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fiij^aitst 


T!'xchL.nt;p 
■  York  Act.  deciy  > 


ANNUAL   REPORT 

Board   of  Health 

Depasthent  of  Health  of  The  City  of  New  York 
year  ending  december  31,  1906. 

VOLUME    L 


NEW   YORK  I 
KTIN   B.  8RUWN  COMPANV.  PRmTERS  AND  STATIONERS, 
No«.  n  "  S7  P*sic  Plac 


MARTIN  B.BRC^N 
A  PKESS* 


TABLE   OF   CONTENTS. 


Vol.  I. 

PAGX 

Board  of  Health 3 

Honorary  and  Consulting  Officers 5 

Medical  Advisory  Board ! 6 

Medical  Examining  Board 6 

Visiting  Physicians  to  the  Hospitals 6 

Medical  Board  of  the  Willard  Parker  and  Riverside  Hospital 7 

Executive  Officers. 8 

Report  of  the  Board  of  Health 9 

Report  of  the  Secretary  of  the  Board  of  Health 22 

Report  of  the  Chief  Clerk 22 

Report  of  the  Assistant  Chief  Clerks  : 

Borough  of  Manhattan 62 

Borough  of  Brooklyn 66 

Borough  of  The  Bronx 67 

Borough  of  Queens 69 

Borough  of  Richmond 70 

Report  of  the  Assistant  Corporation  Counsel 71 

Report  of  the  Sanitary  Bureau 75 

Sanitary  Bureau,  Borough  of  Manhattan 125 

Division  of  Inspections 125 

Division  of  Contagious  Diseases 206 

Medical  Inspection  of  Schools 273 

Ophthalmological  Work 288 

Investigation  of  the  Subway  Tunnel 300 

Sanitary  Bureau,  Borough  of  The  Bronx 304 

(a)  Division  of  Inspections 304 

{6)  Division  of  Contagious  Diseases 305 

Sanitary  Bureau,  Borough  of  Brooklyn 308 

{a)  Division  of  Inspections 308 

(i)  Division  of  Contagious  Diseases 310 

Sanitary  Bureau,  Borough  of  Queens  312 

Division  of  Inspections 313 

Sanitary  Bureau,  Borough  of  Richmond 318 

Report  of  Nurses'  Work 323 


89268 


II  TABLE  OF  CONTENTS. 

Txam 

Report  of  the  Division  of  Communicable  Diseases 325 

Borough  of  Manhattan 338 

Borough  of  The  Bronx 388 

Borough  of  Brooklyn 395 

Borough  of  Queens 404 

Borough  of  Richmond 424 

Clinics  for  Communicable  Pulmonary  Diseases 426 

Diagnosis  Laboratory 452 

Riverside  Sanatorium 463 

General  Statistical  Tables '. 472 

Report  of  the  Research  Laboratory 479 

Report  of  the  Vassine  Laboratory 481 

Report  of  the  Pathologist  486 

Report  of  the  Kingston  Avenue  Hospital 487 

Report  of  the  Reception  Hospital 494 

Report  of  the  Willard  Parker  Hospita^ 497 

Report  of  the  Chemical  Laboratory 502 


INDEX. 


A 

PAon 

Abattoirs , 158 

Abortions 95 

Manhattan 377 

Absences  of  Employees 254 

Accounts,  Methods  of  Keeping 27 

Ambulances,  Service 321 

Analyses,  Chemical 504 

Animals,  Dead ; ic8 

Antitoxin,  Diphtheria 335 

Borough  of  The  Bronx 391 

Borough  of  Brooklyn 403 

Borough  of  Manhattan 377 

Borough  of  Queens 404,  409 

Borough  of  Richmond 425 

Change  of  Grades 57 

Injection  by  Inspectors 478 

Production  of. 486 

Refining  of. 479 

Sales  of  Manhattan 53 

Sales  of  Brooklyn 66 

Sales  of  The  Bronx 68 

Stations 55 

Treatment  by  Inspectors 95 

Antitoxin,  Tetanus 478 

Appropriations. 22 


Bake  Shops 152 

Bank  Account 24 

Bills,  Auditing  of 32 

Births,  Number  Reported 9 

Board  of  Health 3 

Boats 16,  59 

Steamboat  Riverside 16,  59 

Launch  Pelham '6,  59 

Bonds,  Revenue,  Issued 23 


IV  INDEX. 

PAGE 

Bronx,  Borough  of 304 

Brooklyn,  Borough  of 308 

Budget,  Allowance  in 23 

Building  Operations 14 

Alterations 15 

Contracts 15 

New   Building 14 

Burials,  See  Interments 33 

C 

Calves,  Examination  of 239 

Candy  Stores 152 

Carriages,  Disinfection  of 264 

Cash  Statement 26 

Cerebro-spinal  Meningitis 335 

Borough  of  the  Bronx 39* 

Borough  of  Brooklyn 4^3 

Borough  of  Manhattan 374 

Borough  of  Queens 413 

Number  of  Cases  Reported. 95 

Table 449 

Cesspools,  Queens 314 

Chart,  Communicable  Diseases 345 

Borough  of  The  Bronx 389 

Borough  of  Brooklyn 394 

Eorough  of  Manhattan 345 

Borough  of  Queens 406 

Borough  of  Richmond 423 

Chemical  Laboratory 99,  5^^ 

Chicken-pox — 

Isolation  of 229 

Number  of  Reported  Cases 92 

(See  also  Contagious  Diseases,  Division  of.) 

Child  Labor  Law  (see  also  Mercantile  Certificates,  etc.) ii,  135 

Children,  Boarding  of. 312 

Clinics,  Report  of. 426 

Tuberculosis. 18,  327 

The  Bronx 388 

Brooklyn 403,  427 

Manhattan 327 

Coal,  Purchase  of 44 

Committee,  Prevention  of  Tuberculosis 432 


INDEX.  V 

TAQM 

Communicable  Diseases  (see  Division  of)— 

Statistics 472 

Tables  of. 441-451 

Cerebro-spinal  Meningitis 449 

Diphtheria 441 

Typhoid  Fever 447 

Comparison  of  Expenses 24 

Complaints ii 

Manhattan 141 

Summary  by  Boroughs. 65 

Summary  by  Divisions 76 

Construction  and  Repairs 49»  ^7 

Contagious  Diseases  (see  Division  of). 

Contracts 40 

Construction 42,  43 

Removal  of  Night  Soil,  Oflfal,  Etc 42 

Supplies 40 

To  Abate  Nuisances 25 

Cows,    Bronx 304 

Cow  Stables,  Queens 317 

Cow  Stables,  Richmond 320 

Creameries 174 

Inspection  of 174 

Rules  and  Regulations  for 188 

Culture  Stations 378 

Borough  of  Queens 416 

Borough  of  Richmond 321 

Culture  Tubes,  Preparation  of 462 

D 

Dairies  (see  also  Milk  Supply) 174 

Dairy  Stables,  Borough  of  Queens 318 

Day  Nurseries 268 

Contagious  Diseases  in 270 

Rules  for 269 

Deaths,  Reported  in  1906 9 

Diagnosis  Laboratory,  Methods  of — 

Diphtheria 461 

Tuberculosis 461 

Typhoid   Fever ...  462 

Diagnosis  Laboratory,  Summaries  (see  also  Report  of) 476 


VI  INDEX. 

pAQii 
Diagnosticians — 

Duties  of 235 

Orders  by 236 

History  Blanks 236 

Diet,  Extra,  for  Tuberculosis  Patients 427 

Diphtheria  Antitoxin,  (see  Antitoxin) 

Diphtheria — 

Circular  of  Information 215 

Circular  to  Physicians 242 

Cultures  (see  also  Culture?,  Culture  Stations.) 96 

Cultures  by  District  Inspectors 230 

Cultures,  Directions  for 212 

Death  Rate 335 

Diagnosis  of. 461 

Dropped  Cases 222 

Duties  of  Medical  Inspectors  in 211 

Intubation  for 95 

Number  of  Reported  Cases 92 

Tables 441 

Disbursements  by  Assistant  Chief  Clerks 66 

Disinfection — 

In  Private  Houses 263 

Methods  of 259 

Disinfecting  plant 264,  322 

Disinfection — 

Statistics 92 

Testing  of. 481 

Disinfectors,  Duties  of 259 

Dispensaries 349 

District  Inspectors — 

Daily  Reports  of ". 233 

Division  of  Communicable  Diseases,  (see  also  Cerebro-Spinal  Meningitis,)  Tuberculosis, 

Typhoid,  etc. 

Division  of  Communicable  Diseases-^ 

Borough  of  The  Bronx 388 

Borough  of  Brooklyn 395 

Borough  of  Manhattan 338 

Borough  of  Queens 404 


INDEX.  VII 

pxaa 

DiTision  of  Communicable  Diseases — 

Borough  of  Richmond 424 

Cerebro-Spinal  Meningitis 385 

Diagnosis  Laboratory 325,  452 

Culture  Tubes 462 

Diphtheria  Cultures 461 

ImproTements  of 452 

Opsonic  Index 463 

Siaflf 461 

Work  of. 46 1 

Tuberculosis,  Diagnosis  of 461 

Typhoid  Fever,  Diagnosis  of 462 

Diphtheria  Antitoxin 335 

(See  also  Antitoxin.) 

Dispensaries 349 

Districts 348 

Executive  Office 325 

General  Summary 472 

Inspections 349 

Malaria 335 

Manhattan  Office 338 

New  Cases  and  Deaths,  Manhattan 345 

(See  also  Charts.) 

Offices. 326 

Pneumonia 335 

Publications 336 

Rivcri-idc  Sanitarium  (see  also  Report  of.) 327 

Sweeping  and  Dusting 337 

Telephones  and  Carfare  Bills 325 

Tuberculosis  Clinics 327,  390,  427 

Supervision  of 338 

Stercopticon  Exhibits 328 

Typhoid  Fever 335 

Division  of  Contagious  Diseases,  (<ee  also  Reports.) 

Acknowledgment  of  Reports 241 

Borough  of  The  Bronx 305 

Borough  of  Brooklyn 3x0 

Boiough  of  Manhattan  206 

Borough  of  Queens,  (see  Sanitary  Bureau.) 312 

Borough  of  Richmond 319 

Complaints 249 

Culture  List   256 


VIII  INDEX. 

PAOB 

Division  of  Contagious  Diseases  (see  also  Reports.) 

Daily  List  of  Contagious  Diseases 240 

Daily  Report  of  Diseases 255 

Daily  Reports  of  Inspectors 233 

Dead  Cases 231 

Dead  List 255 

Definition  of  Contagious  Diseases 231 

Failure  to  Report 248 

Failure  to  Find  Patient * 249 

General  Office  Work 240 

Institutions 264 

Method  of  Reporting  Cases 209-210 

Physicians,  Index  of,  who  failed  to  report  cases 253 

Placards,  Removal  of 249 

Records,  Filing  of 250 

Removal  from  Institutions 254 

Reports,  Defective 248 

Reports,  By  Disttict  Inspectors. 230 

Reports   Weekly 255 

Richmond,  Borough  of 319 

School  Certificates 233 

School  Children,  Special  Card  lor 23 1 

Schools,  Visits  to,  (see  also  School  Inspection) 91 

Statistics ^ 92 

Telephone  Operators 257 

Tenements,  Visits  to 91 

Termination  of  Case 232 

Undertakers,  Violation  of  Rules  by ; 249 

Work  in  Apartments 249 

Division  of  Inspections — 

Borough  of  The  Bronx 304 

Borough  of  Brooklyn 308 

Borough  of  Manhattan 125 

Borough  of  Queens 313 

Borough  of  Richmond 318 

Drug  Stores 5^ 

E 

Elevators,  Rules  for  the  Use  of 219 

Erysipelas 95»  374»  4^6 

Expenditures 22,  24 

Eye  Diseases  (see  Ophthalmological  Work  and  Trachoma). 

E3re  Diseases  in  Contagious  Hospitals 399 


INDEX.  IX 

PAOB 

F 

Feeding  of  Infants,  Summer  Corps 95 

Finances — 

Appropriations. 22 

Bank  Account 24 

Bonds,  Revenue,  Issued 23 

Budget,  Allowance  in 23 

Cash  Statement 26 

Comparison  of  Expenses 24 

Fish 154 

Food,  Condemned 89 

Food  Inspection 141 

Borough  of  The  Bronx 305 

Borough  of  Brooklyn 309 

Statistics  of 12 

Fruit,  Destroyed 145,  149 

Fruit,  Inspection  of 142 

Fulton  Market 154 

Fumigation 232,  259 

O 

Garages,  Automobile 133 

Gasoline  Explosions 11,  133 

German  Measles — 

Isolation  of  Cases 229 

Number  Reported  Cases 92 

Glanders,  Agglutination  Test  in 239,  480 

Disinfection  in 23S 

Number  of  Cases  of 92 

Records  of 256 

Serum  for 98 

Shooting  of  Horses -. 237 

U 

Health  Squad — 

ArresU  by 12,  139 

Duties  of 138 

Heart  and  Kidney,  Diseases  of,  Deaths  from 10 

History  Cards 222 

Holidays,  Visits  to  Contagious  Diseases  on 235 

Horses,  Purchase  of 46 

Horses,  Register  of 28 


X  INDEX. 

PAOB 

Hospitals,  Construction,  Contracts  for 6i 

Cost  of  Operation 62 

Eye,  Diseases  in 299 

Kingston  Avenue 119,  487 

Reception 109,  494 

Riverside 1 16,  493 

Willard  Parker 493 

Hotels,  Contagious  Diseases  in 219 

Hydrophobia,  (see  Rabies) SS,  98 

I 
Immigrants — 

Contagious  Diseases  in 14 

Contract  with  U.  S.  Government 25 

Inspections  (see  also  under  various  foods  as  Milk,  Fish,  etc). 

Inspections— 

Sanitary 89,  91, 141 

Statistics  of. 76 

Institutions — 

Contagious  Diseases  in 267 

Inspection  of 266 

Public  Health  Law  on 364 

Quarantine  in 267 

Interment,  Honorably  Discharged  Soldiers,  etc 33 

Isolation,  Contagious  Cases 219 

K 

Kingston  Avenue  Hospital 119,  486 

li 

Laboratories — 

Summary  of  Work: 

Chemical 99 

Diagnosis 96 

Research , 97 

Vaccine 97 

Laboratories,  Diagnosis  (see  also  under  Reports,  Research,  etc.) 328 

Laundry,   Hospitals 500 

Lemons,  Seized  and  Destroyed 147 

Lodging  Houses 1 1 

Inspection  of 91,  134 

Rules  for 134 

Statistics 134 

Lots,  Vacant  and  Sunken,  Inspection  of  (see  also  Vacant  Lots.) 91 


INDEX.  XI 

PAOB 


Macaroni  Factories  152 

Malaria 335,  374.  4^5 

Deaths  from 437 

Examination  of  Blood  for 96 

(See  also  Laboratories.) 

Number  of  Cases 95 

Mallein,  Sales  of— 

Brooklyn 66 

Bronx 65 

Manure  Dumps,  Inspection  of 91 

Markets  (see  Food  Inspection.) 

Measles,  Circular  to  Physicians 245 

Duties  of  Medical  Inspectors  in 229 

Number  of  Reported  Cases 9»  92 

Meat 158 

Meat  Inspection — 

Brooklyn 309 

Richmond 322 

Meat  Packing  Establishments 153 

Medical  Boards 6,  7 

Medical  Inspectors,  District,  Duties  of 211 

Meningitis  (see  Cerebro-spinal  Meningitis.) 

Mercantile — 

Certificates 89,  136 

Establishments,  Inspection  of 91,  309 

Law  (see  Child  Labor  Law) — 

Midwives,  R»;ports  on  Eye  Diseases  by 299 

Milk  Dealers  (see  Milk  Stores  and  Milk  Supply.) 

Milk  Inspection 12,  13,  89,  320 

Milk,  Sale  of  in  the  City 196 

Milk  Stores — 

Inspection  of 200 

Permits 196 

Prosecutions 205 

Rules  and  Regulations  for 197 

Milk  Supply- 
Adulterations 164 

Bacteria 165 

Cows,  Rules  for  Keeping 184 

Inspection  of  Dairies 177 


XII  INDEX. 

PAGE 

Milk  Supply- 
Inspections,  New  York  City 206 

Pennits 172 

Rules  and  Regulations  for  Farmers 181 

Sources  of 176 

Temperature  - 169 

Transportation 194. 

Mumps,  Number  of  Reported  Cases. 92 

Nuisances — 

Abatement,  Contracts  for 25 

.  Orders  for  Abatement 63 

Nurses — 

Queens 404 

Richmond 321 

School I9»  94 

Tuberculosis  Clinics 426 

Work  of 323 

O 

Offal,  etc.,  Richmond 108 

Offensive  Trades,  Inspection  of 129 

Officers — 

Executive 8 

Honorary  and  Consultiug 5 

Ophthalmia  Neonatorum 299 

Ophthalmoiogical  Work 210,  288 

Opsonic  Index 463 

Otisville,  Sanatorium  at  (see  Sanatoria) 59 

P 

Parotiditis  (see  Mumps). 

Pasteur  Treatment 98,  478 

Pathologist,  Report  of 485 

Pay-rolls 34 

Pension  Fund 35 

Pension  Fund,  Finances  of 14 

Permits,  Care  of  Children,  Bronx 305 

Permits 76 

Physical  Examinations  of  School  Children 19 

Physicians  Attending  Clinics  (see  also  Schools) 42S 

Physicians,  Visiting,  to  Hospitals 6 

Pineapples  Seized 146 


INDEX.  xiu 

PAOB 

Placards 218 

PneumonU 335.  377t  415 

Deaths  from 365 

Number  of  Cases 95 

Police,  Deuils  to  Health  Squad  (see  also  Health  Squad,  Sanitary  Police) 138 

Poultry 162 

Principals,  Schools — 

Notices  to 214 

Disinfection  in 244 

Prirate  Dwellings,  Inspections 91 

Public  Nuisances 128 

Puerperal  Sepsis,  Number  of  Cases 95 

Pure  Food  and  Drug  Law 152 

Pushcarts 153 

<i 

Quarantine,  in  Institutions 254 

Queens,  Borough  of 312 


Rabies 238,  257,  479 

Reception  Hospital  (see  also  Hospitals) 109,  494 

Refuse,  Removal  of.  Permit  for 140 

Reports — 

Assistant  Chief  Clerk,  Borough  of  The  Bronx 67 

Assistant  Chief  Clerk,  Borough  of  Brooklyn '. . . .  66 

Assistant  Chief  Clerk,  Borough  of  Manhattan 62 

Assistant  Chief  Clerk,  Borough  of  Queens 69 

Assistant  Chief  Clei  k.  Borough  of  Richmond 70 

Assistant  Corporation  Counsel 7^-75 

lioard  of  Health 9 

Chemical  Laboratory 99,  502 

Chief  Clerk 22 

Clinics  for  Communicable  Pulmonary  Diseases 426 

Diagnosis  Laboratory 99,  452 

Division  of  Communicable  Diseases 91 

Borough  of  The  Bronx 388 

Borough  of  Brooklyn 395 

Borough  of  Manhattan 338 

Borough  of  Queens 404 

Borough  of  Richmond 424 


XIV  INDEX. 

PAQB 

Reports — 

Division  cf  Contagious  Diseases : . . .  91 

Borough  of  The  Bronx 305 

Borough  of  Brooklyn 310 

Borough  of  Manhattan 206 

Borough  of  Queens  (see  Sanitary  Bureau) 313 

Borough  of  Richmond  (see  Sanitary  Bureau) 319 

Division  of  Inspections 125 

Borough  of  The  Bronx 304 

Borough  of  Brooklyn 308 

Borough  of  Manhattan 125 

Borough  of  Queens 313 

Borough  of  Richmond 318 

Inspectors  of  Construction  and  Repairs 49 

Kingston  Avenue  Hospital ....  487 

Ophtbalmological  Work  and  School  Inspection  (see  also  Trachoma) 288 

Pathologist 486 

Reception  Hospital 109,  494. 

Research  Laboratory 97,  479 

Richmond,  Borough  of 318 

Riverside  Hospital 1 16,  463 

Sanitary  Superintendent 75 

Secretary,  Board  of  Health 22 

Subway  Tunnel  Investigation 300 

Vaccine  Laboratory 97,  481 

Willard  Parker  Hospital 114,  495 

S 
Sale- 
Antitoxin  53 

Vaccine 54 

Sanatoria — 

Otisville 17.  59 

Riverside 17,  327,  463 

Sanitary  Bureau — 

Report  of 20,  75 

Statistics 10,  20 

Borough  of  The  Bronx 304 

Borough  of  Brooklyn 308 

Borough  of  Manhattan 125 

Borough  of  Queens 313 

Borough  of  Richmond 318 


INDEX. 

Sanitary  Inspectors  (see  Sanitary  Bureau). 

Sanitary  Police  (see  also  Health  Squad) 90 

Scarlet  Fever- 
Cases  Kept  Under  Observation, aj' 

Circular  of  Information 2^ 

Disinfection  in. ttj 

Duties  of  Medical  Inspector  in 224 

Duties  of  Parents  and  Nurses 227 

History  Card 225 

Number  of  Reported  Cases 9« 

Placards 224 

School  Certificates 233 

School  Children  (see  also  School  Inspection.) 

Exclusions i^f  93*  ^75 

Medical  Inspection  of f  S,  273 

Physical  Examination  of , 1%  281 

Nurses,  Work  of 19 

Vision,  Defective  in 299 

Trachoma,  Hospitals  for 2S5 

School  Inspection  (see  also  School  Children.) 

Absentees  Visited 2>J2,  7%^ 

Brooklyn 310 

Code 278 

Daily  Reports  on ^, 

Exclusions. ...    *  '^j  'yjt  275 

Exclusion  Cards 277 

History  of , 273 

Index  Cards 278 

Number  of  Cases  Treated,   1903,1906 287 

Physical  Examinations 281 

Physical  Records 286 

Richmond 320 

Readmissions. 278 

Routine  Inspection 278 

Summaries 285 

Trachoma 285,  287 

Treatment,  Minor  Affections 279 

School  Inspectors — 

Duties  of 275 


XVI  INDEX. 

PAGE 

School  Nurses 283,  323 

Duties  of 283 

Exclusions  by 284 

Inspection  by 284 

Reports  of  Work 285 

Visits  at  Homes 284 

Summary  of  Work,  1903-1906 287 

Treatment  by 283 

Work  of,  Report  on 323 

Searches — 

Births,  Matriages  and  Deaths 64 

Septicsemia — 

Manhattan 377 

Queens 420 

Sewerage  and  Water  Supply,  Queens 312 

Shore  Inspection 90 

Slaughter  Houses '3»  "S* 

Smallpox 92 

Smoke — 

Nuisance 11,  130 

Arrests  for 131 

Borough  of  The  Bronx 304 

Borough  of  Brooklyn 308 

Sanitaty  Code  on,  the 131 

Sputum,  Examinations  of 96 

Stables- 
Disinfection  of 238 

Inspection  of 91 

Richmond 319 

Stationery 50 

Stations,  Antitoxin,  (see  Antitoxin) 55 

Stereopticon  Pictures 17,  382 

Stores  Closed  for  Contagious  Diseases 91,  221 

Storehouses  ~ 

Hospital 502 

Otisville 53 

Riverside 52 

Willard  Parker 53 


INDEX.  rrn 


Cootncts  for. 

Rc<jTUMtKWIS . 


Sobwsj  Tannel 

Summer  Corps 04. 

Supplies 40 

¥i 

47 

SaTing  of  Waste  in 48 

Sweeping  and  Dusdzig J27 

T 

Telephone  Service 30 

Tetanus 377 

Tetanus  Antitoxin,  Sales  of tt 

Trachoma — 

Copper  Sulphate,  in 25« 

Ho^itals 285 

Trachoma  Hospitals — 

Gouvemeur  Slip 288 

One  Hundred  and  Eighteenth  Street 289 

Method  of  Dealing  With 29« 

Operations  for t^  2^  252,  293,  aj6,  297 

Transcript,  Births,  Marriages,  Deaths ^ 

Tuberculin,  Sales ^6 

Tuberculosis — 

Bronx 393 

Brooklyn j'P 

Clinics 97r  3^.  -P7 

Clinic,  Bronx 353 

Clinic,  Brooklyn 403»  4^7 

Death-rate  per  1000 10 

Diagnosis  of 4-^1 

Diet  in 427 

Dispensary  Districts 35^  4^9 

Manhattan  : 

Deaths 357 

Private  Cases 3^o 

Removal  of  Patients 3^5 

Reported  Cases 353 

Wards,  Statistics  of 354 

Number  of  Cases  Reported 95 

Norses,  Work  of 9^ 

Queens 4«3 


XVIII  INDEX. 

PAQB 

Tuberculosis — 

Relief  Committee 43a 

Renovation  After 308 

Richmond 424 

Stereopticon  Pictures 38a 

Supervision  of 329 

Typewriters,  Register  of 29 

Typhoid  Fever 335 

Borough  of  The  Bronx 391 

Borough  of  Brooklyn 403 

Borough  of  Manhattan 365 

Borough  of  Queens 413 

Borough  of  Richmond 425 

Diazo  Test 96,  462 

Diagnosis  of 462 

Number  of  Cases  Reported 95 

Tables  of 447 

Widal  Test 96,  462 

V 

Vacant  Lots 316 

Vacation  of  Premises 77 

Borough  of  The  Bronx 80 

Borough  of  Brooklyn 79 

Borough  of  Manhattan 77,  127 

Borough  of  Queens 82 

Borough  of  Richmond 86 

Summary 88 

Vaccination 92,310 

Vaccine  Laboratory c.  -i^i 

Vaccine  Rabies  (see  Rabies) , ^^^ 

Vaccine  Virus,  Sales  of — 

Manhattan 54 

Brooklyn .  66 

The  Bronx 68 

Varicella  (see  Chicken-pox). 

Vegetables,  Inspection  of 144 

Veterinarians 92,  236,  239 

W 

Wards,  Manhattan,  Tuberculosis  in 354 

Wards,  Manhattan,  Typhoid  Fever  in 367 


INDEX.  XIX 

PAQB 

Wards,  Queens,  Tuberculosis,  etc.,  in 414 

Willard  Parker  Hospital 114 

Whooping  Cough- 
Isolation  of  Cases 230 

Number  of  Reported  Cases 92 

Working  Papers  (see  Mercantile  Law  ;  Child  Labor  Law) « 136 

X 

X-ray  Work,  Tuberculosis  Clinic 428 


•      •  •   • 


-    V 


BOARD   OF   HEALTH. 

Report  for  the  Year  ending  Deccmter  31.  i<jo6. 


Presidtni, 
THOMAS  DARLINGTON,  M.  D. 

ALVAH  H.  DOTY,  M.  D.     .     .     .     .     Health  Officer  of  the  Port. 
THEODORE  A.  BINGHAM      .     .     .     Comrrasstoner  of  Police. 


Secretary, 
EUGENE  W.  SCHEFFER- 


General  Medical  OMcer  of  the  Department, 
HERMANN  M.  BIGGS,  M.  D. 


Secretaries  to  the  Commissioner, 

WILLIAM  A.  CLARK, 
JOHN  P.  HILLY. 


HONORARY  AND  CONSULTING  OFFICERS. 


CHARLES   F.   CHANDLER,  Ph.  D.    .  dmsultmg  SamitcnatL 

CLARENCE  C  RICE,  M.  D CousmJtimg  Laryngologist. 

GEORGE    HENRY    FOX      ....  Consultimg  Dermatologist 

ROGER  S.   TRACY ComsuUimg  Statisticiam. 

DANIEL  DRAPER,  Ph.  D ConsmJtimg  Meteorologist. 

GEO.  F.  SHRADY.  M.  D Cotumltimg  Smrgeom. 

STEVENSON  TOWLE Consulting  Engineer. 

ARTHUR   B.  DUEL Consulting  Otologist. 

SIMON    FLEXNER,  M.  D Consulting  Pathologist. 

ERNST  J.  LEDERLE,  Ph.  D.    .     .     .  ConsulHng  Sanitarian. 

J.    WINTERS  BRANNAN,  M.  D.   .     .     Consulting  Physician   to  the  HostHaU  of 

this  Department. 

W.    P.   NORTHRUP,  M.  D Consulting  Physician   to  the  Hospitals  of 

this  Department. 

ALBERT   T.   SWAN,  M.  D Attending  Physician  to  the  HospitaU  of  this 

Department. 

JOSEPH    E-   WINTERS,  M.  D.  .     .     .     Attending  Physidcn  to  the  Hospitals  of  this 

Department. 

H.    W.    BERG,  M.  D Attending  Physician  to  the  Hospitals  of  thU 

Department. 

HENRY  D.  CHAPIN,  M.  D Attending  Physician  to  the  Hospitals  of  this 

Department. 

LOUIS    FISHER,  M.  D Attending  Physician  to  the  Hospitals  of  this 

Department. 


MEDICAL  ADVISORY  BOARD  TO  THE  BOARD  OF  HEALTH. 


EDWARD  G.  JANEWAY,  M,  D. 
JOSEPH  D.  BRYANT,  M.  D. 
FRANCIS  P.  KINNICUTT,  M.  D. 

RICHARD  H.  DERBY,  M.  D. 
A.  ALEX.  SMITH,  M,  D. 
L.  EMMETT  HOLT,  M.  D. 


WILLIAM  M.  POLK,  M.  D. 

T.  MITCHELL  PRUDDEN,  M.  D. 

ABRAHAM  JACOBI,  M.  D. 

JOHN  WINTERS  BRANNAN,  M.  D. 

HENRY  P,  LOOMIS,  M.  D. 

JOHN  A.  McCORKLE,  M.  D. 


MEDICAL  EXAMINING  BOARD. 


JOHN  HOWLAND,  M.  D.  HENRY  W.  BERG,  M.  D. 

J.  WINTERS  BRANNAN,  M.  D.  WILLIAM  H.  PARK,  M.  D. 

WILLIAM  E.  STUDDIFORD,  M.  D.       EDWIN  J.  RICHARDSON,  M.  D. 


VISITING  PHYSICIANS  TO  THE  HOSPITALS. 


S.  A.  KNOPF,  M.  D. 
JOHN  HOWLAND,  M.  D. 


WILLIAM  J.  PULLEY,  M.  D. 
MATHIAS   NICOLL,  Jr.,  M.  D. 


MEDICAL  BOARD  OF  THE  WILLARD  PARKER  AND 

RIVERSIDE  HOSPITALS. 


J.  WINTERS   BRANNAN,  M.  D.,  President 
HENRY  W.  BERG,  M.  D.,  Secretary, 


JOSEPH  E.  WINTERS,  M.  D. 
ALBERT  T.  SWAN,  M.  D. 
LOUIS  FISHER,  M.  D. 
WM.  J.  PULLEY,  M.  D. 
MATHIAS  NICOLL,  Jr.,  M.  D. 


W.  P.  NORTHRUP,  M.  D. 
HENRY  D.  CHAPIN,  M.  D. 
S.  A.  KNOPF,  M.  D. 
JOHN   HOWLAND,  M.  D. 
WM.  H.  PARK.  M.  D. 


8 


EXECUTIVE  OFFICERS. 


HERMANN  M.  BIGGS,  M.  D.     .     .     .     General  Medical  Officer. 
CHARLES  F.  ROBERTS,  M.  D.     .     .     Sanitary  Superintendent. 
WILLIAM  H.  GUILFOY,  M.  D.     .     .     Registrar  of  Records. 

JAMES   McC.   MILLER Chief  Clerk. 

Borough  of  Manhattan. 

WALTER  BENSEL,  M.  D Assistant  Sanitary  Superintendent. 

CHARLES  J.  BURKE,  M.  D.     .     .     .     Assistant  Registrar  of  Records. 
GEORGE  A.   ROBERTS,  JR.     .     .     .     Assistant  Chief  Clerk. 

RUSSELL  RAYNOR Chief  Sanitary  Inspector. 

ALONZO  BLAUVELT,  M.  D.     .     .     .    Chief  Medical  Inspector. 

J.  S.  BILLINGS,  M.  D Chief   of    the   Division   of   Communicable 

Diseases. 
WILLIAM  H.  PARK,  M.  D.        ...     Director  of  the  Research  Laboratory. 
J.  H.  HUDDLESTON,  M.  D.     .     .     .     Assistant  Director,  Vaccine  Laboratory. 

J.  P.  ATKINSON Chemist, 

Borough  of  Brooklyn. 
TRAVERSE  R.  MAXFIELD,  M.  D.     .     Assistant  Sanitary  Superintettdent. 
SYLVESTER  J.  BYRNE,  M.  D.     .     .     Assistant  Registrar  of  Records. 
ALFRED  T.  METCALFE      ....     Assistant  Chief  Clerk. 

A.  T.  TALLMADGE,  M.  D Chief  Sanitary  Inspector. 

R.  H.  HERKIMER,  M.  D Chief  Medical  Inspector. 

Borough  of  The  Bronx. 
CHARLES  F.  SPENCER,  M.  D.     .     .     Acting  Assistant  Sanitary  Superintendent, 
ARTHUR  J.  O'LEARY,  M.  D.     .     .     .     Assistant  Registrar  of  Records. 

AMBROSE  LEE,  JR Assistant  Chief  Clerk. 

Borough  of  Queens. 

JOHN  P.  MOORE,  M.  D Assistant  Sanitary  Superintendent. 

ROBERT  CAMPBELL,  M.  D.     .     .     .     Assistant  Registrar  of  Records. 

GEORGE  R.   CROWLY Assistant  Chief  Clerk. 

HERMAN  BETZ,  M.  D In  Charge  of  the  Division  of  Inspections. 

Borough  of  Richmond. 
JOHN   T.   SPRAGUE,   M.   D.     .     .     .     Assistant  Sanitary  Superintendent. 

J.  WALTER  WOOD,  M.  D Assistant  Registrar  of  Records. 

CHARLES    E.   HOYER Assistant  Chief  Clerk. 

THOMAS  F.  McCarthy     ....     sanitary  Inspector  in  Charge  of  the  Division 

of  Inspections. 


DEPARTMENT   OF   HEALTH. 


Report  of  the  Bo.\rd  of  He.vlth  to  His  Hoxo«  the  >L\yo«  Regabd- 

ING  THE  OpEKATIOXS  OF  THE  DeP.VBTMEXT  OF  HEALTH  OF 

THE  City  of  Xew  Ygvlk  Dltuxg  the  Yeae 
Ending  December  31,  1906. 


The  Board  of  Health  respectfnlly  submits  the  foDowiiig  report  of 
the  various  operations  of  the  Department  of  Heahh  for  the  year  end- 
ing December  31,  1906: 

There  were  111,722  births  reported  during  the  year,  as  against 
103,881  reported  in  1905.  An  increase  was  also  noted  in  the  number 
of  marriages,  48,355  being  reported  as  against  42,675  in  1905. 

The  death  rate  has  been  slightly  higher  than  during  the  preceding 
year.  76,203  deaths  being  reported,  an  increase  of  2489  over  the  year 
1905.  On  the  whole,  however,  the  death  rate  of  the  old  City  of  New 
York  (present  Boroughs  of  Manhattan  and  The  Bronx)  has  shown  a 
decrease  of  46.70  as  compared  with  the  death  rate  of  the  old  City  of 
New  York  in  1866  when  the  Board  of  Health  was  first  organized. 

There  has  been  a  decrease  in  the  death  rate  from  typhoid  fever, 
smallpox,  and  the  diarrhoeal  diseases  of  children.  Particular  attention 
is  called  to  this  last  fact,  as  there  was  an  actual  decrease  of  126  deaths 
from  this  cause,  notwithstanding  the  increase  in  the  total  population. 
This  result  is  undoubtedly  due  to  a  great  extent  to  the  effors  of  the 
Department  of  Health  in  the  line  of  education  of  the  mothers  as  to 
proper  methods  of  infant  feeding. 

There  has  been  an  increase  in  the  death  rate  from  broncho-pneu- 
monia. This  is  due  undoubtedly  to  the  fact  that  broncho-pneumonia 
is  a  common  sequelae  of  measles,  and  1906  was  a  so-called  measles  year. 
40,000  cases  being  reported  against  20,000  during  1905.    8,955  ^^eaths 


lO 

were  reported  from  pulmonary  tuberculosis,  giving  a  death  rate  of 
2.16  per  1,000,  against  8,335  deaths  and  a  death  rate  of  2.12  for  1905. 
Although  this  increase  is  a  small  one,  it  shows  the  necessity  of  per- 
sistent attention  to  this  disease  by  the  Board  of  Health.  Not  only 
should  the  present  municipal  sanatorium  at  Otisville  be  enlarged,  but 
additional  sanatoria  and  hospitals  should  be  erected  by  the  city  af- 
fording a  means  of  early  diagnosis  of  the  disease,  and  consequent  hope 
of  recovery  for  those  patients  unable  to  pay  for  medical  care. 

The  death  rate  from  epidemic  cerebro-spinal  meningitis  has  mate- 
rially decreased,  showing  that  the  epidemic  of  the  two  previous  win- 
ters has  terminated.  As  a  result,  a  decrease  is  shown  from  the  dis- 
eases classified  under  the  general  term  of  nervous  diseases. 

Particular  attention  should  be  directed  to  the  increase  in  the  death 
rate  from  diseases  of  the  heart  and  kidneys.  This  increase  has  not 
been  confined  alone  to  the  City  of  New  York,  but  is  general  in  the  large 
centers  of  population  throughout  the  country.  For  the  period  from 
1869  ^o  1878,  the  combined  average  death  rate  from  these  diseases  in 
New  York  City  was  17.13  per  10,000,  while  during  1906  the  rate  had 
increased  to  27.34.  The  prevalence  of  influenza  undoubtedly  has  con- 
tributed to  this  increase,  but  the  most  marked  contributory  causes  are 
those  pertaining  to  the  overactivity  of  city  life. 

Sanitary  Bureau. 
The  number  of  inspections  and  reinspections  of  the  Sanitar}  Bureau 
shows  a  steady  increase  over  the  preceding  years,  as  may  be  seen  from 
the  following  table: 

1904 i.595>244 

1905 2,011.519 

1906 2,074,314 


Twenty-seven  thousand  seven  hundred  and  seventy-nine  orders  were 
issued  for  the  abatement  of  nuisances.  Of  the  total  complaints  investi- 
gated, 45,911  were  received  from  citizens,  the  remainder  being  taken 
up  on  the  initiative  of  the  Inspectors. 

Complaints  cared  for  by  the  Sanitary  Inspectors  cover  a  wide  field, 
including  defective  drainage  and  ventilation,   lack   of  water   supply, 


II 

overcrowding  of  lodging-hoases  and  workshops,  noises,  smoke,  and 
various  violations  of  tfie  Labor  Law.  The  dtv  is  divided  into  dis- 
tricts,  and,  in  addition  to  investigatii^  individual  complaints,  the  in- 
spectors are  held  re^wnsible  for  the  sanitar>'  condition  of  their  dis- 
tricts. 

The  smoke  nuisance  from  large  manufacturing  plants  and  from 
locomotives  entering  the  Borough  of  Manhattan  has  been  materially 
reduced.  The  comf^etion  of  the  plan  for  the  installation  of  electric 
locomotives  on  the  New  York  Central  and  New  York,  New  Haven 
and  Hartford  railroads  would  mean  a  complete  abatement  of  this 
nuisance.  During  the  year  tfie  Sanitary  Code  was  altered  by  amend- 
ing the  section  relating  to  tfie  discharge  of  smoke  making  it  broader 
in  its  scope,  so  that  it  may  entirely  cover  the  smoke  nuisance. 

During  the  year,  there  were  several  explosions  caused  by  the  leak- 
age of  gasoline  into  the  city  sewers  from  garages  where  automobiles 
were  stored  and  repaired.  Immediate  action  ^-as  taken  in  this  matter, 
with  the  result  that  since  the  middle  of  May  there  has  been  no  e\4dence 
of  the  escape  of  gasoline  into  the  public  sewers,  and  the  department 
has  received  no  complaints  r^;arding  it. 

Lodging  Houses. 

The  Sanitar>'  Code  prescribes  that  for  all  lodging-houses  contain- 
ing rooms  in  which  there  are  more  than  three  beds  for  the  use  of  lodg- 
ers, or  in  which  more  than  six  persons  are  allowed  to  sleep,  a  permit 
from  the  Board  of  Health  shall  be  required.  There  are  about  102 
lodging-houses  in  the  city,  and  during  the  past  year  the  total  number 
of  lodgings  was  17,978. 

Although  the  Charter  of  the  City  of  New  York  provides  that  in- 
spection of  lodging-houses  must  be  made  at  least  twice  a  year,  it  has 
been  found  advisable  to  detail  one  inspector  solely  to  this  duty,  with 
the  result  that  there  have  been  2,764  inspections  made,  an  average  of 
27  to  each  lodging-house.  This  has  resulted  in  materially  improving 
the  sanitary  condition  of  these  places. 

Child  Labor  Law. 
In  the  enforcement  of  this  law,  an  average  of  500  inspections  have 
been  made  each  week.     Particular  care  has  been  taken  in  guarding 


12 

against  the  violation  of  this  law  in  the  large  department  stores  and 
the  telegraph  and  messenger  service,  particularly  in  the  weeks  imme- 
diately preceding  the  midwinter  holidays.  Out  of  36,590  inspections 
made  of  mercantile  establishments,  violations  of  this  law  were  found 
only  in  3^%  of  the  cases.  A  new  feature  of  this  law  which  went 
into  effect  on  October  i,  1906,  included  the  provision  that  "  in  cities 
of  the  first-class,  no  child  under  the  age  of  sixteen  years  would  be 
employed,  permitted  or  suffered  to  work  in  or  in  connection  with  any 
such  establishment  after  seven  o'clock  in  the  evening  of  any  day." 
This  section  of  the  law  has  met  with  almost  universal  compliance. 

Health  Squad. 

The  Health  Squad  has  been  maintained  at  a  high  standard  of  ef- 
ficiency, and  has  materially  assisted  in  the  abatement  of  nuisances  and 
enforcement  of  Board  orders. 

A  total  of  3,006  arrests  were  made  by  this  squad  during  the  year 
for  violations  of  the  Sanitary  Code. 

Food  Inspection. 

During  the  year  18,276,385  pounds  of  fruit,  food,  and  fish  were 
condemned  and  destroyed,  a  decided  increase  in  amount  over  the  pre- 
ceding year. 

In  addition  to  the  working  force  assigned  to  the  inspection  of  meat 
in  slaughter  houses,  the  inspection  of  markets  and  retail  butcher  shops 
has  made  possible  more  vigorous  enforcement  of  the  law  in  regard 
to  the  sale  of  putrid  and  tainted  meat.  During  the  year  1906,  1,526,239 
pounds  of  meat  were  condemned  and  destroyed,  an  increase  of  over 
300,000  pounds  over  the  amount  condemned  during  the  year  1905. 

Milk. 

The  inspection  of  creameries  shipping  milk  to  the  city  has  been 
carried  on  even  more  systematically  than  during  the  previous  year. 
Unsanitary  conditions  have  been  remedied  by  the  proprietors,  and 
practically  all  of  the  creameries  are  now  in  good  sanitary  condition. 
Although  the  Board  of  Health  has  no  direct  authority  to  compel  the 
owners  of  these  places  to  make  any  change  in  their  equipment  or 


13 

methods  of  handling  milk  and  cream,  it  has  the  powder  to  pmrest  the 
sale  of  milk  in  the  dtr  when  there  is  reason  to  bdiere  that  it  is  pffo- 
duced  or  handled  in  ansamtarr  snrroondings.  The  effect  of  this  prt>- 
hibition  has  been  an  incentiTe  for  the  creameries,  tarrns  and  dairies 
to  observe  the  mles  and  regulations  of  the  department  pertaining  to 
this  subject 

Early  in  1906  it  was  decided  to  extend  die  in^Kction  work  of  die 
department  to  cover  the  sanitary  supervision  of  farms  and  dairies  sup- 
plying milk  to  the  creameries.  This  work  has  been  perforn^ed  as  thca*- 
oughly  as  consistent  with  the  limited  number  of  inspectors  assigned  to 
this  dut>'.  At  present  only  fifteen  inspectors  are  detailed  to  this  work, 
and  it  is  practically  impossible  for  them  to  cover  the  entire  territor;.  sup- 
ph-ing  milk  to  Xew  York  Gty.  This  territory-  includes  some  portion 
of  six  States,  and  there  are  over  fortv  thousand  of  the  farms  and 
dairies.  This  plan  is  an  important  advance  in  the  work  of  safeguard- 
ing  the  milk  supply,  and  the  results  so  far  obtained  have  been  most 
satisfactorv. 

Although  the  milk  supply  of  Xew  York  Gty  is  in  a  purer  zaid  oeancr 
condition  than  it  has  ever  been  before,  in  order  to  make  it  really  ef- 
fective, the  staff  of  inspectors  should  be  materially  increased. 

During  the  year,  708  creameries,  and  11.000  farms  and  dairies 
were  inspected.  The  system  of  inspection  includes  the  carefu:  obser- 
vation of  the  milk  from  the  time  it  leaves  the  farm  until  it  reaches 
the  consumer. 

In  the  cit>'  systematic  inspection  is  made  of  all  shops  where  milk 
is  sold,  and  the  rules  and  r^ulations  of  the  Sanitary  Code  are  strictly 
enforced.  Ehiring  the  year,  131,150  inspections  were  made.  138.729 
specimens  examined,  41.395  quarts  of  milk  destroyed,  and  678  ar- 
rests made  for  \nolations  of  the  Sanitary  Code  in  regard  to  milk. 

Sl.\ughter-Houses. 
Persistent  and  continuous  oversight  of  the  ^laughter-hou5es  has 
been  maintained  for  the  purpose  of  keeping  these  places  in  a  sanitary 
condition  and  preventing  the  sale  of  unfit  meat.  432,540  cattle.  1.613,- 
385  sheep,  954,141  hogs,  294,921  calves — a  grand  total  of  3,294,987 
animals— r-were  slaughtered  in  the  city  during  the  year.     On  account 


14 

of  the  careful  inspection  and  watchfulness  maintained  by  this  depart- 
ment, the  bi-products,  consisting  of  fat,  blood  and  oflFal,  were  treated 
and  disposed  of  on  the  premises  witliout  being  productive  of  any 
nuisance. 

Immigration. 

During  the  month  of  May,  1906,  a  new  form  of  contract  was 
executed  with  the  United  States  Government,  through  the  Commis- 
sioner of  Immigration  of  the  Port  of  New  York,  for  the  care  and 
treatment  of  immigrants  sick  with  contagious  diseases  and  removed 
to  the  hospitals  of  this  department.  Compensation  at  the  rate  of  $2.00 
a  day  for  each  person,  and  $14.00  as  the  cost  of  burial  of  each  immi- 
grant who  dies,  has  brought  in  a  total  revenue  to  the  department  of 
$85,266.  The  new  feature  of  this  contract  includes  the  transportation 
by  the  Department  of  Health  of  all  patients  to  and  from  Ellis  Island 
and  the  department  hospitals.  This  service  is  paid  for  by  the  govern- 
ment at  the  rate  of  $2.00  each  way  for  each  person  transported.  This 
has  proven  an  additional  source  of  revenue  to  the  amount  of  $1,314. 

Pension  Fund. 

The  income  from  searches  and  transcripts  of  births,  marriages  and 
deaths,  has  amounted  to  $21,424.70.  This  added  to  the  fines  and  penal- 
ties, and  interest  on  money  invested,  has  made  a  total  addition  of  $57,- 
222.40  to  the  pension  fund.  The  total  disbursements  for  the  year  were 
$21,205.24,  making  the  pension  fund  at  the  close  of  the  year  $244,- 
028.97.  Four  new  pensions  were  granted  during  the  year,  and  two 
pensioners  who  were  on  the  roll  died. 

Building  Operations. 

Borough  of  Manhattan. 

Willard  Parker  Hospital. 

New  Buildings — 

Cold  storage  building  erected. 
Animal  house  erected. 
Temporary  boiler-house  erected. 
Administration  building  completed. 


IS 

Alterations — 

Main  building  entirely  remodeled. 

Old  boiler-house  remodeled. 

Upper  part  of  disinfecting  station  remodeled  into  a  dormitory  for  help. 

New  stalls  erected  in  stable  of  ambulance  station. 

Contracts  executed  for — 
New  dormitory  building. 
Refrigerating  plant. 

North  Brother  Island, 
Completed — 

Two  isolation  buildings. 

Alterations — 

Old  coalhouse  altered  into  a  waiting  room  and  discharge  room  for  patients. 
Additional  boiler  installed  in  boiler-house. 
Work  in  progress  increasing  area  of  the  island. 
Contracts  executed  fer  repainting  of  buildings. 

Bronx  Office, 
New  Office  building  provided  at  an  annual  rental  of  $2,000. 
Alteration  of  rooms  for  use  as  tuberculosis  clinic. 

Westchester  Property, 
Plans  accepted  in  connection  with  a  vaccine  station — 
Laboratory  buildings. 
Stable. 
Boiler-house. 
Dwelling. 

Borough  of  Brooklyn. 

Kingston  Avenue  Hospital, 
New  morgue  building  being  erected. 

Area  walls  built  around  the  storehouse  and  laundry  building. 
Pipe  gallery  constructed. 
Addition  to  stable  completed. 
Two  additional  boilers  installed. 

Contracts  executed  for — 
Area  walls. 
Incinerator  building. 
Pipe  system. 
Morgue  building. 
Measles  pavilion. 
Extension  to  Nurses*  Home. 


i6 

Plans  received  for — 
Measles  building. 

Plans  completed  for — 

Extension  to  Nurses'  Home. 

Brooklyn  OMce. 
Site  obtained  and  plans  drawn  for  new  office  building. 

Otisville  Sanatorium, 
New  Buildings — 

Dining  pavilion. 

One-story  shack. 

Two-story  shack. 

Six  portable  houses. 
Old  buildings  renovated,  painted  and  repaired. 
Work  in  progress  on  water  supply  and  drainage  system. 

Contracts  executed  for — 
Cow  stable. 
Dairy. 

Storehouses. 

The  storehouse  system  having  proved  practical,  a  storehouse  has 
been  established  at  the  tuberculosis  sanatorium  at  Otisville.  Notwith- 
standing the  isolated  location  of  this  sanatorium,  and  the  conditions  en- 
countered in  securing  the  services  of  competent  help,  the  storehouse 
system  has  been  most  successful. 

Diphtheria  Antitoxin, 
New  grades  and  prices  in  antitoxin   have  been  instituted  and  a 
method  perfected  whereby  antitoxin  is  prepared  for  use  in  syringe  con- 
tainers. 

Steamboat  "  Riverside." 

The  steamboat  "  Riverside  "  has  been  delivered  to  the  department 
and  is  now  in  commission.  This  boat,  which  is  used  for  the  transporta- 
tion of  patients  ill  with  contagious  disease,  has  been  built  with  that  pur- 
pose in  view,  and  has  separate  wards  and  rooms  for  convalescents,  doc- 
tors and  nurses. 

The  launch  "  Pelham,"  used  for  conveying  passengers  and  visitors 
between  the  Riverside  Hospital  and  the  department  dock,  has  also  been 
put  in  commission. 


Title  to  propcitT  at  Ocswiut^  zpai  ^waiicfL  ic  sad  ^ccx  'VKixxxt  11 
establish  a  tnberciiIosES  saaatanaz^  was  r-fx^'rir*:  rr  tne  dcr  ^a^j  fn. 
the  year.  An  octliDe  and  rorrpufsr  spcgrarrnrar  xag  if  i^  sr-4;g^* 
has  been  made,  and  the  instaCataGa  cf  •4tss:  szccIt  imf  f:^fnage  f^^czzL 
has  been  begun.    Plans  hare  ben  prepared  3:?r  ±e  arnrv^riTT.  ~f 


ing  buildings  to  render  tfaem  fir^^rr  z-zr  'jcczpaacj.  air  stadQ  ir 
dormitories  for  patSects,  aiad  Lcr  a  cov  arariV  araf  cascj  ifTfuTrig , 
Contracts  have  been  irsde  for  tbc  ccoscractfoi  if  rwc  ^rraSr^  x  fTnrr^ 
hall,  cow  stable  and  dairy  brfjcir:^,  aad  f<ir  rsc  f&rrszj  cf 
ber,  cement,  pipe  fitth^,  drains,  wzcca  s=k5 
house  has  been  established.    Tbe  sst  zsd  ^cfL^z^s 


improved,  and  a  working  force.  Tncrarng  pcyscsrs. 
and  domestic  senracts  has  been  crgainzsd-    Tbe  rrst  pa: 
ceived  on  July  15,  1906. 

Not  only  is  the  openii^  cf  tbe  OcfsrEZ*  iirarirrzn  ihirirzztlj 
jjstihed  but  it  trndonbtedbr  wiH  be  iGc^i  rza-ier^iie  r>  irr:t=ni:»i2.te 


the  number  of  patients  needing  Lreannit-  F.vrerofci  ficflrd't?  sh:izld 
be  supplied  by  the  city,  so  that  all  indigerit  cases  zsay  be  sec;  an^f  czrrd 
for  early  in  the  prc^ess  cf  tbeir  iifesje.  ni^Jcriz  rerc-rtrj  i»:*«fiCt, 
and  the  probability'  of  spreading  the  cifca^c  TT-.'xtlj. 

Riverside  5axat:biv3;. 

The  capacit>-  of  this  instimtfcn  is  niiv  1:6  lees,  in  increase  cf  36 
beds  since  1905.  Even  with  these  trlzz^ti  lEciliues  there  is  ccnstartly 
a  waiting  list  of  patients  ready  to  enter  this  irstfrjtic^i. 

Stereopticox  Picture  Exhuition. 

In  order  to  extend  the  work  of  popular  educaticn  on  the  subject 
of  tuberculosis,  stereopticon  exhibitions  were  given  in  23  of  the  public 
parks  of  Manhattan  during  the  simm:er  of  1906.  \'arious  pictures  of 
general  interest  were  shown,  interspersed  with  pictures  relating  to  tu- 
berculosis,  and  short,  pithy  sayings  in  regard  to  the  prevention  and  care 
of  the  disease.  These  exhibitions  have  been  so  successful  that  it  is 
hoped  to  extend  their  scope  during  the  following  year. 


i8 

Clinic. 

The  work  of  the  clinic  for  the  treatment  of  communicable  pulmonary 
diseases  has  steadily  broadened  and  progressed.  It  has  served  as  a 
model  for  similar  institutions  elsewhere  and  has  thoroughly  justified 
its  establishment. 

Similar  clinics  were  established  during  the  year  in  the  Borough  of 
The  Bronx  and  the  Borough  of  Brooklyn. 

During  the  year  21,197  patients  were  treated,  with  an  average  daily 
attendance  of  70. 

The  distribution  of  extra  diet  in  the  form  of  milk  and  eggs  has  been 
continued  and  has  given  satisfactory  results. 

Since  the  opening  of  the  sanatorium  for  tuberculosis  patients  at 

Otisville  all  applicants  have  been  examined  at  the  clinic,  and  a  medical 

inspector  has  been  detailed  to  conduct  each  party  of  patients  to  the 

sanatorium. 

Tuberculosis. 

Almost  2,000  fewer  cases  were  reported  during  1906  than  during 
1905,  a  fact  rendered  more  striking  when  it  is  realized  that  the  report- 
ing of  these  cases  is  adhered  to  by  physicians  more  faithfully  each  year. 

Cerebro-spinal  Meningitis. 
Less  than  one-half  as  many  cases  of  this  disease  occurred  during 
1906  as  during  1905,  the  death  rate  being  reduced  from  5.03  to  1.94. 
During  the  year  these  cases  have  been  under  strict  sanitary  supervision. 

Division  of  Contagious  Diseases. 
Fewer  cases  of  small-pox,  scarlet  fever,  diphtheria,  croup  and  vari- 
cella were  reported  than  during  the  year  1905.     Measles  showed  a  de- 
cided increase,  it  being  a  so-called  measles  year. 

Medical  Inspection  and  Examination  of  School  Children. 

During  the  year  1906  the  regular  routine  work  of  excluding  from 
school  attendance  children  ill  with  contagious  diseases  has  been  carried 
on,  with  the  result  that  12,895  children  were  excluded.  This  number 
was  nearly  60,000  less  than  during  1903.  This  enormous  decrease  in 
the  number  of  children  excluded  is  due  to  the  fact  that  minor  contagious 


19 

ailments  are  now  treated  in  the  schools  by  the  nurses,  and  the  con- 
tagion held  in  check,  thereby  making  it  perfectly  safe  for  children  to 
associate  with  their  schoolmates.  This  system  has  been  a  great  aid  in 
the  educational  advancement  of  the  child,  as  practically  no  time  is  lost 
from  school  work,  and  the  personal  efforts  of  the  nurses  in  not  only 
treating  these  children  at  school  but  in  visiting  at  their  homes  and  seeing 
that  the  treatment  is  persistently  carried  on,  has  been  an  invariable 
aid  in  promoting  hygienic  conditions  and  personal  cleanliness. 

The  nurses  of  this  division  have  done  much  of  the  routine  of  the 
inspection  of  the  school  children,  formerly  a  part  of  the  doctor's  duty. 
Medical  inspectors  hav«  devoted  this  extra  time  to  giving  a  complete 
physical  examination  of  the  children.  During  the  year  79,203  children 
were  examined,  and  it  was  found  that  56,259  showed  some  mental  or 
physical  defect.  When  any  abnormality  is  found  to  exist  a  postal  card 
is  sent  to  the  parents  of  the  child,  telling  them  of  this  fact,  and  advising 
them  to  take  the  child  to  a  physician  or  dispensary  for  treatment.  A 
return  postal  card  is  attached  with  the  request  that  the  attending  phy- 
sician fill  this  out  and  mail  it  to  the  department.  It  is  thus  possible  to 
keep  in  touch  with  the  disposition  of  the  case,  and  the  number  of  these 
cards  received  has  been  rpost  gratifying,  as  showing  a  tendency  on 
the  part  of  the  parents  to  care  for  their  children  and  have  their  defects 
remedied  as  soon  as  the  matter  is  brought  to  their  attention. 

Nursing. 

There  are  at  present  53  nurses  assigned  to  duty  in  the  work  of 
medical  inspection  of  school  children  and  caring  for  cases  of  contagious 
<lisease.  The  work  has  been  pursued  along  the  same  lines  instituted  in 
1905,  and  the  results  have  been  most  satisfactory. 

The  school  nurses  have  made  particular  effort  to  see  that  all  children 
with  defective  eyesight  have  been  supplied  with  glasses,  and  this  result 
has  often  been  accomplished  only  as  the  result  of  great  personal  ex- 
penditure of  time  and  effort. 

Children  with  other  physical  defects  have  been  taken  by  the  nurses 
to  physicians  or  dispensaries  when  it  has  seemed  evident  that  the 
parents  were  too  busy  to  do  so  themselves. 


The  woHc  of  the  rrrscs  assagnec  m  &3St  m  ibe  care  of  contagious 
diseases  has  irKjOsbcechr  rtschcc  En  jcss  fear  arrrg^  tbe  more  ignorant 
poproIatSon  as  tc  the  cg«i?  of  b&i'I:^  tbe  case  rcporaed  to  the  Depart- 
ment of  Hfaith.  IsojaiXQ  is  =icre  ea^hr  rsissaiDed  and  the  patient's 
chances  for  recoTerj  befgrrene-i  ri  izzscanczs  vbcre  the  nnrses  assist 
in  the  care  of  the  case. 

Ophthalmoijogicai.  Woks. 

For  the  trcarnxnt  of  trarhcjcra  the  Deparnroit  of  Health  has  at  its 
disposal  a  hospital  of  20  beds,  siti^aicd  at  Oik  Hundred  and  Eighteenth 
street  and  Pkasam  avenue,  and  a  di^xsisarr  situated  at  Gouvemeur 
Slip. 

The  medical  stafiF  assigned  to  this  wcik  ooosists  of  eight  physicians, 
all  of  wh(xn  are  qualified  oculists.  The  number  of  cases  of  trachoma 
treated  by  operation  during  1906  was  1.385,  or  3.000  less  than  during 
1903.  The  nimiber  of  treatments  given,  however,  were  187,717,  an 
increase  of  crv"er  40,000  over  the  number  during  1903.  These  figures 
show  that,  although  the  nimiber  of  cases  of  trachoma  has  not  materially 
decreased,  the  t>-pe  of  case  is  much  in^roved,  as  those  requiring  opera- 
tion are  few  in  nimiber,  regular  treatment  curing  the  type  now  en- 
countered. 

S.\xn.\RY  Bureau. 

The  following  is  a  condensed  summary  of  the  amount  of  work  per- 
formed by  the  Sanitar>-  Bureau  during  the  year  1906 : 

Number  of  inspections  and  reinspeaions  2,074,314 

Number  of  complaints   forwarded    for  orders 27,779 

Number  of  inspections  of  mercantile  establishments 36,590 

Number  of  nuisances    abated    by   personal    effort    by   the    Sanitary 

Squad    (Police) 31,141 

Total  number  of  pounds  of  milk,  fruit,  food,  meat  and  fish,  con- 
demned and  destroyed  18,276,385 

Total  number  of  vaccinations  performed 152,420 

Number  of  infected  rooms  disinfected 86,174 

Number  of  examinations  of  school   children 5,007,244 

Number  of  school  children  excluded  12,895 

Number  of  physical  examinations  (Manhattan)  school  children 79,203 

Number  of  bacteriological  diagnosis  of  suspected  diphtheria 25416 


21 

Number  of  bacteriological  examinations  of  suspected  tuberculosis..  21,779 
Number  of  specimens  of  blood  examined  for  typhoid  fever  reaction, 

Widal  test   6,160 

Number  of  specimens  of  urine  examined  for  typhoid  fever  reaction, 

Diazo  1,220 

Number  of  specimens  of  blood  examined  for  malarial  organisms 1,198 

Number  of  chemical  analyses  13,022 

Number  of  milk  inspections  (year  1905,  104,794) 131,150 

Number  of  specimens  of  milk  examined. 138,729 

Number  of  quarts  of  adulterated  milk  destroyed 4i»395 

Number  of  milk  inspections  outside  City  of  New  York 11,708 

Amount  of  fines  for  violations  of  Milk  Ordinances $I3,045 


Number  of  contagious  diseases  reported — 

Year  1905  50,258 

Year  1906  70,604 

Number  of  communicable  diseases  reported — 

Year  1905  3i,5i6 

Year  1906 32,764 


Number  of  patients  treated  at —  1905.  1906. 

Reception  Hospital  1,894  1,954 

*  Willard  Parker  Hospital 478  988 

Riverside  Hospital 2,048  2,231 

Kingston  Avenue  Hospital 2,263  3»078 


*  Hospital  closed  from  June  17,  1905,  to  March  14,  1906. 


22 


REPORT  OF  THE  SECRETARY  OF  THE  BOARD  OF  HEALTH. 

The  following  is  a  report  of  the  woric  performed  in  the  office  of 
the  secretary  for  the  year  ending  December  31,  1906,  as  accomplished 
under  the  chief  and  auditing  clerk  of  the  Department  of  Health  and 
the  assistant  chief  clerks  assigned  to  duty  in  the  various  boroughs  of 
the  city: 

Chief  Clerk. 

Report  of  the  work  performed  in  the  office  of  the  Chief  Qerk 
during  the  year  1906,  subdivided  into  classes,  established  so  that  proper 
supervision  can  be  at  all  times  maintained,  and  thus  controlling  the  or- 
ganization of  this  branch  of  the  service. 

Finances  of  the  Department. 
The  following  appropriations  were  approved  by  the  Board  of  Es- 
timate and  Apportionment  for  the  support  and  maintenance  of  the 
Department  of  Health  during  the  year  1906,  as  follows: 

STATEMENT  OF  APPROPRIATIONS. 

Title.  Amount. 
Salaries — 

Board  of  Health  and  Executive  Officers ?53.557  00 

Officers,  Clerks,  Inspectors  and  other  employees 590,815  00 

Supplies  and  Contingencies 44»073  00 

Hospital  Fund  (excluding  payments  to  private  hospitals) 170,871  66 

Disinfection    68,050  00 

Bacteriological   Laboratory    63,850  00 

Salaries — Medical   School  Inspection 159,00000 

Abatement   of   Nuisances 1,600  00 

Support  of  Ambulance  Service 28,100  00 

Removal  of  Night  Soil,  Offal  and  Dead  Animals 69,883  00 

Sanitary   Police    94)6oo  00 

Total    $1,344,396  66 


Statement  of  Revenue  Bond  Funds  and  Corporate  Stock  issued 
during  the  year  1906  for  the  purposes  specified  and  to  also  provide  for 
lack  of  funds  caused  by  the  insufficiency  of  appropriations : 


23 


M 


« 


(• 


t( 


Jan.  12,  1906. 
Feb.    2,  19061 
Mar.  16,  igod 
July    6,  igod 
Feb.    2,  igod 
2,  igod 
2,  igod 
2,  igod 
2,  igod 
Mar.  16,  igod 
May  II,  igod 
"     II,  igod 
July     6,  igod 
"       6,  igod 
May  II,  igod 
II,  igod 
II,  igod 
II,  igod 
July     6,  igo6. 
"      d  igod 
Nov.  2S,  igo6. 


Supplies,  etc.,   Tofaermin^fft    raiuimumL 
Salaries  for  XnTses. 


Salaries  for  Xuracs 


M 


U 


« 


Salaries  for  yaraes 

Autitoadxi 

Drug  Laboratorj  .. 
Tuberculosis  Ginic 
Medical  Cannmasaa  1  Pneumcma 
Medical   Gumniaaica      Miesm^ms 

Trachoma   Ho^ital   

Salary,  Bacrerioicgical  Labtirsrcrj  . 

Salary,  Officers,  Gerks,  InspecazrL 

Salary,  Officers,  Clerks,  jaspecxr*  -sc 

Salary,  Officers,  Grrkif.  raspecsir*.  -sc: 

Hospital,  Fund    

Supplies  and  Cotxaa^eacts   

Disinfection   

Summer  Corps  

Re-Indexing,  etc    

Salary,  Medical  School  Irs^ 
Salaries  


HiS^XK  in 


en 


Total 


C0HP*:R-\TE  5TCOL 

Sept.  14,  igo6.     Sites  and  Building?,  Tubercnloiis  Sanatonom 


Ajnr 

X 

*  ^"'" 

X 

JCJOC 

3: 

JDLOaC 

ac 

'cjoc: 

3C 

jiiaoc 

QO 

vno 

aa 

ILOCD 

00 

Jfcjao 

00 

557^,237 

50 

.    S2:2>000 

oc 

The  annual  estimate  of  the  amounts  required  for  the  maintenance 
of  the  department  during  1907  was  prepared  during  July  and  Aug^ust 
and  presented  to  the  Board  of  Estimate  and  Apportionment  on  Augrust 
15,  1906,  the  date  requested. 

After  strict  examination  by  representatives  of  the  Comptroller  and 
by  a  committee  of  the  Citizens'  Union,  who  each  made  an  exhaustive 
investigation  into  and  a  report  upon  the  records  of  this  office,  the  sum 
of  $1,847,819-66  was  allowed  and  included  in  the  Budget  for  1907,  as 
against  $1,344,396.66  allowed  in  the  Budget  for  1906,  an  increase  of 

$503^3. 


24 


The  methods  of  accounting  and  the  condition  of  the  accounts  were 
pronounced  to  be  excellent  by  the  investigators. 

Comparative  Statement  of  the  Moneys  Received  Through  the  Various  Financial 
Resources  of  the  Department  of  Health  During  the  Period  from  1902  to 
1906,  Inclusive. 


Year. 


1902, 

1903 
1904 
190S 
X906. 


Appro- 
pnation. 


$  984,391  48 
iP34,39«  48 
1,109,391  4S 

i,aS9.39«  48 
1,344,396  66 


Bond  Issue. 


#242,662  $0 
230,600  00 
429,458  00 
422397  88 
576,257  50 


Sales  of 

Laboratory 

Products. 


132,048  13 
21,432  91 
28J53  61 

32,36832 
25,638  08 


Care  and 
Maintenance 
of  Immi- 
grants. 


#35,27200 
33,72600 
24,256  00 
47,546  00 
86,58000 


Total. 


« 1,294,374  n 
1320,150  39 

i,59M59  09 
I1761.703  68 
2/>3237a  24 


Comparative  Statement  of  all  Moneys  Expended  for  Salaries  by  the  Department 

of  Health  in  all  its  Branches. 


Year. 


1902 
1903 
1904 
1905 
1906 


Expended. 


« 1,294,374  II 
1^20,150  39 

i,59MS9  09 
1,761,703  68 
2,032,872  24 


Number  of 
Employees. 


1,120 
1,196 
1,270 

1,474 
1,710 


Number  of 
Physicians. 


32s 

340 
368 
380 

447 


In  connection  with  the  payment  of  carfare  bills,  telephone  calls  and 
other  incidental  expenses  contracted  by  the  various  employees  of  the 
department  in  the  transaction  of  official  business  it  was  the  previous 
custom  of  the  Chief  Clerk  of  the  department  to  deposit  checks  received 
from  the  Department  of  Finance  for  vouchers  submitted  with  claims 
to  the  credit  of  his  personal  bank  account,  and  to  draw  checks  to  in- 
dividuals in  payment  against  same  so  that  a  permanent  receipt  could 
be  filed  in  this  office.  For  the  purpose  of  eliminating  any  opportunity 
for  adverse  criticism  and  the  necessity  for  the  drawing  of  personal 
checks  in  the  official  financial  transactions  of  this  office,  a  bank  account 
was  established  with  the  Van  Norden  Trust  Company,  comer  Fifth 
avenue  and  Sixtieth  street,  New  York  City,  in  the  name  of  the  De- 


I>artnient  of  Health,  City  of  New  York,  by  James  McC.  Miller,  Chief 
Cleric,  on  December  i6,  1905,  which  has  proved  a  more  practical  way 
of  maintaining  a  proper  official  record  of  such  transactions. 

During  the  month  of  May,  1906,  a  new  form  of  contract  was  exe- 
aited  with  the  United  States  Government  through  the  Commissioner 
of  Immigration  at  the  port  of  New  York  for  the  care  and  treatment 
of  immigrants  sick  with  contagious  diseases  for  one  year  from  July  i, 
J906,  to  June  30,  1907,  in  the  hospitals  of  the  Department,  with  com- 
pensation at  the  rate  of  $2  per  day  for  each  patient,  and  for  the  burial 
of  such  immigrants  as  may  die  and  are  buried  by  the  Department,  the 
sum  of  $14  for  each  and  every  burial,  which  was  a  source  of  revenue 
to  the  amount  of  $85,266. 

A  new  feature  of  this  contract  was  the  agreement  of  this  Depart- 
ment to  furnish  comfortable  and  suitable  ambulance  transportation  for 
such  immigrants  at  the  rate  of  $2  each  way  for  ever>'  person  trans- 
ported to  and  from  the  locations  designated,  which  proved  an  additional 
source  of  revenue  to  the  amount  of  $1,314,  making  a  g^rand  total  of 
the  sum  of  $86,580  received  for  this  purpose,  which  was  applied  to  the 
Hospital  Fund  for  the  year  1906. 

During  the  year  1906  the  Board  of  Health,  pursuant  to  section  1197 
of  the  Greater  New  York  Charter,  ordered  the  Chief  Clerk  of  the  De- 
partment of  Health  to  execute  a  contract  for  work  necessary  to  be  done 
to  abate  nuisances  existing  on  certain  premises,  making  the  charges 
therefor  a  lien  upon  said  property  for  the  reason  that  the  terms  of  the 
orders  remained  uncomplied  with  and  no  responsible  representative 
could  be  found  in  the  City  from  whom  to  obtain  the  proper  enforce- 
ment of  said  orders.    The  premises  were : 

Nos.  212  and  248  East  One  Hundred  and  First  street,  Manhattan. 

Southwest  comer  of  One  Hundred  and  Thirty-fourth  street  and 
Park  avenue,  Manhattan. 

Northeast  comer  of  One  Hundred  and  Forty-ninth  street  and  Broad- 
way, Manhattan. 

Bay  and  Clinton  street,  Second  Ward,  Richmond. 

No.  245  East  One  Hundred  and  Twenty-seventh  street,  Manhattan. 

A  personal  inspection  was  made  of  each  of  the  above  named  premises 
and  the  existing  nuisances  thereat  abated  without  any  cost  whatsoever 


26 


to  the  Department  of  Health  inasmuch  as  responsible  persons  were 
found  who  remedied  the  existing  unsanitary  condition.  Had  it  been 
found  necessary  to  enforce  the  orders  of  the  Board  it  would  have  been 
necessary  to  expend  in  the  neighborhood  of  $i,ioo  of  the  appropriation 
for  the  abatement  of  nuisances  for  the  year  1906.  This,  of  course, 
under  the  circumstances,  can  be  regarded  as  a  saving  to  the  department 
of  the  amount  stated. 

Tabulated  Statement  of  Cash  Received  in  the  Transaction  of  the  Business  of 
the  Department  during  1906,  Deposited  in  Banks,  and  Transmitted  to  the 
City  Chamberlain  or  to  the  Trustees  of  the  Health  Department  Pension  Fund, 
as  follows: 


1906. 

1 

Care  of 
Immigrants. 

Antitoxin. 

Virus. 

To  City 
Chamberlain. 

Pension 
Moneys. 

rT-9 

To  Trustees 

of  Pension 

Fund. 

January 

February 

March 

$5,844  00 
5,750  00 
3,622  00 

$1,228  91 

1,833  07 
1J6325 

1,223  35 

1,444  27 

1,457  55 

971  63 

51462 

45382 

1,181  29 

3,89668 

1,817  93 

$46239 
44005 
652  26 
84390 

1,129  54 
765  29 
511  51 
462  72 

89629 

1,065  74 

712  46 

309  56 

$7»535  30 
8,023  12 

5,637  51 
2,067  25 

9,179  81 
15,700  84 
30,003  14 

977  34 

7,556  11 

10,795  03 

9,135  14 

5,607  49 

$8,891  70 
3,96700 

3,214  70 
3,244  75 
4,66891 
3»52i  50 
5.22830 
5,53824 
2,317  40 
2,295  00 
5,96320 

8,371  70 

$8,891  70 
3,96700 
3,214  70 

April 

3,244  75 

May 

6,606  00 
13,478  00 
28,520  00 

4,66891 

June 

'^,^21   ^0 

July 

5,22830 
5,53824 

2,317  40 
2,295  00 
5,96320 
8,371  70 

J  ""'J  .■«•••«••••• 
August 

September 

October 

November 

December 

6,206  00 
8,548  00 
4,526  00 
348000 

Total 

$86,580  00 

$17,386  37 

$8,251  71 

$112,218  08 

$57,222  40 

$57,222  40 

Summary. 


Received. 

Disbursed. 

Care  of  Immicrants 

$86,58000 

17,386  37 

8,251  71 

57,222  40 

To  Chamberlain. 

$112,218  oS 

Antitoxin 

To  Trustees  Pension  Fund 

Total  disbursed 

^7.122  40 

Virus 

Pension 

Total  received 

$169,440  48 

$160^40  48 

« 

27 

All  moneys  collected  by  the  department  are  received  in  this  office. 
These  moneys  are  derived  from  the  following  sources,  viz.:  The  sale 
of  laboratory  products;  the  care,  maintenance  and  transportation 
of  immigrants;  fines  and  penalties  for  violations  of  the  Sani- 
tary Code,  and  transcripts  of  the  records  of  the  department.  The 
money  received  for  laboratory  products  and  that  for  the  care  and 
maintenance  of  immigrants  is  paid  over  to  the  City  Chamberlain  each 
month  and  added  to  the  department  appropriations.  The  money  re- 
ceived for  fines  and  penalties  and  that  from  transcripts  is  added  to  the 
Health  Department  Pension  Fund. 

Accounts  of  the  Department. 
The  system  of  accounting  established  includes  principally  the  keep- 
ing of  the  following  books: 

Appropriation  Ledger — Showing  the  various  appropriations  al- 
lowed by  the  Board  of  Estimate  and  Apportionment  in  the  Annual 
Budget,  and  such  additional  sums  as  may  be  obtained  from  the  sale 
of  Revenue  Bonds  and  Corporate  Stock  for  the  maintenance  of  the 
Department ;  also,  liabilities  incurred  and  forwarded  to  the  Department 
of  Finance  for  payment. 

Liability  Books — Showing  the  estimated  and  actual  expense  in- 
curred in  each  transaction  so  that  the  condition  of  each  account  may 
be  determined  at  any  time. 

Monthly  Balance  Book — Showing  at  the  termination  of  each  month 
the  financial  condition  of  all  Appropriations,  Revenue  Bond  and  Cor- 
porate Stock  accounts. 

Payroll  Ledgers — One  for  each  borough,  recording  the  name,  com- 
pensation and  time  employed  of  each  employee,  as  indicated  by  the 
monthly  payroll. 

Segregation  Ledger — For  statistical  information  showing  amount 
expended  for  any  class  of  material  or  purpose,  and  the  branch  of  the 
service  incurring  the  same. 

Record  of  Burial  of  Deceased  Soldiers — Forwarding  to  Department 
of  Finance  claims  for  the  burial  of  deceased  honorably  discharged 
veterans. 


28 

The  above  books  are  not  the  only  accounts  kept  in  this  office,  but 
are  specified  as  those  containing  a  record  of  the  financial  transactions 
of  this  Department. 

Trial  balances  are  made  monthly  showing*  the  liabilities  and  assets 
of  the  Department,  a  copy  of  which  is  forwarded  each  month  to  His 
Honor,  the  Mayor,  for  his  information. 

Systems  have  been  devised  and  successfully  installed  in  the  Sta- 
tionery Office,  the  Drug  Laboratory  and  the  Storehouse  at  Otisville, 
N.  Y.,  which  govern  the  receipt  and  distribution  of  supplies  in  these 
divisions  and  which  are  now  working  smoothly  and  satisfactorily. 

A  new  method  of  accounting  governing  the  distribution  of  hydro- 
phobia treatment  and  laboratory  products  was  put  into  eflfect,  and  many 
changes  in  the  system  controlling  the  sale  of  diphtheria  antitoxins  were 
made  owing  to  a  change  in  the  style  and  price  of  the  containers. 

The  clerk  in  charge  of  the  accounting  of  the  distribution  of  labora- 
tory products,  Mr.  J.  W.  Stagg,  resigned  on  May  31,  his  place  being 
taken  by  Mr.  D.  A.  MulhoUand  of  the  general  auditing  force. 

Horse  Register. 

A  Horse  Register  was  installed  containing  a  full  description  of  each 

horse,  giving  the  number,  color,  age,  special  marks,  where  stabled  and 

work  performed,  which  shows  that  the  Department  owns  the  following 

horses  distributed  as  follows : 

Antitoxin  Stable,  Borough  of  Manhattan 18 

Other  Places,  Borough  of  Manhattan I5 

Borough  of  The  Bronx  I3 

Borough  of  Brooklyn  24 

Borough  of  Queens  7 

Borough  of  Richmond   2 

Tuberculosis  Sanatorium,  Otisville 25 

Total  104 


An  luicjaaciit-  v^ts  takcD  cd  al  iiyc>:Jaing  Tnarhrnps  i:<t^i  ic  This 
DepaitmcDt,  ia  the  x^iiains  Iximng^  znd  herrfftr^  a  tnl  ijni  cant- 
plete  record  of  cadi  TnarHpc  pnrdxsEsed  viT  be  tczti  ic  iii2«^  oSr^t. 


Machattas 3«  c  3;  s  3  a 

3.53 
3  —  3  : 


BnxJLhn n 


3 

Ridusond. —  3 

Otisvilk 3 


Totais.. 


Total  number  of  naddscs  cscd  in  die  De-rartirxiii  cf  Hcilih,  lo^ 

I>EPARTMEXT   TeLEPHOXES. 

The  Department  telepbcmes  are  installed  in  priTate  resioerices  cf 
certain  officials  and  employees  to  facilitate  tbe  tra2isz.ciic*n  cf  c^cial 
business  of  the  Department.  Those  desiring  to  use  the  SAir.e  f:r  per- 
sonal business  are  required  to  pay  to  the  De^iartnicn:  the  ususi  ntes 
charged  by  the  telephone  ocmpany,  an  account  cf  which  is  ren ierei  :o 
them  each  m*onth.  It  has  been  found  necessarv*  to  establish  in  the 
various  boroughs  of  the  Cit\-  the  following  telephones  for  t::e  trans- 
action of  the  official  telephonic  business  of  the  Department: 

Borough  of  Manhattan    45 

Borough  of  Brook]>-n  ^ 

Borough  of  The  Bronx  15 

Borough  of  Queens 6 

Borough  of  Richmond  5 

Total  telephones  installed 9^ 


The  bills  of  the  telephone  company  are  rendered  ninthly  making 
a  charge  of  the  local  and  foreign  calls  against  each  separate  telephone. 
To  all  persons  employed  by  the  Department  entitled  by  reason  of  the 


30 

duties  of  their  respective  positions  to  the  use  of  a  Department  tele- 
phon,  the  following  blank  is  forwarded  at  the  end  of  each  month,  and 
they  are  required  to  promptly  remit  to  this  office  the  cost  of  such  bills 
as  were  for  personal  business  and  to  execute  the  duplicate  affidavits  on 
the  reverse  side  of  the  blank,  enumerating  the  number  of  personal  calls 
used  during  the  previous  month. 

DEPARTMENT  OF  HEALTH 

CITY  OF  NEW  YORK 

Office  of  the  Chief  Clerk 

S.  W.  Corner  Fifty-fifth  Street  and  Sixth  Avenue 

Borough  of  Manhattan 

New  York, 190... 


Dear  Sir: 

The  telephone  company  charges  the  following  foreign  calls  for  the  month 

of 190 ,  against  the  Department  telephone 

located  at  your  residence: 

TELEPHONE  CALLS 
AMOUNT. 

REMARKS 

You  are  requested  to  promptly  remit  to  this  office  the  cost  of  such  calls 
as  were  used  for  personal  business,  and  to  return  this  letter  and  the  enclosed 
affidavits  properly  executed  in  duplicate,  stating  the  number  of  personal  and 
official  calls  used  during  that  period. 

Yours  respectfully, 


Chief  Clerk, 
State  of  New  York,  '\ 

City  of  New  York,  \ss.: 

County  of   ,  I 

being  duly  sworn  deposes  and  says : 

THAT  he  holds  the  position  of ' 

in  the  Department  of  Health  of  the  City  of  New  York;  and  that 

for  the  purpose  of  facilitating  the  business  of  the  Department,  the  said  Depart- 
ment has  had  installed  at  his  residence  located  at a  telephone, 


31 

call  No to  be  used  for  the  official  business  of  the 

Department  of  Health. 

THAT  during  the  month  of  190 he  used  said  tele* 

phone  for  his  own  personal  business,  and  that  of  the  total  number  of  calls 

originating  from  said  telephone  were  for  personal  business,  and 

that  the  remaining  number  of  calls  were  for  official  business  of  the  Department 
of  Health. 

That  he  has  paid  the  Department  of  Health  the  sum  of  $ cost 

of  the  personal  calls  used  by  him  during  the  said  month  of 190 


Subscribed  and  sworn  to  before  me 

this  day  of  A.  D.,  190 


Notary  Public : County, 

or  Commissioner  of  Deeds,  New  York  City. 
State  of  New  York,  ^ 

City  of  New  York,  yss.: 

Cotmty  of  ,  I 

being  duly  sworn  deposes  and  says : 

THAT  he  holds  the  position  of 

in  the  Department  of  Health  of  the  City  of  New  York,  and  that 

for  the  purpose  of  facilitating  the  business  of  the  Department,  the  said  Depart- 
ment has  had  installed  at  his  residence  located  at  a  telephone, 

call  No to  be  used  for  the  official  business  of  the 

Department  of  Health. 

THAT  during  the  month  of  190 he  used  said  tele- 
phone  for  his   own  personal  business,  and  that  of  the  total  number  of  calls 

originating   from  said  telephone    were   for  persona]  business,  and 

that  the  remaining  number  of  calls  were  for  official  business  of  the  Department 
of  Heahh. 

THAT  he  has  paid  the  Department  of  Health  the  sum  of  $ cost 

of  the  personal  calls  used  by  him  during  the  said  month  of 190 


Subscribed  and  sworn  to  before  me 

this day  of A.  D.,  190. . . . 


Notary  Public  County, 

or  Commissioner  of  Deeds,  New  York  City. 


32 


A  new  record  in  bcx)k  form  has  been  installed  in  which  is  recorded 
the  name,  address,  telephone  number,  and  a  record  of  the  local  and 
foreign  personal  calls  paid  for  monthly  by  each  person  using  a  De- 
partment telephone,  thus  improving  the  former  method  of  keeping 
information  of  this  character  on  sheets  of  paper  which  might  easily 
be  destroyed  or  mislaid. 

The  total  amount  received  from  employees  for  the  use  of  official 
telephones  for  private  business  during  the  year  1906,  was  as  follows: 


Borough  of  Manhattan 
Borough  of  The  Bronx 
Borough  of  Brooklyn. . 
Borough  of  Queens. . . . 
Borough  of  Richmond. 

Total.. 


Local 

Calls. 


Total. 


U7S  57 

70  28 

72  86 

X  27 

5  92 


♦607  3« 
118  08 

1S9  II 

1987 
21  72 


•625  90 


|i,oi6  10 


Which  is  periodically  deducted  from  the  bills  of  the  telephone 
company  before  they  are  certified  to  the  Comptroller  for  payment  by 
The  City  of  New  York.  It  will  thus  be  observed  that  a  saving  to  the 
Department  was  effected  through  this  method  of  the  amount  above 
stated. 

Auditing  of  Bills. 

All  bills  contracted  by  this  Department  are  rendered  in  triplicate, 
stamped  with  date  of  receipt  by  the  Division  incurring  the  expense, 
and  certified  to  the  effect  that  the  articles  or  services  enumerated  have 
been  received,  examined,  and  found  correct,  and  for  the  exclusive  use 
of  this  Department,  one  bill  being  retained  in  that  office  for  filing,  and 
two  returned  to  the  office  of  the  Chief  Clerk  where  they  are  charged 
against  the  proper  appropriations,  one  being  filed  with  the  requisition, 
the  other  forwarded  to  the  Department  of  Finance  for  payment^  after 
having  been  approved  by  the  Board  of  Health. 

Considerable  delay  in  auditing  still  continues  due  to  the  failure  of 
business  concerns  to  promptly  forward  the  necessary  bills  which  should 
accompany  the  delivery  of  the  merchandise.     It  was  the  intention  to 


33 


establish  during  1906  a  new  system  for  the  purpose  of  tracing  all 
bills  received  and  placing  the  responsibility  for  any  delay  which  might 
occur,  but  owing  to  the  great  increase  in  the  work  of  the  office  it  was 
not  deemed  advisable  to  adopt  the  system  until  an  additional  clerical 

force  is  provided. 

The  number  of  bills  received,  audited,  and  forwarded  to  the  De- 
partment of  Finance  for  payment  during  the  year  1906  was  approxi- 
mately 35,000. 

The  duty  of  auditing  claims  for  the  interment  of  deceased  honorably 

discharged  soldiers,  sailors  and  marines,  and  their  wives,  finally  devolved 
upon  this  Department  through  an  opinion  of  the  Corporation  Counsel 
rendered  in  February,  1906. 

The  following  claims  have  been  audited  and  forwarded  to  the  De- 
partment of  Finance  for  payment  during  1906. 


Place  of  Death. 


New  York  County. 


Kings  County. 


Queens. 


Year  of 
Death. 


Number. 


Amount  of 
Claims. 


Richmond 


{ 


Total 


1901 
iqo3 
1904 
1905 
1906 

1902 

1904 
1905 
1906 

1904 
1905 
1906 

1905 
1906 


I 
I 

2 

39 

I 

I 

20 

i! 

2 

5 

4 

I 

4 


ia6 


53 


II 


195 


«35  00 
3500 

70  GO 

1,365  00 
«,90S  00 

3500 

35  00 

700  00 

1,085  00 

70  00 
175  00 
140  00 

3500 
140  00 


Total. 


f4t4io  00 


1,855  00 


38500 


17s  00 
#6,825  00 


Department  Payrolls. 
The  payrolls  of  the  various  boroughs  and  hospitals  of  the  Depart- 
ment are  prepared  monthly,  recording  the  name,  residence,  designation,, 
compensation,  and  time  employed,  certified  by  the  proper  officials,  ap- 


appropriate  acooants,  certi- 
forwarded  to  die  Depart- 


pcwefi  bv  die  Board,  charged  against 
atd  b'i  the  Crvil  Service  Cotnrmssioo, 
irent  of  Ftnance  for  paynKnt. 

SciudmU  of  Total  Smmb€r  of  Emfl*jj€is  in  tkd  Sircicf  of  the  Dtfarttmemt  of 
of  Hidltk  im  the  I'^irums  Bcrongkt  on  Dtcrmb^r  ji,  1906^  with  a  Statement 
of  tkeir  Aggregate  Anrnmal  Compensation: 


No.    ,     Amoant. 


BoPMfhof  Manhattan— 
Oftccn,  Ckda  and  odMr  eospiofees 
Hw|p«tal 


Bonm^  r4  The  Brotix— 
Officers.  Ckria  and  other  eoBployees. 
Hosintal 


6« 
au 


Total. 


Borough  of  Queens- 
Officers,  C  lerks  and  other  employees. 

Etorough  of  Richmond- 
Officers,  Clerks  and  other  employees. 

OtUville  Sanatorium- 
Officers,  Clerks  and  other  employees. 


599  16711833 » 

114,5*1  00 


Total 808    !      $786,35600 


167,830  00 
95,«i4  00 


Total ;     x;6  $162,94400 


Borough  of  Brooklyn — 
Officers,  Clerks  and  other  employees.. 
Hospital  sendee 


•63,955  00 


Summary. 


Total,  Officers,  Clerks,  employees,  etc. 
Total,  hospital  serrice 


Grand  total. 


935 

775 

1,710 


$1,047,004  00 
370,574  00 


11,417.578  00 


35 

Pension  Fund. 

The  Board  of  Trustees  of  the  Health  Department  Pension  Fund 
consists  of  the  members  of  the  Board  of  Health,  one  of  whom  is  chosen 
to  be  Chairman,  and  one  elected  as  Secretary,  annually.  Said  Board 
of  Trustees  is  charged  with  the  duty  of  receiving,  investing,  and  ad- 
ministering all  funds  derived  from  fees  for  searches  and  transcripts 
of  Department  records,  and  fines  and  penalties  for  violations  of  the 
Sanitary  Code  and  Health  Laws. 

Pensions  are  granted  to  employees  disabled  by  reason  of  perform- 
ance of  duty  and  to  widows  or  minors  of  employees  who  die  from 
disease  or  injury  suflFered  in  the  discharge  of  duties,  and  for  service 
of  a  period  of  twenty  years,  upon  application  of  such  employee. 

A  report  in  detail  of  the  condition  of  said  fund  is  submitted  to 
His  Honor,  the  Mayor,  annually,  in  the  month  of  January. 

Report  of  the  Condition  of  the  Health  Department  Pension  Fund  t.or  the  year\ 
1906  showing  Receipts  and  Disbursements  during  that  Period: 

RECEIPTS. 


Month. 


January 

February. . 

March 

April 

May 

June 

July 

August 

September. 
October . . . 
November. 
December. 


1906. 


Totals. 


Attorneys* 
Cost. 


$21  50 

51  00 
16  00 
5700 
47  00 
51  00 

108  GO 
70  00 

2800 

64  00 

34  00 


«547  50 


Searches  and 

Transcripts  of 

Births,  Marriages, 

andf  Deaths. 


•1.931  » 
1,707  00 
2,041  70 
1,915  20 
ii72o  90 
1,862  50 
1,672  30 

1,441  40 
1,68690 

1,845  00 
1,734  20 
1,866  40 


^M24  70 


Fines  and 
Penalties. 


$6,939  00 
2,309  00 
1,157  00 
1,272  55 
2,901  01 
1,608  00 
3,44800 

570  75 

602  00 

386  00 

4,229  00 

1,77600 


127,098  81 


Interest. 


3,85609 


4,295  30 


$8,151  39 


Totals. 


$8,891  70 
3*967  00 
3,214  70 
3,244  75 
4,668  91 

7,377  59 
5.228  30 
2,082  15 

2,317  40 
2,295  00 
5,96320 
7,971  70 


157,222  40 


Cash  on  deposit  with  Knickerbocker  Trust  Company,  December  31, 
1906,  drawing  interest  at  4  per  cent.,  as  shown  by  preceding  annual 
report,  $186,806.57. 


36 


DISBURSEMENTS. 


Name. 


JohnT.  Nagle 

Sarah  Terhune 

Jacob  A.  Weil 

Edward  J.  Gallagher 

Charles  A.  Koerber 

Frank  W.  Lester,  M.  D..  < 

Helen  B.  Drain 

WilUamH.VermUye 

George  F.  Morris,  M.  D.. 
Roger  S.  Tracy,  M.  D. . . . 

Belle  F.  Steinsieck 

John  Schnell 

Bartholomew  McGowan.. 

Caspar  Golderman 

F.ti.  Dillingham,  M.D. 

Robert  Hixon 

WUUam  B.  Femhead 

John  A.  Jennings 

Sarah  A.Clarke 

Asa  R.  Dimock 

Frank  Wickham 

Celia  Brown  McLaughlin 

Thomas  F.  Fay 

Magdalena  Walker 

George  F.  Shrady,  Jr 

Julia  L.  Mahoney 

Harry  E.  Dramley 


Date  of 
Retire- 
ment. 


July,  1 

t895 

Jan.  I 

May,  1 

[897 

Jan.  X 

Mar.,  1 

tSgS 

Jan.  I 

Sept.,] 

[898 

Jan.  I 

Oct.,   1 

(898 

Jan.  I 

July,  ] 

189Q 

Jan.  I 

Aug.,  1 

[900 

Jan.  I 

Jan.,   1 

[90X 

Jan.  I 

Mar.,  \ 

1901 

Jan.  I 

May,  : 

[901 

Jan.  I 

Dec.,  ] 

[90X 

Jan.  I 

July.   1 

[902 

Jan.  I 

July,   1 

[902 

Jan.  I 

Apr.,  ] 

1903 

Jan.  I 

May,  ] 

1903 

Jan.  X 

Sept.,  ] 

1903 

Jan.  I 

Dec.,  ] 

[903 

Jan.  I 

Mar.,  1 

[904 

Jan.  X 

July,   1 

1904 

Jan.  X 

Oct..  ] 

1904 

Jan.  I 

May,  1 

[905 

Jan.  I 

July,   1 

1905 

Jan.  I 

Oct.,   : 

1905 

Jan.  X 

Oct.,   1 

1905 

Jan.  I 

Dec.,  ] 

1905 

Jan.  I 

Dec.,  ] 

[905 

Jan.  I 

Nov.,  ] 

1905 

Jan.  X 

Pension  Period. 


1906. 

to  Dec.  31 

to  Dec.  31 

to  Dec.  31 

toDec.3x 

to  Dec.  12  (died) . 

to  Dec.  31 

to  Dec.  31 

to  Dec.  31 

to  Dec.  31 

to  Dec.  3x 

to  Dec.  31 

to  Dec.  31 

to  Dec.  3x 

to  Dec.  15  (died) . 

to  Dec.  31 

to  Dec.  31 

toDec.  3x 

to  Dec.  31 

to  Dec.  31 

to  Dec.  3x 

to  Dec.  3x 

to  Dec.  31 

to  Dec.  31 

to  Dec.  31 

to  Dec.  31 

to  Dec.  31 

to  Dec.  31 


Amount. 


$i,aoo  00 
39000 
850  00 
7S0  00 

56935 
750  00 

300  00 

600  00 

900  00 

1,200  00 
300  00 
600  00 

52500 
1,14839 

i,aoo  00 
240  00 

ifiSo  00 

1,200  00 
300  00 
900  00 

1,200  00 
360  00 

1,200  00 
300  00 
900  00 
300  00 

1,200  00 


37 


PENSIONS   GRANTED,    I906. 


Name. 


Margaret  Gately. ... 
Frederick  A.  Jewett. 
Thomas  Clacfaer. . . . 
John  Finn^fan 


Date  of 
Retire- 
ment. 


July,  1906 
Aug.,  1906 
Aug.,  1906 
Dec.,  1906 


Total  paid  to  pensioners,  1906 

On  deposit  with  Knickerbocker  Trust  Company  at  4  per  cent. 
On  deposit  with  Windsor  Trust  Company  at  4  per  cent 


Pension  Period. 


1906. 
July  I  to  Dec.  31. 
Aug.  I  to  Dec.  31. 
Aug.  I  to  Dec.  31. 
Dec.  I  to  Dec.  31. 


Amount. 


150  00 

500  00 

187  50 

25  00 


^1,205  24 

158,786  36 

64,037  34 


$244,028  97 


It  was  the  custom  of  the  Board  of  Trustees  of  the  Health  Depart- 
ment Pension  Fund,  until  July  14,  1906,  to  forward  quarterly  to  each 
pensioner,  a  t)T)ewritten  letter  enclosing  check  for  the  period  men- 
tioned and  requesting  an  acknowledgment  in  writing  of  the  amount 
forwarded;  the  receipts  were  returned  written  in  many  ways  and  on 
various  kinds  and  sizes  of  note  and  letter  paper  presenting  anything 
but  a  neat  and  businesslike  appearance.  To  systematize  this  particular 
transaction  and  to  facilitate  the  proper  filing  of  receipts,  the  following 
form  was  prepared  and  adopted  and  the  files  are  now  kept  in  a  methodi- 
cal manner. 


38 


iB>l 


DEPARTMENT  OF  HEALTH 

CITY  OF  NEW  YORK^ 
&  W.  Cor.  55tb  Street  «nd  Sixth  Aftnvt 
90R0UGH  OP.BIANHATTAN 


•OARO  Of  TflUSTtCS 

HtALTH   OK^AflTMKNt 

PCNSION  rUNO 


New  York, 


19 


Mr. 


Dmr  Six 


Enclosed  3*011  will  please  find  check  drawn  to  your  order  by  the  Chairman 


and  Secretary  of  the  Board  of  Trustees  of  the  Health  Department  Pensioa'^^md  to  the 


amonnt  of  f 


.in  fall  payment  for  the  onarter  ending 


— 19 


on  account  of  the  annual  peption  graiitad  yon  by  said  Board  of  Trosteeti 


Yon  are  reqtteated  to  properly  execute  the  printed  acknowledgment  on  th*- reverse 
side  of  this  communieatioo  and  to  promptly  retnm  same  to  this  office. 


Vours  respectfully, 


aacretuy.  DapMloMiikof  Health. 


39 


:8 


£ 


I 


CO 

Q 


I 


a 

s 


i 


S 


40 

A  report  of  the  Commissioners  of  Accounts  covering  an  examination 
and  audit  of  the  Pension  Fund,  between  January  i,  1902,  and  May  31, 
1905,  was  received  on  August  29,  1905,  in  which  attention  was  called 
to  the  fact  that  the  sum  of  $6,145  was  being  retained  by  the  Sinking 
Fund  Commissioners,  having  been  erroneously  remitted  to  the  Comp- 
troller and  applied  to  the  payment  of  interest  on  the  Gty's  debt  instead 
of  having  been  paid  into  the  Health  Department  Pension  Fund. 

Measures  were  taken  to  secure  a  refund  of  this  amount  from  the 
Sinking  Fund  Commissioners,  $6,045  o^  which  was  paid  to  the  Trustees 
of  the  Health  Department  Pension  Fund  on  January  25,  1906,  and 
deposited  to  the  credit  of  said  Fund. 

Contracts. 

Pursuant  to  the  provisions  of  Section  419  of  the  Charter,  contracts 
by  public  letting  are  made  for  work  to  be  performed  and  supplies  to  be 
furnished  for  the  use  of  this  Department,  where  the  supplies  and  work 
are  of  a  similar  character  and  the  amount  involved  exceeds  the  sum 
of  $1,000. 

Contracts  were  executed  for  furnishing  the  following  supplies  to  the 
various  offices,  buildings,  hospitals  and  tuberculosis  clinics  of  the  De- 
partment during  the  year  1906: 

Supplies.  Amount. 

Butter,  cheese,  eggs $12314  01 

Milk    (clinics) 2,117  SO 

Bread    4,282  30 

Ice    3,55465 

Vegetables  and  fruits 2,589  30 

Forage  7,443  95 

Milk   (hospitals)    28,734  75 

Meats  63,286  71 

Fish  1,670  06 

Mineral  waters  1,540  00 

Groceries   I5»97S  43 

Drugs  and  chemicals 20,088  84 

Chemical  apparatus 6,115  04 

Pipe  and  fittings 4,730  07 

Lumber   8,239  28 

Enameled  ware  1,621  22 


41 

Supplies.  Amount. 

Cribs   $640  00 

Hospital  furniture 9,866  25 

Cement   940  00 

Horses   8,100  00 

Crockery   2,705  53 

Wooden  tanks,  etc .* 1,227  10 

Total    $177,229  84 

The  above  schedule  does  not  include  a  number  of  awards,  each  of 
which  amounted  to  less  than  $500,  therefore  not  requiring  a  formal 
contract.  Standards  are  constantly  being  improved  and  deliveries  of 
better  grades  received  due  to  close  inspection. 

Wherever  the  present  close  system  of  inspection  has  developed  the 
necessity  for  a  more  specific  description  of  the  supplies  to  be  con- 
tracted for,  the  change  has  been  incorporated  in  the  contract  form  for 
the  succeeding  year,  and  samples  of  a  higher  grade  purchased,  to  be 
used  as  standards  when  required;  thus  the  quality  of  the  supplies  de- 
livered continues  to  improve  annually. 

The  following  contract  forms  for  furnishing  supplies  during  1907 
were  prepared  and  printed  for  advertisement  and  award: 

Milk  and  eggs  (clinics).  Drugs. 

Bread.  Chemicals. 

Fish.  Chemical  apparatus. 

Ice.  Pipe  and  fittings. 

Mineral  waters.  Milk  (hospitals). 

Vegetables.  Cheese. 

Fruits.  Meats. 

Groceries.  Butter. 

Coal  (steamboats).  Eggs. 

Food  supplies,  Otisville  Sanatorium.  Forage. 

Of  the  above  the  following  supplies  are  to  be  purchased  through 
public  letting  for  the  first  time,  having  been  heretofore  procured  in  the 
open  market  through  departmental  orders : 

Eggs  (clinics).  Food  supplies  (Otisville). 

Pipe  and  fittings.  Lumber. 


42 

Contracts  were  approved  for  the  removal  of  night  soil,  offal  and 
dead  animals,  etc.,  for  the  y«ar  1906,  for  a  period  of  five  years,  ending 
with  1909.    These  contracts  were  advertised  and  let  in  1905,  as  follows: 


Contractor. 


McKeever&  Co 

M.  J.  &  J.F.White. 


Covering  Boroughs  of 


Brookl3rn  and  Queens 

Manhattan,  The  Bronx,  Richmond. 


Annual 
Cost. 


l3i,aoo  00 
38,68000 


The  following  contracts  for  the  construction  of  new  buildings,  altera- 
tions, improvements,  etc.,  were  entered  into  during  1906. 


Construction  of 


Dormitory  building 

Area  walls 

Incinerator  building 

Pipe  system 

Dining  hall 

One-story  !^ack 

Two-story  shack 

Morgue  building 

Alterations 

Repainting  buildings 

Refrigerating  plant 

Measles  pavilion 

Extension  to  Nurses'  Home. .. 
Cow  stable  and  dairy 


Location. 


Willard  Parker  Hospital.... 
Kingston  Avenue  Hospital.. 
Kingston  Avenue  Hospital.. 
Kingston  Avenue  Hospital.. 

OtisvUle 

Otisville 

Otisvilte 

Kingston  Avenue  Hospital.. 

Bronx  Office  Building 

Riverside  Hospital 

Willard  Parker  Hospital 

Kingston  Avenue  Hospital .. 
Kingston  Avenue  Hospital.. 
Otisville 


Contractor. 

Cost. 

John  Spence,  Jr 

«3»994  00 

Christ.  Doolev 

4>934  09 
3,018  00 

Jas.  MacArthur 

E.  Rutzler  Co 

a6,88i  00 

H.H.Vought&  Co.... 

9,66800 

H.H.  Vought&  Co.... 

5,38000 

H.H.  Vought&  Co.... 

9,678  00 

las.  MacArthur^r. ..,,,,. 

12,880  00 

T .  M .  KnoDD 

2,70^  00 

J.  P.  Hansen 

2,460  00 

Wm.  Home  Co 

3«775  00 

P.  J.  Brennan  &  Son. . . 

183,000  00 

Dan.  T.  Ryan 

34,600  00 

Kelly&Kelley 

20.124  00 

Total 

txnA^  00 

43 


Contracts  were  entered  into  with  the  following  architects  for  their 
services  in  preparing  plans  and  specifications  for  the  construction  of  the 
improvements  indicated  below: 


ImproTement. 

Location. 

Architect. 

Fees. 

Sundry 

Various 

N.  Wheeler  Smith 

Westervelt  &  Austin.... 

John  H.  Duncan 

Snelling&  Potter 

Scopes  &  Feustman .... 
Chas.  Volz 

t21.000  00 

Extensions  to  Nurses'  Home.. 
Monnwi^  biiildinff ,  etc 

Kingston  Avenue  Hospital.. 
Kingston  Avenue  Hospital.. 
The  Bronx 

2}000  00 
I.2C0  00 

Vaccine  laboratory  olant 

One  and  tw<>-«tofy  ^hackSx  .... 

Otisvllle 

1,000  00 

MesLsles  pavilion 

Kingston  Avenue  Hospital.. 
Kingston  Avenue  Hospital.. 
Otisville { 

QiOOO  00 

Six  isolation  ward  buildinss. . . 

Percy  Griffin 

^,000  00 

Cow  stable  and  dairy . .  • 

Edward   Burnett   not  1 
yet  executed ) 

Total 

1,250  00 

1 

•46,500  00 

Contract  forms  were  also  prepared  and  printed  for  the  construc- 
tion of  the  following  improvements,  not  as  yet  advertised  nor  awarded : 

Vaccine  Laboratory  plant,  Borough  of  The  Bronx. 

Helps'  dormitory,  Otisville. 

Electric  wiring,  Willard  Parker  Hospital. 

Six  isolation  buildings,  Kingston  Avenue  Hospital. 

Purchase  of  Supplies. 

The  increase  in  the  work  of  this  office  can  be  readily  seen  by  the 
number  of  requisitions  received  for  the  purchase  of  supplies,  etc.,  for 
use  in  the  various  branches  of  this  Department  during  the  year  1906, 
which  amounted  to  5,650,  involving  an  expenditure  of  $716,599.89 
compared  with  4,534  for  the  year  1905  at  a  cost  of  $452,176.85,  shows 
a  clear  gain  of  1,116  requisitions  over  the  previous  year. 

In  purchasing  supplies  for  the  use  of  this  Department,  requisitions 
properly  certified  by  the  executive  officers  of  the  different  boroughs  as 
to  the  necessity  therefor,  are  received  in  the  office  of  the  Chief  Clerk, 
examined,  and  presented  to  the  President  of  the  Board  of  Health  for 
approval  and  authority  to  incur  the  expense.  Estimates  are  then  ob- 
tained from  reputable  business  concerns  or  manufacturers,  if  possible, 
and  the  order  given  to  the  lowest  bidder.     Should  the  amount  exceed 


44 


the  sum  of  $i,cxx)  the  supplies  are  purchased  by  contract,  the  result 
of  public  bidding. 

Proposals  for  supplying  coal  to  the  steamboats,  and  institutions 
of  the  Department  during  the  year  1906  were  advertised  for,  but  on 
opening  the  bids  the  prices  were  found  to  be  excessively  high  and  the 
bids  were  rejected. 

The  proposals  were  again  re-advertised,  and  prices  again  found 
excessive  and  the  bids  rejected. 

Authority  was  then  procured  from  the  Board  of  Aldermen  to  pur- 
chase 12,115  tons  of  coal  in  the  open  market  with  the  result  shown 
below: 


Buckwheat  No.  i. 

Stove. 

Egg. 

Tons. 

Amount. 

Tons. 

Amount. 

Tons. 

Amount. 

Lowest  price  bid,  oublic  lettinff 

10,250 
10,250 

1 40,070  00 
34»a76  69 

500 
500 

•  •  •  • 

•  3,39950 
3,01a  50 

"5 
"5 

•  •  •  • 

•  778  00 

Price  oaid.  ODen  market 

735  75 

Savins 

•  5,793  31 

•  38700 

$43  60 

• 

This  effected  a  total  saving  of  $6,222.91  on  10,685  tons  of  coal 
purchased.  Sufficient  quantity  was  ordered  to  last  until  the  Spring  of 
1907  and  provision  was  made  for  the  awarding  of  coal  contracts  during 
the  month  of  April,  1907,  when  the  Summer  prices  for  coal  are  es- 
tablished instead  of  advertising  for  bids  during  the  Winter  season  when 
coal  is  scarce  and  the  prices  at  the  maximum  figure. 


45 


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46 

For  the  first  time  in  the  history  of  this  Department  horses  used  at 
the  Department  stables  as  well  as  those  used  by  officials  entitled  to 
bame  by  reason  of  the  duties  of  their  respective  positions,  were  pur- 
chased under  contract.  The  previous  custom  was  to  buy  horses  in  the 
open  market,  which  proved  unsatisfactory  in  many  ways. 

To  improve  the  condition  of  the  ambulance  service  in  the  various 
boroughs,  and  with  a  view  to  improving  the  carriage  and  wagon  ser- 
vice, an  inspection  was  made  by  the  Veterinarian  of  all  horses  used 
by  the  Department  with  the  result  that  fourteen  horses  were  found  to 
be  in  a  condition  which  practically  made  them  unfit  for  the  purposes 
of  the  Department  in  this  City,  and  instead  of  being  condemned  and 
sold  they  were  shipped  to  the  Tuberculosis  Sanatorium  at  Otisville, 
New  York,  where  they  were  found  most  useful,  the  work  there  being 
of  a  character  that  has  proved  beneficial  to  them  as  well  as  being  a  great 
economy  to  the  Department  for  the  reason  that  it  was  the  intention 
to  purchase  additional  horses  for  use  at  that  institution. 

The  following  horses  were  purchased  under  contract  for  use  in  the 
various  boroughs  of  the  City  as  follows: 

Borough  of  Manhattan 13 

Borough  of  Brooklyn 5 

Borough  of  The  Bronx i 

Borough  of  Queens 4 

Borough  of  Richmond 2 

Total   25 


— at  a  total  cost  of  $8,100,  which  has  placed  this  branch  of  the  service 
on  a  high  standard  of  efficiency. 

Inspection^  of  Supplies. 

During  the  year  1906  there  were  5,071  of  the  total  number  of 
5,650  requisitions  received  on  which  inspections  were  made. 

Upon  receipt  of  goods  at  the  various  institutions  they  are  held 
until  the  same  have  been  inspected  and  passed  by  the  Inspector  before 
being  placed  in  stock,  note  being  made  on  tissue  copy  of  the  order  for 
recording  in  the  office  of  the  Chief  Clerk,  for  the  purpose  of  checking 
the  bills.     Perishable  supplies,  such  as  fruits,  vegetables,  etc.,  which 


47 

are  furnished  on  monthly  bills  on  an  open  requisition,  are  subject  to 
the  same  inspection  and  are  rejected  when  found  necessary. 

The  Departmental  divisions  from  which  requisitions  were  received 
include  the  following :  Hospitals,  laboratories  and  offices  in  the  various 
boroughs.    Requisitions  were  forwarded  as  follows: 

Department  building,  Fifty-fifth  street  and  Sixth  avenue 1,632 

Borough  of  The  Bronx 210 

Borough  of  Brooklyn 240 

Borough  of  Queens 132 

Borough  of  Richmond 123 

Research  Laboratory 608 

Chemical  Laboratory 190 

Vaccine  Laboratory 45 

Drug  Laboratory 150 

Riverside  Hospital 670 

Willard  Parker  Hospital 320 

Reception  Hospital 96 

Trachoma  Hospital  140 

Kingston  Avenue  Hospital 445 

Department  stable,  foot  of  East  Sixteenth  street 70 

Total    5,071 


The  average  number  of  items  on  each  of  the  above  mentioned  requi- 
?!itions  (5,071)  were  approximately  fifty  (50),  and  the  number  of  orders 
issued  were  about  five  (5)  on  each  requisition,  making  a  total  of  25,355 
orders  issued,  and  253,550  items  to  be  inspected. 

The  inspector  visits  each  of  the  hospitals,  laboratories,  offices,  etc., 
at  least  once  a  week,  making  thorough  inspection  of  the  goods  received 
and  rejecting  those  which  do  not  conform  to  the  Department  standards 
and  the  specifications  set  forth  when  the  estimate  is  requested. 

The  matter  of  having  empty  oil  barrels  returned  to  the  Standard 
Oil  Company,  the  Department  receiving  a  credit  allowance  on  their 
bills  at  the  rate  of  $1.15  per  barrel  for  each  one  returned,  proved  a  step 
in  the  interest  of  economy.  This  item  alone,  at  Riverside  Hospital, 
amounted  to  approximately  $175. 

At  the  beginning  of  the  year  several  contractors  endeavored  to  de- 
liver a  very  poor  quality  of  grocery  supplies,  canned  fruits  and  mer- 


48 

chandise  to  the  hospitals  and  laboratories.  Measures  were  promptly 
taken  to  compel  them  to  fulfill  their  respective  contracts  in  accord- 
ance with  the  specifications  and  the  standard  samples,  after  which  the 
goods  delivered  were  of  a  satisfactory  character. 

Furniture,  such  as  desks,  chairs,  wardrobes,  etc.,  instead  of  being 
nnmediately  condemned  and  destroyed  when  broken  or  defective,  as 
heretofore,  are  now  collected  and  stored  in  the  Department  Building, 
and  those  that  can  be  fixed  are  repaired  and  upholstered  and  returned 
to  the  division  where  they  belong.  A  saving  of  at  least  $600  has  been 
effected  in  this  manner  during  the  past  year  in  the  purchase  of  fur- 
niture. 

All  packing  cases  received  at  the  Kingston  Avenue  Hospital  that 
are  made  of  heavy  lumber  are  taken  apart  and  the  lumber  used  by  the 
carpenter  at  that  institution ;  it  would  be  advisable  to  have  this  done  at 
the  other  hospitals.  A  further  saving  could  be  effected  if  the  Drug, 
Chemical  and  Research  Laboratories  were  to  assort  and  store  their 
empty  acid  bottles,  demijohns  and  various  containers  in  which  drugs 
and  chemicals  are  delivered  and  return  them  to  the  various  firms  so 
that  the  Department  could  receive  credit  for  them.  A  considerable 
saving  in  the  purchase  of  glass  bottles  could  be  effected  at  the  Drug 
Laboratory  if  the  empty  medicine  bottles  were  returned  from  the 
various  hospitals,  carefully  sterilized  and  again  used. 

The  glass  tumblers  used  as  receptacles  in  the  delivery  of  jelly  to  the 
various  hospitals  instead  of  being  thrown  away  after  the  contents  were 
used,  as  had  been  the  previous  custom,  were  utilized  as  glasses  for 
drinking  purposes  by  the  domestics  in  the  employ  of  the  institution. 
This  effected  quite  a  saving  in  the  purchase  of  glassware. 

There  are  numerous  other  instances  which  cannot  be  recalled  at  the 
present  time  where  considerable  saving  was  effected  during  the  year. 

The  above  statements  are  made  simply  to  emphasize  the  fact  that 
the  inspection  of  supplies  has  proved  a  great  economy  in  many  ways, 
and  the  force,  consisting  of  one  man  at  the  present  time,  is  totally  inade- 
quate to  cover  the  entire  ground.  This  branch  of  the  service  should  be 
extended  and  two  additional  inspectors  appointed  to  perfect  this  par- 
ticular branch. 


49 

Inspect(»s  of  Construction  and  Repairs. 
During  the  year  1906  an  additional  inspector  was  appointed  to  this 
corps,  making  a  total  force  of  four  sanitary  inspectors,  who  are  as- 
signed to  supervise  the  construction  of  new  buildings  and  repairs  and 
alterations  to  old  buildings.    The  work  performed  was  as  follows : 

Willard  Parker  Hospital — 

The  upper  part  of  the  disinfecting  station  has  been  remodeled  into  a 

dormitory  for  help. 
New  stalls  were  erected  in  stable  of  ambulance  station. 
New  coal  storage  building  erected. 
New  animal  house  erected. 

New  temporary  boiler  house  with  six  boilers  has  been  completed. 
Work  was  completed  in  the  Willard  Parker  Hospital  and  the  building 

was  entirely  remodeled. 
Administration  Building  was  completed. 
Old  boiler-house  remodeled  into  a  kitchen  building  for  the  scarlet 

fever  pavilion. 
Considerable  painting  and  repairing  was  done. 

Kingston  Avenue  Hospital — 

Pipe  gallery  has  been  constructed. 
Addition  to  stable  was  built. 
New  Morgue  Building  now  being  erected. 

