entering the bathing pool.
Inspections were made during the year ai all bathing establishments
where persons are kept over night, to ascertain if any were overcrowded.
It is the custom in some of these places for persons to take a bath during the
evening, and sleep on the premises until morning.
Inspections of baths of this character were made between the hours of
2 and 5 A. M. Three establishments were found overcrowded, and the pro-
prietors warned of the violation. Reinspections, later, showed that all
excess beds had been removed, and the practise of overcrowding discon-
tinued.
Inspections were also made of all baths in an endeavor to compel the
use of individual drinking receptacles, and for the purpose of enforcing
regulation requiring a clean towel for each patron. It is the custom, in
Russian and Turkish baths, for the patrons to drink many cupfuls of water,
during the time they are in the hot rooms, for the purpose of promoting
perspiration, and the drinking utensil was being used in common in a hrge
number of them. Through the efforts of inspectors from this Division
this practise has been discontinued, and individual drinking utensils are now
provided. No violations were found of the regulation requiring clean
towels for each patron.
Horse Shoeing Establishninifs.
There are 246 horse shoeing establishments in the Borough of Man-
hattan. Inspections were made from time to time by the district inspectors,
to enforce the regulations of this Department and prevent a nuisance.
Ice Plants.
Inspections were made, during the year, of plants where artificial ice
is manufactured, and reports descriptive of the process uesd were for-
warded. Certificates were issued in regard to methods employed and
materials used, on request, to Railroad and Steamboat Companies, using
Hygeia ice in interstate Commerce.
31
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Laundries.
Inspections were made, from time to time, during the year by the
district inspectors to enforce the regulations of the Department applying
to laundries.
Lodging Houses.
There are 79 lodging houses in the Borough of Manhattan operating
under permit, and 10 operating without permit. The latter have not been
certified by the Bureau of Buildings or by the Fire Department, and permits
from this Department cannot be issued until these certificates are received.
The 34 lodging houses that were used for soldiers and sailors, during
the early part of 1919, have all been closed and the applications for permits
cancelled.
All lodging houses were inspected, day and night, during the year.
Inspections were made every week (day and night) for the period from
January 1 to March 17. They were inspected every month thereafter, until
the large number of other complaints received demanded almost the entire
attention of the force in November and December, preventing further in-
spection of lodging houses.
Vacant Lots.
Vacant lots in the Borough of Manhattan are the source of considerable
nuisance. They are used as dumping grounds by the occupants of adjacent
buildings and, in some sections, require the constant attention of an inspector
to keep them clean.
Lots below the grade of the sidewalk are inspected, with a view to
providing proper fences to prevent accidents to persons passing by.
Parades.
On the occasion of the return of the 27th Division and 77th Division,
a large number of stands were erected for spectators.
Inspectors from this Division supervised the cleaning of the stands and
spaces adjacent and beneath them, after the parades.
Clothing Trade Survey
A survey, lasting six weeks, was made by five inspectors, of 1143 work-
shops in which garments are manufactured. This survey was made with a
special view to listing the hazards in the trade, and rectifying insanitary
conditions of every description.
It was found, aside from the ordinary insanitary conditions found in
factory buildings, that the w'orkers in the trade were exposed to fumes
from benzine used in many places for cleaning ; and the fumes from illum-
inating gas, used to heat the pressing irons. Flexible tubing is used to
convey the gas to the iron ; it soon becomes dry and cracked, allowing the
gas to escape. These conditions were improved, to a great extent, by the
installation of heavy and properly bound tubing.
32
SANITARY BUREAU
The following was the result of these inspections.
Notices issued 547
Reference to other departments II3
Nuisance abated by personal efforts 314
No cause for action I59
Total
1143
Unmuzzled Dogs.
Efforts are made by the Department of Health to decrease the number
of cases of rabies, caused by dog bites, by compelling the owners of dogs
to muzzle them when they are in public places.
Inspectors from this Division made the following number of arrests,
in connection with this activity, during the year.
Arrests 116
Total amount of fines $94
Suspended sentence 32
Drinking Water.
A sample of water from the reservoir in Central Park was taken every
month and submitted to the laboratory of this Department for bacterio-
logical examination ; samples of bottled water, taken from different places
in the Borough of Manhattan, where complaint was received as to the
quality of the water were also submitted for bacteriological examination.
In all cases of typhoid, samples of the water from the water supply
tank, and from the supply-pipe to the buiding, were also submitted for
bacteriological examination.
An experiment was made with a bottle of water to determine if air in
a room, which replaces water in an inverted bottle whenever water is
removed from the bottle, contaminates the water.
A bottle containing five gallons of water was placed in the room on the
first floor of the building formerly occupied by the Department at 139
Centre Street. This room was visited by a large number of people daily,
to procure birth, marriage, and death certificates.
One-fifth of the water was removed from the bottle daily, and sub-
mitted for bacteriological examination. This was done on five successive
days, and at no time did the examination reveal that the water was polluted.
Lack of Heat.
There were 4921 complaints investigated during the year, in reference
to the lack of proper heat (68° F) in occupied buildings.
The investigation of these complaints was an added activity that was
done without increasing the force, and was accomplished by placing two
Z3
ANNUAL REPORT OF THE DEPARTMENT OE HEALTH
inspectors in some districts, where the number of complaints were numer-
ous, and having other inspectors cover two districts during the period.
The following was the result of these investigations.
Nuisance abated by personal effort 622
No cause for action 4299
Total 4921
No. of Court cases 6
No. Fined 4
No. dismissed 2
Total amount of fines $850
The large number of cases returned "no cause for action" (4299) was
caused, mostly, by the haste of complainants to refer to the Department
whenever the heat was lowered for a short time to make necessary repairs
or to adjust the fire-bed of the furnace. A large amount of time was wasted
by the inspectors in investigating these cases.
In the 622 cases in which the proper degree of heat was provided,
through the efforts of an inspector, considerable time was spent on each
to reach the owner, and to reinspect the premises during the time that the
heating plants were being repaired. In the great majority of these cases
the inability to produce the required degree of temperature was caused by
some defect in the heating system, which the inspector would discover and
call to the attention of the landlord. If repairs were started at once, the
inspector would hold the case in abeyance until the repairs were completed.
Pratiques.
On the presentation of pratiques issued by the Health Officer of the
Port, 1430 permits were issued to unload cargoes of vessels.
Railroads.
The New York Central Railroad adjoining Riverside Drive (72nd to
134th Streets) was kept under observation from June 25 to October 31, for
the purpose of obtaining evidence relative to noise made by the operation of
the trains at night, and the smoke, cinders and coal gas (from the locomo-
tives) which caused a nuisance in adjacent buildings. All of these condi-
tions were found to prevail but a careful analysis of the reports made by
inspectors who made survey failed to establish that the railroad violated
provisions of the sanitary code or regulations of the Board of Health, as
limited by court decisions of this state and affirmed by the Court of Appeals.
Ventilating Openings of Subzvoys.
A nuisance is frequently cause by the waste pipes, connected with the
drip-pans used under the ventilating gratings of the subways, becoming
34
SANITARY BUREAU
obstructed. Inspectors are continually on the outlook for this nuisance and
notify the company at once of the condition. As large amounts of liquids
accumulate in these drip-pans at times prompt action is necessary'. As a
rule, the operating companies clean them out within 24 hours after they are
notified.
Ventilation of Railroad Cars.
Inspections were made of cars on all surface roads, subways and
elevated railroads to determine if sufficient ventilation was being provided
during December. The cars were found sufficiently ventilated, by means of
upper transoms and door-ways in the surface and elevated cars, and by
transoms and between four an six open windows in the subways. About
1500 cars were inspected.
Refuse Material.
There are 12 dumps maintained by individuals and corporations for
receiving manure; three for receiving ofifal, swill and dead animals; and the
Department of Street Cleaning maintains 8 dumps for receiving garbage,
ashes, and rubbish, and 7 for receiving ashes and rubbish only, on the
waterfront of the Borough of Manhattan.
Inspectors from this Division keep all of these dumps under observation.
Special attention is given to the manure and garbage dumps, during the
fly breeding season.
Wherever a nuisance is found at any of them, steps are taken to abate
it at once.
Considerable trouble was experienced with the dumps maintained by
the Department of Street Cleaning, during the year, due to the fact that the
practice of sending garbage to reduction plants had been discontinued and
all garbage dumped at sea.
In changing to the new system, the authorities in charge found it
necessary, to send loaded deck-scows from the river front dumps to the
dump at 107th Street and the East River, where the garbage was trans-
ferred to sea-going bottom dumpers. This offensive material was held at
the dump for a long time, and offensive odors from same pervaded the
neighborhood.
There are about 2000 permits in force which have been issued by this
Division covering vehicles that are used to transport manure, garbage, offal,
ashes, fat, bones, sweepings, and swill. These vehicles are kept under
observation, and whenever they are found uncovered or other regulations
of the Department violated, a summons is issued to the driver.
The following number of arrests were made in connection with such
violations, during the year:
Arrests 51
Amount of Fines $138
35
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Many of these permits often change hands as the owners sell the
vehicles. It is necessary to inspect them frequently, as to equipment, and
to determine if they are still being used by the owner specified in the permit.
Schools.
All buildings leased by the Department of Education for public school
purposes are inspected by inspectors from this Division, before the De-
partment accepts them for use. Also all private schools are inspected by in-
spectors from this Division before a permit is issued to use them
Stables.
All stables are kept under observation by the district inspectors, and the
owners are required to remove all manure from them, and keep the stables
in good sanitary condition.
A census was made of all stables in the Borough, during March, and
showed :
Number of Stables 1,577
Number of Horses 37,825
a reduction of 436 stables and 17,828 horses since 1917. The stables are
operated under permits from this Division,
Spitting.
An "anti-spitting campaign," from November 10th to 22d, inclusive,
gave the following results :
Arrests 424
Sentences Suspended 43
Jail Sentences 1
Fined 352
Amount $584
Dismissed 28
Temporary Privies.
Inspectors from this Division required the installation of temporary
privies for the use of workmen in all new buildings that were erected dur-
ing the year.
ASSISTANT SANITARY SUPERINTENDENT'S OFFICE, BOROUGH OF
MANHATTAN.
, Division of Food and Drug Inspection.
Terminals.
The most important squad of inspectors is the one covering the
terminals, wholesale markets and warehouses. This squad, which consists
of three men, is assigned as follows :
36
SANITARY BUREAU
a — Important piers, and railroad terminals.
b — Wholesale fruit and vegetable markets, and warehouses.
c — Wholesale egg markets, fish, and meat establishments.
It is the duty of this squad to inspect and supervise the handling of
foods at the establishments referred to, seize, condemn, and destrov all
spoiled or otherwise unfit foods which arrive in this city. Enforcing the
piovisions of the Sanitary Code at the points of arrival, prevents the dis-
tribution of spoiled food to various food establishments, and so protects
the public. This detail also eliminates in a great part, the necessity for in-
spection of food at retail establishments, thereby enabling the inspectors to
concentrate upon the more important branches of food inspection service.
Factory Inspection.
A detail was made of inspectors who by their special training are quali-
fied to carry on the inspection of materials, particularly raw materials,
which enter into the manufacture of foods, such as jams, jelly, confection-
ery, spices, etc. ; so that a comprehensive idea could be gained as to quality
of foods used in these factories, as well as the sanitary conditions surround-
ing the handling of the same. This work was so arranged that frozen
products, such as ice cream, which are classified as being seasonable prod-
ucts, would be thoroughly supervised.
Prior to and during the holiday period, when candy was being manu-
factured in very large quantities, it was felt that the squad referred to was
inadequate to cover this important activity. The Borough of Manhattan
w^as, therefore, subdivided into five factory inspectorial districts, and two
inspectors were assigned to w'ork together in each district and concentrate
on each food factory.
Milk Inspection.
The milk inspection service of this Division consists of three inspectors,
one of whom is assigned as supervisor, and whose duty is to see that the
milk and milk products sold in the Borough of Manhattan conform with
the legal standard. It is their duty to cover the entire Borough so that milk
and cream is being continually tested in the various sections. It is also
their duty to procure samples, especially from the distributors, and submit
them to the Chemical Laboratory for analysis. In carrying out this de-
tail, it is necessary for them to cover the various milk arrival points, so as
to preclude the possibility of distributing substandard or questionable milk
throughout the city.
Meat Inspection.
A squad of two inspectors, one veterinarian, and a supervising inspector
is detailed to the various wholesale meat arrival points. It is their duty to
37
ANNUAL REPORT OF THE DEPARTMENT OE HEALTH
inspect all country dressed carcasses, or parts thereof, to ascertain if this
material is fit for human purposes. Where such material is found to be
in a wholesome condition, to stamp it "inspected and passed," as provided
by the local ordinances, and wherever spoiled or diseased material is dis-
covered, to see that it is condemned, and properly disposed of under super-
vision.
Drug Inspection.
A graduate pharmacist was detailed to act as inspector of Drugs, to
cover drug establishments, to ascertain if the drugs handled and sold con-
form with legal requirements, and to investigate complaints which relate to
the drug business generally.
Miscellaneous Inspection Work.
Special details were also arranged, of qualified inspectors, to carry
out special investigations, such as food poisoning cases, and other con-
ditions which require the attention of an inspector who is peculiarly fit to
make such inspections. An assignment was also made of a sanitary in-
spector who, due to his expert knowledge of the sanitary science, could
cover details which require the knowledge of a man with a technical train-
ing in order to procure the proper results.
General Scope of Work of the Division.
The scope of the work of this Division primarily begins with the en-
forcement of the provisions of the Sanitary Code and the State laws and
City ordinances which relate to food and drug inspection activities. This
statement applies particularly to activities to determine the following:
(a) The quality and wholesomeness of food.
(b) The prevention of the adulteration and sophistication of foods
and drugs, and the sale of fraudulent products.
(c) The inspection of all food and drug establishments, to see that
the sanitary conditions are proper.
(d) The co-operation with the Bureau of Preventable Diseases to
prevent the employment of persons afflicted with communic-
able, or contagious diseases, in food establishments ; also to
prohibit the employment of persons in whose families con-
tagious diseases exist and no efforts are made to isolate the
patient.
(e) The co-operation with other city departments, state departments
and Federal agencies, so as to co-ordinate the food activities
and prevent, as far as possible, the duplication of inspectorial
work, and interference with the plans of these other agencies.
The work of this Division is also educational, as well as investigational,
38
SANITARY BUREAU
and is carried on with the idea of teaching those whose ideas of cleanHness
and sanitation are not up to the requirements of the Department of Health.
Terminal Inspection and Wholesale Markets.
Much attention was given to the piers and terminals, owing to the
many strikes called by the labor organizations of drivers, express employes,
etc. Although in some instances large quantities of foodstuffs were held
on the piers, there was comparatively no spoilage, which was probably due
to the previous effective work of the terminal squad. The shippers were
particularly careful to have the shipments come through in good con-
dition, due to the increased cost of transportation, as well as increased
cost of material and labor, because the seizure and destruction of the goods
at this market would cause a heavy financial loss.
Resultant of this state of affairs, there has been considerable improve-
ment in the quality and conditions of the foodstuffs received in this city so
that where normal conditions surrounding the shipment prevailed, the food
arrived in good condition. Whenever shipments were received which con-
sisted in part of decomposed or spoiled food materials, every effort was
exerted by the inspectors to prevent the loss of the sound material con-
tained in the shipments, and in these efforts we were particularly successful,
the incentive being that the materials were worth such a large amount of
money that it was well worth overhauling the shipment. This recondition-
ing process was always carried on under the immediate supervision of an in-
spector, so that none of the spoiled materials could enter into the commerce
of the city.
During the strike situations referred to, when no deliveries of perish-
able foods were being made, it was our purpose and desire to have such
perishable foods released so that deliveries were made under the supervision
of an official of the Department, and the work was carried on in such a
manner that the strikers were not antagonized and were shown the necessity
for taking such action. This precedure prevented a considerable loss of
money to the shipper, and also released for delivery large quantities of
perishable products to the consuming public. For instance, on June 23d,
during the strike of the Teamsters' Association when deliveries of perish-
able commodities were prohibited by the union, a large shipment of berries,
worth a considerable amount of money, was undergoing spoilage on the
pier of the Hudson Navigation Co. (Pier 24, N. R.). Through the efforts
of the representative of this Divsion, permission was obtained from the
strikers to permit the delivery of this material, so as to prevent a complete
loss. Unfortunately, however, due to adverse weather conditions, the fruit
was unsuitable for the general market requirements and was diverted to
food manufacturing establishments, owing to its being dead-ripe, and quick
action being necessary to prevent entire loss.
39
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Factory Inspection.
The food factories of the Borough of Manhattan were inspected at
regular intervals, with the view to ascertain the quality of foods used in
the products manufactured, as well as the sanitary conditions surrounding
such manufacturing processes. It is worthy of note to report that the
great majority of factories in this borough are operated by individuals and
corporations who seem to make every effort to comply with the law.
In a number of instances, however, it was found that unscrupulous
dealers were taking advantage of the public by using decomposed, spoiled, or
otherwise unfit food materials in the manufacture of products sold by them.
Through the excellent work of the inspectors assigned to this detail, we
were successful in locating a number of such dealers, and in each instance
where it was found that the spoiled material was used in the manufacture
of food, the facts were forwarded with the recommendation that the
dealer be prosecuted.
A special investigation was also made, early in the year, to determine
if the product called "Avizol" was being used in the manufacture of hard
candy. This investigation revealed the fact that in some of the candy
factories, "Avizol" was being used, and samples of the product were
procured and submitted to the Chemical Laboratory for analysis, where
it was found that the candies contained sulphurous acid, and added pre-
servative, and the products were therefore sold in violation of Section 139
of the Sanitary Code. The facts were submitted to the Advisory Committee
for the opinion as to the injuriousness of the product "Avizol" and it was
their opinion that it is a deleterious substance and should be prohibited in
food products, especially those used by children. In view of this opinion, the
candy manufacturers were notified to immediately discontinue the use
of "Avizol," and subsequent reinspections failed to reveal that any manu-
facturer was continuing its use.
Bakery Inspection.
Bakeries of the Borough of Manhattan are under continuous surveil-
lance, both to determine the quality of food used in the manufacture of
products and the sanitary conditaions of the bakeries. Although the
bakeries have been under a sanitary certificate for a considerable length
of time, it appears from reports of inspections that many do not view the
requirements of the State Labor Law and of this Department with the
proper attitude. Heretofore, it has been the practice to make a number of
reinspections at bakeries where insanitary conditions were reported to exist,
and a considerable length of time was given for the removal of the vio-
lations, and after a certain number of reinspections, if the insanitary con-
ditions are not corrected, the application for a sanitary certificate was de-
nied, and after the denial notice was served, more reinspections were made.
40
SANITARY BUREAU
This procedure was somewhat cumbersome and did not produce the proper
results, in that it enabled the bakers to continue the manufacture of their
products under insanitary conditions. There was also a considerable loss
of time on the part of the inspectors in making reinspections, as well as
additional duties for the office force in reporting on the bakery. This pro-
cedure has been modified so that whenever application is received for the
renewal of a sanitary certificate and, upon the first inspection, insanitary
conditions are found, the operator is called to this ofifice and conditions
complained of are fully explained to him. He is notified that his failure to
remove the violations, within five days after the hearing, will be deemed
sufificient cause to warrant a recommendation that this application is denied,
and furthermore, that he will be served with a summons for conducting his
business in an unsanitary manner. This change of procedure has been very
satisfactory, and at the present time very few applications are forwarded
to the Board of Health for denial. In following this arrangement, we have
been successful in cleaning up a number of insanitary bakeries.
At the time of making inspections of the bakeries, the inspector also
examines the quality of the food. The great majority of the dealers, it has
been found, purchase materials of good grade and keep them under satis-
factory conditions. Some of the dealers, however, make a practice of buy-
ing low grade food material which they store under improper conditions. A
number of instances have been reported where such food found in the
possession of the bakers would have been used in violation of the Sanitary
Code provisions, and recommendations had been made that the dealers be
brought before the court.
Attention is also given to the exposure of food products in bakeries
as to contamination due to its being uncovered and unprotected from dust.
dirt, and unwarranted human handling. Wherever such violations are
found it is the duty of the inspectors to instruct the operators of the
establishments as to the requirements of Section 142 of the Sanitary Code,
and where the dealers fail to readjust their business methods to meet the
requirements of this section, a summons is served.
Periodical night inspections of bakeries are made for the purpose of
examining the eggs used in the manufacture of cakes, etc. This activity
is of special importance in view of the present high cost of eggs, and the
incentive of unscrupulous dealers to use decomposed eggs in their products.
The results obtained in this activity have been very satisfactory. These
night assignments are beneficial in that they have a moral affect upon the
bakers.
Restaurant Inspection.
Restaurant inspection is considered one of the most important ac-
tivities of this Division. Considering the fact that the foods, at the present
time, are extremely high in price, there is every incentive for restaurant
41
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
operators to buy and serve food of questionable character. The inspectors,
therefore, are very diligent in carrying out this detail to make sure that
the food in the restaurants is sound and wholesome in every respect. Wher-
ever unsound food is found, the facts are forwarded for the attention of the
court.
Special attention is also given to the general sanitary condition of the
establishments, and every care is taken to see that the glasses and utensils
used in the service and preparation of food are thoroughly cleansed, after
use. Upon inspections made, it appears that some of the dealers do not
pay proper attention to the requirements for the washing of drinking
glasses, and wherever such conditions are found, a summons is immediately
served.
In keeping with this activity, it is our desire, wherever possible, to cause
the dealers to install the use of individual drinking cups.
Upon inspection of restaurants, special attention is also given to see
that each food handler possesses a card of physical examniation declaring
him to be free from any infection or communicable disease. Wherever it
is found that the food handler does not possess such a card, reference is
immediately forwarded to the Bureau of Preventable diseases for attention.
Retail Establishment Inspection.
The work of the district inspector relates chiefly to the inspection of
retail food establishments, such as groceries, butcher shops, bakeries, con-
fectioneries, restaurants, fish stores, etc., for the purpose of determining if
the quality of the food held conforms with the requirements of the De-
partment, and to note the sanitary conditions under which they are handled.
It is the duty of the district inspector to report to the office, immediately,
whenever spoiled foods are found in such a condition as to indicate that
they have been recently delivered by a wholesale dealer or distributor, so
that a reinspection may be made at once at the point of delivery, and so
prohibit further distribution. Whenever it is found that the point of dis-
tribution is located outside of the jurisdiction of this division, a reference is
forwarded at once to the borough in which the wholesaler is located so
that they may take proper action.
In a great majority of the retail stores, the quality of food handled is
usually found to be up to the standard. In a few instances, considering
the large number of retail establishments, spoiled foods have been found on
sale, and whenever such is the case, a recommendation is made that the
dealer be prosecuted.
There has been considerable improvement in the sanitary conditions of
establishments since the work has been arranged so that the district in-
spector can concentrate upon establishments of this character.
42
SANITARY BUREAU
Attention is also given to see that the regulations of the Department are
enforced concerning the handling and sale of milk in retail stores.
Milk Inspection.
During the early part of the year, a controversy arose between the
milk producers and distributers, and the situation became so tense that many
of the producers refused to ship milk to the city. This state of affairs
was very serious, and compelled the distributors to tap other sources of
supply, so as to enable them to give this city fresh milk. This situation
made it necessary for them to bring milk into this city from western points
of production, and it was the understanding that such milk brought into the
city should be pasteurized. The pasteurizing requirements were of special
importance in view of the milk being received from sources which have not
been inspected. There was also a possibility that such milk was produced
in localities where the standards of cleanliness imposed by the Depart-
ment were not met. Every effort was, therefore, made to see that the
milk shipped, labeled to be pasteurized, was properly handled. In several
instances, it was found that the large dealers were selling such milk as
pasteurized whereas, in fact, it had been delivered from the railroad
station to the consumer without having been subjected to the process of
pasteurization. Reports were, therefore, forwarded with the recommenda-
tion that these offending concerns be prosecuted.
A siezure was made of thirty-one cans of milk from a wagon of a
large distributer. This milk was found to be extremely dirty and abso-
lutely unfit for human food purposes. The milk did not have the usual
characteristics of fresh milk, in that there was no cream line and was
yellowish in appearance. Representative samples were submitted to the
laboratory for investigation, and it was pronounced to be "reconstituted
milk." Sufficient facts could not be obtained to bring prosecution.
Much of the milk which arrived at this time was found to be below
the legal standard.
The inspectors were successful in obtaining a number of samples af
substandard milk, concerning which proper action was taken. Several cases
were forwarded for prosecution against a dealer in whose possession cream
was found adulterated with starch. In disposing of these cases, the court
imposed a fine of $200. Several cases were also forwarded against milk
drivers who were found skimming milk, carrying water on their wagons.
and committing other violations of the Sanitary Code. In each instance a
recommendation was made that the offending driver be brought before the
court.
During the sunmier months, special attention was given to the enforce-
ment of the regulatio^ls of the Department which required that milk brought
into the city must be below 50 degrees F. Concentration of the inspection
43
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
service was made on the railroad terminals so as to prohibit the delivery
of milk which did not conform to this temperature standard. Owing to
the extreme scarcity of milk during these months, as well as the scarcity of
ice, instead of denaturing the milk, the inspector placed an embargo upon
the shipments, and caused the dealer to bring the temperature below the re-
quired standard before deliveries were permitted. This practice prevented
the destruction of such milk as was good for food purposes, and stopped
the delivery of uncooled milk.
Meat Inspection.
The requirements of the regulations regarding country dressed car-
casses and parts thereof, not bearing the stamp of inspection of recognized
authorities, were carefully carried out. Specially trained and qualified in-
spectors were detailed to make inspections and thorough examinations of
such material arriving in this city. A veterinarian was also assigned to this
squad.
This squad has been exceedingly successful in giving saitisfactoTy
service to merchants who receive country dressed carcasses which, at times,
arrive in large quantities, and not cmly necessitate quick action on the part
of the inspectors but also require that they work considerably over time,
in order to prevent spoilage.
The wholesale meat distributing establishments were kept under the
observation of the district inspector, and from time to time, whenever
necessity required it, the special squad of trained inspectors was detailed
to the inspection of these establishments so as to make doubly sure that
the quality of meat sold conforms with requirements of the Department.
By augmenting the district inspecting force with this special assignment
of trained men, the wholesale meat situation was well covered. The
retail butcher shops were also covered by the district inspectors and, in
a number of instances where unfit and spoiled materials were found under
circumstances indicating that they would be sold to the consumer, the facts
were forwarded to the attention of the court.
Drug Inspection.
The inspection of drug stores and the taking of samples of drugs for
chemical analysis was somewhat curtailed during the past year, due to the
fact that the pharmaceutical chemist formerly employed by this Depart-
ment had resigned, and for a considerable length of time, the position was
vacant.
The activity was also lessened due to the assignment of drug inspectors
to the clinic which was opened for the treatment of drug addicts. We were
successful, however, in obtaining a number of samples of drugs, and wher-
ever substandard drugs were found to be sold, proper action was taken.
44
SANITARY BUREAU
Several cases of importance were disposed of in the Court of Special
Sessions against persons found to be practicing medicine without a license.
In one case, a prison term was imposed.
A number of hearings were also held in the Municipal Term Court with
reference to a case pending against a man who was charged with having
manufactured and sold a so-called serum treatment which was said by him
to be a cure for tuberculosis, and the preparation therefore sold in violation
of Section 118 of the Sanitary Code. This case is still in court and hear-
ings are continued from time to time.
A case was disposed of against a pharmacist who was charged with
having compounded a prescription illegally, in that he failed to dispense the
amount of drugs called for by the physician's prescription. The court, upon
reviewing the facts, imposed a fine of $250.
The inspectors were detailed to visit each drug store located within the
Borough of Manhattan, and distribute a circular relating to Section 117 of
the Sanitary Code, with reference to the registration of patent or proprie-
tary medicines, so that the druggist could be fully informed as to the re-
quirements of this amended section.
Food Adulteration.
Owing to the scarcity of imported olive oil, many of the dealers, espe-
cially those of the foreign element who deal in canned oils and make a busi-
ness of packing or filling cans of oil, resorted to the practice of using cans
which were so labeled and marked as to convey the impression to the pur-
chaser that the oil contained within the cans was imported pure olive oil,
whereas, upon analysis, it was found that the oil was not pure, but was a
compound consisting of a greater portion of cotton-seed oil and, in some
instances, sesame oil ; thereby perpetrating a fraud upon the public in that
the oil was sold at a price far above that which should be charged for com-
pound oil ; also in giving the impression that it was imported olive oil,
when in fact it was not. We were successful in forwarding the facts in a
number of instances of this character so that the case could be brought to
the attention of the court. In each of the cases tried, thus far, the court
has imposed a substantial fine.
An investigation was made to determine if ground coflFee contained
cereals, chickory, or other adulterants. This investigation revealed the fact
that several of the dealers were selling the adulterated articles as pure
ground coffee. In such instance a recommendation was made that the con-
cern be prosecuted.
An investigation was also made concerning the sale of so-called egg
substitutes. It was found, as a result of this investigation, that preparations
of this type do not enjoy any extensive sale in this city. From information
obtained it appeared that the products sold as egg substitutes did not pro-
45
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
duce satisfactory results in baking, which probably accounts for the un-
popularity of the preparations.
In several instances, it was found that pure dried eggs were sold under
misleading conditions, in that statements were made on the label, or other
printed matter, indicating that a certain quantity of the egg would produce
the same results as a given quantity of shell eggs. From the facts obtained
from the Federal authorities as to the egg standards, hearings were given
to the distributers of this misbranded product and, in each instance, the
labeling was corrected so as to conform with the requirements of the De-
partment.
The same was also found to be true of a sample of powdered skimmed
m.ilk of which the label was so worded as to convey the impression that a
given quantity would produce a certain amount of liquid milk. Needless
to say this was misleading, in that skimmed milk powder can only produce
skimmed milk, when mixed with proper proportions of water, and there-
fore, the product was considered misbranded within the meaning of the
Sanitary Code provisions. A hearing was held, which resulted in the dealer
correcting and modifying the printed matter, so as to conform with the legal
requirements.
An investigation was made to determine if a high grade technical glue
was being sold as food gelatine. This investigation revealed the fact that
this fraud was being practiced, and, in one instance we were successful in
obtaining samples of so-called food gelatine from a concern which buys
nothing but glue. The samples are now at the Chemical Laboratories
awaiting analysis. It is felt, however, that greater progress could be made
along these lines if a standard existed for food gelatin.
Exposure of Food on Streets.
In enforcing Section 142, Sanitary Code the inspectors paid particular
attention to the exposure of food within establishments where such food
was exposed to contamination and unwarranted human handling. It is the
policy of this division to give a warning, and instruct the operator of the
establishment as to the requirements. After sufficient re-inspections had
been made and no apparent efforts exerted by the operator to remove the
violations or modify the business methods so as to have the establishment
conform with the requirements of the Department, a summons was served
With reference to the exposure of food to contamination on the public
streets, while this matter primarily comes within the jurisdiction of the
police authorities, the inspectors were notified to serve summons wherever
flagrant violations were found. This procedure was unsatisfactory in that
with the force available, it was absolutely impossible to cope with the situa-
tion.
During the latter part of the year, this code section was amended so
A6
SANITARY BUREAU
that it now practically prohibits the sale of unwrapped candy on the public
streets. Advantage was immediately taken of this amendment, and wher-
ever violations were found, a hearing was given the operator so that he
could be thoroughly instructed as to the requirements.
Cleansing of Utensils.
Particular attention has been given by the inspectors, and from time to
time by special squads, to the requirements of Section 144 of the Sanitary
Code, which provides that utensils used in the service of food or drink be
properly cleansed after use. This code Section is considered by us to be
one of the most important, in that improperly w^ashed utensils, which have
been subjected to contamination by persons suffering from contagious or
communicable disease, are of utmost importance to public welfare. Unfor-
tunately, however, the magistrates do not view this important requirement
with the proper attention, in that the inadequate fines are usually imposed,
and the food dealers find that they only have to pay a small amount of
money, and are, therefore, not impressed with the necessity of properly
observing this important section.
Prosecutions.
As indicated above, a number of important cases have been forwarded
against various food dealers charged with having violated sanitary code
sections. In presenting these cases in court, the inspectors have given their
testimony in such a manner that, in many instances, it was necessary for
them to qualify as experts before important facts surrounding the case could
be given, and as a result of this training, in but a very few instances did we
have acquittals in important cases. This work was carried on with the
expert guidance from the Corporation Counsel's Office.
With reference to the enforcement of minor code sections, which are
disposed of in the Magistrates' Court, the inspectors have been particu-
larly active in bringing to the attention of the court all flagrant violations.
Unfortunately, however, the Magistrates do not view these code sections
with sufficient importance so that, in many instances, our activities along
these lines do not produce very satisfactory results.
Co-operation with Other Agencies.
It has been our policy to co-operate with all other city officials so as
to co-ordinate our activities and prevent, as far as possible, duplication of
inspectorial work, and so as not to interfere with investigations being car-
ried on by other official bodies. As example of the co-operation with the
Federal authorities, it may be reported that, at their request, a number of
seizures of adulterated scallops and other food stuffs were made. This
activity prevents the distribution of food which does not conform with the
Federal food requirements.
47
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Co-operation was also maintained with the U. S. Department of Agri-
culture. This statement applied especially to several large shipments of
tomatoes which arrived in this city in an extremely poor condition and
which presented an unusual appearance. A study by the Federal authori-
ties resulted in the statement that the tomatoes were affected with a certain
disease, and they communicated the facts to their field agent in California,
from whence the shipments were made, so that a thorough field investiga-
tion could be carried out.
In several instances, information was received from the police author-
ities that deaths had been caused by consumption of a liquor said to con-
tain wood alcohol. In each instance, qualified inspectors were immediately
assigned to act in co-operation with the police so that, wherever possible,
samples of suspected liquors were obtained and immediately submitted to
the Chemical Laboratory of the Department for analysis.
As previously stated, inspectors at the piers co-operated with army
officials in instructing quartermasters' representatives in the inspection of
food.
During the latter part of the year, quantities of food were released
for disposition to the general public by the U. S. Army and Navy Depart-
ments. The greater part of this material was sold through the Department
of Public Markets of this city, and, on account of the volume of business,
they were dependent almost entirely upon inexperienced and volunteer
workers to handle the output. The great majority of these workers were
inexperienced in the handling of food, and were not familiar with the
appearance of food undergoing decomposition. A special detail of
inspectors was, therefore, arranged to visit all of the public schools and
other places used as distributing places, and instructions were given to these
workers so that they would be familiar with the appearance of unwholesome
foodstuffs. All food found to be of questionable character was placed
aside for return to the Federal authorities for disposition.
Wood Alcohol in Food Products.
During the latter part of the year, and due to the enforcement of law
which prohibits the sale of intoxicating liquors, deaths were reported as
the result of consuming liquors which contained in a large part wood, or
methyl, alcohol. It was our idea to prevent, as far as possible, the sale of
such liquors, and a detail of specially trained inspectors was arranged so
that each section of the borough was covered and field tests were made at
saloons, or other points, where intoxicating liquors were found. Thousands
of samples were examined, and we were unsuccessful in locating any liquor
containing wood alcohol at these distribution points. It appeared, therefore,
that much of this prohibited compound was sold by peddlers or other
irresponsible persons an that the majority of the saloon keepers were selling
liquors which did not contain wood alcohol.
48
SANITARY BUREAU
TABLE NO. 1.
INSPECTION OF FOOD ESTABLISHMENTS.
Character of Establishments.
Bakeries
Butchers
Butchers and provisions
Cafes
Candy factories
Carbonated and mineral waters . . .
Cold storage plants
Commission houses
Confectionery
Delicatessen
Drug stores
Eggs, wholesale
Egg breaking
Fat rendering
Fish and shellfish
Frozen products
Groceries
IMarkets
Miscellaneous
Pier and wharves
Push carts
Pi. R. terminal
Restaurants and hotels
Slaughter houses — poultry
Smoke houses and meat preserving
Stands
Warehouses
Total
Retail
Establish-
ments.
10,320
9,256
790
4,513
1,012
1,813
12,783
12,786
24,185
19'506
16,264
113,927
Wholesale
Establish-
ments.
1,153
"717
293
118
2,408
395
84
23
176
1,044
1,018
3,435
3,100
"378
1,094
667
i',459
Total
Inspectioas.
10,330
9,256
1,153
790
717
293
118
2,408
4,513
1,012
1,813
395
84
23
176
1,044
1,2782
1,018
16,231
3,100
24,185
378
19,506
1,094
667
16,264
1,423
17,586
130,813
TABLE NO. 2.
CONDEMNATION OF UNWHOLESOME PRODUCTS.
Character of Foodstuffs.
Fruit
Vegetable
Canned goods
Groceries
Eggs '....'.'.'.'.'.
Milk
Cream
Condensed milk
Butter
Cheese
Confectionery
Beef
Veal '.'.'.'.'.'.'.'.'.'.'.]
Mutton or lamb f
Pork '.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'..
Poultry i
Game f
Fish \
Shell fish .".".'.'."."."/
Miscellaneous
Total
~~ 49
Pounds.
4,650,132
2,747,936
175,504
170,877
48,785
35,614
2,734
20,726
7,226
5,413
126,931
12,943
41,767
339,409
604,560
293,962
10,483,856
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
TABLE NO. 3.
PROSECUTIONS DISPOSED OF.
Amount
Sentence
Dis-
Section of Code Violated.
Arrests.
Fined.
Fined.
Sus-
pended.
charged.
19
"'6
4
1
3
116
$345.00
340.00
10
124
139
9
1,020.00
1
6
142
499
1,202.00
71
10
144
367
924.00
35
7
147
405
1,099.50
98
17
151
101
1,638.00
58
18
152
149
4,340.00
78
25
156
7
170.00
3
2
159
138
947.00
31
10
163
541
9,473.00
123
44
331
181
4,560.00
31
9
155
38
438.00
30
3
Total
2,355
$26,396.50
557
161
Health Squad.
The Health Squad, consisting of one Heutenant, two sergeants, and fifty
patrohnen is assigned to the Sanitary bureau, and detailed to the various
buroughs, serves the other Bureaus of the Department officially, when
requested. They enforce official notices and orders, serve summonses and
warrants, vacate premises, enforce marine quarantine, when requested by
the Health officer of the Port, and supplement the field force of the Sanitary
and Food Bureaus.
50
SANITARY BUREAU
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51
DIVISION OF INSTITUTIONAL INSPECTION
Staff.
The Chief of Division is assisted by a force of twenty-three Medical
Inspectors, two clerks and a stenographer.
INSTITUTIONS UNDER SUPERVISION.
Hospitals
Dispensaries
Diagnostic laboratories. . .
Private sanitoria
Homes for adults
Homes for children
Day nurseries
Homes for the aged
Homes for incurables ....
Reformatories and prisons
Miscellaneous
Totals
Out of Town
Fimctions.
According to the type of work performed by them, the medical in-
spectors of the Division are divided into two general groups ; one known
as Institutional Diagnosticians ; and the other as Inspectors of Subsidized
Institutions.
The diagnosticians, beside making diagnoses in institutions of all types,
exercise sanitary supervision of the premises, make physical examinations
and re-examinations, twice a year, of all children, in nonsubsidized institu-
tions, administer sera and vaccines, apply the Schick test, collect cultures,
smears, and blood for laboratory examination, examine food handlers (in
institutions) for certificates, investigate, when application is made for a
permit to conduct day nurseries, child caring institutions, private hospitals,
sanitoria, and laboratories for the diagnosis of communicable disease. They
verify the monthly medical reports of those child caring institutions not
receiving money from the city (as required under State Public Health Law).
They diagnose illness of Health Department employees in institutions, and
perform field work for the Chief Diagnostician and the various bureaus of
the Department, in so far as their work concerns institutions, and investigate
all abortions occurring in institutions, and notify the Police Department if
any appear to be of a criminal nature.
The inspectors of subsidized Institutions visit institutions receiving
pay from the city for the care of inmates. Most of these institutions are
52
DIVISION OF INSTITUTIONAL INSPECTION
located within the city limits, but some are outside, in New York State
and in New Jersey. The inspectors, at the beginning of each year, make
a physical examination of all inmates, regardless of age, and, later, in the
half year make a re-examination of those who were found defective when the
primary examination was made, to note whether the defects found have been
properly corrected, and to urge and advise those in charge to make further
effort to have uncorrected defects properly treated. In addition, these
inspectors make regular sanitary inspections of the grounds and buildings
of institutions assigned to them, and, on request, or by their own initiative,
administer sera, anti-toxins, etc. As a rule they do not undertake the
diagnosis of communicable disease. They also make examination for
physical defects in institutions under the jurisdiction of the Department of
Corrections.
The year opened with 23% of our inspecting force absent on military
and naval duty for which they had enlisted. The first due to return from
service came back January 18, and from that date, others were mustered
out at various times. Those who remained at home did their "bit" by
cheerfully taking on the extra work necessitated by the absence of their
fellow workers, so that the total amount of work accomplished during the
year is very gratifying when the depletion of the force is considered.
Besides the routine work of the Division, the following surveys were
undertaken :
1. Hospital Facilities for Influenza Cases.
2. Bed Capacity for Hospitals.
3. Character of Institutions in the City Maintained without a permit
from the Department.
4. Preparations of Hospitals for a Possible Influenza Epidemic.
5. Capacity and Census of Child Caring Institutions.
6. Nurses Training Schools.
Intra-divisional conferences were held, with short talks on physical
defects found in children; a conference with the Bureau of Standards and
Appeals, as to proper methods to be followed in granting permits for child
caring institutions, and a conference with representatives of the Bureau
of Buildings, Tenement House Department, and the Fire Prevention Bureau
of the Fire Department, regarding the standardizing of procedure in the
various Boroughs.
Until the new Reception Hospital on Queensboro Bridge was com-
pleted, (Dec. 2, 1919) all children about to be admitted to the Children's
Clearing Bureau of the Department of Charities, were examined by us to
determine whether the children had any communicable disease.
53
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Institutions for Children — Summary of Monthly Medical Reports, 1919.
Deaths.
Child Caring Institutions 98
Misericordia 26
N. Y. Foundling 364
N. Y. Nursery and Childs Hospital 306
794
Cases of Communicable Diseases.
Diphtheria 119
Scarlet Fever 69
Measles 192
Pertussis 184
Eye Disease 346
Skin Disease 884
Chicken Pox 172
Mumps 147
German Measles 4
Poliomyelitis 0
Typhoid 18
Tuberculosis 23
Pneumonia 356
Influenza 239
2,743
Cases of Non-Communicable Diseases.
Tonsilitis 983
Injuries 240
Pleurisy 0
Bronchitis 409
Blood Poison 289
Diarrhoea 8
Miscellaneous 7,860
9,783
Deaths in Child Caring Institutions were. .44.3% less than in 1918
Communicable Diseases were 31 .3% less than in 1918
Non-Communicable Diseases were 4.5% less than in 1918
Total Death Rate 14.6% less than in 1918
54
DIVISION OF INSTITUTIONAL INSPECTION
TOTAL EXAMINATIONS OF CHILDREN IN INSTITUTIONS, 1919,
Children
Examined.
Normal.
Defective.
Children
Re-examined.
Manhattan
5,126
7,065
8,424
3,527
1,812
2,666
4,931
1,939
3,314
4,399
3,493
1,588
2,526
2,562
2,412
1,093
Bronx
Brooklyn
Richmond
Total
24,142
13,672
11,348
4,633
12,794
9,039
8,595
7 "^W
Out of City
Grand Total
37,814
15,981
21,833
1 ^ 0*^-1
55
BUREAU OF PREVENTABLE DISEASES
The year 1919, like the preceding year, was a notable one in the history
of the Department, and of this Bureau. The influenza epidemic which
swept the country in 1918, and continued nearly until the late spring of
1919, recurred in the fall of 1919, although in much less violent form, as
was to be expected from the study of previous epidemics. The report on
the epidemic, so far as it concerns the Bureau of Preventable Diseases, will
be dealt with at considerable length elsewhere.
While the influenza epidemic occupied the center of the stage, there
were two things which, from a constructive standpoint, stand out signifi-
cantly in the development of the activities of the Bureau of Preventable
Diseases.
The first and probably the most important constructive development
was the effort to make actual, real, and effective the organization of the
Division of Epidemiology, which, in previous years, had been a mere name
representing only those activities which had to do with the routine super-
vision of typhoid fever, epidemic cerebro-spinal meningitis, and poliomye-
litis. In fact, this Division had been our old typhoid division, operating
under a very dignified and high-sounding title, althouh in all the time in
which it was designated the Division of Epidemiology, previous to 1918, it
had not concerned itself with a single communicable disease other than those
already enumerated.
In the past year, the Division, under the immediate guidance and super-
vision of the Director of the Bureau, developed plans and methods which
had for their aim the immediate detection in any part of the city of an
undue prevalence of any one of the communicable diseases. In other words,
the epidemiological work of the Bureau developed a more accurate endemic
index than had previously been available. Special studies were undertaken
to ascertain the age groups and sex classification of all persons reported to
be suffering from scarlet fever or diphtheria, as well as those who died
from these diseases. So far as our records indicate, this is the first time
that these facts have been accurately and statistically developed. They are
of importance as giving us a method of work which will throw light upon
the relation of special age groups, and of school attendance, to the incidence
of diphtheria and scarlet fever, as well as of other communicable diseases,
and will probably serve as a basis for indicating how to deal most effectively
and intensively with the problem.
A comparison was made of the case incidence and mortality rate from
the commoner communicable diseases in forty-seven cities of this country
having a population of over 100,000. In other words, we had a crude guide
of the difference not only in incidence, but a reflection upon the method of
56
BUREAU OF PREVENTABLE DISEASES
administration in the various cities, as contrasted with our own, which
might serve us as a stimulus and a guide in the further development of our
work.
A special study was made in several thousand diphtheria cases, to
ascertain the relation of the date of injection of antitoxin to the ultimate
outcome of the case.
Special methods of tabulating the results of the activities of our nurses
and physicians in securing cases for the Schick test and for the administra-
tion of toxin-antitoxin, and for tabulating the results of such tests and
immunization, have been prepared.
When encephalitis lethargica was first recognized, the epidemiological
work of this Bureau v.-as immediately adjusted to enable us to secure prompt
information through the Division of Institutional Inspection, through the
Bureau of Records, and through the Meningitis Division of the Bureau of
Laboratories, of the status of this disease, so that we have at all times been
well informed of the comparative incidence and relative importance of this
disease, as contrasted with other diseases.
A careful analysis of the meningitis cases reported through various
agencies to this Bureau, has been conducted with a view to securing more
accurate diagnosis, so that we might be better informed of the true num-
ber of cases of tubercular meningitis, as distinguished from epidemic cere-
bro spinal meningitis, influenzal and other forms of meningitis.
Special studies of the age group of measles have been made.
In connection with the epidemic of influenza, a variety of charts and
records were kept which were of the utmost value in giving us an index of
the rate of prevalence and of the mortality rate of this disease from day to
day, and from week to week. These are a few examples of the varied
activities in the field of epidemiological work which we assumed in this
Bureau, during a most trying period without added clerical staff, and with-
out any medical supervision other than that which the Director himself
exercised.
Notwithstanding these numerous additions to the work of the BureaU:
much has been done in the way of improving the efficiency of our records,
history forms, charts, and methods of procedure for the closer supervision
of typhoid fever cases, for the prompt and more accurate discovery of
sources of infection, and for dealing with what is the most important part
of the typhoid fever problem, the carrier.
The reflections of the enlarged activities of the Division of Epidemiology
not only in the field of typhoid fever but in connection with most of the
other communicable diseases, will appear in the body of the report. It must
be manifest to one who intimately studied the work of this Bureau that its
chief activities during the year has been in the field of epidemiological study,
namely, as a detector of the sources of infection and the distribution of
57
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
communicable diseases, and from this has resulted a more definte conception
of the measures of prevention which were practicable and necessary.
The other important development in this Bureau has been in the field
of venereal disease prevention. The war has given an impetus to this branch
of public health service throughout the country, but the City of New York
by virtue of its enormous population has had to deal with a problem of
greater magnitude in this field, and also because of the innumerable agencies
and of citizen groups who are sensitive with respect to activities carried
on in this field of work, the development of our venereal disease program
has been a very delicate and difificult matter. With out additional staff,
our forces have been so adjusted that we have been able to establish a clinic
in the Women's Court, in which several thousand women are examined
during the year, and smears and blood obtained in each case for examination
of the presence of venereal disease.
We have worked out a stystem of forcible detention of infected women
who are found in the course of our court work, or who are released from
the Workhouse, when we have discovered the presence of venereal disease.
We have also established treatment clinics, two of which are working with
particular effectiveness, despite very great handicaps. The varied activities
in the field of venereal disease control work will be subsequently described
in detail.
Pulmonary Tuberculosis.
At the beginning of 1919, 32,048 cases of pulmonary tuberculosis were
on register in the Bureau of Preventable Diseases. During the year 14,570
new cases were reported by private physicians and hospitals or discovered
by tuberculosis clinics of this Bureau.
A total of 7,395 persons died from this disease during the year, a
mortality rate of 123 per 100,000.
Deducting the number of deaths and the number of cases which moved
away from the City of New York, as also those which could not be located,
and the homeless, we had on register in the Bureau of Preventable Diseases
on the last day of the year 1919, 30,036 cases.
The number of deaths per thousand of population from pulmonary
tuberculosis, which, practically speaking, has steadily declined in the last
two decades, showed a very marked diminution during the year 1919. The
actual number of deaths from this disease was smaller than at any time
since the consolidation of the city in 1898. In other words, with an in-
crease of population of at least 70% since the Greater City was consolidated,
the mortality rate from pulmonary tuberculosis which was 237 per 100,000,
has been reduced to a rate of 123 per 100,000. If the mortality rate which
had prevailed when the Greater City of New York was consolidated, were
to have prevailed in 1919, we would have had approximately 14,236 deaths
instead of 7,395 from pulmonary tuberculosis. This gives the measure in
58
BUREAU OF PREVENTABLE DISEASES
the change in the prevalence and in the mortahty rate from pulmonary
tuberculosis, which has been brought about by varied influences, chief among
which are to be accounted the greater effectiveness of public health work,
the improvement of the housing conditions in the City of New York, and the
general economic improvement.
The marked reduction in the prevalence of tuberculosis and in the
mortality rate from that disease, has not been confined to the City of New
York, but has been recorded quite generally throughout the country.
In several particulars, the record of cases of pulmonary tuberculosis
during the year 1919, has differed from preceding years.
The number of cases which were under the care of private physicians
in 1918 was 3.107; in 1919, the number of cases under the care of private
physicians was 3,697. In our experience, this is a very marked increase
in the private physicians' cases, and in the opinion of those who have
watched these cases carefully, it seems to be due to the fact that money was
more plentiful among a number of the patients who under the economic con-
ditions which normally prevailed in other years, would have come to the
clinics for free treatment in larger numbers.
The number of cases registered as under the care of private physicians,
is by no means an accurate index of the relative importance of the general
practitioner in the prevention and treatment of tuberculosis. While only a
little more than 10 per cent, of the total number of registered cases are un-
der the care of private physicians, it must not be overlooked that the medical
profession of this city, either in their private offices or in connection with
their services in hospitals or dispensaries, must assume the burden of dis-
covering pulmonary tuberculosis in a multitude of clinical cases as to which
they are consulted in one or another capacity. The medical profession, in
other words, is the first line of defense upon whom the Health Department
must place absolute dependence for the discovery of cases of pulmonary
tuberculosis. All students of the subject of tuberculosis prevention and
control are agreed that the early discovery of cases of pulmonary tuber-
culosis is fundamental.
The administrative measures exercised by the Health Department in
supervising and controlling cases of pulmonary tuberculosis, are predicated
largely on the work of the private physician. It is therefore obvious that
every general practitioner in the community, whether he admits it or not,
is in fact a Health Officer upon whose ability to diagnose the early as well
as the late cases of pulmonary tuberculosis — as of other preventable
diseases — and upon whose willingness to co-operate actively and intimately
with the Health Department, the control of tuberculosis in large measure
depends. This is not a novel suggestion. Nevertheless, it seems to ba
constantly overlooked by the medical profession, as by the rest of us, that
it stands in close relation to the public health work of the community ; it
59
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
should be and is a badge of distinction. Although too frequently forgotten,
every physician in the community in entering upon the practice of medicine,
has accepted a social contract whose terms are implied or explicit.
The role of the private physician as an active friend and ally of the
Health Department, working in concert with it for the public welfare, has
not been sufficiently emphasized. The many difficulties preventing closer
affiliation which have been responsible for breeding misunderstandings that
have not infrequently bordered on open hostility, are in large measure in-
herent in the system of individualistic practice of medicine, which separates
the great mass of the medical profession from those who have accepted a
direct and specific contract to render public medical service.
These observations on the role of the private physician are inspired
not only by a desire to pay a deserved tribute to the work of the medical
profession as an agency in public health work, but to indicate the necessity
of closer affiliation and preparation of a program of joint action by the
Health Department and by private physicians, either individually or through
their organizations, which will make more effective the services rendered
by the respective groups to the public at large.
At the end of the year, there remained 4,556 cases of pulmonary tuber-
culosis in the various hospitals and sanatoria which accept tuberculous resi-
dents of this City.
At the beginning of this year, there were 4,775 cases in city insti-
tutions. During the last two years, there has been a very decided diminution
in the number of admissions to hospitals and sanatoria for the care of the
tuberculous.
At the end of the year 1918, we had on record in this Bureau 9,479
tuberculous persons who belonged to the vagrant or homeless types, or who
had disappeared from observation and could not be traced. At the end
of 1919, we had only 6,934 such cases. In other words, we had a re-
duction of 3,145. This is not accounted for by any unusual method or
procedure for tracing the homeless and not found cases. It would seem
leasonable to assume that improved economic conditions accounted to a
considerable degree for this decided reduction in the homeless and "not
found" cases.
At the end of the year there remained 10,817 cases of tuberculosis
which were either receiving treatment at one of the tuberculosis clinics of
the Health Department, or were under observation by the nurses of the
Health Department in order to insure their observance of sanitary pre-
cautions. This is an increase of 291 cases in this classification, as contrasted
with the preceding year.
Of those registered as suffering from tuberculosis at the end of the
year, 27,902 were persons above 16 years of age ; 160 were children under
5 years; and 1,974 were children betw^een the ages of 5 and 16. This is
60
BUREAU OF PREVENTABLE DISEASES
of course a very crude presentation of the age distribution of registered
cases of pulmonary tuberculosis, but these are the best figures available
under present circumstances, and they are presented because they are not
without interest.
Out of a total of 30,036 cases of pulmonary tuberculosis on register
at the end of the year, 9,675 were recorded as having positive sputum. By
and large, these positive sputum cases are under three different types of
supervision.
First, a moderate number are under the supervision of private
physicians, who, in reporting cases, explicitly request that no nurse or other
representative of the Health Department shall at any time visit their patients,
the assumption being that the private physician will make personal visits
to the home and expressly supervise the sanitary conditions under which
such patients live, and report any circumstances surrounding such patient,
which constitute a menace to others. This at least is the assumption.
Clearly, this delegation of function to private physicians is a most im-
portant one and directly concerns community welfare.
Second, the non-departmental tuberculosis clinics of Bellevue, Lenox
Hill, Gouverneur, Harlem, Mt. Sinai, New York, Presbyterian, and St.
Luke's Hospitals, and of the Vanderbilt and New York Dispensaries, are
permitted to keep the cases of pulmonary tuberculosis which attend their
respective clinics, under the supervision of nurses attached to those clinics,
the assumption being that whenever any conditions which may constitute
a menace to the health of others, are observed by representatives of these
private clinics, such facts will at once be reported to the Health Depart-
ment. Because of the lack of a uniform method of reporting such condi-
tions, we have considered requiring each of these clinics to submit at regular
intervals an official statement for each case under the care of such private
clinic, informing this Department whether or not sanitary precautions are
observed, giving the date of visit, and indicating whether or not the cir-
cumstances disclosed by the last visit made to a given case indicated the
necessity for action on the part of the Health Department in the enforce-
ment of laws for the better protection of the public.
Third, the Health Department representatives exercise sanitary super-
vision over cases of pulmonary tuberculosis, sending nurses into the homes
to instruct patients to observe sanitary precautions, to enforce the rules and
regulations of the Department, if necessary, to stimulate the patient to con-
':inue under the care of a private physician or clinic, to secure the examina-
tion of all members of the family in contact with a tuberculosis individual,
and to render such social, charitable or other form of assistance as may be
indicated in any given case.
The three agencies enumerated, divide among themselves the official
control of all cases of pulmonary tuberculosis which remain at home in
the City of New York, the first two exercising a public health function which
61
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
is delegated to them by the Health Department, first, because the Health
Department has not at its disposal an adequate number of nurses to do the
work unaided, and second, because in the case of private physicians in par-
ticular, the Health Department recognizes the rights and privileges of priv-
ate physicians, not merely to minister to the medical needs of the patient
but to serve as counselor, guide and adviser for the entire family so as to
prevent the spread of disease.
The use of the big stick and the exercise of summary police powers
by the Health Department has in late years fallen into great disfavor. In
the majority of cases, the necessity of taking coercive action against indi-
viduals suffering from communicable disease, and forcing them into Health
Department hospitals, has been deemed a confession of failure. But there
are a certain group of individuals with whom persuasion even though it
come from the tongues of angels is not effective in securing compliance
w:th the regulations of the Health Department. It is necessary therefore,
for disciplinary purposes, and in the interest of public welfare, to remove
individuals who will not or cannot observe the rules and regulations of the
Health Department, to a hospital and to detain them there so as to prevent
the spread of communicable disease.
During the year, Riverside Hospital was given over to the care of drug
addicts. In previous years, it had been the place where we had kept under
compulsory detention flagrant offenders against the law or those who were
vagrants, homeless, or otherwise unable to properly care for themselves,
so as to prevent the spread of disease from which they might be suffering.
Only two cases of pulmonary tuberculosis were forcibly detained dur-
ing the year.
About twenty-five persons who had been under compulsory detention
prior to the installation of the drug addict treatment service at Riverside
Hospital, were released when the drug addict work was begun.
During the year there were 1647 deaths from pulmonary tuberculosis
in which no record of a previous report of the disease to the Health De-
partment could be found. These cases were in a number of instances shown
to be due to the failure on the part of private physicians or hospitals to
comply with the requirements of the Sanitary Code in promptly reporting
all cases of communicable disease. We were under the painful necessity of
resorting to legal action in a few cases. Others were satisfactorily explained
and it was shown in many that the failure to report was due to misappre-
hension on the part of the physician in attendance, or to circumstances be-
3/ond his control, — namely, being called for the first time to treat a patient
who was already moribund, — or that extenuating circumstances of equal
validity were proved to have existed. This is a very important part of our
work which has been more largely responsible for the prompt reporting of
pulmonary tuberculosis than any other measure or procedure adopted by
the Health Department.
62
BUREAU OF PREVENTABLE DISEASES
The nurses of the Health Department are called upon during the year to
answer complaints of citizens and private physicians, or they discover through
their own visitation conditions which indicate that a patient has deliberately
or through force of circumstances violated the sanitary regulations of the
Department, or is living under conditions which are a menace to the health
of others. These types of cases calling for a rigorous and intensive super-
vision by the nurses of the Department, are designated "sanitary super-
vision cases." In the course of the year, there were 9903 special visits of
this character by the nurses of this Bureau, who were required to make
them with a view to taking action to secure the abatement of a condition
or practice which was inimical to the public health. At the end of the year,
there were 654 cases still under sanitary supervision. In other words, at
a given moment we have approximately 600 or more cases of this type,
which require concentrated and constant attention of the nurses.
In 3811 cases where the condition of premises following the removal
or death of a patient made it necessary to renovate such apartment, by
thorough cleaning or scrubbing of floors, woodwork and walls, or of paint-
ing, papering, etc., such renovation was performed voluntarily upon the
lequest of the Health Department nurse. In 75 cases, resort had to be had
to legal orders to enforce compliance with this regulation.
Peculiarly enough, the only instances in which the various units of the
Bureau reported that it was necessary to resort to legal action were in the
Bedford and Brownsville sections of Brooklyn.
The Health Department's Tuberculosis Clinics.
The work of the respective clincs differs greatly in the different bor-
oughs and in different districts. The problems presented in each case
are influenced to a very considerable degree by the character of the popula-
tion, the location of the clinic, its personnel, and the methods employed by
those in charge of the respective clinics.
The cases treated in our clinics are divided into two general classifica-
tions. First, those which are held for observation and which are described
in the tabulation (Form 1) under the heading of "Non-diagnosed cases"
and second, those cases in which a diagnosis of tuberculosis has been made.
At the beginning of the year there were 3,044 patients who were still under
observation for purposes of diagnosis. A total of 15,423 new cases ap-
plied at our respective clinics for examination. It is interesting to record
the difference in the various boroughs. In the Borough of Manhattan,
there were 7,549 such applicants; in the Borough of The Bronx, 1.803; in
Brooklyn. 5,277 ; in Queens, 690. and in Richmond, 104.
The two most active clinics in the city were Jefferson Clinic situated
in the Italian district on the upper east side of Harlem in the Borough
of Manhattan with 1,989 new cases; and Prospect Clinic situated at Fleet
63
ANNUAL REPORT OF THE DEPARTMENT OE HEALTH
and Willoiighby Streets in the main office of the Department in Brooklyn
with 1,774 cases. Next in the order of numerical importance come Cor-
lears on the lower east side of Manhattan, with 1,456 new cases; then Stuy-
vesant, a little further north, but also on the east side of Manhattan with
1,364 cases; then the Eastern District Clinic situated in the Williamsburg
section of Brooklyn with 1,250 (in this district the population is large) ;
the sixth in numerical importance is Chelsea Clinic on the middle west side
of Manhattan with 1,088 cases; the remaining clinics vary in importance.
In addition to the number of new applicants for examination and
treatment, there returned to the clinic 5,932 cases, who during the pre-
ceding years had discontinued attendance at the respective clinics while
they were under observation for purposes of diagnosis. In other words,
there was a total of 21,355 cases which were virtually new cases that ap-
plied at the various tuberculosis clinics of this Bureau for diagnosis and
care. Of this number, 14,228, that is practically two-thirds, were dis-
charged as non-tuberculous.
Annually, a number of individuals who apply to the clinics for diag-
nosis, discontinue their attendance before the necessary tests and examina-
tions have been concluded for purposes of diagnosis. During the year 1919,
3,943 individuals discontinued attendance in this fashion. This is, how-
ever, a reduction of 1,272 such cases as contrasted with the preceding year.
Of a total of 24,399 persons who applied to us for diagnosis or who
were under observation at the beginning of the year, we found 3,033 or
a little over 12 per cent, suffering from pulmonary tuberculosis.
At the end of the year, out of a total of 24,399 persons who had been
under observation for diagnosis, 2,710 cases still remained undiagnosed.
