COLUMBIA LIBRARIES OFFSITE 
 
 HEALTH SCIENCES STANDARD 
 
 HX64073319 
 RA1 22.C1 N48 1914 A brief account of p 
 
 RECAP 
 
vi\m.c 
 
 N4£ 
 
 I Q 
 
 Columbia SBnttier^ttp 
 
 mtljeCtipofltegork 
 
 COLLEGE OF 
 
 PHYSICIANS AND SURGEONS 
 
 LIBRARY 
 
 (Z0i>. 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/briefaccountofprOOnewy 
 
PROGRESS 
 
 OF THE 
 
 DEPARTMENT OF HEALTH 
 
 During the Year 1914 
 
 DEPARTMENT OF HEALTH 
 
 OF THE CITY OF NEW YORK 
 139 CENTRE STREET 
 
A BRIEF ACCOUNT OF PROGRESS 
 
 MADE BY THE 
 
 DEPARTMENT OF HEALTH 
 
 OF THE 
 
 CITY OF NEW YORK 
 
 IN 
 
 THE YEAR 1914 
 
 507, '15, 15,000 (P) 
 
A BRIEF ACCOUNT OF PROGRESS 
 
 MADE BY THE 
 
 DEPARTMENT OF HEALTH 
 
 THE YEAR 1914 
 
 Number of Persons Employed 
 
 On January 1st, 1914, there were connected with the Department 
 in an official capacity 3,428 persons; of this number, 79, all physicians, 
 gave gratuitous service in hospitals or clinics. The corresponding 
 figures for January 1st, 1915, are: Total number of persons employed 
 in the Department, 3,421, of which 95 are unpaid. 
 
 The Year's Expenditures and Savings 
 
 The total sum appropriated for the current expenses of the 
 Department of Health for the year 1914 was $3,534,240.50. Of this 
 sum $3,363,767.85 was expended by the Department, leaving a balance 
 of $170,472.65, largely the result of careful economies in administra- 
 tion. The sum of $17,178.50 was transferred to other departments to 
 cover deficiencies. There remained at the end of the year an unex- 
 pended balance of $153,294.15. 
 
 It is evident from the above figures that the Department is one 
 of considerable magnitude. Its importance to the community is 
 shown by the following account of its progress during the year 1914. 
 Before passing to this account, however, it may be well to consider 
 what the law demands of the Board of Health. 
 
 Duties of the Board of Health 
 
 The following extracts from the Greater New York Charter show 
 the extent of the responsibility with which the Board of Health is 
 charged by law: 
 
 It shall be the duty of the Board of Health to aid in the enforce- 
 ment of, and, so far as practicable, to enforce all laws of this state, 
 applicable in said district (i. e., the city and the waters adjacent there- 
 to), to the preservation of human life, or to the care, promotion, or 
 protection of health; and said Board may exercise the authority given 
 by said laws to enable it to discharge the duty hereby imposed; this 
 section is intended to include all laws relative to cleanliness, and to 
 
the use or sale of poisonous, unwholesome, deleterious, or adulterated 
 drugs, medicines or food, and the necessary sanitary supervision of 
 the purity and wholesomeness of the water supply for the City of New 
 York. • 
 
 The Board is authorized to require reports and information relative 
 to the safety of life and promotion of health, from all public dispen- 
 saries, hospitals, asylums, infirmaries, prisons and schools, and from all 
 other public institutions, and from the managers and occupants of all 
 theatres and other places of public resort or amusement. 
 
 The Board shall use all reasonable means for ascertaining the exist- 
 ence and cause of disease or peril to life or health, and for averting the 
 same. 
 
 It shall be the duty of said Board to gather and preserve such 
 information and facts, relating to death, disease and health, from other 
 parts of this state, but especially in said city, as may be useful in the 
 discharge of its duties, and contribute to the promotion of health, or 
 the security of life in the State of New York. 
 
 The sanitary code, which shall be in force in the City of New York 
 the first day of January, nineteen hundred and two, to be binding and 
 in force, is hereby declared and shall continue to be so binding and in 
 force, except as the same may, from time to time, be revised, altered, 
 amended or annulled. 
 
 The Board of Health is hereby authorized and empowered, from 
 time to time, to add to and to alter, amend or annul any part of the 
 said sanitary code, and may therein publish additional provisions for 
 the security of life and health in the City of New York, and confer 
 additional powers on the Department of Health, not inconsistent with 
 the constitution or laws of this state, and may provide for the enforce- 
 ment of the said sanitary code by such fines, penalties, forfeitures, or 
 imprisonment as may by ordinance be prescribed. 
 
 The Board of Health may embrace in said sanitary code all matters 
 and subjects to which, and so far as, the power and authority of said 
 Department of Health extends, not limiting their application to the sub- 
 ject of health only. 
 