Area  walls  have  been  built  around  the  Storehouse  and  Laundry  Build- 
ing and  considerable  filling  in  done. 
Plans  for  a  Measles  Pavilion  were  completed  and  bids  received. 
Plans  for  extension  of  Nurses'  Home  were  completed. 
Two  additional  boilers  were  installed. 

North  Brother  Island — 

Work  is  now  in  progress  increasing  the  area  of  the  island. 

Two  isolation  buildings  have  been  completed. 

Considerable  painting  and  repairing  has  been  done. 

Old  Coal  House  being  altered  into  a  waiting-room  and  discharge  room 

for  patients. 
An  additional  boiler  was  installed  in  boiler-house. 


*        '  ,       V 


so 

Otisville,  N.  F.— 

Dining  pavilion  has  been  erected. 

One-story  shack  has  been  erected. 

Two-story  shack  has  been  erected. 

Six  portable  houses  have  been  erected. 

Old  buildings  have  been  generally  improved  and  much  painting  and 

repairing  has  been  done. 
Considerable  work  has  been  done  on  a  water  supply  and   drainage 

system. 
Plans  for  a  laboratory  building,  stable,  boiler-house  and  dwelling  were 

completed  for  a  vaccine  station  at  Westchester. 
The  following  improvements  were  effected  during  the  year: 
A  new  office  building  was  provided  for  the  branch  office  in  the 
Borough  of  The  Bronx,  at  3731  Third  avenue,  at  an  annual  rental 
of  $2,000,  and  many  alterations  in  the  nature  of  improvements  were 
made  for  the  purpose  of  installing  rooms  for  a  clinic;  also,  electric 
light  apparatus,  skylights,  and  other  necessary  additions. 

A  site  was  obtained  and  plans  drawn  for  a  new  office  building  in 
the  Borough  of  Brooklyn,  bounded  by  Willoughby  street  and  Fleet 
place.  This  structure,  when  completed,  will  be  the  first  office  building 
owned  by  the  City  used  by  this  Department. 

Books,  Blanks,  and  Stationery. 

All  printed  books,  blanks,  and  stationery  supplies  that  were  ordered 
on  the  annual  requisition  were  delivered  promptly  and  in  good  order, 
and  the  only  difficulty  experienced  was  in  the  storing  of  the  printed 
blanks. 

Increased  activities  in  all  branches  of  the  service  made  additional 
demand  for  books,  blanks,  and  stationery  supplies.  The  number  of 
special  requisitions  sent  to  the  City  Record  office  continued  to  be  very 
large  and  resulted  in  much  additional  work  for  this  branch  of  the 
office. 

The  annual  requisition  on  the  Board  of  City  Record  covering  printed 
blanks,  books,  and  lithographed  letterheads  and  envelopes  estimated  to 
be  required  for  use  during  the  year  1907  was  the  largest  requisition 


51 


of  this  character  ever  submitted  by  this  Department;  it  consisted  of 
1,310  forms  requiring  the  printing  of  almost  7,000,000  blanks  as  per 
the  following  schedule: 

Stationery. 


Boroughs. 


Manhattan. 
The  Bronx. 
Brooklyn.. 

Queens 

Richmond.. 

Total.. 


Forms. 

Books. 

Litho- 
graphed 
Blanks. 

Printed 
Blanks. 

Book 
Pages. 

Grand 

Totals 

for 

1907. 

485 
229 
242 

165 
189 

897 
49 

600 
8 
7 

610,500 
47,000 

123,500 
19,500 
13,500 

3,852,202 

410,970 

921412 

144,620 

96,859 

224,280 

12,250 

150,000 

2,000 

1,750 

4,686,982 
470.220 

1,194,912 
166,120 
112,109 

1,310 

1,561 

814,000 

5436,063 

390,280 

6.630,342 

Ordered 

in 

1906. 


3^)46,036 
213,883 

801,089 
81.136 
84,4*5 


4,226,569 


The  care  of  these  articles  has  been  the  subject  of  much  considera- 
tion during  the  past  year;  the  stock  rooms  were  filled  to  their  utmost 
capacity  and  the  additional  small  room  provided  was  not  sufficiently 
large  to  store  all  the  blanks  ordered.  The  result  was  that  blanks  had 
to  be  piled  on  the  floors  in  different  parts  of  the  building  where  they 
were  exposed  to  dust,  and  in  moving  about,  the  strings  in  some  instances 
were  broken  and  the  paper  covering  torn  and  some  of  the  blanks  thus 
became  scattered. 

In  view  of  the  above  facts  it  therefore  becomes  absolutely  neces- 
sary that  immediate  steps  be  taken  to  provide  one  large  storeroom 
with  a  capacity  large  enough  to  store  the  entire  amount  of  blanks  in 
compartments  arranged  according  to  form  number. 

On  February  i,  1906,  the  new  system  recommended  in  last  year's 
report  was  put  into  operation  which  consists  of  vertical  filing  cabinets 
in  which  samples  of  all  printed  forms  used  throughout  the  Department 
are  kept  in  alphabetical  order  between  folders,  and  supplemented  by 
a  card  index  showing  on  the  cards  the  receipt  and  distribution  of  each 
printed  form,  books,  and  of  all  stationery  supplies.  This  new  system 
is  a  great  success  and  the  records  are  now  kept  in  a  proper  and  sys- 
tematic manner. 

In  making  up  the  annual  requisition  the  new  system  was  of  great 
value  and  one  could  tell  at  a  glance  at  the  card  how  many  blanks  were 


52 

used  during  the  past  year  and  how  many  it  would  be  necessary  to  order 
for  the  following  year. 

In  previous  years  new  forms  were  ordered  printed  to  replace  old 
ones  for  any  borough  whose  officers  deemed  it  necessary  to  change 
these  printed  forms  and  the  result  was  that  each  borough  had  different 
blanks  in  use  for  the  same  purpose. 

This  has  been  remedied  by  referring  all  new  blanks  ordered  to  the 
Sanitary  Superintendent  who  will  hereafter  take  the  matter  up  with 
the  Assistant  Sanitary  Superintendent  of  each  borough  and  decide  upon 
a  uniform  blank  for  use  in  all  boroughs. 

Department  Drug  Store. 
The  cost  of  maintaining  the  Department  Drug  Store  room  for  1906 
was  $20,869.45,  $14,034.45  of  which  was  expended  for  supplies  and 
$6,835.00  for  labor. 

The  custom  of  mixing  tea  and  shipping  same  to  the  storehouses  of 
the  various  hospitals  was  discontinued  and  the  formula  sent  direct  to 
the  storehouse  where  the  tea  could  be  mixed  in  the  same  manner  that 
had  been  used  heretofore,  thus  eliminating  considerable  unnecessary 
labor. 

The  crowded  condition  of  the  cellar  used  by  the  drug  store  room  in 
the  basement  of  the  Clinic  Building  being  totally  inadequate  for  the 
purpose,  new  quarters  were  provided  at  No.  1 16  East  Forty-first  street, 
Borough  of  Manhattan,  the  two  upper  floors  and  cellar  being  used  for 
Ihe  accommodation  of  the  drug  store  room  while  a  garage  was  es- 
tablished on  the  first  floor  for  storing  Department  automobiles,  at  an 

annual  rental  of  $3,000. 

Storehouses. 

The  following  table  shows  the  work  performed  at  the  Storehouse 
established  at  the  Riverside  Hospital,  North  Brother  Island,  during  the 
year  ending  December  31,  1906: 

Requisitions  filled  by  storekeq)cr 4.29S 

Average  number  of  items  on  each  requisition 9 

Average  total  number  of  items  for  year 38,655 

Number  of  requisitions  drawn  on  headquarters 5^3 

Number  of  condemned  articles 3t^S5 

value  of  supplies  distributed $25»i92  13 


S3 

The  storehouse  system  having  proved  practical,  it  was  the  intention 
during  the  year  1906  to  install  a  storekeeper,  under  the  supervision  of 
this  office,  at  the  Willard  Parker  Hospital  after  the  completion  of  the 
storehouse  at  that  institution.  On  completion  of  the  storehouse,  how- 
ever, it  was  found  to  be  entirely  too  small  and  inadequate  for  the  needs 
of  the  hospitals  located  at  the  foot  of  East  Sixteenth  street,  conse- 
quently the  receipt  and  distribution  of  supplies  still  continues  under  the 
supervision  of  the  matron  of  the  hospital.  It  was  also  the  intention  to 
erect  a  storehouse  at  the  Kingston  Avenue  Hospital,  and  plans  were 
prepared,  but  have  not  as  yet  been  approved  by  the  Board  of  Health. 

A  storehouse  system  was  established  at  the  Tuberculosis  Sana- 
torium, Otisville,  New  York — this  being  a  new  institution  great  diffi- 
culty was  experienced  in  the  purchase  and  distribution  of  supplies,  the 
Sanatorium  being  located  a  distance  of  about  75  miles  from  the  City, 
the  nearest  place  where  supplies  could  be  obtained  being  either  Middle- 
town  or  Port  Jervis,  both  a  distance  of  about  eight  miles  from  the  in- 
stitution, and  it  was  almost  impossible  to  secure  the  services  of  com- 
petent help.  However,  notwithstanding  these  difficulties,  the  storehouse 
system  was  installed.  The  following  table  shows  the  work  performed 
during  the  year  1906: 

Requisitions  filled  by  storekeeper 1,300 

Average  number  of  items  on  each  requisition 7 

Total  number  of  items  averaged 9,100 

Estimated  value  of  supplied  distributed $20,000 

Requisitions  drawn  on  headquarters 100 

Number  of  articles  condemned 


Sale  and  Distribution  of  Department  Products,  Vaccine  Virus, 

Antitoxin,  Etc. 

There  are  in  operation  at  this  time  318  antitoxin  stations  in  the 

Greater  New  York,  divided  as  follows : 

Borough  of  Manhattan ^11 

Borough  of  The  Bronx 38 

Borough  of  Brooklyn 68 

Borough  of  Queens 27 

Borough  of  Richmond 8 


54 

Antitoxin. 

Value  of  antitoxin  received  from  laboratory $140,63465 

Less  antitoxin  to  replace  old  stock i5»o8o  70 

Free  distribution  $104,069  00 

Cash   17,386  37 

Discount  to  agents i^i  14  34 

On  sale  with  agents 2,170  24 

Stock  on  hand 814  00 

Virus. 

Value  of  vaccine  virus  from  laboratory $31,346  70 

Less  virus  to  replace  old  stock 4,518  65 

Free  distribution $14,969  50 

Cash   8^51  71 

Discount  to  agents 3,143  34 

On  sale  with  agents 141  05 

Stock  on  hand 322  45 


$125,553  95 


$125,553  95 


$26328  05 


$26328  05 


To  more  thoroughly  systematize  the  establishment  of  antitoxin  sta- 
tions and  to  ensure  the  fact  that  proper  facilities  for  the  storage,  sale 
and  distribution  of  the  laboratory  products  of  the  Department  will  be 
maintained  at  the  various  stations,  applicants  are  required  to  properly 
fill  out  the  following  form  or  statement  which  is  referred  to  the  in- 
spector attached  to  this  office  for  the  purpose  of  investigation  and  re- 
port and  a  verification  of  the  facts  stated  in  the  application  before  the 
usual  antitoxin  agreement  is  executed. 


55 


Department  of  Healtti 

OFFICE  OF  THE  CHIEF  CLERK 

Nkw  Vom,-       _ 


TO  THB  CHIEP  CLERK. 

Department  of  Health. 
DsAit  Sir: — Request  ii  bcteby  madefot  the  eaUbtiihment  of  a  station  for  tlw  ad* 
lod  fiec  distribution  of  tlie  laboiator;  products  of  the  Departmeat  of  Health,  said  prodnda 
to  be  received  on  coniignmeDt,  «nbject  to  the  stipulations  contained  in  a  writti 
to  be  bereafter  doly  signed  and  «x«ctlt«d,  npon  tbe  approval  of  tbis  applici 

STATEMENT. 


Locatioii  of   dmg   Store. . 

Qonra  of  Busuest:  Open 


Ftcilitiet  for   ttoring   prodticts  at 


;  CIosc__ .p.  m.,  d«nj.    Bxceptioi 

I   low  temperature 


WQ]  provide,  it  necessary,  metal   receptacle  (apprared   by  Itupector)  to  stoic  products 


neOhiea  for  disbursing   prodnc 
Proaiaity  of  nearest   station^ 


establiBhcd  befbre_. 


5« 


1 


V 


i 


3  £ 


n 


g 


» 


§ 


57 

About  May  i,  1906,  the  Research  Laboratory  instituted  new  grades 
and  prices  and  a  method  whereby  antitoxin  was  prepared  for  use  in 
syringe  containers.  This  required  the  installation  of  a  new  bookkeep- 
ing and  accounting  system  which  has  doubled  the  work  of  the  office, 
without  any  increase  whatever  in  the  clerical  force  which  was  promised 
when  the  system  was  installed,  the  clerks  being  required  daily  to  exceed 
the  official  office  hours  of  the  Department  to  complete  the  work  of 
the  day. 

The  change  in  the  various  grades  of  antitoxin  made  it  necessary 
to  notify  each  of  the  318  anti-toxin  stations  established  in  all  boroughs 
of  the  Greater  City;  accordingly,  the  following  circular  letter  was 
forwarded  for  their  information: 

"  Sir — ^Your  attention  is  directed  to  the  following  scale  of  grades 
of,  and  prices  to  be  charged  for  antitoxin,  approved  by  the  Board  of 
Health  at  a  meeting  held  April  18,  1906: 

"Grade  i — 1,000  units  (500  to  c.c.)  in  vials,  $1;  in  syringe  con- 
tainers, $1.25. 
"Grade  i — 2,000  units  (500  to  c.c.)   in  vials,  $1.75;    in    syringe 

containers,  $2.00. 
"Grade  2 — 3,000  units  (800  to  c.c.)  in  vials,  $2.50;    in    syringe 

containers,  $2.75. 
"  Grade  2 — 5,000  units   (800  to  c.c.)   in  vials,  $3.50    in    syringe 

containers,  $3.75. 
"  Grade  2 — 10,000  units  (800  to  c.c.)  in  vials  only,  $6;  (not  sold 
in  syringe  containers). 
"You  are  therefore  notified,  in  pursuance  to  sections  *  B  *  and  *  D ' 
of  your  antitoxin  agreement  with  this  Department,  wherein  the  right 
is  reserved  to  establish  new  grades  and  prices,  that  the  grades  and 
prices  referred  to  above  are  so  hereby  established,  and  you  are  re- 
quested to  return  to  our  collector,  who  will  visit  your  station  within 
the  next  ten  days,  all  stock  of  grades  previously  manufactured,  and 
cash  or  free-slips  to  the  amount  required  to  balance  your  account. 

"  Upon  settlement  of  your  account  the  collector  will  supply  you 
with  a  sufficient  supply  of  the  stock  of  the  new  grades,  and  you  are 
requested  under  no  circumstances  to  issue  any  of  the  old  grades  here- 
after. 


58 

*  You  will  observe  that  the  new  antitoxin  is  to  be  put  up  in  vials 
and  in  syringe  containers. 

*  No  charge  whatsoevo*  will  be  made  for  antitoxin  in  vials,  when 
issued  on  the  certificate  of  a  physician  to  the  effect  that  the  same  is 
intended  for  the  treatment  of  a  poor  patient  to  whom  the  payment  for 
the  same  would  be  a  hardship. 

'*  When  antitoxin  in  syringe  containers  is  issued  on  a  '*  free- 
certificate  *'  the  sum  of  25  cents  shall  be  collected  before  deliver>'  by 
the  druggist  to  cover  the  extra  cost  of  the  syringe. 

"  New  forms,  blanks,  etc,  will  be  forwarded  as  soon  as  printed. 

"  Respectfully, 

*'  Chief  Cerk.*' 

The  Inspector  attached  to  this  office  personally  visited  each  sta- 
tion, collected  the  old  stodc,  settled  the  account,  and  furnished  each 
firm  with  an  adequate  supply  of  stock  of  the  new  established  grades 
within  a  period  of  30  days. 

On  December  i.  1906,  a  new  system  of  keeping  the  hydrophobia 
treatment  accounts  was  installed  in  this  office,  whereby  the  Research 
I^boratorv  furnishes  a  written  list  of  all  treatments  sent  on  the  dav 
the  treatments  are  forwarded.  A  bill  is  also  mailed  to  the  purchaser 
from  the  Laboratory  with  the  first  portion  of  the  treatment  together 
with  a  notification  that  tmless  pajTnent  is  made  or  acknowledgment 
of  indebtedness  is  received  bv  the  Chief  Qerk  within  four  davs,  treat- 

m  m 

ment  will  be  discontinued.  At  the  expiration  of  the  time  specified  the 
Chief  Qerk  notifies  the  Laboratorv  to  continue  treatment  in  cases 
where  payment  has  been  made  or  indebtedness  acknowledged,  and 
to  discontinue  it  in  all  cases  where  no  reply  has  been  received. 

The  Laboratory  also  reports  each  individual  treatment  to  the  Sani- 
tary .Superintendent.  These  reports  are  forwarded  and  passed  upon 
by  the  Board  of  Health  and  are  then  filed  in  this  office,  thus  complet- 
ing the  record. 

Previous  to  the  date  above  mentioned  the  accounts  were  kept  at 
the  Research  Laboratory  and  returns  of  money  received  for  the  treat- 
ment were  made  semi-monthly  to  this  office. 


59 


The  contractors  completed  and  deiivercd  to  the  Depanment  the 
new    steamboat   "^  Rfierside.'*   wfakfa   was   pot    into  commission. 

This  mod^i  hospital  boat,  whidi  is  osed  for  the  transportation  of 
ccntagions  diseases,  is  126  feet  long,  jo  feet  wide,  and  9  feet  6  inches 
deep,  with  a  steel  hoD  and  two  dedcs.  the  wards  for  patients  being 
on  die  main  deck,  and  die  rooms  for  convalescents,  nurses,  and  quar- 
ters for  the  Commissioner  and  other  officials  being  built  on  the  upper 
deck.  The  boat  is  of  the  twin-screw  t>-pe.  having  two  compound  pro- 
pelling engines  and  a  water  tube  boiler. 

Bids  for  building  the  boat  were  (^)ened  on  March  i.  1905,  and 
the  contract  was  awarded  to  the  Burlee  Dry  Dock  Company  for  the 
sum  of  $68*473.00  on  March  20,  1905. 

Launch  *"  Pelham/' 

The  new  steam  latmch  "  Pelham/'  to  be  used  for  conve>'ing  pas- 
sengers and  visitors  to  and  from  Riverside  Hospital  and  the  Depart- 
ment dock,  foot  of  East  One  Hundred  and  Thirt>'-second  street,  was 
completed  and  put  into  commission  at  a  cost  of  $9,990. 

Tuberculosis  Sanatorium  at  Otisville. 

Title  to  this  propert}-  was  obtained  early  in  the  year  by  Tlie  City 
at  a  total  cost  of  $95,750,  payable  from  the  proceeds  from  tlie  sale 
of  an  issue  of  Corporate  Stock  of  $250,000  authorized  in  1905. 

Great  effort  was  made  by  the  administration  toward  the  perfect- 
ion of  arrangements  for  the  accommodation  of  patients  at  the  earliest 
possible  moment,  and  to  this  end  a  clerk  attached  to  this  office  was 
detailed  who  devoted  the  greater  portion  of  his  time  between  April  i 
and  August  23,  1906,  to  that  purpose  until  the  appointment  of  a  resi- 
dent superintendent  on  the  latter  date. 

During  this  period  a  civil  engineer  was  employed  who  completed 
an  outline  and  a  complete  topographical  map  of  the  property ;  a  firm 
of  landscape  architects  who  prepared  a  tentative  plan  for  its  improve- 
ment, laying  out  roads,  planting  trees,  etc.,  and  a  firm  of  sanitary 


6o 

experts  engaged  who  proceeded  with  the  installation  of  water  sup- 
ply and  drainage  systems. 

An  architect  was  appointed  who  prepared  plans  for  the  alteration 
of  existing  buildings  to  render  them  suitable  for  occupancy  by  patients 
and  help,  and  who  subsequently  prepared  plans  and  specifications  for 
the  construction  of  a  dining  hall,  an  administration  building  and  a 
dorniitorv. 

A  second  architect  prepared  plans  for  the  construction  of  two  shacks 
or  dormitories  for  patients  while  a  third  completed  plans  for  the  erec- 
tion of  a  cow  stable  and  a  dairy  building. 

Contracts  were  advertised  and  let  for  the  construction  of  two  shacks, 
a  dining  hall,  a  cow  stable  and  dairy  building;  for  the  delivery  of 
trees,  lumber,  cement,  pipe  fittings,  drains,  wooden  tanks  and  horses ;  a 
storehouse  mas  established  and  a  storekeeper  engaged  and  a  system 
of  accounting  installed. 

A  field  force  was  organized  who  cut  fire  lines,  made  roads,  built 
walls,  constructed  reservoirs,  repaired  existing  buildings,  laid  water 
and  drain  pipe,  planted  and  pnmed  trees,  planted,  cultivated  and  har- 
vested corn,  hay  and  potatoes  and  generally  improved  the  site  and 
buildings. 

A  domestic  force  was  organized  to  domicile  such  employees  as  re- 
quired maintenance  and  to  care  for  the  patients  while  a  physician, 
nurses  and  orderlies  were  appointed  on  the  medical  staff  of  the  insti- 
tution. 

Direct  telephonic  communication  was  established  between  the  Sana- 
torium and  Middletown  and  New  York,  necessitating  the  construction 
of  nine  miles  of  line. 

Great  difficulty  was  experienced  in  securing  domestic  help  and  in 
procuring  supplies,  the  nearest  base  being  Middletown,  eight  miles 
away,  but  ultimately  satisfactory  arrangements  were  made  for  the  daily 
delivery  of  food  supplies,  for  which  contracts  have  been  prepared  for 
1907. 

Difficulty  was  also  experienced  in  furnishing  and  equipping  the 
buildings  for  occupancy,  the  great  bulk  of  furniture  having  been  pur- 
chased according  to  law  from  the  State  Prisons,  whose  deliveries  were 
long  delayed. 


6i 

All  obstacles  were  eventually  overcome  and  the  Sanatorium  pre- 
pared to  receive  patients  by  July  i,  1906,  the  first  patients  actually  ar- 
riving on  July  15,  1906. 

The  cost  of  improvements  amounted  to  $93473-79  and  included  the 
erection  of  six  portable  buildings,  three  permanent  buildings  and  im- 
provements and  repairs  to  present  buildings,  cutting  of  fire  lines,  im- 
provement on  roadways  and  work  in  connection  with  the  proposed 
establishment  of  a  water  supply  system  and  the  purchase  of  396  i/io 
acres  of  additional  ground  at  a  cost  of  $26,500. 


Department  Hospitals. 

The  following  contracts  were  executed  for  the  construction  of  new 
buildings,  alterations  to  old  buildings  and  permanent  improvements 
effected  in  the  various  hospitals  of  the  Department  during  the  year 
1906,  as  hereafter  enumerated: 


Hospital. 


Willard  Parker.., 

Kingston  Avenue 

Riverside 

The  Bronx 

Otisville 


Contractor. 


{John  Spence,  Jr. 
Wm.  Home  Co. 


Christ.  Dooley 

Jas.  MacArthur 

E.  Rutxler&Co 

Jas.  MacArthur 

P.  J.  Brennan  &  Son 

.Dan.  J.  Ryan , 

J.  P.  Hansen , 

J.  M.  Knopp 

H.H.Vought  &Co. 
H.H.Vought  &Co. 
H.H.Vought  &Co., 
LKeUy&Kelley 


Construction  of 

Dormitory  Building 

Refrigerating  Plant 

Area  Walls 

Incinerator  Building 

Pipe  System 

Morgue  Building •  . . . . 

Measles  Pavilion 

Extension  to  Nurses'  Home. 

Repainting  Buildings 

(Alterations,  Bronx     Office 
(     Building 

Dining  Hall 

One-story  shack 

Two-story  shack 

Cow  stable  and  dairy 

Total 


Cost 


*3>994  00 
3»775  00 
4*934  00 
3,018  00 

26,881  00 

12,880  00 
183,000  00 

34,600  00 
2,460  00 

2,795  00 

9,668  00 

5,380  00 

9,678  00 

20,124  00 


13*3,187  00 


63 


Statement  of  Expenditure  of  the  Various  Hospitals  Controlled  by  this  Depart- 
ment During  igo6,  Showing  Total  Cost  of  Operation  and  Maintenance,  and 
Average  Per  Capita  Cost  for  Each  Hospital: 


Foods  and  Food  Supplies. . . . 

DrugSi  Instruments  and  Phar- 
maceutical Supplies 

Furniture   and   Supplies,  in 
eluding    Fuel,     Engineers* 
Supplies.   Telephone 
Charges,   Carpenters'    and 
Gardeners'  Supplies,  etc.. . . 

Clothing,  Boots   and  Shoes, 
Bedding,  etc 

Repairs  and  Improvements  to 
Buildings  and  Grounds 

Salaries 

Total 


Total. 


20,265  97 


83,2903a 
47,603  60 

8,677  20 
285,259  10 


1570,137  42 


Willard 

Parker 

and 

Reception. 


$26368  16 
4,637  92 


2S164293 
18,180  25 

1,241  86 
84,117  59 


Trachoma. 


«a,488  38 


8063a 


91484 
7,991  18 

"4  45 

23,128  86 


9160,688  71        198,262  03 


Riverside. 


154,29431 


6^7805 


35,731  ai 
I5,5a6  33 

6,54631 
92|Ooo  78 


12x0,976  99 


Kingston 
Avenue. 


•41,39038 
7»943  68 


21,001  34 
13,097  84 

76458 
86,0X1  87 


1170,209  69 


Average  daily  census  of  patients  for  1906. . . 
Daily  cost  per  capita  for  patients 


WiUard 

Parker 

and 

Reception. 


72.59 
I6.06 


Trachoma. 


X9. 
t4.07 


Riverside. 


2x0.29 
2.75 


Kingston 
Avenue. 


219.48 

2.12- 


t  This  cost  includes  the  treatment  ot  14,550  patients  at  the  two  Trachoma  Clinics. 

I  desire  to  state  that  the  excessive  cost  per  capita  at  the  Willard 
Parker  Hospital  is  due  to  the  fact  that  this  institution  was  closed  to 
patients  from  January  i,  to  March  15,  1906,  while  alterations  were 
being  made.  The  help,  however,  were  retained  during  the  said  period, 
v»rhich  explains  the  vast  difference  per  capita  cost  between  this  and  the 
other  institutions. 

The  individual  reports  of  the  Assistant  Chief  Qerks  of  each  bor- 
ough are  respectfully  presented  as  follows: 

Assistant  Chief  Clerk,  Borough  of  Manhattan. 
Report  of  the  work  performed  in  the  office  of  the  Assistant  Chief 
Clerk,  Borough  of  Manhattan,  for  the  year  ending  December  31,  1906. 


63 

The  following  official  reports,  communications  and  applications, 
summarized  and  classified  as  to  the  subject  matter,  were  received 
in  the  office  of  the  Assistant  Chief  Clerk  and  submitted  to  the  Board, 
through  the  Secretary,  for  consideration  and  final  action: 

Special  reports  and  communications  submitted  to  the  Board  of  Health 

for  action 715 

Premises  declared  a  public  nuisance 234 

Premises  ordered  vacated ' 100 

Lodging-house  permits  granted 144 

Cow  permits  granted 162 

Mercantile  permits  granted 14 

Miscellaneous  permits  granted 2,606 

Permits  denied 2,202 

Permits   revoked 5f886 

Board  orders  extended  or  modified 472 

Extension  or  modification  of  Board  orders  denied 583 

Board  orders  rescinded 1,195 

Delayed  and  imperfect  certificates  of  births,  marriages  and  deaths  ap- 
proved and  ordered  filed 2,914 

Corrected  certificates  of  births,  marriages  and  deaths  approved  and  or- 
dered filed 1,334 

Certificates  of  registration  issued  to  master  plumbers 793 


Orders  Issued  by  the  Board  of  Health. 

Orders  of  the  Board  for  the  abatement  of  nuisances  are  issued 
under  the  supervision  of  the  Assistant  Sanitary  Superintendents  in 
the  various  boroughs  upon  the  facts  and  evidence  contained  in  the 
written  reports  of  the  Sanitary  Inspectors,  the  result  of  personal  in- 
spection of  premises  complained  of.  These  orders  call  the  attention  of 
owners,  lessees  and  agents  to  the  violations  of  the  Sanitary  Code  and 
Health  Laws  in  each  case  and  require  the  necessary  alteration,  repairs, 
cleaning  and  improvement  of  the  premises  named  within  three  days 
from  the  receipt  of  the  order.  If,  upon  reinspection,  it  is  found  that 
the  requirements  of  the  order  have  not  been  complied  with,  a  suit 
for  penalty  is  commenced  against  the  delinquents  under  sections  1172 
and  1222,  chapter  466,  Laws  of  1901. 


64 


Summary  of  clerical  work  performed  in  the  various  boroughs  in 
connection  with  the  issuance  of  Board  Orders,  negative  reports  filed, 
and  fees  paid  and  certificates  issued,  the  result  of  searching  for  sani- 
tary violations  against  premises;  also  written  references  forwarded  to 
other  city  departments,  as  follows : 


Borough. 


Manhattan 
Brooklyn . . 
The  Bronx. 
Queens .... 
Richmond.. 

Total 


Board 
Orders 
Issued. 

Negative 
Reports 
Filled. 

References 
to  other 
Depart- 
ments. 

1 

Searches 

Made  and 

Certificates 

Issued. 

14,4" 

5.340 

2454 
1,560 

1,043 

7,427 
8,246 

1,824 

543 
252 

2,218 

2,416 

478 

257 
202 

2,799 
246 

460 

I 

24,808 

18,310 

• 

5,571 

3,506 

Communis 
cations  Re- 
ceived and 
Answered. 


2,468 

70 
266 


Fees 
Received. 


2,804 


$1,426  10 
123  00 
230  00 


50 


$1,77960 


Searches  and  Transcripts  of  Births^  Marriages  and  Deaths. 

Certified  copies  of  the  records  of  Vital  Statistics  as  may  be  found 
to  be  on  file  in  the  Bureau  of  Records  are  furnished  to  applicants 
authorized  to  receive  same,  namely,  interested  parties,  next  of  kin, 
legal  representatives,  etc.,  upon  payment  of  the  fee  in  such  cases  pre- 
scribed by  the  Board  of  Health.  Written  orders  are  signed  by  the 
Assistant  Chief  Clerk  in  the  various  boroughs  and  issued  to  the  Assist- 
ant Registrar  of  Records,  authorizing  the  search  and  issuance  of  a 
transcript  of  the  record,  which,  in  accordance  with  the  regulations 
of  the  Board,  is  authenticated  by  affixing  the  seal  of  the  Department 
of  Health,  and  attested  by  the  signature  of  the  Assistant  Chief  Clerk 
of  the  borough.  When  search  is  made  and  the  record  is  not  found  to 
be  on  file  an  official  certificate  is  issued  to  that  eflFect. 


6s 


Summary  of  applications  for  searches  made  to  the  Assistant  Chief 
Clerks  of  the  various  boroughs,  showing  fees  received  and  work  per- 
formed in  connection  with  searches  and  transcripts  of  the  records  of 
])irths,  marriages  and  deaths  on  file  in  the  Bureau  of  Records  in  the 
Department : 


Boroughs. 

Applicar 

tions 

for 

Searches. 

Transcripts  Signed  and 
Authenticated. 

Not 

Found 

Certificates 

Issued. 

Communi- 
cations 
Received 

Fees 
Received. 

Births. 

Marriages. 

Deaths. 

and 
Answered. 

Manhattan — 

Brooklyn 

The  Bronx — 

Queens 

Richmond .... 

23,83a 

"M35 

2.379 

995 

340 

2,230 

S16 

52 

38 

31 

2,367 

1,144 

107 

56 

14 

1 
i8f09o            2,727 

9,921    1      1,109 
2,734    :       1x5 

1,127      j            76 
329                 35 

5,960 

771 

163 
220 

295 

111,849  30 

S389  30 

1,190  60 

53500 

181  70 

Total 

38.981 

2.867 

3.688 

32,131 

4,062 

7,409 

119,645  90 

Written  Acknowledgment  of  Complaints  Received. 

All  mail  matter  addressed  to  the  Department  of  Health  is  carefully 
scrutinized,  and  those  in  which  complaints  are  made  relative  to  matters 
within  the  jurisdiction  of  the  Department,  and  giving  the  names  and 
addresses  of  the  authors,  are  promptly  acknowledged.  Those  re- 
quiring the  attention  of  other  city  departments  are  acknowledged  and 
immediately  forwarded  for  such  action  as  may  be  found  necessary. 

Statement  of  the  number  of  written  complaints  received  and 
answered  in  the  various  boroughs: 

Manhattan   5,437 

Brooklyn   2492 

The  Bronx 540 

Queens  1,106 

Richmond 684 


10,259 


66 

Money  Disbursed. 

Statement  of  the  disbursements  of  moneys  in  the  various  boroughs 
by  the  Assistant  Chief  Clerks  showing  the  total  and  the  amounts  in 
detail,  also  the  purposes  for  which  the  disbursements  were  made,  as 
follows : 


Borough. 


Manhattan 

Brooklyn 

The  Bronx 

Queens 

Richmond 

Totals 


Department 
Pay  Rolls. 


•677,99796 

199,736  97 

67,496  58 

47,459  76 

43,141  36 


$1,034,832  63 


Hospital 
Pay  Rolls. 


$101,211  07 

93»i75  99 
9a,757  58 


$287,144  64 


Postage 

Stamps  and 

Indcfental 

Expenses. 


$24,000  CO 

4,550  00 
1,250  00 

750  00 

300  00 


$30,850  00 


Assistant  Chief  Clerk,  Borough  of  Brooklyn. 

Report  of  the  work  performed  in  the  office  of  the  Assistant  Chief 
Clerk  during  the  year  ending  December  31,  1906. 

The  following  table  will  show  the  amount  of  vaccine  virus,  anti- 
toxin, mallein  and  tetanus  serum  which  has  been  sold  and  given  away 
free  to  inspectors,  physicians  and  institutions  for  the  year  ending 
December  31,  1906: 


Cash  sales 

Free 

Stock  on  hand.... 

Total 


Antitoxin. 


$116  25 

23,077  75 
892  00 

$24,086  00 


Virus. 


$118  84 

3.244  50 

143  25 

$3,507  09 


Mallein. 


$102  55 

4  20 
7  70 


iii4  45 


Tetanus. 


$16  00 

33200 

16  00 


$36400 


Tuberculin. 


67 

The  money  received  from  all  cash  sales  of  vaccine  virus,  anti- 
toxin, etc.,  also  for  searches  of  births,  marriages,  deaths  and  violations, 
is  forwarded  to  the  Manhattan  office  weekly.  The  following  shows  the 
exact  amount  forwarded  from  January  i,  1906,  to  December  31,  1906: 

1905-  1906. 

Account  of  searches  and  transcripts $5,522  40  $5,889  30 

Account  of  violations 75  00  141  50 

Account  of  antitoxin 93  34  116  25 

Account  of  virus 116  08  118  94 

Account  of  mallein 59  15  103  60 

Account  of  tetanus 11  00  1600 

Account  of  tuberculin 2  50               

Total $5379  47  $6,385  59 

1905.  1906. 

Number  of  orders  issued  for  transcripts 10,690  ii,437 

Number  of  orders  issued  for  searches  for  sanitary  vio- 
lations    150  283 

Assistant  Chief  Clerk,  Borough  of  The  Bronx. 

Report  of  the  work  performed  in  the  Assistant  Chief  Clerk's  Office, 
in  the  Borough  of  The  Bronx,  during  the  year  ending  December  31, 
1906: 

Ehiring  the  past  year  many  structural  improvements  and  alterations 
have  been  made  in  and  about  the  buildings  occupied  by  this  Depart- 
ment in  The  Bronx  at  a  considerable  outlay  of  expense. 

The  interior  of  the  building  as  now  arranged  is  entirely  different 
to-day  than  it  was  upon  our  first  occupancy  of  it.  The  several  offices 
and  divisions  are  properly  separated  and  partitioned  oflF  to  meet  the 
demands  and  requirements  of  the  working  force  and  general  public, 
and  to-day  we  have  one  of  the  most  complete  public  offices  in  this  City. 

The  entire  front  half  of  the  cellar  has  been  arranged  into  separate 
rooms  for  the  storing  of  the  records,  one  assigned  to  each  office  and 
division.  In  the  rear  half  of  the  cellar  has  been  fitted  up  a  sterilizing 
room  in  connection  with  the  Tuberculosis  Qinic. 

The  rear  part  of  the  first  floor  has  been  arranged  as  a  clinic  for  the 
free  treatment  of  people  suffering  from  tuberculosis. 


68 

This  room  has  been  subdivided  into  a  complete  series  of  rooms, 
properly  supplied  with  running  water  and  furnished  throughout  with 
the  regulation  hospital  furniture. 

During  this  year  we  have  instituted  a  system  by  which  the  sale 
and  free  distribution  of  Laboratory  products  is  carried  on  during  the 
hours  of  4  p.  m.  and  9  a.  m.  in  conjunction  with  the  day  hours.  Here- 
tofore we  experienced  some  inconvenience  in  not  being  able  to  supply 
the  public  and  our  inspectors  with  these  products  after  the  office  hours 
of  9  a.  m.  and  4  p.  m.  This  innovation  we  find  has  proved  very  bene- 
ficial to  practicing  physicians  and  the  general  public  at  large. 

Another  new  arrangement  which  I  have  instituted  in  this  office  is  a 
general  certification  of  telephone  calls  made  in  this  building.  A  record 
is  kept  by  our  telephone  switchboard  operator  of  every  call  made  and 
who  makes  the  call.  At  the  end  of  each  month  he  forwards  a  list  of  the 
calls  made  during  the  month,  and  by  a  series  of  certifications  we  are 
able  to  account  for  all  the  telephone  calls  made.  The  result  of  this 
arrangement  has  been  that  quite  a  sum  has  been  collected  throughout 
the  building  for  calls  made  for  personal  business.  This  will,  of  course, 
have  a  tendency  to  minimize  the  reckless  use  of  the  telephone  for  busi- 
ness other  than  official. 

Herewith  is  shown  in  detail  the  amount  of  laboratory  products  sold 
and  given  away  during  the  year  1906  as  compared  with  the  year  1905 : 

Antitoxin. 

1906.  1905. 

Amount  sold  for  cash $33  17  $21  45 

Amount  given  away 5»7S9  75  3^45  50 

Virus.  1906.  1905. 

Amount  sold  for  cash $28  09  $i9  77 

Amount  given  away 421  85  360  15 

Tetanus,  1906.  1905. 

Amount  sold  for  cash $10  00  

Amount  ghrcn  away 125  00  $14  00 

Tuberculin.  1906.  1905. 

pifh.* $100  

$0  50 


69 

Mallein. 

1906.  1905. 

Amount  sold  for  cash $1  75  

Amount  given  away 6  30  $0  35 

There  has  been  a  decided  increase  in  the  number  of  applications 
for  and  receipts  for  searching  of  the  records  of  Vital  Statistics  and 
also  for  sanitary  violations  pending  against  real  property.  The  fol- 
lowing comparative  table  shows  the  amount  received  for  these  two 
items  from  time  this  information  was  available  in  this  borough.  Prior 
to  the  year  1902  searches  of  the  records  of  births,  marriages  and  deaths 
were  conducted  in  the  Manhattan  office. 

Receipts  for  Searches  of  Vital  Statistics. 
1902 $293  20 

1903 689  90 

1904 1,000  20 

1905 881  40 

1906 1,190  60 

Receipts  for  Searches  of  Sanitary  Violations. 
1904 $171  00 

1905 259  50 

1906 265  50 

The  item  for  receipts  for  searches  of  Vital  Statistics  for  the  year 
1904,  $1,000.20,  and  the  decided  decrease  in  the  receipts  of  1905  is 
accounted  for  by  the  reason  of  the  destruction  of  the  steamer  General 
Slocum,  off  North  Brother  Island,  on  June  15  of  that  year,  in  which 
a  great  loss  of  life  occurred,  and  from  that  one  accident  alone  918 
certificates  of  death  were  filed  in  this  office.  From  most  all  of  these 
deaths  at  least  one  transcript  of  the  certificate  was  issued. 

Assistant  Chief  Clerk,  Borough  of  Queens. 
Report  of  work  performed  in  the  office  of  the  Assistant  Chief  Clerk 

during  the  year  1906 : 

Complaints. 

Citizens'  complaints  received 1760 

Citizens'  complaints  acknowledged i.044 

Citizens'  complaints  anonymously  or  personally  made 7^6 


TO 

Orders  and  References. 

Board's  orders  issued i,6oo 

Negative  reports  filed 497 

Communications  in  relation  to  orders  received  and  acknowledged 196 

References  to  other  Departments 269 

Searches  for  Violations. 

Searches  made  and  certificates  issued 

Communications  received  and  answered 

Fees  received 

Searches  and  Transcripts. 

Applications  for  searches 996 

Transcripts  signed  and  authenticated 1,100 

Not  found  certificates  issued 81 

Communications  received  and  answered 275 

Fees  received $509  20 

Requisitions  and  Bills. 

Number  of  requisitions  forwarded  to  Chief  Clerk 147 

Number  of  bills  checked,  certified  and  forwarded 476 


Assistant  Chief  Clerk^  Borough  of  Richmond. 

Report  of  the  work  performed  in  the  office  of  the  Assistant  Chief 
Clerk  during  the  year  1906 : 

The  report  must  necessarily  be  brief  by  reason  of  the  fact  that  the 
Board  of  Health,  at  a  meeting  held  on  March  i,  1906,  passed  resolu- 
tions relieving  the  office  of  the  Assistant  Chief  Qerk  of  many  of  its 
responsibilities  and  duties. 

No  doubt  the  items  heretofore  contained  in  the  reports  of  the  Assist- 
ant Chief  Clerk  have  been  embodied  in  the  annual  report  forwarded 
by  the  Assistant  Sanitary  Superintendent. 

During  the  year  three  hundred  and  seventy-four  (374)  transcripts 
have  been  authenticated,  subdivided  as  follows: 

Deaths 329 

Marriages H 

Births  31 

Collected  in  fees $181  70 


71 

AflScavits  of  four  hundred  parents  of  applicants  for  employment 
certificates  have  been  taken,  the  payrolls  for  the  year  amounting  to 
$38,393.88,  have  been  certified  and  bills  forwarded  to  the  Chief  Qerk, 
amounting  to  $4,077.18,  have  been  authenticated. 

During  the  year  just  closed  the  care  and  disposition  of  laboratory 
products  was  placed  in  charge  of  one  of  the  clerks  in  the  Sanitary 
Bureau. 

In  addition  to  his  regular  duties  the  Assistant  Chief  Clerk  has  been 
frequently  called  upon  to  issue  burial  permits  and  grant  removals  of 
bodies  from  hospitals,  both  at  the  office  and  after  office  hours,  and  at 
night  and  Sundays  and  holidays  at  his  residence. 

There  is  at  present  no  office  force. 


OFFICE  OF  THE  ASSISTANT  CORPORATION  COUNSEL  FOR  THE 
BOROUGHS  OF  MANHATTAN,  BROOKLYN,  THE  BRONX,  QUEENS 
AND  RICHMOND,  YEAR  ENDING  DECEMBER  31,  1906. 

Borough  of  Manhattan. 

Orders  received  from  the  Board  of  Health  for  issuance  of  notice  of 

intention  to  commence  action 6,845 

Notices  of  intention  to  commence  action  issued  and  served 6,845 

Other   notices   issued 825 

Orders  complied  with  after  issuance  and  service  of  notice 5,845 

Orders  complied  with  after  suit 443 

Orders  received  for  suit 464 

Civil  actions  commenced  to  recover  penalties  on  orders,  and  for  viola- 
tion of  Sanitary  Code 464 

Additional  actions  commenced  on  orders  after  failure  to  make  personal 

service  of  summons  on  defendants 8 

Other  civil  actions  commenced 30 

Civil  actions  pending  December  31,  1905 73 

Judgments  recovered  in  civil  actions  in  favor  of  the  Department  of 

Health   97 

Judgments  vacated  and  set  aside  by  order  of  the  Court 72 

Civil  actions  discontinued  upon  request  of  the  Board  of  Health 508 

Civil  actions  now  pending  (December  31,  1906) 21 

Judgments  docketed   34 

Executions  issued   59 


72 

Amount  of  costs,  penalties  and  judgments  collected  in  civil  actions  and 

paid  to  Secretar>'  of  Board ^^^ 

Amount  of  claims  collected  before  and  after  suit  for  antitoxin  and  virus 
furnished  by  the  Department  to  various  parties  and  paid  to  the 

Secretary  of   Board $35  66 

Criminal  actions  pending  last  year  in  Court  of  Special  Sessions I5 

Criminal  actions  commenced 3.4» 

Defendants  held  for  trial  in  Court  of  Special  Sessions 959 

Defendants  discharged  by  Magistrates 3^9 

Defendants  convicted  by  Magistrates 2,200 

Judgments  of  conviction  in  Court  of  Special  Sessions %7 

The  above  judgments  of  conviction  include  four  of  ten  dsLvs 
each  in  the  City  Prison,  one  of  which  iras  afterward  changed  to  a 
tine  of  $100,  and  also  six  of  a  fine  of  $I0D  each,  and  one  of  $150- 

Complaints  dismissed  in  Court  of  Special  Sessions 10 

Judgments  of  acquittal  in  Court  of  Special  Sessions 33 

Criminal  actions  now  pending  in  Court  of  Special  Sesstons  (December 

31.   1906> 54 

Fines  imposed  by  Court  of  Special  Sessions $11333 

Fines  imposed  by  Magistrates $4,163  84 

Appeals  by  defendants 3 

Appeals  withdrawn  by  the  defendant i 

Appeals  pending  ^.December  31.  1906^ 2 


Orxlw  rtvvixM^i  trv^^  ,he  Board  of  Health  for  issuance  of  notice  of 

im1^miv^n  Tv^  commencif  action 3,478 

N\Mk^  ot  isurmion  k-  cv%mroence  action  i^ssoed  and  serred 3,478 

Ofvler*  vvmpUc.1  xiith  before  and  after  suit 3,407 

Orxler*  rt\>ci»Ni  K>r  i^uit 

C^vil  avtkxns  c>>nm>^-.M  to  rtvvx^  penalties  on  orders.  aiMl  for  riola^ 

tHNw  01  Samiar>^  Code 

Ovil  actkHv.  vetMi,^  «V>e«Wr  3^100^5^.;*^.'^^.!!! 274 

Hriit  '^^ '^'^  ^  "^"'^  ""^^"^  ^  ^^"^  ^^  ^  De^ftmem  of 

Sl^r;:;:^':";'^^  ■"■  "*> * 

^••''^''•*  mu<d  ^ 

^   ■'     115 


73 

Amount  of  costs,  penalties  and  judgments  collected  in  civil  actions  and 

paid  to  Secretary  of  Board $i8o 

Criminal  actions  pending  last  year  in  Court  of  Special  Sessions 47 

Criminal  actions   commenced 404 

Defendants  held  for  trial  in  Court  of  Special  Sessions 404 

Judgments  of  conviction  in  Court  of  Special  Sessions 338 

Complaints  dismissed  in  Court  of  Special  Sessions 34 

Judgments  of  acquittal  in  Court  of  Special  Sessions 26 

Criminal  actions  now  pending  in  Court  of  Special  Sessions  (December 

31,   1906) 53 

Fines  imposed  by  Court  of  Special  Sessions $4*365 

Appeals  by  defendant 2 

Appeals  now  pending 2 

Borough  of  The  Bronx. 

Orders  received  from  the  Board  of  Health  for  issuance  of  notice  of 

intention  to  commence  action 1,037 

Notices  of  intention  to  commence  action  issued  and  served 1,037 

Other  notices  issued 285 

Orders  complied  with  after  issuance  and  service  of  notice 662 

Orders  complied  with  after  suit 154 

Orders  received  for  suit 175 

Civil  actions  commenced  to  recover  penalties  on  orders  and  for  viola- 
tion of  Sanitary  Code 175 

Civil  actions  pending  (December  31,  1906) 9 

Judgments  recovered  in  civil  actions  in  favor  of  the  Department  of 

Health    21 

Judgments  vacated  and  set  aside  by  order  of  the  Court 13 

Civil  actions  discontinued  upon  request  of  the  Board  of  Health 163 

Civil  actions  now  pending  (December  31,  1906) 13 

Judgments  docketed   12 

Executions  issued   15 

Amount  of  costs,  penalties  and  judgments  collected  in  civil  actions  and 

paid  to  Secretary  of  Board $54 

Criminal  actions  pending  December  31,  1905 

Criminal  actions  commenced 79 

Defendants  held  for  trial  in  Court  of  Special  Sessions 54 

Defendants  discharged  by  Magistrates 8 

Defendants  convicted  by  Magistrates 17 

Judgments  of  conviction  in  Court  of  Special  Sessions 50 

Complaints  dismissed  in  Court  of  Special  Sessions 2 


72 

Amount  of  costs,  penalties  and  judgments  collected  in  civil  actions  and 

paid  to  Secretary  of  Board $329 

Amount  of  claims  collected  before  and  after  suit  for  antitoxin  and  virus 
furnished  by  the  Department  to  various  parties  and  paid  to  the 

Secretary  of   Board $35  66 

Criminal  actions  pending  last  year  in  Court  of  Special  Sessions 15 

Criminal  actions  commenced 3*488 

Defendants  held  for  trial  in  Court  of  Special  Sessions 959 

Defendants  discharged  by  Magistrates 329 

Defendants  convicted  by  Magistrates , 2,200 

Judgments  of  conviction  in  Court  of  Special  Sessions 877 

The  above  judgments  of  conviction  include  four  of  ten  days 
each  in  the  City  Prison,  one  of  which  was  afterward  changed  to  a 
fine  of  $100,  and  also  six  of  a  fine  of  $100  each,  and  one  of  $150. 

Complaints  dismissed  in  Court  of  Special  Sessions 10 

Judgments  of  acquittal  in  Court  of  Special  Sessions 33 

Criminal  actions  now  pending  in  Court  of  Special  Sessions  (December 

31,   1906) 54 

Fines  imposed  by  Court  of  Special  Sessions $ii333 

Fines  imposed  by  Magistrates $4*163  84 

Appeals  by  defendants 3 

Appeals  withdrawn  by  the  defendant i 

Appeals  pending  (December  31,  1906) 2 

Borough  pf  Brooklyn. 

Orders  received  from  the  Board  of  Health  for  issuance  of  notice  of 

intention  to  commence  action 3*478 

Notices  of  intention  to  commence  action  issued  and  served 3>478 

Orders  complied  with  before  and  after  suit 3»407 

Orders  received  for  suit 492 

Civil  actions  commenced  to  recover  penalties  on  orders,  and  for  viola- 
tion of  Sanitary  Code 492 

Civil  actions  pending  December  31,  1905 274 

Judgments  recovered  in  civil  actions  in  favor  of  the  Department  of 

Health 136 

Judgments  vacated  and  set  aside  by  order  of  the  Court 45 

Civil  actions  discontinued  upon  request  of  the  Board  of  Health 567 

Civil  actions  now  pending  (December  31,  1906) 108 

Judgments  docketed  65 

Executions  issued  115 


73 

Amount  of  costs,  penalties  and  judgments  collected  in  civil  actions  and 

paid  to  Secretary  of  Board $i8o 

Criminal  actions  pending  last  year  in  Court  of  Special  Sessions 47 

Criminal   actions   commenced 404 

Defendants  held  for  trial  in  Court  of  Special  Sessions 404 

Judgments  of  conviction  in  Court  of  Special  Sessions 338 

Complaints  dismissed  in  Court  of  Special  Sessions 34 

Judgments  of  acquittal  in  Court  of  Special  Sessions 26 

Criminal  actions  now  pending  in  Court  of  Special  Sessions  (December 

31,   1906) 53 

Fines  imposed  by  Court  of  Special  Sessions $4*365 

Appeals  by  defendant 2 

Appeals  now   pending 2 


Borough  of  The  Bronx. 

Orders  received  from  the  Board  of  Health  for  issuance  of  notice  of 

intention  to  commence  action 1,037 

Notices  of  intention  to  commence  action  issued  and  served 1,037 

Other  notices  issued 285 

Orders  complied  with  after  issuance  and  service  of  notice 662 

Orders  complied  with  after  suit 154 

Orders  received  for  suit 175 

Civil  actions  commenced  to  recover  penalties  on  orders  and  for  viola- 
tion of  Sanitary  Code 175 

Civil  actions  pending  (December  31,  1906) 9 

Judgments  recovered  in  civil  actions  in  favor  of  the  Department  of 

Health    21 

Judgments  vacated  and  set  aside  by  order  of  the  Court 13 

Civil  actions  discontinued  upon  request  of  the  Board  of  Health 163 

Civil  actions  now  pending  (December  31,  1906) 13 

Judgments  docketed   12 

Executions  issued   15 

Amount  of  costs,  penalties  and  judgments  collected  in  civil  actions  and 

paid  to  Secretary  of  Board $54 

Criminal  actions  pending  December  31,  1905 

Criminal  actions  commenced 79 

Defendants  held  for  trial  in  Court  of  Special  Sessions 54 

Defendants  discharged  by  Magistrates 8 

Defendants  convicted  by  Magistrates 17 

Judgments  of  conviction  in  Court  of  Special  Sessions 50 

Complaints  dismissed  in  Court  of  Special  Sessions 2 


74 

Judgments  of  acquittal  in  Court  of  Special  Sessions i 

Criminal  actions  now  pending  in  Court  of  Special  Sessions  (December 

31,   1906) I 

Fines  imposed  by  Court  o*f  Special  Sessions $805 

Fines  imposed  by  Magistrates $22 


Borough  of  Queens. 

Orders  received  from  the  Board  of  Health  for  issuance  of  notice  of 

intention  to  commence  action 264 

Notices  of  intention  to  commence  action  issued  and  served 264 

Orders  complied  with  after  issuance  and  service  of  notice 193 

Orders  complied  with  after  suit 86 

Orders  received  for  suit 88 

Civil  action  commenced  to  recover  penalties  on  orders,  and  for  viola- 
tion of  Sanitary  Code 88 

Civil  actions  pending  December  31,  1905 21 

Judgments  recovered  in  civil  actions  in  favor  of  the  Department  of 

Health    16 

Judgments  vacated  and  set  aside  by  order  of  the  Court 2 

Civil  actions  discontinued  upon  request  of  the  Board  of  Health 66 

Civil  actions  now  pending  (December  31,  1906) 29 

Judgments  docketed   2 

Executions  issued   5 

Criminal  actions  pending  last  year  in  Court  of  Special  Sessions 3 

Criminal  actions  commenced 58 

Defendants  held  for  trial  in  Court  of  Special  Sessions 58 

Judgments  of  conviction  in  Court  of  Special  Sessions 19 

Complaints  dismissed  in  Court  of  Special  Sessions 33 

Judgments  of  acquittal  in  Court  of  Special  Sessions 4 

Criminal  actions  now  pending  in  Court  of  Special  Sessions  (December 

31,   1906) 5 

Fines  imposed  by  Court  of  Special  Sessions $510 


Borough  of  Richmond. 

Orders  received  from  the  Board  of  Health  for  issuance  of  notice  of 

intention  to  commence  action 265 

Notices  of  intention  to  commence  action  issued  and  served 265 

Orders  complied  with  after  issuance  and  service  of  notice 165 

Orders  complied  with  after  suit 104 

Orders  received  for  suit 114 


75 

Civil  actions  commenced  to  recover  penalties  on  orders  and  for  viola- 
tion of  Sanitary  Code • 114 

Civil  actions  pending  December  31,  1905 41 

Judgments  recovered  in  civil  actions  in  favor  of  the  Department  of 

Health  25 

Judgments  vacated  and  set  aside  by  order  of  the  Court 17 

Civil  actions  discontinued  upon  request  of  the  Board  of  Health 119 

Civil  actions  now  pending  (December  31,  1906) 28 

Judgments  docketed  33 

Executions  issued   25 

Amount  of  costs,  penalties  and  judgments  collected  in  civil  actions  and 

paid  to  Secretary  of  Board $67 

Criminal  actions  pending  last  quarter  in  Court  of  Special  Sessions 

Criminal  actions  commenced 16 

Defendants  held  for  trial  in  Court  of  Special  Sessions 14 

Defendants  discharged  by  Magistrates 2 

Judgments  of  conviction  in  Court  of  Special  Sessions 11 

Complaints  dismissed  in  Court  of  Special  Sessions 2 

Judgments  of  acquittal  in  Court  of  Special  Sessions i 

Criminal  actions  now  pending  in  Court  of  Special  Sessions  (December 

31,  1906) 

Fines  imposed  by  Court  of  Special  Sessions $165 


SANITARY  BUREAU. 

The  Sanitary  Bureau  of  the  Department  of  Health  is  under  the 
charge  of  the  Sanitary  Superintendent,  assisted  by  five  Assistant  Sani- 
tary Superintendents,  one  in  charge  of  each  borough. 

The  following  is  a  summary  of  the  operations  of  the  Sanitary 
Bureau,  which  is  charged  with  the  duty  of  inspecting  and  reporting, 
in  proper  form,  all  nuisances  or  causes  of  danger  to  the  public  health ; 
with  the  execution  of  the  orders  of  the  Board;  with  the  care  of  con- 
tagious and  communicable  diseases;  with  the  inspection  of  foods  and 
offensive  trades;  with  the  inspection  of  mercantile  establishments  and 
issuance  of  employment  certificates  with  the  pathological,  bacteriologi- 
cal and  chemical  research  and  investigations,  and  with  the  inspection 
of  scholars  attending  the  public,  parochial  and  private  schools. 


76 

The  number  of  inspections  and  reinspections  made  was  2,074,314, 
classified  as  follows : 

By  the  Division  of  Inspection 1472,204 

By  the  Division  of  Contagious  Diseases 516,916 

By  the  Division  of  Communicable  Diseases 82,744 

By  the  Division  of  Laboratories 2450 

Total  2,074^14 

The  number  of  complaints  forwarded  for  Board's  orders  was  2yyyyg, 
classified  as  follows : 

By  the  Division  of  Inspection 26,092 

By  the  Division  of  Contagious  Diseases 142 

By  the  Division  of  Communicable  Diseases 1,545 

Total  27,779 


The  number  of  complaints  received  from  citizens  was  45,911,  all  of 
which  were  referred  to  the  Inspectors  and  Sanitary  Police  for  in- 
vestigation and  report. 

The  Sanitary  Superintendent  during  the  same  period,  under  in- 
structions and  authority  of  the  Board,  granted  4,160  permits  to  dis- 
charge cargoes,  under  proper  vouchers  from  the  Health  Officer  of  the 
Port,  and  12,783  miscellaneous  permits  under  the  Sanitary  Code. 


71 

The  following  tabulated  statement  and  summary  shows  the  date, 
location,  cause  of  action  and  the  result  of  vacation  of  premises  by  the 
Board  of  Health,  in  compliance  with  the  requirements  of  sections  1176 
and  1299  of  chapter  466,  Laws  of  1901 : 

Borough  of  MaiUtaiian. 


No.  I    Date. 


I 
3 

3 

4 
5 

6 

7 

8 


II 

13 

13 
14 

IS 

16 


31 
X2 

»3 
24 
25 

96 

27 

38 

30 
31 


•r 


Apr.   4 

"       4 
May   9 


it 


9 
23 

23 

23 
23 
23 


Premises. 


10    ;  June   6 


I 


it 

tt 

tt 

H 

U 

n 


6 

13 

13 
13 

13 

«3 


No.  358  East  Fifty-first) 
street j 

No.  3S7  East  One  Hundred  ) 
and  Twenty-fourth  street  I 

No.  310  West  Thirty-fifth) 
street j 

No.  106  East  Eleventh  street.. 

No.  301  West  Twenty-third 

street 

No.  303  West  Twenty-third 

street *" 

No.  siSH  East  One  Hundred 

ana  Eighteenth  street.. . . 
No.  649  West  Fifty'4econd 

street 

No.  6si  West  Fifty-second 

street 

Southwest  comer  One  Hun- 1 

dred   and    Thirty-fourth^ 

street  and  Park  avenue. .  j 
No.  143  West  street 


No.  49  WilleU  street. 


17 

18    \    '* 


13 


371 


19      July  II 

30  "        II 


No.  75  Goerck  street 

No.  103  East  One  Hundred  ) 

and  Fourth  street  ) 

No.  104  East  One  Hundred 

and  Fourth  street 

No.  106  East  One  Hundred 

and  Fourth  street 

No.  108  East  One  Hundred 

and  Fourth  street 

Nos.  616-36  West  Fortieth 

street 

No.  105  Bowery 


"      18 

Aug.    I 

1 

I 

33 


t* 


(t 


Sept.  5 


ii 


it 


i* 


5 
5 


No.  17s  East  Houston  street. . 
Nos.  838-30  Seventh  avenue... 

No.  1S9  Third  avenue 

No.  S03  Canal  street 

No.  83  Park  Row i 

No.  144  West  street 

No.  343  East  Fiftieth  street. . . 

No.  465  Lexington  avenue 

Northwest  comer  Broadway) 
and  Hawthorne  street I 

Nos.  103-104  West  Forty-) 
seventh  street ) 

No.  15  West  Forty-second) 
street 1 


S     No.  306  Forsyth  street. 


Defective  plumbing  and  defective  . 

drainage 

Defective  phimbing  and  defective  , 

drainage 

Defective  plumbing 


Public  nuisance 

Nuisance 

Public  nuisance 


n 


II 


l( 


II 


It 


11 


II 


Result. 


1906. 
Complied  May    4. 


Defective  plumbing , 


u 


(( 


II 


Public  nuisance 

Defective  drainage. 
Public  nuisance 


II 


Defective  plumbing  and  defective  ) 
drainage f 

Defective  plumbing  and  defective  ) 
drainage j 

Defective  plumbing  and  defective  I 
drainage t 

Public  nuisance 

Defective  plumbing 


(I 


II 


Nuisance 
II 


Defective  plumbing 


II 


II 


t( 


II 


<< 


(I 


11 


i( 


({ 


i( 


<( 


t< 


u 


t( 


(i 


II 


II. 

Aug.  39. 
May  18. 
Aug.  39. 

"  29. 
June  36. 
Sept.  14. 

"     14. 

Nov.  33. 
July     9. 


ti 


k( 


5. 


5. 

'*  18. 
"  18. 
"     18. 


•'     18. 

Work  progressing. 

Complied  July  16. 

"     23. 

*'       Aug.  16. 

"       Oct.    18. 

"  "      10. 

Work  progressing. 

Complied  Oct.     a. 


i( 


(( 


(t 


{( 


10. 


12. 


Work  progressing. 

Complied  Oct.     4. 

"       Sept.  27. 

Work  progressing. 


78 


No.  31}  East  Fifteenth  street. 

No.  141  Uonioe  street 

No.  Sol  E»ll  Fifth  street 

Nos.  3aa-3u  Wert  Thirty- 1 

fourth  street I 

No.  SI  Eart  Ninth  rtnet 

No.  339  W«M  SiitMh  street.. 

No.  ;r,-Wliiie  street. 

Nos.  iio-Sio  Eist  Seventy- ( 

Nos.  ii^4a>  Broadway  and  ) 

No.  277  Canal  streei J 

No.  S7  West  Tenth  street 

No.  476  Ninth  aienue (front)- 
No.  747  East  Elerenth  street. 
Nos.  S70-S76 West  Broadwuy.. 

No.  5S  West  Third  street 

No^w    West    Fifty-fifth  I 

No.q  Rutgers  street 

No'i.   5I-5S    West   Ninety- 1 

No.  3S  East  Droadway  (rear). 
No.  txj  Vtit  Siity^eeond  I 

No.  84  Bowery 

No.  143  West  Thirty-second  I 

No*  ift?  Eait  Oiia'Hii^dred| 

No*"3a  Wes"  KfeHundred  I 
andThitty-eighthslrwt  f 

No.  liqWesi  Endavtnut.... 

South  of  Reade^treet.nonhl 
of  Duane  Urtet,  wtst  of  I 
West  street  anJ  east  of  f 
Wa-shinnlonrtreet I 

No.  >][  West  Elghty4ev-i 
enth  street f 

No^sw    liast    Thirteenth  I 

No.  I9i  Avenue  C 

No.   !I7   East    Thiiteenthl 

street t 

No.  i)f  Canal  street 

No.  14J  Division  street 

No.   Gio    East    Thirteenth  I 

No.  S07  Wert'Sbityiourth  1 
rtreet J 

No.  shAtcducC 

No.  438  BaU  Thirteenth) 
Street f 

No.  17  Cooper  square 


Defective  plumbing 

Nuisance 

Public  nuisance 

Defective  plumldog 

FubUc  nuisance 

Nulssncs 

Defective  plnmbtDS  and  defective  I 

drainage I 

Nuisance 

Defective  plumUng 

Defective  drainage 

Public  nuisance 

Effective  plumbing 

Public  nuisance 

Lack  of  water  supply 

Public  nuisance 

Defective  plumbing 

Public  nuisance 

Defective  plumbing 

Public  nuisance 

Defective  plumbing 

Public  nuisance 


Sept.96. 
Oct.  31. 


Work  progressing. 
Complied  Oct.  30. 


Work  progressing. 
Complied  Dec.  i. 
Work  progressing. 

Compiled  Dec.  14. 


Work  progres^ng. 


79 


No.      Date. 


68      Dec.  12 


TO 
71 

7* 

73 

74 

75 


(4 


12 

12 
12 

12 

12 

19 
19 


Premises. 


No.  442    East    Thirteenth! 
street f 

No.  155  First  avenue 

No.  216  First  avenue 

No.  3S7  East  Seventy-sixth ) 

street j 

No.  712    Eleventh    avenue  I 

(front) } 

No    712    Eleventh   avenue  I 

(rear). ( 

No.  413  East  Twelfth  street  1 

(rear) / 

No.  362  Seventh  avenue 


Cause. 

Public  nuisance 

i< 

.< 

Defective  drainage.. 

Public  nuisance 

It 

Defective  plumbing.. 


Result. 

1906. 
Work  progressing. 

Complied  Dec.  24. 

Work  progressing. 

Complied  Dec.  21. 

Work  progressing. 


u 


<( 


t« 


t( 


X 


Borough  of  Brooklyn. 


No. 


I 

Feb.  21 

2 

Mar.   7 

3 

Apr.  II 

4 

"     as 

s 

"     25 

6 

May    9 

7 

"      23 

8 

"      23 

9 

u        23 

10 

June    6 

fl 

12 

«3 

14 

15 

16 

17 
18 

■9 


21 
22 


Date. 


July  II 

Aug.  29 
Sept.  26 
Oct.  3 
10 


ft 

n 
({ 
It 


10 
10 

10 
31 
31 


Nov.  7 
'*      21 


Premises. 


Northwest  comer  Kingston) 
avenue  and  Rutlanaroaui/ 

Three  houses  west  of  Third! 
avenue  on  Cedar  lane. . . .  / 

No.  274  Twentieth  street 

North  side  Bay  Ridse  ave-) 
nue,  two  houses  west  of  > 
Ninth  avenue ) 

No.  17  McKibben  street 


No.  2421  Eighty-third  street.. 

No.  520  Eighth  street 

No.  S22  Eighth  street  

No.  524  Eighth  street 

North  side  Thirteenth  street^ 
between  Wythe  avenue ! 
and  Berry  street,  Kings  1 
County  Iron  Foundry. ...  J 

North  Eighth,    Ninth   and) 
Roebling  streets  and  No.  >- 
235  North  Eighth  street..) 

No.  2345  Eighty-third  street.. 

No.  57  Bay  Thirty-fifth  street 
No.  12  Grattan  street 


No.  599  Manhattan  avenue... 


No.  327  Blake  avenue 

No.  92  Meserole  avenue 

East   Eighteenth  street  be-) 
tween  Avenues  Y  and  Z..  / 

No.  60  Moore  street,  second 
floor 

No.  60   Moore  street,  first 
floor 

No.  31  Humboldt  street 

Nos.  1549-1551  Bushwick) 
avenue / 


Public  nuisance  . . . 
Defective  drainage. 
Nuisance 


Defective  drainage. 
Public  nuisance  . . . 


« 


Defective  drainage 

Public  nuisance 

Defective  drainage. 


It 


(( 


Public  nuisance 

Defective  plumbing 
Public  nuisance  — 
Defective  drainage. . 
Public  nuisance 


{ 


Result. 


1906. 

Complied  Nov. 

20. 

"       May 

31- 

"       Apr. 

19. 

**       June 

V- 

Work  progressing. 

Complied  Dec. 

31. 

((               u 

I. 

<(              (i 

I. 

((               n 

I. 

Extension  of    time 
granted  by  Board. 

Work  progressing. 

Vacated    Aug.  31. 
Work  processing. 
Vacated  Oct.  5. 
Work  progressing. 

Vacated  Dec.  26. 

Vacated  Nov.  10. 
Work  progressing. 
Vacated  Oct.  19. 
Work  progressing. 

(4  t> 


Vacated  Nov.  24. 
Work  progressing. 


Complied  Dec.  31. 
Vacated  Dec.  13. 


L 


^ 

h.w. 

^ 

:». 

- 

:x 

.!«..» 

:S 

- 

:x 

'«ia..x 

a 

- 

:x 

<«.  :m. 

— 

- 

:x 

««.  .9 

» 

- 

:x 

^.  3i 

» 

3*. 

- 

IV.   a  J 

-^ 

- 

» 

fci.  :a.-. 

■  npfni 


JT  ^ 


*i.       1 


8i 


Re»:t 


16 
S9 


!j 


raad,  400  iect   aoftb  id 


-        M  <   W« 


€f  One 


ll 
} 


31 

3s 


33 

34 


SesCiS"    Reeds  Mm 
•^    191    No«^  silk 

1        ene,  nt  boose  sooth  (rf 
Westdiester  a 

Sooth  side  Fenr  lane,  ist 
hOQse  cast    of    Eastern 

Booleraxd 

19!  Noffth  side  Tvo  Handredl 
aad  Tenth  street,  ad  . 
hoose  west  of  Elliot  ar-  f 

I       enne J 

19  North  side  Two  Hundred ) 
and  Tenth  street,  jd  I 
boose  west  oi  EUiot  zr-  \ 
enne J 

North  side  Two  Hundred  1 
and  Tenth  street.  4th  i 
boose  west  oi  Elliot  zr-  [ 
enne.. I 

East  side.Blondale  avenue,) 
yA  house  south  of  East-> 
Chester  road j 

East  side  Boston  Post  road,) 
north  oi  Fifth  avenue,  ^ 
Eastchester  ....•..•• .... 

Prospect  Park  Hill,  Pelham 
Bay  Park 

South  side  Rock  street  and 
Albany  Post  n»d 

Sooth  side  One  Hundred^ 
and  Forty-fifth  street,  ist  • 
boose  west  of  Wales  av- } 
enne j 


«9 


»     Oct  51 

3lK  ,  Not.  21 

I 
n  \  "     ai 

«>    Dec.  u 

41      "     19 


ti 


Defective  drainage 


« 


«( 


Public  nuisance . 


« 


«( 


(( 


Defective  plumbing 


pfied  Dec.  11. 
Sept.  10. 

Iu]\    11 


l>ec.  51. 

epc.  II. 
Work  progressing. 

Work  progressing. 


I    Vacated  Sept.  11 


.    Complied  Nov.  a$. 

i>ct.     a. 

\  Work  in  abeyance 
pending  construc- 
tion of  street  sewer. 


) 


Complied  Nov.  30. 
Work  progressing. 

Complied  Nov.  a6. 
Dec.     1. 


1. 

Kov.  aS. 

Work  progressing. 

i<  «• 


82 

Borough  of  Queetu. 


b  Central  avenue.  Coioaa. 
11:1  Smith  sireel.  Corona. 
No,  H7  BiienaVittn  ttrett.l 

"orona ( 

fli  Twelfth  «r«t,  Col-I 

East  side  Old  Fliishiiigniad, ) 
100  leet  louth  of  TitandJ- 
street         ) 

'io.  7  Emtna  str«t,  Metro-  ( 
polilan f 

fo.  n  lacob  place,  Jamaica.  - 

So    61  West  Amlly  street,! 

_^    Flushme..  ..     ( 

'"HoI.lanS'aYeiiSe'^..'?!.  f 

North  side  Eleventh  street,  \ 
JO   leel   eaat   of    Ninlh  I 

.renue.Whitestone ( 

Nojj   wW  Grove  street, 1 

FlushinK, ( 

I  North  side Tulton  streel.  too  ) 

feet  west  of  Maiden  Lane  f 
Twentieth  street,  near  Fifth  1 

avenue,  CQllege  Point...  f 
North  side  Fluihlnaavenue.j 

ingroad,  Maspeth ( 

East  side  Astoria  road  jwl 


rt'slSe  olI^Townt 
ing,  ido  feet  nortl 
■'—  -ivenue^M-  - 
old   Tow 


50  feel  north  of  lietts 


Maspelh.  . 
old  Town  L 


I   feet    1 


East  Bide 

Ins,   3!i-    — 

Betts  avenue.  Mupeth. 
lo.    5   Cedar    plan,  L.    i. 

South  tide'Metropoiiiin'av-' 
enue,  between  Newtown 
Creek  Utidge  and  Wood- 
ward avenue,  400  feet  west 
of  Bridge 

No.  418  Greene  street,  Evet- 
.  ewn I 

No.  ]»  FainnouBl  street, 
Everereen 

adjoining  Llbmy  Parkl^ 
Eyerereen J 

>Jorth  east  comer  Harmon) 
strwtandCovertavenue,^ 
Everereon I 

East  side  Ocean  View  av-i 
ining     Forest)- 


., 

,. 

„ 

., 

„ 

„ 

., 

,, 

,. 

„ 

„ 

., 

Complied  Mar.  14. 
Oct.     6. 


Work  prognsiing. 
Complied  June   6. 


83 


nuc,  zn  ieet  nottb  of  Ub- 

hIL™.".', ., 

-omer  Dry  Hariiin  andj-n-, 
niper  Swamp  roadt.  Mid- 
die  V  man. 

Zast  iiOeWitd  ttntt.fio, 
feel  Bocth  of  Libefty  a»e- 
nue.  Ridimond  Hit].  ...' 

toad.  one-i(uutei  mile 
west  of  railroad.  Rich- 
mond Hill 

So.  74  Chenr  itraet,  Brook- 
isiiHiJb.  . 

.\  «t  side  Dn 
feet  south   .. 
road.  Union  Ci., 

Eui  tide  Fixdick 


Rodiany  t 


of  Centra!) 

:l>ue.  (ilcndale I 

ipolaan  jwnue  oppo-) 
F  Helen   ttml.    Eul 

,    Centie  street  neatrock  road,  I 


Uoioo  CODIW  . . 


e.ClendaleParkI 


.1  Work  jitogreising. 
. '  Complied  July  13. 


ork  progressing. 

implied  Dec.  17. 

Work  prosreuing. 

,    Complied  July    3. 


Defective  drainage  .. 


No.    s     Railroad     avenue, 

!4o.  7  Railroad  arenue,  I 
RockawaT  Bead) 

bonier  jRckwn  avenue  and  , 
Riwson  itreet,  Long 
bland  City ' 

Weit  «ide  Columbia  avenue, , 
nonb  of  nllroad  Croat 
ins,  Maspeth ' 

NoctE  itde  Jockion  avenoe,  i 
SCO  feet  west  of  Newtown 
load.  Long  liland  Cit;. . 

West  side  Bowery  Bav  road, 
115  feet  north  of  Vande- 

^nd  Cit™.".*'. 

No.   71    Newtown  avstiue, 

Long  Island  City 1 

Real  3    No.  uf    " 

sticel,  Lofurb 
>Jo.    6g    FtaSlrfe.. , 

Long  bland  Clly j 

•lo.  ai;  Elm  itreet,  Longl 

Island  City | 

to.  II  Purvles  street,  Long  I 

Island  City 

Opposite  No.  6a  Frankfort  | 

str(«i.  I.oni  Ulind  Cilv.  1 
No,  4 


..  ud    Wl 

ns  Island  I 


-iCit,.,, 


No.  16  School  street   neaij 

Skillnun   annue,    Long 

Island  City 

No.  ii  Shermui  street,  Long 

Island  City 

No.  86  Marion  stmt,  Long 

Island  City 

No.    13]    Newtown    road. 

Long  Island  City 

No.  117  Park  place,  Long 

Island  City 

Potter  avenue  and  Crescent' 

street.  Long  Island  City. 
West  side  Hali  street,  400 

feel   north    of    Fluslling 

No.  133  Honeywell  street.... 

Comer  Seventeenth  street: 
and  Eighth  avenue,  Col- 
leaePdinl | 

SonlKwesl  comer  New  York] 
avenue  andFuHonstivet, 
Jamaica J 

No.  16  Fifth  stnet  north  of 
Woodside. 

Ho.  &>  Henry  ilRet,Winfiekl. 
19  Junction  ave..  Corona. 

No.  i3Grove street, Flushing. 

Ho,  103  Lake  street,  Corona. . 

No.  103  Grove  street.  Corona, 
e  street  and  Mlddlebuiii  I 
..renue,  Woodside Tf 

South  side  Elm  avenue  op., 
Mite    Forest      avenue, ! 


Defective  drainage 
Pnbbe  nuisance 

Defective  drainage 
Public  nuisance 


CoBidled  Atig.  11. 

"        Dec.  J. 

Aug.  7. 


Work  progressing. 
Complied  Dec.  17. 


Work  piogresiing. 
Complied  Oct.   11. 


Work  progressing. 
Complied  Sept.  b. 


Sept.  as. 
Nov.  It. 


Ho.  trao  Gnene  avcnoe, 
BIdsnood 

wnth  ddc  Elm  stieM  op- 
posite    Parc*t    aveaoe, 

Eut  u3e  Woodha*ea  ave- 
nue, lom  f«t  soulh  oi; 
pipe  line 

Ko.  n&i  MeltiipoUtaii  ave-^ 

Court  «feel  opposite 
Toledo  ivenue,  Newtown , 

UetTopoJitan  avenue  op- 
~o»ile  Helen  street,  Mel-! 

rlllsn 
ide  Court  stieel,  200, 
«t  west  of  Toledo  ive- ! 

mug  road,  700  feet  east) 
IJefferaon  avenue.  Ne»-| 

WhI    lidc '  Bet'ts' '  aveniie".  1 

lam  feel  nurth  of   Mas-) 

peth  avenue.  Maspeth...) 

Mo.  u  Butler  stieet,  Metro-) 

poiitan I 

Woodildc  near  Kelly  ave- ) 
nue.  Woodiide I 

Southweit  comer  Old  Brooli  I 
School  road  md  Debe- 1 
voiie   avenue,    Lsutelf 

HiU ) 

Tourt  dreel, opposite  Pros-) 
pert  street,  Ne«i  own ....  / 

Old  Brook Scfiool road,  near) 
Debevolse  avenue, Caurel  > 
HiU 1 

Twentrflflventh  street  nortbp 
of  Third  avenue.  College  V 

reland  Miu'road,"MUtli*oh 
Flushing  avenue.  Flush-  V 
ing 1 

I0.    sio    ColdsD     avenoe,) 

Nof '"^'"^'Sirend'  'i'r^V.  I 
Woodslde i 

Weil  side  Blaclutump  road, ) 
cne-haK  mile  north  of  > 
HilliLde  avenue,Jamaica. ) 

I0.  6oi  Seventh  avenue,) 
Cnlleee  Point ) 

East  side  Blackstumip  road.l 
about  one^iuatter  mile  [ 
north  of  HUlside  avenoe.  I 
Jamaica I 

No.  168  Sixteenth  avenue,! 
Long  Island  City I 

Mo.  i*i  Fourth  avenue.  I 
Long  Island  City ( 

HempMead       Turnpike,  V 

"sScSd  st™t"wood^d"  f 

Worth  side  Old  -South  road, ) 

about  100  feet  West    0/  1 

CentTevi]leaver;ue,  Aciue- 1 

duct I 

Fnlton  street,  near  l>alalina  I 


Defective  drainage. . . 
Public  nuisance 


,  Complied  Dec  10. 
"       Sept.  25, 

Oct.  10. 
,  Wofk  ptograadng. 
.    Compiled  Dec.  n- 

Oct.  J3- 

Dec.  s^. 
,  Work  progieulng- 
.    Complied  Nov.  11. 

Dec.  u. 
,   Work  progressing. 


.    Compiled  Dec.  1 
Work  progressin 

.  Complied  Nov.  i 
.!  '■       Oct.   J 

. ;  Work  progressini 
.  Compiled  Dec.  j 
.    Work  progressing. 


86 

Borough  of  Richmond. 


Noitli  side  lUchmond  road  I 

Necku-  avenue,  fourth  Ward. 
W«lt  side  Manor  road,  be) 

veen    Richmond  Turn  ! 

ike     and     New     Yolk  [ 

FtrM  pS«',STOond'Wirt  ".. 

Ii  sid«  Richmond  ave- 

iie,  Second  Wanl 

tola    and    SI.     Mary'. 

fpnuei,  RoMbuik 

.  tide  Ricliniond  M: 

(al  N'eiv  ftrigliton, 

WatchOBue  road,  near  , 

■iwbrook     road.     Third 

Vard 1 

Barker  ilml.  near  Cutie- 1 
-  in  avenue  First  Ward. .  / 

_hrlaea,  Third  Wird!"." 

We«I  aide  Manor  road,  neai 

TodI     Hill    road,    Flrsi 

iichtnoiid  Turnpike]  ei-il'oL 
Bulls  Head 

Hichmond  Turnpike,  be-' 
twoen  Wlllowhfooli  road 

West  side  of  Manor  road,' 

FlrM  Ward i 

South  side  Watchogue  road, I 

neat    Westerleilh,  First  S- 

Ward ". f 

.omer   Carey  avenue   andl 

Richmond  turnpike I 

Eail  side  of  Rldimond  ave- 1 

nue.  Springfield i 

South  side  Washinffton  ave- 1 

nue.  Third  WaiS J 

Amboyroad  neat  AnnadBle) 

road,  Filth  Ward J 

Sguth  side  Washington  ave-) 

nue.  Third  Ward f 

S(.fiii,i.eavenne.  Fifth  Ward.. 

-'     '"■■"'''"""] 

Shanota  line,  Fiflh  Ward.. 

:t.iiiL-i     L.ldii,.r    .mu    ludl) 

Hill  tuada,  Second  Ward  i 

South  side  VlrEiiii»»venue,l 

Fourth  Wai3 f 

Twelfth  street,  First  Ward... 
lea  VicwaTenue.Gaiietson., 
Lyman  avenue,  Fourth  Ward. 

Richmond   avenue.  Fourth) 

Ward ; 

Comet      Fingerboard     andj 

Richmond  avenue  n^'Eg^l 

bertville,  Fourth  Ward..) 

Ambov  road  nejr  New  Dorp,  I 

Fourth  Ward t 

:omer  St.  John's  avenue) 
and  Third  street.  Fourth  > 
Ward J 


Public  nuisaoce ;  Work  ptogrctHng. 

Complied  Nov.is. 

■  Wurlt  progressing. 

Complied  Mar.  30. 


,  W  ork  prc^TEising. 
.    Complied  Dec.  15. 


.  Work  progre&iung. 
.    Complied  Nov.  30. 

Feb.  33. 

Nov.  13. 
.  Work  progressing, 
.    Complied  Apr.  17. 


Work  progressing. 
.   Complied  Mat.  30. 


87 


35 

36 

37 

38 

39 

40 
41 
42 

43 
44 

45 

46 

47 
48 
49 
90 
51 
52 
53 
54 
55 
56 

57 
58 
59 
6o 

6i 

63 

64 

65 

66 

67 

68 

69 
70 


Feb.  28 
Apr.  II 


(( 


as 

-  2S 

-  2S 

May    2 


it 


2 
"      16 

June  13 
"      13 

July  II 

18 


({ 


t( 


i( 


Aug. 


it 


n 


18 
18 
18 
19 

I 
I 
I 
I 
I 
8 


Riverside  avenue,  Kreisch-) 
erville f 

Richmond  road  near  Fresh) 
KUlroad \ 

Sharrotts  road,  Fifth  Ward. . 

West  Side  Richmond  Turn-) 

pike.  Third  Ward f 

No.  4  Sherman  street,  Third) 

W^ard ; 

Clark  avenue  near  Amboy ) 

road,  Oakwood ) 

No.  342  Bay  street.  Second) 

Ward } 

West    Side    Davis  avenue 

near  Richmond  Terrace, 

First  Ward 

No.  250  Jersey  street,  First 

Ward 

No.  256  Jersey  street,  First 

Ward ! 

Britton  avenue,  Fourth  Ward. 

No.  25  Tyson  street.  First 

Ward 

No.  15  Brighton  avenue, 

First  Ward 

No.  31  Franklin  street  First' 

Ward 

North  side  Fresh  Kill  road, " 

Fourth  Ward 

Foot  of  Seguins  lane.  Fifth  \ 

Ward ....,..; 

West    side    Carey   avenue,  1 

Chelsea,  Third  Ward....  j 
6  Pine  street,  First  Ward 


Public  nuisance 


i( 


n 


(( 


Defective  drainage. 
Public  nuisance  .  . . 
Defective  drainage. 

Public  nuisance 


I  1906. 

■  Complied  Oct.  3. 

May  31. 
Work  progressing. 
Complied  Nov.  7. 

May  7. 
Work  progressing. 
Complied  July    5. 


•'       8 
Sept.  12 

19 


<i 


28  Canal  street,  Second  Ward 
235  Bay  street,  Second  Ward. 
8  Pine  street,  First  Ward 


t( 

«9 

Oct. 

24 

t» 

24 

it 

24 

31 

n 

31 

(t 

31 

41 

31 

it 

31 

(• 

31 

t< 

31 

} 


Foot  of  Androvette  avenue, ) 
Fifth  Ward / 

194  Broadway,  First  Ward 

Foley's  Grove,  Fourth  Ward.. 
Danube  avenue.  Fourth  Ward 

Belmont  place  and  Vine ) 
street,  First  Ward J 

Richmond  avenue,  near) 
Butcherville  road.  Third  y 
Ward i 

North  side  Manor  road, 
First  Ward 

Signs  road.  Third  Ward. . . . 

South  side  Richmond  Turn- 
pike, near  Castleton  cor- 
ners  

Catherine  street,  near  Rich- 
mond avenue,  Third 
Ward 

Pleasant  Valley  avenue,  Sec- 
ond Ward S 

Elm  street,  near  Castleton  V 
avenue,  First  Ward / 

West  side  Holland  avenue,  ( 
Third  Ward f 

No.  2  Holland  avenue.  Third  i 
Ward I 

No^  Holland  avenue,  Third  1 
ward j 


Defective  drainage. 


(I 


i( 


Public  nuisance. 


t< 


(( 


Defective  drainage 


<i 


Public  nuisance 

Defective  drainage. 
Public  nuisance  — 


ii 


Nov.  8. 
Work  progressing. 

;  Complied  Nov.  27. 

Aug.    I. 

Oct.  16. 

J* 
Nov.  17. 

Work  progressing. 

Complied  Dec.  15. 

Nov.  22. 

Work  progressing. 

I  Complied  Nov.  22. 

I  Work  progressing. 

I  Vacated  Oct.  18. 
I  Work  progressing. 

'  Work  progressing. 


Defective  drainage , Complied   Oct.  2. 


Public  nuisance. 


i( 


it 


it 


it 


tt 


tt 


Defective  drainage 


it 


(t 


Nov.  22. 

Dec.  18. 

•'     8. 
•'        Nov.  22. 


(i 


it 


8. 


Work  progressing. 


'( 


88 


No. 

71 
72 

73 
74 
75 
76 

77 
78 
79 
80 
81 

82 

83 
84 
85 
86 

87 


Date. 


Oct. 


i( 


a 


<t 


Nov 


31 
31 
31 
31 
31 
7 


i( 


(( 


(t 


i( 


(t 


7 

7 

71 

7) 


Dec.  26 


(( 


26 


Premises. 


No.  4  Holland  avenue,  Third  I 

Ward I 

No.  s  Holland  avenue,  Third ) 

No.  6  Holland  avenue,  Third  ) 
Ward f 

North  side  Washington  ave-V 
nue,  Third  Ward / 

West  side  Holland  avenue,  I 
Third  Ward f 

West  side  Holland  avenue, ) 
south  of  Richmond  ter-V 
race.  Third  Ward 

West  side  Holland  avenue, ' 
178  feet  south  of   Rich- 
mond     terrace.      Third 
Ward 

West  side  Holland  avenue,^ 
SSo  feet  south  of   Rich- 
mond    terrace,      Third 
Ward ^ 

West  side  Holland  avenue,' 
6so  feet  south  of   Rich- 
mond    terrace.      Third 
Ward 

West  side  Holland  avenue, 
67s  feet  south  of  Rich- 
mond terrace.  Third 
Ward 

West  side  Holland  avenue' 
700  feet  south  of  Rich- 
mond    Terrace,     Third 
Ward 

West  side  Davis  avenue, 
First  Ward 

North  side  Washington 
avenue.  Third  Ward 

Gordon  street  near  Pine 
street,  Second  Ward.... 

North  side  Washington 
avenue.  Third  Ward 

No.  192  Vanderbilt  avenue, ) 
Second  Ward ) 

No.  194  Vanderlnlt  avenue,  I 


Second  Ward. 


Cause. 

Defective  drainage  . 

it 


»( 


Public  nuisance  . . . 
Defective  drainage 


n 


t( 


It 


(i 


(( 


Public  nuisance 


(i 


i( 


Defective  drainage. 


Resah. 

1906. 
Work  progressing. 


t( 


tt 


it 


tt 


t( 


tt 


t( 


It 


tt 


tt 


tt 


t< 


u 


tt 


Complied  Nov.  31. 
"  Nov.  30. 
Woxic  progressing. 
Complied  Dec.  19. 
Woric  progressing. 


tt 


ft 


Summary  of  Premises  Ordered  Vacated  During  the  Year  1906. 

Number  of  premises  ordered  vacated  after  giving  notice 346 

Number  of  premises — work  complied  with 234 

Number  of  premises — work  not  complied  with 112 


Of  those  not  complied  with — 

Work  in  progress 

Time  for  compliance  extended  by  Board 


100 
I 


Work  not  in  progress — 

Premises  vacant  f 

Work  in  abeyance  pending  construction  of  sewer i 

Cows  ordered  to  public  pound I 


II 


89 


WORK    PERFORMED    BY    THE    DIVISION    OF    INSPECTION. 

Work  Performed  by  the  Inspectors. 

Number  of  inspections 1^)90,262 

Number  of  reinspections 59>396 

Total  number  of  inspections  and  reinspections 1,149,658 

Classified  as  to  Character  of  Premises. 

Number  of  tenement  houses I3f347 

Number  of  shore  inspections , 3»029 

Number  of  lodging  houses 1,502 

Number  of  priyate  dwellings 27435 

Number  of  mercantile  establishments 32,865 

Number  of  manufactories  and  workshops 13729 

Number  of  stables 13,077 

Number  of  sunken  and  vacant  lots 4,075 

Number  of  miscellaneous  (including  milk  and  food  inspections) 1,040,799 

Total    1,149,658 

Number  of  complaints  forwarded  for  Board's  orders 16,610 

Number  of  negative  reports  forwarded I3,499 

Number  of  specimens  of  milk  examined 138,729 

Number  of  specimens  of  milk  collected  for  analysis 9,540 

Number  of  quarts  of  adulterated  milk  destroyed 41 ,395 

Number  of  permits  issued 14,961 

Number  of  arrests  made 987 

Number  of  persons  held  on  bail 963 

Number  of  persons  discharged 17 

Number  of  pounds  of  milk,  fruit,  meat  and  fish  condemned  and  de- 
stroyed      18,276,385 

Mercantile  Establishments. 

Number  of  children  interviewed  applying  for  certificates 44,777 

Number  of  employment  certificates  granted 21,220 

Number  of  duplicate  certificates  issued 702 


90 

Number  refused  by  reason  of  insufficient  education 479 

Number  refused  by  reason  of  insufficient  tuition 1,637 

Number  refused  by  reason  of  insufficient  evidence  as  to  date  of  birth. .  1,113 

Number  refused  by  reason  of  physical  incapacity 5 

Number  of  applicants  under  age 864 

Number  of  applicants  over  age 699 

Total  number  refused 4797 

Number  of  complaints  received 148 

Number  of  complaints  returned  for  orders 1,032 

The  number  of  dead  animals  and  the  quantity  of  offal,  garbage,  etc.,  removed 
from  the  shore  front  by  the  Shore  Inspectors  was : 

Dogs    769 

Cats    370 

Rats    295 

Goats    33 

Sheep    80 

Hogs    18 

Calves    4 

Horses    14 

Fowls  450 

Total  number  of  animals 2,033 

s 

Fish,  number  of 274 

Offal,  pieces  of 267 

Meats,  pieces  of 1,081 

Bedding,  pieces  of 335 

Clothing,  pieces  of 428 

Mattresses,  number  of 447 

Human  bodies,  number  of 3 

IVork  Performed  by  the  Sanitary  Police. 

Number  of  inspections 285,201 

Number  of  reinspections 37,345 

Total  number  of  inspections  and  reinspections 322,546 


91 

Classified  as  to  Character  of  Premises. 

Number  of  tenement  houses 61,290 

Number  of  lodging  houses 2,061 

Number  of  private  dwellings 40,925 

Number  of  mercantile  establishments 3f725 

Number  of  manufactories  and  workshops 12,561 

Number  of  stables 23,719 

Number  of  manure  dumps 8,731 

Number  of  sunken  and  vacant  lots 1 1,096 

Number  of  miscellaneous 158.438 

Total    322,546 

Number  of  complaints  forwarded  for  Board's  orders 9,482 

Number  of  complaints  made  and  referred  to  Inspectors 984 

Number  of  negative  reports  forwarded 1 1,505 

Number  of  nuisances  abated  by  personal  effort 31. 141 

Number  of  visits  to  stop  work,  close  stores  and  premises  under  observa- 
tion on  account  of  contagious  diseases 4,089 

Number  of  ash  receptacles  removed  from  outside  stoop-line 17,466 


Number  of  arrests  made 3.442 

Number  of  persons  held  on  bail 845 

Number  of  persons  discharged 580 


WORK  PERFORMED  BY  THE  DIVISION  OF  CONTAGIOUS  DISEASES. 

Number  of  visits  to  cases  of  contagious  diseases 198,173 

Number  of  cases  visited  for  special  diagnosis 8.553 

Number  of  complaints  forwarded  for  Board's  orders 142 

Number  of  visits  to  tenement  houses 261.451 

Number  of  visits  to  hotels 636 

Number  of  visits  to  schools 1 16,126 

Number  of  visits  to  private  houses 44,793 

Number  of  visits,  miscellaneous 28,663 

Total  number  of  visits 451.669 


9» 

Number  of  pnaurj  Taccinationa 3&ASS 

Number  of  reraccmatioiu 88,448 

Number  of  vacdiutkxu  in  scbools 37,517 

Total  number  of  vaccinatioiu 152.4^ 

Number  of  certificates  of  Taccinatioo  issued 37,S4i 

Number  of  in^iectioas  of  stables  by  Veterinarians 7,631 

Number  of  animaU    examined 46^343 

Number  of  poct-roortcm  on  animaU 135 

Number  of  slandered  horses  coademned  and  destroyed I,ia8 

Number  of  perions  removed  to  f^ootagious  Disease  Hospital 6,230 

Number  of  dead  bodies  removed  to  Morgue 360 

Number  of  bouses  visited  for  disinfectioa 57.6t6 

Number  of  infected  rooms  disinfected 86>i74 

Number  of  times  ambulances  and  vehicles,  etc.,  disinfected 3,820 

Number  of  pieces  infected  goods  disinfected 101,718 

Number  of  pieces  infected  goods  destroyed 31, '94 

Total  number  of  visits Si6>9i6 


Number  of  DUeaset  Reporttd. 

Year  E»dmg  Dee 

31. 

V6. 

Borougfai 

a. 
IJ 

a 

1 
1 

1 

s 

1 

5 

t 

I 

1 

s 

5 

1 

S,aii 
iJS' 
617 

5*6 
■45 
7,M. 

i3,»»7 
3,005 
1,766 
l.7»9 

i,iS> 

171 

"9 

J4l 

4i 

a 

3 
14 

34,Mi4 

'Mi 

38,60 

1^4* 

4,«'7 

*,tn 

4» 

6 

70,60* 

- 

1X4 

I.0Q3 

_^ 

_1 

'j_ 

'^ 

Work  Ptrfontud  by  tht  Utdieal  School  Intftclors. 


Schoob. 

Number  of 

Viutsto 
Schools. 

Numbnsf 

Nambttcrf 

fsss 

P~Hl- «»'♦—>■ 

.3,006 
ah, 

4,3fc,M3 

Ji,70i 

»9,o74 

406 

74 
■M 

».~4.^1   C^—l. 

85 

ss,a.3 

).007,»44 

",8« 

TaU«  SkowMg  Dutatet  for  Which  Children  Were  Excluded. 


Sdiooli. 

, 

1 

{ 

1 

s 

1 

1 

1 

3! 

1 

•3W 

•= 

3 
•11 

13 

•60 

74 

3 

t.jai 

3 

7 

5,150 

* 

; 

3 

1.463 
16S 

1 

•583 
fa6 

•8 
t 

•6 

* 

•17 

•626 
6*) 

M75 

M 

475 

11,661 

AidSodelir [ 

406 
'!4 

Kiodersarten  Sdioals 

.4 

Total 

•- 

•fa 

♦3D 

■,» 

i,j»6 

5,S4S 

».I5S 

,M 

!08 

.... 
",845 

it,  diphtheria,  icailet  fevei  and  chicken-pox  marked  thaa  f). 


94 

IVork  Performed  by  the  School  Nurses. 

Number  of  visits  to  tenement  houses 4i>504 

Number  of  visits  to  schools 27,097 

Number  of  miscellaneous  visits i,597 

Total  number  of  visits 70,198 

Number  of  Cases  of  Diseases  Cared  For. 

Pediculosis 706,600 

Trachoma    180401 

Contagious  eyes  diseases 185,474 

Scabies  5,757 

Ringworm    18,235 

Impetigo    32,595 

Favus    2,342 

Measles    2,578 

Diphtheria    610 

Scarlet    Fever 1,525 

Miscellaneous 61,624 

Total  number  of  cases  treated 1,197,741 

Number  of  new  children  treated 88.902 

Number  of  examinations  of  children ^^ 3.119,815 

Number  of  exclusions  of  children 117 

Work  Performed  by  the  Summer  Corps. 

Number  of  visits  to  tenements 49.532 

Number  of  miscellaneous  visits 9*469 

Number  of  families  visited 350,618 

Number  of  children  examined  at  pier  for  St.  John's  Guild 39, 181 

Number  of  sick  treated 3,33i 

Number  of  revisits 1,655 

Number  of  primary  vaccinations 2,463 

Number  of  revaccinations 7,096 

Number  of  certificates  of  vaccination  issued i,i93 

Number  of  circulars  and  hangers  distributed i56wH9 

Number  of  ice  tickets  distributed 1,021 

Number  of  milk  tickets  distributed 2,627 

Number  of  St.  John's  Guild  tickets  distributed 9476 

Number  of  sunstroke  circulars  distributed 24,363 

Number  of  miscellaneous  circulars  distributed 10,747 


95 

Number  cf  \i?ii*  to  caisics-  ce : 

Scarier  fever 

Diphifacria 

Measles  

Manner  of  feedimg  560697  cioI-dTeai,  oDder  two  years.  i-iiiTei-d : 

Breasi-f cd  - 

Condensed  milk 

Loo^e  miik 

Modified  milk 

Paier.t  food 

Other  fettling 


9t5 
^610 


WORK   PERFORMED  BY  THE  DIMSIOX  OF  COMMUXIC 

DISEASES 

Number  of  new  ca^es  treaied  T*-i:h  diphtheria  antitoxin 

Number  of  curative  in;ectic>fii  given 

Number  of  cases  immunized  whh  diphtheria  amitoxin 

Ntmiber  of  cases  of  diphtheria  intubated   

Numbt r  of  diphtheria  inspections 

Number  of  living  cases  of  tuberculosis  investigated 

Number  of  dead  cases  of  tuberculosis  investigated 

Number  of  :>'phoid  fever  inspections 

Numl>cr  '-f  cerebro- spinal  meningitis  inspections 

Number  of  miscellaneous  inspections 

Total  number  of  inspections 

Ni:ml)er  of  original  complaints  forwarded  for  Board's  orders 

Numlier  of  fumigations  performed 


ABLE 


5.195 

28S 

12,014 

»OsJ35 
7kU>2 

4.J8.' 

.^.135 

45.55f> 

8j.r44 

1 .545 


y umber  of  Communicable  Diseases  Reported  Year  Ending  Dec.  31,  1906. 


Boroughs. 


c 
g 

s 
H 


Manhattan 12,693 

Brooklyn |  5»3*4 

TbeBronx ;  1,198 

Queens 603 

Richmond 367 


City  of  New  York... 


ao,o85 


> 
c« 

•a 

s 


221 

76 

a6 

23 
78 


424 


61.1 


679 
241 

72 
21 

1,032 


an 


On 


u      I        O 

< 


25 

28 
21 

24 
18 


S6 
6 


1 
•I 


(4 


116 


'       5 

1 
22 

1 

I 

i 
20 

1 

.. 

35 

68 

788 

626        I7.46Q 
85        10,736 

2,3Q> 
77S 


32,764 


i 


ivbos 

iS7 

t8j6ii 

IT  OK  Tin*-  j:  '  I  ■  I   mrffTi       .    .         6,105 

3^ijiiiw  '  a:  aBEBesEDB?  a:  ...  :,i;rx  '^mituv^                 iJSdS 


^anzKr  re  ur.rr  ir>f.iFca.  rrapTTi-^ri^  a:  jcsufcr-  i*t  liniAnWpi  ii.   25,416 

JSmnBer  ir  zssas  T:wmL  xr  ne  rm;  uiiWk'.nf  :aL                           9J03 

^xm^sr  n:  zaaes-  jmiul  tut  t*  le  ttc  riuiii.iir  ^              lAfiS? 

Xnzmer  ir  im  t*  fifTTpcal  asa|!nr^s&^  mitm  .^n^ It476 

476 


Xnzzner  re  mTir'&  ^akrr  l«^  Msdcau  SdaHL  T^ny  i"  i^ 410 

KmznKr  re  la/r-  iJintmi'  aaxnnacuis  ic  lyfmiii  iitbd  cbk  of  sib- 

j*K2t€  nnicmijass                                          2i<779 

ymrnig'  re  :uiir:iie  lairTlr  jjamL  .                6j^ 

yrrmftgr  it:  uiiiesLk  ^ariTr  ax  igmpc.^ M^997 

}<:rziM^  cf  fqwrTTTim^  cc  biKic  csaimxisc  inr  tcyftioid  itvts   leacrioe 

^TAlc*:  tfs      6.160 

Svsob^  cf  gyrfjiiinff  sie?naE  joscrrr  reaciar. M93 

K:2=Xft7  of  fgiecaniGs  ^i?«ii^  aieg^cm  rcaca^ 4«C^ 

Ktrciier  c/f  S9>ecme=s  ^Knnns  doaftxizL  Tcacban 5<% 

KtacVer  of  tptyinifTif  of  mine  ^**""'m*H  for  tjyhoid  fiiu 

^Dazoy  

Number  of  tftecimens  sSbcyiag  poszdre  reacbao 401 

Ntmiber  of  fpedmens  shoving  ntgaiirt  readioo 762 

Kumb^  of  tprciniCTis  shoving  doubtful  readioo 57 

Kumber  of  fpectmens  of  blood  ecammed  lor  malanal  ofganisaK it  198 

Stunbtr  of  malarial  organisms  fomd 122 

Number  of  mUzrial  oraginsms  not  foond ti076 

Number  of  specimens  of  cerebro-qnnal  floid  ^^ramwiH 6 

Number  of  positive 2 

Number  of  (negative 4 

Number  of  visits  to  collect  diphtheria  culture  tubes,  samples  of  s^utmB, 

etc 31^1 

Number  of  laboratory  preparations  made to^TSO 

Number  of  culture  tubes  prepared Vfi4^ 

Number  of  swafis  mudt 9Q/X)9 


97 

Nmnlxr  of  iputum  jan  prepared 18.665 

Nomber  of  Widal  otttfiu  pr^and 5,597 

Nmnber  of  Diazo  ootfits  prepared 1.370 

NnmbcT  of  maUria  ootfits  prepared 2,230 

Namber  of  cerebro-'pinai  menhigitu  ontfiti  prepared 350 

NmiAer  of  new  cases  treated  at  TabcrcnlosU  Clinics 4.1^ 

Nmnber  of  old  cases  treated  at  Tuberculosis  CUnics I7.3S3 

Nmnber  of  prescriptions  filled 36,839 

Nmnber  of  cases  recerriog  extra  diet t.oBi 

Nmnber  of  new  extra  diet  orders 0 

Nmnber  of  renewals  1-025 

Number  of  patients  under  observation  at  borne 1,503 

WORK  PERFORMED  BY  THE  DIVISION  OF  LABORATORIES. 
fVork  Performed  at  the  Vatcine  Laboratory. 

Nmnber  of  visits  to  teoenient  houses 3,061 

Number  of  miscellaneoas  visits 3^9 

ToUl  number  of  visits 2450 

Total  primary  vaccinations *  '33[ 

Ntunber  of  vaccination  certificates  issued i.730 

Number  of  specimens  of  vaccine  vims  tested  bacteriologically 89a 

Nomber  of  animals  vaccinated  77 

Number  of  animals  collected  from 77 

Number  of  grammes  of  vaccine  virus  collected 2,087-23 

Number  of  cubic  centimeters  of  liquid  vaccine  vinis  prepared 10.77' 

Number  of  spades  charged  with  humanized  virus +660 

Number  of  capillary  tubes  of  vaccine  virus  prepared 94.66o 

Number  of  small  vials  of  vaccine  virus  prepared 1A37 

Number  of  large  vials  of  vaccine  virus  prepared 7.030 

Number  of  mailing  blocks  prepared 124.76' 

Number  of  autopsies  on  animals 77 

Number  of  guinea  pigs  injected  with  vaccine  virus 187 

Number  of  other  animals  experimented  upon 10 

Work  Performed  at  Ike  Research  Laboratory. 

Number  of  bacteriolt^cal  examinations  of  old  culture  of  diphtheria 

bacilli   «' 

Number  of  inoculations  of  animals  with  toxins  for  development  of  anti- 
toxic substances  46i 

Number  of  animals  bled  for  antitoxic  serum 178 


98 

Number  of  cubic  centimeters  of  diphtheria  antitoxic  serum  produced. .     1,090,585 
Number  of  cubic  centimeters  of  diphtheria  antitoxic  serum  bottled  for 

distribution 260775 

Number  of  cubic  centimeters  of  tetanus  antitoxic  serum  produced 4»490 

Number  of  cubic  centimeters  of  tetanus  antitoxic  serum  bottled  for  dis- 
tribution    11,710 

Number  of  cubic  centimeters  of  mallein  produced 7400 

Number  of  cubic  centimeters  of  mallein  bottled  for  distribution 2,603 

Number  of  cubic  centimeters  of  tuberculin  produced aoo 

Number  of  cubic  centimeters  of  tuberculin  bottled  for  distribution 336 

Number  of  samples  of  toxins  tested 484 

Number  of  samples  of  antitoxic  serums  tested 1,212 

Number  of  disinfection  tests 8,337 

Pasteur  Treatment, 

Number  of  cases  receiving  Pasteur  treatment 323 

Number  of  injections  made  in  patients 6,290 

Number  of  inoculations  of  fixed  virus 359 

Number  of  cases  sent  to  Rhode  Island  Hospital  for  Pasteur  treatment.  10 

Diagnosis  of  Hydrophobia. 

Number  of  anima's  inoculated  for  diagnosis 92 

Number  of  animals  received  for  diagnosis 92 

Diagnosis  of  Glanders. 

Number  of  serums  tested 274 

Number  of  animals  innoculated 88 

Number  of  specimens  examined  56 


Number  of  bacteriological  examinations  of  water 87 

Number  of  bacteriological  examinations  of  milk  3i830 

Number  of  bacteriological  examinations  of  feces 2 

Number  of  bacteriological  examinations  of  urine i 

Number  of  miscellaneous  examinations — pneumonia  98,  hydrophobia 
260,  rabies  26,  diphtheria  cultures  for  virulence  14,  carcrum  oris  i, 
dust  (school  room),  i,  variola  6,  varicella  5,  bactericidal  test  i,  otitis 
27 f  meningitis  3,  scarlet  fever  tests  24,  measles  11,  vaginal  smears 
190,  pleurisy  i,  scurvy  i,  bottles  of  antitoxin  serum  tested  3,  carci- 
nomata  6,  bread  i,  abscesses  3,  malaria  3,  tuberculin  i,  typhoid  fever 
I,  agglutinations  17,  hydrophobias  tested  for  virulence  4,  anthrax 
cultures  87,  sera  tests  39,  experimental  rabies  4,  tuberculosis  sera  34, 
normal  sera  14 


99 

WORK  PERFORMED  AT  THE  CHEMICAL  LABORATORY. 

Number  of  reports  forwarded  and  filed I3>52i 

Total  number  of  analyses 13,022 


Classified  as  to  Character  of  Analysis, 

Number  of  acacia  (gran.) i 

Number  of  acetanilid  powder i 

Number  of  aconite  (tr.) 4 

Number  of  aconite  (fl.  ext.) 3 

Number  of  aconite  root 4 

Number  of  apple  butter i 

Number  of  alcohol  (absolute) i 

Number  of  alcoholic  liquors 17 

Number  of  aloes 7 

Number  of  ammonol  tablets i 

Number  of  atropine  tablets i 

Number  of  avisol i 

Number  of  bacon i 

Number  of  baking  powder 4 

Number  of  bauern  wurst i 

Number  of  barley  (patent) i 

Number  of  beading  oil i 

Number  of  beef   (spiced) 3 

Number  of  beef  pickles  5 

Number  of  beer  10 

Number  of  belladonna  (powder) 16 

Number  of  belladonna  root i 

Number  of  beans   2 

Number  of  beets   (canned) 1 

Number  of  blood  pudding 37 

Number  of  blood  wurst 13 

Number  of  blood  colors   6 

Number  of  bologna  302 

Number  of  blue  ointment 

Number  of  bismuth  subnitrate 

Number  of  borax   10 

Number  of  boric  acid  

Number  of  bovinine   

Number  of  bread    

Number  of  brandy  cognac  

Number  of  breast  fat 


lOO 

Number  of  buchu  leaves  5 

Number  of  buchu   (fluid  extract) 2 

Number  of  buchu  tincture  ► 5 

Number  of  butter  8 

Number  of  bull,  meat  flour i 

Number  of  calcium  chloride  i 

Number  of  calcium  hypophosphite i 

Number  of  calomel   2 

Number  of  candy   341 

Number  of  candy  coloring  15 

Number  of  candy  flavor i 

Number  of  cannabis  indica  (powd.  extract) 6 

Number  of  cannabis  indica  (fluid  extract) i 

Number  of  camphor  liniment  i 

Number  of  carbolic  acid  (crude) i 

Number  of  carbolic  wash  4 

Number  of  cascara  quinine  bro.  tablets i 

Number  of  cascara  sagrada  (fluid  extract) t 

Number  of  cascara  sagrada  (tincture) 5 

Number  of  catsup   10 

Number  of  celery  i 

Number  of  cerium  oxalate 4 

Number  of  cervelat  wurst  2 

Number  of  cherries,  preserved  i 

Number  of  chicken,  potted  i 

Number  of  chloral  hydrate  5 

Number  of  chewing  gum  i 

Number  of  chicken  feed  i 

Number  of  chloroform    3 

Number  of  chocolate  3 

Number  of  chocolate  syrup i 

Number  of  chow-chow   2 

Number  of    cider  6 

Number  of  cigars  2 

Number  of  cinnamon  2 

Number  of  citrate  of  magnesia  3 

Number  of  coal  53 

Number  of  coat  (for  oil  of  vitriol) i 

Number  of  cocoaine   3 

Number  of  cocoa  i 

Number  of  coca  leaves  2 

Number  of  codeine   5 


lOI 

Number  of  cod-liver  oil a 

Kamber  of  coffee   a 

Number  of  coffee,  liquid i 

Number  of  congo,  brown i 

Number  of  com,  camied  lo 

Number  of  colchicum  seeds  (powd) 7 

Number  of  colchicum  seeds  (tincture) 3 

Number  of  colchicum  seeds  (fluid  extract) 6 

Number  of  conium  (powd)  x 

Number  of  conium  maculatum  i 

Number  of  coloring  matter  3 

Number  of  coumarin    3 

Number  of  corned  beef  5 

Number  of  com  starch i 

Number  of  creme  de  menthe  (ess.) i 

Number  of  cream  (evaporated)  16 

Number  of  creams    163 

Number  of  cream  thickener  i 

Number  of  cremolin  paste  3 

Number  of  cylinder  oils  4 

Number  of  dagger  (presence  of  blood) i 

Number  of  deposit  from  grave  um i 

Number  of  digitalis  (tincture)   4 

Number  of  digitalis  (fluid  extract) 3 

Number  of  digitalis  (pulverized)   3 

Number  of  digitalis  (infusion)    3 

Number  of  drawer  containing  a  dry  residue i 

Number  of  tgg  (komo)    i 

Number  of  egg  substitute  (komo)   i 

Number  of  engine  oil    a 

Number  of  ergot  (powdered  extract) a 

Number  of  ergot   (crushed)    x 

Number  of  ergot  (fluid  extract)   9 

Number  of  ergot,  secale  comatum  2 

Number  of  essence  of  peppermint i 

Number  of  ether  2 

Number  of  Eureka  paste  i 

Number  of  experimental  analyses 1 18 

Number  of  extract  pure  almond  i 

Number  of  extract  bitter  almond 5 

Number  of  extract  clove i 

Number  of  extract  cinnamon  i 


k 


I02 


Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 
Number  o 


extract  coffee 

extract  Jamaica  ginger  . 

extract  lemon  peel  

extract  lemon  

extract  orange 

extract  pineapple 

extract  pistache   

extract  maraschino 

extract  strawberry 

extract  peach   

extract  raspberry 

extract  rose 

extract  sarsaparilla 

extract  vanilla   

extract  tutti  frutti  

fat  

fertilizer  (fresh)   

fertilizer  (screened)    . . . 

filler   

fish  (dried)   

formaldehyde    

fox  glove  (crushed) 

frankfurters   

Freeze  'Em  pickle  ...... 

fruit,  whole,  cherry 

fruit,  crushed  

fruit,  stock   

gelsemium  (fluid  extract) 
gelsemium  (tincture) .... 

gherkins  (pickled)   

gelatin   

gallic  acid 

glycerin   

ginger  ale  

ginger  ale,  fruit  essence. 

ginger  fruit  syrup 

ginger,  tincture  

glucose,  new  process. . . . 

grape  juice  

gum  kino 

ham  (pressed)  

ham  (potted)   


1 
5 

2 

34 
8 

7 
6 

I 
13 

2 
II 

5 

4 
aB 

I 

I 

I 

I 

I 

5 

4 
I 

244 

I 
I 

4 

4 
8 

3 
3 
3 

2 

3 

3 

I 
I 

z 
I 

a 

4 

3 
I 


I03 

Number  of  head  cheese 71 

Number  of  health  extract i 

Number  of  hemlock   (ground) 2 

Number  of  henbane  leaves  (ground) 4 

Number  of  henbane  fluid  extract i 

Number  of  henbane  powder  extract 2 

Number  of  honey    3 

Number  of  hyoscyamus  herb  i 

Number  of  hyoscyamus  tincture  4 

Number  of  hyoscyamus  fluid  extract 4 

Number  of  hyoscyamus  powdered  extract 5 

Ntmiber  of  hyoscyamus  leaves   2 

Number  of  hydrastic  root   I 

Number  of  horse  ball  3 

Number  of  horse  radish  i 

Number  of  hydrogen  peroxide  2 

Number  of  ice    i 

Number  of  ice  cream i 

Number  of  iodine  tincture  6 

Number  of  iodide  of  iron  pills 4 

Number  of  ipecac  (powdered)   11 

Nimnber  of  ipecac  root  (ground) 5 

Number  of  jalap    4 

Nimiber  of  Jamaica  rum  i 

Number  of  jam    9 

Number  of  jelly    8 

Number  of  knack  wurst  14 

Number  of  konserviring  saltze  2 

Number  of  kummell    i 

Number  of  landyaeger    i 

Number  of  lard  and  tallow  purifier i 

Number  of  lemon  paste  x 

Number  of  lemon  syrup  2 

Number  of  lemon  juice  2 

Number  of  lime  juice 4 

Number  of  lima  beans  (canned) ^ 

Number  of  liquid  from  wash  basin i 

Number  of  liquids   20 

Number  of  liquids  used  on  meat a 

Number  of  liquors  (alcoholic)   8 

Number  of  liniment  saponis  i 

Number  of  liverwurst    m 


Number 

Number  0< 

Number  ol 

Number 

Number  ol 

Number  ol 

Number 

Number 

Number  ol 

Number 

Number 

Number 

Number 

Number  ol 

Number  ol 

Number 

Number 

Number 

Number  ai 

Number 

Number 

Number  oi 

Number  ol 

Number 

Number  ol 

Number  ol 

Number 

Number  ol 

Number 

Number 

Number  ol 

Number  ol 

Number 

Number  ol 

Number  ol 

Number 

Number 

Number 

Number  ol 

Number 

Number 

Number  ol 


104 
liver  pudding  

lobelia  (fluid  extract) 

lobelia  tincture  

lobelia  (ground)    

lozenges  

malted  milk   

maple  syrup  

meat  (specked)    

metal  polish  

medicine    

magnesium  citrate  

magnesium  aperient  

milks   (adulterated)    

milks     unadulterated)    

milks   (condensed)    

milks  (human)    

milks    (special)    

milks  (komo) 

milks  (powder)    

milks  (sugar)   

milks  (white  cross) 

molasses  (canned)   

morphine    

mustard   

mustard  oil  

nitroglycerin  tablets  

nux  vomica  (fluid  extract) 

DUX  vomica  (tincture)   

nux  vomica  (ground) 

oil  (v^etable  komo) 

oils  (for  machinety) 

oils  (olive)   

oil  of  anise    

oil  of  gaultheria 

oil  of  pineapple  

oil  of  orange  

oil  of  lemon  

oil  of  raspberry  

oil  of  strawberry  

oil  of  wintergrecn 


3,gB4 
6^5 


I05 

Number  of  opium    29 

Number  of  opium  (pulverized)   2 

Number  of  orange  paste   i 

Number  of  orange  color 2 

Number  of  organs,  human  (in  jar) 

Number  of  oxalic  add   

Number  of  0x0  wash  powder 

Number  of  paint   

Number  of  paprika  fat 

Number  of  paprika  

Number  of  paraform    2 

Number  of  paraffin   i 

Number  of  pastrama    3 

Number  of  pepsin  (powdered) - .  10 

Number  of  peas  (canned) 12 

Number  of  peaches  (canned) 3 

Number  of  pessaries i 

Number  of  pepper  6 

Number  of  phenalgen    i 

Number  of  pile  oil   x 

Number  of  pills  4 

Number  of  pickles  5 

Number  of  plum  pudding x 

Number  of  potato  flour  (komo) i 

Number  of  peach  fruit  essence 1 

Number  of  pineapple  essence i 

Number  of  plaster  from  wall  (for  blood.) i 

Number  of  powder   (white)    3 

Number  of  preservatives  10 

Number  of  preservaline  3 

Number  of  pork  trimmings  i 

Number  of  potassium  bitartrate  2 

Number  of  potassium  iodide  3 

Number  of  potassium  nitrate i 

Number  of  potassium  hypophosphite i 

dumber  of  poultry  wash 3 

Number  of  rhubarb  (fluid  extract) 5 

Number  of  rhubarb  (powdered)    2 

Number  of  rhubarb  (tincture)   i 

Number  of  rhubarb  (canned)   2 

Number  of  Rochelle  salts  8 

Number  of  red  fruit  color 5 


io6 

Number  of  raspberry  fruit  essence i 

Number  of  raspberry  vinegar  * 

Number  of  salt  2 

Number  of  saltpetre 2 

Number  of  salt  solution  3 

Number  of  sandwich    

Number  of  salami 

Number  of  salad  oil  

Number  of  salmon  (canned)  

Number  of  sardines 

Number  of  senna  (tincture) 

Number  of  senna  (fluid  extract) 

Number  of  sausages  72 

Number  of  sausage  filler 

Number  of  scraping  from  finger  nails 

Number  of  semen  colchici 

Number  of  shortening  compound  (komo) 

Number  of  silver  nitrate 

Ntunber  of  soap  

Number  of  soda  

Number  of  sheeting  (hospital)  

Number  of  soys  

Number  of  sarsaparilla,  fruit  essence  

Number  of  sewage    

Number  of  shellac 

Number  of  spirits  of  camphor 

Number  of  snuff 

Number  of  steak 

Number  of  strawberry,  fruit  essence 

Number  of  strawberries,  canned 

Number  of  sugar  (granulated) 

Number  of  sugar  color  

Number  of  sugar  glucose  mixture 

Number  of  soap  liniment  

Number  of  smoked  beef 

Number  of  soup 

Number  of  soda  water 

Number  of  sodium  salicylate  

Number  of  sodium  sulphate 

Number  of  stomach  contents  

Number  of  stone  (bladder) 

Number  of  stramonium  leaves  (fluid  extract) 


I07 

Number  of  stramonium  tincture  

Number  of  stramonium,  sem.  tincture. 