At the beginning of the year, there were 2,888 cases of pulmonary
tuberculosis on register as under the care of the respective clinics of the
Bureau. A total of 3,280 new cases was added to this number in the
course of the year. In addition, there were also 3,687 returned cases of
pulmonary tuberculosis which had either been discharged from institutions
or who had returned after an interval to resume treatment at the clinics.
All told there were 9,847 persons suffering from pulmonary tuberculosis
under the care of our clinics during the year.
It is thus evident that the Health Department tuberculosis clinics directly
served the needs of about 32 per cent of the 30.036 cases on register as
having pulmonary tuberculosis. When it is remembered that the diagnosis
and treatment of cases of tuberculosis is only one of numerous functions
served by the respective tuberculosis clinics and branch offices of this
Bureau, it will be seen that it is unjust to charge the cost of personnel and
maintenance of these clinics against the service rendered the 9.847 patients
who were treated in these clinics. The per capita cost per annum is fre-
quently estimated on the assumption that the cost of maintenance of the
64
BUREAU OF PREVENTABLE DISEASES
clinic and branch office is due solely to the work which is being done in the
diagnosis and treatment of the 9,847 patients alluded to. Those critics of
the tuberculosis health service whose chief concern seems to be the financial
outlay which these clinics involve, overlook the great importance of having
stations to which 24,399 persons came during the year for free diagnosis
as to the presence of tuberculosis. As already stated, they also overlook
the fact that these are administrative centers which are necessary to bring
all phases of the Bureau's activities in connection with the control of all com-
municable diseases in the closest possible touch with the people of a given
district. The clinics are used for venereal disease examination, for the
Schick test, and some of them for the examination of foodhandlers and
other special examinations which may from time to time be undertaken in
the elTort of furthering our preventive program.
Of the total number of tuberculosis cases under the care of our clinics,
932 were discharged as apparently arrested ; 68 were transferred to clinics
not under control of the Health Department; 1,100 entered hospitals; and
656 were sent to sanatoria. Cases discontinued for non-attendance numbered
4,188. A total of 212 persons under the care of our clinics as cases of
pulmonary tuberculosis, died during the year.
A total of 7560 cases of pulmonary tuberculosis treated at our clinics
were removed from the register during the course of the year, either because
they had gone out of town or entered hospitals, disappeared from sight, or
died. At the end of the year we had a total of 2,287 cases remaining under
the care of our clinics. This is a decrease of 751 cases since the beginning
of the year. Of these 2,287 cases, 2,083 were adults and 204 children.
Patients having a positive sputum numbered 654, of whom 640 were adults
and 14 children. There were 1,663 negative sputum cases divided between
1,443 adults and 190 children.
There were 10 cases of bone or glandular tuberculosis among adults
and 42 among children who were under the care of our clinics. In con-
nection with this phase of our tuberculosis activity, it has long been felt
to be desirable and necessary that the Health Department should receive
reports of all cases of bone, glandular, abdominal, or meningeal tuberculosis,
so that we might be in a better position to realize the full extent of our
tuberculosis problem in the city. It seems, therefore, that all forms of tuber-
culosis, in addition to the pulmonary type, should be made reportable by
Sanitary Code amendment. The importance of requiring physicians and hos-
pitals to report cases of non-pulmonary tuberculosis is evidenced by the fact
that during 1919, there was a total of 1,103 deaths from non-pulmonary
tuberculosis. Of this number, 581 deaths resulted from tuberculosis menin-
gitis, and 522 from abdominal, glandular, and other types of tuberculosis.
Bearing in mind that we had a total of 7,395 deaths recorded in the city
as due to pulmonary tuberculosis, it will be seen that the proportion of
65
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
deaths due to non-pulmonary tuberculosis is by no means small; in fact,
these deaths from non-pulmonary tuberculosis were approximately 13 per
cent, of the total number of deaths from tuberculosis reported during the
year.
Statistics of Clinics — In the 20 clinics maintained by the Bureau in the
various boroughs of the city, the total number of clinic sessions held during
the year was 6598.
The total number of clinic hours during the year was 9784.
The total number of first visits of patients to the clinics was 15,527.
This figure is of interest because in each case of a first visit, the examining
physician is required to give a greater amount of time to the patient than is
required when later visits are made.
The various types of patients under the care of these clinics made 69,631
revisits, or a total of 85,158 visits. While this total is less by 3065 than
the number of visits made during 1918, it nevertheless compares favorably
with that year because of the general falling off in the number of reported
cases of pulmonary tuberculosis and in the number of cases under the care
of the various hospitals and dispensaries.
The medical staff were required to visit the homes of patients for the
purpose of making special investigations, or of giving bedside treatment to
those who were unable to attend the clinic. The total number of such visits
was 3586.
Duirng the year, the nurses made 131,516 visits to cases of pulmonary
tuberculosis under the superivision of the Health Department. Bearing in
mind that this was a year which was marked by the recurrent wave of the
influenza epidemic, and that the nurses in this Bureau had to bear the brunt
of the field service, especially in giving bedside care to influenza and
pneumonia patients and to bring them relief in many other ways, the records
of visits made by nurses is a very favorable one.
Hospital Facilities for Tuberculosis Children. Difficulty was experi-
enced during the year in placing boys and girls, particularly the former, who
were suffering from incipient tuberculosis in appropriate institutions, be-
cause they require more care than do adults in the same stage of the disease.
This is a difficulty which should be corrected. While the number of boys
eligible for admission to a sanatorium is small, it is nevertheless important
that they should not suffer for lack of proper institutional care.
Hospital Diagnosis Station. The Hospital Diagnosis Station was es-
tablished by this Bureau during the last month of 1918, for the purpose of
serving as a clearing house for the admission of cases to Otisville Sana-
torium and Riverside Hospital. This Hospital Diagnosis Station has given
a very excellent account of itself. The Department clinics sent 926 patients
who had made application for Otisville; the non-department clinics and
private physicians referred 343 patients; the total being 1269 applicants.
Including those patients who had previously been inmates of Otisville, a
66
BUREAU OF PREVENTABLE DISEASES
total of 1328 applicants were passed upon by the Hospital Diagnosis Station
during the year. Of this number, 940 patients were accepted and 257 were
rejected; 106, after making application failed to appear for examination.
Out of a total of 1328 cases, 108 were referred to the Department of Public
Welfare. In addition to the 1328 cases which were examined for admis-
sion to the Otisville Sanatorium, there were 130 applicants examined for
admission to Riverside Hospital. In all, 190 patients were admitted to
Riverside Hospital through the Hospital Diagnosis Station, and 58 were
sent to Kingston Avenue Hospital. (See Table 2.)
Supervision of Lodging House Cases. The supervision of lodging
house cases has always been most unsatisfactory, and has contributed little
in actual results to warrant the expense of energy and time which it en-
tailed. At the present time, whether because of the effects of prohibition
or because of important economical conditions, many lodging houses are
comparatively deserted. The Municipal Lodging House and other insti-
tutions have a daily census which is remarkably low. We have not had an
adequate nursing staff to visit these cases. Unproductive as such visits are,
they must nevertheless be conducted in the hope that we will be able to
supervise a group in the community who are conspicuous as a source of in-
fection not only to fellow inmates in lodging houses, but to various other
groups in the community. Few as these cases have recently been, they con-
stitute an important part of our problem in the control of tuberculosis.
They are likely at any moment to increase in number. One remedy which
deserves serious consideration is the forcible removal to a hospital of every
lodging house case of pulmonary tuberculosis with positive sputum.
67
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
TABLE 2.
WORK OF HOSPITAL DIAGNOSTIC STATION, 1919.
Department
Clinic.
Non-Dept.
Clinic.
Private
Physician.
Total.
New applicants
Applicants for re-admission
Accepted
Rejected
Refused examination
Awaiting decision
Awaiting examination end of year .
926
50
715
196
81
4
12
265
7
181
41
22
2
4
78
2
44
20
3
0
3
1,269
59
940
257
106
6
19
Number of cases examined 1,203
Number referred to H. A. B 108
Number referred for X-ray 23
Number awaiting decision 6
Men.
Women.
Boys.
Girls.
Total.
Accepted diu-ing year
Admitted
Refused to go — taken off list
577
501
42
16
18
244
202
29
3
10
59
29
2
0
28
60
53
5
0
2
940
785
78
Rejected by Otisville Physician
Remaining on waiting list
19
58
Number of applicants for Riverside Hospital 130
Rejected for Otisville, recommended for Riverside Hospital 60
Permits for Riverside issued 190
Permits for Kingston Avenue Hospital issued 15
TABLE 3.
PREVALENCE, MORTALITY AND CASE FATALITY RATES OF PULMONARY
TUBERCULOSIS DURING 1919.
Cases
in
Register.
Cases per
1,000 of
Population.
Deaths.
Deaths per
1,000 of
Population.
Cases
Fatality
Per Cent.
Manhattan
Bronx
Brooklyn
Queens
Richmond
17,449
3,583
7,212
1,525
267
6.28
5.55
3.48
3.75
2.58
3,597
920
2,252
474
152
1.29
1.42
1.09
1.17
1.47
.20
.25
.31
.31
.56
City
30,036
5.00
7,395
1.23
.24
72
BUREAU OF PREVENTABLE DISEASES
Communicable Diseases.
Excluding influenza and pneumonia, which naturally overshadowed all
the other communicable diseases in significance during the year 1919, a
great deal that is of interest and importance can be elicited from a review of
the incidence of the commoner communicable diseases.
Diphtheria
In the publication notices which this Bureau has prepared with refer-
ence to diphtheria, we emphasized the fact that notwithstanding the enorm-
ous saving of lives which has resulted from the use of diphtheria antitoxin
since the time of its introduction in 1884, this disease has commanded a
place of great importance as one of the significant causes of infant and
child mortality. We emphasized the fact that approximately 12,000 cases
were reported to us annually. Our argument could have been made more
forcible by the citation of the total number of cases of diphtheria which
were reported during the year 1919, namely, 14,014 as against 11,455 cases
reported during 1918. While it is true that the year 1918 was signalized
by the intensity of the influenza and pneumonia epidemic and that coincident
with this intensity of the latter diseases, the commoner communicable dis-
eases showed a very much lower prevalence than normal, nevertheless the
increase in the reported number of cases of diphtheria during 1919, is greater
than normal, at least in the sense that the steady reduction in mortality per
100,000 of population which had been noticeable up to 1918, has been in-
terrupted. During 1919, the number of cases of diphtheria per hundred
thousand of population showed a fairly large increase.
Whereas, in 1917, we had 220 cases per hundred thousand of popula-
tion, and in 1918, only 190 cases per hundred thousand of population, in
1919, we had 233 cases per hundred thousand of population. Fortunately,
there was no increase in the mortality rate per hundred thousand of popula-
tion. In other words, we apparently had an incidence of diphtheria which
was greater than normal possibly because there had developed susceptible
material by reason of the lowered incidence in the preceding year.
How much more serious this disease is than some of the others, can
best be seen by a comparison of the total number of deaths resulting from
diphtheria and from some of the other of the commoner communicable dis-
eases. There were 1,239 deaths from diphtheria in 1919, as contrasted with
136 deaths from scarlet fever, 218 from measles, 161 from whooping cough,
121 from typhoid fever, 171 from cerebro spinal meningitis, and 15 from
acute anterior poliomyelitis. It will thus be seen that as a direct cause of
death, excluding influenza and pneumonia, diphtheria ranks second to pul-
monary tuberculosis. But it should be remembered that the 7,395 deaths
from pulmonary tuberculosis which occurred during the year 1919, were
distributed over all age groups; whereas, the 1.239 deaths from diphtheria,
as also the deaths from the other commoner communicable diseases, except
73
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
typhoid fever, were practically limited to children under 15 years of
age. If, therefore, we could with assurance calculate the number of children
under 15 in the City of New York, we would find that the number of
deaths from diphtheria per hundred thousand of children, would make this
disease assume an even larger importance when compared with the number
of deaths per hundred thousand of the general population caused by pul-
monary tuberculosis.
The Department of Health during the year 1919, at the special urging
of the Bureau of Preventable Diseases, capitalized the experience and the
scientific research splendidly carried out by the Bureau of Laboratories, by
putting the Schick test and active immunization into practical use as an every-
day preventive measure, to be applied by the Health Department and by the
private physicians of New York. Surely, this was a most justified and
necessary step in the prevention of a disease which may well strike terror
in the hearts of parents and guardians of children.
In passing, it is well to call attention to the fact that while the rate of
prevalence of diphtheria was 233 per hundred thousand of population in
the city as a whole, the disease seemed to concentrate itself with greatest
intensity in the Borough of The Bronx where there were 349 cases per
hundred thousand of population. Next in the order of intensity came the
Borough of Richmond, where there were 305 cases per hundred thousand
of population. Third, the Borough of Queens with 285 cases per hundred
thousand of population. Both the Boroughs of Manhattan and Brooklyn,
the most populous boroughs of the city had only 212 cases per hundred
thousand of population. In the Borough of The Bronx, the child popula-
tion has grown very considerably. This was pointed out in a previous re-
port. The influx of newly married couples in the Bronx where living con-
ditions and rentals were, comparatively speaking, more satisfactory, would
perhaps account for this phenomenon, at least to a considerable measure.
In this connection, the report of the experience of the Bureau with the
application of the Schnick test, should be of definite value. In view of the
fact that the Schnick test is the one truly hopeful and promising measure
which will enable us to distinguish those children in the community who are
susceptible to diphtheria, and upon whom active immunization should be
practiced as a means of permanently removing susceptibility to diphtheria,
it is well to record at this time the experience which we have had in this
Bureau in connection with the application of the Schick test and active im-
munization, since May, 1919, to the end of the year (this test was put into
eflFect as a practical preventive measure in May, 1919). See table 4, at-
tached).
74
BUREAU OF PREVENTABLE DISEASES
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75
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
In the Borough of Manhattan we had 1,491 Schick tests; in the Bor-
ough of The Bronx, 137; in Brooklyn, 1,016; Queens, 308; Richmond, 28;
and in the city as a whole, 2,980. With the exception of the Boroughs of
Brooklyn and Queens, we found a positive Schick test reaction in one-third
of our cases. In the Boroughs of Brooklyn and Queens, we found 60 per
cent, positive cases among the children tested. For the city as a whole, there-
fore, we found 45 per cent, giving positive Schick test reaction and 55 per
cent negative. The experience of the Boroughs outside of Brooklyn and
Queens, is in keeping with that of the previous investigators who have found
that, practically speaking, for all ages, one-third of the children were suscep-
tible. It is difficult to say whether the large number of positive Schick tests
reported in the Boroughs of Brooklyn and Queens was due to excessive cau-
tion in judging pseudo reactions and doubtful reactions. It is of course far
better and safer to administer toxin-antitoxin for purposes of active immuni-
zation when there is the slightest vestige of doubt as to the interpretation of
the Schick test, rather than take the chance of declaring a person immune to
diphtheria on the basis of a Schick test reaction which is not definite. Dur-
ing the period in 1919 when the Schick test was applied, 2,743 children were
actively immunized against diphtheria. Of this number, unfortunately not
all received three immunizing doses.
The nurses did conspicuous service during the year in making a house
to house canvass in many districts of the city to distribute literature in
relation to the Schick test and to active immunization against diphtheria.
Bearing in mind that our Schick test campaign was pioneer work hitherto
unknown to the citizens of New York, we feel that to the nurses belongs
the bulk of the credit for gaining the consent of parents to have this test
applied to nearly 3,000 patients in this city in the course of a little over
seven months. Undoubtedly, the relatively large number of Schick tests
which are being performed by this time by the Bureau of Child Hygiene
are in like fashion due to the efforts of the nurses of that Bureau. In
every tenement house in which a case of diphtheria was reported from May,
1919, it has been the practice of the nurses of the Bureau of Preventable
Diseases to distribute a circular to all families in such buildings, calling
attention to the signal value of the Schick test and active immunization.
During the year, the nurses of the Bureau of Preventable Diseases took
41,901 cultures from the throats of diphtheria children. Through their
instrumentality, 2,609 exposed persons were given passive immunization
with anti-toxin for the purpose of immediate protection. Of the 14,014
cases of diphtheria, 78 required constant supervision and the greatest vigi-
lance, because of a tendency on the part of such families to violate the rules
of quarantine. These were difficult cases to handle and required very many
visits. Specific instructions as to quarantine and the proper isolation of the
patient, and the observations of sanitary precautions were issued by the
nurses of the Bureau in 13,169 cases. In 20 famihes, they gave nursing
76
BUREAU OF PREVENTABLE DISEASES
care to patients who would otherwise have been more or less neglected.
In 24 cases, they secured charitable aid for the benefit of the families to
help tide over financial difficulties which assumed special significance be-
cause of the presence of sickness in such families. In 28 families, the
nurses were instrumental in bringing about very radical changes in housing
conditions, obtaining employment, or otherwise improving the general social
condition of the family. In 82 cases, we were able to persuade people who
were intent upon keeping the patient at home, to send such patient into a
hospital, because the financial condition of the parents, and the home ccm-
ditions as well, militated against the proper treatment and care of the
patient. In 1,929 cases, the nurses persuaded the landlords or tenants to
voluntarily renovate premises which had been occupied by a diphtheria
patient, causing more or less radical alterations and improvements in sani-
tary conditions to be effected. They were required to resort to legal action
in order to secure complete renovation of premises occupied by patients in
only five instances. They made a grand total of 81,804 visits to cases of
diphtheria during the year, notwithstanding the tremendous burden of work
imposed upon them by the necessity of tuberculosis visits, and by the;
visitation of the influenza and pneumonia epidemic which recurred during
the year.
Scarlet fever.
A total of 4,594 cases of scarlet fever was reported during the year
1919 as contrasted with 4,460 during 1918. According to the Health De-
partment estimate of the population of the City of New York, this would
signify that while there was an increase in the total number of cases
reported during 1919, there was no increase in the number of cases per
hundred thousand of population as contrasted with the preceding year.
There was a very decided reduction in the number of deaths from this
disease during 1919, namely, 136 deaths as contrasted with 177 during
1918. This is in harmony with our experience in connection with this
disease during the past several years. There has been practically an
uninterrupted drop in the prevalence of scarlet fever and in the mortality
rate in particular during the last twenty-one years when first we began
to record statistical data with reference to this and to other communicable
diseases for the Greater City of New York.
The cases of malignant type of scarlet fever which were described in
the older textbooks and which one could from time to time see even fifteen
years ago, are now extremely rare. While urban conditions have been
thought at various times to have tended to create immunity against certain
of the communicable diseases among the population in such communities,
one wonders whether scarlet fever, whose cause is yet unknown but which
seems likely to be related to some form of streptococcus infection, may not
appear in modified form, as for instance, in a marked measles or pneumonia
77
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
epidemic, as a secondary complication, causing a large number of deaths
from streptococcus infestion. This is purely speculative, but it is well to
bear in mind this cardinal fact, that the constant lowering in prevalence of
anyone of the communicable diseases, should not encourage us to relax our
vigilance in the control and prevention of that disease so far as it lies within
our power to do so. We should not be lulled into a sense of false security.
In the opinion of those who have analyzed figures relating to the
incidence of scarlet fever, the marked reduction in the number of cases
reported to the Health Department during the last several years, is not to
be interpreted as being due to a lessened vigilance on the part of practi-
tioners of this city or to mistaken diagnosis or failure to report cases. We
are constantly on the alert to discover an undue incidence of deaths from
acute nephritis or endocarditis among children, taking particular pains in
all such instances to ascertain whether there was a preceding acute infection,
resembling scarlatina.
In connection with scarlet fever, the nurses, while not called upon to
do nearly as great a volume of work, as with diphtheria, were nevertheless
very busily engaged in enforcing proper isolation and quarantine and the
observation of sanitary precautions. While numerically the number of
cases of scarlet fever was considerably less than the cases of diphtheria, this
disease, however, is of so much greater duration in the average case that
repeated visits were required.
The total number of visits made by the nurses of the Bureau was
30,203. In only five instances were they required to give bedside nursing
to the patient of the same character as had been required in the case of the
20 diphtheria patients. An analysis of the record of nurses' work would
indicate that in keeping with the times, the conception of their duty and the
opportunities for service to the community, have been greatly widened
so that they do not merely enforce the rules and regulations of the Health
Department, but they are agents for improving conditions in the home
and for ministering to the immediate needs of the patient and the family
wherever communicable disease brings them into contact with such families.
They aim to readjust the family under better housing conditions, to secure
employment for those who may be out of work, to secure charitable aid
for those who may require it, and to make themselves generally serviceable
so that they may be known as "friendly visitors."
Whooping Cough.
The prevalence of whooping cough shows a most striking reduction.
There were a total of 1,658 cases reported during 1919 as contrasted with
5,558 in 1918. Whether this was due to an actual diminution in the pre-
valence of whooping cough, such as was experienced in connection with
measles in particular, during the period of the influenza and pneumonia
epidemic, or whether the small number of cases reported was due to the
78
BUREAU OF PREVENTABLE DISEASES
habitual failure on the part of practising physicians in this city, to report
such cases to the Health Department, or on the part of parents to allow
patients suffering from whooping cough, to remain unseen by private
physicians, it is impossible to say, but the striking reduction is by no
means an indication that whooping cough, like scarlet fever, is steadily
receding in importance. We are well justified in believing that whooping
cough will come to engage the attention of health officers throughout the
world to a greater degree almost than any other of the commoner com-
municable disease. We may say this advisedly; for if the Schick test is
applied with any degree of thoroughness in advanced communities in the
next five or ten years, diphtheria will very fast dwindle into insignificance
as a public health problem. One is justified in taking this very optimistic
attitude with respect to diphtheria on the basis of the excellent account
which the Schick test and active immunization have thus far given of them-
selves. If diphtheria through the Schick test does become less conspicuous
whooping cough will gain proportionately in importance.
Whooping cough looms up large because in the great majority of cases,
the parents do not call in a private physician, and one case of whooping
cough developing in a family, is sure to be followed by a fairly large group
of secondary cases. This disease is a grave menace during the summer time,
in particular. We get a reflection of the deadly effects of this disease
through the increasing number of deaths from whooping cough which have
been noted during the last several years, and in particular, by the relatively
large number of deaths from pneumonia occurring in children of earlier age
groups. It is safe to say that a fairly large number of deaths from
pneumonia in children of the earlier age groups, is directly or mdirectly the
result of pertussis infection.
Because of the long duration of whooping cough and especially because
of the inability of physicians to identify the disease in its incipiency, there
has been a traditional laxity in the enforcement of isolation in cases of
whooping cough. The laws with reference to isolation of whooping cough
cases are a dead letter in practically every community. It would be in-
finitely wiser and might help us to save many lives if we frankly acknowl-
edged the deficiencies of our present system and instead of pretending
that we are enforcing the law, if we admitted our failure and set about
to meet the problem in a more straightforward and constructive manner.
In other words, the time has come when we ought to insist upon a cam-
paign of education which will be unrelenting and thorough, in order to bring
home to the great majority of people in the community a knowledge of the
grave character of whooping cough as a menace to child life.
Typhoid Fever.
The work in connection with the control and the prevention of typhoid
fever, has been important in many particulars. We had always prided our-
79
ANNUAL REPORT OF THE DEPARTMENT OE HEALTH
selves on our record, and we felt that we were justified in taking particular
credit to ourselves in our achievements in the field of typhoid fever con-
trol, especially in view of the fact that we have for many years been ac-
corded the palm for our typhoid fever control activities in the yearly review
of the typhoid fever situation in America which it has become the fixed
custom of the American Medical Association to make. The following
quotation from the Journal of the American Medical Association of March
6, 1920, in which typhoid fever as occurring in the large cities of the United
States during 1919 is reviewed, is particularly apropos :
"Chicago, New York, Boston, and Cleveland report typhoid rates that
are astonishing low. As in previous years, the New York City Health De-
partment has printed quarterly the result of its detailed study of each
typhoid case. Increasing success seems to mark the work of the Depart-
ment in tracing sources of infection for the last quarter of 1919. It was
reported that the probable mode of infection was determined in 35.7% of
the cases as against 30% in the corresponding quarter of 1918. Relatively, a
large proportion of the cases was traced to out-of-town infection. The ma-
jority of cases traced to their source within the city were due to contact with
active cases or chronic carriers. Water-borne and milk-borne typhoid in-
fection seems to have almost disappeared from New York City."
We have retired into second place among the ten largest cities in so far
as the control of typhoid fever is concerned, not because we have failed to
make very considerable improvement in our methods and each year to bet-
ter the results of the preceding year, but because we are extremely hard
upon ourselves in including every case of typhoid fever reported to us, even
though the diagnosis is not bacteriologically confirmed. It seems that in
some cities, the only cases which are listed as typhoid fever are those in
which the doctor can definitely demonstrate that this clinical diagnosis is con-
firmed by bacteriological evidence. The burden of proof is placed upon the
doctor in other cities. We feel that this is a mistaken attitude, and even
though it has caused us the loss of first place among the large cities of this
country, in the control of typhoid fever, we feel that the more scientific and
constructive attitude is to include those cases in which the private physician
insists upon the diagnosis of typhoid fever, but in which he has been unable
to obtain laboratory confirmation.
In 1919, we reached the remarkably low point of 2 deaths per 100,000
of population.
Our procedure in the supervision and control of typhoid fever cases
and the methods for the prevention of typhoid, have been very greatly im-
proved during the last year in a number of important details. This derives
a special significance from the fact that typhoid fever still ranks ninth as a
cause of death in this country. It ranks fifth among the infectious diseases,
being exceeded only by tuberculosis, pneumonia, infantile diarrhoea, and
diphtheria. While the disease causes death in only a little over 2% of the
80
BUREAU OF PREVENTABLE DISEASES
cases under five years of age, it results fatally in 35% of the cases in adults
over forty-five years of age. Taking into account the financial loss entailed
by loss of wages, the cost of nursing and medical care, and especially the
economic loss represented by each fatal case, typhoid fever still retains a
place of very considerable importance in the list of infectious diseases.
However, in view of the fact that a relatively large number of all cases are
caused by typhoid carriers in the community, of whom only a few under
existing conditions can be discovered we have still reason to feel that we
must maintain vigilance in order to exclude this disease from the community.
We had a total of 854 cases of typhoid fever in the City of New York
during 1919, as contrasted with 1,238 during the preceding year. This is a
remarkably small number of cases for the City of New York. Since the
year of the consolidation of the Greater City, up to and including 1915, the
number of cases of typhoid fever reported each year ranged between 2,200
and 4,400 with the exception of 1899 when we had the lowest number of
cases, namely, 1,950; the actual number of cases is here stated, and we ex-
clude for the time being the ratio of cases per thousand of population.
There were 121 deaths in the City of New York from this cause dur-
ing 1919 as compared with 196 during 1918.
The one striking and conspicuous improvement now needed is in tht
formulation of rules and regulations to be adopted by the Board of Health
for the control of typhoid carriers. During 1919, we had under our ob-
servation a total of 67 typhoid carriers. While several had formerly been
engaged as food handlers, none were so employed since first they were
identified as carriers. A few now prepare food for their own families. With
few exceptions, the members of families of typhoid carriers have been im-
munized. With the exception of four of these individuals, the home con-
ditions and the personal habits in all cases were excellent. They had been
carefully instructed how to protect others, and they carefully observe
these instructions. The four cases who were refractory, required special
care in order to make them comply with our requirements. Of the 67, 50
were female and 17 male. Of these group of carriers, 4 deny ever hav-
ing had typhoid fever; 7 are inmates of insane asylums, and particular
vigilance is required to prevent infection of others in those institutions in
which they are kept.
"Typhoid Mary" is still detained at Riverside Hospital, as is also one
other chronic carrier who has been the cause of several small outbreaks,
and whom we deem it best in the interest of others to be kept at Riverside
Hospital.
During the year, 3 of our carriers absconded and we have been unable
to trace them.
Our rules and regulations governing the control of these carriers, if
strengthened along lines which have been suggested during the year, will
add very measurably to the safety of the community. The very fact that
81
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
we have a group of carriers in the community, some of whom are known
and many more of whom have very likely escaped detection up to the
present time, makes it essential that typhoid immunization be accepted by
all persons who are compelled to eat in public restaurants or dining rooms,
notwithstanding the fact that we have inaugurated a system of foodhandler
examination.
Unfortunately with the facilities at our disposal, we have not been
able to do more than merely scrape the surface in the examination of ap-
proximately three-quarter million of foodhandlers in this city. Further-
more, every person who travels for business or pleasure, as well as those
living in institutions where large numbers of persons are congregated,
should by all means be persuaded and urged to accept typhoid immunization.
In Table 5, an analysis has been presented of all typhoid fever cases
and of all deaths from this cause, classification being made by sex and
by age group. It shows quite definitely that only 2% occurred in children
under five years of age. There is a gradual ascent in the case fatality rate
as we reach the higher age groups, the maximum being found in the age
group from 20-24 years. Thereafter, there is a gradual decline.
During the year, we had to deal with several small outbreaks, the
largest of which occurred in the Yorkville district, where 39 cases were
reported in a period extending from early in October to the middle of
November. This outbreak was concentrated in a rather narrow area and
in spite of the fact that more than twenty nurses were assigned to make
a most intensive house to house investigation in the district, and in spite
of the most painstaking attempts to ascertain if possible whether the milk
supply, foodstufifs or any other of the commonly accepted factors were
responsible for the outbreak, we were baffled. We came to the conclusion,
however, that the defective condition of plumbing in two buildings where
a considerable number of cases had occurred, was responsible for allowing
the excreta of infected individuals to escape into the yards of these buildings
in large quantity over a long period of time, furnishing material upon which
flies without numbers were observed to feed. Our observations led us to feel
rather strongly that the presence of innumerable flies feeding upon this con-
taminated human excreta, coming in particular from persons whom we knew
to be affected, was very likely responsible for the spread of the outbreak.
Other outbreaks which occurred during the year were, comparatively
speaking, insignificant and do not deserve special mention.
During the year, 32 cases of typhoid fever gave a very definite history
of eating oysters and clams obtained from various sources. In no instance,
was it possible to demonstrate definitely that shellfish were responsible for
the attack of the disease. In a number of instances, the eating of shellfish
was indulged in out-of-town, and these sources could not be traced. In
still other instances, samples of shellfish were obtained as early as possible
from the same source and examined for typhoid bacilli or B. coli.
82
BUREAU OF PREVENTABLE DISEASES
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Epidemic cerebrospinal meningitis.
The prevalence of epidemic cerebro-spinal meningitis was well within
normal limits. During the year, there was reported a total of 317 cases of
epidemic crebro-spinal meningitis. Of this number, 171 terminated fatally.
In 53% of the total number of cases reported, the diagnosis was confirmed
by the examination of the cerebro-spinal fluid.
Of the total number of cases reported, 168 were under five years of
age. In other words, 49% of the cases fatalities occurred at this age. Sixty-
seven per cent of the cases occurred in males ; on the other hand, 62% of
all the deaths occurred among females. It will be seen in Table 6 that in
the age group under five years, 50% of all ages terminated fatally, as
compared with 32% in the age group from 5 to 9; 47% in the age group
from 10 to 14; 65% in the age group from 15 to 19; 47% in the age
group from 20-24; 85% in the age group from 25 to 29; and 75% in the
age group from 30-34. Of the cases occurring in the age group from 35
to 39, and 40 to 44 all terminated fatally.
Poliomyelitis.
The prevalence of poliomyelitis was also very much less than during
the preceding years. A total of 44 cases and 14 deaths was reported during
the year. Of the total number reported, 57% of the cases and 64% of
all deaths occurred in children under five years of age. From 5 to 14 years
inclusive, there were 14 cases without any death.
Altogether the situation with reference to this disease during the
year 1919 was most favorable.
Table 7 attached shows the result of a study of poliomyelitis by a<^e
group and sex.
85
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89
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
TABLE 9.
MEASLES— DEATHS DURING 1919.
Manh.
Bronx
Bklyn.
Queens
Richd.
City
Percentage
Total
143
9
51
8
7
218
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
Total Sexes
67
76
5
4
30
21
6
2
3
4
Ill
107
51
50
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18
32
10
6
0
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36
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49
14
8
3
31
54
14
3
2
15
22.5
6.4
3.7
1.4
15
1—2
2—3
3—4
2.5
6.4
1 4
4—5
1
Total under 5
66
75
5
3
26
20
6
2
3
4
106
104
48.1
47.7
5—9
10—14
1
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0
Measles.
The incidence of measles during 1919 was extraordinarily light. A
total of 8,194 cases was reported during the year. This was less than one-
quarter the number of cases that we have had reported during a con-
siderable number of the preceding years. The reduction was so striking
as to constitute a unique phenomenon in our experience. The absence of
any great epidemic of this disease in any of the years immediately preceding,
would indicate that there were quite as many individuals in our com-
munity who were susceptible to measles during 1919 as during other years.
Since, apparently, it was not the lack of susceptible material, the question
arises whether the organism responsible for the influenza and pneumonia
epidemic was in any way either associated with or related to the causative
agent of measles. While it is possible that private physicians failed to re-
port a large number of the cases during the year because of the tremendous
volume of work during the influenza and pneumonia epidemic, and this
may account alone for the unusual low incidence of measles, our oc-
casional house to house investigations during the year lead us to believe
that this was not the case. Moreover, the number of deaths reported from
this disease, 218, was so very much lower than the number reported during
any of the preceding years, that we feel confident that the mortality rate
from this disease furnishes us with a fairly reliable index, showing that
90
BUREAU OF PREVENTABLE DISEASES
the disease was in reality reduced to almost neglible proportions during the
year.
Out of a total of 8,194 cases reported during the year, the age was given
by the physician reporting the cases in 6,767 persons. While the officers
of this Bureau invariably make inquiry of the physician reporting the case
when he fails to give the age of the patient, and although this was done
in connection with all cases reported during the year, a study was limited to
those cases in which the age was given in the first instance. (See attached
table.)
Table 8 is a classification by age groups of the cases occurring in the
various boroughs in which the age was reported. It is interesting to note
that the higher percentage of cases reported in any age period was in chil-
dren 6 years of age, namely, 16% ; the next highest in children 7 years of
age, as well as those 2 years of age, namely, 13% respectively.
The inference would seem to be warranted that while measles to a very
considerable degree is a disease affecting children of pre-school age, that
by and large, it finds its largest number of victims among school children.
A study was made of the age groups of the 218 deaths from measles
reported during the year, and is given in the attached table 9.
A tendency toward a reduction in the mortality rate from measles
which has been apparent for many years, is well indicated in Table 10
showing the number of cases of measles, death rates, and the population
of the city. Up to the year of consolidation, the City of New York
comprised the Boroughs of Manhattan and The Bronx, and the figures
indicated in the attached table from 1866 to 1898 are for the city as con-
stituted at that time ; from 1898, the figures relate to the Greater City
comprising the five boroughs.
In Table 11 is given the age grcrup, sex, and color of all cases of death
from measles which occurred from 1866 to 1919. This table is extremely
interesting, and while the age group classification varied from time to time,
the figures as given here are essentially correct and indicate very strikingly
the tremendous case fatality rate from measles in children under five years.
In 1918, 93% of the total deaths from measles occurred in children
under five years of age. The brunt of the attack and the bulk of the fatal-
ities occurred in children between the ages of 1 and 2 years.
Encephalitis lethargica.
Particular attention was given during the year to the occurrence in
this community of cases of encephalitis lethargica. Reports of such cases
began to filter into the Department of Health in October, 1918. The
greatest incidence of this disease seemed to occur as an aftermath to the
successive visitations of influenza and pneumonia.
There were 167 bases of encephalitis lethargica reported to the Health
91
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Department during 1919. The disease was not a reportable one nor did it
seem necessary at the outset to make it reportable, especially because it is
in the nature of an unusual occurrence. No doubt the number of reported
cases, namely 167, represents a relatively small percentage of the total
number of cases which occurred in the City of New York during the year.
The disease seemed to attack all age groups, but was apparently more preva-
lent in children from 5 to 9 years of age, and became increasingly frequent,
attaining the maximum prevalence in those between 20 to 35 years of age.
Of the 167 cases reported, 43 terminated fatally.
In view of its importance, special measures were advised and recom-
mended during the year to secure as complete statistical data as possible
with reference to the prevalence and the clinical manifestations of this
disease.
TABLE 10.
MEASLES— CASES REPORTED AND DEATH RATES.
(Former New York City.)
Death
Death
Year
Cases
Rates
Population
Year
Cases
Rates
Population
1866
1893
7,122
.19
2,643,211
1867
1894
9,493
.28
2,774,511
1868
.19
1,'205,588
1895
8,203
.34
2,868,585
1869
.62
1,271,622
1896
11,850
.36
2,938,950
1870
.27
1,340,704
1897
9,118
.19
3,005,985
1871
.35
1,369,320
1898
15,056
.19
3,272,418
1872
.37
1,398,748
1899
12,530
.17
3,356,722
1873
.26
1,429,018
1900
19,299
.23
3,446,042
1874
' 1,407
.27
1,495,959
1901
11,990
.12
3,554,079
1875
703
.11
1,528,184
1902
20,252
.19
3,665,825
1876
1,638
.33
1,575,132
1903
13,689
.13
3,781,423
1877
1,719
.11
1,623,524
1904
32,861
.22
3,901,023
1878
2,172
.22
1,673,406
1905
19,026
.12
4,025,742
1879
2,333
.22
1,724,823
1906
38,653
.27
4,166,556
1880
3,891
.36
1,777,351
1907
16,637
.16
4,314,237
1881
3,076
.27
1,830,876
1908
38,276
.21
4,469,248
1882
4,637
.57
1,886,017
1909
31,950
.21
4,632,078
1883
3,828
.40
1,942,820
1910
35,374
.16
4,794,935
1884
4,395
.44
2,001,338
1911
35,540
.13
4,929,586
1885
4,095
.44
2,061,622
1912
39,018
.13
5,064,237
1886
5,028
.36
2,132,818
1913
29,163
.12
5,198,888
1887
6,062
.42
2,211,272
1914
25,793
.15
5,333,539
1888
7,279
.29
2,279,068
1915
38,186
.11
5,468,190
1889
6,443
.29
2,349,006
1916
21,603
.08
5,602,841
1890
9,544
.38
2,420,817
1917
27,419
.08
5,737,492
1891
11,980
.35
2,492,787
1918
28,675
.13
5,872,143
1892
12,780
.40
2,566,896
1919
8,194
.04
6,006,784
92
BUREAU OF PREVENTABLE DISEASES
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93
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
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BUREAU OF PREVENTABLE DISEASES
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95
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
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96
BUREAU OF PREVENTABLE DISEASES
TABLE 12.
GENERAL INCIDENCE OF PREVENTABLE DISEASE IN NEW YORK CITY, 1919.
Cases
Reported.
Cases per
1,000 of
Population.
Deaths.
Deaths per
1,000 of
Population.
Case
Fatality.
Per Cent.
1918.
1919.
1918.
1919.
1918.
1919.
1918.
1919.
1918.
1919.
Diphtheria:
5.164
1,873
3,386
811
221
5,898
2,253
4,389
1,158
316
1.89
3.01
1.67
2.06
2.17
2.12
3.49
2.12
2.85
3.05
598
139
395
94
18
520
173
423
99
24
.22
.22
.19
.24
.18
.19
.27
.20
.24
.23
11.58
7.42
11.67
11.59
8.15
8.82
7.68
9.64
8.55
Richmond
7.59
City
11,455
1,782
863
1,332
395
88
14,014
1,687
715
1,636
445
111
1.95
.65
1.39
.66
1.01
.86
2.33
.01
1.11
.79
1.10
1.07
1,244
93
10
57
16
1
1,239
59
22
43
12
.21
.03
.02
.03
.04
.01
.21
.02
.03
.02
.03
10.86
5.22
1.16
4.28
4.05
1.14
8.84
Scarlet Fever:
3.50
3.08
2.63
2.70
Richmond
City
4,460
9,869
3,940
11,559
2,582
725
4,594
4,531
1,388
1,295
519
461
.76
3.61
6.33
5.71
6.57
7.13
.76
1.63
2.15
.62
1.28
4.45
177
370
57
310
44
9
136
143
9
51
8
7
.03
.14
.09
.15
.11
.09
.02
.05
.01
.02
.02
.07
3.97
3.75
1.45
2.68
1.70
1.24
2.96
Measles:
3.16
.65
3.93
1.54
Richmond
1.52
City
28,675
1,920
978
1,792
593
275
8,194
575
207
681
131
64
4.88
.70
1.57
.86
1.51
2.70
1.36
.21
.32
.33
.32
.62
790
328
73
163
83
17
218
60
17
58
14
3
.13
.12
.12
.08
.21
.17
.04
.02
.03
.03
.03
.03
2.75
17.1
5.8
9.1
14.0
6.2
2.66
Whooping Cough:
10.4
8.21
8.5
10.7
Richmond
4.7
City
5,558
7,885
1,501
4,228
080
145
1,658
7,713
1.760
4.363
542
192
.95
2.89
2.41
2.09
1.73
1.43
.28
2.77
2.72
2.11
1.33
1.85
664
4,321
967
2.677
626
188
101
3,.597
920
2,252
474
152
.13
1.58
1 .55
1.32
1.59
1.85
.03
1.29
1.42
1.09
1.17
1.47
11.9
54.8
64.4
63.3
92.1
129.6
9.7
Pulmonary Tuberculosis:
46.6
52.3
51.6
87.4
Richmond
79.2
City
14,439
554
141
453
75
15
14,570
407
102
259
65
21
2.46
.20
.23
.22
.19
.15
2.43
.15
.16
.12
.16
.20
8.779
84
16
81
9
6
7,395
51
11
43
10
6
1.50
.04
.03
.04
.02
.06
1.23
.02
.02
.02
.02
.06
60.8
15.2
11.4
17.9
12.0
40.0
50.7
Typhoid Fever:
12.5
10.8
16.6
15.4
Richmond
28.6
City
1.238
234
22
164
31
26
854
142
34
111
19
11
.21
.09
.03
.08
.07
.26
.14
.05
.05
.05
.05
.11
190
145
6
92
12
7
121
82
5
68
14
2
.03
.05
.01
.04
.03
.07
.02
.03
.01
.03
.03
.02
15.8
57.7
27.3
56.1
38.7
26.9
14.2
Cerebro-Spinal Meningitis:
57.7
14.7
61.3
73.7
Richmond
18.2
City
477
59
19
48
8
317
18
5
14
6
1
.08
.02
.03
.02
.02
.05
.006
.008
.007
.001
.01
262
12
3
11
3
171
7
"i
1
.04
.004
.005
.005
.007
.03
.002
'!663
.002
54.9
20.3
15.8
22.9
37.5
53.9
Poliomyelitis
38.9
50.6
16.7
Richmond
City
134
42
.02
.007
29
15
.005
.002
21.6
35.7
97
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Major and Unusual Infectious Diseases.
Smallpox.
Of the 18 cases listed, 11 arrived in the City from south, west or
north during their incubation period. Seven, undoubtedly, were subjected
to infection within the city limits. Of these 7, 3 had known exposures to
preceding cases. No exposure could be traced to account for the remain-
ing four. They presumably, came in contact with mild and unrecognized
cases about their various places of business, along the water front, or in
railroad freight yards.
The cases were all mild ; no complications ; no fatalities.
Two of the patients had last known exposures on the nineteenth and
twenty-first days respectively, before the onset of symptoms. All the
patients were adults; none had been vaccinated successfully within five
years. Two had never been vaccinated. One, the patient with twenty-one
days' incubation, was vaccinated unsuccessfully at time of exposure, illus-
trating apparently susceptibility to smallpox and unsusceptibility to vaccine.
Seven hundred and ninety-four possible contacts were vaccinated.
Anthrax.
Fourteen cases of anthrax were listed, all adults ; thirteen male and
one female. Six died, all face lesions ; four with face lesions recovered.
It is noteworthy that previous to 1917, practically all patients with face
lesions died. Since the beginning of 1917, serum has been used more
generally and about 50% of the face and neck cases have recovered.
In 1917, 7 out of 15 face lesion cases recovered.
In 1918, 10 out of 15 face lesion cases recovered.
In 1919, 4 out of 10 face lesion cases recovered.
Patients with lesions on extremities usually recover irrespective of
treatment.
Rabies.
Five cases of rabies listed and 5 deaths. Patients were all children
under 8 years of age. Two received antirabic treatment, begun within a
day or two of time of bite. Both were face bites, and the shortness of the
incubation — less than a month in both cases — precluded the possibility of
effective treatment. Three of these cases were first reported by death
certificate. The histories obtainable were incomplete. Five cases are an
unpleasantly large number, the largest for several years.
Tetanus.
Twenty-one cases were listed with 9 deaths. Nine of these cases
occurred in Brooklyn ; 6 in Queens, and 6 in Manhattan. The use of serum
is now general in connection with tetanus and is frequently effective even
98
BUREAU OF PREVENTABLE DISEASES
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105
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
TABLE 18.
TESTS FOR VENEREAL DISEASE PERFORMED IN THE LABORATORY.
1918.
1919.
Total number of Wassermann specimens received
Total number specimens (unfit) not examined
Total number positive Wassermann tests
Total number specimens received for complement-fixation test for
gonorrhoea
Total number positive (gonorrhoea)
Total number nor examined (unfit)
Total number smears for gonococci
Total number positive for gonococci
63,166
71,145
4,408
6,381
13,624
12,688
8,509
10,224
897
404
361
494
9,789
12,024
1,957
1,904
106
BUREAU OF PREVENTABLE DISEASES
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
TABLE
MEDICAL ADVISORY SERVICE
BOROUGH OF
Marital
Occupa-
<a
ource
of
Sex.
State.
Birth.
tion.
I
Qfection.
a
13
6
a
.95
'3
_2
"3
"3
a
S
a
•a
S
'u
u
OS
a
•a
o
1
a
Q
o
a
.sl
-0 O
03 f^
o
J3
Q
<;
h
m
s
P^
<
m
P
t)
ru
o
o
January
...1919
240
214
26
161
79
111
129
160
80
109
144
38
58
1918
282
247
35
210
72
112
70
250
32
62
126
24
25
February. . . .
.. .1919
199
171
28
139
60
86
113
145
54
85
119
40
40
1918
267
221
46
190
77
100
167
248
19
72
130
25
32
March
...1919
229
211
18
159
70
100
129
176
53
103
158
37
34
1918
290
263
27
217
73
119
171
279
11
82
152
33
15
April
...1919
227
210
17
161
66
121
106
168
59
77
159
38
30
1918
348
317
31
267
81
135
212
334
14
59
148
28
28
May
...1919
304
282
22
207
97
143
161
240
64
112
220
37
47
1918
281
255
36
225
56
126
154
268
13
32
138
19
9
June
...1919
310
283
27
209
101
164
146
202
108
128
203
58
49
1918
186
166
20
155
31
78
108
176
10
16
105
11
1
July
...1919
341
308
33
250
91
174
177
240
101
113
205
63
73
1918
244
219
25
156
69
96
152
182
58
45
125
27
18
August
...1919
293
245
48
212
81
157
136
183
110
52
200
42
50
1918
218
191
27
178
40
93
125
211
7
15
119
14
7
September.. .
...1919
236
211
25
178
58
118
118
138
98
32
164
26
46
1918
213
186
27
166
44
90
123
203
10
13
102
14
6
October
...1919
312
267
45
216
76
163
149
218
94
64
197
45
70
1918
159
141
18
113
46
72
87
53
107
19
45
11
5
November. . .
. . .1919
217
198
19
163
54
112
105
157
60
61
146
30
41
1918
175
154
21
125
50
60
115
142
33
19
88
12
4
December. . .
.. .1919
203
177
26
148
55
138
65
172
31
30
127
26
50
1918
...1919
181
160
21
127
57
93
90
35
48
91
109
22
47
Total. . .
3,111
2,777
334
2,217
894
1,597
1,524
2,199
912
969
2,082
481
608
1918
2,844
2,520
324
2,145
699
1,174
1,664
2,381
362
525
1,387
240
197
110
BUREAU OF PREVENTABLE DISEASES
22
FOR VENEREAL DISEASE
MANHATTAN.
Nature of
Referred
Source of
Infection.
Previously Treated by
to
Reference
C8
O
o
o
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117
79
21
23
4
90
72
9
4
61
93
147
147
59
1
67
95
18
140
65
10
139
15
69
43
2
7
1
83
72
186
59
76
136
11
60
49
17
73
3
54
79
12
5
48
60
139
130
16
64
112
7
131
74
16
53
9
75
60
7
18
5
71
74
175
52
i
68
130
14
87
61
18
62
8
53
97
9
11
53
58
171
167
38
47
132
12
isr
85
18
65
8
111
64
3
8
12
94
81
173
69
7
83
112
19
70
82
18
57
10
33
122
6
6
50
47
180
252
13
69
127
18
157
101
19
71
3
116
77
4
5
7
116
83
189
81
'7
92
153
16
113
88
37
66
8
90
143
11
1
51
73
231
258
24
18
66
146
50
108
93
18
72
3
71
82
1
3
4
92
77
179
25
3
99
151
5
93
104
36
66
5
96
115
27
11
65
60
223
254
27
16
87
157
16
54
64
10
58
2
32
53
2
3
1
52
57
149
4
1
64
109
6
100
109
32
101
14
92
176
8
19
33
78
263
284
9
10
98
193
18
96
89
13
50
5
82
54
2
3
31
58
69
167
15
24
45
135
24
92
73
4
128
5
57
104
3
9
105
47
147
127
12
4
56
178
38
77
77
9
55
6
44
34
1
5
5
49
52
153
5
3
67
140
2
84
58
7
93
3
41
130
1
4
48
25
208
231
10
1
34
119
95
80
68
4
61
4
44
40
1
6
2
42
45
137
2
1
57
148
2
87
92
27
86
19
76
106
2
10
75
25
95
221
66
18
24
74
111
63
53
2
41
1
47
16
5
7
14
16
47
65
8
8
14
44
2
66
52
4
93
3
44
130
1
7
30
27
125
183
9
20
87
100
69
73
11
35
5
43
29
1
9
28
47
110
1
26
112
3
2
61
46
2
94
41
100
4
56
31
124
174
18
43
69
59
81
57
4
45
'4
85
37
i
5
37
66
104
114
12
'2
71
62
10
1,030
993
224
941
82
767
1,374
87
91
692
624
2.052
2,174
301
68
665
1,599
542
1,177
889
134
945
65
819
589
26
62
295
764
1,014
1,797
320
61
762
1.472
123
111
ANNUAL REPORT OF THE DEPARTAIENT OF HEALTH
TABLE 23.
MEDICAL ADVISORY SERVICE FOR VENEREAL DISEASES.
(Borough of Brooklyn.)
January. . . .
February. . .
March
April
May
June
July
August
September. .
October ....
November. .
December. .
Total
During 1918.
New-
Patients.
14
32
29
31
22
27
27
21
29
28
27
26
313
Old
Patients.
19
26
21
29
36
30
29
71
42
18
26
29
376
Wassermann
Tests.
460
476
540
483
531
406
481
483
469
324
369
404
5,426
During 1919.
New
Patients.
33
41
59
60
74
56
77
78
45
76
58
45
702
Old
Patients.
31
35
44
67
55
74
79
95
65
102
177
162
986
Wassermann
Tests.
549
449
518
474
545
613
543
515
519
637
576
464
640
PATIENTS TREATED.
Syphilis.
Gonorrhoea.
Total injections of Salvarsan
Total injections of Mercury
71
170
238
2
TABLE 24.
MEDICAL ADVISORY SERVICE FOR VENEREAL DISEASES.
(Borough of Bronx.)
1919.
1918.
New
Patients.
Old
Patients.
Wassermann
Tests.
New
Patients.
Old
Patients.
Wassermann
Tests.
January
February
March
12
6
6
8
2
8
45
41
28
45
33
22
4
2
3
4
6
1
4
20
16
14
24
28
69
74
93
70
84
76
82
86
S3
96
87
85
8
6
3
8
2
4
5
4
6
3
4
5
.
70
73
41
April
May
June
July
August
September
October
November
December
85
61
61
69
65
76
58
51
78
Total
256
126
985
58
788
112
BUREAU OF PREVENTABLE DISEASES
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113
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Occupational Clinic.
The work of the Occupational CHnic in Manhattan is briefly sum-
marized in the attached Table 26. The necessity of distributing the clinic
physicians doing this work to various boroughs has resulted in a reduction
in the number of cases of foodhandlers examined by the Occupational Clinic
in the Borough of Manhattan. In the latter borough in the first year of
our work in this field, our clinic physicians examined 42,000 foodhandlers,
during the year just gone, we examined less than 13,000.
This work is so important that it is extremely regrettable that we
have not been able to make it more significant than it was in the first year
of its establishment. The work is important, both as regards the periodic
medical examinations, and as a means of protecting the citizens of New
York from affected foodhandlers.
The attached Table 26 is submitted in connection with the work of
the Manhattan Occupational Clinic.
Special Study — During the year, a study was made by physicians
assigned to the Occupational Clinic, Borough of Manhattan, among one
hundred and seventy members of Franklin Union No. 23, composed of
pressmen, feeders, and others engaged in the printing trade, who were
examined at union headquarters. This study which was conducted in a
thorough and careful manner revealed nothing of striking interest that
would in any way indicate that pressmen are subject to unusual dangers.
The facts disclosed by this examination were such as one would expect to
find among any group of occupied individuals whose work occasionally calls
for considerable physical efifort. The prevalence of tuberculosis, de-
generative diseases, and of other special physical defects, was normal as
compared with other industries. We were extremely surprised to learn that
lead poisoning which one might with reason expect to be abnormally pre-
valent among pressmen, was practically absent.
One active case of pulmonary tuberculosis was found, and six arrested
cases. Ten cases of chronic endocarditis were discovered, and in addition,
one of chronic myocarditis and one case of syphilitic aortitis. There were
a number of cases in which abdominal pain or colic was found ; these num-
bered all told, 84 cases. Eighty-one of these workers were suffering from
marked constipation. In the absence of muscular weakness or paresis, or of
basophilic granulations, or of the lead line, or other symptoms, it was im-
possible to say whether these cases were cases of lead poisoning. Unfortu-
nately, we could not secure the co-operation of any chemist of the Depart-
ment of Health or of any outside agency to make the necessary exami-
nations for lead in the urine, which alone would have enabled us to judge
whether any of these individuals were suffering from lead poisoning. In
114
BUREAU OF PREVENTABLE DISEASES
view of the fact that a number of these individuals work in an environment
in which lead dust is present frequently in very considerable quantities, it is
very likely that cases of lead poisoning were present among those who com-
plained of constipation and abdominal colic; but it would be unscientific and
unwarranted to make any deductions in the absence of more definite con-
firmatory evidence of clinical or laboratory character.
Table 27 gives the cases of all diseases reported during 1919 to the
Bureau of Preventable Diseases.
115
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Suspected
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116
BUREAU OF PREVENTABLE DISEASES
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117
BUREAU OF LABORATORIES.
The work of the Bureau of Laboratories has been carried on under
seven Divisions namely : I, Administration ; II, Media and SteriHzation ; III,
Diagnosis; IV, Microbal Sanitary Examinations; V, Production of Serums
and Vaccines; VI, AppHed Therapy; VII, Special Investigations.
The regular staft consists of a director, 5 assistant directors, 1 medical
inspector, 1 pathologist, 1 inspector of foods, 21 bacteriologists, 1 chemist,
1 chief clerk, 1 librarian, 2 stenographers and typewriters, 3 typewriting
copyists, 11 clerks, 6 bacteriological diagnosticians, 65 laboratory assistants,
18 laborers, 74 helpers, and 1 messenger.
The complete volume of work, so far as it can be indicated by figures,
is recorded on special forms, filed semi-monthly, quarterly, and yearly in
the Division of Administration. A condensed report is sent semi-monthly
to the Commissioner.
The most noteworthy thing during the past year, outside of the routine
work, is the investigation of acute respiratory infections undertaken in
conjunction with the United States Public Health Service. The Divisions of
Preventive Medicine of Harvard, and of Chicago Universities, and the
Metropolitan Life Insurance Company. The results, so far obtained, are
given under Special Investigations.
The Division of Administration.
This Division includes the organization and executive control of all
work, such as (1) The standardization and apportionment of work and
workers, (2) The ordering of supplies, (3) Bookkeeping for stores and
production, (4) Other clerical work, consisting chiefly of letters and
ofiticial reports. The determination of unit costs has been discontinued.
The Divisions, other than those of administration and special investiga-
tions are divided into two groups, one group consisting of three divisions,
namely, the Divisions of Media Preparation, of Diagnosis, and of Mi-
crobal Sanitary Examinations, is placed under the immediate charge of
the First Assistant Director, and the second group, namely the Divisions of
Production and of Applied Therapy, is under the charge of the Second
Assistant Director. The Division of Special Investigations is made up, as
usual of the investigative work of all the Divisions.
Concentration of Antitoxic Plasma.
The various operations have been carefully studied. Some changes in
the technic have been made, resulting in a very material saving in labor,
time and supplies. With the same number of workers the plasma con-
centrated (diphtheria and tetanus), has been increased from 1,145,850 c.c,
in 1918, to 3,256,600 c.c. in 1919. The changes are as follows: (a) A
118
BUREAU OF LABORATORIES
new press, which was in stock, was put into use, much more uniform
pressure being obtained, (b) The heating tank has been htted with a
steam distributing system, which insures even heating in all parts of the
tank, (c) Filter paper has been replaced by cloth, for the collection of
the euglobnlin fraction, resulting in a saving of filter paper, and of labor in
handling the precipitate, (d) Attempts have been made to collect the pseudo-
globulin fraction on cloth. To date, the results have not been entirely suc-
cessful, but further experiments are being carried out. (e) The pseudo-
globulin fraction after draining is transferred to, and pressed between,
cloths, thereby saving paper formerly used to absorb the liquid and reduc-
ing the time for the pressing to about 36 hours. Formerly, the operation
required six to ten days.
Distribution of Liznng Organisms.
All living microorganisms sent out by this Bureau (about 800 speci-
mens during the year) were under the close supervision of the First As-
sistant Director and were sent in accordance with the state law and the
State Board of Health regulations.
Division of Media and Sterilization.
The production of media during the year 1919 has been carried on
along the same general lines as before, with the exception of one change —
this being the method of determining the reaction of culture media. The
titri-metric method so long used with phenolphthalein as the indicator has
been almost wholly supplanted by regulating the hydrogen ion concentra-
tion. The older titrimetric method takes into account the total acidity of
a medium, whereas the hydrogen ion concentration method gives informa-
tion as to the actual acidity, that is, the reaction under which the bacteria
are actually placed for growth.
With this method the more delicate organisms, cultivated with difficulty
under the best of circumstances, are assured cultural conditions more
favorable for their development; also the production of such substances
as diphtheria toxin is made more uniform.
A summary of the work of the Division is shown in the following
table :
119
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
r.
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Pieces of Glassware
Washed.
1,006,957
1,018,825
1,024,873
1,036,688
871,275
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120
BUREAU OF LABORATORIES
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121
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Division of Microbal Sanitary Examinations.
The work of this Division includes the routine bacteriological examina-
tions of milk, water, and of disinfection tests, and the microbal examina-
tions of other foods stufifs, of materials from trades, etc.
In addition to these regular samples the following were examined:
Milk from Department of Charity and Correction 2,637
Reconstituted Milk, and miscellaneous samples 148
Creams 141
Ice Cream 146
The volume of work done, including the water tests and the controls,
is indicated by the following figures : —
Total number of specimens examined 52,204
Total number of plates made 100,247
Total number of fermentation tests 8,772
WATER EXAMINATIONS.
(These examinations are for the Sanitary Bureau and the full interpretations are made by
that Bureau.)
BACTERIOLOGICAL EXAMINATIONS OF WATER MADE DURING 1919.
Source.
Good.
Fair.
Bad.
No
Opinion
Given.
Total.
Manhattan :
Regular supply
127
1
"7
40
3
2
10
9
1
7
17
2
176
Wells
5
Coolers and tanks
9
Baths, vicinity
34
Total
135
2
"1
55
2
"4
34
1
12
2
226
Bronx:
Regular supply
4
Wells
1
Baths, including Riverside
17
Total
3
1
8
6
6
2
"3
13
"1
14
22
Brooklyn:
Regular supplv
3
Wells
9
Baths, including beaches
23
Total
15
35
5
2
5
8
1
i
15
2
5
4
35
Queens:
Regular supply
Wells
45
11
Drinking fountains
6
Baths, including beaches
1
Total
42
7
2
1
10
14
5
3
11
44
3
3
63
Richmond :
Wells
65
Cisterns
10
Baths, including beaches
7
Total
Out of Town:
Wells
10
14
22
7
50
13
5
82
39
Total
219
105
136
7
467
122
BUREAU OF LABORATORIES
Examination of Oysters — Six hundred and fifty-two samples of
oysters were examined bacteriologically. Examinations were continued dur-
ing the "closed season."
One hundred and twenty-two of the samples had a coliscore of 50 and
over, i. e. should have been condemned under the rating of the American
Public Health Association. By far the greater number of these high scores
were obtained between March 1st and October 1st.
Division of Diagnosis.
This Division is divided, chiefly for the sake of topographic conven-
ience, into two Divisions, namely, Direct Diagnosis, and Indirect Diagnosis,
the former carried on in the laboratories at headquarters, while Indirect
Diagnosis includes those requiring a more varied technic, best managed in
the laboratories at 16th Street
DIRECT DIAGNOSIS.
Year.
Wassermann
Tests.
Diphtheria
(culture).
Tuberculosis
(sputum).
Tvphoid
(Widai).
1919
1918
1917
1916
64,965
71,418
123,500
55,214
112,708
134,054
141,284
133,032
41,615
52,934
54,808
64,603
5,940
9,060
13,208
17,535
Division for the Production of Serums and Vaccines
The following table gives the amounts of the more important products :
Product.
Diphtheria toxin
Diphtheria antitoxin plasma
Tetanus toxin
Tetanus antitoxin plasma and serum
Antimeningitis serum ,
Antipneumococcus serum ,
Normal horse serum
Pertussis vaccine
Streptococcus vaccine
Pneumococcus vaccine
Staphylococcus vaccine
Gonococcus vaccine
Typhoid vaccine
Tuberculin vaccine
Smallpox vaccine (cow pox vaccine), see following:
Produced in c.c.
1918.
1919.
725,000
1,288,000
1,790,000
2,302,400
281,150
440,555
420,100
1,133,500
1,516,265
558,500
873,575
475,100
231,625
396,630
78,180
38,400
23,600
38,500
5,900
21,400
25,000
93,100
46,000
46,100
117,700
41,900
5,916
1,950
Cozvpox Vaccines — An improvement in the vacuum method of filling
capillary tubes has been devised by Mr. Thomas A. Watson of the Bureau.
This improvement consists of introducing a small disc of wire gauze under
the ends of the capillary tubes to raise them from the bottom of the con-
tainer. The raising of the ends of the tubes aids greatly in obtaining a uni-
123
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
form filling of the tubes. The loss, through imperfect filling, has thus been
reduced from about forty to four percent. This saving has made it possible
to use the vacuum method entirely for filling all of our output of capillary
tubes.