 Is the Board of Health doing all that the law requires of it? There 
 are many citizens who hold the contrary, and by these, day by day, the 
 Department is urged to widen the scope of its activities. Its present 
 effort is to increase its usefulness without adding to its expenditures. 
 If it succeeds in this, the conservatives in finance and the progressives 
 in policy should both be satisfied. 
 
 The Health of the City. 
 
 The number of deaths reported during the year was 74,803, mak- 
 ing a rate of 13.40 per 1,000 of the population. This is the lowest 
 death rate ever recorded in the City of New York. If we compare 
 this with last year's record, namely, 73,902 deaths and a rate of 13.76 
 for the year 1913, we find that there has been a decrease in the death 
 rate of .36 of a point. How much this means to the community may 
 perhaps be better appreciated by saying that if the death rate of 
 1913 had prevailed during the past year, there would have been 
 2,010 more deaths than actually occurred. 
 
 A Notable Decrease in Infant Mortality. 
 
 The most noteworthy feature of the decreased mortality was 
 the record-breaking infant death rate of 94.6 per 1,000 children born. 
 
This is the lowest infant death rate ever attained in the City of New 
 York, and the lowest of any large city in this country. The infant 
 death rate in 1913 was 102, which was the lowest rate in the City up 
 to that year, so that the decrease this year in the rate over last year 
 is a little over 6 per cent. The Bureau of Child Hygiene claims and 
 is entitled to a measure of credit for this splendid result. 
 
 Analysis of Causes of Death. 
 The following causes of death showed a considerably decreased 
 mortality: typhoid fever, measles, scarlet fever, all forms of acute 
 respiratory diseases and diarrhoeal diseases under five years of age. 
 There were 10,286 deaths from all forms of tuberculosis as against 
 10,031 deaths in 1913. The slight increase in the absolute figures, 
 however, is more than accounted for by the increase in population, 
 so that there is actually a slight decrease in the rate per 1,000 of the 
 population. There were 16,804 deaths from the combined causes of 
 organic heart, kidney and brain diseases as against 16,194 in 1913, 
 an increase of 610 deaths. The number of deaths from cancer was 
 4,463, an increase of 240 over the figure of last year; 4,516 infants 
 died from congenital causes, such as malformations, marasmus, pre- 
 maturity, etc.; 4,982 people met with violent deaths; the death rate 
 from purely accidental deaths decreased somewhat, whilst that from 
 suicides increased considerably, there having been 915 deaths reported 
 from this cause; 13,312 children died before completion of the first 
 year of life and 19,518 before completion of the fifth year. There 
 were 41,235 deaths of males as against 33,568 deaths of females; 
 30,825 deaths occurred in institutions, 29,561 in tenements, 11,819 in 
 dwellings and 746 persons in hotels. In addition to this 1,852 died 
 in rivers, streets, etc. 
 
 Important Officials Placed on Full-Time Service. 
 From the standpoint of general organization and departmental 
 efficiency, the most important general order issued during the year 
 was that requiring full-time service on the part of bureau chiefs and 
 other important Department officials. This order, which is now 
 effective, was as follows: 
 
 Directors of Bureaus who are in receipt of salaries of $5,000.00 or 
 more per annum, and Assistant Directors of Bureaus, Assistant Sanitary 
 Superintendents. Chiefs of Divisions and all other medical officers who 
 are in receipt of salaries of $3,000.00 or more per annum, are hereby 
 declared to be full-time officers of the Department and, as such, are 
 required to give their services to the Department during the full working 
 day. 
 
 They shall not be allowed to engage in the general practice of medi- 
 cine, or in any other regular occupation or business. With the approval 
 of the Commissioner, they may be permitted to engage in public health 
 work outside of the Department, but the Department retains the right 
 to determine whether such outside work interferes with, or is prejudicial 
 to, the proper performance of departmental duty, and, after due notice, 
 may withdraw such permission at any time. 
 
 Public health administration thus becomes a career — though, it 
 
8 
 
 must be acknowledged, not a particularly remunerative one — for a 
 limited number of qualified men in the City of New York. 
 
 The Sanitary Code Rewritten. 
 
 The Sanitary Code has been completely rewritten, and in its new 
 form is definitely correlated to the ordinances of the Board of Alder- 
 men. This was brought about by conference with the Codification Com- 
 mittee of the Board of Aldermen. In the preparation of the new Code, 
 the Board was assisted constantly and ably by the Corporation Counsel 
 and his staff. 
 
 Among the twenty or more sections which have been added to 
 the Code, the most important, from the standpoint of public health, 
 are the following: 
 
 1. Requiring the naming of ingredients of "patent" medicines on the 
 
 labels of the packages, or, in lieu thereof, the registration 
 of the ingredients with the Department of Health. 
 