Number  of  stramonium,  powdered 

Number  of  sodium  phosphate 

Ntunber  of  sodium  hypophosphite 

Number  of  sol.  glonoin 

Number  of  string  beans 

Number  of  strychnine  capsules  

Number  of  spinach  (canned)   

Number  of  squash  (canned)   

Number  of  tablets  

Number  of  tablets  (Chases) 

Number  of  tablets  (hypodermic)  

Number  of  tannic  acid 

Number  of  tea  (herb)  

Number  of  tomatoes  (canned)   63 

Number  of  tonic 

Number  of  tongue  (potted) 

Number  of  tin  pan  said  to  contain  blood 

Number  of  tripe  

Number  of  turpentine 

Number  of  urine 

Number  of  vanilla  bean 

Number  of  vanilla  tincture   

Number  of  vinegar  5 

Number  of  valerian  tincture   10 

Number  of  valerian  (fluid  extract) 6 

Number  of  van  lodeur  i 

Number  of  vomit  i 


Number  of  waters  (colored)  i 

Number  of  waters  (sanitary  anal.) 566 

Number  of  waters   (cellar)    34 

Number  of  whisky    18 

Number  of  wine 6 

Number  of  white  lead  

Number  of  Worcestershire  sauce 

Number  of  yellow  (coal  tar  derivative) 

Number  of  zanzarine 

Number  of  zinc  oxide 


t 

i 


Total  number  of  analyses 13,022 


io8 

Number  of  lactometers  tested 217 

Number  of  thermometers  tested  140 

Number  of  Babcock  Hasks  tested 142 

Work  Performed  by  the  Pathologist. 

Number  of  autopsies  (human) 8 

Number  of  autopsies  (animal) 2 

Number  of  bleedings  for  antitoxic  serum 319 

Number  of  cubic  centimeters  of  senun  prepared Ii704i975 

Number  of  injections  of  animals 662 


The  number  of  dead  animals  removed  from  the  streets  and  the  quantity  of 
ofifal,  etc.,  removed  from  the  markets  and  slaughter-houses  by  the  Contractors  was 
as  follows: 

Horses  21,640 

Mules 42 

Donkeys  5 

Colts 64 

Ponies 24 

Bulls I 

Cows 324 

Calves 970 

Sheep 3x5 

Goats   102 

Hogs  126 

Pigs 2 

Asses   X 

Bears   I 

Deers   I 

Cats  and  dogs  from  the  streets 101,329 

Cats  and  dogs  from  public  pounds 98*064 

Total  number  of  animals 223,011 

Offal,  barrels  of I9>i57 

Fish,  barrels  of 10,740 

Poultry,  barrels  of 1^96 

Beef,  quarters  of 311 

Veal,  quarters  of 1^71 

Squab  pigeons,  boxes  of 200 


I09 

Meats,  boxes  of 

Game,  boxes  of 

Pork,  boxes  of 

Meats,  assorted,  boxes  of 


REPORT  OF  PATIENTS  TREATED  AT  RECEPTION  HOSPITAL. 

BouuGB  OF  Mambattah. 

General  Statemtnl. 


1906. 

Hilei. 

Fenulei. 

Total. 

MatiT*. 

Foceip.. 

Total. 

pa^tl- 

Itaoaiidv  in  Hospital,  Decern- 1 
b-JL-W 1 

6 
i/aj 

W 

1^ 

1,338 

604 

i,94> 

S' 

I/W) 

m 

i,9S* 

>,lio 

604 

l.«J4 

70 
Si 

116 

73S 

J57 
".S31 
■SO 

IS3 

106 

104 
443 

*!7 
i,J3i 
'So 

1,019 

w 

>«« 

1,347 

»i 

i,«3l 

Remaining  in  Hospital,  Decern- 1 
ber  31. 11)06 t 

.. 

6 

16 

3 

'3 

16 

■ 

Remaining  in  Hospital  December  31.  1905. 


Age, 

NatiTO. 

Foreign. 

? 

4 

f 

i 

1 

i 

■3 

J 

1 

1 

J 

3 

3 

■ 

4 

■■ 

..  1  ., 

^ 

Total 

. 

= 

6 

5 

= 

= 

= 

= 

■ 

1 

no 
AdmiUtd. 


Age. 

NiMve. 

Fordgn. 



i 

■1 

i 

IS 

1 

S 

! 

1 

J 

t 

1 

'43 
3J1 

IN 
37 

6 

3 

3 

104 

48 

■3' 
1-3 

la 

I 
B 

30 

3 
IS 

33" 

i6 

37 

4' 

40 
Bj 
Si 

>S7 

(0 

3Sl 
4Bt 

Mumps 

■ 

' 

Br 

■^ 

■" 

' 

' 

Diphtheria,  scarlet  fever  uid  meula 

Diphlheriii,  »«rlet  fev«  md  pertuuii 

) 

u6 

8,6 

A^ 

!■» 

643 

6.. 
3« 

',n53 

.>4 

uf> 

<8 

M 

67 

3 

Bi 

7f) 

»s 

30 

i4 
14 

Diphtheria  , . . . 
Scarlet  fever.. 


Stnall-poa 

Varicella 

German  meailei 

Diphtheria  and  scarlet  fern. . 


Ak. 

Native 

Forelg 

1 

1 

1 

■2 

1 
1 

1 

I 

1 

J 

1 

1 

K  hth<riiL>»imeii»l« 

' 

■ 

I 

■ 

6 

6 

llEislraiiiidoriailla 

Diphtheria,  jcai1ellev«r  and  pertuuli 

n 

<* 

.' 

5" 

s. 

,„ 

37 

ifi 

63 

13 

4> 

»9 

i 

S" 

•S 

3 

■6 

iS 

» 

«3 

DipbthcHa 

Scarlet  fanr. . 


Viriolla 

Diphtheria  and  scarlet  fever... 
Diphtheria  and  measles 

Oiphtheria  ind  varicella 

KphUaria  and  pertussis 

StulM  fever  and  meailtts 

^Oiln  lever  and  varicella 

"euiciand  pettusiii 

Ucailei  and  varicella 

'^irtlheria,  scarlet  fever  and  it 
*"»»»WnlMi» 


Total.., 


"'luervalion... 


Age. 

NltiYB, 

Foreign. 

1 

1 

•s 

B 

1 
1 

1 

1 

1 

1 

S 

i 

i 

i 

> 

' 

5 

s 

3 
S 
3 

3» 

>3 

10 

3 
13 

3 

4 

] 

3& 

31 

M 

III 

Diphlheria.  scarlet  fever  and  measles 

99 

V 

ifi 

53 

49 

,» 

H 

'S 

40 

M* 

-""»"■■»•■ 

6 

• 

■ 

■ 

- 

. 

• 

• 

. 

S 

ifemiNtimjr  m 

Hospital  Dteember  31,  ISkC 

Dlnhlheri* 

3 

! 

■; 

S 

g 

CerebTMpinal  menlngit 

Tolai 

S 

■ 

6 

■ 

■ 

3 

» 

« 

■* 

■ 

■ 

3 

S 

■" 











"3 

RteatilulatiaH. 


31,  iW- 

Admitted. 

DlicbvKed 

TnuH- 
fetred. 

Died. 

Remsin. 

13.^i«r 

3',  i9ofi. 

1 

1 

1 

a 

1 

1 

lb 

1 

S 

1 

1 

1 

1 

1 

DibOieria 

J 

iS; 

«8 
.6 

8 
J 

13 

3 

34 

' 

»7 

8 
5 

17s 
30" 

138 
«70 

5 

13 

3 
6 

3 

S 

Sm.lH»« 

"""P*- 

Viriotlta 

PWlMriJ 

Gtrmanraautea. 

Diphtberiauid  aaiitt  ieni... 

IMlditlHuaiidmeulu 

IHpbtbertoaiidvailceUa 

D^ifathcilauidpeitiuils 

Scvktfemaiulineules 

SorictfenrindminUa 

Htasla  and  peituuii 

HcailaaadnricelliL 

Dipl^i^  «rkt  ferer  ^  1 

ei»odOT 

Tsbermlori. 

CtnteMpiul  menlDKilis 

■ 

• 

5 

B7 

SS6 

87 

" 

771 

,.. 

78 

64 

7 

r«oi««ti 

. 

86 

63 

34 

S 

» 

•S 

ai 

* 

' 

3 

'"-•^ 

■ 

114 

REPORT  OF  PATIENTS  TREATED  AT  THE  WILLARD  PARKER 

HOSPITAL.' 

Borough  of  Manhattam. 

Gtntral  Stattmtnt. 


tvA. 

Haks. 

Females. 

Total. 

Native. 

Foreign. 

Total. 

Accom- 
panying. 

490 

4li 

988 

W 

19! 

9SS 

^ 

M3 

3^9 

fill 
'9 

46S 

14 

6iS 

*35 

Total 

«. 

431 

87» 

69* 

"76 

Bti 

b 

Rem^ntng  in  Hospital  Decem-I 

„ 

67 

itb 

»4 

- 

lit 

0  March  u.  t9°6. 


Age. 

Native. 

Foreign. 

i 

i 

-^ 

1 

•s 

■2 

i 

1 

1 

1 

J 

^ 

1 

1 

ta. 

H 

573 

■8 

ITH 

isa 
6 

378 
«3 

37a 
17 

7S0 
40 

" 

.Sj 

93S 
S3 

jg 

3 

S9I 

139 

■ss 

401 

389 

790 

S9 

■« 

198 

9sa 

■ 

* 

3 

3 

3 

3 

311 

.69 

138 

... 

» 

3 

68 

8> 

ISO 

btS 

p    ymg 

. 

. 

3 

3 

3 

"5 

Trmuftrrtd. 


AgB. 

Kahw. 

Foreign. 

i 

i 

i 

1 

1 

1 

S 

1 

1 

t 

'i 

3 

• 

7 

,. 

" 

* 

tP7 

•> 

6 

"30 

» 

■^ 

■■ 

13 

- 

ta 

*9 

„ 

e 

IJI 

» 

.„ 

„ 

13 

M 

QS 

Remaining  in  Hospital,  Dec.  31,  igo6. 


ct  F««i 

Total  . 


40 

.B 

, 

» 

36 

56 

5 

^ 

9 

16 

" 

^ 

" 

17 

38 

3 

,. 

'3 

56 

*^ 

■> 

•■ 

S3 

« 

■ 

■< 

■■ 

Remaining 
Decembn 
3'.  "floS- 

Admitted. 

Discharged]      T™|j- 

Difd. 

Remain- 

1 

S 

1 

1 

1 

1 

1 

1 

B 

1 

1 

1 

1 

X 

1 

DiplitbBla 

464 

471 
»7 

2ft) 

I') 

t 

10 

.4< 

" 

ii 

40 

Stsil«F«»er 

49= 

49S 

* 

31 

1 

■43 

" 

« 

67 

A^wpuring 

REPORT  OF  THE  PATIENTS  TREATED  AT  RIVERSIDE  HOSPITAL. 

BcaocGB  <ff  The  Bbonx. 

Geiural  StatemtnL 


Uf£. 

Hals. 

FenBlM. 

To«aL 

Sithre. 

F<«i«». 

ToUL 

ASS. 

68 

956 

»,M4 

MSS 

>9 
J«9 

"7 

), 

■^ 

1^ 

1^1 

1^73 

*5« 

VJi 

J» 

lbs 

7SO 
19S 

*S7 

I,US 

4S0 
7S 

1.57S 
4S7 

' 

"^ 

«> 

»,0J» 

1.S04 

.- 

VJ" 

33 

1 

R«™Jniiw  In  Ho^til,  Dec.  31 

113 

76 

iw 

6t 

. 

». 

Jf^HMtMiMj  in 

Hospital  December  31,  1905. 

Ag«, 

Native.           |          Fotign. 

1 
1 

1 

s 

1 

1 

1 

1 

i 

1 

3 

1 

1 

i 

Dinblherii 

49 
6 

3 

< 

4 
t4 

3" 

u 

> 
■ 

so 

n 

10 
33 

»7 

■6 
'3 

SO 

"" 

■' 

■" 

" 

ToUl 

69 

3! 

K« 

7> 

40 

III 

At 

iS 

tt 

■ 

' 

' 

3 

' 

. 

. 

~ 

— 

* 

117 
Admitltd. 


Ag>. 

NXiw 

Fortigi 

11 

!l 

11 

1 

J 

i 

1 

a 

1 

1 

1 

114 
431 

lOi 

Si 
130 

m 

61 
»J6 

ISS 

164 

3 
86 

146 

1S4 
■3 

48 

37 

301 

336 
iS6 
16 

H3 

3» 
34 
Its 

8 
83 

51 

3 

3« 

8i 

*<> 

3 

V\ 

^^ 

H_.I- 

113 

Ifeuleiuuinilnlbi 

■ 

9M 

i* 

Wfi 

7S0 

n>s 

I.4SS 

3.8 

»5' 

S6, 

rti  r-« 

' 

s 

V 

' 

" 

M 

*> 

- 

34 

Diphtheri 

'75 

3? 
6 

84 
rt7 

» 
68 

J07 

133 

"5 

13 
6S 

■6S 
107 

8 

5 

3»< 
4<8 

S 
?8 

3. 
31 
'31 

7« 
8i 

6 

61 

3'S 
40s 

64* 

SorteK 

UeulB 

48 

140 

6a> 

S'>< 

170 

5S7 

S3S 

i,i»5 

»38 

2» 

4S= 

157s 

3 

6 

» 

3 

■4 

■7 

.7 

•* 

Died. 

i 

65 

335 

3 
3' 

9" 

60 

68 
36 
31 

6 

u 

•63 

•7 
MS 

S 
61 

37fl 

•8 

3 

■■ 
>3 

30 

3 

7 

31 

78 

' 

— 

' 

■ 

■ 

' 

.. 

RtmaintHg  in  Hospital  Dtcrmber  31,  1906. 


Age, 

Niti™. 

ro„,„. 

1 
1 

1 

5 

1 

i 

1 

1 

1 

1 

1 

I 

5 

S 

3 
19 

i 

'7 

lOJ 

'7 

8 

5 

3 
13 

u 

i 
33 

Totil 

>35 

30 

39 

>, 

« 

37 

iy> 

^"-^-^■« 

.. 

_!_ 

> 

S 

S 

December 
3",  '905- 

Admitted. 

Discharged 

Trans- 
ferred. 

Died. 

Semain- 
Ji.  1906- 

1 

1 

1 

S 

1 

1 

S 

1 

1 

S 

1 

1 

S 

43 

87 
6 
»7 

16 

1 

S 
>7 

S 

7a 

1 

4' 
60 

'3 

6S 

■87 

*3o 

t 
71 

1,06! 

187 

m 

39S 

76 

1)56 

>5S 

19a 
343 

163 

us 

Z 

7 

-34 

7S0 

69 

SI 

IS9 

^ 

' 

Diphtheria  and  toilet  fever. . . . 

DiphtheriaWmeulei 

Scarlet  ferer  and  measles 

Measles  and  varicelli 

s 

33 
7* 

_^ 

' 

j^ 

3 

iS 

' 



^ 

119 

REPORT  OF  PATIENTS  TREATED  AT  KINGSTON  AVENUE 

HOSPITAL. 

Borough  op  Brooklyn. 

General  Statement, 


1906. 

Remaining  in  Hospital  Decern- ) 
berji.igos } 

Admitted 

Total 

Discharged 

Transferred 

Died 

Total 

Remaining  in  Hospital  Decern-) 
31,1906. } 


Males. 


75 
M95 


1,570 


1,128 
127 
2iq 


1,474 


96 


Females. 

Total. 

Native. 

Foreign. 

Total. 

90 
1,418 

165 
2,913 

77 
1,121 

88 
1,792 

165 
2,913 

1,508 

3,078 

1,198 

1,880 

3,078 

990 
173 
248 

2,118 
300 
467 

853 

81 

190 

1,265 
219 

277 

2,118 
300 
467 

1,411 

2,88s 

1,124 

1,761 

2,885 

97 

193 

74 

119 

193 

Accom- 
panying. 


12 

360 


372 


341 
9 
I 


351 


21 


Remaining  in  Hospital  December  31,  1905. 


Diphtheria . . 
Scarlet  fever. 
Measles 


0) 


6 
20 

35 
Varicella i     6 

Pertussis 5 

Scarlet  fever  and  measles !     9 


Measles  and  pertussis. 
Measles  and  varicella. 


Total 


Accompanying 


2 
2 

85 


Age. 


o 


6 

25 
20 

5 

I 

3 

2 


62 


en 


O 


II 
7 


18 


II 


7 

23 
3 
5 
1 


40 


Native. 


a 

(Z4 


4 
19 
4 
3 
5 
I 
I 


yj 


o 


II 
42 

7 
8 
6 
I 

2 


77 


I 

5 

22 

I 


35 


Foreign. 


S 
-a 

a 

(X4 


9 

33 

2 

•  • 

6 

2 
I 

53 
II 


o 
H 


I 

U 
55 

3 

•  • 

II 

2 
2 

88 
II 


o 
H 


12 

50 
62 

II 

6 

12 

4 
2 


16; 


12 


I20 
Admitted. 


Dipblheria 

Scarlet  fever 

Smallpox 

ViriteUi 

Pertuisi) 

German  measles 

Diphlberia  and  scarket  fever 

Diphtheria  and  meaaleg 

IHphtheria  and  varicella 

EKphtherii  and  pertussis 

Scarlet  fever  and  measles 

Scarlet  feret  and  varicella 

Sculet  (ever  and  pertassls 

Measles  and  peitussis 

Measles  and  varicella 

Varicella  and  peitussis 

Humps  and  measles 

Measles,  scarlet  feret  and  varicella. 

Measles,  scarlet  fever  and  pertussis 

Measles,  varicella  and  pertussis 

Measles,  scarlet  fever  and  diphtheria 

Scarlet  fever,  pertussis  and  diphtheria... 
Typhoid  fever 

Total 

For  observation 


121 

DUchargid. 


Age- 

Native. 

ForeigT,. 

1 
1 

1 

1 

•2 

1 

1 

S 

1 

t 

1 

1 

1 

t 

DbAtberia 

44 
SO 

3 

107 

4! 

105 
78 

tofi 

176 

9= 

>67 
63 

iS 

7 

7 
6 

3 

S 

198 
343 

6i 
19 

■s 

16 

43 
6 

33 
83 
381 

t6 

48 
<4S 
833 

36 

S7 

It 

491 
98» 

9" 
77 

^ 

3* 

91 

IHpfatberiaaixlnrkelU 

' 

"9 

Scrtttferer,  diphtheria  and  pertuiils-... 

SciiletfeTei,  nieislesandpemiMis 

Htules,  Karlet  fever  and  varlcBlla 

Mnp) 

3 

* 

1,001 

7S8 

ya 

470 

38. 

8si 

6S6 

6(>S 

I^I 

v.. 

' 

^ 

■ 

' 

I 

.3 

S 

3 
3>3 

3^8 

*«mpM,,i„g 

M> 

122 
Trantferrtd. 


Age. 

Forein 

1 

1 

D 

1 
s 

1 

■s 

1 

1 
S 

1 

-a 

I 

1 

1 

i 

i 

Diphtheri 

'3 

34 

J 

6 

6 

6 
3 

i6 

77 

3 

'SJ 
A 

3 

3 

I? 

: 

^ 

DIphlherii  Md  pertiHsis 

■ 

, 

... 

6S 

,. 

Sa 

<i 

" 

9» 

"3 

..s 

«• 

■ 

3 

* 

' 

3 

3 

! 

"3 
Ditd. 


Age. 

N.tive. 

Foreign. 

1 
1 

1 

■s 

2 

1 

■e 

1 

1 

a 

j 

1 

s. 

1 

1 

s 

s 
■s 

1S6 

S 

3 
4 

S5 

'i 
b 

3 

By 

5* 

3* 

8 
>3 

Si 

3 

M 

16 

75 

3 

8 
IS 

■IS 

49 

■S6 

"» 

Adom     n  in 

■ 

' 

Remaining  in  Hospital  December  31,  1906. 

So 

107 

3» 
63 

3 
b 

'3 

iS 
34 

3S 
6 

U 

33 

S 

i6 

36 

69 

IT 

— 

" 

" 

" 

31,  KJOS- 

Admitted. 

Disdxarged. 

Kf. 

Died. 

Rem^- 

De^ber 
3>."**. 

i 

s 

j 

ill 

i 

J 

1 

S 

1 

1 

S 

j 

i 

s 

1 

Kphtberia 

aS 

37 

5 
i 

" 

•■ 

1 

I 

'93       »» 
*    ,3» 
7D     'to 
7f     1    34 

141 

543 
63 

t6 
4& 

ISO 

445 
A 

46 

13 
13 

s 

g 

«7 
87 

63 
3S 
87 

3 
6 

3 

66 
43 
9< 

8 

3 
16 

3 

8 
*7 
35 

7 

6 

98 

S 

3» 

c™,ii™. 

. 

' 

Typhoid  ferer 

«<""(« 

Dipbtbetiaand  Bwailes 

Diphtheria  and  varicella. 

Dipbthena  and  pertus^ 

Scvlet  fever  and  measles 

Scarla  ferer  and  pertDssii ... . 
Measles  and  pertusus 

- 
>! 

59 

3 
'3 

.J 

6 

Varicella  and  pertussU 

Mumps  and  measles. 

Scarlet  fever,  diphtheria  and 

scJEr^,-Wi;fe.-,M 

HeulSr^M '  liHi' '  ^'d 

*"^{,"^'^..^..'r: 

75 

^ 

!.«<> 

1,409 

i,iie 

986 

l»4 

■«8 

119 

148 

96 

« 

S 

■ 

335 

3 
J 

5 
6 

. 

'■ 

125 

DIVISION  OF  INSPECTIONS. 

Borough  of  Manhattan. 
There  are  two  classes  of  employees  in  the  Division  of  Inspections — 
the  clerical  force  and  those  who  perform  the  work  in  the  field.  This 
corps  is  composed  of  Sanitary  Inspectors,  the  Patrolmen  forming  the 
Health  Squad,  and  Inspectors  of  Foods  assigned  to  milk,  meat,  fruits 
and  fish.  Their  duties  and  their  relation,  one  to  another,  are  shown  in 
the  accompanying  table.  The  clerical  force  is  subdivided,  as  shown  in 
the  table,  and  assigned  to  duty  in  keeping  the  divisional  records  and 
performing  the  necessary  clerical  duties,  as  indicated. 

The  Sanitary  Inspectors  have  cognizance  of  and  are  responsible  for 
the  enforcement  of  all  health  laws  and  regulations  in  the  districts  to 
which  they  have  been  assigned,  in  all  premises  or  places  other  than 
those,  jurisdiction  over  which  is  given  by  law  to  the  Tenement  House 
Department 

The  duties  of  the  Health  Squad  are,  to  a  certain  extent,  the  same, 
cxcq)t  that  they  do  not  make  investigations  which  require  a  technical 
knowledge. 

The  Inspectors  of  Foods  perform  the  duties  appropriate  to  their 
titles. 

For  convenience  in  administration,  the  City  is  divided  into  districts 
of  reasonable  size.  Each  class  of  Inspectors  has  a  district  to  which 
he  is  assigned,  but  it  naturally  results  from  the  varied  character  of  the 
v;ork  that  the  district  boundaries  are  not  the  same  for  men  in  different 
classes. 

Sanitary  Inspection. 
The  complaints  which  are  assigned  to  the  Sanitary  Inspectors  for 
investigation  are  of  the  widest  range;  they  include  such  matters  as 
defective  drainage  and  ventilation,  lack  of  water  supply,  overcrowding 
in  lodging  houses  and  workshops,  nuisances  of  all  kinds  arising  from 
tlie  operation  of  factories  and  machinery,  the  ringing  of  church  bells, 
various  noises  caused  by  the  operation  of  public  conveyances,  com- 
plaints of  violations  of  such  portions  of  the  Labor  Law  as  the  Depart- 
Kent  of  Health  is  enjoined  to  enforce,  and  the  many  other  causes  of 
complaint  which  must  necessarily  exist  in  a  large  city. 


i 


126 

It  is  the  inspector's  duty  to  immediately  investigate  all  complaints 
which  are  referred  to  him  from  the  office  of  the  Chief  Sanitary  In- 
spector and  to  submit  a  report  of  the  conditions  found,  with  his  recom- 
mendation for  the  necessary  notice  or  order  to  be  issued,  compliance 
with  which  would  render  the  premises  complained  of  sanitary,  or 
would  cause  the  existing  conditions  to  comply  with  the  law.  After 
the  elapse  of  the  requisite  number  of  days  the  office  copies  of  the 
orders  and  notices  which  have  been  issued  as  a  result  of  these  recom- 
mendations are  referred  to  the  Inspector  for  reinspection,  to  ascer- 
tain whether  they  have  been  complied  with  or  no.  In  addition  to  this 
work  the  Inspectors  are  required  to  make  original  inspections  through- 
out their  districts  during  their  unoccupied  time,  reporting  any  im- 
proper conditions  which  they  may  observe,  and  submitting  recommen- 
dations for  their  improvement.  The  Inspectors  are  required  to  so  cover 
and  examine  their  districts  as  to  keep  them  in  as  good  condition  as 
could  reasonably  be  required.  The  District  Inspectors  also  investigate 
and  report  upon  all  applications  for  permits  which  are  issued  by  the 
Board  of  Health,  other  than  permits  for  the  sale  of  milk,  and  submit 
reports  either  recommending  that  the  permits  asked  for  be  denied  or 
granted.  Applications  for  modification  of  an  order  or  notice  or  relief 
from  complying  with  said  order  or  notice  are  referred  to  an  inspector 
other  than  he  who  made  the  original  recommendation  to  examine  into 
the  conditions  existing  and  report  as  to  the  propriety  of  granting  the 
application. 

In  those  instances  where  the  conditions  are  dangerous  to  life  or 
detrimental  to  the  health  of  either  the  occupants  of  the  premises,  or  of 
neighboring  ones,  unless  work  to  comply  with  the  orders  of  notices  is- 
sued by  the  Department  of  Health  is  begun  within  a  reasonable  time, 
the  premises  are  examined  by  the  Qiief  Sanitary  Inspector,  who,  upon 
verification  of  the  reported  conditions,  reports  the  facts  to  the  Assistant 
Sanitary  Superintendent,  who,  in  turn,  certifies  to  the  Board  of  Health 
that  the  conditions  are  dangerous  to  life  or  detrimental  to  health,  and 
recommends  that  the  premises  be  ordered  vacated  or  that  the  condi- 
tions existing  be  declared  to  be  a  public  nuisance.  During  the  past 
year  this  action  was  taken  in  the  following  instances,  with  the  results 
indicated : 


127 

Premises  Ordered 

Vacated. 

PnmlMS. 

Date  Complied  With. 

April  4.1906 

1  "fe^^S^  "  ""^  "^  ■'^^"^  ( 

May    14.  ,w*. 

"       *    " 

"     ft   " 
"    "J,   " 

Aug.  30.    " 

Sept,   t.    " 

No».J0i-JD3We«tT«!iity-thirdsttert..., 

"    0.   •' 

Nos.  &19-651  Wot  FottT-wcond  street.... 

"      18,   " 

"    «J.   " 

/No.    5iS«    EMt   One   Hundred  aadl 

June  1&,    •' 

J™    6.    " 

Ho.  143  West  street 

Julj     1,    '• 

•■    13.    " 

No.  to  East  One  Hnndted  and  Fourth 

"      «3.    " 

N^ioj  EM  biie  Hui^d;^  and  Fourth 
No.  io6EirtOiVHiiiidiid'iiriF<^'h 

"    13.    " 

"      n.    " 

"    13,    " 

sbeet f 

"      aj,    " 

J*  11,    " 

"      16,    •■ 

No-toPaAiow 

..      ,     .. 

Oct.    19.11106. 

.. 

.. 

s^.  s,  ■• 

•  Northwest   comer   of    Broadway   and) 

Not  complied  with.   (Vacant 

Dec.   »9.i9o6. 
Oct.    ij,    '■ 

.. 

,. 

"     5.   " 

Nm.  101-104  West  Forty-5e»enlh  street.. .. 

"        S,    " 

"   11,   " 

)  Nos.  418-413  Broadway  and   No.  177  1 
{     CarSlSwUt "t 

"       »9,    " 

Noi.  3»o-3i»  West  Thirty-lourth  ilreet.. . . 

Order  rescinded  Oct.  11. 1906. 

"   n,   " 

No.  310-310  East  Seventy-fifth  street 

Oct.     3.1906. 

"  i»,   " 

No.  4f«  Ninth  avenue 

Not.     I,    " 

■'      '9,     " 

"    3,    " 
"    3.   " 
"     3,    " 

-      17      " 

128 


Date  of 

Issuance  of 

Order. 

Oct. 

241I906 

It 

24,       ** 

Nov. 

7,    " 

<i 

7,    " 

(t 

ai,    ** 

It 

a8,    " 

<( 

28,    " 

Dec. 

12,    " 

M 

wn        « 

Premises. 


No.  35  East  Broadway  (rear) 

No.  84  Bowery 

No.  143  West  Thirty-second  street 

j  No.  167  East  One  Hundred  and  Twenty-) 
I     seventh  street / 

t  South  by  Reade  street,  north  by  Duane ) 
street,  west  by  West  street  and  east  \ 
by  Washin^on  street ) 

No.  243  Division  street 


No.  129  Canal  street 

No.  7x3  Eleventh  avenue  (front). 
No.  362  Seventh  avenue 


Date  Complied  With. 


Oct.   31,  X906. 
Nov.  27,    ** 
Dec.   12,    ** 

Not  complied  with.    Work  in  progress. 
Dec.  31,  X906. 

**     31,    " 
Jan.   14, 1907. 
Not  complied  with  (vacant) . 


Number  complied  with 

Number  not  complied  with 


Total 


44 
I 


Premises  Declared  to  be  a  Public  Nuisance, 


AS 


Date  of 

Issuance  of 

Order. 


June    6, 1906 
**    13.    " 

•*    13,  " 

"    a7,  *• 

July   XI,  " 

"    18,  *' 

Aug.    I,  '* 

Sept.  X2,  " 

"    19,  *' 

Oct.    3,  •• 

-    24,  •* 

Nov.    7,  ** 

**      7.  " 

"    28,  •* 

*'    28,  " 

*»    28,  *« 

«    28,  " 


Premises. 


(  Southwest  comer  of  One  Hundred  and  \ 
\     Thirty-fourth  street  and  Park  avenue.  I 

No.  7S  Goerck  street 


No.49Willett  street 

Nos.  616-36  West  Fortieth  street  . . 

No.  17s  East  Houston  street 

Nos.  828-30  Seventh  avenue 

No.  144  West  street 

No.  239  West  Sixtieth  street 

No.  747  East  Eleventh  street 

Nos.  51-55  West  Ninety-third  street. 
No.  227  West  Sixty-second  street . . . . 


No.  169  West  End  avenue 

f  No.  32  West  One  Hundred  and  Thirty- ) 
i    eighthstreet i 

No.  196  Avenue  C 


No.  504  East  Thirteenth  street. 
No.  517  East  Thirteenth  street. 
No.  620  East  Thirteenth  street. 


Date  CompUed  With. 


Dec.     X,  1906. 

July  25,    " 

"  25,    " 

Dec.  31,    " 

July  21,    ** 

Aug.  17,    ** 

Oct.  4,    " 
Sept.  25.    " 

Oct.  8,    •« 

••  12,    *• 

Dec.  3,    " 

"  3.    '• 
Not  complied  wHh. 

Dec.  24, 1906. 


14 


II, 


II 


II 


Not  complied  with. 


129 


Date  of 

Isananoeof 

Older. 

Premises. 

Date  Complied  With. 

Not.  iS,  1906 
Dec.    5,    ** 

No.  an  West  Elghty^eTsnth  street 

No.  904  ATcnne  C ..»»....  ^  ^  ^  » . .  *  x  ^ 

Not  complied  with.    Work  in  progress. 
Jan.   14,1907. 
Not  complied  with. 
Dec.  37,  XQ06. 

**      5     M 

No.  438  E.  Thirteenth  street 

'*     5.    •• 

No.  ao7  West  Sixty-fourth  street 

"    12,    " 

NOr  iQ  Cooper  Souare 

*•      37.     ** 

*•    11.    " 

No.  712  Eleventh  ayenue  frear) 

Jan.   14,1907. 
Dec.  37, 1Q06. 

'*    la,    " 

No.  155  First  avenue 

'*    la,   *• 

No.  316  First  avenue 

Jan.   11,1907. 

'♦    11,   «* 

No.  44a  East  Thirteenth  street 

"   u.   " 

Dec.  34.  XQ06. 

"   19,   •* 

No.  413  East  Twelfth  street 

Not  complied  with. 

^nmbcT  complied  with  ... 
Number  not  complied  with 


23 
5 


Total 


28 


At  one  time  it  was  customary  to  have  two  or  three  inspectors  especi- 
%  detailed  to  handle  complaints  and  investigations  relating  to  "  of- 
fensive trades  " ;  in  the  past  few  years,  however,  it  has  seemed  more 
advisable  to  have  this  work  done  by  the  district  inspectors,  with  the 
'result  that  at  present  every  member  of  the  corps  is  now  able  to  prop- 
^rly  attend  to  these  complaints,  and  they  consequently  receive  quicker 
^^d,  it  is  to  be  hoped,  better  attention.     Included  in  this  category  are 
'^oises  and  odors  from  manufactories,  nuisances   from  the  operation 
^*  machinery,  and  fumes,  cinders  and  smoke  from  the  operation  of 
^Tnaces. 

The  smoke  nuisance  is  in  about  the  same  condition  as  reported  in 

P^^ious  years.    Many  arrests  have  been  made  and  convictions  secured 

^   the  Court  of  Special  Sessions,  with  the  result  that  at  present  there 

^«  very  few  serious  nuisances  in  existence,  and  in  these  cases  pro- 

^^dings  are  now  pending  in  court  looking  to  the  abatement  of  these 

^isances. 

There  are  six  large  power-houses  consuming  an  enormous  quan- 
^^y  of  coal  every  twenty- four  hours,  and  producing  a  great  amount 


I30 

of  electric  power.  This  power  is  utilized  in  lighting  hotels,  theatres, 
public  buildings,  the  public  streets,  and  in  operating  the  three  great 
systems  of  transportation,  the  subway,  the  surface  railways  and  the 
elevated  roads.  All  of  these  plants  have  been  conducted,  through  the 
cooperation  of  the  managing  officials,  with  very  little,  if  any,  discharge 
of  smoke,  with  one  exception.  The  problem  presented  by  this  plant  has 
been  very  thoroughly  inquired  into  by  experts  employed  by  the  Board 
of  Health,  and  by  the  owners  of  the  plant  in  question,  and  drastic  im- 
provements have  been  recommended,  which,  when  fully  completed, 
will  do  away  entirely  with  the  nuisance  existing  in  this  plant.  The 
discharge  of  smoke,  coal  gases  and  cinders  from  the  locomotives  en- 
tering the  Borough  of  Manhattan  is  being  materially  reduced  daily. 
The  long  expected  installation  of  electric  locomotives  on  the  New 
York  Central  and  the  New  York,  New  Haven  and  Hart- 
ford Railroads  is  now  partially  accomplished.  A  number  of 
trains  are  leaving  the  Grand  Central  Station  each  day  pro- 
pelled by  electric  power,  and  as  the  engineers  and  firemen 
are  becoming  properly  instructed  in  this  method  of  traction,  more 
and  more  steam  locomotives  are  being  taken  off  the  lines.  The  proba- 
bility is  that  early  in  the  coming  year  steam  locomotives  in  the  Bor- 
ough of  Manhattan  will  have  become  a  thing  of  the  past.  The  same 
system  of  controlling  the  smoke  nuisance  on  these  railroads  by  em- 
ployees of  the  company  has  existed  in  1906,  as  in  former  years.  The 
main  line  of  the  New  York  Central,  from  Harlem  River  to  One  Hun- 
dred and  Thirty-eighth  street  to  Forty-second  street  is  kept  under  con- 
stant  supervision  by  Inspectors  employed  by  the  Railroad  Company, 
whose  duty  it  is  to  note  the  number  of  locomotives  detected  in  dis- 
charging smoke,  together  with  the  time  of  the  occurrence.  A  similar 
state  of  affairs  exists  on  the  Hudson  River  Division,  Thirtieth  street 
and  Ninth  avenue  to  Spuyten  Duyvil  creek.  The  engineer  and  the 
fireman  of  the  offending  locomotive  are  immediately  disciplined  se- 
verely by  the  Railroad  Company.  Consequently,  there  is  no  smoke  of 
any  moment  discharged  from  the  locomotives  of  railroads  in  this  bor- 
ough. 

On  the  19th  of  December  the  Sanitary  Code  was  altered  by  the 
Board  of  Health  by  removing  from  section  96  any  provision  which  it 


131 

may  have  contained  in  relation  to  smoke,  and  introducing  a  new  sec- 
tion, known  as  section  i8i,  intended  to  entirely  cover  the  smoke 
nuisance.    This  section  is  as  follows: 

"  No  person  shall  cause,  suffer  or  allow  dense  smoke  to 
be  discharged  from  any  building,  vessel,  stationary  or  loco- 
motive engine,  place  or  premises  within  the  City  of  New  York, 
or  upon  the  waters  adjacent  thereto,  within  the  jurisdiction 
of  said  City;  all  persons  participating  in  any  violation  of  this 
provision,  either  as  proprietors,  owners,  tenants,  managers, 
superintendents,  captains,  engineers,  firemen  or  otherwise  shall 
be  severally  liable  therefor." 
It  has  been  in  force  such  a  comparatively  short  length  of  time  that 
it  is  impossible  at  the  time  of  this  report  to  make  any  definite  state- 
ment as  to  whether  it  is  more  or  less  effective  than  the  old  section  of  the 

Code. 

Arrests  for  Smoke  Nuisance,  1906. 

Number  held  on  bail  in  Police  Court 211 

Number  discharged  10 

Total 221 

Number  fined  in  Special  Sessions  Court 5 

Number  discharged  in  Special  Sessions  Court 29 

Number  sentences  suspended  in  Special  Sessions  Court 160 

Number  cases  pending  in  Special  Sessions  Court 17 

Total 211 

Amount  of  fines  $240  00 


Gasoline  Explosions, 
Early  in  the  month  of  April  a  number  of  serious  explosions  took 
place  in  cellars  and  in  the  sewers  of  the  streets  on  the  west  side  of  this 
trough  in  that  section  of  the  City  bounded  by  West  Forty-ninth,  West 
Fifty-sixth  streets,  Broadway  and  the  North  river.  This  matter  was 
first  called  to  the  attention  of  the  Department  of  Health  in  the  last 
week  of  April.  Explosions  became  so  frequent  and  the  conditions  were 
apparently  so  grave  that  two  Inspectors  of  the  Division  were  assigned 


132 

to  make  a  thorough  and  careful  investigation  of  the  causes  of  the 
explosions  and  of  the  circumstances  surrounding  the  causes  of  the  ex- 
plosions. They  reported  that  the  explosions  were  the  result  of  an  ad- 
mixture of  the  proper  proportions  of  gasoline  vapors  and  air  in  the 
public  sewers.  This  mixture  of  vapors  found  its  way  into  the  cellars 
and  basements  of  numerous  buildings,  by  means  of  defects  in  the  plumb- 
ing and  drainage  system  of  said  premises.  It  was  found  that  all  of 
these  explosions  took  place  along  the  sewerage  system,  the  trunk  of 
which  extended  from  Fifty-sixth  street  west  to  Eighth  avenue,  south 
of  Eighth  avenue  to  Fifty-fifth  street,  thence  west  to  Ninth  avenue, 
thence  south  to  Fifty-first  street,  and  thence  west  to  the  North  river. 
Upon  ascertaining  this  fact  the  garages  situated  in  the  district  drained 
by  this  system  were  all  carefully  examined.  The  following  is  an  ex- 
tract from  the  inspectors'  report  of  their  findings : 

"  We  found  that  in  some  of  these  garages  no  gasoline  was 
stored  on  the  premises  and  that  in  others  various  systems  of 
storage  tanks  were  installed. 

"  In  the  premises  No.  235  West  Fifty-sixth  street,  occupied 
by  the  Hoi-Tan  Company,  and  in  the  premises  Nos.  237-41 
West  Fifty-sixth  street,  occupied  by  Smith  &  Mabley,  the  stor- 
age system  is  that  installed  by  the  Snell  Hydraulic  Oil  Storage 
Company.  This  system  operates  on  the  principle  that  a  column 
of  water  12  inches  high  will  counterbalance  a  column  of  gaso- 
line 17  inches  high.  This  system  consists  of  a  series  of  tanks 
connected  together  and  to  which  are  attached  suitable  pipes  for 
conveying  the  gasoline,  and  others  for  supplying  the  water 
pressure  necessary  to  force  the  gasoline  from  the  tanks.  This 
system  has  been  imperfectly  installed.  Consequently  the  per- 
sons who  were  charged  with  filling  the  tanks  were  not  able  to 
or,  at  any  rate,  did  not  ascertain  whether  any  gasoline  found  its 
way  into  the  water  leg  of  the  system  and  thence  into  the  public 
sewer  or  not.  As  a  matter  of  fact,  we  found  that  on  most  occa- 
sions when  the  tanks  of  these  two  concerns  were  being  filled 
that  the  odors  of  gasoline  in  the  adjacent  sewer  became  very 
strong,  in  some  cases  almost  unbearable,  showing  that  at  times 
a  very  large  amount  of  gasoline  was  carelessly  allowed  to  find 


n 


t( 


« 


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133 

its  way  into  the  public  sewer.  An  apparatus  is  now  being  placed 
on  the  feed  pipes  of  the  storage  tanks  in  these  two  garages 
which,  it  is  claimed,  will  absolutely  prevent  the  improper  dis- 
charge of  gasoline.  In  addition  to  this  obvious  source  of  the 
entrance  of  gasoline  into  the  public  sewer  we  examined  the 
drainage  system  separately  of  each  garage  and  found  strong 
odors  of  gasoline  arising  from  the  house  trap  of  the  main  iron 
house  drain  near  the  front  wall.  Samples  were  taken  from 
the  public  sewer  in  the  street  and  from  each  of  the  house  traps 
of  the  following  five  garages: 

Ford  Motor  Company,  1723  Broadway. 
DeCauville  Motor  Company,  235-41   West  Fifty- 
fifth  street. 

Pope  Manufacturing  Company,  1733-7  Broadway. 
Rainier  Auto  Company,  1627-9  Broadway. 
Majestic  Motor  Company,  1713-15  Broadway. 

"  All  of  these  samples  contained  gasoline  in  varying  quanti- 
ties, showing  that  these  five  places,  in  addition  to  the  two  first 
mentioned,  discharge  gasoline  into  the  public  sewer  in  sufficient 
quantities  to  produce  an  explosive  mixture  of  gasoline  and  air, 
which,  if  brought  in  contact  with  a  flame  or  spark  under  the 
proper  conditions,  might  produce  most  serious  results.    Separate 
reports  covering  the  conditions  in  each  one  of  the  above  men- 
tioned premises  were  forwarded  with  the  recommendation  that 
an  order  be  issued  requiring  the  discontinuance  of  the  nuisance 
caused  by  the  discharge  of  gasoline  into  the  public  sewer." 
It  may  thus  be  seen  that  there  were  two  means  by  which  gasoline 
might  find  its  way  into  a  public  sewer  from  a  garage.     First,  defects 
in  the  storage  system,  and,  second,  carelessness  in  the  use  of  gasoline 
around  the  premises  either  in  filling  automobile  tanks  or  in  using  ex- 
cessive quantities  of  gasoline  for  cleansing  and  washing  purposes.    As 
indicated  in  the  report  quoted  above,  orders  were  issued  on  all  of  the 
premises  in  question.    The  careless  handling  of  gasoline  in  filling  the 
tanks  on  the  machines  and  for  washing  purposes  was  discontinued  at 
once.    The  use  of  the  storage  tanks  in  the  garage  at  No.  235  West 
Fifty-sixth  street  and  Nos.  237-41  West  Fifty-sixth  street  was  discon- 


134 

tinned  nntil  snch  time  as  a  safety  derice  coold  be  placed  on  these  tanks, 
which  would  prevent  the  escape  of  gasoline  through  the  water  leg  of 
the  system  into  the  public  sewer.  This  work  was  completed  in  the 
middle  of  May  and  the  restriction  upon  the  use  of  the  tanks  was  re- 
moved. Since  that  time  there  has  been  no  evidences  of  the  escape  of 
gasoline  into  public  sewers  and  the  Department  has  received  no  com- 
plaint to  that  effect. 

Lodging  Houses. 

There  are  probably  no  buildings  occupied  for  living  purposes  which 
are  in  more  need  of  constant  supervision  by  Sanitary  Inspectors  than 
those  occupied  as  lodging  houses  and  so-called  "  furnished  room " 
houses.  These  houses  are  tenanted  by  persons  who  are  of  a  more  or 
less  roving  disposition,  who  have  no  particular  personal  ties  with  the 
premises  and  are  therefore  extremely  careless  in  their  usage  of  the 
property.  The  Sanitar>"  Code  prescribes  that  for  all  lodging  houses 
containing  rooms  in  which  there  are  more  than  three  beds  for  the  use 
of  lodgers,  or  in  which  more  than  six  persons  are  allo^Td  to  sleep,  a 
I)ermit  from  the  Board  of  Health  shall  be  required. 

Table  of  Occupancy, 

Number  of  lodging  houses  for  men,  95;  total  number  of  lodgings I7>i29 

Number  of  lodging  houses  for  women,  3;  total  number  of  lodgings...  319 

Number  of  lodging  houses  for  children,  4;  total  number  of  lodgings..  530 


Total    17,978 


As  in  former  years,  one  Sanitary  Inspector  has  been  assigned  to 
duty  in  the  supervision  of  lodging  houses.  The  Charter  of  The  City 
of  New  York  provides  that  the  Department  of  Health  shall  make  an 
inspection  of  each  lodging  house  in  The  City  of  New  York  at  least 
once  in  six  months.  Experience  has  taught  that  inspections  of  this 
sort  are  not  adequate  and  are  not  satisfactory,  and  therefore  it  has  been 
deemed  better  to  have  one  Inspector  on  duty  in  connection  with  the 
lodging  houses  at  all  times  in  order  that  lapses  on  the  part  of  lodging 
house  proprietors  shall  be  corrected  almost  immediately,  with  the  re- 
sult that  the  lodging  houses  are  kept  in  as  good  condition  as  places  of 
this  character  might  be  reasonably  expected.    There  have  been  2,764 


J  35 

inspections  of  lodging  houses  made  during  the  year,  an  average  of  27 
apiece,  instead  of  two  apiece,  as  required  by  the  law. 

Enforcement  of  the  Child  Labor  Law. 
The  inspections  which  this  Department  is  required  to  make  in  the 
enforcement  of  the  Child  Labor  Law  are,  in  the  majority  of  cases, 
made  by  the  district  sanitary  inspectors.    They  are  required  to  make  a 
minimum  of  20  inspections  a  week  in  this  particular  line  of  work,  but 
the  majority  make  many  more  than  this,  so  that  the  average  number  of 
inspections  a  week  is  something  more  than  500.    In  addition  to  the  in- 
spections made  by  the  district  inspectors  there  is  an  inspector  assigned 
especially  to  watch  the  large  department  stores,  the  telegraph  and  mes- 
senger service  and  such  complaints  of  violation  of  the  Child  Labor  Law 
as  may  be  referred  to  him.    During  the  month  preceding  the  Christ- 
mas holidays  there  were  temporarily  assigned  to  assist  him  in  this  work 
five  other  inspectors.    During  the  past  year  there  were  25,725  inspec- 
tions of  mercantile  establishments.    As  an  indication  of  the  apparently 
universal  compliance  with  the  law,  so  far  as  the  Department  of  Health 
is  required  to  take  cognizance,  it  would  be  proper  to  state  that  during 
the  year  1906  there  were  but  145  complaints  received  of  violations.    Of 
these  85  were  verified  on  inspection  and  60  were  found  to  be  ground- 
less.   In  addition  to  this  there  were  875  recommendations  for  notices 
made  by  the   inspectors  as  a   result  of  their  original   investigations, 
making  a  total  of  960  notices  which  were  issued  for  violation  of  the 
Mercantile  Law.    In  other  words,  out  of  the  25,725  inspections  made, 
there  were  but  ^yi  per  cent,  of  the  cases  in  which  the  Inspectors  found 
violations  of  that  part  of  the  Mercantile  Law    the  enforcement  of 
which  this  Department  is  charged  with. 

Criminal  prosecutions  were  made  in  a  few  instances  of  flagrant 
violations  of  the  Mercantile  Law.  In  the  table  will  be  found  the 
number  of  cases  and  their  disposition. 

Section  161  of  the  Mercantile  Law  was  amended  at  the  last  session 
of  the  Legislature  and  went  into  effect  on  October  i,  1906.  The  es- 
sential feature  of  this  amendment  is  the  following  sentence: 

"  But  in  cities  of  the  first  class  no  child  under  the  age  of  16 
years  shall  be  employed,  permitted  or  suffered  to  work  in  or  in 


136 

connection  with  any  such  establishment  after  seven  o'clock  in 
the  evening  of  any  day." 

This  amendment  was  very  generally  complied  with  by  the  employers 
of  children,  except  during  the  few  weeks  preceding  the  Qiristmas  holi- 
days, and  after  the  assignment  of  the  additional  inspectors  to  the  spe- 
cial mercantile  work  and  the  arrest  of  a  comparatively  few  employers, 
the  provision  of  this  amendment  in  regard  to  the  employment  of  chil- 
dren was  very  generally  respected  throughout  the  borough.  While  it 
is  undoubtedly  true  that  there  are  many  isolated  cases  of  violations  of 
the  Mercantile  Law,  it  would  seem  that  the  provisions  of  the  law  are 
very  generally  lived  up  to,  and  it  does  not  seem  possible  to  more  thor- 
oughly enforce  these  provisions  unless  an  additional  corps  of  in- 
spectors were  employed  who  could  be  assigned  to  this  duty  and  none 
other,  and  even  then  it  would  be  a  question  whether  the  conditions 
would  show  sufficient  improvement  to  warrant  the  expenditure  of  the 
additional  sum  of  money. 

The  work  which  the  Department  of  Health  is  required  to  perform 
in  compliance  with  the  Mercantile  Law  is  of  two  kinds,  inspection  or 
field  work  and  the  issuance  of  mercantile  certificates  to  children  be- 
tween the  ages  of  14  and  16  years  who  may  desire  to  work  in  a  mer- 
cantile establishment  or  a  factory.  The  requirements  of  the  law  which 
must  be  complied  with  before  a  Mercantile  Certificate  can  be  issued 
are  most  specific.  The  parent  or  guardian  of  the  child  must  furnish 
a  passport  or  duly  attested  transcript  of  the  certificate  of  birth  or  bap- 
tism, or  other  religious  record,  showing  the  date  and  place  of  birth  of 
such  child,  and  a  school  record  properly  filled  out  and  signed,  as  pro- 
vided by  law.  This  school  record  must  show  that  the  child  has  re- 
ceived at  least  130  days'  tuition  since  its  thirteenth  birthday  and  that 
during  that  time  it  has  been  instructed  in  reading,  spelling,  writing, 
English  grammar  and  geography  and  is  familiar  with  the  fundamental 
operations  of  arithmetic  up  to  and  including  fractions.  In  addition  to 
stating  that  this  documentary  evidence  has  been  placed  on  file  the 
officer  of  the  Department  issuing  the  Mercantile  Certificate  must  cer- 
tify that  the  child  is  able  to  read  and  write  simple  sentences  in  tlie 
English  language,  and  that  it  has  reached  the  normal  development  of 


137 

a  child  of  its  age,  is  sotuid  in  health  and  is  physically  able  to  do  the 
work  which  it  is  to  perform. 

Unfortunately  there  are  many  children  who  are  unable  to  furnish 
evidence  of  age  such  as  is  admissary  under  the  provisions  of  this  law. 
A  comparatively  small  number  who  have  received  certificates  of  gradu- 
ation are  enabled  to  present  these  in  lieu  of  other  evidence  of  age,  but 
even  this  concession  does  not  reach  all  of  the  children  who  are  phys- 
ically and  mentally  capable  of  doing  work. 

In  1904  the  Legislature  amended  the  law  so  as  to  permit  the  Board 
of  Health  at  a  regular  meeting  to  accept  other  documentary  evidences 
than  the  ones  above  mentioned  provided,  in  its  opinion,  such  evidences 
were  bona-fide  proofs  of  age  and  that  the  child  in  fact  was  over  the 
age  of  14  years.  The  issuing  of  certificates  under  this  law  has  been 
conducted  in  1906  as  it  was  in  1905  and  has  undoubtedly  resulted  in 
^wing  many  children  to  secure  employment  who  otherwise  through 
the  apparently  harsh  provisions  of  the  law  would  have  been  prevented 

• 

trom  obtaining  Mercantile  Certificates.  Amongst  the  different  evi- 
dences of  age  presented  are  certificates  from  the  Commissioner  of  Im- 
"Ration  that  a  child  entered  the  Port  of  New  York  at  a  given  date, 
3t  which  time  it  was  known  to  be  of  a  certain  age.  Family  Bibles,  vac- 
cination  certificates  issued  shortly  after  the  birth  of  the  child  and  cer- 
tificates of  the  physicians  who  attended  the  child  at  a  very  early  age. 
^ere  have  also  been  presented  six  or  eight  insurance  policies,  which 
were  accepted  as  legal  proof.  During  the  year  there  were  739  certifi- 
cates of  this  character  issued  by  direction  of  the  Board  of  Health. 

The  work  performed  by  the  Inspectors  of  this  division  in  enforcing 
the  Mercantile  Law  will  be  shown  in  this  table : 

Number  of  inspections  of  mercantile  establishments 25,725 

Number  of  complaints  received  I45 

Number  of  complaints  returned  for  orders 85 

Number  of  complaints  returned  negative 60 

Number  of  originals   875 

Number  of  children  interviewed  30»976 

Number  of  certificates  granted  i if387 


a 


Number  of  children  refused,  insufficient  education 158 

Number  of  children  refused,  insufficient  tuition 1,215 


138 


-    :■!   .S0!T  CX   CXUdxS  rcTlSCfi.  jimCHK  If  .11.   CIJUfiilKc   r-3   ■bXb. .........  OOO 

=ier  CI  c=:^-frer  rrrzscd.  c«r  2«e 34^ 

S-T'^jT'  of  cfjidrcg  refzaed.  g&jwa!  TTrayfc-Jiij 5 


Total  rcfscd  2^65 


Total  oozsbcT  of  arrests 14 

Total  mnnbcr  cf  5s€s 2 

Total  mmzber  discharged 4 

Total  ctzcber  of  cases  pending 8 

Amoont  cf  fines $40  00 


Healik  Squad. 
The  Cbmmissioiicr  of  Police,  by  direction  of  the  Charter,  details 
oflScers  and  men  to  diis  Squad.  It  is  at  present  commanded  by  a 
Sergeant  of  Police,  and  is  composed  of  three  romKlsmen  and  60  patrol- 
men. The  Health  Squad  investigates  complaints  relating  more  especial- 
ly to  cleanliness,  and  the  removal  of  refuse,  including  the  removal  of 
manure  from  horse  stables  throughout  the  City,  shaking  of  carpets 
and  rugs,  filthy  garbage  and  refuse  cans,  dirty  lots,  ^-ards  and  cellars, 
and  noisy  dogs  and  other  animals.  They  are  also  used  in  the  enforce- 
ment of  the  provisions  of  the  Sanitary  Code,  more  especially  those 
relating-  to  the  improper  exposure  of  food  stuffs,  the  keeping  and 
killing  of  live  poultry'  in  tenement  houses,  making  arrests  for  viola- 
tion of  the  smoke  ordinance  and  provisions  of  the  Sanitary  Code 
against  allowing  dust  and  dirt  to  escape  from  premises,  more  or  less 
caused  by  the  beating  and  shaking  of  carpets,  and  tfie  dust  arising 
from  the  destruction  of  buildings  by  house  wreckers,  the  transporta- 
tion of  manure  and  other  refuse  without  permits,  and  finally  the  en- 
forcement of  section  178  in  relation  to  spitting  in  cars,  ferry  boats,  in 
or  on  stations  and  platforms,  and  other  public  places.  The  Sanitary 
Police  are  likewise  used  to  carry  out  the  directions  of  the  Board  in 
relation  to  the  vacating  of  houses  which  are  in  uninhabitable  condi- 
tions, and  in  relations  to  buildings  or  other  places  which  have  been 
declared  public  nuisances.  The  members  of  the  Squad  are  frequently 
of  much  assistance  to  the  Inspectors  of  the  Division  in  gaining  ad- 


139 

mission  to  premises,  and  in  the  inspection  of  milk  at  the  ferries  and 
other  terminals.  They  perform  a  very  considerable  amount  of  duty 
in  connection  with  the  work  of  the  Division  of  Contagious  Diseases, 
which  will  be  treated  of  in  connection  with  the  report  of  that  Division. 
The  following  table  is  a  statement  of  the  arrests  other  than  those 
for  the  sale  of  adulterated  milk,  made  by  the  Sanitary  Squad  during 
the  year  1906,  together  with  the  disposition  of  each  case,  either  in  the 
Police  Magistrate's  Court,  or  in  the  Court  of  Special  Sessions. 


Section  Violated. 


la. 


12. 


41.. 
49.. 


45- 


46.. 
56.. 


S9. 


73.. 
74*. 
79.. 


81. 


«7 

88 

96  (Manhattan). 


97. 


109.. 
116.. 


118. 


"9 

133 

163  (Merc.  Law) 


178. 


385  (Penal  Code) 

late    (Greater    New    York) 
Charter) j 

"65 


q6  (Queens) 

Violation    of    Corporation) 
Ordinance > 


Number 
Fined. 


I 

9 
391 

690 

3 

a 
6 

•   •   ■  a 

76 

4 
I 
I 

2 

4 
5 

28 

a 

76 

72 

•  •  •  • 

I 
1,156 


Number 
Discharged. 


a 
I 

•  •  • 

I 

14 
44 

5 


n 


33 
I 

3 
3 
5 

3 

I  •  •  • 

3 
199 


Number 

Sentence 

Suspended. 


•  •  •  « 


I 
II 


133 


a 

7 
I 
I 


31 


Number 
Pending. 


20 


•3 


Amount 
of  Fines. 


#10  00 

20  00 

726  00 

1,57a  78 
30  00 
15  00 
7500 

497  00 

20  00 

500 

10  00 
20  00 

190  00 

25  00 

64  00 

50  00 

1,05300 

341  00 

20  00 

1,651  08 

I  00 

10  00 

15  00 


•  City  Prison. 


I40 

Total  fined   2MA 

Total  discharged   54.1 

Total  sentence  suspended  195 

Total  pending   53 

Total  city  prison  3 

Total    3J006 

Total  amount  of  fines  imposed 9^A^o  86 


Refuse  Renunul. 

In  a  city  of  the  size  of  New  York  there  is  naturally  an  enormous 
amount  of  refuse  which  must  be  promptly  and  propcriy  removed.  The 
Department  of  Street  Qeaning  removes  and  disposes  of  all  house- 
hold waste  (ashes,  garbage  and  paper  waste).  Everything  else  must 
be  removed  by  the  persons  who  are  responsible  for  its  creation. 

In  the  Sanitary  Code  are  sections  which  prohibit  the  transporta- 
tion of  such  material  without  a  permit  By  resolution  of  the  Board 
of  Health,  such  permits  are  issued  by  the  Chief  Sanitary  Inspector, 
under  the  direction  of  the  Sanitary  Superintendent  and  his  assistants; 
these  permits  expire  with  the  year.  On  the  face  of  the  permit  appears 
tlie  name  and  address  of  the  holder  and  a  statement  of  the  character 
of  material  he  is  authorized  to  transport,  and  a  designation  of  the 
place  at  which  it  must  be  deposited.  These  places  are  kept  under 
observation  by  Inspectors  of  the  Department  to  insure  that  the  various 
materials  will  be  disposed  of  expeditiously  and  without  offense. 

Besides  these  precautions,  patrolmen  furnished  with  bicycles  are 
nv>re  or  less  constantly  patrolling  the  streets  to  enforce  the  conditions 
of  the  different  classes  of  permits. 

Permits  Issued  During  1906. 

(Transportation.) 

T^  trftiMfpMt  m«mire 958 

T^HtM^Oit  in  and  bones  (butdicrs*  refase) 202 

^  tfMMpin  Slrin  (refose  from  hotels,  resunrants  and  dubs) 49 

(private  ctitmcn)  33 


i 


141 

Number  of  arrests  for  illegal  transportation 273 

Number  discharged  21 

Number  fined  351 

Amount  of  fines I845  00 

The  work  performed  by  the  sanitary  part  of  the  Division  is  here- 
with summarized : 

Number  of  primary  inspections 269,133 

Number  of  reinspections 54»48o 

Total  323,613 

Tenements  58473 

Lodging  houses 2,764 

Private  dwellings  22,228 

Mercantile  establishments  25,725 

Manufacturing  and  workshops 21,779 

Stables  18,944 

Manure  dumps 5,728 

Sunken  and  vacant  lots 5,934 

Miscellaneous   162,038 

323,613 

Number  of  complaints  received I3,047 

Number  of  complaints  returned  for  orders 16,196 

Number  of  complaints  returned  negative 13,186 

Number  of  mercantile  certificates  issued 11,387 

Number  of  mercantile  certificates  refused 2,865 

Number  of  arrests    3,oo6 

Number  of  trials  2,980 

Amount  of  fines $6420  86 


Food  Inspection. 

An  important  subdivision  of  this  Division  is  that  of  the  Inspection 
of  Foods.  This  includes  fruit  and  vegetables,  fish,  meat  and  milk. 
The  Chief  Sanitary  Inspector  of  the  Borough  of  Manhattan  is  charged 
with  the  inspection  of  fruit  and  vegetables  (wholesale  markets)  in  all 
boroughs,  fish  and  meat  in  the  Borough  over  which  he  has  charge  in 
the  Division  of  Inspections,  and  finally  everything  which  relates  to  the 


mk  siroilj  re  :ae  -Cxt.  nfber  dioa  the  issmi^  of  permits  to  sell  milk 
ami  x:  ksss^  r.:ws  ir  ae  Soraag^  oi  Tbt  Bronx,  Broold}'n,  Queens 

Tr*  xsiifc  "^Trrr  ss  lbs  vorii:  dbcre  has  been  assigned  an 
rrr  cf  ?ccoj^  Tri±:  -fat  vfice  tide  of  Siqicnrising  Inspector  of 

rnr  ras  icwrraaco  crcr  Ac  inspectioo  of  fruits,  vege- 
i=  :be  Srm::^  of  Manhattan  and  of  imported  fruit 
=  ±!e  3cr:i::§*i  of  Brccftdrn. 
Fr~5  ant  cErSie^i  frr:^  r«':>  casscs-— decidiioiis  and  citrus,  Decidu- 
ocs  rrrhs  e:z:!Tacr  e\«nr  kfni  ocbcr  than  berries,  that  grow  at  certain 
seaiccs  ar>d  Ixiit  co«  a  jicir-  The  »coik1  dass  comprises  the  orange, 
Se:r>ca  arsi  graj^e  fr=ft  £xr£T,  whach  bear  throughout  the  year.  The 
leaves  froci  sach  tnecs  do  cxA  perceptiblT  fall  and  are  always  green. 
Fruits  shipped  to  dns  osaxket  are  grcmn  as  far  south  as  the  loth  d^iree 
ix>rth  latitude.  This  paraDd  runs  tfaroc^  Cartagina,  United  States  of 
Colombia.  The  western  boundary  of  the  fruit  producing  area  is  the 
Pacific  Coast,  although  the  bulk  is  not  obtained  farther  west  than  eighty- 
five  degrees  east  of  Greenwich.  This  meridian  runs  through  the  center 
of  the  State  of  Michigan.  Fruit  is  also  obtained  from  the  Mediterra- 
nean ports  of  Sicily,  Italy  and  Spain.  Dried  fruits  are  obtained  very 
largely  from  Turkey  and  Persia,  and  at  times  apples  have  been  shipped 
from  Xew  Zealand,  so  that  fruit  is  shipped  at  times  from  nearly  all 
parts  of  the  civilized  world.  The  introduction  of  irrigation  in  the 
western  States  has  caused  the  fruit  raising  industry  to  grow  with  great 
rapidity,  and  especially  in  the  Territory  of  Arizona.  It  may  be  inter- 
esting to  note  that  the  same  merchants  are  identified  with  both  the  sale 
of  dairy  products  and  of  fruit.  This  combined  interest  is  the  third 
largest  industry  in  the  world.  Fruits  and  vegetables  from  nearby 
sources  of  supply  are  transported  in  very  much  the  same  manner  as  any 
other  class  of  freight,  that  coming  from  gjeat  distances,  either  on 
steamers  from  the  tropics  or  in  cars  from  the  far  west,  is  more  care- 
fully handled  and  protected  so  as  to  reduce  the  loss  to  a  minimum.  The 
western  fruit  is  transported  in  properly  ventilated  refrigerator  cars  and 
those  vessels  bringing  fruits  from  the  tropics  are  especially  constructed 
»tul  with  a  modem  ventilating  system.    The  only  instance  of 

^mit  in  which  speed  is  lacking  is  in  the  shipment 


143 

of  pines  in  bulk  from  Key  West  and  the  Bahamas.  This  is  done  in 
schooners,  the  average  length  of  passage  being  about  twelve  days.  The 
principal  points  of  arrival  of  fruit  are  as  follows : 

Delaware,  Lackawanna  &  Western  Railroad,  Pier  13,  North  river. 
American  Line,  Pier  14,  North  river. 
New  York  Central  Railroad,  Pier  16,  North  river. 
Erie  Railroad,  Pier  20,  North  river. 
Baltimore  &  Ohio  Railroad,  Pier  22,  North  river. 
Pennsylvania  Railroad,  Pier  29,  North  river. 
Old  Dominion  Line,  Pier  36,  North  river. 
Qyde  Line,  Pier  45,  North  river. 
Ward  Line,  Piers  16  and  17,  East  river. 

The  bulk  of  the  Mediterranean  fruit  lands  in  Brooklyn,  between 
Fulton  and  Forty-second  streets.  In  addition  to  these  principal  points 
of  arrival  all  of  the  steamship  companies  and  all  of  the  express  com- 
panies and  river  boats  transport  a  considerable  amount  of  produce  in 
small  quantities  throughout  the  year. 

The  Savannah,  Pennsylvania  and  Old  Dominion  companies  open 
Aeir  docks  for  business  at  3  o'clock  a.  m.  These  places  are  our  great 
markets,  where  70  per  cent,  of  the  product  is  sold.  From  these  points, 
as  a  rule,  the  entire  community  is  supplied.  All  of  this  is  done  at 
private  sale. 

All  jobbers  and  retail  grocers  go  there  to  make  their  daily  purchases. 
The  heaviest  days  are  Mondays,  Wednesdays  and  Fridays. 

The  next  important  method  of  distribution  is  by  public  auction,  the 
principal  places  being  Pier  20,  North  river,  and  the  Erie  Railroad, 
known  as  the  "  California  Dock."  All  far  western  fruit  arrives  there 
and  is  lined  up  from  midnight  to  8  o'clock  a.  m.,  when  samples  are 
opened  and  exposed  to  the  buyers.  (No  retailing.)  At  8  o'clock  a.  m. 
the  fruit  is  sold  upstairs  in  a  large  room  especially  constructed  for  the 
purpose.  There  are  two  auction  companies,  who  alternate  as  to  whom 
shall  be  the  first  in  selling. 

All  Mediterranean  fruits  are  sold  by  auction.  The  goods  are  lined 
up,  as  on  the  California  Dock,  at  the  Brooklyn  and  Jersey  City  wharves. 
The  buyers  examine  the  lines  which  they  wish  to  purchase,  mark  their 
catalogs,  then  return  to  New  York,  where  the  goods  are  sold  by  Brown 


144 

&  Seccomb  and  the  Fruit  Auction  Company.  The  only  other  fruit  sold 
by  auction  is  about  80  per  cent,  of  the  "  pines  "  and  20  per  cent,  of  the 
bananas. 

Railroad  and  express  fruit,  other  than  the  above  described,  goes 
direct  to  the  commission  merchant's  stores,  and  from  there  it  is  sold 
to  the  retailers  and  peddlers. 

With  few  exceptions  vegetables  arrive  at  the  same  places  as  fruit, 
but  are  shipped  from  nearby  points.  The  season  begins  about  March 
15  with  Floridian  products,  and  as  the  season  advances  the  supply  gradu- 
ally works  north,  until  October,  at  which  time  the  northern  part  of  this 
State  ends  the  season  with  fresh  shipments,  potatoes,  cabbages,  turnips 
and  carrots  excepted,  which  are  shipped  all  winter  and  until  the  be- 
ginning of  the  following  season.  Large  quantities  of  cabbage  arc  ob- 
tained from  Germany,  while  from  Ireland,  Scotland,  Belgium  and 
Germany  at  times  when  the  native  crops  are  short  and  prices  high, 
are  imported  potatoes.  The  duty  of  twenty-five  cents  per  bushel  on  po- 
tatoes and  onions  is  sufficient  to'  be  prohibitive,  except  at  times  of  great 
scarcity  in  this  country.  Large  quantities  of  onions  are  obtained  fnmi 
Spain,  and  at  times  many  are  imported  from  Eg3rpt.  Occasionally  there 
is  such  an  influx  of  vegetables  from  the  South  that  the  outgoing  steam- 
ers of  the  Savannah  and  Old  Dominion  Lines  carry  much  of  tfie  product 
which  they  had  brought  north  to  sea  and  dump  it  As  many  as  12,000 
crates  have  been  known  to  be  disposed  of  in  this  way  in  one  day.  The 
chief  places  for  the  distribution  of  vegetables  in  bulk,  that  is  loose,  in 
car  lots,  are  the 

New  York  Central  Railroad,  foot  of  West  Thirty-third  street 

Erie  Yards,  foot  of  West  Twenty-seventh  street. 

Palmer's  Dock,  Williamsburg. 

As  in  the  other  classes  of  inspection  already  described,  the  fruit  and 
fish  inspectors  are  assigned  to  districts  in  which  they  are  expected  to  be 
familiar  with  the  quality  of  the  food  stuffs  offered  for  sale.  They  ro- 
tate periodically,  so  that  each  Inspector,  in  time,  becomes  familiar  with 
the  conditions  existing  throughout  the  borough.  From  the  nature  of 
the  work  it  is  also  necessary  to  assign  inspectors  to  a  special  kind  of 
work,  consequently  there  is  one  man  who,  eight  months  in  the  year,  is 
Icept  at  the  wholesale  market  along  the  river  front.    This  supervision 


145 

is  maintained  during  the  night  time.  There  is  another  detailed  to  make 
frequent  examinations  of  the  food  stutis  offered  for  sale  in  the  large 
department  stores  and  also  to  keep  in  touch  with  the  sate  of  canned 
condensed  milk,  mineral  waters,  syrup  extracts  and  kindred  food  prod- 
ucts. There  is  still  another,  whose  duty  it  is  to  keep  in  touch  with  the 
wholesale  grocers,  confectionery  supply  houses,  canned  goods  brokers, 
and  the  importers  of  dry  groceries,  and,  lastly,  a  man  of  long  experience 
has  been  assigned  to  take  charge  of  the  railroad  yards  and  the  river 
front,  thus  forming  a  system  of  inspection  as  perfect  as  tnav  he  devised 


UNLOADING    BANANAS, 

with  the  limited  number  of  men  employed.  (Twelve,  of  which  number 
one  is  lately  deceased,  and  two  have  been  ill  for  a  long  period  of  time, 
thus  making  a  net  working  force  of  nine.) 

The  Borough  of  Brooklyn  has  but  one  Inspector,  who  looks  after 
imported  food  stuffs  and  whose  territory  is  limited  to  the  shore  front. 
His  work  is  considered  extremely  important  and  delicate,  for  it  deals 
largely  with  a  foreign  element  and  the  United  States  Government, 
This  branch  of  the  Department  work  was  inaugurated  June  4,  1906, 
and  to  give  an  idea  of  its  volume  from  that  time  to  date  the  results 
I  are  here  appended : 


146 

Pineapples  Seised  and  Destroyed. 


Date. 


iqo6. 
June    4 . . 


tt 


6.. 

8.. 
12.. 
14.. 
19.. 
21.. 
16.. 
25.. 
27.. 
29.. 
July     2.. 

**  5.. 
**  7.. 
'*     11  . 

'*     13.. 

*•  13  ' 
*'     17.. 

17.. 


(i 


ii 


n 


it 


*i 


i» 


it 


(t 


^i 


Steamer  and  Location. 


t  • 


♦     26.. 


Aug. 

I.. 

3.. 

6.. 

9.. 

16.. 

21.. 

23-. 

30.. 

Sept. 

7-' 

"       12.. 

•*       15.. 
"       20.. 


Vigilancia,  Pier  17,  East  river,  Brooklyn.... 

Bayaxno,  Pier  18,  East  river,  Brooklyn 

Monro  Castle,  Pier  19,  East  river,  Brooklyn. 

Monterey,  Pier  17,  East  river,  Brooklyn 

Matanza,  Pier  18,  East  river,  Brooklyn 

Segurancia,  Pier  17,  East  river,  Brooklyn . . . 

Seneca,  Pier  18,  East  river,  Brooklyn 

Merida,  Pier  19,  East  river,  Brookh*n 

Monro  Castle,  Pier  19.  East  river,  Brooklyn. 
Esperanza,  Pier  17,  East  river,  Brooklyn.... 

Matanza,  Pier  18,  East  river,  Brooklyn 

Mexico,  Pier  19,  East  river,  Brooklyn 

Vigilencia,  Pier  17,  East  river,  Brooklyn 

Monro  Castle,  Pier  18,  East  river,  Brooklyn . 

Monterey,  Pier  17,  East  river,  Brooklyn 

Mexico,  Pier  18,  East  river,  Brooklyn 

Philadelphia,  Pier  11,  East  river,  Brooklyn. . 

Caracas,  Pier  11,  East  river,  Brooklyn 

Merida,  Pier  17,  East  river,  Brooklyn 

Esperanza,  Pier  18,  East  river,  Brooklyn . . . . 

Mexico,  Pier  17,  East  river,  Brooklyn 

Seguranca,  Pier  18,  East  river,  Brooklyn.... 
Morro  Castle,  Pier  17,  East  river,  Brooklyn. 

Monterey,  Pier  17,  East  river,  Brooklyn 

Mexico,  Pier  17,  East  river,  Brooklyn  

Morro  Castle,  Pier  18,  East  river,  Brooklyn. 
Esperanza,  Pier  17,  East  river,  Brooklyn. . . . 

Mexico,  Pier  18,  East  river,  Brooklyn 

Morro  Castle,  Pier  18,  East  river,  Brooklyn, 

Mexico,  Pier  18,  East  river,  Brooklyn 

Morro  Castle,  Pier  18,  East  river,  Brooklyn. 
Esi>eranza,  Pier  17,  East  river,  Brooklyn.... 
Mexico,  Pier  17,  East  river,  Brooklyn 


Number 
Crates. 


350 

585 

747 

749 
870 

417 
909 

584 

832 

1,181 

1,811 

M75 

467 

1,041 

248 
577 
145 
35 
183 
124 

143 

215 
^90 

27 
228 

'7 
104 

134 
2S6 
202 
300 
201 

143 
15,620 


Pounds. 

24,500 
40,950 
52,290 

52,430 
60,900 

29,190 
63,630 
40,880 
58,240 
82,670 
126,770 
103,250 
32,690 
72,870 
17360 

•       40,390 

10,150 

2,450 

12,810 

8,680 

10,010 

15,050 

20,300 

1,890 

15,960 

1,190 

7,280 

9.380 

20,020 

i4<MO 

21,000 

14,070 

10,010 

1,093,400 


Crates,  70  pounds  each. 


147 

Mangoes. 


_      Date. 


1906. 
July  24.. 


Steamer  and  Location. 


Esperanza,  Pier  18,  East  river,  Brooklyn. 


Number 
Crates. 


47 


Pounds. 


tMS 


Crates,  3s  pounds  each. 


Preserved  Cherries. 


Date. 


1906. 
July  13... 


Steamer  and  Location. 

Number 
Casks. 

Pounds. 

Indiana.  Pier  6.  Bush  Docks.  Brooklyn 

2 

700 

Garlic  (Storage  lyarehouse). 


Date. 

Location. 

Number 
Hampers- 

Pounds. 

1906. 
July  19.. 

Aug.  21.. 

Sept.  6.. 

Union  Stores,  foot  Sedewick  street.  Brooklyn 

614 
783 
738 

i8u2o 

Masters  Stores,  foot  Brown  street,  Brooklyn 

Union  Stores,  foot  Sedirwick  street.  Brooklyn .,. ^^ ,.....,,.,,,.  rt , ^ 

22.140 

2,235 

64,050 

Hampers,  35  pounds  each. 


Record  of  Lemons  Seised  and  Destroyed  (Brooklyn) 


Date. 


1906. 

J 

une 

IX.. 

«t 

II.. 

«t 

16.. 

*i 

18.. 

«i 

19.. 

*t 

21.. 

t* 

25.. 

1 

28.. 

J 

ulT 

2.. 

Steamer  and  Location. 


Principessa  Latetia,  Pier  5,  Bush  Docks 
Napolitan  Prince,  Pier  4,  Bush  Docks. . . 

Irene,  Pier  5,  Bush  Docks 

Francesca,  Pier  5,  Bush  Docks 

Carpathia,  Pier  52,, N.  R.  Man 

Sicilia,  Pier  5,  Bush  Docks 

Cera,  Pier  4,  Bush  Docks 

Citta  Di  Messina,  Pier  6,  Bush  Docks. . . 
Sicilian  Prince,  Pier  4,  Bush  Docks 


Number 
Boxes. 

Potmds. 

278 

22,240 

164 

13,120 

307 

24,560 

52 

4,160 

191 

15,280 

273 

21,840 

733 

58,640 

1,432 

114,560 

260 

so,8oo 

148 


Date 


iqo6. 

July 

2 

it 

5 

tt 

7 

11 

10 

41 

M 

14 

i6 

44 

17 

44 

31 

44 

83 

44 

23 

44 

24 

44 

23 

44 

28 

44 

30 

Aug. 

a 

44 

3 

44 

4 

44 

13 

44 

>5 

44 

i6 

Steamer  and  Location. 


Maria,  Pier  5,  Bush  Docks 

Sofia  Hohenberg,  Pier  5,  Bush  Docks 

Cretic,  Pier  29,  North  river,  Manhattan. . . 

Italia,  Pier  6,  Bush  Docks 

Teresa,  Pier  6,  Bush  Docks 

Gerty,  Pier  4,  Bush  Docks 

Emy ,  Pier  5,  Bush  Docks 

Indiana,  Pier  6,  Bush  Docks 

Guilia,  Pier  5,  Bush  Docks 

Slavonia,  Pier  53,  North  river,  Manhattan 

Lucia,  Pier  5,  Bush  Docks 

Vincenzo  Bonnano,  Pier  6,  Bush  Docks... 

Emelia,  Pier  5,  Bush  Docks 

Napolitan  Prince,  Pier  4,  Bush  Docks 

Hermine,  Pier  5,  Bush  Docks 

Clara,  Pier  5,  Bush  Docks 

Francesca,  Pier  5,  Bush  Docks 

Luisiana,  Pier  4,  Bush  Docks 

Regina  Ehia,  Pier  5,  Bush  Docks 

Cretic,  Pier  5a,  North  river,  Manhattan. .. 


17,77a 


Number 
Boxes. 

Pounds. 

872 

69,760 

349 

«7.9«) 

1,146 

91,680 

loa 

8,160 

464 

37,x» 

692 

55J6o 

i3« 

11,040 

II 

880 

86 

6,880 

121 

9.680 

1,230 

98,400 

7417 

556,275 

698 

55,840 

17 

1,360 

144 

11,520 

102 

8,160 

47 

3,760 

23 

1,840 

403 

32,240 

20 

1,600 

1,384.675 


7417  Boxes  at  7§  pounds  each. 
10,355  Boxes  at  85  pounds  each. 


Prickly  Pears. 


Date. 


1906. 
Sept.   24 


44 


25 

Nov.    12 


Steamer  and  Location. 


Francesca,  Pier  5,  Bush  Docks,  Brooklyn 
Cretic,  Pier  49,  North  river,  Manhattan.. 
Francesca,  Pier  5,  Bush  Docks 


Cases  80  pounds  each. 


Cases. 


54 
5* 

14 


ISO 


Pounds. 


4J20 

4,160 
1,120 


9A» 


149 

Record  of  Grapes  Seised  and  Destroyed. 


Date. 


1906. 
Aug.     4 

Sept.  2S 

Oct.      5 


Steamer  and  Location. 


•  • 

8 

<« 

16 

ft 

M 

44 

as 

14 

29 

44 

31 

Not. 

3 

44 

8 

44 

10 

14 

13 

11 

14 

14 

17 

14 

19 

ti 

*4 

tl 

30 

it 

30 

Dec. 

I 

(1 

3 

(t 

4 

it 

S 

i( 

5 

ii 

7 

it 

8 

41 

8 

4t 

10 

44 

II 

41 

12 

it 


4( 


31 

Various 
Dates 


Francesca,  Pier  5,  Bush  Docks 

Cretic,  Pier  49,  North  river,  Manhattan 

Germania,  Pier  34,  Atlantic  Docks 

Algeria,  Pier  39,  Union  Stores 

Gallia,  Pier  37,  Atlantic  Docks 

Madonna,  Pier  38,  Atlantic  Docks 

Dora,  Pier  5,  Bush  Docks 

Carolina,  Pier  3,  Bush  Docks 

Italia,  Pier  29,  Union  Stores 

Roma,  Pier  34,  Atlantic  Docks 

Virginia,  Pier  6,  Bush  Docks 

Guillia,  Pier  5,  Bush  Docks 

Athalie,  Pier  7,  Bush  Docks , 

Francesca,  Pier  5,  Bush  Dock 

Neustria,  Pier  38,  Atlantic  Docks 

Perugia,  Pier  29,  Union  Stores 

Monviso,  Pier  6,  Bush  Docks 

Massilia,  Pier  38,  Atlantic  Docks 

Emilia,  Pier  4,  Bush  Docks 

Germania,  Pier  38,  Atlantic  Docks 

Sophia  Hohenberg,  Pier  $,  Bush  Docks 

Emy,  Pier  5,  Bush  Docks 

Provincia,  Pier  38,  Atlauitic  Docks 

Cretic,  Pier  49,  North  River,  Manhattan 

Carpathia,  Pier  $2,  North  River,  Manhattan.. 

Ultonia,  Pier  51,  North  River,  Manhattan 

Oceanic,  Pier  48,  North  River,  Manhattan 

Minnetonka,  Pier  39,  North  River,  Manhattan. 

Madonna,  Pier  34,  Atlantic  Docks 

Gallia,  Pier  38,  Atlantic  Docks 

Celtic,  Pier  48,  North  River,  Manhattan 

Dora,  Pier  5,  Bush  Docks 


Number 
Barrels. 


[■Auction  Houses,  No.  14  Jay  street,  No.  235  West  street,  Manhattan 


7,712 


Pounds. 


8IH 

i,6to 

9 

49S 

3a 

1,760 

43 

«,J65 

46 

2,530 

18 

990 

17 

935 

14 

770 

74 

4,070 

38 

2,090 

23 

1,265 

161 

8.85s 

a83 

15,565 

II 

605 

141 

7.755 

98 

5,350 

103 

5.665 

"5 

6,325 

24 

1.320 

93 

5,"5 

52 

2,860 

163 

8,965 

M70 

80,850 

47 

2,585 

1,181 

64,955 

767 

42,185 

226 

12,430 

14 

770 

272 

14,960 

626 

34,430 

21 

1,155 

1,163 

63,965 

286 

15,730 

421,325 


Pounds. 

7,631  Bbls.  at  55  pounds  each  419,705 

81X  Bbls  at  20  pounds  each 1,620 


421,32 


ISO 

Macaroni. 


Date. 

1906. 
Aug.    15 

Sept.     5 

Dec.    26 


Steamer  and  Location. 


Sicilian  Prince,  Pier  4,  Bush  Docks 
Indiana,  Pier  6,  Bush  Docks.. ..... 

Calabria,  Pier  29,  Union  Stores 


Number 
Pkgs. 


21 

72 
67 


160 


Pounds. 

462 
1,728 
1,474 


3.664 


Canned  Tomatoes. 


Date. 

Location. 

Number 
Cases. 

Pounds. 

1906. 
Dec.    10 

From  A.  Musica.  No.  2^  Water  street.  Manhattan 

143 

6,864 

Pomegranates. 


Date. 


1906. 
Aug.    15 


Steamer  and  Location. 


Monviso,  Bush  Docks,  Brooklyn. 


Number 
Cases. 


183 


Pounds. 


i3,7«5 


Italian  Melons. 


Date. 


1906. 
Oct.      8 

Nov.    12 


Steamer  and  Location. 


Algeria,  Pier  29,  Union  Stores. 
Athale,  Pier  7,  Bush  Docks.. . . 


Number 
Cases. 


II 
as 

36 


Pounds. 


880 

2,000 

2,880 


1 

I 


151 

Oranges. 


Date. 


iqo6. 

Nov. 

2 

<i 

27 

Dec. 

i8 

i( 

26 

It 

26 

Steamer  and  Location. 


Porto  Rica,  Pier  35,  East  River,  Brooklyn. 

Ponce,  Pier  35,  East  River,  Brooklyn , 

Caracus,  Pier  11,  East  River,  Brooklyn...., 

Zulu,  Pier  35,  East  River,  Brooklyn , 

Philadelphia,  Pier  11,  East  River,  Brooklyn 


Number 
Boxes. 


263 


Pounds. 


19 

1,520 

56 

4480 

37 

2,960 

91 

7,a8o 

60 

4.800 

21,040 


Date. 


1906. 
Dec.    14 


Vegetables. 


Steamer  and  Location. 


Algeria,  Pier  24,  Union  Stores. 


Number 
Cases. 


48 


Pounds* 


1,840 


Recapitulation. 


Lemons    

Grapes    

Pineapples    

Prickly  pears 

Mangoes    

Preserved  cherries 

Garlic    

Macaroni    

Canned  tomatoes 
Pomegranates    . . . 

Italian  melons  

Vegetables   

Oranges  


Pounds. 

1,384.67s 

421,32s 

1,093,400 

9,600 

1,645 

700 

64,050 

3,664 

6,864 

13,72s 
2,880 

1,840 
21,040 


Total   3,02S,4o8 


152 

During  the  past  year  all  of  the  retail  confectionery  stores  and  cel- 
lars where  candy  is  manufactured  have  been  inspected.  In  many  in- 
stances the  utensils  used  and  the  conditions  surrounding  the  manu- 
facture of  candy  were  far  from  sanitary.  The  utensils  were  old,  rusty 
and  dirty.  In  many  cases  the  floors  were  found  to  be  broken  and 
saturated  with  offensive  liquids,  so  that  it  was  impossible  for  them  to 
be  kept  clean. 

People  lived  and  slept  in  close  proximity  to  their  work.  There 
were  about  3,500  places  of  this  character  inspected,  as  a  result  of  which 
nearly  400  notices  or  orders  were  issued.  Most  of  these  have  been 
complied  with.  In  one  or  two  instances  the  manufacture  of  canly 
under  such  circumstances  was  declared  to  be  a  public  nuisance  by  the 
Board  of  Health,  and  the  places  closed.  In  many  other  cases  the  busi- 
ness was  discontinued  by  the  proprietor,  rather  than  go  to  the  expense 
of  making  the  improvements  and  alterations  required.  A  similar  in- 
spection has  been  made  of  the  bake  shops,  the  Italian  macaroni  manu- 
facturers, and  the  retail  grocery  stores;  especially  has  the  practice  of 
drying  macaroni  on  the  sidewalks  in  front  of  the  stores  been  dis- 
couraged. 

The  national  agitation  caused  by  the  passage  of  the  Pure  Food 
and  Drug  Law,  June  30,  1906,  has  not  increased  the  activity  of  that 
part  of  the  Department  service  dealing  with  foods,  for  at  all  times 
section  68  of  the  Sanitary  Code,  adopted  many  years  ago,  has  been 
strictly  enforced.  It  has,  however,  helped  to  bring  into  close  rela- 
tionship all  of  the  food  manufacturers  with  the  Health  authorities,  thus 
making  the  Department  one  of  vast  importance  in  connection  with 
all  food  producers.  Qose  association  with  the  various  manufacturers 
of  food  has  developed  the  unquestionable  truth  that  fully  95  per  cent 
of  the  dealers  desire  to  observe  and  not  to  evade  the  laws;  usually 
infractions  are  caused  by  ignorance  rather  than  intent. 

During  the  year  1906,  1.365  samples  of  various  foods  and  drugs 
have  been  obtained  and  delivered  to  the  Chemical  Laboratory  for 
analysis.  Included  in  this  number  are  articles  which  are  usually  sup- 
posed to  be  adulterated,  among  which  may  be  mentioned  spices,  flavor- 
ing extracts,  fruit  syrups,  maple  syrup,  jams,  jellies,  confectionery, 
confectionery  coloring,  dried  fish  and  dried  fruit,  canned  foods,  canned 


153 

condensed  milk,  gelatine,  liquid  eggs,  teas,  coffees,  butter,  catsups, 
sauces,  baking  powders,  sausages,  drugs  and  physician's  prescriptions, 
to  determine  cases  of  substitution. 

Inspectors,  in  conjunction  with  their  routine  work,  obtain  samples 
of  the  articles  mentioned  in  the  list  above,  and  deliver  them  personally 
to  the  Chemist  at  the  Laboratory,  who  is  to  be  assigned  to  make  the 
analysis,  so  that  in  the  event  of  prosecution  the  chain  of  evidence  from 
the  vendor  to  the  Chemist  will  not  be  broken. 

During  the  agitation  early  in  the  year  in  relation  to  the  meat  pack- 
ing industry,  all  places  in  this  borough  where  sausages  were  sold  and 
made  were  inspected,  and  samples  obtained  to  ascertain  whether  they 
contained  preservatives  and  coloring.  Many  were  found  to  contain 
borates  and  coal  tar  dyes.  In  such  cases  the  makers  and  vendors  were 
summoned  to  the  office  of  the  Assistant  Sanitary  Superintendent,  and 
their  attention  called  to  the  fact  that  the  use  of  these  materials  in 
sausage  was  a  violation  of  the  provisions  of  the  Sanitary  Code,  and 
they  were  warned  that  a  second  offense  would  lead  to  the  case  being 
brought  before  the  Criminal  Court. 

Re-examinations  were  made  of  all  these  places  subsequently,  and 
samples  were  obtained  for  re-analysis.  With  but  very  few  exceptions, 
upon  reinspection,  no  preservatives  or  artificial  coloring  were  found, 
and  in  those  few  cases  arrests  were  made,  and  fines  imposed  by  the 
Court  of  Special  Sessions. 

There  have  also  been  made  a  few  arrests  for  other  adulterations, 
and  for  false  labeling  and  misbranding,  in  all  of  which  cases  the  offend- 
ers were  convicted,  and  fined  in  the  Court  of  Special  Sessions. 

The  territory  known  as  "  The  East  Side  "  comprises  that  part  of 
Manhattan  Island  bounded  by  Houston  street,  Chatham  square,  and 
Bowery  to  East  river ;  the  population  there  is  the  heaviest,  and  is  com- 
posed chiefly  of  foreigners,  mostly  Hebrews.  They  deal  in  every 
known  kind  of  food,  having  their  places  of  business  on  the  sidewalk, 
on  push  carts,  and,  in  fact,  anywhere  space  is  available.  They  do  not 
understand  English,  nor  do  they  care  to  when  approached  by  the  De- 
partment's inspectors,  who  are  ever  alert  to  see  if  their  wares  are  fit 
to  sell.     One  inspector  is  on  duty  constantly,  assisted  by  two  others 


154 

Tuesdays  and  Fridays  (their  great  market  days).  He  is  furnished 
with  a  wagon  by  the  Department  of  Health,  in  order  that  he  may  re- 
move for  destruction  the  food  stuffs  seized  by  him. 

Nearly  all  foreign  fruits  pay  duty  to  the  Government,  and  when 
it  arrives  in  poor  condition  great  care  must  be  exercised,  in  order  that 
the  two  powers  may  work  in  harmony. 

The  Government  do  not  object  to  condemnation  proceedings,  but 
wish  to  be  assured  that  the  fruit  will  reach  the  dump.  Heretofore, 
the  Government  sold  lemons  at  auction  that  were  abandoned  by  the 
importers  as  not  worth  freight  and  duty ;  that  was  an  evil  to  overcome, 
for  nearly  all  of  it  was  purchased  by  the  East  Side  dealers.  Finally, 
airangements  were  made  with  the  Federal  authorities  that  all  aban- 
doned goods  were  to  be  sold  the  same  as  usual,  but  only  sound  deliveries 
made.  Importations  of  food  stuffs  are  increasing  in  such  proportions 
that  inspections  and  condemnations  have  assumed  a  magnitude  that 
make  it  absolutely  essential  for  additional  assistance,  in  order  that  the 
present  efficiency  may  be  maintained. 

Fish. 

An  evil,  with  which  the  Department  has  been  contending  for  years, 
is  the  Fulton  Fish  Market,  and  streets  adjacent  thereto,  by  reason  of 
the  incessant  complaints  made  by  citizens  having  their  wearing  ap- 
parel ruined  by  coming  in  contact  with  fish  and  fish  slime,  '^lere 
was  some  slight  excuse  for  this,  owing  to  the  limited  space  and  nar- 
row streets. 

By  constant  vigilance,  care,  threats  and  diplomacy,  practically  a 
normal  condition  now  prevails,  and  not  a  complaint  in  seven  months 
has  been  made.  This  state  of  tranquillity  and  efficiency  has  not  at  any 
time  heretofore  existed. 

The  retail  markets  for  fish  are  fewer  than  in  previous  years,  owing 
to  the  fact  that  the  stringent  Department  rules  require  the  dealers 
who  occupy  stalls  and  stands  to  live  up  to  high  sanitary  conditions, 
which  many  had  previously  refused  to  do,  as  it  involved  the  expendi- 
ture of  too  much  money.  All  of  the  Ice  Houses  and  Cold  Storage 
buildings  arc  regularly  visited  by  an  Inspector  familiar  with  the  fish 


'55 

trade,  and  in  the  summer  months  he  looks  after  the  fish  while  being 
stored,  to  see  that  only  the  best  goes  to  the  freezer.  During  his  sub- 
sequent visits  to  these  places  he  carefully  notes  the  tetnperature  to  see 
that  it  is  not  intermittent  above  32  degrees  Fahr.  Fish,  in  many  in- 
stances, before  being  offered  for  sale,  is  assorted  into  different  sizes 
and  kinds. 

Most  of  the  diflFerent  wholesale  fish  dealers  outside  of  New  York,  I 
and  also  the  owners  of  the  retail  fish  markets,  of  this  and  neighbor-  I 


ing  cities,  arrive  at  the  market  about  5  a.  m.  A  certain  few  make  it 
a  practice  to  get  to  the  market  any  time  between  the  hours  of  7  a.  m. 
and  Q  a.  m. 

Then  there  is  what  is  commonly  called  the  basket  trade,  which  is 
principally  composed  of  Sicilians.  They  arrive  early  with  zinc  lined 
baskets,  which  hold  about  100  lbs.  of  fish.  They  purchase  as  much 
as  they  can  conveniently  carry,  and  dispose  of  same  to  the  different 
families  in  the  five  Boroughs  of  Greater  New  York,  also  Jersey  City 
and  Hoboken,  going  even  as  far  as  Newark.  N.  _f. 


'57 

in  order  lo  give  a  brilliant  line,  which  finds  it  a  ready  market,  and, 
addition,  use  coal  tar  to  give  a  smoky  taste;  this  kind  of  sea  food  is  ] 
usually  sold  by  delicatessen  stores,  and  the  subtlety  covers  a  great  de-  ] 
ception,  for  it  affords  opportunity  to  sell  a  very  low  grade  fish  for  a  J 
high-priced  one.    This  traffic  and  abuse  is  now  being  carefully  investi- 
gated, and  when  Ihe  chemical  analysis  will  have  been  finished  the  of- 


k-ndei 


I'ill   1 


:   wilti. 


m-^ 


I 


There  has  been  but  little  cliangt  in  the  methods  of  handling  meat 
lor  the  New  York  market  commercially.     There  have  been  no  new 
abattoirs  erected  and  very  few,  if  any,  changes  have  been  made  in  the 
abattoirs  already  in  existence.    As  a  result  of  the  investigation  of  the 
lood  qneslion,  and  more  especially  that  of  the  preparation  of  meat  for 
food  by  the  United  States  Government  early  in  the  year,  the  number  of 
men  assigned  to  the  inspection  of  meal  was  increased  by  five  new  in- 
spectors, appointed  on  the  4th  of  June,   1906.     This  addition  to  the 
working  force  is  enabling  the  Department  to  keep  a  closer  watch  upon  j 
the  slaughter  houses  and  upon  the  markets  and  retail  stores  in  which  J 
meat  is  sold.    In  consequence  of  this  increased  force  the  Inspectors  of  I 
this  Department  condemned  1,526,239  pounds  of  meat  during  the  yeari 
1906,  against  342.269  pounds  during  the  year  1905. 


Slaugliter-hoitses. 

The  districts  in  which  slaughter-houses  (other  than  poultry  slaugh- 
ter-houses) may  he  conducted  are  defined  in  section  84  of  the  Sanitary 
Coile.  In  each  district  a  sufficient  number  of  Inspectors  of  Foods  I 
(meat)  are  assigned  to  control  the  slaughtering  of  animals  and  the  I 
quality  of  the  meat  produced.  They  are  required  to  examine  the  stock  1 
on  the  hoof  and  after  killing,  and  to  seize  and  destroy  all  such  as  is  ui 
for  human  food.  The  meat  which  is  condemned  is  inmiediately 
stro>i:d  in  the  tanks  which  are  used  for  the  destruction  of  the  offal  from  I 
Ihc  slaughter-house.  These  inspectors  are  also  required  to  see  that  the  I 
.slaughter-houses  and  their  appurtenances  are  at  all  times  kept  sanitary.  I 

In  addition,  from  time  to  time,  a  sanitary  inspector  makes  a  thorough 
examination  of  the  slaughter-houses  and  disposal  plants  and  submits 
written  reports  as  to  their  condition.  Early  in  the  summer  one  of  the 
oldest  disposal  plants  on  the  west  side  was  declared  to  be  a  public 
nuisance,  as  a  result  of  which  very  extensive  alterations  and  improve- 
ments have  been  made,  and  the  plant  is  now  in  as  good  condition  a& 
such  a  plant  may  be  placed. 

It  may  seem  strange  that  the  most  poignant  reason  for  the  exist- 
ence of  slaughter-house.';  in  the  heart  of  a  large  city   is  a  religious  one,  | 


159 

but  such  is  the  fact.  The  Jewish  population  of  Xew  York  is  greater 
than  that  of  any  city  in  the  world,  and  as  the  Orthodox  Jew  is  not  al- 
lowed by  his  religion  to  eat  food  which  is  not  "  Kosher,"  the  necessity  is 
explained. 

The  rabbinical  definitions  of  "  Kosher  "  meat  are  such  that  animals 
cannot  be  slaughtered  at  any  distance  from  the  point  at  which  the  meat 
is  to  be  consumed.  In  all  of  the  local  slaughter-houses  arc  Jewish  re- 
ligious officials,  who  examine  each  carcass  and  mark  it  either  "  Kosher  " 


The  disposal  of  the  blood  and  offal  from  these  slaughter  houses  is 
a  most  serious  one  and  one  over  which  the  Deparlnient  of  Health  keeps 
constant  supervision  in  order  that  no  offensive  odors  may  arise  or  that 
no  nuisance  may  be  created.  As  a  result  of  this  control  there  have  been 
few,  if  any.  complaints  received  which,  upon  uivestigation,  were  found 
to  be  justifiable.  The  following  tables  will  show  the  number  of  animals 
slaughtered  for  food  in  the  Borough  of  Manhattan  during  the  year 
1906: 


i6o 


Animals  Slaughtered  at  East  Side  Abattoirs. 

By-products, 


Cattle. 


January  . 
February 
March... 
April 


May 
June. 


July. 


August.... 
September 
October... 
November. 
December. . 


Total. 


25/J66 
27Ja8 
25734 
22,879 

a9,925 
26,197 
21,215 
28,602 

231814 
28.236 

25714 
25,651 


Sheep. 


Calves. 


311.261 


73,756 
7c,39i 
69,134 
76,589 
123,021 

100455 
90,990 
78.187 
72,128 
90,026 
77.501 
71,039 

993,2  »7 


8,243 

8.680 

11,051 

23,514 
35,867 
22,898 
16,996 
27,188 

9,931 
14,067 
10.096 

9,364 


197,895 


Total. 

107,965 
106,399 
105,919 
122,982 
188,813 

149.550 
129,201 

133»977 

105,873 

132,329 

113,311 
io6/>54 

1,502,373 


Animals  Slaughtered  at  JVest  Side  Abattoirs. 


January  . 
February. 

March 

April 

May 


June 

July 

August 

September . 
October  . . . 
November. 
December 


Total 


Cattle. 

11.053 
11.372 

9,855 
10,231 
10,054 

5.687 
10,090 
11,115 

9i442 
11,762 

10,337 
10,281 

121.279 


Sheep. 

45,415 
45,580 
38,885 
46,045 
41,568 
89.779 
60,387 

51,659 
52,626 
58,017 
48,626 
41,581 

620,168 


Hogs. 

100,555 
1 16,220 
74,486 
99,015 
74,561 
59,706 
bifiib 
54,080 

64,730 
88,480 
81,615 

79,659 


954,141 


Calves. 

3.554 
4,423 
5,855 
8064 

13,019 

13.528 

11,196 

9,671 

7,054 
8.878 

7,103 
4.681 

97,026 


Total. 

160,577 

177,595 
129,081 

163.355 
139,202 
168,700 

142,699 
126,525 

133,852 

167,145 
147,681 

136,202 

1,792.614 

k     - 


Suvimary. 


East  Side.. 
West  Side 


(irand  Total 


Cattle. 

311,261 
121,279 


Sheep. 


Hogs. 


993,2n 
620,168 


954,141 


432,540 


1.613,385 


954,141 


Calves. 

197,895 
97,026 

294.921 


i6i 

From  these  animals  there  was  obtained  fat,  blood  and  offal,  which 
was  treated  and  disposed  of  on  the  premises,  without  offense,  to  the 
amount  shown  in  this  table : 


January . . 

February 

March... 


April 


May. 
June. 


July 

August 

September . 
October... 
November. 
December  . 


Total  East  Side. 


East  Sidr  Slaughter-houses. 


Offal. 


Blood. 


563  tons. 

1 

476 

«             1 

1 

51S 

1 

605 

330 

417 

272 

3S4 

245 

^ 

.        1 

412 

1 

3Q0 

'*        1 

4,043 

tons. 

1 

95  tons. 

93  ** 

82  •• 

90  '• 

72  •' 

QI  " 

75  •• 

83  " 
74  " 
59  " 

84  •* 
79  ** 

977  tons. 


Fat  Rendered. 

5,648,450  Ibt. 
5,814,670    ** 

6,974,328    ** 
8,698,980    " 

4,881,750    " 
6,005,32a    ** 

5.069,983    " 
7,231,420    " 

5,357,381  " 

2,528.763  " 

2,029,094  " 

2.537,168  " 

62,777.309  lbs. 


West  Side  SLAitiUTER-HoisEs. 


January  . 
Febniary 
March... 
April 


May 

June. 

July. 


Aug^ust  . . . 
September. 
October.... 
November. 
December  . 


Total  West  Side. 
Total  East  Side. 

Grand  Total 


Otfal. 

157  tons. 
159    " 

i3«    '• 
137    " 

13S  " 

210  " 

230  " 

176  •• 

260  " 


257    " 


232    " 
244    " 

2.338  tons. 
4.943    '* 

7. 281  tons. 


Blood. 

Fat  Rendered 

851 

tons. 

i,37vS.68o  lbs. 

S7 

2,458,055    •' 

69 

3.882,190    •' 

76 

2.392.380    " 

70 

2,867,150    " 

119 

3,409.982    •' 

97 

2,852,000    " 

64 

2,520,350    '• 

79 

2.750,205    *' 

67 

3.444,246    " 

61 

3.215.481    •' 

53 

2.897.751    '• 

027 

tons. 

34,068.560  lbs. 

977 

t  k 

62.777.300    •' 

1.004  1 

tons. 

96.84 5, .S69  lbs. 

l62 

Poully  Slaughter-houses. 

The  only  excuse  for  the  existence  of  slaughter-houses  of  this  char-  I 
acter  in  the  built-up  portion  of  a  city  is  the  reason  given  for  the  main- 
tenance of  slaughter-houses  for  cattle  and  small  stock. 

From  the  natural  characteristics  of  poultry  it  is  a  question  whether 
places  of  this  sort  can  be  conducted  at  all  times  without  offense. 

In  order  to  meet  these  conditions  Meat  Inspectors  have  also  had 
these  establishments  under  constant  supervision,  and  at  times  Sanitary 
Inspectors  and  Patrolmen  have  been  instructed  to  visit  them  and  en- 
force all  necessary  precautions.  In  addition,  a  copy  of  tlie  followingf 
reflations  adopted  by  the  Board  of  Health  are  posted  in  one  or  more 
conspicuous  places  in  each  jwultry  slaughter-house. 


Rules  and  Regnlalio»s  to  be  Obscrz'cd  in  Conducling  Poultry  Slaughter- 
Houses  in  the  City  of  Ne%v  York. 

1.  The  floors  of  these  premises  must  be  swept,  Hushed  and  deodor- 
ized at  the  close  of  each  day's  business. 

2.  All  parts  of  the  walls  and  ceilings,  which  are  not  sheathed 
with  metal,  must  be  cleaned,  painted  or  whitewashed  as  often  as  re- 
quired by  the  Department  of  Health. 

3.  All  parts  of  cages  (other  than  the  floor)  and  gutters  must  be 
cleaned  and  painted  as  frequently  as  may  be  required.  The  floors  of 
all  cages  must  be  scraped  and  cleaned  immediately  after  emptying. 

4.  No  cage  shall  be  used  for  the  storage  of  fowl  for  a  longer 
period  than  three,  days,  without  emptying  and  cleaning. 

5.  The  sheathed  sides  of  the  killing  room,  the  absorption -box, 
and  the  gutter  beneath  the  same,  must  be  thoroughly  cleaned  with  a 
strong  solution  of  soda,  and  flushed  at  the  close  of  each  day's  work. 

6.  Sawdust  which  has  been  used,  and  all  other  refuse,  of  any  kind 
whatsoever,  must  be  deodorized  and  removed  from  tlie  premises  daily. 

7.  The  storage  of  crates  containing  poultry  is   forbidden   in  or  , 
about  the  premises, 

8.  No  empty  crates  may  be  stored  on  the  premises  except  in  such   , 
places  as  may  be  approved  by  the  Department  of  Health. 

9.  The  accumulation  of  disused  barrels,  boxes,  or  other  offensive  1 
material  will  not  be  allowed  upon  the  premises. 


1 63 

lo.     No  poultry  are  to  be  allowed  at  liberty  on  the  premises. 
Any  violation  of  these  regulations  will  be  deemed  sufficient  cause 
for  the  revocation  of  the  permit  to  slaughter  poultry. 

By  order  of  the  Board  of  Health, 

Thomas  Darlington,  M.  D.. 

Commissioner  of  Health. 

Eugene   W.   Scheffer,   Secretary. 

On  the  31st  of  December,  1905,  there  were  30  permits  for  the 
maintenance  of  a  poultry  slaughter-house,  and  on  December  31,  1906, 
there  were  38,  an  increase  of  8  in  the  total  number. 

Five  million  nine  hundred  and  seventeen  thousand  three  hundred 
and  sixty-five  head  of  poultry  were  slaughtered  for  food  in  the  Borough 
o:  Manhattan  in  the  year  1906. 

The  Milk  Supply. 

Milk,  as  known  in  commerce,  is  the  secretion  of  the  mammary 
glands  of  cows.  The  milk  from  other  domestic  animals,  while  whole- 
some, and,  in  some  cases,  more  nearly  like  human  milk,  chemically, 
than  cows'  milk,  is  not  met  with,  and  is  not  to  be  considered  as  part 
of  New  York  City's  supply. 

Normal  cows'   milk   contains   on   the   average  as   follows : 

Per  Cent. 

Water    84  to  87 

Carbohydrates  (lactose)    4  to   5 

Proteids  or  albuminoids  (casein,  albumen,  etc. ) 4  to   S 

Fats    3  to   4.50 

Salts  or  ash 70 


-: — 1-  1 


The  composition  of  milk  varies  considerably  in  difFerent  breeds, 
and  in  quite  an  extent  in  different  cows  of  the  same  breed.  The  Jer- 
sey, Alderney  and  (iuernsey  breeds  j)rodiu:e  the  milk  which  is  richest 
in  fat,  while  the  Ayrshire  and  llolstein  milk  i-^  lowest  in  fats  and  solids. 
The  solids  other  than  fat  do  not  vary  in  as  j^reat  j)roportion  as  th^ 
fat. 


i64 

Milk,  as  sold  in  the  City,  is.  to  a  very  great  extent,~~vai 
the  product  of  the  various  dairies  selling  milk  to  one  shipper  is  mixed 
so  that  the  output  from  each  creamery  is  of  a  nearly  iiniforiu  quality. 

Milk,  in  itself,  is  a  complete  food,  and  contains  all  of  the  elements, 
necessary  to  sustain  life.  It  is  one  of  the  most  universal  of  foods,, 
and  especially  is  it  a  food  for  invalids,  children  and  infants.  It  is  ofij 
the  utmost  importance  that  it  should  be  in  a  wholeso:ue  condition  when. 
it  reaches  the  consumer,  and  that  it  should  be  deliveri'd  to  the  coii- 
fumer  as  it  is  uorniallv  *ecrelcil   hv  a  healthv  c<i\v. 


« 


WET   COW   VAHtl 

The  most  common  adulterations  of  milk  are  the  removal  of  cream  J 
or  the  addition  of  water,  both  of  which  reduce  its  nutritive  v 
and  the  use  of  preservatives  to  prevent  souring,  thus  extending  the  ■ 
life  of  milk  in  the  market.  All  these  are  injurious  to  the  consumer.  .1 
more  especially  to  children  whose  food  so  largely  consists  of  milk.  J 
Variation  in  the  quality  of  milk  is  very  apt  to  derange  the  digestive  3 
organ  of  a  child  and  preservatives  seriously  interfere  with  digestion. 

Bacteria  are  among  the  smallest  and  sin^plest  of  all  living  things. 
They  can  only  be  seen  when  magnified  by  the  microscope  many  thou- 


■6s 

sand  times.  They  much  resemble  the  cells  of  which  plants  are  com- 
posed, and,  like  plants,  require  moisture,  warmth  and  food  to  grow. 
When  these  conditions  are  present  they  multiply  very  rapidly,  so  that 
from  one  germ  200  may  be  produced  in  three  hours.  10,000  in  six 
hours,  10,000,000  in  nine  hours,  and  2,000,000,000  in  eighteen  hours. 

As  bacteria  increase  in  numbers,  they  gather  nourishment  from 
the  milk  or  other  substances  in  which  they  develop  and  like  other 
higher  forms  of  life  transform  what  they  take  into  their  bodies  into 


useless  or  poisonous  products.  They  thus  both  rob  the  food  of  its 
nutritious  substances  and  add  others  to  it  which  are  more  or  less  poi- 
sonous. When  bacteria  grow  in  living  things,  whttlier  they  be  men, 
animals  or  plants,  they  excite  changes  in  them  which  we  know  as 
disease.  The  bacteria  which  grow  in  dead  things  caure  them  to  fer- 
ment, rot,  or  putrefy.  Thus  uiilk  becomes  sour  through  the  change 
of  its  milk  sugar  into  acid,  produced  by  bacteria.  But  long  before 
milk  becomes  sour  to  the  taste,  it  may  contain  enormous  numbers  of 


I 


bacteria  and  has  already  become  unwholesome,  and  perhaps  dat^vr- 
ous,  when  employed  for  food,  especially  for  young  children. 