A new style package for the small vial (10 vaccinations) has been in-
troduced. This package consists of a firm cardboard box, with the neces-
sary labeling printed on the cover. The vial is held securely in a small com-
partment. There is another compartment for the container, with ten needles
and a small envelope with ten applicators. Also a folded paper with full
directions for performing vaccination.
The large vial (50 vaccinations) has been discontinued. Instead the
virus is disbursed in one c. c. amounts (when so ordered for the vaccina-
tion of large numbers at one time) at $1.25, net, per c. c. If needles and
applicators are desired by the purchaser, they are supplied at an extra
charge of 20 cents for each fifty. The new style package, described above,
for the ten vaccination vial will accommodate the vial holding 1 c. c. ; also
the fifty needles and fifty applicators. The practical discontinuation of the
large vial has led to an increased output of small vials.
The epidemic of smallpox in Canada has given rise to an increased
num.ber of calls for vaccine virus, not only from Canada itself but also
from those portions of New York and other states near the Canadian border.
As will be seen in the accompanying table, more virus was produced in
1919 than in 1918, and from fewer calves, as the 11,386 c. c. of virus was
collected from only 35 calves ; whereas in 1918 only 10, 350 c. c. was obtained
from 44 calves. The average yield of 325 c. c. per calf, in 1919, is greater
than any year since 1915, when an average of 331 c. c. was produced.
The work on vaccine virus during 1919, as compared with that during
the last five years is given in the following :
Calves
Vacci-
nated.
Calf
Crops
Col-
lected.
Average
Amount
per
Calf.
(c.c.)
Pro-
duced.
(c.c.)
Dis-
bursed.
(c.c.)
Disbursed.
Year.
Capillary
Tubes.
Large
Vials.
Small
Vials.
1919
1918
1917
1916
1915
1914
35
46
28
26
13
46
35
42
28
26
13
47
325
246
280
300
331
250
11,386
10,350
7,849
7,810
4,307
11,764
10,644
7,460
6,529
5,682
5,893
9,480
263,738
250,916
194,310
154,623
195,605
247,720
' 2,067
2,344
2,427
2,153
6,382
17,353
4,500
4,246
4,609
3,719
3,852
Work on Rabies.
This Bureau furnished rabies vaccine, during the year, for 414 persons.
These cases were located as follows :
City of New York 270
124
BUREAU OF LABORATORIES
State of New York 65
State of New Jersey 26
State of Connecticut 13
State of Rhode Island 20
State of Pennsylvania 3
State of Massachusetts 7
State of Ohio 3
State of Kentucky 3
State of Tennessee 1
*West Indies 3
Total 414
The number of New York City cases, 270 in 1919, is far greater than
the number (185) for 1918. These 270 cases are classified as follows:
Bitten by animal : which proved rabid by miscroscopical
examination of brain 66
Bitten by animal : which proved clinically rabid, microscopi-
cal examination not made 3
Bitten by animal : (Stray) not found 80
Bitten by animal Examination not madef 25
Bitten by animal : Negative by animal test 61
Bitten by animal : Negative by observation of animal 35
Total 270
The recorded number of 69 cases bitten by rabid dogs during 1919 is
more than twice the number in 1918, when 25 cases were recorded. The
69 cases were located in the various boroughs as follows :
Manhattan, 8 ; Brooklyn, 58 ; Queens, 3 ; Bronx, 0.
This marked increase in the number of persons bitten by rabid dogs in
New York should be viewed with anything but satisfaction. As will be
seen in the accompanying table, the effect of the muzzling ordinance, in 1915,
and its enforcement during the succeeding years was to reduce the number
of persons bitten by rabid dogs from 509, in 1914, to 25, in 1918. That the
number has begun to increase, as shown by this year's figure of 69, points
to lax enforcement of the muzzling laws, especially in Brooklyn which had
the majority of the cases, 58.
The call for rabies vaccine, by Borough, was as follows : IManhattan
79, Brooklyn 159, Bronx 31, Queens 1. Total 270.
Below is given the table showing the statistics of patients treated during
the past seven years As will be noted three deaths occurred in 1919.
* These cases came to New York for treatment.
t Under this heading are placed cases with history similar to following: Pet dog
in family became ill and died suddenly without being seen by veterinarian. Body of
dog was carried to offal dock. A day or two later the family exposed consulted phy-
sician in charge of clinic, who, considering circumstances suspicious, gave treatment.
125
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
STATISTICS OF PATIENTS RECEIVING PASTEUR ANTIRABIC TREATMENT,
1913-1919.
(Patients treated less than one week, pending diagnosis in biting animal, or refusing to
continue after less than one week's treatment, are not included in this table. Mortality statis-
tics are based on number of persons bitten by rabid animals and not on total number treated.)
Patients Treated.
Biting
Animals
Proved
Rabid.
Percent-
age of
Positive
Cases.
Mortality
Total
Human
Rabies
Deaths
Among
Patients
Treated.
Gross.
Deaths
15 days
or more
After
End of
Treat-
ment.
Corrected.
Years.
Percentage
of Cases
in which
Biting
Animal
was
Rabid.
Percentage
of Cases
in which
Biting
Animal
was
Rabid.
1919
In City 228
Out of City 135
Total 363
In City 145
Out of City 269
Total 414
In City 175
Out of City 239
Total 414
In City 115
Out of City 131
Total 246
In City 220
Out of City 206
Total 426
In City 509
Out of City 343
Total 852
In City 528
Out of City 447
Total 975
69
112
30.3
83.0
2
1
0.0290
0.0090
0
0
0.0000
0.0000
181
49.9
3
0.0166
0
0.0000
1918
25
230
17.2
85.1
0
0
0.0000
0.0000
0
0
0.0000
0.0000
255
61.6
0
0.0000
0
0.0000
1917
48
230
27.4
96.2
0
1
0.0000
0.0043
0
1
0.0000
0.0043
278
61.8
1
0.0035
1
0.0035
1916
40
114
34.8
87.8
1***
0
0.025
None
0
0
0
0
154
63.0
1
0.025
0
0
1915
124
164
56.2
79.6
0
1
0.000
0.006
0
0
0
0
288
67.6
1
0.0034
0
0
1914
*♦
355
258
69.7
75.2
2
1
0.0056
0.0038
1
0
0.0028
None
613
71.9
3
0.00489
1
0.00163
1913
373
359
70.6
80.0
3
1
0.008
0.0028
1
0
0.0027
None
732
75.0
4
0.00546
1
0.00136
**1914 Muzzling ordinance adopted in July and put in operation in the Autumn.
1915i
1916(Muzzling ordinance in force. Note reduction of number of patients requiring
1917( Pasteur treatment in City.
1918)
***Completed treatment September 1, 1916. Died of Rabies March 9, 1917.
126
BUREAU OF LABORATORIES
Diifision of Applied Therapy.
The report of this Division for the year shows a decrease in the work
as compared with 1918, chiefly on account of the falHng off in the number
of cases of epidemic meningitis, from 143 to 61. The number of cases of
epidemic meningitis for 1918 was the highest since the work has been in
progress. The number of cases of tuberculous meningitis also decreased.
Other forms of purulent meningitis, especially influenzal, showed a slight
increase. It is of interest that one case of staphylococcic meningitis re-
covered. This is the only recovery in our experience, and one of very
few on record.
The most interesting part of the year's work was the study of cases
of encephalitis. These began to appear in the autumn of 1918. The
etiology is still in doubt. Attempts at transmission to monkeys by the in-
tracranial inoculation of autopsy material have been unsuccessful. The
spinal fluid findings are similar to those of poliomyelitis, and probably
represent the reaction of the meninges to an inflammatory process in the
substance of the brain and cord.
It is the opinion of most observers both here and abroad that it is
connected in some way with the epidemic of influenza, on account of its
simultaneous appearance in all countries during the late epidemic, its
reappearance simultaneously with the second epidemic of influenza this
winter, and historical accounts that show that previously these two condi-
tions have been associated.
TABLE OF CASES OF MENINGITIS EXAMINED
Consulta-
tions
New
Cases.
Lumbar
Puncture
Inocula-
tion
Epidemic
254
77
26
14
19
26
1
5
14
81
130
01
61
8
8
4
2
1
1
14
61
123
252
71
26
14
19
26
1
5
14
72
96
252
Tubercular
Influenzal
26
Pneumococcus
14
Streptococcus
19
Staphylococcus
26
Syphilitic
1
Colon Bacillus
5
Poliomyelitis
Encephalitis
Other Diseases
Total
647
344
596
343
890 spinal fluids were examined, and 80 guinea-pig inoculations were made.
Division of Special Investigation.
Besides the work already reported under the various Divisions, the
following special investigations were undertaken.
127
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Studies on Epidemic Influenza — (a) In continuing the work on the rela-
tion of the influenza bacillus to epidemic "flu," we showed clearly that, ac-
cording to the absorption-of-aggultinin tests, no epidemic strain existed
among those we isolated from many cases. (b) Specially mixed vaccine,
has been used in a large group of controlled volunteers, the statistics from
which are being compiled.
Incidence of Common Colds.
An extensive study of common colds was undertaken. The investiga-
tions so far have shown (a) That a filtrable virus as the specific cause was
not demonstrable, (b) That no one specific organism was demonstrable.
Culture Media for the Diagnosis of Diphtheria.
A study of diphtheria organism grown on various media compared
with the same strains grown on Loffler's blood serum gave the following
results :
(a) Throat cultures on Loeflfler's blood serum, made with horse blood,
showed as characteristic a picture of diphtheria bacilli, and gave a greater
average of positive results than did the same cultures grown on the stock
Loeffler medium made with beef serum shipped from Chicago.
(b) Throat cultures on Loeffler's blood serum made with dehydrated
Loeffler's blood serum gave a greater proportion of positive results than
with Loeffler's serum made in the usual way, with liquid serum from either
beef or horse.
(c) Throat cultures on three media made with agar (vitamine agar,
whole blood agar, and liver agar) gave almost wholly negative results
in contrast to positively typical diphtheria cultures obtained from the same
throats on Loeffler's blood serum.
(d) Throat cultures, and cultures of pure diphtheria strains, grown
on glucose-agat", combined with increasing percentages of horse serum, did
not show as good results as the same cultures grown on the standard
Loeffler's blood serum. The latter part of the series (agar containing the
higher proportions of serum), gave results sufficiently comparable to those
on the Loeffler medium as to suggest that these agar and serum mixtures
might prove useful in emergencies if the standard medium were not available.
Active Immunisation Against Diphtheria.
The investigations upon producing a permanent immunity have been
actively continued. Two thousand infants, under ten days of age, were
given three full sized injections. Tests at the end of eight months did not
show the degree of immunization hoped for. Infants as young as these
apparently do not respond well. Absolutely no deleterious results were
noted.
128
BUREAU OF LABORATORIES
The duration of the immunity in the children injected four and one-
half years ago was found to have continued. It is safe to say, therefore,
that three injections will produce sufficient anti-toxin to give immunity
in 95^ for at least four and one-half years.
About the only drawback to actively immunizing persons against diph-
theria is the marked reactions which occur from protein substances, other
than the specific toxin, in older children and adults.
Attempts to separate the toxin-antitoxin from the other protein material
has been partially successful in that the pseudo-reactions have been less,
but the immunizing results have not been quite as good. It is intended to
continue the investigation.
In cooperation with the Bureau of Child Hygiene, the parents of the
children in twenty schools were circularized, and where they were willing
the children were Schick-tested, and, when found positive, given injections
of toxin-antitoxin.
129
BUREAU OF CHILD HYGIENE
During the year 1919, the organization of the Bureau of Child Hygiene
was changed materially. More responsibility was vested in the individual
Boroughs, and the administrative unit was changed from the Division to
the Borough; that is, the type of organization by functions was changed
to organization by local units.
The central stafi' of the Bureau now consists of the Director, Assistant
Director, the Superintendent of Nurses, the Chief Clerk and the essential
clerical and stenographic force. On account of the highly specialized
nature of the following functions the supervisors in charge of each group
are attached to the central office and report to the Director: Chief of
the Division of Employment Certificates, Supervising Inspector of Open
Air Classes, Supervising Oculist and Supervising Dentist. The organization
in each Borough consists of a Borough Chief with the necessary district
medical supervisors and supervising nurses and the field force. The entire
policy for the work of the Bureau, outlining the program and putting it
into effect, with complete supervision and responsibility for all functional
activities, rests with the central staff". The local Borough Chiefs are respon-
sible for the proper carrying out of all orders issued and necessary dis-
ciplinary measures connected with executive functions in the Boroughs under
their jurisdiction.
Baby Welfare Work During 1919.
The Division of Baby Welfare of the Bureau of Child Hygiene is charged with the
responsibility of safeguarding infants and children from the pre-natal period until school
entrance. Such obligation was discharged in the main through the Baby Health Sta-
tions, sixty of which were operated and maintained by the Department of Health
during the year; 28 in Manhattan, 24 in Brooklyn, 4 in The Bronx, 3 in Queens and 1
in Richmond. The number of stations has gradually increased from the original organiza-
tion of 15 in 1911, to 55 in 1912, 56 in 1913-14, 59 in 1915 and 60 in 1916, the additional
station during 1919 being operated in the Borough of The Bronx.
As stated last year, these centres established for the supervision and care of infancy
and early childhood were at first called Infants' Milk Stations. This term has now been
discarded and they have been designated as " Baby Health Stations," a term broader
and more comprehensive in scope and one calculated to emphasize the educational and
prophylactic objects of the service, rather than the value of milk per se, as the essential
factor in the control of infant morbidity and mortality. While established primarily
for the care of babies under two years of age, other important activities have developed
around these Baby Health Stations as centres for the preservation of child health and
life, so that the more important functions of the bureau clearing through them, are as
follows :
1. Inspection and supervision of expectant mothers — pre-natal care.
2. Supervision of the care and feeding of babies under two years of age.
3. District or home visiting by a corps of field nurses, throughout the year
and particularly during the hot term.
130
BUREAU OF CHILD HYGIENE
4. Physical examination of children of the prc-sciiool age — two to six years —
together with follow-up visits to the home for giving advice and instruction as
to the physical defects found and ways and means for affecting a remedy or
cure of the same.
5. Centres for other departmental as well as local social service activities, and
for the co-operation of all agencies in the City interested in Child Welfare.
The organization of the division has remained substantially the same as in former years,
namely, one inspector for three stations, attending each twice weekly, one nurse for each
station, in attendance daily, and one nurse's assistant for each station, attending daily.
While in former years provision was made through budgetary appropriation for the
assignment of a/large number of nurses from May to September, inclusive, in order to
assist at the Baby Health Stations during the summer months when the attendance was
unusually large, and, when children were more liable to become ill because of seasonal
conditions, during 1919 only 87 months' nursing service were allowed for this type of
work, as against 287 months during 1918, and approximately 275 months in other pre-
vious years. The policy of the Division, like that of the Bureau, in all of its activities,
has been preventive rather than corrective, and the watchwork has been "keeji the well
baby well.''
])istrttction and Suprrvision of Expectant Mothers.
A point has been reached in the supervision of infancy where it appears that the
number of infant deaths from congenital diseases is so great that it controls in large
measure the curve of infant mortality. In fact, for several years past, statistics have
shown that the number of infant deaths from congenital diseases alone was almost equal
to or exceeded that of diarrhoeal diseases and respiratory diseases combined.
As far back as 1913 the bureau realized that any further material reduction in the
infant mortality rate of the Greater City must come through organized effort to supervise
expectant mothers. Congenital diseases bear no relation to errors in infant hygiene and
dietetics, but are dependent within certain limits upon conditions in the mother, operative
before, at. or shortly after birth of the child. For the past six years the bureau has
emphasized the need and Importance of a special corps of nurses for this phase of its
activities and has submitted not only argumentative statistical data showing the great
need of pre-natal care, but has shown from the results of the work accomplished by a
limited corps of nurses in recent years that if the same methods of approaching the
expectant mothers could be applied to the city at large, as was the case in the limited
amount of work performed by these nurses, that there would result not only a reduc-
tion in the infant mortality rate as a whole, in the infant mortality rate from congenital
diseases, fewer deaths during the first months of life, fewer still-births, fewer pre-
mature births, fewer cases of sore eyes, fewer accidents to children, and. not only an
increased percentage of maternal nursing, an augmented number of deliveries by phy-
sicians instead of midwives. improved birth registration, care of infants in the early
months of life, but, a decided reduction in the maternal mortality rate and in the accidents
and injuries of children at birth.
Despite all this, however, no available force for conducting this type of work on a
large scale has ever been placed at the disposal of the bureau. For several years past
seven or eight nurses were assigned to this work by virtue of a special budgetary appro-
priation which allowed for the appointment of special nurses during the summer months.
During the year 1919, owing to reduction in the budgetary allowance for these temporary
nurses, Isecausc of a large number of vacancies in the nursing force, because of special
surveys, studies and other activities, and because of resignations, only two or three
nurses were enabled to take up this work, and even at that, irregularly. The result has
been that during 1919 fewer expectant mothers have been supervised by the bureau than
in any previous year since 1914. the first full year in which this work was conducted,
131
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
although preliminary arrangements had been made for such work in the latter part of
1913. Nevertheless, although few cases of expectant mothers were supervised, the same
experience of former years has been recorded, viz., that in the cases supervised the
infant and maternal morbidity and mortality rates are far less than those of the city
at large. With an annual birth registration of between 135,000 and 140,000, and with
approximately 75,000 expectant mothers sorely in need of supervision annually, a corps
of three to eight nurses, even when supplemented by the regular Baby Health Station
nurses, could scarcely do more than scratch the surface of the problem. A nurse assigned
to the instruction and supervision of expectant mothers, if she is to perform the work
properly and if she is to give the expectant mother the full measure of advice necessary
for making her pregnancy comfortable, her labor safe and her puerperium uneventful,
and if she is to safeguard the health and life of the new-born infant, cannot proceed with
her work in a perfunctory way. This type of work requires tact, judgment, conscien-
tiousness, adaptability, perseverance and heart. It is no ordinary matter to instruct an
expectant mother in a practical way. For that reason a " pre-natal nurse " cannot super-
vise conscientiously more than 300 to 400 mothers annually. It is therefore no exag-
geration to say that, if the instruction and supervision of expectant mothers is to be
conducted by the Department of Health in a way which would be productive of results,
at least one pre-natal nurse should be assigned to each of the sixty Baby Health Sta-
tions in the Greater City. This number may appear large, and in a sense prohibitive,
but it must be remembered that the field of activity is large and that the need is urgent
and immediate. There appears little hope of affecting any great reduction in the infant
mortality rate of this City in the near future, unless concerted effort is made in the
direction of supervising expectant mothers. We have almost reached the limit in our
control of diarrhoeal, respiratory and contagious diseases in infancy. Some improve-
ment in the latter will undoubtedly be made, but not in amount sufficient to materially
influence the total infant mortality rate.
In addition to the instruction of expectant mothers by the limited special corps of
nurses, the regular Baby Health Station nurses offered similar instruction to these
mothers, as they visited the stations or as they found them in their homes. This work
was necessarily less intensive than that performed by the special corps of nurses, but
was not without effect. This supplementary pre-natal service has in recent years reached
the following number of expectant mothers :
Year
. 1914
1915
1916
1917
1918
1919
Number. . .
. 1968
1838
1620
2109
1634
4977
While in former years the pre-natal nurses only followed up the new-born babies
for a period of one month, this work was further extended during 1919 to the end that
new-born babies were supervised in so far as was possible with our migratory popula-
tion for the entire period of the first year, either directly or indirectly through the
agencies of the various Baby Health Station nurses.
As has been intimated, the inability of the bureau to conduct pre-natal work as
extensively as the indication demonstrated was offset in a measure by a stimulus which
our results gave other organizations to take up this work. In co-operation with the
Department of Health, the Maternity Center Association has zoned or districted the
Borough of Manhattan so as to keep within definite local or neighborhood confines the
pre-natal, obstetrical and post-natal activities of a given area, to reach a larger number
of mothers, to prevent overlapping and duplication of effort and to afford the public
the greatest amount of good with a minimum of inconvenience. This type of work
has been extended to other boroughs, and in the Borough of Brooklj'n several pre-natal
clinics were established during the year, and several hospitals established pre-natal clinics.
In the Borough of The Bronx, the New York Milk Committee and later the Red Cross
132
BUREAU OF CHILD HYGIENE
Chapter, co-operated with the Department of Health in furthering this phase of the
activity. Physicians, midwives, maternity institutions, nurse's settlements and child
welfare agencies have all shown an augmented interest and a greater effort at co-opera-
tion in the care of expectant mothers, and physicians have taken advantage of the nurses'
advice to the patients under their direction. Midwives have gladly submitted to the
Department the names of expectant mothers under their care for pre-natal advice. Ma-
ternity institutions have generously loaned themselves to the zoning idea and have actively
co-operated in the examination and admission of mothers and have referred infants
discharged from their service to the Baby Health Stations, while nurses's settlements
have referred cases ante and post-partum to an increasingly gratifying degree. Charity
organizations, philanthropic societie"- and individuals have become interested to the extent
of assigning to and paying for nurses in this field and of providing material relief in
the form of milk, maternity and baby outfits, foods, etc. The nurses have organized
sewing classes and cooking classes lor expectant mothers, which have proved not only
of material benefit, but have afforded them a certain amount of social intercourse and
relief from home duties so necessary for a proper and healthy mental attitude during
pregnancy.
Still-births reported by midwives, in which suspicion existed that congenital syphilis
was the cause, were visited by inspectors and nurses, and the mothers instructed with
a view to securing a living child in a future pregnancy. The well-known high infant
mortality rate from congenital diseases among the Negroes was attacked through the
co-operation of The Association for Improving the Condition of the Poor, a special
nurse being assigned by them in the Columbus Hill District to work exclusively among
these people. It has become apparent that the death rate from congenital diseases is
comparatively low among the Italians, Russians, Austro-Hungarians and relatively high
among the Americans and Negroes. It is not unlikely that the future will tend towards
a readjustment of this type of work, in that more attention will be given to native
Americans than has been done in the past.
Further extension of the supervision of expectant mothers lies in the direction of
compulsory notification of pregnancy, or, in the event of this being impossible, greater
co-operation from midwives and maternity institutions in voluntarily reporting cases
of expectant mothers registered with them ; in forwarding to each newly married couple
literature on the subject of the expectant mother; in providing measures, whereby each
and every expectant mother at the time of registration with the prospective attendant
at birth will be given educational literature on how to conduct herself during pregnancy,
so as to maintain and improve her life and well-being, and insure her own safety and
that of her new-born infant at the time of delivery.
In its efforts to control the high infant mortality rate from congenital diseases,
with the limited force at its command, and to place at the disposal of as many expectant
mothers as possible, concise and direct information relative to their care during preg-
nancy the bureau prepared during the year a pamphlet on pre-natal care. This pamphlet
called the attention of future mothers to the importance of maintaining good health
during the period of pregnancy and outlined fourteen points of advice and instruction.
Some sound advice was also given to the father of the coming child. Inasmuch as the
care of the child during the first month of life is intimately correlated to the pre-natal
period of its existence, an "afterword" was added in this pamphlet, in which some
twenty-one suggestions were offered as to the proper care of the child during this crucial
period of its existence.
Supervision of the Care and Feeding of Babies Under Tzvo Years of Age.
Despite the social unrest, the strained economic conditions of the day, the high
cost of living and other disturbing factors of the time, an infant mortality rate of
133
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
81.6 per thousand children born was reported for the Greater Citv during 1919, the
lowest infant mortality rate in the city's history, the nearest approach to this rate being
in 1917, when it was 89. A comparative table of births, infant deaths and infant mortality
rate for ihe last six-year period is as follows :
CITY OF NEW YORK.
DEATHS AND DEATH RATE— UNDER ONE YEAR— PER 1,000 BIRTHS REPORTED,
Year.
Total Births
Reported.
Deaths Under
One Year.
Death Rate
Per 1,000
Births Reported.
1914
140,647
141,256
137,644
141,564
138,042
130,377
13,312
13,866
12,818
12,568
12,657
10,639
95
1915
98
1916
93
1917
1918
89
92
1919
81.6
The infant mortality rate by boroughs for the past four years was as follows:
INFANT MORTALITY BY BOROUGHS— 1916, 1917, 1918, 1919.
Year.
Manhattan.
The Bronx.
Brooklyn.
Queens.
Richmond.
Total.
1916
1917
102 2
94 0
96.1
87.2
74 1
79.4
77.3
73 9
87.9
84.9
90.4
77.4
93.6
91.5
92.9
79.7
93 0
91 2
105 0
87.8
93.1
88.8
1918
91.7
1919
81 6
We find, therefore, for the City as a whole, there was a reduction of over ten
points per thousand children born in the infant mortality rate, this representing a
numerical decrease of 2,018 infant lives below that of 1918. A decrease in the birth
registration during 1919 of some 7,665 below that of 1918 was a natural anticipation of
the conditions surrounding the war.
The decrease in the City infant mortality rate was participated in l)y each and
every borough, the greatest decrease occurring in the Borough of Richmond and the
lowest in the Borough of The Bronx. The Borough of The Bronx, however, maintains,
as it has for many years past, the lowest infant mortality rate of all the boroughs, albeit
that the reduction in 1919 was less than in any of the other boroughs. The Borough of
The Bronx, with an estimated population of over 660,000, may be compared with some
of the ten larger cities in the United States, e. g., St. Louis, Cleveland and Boston.
From figures at hand, it appears that St. Louis will show the lowest infant mortality
rate of all the ten larger cities in the United States during 1919, recording a rate of
75.4, with a birth registration of 13,570, and 1,021 infant deaths. The Borough of The
Bronx during 1919 registered 14,788 births and 1,093 deaths, with an infant mortality
rate of 73.9, thus showing a lower infant mortality rate than St. Louis, with which it
may be reasonably compared. The Borough of The Bronx has shown this favorable
status of infant mortality for several years for the following probable reasons: (a) A
large Jewish population, among whom the mortality in all of the boroughs is com-
paratively low, and among whom breast-feeding is largely practiced; (b) a more mod-
134
BUREAU OF CHILD HYGIENE
ern type of tenement dwelling than in some of the larger boroughs; (c) a large nuin')-'r
of newly married couples, most of whom have had the advantages of more modern educa-
tion, in the schools and in the high schools, and have at some time or other participated
in the organization of the little mothers' leagues and health leagues of the bureau, in
which lessons on hygiene and sanitation and baby care have been part of the program ;
(d) less congestion and overcrowding than in the larger boroughs; (e) the personal and
individual care which most of the mothers give to their babies, instead of entrusting
them to the care of servants and neighbors; (f) the relatively fewer infant institutions
in the borough.
Reports at hand indicate that all of the ten of the larger cities in the United States
will report a substantial reduction in the infant mortality rate during 1919. It would
therefore have been surprising if New York City had lagged behind in this infant
mortality reduction, which seems to have been common to practically all of the larger
cities. In analyzing the cause for this record infant mortality rate for New York City
the following suggestions present themselves :
(a) The momentum of the educational propaganda instituted by the Bureau of
Child Hygiene, since its organization in 1908, is bearing fruit. This momentum is one
of enormous proportions and readily realized and appreciated by those engaged in child
welfare work. The education given the public is accumulative and carries over. Les-
sons taught to mothers for infants of former years are now applied to the newcomers.
The public has come to learn the lesson of " keep the well baby well." The mother
now knows what comm.unities have also learned, that it costs less to prevent illness than
to cure it.
(b) The public has been taught that healthy babies are an asset — unhealthy babies
a liability. Mothers now concentrate on the baby. He is usually the first considered
as regards diet, care, shelter, clothing and comfort. The money at hand is now first
.-^pent for the needs of the baby.
(c) The disproportion between food and living costs and wages which at first
showed a debit on the side of wages has progressively changed, so that in many cases
of unskilled labor the increased income more than counterbalances the increased cost of
living. There is much truth in the statement recently made " that jobs are overpaid
and positions are underpaid." Since the mass of workers are unskilled, the import of
this statement is readily appreciated. The general public are now eating food and wear-
ing clothes of the better kind, and living under as good, if not better, conditions than in
peace times. There are many and notable exceptions, of course, in this regard, but the
general truth of the statement holds, it seems.
(d) The nation-wide movement during war times and the early post-war period for
better babies and better children has seemed to work out as it did in England, where
in the second full year of the war, 1916, the infant mortality rate was 96, the lowest
in the history of the United Kingdom. There it was due not only to a realization on
the part of the general public that infant care was of prime importance, but to govern
mental grants of money for the protection of motherhood and infancy. Here, as a
result of an awakening of the public consciousness and as a result of the co-operation
of National, State and Municipal bodies, as well as of the co-operation of a large number
of private organizations and individuals, the latter resulting as aa outgrowth of the
war, an unusual amount of attention has been directed towards the supervision of infants
and children. The time has come when this civic consciousness has resulted in giving
the baby a square deal.
(e) The absence of any epidemic and the low incidence of the commoner children's
diseases has been a decided factor in this low infant mortality status. Epedimics, as
previously noted, not only cause havoc by attacking infants and young children, but
135
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
also, because of affecting the adult members of the family, rob these children of the
care and necessities of life which are theirs in normal times.
(f) It is not impossible or unlikely that the prohibition wave has had some
influence. With les's alcoholic indulgence on the part of the fathers, and, fortunately,
of the mothers, there arises not only more money for family needs and a general
improvement of home conditions in general, but a general improvement in family
moral tone, in better condition of health, greater family stability, and better earning
capacity. A beginning has only been made in this direction, and time will demonstrate
the blessings of prohibition, absolute or modified, in the health and general well-being
not only of the children but in the adult population.
(g) The general health of the entire population during 1919 has been better than
in many years, as may be seen from the following :
Total death rate, all causes, New York City, per 1,000 estimated population:
1910 16.00
1911 15.30
1912 14.41
1913 14.21
1914 14.03
1915 13.93
1916 13.89
1917 13.78
1918 16.71
1919 12.39
It is reiterated that with the better health of the heads of the family, comes better
economic conditions, more money, better care of the children, and therefore better
provision for their well-being.
(h) The increased interest of municipalities and private organizations and indi-
viduals in baby and child welfare has been mentioned. Throughout the period of
the war the possibility of the usual effects of combat and its aftermath, namely, a high
infant mortality and a decreased rate, has been constantly preached and has stimulated
a large number of agencies and individuals to lend their time, energy and money
towards the prevention of the errors of omission and commission made by other coun-
tries engaged in the war. The weight of this influence has been no small factor in
helping to effect a reduction in infant mortality.
(i) The school boys and school girls have been allies of considerable moment in
aiding child conservation. They have been responsible for bringing into the homes
lessons on child diet and child hygiene, which were particularly emphasized in the
school curriculum and through the Bureau of Child Hygiene representative during
the year. They have been educated to play their part in the general improvement
of family conditions and have learned many lessons which have been of incalculable
value to the families as a whole.
(j ) The education of the public by National, State and Municipal Food Conserva-
tion Committees and by many other committees of a semi-official or private nature in
the proper purchase, preparation, selection and care of foods for infants and children,
the relative value of these different foods, the adaptation of the same to meet racial
characteristics and tastes, the instruction of how to make the dollar bring the greatest
return, have all made an impresision for good upon the health of infants and children.
(k) At the onset of the war, when a large number of doctors and nurses responded
to the call to the colors, many expressed the fear that the dearth of professional talent
would react unfavorably upon the community health. Strange to say, the reverse
obtained and it was not altogether to be unexpected. This situation compelled many
136
BUREAU OF CHILD HYGIENE
individuals, the large body of so-called neurasthenics, who in normal times not infre-
quently neglect their children because they have no time to think of anyone but them-
selves, to draw upon their own resources, to become more self-reliant and to assume
responsibilities which are their own and which were formerly thrown upon the
shoulders of others.
(1) The social and industrial unrest and the uncertainty of the future has made
many families cautious in regard to spending money. There has been less gayety than
in former years, less social gatherings in hotels and restaurants, and consequently
more of the " stay at home " kind have been developed. Domesticity almost always
lends itself to betterment of home conditions.
(m) As a result of the increased income among the unskilled classes, many of
the laboring and middle classes have " gone to the country " during the summer and
have thus afforded their children that change of air and environment which is con-
ducive to an invigoration of mind and body, and with it to an increased vitality and
resistance to disease.
As regards the main group diseases which cause deaths of infants, it is very evident
that the favorable status of infant mortality in 1919 was due to the very noticeable
diminution in the morbidity incidence and the mortality from contagious and respiratory
diseases in infancy. While the infant mortality rate from contagious diseases was 4.3
for the Greater City in 1918, it was only 1.9 during 1919. Similarly, while the infant
mortality rate for respiratory diseases in infancy was 21.7 during 1918, 15.5 was the
rate recorded for 1919. The infant mortality rate from congenital diseases has remained
practically stationary as it has for a great many years past, the rate being 38.7 during
1918 and 37.2 during 1919. The infant deaths from diarrhoeal diseases was slightly
increased, the rate being 14.7 for 1918 as against 15.9 for 1919. All other diseases
showed an infant mortality rate of 12.3 in 1918 as against 11.2 for 1919.
Irrespective of any and all other considerations, however, the outstanding fact
remains, that an infant mortality rate of 81.6 for a city so large and so cosmopolitan
as New York, and for one which records an annual birth registration far in excess
of any other city in the United States, must be considered an accomplishment of no
small merit and a tribute to the conscientious work of the employees of the bureau.
For several years past the bureau has made a special effort to keep in check
or reduct the inordinately high infant mortality which exists among the Negroes,
a rate which in former years was 100 per cent, higher than among the whites. During
1919 there were 3,604 Negro births recorded, with 545 infant deaths, or an infant
mortality rate of 151 per thousand children born. This rate, while very high, is
nevertheless considerably lower than that of previous years, as will be seen from
the following tabulation :
CITY OF NEW YORK
INFANT DEATH RATE PER 1,000 BIRTHS.
iSt
Year.
City Rate.
Whites.
Negroes.
1915
98.2
96.2
202
1916
93.1
90.7
193
1917
88.8
87.1
168.9
1918
91.7
89.7
170.8
1919
81.6
79.6
151
137
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
An interesting feature in connection with the Negro infant mortality rate is, that
while the city birth registration shows a decrease of over 7,000, the birth of Negro
babies showed an increase during 1919, 3,604 births being recorded as against 3,272 for
1918; 2,990 for 1917; 2,530 for 1916; 2,614 for 1915.
Stillbirths.
The stillbirth situation, in so far as recorded cases are concerned, showed a more
favorable status than for several years past, as will be seen from the following
tabulation :
Stillbirths Reported— City of New York.
1915 6,413
1916 6,253
1917 6,117
1918 6,793
1919 5.984
The unusually large number of cases recorded during 1918 was due, of course,
to the wave of influenza, which, if it did not kill pregnant women by way of
pneumonia, sepsis or hemorrhage, not infrequently resulted in stillbirth.
The following tables will show in detail the status of the infant mortality situation
for the corresponding years 1918-1919 in the Greater City and in the individual
boroughs :
138
BUREAU OF CHILD HYGIENE
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141
AN^^UAL REPORT OF THE DEPARTMENT OF HEALTH
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142
BUREAU OF CHILD HYGIENE
The Baby Health Stations have been the predominating agency of the Bureau, for
the control of the morbidity and mortality of infancy and early childhood. In an
effort to reduce infant mortality, two essential basic principles have been kept in
mind: (a) the encouragement of maternal nursing; (b) efforts to secure the enroll-
ment of babies as soon after birth as possible.
(A) Etuouiagcinoit of Maternal Nursing.
Throughout the year a continuous and persistent compaign of education on the
value and importance of breast-feeding as a life-saving measure and as a means of
increasing bodily resistance against inroads of disease has been fostered. During 1919,
as in previous years, the majority of the infants enrolled at the Baby Health Stations
were breast-fed exclusively or in part, and mothers who, upon admission, were
inclined or desired to discontinue maternal nursing, or who had done so previously
inclined or desired to discontinue maternal nursing, or who had done so previously,
were instructed in all matters bearing upon hygiene, diet, personal and home clean-
liness, exercise and other related subjects, with a view to secure refunctioning breasts
and a continuance or renewal of breast-feeding. No child was permitted to be
artificially fed unless all measures for the maintenance of a supply of breast milk
had been tried and found wanting. Success of this policy is shown by the following:
City of New York.
Infants Admitted to Baby Health Stations.
Per Cent.
Per Cent.
Year.
Breast-fed
Breast-fed
Per Cent.
Exclusively.
and Bottle-fed.
Bottle-fed.
1913
54.85
19 60
25 55
1914
62.47
17.21
20 32
1915
59.
18.
23.
1916
68.
14.
18.
1917
68.3
13.2
18.5
1918
67.
17.
16.
1919
66.9
17.
16.
In analyzing the character of feeding at the various stations as well as for the
City and boroughs as a whole, it has been found that the highest percentage of babies
breast-fed exclusively takes place among the Jewish and Italian clientele. Not only
has an effort been made to increase maternal nursing at the Baby Health Stations, but
as a means of increasing the number of available wet nurses in the City, the inspectors
of the Bureau, when investigating the genuineness and cause of stillbirths reported
by midwives, made careful inquiry of the mothers' willingness and ability to wet-nurse
another baby, subject, of course, to all the necessary physical and blood examinations.
These cases were tiled at the department and a wet-nurse registry was gradually
established. It must be stated, however, that the number of women so registered
was comparatively few.
{B) Efforts to Secure P.nroUment of Babies as Soon After Birth as Possible.
The year 1919 lent corroboration to the statements of former years, as to the
urgent need of reaching infants as soon after birth as possible, if any appreciable
143
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
reduction in infant mortality is to be secured. The number of deaths under one
year of age for 1919, grouped according to months, will be seen from one of the tables
previously attached (Table No. 3). Out of a total of 10,639 infant deaths during the
year, the following deaths took place during the various months of the first years :
New York City.
Age.
Number of Deaths.
Percentage of
Deaths During
the First Year.
Under 1 month
4,.537
821
756
1,906
1,443
1,176
42 7
1 to 2 months
7 7
2 to 3 months
7 1
3 to 6 months
17 9
6 to 9 months
13 6
9 to 12 months
11 0
In other words, over 40% of all deaths during the first year of life takes place
during the first month of life, and over 50% during the first three month of life.
To reduce infant mortality, therefore, to any great degree, it becomes necessary to
reach the infant early — the sooner the better. The high percentage of infant deaths
during the first month of life is intimately correlated to the supervision of the ex-
pectant mother, in that approximately 75% of deaths during the first month are due
to congenital diseases. It is perfectly natural, therefore, that the Bureau should seek
the enrollment of babies at the stations, as soon after birth as possible, and its
campaign of pre-natal care and the co-operation of private agencies has resulted in
an increased enrollment at the Baby Health Stations of infants under one month
of age— from 2%, in 1914, to over 12%, in 1919, as follows :
City of Nev^^ York.
Age of Infants Admitted to Baby Health Stations — Arranged by Percentage.
Age
1915.
1916.
1917.
1918.
1919.
Under 1 month
11.66
22.62
20.91
25.26
11.98
7.57
13.50
21.10
17.20
22.00
14.20
12.00
11.75
25.63
18.28
22.49
12.20
9.65
11.
26.
18.
23.
13.
9.
12 3
1 to 2 months
26 3
2 to 3 months
18 1
3 to 6 months
22
6 to 9 months
12 3
9 to 12 months
8 9
While the number of babies under one month of age enrolled at the Baby Health
Stations increased somewhat during 1919, it is evident that additional effort must
be made for the enrollment of a larger number of babies directly after birth. This
is a phase of the work which merits the attention of all those interested in the control
of infant mortality.
The popularity of the Baby Health Station service in the public eye is attested
by the large enrollment from year to year, as follows :
144
BUREAU OF CHILD HYGIENE
City of New York.
Year.
1911
1912
1913
1914
1915
1916
1917
1918
1919
Number of
Stations.
15
55
56
56
59
59
59
59
60
Number of
Children Under
I Year of Age
AttendingStations
During Year.
5,006
21,316
26,350
27,165
37,197
39,646
41,496
41,691
39,304
Number of
Children
1 to 2 Years of Age
AttendingStations
During Year.
2,146
9,136
11,293
11,643
8,865
8,656
5,569
4,491
6,571
Number of
Children Under
2 Years of Age
AttendingStations
During Year.
7,152
30,452
37,643
38,808
46,062
48,302
47,165
46,182
45,875
The influence of the Baby Health Stations has shown itself in the improved
general condition of the children on admission, greater personal and home hygiene
and cleanliness, relatively fewer cases of mal-nutrition and disorders of digestion,
a better and more intelligent response of parents to instruction and advice, and in-
creased confidence in the nurse as a friendly visitor, a better knowledge on how to
give "first aid" in illness, and an improved regularity in attendance. The increasing
enrollment of a large number of babies from districts beyond the station confines,
and of those who purchase their milk from other sources, bears testimony to the fact
that the public have come to look upon the stations as educational centers or pre-
ventoria, rather than as milk depots. The patrons have realized more that ever that
it is better and easier to look after the baby when well, and to keep it well, than
to cure it after it is sick.
In some stations the enrollment has been exceptionally large, too large in fact to
afTord proper care and supervision. Baby Health Stations with an enrollment of from
500 to 700 babies, found it difficult to give each and every child the individual atten-
tion that is necessary. It has, therefore, been found advisable to modify the control
of the station attendance, so as to produce the best result for the largest number, in
that, instead of insisting upon regular attendance for all babies at least once a week,
arrangements have been perfected so that they attend either bi-weekly, weekly, every
two or three weeks, according as they are, very young, sick, weak, or delicate, breast-
fed or artificially fed, or entirely well. A definite working schedule was formulated
and cases were considered as active or inactive within their own group. By this
means, baby health stations with an extremely large enrollment, have reduced the
daily attendance of babies to within reasonable limitations, and the babies that needed
attention most were given special consideration. Provision was also made to keep
a watchful eye on babies that were sick, weak, delicate or suffering from mal-nutri-
tion, and these cases were noted on the history card as "S" (sick) or " — " (minus)
babies. In former years babies of this type, whose mothers refused to bring them
regularly to the station without sufficient reason or warrant, were dropped from
the rolls after every effort was made to keep them in regular attendance. At the
present time this class of babies, whether enrolled at the station, or, when found on
home visits, are kept under observation and followed up at home, where all necessary
instruction and advice are given. In ofher words, a large number of frail babies,
who formerly were not brought to the station, and who, therefore, failed to receive
proper care, have been supervised. This is in line with the principle, that if Mahomet
145
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
won't come to the mountain, the mountain must go to Mahomet. This, it seems,
is a definite step forward in infant mortahty control, and the sins or the ignorance
of the parents are not permitted to react upon the infants. While it is appreciated
that with a large number of this class of infants under supervision at the stations,
the number of station infants deaths will increase, nevertheless, it is felt that a certain
number of these babies would otherwise have died, and in this wise the general city
infant morbidity and mortality were improved.
This policy was the outgrowth of years of experience in district or home visiting
by nurses, during the summer months, where it was found that of the mothers and
babies referred by them at the close of the summer, to the various baby health
stations, only 3 to 6 per cent, took advantage of this opportunity and enrolled the
babies at the stations.
That the public have come to look upon the Baby Health Stations as prophylactic
centres or places designed for the purpose of keeping well babies well, was exemplified
by the fact that during 1919, only 4.6 per cent, of all the babies enrolled were found
to be suffering at the time of admission with gastro-enteritis, and only 12.1 per cent,
of the children enrolled were found to be suffering from mal-nutrition.
Milk Dispensed at Baby Health Stations — Although the milk dispensed at the
Baby Health Stations is considered, as aforenoted, the lesser part of the stations'
usefulness and influence, the amount sold is necessarily large since it is dispensed
not only to babies who must be artificially fed, but to nursing mothers, expectant
mothers, older children suffering from mal-nutrition or other disorders, cases of pul-
monary tuberculosis, convalescents from influenza or other general diseases, school
children in the open-air classes, in fact, to anyone who presents certification from a
duly accredited physician, or allied child-caring or social agency, to the effect, that
in their opinion, the person making application is in need of milk and unable to pay
the prevailing market price.
During 1919, 5,612,132 quarts of milk were sold as against 5,815,425 quarts in
1918, and 5,982,412 in 1917. There is a diminution therefore in the amount of milk
sold at the Baby Health Stations for 1919. This diminution is seen in all of the
boroughs, with the exception of The Bronx and Richmond, the increase in The Bronx
being due to, in all likelihood, the opening of an additional station ; the increase in
Richmond being due to a far better service of the milk company than in recent years.
This situation is shown in the following tabulation :
Milk Sold {Quarts) at Baby Health Stations.
Year Manhattan The Bronx Brooklyn Queens Richmond Total
1918 2,762,213 157.265 2,740,247 102,307 53,393 5,815,425
1919 2,653,465 189,870 2.612,284 101,209 55.304 5,612.132
r i
It would seem at first glance as if the advance in the price of milk during the
year as against former years would have caused a decided decrease in the amount
of milk sold. The fact of the matter is, however, that as compared with the latter
part of 1918, the price of milk as sold at the Baby Health Stations was practically the
same, as follows :
Selling Price of Milk at Baby Health Stations.
1918— 1919—
January to October. . . 12-13i^:^c. per qt. January to April 15c. per qt.
October to December. 15-16 c. per 9^- April to July 14c. per qt.
July to November 15c. per qt.
November 23 to Decem-
ber 31 16c. per qt.
146
BUREAU OF CHILD HYGIENE
The diminution in the amount of milk dispensed at the Baby Health Stations
during 1919, as against 1918, to the extent of over 200,000 quarts, is not accounted for
altogether by the high price of milk. In the first place it must be remembered that in
the early part of the year, when there was a controversy going on between the produc-
ers and distributors — the so-called milk strike — there were weeks when the amount of
milk delivered to the baby health stations was considerably below that of its normal
output. At one considerable period, only 47 per cent, of the normal delivery was
made to the stations. Furthermore, it must be remembered that the registration at
the Baby Health Stations during 1919 was slightly below that of 1918, and while this
number approximates only 300, nevertheless, several hundred quarts a day for a
year is quite an item.
In fact, the increase in the price of milk at the Baby Health Stations, which has
of course, kept pace with the increase in price in the open market, and which prac-
tically doubled itself at the stations, as it has in the open market, from 8 cents per
quart in October, 1916, to 16 cents per quart at the end of the year, has not in itself
diminished the sale of milk at these stations. It seems as if the maintenance of the
large sales at the stations may be accounted for as follows :
(1) The public have become educated to the fact that milk is not only an essential,
vital and indispensable food for infants and growing children, but, even at the ad-
vanced price, is the most economical of foods, in that, ounce for ounce, at the price,
it offers the largest amount of nourishment, health and vitality. The public have
come to purchase milk in many cases to the exclusion of other less essential and
less nourishing foods, particularly for infant and child consumption.
(2) The public have learned the economy of paying more for a safe, clean, pure
milk, and have found that paying more for milk is cheaper than paying for illness
or funerals.
(3) No matter what the market price of the grade of milk dispensed at the
stations has been — Grade "A" pasteurized, bottled — the differential between the
station and the open market price has always been at least 3 cents less ; in fact, during
one period of the year, the differential was 4 cents per quart, and for a short time,
5 cents per quart, the latter being the largest differential since the organization of
the baby health stations. With from three to five cents saved to the public on each
quart, the economic advantages accruing to the poorer element of the community,
on the basis of almost six million quarts annually, is readily appreciated, and demon-
strates how, when the market price goes beyond a certain limit, a large number of
mothers who otherwise would purchase milk from delivery w^agons, dairies, stores,
etc., wend their way to the Baby Health Stations.
(4) Lowering the bars of the sale at the Baby Health Stations to those who in
normal times could well afford to pay the market price, but to whom in these
abnormal days, the prevailing market price worked a hardship.
Such falling off in the sale of milk at the Baby Health Stations as took place
during 1919 did not appear due to any decreased consumption by the infants and
young children. It has been previously noted, that milk is sold at these centres not
only for infants and young children, but to older children and adults, under certain
circumstances. It is well known that under natural conditions, milk at the baby
health stations sells at a price within the means of these adults, that is to say from
10 to 12 cents per quart, or perhaps, 13 cents per quart, and that they purchase this
milk at the baby health stations because of the desire to secure the best type of milk
within their means, and secondly, because of the saving as against the market price,
which, with the aforementioned station price, would usually be approximately 13 cents
to 16 cents per quart, or perhaps a little more. In other words, 13 cents per quart,
for the station type of milk, is about the limit of burden which these people can
147
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
carry. With the price of milk during this year at the stations, ranging from 14 to
16 cents per quart, and the market price ranging from 18 to 20 cents per quart, for
the same type of milk, it is very probable that many of these adults and older
children at least, have sought the open market for their milk supply and have pur-
chased for their consumption Grade "B," loose milk, which sold during the year in
the stores from 11 to 13 cents per quart — a price more commensurate with their
income. It may be that the aforementioned circumstance took place in the feeding
of a certain amount of infants and young children, and that the slight increase in
infant mortality from diarrhoeal diseases during 1919, the rate being 15.9 per
thousand children born, as against 14.7 per thousand children born in 1918, may be
accounted for by this fact.
The increased price of milk has an interesting psychological side to it, in the
sense that while the public clamors loudly at an increase of 100 per cent, in the cost
of so vital a necessity, it seems to take as a matter of course, an increase of 100 to
200 per cent, or more, in the price of less essential foods, wearing apparel, luxuries,
etc. One thing is certain, milk is the infant's and poor man's food and nothing should
be left undone to place at their disposal a full supply at the lowest possible price,
consistent with genuine economic conditions. There seems to be a hitch, a kink,
somewhere between the producer's price and amount the consumer is called upon to
pay, and until some definite, reliable and fair legislation is enacted to provide for a
liberal supply of milk to all at a reasonable price, the public will continue to pay.
In order to safeguard the quality of milk dispensed to the babies at the stations,
every effort has been made by the bureau, acting in co-operation with the Bureau of
Food and Drugs, to supervise its transportation and delivery to the end that the
temperature of the milk was kept at or below 50 deg. F. from the time of delivery
until it reached the home of the mother, and, that the bacterial count was not higher
than that provided for in the rules and regulations governing the sale and distribu-
tion for this grade of milk, namely, 30,000 bacteria per c. c. To this end, periodic
bacterial counts of samples have been made by the Bureau of Food and Drugs, and
this bureau informed of the situation. Also, the milk was so supervised that it was
well iced up to the time of delivery, and the companies delivering ice at the stations
supervised to the extent that the necessary amount of ice was delivered for the
refrigerators at each station. The temperature of the milk delivered was taken early
every morning, by the nurse's assistant, and, any unusual rise in temperature was
made the subject of special investigation. Rules of procedure governing the care
of the milk at Baby Health Stations and the home, for nurses and nurses' assistants,
were forwarded to each station.
While Grade "A" bottled milk has been the only type of milk dispensed at the
stations since their organization (except of course, under the unusual circumstances
of strike or difficulty in transportation, when for several days at a time Grade " B "
milk would be delivered), there was so much public clamoring to the effect that
families found it difficult to provide the necessary amount of milk at the prevaiHng
market price, that the Department decided to try the experiment of offering for sale,
at several of the baby health stations, in the afternoons. Grade " B " bottled milk at
15 cents per quart, the same selling in the open market at 18c. per quart, at the time.
The object of this sale was an effort to assist the tenement population to reduce the
cost of living, and to place at their disposal on the cash and carry basis, a good
quality of milk, below the prevailing price. This experiment which was begun in the
latter part of 1919, at nine stations in the Borough of Manhattan, seemed to offer
some promise, so that within a comparatively short tim the sale was extended to
other stations in the Borough of Manhattan, and to stations of other boroughs. The
sale of this milk was eventually conducted at all the stations of the Greater City, with
148
BUREAU OF CHILD HYGIENE
three exceptions, the latter being due to conditions over which the Department had
no control.
This sale was conducted in the afternoon, after the regular baby health service was
completed, and special care was exercised of course, to see that the infants and young
children continued to receive Grade "A" bottled, pasteurized milk, the type which
is recommended for infant feeding.
As the result of publicity given by the department, to the relation of a plentiful
supply of clean, wholesome milk to the nutrition of infants and growing children, and,
to the existence of mal-nutrition on a comparatively large scale, among children of
the City, a number of private citizens and commercial concerns, forwarded sums of
money to the Department with the request that the same be used in furnishing milk
'free of cost to the children of those families, which the Department found sorely in
need of this food.
In the early part of the year when the amount of available milk was low, a large
number of communications were received by the bureau from the public, stating that
the milk dealers failed to supply them with the necessary amount of milk for their
infants and children. These cases were referred to the Bureau of Food and Drugs,
and, in each instance, an acknowledgment of the letter was made directly to the
writer, and a letter was forwarded to the milk concern specified, requesting that they
make every effort to supply milk to the complainant. The bureau has held fast to
its policy of dispensing milk in quart bottles, rather than in the form of prepared
individual feedings. Formulae were regulated by the doctor-in-charge, to fit the in-
dividual child. Practical demonstrations of the prescribed formulae were given with
special care, by the nurses at the stations, and in the home, and repeated until the
nurse was convinced that the mother understood. No hard and set rules were outlined
for the physicians in the artificial feeding of infants, except that two fundamental
principles were insisted upon in their method of feeding; (1) to encourage, urge, and
secure breast-feeding whenever possible; (2) to fit the formula to the individual
needs of the child, as regards age, weight, development, digestive capacity, tolerance.
For the most part simple dilutions of whole milk with the additoin of the various
sugars were used. In difficult feeding cases, various food modifications and propor-
tions were tried. Cases of mal-nutrition and marasmus, were given particular atten-
tion at the stations and in the homes, and effort was made in selected cases to have
a neighbor nurse the baby or furnish expressed breast milk.
Unfortunately, the infant mortality rate is the only numerical valuation at present
available, to show the the influence of the Baby Health Stations' service, and other edu-
cational propaganda of the bureau, although it is admitted on all sides that their effect
on infant and child mortality is far greater, but alas not ascertainable. A true index
of infant mortality control, is the reflection which this type of work has upon the
mortality of later childhood — from 2 to 5 years, and under 5 years of age. That this
situation was favorable for the year 1919, may be seen from the following tabulation ;
CITY OF NEW YORK.
MORTALITY RATES— 2 TO 5 YEARS AND UNDER 5 YEARS OF AGE.
DEATH RATE PER THOUSAND ESTIMATED POPULATION.
Year. 2 to 5 Years. Under 5 Years
1917 7.80 30.0
1918 11.1 23.7
1919 6 9 24.7
149
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
It is therefore seen that the efforts of the bureau in the control of infancy and
early childhood, during 1919, resulted in an infant mortality rate, and a mortality rate
between 2 and 5 years, and under 5 years of age, which were the lowest ever recorded
in the history of the city.
It has been customary in speaking of the infant mortality rate of the City of
New York, to compare it with the other large cities of the United States. During
1917-1918, this rate for New York City compared most favorably with the other
nine largest cities in the United States, in that for 1917 it was the lowest of the ten
largest cities, St. Louis being first, and in 1918 it was the lowest of any of the ten
largest cities in this country. During 1919, a similar situation obtained, and we find
that New York City with an infant mortality of 81.6 shows the lowest rate of any
of the ten largest cities in the country, with the exception of St. Louis, which recorded
a rate of 75.2.
Below will be found two tables, one showing the infant mortality rates of the
ten largest cities in the United States, for the year 1917-1918 ; the second showing
the number of births, deaths and the infant death rate for the ten largest cities of
the United States during 1919:
INFANT MORTALITY RATES FOR THE TEN LARGEST CITIES IN THE UNITED
STATES BASED ON 1,000 BIRTHS REPORTED
1917.
1918.
New York City
St. Louis
Cleveland
Detroit
Boston
Buffalo
Pittsburgh
Philadelphia. . .
Chicago
Baltimore
88.8
91.7
79.6
94.4
100 0
97.74
103 4
107.0
99.6
114.8
103.66
121.5
111.0
122.5
111.0
123.9
106.3
131.3
119.26
147.7
INFANT DEATH RATES OF THE TEN LARGEST CITIES IN THE UNITED
STATES, 1919.
New York City
St. Louis
Cleveland
Detroit
Boston
Buffalo
Pittsburgh
Philadelphia . . .
Chicago*
Baltimore
Births.
130,377
13,570
19,200
25,377
18,735
12,708
14,307
42,046
63,359
17,631
Deaths.
10,639
1,021
1,743
2,460
1,814
1,396
1,656
3,778
5,766
1,711
Infant
Death Rate.
81.6
75.2
90.8
96.8
96.8
109.8
115.3
89.8
91.0*
97.0
•Estimated only. Not willing to give out number of births, as they cannot enforce registra-
tioa, on account of lack of funds.
150
BUREAU OF CHILD HYGIENE
As stated, it has been customary to compdre New York City with the other
nine largest cities of the United States, and yet, a glance at table No. 2, will show
that the comparison is hardly fair. New York City is practically in a class by itself,
as far as birth registration is concerned. The number of births recorded for New
York City during 1919, namely, 130,377, equals practically the sum total of births
recorded in Philadelphia, Chicago and Detroit, namely 130,782. The comparison fur-
thermore, hardly seems fair when one considers that the combined population of
Chicago, Philadelphia, Detroit, and St. Louis, based on the estimated population of
1918, is about the same as that of New York City alone. If comparisons are to be
made at all, it might be reasonable to classify the Borough of The Bronx with St.
Louis, and the Borough of Brooklyn with Chicago. On this basis, we find that the
Borough of Brooklyn, with an estimated population of about the same as Chicago,
shows an infant mortality rate for 1919 of 77.4, as against 91 for Chicago; and the
Borough of The Bronx, an infant mortality rate for 1919 of 73.9, as against 75.2 for
St. Louis.
It is true that the reduction in some of the other larger cities of the United States
during 1919 has been greater than that of New York City. It must be remembered,
however, that during this year the conditions which prevailed in New York City
were far more unusual than those in any of the ten largest cities in the United
States, in that New York City was the clearing house for all conditions, which
might have affected adversely the infant mortality rate — commercial, industrial,
economical and military — and that this together with the large floating population in
New York City during the war increased the attendant dangers of those factors
which make for a rise in infant mortality. From whichever standpoint, therefore,
we view the infant mortality situation in New York City during 1919, it must be ad-
mitted that the results both for the city as a whole and for the individual boroughs
was most gratifying.
Studies — Surveys — Exhibits.
In order to co-operate in the reduction of the diphtheria incidence among infants
and young children, the Baby Health Station service assisted in performing Schick
tests to determine the susceptibles and administered toxin-antitoxin injections, to
the limit of their capacity. This work was performed at the various stations, par-
ticularly in the Boroughs of Manhattan and Brooklyn, by the field force of the bureau,
in co-operation with representatives of the Bureau of Laboratories. Literature was
distributed, talks were given by inspectors and nurses, parents were urged to have
the children tested and injected, homes were visited, cases were secured, and a gen-
eral educational drive, as to the effects of toxin-antitoxin as a preventive of diphtheria,
was made. An endeavor was made to educate the public as to the harmlessness
of the tests and to the great benefits which could be derived from the immunization,
as a preventive measure against diphtheria, which shows its greatest incidence and
mortality among children from 1 to 5 years of age.
While the number of injections and tests performed at the stations was not very
large, the way was paved for a greater popularization of this procedure, which, it is
expected will be taken up to a greater degree during 1920.
During 1918 this work was begun and extended in the Borough of Manhattan.
During 1919, greater emphasis was given to this procedure in the Borough of Brook-
lyn. All in all. almost 1,500 children were " Schicked," and some 1,400 immunized.
More intensive surveys of Baby Health Station districts, with a view to securing
the best available and most economical sites and quarters for the stations, were made,
and special investigations were directed in this regard, to the locality factors of infant
mortality, child population, prevailing nationality, intelligence of parents, housing,
151
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
existence of child-caring agencies, as well as other city-owned or rented places in
the district.
Education exhibits at the stations included panels on pre-natal care, colored
panels on motherhood, panels on child-care, placards on clean milk, and a large
number of educational placards, posters, leaflets and circulars, furnished by the Bureau
of Public Health Education, as well as food bulletins and exhibits, and, literature on
milk and other foods, employment, Americanization, etc. Not only were these exhibits
placed within the stations, but the windows of the stations were used for advertising
purposes, so to say, so that those "who ran by the stations, may read."
During 1919, there was a slight increase in the infant mortality rate from
diarrhoeal diseases, the rate for 1919 being 15.9, and for 1918 14.7. Compared, how-
ever, with former years, the rate for 1919 is most gratifying, the rates for more
recent years being as follows :
Infant Mortality Rates, Diarrhoeal Diseases, City of New York.
Year
Rate
1917 19.1
1916 17.7
1915 22.5
1914 21 .0
1913 22. 5
1912 25.0
This increase during 1919 led the bureau to make a survey in order to determine
the relation between the character of the feeding and infant deaths from diarrhoeal
diseases. It has been the observation of the bureau for a great many years, that
infants breast-bed exclusively were less likely to succumb to diarrhoeal diseases than
those artificially fed, and the result of the study corroborated this long observation.
All in all, the history of 1.065 infants, who died during the months of May, June,
July and August, 1919, in which reliable information could be secured as to the
character of the feeding before death, were studied and tabulated, with the follow-
ing results :
Character of Feeding.
No. of
Cases
Percentage
of Deaths.
178
154
67
11
286
221
10
22
25
91
16.7
Breast and bottle
14.4
6.3
10
Bottle only
26.9
Bottle and other .
20.7
Bottle and loose . .
1.0
Jjoose
2.1
2.4
Other .
8.5
In order to determine the possible relationship between the increasing prices of
milk during the year, and the health and nutrition of infants and children, as regards
the quantity and quality of milk used, the substitution of less desirable articles of
152
BUREAU OF CHILD HYGIENE
food for feeding, the ability of parents to purchase milk at the advanced prices, and
the classes and nationalities most aflfected, two surveys were made.
The first survey was conducted by the nurses attached to the Bureaus of Child
Hygiene and Preventable Diseases; areas representative of congested districts in the
City were chosen in each borough. The results of the first survey follow :
The first survey was ordered by the Commissioner of Health, Dr. Royal S. Cope-
land, to aid the Special Committee on the Price of Milk, appointed by Governor
Smith, inl procuring first hand and up-to-date facts as to the quantity and quality of
milk used in the city, its increase in price, the substitution of other articles of food
for it in the feeding of young children, the ability of parents to purchase milk at the
advanced prices, the classes of the community most affected, and above all the effects
of the deprivation of necessary food upon' the health of the children of the city.
.The survey was based on an investigation made by the public health nurses attached
to the Bureaus of Child Hygiene and Preventable Diseases, and areas, representative
of the congested district of the city, were chosen in each borough that would reflect
the actual conditions affecting the various phases of the problem.