The  bacteria  or  germs  which  cause  the  various  infectious  diseases, 
such  as  typhoid  fever,  scarlet  fever,  diphtheria,  consumption, 
readily  live  and  multiply  in  milk,  and  outbreaks  of  these  diseases  have  I 
been  frequently  traced  to  contamination  of  milk  bv  ignorant  or  care-  ■! 
less  milkmen  who  have  infected  the  milk  with  disease  germs  from  their  I 
hands,  from  polluted  water  or  other  sonrces,  either  while  themselves  I 
sick  or  recovering  from  some  one  of  these  diseases,  or  while  nursing  I 


Mir.K   TR,M\    STOPPING    AT   CREAM"ERY', 

Others  who  were  snfTcring  from  them.  -Many  thousands  of  cases  of  ill-  j 
uess  and  death  have  thus  been  produced.  This  is,  of  course,  entirely  ] 
unnecessary  and  can  be  prevented.  It  is  most  important,  therefore,  for  A 
all  persons  who  handle  milk  to  know  from  what  portion  of  the  body  I 
tlitse  minute  germs  are  given  off  so  that  they  may  adopt  the  necessary  ] 
precautions  to  prevent  infection  of  the  milk.  The  germs  which  cause  I 
scarlet  fever  are  thrown  off  in  the  discharges  from  the  nose  and  throat  1 
and  in  the  scaling  from  the  skin.  Those  which  cause  typhoid  fever  are  1 
voided  in  the  urine  or  feces,  and  thus  often  reach  the  spring  or  well  J 


167 

water  with  drainage  which  has  leaked  into  it.    Thostr  which  cause  coii- 

umption  and  diphtheria  are  contained  in  the  expectoration.    The  germs 
from  cows  which  are  diseased,  especially  when  affected  with  consump- 

ion  or  disease  of  the  udder,  may  also  infect  the  milk  and  produce  aick- 
icss  in  those  who  drink  it.    The  bacteria  which  cause  milk  to  sour  am 
ferment  and  so  become  unwholesome  are  derived   from  manure  and 

lirt.  which  drop  into  the  milk  pail  from  the  cow's  belly  or  ndder  or  tail 
ir  from  the  dust  in  the  air,  or  from  the  dirt  off  the  milker's  hands,  or 

hey  are  contained  in  the  pails  and  cans  which  have  not  been  thoroughl\ 
cleaned  after  having  been  previously  used  for  milk. 

1 

^gg| 

1 

I 

When  milk  is  collected  under  cleanly  conditions  not  more  than  one 
twentieth  as  many  bacteria  fall  into  it  as  when  the  conditions  are  dirty 
A  very  little  sour  milk  contains  millions  of  bacteria. 

Milk  afTords  one  of  the  best   foods  for  the  growth  of  bacteria 
When  fresh,  however,  it  contains  substances  which  retard  somewha 
the  development  of  bacteria  for  a  few  hours,  if  they  are  not  too  nn 
nerous,  but  we  depend  upon  low  temperatures  to  further  limit  change 
n  it.    Just  as  large  forms  of  plant  life  cannot  grow  in  cold  weather 
so  also  these  minute  germ  plants  are  prciTnted  from  multiplication  b; 
cold. 

1 

i68 


Bacteria  founil  in  milk  generally  multiply  most  rapidly  at  a  tem- 
perature of  95  degrees  Fahrenheit  and  cease  to  multiply  at  all  at  the 
freezing  temperature.  Any  reduction  of  the  temperature  below  95  de- 
grees Fahrenheit  limits  the  rapidity  of  growth,  but  it  is  not  until  the 
temperature  is  45  degrees  Fahrenheit  that  the  growth  is  nearly  ar- 
rested. At  40  degrees  Fahrenheit  there  is  no  increase  for  24  hours  in 
the  number  of  bacteria  present  in  milk,  and  at  32  degrees  Fahf\'nheit 
milk  remains  unchanged  for  an  indefinite  period.  In  fresh  milk,  prop- 
erly collected  and  (juicklv  cooled   to  43  degrees   Fahrciihi'it    and   kept 


at  this  temperature  during  the  first  24  hours,  there  is  no  increase  in 
this  number  of  bacteria :  after  24  hours  the  peculiar  properties  of  fresh 
milk  to  resist  the  growth  of  bacteria  become  exhausted  and  the  bacteria 
also  become  gradually  accustomed  to  the  cold,  so  that  even  at  this 
temperature  the\'  may  rapidly  increase  and  in  a  few  days  cause  the 
milk  to  become  sour. 

For  example,  a  sample  of  milk  taken  under  good  conditions  con- 
tained, immediately  after  milking,  300  bacteria  in  each  drop.  It  was 
cooled  to  45  degrees  Fahrenheit  and  the  temperature  maintained  at  this 
point.     After  24  hours  it  contained  in  each  drop  only  200  bacteria; 


m 


'  /  r/fff/^^trt 


i69 

alter  48  liours,  yoo;  ami  after  "jz  hours.  150,000.  The  milk  curdled 
00  the  sixth  day.  Another  specimen  lakcn  in  a  dirty  barn,  cooled  and 
kept  at  52  degrees  Fahrenhdt.  contained  at  first  2.000  bacteria  in  each 
drop ;  in  24  hours,  6.000 ;  in  48  hours,  345,000,  and  in  72  hours,  16,500,- 
000.    The  milk  curdled  on  the  fourth  day. 

The  following  interesting  table  prepared  from  data  obtained  by  the  J 
Research  Laboratory  of  this  Department  sets  forth  these  facts  very  J 
appropriately : 


which  Elapsed  BefoK  Making  Te.'il. 


J9*F.i«-C.),. 
4.''F.<i.j*C.), 

^ipF-di  0... 

So'F,  (lifC-)- 
SS-F.(.JC.). 
«0»F.(i6'C|.. 
M-  F.  (»'  C-) 
WF.fjo'Ct 
W   F.(3S'C.) 


jSjioo 


4S  hnnn. 

96hou«. 

1,100 

SS 

.SZ' 

IS 

;;» 

MO  ,000 

3;, 000.000,000 

Jt  must  be  admitted  that  it  is  impossible  to  obtain  cow's  milk  under 
the  ordinary  conditions  without  aJlowiiig  some  bacteria  (which  always 
abound  in  the  dirt  and  dust  of  the  barn  and  on  the  cattle)  to  drop 
into  it.  but  the  number  may  be  limited,  and  it  is  wholly  unnecessary  and 
inexcusable  to  permit  the  germs  of  the  diseases  of  human  beings  or 
tattle  to  enter.  A  moderate  number  of  germs  obtained  from  dirt  ren- 
der the  milk  distinctly  unwholesome,  even  for  young  infants,  but  the 
fewer  bacteria  in  it  the  more  wholesome  it  is,  and  when  the  number 
becomes  very  lai^e  the  milk  becomes  not  only  unwholesome  but 
dangerous,  and  the  use  of  such  milk  is  the  commonest  cause  of  the  diar- 
rhceal  diseases  of  children,  particularly  prevalent  in  summer.  The  im- 
portance of  this  ma)-  be  appreciated  when  it  is  known  that  6,000  deaths 
occurred  from  the  diarrhosal  diseases  in  New  York  City  among  chil- 


I70 

drcn  tinder  hve  during  the  year  igo6.     It  must  be  remembered  that   . 
under  all  conditions  considerable  time  must  elapse  before  milk  reaches  I 
the  consumer  and  before  it  is  used,  and  that  if  it  is  not  carefully  handled 
the  number  of  germs  contained  in  it  when  used  becomes  very  large  and 
sometimes  almost  incredible;  there  may  be  at  the  end  of  the  third  day   i 
two  or  three  thousand  niilliou  germs  in  a  teaspoonful  of  milk  not  prop- 
t-rly  collected  and  cooled.    As  tlie  milk  must  often  be  kept  in  the  house  J 
for  twelve  hours  or  more  after  it  is  delivered  and  before  it  is  c 
snmed,  it  nalnrally  becomes  still  more  iin wholesome  befnre  being  used. 


;k  milk  is  sold. 

and  it  therefore  becoines  more  important  that  milk  should  reach  the 
consumer  in  good  condition. 

The  number  of  bacteria  in  milk  should  be  as  low  as  is  possible  under 
the  conditions  under  which  practical  dairy  farming  must  at  present 
be  carried  on.  The  cattle,  stables  and  milkmen  should  be  kept  clean 
and  the  pails  and  cans  should  be  always  scrupulously  clean.  The  milk 
should  be  immediately  cooled  after  being  collected  and  transported  to 
llie  cars  and  to  the  city  with  the  least  possible  delay.  So  far  as  it  prac- 
ticable each  day's  miik  supply  should  reach  the  city  on  the  following' 


1/1 

iiiorning.  and  the  leniperaliire  nf  the  milk  should  be  continuously  main- 
tained at  45  degrees  or  less. 

These  facts  being  accepted,  the  Department  of  Health  has  deter- 
mined to  safeguard  New  York  City's  milk  supply  at  all  points.    To  at- ' 
lain  this  end  it  has  organizcil    the    milk    inspection  corps  along  the  I 
broadest  lines. 

The  complete  and  proper  supervision  of  the  milk  supply  of  The  City  ' 
of  New  York  is  a  subject  to  which  the  Department  from  year  to  year  I 
has  devoted  more  and  more  attention. 


IIEHIIL'S    METUi 

It  has  long  been  recognized  that  there  are  two  conditions  which  in- 
Huence  and  control  very  materially  the  keeping  qualities  of  milk  and 
which  may  cause  it  to  become  most  imwholesome. 

One  of  these  conditions  is  absolute  cleanliness  from  ibe  moment  the 
milk  is  drawn  from  the  cow  until  such  time  as  it  is  delivered  into  the 
hands  of  the  consumer.  The  other  is  the  temperature  at  which  the 
milk  is  kept  during  this  period. 

For  over  ten  years,  under  the  provisions  of  section  56  of  the  Sani- 
tary Code,  the  Department  of  Health  has  been  issuing  permits  to  va- 


nous  persons  within  The  City  of  Xew  York  to  receive,  hold,  keep  and 
offer  for  sale  fresh  or  condensed  milk.  During  all  this  time  the  appli- 
cations for  these  permits  have  been  most  carefully  investigated  as  to 
ibe  conditions  with  which  it  is  expected  to  surrunnd  the  milk  while 
OR  sale. 

It  has  been  more  and  more  realized  within  the  past  tew  years  that 
this  was  but  a  small  step  towards  the  purification  of  the  milk  supply 
as  a  whole,  and  it  was  deemed  tteccessary  to  reach  out  and  attempt  to 
control  arwi  correct  the  conditions,  which,  if  allined  to  eJti?^.  could  not 


be  overcome  by  the  most  cai^ful  sanitary  supervision  after  the  milk 
icatched  the  dealers  in  the  city. 

On  the  theory  that  a  person  making  an  applicatinn  for  a  permit  to 
sriS  mifc  by  the  nxre  fact  of  his  applicative  consented  to  a  thotxtngh 
mvestigatian  of  his  supply  from  beginnii^  to  end.  investigations  into 
the  transportation  of  milk,  and  the  cooling  of  the  same  while  on  die 
raifamds  in-tiansii-  were  began  in  igoo.  Numerous  consultatioos  were 
held  dtiring  that  and  the  ensuing  \-ear  with  the  oAicials  of  the  railraads 
ifimtly  concerned  in  this  transportation;  these  gentlemen  understand-  ( 


'73 

ing  most  fully  that  tliis  work,  while  it  might  work  a  temporary  hard- 
ship on  the  railroads  in  question  in  that  they  were  not  fully  supplied 
with  the  proper  cars  and  a  sufficient  quantity  of  ice.  also  realized  that 
anything  which  might  tend  to  increase  the  keeping  qualities  of  milk 
prevented  sonring  and  prevented  its  becoming  unwholesome,  would 
ultimately  redoiuid  very  much  to  the  advantage  of  the  various  railroikds 
which  they  represented,  and,  conwquently.  they  met  the  suggestions 
of  the  Department  most  cordially  and  did  everything  that  was  in  their 


;n  wooi>en'  gutter. 
power  at  that  time  to  see  that  these  suggestions  were  promptly  and 
properly  carried  out.  Since  that  time  until  the  present  writing  a  gradual 
improvement  in  the  transportation  of  milk  has  resultt^d ;  larger  and 
better  cars  of  the  refrigerator  type  are  being  constantly  built  and  placed 
in  service.  All  of  the  railroads  are  erecting  or  have  erected  additional 
ice  houses  of  great  capacity  in  order  that  they  might  supply  their  ship- 
pers with  a  sufficient  quantity  of  ice  to  carry  them  through  the  warm 
and  critical  months  of  the  vear. 


1/4 

During  the  year  1902  an  Inspector  was  first  sent  into  the  coiintr 
to  make  examinations  of  the  milk  shed.    He  made  investigations  as  mM 
result  of  complaints,  and  when  the  results  of  the  chemical  or  bacterio- 
logical examinations  of  milk  in  the  City  showed  it  to  be  unwholesome^ 
either  on  account  of  an  excessively  high  count  of  bacteria  or  because 
of  adulteration  by  the  addition  of  water  or  preservatives,  or  the  removi 
of  cream.     During  this  year  inspections    were    made    at    cr& 
and  dairies  at  several  points  on  each  of  the  milk  carrying  roads,  witfr* 
the  object  of  finding  out  conditions  and  the  changes  which  needed  to 


IH    EQUII'MEXr 


be  made,  both  in  tlie  production  and  transportation  of  milk.  The  same 
hnc  of  work  was  continued  during  the  following  year  while  in  1904 
little  was  done  until  near  the  end  of  the  year. 

In  the  year  1905  the  first  completely  systematic  investigation  of  the 
creameries  was  inaugurated.  Through  the  hearty  co-operation  of  the 
railroads  concerned  the  Chief  Sanitary  Inspector  and  two  milk  in- 
spectors made  tours  over  each  one  of  the  large  milk  carrying  railroads 
and  made  a  thorough  examination  of  each  creamery  situated  on 
line  of  the  road.    In  this  way  over  500  creameries  were  inspected. 


the  I 

and         J 


175 

:n  almost  every  instance  conditions  were  found  which  were  not  up  t 
rile  standard  required.  In  some  few  places  the  surroundings  i 
unsanitary  tliat  the  handling  of  milk  was  discontinued.  In  almost  every 
instance  sometliing  was  found  to  criticise  and  correct.  Of  course  in 
a  few  cases,  tiie  corrections  were  of  a  minor  nature,  but  the  drainage 
was  found  almost  universally  defective,  the  milk  improperly  protected 
from  contamination  by  dust  and  dirt,  and  in  some  instances  the  milk 
cans  and  other  utensils  used  for  the  handling  of  milk  not  properly 
cleansed,     Durint;  the  year  hxV)  this  inspt-clion  has  licon  farri5.'il  on  even 


u 


WHERE    THE    FAMU.V   WASHINfi    WAS    DONE    IN    THE    CREAMERY. 

more  systematically  than  it  was  in  the  previous  year.  The  Chief  Sani- 
tary Inspector,  accompanied  by  two  milk  inspectors,  again  made  tours 
over  the  milk  shipping  railroads,  and  in  many  instances  it  was  found 
that  the  creamery  owners  or  managers  had  fully  complied  with  the 
recommendations  resulting  from  the  previous  inspections. 

The  average  creamer}'  was  far  better  equipped  in  1906  to  handle 
milk  properly  than  it  had  been  in  the  previous  year.  This  work  will 
be  continued  until  all  the  creameries  have  been  placed  in  a  satisfactory 
condition. 


I 


Early  m  igo6  it  was  realized  that,  having  devoted  much  time  and 
attention  to  the  creameries,  it  would  be  nectssarj-  to  reach  out  further 
into  the  country  and  to  investigate  the  milk  at  its  very  sources.  With 
this  idea  in  view  the  two  inspectors  who  were  inspecting  the  creameries 
were  instructed  to  examine  a  limited  number  of  farms  within  their 
districts  in  order  that  the  Department  might  have  an  idea  of  the  con- 
ditions requiring  correction  at  the  farms.  On  many  farms  conditions 
were  found  which  retjuired  immediate  attention  and  which  rendere'l 
the  milk  pn.ilii<n-il  ilu'remi  cvireiiiely  unwhi.l.'S'inu-. 


1^ 

b 

N.\HROW  CE.VTUB  FLOOR  GITTTER 

In  t!ie  l.-itter  part  of  May  additional  inspectors  were  appointed  for 
the  very  important  work  of  investigating  the  milk  supply  at  the  point 
of  its  production,  and  beginning  on  June  4,  1906.  the  corps  was  aug- 
mented by  the  addition  of  fifteen  inspectors.  These  men.  as  fast  as 
they  could  be  instructed  in  the  details  of  their  duties,  were  assigned 
to  work  in  die  inspection  of  farms.  These  men  have  been  employed 
continunisty  since  the  commencement  of  this  work  and  have  made  a 
large  manber  of  inspections.  In  but  few  instances  have  farms  been 
found  that  could  be  passed  without  some  criticism  or  some  recommen- 


justifying  the  exi>en(litiire  of  addi- 


(btion  for  improvement,  thus  full; 
tional  money  to  carry  on  this  work. 

The  men  who  are  assignefl  to  country  work  live  in  their  districts 
and  devote  all  of  their  time  to  the  Department's  work,  except  during  the 
last  two  or  three  days  of  each  month,  when  they  report  at  the  office  of 
the  Department  of  Health  in  New  York  City  for  the  purpose  of  sub- 
mitting their  expense  vouchers,  drawing  their  salaries  and  receiving 
any  instructions  which  it  may  te  deemed  necessarv  to  issue. 


PASTEUR IZ I XI";    ROOM    IV    CITY    PLAN' 

This  country  inspection  is  conducted  in  as  systematic  a  manner  as 
possible,  the  men  going  from  creamery  to  creamery  along  the  railroad 
and  remaining  at  each  creamery  until  all  of  the  farms  supplying  that 
particular  place  haw  been  investigated  and  reported  upon.  These  re- 
ports are  mailed  to  the  Department,  where  letters  to  the  operators  of 
the  farms  are  prepared,  embracing  all  of  the  necessarv  recommenda- 
tions to  make  the  farms  sanitary,  and  to  safeguard  the  production  of 
milk  at  that  particular  place.  These  letters  of  instruction  are  forwarded 
to  the  creamery  operator  for  distribution  among  his  dairymen.     The 


4 


■78 

Inspector  su^its  his  report  on  a  tiling  card  which  is  illustrated  belowjl 
From  the  nature  of  his  report  on  the  varions  numbered  items  the  requi'l 
site  letter  of  instrnction  is  prepared.     All  reports  relating  to  any  par- 
ticular creanuTv  are  filed  tofjelher. 


179 


DAIRY  BLANK. 

Department  of  Health. 

City  of  New  York. 


File  Nu.                                                  Date 
Tenant.  Owner   


Township 

P.  O.  Address  

County   State 

Occupied  farm  since 

Time A.  P.  M.,  Dist Insixjction  No 

Milk  delivered  at  

On  U.  R Miles  to  N.  Y 

Operated  by   

N.  Y.  Address 

Distance  from  croanu-ry  

I.  Dairy  rules   posted No.  of  cows 

J.  Size  of  cow  barn Width I-ength 

Height   Cu.  ft.  for  each  cow 

3.  Floors  and  gutters  constructed  of , 

Are  watertight   

4.  Ceilings  constructed  of 

Are    tight   

5.  Side  walls,  ceilings  and  ledges  are clean dirty cobwebs 

6.  Harn  witewashcd  on    

7.  Window  space   s(|uare  feel  is sufficient .  . 

8.  Live  stock  in  same  hmmu  with  cows 

9.  Floors  an<l  c(»w   beds clean 

10.  Cows  are  bedded  with 

11.  Method  of  ventilating  cow  barn 


Which  is   sufficient   

12.  Liquid  matter  from  cow  barn  drains  to 

13.  Manure  in  Summer  removed  to 

In  Winter  to  

Manure  pile  is ft.  from  cow  barn 

14.  Condition  of  cow  yard 


15.  Well  or  Spring  in  cow  yard Yes No 

Used  for 


i8o 

j6.  Cows  in&pccted  In-  V'tterinarian  on 

WboM:  reyjn  ii-as 

J/.  Cows  kick  or  at  calving  -imt  havt strparatt  qnartcrs 

18.  O^ws  are  cleaned  before  milkinf^ have din 

or  manure  on  flanks,  taih,  sides  or  udders. 

19.  I/./ng  hairs  on  belly,  flanks,  udder  and  tail  are clipped 

20.  Date  and  nature  of  the  last  infectious  disease  on  the  farm  or  in  the  families 

of  the  dair>-men  

21.  Milking  wi:h  wet  hands  is allowed 

22.  Fore-milk  is  used 

^3 Ots.  of  milk  produced Does 

c'.rtnply  wi'h  paragraphs  4.  5.  0,  7,  8,  Sec.  53  of  the  Sanitarj-  Code 

24.  Milk  is  strained  in  

25.  Milk  is  cor^led  at   to *  Fahr 

Jb.  Milk  house   

27.  Milk  pails  and  utensils  are clean 

28.  Water  supply   

Located   and ft.  deep 

ft.  from  privy ft.  from  manure  pile  and  bam 

Any  apparent  contamination  of  water  supply 

Special  recommendations  and  remarks 


Signed 


Inspector  of  Foods. 


p 

In  addition  to  the  Idler  of  instruction,  the  Department  has  sent 
out  rules  and  regulations  printed  on  linen  in  large  numbers,  for  dis- 
ributton  amongst  the  farmers  and  creamery  operators.     This  distri- 
bution has  undoubtcdiv  had  very  excellent  results.     It  has  produced 
discussion  amongst  the  farmers,  and,  in  a   way,  prepared  them   for 
the  visit  of  the  Inspector,  as  they  have  been  able  to  anticipate,  to  a 
certain  extent,  the  nature  of  his  inspection.     The  more  intelligent  anc 
progressive  have   endeavored   to   improve   their   farms   in  accordance 
with  these  regulations.     The  following  is  a  copy  of  the  Department 
of  Health  rules  and  regulations  in  relation  to  the  production  of  milk 

t 

'  '* 

rj 

1 

k 

wiiUHi;  AM.  j\\y  i-vMiLV  im  their  share. 

TO  BE  POSTED  IN  ALL  DAIRIES. 

Department  of  Health,  The  City  of  New  York. 

Rules  and  Regulations  to  be  Observed  by  Farmers  and  Dairymen  in 

the  Care  of  Cows  and  Handling  of  Milk  Shipped 

to  The  City  of  New  York. 

The  Cazfs, 

1.  The  cows  must  be  kept  clean. 

2.  Manure  must  not  be  permitted  to  collect  upon  the  tail,  sides 
udder  and  belly  of  any  milch  cow. 

l82 

Stables. 

1.  Cow  stables  must  be  well  lighted  and  ventilated. 

2.  Floors  must  be  tight  and  well  drained. 

3.  Manure  must  be  removed  from  the  stalls  and  gutters  before 
the  morning  milking  and  also  before  the  afternoon  milking,  where  the 
cows  remain  in  the  stable  all  day. 

4.  Walls  and  ceilings  must  be  kept  clean. 

5.  The  ceilings  must  be  so  constructed  that  dust  and  dirt  therefrom 
shall  not  readilv  fall  to  the  floor  or  into  the  milk. 

6.  Stables  must  be  whitewashed  at  least  once  a  year. 

The  Water  Supply. 

1.  The  water  used  in  the  barn  and  for  washing  milk  utensils  must 
be  free  from  contamination. 

The  Milk  House. 
I.     A  milk  house  must  be  provided,  which  is  separated   from  the 
stable  and  dwelling  house. 

2.  It  must  be  kept  clean  and  must  not  be  used  for  any  purpose 
except  the  handling  of  milk. 

The  Milkers. 

1.  No  person  having  any  communicable  disease,  or  one  caring  for 
persons  having  such  disease,  must  be  allowed  to  handle  the  milk  or 
milk  utensils. 

2.  The  hands  of  the  milkers  must  be  carefullv  washed  immediately 
before  milking. 

The   Utensils. 
1.     All  milk  utensils,  including  pails,  cans,  strainers  and  dippers, 
must  be  kept  thoroughly  clean  and  must  be  washed  and  scalded  after 
each  using. 

The  Milk. 

1.  Milk  from  diseased  cows  must  not  be  shipped. 

2.  The  milk  must  not  be  in  any  way  adulterated. 

3.  The  straining  of  milk  must  be  done  in  the  milk  house  only. 

4.  All  milk  must  be  cooled  to  a  temperature  not  above  55  degrees 
within  two  hours  after  being  drawn,  and  kept  thereafter  below  that 


'«3 

I  miut  be  cooled  to  50  degrees  or  less  if  not  d 
creamer^-  t«ice  daily. 

5,  The  use  of  an>'  preserv-ative  or  colorin|r  matter  is  an  adultera- 
tion, and  its  use  b)-  a  producer  or  shipper  will  be  a  siUficient  cause  for 
the  exclusion  of  his  product  from  the  City  of  New  York. 


KtUUMMr.NDAriQNS. 

In  addition  to  the  preceding  rules,  the  Deparimtnt  iiiak<.s  ihe  fol- 
lowing recommendations: 

The  Bar,,   Yanl. 

1.  It  should  be  wi-11  drained  and  dry  and  should  be  as  much  shel- 
tered as  possible  from  the  cold  and  wind. 

2.  Manure  should  not  be  allowed  tn  colk'Ct  in  the  barn  yard  and 
should  not  be  at  anv  lime  in  contact  with  ihc  stable  or  milk  house. 


The  Slablcs. 
The  cow  stable  should  have  an  abundance  of  light  and  ventila- 
The  ventilation  should  preferably  be  from  the  top. 


There  should  be  at  least  600  cubic  feel  of  air  space  for  ( 


3.  It  is  desirable  tliat  the  place  where  the  cows  are  kept  be  use 
for  no  other  purpose.  A  cow  barn  should  not  be  used  as  a  storage 
place  for  straw,  hay  or  other  feeds,  or  as  a  wagon  or  tool  house,  as 
the  dust  and  dirt  which  accumulates  in  a  place  of  this  character  is 
liable  to  drop  into  the  milk  while  being  drawn. 

4.  The  stable  floor  should  be  made  tight,  and  of  some  non-a 
ent  material, 

5.  Cement  or  brick  floors  are  the  best,  as  they  can  more  easily 
be  kept  clean  than  wood  or  earth. 

6.  If  the  place  over  the  cow  is  used  for  storage  of  hay,  the  ceil- 
ing should  be  made  tight  to  prevent  chaff  and  dust  falling  through. 
The  practice,  somewhat  common  among  the  farmers,  of  picking  hay, 
etc.,  on  loose  poles  over  the  cows  is  exceedingly  bad,  since  it  invites 
the  collection  of  dust  and  cobwebs,  and  the  difficulty  of  keeping  the 
stable  clean  is  increased.  J 

7.  The  stable  should  be  whitewashed  twice  a  year,  H 

8.  The  manure  gutter  should  be  from  six  to  eight  inches  deep' 
and  should  be  kept  free  from  manure. 

9.  The  use  of  land  plaster  or  lim^;  is  recommended  up^m  the  floors 
and  gutters. 

10.  The  flooring  where  the  cows  stand  shoidd  be  short  enough 
so  that  all  manure  will  be  dropped  into  the  gutter  and  n  it  upon  the 
floor  itself. 

n.  The  floor  should  be  swept  at  le:ist  an  hour  before  milking,  in 
order  that  the  dust  may  have  a  chance  to  settle  before  the  milking 
is  begun. 

12,  If  individual  drinking  basins  are  used  for  the  co.vs  they  should. 
be  frequently  drained  and  cleaned. 


The  Cozi's. 
I.     The  cows  should  be  kept  at  all  times  in  a  healthy  condi 
and  an  examination  by  a  veterinary  surgeon  shouhi  be  made 
vear. 


J 

ondittoj^^^H 
twice^^^H 


■85 

2.  The  cows  slioiilc!  be  groomed  daily  and  all  collection  of  manure, 
mud  or  other  filth  should  not  be  allowed  to  remain  upon  their  Hanks, 
sides,  udders  or  bellies  during  milking. 

3.  The  clipping  of  long  hairs  from  the  udder  and  right  side  of  ' 
the  cow  is  of  assistance  in  preventing  the  collection  of  filth,  which  may  ^ 
drop  into  the  milk. 


4.  The  tails  .shmiM  be  cut  so  that  the  brush  should  he  well  above 
the  ground. 

5.  In  winter  the  tail  may  be  clipped. 

6.  The  cows  should  be  bedded  with  sawdust,  shavings,  dried  leaves, 
straw  or  some  equally  clean  material. 


4 


J 


7-     The  list  of  horse  mamire  for  bedding  is  to  be  condemned. 

To  prevent  the  cuws  from  lying  down  and  getting  dirty  be- 
tween cleaning  and  milking,  a  throat  latch  of  rope  or  chain  should  be 
fastened  across  the  stanchions  under  the  cow's  neck.  ^A 


The  Milking  aiij  Milkers. 

1.  The  milkers  should  be  clean. 

2.  Their  hands  should  he  thoroughly  washed  v 
and  carefully  dried  on  clean  towels  befon?  niiikin^. 


itb  soap  and  water 


3.  Clean  overalls  and  jumpers  should  be  wuni  during  the  mill 
of  the  cows,  should  be  used  for  no  other  purpose,  and  when  not  in 
should  be  kept  in  a  clean  place  protected  from  dust. 

4.  The  hands  and  teats  should  he  kept  dry  during  milking. 

5,  The  practice  of  moistening  the  hands  with  milk  is  to  be  i 
demned. 

6,  The  first  few  streams  from  each  teat  should  he  rejected  as 
contains  more  bacteria  than  the  rest  of  the  milk. 


I 


iS7 
7.     All  milk  drawn  from  cows  30  days  befor^Mid 


10  ( 


after 


calving  should  be  rejected  and  also  milk  from  diseased  cows. 

8.  The  pails  in  which  the  milk  is  drawn  should  have  as  small  an 
ojiening  at  the  top  as  can  be  nsed  in  milking.  This  renders  the  collec- 
tion of  dirt  less  likely. 

9.  The  milking  should  be  done  rapidly  and  quietly  and  the  cows 
shotdd  be  treated  kindly, 

10.  Dry  fodder  should  not  be  fed  to  the  cows  during  or  just  be- 
fore milking  as  dust  therefrom  will  fall  into  the  milk. 


The  Milk. 

1.  The  milk  should  be  removed  as  soon  as  drawn  to  the  milk  house 
and  strained  and  cooled  to  the  proper  temperature  at  once. 

2.  A  good  plan  is  to  strain  the  milk  into  cans  which  are  standing 
in  ice  water  which  readies  the  neck  of  the  can. 

3.  The  more  rapidly  the  milk  is  cooled  the  safer  it  is  and  the  longer 
it  will  keep  sweet. 

4.  Ice  should  be  used  in  cooling  as  very  few  springs  arc  cold 
enough  for  the  purpose. 

5.  If  aerators  are  used  Ihey  should  stand  where  the  air  is  free 
from  dust  or  odor,  and  on  no  account  should  they  be  used  in  a  stable. 

6.  Milk  strainers  should  be  kept  thoroughly  clean  and  scalded  a 
second  lime  just  before  using,  and  if  cloth  strainers  are  used  several  of 
them  .should  be  provided  in  order  that  they  may  be  frequently  changed 
during  the  straining  of  the  milk. 

By  order  of  the  Board  of  Health. 

Thqm.\s  D.vri.ington,  M.  D.,  President. 
Eugene  W.  Sciuikfer,  Secretary. 

It  has  been  estimated  that  there  are  somewhere  between  thirty  and 
forty  thousand  dairy  farms  producing  milk  which  is  shipped  to  The 
City  of  New  York.  This,  of  course,  is  exclusive  of  those  farms  on 
which  milk  is  produced  to  be  made  into  butter,  cheese  or  condensed  for 
preservation  in  scaled  cans.  With  the  present  force  of  Inspectors  it 
will  be  impossible  to  visit  these  farms  oftener  than  once  in  twelve  or 
fifteen  months.  Of  course,  any  proper  supervision  is  better  than  none 
at  all,  but  this  rate  of  progress  is  ridiculously  small ;  with  a  force  of 


belween  eighty  and  one  hiiiulred  inspectors  the  Department  could  re- 
inspect  each  creamery  and  dairy  every  sixty  days,  and  it  is  to  be 
hoped  that  these  additional  inspectors  will  be  provided  in  the  near 
future. 

CREAMERIES. 

To  BE  Posted  in  All  Cre^vmeries. 

Department  of  Health,  The  City  of  New  York. 

As  a  condition  to  the  issuance  of  permits  for  the  sale  of  milk  in  The 

City  of  New  York  all  places  where  such  milk  is  produced  or  bandied 


3e 

i 


mSHHP^^^^^^^^I^B  'I 

cow  YARD  AND  DIRTY  CATTLE, 

must  be  open  to  inspection  by  employees  of  the  Department  of  Health 
of  The  City  of  New  York. 

Rules  and  Regul.'Vtions  which  Must  be  Observec  by  Those  Op- 
erating Creameries  and  Stations  Shipping  Milk 
FOR  Use  in  New  York  City. 
The  Buildings. 
1.     The  floors  of  these  buildings  must  be  constructed  of  some  ma- 
terial  which  will  render  them  water-tight  and  must  be  graded  and 


i 


i8g 

drained  towards  one  or  more  points  from  which  water  must  be  carried 
away  by  suitable  drains.  Floors  of  cement  or  stone  are  the  best  for 
this  purpose. 

2.  The  floors  must  be  drained  by  water-tight  gutters  either  into 
cesspools  so  situated  as  not  to  be  ofTensive  or  conducted  to  such  a  dis- 
tance as  not  to  cause  a  nuisance. 

3.  The  water  used  for  cleaning  pails,  cans  and  other  utensils  must 
be  from  a  public  water  supply,  or  if  drawn  from  a  well  or  spring  must 
be  approved  by  this  i^eparlmeiit. 


4.  The  milk  room  must  be  used  for  no  other  purpose  than  the 
handling  of  milk,  and  must  be  clean  and  well  ventilated. 

5.  Premises  must  at  all  times  be  free  from  a  collection  of  water, 
rubbish  or  any  offensive  material. 

6.  Cooling  tanks  for  milk  must  be  lightly  constructed  of  non-ab- 
sorbing material  and  frequently  cleaned.  The  water  must  be  changed 
so  frequently  as  not  to  become  offensive. 

7.  Walls  and  ceilings  must  be  kept  clean. 
Aerators  and  coolers  must  be  protected  from  dust  and  dirt  and 

from  impure  air. 


rgo 

The  Employees. 

1.  No  person  suffering  from  a  contagious  disease  or  one  in  at- 
tendance upon  such  patient  shall  be  empiored  in  the  handling  of  milk  or 
milk  utensils. 

2.  AH  employees  who  handle  milk  and  milk  utensils  must  be 
cleanly  in  their  habits.  The  garments  worn  by  such  employees  must 
be  kept  in  a  clean  condition. 

3.  Spitting  in  or  upon  any  part  of  the  building  must  be  absolutely 
prohibited. 


The  Milk. 

1.  Milk  of  a  temi>eralure  above  60  degrees  must  not  be  received 
at  the  creamery  or  shipping  station. 

2.  Milk  must  be  handled  as  little  as  possible  and  all  unnecessary 
exposure  to  the  air  must  be  avoided. 

3.  Milk  must  he   rapidly  cooled  to  a  temperature  of  50  degrees 
or  less  and  so  kept  until  shipped. 

4.  All  pipes  through  which  milk  is  allowed  to  flow  must  be  so  ar- 
ranged as  to  be  easily  and  thoroughly  cleaned. 


^ 


191 

5-     All  milk  utensils,  including  cans  and  bottles,  must  be  kept  clean  ' 
and  sterile. 

6.  Managers  of  creameries  and  receiving  stations  will  be  expected 
to  refuse  to  receive  milk  from  farmers  who  do  not  observe  llie  rules 
of  this  Department. 

Recommendations. 
!.     In  addition  to  the  foregoing  rules,  the  observance  of  which  the 
Department  of  Health  demands,  the  following  recommendations  in  the 
construction  of  creameries  and  the  handling  of  milk  are  presented: 

A.  Creameries   should   be   well   lighted.     Ventilation    should   be  , 
ample,  preferable'  through  the  roof. 

B.  Milk  should  be  handled  in  rooms  supplied  with  natural  light. 


C.  Creameries  should  be  so  arranged  that  the  milk  may  flow  by 
gravity  from  the  point  where  it  is  received  to  its  final  point  of  handling. 
Pumps,  which  are  always  difficult  to  keep  clean,  should  never  be  used, 

D.  Outside  dust  should  be  prevented  from  entering  the  room 
where  milk  is  handled,  and  flies  should  be  excluded. 

E.  The  rooms  should  be  plastered  or  ceiled  to  avoid  places  where 
dust  may  gather, 

F.  Frequent  painting  or  whitewashing  is  strongly  urged. 

G.  The  receiving  tanks,  mixing  vats  and  tanks  upon  the  bottling 
tables  should  be  provided  with  covers. 


I 


In  the  time  which  elapsed  between  tours  of  inspection  in  1905  and 
the  tours  of  inspection  in   1906  a  number  of  the  dilapidated  and  old 
creamery  buildings  were  torn  down  and  modern  ones  erected  in  their 
stead.     In  all  instances  the  new  creameries  have  been  provided  with  I 
asphalt  or  concrete  floors.     Improved  methods  of  storing  the  milk  at  j 
the  proper  temperature  have  been  introduced,  and  the  mixing  vat,  re-  j 
ceiving  vat  and  other  apparatuses  have  been  so  enclosed  as  to  prop-  I 
eriy  protect  the  milk  from  dust  and  dirt. 

Incidentally  very  many  of  the  old  creamery  buildings  which  1 
not  replaced  by  new  ones  have  been  most  thoroughly  overhaided.  new 


water-tight  and  water-proof  floors  provided,  improved  milk  vats  and 
milk  storage  tanks  installed,  and  the  buildings  placed  in  as  good  con- 
dition as  could  be  expected. 

It  may  be  assumed,  verj'  justly,  that  if  the  Department  of  Health 
had  not  been  carrying  on  this  active  supervision  of  the  milk  supply 
these  new  creameries  would  not  have  been  constructed,  and  the  milk 
uilended  for  consumption  in  the  City  would  still  be  handled  in  the 
antiqualed  way. 

In  almost  every  instance  before  the  creameries  mentioned  were  con- 
Tucted  the  builders  presented  their  plans  and  ideas  to  the  Department  J 


193 

for  discussion.  The  time  undoubtedly  will  arrive,  and  probably  within 
a  comparatively  few  years,  when  all  of  the  creameries  will  be  repaired 
or  reconstructed,  and  the  handling  of  milk  conducted  according  to  the 
best  and  most  modern  methods. 

The  proper  icing  of  the  milk  containers  while  in  transit  has  also 
received  the  careful  attention  of  the  Department,  with  the  result  that 
milk  has  arrived  at  the  terminals  at  a  much  lower  temperature  and  in 
much  better  condition  than  in  any  previous  year.  Of  course,  in  the 
l.itter  part  of  the  year,  when  the  ice  in  storage  became  gradually  used 


I 


MANURE  THROWN  FROM  COW  STABLE  WINDOW. 

Up,  there  were  instances  of  not  putting  enough  ice  on  the  cans,  but, 
as  a  rule,  there  was  very  little  cause  for  criticism. 
Dairies    Inspected,    ii,ooo;    Creameries    Inspected,    708:    Total, 
11.708. 

One  of  the  weakest  links  at  present  in  the  chain  of  supply  is  the 
custom,  upon  the  arrival  of  the  milk  trains  at  the  various  terminals, 
thai  exists  amongst  the  employees  of  the  railroad  companies,  to  imme- 
diately open  the  cars  and  roll  the  cans  and  boxes  containing  milk  out 


I 


194 

upon  the  platform,  where,  frequently,  on  hot  nights  during  the  s 
tJiey  are  exposed  to  a  temperature  of  75  degrees  or  80  degrees  for  a  ' 
number  of  hours.  This  is  a  matter  which  will  require  most  careful  con- 
sideration and  which  it  is  hoped  may  be.  to  a  very  large  extent,  cor- 
rected I:cfore  the  coming  summer.  Unfortunately  there  is  a  commercial 
Bide  to  this  question  that  appears  to  be  very  difficult  of  solution.  The 
practice  is  for  the  milk  dealers  during  the  day  to  collect  the  empty  cans 
from  their  customers  and  load  them  on  trucks  which  are  sent  to  the  | 
terminals,  where  the  empty  cans  are  placed  upon  the  platforms,  and  the    ' 


BARN   AND  COW   YARD.  CHICKEN   HOUSE  AND   BRUOK. 

full  cans  of  milk  are  loaded  on  the  trucks  and  immediatelv  taken  to 
the  City  for  distribution.  The  empty  cans  are  then  loaded  into  the 
trains  as  expeditiously  as  possible,  and  in  the  early  morning  hours 
these  trains  are  started  back  over  their  routes  to  distribute  the  cans 
to  the  various  creameries  in  order  that  they  may  be  properly  washed 
and  filled  for  return  to  the  City  on  the  following  night.  In  order  to 
keep  the  cans  in  the  cars  until  the  trucks  called  for  them  it  would 
probably  involve  the  purchase  of  at  least  one  additional  set  of  cans 


i 


195 

on  the  part  of  the  milk  dealers,  and  the  providing  of  at  least  half  as 
many  cars  again  as  are  now  in  service  by  the  railroad  companiq3.  The 
expense  involved  in  this  is  necessarily  very  large,  and  one  in  which  the 
people  interested  are  not  over-anxious  to  enter  without  giving  the  mat- 
ter very  serious  consideration. 

A  number  of  larg^  dealers  of  milk  in  The  City  of  Xew  York  have 
had,  within  the  past  year,  built  milk  trucks  of  great  capacity,  constructed 
somewhat  on  the  order  of  a  furniture  van,  with  tight  sides  and  pro- 
vided either  with  roofs  or  canvas  covers,  the  object  of  this  being  to  hold 
the  temperature  of  the  milk  down  to  the  lowest  possible  point  in  its 
transit  from  the  railroad  platforms  to  the  stores  of  their  customers. 
In  addition,  many  of  them  remove  the  ice  from  the  cars  in  which  their 
milk  is  transported  and  place  it  on  and  around  the  cans  in  the  wagons 
to  assist  in  the  cooling  process. 


Railroad. 


Erie 

Harlem 

Ontario  &  Western 

New  York,  Susq.  &  Western 

West  Shore 

Xew  York,  New  Haven  &  Hartford. 

Dela.,  Lack.  &  Western 

New  York  Central 

Central  R.  R.  of  N.  J 

Hudson  River  Transportation  Co... 

Lehigh  Valley 

Other  sources 


Number  of 
Creameries 
Inspected. 

Milk,  Cream  and 

Condensed 
Milk  Shipped. 

"4 

5,586 

25 

8i6 

8o 

5,172 

30 

2.200 

23 

2,339 

24 

1,652 

78 

6,058 

73 

6,307 

'^ 

226 

^5 

793 

67 

2,797 

•  •  •  • 

600 

Total 


543 


34,576 


ig6 

In  The  City  of  New  York  there  are  approximately  14^^^ 
holding  permits  for  the  sale  of  milk,  distributed  as  follows; 


SiDn 
Pennit). 

^x. 

J.6S6 

m 

MS 

464 

■-.flS. 

1,1* 

The  larger  portion  of  the  stores  offering  milk  for  sale  receive  no   , 
financial  return  from  the  milk.     The  conditions  surrounding  the  busi- 
ness of  conducting  a  grocery  store,  especially  in  the  so-called  "  tenement 
house  "  district,  are  such  that  a  store  which  does  not  sell  milk  receives 
very  little  of  the  neighborhood  custom  for  their  groceries.     The  habit  | 
of  the  people  in  these  districts,  in  living  what  might  be  called  a  "hand 
to  mouth  "   existence,  and  going   to  the  grocery  store  a   short  time  J 
previous  to  each  meal  and  buying  such  provisions  as  may  be  necessary  I 
for  that  meat,  naturally  draws  the   would-be   customer  to   the  place  1 
where  he  or  she  may  buy  most  of  the  requisites  for  the  meal.   There- 
fore, the  grocery  stores  in  these  localities  have  acquired  the  custom  J 
of  selling  milk  without  profit,  as  what  might  be  considered  a  "  leader."! 
It  has  been  noticed  that  during  the  past  two  or  three  years  the  selli 
of  milk  in  bottles  is  greatly  increasing,  indicating  that  the  consumers! 
realize  the  necessity  of  a  pure  milk  supply  and  prefer  to  buy  theirfl 
milk  in  a  manner  which  precludes,  as  much  as  possible,  the  danger  ofl 
contamination  either  by  germ  life  or  dishonest  vendors. 

When  an  application  for  a  permit  for  the  sale  of  milk  is  made,  ; 
copy  of  the  following  rules  and  regidations  are  handed  to  the  applicant.  1 
and  he  is  instructed  that  unless  the  conditions  under  which  he  pro-  I 
poses  to  sell  milk  comply  with  these  rules  and  regulations,  his  permit-J 
will  be  denied. 


1 

Ruies  and  Regulations  for  the  Care  and  Storage  of  Milk. 

1.  Milk  must  not  be  kept  for  sale  or  stored  in  any  room  used  for 
sleeping  or  domestic  purposes,  or  opening  into  same. 

2.  Milk  must  not  be  transferred   from  cans  to  bottles  or  other 
vessels  on  streets  or  on  ferries  or  at  depots,  except  when  transferred 
to  vessel  of  purchaser  at  time  of  delivery. 

3.  Milk  must  not  be  sold  in  bottles  except  under  the  following 
rules : 

Bottles  must  be  washed  clean  with  a  hot  water  solution  of  soap 
or  soda  or  some  other  alkali  and  then  with  hot  water  before  filling 
with  milk. 

1 

rf^ 

1 

^ 

Hi^ 

;ptf^^^ 

^^^^BB^^]^^ 

^Tte 

LHKAMERV   WIIKRE  CORRE(  T  MKTHODS  PREVATl,. 

Bottles  must  not  be  filled  except  at  the  dairy  or  creamery,  and  in 
the  city  only  in  rooms  so  situated  as  to  prevent  the  contamination  0 
the  milk  by  dust  or  other  impurities. 

Bottles  must  not  be  washed  or  filled  in  any  rooms  used  for  sleep- 
ing or  domestic  purposes  or  opening  into  same. 

4.     The  vessels  in  which  milk  is  kept  for  sale  must  be  protected  by 
means  of  a  suitable  covered  receptacle  and  so  placed  in  the  store  to 
prevent  dust  from  the  street  or  other  impurities  falling  into  it. 

1 

5-     Store  permits  must  be  posted   in  stores   so  that  they  can  I 
easily  seen  at  all  times. 

6.     Wagon  permits  must  be  carried  on  the  wagon  at  a!!  times  \ 
engaged  in  tlie  sale,  transportation  or  delivery  of  milk. 

7-     The  number  of  wagons  and  the  number  of  pcnnit.  the  latter  to  be  ] 
preceded  by  the  words  "  Department  of  Health  Permit,"  must  be  paint- 
ed on  both  sides  of  the  wagon  in  letters  two  (2}  inches  in  length  and  | 
one-half   C/^)   inch  in  width,  and   in  some  contrasting  color  to  that  ] 
of  the  wagon. 


8.  After  the  day's  sales  are  over,  the  cans,  bottles,  measures,  andfl 
other  utensils  usetl  in  the  sale  of  milk  must  be  thoroughly  cleaned! 
with  lukewarm  water,  lo  which  a  small  amount  of  soda  has  been  addedl 
in  proportion  of  one  teaspoonful  of  washing  soda  to  a  gallon  of  water.  J 

9,  The  overflow  pipe  from  the  ice  box  in  which  the  milk  is  kept  I 
must  not  be  connected  directly  with  the  drain  pipe  or  sewer,  but  muat 
discharge  into  an  open  water  supplied,  properly  trapped,  sewer  c 
iMCtcd  sink  (see  section  38  of  the  Sanitary  CoiIe>. 


199 

The  ice  box  in  whicli  milk  is  kept  mustT<~cIeaiiie'd  by  scnib^ 
bing  out  with  a  hot  soda  solution,  as  in  rule  3,  at  least  twice  a  week, 

11.  In  selling  milk,  the  contents  of  the  can  should  be  tlxjroughly 
mixed  before  measuring  out  the  amount  desired.  This  will  prevent 
unintentional  skimming,  and  the  last  quart  of  milk  sold  from  the  can 
will  contain  as  much  cream  as  the  first  quart  sold. 

12.  It  sometimes  happens  that  in  cold  weather  the  milk  may  be 
delivered  to  the  dealer  more  or  less  frozen.     If  such  is  the  case,  the 


ice  from  the  sides  of  the  can  should  be  detacheil  and  the  content.-. 
gently  heated  until  the  ice  is  all  mehed.  If  there  is  much  ice  in  the 
can  it  is  absolutely  necessary  to  do  this  before  the  milk  is  sold,  other- 
wise the  liquid  part  dipped  out  and  sold  at  first  will  contain  more  of 
the  solid  parts  of  the  milk  and  cream,  while  the  ice  remaining  aiiil 
consisting  principally  of  water  will,  after  a  time,  melt  and  will  result 
in  the  milk  containing  more  water  than  pure  milk  should  have,  and 
may  appear  as  if  it  had  been  adulterated  with  water. 


p 

13.     Do  not  place  ice  in  milk  if  it  is  desired  to  cool  it  or  keep  it^^^H 

cold,  as  the  ice  will  melt,  and  the   milk   then  appears  tn  have  been  ^^H 
adulterated  with  water.                                                                                   ^^^| 
On  the  day  following  the  receipt  of  the  application,  an  inspection.  ^^^| 
is  made  of  the  premises  by  an  Inspector,  who  examines  them  care-  ^^H 
fully.    If  he  finds  that  the  conditions  are  proper  for  the  care  and  hand-    ^^^ 
ling  of  milk,  he  notifies  the  dealer  that  a  recommendation  will  be  made            1 
to  the  Board  of  Health  to  grant  him  a  permit  for  the  sale  of  milk.             ' 
and  a  small  card  is  left  with  him.  stating  that  the  proprietor  of  ih-? 

' 

L 

store   has  applied  for  a  permit,  which,  if  granted  by   the   Board  of 
Health,  will  be  delivered  on  a  certain  date.     This  is  intended  as  an 
mdication  to  the  milk  inspector  of  the  district,  or  to  any  other  person 
authorized  to  ask  the  question  that  the  proprietor  has  complied  with 
the  law  forbidding  the  sale  of  milk  without  a  permit,  so  far  as  lies 
n  his  power.     If,  on  the  other  hand,  the  conditions  are  such  that  3 
Mrmit  cannot  be   recommended,  the   inspector  informs  the  applicant 
wherein  his  premises  do  not  conform  to  the  regulations,  and  a  reasoii 

1 

Terigth~~ortime  is  given  him  in  which  to  overcome  these  objec- 
tions. The  inspector,  in  the  course  of  a  few  days,  makes  a  reinspec- 
tion,  and  if  the  premijes  are  found  then  to  be  sanitary,  he  does  as 
first  indicated.  If.  on  the  other  hand,  they  are  still  unsanitary  the  in- 
spector submits  his  report,  staling  the  facts,  and  recommending  that 
the  application  for  a  permit  for  the  sale  of  milk  be  denied.  After  * 
permit  has  been  denied  by  the  Board  of  Health,  a  written  notice  to 
that  effect  is  .served  upon  the  proprietor  of  the  store,  and  if  he  is 
subsequently  detected  in  the  sale  of  milk  without  a  porniit.  tin*  case  is 


the  impo- 


P.MRY    STORK, 

presented  to  the  criminal  courts,  which  usually  results  ir 
sition  of  a  substantial  fine. 

The  inspection  of  milk  within  the  city  is  carried  on  according  to 
an  old  and  well  established  system.  The  various  boroughs  are  divided 
into  districts  so  that  each  inspector  will  have  approximately  the  same 
number  of  places  where  milk  is  sold  under  his  charge.  He  is  expected 
to  have  a  full  knowledge  of  the  character  of  the  stores  and  of  the 
wholesale  dealers  supplying  milk  within  his  district,  and  to  use  his 
judgment   within  certain  limits  in  making  his  inspection,  the  object 


TK.STIXG    MILK    IN"    POOKER    CLASS    STHKE. 


203 

being  for  him,  so  far  as  lies  in  his  power,  to  be  assured  that  the  milk 
offered  for  sale  within  his  district  is  pure,  and  is  kept  under  proper  con- 
ditions. He  is  expected  to  do  his  work  at  such  times  during  the  day 
or  night  as  will  best  accomplish  this  result.  The  inspectors  are  required 
to  wear  the  badge  which  is  furnished  by  the  Department  of  Health 
where  it  may  be  readily  seen.  Upon  entering  a  store  they  introduce 
themselves  as  inspectors  from  the  Department  of  Health,  and  ask  if  ' 
milk  is  offered  for  sale.  If  answered  in  the  affirmative,  they  then 
inform  the  proprietor  that  they  desire  to  inspect  his  milk,  and  proceed 
along  the  following  lines: 

They  examine  the  permit  and  ascertain  whether  it  was  issued  in 
the  name  of  the  present  proprietor  of  the  store,  or  no.  They  then 
go  to  the  milk  container,  first  asking  the  storekeeper  if  this  is  the  milk 
which  he  is  offering  for  sale.  They  then  stir  the  milk  very  thoroughly, 
and  dip  out  a  sufficient  quantity  to  make  the  necessary  examination 
with  lactometer  and  thermometer.  If  there  are  other  cans  containing 
milk  to  be  sold  in  the  store,  they  then  examine  these  in  the  same  man- 
ner. If,  in  their  judgment,  the  milk  is  adulterated,  they  empty  the  con- 
tents of  the  testing  cylinder  back  into  the  can,  and  again  stir  the  milk. 
This  is  done  to  insure  the  obtaining  of  a  uniform  sample,  and  to  pre- 
vent injustice  to  the  dealer.  The  cylinder  is  filled  the  second  time, 
the  lactometer  and  thermometer  reading  are  checked  with  the  previous 
one,  and  then  the  actual  taking  of  the  samples  commences.  For  this 
purpose  the  inspectors  are  provided  with  bottles  of  two  kinds,  one  a 
four-ounce  bottle  with  perforations  in  the  neck,  and  one 
four-ounce  bottle  with  a  plain  neck.  Milk  is  poured  from  the  cylinder 
into  each  of  these  bottles  until  they  are  filled.  They  are  then  corked, 
and  through  the  cork  of  the  bottle  with  the  perforated  neck  a  wire  is 
passed,  which  is  then  wound  about  the  neck  of  the  bottle,  and  the  ends 
passed  through  a  lead  seal.  This  seal  is  pressed  by  means  of  a  punch, 
on  one  die  of  which  appear  the  words  "  Department  of  Health,  City 
of  New  York,"  and  on  the  other  a  letter  by  which  the  inspector  is 
designated. 

Each  inspector  has  supplied  to  him  a  number  of  tags,  used  for  the 
labeling  of  the  bottles;  a  tag  is  sealed  onto  the  bottle  with  the  wire, 
and  contains  the  number  of  the  sample,  and  the  inspector's  designating 


204 

letter,  the  name  and  address  of  the  place  from  which  the  sample  was 
taken,  the  name  of  the  inspector  taking  the  same,  and  his  reasons 
for  taking  the  same. 

On  the  other  bottle  is  secured  a  stub,  removed  from  the  original, 
on  which  is  a  place  for  the  number  of  the  sample,  and  the  inspector's 
designating  letter. 


Dept  of  Keahft. 

DIv.  or  Inspections. 


Sample  No... 
Inspector 


Citr  Of  New  YDftc. 

Sixth  Ave.an(]66th.Strdet 

..  Borouigh  ofc . 


.  ..Inspection  Vo.^. 


Address 

Reason  for  Samplings 


This  system  has  been  adopted  in  order  to  prevent  any  possible  chance 
of  mixing  or  substituting  samples.  The  sealed  sample  is  delivered  to 
tlie  proprietor  or  person  in  charge  of  the  store  and  the  other  sample  is 
delivered  to  the  Assistant  Qieinist  at  the  Laboratory  of  the  Department 
of  Health,  who  is  to  make  the  analysis. 

In  all  cases  where  samples  are  taken  for  analysis,  in  addition  to  the 
report  which  the  Inspector  makes,  he  submits  a  report  on  a  filing  card, 
giving  all  of  the  essential  facts  of  the  inspection. 

On  the  obverse  of  the  card  are  blanks  provided  for  the  Qiemist  on 
which  he  may  report  the  result  of  the  analysis.  These  cards,  upon  the 
completion  of  the  analysis,  are  filed  under  the  name  of  the  dealers  so 
that  at  any  time  a  complete  history  of  the  samples  taken  from  any  par- 
ticular dealers  in  the  Cit3'  may  be  obtained.  After  the  receipt  of  the 
result  of  the  analysis  of  the  sample  from  the  Chemist  the  cards  are 
submitted  to  the  Chief  Sanitary  Inspector,  who  endorses  on  those  found 
to  be  below  the  legal  standard  the  word  "  Arrest."  These  tickets  are 
then  delivered  to  the  Inspector,  who,  accompanied  by  a  Patrolnian  of 
the  Health  Squad,  goes  to  the  Police  Magistrate's  Court  in  whose  dis- 


i 


20S 

Irict  the  offense  was  committed,  and  obtains  a  warrant  for  the  arrest 
of  the  dealer.  The  warrant  is  delivered  by  the  Magistrate  to  this  Pa- 
trobnan,  who  makes  the  arrest  and  produces  the  defendant  in  court. 
The  usual  practice  is  for  these  defendants  to  be  immediately  held  for 
trial  in  the  Court  of  Special  Sessions.  The  Inspector  places  on  the 
ticket  the  result  of  this  arraignment,  and  the  tickets  are  then  returned 
to  the  office  and  held  until  such  time  as  the  case  may  be  called  for  trial. 
For  convenience  in  the  various  divisions  of  the  Court  of  Special  Ses- 
sions a  certain  day  of  each  week  is  set  aside  for  Department  of  Health 
cases.  A  calendar  is  prepared,  and  this  calendar,  together  with  all  of 
the  milk  tickets  which  bear  upon  the  cases  in  question,  and  any  other 
items  of  evidence  which  it  is  necessary  to  produce  in  court,  are  taken 
there  by  an  Inspector  especially  detailed  for  this  purpose.  After  the 
trial  the  result  of  same  is  then  placed  upon  the  ticket  and  the  ticket  re- 
turned to  the  office  of  the  Chief  Sanitary  Inspector  for  filing. 

If  an  Inspector  on  his  rounds  discovers  milk  which  is  manifestly 
adulterated  by  the  addition  of  water  or  by  the  removal  of  cream,  or 
milk  which  is  not  of  the  temperature  (50  degrees)  required  by  the  Sani- 
tary Code,  this  milk  is  immediately  destroyed,  and  a  special  report  of 
the  fact  is  made  to  the  office  of  the  Chief  Sanitary  Inspector. 

During  the  summer  months  the  Inspectors  frequently  are  combined 
into  corps  and  make  thorough  examinations  of  the  milk  at  the  ferries 
and  receiving  points  for  the  purpose  of  destroying  all  milk  which  is  not 
of  the  proper  temperature.  At  other  times  during  the  year,  especially 
on  Sundays  and  holidays,  similar  examinations  by  corps  of  inspectors 
are  made  of  districts  in  which  it  is  suspected  that  quantities  of  adul- 
terated milk  are  being  sold,  with  the  usual  result  that  many  samples  of 
adulterated  milk  are  collected,  and  an  exceptionally  large  number  of 
convictions  are  obtained  in  the  Court  of  Special  Sessions. 

The  Inspectors  making  inspections  throughout  the  country  districts 
frequently  discover  evidences  of  adulteration  of  milk,  either  at  the  point 
of  production  or  at  the  creamery.  They  are  all  supplied  with  a  cypher 
code,  by  means  of  which  they  can  telegraph  adequate  information 
promptly  to  the  main  office. 

During  1906  in  numerous  instances  this  was  done  with  the  result 
that  a  corps  of  City  Inspectors  were  detailed  to  examine  the  suspected 


2o6 

milk.  This  resulted  in  the  obtaining  of  an  exceptionally  large  number 
of  samples  of  adulterated  milk  in  a  short  space  of  time  and  has  pre- 
vented, to  a  great  degree,  the  wholesale  adulteration  of  milk. 

Total  number  of  inspections  and  reinspections 130^1 

Total  number  of  specimens  examined  158^5 

Total  number  of  samples   9>540 

Number  of  quarts  of  milk  destroyed 4i>395 

Number  of  arrests   678 

Number  held  on  bail 666 

Number  discharged  11 

Number  of  trials   644 

Amount  of  fines $i3f045 


DIVISION  OF  CONTAGIOUS  DISEASES. 

Borough  of  Manhattan. 

The  Division  of  Contagious  Diseases  was  organized  in  September, 
1887,  and  its  functions  in  the  Borough  of  Manhattan  are: 

1.  The  diagnosis  of  suspected  contagious  diseases  and  of  all  cases 
of  contagious  disease  removed  to  the  Department  and  Minturn  hos- 
pitals. 

2.  The  examination  of  contagious  disease  patients  at  Riverside 
Hospital  and  at  the  Scarlet  Fever  Hospital  in  this  borough  reported 
ready  for  discharge,  to  ascertain  that  such  patients  are  fully  recovered 
and  in  a  non-contagious  condition. 

3.  The  maintenance  of  isoluation  of  patients  ill  with  contagious 
diseases  at  their  homes. 

4.  The  removal  to  a  Department  of  Health  hospital  of  patients  who 
develop  contagious  disease  in  a  general  hospital,  in  an  institution,  home 
or  asylum,  and  those  who  cannot  be  or  refuse  to  remain  properly  iso- 
lated at  their  homes  until  the  (lisoasc  is  terminated. 

5.  The  fumigation  of  infected  rooms  and  the  disinfection  of  in- 
fected materials. 

6.  The  removal  of  infected  goods  to  Department  Station  to  be  de- 
stroyed or  sterilized  and  returned. 


207 

7.  The  removal  to  the  Department  Morgue  for  burial  by  the  City 
authorities  of  bodies  of  persons  who  have  died  of  contagious  diseases 
and  cannot  be  buried  by  the  relatives  or  friends. 

8.  The  free  vaccination  at  proper  intervals  of  all  teachers  and 
children  in  the  public  schools. 

9.  The  free  vaccination  of  all  who  apply  at  the  Central  Office  for 
vaccination. 

10.  The  free  vaccination  of  all  employees  of  the  Department  of 
Health  and  all  other  City  departments,  upon  request,  or  when  considered 
necessary  to  prevent  the  spread  of  small-pox. 

11.  The  free  vaccination  of  all  persons  exposed  to,  living  in  the 
house  with  or  in  the  immediate  neighborhood  of  a  person  found  to 
have  small-pox. 

12.  The  free  vaccination  of  city  lodging  house  inmates  and  inmates 
of  the  city  prisons. 

13.  The  free  vaccination  of  all  who  are  not  "  protected  "  at  their 
homes,  in  large  department  stores  or  other  places  employing  a  large 
number  of  persons. 

14.  The  medical  inspection  of  school  children,  excluding  those 
found  to  have  contagious  diseases,  and  mailing  postals  to  parents  of 
those  children  found  to  have  physical  defects. 

15.  "Summer  Corps"  work,  consisting  of  visits  to  tenement 
houses,  treatment  of  sick  children  under  two  years  of  age  and  instruc- 
tions to  mothers  in  the  care  of  infants. 

16.  The  treatment  of  school  children  having  trachoma  in  the  De- 
partment Trachoma  Hospital  and  dispensaries. 

17.  The  diagnosis  of  suspected  glanders  in  horses  and  the  destruc- 
tion of  all  cases,  and  the  disinfection  of  stables  where  cases  occur. 

18.  The  diagnosis  of  suspected  rabies  in  dogs  and  the  destruction 
ot  all  cases. 

19.  The  disinfection  of  books  exposed  to  infection  and  belonging 
to  public  libraries,  public  schools,  etc. 

20.  Mailing  to  public  and  parochial  schools,  hospitals,  institutions, 
etc.,  a  daily  printed  list  giving  name,  age,  address  and  disease  of  every 


208 

case  of  contagious  disease  reported  during  the  previous  twenty-four 
hours,  and  also  the  same  facts  in  relation  to  rooms  fumigated  during  the 
previous  twenty-four  hours. 

The  staff  of  the  Division  of  Contagious  Diseases  consists  of: 

1.  Chief  Medical  Inspector. 

2.  Assistant  Chief  Medical  Inspector. 

3.  Medical  Inspector  (ophthalmologist). 

4.  Medical  Inspectors  (diagnosticians). 

5.  Medical  Inspector  in  charge  of  institutions  and  day  nurseries. 

6.  District  Medical  Inspectors. 

7.  Medical  Inspectors  (oculists). 

8.  Medical  Inspectors  of  Schools. 

9.  Medical  Inspectors  (vaccinators). 

10.  Medical  Inspectors  (summer  corps). 

ft 

11.  Supervising  Nurse. 

12.  Trained  Nurses  for  district  work,  school  work,  Trachoma 
Hospital,  Trachoma  dispensaries. 

13.  Veterinarians. 

14.  Disinfectors. 

15.  Ambulance  Drivers. 

16.  Drivers  and  Helpers  on  "  goods  wagons." 

17.  Clerks. 

18.  Stenographers  and  Typewriters. 

19.  Telephone  Operators. 

20.  Office  Boys. 

Section  133  of  the  Sanitary  Code,  as  adopted  1903,  is  as  follows: 
"  It  shall  be  the  duty  of  every  physician  to  report  to  the  Department 
of  Health,  in  writing,  the  full  name,  age  and  address  of  every  person 
suffering  from  any  one  of  the  infectious  diseases  included  in  the  list 
appended,  with  the  name  of  the  disease,  within  twenty-four  hours  of 
the  time  when  the  case  is  first  seen." 


209 

A.  Contagious  (very  readily  communicable) — Measles,  rubella 
(rotheln),  scarlet  fever,  small-pox,  varicella  (chicken-pox),  typhus 
fever,  relapsing  fever. 

B.  Communicable — Diphtheria  (croup),  typhoid  fever,  Asiatic 
cholera,  tuberculosis  (of  any  organ),  plague,  tetanus,  anthrax,  glanders, 
epidemic  cerebro-spinal  meningitis,  leprosy,  infectious  diseases  of  the 
eye  (trachoma,  suppurative  conjunctivitis),  puerperal  septicaemia, 
erysipelas,  whooping-cough. 

C.  Indirectly  Communicable  (through  intermediary  host) — ^Yel- 
low fever,  malarial  fever. 

The  following  contagious  diseases  are  referred  to  this  Division: 
Diphtheria  (croup),  scarlet  fever,  measles  (rubeola),  German  measles 
(rotheln),  small-pox,  varicella,  typhus  fever,  relapsing  fever,  Asiatic 
cholera,  plague,  yellow  fever,  tetanus,  anthrax,  glanders,  infectious 
diseases  of  the  eye  (trachoma  suppurative  conjunctivitis),  whooping 
cough. 

These  diseases  may  be  reported  by  the  attending  physician  in  one 
of  the  following  methods : 

(a)  By  the  official  postal  cards  of  the  Department,  which  are  fur- 
nished gratuitously  on  request. 

.REPORT  :0F;C0NTAGI0VS|  DISEASE  ^ 

PHYSICIANS  WILL  greatly  CacilitAt*  tbe  work  of  this  defMtftSMkt  bf  AUtaflT  ^  OOe 
^jQMecitfd*  by  the  beddde  of  the  patient  asd  dropptiigit  at  oaoelntbtiieaMtt  P.  O.  B^ul 

Ntfv  Yof4t,', 190 

Jime  of  Pjdient Ag€> 

tUsditnce Hw 

DbeMse  '  Dantiwt  of  Mintss 


■*«--> 


Horn)  ConiNidtd No*  ofFwtittts  in  house. 

liOeaHm  of  School  tittnded  fy  Qdtdren  in  Fimtty .. — . 


ti  due  of  DtphiherU  do  yoa  v>ish  »  Bacterial  CuUare  made  ?  Answer  Yea  or  No* 

ResUence  , - , ,  ,  


to  CM!  c<  Dipfcfhiffit,  dp  ywi  wtift  >!>■■  ■  irtnii  of  faaftr  fwaatotd  >y  t^  Di^if  it  of  fLmSXk  %  AOPvtrTotevPs. 


2IO 


(b)  By  telephone  when  the  administration  of  diphtheria  antitoxin 
by  the  Department  is  requested  or  the  removal  of  a  contagious  disease 
patient  to  the  Department  hospital  is  desired.  Such  report  must  be 
followed  by  one  on  an  official  postal. 

Report  of  Contagious  Disease 

•VTBLBPHONB 


Hew  Yoik, \90 

P.K. 


|fA|M  oCPifleiU,.. - - 

SinAoDOii^M. - > . — « -~. .~. Flow, ^.  ..Roon  Hd.__...^ 


Hob  «f  ftmUlii  In  fltooMV— - Chmp  One  f  Y«i  or  Ka 

|^|tOty«^.»..»....^ Imamitw, ...Cultoret  Tei  or  VOk 

A.  If. 

Mtftortd  to  ^ iwtm  igo 

P.  H 

(c)  In  diphtheria,  when  a  culture  taken  by  the  attending  physi- 
cian and  forwarded  to  the  IVpartment  of  Health  shows  upon  examina- 
tion diphtheria  Imcilli,  the  slip  accompanying  the  culture  will  be  ac- 
eeptetl  at)  a  report  of  the  case. 

Casen  of  eontaniotis  tlisease  are  brought  to  the  attention  of  the  De- 
partment in  varltMis  ways  besides  the  reports  of  attending  physicians, 
vix. ; 

(a)  "  \Vall«M|  In"  eases.  (Patients  that  go  direct  to  the  hos- 
pital, without  l>elng  first  seen  by  a  tliaguastician.)  These  cases  are  re- 
ju^rtetl  by  the  lu^spitaL 

(h)  Those  exehided  fn^ni  scIuh^Is  by  tlit^  Me^lical  School  Inspec- 
tt^rs*  who  telepbt^nc  to  (.VtUral  OIIuh?  the  full  name,  ago  and  address 
ami  the  disease  of  each  child  rseludetl  and  tu>tr  san^e  on  their  daily 
it^jH^rls,  which  air  tnalled  t\>  iVntral  OftW. 

(c'^  t^'ases  K^(  ctMUrt|;io\ts  disease  Um\\\\  bv  Moxlioa!  School  In- 
s|KVtor5i  on  **  aKsetUtr  "  visits.  VluUbvn  absent  fn^nt  scluvl  three  days 
without  known  excuse  atr  trfefttsl  \\\  the  ^^^bcal  Scbv\>l  Inspectors 


211 

and  visited  by  them.  If  they  find  a  school  child  or  some  member  of  the 
family  ill  with  a  contagious  disease  and  not  previously  reported  they 
send  a  telephonic  and  written  report  to  Central  Office,  giving  full  name, 
age  and  address,  disease,  duration  of  illness,  and  if  there  is  an  attend- 
ing physician,  his  name  and  address. 

(d)  Complaints  of  citizens,  which  may  be  mailed  to  Central  Office 
or  made  personally  to  District  Medical  Inspectors. 

(e)  Secondary  cases  reported  by  District  Medical  Inspectors  in 
families  where  there  is  no  attending  physician  or  where  the  attending 
physician  has  failed  to  report  them. 

(f)  Where  first  report  is  the  death  certificate. 

Each  morning  (except  Sundays  and  holidays)  at  nine  o'clock  all 
cases  of  contagious  disease  reported  during  the  previous  twenty-four 
hours  are  referred  to  the  District  Medical  Inspectors  (by  telephone  or 
personally  at  Central  Office),  who  visit  these  cases  that  day. 

Duties  of  District  Medical  Inspectors, 

The  Borough  of  Manhattan  is  divided  into  districts  and  a  Medical 
Inspector  assigned  to  each.  When  a  case  of  contagious  disease  is  re- 
ferred to  him  he  must  visit  it  that  day  and  keep  it  under  surveillance 
until  terminated  and  the  infected  rooms  fumigated. 

Diphtheria — The  District  Medical  Inspector  is  required  to  see  each 
case  of  diphtheria  the  day  it  is  referred  to  him,  and  upon  his  first  visit 
he  is  required  to  take  a  culture  from  the  patient's  throat  (or  nose), 
tmless  this  has  already  been  done  by  the  attending  physician  or  Anti- 
toxin Inspector  (or  the  patient  found  intubated),  or  unless  the  attend- 
ing physician  has  requested  that  no  culture  be  taken  by  the  Medical 
J  nspector. 


212 


DEPARTMENT  OF  HEALTH 

BOROIXIH  OP  MANHATTAN 


DRECnONS  FOR  HAJONG  CniTUimS 

TIm  pfttleot  thoald  be  placed  hi  a  good  light,  and.  if  a  child,  properl]f  ji|tld.  la 
caiet  where  It  is  poteible  to  get  a  good  view  of  the  thfoai  depress  ihe  toog«^  ami  nib 
the  cotton  swab  gently,  huifrtefy,  against  anj^  visible  exudate^  rtvoMng  ik0  win  tf 
twem  tkijingirin  so  ts  to  bring  all  portions  oC  the  swat^  in  conuct  with  the  mucoasr 
nembfane  or  exudate.  In  other  cases,  indtiding  thoie  in  which  ttte  exudatels  confined 
Co  the  I&rynz,  pass  the  swab  back  as  far  as  possible,  avoi^ng  4ke  l0ivi«r,.and  rub  ic 
freely  as  described  above  against  the  mucous  membrane  of  *the  pharynx  and  toftsils. 
Withdraw  the  cotton  plug  from  the  culture  tube,  holding  it  so  that  the  portion  with* 
drawn  froth  the  tube  does  not  come  in  conuct  with  the  fingers  or  with  any  other 
snbsunce«  Insert  the  swab  and  rub  it  gently  but  tkoeoughlv  boik  and  forth 
0Vir  thi  tntif^i  surfatt  of  tJU  hhcd  serum.  At  least  hatf  a  minute  should  be  given 
to  this  operdtion,  the  wire  being  revolved  so  as  to  bring  all  portions  of  the  swab  in 
contact  with  the  surface  of  the  blood  serum.  Do  not  allow  the  swah  to  touch  anything 
ixeeft  thi  throat  of  the  patient  and  the  surface  of  the  serum.  Do  not  push  the 
swab  into  the  serum,  nor  break  the  surface  in  any  way.  Do  not  use  tubes  in  which  the 
serum  is.contaminatcd,  is  liquefied,  or  is  dried  up.  Then  replace  the  swab  in  its  own 
tube,  plug  both  tubes,  mark  the  culture  tube  with  name  of  patient  for  identification 
with  accompanying  blank,  which  should  \it  fully  filled  out,  and  return  both  tu^es  and 
blank  promptly  to  a  culture  sution.  Unsatisfactory  cultures,  exhibiting  insufficient 
growth  or  contamination  by  forefgn  t>acteria,  usually  result  from  failure  to  follow 
caftfolly  the  above  directions.  A  report  will  be  forwarded  the  following  d»y  by 
mail,  before  1  r*  x-t  or  will  be  telephoned  by  10  A.  M.,  where  the  attending 
physldatt's  telephone  call  can  be  asceruined.  CommnnicaUous  should  be  addressed 
to  J.  S.  BlLUNOS,  Jr.,  M.  D.,  Assistant  Director,  Diagnosis  Laboratory,  Sixth  Avenue 
•ad  sstb  Street,  New  York  City. 


213 


tWBJETVBlS  SWAB  AKD  BOTH  XUBBS. 

wumniditn  worn  mAimra  cwrvmam  9m  wmum 
PIPHWKBTA,— Oaltme  for  Diagaoeifl. 

VMM  ef  lltkar  or  Cdltore 

JDtte'  Time 

SwM^ttMnt  Age 

Ad4iei8 

Att  ngfi.  Telephono'BesiiIt  to 

'Addiees 

Boratkm'of  Disease  Location  of  Membrane 

Boir^Ooatemoted  f 

tWaa  Spodmen  satisfactorily  obtained  f 

; Was  an  Antiseptic  applied  to  the  throat  within  two  hours  f 

Clinical  Diagnosis 

Has  Antitoxin  been  osedf 

Have  others  In  &mily  been  immnnized  T 

If  Odtore  negative  do  you  still  wish  case  to  be  considered  as  one  of 
*^  diphthoSa? 

'Renarlcs  S 

S 

^       l9"TU8BlultolMlUl6doa(totUs?ol]itbyltteDd^  p 

Aecmlyi^  an(2  Heported ExamiTiers ^^ 

MMffncd  to  Inspector, _^ - 


■  •  ••  *•****•*■  —  ■■■■■«♦•■■»»■——■■■•••■•— •••  —  ••4—»—i 


BemM  <ff  Examination^ 

The  primary  culture  slip,  properly  filled  out  and  accompanied  by 
the  culture  tube  and  swab,  must  be  left  at  a  culture  station  before  3 
p.  m.  in  order  that  it  may  be  collected  that  day  and  a  report  sent  from 
the  Laboratory  the  following  morning  to  the  attending  physician,  Dis- 
trict Medical  Inspector  and  Division  of  Contagious  Diseases  Office. 
If  the  patient  is  intubated  the  District  Medical  Inspector  must  notify 
Central  Office  in  writing. 

He  must  see  that  the  patient  is  isolated,  ascertain  whether  or  not 
there  are  school  teachers  or  children  in  the  family,  and,  if  so,  mail  an 
official  postal  to  the  school  or  schools  attended  by  them,  excluding 
them  from  school  attendance. 


214 


DEPARTHBNT  OF  HEilTH 

aOROUOH   OP    VIANHATTAN 

myiSIOM  tP  C0IITA6I0U8-0ISEA8ES 

The  following-named  children,  pupils  of  your  school,  are 
exposed  to  the  contagipn^f    .  at 


Sta  t4S*  No  piinelpal  or  superlntefidefit  of  any  ichod, 
and  no  parent,  master  or  Custodian  of  any  child  or  minor 
(having,  the  power  and  authority  to  prevent)  shall  permit 
any  ehtid  or  minor  having  starlet  fever,  diphtheria  (cronp), 
8mall*poz  or  any  dangerous,  infectious  or  contagious  dJs* 
ease,  or  ai\y  child  in  any  familv  in  which  any  such  diseasa 
exists  or  has  recently  existed,  to  attend  any  public  of. 

{>rivate  school  until  the  Board  of  Health  shall  have  giveo 
ts  permission  therefor,  nor  in  any  manner  to  be  unoec* 
cssarily  axposed.  or  to  needlessly  expose  any  other  person 
lo  the  caldng  or  to  the  infection  of  any  contagious  discaaa^ 

RespectfuUyt 


tttporUdbf         r.^-^^f^  ^^'attfrnJiioTltufecter. 


He  must  leave  a  "  circular  of  information  regarding  diphtheria 
with  the  nurse  or  attendant. 


» 


215 


143  J— 1906  759,  'o6, 12,000  (P) 

DEPARTMENT    OF    HEALTH 

OF  THE 

City  of  New  York 

circular  of  information  regarding  diphtheria. 

Diphtheria  is  an  acute,  infectious  and  very  readily  communicable  disease, 
caused  by  the  presence  of  the  diphtheria  or  "  Klebs-Loeffler "  bacillus.  The 
disease  varies  in  severity  from  the  mild  catarrhal  t3rpe,  where  there  is  only  slight 
inflammation  of  the  tonsils,  pharynx,  larynx  or  nose,  with  no  accompanying  con- 
stitutional symptoms,  to  the  most  severe  type,  where  extensive  membrane  is 
present  in  the  throat  or  nose  and  the  patient  is  completely  prostrated. 

The  disease  is  communicable  as  long  as  the  diphtheria  bacilli  are  present 
and  is  generally  transmitted  directly  by  the  discharges  from  the  nose  and  throat 
of  the  sick  person,  and  also  by  means  of  clothing,  books,  toys,  and  other  articles 
which  have  been  in  close  contact  with  the  sick  person. 

Your  attention  is  respectfully  called  to  the  contents  of  this  circular,  with 
reference  to  the  duties  of  the  inspectors  of  the  Department  of  Health  and  the 
obligations  of  parents  and  nurses  in  every  case  of  diphtheria. 

1.  Within  24  hours  after'^a  case  of  diphtheria  is  reported  an  Inspector  from 
the  Department  of  Health  will  visit  the  premises  (when  the  notification  is  received 
by  the  Department  on  Saturday  afternoon  or  Sunday  the  case  will  be  visited  the 
following  Monday)  and  will  see  that  the  case  is  properly  isolated.  He  will  not 
examine  the  patient.  H  the  case  is  to  be  sent  to  the  hospital  a  diagnostician  from 
the  Department  must  examine  the  case. 

2.  In  apartment  and  tenement  houses  and  also  in  furnished-room  and 
boarding-houses  the  inspector  will  placard  the  door  of  the  apartment  containing 
the  patient.  This  placard  must  not  be  removed  except  by  an  employe  of  the  De- 
partment. Unauthorized  removal  of  the  placard  is  a  direct  violation  of  the 
Sanitary  Code  and  may  be  followed  by  the  arrest  of  the  offender  and  removal  of 
the  patient  to  the  Department  Hospital. 

3.  The  inspector  will  exclude  from  school  attendance  all  teachers  and  chil-' 
dren  living  in  the  quarantined  apartment  and  notify  all  other  families  in  the 
house  of  the  existence  of  the  case,  and  will  take  such  other  precautions  as  may 
be  necessary  to  prevent  the  spread  of  the  disease.  He  will  visit  the  case  there- 
after as  often  as  necessary  to  maintain  isolation,  or  until  a  culture  from  the 
throat  is  free  from  diphtheria  bacilli.  Isolation  must  be  maintained  until  a 
culture  has  shown  that  the  diphtheria  bacilli  are  no  longer  present,  but  under  no 
circumstances    (when  diphtheria  bacilli   have  been   found)    will  a  case  be  dis- 


2l6 

charged  in  less  than  ten  days  from  the  beginning  of  the  illness,  even  if  succeed- 
ing cultures  should  prove  to  be  free  from  diphtheria  bacilli  before  the  expiration 
of  the  ten  days.  Then  the  inspector  will  give  permission  for  the  patient,  after 
a  proper  bath,  to  leave  the  sick  room  and  will  order  proper  and  necessary  dis- 
infection of  the  infected  room  and  its  contents.  Failure  to  maintain  isolation 
may  be  followed  by  the  removal  of  the  patient  to  the  hospital. 

4.  A  special  corps  of  inspectors  is  provided  by  the  Department  for  the  ad- 
ministration of  antitoxin  to  the  sick  person  and  to  others  in  the  family  (for  the 
purpose  of  immtmization),  provided  that  such  administration  is  requested  by  the 
attending  physician.  This  request  should  always  be  made  by  telephone  or  mes- 
senger to  the  Department. 

5.  During  the  illness  no  work  of  any  kind,  such  as  tailoring,  laundering, 
manufacturing  of  cigars  or  other  merchandise  will  be  permitted  in  the  rooms  or 
apartments  occupied  by  the  family.  Cases  occurring  in  rooms  connected  with 
stores  will  either  be  removed  to  the  hospital  or  the  store  will  be  closed  and  kept 
under  police  surveillance  until  disinfection  has  been  performed. 

6.  In  case  of  death,  burial  within  twenty-four  hours  is  required.  No  persons 
except  those  belonging  to  the  immediate  family  will  be  allowed  at  the  funeral 
services. 

7.  In  many  instances  landlords  apply  to  the  Department  for  an  order  for 
the  removal  to  the  hospital  of  a  tenant  ill  with  a  contagious  disease.  This  action 
is  desired  either  because  the  tenant  does  not  pay  his  rent  or  for  the  protection 
of  the  landlord.  In  other  instances  tenants  ill  with  contagious  diseases  refuse  to 
pay  rent,  relying  upon  the  Department  of  Health  to  keep  them  in  their  apartments. 
The  Department  wishes  it  distinctly  understood  that  it  will  not  interfere  in  the 
differences  between  landlord  and  tenant  until  they  have  been  settled  in  Court. 
If  a  dispossess  warrant  is  granted  by  the  Court  the  Department  will  provide  for 
the  removal  of  the  patient  to  the  hospital 

8.  After  the  disinfection  has  been  performed  the  inspector  will  again  visit 
the  premises,  and  if  conditions  are  satisfactory,  will  issue  permits  for  the  children 
to  return  to  school. 

9.  Disinfection— When  careful  isolation  has  been  maintained  during  the  ill- 
ness, disinfection  will  be  limited  to  the  sick  room.  Much  labor  and  annoyance 
will  be  saved  where  the  infection  of  other  rooms  has  been  avoided  by  careful 
isolation.  After  disinfection  of  the  room,  rugs,  carpets,  pillows,  mattresses  and 
unwashable  bed  and  other  clothing  will  be  removed  for  steam  disinfection.  The 
goods  so  removed  will  be  returned  the  following  day.  Upon  request  bedding  and 
other  goods  indicated  for  destruction  will  be  removed  and  destroyed  and  must 
never  be  sent  from  the  house  or  thrown  into  the  street  by  the  owner. 


217 

DUTIES    OF   PABENTS   AND    NUSSES. 

1.  Complete  isolation  of  every  case  of  diphtheria  as  ordered  by  the  medical 
inspector  of  the  Department  of  Health  must  be  maintained  tmtil  the  disease  is  at 
an  end  and  disinfection  has  been  performed. 

2.  Children  in  the  family  must  not  be  allowed  to  attend  school  until  they 
have  received  a  certificate  from  the  Department  of  Health. 

3.  The  room  used  for  the  case  should  be  as  nearly  bare  of  furniture  as  pos- 
sible. Carpets  and  hangings  should  be  removed  before  the  patient  is  placed  in 
the  room.  Toys  or  books  used  by  the  sick  person  should  be  thoroughly  disin- 
fected or  destroyed  after  recovery  or  death.  The  sick  room  should  be  well  aired 
several  times  daily,  the  floor  mopped  and  woodwork  frequently  wiped  with  damp 
cloths.  Under  no  circumstances  must  the  floor  be  swept  when  it  is  dry.  It 
should  be  sprinkled  with  sawdust,  bits  of  newspaper  or  tea  leaves,  all  thoroughly 
moistened,  and  then  carefully  swept  so  that  no  dust  may  arise. 

4.  When  practicable,  one  attendant  should  take  entire  care  of  the  patient 
and  no  one  else  beside  the  physician  should  be  allowed  in  the  room.  The  attend- 
ant should  have  no  communication  with  the  rest  of  the  family.  Visitors  must 
not  be  admitted  to  the  apartment  as  long  as  the  placard  remains  on  the  door. 

5.  Plates,  cups,  glasses,  knives,  forks,  spoons,  etc.,  used  by  the  patient 
should  be  kept  for  his  especial  use  and  under  no  circumstances  removed  from 
the  room  or  mixed  with  similar  utensils  used  by  others.  They  should  be  washed 
in  the  room  in  hot  soap-suds  and  then  rinsed  in  boiling  water.  After  use,  the 
soap-suds  should  be  thrown  into  the  water  closet. 

6.  All  cloths,  bed  linens  and  personal  clothing  which  have  come  in  contact 
in  any  way  with  the  sick  person  should  be  immediately  immersed  in  a  2%  carbolic 
solution  before  removal  from  the  room.  They  should  be  soaked  for  one  hour 
and  may  then  be  removed  from  the  room  and  boiled  in  water  or  soap-suds  for 
five  minutes. 

7.  Surfaces  of  any  kind  soiled  with  the  discharges  should  be  immediately 
washed  with  the  carbolic  solution. 

8.  After  making  applications  to  the  throat  or  nose  of  the  patient  and  before 
eating,  the  hands  of  the  attendant  should  be  disinfected  by  thorough  scrubbing 
in  hot  soap-suds  and  then  in  the  carbolic  solution. 

9.  After  the  inspector  of  the  Department  of  Health  has  ordered  disinfection, 
the  entire  body  of  the  patient  should  be  bathed  and  the  hair  washed  with  hot 
soap-suds.  The  patient  should  then  be  dressed  in  clean  clothes  (which  have  not 
been  in  the  sick  room  during  the  illness)  and  removed  from  the  room.  The 
attendant  should  also  take  a  bath  and  put  on  clean  clothes  before  mingling  with 
the  family  or  other  people.  The  clothes  worn  in  the  sick  room  should  be  left 
there  to  be  disinfected  with  the  room  and  its  contents.    Under  no  circumstances 


2l8 

should  the  sick  room  be  again  entered  or  occupied  or  anything  removed  from  it 
until  disinfection  has  been  performed. 

Thomas  Darungton,  M.D., 

Commissioner  of  Health, 
Hermann  M.  Biggs^  M.D., 

General  Medical  Officer. 

If  the  family  resides  in  a  tenement  (apartment)  house,  or  in  a  fur- 
nished-room or  boarding  house,  he  must  place  a  diphtheria  placard 
(paster)  on  the  door  leading  from  the  hall  to  the  apartment  or  room 
(if  this  has  not  already  been  done  by  the  Antitoxin  Inspector,  Diag- 
nostician or  officer  of  the  Health  Squad),  and  this  placard  must  not  be 
removed  except  by  an  employee  of  the  Department.  The  unauthor- 
ized removal  of  the  placard  is  a  violation  of  section  137  of  the  Sani- 
tary Code  and  may  be  followed  by  the  arrest  of  the  offender  and  re- 
moval of  the  patient  to  the  hospital. 

Department  of  Health,  The  City  of  New  York 

DIPHTHERIA 

All  penoofl.  not  oocuimiiU  of  this  afMUfment*  an  advljed  off  the  pwionoe  if 
Oiplitlierbi  In  It,  «nd  are  warned  not  to  enter.  ' 

Tbe  pcnon  having  Diphtheria  must  not  leave  the  apartment  nntU  the  removal  dtMi 
ootiOB  by  the  Depattment  of  Health. 

By  order  off  the  Board  of  Health. 

Alfe  l^erMoen*  welche  nicht  In  dleeen  Rflnmen  wohnen,  warden  hictdurch  benachrichtlft. 
Oaa  Diphtheria  hler  anigdirodien  1st*  and  warden  gewaint,  dleee  Wohnung  m  hetretea. 

Die  mit  DIphtherte  kranken  Perienen  dfirfen  die  Wohnnnf  nIcht  eher  verfaeeen* 
Me  diema  Plakat  von  der  QeenndheitabehOrde  wieder  enttemt  let. 

In  Auftrage  dee  Rathes. 

Ttatte  le  persooe  che  non  tone  ocwipanH  dl  quest*  appartlmenlo  sono  avisatti  della 
pieeenza  del  DUfetterfla  ^  aono  avisatti  dl  non  entrard. 

La  persona  avendO  U  Diflbtterlta  non  dcve  laedare  rappartlmento flBCh^  quest* avtoei 
Dortato  via  dal  Dipartlniento  dl  Salute. 

Per  ordlne  der  Antorltk  dl  Salute. 


^ 


THOMAS  DARLINGTON.  M.Dn  President 

BUQBNB  W.  SCHBFPER.  Seoetaiy 

Date — .I.I.I-...... 


219 

The  District  Medical  Inspector  must  notify  all  other  tenants  or  oc- 
cupants of  the  house  (personally  or  by  a  card  provided  for  the  pur- 
pose) that  there  is  a  case  of  diphtheria  in  the  house. 


in: 


ARTMENT  OP  HEALTH 

aOtOUM  OT  MANHATTAN 
SOCHI  AVBNUB  AND  ffOI  fTRBBT 


DIVISION  OP  00NTA<n0U8  DISBASBS 

New  v^i^.  1^ 


TV  tJf  Cimfamt  a/  tkig  Aparfmemt: 

Ton  are  hereby  hotMed  tbat  there  it. 

Ja  Ifce  fiA9 J  of  >  ■ 


9ft  tilt  ■  floor  of  these  premises  Na. 

BjT  order  of  the  Board  of  Health. 


THCmAS  DARUNGTOI^  ILIX, 

Presidents 


A.  BLAOVSLT,  IL  D., 


Medical  Inspeciof^. 


If  there  is  a  janitor  or  manager  for  the  tenement  or  apartment 
house  he  is  notified  that  if  there  is  an  elevator  members  of  the  family 
are  not  permitted  to  use  it  to  go  down  from  their  apartment,  but  may 
use  it  when  coming  up  from  the  street. 

In  hotels  the  manager  must  be  informed  of  the  rules  of  the  De- 
partment relating  to  the  isolation  of  the  patient. 

The  Medical  Inspector  will  visit  patient  as  often  as  necessary  (at 
least  once  a  week)  to  maintain  isolation  until  a  ctilture  shows  no  diph- 
theria bacilli. 

Should  isolation  not  be  maintained  the  Inspector  notifies  the  Central 
Office  by  telephone  and  in  writing,  and  the  family  or  attendants  are 
warned  by  a  policeman  of  the  Health  Squad  to  comply  with  the  rules 
of  the  Department  Continued  failure  to  isolate  patient  may  be  fol- 
lowed by  removal  to  hospital.  Secondary  cultures  must  be  taken  at 
least  once  a  week,  and  oftener  at  the  later  periods  of  the  illness.  If  the 
attending  physician  takes  the  first  culture  it  is  assumed  that  he  wishes 
to  take  the  secondary  cultures,  and  they  will  not  be  taken  by  the  Dis- 
trict Medical  Inspector  unless  the  attending  physician  requests  it,  or 
lias  discontinued  his  visits  to  the  patient 


220 


• 


ISi;^l|0|  sum.  tl,  61.000  (P) 

DEPARTMENT  OF  HEALTH 

'  DIAGNOSIS  LABORATORY 
Division  of  Communicable  Diseases 
SIXTH  AVBNUB  AND  nPTY-FlFTH  STREET 


DIREGTIONS   FOR    IMAKING    CULTURES 

The  patient  should  be  placed  ia  a  good  light,  and  if  a  child,  properly  hel4  In 
cases  where  it  is  possible  to  get  a  good  view  of  the  throat,  depress  the  tongue  and  rub 
the  cotton  swab  gently,  hutjrtefy^  against  any  visible  exudate,  revolving  the  win  between 
the  fingers,  so  as  to  bring  all  portions  of  the  swab  in  contact  with  the  mucous  membrane 
Of  exudate.  In  other  cases,  including  those  in  which  the  exudate  Is  confined  to  the 
larynx,  pass  the  swab  back  as  far  as  possible,  avoiding  tke  tongue,  and  rub  it  freely  as 
described  above  against  the  mucous  membrane  of  the  pharynx  and  tonsils.  Withdraw 
the  cotton  plug  from  the  culture  tube,  holding  it  so  that  the  portion  withdrawn  from 
the  tube  does  not  come  In  contact  with  the  fingers,  or  any  other  substance.  Ivsert  the 
swab,  and  ruh  it  gently  but  THOROUCHLY  ^<k>J  and  forth  over  the  entire  SMrface  of  the  blood 
serum,  A%  least  half  a  minutfthonld  be  given  to  this  operation,  the  wire  being  sevolved 
so  as  to  bring  all  portions  of  the  swab  In  contact  with  the  surface  of  the  blood  serum. 
/h  not  qllouf  the  swah  io  touch  anything  except  the  throat  of  the  patient  and  the  surface  of  the 
serum.  DooinS  push  tke  swab  into  the  serum,  ncr  break  the  surface  in  anysoay.  Do 
not  use  tubes  ib  whith  the  serum  Is  contaminated,  liquefied  or  dried  up.  Then  replace 
tibe  swab  in  Its  own  tube,  plug  both  tubes,  mark  the  culture  tube  with  name  of  patient  for 
Identification  with  accompanying  blank,  which  should  be  fully  filled  out,  put  the  tubes 
and  blank  In  the  box.  and  return  promptly  to  a  culture  sution^  Unsatisfactory 
Cttltnres.  exhibiting  insuflScient  growth  or  contamination  by  foreign  bacteria,  usually 
result  from  failure  to  follow  caref«lly  the  above  directions.  Report  of  later  cultures 
will  be  mailed  the  following  day  by  I  P.  m..  or  can  be  obuined  by  telephone  after  11  a.  m. 

For  farther  information  address  Dr.  J.  S.  BtUiiigs,  Jr.,  Division  of  CommunlcabU 
Diteaset,  Department  of  Health.  New  York  City. 


221 


tSrtLBTVWLH  SWAB  AND  BOTH  TVBBB. 

mmmcmonn  fob  makiho  oiriiTVBBi  oir  otbbb  wmm 

DIPHTHERIA.— Later  Culture. 


Number  of  Cvlture,  2d,  3d,  4th,  5th»  6tli,  7th,  8th. 


% 


Inspector  or  Physician 

Name  of  Patieat 

Age 

Address 

B 

5   Att.  Phys.. 


i 


Address 


Duration  of  Disease 


urnis  Blaik  to  te  Ulel  out  to  tUs  polDt  lir  Atteillii  Pkrsiciu. 

k  Examined  and  Reported Examiner 

Assigned  to  Inspector 


Result  of  Examination 


Lab.  No Day  No. 


Should  a  patient  be  found  in  rooms  at  rear  of  or  connecting  with  a 
£tore  it  will  be  necessary  either  to  have  store  closed  at  once,  and  to  re- 
main closed  until  the  case  is  terminated  and  the  rooms  fumigated,  or  to 
liave  the  patient  removed  to  the  hospital.  If  the  family  elect  to  have  the 
store  closed  it  is  placed  under  police  surveillance  (precinct  and  Health 
Department)  until  the  rooms  have  been  fumigated.  If  found  open  at 
any  time  patient  may  be  removed  (by  force  if  necessary)  to  the  hos- 
pital. If,  during  the  illness  it  is  found  that  tailoring,  laundering  or 
the  manufacturing  of  any  merchandise  is  being  carried  on  in  any  of 
the  rooms  occupied  by  the.  family  the  District  Medical  Inspector  must 
notify  Central  Office  by  telephone  and  in  writing,  and  a  Health  Squad 
Policeman  is  sent  to  stop  all  work  and  warn  the  family  not  to  resume 
the  same  until  after  fumigation,  under  penalty  of  having  patient  re- 
moved k)  lK)6pital. 


222 


When  the  Inspector  receives  a  report  from  the  Laboratory  of  the 
Department  of  Health  that  a  secondary  culture  is  free  from  bacilli  he 
orders  disinfection  of  the  infected  rooms  with  contents  and  the  removal 
(after  fumigation  in  rooms)  of  infected  mattresses,  carpets,  rug^,  pil- 
lows, etc.,  to  the  Department  station  for  sterilization.  These  goods  are 
removed  the  day  after  rooms  are  fumigated  and  returned  the  day  fol- 
lowing their  removal. 

After  fumigation  District  Medical  Inspector  issues  school  certificates 
(if  required)  and  mails  to  Central  Office  a  diphtheria  history  card, 
properly  filled  out  and  signed. 

DIPHTHBRIA 

Name ^ Age Address Aocr — «. 

P.  H.  Ten,  Families Reported  by. ^...^ 

Date  of  Report Beportof  Culture. ^....Culturts  Takea 

Culture  Neg»lti» ^.. 

Dates  of  Inspection ^ 

Onset  of  Disease. Dr « Address .,.„ 

Called^on Day  of  Disease     Antitoxin  used  on Day  of  Disease 

Clven  by  Private  Physician  Inspector,    Subsequent  Injections 

Amount  Given  1  2  3.    Other  Cases  in  Family 

I        2       3        4       5       6 
Complaints  Received 


•  «M**«**> 


•  .«n  M  .*ba*««. 


Complaints  Returned 


F.  and  D,  Ordared 

F.  and  D.  Perform6d.»,, 


School  Children  in  Family School  Certificates  Issued, 


•*•%•••••••••••••••••• 


•  ••••^•^•••••••••^l^%^^# 


130  J-1905   18t.288.  20.000  (P)  

When  a  patient  is  reported  ill  with  diphtheria  and  a  prompt  primary 
culture  shows  no  diphtheria  bacilli  a  letter  is  sent  by  the  Chief  Medical 
Inspector  to  the  attending  physician,  and  he  is  requested  to  note  on  an 
enclosed  postal  whether  or  not  he  wishes  the  case  dropped  or  held  as 
one  of  diphtheria.  If  an  answer  from  the  attending  physician  is  not 
received  when  three  days  have  elapsed  the  case  is  dropped  as  "  no  case." 
If  the  attending  physician  wishes  the  case  dropped  the  District  Medical 
Inspector  is  notified  to  remove  diphtheria  placard,  inform  the  family 
and  tenants  that  it  was  not  a  case  of  true  diphtheria  and  issue  school 
certificates  if  required.  He  then  forwards  to  Central  Office  a  diph- 
theria history  card,  prt^rly  filled  out  and  signed. 


223 

i4oJ— I9«S  1491, 'OSt  3,000  (P) 

DEPARTMENT    OF    HEALTH 
Thb  City  op  New  Yokk 

BOBOUGH  of   MANHATTAN 

Sixth  Avenue  and  Fifty-sixth  Street 

Officb  or  TBI  Chief  Medical  Inspector, 
DiTiAioir  m  Contagious  Diseases 

New  York 190 


Dear  Sir: 

On you  reported 

of 

ill  with 

diphtheria. 

The  bacteriological  examination  of  culture  from  this  case  did  not  show  the 
presence  of  Klebs-Loeffler  bacilli.  Do  you  wish  the  case  dropped  as  ''no  case" 
and  f umigatioa  omitted       Kindly  answer  on  enclosed  postal. 

Yours  respectftdly^ 


Chief  Medical  Inspector. 
If  antwer  i%  aot  received  within  four  days,  case  will  be  dropped. 

New  York, _ 190 

m 

DEPARTMENT  OF  HEALTH. 

Sirsi. 

I  hereby  direct  that„ „. 


of 


***^*'<**^^— >—^>*^^—*^»*———— *^**—**—^— —•■[»•>—■  •■••■■^  •»•*•»—■*•■•——•»■■**»•—>>>«  ^»»JU»  •*■  —  —  » 


and  fumigation  of  premises  |  °^omed 

Respectfully. 

(Name) 

(Address)....^ 


'«{j!;?r* 


•••^•••4^* 


■■■i»^^.^—»— »»•>—•■    >••••• 


•••••••••••••••••••••«*•••••••••••••••••••••••. 


."Tcariet  F^rT-tr — Eai:h  *<:2LrI«  ferer  -iaixtz  =:':st  ':«  Toceni  srj  the 
r>»crirx  A^fftffeal  rrac*ttrj:r  -.ti  ±e  tsLj  ie  recerre*  ±«f  cast,  azad  oq  his 
Sr«  7'Urc  hft  ptr^riw  the  -arr«*  cccri^t  i*  —   frcrtberia.  :a  regard  to 

'^yf  tfut  farr.ilj  frvrr-  vJzyxX  jtzi^j^  a  "  cirnlar  •::  infirrriatcii  regarding 
v^rfer  fft^*r."  4r.*i  :r  ir.  ir.  ^csArrm^n-  :r  :ir>Krn*T:-  b:«i*t.   :r  :3  i  board- 


Depaftment  of  Heafth,  The  CHy  of  New  York 

SCARLET  FEVER 


41  quest*  appartisert)  joao   crisjttl  dclla 
rapputimcnto  f  scM  qaest*  «viw  ^ 


TMNNAS  DARLVIGTOli  MJlL, 


The  Inspector  must  also  notify  all  tenants  or  occupants,  and  also 
the  manafifer  or  janitor,  if  there  is  one.  As  in  diphtheria,  members  of 
the  family  arc  not  allowed  to  use  the  elevator  in  going  down  from 
the  apartment,  but  may  use  it  when  coming  up  from  the  street.  The 
same  rules  and  rq^Iations  as  in  diphtheria  are  followed  in  relation 
t/>  enforcing  of  isolation,  prevention  of  any  kind  of  "  work  *'  in  the 
apartment,  and  closing  of  store  or  removal  of  patient  to  the  hospital 


when  case  is  found  in  room  behind  or  connecting  with  a  store.  He 
also,  after  his  first  visit,  mails  a  special  report  to  Central  Office  for 
each  case  of  scarlet  fever,  giving  name,  age  and  address  of  patient,  floor 
or  room  occupied  by  family;  if  in  a  tenement,  number  of  families  in 
house,  number  of  rooms  occupied  by  family,  how  many  adults  and 
children  in  family,  and  whether  or  not  patient  can  be  properly  isolated. 
If  in  a  private  house,  furnished-room  or  boarding-house,  that  fact 
is  noted.  If  the  patient  cannot  be  properly  isolated  and  a  Diagnostician 
concurs  in  this  opinion  and  diagnoses  the  case  as  scarlet  fever,  patient 
may  be  removed  to  the  Department  hospital.  The  District  Medical 
Inspector  must  visit  patient  at  least  once  a  week,  or  oftener,  if  he 
receives  complaints  relating  to  the  case,  or  proper  isolation  requires  it, 
until  five  weeks  have  elapsed  from  the  onset  of  the  disease.  Then 
if,  after  examining  the  patient,  he  finds  that  all  desquamation  has 
ceased,  fumigation  is  ordered,  and  also  removal  of  goods,  as  in  diph- 
theria; after  fumigation  he  issues  school  certificates  (if  required),  and 
mails  to  Central  Office  a  history  card,  properly  filled  out  and  signed. 


Disease ^ Name Age 

Address Floor P.  H. Ten No.  FamlUei 


Case  Reported  by. 
Date  Reported 


Inspected  on 


Con^plaints  Received 
Complaints  Returned 

Special  Reports 

School  Children  in  Family 

Fumigation  Ordered,,    .,.,■■■ 


1 

2 

3                  4 

5 

School  Certificates  Issued 
Performed 


m  J-IW   18a-238.  40.000  (P) 


M.D. 

Medical  Jntpfctor. 


leA  'o?.  Ifim  ( P) 


DEPARTMENT  OF  HEALTH 


CiiY  or  Nmr  YoMt 

Stub  Aveaue  and  55th  Street 

CiBCuiJU  or  IsroKHATioM  Rscjlxdihc  Measles. 

Mea*ki  ti  the  most  contagious  of  all  ihc  craptive  diseases  of  childhood  and  is 
Ihr  caiue  of  so  many  deaths  in  young  childrcD  that  it  becomes  a  BMtlcr  of 
great  importance  that  extreme  care  should  be  used  in  all  ihe  details  of  its 
managenieni.  It  is  contagious  from  the  beginning  of  symptoms  until  desqoaroa- 
(ion  has  been  comptered,  a  period  of  at  least  two  and  often  three  weeks.  The 
lymploms  (or  invasion)  commence  from  eleven  to  fourteen  days  after  exposure 
to  another  case,  at  which  time  the  disease  was  contracted.  Measles  is  conveyed 
lo  others  by  the  discharges  from  ihe  nose  and  throat,  and  also  by  the  scales 
thrown  off  from  the  surface  of  the  skin,  li  may  be  carried  by  Ihe  clothing  of 
the  tick  or  of  those  in  very  close  contact  with  the  sick. 

Your  attention  is  urgently  called  to  the  contents  of  this  circular  at  to  the 
duties  of  the  inspectors  of  the  Department  of  Health,  parents  and  nurses  m 
every  cue  of  measles, 


Dtitifi   of  Ihc  Inspectort  of  the  Department   of  Hralth. 

1,  Within  twenty-four  hours  of  the  receipt  of  notification  of  a  case  of  measles 
an  inspector  from  the  Dcpanment  of  Health  will  visit  the  family  (when  the 
nolllicatiun  is  received  by  the  Department  on  Saturday  afternoon  or  Sunday, 
the  raic  will  be  visited  the  following  Monday),  and  will  see  that  the  case  is 
properly  isolated.  He  will  not  examine  the  patient  until  the  Department  of 
Health  hat  bttH  noMtd  by  Ihe  ollrnding  physician  Ihot  the  case  is  lermiHated. 
The  inspector  will  then  examine  the  patient  to  sec  that  desquamation  has  been 
completed.  When,  however,  isolation  has  not  been  maintained  and  the  patient 
is  lo  be  removed  to  the  hospital,  a  diaBnostician  must  examine  the  patient. 

2.  In  apartments,  lencmcnla,  furnished -room  and  boarding  houses  the  inspector 
will  placard  Ihe  main  door  ol  the  apartment  containing  the  patient.  This  placard 
must  not  be  removed  except  by  an  employee  of  the  Department.  Unauthorized 
removal  of  llic  placard  is  a  direct  violation  of  the  Sanitary  Code  and  may  be 
followed  by  the  arrest  of  the  offender. 

J,  The   inspector   will   notify  all  other   famr 
of  Ihe  case,  exclude  all  children  in  the  fam:  -^rr-^^^t~-,  ^^^  j^j^^ 

such  other  precautions  as  may  be  necessary 


He  wiM  jimt  the  case  themflcr  as  oftca  as 

desqnaiaatiQB  k  romplctcd  and  tbe  case  is 

the  inspector  will  gihre  prnnmMin  for  tbe 

the  sick-rooB  and  will  order  proper  and 

room  and  its  contents.    Under  no 

leave  tbe  room  mtil  permission  is  grrcn  b^  tbe  nn^ft  lor.    Failnrc  to 

isolation  maj  be  followed  bj  the  removal  of  tbe  pazicm  to  tbe  bospital 

4.  During  tbe  illness  no  work  of  anj  kind,  as  taik>ring;  lamidering; 
ing  of  cigars  or  other  merchandise  will  be  permitted  in  die  rooms  or 
occupied  hf  tbe  family.  Cases  occnrring  in  rooms  connfctcd  widi  stores  wiO 
either  be  removed  to  the  hospital  or  tbe  store  will  be  dosed  and  kept  onder 
police  surveillance  tmtil  disinfection  has  been  performed. 

5.  In  case  of  death,  burial  within  twcntj-foor  hours  is  required.  So  persons 
except  those  belonging  to  the  immediate  familj  will  be  allowed  at  tbe  hmeral 
services. 

6.  In  manjr  instances  landlords  ^^ply  to  the  Departmem  for  an  order  for  tbe 
removal  to  tbe  hospital  of  a  tenam  ill  with  a  contagious  disease.  This  action 
is  desired,  either  because  the  tenant  does  not  pay  his  rent  or  for  the  projection 
of  the  landlord.  In  other  instances  tenants  ill  with  contagious  diseases  refuse  to 
pay  rent,  relying  upon  the  Department  of  Health  to  keep  them  in  their  apart- 
ments. The  Department  wishes  it  distinctly  understood  that  it  will  not  interfere 
in  the  matter  until  the  differences  between  the  landlord  and  tenant  have  been 
settled  in  court.  In  the  event  of  the  granting  of  a  dispossess  warrant,  tbe  Depart- 
ment will  provide  for  the  removal  of  the  patient  to  the  hospital. 

7.  After  disinfection  has  been  performed  the  inspector  will  again  visit  the 
premises,  amd  if  conditions  are  satisfactory,  will  issue  permits  for  the  children 
to  return  to  school. 

8.  DisiNFEcnoif — When  careful  isolation  has  been  maintained  during  the  ill- 
ness, disinfection  will  be  limited  to  the  sick-room.  Much  labor  and  annoyance 
will  be  saved  where  infection  of  other  rooms  has  been  avoided  by  careful  isola- 
tion.    After  fumigation  of  the  room,  any  rugs,  carpets,  pillows,  mattresses  and 

un washable  bed  and  other  clothing  may  be  removed  by  the  Department  at  the 
request  of  the  attending  physician  for  steam  disinfection.  The  goods  so  removed 
will  be  returned  the  following  day.  Upon  special  request  for  such  action,  bedding 
and  other  goods  will  be  removed  and  destroyed  and  must  never  he  tent  from 
the  home  or  thrown  into  the  street  by  the  owner. 

Duties  of  Parents  and  Nurses. 
I.  G)«vlete  isolation  of  every  case  of  measles  as  ordered  by  the  inspector  of 
the  Dqiarlneot  of  Health  must  be  maintained  until  disinfection  has  been  per- 
formed. 


2.  Children  in  the  family  must  not  be  allowed  to  attend  school  until  they  have 
received  a  certificate  from  the  Department  of  Health. 

3.  The  room  used  for  the  case  should  be  as  nearly  free  from  furniture  as 
possible.  Carpets  and  hangings  should  be  removed  before  the  patient  is  placed 
in  the  room.  Toys  and  books  used  by  the  sick  person  should  be  thoroughly  dis- 
infected or  destroyed  after  recovery  or  death.  The  sick-room  should  be  well 
aired  several  times  daily,  the  floor  mopped  and  woodwork  frequently  wiped  with 
damp  cloths.  Under  no  circumstances  must  the  floor  be  swept  when  it  is  dry.  It 
should  be  sprinkled  with  sawdust,  bits  of  newspaper  or  tea  leaves,  all  thoroughly 
moistened,  and  then  carefully  swept  so  that  no  dust  may  arise. 

4.  When  practicable,  one  attendant  should  take  entire  care  of  the  patient 
and  no  one  else  beside  the  physician  should  be  allowed  to.  enter  the  room.  The 
attendant  should  have  no  communication  with  the  rest  of  the  family.  Visitors 
must  not  be  admitted  to  the  apartment  as  long  as  the  placard  remains  on  the  door. 

5.  Plates,  cups,  glasses,  knives,  forks,  spoons,  etc.,  used  by  the  patient  should 
be  kept  for  his  especial  use  and  under  no  circumstances  removed  from  the 
room  or  mixed  with  similar  utensils  used  by  others.  They  should  be  washed  in 
the  room  in  hot  soap-suds,  and  then  rinsed  in  boiling  water.  After  use  the  soap- 
suds should  be  thrown  into  the  water  closet. 

6.  All  cloths,  bed  linen  and  personal  clothing  which  have  come  in  contact  in 
any  way  with  the  patient  should  be  immediately  immersed  in  a  2j4%  carbolic 
solution  before  removal  from  the  room.  They  should  be  soaked  for  one  hour 
and  may  then  be  removed  from  the  room  and  boiled  in  water  and  soap-suds 
for  five  minutes. 

7.  Surfaces  of  any  kind  soiled  with  the  discharges  should  be  immediately  washed 
with  the  carbolic  solution. 

• 

8.  The  discharges  from  the  nose  and  mouth  of  the  patient  should  be  received 
on  handkerchiefs  or  cloths,  which  should  be  at  once  burned  or  immersed  in  a 
25^%  carbolic  solution. 

9.  After  making  applications  to  the  throat  or  nose  of  the  patient,  and  before 
eating,  the  hands  of  the  attendant  should  be  disinfected  by  scrubbing  in  hot 
soap-suds. 

10.  When  the  skin  of  the  patient  is  peeling,  the  body  should  be  washed  daily 
with  warm  soap-suds  and  afterwards  anointed  with  oil  or  vaseline.  This  should 
be  repeated  until  all  roughness  of  the  skin  has  disappeared. 

11.  After  the  inspector  of  the  Department  of  Health  has  ordered  disinfection^ 
the  entire  body  of  the  patient  should  be  bathed  and  the  hair  washed  with  hot  soap- 
suds. The  patient  should  then  be  dressed  in  clean  clothes  (which  have  not  been 
in  the  sick-room  during  the  illness)  and  removed  from  the  room.  The  attendant 
should  also  take  a  bath  and  put  on  clean  clothes  before  mingling  with  tlie  family 


Z29 

or  other  people.  The  clothes  worn  in  the  sick-room  should  be  left  there  to  be 
disinfected  with  the  room  and  its  contents.  Under  no  circumstances  should  the 
sick-room  be  again  entered  or  occupied  or  anything  removed  irom  h  until  disin- 
fection has  been  performed. 

THOMAS  DARLINGTON,  M.  D., 

Commissiongr  of  Health. 

Hermann  M.  Biggs,  M.  D., 

General  Medical  Officer. 

Measles — The  District  Medical  Inspector  must  visit  each  measles 
case  the  day  he  receives  it,  and  pursue  the  same  rules  as  in  diphtheria 
and  scarlet  fever  in  relation  to  the  isolation  of  the  patient,  exclusion 
of  school  teachers  and  children,  placing  of  measles  placard,  notifying 
of  tenants,  managers  and  janitors  of  apartment  houses,  and  leaving 
*'  circular  of  information  regarding  measles."  The  same  rules  as  in 
diphtheria  and  scarlet  fever  apply  as  to  the  use  of  the  elevator,  work 
of  any  kind  in  the  apartment,  and  where  patients  are  in  rooms  at  rear 
of  a  store.  Patients  must  remain  isolated  at  least  two  weeks  after 
onset,  and  then  if,  after  examination  of  patient,  no  desquamation  of 
skin  is  found,  fumigation  is  ordered.  (No  goods  removed  tor  steriliza- 
tion in  measles.)  After  fumigation,  school  certificates  are  issued,  and 
history  card  is  mailed  to  Central  Office. 

German  Measles — Patients  must  be  isolated  and,  if  school  teachers 
or  children,  must  be  excluded  from  school  by  the  District  Medical  In- 
spector on  the  day  the  case  is  referred  to  and  visited  by  him.  A  week 
after  the  onset  he  will  issue  school  certificates,  if  there  is  no  desquama- 
tion, without  fumigation  of  the  room.  Rooms  are  not  placarded  for 
this  disease. 