The nurses engaged in this work were instructed to visit individually each family
in the area assigned to them, to interview the mother of the family, and to note the
physical condition of the children.
There were 11,007 families visited and reported on, divided as follows:
Borough of Manhattan 4,600
Borough of The Bronx 2,056
Borough of Brooklyn 3,395
Borough of Queens 467
Borough of Richmond 489
Total families visited 11 ,007
All children l>etween the ages of one and seven years were examined, their physical
condition and the nativity of the mother entered on the blank form prepared- for that
purpose. In addition to this the following items called for on the blank forms were
gathered and tabulated as shown in the accompanying tables ; number of cups of milk
used, number of cups of coffee, tea. and cocoa entering into the diet ; lessened quantity
of whole milk used, expressed in quarts ; increased quantity of condensed milk used,
expressed in cans; number of families in which children were deprived of milk by
reason of increased cost of same ; number of children suffering from deprivation of
milk ; effect of lessened use of milk upon the physical condition of the children, as
shown in number of children suffering from malnutrition, anaemia, underweight, and
other physical defects ; quantity and nature of substitutes used, and increased price of
milk, arranged by grades, in September, 1919, as compared with September, 1916, from
which latter date the price of milk advanced.
The number of children in the 11,007 families visited was 19,037, arranged accord-
ing to age groups as follows :
1-2 years 3.052
2-3 years 3,647
3-4 years 3,579
4-5 years 3,556
5-7 years 5.203
The fewer number of children at one year of age, as compared with the succeeding
ages, is entirely at variance with the normal experience as shown in census enumera-
tions, and previous tabulations, and is contrary to calculations, estimates, etc.. made
in previous years. This decreased number of children of one year of age is explainable
by the decreased birth rate of the years 1917 and 1918, as a result of the entrance of this
153
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
country into the war — the decreased marriage rate of 1917 affecting the birth rate of
1918. This reduction in the number of children under one year of age, as compared
with those two years of age, was found to have occurred in all the boroughs of the
city, with the exception of the Borough of The Bronx.
There were 40,573 cups of milk used daily by 19,037 children, or two cups and one
ounce of milk for each child daily, an amount totally inadequate at each of the
individual ages, but markedly so at the ages of one and two years ; milk is the blood
of children at these ages, and whosoever deprives them of this sustenance for financial
or other reasons should feel the full hand of the law, if such can be placed upon
him, and, if not, the execration of his fellow men.
We find that children of American mothers received daily two cups and three
ounces of milk; of Italian mothers one cup and six ounces; of Russian mothers, two
cups and four ounces; of Austro-Hungarian mothers, two cups and three ounces; of
German and Irish mothers, two cups and six ounces.
Viewed from the point of individual boroughs, the amount of milk per capita
was approximately the same.
The number of cups of coffee, given daily to the children in the 11,007 families,
was 12,439; and of tea, 7,438 cups. It is evident that approximately two cups of tea
or coflfee are given, on the average, to each child. When it is understood that coflfee and
tea are stimulants, without any appreciable value as nutriments, it is realized
that both should be tabooed in child life, and the conclusion is irresistible that mal-
nutrition and all the evils attendant thereto must prevail among children fed on such
material.
The tables show that in 10,793 families substitutes in the form of tea, coflfee,
cocoa, cereals, and other drinks were used, that is to say, in over 98 per cent, of the
homes investigated, this dangerous practice was in vogue. Some mothers through
ignorance of food values, adopt this baneful practice, and many mothers who know
better are compelled by reason of the high cost of milk to seek these deleterious
substitutes.
In 7,219 instances, less milk was bought, according to statements of the mother;
more condensed milk was used in 1.017 families. Mothers, to the number of 5,775,
claimed that children were deprived of milk by reason of high cost of the same, and
4,053 children were found to be using less milk.
The examination by the nurses showed the following prevalence of nutritional
disorders among the children. This is the most interesting and important disclosure of
of the survey. There were 1.294 children found suffering from definite malnu-
trition; 993 children from anaemia; 785 children were found to be under normal weight;
608 children suffered from other disorders ; and 3,648 were found to be undernourished.
In 1916 there were brought daily 1,028 quarts of Grade "A" milk, bottled, at an
average price of 13 cents, while in 1919 there were only 515 quarts bought daily at
a price of 18.6 cents per quart — that is, the amount of this grade of milk purchased
decreased fifty per cent,, the price increasing 43 per cent.
Grade "A" loose, bought in rare instances, was sold in 1916 at 9 cents and in 1919
at 18 cents, an increase of 100 per cent., the amount used decreasing only slightly.
Grade "B." bottled, was paid for in 1916 at a price of 10.8 cents, the amount in daily
use being 1,100 quarts, as compared with a price of 16.5 cents and a daily amount of
801 quarts, the increase of price being 50 per cent, and the decrease in amount 27 per
cent. Grade "B" loose could be had, in 1916. at 8.9 cents per quart, at which price
2,045 quarts were bought daily, as compared with a price of 12.3 cents and an amount
of 2,534 quarts daily, an increase in price of 38 per cent., and an increase in daily
amount of 24 per cent. The price of condensed milk rose from 10.4 cents, in 1916, to
18.5 cents, in 1919, an increase of 78 per cent., the amount used (relatively small),
doubling in 1919.
154
BUREAU OF CHILD HYGIENE
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
The second survey was somewhat along similar lines to the first, except that it
embraced a younger age group, namely, children under six years of age, and entered
into the apparent social and economic condition of the family as well as the degree
of nutrition and other factors; a copy of the form used in this survey is hereto
affixed.
General Co-operation in the Work.
Conditions following the war, and the unstable economic conditions, resulted in a
more interested co-operation from many sources, all of which resulted in bringing
much comfort and material relief to many needy and deserving families. This co-
operation included, among the many, the Mayor's Committee of Women on National
Defense, allied city departments, the Mayor's Ice Committee, the Women's Auxiliary
of the Baby Health Stations, charitable, philanthropic and social service agencies,
hospitals, St. John's Guild, Salvation Army, Red Cross, Young Women's Christian
Association, Christ Child's Society, After-Care Circle, the Wholesale Ice Company,
Herald Ice Fund, newspapers in English and foreign languages. Babies' Welfare
Association, Teachers' College, Pratt Institute, New York Child Welfare Committee,
maternity centres. Red Stocking Committee of Brooklyn, Social Service Exchange,
neighborhood associations. Elks, guilds, theatres, etc.
As the result of the establishment by the Mayor of a large number of ice dis-
tributing stations in the various boroughs, many needy families were enabled to
secure ice free of cost. This co-operation, in addition to the usual amount of ice
distributed by the Wholesale Ice Company, and the Herald Ice Fund, through the
Babies' Welfare Association, did much to assist in the control of infant life. The
free excursions during the summer, organized by the Mayor's Committee of Women
on National Defense, provided for daily excursions for a long time for mothers and
babies of the poor.
The Clover Farms Company, the milk distributing concern for the Baby Health
Stations, co-operated in several ways, particularly by their willingness to make official
certain rules and regulations suggested by the Bureau, whereby the dispensers of milk
at the stations would sell the milk with a minimum amount of confusion and mis-
understanding, and whereby the drivers would exercise greater care in the delivery
of milk, and in placing the same in refrigerators at the stations. These rules and
regulations were printed by the Clover Farms Company and posted in the various
stations of the Greater City.
In endeavoring to popularize the use of milk as a food for infants and children
and to increase its family consumption, the Bureau co-operated with the Children's
Milk Week Committee. This Milk Week was celebrated from April 21 to April
27, 1919, at the 71st Regiment Armory, and the Bureau took advantage of this
opportunity to emphasize the nee-d and importance of proper nutrition and other care
in infancy and early childhood. W^ith this object in view, a baby and child contest
was conducted in all of the boroughs of the Greater City. Eighty-five centres, com-
prising all the Baby Health Stations of the department and many Baby Health Stations
of allied child-caring agencies were included in this contest. Unlike other contests,
this was not a mere baby show, but included children of pre-school age. Special
score cards were prepared, one for children under two years of age, and one for
children from two to six years of age, and physical examinations were made of the
better babies at each of these centers, in order to establish the best at each one of
these centres. The primary examinations were conducted by the medical inspectors
of the Bureau; the various boroughs were zoned into districts, and as a result of a
process of elimination, the best district and borough baby, and the best district and
borough pre-school age child, and finally the best city baby and the best city pre-
school age child were decided upon. The final determination of the best borough
156
BUREAU OF CHILD HYGIENE
and city baby and pre-school age children, was made by a special advisory committee,
consisting of prominent pediatricians of the Greater City. Provision was made for
the distribution of money prizes and medals. The best city baby and the best city
pre-school age child, received the Mayor's gold medal, a letter of congratulation from
the Commissioner of Health, and a fifty-dollar victory bond. East best borough
baby and best borough pre-school age child was given a silver medal, a twenty-dollar
gold piece and a letter of congratulation, signed by the Commissioner of Health,
and each of the twenty best district babies and best pre-school age children, was
given a five-dollar gold piece, a silver medal and a letter signed by the Commissioner,
and finally, each of the best Baby Health Station babies and pre-school age children
was given a medal and a letter signed by the Commissioner of Health. The bureau
had a large booth at the exhibit, at which babies and children were weighed and
given small tags, on one side of which was noted the weight and height of the baby
or child, together with the normal weight and height for its age ; and on the reverse
side there was a statement emphasizing the value of milk as a food. Nurses and
doctors were in attendance daily. The exhibit contained a large number of photo-
graphs, pictures and a large amount of educational literature was distributed.
The distribution of prizes to the city, borough and district winners took place at
the exhibit on different days of the week, and each day was known as the respective
borough day. The presentation of the medals, bonds and gold pieces was made by
the Commissioner of Health.
The value of Baby Health Stations as educational factors in the Greater City was
further emphasized by the establishment of several additional Baby Health Stations
maintained by allied child-caring agencies, namely, The Greenwich House, The Master
School, and the Henry Street Nurses' Settlement.
The educational advantages of Baby Health Stations was further emphasized in the
Borough of Queens, where, because of a limited number of stations and the large dis-
tances that it is necessary to travel, five temporary Baby Health Stations were estab-
lished during the summer months, at public schools and at the branch offices of the
Health Department. These temporary Baby Health Stations were supported this year,
as in former years, largely through voluntary contributions of mothers' clubs asso-
ciated with the schools, and arrangements were made with a local concern to supply
a high grade of milk for infant and child-feeding, at a cost below the prevailing
market price.
All of the aforementioned shows that child care is no longer to be considered an
individual problem nor the problem of a municipal health department alone. It is now
a community problem or a close business partnership of all agencies and individuals
interested in child welfare. Sucli results as are being attained in this City can come
about only through a well-organized, co-ordinated and correlated effort on the part
of all agencies interested in infants and children, with the health department acting
as a clearing house. The control of infant and child morbidity and mortality is more
of a socio-economic than a medical problem. Naturally, social service work has always
been with us, and probably always will be. It has taken some time to arrive, but,
it is here, and will never in all likelihood be relegated to the rear. Its importance and
significance during 1919 was more evident than ever, and every available source and
channel for securing relief has been searched and used by the medical and nursing staff
of this bureau, in their effort to secure as much material aid, relief and comfort, as
was necessary for the needy and deserving families which came under their jurisdic-
tion.
While individual instruction is the aim of the Baby Health Station service, it has
been found expedient at times, to hold various classes for mothers, where general
157
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
instruction in preventive health measures can be given. This year, as in former years,
classes on the prevention of respiratory diseases, cooking classes, and sewing classes
have been held.
The fact that respiratory diseases have assumed second place in the infant mortality
statistics, has demonstrated the need of instruction in preventive measures. While
it is true that the prevalence of respiratory diseases of infancy was unusually low in the
early part of the year, nevertheless, it was considered advisable to continue these
classes. This program justified itself because toward the latter part of the year an
increase in respiratory diseases took place. Instruction was given on all factors which
were likely to increase respiratory diseases, such as the importance of ventilation, the
dangers of overcrowding, of coughing, sneezing, spitting, kissing, etc.; the use of
separate eating utensils, towels, tooth brushes, etc.; the imjxjrtance of oral and nasal
hygiene, the care of the teeth, the dangers of hand to mouth infection, the isolatoin
of all children and adults with coughs and cold, etc.
Cooking classes, by the nurses or by trained dietitians from various co-operative
agencies, such as Teachers' College, Pratt Institute, the Association for Improving the
Condition of the Poor, were held regularly, in order to educate mothers in the
proper and most economical methods of purchase, preparation, care and palatability
of food. The economic conditions of the day, rendered it necessary and important to
show the tenement population how to spend their money most advantageously and
profitably. These classes laid particular stress upon the fact that milk was a food and
not a beverage, that it has a high nutritive value and that there were many ways in
which it could be prepared to suit the taste as well as the food habits of the different
nationalities.
Sewing classes were conducted mainly for expectant mothers, and demonstration
on how to prepare at a small price articles for the new arrival and for the confinement,
were held at regular intervals. These classes not only proved of material advantage
to the mothers, but the gatherings afforded them a certain amount of social intercourse
which relieved the monotony of their daily life, and gave them a healthier mental
attitude, which is so essential during pregnancy. In many instances, the material used
at these classes were furnished free of cost, by one or another of the co-operative
agencies, or by private individuals, frequently through the efforts of the nurse in
charge, so that a decided saving for many mothers was effected.
Classes in corrective exercices were also held through the courtesy of the Peoples'
University Extension Society, this organization furnishing an instructor to several of
the stations. These classes were open to all the older children of the neighborhood,
who suffered from muscular relaxation of faulty posture and carriage, resulting in
round shoulders, spinal curvature or other orthopedic defects. These classes were all
well attended, some of the members having been in attendance for several years past.
Baby Health Sfaiions as Centres for Other Dcpartmemtal and Local Social Service
Activities — Other departmental and local activities have centered around the Baby
Health Stations, this year as in other years. They have come to be recognized as
community for neighborhood centres, to which most of the inhabitants of the vicinity
come for advice and instruction, that relate to the family as a unit. In the early part
of the year they were used for the sale of eggs, at a price below that of open market,
the eggs being delivered by the Department of Public Alarkets, the same being con-
ducted by the nurses of the stations, and open to all who desired to purchase. While
this sale was surrounded with numerous difficulties, annoyances and irregularities, and
while it interfered with the regular station service and routine, it served a purposek
by placing in the bands of the needy public, a valuable article of diet at a reasonable
price.
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BUREAU OF CHILD HYGIENE
Vaccinations have been performed at the stations the year round. Midwives, and
mothers' meetings of various kinds have been held; Little Mothers' Leagues have
met there at regular intervals ; groups of high school girls have been given practical
instruction in the care of the baby, and food preparation. Various child-caring, social
service, philanthropic, and other agencies, as well as maternity centres, have been
afforded desk room. Baby Health Station and social workers, doctors, nurses and
other workers, from all parts of the world, have been instructed in the station activities
and service. Local baby improvement contests have been held, and every facility has
been offered the various municipal, state and National representatives, in furthering
work of all kinds, which makes for the health and well-being of the family. In a
word, all efforts for unifying the care of infants and children have been grouped and
developed around the stations.
That the work performed at the Baby Health Stations, is recognized to be of a
standard worthy of emulation, is exemplified by the fact that visitors from all parts of
the world have come to them in order to study their methods. It is no exaggeration to
say that there was scarcely a progressive community or country that did not send
some representative to the Baby Health Stations during the year. Thus we find repre-
sentatives from Poland, Australia, Japan, England, France, Havana, China, Canada,
Texas, Washington, California. Kentucky, Oklahoma, Ohio, Michigan, Pennsylvania,
Jersey, etc., etc.
Little Mothers' Leagues.
The Little Alothers' Leagues, which are organizations composed of school girls
twelve years of age and over, have been part of the bureau organization for over
ten years, and have been established and conducted in many of the public and a few
of the parochial schools. As such, they are largely summer month institutions. The
need for conducting these leagues the year round has long been felt by the bureau,
and such organization has been effected at the baby health stations, and many of
them have had a Little Mothers' League for the past several years.
The school leagues, in many cases, meet at the stations during the summer and
then become incorporated with the permanent Baby Health Station leagues. During
the year thousands of school girls come under the educational influence of inspectors
and nurses of the bureau, through these leagues, and as a result thereof, not only carry
daily lessons of child care, hygiene and sanitation into the homes, but take better
care of their baby sisters and brothers, to say nothing of becoming better prepared
for the exacting duties of motherhood.
Many of these leagues have formed cooking classes, in addition to their regular
program, and, as in the case of cooking classes held for their mothers, the members
have been taught by the nurses of the bureau and by expert dietitians from allied
co-operative agencies, in the proper purchase, preparation, care, nutritive value,
palatability, etc., of various food articles. They have served also as a wedge for the
furtherance of the Americanization program of the National Government, and have
proved gratifyingly responsive in work relative to after-war needs.
These leagues organized for the most part in the poorer sections of the city,
where the need for help by mothers seems most urgent, naturally consist mostly of
children of foreign-born parentage. The membership of most of the leagues consists
of children whose parents have been born in many of the foreign countries. During
the year sufficient interest was aroused in one of the Baby Health Stations near the
Chinese section of the city to organize a league consisting of Chinese children, who
responded most willingly and most interestingly to the instruction given by the
nurse-in-charge.
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ANNUAL REPORT OF THE DEPARTMENT OE HEALTH
The membership of the Little Mothers' Leagues of the public and parochial
schools, and of the Baby Health Stations, totals about fifteen thousand (15,000) annually.
With these leagues in existence for over ten years, it can readily be appreciated
what a potent force this organization has had over the control of infant mortality
in this city. These girls are very responsive to instruction and have acted as mission-
aries of education, not only for their own family, but for many of the families in the
neighberhood. And, furthermore, they not only carry this education into the homes,
but are sufficiently interested in the practical side of their work to gather funds
through their own resources and to apply the same to the needs of some worthy baby
or babies, particularly for the purchase of milk. It is no exaggeration to say that
a large part of the reduction in infant mortality, which has taken place in the city
during recent years, is due to the accumulative education of the " Little Mothers " of
the Greater City.
District or Home Visiting Control of Infant Mortality by a Vorps of Field Nurses.
During the months of July and August, and part of September, the supervision
of infant life is supplemented by the assignment of an augmented force of nurses
from the Division of School Medical Inspection, in addition to the regular work con-
ducted through the baby health stations. During this heated period, school nurses
are assigned to special districts of the city, in which analysis has shown either a
high infant mortality rate or a large infant population. Each nurse is held responsible
for the enrollment, supervision, care and follow-up of 150 infants in her respective
district and in the event of removal, death or refusal to accept service, she is held
responsible for making up the original complement of 150 by a canvass of the neigh-
borhood.
Visits are made to these infants according to the needs of the situation, to well
babies at least once every week or ten days, and to sick, delicate or frail infants, as
frequently as necessary. These '' district nurses," as they are called, make their
headquarters in most cases at adjoining Baby Health Stations, and conferences are held
daily with the medical inspectors, who visit the homes of sick and sub-normal infants,
and prescribe all necessary treatment and advice for cases of gastro- intestinal disorders
or diseases of nutrition. First-aid or emergent treatment is given in all cases ill
with other diseases, and then every effort made to see that the baby receives subsequent
care at the hands of private physicians, hospitals or dispensaries.
The volume of work performed in this direction, during 1919, was somewhat
lower than in former years, due to the fact that provision was only made in the 1919
budget for the assignment of 87 months' of temporary nursing service, as against 285
months in former years. This circumstances necessitated the assignment of many
school nurses to the Baby Health Stations to fill in the vacancies of the regular baby
Health Station nurses, whereas in former years this work was undertaken by the
nurses temporarily assigned during the summer months.
At the expiration of the summer the babies under district supervision were re-
ferred by card to the neighboring Baby Health Station for a continuance course of
advice and the mothers were urged to attend regularly. Unfortunately, only a very
small per cent, of these mothers — 6 per cent. — subsequently took advantage of the
station opportunity. The small per cent, of mothers, who. during the summer receive
advice and instruction from the district nurses, and subsequently enroll their babies
at the station, has become common observation for many years. Irrespective of how
many Baby Health Stations are maintained by the Department, there will always be
a large number of mothers who will refuse to bring their babies to these centres,
either because of indifference, neglect, or carelessness, and who cannot be reached
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BUREAU OF CHILD HYGIENE
through the stations because of a limited working force; and it is sadly true that
verjr often babies who need care most never reach the station because of this in-
differences or neglect on the part of the mother. A combination, therefore, of Baby
Health Station service for the year round, and home visits during the summer months,
has proved of distinct usefulness. Such babies found during the summer, who are
frail, delicate, or poorly nourished, are followed up by the Baby Health Station
nurse, whether or not the mother enrolls the baby at the health station.
Infant mortality control during the summer months, through home or " district
visits," has been conducted by the bureau since 1911. The number of babies super-
vised in the homes, during the summer months, by this corps of nurses, ranged
between fourteen thousand and sixteen thousand, from 1911-1919 inclusive. The
number of babies under one year of age so supervised during these years was
156,567. It is evident that this method of procedure, which is preventive rather than
corrective, is no small contribution to the control of infant mortality in this city.
Physical Examination of Children of Prc-School Age.
For many years the bureau has recognized that there existed a gap in its adminis-
tration of child hygiene activities, between the baby health station child and the
school child. This gap is the proper supervision of children of pre-school age, 2 to
6 years. The pre-school age is one of the most neglected periods of childhood.
Ample provision has been made for the control of infant mortality and for the super-
vision of the school child, and commendable results have been accomplished in both
directions. The pre-natal and the pre-school age periods are the two weak links in
the chain forged about the control of child life. The pre-natal period bears the same
relation to the infant that the pre-school age bears to the school child. Just as the
best time to take care of the health of an infant is before it is born, just so the best
time to take care of the health of the school child is before it enters school, rather
than after. With the neglect of either the pre-natal period or the pre-school age,
the continuity of successful control of child life will be interrupted.
The Baby Health Stations, established and maintained primarily for the care and
feeding of babies under two years of age, have not lent themselves under the present
system of organization to any extended supervision of children of the pre-school age,
for several reasons, namely — because of the increased volume and scope of infant
and early childhood care, necessitating a corresponding increase of time and energy,
on the part of the limited medical and nursing force ; because mothers seem to have
all they can do to look after the baby or babies that are brought to the stations, with-
out the added burden of bringing children of the pre-school age to these centres; and
because of the insufficient force of medical inspectors to conduct this work after the
regular baby health station hours. While the bureau recognizes the importance of
this work, comparatively few examinations were made at the stations during 1919.
Sufficient data, however, has been compiled from a study of the examination made
in recent years to justify the recommendation that this type of work should be ex-
tended by the municipality. The percentage of mal-nutrition among children of the
pre-school age is larger as a rule than that among children of the public schools, and
other physical defects are quite as common, and in some instances more so. The
studies of recent years have indicated the extreme importance of these examinations
and the influence which proper correction of physical defects at this age period would
have upon the educable capacity and school progress of the child. Physical examina-
tion and follow-up work of children of the pre-school age is one of the most press-
ing public health problems of the present, and one of enormous magnitude, when it is
remembered that the estimated population in the City of New York of children from
2 to 6 years of age is almost 500,000, and that this is about one-half of the estimated
161
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
school population. When is is remembered, furthermore, that the entire working
medical force of the division of School Medical Inspection examines approximately
300,000 school children annually, it is easily appreciated what a large working medical
force would be necessary in order to make any definite impression upon the status
of children of the pre-school age. In fact, the problem is so big that it is one for the
community to undertake, rather than for the Health Department alone, and, if this
problem is ever to be solved, ways and means for these examinations at various centers,
such as schools, hospitals, dispensaries, settlements, guilds, clinics, day nurseries, baby
health stations, etc., will have to be devised, or the public will have to be educated
up to the necessity of having these children examined periodically by private physi-
cians.
To sum up, then, while the volume of work perfomed was slightly below that
of last year, essentially because of conditions associated with the war, diversion of
the field force because of influenza, special surveys and other studies and a social
unrest, the character of the work was maintained at a high standard, there was a
betterment on the part of the employees in the general condition and scope of the
various activities, a better, more sympathetic and more whole-hearted degree of co-
operation on the part of allied agencies, a more earnest view of the clientele, as to
the objects and purposes of the stations, and a fine spirit of willingness, earnestness
and loyalty on the part of the employees, during the trying days of 1919.
School Medical Inspection.
During the year a list of children from families in which there was a case of
tuberculosis has been regularly furnished to the Bureau of Child Hygiene, by the
Bureau of Preventable Diseases, and every effort has been made to place the children
of these families in an open-air class, when there was a school with such a class
sufficiently near.
Every effort was made to prevent a recrudescence of influenza cases among school
children. Five hundred thousand (500,000) circulars on the prevention of colds and
influenza were distributed. During February and March every Friday was devoted
by medical inspectors to the examination of pre-school-age children. This led to
the detection of a number of defects among these children and every effort was made
by the inspector and nurse to have them corrected.
The retirement of one supervising inspector on March 1, from the Borough of
Manhattan service, led to the doubling up of supervision upon two full-time men, and
the work was carried on by these two men throughout the year. 0" account of the
dropping of a number of inspectors, through lack of budget appropriation, the schools
were regrouped, in order to cover all schools as fully as possible.
A list of schools in which there were a number of poor families, and where the
degree of malnutrition was high, was submitted to the Chief of the Division of School
Inspection, in order, if possible, that milk might be furnished to the children therein.
A special nutrition survey was made in forty-three (43) schools, and there were
found of the
No. 1 cases 9,636
No. 2 cases 38,493
No. 3 cases 17,571
No. 4 cases 4,884
with a percentage ranging from 17 to 61 of malnutrition, and a general average of 32%.
No. 1 Case — Represents children in excellent condition.
No. 2 Case — The average normal child.
No. 3 Case — Those requiring supervision for malnutrition.
162
BUREAU OF CHILD HYGIENE
No. 4 Case — Those with organic trouble, or otherwise requiring medical care for
the malnutrition from which they are suffering.
The results by ages, show that there were, in the
Kindergarten 40% malnutrition
1st year 43% malnutrition
2d year 40% malnutrition
3d year 'hl'7c> malnutrition
4th year 11% malnutrition
5th year 35% malnutrition
6th year Zl% malnutrition
7th year 26% malnutrition
8th year 22% malnutrition
9th year 21% malnutrition
A survey to determine the relation of the high cost of milk to its decreased use,
and, consequent under-nourishment of young children, was instituted. Some ten
thousand (10,000) families, were visited by inspectors of the Department, in selected
sections. Families where there were one or more children between the ages of one
and six were chosen. The survey was instituted to show how much milk of the
various grades is used at the present time in comparison to 1916, before the increase
in price, and also, whether any of the children of this age-group, are suffering from
malnutrition, owing to the use of less milk.
A number of visitors from all over the world have inspected the school work
during the course of the year and have written various letters to the Director and
others, showing their appreciation of the work and its value.
New physical record cards were placed in many of the schools, and the inspectors
and nurses were advised to use these as much as possible in their examination of the
children, so as to save the loss of a large number of previous examinations through
destruction of the old card, without its having been properly copied.
During the course of the year it was reported that an increase in the number of
cases of scabies had occurred. This was found to be so to a certain extent. It was
believed, but not thoroughly demonstrated, that the cases had been caused by a large
number of returned soldiers from abroad, who suffered with mild types of the disease.
A large amount of social service work was done by the nurses throughout the
year in taking care of families in their districts. All nurses became particularly active
around Thanksgiving and Christmas time, providing suitable cheer in the way of good
food and proper clothing for worthy families.
There was a notable increase in the number of cases of measles during the last
quarter of the year. Every effort was made to see that the teachers sent down to the
nurse and inspector, cases showing initial sj-mptoms of the disease. Rooms in which
two or more cases occurred were thoroughly scrubbed and aired, as a possible aid in
the prevention of more cases, and such classes were routined regularly for a period of
two weeks, in order to note early symptoms in other children and exclude them.
Chickenpox and diphtheria also showed an increase^ but careful watching seemed
to reduce rapidly the number of infections from these.
General Contagious Diseases Found in Schools and Excluded.
There were found in the schools and excluded during the year 1919, 1,846 cases of
general contagious diseases ; this is 149 more than for 1918, when there were 1,697.
Every effort was made to detect contagion in its early stages, so as to place the child
under observation of a physician as soon as possible, and to obviate the loss of a
larger number of school days than is absolutely necessary. To facilitate this work,
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
teachers were from time to lime instructed by medical inspectors and nurses in the
signs and symptoms of contagious diseases, and urged to send to the nurse or doctor
as soon as they noticed any child who did not appear to be entirely normal. The
number of cases excluded from school is rapidly falling off, and it is felt that this
co-operation of the teacher, nurse and doctor has a great deal to do with it.
The reported "Cases of Major Contagious Diseases Found at Home" have fallen
off because the parents are learning to know that, while the teacher is anxious to keep
up her attendance,, absence for a contagious disease will not count against her class.
Most of them now also realize that the reporting of a case does not mean its removal
to a hospital, and understand that it is safer for all concerned that cases should be
reported, so that quarantine can be established, rather than to leave them alone and to
serve as a source of infection in the neighborhood. There were found on "home
visit" only 95 unreported cases of major contagious diseases during 1919, while in 1918
there were 368.
Contagious Eye and Skin Diseases Found in Schools.
There is an apparent increase in contagious eye and skin diseases found in schools.
In 1919 there were 237,437, and in 1918 there were 209,991. This is due to the fact
that at the first sign of any minor contagion or eye trouble, most teachers to-day send
the child to the nurse who promptly institutes treatment, or sends it to a suitable clinic
or its private physician.
The number of pediculosis cases especially has increased, because a number of
principals have asked that extra attention be given this condition, and that children
with only a few nits» who might possibly have escaped in previous years, be recorded
on the class index cards, so as to eliminate, as far as possible, the danger of any
further infection by getting every single child under proper treatment. Splendid co-
operation has been afforded the nurse by the school principals and teachers, in a very
serious endeavor to diminish the number of these cases.
The number of cases of trachoma has declined from 2,052 in 1918 to 1,675 in 1919.
Follicular conjunctivitis has dropped from 864 in 1918 to 128 in 1919.
Acute conjunctivitis has dropped from 13,697 in 1918 to 12,457 in 1919.
There has been an increase in the number of ringworm cases from 3,474 in 1918
to 4,190 in 1919.
Scabies increased from 1,795 in 1918 to 2.840 in 1919.
Impetigo increased from 11,239 in 1918 to 15,264 in 1919.
Various miscellaneous disorders have increased from 57 in 1918 to 357 in 1919.
This is due to the fact, as previously stated, that more attention is being paid by the
teachers to these conditions during morning inspection than in previous years.
There was also an increase in the number of exclusions for these minor contagious
diseases, from 10,925 in 1918 to 12,384 in 1919. It has been found in a number of
instances that to exclude a child occasionally in a school has a good effect on others,
and that treatment for many cases can thus be more rapidly secured.
The visits and consultations by inspectors have fallen off considerably during the
year, as so much of their time has been taken up with special surveys and investiga-
tions. A total of 37,677 visits were made by the inspectors in 1919, in contrast with
60,622 in 1918. As a matter of fact, there were less visits for physical defects required
by the inspectors, because the nurses could make most of these. This was due to
the fact that the inspectors made a lesser number of physical examinations during the
year, so that each nurse had no more pupils with physical defects than she could her-
self look after.
In 1918 there were 10,781 visits made to contagious diseases by the inspectors,
while in 1919 there were only 4,307. This is to a large extent accounted for by the
164
BUREAU OF CHILD HYGIENE
fact that there were less unreported cases of contagious diseases in 1919 than in 1918.
The nurses made a total of 288,158 visits in 1919, as contrasted with 287,347 in
1918. This is a very splendid showing, when it is considered that part of their time,
too, was taken up with special work.
The inspectors held 18,142 consultations in schools in 1919 and 19,827 in 1918.
The nurses held 121,813 consultations in 1919 and 116.247 in 1918. This also
shows excellent work on the part of the nurses.
Vaccinations.
Vaccinations performed in the schools in 1918 amounted to 23,926, while but 19,828
were performed in 1918; 1,459 re-vaccinations were performed in the schools, as against
1,297 in 1918. Medical inspectors of this division also performed a large number of
vaccinations at the baby health stations during the months of May and June and
assisted in the performance of some at the borough offices, during the rush periods.
Examinations for Physical Defects.
The number of children examined compares very favorably with that of 1918:
Regular examinations :
1919. 1918.
Number examined 248.978 247.735
Number found with defects other than of teeth
only 91.268 86,311
(36.6%) (34.8%)
Number found with defects of teeth, as only defect.. 92,812 104,587
(37.3%) (42.2%)
Other Examinations :
Re-examinations 85,570 94,304
1919. 1918.
Summary of Regular Examinations for Physical Defects:
Number of children examined 248,978 247,735
Number found to have defective vision 17,895 23,362
a.27o) (9.4%)
Number found to have defective hearing 1,252 1,214
(.5%) (.4%)
Number found to have defective nasal breathing.... 28,986 25,168
(11.6%) (10%,)
Number found to have hvpertrophied tonsil 38,151 33.475
(15.3%) (17.5%)
Number found to have cardiac disease ■ 3.798 3.979
(1.5%) (1.2%)
Number found to have pulmonarv disease 689 742
(.3%) (.2%)
Number found to have orthopedic defects 2,243 1,989
(.9%) (.77c)
Number found to have nervous affections 1,407 1,504
(.6%) (.6%)
Number found to have defective teeth 155,218 161,686
(62.3%) (65.2%)
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Summary of Cases Terminated :
Defects of vision corrected by glasses 8,787 12,040
(49.1%) (51.5%)
Defective nasal breathing corrected by surgical means 5,836 5,543
(20.9%) (22.0%)
Hypertrophied tonsils corrected by surgical means.. 7,276 6,809
(19.0%) (20.3%)
Orthopedic defects corrected by surgery 18 49
(.8%) (2.5%)
The results achieved in the number of cases terminated with actual treatment
compare favorably, indeed, with those of 1918 and preceding years.
Cases Terminated.
It has not been found possible to terminate as many cases in 1919 as in 1918^ on
account of the lessened number of physicians at the various hospitals and clinics, and
the fact that the price of treatments has gone up markedly.
1919. 1918.
Received treatment :
Defects of teeth only 7,660 12,605
Associated defects 41,484 52,690
Refused treatment:
Defects of teeth only 877 1,379
Associated defects 2,647 4,423
Left school :
Defects of teeth only 941 1,096
Associated defects 3,657 4,245
Health Leagues.
The work among these leagues has not been particularly encouraging during the
year. There have been so many changes in nurses groups, and so much other work
to be attended to, not only by the nurse, but by the teacher, who has had to double up
the number of children in her class and prepare for pageants, drives, and the like, that
it has not been possible to secure the co-operation of the teaching force, nor the
attention of the children for concentrated work of this kind. An endeavor has been
made, of course, to keep as many leagues going as possible, but, with the exception
of one or two instances, the result achieved has not been brilliant.
Miscellaneous School Activities.
Every endeavor has been made to increase the number of parents present when
the children are examined. Notes were sent to them by teachers of kindergarten and
1-A classes, consultation slips have been sent by the nurses, and yet the number
present has not been at all satisfactory. It has been found that a large number of the
parents, especially in the poorer districts, work, and therefore cannot take the time to
attend. In the better districts the parents do not attend on account of social and
other duties. They seem to feel that the examinations made by the doctor are good,
and in many instances accept his recommendations and get their child under treatment.
More and more co-operation is being established between teachers, principals, dis-
trict superintendents, parents' associations and the school doctors and nurses. In some
districts the nurse can get almost anything that she requires, from the people in the
district. In some districts, too, the school authorities and parents look upon the
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BUREAU OF CHILD HYGIENE
inspector as a real medical advisor, and come to him to discuss their various troubles
and ask advice from him. It is the constant endeavor of the nurse to increase the
num.ber of visits to dispensaries by children who cannot afiFord to pay a private phy-
sician. Very often, when the parents cannot attend with the children, the nurse will
gather a group about her some morning, or afternoon, and take them all to a neigh-
boring clinic for treatment.
The arms of all children admitted to school for the first time are examined by
the medical inspector for vaccination scar. If none is apparent, the principal is so
advised and requested to see that the child secures proper vaccination. Principals have
also been advised of the vaccination law so that they may instruct their clerks to secure
proper vaccination certificates from children, other than those entering school for
the first time.
Not much can be done to lessen the number of children whose vision is not
tested at the first examination. The picture and object charts advocated by some are
not efficient in detecting defects of sight. The shadow test should be used on all
children entering school for the first time. There are difficulties, however, in the
way of performing this test by the inspector, which have as yet not been overcome.
Various sight defects are discussed with the teacher when the doctor looks over
the class. She is requested and encouraged to send down to the doctor, for more
complete examination, any child with "squint" who seems to strain in looking at
objects, or who hold them too close to or too far away from the eyes. The percentage
of children who obtain glasses for defective vision is constantly increasing. This is
due to the fact that children wearing glasses are no longer looked upon as a rarity in
the City, and therefore their friends do not make so much fun of them as formerly.
They are therefore more willing to secure them and to wear them. Then, too, the
parents have learned, through the instructions of the nurses and doctors, of the
danger of neglecting defective vision and are more willing to take their children
for suitable examination.
In many cases funds are provided sometimes by the principals, more often by
the nurse, with which to secure glasses for those children whose parents are unable
to pay for them.
Every effort is made by the nurses to secure effective treatment for defects,
such as mouth breathing, decayed teeth and hypertrophied tonsils. The nurses visit
the social service agencies of the hospitals or clinics in their district, and by doing
favors, such as securing family histories or other data required for the work of the
former, will, in turn, secure beds and operative facilities for tonsils, teeth, adenoids,
or examinations for defective vision, through the influence which the social service
department is able to exert upon the medical staff. The nurses also, in this way, very
often secure free treatment for cases that could not otherwise be treated.
It has not been possible to do much in the way of establishing nutrition classes.
A number of principals though have been interested in the work for defective nutri-
tion, especially when they have been informed that there is a high percentage of mal-
nutrition in their school. They have held parents' meetings, to which a doctor and
nurse have been invited to be present, to discuss the feeding and care of children,
and have assigned a special teacher to assist the nurse in instructing parents in the
proper preparation of food and the kinds of food to give.
No special efforts have been made to establish cardiac classes. Requests have
come from certain principals to examine certain pupils in their school, who were sup-
posed to be suffering from that disease. These children have been examined. Where
cardiac conditions have been found, the children and parents have been instructed and
the teacher advised as to the proper care of the child.
Doctors and nurses have attended many parents' meetings for the instruction
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
of mothers and fathers in the care and bringhig up of their children. Some of these
meetings have been very largely attended and the interest displayed evidences the
fact that the effort made to bring the parents together for work of this kind was well
worth while.
Toothbrush drills have been given regularly throughout the year ; at least twice
a term to every child in the school, but more often in the lower grades. Toothpaste
furnished by one of the largest manufacturing concerns has been given to the child
as a reward for proper care of the teeth. Some of the nurses have purchased tooth-
brushes wholesale, so that all the children in the school could be supplied.
Through parents' association, welfare organizations, neighborhood houses and
agencies a number of the nurses have been able to secure milk and, in some cases,
lunches for needy children. Many of the parents have been surprised to learn that
their children have been drinking milk in school, and it has been much easier to
impress them with the fact that they should have it at home, and that the children
will take it.
Several neighborhood houses have established lunches for worthy children, where
they are served a hot noonday meal, at a cost not exceeding five or ten cents. In
many of the open-air classes the children bring a penny or two a day, and this is
sufficient to provide them with milk and cereals. Some of the nurses have held
bazaars at which they have made quite large sums of money. The health leagues in
the schools have helped make these bazaars a success, or in other ways co-operated
in obtaining money, not only for milk and lunches, but also for shoes, eye-glasses and
other necessities for worthy children.
All of the hospitals and dispensaries have been canvassed in order to obtain spe-
cial concessions for school children. Many of them set aside a definite time when a
nurse may bring children to the clinic for treatment. Many of them, too, will remit
the fee for medicine or operation, if the child is sent with a note, stating that it is a
worthy case.
In order to detect, eliminate and prevent the spread of contagion, teachers have
regularly been instructed in the detection of early signs and symptoms of the con-
tagious diseases. They have been instructed to send to the doctor or nurse any child
showing signs of fever, flushed face, rash, pallor, or apparently suffering from
gastric or other disturbance. An endeavor has been made to see that the daily list
of contagious diseases is sent through the schools regularly each day, and that the
teacher notes in the record book any child absent from her class on account of con-
tagious disease, or in whose family there is such a case. A list of absentees is fur-
nished the medical inspector daily, by the principal, of cases where it is suspected
that contagious diseases may be existent in the home. Wherever two or more cases
of the same disease appear in a classroom, the class is "routined" (inspected) regu-
larly by the doctor and the nurse until the period of incubation, following the last
case, has passed. In the case of diphtheria, cultures are taken — if the infection of the
second case appears to have come from the first. Parents are advised to have the
Schick test performed on their children, so that it may be determined whether or not
they are susceptible to diphtheritic infection, and immunization is also offered when
considered advisable.
When it comes to the question of pediculosis, one feels that the problem is
rather one to be " dissolved " than solved. Could the chemist provide us with some-
thing that would loosen the nits from the hair and yet not injure it, this problem
would be greatly lessened. As it is at the present time, many formulae and methods
are used in order to attempt to keep down the number of these cases. The problem
has become so important, and apparently so lucrative, that a number of women in
this city have gone into the business of freeing children's heads from pediculosis.
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BUREAU OF CHILD HYGIENE
In the schools, more and more of the principals are coming to see the importance of
this problem. A number of them now refuse to promote or to graduate children
from their schools, whose heads are unclean. In the classroom they are segregated,
being put in aisles by themselves. They are not allowed to wear hair ribbons ; receive
a " C " or lower mark in hygiene in many of the schools, and the percentage of the
class itself is marked low, if there are cases of unclean heads in it.
The health leagues have also helped in the problem of cleaning up, the girls taking
a special interest in the welfare of their school, and feeling that it is a disgrace to
have cases of this kind in any class.
Little Mothers' Leagues.
Little Mothers' Leagues in schools should be conducted throughout the year by the
teachers themselves in the schools. It should not be a part of the nurse's duties to
give definite instructions for a period of time to the scholars. Lessons should be
arranged by the teachers, and occasionally the nurse and inspector should be called
in to talk to the children on these topics; the work being part of the school cur-
riculum, the same as cooking and sewing, would have to be undertaken by all the
girls of twelve years of age or over, and the results achieved would be in propor-
tion to the number taught by the teacher and those now taught by the nurse.
Of course, it is realized that this policy cannot be adopted just now, as it must
be passed upon by the Board of Education. In order, therefore, to make the lessons
as effective as possible at the present time, they should be begun in March or April,
so that as many lessons as possible can be given by the nurse during the school
period. Principals should be spoken to by the supervisors and shown the value of
the work, in order that they may co-operate, possibly assigning a teacher to assist
the nurse in maintaining discipline and noting that all girls twelve years of age and
over attend meeting regularly.
On account of the small number of nurses assigned to the Bureau, it is rather
difficult to continue the leagues throughout the entire summer, as they require nurses
who are especially fond of children, who know how to handle them, and who will
take a particular interest in this sort of work.
The children also become restless during the summer period and unless they are
taken on trips and excursions occasionally, and offered rewards and prizes for their
attendance, they soon drop out of the league, and it has to be disbanded.
The fact that a new nurse must be assigned to take care of the league when their
own school nurse goes on vacation, also is a factor in diminishing the attendance ;
the girls not knowing the new nurse, and not knowing how she is going to act
towards them, do not care to attend.
It will be well, therefore, in the latter part of July, to merge the school league
with the nearest baby health station league, if there is one in the vicinity, so that
the girls can be interested in the demonstration work and the actual care of babies
at the stations. Girls who attend regularly should be provided with a little ornate
certificate or diploma, showing that they have attended regularly and have completed
the required course of instruction.
Co-operation of the Department of Education.
The adoption of the " Syllabus of Hygiene " by the Department of Education has
worked great good in getting more co-operation in health work by teachers. .\
greater number of cases have been referred by teachers for examination, although
it is true that a large percentage of these are found by the doctors to have nothing
the matter with them. In some schools where the principals are particularly inter-
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
ested in the work, the teachers pay great attention to the condition of their children,
and materially assist the nurses in cleaning them up, and in the correction of physical
defects. In other schools, however, the teachers simply refuse to do the work called
for in the syllabus, and no more cases are referred than formerly.
In some of the schools the teachers have carried out the provisions relating to the
testing of eyesight with the Snellen chart. The large number of children, however,
found defective by the teacher, show that they have not been properly instructed.
A number of children marked with vision as high as 20/70ths and 20/lOOths, have
been found, upon re-examination by an inspector, to have normal vision.
Many of the teachers seem to be more careful than formerly in referring minor
contagious cases and cases of illness to the doctor or nurse. This has resulted in
some schools in, practically, the elimination of minor contagious diseases, such as
ringworm, impetigo, scabies and the like.
General Impressions of the Years Work.
The standard of personal cleanliness in the schools, on the whole, seems to be
gradually improving. The nurses are constantly preaching "cleanliness" through their
talks to the children in the classroom, through health leagues and through the Little
Mothers' Leagues. Most teachers are glad to help in work of this kind, as they feel
with dirty children in their classes they themselves cannot keep clean.
The stoppage of immigration, too, in keeping out the uneducated hordes of illiterate
folk from Europe, who have not become used to our American methods of hygiene and
sanitation, has given us time to work on those at present here and make them realize
that cleanliness is really next to godliness.
The greatest deficiencies in our present system of early detecting, preventing and
excluding children suffering from contagious diseases are the facts that teachers do
not generally know the signs and symptoms of contagious diseases, and therefore do
not detect them early enough to be of value. The daily list of contagious diseases
does not always reach the schools to be sent through them in time for exclusion of
other children in a family, and in some schools is not closely scanned by the teachers,
in order to find children who should be out, or, perhaps, is not sent through the school
at all by the principal. Teachers do not go over their list of absentees closely enough
in order to ascertain, if possible, whether or not it is a contagious disease that is
keeping the pupil out. Very often by a discreet inquiry in the classroom, or by send-
ing for a brother or sister in the school, the teacher will be able to find, and to notify
the department of, concealed cases of contagion.
The greatest obstacles in the way of procuring treatment for children suffering
from physical defects are:
In the first place, the fact that there are, by no manner or means, sufficient facili-
ties in the city for caring for all of the children whose parents are willing to have
them treated. Clinics, hospitals and dispensaries are constantly overcrowded with
school children applying for treatment; there are so many of these that the doctors
cannot give them the proper time or care, and so the parents and children go away
dissatisfied and do not return.
In the next place, the ignorance of parents in general helps to keep down the
number who should have treatment. It is in many cases difficult and in some impos-
sible to persuade a mother or father that a child should be operated upon for tonsils
or adenoids, or secure glasses, and often, in many cases, that the teeth should have
attention. Then, too, the child must be considered. It is surprising to note the large
number of children who rule their parents, and if the child refuses to go for treatment
the parent simply shrugs his or her shoulders, and says to the doctor or nurse, "What
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BUREAU OF CHILD HYGIENE
can I do?" In many instances, also, parents cannot afford to pay a private physician,
and yet do not wish to take their children to the hospital, either from the fact that
they do not wish to accept charity, or that they fear the hospital may keep the child and
operate upon it, whether or not the parent wishes it. In some clinics, too, the charge
for treatments has gone up so much that parents cannot afford these either. Private
physicians' fees, in the majority of school children's cases, for special treatments, are
practically prohibitive. Sometimes parents may be willing to take their children, but
on account of their employment, find it impossible to do so.
Other Work By School Medical Inspection Personnel.
A great deal of work has been done by employees, doctors and nurses in the
Division of School Medical Inspection for other bureaus, as well as other divisions
in the Bureau of Child Hygiene, and also for outside agencies.
The Bureau of Records has been supplied with a medical inspector every other
Sunday throughout the year; has been given relief, when their burial permit clerk has
been ill or on vacation, for weeks at a time.
It has furnished to the Bureau of Preventable Diseases diagnosticians for work
during the epidemic of influenza, as well as when their work in that bureau became
heavy. The inspectors have given a number of talks on tuberculosis and other topics
for the Bureau of Public Health Education.
To the Mercantile Division of this Bureau, doctors and nurses have been supplied
during the -ush periods. During the summer vacation paper rush period practically
every doctor and nurse in the division was assigned to this work in the various school
centres, in which these papers were issued.
Doctors and nurses were assigned to the Mayor's Committee boat "Correction"
during the summer time, and also to the St. John's Guild.
A force, sufficient to cover the work, was assigned to the Drug Addict Clinic,
when it was first opened, and continued there for a long period.
Doctors were assigned to the Baby Health Stations beginning in May and through
June, to perform vaccinations for the large number of children applying therefor at
that period.
Doctors were also assigned daily, for four days a week, in the Boroughs of
Manhattan and Brooklyn, to the various truant centres to perform examinations on
truants brought before the courts at these places.
Doctors and nurses were assigned to bring up to date a long list of delinquent
visits to midwives and foundling keepers for the Division of Midwives and Foundlings.
The entire force of inspectors was assigned to the Commissioner's office to carry
out the malnutrition survey for children between the ages of two and six years.
At the diet kitchen of the New York Diet Kitchen Association inspectors were
assigned regularly every Saturday throughout the year, and for three days a week
during the summer vacation period.
During a smallpox scare a number of inspectors were assigned to vaccinate in
schools in the neighborhood in which the cases had occurred.
Practically all physical examination work was discontinued for a long period
during which malnutrition surveys, asked for by the Board of Education, were being
made and completed as rapidly as possible ; thereafter the No. 3 and No. 4 cases found
in these surveys were examined by the inspectors who had made them.
Eye Clinics.
The object of the eye clinics of the Bureau of Child Hygiene is:
First — The detection and treatment of all contagious eye diseases among school
children, whose parents are unable to pay for private treatment.
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Second — The detection of errors of refraction and the correction of these errors.
Refraction at these clinics is done by highly trained oculists of proven ability. In the
usual eye clinic of the public hospital, the drudgery of refraction is, as a rule, left
to the newest and least experienced assistant. It is being realized by the medical
profession, that the correct refraction of most children is a difficult problem, calling
for a high degree of ability on the part of the oculist and the value of the work done
in our clinics is being appreciated by doctors, teachers, and social workers in the
general hospitals, who refer many cases to the clinics.
Third — The detection and supervision of the partially sighted and blind children,
and the treatment of these cases.
The organization of the clinics is somewhat changed from that of last year, the
executive officers being:
First — The Director of the Bureau, in full charge.
Second — The Assistant Director.
Third — The Borough Chiefs, who have administrative and disciplinary super-
vision of oculists and nurses.
Fourth — The Supervising Oculist in charge of all technical w-ork in all Boroughs,
Fifth — The District Micdical Supervisor, and Supervising Nurses, in charge of
the oculists and nurses in their districts.
Sixth — The oculists and nurses assigned to each clinic to carry out the detail
work. In addition to these the medical inspector and school nurse co-operate to the
extent that all work' in harmony to detect all eye cases in the schools and refer them
to the clinic for treatment, as well as to look after the necessary follow-up work which
is so important among the poorer classes.
There are ten eye clinics — six of these are in Manhattan, two in Brooklyn, one
in the Bronx, and one in Queens.
The work done last year by the teachers in regard to vision testing has been
continued this year with somewhat better results. This feature of the work is
possible of great expansion if a working plan can be created whereby all children
shall be given a vision test by the teacher at the beginning of each term. The test
should be made in accordance with a set of simple rules for vision testing to be
furnished by the Supervising Oculist.
The clinic and school nurses have done remarkably well during the past year in
keeping the clinic active. There is, however, more assistance needed in the follow-
up work in the homes in order to carry out the treatment prescribed in many cases,
as we have a list of several hundred children whose cases have not been terminated,
and the clinics have lost touch with them, due to their failure to keep the appoint-
ments made for them.
The success in the treatment of Trachoma, by the intense bi-chloride rub has
continued and produced such decided results that we are forced to revise some of our
long standing beliefs in regard to this disease. In cases of acute trachoma uncom-
plicated by syphilis or tuberculosis, and which have not been previously treated with
blue-stone or other treatments, and which have not been operated upon, the intense
bi-chloride rub, under cocaine, will completely cure without leaving any scar tissue.
This leads us to the conclusion that the scar tissue of trachoma is due to the faulty
treatment or control of the disease.
In the treatment of corneal opacities the negative galvanism has been further
developed and is still used extensively at the special sight conservation clinic at
P. S. 30, Manhattan.
The Blind and Sight Conservation work is continuing to grow in importance and
results. We now have 699 active cases under supervision and treatment at the
Sight Conservation Clinic. 1,114 cases with vision of 20/50 or worse have been sent
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BUREAU OF CHILD HYGIENE
to us as candidates, of which 639 have been terminated cured, and 475 while still
under treatment, have improved to such an extent that they have been assigned to
normal classes. Of those cases in the Sight Conservation Classes, 33 have been
terminated cured, and 34 though still under treatment, have so improved that they
have been re-assigned to the normal classes. There are at present 99 children in the
Blind Classes.
There is a sufficient number of children in the public schools of New York City,
with a vision so poor that they should be in sight conservation classes. There should
be a sight conservation class for approximately every 10,000 pupils. The sight con-
servation method of teaching combined with constant oculist supervision is of the
utmost value in the prevention of the progress of myopia, and a perfected method
of dealing with children with myopia of a small degree, to prevent the progress of
the condition, should be created along the lines of similar work now done in the
public schools of London, England. It is recommended that the lighting of the
public schools receive more serious attention that it has in the past, as poor lighting
of schools is undoubtedly the cause of a great deal of myopia. It is universally
recognized that myopia is increasing rapidly, that myopia is due to eye strain and
that the effort made by the growing child to study in schools in poof light, and often
in artificial light, which is always a strain, is a most active cause for this increase.
We have classrooms in some of the schools which are lighted nearly every day with
gas light of very poor quality. One large High School has a study room which is
used all day by hundreds of pupils, and is lighted only by electricity placed in a high
ceiling.
The guidance of the Blind and Sight Conservation Classes is being put more and
more on the Supervising Oculist; this includes conferences with other organizations
interested in this work, as the National Committee for the Prevention of Blindness,
etc., and the feature is sure to increase as the work develops.
Following is the summary of the work done in the clinics last year
Refraction Service —
Total No. Cases 12.544
Total No. Visits 30,567
Total No. Refractions 27,315
Total No. Rx. for Glasses 10.605
This is a slight increase over last year.
Contagious Service —
Total No. Cases 7,276
Total No. Treatments 56.368
showing an increase in new cases over last year, with a decrease in the number of
treatments due, probably, to improved methods in treating follicular conjunctivitis.
Dental Clinics.
The dental clinic problem has been moving fast since its inception and establish-
ment in January, 1914. In that year eight clinics were established with two dentists
and a nurse in one clinic, and one dentist and a nurse in each of the others. Each
succeeding year, as experience indicated, the scope and intent of the clinic work has
been changed to meet new conditions.
Experience has taught that, everything else being equal, the proper place to do
dental work for children is within the school building. There are many reasons for
this, but briefly, the time saved to the child's schooling by not having to waste time
going to or from, or waiting at a clinic, is one of the two chief reasons, the other
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
being the fact that the child accepts the work in a more normal frame of mind, and
the total educational effect, dentally speaking, is more evident and lasting. Along
with this, the advent of the dental hygienist in this State, and the realization of her
value as an essential assistant in a dental clinic, is now completely recognized.
Three of these hygienists were employed temporarily in the Fall of 1917, but
owing to the war conditions, their services were not continued in 1918 or 1919, but
our programme for the new year calls for a great addition to this branch.
The dental work, as done, is confined to the two younger years of school, with
special attention given at all times to children who are held up on the issuance of
their work paper certificates, and children in such special classes as the anaemic and
sight conservation classes.
The work as done by the dentists consists of all necessary fillings of amalgam —
the various cements, and necessary extractions as well as actual prophylactic work
and instruction.
The nurse or registrar takes complete care of the clinic and of its clinical records,
as well as assisting the dentist while operating. She also does prophylactic work and
instruction.
The records that are kept are :
(a) Parent's consent card.
(b) Index reference cards.
(c) Case history cards.
(d) Daily record card of work done by dentist.
(e) Daily record card of work done by nurse or hygienist.
(f) Daily record of all work done in the cHnic.
(g) Weekly report cards of all work done in the clinic.
Interruption in the work of the clinics has been reflected in our figures for the
year. These interruptions were chiefly due to resignation and difficulty of replacement
by suitable persons.
Although the size of the dental staff remains the same as in previous years, the
amount of work performed shows a distinct increase. The figures for the year are
as follows :
Dental Work During 1919.
No. of cases brought forward (cases not completed in previous
year) •••• 4,313
No. of visits to the clinic (initial visits) 6,689
No. of re-visits to the clinic (visits necessary to complete work) 10,253
Total visits to clinic 16,942
No. discharged 5,4d3
No. cured (cases on which complete work has been done) 5,358
No. dropped (cases dropped for special reasons) 95
No. cases pending (work not complete on these at the termination of the
year) 1,238
No. 'Of treatments (a treatment is counted for every separate distinct item
in connection with dental work performed) 3/,662
Total number of extractions 16,191
Deciduous teeth 12,870
Permanent teeth 3,321
Fillings (of every variety) 13,437
Temporary fillings 1,256
Permanent fillings 12,181
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BUREAU OF CHILD HYGIENE
Cleanings 5,698
Other operations (indicates every item of work done for the child not
specially listed) 4,940
Visits by nurses to homes (with reference to special cases) 272
Operations (sum total of dental operations performed in child's mouth) .... Z2i,977
Special Nursing Features.
Chajiges have taken place in the nursing force of the Bureau during the past year,
due in a measure to the return of many nurses from military service abroad, and to
the great demand for public health nurses in other cities and communities offering
attractive inducements to those who have had experience such as the Bureau offers.
Numerous visitors come to this office from all over the country and even from foreign
parts who are engaged in public health work of one sort or another, who come for the
purpose of learning our methods of school and baby welfare nursing; numerous stu-
dents taking public health courses in the city come to us for their practical experience.
It has been the desire of the Superintendent of Nurses to broaden, in so far as it
is physically possible, the nurse's attitude towards her work and to make her better
able to cope with the problems that confront her in the performance of her daily
duties, by lectures and visits to special clinics.
The special assignments, such as malnutrition and other surveys, have taken much
time; it is gratifying to notice the intimate relation the nurse bears to the children
under her care in spite of the large number under supervision, ranging from 4,000
to 7,000 per nurse.
The children who have received the intensive instruction during the past year are
those suffering from malnutrition or some other form of under-nourishment ; dona-
tions have been made by philanthropic people who were impressed by the publicity
given ajnd by the large percentage of under-nourishment among school children. A
fund of $300 has been disposed of in buying milk for children of the public schools;
during the summer months large groups of children have been sent to the country,
using for this purpose every available facility at our command.
In connection with the Milk and Dairy Farm Exposition at the 71st Regiment
Armory during the month of April this Bureaiu equipped a booth representing a
Baby Health Station, at which there was a daily attendance of doctors and nurses
who instructed visitors, distributed literature, and explained the purpose of the Baby
Health Stations all visitors who showed an interest. A baby contest was held and
prizes distributed to the physically perfect babies attending the Baby Health Stations
throughout the city.
Issuance of Employment Certificates.
Notwithstanding the increase in the number of children applying for employment
certificates, this has been one of the few years in which legislation containing more
stringent provisions for the issuance of such certificates has not been enacted. This
does not mean that agencies interested in the welfare of children did not present or
support new measures; on the other hand, many bills were introduced, but failed to
pass during the sessions. Among the important measures concerning this phase of the
Department's aJctivities was a bill providing for the transfer of the issuance of employ-
ment certificates, together with the office personnel, to the Bureau of Attendance of
the Department of Education. The bill failed to pass. From present indications, many
new measures will be added to those of last year and introduced during the 1920
session of the legislature.
Public and private agencies interested in the question of vocational guidance and
junior placement have endeavored to interest the applicants in their activities and the
benefits to be derived by registering before entering industry. The Bureau of Child
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Hygiene, of the Department of Health, regrets that very little was accomplished in
this direction, for the reason that it was impossible to get the children to consider
the subject. They needed no assistance in locating positions and, generally speaking, all
preliminaries, including interview with prospective employer, date specified for entrance
and salary question, had received attention before application for a certihcate was
made. Invariably the salary was greatly in excess of that received by Department em-
ployees of the same age in similar assignments.
The Division has been confronted from time to time with various problems, involv-
ing the Child Labor Law, which seemed to work an injustice with certain applicants;
therefore, in the preparation of this report the officials in the different Boroughs were
asked for an opinion.
First — Elimination of the 130 days' attendance required of all applicants between
their thirteenth and fourteenth year, or the year preceding the date of application.
Many children graduate, and through neglect of the school authorities to inform them
that they nuist attend school or obtain an employment certificate, remain at home or
work illegally, and when the attendance off^icer visits the case, the child has been absent
and cannot supply the requisite number of days. This provision is excellent in checking
truancy for the undergraduate, but for children who have completed the elementary
course, it is unreasonable to insist upon their remaining in school marking time to
make up the 130 days. In this connection it is recommended that the Department
support any measure which provides for the elimination of this clause with reference
to graduates or children absent from school through illness.
Second — The repeal of the Summer vacation permit. This certificate permits
children over fourteen years of age who meet the school attendance requirement and
qualify physically, to be employed in mercantile establishments from July 1st to
August 31st. This temporary period of employment gives the child a taste of work,
and manv fail to return to school in the Fall until the attendance officer forces com-
pliance with the law : many employers fail to dispense with the child's service ; more-
over, very little choice of position is given and much adverse criticism has been voiced
regarding the destruction to mercantile establishments, as it is claimed that the modern
factory is superior to the store basement. Many employers are reluctant to employ
children and teach them the work for the temporary period of two months.
Third — Increase of age limit. At the Convocation on Education, held in Albany,
this was a much mooted question. During the session the increase was opposed by sev-
eral school authorities, while both manufacturer and labor urged its adoption. At the
final session one of the resolutions adopted for consideration in the Children's Code
bill was a sixteen years' age limit for employment of children in New York State. It
is quite certain that any legislation in this direction must be accompanied by a diversi-
fied curriculum to handle the 27,000 children retained in school.
During the year 50,866 applications were received for permanent certificates. The
physical examinations totaled 49,052 ; of these 26,036 were found normal or without
physical defects ; the remaining 23,016 comprise children with very slight defects, which
merely required advice ; others with minor defects requiring treatment and the with-
holding of certificates pending same, or cases in which defects were of such nature
as to refuse certificates outright; 4,437 children with minor physical defects were tem-
porarily withheld ; the defects were as follows, some children having more than one
defect :
Children with defective teeth 2,717
Children with defective vision 2.195
Children with acute eye diseases 29
Children with hypertrophied tonsils 266
Children with miscellaneous defects 509
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BUREAU OF CHILD HYGIENE
In these cases, after the defect was treated or corrected, the certificate was granted.