Varicella — Patients  must  be  visited  by  the  District  liedical  Inspec- 
tor the  day  they  are  referred  to  him,  and  isolated.  If  a  school  teacher 
or  child,  an  official  postal,  excluding  from  school,  must  be  mailed  to 
the  school.  If  there  are  other  teachers  or  school  children  in  the  family 
who  have  not  had  varicella,  they  must  be  excluded.  If  satisfactory 
evidence  is  given  that- they  have  had  the  disease,  they  may  continue  at 
school.  No  placarding  for  this  disease.  After  patient  has  "  shed  "  all 
scabs,  school  certificates  are  issued,  without  fumigation. 


230 

Whooping  Cough — Patients,  if  attending  school,  must  be  excluded 
from  attendance  by  District  Medical  Inspector.  No  Placarding.  No 
fumigation.  Upon  presentation  of  a  certificate  from  a  physician  that 
patient  has  recovered,  child  will  be  allowed  to  return  to  school,  and 
the  Medical  School  Inspector  will  be  directed  to  notify  the  child's 
teacher  to  again  exclude  the  child  if  the  characteristic  cough  should 
recur. 

In  addition  to  the  duties  of  a  District  Medical  Inspector,  as  noted 
above,  he  is  required  to  report  on  official  postal  all  secondary  cases 
occurring  in  families  where  a  case  is  under  his  surveillance,  if  there 
is  no  attending  physician,  or  if  the  attending  physician  fails  to  report 
them,  and,  at  the  same  time,  send  special  written  report  of  same 
on  a  blank  provided  for  the  purpose.  He  must  report,  by  postal  and 
in  writing,  every  case  of  contagious  disease  found  by  him  in  his  dis- 
trict, whether  through  personal  effort,  or  complaint,  and  in  each  case 
give  full  particulars  as  to  full  name,  age,  address,  disease,  duration 
of  illness,  character  of  premises,  and  whether  or  not  there  has  been 
an  attending  physician. 

All  complaints  sent  to  him  from  Central  Office  by  telephone  or  mail 

must  be  promptly  investigated  and  answered. 

When  a  case  referred  to  the  District  Medical  Inspector  cannot  be 
found  at  the  address  given,  he  must  report  the  fact  at  once  to  Central 
Office  by  tdqjhone  and  in  writing.  When  corrected  address  is  ob- 
tained from  the  physician  or  person  reporting  the  case,  it  will  again 
be  sent  to  the  Inspector. 

He  must  mail  promptly  a  special  report  on  each  diphtheria  patient 
found  intubated,  and  take  no  culture  until  patient  has  been  extubated. 
If  cultures  are  not  taken  at  proper  intervals,  he  is  required  to  give  the 
reasons,  in  writing ;  and,  if  fumigations  are  not  ordered  promptly,  after 
culture  is  reported  negative,  or  at  the  end  of  two  weeks'  illness  in 
measles  and  five  weeks  in  scarlet  fever  (unless  there  are  secondary 
cases  in  family),  his  written  explanation  must  be  sent  to  Central  Office, 

When  a  case  of  contagious  disease  is  terminated,  and  there  is  a 
secondary  case  in  the  family,  postponing  fumigation,  the  history  card 
for  the  terminated  case  must  be  promptly  sent  to  Central  Office  to  be 
filed,  and  not  kq)t  back  until  all  the  cases  have  been  terminated. 


231 

When  a  "  dead  case  "  (one  where  the  first  report  is  from  the  death 
certificate)  is  referred  to  him,  he  must  order  prompt  fumigation  of 
infected  rooms  and  forward  a  report  in  writing,  stating  how  long 
patient  has  been  ill  and  under  the  professional  care  of  the  attending 
physician.  If  other  cases  are  found,  or  other  illness  in  the  family  pre- 
vents prompt  fumigation,  that  fact  must  be  noted.  A  history  card  is 
required  for  each  "  dead  case." 

When  cases  of  measles,  varicella,  or  German  measles,  reported  by 
a  Medical  School  Inspector,  are  referred  to  him,  and  he  cannot  con- 
firm the  diagnosis,  he  must  promptly  report  the  fact  to  Central  Office, 
by  'phone  and  in  writing. 

Wlicn  a  case  of  scarlet  fever  has  been  seen  by  a  Diagnostician, 
and  left  for  "  observation  "  by  the  District  Inspector,  he  must  send 
to  Central  Ofiice  a  prompt  written  report.  If  desquamation  appears, 
or  if  none  has  appeared  when  the  third  week  of  disease  has  passed, 
that  fact  must  be  noted,  and  case  may  be  dropped  as  "  no  case." 

Should  the  family  criticise  the  diagnosis  of  the  physician  who  re- 
ported the  case,  and  appeal  to  the  EHstrict  Medical  Inspector,  he  must 
not  discuss  the  subject  with  them,  or  give  his  diagnosis  of  the  case, 
but  refer  the  matter  to  the  Chief  Medical  Inspector.  He  should  report 
in  writing  to  Central  Office  the  statements  of  the  family  and  give  his 
opinion  in  relation  to  the  diagnosis.  Should  the  family  refuse  to  keep 
the  patient  isolated,  case  must  be  referred  to  a  Diagiio>stician,  and  if 
reported  by  him  as  a  true  case,  may  be  removed  to  tfie  ha«pital. 

When  a  case  of  contagious  disease  is  removed  to  a  Department 
hospital  from  a  general  hospital.  di%pcnsar>',  or  instittttion^  and  it  i« 
found  that  the  patfent  has  gone  from  his  home  to  the  fr>fpftal,  di*- 
pensar>-  or  :r.r.;t.::>yr.  -Ah:!e  i'A  with  the  cor.tagioos  disease,  the  Dis- 
trict Medical  Ir^^.ytctrjr  of  that  district  is  directed  to  order  prompt  fumi- 
gadcn  at  thf:  patf^.t's  rrjrrje.  and  maf!  a  history  c^rd  of  the  case. 

AiitT  h:^  f.--  vf-:t  v.  a  cchorl  chiW  wfth  cor.tagiocs  disease,  the 
District  ^f --::.>.:  lr.\y:f*j/:  zcriw  jyAt  on  a  £I:n4?  card  provided  tor  the 
pcrp/i-w:  t.'*  :\::  r.zTr,^,  '<zt.  4/f^*r-s  and  disease,  mnci^er  and  kKation 
of  th*  v/rr.:    rjirr>^   A  t-tacher  or  gr5.de  of  das*.  dunJbon  of  ilhieM 


232 

and  whether  or  not  child  was  excluded  from  school  by  the  Medical 
School  Inspector.     These  cards  are  filed  under  the  schocd  addresses. 

School   Location 

Class  Teacher  

Date  

Name   Age 

Address Floor 

Diphtheria    

Scarlet  Fever 

Measles 

Chicken-pox 

Mumps  

Whooping-cough   Medical  Inspector 

When  a  case  of  diphtheria,  scarlet  fever,  or  measles  is  terminated, 
the  District  Medical  Inspector  must  order  prompt  fumigation  of  the 
infected  rooms,  and,  in  diphtheria  and  scarlet  fever,  the  removal  of 
infected  goods  for  sterilization.  He  must  fill  out  the  oflBcial  fumiga- 
tion card,  and,  after  enclosing  it  in  an  envelope  provided  for  the  pur- 
pose, leave  it  before  3  p.  m.  at  a  culture  station,  in  order  that  it  may 
be  taken  up  by  the  collector,  and  brought  to  Central  office  that  even- 
ing, and  the  fumigation  performed  the  following  day.  He  also  places 
in  the  envelof)e  a  list  of  all  the  fumigations  ordered  by  him  for  the 
following  day.  Should  he  have  no  fumigations  for  the  following  day, 
that  fact  must  be  noted  on  a  card,  and  left  in  the  envelope  at  the  cul- 
ture station. 

M^H€fmSw^^ i.^.i ■■■■■'■itutiUMi ■■—■■■>• > 4\^pP^^^^  ■ 


•  <——•■■  I  on— —POO ■■    ^■MM*H 


•  —  •••♦#   w  V V   ^•••■*-i  ■•^••^■^^•■••■•••■—■■■■■^■■■■•—^—^——^•♦♦♦■••■'«— »■*»«—*»•■»••»>«»■>—•■«»«■>«»*««»•— «—tf«ifc    w%r%0w 


Name. Age. Character  of  Prem..^ 

Fumigation  Ordered^ .. by. 

Fumigation  Performed^ by. 


%■■»■•■■■••■#••»••• 


For  Removal 


Bi  Chloride  Grs.  Para/orm. 

.  Rooms. Lbs.  Sulphur . Oz.  FormaUkJ^di. 

^,  j  Mist.  Formaldehyde. 
^'-  (  Sulph.  Aluminum. 

i  Bedding Destroy.       Return. 

(  Carpets .^  Destroy.       Rehires 


233 


uiJ-mi 


nPABTiaDfT  OF  BBALm. 


ornnoi 

1  or 

IMf 

...IP0 

VAM 

mokmm 

s 

S 

"-» 

iJVS^^HtttnCi 

"WSSTpStt^ 

!  —  ■■■■■■<■■  ■■■■  ■■■■■■  Itf^t 


149- J- 1907 


2862,  '06-20.000  (P) 


DEPARTMENT  OF  HEALTH 

City  of  New  York 

S.  W.  Cor.  55tk  Street  &  Sixth  Avenue 


BOROUGH   OF   MANHATTAN 


FOR  DISINFECTOR. 

If  school  certificates  are  required,  the  District  Medical  Inspector 
must  visit  the  family  the  day  following  the  fumigation,  and  deliver 
the  school  certificates  if  everything  in  relation  to  the  fumigation  is 
found  to  be  satisfactory. 

Each  day,  he  must  note  on  a  "  daily  report "  card  provided  for  the 
purpose  the  full  name,  age,  address  and  disease  of  each  patient  visited 
that  day,  noting  in  each  case  the  character  of  the  building,  date  when 
case  was  listed  and  referred  to  him,  and  action  required.  He  also,  on 
the  reverse  side  of  the  card,  records  the  total  number  of  visits  made, 
and  the  Iota)  number  of  each  of  the  various  diseases  visited  that  day. 


234 

This  daily  report  card  must  reach  Central  Office  the  following  afiom- 
ing,  and  from  these  cards  his  weddy  report  is  made  up. 


X 


■CRT 


jeiiiDL 


Mouan 


'mmmmmmmmmmt 


JbtanyL 


«^"'^'«» 


iTi  Howsn 


T«Mb 


im 


9MLmiMlt<P) 


235 

Should  a  legal  holiday  precede  or  follow  a  Sunday,  Ae  District 
Medical  Inspector  must  see  the  new  cases  of  contagious  disease  re- 
ferred to  him  on  that  day,  but  may  omit  revisits  to  old  cases. 

The  District  Medical  Inspector  must  examine  the  daily  printed  lists 
of  contagious  disease  mailed  to  him,  in  order  that  he  may  be  sure  that 
all  the  cases  noted  under  his  district  have  been  referred  to  him  from 
Central  Office,  and  that  all  fumigations  ordered  in  his  district  are  noted 
on  the  daily  list. 

The  Diagnosticians  of  the  Division  are  on  duty  at  all  times,  and 
may  be  called  upon  at  any  hour  of  the  day  or  night.  They  are  re- 
quired to  diagnose — 

(a)  Every  suspected  case  of  contagious  disease  reported  to  the 
Division. 

(b)  Every  contagious  disease  case  reported  in  a  general  hospital, 
home,  asylum,  institution,  lodging-house,  or  dispensary. 

(c)  Every  contagious  disease  case  before  its  removal  to  Mintum 
or  a  Department  hospital. 

(d)  Every  case  found  in  rooms  at  rear  of,  or  connected  with,  a 
store. 

(e)  Every  case  where  the  family  refuse  to  stop  work  in  the  apart- 
ment or  to  keep  the  patient  isolated  after  several  warnings. 

(f)  Every  case  reported  as  typhus  fever,  small-pox,  or  plague. 

(g)  Every  adult  patient  reported  ill  with  varicella. 

(h)  Every  case  reported  by  Medical  School  Inspector  or  District 
Medical  Inspector  where  the  attending  physician  has  failed  to  report 
the  case. 

They  examine  all  patients  ready  for  discharge  at  the  Riverside  and 
Scarlet  Fever  hospitals,  and  must  certify  that  each  patient  is  in  a  non- 
contagious condition  before  it  can  leave  the  hospital. 

Cases  are  referred  to  them  by  telephone  from  Central  Office,  and 
their  reports  on  cases  are  received  at  Central  Office  in  the  same  man- 
ner.    When  a  Diagnostician  orders  a  patient  to  a  Department  hos- 


236 

pital,  he  fills  out  a  removal  blank,  which  is  left  for  the  ambulance 
surgeon,  and  fills  out  a  fumigation  card  which  is  left  for  the  disinfector. 


4490 

I 


-M- 4496 


DEPARTMEKT   OP  'HBiU.TH, 

MWMtUTn 

MtflhrK- 


^ 


448S 

r 


la 


3 1 


illlhi 


I 

i 

i 
I 


ll'-~ 


I! 


When  it  is  reported  that  a  diphtheria  patient  needs  immediate  hos- 
pital treatment,  an  ambulance  or  coupe  is  at  once  sent  and  patient  re- 
■  moved  as  an  "  emergency  "  case,  without  being  seen  by  a  Diagnostician. 
During  1906  the  Diagnosticians  examined  5,057  persons,  found  4,721 
had  contagious  disease,  visited  2,731  tenements,  65  hotels,  30  schools, 
144  private  houses  and  1,988  miscellaneous  dwellings. 

The  Veterinarians  of  this  Division  are  required  to  diagnose  all  re- 
ported and  suspected  cases  of  glanders  in  horses,  and  other  contagious 


237 

diseases  in  animals.  In  glanders  the  animals  affected  are  destroyed, 
and  all  infected  stalls,  harness,  stable  furniture,  etc.,  are  disinfected. 
Each  glandered  horse  is  destroyed  (shot)  by  a  patrolman  of  the 
Health  Squad,  upon  an  order  signed  by  the  Chief  Medical  Inspector 
and  the  Veterinarian,  and  the  body  is  promptly  removed  to  the  offal 
dock. 

W  J— 1101  pAiit   No       

DBPABTMEN^T   OF/HEAJLTH 

"BOROUGH ^OF    MANJfATTAtl 
Sixth  A  vocuM*  and  50it>  StfW 

ta  9ceordMuce  with  SeoUon  xas  of*  the  Sanitary  Code  of  Tlic  City  of 

•      .  • ,  •'  ' '       ,  ' 

IwOW  yofy-; ....■■^■■~.*~.-...~...-~^~...-.^..~. .♦»■■■■-.... m....^.^^^^..j^itroloiatif  noaltu  SqumOp 

ia-honlby  diTcctcd  tO'  itiU  tJio - ~.~»~.~~....~...^ ~ ~ ~ belon^io^ 

)\/  ■  . 


aaiauii  /«  mUtoring  itom  glmmdera* 


Chiei  M^iietl  T^wfT^f^* 


The  ahore  order  haa  been  tomplied  with, 
mfnere  xuieo-  M<i-  ■  ■' -■- «■•■■ ■— • 


.-. for  the  reaaon  that  aaid 

WALTMR  DBNSBIh  M.  D., 

Atalttmnt  8*aitary  auperinteadeat 


VeUriamriMa 


J^yijyi^y»»*»»»—#^^>—<»*»—^«»**—iw  — —*«■■••»••■  »■■■  —•■*>*•■»♦»•■%— ^»«—  ■•••  aZC^U^k  * 


.— ■        w* 


BMtrolauut,  Health  Sqamd 
VBSTROY:  Halter.    Blanket    Peed  Bag.  siai75. 'm.  i.ooo (P) 


238 

The  Veterinarian  leaves  at  the  stable,  in  an  envelope,  for  the  dis- 
infector,  a  disinfection  card  on  which  he  has  noted  full  instructions 
in  relation  to  the  disinfection  of  all  infected  materials.  When  a 
glandered  horse  is  found  in  a  stable,  all  the  other  horses  must  be  care- 
fully examined  by  the  Veterinarian,  and  should  any  suspected  cases 
be  found,  they  must  be  tested  with  mallein.  A  full  report  in  writing 
must  be  filed  at  Central  Office  for  every  case  visited. 

Pao6  Wg  ,  „>    ,    ,  m. ,— 

This  Slip  to  be  Retanied  to  the  Offlee  by  the  Disinfeetot 

JPfO*  3*  »'"*» ■ ■! •*— —  JfftQji  w 

DlginfeHion  Of  Stable, 

St All: 

Floating -~ " - MMnger 

Peed  box Sides 

ADJOININO  STALLS: 

HatnesSt  HalteTf  BUmkeU,  Sheets,  Brooms^  Sponges^  Brvmb0S. 


»—— »— %ii>l^a— im,ii  — ■■  W—W— — ^— — «— — i»ti>i— 


•  vp*  •••••••  •••••••••••••^pv^Mv** 


•  ■•■—•—•^••■•♦••»4»*«»*»«f—»«»—«*««^i»«i«t  — ••••—•■■•*>———»•■— ■■■■■■>■*»••  ^^««#— »»<»»»»>>■—»»»»■— ^>%^p^»—»ai 


Common  Watering  Trough  — - - - — 

1>}&STR0Y:  Blanket.    Baiter.    Tetd  bag. 

REMARKS: 


•  ••••••■  •«••■••.■•••••••«•■■»«•••■>■>•••(  ••••  .•••«•.   |-|---TB«-T       ■■■■■■■■IIH  MM       Tfl        I  ■■■»■>■■■  ■^■■■■ilagf 


J>i»ixLitctor.  V0t9ttaniaMu 


Description  of  Animal 


"«■**"*'*'■      ■ m*!  I«        IMMM...— W«».««.»W.«..^ 


Every  complaint  received  of  a  person  having  been  bitten  by  a  dog 
is  referred  to  a  Veterinarian,  who  is  given  the  name  and  address  of 
the  person  bitten,  and  the  name  and  address  of  the  owner  of  the  dog, 
and  a  description  of  the  animal.  If  the  Veterinarian  is  positive  that 
the  dog  has  not  rabies,  he  notifies  the  person  bitten.  If  the  dog  has 
rabies,  it  is  destroyed,  and  the  body  sent  to  the  Laboratory  in  East 
Sixteenth  street,  and  the  person  bitten  is  advised  to  report  at  the  Lab- 
oratory for  Pasteur  treatment. 

If  it  is  suspected  that  the  dog  has  rabies,  it  is  sent  to  the  Laboratory 
to  be  kept  under  observation. 


239 

During  the  year  many  cases  of  contagious  sidn  disease  of  animals 
were  reported  and  referred  to  the  Veterinarians.  A  full  report  in 
writing  of  every  case  visited  is  sent  to  Central  Office  by  the  Veter- 
inarian, and  filed  in  an  envelope. 

A  Veterinarian  of  this  Division  makes  a  careful  physical  examina- 
tion of  each  calf  sent  to  the  Vaccine  Virus  Laboratory,  and,  after  the 
vaccine  virus  has  been  collected  from  the  calf,  the  Veterinarian  holds 
a  post-mortem.  A  written  report  of  each  examination  is  forwarded 
to  the  director  of  the  Vaccine  Laboratory. 

During  1906  the  three  Veterinarians 

Examined,  horses  24,482 

Condemned,  horses   530 

Tested  with  mallein,  horses 356 

Held  post  mortems  on  horses 121 

Inspected,  stables   347^ 

Examined  for  suspected  rabies,  dogs 132 

Found,  cases  of  rabies  3 

During  the  past  year  a  great  number  of  specimens  of  blood  have 
been  taken  from  horses  suffering  from  diflFerent  diseases  (and  es- 
pecially horses  in  diflFerent  stages  of  glanders),  to  determine  the  value 
of  the  agglutination  test  for  glanders.  The  work  was  largely  experi- 
mental, but  is  proving  a  vakiable  aid  in  detecting  the  disease  before 
any  clinical  symptoms  develop.  It  has  been  necessary  to  take  specimens 
from  horses  suflFering  from  other  diseases,  to  determine  what  organ- 
isms have  a  specific  agglutinin  which  may  be  common  agglutinin  for 
glanders,  and  if  they  have  a  common  agglutinin  for  glanders,  to  what 
degree.  Horses  whose  agglutination  reaction  has  been  i-iooo  and  over 
occasionally  give  a  good  mallein  reaction,  and  on  post-mortem,  lesions 
of  glanders  are  found. 

General  Office  Work, 
The  Borough  of  Manhattan  is  divided  into  east  and  west  side  dis- 
tricts, the  dividing  line  being  Fifth  avenue  from  Harlem  river  to  Four- 
teenth street,  to  Broadway,  to  Battery  place,  the  district  numbers  be- 
ginning at  the  upper  end  of  the  borough  on  the  west  side,  running 
down  the  west  or  North  river  side  to  the  Battery,  and  up  the  East 
river  side  of  the  borough  to  the  Harlem  river. 


240 

Maps  at  Central  Office  are  marked  to  show  the  boundaries  of  the 
districts.  Each  district  is  properly  numbered,  and  the  name,  address 
and  telephone  number  of  the  Medical  Inspector  in  charge  is  noted  on  it. 

A  typewritten  list  is  furnished  the  Chief  .Medical  Inspector,  the 
telephone  operators,  and  each  of  the  clerks  of  the  Division,  showing 
the  number  of  each  district,  its  boundaries,  and  the  name,  address  and 
telephone  number  of  the  Medical  Inspector  in  charge.  A  copy  of 
this  list  is  also  kept  in  the  Laboratory,  to  facilitate  mailing  of  culture 
reports  to  the  District  Medical  Inspectors. 

If  districts  are  made  larger  or  smaller  (depending  on  the  marked 
increase  or  decrease  in  number  of  cases  reported),  or  the  Medical 
Inspectors  in  charge  are  changed,  new  lists  showing  date  of  change 

are  substituted. 

Each  morning,  at  nine  o'clock,  the  reports  of  all  cases  of  con- 
tagious diseases  received  in  the  first  mail,  together  with  those  re- 
ceived during  the  previous  twenty-four  hours,  are  sorted  and  grouped 
according  to  the  districts  in  which  they  are  located,  each  report  having 
its  district  number  marked  upon  it,  and  the  date  and  hour  received  at 
Central  Office  stamped  on  it.  Five  clerks  then  telephone  the  cases  to 
the  District  Medical  Inspectors  from  the  original  reports,  giving  name, 
age  and  address  of  patient,  disease  and  such  necessary  information  as 
may  be  required ;  as,  for  instance,  in  diphtheria  cases,  if  attending  phy- 
sician does  not  wish  cultures  taken  by  District  Medical  Inspectors.  The 
stenographers  then  prepare  (from  the  original  reports)  the  first  part 
of  the  daily  typewritten  list  for  the  printer,  showing  all  the  new  cases 
for  that  day,  each  under  its  proper  district  numbers  giving  family  name 
of  patient,  age,  address  and  disease.  This  typewritten  list  is  finished, 
by  adding  under  the  proper  district  numbers  all  fumigations  performed 
during  the  previous  twenty-four  hours,  each  showing  name  of  family, 
address  and  disease).  Corrections  of  previous  lists  and  cases  dropped 
as  "  no  cases  "  during  the  previous  twenty- four  hours  are  also  noted 
on  the  report. 

This  typewritten  daily  list  when  completed,  is  given  to  a  messenger 
from  the  printer's  office,  together  with  the  envelopes  in  which  the 
printed  copies  are  to  be  mailed,  and  which  have  been  properly  ad- 
dressed and  stamped  at  Central  Office. 


241 

The  envelopes  for  the  public  schools  of  the  borough  (properly  ad- 
dressed and  stamped)  are  received  from  the  Board  of  Education  office. 

The  daily  mailing  list  of  this  Division  averages  375  addresses,  and 
a  weekly  mailing  list  of  about  16  is  sent  each  Friday  to  Sunday  schools. 
The  daily  lists  are  printed,  placed  in  the  envelopes,  and  mailed  each 
afternoon  from  the  printer's  before  six  o'clock,  and  are  delivered  with 
the  first  mail  the  following  morning.  The  printer's  messenger  brings 
to  the  Central  Office  each  morning  extra  copies  of  the  list  printed  the 
previous  day,  and  these  are  compared  with  the  typewritten  copy  kept 
at  the  office,  in  order  to  detect  errors.  A  copy  of  this  daily  printed 
list  of  contagious  diseases  is  mailed  to  the  Chief  Medical  Inspector, 
each  Diagnostician  and  District  Medical  Inspector,  every  hospital  and 
institution  in  the  borough,  every  principal  in  the  public  schools,  every 
parochial  school,  many  private  schools  and  kindergartens,  to  all  branch 
public  libraries.  Tenement  House  Department,  etc.  This  list  has  been 
issued  daily  since  March  31,  1902. 

When  the  attending  physician  reports  a  case  of  contagious  disease 
on  an  ordinary  postal  or  by  letter,  it  is  assumed  that  he  has  no  official 
postals  for  reporting  cases,  and  a  dozen  are  mailed  to  him  at  once, 
and  the  fact  noted  on  his  report.  Every  request  for  official  postals 
is  promptly  complied  with. 

Every  report  of  a  case  of  diphtheria,  scarlet  fever  or  measles  re- 
ceived from  the  attending  physician  (by  culture,  telephone  or  mail)  is 
promptly  acknowledged;  and  should  he  not  receive  such  acknowledg- 
ment, he  may  know  that  his  report  has  not  been  received  by  the  De- 
partment. 


242 

143  J— i9o6  759,  'o6, 12,000  (P) 

DEPARTMENT    OF    HEALTH 

OF  THE 

City  of  New  York 
Sixth  Avenue  and  55th  Street 

19 

,  M.D., 


Dear  Doctor: 

Your  report  to  the  Department  of  Health  that 

of  

is  ill  with  diphtheria  and  under  your  professional  care  is  hereby  acknowledged. 
Your  attention  is  respectfully  called  to  the  following  regulations  of  the  Depart- 
ment of  Health  regarding  diphtheria  and  to  the  "  Circular  of  Information  Re- 
garding Diphtheria."  A  copy  of  this  circular  will  be  sent  to  the  family  of  the 
sick  person. 

Regulations  of  the  Department  of  Health  Relating  to  the  Attending 

Physician  in  Cases  of  Diphtheria. 

1.  A  prompt  report  of  each  case  of  diphtheria  must  be  made  to  the  De- 
partment of  Health  as  soon  as  the  case  is  discovered.  This  report  may  be  made 
in  one  of  the  three  following  methods : 

(a)  By  the  official  postal  cards  of  the  Department.  These  cards  can  be 
obtained  on  application  to  the  Division  of  Contagious  Diseases. 

(b)  By  telephone,  when  the  administration  of  antitoxin  or  the  removal  of 
a  patient  to  the  Department  hospital  is  desired.  Such  reports  must  be  supple- 
mented by  a  regular  report  on  the  official  postal  card. 

(c)  By  a  culture  taken  by  the  Attending  Physician  and  forwarded  to  the 
Department  of  Health.  If  upon  examination,  diphtheria  bacilli  are  found,  the 
slip  accompanying  the  culture  will  be  accepted  as  a  report  of  the  case. 

The  Department  will  promptly  acknowledge  all  reports  and  should  the  at- 
tending physician  not  receive  such  acknowledgment,  he  may  know  that  his 
report  has  not  been  received  by  the  Department.  Upon  receipt  of  the  report  of 
a  case  an  inspector  from  the  Department  of  Heahh  will  visit  the  premises. 

2.  The  clinical  diagnosis  of  diphtheria  must  in  all  cases  be  supplemented  by 
a  culture  from  the  throat  or  nose  or  both,  and  when  the  examination  of  such 


243 

cultures  confirms  the  diagnosis,  quarantine  of  the  cases  must  be  maintained  until 
subsequent  cultures  indicate  the  disappearance  of  all  diphtheria  bacilli.  Cultures 
should  be  taken  at  least  once  a  week  and  even  more  frequently  at  the  latter 
period  of  the  disease,  in  order  that  the  hardships  of  isolation  and  school  exclusion 
may  be  decreased.  When,  however,  diphtheria  bacilli  have  been  found  in  the 
cultures  examined  by  the  Department,  quarantine  of  the  case  will  be  required 
for  at  least  ten  days  from  the  beginning  of  the  illness,  even  though  later  cultures 
are  reported  free  from  diphtheria  bacilli  within  a  shorter  time.  In  general  after 
a  culture  showing  no  diphtheria  bacilli  has  been  received  disinfection  will  be 
promptly  performed. 

3.  When  the  attending  physician  sends  the  initial  culture  to  the  Department 
for  examination  in  a  case  of  diphtheria,  it  is  assumed  by  the  Department  that  he 
has  indicated  his  desire  and  intention  to  take  all  secondary  cultures.  If  the 
physician  does  not  take  the  cultures  and  does  not  state  his  intentions  in  regard  to 
the  same  to  the  Department  of  Health,  the  inspector  will  take  all  necessary  cul- 
tures. If  for  any  reason  a  physician  discontinues  treatment  of  a  case  in  which 
he  has  been  taking  cultures,  he  must  notify  the  Department  of  Health,  so  that 
further  cultures  may  be  taken,  if  necessary. 

4.  The  diagnosis  and  supervision  of  cases  reported  to  the  Department  as 
diphtheria,  and  in  which  a  negative  culture  has  been  returned  will  be  adjusted 
by  the  Chief  Medical  Inspector  through  written  communication  to  the  attending 
physician. 

5.  Antitoxin  will  be  administered  by  the  Department  inspectors  either  to 
the  sick  person  or  to  other  members  of  the  family,  upon  telephonic  request  to 
the  Department  (4900  Columbus).  Free  antitoxin  may  be  secured  at  the  Depart- 
ment of  Health  office  or  at  any  of  the  stations  throughout  the  City,  upon  signing 
a  statement  that  payment  for  it  by  the  family  would  be  a  hardship.  The  physician 
is  then  required  to  furnish  on  a  blank  supplied  for  the  purpose  the  facts  with 
reference  to  the  history  of  the  case,  after  recovery  or  death. 

6.  All  children  in  the  family  should  receive  immunizing  doses  of  antitoxin. 

7.  Upon  request  of  the  physician,  intubation  will  be  performed  by  the  De- 
partment Inspectors  at  the  home,  in  the  presence  of  the  attending  physician,  and 
the  case  then  left  in  his  care  or  removed  to  the  hospital  for  future  attention 
(the  latter  course  is  strongly  advised). 

8.  Whenever  a  case  of  diphtheria  is  found  in  rooms  in  the  rear  of,  or  com- 
municating with,  a  store,  the  inspector  is  required  to  have  the  store  closed  at 
once,  or  to  report  the  case  for  immediate  removal  to  the  hospital. 

9.  Careful  and  continued  isolation  of  the  sick  person  must  be  enforced  until 
disinfection  has  been  performed. 

10.  All  children  living  in  the  quarantined  premises  must  be  promptly  ex- 
cluded from  school  attendance. 


244 

11.  All  secondary  cases  must  be  reported,  even  if  the  first  case  is  still  under 
the  surveillance  of  the  Department  of  Health. 

12.  Suspected  cases  must  be  treated  as  true  cases  until  sufiident  observation 
has  shown  that  the  patient  has  a  non-communicable  disease.  All  cases  will  be 
considered  as  diphtheria,  if  so  reported.  Any  change  in  the  original  diagnosis 
must  be  made  in  writing  to  the  Department  of  Health,  and  must  be  confirmed  by 
a  diagnostician  of  the  Department. 

13.  Physicians  must  not  order  the  removal  of  patients  to  the  contagious 
disease  hospital  or  elsewhere  in  cabs  or  other  vehicles,  but  should  notify  the 
Department  of  Health  and  the  removal  will  be  effected  by  a  coupe  or  ambulance 
of  the  Department. 

14.  A  case  of  diphtheria  must  not  be  removed  from  one  house  to  another, 
or  even  to  another  apartment  in  the  same  house,  without  the  permission  of  the 
Department.  Such  removal  is  in  direct  violation  of  the  provisions  of  the  Sani- 
tary  Code. 

15.  When  a  secondary  culture  from  the  throat  of  a  patient  has  been  examined 
by  the  Department  of  Health  and  is  free  of  diphtheria  bacilli,  an  inspector  will 
visit  the  house  and  order  disinfection.  The  patient  must  not  be  discharged  from 
observation  until  disinfection  has  been  performed. 

16.  In  private  houses  only  disinfection  may  be  performed  under  the  super- 
vision of  the  attending  physician,  provided  he  follow  accurately  the  directions 
given  in  the  following  rules  and  regulations.  Upon  request  a  blank  will  be  pro- 
vided upon  which  he  must  state  the  manner  and  extent  of  the  work  performed 
under  his  supervision.  If  satisfactory  to  the  Department,  this  will  be  accepted 
in  place  of  disinfection  by  the  Department. 

In  every  case  of  disinfection  under  the  supervision  of  the  attending  physician 
the  following  regulations  must  be  complied  with: 

All  cracks  and  crevices  in  rooms  to  be  disinfected  must  be  sealed  or  calked, 
to  prevent  the  escape  of  the  gas,  and  one  of  the  following  disinfectants  used  for 
room  disinfection,  in  the  quantities  named : 

Sulphur,  4  lbs.  for  every  1,000  cubic  feet  of  air  space,  8  hours*  exposure. 

Formalin,  6  oz.  for  every  1,000  cubic  feet  of  air  space,  4  hours*  exposure. 

Paraform,  1,000  grains  for  every  1,000  cubic  feet  of  air  space,  6  hours*  ex- 
posure. 

The  following  disinfecting  solutions  may  be  used  for  goods  which  are  after- 
wards to  be  washed: 

Carbolic  acid,  2  to  5  per  cent. 

Bichloride  of  mercury,  1-1,000. 

After  disinfection  of  rooms,  carpets,  rugs,  mattresses,  pillows,  etc.,  must  be 
sent  away  for  disinfection  by  steam,  and  the  rooms  should  then  be  thoroughly 
aired  and  cleaned  with  soap  and  water. 


245 

The  Departmciit  of  Healdi  will  rcmoTC  anj  foods  diat  may  reqnire  further 
disinfection  and  retom  them  widioat  diarge. 

The  office  of  the  Dirision  of  Contagions  Diseases  of  the  Department  of 
Health  is  always  open  and  a  telephone  message  to  4900  Colnmhos  will  secure 
prompt  attention,  but  a  telephone  report  will  not  be  accepted  in  place  of  a  written 
report ;  the  latter  must  always  be  sent. 

Thomas  Dabungion,  M.D^ 

Commissioner  of  Health. 
Hermann  M.  Biggs,  M.D^ 

General  Medical  Officer, 

Borougfi  Offices,  Department  of  Healtfi. 

Manhattan— S.  W.  cor.  55th  St  &  6th  Ave TcL  4900  G>lmnbus. 

The  Bronx — S.  W.  cor.  St.  Paul's  Place  and  3d  Ave Tel.  975  Melrose. 

Brooklyn— 38-40  Qinton  St Tel.  4720  Main. 

Queens — ^374  Fulton  St,  Jamaica Tel.  361  Jamaica. 

Richmond— 54-56  Water  St,  Stapleton,  S.  I Tel.  440  Tompkinsville. 


132  J— 1906  2ia~i9i,  '06, 30,000  (P) 

DEPARTMENT    OF    HEALTH 

OF  THE 

City  of  New  York 
Sixth  Avenue  and  ssth  Street 

19 

,  M.D., 


Dear  Doctor: 

Your  report  to  the  Department  of  Health  that 

is  ill  with  measles 

and  under  your  professional  care  is  hereby  acknowledged. 

Your  attention  is  respectfully  called  to  the  following  regulations  of  the  De- 
partment of  Health  regarding  measles,  and  to  the  enclosed  "  Circular  of  Informa- 
tion "  with  reference  to  the  duties  of  the  inspectors  of  the  Department  of  Health, 
parents  and  nurses  in  this  disease.  A  copy  of  this  circular  will  be  sent  to  the 
family. 


246 

Regulations  of  the  Department  of  Health  in  Regard  to  Measles, 

1.  A  prompt  report  of  each  case  of  measles,  with  all  necessary  data,  on  an 
official  postal  card,  must  be  made  to  the  Department  of  Health  (Sanitary  Code, 
Section  133),  as  soon  as  the  case  is  discovered  or  diagnosed.  This  report  will  be 
promptly  acknowledged  by  the  Department  of  Health,  and  if  such  acknowledgment 
is  not  received  by  the  physician  he  may  know  that  his  report  has  not  been  received 
by  the  Department.  Upon  receipt  of  this  report  an  inspector  from  the  Depart- 
ment of  Health  will  visit  the  family. 

2.  All  children  in  the  family  must  be  promptly  excluded  from  school 
attendance. 

3.  Careful  and  continued  isolation  of  the  patient  must  be  enforced  until  the 
case  is  terminated  and  disinfection  has  been  ordered  by  the  medical  inspector  of 
the  Department. 

4.  All  secondary  cases  must  be  reported  even  if  the  first  case  is  still  under 
surveillance  of  the  Department  of  Health. 

5.  Suspected  cases  must  be  treated  as  contagious  cases  until  a  sufficient 
observation  has  shown  that  the  patient  has  a  non-contagious  disease.  All  cases 
will  be  considered  as  measles,  if  so  reported.  Any  change  in  the  original  diagnosis 
must  be  made  in  writing  to  the  Department  of  Health  and  must  be  confirmed 
by  the  diagnostician  of  the  Department. 

6.  Physicians  must  not  order  the  removal  of  patients  to  the  contagious  disease 
hospital,  or  elsewhere,  in  cabs  or  other  vehicles,  but  must  notify  the  Department 
of  Health  and  the  removal  will  be  effected  by  a  coupe  or  ambulance  of  the  De- 
partment. 

7.  Whenever  there  is  a  case  of  measles  in  rooms  in  the  rear  of,  or  com- 
municating with,  a  store,  the  inspector  is  required  to  have  the  store  closed  at  once, 
or  to  report  the  case  for  immediate  removal  to  the  hospital. 

8.  A  case  of  measles  must  not  be  removed  from  one  house  to  another,  or 
even  to  a  different  apartment  in  the  same  house,  without  the  permission  of  the 
Department.  Such  removal  is  in  direct  violation  of  the  provisions  of  the  Sanitary 
Code. 

9.  No  case  of  measles  shall  be  discharged  from  observation  until  the  Depart- 
ment  has  been  notified,  the  case  examined  by  an  inspector  to  see  if  desquamation 
is  entirely  completed  and  the  premises  properly  disinfected.  This  examination 
by  the  inspector  is  necessary  because  the  Department  of  Health  must  have  official 
information  as  to  the  completion  of  desquamation  before  a  child  is  dismissed 
from  observation;  other  people  with  children  demand  this  protection.  At  no 
other  time  is  the  inspector  allowed  to  examine  the  patient  In  any  case,  however, 
where  isolation  has  not  been  maintained  and  it  becomes  necessary  to  remove  the 
patient  to  the  hospital,  a  diagnostician  will  make  an  examination. 


247 

10.  It  is  recommended  that  physicians  provide  a  special  washable  gown  for 
each  case  of  measles.  This  gown  should  be  put  on  before  entering  the  sick-room 
and  taken  off  outside  the  sick-room  as  soon  as  the  visit  is  completed.  The  gown 
should  be  kept  in  a  closet  or  suitable  place,  separate  from  all  other  clothing,  and 
the  gown  and  the  closet  should  be  disinfected  after  the  termination  of  the  case. 

11.  In  private  houses  only,  disinfection  may  be  performed  under  the  super- 
vision of  the  attending  physician,  provided  he.  follow  accurately  the  directions 
given  in  the  following  rules  and  regulations.  Upon  request  a  blank  will  be  pro- 
vided upon  which  he  must  state  the  manner  and  extent  of  the  work  performed 
under  his  orders  and  supervision.  If  satisfactory  to  the  Department,  this  will  be 
accepted  in  place  of  disinfection  by  the  Department 

In  every  case  of  disinfection  the  following  regulations  must  be  complied  with : 
All  cracks  or  crevices  in  rooms  to  be  disinfected  must  be  sealed  or  calked,  to 

prevent  the  escape  of  the  disinfectant,  and  one  of  the  following  disinfectants  used 

in  the  quantities  named: 

a.  Sulphur,  4  lbs.  for  every  1,000  cubic  feet  of  air  space,  8  hours  exposure. 

b.  Formalin,  6  oz.  for  every  1,000  cubic  feet  of  air  space,  4  hours  exposure, 
c    Paraform,  1,000  grains  for  every  1,000  cubic  feet  of  air  space,  6  hours  ex- 
posure. 

The  following  disinfecting  solutions  may  be  used  for  goods  which  are  after- 
wards to  be  washed : 

a.  Carbolic  acid,  2  to  5  per  cent. 

b.  Bi-chloride  of  Mercury,  1-1,000. 

After  fumigation  of  the  rooms,  any  rugs,  mattresses,  etc.,  may  be  removed  by 
the  Department  at  the  request  of  the  attending  physician  for  disinfecting  by  steam 
and  the  rooms  should  then  be  thoroughly  aired  and  cleaned  with  soap  and  water. 

12.  The  Office  of  the  Division  of  Contagious  Diseases  of  the  Department  of 
Health  is  always  open  and  telephone  messages  to  1204  Columbus  will  secure 
prompt  attention,  but  a  telephone  report  of  a  case  of  contagious  disease  will  not 
be  accepted  in  place  of  a  written  report;  the  latter  must  alxM/ays  be  sent. 

Thomas  Darlington,  M.D., 

Commissioner  of  Health. 
Hermann  M.  Biggs,  M.D., 

General  Medical  OMcer. 

Borough  OMces,  Department  of  Health. 

Manhattan— S.  W.  Corner  55th  St.  &  6th  Ave Tel.  4900  Columbus 

The  Bronx— 3731  Third  Avenue Tel.  975  Melrose 

BROOKLrN— 38-40  Clinton  Street Tel.  4720  Main 

Queens — 374  Fulton  St.,  Jamaica Tel.  361  Jamaica 

Richmond— 54-56  Water  St.,  Stapleton,  S.  I Tel.  440 Tompkinsville 


248 

Should  the  attending  physician  not  give  "  full  particulars "  when 
reporting  a  case,  a  notice  of  the  fact  is  mailed  to  him  (and  carbon 
copy  filed  in  envelope  of  case),  with  the  request  that  in  future  he 
will  comply  with  section  133  of  the  Sanitary  Code.  When  he  has 
failed  to  give  either  full  name  or  age  of  patient,  the  omitted  part  is 
obtained  from  the  District  Medical  Inspector's  daily  report  card  the 
following  morning,  and  noted  in  the  record  of  the  case ;  or,  if  the  case 
has  been  referred  to  a  Diagnostician,  his  report  will  supply  the  omis- 
sion. 

DEPARTMENT    OF    HEALTH 

Division  of  Contagious  Diseases 

borough  of  manhattan 

Sixth  Avenue  and  55th  Street 

New  York 19... 


Dear  Doctor: 

We  arc  in  receipt  of  your  report  by 

of in  the  person 

of aged 

of , 

not  being  given. 

In  future,  when  reporting  a  case  of  contagious  disease,  kindly  give  full  name, 
age,  address,  etc,  in  order  that  there  may  be  a  complete  record  in  this  Division,' 
and  oblige, 

Yours  respectfully. 


Chief  Medical  Inspector, 

When  a  complaint  is  received  at  Central  Office  that  a  physician  has 
failed  to  report  a  case  of  contagious  disease,  has  delayed  reporting 
a  case  until  patient  was  found  by  a  Medical  Inspector,  or  has  ordered 
the  removal  of  a  patient  ill  with  contagious  disease  to  a  hospital  or 
elsewhere  in  a  cab  or  other  vehicle,  a  communication  is  mailed  to  him 
from  Central  Office  (and  carbon  copy  filed  in  envelope),  calling  at- 
tention to  the  violation,  and  requesting  an  explanation. 


249 

When  a  District  Medical  Inspector  telephones  Central  Office  that 
a  case  cannot  be  found  at  the  address  given,  if  the  person  reporting 
the  case  cannot  be  promptly  communicated  with  by  telephone,  a  De- 
partment policeman  is  sent  to  obtain  the  correct  address.  When  a 
complaint  is  received  at  Central  Office  that  a  store  previously  ordered 
closed  has  been  found  open,  a  Department  policeman  is  sent  to  warn 
the  family  or  attendants  that,  if  a  second  complaint  is  received,  patient 
may  be  removed  to  the  hospital.  The  policeman's  written  report  is 
filed  in  envelope. 

When  complaint  is  received  that  a  placard  has  been  removed,  a 
Department  policeman  is  sent  to  replacard  the  apartment,  and  warn 
the  family  that  a  repetition  of  the  offence  will  be  followed  by  the  re- 
moval of  the  patient  to  the  hospital.  The  policeman's  report  is  filed 
in  envelope. 

When  a  complaint  is  received  that  "  work  "  of  any  kind  is  being 
done  in  any  room  of  an  apartment  where  there  is  a  case  of  contagious 
disease,  a  Department  policeman  warns  the  family  that  a  continuance 
of  this  violation  will  cause  the  removal  of  the  patient  to  the  hospital, 
and  the  policeman's  report  is  filed  in  the  envelope. 

Should  a  complaint  be  received  that  an  undertaker  has,  in  a  case 
of  death  from  a  contagious  disease,  allowed  a  public  funeral,  used 
an  icebox,  failed  to  bury  the  body  within  twenty-four  hours  after 
death,  or  placed  draperies  about  the  room,  a  Department  policeman 
is  sent  to  enforce  compliance  with  the  sections  of  the  Code  relating  to 
these  violations,  and,  if  draperies  have  been  used,  they  are  fumi- 
gated by  the  Department  before  being  returned  to  the  undertaker.  He 
is  also  requested,  by  mail,  to  call  at  Central  Office  and  explain  why  he 
violated  section  141  of  the  Sanitary  Code,  and  informed  that  a  second 
offence  will  be  followed  by  summary  action.  A  carbon  copy  of  this 
letter  is  filed  in  the  envelope  of  the  case. 

All  complaints  (written  or  telephonic)  relating  to  cases  of  con- 
tagious diseases  are  noted  in  a  book  kept  for  the  purpose,  and  referred 
to  the  proper  District  Medical  Inspector  for  prompt  investigation  and 
report  in  writing.  A  record  is  kept  of  the  date  on  which  complaint 
is  received,  sent  to  inspector,  and  returned  by  him. 


250 

Since  1902  the  records  of  contagious  disease  have  been  kept  in 
envelopes,  which  are  filed  under  an  alphabetical  street  list.  These 
envelopes,  8^x5^  inches,  are  made  of  heavy,  light  brown  manilla 
paper,  and  open  at  one  end.  The  printing  upon  the  face  is  yellow 
for  measles,  red  for  scarlet  fever,  brown  for  diphtheria,  black  for 
smallpox,  etc. 

Each  day,  after  the  cases  have  been  referred  to  the  Medical  In- 
spectors, and  the  daily  printed  list  has  been  completed,  each  report 
of  a  case  is  filed  in  the  proper  disease  envelope,  and  on  the  outside 
is  noted  the  address  of  patient,  name,  age,  date  of  report,  duration 
of  illness,  how  reported,  and  name  of  Medical  Inspector.  In  diph- 
theria, if  patient  is  intubated,  that  fact  is  noted,  and  whether  "Loeffler" 
was  present  or  absent  in  the  first  culture,  and  the  date  of  same.  Dates 
of  secondary  cultures  are  noted,  and  also  date  when  a  secondary  cul- 
ture is  negative.  Secondary  cases  reported  in  the  family  before  the 
first  case  is  terminated,  and  the  rooms  fumigated,  are  recorded  in  the 
same  envelope,  and  names,  etc.,  noted  on  the  outside.  When  other 
cases  in  a  family  are  reported  after  the  first  is  terminated  and  fumiga- 
tion performed,  another  envelope  is  used.  Every  record  relating  to 
the  case  is  filed  in  the  envelope,  from  the  postal  reporting  it  to  the 

fumigation  and  history  cards. 

An  important  duty  of  the  clerk  in  charge  of  the  filing  case  is  to 

see  that  fumigation  of  rooms  after  diphtheria,  scarlet  fever  and  measles 
is  promptly  ordered  by  the  District  Medical  Inspector.  When  it  is 
noted  on  a  diphtheria  envelope  that  a  secondary  culture  was  nega- 
tive, and  no  fumigation  is  ordered  in  a  few  days,  and  no  cause  of 
delay  found  filed  in  the  envelope,  he  must  ask  the  District  Medical  In- 
spector for  an  explanation.  In  scarlet  fever  cases,  after  five  weeks 
have  elapsed,  and  in  measles,  after  two  weeks,  if  no  fumigation  is 
ordered,  and  no  reason  for  delay  found  filed  in  the  envelope,  an  ex- 
planation is  due  from  the  District  Medical  Inspector. 

When  fumigation  has  been  performed,  the  date  is  stamped  on  the 
envelope,  and  the  "  fumigation  "  card  is  held  by  the  clerk  two  days. 
If  the  history  card  has  not  then  been  received,  he  requests  the  Dis- 
trict Medical  Inspector  to  bring  it  at  once  to  Central  Office.  When 
received,  the  date  is  stamped  on  it,  it  is  filed  in  the  envelope,  a  check 


251 

is  put  on  the  face  of  the  envelope,  and  it  is  filed  in  another  case,  where 
it  remains  until  March  of  the  following  year. 

When  an  envelope,  with  its  contents,  is  taken  from  the  filing  case, 
a  blank  provided  for  the  purpose,  dated  and  properly  filled  out,  must 
be  left  In  its  place.  On  this  substitute  is  noted  when  and  by  whom 
envelope  was  taken,  and  also  the  principal  data  from  face  of  envelope. 
When  the  envelope  is  returned,  this  blank  is  destroyed. 


i\u 


►ARTMENT  OF  HEALTH 

'IHB  OTY  OP  VIEV  YORK 


tJtMiki^^mm 


Addna^ 


NaoML 


DftM     61     KtpCttm 


Jl£e. 


■  ^1   n     *     ■     I     I 


Eftvinop^  XuECfiL 


By. 


DIPHTHERIA 


NamcL 


Date  of  Report. 


Diiftttiottof  Wmmat 


DIPHTHERIA 


Addreao 


yr^ 


JUm, 


Removed  to. 


.HoopftM. 


.Doyo. 


RMttK  oC  Ctftiiri-L-  P.-i-  A. 


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_Dcod 


JtUd^imttU 


J 

I 


253 


SMALL  POX 


\m^».m.tMmn 


SMALL  POX 


NaVML 


.AgCL 


.Yr». 


JMa 


IMiotfRtporC 


.Removed  to  Hoopltat 


Ripottod  bj  ^CBrd» Teleplioiio»  iMpector  -Dead  Lbi.**  Coaplalnt. 


BuDlgated. 


Dead  Utt. 


JL  D. 


Jlled.Iiu^ 


«» 


•Af«^ 


.Ym^ 


Data  of  Report. 


.Removed  tot. 


.Ho^ttaL 


Pwnttioo  ot  OltuM, 


.O^ya. 


fianofted  bv  Caid.  Telephoae.   Iflenttttiitf  **Daaa  LfaL**  ^irmirlalnt 


Dead  Uat. 


A  D. 


JHcAlflipPC. 


Since  1902  a  card  index  file  has  been  kept  at  Central  Office,  giv- 
ing the  name  and  address  of  every  physician  who  has  failed  to  give 
"  full  particulars  "  in  any  case  reported  by  him,  who  has  failed  to 
report  any  case  attended  by  him,  who  has  sent  in  a  "  delayed  "  re- 
port, or  who  has  ordered  the  removal  of  a  patient  ill  with  contagious 
disease  to  a  hospital  or  elsewhere,  in  a  cab  or  other  vehicle. 


254 

Each  entry  on  the  filing  card  shows  the  name  and  address  of 
patient,  disease,  and  date  when  case  was  listed,  so  that  by  referring 
to  the  envelope  of  the  case,  a  full  record  of  the  facts  can  be  obtained. 

Should  these  violations  of  the  Sanitary  Code  by  any  physician 
be  too  often  repeated,  the  matter  is  referred  to  the  Board.  A  card 
index  file  is  also  kept,  giving  the  name  and  business  address  of  every 
undertaker  who  has  failed  to  comply  with  the  sections  of  the  Code  re- 
lating to  the  care  and  burial  of  bodies  that  have  died  of  contagious 
disease. 

When  a  case  of  contagious  disease  is  removed  from  an  institu- 
tion or  asylum  for  children  to  a  Department  hospital,  written  notice 
of  quarantine  of  institution  or  asylum,  preventing  admission  or  dis- 
charge of  patients,  is  mailed  from  Central  Office  to  the  institution, 
and  also  to  the  office  of  the  Society  for  the  Prevention  of  Cruelty  to 
Children,  and  the  office  of  the  Charity  Organization  Society. 

Should  no  secondary  case  develop,  a  written  notice  that  quarantine 
has  been  raised  is  mailed  to  the  same  addresses,  in  diphtheria  seven 
days,  in  scarlet  fever  ten  days,  and  in  measles  fourteen  days  later. 
Carbon  copies  of  each  notice  are  filed  at  the  Central  Office. 

When  it  is  learned  that  a  patient  ill  with  contagious  disease  in 
the  borough  has,  while  ill,  come  from  an  out-of-town  address,  the 
health  officer  of  the  locality  is  notified  by  mail,  and  a  carbon  copy 
of  the  notice  is  filed  in  the  envelope  for  the  case,  and  also  a  cross 
file  under  "  Health  Officers."  Should  a  patient  abscond  to  an  out- 
of-town  address,  the  same  action   is  taken. 

Whenever  an  employee  of  the  Division  is  absent,  notice  must  at 
once  be  sent  to  Central  Office  by  telephone  or  telegraph,  and  followed 
within  three  hours  by  written  notification  of  absence  on  an  official 
blank.  On  returning  to  duty,  the  employee  must  report  to  Central 
Office,  and  make  out  on  a  special  blank  an  application  for  leave  of 
absence  for  the  dates  of  absence,  and,  if  absence  is  due  to  illness,  a 
physician's  certificate  must  be  attached. 

A  report  is  forwarded  each  day,  giving  a  list  of  employees  (with 
their  titles)  that  are  reported  absent  that  day,  with  the  cause,  a  list 
of  those  that  have  returned  to  duty  that  day,  with  date  of  first  absence^ 


255 

and  cause,  and  a  list  of  those  still  absent,  with  date  of  first  absence, 

and  cause. 

An  "  absentee "  list  is  kept  in  the  office  of  the  Chief  Medical  In- 
spector, showing  name  and  title  of  every  employee  absent,  date  of 
notification,  date  of  return,  date  of  application  and  cause  of  absence. 

A  daily  report  is  forwarded  to  the  Commissioner,  General  Medi- 
cal Officer,  Superintendent,  Academy  of  Medicine,  etc.,  showing  total 
number  of  cases  (by  diseases)  reported  during  previous  twenty-four 
hours,  and  compared  with  similar  report  of  same  date  the  previous 
year,  also  number  of  cases  of  each  disease  removed  to  Department  or 
Mintum  hospitals.  A  list  is  forwarded  to  the  Assistant  Sanitary  Su- 
perintendent on  the  twentieth  day  of  each  month,  giving  name  and 
title  of  each  employee  of  the  Division,  and  noting  any  changes  that 
have  occurred  during  the  previous  month. 

A  weekly  report  is  forwarded  to  the  Assistant  Sanitary  Superin- 
tendent every  Monday,  compiled  from  the  daily  report  cards  of  the 
District  Medical  Inspectors,  the  weekly  reports  of  the  Diagnosticians, 
Medical  Inspector  in  charge  of  the  Trachoma  Hospital  and  dispen- 
saries. Medical  School  Inspectors,  Vaccinators,  Nurses,  Veterinarians, 
Disinfectors,  Ambulance  Drivers,  and  the  Disinfector  in  charge  of  the 
Disinfecting  Station.  From  these  weekly  reports,  monthly,  quarterly, 
semi-annual  and  yearly  reports  are  compiled  and  forwarded. 

An  employee  of  the  Tenement  House  Department  visits  the  De- 
partment each  day,  and  obtains  a  list  of  the  cases  of  contagious  diseases 
in  tenement  houses  that  have  been  terminated  during  the  previous 
twenty-four  hours. 

A  supply  of  the  following  laboratory  products :  vaccine  virus,  diph- 
tlieria  and  tetanus  antitoxin  and  mallein  is  kept  in  an  ice-box,  to 
supply  the  immediate  wants  of  inspectors,  physicians,  hospitals  and 
institutions,  when  the  other  offices  of  the  Department  are  closed,  viz. : 
nights,  Sundays    and  holidays. 

On  Sundays  and  holidays  all  "  new  "  cases  of  diphtheria,  scarlet 
fever  and  measles  in  tenement  houses  are  placarded  by  policemen  of  the 

Health  Squad. 

A  "  dead  "  list  is  received  twice  each  day  from  the  Bureau  of  Rec- 
ords, compiled  from  the  death  certificates  for  cases  that  have  died  from 


2s6 

contagious  disease.  On  it  is  noted  full  name,  age  and  address  of  pa- 
tient^ disease,  date  of  death,  number  of  death  certificate  and  name  and 
address  6i  attending  physician.  If  a  case  on  this  list  is  found  to  have 
been  reported,  the  date  of  death  and  number  of  death  certificate  is 
noted  on  the  filing  envelope,  and  District  Medical  Inspector  notified  to 
order  fumigation.  If  a  case  is  not  found  in  the  filing  case  an  envelope 
is  made  out  for  it  as  one  reported  from  the  "dead. list,"  and  the  Dis- 
trict Medical  Inspector  notified  to  visit  premises,  obtain  full  history 
and  mail  written  report  to  Central  Office.  He  also  orders  fumigation 
of  infected  rooms. 

A  "  culture  "  list  is  received  daily  from  the  Laboratory,  giving  re- 
sult of  each  diphtheria  culture  examination  that  morning,  whether  show- 
ing diphtheria  bacilli  or  no  diphtheria  bacilli,  and  listed  under  primary 
cultures,  secondary  cultures  and  trial  cultures.  Primary  cultures  show- 
ing Klebs-Loeffler  bacilli,  and  not  previously  reported,  are  listed  as 
new  cases  of  diphtheria  the  following  morning.  Dates  of  secondary 
cultures  and  of  primary  cultures  of  previously  reported  cases  are  noted 
on  the  envelopes,  and  if  negative  that  fact  is  noted  to  show  termina- 
tion of  case. 

A  "  hospital  record  "  book  is  kept  at  Central  Office,  giving  full  data 
of  each  case  seen  by  a  Diagnostician  and  of  every  "  walked  in  "  case. 

All  records  of  reported  and  suspected  cases  of  glanders  in  horses 
are  kept  at  Central  Office  by  means  of  the  envelope  filing  system  (as 
in  contagious  diseases)  under  an  alphabetical  street  list  of  the  stable 
locations. 

Each  envelope  is  given  a  number  corresponding  to  the  page  of  the 
book  in  which  all  the  facts  relating  to  the  case  are  entered,  and  a  carbon 
copy  of  this  page  it  filed  in  the  envelope.  A  written  report  of  the  Vet- 
erinarian to  whom  the  case  was  referred  is  filed  in  the  envelope,  also 
his  order  for  the  destruction  of  the  horse  and  the  disinfection  of  the 
stable  when  returned  by  the  policeman  and  the  disinfector.  Should 
there  have  been  a  mallein  test,  a  record  of  that  is  also  placed  in  the 
envelope. 


257 


GLANDERS  HH^HBIII  GLANDERS 


No.. 

LomUoo  of  Stable — ~  -^ -No.  of  Hones. 

ChimctcrolSUUo 


Niuno  of  Owner      .  AddreM- 


D«te of  Reporu — — ...     >   ■■ lAicriptloii  of  Aittiaiia. 

Repofted  vy  duttn  in  i  ■  TeiQ^lmwiww^^i^tnspector  ■   ■ 

IM^inatttoMi  tit  At|ltw*t  -      , 


■  ^i< 


Pa^fcatid. 


.VeCerlnerlMi. 


All  records  of  suspected  rabies  in  dogs  are  kept  at  Central  Office 
by  the  envelope  system,  and  in  each  envelope  is  filed  the  complaint  and 
a  full  written  report  of  the  Veterinarian  detailed  on  the  case.  The  en- 
velopes are  filed  under  the  address  of  the  owner  of  the  dog,  and  a  cross 
file  (card  index)  is  kept  under  address  of  complainant. 

Telephone  operators,  five  in  number,  are  assigned  to  duty  in  this 
Division.  There  are  two  on  duty  from  9  a.  m.  to  4  p.  m.  daily  and  one 
from  4  p.  m.  to  9  a.  m.  each  night  and  on  Sundays,  holidays  and  half- 
holidays.  They  receive  all  requests  for  removal  of  contagious  disease 
patients,  telephone  all  "hospital"  and  "special  diagnosis"  cases  to 
the  Diagnosticians.  The  reports  of  Diagnosticians  are  received  and 
noted  on  a  special  blank. 


258 


lAi-noi 


DEPARTMENT  OF  HEALTH, 

BOROUGH  or  MANKATTAR 

IXVISION  OF  CONTAGIOUS  DISEASBSL 

MESSAGE  RECEIVED. 


Dtf 


itt. 


Tfane 


A.I1 


KM. 


JiMBSL 


d4n. 


Y— fi 


Mo«. 


Addran. 


P12SL 


Room  Wo. 


•JDiMua. 


Howrepoctodl^S^gg- 


Pottal 


I  _p*^t^^*»^ , 


I   _Pf*tTt\ 


bf 


DU6M0STICIAN*S  RBPORT, 


^JMniMntidaiy, 


A.II. 


ZSlil^zzcs 


f.M. 


JUL 


J&d 


YotfB 


Moi. 


RWBOfO  ffOB^ 


floor 


RoomWo, 


Floor 


No. 


Dtogootit 


yaofdayoiU 


Mtrlod  or  tiaglo 


HaialMrily 


Ptoca  of  bnilpew 


Sooiwof  COIitM<00 


ChofteuroflioaM 


Hoir  fwoovoQ 


Drivw 


fOIIIOATB 


DldlMTfeCT 


i*^* 


TJte.ofSolpkw 
Oi.afFonnolto 
Oft.  of  Pttfmiora 


jSHSS^ 


DAIB 


Diilofoeior 


■ii 


mmm 


fSBSESsnssr 


259 

They  telephone  to  the  proper  hospital  all  orders  for  the  removal  of 
patients,  they  send  all  cases  reported  as  suspected  glanders  to  the  Vet- 
erinarians and  receive  their  reports.  All  telephone  communications 
relating  to  the  work  of  the  Division  are  received  and  answered  by  them. 
They  are  required  to  note  in  the  telephone  blotter  all  messages  received 
and  sent.  Nights,  Sundays  and  holidays  they  receive  all  requests  for 
injection  of  patients  with  antitoxin  and  requests  for  intubation,  attend 
to  the  sale  of  virus  and  antitoxin  and  receive  complaints  and  communi- 
cations of  every  description,  referring  the  same  to  the  Division  having 
jurisdiction  over  the  matter. 

Duties  of  Disinfectors. 

The  disinfectors  of  the  Division  carry  out  the  orders  for  the  fumi- 
gation of  rooms  and  disinfection  of  materials,  as  requested  by  the  Diag- 
nosticians and  District  Medical  Inspectors.  Since  1904  fumigations 
have  been  performed  with  formaldehyde  gas ;  eight  ounces  of  a  formal- 
dehyde mixture,  composed  of  six  parts  40  per  cent,  formalin  and  two 
parts  solution  of  aluminum,  are  poured  over  a  pound  of  fresh,  un- 
slacked  finishing  lime  for  every  1,000  cubic  feet  of  air  space  or  fraction 
tliereof.  This  liberates  all  the  formaldehyde  gas  in  about  fifteen  to 
twenty  minutes,  and  is  entirely  safe.  The  formaldehyde  mixture  is 
put  up  at  the  Department  station  in  half-gallon  bottles,  and  the  lime 
in  pound  cans,  tightly  covered,  ready  for  use  by  the  disinfectors.  Sup- 
plies are  kept  at  Central  Office  and  at  the  various  precinct  police  stations. 

Fumigations  ordered  by  the  Diagnosticians  are  received  by  tele- 
j)hone  at  Central  Office  and  noted  on  "  disinfection  "  cards,  and  the 
fumigation  cards  left  in  the  envelopes  at  the  culture  stations  by  the 
District  Medical  Inspectors  are  collected  each  afternoon  and  brought 
to  Central  Office  that  evening. 

Each  day  at  5.30  a.  m.  the  disinfector  in  charge  at  Central  Office 
opens  these  envelopes,  checks  off  the  cases  to  see  that  the  cards  corre- 
spond with  the  lists  of  fumigations  ordered  by  the  District  Medical  In- 
spectors, arranges  them  according  to  location  and  distributes  the  cards 
to  the  disinfectors  at  7.30  a.  m.  These  cards  are  signed  by  the  disin- 
fectors and  returned  at  once  to  the  disinfector  in  charge.  They  are 
then  filed  in  a  card  index  kept  for  that  purpose.    All  the  fumigations 


26o 

ordered  by  the  Diagnosticians  are  copied  on  a  separate  sheet  and 
checked  off  in  the  same  manner  as  the  others.  Each  disinfector  sup- 
plies himself  with  sufficient  materials  to  disinfect  and  fumigate  the 
cases  assigned  to  him  and  is  ready  for  his  work  at  8  a.  m.  If,  for  any 
reason,  a  disinfector  cannot  fumigate  a  case  as  ordered,  he  must  im- 
mediately get  his  instructions  by  telephone  from  headquarters  and  be 
guided  thereby  as  to  what  he  shall  do.  In  this  way  the  man  in  charge 
is  informed  as  to  what  his  men  are  doing,  and  he  knows  evien  before 
the  disinfectors  arrive  the  next  morning  just  how  the  work  of  the  pre- 
vious day  stands.  A  daily  report  is  submitted  by  each  disinfector  upon 
his  arrival  at  headquarters.  This  report  gives  in  detail  the  work  per- 
formed on  the  day  previous.  In  every  case  where  bedding,  carpet,  etc., 
are  to  be  removed  for  sterilization  the  disinfector  leaves  a  list  of  such 
articles  in  the  room  disinfected,  together  with  the  "  test  cards."  These 
are  taken  by  the  driver  of  the  "goods  "  wagon.  Another  list  is  mailed 
to  the  Disinfecting  Station  at  the  foot  of  East  Sixteenth  street  and  the 
collection  made  accordingly.  When  the  daily  reports  are  received  at 
Central  Office  the  slips  containing  the  cases  are  checked  off  and  the 
cards  signed  by  the  disinfectors  are  referred  to  a  clerk  to  file  in  the 
case  envelopes.  Where  a  fumigation  has  not  been  performed  because 
sickness  has  developed  since  the  Inspector's  visit  the  card  is  returned 
to  the  Inspector,  and  a  memorandum  filed,  stating  why  the  case  was  not 
terminated.  Weekly  reports  are  submitted  by  the  disinfectors  and  a 
detailed  daily  record  of  the  cases  fumigated  and  carried  over  is  kept 
by  the  disinfector  in  charge,  so  that  the  Chief  Medical  Inspector  may 
be  informed  of  the  work  each  man  is  doing.  The  disinfector  in  charge 
of  the  sterilizing  plant  at  the  foot  of  East  Sixteenth  street  submits  a 
daily  list  of  the  goods  collected.  He  also  notes  where  they  are  re- 
fused. These  reports  are  checked,  and,  if  necessary,  an  officer  of  the 
Health  Squad  is  sent  to  enforce  the  removal  of  the  goods,  in  accord- 
ance with  the  rules  and  regulations  of  the  Department.  When  the 
disinfectors'  daily  reports  are  received  in  the  morning  each  case  is 
marked  with  its  district  number  to  insure  its  proper  entry  on  the  daily 
printed  list.  A  duplicate  "bedding  list"  is  made  out  every  morning 
and  sent  to  the  Disinfecting  Station  so  that  it  may  be  compared  with 


the  fists  sent  in  br  the  dianfectors  and  xcistibes  in  address  iMc<l.  AH 
imn^ation  orders  trom  tbe  DirisiaQ  of  Coinnninioable  Di$ca$cji  i<«^ 
cases  of  tnbqmkisis,  trpbcnd  fercr.  cerebro-sfunal  maiinsitiss  etc.*  are 
given  to  the  disinfector  in  charge  at  Central  Ofiice  and  sent  out  in  the 
usoal  vaj.  Tbe  disinfection  of  all  stabies  from  which  glandentHt 
horses  ba\^  been  remored  is  ordered  on  a  special  card  by  a  IVpartnKtit 
Veterinarian,  the  card  being^  left  in  an  envdc^  at  the  stable.  IM^s^in- 
fectors  are  detailed  for  this  work.  The  disinfection  is  in  all  ca^s^es  per^ 
formed  according  to  the  written  instructions  of  the  Veterinarian^ 
Flooring  and  other  contaminated  woodwork  is  torn  out  and  thoroughly 
disinfected  by  spra}-ing  with  a  i-iooo  solution  of  bichloride  of  mercury* 
Later  all  of  this  infected  material  is  removed  and  bumetl.  There  are 
two  disinfectors  on  duty  at  night  and  three  on  Sundays  and  holidays. 
Their  names  are  posted  on  the  bulletin  board,  and  they  are  calleil  upon 
when  necessary.  In  all  cases  where  disinfection  or  fumigation  is  re- 
fused, without  adequate  reason,  a  member  of  the  liealth  Squad  is  sent 
to  enforce  the  order. 

Before  infected  rooms  are  fumigated  all  cracks,  crevices  and  open- 
ings must  be  thoroughly  sealed  with  the  strips  of  paper  provided  by  the 
Department,  all  infected  materials  spread  about  so  as  to  expose  the 
greatest  possible  surface,  and  all  closet  doors  and  bureau  drawers 
opened.  The  proper  amount  of  lime  is  then  placed  in  a  pail  or  suitable 
vessel,  and  sufficient  formaldehyde  solution  poured  over  it;  the  outer 
door  is  then  sealed  on  the  outside  and  the  paster  placed  upon  it.  showing 
v/hen  fumigation  began  and  when  rooms  can  be  opened  and  aired. 


262 
IIS  J--1906  2ia-i84,  '06,  18,000  (P) 

DEPARTMENT  OF  HEALTH 

the  city  of  new  york, 

Division  of  Contagious  Diseases 

Sixth  Avenue  and  55TH  Street. 

New  York, 190. . . . 

This  apartment  was  placed  under  fumigation  at M., 

and  must  remain  sealed  until M.  after  which  hour  it  may  be  opened. 

By  order  of  the  Board. 

Thomas  Darlington,  M.  D., 

Commissioner. 

Eugene  W.  Scheffer,  Secretary. 

Diese  Zimmer  wurden  zum  Ausrauchern  geschlossen  um Uhr 

morgens   (Nachmittags)   und  mussen  geschlossen  bleiben  bis   

Uhr  nachmittags   (Abends).     Nach  dieser  Stunde  durfen  die  Zimmer  geoffnet 
werden. 

Im  Auftrage  des  Sanitats  Rathes. 

Thomas  Darlington,  M.  D., 

Commissioner. 

Eugene  W.  Scheffer,  Secretary. 

Questo  appartamento  e'  stato  messo  sotto  fumigazione  al e  deve 

rimanere  serrato  sino  dopo  la  quale  ora  potra'  venir  aperto. 

Per  ordine  del  Dipartimcnto. 

Thomas  Darlington,  M.  D., 

Commissioner. 
Eugene  W.  Scheffer,  Segretario. 

The  disinfectors,  when  on  duty,  wear  a  uniform,  indicating  that 
they  are  employees  of  the  Department  of  Health. 

Only  in  private  houses  may  fumigation  be  performed  under  the 
supervision  of  the  attending  physician.  Upon  request  an  official  blank 
will  be  furnished,  upon  which  he  must  note  what  has  been  done  under 
his  orders,  and,  if  satisfactory  to  the  Department,  this  will  be  ac- 
cepted. After  fumigation  mattresses,  carpets,  etc.,  will  be  removed  by 
the  Department  for  sterilization  at  the  Department  plant 


^y  -r>*<'t;-A:— 1-». 


V« 


jr  c 


;».  i; 


Itffc  ^x^w^H  3>^  ^hwii^frc^tw^ 


.>!  ;\ 


Is  rvesj  case  :£  fisnfsmnr  ::3ir  iSIcvniip  t^txiUooik:^^  9t«Kt  Ve  vvw^^tsl  >ii^ 

cf  lie  ^saiccraaiL 

£sc2ectzr:$  say  Ve  c$ei  is  t)B(  <;m»{^(k«  lMMl»<^ll : 

Fonnafin,  6  oz:  for  rrrnr  ixi»  cabic  tt<t..  4  hoaw*  t\iK>*Kiitv 
Parafbrm,  i  gr.  to  ctctt  cobic  ic^C  6  boar^*  txpv»ur^ 
Carbolic  Add,  2  per  cent  to  5  per  cent  sohithMV  «nU  lUcbk^ruW  \^t  Mviv^MW 
I- 1000^  may  be  used  for  disinfecting  sohitionsk 

The  Department  of  Health  will  remove  any  gixnU  that  may  rt^uit^  i\\\\\\f\ 
disinfection. 


rz.  I' 


Diphtheria. . . . 
Scarlet  Fever. 
Measles 


Fumigations  for 


1 1 « 1 1 1 


1^1 
•lit^t 


r...^  .  *'  ■ 


264 

Each  day,  Department  wagons  remove  infected  goods  (fumigated 
the  previous  day  in  the  rooms)  to  the  Department  disinfecting  plant 
in  East  Sixteenth  street,  where  they  are  sterilized,  and  returned  the 
following  day  in  another  set  of  wagons. 

During  1906,  45436  pieces  of  goods  were  sterilized  and  returned, 
and  18,941  pieces  destroyed. 

When  the  Department  ambulance  or  coupe  delivers  a  contagious 
disease  patient  to  the  hospital,  it  is  immediately  fumigated,  by  being 
placed  in  a  tightly-closed  chamber,  and  exposed  to  formaldehyde  gas 
for  an  hour.  When  a  carriage  or  coupe  (not  owned  by  the  Depart- 
ment) brings  a  contagious  disease  patient  to  the  hospital,  it  is  fumi- 
gated in  the  same  manner  before  leaving. 

During   1906,   1,844  such   fumigations  were  performed. 

The  institutional  work  as  carried  out  under  the  direction  of  the 
Chief  Medical  Inspector  consists  of  medical  and  sanitary  inspection, 
and  systematic  collection  and  compilation  of  records  of  contagious 
diseases.  There  are  at  the  present  time,  in  the  Borough  of  Man- 
hattan, 19  institutions  which  come  under  the  Public  Health  Law. 

EXTRACTS  FROM  PUBLIC  HEALTH  LAW. 

Chapter  661,  Laws  of  1893,  as  Amended  by  Section  2,  Chapter  667,  Laws 

OF  1900. 

S  213.  Examination  and  quarantine  of  children  admitted  to  institutions  for 
orphans,  destitute  or  vagrant  children  or  juvenile  delinquents. — Every  institution 
in  this  State,  incorporated  for  the  express  purpose  of  receiving  or  caring  for 
orphan,  vagrant  or  destitute  children  or  juvenile  delinquents,  except  hospitals, 
shall  have  attached  thereto  a  regular  physician  of  its  selection  duly  licensed  under 
the  laws  of  the  State  and  in  good  professional  standing,  whose  name  and  address 
shall  be  kept  posted  conspicuously  within  such  institution  near  its  main  entrance. 
The  words  "Juvenile  delinquents"  here  used  shall  include  all  children  whose 
commitment  to  an  institution  is  authorized  by  the  penal  code.  The  officer  of 
every  such  institution  upon  receiving  a  child  therein,  by  commitment  or  otherwise, 
shall,  before  admitting  it  to  contact  with  the  other  inmates,  cause  it  to  be  examined 
by  such  physician,  and  a  written  certificate  to  be  given  by  him,  stating  whether 
the  child  has  diphtheria,  scarlet  fever,  measles,  whooping  cough  or  any  other  con- 
tagious or  infectious  disease,  especially  of  the  eyes  and  skin,  which  might  be  com- 
municated to  other  inmates,  and  specifying  the  physical  and  mental  condition  of 
the  child,  the  presence  of  any  indication  of  hereditary  or  constitutional  disease. 


265 

and  any  deformity  or  abnormal  condition  found  upon  the  examination  to  exist. 
No  child  shall  be  so  admitted  until  such  certificate  shall  have  been  furnished, 
which  shall  be  filed  with  the  commitment  or  other  papers  on  record  in  the  case, 
by  the  officers  of  the  institution,  who  shall,  on  receiving  such  child,  place  it  in 
strict  quarantine  thereafter  from  the  other  inmates,  until  discharged  from  such 
quarantine  by  such  physician,  who  shall  thereupon  indorse  upon  the  certificate  the 
length  of  quarantine  and  the  date  of  discharge  therefrom. 

S  214.  Monthly  examination  of  inmates  and  reports, — Such  physician  shall  at 
least  once  a  month  thoroughly  examine  and  inspect  the  entire  institution,  and  re- 
port in  writing,  in  such  form  as  may  be  approved  by  the  State  Board  of  Health, 
to  the  board  of  managers  or  directors  of  the  institution,  and  to  the  local  board  of 
the  district  or  place  where  the  institution  is  situated,  its  condition,  especially  as 
to  its  plumbing,  sinks,  water-closets,  urinals,  privies,  dormitories,  the  physical 
condition  of  the  children,  the  existence  of  any  contagious  or  infectious  disease, 
particularly  of  the  eyes  or  skin,  their  food,  clothing,  and  cleanliness  and  whether 
the  officers  of  the  institution  have  provided  proper  and  sufficient  nurses,  orderlies, 
and  other  attendants  of  proper  capacity  to  attend  to  such  children,  to  secure  to 
them  due  and  proper  care  and  attention  as  to  their  personal  cleanliness  and 
health,  with  such  recommendations  for  the  improvement  thereof  as  he  may  deem 
proper.  Such  boards  of  health  shall  immediately  investigate  any  complaint 
against  the  management  of  the  institution  or  of  the  existence  of  anything  therein 
dangerous  to  life  or  health,  and,  if  proven  to  be  well  founded,  shall  cause  the 
evil  to  be  remedied  without  delay. 

S  215.  Beds;  ventilation. — The  beds  in  every  dormitory  in  such  institution  shall 
be  separated  by  a  passageway  of  not  less  than  two  feet  in  width,  and  so  arranged 
that  under  each  the  air  shall  freely  circulate,  and  there  shall  be  adequate  ventila- 
tion of  each  bed,  and  such  dormitory  shall  be  furnished  with  such  means  of 
ventilation  as  the  local  board  of  health  shall  prescribe.  In  every  dormitory  six 
hundred  cubic  feet  of  air  space  shall  be  provided  and  allowed  for  each  bed  or 
occupant,  and  no  more  beds  or  occupants  shall  be  permitted  than  are  thus  pro- 
vided for,  unless  free  and  adequate  means  of  ventilation  exist  approved  by  the 
local  board  of  health,  and  a  special  permit  in  writing  therefor  be  granted  by  such 
board,  specifying  the  number  of  beds  or  cubic  air  space  which  shall,  under  special 
circumstances,  be  allowed,  which  permit  shall  be  kept  conspicuously  posted  in 
such  dormitory.  The  physician  of  the  institution  shall  immediately  notify  in 
writing  the  local  board  of  health  and  the  board  of  managers  or  directors  of  the 
institution  of  any  violation  of  any  provision  of  this  section. 

In  addition  to  this  number,  there  are  many  private  or  semi-public 
institutions.  The  former  are  incorporated  for  the  purpose  of  receiv- 
ing and  caring  for  orphan,  vagrant  or  destitute  children,  or  juvenile 
delinquents.     They  send  monthly  reports  to  this  Department,   which 


266 

reports  are  referred  to  the  Medical  Inspector  having  charge  of  the 
institutional  work.  This  inspector  visits  each  institution  regularly, 
and  if  sections  213,  214  and  215  of  the  Public  Health  Law  are  found 
complied  with,  the  report  is  endorsed  by  him,  and  returned  to  the 
Chief  Medical  Inspector.  When  violations  of  the  Public  Health  Law^ 
or  the  regulations  of  this  Department,  are  found,  a  report  to  that 
effect,  with  proper  recommendation,  is  appended  to  the  endorsement 
made  upon  the  monthly  report  of  the  institution. 

The  private  or  semi-public  institutions  are  visited  whenever  con- 
tagious diseases  occur,  or  when,  for  some  good  and  sufficient  reason^ 
it  is  thought  necessary  to  inspect  them. 

When  an  application  for  a  permit  is  received  from  an  institution, 
or,  when  an  application  for  a  new  permit  is  made,  the  applicati(Hi  is 
referred  to  the  Inspector  of  Institutions  for  inspection  and  report. 
The  premises  are  visited  by  the  inspector,  a  thorough  inspection  made, 
and  the  dormitories  measured  to  determine  the  number  of  beds  per- 
mitted in  each,  the  number  being  regpilated  largely  by  the  location  of 
the  dormitories,  and  character  of  the  ventilation,  the  minimum  basis 
being  twenty-two  and  one-half  square  feet  of  floor  space  for  each 
bed  or  crib,  or  occupant  thereof.  The  measurements  of  the  dormi- 
tories, in  detail,  with  the  number  of  beds  allowed  in  each,  are  noted 
on  a  form  provided  for  that  purpose.  This  is  appended  to  the  appli- 
cation, and,  with  proper  endorsement  by  the  inspector,  is  then  re- 
turned to  the  Chief  Medical  Inspector,  who  forwards  it  to  the  Assist- 
ant Sanitary  Superintendent  of  this  borough. 

In  the  case  of  an  old  institution  making  an  application  for  a  new 

permit,  in  consequence  of  changes  in  dormitories,  or  removal  of  in- 
stitution, the  same  form  is  complied  with,  and  a  special  report  to 
the  Chief  Medical  Inspector  follows.  This  report  notes  the  changes 
in,  or  removal  of,  the  institution,  and  recommends  that  a  new  permit 
be  issued  in  accordance  with  the  specifications  contained  in  the  de- 
tailed memorandum  previously  returned. 

When  an  institution  removes  from  this  borough,  or  for  any  rea- 
son is  discontinued,  a  report  to  that  effect,  with  a  recommendation 
for  the  revocation  of  the  permit,  is  made  to  the  Chief  Medical  In- 
spector. 


267 

The  inspection  of  an  insdtxatSosi  is  irade  with  special  reference  to 
sections  213,  214  and  215  of  the  Pnblic  Health  Law,  fiarcicQlar  at- 
tention being  paid  to  qnarantiDe  and  isolatian  of  children  admitted 
to  the  institution,  the  re^gnlations  of  this  Department  requiring  that 
such  children  be  kept  in  strict  quarantine  for  a  period  of  not  less  than 
fourteen  days,  the  proper  isolation  of  contagious  cases  sudi  as  chicken- 
pox,  mtunps,  whoc^ing-cough,  and  contagious  eye  and  skin  diseases. 

The  sanitan-  inspection  includes  such  details  as  general  cleanli- 
ness, ventilation,  arrangement  of  beds  in  dormitories,  condition  of 
beds  and  bedding,  particularly  mattresses. 

Several  large  institutions  have  done  away  with  mattresses  en- 
tirely, and  others  are  considering  the  advisabilit}-  of  doing  so.  From 
a  sanitary  viewpoint,  it  would  be  a  good  thing  if  all  dormitor)'  mat- 
tresses were  done  away  with,  particularly  those  used  by  small  chil- 
dren, as  it  is  next  to  impossible  to  keep  them  in  a  sanitary-  condition. 
When  pads  and  folded  blankets  are  used,  it  is  a  very  simple  matter 
to  wash,  fumigate  and  disinfect  them.  This,  of  course,  is  not  easily 
done  in  the  case  of  a  hair  mattress.  WTien  wool  and  other  sub- 
stances are  used,  the  difficulty  is  increased. 

The  toilet,  bathing  and  washing  facilities  are  also  included  in  rou- 
tine inspection.  When  the  toilets,  sinks,  etc.,  appear  in  any  way  un- 
satisfactory, a  report  to  that  effect,  recommending  a  thorough  sani- 
tary inspection  of  the  premises,  is  made  to  the  Chief  Medical  In- 
spector. 

In  the  washrooms,  all  sinks,  basins,  towels,  wash-rags,  hair  brushes, 
combs  and  toothbrushes  are  carefully  examined.  When  the  inspector 
finds  an  unusually  large  number  of  children  in  an  institution  suffer- 
ing with  diseased  eyes,  he  makes  a  report  to  the  Chief  Medical  In- 
spector, requesting  that  an  oculist  be  sent  to  examine  them. 

The  contagious  diseases  reported  by  each  institution  are  referred 
daily  to  the  Inspector  of  Institutions,  and  noted  on  filing  cards,  with 
the  name  and  location  of  the  institution,  name  and  age  of  the  patient, 
disease  and  disposition  of  the  patient,  that  is,  whether  removed  to 
the  Department  hospital  or  left  at  the  institution.  (Cases  of  scarlet 
fever  and  diphtheria  are  regularly  removed  from  institutions,  unless 
there  are  proper  facilities  for  complete  isolation.)     These  cards  arc 


268 

filed  in  a  card  index,  which  is  kept  at  the  Central  Office.  At  the 
end  of  the  year,  all  cards  are  removed,  and  a  chart  made  up,  show- 
ing in  detail  the  cases  of  contagious  diseases  reported  by  institutions 
for  each  month  of  the  year.  When  the  monthly  medical  report  of 
an  institution  is  received,  the  contagious  diseases  reported  thereon 
are  compared  with  the  particulars  on  file  in  this  office,  and,  when  a 
discrepancy  is  found,  as  sometimes  occurs,  the  institution  is  notified 
immediately,  and  the  necessary  correction  made.  This  insures  abso- 
lute accuracy  of  these  records. 

St.  John's  Orphan  Asylum,  43  st.  &  Ave.  M. 

Jan.  24,  1907 :  John  Williams,  4  yrs. 

Scarlet  fever.    — To  W.  P.  Hospital. — 

In  Asylum  3  days— came    from  14  9th  ave.,  Hoboken,  N.  J. 

Day  Nurseries, 

A  day  nursery  is  an  institution  where  children  from  six  months 
to  two  years  of  age,  sometimes  even  older,  are  cared  for  during  the 
daytime  while  their  mothers  are  employed.  The  children  are  usu- 
ally received  between  the  hours  of  7  and  9  a.  m.,  and  kept  until  even- 
ing, when  the  mothers  call  for  them  and  take  them  to  their  homes. 
The  nursery  is  in  charge  of  a  matron  or  "  house-mother,"  who  is  as- 
sisted by  one  or  more  trained  nurses  and  various  other  helpers.  There 
are  fifty-two  day  nurseries  in  this  borough,  all  conducted  in  accord- 
ance with  section  25  of  the  Sanitary  Code.  When  application  for  a 
permit  to  conduct  a  day  nursery  is  received,  it  is  referred  to  the  In- 
spector of  Institutions,  who  visits  the  premises  and  makes  a  thorough 
inspection,  paying  particular  attention  to  ventilation,  toilet,  bathing 
and  washing  facilities,  the  arrangement  of  cribs  and  beds  in  sleeping 
rooms  (the  floor  space  of  dormitories  is  limited  as  in  other  institu- 
tions, minimum  twenty-two  and  one-half  square  feet). 

When  everything  is  found  in  a  satisfactory  condition,  the  applica- 
tion is  returned,  with  an  endorsement  to  that  effect,  and  a  recom- 
mendation that  a  permit  be  issued. 

All  day  nurseries  applying  for  permits  since  January  i,  1905,  have 
been  obliged  to  conform  to  the  following  rules  and  regulations: 

"  The  beds  or  cribs  in  all  day  nurseries  in  every  room  in  which 
cribs  or  beds  are  used,  shall  be  separated  by  a  passageway  of  not  less 


269 

than  two  feet,  and  all  the  cribs  or  beds  shall  be  so  arranged  that 
under  each  of  them  the  air  shall  freely  circulate  and  give  adequate 
ventilation.  No  more  than  one  occupant  shall  be  allowed  for  each  crib 
or  bed,  except  that  two  children  of  the  same  family  under  the  age 
of  four  years  may  occupy  one  crib  or  bed.  All  cribs  or  beds  shall  be 
of  iron,  covered  with  >\hite  enamel  paint  (or  brass,  if  preferred), 
and  shall  be  provided  with  a  wire  spring  mattress,  over  which  may 
be  placed  a  woolen  blanket,  and  such  other  coverings  as  may  be 
necessary.  Xo  hair,  husk  or  feather  mattresses  shall  be  allowed.  No 
less  than  22y2  square  feet  of  floor  space  shall  be  provided  and  allowed 
for  each  bed  or  crib  or  occupant  thereof. 

Before  permitting  any  infant  or  child  to  come  in  contact  with  the 
other  children  who  may  be  present  in  the  nursery,  it  shall  be  the  duty 
of  the  officers  to  cause  a  careful  physical  examination  to  be  made  of 
such  infant  or  child,  and  if  it  is  found  suffering,  or  has  very  recently 
sufl'cred  with  any  contagious  or  infectious  disease,  such  as  diphtheria, 
scarlet  fever,  measles,  whooping-cough,  chickenpox,  smallpox,  or  any 
other  contagious  disease,  especially  of  the  eyes,  skin  or  scalp,  or  tuber- 
cular disease  which  might  be  communicated  to  the  other  inmates 
thereof,  it  shall  not  be  admitted.  In  the  cases  of  diphtheria,  scarlet 
fever,  measles,  whooping-cough  or  chickenpox,  it  shall  be  at  once 
isolated,  and  the  Division  of  Contagious  Diseases  of  the  Board  of 
Health  notified. 

For  every  child  admitted,  a  suitable  suit  of  clothing,  the  property 
of  the  nursery,  shall  replace  that  belonging  to  the  child  (unless  the 
clothing  in  which  the  child  is  brought  is  in  a  thoroughly  clean  con- 
dition when  admitted),  to  be  worn  during  the  day,  and  the  clothing 
removed  from  the  child  shall  be  disinfected  in  some  efficient  manner, 
and  thereafter  exposed  to  free  air  circulation. 

Xo  child  shall  be  admitted  to  the  community  of  others  already  in 
the  nursery  until  it  has  been  thoroughly  washed  and  bathed,  and  its 
head  cleaned  of  all  vermin.  All  underclothing  or  napkins  that  may 
become  soiled  through  the  day  shall  be  immediately  removed  and 
placed  in  a  tub  or  proper  vessel,  and  washed,  and  laundered  upon  the 
premises.  No  soiled  underclothing  shall  be  allowed  to  be  removed 
from  the  nursery  in  an  unclean  condition. 


270 

All  day  nurseries  existing  previous  to  January  i,  1905,  are  also 
required  to  observe  these  rules  and  regulations,  with  one  exception; 
that  is,  several  of  the  best  nurseries  in  this  borough  have  always  used 
hair  mattresses.  These  they  have  been  permitted  to  retain,  but  only 
so  long  as  they  are  in  perfect  sanitary  condition. 

All  cases  of  contagious  disease  reported  by  hospitals  are  recorded 
on  filing  cards,  giving  name  and  location  of  hospital,  name  and  ad- 
dress of  patient,  age,  disease,  duration  of  illness,  disposition  of  case, 
length  of  time  in  hospital.  These  cards  are  referred  daily  to  the  in- 
spector of  Institutions,  and  filed  in  a  card  index  similar  to  that  con- 
taining the  institution  records.  They  also  are  removed  at  the  end  of 
the  year,  and  all  data  transferred  to  a  chart,  giving  the  detail  for  each 
month  of  the  year. 

Bellevue  Hospital,  Foot  E.  26th  st. 
Jan.  24,  1907:  John  Doe,  3  yrs. 
Diphtheria.    To  Reception  Hosp. 
In  Hosp.  3  weeks.    Res.  17  Ave.  X. 

St.  Peter's  Hospital,  14th  st  &  Ave  G. 
Jan.  24,  1907:  Mary  Jones,  5  yrs. 
Scarlet  fever.    Res.  25  West  2nd  st. 
In  Hospital  18  days.     Isolation  perfect. 

The  following  table  shows  the  number  of  cases  of  contagious  diseases  reported 
during  1900  to  1906: 


BOROUGH    OF    MANHATTAN. 


Smallpox 

Scarlet  Fever 

Diphtheria  and  Croup 

Measles 

Varicella 


1900. 

I90I. 

13a 

1,198 

3,927 

10,113 

7430 

6,774 

10,690 

7,59a 

2,036 

755 

6,895 

9,679 
11,645 

2,165 


1903. 

1904. 

1905. 

30 

42 

12 

6,705 

7,747 

4,233 

10,568 

11,0x6 

7,553 

7,283 

17,838 

9495 

2,548 

2,124 

2,699 

1906. 


48 
4,068 

7,444 
18,265 

«i398 


Ik£  'Aansaif   nui^ 


3-    /r    ,' 


ff         ■>  s* 


Fe*vrf 

Mar.   Ti 


F=? 


JTr 


Apr.3s. 
Majp 


ic         T?r 


us 


S-^        ~53«        « 


July  51.. 
Aug.  31. 
Sept.  2ty. 


i^ 


*3 


ir^ 


Third  Q^iaiter <IP7       1.367  5*r 


Oct.31 134  434 

Not.  30 '      x:7  456 

Dec.  31 


^- J 


«      r  jxc       m: 


r6 


5*        ^ 


lot      ^I 


Fourth  Qoaiter. 


3»S 

K5 


«s^ 


5 

« 

4 


15* 

• 

ss 

55 

45 

174 

-• 

»5: 

^: 

55 

577 

,  , 

«rQ 

101 

v?» 

714       1^75  7=7        «        474      *a6    '      434 


Grand  Total i8.a6s      7-444       4.c6S       4S      1,308      S^        i,iSi 


I 
I    I 

J!       S 


t 


"5 


^         ^.WSS 


^ 

t»r$i 

—  — 



5 

J»^Jl 

0 

i.iilb 

w 

i.r*5 

jc» 

ji.?*$ 

J^ 

.^4.^^4 

DIVISION  OF  COXTAGIOUS  DISEASES. 

Report  of  the  zcork  of  this  Division  for  the  year  ending  Peeember  29,  1906, 

Number  of  visits  to  cases  of  contagious  diseases Ui.057 

Number  of  cases  visited  for  special  diagnosis 5,057 

Number  of  visits  to  tenement  houses i-M.55^» 

Number  of  visits   to   hotels 4(k) 

Number  of  visits    to    schools    fM.<»5<> 

Number  of  visits  to  private  houses 4»<»<>9 


2^2 

Number  of  visits  to  not  found  cases I,I44 

Number  of  visits,  miscellaneous    10,984 

Number  of  visits   224203 

Number  of  primary   vaccinations    19,621 

Number  of  rcvaccinations    103,117 

Total  number  of  vaccinations   122,738 

Ntunber  of  certificates  of  vaccination  issued 23,974 

Number  of  persons  removed  to  Contagious  Disease  Hospital ....  2,281 

Number  of  dead  bodies  removed  to  Morgue 50 

Number  of  houses  visited  for  disinfection 29,290 

Number  of  rooms   disinfected    48,301 

Number  of  times  Ambulances,  etc.,  disinfected 1,844 

Number  of  pieces  goods  disinfected   45*436 

Nimiber  of  pieces  goods  destroyed  18,941 

Number  of  animals  examined 24,482 

Ntmiber  of  cases  of  rabies  found  3 

Number  of  post  mortems  on  animals 121 

Number  of  horses  tested  with  mallein 356 

Number  of  glandered  -horses  condemned  and  destroyed 530 

Number  of  animals  examined  by  "  agglutination  "  test 118 

Number  of  inspections  of  stables ZA'fi 

Total  number  of  visits 256,969 


Number  of  Visits  To— 

Cases. 

Cases 

for 
Special 
Diag- 
nosis. 

Tene- 
ment 
Houses. 

Hotels. 

Schools 

Private 
Houses 

Not 
Found. 

Miscel- 
laneous 

Total 

Diamosticians 

4,7ai 

5,057 

a,73x 

65 

30 

144 

76 

1,988 

S*034 

Medical  inspectors 

87,«36 

69,488 

395 

186 

3,865 

1,068 

4,346 

79J4S 

Total  Diagnosticians 

Total   Medical  InO 
spectors ] 

4,7*1 
87,236 

5,057 

a,73i 
69.488 

65 
395 

30 
186 

144 
3,865 

76 
1,068 

1.988 
4,346 

5,034 
79,34« 

Grand  total  — 

91,957 

5,057 

72,219 

460 

216 

4,009 

1,144 

6,334 

84,381 

Dtslnfecton... 


364S7 


■.8J3 


48,Joi 


5J<»1 


3.851 


^.»7 


n 


Work  Performed  by  yeteritutrians. 

Number  of  animals  examined   24,483 

Number  of    cases  rabies  found 3 

Number  of  post  mortems  on  animals lat 

Nmnber  of  horses  tested  with  mallein 356 

Number  of  glandered  horses  condemned  and  destroyed 530 

Nnmber  of  inspections  of  stables 3476 

Number  of  animals  examined  by  "  agglutination  "  test 118 

Work  Performed  at  DitinfecUng  Station. 

Number  of  limes  ambulances  and  other  vehicles  disinfected 1344 

Number  of  pieces  of  goods  disinfected 45.436 

Number  of  pieces  of  goods  destroyed 18,941 

Work  Performed  by  Ambulance  Drivers. 

Number  of  persons  removed  to  Hospital 2,381 

Number  of  bodies  removed  to  Morgue 50 


The  Medical  Inspection  and  Examination  of  School  Children. 
History. 

March,  1897:  Appointment  of  one  hundred  and  fifty  Medical  In- 
spectors at  a  salary  of  $30  per  month.  Morning  inspection 
only  required, 
September,  1902 :  System  elaborated  to  include  morning  inspec- 
tion, routine  weekly  inspection  of  children  in  the  class-rooms 
and  visiting  of  absentees  at  their  homes.  Salary  of  Inspectors 
increased  to  $100  per  month. 


274 

December  i,  1902:    Appointment  of  a  corps  of  Trained  Nurses  at 

a  salary  of  $75  per  month. 
December  16,  1902:    Establishment  of  a  hospital  and  dispensary 

for  the  exclusive  treatment  of  cases  of  trachoma. 
March  2^,  1905:     Inception  of  complete  physical  examination  of 

each  school  child. 

Objects. 

1.  Repeated  and  systematic  inspection  and  examination  of  school 

children  to  determine  the  presence  of  infectious  or  contagious 
disease. 

2.  Exclusion  from  school  attendance  of  all  children  affected  with 

acute  contagious  disease. 

3.  Subsequent  control  of  the  case,  with  isolation  of  the  patient  and 

disinfection  of  the  living  apartments  after  termination  of  the 
illness. 

4.  Control  and  treatment  of  minor  contagious  affections,  permit- 

ting the  child  to  remain  in  attendance  at  school. 

5.  Information  of  unreported  cases  of  contagious  disease,  occur- 

ring in  school  children  at  their  homes. 

6.  Exclusion  from  school  attendance  of  those  children  in  whose 

families  there  exists  a  contagious  disease. 

7.  Complete  physical  examination  of  each  school  child  for  the  pur- 

pose of  determining  the  existence  of  non-contagious  affec- 
tions and  advising  treatment  of  same. 

Schools  Visited. 

Public  schools,  parochial  schools,  American  Female  Guardian 
Society  schools.  Children's  Aid  Society  schools  and  kinder- 
gartens. 

Force. 

1.  Assistant  Qiief  Medical  Inspector,  in  charge  of  work. 

2.  Corps  of  Medical  Inspectors,  all  of  whom  are  physicians. 

3.  Supervising  Nurse,  in  direct  charge  of  the  nurses. 

4.  Corps  of  Trained  Nurses. 


2/5 

Working  Plan  of  the  System. 
Duties  of  Medical  Inspectors. 

Each  Inspector  is  assigned  to  dut}'  in  a  group  of  schools. 

I.  Morning  Inspection. 

Inspector  \isits  each  school  in  his  charge  before  ten  o'clock 
each  morning  and  examines,  in  a  room  set  apart  for  this  purpose, 
the  following: 

(a)  All  children  isolated  by  the  teachers  as  suspected  cases 
of  contagious  diseases. 

(b)  All  children  who  have  been  absent  from  school. 

(c)  Children  returning  after  pre\'ious  exclusion. 

(d)  Qiildren  previously  ordered  under  treatment. 

(e)  Children  referred  by  the  school  nurse  for  diagnosis. 

(f)  All  affected  children  showing  no  evidence  of  treatment. 

Cases  to  be  Excluded, 

(a)  Children  showing  signs  or  symptoms  of  small-pox,  diph- 
theria, scarlet  fever,  measles,  chicken-pox,  whooping 
cough  or  mumps. 

Cultures  are  taken  in  all  cases  of  sore  throat  to  determine  the 
presence  of  the  diphtheria  bacillus. 

Cases  of  small-pox,  scarlet  fe\-er  and  measles  are  reported, 
by  telephone,  to  the  Central  Office,  so  that  a  diagnostician  may  at 
once  visit  the  case,  confirm  the  diagnosis  and  order  isolation.  In 
these  cases  a  postal  card  is  sent  from  the  Division  of  Contagious 
Diseases  to  the  Principal  of  the  school  informing  him,  or  her,  of 
the  presence  of  contagious  disease,  with  instructions  that  no  mem- 
ber of  the  family  be  allowed  to  attend  school  until  the  termination 
of  the  case. 


276 

DEPARTMENT  OF  HEALTH, 
BoBOUGH  OF  Manhattan. 

DIVISION  OP  CONTAGIOUS  DISEASES. 

New  York, 190 

The  following-named  children,  pupils  of  your  school,  are  exposed  to  the 

contagion    of 

at    

Sec.   145.     No  principal  or  superintendent  of  any  school,  and  no  parent, 

master  or  custodian  of  any  child  or  minor  (having  the  power  and  authority  to 

prevent)  shall  permit  any  child  or  minor  having  scarlet  fever,  diphtheria  (croup), 

small-pox  or  any  dangerous,  infectious  or  contagious  disease,  or  any  child  in 

any  family  in  which  any  such  disease  exists  or  has  recently  existed,  to  attend 

any  public  or  private  school  until  the  Board  of  Health  shall  have  given  its 

permission  therefor,   nor  in  any  manner  to   be   unnecessarily   exposed,  or  to 

needlessly  expose  any  other  person  to  the  taking  or  to  the  infection  of  any 

contagious  disease. 

Respectfully, 

Chief  Medical  Inspector. 
Reported  by 

Medical  Inspector. 

POSTAL  CASD. 

(b)  Cases  of  pediculosis,  with  live  pediculi. 

(c)  Children  affected  with  contagious  eye  and  skin  diseases, 
and  dormant  pediculosis,  who  have  presistcntly  refused 
to  undergo  treatment. 

Cases  to  be  referred  to  their  own  Physician,  a  Dispensary  or  to  the 
School  Nurses  for  Treatment. 

(a)  Acute  conjunctivitis. 

(b)  Pediculosis. 

(c)  Skin  disease,  including  ringworm  of  scalp,  face  or  body, 
^   scabies,  favus,  impetigo  and  molluscum  contag^osum. 

These  children  are  re-examined  the  following  day  and  allowed 
to  attend  school  as  long  as  treatment  is  continued.  Children  af- 
fected with  trachoma  are  referred  to  their  own  physician  or  to  a 
dispensary  for  treatment,  and  are  allowed  to  attend  school  as  long 
as  evidence  of  treatment  can  be  shown. 


V/ 


Eadi  Godnded  child  is  tomisbcd  with  in  officul  txdosion 
card,  properiv  fiDed  ooC  as  foDoirs: 

DEPARTMENT  OF  HEALTH. 


.V«r   York 190 

Xame  -ic*  

Address 

IS  ORDERED  TO  DISCOXTIXLE  ATTEXDASCE  AT 

School  Xo located  at 

Reason:    

Mt^al  inspector. 

(SEB  OTHER  SIOB.) 

EXCLUSION  CARD,  SHOWING  FACE. 

NOTICE  TO  PARENTS. 


The  disease  mentioned  on  the  other  side  of  this  card  is  a  con- 
tagious affection  and  liable  to  be  transmittted  to  other  children.  The 
child  should  receive  prompt  treatment  by  any  physician  (or  at  any 

dispensary),  and  should  return  to  school ,  190 — , 

for  re-examination  by  the  Medical  Inspector  of  the  Department  of 
Health.  If  found  free  from  contagion  at  this  time,  he  or  she  may 
resume  attendance  at  school. 

EXCLUSION    CARD    SHOWING    REVERSE. 

Each  pupil  referred  to  the  Nurse  for  treatment  receives  from 
the  Medical  Inspector  a  slip  on  which  is  written  the  code  number 
indicating  the  diagnosis  of  its  affection. 


1.  Diphtheria. 

2.  Pediculosis. 

3.  Tonsillitis. 

4.  Pediculosis. 

5.  Acute  Conjunctivitis. 

6.  Pediculosis. 

7.  Trachoma. 

8.  Pediculosis. 

9.  Zero. 

10.  Scarlet  fever. 

11.  Measles. 


278 

CODE. 

12.  Varicella. 

13.  Pertussis. 

14.  Mumps. 

15.  Zero. 

16.  Scabies. 

17.  Ringworm. 

18.  Impetigo. 

19.  Favus. 

20.  Molluscum  Contagiosum. 

21.  Acute  Coryza. 


CODE   CARD   SHOWING    NUMBERS    INDICATING   DISEASES. 

Cases  to  be  Readmitted. 

Children  returning  after  small-pox,  scarlet  fever,  diphtheria, 
measles  and  chicken-pox,  must  present  a  certificate  from  the  Di- 
vision of  Contagious  Diseases  before  readmittance. 

Children  returning  after  mumps  and  whooping  cough  may  be 
readmitted  at  the  discretion  of  the  Medical  Inspector. 

2.  Routine  Inspection, 

At  the  beginning  of  each  term  the  Medical  Inspector  makes 
a  routine  examination  of  each  child  in  the  schools  in  his  charge. 
The  eye-lids,  throat,  skin  and  hair  of  each  pupil  are  examined. 
The  Inspector  is  not  allowed  to  touch  the  child,  but  the  latter  is 
required  to  pull  down  its  own  eye-lids,  open  its  mouth,  show  its 
hands,  and,  in  the  case  of  girls,  lift  up  its  back  hair.  Individual 
wooden  tongue  depressors  are  furnished  by  the  Department. 

All  cases  of  disease  are  recorded  on  index  cards  with  the 
proper  data  in  appropriate  columns.  Code  numbers  are  always 
used  to  indicate  the  character  of  the  disease. 

Cases  requiring  more  extended  examination  are  sent  to  the 
Inspector's  room  at  a  definite  time,  for  that  purpose. 

All  cases  of  contagious  disease  discovered  are  dealt  with  as 
indicated  in  the  description  of  Morning  Inspection. 


1 

i  1 

i 

1 

1 

- 

- 

- 

* 

° 

~ 

* 

i 

i 

280 

All  children  ordered  under  treatment  are  required  to  report 
to  the  Medical  Inspector,  at  a  definite  time,  the  following  morning 
for  re-examination.  If  treatment  has  been  instituted,  the  fact  is 
recorded  on  the  index  card,  the  child  ordered  to  report  at  regular 
intervals  and,  as  long  as  treatment  is  necessary  and  continued,  the 
child  is  allowed  to  remain  in  school.  Children  showing  no  evidence 
of  treatment  are  excluded  forthwith. 

Each  day  a  record  of  the  number  of  children  examined,  with 
names,  addresses  and  cause  of  exclusion  of  each  excluded  child 
is  mailed  to  the  Central  Office.  A  duplicate  is  kept  on  file  at  the 
school.    The  following  is  the  form  of  card  used  for  this  purpose: 


43  K— 1906 


2ia-20i,  '06,  20,000  (P) 


DEPARTMENT  OF  HEALTH,  NEW  YORK  CITY, 

School  No Division  of  Contagious  Diseases,  Manhattan 

New  York,  190 

To  the  Assistant  Chief  Medical  Inspector: 

Sir:  I  have  examined  this  day  in  this  School  on  Morning 

Routine Total pupils.    Time  of  {Arrival 

X  Departure 

Pupils  excluded  and  reasons  therefor. 


NAME 

AGE 

RESIDENCE 

CAUSE  OF  EXCLUSION 

• 

• 

• 

Medical  Inspector. 


DAILY  REPORT  CARD 


3.  Pkjsital  Exmmmatijm  cf  Sdkaai  Ckudrrx. 

After  tbe  above  <fufrev  arc  oxnptsssd.  &t  cftfjcrei  are  ordieied 
to  icpcrt.  is  tzinz.  xsy  &e  MerfSral  Ligpeiicr  Dzr  a  cjcrpiiete  p&rsscabL 
C3caiEaBtaao.  Tts  wjfc.  ^  ccofocrd  a  i  rxx:  at  lea^  tvenrr 
feet  locg-.  A  <jm:!i&tr  reccri  cf  are  ccsnSrScii  of  casca  f^rTtj  s  fcept 
oo  a  card  at  dae  fcljGwiaig^  f orzr : 


57  K— 1906  ^c^aoTr  uexoooCP) 

PHYSICAL  RECORD. 

P.  S Cass Dar*  

Aje  A6frK3   


I.    Xatr.  a  a  :a    I>t£.  Xaa.  Brsiiit.  Y.  X. 

2L    EbL  Cer.  GL  JY.X.  rr.    T«d^  Ra 


J  A- P.  L2L    Detocm.  Pllai.  Y.X. 

3.    Chorea.  Y.  X.  ijl    Hjp«r.  Tocsw  Y.X. 


Y.  X.  u.    P.  Xas^  Grrwtfes.  Y.  X. 

S    Ptakm  Dml  Y.X.  IS-    Mentalitr.  RG. 

6l    Sldn  Dis-  Y.  X.  16.    Tneac  oecessary,  Y.  X. 

Y.  X.  17.    Xir^ocalitT : 

Y.  X.  Rtsarks : 

Y.X. 
CSnbj.  Obi. 
(  Y.  X. 

Y.  X.  Me\L  In$?. 

Explanation  of  Abbre\-iations : 
*'Y'"  means  Y'es. 
'*X"  means  Xo. 
"G"  means  Good. 
"B"  means  Bad. 
"A"  means  Anterior. 
"P"  means  Posterior. 

The  condition  in  each  case  in  indicated  by  crossing  out  the 
unnecessary  letter. 

Each  child  is  thoroughly  examined  for  the  following  condi- 
tions : 

Nutrition,  enlarged  cervical  glands,  anterior  or  posterior,  car- 
diac disease,  pulmonary  disease,  skin  disease,  deformity  of  spine, 


282 

chest  or  extremities,  defective  vision — Snellen's  test  cards  at  20 
feet,  also  reading  tests,  defective  hearing — whispered  voice  should 
be  heard  at  a  distance  of  20  feet,  nasal  obstruction — ^thick  nasal 
discharge  or  inability  to  blow  the  nose,  defective  teeth,  deformity 
of  palate,  post  nasal  growths — to  be  suspected  in  any  case  of  de- 
fective hearing  or  nasal  occlusion,  condition  may  be  determined 
by  inspection,  palpation  not  allowed,  mental  condition,  to  be  de- 
termined by  general  observation. 

In  each  instance  where  treatment  is  deemed  necessary  an 
official  card,  notifying  the  parents,  is  filled  out.  These  cards  and 
the  Physical  Record  cards  of  each  day  are  sent  to  the  Central 
Office  with  the  daily  school  report. 

"  This  notice  does  NOT  exclude  this  child  from  school." 

DEPARTMENT   OF   HEALTH, 
The  City  of  New  York. 

190 

The  parent  or  guardian  of 

of is  hereby  informed  that 

a  physical  examination  of  this  child  seems  to  show  an  abnormal  condition  of 
the 

Remarks :    

Take  this  child  to  your  family  physician  for  treatment  and  advice.     Take 
this  card  with  you  to  the  family  physician. 

Hermann  M.  Biggs,  M.  D.,  Thomas  Darungton,  M.  D., 

General  Medical  Officer.  Commissioner  of  Health. 

parents'  notification  card. 

4.  Absentee  Visiting, 

The  Inspector  obtains  from  the  Principal  of  the  school,  each 
day,  a  list  of  all  children  who  have  been  absent  from  school  for 
several  days  for  any  unassigned  cause.  These  children  are  visited 
at  their  homes  and  a  list  of  the  names,  ages  and  addresses  of  all 
cases  of  contagious  diseases  discovered  is  sent,  each  day,  with  the 
school  report,  to  the  Central  Office. 


283 

Weekly  Report. 

A  weekly  report  of  all  work  performed  is  sent  to  the  Central 
Office.  This  report  contains  date,  schools  and  location  of  same 
visited  each  day,  residences  visited  and  name  of  each  child  found 
with  a  contagious  disease  at  its  home  address. 

Duties  of  Supervising  Nurse. 

The  Supervising  Nurse  has  entire  charge  of  all  of  the  Nurses. 
She  assigns  the  nurses  to  duty  at  certain  schools,  sees  that  neces- 
sary supplies  are  furnished,  instructs  the  nurse  in  their  duties,  in- 
spects their  work,  receives  their  reports  of  work  performed  and 
keeps  a  record  of  all  examinations,  treatments  and  diseases  treated 
by  each  nurse  in  each  school. 

Duties  of  School  Nurses. 

Each  nurse  is  assigned  a  group  of  schools.  She  reports  each 
day  at  each  school,  at  a  certain  specified  time. 

I.  Morning  Inspection, 

In  a  special  room,  assigned  for  the  purpose,  the  nurse  receives 
all  children  ordered  to  report  to  her  for  treatment.  These  cases 
include  pediculosis,  ringworm,  scabies,  favus,  impetigo,  molluscum 
contagiosum  and  conjunctivitis.  The  treatment  used  for  these 
conditions  is  as  follows : 

Pediculosis:  Children  are  assembled  in  groups  and  are  in- 
structed orally,  and  by  means  of  circulars  printed  in  a  language 
suited  to  the  nationality  of  the  child,  as  to  the  methods  of  home 
treatment.  These  cases  are  not  treated  in  the  schools.  Treatment 
advised  is  as  follows :  Live  pediculi ;  saturate  the  hair  with  equal 
parts  of  kerosene  and  sweet  oil;  next  day  wash  with  solution  of 
potassium  carbonate  (one  teaspoonful  to  one  quart  of  water),  fol- 
lowed by  soap  and  water. 

"  Nits  " :  To  remove  "  nits,"  use  hot  vinegar  or  actually  re- 
move from  hair  by  hand. 

Favus  and  RingAvorm  of  Scalp:  Mild  cases,  scrub  with  Tr. 
Green  Soap,  remove  hair,  cover  with  Flexible  Collodion.  Severe 
cases,  scrub  with  Tr.  Green  Soap,  remove  hair,  paint  with  Tr. 
Iodine  and  cover  with  Flexible  Collodion. 


284 

Ringworm  of  Face  and  Body:  Wash  with  Tr.  Green  Soap 
and  cover  with  Flexible  Collodion. 

Scabies:  Scrub  with  Tr.  Green  Soap,  apply  Sulphur  Oint- 
ment, 

Impetigo :  Remove  crusts  with  Tr.  Green  Soap,  apply  White 
Precipitate  Ointment. 

Molluscum  Contagiosum :  Express  contents,  apply  Tr.  Iodine 
with  toothpick  wound  with  cotton. 

Conjunctivitis :    Irrigate  with  saturated  solution  of  Boric  Acid. 

Cases  to  be  Visited  by  the  Nurse  at  the  Hoftte  of  the  Children. 

1.  Flagrant  cases  of  pediculosis.    The  nurse  shows  the  mother 

how  to  treat  the  condition  and  encourages  persistence. 

2.  Exluded  cases  who  do  not  return  at  the  appointed  time. 

3.  Trachoma  cases  where  treatment  is  not  sought  regularly. 

The  nurse  urges  the  need  of  treatment  and  if  necessary 

takes  the  child  to  a  dispensary. 
The  nurse  is  not  allowed  to  treat  cases  of  trachoma.  Chil- 
dren so  affected  must  report  to  the  nurse  each  week  and  show  a 
physician's  certificate  or  dispensary  card,  properly  dated,  showing 
evidence  that  the  child  is  continuously  under  treatment.  Persistent 
failure  to  show  such  evidence  is  cause  for  exclusion. 

2.  Routine  hispection. 

When  Morning  Inspection  has  been  completed  the  nurse  visits 
the  class-rooms  and  makes  a  weekly  routine  inspection  of  the  eye- 
lids, hair,  skin  and  throat  of  each  pupil.  The  method  pursued  is 
that  given  under  the  Duties  of  the  Medical  Inspector,  Routine  In- 
spection. 