The courts handHng violations of the compulsory education law have objected to this
procedure. It may seem unnecessary to refuse a child for defective teeth or defective
vision, but the benefit to the childs health, which correction or treatment will procure,
is of paramount importance to the Department, irrespective of the temporary inconven-
ience due to the child's delay in entering industry. It is the aim of the Department
to place the child in a condition as near normal as possible and thereby lessen or safe-
guard against future defects arising from the effects of industry. When it is con-
sidered that approximately seventy-five per cent, of the cases, so delayed, are corrected
or treated and subsequently granted, that facilities are available for the treatment
without cost to the parent, and that only the obstinate or negligent cases are brought
into court, the benefit derived by the child in an improved physical condition seems to
warrant the continuance of the procedure. In the above classification "miscellaneous"
covers the temporarily withheld cases, which failed to obtain treatment and were
refused certificates. Permanent employment certificates permitting children between
fourteen and sixteen years of age to be employed in mercantile establishments or
factories were issued to 49,294 applicants. Summer vacation certificates were issued
to 4,736, and in 179 cases it was necessary to refuse certificates for the reasons stated
in the attached statistical report of the work of the Division.
During the temporary assignment of the Chief of the Division of Employment
Certificates to another branch of the City government, the New York Child Labor
Committee volunteered the services of its Assistant Secretary to direct the work of
the Division, and this assistance was gratefully received and appreciated during the
trying period of the annual June rush, when the Division was functioning from about
fourteen schools throughout the City.
The spirit of co-operation established in previous years with the Department of
Education and State Industrial Commission has continued. The former has a repre-
sentative assigned to the Manhattan and Brooklyn ofifice for the purpose of referring
undergraduates, as they receive their certificates, to the continuation classes in accord-
ance with the compulsory school law. In addition, the Assistant Director of the
Bureau of Child Hygiene has on several occasions examined children referred by the
Department to determine whether or not their education, as taught by private tutors,
or in private schools, is equivalent to that required by the law for an elementary school
course or completion of the sixth year. The State Industrial Committee has supervi-
sion over the issuance of certificates, and frequent conferences between Department
employees have been held and all violations found by Health Department employees
have been referred for investigation.
To improve the work of the Division of Employment Certificates the following
recommendations are made :
1. Legislation to exempt graduates from 130 days' attendance provision required
of applicants between the thirteenth and fourteenth year, or the year preceding appli-
cation.
2. The repeal of the summer vacation permit law.
3. An increase in the age limit to sixteen years, except for graduates.
Open-air Classes.
In 1904, the Sea Breeze Hospital, located at Coney Island, and caring for children
suffering from bone and gland tuberculosis, organized an open-air school for these
patients.
In 1908, Bellevue Hospital organized an open-air school on an old discarded ferry-
boat, which was properly altered for this purpose. It was called a day camp, as the
children remained there from 8:30 a. m. to 5 p. m. on school days.
177
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Others have been opened since, both on ferryboats and roofs of hospitals and
clinics. They are designated as day camps, and very successful results have been
demonstrated.
In 1910, an " anaemic class " was organized in P. S. 21, Manhattan, for children
who were physically sub-normal. The New York Tuberculosis Committee proposed
this experiment and they supplied the equipment and food.
In 1914, The Board of Education took over these classes in the schools and the
number has been increased each year. The scope of usefulness has also been widened,
as it has been demonstrated that with few exceptions every child will be benefited
under such an environment.
Children discharged from day camps or sanatoria as arrested cases were formerly
transferred to regular school classes. This exposed them to a relapse, and frequently
their work was also too tedious and the concentration required was more than they
could tolerate.
These children are now admitted to an open-air class whenever it is possible for
them to attend a school having such a class. Soon after, children exposed to tuber-
culosis in their homes were also admitted to the open-air classes.
In 1913 open-window classes were organized. These are classes where the teach-
ers are permitted to keep their windows open throughout the entire year. There is no
special selection of pupils, but an entire regular class is placed in one of these rooms.
There is no supervision of this work. The teacher has full control in the management
of her class. No data are available as to the results of open-window classes.
In March, 1917, the Board of Education requested the Health Department to take
full medical charge of the open-air classes, as the Board found that the medical
duties in these classes had increased to such an extent that they were unable to pro-
vide it. The Bureau of Child Hygiene assumed medical supervision of these classes
and was authorized to carry out the following duties :
1. To recommend organization of new classes.
2. To recommend location of classrooms.
3. To recommend proper equipment.
4. To recommend standards and exercise supervision as to ventilation, heating
and temperature classrooms are to maintain.
5. To recommend the pupils to be admitted.
6. To make periodical physical examinations of all pupils and notify parents as to
conditions found.
7. To make home visits for the purpose of conferring with, and advising parents
as to the need of correcting conditions found.
8. To supply teachers with full inform.ation as to conditions found and arrange
for co-operation between teacher, medical inspector and nurse.
9. To make routine medical inspection at definite intervals, for the purpose of
observing the physical status of the children and room conditions.
10. To supervise and direct weighing pupils monthly and measuring them each
term.
11. To make recommendations as to the discharge of pupils.
12. To prescribe physical training exercises for individual pupils.
These classes were formerly officially designated as "Anaemic Classes." As this
name gives an erroneous conception of the types of pupils admitted, the Bureau of
Child Hygiene recommended that they be called "Open-Air Classes."
By thus designating them the three types of classes with special ventilating meth-
ods are appropriately grouped, namely: (1) Outdoor Classes, (2) Open- Air Classes
and (3) Open-Window Classes.
Furthermore, by changing the name to "open-air" classes, the stigma which attached
178
BUREAU OF CHILD HYGIENE
itself to all pupils in "anaemic" classes is avoided, and these pupils are looked upon
as the same as those in regular classes. The parents do not object to give their con-
sent to their children being admitted to an open-air class, though they frequently
refused to have them admitted to an ''anaemic" class.
This report will only refer to one type of special ventilated classes; namely, open-
air classes.
The purpose of these classes is to make it possible for types of pupils whose
physical condition prevents them from attending school in regular classes to regain their
normal physical condition and at the same time to procure their education without any
loss of time.
The Bureau of Child Hygiene has established an organization to conduct this
work systematically and efficiently. The organization consists of:
1. The Director of Bureau.
2. The Assistant Director.
3. Supervising Medical Inspector of the Open-Air Classes.
4. District Supervising Medical Inspector of Schools.
5. District Supervising Nurse of Schools.
6. Medical Inspector of Schools.
7. Nurse of Schools.
The respective duties of the various divisions of this organization are:
1. Director :
In full charge of the work, directing and making final decisions as to
how the work is to be carried on .
2. Assistant Director :
The executive head of all work conducted in schools by the Bureau, to
whom the entire supervising force reports full details of all work performed.
He offers suggestions and ideas for improvement of the service. He sub-
mits to the Director for approval his recommendations and suggestions, as
well as those of the supervising staff.
3. Supervising Medical Inspector of Open-Air Classes :
The executive field head in charge of all the classes. He instructs the
district supervising force, medical inspectors, nurses and teachers, how the
work is to be conducted and how instructions are to be carried out. He
reports directly to Chief of Division.
4. District Supervising Medical Inspector of Schools.
In charge of a definite district. He is responsible for the character of
work performed by the medical inspectors of his district and is the general
adviser to the district supervising nurse assigned to his district. He reports
directly^ to the Chief of Division, who refers indicated communications to the
Supervisor of open-air classes for his approval and investigation.
5. District Supervising Nurse :
In charge of a definite district. She is responsible for the character of
work performed by the school nurses of her district. She reports directly
to the Chief of Division and the District Medical Supervisor of her district.
Her communications are referred by the Chief of Division to the Supervisor
of open-air classes for his approval and investigation.
6. Medical Inspector of Schools :
Assigned to definite schools. He is responsible for the admission and
discharge of pupils of open-air classes. He examines the pupils at regular
intervals, so as to advise what shall be done to improve their physical con-
dition, as well as to advise the nurse as to action required of her. He
makes home visits on absentees and on cases referred to him by the nurse.
He reports directly to the District Supervising Medical Inspector.
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
7. Nurse of Schools :
Assigned to definite schools. She is responsible for the weekly inspec-
tion of pupils. She carries out instructions of Medical Inspector, co-operates
with the teacher, visits homes, conducts school consultations, and performs
social service work. She reports directly to her District Supervising Nurse.
At present the following types of children are admitted to the Open-Air Classes :
1. Children exposed to tuberculosis at home or in whose family there has been a
recent death from this disease.
2. Children who have had tuberculosis which is now arrested or cured.
3. Children suffering from malnutrition.
4. Children who become tired easily or show languor or fatigue before the end
of the day and on this account are unable to carry on their class work.
5. Children suffering from nervous diseases except chorea.
6. Children who frequently are absent because of colds, bronchitis, etc.
7. Children suffering from cardiac disease who are recommended by the private
physician as being proper cases for these classes.
The number of classes when this work was officially begun by the Department of
Health, on February 1, 1917, was 84 classes. The number has since been increased to
107 classes on January 1, 1920. The increase is only limited on account of the lack
of available classrooms for this purpose and the lack of funds to provide the necessary
equipment.
Classes are located in public parks, roofs of schools and private buildings and in
classrooms located in the public schools.
The ideal rooms for our city are regular classrooms with an easterly and southerly
exposure, on a floor high enough to provide a maximum amount of light and air.
These rooms require only that the windows be altered so that they can be entirely
opened. However, such conditions are not available in all the buildings, especially the
old types, but it has been fully demonstrated that splendid results can be procured
in any classroom, providing it is large enough for the purpose and has an ample amount
of light and air.
Classrooms located in public parks or on roofs are too costly to fit up with the
proper amount of structural changes demanded and besides are very expensive to
maintain. While satisfactory conditions can be provided in the parks, the roofs in our
city are very objectionable because of the smoke, dirt and difficulty of providing
proper shelter from high winds, rain and snow.
The extra cost to provide the structural changes in a classroom located in a school
is comparatively little, and besides it costs no more than a regular room to maintain it.
There has been no difficulty in maintaining a full register in all the classes this
year. The attendance was also excellent, averaging much higher than the regular
classes. Fortunately, there was no epidemic this year that affected the attendance of
these classes. The Board of Education has established 25 as a maximum register in an
open-air class.
The equipment remains the same as last year. Each child has a sleeping bag. cot
and movable chair. On account of the lack of funds, however, no new equipment was
procured during the year, and it was also impossible to hav'e any damaged equipment
repaired.
The equipment used is the minimum that car be of any service. With this limited
equipment it becomes necessary for the children to provide themselves with a great
deal of extra clothing, sweaters, gloves and overshoes. The need of a better equipment
has been frequently discussed, but nothing can be done until the funds available will
make it possible to improve it.
180
BUREAU OF CHILD HYGIENE
It also appears essential that the teachers be provided with a proper equipment, so
that they will not find the low temperature unbearable.
The work has been conducted along the same lines as last year, as it has been
found unnecessary to change the instruction to medical inspectors, nurses and teachers.
The medical inspectors examine every child at the beginning and end of each term
and as often during the term as any individual child requires it. At each visit to a
school having open-air classes the nurse and teacher advise the medical inspector of
the condition of the children and particularly those who require his personal attention.
The nurses visit the classes at least once a week and keep the medical inspector
informed as to the condition of the children. As the nurses visit these schools daily,
the teacher is always able to reach the nurse in the event of any of the children
requiring special attention.
All data for each child is noted on the 296-K form, an individual card being kept
for each child.
The following-up is conducted in three ways: school consultations, home visits and
mothers' meetings. A regulation of the Associate City Superintendent of Schools in
charge of the open-air classes demands that the first home visit each term be made by
the class teacher.
The nurses hold scliool consultations and make home visits as often as the indi-
vidual cases require it.
In the event of any case requiring special attention the nurse refers it to the
medical inspector who holds a school consultation or makes a home visit according
to the needs of the individual cases referred to him.
Mothers' meetings are held monthly by the teachers and the medical inspectors and
nurses co-operate with the teachers at these meetings.
This year has been a very difficult one because of two conditions for which there
was no remedy. 1st — Lack of teachers. 2d — Lack of equipment.
1st. Though no teachers in the open-air clases resigned, there were, however, a
number of changes due to promotions. Many of these teachers hold licenses for
higher positions in the elementary and high schools. As the increase in salary for
the open-air class teachers was very little, many of them availed themselves of the
opportunity to procure a promotion. On this account a number of classes have new
teachers, and in some few instances there are classes still without any teacher. The
outlook, according to the opinion of the Associate City Superintendent in charge of
open-air classes, is not very bright, as he states that there will be a number who will
still receive promotions, and he has no one available to fill their places, at least not this
year.
2d. No new equipment was obtained during the year, and no equipment damaged
was repaired because of the lack of funds.
Some classes organized for more than two years are still without their equipment.
In regard to equipment the outlook is better, as there is quite a fund available ; in fact,
the Associate City Superintendent in charge of these classes believes he can now supply
or repair without leaving any equipment lacking.
The teachers assigned to open-air classes are exceptionally competent and inter-
ested in their work. They are now selected with great care, and the supervisor of
open-air classes is always consulted before an appointment is given. The principals all
now appreciate that no teacher is too good for this work, and in selecting one for their
class they are influenced by the qualifications which have been established as essential
for any one desiring to teach in one of these classes. These qualifications are : good
health; even temperament; capacity for doing a large amount of school Avork well.
as a number of grades must be taught; physical ability to make home visits; tact in
handling both children and parents ; willingness to do social service and a desire to
181
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
study the problems of this work in the class by reading and taking appropriate courses
of study.
The principals and teachers have afforded us full co-operation and are always
willing and anxious to do anything that will be of benefit to their individual pupils,
both in school and in their homes.
The classes all observe the following daily routine :
9-10 a. m School work
10-10 : 15 a. m Extra feeding
10:15-11 a. m School work
11-12 noon Rest period
12-1 p. m Lunch period
1-2 :45 p. m School work
2 :45-3 p. m Extra feeding
We have positively established the fact that the best results are obtained with an
a. m. rest period; that is, from 11 to 12 noon, directly before the lunch period. The
teachers are now unanimously in favor of this routine, as they all agree that a maxi-
mum amount of school work is done with a minimum amount of fatigue. At the final
dismissal at 3 p. m. none of the pupils show fatigue. Their p. m. school work is as
satisfactory as their a. m, is. Classes located on roofs or upper floors observe a rest
period from 1 to 1 :10 p. m., which is deducted from their a. m. one, so that the children
can get a short rest after climbing so many stairs.
While the original aim of this work was to care for some of the sub-normal
physical children, it has been now extended to all types of children physically sub-
normal, including cardiac disease cases. The cardiac disease cases must, however, be
recommended by their private or' hospital physician, as a satisfactory case for such
a class.
The number of applications now being received from physicians, requesting that
their patient be admitted to such a class, is steadily increasing, and, in fact, many must
now be refused on account of the lack of classes.
The work is in this respect sadly handicapped, as the classes can accommodate
but a small percentage of those desiring and needing the advantages offered in these
classes.
The number of school children exposed to tuberculosis in their homes is over ten
thousand (10,000), while the total capacity of all the classes is less than three thousand
(3,000). If the total number of other types of children that should have the benefits
afforded in these classes were added to the exposed cases, it would be found that fully
ninety thousand (90,000) children require such an environment. The present outlook,
however, does not give one hope of increasing the capacity of these classes materially
for several years.
The Board of Education, however, has promised and has already made provision
that at least one open-air class be built in every new school of average size.
The great need for more classes is also felt in the fact that it becomes necessary
frequently to discharge a child who has improved so much that it is deemed only fair
that another whose condition is bad be given the same opportunity. Many who regain
their physical condition would, however, be better off, were they able to remain indefi-
nitely in an open-air class, as many, though they do not go back physically, find it very
difficult to do their school work in a regular class, as they miss the advantages of the
open-air class, such as light, air, rest, extra feeding, etc., all of which are conducive
to real mental activity.
Another phase which has been studied in a very limited manner is the effect of
this environment upon the average normal child.
At P. S. 158, Manhattan, there is a class of normal average boys who are in an
182
BUREAU OF CHILD HYGIENE
open-air class and follow the full routine, except omitting the rest period. This has
been now conducted for five years, a new class each term, making ten (10) classes to
date. The classes have all been of the seventh and eighth years. The register has
always been over forty pupils. The results have been exceedingly good, as the class
each term has been the banner class of the district when the District Superintend-
ent's tests were held. The attendance has also been the best of the district. The
teacher in charge finds the boys do much better work, more of it, can concentrate
better and require less home work than those in regular classrooms. The teacher
states that he himself is never fatigued, is always able to do more work himself and
finds he can maintain his interest throughout the entire day.
This appears to be the next step in this work. If results can be procured for the
sub-normal physical child, would it not be of greater value to prevent the children
from becoming sub-normal by giving them the opportunities while normal that is now
only afforded in most instances to a limited few physical sub-normal pupils.
The rest period is not required by the average normal child, but the extra feeding
is, when they are in a low temperature for a considerable part of the day.
All the school work, except shop work and drawing, can be done in the open-
air classes.
We all know that the children in the kindergarten and first-year classes are better
physically than they will be after going to school for several years. Were they, how-
ever, to have the advantages oflfered in the open-air classes throughout their school
life, could it not be expected that at least the greater majority would leave school at
least physically normal? Besides, under such conditions, it would not be expecting
too much to have the infectious diseases, especially tuberculosis, greatly reduced, for
they all would surely be better physically when starting their commercial life.
Following the proper way to live so many years, as they would have to do during
their school life, would in most instances become a habit that most of them would
follow for the rest of their life.
The open-air classes as now conducted remain a study with big limitations; were
it extended to all children, no special classes would be required, and each classroom
could accommodate a full register instead of a limited few. This must be the ultimate
result that will be followed sooner or later, as the most progressive step in preventive
medicine.
So long as we have our present limitations, many problems remain unsolved. So
much has to do with the home condition or these children. The nurses and teachers
have done a great deal of social service work which must be part of their duties.
Conditions as at present exist make it very difficult to overcome home shortcomings.
One of the biggest problems is to provide proper medical attention. At times it is
difficult to get the parents to consent to having their children receive proper medical
or surgical care for the defects found by the medical inspectors. In most instances,
however, the nurses and teachers have gained the confidence of the parents who
willingly agree to have their children properly attended to. However, the facilities
are not at hand, and many a child is discharged from the class without having been
able to procure treatment. This applies especially to dental care. With few excep-
tions these classes are located in the poorer neighborhoods, and the parents cannot
afford to pay for treatment.
None of the available institutions are willing or appear to be able to care for all
the cases within a reasonable time.
Another problem is the lack of special training of the new teachers. There is no
proper course that they can take to fit them for this special work. No teacher ought
to be given a class until she has been correctly trained. A new teacher is of little use
to her class for the first two or three months she takes up the work, as in most cases
183
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
they have only taught one grade at a time. It requires practice and skill to teach
six or eight grades during one term.
Though mothers' meetings are held regularly, they are not systematically con-
ducted, and one of the great essentials of this work is to have, especially the mother,
understand what she can do for her child in regard to carrying out the proper home
conditions that will benefit her child. They must understand what results can be
procured before you can interest them to change their home conditions.
One of the greatest problems is to overcome the great loss these children have
during the summer vacation especially, though it is always apparent after shorter
ones. While we have been able to send a limited number away each summer, the
time they are away is so short that little is gained or if gained lost again on their
return to the city. Many of these children need a prolonged stay in the country
during the summer, but no places are available for such purposes.
A school farm would solve this to some extent, were it possible to procure it, as
the children could do enough of the work to make it nearly self-supporting. Over
50 per cent, of the gain made during the school session is lost during the summer
vacations.
The proper equipment is easily solved, as it only depends on the funds being
available for this purpose.
In our present method of work the inspectors and nurses have their regular school
work to conduct, and the open-air class work is extra. Many have no such classes.
Were it possible, a separate corps should be assigned to this work. They could be
properly trained, and the work would be regularly, systematically and uniformly done.
Frequently the work of the inspectors of the open-air classes is now interrupted or
interfered with on account of some special work that must be done or some emergen-
cies that arise. This work can never be done as well as it should be without a spe-
cial corps.
The mothers' meetings, home visits, school consultations and home conditions
require some personal qualifications which are not found in many of our corps. Per-
haps they do the best they can, but this is not adequate.
Milk has been supplied to nearly every class this year. The cereal and milk has
been dicontinued, because so much milk was procurable. The usual quantity given
was eight ounces twice a day, a. m. and p. m.
In the Boroughs of Manhattan, Bronx and Richmond each class provided its own
fund or received it from private sources. In the Boroughs of Brookljm and Queens
the Tuberculosis Committee of these boroughs supplied it for all the classes. The
children are urged to bring bread or rolls and butter to eat with their milk. In most
instances they bring more than an ample supply of food.
One has only to see how anxious the children are to eat and drink to be con-
vinced of the necessity of it. Likewise, those who do not partake of it never gain
or improve as much as those who do, and in time they also join in with the rest and
take their share very willingly and with great pleasure.
The number of physical defects which have not been properly corrected are con-
siderably less than last year. Permission is in most cases willingly given by the parents
to have their children properly cared for, but there is a great lack of institutional
facilities to procure the required treatment. In some instances teachers have been able
to interest private physicians sufficiently to get them to treat their pupils gratuitously.
Because of the lack of medical facilities and the inability of many to pay for private
treatment, many children whose parents consent to treatment cannot be cared for.
The social service work of the teachers and nurses has increased decidedly. The
supervising inspector of open-air classes has roused their interest in this part of the
184
BUREAU OF CHILD HYGIENE
work and proved the true value it has in procuring the desired results. The teachers
now all consider it an essential part of their duties.
The supervising inspector of open air classes held the usual meetings with the
teachers of these classes and gave a course of lectures on the medical aspect of this
work, so that the teachers should have a working knowledge of this phase of the work
to assist them in carrying out their duties with intelligence.
The home conditions have received a great deal of attention, and the results are
very satisfactory. The teachers and nurses have been able to interest most of the
mothers to correct any faulty conditions they found and, what is most important, to
have the children observe at home the same routine en days there are no school ses-
sions, as they carry out in school. Most of the children take extra feedings and
observe a rest period at home on days there is no school session. This has required a
great many home visits by the teachers and nurses, besides the mothers' meetings.
The waiting list is maintained in every school by the medical inspector. There is
no difficulty in procuring enough proper types of cases or in procuring parents' con-
sents to have these children transferred to an open-air class.
The supervising inspector of open-air classes has visited all the classes systemat-
ically and has held conferences with the principals, teachers, supervising medical
inspectors, supervising nurses, medical^inspectcrs and nurses in reference to the classes.
He has explained to them the various phases of the work and especially questions of
importance concerning their own classes. He has examined the records and explained
to the inspectors and nurses all errors found. He has attended and addressed many
parents' meetings.
As previously noted in past years, the essentials of this work are fresh air, food,
light, correction of physical defects that retard growth and development, and hygienic
home and living conditions. None of these can be slighted, and all must be observed
to procure satisfactory and lasting results.
Our health supervision is along the right lines« and our results depend entirely
upon the fact of how efficiently the work can be carried out.
The figures submitted give the best proof of results :
Work in the O pen-Air Classes of the Public Schools of New York City.
Number of schools with open air classes 78
Number of open-air classes 110
Register of classes 2,705
Number of pupils examined 3,388
Boys 1,423
Girls 1,965
Number found with defective vision 451
Glasses obtained 372
Number found with defective hearing 36
Treated 27
Number found with defective teeth 1.811
Treated 1,134
Number found with defective nasal breathing 396
Treated (operation) 161
Number found with hypertrophied tonsils 478
Treated (operation) 201
Number found with defective nutrition , 2,855
Improved in open-air classes 2,618
Number found with cardiac disease 96
Treated 96
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Number found with pulmonary disease 72
Treated 67
Number found with orthopedic defects 86
Treated 86
Number found with nervous affections 31
Treated 31
Total number of children discharged from classes 683
Total number of pretubercular children 628
Total number who gained 3,161
Total number who did not gain 214
Total number who lost 23
Work of Medical Inspectors.
Inspections 743
Regular physical examinations 3,688
Re-examinations 9,674
Work of Nurses.
Contagious Diseases :
Inspections 45,167
Instructions and treatments 12,344
Physical Defects :
Instructions at school 12,545
School consultations with parents 1,612
Cases terminated 926
Visits :
For contagious diseases 394
For physical defects 4,639
To dispensaries ' 241
To lectures 237
The method of weighing the children has improved and is now uniform, so that
the data are accurate. No child is considered to have improved unless a gain of at
least half a pound a month is made. The average gain during the year was more than
eight and a half pounds. Those who have not made a normal average gain are studied
by the medical inspectors to ascertain the cause of the failure to gain. In most
instances this is remedied and a gain quickly established.
The children show a proportionate gain according to the temperature — the lower
the temperature, the greater the gain. This seems to prove that it is not only fresh air,
but also a low temperature that is required to procure a rapid gain in weight. This
appears to be due to the fact that the appetite is remarkably increased during cold
weather. With the first signs of spring, the children fail to gain as rapidly, and one
can readily determine that their appetites immediately decrease. This is an observation
that has always been noted by those closely following this work.
Open-Air Scholarship Record.
The school progress of the children in the open-air classes is perhaps best demon-
strated by the following table, the data for which was supplied by the teachers of the
open-air classes :
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BUREAU OF CHILD HYGIENE
OPEN AIR SCHOLARSHIP.
Grades Advanced.
Progress as Compared to Previous Record.
More Than
One Grade.
One Grade.
Less Than
One Grade.
More
Rapidly.
Same Rate.
More
Slowly.
277
2,802
309
840
2,520
28
The few children who failed to progress at least as well as they did in their
former classes are backward children. It is readily appreciated that a mental defective
cannot progress pedagogically in an open-air class where the individual instruction
he requires cannot be offered to him, even though his phj'sical condition be brought to
normal. The classes have too many grades to permit the teachers to give much indi-
vidual instruction.
Results of Work in Open-Air Classes.
Last year a report was submitted of 367 children who were followed up after dis-
charge from open-air classes. These children were followed up again this year, and it
has been found that every one of them has continued to remain in good physical con«
dition, able to carry out the work of his or her regular grade.
This year 683 children were discharged from the open-air classes as fit to proceed
in a regular class. Of this number it has been possible to follow up 491 to the end of
this school year, with the following results :
CASES DISCHARGED FROM OPEN-AIR CLASSES
Gained Remained Lost Scholarship
Weight. Same Weight. Weight. Improved. Same.
Worse.
417 2 0 116 311
0
It has not been necessary to return a single child, discharged during the year, to
an open-air class because of loss in weight or because the physical condition became
so bad that they were unable to carry out successfully the work in a regular class.
These results are undoubtedly due to the fact that the medical inspectors exercise
great care in selecting children to be discharged from open air classes, and to the
further fact that the children continue to live as they were taught to do in the open-
air classes.
Summer Vacation.
The Association for Improving the Condition of the Poor cared for five hundred
boys of the open-air classes at their summer camp at Southfield, N. Y., during the
summer of 1918. They are to do the same again this summer for a like number of
boys. Those who had this splendid opportunity, all showed the benefits of their stay
in the country.
The Tuberculosis Committee of the Boroughs of Brooklyn and Queens opened
a camp on Long Island and will care for seventy-five girls of their boroughs, all
selected from the open-air classes, during the summer.
All the members of the Bureau of Child Hygiene whose work brings them in
touch with the open-air classes take this opportunity to express their thanks for the
hearty co-operation of the Associate City Superintendent in charge of special classes,
187
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
as well as to the principals and teachers, the various committees on prevention of tuber-
culosis and their respective supervisors, who follow up this work so closely.
The frequency that parents appeal to the inspectors, nurses and teachers to keep
their children in these classes because they have improved so much proves again its
value.
The results of children who have been discharged show that in most instances the
gain they have made is lasting, if not permanent.
All children improve physically.
Most of them improve in school work besides.
All learn hygiene living conditions.
All follow rules to maintain health.
Most have their physical defects corrected.
Cardiac cases markedly improve.
Arrested cases of tuberculosis have no relapses.
Exposed cases to tuberculosis maintain good health and do not acquire the disease.
They learn to eat proper food and to like it.
Supervision of Midwives and of Children Boarded in Private Homes.
The need of private homes for the board and care of children has been abnormally
acute during the past year, because of the unsettled economic and social conditions,
and these factors have made it exceedingly hard to obtain them. In the past, the
foundling keepers have been just able to meet the cost of food and clothing from the
compensation, but the increased cost of food and clothing and the scarcity even of
these necessities has decreased the number of those applying for permits as shown by
the following table ;
NUMBER OF PERMITS IN FORCE DECEMBER 31, 1911 TO 1919, INCLUSIVE.
1911 2,027
1912 2,835
1913 3,123
1914 4,234
1915 4,740
1916 5,330
1917 5,698
1918 3,238
1919 2,798
Routine Procedure in the Licensing and SuperTnsion of Homes.
Previous to 1918, homes were given permits for a maximum number of children.
During 1918 the policy was changed to issuing permits for a minimum number of chil-
dren. It was felt that in many instances, even with this change of procedures that
permits were issued for a larger number of children than the home was capable of
accommodating. Therefore, in 1919, permits were issued for the care and board of
one or two children, and where a permit was requested for three or more, two inspec-
tions were made by different medical inspectors, and the permit was issued for the
.smaller number. It is believed that this has placed a check on the overcrowding of
homes and has improved the conditions under which the children live and facilitated
their care not only by the permit holder, but by the Department.
Classification of Homes.
Homes are classified according to their adaptability to the care of breast fed and
artificially fed babies under two years of age and children from two to six years of
age and are graded according to their general moral and sanitary conditions. This
grading and classification of homes has facilitated the placing of children.
188
BUREAU OF CHILD HYGIENE
Co-operation with Other Agencies.
This Division has actively co-operated with the Department of Public Charities,
the Babies' Welfare Association and other agencies placing children. Lists of homes
properly classified and graded have been furnished. The Association for the Preven-
tion of Cruelty to Children has been furnished a monthly list of ntvt permit holders,
and this organization has greatly aided the Department in following up those who
have moved or who have obtained permits through false statements. The Division
has also co-operated with the Association in the prosecution of those violating the rules
and regulations governing the board and care of children. Through the activities of
this Association the Department has been able to remove children from undesirable
homes on short notice. The home boarding children received from parents or rela-
tives continues to be the greatest problem of the Department. It is among these
that there is the greatest neglect and violation of the rules and regulations governing
the board and care of children. Many of these delinquencies have been brought to
court, but with very little result. An exception to this is a case of a foundling keeper
of the Borough of Brooklyn who had constantly violated the regulations for a period
of four years. She had been brought to court no less than four times, but had always
been able to have the case dismissed or prolonged until it was tinally dropped. She
boarded children without a permit, and when a permit was granted boarded more than
allowed, openly defying the Department. This woman happened to live in a neighbor-
hood where a large number of permits were in force, and her attitude toward the
Department was demoralizing. Finally her case came up before a Magistrate who was
particularly interested in child welfare, and he went into it in detail, with the result
that she was convicted of violation of the Sanitary Code and fined. This particular
case required a great deal of preparation and time, which was compensated for, as it
improved the morale among all of the foundling keepers and also gave the inspectors
and nurses confidence in enforcing the regulations.
Registry Kept by Foundling Keepers.
During 1919, a special effort was made to have foundling keepers maintain their
registry of children boarded as required by the state law and the Sanitary Code. This
registry has aided the Department in fixing the responsibility for those who placed chil-
dren to board and has also been a check on the visits of the nurse and inspector.
Intcr-departiuental Co-operation.
Institutions and agencies placing children to board have been urged to avail them-
selves of the facilities offered in the care and feeding of infants and children at the
Department of Health Bab}' Health Stations. Many cases of mulnutrition, a common
condition in the homes of those boarding private children, have been cured as a result
of the supervision by the Baby Health Station doctor and nurse. Particular mention
should be made of the excellent work done at the Baby Health Station, 2155 Fifth
avenue, in this respect. The division nurses and inspectors have actively co-operated
with the Bureau of Preventible Diseases by reporting infection and possible tuberculo-
sis in the homes of foundling keepers. Every effort has been made to increase the
number of available wet nurses by requesting mothers of still-born babies and mothers
of babies who have died to wet-nurse the child of another. These mothers are required
to submit to an examination of their blood before they are allowed to receive a baby.
Study of Permits to Board and Care for Children.
Believing that there were a large number of permits in force which were not
utilized at all or to a lesser extent, a study of all permit holders was made with the
following results (table showing permits in force in relation to the number of chil-
dren actually in board) :
189
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Number
Nimiber of
Number
Number of Children Actually in Board
of
Children
Allowed
of
Permits
Total
Permits
in Force
on Same
Inactive
1
2
3
4
5
6
1. 836
836
319
517
517
2. 1,072
2,144
314
318
880
1,198
3. 587
1,761
138
74
220
795
1,089
4. 222
888
40
8
36
108
480
632
5. 71
355
8
1
8
48
44
155
256
6. 10
GO
2
12
15
12
39
Total, 2,798
6,044
821
918
1,144
951
536
170
12
3,731
Note. — The number noted under "total" should be the sum of the numbers
listed under 1, 2, 3, etc.
This table shows of 2,798 permits in force, 821 were not utilized. The largest num-
ber of permits were for two children and were utilized to the greatest extent; that a
total of 6,044 children were allowed to board on 2,798 permits, and that there were
actually in board 3,731 children on 1,977 active permits, an average of nearly two chil-
dren per permit.
Recommendations for the improvement in the methods of control of private homes
boarding children :
1. That all agencies placing children to board be required to obtain a permit to
do so, and that those holding permits to board children be required to receive chil-
dren only from agencies having a license to place them.
2. That the City compel all foundling keepers receiving City charges under two
years of age to register them at the nearest Department of Health Baby Health Sta-
tion and attend the station regularly.
3. That when the permit is mailed to a foundling keeper a copy of the rules and
regulations governing the board and care of children accompany it, or else have the
rules and regulations printed on the reverse side of the permit. Also that a circular
of infant and child care with the addresses of the various Baby Health Stations accom-
pany each permit.
Delinquencies of Foundling Keepers.
During 1919 a total of 19 permits were revoked for cause. Two hundred and fifty
complaints were received regarding foundling keepers and were investigated.
Supervision of Midwives.
During 1919 the Division tried to maintain an efficient control of the practice of
midwives in spite of the fact that conditions throughout the city were abnormal;
many physicians were still in war service; hospitals were overcrowded and the birth
rate abnormally high, through educational propaganda regarding the employment of
only those midwives who are well trained and who reflect their training in their per-
sonal appearance. This educational propaganda has resulted in the elimination of the
old type of midwife and the increased utilization of the better trained type. With these
handicaps the actively practicing midwives have delivered not quite as many cases as
formerly in the entire city, but have delivered more cases per midwife. Still there
has been no increase in sepsis or stillbirths. The following table shows the extent
of the practice of midwives, years 1909 to 1919, inclusive:
190
BUREAU OF CHILD HYGIENE
STATISTICS OF MIDWIFE PRACTICE.
Number of
Number of Births
Per Cent.
Year.
Midwives
Attended
of
Registered.
by Midwives.
Total Births.
1909
3,131
49,616
40.35
1910
1.515
51,996
40.28
1911
1,488
51,756
38.48
1912
1,325
52,743
38.88
1913
1,488
50,364
37.27
1914
1,488
52,997
37.69
1915
1,469
49,915
35.34
1916
1,799
46,487
33.78
1917
1,656
47,525
33.6
1918
1,612
42,307
30.6
1919
1,695
41,876
32.1
Suppurative Eye Cases.
This Division has been delegated in the control of suppurative eye conditions
which are reportable to the Department of Health under Section 91 of the Sanitary
Code. A tabulation of the cases reported shows the following:
SUPPURATIVE EYE DISEASES AMONG INFANTS.
1918.
1919.
Number of suppurative eye cases reported. .
Reported by midwives
Reported by physicians
Reported by institutions
Reported by other organizations
Number of cases cured
Number of cases blind
Number of cases partially blind
Moved and condition not known
True Ophthalmia.
Number of cases reported
Reported by midwives
Reported by physicians
Reported by institutions
Reported by other organizations
Number of cases cured
Number of cases blind
Number of cases partially blind
Moved, condition unknown
35
57
25
27
4
9
2
7
4
14
32
49
17
27
5
2
5
7
5
18
2
10
20
2
* Died.
A review of the foregoing table is gratifying, as it shows the infrequency with
which the midwife meets with true ophthalmia and that they are using the prophylactic
drops in most instances. Also that they are reporting suppurative eye conditions, as
the number of simple suppurative eye cases reported has increased from year to year,
and the number of cases of true ophthalmia has decreased. The results of the treat-
ment of these cases are also very gratifying. It is known that a large number of
cases visiting clinics and hospitals are not reported, and a questionaire has been sent
191
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
to each hospital and clinic requesting data as to the suppurative eye cases treated.
This information has been compiled and will form a basiis for a better co-operation
between those institutions interested in the prevention of suppurative eye conditions
and blindness, namely, the Department of Health and those who treat diseases of
the eye.
Puerperal Sepsis.
As in the case of suppurative eye conditions, this Division has also been delegated
in the control of puerperal sepsis. All reports of this illness are forwarded to the
Division, as are the certificates of death from childbirth. The following table gives
the facts regarding puerperal sepsis for the years 1915 to 1919, inclusiive :
PUERPERAL SEPSIS CASES.
Year.
Attended by Midwife.
Attended by Physician.
Attended by Hospital.
Fatal.
Non-fatal.
Fatal.
Non-fatal.
Fatal.
Non-fatal.
1915
1916
43
50
40
15
14
0
0
1
1
2
226
195
156
61
41
2
16
20
18
30
33
84
102
21
135
1917
70
1918
114
1919
72
The foregoing shows that there has been a marked decrease in fatal sepsis among
cases cared for by midwives, especially during the years 1918 and 1919. This decrease
has alsio occurred in the practice of private physicians. There has been an increase in
the number of deaths from sepsis in the cas'es attended in hospitals. This is explained,
it is believed, by the educational propaganda regarding the children of all primipara
and abnormal cases in hospitals.
Stillbirths.
During 1919, midwives attended a total of 42,204 living and stillbirths ; 41,876 living
and 328 stillbirths, showing a stillbirth rate of .078. Thisi is exceedingly low, as the
obstetrical authorities state that the stillbirth rate ranges from two to five per cent.
Delinquencies of Midwives.
During the year, 290 homes of midwives were reported as uncleanly ; 208 midwifery
bags were reported to be in an insanitary condition : 25 midwives were reported as
personally unclean; 2 midwifery permits were revoked for cause; 5 midwives were
arrested and found guilty as' charged; one was sent to prison. Alidwives registered
626 expectant mothers for prenatal care. The status for New York City in the control
of the practice of midwifery is shown by the fact that representatives were sent to
New York to observe our methods of control from Scotland, Dutch West Indies, New
Zealand, and from many cities of our own country. A branch of the Welfare Depart-
ment of the United States Government requested information as to our methods of
control of criminal practice, stating that abortionists were leaving New York for
practice in other cities.
192
BUREAU OF FOOD AND DRUGS
During 1919, the work of the Bureau of Food and Drugs, in protecting
the food supply of New York City, was vigorously pushed. The need for
greater activity was caused by the fact that, during the first six months of
the year, New York City was used, practically, as a port of debarkation.
A large percentage of the home-coming troops were demobilized in the
camps in the vicinity of New York City and this resulted in a continuous
welcome to the troops, which had the effect of materially increasing, tem-
porarily at least, the number of people in the City. The hotels were crowded
and, as a result, the volume of food consumed in the City was greatly
increased.
During the year 1919, in addition to the regular activities of this
Bureau, we were called upon to assist in a number of special activities.
Drug Addiction.
Owing to the enforcement of prohibition, it was feared that there would
be a material increase in the number of persons addicted to the use of habit-
forming drugs. A survey made in the spring of 1919, indicated that a
number of physicians and druggists were illegally prescribing and dispensing
narcotic drugs, and were doing it to increase and foster this habit.
In order to cope with this situation, the State Department of Narcotic
Drug Control, which was charged with the supervision of the sale of nar-
cotic drugs in New York State, cooperating with the Department of Health,
adopted special rules and regulations for the City of New York, and the
Commissioner of Health was designated as the agent of the State Depart-
ment of Narcotic Drug Control. Under these rules, every person addicted
to the use of cocaine or opium, or any of their derivatives, was required to
register with the Commissioner of Health. The Bureau of Food and Drugs
was placed in charge of this work. A registration office was established,
which was opened in June, 1919, at 128 Prince street. Borough of Man-
hattan.
The regulations of the State Department of Narcotic Drug Control
provided that a physician could not prescribe, and that a druggist
could not dispense, cocaine or opium or any of their derivatives, to a drug
addict, unless the addict could present an official Registration and Dosage
Card issued by the Commissioner of Health of New York City. This card
provided for the name and address of the addict; the sex; weight; height;
age; race or color; color of hair; color of eyes; nationality; occupation;
employer and his address ; and other marks of identification. The card was
signed by the Commissioner of Health, and the seal of the State Department
of Narcotic Drug Control was affixed. A photograph of the ad-
dict was also attached on the upper right-hand corner of the card.
193
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Attached to the card was a monthly dosage sheet on which the physician
prescribing the drug set forth the amount of drug prescribed, the kind of
drug prescribed, and signed his name. Space was also left for the signature
of the druggist who dispensed the drug. These dosage sheets were issued
each month and it was necessary for the addict to appear in person, at the
Registration Office, to obtain such dosage sheet. It could only be issued
when the addict presented the dosage sheet for the previous month,
showing that the narcotic drug had been obtained in a proper manner
and that the physician attending the addict was prescribing drugs in ac-
cordance with the State and Federal Laws.
During 1919, 6,579 addicts were registered by this Department. Of
this number, 5,047 were males and 1,532 were females.
The following is a table showing the age groupings of the addicts who
registered :
Age Groups.
Male.
Female.
Total.
16 to 20 years
21 to 25
72
1,653
1,515
935
480
314
65
13
14
365
515
296
188
109
28
17
86
2,018
26 to 30
2,030
31 to 35
1,231
36 to 40
668
41 to 50
423
51 to 60
93
Over 60
30
Totals
5,047
1,532
6,579
A table is also submitted showing the racial groupings of the addicts
who registered :
Racial Groups.
Male.
Female.
Total.
White
Black
Yellow
Red
4,588
454
5
1,190
342
5,778
796
5
Totals
5,047
1,532
6,579
In the early part of June, because of the activities of the State Depart-
ment of Narcotic Drug Control, and the activities of the Police Department
and this Department, a number of physicians who were illegally prescribing
for drug addicts, temporarily discontinued prescribing to such addicts.
As a result of this, their patients could not receive treatment, which caused
the addicts considerable distress. In order to meet this situation, the Com-
missioner of Health opened a Narcotic Clinic where these addicts could
194
BUREAU OF FOOD AND DRUGS
receive treatment pending their commitment to a hospital for treatment.
During 1919, there were 216,359 prescriptions filled at this Clinic, and
3,555 ounces of heroin and 1,125 ounces of morphine were dispensed.
During the year, 1,390 addicts were committed to hospitals for treat-
ment.
Milk
Cost of Milk.
The increased price of milk received considerable attention from the
Department of Health during 1919, and this Bureau was called upon to
conduct several investigations in connection therewith.
A survey was made by the Department of Health and, of 1,107 families,
it was found that :
1,294 children were suffering from malnutrition.
993 children were suffering from anaemia,
785 children were under normal weight,
608 children were suffering from other disorders,
3,648 children were found to be under-nourished.
As a result of the agitation due to the increased price of milk. Gov-
ernor Alfred E. Smith appointed a Fair Price Milk Committee for New
York City, and the Commissioner of Health was appointed as Chairman of
this Committee. This Bureau made a number of investigations for this
Committee and representatives visited and reported on milk conditions in
Philadelphia, Boston, Buffalo and Rochester. Surveys were also made by
the Bureau, which information was used by the Committee in compiling
its report to the Governor.
Amendments to the Sanitary Code.
During 1919 the following amendments to the Sanitary Code were
adopted :
Wood Alcohol Poisoning — Section 106, of the Sanitary Code, was
amended so as to require every hospital, institution, or dispensary, to report
immediately to the Department of Health the name, age and address of
every occupant or inmate therein, affected with wood alcohol or wood
naphtha poisoning.
This Section also makes it the duty of every physician to immediately
submit a similar report to the Department of Health, relative to any person
found by him to be affected with wood alcohol or wood naphtha poisoning.
Proprietary and Patent Medicines — Section 117 of the Sanitary Code,
Regulating the Sale of Proprietary and Patent Medicines, was amended so
as to conform to the objections raised by the Court of Appeals in Section
117, as originally adopted.
Food; to Be Protected from Dust, Dirt, Flies or Other Contamination
— Section 142, of the Sanitary Code, was amended so as to provide that
195
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
no candy, bread, pastry, or other bakery product intended for human con-
sumption shall be kept, sold, offered for sale, or displayed, in any open
window or doorway of a building, or upon any stand, or pushcart, wagon,
or other vehicle in any street or other pubUc place, unless such candy or
bread, pastry, or other bakery product is separately wrapped in paper or
contained in a cardboard box or other dust and flyproof wrapper or container.
Poultry Slaughter Houses — The regulations governing the approval of
poultry slaughter houses were amended so as to provide that no site for a
poultry slaughter house shall be approved by the Board of Health if it is
located over 200 feet from the waterfront, or located within a radius of
200 feet of a church, school, library, hospital, sanatorium or other public
or private institution, or it is located within 100 feet of a dwelling, tenement
house or apartment house.
Shellfish — Section 171 of the Sanitary Code, regulating the sale of
adulterated or misbranded shellfish, was amended so as to provide that
" shellfish shall be deemed to be adulterated, if, after removal from the
shell, they are cleansed in fresh water or water of a lower salinity than the
water in which they are grown."
Staff of Bureau.
In the Budget for the year 1919, there were practically no changes in
the personnel of this Bureau, the personnel of the Bureau being as follows :
Director 1
Assistant Director 1
Chiefs of Divisions 6
Inspectors of Food 100
Sanitary Inspectors 15
Veterinarians 8
Chemists 10
Laboratory Assistants 5
Clerks 20
Stenographers and Typewriters 4
Typewriting Copyists 3
Helpers 2
Laborer 1
Total 176
There were practically no changes in the organization of this Bureau
during 1919, the organization being as follows:
(a) Executive Office,
(b) Borough Offices.
Executive Office — The functions of the Bureau of Food and Drugs
w^ere directed and supervised through the Executive Office.
196
BUREAU OF FOOD AND DRUGS
The following functions: (1) Milk Supply, (2) Oyster Supply, (3)
Sale of fraudulent patent and proprietary' medicines, (4) Chemical Labora-
tory, were under central control, and were directed from the Executive
Office.
Borough Offices — In each Borough of New York City, a Division of
Food and Drug Inspection is maintained under the supervision of a Borough
Chief.
Their function is to supervise and inspect all food establishments ex-
cepting such as are under Central Control.
General Scope of Work of the Bureau.
As previously reported, the work of the Bureau was organized and
supervised with the idea of placing emphasis on the more important phases
of the food and drug supply.
In laying out any of the work of this Bureau, we always have before
us the following scheme in which the work is laid out in its relative impor-
tance, and we concentrate according to this arrangement of the work.
First — The inspection of food in its raw state at points of entry, such
as railroad terminals, piers and wholesale markets.
Second — The inspection of the factories where food products are man-
ufactured from the raw materials.
Third — Inspection of bakeries, restaurants and hotels.
Fourth — Exclusion of diseased food handlers.
Fifth — Inspection of retail stores.
Food Standards.
During the past, this Bureau has been handicapped to a great degree
by the lack of standards for many essential foods. The necessity for stand-
ards controlling ice cream was forcibly brought to mind by the results of
investigations by inspectors of this Bureau, which showed that ice cream
sold in the City was adulterated ; that it contained glue, and that the gelatin
used contained heavy poisonous metals.
Prosecutions could not be instituted owing to the fact that the amount of
poisonous metals found were in such quantities that it was almost, if not
impossible to secure expert testimony as to its deleterious effect upon the
human system. Some twenty court cases were held pending during the
year for this reason.
One hundred and twenty-one samples of ice cream were drawn from
the different factories and it was found that the butter fat in this product
ranged from 1% to 10% milk of butter fat. This ice cream was sold at a
wholesale price of from 35 to 50 cents per quart when sold loose. When
sold as " brick ice cream," 5 to 10 cents per quart was added. In cases
where this ice cream was sold in conjunction with ice cream sodas, the price
197
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
averaged 90 cents per quart. In a great many cases, ice cream sold to the
public was found to contain corn starch or other fillers, to the exclusion
of milk products. Although these products were not of a harmful nature,
nevertheless, it was misleading and fraudulent. The wide variance in the
butter fat content showed that the term " ice cream " was misleading and a
fraud was being perpetrated upon the public — for the price paid did not
control the quality of the article dispensed.
This Bureau, after conference with large and small manufacturers of
ice cream and gelatin, after consulting reports of other states and cities as
well as the United States Bureau of Chemistry and independent research
work and investigations, decided upon a standard for ice cream and gelatin,
and incorporated said findings in a report recommending the adoption of
two new sections of the Sanitary Code. This is only a preliminary in the
step to have food standards adopted for all essential foods in the City. This
is one of the most important activities that this Bureau can engage in, and
it is contemplated that, during the coming year, considerable time will be
given to this.
Milk Inspectioti.
Milk Strike — The dawn of the new year brought to our City its second
milk strike within less than three years. It was caused through the demand
of the Dairymen's League that the producers be paid $4.01 per 100 pounds
of milk containing 3 per cent, of butter fat, and the refusal of the various
dealers, through the New York Milk Conference Board, Inc., to pay more
than $3.60 per cwt. The regular producers began to withhold their milk on
January 1, 1919, and most of them continued to do so until January 18, 1919.
inclusive, when the local fluid milk dealers and the condensed milk interests
capitulated, and agreed to the terms of the dairymen. It was not until
January 21, 1919, however, that the City was receiving its complete supply
from the usual sources.
During the strike period, the dealers, in their endeavor to maintain their
businesses, and to supply the public with the milk it actually needed, drew
upon every available supply. As a result, milk was shipped from Phila-
delphia, Baltimore, Harrisburg, Pittsburg, Cleveland, Chicago, Boston, etc.,
and from smaller cities and towns, which, ordinarily, diverted their produce
to the larger cities mentioned. Before any of this " foreign " milk was per-
mitted sale in New York, the Department received telegraphic assurances
from the City which supervised its production and handling, that it was
produced and handled in accordance with the rules and regulations of that
particular City. As a further safeguard, all of this emergency supply was
ordered shipped to this City labeled, " To be Pasteurized," and was pas-
teurized, under the supervision of a representative of this Bureau, in one
of the approved plants. The usual force was augmented by inspectors as-
signed from the several borough offices, and, in this way, one or more
198
BUREAU OF FOOD AND DRUGS
inspectors were assigned to each pasteurizing plant in the City, during the
hours of operation. Careful supervision was also maintained at the railroad
terminals to see that all milk labeled " to be pasteurized " was forwarded to a
pasteurizing plant for treatment, before being offered for sale.
Reconstituted Milk and Cream — The manufacture and sale of recon-
stituted milk by the New York City Department of Farms and Markets has
been discontinued at both locations where this product was prepared dur-
ing 1918. A company, located at Richmond Hill, Borough of Queens,
arranged an ideal milk plant and began the manufacture of recon-
stituted cream, their sales being made mainly among the sour cream dealers.
Two or three other small dealers were also granted permits to manufacture
and sell this product, but, upon finding themselves unable to compete suc-
cessfully with the rest of the sour cream trade, the business was abandoned,
and attention turned to the manufacture and sale of a product, the ingredients
of which included vegetable oil, usually cocoanut butter.
Checking Work of Veterinarians — As indicated previously, one of the
veterinarians attached to this Division, was detailed to the physical exam-
ination of cattle, and the checking of tuberculin test charts with the cattle
themselves, at the ninety dairies located within the City limits, up to March
24, 1919. During the period from January 1, 1919, several lots of cows were
embargoed by him until they were properly ear-tagged, and otherwise pos-
itively identified by the veterinarian who tuberculin-tested them before ship-
ment. Two lots of cows, comprising 29 head, were held up because ol'
apparent irregularities in the original test. Upon the retest, only one reactor
was found, and the others were released for sale. In one shipment of 42
cows from Cortland, New York, it was found that six animals which had
reacted to the test, were included. These were embargoed, the facts pre-
sented to the Federal Bureau of Animal Industry, and the animals in question
slaughtered under federal supervision.
Country Milk Efficiency and Economy — As in the previous year, ar-
rangements were made with the General Passenger Agents of the various
railroad lines in the New York City milk shed, to have issued to each country
inspector special permission to ride on milk and freight trains. More than
ever before, it has been realized that this a contributing factor to efficient
milk inspection in the country.
Milk Surveys — During the year, several milk surveys were made, by
means of which the exact amount of milk arriving on one night at the various
railroad platform.s and terminals, for sale in Greater New York, was de-
termined. The minimum amount was found to be 1,794,058 quarts, while
the maximum was 2,088,632 quarts.
Milk Temperatures — The Winter of 1918-1919 was unusually mild and,
as a result, the ice crop was light, and of poor quality in general. Dairymen,
milk distributors and milk-carrying railroads were all handicapped, and ob-
tained either an insufficient supply of ice or none at all.
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Because of the unfavorable winter, it was realized early in the summer
that complete compliance with the official cooling regulations could not be
obtained without excluding at least 60 per cent, of the normal milk supply,
thereby bringing on a milk famine, and directly endangering human lives.
After a conference with officials of the New York Milk Conference
Board, Inc., and the Dairymen's League, Inc., it was decided that up to,
and including, September 30th, 1919, the cooling standards in the country and
city would be raised five degrees : i. e., the "A" milk in the country could
be accepted at a temperature of 55 degrees Fahrenheit ; the "B" milk in the
country at 65 degrees Fahrenheit ; and all milk in the City could be offered
for sale at a temperature as high as 55 degrees Fahrenheit. The Bacterio-
logical Standards, however, remained unchanged, and were enforced as if
no leeway had been allowed in the temperature standards.
Milk Exposition — The second annual exposition of milk, milk products,
milk-handling apparatus and machinery was held in the 71st Regiment
Armory during the week beginning April 21st. The attendance was large
and the exhibits were not only interesting, but extremely educational. This
Department, in addition to showing its usual milk data, charts, photographs,
and the like, conducted a laboratory booth, wherein were shown the official
methods of testing milk and cream for chemical and bacteriological content.
The departure created considerable interest and favorable comment.
Efficiency of Pasteurizers and Flash Pasteurization — During the year,
time, color and temperature tests were conducted on several of the continuous
pasteurizing outfits in the country plants. At most of these, it was deter-
mined that the holding period was less than the required 30 minutes. As
a result, larger apparatus was installed in some instances. In others, a third
holding tank was added ; and in still others, the milk pump was regulated so
as to force less milk through the holders.
Flash pasteurization of milk was detected on several occasions during
the year by the country inspectors: i. e., they found the milk being heated to
142 degrees Fahrenheit or higher, and then being cooled without any holding
whatever, or, possibly, for from five to fifteen minutes only. Among those
places where this violation was noted were Bridgewater, New York,
Leonardsville, N. Y. and Burdick's Crossing, N. Y. In all cases, such milk
was embargoed upon arrival in New York City, and was denatured or man-
ufactured into butter and cheese under the supervision of the inspectors.
City Pasteurizing Plants — The city pasteurizing plants were found, on
the whole, during the year, to be in satisfactory condition: that is, properly
equipped and operated. However, dirty piping, apparatus, cans and bottles
were found upon occasions. In all such instances, it was the policy to hold
up the entire process of milk-handling at the offending plant until the dirty
apparatus or utensils were suitably cleansed.
The help at these pasteurizing plants is strongly unionized and, natur-
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ally, the delays caused in the manner referred to above, in many cases, meant
overtime and payment of wages one and one-half times the usual rate.
Prosecutions — The usual attention was directed to the detection of
violations of Section 159 of the Sanitary Code (dirty empty containers),
and Regulation 144 (transferring milk on the streets) ; also to the misbrand-
ing of milk and milk products, as set out in Section 139 of the Sanitary Code.
Miscellaneous — On OctoDer 11. 1919, the harbor strike practically tied
up all ferry service from the State of New Jersey to this city, with the excep-
tion of the boats operated by the Delaware, Lackawanna and Western Rail-
road. As might be surmised, there followed a tie-up of part of our milk
supply, which, eventually, necessitated the re-routing of milk trains whose
terminals were located in the State of New Jersey, either over the New York
Central Lines via the Poughkeepsie Bridge, or over the Pennsylvania Lines,
through the North River Tunnels. With the exception of the first day, the
shortage of the milk supply was negligible, but, naturally, there was consid-
erable delay during the strike period. On November 1st, it was expected that
the threat of the milk wagon drivers to strike would be carried out. How-
ever, through the efforts of Governor Smith, the difficulties were arbitrated,
concessions made by the milk dealers and the union members, and a two-
year agreement consummated.
Enforcement of milk standards resulted in the following:
Degrading Grade "B" Plants 71
Degrading Grade "A" Past. Plants 6
Degrading Grade "A" Raw Plants 4
Excluding Grade "B" Plants 79
Excluding Grade "A" Past. Plants 1
Resumed on Probation (all sources) 103
Degrading order enforced, while on probation 14
Oysters and Other Shellfish.
During 1919, this Bureau enforced the law and the regulations govern-
ing the sale of shellfish in this city, especially oysters. Sections 164 and 171
of the Sanitary Code regulate the sale of oysters and prohibit the sale of
oysters which are adulterated or misbranded. All wholesale dealers in
oysters, local planters, and retail dealers receiving direct shipments from out
of town sources have proper permits. Numerous new permits were issued
and revoked for proper causes, and several applications for permits were
denied for failure or inability of the applicants to procure suitable credentials
from the Conservation Commissions and the Boards of Health of this and
other States.
Jamaica Bay — It is estimated that over 300,000 bushels of oysters were
planted in Jamaica Bay during the year. Young oysters or "set" were scarce
and high priced and, therefore, larger oysters, in greater number than ever
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
were planted. The bulk of the "sets" came from the waters of Long Island
Sound.
The regulations governing the sanitary and insanitary zones, as estab-
lished by the United States Government, were enforced. A patrol of Jamaica
Bay was maintained between April 15th and December 1st, and oysters sold
during the interim were floated for at least seven days in an approved area.
Hassock, John's and Garrettson's Creeks, and Mill Pond, were approved areas
during the year. Approval of these areas, except Hassock Creek, was with-
drawn for several weeks in August.
A mussel "set" in Jamaica Bay during the summer caused considerable
expense and annoyance to the oystermen.
A sanitary survey of the Bay was undertaken and the systematic record-
ing of every public and private sewer, cesspool, privy and dwelling house
was begun. The number and character of the vessels regularly plying the
waters of the Bay and their sanitary accommodations were reported on.
The taking of a census to determine the population on the bars, marshes and
islands within the Bay was inaugurated. All of the sewage disposal works
were visited and the treatment and character of the effluents observed. The
temperature, salinity and appearance of the waters over oyster fields, and
unusual tidal conditions, were recorded.
During the time the Bay was patrolled, the throwing of garbage and the
commission of other nuisances were abated by personal effort. Hundreds
of samples of Bay water and oysters were submitted for laboratory tests.
The results show that this body of water is dangerously polluted — the labora-
tory data are substantiated by the sanitary inspection. Millions of gallons
of raw sewage discharge daily in close proximity to intensively cultivated
oyster grounds. Large quantities of oysters from this Bay were consumed
in a raw state during the summer season.
Oysters grown in Jamaica Bay are prohibited for sale in this city
between April 15th and December 1st, unless transplanted in an unpolluted
area approved by this Department.
The Federal ban on inter-state shipments was lifted November 28, 1919.
During February and August considerable publicity was given Jamaica
Bay oysters. Two oystermen instituted civil actions in the courts against a
dye manufacturing concern, alleging that their oysters were colored with
dyes and rendered unsalable. The oystermen were awarded $24,500. Appeals
from these decisions are pending in the courts.
A plant for treating oysters electrically was established and maintained
on Ruffle Bar for about four months. The output from this plant was kept
under observation, and 156 pounds of oyster meats condemned. This plant
discontinued operations.
Raritan Bay {Princess Bay) — More than a million bushels of oysters
are growing on intensively cultivated beds in Raritan Bay. Rough stock
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and seed are used and, therefore, a goodly percentage are shells. The re-
stricted zones, including Great Kills Harbor, were kept under observation.
All except a few planters have discontinued placing oysters in the insanitary
zones. Clams are planted instead, and some of the bottoms are disused.
The oysters marketed from some of the beds during the summer had
a distinct petroleum odor. Investigation revealed that oil tankers returning
to this country in ballast pumped oil and unclean water in close proximity
to the shellfish bearing areas.
Large shipments of oysters from this Bay were made in interstate com-
merce. Shell oysters in carload lots were forwarded to the Pacific Coast and
planted in San Francisco Bay, for storage purposes. Nearly all shipments
were culled and prepared in Fulton Market. Numerous samples of oysters
were submitted for laboratory tests. Sanitary inspection of this Bay shows
its waters are polluted. Large quantities of oysters from this Bay were
consumed in a raw state during warm weather.
Out of Town Oysters — Samples of shellfish from every oyster growing
section on the Atlantic Coast, from Prince Edward Island, Canada, to Florida,
shipped into this market, were submitted for laboratory tests.
A sample of dried and smoked oysters from China was procured in this
market. Canned oysters of the so-called "cove" variety from Maryland,
South Carolina, Georgia and Florida were also sampled. A small percentage
of these oysters are consumed in the city, the balance being sent West in the
United States and for export to the West Indies and Europe. A sample
of dried oysters (oyster powder), manufactured in Virginia, was delivered
to the Chemist for examination.
A new preparation, called "clam concentrate," and consisting of clams
and oysters in the form of a jelly, was placed on the market this year. This
preparation is preserved with one-tenth of one per cent, of benzoate of soda
and is manufactured at Asbury Park, New Jersey. Samples were procured
to determine if same were legal.
Adulteration of Oysters by the Addition of Water — An investigation of
oysters which are "tanked," "washed" and "blown" was instituted in January
and a separate report forwarded showing that oysters are adulterated by the
addition of water. Paragraph 7 was added to the regulations adopted under
Section 171 of the Sanitary Code, in order to prevent this adulteration. Salt
is now used by the oystermen in the fresh water of the "blow tanks," in order
to comply with the law.
Quantity of Oysters Marketed — In round numbers, about one million
bushels of oysters were sold and consumed as food in this city. More than
165 persons and corporations shipped oysters into the City of New York.
Oysters were shipped from 33 different bays and harbors on the Atlantic
Coast, actually determined from tags removed from containers arriving in
this market.
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Clams, Mussels, Scallops — The sale of clams, mussels and scallops is
not regulated by this Department in the samei manner as oysters. There is
abundant proof in literature that clams, mussels and scallops are liable to
become agents in the spread of disease. Forty samples of clams were pro-
cured for bacteriological examination.
Approximately 48,000 bushels of mussels were delivered and consumed
in this city. Mussels grow naturally on Rockaway Bar and Long Island
Sound, and are cultivated in the waters of Cold Spring Harbor. Three
samples of mussels were submitted for laboratory tests.
Terminal Inspections and Wholesale Markets.
Borough of Manhattan — Owing to the general unrest of labor after the
close of war and during the past year much attention was given to the piers
and terminals, due to the many strikes called by the labor organizations
covering the longshoremen, drivers, express employees, etc., so that consider-
able time was given to the chief points of entry of foodstuffs. Although
in some instances large quantities of food were held on the piers, there was
comparatively no spoilage, which was probably due to the previous effective
work of the terminal squad. The shippers were particularly careful to have
the shipments come through in good condition, due to the increased cost of
transportation, as well as increased cost of material and labor, because the
seizure and destruction of the goods at this market would cause a heavy
financial loss.
Resultant of this state of affairs, there has been considerable improve-
ment in the quality and the conditions of the foodstuffs received at this Port,
so that, where normal conditions surrounding the shipment prevailed, the
food arrived in good condition. Wherever shipments were received which
consisted, in part, of decomposed or spoiled food materials, e\evy effort
was exerted by the inspectors to prevent the loss of the sound material
contained in the shipment, and in these efforts we were particularly suc-
cessful in preventing waste, the incentive being that the materials were worth
such a large amount of money that it was well worth overhauling the ship-
ment. This reconditioning process was always carried on under the imme-
diate supervision of an inspector, so that none of the spoiled materials would
enter into the commerce of the city.
During the strike situations referred to, when no deliveries of perishable
foods were being made, it was our purpose and desire to have such perishable
foods released so that deliveries were made under the supervision of an
official of this Department, and the work was carried on in such manner that
the strikers were not antagonized and were shown the necessity for taking
such action. This procedure prevented a considerable loss of money to the
shipper and also released for delivery large quantities of perishable products
to the consuming public. For instance, on June 23, 1919, during the strike of
the Teamsters' Association, when deliveries of perishable commodities were
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prohibited by the Union, a large shipment of berries, worth considerable
amount of money, was undergoing spoilage on the pier of the Hudson Navi-
gation Co., Pier 24, North River. Through the efforts of the representa-
tive of this Division, permission was obtained from the strikers to permit the
delivery of this material, so as to prevent a complete loss. Unfortunately,
however, due to adverse weather conditions, the fruit was unsuitable for the
general market requirements and was, therefore, diverted to food manufac-
turing establishments, owing to its being dead-ripe, and necessitated quick
action to prevent the entire loss.
In several instances, large shipments of oranges and lemons were located
on piers, and which had been abandoned by the consignee on account of the
spoiled food being in such a percentage, and the market being unsuitable and
unprofitable for them to overhaul the shipment. Instead of destroying the
entire lot, we were successful in our efforts to obtain these shipments, so
that the sound portion thereof could be used in the hospitals of this city,
with no cost to the City for good, wholesome fruit. In carrying out this
work, we were not only successful, therefore, in preventing the destruction of
sound material, but were also successful in distributing large quantities of
fruit to the City Hospitals.
These activities also applied to the inspection of foodstuffs at the
various wholesale markets, with the exception that, at the wholesale estab-
lishments, the inspectors were particularly keen to observe the conditions
surrounding the food materials, generally, and in several instances, especially
with the large packers, spoiled meats have been found in their possession and
under such circumstances as to indicate that, if the inspector had not found
such material, it would have been sold to the retailer and ultimately to the
consumer. In every instance where such materials had been found, a recom-
mendation has been made that the offending dealer be prosecuted.
It was also a pleasure to co-operate with the representatives of the
United States Army in having the inspectors visit the piers and wholesale
markets in company with officers from the Quartermaster's Department,
with the idea of showing them our methods of terminal inspection, and so
that they may be fully acquainted with the food inspection service and to
increase their knowledge of foodstuffs.
Borough of Brooklyn — The Borough Chief, Borough of Brooklyn,
reports the following : Despite our efforts for conservation, instead of con-
demnation of foodstuffs, consignees have refused to overhaul partly dam-
aged or deteriorated consignments, which resulted in a total loss of same.
Their contentions were that market and labor conditions did not warrant
their paying for overhauling. In some instances, all they derived was the
rebate of the duty ; and in other instances, the discharging of cargoes onto
unheated and improperly protected piers, or the shipping of perishable goods
in unrefrigerated ships, caused rapid deterioration.
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Factory Inspection.
The Borough Chief, Borough of Manhattan, reports as follows : As
previously indicated, the food factories of this Borough were inspected at
regular intervals, with the view to ascertain the quality of foods used in the
products manufactured, as well as the sanitary conditions surrounding such
manufacturing processes.
It is worthy of notation to report that the great majority of factories in
this Borough are operated by individuals and corporations who seem to make
every effort to comply with the laws.
In a number of instances, however, it was found that the unscrupulous
dealers were taking advantage of the public by using decomposed, spoiled
or otherwise unfit food materials in the manufacture of products sold by
them. Through the excellent work of inspectors assigned to this detail, we
were successful in locating a number of such dealers, and in each instance
where the spoiled material was found to be used in the manufacture of food,
the facts were forwarded with the recommendation that the dealer be
prosecuted.
A special investigation was also made early in the year to determine
if the product called "avizol" was being used in the manufacture of hard
candy. This investigation revealed the fact that, in some of the candy
factories "Avizol" was being used, and samples of the product manufactured
by the concerns were procured and submitted to the Chemical Laboratory
for analysis, where it was found that the candies contained sulphurous acid,
an added preservative, and the products therefore sold in violation of Section
139 of the Sanitary Code. The facts were submitted to the Advisory Com-
mittee for an opinion as the injuriousness of the product "avizol," and it
was their opinion that it is a deleterious substance and should be prohibited
in food products, especially those used by children. In view of this opinion,
the candy manufacturers were notified to immediately discontinue the use of
"avizol," and subsequent reinspections made failed to reveal that any manu-
facturer was continuing its use.
The Borough Chief, Borough of Brooklyn, reports as follows : The
knowledge gained by the observation of methods in the visiting of the various
kinds of factories and the imparting of same on subsequent visits to other
factories, has tended to correct many slipshod methods in the handling and
care of foodstuffs, which resulted in great conservation.
At a large jam and jelly manufacturing plant there were found 5,050
pounds of fruit pulp unfit for human consumption. Upon previous inspec-
tion of these premises, the inspector noted that their arrival was heralded
throughout the building by means of buzzers, telephone calls from floor to
floor and, subsequently, the two inspectors entered from different parts of the
building, one going direct to the cooking room and the other to the office.
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BUREAU OF FOOD AND DRUGS
The one going to the cooking room reached there in time to see this unwhole-
some food, which was about to be removed from the cooking room upon
the receipt of message from the office. The said message was overheard by
Inspector. Prosecution resulted in a fine of $100.
At a large factory dealing in farinaceous foods, the inspectors observed
the packing of unsound ground tapioca in one-pound packages for the retail
trade. The entire amount, mouldy and dirty tapioca (89,600 pounds), was
condemned as unfit for human consumption, prosecution was instituted and
the case is now pending in Court, as the firm in question has hired the most
expert testimony in the city to testify that mouldy and dirty tapioca is fit for
human consumption. Notwithstanding this testimony, the present indications
are that the Court will impose a substantial fine on this corporation.
At the premises of a candy dealer catering to peddlers who peddle candy
in the neighborhood of public schools of the city, there were found 900
pounds of chocolate-covered candy which, upon examination, was found to
be wormy. Prosecution resulted in a fine of $250 and a threat from the
Court that he intended to impose a jail sentence.
Upon examination, of pie sold at a large restaurant, it was found that
ingredients used were not up to the standard. Investigation was continued
at the large wholesale pie bakery concern supplying this restaurant, and there
was found a tub of mince pie filling ready for the oven and 1,485 pounds of
wormy raw fruit, said fruit containing water bugs and cockroaches. Prose-
cution resulted in a fine of $500.
At a large wholesale chocolate candy manufacturer, 2,400 pounds of
wormy and weevily corn flakes were found. Said firm makes a speciality of
manufacturing a cheap chocolate-covered cocoanut bar. Prosecution resulted
in a fine of $500. Evidence indicated the firm was scared and endeavored
to sell same to another manufacturer prior to its being found on their
premises.
At a number of the cheaper grades of candy factories there was found
in use, in the manufacture of hard candy, a product of which the active
principle is sulphurous acid. The said product, after investigation by the
Department of Health's Medical Advisory Board declared it to be injurious
to health, especially that of children.
Bakery Inspection
The Borough Chief, Borough of Manhattan, reports the following:
Bakeries of this Borough are under continued surveillance, both to deter-
mine the quality of foods used in the manufacture of products and the
sanitary conditions of the bakeries. Although the bakeries have been under
a sanitary certificate for a considerable length of time, it appears from the
reports of inspection, that many do not view the requirements of the State
Labor Law and of this Department with the proper attitude: that they
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
could and should maintain their bakery in a clean and satisfactory manner.
Attention is also given to the exposure of food products in bakeries as
to contamination, due to its being uncovered and unprotected from dust,
dirt and unwarranted human handling. Wherever such violations are
found, it is the duty of the inspectors to instruct the operator of the estab-
lishment as to the requirements concerning Secion 142 of the Sanitary
Code, and where the dealers fail to readjust their business methods to meet
the requirements of this Department, a summons is served.
Periodical night inspections of bakeries are made for the purpose of
examining the eggs used in the manufacture of cakes, etc. This activity is
of especial importance, in view of the present high cost of eggs and the
incentive of unscrupulous dealers to use decomposed eggs in their products.
The results obtained from this activity have been very satisfactory. These
night assignments are beneficial in that they have a moral effect upon the
bakers.
The Borough Chief, Borough of Brooklyn, reports the following:
Special attention has been directed to the use of substitutes of non-food
value for food value product in the manufacture of cakes and breadstuffs.
In addition, the question of investigation as to the use of petrolatum in
shortening for shortening of food value, was taken up. In these investiga-
tions, in two instances the use of saccharin, a coal-tar product of no food
value, was found being substituted for sugar which is of food value, in the
manufacture of charlotte russes. Prosecution was instituted in the said
instances and cases are pending.
Restaurant Inspection
The Borough Chief, Borough of Manhattan, reports the following:
Restaurant inspection is considered one of the most important activities,
as it deals direct with the public. Considering the fact that foods at the
present time are extremely high in prices, there is every incentive for
restaurant operators to buy and serve food of a questionable character.
The inspectors, therefore, are very diligent in carrying out this detail to
make sure that the food found in the restaurants is sound and wholesome
in every respect. Wherever unsound food is found, the facts are forwarded
for the attention of the Court.
Special attention is also given to the general sanitary conditions of the
establishment, and every care is taken to see that the glasses and utensils
used in the service and preparation of food are thoroughly cleansed after
each use. Upon inspections made, it appears that some of the dealers do
not pay proper attention to the requirements of the washing of drinking
glasses, and wherever such conditions are found, a summons is immediately
served.
In keeping with this activity, it is our desire, wherever possible, to
cause the dealers to install the use of individual drinking cups.
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Upon inspection of restaurants, special attention is also given to see
that each food handler possesses a card of physicial examination declaring
him to be free from an infectious or communicable disease. Wherever it
is found that the food handler does not possess such card, a reference is
immediately forwarded to the Bureau of Preventable Diseases for their
attention.
The Borough Chief, Borough of Brooklyn, reports the following:
In this character of establishment, especial attention is directed to the
quality of foodstuffs at premises, and to the sanitary conditions surround-
ing the preparing and handling and sale of same.
In addition, special attention is also given to the proper cleaning of
utensils and to the food handlers employed thereat being in possession
of Department of Health medical cards. Also, that foodstuffs displayed
thereat is properly protected to prevent contamination due to unwarranted
human handling or expose to dust, dirt or other offensive matter.
The Borough Chief, Borough of The Bronx, reports the following:
All of the restaurants situated in the public schools in this Borough were
inspected and put under permit. Some of these establishments were oper-
ated by private individuals and were found to be in a general insanitary
condition and it was found necessary to communicate with the Department
of Education to obtain compliance on many of the violations found. Con-
ditions that required structural alterations were attended to by the Depart-
ment of Education.
Retail Inspections
The Borough Chief, Borough of Manhattan, reports the following:
The work of the district inspector relates chiefly to the inspection of retail
food establishments such as groceries, butcher shops, bakeries, confection-
eries, restaurants, fish stores, etc., for the purpose of determining if the
quality of food held in these various establishments conforms with the
requirements of this Department, and to note also the sanitary conditions
under which they are handled. It is the duty of the district inspector to
report to the office, immediately, whenever spoiled foods are found in such
a condition as to indicate that they have been recently delivered by a whole-
sale dealer or distributor, so that a reinspection may be made at once at
the point of delivery and so prohibit further distribution. Whenever it is
found that the point of distribution is located outside of the jurisdiction
of this Division, a reference is forwarded at once to the Borough in which
the wholesaler is located so that they may take proper action.
In a great majority of the retail stores, the quality of food handled
is usually found to be up to the standard. In a few instances, considering
the large number of retail establishments, spoiled foods have been found
on sale, and whenever such is the case, a recommendation is made that
the dealer be prosecuted.
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
There has been considerable improvement in the sanitary condition of
establishments since the work has been arranged so that the district in-
spector can concentrate upon establishments of this character.
The Borough Chief, Borough of Brooklyn, reports the following:
A greater percentage of condemnations at retail establishments consists of
swelled canned goods because it is necessary, under the present system of
doing business in this line, that the retailer holds said canned goods until
the representative of the wholesaler sees same. Steps have been taken by
the Department to eliminate the necessity on the part of the retailer to do
this, and to arrange some system whereby they could, immediately upon
finding swelled canned goods, destroy same and be rebated on a percentage
basis for amount received, or some other method devised whereby the
possibility of prosecution for unsound goods would be minimized.
The Borough Chief, Borough of The Bronx, reports the following:
Although, in a great majority of instances, cooperation was obtained
from the storekeepers and sanitary conditions improved where warnings
were given by inspectors, it was found necessary, in 215 instances, to serve
summonses as a result of dirty stores. The fines imposed in these cases
amounted to $920.50.
On 254 cases prosecuted during the year as a result of foodstuff con-
demned (unsound eggs included) which cases resulted in fines totaling
$3276.00 being imposed, a great majority of such cases were a result of
unsound food being found in retail stores. Only in instances where there
is some reason to believe that such unsound food was to be sold, were such
cases taken to Court.
The Borough Chief, Borough of Queens, reports the following: The
inspection of retail stores is capable of being reduced to a routine proposi-
tion and while the work is not neglected in the inspection of these stores, it
is not rated on the same plane of importance with that of the factory,
bakery and restaurant inspection.
Meat Inspection
The Borough Chief, Borough of Manhattan, reports the following:
Specially trained and qualified inspectors were detailed to make inspections
and thorough examinations of carcases and parts thereof which arrive
in the City. Whenever meat is received which is apparently diseased, or
of a questionable character, which requires the opinion of a technical
expert, a veterinarian who is also assigned to this squad of inspectors is
called upon to make his examination and dispose of the questionable
material.
The Borough Chief, Borough of The Bronx, reports the following:
During the latter part of the year, particular attention was directed to the
inspection of hogs on the twenty hog farms in this Borough, with the result
that on three farms, cases of hog cholera were located. On all of these
210
BUREAU OF FOOD AND DRUGS
farms, quarantine was immediately established and daily inspections made
until disease had disappeared.
As a result of this outbreak the veterinarian condemned 109 of these
hogs, weighing 2900 pounds. Hog cholera serum, which was injected un-
der the direction of this veterinarian, resulted in the saving of many of
these animals.
Food Adulteration
The Borough Chief, Borough of Manhattan, reports the following:
Owing to the scarcity of imported pure olive oil, many of the dealers,
especially those of the foreign element who deal in canned oils and make
a business of filling cans of oil, resorted to the practice of using cans which
were so labeled and marked as to convey the impression to the purchaser
that the oil contained within the cans was imported pure olive oil, whereas,
upon analysis, it was found that the oil was not pure, but was a compound
consisting of a greater portion of cotton seed oil, and, in some instances,
sesame oil: thereby perpetrating a fraud upon the public in that the oil
was sold at a price far above that which should be charged for compound
oil, and also in giving the impression that it was imported olive oil, when,
in fact, it was not. We were successful in forwarding the facts in a num-
ber of instances of this character so that the facts could be brought before
the attention of the Court. In each of the cases tried, thus far, the Court
has imposed a substantial fine.
An investigation was also made to determine if ground coffee contained
cereals, chickory or other adulterants. This investigation revealed the fact
that several of the dealers were selling the adulterated article as being the
pure ground cofifee, and, in each instance, a recommendation was made that
the concern be prosecuted.
An investigation was also made concerning the sale of so-called egg
substitutes. It was found, as the result of this investigation, that prepara-
tions of this type do not enjoy any extensive sale in this City. From in-
formation obtained, it appeared that the product sold as tgg substitute did
not produce satisfactory results in baking, which probably accounts for
the unpopularity of the preparations of this type.
In several instances, it was also found that pure dried eggs were
sold under misleading conditions, in that statements were made on the
label or other printed matter, indicating that a certain quantity of the egg
would produce the same results as a given quantity of shell eggs. From the
facts obtained from the Federal authorities, as to the egg standards, hear-
ings were given the distributors of this misbranded product and, in each
instance, the labelling was corrected so as to conform with the requirements
of this Department.
This is also true of a sample of powdered milk which was so worded
211
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
as to convey the impression that a given quantity of powdered skimmed milk
would produce a certain amount of liquid milk. Needless to say, this was
misleading in that skimmed milk powder can only produce skimmed milk
when mixed with the proper proportion of water and, therefore, the product
was considered misbranded within the meaning of the Sanitary Code provi-
sions. A hearing was held which resulted in the dealer correcting and
modifying the printed matter, so as to conform with the legal requirements.
An investigation was made to determine if a high grade technical glue
was being sold as food gelatin. This investigation revealed the fact that
this fraud is being practiced, and in one instance, we were successful in
obtaining samples of so-called food gelatin from a concern who buys
nothing but glue. The samples are now at the Chemical Laboratory awaiting
analysis.
The Borough Chief, Borough of Brooklyn, reports the following:
Olive oil dealers were found, in numerous instances, adulterating pure olive
oil with cotton seed oil. Prosecution was instituted.
Beverage dealers, in many instances, were found labelling their product
so as to deceive or mislead the purchaser: i. e., in that said label did not
specify that the article in question had been artificially colored or flavored,
or that article in question was a compound, imitation or blend. Said con-
dition was corrected by summoning dealer to the office, which resulted in
correction of label.
Egg substitute dealers were found to be labeling their product either
with a picture of a hen or eggs, or wording purporting that same contained
eggs, whereas, as a matter of fact, the same did not. Said conditions were
corrected.
Exposure of Foods on Streets.
The Borough Chief, Borough of Manhattan, reports the following:
With reference to Section 142 of the Sanitary Code, I would state that the
inspectors paid particular attention to the exposure of food within establish-
ments where such food was exposed to contamination and unwarranted
human handling. It is the policy of this Division to give a warning and in-
struct the operator of the establishment as to the requirements of this
Department. After reinspections had been made and no apparent efforts
exerted by the operator to remove the violations or modify his business
methods so as to have the establishment conform with the requirements of
this Department, a summons was served.
Cleansing of Utensils.
The Borough Chief, Borough of Manhattan, reports as follows : Par-
ticular attention has been given by the district inspectors, and from time to
time by special squads, to the requirements of Section 144 of the Sanitary
212
BUREAU OF FOOD AND DRUGS
Code, which provides that utensils used in the service of food or drink should
be properly cleansed after use. This code section is considered by us to
be one of the most important in that improperly washed utensils, which have
been subjected to contamination by the use of a person suffering from a
contagious or communicable disease, is of utmost importance to the general
public welfare ; therefore this special attention. Unfortunately, however,
the Magistrates do not view this important requirement with the proper
attention, in that inadequate fines are usually imposed, so that food dealers
who have been served with a summons and upon appearing before the
Court, find that they only have to pay a small amount of money and are
not impressed with the necessity of properly observing this important
code section.
Prosecutions.
The Borough Chief, Borough of Manhattan, reports as follows: A
number of important cases have been forwarded against various food dealers
charged with having violated Sanitary Code Sections. In presenting these
cases at Court, the inspectors have given their testimony in such a manner
that, in many instances, it was necessary for them to qualify as experts
before important facts surrounding the case could be given ; and as a result
of this training, in very few instances did we have acquittals of any impor-
tant case.
With reference to the enforcement of minor code sections which are
disposed of in the Magistrates' Court. I would state that the inspectors have
been particularly active in bringing to the attention of the Court all flagrant
violations. Unfortunately, however, the Magistrates do not view these
code sections with sufficient importance so that, in a great many instances,
our activities along these line.'i do not produce very satisfactory results.
Co-operation.
The Borough Chief. Borough of Manhattan, reports as follows: It
has been our policy to co-operate with all other food, drug, police and
other City officials so as to co-ordinate our activities and prevent, as far
as possible, a duplication of inspectorial work, and so as not to interfere
with investigations being carried on by other otTicial bodies.
As examples of the co-operation with the Federal authorities, I would
report that, at their request, a number of seizures of adulterated scallops
and other foodstuffs were made. This activity prevented the distribution
of food which did not conform with the Feneral requirements.
Co-operation was also obtained with the U. S. Department of Agri-
culture which carries on a study of plant disease. This statement applies
especially to several large shipments of tomatoes which arrived in this City
in an extremely poor condition and which presented an unusual appearance.
213
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
A study of this condition by the Federal authorities, at our request, resulted
in the statement that the tomatoes were affected with a peculiar disease,
and they communicated with their field agent in California from whence
the shipments were made so that a thorough field investigation could be
carried out and, if possible, prevent further loss of tomato shipments. This
activity was of utmost importance because it undoubtedly prevented the
complete loss of large shipments from that section of the country.
In several instances, information was received from the Police authori-
ties that deaths had been caused by the consumption of a liquor said to
contain "wood alcohol." In each instance qualified inspectors were im-
mediately assigned to act in co-operation with the Police so that, wherever
possible, samples of suspected liquors were obtained and immediately sub-
mitted to the Chemical Laboratory of this Department for analysis.
In several instances, also, the Jersey health authorities have called upon
us for assistance in carrying out investigations which relate to a certain
extent to food dealers operating in that city. At their request, inspectors
were detailed to work in conjunction with their inspectors. Through this
activity, in one instance, a discovery was made of a milk dealer deliberately
adding water to milk which, undoubtedly, would have been brought into
this City. These facts were given to the Jersey authorities so that they
could take proper action.
From time to time, investigations have been made of drug stores, which
resulted in the finding of several violations of the State Pharmacy Law,
which is enforced by the New York State Board of Pharmacy. In each
instance a ftdl and complete report was forwarded to that Board so that
they would be conversant with the facts and take whatever action they
deemed advisable.
Other Items of Interest.
The Borough Chief, Borough of Manhattan, reports as follows: Dur-
ing the latter part of the year and due to the enforcement of law which
prohibits the sale of intoxicating liquors, many deaths were reported as the
result of consuming liquors which contained, in a large part, wood or methyl
alcohol. It was our idea to prevent, as far as possible, the sale of such
liquors, and a detail of specially trained inspectors was arranged so that
each section of the borough was covered and field tests were made at saloons
or other points where intoxicating liquors were found. Thousands of sam-
ples were examined, and we were unsuccessful in locating any liquor con-
taining wood alcohol at these distributing points. It appeared, therefore,
that much of this prohibited compound was sold by peddlers or other irre-
sponsible persons, and that the majority of the saloon keepers were selling
liquors which did not contain wood alcohol.
214
BUREAU OF FOOD AND DRUGS
Chemical Laboratory.
The analytical work is grouped in natural divisions, namely :
1. Milk and Cream.
2. General Food Analyses.
3. Drug Analyses.
4. Water Analyses.
5. Miscellaneous Analyses.
Microscopic determination was used whenever appliable.
The total number of milk and cream samples examined (including —
for milk — the determination of total solids, fats, solids not fat, water, and
preservatives: for cream — the determination of fat content and preserva-
tives) is as follows:
Table I.
Found
Adulterated.
MUks 7882 1499
Creams 3705 1162
Preservatives were not found in any sample of milk or cream.
Milk analyses during the year show an average adulteration of 19 per
cent. The greatest number of adulterations occurred during the first months
of the year. Table II, gives the monthly adulteration :
Table II.
Per cent, found
adulterated
January 18%
February 27%
March 10%
April 14%
May 7%
June 12%
July 13%
August 17%
September 11%
October 9%
November 8%
December 8%
The. average for cream adulteration was 31 per cent. These occurred
also, in greater number, during the first months of the year. Table III gives
the monthly adulteration:
215
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Table III.
Per cent, found
adulterated
January 28%
February 36%
March 9%
April 7%
May 18%
June 10%
July 16%
August 10%
September 6%
October 8%
November 9%
December 5%
Comparison during the years 1918 and 1919 are as follows :
Table IV.
Percentage of Adulteration.
1918.
1919.
Milks
Creams
20%
51%
19%
31%
General Food Analyses include the following substances given in Table
V, with the total number examined and those found adulterated.
The most important of these substances is the alcoholic group. Methyl
alcohol, as an adulterant of alcoholic liquors, has been found for years
in a small percentage of cases and has occurred only sporadically.
216
BUREAU OF FOOD AND DRUGS
Table V.
ANALYTICAL WORK OF CHEMICAL LABORATORY DURING 1919.
Alcoholic beverages
Bread, flour and tapioca.
Candy, ice cream, etc
Coloring matter
Condensed milk
Condiments, catsup, pickles, etc. . . .
Disinfectants and preservatives
Dairy products — eggs, butter, cheese,
lard, etc
Fish, canned, etc
Fruits, canned, dried, etc
Flavoring extracts
Meats, canned, pres., etc.
Non-alcoholic beverages. .
Oils, olive
Preserves
Soups
Spices
Sugars and sjTups . . ,
Teas, coffees, cocoas .
Vegetables, canned, etc. .
Found Adulterated.
7 Contained wood alcohol.
1 Flour — contained moulds.
1 Flour — was potato starch.
1 Tapioca — dirty.
15 Candy — contained sulphur dioxide.
15 Unfit for food.
2 Mustard — contained salicylic acid.
1 Prawn.
1 Figs.
1 Raisins.
4 Chopped meat — contained sulphur dioxide.
1 Corned beef.
12 Contained alcohol.
2 Soda — contained starch.
52 Contained cottonseed oil.
23 Cocoa — contained dirt.
1 Coffee — contained chicory.
Foods containing moulds and bacteria, or decomposed foods of animal
or vegetable origin, may be dangerous to health and are, therefore, for-
bidden by the Sanitary Code.
The Laboratory, during the year, has supported the examination of
the food inspectors where embargoes were placed upon suspected foods.
Samples of flour, condensed milk, prawn, figs, raisins and corned beef were
condemned for the foregoing reason.
One hundred and twenty-one samples of confectionery were found to
comply with the requirements of the Sanitary Code, with the exception of
15 samples of candy containing sulphur dioxide, not stated upon the label.
Owing to foreign export restrictions upon olive oil during the war, the
supply of olive oil in the United States has been greatly decreased and the
temptation to substitute other edible oils for olive oil, wholly or in part,
has been great. This is shown by the fact that of 242 samples represented
to be olive oil, 21 per cent, contained, or were substituted by. cottonseed oil.
Though sugar has been scarce and expensive, examination of samples
taken on complaint and in the regular course of inspection were found to
be unadulterated.
Canned vegetables brought to the Laboratory through complaint and
routine regular inspection were found to be unadulterated. Chemical pre-
servatives not stated on the label appear to be becoming a custom of the
past, judging from the analytical records of the Laboratory.
217
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Salicylic acid was found in two samples of mustard and sulphur di-
oxide in four samples of chopped meat. Sulphur dioxide found in the
candy samples was not introduced by the candy manufacturer, but is a
by-product in the manufacture of glucose that had not been entirely removed.
Drug Analyses — The examination of drugs and medicines includes, not
only finished products, but also crude drugs.
Chemical examination and microscopical examination was applied,
in some cases supplementing each other, in other cases, alone.
Table VI gives the list of such substances analyzed and the large num-
ber of adulterated samples, 91, of a total of 676, or 13.3 per cent., indicating
the scope of the work necessary, as these samples came from all sources
of sale in various parts of the City. These samples, for the most part,
represent retail dealers.
Table VI.
Drug Analyses During 1919.
Total Found
Exam- Adulter-
ined ated
Drugs and Medicines 676 1 Denatured Alcohol
4 Aspirin Tablets.
1 Bay Rum,
5 Citrate Magnesia.
1 Syr. White Pine Comp.
1 Tr. Gentian.
1 Headache Powder.
1 Tr. Larkspur.
17 Lime Waters.
3 Ammonium Liniment.
1 Soap Liniment.
1 Sweet Spirits of Nitre.
7 Zinc Ointment.
7 Prescriptions.
2 Rhubarb and Soda.
4 Seidlitz Powder.
1 Spirits of Camphor.
1 Guaiacol Carb. Tablets.
1 Tr. Iodine.
1 Sp. Vini Rect.
21 Breast Tea.
2 Chamomile Flowers.
2 Asafoetida.
1 Buchu Leaves.
1 Belladonnae Leaves.
1 Crocus.
2 Dried Raspberries.
1 Valerian.
218
BUREAU OF FOOD AND DRUGS
The adulterations fall into the following groups:
1. Mislabeling — example — Denatured Alcohol.
2. Substitution — example — Breast Tea — Chamomile Flowers — Cotton-
seed oil for sesame oil in ammonium liniment; vaseline in place of ben-
zoinated lard in zinc ointment.
3. Short weight — example — Seidlitz powders ; ethyl nitrate in sweet
spirits of nitre, and prescriptions.
4. Insufficient amount of drug in solution — example — Lime water;
magnesium carbonate in citrate of magnesia; glycerin in rhubarb and soda.
5. Excess of stems in crude drugs — example — Buchu leaves; Bella-
donnae leaves.
6. Excess of Ash in Crude Drugs — example — Belladonnae; Aloes;
Myrrhae ; Capsicum ; Asaf oetida ; Senna ; Cubeb.
Wood alcohol was absent in all samples calling for alcohol.
Table VII, gives the list of crude drugs with adulterations :
TABLE VII.
Samples
Examined.
Found
Adulterated.
Breast tea
Anise
Jalap
Belladonna
Chamomile
Senna
Tragacanth
Myrrh
Rhubarb
Lycopodium
Althea
Digitalis
Arnica
Aloes
Asaf oetida
Licorice
Saffron
Cantharides
Raspberries
Ergot
Acacia
Capsicum
Buchu
Cigarettes
Nux Vomica
Cubeb
Valerian
Senega
Fennel
Hydrastis
Sassafras
Juniper
Colchicum
Hiera Picra
Sarsaparilla
Comp. licorice powder
Stramonium
Tilia
Gentian
Guaiac
Total
219
59
10
12
8
16
19
2
4
17
3
5
12
2
11
10
1
5
3
26
1
1
4
2
2
2
3
5
1
2
2
1
1
1
2
1
4
1
1
1
21
269
30
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Of the total number of samples received by the Chemical Laboratory
during the year and excluding milk laboratory samples, approximately
21.9 per cent, were examined miscroscopically.
The Laboratory is very fortunate in having micro-analytical facilities
of an especially high order with the privileges and advantages offered by the
College of Pharmacy of Columbia University. An excerpt from a statement
of the Micro-analyst regarding his work for the past year is given as bearing
very definitely upon this work.
"Drugs — Systematic inspection of wholesale establishments dealing in crude drugs
is made, reserving a day each week or two for the purpose ; and providing for rein-
spection at suitable intervals. The chemist should, if possible, accompany the inspector
on these visits. This plan permits greater and more varied inspection without over-
loading the laboratory with samples which are of good quality. It brings the labora-
tory service to the source of the material undergoing inspection. A definite list of
items liable to adulteration or sophistication should be established for use of the inspec-
tors when they are working alone. Items for which the official specifications are not
definite, or which are not official, should be omitted from such a list or provision be
made in the Sanitary Code to cover these instances.
"Foods — This Laboratory is probably the only Municipal Laboratory in the coun-
try which has the facilities for extensive and intelligent work in the microscopy of
foods. In many instances, chemical analysis fails to give the information most de-
sired in regard to a foodstuff. In almost every prosecution where the mircro-analyst
has testified, the Department has secured a penalty. There is a great opportunity fof
systematic work on manufactured foodstuffs and the issuance of bulletins regarding
the results of inspection and analysis."
The recommendation that the analyst be present to take samples of crude
drugs personally from wholesale houses, is especially important and has
been carried on to some extent.
The importance of microscopy applied to foods is shown by the follow-
ing list of foods examined in this way partially, or entirely :
6 Candy.
2 Water.
2 Frankfurters.
1 Coriander.
1 Prawn.
1 Tapioca.
4 Pie Filling.
2 Horse Radish.
1 Prunes.
2 Ginger.
8 Flour.
1 Cloves.
2 Figs.
1 Lobster,
220
1 Tea.
7 Coffee.
2 Egg Powder.
25 Cocoa.
1 Nutmegs.
8 Mustard.
5 Cinnamon.
1 Pepper.
28 Milk.
4 Tomato Products.
2 Bread.
2 Custard Powder.
1 Orangeade.
1 Raisins.
4 Cardamon.
BUREAU OF FOOD AND DRUGS
Water Analyses — Water analyses made consisted, principally, of ex-
aminations for sanitary purity.
Miscellaneous Analyses — Miscellaneous samples examined were con-
nected with food work in various ways.
General Summary,
In conclusion, despite the many handicaps, due principally to the many
vacancies which have existed in the service during the past year, this
Bureau not only maintained the high standard of work performed in former
years, but, in many instances, excelled the previous standard of work. This
was, in a large measure, due to the willingness and untiring efforts of the
employees of the Bureau who, willingly and without complaint, gave con-
siderable overtime to their v/ork.
It should also be pointed out that, although the work of this Bureau
is com.prehensive, it is still felt that we are only scratching the surface :
that there is much work to be done in educating the people along the lines
of how to eat and what to eat.
There is considerable work before us in establishing food standards,
which are very essential to the proper conduct of the work of this Bureau.
The work of the past year has also brought forcibly to our attention
that the Health Department is not merely concerned with the quality of
the food, but that the economic feature has, also, a direct relation to public
health : as, for instance, the result of the work of the past year in connection
with milk. With the high prices of milk, there was a decrease in its con-
sumption and this was reflected by the fact that mothers substituted other
foods for milk with the result that their children became undernourished.
It is, therefore, very essential that, in planning the food work of this
Department in future, the economic feature of the food supply receive
serious consideration.
221
BUREAU OF HOSPITALS.
The following is the report of the work performed in the Bureau of
Hospitals, for the year, 1919. In all, 12,747 cases of illness were treated;
of these 4,516 were in Willard Parker Hospital and Reception Hospital;
3,157 were in the Riverside Hospital; 3,336 were in the Kingston Avenue
Hospital; 321 were in the Queensboro Hospital; and 1,417 were in the
Municipal Sanatorium for Tuberculosis at Otisville — representing a total
of 454,738 patients days, as follows: 76,716, Willard Parker Hospital;
117,803, Riverside Hospital; 73,722, Kingston Avenue Hospital; 5,313,
Queensboro Hospital; and 181,184, Municipal Sanatorium.
Medical Progress During the Year.
Venereal Disease Service — The Venereal Disease Service for women
at Riverside Hospital increased to such a nextent that it was necessary to
add three additional twenty-bed wards, in addition to the special building
erected for the care of such cases. A standard treatment was adopted for
syphilis consisting of six salvarsan and twelve mercurial salicylate injections
after which the patient can be discharged provided there are no open lesions
of the disease. Through the courtesy of the Public Health Service, there
was presented to the hospital, three irrigating tables. The principal feature
of these tables is represented by a holding device for hot water, or chemical
irrigation solution, whereby it is possible to begin irrigation with a solution
of as high a temperature as the patient can bear in the initial injection and
change, without discontinuing irrigation, to a temperature several degrees
higher. The patient, herself, can manipulate the device and one nurse
can direct treatment for several patients at one time. This method
of treatment lessens the length of the infection and permits the discharge
of cases much earlier than was the case before it was installed.
In August, the rapidly increasing drug addict service at Riverside
Hospital made it necessary to transfer the venereal disease service to the
Kingston Avenue Hospital for infectious diseases, Brooklyn, where the
new diphtheria building was utilized for the care of the patients.
Through the cooperation of various social service organizations and the
Girls Manual Training School, a class for vocational training of the women
patients in the venereal disease service was installed and a manual training
teacher taught the patients.
Drug Addiction — In August, the Department began to send large num-
bers of drug addicts from the Narcotic Clinic to Riverside Hospital for
treatment. In order to get the best service, all other classes of cases were
transferred from the Island to various hospitals in this and other Depart-
ments. A reorganization of the staff was made and a practically new staff
of nurses employed. At the time this service was begun, it was impossible
222
BUREAU OF HOSPITALS
to obtain nurses under the schedules established by the Board of Estimate
and Apportionment. As the source of nurse supply was almost entirely
from the Red Cross service, the nurses returning from France being the
ones available it was necessary to pay salaries which represented the min-
imum that the nurses and Red Cross believed to be proper for the duties
of the detailed work at Riverside.
The Assistant to the Director, detailed to the direction of the drug
addict service, after many conferences, established a routine method of treat-
ment which demanded a medical and nursing personnel about similar to those
used in the care of any other acute infection. The treatment consists of
the rather rapid withdrawal of the drug, to which the patient is addicted,
down to the minimum amount that the patients can get along with, without
showing acute symptoms of deprivation. When this point has been reached,
the patient is admitted to the so-called hyoscin-ward where hyoscin, in a
sufficient quantity to bring about anaesthesia, is administered according
to the needs of the individual patients for a period not exceeding thirty-six
hours. No two patients receive the same amount of hyoscin. The doses
administered are much below those usually prescribed in the routine use of
this remedy. After the period of anaesthesia, the patients are transferred
to convalescent wards where they remain for a period of four weeks, and are
then discharged. This treatment has been described in one of the bulleting
of this Department.
The large number of cases treated is convincing evidence of the fact
that drug addicts may have their drug of addiction withdrawn scientifically,
humanely, and without much suffering, in a short period of time, but this fact
does not solve the problem of drug addiction, and unless proper laws are
enacted that will prevent the easy distribution of narcotic drugs to addicts,
the results of the treatment will not materially influence the problem con-
fronting this community.
Tuberculosis — The tuberculosis service for women, temporarily sus-
pended during the War, was reopened at the Kingston Avenue Hospital.
The closing of the Riverside Hospital to tuberculosis made it necessary
to send patients from there to Sea View and Metropolitan. This service
will be reestablished on April 1st, 1920.
Leprosy — The Riverside Hospital and the Willard Parker Hospital
have been treating two cases of leprosy for the United States Navy.
Chaulmoogra oil, in various preparations, has been the chief agent used.
One case has practically recovered; the other case has improved but has
had many relapses.
Influensa in Sanatorium at Otisville — In my report of 1918, attention
was called to what seemed to be an immunity to influenza in the patients
at the Sanatorium. This deduction was an error, for, in January, an epi-
demic of fifty cases occurred, of whom five died. A corps of experienced
223
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
orderlies and nurses were sent to the Sanatorium and, by adopting the
methods used for controlling infections in the Contagious Hospitals, the
epidemic was checked and the mortality rate kept very low.
Medical Education.
Opportunities for instruction of pupil nurses has been extended to the
New York Hospital, which now sends the members of the graduating class
for a term of three months. This requires a course of lectures and practical
ward instruction by specially assigned nurses. In return, the hospital
obtains the services of the nurses.
A post graduate course in Public Health nursing has been given to
graduates of the Schools of the Hospitals of the Department of Charities.
Students from Columbia and Teachers Colleges have visited the Hos-
pitals, and been given instruction by the hospital staff. The highly special-
ized type of service in these hospitals make them particularly valuable for
teaching purposes, both in administrative and medical matters.
During the entire school year, clinics have been held for the students
of the following teaching institutions : Cornell University, Columbia Uni-
versity, Fordham University, Long Island College Hospital, New York
University, Women's College, Special Classes from the Public Health Ser-
vice. In addition, special clinics have been given to practicing physicians of
New York, inspectors of the State Board of Health, groups of medical
inspectors, and nurses of this Department, and other groups from the United
States Army and Navy.
Nezv Ward Buildings.
At the Kingston Avenue Hospital, Brooklyn, Pavilion No. 3, a one
hundred bed building designed for the care of diphtheria was equipped with
proper hghting fixtures and opened for the purpose for which it was built.
This building was peculiarly adapted to the care of diphtheria; in fact, the
wards were particularly arranged with a cubical construction which has been
found, at the Willard Parker Hospital, to be best adapted for this disease.
At the Municipal Sanatorium, Shack No. 112, a forty-bed building
for tuberculosis, has been completed and occupied. During the epidemic of
influenza which infected the Sanatorium early in January, this building was
used for a hospital, and it proved to be the most valuable hospital building
that is located on the Sanatorium grounds. There are no buildings for
patients now under construction.
The maids' dormitory at Riverside Hospital, which has been under
construction for several years was completed and occupied on January
24th, 1919. This is a particularly good dormitory building. Not more
than two maids are permitted to occupy one room at a time and the building
is, to all intentional purposes, as good as any modern nurses home, and
224
BUREAU OF HOSPITALS
should attract a higher class of domestic help. Furthermore, the departure
from a dormitory type of building to that of individual rooms, materially
lessen the danger of the spread of infection amongst the maids in the event
of one case coming down with some contagious disease.
At the Kingston Avenue Hospital, the kitchen building which has been
under construction for nine years has just been completed. This building,
which is modern and up-to-date in every respect, has been a sort of a
" battledore and shuttlecock " proposition between various efficiency experts
of various kinds from the beginning of its construction up to the day it
was finally completed.
At Otisville, the Staff House, construction on which was commenced
in 1917, has been lying in a half completed state, deteriorating from ex-
posure to the elements. In 1917, the schedules of laborers prepared and
adopted by the efficiency experts being lower than that paid in the imme-
diate vicinity of where building was going on, precluded the possibility
of labor being employed to prosecute the work. In 1918, the procedure
of procrastination on the part of the Board of Estimate and Apportionment
in regard to this building, prevented further building from going on, and
in 1919, the work could not be prosecuted because the Board of Estimate
and Apportionment, on December 31st, 1918, rescinded the funds which
had been provided for the building, thereby effectually stopping further
work.
At the Willard Parker Hospital, a carpenter shop and storage shed
has been erected under the shadow of the gas tanks on the west border of
the hospital grounds. When this building is completed, it will be possible
to tear down the old carriage, paint shop and storage sheds for lumber
that now represent a fire menace to the staff house and maids' dormitory
and which will leave these buildings accessible from the street without
passing through these old " eye-sores " that have existed here so long.
Improvements in the Service.
An Admission Ofifice for the Municipal Sanatorium at Otisville has
been opened at 128 Prince Street, in connection with the Diagnostic Clinic.
The opening of this office has been of great value to the Sanatorium. The
admitting physician is familiar with the needs and wants of the Sanatorium;
he knows how many substandard cases are present and in this wav is able
to choose patients that are desirable for the vacancies that exist. Prior to
this innovation, the first intimation that the Sanatorium had of the charac-
ter of patients it was to receive was when the patients arrived at the Recep-
tion Hospital, and in many instances, although they were supposed to be
favorable, second stage cases or incipient cases, they frequently had to be
sent directly to the infirmary. Knowing the present conditions, there is less
of that kind of trouble.
Obsolete equipment and articles no longer required by this Bureau
225
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
have been offered to the Sinking Fund for the benefit of other City Depart-
ments that might have need for them. The old, portable smallpox shack
at Riverside Hospital, which has been serving as a church for all denomina-
tions for many years, was razed to the ground during the summer and the
churches transferred to two former wooden ward buildings in good condi-
tion. There is now a Roman Catholic and a Protestant Church that would
be a credit to any village, representing the same number of church goers
as are found at Riverside Hospital.
With the beginning of the drug addict service at Riverside Hospital,
it became evident that some sort of a commissary or community store would
be necessary to supply the wants of the patients which were not strictly hos-
pital charges. Such a store has been established and has proven a great
convenience to the patients, and has relieved the hospital authorities from
many onerous duties connected with supplying patients those articles not a
part of its routine stores. The operation of this store is in the hands of a
committee, and, from the profits, it employs clerks. Any surplus money
accumulated as a result of profit is used for purchasing entertainment,
equipment for recreation, books, etc., for the patients. A certified account-
ant has been employed to audit its accounts.
Cooperation with Other City Departments.
The Bureau of Hospitals has had, during the year, to cooperate with
many other City Departments, the Federal Government, the various State
Departments and with organizations of National, State and Municipal
importance. The Corrections Department, being without proper boats at
Riker's Island, the Health Department, at a great inconvenience to its
service, has furnished, for a good part of the year, a ferry to and from
Riker's Island. This Bureau does not begrudge the Department of Cor-
rections the service it has given ; but it wants it to be known that this was
afforded at great inconvenience to the Department of Health, and some
suffering on the part of its patients.
This Bureau has received, through the Bureau of Foods and Drugs,
an appreciable amount of food stuffs that had been condemned as unfit for
use as a whole, but in which there were many good amounts that could
be salvaged and used. Among these was one consignment of hamiS and
bacon that had been condemned under Army regulations, and out of which
a sufficient amount was salvaged to make material saving in the cost of our
food consumption. Another large delivery came from a warehouse where
a fire from twenty tons of sulphur had so rusted the cans as to make them
unfit for commercial purposes. The food was perfectly good, and repre-
sented a great saving to this Bureau. A delivery of these goods was sent
to Bellevue Hospital and Riker's Island. Deliveries of lemons also were
received.
In order that certain boats of the City could be released for the use of
226
BUREAU OF HOSPITALS
the Mayor's Committee on Welcoming Soldiers, the boats of this Depart-
ment undertook to carry on the service of those being used by the Com-
mittee. This represented a great deal of overtime and onerous work by
the employees of the boat service and they deserve commendation for their
patriotic response to duty.
During the summer, the Bureau of Industrial Hygiene requested the
sterilization of certain articles which were supposed to be unfit for com-
mercial use. These were principally shaving brushes. Steam sterilization
was performed, and the brushes renovated in our paint shop. This repre-
sented a great deal of work, but gave the Department a feeling of security
in regard to the non-infectiousness of these brushes.
The New York Trade School loaned to Riverside Hospital, for the
benefit of the women in the Venereal Disease Service, sewing machines for
the purpose of teaching them a trade. This was an effort, on the part
of the Trade School, together with other civic organizations, to give these
women a working knowledge of plain sewing so that when they left the
hospital, they would be able to obtain a job, and not go back to their former
environments. The Trade School also furnished a teacher, and all the
people who contributed to this good work are to be commended for their
thoughtful efforts.
Miss Heller, representing the American Red Cross, has regularly visited
the hospitals throughout the year, giving a very good social service to the
soldiers and sailors and recently to the chronic tube cases. Through her
intervention, the lepers were given a number of automobile rides, and the
chronic tube patients have been given several parties. The latter were also
guests of the Barnum and Bailey Circus at its performance at Bellevue
Hospital. The Knights of Columbus and the Society of St. Vincent de
Paul have given a number of entertainments at Riverside Hospital during
the year.
227
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
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BUREAU OF HOSPITALS
MUNICIPAL SANATORIUM.
GENERAL STATE:MENT FOR YEAR.
Patients.
Remaining
Dec. 31,
1918.
New.
Total
Patients
Treated.
Discharged
Died.
Remaining
Dec. 31,
1919.
Tuberculosis
415
1,002
1,417
853
27
537
Total
415
1,002
1,417
853
27
537
233
BUREAU OF PUBLIC HEALTH EDUCATION
AND
DIVISION OF INDUSTRIAL HYGIENE.
The Bureau of Public Health Education operated to extend and to
co-ordinate the educational work being carried on by the Department of
Health. During this year, the Bureau conducted the following activities:
Publications.
Regular — Weekly Bulletin, Monthly Bulletin, Food and Drug Bulletin,
School Health News, Staff News.
Irregular — Reprints and Monographs.
Occasional — Health Leaflets, Posters, Placards, etc.
The policy adopted regarding the publications was to make each of the
periodicals pursue a line of educational publicity that was connected with
the work for which the publication was issued.
For instance, in School Health News, the general subject of personal
hygiene was discussed extensively in each issue, with sufficient new notes
to make the publication readable.
The Weekly Bulletin was operated on the same line, except as it am-
plified the policy of the Department relative to special undertakings. In
this way, it endeavored to secure more general cooperation between the
public and the Department, it being felt that unless the public — and par-
ticularly the medical profession — understood thoroughly the meaning of,
and the reason for, a law or regulation, as well as the existence of it, there
was a distinct tendency to disregard the same. It was, therefore, necessary
to keep the public fully informed regarding the latest developments in
public health. The amendments to the Sanitary Code, as well as special
rules and regulations, were published, as early as adopted, in order to give
the same better publicity.
The Monthly Bulletin continued to be the organ for the issuing of
scientific articles relating to public health work, and was a valuable means
of conveying official information, not only to our own citizens, but to
health authorities throughout the country.
A complete revision of the mailing list of all the issues was made, bring-
ing the same up-to-date and removing obsolete names, thereby saving
postage and wastage.
Motion Pictures.
Open air shows are occasionally given. Films are rented and exhibited
in regular theatres. Films are furnished free to schools and educational
234
BUREAU OF PUBLIC HEALTH EDUCATION
associations, and special feature scenarios are occasionally prepared, as well
as news feature films.
Information Bureau.
Persons and organizations desiring information are aided in every
possible way, and out of town and foreign inquiries are handled in large
numbers.
Lunch Room.
The Bureau operates a lunch room for Department employees, which
also serves as an exhibit, in instructing how clean eating places should be
operated.
Miscellaneous.
The Bureau, in addition to its files of health literature, contains a very
considerable collection of photographs and other data, which is loaned free
to responsible persons.
The following is a statistical tabulation of the work performed by this
Bureau, together with the corresponding figures for 1918 :
Activity.
1919.
1918.
Lectures
Motion picture films
Special literature issued
Requests for health literature
Requests for lantern slides, photos and exhibits
Special exhibits
Reprints and monographs
Special write-ups
Special literature distributed
Press notice
Callers
Conferences
627
51
14
27
4,001
10
6,787
1,910
2,291
190
6,248
1
63
19
6
127,569
1
20
397
232
Venereal Diseases.
During the past year, this Bureau was placed in charge of the ex-
penditure of the funds provided by the Government (Kahn-Chamberlain
Act), which specifically required educational work for the prevention and
control of social diseases, more particularly gonorrhoea and syphilis.
Division of Lectures.
A new division was organized during the year, named the Division
of Lectures, of which the Supervisor of the Division of Industrial Hygiene
was placed in charge, with an Advisory Board on Social Diseases, through
the funds above mentioned.
235
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Private lecturers were paid, who gave lectures on request. Arrange-
ments were made with private and public organizations, to which lectures
were given.
The statistical table, below, shows the approximate number of lectures
and the audiences which attended these lectures, stress being particularly
laid upon the prevention of disease :
LECTURES GIVEN DURING 1919.
Month 1919.
Number
Lectures.
Audience.
Female.
Male.
Total.
June
48
17
11
36
45
64
82
27
1,280
680
900
580
2,125
3,765
3,760
1,225
5,120
1,090
' 1,130
1,306
2,254
3,265
1,050
6,400
July
1,770
August
September
900
1,710
October. . . .
3,431
November .
6,019
December
7,025
Miscellaneous
2,275
Totals
330
14,315
15,215
29,530
Lectures in Italian were given to all, in the Bush Terminal stores,
about 3,400. In Manhattan, to large factories, about 10,000 foreigners
being reached, in their native tongue. Talks in Yiddish were given in
" Y's," settlements, night schools, union headquarters, and shops, some
5000 being reached through this language.
The constant aim has been to arouse interest, generally, and secure the
support and interest of the community, in a definite concrete way, for the
improving of health conditions.
Exhibits.
During the past year, the exhibit work has been conducted much along
the same lines as heretofore. The loaning of lantern slides, motion pic-
ture film posters, and other exhibit material, is going on constantly, and
there is a great demand for health exhibits from a large variety of local
interests.
A number of slides, illustrating public health work, have been added
to the Loan Library of Slides, and a number of requests therefor have been
filled, as well as an enormous amount of use made of these slides by our
own lecturers.
236
BUREAU OF PUBLIC HEALTH EDUCATION
Experience shows that this Bureau needs more effective and more popu-
lar means of disseminating its heahh information, and that this could be
met by a travelling motion picture outfit.
The Bureau also needs a number of new films on child welfare,
venereal diseases, infant feeding, fly, mosquito, eye, and tuberculosis work.
In cooperation with other organizations, this Bureau has given publicity
to literature received from federal and state organizations. We particu-
larly desire to call attention to the cooperation given by private societies,
particularly those especially interested in the education of young people
and those concerning themselves with work among criminals, and social
disease work.
Division of Industrial Hygiene.
The Division of Industrial Hygiene was transferred from the Bureau
of Preventable Diseases to the Ofihce of the Commissioner of Health on
January 28, 1919. The staff consisted of two medical inspectors and one
clerk. The Commissioner placed the Division under the direction of a
Superintendent, sharing offices wnth the Bureau of Public Health Education.
About February 1, 1919, a temporary staff of industrial-medical and
sanitary-inspectors was appointed, there being ten medical-industrial in-
spectors and twenty-five sanitary-industrial inspectors.
In order that these temporary employees might be trained to undertake
this special work, a course of lectures on the nature of the work that they
were to perform was given by experts from other Bureaus, within the
Department, and from persons specially qualified in the lines of endeavor,
from without the Department. The cooperation of the State Industrial
Commission was secured, and member.'* of their staff aided in instructing
this new staff. The Bureau of Food and Drugs, and the Sanitary Bureau
gave these new inspectors field work in order to acquaint them with Health
Department activities; and the Counsel of the Department of Health had
them visit the Municipal Court for the purpose of showing them the
procedure.
The temporary inspectors continued their duties until the permanent
staff was appointed from the Civil Service list of candidates for these
positions. The services of the temporary industrial-medical inspectors was
discontinued on July 4, 1919; and on July 5, a new staff of industrial-
medical inspectors was appointed, only five of the staff of the temporary
inspectors being reappointed as permanent inspectors : therefore, the entire
staff had to be re-trained. On July 31, 1919, a list of successful candidates
was promulgated by the Municipal Civil Service Commission, and in
August, 25 permanent industrial-sanitary inspectors were appointed, 8 of
whom were women. These new inspectors, both medical and sanitary, were
237
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
given a course of lectures and instructions on industrial hygiene similar
to the course given to the temporary staff.
Occupational Diseases.
The following number of occupational diseases were reported during
the year:
Reported by
Private Physicians.
Reported by Hospitals
and Dispensaries.
Lead poisoning. . . .
Mercury poisoning
Aniline poisoning . .
Anthrax
Totals
10
1
1
13
25
Illuminating Gas Poisoning.
Because of the number of deaths due to gas asphyxiation from various
causes, which might be avoided, an investigation of all cases of gas
asphyxiation was started in November, 1919,
It is intended to bring to the attention of the President of the Board
of Aldermen, these accidents, with a view to having a standard gas tube
ordinance framed; as second hand gas tubing is being sold, which is very
often porous.
The tabulation, following, shows that 7 of the accidents were caused
by faulty tubing.
Illuminating Gas Poisoning.
Open jet 27
Leak in gas tubing 7
Gas stove leaking 10
Turned-off gas near stove, real cock open 3
Frozen gas, fixed, open gas jet 4
Leak in pipe 11
Tubing disconnected 3
Gas stove jet open 12
Gas stove and light cocks too close 3
Deficient pressure, gas went out 8
Total 88
238
BUREAU OF PUBLIC HEALTH EDUCATION
Lectures.
During the year, the Division of Lectures worked zealously to secure
audiences of workers for lectures on public health and industrial hygiene,
getting in touch with unions and other workingmen's associations, to bring
this about. The Division met hearty cooperation in this, and 449 lectures
were delivered on the following subjects:
Sex Hygiene 18
Venereal Diseases 129
Drugs and Patent Medicines 25
Personal Hygiene 94
Social Hygiene 10
Accident Prevention 62
Dangers of Dust 1
Industrial Hygiene 5
Protective Clothing 1
Sanitation 23
Drug Addiction 29
Tuberculosis 8
Menstruation 4
Typhoid 13
Cancer 9
First-Aid 5
Public Health 2
Women in Industry 11
Total 449
In this way, the Division was able to get before the workers knowledge
which, heretofore, the Health Department was not in a position to offer.
There were over 60,000 workers reached in this way.
Physical Examinations.
During the year, the industrial workers were given physical examina-
tions by the industrial-medical inspectors of this Division. Following is
a tabulation showing the industries and the number of workers in these
industries, examined during the year:
Photo-Engravers 1,312
Auto Trimmers 44
Auto Assemblers 31
Auto Metal Workers 32
Painters 109
Woodworkers 84
239
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Blacksmiths 78
Button Workers 9
Sutures and Ligatures 5
Clothing Industry 32
Celluloid Workers 24
Butcher 10
Cigar Makers ■ 23
Artificial Flowers 10
Miscellaneous 62
Total 1,865
There was a notice sent to each of the men examined, informing them
as to their physical condition at the time of the examination. Where
physical defects were found, the man was advised to go to his family
physician for treatment.
A letter of appreciation was sent to the Division by the president of
the photo-engravers' union, thanking him for the way the examination
of the photo-engravers was performed. In this letter, he said that the men
were thoroughly satisfied and that the Health Department had accomplished
great work.
A special article on physical examinations was prepared by the Super-
intendent of the Division and published in the Monthly Bulletin, which was
distributed to a number of factories and labor organizations, in order to
inform them of the necessity for individual physical examination, and to
obtain the cooperation of the public in an endeavor to make a health survey
of workers in industry.
Distribution of Placards.
The following number of educational posters were distributed through
the efiforts of the inspectors. The employers and employees showed great
interest in these placards, as they soon learned to realize their value. They
began to appreciate the fact that these notices served as a warning to workers
who were inclined to be less careful of the health of their co-workers in
the cleanliness of the workroom.
9,500 " No Spitting " signs.
9,000 " Do Your Part " signs on cleanliness of toilets.
12,000 " Warning " signs for Garages.
3,000 " Notice " to employees to report insanitary condition.
4,000 " Dangers of Wet Paint " signs.
Following is a list of industries inspected during the year, violations
found, and action taken by this Division :
240
BUREAU OF PUBLIC HEALTH EDUCATION
INDUSTRIAL INSPECTIONS DURING 1919.
Insp.
Reinsp.
N. C. A.
Items Referred to
A. P. E.
State
Ind. Com.
Fire
Dept.
Candy
10
85
651
75
29
889
57
41
240
1,155
24
335
27
27
16
24
9
60
27
204
327
37
630
748
3
58
507
66
54
1,242
69
23
115
629
53
406
40
23
19
22
6
37
50
284
232
23
430
579
8
12
679
36
2
651
16
104
153
1,696
38
347
8
3
14
11
4
45
40
34
156
24
497
319
7
200
1,442
138
87
2,016
34
176
334
1,252
75
932
37
23
11
46
13
15
46
319
453
74
469
1,031
2
3
1
1
i
1
1
2
2
Chemicals
1
Clothing
1
Embroideries
Furs
Garages
1
Heavy machinery
Jewelry
Laundry
Millinery
Paper boxes
Print, and Litho
Rags
Sheet metals
Ship building
Shoes
Silk
Stone cutting
Storage batteries
Textiles
2
Tobacco
Woodworking
Woolens
Miscellaneous
1
Totals
5,727
4,970
4,897
9,230
14
6
Narcotic Drug Clinic.
During the month of April, 1919, the Commissioner of Health insti-
tuted a free narcotic dispensary for the purpose of relieving an emer-
gency condition and studying the narcotic addict, appointing an advisory
board of three, consisting of the Chairman, Dr. S. Dana Hubbard, and
members : Miss Sara Graham-Mulhall (later 1st Deputy Commissioner,
Department of Narcotic Control of New York) and Dr. Marion McMillan,
formerly Acting Director of the Bureau of Foods and Drugs.
On April 10, 1919, the dispensary was opened, and the number of
addicts rapidly increased, the Clinic being operated at 145 Worth Street,
Manhattan, from 2 to 8 p. m., daily. The Division of Industrial Hygiene
supplied a staflf of five physicians, daily, until the work was turned over to
the Director of the Narcotic Clinic, on July 1, 1919. During this period the
Narcotic Clinic was visited by 2,723 addicts, of whom there were 2,216
males and 507 females.
Owing to the fact that the registration of addicts became compulsory,
on July 1. 1919, a gradually increased number of addicts applied to the
narcotic dispensary, and it became necessary to assign three additional
medical inspectors, and two sanitary inspectors, to assist in the work, this
assignment being continued until October, 1919.
241
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
BOROUGH OF BROOKLYN
Sanitary Division.
The activities of the Sanitary Division for the year have been largely
increased, particularly in the number of heat complaints that commenced
early in October. Much of this work was very exacting and required
prompt arid special care and long hours of court action. Inspectors have
had to be far more active in many districts in abating nuisances on account
of illness and also due to the war activities.
There has been a general survey made of the theatres and motion
picture houses in this Borough, on three different occasions, relative to the
use of common towels, common drinking cups, dry sweeping and the pro-
viding of proper and adequate ventilation. The subway and elevated rail-
road stations have been gone over, frequently, each month. During the
summer months, the stables throughout the borough were kept under close
observation in an endeavor to prevent fly breeding, to abate such nuisances,
when found, as rapidly as possible.
The following inspections were made during the year 1919.