The  nurses  keep  a  special  set  of  index  cards.  All  cases  of  con- 
tagious disease  found  are  noted  on  these  cards.  Special  cards  are 
kept  for  the  recording  of  all  cases  of  pediculosis ;  these  cases  are  under 
the  exclusive  care  of  the  nurse.  Other  cases  are  noted  and  ordered  to 
report  to  the  Medical  Inspector  for  the  purpose  of  confirming  the 
diagnosis.  The  nurse  must  exclude  all  children  showing  symptoms  of 
diphtheria,   scarlet   fever,   measles,   whooping   cough,   chicken-pox   or 


Tj  zsjEsrzt  TSc 


Xl  lac  3ijag  ic  12C 


and 


t  n: 


of  ibt 


1L 


mruinin^ 


X  75 


m     LJlUCr^L     •^■TTi 


Xnaiber  a:  CinJcra:  Ztsz3=^l. 
Niimlirr  zdc  LJzcriiZi^  lii  . 

The  nm^e  also  scni:^  i:  zht  Sirxrv^sm^  X 
gnring  liic  local  aauiiij:  and  rharany"  o:  die 
the  vcck. 

The  DepartxDcnt  of  Hc^Jti:  nsontAiss  on^  He 
pensarics  for  tbe  ura: rmt  c*:  tracriDnsa-    A  Dis^nsary  is  situated  at 
Gouvemcnr  SHp  and  a  Hc^pisI  and  Efespeasarr  at  the  comer  of  i  iSih 


I  and  rao  I>is~ 


street  and  Pleasant  arennc,  B-^rctagh  of  Manhartan.  All  caf^cs  of 
trachoma  not  under  the  care  cf  a  po^^'aie  physician  are  referred  for 
treatment  to  these  hospitals  and  dispensaries  hv  the  Medical  Inspector 
or  School  Nurse.  The  date  of  each  treatment  is  stamped  on  a  special 
card  and  the  Inspector  or  Xurse  is  thus  enabled  to  detennine  if  the 
child  is  regularly  under  treatment. 

Tables  showing  the  amount  and  character  of  the  work  ixTforniCil 
by  the  Medical  Inspectors  and  Xurses  during  the  past  throe  years, 
in  all  of  the  Boroughs  of  Xew  York  City,  are  appended  herewith. 

Table  of  Work  Performed  by  Medical  Inspectors  of  Schools  in  sill  BorO¥ghs, 

City  New  York,  1903,  1904,  1905. 


Number  of  visits  to  schools. . . 
Number  of  children  examined 
Number  of  children  excluded. 


1905. 


1906. 
•  »«•»;  .•44 


286 


Reasons  for  Exclusion. 


Measles 

Diphtheria 

Scarlet  fever 

Whooping  cough 

Contagious  eye  diseases . 

Pediculosis 

Chicken  pox 

Contagious  skin  diseases. 
Miscellaneous 

Total 


250 

530 
66 

3^ 

32,525 
21,100 

909 
4,029 
5.521 


65,294 


1,172 

155 

55 

187 
10.624 

8717 

780 

2,123 

1,556 


25,369 


3" 

74 

47 

351 

8,833 

4,692 

937 

2,018 

1,580 


18,844 


377 

77 

43 

319 

5.845 

«,i55 

669 

1,616 

1,794 


12,89s 


Table  of  Physical  Record  of  Children. 

March  27  to  December  23, 1905. 

Total  number  of  children  examined 

Number  of  cases  of  bad  nutrition 

Number  of  cases  of  diseased  anterior  cervical  glands. 

Number  of  cases  of  diseased  posterior  cervical  glands 

Number  of  cases  of  chorea 

Number  of  cases  of  cardiac  disease 

Number  of  cases  of  pulmonary  disease 

Number  of  cases  of  skin  disease 

Number  oi  cases  of  deformity  of  the  spine 

Number  of  cases  of  deformity  of  chest 

Number  of  cases  of  deformity  of  extremities 

Number  of  cases  of  defective  vision 

Number  of  cases  of  defective  hearing 

Number  of  cases  of  obstructed  nasal  breathing 

Number  of  cases  of  defective  teeth 1 

Number  of  cases  of  deformed  palate 

Number  of  cases  of  hypertrophied  tonsils 

Number  of  cases  of  posterior  nasal  growths 

Number  of  cases  of  defective  mentality 

Number  of  cases  where  treatment  was  necessary 

•Nationality— Native 

—Foreign 

—Not  obtained 


55J32 

3.«83 

"4,214 

3,047 
738 

89s 
600 

989 
485 
401 

498 

16,394 
1,296 

6,i8a 

18,182 

698 

8,347 

5,119 
1,210 

33*551 


1906. 


78401 
4,921 

a9,i77 
8.664 
1,380 
x/>96 
757 
1.558 

4^4 
961 

550 
17,928 

869 

".314 

39,597 

831 
18,306 

9438 

i,8S7 

56^59 
18,125 

37,234 

900 


*  Only  obtained  in  cases  where  treatment  was  necessary. 


^7 

Table  of  Absentee  Visiting. 


Dipbtheria 


Whooping  cou^. 

Mumps 

CliidDenpoz 

Typhoid  ferer. . . . 

Tnbercnlosis 

Erysipelas 

Meniogitis 


Total. 


1904. 


613 

7 

57 

3S 

4S 

103 

I 

0 

0 

0 


861 


!     1905. 

1906. 

284 

1,080 

4 

6 

34 

56 

8a 

i6a 

66 

338 

146 

23* 

> 

I 

3 

!    I 

2 

2 

0 

3 

0 

623 

1,789 

Table  of  Work  Performed  at  Eye  Hospital  and  Dispensaries. 


Number  of  cases  treated  by  operation. 


Number  oi  cases  treated  without  operation. ; 


Total  number  of  children  treated 

Total  number  of   visits  made  for  subse- 1 
quent  treatments ) 

Total  number  of  treatments 

Number  of  children  not  having  trachoma  ( 
examined f 


t 


4.337 
",399 
15,736 

129,830 

145.566 

3»"i 


1.729 

7,775 

9.504 

122,628 

132,132 
1,815 


1,460 

9,223 

10,682 
161,644 

172,  V7 
3.222 


1906. 


1.385 

8,i7i 

10,556 

177,161 

187,717 
6,141 


Table  of  Work  Performed  by  the  Nurses. 


1903. 


1904. 


1905. 


IffC/f. 


Number  of  visits  to  schools 

Number  of  visits  to  tenement  houses. 
Number  of  visits,  miscellaneous 


Total  number  of  visits. 


27,010 

26,703 

1,046 


25,943 

40/>7o 

1.344 


54.759 


67,357 


27,097 

4!, 5*^4 


X umber  of  Cases  Treated. 


Pediculosis 

Contagious  eye  diseases  . 
Contagious  skin  diseases. 
Miscellaneous 


Total  number  of  treatments. 


509,142    I 
204,277 
24,15/ 

45. "2 
7^2/Ai 


6r6.3.<?4 

40.0;* 

tfjh  ri'if 


'f  '.'I 


I. It*     '^ 


288 


A  REPORT  OF  THE  OPHTHALMOLOGICAL  WORK  OF  THE 
DEPARTMENT  OF   HEALTH,    1906,   IN   WHICH    IS   IN- 
CLUDED A  DESCRIPTION  OF  THE  METHODS  OF 
TREATMENT    EMPLOYED    BY    THE    DEPART- 
MENT   IN    CASES    OF    TRACHOMA,    AND 
SOME  DEDUCTIONS  AS  TO  THE  COM- 
PARATIVE   VALUE    OF    DIFFER- 
ENT  METHODS. 


Borough  of  Manhattan. 

Before  considering  in  detail  the  ophthalmological  work,  performed 
by  the  Department  during  the  year,  1906,  a  short  review  of  this  work 
from  its  commencement  would  seem  to  be  desirable. 

In  December,  1902,  the  Department  of  Health  commenced  the  sys- 
tematic treatment  of  cases  of  trachoma  occurring  in  the  schools  and 
occupied  for  this  purpose  the  old  building  of  Gouverneur  Hospital. 
The  work  in  the  old  Gouverneur  Hospital  was  continued  until  May, 
1904,  when  this  building  was  torn  down  and  the  Department  was 
forced  to  vacate.  Since  that  time,  the  work  in  this  locality  has  been 
continued  in  two  portable  frame  houses,  situated  on  Gouverneur  Slip. 
During  the  period  that  the  Department  occupied  the  old  Gouverneur 
Hospital  building  many  operations  were  performed  upon  these  cases, 
but,  with  the  removal  to  the  portable  houses,  operative  work  ceased 
and  since  that  time,  the  Department  has  been  able  to  treat  trachoma 
only  by  non-operative  measures  in  that  part  of  the  city.  In  March, 
1904,  the  Department  opened  a  hospital  at  One  Hundred  and  Eight- 
eenth street  and  Pleasant  avenue,  in  which  operations  were  resumed. 
The  following  are  the  figures  for  the  institution  in  Gouverneur  street, 
from  its  commencement  in  Gouverneur  Hospital  to  the  present  time. 
The  small  number  of  operations  in  1904  is  due  to  their  discontinu- 
ance during  the  early  part  of  that  year. 

1902  (Commencing  December  i6th). 

Cases  treated  by  operation 127 

Cases  treated  without  operation 97^ 


Ciscs  i:*s."*c  •yirma:  r^«=:ari3r.  3?sJfi* 


>45 


^^^3^^      *iA  ^^  ^"fc  ^^      ^P  <^*^J*'ii^       *  **»»^^^  *  ■  —  ---.  ..**.  «,«^..^  ^  ^^^^^ 


Cases  treated  wiibzist   Dferirirc d::>a 

In  the  izTt^ir^  tallt^  ire  ircluiei  :r-v  0*5^5  of  i*a^hv>n^,  givir^C 
a  total  cf  cases  treated  ry  coeratira,  5.059.  and  without  v^pcratk>n. 

36,134. 

During  this  period,  9,640  cases  of  contagious  eye  diseases  other 

than  trachoir-a  were  also  treated.     The  nun:ber  of  revisits  anH>ui>ti\l 

in: 

1902    I,4U 

1903    UU  AU 

1904    5^  J!^ 

4905     I  Jl\^JO 

1906    1^5,^05 


%  ■  > 


\ 


In  this  tah!c  cf  revisit?  are  incliulctl  all  cases  o\  contaj^ious  ovt 
diseases,  whether  trachoma  or  not.  The  total  nunihor  of  revisits  for 
the  years  mentioned  reaches  the  enormous  figfures  of  463,650. 

The  figures  of  the  Hospital  for  Contagious  Eye  I'Xseases  at  One 
Hundred  and  Eighteenth  street  and  Pleasant  avenue  are  as  fcilUnvs : 

1904  (March  to  December). 

Number  of  cases  treated  by  operation lt^^,\ 

Number  of  cases  treated  without  operation ,^.'5.1 


"  •  ■  1 


1905. 

Number  of  cases  treated  by  operation '  .'K«> 

Number  of  cases  treated  without  operation .Ii-wmi 


290 

i9o6. 

Number  of  cases  treated  by  operation i^S 

Number  of  cases  treated  without  operation 4.377 

Total  number  of  cases  treated  by  operation 4>9o8 

Total  number  of  cases  treated  without  <^)eration 10,730 


(This  table  comprises  only  cases  pf  trachoma.) 

During  this  period,  2,398  cases  of  contagious  eye  diseases,  other 
than  trachoma,  were  treated.  The  number  of  revisits  of  all  cases  was 
as  follows: 

1904    33.703 

1905    41424 

1906    51,956 


Total    127,083 


At  the  commencement  of  the  year  1906  the  Department  therefore 
had  at  its  disposal,  for  the  treatment  of  contagious  eye  diseases  in 
school  children,  a  hospital  of  twenty  beds,  situated  at  One  Hundred  and 
Eighteenth  street  and  Pleasant  avenue,  and  a  dispensary  situated  at 
the  foot  of  Gouverneur  Slip.  The  medical  staff  of  these  two  institu- 
tions consists  of  eight  physicians,  all  of  whom  are  qualified  oculists  and 
have  been  connected  with  one  or  other  of  the  established  eye  hospitals 
in  this  City,  and  two  physicians  who  are  experienced  anaesthetists.  The 
hospital  at  One  Hundred  and  Eighteenth  street  is  fully  equipped  for 
the  operative  treatment  of  trachoma,  and,  in  addition,  affords  space  for 
the  daily  treatment  in  the  clinic  of  cases  in  which  operation  is  not  con- 
sidered desirable  and  for  the  continuous  after  treatment  of  patients 
upon  whom  operations  have  been  performed.  The  dispensary  at  the 
foot  of  Gouverneur  Slip  has  no  operative  service.  It  is  equipped  only 
for  the  treatment  of  patients  living  in  that  locality  who  have  been 
operated  upon  at  the  hospital  in  One  Hundred  and  Eighteenth  street 
and  for  the  treatment  of  school  children  in  the  vicinity  upon  whom 
operations  have  not  been  deemed  essential.  Its  most  important  function, 
perhaps,  consists  in  its  affording  a  place  in  which  operative  cases  can 
be  selected  and  from  which  they  can  be  transferred  to  the  hospital  at 
One  Hundred  and  Eighteenth  street. 


291 

In  order  fully  to  understand  the  procedures  adopted  by  the  De- 
partment in  cases  of  trachoma  occurring  in  the  schools  we  must  begin 
with  the  work  of  the  School  Inspectors.    With  them  rests  the  detec- 
tion of  the  cases  and  the  primary  diagnosis.    While  these  Inspectors 
are  all  physicians  they  are  not  oculists,  and  their  diagnosis  is  only 
tentative,  but  while  not  possessing  a  complete  training  in  eye  diseases, 
all  these  Inspectors  have  received  special  instruction  in  the  diagnosis 
of  trachoma,  either  at  the  Department  Eye  Hospitals  or  at  the  New 
York  Eye  and  Ear  Infirmary.    Let  us  follow  a  case  from  its  detection 
in  the  schools  to  its  final  discharge  from  the  hospital  when  cured.    A 
card  stating  that  the  child  has  a  contagious  affection  of  the  eyes  and 
recommending  that  he  be  placed  under  treatment  is  given  by  the  School 
Inspector.    This  does  not  mean  that  the  Department  demands  that  tlie 
patient  shall  go  to  one  of  its  own  institutions.    The  Department  simply 
insists  that  unless  he  be  placed  under  treatment  he  may  not  attend 
school.     The  patient  may  be  treated  by  his  own  physician,  by  any 
oculist  or  at  any  eye  hospital  or  dispensary.    Nor  does  the  Departmrnt 
attempt  to  prescribe  the  method  of  treatment  that  shall  be  followed.    Jt 
does  not  insist  upon  operative  procedures  in  any  case,  and  any  of  tl:e 
recognized  methods  of  treatment  will  suffice.     In  case  the  treatment 
is  instituted  by  the  family  physician  a  certificate  from  him  to  that  effect 
will  admit  the  patient  to  school  during  the  continuance  of  his  treat- 
ment, and,  if  the  treatment  be  undertaken  by  any  hospital  or  dispensary 
other  than  those  of  the  Department,  the  card  of  the  institution  stamped 
with  the  dates  of  his  visits  will  permit  the  patient  to  attend  school.    In 
cases  in  which  the  family  physician  disagrees  with  the  Inspector  as  to 
the  diagnosis  the  case  is  referred  to  the  Ophthalmologist  of  the  De- 
partment.   If  the  patient  seek  advice  at  one  of  the  hospitals  of  the  De- 
partment the  diagnosis  of  the  School  Inspector  is  then  confirmed  or 
reversed,  as  the  case  may  be,  by  the  physician  in  charge  of  the  Clinic. 
This  physician,  as  has  been  stated,  is  a  qualified  oculist,  and  he  either 
recommends  operation  or  treats  the  case  by  non-operative  measures, 
according  to  his  judgment.    If  operation  be  deemed  advisable  the  child 
is  directed  to  bring  one  of  his  parents  to  the  hospital,  and,  if  the  parents 
consent,  the  child  is  operated  upon  after  having  again  been  examined 
by  the  operator.    It  will  thus  be  seen  that  no  case  of  trachoma  is  sub- 


286 


Reasons  for  Exclusion. 


Measles 

Diphtheria 

Scarlet  fever 

Whooping  cough 

Contagious  eye  diseases . 

Pediculosis 

Chicken  pox 

Contagious  skin  diseases 
Miscellaneous 

Total 


250 

530 
66 

3^ 

32,525 
ai,ioo 

909 
4,029 
5,521 


65,294 


1,172 

155 
55 

187 
10.624 

8717 

780 

2,123 

1,556 


25.369 


312 

74 

47 

351 

8,833 

4,692 

937 
2,018 

1,580 


18,844 


377 

77 

43 

319 

5.845 

2,155 

669 

1,616 

1,794 


12,895 


Table  of  Physical  Record  of  Children. 

March  27  to  December  23, 1905. 

Total  number  of  children  examined 

Number  of  cases  of  bad  nutrition 

Number  of  cases  of  diseased  anterior  cervical  glands. 

Number  of  cases  of  diseased  posterior  cervical  glands 

Number  of  cases  of  chorea 

Number  of  cases  of  cardiac  disease 

Number  of  cases  of  pulmonary  disease 

Number  of  cases  of  skin  disease 

Number  of  cases  of  deformity  of  the  spine 

Number  of  cases  of  deformity  of  chest 

Number  of  cases  of  deformity  of  extremities 

Number  of  cases  of  defective  vision 

Number  of  cases  of  defective  hearing 

Number  of  cases  of  obstructed  nasal  breathing 

Number  of  cases  of  defective  teeth 1 

Number  of  cases  of  deformed  palate 

Number  of  cases  of  hypertrophied  tonsils 

Number  of  cases  of  posterior  nasal  growths 

Number  of  cases  of  defective  mentality 

Number  of  cases  where  treatment  was  necessary 

•Nationality— Native 

—Foreign 

—Not  obtained 


55,332 
3,283 

14,214 

3,047 

738 

895 
600 

989 

485 
401 

498 

16,394 
1,296 

6,182 

18,182 

698 

8,347 

5,119 
1,210 

33,551 


1906. 


78401 
4,921 

a9,i77 
8,664 
1,380 
i/>96 
757 
1.558 

424 
961 

550 
17,928 

869 

".314 

39.597 

831 
18,306 

9438 

1,857 

56,259 

18,125 

37,234 

900 


*  Only  obtained  in  cases  where  treatment  was  necessary. 


X-  :«  nae  3nr 


cipinirn  cf  :3c  ^rrscsxis  jl  ^nru\^iijL  ¥3i*  zrsc  zx.  snx.  rrrsct  "v^iaiL 
probobLj  sxvt  ae-x  Jiuy.wv^f  :f  2.  s'tirmr  re  Mnr  an£  >»£  Oipst  saisc^ 
Gx.g:nc  Iras  arrr  -imirf^sL  Irjsi  rrnr  :::  rnuc  ir  :3k  rte-«tr5- 

fnL    Is  Qt  ^apirxj  if  rsss  x  Irs^  rancussilj  isaisi  ir  3n5  i^'TCtviiL 
and  tbc  itrt'^  iccczniei  5d  30:  5e=ir  n  isrrr  ±k  rrnc  cnriir'r*!  ax  as^ 


c  s,  n  sad  cisies,  a  vaste  ot  txrsc. 
idzrc  czrsVrvcc  bv  the  Dwartr=«nt  ccci^ist^  ot 
•*  caqjTCssicn,*"  irhbctn  prcvic'iis   5Ciri£cs.t;c<i-     Scan£catk>a  aloiK^   in 
recent  cases  is  to  be  coodcxracd.    It  can  ocIt  canse  the  removal  ot  the 

superficial  fcHicIes  vrhile  :i  pr>f-ce5  a  certain  anfOimt  of  dei:tn:ctiv>n 
of  the  mucous  inen±rane  and  tends  to  the  n^-arked  formation  of  cica- 
tricial tissue.  Employef  Viixh  expression,  it  is  undesirable  for  t':e  same 
reasons,  and,  except  in  ver>-  rare  cases,  is  :ibsoIute!y  unncce$sar}\  In 
the  operation  of  expression  Prince's.  Xoyes'  and  Knapp*s  forceps  have 
been  used.  For  the  past  two  years  reliance  has  been  placed  almost 
solely  upon  those  of  Knapp.  The  two  former  express  the  gpranules 
by  a  method  in  which  lateral  stripping  of  the  membrane  plays  an  im* 
portant  part.  In  mild  and  superficial  cases  they  answer  their  puq)Ose 
perfectly  well,  but  when  the  follicles  are  deeply  seated  the  fore:  re- 
quired for  their  removal  by  means  of  this  stripping  action  is  apt  to  in- 
flict serious  damage  upon  the  conjuncti\'a,  to  denude  it  of  its  epithcHunt, 
and  to  leave  a  condition  of  sclerosis,  and  tends,  in  addition,  to  nmkc 
the  resulting  adhesions  dense  and  unyielding.  The  pressure  exerted 
vertically  by  Knapp's  roller  forceps  seems  to  effect  all  that  their  author 
claims,  and,  by  their  use  the  granules  are  most  thoroughly  exprejijietl 
and  with  the  least  possible  trauma.    In  the  canthi.  in  which  nituatloti 


294 

the  granules  are  apt  to  be  for  the  most  part  superficial,  Prince's  forceps 
may  be  advantageously  employed.  The  forceps  of  Noyes  are  at  present 
used  almost  entirely  for  the  purpose  of  everting  the  lids,  although  the 
employment  of  any  instrument  for  this  purpose  is  only  exceptionally 
necessary  when  the  operator  is  expert. 

The  success  of  an  operation  for  trachoma  depends  largely  upon 
the  personal  equation  of  the  operator  and  upon  the  character  and  dura- 
tion of  the  after  treatment.  Carefully  performed  by  a  painstaking, 
conscientious  man  who  understands  his  work,  and  supplemented  by 
treatment  of  an  appropriate  character  prolonged  for  a  proper  length  of 
time,  it  is  as  generally  successful  as  most  of  the  more  important  opera- 
tions of  ophthalmic  surgery.  Under  such  circumstances  this  opera- 
tion, even  in  hospital  practice,  should  result  in  about  70  per  cent,  of 
cures,  and  in  private  practice  the  number  of  cures  should  probably  be 
greater.  Lack  of  a  proper  appreciation  of  the  true  conditions  that  ob- 
tain in  this  disease  is  responsible  for  much  careless  and  too  rapid  op- 
crating  of  a  nature  not  sufficiently  thorough.  The  very  general  im- 
pression among  surgeons  that  the  operation  is  always  easy,  that  it 
should  not  take  more  than  four  or  five  minutes,  and  that  it  is  worthy 
only  of  the  attention  of  an  inexperienced  junior  member  of  a  hospital 
staff,  is  largely  responsible  for  many  of  the  bad  results  that  are  obtained 
and  for  the  bad  reputation  that  the  operation  has  acquired  with  many. 
Above  every  other  consideration  the  operation  should  be  thorough.  It 
should  not  terminate  until  every  visible  granule  has  been  removed  and 
until  the  membrane  held  is  thin  and  translucent.  It  is  most  desirable 
that  this  should  be  accomplished  without  tearing  the  conjunctiva  or  un- 
necessarily denuding  it  of  its  epithelium.  It  is  only  with  the  Knapp's 
forceps  that  these  results  can  be  obtained  in  deeply  infiltrated  cases,  and, 
in  such  cases,  the  operation  may  very  well  take  twenty  minutes  in  the 
hands  of  an  expert.  In  regard  to  the  infliction  of  trauma  the  main  point 
is  not  to  tear  the  conjunctiva,  but,  if  necessary,  the  forceps  should  be 
rolled  over  the  membrane  again  and  again,  and  considerable  vertical 
pressure  should  be  exerted  until  all  the  granules  have  been  expressed 
not  only  from  the  surface  but  from  the  deeper  parts.  The  practic  of 
discontinuing  the  operation  when  the  surface  feels  smooth  to  the  finger 
r^Lunot  be  too  strongly  condemned. 


The  use  of  the  faaDdag^t  hsts  been  discamfmied  at  the  Dcpaxtzsient's 
hospitals  and  cxxd  appiicat5c3Q5  axe  used  instead,  for  twelTe  honrs  in 
most  cases,  and  longer  if  oedeira  of  the  lids  should  persist.  The 
bandage,  while  probablv  Ijnriting  the  oedema  in  inany  cases,  seems  to 
increase  the  density  of  the  adhesions.  Cold  applications  seem  to  give 
entire  satisfaction.  Adhesions  are  separated  every  twelve  hoars  during 
the  two  days  that  the  child  remains  in  the  hospital-  In  most  cases  their 
tendencv  to  reform  to  anv  extent  ceases  at  the  end  of  this  time.  If 
they  persist  they  are  separated  in  the  morning  clinic  each  day  for  as 
long  as  may  be  necessan*.  Much  has  been  said  in  relation  to  the  in- 
fliction of  trauma  and  the  resulting  formation  of  adhesions.  Undoubt- 
edly the  number  and  density*  of  the  adhesions  are  ver\-  generally  pro- 
IK>rtionate  to  the  amount  of  trauma  inflicted,  but,  if  in  deeply  infil- 
trated cases,  a  certain  amount  of  bruising  short  of  tearing  the  conjunc- 
tiva is  necessar>-  for  the  complete  removal  of  the  granules,  the  requisite 
amount  of  trauma  should  be  inflicted  and  the  resulting  complications 
treated  as  they  arise.  Adhesions,  for  the  most  part,  when  not  due  to 
tears  of  the  conjunctiva,  can  be  separated  and  can  be  kept  separated, 
and,  in  the  few  cases  in  which  they  cannot,  a  slight  adhesion  remaining 
is  not  usually  productive  of  any  permanent  ill  results.  The  writer  has 
seen  but  one  case  of  entropium,  due  directly  to  an  operation  for  tra- 
choma. In  this  case  the  conjunctiva  contained  many  dense  adhesions, 
but  the  child  had  been  sent  home  immediately  after  operation  and  had 
never  returned  for  subsequent  treatment.  Adhesions  due  to  tears  are, 
of  course,  more  serious  than  those  due  to  the  agglutination  of  the  tem- 
porarily denuded  surfaces  of  the  membrane,  but  it  sometimes  happens 
that  division  of  the  resulting  band,  when  it  is  unattached  in  some  part 
of  its  course,  will  give  an  excellent  result.  To  conclude  the  considera- 
tion of  the  operation  itself,  it  may  be  stated  that  while  gentleness  in  op- 
erating upon  mucous  membrane  is  always  desirable,  an  operation  for 
trachoma  above  everything  else  should  remove  all  the  trachoma 
granules. 

Except  in  very  mild  and  superficial  cases  the  operation  should  he 
performed  under  ether  or  chloroform.  Nitrous  oxide  j^as  alone  should 
never  be  employed.  It  cannot  be  relied  upon  to  maintain  anaesthesia 
with  safety  for  prolonged  periods,  and  the  congestion  which  it  causes 


296 

is  productive  of  excessive  hemorrhage  which  obscures  the  site  of  the 
operation  and  very  materially  embarrasses  the  operator. 

For  the  first  few  days  following  operation  the  silver  salts  are  usu- 
ally employed  until  such  secretion  as  may  exist  has  been  checked.  The 
patient  then  returns  to  the  hospital  twice  or  thrice  weekly  for  the  ap- 
plication of  the  sulphate  of  copper.  This  treatment  is  continued  until 
all  hypertrophy  has  disappeared  and  the  membrane  presents  a  normal 
appearance.  When  the  operation  has  been  properly  performed  and 
the  after  treatment  has  been  persistently  carried  out  the  results  are, 
as  has  been  already  stated,  very  generally  satisfactory.  It  is  indeed  most 
gratifying  to  observe  a  case  in  which,  previous  to  the  operation,  the 
membrane  has  been  studded  and  infiltrated  with  hard  granules,  pre- 
senting after  a  few  weeks  an  appearance  frequently  differing  not  at  all 
from  the  normal.  Such  cases  are  exceedingly  common ;  others,  perhaps, 
will  present  upon  close  inspection  a  few  cicatrices,  and  cases  with  one 
or  two  slight  permanent  adhesions  sometimes  occur,  but,  as  already 
stated,  these  abnormalities  in  the  conjunctiva,  when  but  slightly  marked, 
do  no  harm  although  they  are,  of  course,  to  be  avoided  as  much  as 
possible. 

The  patients  who  live  in  the  vicinity  of  One  Hundred  and  Eighteenth 
street  return  to  the  hospital  for  after  treatment ;  those  living  in  the  lower 
part  of  the  Gty  to  the  dispensary  at  Gouvemeur  Slip.  The  final  re- 
sults in  the  former  are  somewhat  better  than  in  the  latter,  for  the 
reason  that  the  former  are,  as  a  rule,  much  the  more  persistent  in  at- 
tending to  after  treatment  and  their  smaller  number  renders  them  much 
more  easy  to  manage  by  the  School  Inspectors,  upon  whom  the  re- 
sponsibility of  enforcing  the  subsequent  visits  largely  depends. 

Cases  of  pannus  are  sometimes  met  with.  These  are  treated  by  the 
ordinary  methods.  In  addition  to  expression  atropine  and  hot  applica- 
tions are  employed,  and  canthotomy  when  necessary.  Canthotomies 
in  these  cases  are  often  followed  by  every  excellent  results.  In  cases 
of  pannus,  in  which  the  gfranules  have  been  replaced  by  cicatricial  tissue, 
linear  scarifications,  repeated  twice  or  thrice  weekly,  are  of  decided 
benefit.  If,  in  examining  his  cases  before  operating,  an  active  pannus 
is  discovered  by  the  operator  he  very  generally  defers  operation  until 
♦^e  acuter  symptoms  have  subsided.    In  cases  with  considerable  secre- 


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siiie  re  "T* 


sixzgriti  2zii  fat  ^*  vis  jijsi  T:e  zL=«i  dc  n-t  i'-'r^  ^3^  j;^xx^i-rx-vv 
free:  dii-se  ~rS»— i-  =Lf^  i*=5crl:ei  rj  Jrcfrs.  rr  i^iar^  >cr;r,s^,v\w, 
arc  i'Zr=»i  rscsxf  :  f  rre  l.i^i^'jsr  "rcicH-^iw  l-  i^^5«r  Ci5<^  V,v^>=s  ^rJ.^^> 
that  the  cnerns-i  fir  ±ki  fy*  ^  rctrnzilj  bx^j«!S-  xrvi  '^^^  >5**<^ 
meet  the  irriiir  bL5  =::rT=2ri-:j  bii  irrr>  .xwcr^::>  f.-  v\v^,!l*,,v. 
The  mfcctx:^  -przcsJiiT  ::.:k  -^i-  =  -3e  chills  b.x:>e,  1:  :>  v^t  vN^*^>^^ 
possible  that  if  this  case  bad  beea  rpsiined  in  the  hos^MUJ  ixMXji^t  \u 
fection  might  net  have  cccrarcxi,  Tr.is  pves  an  eve  nvHt4*aU  \>UnUm 
the  Department's  ir.eihod  of  about  i-JCO  v^t  i  i>er  o^s^.t. 

In  the  io,ooo  patients  operated  upon  no  death  has  \xv\uv\sl  iuMU 
the  anaesthetic,  and  in  the  last  t\vo  years  it  has  nol  \>e\M^  i>o.\^^vu\ 
to  administer  oxygen  or  stimulants  in  a  single  case,  iMhci.  ^M%^^^K^I 
hy  nitrous  oxide  gas,  has  been  generally  employed,  t'hloiolonw  u  \\^^'\ 
in  cases  with  kidnev  lesions.  The  condition  of  the  ho«ut.  Un\i;'»  i\\\A 
kidneys  is  always  determined  before  operatiim.  Tho  u\r»aHo  K\\\\sy\\\\\ 
of  ether  used  in  each  case  is  about  two  ouikts.  Ivsprr^inn  \\\\^V\  l"»  ♦»! 
cocaine  anaesthesia  has  been  tried,  cocaine  in  HubMiiUio  uihl  In  muImIIhm 


298 

having  been  employed.  Except  very  mild  cases  the  results  have  not 
been  satisfactory.  Ethyl  chloride,  given  by  an  anaesthetist  accustomed 
to  its  use,  produced  dangerous  symptoms  in  two  cases,  and,  after  a 
short  trial,  its  use  was  abandoned. 

In  the  speaking  of  the  results  achieved  by  the  City  in  the  treat- 
ment of  trachoma  it  is  very  difficult  to  give  satisfaction  by  means  of 
figures.  Many  cases  change  their  residence  and  disappear  from  obser- 
vation and  many  relapses  are  doubtless  operated  upon  at  other  institu- 
tions. An  attempt  was  made  during  the  present  year  to  report  upon 
the  condition  of  700  cases  selected  indiscriminately  from  among  those 
operated  upon  during  the  two  previous  years.  These  cases  lived  in 
widely  separated  parts  of  the  City  and  the  tracing  of  them  was  exceed- 
ingly difficult.  Less  than  300  could  be  found  and  the  results  in  these 
showed  71  per  cent,  of  cures,  the  word  "  cure  "  meaning  that  no  follicles 
and  no  hypertrophies  existed.  Still  these  figures  give  a  very  inadequate 
idea  of  the  permanenecy  of  the  results  for  the  length  of  time  elapsing 
between  the  examination  and  the  operation  varied  very  greatly  in  the 
individual  cases  and  no  attempt  was  made  to  distinguish  the  cases  that 
had  been  mild  and  those  that  had  been  severe  in  character.  However, 
as  representing  the  gross  results  in  cases  selected  indiscriminately  from 
those  operated  upon  during  a  certain  period,  these  figures  are  certainly 
to  be  regarded  as  encouraging.  Perhaps  the  best  judgment  of  the 
results  of  the  Department's  work  is  to  be  found  from  the  following 
more  general  statement.  First,  the  number  of  cases  in  the  schools  in 
spite  of  the  continued  infection  from  the  tenements  is  decidedly  di- 
minished. Secondly,  cases  of  trachoma  are  much  less  numerous  in  the 
Eye  Hospitals  of  this  City  than  they  formerly  were,  and  the  number 
of  advanced  cases  and  of  those  requiring  operation  is  very  materially 
less.  Thirdly,  the  number  of  cases  found  in  the  public  baths  during  the 
past  summer  was  not  one-third  of  that  found  two  summers  ago.  In 
view  of  these  facts  it  would  not  seem  too  much  to  state  that  the  number 
of  cases  of  trachoma,  and  particularly  of  the  bad  cases  in  New  York 
City,  has  very  much  diminished  since  the  Department  began  its  work 
four  years  ago,  and  it  is  perhaps  not  too  much  to  hope  that,  with  greater 
hospital  facilities,  which  are  sadly  needed,  with  a  closer  inspection  of 
the  public  baths  and   possibly  with  the   dissemination  of  instructive 


literature  amoo^  the  tunilies  of  those  indicted,  tradKima  in  Xew  York 
CitA*  could  in  a  few  vears  be  nrduced  to  a  ver\-  inconsiderable  factor. 

Examination  of  the  visual  acuity-  of  1.000  school  children.  :n<ti:uteti 
in  1904.  shows  that  in  about  jo  per  cent,  vision  was  defective  in  one  or 
lx>th  eyes.  In  consequence  of  this  result  the  further  exaniinatic^n  of  all 
school  children  was  recommended.  This  work  has  been  carrieti  0!i  up 
to  the  present  time  by  the  School  Inspectors,  and  the  results  obtaineil 
and  the  methods  employed  will  be  found  in  another  part  of  this  rewrt. 

In  April,  1905,  the  attention  of  the  Department  was  called  10  the 
possibilit>'  of  limiting  the  deleterious  results  which  so  fre\|uently  iv^Uow 
ophthalmia  neonatorum,  occurring  in  the  practice  of  niidwives.  The 
reporting  of  such  cases  to  the  I>epartment  was  insisteii  upon,  and  each 
case  reported  was  visited  by  an  Inspector,  who  infomieil  the  ^varents 
of  the  destructive  nature  of  the  aflFection  and  advised  them  to  place  the 
infant  under  the  care  of  some  qualified  physician  or  to  take  it  for  daily 
treatment  to  some  institution.  Midwives  were  instructeil  by  circular 
in  the  treatment  of  Crede  and  were  informed  that  the  nitrate  of  silver 
solution  would  be  provided  gratis  at  the  Departir.ent.  The  results  of 
these  methods  have  apparently  been  very  satisfactory-.  Many  cases  were 
reported  and  many  midwives  applied  to  the  Department  for  Creole's 
solution,  which,  considering  the  fact  that  requests  for  it  are  still  fre- 
quently made,  must  be  in  very  general  use.  It  is  ver\'  certain  that  those 
measures  have  been  productive  of  the  utmost  gooil,  although  it  is  for 
obvious  reasons  difficult  to  give  figures  in  this  connection.  The  cases 
of  eye  disease  occurring  in  the  scarlet  fever,  measles,  diphtheria  and 
small-pox  hospitals  during  the  year  1906  deserve  a  passing  notice.  The 
cases  of  diphtheritic  conjunctivitis  are  ver\'  properly  divideil  into  those 
in  which  the  LoefTler  bacillus  and  those  in  which  tlie  streptivoccus 
predominates.  In  the  former  class  of  cases  the  prc^j^nosis  has  been 
found  to  be  fairly  good.  They  are  characterized  clinically  by  the  clas- 
sical brawny  infiltration  of  the  lids,  by  the  lardaceous  appearance  of  the 
conjunctiva,  the  scantiness  of  secretion  and  the  presence  of  niomhranous 
exudate  which  is  frequently  very  well  marked.  The  treatment  has 
consisted  in  antitoxin,  canthotomy,  atropine  and  hot  applications  when 
the  cornea  became  involved.  Under  this  treatment  the  very  general 
rule  has  been  that  the  eye  has  been  saved  if  the  patient  continue  to  li\T. 


300 

Antitoxin  appears  to  be  of  unquestioned  value.  The  disease  may  be 
primary,  it  may  follow  an  affection  of  the  throat  or  nose,  or,  when 
])rimary,  it  may  be  succeeded  by  an  affection  of  these  cavities.  The 
streptococcal  type  is  characterized  clinically  by  less  swelling  and  infil- 
tration of  tlie  lid.  less  tendency  to  membranous  formation  on  the  lids, 
more  profuse  secretion  and  a  marked  tendency  to  involvement  of  the 
cornea  with  consequent  perforation  and  loss  of  the  eye.  The  prognosis 
so  far  as  the  eye  is  concerned  is  practically  fatal. 

Ca>es  of  (lacryo-cystitis  have  occurred  in  cases  of  diphtheria,  measles 
and  small-iH)x.  They  have  lieen  treated  in  the  usual  way  and  the  re- 
sults have  been  very  gocxl. 

The  corneal  affections  occurring  in  measles  have  been  observed  to 
differ  very  {^^ri^atly  in  severity  in  different  series  of  cases.  Frequently 
<nough  the  ordinary  treatment  by  means  of  atropine  and  hot  water, 
followed  later  by  the  yellow  oxide  ointment,  has  given  excellent  results. 
In  other  cases  the  ulcerations  have  only  been  checked  by  the  actual 
cautvrv .  Two  such  eves  have  l>een  lost.  In  other  cases  the  infants  were 
markedly  marasmic. 

llypt^pyon  keratitis  occurring  in  cases  of  small-p)Ox  has  generally 
resulted  in  the  loss  of  the  eyes.  One  case  was,  however,  saved  by  cau- 
terization and  paracentesis.  The  case  recovered  with  a  large  central 
leucoma  hut  sufficient  of  the  cornea  remained  clear  to  enable  an  artifi- 
cial jMipil  to  be  satisfactorily  made. 


RKPi^KT  OF  IW'KSTIGATION  CON'CERXING  THE  SUBWAY 

TUNNEL. 

Borough  of  Manhattan. 

1 .  This  tiumcl  is  to  he  the  extension  of  the  subway  and  will,  when 
completed,  reach  from  the  Battery,  Manhattan,  to  the  foot  of  Jorale- 
mon  street,  Brooklyn,  |)assing  under  the  East  river.  The  boring  opera- 
tions are  now  nearly  completed,  only  about  60  feet  of  sand  separating 
the  shields  which  are  being  driven  from  the  Brooklyn  side  from  those 
v.orked  from  the  Manhattan  end. 

2.  The  tunnel  will  consist  of  two  separate,  single-track  tubes,  each 
151/2  feet  in  diameter  and  about  6,000  feet  long.    They  arc  being  con- 


stnicted  m  me  osaaL  Tmrnt**"  ly  -ncart  .z  zisruiansL  r.n  -ti^  miit 
up  and  bctotc  jcgerfwsr  ±-3n  ±ii  husuul  T"ic  v  .rx  ilw  it-rcr-'iiiiQ:  :** 
at  a  point  appr^Aimagiy  -miCTnij  'xr¥-isi  -nc  -uinnanaii  sni  Zr-jcui/-:! 
shafts  and  abccc  jr>  ftfgr  '3«£i:w  -ric  Tornac-  i  ::c  - -^r  Tie  -narbr-a. 
being  excavacsi  is  ^ami  ilrfnrtari  *  rj[is«*usrii:.::  z^lt:  :z  -zm  y-:n 
been  throng!:  r:ck. 

3.  The  contraci  is  parr  :•:  rcac  jfc  2\-  zitt  7x7  ij  f  ^^rC^ra.*:.  "^ 
the  sub-contractiir  rsctinahLe  5;r  ±11^?  'sm  .f  ±tt  v  :r£  --  :.-?•:  \"i'v  Yn 
Tunnel  Cc'gparj'.  :f  V:.  -t2  'fVii  ^ir^-tr: 

4.  The  rre^ics  if  -v:ri-T?r  zrarr«ri-l-    iircinrLrt  li^.^c  :z   .."^rDi  or 
the  other  nmeL?  :c  "v^nrr  t^*  J:a."T»  ''--r^j.fi^l;   rfitinri    Trtt  :c^".  rj.^il 

is  at  the  p^riLici-  jcc  :r  ^x:  f±sr  .•tririii  ziryt  ri-rrti'fs.  rri;  rst  :;  :rtf 
tttbes  beinc  ::-r.z'.tZi  txjscc  ::r  -s.;  .rr  '-ir*t  *-iZsif.  I:  :s  rrrs  r^-ssfrC^ 
to  descend  th«;  ?r^r:  *r  i!ie  lantr-  ::'  -^-.i^rt.  tr.'i  -rrxj:  -=»ri7s  rhir. 
2,000  ittz  t-c:  zrZ'i^trr  iie  r_-rtr.  •':r'.:n  :-:i  -1  V  "J't  .riirsr^.  irrr^- 
pnerrc  p  r-c^  *\ir r .  "LZf  1  i*'--»_ — _--..  _■  ria-iirjit  -  i^r  *^i_ir '  ^  '•!  "^  t  le^z.  r  ?*_* bl fr*  r  r ."  ■"."! 
one  nifce  m  'jl-z  .I'-'ir  :iir:r:;tr  -J't  r  •ijt  zssz  .£  -J"-t  nvtr  rei  -z  fcv^n" 
placcf  5»:  :i:i:  i:  if  -irs--  ::  's.  f  f-  ^  -^  :"•:  ::  i::r  ii^tz  .::S:": 
goinj?  back  : :  :*-.t  i>a:t 

Each  tube  r.-if  :r.I  :  . :  air  ":ck:?,  1::  -iT^r  .h::>.  :>  usei  :r.Iy  25  ar. 
enierger.cy  Icck.  and  2.  "-ar^t  I:--vtr  ".:•:*•:.  "?-r:  ivth  ::r  2  Truck  "cvk  a::.: 
for  the  pa.?<a^-t  :f  the  n-.-rr..  The}  are  r.:t  pnviie^i  with  pres^un.* 
gauges.  tin:e  pieces  nor  ±erny>::ieter5.  A  '.-zck  ten-ier  was  tound  on  dut} 
at  this  point,  but  the  air  pressure  was  re^LiIated  frorr.  within  the  lock 
by  n:eTnbers  -A  the  party.  We  tin:ed  'ir.e  pany  conrlns:  out  and  jo  min- 
utes were  consurred  in  the  passage  out  of  the  pressure. 

These  !:-cks  are  oi-nnected  with  a  warming  apparatus  which  wanr.s 
the  air  in  the  Ic-cks  when  a  party  is  com:ng  out.  thus  removing  the  dull 
due  to  the  expansion  of  the  air.  In  this  respect  the  wamiors  perform  a 
useful  function.  But  the  coal  fires  used  in  operating  them  give  off  a 
large  amount  of  noxious  gases  which  vitiate  the  air  in  the  cvMuplotod 
portions  of  the  tubes  outside  of  the  pressure.     When  these  tiros  are 


302 

Inirning  it  is  almost  impossible  to  breathe  in  the  upper  part  of  the  tubes 
near  the  air  locks. 

6.  The  medical  supervision  of  the  men  working  in  this  tunnel,  of 
wRom  there  are  between  500  and  600,  is  left  entirely  to  the  labor  union. 
The  physician  of  the  labor  union  certifies  the  fitness  of  the  men  to 
work,  and  they  are  then  put  to  work  without  further  examination  on 
the  part  of  the  contractors.  The  labor  union  also  provides  the  lock 
tenders.  There  is  no  physician  in  attendance  at  the  top  of  the  shaft,  re- 
liance being  placed  on  medical  aid  summoned  when  required.  A  room 
is  set  apart  for  workmen  who  may  become  afflicted  with  caisson  dis- 
ease, however,  and  this  room  is  provided  with  a  medical  lock.  The 
hours  of  work  are  divided  as  follows :  2  hours'  work,  then  4  hours*  rest, 
then  2  hours'  more  work.    This  constitutes  a  shift. 

No  medical  rules  are  found  posted. 

The  usual  supply  of  hot  coflfee  is  provided  but  none  of  the  work- 
men were  found  availing  themselves  of  it. 


REPORT     OF     CONDITIONS     RELATING     TO     PERSONAL 
SAFETY  IN  THE  CONSTRUCTION  OF  THE 

SUBWAY  TUNNEL. 

On  June  26  a  communication  was  received  from  the  Chief  Clerk  of 
the  Coroner's  office  stating  that  an  inquest  had  been  held  to  ascertain 
the  cause  of  death  of  Galina  Weikkola. 

The  Coroner's  Jury,  after  investigation,  came  to  the  conclusion  that 
the  said  Galina  Weikkola  came  to  his  death  on  the  29th  of  May,  1906, 
by  air  embolism,  the  "  bends."  Furthermore,  the  jury  censured  the 
contractors,  S.  Pierson  &  Son,  for  not  giving  the  man  a  proper  physical 
examination  before  allowing  him  to  go  to  work. 

An  investigation  was  made  by  two  very  competent  inspectors  of  this 
Department  concerning  the  conditions  said  to  obtain  in  these  two  tun- 
nels. 

In  regard  to  the  first  statement  that  a  proper  physical  examination 
was  not  given  before  allowing  the  men  to  go  to  work  it  was  found  that 
aU  applicants  were  given  a  full  physical  examination  and  were  rejected 


{occ  jML^mLJd.  ,iMniw>     >^^oK  "Ofwrgp  ms  aauimnmnr  *iy*r 


I  jiiiK  .^.  aati 


giugt^  art  ^ssKL  Jt  T^acuns  T»rs  rf  ism  lanx^  ant  -nvms  wiusyz  iK 

»=Tr  It   vrircnu:  xmassr  rjnr- 

•irmc  "ie  arrant  ^"Avmni:  "hsr  -fnt  v -nrcnts  ht;  jiLcw^*£  ^ 
aac  roc  rt:  -^ot  1:03  tzk  -^saiidr  r  v:is  ±xnni  -rrac  i?»^  injniog< 
were  aSD««  i^r  -±1;:  irssnr*  jl  -fnt  aicl  11  "nsrnne  jotssl  7?  "JTac  ar  :iK 

of  tiic  r  ra'i^"  rr  'lesx*  "fnt  air*ssiiri  xl  'fm  jick  ^rnatei  :3k  Tr«8 
of  tiic  cxacrssl  sir.    TiKse  znat*  ir-i  rasainzardj  iJiirw'ssd  ar  il  r 

work  nndc  dae  irsiHcr^  •iri,!**  !H£  h:  ±1:*  rarnmar  sa 


■•  It's?*  sr  r 
m  tiic  locks  ^:  :rar  ±ie  jp jt\  it.l  r3£if  icserr-  33 
thcv  were  -=:  irVirag-  r  w^  zz^cziti  r^ar  ibt  Jicis  *« 


of  these  gaisgcs  h  naj  be  sezrec  ±a:  ±ie  iir  pocss^re  nNXHndW  on  the 
gauge  in  the  v,n-.ir:,  cc  ibe  gaisge  ir  the  I'^xi  inc  oc  the  snain  hi!K) 
gauges  carried  V.  the  irsspectrrs,  mc  the  gature  in  the  office  of  the 
superintendent  cf  the  work  were  aZ  the  ^aire,  nan^elv.  ju|  pounds^. 

In  regard  to  the  nrst  rec:crjn-.en«tat:r.  r:.a.!e  by  the  Coroner's  Jur\ 
that  some  adequate  means  sh*:ald  be  de\-i>ed  to  prevent  the  wvrknien 
from  giving  their  passes  to  any  outsiders  and  thus  enabling  them  to  gv> 
to  work  without  a  proper  physical  exan:ination,  it  may  be  states!  that 
the  contractors  have  taken  the  precaution  of  lianging  notices  at  various 
places  before  the  eyes  of  the  workmen,  telling  them  of  the  dangers  to 
be  encountered  by  any  person  or  persons  in  doing  the  work  wit!>out 
proper  physical  examination.  If  any  person  being  thus  informed  still 
persists  in  entering  the  tunnel  without  a  physical  exan>ination  it  iKx^s 
not  seem  quite  proper  to  hold  the  contractors  responsible. 

In  regard  to  the  second  recommendation  that  the  IJoard  of  Health 
be  more  strict  in  the  supervision  of  this  work,  and  in  seeing  that  all  pre 
cautions  possible  are  taken  to  prevent  further  loss  of  life,  it  may  be 
slated  that  sufficient  supervision  is  and  has  been  maiutaine<l. 


304 

SANITARY  BUREAU. 

Borough  of  the  Bronx. 

Compared  with  the  year  1905  the  work  shows  a  decided  increase, 
there  having  been  more  work  performed  in  all  divisions  of  the  Depart- 
ment office. 

Division  of  Inspections. 

In  this  division  the  energy  of  the  Department  was  largely  focused 
upon  stables  wherein  cows  were  kept  and  milk  produced  and  also  upon 
manufacturing  plants,  the  various  railway  lines  and  other  businesses 
which  have  in  years  heretofore,  by  polluting  the  air  with  black  smoke, 
been  the  cause  of  very  many  complaints  to  the  Department. 

In  pursuing  our  stable  work  every  stable  in  this  borough  wherein 
cows  were  kept  has  been  inspected.  In  making  these  inspections  ad- 
dresses were  obtained  from  our  files  of  all  persons  to  whom  permits  to 
keep  cows  had  been  granted  since  the  establishment  of  the  borough 
government.  Beside  those  nearly  sixty  persons  were  found  who  were 
keeping  cows  without  Department  permits.  Against  each  one  of  the 
latter  orders  of  the  Board  to  remove  cows  were  issued.  The  total  num- 
Iner  of  stables  found  was  385.  Against  a  great  many  of  these  stables 
orders  of  the  Board  were  issued,  many  of  which  required  radical 
structural  changes.  It  is  my  belief,  founded  on  many  personal  inspec- 
tions of  stables  during  the  fall  just  past  and  the  early  winter,  that  in 
no  previous  year  since  the  establishment  of  the  Department  of  Health 
has  there  been  such  an  improvement  in  the  sanitary  condition  of  cow 
stables  as  during  the  year  just  past,  and  the  resultant  good  to  the  pub- 
lic, especially  to  children,  by  the  improvement  of  the  milk  produced  in 
the  dairies  within  this  borough  consequent  upon  the  improvement  of 
(he  sanitary  condition  of  the  stables  and  the  methods  in  milking,  cooling 
and  handling  the  milk  can  hardly  be  conceived  of  or  computed. 

Black  smoke  from  factories,  locomotives,  etc.,  has  for  a  long  period 
of  time  been  recognized  by  the  Department  as  a  nuisance  and  many 
Orders  of  the  Board  have  been  issued  against  those  responsible  therefor. 
The  instructions  of  the  Sanitary  Superintendent,  a  few  months  since, 
to  criminally  prosecute  offenders  instead  of  the  slower  process  of  Board 
Orders,  have  resulted  in  a  remarkable  change  in  conditions.     In  the 


30S 

spring  and  summer  many  were  the  complaints  received  at  the  Depart- 
ment relating  to  smoke ;  now  there  are  practically  none,  nor  have  there 
been  any  for  many  weeks.  The  many  arrests  that  have  been  made 
within  the  borough  of  offenders  have  resulted  in  a  remarkable  clarifica- 
tion of  the  atmosphere  along  the  railway  lines  and  water  front,  whereat 
many  of  the  large  factories  are  located.  The  amendment  of  section  96 
of  the  Sanitary  Code  on  March  14,  1906,  by  having  become  known  to 
tactory  owners,  has  undoubtedly  contributed  to  the  betterment  of  con- 
ditions and  many  of  the  largest  manufacturing  plants  have  installed  or 
are  now  installing  smoke  consumers.  The  old  round-house  of  the  New 
York  Central  &  Hudson  River  Railroad  on  One  Hundred  and  Fiftieth 
street  and  Spencer  place,  the  smoke  from  which  was  probably  the  cause 
of  more  complaints  than  any  other  premises  or  business,  has  been  re- 
moved therefrom  to  a  remote  part  of  the  borough,  and  since  its  removal 
to  its  present  location  not  a  complaint  has  been  received  relating  thereto. 

Board  and  Care  of  Children, 
During  the  year  just  past  the  file  of  persons  to  whom  permits  to 
board  and  care  for  children  had  been  issued  since  the  establishment  of 
this  branch  office  has  been  gone  over  and  every  premises  visited  where 
a  permit  was  in  force.  Many  holding  permits  had  removed  or  given 
up  the  business  of  caring  for  children.  In  all  such  cases  permits  were 
revoked.    The  total  number  revoked  was  243. 

Food  Inspections 
Increase  of  work  along  this  line  has  been  very  pronounced  during 
the  past  year  as  compared  with  the  year  1905,  both  in  number  of  in- 
spections made  and  the  number  of  pounds  of  food  destroyed.  The  ap- 
pointment of  an  additional  Food  Inspector  early  in  the  year  has  con- 
tributed to  the  increase  of  work  performed  while  the  transfer  of  our 
only  milk  inspector  in  February  to  Manhattan  Borough  has  in  a  measure 
subtracted  from  the  amount  of  work  in  the  branch  of  the  service  which 
relates  to  inspection  of  milk.  No  inspections  of  milk  are  now  being 
made  in  this  borough  by  inspectors  attached  to  this  branch  office. 

Division  of  Contagious  Diseases, 
There  were  more  contagious  diseases  reported  during  the  year  than 
in  1905,  largely  due  to  the  prevalence  of  measles  during  the  first  and 


3o6 

second  quarters.  There  was  a  very  large  increase  in  the  number  of 
visits  to  cases  and  the  number  of  rooms  disinfected  and  the  number  of 
persons  removed  to  hospitals. 

The  increase  of  the  number  of  children  vaccinated  during  the  year 
has  been  very  marked. 

On  December  ii,  1905,  the  area  in  Manhattan  Borough  to  be  cov- 
ered by  The  Bronx  wagons  for  collection  of  goods  for  disinfection  was 
fixed  at  One  Hundred  and  Forty-fifth  street  to  Ship  Canal  on  the  north, 
and  during  the  year  just  past  our  wagons  have  covered  said  area.  The 
area  covered  by  our  ambulances  is  still  from  Ninetieth  street  to  City 
Line  on  the  north. 

On  November  17,  1906,  the  lime-formaldehyde  method  of  disinfec- 
tion was  discontinued  and  the  permanganate  of  potash-formaldehyde 
method  was  inaugurated  in  its  stead;  after  a  few  weeks'  trial  of  the 
latter,  by  the  order  of  the  Acting  Sanitary  Superintendent,  the  lime- 
formaldehyde  method  was  re-adopted. 

The  corps  of  medical  school  inspectors  being  a  small  one  the  district 
medical  inspectors  are  assisting  in  school  work  and  each  inspector  has 
two  schools  under  his  care;  by  this  method  about  twenty  schools  are 
provided  with  medical  inspectors,  which  is  a  great  relief  to  our  medical 
school  work. 

The  schools  in  this  borough,  except  in  portions  which  are  thickly 
built  up,  are  widely  separated,  which  means  a  great  deal  of  time  spent 
by  medical  inspectors  in  traveling  from  one  school  to  another,  therefore 
but  a  few  schools  can  be  given  to  each  inspector,  and  it  has  been  neces- 
sary in  certain  of  the  outlying  schools  to  have  visits  made  only  on 
alternate  days.  The  corps  of  medical  inspectors  being  small  the  work 
which  they  have  been  called  upon  to  do  has  been  arduous,  and  although 
I  have  much  desired  to  have  physical  examination  made  of  pupils  who 
are  backward  in  their  studies,  to  ascertain  whether  or  not  there  were 
physical  conditions  which  might  account  for  dullness  of  mentality,  I 
have  not  \et  been  able  to  do  so.  I  would  strongly  recommend  an  in- 
crease in  the  number  of  medical  school  inspectors  in  our  corps  that  a 
physical  examination  of  the  pupils  within  our  schools,  conducted  in  a 
manner  which  has  proven  so  satisfactory  in  the  Borough  of  Manhattan, 
can  be  adopted  within  this  borough. 


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Number  : :'  a3CTrar:ii>  estab&shxnents 

Number  •:•:  mar.ufartones  aixi  vorksbops  risited 

Number  of  ftaUes  visited 

Number  cf  sunker.  and  vacant  ktts  visited 

Number  of  miOc  inspectors 

Number  of  pounds  of  food,  fruit  and  meat  destro)-ed 

Number  of  fruit  and  food  inspections 

EHvision  of  Contagious  Diseases. 

Numbo*  of  visits  to  cases  of  contagious  diseases 

Number  of  visits  to  tenement-houses 

Number  of  visits  to  schools 

Number  of  visits  to  private  dwellings 

Number  of  miscellaneous  visits 

Number  of  primary  vaccinations 

Number  of  revaccinations 

Number  of  vaccinations  in  schools 

Total  vaccinations 

Number  of  certificates  of  vaccination  issued 

Number  of  children  excluded  from  schools 

Number  of  cases  of  diseases  cared  for  by  school  nurses 

Number  of  examinations  ot  children  by  school  nurses 

Number  of  persons  removed  to  contagious  disease  hospitals. 

Number  of  houses  visited  for  disinfection 

Number  of  infected  rooms  disinfected 

Number  of  times  ambulances  and  vehicles  disinfected 

Number  of  pieces  of  infected  goods  disinfected 

Number  of  pieces  of  infected  goods  destroyed 

Tolal  number  of  inspections 

Mercantile  Establishments. 

Number  of  children  interviewed  applying  for  certificatei^ 

Number  of  employment  certificates  granted 

Number  of  employm«nt  certificat«rs  refused 


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SANITARY  BUREAU, 
Borough  of  Brooklyn. 
Division  of  Inspections. 

Complaints — The  number  of  complaints  received  during  the  past 
year  is  slightly  less  than  the  year  1905,  which  is  due  to  the  fact  that 
a  great  many  complaints  are  now  sent  direct  to  the  Tenement  House 
Department.  There  were  2,371  original  complaints  made  during  the 
past  year.  This  is  much  less  than  the  year  1905,  one  of  the  reasons 
being  that  during  the  summer  of  1905  many  original  complaints  were 
made  by  inspectors  investigating  the  prevalence  of  typhoid  fever  in 
this  borough. 

Enforcement  of  Orders — The  method  of  enforcing  orders  during 
the  past  year  has  been  the  same  as  heretofore.  This  method  has  not 
proven  effective  in  a  large  majority  of  cases,  for  the  reason  that  it  is 
not  even  possible  to  secure  the  attendance  of  the  defendant  in  court, 
and  most  of  the  judgments  obtained  are  taken  by  default.  Again, 
many  of  the  Judges  of  the  Municipal  Courts  are  not  disposed  towards 
giving  judgments  for  the  Department,  holding  that  proceedings  are 
improper  from  a  legal  standpoint.  The  method  used  in  former  years, 
namely,  that  of  instituting  criminal  proceedings  against  all  those  who 
fail  to  comply  with  the  order  of  this  Department  was  far  more  suc- 
cessful, and  the  number  of  orders  not  complied  with  was  always  at 
a  low  figure.  I  most  heartily  recommend  that  this  system  be  re- 
established. 

Smoke  Nuisance — A  very  small  number  of  complaints  of  citizens 
in  regard  to  the  nuisances  of  this  nature  are  received  at  this  office. 
In  cases  where  complaints  are  received  it  is  almost  impossible  to  obtain 
the  necessary  evidence  of  the  violation  of  the  Sanitary  Code,  as  re- 
quired by  the  courts  in  this  borough,  for  the  reason  that  the  com- 
plainants are  averse  to  appearing  in  court  to  give  their  testimony, 
loi  original  complaints  by  inspectors  relative  to  the  smoke  nuisance 
were  received;  41  arrests,  9  convictions,  and  $725  was  collected  in 
fines. 

Renovation  After  Cases  of  Tuberculosis — During  the  year  1906 
779  orders  for  the  renovation  of  apartments  which  have  been  occu- 


309 

pied  by  consumptives  have  been  issued,  as  against  825  for  the  year 
1905.  These  orders  are  made  upon  complaints  forwarded  to  this  office 
by  the  medical  inspectors  of  the  Division  of  Communicable  Diseases, 
and  the  orders  in  most  cases  are  promptly  complied  with. 

Meat  Inspections — The  inspection  of  meat  has  been  carried  on  as 
in  former  years,  attention  being  chiefly  given  to  animals  on  the  hoof, 
and  to  carcasses  after  slaughter.  Shop  inspections  are  also  made 
throughout  the  borough.  The  appointment  of  additional  meat  in- 
spectors  has  made  it  possible  to  largely  increase  the  number  of  shop 
inspections,  consequently  the  efficiency  of  this  work  has  been  greatly 
increased. 

Food  Inspections — Two  inspectors  are  employed  in  the  inspection 
of  fruit,  vegetables,  and  foods  other  than  meat  and  milk  which  are 
offered  for  sale  in  the  stores  in  this  borough.  Our  reports  in  the  mat- 
ter of  fruit  condemned  you  will  find  to  be  much  lessened  this  year 
over  previous  years  by  reason  of  the  fact  that  the  inspection  of  all 
imported  fruit  is  now  done  by  the  New  York  Office  Inspectors,  and 
credit,  therefore,  is  given  to  the  New  York  Office. 

Employment  Certificates — The  work  of  issuing  employment  certifi- 
cates is  carried  on  as  in  former  years,  amendatory  legislation  tending 
to  considerably  eradicate  cases  of  hardship  which  arose  under  the 
law  as  originally  enacted. 

Inspection  of  Mercantile  Establishments — While  no  force  of  in- 
spectors has  been  provided  to  do  this  work,  we  are  having  our  regu- 
lar district  inspectors  of  the  Division  of  Inspections  make  these  in- 
spections in  the  course  of  their  usual  work  in  their  own  districts,  and 
have  established  a  card  system  showing  their  inspections  from  time 
to  time.  The  number  of  convictions  for  violation  of  the  Mercantile 
Law  and  the  employment  of  minor  labor  in  this  borough  has  been 
very  few. 

The  Sanitary  Squad  as  at  present  constituted  is  entirely  inadequate 
to  meet  the  requirements  placed  upon  it,  and  it  is  necessary  in  view  of 
the  rapid  growth  of  the  suburbs  in  this  borough  that  at  least  ten  ( 10) 
additional  patrolmen  be  added  to  the  Sanitary  Squad  in  order  that  the 
borough  may  be  properly  covered.     Our  force  of  eleven   (11)  patrol- 


3IO 

men  and  one  ( i )  roundsman  is  absolutely  overworked  under  the  pres- 
ent conditions. 

DiiAsion  of  Contagious  Diseases. 

The  work  of  the  Contagious  Disease  Division  has  proceeded  very 
satisfactorily  during  the  past  year.  At  the  beginning  of  the  year  we 
had  an  exceedingly  great  number  of  measles  cases  reported,  which 
continued  up  to  about  the  first  of  July.  The  borough  is  now  divided 
into  twenty-two  (22)  inspection  districts,  and  the  inspectors  are  doing 
very  excellent  work. 

The  Medical  School  Inspection  is  carried  on  remarkably  well,  not- 
withstanding the  fact  that  for  the  greater  part  of  the  year  we  had 
a  very  insufficient  staff  due  to  the  fact  in  a  great  measure  that  we 
had  to  place  fourteen  ( 14)  extra  men  at  work  in  the  district  inspecting, 
owing  to  the  prevalence  of  the  measles  epidemic  above  mentioned. 

At  the  opening  of  school,  September  10,  11  and  12,  1906,  a  gen- 
eral inspection  was  made  of  all  the  schools  in  the  borough;  a  total 
number  of  154,644  children  being  examined.  Of  this  number,  1,320 
were  found  to  have  pediculosis;  667  were  found  who  had  trachoma, 
of  which  299  were  excluded ;  200  cases  of  skin  disease  were  found, 
of  which  25  were  excluded;  266  were  found  who  had  conjunctivitis, 
of  which  123  were  excluded ;  and  160  were  found  who  had  blepharitis. 
This  general  inspection  proved  to  be  a  very  great  blessing  to  the  school 
inspectors,  simplifying  their  work  very  much  as  to  their  future  in- 
.spections,  placing  all  this  vast  number  of  children  under  observation, 
and,  consequently,  reducing  the  source  of  contagion  to  other  children. 
The  great  diminution  of  the  number  of  children  is  the  best  possible 
testinx>nial  to  the  thorough  work  done  during  the  first  three  days 
of  school. 

In  connection  with  the  regular  school  inspections,  the  medical  in- 
spectors have  performed  vaccinations  in  this  borough  other  than  those 
performed  at  the  Central  Office  by  the  physician  detailed  for  that 
purpose,  and  by  one  medical  inspector  whose  time  is  devoted  to  vac- 
cinating those  who  apply  by  mail  for  vaccinations  to  be  done  at  home, 
when  not  employed  on  some  other  special  work.  The  total  number 
of  vaccinations  for  the  year  was  18,853,  which  is  approximately  2,000 
more  than  we  succeeded  in  obtaining  last  year  (1905).     The  increase 


3" 

in  vaccinations  mav  be  accounted  for  bv  the  fact  that  \vc  Wave  had 
some  cases  of  small-pox  in  this  borough  during  the  past  Umr  months, 
which  may  possibly  have  proven  an  incentive  to  people  to  secure  a 
successful  vaccination.  The  medical  inspectors  of  schooU  are  doing 
very  excellent  and  highly  creditable  work. 

The  medical  inspectors  detailed  as  diagnosticians  are  doinjr  "»ost 
excellent  work.  They  are  working  almost  every  da\  aiul  even  em- 
ployed during  the  night,  searching  houses  through  the  section  of  this 
borough  occupied  by  colored  people,  for  concealed  cases  oi  small- 
pox. In  connection  with  the  work  of  the  diagnosticians,  they  have 
caused  to  be  removed  to  the  Kingston  Avenue  Hospital  for  violation 
of  quarantine,  137  cases.  They  have  also  caused  to  l»e  closed  44 
stores,  due  to  an  infectious  or  contagious  disease  in  an  apartment  ad- 
joining. 

The  veterinarians  of  this  Department,  of  which  there  are  two, 
are  doing  very  satisfactory'  work,  maintaining  a  proper  an4  strict  su- 
pervision over  all  sales-stables  in  connection  with  tl:eir  rtj^ailar  rou- 
tine work.  During  the  past  year  cases  of  rabies  have  considerably 
increased,  and  in  each  instance  we  have  been  very  zealous  in  obtain- 
ing the  names  and  addresses  of  persons  who  have  been  knov\n  to  be 
bitten,  and  sending  the  carcass  of  the  dog  to  the  Research  Laboratory 
for  examination,  and  thereby  taking  every  means  of  safeguardinc:  the 
public  from  any  further  infection  of  rabies. 

The  disinfectors  of  this  Department  have  done  most  excellent  work 
during  the  past  year.  Not  once  during  the  year  has  it  been  neces- 
sary to  prefer  charges  against  any  one  of  them,  excepting  in  one  in- 
stance and  he  was  a  man  recently  attached  to  this  office  and  has  since 
been  transferred.  Total  number  of  houses  visited,  19,145-  ^'^^^^  """^" 
ber  of  rooms  fumigated,  23.866.  This  is  far  in  excess  of  the  work 
performed  during  the  year  1905.  As  is  apparent,  the  i)ortion  nf  rooms 
fumigated  to  the  number  of  visits  is  in  excess  of  last  year.  This  is 
due  to  the  large  number  of  rooms  ordered  fumigated  by  the  inspectors 
attached  to  the  Division  of  Communicable  Diseases,  as  it  frequently 
occurs  that  the  inspectors  of  the  Division  of  Communicable  Diseases 
order  six  and  sometimes  seven  rooms  to  a  case.     Number  of  pieces 


312 

of  gocxis  disinfected,  44,606;  number  of  pieces  of  infected  goods 
destroyed,  8,846. 

The  office  staff  is  verj'  efficient  at  the  present  time.  The  various 
files  of  the  division  were  never  in  better  shape.  During  the  past  year 
we  have  had  added  to  the  work  of  the  division  the  supervision  and 
inspection  of  the  babies  boarded  outside  by  institutions.  That  work 
was  formerly  looked  after  by  an  inspector,  but  we  have  found  that 
the  great  increase  in  numbers  called  for  the  detailing  of  another  in- 
spector to  assist  the  first.  At  the  present  time  we  are  having  visits 
made  to  every  person  holding  a  permit  to  board  and  care  for  children, 
and  we  hope  ver}-  shortly  to  make  a  recommendation  to  have,  probably, 
as  many  as  two  hundred  permits  revoked  for  various  reasons.  After 
the  old  permits  are  revoked,  and  the  number  sifted  down,  we  will  have 
about  three  hundred  and  fifty  children  boarded  out  in  this  borough 
which  will  require  occasional  inspection.  The  inspection  of  these 
children,  and  the  calls  made  to  new  applicants  will,  undoubtedly,  keep 
two  inspectors  busy.  For  that  purpose  we  have  two  female  inspectors 
detailed  to  this  work,  and  their  work  is  very  satisfactory. 

During  the  past  year  also,  we  have  undertaken  to  have  the  Day 
Nurseries  visited  regularly,  and  inspected  the  same  as  other  institutions 
harboring  juveniles.  That  is  once  a  month,  and  to  intelligently  keep 
a  record  of  same.  We  are  using  an  ordinary  index  card  properly 
stamped,  setting  forth  the  average  attendance,  light,  heat,  etc.  In  fact, 
the  pre-requisites  to  an  intelligent  and  efficient  record.  This  work 
is  also  done  by  a  female  inspector  who  has  been  for  the  past  two 
years  assigned  as  a  regular  inspector  of  institutions. 


SANITARY  BUREAU, 
Borough  of  Queens. 

Work  performed  by  Inspectors,  etc.,  during   1906. 

Inspeciions   and   reinspcctions 55437 

Number  of  orders  issued 1,600 

Number  of  pounds  of  foodstuffs  condemned  and  destroyed 35,961 

Permits  issued 1,206 

Number  of  employnunt  certificates  granted 1,015 

Number  of  visits  to  contagious  diseases 9»492 


3^1 

njiiiiif  t     LlT^MXi 

of  anoBis  i't^iiMMMJ . .             StiiSto 

Number  of  faonsK  visited  mr  tismecnon .                         ...  v"^ 

Kuoifacx  of  romiB  dianfEcsea.  5.401 

Hqnber  of  {oeces  of  ^jad&  iisnfesmeu.  -2^-US 

Xamber  of  pieces  of  inffi  .'hi  apHMs  it^^myci.  1.7^ 

XoDiber  of  aabies  insfrtred  .  5.^5 

Xmnber  of  rabies  vacate*!         ...               ...  -^JiJ 

Xuuiiicr  of  a)w*  rcnoved  fmnx   msamtarr  -obics.    . .  -.J45 

Xmnfaer  «3t  •iairy  itabies  now  in  existence. .  . .                $5 

Xomber  :f  '  ?rngie  ::nw  '  itabit^  .low  m  -ix:i':cnc^.  55 


Increase  jr  Fjiru^anuH  •«  .*"'rc  Borjuz^t- 
For  some  years  past,  begiimm^  possibly  ac  ±e  time  or  the  in- 
corporation •:£  dbe  now  3cn:ti§h  :f  '^'^•^^^  *""^^  ^^  Greater  City  of 
Xcw  \oric.  a  ^teaify  incr^iase  :f  the  o«:puIadon  or  this  borou^  com- 
menced, and  baa  steaiiily  k?pc  at.  3v  dii:?  :ncrea:?e  I  viu  not  mean 
the  great  crowds  of  'tea^ure  ir-o  -ecrear:«:n  seekers,  coming  tor  ji 
longer  or  shorter  stav.  ir  ihe  -iea^jiiic  res<:rt5  and  iiroontintJ:  to  above 
ioox«o  on  rriany  .lays  iurir.^  the  ^umr^er.  but  parties.  faiiTilies,  etc.. 
who  nnd  :h:>  ri.rui^h  t-j  -jui:  :!-^:r  :  i-eas  of  fresh  air  and  healthful 
surrounding  r :  :he-  uiuallv  ^ettli  i'jwn  for  ;^xx:.  buv  ^prvHinvl  anvl 
build  a  hor-.e.  :r  pr:ci:re  o-nc  aires,  i  in  existence — the>e  fonn  the  iit- 
crease  of  t-«:t>ulati'jn.  Accoriiinc:  :<  :he  n^^ires  of  the  Bureau  of  \  itU; 
Statistics,  th:?  increase  is  seen  in  the  following  schedule: 

Popuiaror.  cf  the  b«jr-:u2h  in   1905 iv»vxw 

Populaticr:  r.f  the  b*jrough  :n   1906 A\X08d 

Popalation  of  'he  Nzroagh  in  1907 

Population  calculated  to  July  i.  1907 -'-wS^K^ 

And  it  must  be  remembered,  all  this,   in   the   face  of  the   ruther 
scant  means  of  transportation,  the  absence  of  an  adeiiuate  sewtMa^o 
system,  and  an  increased  price  of  ordinary  commixlities  over  thvvie  ox 
isting  in  the  Borough  of  ^[anhattan. 

Division  of  IftspcctioHS. 
Toward  the  end  of  September  of  ii)0(>.  a  Oivisiiui  oi   hisptH'tiou^ 
for  the  Borough  of  Queens  was  created  by   the   lUmrtl.  and  all   in 
spectors  at  work  in  this  borough  were  placed  untlcr  its  supervision 


314 

except  those  directly  under  the  direction  of  the  Division  of  Com- 
municable Diseases.  This  was  necessary  for  the  reason  that  all  Medi- 
cal Inspectors  do  sanitary  work  as  well  as  school  work.  These  men 
therefore  act  in  three  capacities,  viz.:  School  inspection  work.  Sani- 
tary work  and  Contagious  Disease  work,  which  answers  well  enough 
at  present;  there  must,  however,  be  a  separation  of  the  work  in  the 
near  future,  as  the  medical  and  contagious  disease  work  increases  with 
the  increase  in  the  population.  The  sanitary  work  is  also  constantly 
increasing,  faster  than  the  increasing  population  for  the  reason  given 
on  the  next  pages,  consequently  absorbing  too  much  time  of  the  Medi- 
cal Inspectors  to  properly  attend  to  their  duties.  The  few  Sanitary 
Inspectors,  not  being  able  to  largely  increase  their  field  of  activity, 
it  seems  clear  that  if  the  Medical  Inspectors  are  expected  to  do  their 
work  properly  and  attentively,  the  sanitary  work  must  be  performed 
by  Sanitary  Inspectors  and  their  number  largely  increased.  The  tech- 
nical work  they  are  called  upon  to  do  requires  that  experienced  laymen 
should  be  assigned  to  do  that  kind  of  work,  having  practical  training 
and  whose  mind  is  not  burdened  with  a  medical  side  to  their  duties. 

During  the  year  1906,  the  total  number  of  inspections  amounted 
^<^  55437  y  this  must  be  considered  as  representing  a  great  deal  of 
work  in  a  borough  which  spreads  over  so  much  territory,  and  which 
is  divided  in  but  12  districts. 

The  sanitary  work  alone  required  36,935  inspections  caused  by 
every  possible  kind  of  complaint,  from  the  barking  of  a  dog  to- the 
drainage  or  filling  in  of  acres  of  swamp  land.  The  most  often  re- 
curring complaints  are  naturally  those  which  deal  with  oflFensive  odors, 
real,  imagined  or  sentimental,  but  they  all  call  for  inspection,  and  if 
sufficient  to  cause  a  nuisance,  require  orders  for  their  abatement. 

A  subject  requiring  a  great  deal  of  attention  is  that  of 

Cesspools  and  Privy  Vaults, 

Streets  are  laid  out  by  private  parties,  such  as  Realty  Companies, 
who  buy  up  tracts  of  land  from  5  to  500  acres  and  by  laying  the  land 
out  in  building  lots,  produce  streets,  sometimes  way  below  or  much 
above  the  grade  which  will  finally  become  the  real  one    when  taken 

'T  by  the  City.    These  companies  oftentimes  provide  for  water  and 


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\p'.Tz*z:Z^  2*  "iitiir.  •    ;^  i*  ::   i  aviri^'z  >  >cr'"'.        "  .N*  ,^'. v*    -.w-, ss^x 


the  E'jrta-  :f  Se-«^£r>.  rr.ier  :h-e  rre>5?':::  iV^xV^^  :^VN^\v«^  h,*»  sk^^^v 
all  in  ii5  pcwcr  :o  increase  :he  r.ur::ScT  v^:  sox^f.s  a>  «uwh  ,'^\  ^s\\x\t\K- 
but  the  great  tcrriton-  to  Nr  cv\>:rcvi  nukes  this  «upu^\\Mi\o\il  ,i  >v\\ 
expensive  job.  and  necessarily  sknv.     Whorevcr  a  nowoi  h,^^  U^s^ii  \sSy^\ 
and  a  water  supply  is  at  luind.  cvMUuviious  rtiv  o»\Umv\I  lo  W  \\\\sU 
by  this  Department.     All  public  wator  supplied  lo  \\w  \\\\u\U\A\\\n  »»* 
this  borough  comes  from  driven  wells  Kvated  \\\   v«ni»»Mii  nmMhUut 
localities  for  rapid  distribution;  there  are  at  pu'?ienl    i/  |»ni»»|»ln|i  »»*•* 
tions  in  existence,  samples  of  water   from  eat  h   •»!    whiih   «o»    \M*%\\ 
each  month  and  a  complete  sanitary  aualynln  in  wumU       \\\*\    ••»»    *» 
ported  usually  of  good   quality.   althotiKli   lli«»»»e   »hiii    lh«    ■Imim"   »•! 


3i8 

6.     Manure  kept  in  a  tight  box  outside  stable,  and  removed  twice 

each  week. 

Dairy  Stables. 

The  Dairy  Interest  in  Queens  is  quite  extensive  and  much  money 
is  invested  in  farms,  stables,  cows  and  feed.  In  1905,  when  the  first 
rules  and  regulations  for  cow  stables  were  formulated  and  became 
known  among  Dairy  Farmers,  they  were  quite  astounded  and  very 
incredulous,  because  it  was  never  known  that  any  one  could  request 
more  than  a  whitewash,  more  or  less  carefully  applied,  and  the  re- 
placing of  a  rotten  plank  or  two  in  the  floor.  All  those  who  had  this 
idea  too  securely  fixed  in  their  mind  are  now  out  of  business,  and  in 
this,  as  in  other  mundane  matters,  it  was  "  the  survival  of  the  fittest," 
the  man  who  could  see  the  need  and  use  of  a  clean  cow  stable  won 
out.    What  has  been  accomplished  can  be  clearly  stated: 

1.  Qean  walls  all  around  the  inside  of  the  stable. 

2.  A  sanitary  base  at  the  foot  of  the  wall  permitting  no  "  dirty 
corners." 

3.  Plenty  of  windows,  plenty  of  light  and  sunshine. 

4.  Ventilation  by  windows  on  the  sides  of  the  stable  and  above 
the  roof  by  extending  same. 

5.  Good  drainage,  good  manure  boxes  and  no  saturation  of  the  sur 
rounding  ground. 

6.  Healthy  cows,  improvement  in  the  milk  supply  and  cleaner 
cows. 


SANITARY  BUREAU, 

Borough  of  Richmond. 

The  Sanitary  Division  in  this  borough  consists  of  five  Sanitary 
Inspectors,  one  detailed  to  each  of  the  five  districts  comprising  the  five 
wards  in  the  Borough  of  Richmond.  Their  duties  consist  of  investi- 
gating citizens'  complaints  and  general  sanitary  work  in  their  respective 
districts.  The  work  in  this  Division  has  somewhat  decreased  in  the 
last  year,  due  to  the  lessening  of  citizens'  complaints,  as  all  houses 
on  the  line  of  public  sewers  have  been  properly  sewer  connected  and 
♦^^-^  nuisances  caused  by  privy  vaults  and  cesspools    abated.     There 


319 

is,  howcTcr,  a  large  area  oo  tibis  isJaad  is  die  X'lDage  of  SontfaBeld, 
which,  from  a  samtanr  poem  of  ricw.  is  in  vcnr  bad  cooditioa.  there 
beii^  no  pablic  sewers,  cansing  comfitioQs  which  necessarily  become  a 
public  miisancc.  This  matter  has  been  taken  op  by  the  Department 
of  Health  and  recommcndatioos  forwarded  to  the  President  of  the  Bor- 
ough, whidi  I  have  been  informed  has  been  the  means  of  the  construc- 
tion of  a  large  sewage  system,  which  \*ill  be  begun  in  the  very  near 
future,  and  will  abate  this  nuisance. 

The  vacant  lots  and  stagnant  pools  whidi  have  been  due  to  the 
contour  of  the  ground  and  the  construction  of  streets,  have  been  largely 
abated  by  permissicm  granted  to  the  Street  Qeaning  I>epartment  to  fill 
in  with  fresh  earth  and  clean  ashes,  thus  abating  a  nuisance  which 
prior  to  their  ha\nng  been  filled  in  were  a  source  of  complaint  and  a 
breeding  place  for  mosquitoes. 

All  the  ponds  and  the  marshes  surrounding  the  borough  have  been 
drained,  the  work  having  been  done  by  Commissioner  Dot}'  under  a 
special  appropriation  by  the  Board. 

The  building  of  bulkheads  along  the  water  front  and  their  filling 
in,  and  the  carrying  out  of  the  sewer  system  to  beyond  low  water 
mark,  has  improved  the  sanitarj-  condition  of  the  entire  water  front. 

Contagious  Diseases — The  number  of  contagious  disease  cases  dur- 
ing the  past  year  exceeded  that  of  the  previous  year,  the  increase  being 
in  the  number  of  cases  of  diphtheria  and  measles.  We  have  had  no 
cases  of  small-pox  in  this  borough,  and  t}'phoid  fever  has  been  decidedly 
on  the  decrease. 

All  cases  of  contagious  diseases  have  been  inspected  by  the  Medical 
Sanitary  Inspectors  of  this  Department,  and  the  household  goods  have 
been  removed  to  the  Disinfecting  Plant  for  sterilization.  This,  how- 
ever, has  also  been  carried  out  in  all  cases  coming  under  the  Division  of 
Communicable  Diseases,  and  in  all  cases  of  typhoid  and  tuberculosis. 

Stables — A  general  inspection  has  been  made  of  all  the  stables  in 
the  Borough  of  Richmond,  and  a  large  number  of  orders  issued,  result- 
ing in  a  very  great  improvement  in  their  condition,  one  feature,  in 
connection  with  their  sanitary  condition,  being  the  prompt  removal 
of  the  manure  daily,  or  providing  a  properly  constructed  manure  pit, 


320 

which  has  been  allowed  in  the  outlying  districts  of  this  borough  for 
the  reason  that  farmers  are  compelled  to  keep  the  manure  for  fertilizer 
for  their  farms. 

Milk  Inspection — ^The  milk  inspection  in  this  borough  has  been 
transferred  to  the  Borough  of  Manhattan,  consequently,  the  supervision 
and  reports  have  been  sent  to  the  Central  Office  direct.  There  is  but 
one  Milk  Inspector  in  this  borough  and  I  am  of  the  opinion  that  to 
keep  a  proper  supervision  over  the  milk  dealers,  there  should  be  at 
least  three. 

Cow  Stables — There  were  in  this  borough  at  the  beginning  of  the 
year  1906,  one  hundred  and  twenty-six  cow  stables  where  milk  was 
produced  and  sold  to  the  public  and  coming  under  the  head  of  dairies. 
The  inspection  of  the  sanitary  conditions  of  these  stables  was  placed 
in  charge  of  Dr.  Nichols,  the  Veterinarian  in  this  Borough,  who  made 
a  very  exhaustive  examination  and  found  that  they  were  by  no  means 
in  proper  sanitary  condition.  Orders  were  issued  compelling  them  to 
bring  their  dairies  up  to  the  standard  of  those  in  other  boroughs  and 
issued  from  the  Department  in  New  York,  requiring  them  to  make 
certain  changes  in  construction  to  conform  to  the  rules  and  regulations 
of  the  Department  of  Health.  This  necessitated  such  extensive  im- 
provements that  a  majority  of  them  were  compelled  to  give  up  their 
business  and  dispose  of  their  cattle.  There  are  a  few  remaining  who 
did  not  comply  with  the  orders  issued,  and  recommendations  were  made 
to  the  Department  that  their  places  be  declared  public  nuisances,  which 
orders  were  served  upon  them.  It  being  impossible  to  remove  cattle 
to  the  Pound  in  this  Borough,  where  premises  are  declared  a  public 
nuisance,  their  permits  to  keep  cattle  and  sell  milk  were  revoked,  and 
criminal  proceedings  brought  against  them,  so  that  I  believe,  at  pres- 
ent, that  all  the  dairies  producing  milk  in  this  borough  are  up  to  the 
standard  required  by  the  rules  of  the  Department. 

Medical  Inspectors — ^There  are  five  Medical  Inspectors  in  the  Bor- 
ough of  Richmond  who  also  do  general  school  work  and  their  medi- 
cal inspections.  Every  school  in  the  Borough  of  Richmond  in  the 
thickly  populated  district  is  inspected  every  day  and  in  the  outlying 
country  district  three  times  a  week. 


321 

I  believe  that  this  systematic  inspection  of  the  schools  has  been  tlie 
means  of  lessening  epidemics  of  contagious  disease  which  have  cropped 
out  in  previous  years. 

More  attention  has  been  paid  to  the  eyes  of  school  children  for  the 
purpose  of  detecting  trachoma  and  preventing  it  spread.  All  children 
thus  infected  have  been  excluded  from  the  schools  unless  under  treat- 
ment privately,  or  at  some  dispensary. 

Systematic  vaccination  in  the  public  schools  has  been  carried  on 
by  the  Medical  Inspectors,  and  there  are  no  children  attending  school 
that  have  not  been  vaccinated. 

School  Nurses — The  District  School  Nurses  appointed  in  this  bor- 
ough have  done  excellent  work,  but  the  territory  is  so  large  that  they 
are  only  able  to  cover  ten  schools,  five  schools  each. 

There  are  thirty-three  schools  in  this  borough.  The  outlying  coun- 
try district  schools  have  received  no  benefit  whatever  from  the  school 
nurse  system.  I  would  recommend  that  at  least  three  additional  nurses 
be  appointed  covering  these  schools,  to  carry  on  this  very  important 
work. 

The  condition  of  the  children  in  the  public  schools  has  very  de- 
cidedly improved  in  the  past  year,  due  to  the  efforts  of  these  nurses, 
in  visiting  their  homes  and  instructing  their  parents  where  it  was  neces- 
sary'. 

Culture  Stations — The  establishment  of  culture  stations  has  been 
of  very  great  service  to  the  physicians,  and  especially  those  living  in 
the  country  districts,  where  they  are  unable  to  get  an  early  diagnosis 
or  obtain  antitoxin  at  short  notice. 

It  is  my  opinion  that  this  office  should  be  kept  oi>en  at  night  for 
the  reception  of  cultures,  distribution  of  antitoxin,  and  ambulance  calls. 

Very  great  demands  have  been  made  for  antitoxin,  and  it  is  taring 
depended  upon  for  immunization  and  treatment  by  physicians  generally. 

Ambulance  Service — The  ambulance  service  has  been  more  prrmii- 
nently  in  demand  this  year  than  in  previous  years,  for  the  reason  that 
the  general  practitioners  are  requesting  that  the  cases  of  scarlet  fever 
and  diphtheria  be  removed  to  the  Reception  Hospital  of  the  S,  R- 
Smith  Infirmary. 


322 

I  would  recommend  that  an  additional  ambulance  driver  be  ap- 
pointed to  be  on  duty  at  the  ambulance  station  during  the  night,  as 
we  receive  numerous  calls  for  the  ambulance  after  four  o'clock,  and 
at  present  we  are  dependent  upon  the  Night  Watchman  to  remove 
the  cases,  and  when  he  leaves  the  plant  there  is  no  one  to  care  for 
the  fires  or  the  boiler. 

Meat  Inspection — The  inspection  of  meat  has  been  carried  on  as  in 
former  years,  especial  attention  being  given  to  carcasses  after  slaughter. 
With  our  present  force,  which  consists  of  one  inspector,  the  inspections 
of  the  shops  are  not  as  frequent  as  they  should  be.  The  inspector 
detailed  as  meat  inspector  is  also  detailed  as  a  fruit  and  food  inspector, 
and  all  other  foods  which  may  be  offered  for  sale  in  markets  or  stores. 

There  has  been  a  large  quantity  of  decayed  fruit  and  vegetables 
destroyed  during  the  past  year,  and  also  an  inspection  kept  over  the  ice 
boxes  and  other  places  where  food  is  stored. 

This  work  has  been  very  satisfactorily  carried  on  by  Inspector  Kerr. 

Orders — There  has  been  a  very  decided  falling  off  in  the  number  of 
cases  brought  for  non-compliance  with  orders  within  the  past  year  and 
we  have  but  very  few  cases  pending  in  Court.  Complance  with  a  very 
large  majority  of  the  orders  has  been  brought  about  by  personal  effort 
on  the  part  of  the  inspector,  the  fact  being  generally  known  that  if 
orders  are  not  complied  with,  they  will  be  prosecuted. 

There  are  no  lodging-houses  in  the  Borough  of  Richmond,  and 
very  few  tenement  houses.  We  have  had  some  trouble  in  tenement 
houses  in  having  orders  complied  with,  where  references  have  been 
made  to  the  Tenement  House  Commission.  This  matter  I  brought 
to  your  attention  some  time  ago,  and  I  believe  since  then  the  matter 
has  been  taken  up  and  the  reference  orders  more  promptly  executed. 

Disinfecting  Plant — ^The  disinfecting  plant  has  been  in  operation 
during  the  entire  year,  with  very  satisfactory  results. 

When  consolidated  with  the  Greater  City  of  New  York,  the  work- 
ing force  was  nearly  twice  as  large  as  at  present.  From  time  to  time 
it  has  been  reduced,  by  resignation  or  death,  until  at  present  we  are 
working  with  a  very  much  reduced  force  and  a  decided  increase  in 
the  demand  made  upon  us. 


aawaL  inrgis.  :aaiiJLii  ■    nsaOiRn^Ts.  jtctacxiwi  *»S&&kv  ^-^v*.   '^•v 


— w*j. 


2?  rr  2.  mri  ^;=-^i-n —    ra;  3;ss  Tn   i-*trv"","^'i 


EASES.  IN .T. ."TIN..  THE  MEiXvAl    INS:  KV 

7::n  o?  sch.x^l  ohuiyrfn. 

Qoecns  and  RSr-TicgsL  curir^  the  \rjir  loco: 

Sckj^l  Xm'^ses — The  v^ar  jusi  linishfvl  has  pr^^x^l  %mh^  v^(  ivwvax^ 
able  interest  ^nd  prc^nt  to  the  schvx^l  ohildnM>,  v'^wixxjj:  tv"^  <^'  \vvxiMvut 
teackir^  :i  cleanliness  by  the  n::r>c>i.     Fhe  nv\<t  j:rAUt>n\^<  tVN\xUx  \HM' 
haps,  is  trx  bright,  intelligent  kv^k  in  the  UvVs  of  uu^uy  xM  tho  ohxl 
dren  who  used  to  look  tirevi  and  oarewonx.      This  is  \Miuo\|\UK   d\u' 
to  the  care  given  to  the  eyes,  and  tlK*  CvnxsiaiU  ort\^ris  \^(  U\o  n\Uxox 
in  obtaining  glasses  for  the  children  with  doCective  si^'^t*  in  n^jnu   \\\ 
stances  paj-ing  for  the  glasses  themselves  ratl\or  llu*\n  stn^  the  ehiUhvn 
go  without.    The  nurses  have  taken  a  munlxT  of  cluUlivu  to  hoNpittdn 
and  dispensaries  for  the  removal  of  adenoids  and  enlar^vd  ton^iU  whou 
the  mother  was  unable  to  do  so.     The  results  are  ronuuk<thlo,     t  hd 
dred  formerly  considered  "  dcfeetives  *'  are  amon^  the  hrlKldoit   i\\\\\ 
most  studious  in  the  class.    The  children  are  more  careful  In  heepln^ 
the  skin  and  hair  clean;  filthy  clothes  are  now  an  tintiHtinl  fi'iUtiie,  iihd 
the  air  in  the  class-rooms  is  decidedly  hetler  owin^  to  the  |ii»«v»illlnM 
cleanliness. 

Visits  to  Homes — The  visits  to  the  homen  and  pareiil**  n|  ilio  ilill 
dren  have  increased,  owing  to  the  more  ri^id  rxamhmllonn  inud««  hv 


3^ 

the  Medical  Inspector.  When  any  defect  of  eyes  or  throat,  such  as  en- 
larged tonsils  or  adenoids,  has  been  recorded,  the  nurses  have  visited 
the  homes  and  urged  the  parents  to  have  the  defects  remedied.  A  large 
percentage  respond  and  have  the  matter  attended  to  at  once. 

Numerous  cases  of  unreported  disease,  such  as  measles,  scarlet  fever, 
diphtheria,  and  tuberculosis,  have  been  found  when  making  the  visits. 
These  were  reported  at  once  and  the  cases  isolated  or  removed  to  hos- 
pitals. Many  other  cases  have  been  reported  to  the  Relief  Agencies 
through  this  office. 

Contagious  Staff — No  change  has  been  made  in  this  staff.  Two 
nurses  cared  for  the  cases  of  scarlet  fever  and  measles  in  the  homes 
of  the  very  poor  when  reported.  Instructions  were  given  as  to  the 
proper  isolation  and  disinfection,  etc,  of  each  patient,  the  nurses  giving 
baths,  making  beds  and  helping  prepare  food  where  assistance  was  re- 
quired. Through  this  instruction,  many  cases  were  reported  to  the  De- 
partment of  Health,  where  formerly  they  were  afraid  to  do  so. 

Suggestions — ^As  the  present  staff  of  53  nurses  is  entirely  inade- 
quate for  the  amount  of  work  required  of  them  in  the  schools  of 
Greater  New  York,  I  would  suggest  that  the  staff  be  increased  to  100 
nurses.  In  Manhattan,  each  nurse  is  required  to  inspect  8,887  chil- 
dren, treat  any  minor  contagious  disease  found  among  them,  assist 
the  doctor  while  treating  trachoma  in  the  school  and  then  ^nsit  as  many 
of  their  homes  as  needs  indicate. 

(There  are  only  2$  school  hours  in  the  week.) 

The  average  number  of  children  inspected  daily  is 546 

The  average  number  of  children  treated  daily  is 109 

The  average  number  of  visits  to  homes  daily  is 5 


The  principals  of  the  schools  are  constantly  requesting  more  of 
the  nurses'  time  and  it  has  been  clearly  proven  that  there  is  less  truancy 
in  the  schools  where  more  time  and  supervision  is  given  by  the  nurses. 


JE~^IZ\    IF 


I-*' ^---  - 


is^ESLL. 


r  -^    ^^n^» 


»t  marc^ 


11  111  "^   ^Kl. 


-■'■ 


-  "  ' '"»"   ^: 


..^ « k. 


r    I     lit  .zST-      3T 


-»- «  i.:!3u 


iKi  .  ■  — . 


i.k^.*. 


Zr-.-ofii-rr    acu    ^t-^teil     il 


::!?!:  n:  ar 


.\ss: 


-cc  2.  s:i 


.  ^.*:r7i:^  *-^  .-  •^.vmcT 


■  «i  ■  ^^  ^ 


^ITr    ^j.^lt- 


"^^rx  i^  iTi*  ^'"'isiii  ETi  ni^r: 


Charge  of  zht  Zirri'nr::  :f  Z.Iiiihirrxr:  r-  :bc  r.vt:^  fsW,w'\  xV\^\i>4xN> 
bv  dac  old  cbe=D=L:  'iibrntrrr,  ihe  rcvxn  xtk-Ji^n!  b>  h^.^^^  V<uv<  uKnM^ 
by  djc  Assistsrt  Crlti  c:  EHvifSor:  and  Ch^.ef  ot  Omvv  \Smuv<  KXVN 
the  offices  mere  ren-rvated,  book  sheSirs  5n2it4l)<\l  a«xI  ai  )M\ hci^I  O^n  n 
are  most  satisfactcn-  in  everv  wa>\ 

Carfare  ar^  TcIt{^konc  Bilh — The  |va\tucm  \^f  iho  \\\H>^\v  a\\\\  <vU 
phone  bills  of  nurses  and  inspectors  was  iruuslVnTil  U^  \\\\^  %^Ouv  \\y\s\\ 
that  of  the  Chief  Gerk,  in  the  early  autunm,  nmtrvl«^llv  \H\  bM>»t»^u  S\w 
clerical  work  of  the  office  ami  placinjj  consiiloiuMo  ynulo^lhil  l\HiM^ttt«l 
responsibility  on  the  Giief  of  Division.  Owin^  \\^  ^'^^\\\\^\t^\^^\n  \\\\\{\H\ 
been  made  that  the  elevated  railroad  tiokol.n  iMwuod  (o  IuIt  n»lh'il»«M 


326 

were  being  sold,  the  purchase  of  such  tickets  was  discontinued,  thus  in- 
creasing the  amount  of  money  which  has  to  be  advanced  personally 
by  the  Chief  of  Division,  each  month,  to  about  $225.  Even  with  the 
greatest  promptness  in  forwarding  bills,  etc.,  the  total  amount  thus  ad- 
vanced is  often  in  the  neighborhood  of  $500.  To  obviate  this,  which  is 
manifestly  unfair,  the  emergency  fund  of  the  Department  in  the  hands 
of  the  Secretary  should  be  increased  about  $500,  said  increase  to  te 
at  the  disposal  of  the  Chief  of  Division  for  advance  payment  of  car- 
fare bills. 

Manhattan  Office — As  stated  above,  the  offices  of  the  Inspector-in- 
Charge  of  the  Borough  of  Manhattan  were  removed  to  the  rooms 
formerly  occupied  by  the  chemical  laboratory  in  the  building  at  Fifty- 
fifth  street  and  Sixth  avenue.  These  rooms  were  ample  in  size,  but 
in  very  bad  condition.  It  being  impossible  to  have  the  needed  renova- 
tion performed  by  contract,  the  work  was  done  satisfactorily  by  em- 
ployees of  the  Division,  to  whom  thanks  are  due.  For  further  par- 
ticulars regarding  the  work  of  the  office,  reference  may  be  had  to  the 
attached  report  of  the  Inspector-in-Charge. 

Broolilyn  Office — Because  of  the  injunction  obtained  by  persons  re- 
siding in  the  neighborhood  of  75  Henry  street,  the  offices  of  the  Di- 
vision were  removed  on  October  i,  1906,  to  361  Jay  street,  a  much 
smaller  building,  but  amply  sufficient  for  the  needs  of  the  Division. 
For  information  regarding  the  Brooklyn  Clinic,  see  report  of  the 
Chief  of  Clinics. 

Bronx  Office — The  Bronx  Office  of  the  Division  was  removed,  along 
with  the  other  offices  of  the  Department  of  Health  in  that  borough,  to 
a  new  building  at  3731  Third  avenue.  A  large,  light  room  was  assigned 
to  the  Division  where  the  work  has  been  carried  out  very  satisfactorily. 
For  report  of  the  Bronx  Clinic,  see  report  of  the  Chief  of  Clinics. 

Queens  Office — During  1906,  owing  to  the  small  number  of  em- 
ployees assigned  to  this  branch  of  the  Division,  the  office  was  main- 
tained at  the  Manhattan  Headquarters.  Arrangements  have,  however, 
been  made  for  opening  an  office  in  Jamaica  in  the  same  building  with 
the  general  offices  of  the  Department.  This  will  be  done  about  Febru- 
ary I,  1907,  when  the  Inspector-in-Charge  will  take  up  his  residence 


iir  -fie  lygiAU^   it  aai   :r  "Tt  Zi-r'^uxn    ix  TTie  Irr^nrv     Sonm  n^i^- 

t  t:  -HK  ariKinirmsc  -.x  s&sra  gTCTHimj: 
r  ir  nrwrt  tsssc  Thssr  luwincmicic^  i^^ 

Tnaa  am  i  Tiiiiicriniiiir  cax  r^oxr  n  »r  rrlar  ic  :dir 

Imr   an:  r  ^  itro?!.  :i:  Tierir  arr**^  ranL^'-iufec  ^»,T:i 

y-r¥  ani  iiiiii:  .u'tl  nssin^  anL  TTtrorf  cir-ffi^  isn't  "i^ct  ikj^mo. 

i5e-i  i:r  is«  ir  il  :3if  n«iemii.'«s  nsrtTnnmg^  rf 

Lesions-  The  cro.^rTg:  cf  ihe  CiT>  r=ro  c:;5Cr3Cts^  «ich  oox^rwJ  bv  a  jur- 
ifculir  mbcrczjoss  ci5«stsary,  hi>  mv^fffcevi  twt  w^3  axKl  h  k  prv- 
posed  to  extead  the  sv^tem  dining:  1007,  ww  dispcnsims  <tl^rnl^ 
into  the  arrangen^CEt.  Anenbcsn  is  e?peciaEy  ca!M  tt>  that  paurt  of 
the  report  of  Ae  Chief  of  Clinks  deaJxi^  with  this  natter.  SiMi>r  ja> 
nx)re  new  patients  were  treated  in  the  Manhattan  Clinic  during  igot^ 
than  during  1905 :  and  1.800  more  visits  were  paid  to  the  Oini\\  The 
distribution  of  milk  and  eggs  in  suitable  cases  was  furtlier  safe$[nar\)evl 
by  the  assistance  of  \-isitors  of  the  Charity  Organixation  SiX'^ietv  and  of 
the  Brookh-n  Bureau  of  Charities,  It  is  nmwreil  that  this  dintribtition 
is  to  be  discontinued  during  uyoj  owing  to  lack  of  funds.  It  is  a  nu\*t 
valuable  part  of  the  work  of  the  clinic  aiul  it  is  ht>pe\l  thttt  nrKtHi^o 
ments  will  be  made  for  its  contintmnce, 

Riverside  S'awa/oriMWi— During  H)Of>  the  Ctt|>«olty  t^f  Klvcrnlilo  S«im 
torium  was  increased  by  forty-six  bctU.     It  now  ttocomniotlrtt0«  oiii» 


328 


«i>ijiiiii'i:i 


hundred  and  sixteen  patients.  There  being  practically  no 
tions  for  tuberculosis  patients  in  the  Borough  of  Brooklyn,  twenty  beds 
have  been  assigned  to  that  borough.  The  sanatorium  is  full  practically 
all  the  time,  and  there  is  a  long  waiting  list.  A  number  of  favor- 
able cases  were  transferred  to  Otisville  during  the  year. 

Stereopticon  Tuberculosis  Exhibition — ^These  exhibitions  were  a 
great  success,  every  one  being  attended  by  a  large  number  of  people, 
and,  undoubtedly,  a  great  deal  of  good  was  done  by  them.  In  order  to 
save  expense,  a  complete  outfit  consisting  of  lantern,  lenses,  oxy- 
hydrogen  apparatus,  etc.,  has  been  purchased,  and  it  is  proposed  to 
give  similar  exhibitions  in  various  halls  throughout  the  City  during 
the  winter.  The  outdoor  exhibitions  will  be  resumed  in  the  smnmer 
of  1907.    Moving  pictures  and  dissolving  views  will  also  be  given. 

Diagnosis  Laboratory — Great  improvements  have  been  made  in  the 
Diagnosis  Laboratory.  Two  rooms  have  been  added  and  the  entire  lab- 
oratory renovated  throughout;  the  walls  and  woodwork  painted;  new 
linoleum  laid  on  the  floor;  new  wall  tables,  gas  and  water  supply  in- 
stalled. For  particulars,  see  report  of  the  Acting  Assistant  Director. 
Almost  10,000  more  diphtheria  cultures  were  examined  during  1906 
than  during  1905,  the  increase  being  almost  entirely  in  cultures  from 
other  boroughs  than  Manhattan.  This  is  very  gratifying,  showing  that 
physicians  in  the  outlying  boroughs  are  utilizing  the  services  of  the  lab- 
oratory. 3,000  more  specimens  of  sputum  were  examined — ^the  total 
being  over  21,000 — an  increase  of  over  20,000  in  ten  years.  Almost 
one-third  of  these  showed  tubercle  bacilli.  The  number  of  specimens 
examined  for  the  Widal  and  Diazo  reactions  and  for  the  presence  of 
malarial  organisms  was  slightly  increased  over  1905.  8,000  more 
preparations  were  made  in  the  laboratory  and  11,000  more  culture  tubes 
than  in  1905. 

Culture  Stations — The  culture  station  service  throughout  Greater 
New  York  during  1906  has  been  satisfactory  in  all  respects.  An  im- 
proved tin  box  for  supplies  has  been  devised  and  distributed  to  one 
hundred  and  fifty  sub-stations,  and  all  the  regular  stations  in  Brooklyn 
were  supplied  with  large  steel  cabinets.  Very  few  complaints  have  been 
received  from  physicians. 


y^ 


Supervision  of  Com>iuxic\bls  Diseases. 

I,  Tuberculosis — For  the  first  time  the  Department  of  Health  can 
bring  forward  proof  of  improvement  in  the  tuberculosis  situation  in 
the  Borough  of  Manhattan.  Almost  2,000  fewer  new  cases  of  the  dis- 
ease were  reported  during  1906  than  during  1905,  although  additional 
precautions  were  taken  to  insure  as  complete  registration  as  possible. 
It  would  seem  as  if  the  continued  efforts  of  the  Department  of  Health 
along  this  line  are  at  last  beginning  to  bear  fruit.  I^te  in  the  year 
the  following  important  changes  were  made  in  the  system  of  registra- 
tion and  investigating  cases  of  tuberculosis. 

(a)  The  postal  card  notification  by  institutions  was  discontinued. 
Information  as  to  all  admissions,  discharges  and  deaths  is  now  obtained 
by  telephone  daily,  three  times  a  week,  or  weekly. 

(b)  All  such  primary  reports,  including  postal  card  reports  from 
physicians,  are  filed  according  to  the  source  of  report,  thus  doing  away 
with  the  necessity  of  keeping  an  institution  book  and  a  separate  phy- 
sicians' index. 

(c)  All  cases  are  assigned  to  inspectors  and  nurses  by  telephone, 
the  original  blue  record  card  being  kept  in  the  office  and  not  sent  out 
to  the  inspectors. 

(d)  Inspectors  and  nurses  arc  supplied  with  special  notebooks  in 
which  all  data  are  entered.    Samples  of  these  arc  given  herewith. 

(e)  The  reports  of  all  inspections  and  investigations  during  the 
preceding  twenty-four  hours  are  obtained  from  the  inspect^irs  and 
nurses  by  telephone  daily. 

The  above  system  has  been  introduced  in  all  boroughs  and  lias 
proved  most  satisfactory.  There  is  a  great  saving  of  time — fumiga- 
tions being  done  four  or  five  days  earlier  than  previously — less  clerical 
work  is  called  for,  and  the  system  of  indexes  simplified.  During  u/ij 
it  is  proposed  to  begin  perioflic  disinfection  of  the  ck/tliing,  etc,,  of 
tuberculosis  cases  at  their  homes.  With  the  txccpiUm  of  Manhattan, 
the  number  of  new  cases  of  tuberculosis  repf^rtcd  in  all  txifotigh*  wa« 
increased.     Information  was  obtained  from  the  attending  physician  \u 


330 

every  private  case  of  tuberculosis  on  file  in  Greater  Xew  York,  August 
I.  1906.     Results  are  given  in  the  f:>llom-ing  table: 

Tabulated  Results  in  the  Five  Boroughs  of  Letters  Sent  Out  to  Private 
Physicians  Regarding  Tubercular  Patients  under  their  Observation: 


e 


I 

5 


Letters  Kot  OQt S-rj* 

Repfies  reorired 4-u6 

Failed  to  reply i«445 

Rcftnued,  Dn.  N.  F 16s 

Cues  recovered ^6 

Cases  isDproved. 231 

Cascsdied «35 

Caseswone J9 

Nochanfe S* 

Out  of  town 444 

Oat  of  borough 39 

f 

Under  obsenration  (in  file  .;  2/»i 

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Typhoid  Fez'^— Almost  33  per  cent  fewer  cases  were  reported 
during  1906  than  during  1905,  the  great  decrease  taking  place  in  Brook- 
h-n  (700).  The  number  of  deaths,  however,  remained  about  the  same, 
the  case  fatality  being  18  per  cent,  as  compared  with  15  per  cent,  in 
1905.  There  was  another  slight  outbreak  of  the  disease  in  the  Bor- 
ough of  The  Bronx  in  the  same  area  in  which  an  outbreak  occurred 
in  1905.  New  folding  cards  have  been  devised  to  take  the  place  of 
the  old  large  history  cards.  The  data  obuincd  from  the  histories  of 
all  cases  of  typhoid  fever  reported  have  been  tabulated  and  are  attached 
to  this  report. 

CerebrO'Spinal  Meningitis-— Le%s  than  one-half  as  many  cases  of 
this  disease  occurred  during  1906  as  compared  with  1905— the  death 
rate  being  reduced  from  5.03  to  1.94.  The  case  fatality  was  slightly 
increased,  however.  All  data  obtained  from  the  histories  of  all  cases 
of  cerebro-spinal  meningitis  reported,  have  been  tabulated  and  are  at- 
tached to  this  report. 

Pneumonia — ^The  number  of  deaths  and  the  death  rate  of  this  dis- 
ease were  about  the  same  as  during  1905. 

Malarial  Fever — As  shown  in  a  special  report  by  Dr.  Victor  Ncescn, 
M.  D.,  concerning  the  deaths  supposed  to  be  due  to  malarial  fever, 
it  seems  probable  that  a  large  proportion  of  such  deaths  are  in  reality 
due  to  typhoid  fever  or  other  causes. 

Administration    of    Diphtheria    Antitoxin — Diphtheria    was    more 
prevalent  and  more  fatal  in  New  York  during  1906  than  during  1905. 
About  1,000  more  cases  occurred  (mostly  in  the  Bronx,  Ikooklyn  and 
Queens)   and  430  more  deaths.     The  death  rate  was  increased  from 
3.6  in  1905  to  4.5  in  1906,  and  the  case  fatality  from  10.7  per  cent, 
to  12.8  per  cent.    The  lowest  death  rate  and  case  fatality  occurred  in 
the  Bronx,  being  respectively  2.9  and  7.9  per  cent.    The  work  of  the 
inspectors  of  the  Department  shows  the  same  good  results  as  hereto- 
fore, the  case  fatality  in  their  cases  being  only  6.9  per  cent.,  including 
the  moribund  cases.     A  great  majority  of  the  fatal  cases  were  those 
in  which  the  inspectors  were  called  in  on  or  after  the  third  day  of  the 
disease.     The  majority  of  the  patients  received  from  5,000  to  io,oofj 
units  of  antitoxin.    Of  the  8,000  persons  immunized  against  diphtheria. 


336 

only  bvo-tenths  of  one  per  cent  developed  the  disease.    See  the  tabula- 
tions of  results  attached  to  this  report 

PUBUCATIONS. 

During  the  year  the  following  books  and  pamphlets  were  prepared 
and  issued: 

1.  "  Report  of  the  Clinic  for  the  Treatment  of  Communicable  Pul- 
monary Diseases."  This  was  a  bound  volume,  fully  illustrated,  and 
met  with  general  approval. 

2.  "  Handbook  of  the  Routine  Procedure  and  Regulations  of  the 
Division  of  Communicable  Diseases"  (Form  No.  202L).  This  was 
prepared  for  the  use  of  the  inspectors  and  nurses,  and  leather  bound, 
interleaved  copies  were  supplied  to  each  employee.  It  gives  a  full 
description  of  the  work  of  the  Division  and  has  been  widely  distributed 
to  physicians  and  laymen. 

3.  Pocket  handbook  giving  list  of  culture  stations,  list  of  services 
rendered  physicians  by  the  Department  of  Health,  etc.  (Form  No. 
206L). 

4.  Handbills  calling  the  attention  to  the  danger  of  dry  dusting 
and  sweeping;  printed  in  English,  German  and  Yiddish  (Form  Nos. 
176L  and  200L).     (Sample  herewith  given.) 

In  addition,  almost  all  the  circulars  and  blanks  of  the  Division  have 
been  revised  and  added  to. 

This  opportunity  must  be  taken  to  commend  the  work  of  Dr.  Victor 
Neesen,  Inspector-in-Charge  of  the  Borough  of  Queens,  who  rendered 
most  valuable  assistance  in  the  preparation  of  the  above-mentioned  pub- 
lications and  who  had  entire  charge  of  the  statistical  tabulations  of  the 
Divisicm. 


337 

DEPARTMENT  OF  HEALTH 

THE  CITY  OF  NEW   YORK 


DIVISION  OF  COMMUNICABLE  DISEASES 


SWEEPING   AND   DUSTING 

In  sweeping  a  room  raise  as  little  dust  as  possible,  because  dust,  when 
breathed,  irritates  the  nose  and  throat  and  may  set  up  catarrh.  Some  of  the 
dust  breathed  reaches  the  lungs,  making  portions  of  them  black  and  hard  and 
useless. 

If  the  dust  breathed  contains  the  germs  of  consumption — tubercle  bacilli — 
which  come  from  consumptives  spitting  on  the  floors,  the  risk  is  run  of  getting 
consumption.  If  consumptives  use  proper  spit  cups  and  are  careful  in  coughing 
or  sneezing  to  hold  a  handkerchief  over  the  nose  and  mouth  so  as  not  to  scatter 
spittle  about  in  the  air,  the  risk  to  others  of  getting  the  disease  by  living  in  the 
same  rooms  with  the  consumptives  is  mostly  removed. 

To  prevent  making  a  great  dust  in  sweeping,  use  moist  sawdust  on  bare 
floors.  When  the  room  is  carpeted,  moisten  a  newspaper  and  tear  it  into  small 
scraps  and  scatter  these  over  the  carpet.  In  sweeping,  brush  these  scraps  of 
paper  along  with  the  broom  and  they  will  catch  most  of  the  dust  and  hold  it  fast, 
just  as  the  sawdust  does  on  bare  floors.  Do  not  have  either  the  paper  or  the 
sawdust  dripping  wet,  only  moist. 

In  dusting  a  room,  do  not  use  a  feather  duster,  because  this  does  not  remove 
the  dust  from  the  room,  but  only  brushes  it  into  the  air.  Walking  on  floors  does 
this  also  unless  the  floors  are  clean. 

Use  soft,  dry  cloths  to  dust  with  and  shake  them  frequently  out  of  the  win- 
dow; or  use  slightly  moistened  cloths  and  rinse  them  out  in  water  when  finished. 
In  this  way  the  dust  can  be  gotten  out  of  the  room. 

In  rooms  which  have  bare  floors,  in  houses,  stores,  shops,  school-rooms,  etc., 
all  dust  can  be  easily  removed  after  it  has  settled,  by  passing  over  the  floor  a  mop, 
which  has  been  wrung  out  so  as  to  be  only  moist,  not  dripping  wet. 

Thomas  Daelington,  M.  D., 

President,  Board  of  Health. 
Hermann  M.  Biggs,  M.  D., 

Medical  Officer, 


338 


It  is  rccofnmen'kd : 

1.  That  tubtrailoils  cl:nscs  be  established  in  the  boroogfas  of 
Queens  and  Richn:ond- 

2.  That  the  diagnosis  laboratory  be  enlarged  as  described  in  the 
report  of  the  Acting  Assistant  Director. 

3«  That  the  necessarv'  steps  be  taken  for  the  early  appcKntment  of 
thirty  attending  physicians  for  the  tuberculosis  clinics. 