Barber shops 2,732
Baths and bathing establishments 1,052
Cesspools and Privies 1 ,366
Comfort stations 826
Common cups and towels 1 ,239
Birds and small animals 163
Camps 303
Dwelhngs 13,140
Dumps 536
Factories 137
Horseshoeing establishments 333
Laundries 825
Lodging houses 289
Motion Pictures 255
Roof tanks 82
Garages 91
Smoke 1,422
Stables 9,901
Water 135
Arrests 1,135
There have been frequent inspections of bathing beaches during the
season, to see that the proprietors comply with the rules and regulations
of the Department relative to proper sterilization of bathing suits, towels,
etc., and to see that the beaches were kept in clean condition. Little
242
BUREAU OF PUBLIC HEALTH EDUCATION
difficulty was found in securing compliance with the regulations in camp,
tent, and bungalow colonies.
Sanitary Engineer.
The activities of the Mosquito Extermination Division consists of (a)
maintenance of the ditches installed in the Boroughs of Brooklyn, Bronx,
Queens, and Richmond ; (b) the installation of new ditches in these
boroughs; and (c) co-operation with Government officials with reference
to adjacent Government reservations.
A budget allowance of $4,332.25 was granted, and made available March
24, 1919, covering 1,333 days for per diem laborers at $3.25 per day (foreman
excluded). This amount was inadequate and, later, $10,000. was requested,
but only $9,033 was granted for personal service, transportation and supplies
being excluded.
This amount became available when the first fund was exhausted and
the force was increased from fourteen to twenty-six laborers, carried to
December 31, 1919.
The entire marsh area in the borough was thoroughly cleaned, and the
maintenance work was commenced at Old Mill, on April 7th, by a force of
fourteen laborers and continued westerly to Coney Island, which was reached
September 15th. The force was then moved back to Old Mill and the work
proceeded easterly to the City line and Hook Creek, adjacent to the Nassau
County line, and completed December 31st.
The late date on which this work was commenced was due to the delay
in release of funds and to difficulty in obtaining laborers from the list at
the price allowed by the City.
A total of 2,229,790 feet of ditches was cleaned, and 500 feet dug in
the Borough during the year.
No work was done in the Dyker Beach Park section, as an adequate
outlet was not provided until late in the season. This tract was kept under
observation and pressure was brought on the Department of Parks to obtain
an adequate outlet, resulting in culvert being cleaned, and extended back
on inlet side about 75 feet to prevent sand filling same.
Fill still in progress at 92nd Street and the Parkway.
Ditches cleaned, Salt Marsh, Jamaica Bay section 2,229,790 ft.
Ditches dug. Salt Marsh, Jamaica Bay section 500 ft.
Total cleaned and dug 2,230,290 ft.
Division of Preventable Diseases.
Venereal Chiiies — During the early part of the year, three diagnostic
clinics were organized in this Borough : in the Eastern District. Brownsville,
and Prospect sections, but the Eastern District and Brownsville sections
243
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
clinics were disbanded as there was not a sufficient demand to warrant con-
tinuing the same. At present we have but one diagnostic clinic, and this
is at the Prospect Branch Office where we also have our treatment clinic.
Out of the original 6 physicians appointed to this work, three have resigned.
Day Camp " Rutherford " — We made a very interesting study of 100
children on the Day Camp "Rutherford" to determine the effect upon the
condition of their nutrition and general physique by being taken care of
on this boat, receiving proper food, through instruction along the lines of
health.
Epidemiological — A marked decrease in number of typhoid cases re-
ported during the year is shown (1918, 89 cases) (1919, 58 cases). There
has been an increase in the incidence of diphtheria, scarlet fever, and measles.
Statistical — 980 new cases were examined in the clinic of which 214
were diagnosed as tuberculosis, as compared with 959 cases for year 1918
an increase of 21 cases. There has been some loss in clinic attendance, but
this case can be accounted for by the fact that, though more new patients
were examined, 86 less were diagnosed as tuberculosis, and but one or two
visits to clinic were made by most of new patients.
A special effort has been made to persuade all exposed cases to come
to the clinic for examination and more in the way of preventive work thus
accomplished.
Special — In May, 1919, a campaign was started to persuade parents
in the district to send children to clinic for Schick test and treatment of
those found susceptible. The number of children given the test is not so
great as we would have liked, as the parents explained that the test was
being given in schools more conveniently located.
Prospect Clinic — During 1919 the clinic attendance was most satisfac-
tory both from the viewpoint of total attendance and new cases admitted.
The work done by all the physicians on duty has been highly satisfactory,
their painstaking work and courteous treatment of patients being self-
evident in the clinic attendance, as shown by the yearly report. During the
year the staflf made 6,861 physical examinations of patients and 364 visits
to sick patients and complaints in the district.
The nursing service has been highly efficient and that our clinic attend-
ance is larger is due to the social service work done by the nurses. The
nurse in charge of the clinic has taken great interest in the patients and has
made a large number of recommendations to hospital, sanitorium and pre-
ventorium. We have been very successful in placing patients and, while
it effects our total clinic attendance somewhat, it is most satisfactory to
the patents to know that everything possible is being done for them.
Brownsville Clinic — During the year a new activity has been added to
our office, viz: the Schick test work. This indeed has become a very im-
portant adjunct to our already busy office.
244
BUREAU OF PUBLIC HEALTH EDUCATION
Veterinarian Division.
The Veterinarian Division reports the following for the year :
Anti-rabie Work — 911 dog bites reported; 147 persons treated in
anti-rabie clinic; 1,909 Pasteur injections given; 374 bitten persons advised
in clinic; 923 dogs examined ; 201 dogs destroyed; 29 cases of rabies (dogs) ;
4 cases of rabies (human).
Glanders Prevcniton — 8,157 horses examined; 119 horses tested; 17
glandered horses destroyed; 2,000 horses tagged.
Division of Child Hygiene.
Midzvives and Foundlings — At the beginning of the year there were
512 midwives in the Borough holding permits. On December 31, 1919,
there were 507. Permits revoked during 1919, 27. First inspections of
midwives, 22; reinspections, 2,536; special visits, 2,051, making a total
of 4,610. Every midwife holding a permit was visited at least once each
month by a nurse.
All death certificates of persons dying of sepsis following pregnancy
were investigated as follows :
Puerperal sepsis, fatal cases 62
Puerperal sepsis, non-fatal cases 33
At the beginning of the year 866 foundling permits were in force. On
December 31, 1919, 824 permits were in force. Total inspections made, 7,323.
It is gratifying to note the reduction of the death rate of infants under
one year of age in the Borough. The death rate of infants under one year
was 77.4 ; the lowest infant mortality rate on record for the borough, and the
lowest of the five boroughs for the year.
School Medical Inspection — The number of schools visited by our in-
spectors and nurses was 180 public schools, and 25 annexes, houses in sepa-
rate and distinct buildings. The nurses assigned to schools have, on an
average, 4,369 pupils and each inspector has about 12.000.
Contagious eye and skin diseases found in school are less in number
on account of the vigilance of the inspectors and nurses and the co-operation
of principals and teachers, with the exception of scabies, which was partly
due to the return of overseas forces. Exclusions from school are less in
number as the parents are becoming more acquainted with symptoms of
contagious diseases, and are keeping the children home at the first signs of
any contagious disease. Special efforts are made to hold special consultations
with parents daily, and particularly on Saturdays. Excellent responses have
been made.
Division of Food and Drugs.
By the establishment of the Division of Food and Drugs in this Borough
to handle local matters, much commendation of the Department has been
received from associations of food dealers, on account of their ability
245
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
to adjust local matters in the local Department office. This division during
the past year, in addition to being of immense value in the prevention of
infectious diseases, by their close supervision over the sanitary conditions
in hotels, restaurants and public drinking places, has also closely supervised
the condition of the Borough's food supply, both at its terminals, in ware-
houses, manufacturing establishments and retail stores, also by their co-
operation and through their advice much foodstuffs have been conserved
which might otherwise have been of no value. During 1919, by action of
the Board of Health, no horses were slaughtered or horse meat permitted
to be sold for human consumption after May 1st, 1919.
Despite our eftorts for conservation, consignees have often refused to
overhaul partly damaged or deteriorated consignments which resulted in a
total loss of same. Their contentions were that market and labor conditions
did not warrant their paying for overhauling. In some instances the dis-
charging of cargoes on to unheated and improperly protected piers, or the
shipping of perishable goods in unrefrigerated ships, caused rapid de-
terioration.
A large percentage of the condemnations were due to the unsettled
economic conditions and the cancellation of war contracts, which caused
large quantities of food on hand to deteriorate.
Department records show that a number of large condemnations of
farinaceous foods were diverted into channels for animal food.
During the year 6,002 inspections were made relative to milk, of which
were: stores, 2,223; wagons, 1,872; milk depots, 732; pasteurizing plants,
337; miscellaneous, 838, and the following samples were obtained and de-
livered to the Department of Health Laboratories for analysis :
Milk 2,871
{ Cream 1,860
Said samples were taken for chemical analysis and 1,386 samples of
milk for bacteriological examination.
The chemical analysis of 4,731 samples of milk and cream delivered
to the Laboratory resulted in prosecution of 437 violators for the adultera-
tion of milk and cream.
Exposure of Food on Streets — The service of final warning notices
and the prosecution of violators in 119 instances has practically eliminated
this character of Sanitary Code violations.
Cleansing of Utensils — The service of numerous final warning notices,
and the prosecution in 141 instances has tended to decrease the number of
violations of this character.
Sanitary Division.
oamtary uivision.
The operation of the Sanitary Division under a Chief Sanitary In
spector has accomplished much during the year.
246
BUREAU OF PUBLIC HEALTH EDUCATION
BOROUGH OF THE BRONX.
Assembly Flails and Theatres — This class of premises were subject to
careful inspection relative to light, ventilation, cleanliness and toilet fa-
cilities.
It was necessary in the early part of the year to institute educational
programs in order that the proprietors of the assembly halls, amusement
parks, meeting halls and other places of public assembly could thoroughly
understand the policy of the Department of Health relative to this class
of premises. As a result the conditions improved and all nuisances on
premises were abated.
Barber Shops — All barber shops in this Borough were inspected and
copies of the regulations furnished the owners. The general sanitary con-
ditions (where necessary) were improved.
Birds and Small Animals — Premises where birds and small animals are
for sale were inspected and kept under observation from time to time dur-
ing the year.
Bathing Beaches — During the month of March the Assistant Sanitary
Superintendent notified all owners of bathing beaches in this Borough of
the necessity of completing all necessary repairs and insisted that the estab-
lishments be ready for inspection by this Division at such date as to permit
the granting of a permit on the opening date. This assisted materially in
reminding the owners of their responsibility and, in many instances, the
request was complied with. During the year the Bronx Exposition Park
was opened and this maintains, it is said, the largest bathing pool in the
United States. All bathing beaches were operated as required by the official
regulations.
Camps — The camps located at City Island, Throggs Neck, Orchard
Beach, Edgewater and Fort Schuyler were kept under constant observa-
tion during the camping season. The individual camps show a tendency
to increase. All campers were notified at the beginning of the season that
they must not occupy camps until their applications were approved. The
general condition of this class of premises seems to show a steady improve-
ment and, from year to year, the owners show a willingness to co-operate
and to improve conditions as suggested.
Common Towels and Drinking Cups — A survey of all theatres, depart-
ment stores, fire houses and public places where common cups or towels
might be in use was made. Where same were found they were removed
forthwith with the result that all common towels and drinking cups have
been dispensed with.
Dogs— A survey, from time to time, relative to violation of Section
17 of the Sanitary Code was made by patrolmen of the Health Squad and
the inspectors of the Division, and where necessary summonses were served.
247
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Notices to all dog owners known and to every store where birds and
small animals were sold were delivered by patrolmen and inspectors. A
quantity of the notices were left in these stores to be dehvered to dog owners
who might call in the course of business.
Sanitary Engineer.
A force of three per diem laborers and one assistant foreman from the
yearly force were employed from March to December 31st on maintenance
work, and a total footage of 1,072,463 feet of ditches were cleaned, and
8,695 feet of new ditches were dug.
This force was adequate to maintain the condition of the entire salt
marsh area in the Borough, and no mosquitoes were found breeding on them.
Pelham Bay Park (about 450 acres) was maintained by Park Depart-
ment and a contract let for this work for $449. This park was kept under
observation by the Mosquito Squad.
A fill in progress on a section of salt marsh by the N. Y., N. H. & H.
R. R. and Westchester obstructs a number of drainage ditches, and arrange-
ments were made to have the railroad oil these ditches at regular intervals
and prevent mosquito breeding.
Considerable work was done in an inland section of Lohbaeur Park,
Westchester, where mosquitoes were numerous. A decayed box culvert was
removed, water course re-dug, additional ditches provided and conditions
much improved. Fill in progress west of Eastern Boulevard at rear of St.
Raymond's Cemetery, Westchester, and a great improvement has been made
in this section during the year. Fill in progress at Hunt's Point and
mosquito breeding places are practically eliminated. A large area is being
filled at Classon Point and when completed this entire section which was
formerly salt marsh will be immune from mosquito breeding.
Considerable breeding located in the section of marsh land between the
lake and Mosholu Parkway and in Van Cortlandt Park, also in the section
between Parade Grounds adjacent to Broadway and the Parkway. The
attention of park officials was called to the matter and the lake was lowered
and cleaned at regular intervals during the season. In the meantime oil
was distributed at intervals on the section adjacent to Broadway up to
November, when a permanent improvement was made by Health Depart-
ment maintenance men.
Ditches cleaned, inland 23,006 feet
Ditches cleaned, salt marsh 1,049,457 feet
Ditches dug, inland 6,390 feet
Ditches, dug, salt marsh 2,305 feet
Total cleaned and dug 1,081,158 feet
248
BUREAU OF PUBLIC HEALTH EDUCATION
Division of Preventable Diseases.
Nothing of importance occurred in connection with communicable
diseases during the year. The iiifluenza epidemic, which began in Sep-
tember, 1918, ran into the early months of 1919. A small epidemic of
typhoid fever occurred in the Mott Haven District.
Incidence of Communicable Diseases.
1918. 1919.
Diphtheria 1,868 2,251
Scarlet fever 864 718
Measles 3,935 1,384
Typhoid fever 149 109
Para-typhoid 2
Chicken pox 679 723
Cerebro spinal meningitis 20 34
Poliomyelitis 26 4
Whooping cough 1,068 206
Influenza 20,808 3,360
Pneumonia 2,478 1,118
Smallpox 1
Leprosy 1
Diphtheria — There was an increase of 383 cases of diphtheria reported
over 1918, and 804 over 1917. No reason can be assigned for this. The
cases were scattered over the Borough.
Tuberculosis Clinic Report.
1918. 1919.
New cases 2,121 1,809
No. of revisits 12,934 18,811
No. of diagnosed cases 621 393
Total deaths 1,562 561
Occupational Clinic.
1918. 1919.
Food handlers examined 818 1,734
Bakers 394 619
Industrial 18
Private physicians' cases 1,020
In April a venereal disease clinic was opened at the Borough office
with the following results:
VENEREAL DISEASE CLINIC.
New cases 648
Revisits , 175
249
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Specimens taken for Wasserman test 405
Smears and widals 22
Anti-rabic Clinic.
1918. 1919.
New dog bite cases given advice 484 238
New cat bite cases given advice 10
Pasteur injections given 964 779
Cases investigated 22
Typhoid Fever — During August, September, and October we had a
slightly increased incidence of typhoid fever. Most of the cases occurred
in census districts 3 and 4.
Seven of the cases were in children under 12 years of age, and a
common source of infection was possibly milk, or an infected spring in the
neighborhood.
Veterina via n D ivisio n .
The Veterinarian Division reports the following for the year :
Anti-rabic Work — 412 dog bites reported ; 72 persons treated in clinic ;
779 Pasteur injections given; 248 persons advised in clinic; 144 dogs exam-
ined; 126 dogs destroyed.
Glanders Prevention — 7,602 horses examined; 69 horses tested; 19
glandered horses destroyed ; 650 horses tagged.
Division of Child Hygiene.
General Impression of the Year's Work — As one nurse expresses it,
the " Syllabus on Hygiene has quieted down." This does not mean that
interest of teachers has not increased, but that the overworked teacher is
unable to develop into a sanitarian or hygienist such as the syllabus seems
to require. Teachers' judgment in referring cases for diagnosis is about
as good as could be expected but is only fair.
The Standard of Personal Cleanliness is improving and is, of course,
most noticed in economically poorer schools, and is partly due to rising
income. Some principals are very keen in the enforcement of hygienic
measures and strict with teachers in respect to the syllabus. In such cir-
cumstances the use of the syllabus is rather more a text than a program
but is having its beneficial effects.
Lack of clinical facilities is the great obstacle in this Borough in pro-
curing prompt treatment for physical defects ; large numbers of our children
must travel far into Manhattan for such attention.
All agencies for service are strained nearly to the breaking point. So
far as the Health Department is concerned the betterment of service requires
more medical inspectors and more nurses. With from ten to twelve thousand
250
BUREAU OF PUBLIC HEALTH EDUCATION
per nurse, written or oral discussions of betterment resolve into litreature
or oratory, and can only momentarily stimulate the faithful efforts of weary
workers who see fields for advanced service but cannot reach them. The
fact that such numbers are looked after so well is in itself a token of the
value of the continually constructive effort of the general management of
the Bureau.
Statistical Summary of School Work, Bronx Borough, 1919.
Schools Registration
1 High School 3,763
57 Elementary Schools 115,040
31 Parochial Schools 15,335
New Admissions to Public Schools 9,807
Examined by Private Physicians 1,181 (12^)
Examined by Medical Inspectors 8,626 (88^)
New Admissions to Parochial Schools 1,609
Examined by Private Physicians 121 (7.5%)
Examined by Medical Inspectors 1,488 (92.5%)
General contagious diseases found in school and excluded 141
Unreported cases of major contagious disease found at home 26
Contagious eye and skin diseases found in school 32,861
Exclusions from school 2,476
Visits and consultations 54,778
Vaccinations 11,727
(a) Re-vaccinations 317
(b) Certificates issued 6,403
Examinations for physical defects 30,080
Cases terminated 7,890
Summary of cases terminated —
(a) Percentage of defective vision receiving glasses 38.3
(c) Percentage of cases of hypertrophied tonsils receiving
treatment 22 . 4
(c) Percentage of cases of hypertrophied tonsils receiving
surgical treatment 21.6
(d) Percentage of orthopedic defects receiving surgical treat-
ment 0
Little Mother Leagues 21
Health Leagues 17
Clinics for school children 2
Baby Welfare — Statistical data of this work is discussed under school
medical inspection and the remarks therein are applicable here.
251
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Statistical Summary of Baby Welfare Work, Bronx Borough, 1919.
1. Total number of babies under two years of age admitted 2,688
(a) Number of these under one year 2,401
(b) Number of these between one and two years. . . 287
2. Total number of babies under one year admitted :
Under 1 month 173 7 .2(fo
1 to 2 months 603 25.0%
2 to 3 months 360 15.4%
3 to 6 months 642 26.9%
6 to 9 months 414 17.5%
9 to 11 months 209 8.0%
3. Total number of babies under one year admitted :
(a) Breast fed exclusively 1,484 61 .8%
(b) Breast and bottle fed 435 18.2%
(c) Bottle fed exclusively 482 20.0%
4. Total number of babies under one year admitted :
(a) Sick with gastroenteritis on ad-
mission 121 5.0%
(b) Sick with malnutrition on ad-
mission 135 5 . 6%
5. Total number of babies under two years of age on the register
of the stations, December 31, 1919 1,645
(a) Number of those under one year 1,105
(b) Number of those between one and two years. . . 540
6. Total number of mothers to whom milk was distributed during
the year 317
Midwives and Foundlings.
As in this Borough all midwives are visited by one inspector, the work
is perhaps more uniform than where a number of inspectors are employed
who may not, as in our case, be giving time exclusively to this type of work.
So far as sore eye conditions and puerperal infections are concerned,
results do not point to any serious incompetency on the part of the mid-
wives in general.
Foundling Keepers — Except in the presence of wanton neglect and
cruelty it is the conviction of our staff that foundlings are better off in
almost any home than in the average institution. It is with extreme reluc-
tance, therefore, that recommendation for revocation of a permit is made,
and an open mind is held as to the restoration of permit when the habits
and state of mind of a delinquent are represented as amended.
Our homes are supervised very closely, and are carefully graded. A
list of vacancies is placed in the hands of the Babies' Welfare Association,
and all inquiries for place are directed there. Custodians of children of
252
BUREAU OF PUBLIC HEALTH EDUCATION
tender years are directed to keep in touch with Baby Health Stations, and
nurses and physicians in said stations pay particular attention to these
patrons.
Prompt visits are made to all applicants, including those referred to
us by associations for conservation of child life, and inquiries or requests
from any society are welcomed and responded to.
Cordial relations are maintained with the Superintendent of the Gerry
Society. He and his officers have been invited to lay before us any informa-
tion they may have concerning homes, and their aid has been solicited and
received in dealing with refractory cases.
In suggesting improvements, it occurs primarily to us that the average
price paid for boarding is too small. Institutions should set an example
by providing for more liberal pay. This is needed particularly for the in-
stitutional child.
Statistical Data of Midzvife and Foundling Work, Bronx Borough, 1919.
1. Number of midwife permits in force January 1, 1919 145
Number of midwife permits in force December 31, 1919 136
2. Number of births attended by midwives 2,754
Number of stillbirths attended by midwives 38
Number of sepsis cases occurring in practice of midwives 1
Number of midwives arrested and found guilty 0
Number of midwives fined or imprisoned 0
3. Number of sore eye cases reported 5
(a) Reported by midwives 2
(b) Reported by physicians 3
(c) Reported by institutions 0
(d) Reported by other organizations 0
Number cured 5
4. Number of cases of ophthalmia neonatorum reported 0
5. Number of fatal cases of puerperal sepsis 9
(a) Attended by midwives 1
(b) Attended by physicians 2
(c) Attended by institutions 6
Number of non- fatal cases of puerperal sepsis 1
(a) Attended by midwives 0
(b) Attended by physicians 0
(c) Attended by institutions 1
6. Delinquencies of midwives :
(a) Homes found unclean 2
(b) Bags found unclean 2
(c) Person found unclean 2
253
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
(d) Cases attended where mother died after confine-
ment 0
(e) Failure to report births 0
(f) Failure to report stillbirths 0
(g) Delay in reporting births 0
7. Number of permits of midwives revoked for cause 1
Number of complaints against midwives 5
Number of expectant mother cases 18
8. Number of foundling keepers' permits in force January 1, 1919. 449
Number of foundling keepers' permits in force December 31,
1919 387
9. Number of permits of foundling keepers revoked for cause. ... 1
Number of complaints against foundling keepers 20
10. Lectures by staff regarding work of foundling keepers 0
Lectures by staff regarding supervision of midwives 2
Employment Certificates — The numbe"" of certificates issued increased
markedly during the year, owing to the conditions of the labor market.
We have given the Department of Education all the co-operation it
has asked of us and, further, all we could think of. The attendance officers
are given the greatest freedom in relation to matters in our files, and we
have contributed our share in the examination of children brought before
the tribunal in the Bureau of Attendance.
One of our inspectors, at one time, was assigned to the Municipal Court,
to give such advice from a medical standpoint as the Court might require.
All inquiries from the State Industrial Commission and from the Child
Labor Committee have been answered freely, and we have placed ourselves
at their disposal. We have kept in touch with the Child Labor Committee.
The Borough Chief of this Borough was invited to take a responsible place
on the staff of the National Child Labor Association, on recommendation
of a member of this Committee.
The follow-up by school nurses, on temporarily withheld cases, has been
attentive and thorough, yielding excellent results, as reports will show.
The following statistical data are submitted on the work in general :
Employment Certificate Work, Bronx Borough, 1919.
1. Total number of employment certificates granted 6,753
(a) Summer vacation certificates 578
(b) Permanent employment certificates 6,175
2. Number of employment certificates in force January 1, 1919. . . . 8,771
Number of employment certificates in force December 31, 1919. . 8,820
Number of employment certificates expired during 1919 6,126
3. Number of children refused certificates for physical incapacity.. . 109
254
BUREAU OF PUBLIC HEALTH EDUCATION
(a) From Parochial Schools:
1 . Malnutrition 1
2. Cardiac disease 4
3. Pulmonary disease
4. Miscellaneous
(b) From Public Schools :
1. Malnutrition 11
2. Cardiac disease 31
3. Pulmonary disease
4. Miscellaneous 62
4. Total number of cases temporarily withheld 499
(a) Defective teeth 140
(b) Defective vision 317
(c) Acute eye disease
(d) Hypertrophied tonsils 7
(e) Miscellaneous 35
Diznsion of Food and Drugs.
Activities of this Division embraced the supervision over the sale of
foods and drugs in the Borough, and supervision over the sanitary conditions
surrounding the handling of food and drugs.
The greater part of the food and drug work in this Borough consists of
the inspection of food and drugs (milk included) in retail establishments.
Necessarily the greater portion of the squad were assigned to this work.
Wholesale meat and produce markets required a great deal of attention,
and one inspector gave the greater portion of his time to the inspection of
these markets.
The milk work, which consistsi of the inspection and sampling of milk
for chemical analysis, in the wholesale and retail establishments and on
wagons, and also the investigation of conditions surrounding the sale of such
milk, was taken care of by the district inspectors in the retail stores, and by
one inspector at the wholesale depots and wagons. Inspection of drug estab-
lishments, wholesale and retail, was under the supervision of one inspector.
This inspector, in addition to taking samples of crude drugs and patent
medicines and prescriptions, also looked after the sanitary conditions in these
establishments.
While all of the above special activities were given attention during the
entire year, squads were assigned periodically to give their sole attention, on
a given day, to one of the above activities. These special raids accomplished
excellent results.
Terminal Inspection — The New Haven Railroad Terminal is the point
of entry in this city for the produce that is grown in the New England sec-
tion. The principal products that arrive at this terminal are potatoes from
255
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Aroostook County, Maine, and onions from the Connecticut River Valley.
There is also a considerable quantity of northern apples shipped to this
point.
This terminal market was covered daily, and approximately 150,000
pounds of assorted vegetables and 21,000 pounds of assorted fruit were
condemned during the year.
Factory Inspection — The principal factories located in this Borough
consist of candy manufacturers, frozen product manufacturers and soda
water manufacturers. Of these the candy manufacturers predominate.
There are several very large candy factories, where so-called hard candies
are manufactured.
During the year, 138 inspections of the candy factories alone were
made, and in every such establishment where hard candies were manufac-
tured samples werei taken and submitted for chemical analysis. The usual
adulterant in this type of candy is sulphur-dioxide, but in none of the samples
examined was such ingredient found.
All of the ice cream factories were put under permit, during the year,
and several establishments located in Mount Vernon and New Rochelle, that
shipped and sold cream in this Borough, were inspected and put under permit.
In two instances, where insanitary conditions were found at a cream factory,
and where no effort was made to comply with the regulations of this Depart-
ment, court action was found necessary after denial of application for permit.
Thursday night bakery inspection was continued during the year, which
accounted for a great portion of the eighty-five cases that were prosecuted
for violations of Section 331B of the Sanitary Code. The total fines for the
year, as a result of finding unsound eggs in various establishments, amounted
to $1,255, and a large portion of these violators were unscrupulous bakers.
The fines imposed ranged from $5 to $100. There were 3,261 inspections
made of bakeries during the year.
Restaurant Inspection — -There were 1,665 inspections made of restau-
rants during the year, and practically all of the restaurants in this Borough
are now under permit.
Retail Inspection — There were, during the year, 21,791 inspections made
of retail establishments, as compared with 6,571 inspections of wholesale es-
tablishments. These establishments were inspected for the purpose of im-
proving the sanitary conditions surrounding the handling of food, and in-
specting the character of conditions of foodstuffs in the stores.
Although, in a great majority of instances, co-operation was obtained
from the storekeepers and sanitary conditions improved where warnings
were given by inspectors, it was found necessary, in 215 instances, to serve
summonses as a result of dirty stores. The fines imposed in these cases
amount to $920.50.
Of 254 cases prosecuted, during the year, as a result of foodstuffs con-
256
BUREAU OF PUBLIC HEALTH EDUCATION
demned (unsound eggs included), which cases resulted in fines totalling
$3,276 being imposed, a great majority of such cases were a result of unsound
food being found in retail stores. Only in instances where there was some
reason to believe that such unsound food was to be sold, were such cases
taken to Court.
Milk Inspection — During the year, inspectors gave attention to the
inspection of milk in the possession of wholesalers (at depots and on wagons)
and to the inspection of milk in retail stores. Considerable attention was
given to the sanitary conditions surrounding the handling of milk in retail
stores, and the proper care of milk utensils by these storekeepers. A great
deal, educationally, was accomplished by this work.
There were 891 samples of milk taken during the year for chemical
analysis, eighty of which were found to be below standard. There were 512
samples of cream taken. 143 of which were found to be below standard.
Not all of these low samples were found to be sufficiently low to warrant
prosecution, there being 170 of these cases forwarded for prosecution. The
total fines imposed, as result of adulterated samples of milk and cream,
amounted to $1,925.
The list of sour cream dealers on whom adulterated cream was found
is extremely long.
In addition to the above cases, thirty-nine cases were prosecuted in court
for failing to properly cleanse milk utensils. Fifteen cases for various other
violations of the milk regulations, such as mislabeling, transferring milk on
public highways, etc.. were also prosecuted and fined.
Meat Inspection — During the latter part of the year, particular attention
was given to the inspection of hogs on the twenty hog farms in this Borough,
with the result that on three farms cases of hog cholera were located. On
all of these farms quarantine was immediately established, and daily inspec-
tions made until the disease had disappeared. As a result of this outbreak,
our veterinarian condemned 109 hogs weighing 2,900 pounds. Hog cholera
serum, which was injected under the direction of this veterinarian, resulted
in the saving of many of these animals.
Inspections were made, during the year, of 3.074 retail butcher shops.
Inspections were made of 2.702 wholesale meat establishments, and 102 in-
spections were made of meat preserving establishments. In addition to these.
580 inspections were made of poultry slaughter houses during the year. In
the latter establishments, in six cases where unwholesome poultry was found
on the premises, prosecution was instituted. Convictions were obtained in all
cases, and the fines ranged from $10 to $50 for each offense.
Drug Inspection — During the year, inspections were made of 1,233 estab-
lishments in the Borough. Particular attention was paid to the improving of
sanitary conditions and to the sampling, from time to time, of various drugs
and prescriptions.
257
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Exposure of Foods — Particular attention was given during the year to
the exposure of meat on wagons in this Borough. From time to time squads
were assigned to cover a wholesale meat market, and serve summonses on
drivers of wagons who left the market with meat uncovered. Although a
few summonses were served and small fines imposed, as a result of this work,
during the earlier part of the year, later inspections disclosed that the drivers
of meat wagons were properly covering their meat.
Upon request, a patrolman was assigned to the Division of Food and
Drugs, during the summer, to investigate the exposure of food on the streets,
and serve summonses where violations were found. This work was deemed
very essential, at that time, but after two weeks of successful effort this
patrolman was transferred and taken away from the work entirely.
During the entire year, 122 summonses were served as a result of food-
stuff being offered for sale and not properly protected from dust and dirt,
and fines amounting to $282 were inrposed.
258
BUREAU OF PUBLIC HEALTH EDUCATION
BOROUGH OF QUEENS.
Sanitary Division.
In almost all particulars the work in the borough has improved in the
past year as compared with 1918. We find that of total inspections made
by 7 field inspectors in sanitary work there was an increment of 1,600 in
1919, as compared with 1918, and this despite a force of 8 in the latter
year. In arrests we also exceed former figures, 981 in 1919, as compared
with 379 in 1918. In fines we collected $519 more in 1919 than 1918. Per-
sonal abatement of nuisances show'ed an increase of 600.
One incinerator unit has been added at Flushing to the number of 3 in
the Borough, and we now have stations at Long Island City, Maspeth (East
Williamsburgh), Arverne and Flushing. These plants have solved many
trying sanitary problems and have stopped many acrimonious complaints.
Particularly has this been noticeable in the Rockaways in the past two sea-
sons, where the inadequate facilities for disposal had been the occasion of
serious discontent.
There have been the progressively increasing number of sewer connec-
tions in the borough and, as a corollary, the abolition of numbers of cess-
pools and privy vaults. In mosquito plots filled, oiled or drained the figures
are indicative of most intense activity on our part.
Division of Food and Drugs — This unit, from a force of 3 inspectors
has grown to 14, including division chief, supervisor, field inspectors, veteri-
narian, clerks, stenographer and patrolman. It is now a very complete and
satisfying unit.
Division of Institutional Inspection.
We believe that the work in this particular has never been so systemati-
cally and efficiently accomplished or done with such exclusive and specialized
attention as in the past year. The institutions, we believe, have also felt
this additional expenditure of time offered them and have co-operated and
co-ordinated readily in all our identities outlined to them.
Our records show :
No. of institutions 38
No. of physical examinations (primary) 1,608
No. of physical examinations (defectives) 234
Division of Sanitary Inspection.
The early part of the year showed the decline and finish of the epidemic
of influenza that broke out in the fall of 1918. During this period the force
was busily engaged in frequent inspection of all places of public assembly,
public conveyances, etc.. and all special regulations adopted by the Board of
Health for prevention of influenza were enforced.
Fly Breeding Control — Most important activity in this respect was the
inspection of stables, of which 2,707 were made, and attention paid to proper
disposal and treatment thereof so as to prevent fly breeding.
259
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Public Water Supply — The public water supply of the Borough was
kept under regular observation and samples collected for analyses, but in
a few instances the result of these examinations showed " suspicious," when
some local surrounding insanitary conditions w ere corrected and re-examina-
tions of the supplies showed same to be potable.
Heat Complaints — During the colder part of the year our force was
kept busy answering lack of heat complaints, owing to the recently enacted
section of the Sanitary Code regulating this question. In the majority of
instances, these complaints were abated by personal effort, it being found
necessary to take but one case to court.
Other Special Activities — A great amount of work was also expended
by this Division in the inspection and control of the following classes of
premises, in which detailed regulations of the Board of Health have been
adopted, under various sections of the Sanitary Code, and have to be
enforced :
Inspections.
Barber shops 193
Baths 281
Camps .^ 785
Comfort stations 284
Horse shoeing establishments 43
Laundries 69
Lodging houses 36
|l Rendering plants 36
' Sanitary Engineer.
One million three hundred seventy-eight thousand two hundred (1,-
378,200) ff^^et of ditches were cleaned in the Borough, in Jamaica Bay sec-
tion, and, in addition, 184,000 feet of ditches were cleaned at Far Rockaway,
and 72,400 feet of ditches cleaned at Arverne.
On the north side of the Borough an average force of four men were
employed to maintain the ditches installed and clean the salt marsh area.
Co-operation with Government officials continued at Fort Tilden, Rocka-
way Point, with reference to area on Government reservation and adjacent
thereto.
Feet.
Ditches cleaned, salt marsh, Jamaica Bay Section 1,378,200
Ditches cleaned, salt marsh, Arverne .^ 72,400
Ditches cleaned, salt marsh. Far Rockaway 184,000
Ditches cleaned, salt marsh, Little Neck 7,570
Ditches dug, salt marsh. Little Neck 750
Ditches cleaned, salt marsh. College Point 422,790
Ditches cleaned, salt marsh. Flushing, Corona, Elmhurst 559.025
Ditches dug, salt marsh, Flushing, Corona, Elmhurst 300
260
BUREAU OF PUBLIC HEALTH EDUCATION
Ditches cleaned, inland, Guttman Swamp ;. . . . 51,500
Ditches cleaned, inland, Mill Creek 12,050
Ditches dug, inland, Mill Creek 6.200
Total cleaned and dug 2,694.785
Division of Preventable Diseases.
The accomplishments of the service during the year are interesting in
many respects. The statistics show an increase in service in the field and
office. This is gratifying considering that there has been a reorganization
under a borough unit developed during this time. This change in method
of administration called for an entirely different system, both in the borough
and branch offices, than that employed in the health districts plan, and the
formation of new filing records and tabulation of activities on a borough
basis.
The community service of the branch offices has been revised and the
field broadened, comprising occupational clinics, daily, tuberculosis clinics,
held three afternoons and one night weekly at each office, also venereal dis-
ease clinics, at the Queens Plaza and Jamaica offices, to serve both northern
and southern sections of the borough.
The inauguration of Schick test service, with the demonstration centers
for physicians in each branch office was a new departure and achieved con-
siderable results.
The prevalence of influenza in the earlier months of the year, and the
increased incidence of diphtheria and scarlet fever, together with the above
activities, engaged the attention of the borough force ; and, considering the
growth and the spreading out of the population over a large expanse of
territory, the work was performed satisfactorily.
The incidence of typhoid fever in the borough was noticeably lower
than during the preceding year. Intensive sanitary surveys were made in
each case, and conditions corrected by official action, when found bad.
Bathing in contaminated pools in Richmond Hill Circle, where several child
cases developed, was stopped and no more cases followed. Strict supervi-
sion of all carriers was maintained, and new ones discovered and placed
under surveillance. Two borough cases were traced to an outbreak in Port
Jefferson, L. I.
Figures showing our increased service follow :
VISITS BY STAFF COMPARED TO PREVIOUS YEAR.
1919 1918
Nurses — visits to general contagion 16.257 8.336
Nurses — visits to tuberculosis 7.597 7,352
Inspectors — visits to cases 916 858
Schick Tests 693 0
Injection of toxin-antitoxin 657 0
261
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
The veterinary division of this office maintained an excellent service in
the investigation of dog-bite complaints, supervision of rabid dogs and fol-
low-up of the latter, and by giving prompt advice in all cases.
The enforcement of Section 21 compelling owners to have their horses
tested and branded was a new departure, and was urged to the limit of our
facilities for handling the work.
Another new development was that of the venereal disease clinics,
organized in April, and advertised by an intense propaganda. The lack of
treatment facilities in this borough inhibit the progress of this work.
The occupational clinics showed a distinct improvement, both as to
clinical examinations and to the amount of service.
OCCUPATIONAL CLINIC WORK.
1919 1918
No. of food handlers examined in clinics 2,999 716
No. of food handlers examined by private physicians. . 3,243 56
Diphtheria and Croup 1,158 811
Scarlet Fever 445 395
Typhoid Fever 67 75
Poliomyelitis 6 6
Cerebro-Spinal Meningitis 24 17
Variola 2 1
Measles 529 2.582
Liberty Measles 24 133
Whooping Cough 131 437
Chicken Pox olT 218
Mumps 158 84
Tetanus 6 4
Rabies 1 0
Anthrax 0 1
Typhus 1 0
Influenza 1.476 10,388
Pneumonia 529 1,665
Lethargic Encephalitis 3 1
Tuberculosis 542 680
Field Service by Borough Staff — Contagion 16.257
Number of visits, by Nurses — Tuberculosis 7,597
By Inspectors 916
Number of diphtheria immunizations 138
Number of typhoid immunizations 72
Number of injections of tetanus antitoxin (prophylactic) 6
Schick Tests and Active Immunizations (Exclusive of Institutions)
Number of tests 693
Number of injections — toxin-antitoxin 657
262
BUREAU OF PUBLIC HEALTH EDUCATION
Veterinarian Dimsion.
The Veterinarian Division reports the following:
Anti-rabic Work — 333 dog bites were reported; 483 dogs examined;
49 dogs destroyed; 6 cases of rabies (dogs) ; 1 of rabies (human).
Glanders Prevention — 1,006 horses were examined; 48 horses tested;
6 glandered horses destroyed ; 250 horses tagged.
Division of Child Hygiene.
In the Borough of Queens a combined plan of service between the
Division of Child Hygiene and Preventable Diseases has been maintained,
viz., all employees do work for both Bureaus.
The entire district medical service has been supplied by the Division
of Child Hygiene during the past year, as no medical inspectors, diagnos-
ticians, etc., have been assigned to duty in the Borough by the Division of
Preventable Diseases. In addition to school and district work for the
Division of Child Hygiene, medical inspectors have been required to per-
form service as diagnosticians in their respective districts during the day,
on week days. Saturday afternoon, Sunday, holiday and night calls for
diagnostician service have been attended to by the assignment to this duty
of the Borough Chief of Child Hygiene, the District Medical Supervisor,
and the Borough Chief of the Division of Preventable Diseases.
The detail of a medical inspector from the Child Hygiene force to
attend to the work in institutions has further reduced the force available
for strictly child hygiene work. This medical inspector reports, through
the Assistant Sanitary Superintendent, directly to the Chief of the Division
of Institutional Inspection, and the Division of Child Hygiene receives no
credit for the work performed.
All nurses in the borough have worked under the same general plan
as the medical inspectors. Their work has consisted of a combination of
the work of the Bureaus of Child Hygiene and Preventable Diseases.
School nursing service has been given by all district nurses in the morning
hours, and district visiting on child hygiene work and preventable disease
work performed in the afternoon hours.
This plan has the advantage of increasing the number of nurses visit-
ing the schools, giving each nurse a lessened number of schools to cover
than would be the case if the service was divided into Bureaus. This allows
the schools to receive the visits of nurses more frequently. It also has
the advantage of offering the opportunity for prevention of overlapping of
service of nurses in district visiting, and permitting the nurses to group
their visits due on all work in such a way as to save time and efTort.
263
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
SCHOOL MEDICAL INSPECTION STATISTICS.
Schools.
6 High
94 Elementary.
28 Parochial . . .
Total register .
Registration.
8,271
70,597
16,995
91,863
New admissions to school
Examined by private physicians.
Examined by medical inspectors.
2,380
144
2,136
The following tables represent the general results of the work of school
medical inspection. 1918 and 1919 compared :
GENERAL CONTAGIOUS DISEASES FOUND IN SCHOOL AND EXCLUDED.
Diph-
theria.
Scarlet
Fever.
Measles.
German
Measles.
Chicken
Pox.
1919
3
1
Whooping
Cough.
2
5
Tuber-
culosis.
5
36
Gonor-
rhoea.
0
11
Syphilis.
22
1918
9
]\Iumps.
Misc.
1919
1918
11
15
2
19
3
5
CONTAGIOUS EYE AND SKIN DISEASES FOUND IN SCHOOL.
Mol-
Pedi-
Tra-
Con-
Ring-
Im-
luscum
culosis.
choma.
junct.
worm.
Scabies.
petigo.
Favus.
Contagi-
osum.
1919
18,198
95
3,679
475
339
3,437
134
447
1918
11,734
236
3,431
190
184
1,697
64
104
264
BUREAU OF PUBLIC HEALTH EDUCATION
Visits Made to.
Inspector.
Nurse.
Total.
1918.
1919.
1918.
1919.
1918.
1919.
Contagious diseases
842
1,445
"l77
91
849
"527
3,945
18,809
574
6,416
1,842
17,979
749
11,680
4,787
20,254
574
6,593
1,933
18,828
749
13,207
Physical defect cases
Dispensaries
Special
Totals
32,208
34,717
WORK OF EYE CLINIC AT PUBLIC SCHOOL NO. 81.
Total number of patients
Total number of revisits
Total number of visits
Total number discharged
Cured
Dropped
Total number of treatments
Refractions
Prescriptions filled
Prescriptions for glasses.
1918.
1919.
1,279
1,741
1,708
3,521
2,987
4,262
1,100
1,160
1,077
1,156
23
4
1,379
4,508
2,987
2,754
1,077
2,137
1,102
1,079
Foundling Keepers — Medical inspectors made 695 visits inspecting
homes of 435 foundling keepers. Nurses made 3676 visits, re-inspecting and
controlling the same.
Employment Certificates — During the year, the work of issuing employ-
ment certificates has been conducted from four centers in the Borough,
these centers being the four Branch Offices of the Department of Health in
tliis borough, viz. Jamaica, 372 Fulton St. ; Ridgewood. 753 Onderdonk Ave. ;
Plaza, 138 Hunter Ave., L. I. City; Corona, 127 46th St.. Corona.
The issuing of such certificates at these offices, while a great con-
venience to the people in saving them time and expense in travel, adds
greatly to the burden of the nursing and medical inspection forces of the
Bureau.
NUMBER OF EMPLOYMENT CERTIFICATES ISSUED DURING THE YEAR.
1918.
1919.
Summer.
Regular.
Summer.
Regular.
Jamaica
91
150
3
1,262
1,277
1,300
639
87
129
17
7
1,251
Plaza
1,154
Ridgewood
1,112
Corona
394
Borough Totals
244
4,478
240
3,911
265
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
BOROUGH OF RICHMOND.
The appended reports of the Bureaus of Preventable Diseases, Child
Hygiene, Food and Drugs, and of the Sanitary Bureau contain detailed ac-
counts of the activities of the year.
Sanitary Division.
Mosquitoes — Notices or orders have been issued to all owners of prop-
erty upon which stagnant water is ponded, affording breeding places for
mosquitoes. Early in January, several tours of inspection were made. As
a result of these inspections, a very definite plan of action was decided upon
and several conferences were held with the sanitary inspectors and patrolmen
of the Health Squad.
All owners of property upon which stagnant water was ponded were
notified by letter of a conference to be held in the office of the Assistant
Sanitary Superintendent. Accordingly, twenty-five of the larger property
owners called and many letters were received from others, stating their in-
ability to be present at that time. Arrangements were made and these
owners were interviewed at a later date. The Assistant Sanitary Superin-
tendent addressed the assembled owners and discussed the mosquito situa-
tion in general, after which the individual cases were given particular at-
tention. All expressed a willingness to cooperate with the Department and
agreed to carry out, as far as possible, suggestions made.
Flies — Every stable in the Borough of Richmond was regularly in-
spected. Inspectors were directed to pay particular attention to the proper
disposition of manure. Every inland dump was inspected regularly and in
cares where the dump was found not properly maintained, the Superinten-
dent of the Street Cleaning Department was at once notified, and reinspec-
tion made within three days to see that the nuisance found was corrected.
The inspectors were directed to see that all garbage cans were properly cov-
ered, and yards maintained in a cleanly condition. At the beaches regular
inspections were made during the entire season, re proper care of garbage,
and where any violations were found, summary action was taken. On all
farm land where manure was stored the owners were instructed in the
proper treatment of manure. Inspections were made, regularly, to see that
the storing of manure was not attendant with nuisance. Many truck
gardens were inspected and in every case where manure was used as fertil-
izer, fiy preventive measures were insisted upon.
Bathing Establishments — All proprietors were notified in April that
they would not be allowed to conduct business without a permit from this
Department and were instructed to have their premises ready for inspection
so that permits could be obtained in time.
The beaches and bungalow colonies were inspected, daily, during the
entire season. Saturday of each week was set aside for an intensive cam-
paign of the beaches and bungalow colonies. Where any violations were
266
BUREAU OF PUBLIC HEALTH EDUCATION
found, summary action was taken. A serious problem of the beaches is the
lack of proper sewerage, necessitating very close supervision of all privy
vaults and cesspools. The beaches are supplied with city water. Formerly,
a shore inspector was on duty on these beaches. Owners were directed to
clean the beach in front of their establishments as often as required.
Water Supply — A considerable portion of Richmond Borough is not
supplied with city water. The only source being from driven wells. An
inspection of these wells was made and if there was any suggestion of
pollution or contamination, a sample of water was forwarded to the
Laboratory for bacteriological examination. In the presence of a case of
typhoid fever, samples from all wells in the vicinity were taken and the
well on patient's premises was ordered discontinued. Examination of
several wells showed the water to be of suspicious quality. Owners of
these wells were cautioned against the use of this water.
Sanitary Engineer.
The work in this Borough is varied, comprising installation of culverts,
building of sluiceways, cleaning of old and digging of new ditches, cleaning
and re-digging of water courses, and the installation of drains, details to
other Boroughs in cases of emergency, and the cleaning of ditches and
drains on highways. This refers to all the salt marsh area and inland
swamps in the Borough.
New ditches dug, inland 78,420 feet
New ditches dug, salt marsh 76.801 feet
Ditches cleaned, inland 136,644 feet
Ditches cleaned, salt marsh 845.641 feet
Total truck mileage 10.662 miles
Total oil used 100 bbls. (5.000 gals.)
Division of Preventable Diseases.
The following is a tabulation, for the years 1918 and 1919. of in-
fectious diseases reported :
Disease.
Cases.
1918.
1919.
221
318
88
HI
725
461
1
1
275
64
25
11
1
i
1
2
89
i57
50
10
45
140
19
24
145
198
6,118
796
493
330
Diphtheria
Scarlet fever
Measles
Smallpox
Pertussis
Cerebro spinal meningitis.
Poliomyelitis
Tetanus
Anthrax
Chicken pox
Liberty measles
Mumps
Typhoid
Pulmonary tuberculosis . .
Influenza
Pneumonia
267
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Diphtheria — Among the 318 cases of diphtheria reported, 42 were
secondary cases. 1,963 visits were made to these cases, and 2,315 cultures
were taken. These figures include trial cultures taken on other members
of the families. The average number of cultures taken for each case was 7.
Immunizations to the number of 240 were performed by diagnostician.
The Schick test was recommended to 166 families, and 32 tests were
performed. In all cases of diphtheria, the house in which the case occurred
was canvassed by the nurse, and the Schick test recommended for children.
Scarlet Fever — Number of nurses visits to these cases were 399; 14
were secondary cases.
Measles — Number of nurses' visits to cases of measles were 357. There
were 107 secondary cases.
Pertussis — Number of nurses' visits to cases of pertussis were 57.
There were 26 secondary cases.
Smallpox — One case of smallpox occurred in September. The patient
was a colored woman reported by the Staten Island Hospital. She lived
in West New Brighton and gave no out of town history. Thirty-one
vaccinations were performed at the time, 17 in the Staten Island Hospital,
and 14 persons with whom the patient had been in contact, before entering
the hospital, were also vaccinated. Residents of the two family house in
West Brighton, from which the patient had been removed, and of a house
in New Brighton where the patient had done laundry work, were kept
under close observation for 21 days. No secondary cases developed.
Chicken Pox — In every case where patient was over 16 years of age
the diagnostician was assigned to verify diagnosis.
Poliomyelitis — One case occurred. There were 13 nurses' visits made.
Encephalitis — One fatal case was reported in a child one year of age.
Typhoid Fever — 147 nurses' visits were made to typhoid fever cases.
Three cases occurred in the Marine Hospital were listed, but not investigated.
One secondary case occurred. There were 8 possible out of town infections.
Source of infection of the remaining cases could not be traced. Fourteen
exposed persons were immunized. Seven persons took the prophylactic
immunizations prior to going out of town.
Of the six typhoid carriers, which were listed in the Borough of Rich-
mond, one case moved to New Jersey and another was admitted to Riverside
Hospital. Of the remaining cases, three are apparently convalescing, and
one case remains active.
Cerebrospinal Meningitis — Nurses' visits to these cases were 23 in
number.
Tetanus — One fatal case was reported in a child, 9 years of age.
Nurses' Visits — Measles and pertussis cases were assigned to nurses
for one visit, during which instructions were given as to precautions, cleaning,
and readmission of children to school. The major infections were kept
268
BUREAU OF PUBLIC HEALTH EDUCATION
under observation by the nurses until the cases were ready to be terminated.
In case of removal to hospital, assignments were given to nurses to ascertain
home conditions, and exclude school children and foodhandlers for the
incubation period. The initial visit to cases of cerebro-spinal meningfitis
and poliomyelitis was made by the diagnostician.
Tuberculosis — The following table gives a summary of this work:
1918.
1919.
Private physicians' cases
At home cases
Health Department clinic cases
In hospital
Out of town
Not found
Total
32
37
97
107
9
15
54
54
40
36
20
18
252
267
Venereal Clinic — This was opened on May 1st and seventy-seven cases
treated.
Veterinarian Division .
The Veterinarian Division reports the following :
Anti-rabic Work — 85 dog bites ; 61 dogs examined ; 12 dogs destroyed ;
no cases of rabies (dogs) ; no cases of rabies (human).
Glanders Prevention — 280 horses were examined ; 14 horses tested ;
7 glandered horses destroyed ; 100 horses tagged.
Division of Child Hygiene.
Boardcd-Oiit Children — There are in the Borough 134 foundling homes,
having permits to board 2)i7 children ; 14 of them have no children; 26 have
only part of the number aliowed them by permits, and the remaining 94 have
their full capacity, totalling 276 children actually in board, and leaving avail-
able homes for 61 children.
Following an inspection of the premises by the medical inspector, to
ascertain the condition before granting the permit to board children, a
monthly visit is made by the nurse. During these visits instructions are
given as to the general care of the children and special attention given to
any particular case that may arise. Every effort is made to get the found-
ling keepers who board infants to take advantage of the privileges offered
them by the Baby Health Station. This is difficult to accomplish because of
the large area over which these homes are scattered, and the poor transporta-
tion facilities of this Borough. To offset this, there are many advantages
that are not found in the more crowded sections of the city, such as play
269
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
yards surrounding the homes, more sunHght and fresh air available for the
sleeping rooms.
During the past year it was necessary to revoke one permit. This case
was one in which the permit was granted under favorable conditions, but,
later, the foundling keeper took back to her home one of her own children
who is mentally deficient, as well as a mentally deficient child from another
source. When these conditions were discovered, and request made for her
to give up the mentally deficient children, the foundling keeper refused to
do so, and it became necessary to revoke her permit.
Baby Health Stations — At all times at the station, and during the home
visits, the nurse makes every effort to encourage mothers to breast-feed the
babies. There has been a greater supply of milk dispensed than in previous
years, regardless of the increased cost. Because of the activities in instruct-
ing mothers in the importance of the best grade milk for themselves and
babies, many of the mothers deprive themselves of other things to obtain
sufficient funds to get better grade milk, and in those cases where financial
conditions will not permit, aid has been obtained from various neighborhood
organizations.
School A^cdical Inspection — The general sanitary condition of the public
and parochial schools in this Borough is unusually good and, with one
exception, there is no marked over-crowding in the school rooms. This
exception is at Public School No. 17, where the registration is several hun-
dred more than the normal capacity of the building. Plans for a new build-
ing have been approved for some time, but construction has not been started.
The overcrowding at this building necessitates that the medical inspections
be done under unfavorable conditions.
During a portion of 1919, there were times when the full quota of
inspectors and nurses were not available, but towards the latter part of the
year this was remedied and a fair organization and distribution of the work
was accomplished.
Number o
Number o
Number o
Number o
Number o
Number o
Number o
Number o
Number o
Number o
Examinations for Physical Defects.
pupils examined 3,353
pupils showing defective vision 118 — 3%
pupils showing defective hearing 8 — 2%
pupils showing defective breathing 302 — 9%
pupils showing hypertrophied tonsils 409 — 12%
pupils showing defective nutrition 151 — 4%
pupils showing cardiac diseases 38 — 1%
pupils showing pulmonary diseases "^ — 1%
pupils showing orthopedic defects 14 — 3%
pupils showing defective teeth 1,633 — 49%
270
BUREAU OF PUBLIC HEALTH EDUCATION
Total number of defects 2,685
Number of cases vision not tested 454
Number of re-examinations 671
General Contagious Diseases Found in School and Excluded.
Diphtheria 1
Measles 18
German Measles 1
Chicken Pox 17
Mumps 9
Vaccinations
Primary
Secondary
Certificates
Issued
At Borough Office
606
1,606
52
69
4''3
In the Schools
1 301
Totals
2 212
121
1,724
The principals of the schools seem to appreciate their responsibility in
obtaining the consent of the parents for the vaccinating of their pupils, and
co-operate in every way with the schools' nurses to obtain the vaccination
of each pupil, when necessary.
In only one of the schools in this Borough has it been possible to estab-
lish special classes for nutrition, but the nurses have been able, in many
instances, to influence the mothers to allow their children, if under-nourished,
to bring suitable lunches to school, daily, and the people co-operate in this
eflfort to bring the children up to more nearly normal nutrition.
The very small number of cardiac cases found in the routine medical
inspection has not warranted an attempt to establish special cardiac classes in
any of the schools.
The adoption by the Department of Education of the syllabus in hygiene
has resulted in a marked improvement in the co-operative work of the
teachers with the medical inspectors and nurses, as evidenced by the number
of pupils that are referred for inspection. A decided improvement has been
noted in the general cleanliness of pupils, particularly regarding oral hygiene.
There are decided advantages in the present system of early detecting and
excluding pupils suffering from contagious diseases. The only obstacle to
contend with in this matter is an occasional lax teacher, who fails to make an
efficient inspection of the pupils, but this is a rare occurrence.
271
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
Schools Registrations.
Schools. Registrations.
2 High 1,168
Z7 Elementary 15,145
9 Parochial 1.712
Total 18,025
Division of Food and Drugs.
Food Adulteration — Condemnations of assorted foodstuffs were made
where the same were f omid unsound and dangerous for human consumption ;
where milk and cream were found tQ/ be adulterated, prosecutions were in-
stituted. Hearings wxre given in some cases where foodstuffs were found in
an unwholesome condition. Prosecutions were instituted where cases war-
ranted.
Exposure of Foodstuffs — Summonses were served and cases prosecuted
in thirty-one cases of food exposure ; where the desired results were not
obtainable by personal effort, warning letters or hearings were given. Good
results have been achieved, and violations of this character greatly reduced.
Cleansing of Utensils — Regulations providing for the cleansing of
utensils have been well observed during the year. Frequent inspections of
restaurants and cafes, warning letters and hearings given violators, resulted
in only six summonses being served during the year. This is also partly due
to raids conducted by this Division during the summer of 1918, when we
closed about 18 eating and drinking cafes, by Board Orders, and served
summonses on others. Activities of this character having a wholesome effect
in small communities, such as this Borough.
Terminal Inspections — These have improved the method of handling
and caring for foodstuffs arriving from foreign ports, in that more frequent
inspections are made. All steamships are met by the inspectors, and food-
stuffs carefully inspected ; where cargoes are found damaged, embargoes are
placed on same. Where consignee is required to move foodstuffs so em-
bargoed to another Borough, permission is given him, and the Borough to
which foodstuffs are removed is notified, so there is an unbroken supervision
kept on embargoes until final disposition.
The supervision of dairies has improved, in that frequent inspections
are made. The herds of dairy cows, where Grade A Raw milk is produced,
have been put in good condition physically. All cows not having been tested
w'ithin the year, have been tested under the supervision of the veterinarian.
All cows, entering the Borough for dairy purposes, are checked up and sus-
pects excluded. Some attention is given to private cows, to see that sanitary
conditions prevail.
272
BUREAU OF PUBLIC HEALTH EDUCATION
Bakeries and other retail food stores are more frequently inspected, and
conditions have been much improved. Where violations of the Sanitary
Code are found to exist on a second inspection, the owner is told by letter
to call at the office to explain why the violation has not been removed. In
nearly all cases, a talk with the Borough Chief brings about the desired
results. In some cases, warning letters are effective, and by this method we
gain gratifying results, and are gaining the good-will and the co-operation
of the people with whom we deal.
Restaurants and cafes along the water front have been brought up to a
better sanitary condition. Adequate hot water systems have been installed,
walls and ceilings painted, instead of papered, and toilets vestibuled and kept
in sanitary condition.
Summary of Veterinarian Activities.
Cattle — Supervised tuberculin test of Grade A herds ; physical examina-
tion of cows in Grade B herds ; inspections of cows kept under Bang system ;
inspections of cows for other infectious and contagious diseases.
Meat Inspection — Passing on carcasses for food, in so far as any dis-
ease is concerned.
Hogs — Immunization of New York City Farm Colony herd for hog
cholera, vaccinated 200 ; herd at Sailor's Snug Harbor, 140 ; total 340.
Preventive inoculation with serum in herds in which disease started.
Poultry — Roup investigated — one outbreak of this disease among
poultry ; advised sanitary measures and treatment for same.
273
BUREAU OF RECORDS.
Vital Statistics
The year just ended has been a remarkable one in that the death rate
has reached the lowest level ever recorded since the establishment of accu-
rate vital statistics fifty years ago. The death rate for the year was 12.39
per 1,000 of the population, as compared with a rate of 16.71 in 1918, and
13.94 for the five-year period 1913 to 1917, inclusive. The death rate at
the time of the organization of the Board of Health fifty-three years ago
was a little over 28 per 1,000 of the population, which compared with the
death rate of 12.39 shows a reduction of more than 50 per cent, in the
mortality of the city. Broadly speaking, where two persons died fifty years
ago out of every 1,000 of the population, only one died during the past year.
The accompanying table shows chiefly the experience of the year just
passed with that of the average of the quinquennium, 1913 to 1917; this
comparison being chosen in order to eliminate the effect of the great epi-
demic of influenza in the year 1918, thus constituting a fairer basis for
comparison. By this a decrease of 9,327 deaths is shown.
DEATHS FROM PRINCIPAL CAUSES.
Average for Quinquennium, 1913-17, as Compared with 1919.
All causes
Typhoid fever
Typhus fever
Smallpox
Measles
Scarlet fever
Whooping cough
Diphtheria
Influenza
Tuberculosis, pulmonary
Other tuberculosis diseases
Cancer
Apoplexy and softening of brain . .
Organic heart disease
Brights disease and ac. nephritis. .
Acute bronchitis
Lobar pneumonia
Broncho pneumonia
Diarrhoeal diseases, under 5 years
Congenital diseases
Accidents
Homicides
Suicides
Cirrhosis of liver
Alcoholism
Poisoning, wood alcohol
Corrected
Average
1913-1917.
83,760
324
1
631
322
425
1,382
598
9,574
1,489
5,032
1,006
11,400
6,596
792
6,554
4,927
3,876
4,814
4,176
305
956
813
625
4
Year
In-
De-
1919.
crease.
crease.
74,433
121
9,327
203
1
"218
413
136
186
161
264
1,240 ■
4,830
7,396
1,103
' '4,232
142
' 2,178
386
5,141
870
109
136
10,429
5,000
547
971
1,596
245
6,192
4,787
2,475
362
140
1,401
3,845
3,787
969
389
277
28
702
254
383
430
176
449
62
58
Year
1918.
98,119
196
790
177
665
1,245
12,562
8,779
1,318
4,931
1,057
12,105
5,269
760
13,641
6,987
2,556
4,234
4,202
245
724
433
252
4
274
BUREAU OF RECORDS
The two causes that have shown an increase have been cancer and influ-
enza. It will be remembered that, in the first three months of the year, the
recrudescence of influenza appeared, with the result that there was a great
increase in the number of deaths reported therefrom, as well as in the deaths
reported from the acute respiratory diseases. The increase in the pneu-
monias and bronchitis, however, was gradually, month by month, lowered as
compared with the previous years, until finally the increase was wiped out
and a decrease among these two causes was shown by the end of the year.
A noteworthy decrease was the unprecedented drop in the mortality from
tuberculosis of the lungs. It was evident that during the epidemic of influ-
enza that persons sufifering from pulmonary tuberculosis was not at all
affected by the prevailing epidemic. Apparently tuberculosis conferred a
relative degree of protection as against influenza, so that the mortality from
the former was not increased by reason of the epidemic.
The mortality rate of infants under one year of age, which is considered
a reliable index of the sanitary conditions prevailing in a community,
reached the low record of 82 per 1,000 of the children born. This is the
lowest infant mortality rate on record for the city. That for the year
previous was 92 ; the year previous to that 89. In passing it might be added
that the decrease in the infant mortality rate since the organization of the
Greater City in 1898 is somewhat over 50 per cent.
Thirty-nine thousand eight hundred and eighty-nine (39,889) males died
during the year, as compared with 34,544 females; 3,211 deaths of colored
persons were reported, and 131 deaths of Chinese and Japanese; 31,390 per-
sons died in institutions ; 27,839 in tenements ; 12,535 in private dwellings ;
852 people died in hotels; 1,898 on the streets or in rivers; 2,686 non-resi-
dents of the city died during the year. The recent high mortality from
wood-alcohol poisoning is evidenced by the report of 62 deaths during the
year from this cause, as compared with 9 during the previous year. The
most interesting decrease in the mortality from the diseases caused directly
by the abuse of alcohol is shown in the figures giving the mortality from
alcoholism and cirrhosis of the liver. In 1919 there were 176 deaths re-
ported from alcoholism (133 of which occurred during the first six months
of the year, as against 43 in the last six months), and 383 deaths from
cirrhosis of the liver, making a total of 559 deaths from these two causes, as
compared with 687 deaths in the year 1918, and 1,228 deaths in the year
1917. There were 130.377 births reported during the year, a decrease of
9,454, as compared with the year 1918. This is one of the effects of the
war, the birth rate being the lowest that we have had in the city during the
past twenty years. On the other hand, the marriages increased from 56,733
in 1918 to 60.256 in 1919. The results of this increase will be undoubtedly
reflected in an increased birth rate during the coming year.
The following are the deaths and death rates by boroughs for the year
1919, distributed to borough residence:
275
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
DEATHS AND DEATH RATES BY BOROUGHS, YEAR 1919.
DISTRIBUTED TO BOROUGH RESIDENCE.
Manhattan.
Bronx.
Brooklyn.
Queens.
Richmond.
City.
Deaths
Rate
33,304
11.98
8,258
12.79
25,809
12.46
5,339
12.14
1,723
16.62
74,433
12.39
276
BUREAU OF RECORDS
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278
BUREAU OF RECORDS
BIRTHS BY NATIVITIES OF PARENTS.
Country.
City of New York.
Nativity of
Nativity of
Mother Only.
Both Parents.
Mixed
Parentage.
8,375
3,740
323
157
52
226
296
856
92
260
1,063
875
4,032
1,716
23,745
887
20,138
2,951
136
310
377
258
31
70
39,689
12,336
5,477
1,909
Austria Hungary. .
Bohemia
British America . . .
England
France
Germany
Ireland
Italy
Russia and Poland.
Scotland
Sweden
Switzerland
United States
Other Foreign
Unknow^n
Total
103,826
26,551
279
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
MARRIAGES REPORTED
Total.
White.
Black.
Chinese.
Single.
Widowed.
Date.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
January.
February
March. .
April ....
May. . . .
June. . . .
July
August. .
Septembe
October.
Novembe
Decembe
r. . .
r. . .
. 6,937
. 3,971
. 4,306
3,888
. 3,787
6,492
. 6,332
2,951
. 4,858
. 5,101
. 5,179
6,394
6,379
3,802
4,095
3,732
3,597
6,288
6,119
2,860
4,726
4,892
4,972
6,136
6,400
3,807
4,100
3,732
3,596
6,292
6,122
2,860
4,728
4,895
4,974
6,136
556
168
271
155
190
202
212
91
130
208
206
254
537
164
266
156
191
199
210
91
129
2C5
204
257
2
1
' 1
"2
1
'"•2
1
1
4
" i
' "i
1
1
1
6,121
3,479
3,848
3,499
3,304
5,894
5,713
2,643
4,419
4,676
4,691
5,881
6,099
3,480
3,867
3,529
3,245
5,994
5,794
2,686
4,500
4,677
4,753
5,905
725
440
467
361
433
542
545
280
397
363
448
455
706
406
429
290
480
436
447
225
309
343
360
409
Tota
. 60,256
57,598
57,642
2,643
2,609
15
5
54,168
54,529
5,456
4,840
280
BUREAU OF RECORDS
DURING YEAR 1919.
Divorced.
Native.
Foreign.
R
eligious Marriages
Civil M
arriages.
Protes-
Ethical
Alder-
Judi-
M.
F.
M.
F.
M.
F.
Catholic.
tant.
Jewish.
Culture.
manic.
cial.
91
132
3,319
3,621
3,618
3,316
840
1,063
1,074
1
3,9.56
3
52
85
1,881
2,011
2,090
1,960
837
740
939
1,4.50
5
51
70
2,081
2,5C4
2,285
1,862
748
768
1,008
1,834
7
28
69
1.807
1,973
2,081
1,915
631
993
980
1,277
7
50
62
1,488
1,762
2,299
2,025
966
1,018
824
978
1
56
62
3,208
3,603
3,284
2,889
1.533
1,824
1,778
1,344
9
74
91
3,401
3,682
2,931
2,650
1,480
1,617
1,675
2
1,551
7
28
40
1,655
1,743
1,296
1,208
865
1,021
683
1
380
1
42
49
2,546
2,782
2,312
2,076
1,296
1,739
1,355
4
454
10
03
81
2,683
2,920
2,418
2,181
1.481
1,402
9.58
3
1,247
10
40
66
2,635
3,016
2,544
2,163
1,181
1,583
1.340
2
1.057
10
57
80
2,942
3,172
3,452
3,222
1,435
1,270
1.602
2
2,077
8
632
887
29,646
32,789
30,610
27,467
13,293
15,038
14,222
20
17,605
78
281
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
DEATHS OF CHILDREN UNDER ONE YEAR OF AGE BY NATIVITIES OF BOTH
PARENTS— DEATH RATES PER 1,000 BIRTHS REPORTED BY NATIVITIES
OF BOTH PARENTS— 1919.
Austria-Hungary
Bohemia
England
France
Germany
Ireland
Italy
Russia-Poland
Scotland
Sweden
United States
Other foreign 1
Mixed native and foreign |-
Unknown J
Total
Births
Reported
by Nati%aties
of Both
Parents.
8,375
323
296
92
1,063
4,032
23,745
20,138
136
377
39,689
32,111
130,377
Deaths Under
One Year
by Nativities
of Both
Parents.
553
23
32
9
101
363
2,060
1,255
19
23
3,532
2,669
10.639
Death Rate
per 1,000 Births
Reported by
Nativities of
Both Parents.
66
71
108
99
95
90
87
62
140
61
89
83
82
2S2
BUREAU OF RECORDS
o
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1-4
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DOD
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2^1
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
DEATHS FROM ALL CAUSES ACCORDING TO NATIVITY OF DECEASED AND
PARENTS OF DECEASED, NEW YORK CITY, YEAR 1919.
Country.
Nativity of
Deceased.
Nativity of
Parents of
Deceased.
United States
Ireland
Germany
Italy
Russia
England
Austria-Hungary . .
Scotland
British America. . .
Switzerland
France
Bohemia
Roumania
Poland
Syria
Sweden
Norway
Denmark
Finland
Holland
Cuba
Other West Indies.
Belgium
Spain
Greece
China
Australia
Other foreign
Unknown
Mixed nationalities
Total
43,493
6,160
5,410
4,196
5,011
1,378
2,840
497
463
229
374
263
349
442
70
572
403
134
156
105
81
478
36
162
241
123
10
405
352
16,471
11,403
8,342
8,604
7,447
1,485
4,132
643
338
243
437
399
427
807
82
708
559
144
196
134
84
750
32
223
341
119
8
470
2,623
6.782
74,433
74,433
284
BUREAU OF RECORDS
DEATHS OF NON-RESIDENTS FROIM CERTAIN CAUSES, 1919.
Cause of Death.
Typhoid fever
Pulmonarj' tuberculosis . . .
Other tuberculous diseases
Cancer
Alcoholism
Heart diseases
Acute respiratory diseases .
Diarrhoea! diseases
Appendicitis
Cirrhosis of liver
Diseases of women
Congenital debility
Accidents
Suicides
Other causes
Total
Under 1 year
1 to 4 years
5 to 14 years
15 to 24 years
25 to 44 years
45 to G4 years
65 years and over
Total
Institutions
Hotels
Other places
Total
New York City.
15
308
39
267
12
242
441
52
45
11
27
89
151
42
945
2,686
1S9
83
51
504
958
606
295
2,686
2,049
101
536
2,686
285
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
DEATHS FROM ALL CAUSES AND DIARRHOEAL DISEASES UNDER ONE YEAR
OF AGE BY WEEKS— 1919.
All Causes,
Diarrhoeal Diseases.
Week Ending.
s
o
G
O
03 (N
^05
J3
a
c
to
O
03 iM
c
o
0
1
c
i
a
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03 (N
0
73
a
-a
a
5fc
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O C
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J3 t.
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CO
o
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CO
CO
03
H
January 4
124
21
24
29
23
22
243
7
1
5
10
5
2
30
January 11 ... .
103
14
18
44
17
25
221
5
2
4
6
2
19
January 18. . . .
124
18
26
57
27
25
277
7
1
4
16
3
"3
34
January 25. . . .
112
21
16
41
33
34
257
3
3
3
4
1
3
17
February 1 . . . .
129
26
15
46
35
34
285
2
3
4
6
2
1
18
February 8 . . . .
102
19
11
65
35
21
253
6
2
16
5
3
32
February 15. . .
125
25
18
54
32
28
282
' i
1
3
7
4
2
18
February 22 . . .
122
22
21
58
31
36
290
5
4
6
19
3
1
38
March 1
113
21
10
41
35
34
254
3
1
2
10
5
2
23
March 8
118
22
11
50
24
35
260
3
2
1
4
4
2
16
March 15
112
28
12
59
43
34
288
4
3
17
6
3
33
March 22
106
22
15
26
38
30
237
2
2
3
5
6
1
19
March 29
92
14
27
29
38
25
225
3
5
8
7
4
2
29
April 5
97
19
20
42
35
31
244
3
4
2
7
1
4
21
April 12
87
17
21
28
33
39
225
1
1
4
7
4
6
23
April 19
98
16
16
33
39
27
229
1
1
4
4
5
2
17
April 26
103
14
15
28
29
25
214
2
2
2
5
4
2
17
May 3
84
15
12
36
31
14
192
T
3
2
5
4
2
17
May 10
91
20
16
17
39
22
205
3
4
2
3
5
17
May 17
88
20
11
23
20
25
187
4
9
5
4
3
"3
28
May 24
76
13
11
33
17
26
176
2
2
4
9
5
6
28
May 31
75
12
7
26
16
26
162
1
4
1
6
1
4
17
June 7
86
19
13
23
21
20
182
4
3
1
3
8
3
22
June 14
59
9
15
19
22
16
140
3
3
9
5
5
25
June 21
72
11
6
25
14
16
144
' i
2
3
8
4
7
25
June 28
70
11
9
29
21
10
150
2
4
3
14
11
6
40
July 5
52
82
9
8
11
13
27
47
16
36
13
23
128
209
"5
2
3
4
5
13
30
5
26
4
8
28
July 12
77
July 19
62
8
13
36
21
28
168
1
2
9
25
10
18
65
July 26
62
15
11
44
35
27
194
2
6
6
28
21
19
82
August 2
63
19
24
65
63
37
271
8
13
48
46
25
140
August 9
50
11
17
49
56
34
217
"4
5
7
36
43
23
118
August 16
61
12
20
46
43
25
207
2
4
7
28
32
18
91
August 23
79
12
14
52
43
29
229
6
4
8
35
30
24
107
August 30
65
14
25
55
39
26
224
2
4
13
33
28
20
100
September 6 . . .
82
11
10
60
40
25
228
3
4
6
34
29
16
92
September 13. .
83
10
14
43
34
21
205
2
3
5
27
18
10
65
September 20 . .
81
17
13
30
20
15
176
6
7
8
14
9
6
50
September 27 . .
93
20
15
29
22
20
199
5
5
7
13
10
11
51
October 4
75
15
13
48
27
17
195
1
8
3
24
13
8
57
October 11. . . .
73
11
10
34
19
14
161
5
3
4
14
8
4
38
October 18. . . .
79
19
13
28
10
19
168
3
5
9
8
3
6
34
October 25. . . .
77
11
18
35
19
12
172
3
8
9
11
3
34
November 1 . . .
80
12
9
24
23
16
164
3
5
6
8
6
2
30
November 8. . .
81
15
17
20
12
10
155
3
4
8
8
4
3
30
November 15. .
60
8
8
27
10
13
126
2
1
12
4
1
20
November 22. .
70
■ 14
11
20
16
8
139
' 3
2
5
7
5
2
24
November 29 . .
87
15
10
24
15
8
1.59
6
2
3
5
3
1
20
December 6. . . .
92
14
11
21
15
13
166
4
2
2
8
4
3
23
December 13. . .
94
17
15
29
25
16
196
3
3
5
8
5
4
28
December 20. . .
91
16
16
22
11
12
168
4
3
5
4
1
1
18
December 27. . .
93
22
11
24
24
18
192
4
4
3
6
5
3
25
Total 52 weeks
4,535
824
758
1,900
1,442
1,179
10,638
150
173
244
696
489
318
2.070
286
BUREAU OF RECORDS
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BUREAU OF RECORDS
REGISTERED MORTALITY FROM ALL CAUSES AND CERTAIN INFECTIOUS
DISEASES, BY WARDS, YEAR 1919.
BOROUGH OF MANHATTAN.
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11.5
4
2
32
3
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1,915
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4
4
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21,336
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2 .
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6
62
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25
23
385
116
5
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5,666
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4
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19,670
228.7
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2
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30
14
362
78
7
198.0
102,101
515.6
3.
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1
30
61
63
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49
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307
8
183.0
33,182
181.4
5
3
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35
30
26
427
127
9
322.0
64,909
201.6
4
30
149
95
82
52
1,081
238
10
110.0
66,439
604. 0
2
11
52
37
41
16
562
171
11
196.0
136,548
696.7
3 .
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2
27
68
72
86
47
922
295
12
6,154.0
806,648
131.1
22 .
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19
159
1,209
1,116
795
324
12,458
2,472
13
107.0
64,651
604.3
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31
29
39
21
463
134
14
96.0
38,321
399.3
2
9
70
67
54
44
541
193
15
198.0
30,584
154.5
1
2
52
21
26
9
353
59
16
349.0
55,926
160.2
2
3
12
125
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59
36
1,018
174
17
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172,334
520.6
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150
154
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1,867
534
18
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62,821
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213
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1,385
313
19
1,481.0
292,950
197.7
6 .
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264
159
4,080
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20
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73,308
165.1
2 .
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2
13
157
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84
54
1,202
267
21
411.0
62,345
151.7
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2
13
129
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70
32
1,135
224
22
1,529.0
209,154
136.8
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49
398
258
211
131
3,588
680
Total
13,226.0
2,331,491
176.3
51 .
. 143
59
520
3,597
2,654
2,268
1,205
33,304
7,311
BOROUGH OF THE BRONX.
23
24
4,267.0
22,255.8
268,880
162,062
63.0
7.3
5
6
7
2
12
10
94
79
524
396
356
355
272
297
125
84
4,227
4,031
880
751
Total
26,522 8
430,942
16.2
11
9
22
173
920
711
569
209
8,258
1,631
291
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
BOROUGH OF BROOKLYN.
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302.9
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153.3
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3 .
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82,687
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39
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152
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182
10
318.7
41,238
129.4
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45
31
46
548
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21,659
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591
105
12
663.1
29,262
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2
31
104
66
59
49
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211
13
230.3
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130.7
7
42
24
24
14
384
96
14
282.6
33,329
117.9
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38
38
29
30
336
131
15
244.8
35,887
146.6
2 .
16
38
38
38
29
432
149
16
244.8
68,244
278.7
2 .
10
64
57
43
26
662
177
17
823.3
70,346
85.5
2 .
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4
16
117
94
49
82
1,085
282
18
873.0
35,708
40.9
1 .
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1
21
59
62
33
41
614
150
19
413.8
44,860
108.4
11
65
55
35
11
654
108
20
461.4
27,463
59.5
1 .
5
51
56
29
19
557
98
21
483.2
78,741
163.0
2 .
4
16
71
86
44
34
886
211
22
1,361.6
81,283
59.7
5 .
. 3
17
112
134
65
48
1,447
237
23
736.0
65,561
89.1
2
6
114
92
57
33
1,253
169
24
1,198.5
80,466
67.2
2 .
4
18
91
97
80
27
1,160
225
25
567.8
63,597
112.0
1 .
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9
78
51
51
20
843
140
26
3,590.2
177,963
49.5
1 .
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7
55
146
206
172
68
2,273
621
27
400.7
76,000
189.6
1 .
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56
52
50
25
630
157
28
884.4
77,451
87.6
1 .
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2
17
142
128
87
31
1,584
187
29
3,800.0
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3 .
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18
79
108
57
29
1,308
212
30
5,401 . 1
76,406
14.1
5 .
1
7
57
162
236
158
74
2,652
557
31
6,312.3
30,988
4.9
1
6
24
42
26
13
478
93
32
5,479.5
17,419
3.2
1
1
1
9
3
10
3
91
16
Total
38,977.8
1,634,508
41.9
43 .
. 51
43
423
2,252
2,225
1,593
990 25,809
5,453
BOROUGH OF QUEENS.
1
4,650.0
61,763
13.3
3
5
6
30
81
103
75
57
1,120
283
2
14,700.0
105,219
7.2
1
1
3
17
136
133
85
54
1,570
298
3
22,000.0
37,171
1.7
3
3
21
49
50
44
19
774
142
4
36,600.0
67,412
1.8
3
2
29
202
113
66
53
1,553
262
5
3,770.0
12,476
3.3
2
6
33
9
9
322
50
Total
81,720.0
284,041
3.5
10
8
12
99
474
432
279
192
5,339
1,035
BOROUGH OF RICHMOND.
1
2
3
4
5
3,340,0
4,130.0
10,050.0
8,180.0
10,900.0
27,201
16,871
19,812
10,662
11,423
8.1
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2.0
1.3
1.0
4
2
3
3
1
5
8
6
4
1
52
39
33
22
6
54
44
40
17
17
21
19
15
13
6
15
20
14
11
9
505
388
399
272
159
93
65
77
47
32
Total
36,600.0
85,969
2.3
6
7
24
152
172
74
69
1,723
314
292
BUREAU OF RECORDS
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295
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
MARRIAGES,
BIRTHS, DEATHS
Total.
White.
Colored.
Other.
Native
Parents.
Foreign
Parents.
Parentage
of
Mixed.
Nativities.
Parentage
Unknown
or Not
Stated.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
Marriages. .
Births
Deaths
Stillbirths. . .
60,256
130,377
74,433
*5,984
57,598
64,723
38,083
3,020
57,642
61,974
32,970
2,576
2,643
1,813
1,645
191
2,609
1,791
1,568
132
15
43
155
3
5
33
12
29,646
20,569
8,602
1,028
32,789
19,587
7,869
883
30,610
32,964
25,774
1,739
27,467
31,865
22,783
1,446
12.871
3,578
377
12,204
3,204
292
175
1,929
70
142
694
87
*Sex undetermined, 62.
296
BUREAU OF RECORDS
AND STILLBIRTHS REPORTED— 1919.
Di-
Not
Months of Utero-Gestation.
Single.
Married.
Widowed.
vorced.
Stated.
1
2
3
4
5
6
7
8
9
10
Not
Stated.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
54,168
54,529
5,456
4,840
632
887
2
24
125
307
513
657
755
738
2,476
244
18,726
1S.358
15,918
12,027
4,651
9,034
89
69
499
62
143
297
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
DEATHS FROM INFLUENZA, BRONCHO AND
OLD CITY MANHATTAN AND BRONX— 1889-1897.
Influenza.
Broncho and
Year.
Total.
a
£!
d
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a
Total.
c
JD
i
^
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fa
s
<
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3
1-5
3
1-5
0
^
Q
>^
fa
S
<
S
1889
7
314
854
7
i29
4,075
4,989
5,818
405
1,111
502
394
434
478
534
487
646
508
465
1,112
352
1890
' 260
1
■■■30
ic
45
' '4
507
' 1
123
2
34
■ ■ ■
4
412
1891
4
3
4
563
1892
495
227
281
5
' 'i69
4
50
47
20
86
13
30
3
9
1
13
5
5
35
5,841
6,487
648
687
609
613
685
1,089
691
1,082
711
1893
' '2
4
653
1894
188
71
33
29
16
5
6
' '4
' 1
4
6
13
4,725
680
551
525
512
425
1895
567
242
165
84
44
15
2
1
2
4
8
5,751
835
609
618
681
541
1896
101
16
18
17
26
5
' 1
1
2
4
U
5,383
633
619
739
803
522
1897
196
10
28
64
51
21
"4
1
' '2
2
3
10
4,621
422
494
627
489
401
1898
393
11
26
30
26
8
2
2
1
15
272
8,094
787
789
910
830
743
1899
461
237
91
50
24
13
1
' 1
9
10
25
8,531
1,035
952
912
890
743
1900
612
32
112
219
143
42
16
2
' i
2
5
38
10,482
1,129
1,348
1,753
1,511
961
1901
856
398
194
114
67
20
9
1
4
" "s
13
28
9,168
1,344
888
1,170
955
743
1902
157
30
37
32
15
4
1
' i
2
8
9
18
9,377
1,322
1,261
1,053
945
911
1903
418
23
146
131
42
18
5
1
' i
6
14
31
9,714
1,071
1,156
1,116
942
922
1904
501
70
103
128
87
29
5
1
2
1
22
53
12,369
1,516
1,653
1,767
1,729
1,134
1905
311
108
65
56
16
16
6
2
"2
2
2
18
18
9,783
1,306
1,088
1,117
1,071
853
1906
241
40
37
43
35
19
6
3
2
3
12
41
10,868
1,293
1,184
1,397
1,291
1,039
1907
714
155
109
109
50
24
17
3
6
15
22
204
11,806
1,504
1,310
1,398
1,157
982
1908
403
167
94
63
33
7
4
1
. . .
3
11
20
9,. 508
1,219
1,123
1,152
1,116
942
1909
335
37
34
77
89
28
3
" i
4
5
19
38
10,614
1,097
964
1,307
1,365
980
1910
366
47
49
75
52
24
13
5
3
1
7
14
76
10,519
1,332
1,042
1,333
1,184
878
1911
486
152
101
82
50
35
6
2
1
5
10
17
25
10,055
1,239
1,118
1,375
1,314
940
1912
269
35
45
49
37
16
6
4
3
4
11
19
40
9,979
1,118
1,134
1,216
1,051
1,062
1913
350
71
67
73
47
20
8
3
3
5
4
20
29
10,042
1,132
1,357
1,504
1,001
956
1914
336
55
52
103
54
17
6
4
3
2
8
10
22
9,678
1,051
1,100
1,496
1,051
951
1915
526
43
34
81
129
49
19
10
3
6
12
23
117
10,922
1,203
976
1,463
1,544
978
1916
853
381
180
100
47
30
13
3
5
2
10
21
61
10,568
1,725
1,115
1,196
1,028
968
1917
657
220
134
94
43
30
14
8
8
10
15
32
49
11,051
1,954
1,345
1,199
1,047
1.022
1918
12,562
72
52
133
106
36
7
6
5
114
8,384
2,731
916
20,628
1,471
1,304
2,294
1,746
856
1919
4,834
1,967
1,311
877
327
148
38
14
10
24
48
28
42
10,977
2,562
2,055
1,818
1,144
726
298
BUREAU OF RECORDS
LOBAR PNEUMONIA AND ACUTE BRONCHITIS.
GREATER CITY— ALL BOROUGHS— 1898-1919.
Lobar Pneumonia.
Acute Bronchitis.
a;
c
3
>-5
<
O
>
o
Z
Q
Total
■-5
J2
s
r^
a
<
c
3
3
<
a
O
o
0
Year.
229
147
161
205
270
308
562
1,814
182
217
234
159
133
107
96
104
105
120
129
228
1889
276
205
223
196
285
362
533
1,987
391
190
229
201
163
110
94
98
96
121
136
152
1890
352
237
208
242
296
508
674
1,836
174
127
195
333
179
120
82
82
107
124
117
196
1891
385
301
2.55
2.54
340
464
498
1,7.54
221
179
206
195
185
125
100
57
107
104
132
137
1892
359
252
223
2.34
287
379
629
1,577
181
135
241
229
134
80
68
76
82
93
101
157
1893
314
230
206
224
286
333
4.39
1,329
175
1.50
128
136
97
103
62
63
71
95
107
136
1894
311
231
268
267
366
449
575
1,036
229
195
180
167
126
80
66
70
74
118
144
181
1895
284
257
218
298
340
324
346
1,292
142
131
179
177
125
67
58
80
72
88
76
97
1896
303
228
236
259
358
353
451
1,089
100
124
125
109
103
77
51
54
72
86
83
105
1897
472
404
347
420
543
684
1.165
1,923
187
207
227
188
167
99
80
81
109
155
169
254
1898
491
4.36
343
428
574
703
1.024
1,988
222
220
200
177
143
123
90
81
126
181
221
198
1899
595
433
343
307
539
659
844
1,964
230
283
311
251
152
91
66
62
71
115
156
170
1900
533
375
3C1
401
571
771
1 ,0.50
1,683
225
107
216
176
128
92
53
78
90
109
137
212
1901
527
442
399
472
5,50
083
812
1,898
278
243
198
183
170
80
76
81
109
129
162
183
1902
5.56
480
3X0
424
543
919
1,199
1,500
105
191
162
149
158
84
68
71
89
102
1.52
109
1903
562
429
404
442
586
894
1,2.53
1,735
243
201
222
194
1.59
106
09
50
86
101
132
166
1904
586
443
430
390
579
8.59
1 ,055
1,417
173
141
107
170
123
86
76
75
64
85
119
138
1905
634
444
414
504
065
8.54
1,149
1,319
195
102
187
142
107
6()
61
50
53
84
83
123
1906
777
528
612
.501
643
923
1,471
1,048
129
139
109
98
92
65
65
50
53
57
80
105
1907
502
380
379
443
560
715
977
819
114
82
78
100
53
45
36
33
50
51
70
107
1908
704
500
417
480
680
885
1,235
1,051
127
92
115
112
100
46
40
48
68
80
81
142
1909
641
485
417
485
590
762
1,304
928
125
92
96
95
57
05
45
48
60
52
84
109
1910
552
466
397
403
567
715
9()9
877
98
95
96
97
77
44
40
32
37
59
87
115
1911
662
483
429
396
649
718
1,001
732
107
78
88
86
70
38
29
24
32
50
65
65
1912
690
498
424
425
481
698
876
693
70
83
83
63
76
48
32
39
26
43
58
72
1913
639
444
39(5
380
469
089
1.012
601
02
00
82
55
48
41
29
32
26
36
53
77
1914
821
483
424
409
547
700
1,374
711
100
09
67
78
58
45
26
27
34
41
60
106
1915
661
545
537
431
508
090
1,104
813
111
97
97
74
76
59
45
37
31
44
46
96
1916
648
378
380
434
636
804
1,144
789
125
104
87
58
70
52
17
20
31
51
65
103
1917
445
3.54
313
470
7.187
2,009
1,519
760
118
99
99
70
61
27
22
12
28
98
64
62
1918
351
310
273
248
351
446
693
547
104
76
81
70
38
20
20
14
21
19
38
46
1919
299
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
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10 to 14 years. .
15 to 19 years. .
20 to 24 years..
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80 to 84 years. .
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111
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BUREAU OF RECORDS
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ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
MONTHLY AND ANNUAL PRECIPITATION.
Year.
Jan.
Feb.
Mar.
Apr.
May.
June.
July.
Aug.
Sept.
Oct.
Nov.
Dec
An-
nual.
1871. ...
1872. . . .
1873. . . .
1874.. . .
1875....
1876....
1877. .. .
1878... .
1879
1880....
1881
1882... .
1883....
1884
1885....
1886... .
1887
1888.. ..
1889
1890
1891... .
1892. .. .
1893
1894. .. .
1895....
1896....
1897
1898
1899
1900
1901
1902
1903
1904... .
1905....
1906... .
1907... .
1908
1909
1910....
1911.. ..
1912
1913
1914
1915. . . .
1916. .. .
1917. . ..
1918
1919. ...
1.15
2.40
5.05
4.82
2.87
1.21
3.55
4.53
3.05
2.19
5.41
6.15
3.22
6.07
3.50
5.02
4.19
5.14
5.38
2.95
5.73
5.61
3.56
2.70
5.62
1.25
3.51
3.95
4.08
4.18
2.07
2.28
3.44
3.38
3.93
2.98
3.26
3.84
3.33
5.61
2.27
1.86
2.77
3.69
5.61
1.08
2.44
3.41
3.35
3.86
1.45
1.73
2.41
3.23
5.39
1.67
3.40
2.74
2.11
5.06
4.36
4.58
5.09
6.09
5.90
5.26
4.03
3.07
3.86
4.69
1.27
7.81
5.15
0.82
5.50
2.72
4.06
5.46
5.16
0.86
5.78
3.83
2.18
2.79
2.57
2.52
5.36
4.31
4.07
3.17
2.06
2.18
3.27
5.03
4.49
1.70
1.98
3.45
4.90
3.93
1.92
1.88
4.25
7.90
6.65
4.02
2.04
4.66
6.78
2.32
1.63
4.43
1.19
3.54
3.51
5.64
4.09
6.67
4 .22
4^62
4.47
1.69
2.80
6.13
2.51
2.92
6.78
3.18
5.18
4.32
3.65
3.44
3.65
5.58
3.80
2.15
3.19
0.86
2.87
5.68
5.17
4.55
1.14
3.71
3.38
1.51
4.69
3.41
2.49
3.05
7 02
3.21
3.79
3.18
1.93
4.06
3.18
1.00
2.15
3.82
2.66
2.44
4,95
3.67
3.57
5.90
2.58
2.37
2.36
6.36
2.51
2.92
1.24
2.96
3.23
1.23
2.06
6.82
3.51
2.88
3.94
2.45
5.78
3.89
1.82
5.93
4.53
3.06
3.61
5.32
2.67
2.10
3.28
2.35
3.78
2.55
4.49
2.44
4.08
2.16
1.47
3.94
0.73
3.73
2.23
0.82
2.33
4.21
3.03
4.35
2.22
6.53
0.99
4.87
3.25
3.11
3.10
4.30
5.06
3.90
2.04
2.01
5.30
5.55
1.14
4.05
7.01
1.23
0.33
1.61
1.12
4.67
4.08
9.10
1.72
1.66
0.91
3.94
2.51
1.97
3.23
3.49
3.29
3.37
3.81
7.14
2.94
1.29
2.87
1.66
2.87
3.31
2.91
3.42
1.69
6.23
2.82
4.00
4.16
1.86
3.01
7.70
1.68
2.38
4.19
1.18
2.97
2.56
0.86
2.57
6.38
2.98
1.28
1.83
3.36
0.94
5.91
7.42
2.70
4.18
1.70
3.29
1.70
3.17
5.10
4.63
1.17
1.43
1.83
3.66
3.94
5.57
4.12
2.23
3.60
9.45
4.15
3.22
5.23
5.72
3.86
5.26
3.39
6.67
1.31
2.75
3.37
6.14
3.04
2.57
6.75
1.27
9.63
3.96
4.11
2.45
1.26
2.89
4.40
4.45
9.52
4.76
6.20
4.33
5.41
3.12
3.23
4.31
6.01
3.21
1.18
4.33
1.98
0.23
1.55
3.26
3.02
5.13
4.60
3.44
5.96
3.61
7.93
5.48
6.13
7.66
2.53
10.42
2.97
2.54
7.30
5.17
4.40
1.56
1.63
2.29
8.56
7.70
1.18
3.66
6.35
3.39
4.06
5.87
3.90
7.18
1.54
4.12
2.46
3.14
3.12
3.90
2.69
6.88
3.29
5.96
7.13
5.23
3.68
2.48
5.65
7.94
2.13
7.38
2.77
1.84
2.18
5.37
0.59
1.79
1.70
7.74
2.13
3.44
2.51
7.21
2.51
5.24
1.33
3.20
1.45
2.26
1.38
14.51
3.57
0.15
0.72
1.79
2.30
7.40
7.43
8.21
2.12
0.87
2.27
8.04
0.95
3.04
1.64
1.28
5.89
2.36
2.33
3.59
2.60
3.18
7.11
2.54
8.00
1.60
2.66
1.43
1.51
3.38
5.28
0.20
2.52
2.98
2.74
3.54
3.60
7.07
3 . 53
2.47
1.82
3.13
1.68
7.69
1.71
0 58
2.81
2.10
1.69
4.27
3.63
5.62
3.90
2.36
4.14
2.53
6.46
2.69
0.63
5.28
5.83
4.04
1.71
0.72
6.14
2.05
4.17
2.20
6.66
11.55
3.21
2.67
4.30
3.82
1.92
0.74
3.79
5.38
4.32
10.56
1.92
2.25
0.63
5.68
0.83
3.17
4 . 33
5.04
4.01
2.21
4.43
4.40
5.48
3.74
2.22
2.40
2.87
1.80
1.65
3.44
5.05
4.61
2.04
4.81
9.82
0.82
2.06
8.28
3.71
3.83
3.58
2.12
4.44
5.90
2.13
4.26
1.31
1.19
0.90
2.62
1.67
1.28
5.05
0.75
1.58
4.62
4.22
2.21
1.91
2.08
1.09
1.57
0.68
2.04
3.33
1.24
2.54
2.06
1.69
2.78
2.29
0.95
4.93
5.86
4.15
4.37
2.22
3.40
6.66
2.69
3.73
4.20
4.05
1.81
5.43
3.30
1.64
3.49
5.23
1.87
1.70
4.83
2.93
1.37
1.98
6.05
6.19
2.81
3.87
3.67
3.53
3.91
3.21
5.00
1.95
3.39
4.24
2.40
4.01
4.23
3.97
3.70
3.70
2.53
48.80
45.78
39.98
39.84
45.19
47.40
40.94
46.66
36.21
37.34
40.40
46.61
38.83
55.34
42 12
46.73
46.63
52.95
58.68
52.30
41.44
38.90
53.01
44.17
35.73
37.99
44.27
45.12
42.06
41.78
47.06
47.07
48.60
41.57
44.48
41.82
45.28
41.43
41.55
35.98
40.34
38.50
44.39
33.50
40.83
33.17
39.28
33.59
48.38
Means.
3.65
3.70
3.87
3.38
3.19
3.24
4.23
4.38
3.43
3.63
3.18
3.42
43.27
Note. — Highest and lowest monthly and annual precipitation in bold-face figures.
322
BUREAU OF RECORDS
DAILY MAXIMUM TEMPERATURE— 1919.
Day.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Moans .
Jan.
Feb.
Mar.
Apr.
35
May.
June.
July.
Aug.
Sept.
Oct.
Nov.
GO
34
53
52
74
88
80
72
58
70
60
41
46
44
67
92
89
75
71
63
60
37
49
54
57
70
91
95
78
68
85
50
30
43
58
61
80
92
98
79
76
65
52
30
42
58
53
86
83
96
74
76
76
47
30
39
44
62
60
75
84
76
82
77
48
40
41
42
76
61
85
80
84
90
71
47
40
37
47
64
72
67
78
85
91
56
48
38
35
56
55
64
61
71
76
87
64
50
30
32
51
50
48
74
72
76
70
78
55
39
38
48
61
51
82
71
80
81
81
54
28
35
50
62
55
75
77
78
70
53
58
33
47
59
58
73
83
80
71
72
60
58
43
46
36
59
74
78
76
66
74
59
43
43
46
37
51
60
76
72
74
66
71
43
44
40
40
54
59
78
76
78
66
77
50
45
41
55
57
66
78
75
68
73
64
55
46
38
62
54
67
75
72
65
67
61
58
45
38
44
62
69
74
81
78
67
64
47
44
43
60
63
65
82
73
81
81
55
35
46
38
65
62
65
85
76
85
78
60
51
47
39
47
66
64
74
76
85
76
63
51
48
46
56
68
72
77
82
86
70
59
50
44
47
54
54
71
85
87
89
69
60
48
47
44
62
42
72
77
83
77
76
61
51
51
46
58
45
80
73
82
72
66
61
59
50
42
57
63
82
74
89
70
65
68
47
46
51
37
59
73
72
90
72
72
81
41
41
31
50
90
68
79
78
72
56
60
42
44
62
86
74
79
77
76
56
62
41
38
84
79
80
70
42
41
50
57
69
78
81
77
74
66
52
Dec.
41
44
30
31
34
44
48
45
52
49
30
40
60
58
27
24
22
14
25
31
32
40
45
39
29
33
39
41
26
37
39
Note. — Highest monthly temperatures in bold-face figures.
DAILY MINIMUM TEMPERATURE— 1919.
Day.
Jan.
Feb.
Mar.
Apr.
May.
June.
July.
Aug.
Sept.
Oct.
Nov.
41
24
33
21
44
59
58
66
62
48
59
37
25
28
22
50
58
72
61
65
52
39
30
25
35
34
53
72
74
60
62
63
37
17
33
37
43
57
71
77
64
62
59
41
14
28
43
42
57
68
80
68
59
61
41
19
26
28
46
49
65
71
68
61
62
37
25
24
28
41
46
65
65
68
68
45
36
30
32
34
47
57
55
63
62
72
43
37
19
26
36
43
47
53
61
59
59
46
32
9
19
36
40
42
56
62
60
59
63
36
12
16
37
50
44
60
60
65
63
53
47
9
29
34
51
44
59
58
67
56
41
51
17
31
36
45
47
57
64
59
53
39
34
30
38
26
41
54
64
63
56
57
51
30
34
37
30
43
46
62
63
62
60
55
34
28
28
35
39
45
60
66
65
60
61
35
35
26
39
42
49
64
67
64
56
50
39
36
25
40
42
53
62
65
61
51
45
39
34
22
36
39
54
61
69
61
54
46
29
30
23
41
44
54
63
69
64
65
44
26
34
32
46
49
55
65
70
68
65
51
28
39
35
36
41
54
59
72
70
68
55
41
41
33
31
46
57
60
70
69
57
52
39
28
35
40
33
56
66
68
70
54
51
36
26
34
36
27
57
66
72
60
57
47
34
36
23
40
29
60
66
66
59
55
53
46
35
22
37
39
61
66
69
58
51
59
35
33
33
22
47
56
59
72
59
53
48
30
33
24
45
58
52
67
59
57
43
37
32
26
42
71
55
62
65
67
45
32
29
23
65
65
66
56
28
28
34
40
53
62
67
63
59
51
37
Dec.
1
2
3
4
6
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Means .
28
29
18
17
25
29
39
37
42
22
20
29
40
22
17
13
2
0
12
17
24
30
28
25
17
16
30
22
17
18
29
Note.
-Lowest monthly temperatures in bold-face figures.
323
U. S. Department of Agriculture — Weather Bureau.
Charles F. Marvin, Chief.
ANNUAL METEOROLOGICAL SUMMARY, 1919
WITH COMPARATIVE DATA.
New York, N. Y.
Compiled under the direction of James H. Scarr, Meteorologist.
New York, N. Y., U. S. Weather Bureau.
Annual Summary
The mean temperature, 52.8°, is 1.1° above normal. The first seven
months and October and November were above normal ; September was
norrnal; August and December, below. The highest temperature, 98°, oc-
curred on July 4th; the lowest, zero, on December 13th.
Precipitation, 48.38 inches, is 3.75 inches above normal, and the greatest
since 1903. March, May, July, August and September had more than nor-
mal, although only July and August had important plus departures. Long-
est period without precipitation, 11 days, May 26th-June 5th; longest period
with daily rains (traces included), 9 days, July 15th-23d. The number of
cloudy days, 159, is the greast of record; and the number of days with dense
fog or dense haze, 34, is the greatest since 1898.
Records were broken as follows : January — Warmest New Year's Day.
March — Greatest monthly wind movement and maximum wind velocity.
June — Greatest number of days with dense fog or dense haze. Year —
Greatest number of cloudy days.
Weather by Months
January — Mean temperature, 35.2°, is 5°above normal, 13.2° higher
than 1918, and has been exceeded hut twice in the last 13 years. The
extremes, 60° on the 1st, and 9° on the 10th, are not unusual ; but the maxi-
mum, 60° on the 1st. is the highest Nezu Year's temperature of record.
Temperatures were below normal only on the 4th-6th and 9th-13th. Precipi-
tation, 3.35 inches, is 0.44 inch below normal. Two-thirds of this occurred
on the 1st and 3d. Total snowfall, 0.3 inch on the 8th, equals the least of
record. Gales were frequent, and the maximum, 84nw. on the 24th, has
been exceeded but once.
324
ANNUAL METEOROLOGICAL SUMMARY
February — Mean temperature, 34.7°, is 4° above normal and, except
1909 and 1915, the highest since 1891. Except for the winters of 1879-80,
1889-90, and 1912-13, this is the ivarmest winter of record. The maximum,
51° on the 28th, is not unusual, but the minimum, 16° on the 11th, is the
highest monthly mininnnn since 1897. The temperature was below nor-
mal on only 4 days. Precipitation, 3.45 inches, was mostly rain, well distrib-
uted, and only 0.29 inch below normal. The total snowfall, 0.7 inch, occurred
on 3 days and is, with one exception, the least of record. Gales were fre-
quent, though the maximum, 66 nw. on the 26th, is not unusual.
March — Mean temperature, 42.0°, is 4.5° above normal, the highest
since 1913. The last 4 days were the coldest of the month. The extremes,
65° on the 21st and 22° on the 28th. are not unusual. Precipitation, 4.69
inches, is 0.59 inch above normal. Total snowfall, 1.9 inches on two days,
is one-fourth the normal, but more than half the fall for the entire winter.
Wind movement, 17,958 miles, is the greatest of record. Gales were fre-
quent. The maximum, 92 nw. on the 28th, is but 4 below the highest of
record. For a 24-hour period on the 28-29th an average hourly velocity of
67 miles was maintained.
April — Temperature and precipitation were slightly above normal. The
last week was the coldest except for the first two days which ended the cold
wave of the last week in March. Traces of snow occurred on 3 days, that on
the 26th being the last of the season. The total winter's snowfall, 3.3
inches, is about one-third of the previous least of record. The last killing
frost occurred on the 25th. Gales were frequent but not unusually severe.
Cloudiness was above the normal. Thunderstorms occurred on the 15th and
16th.
May — Had tzvo zvarm periods, 2d-5th, and 23d-31st. The rest of the
month was generally cool, though the mean, 61°, is 2° above the normal.
The extremes, 42° on the 10th, and 90° on the 29th, are not unusual. There
were 12 days with rain — one more than normal. The total, 3.81 inches, is
0.63 inch more than normal. Wind movement was about normal, but the
prevailing direction, east, is unusual. Sunshine was deficient, and cloudi-
ness above normal. Dense fog occurred on 4 days, and thunderstorms on
the 5th, 17th. 23d. and 24th.
June — Ninth was the last of a 16-day period of warm, dry weather. The
rest of month averaged cool, though the mean, 69.7°. is 1.2° above normal.
The maximum, 92° on the 2d, and the minimum, 52° on the 29th. are not
unusual. There were 16 days with haze or dense fog, probably the greatest
number of record. Precipitation was deficient in frequency and amount.
Thunderstorms occurred on the 20th and 27th. The former was severe in
upper Manhattan, the Bronx and Queens, and much damage resulted. It
was accompanied by hail. Wind movement was light, and there were no
general gales.
325
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
July — Is the tenth consecutive month with an excess in temperature,
the accumulated excess in this period being 813°. The first six days were
warm. The maximum, 98.2°, was on the 4th. The rest of the month was
generally cool, cloudy and wet. Rain occurred on 14 days — 2 more than
normal, but 5 less than the greatest of record. The total, 6.64 inches, is
3.39 inches more than normal, and the greatest since 1897. Thunderstorms
occurred on the 6th, 16th, 19th, 26th, and 28th. The storm on the 28th was
severe ; violent zvind squalls doing much damage in the City, and in nearby
New Jersey and Long Island sections. Gales were frequent, and the total
wind movement, 11,004 miles, is well above normal.
August — Was cool and wet. The mean temperature, 70.2°, is 2.0° be-
low normal. The maximum, 89° on the 24th, and the minimum 56° on the
14th, are not unusual. Precipitation (mostly at night) occurred on 11 days,
one more than normal. The total, 7.74 inches, is 3.21 inches above normal
and the greatest, except once, since 1884. Thunderstorms occurred on the
15th, 18th, 24th and 25th. Damage in portions of the City and vicinity
resulted from gales or squalls on the 14th and 25th.
September — Mean temperature, 66.5°, is exactly normal. The ex-
tremes, 91° on the 8th, and 51° on the 27th, are well within the record. Pre-
cipitation was normal in amount and frequency. Wind movement was about
normal, and no severe gales occurred. A thunderstorm occurred on the
11th, and dense fog on four different days.
October — Mean temperature, 58.4°, is 2.8° above normal. The maxi-
mum, 85° on the 3d, is 3° below the highest of record. The minimum, 39°
on the 13th, is 10° above the lowest of record. Light frost formed in the
vicinity on the 8th and 9th, and heavy frost on the 19th. Precipitation, 3.17
. inches is 0.54 inch less than normal. There were 14 rainy days, one less than
the greatest number of record. There were 6 other days with only a trace of
rain, which, included, gives the greatest of record. Thunderstorms occurred
on the 6th, 11th and 16th. Dense fog was observed on 7 days. Cloudiness
w-as excessive, and sunshine unusually deficient. The total wind movement,
10.706 miles, is the loivest of record for the present exposure. Gales were
not unusual, but the prevailing direction, east, is abnormal.
November — Mean temperature, 44.4°, is 0.4° above normal. The
maximum, 70° on the 1st, is only 4° below the highest of record. The mini-
mum, 26° on the 20th, is high. Precipitation 3.33 inches, is 0.11 inch below
normal. There were 13 rainy days, the greatest number since 1897. The
first snow of the winter, trace, and the only snow in November occurred on
the 19th. The first killing frost occurred on the 14th. The total wind move-
ment, 14,254 miles, is moderately high. Gales occurred on 12 days. The
maximum, 61 nw., occurred on the 6th. The percentage of sunshine, 48, is
the lowest since 1902. Unusually high tides occurred from the 7th to 11th.
December— MediVi temperature, 30.0°, is 4.4° below normal. Only .ux
Decembers since 1871 were colder. The maximum temperature, 60°, is not
326
ANNUAL METEOROLOGICAL SUMMARY
unusual. Tlic minmimi, zero on the 18th, is noteworthy, because there is
but one earlier occurrence of zero weather on record. The monthly range,
60°, is the greatest of record. The number of days with tempearture not
above freezing (12) is twice the December average. The precipitation, 2.53
inches, is 0.92 inch below normal; 1.97 inches was rain. Precipitation after
the 15th was all snow, 7.9 inches, and the ground remained snow-covered
during that period. Excepting the 11th, rain or snow fell daily from the 6th
to the 17th inclusive. Winds of gale force occurred on 12 days. The num-
ber of cloudy days, 17, has been exceeded but tzvice since 1871.
Miscellaneous Data for 1919
Barometric Pressure (reduced to sea level) — Mean, 30.04 inches; highest,
30.83 inches, March 15; lowest, 29.27 inches, February 15.
Temperature — Greatest daily range, 36°, December 14; least daily range,
4°, July 20.
Greatest monthly range, 60°, December; least monthly range, 33°,
August.
Highest mean of three consecutive days, 87°, July 3-5 ; lowest mean
of three consecutive days, 12°, December 16-18.
Precipitation — Longest period without a measurable amount of precipita-
tion (0.01 inch or more), 11 days. May 26-June 5 and November 14-24.
Greatest number of consecutive days with precipitation (0.01 inch
or more), 6, July 18-23 and November 25-30.
Snow — Greatest amount in 24 /lours, 2.0 inches, December 24-25.
Greatest depth of snow on the ground, measured at 8 p. m., 1.9
inches, December 19.
Last snow in Spring occurred April 26 ; first snow in Autumn oc-
curred November 19.
Frost — In Spring : last killing frost occurred April 25 ; last light frost oc-
curred April 26.
In Autumn : first light frost occurred October 8 ; first killing frost
occurred November 14.
Thunderstorms — First, April 15; last, October 16.
Auroras — None.
Hail — June 20 ; July 26.
327
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
ANNUAL METEOROLOGICAL
WHITEHALL BUILDING, 17 BATTERY PLACE,
Temperature.*
Precipitation.**
1
Rel. Hum. 1
[Percent.] |
Mean
Extremes.
a
1
Month.
6
3
e
s
3
E
■3
Xi
a
0
E
3
B
'?.
s
3
s
'3
i
"ca
Eg
II
0
0
<
a
o
o
:2;
S
S
§
r^
Q
S
Q
H
%^
Q
ai
00
00
January
42
28
35
60
1
9
10
3.35
1.33
2-3
0.3
67
59
64
February ....
41
28
35
51
28
16
11
3.45
1.28
25-26
0.7
64
55
60
March
50
34
42
65
21
22
28
4.69
1.59
27-28
1.9
67
64
59
April
57
40
49
76
7
21
1
2.55
1.30
16-17
T.
62
50
56
May
69
53
61
90
29
42
10
3.81
1.09
9-10
0.0
6V
53
63
June
78
62
70
92
4
52
29
2.23
0.95
27
0.0
72
59
71
July
81
67
74
98
4
58
1
7.93
3.27
19-20
0.0
72
60
V2
August
77
63
70
89
24
56
14
7.74
2.39
17-18
0.0
78
63
70
September. . .
74
59
66
91
8
51
27
3.60
2.27
22-23
0.0
79
62
73
October
66
51
58
85
3
39
13
3.17
0.83
11-12
0.0
81
VO
74
November. . .
52
37
44
70
1
26
20
3.33
0.69
12-13
T.
72
61
68
December. . .
37
23
30
60
13
0
18
2.53
1.03
9-10
7.9
74
62
64
Year
60
46
53
98
Jul.
4
0
Dec.
18
48.38
3.27
July
19-20
10.8
71
59
66
Elevation of Instruments (feet): *414; **407; t454.
JDaylight hours only.
328
ANNUAL METEOROLOGICAL SUMMARY
SUMMARY.
NEW YORK, N. Y— YEAR, 1919.
Wind.t
Number of Days.
.'Sun-
shine.
Maximum.
M
ax.
M
in.
DO
a-<
++
"o
o
u
Temp.
Te
mp.
T3 O
3
O
S 3
o
3
o
o
E
_ i
6
^°
g.-e
£ c
4) °
til o
03— J
n
5f fl
•S S
<D.2
>
5
6
a
O <D
f ft
CO m
<u
O
fl,
3
O
O
;|.£
IS
O
-0
c
3
.a
H
c
Q
o
c
go
CO
o o
CO
O OS
IN CO
c<3
"3
^ a
148
50
6.3
18.7
nw
84
nw
24
14
9
8
14
7
0
2
1
5
0
18
0
182
61
5.2
19.8
nw
66
nw
26
10
12
4
12
11
0
2
4
0
0
19
0
203
55
6.7
24.1
nw
92
nw
28
18
6
9
16
12
0
1
3
1
0
10
0
242
tiO
6.5
19.1
nw
62
nw
24
12
5
13
12
11
2
1
0
0
0
4
0
2,53
50
6.4
15.3
e
55
nw
5
4
9
6
16
12
4
4
0
0
1
0
0
318
70
5.3
12.0
s
48
n
20
2
10
11
9
6
2
3
0
0
3
0
0
298
65
6.1
14.8
s
65
sw
26
6
8
12
11
14
5
3
0
0
4
0
0
270
63
5.9
14.3
nw
40
ne
14
2
7
13
11
11
4
0
0
0
0
0
0
220
59
5.6
13.8
nw
49
nw
12
3
9
10
11
8
1
4
0
0
1
0
0
150
44
7.2
14.4
e
63
w
2X
4
6
9
16
14
3
7
0
0
0
0
0
142
48
6.5
19.8
nw
61
nw
6
12
7
9
14
13
0
2
0
0
0
6
0
117
41
7.2
17.2
nw
72
nw
10
12
5
9
17
14
0
5
7
12
0
27
1
2.543
56
6.2
10.9
nw
92
nw
Mar.
28
99
93
113
159
133
21
34
15
18
9
84
1
§ Normal standard time.
329
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
NORMAL AND
BASED ON RECORDS
Temperature.
Rel.
Hum.
Sunshi
ne.
Precipitation.
,
>.
Per Cent.
£
Month.
a
C3
a
<s>
'.3
O
o
S
3
a
'S
s
3
a
'3
is
0
m
to
o
i-l
a
«
'3
Q
03
>
'3
Q
a
o
ii O
03W
o
5 O
1-1
d
03
o
a
m
00
00
a
3
2;
6
'i
c2
o
u O
3 g
January
38
24
30
40
22
14
6
3.79
6.15
1.08
8.7
76
71
152
298
51
6.0
February. . . .
38
24
31
40
23
14
6
3.74
7.81
0.82
10.3
73
68
184
298
61
5.5
March
45
31
38
48
29
14
5
4.1C
7.90
0.86
7.6
73
67
209
371
56
5.8
April
57
41
48
54
41
16
5
3.3C
7.02
1.00
0.8
70
65
238
400
59
5.6
May
68
52
59
65
53
16
4
3.18
9.10
0.33
0.0
72
66
268
449
60
5.7
June
77
61
68
72
64
16
4
3.26
7.70
0.86
0.0
74
69
284
452
63
5.3
July
82
67
74
78
70
16
3
4.54
9.63
0.23
0.0
75
69
287
458
63
5.4
August
8n
66
72
77
69
14
3
4.5c
10.42
0.59
0.0
77
71
260
427
61
5.5
September. . .
74
60
66
72
61
14
4
3.5?
14.51
0.15
0.0
78
72
231
374
62
4.9
October
fi3
49
56
61
50
14
4
3.71
11.55
0.58
T.
76
69
203
344
58
5.0
November. . .
51
38
44
50
37
18
5
3A4
9.82
0.68
1.2
75
69
163
297
55
5.6
December. . .
41
28
34
42
25
13
5
3.45
6.66
0.95
6.6
75
70
147
287
51
5.8
Year
60
45
52
54
49
14
4
44.63
58.68
33.17
35.2
74
69
2,626
4,455
58
5.5
♦Daylight hours only.
330
ANNUAL METEOROLOGICAL SUMMARY
COMPARATIVE DATA.
OF 20 TO 49 YEARS.
Wind.
Number of Days.
Clear.*
Cloudy
*
Precipitation.
M
ax.
Min.
o •
[Sea
le 0 to 3.]
ISca
le 8 to 10]
[.01 or More.)
Te
mp.
Temp.
M o
>>r^
m
T!'-
"3
>
^
3 C
O «
_j
^
1
oil
CD 'f
0) c
fa
"3
>i
bO
Oh
M
M
MX
M<
6*3
a
3
O
|s
^1
>
<5
a
o
u
o
03
O
<
o
a
>
<
d
o
a
a
3
ja
H
a
o
Q
o
c
o a
c^ a
^3
13
nw
6
8
14
3
11
12
19
7
12
21
4
t
4
6
9
0
24
t
14
nw
8
8
14
1
10
10
17
3
10
19
4
t
2
5
8
0
22
t
13
nw
7
8
15
2
12
11
17
4
15
20
5
1
3
4
2
0
17
0
13
nw
6
9
15
1
11
10
21
5
11
Ifi
4
2
2
1
0
t
3
0
11
nw
3
9
17
1
12
10
18
4
11
21
5
3
2
0
0
t
0
0
10
8W
2
9
18
2
14
7
20
2
10
17
4
5
1
0
0
1
0
0
9
8
2
9
15
2
14
8
19
2
12
19
3
7
1
0
0
3
0
0
9
8
1
9
17
2
13
9
1«
3
10
17
4
o
t
0
0
1
0
0
10
W
2
11
20
2
10
9
17
1
9
17
2
2
1
0
0
1
0
0
12
nw
4
11
19
2
10
10
17
3
9
15
3
1
2
0
0
0
t
u
13
nw
6
9
17
2
10
11
18
5
9
17
3
t
2
1
1
0
7
0
13
nw
tt
8
15
3
11
12
19
3
10
18
4
t
3
4
6
0
20
t
12
nw
53
108
138
65
138
119
159
73
128
152
106
27
24
21
26
7
95
1
tLesa than one.
331
ANNUAL REPORT OF THE DEPARTMENT OF HEALTH
DAILY PRECIPITATION— 1919.
Day.
Jan.
Feb.
Mar.
Apr.
May.
June.
July.
Aug.
Sept.
Oct.
Nov.
Dec.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
.49
1.06
.38
T.
T.
T.
.06
T.
T.
T.
.09
T.
1.26
.01
06
T.
T.
07
82
32
05
15
03
58
6i
67
T.'
.80
.20
.02
T.
.77
.19
T.
T.
T.'
77
01
T.
.38
.28
.93
.03
T.
T.
.60
.08
T.
.09
.15
77
43
09
T.'
.25
T.
.75
2.53
1.57
.04
.87
.63
.15
.06
.06
.05
1.07
58
T.
.49
T.
.04
04
30
37
T.
T.
02
.23
.18
T.
T.
05
78
T.
.07
.28
"t."
T.
.06
.03
".16
.03
.24
.06
.06
.42
.69
.20
.06
.24
T.
.01
.06
'!i2
.24
.01
Total.
3.35
3.45
2.55
3.81
2.23
7.93
7.74
3.60
3.17
3.33
2.53
"T", trace, less than .01 inch.
332
INDEX
A Page
Anthrax 98
Antitoxic Plasma, Concentration of 118
Applied Therapy, Division of 127
Appropriation for the Year 16
Assembly Halls 29
B
Babies As Soon After Birth As Possible, Enrollment of 143
Babies Under 2 Years of Age, Supervision of 133
Baby Health Station, Age of Infants Admitted to 144
Baby Health Station, Milk Sold at 146
Baby Welfare Work 130
Bakery Inspection 40, 207
Barber Shops 29
Bathing Establishments 31
Birds and Small Animals, Stores for 30
Board of Health 9
Bronx, Borough of the 247
Brooklyn, Borough of 205
Brooklyn, Borough of 242
C
Cash Receipts Turned Over to the General Fund of the City 17
Cerebro-Spinal Meningitis 85
Chemical Laboratory 215
Chickens and Pigeons, Permits for 30
Child Hygiene, Bureau of 130
Children, Institutions for 54
Children of Pre-School Age, Physical Examination of 161
Children, Study of Permits to Board and Care for 189
Clothing Trade Survey 32
Comfort Stations 30
Common Colds, Incidence of 128
Complaints, Division of 17
Construction and Repairs, Division of 18
Contagious Diseases Found in Schools and Excluded, General 163
Contagious Ej'e and Skin Diseases Found in Schools 164
Cooperation, Inter-Departmental 189
Cooperation with Other Agencies 47
Court Cases, Detention and Release of 103
Cowpox Vaccines 123
D
Deaths from Principal Causes 274
Defects, Physical Examinations for 165
Dental Clinics 173
Dental Work During 1919 174
Diagnosis, Division of 123
Diphtheria, Active Immunization Against 128
Diphtheria, Culture Media for the Diagnosis of 128
Directory of the Board of Health 13
Diseases, Communicable 73
Dogs, Unmuzzled 33
333
Page
Drug Addiction 193
Drug Analyses 218
Drug Inspection 38, 44
E
Education, Cooperation of the Department of 169
Employment Certificates, Issuance of 175
Encephalitis Lethargica 91
Examinations, Physical 239
Exhibits 236
Eye Cases, Suppurative 191
Eye Clinics 171
F
Factory Inspection 37, 40, 206
Food Adulteration 45, 211
Food and Drugs, Bureau of 193
Food on Streets, Exposure of 46, 212
Food, Preventing Waste of 29
Food Standards 197
Foundling Keepers, Delinquencies of 190
Foundling Keepers, Registry Kept by 189
G
Gas Poisoning, Illuminating '. 238
General Administration, Bureau of 15
Glanders, Prevention of 29
H
Health Leagues 166
Health Squad 50
Heat, Lack of 33
Heating and Dwellings 26
Horse Shoeing Establishments 31
Hospitals, Bureau of 222
I
Ice Plants 31
Industrial Hygiene, Division of 237
Infant Mortality Rates, Diarrhoeal Disease 152
Information Bureau 235
Institutional Inspections, Division of 52
L
Laboratories, Bureau of 118
Laboratory Products 17
Laundries 32
Law Division 20
Lectures, Division of 235, 239
Little Mothers Leagties 159, 169
Living Organisms, Distribution of 119
Lodging Houses TH
Lunch Room 235
334
M Page
90
Measles ^^ ^"i
Meat Inspection i To
Media Sterilization, Division of |^^
Microbal Sanitary Examinations, Division of |^|
Midwives, Delinquencies of j^^
Midwives, Supervision of |^^
Milk, Cost of {^
Milk, Country Efficiency and Economy ^^
Milk, Exposure of r^
Milk, Surveys |^
Milk, Temperature of ^^
Mosquitoes : ■ , ,,
Mothers, Expectant, Instruction and Supervision of i^i
Motion Pictures 203
Mussels
N
Narcotic Drug Clinic 241
Nursing, Maternal, Encouragement of ^'^■^
o
Occupational Clinic ^^^
Occupational Diseases i77 ' i qc " io/; fS
Open-Air Classes 177, 185, 186, 187
Oysters and Other Shellfish 201,203
Oysters, Examination of ^'^■■^
P
Pasteur Antirabic Treatment, Statistics of 126
Pasteurizing and Flash Pasteurization, Efficiency of 200
Personal Service 1^
Poliomyelitis °^
Poultry Slaughter Houses 1^°
Pratiques '^^
Preventable Diseases, Bureau of ^o
Privies, Temporary ii '^m oil
Prosecutions '*!» ^^^' i\-i
Publications
234
Puerperal Sepsis Cases 1^2
Public Health Education, Bureau of ^^^4
Pulmonary Tuberculosis ^°
R
Rabies ^^
Rabies, Prevention of j^
Rabies, Work on 124
Railroads ^SL
Railroad Cars, Ventilation of ^^
Records, Bureau of o(f^xi
Refuse, Removal /ybm
Restaurant Inspection ^1> ^^
Retail Establishment Inspection ^^
s
Sanitary Bureau 25
Sanitary Code, New Sections and Amendments to 15
Scarlet Fever '^
Schools, Sanitary Inspection of ^o
335
Page
Schools, Medical Inspection of 171
Smallpox 98
Spitting 36
Stables 25, 36
Statistics, Vital 274
Stillbirths 192
Supplies, Purchase and Storage of 17
T
Terminal Inspection 39, 204
Terminals 36
Tetanus 98
Transmittal, Letter of 13
Typhus 99
U
Utensils, Cleansing of 47
V
Vacant Lots, Sanitation of 32
Venereal Diseases 222, 235
w
Ward Buildings, New 224
Water, Drinking 33
Water, Examinations 122
Welfare Division 19
Wholesale Markets 204
Wood Alcohol in Food Products 48
336
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