4.  That  the  distribution  of  milk  and  e^s  in  suitable  cases  of  pul- 
monary tuberculosis  be  continue^l. 

Borough  of  Manhattan. 
Report  of  Inspector-in-charge. 

Office — During  the  first  week  of  March  the  borough  offices  of  the 
Division  at  Fifty-fifth  street  and  Sixth  avenue  were  removed  from  the 
second  to  the  fourth  mezzanine  floor  (the  old  Chemical  Laboratory). 
The  old  quarters  wene  very  small,  badly  ventilated  and  entirely  laddng 
in  facilities  for  the  proper  performance  of  the  steadily  increasing  work. 
The  new  quarters  afford  ample  room  and  ever>'  convenience.  The  con- 
sist of  (a)  one  large  general  room  where  each  wedc  the  inspectors  and 
nurses  assemble  to  receive  new  instructions  and  to  complete  the  record 
of  their  work  for  the  past  week ;  (b)  a  separate  room  for  all  clerical 
work  in  connection  with  tuberculosis,  files,  indexes,  etc.;  (c)  a  room 
for  all  clerical  work  in  connection  with  the  reports  and  records  of  bac- 
teriological examinations  in  the  Diagnosis  Laboratory  for  diphtheria, 
sputum,  typhoid  fever,  etc. ;  (d)  office  of  Inspectors  in  charge  of  the 
boroughs  of  Manhattan  and  Queens;  (e)  office  of  inspector-in-charge 
culture  stations  and  telephone  operator;  (f)  a  large  storeroom  for  all 
stationery  and  circulars  of  the  Division,  which  are  arranged  in  nu- 
merical order  according  to  the  form  number  of  the  blank,  thus  min- 
imizing the  work  of  taking  stock. 

When  first  occupied  the  new  quarters  were  in  a  deplorable  state,  the 
walls,  woodwork,  etc.,  being  sadly  in  need  of  renovation.  Such  reno- 
vation has  since  been  done  and  the  floors  of  the  rooms  covered  with 
linoleum  so  that  the  offices  are  very  presentable  and  entirely  satisfactory. 


A  plan  of  the  oflSces,  and  photopiiphs  of  the  various  rooms  arel 
given  herewith. 


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P FLOOR  PLAN  OF  THE  MANHATTAN  OFFICKS  OF  THE  l>IV 
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346 


Map  of  the  Borough  of  Manhattan 

Illustrating  the  different  districts  assigned  to  the  Medical  Inspectors, 
Xurses  and  tuberculosis  dispensaries. 

Red  lines,  Inspectors'  district:  blue,  Xurses'  district:  green,  dis- 
pensaries. 

MORTH 


SOUTH 


347 

A  stenographer  has  been  added  to  the  office  force,  replacing  two 
former  clerks,  one  resigning  and  the  other  being  transferred  to  the 
Borough  of  The  Bronx. 

The  work  of  the  crfiicc  having  greatly  increased  it  was  found  neces- 
sary during  the  latter  part  of  the  year  to  detail  a  medical  inspector  and 
a  nurse  to  assist  in  the  routine  work.  Numerous  minor  changes  and 
nnprovements  have  been  made  in  the  methods  of  handling  the  various 
communicable  diseases,  all  of  which  will  be  described  later  under  their 
respective  headings;  as  a  whole  the  work  has  been  carried  out  along 
about  the  same  lines  as  heretofore. 

The  chart  on  page  345  shows  the  weekly  number  of  new  cases  of 
and  deaths  from  communicable  diseases  in  the  Borough  of  Manhattan 
during  1906. 

Inspectors, 

District  i.     Battery  to  Canal,  Rutgers,  east  of  Broadway. 

District  2.    Canal,  Rutgers,  east  of  Broadway  to  Broome  street. 

District  3.     Broome,  east  of  Broadway  to  Stanton  and  Prince. 

District  4.  East  of  Broadway,  Stanton,  Prince  to  Eighth  street, 
St.  Mark's  place — Astor  place. 

District  5.     East  of  Broadway  from  St.  Mark's  place — Astor  place. 

District  6.     East  of  Fifth  avenue,  Thirtieth  to  Seventy-ninth  streets. 

District  7.  East  of  I^^ifth  avenue.  Seventy-ninth  to  One  Hundred 
and  Third  streets. 

District  8.  East  of  Fifth  avenue,  One  Hundred  and  Third  to  One 
Hundred  and  Twenty-fifth  streets. 

District  9.  North  of  One  Hundred  and  Tenth  street  to  Harlem 
river,  west  of  Fifth  avenue  to  One  Hundred  and  Twenty-fifth  street, 
north  of  One  Hundred  and  Twenty-fifth  street  to  river. 

District  10.  North  of  Forty-fifth  street,  west  of  Fifth  avenue  to 
river. 

District  11.  Fourteenth  street,  north  to  Forty-fifth  street,  west  of 
Fifth  avenue  to  river. 

District  12.     Battery,  west  of  Broadway  to  Fourteenth  street. 


348 

Nurses, 

District  i.     Battery,  Grand,  east  of  Broadway. 

District  2.     Grand  street  to  Prince,  Stanton,  east  of  Broadway. 

District  3.  Prince,  Stanton,  east  of  Broadway  to  Thirty-eighth 
street. 

District  4.  Thirty-eighth  street,  east  of  Fifth  avenue,  to  Ninety- 
sixth  street. 

District  5.     Ninety-sixth  street,  east  of  Fifth  avenue,  to  Harlem 

river,  also  One  Hundred  and  Tenth,  west  of  Fifth  avenue,  to  river. 

District  6.  Thirty-seventh  street  to  One  Hundred  and  Tenth  street, 
west  of  Broadway. 

District  7.     Battery  to  Thirty-seventh  street,  west  of  Broadway. 

Dispensaries. 

District  i.  Department  of  Health  Qinic — All  of  the  west  side  and 
The  Bronx. 

District  2.  Gouverneur — From  Brooklyn  Bridge,  east  of  the 
Bowery,  to  Grand  street  and  East  river. 

District  3.  Bellevue — Grand  street,  Bowery,  Fourth  avenue,  Broad- 
way and  Fifth  avenue  to  Fifty-ninth  street  and  East  river. 

District  4.  Presbyterian — Fifty-ninth  street  and  Fifth  avenue  to 
Ninety-sixth  street  and  the  East  river. 

District  5.  Harlem — Ninety-sixth  street  and  Fifth  avenue  to  Har- 
lem river  and  East  river. 

In  order  to  facilitate  the  assignment  of  the  work  to  the  inspectors 
and  nurses  the  above  chart  of  the  City  is  kept  with  the  various  districts, 
outlined  by  means  of  different  colored  worsted  held  in  place  by  small 
tacks.  The  red  lines  indicate  the  inspectors'  districts,  blue  the  nurses' 
and  yellow  those  of  the  tuberculosis  dispensaries.  As  the  districts  are 
often  changed  during  the  year,  according  to  the  amount  of  work  in 
them,  it  frequently  becomes  necessary  to  change  the  boundary  line  of 
the  inspectors  and  nurses  in  order  to  equalize  the  work.  Naturally  thiS 
can  be  done  very  easily  by  simply  moving  the  tacks  and  thus  avoid 
'naving  to  buy  a  new  map  each  time. 


349 

Inspectors — The  total  number  of  inspectors  has  remained  the  same 
although  two  new  inspectors  were  assigned  to  the  Division  during  the 
year,  one  to  fill  a  vacancy  caused  by  death  and  the  other  being  assigned 
to  the  Qinic. 

The  work  of  the  inspectors  has  been  very  satisfactory,  27,566  in- 
spections having  been  made  by  them  for  the  past  year.  Since  the  new 
procedure  of  assigning  all  work  and  receiving  all  reports  by  telephone 
went  into  eflfect  the  work  given  out  each  day  is  completed  within  twenty- 
four  hours.  Complaints  receive  prompt  attention  and  inspection  and 
fumigations  are  done  without  delay  or  loss  of  cards,  etc.,  in  the  mail. 
One  unsatisfactory  feature  of  the  new  system  is  that  in  the  inspection 
of  dead  cases  the  inspector  occasionally  calls  so  promptly  that  he  finds 
the  funeral  in  progress  or  a  wake  being  held,  he  not  only  disturbing  the 
family  but  being  compelled  to  revisit  the  premises. 

Nurses — The  assignment  of  work  to  the  nurses  is  done  by  telephone, 
just  as  in  the  case  of  the  inspectors.  The  advantages  are  many — (a) 
early  instruction  of  the  patient  and  his  family  and  prompt  distribution 
of  circulars  of  instruction  regarding  prophylaxis;  (b)  if  patient  should 
be  kept  under  observation  or  is  in  need  of  assistance  the  necessary  action 
can  be  taken  earlier:  (c)  information  is  obtained  as  to  the  failure  of  the 
patient  to  return  to  the  address  given  after  leaving  the  hospital ;  this 
information  is  important  for  the  proper  record  of  the  case  in  the  office 
and  to  prevent  the  exposure  of  others  not  properly  informed  as  to  the 
nature  of  the  disease. 

The  force  of  nurses  has  remained  the  same  throughout  the  year,  two 
having  resigned  and  two  having  been  appointed  in  their  stead.  The 
total  number  of  their  inspections  amounted  to  26,801,  nearly  the  same 
as  last  year,  notwithstanding  the  fact  they  had  a  less  number  of  cases 
to  keep  under  their  observation  as  the  various  tuberculosis  clinics,  in- 
ciudmg  that  of  the  Department  of  Health,  sent  out  their  own  nurses 
to  care  for  those  cases  they  had  under  treatment. 

The  following  table  shows  the  number  of  visits  made  by  nurses  to 
cases  of  tuberculosis  under  their  observation : 


3SO 


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351 

The  figures  show  that  the  greater  number  of  cases  needing  a  nurse's 
care  reside  in  the  lower  west  side  of  the  City,  probably  because  there  is 
no  large  hospital  or  tuberculosis  dispensary  in  that  section. 

Dispensaries — As  previously  stated,  four  tuberculosis  dispensaries 
(including  that  of  the  Health  Department)  have  agreed  to  district  the 
City  between  them.     See  map,  page  433. 

When  a  nurse  finds  a  case  of  tuberculosis  in  need  of  medical  care 
she  refers  the  patient  to  the  dispensary  in  the  district  in  which  the 
patient  resides. 

The  following  table  shows  the  number  of  cases  under  observation 
at  the  five  tuberculosis  dispensaries  on  a  given  date  in  March  and 
August,  1906: 


352 


11 

3-' 

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353 

Tuberculosis — The  number  of  new  cases  of  tuberculosis  reported 
during  1906  was  12,693,  ^  decrease  of  1,388  cases  from  1905,  showing 
that  the  Department  has  made  considerable  progress  in  checking  the 
disease.  This  decrease  is  evidently  not  due  to  the  fact  that  hospitals, 
institutions,  physicians,  etc.,  have  not  complied  with  the  regulations  of 
the  Department;  on  the  contrary,  the  hospital  census  shows  a  marked 
improvement  in  the  result  obtained  at  each  census.  It  is  probably  due 
in  large  part  to  the  persistent  and  efficient  work  along  various  lines  of 
the  Department  in  enlightening  the  public  at  large  of  the  dangers  of 
the  disease  and  how  to  employ  proper  prophylaxis. 

Of  the  12,693  cases  reported  the  majority  (6,975)  were  in  institu- 
tions; 2,713  were  reported  by  sputum,  1,626  by  private  physicians,  157 
from  other  sources;  1,222  cases  were  reported  by  death  certificates. 
These  last  comprised  (a)  cases  not  under  the  care  of  a  physician  at  the 
time  of  death ;  (b)  where  the  physician  signing  certificate  had  only  been 
in  attendance  for  two  or  three  days  prior  to  death ;  (c)  institution  cases 
dying  within  a  few  hours  or  days  after  admission,  and  (d)  cases  which 
the  physicians  failed  to  report  during  life;  these  were  ver>'  few,  and 
.satisfactory  explanations  have  been  obtained  in  most  instances. 


354  . 


The  following  table  shows  the  localization  according  to  wards  of 

the  new  cases  reported  during  each  month  for  the  y^ars   1904,  1905 

and  1906: 

Tuberculosis  Ward  List,  Borough  of  Manhattan, 

1904,  1905  and  1906. 


Ward  Number. 


One 

Two 

Three 

Four 

Fire 

Six 

Seven 

Eight 

Nine 

Ten 

Eleren  ..... 

Twelve 

Thirteen.... 
Fourteen . . . 

Fifteen 

Siicteen 

Seventeen. . 
Eighteen... 
Nineteen... 
Twenty .... 
Twenty-one 
Twenty-two 


January. 


1904 


la 

•  • 

4 
24 

7 

19 
51 
4X 
44 
S3 
37 
191 
21 
12 

17 
30 
56 

Sa 

126 

77 
64 
94 

1,032 


1905 


12 

2 

6 

20 

14 
8 

4a 

28 

62 

46 

187 
16 

5 

8 
50 
59 
50 

49 

21 

87 


IQ06 


932 


12 

•  • 

I 

38 

9 
18 

78 
19 
57 
38 
30 
180 

13 
17 
23 

40 
81 

49 
120 

51 

33 

113 


1,020 


February. 


1904 


17 
I 

2 

19 
II 

18 
47 
25 
41 
43 

V 
181 
18 
II 
16 

24 

66 

Sa 

113 
61 
SO 
90 


932 


1905 


17 
I 

4 

19 
8 
10 
72 
30 
40 
74 
89 
183 

6 

12 

36 

4S 
43 

107 

33 
26 

7S 


IQ06 


89a 


12 

•  ■ 

4 

43 
10 

14 
67 
20 

38 

43 

24 

215 

14 
10 

13 
27 

62 

42 

"4 

39 

20 

94 


March. 


1904 


924 


18 

2 
8 

3a 
9 

19 
68 
21 

44 
80 

55 


39 
*) 

20 

34 
89 
59 
142 
72 

5a 

122 

1,216 


1905 

15 

16 
21 

Sa 

«) 

44 

132 

S4 
S4 

97 

65 
192 

34 
as 

35 
44 
76 
40 
144 
47 
28 

138 


1906 


12 

•  • 

4 
60 

15 
16 

138 
a7 
43 
63 
34 

288 

as 

22 

18 

4a 

120 

74 

174 

70 

50 
156 


April. 


1904  1905 


1,38a 


17 
2 
2 
ai) 
13 
3a 
67 

20 
4a 

74 

39 
219 

38 
41 
27 

36 
120 

57 
161 

79 
45 


I 


MSI  j  i.t85 


17 
20 

17 
26 

20 

30 

'34 

Sa 

4a 

48 
62 

a35 

IS 
18 

a9 
39 
60 
81 
152 

54 

66 

125 


1906 

10 

2 
2 

44 
6 

10 

85 
29 

37 
36 

as 

216 

12 

14 

9 

26 

80 
3a 

133 
65 
36 

"9 


1,342  i  1,028 


355 


Tuberculosis  Ward  List,  Borough  of  Manhattan. 
1904,  1905  and  1906. 


Ward  Number. 


1904 


One 21 

Two I 

Three a 

Four 18 

Five 10 

Six 27 

Seven 59 

Eight 32 

Nine j  38 

Ten I  39 

Eleven 33 

Twelve 204 

Thirteen 36 

Fourteen 26 

Fifteen 25 

Sixteen 39 

Seventeen S8 

Eighteen 58 

Nineteen 157 

Twenty 83 

Twenty-one ,  53 

j 

Twenty-two j  103 


May. 

1906 

1 

June. 

1905 

1904 

1905 

9 

6 

16 

12 

5 

4 

I 

16 

28 

4 

I 

19 

II 

14 

9 

93 

19 

5 

10 

II 

14 

15 

16 

19 

164 

56 

69 

138 

47 

23 

28 

37 

44 

51 

48 

26 

S3 

36 

40 

38 

28 

«3 

3S 

26 

184 

206 

186 

163 

10 

23 

15 

17 

10 

20 

14 

II 

39 

17 

16 

23 

as 

3a 

24 

31 

65 

68 

94 

74 

62 

49 

51 

58 

I4« 

125 

129 

131 

15 

S9 

94 

33 

69 

39 

45 

67 

76 

121 

158 

127 

1,125 

«)6 

1,099 

1,100 

1906 

6 
3 
4 
18 
10 
28 
82 

19 
64 
61 

34 
a63 

23 

20 

5 

38 
92 
55 

154 

58 

52 
138 

1,217 


July. 


1904 


15 

so 
22 

25 

33 

a8 

159 
33 
31 
34 
30 

195 
II 

17 
27 
28 
66 

37 

140 

18 

97 
160 

1,226 


1905 


1906 


10 

10 

18 

65 

7 

53 
6a 

47 
201 
21 
17 
17 
45 
97 

51 

140 
86 
60 

131 
1,148 


8 

2 
2 
8 
10 
9 

55 

28 

55 

33 
51 

210 

23 
16 
12 
26 

67 

38 

95 
56 

37 
112 

953 


August. 


1904 


2 
2 

23 

8 

21 

50 
II 

52 
42 

25 

197 
21 

17 
18 

«3 

62 

50 
no 

67 
42 

134 

997 


1905  i  1906 


I 


10 
12 

13 
36 
21 
18 
125 

41 
37 
48 
36 

2S8 

29 
10 

38 
32 
89 
49 
132 

24 

66 

107 


7 

4 

3 
18 

16 
20 
69 
33 
47 
60 

38 
230 

34 
22 

18 

44 
80 

57 

134 

67 

49 

132 


i,soi  I  1,182 


354 


The  following  table  shows  the  localization  according  to  wards  of 

tlie  new  cases  reported  during  each  month  for  the  \-ears   1904,   1905 

and  1906: 

Tuberculosis  Ward  List,  Borough  of  Manhattan. 

1904,  1905  and  1906. 


January. 


Ward  Number. 


One... 
Two.., 
Three. 
Four. 
Flye... 
Six.... 


Eight.... 

Nine 

Ten 

Ekren  .. 
Twelve... 
Thirteen. 
Fourteen. 
Fifteen... 


Eighteen 

Nineteen 

Twenty 

Twenty-one . 
Twenty-two. 


February. 


March. 


4 
24 

7 
19 
51 
41 
44 
S3 
37 
191 
ai 

13 

17 
30 
56 

5a 

ia6 

77 
64 

94 

ii93» 


13 

a 

6 

ao 

M 
8 

42 

a8 

6a 

46 

i«7 


I 

38 

9 
18 

78 
19 
57 
38 
30 
180 


1904 

17 
I 

a 

19 
II 

18 

47 

25 

41 
43 

«7 
181 


IQ06  ,  1904  i  1905  1906 


16 

13 

•»i 

5 

17 

II    1 

8 

n 

16    I 

50 

40 

U    ' 

59 

81 

66 

50 

49 

5«    1 

137 

ISO 

113 

49 

51 

61 

ai 

33 

50 

87 

"3 

90 

93» 

ifOao 

93> 

17 

I 

4 

19 
8 
10 
7a 
30 
40 
74 
89 
1S3 

6 

la 

36 

45 

42 

■07 

33 
a6 

7S 
89> 


la 

4 

43 
10 

14 

67 

ao 
38 
43 

ai5 

14 
10 

«3 
«7 
6a 

42 

"4 

39 

ao 

94 


18 

2 
8 

3a 

9 

19 
68 
ai 

44 
80 

55 


39 
*) 

ao 


15 
16 

21 
5* 

I  ** 

!  13a 

54 
54 
97 
65 
I  19a 
34 

25 

35 

44 

76 
40 
144 
47 
a8 

138 


la 

4 
60 

15 
16 

138 

rj 

43  ;  42 

63  !  74 


April. 

1904 

1905 
17 

1906 

17 

10 

2 

ao 

2 

2 

:   '7 

2 

») 

It 

44 

13 

!  20 

1 

6 

32 

JO 

10 

67 

!   "34 

85 

1 


34 
288 

25 
22 

18 

42 

120 

74 

174 

70 

50 

156 


39 

219 

38 

41 

27 

5& 
lao 

57 
161 

79 

45 

las 


I  52 

■ 

i  42 

■  48 

6a 

235 

15 
18 

>9 
39 
60 
81 

152 
54 
66 

12^ 


29 
37 
36 

25 

216 

12 

14 

9 
26 

80 
3a 

133 
65 
36 

119 


I 

I 


1^16  i^  ,  MSI !  i»>8s  I  1.342  1.0J8 


TubtrculosU  Ward  List,  Borough  of  Manhatttm. 
1904,   1905  and  1906. 


Wud  Hambtt. 

Mw, 

JUM, 

July. 

Ausu>t. 

.W 

>405 

i«o6 

.« 

(6 

19 

■3« 
37 
16 
3* 
16 

«» 
3> 

ss 

'3' 
33 

&7 
IJ7 

T9ci6 

19<M 

•vi 

1906 

IW 

.«;.•* 

Si 

i 

It 

16, 

56 
>3 

36 

106 

17 

6S 

'>S 
S9 
34 

16 

■6 

18 

iS 

1I6 

'5 
16 
« 

4S 

■S! 

■8 

Si 

64 
61 

3* 

"3 

S 
38 

5; 

'M 
{8 
5> 

'58 

1317 

>S 

K 
>{ 

33 

)i 
"» 
33 

3> 

34 
30 

•7 
*g 
U 
37 
140 
tS 

1,116 

7 

i 

ID 
•S 

« 

S3 
61 

4S 

V 

S' 
140 

86 

6a 
131 

'.Ml 

8 

a 

A 
!S 

33 

51 

aj 
t« 

16 
67 
38 
95 
ib 
37 

«3 

IS 

8 

50 

S» 
4» 

I 

*3 

61 

67 
4* 
'34 

W 

ID     '       7 

( 

; 

36    ■    >S 

«    i    ,6 

Sl» 

18  :  JO 

„  1* 

41     33 
37  1  « 
48     60 
36I38 

as   \ty> 

i»    ,     34 

30 
33 

36 

« 
S« 
i8 

'J7 
S3 
53 

'03 

id 

10 
•4 
■5 

65 

IS 
76 

Fat««n 

38    '■     >B 
31          44 

84    '■    ia 
m    '     S7 
13a    '   134 
.4    1    67 
66    '    49 

Ei(hteen 

NiMWen 

T* 

I  ...i. 

«)6 

',»» 

.,,«, 

.,«. ;  i,>8. 

356 

Tuberculosu  Ward  List,  Borough  of  Manhattaa. 

1904,  1905  and  1906. 


Ward  Number. 

September. 

December. 

1404 

iqos 

>9»6 

IW 

.« 

1906 

1904 

■90i 
17 

97 

31 
18 

13 

8 

13 
49 
31 
« 

114 

.906 

18 

43 
34 

31 
63 
49 
i'3 
«6 

<904 

i 

S* 

6t 
S' 
»33 

»4 
■3 
3' 
5S 

>68 
J6 
S' 

■905 

IS 

18 
■3 
30 

M 

k6 

fa 
34 

^ 

'3 

"S 

18 

iS 
39 
«I 

■So 
18 

S 

68 
V 
87 
S7 
» 

t 

31 

3! 
3* 

47 
6a 
S« 

5W 
33 
»» 
♦» 

"3 

IK 
43 
Si 

"77 

s 
16 

■s 

'S 

84 
'i 

3* 

SI 

u8 

■0 

I        1           T 

' 

5 

7" 
54 

Jt 

3* 
5» 
66 

'5 

61 
16 
73 
61 
34 
up 
16 

4>) 
V> 

u 

ui 
64 
58 

■IS 

s 

59 
'S 

49 
.3' 
i«6 

30 

: 

103 
61 

ai 
.1. 

6 
»J 

7 

: 

18 

1)6 

6 
6 
30 
64 
36 

S» 
34 
7« 

' 

' 

54 

41 

■4     ■    38 
'3    .    » 

FtfMen.. 

3>  ;  41 

(8       .OS 

3S         48 
u.    1   .« 

37    ;    73 
46    1    30 

■«7    , 

Vfb 

>,S« 

■^ 

l,II« 

t* 

sn 

S17 

9». 

«Si 

t,«r« 

1,030 

r,o»S 

357 

The  reason  that  the  greatest  number  of  cases  was  reported  from  the 
Twelfth  Ward  is  probably  due  to  the  fact  that  it  comprises  a  greater 
area  and  contains  many  of  the  larger  hospitals :  the  Ninth  and  Seven- 
teenth Wards,  which  -are  very  much  smaller  in  area  and  situated  on 
the  lower  east  side,  contained  many  more  cases  in  comparison.  The 
First  Ward,  which  is  chiefly  a  business  district,  had  the  least.  During 
the  week  ending  August  25  453  new  cases  were  reported,  which  hap- 
pened to  be  just  the  time  the  hospital  census  was  completed,  accounting 
for  this  high  figure ;  the  week  ending  September  10  showed  the  least 
number  (188). 

Deaths  from  Tuberculosis — Below  is  a  chart  showing  the  number  of 
deaths,  tabulated  according  to  wards,  for  the  years  190$  and  1906: 


358 

TabHiation  of  Dead  Cases  of  TnberculotU  According  f> 


359 


Wmrii  flR  IJW  Bunrngk  of  Mamhattait  for  1905  and  1906. 


July. 

Al«D9k. 

Scpteiiibcr. 

October. 

NoiFmnber. 

^f6' 

1906. 

1905. 

1906. 

1905. 

1906. 

1905. 

1906. 

1905. 

1906. 

7 

6 

6 

•  • 

3 

4 

3 

4 

8 

5 

I 

•  • 

I 

I 

•  • 

•  • 

I 

•  • 

1 

9 

•  • 

•  ■ 

•  • 

•  • 

I 

■  • 

a 

■  • 

s 

8 

5 

II 

II 

8 

9 

5 

6 

6 

3 

I 

4 

5 

3 

a 

4 

I 

6 

8 

4 

la 

6 

5 

9 

10 

9 

6 

8 

8 

la 

10 

7 

7 

6 

If 

S 

7 

4 

8 

a 

a 

4 

5 

6 

18 

13 

15 

H 

14 

18 

10 

10 

14 

11 

6 

5 

7 

9 

9 

II 

5 

3 

M 

11 

5 

8 

8 

"3 

7 

■5 

II 

69 

6« 

47 

65 

73 

70 

54 

81 

67 

S 

•  • 

5 

7 

7 

a 

3 

a 

4 

7 

I 

3 

10 

S 

5 

a 

4 

5 

6 

8 

6 

8 

3 

7 

a 

8 

3 

M 

II 

9 

aa 

17 

la 

15 

9 

11 

16 

16 

13 

«7 

aa 

5 

9 

11 

17 

16 

10 

10 

ao 

11 

18 

la 

14 

la 

69 

49 

6a 

51 

63 

34 

40 

4> 

51 

«5 

SI 

17 

31 

22 

ai 

ai 

M 

33 

18 

2S 

ao 

ai 

93 

16 

la 

8 

«9 

34 

38 

»9 

40 

4a 

Sa 

38 

3" 

41 
313 

44 

360 

3» 

i65 

341 

384 

367 

a97 

a65 

313 

Oocennber. 


1905- 

1906. 

5 

3 

1 

a 

9 

9 

5 

4 

«3 

5 

8 

la 

8 

5 

18 

«5 

»9 

II 

II 

10 

77 

87 

4 

5 

S 

8 

5 

7 

II 

18 

aa 

V 

16 

ai 

70 

74 

tt 

37 

m 

as 

M 

45 

-■ 

♦■0  I    440 


36o 

The  largest  number  of  deaths  (170)  occurred  during  the  week 
ending  November  17,  the  least  (82)  during  that  ending  September  i. 
The  Irish  race  lead  in  proportion  to  population,  but  no  particular  local- 
ity is  affected,  they  being  more  or  less  scattered  throughout  the  City. 
The  Norwegian  nation  had  the  least  according  to  their  population  here. 

Tuberculosis  Maps — The  same  tuberculosis  maps  are  being  used 
upon  which  have  been  recorded  all  new  cases  of  tuberculosis  occurring 
in  the  Borough  of  Manhattan  for  the  past  three  years.  Solid  circles 
in  different  colored  inks  are  used  to  indicate  each  case. 

Black  for  1904. 

Red  for  1905. 

Green  for  1906. 

And  for  the  coming  year  brown  will  be  used. 

Private  Physicians'  Cases — As  in  previous  years,  information  re- 
garding every  "  private  "  case  of  tuberculosis  was  sought  for  from  the 
physician  who  reported  the  case. 

Tabulation  of  the  replies  gave  the  following  results: 

Letters  sent  out  S*73^ 

Replies    received 4,126 

Failed  to  reply  1,445 

Returned,  doctors  not  found 165 

Patient  recovered   266 

Patient   improved    231 

Patient  dead   835 

Patient  worse 29 

No  change  52 

Out  of  town  444 

Out  of  borough  29 

Under  observation   (in  file) 2,001 

'*  Don't  know  "  or  out  of  doctor's  supervision 1,699 


In  those  CAses  where  no  information  was  received  from  the  attend- 
ing physician  it  was  obtained  by  nurses,  who  called  at  the  address  given. 
In  many  instances  it  was  found  that  some  of  the  patients  had  died, 
others  had  left  the  borough,  while  some  were  being  treated  by  other 
physicians.    In  only  a  few  cases  it  was  found  that  they  had  recovered. 


36 1 


A  census  of  all  cases  of  pulmonary  tuberculosis  in  public  institu- 
tions was  taken  March  i  and  August  i. 

The  table  below  shows  the  results  of  such  census  for  the  past  three 
years  : 


Total  No.  c 
NewCaaes.... 
Male  Cases... 
Female  Cases 
Duplicates.... 


1903. 


Jan. 


899 
166 


May. 


1,170 
36 


733 


1,040 


Oct. 


1,303 
229 


i/>74 


1904. 


May. 


1,557 
197 


1,360 


Sept. 


1,553 
47 


1905. 


Mar. 


Aug. 


1,828 
246 


I 

1,506       1,582 


1.830 

186 

1,200 

630 
",644 


1906. 


Mar. 


1,993 
183 

1,325 
668 

1,810 


Aug. 


>,7i9 
187 

1,069 
650 

1,532 


The  comparison  of  the  census  with  the  Departmental  records  should 
be  minimized  this  coming  year  as  the  institutions,  in  place  of  reporting 
as  heretofore  all  cases  by  postals,  now  do  so  daily  by  telephone,  the 
reports  being  acknowledged  by  postals  on  the  day  of  receipt.  All  cards 
are  filed  under  the  respective  institution  reporting  same.  This  pro- 
cedure obviates  the  possibility  of  any  reports  going  astray  while  in 
transit  to  the  Department.  When  the  next  census  is  taken  (March  ist) 
the  cases  on  file  in  the  Department  should  agree  exactly  with  the  re- 
ports from  the  hospitals. 

Institutions — A  few  more  hospitals  treating  tuberculosis  have  been 
added  to  the  table,  showing  the  number  of  cases  treated  (obtained 
from  their  published  annual  reports)  as  compared  with  the  number  of 
cases  reported  to  the  Department  of  Health. 

Table  Showing  Annual  Number  of  Cases  of  Tuberculosis  Treated  and  Number 
Reported  to  the  Department  of  Health  for  Eleven  Large  Hospitals. 


St.  Joseph's— 

Treated.. 

Reported 
St.  VincentV 

Treated.. 

Reported 


1903. 


1,565 
1,090 

122 

65 


1904. 


1905. 


1,707 
1,240 

III 
S8 


1,699 
1,406 

37 

21 


1906. 


1,699 
1,474 


26 


362 


Seton— 

Treated 

Reported 

Lincoln- 
Treated 

Reported 

Metropolitan- 
Treated 

Reported 

Manhattan  State- 
Treated 

Reported 

Riyerside— 

Treated 

Reported 

Bedford  Santtarhim— 

Treated 

Reported 

Bellevue— 

Treated 

Reported 

Montefiore— 

Treated 

Reported 

House  of  Relief- 
Treated 

Reported 


1903. 

865 
607 

177 
170 

a/>73 


1904. 


190J 


1.198 
870 

a84 
2sa 

a.5©7 
a. 160 


5*4 

i^ii 

an 

ns 
3.3rr 


•s 


Ml 


i,3«i 


53r 


3IS 


1906. 


i.»79 
1,341 


a.545 


107 


no 


3S9 


i,»47 

1,481 

93 
$56 

159 
3*7 


Lincoln  Hospital  no  longer  receives  patients  suflFering  from  tuber- 
culosis. The  institution  book,  which  formerly  recorded  the  weekly 
reports  of  tuberculosis  from  the  various  institutions,  will  now  be  dis- 
continued as  it  will  be  a  very  easy  matter  to  refer  at  any  time  to  the 
report  card  index  and  obtain  the  desired  information. 

Duplicate  Cases — The  number  of  duplicate  cases  was  7,560,  1,546 
less  than  last  year. 

Not  Found  Cases — The  number  of  ■■■*■"*  ^^miwI  st  the  address 
gjvien  were  in  excess  of  those  of  19  e  fact  that 


I     issssa?S3oo 

I    li:::::::::ii?i:==:^s^;^'«  1 

1     1 -=re>l''  ' 

I   ?==========EE==E=EEEi!==  '. 

i     ffllllllllllllllll|:SIHJ 
p      i     g     s     s     s     s     ?     S     S      2    "J 

3^5 

more  extended  inquiry  was  made  into  the  condition  and  whereabouts 
of  the  private  cases. 

Forcible  Removals — It  was  necessary  in  only  23  instances  to  remove 
cases  of  tuberculosis  to  Riverside  Hospital  against  their  will. 

A  new  order  went  into  eflFect  during  the  latter  part  of  the  year 
which  made  it  more  difficult  to  have  patients  removed  against  their 
will ;  (i)  the  consent  of  the  attending  ph)jsician  had  to  be  obtained ;  (2) 
a  record  of  patient's  sputum  having  been  examined  by  the  Department 
showing  the  tubercular  bacilli;  (3)  or,  physically  examined  by  one  of 
our  inspectors,  confirming  the  diagnosis;  (4)  others  being  exposed  to 
the  disease,  especially  children;  (5)  non-observance  of  prophylaxis. 

Voluntary  Renovation — Premises  previously  occupied  by  consump- 
tives were  voluntarily  renovated  by  the  owners  in  388  instances,  the 
landlord  attending  to  same  before  a  compulsory  order  was  instituted 
against  him. 

Deaths  from  Pneumonia — Every  death  from  pneumonia  was  com- 
pared with  the  tuberculosis  records,  and  very  few,  possibly  not  more 
than  a  half  dozen,  were  found  to  have  been  reported  previously  as 
tuberculosis.  Investigations  were  made  in  every  such  case  and  almost 
invariably  a  satisfactory  explanation  was  obtained. 

Typhoid  Fever — This  disease,  as  the  accompanying  chart  for  the  last 
three  years,  shows  very  little  deviation  as  regards  the  time  of  year 
when  the  greatest  number  of  cases  and  deaths  occur.  During  1906 
1,713  cases  were  reported,  144  less  than  in  1905.  The  greatest  number 
of  cases  occurred  during  the  week  ending  September  15  (85),  while 
the  least,  5  in  all,  were  during  the  week  ending  June  9.  In  addition 
there  were  also  reported  153  cases  which  proved  on  investigation  not 
to  be  typhoid  fever. 

The  table  on  page  368,  tabulating  the  cases  according  to  wards, 
shows  that  the  greatest  number  of  cases  were  reported  from  the  Twelfth 
Ward.  This,  of  course,  is  due  to  the  fact  that  that  ward  is  the  largest 
and  most  populous.    Ward  i  had  the  least,  being  a  business  district. 


366 


of  Cms 

of  Typhoid  Fevtr  According  to 

Jiuulty. 

Februarr. 

March. 

April. 

y.y.       ■      June.       ] 

190s.  1  1906. 

1905. 

1906. 

.«. 

1906. 

190S. ;  1906. 

1905.  ]  1906. 

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Wards  in  the  Borough  of  Manhattan  for  1905  and  1906. 


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56B 

Disinfeciion  and  F^nugatiofi — Bedding:  vaf  fnmig^ed  in  ninety- 
two  instaxxx^,  almost  Twict  aF  man}-  a?  last  year,  probablv  dne  to  tbc 
fact  thai  postals  wert^  sent  tc  the  attending  physician  requecteig  bin 
to  inform  the  Department  when  the  case  had  terminated  or  frooe  to  a 
hospital  so  that  fumigaticm  ccnijd  l>e  j:»erfc»rmed. 

RoMtine  Froccd^irc  and  Fo^yns — Be.ginnin|r  Tannan-  i.  1907,  the 
large  Xyph<ji6  history  will  be  rej.>laced  b}  a  smaller  folding  card.  This 
will  be  a  great  improvemenT  over  the  c«ne  already  in  use.  The  old  card 
was  of  such  size  that  it  l»ecame  fc'lded  in  tht  mail,  making  it  hard  to 
fiJe  or  carr>'  around  by  the  inspect cts,  while  the  new  c*ne  will  be  in  uni- 
f^jn  with  the  tuberculosis  card,  being  tht  size  cf  a  j:»c»5ta]. 

Every  case  has  been  plc»rted  c^n  a  large  map.  as  -was  done  in  1905;. 
A  photograph  of  the  map  is  given  herev^-ith,  shov^-ing  that  there  was  no 
special  localization  of  the  disease  in  any  particular  serrion  of  the  City, 


371 

Inspection  of  Milk  Stores — ^This  was  done  in  every  instance  where 
the  source  of  infection  was  stated  as  being  possibly  due  to  drinking 
of  infected  milk.  Some  two  hundred  inspections  were  made,  but  in  no 
instance  did  the  inspectors  find  anything  wrong  either  as  to  unsanitary 
conditions  or  lack  of  care. 

Dead  Cases — The  total  number  of  deaths  from  typhoid  was  325. 
Ouring  the  week  ending  October  6  the  largest  number  occurred,  20  in 
all,  while  the  least  was  one,  for  the  weeks  ending  January  13,  March  3 
and  24. 


372 


Tabulation  of  Dead  Cases  of  Typhoid  Fever  According  to 


Ward  Nu. 


January.       Fefaruar>'.  '     March.  April 


May. 


June. 


I 
iqpy.    1406.  191^.  iqo6.  jqoff;.  jqab.     iqoy.    iqob.  1905.  1900.  lOK.  1906. 


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Wards  in  the  Borough  of  Manhattan  for  1905  and  1906. 


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374 

Cerebrospinal  Meningitis — The  prevalence  of  cerebro-spinal  men- 
ingitis greatly  diminished  during  1906  as  compared  with  the  two  pre- 
vious years,  only  679  cases  being  reported,  two  and  a  half  times  less 
than  the  year  1905.  Of  these  36,  the  greatest  number,  occurred  during 
the  week  ending  February  21,  while  during  the  week  ending  December 
29  there  were  only  two.  It  is  possible  that  this  decrease  was  partly  due 
to  the  fact  that  the  Department  of  Health  treated  cerebro-spinal  menin- 
gitis as  a  communicable  disease.  Quarantine  was  established,  disinfec- 
tion and  fumigation  was  done  wherever  it  was  necessary  and  all  pos- 
sible precautions  taken  against  the  spread  of  the  disease. 

The  percentage  of  mortality  ran  high,  there  being  545  deaths. 

In  addition  to  the  above  80  cases  were  reported,  which,  on  investi- 
gation, proved  not  to  be  cerebro-spinal  meningitis. 

All  cases  of  tubercular  meningitis  are  now  investigated. 

Disinfection  and  fumigation  was  done  in  464  instances.  In  228  cases 
the  first  report  received  was  the  death  certificate.  Many  of  these  were 
hospital  cases. 

All  cases  were  plotted  on  a  large  map  as  heretofore.  The  photo- 
graph of  this  map,  given  herewith,  shows  the  same  distribution  of  the 
cases  as  in  1905 — i.  c.,  in  the  poorer  quarters,  around  the  periphery  of 
the  island,  especially  in  the  localities  where  Italians  arc  most  numerous. 

lirysipclas — ( )f  the  626  cases  reported  in  the  Borough  of  Manhat- 
tan this  year  the  majority  were  reported  hy  the  various  hospitals  and 
institutions.  As  yet  the  Department  of  Health  has  not  strictly  en- 
forced the  reporting  of  cases  of  erysii)elas  by  ])liysicians.  it  is  hoped 
eventually  to  do  this.  The  number  of  deaths  were  up,  tlic  mortalitv 
being  less  than  that  of  last  year. 

Malaria — 224  cases  were  reported;  31  of  these  were  cases  that  died^ 
not  having  been  reported  during  life.  livery  dcatli  fn^ir.  malaria  has 
been  rigidly  investigated  as  it  is  S(^  treciuontlv  found  tliat  ilio  patient 
really  died  of  some  other  disease,  such  as  tv])]ioi«l  tVwr.  pnori)eral 
septicaemia,  etc. 

(See  separate  report.) 


•  I 

f  . 


377 

Glanders — Only  one  case  was  reported. 

Abortion — There  were  only  56  cases  reported  for  the  entire  year, 
and  these  were  principally  reported  by  the  hospitals  and  institutions. 
No  definite  action  has  been  taken  as  yet  as  regards  the  compulsory  re- 
portinj;  of  this  condition  by  the  profession.  A  new  form  card,  similar 
to  the  others  in  use  by  the  Division,  has  been  devised. 

Septicaemia — Only  25  cases  were  reported  in  the  entire  Borough 
of  Manhattan.  I-ikewist.  little  cognizance  has  been  taken  of  this  for 
the  present. 

Tetanus — Of  the  20  cases  reported  all  were  visited  by  inspectors. 
Injection  of  tetanus  antitoxin  was  offered  in  every  instance  but  only 
i  I  patients  accepted  same.  The  amount  of  antitoxin  injected  to  each 
patient  ranged  from  5  to  20  c.c  The  inspector  revisited  the  patient 
in  ten  to  fourteen  days,  and  in  no  instance  did  they  develop  tetanus. 
The  time  of  year  when  most  of  the  cases  were  reported  was,  naturally, 
the  month  of  July. 

Administration  of  Diphtheria  Antitoxin  in  the  Horon^h  of  Manhattan.  . 

The  results  obtained  by  the  free  administration  of  antitoxin  in  cases 
of  diphtheria  in  the  Borough  of  Manhattan  for  the  past  year  are  given 
in  a  separate  report, 

I nimunisation  was  performed  in  5,5861  cases.  The  slight  decrease  in 
the  number  of  immunizations  from  last  year's  figures  may  be  due  to  the 
fact  that  there  were  not  so  many  outbreaks  of  diphtheria  in  the  large 
institutions  for  children  where  widespread  immunizations  are  neces- 
sary. 

It  may  be  of  interest  to  mention  the  prompt  and  efficient  work  of 
the  inspectors.  For  the  past  year  a  record  was  kept  of  the  time  each 
inspector  attended  to  the  call  sent  in,  and  it  was  found  that  in  the  ma- 
jority of  cases  they  made  their  inspection  within  one  and  two  hours  of 
the  time  the  case  was  reported. 

Pneumonia — The  prevalence  of  pneumonia  for  the  past  year  has 
doubled,  1.456  deaths  against  716  for  1905. 

Obituary — In  the  death  of  Dr.  Thos.  DeL.  Burckhalter,  Medical 
Inspector  in  this  Division,  the  Department  lost  the  services  of  an  effi- 


378 

cient,  faithful  and  honorable  physician  and  one  whose  special  training 
in  contagious  diseases,  having  been  resident  physician  to  the  Willard 
Parker  Hospital  for  a  number  of  years,  made  him  especially  fitted  for 
the  work  connected  with  this  Division  and  whose  loss  is  regretted  by  all 
who  were  fortunate  enough  to  be  associated  with  him. 

Borough  of  Manhattan. 

Report  of  the  hispector  in  Charge  of  Culture  Stations. 

There  are  at  present  in  the  Greater  City  297  drug  stores  acting  as 

culture  stations,  of  which  95  are  *'  regular  "  stations  visited  daily  by 

the  collector,  and  202  "  sub-stations  '*  sending  specimens  and  obtaining 

supplies  through  the  nearest  regular  station.    These  stations  are  divided 

as  follows: 

Regular         Sub- 
Stations.    Stations. 

Borough  of  Manhattan 26  154 

Borough  of  The  Bronx 10  29 

Borough  of  Brooklyn 41  a 

Borough  of  Queens 10  16 

Borough  of  Richmond 8  i 

(Of  the  regular  stations  in  Brooklyn  6  only  are  visited  on  Sundays 
and  holidays,  the  others  delivering  to  the  nearest  station.) 

In  The  Bronx  two  new  stations  have  been  established  and  none 
discontinued. 

In  Manhattan  nine  new  stations  have  been  established  and  four 
discontinued. 

In  Brooklyn  one  new  station  has  been  established  and  one  discon- 
tmued. 

In  Queens  two  new  stations  have  been  established  and  one  discon- 
tinued. 

The  Brooklyn  service  has  been  improved  by  the  installation  of 
tliirty-three  cabinets  similar  to  those  placed  in  the  regular  stations  in 
Manhattan,  and  eight  large  tin  boxes  (see  photographs).  It  is  ex- 
pected that  the  regular  stations  in  the  other  boroughs  will  be  supplied 
with  cabinets  during  the  coming  year. 


379 

In  Manhattan  135  of  the  sub-stations  have  been  furnished  with  large 
boxes  which  are  properly  divided  to  contain  the  various  outfits  and,  as 
s  conrequence.  are  kept  in  much  better  order  than  the  small  boxes 
formerly  used.  It  is  expected  that  all  the  sub-stations  will  be  fumished 
with  these  boxes  in  the  near  future. 


During  the  year  a  vest  pocket  booklet  (Form  zo6  L)  containing 
a  list  of  all  the  culture  stations,  the  time  of  day  when  each  regular  sta- 
tion is  visited  by  the  collector,  the  station  to  which  each  sub-station 
delivers  specimens,  and  also  condensed  information  for  physicians  in 
regard  to  the  work  of  the  Department  nf  Health,  was  prepared  and  dis- 
tributed and  met  ^-eneral  approval. 


1 

38. 

A  number  of  ihc  sub-slatbns  are  situated  at  a  considerable  distance 
rom  the  nearest  regular  station,  making  it  necessary  for  the  messenger 
0  use  the  street  cars,  and  agreements  have  been  made  with  the  pro- 
prietors of  these  stations  to  pay  the  car  fares  for  such  rides. 

Jn  October  the  auditing  of  these  car  fare  bills  was  turned  over  to 
ne  and  I  found  that  several  of  these  stations  regularly  turned  in  bills 
which  represented  a  visit  every  day  in  the  month.     In  order  to  de- 
termine if  this  service  was  actually  performed  I  sent  to  each  station 
-I  package  of  cards  stamped  with  ihe  name  of  the  station  and  dales  for 

1 

H^^^BB 

^P^ 

uivi.-iicm  OF  cnMMi!N-K-.Mii.i-:  nisKASK^— -siipi'i.v  \\(>\  issi-t:ii  to  iulitr 

tlie  month   of  November,   with  instructions   that  every  day   that  the 
messenger  called  at  the  collection  station  a  card    corresponding  to  the 
date  of  visit   must  be  left  in  the  cabinet. 

These  cards  have  been  brought  in  by  the  collectors,  stamped  with 
(he  date  of  receipt,  and  turned  over  to  me  for  filing.     As  this  system 
has  been  in  operation  for  only  two  months,  it  is  impossible  to  give  exact 
figures  for  comparison,  but  I  believe  that  considerable  saving  will  re 
suit.    The  regular  stations  have  been  visited  once  in  two  weeks  by  on« 
of  the  laboratory  assistants  in  a  Department  wagon  and  the  stock  o 
supplies  replenished. 

1 

J82 

The  sub-stations  have  been  inspected  each  nionth  by  the  nurses  an^ 
requisitions  for  supplies  made  out  witen  necessary.     I  have  also  ] 
sonaily  inspected  the  condition  of  the  regular  stations. 

In  general  the  condition  of  the  stations  has  been  very  satisfactoi 
and  few  complaints  have  been  received  from  physicians,  either  in  i 
pard  to  lack  of  supplies  or  delays  in  the  deliveries  of  specimen 

The  majority  of  the  proprietors  of  the  stations  appear  to  take  c 
siderable  interest  in  the  work  of  the  Department  and  are  anxious  1 
keep  their  supplies  in  good  condition  and  make  deliveries  promptljrj 
Considering  the  fact  that  the  service  is  purely  voluntary  and  without 
compensation.  I  think  the  results  arp  as  satisfactory  as  can  be  expected.   I 

There  are  slill  a  number  of  culture  stations  which  are  not  supplied 
with  antitoxin  and  vaccine  owing  to  the  fact  that  the  Chief  Clerk  de- 
clines to  issue  contracts  for  the  same.  The  proprietors  either  do  not 
keep  the  Department  antitoxin  or  arc  obliged  lo  purchase  it,  and,  of 
course,  cannot  supply  it  to  physicians  on  free  slips.  This  makes  trouble 
for  the  druggists  as  physicians  do  not  understand  why  one  station 
should  differ  from  another.  It  seems  to  me  that  this  divided  arrange- 
ment of  stations  is  not  satisfaclofy  and  that  it  would  be  better  to  Iiave 
the  distribution  of  all  supplies  and  products  under  the  control  of  the 
Division  of  Communicable  Diseases. 


L  ih< 

k 


Borough  or  Maxhattan. 
Stcrcoplicon  Picture  Exhibitions  on   Tuberculosis. 

The  Department  has  long  realized  that  the  most  important  featu 
of  the  organized  efforts  to  limit  the  spread  of  pulmonary  tuberculo! 
now  being  made  so  generally  throughout  the  world  is  popular  edlK 
lion.  In  its  work  it  has  sought  to  educate  the  public  in  various  waytf 
By  the  publication  and  distribution  of  literature  on  the  subject;  by  i 
struction  given,  verbally,  by  its  physicians  and  nurses ;  by  formal  I 
tnres  and  by  co-operation  with  the  various  charitable  and  other  org 
zations  interested  in  the  problem  of  the  prevention  of  tuberculosis. 

It  is  necessary,  before  any  good  results  can  be  expected,  to  tea 
the  simple,  every-day  truths  about  the  disease ;  its  read>'  preventioi 
the  possibility  of  its  cure,  and  the  proper  care  of  those  suffering  fro 

It  is  important,  further,  to  interest  others  who.  though  not  ignora 


383 

are  indifferent  to  the  necessity  of  iiniled  energetic  action  on  the  part 
of  the  municipality  in  order  to  control  this  modern  plague. 

To  further  extend  this  work  of  popidar  education  stereopticon  ex- 
hibitions wert  given  in  twenty-three  of  the  public  parks  of  Manhattan 
during  the  summer  of  1906,  illustrating  various  points  in  connection 
with  the  disease,  and  what  is  being  done  in  various  ways  by  the  City  to 
control  it  and  to  care  for  its  victims.  These  pictures  showed  the  ways 
in  which  the  baciUi  causing  the  disease  are  transmitted  by  the  cough 
and  expectoration  of  those  who  have  it ;  by  dust  and  air  filled  with 
particles  of  the  dried  sputum ;  the  effect  of  the  disease  on  the  lungs ;  how 
over-crowded,  dirty,  badly  v»;ntilated  rooms  and  tenements  cause  and 
spread  it :  how  these  conditions  are  being  remedied  by  new  building 
laws;  how  this  Department  cares  for  rooms  infected  with  the  germs  of 
consumption,  by  fumigation,  and  the  removal  and  disinfection  of  the 
bedding  and  furnishings;  how  it  cares  for  patients  in  Riverside  Hos- 
pital, anij.  finally,  the  possibility  of  the  arrest  and  even  cure  of  the  dis- 
ease in  country  sanatoria  such  as  that  recently  opened  by  tire  Depart- 
ment at  Otisville,  Orange  County,  New  York. 

In  addition  the  following  terse  sentences  of  advice,  in  English  and 
Yiddish,  were  interspersed  with  the  views  on  the  screen : 

No.  I.  Consumption  causes  more  deaths  than  any  other  disease. 
Nearly  one-third  of  all  the  people  who  die  between  twenty  and  forty- 
five  years  of  age  die  of  consumption. 

No.  2.  If  you  want  to  know  how  to  protect  yourself  and  your  fam- 
ily from  consumption  take  time  to  read  these  bulletins. 

No.  3.  Consumption  attacks  especially  those  who  live  in  crowded 
or  badly  ventilated  rooms. 

No.  4,  Consumption  is  caused  by  the  poison  present  in  the  con- 
sumptive's spit. 

The  poisonous  spit  dries  and  goes  as  dust  into  other  people's  lungs. 

No.  5.  A  little  poisonous  spit,  when  scattered  in  dust,  is  enough 
to  affect  dozens  of  people. 

People  who  spit  on  the  floors  of  their  homes  spread  the  disease. 

No.  6.     Consumption  is  caused  by  the  dust  from  dried  spit. 


384 

Workmen  who  spit  on  the  floors  of  their  work-shops  spread  the 
disease. 

No.  7.     People  who  spit  on  the  sidewalks,  where  women  get  it  on 
their  dresses  and  take  the  poison  home,  spread  the  disease. 

No.  8.     Stop  spitting,  excepting  into  spittoons  or  into  the  gutters; 
you  may  have  consumption  and  not  know  it. 

No.  9.     Don't  spit  on  floors. 

Don't  spit  in  corners  of  rooms. 

You  may  have  consumption  and  not  know  it. 

No.  10.     Don't  spit  on  stairs. 

Consumption  is  caused  by  the  dust  from  dried  spit. 

Don't  spit  on  sidewalks. 

No.  II.  If  you  have  consumption  don't  give  it  to  others  by  spit- 
ting.   If  you  have  not,  don't  let  others  give  it  to  you. 

No.  12.  A  consumptive,  who  coughs  and  spits  anywhere  and 
everywhere,  is  a  danger  to  the  community. 

No.  13.  He  is  a  danger  to  the  neighborhood.  He  is  a  danger  to  the 
family.     He  will  poison  the  house  he  lives  in. 

No.  14.  A  consumptive  who  coughs  and  spits  anywhere  and  every- 
where must  be  made  to  stop  it.     He  is  a  danger  to  his  family. 

No.  15.  If  he  will  not  stop  spitting  he  must  be  reported  to  the 
Board  of  Health  as  a  dangerous  nuisance. 

No.  16.  A  consumptive  should  spit  into  a  cloth  or  paper,  which 
can  be  burned.  If  he  spits  anywhere  else  he  is  a  source  of  danger  to 
you  and  your  family. 

No.  17.  .\  careful  consumptive,  one  who  coughs  into  a  handker- 
chief and  spits  into  it,  or  into  anything  that  can  be  boiled  or  burned,  is 
',)erfectly  safe  to  be  about  you. 

No.  18.  P»o  kind  to  the  careful  consumptive,  as  you  would  have 
i>thers  kind  to  you  if  you  were  sick. 

Xo.  u).  The  only  consumptive  to  be  afraid  of  is  the  careless  con- 
sumptive. He  is  a  danger  to  the  neighborhood.  He  coughs  and  spits 
an V where  and  everywhere. 


385 

No.  20.  Sunlight  and  fresh  air  kill  the  poison  in  the  consumptive's 
spit. 

No.  21.  In  dark,  damp  or  poorly  ventilated  rooms  the  poison  re- 
mains for  months  a  source  of  danger. 

No.  22.  Rooms  which  have  been  occupied  by  a  consumptive  should 
be  thoroughly  cleaned  and  then  disinfected  by  the  Board  of  Health. 

No.  23.     See  that  you  have  fresh  air  in  your  homes. 

No.  24.     See  that  you  have  fresh  air  in  your  work-shops. 

Don't  live  in  a  room  where  there  is  no  fresh  air. 

Don't  work  in  a  room  where  there  is  no  fresh  air. 

Don't  sleep  in  a  room  where  there  is  no  fresh  air. 

No.  25.  The  trouble  is  that  people  don't  let  air  enough  or  sunlight 
enough  into  their  homes. 

No.  26.  If  you  suspect  that  you  have  consumption — if  you  have  a 
slight  persistent  cough,  if  you  are  gradually,  steadily  losing  weight — 

No.  27.     If  you  are  beginning  to  feel  tired  all  the  time — 

No.  28.  If  you  have  a  slight  feeling  of  feverishness  every  after- 
noon— 

No.  29.  Go  at  once  to  your  family  physician,  or,  if  you  are  not  able 
to  do  that,  go  at  once  to  a  dispensary. 

No.  30.  Don't  waste  time  or  money  on  patent  medicines  or  "  Con- 
sumption Cures."    They  don't  cure. 

No.  31.  Consumption  may  be  cured,  if  taken  in  time,  but  usually 
not  otherwise. 

No.  32.  Patent  medicines  do  not  cure  consumption ;  most  of  them 
are  practically  alcoholic  drinks  in  disguise. 

No.  33.  They  brace  you  up  for  a  little  while;  after  that  you  are 
worse  than  before. 

No.  34.  "  Ccmsumption  Cures  "  do  not  cure  consumption.  While 
you  are  taking  them  you  are  losing  time,  and  time  you  cannot  afford  to 
lose. 

No.  35.  The  treatment  of  consumption  is  fresh  air,  day  and  night ; 
rest,  as  much  as  possible ;  food,  as  much  as  you  can  take. 


386 

No.  36.     Fresh  air — day  and  night,  summer  and  winter. 

Rest — all  you  can  get. 

Food — all  you  can  eat ;  plain  food,  bread  and  butter  and  milk. 

No.  37.     Fresh  air,  rest,  food.     These  give  you  your  chance  to  get 
well  of  consumption. 

No.  38.     Medicine  will  help  but  it  is  not  so  important. 

Avoid  alcoholic  drinks  if  you  have  consumption. 

No.  39.     Alcoholic  drinks  are  particularly  bad  for  persons  suffer- 
ing from  consumption.    They  do  not  cure — they  kill. 

No.  40.     Few  people  were  ever  benefited  by  the  use  of  alcohol. 
Thousands  of  people  have  been  ruined  by  it. 

No.  41.     Self-indulgence  and  intemperance  are  very  bad  for  the 
body.    Vice,  which  weakens  the  strong,  kills  the  weak. 

Exhibitions  were  given  at  the  following  parks  on  the  dates  given 
below: 

July  30,  Battery  Park,  foot  of  Broadway. 

August  I,  City  Hall  Park,  Broadway  and  Chambers  street. 

August  3,  Mulberry  Bend  Park,  Mulberry  and  Bayard  streets. 

August  6,  William  H.  Seward  Park,  Canal  and  Jefferson  streets. 

August  8,  Corlears  Hook  Park,  Corlears  and  South  street. 

August  ID,  Hamilton  Fish  Park,  Houston  and  Willett  streets. 

August  12.  Abingdon  Square  Park,  Abingdon  square. 

August  13,  Hudson  Park,  Hudson  and  Leroy  streets. 

August  14,  Recreation  Pier,  Christopher  street. 

August  15,  Washington  Square  Park,  Fifth  avenue  and  Waverly 
place 

August  16,  Recreation  Pier,  Third  street  and  East  river. 

August  17,  Tompkins  Square  Park,  Avenue  A  and  Seventh  street. 

August  20,  Park  bounded  by  Seventeenth  and  Eighteenth  streets 
and  East  river. 

August  22,  Stuyvesant  Park,  Rutherford  place  and  Sixteenth  street. 

August  24.  Union  Square  Park,  Broadway  and  Fourteenth  street. 

August  27,  Madison  Square  Park,  Broadway  and  Twenty-third 
street. 


387 

August  29,  Alex.  Hamilton  Park,  Twenty-seventh  and  Twenty- 
eighth  streets,  Ninth  and  Tenth  avenues. 

August  30,  Recreation  Pier,  Twenty-fourth  street  and  East  river. 

September  2,  Park  bounded  by  Thirty-fifth  and  Thirty-sixth  streets, 
First  and  Second  avenues. 

September  5,  Bryant  Park,  Sixth  avenue  and  Forty-second  street. 

September  6,  DeWitt  Clinton  Park,  Fifty-second  and  Fift>'-fourth 
streets  and  North  river. 

September  7.  Recreation  Pier,  Fiftieth  street  and  North  river. 

September  10,  Central  Park,  The  Green. 

September  12,  John  Jay  Park,  Seventy-sixth  and  Seventy-eighth 
streets  and  East  river. 

September  14,  East  River  Park.  Eighty-fourth  to  Eighty-ninth 
streets  and  East  river. 

September  17,  JeflFerson  Park,  One  Hundred  and  Eleventh  to  One 
Hundred  and  Fourteenth  street  and  First  avenue  and  East  river. 

September  18,  Mount  Morris  Park,  Mt.  Morris  to  Madison  avenue, 
One  Hundred  and  Twentieth  to  One  Hundred  and  Twentv-fourth 
streets. 

September  28,  St.  Nicholas  Park,  One  Hundred  and  Thirtieth  to 
One  Hundred  and  Forty-fifth  streets,  St.  Nicholas  to  Tenth  avenue. 

September  29,  Recreation  Pier,  West  One  Hundred  and  Twenty- 
fourth  street. 

These  exhibitions  were  most  successful.    Lasting  about  an  hour,  in 

each  case  they  attracted  and  held  crowds  of  people  of  all  ages  and  so- 
cial conditions,  and,  doubtless,  many  persons  who  could  not  be  reached 
in  any  other  way  were  influenced.  With  this  encouragement  and  with  a 
desire  to  extend  their  influence  as  much  as  possible,  similar  exhibitions 
\N'ere  given  on  certain  of  the  Recreation  Piers. 

The  National  Association  for  the  Prevention  and  Study  of  Tuber- 
culosis, impressed  with  the  novelty  and  value  of  these  exhibitions,  pre- 
pared copies  of  the  slides  for  use  in  a  traveling  exhibition  in  other 
cities  of  the  country. 

These  exhibitions  will  be  made  more  interesting  and  instructive  by 
new  photographs  taken  especially  for  them;  the  preparation  and  dis- 
tribution to  the  spectators  of  a  printed  leaflet  or  card  of  information 


388 

and  instruction  and  the  prq)aration  of  moving  pictures,  and  continued 
during  the  winter  as  popular  illustrated  lectures,  if  possible  in  connec- 
tion with  the  Department  of  Education's  lectures  in  the  public  schools. 
Arrangements  will  be  made  to  give  the  picture  exhibits  again  in  the 
parks  during  the  coming  summer. 

Borough  of  The  Bronx. 

Report  of  the  Inspector  in  Charge. 

The  year  just  ended  has  been  one  of  great  accomplishment  for  the 
Division  of  Communicable  Diseases  in  the  Borough  of  The  Bronx,  and 
it  closes  with  results  eminently  satisfactory  to  those  whose  duty  it  has 
been  to  assist  in  the  work  connected  with  the  Division. 

During  the  j-ear  the  office  force  has  remained  the  same  in  number, 
although  the  personnel  has  been  somewhat  changed  owing  to  the  resig- 
nations and  transfers.  The  general  routine  of  work  in  the  office  has 
remained  practically  the  same  with  the  exception  of  a  radical  change 
in  the  method  of  handling  the  tuberculosis  records,  this  change  having 
been  introduced  by  the  Chief  of  the  Division  during  the  month  of 
November.  Details  of  this  change  will  be  found  in  the  report  of  the 
Chief  of  Division. 

Tuberculosis  Clinic, 

During  the  year  preparations  have  been  made  for  the  opening  of  a 
public  clinic  for  the  treatment  of  communicable  pulmonary  and  throat 
diseases  on  the  ground  floor  of  the  building  now  occupied  by  The  Bronx 
Borough  branch  of  the  Department  of  Health  at  No.  3731  Third  ave- 
nue.   Plans  were  filed,  contracts  let,  etc.,  and  at  the  close  of  the  year 
everything  is  practically  completed.     Most  of  the  furniture  and  appa- 
latus  has  been  delivered  from  the  manufactories,  and,  unless  something 
unforeseen  occurs,  the  clinic  will  undoubtedly  be  opened  by  February  i, 
1907.     The  space  in  the  building  devoted  to  clinic  purposes  has  been 
divided  into  six  rooms  and  two  toilets,  all  arranged  so  as  to  allow  of  free 
ventilation  by  transoms,  doors  and  air-shafts.     The  rooms  are:    (a) 
registration  room,  (b)  patients*  waiting  room,  (c)  drug  and  coat  room, 
(d)  throat  room,  (e)  female  examination  room,  (f>  male  examination 
room,  (g)  toilet  and  wash  room  for  physicians,  (h^  toilet  for  patients. 


390 

Each  exam  illation  room  and  tlie  physicians"  toilet  and  wash  roo 
supplier]  with  hot  and  cold  running  water.  The  furnishings  of  thi 
ciinic  are  of  the  same  type  as  those  in  use  in  the  other  clinics  niainlainw 
by  the  Department  of  Health  in  Greater  \ew  York  for  the  treatment  of 
communicable  pulmonary  diseases.  The  methods  of  keeping  the  rec- 
ords, the  formulary,  etc.,  will  be  the  same  as  is  now  in  use  in  these 
clinics.  The  establisliment  of  this  clinic  will  undoubtedly  fill  a  long-felt 
want  in  the  Borough  of  The  Bronx,  as  there  are  very  many  consump- 
tives living  in  this  hnniuyh,  wliri  are   wilhnnt  treatmcTil    and   willinut 


i\l  M  I'N  UWULK     DISr_\Si 

nnisioN'.  ROROUtiH  i 


C  H 1 EP     OF 


means  to  pnnriire  the  same  from  a  private  physician,  and  who  will  Tin- 
questionablv  eagerlv  embrace  the  tipportunitv  to  procure  good  treat- 
ment near  their  homes  free  of  co.st.  The  establishntent  of  this  clinic 
will  also  relieve  to  some  extent  the  pressure  on  the  clinic  in  the  Horough 
of  Manhattan,  to  which  all  Bronx  cases  have  now  to  be  referred.  A 
competent  corps  of  physicians  will  be  in  attendance  on  the  patients, 
and  the  clinic  will  be  under  the  genera!  supervision  of  the  Chief  of  the 
Tuberculosis  Clinics  and  under  the  immeiliatc  charge  of  the  Inspector 
in  Charge  of  the  borough. 


391 

Administration  of  Diphtheria  Anlito.vin. 

The  work  of  the  inspectors  during  the  year  has  been  coin  men  dab  !e. 
Promptness  ami  llioroiig;hness  has  been  the  rule.  The  work  in  the  ad- 
ministration of  diphtheria  antitoxin  and  in  intubating  has  been  success- 
ful in  a  high  degree,  as  shown  by  the  very  small  number  of  cases  of 
secondary  infection.  In  the  matter  of  intubation  we  have  been  greatly 
aided  by  the  staff  of  physicians  under  Dr.  Watson,  Resident  Phy- 
sician at  Riverside  Hospital,  North  Brother  Island.  Calls  upon  him  in 
cases  for  intubation  where  our  inspectors  have  not  been  immediately 
available,  owing  to  absence  upon  other  calls  at  the  [inie,  have  been 
cheerfidly  responded  to  at  once  and  the  Hves  of  many  children  suffering 
from  laryngeal  diphtheria  have  been  preserved  by  this  prompt  and  ef- 
fectual action  on  the  part  of  his  hospital  staff.  There  are  at  present 
forty  culture  stations  in  (he  borough. 


Typhoid  Fi'z'cr. 
During  the  latter  part  of  the  fall  there  was  a  sudden  rise  in  the 
immher  of  cases  of  typhoid  fever  reported  to  the  Department  in  this 
borough.  It  was  also  noticed  that  a  very  large  percentage,  about  75 
per  cent.,  lived  in  a  certain  section  of  the  borough,  not  much  more  than 
half  a  mile  square.  The  cases  for  a  few  days  increased  rapidly  in  num- 
ber and  reached  on  one  day  eighteen — a  very  large  number  for  one  day 
in  this  borough.  Immediate  steps  were  taken  for  the  purpose  of  ascer- 
taining, if  possible,  the  cause  of  the  outbreak,  and  for  the  purpose  of 
eradicating  the  disease  before  it  might  gain  a  foothold  which  would 
make  it  a  serious  menace.  The  following  measures  were  at  once 
adopted : 

1.  A  house-to-house  canvass  of  the  infected  district  to  locate  hidden 
or  unreported  cases,  if  any,  or  any  cases  not  under  the  care  of  a  phy- 
sician. 

2.  The  distribution  of  circulars  of  information  to  as  large  a  num- 
ber of  families  living  in  the  said  district  as  possible. 

3.  The  visiting  of  all  reported  cases  by  Inspectors  and  the  instruc- 
tion by  means  of  literature  in  precautionary  measures. 

4.  The  disinfection  of  apartments  and  bedding  after  the  termina- 
tion of  the  cases  by  death,  recovery  or  removal  to  the  hospital. 


395 

owing  to  bad  sanitary  conditions  at  the  home  and  also  to  the  dangers 
of  infection  of  other  member.s  of  the  family. 

There  was  a  considerable  increase  in  the  numher  of  cases  of  tuber- 
culosis reported  this  past  year  over  1905.  This  is  diis,  apparently,  to 
large  increase  in  population  during  the  year — a  fair  proportion  of  this 
increase  coming  from  the  crowded  and  less  sanitary  portions  of  Maii- 
liattan.  Physicians  in  general  are  more  carefully  reporting  their  cases, 
as  are  also  the  hoipitils  and  dispensaries.  (General  enlightenment  of 
Ihe  public  at  large  through  the  lay  press  and  through  the  distribution 
of  circulars  in  many  languages  by  the  Department  of  Health  to  af- 
tlicteil  families  and  others  have  caused  the  laity  to  be  on  the  alert  and 
to  seek  earlier  medical  advice  than  heretofore.  The  Uronx  also  shelters 
a  very  large  number  of  tuberculosis  cases  in  Seton  and  St.  Joseph's 
Hospitals,  both  of  which  are  constantly  filled  with  these  afFlicled  people. 
A  goodly  number  of  cases  of  tuberculosis  have  been  sent  from  this 
borough  to  Ray  Urook  and  <  Itisville  Sanatoria  and  to  St.  Vincent's 
Hospital  on  Statcn  Island. 

The  new  clinic  will  he  able  to  lake  care  of  a  large  numher  of  am- 
bulatory cases,  and,  altogether,  the  outlook  for  the  year  1907  in  the 
caring  for  the  supervision  over  consumptives  is  one  of  good  promise. 

In  conclusion  it  is  to  be  said  that  the  standard  of  the  work  of  the 
Division  in  the  borough  has  been  greatly  raised  during  the  past  year — 
due  in  great  measure  to  the  faithful  and  conscientious  work  of  the  in- 
spectors, nurses  and  employees. 


HoKouciH  UP  Hkooki.vn. 
Report  of  the  Inspector  in  Charge. 

Recapitulating  the  work  of  this  Division  in  the  Borough  of  Brook- 
lyn during  1906  and  the  progress  made.  I  beg  to  report  as  follows: 

The  offices  of  the  Division,  located  for  some  eighteen  months  at  N'o. 
75  Henry  street,  were  removed  on  the  first  of  October,  igo6,  to  \o.  361 
Jay  street,  this  change  having  been  made  necessary  by  the  opposition 
of  residents  of  Henry  street  and  the  vicinity  to  the  opening  of  the  tu- 
berculosis clinic,  they  having  secured  a  permanent  injunction  against 
the  same,  and  while  the  new  building  is  not  so  spacious  as  the  old.  yet 


it  :-!  r'^ir  '::.-.r*:  :-;r.:ri'  '^r      ..-r:i-.^--::-.--r:":     :'  :>  r  •,:::?  niort:  suitable  for 

'Jh«.:  r.'.ri-ur.:!-.  incr-rivir.^  v.  rk  :  :r.-j  I^:v>:-  n  rer.'iered  necessarv, 
'•.'irlv  in  th':  \*r^z.  ::i';  err.%!  ••.:■.>■:.:  ■:  :a  a  :  ::::  n.V:  clerks  and  two 
i  fry  lira!  in^pfrct'.r'. 

'11 '•  :i'-.v  t-ri'ph  .n*.  -;. -t":..  f  rv;:::-:r^::  r.  a::;  assitninient  for  in- 
^[^•rTi'^rj  'f  itilf.-nM:!^*:-  ca»'>  ha*  v."rkc'i  very  well  as  far  as  the  in- 
s\9(r\ur-  ar*^:  » onrerned.  tiK-re  fnrincr  ^.i^rh:  «:'  them  '»n  rlistrict  duty. 
Siiic.t  it*  fomn.'-nrcir.riit  their  \V'»rk  ha>  r.  -l  heeii  heavy:  with  the 
nursr;^.  h'/.M-v«r.  it  ha-,  n't  been  i»'.-<i!»ic  f.  r  the  tV'iir.  between  whom 
\]\i'  cntiM-  ^i'tvttyVyih  ii  'lividc!.  v>  c'»vtT  the  iK-CL-s^ary  ground  so  as  to 
rf9\u\}\*'U-  all  v\«*rk  a^-ijrncM  within  the  all«.»tte«i  twenty-four  hours.  It 
is  hojifwi.  however,  that  the  services  of  an  a^Mitional  nurse  for  district 
rhity  can  he  secured,  which  wouhl,  in  all  probability,  solve  the  problem. 

To  show  the  distri!)utioii  ox  the  cases  of  pulmonary  tuberculosis  an 
<'iilarj;^ed  map  of  the  borouj^h  was  ]nirchaseil  and  each  and  every  case 
rq)orte«l  was  iiidicaterl  thereon  with  a  tack,  and  this  chart  now  adorns 
the  entire  side  of  one  room  fsee  i)h<»toi^ra])h ). 

Tuberculosis. 

(  )ur  principal  work,  the  sanitary  supervision  of  tubercidosis,  has 
been  c.'irriejl  nn  alon^  the  old  lines,  but  these  have  perhaps  been  fol- 
lowed out  more  thorouj^hly  than  ever  befnre.  result inj^  in,  first,  the 
b»tal  report  during  the  v<';ir  ^A  sniiu'  5,.|<xi  eases  of  i)ulm(Miarv  tubercu- 
losis. |(>ii  eases  in  :i.lvanee  of  1005  ;  i^\  this  number,  those  that  the  De- 
partment w.is  |»ermitte«I  to  visit.  reeei\ed  i^vJ50  visits  from  our  in- 
spectors and  nnisi's.  M«»ie  eiienlais  of  Inlurmation  rei^ardinjjf  this  dis- 
ease well'  tlistributiMJ  than  evi*r  before  b\  insjuvtors.  by  nurses  and  at 
v.nioii'-  meetin-^s,  ct»nrerninj^  this  di'^iase.  held  in  the  boroup^h  dttring" 
the  \e.ii  under  piiv.ite  .msjiivrs.  I'he  new  dnstini:  circidar  figured 
pionnnentlx  and  one  w.is  issiu-d  b\  nm  se  or  inspecior  on  each  visit 
without  lesptvt  to  the  n.itme  »»!   ilu'  »!iMa«-e 

We  ha\e  bet  n  continn.dlx  .''1  tl'e  l.^^U.^ii:  to'.-  intVc:e»i  l\nisos.  and 
\!i  oidei  to  jMeNcr.i  the  posm1m1i:\  oi  ms'Ii  ,'.v\  e'.^vi":!^.  iss-.-.,-.'  ^lurinsr  the 
\e.u  s,  v\-  --S  1^•^^w.ll!OIl  »»!dv'!s.  ,\\\  \\w\k.\>^k  \k\  t ' \'  vvivi.'iis  year 
I't   .il-o'.;t    AV* 


i 


I. 


r 


403 

Typhoid  Fever. 

This  disease  has  been  less  prevalent.  The  1,200  cases  reported  being 
700  less  than  last  year,  and  through  the  circulars  of  information  con- 
cerning this  disease,  distributed  in  every  instance,  the  Department  may 
claim  some  credit  in  having  prevented,  in  many  cases,  direct  infection. 

Cerebrospinal  Meningitis, 

Only  200  cases  of  ccrebro-spinal  meningitis  having  been  reported 
during  uyoCh  the  disease  may  be  considered  to  have  become  sporadic, 
and  the  fumigations  and  disinfections  done  and  the  circulars  distributed 
may  again  claim  some  good  effected. 

Diphtheria, 

This  disease  has  been  rather  more  prevalent  during  1906  than  dur- 
ing 1905. 

As  o.wQ  good  result  of  the  Department's  work  I  may  mention  the 
fact  that  out  of  1,982  persons  immunized  against  the  disease  by  the  in- 
spector.^ (and  they  have  injected  every  one,  to  their  knowledge,  exposed 
to  the  disease)  only  three  develoj)ed  diphtheria,  and  each  in  this  in- 
stance was  a  very  mild  form. 

On  the  1 2th  of  November  the  long  delayed  tuberculosis  clinic  was 
opened  and  started  under  the  most  promising  auspices,  with  a  most 
excellent  corps  of  attending  physicians  and  nurses.  The  attendance 
runs  from  two  to  five  new  cases  daily  and  from  five  to  fifteen  revisits, 
but  this  number  is  constantly  augmenting.  Through  the  kind  offices  of 
the  1  Brooklyn  Bureau  of  Charities,  daily  distribution  is  made  of  two 
quarts  of  milk  and  three  eggs  each  to  some  forty  of  the  clinic's  patients, 
who  have  been  adjudged  suitable  for  such  extra  diet. 

The  clinic  is  now  open  for  patients  from  2  to  4  p.  m.  daily,  but  it 
will  soon  l)c  necessary  to  have  morning  and  evening  hours  similar  to 
those  uf  the  ^Manhattan  clinic. 


404 


Rt'f*i^rt  of  the  Inspector  in  Charge. 

I. — frsftttors. 
\o  chanjj^c  in  the  lumiber  or  pcr>i.»nncl  «.»£  the  Inspectors  occurre 
during  the  year,  the  Division  continiTins^r  to  have  one  inspector  of  il 
own.  plus  the  services  of  a  diagnostician  fr.r  antit«.^xin  injection.  l<3ane 
by  the  Division  «»f  Ir.spiecti«»ns. 

That  this  ft:«rce  is  hardly  adequate  ioT.  nor  commensurate  with  th 
size  of  the  borougli.  is  apparent  at  a  glance. 

Sict  of  Borough — Lenv^th.  24  rrilcs :  width.  15  miles:  area.  10 
square  miles.  PopuIat:«  n.  J5o.(.xx\  ilivided  as  ft^ll»-»\vs:  First  Ware 
6^.000;  Second  Ward.  6^.oi»:  Third  Ward.  Jij.ooo:  Fourth  Ware 
42.000:  Fifth  Ward.  10.300. 

(a)  Ft.T  antitoxin  inicctii'ii  the  b.-^roujirh  was  divided  into  two  dis 
tricts.  the  first,  coir.prisinir  the  I-'irsr  a::'!  Second  Wards:  the  seconc 
the  Third.  Fourth  and  Fifth  Wards.  These  two  districts,  comparec 
show  the  maj'.'r  part  •  f  the  aruit'^xir.  work  was  done  in  the  first  dis 

trict. 

i"  r^t  Second 

I^  -r-:::  Pistrict. 

P*rir..j.ry  ir.-e-it:- r.<       ...  ~:  53 

Per-'"!.".^  :n:x.-:.;/-ii  . . .  •  -.■■  "6 


\h\  F«jr  tu!  crci:!'  >:>.  :\pii":«l.  C.  S.  - -.  :iv.  :  .•/'.  :ixT  inspections 
lix'  bi^r-  uirh  was  C"VcrL«l  in  its  entity  by  :l:c  •  !io  ••.>;.^or-  r.  The  tota! 
area  of  the  district  i^cinc:  107  S'lv.a^e  !::i'es.  '/"'■t'.-.'.  .■.'.'  Aa::ct-  had  to  b< 
marie  f'-r  dela}   in  reaci::nir  nrc::::-o-  w-:::i::  :*x  :'v<o'-'  <  !  :i:::e  limit. 

II. — X^irses. 
L'p  v.*  X«»vciv.btT  J',  a  niir-e  wa>  as-ic^U"  :  :     w,^:k  :\\       :.i\>  a  week 
in  this  borough,  the  balance  .f  her  time  bei::g  .livi.ic.:  -c:a.v::   Rich- 
mond Borough  and  the  Manhattan  T;iberci::o>i>  C:i::io.      Tl-^  :  r  ved 
xo  be  so  unsatisfactory,  by  rcas.-n  of  tho  i':-ca<.  •  :   a    rk  .i-  :  f.   de- 


40S 

lay  in  \'isiting  cases  (patients  frequently  being  reported  as  dead  before 
first  visit  of  nurse  was  made)  that,  on  November  20,  a  nurse  \\zs  as- 
signed exclusi\-ely  to  the  borough. 

Borough  of  Queens. 

COMPARATIVE  TABLE  I. 


Disease. 


1905. 


Diphtheria 

Tuberculosis 

Typhoid 

C.  S.  M ' 

Pneumonia 

Malaria 

Erysipelas 

Sepsis   

Abortion  


Cases. 

Deaths. 

- 

72 

Cases. 

Death 

577 

627 

94 

504 

278 

603 

308 

146 

31 

166 

30 

38 

48 

21 

16 

105 

384 

534 

4«3 

2 

4 

23 

7 

2 

6 

ao 

10 

II 

16 

24 

16 

4 

10 

I 

3 

1906. 


Note — Where  the  above  figures  do  not  correspond  with  the  sum  of  the  daily 
reports,  it  is  because  of  the  subtraction  at  the  end  of  the  year  of  the  total  number 
of  "  no  cases  ** — i.  e,,  cases  that  have  been  counted  but  returned  "  no  case." 


4o6 


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Aog 

III. — Records. 

During  the  year  the  following  changes  in  gathering  and  keeping 
the  records  were  inaugurated : 

The  method  of  reporting  tuberculosis  cases  by  institutions,  and  of 
assigning  these  cases  to  inspectors  and  nurses,  was  changed  from  the 
mail  to  the  telephone.  (For  the  detail  of  this  arrangement  see  Chief 
of  Division's  report) 

The  operation  of  this  system  in  this  borough  was  attended  with 
some  difficulty.  Out  of  the  five  hospitals  in  the  borough  one  had  no 
telephone  and  one  had  recently  adopted  a  rule  to  receive  no  more  cases 
of  tuberculosis.  The  telephone  service  to  Astoria  was  and  still  is  so 
wretched  it  is  only  with  great  difficulty  that  messages  can  be  transmitted 
with  any  degree  of  accuracy,  and  that  no  momentous  errors  have  oc- 
curred is  only  an  indication  of  the  carefulness  of  both  the  operator 
in  Manhattan  and  the  inspector  in  Queens. 

Maps — As  in  1905,  the  locality  of  all  cases  of  tuberculosis,  cerebro- 
spinal meningitis,  typhoid  and  pneumonia  were  indicated  on  large  maps 
of  the  borough  by  means  of  colored  tacks. 

These  maps  show  at  a  glance  the  segregational  tendency  of  these 
disease,  clumps  of  tacks  pointing  plainly  to  foci  of  contagion.  For 
example,  the  worst  two  spots  for  tuberculosis  are  Hunter's  Point,  in 
Long  Island  City,  and  Ridgewood,  adjacent  to  the  Brooklyn  boundary 
line. 

Chart — A  chart  was  kept,  indicating  by  colored  lines  the  weekly 
rise  and  fall  of  the  communicable  diseases. 

In  this  borough  the  weekly  reported  number  of  the  various  diseases 
so  nearly  corresponded  that  the  frequent  criss-crossing  of  the  colored 
lines  on  the  chart  was  confusing.  I  therefore  recommend  that  the 
chart  for  1907  be  modified  as  per  plan  proposed. 

The  reproductions  of  each  disease  separately,  as  here  submitted, 
were  so  made  in  order  to  obviate  the  bewilderment  incident  to  a  con- 
templation of  the  whole. 

IV,— Diphtheria, 
The  time  of  year  in  which  diphtheria  was  most  prevalent  in  the 
borough  was  the  week  ending  December  22,  with  thirty-two  (32)  cases 
reported  and  four  (4)  deaths. 


410 

The  locality  of  the  greatest  occurrence  was  Hunter's  Point,  in  Long 
Island  City. 

Total  number  of  cases  reported  during  the  year 623 

Total  number  of  deaths  9i 


Of  the  105  cases  injected  by  the  Department  only  nine  were  in- 
tubated. This,  with  the  small  number  of  deaths  (8),  would  seem  to 
indicate  that  the  cases  were  visited  promptly  and  injected  early  in  the 
course  of  the  disease. 

Private  Physician's  Cases — Ever>'  physician  reporting  a  case  of  diph- 
theria, but  declining  the  offer  of  antitoxin  injection,  was  interviewed 
by  an  inspector,  with  a  view  to  ascertaining  if  antitoxin  was  adminis- 
tered privately ;  if  not,  why  not ;  and  offering  again  the  services  of  the 
Department. 

The  inspectors  reported  to  the  Inspector-in-charge,  from  time  to 
time,  that  many  of  the  physicians  so  interviewed  grew  angry  at  the 
fancied  interference  of  the  Health  Department  in  their  affairs,  but  the 
employment  of  tact  usually  elicited  the  information  without  causing 
such  offense  as  to  result  in  a  formal  protest  to  this  office. 

A  brief  summary  of  this  work  follows : 

Number  of  physicians  interviewed loi 

Number  of  interviews 278 

Privately  injected 25a 

"  Does  not  believe  in  antitoxin" 2 

"  Case  too  mild  for  antitoxin  " ^ 

"  Does  not  use  it  in  croup  " l 


f> 


1 


"Didn't  have  to 

"  Doing  well  without  antitoxin  " 3 

"CaDcd  too  late" i 

"  Child  too  nervous  " i 

"Did  not  wish  to  use  it" i 

"  Injection  not  warranted  " i 

•'  Case  convalescent " 3 

"  Case  not  diagnosed  as  diphtheria  " a 

"  No  reason  "  . 


6 


Quarantine  Release. 


■^ 


Quarantine  Release. 
Complaints  having  been  received  that  quarantine  was  raised  by  the 
Division  of  Contagious  Diseases  of  the  borough  before  later  cultures 


411 

showed  diphtheria  bacilli  to  have  disappeared,  or  without  any  later 
cultures  having  been  taken,  the  matter  was  investigated  and  the  charge 
found  to  be  true.  Since  that  time  daily  scrutiny  of  quarantine  releases 
has  been  maintained  by  the  Inspector-in-charge,  and  the  Assistant  Sani- 
tary Superintendent  communicated  with  in  each  case  of  omission. 

V. — Tuberculosis. 

The  time  of  the  year  in  which  tuberculosis  was  most  prevalent  in  the 
borough  was  the  week  ending  April  7,  with  twenty  (20)  cases  reported, 
and  eight  (8)  deaths. 

The  locality  of  the  greatest  occurrence  was  Hunter's  Point  (Long 
Island  City),  with  Ridgewood  (in  the  Second  Ward)  a  close  second. 

Total  number  of  cases  reported  during  the  year 604 

Total  number  of  deaths jo8 

Cases  reported  by  institutions 91 

Cases  reported  1^  private  physicians 220 

Cases  reported  by  dead  list 99 

Cases  reported  by  sputum 158 

Cases  reported  by  other  boroughs S3 

Cases  reported  miscellaneously 6 

Duplicate  reports   206 

Cases  not  found 166 

Cases  entering  hospitals 50 

Mistaken  diagnosis  3 

Voluntary  renovations  251 

Fumigations   360 


The  last  two  items,  compared,  indicate  a  gratifying  willingness  on 
the  part  of  the  inhabitants  of  Queens  to  augment  the  efforts  of  the 
Health  Department  in  dealing  with  this  disease.  There  were  only 
twenty-nine  (29)  ordered  renovations. 

Forcible  Removals — ^There  were  only  two  forcible  removals  during 
the  year. 

Hospitals — The  census  of  cases  of  tuberculosis  in  hospitals  was 
taken  twice,  March  i  and  August  i. 

The  returns  made  it  obvious  that  in  spite  of  frequent  visits  by  the 
Inspector-in-charge,  letters  of  instruction,  etc.,  the  hospitals  were  not 


vast  "iie  nusnin  if  jca.'i^'.mr  ±ia  iur'  5r:r  rie  tiiuac  iir^<Bizar  aik*  gmrinrEE- 

Sir  ^azT'jiHmj'  -sr^  Ji  "fie  TKraimam:-  :f  siuh  iuirtaw.  atF  Ah:^  »  21& 
jisiaJTT  5:r  suiurs  x.  oeriinn  :hem.  irui  is  zie  imrumDcn:  ■;:£  Ac  $«>- 

::ill  inil  if-mnsi  rtniirs  iesmef.  •ji»:iTii3ii*  mni  zhn  iiiJtst  rorairr^tE  cf 
gaing  f:t»  j»:RT:in:ne  macent  :f  rie  niritiL  jLicir-i  '3i:«:k3  -we:*  finnii^ifid 
V.  !±e  .^snmtii'.na.   ami  ±e7  ar^  31: w   zLle.!  ic    imrs.  i  -vsttM:  snr  i3k 

m&rruiraiG  a*  -i  tiieir  cnnrirs  zi:2*is  :f  t:ii*:i;mj:sif  to*  sesn  «?c2L  raa 

tl!:2i  r^ricspi  fir  "ihe  fnc  timt;     m  J  ire  :  vriir  I'te  fiur'vrar  resois: 

Ler::cr*  fcat  -^ur .....  3^4 

^tjtfia!%  VKxtrsi 33S 

Fasfci  5&  rs^7 .     ..  29 

CiMi  imgrs^fif ^ 

CuM$  W'sne L2 

Cid«»'£;eil 69 

VtuaetAiiCX.tf .  €7 


fcr  ^^^*fi<v,tir^  2nd  die  "  Prrra:*  Ci<e  "  £Ie  t3^  lixn  c^:rr«:ted  to  date 

Tte  fiirivatfe  pfn'iiciarLs'  file  or  "*  o:c-repi:r:e*i  cis^es  "  sfa^w^  rbc  fol- 

Ifwtgr  ci  thfueuM  bSSag  to  report  ace  cue j6 

K«fii^<r  f4  ^y3idu»  iaSBa^  xo  report  two  cases 13 

?(am&er  fA  ^kfndsoLA  ha&ag  to  rtpon  dscc  or  z»3?e  cises 4 

StUKher  (A  $briiaim  rcritcrinj  two  letters  before  reply=« 17 

Kwnber  <!>f  pbjrfidam  nrntdtiag  tbret  letters  before  replyb:? o 


413 

Cases  of  Tuberculosis  Reported  as  Having  Died  from  Other  Cause 
— Four  (4)  of  these  cases  were  investigated  with  very  unsatisfactory 
results,  the  physicians  maintaining  the  cases  were  not  tuberculous  in 
spite  of  our  records  (sputum,  etc.)  to  the  contrary. 

VI. — Typhoid  Fever, 

The  time  of  the  year  in  which  typhoid  was  most  prevalent  in  the 
borough  was  the  wteek  ending  August  18,  with  thirteen  (13)  cases  re- 
ported and  no  deaths. 

The  locality  of  the  greatest  occurrence  was  Hunter's  Point  (Long 
Island  City). 

Total  number  of  cases  reported  during  the  year 166 

Wrong  diagnosis 9 

Total  number  of  deaths 30 

Of  the  156  cases  reported  forty-nine  (49)  were  treated  in  hospitals, 

the  remainder  at  their  homes. 

Cases  which  physicians  failed  to  report  before  death 4 

Number  of  disinfections 70 

Number  of  milk  stores  inspected Z9 

Number  of  oyster  stores  inspected i 

VII. — Cerebrospinal  Meningitis, 

The  time  of  year  in  which  cerebro-spinal  meningitis  was  most  preva- 
lent in  the  borough  was  the  week  ending  November  17,  with  three  (3) 
cases  reported  and  no  deaths. 

The  locality  of  the  greatest  occurrence  was  the  Ridgewood  section, 
adjacent  to  Brooklyn. 

Total  number  of  cases  reported  during  the  year 21 

Wrong  diagnosis   2 

Total  number  of  deaths 16 

Cases  which  physicians  failed  to  report  before  death 5 

Number  of  fumigations  and  disinfections 18 


4M 

BCMOOCH    OF  QUIEKS. 

Tmbrrctilosit.    Ctrfhrii-tfimaJ  UentMeitis  and    Tyfhotd  Fever,  at  Refortrd  fry 
H'tfkt  amd  ArroKCcd  by  IVardi. 


'■    ji... 
Aj-il  7-... 


■'     14-.. 


W«n)  1.  -Wirf  U. 


3 

H     6 


Ward  I. 

Ward  11. 

Wird  III. 

Wild  IV. 

Ward  V. 

Week  Ending. 

1 

183 

i 

H 
J 

3 

i 
s 

■A 
I 

3 

36 

71 

1 

9S 

3* 

H 

1 

-        „ 

"       a? 

" 

" 

-■!  ' 

■' 

5    S8 

iV, 

" 

December  i 

.. 

»9 

- 

'3 

VIII. — Pneumonia. 
The  time  of  year  in  which  pneumonia  was  most  prevalent  in  the 
borough  was  the  week  ending^  March  3d,  with  twenty-one  (21)  deaths 
reported. 

Total  number  of  cases  reported  during  the  year,  534, 
Of  these  only  fifty-nine  (59)  were  living  cases,  the  balance  (483) 
being  reported  by  dead  list 

IX. — Malaria. 
Total  number  of  cases  reported  during  the  year,  23, 


4i6 

All  deaths  from  this  disease  (ii)  were  investigated,  and  in  four 
instances  it  was  found  that  other  causes  than  malaria  were  responsible 
for  death,  so  the  death  certificates  were  corrected  accordingly. 

X. — Erysipelas. 
Cases  reported  during  the  year,  20. 
Reports  filed,  no  investigation. 

XI. — Abortion, 

Cases  reported  during  the  year,  i. 
Reports  filed,  no  investigation. 

XII. — Puerperal  Septicaemia. 
Cases  reported  during  the  year,  24. 
Reports  filed,  no  investigation. 

XIII. — Culture  Stations, 
The  sixteen  substations  in  the  borough  were  inspected  every  month 
by  either  the  inspector  or  nurse,  and  thrice  during  the  year  by  the  In- 
spector-in-Qiarge.  One  station  (Bay side)  was  discontinued  and  an- 
other (Rockaway  Beach)  was  put  on  probation.  Other  than  these, 
the  pharmacists  evinced  a  willingness  to  do  as  directed,  and  the  boxes, 
although  in  some  instances  too  small,  are  now  in  good  order  and  con- 
dition. 

XIV. — Tabulation  of  Histories  and  Compilation  of  Statistics  for  the 

Diiision. 

It  was  decided  at  the  beginning  of  the  year,  that  this  work  would 
be  better  done,  continuously  (from  week  to  week)  throughout  the 
year,  instead  of  being  left  for  the  closing  weeks.  The  task  was  as- 
signed to  the  Inspector-in-Giargc  of  Queens,  who  drew  up  sheets 
for  each  borough  and  for  each  iliscasc.  The  histories,  when  completed, 
were  sent  to  his  office  by  the  itisjHHrtors  in  chargfe  of  each  borough, 
and  were  returned  stamped  "  Talnilatod."  for  filing. 

This  plan  should  have  worked  very  well,  the  one  flaw  being  the 
sending  of  incomplete  histories  to  bo  tabulated.  This  lack  of  care 
caused  much  inconvenience  and  delay.     In  order  to  o*.vi:Uo  this  diffi- 


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DIVISION    OF   COMMI.NICAI1I.K    IH&E.\SE!>.    BOHOL'GII    01-    QLIEENS— "  DISTRIBU- 
IN    OK    CASES    OK    TYPHOID    FEVEK.    CEREBRO-SPINAL 
MENINGITIS  ANU  PNEUMONIA.  1906." 


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424 

culty,  it  is  recommended  that  the  histories  for  each  borough  be  here- 
after tabulated  by  the  Inspector-in-Charge  of  each  borough. 

Added  force  is  lent  to  this  suggestion  by  the  fact  that  the  steady 
increase  in  the  office  work  of  the  Borough  of  Queens  will  compel  the 
appointment  of  a  clerk,  unless  the  above  recommendation  is  adopted. 

Recommendations. 

1.  Establishment  of  a  tuberculosis  clinic  either  in  Long  Island  City 
or  Jamaica.  The  necessity  for  such  a  clinic  grows  daily  with  the  in- 
crease  of  the  population  of  the  borough. 

2.  Removal  of  borough  office  to  the  borough  building  in  Jamaica. 
This  recommendation  is  made  with  full  knowledge  that  its  adoption 
will  work  an  inconvenience  to  the  present  Inspector-in-Charge  of  the 
borough,  but  as  the  "  good  of  the  service  "  should  overshadow  per- 
sonal preference,  it  is  made  in  that  spirit. 

3.  Transfer  of  the  Work  of  Tabulation — The  divisional  statistics 
of  each  borough  to  be  tabulated  by  the  respective  Inspector-in-Charge 
(the  private  physician  antitoxin  histories  by  the  Inspector-in-Charge 
of  Culture, Stations). 

4.  Rearrangement  of  Inspector's  Districts — The  assignment  of  an- 
other inspector  to  the  borough,  to  relieve  the  borrowed  services  of  a 
diagnostician,  and  to  more  equitably  divide  the  work,  is  a  pressing 
need,  which  bids  fair  to  be  supplied  within  the  next  few  months  by 
the  transferrence  of  a  Manhattan  Inspector,  at  his  own  request,  to 
Queens. 


Borough  of  Richmond. 

Report  of  the  hispcctor-in-Chargc. 
Commencing  January  i,  1906,  all  inspections,  administration  of 
antitoxin,  etc.,  which  formerly  was  done  by  the  various  district  in- 
spectors of  the  Division  of  Contagious  Diseases,  have  been  done  by 
the  Inspector-in-Charge  and  one  nurse,  the  latter  spending  two  days 
per  week  here  until  December  ist,  since  when  she  has  spent  four  days 
per  week  there. 


425 

All  disinfections  have  been  made  by  our  own  disinfector,  promptly 
and  thoroughly. 

This  small  force,  with  the  very  large  territory  to  be  covered  added 
to  the  very  poor  public  transit  facilities,  has  had  at  times  very  hard 
work  to  get  the  work  done  on  time,  but  I  am  glad  to  report  that  the 
work  has  always  been  promptly  and  efficiently  performed. 

There  has  been  no  epidemic  of  any  of  the  communicable  diseases 
under  the  supervision  of  this  Division  in  this  borough — all  cases  re- 
ported being  sporadic,  and  in  only  one  instance  (a  case  of  typhoid) 
was  there  any  suspicion  of  direct  infection. 

Typhoid  Fever. 

There  were  two  less  cases  of  typhoid  fever  this  year  than  last, 

and  the  death  rate  was  1.3  per  1,000  of  population  as  against  1.5  per 

1,000  last  year. 

Tuberculosis. 

There  were  20  per  cent,  more  cases  of  tuberculosis  reported  this 
year  than  last,  while  the  number  of  previously  unreported  dead  cases 
has  fallen  from  41  in  1905  to  28  in  1906,  thus  showing  that  the  phy- 
sicians are  reporting  their  cases  better.  The  death  rate  per  1,000  has 
fallen  from  21.2  per  1,000  in  1905  to  17.1  in  1906.  The  presence  in 
this  borough  of  a  sanatorium  for  tuberculosis  which  receives  most 
of  its  cases  from  other  boroughs,  brings  this  death  rate  higher.  If  we 
subtract  the  deaths  of  patients  in  this  sanatorium  from  the  total  deaths 
from  this  cause  we  get  a  revised  death  rate  for  this  borough  of  12.4 

per  1,000. 

Pneumonia. 
There  have  been  a  great  many  more  cases  reported  during  1906 
as  the  physicians  understand  more  and  more  that  this  is  a  reportable 
disease.    The  death  rate  per  1,000  has  fallen  markedly,  however,  from 
22.  in  1905  to  18.9  in  1906. 

Diphtheria. 
Twenty-one  cases  of  diphtheria  received  35  curative  injections  of 
antitoxin,  with  no  deaths  due  to  diphtheria  proper.     Twelve  intuba- 
tions were  made  with  no  deaths.     220  exposed  individuals  received 
immunizing  doses  of  antitoxin  and  only  one  of  these  cases  subsequently 


*l 


426 

contracted  diphtheria  and  as  it  de>'eloped  in  less  than  24  hours  after 
the  immunization  was  performed,  the  child  probably  had  the  disease  at 
that  time.     The  case  proved  a  ver\-  mild  one. 

Clinics  for  the  Tre.\tment  of  Communic.\ble  Pulmonary 

Diseases. 

Report  of  the  Chief  of  Clinics. 

A  review  of  the  work  of  the  Clinic  for  the  Treatment  of  Communi- 
cable Pulmonar}'  Diseases  for  the  year  1906  is  interesting,  quite  as  much 
for  the  large  share  it  has  had  in  the  various  efforts  made  for  the  care 
and  relief  of  tuberculous  patients  by  municipal,  private,  and  charitable 
organizations,  as  for  the  steady  progress  and  effectiveness  of  its  own 
work. 

The  dispensary  system,  so  much  more  tardy  in  development  in  this 
country  than  in  France  or  Germany,  has,  in  the  past  year,  grown  rapid- 
ly, becoming  daily  more  satisfactory  and  more  an  essential  part  of 
the  modern  anti-tuberculosis  machine. 

When,  therefore,  it  is  said  that  the  Department  Clinic  has  thor- 
oughly justified  the  purposes  for  which  it  was  established;  that  it  has 
been  a  clearing  house  for  the  various  classes  of  consumptives  as  well 
as  an  individual  school  of  instruction,  or  preventorium;  that  it  has 
served  as  a  model  for  similar  institutions  elsewhere  in  this  country; 
and  that  it  has  shared  actively  with  similar  dispensaries  here,  in  con- 
certed measures  for  the  relief,  care  and  control  of  the  City's  consump- 
tives, it  is  evident  that  the  year  has  been  one  of  success  and  progress. 

History  Cards. 

An  improved  set  of  history  cards  has  been  devised  which  is  more 
comprehensive  and  is  designed  for  use  in  and  to  secure  uniformity  of 
the  records  of  all  the  tuberculosis  institutions  of  the  Department. 

Otisz*ille  Sanatorium. 

Since  the  opening  of  the  sanatorium  for  incipient  patients  at  Otis- 
ville.  all  applicants  have  been  examined  in  the  clinic  and  admitted  by 
the  Chief  of  Qinic.  To  the  Assistant  to  the  Chief  of  Clinic  has  been 
assigned  the  conduction  of  each  party  of  patients  to  the  sanatorium. 


427 

State  Sanatorium, 
Applicants  for  admission  to  the  State  Sanatorium  at  Ray  Brook, 
N.  Y.,  have  also  been  examined  at  the  Clinic,  subject  to  review  by  the 
Chief  of  Clinic,  and  final  examination  by  the  Chief  of  Division. 

Extra  Diet. 
Extra  diet  in  the  form  of  milk  and  eggs  has  been  supplied  on  recom- 
mendation of  the  physicians  in  attendance  and  subject  to  the  approval 
of  the  Chief  of  Clinic,  to  incipient  and  favorable  second  stage  cases 
only,  and  only  after  careful  investigation,  by  a  nurse,  of  their  financial 
need  and  fitness  for  such  aid,  previous  experience  having  shown  the 
necessity  of  great  care  and  constant  control  to  prevent  abuse  of  this 
valuable  adjunct  to  treatment.  Further,  only  those  who  become  and 
remain  patients  of  the  clinic  now  receive  the  extra  diet,  its  distribu- 
tion by  the  Manhattan  office  of  the  Division  having  been  discontinued 
early  in  the  year.  As  heretofore,  both  eggs  and  milk  have  been  dis- 
tributed through  the  depots  of  the  N.  Y.  Diet  Kitchen  Association  at 
the  expense  of  this  Department.  The  appended  tabulations  indicate 
the  limitations  which  it  has  seemed  wise  to  make  in  the  distribution  of 

extra  diet. 

Nurses, 

The  assignment  of  an  additional  nurse  to  the  work  of  visiting 
patients  in  their  homes  has  assisted  in  the  extension  of  the  Clinic's 
sphere  of  influence  and  has  made  it  possible  to  keep  more  patients 
needing  such  attention  under  observation.  It  is  recommended  again, 
as  in  the  report  of  1905,  that  this  feature  of  dispensary  work  is  es- 
sential and  should  be  extended  as  rapidly  as  possible  along  the  lines 
of  legitimate  nursing,  the  instruction  and  care  of  patients,  and  the  dis- 
infection and  fumigation  from  time  to  time  of  their  personal  and  bed 
clothing  in  their  homes. 

Brooklyn  Clinic, 
In  accordance  with  the  plan  of  this  Department  to  establish  dis- 
pensaries in  the  other  boroughs  of  the  City,  the  Brooklyn  Clinic  was 
opened  in  the  building  of  this  Division  at  361  Jay  street,  on  November 
12,  1906.  It  is  similar,  in  equipment,  methods  of  operation  and  pur- 
pose, to  the  Manhattan  Clinic.    Occuping  the  ground  and  first  floors. 


I" 


428 

there  are  provided  a  registration  room,  a  waiting  room  for  patients,  an 
examination  room  each  for  men  and  women,  and  a  throat  room.  Owing 
to  many  delays  the  latter  is  not  yet  equipped,  and  the  clinic,  as  a  whole, 
has  scarcely  established  itself,  but  the  work  done  so  far  has  been  ver)' 
satisfactory. 

Chief  of  Clinics,  Supervising  Nurse,  Clinic  Nurses, 

With  this,  the  first  extension  of  the  Department  dispensary'  system, 

the  organization  and  immediate  direction  of  the  Brooklyn   Clinic,  as 

I  j 

j  well  as  all  those  soon  to  be  put  in  operation  elsewhere,  was  assigned 

to  the  Chief  of  Clinic  under  the  title  of  Chief  of  CHnics,  and  Miss  Lx)is 
Davidson  was  detailed  as  supervising  nurse  of  clinic  nUrses.  For  the 
Manhattan  clinic,  in  addition  to  three  nurses  assigned  to  clinic  work, 
two  nurses  are  detailed  from  the  Willard  Parker  Hospital.  For  the 
Brooklyn  Clinic  three  nurses  are  detailed  from  the  Kingston  Avenue 
I  lospital. 

X'Ray  Work. 

Unfortunately,  little  use  has  been  made  of  the  X-Ray  plant  except 
for  radioscopic  examinations,  as  owing  to  lack  of  a  suitable  dark  room 
no  photographic  work  could  be  done.  However,  since  the  removal 
of  the  drug  laboratory  from  the  cellar  of  the  clinic,  a  completely 
equipped  dark  ro<Mn  has  been  designed  and  is  now  being  installed  there. 
Improvements  have  been  made  in  the  efficiency  of  the  plant  and  the 
ease  and  safety  of  its  operation,  and  under  the  direction  of  Dr.  L.  G. 
Cole,  who  has  kindly  oflfered  his  services,  it  is  hoped  during  the  com- 
ing year  to  make  some  studies,  by  means  of  photographic  plates,  of 
incipient  lesions. 

Attending  Physicians. 

Some  changes  have  been  made  in  the  personnel  of  the  attending- 
physicians.  Their  services,  given  without  remuneration,  have  been 
for  the  most  part  faithful  and  efficient.  The  work  is  exacting,  not 
without  hazard,  and  requires  skill,  judgment  and  a  knowledge  of  the 
tuberculosis  problem,  which  only  men  trained  in  this  work  possess. 
This  Department  cannot  expect  to  secure  and  retain  the  services  of 
such  clinical  assistants  without  making  them  some  financial  return; 
certainly  it  cannot  demand  their  ser\ices  to  the  detriment  of  their  own 


429 

private  work,  and  it  is  therefore  strongly  recommended  in  order  to 

secure  more  constant  attendance  and  fewer  changes  in  the  attending 

staff,  that,  as  has  been  promised  for  so  long  a  time,  adequate  salaries 

be  paid. 

Dispensary  Districts. 

An  exceedingly  important  feature  of  the  year's  work  to  which  at- 
tention is  especially  directed  is  the  cooperation  of  the  Manhattan  Clinic 
with  other  tuberculosis  dispensaries  of  that  borough  and  under  the 
auspices  of  the  Charity  Organization  Society's  Committee  on  the  Pre- 
vention of  Tuberculosis,  in  the  Society's  relief  work,  and  the  develop- 
ment from  this  of  a  system  of  dispensary  districts  which  promises  in 
the  future  to  be  an  important  factor  in  the  municipal  control  of  pulmo- 
nary tuberculosis. 

Certain  charitable  persons  having  given  to  the  Charity  Organiza- 
tion Society  a  considerable  sum  of  money  to  be  expended  for  the  re- 
lief of  tuberculosis  patients,  a  sub-committee  was  appointed  consisting 
of  the  Secretary  of  the  Committee,  Mr.  Paul  Kennaday;  the  Assist- 
ant Secretary  of  the  Society,  Mr.  C.  C.  Carstens ;  Mr.  Gaylord  White, 
interested  in  the  Society's  work;  Dr.  S.  F.  Hallock,  closely  identified 
with  the  district  work  of  the  Society,  and  the  following  physicians: 

Dr.  Jas.  Alexander  Miller,  chairman;  director  of  the  tuberculosis 
dispensaries  of  Bellevue  and  Allied  Hospitals. 

Dr.  J.  H.  Huddleston,  in  charge  of  the  tuberculosis  work  of  Gouver- 
neur  Hospital  Dispensary. 

Dr.  Henry  L.  Shively,  in  charge  of  the  tuberculosis  work  of  the 
Presbyterian  Hospital  Dispensary. 

Dr.  Henry  W.  Patterson,  in  charge  of  the  tuberculosis  work  of 
Vanderbilt  Clinic. 

Dr.  B.  H.  Waters,  in  charge  of  the  clinics  of  the  Department  of 
Health. 

Early  in  the  year,  this  committee,  sitting  once  a  week,  began  re- 
viewing cases  referred  to  it  by  the  district  agents  of  the  Charity  Or- 
ganization Society  and  deciding  the  best  disposition  to  make  of  each; 
in  some  cases  removing  them  to  better  quarters  and  paying  the  excess 
rent;  in  others  paying  the  wage  loss  while  patients  were  in  a  sana- 
torium, providing  beds  for  the  separate  use  of  patients,  sending  patients 


430 

for  periods  of  several  weeks  or  months  to  the  country,  besides  giving 
much  financial  assistance.  (For  more  detailed  information,  see  below 
and  also  the  special  report  of  this  Committee.) 

It  was  soon  found  that  such  work  required  preliminary  medical  ex- 
aminations and  reports,  and  while  at  first  such  reports  were  obtained 
from  the  dispensary  at  which  the  patient  was  attending,  it  was  later 
thought  desirable  that  the  respective  chiefs,  being  members  of  the  com- 
mittee, could  best  do  this  work. 

Many  patients  too  ill  to  attend  the  dispensary  required  to  be  visited 
in  their  homes.  The  greater  part  of  this  visiting  has  been  done  by  the 
physicians  of  this  Department. 

Still  later,  in  order  to  facilitate  the  work  of  the  dispensary  nurse 
and  to  avoid  duplication  of  their  visits,  it  was  decided  to  assign  to  each 
dispensary  represented  on  this  committee,  a  definite  district,  and,  after 
June  1st,  to  require  each  dispensary  to  refer  every  new  patient,  as  soon 
as  a  final  diagnosis  of  pulmonary  tuberculosis  could  be  made,  to  the  dis- 
pensary in  whose  district  he  or  she  lived,  further  treatment  being  there- 
after refused  in  the  dispensary  of  original  application. 

The  districts  as  first  laid  out  were : 

Bellevue,  bounded  on  the  south  by  East  Tenth  street,  on  the  west 
by  the  Bowery,  Broadway  and  Fifth  avenue,  on  the  north  by  Fifty-ninth 
street,  and  on  the  east  by  the  river. 

Gouverneur,  bounded  on  the  south  by  Brooklyn  Bridge,  on  the  west 
by  the  New  Bowery,  on  the  north  by  Grand  street,  and  on  the  east 
by  the  river. 

Presbyterian,  bounded  on  the  south  by  Fifty-ninth  street,  on  the 
west  by  Fifth  avenue,  on  the  north  by  Ninety-fifth  street,  and  on  the 
east  by  the  river. 

Harlem,  bounded  on  the  south  by  Ninety-fifth  street,  on  the  west 
by  Fifth  avenue,  on  the  north  and  east  by  the  river. 

The  Department  of  Health,  the  rest  of  Manhattan  Borough  and 
the  other  boroughs  of  the  City. 

Later,  Bellevue  district  was  increased  by  the  extension  of  the  south- 
em  boundary  to  Grand  street.  Still  later,  on  the  admission  of  Van- 
derbilt  Clinic  to  the  system,  certain  chsLnvw^^^rndtm^yx'^re  made, 
so  that  at  present,  as  shown  on  the  acco  • 


431 

Bellevue,  on  the  south  by  Grand  street,  on  the  west  by  the  Bowery, 
Broadway  and  Fifth  avenue,  on  the  north  by  Forty-second  street,  and 
on  the  east  by  the  river. 

Gouverneur,  on  the  south  by  Dover  street,  on  the  west  by  the  New 

Bowery  and  the  Bowery,  on  the  north  by  Grand  street,  and  on  the 

east  by  the  river. 

Presbyterian,  on  the  south  by  Fifty-ninth  street,  on  the  west  by 

Fifth  avenue,  on  the  north  by  One  Hundred  and  Tenth  street,  and  on 
the  east  by  the  river. 

Harlem,  on  the  south  by  One  Hundred  and  Tenth  street,  on  the  west 

by  Eighth  avenue,  and  on  the  north  and  east  by  the  river. 

Vanderbilt,  on  the  south  by  Fiftieth  street,  on  the  west  by  the  river, 

on  the  east  by  Eighth  avenue  and  Central  Park  West,  and  on  the 

north  by  the  borough  limits. 


MAP  OF  MANHATTAN  DISTRICTS. 

As  will  be  seen  by  reference  to  the  statistical  tables,  this  procedure 
has  affected  little,  if  at  all,  the  attendance  at  the  Manhattan  clinic  of 
the  Department.  This  is  probably  due  to  the  fact  that  there  has  been 
during  the  year  a  steady  increase  in  the  number  of  patients  applying  for 
admission.  Whether  the  recent  assignment  of  a  district  to  Vanderbilt 
clinic,  which  occurred  about  December  ist,  will  greatly  diminish  our 
attendance  remains  to  be  seen.  Even  if  it  should  it  will,  within  certain 
limits,  be  an  advantage,  as  it  is  not  possible  now  to  give  to  so  many 
patients  the  careful  individual  attention  demanded  in  a  tuberculosis 
dispensary. 

This  scheme  has  been  of  such  advantage  and  has  been  so  easily 
put  into  operation,  securing  as  it  does,  convenience  for  the  patients, 
facility  and  saving  of  time  for  the  dispensary  nurses,  and  an  orderly 
distribution  of  patients,  that  the  question  may  well  be  considered  of  ex- 
tending and  strengthening  the  system,  not  as  a  part  or  only  a  part  of 
the  Charity  Organization  Society's  relief  plan,  but  as  a  definite  mu- 


432 

nicipal  system.  True,  objection  has  already  been  made  by  teachers  of 
medicine  that  it  tends  to  deprive  them  of  teaching  material.  It  remains 
then  only  for  the  institution  in  which  teaching  is  done,  to  establish  in 
their  respective  dispensaries  special  classes  for  tuberculosis  patients.  In 
one  instance  this  has  already  been  done.  This  objection  has  been  over- 
ruled and  the  dispensary  in  question  has  entered  into  the  arrangement. 
In  an  interesting  and  exhaustive  report  on  the  hospital  and  dis- 
pensary problem,  made  for  the  Committee  on  the  Prevention  of  Tuber- 
culosis of  the  Charity  Organization  Society,  by  Mr.  Christopher  Easton, 
he  recommends  that  a  system  of  tuberculosis  dispensaries  be  established 
under  a  uniform  administration.  This  in  many  of  its  essentials  has 
already  been  accomplished  by  this  group  of  associated  dispensaries,  with 
benefit  to  each,  and  the  logical  development  and  extension  of  any  such 
dispensary  plan  would  seem  also  to  involve  and  necessitate  a  require- 
ment which  would  be  entirely  justifiable  on  preventive  grounds,  and 
entirely  within  the  powers  of  this  Department,  namely:  That  tubercu- 
losis patients  be  permitted  to  attend  only  special  tuberculosis  dispen- 
saries. Such  patients  are  not  received  now  in  any  of  our  general  hos- 
pitals. Why  should  we  receive  them  in  our  general  dispensaries  and 
subject  the  other  patients  in  overcrowded  waiting  rooms  to  the  danger 

of  infection? 

It  is  recommended  that  this  dispensary  plan  and  the  suggestion  here 

made  be  considered  by  the  Department  during  the  coming  year. 

The  following  tabulations  indicate  how  great  a  share  the  clinic  of 

the  Department  has  had  in  the  relief  work  of  the  Charity  Organization 

Society  referred  to  at  length  above,  and  the  appended  tabulations  of 

the  work  of  the  clinic  for  the  year  and  of  the  Brooklyn  clinic  for  the 

last  two  months,  indicate  the  following  facts  of  especial  interest : 

Tabulation  of  Cases  Referred  to  the  Relief  Committee  of  the  Committee  on  the 

Prevention  of  Tuberculosis  of  the  Charity  Organisation  Society,  by  the 

Manhattan  Clinic,  January  30  to  December  31,  1906. 

Cases. 

Number  of  cases  examined  and  reported  upon  for  this  committee 263 

Diagnosis,  pulmonary  tuberculosis 222 

Diagnosis,  negative  41 

Aid  recommended  by  Manhattan  clinic 38 

Hospital  recommended 107 

Country  care  recommended 28 


433 

Action  Taken  by  Tuberculosis  Relief  Committee  in  These  Cases, 

Cases. 

Patients  sent  to  hospital 57 

Patients  sent  to  country 29 

Assistance,  food,  clothing  and  rent  to  patient 44 

Assistance,  food,  clothing  and  rent  to  patient's  family 35 

Clothing,  only,  supplied    ii 

Employment  obtained  4 

Families  removed  to  new  apartments  from  old  dirty  ones,  moving  expenses, 

rent,  etc.,  paid 9 

Emergency  relief  supplied 3 

Extra  diet  supplied 12 

Rent,  only,  paid 3 

Insurance  paid  i 

Children  sent  to  institution 2 

Advanced  cases  referred  to  the  District  Committee 18 

After  June  ist,  according  to  the  dispensary  system,  suggested  by 

this  committee,  there  were: 

Patients. 

Referred  to  other  tuberculosis  dispensaries 307 

Referred  by  other  tuberculosis  dispensaries  to  this  clinic 124 

Referred   to   Gouverneur 71 

Referred  to  Bellevue 127 

Referred  to  Presbyterian 39 

Referred  to  Harlem 70 

307 

Referred  by  Gouverneur  30 

Referred  by  Bellevue 69 

Referred  by  Presbyterian 9 

Referred  by  Harlem 16 


124 


434 


Tuberculosis  Clinic. 


Total  new  patients  treated 

Total  new  patients  treated,  male.. . 
Total  new  patients  treated,  female. 

Total  old  patients  treated 

Total  old  patients  treated,  male. . . . 
Total  old  patients  treated,  female. . 
Total  number  of  patients  treated . . . 

Average  daily  attendance 

Number  of  Russians  treated 

Number  of  Austrians  treated 

Number  of  Germans  treated 

Number  of  Irish  treated 

Number  of  Colored  treated 

Number  of  United  States  treated. . . 

Various 

Tailors,  furriers,  sweatshops 

Tailors 

Operator 

Furrier 

Cigarmaker 

Factory 

Housework 

Various 


Foreign  bom  patients 

Foreign  bom   patients  who  contracted  tuberculosis  I 
buore  arrival  in  this  country f 

Residents  of  Manhattan 

Residents  of  Bronx 

Residents  of  Brooklyn 

Residents  of  Queens 

Residents  of  Richmond 

^Number  of  quarts  of  milk  supplied  to  clinic  patients 

^Number  of  eggs  supplied  to  clinic  patients 

Total  number  of  new  cases 

Diagnosis  tuberculosis,  sputum  positive 


Manhattan. 


190S. 


1906. 


3,815 

4,088 

2^443 

J2,579 

1,372 

1,509 

15,580 

17,109 

10,608 

11,165 

4,972 

5,944 

19,395 

21,197 

64 

70 

474 

424 

MS 

203 

110 

92 

lao 

169 

3* 

39 

588 

244 

201 

281 

418 

615 

105 

128 

313 

143 

10 

10 

18 

32 

193 

60 

293 

375 

484 

753 

1,064 

888 

65 

50 

3,272 

3,397 

147 

14X 

34X 

496 

24 

a9 

31 

7 

12,510 

1 22,299 

9,757 

44,544 

3,8iS 

4,088 

881 

781 

Brooklyn. 
Nov.  i2-I>ec.  31 


1906. 


118 

70 

48 

45a 
289 

163 

570 

14 
II 

3 
3 
4 
I 

14 

6 

16 

3 


3 
10 

8 

27 


570 


118 
25 


*  Diet  supplied  to  187  patients. 

t  Quarts  of  milk  supplied  by  the  Division,  50,142.    Eggs  supplied  by  the  Division,  96,480. 


435 


Diagnosis  tuberculosis,  sputum  negative 

Total  number  of  positive  cases  transferred  to  hospitals. 
Total  number  of  positive  cases  transferred  to  sanatoria. 

Under  treatment  at  clinic 

Not  found  at  address  given 

Deaths 


Cases  under  treatment,  diagnosis  doubtful 

Cases  not  found  tuberculosis,  transferred  to  general  I 
hospitals  and  dispensaries,  or  discharged ) 

Cases  examined  for  Ray  Brook 


Cases  recommended  as  suitable  for  admission. 
Number  of  specimens  of  sputum  examined. . . . 

Tubercle  baciUi  found 

Tubercle  bacilli  not  found 

Number  of  patients  treated  in  throat  clinic. . . . 


Manhattan. 

Brooklyn. 
Nov.  u-I>ec.3i. 

1905. 

1906. 

1906. 

789 

i/»5 

14 

554 

607 

1 

119 

X89 

*  •  •  • 

451 

870 

191 

409 

210 

2 

137 

128 

•  •  •  • 

327 

176 

74 

2|i45 

2,126 

•  •  •  • 

651 

270 

•  •  •  • 

107 

♦131 

•  ■  •  • 

2,231 

2»3iS 

75 

881 

781 

25 

1.350 

i»534 

50 

521 

1,548 

.... 

*  Number  admitted,  116. 


Laryngeal  examination  was  made  of  2,307  patients.     Of  these  1,621 
presented  the  following  pathological  conditions : 


Not  Tubercular. 

Chronic  hypertrophic  rhinitis   244 

Chronic  laryngitis 195 

Chronic  pharyngitis 572 

Chronic  rhino-pharyngitis 508 

Tonsillar  hypertrophy 42 

i,S6i 

Tubercular, 

Laryngitis  102 

Pharyngitis i 

103 

1664 

Of  the  remainder  various  lesions  were  presented  by 166 

The  percentage  of  laryngeal  tuberculosis  in  patients  having  pulmon- 
ary tuberculosis  is  shown  to  be  about  5>4  per  cent. 


436 


Annual  Report  of  Tuberculosis  Cunics. 
boroughs  of  manhattan  and  brooklyn. 
Manhattan  Tuberculosis  Clinic — Attendance  Table, 


Month. 


Januau-y.... 
February  . . 

March 

April 

May 

June 

July 

August 

September. 
October . . . 
November. 
December. 


N 

ew  Cases. 

Old  Case! 

i. 

Total. 

M. 

F. 

T. 

M. 

F. 

T. 

M. 

F. 

T. 

193 

119 

312 

1,044 

530 

1,574 

1,237 

649 

i^ 

149 

81 

230 

927 

449 

1,376 

ifiTt 

530 

1,606 

208 

127 

335 

1,031 

528 

1,559 

1,239 

655 

1394 

228 

140 

368 

970 

529 

1 ,499 

1,198 

669 

1,867 

251 

143 

394 

1,056 

602 

1,658 

1,307 

745 

2/352 

238 

133 

371 

1,036 

509 

1,545 

1,274 

6*2 

1,916 

213 

127 

340 

937 

429 

1,366 

1,150 

556 

1,706 

214 

155 

369 

819 

409 

1,228 

1.033 

S64 

1,597 

239 

109 

348 

798 

417 

1,215 

1,037 

526 

1,563 

248 

142 

390 

1,019 

594 

1,613 

1,267 

736 

2,003 

211 

12S 

339 

760 

498 

1,258 

971 

626 

1,597 

1S7 

105 

292 

768 

450 

M18 

955 

555 

1,510 

2.579 

1,509 

4.0S8 

11,165 

5.944 

17,109 

13,744 

7,453 

21,197 

Daily  average  attendance,  70. 


Brooklyn   Tuberculosis  Clinic — Attendance  Table* 


Month. 

New 

Cases. 

Old  Cases. 

Total. 

M. 

K. 

T. 

M.           F 

T. 

M. 

F. 

T. 

November  12-  ^ 

...           41 

•*— 

21 

69 

4^ 

1C4           65 
i55  ,        or 

169 
2S3 

146 
213 

9a 
119 

332 

l>ecemUf  r 

aS  1 

C^f  1.13 J  foroij;:!^  Ix^rn  patioius.  only  fitly  or  less  than  one-half  of 
one  per  cent,  vvntraetCvi  tlio  liiscase  previous  to  their  arrival  in  this 
countrv. 

T!\e  nmr.ber  of  tu'w  pal  lei*.: >,  iV.e  !r.::v.Ver  of  revisits,  and  the  dailv 
averaco  aiiendanoe  was  inorvasovl.  v-.esri:o  ;>.e  i" creased  number  of 
special  tubeRni^sis  v!isix:".sa:ics  atul  :Ve  r.v::vVcr  cf  pa:ie:::s  i^see  above) 
transferred  to  them  *>>  t!v.s  cl'.v.ic  i-.*  excess  x^:  :'\^se  :-.-.::s:erred  by  them 
to  this  clinic. 


437 

In  only  176  instances  was  the  diagnosis  considered  doubtful,  as 
against  327  last  year.  This  seems  to  indicate  better  observation  of 
patients  and  greater  skill  and  decision  on  the  part  of  the  clinic  phy- 
sicians. 

The  small  number  of  "  not  found  "  cases,  the  large  number  of  visits 
made  (over  86  a  week)  and  the  number  of  patients  (318)  visited  more 
or  less  frequently  during  the  year,  shows  commendable  work  by  the 
nurses. 

Only  a  little  over  33  1-3  per  cent,  of  sputum  examinations  proved 
to  be  positive.  This  seems  to  be  too  small  a  percentage  and  steps  have 
been  taken  to  make  special  searches  of  those  specimens  which  have 
been  twice  negative,  when  the  clinical  diagnosis  is  tuberculosis. 

The  reduction  in  the  number  of  applicants  for  admission  to  the 
State  Sanatorium  at  Ray  Brook  and  the  increased  proportion  of  tliose 
recommended  as  suitable  for  admission,  is  perhaps  best  explained  by 
the  better  understanding  which  a  year's  experience  has  given  both  phy- 
sicians and  patients,  of  the  conditions  imposed  by  the  sanatorium  re- 
quirements. 

The  total  amount  of  milk  issued  includes  that  issued  during  the 
first  four  months  of  the  year  by  the  Manhattan  office  of  the  Division. 
Of  this,  22,299  quarts  were  issued  to  clinic  patients,  and  since  May  ist 
the  monthly  average  for  the  clinic  has  been  about  1,800  quarts.  Ap- 
proximately the  same  reduction  was  made  in  the  number  of  eggs  is- 
sued. 

Investigation  of  Deaths  Due  to  Malarial  Fever, 
Death  from  malarial  fever  in  this  climate  and  in  this  age  should 
occur  very  rarely,  if  at  all.  The  exceptional  cases,  it  would  seem, 
would  be  those  cases  of  pernicious  malarial  fever,  imported  from  the 
tropics.  With  the  accurate  means  of  bacteriological  diagnosis  now 
within  the  knowledge  and  at  the  command  of  every  physician  in  New 
York  City,  mistakes  in  diagnosis  and  the  confounding  of  malaria  witli 
typhoid,  etc.,  ought  to  be  reduced  to  the  minimum.  With  the  specific, 
quinine,  intelligently  employed,  and  with  the  recently  acquired  knowl- 
edge of  the  cause  and  prevention  of  the  disease ;  and  with  the  authori- 
ties, municipal  and  State,  putting  into  practical  eflfect  the  prophylactic 


438 

suggestions  of  scientists,  fatalities  from  "  malaria  *^  per  se,  should  be 
practically  anknoi!^!!. 

For  the  purpose  of  ascertaining  just  what  proportioD  of  the  re- 
ported deaths  from  malaria  should  be  attributed  to  other  and  more 
potent  causes,  the  following  card  was  designed  for  the  use  of  inspectors 
of  this  di\'ision  in  gathering  the  information  and  for  tabalating  the 
results. 

DEPAETHENT  OF  HEALTH 


MATJII^TA 


MVJSBOH  OP 


Dofoul^  o£*i— i^— — ■    ■  Ditt 


Addnc    ■  ■  ■■■     ■    I      I  Floor.  ■    ■   ■  ■  ■  .  No.    ■     ■  ■ 

■ 

Mtfno  ■  Age OccQ M.  P.  If .  S  W.  KtL- 

Reportad.    Dtte Hof«r  P.  a  B.  DL.  G^  L 

By      II     11  I    ■  I       ■       II        I  AdoTBS^"— *■      ■    ■  ■  »^i— ^— M^— > 


Agn.  ■  ■  To  I  I  Ret .—-..—  B7. 


Awl         I  To   ■  Ret..  ^f. 

ITSIr-lMT 


Procedinij  ^»»*^*^*  Tcrmp- 

Chflls Sweating Spleen  enhrgod 

Blood  ex&minM  Wldal— : RbsuUs— .._ 

Rose  spots ^Type Tertian  Quofldltn  ,  .  Quartm 

Makrial  Plasmodia—— Results 


Hcs  paUect  been  a  resident  of  New  York?   If  so,  where?: 


Bitten  by  Mosquitoes?. 
Diagnosis  based  on 


Remarks : 


Date*. 


■*"i"w"^ 


— M,  O. 


439 

Routine — These  cards  are  issued  from  the  borough  office,  from  re- 
turns received  from  the  Registrar's  Office,  where  the  information  is 
obtained  from  the  original  death  certificates.  The  cards  are  then  sent 
by  mail  to  the  inspector  in  whose  district  the  attending  physician  re- 
sides. The  inspector  makes  an  appointment  with  the  physician,  then 
calls  upon  him,  and  in  as  diplomatic  a  manner  as  possible  seeks  elucida- 
tion on  the  following  points: 

1.  On  what  basis  the  diagnosis  was  made;  whether  blood  exam- 
ination or  clinical  signs. 

2.  If  no  blood  examination  was  made,  the  reason  why;  the  in- 
spector politely  pointing  out  the  facilities  offered  by  the  Health  De- 
partment, free  of  charge,  and  urging  that  in  future  cases  of  the  kind, 
they  be  utilized. 

3.  The  Inspector's  own  opinion,  based  on  the  remarks,  manner, 
and  apparent  scientific  sincerity  of  the  physician ;  also  on  the  entrance 
into  the  case  of  insurance  and  the  necessity  of  adjusting  the  cause  of 
death  to  fit  the  requirements  of  the  insurance  company. 

Upon  the  return  of  these  histories  from  the  inspectors,  they  are 
forwarded  to  the  Registrar's  Office,  where  correction  of  the  death 
certificates  is  made  where  it  is  deemed  advisable.  The  cards  are  then 
returned  to  the  borough  office  for  tabulation  and  filing. 

Results — A  review  of  these  histories  for  all  the  boroughs  for  1906 
shows  Manhattan  to  have  had  22;  Bronx,  3;  Brooklyn,  6;  Queens,  11, 
and  Richmond,  none ;  a  total  of  42  for  the  Greater  City.  Of  this  total 
23  or  more  than  half  were  between  the  ages  of  20  and  40;  15  had 
preceding  attacks;  the  duration  of  illness  in  9  was  1-2  weeks;  in  4 
less  than  i  week;  in  3,  2-3  weeks;  and  in  22  over  3  weeks.  The 
temperature  was  intermittent  in  only  15  cases.  27  had  chills;  27  had 
sweats;  28  had  enlargement  of  the  spleen;  2  had  rose  spots.  In 
most  cases  the  type  of  the  exacerbation  was  not  stated;  where  it 
was,  14  were  tertian;  4  were  quotidian;  and  i  quartan.  The  blood 
was  examined  in  only  7  cases,  6  of  which  showed  malarial  plasmodia, 
and  none  Widal.  Ten  (10)  of  the  41  resided  out  of  the  city  before 
attacked.  9  were  bitten  by  mosquitoes — whether  the  anopheles  was  not 
stated.    In  31  cases  the  physician  made  his  diagnosis  by  clinical  signs. 


440 

In  only  9  cases  was  the  death  certificate  altered,  althougfh  the  inspec 
tors  returned  a  contrary  opinion  in  12  cases. 
These  opinions  follow: 

Considered  to  be 

Typhoid 

Alcoholism   

"  Pulmonary   Trouble" 

Cerebral  Compression 

Tuberculosis  

Acute  Gaslrilis 

Broncho- Pneumonia    

Puerperal  Septicaemia 

Meningitis 


So  that  in  only  6  instances  (14  per  cent.)  could  it  be  positively 
stated  that  the  patient  had  malarial  fever;  and  in  I2  {28  per  cent.) 
it  was  almost  certain  that  the  patient  did  not  die  from  that  cause. 


441 


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447 

TABULATION  OF  CASES  OF  TYPHOID  FEVER  IN  1906. 

Typhoid  Fever,  1906. 


Male 

Femade 

Not  stated 

Age. 

0  to  X  year 

1  to  5  years 

Stoio    "    

10  to  20    "     

20  to  50    *'     

50  and  oyer 

CommerciAl  business  men. 

Clerks 

Factory  workers 

Firemen 

Houseworkers 

Laborers,  indoor 

Laborers,  outdoor 

Literary  workers 

Mauiual  trades 

Policemen 

Professional 

Skilled  artisans , 

School  attendants 

Storekeepers 

Sailors 

Sewers 

Soldiers 

Private  house 

Boarding  house 

Boats 

Lodging  house 

Hotels  auid  Institutions... 

Stable 

Tenements 

Tents 

Sanitary  condition,  bad.. . 


Manhattan 


965 

638 

28 

3 
55 

131 

397 

984 

61 

58 
165 

23 

6 

346 

89 
161 

S 

8a 

a 

84 

27 

323 

32 
M 

49 

3 

197 

60 

26 

a6 
149 

X 
X,I2X 

•  •  •  • 

X89 


The  Bronx. 


134 

X23 


xo 

30 

70 

140 

7 
5 

30 


Brooklyn. 


6x 

4 
17 

•  •  •  • 

23 

3 
12 

5 

6 

S 

3 

3 

3 

75 
x 

•  •  •  • 

3 
6 

I  •  •  • 

148 

I  •  •  • 

12 


653 

464 

37 

2 

24 

77 
308 

693 
49 
20 

136 

33 

•  •  •  ft 

258 
X3 

94 
I 

"5 

4 
43 
13 

302 

31 
41 

•  ■  •  • 

466 

33 

23 

6 
24 

■  •  •  • 

478 

X 

76 


Queens. 


95 
56 


6 
25 

49 

65 

6 

2 

M 
6 

•  •  • 

32 

4 

18 

. . » 

7 

X 

4 
5 

47 

3 

2 


95 


Richmond. 


36 


49 
19 

2 


I 
16 

53 

■  •  • 

I 

4 
I 

■  •  • 

13 


3 

2 

3 

•  •  • 

5 

X 

29 

•  •  • 

3 
27 

3 
38 

3 

3 


Total. 


i,8q6 

x,3oo 

67 

5 

95 
264 
840 

»»935 
133 

86 
349 

55 

6 

700 

109 

293 
6 

230 

X2 

146 
50 

582 
72 

99 

69 

7 

860 

96 

77 

36 

184 

X 

1,784 

X 

284 


448 


Blood  examined 

Widal  positive 

Urine  examined 

Diaro  positive 

Spleen  enlarged 

Rose  spots  present 

Other  cases— family 

**  house 

"  friends 

Patient  has  separate  room. 
Water  bottled 

"     Croton 

*•     tank 

Precautions  taken 

Source 

Source  milk 

Source  oysters 

Source  exposure 

Source  O.  O.  T 

Source  unknown 


Manhattan 


1,0^ 

1,086 

475 
1,161 

1/J67 

144 

S4 

32 

771 

no 
1,306 

"5 

If464 

357 

65 

191 

484 
534 


The  Bronx. 

175 
118 

91 

37 

155 

157 

A 

M 

2 

177 

18 
109 

21 
230 

80 
5 

33 
57 
82 


Brooklyn. 

675 
530 
496 
302 
828 
801 
84 
57 

15 

678 

54 

945 

85 

1,031 

s6i 

44 
106 

ni 
45* 


Queens. 

86 
70 
64 

45 

129 

III 

18 

I 

X 

X08 

2 
131 

x6 
146 

37 

2 

17 
17 
78 


Richmond. 

68 
6x 
41 
31 

44 

5s 

2 
I 

4 

21 

2 
30 

33 

63 

5 

4 
6 

38 

17 


TotaL 


i,8ds 

hTfi 
8|o 

2JI7 
2,l8l 

«76 

»57 

54 

»,755 

186 

a,S2i 

«7i 
a>9S4 

740 
uo 

353 

8I7 
1,163 


449 

TABULATION  OF  CASES  OF  CEREBRO-SPINAL  MENIN- 
GITIS FOR  1906. 

Cerebrospinal  Meningitis,  1906. 


Male 

Female 

Not  stated 

Age— 

0  to   I  year 

1  to   5  years 

Stoic     "     

10  to  20     **     

Over  20     **     , 

Not  stated 

United  States 

Englauid  auid  Scotland 

Ireland 

Japan 

Germany   

France 

Russia 

Italy 

Black 

Not  stated 

Tenement 

Halls  dirty 

Area  dirty 

Yard  dirty 

Street  dirty 

C.  S.  M.  in  neighborhood.. 

Ventilation  bad 

Light  bad..... 

Plumbing  bad 

No  cleanliness 

Dust?    Yes 

Parasites  ?    Yes 

Pets?    Yes 

Present  health?    Bad 


Manhatt2ui 


338 
386 

3 

100 
193 
127 

"3 
95 

•  •  •  • 

263 

3 

26 

I 

39 
I 

76 
109 

5 

•  •  •  • 

597 
178 
178 
188 

199 
126 

lOI 

100 
99 

"3 
125 

61 

59 

13 


The  Bronx. 


32 

28 


20 

15 

4 

12 

9 

28 


I 

9 


39 
7 
3 
7 

14 

XI 

5 

4 

2 

7 
II 

5 
15 


Brooklyn. 


"5 

90 

4 

28 
64 
39 
43 
35 

•  •  • 

67 

2 
8 


25 

44 

2 

I  •  •  • 

149 
6x 

46 
50 
40 
21 

35 

28 

19 
50 

65 
22 

23 

5 


Queens. 


10 


3 
6 

3 

2 

5 

>  •  • 

IX 


I 
I 

>  •  • 

10 


5 

4 


Richmond.)     Total. 


15 

2 


I 

4 

5 

6 


10 
I 
I 


5 

II 

3 

X 

3 

X 

7 

X 

I 

•  • 

3 
2 
2 
4 


611 

415 
7 

152 

38l 

178 
176 
146 

•  •  •  • 

379 
6 

38 
I 

55 

I 

102 
163 

8 

5 

806 

248 
228 
247 

255 

166 
142 

133 

130 
173 
308 

94 

X04 

x8 


4SO 


Food  and  clothing  ?    Bad.. 

Personal  cleanliness  ?   Bad 

Susceptibility  to  colds 

Exposure  to  C.  S.  M 

Exposure    to    over-heat 


} 


ing,  etc 
Exposure  to  cold,  etc 

Health  at  onset,  bad 

Onset  slow 

Stiffness  of  neck 

Headache 

Conyulsions 

V^omiting 

Eruption,  petech 

Eruption,  herpes 

Nasal  discharge 

Kemig's  sign 

So  temperature 

Leucocytes  counted 

Eye  involved 

Ear  involved 

Pneumonia 

Paralysis 

Diagnosis  by  clinical  signs. 

Diagnosis      by     lumbar ) 
puncture ( 

Ireatment,  medical 


Manhattan. 


fi 


tt 


tt 


u 


Death  on  first  day 

**         second  day 

third  day 

fourth  day 

fifth  day 

fifth  to  tenth  day 

Death  on  tenth  to  tuenti- 
ethday 

Death  on  twentieth  day 
and  over 

Day  not  stated 

Sent  to  hospital 

Prom  convulsions 

Prom  coma  and  exhaustion 
From  pneumonia 


4S 
34 
50 
as 

50 
81 

42 

39 
556 
437 
348 
538 
131 

ia3 

92 
386 

•  •  •  • 

aoa 

85 

3' 

30 

33 

387 

240 

607 

37 

34 

38 

37 

33 

70 

108 

ia6 


The  Bronx. 


91 

381 

13 


3 

3 
6 

3 
3 
5 

7 
4 
47 
37 
36 
46 

13 
II 

7 
27 

•  •  • 

10 

17 

3 

4 

7 

45 

15 

5a 

3 

3 

4 
5 

4 

13 

8 
9 
3 

•  •  • 

3 
41 


Brooklyn. 


13 

23 

6 

10 

3 

13 

7 

13 
193 

151 

132 

171 

29 

3a 

41 

129 

I 

2 

35 

3 

6 

24 

168 

41 

191 

10 

19 
12 

15 

10 

35 

33 

30 

5 

3 

5 

159 

3 


Queens. 


4 
I 


17 
16 
12 
16 

3 

7 
8 

13 

I 
I 

»  •  • 

I 

3 
19 

»  •  • 

19 


I 
17 


Richmond. 

TcytaL 

•  •  •  • 

60 

60 

•  •  •  • 

66 

44 

56 

lOl 

•  •  •  • 

56 

60 

14 

8a6 

16 

657 

8 

5>6 

16 

787 

3 

178 

I 

174 

5 

153 

15 

569 

•  ■  •  • 

I 

•  •  •  • 

215 

•  •  •  4. 

138 

•  •  •  • 

37 

4» 

67 

13 

63a 

5 

301 

13 

88a 

50 

61 

•  •  •  • 

S4 

61 

48 

lai 

156 

•  •  •  • 

170 

15 

•  •  •  • 

3 

lOI 

8 

606 

•  •  •  • 

15 

451 


Not  Stated 

Recovery  complete 
On   I  to   7  days. . . 

"    7toi4    **    ... 

"  Htoai    **     ... 

"  21  to 28    **     ... 

••  28  to  35 

'*  35  +  days. 
Not  stated.... 


it 


Recovery  incomplete.... 

Micro-organism  in  spinal 
fluid 

Fumigation  and  disinfec- 
tion ordered 

Antitoxin  administered... . 

Antitoxin  recoveries 

Antitoxin  deaths 

No  case,  doubtful 

No  diagnosis 

Simple  M 

Traumatic  M 

Tubercular  M 

Syphilitic  M 

Pneumonia. . « 

G  astro-intestinal 

T>'phoid...  

Bronchitis 

Strep,  meningitis. .' 

Nephritis 

Influenza 

Measles 

Endocarditb 

Not  found 

Septicaemia 

Otitis 

Tuberculosis 


Manhattan 


3 

13 

17 
«9 
15 
48 

•  •  •  • 

24 

185 

495 
16 

6 

10 

>  •  •  • 

6 
I 

>  •  •  • 

13 

I  •  •  • 

x6 

4 
I 
I 

4 
I 

I 

I 

I 

II 


The  Bronx. 


6 
7 


3 
5 

50 


Brooklyn. 


43 
28 

X 

3 
8 

2 

3 

6 

•  • 

9 

27 
174 

2 
I 


Queens. 


x8 


16 

>  •  • 

I 

6 


I 
I 

2 


19 


Richmond. 

Total. 

I 

50 

7 

157 

•  •  •  • 

3 

•  •  ■  • 

18 

3 

28 

I 

«3 

•  •  •  • 

x8 

•  •  •  • 

58 

3 

9 

I 

37 

4 

221 

IX 

749 

•  •  •  • 

x8 

•  •  •  • 

7 

•  •  •  • 

IX 

8 

•  •  • 

38 

•  •  • 

17 
10 


452 

Diagnosis  Laboratory. 

Report  of  the  Assistant  Director, 

It  is  with  much  pleasure  that  I  can  report  the  renovation  of  t 
entire  Diagnosis  Laboratory.  No  money  being  available  for  the  pi 
pose,  the  work  of  painting  the  woodwork,  kalsomining  the  walls  ai 
making  repairs  in  general,  devolved  upon  the  laboratory  force  ai 
they,  displaying  an  admirable  "  esprit  de  corps,"  each  one  contribut 
his  share  of  work  to  the  general  improvement  of  the  laboratory,  wi 
the  result  that  the  Diagnosis  Laboratory  from  a  poorly  ventilate 
poorly  equipped  and  ill-lighted  assortment  of  rooms,  now  has  the  a 
pearance  and  tone  of  a  first-class  laboratory. 

There  is  still  room  for  improvement.  If  a  supply  room  could  ■ 
built  on  the  roof  and  connected  with  a  door  cut  through  the  wall 
the  head  of  the  main  stairwav,  it  would  facilitate  the  work  of  tl 
laboratory  (and  prevent  much  interruption  of  the  same)  by  changii 
the  course  of  traffic.  The  numerous  persons  coming  to  the  laborato 
for  supplies,  etc.,  would  no  longer  enter  the  laboratory  proper,  b 
their  course  would  be  deviated  directly  to  the  supply  room.  An  a 
ditional  examining  room  should  also  be  added,  the  present  quarters 
the  laboratory  assistants  being  somewhat  cramped. 

For  further  plans  of  Laboratory,  see  accompanying  photograpl 


■    COMMUNICABLE    IJISEASK.S.    DIAt;NTISIS    LAKORATORY— 


[/INb  A.NU  WASH  !;UUM.- 


yiii 


461 

The  laboratory  staff  at  present  consists  of  the  Acting  Assistant 
Director,  three  assistant  bacteriologists,  three  bacteriological  diag- 
nosticians, seven  laboratory  assistants,  two  laborers,  one  hospital  clerk 
and  three  clerks. 

The  assistant  bacteriologists  and  laboratory  assistants  are  pro- 
vided with  white  linen  suits,  which  are  worn  while  they  are  working 
in  the  laboratory. 

The  statistical  work  of  the  laboratory  is  g^ven  on  a  separate  sheet. 

Following  is  a  report  of  the  work  performed  in  the  various  branches 
during  1906: 

The  routine  work  consists  in: 

Examination  of  cultures  for  diphtheria  bacilli, 

Examination  of  sputum  for  tubercle  bticilli. 

Examination  of  blood  for  Widal  reaction. 

Examination  of  urine  for  Diazo  reaction. 

Examination  of  blood  for  malarial  organisms. 

Examination  of  smears  for  diplococcus  intracellularis  meningitidis. 

Examination  of  smears  for  pneumococcus  of  Frankel. 

Examination  of  Cultures  for  Diphtheria  Bacilli. 

A  slight  improvement  has  been  made  in  the  routine  preparation 
of  specimens ;  three  films  instead  of  two  being  placed  on  an  ordinary 
glass  slide ;  this  saves  time  both  for  the  maker  of  the  specimen  as  well 
as  the  examiner,  besides  reducing  the  expenses  of  the  laboratory.  In 
all  other  respects  the  work  is  carried  on  in  the  same  manner  as  in 
the  previous  year.  50,609  culture  tubes  were  examined,  18,950  being 
proven  positive  and  369  negative  specimens;  these  were  confined  to 
two  boroughs,  Manhattan  and  Brooklyn. 

Tuberculosis, 

The  work  during  the  past  year  has  greatly  increased,  a  daily  aver- 
age of  over  eighty  (80)  specimens  having  been  examined,  thereby  testi- 
fying to  the  work  accomplished.  We  are  grateful  for  having  been 
furnished  with  a  separate  room,  in  which  the  preparation  of  films  is 
carried  on  by  two  laboratory  assistants,  from  six  until  eleven  in  the 


463 

morning.    No  sooner  is  this  work  ct»npleted  than  the  entire  room  i 
disinfected  with  a  5  per  cent  carbolic  solution. 

During  1906  there  were  21,773  specimens  examined,  with  a  tot 
ot  6,753  positive  results,  yet,  the  number  of  positive  specimens  foun 
might  be  increased,  if  the  laboratory  staff  were  enlarged  permittin 
a  still  more  thorough  searching  of  n^ative  -spedmens. 

All  positive  examinations,  on  request  of  the  physicians  of  Great< 
New  York,  are  telephoned  to  their  residences  no  later  than  10.00  a.  n 
the  next  morning. 

Typhoid. 

In  regard  to  the  Widal  examination,  the  one  to  ten  dilution  hs 
been  ilropped  and  the  one  to  twenty  alone  employed  with  a  time  lim 
lixed  at  iMic-half  hour.  Since  this  has  been  done,  there  is  no  longt 
H  rciiiiest  by  the  physicians  to  kindly  explain  the  results  of  examina 
liiui,  Mr.  J.  S.  C  Stclling,  a  bacteriological  diagnostician,  has  ha 
-v.ime  dillieiilly  in  preserving  the  vitality  of  the  Bacillus  typhosu! 
bill  siiuo  the  UuUt  have  Iwcn  transferred  from  bouillon  to  agar  aga 
iiisiead  of  btMiItkin  to  Inniillon,  and  the  former  used  as  a  stock  snbi 
tiim  for  a  week,  this  trouble  has  been  obviated. 

I'or  the  year  iixX>.  tlic  total  examinations  were  6,181 ;  of  thes 
I.50J  were  proven  i>ositive.  4.05)1   negative  and  588  doubtful. 

In  tlii>  exaniiiiaiions  of  urine  for  Ehrlich's  diazo-reaction  ther 
liiis  been  no  eh;uiKe:  it  might  be  advisable  to  have  the  physicians  noti 
tii'il  to  iieud  ill  t';irl\  sptviinens.  for  instance,  where  duration  of  diseasi 
is  ten  days  or  loss,  as  the  positive  residt  of  examination  of  the  urim 
ivin  be  obtaiutfd  nnich  earlier  than  the  Widal  reaction.  The  total  nutn 
tier  of  examinations  was  i.j^\  of  which  405  were  proven  positive 
7(15  negative;  50  doubtful.  Tlw  methylene  bine  reaction  for  the  san» 
p'-irpose  as   the  diaio-reaction  did  not  give  satisfactory  results. 

Culture  Tuba. 

During  I00(>  all  culture  tnl>cs  for  substations  have  been  sealed  witli 
paraffin  instead  of  rubber  caps. 

This  change  has  brought  about  a  great  saving  in  expense.  Dur- 
ing 1907  all  stations  will  be  stipplied  with  them. 


463 

The  price  of  rubber  caps  has  been  two  hundred  dollars  ($200.00) 
per  ten  ttiousand  (10,000),  while  it  costs  but  five  dollars  ($5.00)  to 
paraffin  the  same  number  and  the  results  attained  as  to  the  keeping 
of  the  tubes  moist  and  sterile  are  better  than  in  previous  years. 

Opsonic  Index. 
During  the  latter  months  of  1906  investigations  in  connection  with 
the  determination  of  the  tubercle-opsonic  index  were  begun.  It  is 
hoped  to  continue  these  during  1907,  paying  special  attention  to  the 
tuberculo-opsonic  index  of  healthy  persons  of  various  nationalities. 
Should  the  results  prove  of  value,  the  appointment  of  additional  bac- 
teriologists will  be  necessary. 

Report  of  the  Riverside  Sanatorium^  North  Brothers'  Island, 

City  of  New  York. 

The  capacity  of  the  Riverside  Sanatorium  on  January  i,  1906, 
was  four  (4)  pavilions,  with  eighty  (80)  beds.  The  capacity  of  the 
Riverside  Sanatorium  January  i,  1907,  is  six  (6)  pavilions,  with 
one  hundred  and  sixteen  (116)  beds. 

Plant, 

The  present  accommodations  are  six  pavilions,  Nos.  6,  8,  9,  10,  11 
and  12.  Of  these,  8,  10,  11  and  12  are  for  males;  capacity,  seventy- 
eight  (78)  beds.  Pavilions  6  and  9  are  used  for  females;  capacity, 
thirty-eight   (38)    beds. 

In  description  in  detail  it  may  be  said  that 

Pavilion  6  has  one  ward  of  14  beds 14 

Pavilions  8  and  9  have  four  wards  each  of  6  beds 48 

Pavilions  11  and  12  have  two  wards  each  of  12  beds 48 

Pavilion  10  has  one  ward  in  use,  6  beds 6 

Total   116 

Pavilion  10  is  in  use  partly  as  administration  centre  for  the  tuber- 
culosis division.  One  ward  is  divided  into  two  rooms  whicli  serve 
respectively  as  office  and  laboratory;  a  second  ward  serves  as  a  male 
dining-room,  seating  forty ;  and  a  third  ward  is  occupied  by  six  patients. 
The  fourth  ward  is  occupied  by  orderlies  who  were  formerly  tubercu- 


VJSB  ^yi*irv     Tns  Tarr-iiot  rrnr.Kiiff  ikkc-  i  fimaill  rrcim   mlikli  was 
129S1  irr  "ni:  ^'rr;L*iTr  if  rnyr*^  nuftiV  rafir^.  Intt  bss  duiii^ 
isii  IT  ior  tie  i^'^H'iiirir  re  i5k  cpc  cm*,  nose  and 


n.»«»«*  Vir^  -H'-zir^  "T-^-"^*  T'^v-  •*-»•  iifciF^'CEi.  *•*>*•  iie2$  SI  3  y^  J  angles  to 

mid  t:Etr.7i  s  mzrti^ti  't'^  '"'><'  "wtm^  bsagr  isucn  a  rol  cross* 

:re  scairt   iitrvtrsi   :re  tgrTrtinr^.      Ha?  rdbor  i«rt  of 
zritn  iTinir:  :  .:*:i:     —  tJiTilirc.  t    r:  i  -230  ir  eaA  of 
iffT^niii.     Tbt  "WTTiiin^  J  irt  iZ  iirrt  t=»i  txtj  r:  inrnbcr  troen  focxr 
^  'mnrfs  ■••rr  S3  lei*   ri  zaz.  zz.  rarr  :f  lie  itr^c  Tards. 

p£Tiii:cii  ii-i^  *ar!r  hix*  iek  biir  anf  tm^?  lakss  in  each  ward. 
E-nerj  parfjic  hts  a  fcirfrincz  s=kt  a  riticr  m*3di  is  pnnrided  wiA 


C'sc  caj±  f:r  =ijss  2Z}i  fcriili^.  ro*  *>^--^::!jer  hcose  for  males 
aiki  coc  tcrt  bic:**. 

The  F=  bi-.i5*  ::r  ng:  is  ic^xfcxS  f*?:  hi^i,  endased  irith  glass 
wiDdcTTS  ihz:  cis  bt  coct5fi  fr:c:  ibnr*  zc  btli-w.  The  ooc  for  women 
is  19x10x8  feet  higt.  «r>cl:«-i  "arith  c'-as^  windows  on  hinges  that 
can  be  hyzk^t-t  :>  :be  cei'.ir^  abive.  r=.iking  ar.  oom  air  paviliolu 

Tbe  si::z:::=:xr  bctzse  is  abc-m  lyxicxS  fe«t  high,  open  on  all  sides. 

The  tent  boose  is  large  cnr::gb  to  acc^rtnt'Odaie  two  patients  with 
dressing-room  and  sleeping-rooriL 

Tbe  wards  and  tbe  son  rooois  are  steam  beatcd.  The  wards  are 
lighted  by  electridtv. 

Care  of  Plant. 

The  grounds  around  the  pavilions  are  cared  for  by  two  men  whose 
duty  it  is  to  irick  up  all  waste,  etc.,  keep  grass  in  good  condition. 

The  floors  of  all  wards,  toilets  and  bath  are  washed  daily  with 
soap  and  water  with  washing  -nd  10  per  cent  ammonia,  and 

with  creolin  twice  a  week. 


46s 

Tables,  beds,  stands  and  window  sills  are  wiped  off  with  1-40  car- 
bolic acid  solution. 

All  cleaning  in  wards  is  done  between  the  hours  of  6.30  and  10.00 
a.  m.  No  dry  sweeping  is  permitted.  The  wards  are  fumigated  with 
formalin  on  an  average  of  every  ten  days. 

Nurses. 

There  are  fifteen  nurses  in  the  tuberculosis  service.  They  are 
employed  by  the  Superintendent  of  Nurses,  at  $40.00  per  month  and 
maintenance,  and  come  from  the  various  training  schools  of  the  United 
States  and  Canada.  The  duties  of  the  nurses  are,  taking  tempera- 
tures, giving  medication,  baths,  doing  dressings,  preparing  extra  diets, 
supervising  the  orderlies  and  cleaners  and  regulating  the  ventilation 
of  the  wards. 

Orderlies. 

There  are  seven  orderlies.  For  the  past  ten  months  we  have 
been  employing  men  who  were  formerly  tuberculosis  patients.  They 
are  employed  by  the  Superintendent  of  Nurses  at  $30  per  month  and 
maintenance.  Thus  far  they  have  given  entire  satisfaction.  The  or- 
derlies do  the  general  waiting  on  of  bed  patients,  making  of  beds, 
the  care  of  the  linen  and  distribution  of  same,  and  other  necessary 
duties. 

Cleaners. 

There  are  thirteen  cleaners,  including  helpers  in  the  dining-room 
and  are  employed  by  the  Superintendent  of  Nurses  at  $16  and  $18 
per  month  and  maintenance.  They  are  usually  secured  through  the 
Employment  Agency,  although  at  the  present  time  there  are  some  who 
were  former  tuberculosis  patients. 

Care  of  Sputum. 

Seabury  and  Johnson  sputum  cups  are  used  exclusively.  They  are 
collected  three  times  daily,  at  7.30  a.  m.  and  i.oo  and  6.30  p.  m. 

The  man  whose  duty  it  is  to  collect  the  sputum  carries  a  large 
white  enamelled  covered  pail  in  which  he  puts  the  cups  which  have 
been  in  use  in  each  ward,  collecting  all  the  cups  in  one  pavilion  and 
then  emptying  the  contents  into  a  garbage  can  provided  for  that  pur- 


it 

i! 


466 

pose.    This  can  is  emptied  into  the  crematory  every  morning  at  nil 

o'clock. 

The  pail  and  garbage  can  which  is  thus  used  is  carbolized  eve 

day,  and  the  brass  frames  for  the  pasteboard  cups  are  carbolized  on 

a  week. 

Care  of  Patients. 

Food — The  cooking  for  all  the  pavilions  is  done  in  the  genei 
kitchen.  It  is  transferred  from  the  kitchen  to  the  wards  and  dinin 
room  in  a  wagon  provided  with  steam  cans. 

The  meals  for  ambulatorv  cases  are  as  follows: 

Breakfast. 

Cereal,  meat,  eggs,  toast,  coffee,  bread   (white,  graham  or  ry< 

and  butter. 

Dinner. 

Soup,  meat,  vegetables,  toast,  dessert,  tea  and  coflFec. 

Supper. 
Hot  or  cold  meat,  eggs,  toast,  coffee  and  tea,  fruit. 

Extra  for  all  Cases. 

Raw  scraped  beef,  rare  roast  beef,  cooked  scraped  beef,  beef  jui< 
The  food  for  all  bed  cases  is  served  in  the  wards  on  bed  trays.     B 

sides  the  extra  food,  the  nurses  prepare  several  delicate  dishes  for  tl 

more  enfeebled  patients.    Eggs  and  milk  are  kept  in  the  wards  at  ; 

times,  so  that  the  patients  may  have  access  to  them  during  the  da 

Many  take  from  this  extra  supply,  six  eggs  a  day. 

On  admission  to  the  hospital  each  patient  is  stripped  of  his  or  h< 

clothing,  given  a  bath,  and  issued: 

I  undershirt. 
I  pair  dra^rers. 
I  pair  socks. 
I  pair  shoes. 
I  top  shirt 
I  pair  pants. 
I  cardigan  jacket 
I  cap. 

I  pair  pajamas. 
I  overcoat 


467 

— and  the  women  are  given  the  clothing  they  require.  The  clothing 
worn  by  the  patients  to  the  hospital  is  fumigated  and  sent  to  a  room 
where  it  is  labeled  and  numbered.  It  remains  there  until  the  patient 
is  discharged  or  dies.  In  the  first  case  they  are  returned  to  the  patient; 
in  the  latter,  they  are  turned  over  to  relatives  or  friends. 

Admission  of  Patients, 
All  admission  cards  are  issued  by  the  Chief  of  the  Division  of 
Communicable  Diseases,  and  under  no  circumstances  will  a  case  be 
received  into  the  hospital  without  first  consulting  his  office.  After 
receiving  a  card,  the  patient  is  sent  to  the  Reception  Hospital,  at  the 
foot  of  East  Sixteenth  street,  or  Health  Department  dock,  at  the 
foot  of  East  One  Hundred  and  Thirty-second  street,  where  they  are 
transferred  to  the  hospital  on  the  steamship  "  Franklin  Edson." 

Class  of  Patients. 
First — ^Voluntary  cases. 

Second— Compulsory  cases. 

Cases  of  the  second  class  are  those  which  are  forced  in  by  the 
Health  Department,  as  being  a  menace  to  the  public  health.  These 
are  removed  by  ambulance  and  it  is  sometimes  necessary  to  have 
an  officer  at  the  house  to  assist  in  the  removal. 

Discharge. 
The  method  by  which  a  patient  procures  a  discharge  is  as  follows : 
Application  is  first  made  to  the  physician  in  charge  who  communi- 
cates the  wishes  of  the  patient  to  the  Chief  of  the  Division  of  Com- 
municable Diseases.  An  inspector  is  then  directed  to  the  home  of 
the  patient,  and  if  he  finds  the  premises  conform  to  the  Department 
regulation,  he  or  she  is  then  discharged.  In  case  the  inspector's  report 
is  adverse,  the  patient  is  compelled  to  remain  in  the  hospital. 

Visiting  Days. 
The   visiting   days   are   Tuesday   and   Thursday,    10.00   a.   m.   to 
12.00  M.;  Sundays,  i.oo  p.  m.  to  3.00  p.  m.     The  boat  leaves  the 
Department  of  Health  Dock,  foot  of  East  One  Hundred  and  Thirty- 
second  street,  fifteen  minutes  after  the  hour. 


468 

Medical  Care  of  Patituts. 

On  admission,  a  fnQ  tiistor>'  is  taken. 

Form  of  histon-.  the  same  as  tiat  used  in  the  tuberculosis  dime 
of  the  Department  and  at  OdsriDe  Sanabmum. 

The  temperature,  palsc,  respiration  are  taken  between  5  and  6.31 
3.  m..  and  2.00  and  4.00  p.  m.  Patients  with  a  temperature  above  la 
are  kept  quiet  in  bed.  Those  that  are  norma]  are  allowed  to  take  i 
moderaic  amount  of  exercise. 

Vcntiuvion  of  Wards. 
The  wards  are  kepi   under   forced  ventilation  at  all   times.     Th 
temperature  varies  between  50  and  60  degrees  in  winter.      In  sum 
mer  the>-  arc  open  on  all  sides. 

General  Suferzvion. 

The  work  is  directly  imder  the  super\-ision  of  Dr.  S,  P.  Watson 
Resident  Physician :  Dr.  F.  S.  Wcsnnorcland,  Assistant  Resident  Phy 
sician.  The  visiting  staff  consists  of  Drs.  Knc^f,  Huddleston  an< 
Pulley.  During  the  period  of  their  ser\-ice  they  \-isit  the  hospital  onci 
a  week  and  can  be  called  whenever  it  is  found  necessary  to  have  theii 
advice. 

During  the  year  1906,  322  patients  (male  and  female)  were  ad- 
mitted. 

The  following  table  shows  tlie  nationality,  occupation,  age  at  en- 
trance and  the  district  in  whicli  they  lived  prior  to  their  admission 
to  the  hospital : 

Xatiomtlity. 

United  States  158 

Ireland  56 

Gennaity  17 

England  10 

ScotlMd  6 

Italy  6 

Sweden  4 

Switzerland  j 

Hungary 5 

Austria 9 

RouDunia  a 


469 

Norway  I 

Portugral  I 

Poland    I 

Occupation, 

Laborer   ^ 

Civil  Engineer i 

Miner  I 

Tailor 16 

Bookkeeper 4 

Truckmen  20 

Carpenter   9 

Qerk  20 

Plumber  6 

Musician  3 

Painter  4 

Druggist  2 

Cook   a 

Cigarmaker  a 

Peddler  5 

Fireman i 

Soldier  a 

Housework  66 

Electrician I 

Machinist 3 

Stenographer  3 

Butcher   i 

Barkeeper   5 

Factory  31 

Conductor 4 

Barber   i 

Porter 4 

Printer  7 

Waiter  4 

Piano  maker  i 

Artist  3 

News  agent a 

Minister a 

Blacksmith   3 

Baker  i 

Photographer i 

Janitor  7 

Brewer    I 

Age, 

10  years a 

15  years la 

20  years 48 

25  years 5a 


470 


JO  years SO 

35  years ^ 


40  years. 
45  years. 
50  years. 
55  years. 
60  years. 
65  years. 
70  years. 


40 

10 

3 

4 
I 


Districts. 


Harlem  Dispensary. 

Presbyterian 

Bellevue 


Gouvemeur 

VanderlMlt    

Health  Department  Qinic 

Brooklyn  

Staten  Island  


12 

28 

124 

4 


63 
5 


The  following  table  shows  the  results  in  the  cases  during  the  year 
1906.  The  classifiication  in  stages  is  in  accordance  with  that  recom- 
mended by  the  National  Association  for  the  Prevention  of  Tuber- 
culosis, at  entrance,  duration  in  sanatorium  and  condition  at  exit: 


Firtt  stage... 
Second  stage. 
Third  stage. . 

Dead 

Progressed... 
InproTed*... 
Discharged.. 
Hospital 


I  Week. 

I  Week  to 
3  Months. 

3  Months 

to 
6  Months. 

6  Months 

to 
9  Months. 

9  Months 
to  I  Year. 

3 

so 

4 

I 

•  « 

8 

57 

«) 

5 

8 

19 

98 

37 

31 

la 

16 

39 

17 

5 

■  • 

10 

96 

s8 

la 

10 

4 

40 

as 

10 

10 

9 

75 

43 

9 

4 

S 

61 

10 

13 

16 

Total, 

8 
107 

187 

77 

156 

89 
140 

»o5 


Rules  for  Patients. 

1.  Never  spit  on  the  grounds,  on  the  floor  of  the  wards  or  toilet 
rooms,  into  the  sinks  or  anywhere  except  into  the  cup  or  bottle  pro- 
vided for  that  purpose.  ^^^^^ 

2.  You  are  required  to  carry  your  ;  *  with  you 
wherever  you  go.     Never  leave  it  lyi  ds.     If 


471 

your  cup  is  more  than  half  full,  exchange  it  for  a  fresh  one  at  the 
place  appointed  for  that  purpose.  If  you  have  a  bottle,  you  must 
clean  it  yourself  according  to  the  instructions  you  will  receive  from 
the  nurse.  If  you  should  accidentally  spill  the  contents  of  your  sputum 
cup,  inform  the  nurse  or  orderly  of  the  fact,  so  that  the  place  may  be 
properly  disinfected. 

3.  Never  swallow  your  sputum.  Don't  cough  unless  you  have  to. 
Hold  a  piece  of  gauze  before  your  face  when  coughing  or  sneezing. 
Avoid  soiling  your  hands,  face  or  clothing  with  sputum.  Wash  your 
hands  before  each  meal. 

4.  Unless  instructed  by  the  doctor  or  nurse  to  remain  in  bed,  all 
patients  able  to  walk  must  arise  with  the  bell  at  6  a.  m.  Patients  must 
go  to  bed  not  later  than  9.30  p.  m.,  after  which  hour  no  games  will 
be  allowed  in  the  ward. 

5.  Patients  are  not  allowed  in  the  wards  while  the  same  are  being 
cleansed,  nor  at  any  other  time  during  the  day  excepting  by  special 
permission  of  the  doctor  or  nurse. 

6.  The  use  of  whiskey  or  alcoholic  beverages  other  than  those 
prescribed  by  the  doctor  is  absolutely  prohibited.  There  must  be  no 
smoking  in  the  wards  or  toilet  rooms. 

7.  Boisterous  conduct,  profanity  and  loud  talking  or  quarreling 
are  strictly  prohibited. 

8.  Patients  must  not  brush  their  clothing  nor  shake  their  blankets 
or  bedding  in  the  wards. 

9.  Patients  are  not  allowed  to  raise  or  lower  the  windows  nor 
to  meddle  with  the  valves  of  the  radiators.  If  there  is  too  much 
draught,  or  if  it  is  too  hot,  inform  the  nurse  and  she  will  make  the 
necessary  correction. 

10.  Your  chances  of  getting  well  depend  largely  upon  the  ob- 
servance of  these  rules.  It  is,  therefore,  to  your  interest  to  obey  them 
and  to  see  that  they  are  followed  by  the  other  patients.  The  individual 
who  breaks  these  rules  is  your  enemy  and  should  be  promptly  reported 
to  the  doctor  or  nurse.  If  you  have  any  other  complaint  to  make,  state 
the  case  to  the  doctor. 


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Antitoxin  Injections — Inspectors'  Records. 
Reached  Premises. 


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15 

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13 


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479 

Research  Laboratory. 

The  following  report  covers  the  essential  features  of  the  work 
carried  out. during  1906.  After  the  ending  of  1905  the  practical  re- 
fining of  diphtheria  antitoxin  was  definitely  accomplished.  Since  then 
we  have  been  treating  all  cases  of  diphtheria  in  Greater  New  York 
with  this  refined  and  concentrated  antitoxin.  In  the  hospital  we  have 
carefully  watched  the  effect  of  this  refining.  We  have  done  this  by 
giving  to  half  the  children  the  serum  in  its  non-refined  state,  and  then 
treating  the  other  half  of  the  children  with  the  refined  antitoxin. 

The  results  of  this  observation  have  proven  conclusively  that  the 
refining  of  the  antitoxin  not  only  has  the  advantage  of  giving  a 
stronger  antitoxin,  but  it  also  has  the  adantage  of  producing  fewer 
rashes  and  other  disagreeable  symptoms.  We  have  improved  our 
methods  of  producing  diphtheria  antitoxin,  so  that,  with  less  horses, 
than  in  1905,  we  produce  more  than  twice  as  much  diphtheria  anti- 
toxin. During  1906  more  than  1,000  liters  of  serum  were  obtained 
from  the  horses,  so  that  we  now  have  quite  a  large  supply  on  hand, 
and  have  at  present  only  10  horses  in  the  stables. 

Upon  tetanus  antitoxin  we  have  done  considerable  experimental 
work.  This  has  enabled  us  to  refine  it  the  same  as  diphtheria  anti- 
toxin. We  have  also  shown  by  animal  experiments  that  every  minute 
of  delay  after  the  beginning  of  symptoms  is  a  great  loss  in  the  proba- 
bility  of  doing  good  by  the  injections  of  antitoxin.  When  during  the 
early  symptoms  very  large  doses  are  given  intravenously,  we  found  not 
only  in  animals  but  also  in  man  that  good  results  were  frequently  ob- 
tained. It  is  interesting  to  note  -that  the  number  of  deaths  from  diph- 
theria in  Greater  New  York  was  less  during  1906  than  any  previous 
year. 

There  has  been  a  good  deal  of  activity  in  the  study  of  hydrophobia 
as  well  as  a  great  increase  in  the  number  of  patients  treated  for  the 
bites  of  rabid  dogs.  During  the  past  year  323  persons  have  been 
treated.  This,  which  is  a  considerable  increase  over  1905,  took  place 
largely  in  the  fall,  and  is  due  to  our  development  of  mailing  the  Pas- 
teur Vaccine  to  the  suburbs  and  to  distant  places.  Much  work  has 
been  done  under  the  direction  of  Dr.  Williams  upon  the  cause  of 
hydrophobia.    This  has  divided  itself  into  two  different  parts.    First, 


i 


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re?:ih5  nrcziDei  i^  the  sCDfr  o=t5aed  sader  i  and  2a  lu 
bed  rernr  btlTfzl.  Ir  ihe  tr?:  p';ajc  in  canfimsx^  o«2r  work  on 
:»Fti:  -riSi-jt  ::  the  rjc|T:  'rofie^:  and.  secooihr,  in  adding-  n 
5or*  ir  fiv:»r  ::  th*  rrTtrrcar  rsinre  of  tbc  bcxiies.  The  w< 
fe-  r:  hi^  jn?:  leen  lier^i.  >?  w*  rsTmott  give  results. 
Tbt  -Hirk  re  th^  rri:»j:«£r»  ::  i^arrrrrla  and  Tarioia  has  been  a 
jff  £jf  c:cisi>r5  ir  tbe  f:rafT  cf  oerekipmcnt  of  Ae  vaccine  bod 
5er  tbf  =icrDsc:?(pe  ir  the  living-  coraca]  tissue,  and  we  are  getti 
zizs  wt^±:  cDcrcTAirf  ::l5  t^  think  tJal  we  may  be  aUe  to  add  t 
ina!  jrrc*:f  as  tc   the  prr:r;rci£22   nirzre  of  these  bodies.      We   ha 


i!:e  jericcis  str^iy  cf  the  CLzse  cf  scarlet  fever.  The  secti 
w?.rk  m  the  etirC:**:^-  of  5csr3et  fever  is  prc^ressing  slowly  becat 
cf  the  few  desths  which  are  cccurring  at  the  bdght  of  the  disea 
We  have  s-cceefei,  hcwever.  ir:  getrir.g  soaje  good  autopsy  mater 
which   is  b-eing  carefullv   srjiied. 

A  ver}-  in:tcrtat:t  riece  cf  wcrk  h-as  been  undertaken  upon  t 
aggiutination  cf  culr-res  cf  gliniers  bacilli  by  the  blood  of  hors 
with  either  latent  or  cevelcped  grianders.  This  test  indicates  that 
great  many  horses  tliat  were  only  s-jspected  of  hanng  glanders  real 
arc  infected.  The  great  ad\-antage  of  the  agglutination  test  over  tl 
mallein  test  is  that  it  does  not  disable  the  horse  at  all,  and  does  n 
keep  the  horse  from  work,  even  for  a  moment  There  are  still 
number  of  points  to  be  decided,  as  what  degree  of  agglutination  ind 
catcs  strongly  that  the  horse  has  glanders,  and  what  d^jee  of  agg-li 
tination  makes  the  diagnosis  positive.  We  are  still  actively  engage 
in  the  study  of  this  question.  Mallein  is  still  being  produced  for  tl 
use  of  the  Department,  and  for  those  outside  of  the  Department. 

Upon  tuberculosis  we  have  done  but  little  work  except  of  a  rot 
tine  nature,  but  are  intending  to  take  up  immunization  with  vaccine 
upon  a  considerable  scale. 


48 1 

• 

We  have  been  carrying  on  tests  of  the  opsonic  index  in  cases  of 
tuberculosis  which  are  being  treated  with  the  bacterial  substances  of 
the  tubercle  bacillus. 

We  have  been  aiding  the  New  York  County  Medical  Society  in 
the  supervision  of  a  number  of  dairies,  the  examination  of  the  milk 
being  done  free  of  charge  in  the  laboratory.  Much  work  upon  pas- 
teurization has  been  started. 

Disinfection  continues  to  be  overlooked  by  the  Laboratory,  but 
no  important  work  except  of  a  routine  nature  has  been  carried  on. 
Over  8,000  tests  from  rooms  that  have  been  disinfected  have  been 
made. 

At  the  end  of  the  year  we  are  engaged  upon  the  following  prob- 
lems: The  refining  of  antitoxin;  the  use  of  vaccines  in  tuberculosis 
and  other  diseases;  the  value  of  the  opsonic  test;  the  prevalence  of 
glanders  in  the  horses  of  New  York,  and  the  use  of  the  agglutination 
test  in  detecting  it;  the  effect  of  different  temperatures  applied  for 
different  lengths  of  time  upon  the  disease  germs  that  occur  in  milk. 

A  routine  manufacture  of  diphtheria  antitoxin,  tetanus  antitoxin, 
mallein,  tuberculin,  and  vaccines  for  several  diseases  is  being  car- 
ried on  as  before. 

Vaccine  Laboratory. 

Report  of  the  work  performed  at  the  Vaccine  Laboratory  during 
the  year  1906. 

The  routine  work  has  been  carried  on  as  in  previous  years  and 
the  accompanying  table  gives  the  statistical  items. 

Plant — On  account  of  the  expected  construction  of  a  new  lab- 
oratory few  changes  have  been  made  in  the  present  plant  during  the 
past  year.  There  has  been  installed,  however,  an  electric  motor, 
which  supplies  the  power  for  a  suction  pump  used  to  fill  capillary 
tubes,  for  a  compressed  air  cylinder  used  to  produce  a  blow-pipe  flame 
for  sealing  tubes,  and  for  a  shaft  supplied  with  belting,  which  turns 
the  grinders  by  which  the  vaccine  pulp  is  emulsified.  There  has  also 
been  installed  another  electric  motor,  which  furnishes  the  power  for 
clipping  the  calves. 

Routine — There  have  been  few  changes  during  the  past  year  in 
the  process  of  preparing  vaccine  virus.    The  ratio  of  pulp  to  glycerine 


482 

mixture  lias  been  continued  at  i  to  4.  All  the  calves  are  now  dipp 
closely  on  entrance  to  the  stable,  and  the  resulting-  increase  in  dea 
liness  of  the  animals  is  marked.  No  patholc^cal  omdition  was  < 
served  in  the  calves  at  autopsy  during  the  entire  year. 

Since  the  demonstration  in  this  laboratory  of  tetanus  bacilli  in  c 
faxes,  it  has  been  the  practice  to  make  an  anaerobic  culture  from  ev< 
collection  of  virus  and  test  it  for  the  presence  of  tetanus  toxine.  T 
work  is  performed  as  follows:  A  three-inch  test  tube  containi 
nutrient  bouillon  is  inoculated  with  the  contents  of  one  capillary  ti 
of  vaccine  virus.  A  6-inch  test  tube  is  then  prepared  with  i  1-3  | 
of  pyropallic  acid  and  a  short  piece  of  potassium  hydrate  stick.  1 
tube  is  ouc-half  filled  with  water  and  the  3-inch  tube  is  placed  in 
6-inch  tube  so  that  the  rim  of  the  smaller  tube  rests  on  the  rim 
tite  larger.  Both  tubes  are  then  covered  with  an  inverted  glass  t 
tube  and  placed  in  a  glass  containing  enough  water  to  cover  the  moi 
of  the  inverted  tube,  and  thereby  to  prevent  the  entrance  of  air.  1 
whole  apparatus  is  then  placed  in  an  incubator  at  37  degrees  cei 
grade  for  forty-eight  hours.  On  removal  the  bouillon  is  filtei 
through  a  Rerkfeld  filter  and  the  filtrate,  which  would  contain  a 
tetanus  toxine  present,  is  injected  to  the  amount  of  J^  a  cubic  cei 
meter  into  a  puinca-pig.  Tlie  pig  is  kept  under  observation  for  thi 
(lay.s,  and  if  there  are  no  symptoms  of  tetanus  the  virus  is  deemed  fi 
of  tetanus  toxine.  Since  the  adoption  of  this  routine  examination 
virus  has  been  found  to  show  the  presence  of  tetanus.  To  determi 
the  prosciico  of  ordinary  pyogenic  organism  the  contents  of  one  caf 
lary  tube  of  vaccine  virus  are  injected  beneath  the  skin  of  anott 
guinea-pig.  and  this  pig  is  kept  under  observation  five  days.  Durii 
the  jcar  all  the  guinea-pigs  have  shown  no  reaction  with  the  except!' 
of  two.  These  two  developed  small  abscesses,  but  as  they  were  i 
jccted  by  a  new  laboratory  assistant  it  is  thought  probable  that  t 
abscesses  were  the  result  of  careless  technique. 

Some  chance  obser\ations  in  the  purchase  of  capillary  tubes 
drug  stores  throughout  the  City  have  shown  that  it  is  not  an  unfr 
quent  practice  of  the  stores  to  keep  and  sell  vaccine  virus  far  too  o 
to  be  efficient.    To  one  Laboratory  Assistant  is  therefore  assigned  tl 
task  of  visiting  drug  stores  throughout  the  Cit\,  inspecting  the  stoi 


483 

of  capillary  tubes  on  hand,  withdrawing  tubes  of  inefficient  virus  and 
replacing  them  without  cost  to  the  druggist  with  an  equal  number  of 
tubes  of  fresh  virus.  During  the  last  three  months  of  the  year  769 
tubes  were  so  reclaimed  and  an  equal  number  of  fresh  tubes  issued. 

Experimental  Work — When  glycerine  was  first  used  as  an  emulsi- 
fying agent  the  statement  was  made,  and  in  part  supported  by  ex- 
periments made  in  this  laboratory,  that  the  glycerine  has  an  antiseptic 
effect  on  the  germs  contained  in  the  vaccine  pulp,  and  that  contact 
with  the  glycerine  for  a  few  weeks  is  sufficient  to  render  the  virus 
sterile,  as  far  as  the  ordinary  bacteria  are  concerned.  It  became  early 
evident  that  while  certain  bacteria  are  easily  killed  certain  others  are 
practically  unaffected,  and  when  these  varieties  are  present,  glycerinated 
virus  a  year  or  more  old  may  contain  many  bacteria.  While  these 
bacteria  are  as  a  rule  non-pathogenic  it  cannot  be  positively  asserted 
that  in  all  cases  there  is  no  possibility  that  they  may  not  contribute 
to  inflammation  at  the  site  of  inoculation.  It  is  desirable,  therefore, 
to  get  rid  of  these  bacteria  as  far  as  possible,  and  experiments  have 
been  conducted  to  this  end. 

It  must  be  recognized,  however,  that  the  prime  requisite  of  vac- 
cine virus  is  not  the  production  of  a  sterile  fluid,  but  the  production 
of  a  virus,  which,  when  inoculated,  will  produce  the  disease  vaccinia. 
It  has  been  demonstrated  in  the  laboratory,  for  example,  that  it  is 
possible,  by  incubating  the  tubes  of  glycerinated  virus  for  twenty-four 
to  forty-eight  hours,  to  increase  the  bactericidal  power  of  the  glycerine, 
and  to  produce  nearly  sterile  virus  quickly,  but  the  process  of  incuba- 
tion is  found  to  diminish  the  efficiency  of  the  virus. 

Experiments  have  been  made  by  adding  J4  per  cent,  carbolic  acid 
to  the  glycerinated  emulsion,  and  while  it  is  found  that  this  addition 
notably  diminishes  the  number  of  bacteria  present,  it  does  not  render 
the  virus  sterile.  One  per  cent,  carbolic  acid  in  glycerine,  however, 
kills  the  germs  rapidly.  It  is  the  custom  of  the  laboratory  to  make 
plate  cultures  and  counts  on  each  of  two  tubes  of  virus  on  the  seventh 
day  after  collection;  again  on  the  fourteenth;  again  on  the  twenty- 
first,  and  finally  on  the  twenty-eighth  day  after  collection. 

The  counts  vary  considerably  for  the  following  reasons.  The 
skin  of  one  calf  and  the  vesicles  produced  on  it  contain  more  bacteria 


484 


--vir. 


•  ?    i:      _T  riTT. 


.^-. 


-it^irles  of  another  calf;  the  quantity  of  virus  u 
•::  rrerl>elv  fixed,  for  all  the  tubes  do  not  cent 
^.ziT.z :  the  virus  being  an  emulsion  and  not  a  liqi 

i:?:rlb--:::on  of  the  bacteria,   so   that  two  drops 

rr.  the  sarr.c  emulsion  may  give  somewhat  diffei 

w:ri<.  the  count  is  recognized  simply  as  an  in 


:  !!   Air.*:  :AV'!e  exhibits  the  average  number  of  bacteria 
:-  ■     r.  tich  of  the  four  dates  from  ten  calves    (a)   while 
c'.;. ccrir.c  was  the  only  antiseptic;    (b)    while   5 2   per  c 
cir':-:*.::  :.j..*.  :r.  ir'.ycerinc  was  the  only  antiseptic;  and    (c)   after 
:r.:r;-;:c:-  r.  ::  x  per  cent,  carbolic  acid  in  glycerine. 


^ .    ^ ». . . 


Pit 


Glycerine. 


list  .. 


Innumenble. 

Innumerable 

Innumerable. 


aSlh     LoiKest  number  in  So  plates,  2629. 


H  Per  Cent. 
Carbolic. 


iPer  C 
Carbo 


407* 
3.103 

1.578 
6u 


1 


L*  . 


To  iletermiiio  tlic  effect  of  carbolic  acid  upon  the  efficiency  of 
virus,  the  jjulp  taken  from  twenty-five  successive  calves   was   mi: 
in  each  case  one-half  with  ^i  per  cent,  carbolic  acid  in  50  per  c 
glycerine,  and  the  other  half  with  i  per  cent,  carbolic  acid  in  50 
cent,  j^lvccrine.     The  two  sets  of  material  from  each  calf  were  te* 
by  repeated  use  in  primary  vaccinations  over  a  period  of  months.  ; 
it  was  found  that  there  was  no  difference  between  the  two  in  the 
of  the  virus. 

DurinfT  the  latter  months  of  the  year,  therefore,  the  routine  prcpa 
tinn  of  virus  has  been  to  emulsify  it  in  i  per  cent,  carbolic  acid. 
per  cent,   glycerine  and  40  per  cent,   water. 

There  have  at  times  appeared  observations  on  the  pnssihility 
producing  the  disease  "  Wiccinia  "  by  incculating  iv.aterial  taken  in 
a  vaccinated  animal  aj^irt  iro:n  the  site  of  tlie  vesicle,  and  this  h 
oratory  has  ir.ade  a  nutr.ber  oi  tests  0:1  tl-.e  presence  of  the  speci 
ors^anism  of  vaccinia  in  the  i:igi:::i.il  gla::.:?  of  :::o  c^Iv-s  inrculatt 
These  observations  are  worthy  of  a  spoci.i:  res;.^vv:  Vcciiise  the  glan 


48s 

were  removed  at  autopsy  after  the  skin  containing  the  scars  of  the 
curetted  vesicles  had  been  removed,  and  because  the  autopsy  was  per- 
formed in  the  slaughter-house  at  a  distance  from  the  laboratory  by  a 
veterinary  surgeon,  who  does  not  come  in  contact  with  the  vaccine 
material  so  that  it  may  be  safely  assumed  that  there  was  no  possibility 
that  these  glands  became  infected  by  contact  with  vaccine  material. 
Parts  of  the  glands  were  cut  up  and  the  gland  mixed  with  50  per  cent, 
glycerine,  and  the  material  so  obtained  was  examined  bacteriologically, 
and  then  used  for  primary  vaccinations.  It  should  be  said  here  that 
cultures  made  from  these  were  sterile  in  all  but  one  instance,  in 
which  a  diplococcus  was  found.  Tests  were  made  on  glands  taken 
from  twenty-five  calves,  and  the  glands  were  removed  at  periods 
following  the  vaccination  of  the  calves  varying  from  six  to  twenty- 
two  days.  In  two  instances  only  out  of  the  twenty-five  were  posi- 
tive results  obtained  in  primary  vaccination.  In  one  the  gland  had 
been  removed  thirteen  days  after  vaccination  of  the  calf,  and  in  the 
other  six  days  after  vaccination.  It  is  apparently  demonstrated,  there- 
fore, that  exceptionally  the  inguinal  glands  of  the  vaccinated  animal 
may  contain  the  specific  organism  of  the  disease.  The  spleen  was 
tested  in  like  manner  twice,  but  in  neither  instance  did  a  positive  re- 
sult follow  use  in  primary  vaccination. 

The  degree  of  dilution  of  the  pulp  by  the  glycerine  mixture  is 
one  of  the  points  of  difference  in  vaccine  laboratories'  practice.  Ex- 
periments have  been  made  in  this  laboratory  to  determine  the  effect 
on  the  efficiency  of  virus  of  various  degrees  of  dilution.  It  may  be 
stated,  first,  that  all  degrees  up  to  one  part  of  pulp  in  six  parts  of 
glycerine  emulsion  yield  virus  which  is  uniformly  efficient  if  the  virus 
is  used  promptly.  A  series  of  preparations  in  which  the  ratios  of 
virus  to  excipient  have  been  i  to  2,  I  to  2)^,  i  to  3,  I  to  3j4, 
I  to  4,  and  I  to  5,  have  been  watched  and  tested  over  periods  of  time 
extending  in  some  cases  to  two  years.  Conclusions  are  difficult  because 
a  strongly  efficient  virus  in  any  of  these  dilutions  will  last  much  longer 
than  a  mildly  efficient  virus,  but  the  tabular  view  of  the  results  ob- 
tained indicates  that  up  to  the  dilution  of  i  to  4  there  is  no  appreci- 
able difference  in  the  duration  of  the  efficiency  of  the  virus.  High 
dilutions  are  uncertain  because  it  is  not  at  present  possible  to  divide 


486 

the  pulp  finely  enough  to  permit  its  even  spread  through  many  time 
its  weight  of  liquid.  A  dilution,  for  example,  of  one  part  of  pulj 
to  24  of  excipient  has  been  found  in  many  cases  to  be  efficient  wbe 
used  in  primary  vaccination,  but  in  a  hundred  primary  vacdnatios 
its  percentage  of  efficiency  is  small.  Experimentally  dilutions  hav 
been  prepared  and  tested,  ranging  all  the  way  from  one  part  of  pul 
to  six  of  excipient  to  one  part  of  pulp  to  five  hundred  of  excipien 
Successful  vaccinations  are  common  with  all  dilutions  up  to  one  pa 
of  pulp  and  two  hundred  and  fifty  of  excipient  Higher  dilutions  ths 
the  last  rarely  give  successful  "  takes." 

The  amount  of  immunity  granted  by  a  single  vesicle  has  been  t! 
subject  of  some  debate.  Experiments  have  been  made  in  the  labor 
tory  on  the  immunity  against  vaccinia  produced  by  a  single  smi 
vesicle  on  the  calf.  It  is  somewhat  difficult  to  produce  a  small  vesk 
on  the  calf  because  even  when  the  virus  is  pricked  into  the  skin  1 
one  thrust  of  a  needle  the  resulting  vesicle  may  be  of  considerable  sii 
J4  of  an  inch  in  diameter,  for  example.  Three  calves,  however,  we 
vaccinated  so  as  to  produce  the  smallest  vesicle  possible,  and  i 
vaccinated  two  to  three  weeks  after  the  original  vaccination;  in  ea 
case  the  re-vaccination  failed,  and  it  is  inferred  that  at  least  again 
early  re-vaccination  the  smallest  vesicle  possible  to  obtain  on  a  c: 
affords  immunity. 

Pathologist. 
Report  of  Work  Performed  During  the  Year  1906. 

Autopsies  have  been  conducted  on  cases  dying  of  suspected  con 
municable  diseases  when  further  investigation  was  deemed  importati 
Also  upon  horses  dying  while  being  used  for  the  development  of  ant 
toxins. 

A  larger  part  of  the  work  is,  however,  represented  by  the  pr( 
duction  of  antitoxins,  the  duties  consisting  of  regular  inspections  c 
the  horses  and  stable,  supervision  of  injections  and  bleedings  of  tfa 
horses,  and  handling  of  the  antitoxin  in  bulk.  The  total  numbe 
of  horses  under  treatment  during  the  year  was  thirt>--seven  (37) 
Most  of  these  were  employed  in  the  production  of  diphtheria  anti 
toxin,  and  from  twenty-six  (26)  of  them  so  used  antitoxin  was  ofc 


487 

tained.  This  diphtheria  antitoxin  product  is  represented  by  a  total 
of  1,680,685  c.  c,  of  which  amount  165,355  c.  c.  was  in  the  fomi 
of  serum  and  1,515,330  c.  c.  was  citrated  plasma. 

From  two  horses  injected  with  tetanus  toxin  there  was  obtained 
tetanus  antitoxin  to  the  extent  of  24450  c.  c. 

A  few  horses  were  used  for  experimental  inoculations  with  the 
toxins  of  dysentery  bacilli,  typhoid  bacilli,  streptococci,  and  rabies. 

The  total  number  of  injections  was  662  and  of  the  bleedings  319, 
the  latter  yielding  serum  or  citrated  plasma  having  a  combined  bulk 
of  1,704,975  c.  c. 

KINGSTON  AVENUE  HOSPITAL. 

Medical  Work. 

Three  thousand  and  seventy-eight  (3,078)  with  three  hundred  and 

seventy-two  (372)  accompanying  have  been  treated  as  follows: 

165  cases   remaining   

399  cases  diphtheria,  mortality  rate  31  -3 

609  cases  scarlet  fever,  mortality  rate  la.  I 

1,344  cases  measles,  mortality  rate  ia.6 

108  cases  small  pox,  mortality  rate  5-5 

I  case  measles,  scarlet  fever  and  varicella 

78  cases  varicella,  mortality  rate 5.6 

II  cases  pertussis,  mortality  rate 5.8 

3  cases  German  measles,  mortality  rate 

69  cases  diphtheria  and  measles,  mortality  rate 1.7 

50  cases  diphtheria  and  scarlet  fever,  mortality  rate 22.0 

I  case  diphtheria  and  varicella  

I  case  diphtheria  and  pertussis  

1  case  typhoid  fever,  mortality  rate  100.00 

129  cases  scarlet  fever  and  measles 

II  cases  scarlet  fever  and  varicella 

8  cases  scarlet  fever  and  pertussis 

30  cases  measles  and  pertussis 

27  cases  measles  and  varicella 

2  cases  measles,  scarlet  fever  and  diphtheria 

1  case  measles,  varicella  and  pertussis,  mortality  rate 100.00 

2  cases  measles  and  mumps 

2  cases  mumps    


5  cues  measlei,  torlet  fever  and  pertnisii  . 

I  case  varicella  and  pertussis  

8  cues  scarlet  fever  and  pcrtusiis 


Of  the  diphtheria  cases  six  (6)  died  within  twelve  (12)  houn 
fourteen  (14)  within  twenty-four  (24)  hours,  thirteen  (13)  withi 
thirty-six  (36)  hours,  and  ten  (10)  within  forty-eight  (48)  hour 
after  admission.  There  were  one  hundred  and  fourteen  (114)  intu 
bation  cases  of  which  seventy-two  (72)  died. 

It  will  be  seen  from  the  foregoing  figures  that  the  high  deat 
rate  may  be  explained  by  the  deaths  occurring  in  those  cases  tha 
were  profoundly  toxicated  upon  admission  or  in  cases  requiring  in 
tubation,  but  if  the  intubation  and  moribund  cases  are  eliminated,  th 
death  rate  is  very  much  tower.  I  would  also  call  your  attention  t 
the  fact  that  a  large  percentage  of  the  cases  sent  to  our  institutioi 
are  in  a  poorly  nourished  condition  and  physically  unable  to  comba 
the  disease. 

I  would  respectfully  call  your  attention  to  the  necessary  cost  o 
the  treatment  of  mixed  infections.  You  wilt  observe  that  there  hav 
been  five  hundred  and  twenty-six  (526)  mixed  infections  in  the  hos 
pital  distributed  over  a  range  of  nineteen  (19)  different  mixed  in 
fections.  It  not  infrequently  happens  that  it  is  necessary  to  take  cari 
of  a  large  number  of  different  infections  at  one  time  necessitating  i 
day  nurse,  night  nurse  and  a  ward  attendant  for  every  infection.  Ii 
most  instances  there  would  be  only  one  or  two  cases  to  one  isolatior 
ward,  Tlie  facilities  of  this  hospital  are  wholly  inadequate  for  taking 
care  of  these  cases.  At  the  present  time  there  should  be  provided  a 
number  of  admission  wards  where  the  cases  admitted  daily  could  be 
kept  for  observation,  until  the  incubation  period  of  the  various  con- 
tagious diseases,  to  which  the  patient  is  liable,  has  passed.  To  pre- 
vent the  spread  of  mixed  infections  in  tiiis  hospital,  where  there  are 
so  many  foreign  patients  admitted,  from  whom,  and  of  whom,  there 
is  no  possibility  of  getting  histories,  demands  the  utmost  care  on  the 
part  of  the  officials  of  the  institution  and  tlie  very  best  methods  of 
isolation.  Both  of  these  factors  are  absolutely  essential,  the  absence 
of  either  of  them  makes  the  sprea''   "*    infection    almost    inevitable. 


489 

There  have  been  made  (exclusive  of  diphtheria)  five  thousand  six 
hundred  and  thirty-nine  (5,639)  examinations  in  the  Pathological 
Laboratory  as  follows: 

Urines,  four  thousand  six  hundred  and  sixty-two  (4,662)  bac- 
teriological examinations;  exudates,  etc.,  nine  hundred  and  seventy- 
seven  (977)  ;  of  these  five  hundred  and  sixty-two  (562)  smears  have 
been  made  from  cases  suffering  from  vaginitis,  of  which  two  hun- 
dred and  ten  (210)  have  shown  the  presence  of  an  organism  having 
the  morphological  and  staining  characteristics  of  the  gonococcus  and 
the  clinical  aspect  of  the  cases  has  been  that  of  specific  vaginitis.  This 
disease  has  been  of  such  an  infectious  character  as  to  demand  its  isola- 
tion and  treatment  as  that  of  a  most  communicable  disease.  All  the 
female  children  admitted  are  held  in  an  observation  room  until  it  can 
be  determined  whether  vaginitis  is  present.  This  disease  is  so  per- 
sistent that  frequently  a  child  has  to  be  retained  for  some  time  after 
its  recovery  from  the  contagious  disease  for  which  it  was  admitted. 
The  most  favorably  recommended  therapeutic  measures  have  been 
employed  to  cure  this  disease  and  for  the  last  month  systematic  vac- 
cinations have  been  employed,  with  the  view  of  raising  the  resistance 
of  the  children  to  such  a  degree  that  a  cure  will  be  effected.  Too 
few  cases  have  been  observed  to  draw  any  conclusion  as  to  the  value 
of  this  mode  of  treatment.  During  the  year  a  systematic  study  of 
the  pathological  lesions  of  the  diseases  treated  in  this  hospital  has 
been  carried  on  in  the  Research  Laboratory  and  will  be  continued  dur- 
ing the  year  1907. 

Administrative  Work. 

There  are  on  the  grounds  of  the  Kingston  Avenue  Hospital  thirty- 
one  (31)  buildings  as  follows:  Administration  building,  stable  with 
annex,  disinfecting  station,  kitchen,  ice  plant,  storehouse  and  laundry, 
five  (5)  pavilions,  diphtheria  building,  scarlet  fever  building,  six  (6) 
cottages,  four  (4)  wigwams,  boiler  house,  two  (2)  morgues,  paint 
shop,  two  (2)  incinerator  houses,  one  (i)  greenhouse,  and  the  nurses' 
home. 

There  are  employed  in  the  institution  one  hundred  and  ninety-nine 
(199)    persons  as   follows:     Two   (2)    hospital  physicians,  five    (s) 


490 

medical  internes,  one  (i)  matron,  ten  (lo)  hospital  clerks,  of  whom 
three   (3)  are  detailed  to  the  Tuberculosis*  Clinic  in  Jay  street,  one 
(i)   is  detailed  to  the  chief  of  the  ambulance  service,  two   (2)   arc 
detailed  to  the  Borough  Headquarters  at  Nos.  38-40  Clinton  street, 
one   (i)   Superintendent  of  Nurses,  fifty-one  (51)   nurses,   of  whom 
three  (3)  are  detailed  to  the  Tuberculosis  Qinic  in  Jay  street,  fifty-six 
(56)  domestics,  of  whom  one  (i)  is  detailed  to  the  Tuberculosis  Qinic 
in  Jay  street,  five  (5)  firemen,  three  (3)  carpenters,  one  (i)  telephone 
operator,  one   (i)   gardener,  one   (i)   watchman,  two    (2)    orderlies, 
thirty-seven  (37  laborers,  of  whom  two  (2)  are  detailed  to  the  Head- 
quarters of  the  Borough,  Nos.  38-40  Clinton  street,  two  (2)   are  de- 
tailed at  the  Disinfecting  Station  of  the  borough,  eighteen   (18)   driv- 
ers, of  whom  one  (i)   is  detailed  at  Nos.  38-40  Qinton  street,  one 
(i)  driver  detailed  to  the  Visiting  Physician  of  the  Kingston  Avenue 
Hospital,  and  seven  (7)   drivers  detailed  to  the  Disinfecting'  Station 
of  the  borough,  one  (i)   helper,  four  (4)   engineers. 

In  estimating  the  cost  of  administration  of  this  institution,  the 
money  expended  on  these  special  details  should  not  be  charged  against 
the  hospital. 

During  the  past  year  permanent  improvements  have  been  added 
to  the  hospital  as  follows:  Pipe  trench  completing  the  installation  of 
the  new  steam  system;  retaining  wall  about  the  storehouse  and  laun- 
dry; enclosing  the  stairway  of  the  dormitory;  the  erection  of  four 
portable  wigwrams  for  isolation  purposes;  the  completion  of  new 
stable ;  completion  of  new  incinerating  plants ;  division  of  the  rear  half 
of  Pavilion  3  into  four  isolation  rooms;  painting  interior  of  wards 
2,  3,  5  and  6;  the  renovation  of  lavatories  of  wards  2,  3,  5  and  6. 

The  grounds  of  the  hospital  are  being  gradually  filled  in,  there 
having  been  deposited  several  thousand  loads  of  dirt  during  the  year. 
This  is  being  so  distributed  that,  in  the  spring,  the  grounds  will  pre- 
sent a  much  better  appearance.  The  difficulty  of  getting  contractors 
to  proced  rapidly  with  contracts  awarded  them  on  this  plant,  on  ac- 
count of  men  not  wishing  to  work  in  the  grounds  of  a  contagious  dis- 
ease hospital,  has  made  it  necessary  for  us  to  have  as  much  as  pos- 
sible of  the  repair  and  improvement  work  of  the  institution  performed 
by  our  own.  employees.    That  you  may  have  some  information  regpard- 


491 

ing  the  extent  of  this  work  it  is  detailed  to  you  by  departments  as 
follows : 

Carpenters. 
During  the  year  1906  the  following  permanent  improvements  have 
been  made  by  the  carpenters  of  this  institution:  The  raising  of  Cot- 
tage No.  10  for  the  purpose  of  allowing  the  pipe  gallery  to  be  con- 
structed under  it  and  resetting  it  on  its  foundation  (the  lowest  esti- 
mate submitted  for  this  particular  piece  of  work  was  over  $800)  ;  the 
erection  of  five  tent  platforms;  the  renovation  and  reconstruction  of 
the  bathrooms  in  Pavilions  2,  3,  5  and  6;  the  subdivision  of  the  north 
end  of  Pavilion  3  into  four  isolation  rooms;  the  erection  of  plat- 
forms for  four  wigwam  cottages  together  with  the  sheathing  inside 
of  the  same ;  the  erection  of  4,070  lineal  feet  of  shelving  in  the  store- 
rooms of  the  hospital ;  the  erection  of  400  ft.  of  fencing ;  the  partition- 
ing off  and  sheathing  the  room  of  2,000  cubic  feet  of  space  in  the  base- 
ment of  the  administration  building;  the  installation  of  transoms  for 
ventilation  in  the  inside  room  of  the  stable  dormitory;  the  partition- 
ing off  of  a  dormitory  in  the  south  half  of  the  basement  of  the  scarlet 
fever  pavilion;  the  partitioning  off  of  a  storage  room  in  the  ice  plant. 

In  addition  to  the  permanent  improvements,  the  carpenters  have 
kept  up  the  repairs  of  woodwork  in  the  institution,  as  well  as  a  num- 
ber of  days  of  repair  work  at  the  borough  building  at  Nos.  38-40 
Qinton  street. 

Engineering  Department — The  following  permanent  improvements 
have  been  made  by  the  Engineering  Department: 

Installing  new  gas  ranges  in  the  administration  building;  running 
gas  to  doctors'  room  in  basement;  installing  new  steam  line  under 
Pavilion  i  for  cooking  purposes ;  installing  new  gas  range  in  Pavilion 
I ;  repairing  steam  coil  in  Pavilion  i ;  and  running  new  return  line 
under  building  from  heating  system;  installing  new  steam  coils  in 
Pavilions  2  and  3;  installing  new  return  under  Pavilion  4  and  new 
nipples  in  radiators  in  Pavilions  4  and  5 ;  installing  new  returns  under 
Pavilion  6;  cutting  out  old  water  line  in  rear  of  Pavilion  6  and  put- 
ting in  new  one;  putting  boilers  in  running  order;  removing  No.  3 
sewer  pump  from  boiler  room  to  engine  room  and  putting  same  in 


492 

good  order,  thereby  making  practically  a  new  pump  out  of  same; 
redrilling  blowers  on  Nos.  4  and  5  boilers;  putting  new  grate  bars 
in  No.  3  boiler;  putting  new  gas  line  in  front  of  all  of  the  five  boil- 
ers; rebushing  pulley  for  extractor  in  laundry;  taking  laundry  engine 
apart  and  making  same  as  good  as  new;  taking  down  two  old  Nason 
straps  from  laundry  drying  room  mangle  and  connecting  same  with 
our  return  system;  putting  new  2-inch  steam  line  in  laundry  for  heat- 
ing sleeping  apartments  upstairs;  taking  extractor  apart  and  putting 
same  in  good  working  order;  repairing  mangle;  cutting  new  floor 
drain  in  laundry;  lowering  sewer  line  from  stable  that  runs  through 
tunnel ;  putting  generator  in  stable  for  ambulance  station ;  taking  small 
sterilizer  from  old  building;  installing  same  in   disinfection  station; 
cutting  through  wall  and  building  new  wall  around  No.  i  sterilizer; 
drilling  through  wall  to  raise  tracks ;  putting  new  gas  ranges  in  Nurses' 
Home ;  putting  new  gas  line  in  Nurses'  Home  to  light  the  icebox ;  in- 
stalling gas  piping  and  fixtures  in  wigwams ;  running  new  cold  water 
line  under  platform  of  wigwams;  putting  steam,  hot  and  cold  water, 
gas  and  sewer  connections  in  wigwams  after  they  had  been  removed 
to  cottage  platform,  using  on  this  job  200  feet  of  54-inch  pipe,  128 
feet  of  4-inch  sewer  pipe  and  250  feet  of  i-inch  steam  pipe,  covering 
same  with  hair  felt,  asbestos  paper  and  canvas;  cutting  through  wall 
of  engine  room  for  suction  line ;  overhauling  all  valves  on  steam  plant ; 
renewing  all  defective  flanged  joints;  putting  the  steam  plant  in  good 
working  order ;  putting  new  2-inch  return  line  between  Pavilions  I  and 
2 :  taking  coal  elevator  apart  and  putting  same  in  good  order ;  taking 
engine  for  coal  elevator  apart  and  repairing  same;  making  new  con- 
crete floor  between  boiler  room  and  coal  shed ;  concreting  floor  in  en- 
gine room  where  old  boilers  stood;  new  steam  connection  for  sewer 
pumps ;  putting  No.  2  sewer  pump  in  first-class  order ;  running  gas  in 
hallway  of  dormitory,  over  laundry  and  dormitory  over  storehouse; 
digging  trench  for  new  line  of  suction  pipe  from  engine  room  to  tank ; 
calked  all  the  joints  on  old  8-inch  suction  line ;  installed  two  new  radi- 
ators in  administration  building. 

In  addition  to  the  permanent  improvements  the  engineering  de- 
partment has  kept  up  all  of  the  current  repairs  for  the  year. 


493 

Painiers. 

All  of  the  painting  performed  at  this  hospital  during  the  year  has 
been  done  by  its  own  employees.  Scraping  and  painting  on  the  out- 
side of  Pavilions  Nos.  5  and  6;  painting  of  the  interior  of  Pavilions 
Nos.  2,  3,  5,  6,  and  the  interior  of  Pavilion  No.  7,  the  painting  of  the 
interior  of  the  wigwams  and  cottages  and  the  enameling  of  the  hos- 
pital furniture. 

The  needs  for  further  permanent  improvements  of  this  hospital  are 
great,  especially  for  dormitories,  laundry  and  a  kitchen. 

Dormitory, 
The  present  dormitory  facilities  are  entirely  inadequate,  it  being 
necessary  at  the  present  time  to  house  certain  of  the  ward  helpers  in 
the  basement  of  the  scarlet  fever  pavilion.  There  is  not  in  the  insti- 
tution a  dormitory  in  which  orderlies  can  be  housed.  It  has  been  the 
policy  of  the  management  of  this  institution  to  encourage  male  em- 
ployees to  lodge  at  their  own  homes.  There  should  be  kept  on  the 
plant  a  sufficient  number  of  male  employees  at  all  times  to  meet  any 
fire  emergency.  I  would  respectfully  recommend  that  the  proposed 
new  administration  building  be  provided  as  soon  as  possible  and  that 
the  present  administration  building  be  made  into  a  dormitory  for  do- 
mestics.   Such  a  change  would  allow  of  the  present  female  dormitories 

being  used  for  male  help. 

Laundry. 

The  laundry  of  the  present  institution  is  entirely  inadequate.  It 
consists  of  one  thousand  four  hundred  forty  (1440)  square  feet 
of  floor  space,  two  washers,  one  extractor,  five  stationary  washtubs, 
one  mangle  and  six  hundred  eighty-eight  (688)  cubic  feet  of  dry- 
ing space.  The  number  of  articles  passing  through  this  laundry  during 
the  year  was  six  hundred  forty-four  thousand  four  hundred  (644,400). 
The  number  of  persons  employed  in  the  laundry  is  fourteen  (14). 

You  will  see  that  in  addition  to  the  inadequate  facilities  the  plant 
has  been  overcrowded  by  the  employees.  I  would  therefore  respect- 
fully recommend  that  the  first  improvement  that  takes  place  in  the 
Kingston  Avenue  Hospital,  after  providing  a  new  dormitory,  be  that 
of  the  erection  of  a  laundry  of  a  capacity  sufficient  not  only  for  our 
present  needs,  but  for  the  needs  of  this  institution  ten  ( 10)  years  hence. 


494 

Kitchen, 

About  thirty-six  thousand  (36,000)  meals  were  served  from  the 
Giet  kitchen  of  this  institution  during  the  year  1906. 

The  kitchen  is  one-half  (yi)  oi  one  of  the  old  wooden  pavilions.  It 
has  seven  hundred  seventy  (770)  square  feet  of  space,  contains 
one  (i)  large  coal  range  and  is  not  provided  with  hot  water  system. 
For  the  first  half  of  the  year  there  was  one  steam  cooker,  the  second 
being  installed  in  July.  It  has  none  of  the  furnishings  of  a  modem 
kitchen.  It  is  therefore  recommended  that  the  building  next  provided 
after  the  laundry  be  that  of  a  kitchen  adequate  to  the  demand  of  this 
institution  ten  years  hence. 

Reckption  Hospital. 

Medical  IVork — 1,954  cases,  with  52  accompanying,  have  been 
treated  as  follows: 

Remaining    12 

Diphtheria    358 

Scarlet  fever 489 

^(easles 607 

Small  pox   44 

Mumps r I 

Varicella   21 

Pertussis  12 

German  measles  4 

Diphtheria  and  scarlet  fever 20 

Diphtheria  and  measles  87 

Diphtheria  and  varicelb    3 

Diphtheria  and  pertussis i 

Diphtheria,  scarlet  fever  and  measles 5 

Scarlet  fever  and  measles 3 

Scarlet  fever  and  varice^lla 2 

Diphtheria,  scarlet  fever  and  pertussis i 

Measles  and  pertussis 9 

Measles  and  vAricelta  2 

GUnders    i 

Hydiv^phc^bu   I 

Cerv^Tv^  si^njkl    Men::*4iit5s 16 

Tuber\"ukvs:s  .  106 


495 

Administration  Work — 203  persons  are  employed  in  the  hospital 
work. 

The  report  of  permanent  improvements  and  general  repairs  to 
buildings  is  included  in  the  report  of  the  Willard  Parker  Hospital. 

I  have  the  honor  to  submit  to  you  the  following  report  of  the  work 
of  the  Willard  Parker  Hospital  for  the  year  1906. 

The  hospital  did  not  receive  any  patients  until  March  14,  1906,  so 
that  the  report  actually  shows  about  nine  months*  work. 

Medical  Work, 

Nine  hundred  and  eighty-eight  cases,  with  6  accompanying,  have 
been  treated  as  follows:  935  cases  diphtheria,  53  cases  of  scarlatina,  6 
accompanying.  The  death  rate  in  the  diphtheria  was  34.9  per  cent. 
This  high  rate  is  accounted  for  by  the  number  of  cases  admitted,  either 
profoundly  intoxicated  with  diphtheria  poison,  as  intubation  cases,  or 
cases  complicated  with  broncho-pneumonia.  The  number  of  cases  dying 
within  48  hours  after  admission  were  81,  36  within  12  hours,  24  between 
12  and  24  hours,  14  between  24  and  36  hours,  and  10  between  36  and 
48  hours  after  admission.  Thus  it  will  be  seen  that  60  cases  died  before 
24  hours  after  admission,  and  it  can  be  assumed  that  the  majority  were 
too  much  poisoned  to  respond  to  treatment. 

Intubation  Cases — The  total  number  of  tube  cases  treated,  from 
March  14,  1906,  to  December  31,  were  323.  Of  this  number  153  were 
discharged  cured  and  170  died.  When  the  fatal  intubation  cases  are 
eliminated  it  is  found  that  the  mortality  is  only  8.4  per  cent. 

A  complication  that  has  caused  a  very  great  deal  of  annoyance  and 
the  most  rigid  adherence  to  isolation  to  prevent  its  spread  has  been 
vaginitis.  There  have  been  a  large  number  of  these  cases,  and  in  many 
instances  they  have  persisted  long  after  the  contagious  disease  was 
entirely  cured.  Every  therapeutic  measure  has  been  used  to  hasten 
their  recovery.  During  the  last  month  a  number  of  cases  have  been 
vaccinated  with  the  hope  of  effecting  a  cure  by  the  increase  of  opsonins 
in  the  blood ;  there  have  been  too  few  cases  to  draw  conclusions,  but  if 
results  warrant  it  the  treatment  will  be  continued  in  the  chronic  cases. 

On  December  24,  1906,  two  wards  in  the  new  scarlet  fever  pavilion 
were  opened,  and  cases  of  scarlet  fever  were  admitted.    Up  to  the  31st 


of  December  53  cases  were  treated,  with  two  deatfis,  wiHi  the  mortality 
.ate  of  ^.yy  per  cent. 

Your  attention  is  especially  called  to  the  expense  of  treating  mixed 
infections.  Each  case  suffering  with  a  mixed  infection  with  contagious 
diseases  needs  isolation,  with  one  day  nurse,  one  night  nurse  and  one 
day  attendant.  It  is  especially  necessary  that  the  hospital  be  provided 
with  the  proper  receiving  wards  where  the  cases  admitted  daily  can  be 
watched  until  after  the  incubation  period  of  the  acute  contagious  dis- 
eases. There  is  no  proper  place  for  isolation,  excepting  Reception 
Hospital,  which  is  inadequate.  From  the  beginning  of  my  administra- 
tion, on  April  i,  1906,  a  systematic  study  of  the  skin  and  mucous  mem- 
branes of  the  diseases  treated  in  the  hospitals  has  been  conducted.  This 
work  is  being  done  in  the  Research  Laboratory  of  the  hospital  and  is 
to  be  continued  during  the  present  year.  The  system  of  keeping  his- 
tories in  the  hospital  cases  has  been  simplified  by  a  new  chart  that  it  is 
hoped  will  make  the  clinical  records  of  the  hospital  complete  and  easily 
accessible. 

Visitors — Your  attention  is  called  to  the  necessity  of  regulating 
hours  of  visiting  patients  at  the  hospitals.  On  visiting  days  it  is  a  com- 
mon occurrence  to  see  every  child  in  a  ward  with  thirty  beds  crying  at 
once.  The  depressing,  not  to  say  dangerous  effect  on  every  sick  case, 
cannot  be  overestimated.  1  would  therefore  recommend  that  visiting 
be  restricted  to  one  day  a  week,  and  that  only  one  person  at  a  time  be 
allowed  to  visit.  In  all  cases  of  very  sick  patients  the  hospital  notifies 
the  interested  persons  that  they  may  see  the  case  at  any  time,  under 
conditions  approved  by  the  physician  in  charge.  ^^^ 

All  visitors  to  the  contagious  hospitals  are  vaccinated.  ^^^H 

Administration  Work.  ^^^1 

Two  hundred  and  three  persons  are  employed  in  the  hospital  work, 
as  follows:    Two  hospital  physicians,  working  in  the  Willard  Parker 


f.nd  Reception  Hospitals ; 
Sanatorium :  4  internes, 
wards  of  the  Willard  P 
the  hospital;  i  hospita 
Fifty-fifth  street:  i  hos 


[  h- — ■'■•'  physician,  assigned  to  the  Otisville 
diphtheria  and  scarlet    fever 
tspital  clerks,  working  in 
tuberculosis  clinic  at 
-.  President's  office;  I 


497 

liospital  clerk,  assigned  to  the  Division  of  Communicable  Diseases;  i 
hospital  clerk,  assigned  to  the  Vaccine  Laboratory  at  the  Willard  Parker 
Hospital  plant ;  i  matron  of  the  Willard  Parker  Hospital ;  i  supervising 
nurse,  37  nurses,  two  of  whom  are  assigned  to  tuberculosis  clinic;  2 
helpers,  3  engineers,  8  firemen,  i  carpenter,  i  elevator  man,  2  drivers, 
assigned  to  the  President's  office ;  i  driver,  assigned  to  the  Division  of 
Communicable  Diseases;  i  driver,  assigned  to  the  Assistant  Sanitary 
Superintendent;  6  drivers,  assigned  to  the  disinfecting  station;  4  am- 
bulance drivers,  i  watchman,  assigned  to  the  drug  laboratory ;  2  labor- 
ers, assigned  to  the  Research  Laboratory  of  the  hospital ;  2  laborers,  as- 
signed to  the  vaccine  laboratory;  i  laborer,  assigned  to  the  Division 
of  Communicable  Diseases;  i  laborer,  assigned  to  Borough  of  Rich- 
mond; I  laborer,  assigned  to  the  Disinfecting  Station;  2  laborers,  as- 
signed to  Fifty-fifth  street  building.  Total  number  of  assigned  la- 
borers, 27.  Total  number  of  domestics,  81.  Four  domestics,  assigned 
to  the  Fifty-fifth  street  building;  i  domestic,  assigned  to  the  vaccine 
laboratory,  and  10  domestics,  assigned  to  the  research  laboratory 
building.  Your  attention  is  called  to  the  large  number  of  employees 
of  this  institution,  who  are  on  special  detail.  And  in  considering  the 
expense  of  administration  should  not  be  charged  against  the  hospital 
in  estimating  the  cost  of  treatment  per  patient. 

I  consider  the  various  buildings,  with  the  employees  working  therein, 
at  the  foot  of  East  Sixteenth  street,  essentially  of  the  hospital  plant, 
but  in  estimating  cost  of  maintenance  each  should  be  considered  sepa- 
rately. 

At  the  Willard  Parker  Hospital  there  are  20  buildings,  as  follows : 

Disinfecting  station. 

Gatehouse. 

Ambulance  station. 

Vaccine  Laboratory. 

Old  Willard  Parker. 

Boiler  house. 

Coal  storage  house. 

Animal  house. 

Morgue. 

Plague  Laboratory  building. 


498 

Research  Laboratory  building. 

Administration  building. 

Reception  kitchen. 

Inspector's  house. 

Scarlet  fever  pavilion. 

Scarlet  fever  kitchen. 

Reception  Hospital. 

Dock  house. 

Reception  storehouse. 

Avenue  C  annex. 

During  the  year  the  following  permanent  improvements  have  been 
made: 

Avenue  C  Annex — Renovation  of  sidewalk.  Repairing  rain  leader 
with  new  cast-iron  pipe.  Alteration  of  the  gas  pipe  system  so  that  all 
gas  is  now  controlled  by  one  meter. 

Disinfecting  Station  and  Dormitory — ^The  second  and  third  floors 
of  the  disinfecting  station  have  been  renovated  and  turned  into  a  dor- 
mitory for  hospital  help,  with  i6  rooms  and  48  bed  capacity. 

Ambulance  Station  and  Vaccine  Laboratory — New  floors  have  been 
placed  in  the  horse  stalls  of  the  ambulance  station  and  the  stalls  placed 
in  first-class  condition.  The  Croton  water  supply  pipe  of  the  ambulance 
station,  which  formerly  was  defective,  has  been  repaired.  New  electric 
fixtures  have  been  installed  throughout  the  ambulance  station  and  Vac- 
cine Laboratory. 

Plague  Laboratory — A  new  Nason  steam  trap,  with  necessary  steam 
fitting,  has  been  installed  so  that  the  hot  water  supply  is  completely 
controlled  and  a  permanent  supply  of  hot  water  provided.  The  cold 
water  supply  pipe  of  this  building  has  been  replaced  by  a  new  pipe. 

Morgue — Morgue  has  been  painted. 

New  Boiler  House  and  Coal  Storage  have  been  completed.  A  new 
malleable  iron  blow-oflF  pipe  from  the  boiler  house  to  the  river  has 
been  installed.  The  electric  lighting  has  been  installed  in  the  boiler- 
house  and  coal  storage. 

Willard  Parker  Hospital  and  Annex— Tht  Willard  Parker  Hospital 
has  been  renovated  throughout  and  was  occupied  for  the  first  time  since 


499 

renovation  on  March  14,  1906.    This  building  is  now  modern  and  up 
to  date  in  every  respect.    Screens  and  awnings  furnished  throughout. 

Administration  Building — Has  been  turned  over  to  the  Department 
and  accepted,  and  is  now  fully  occupied,  the  ground  floors  being  used 
for  administrative  purposes  and  the  floors  above  the  ground  being  used 
as  a  nurses'  home.  Since  the  building  has  been  occupied  the  cellar 
has  been  partitioned  off  into  storerooms  for  the  engineer,  hospital  clerk 
and  storagie  for  groceries  and  general  storage. 

Nezv  Research  Laboratory — Shades  and  awnings  have  been  fur- 
nished for  this  building.  Vacuum  pipes  have  been  installed  for  the 
laboratory  parts  of  the  building.  Two  new  chemical  tables,  with  all  ap- 
pliances, water,  gas,  etc.,  have  been  supplied  on  the  fourth  floor.  Win- 
dows and  doors  of  the  storeroom  on  the  first  floor  and  windows  and 
doors  throughout  the  cellar  have  been  protected  by  heavy  wire.  Hot 
water  bath  for  the  chemical  tables  on  the  third  floor  has  been  installed. 

Scarlet  Fever  Pavilion  has  been  completed  and  opened  and  on  De- 
cember 31  contained  53  patients. 

The  New  Kitchen  for  the  Reception  Hospital  is  nearly  completed. 

The  Reception  Hospital  atid  Waiting  Room — Plumbing  work  has 
been  repaired  throughout  and  new  cisterns  furnished  for  the  toilets. 
The  waiting  room  on  the  dock  has  been  painted. 

The  difficulty  of  getting  emergency  work  done  quickly  in  this  hos- 
pital, on  account  of  the  fear  that  workmen  have  that  they  may  contract 
contagious  disease  here,  and  the  subsequent  delay  and  annoyance,  has 
made  it  advisable  to  have  all  possible  repair  and  permanent  improvement 
work  done  by  our  own  employees.  I  call  your  attention  to  the  follow- 
ing improverfients  made  in  this  way. 

Engineering  Department — Five-inch  blow-oflF  line  from  the  boilers 
to  the  river.  Sewers  cleaned  three  times.  Overhauling  of  the  pumps 
and  elevator  in  the  Willard  Parker  Hospital.  The  making  of  all  steam, 
gas  and  water  connections  and  the  installation  of  the  sterilizing  ap- 
paratus in  the  operating  room. 

Reception  Hospital — One  hundred  and  ten  feet  of  defective  water 
piping  and  70  feet  of  steam  piping  renewed. 

Scarlet  Pezzer  Building — Overhauling  of  pumps  and  one  elevator, 
renewing  30  feet  of  defective  water  piping  and  20  feet  of  steam  piping. 


500 

Extending  lo  new  gas  lines  and  the  installation  of  eight  new  electric 
fixtures. 

Research  Laboratory  Building — Installation  of  gas  piping  for  ster- 
ilizers, installation  of  the  vacuum  apparatus  in  bottling  room.  Installing 
the  gas  attachments  to  i  chemical  table,  installation  of  the  steam  piping 
for  the  water  baths  in  the  Chemical  Laboratory. 

Administration  Building — Overhauling  2  pumps,  2  steam  traps,  i 
elevator  and  the  electric  call  bells. 

Ambulance  Station — Renewing  20  feet  of  water  piping,  overhauling 
elevator  engine. 

Vaccine  Laboratory — Renewing  60  feet  of  water  piping,  installing 
call  bells,  renewing  30  feet  steam  piping  and  repairing  of  the  vacuum 
pump. 

Plague  Laboratory — Renewing  25  feet  of  water  piping,  renewing 
20  feet  of  piping  on  the  main  steam  line. 

Boiler  House — Overhauling  of  two  pumps  and  one  pump  regulator, 
repairing  of  the  main  steam  lines,  repairing  two  blow-off  valves,  one 
steam  trap,  repairing  four  stock  valves,  repairing  three  regulators,  in- 
stallation of  13  electric  lights. 

Annex  Building — Overhauling  of  furnace,  installation  of  10  feet  of 
new  pipe  to  furnace,  renewing  15  feet  of  water  piping. 

Besides  this  work,  which  represents  permanent  improvements,  the 
engineering  department  has  kept  up  all  of  the  ordinary  repairing  in  the 
water  supply,  gas  and  electricity. 

Carpenter  Shop — The  following  permanent  improvements  have  been 
made  by  the  carpenters : 

The  erection  of  a  fence  around  the  grounds  of  the  Willard  Parker 
Hospital  Building.  The  erection  of  a  fence,  making  an  animal  yard. 
Tlie  partitioning  off  of  storerooms  in  the  cellar  of  the  Research  Labora- 
tory and  Administration  Buildings.  The  erection  of  one  large  work 
table  in  the  Chemical  Laboratory  and  the  erection  of  one  work  table  in 
the  Research  Laboratory.  In  addition  to  this  the  carpenters  have  kept 
up  all  minor  repairs,  such  as  repairs  to  doors  and  windows  of  the  insti- 
tution, besides  the  making  of  closets,  shelves,  etc.,  throughout  the  build- 
ings of  the  hospital  plant. 


SOI 

In  the  last  year  the  greatly  increased  capacity  for  patients  at  this 
hospital  has  made  it  necessary  to  very  much  increase  the  number  of 
employees,  and  your  attention  is  called  to  the  necessity  of  furnishing 
the  hospital  with  the  following  buildings: 

Dormitories  for  the  Help — Under  the  present  conditions  about  one- 
half  of  the  female  help  is  housed  in  what  is  called  the  Avenue  C  Annex, 
at  Avenue  C  and  Sixteenth  street.  The  domestics  working  in  the  Ad- 
ministration Building  are  accommodated  on  the  top  floor  of  that  build- 
ing, while  the  ward  maids,  as  far  as  possible,  are  accommodated  in  the 
new  dormitory  over  the  disinfecting  station.  None  of  these  buildings 
was  intended  for  the  purposes  for  which  they  are  used,  and  as  this 
plant  grows  it  will  be  absolutely  necessary  to  provide  proper  dormitory 
facilities  for  the  care  of  the  female  help.  I  would  respectfully  recom- 
mend that  the  first  improvement  made  by  the  Department  of  Health 
be  that  it  furnish  the  proper  dormitory  for  the  female  help  employed 
in  this  plant. 

Male  Help — All  of  the  male  employees  have  been  encouraged  to  live 
on  the  outside.  It  would  be  impossible  to  keep  them  under  the  present 
conditions,  but  we  are  forced  to  provide  sufficient  room  for  enough  men 
for  fire  protection ;  aside  from  that  no  provision  has  been  made  to  house 
male  help.  In  the  event  of  a  new  dormitory  for  the  female  help  being 
provided  it  would  give  us  the  new  dormitory  over  the  disinfecting  sta- 
tion, which  is  at  present  occupied  by  the  female  help,  and  which  was 
originally  intended  for  the  male  help.  This  would  be  sufficient  for  the 
needs  of  the  hospital  for  about  ten  years. 

Laundry — ^This  hospital  has  no  laundry  and  is  entirely  dependent 
upon  Riverside  Hospital  for  its  laundry  work,  with  the  exception  of 
that  done  for  the  executive  officers.  This  lack  of  a  laundry  has  fre- 
quently seriously  handicapped  the  executives  of  the  hospital  in  keeping 
their  wards  in  good  condition.  Furthermore,  it  is  necessary,  under  the 
present  conditions,  to  have  one-third  if  not  a  half  more  articles  in  use 
than  would  be  necessary  were  the  laundry  on  the  hospital  grounds,  this 
being  occasioned  by  the  fact  that  the  actual  amount  of  goods  subject 
to  laundry  use  is  found  in  duplicate  on  the  boat  going  to  North 
Brothers'  Island,  in  duplicate  again  at  the  laundry  at  North  Brothers' 
Island  and  in  duplicate  again  on  the  boat  being  returned  from  North 


Brothers*  Island.  Furtherrnorc.  there  ts  constantlT  troable  aboat  gectix^ 
the  laundry  returned  properly,  so  that  frequently  it  is  necessary  to  wash 
diapers  and  other  absolutely  essential  goods  of  the  hospital^  and  drj 
tbem  in  attics  or  over  radiators,  as  best  we  can.  I  woold.  therefore,  re- 
spectfully recommend  that  the  second  building  considered  for  this  plant 
be  a  laundry,  to  be  furnished  as  soon  as  possible. 

Machine  Shop — The  engineering  department  is  very  raticfa  handi- 
capped in  their  work  by  the  fact  that  all  steam,  gas  and  water  fittings 
must  be  purchased  by  the  usual  requisition  routine,  which  takes  sd  long 
a  time  that  it  frequently  t?rce5  us  to  have  work  done  on  emergency 
requisition  which  we  would  otherwise  do  ourselves.  If  the  proper 
machine  shop  was  installed  in  the  hospital  plant  a  great  many  of  the 
fittings  that  are  now  purchased  would  be  made  by  our  ov.-n  men.  and. 
what  is  more  to  the  point,  can  be  furnished  immediately  when  needed. 
I  would  therefore  respectftdly  recommend  that  when  the  laundry-  build- 
ing is  provided  that  the  basement  stor>-  be  fitted  us  as  a  machine  shop 
so  that  the  power  of  the  laundr>'  may  be  utilized  for  the  machinery-  in 
the  machine  shop. 

Storehouse — The  present  storehouses  are  wholly  unequal  for  the 
work  they  are  called  upon  to  do.  .\t  the  present  time  we  have  one 
5torerocm  in  the  westerly  en«i  of  the  Administration  Building  and  three 
rooms  on  the  first  floor  of  the  same  building,  which  are  used  for  storage 
purposes.  All  of  these  are  overcrowded  and  do  not  meet  the  demands 
of  the  hospital  at  its  present  size:  when  the  new  buildings  now  con- 
templated are  comp5eted  it  will  be  absolutely  necessary  to  have  new 
iitorchouses.  It  is  therefore  recom.mended  that  the  Department  of 
Health  acquire,  immediately,  that  portion  of  the  Gas  Compwiny's 
grounds  west  of  the  east  side  of  Avenue  D.  and  that  they  appropriate 
the  two-story  brick  building  on  those  grounds  for  storehouse  purposes. 

Chemical  Laboratory. 

The  following  is  a  report  of  the  amount  of  work  performed  in  the 
Chemical  Laborator>-  during  the  year  ending  December  31.  1906. 

The  amount  of  work  accomplished  in  number  of  analyses  and 
varietv  has  exceeded  that  of  any  previous  \ears. 


503 

It  has  comprised  the  examination  of  a  varied  class  of  substances, 
including  foods,  drugs,  Health  and  other  Department  supplies,  medico- 
legal examination,  the  testing  of  new  methods  and  experimental  work. 
Though  principally  for  the  Department  of  Health,  it  also  represents  a 
considerable  amount  for  other  Departments,  as  will  be  seen  in  the  item- 
ized statement. 

In  addition  to  the  analytical  work  should  be  considered  the  time  of 
the  Chemists  spent  in  the  courts  as  expert  witnesses. 

These  results  of  the  year's  work  are  primarily  due  to  the  fact  that 
the  new  laboratory  at  the  foot  of  East  Sixteenth  street  was  ready  for 
occupancy  early  in  the  year.  The  moving  of  the  laboratory  stock  of 
apparatus  and  reagents  from  the  Health  Department  building  at  Fifty- 
fifth  street  and  Sixth  avenue  was  begun  about  the  first  of  February 
ajid  occupied  two  weeks. 

This  laboratory  is  much  more  convenient  in  its  equipment  of  water, 
steam,  electricity  and  light  and  much  better  arranged  in  its  room  di- 
vision for  analytical  work. 

The  following  is  a  detailed  statement,  alphabetically  arranged,  of 
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For  Department  of  Water  Supply,  Gas  &  Electricity 19 

For  Hall  of  Records  Building  i 

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Number  566,  Lithia  water. 
Number  24894,  taken  from  Simpson,  Crawford  &  Simpson  Co.,  Nineteenth  street 

and  Sixth  avenue. 

Result. 

Parts  by  weight  per  million: 

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oxide  1.50,  Alumina  20.64,  Potassium  oxide  112.43,  Lithium  oxide  4.05,  Sodium 
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