 2. Requiring employers to uss reasonably effective devices, means 
 
 and methods to prevent the contraction by employees of ill- 
 ness or disease incident to the work or process in which such 
 employees are engaged. 
 
 3. Providing for the sanitation, ventilation and lighting of theatres and 
 
 other places of assembly, and of all places where people are 
 employed. 
 
 4. Requiring owners of stables to obtain permits from the Board of 
 
 Health, and to conduct their establishments in accordance with 
 prescribed regulations. 
 
 5. Regulating the cold storage of food. 
 
 6. Requiring physicians, when reporting infectious diseases, to specify 
 
 whether the individual affected has been engaged in handling 
 food products. 
 
 7. Requiring institutions and private physicians to report cases of 
 
 venereal diseases. 
 
 8. Requiring superintendents of hospitals and private practitioners to 
 
 report occupational diseases and injuries. 
 
 9. Requiring physicians and superintendents of hospitals to report 
 
 groups of cases of suspected food poisoning. 
 
 10. Providing, in the interest of school children, for the supervision, 
 
 and in case of necessity only, for the exclusion from school of 
 teachers suffering from pulmonary tuberculosis in a communica- 
 ble form. 
 
 11. Prohibiting persons who are suffering from communicable diseases 
 
 from working in their homes upon articles intended for general 
 consumption. 
 
 12. Prohibiting the distribution of free samples of proprietary medicines 
 
 or other substances of an alleged medicinal or curative character 
 intended for internal human use. 
 
13. Regulating the free distribution of vaccine, antitoxin, serum and 
 
 cultures, and providing a penalty for physicians who accept pay- 
 ment for vaccines and analogous products which have been ob- 
 tained from the Department gratuitously. 
 
 14. Providing that persons ill with communicable disease may not 
 
 handle or sell food. 
 
 15. Providing for decent and clean conditions in food manufactories, 
 
 hotel and restaurant kitchens and retail food stores. 
 
 16. Providing for the physical examination of children at the time of 
 
 entering public school by private physicians or by medical in- 
 spectors of the Department of Health. (This section corre- 
 sponds in substance with a statute which applies to all parts 
 of the state except the City of New York.) 
 
 17. Providing for the control by permit of all private hospitals other 
 
 than those which are specifically authorized by law. 
 
 18. Requiring the lessees or owners of marsh lands and sunken lots to fill 
 
 in or drain the same or to employ such other methods as will 
 prevent the breeding of mosquitoes. 
 
 19. Providing for the sanitation of passenger cars and omnibuses. 
 
 20. Regulating public laundries. 
 
 21. Prohibiting offensive and dangerous practices in the manufacture 
 
 of cigars and cigarettes. 
 
 22. Requiring the ■ removal of harmful dust, gases and other impurities 
 
 from work rooms by suction devices. 
 In addition to the introduction of this important new matter, the 
 Code has been changed in form so that its contents are now more 
 logically arranged. From beginning to end the language has been sim- 
 plified, and wherever necessary has been changed so as to harmonize 
 with existing statutes, with aldermanic ordinances, and with the regu- 
 lations of other departments. 
 
 Code Amendments Adopted Prior to the General Revision. 
 
 During the year, prior to the general revision of the Code, the fol- 
 lowing important amendments were adopted : 
 
 1. Prohibiting the sale of bichloride of mercury except upon a 
 physician's prescription. 
 
 2. Prohibiting unmuzzled dogs in streets and other public places. 
 
 3. Prohibiting the use of wood alcohol in preparations intended 
 for human use. 
 
 4. Prohibiting the sale of opium, morphine, and other habit-forming 
 drugs except on the written prescription of a physician. 
 
 5. Requiring the manufacturers and importers of artificial or natural 
 spring water to file with the Department certain information concerning 
 the character and composition of the water. 
 
 6. Prescribing the duties of physicians, hospitals, dispensaries, and 
 other institutions with respect to reportable diseases. 
 
 7. Prohibiting the common use of forks at free lunch counters. 
 
10 
 
 New Sanitary Regulations. 
 
 Among the important regulations promulgated by the Department 
 during the year are the following : 
 
 1. Regulations providing for sanitary conditions in floating baths, 
 stationary pools, and bathing beaches. 
 
 2. Regulations governing sanitary conditions of tents, camps and 
 bungalows. 
 
 3. Regulations regarding the use of coffin seals in cases of death 
 from infectious diseases. 
 
 4. Regulations regarding the sale of milk and cream, including 
 sections relating to bacterial content. 
 
 5. Regulations safeguarding the health of children cared for in 
 day nurseries. 
 
 6. Regulations governing the handling, storing and sale of food in 
 stores, factories, hotels, restaurants, etc. 
 
 The New Bureau of Public Health Education. 
 
 There was established during the year a bureau known as the Bureau 
 of Public Health Education. The working staff of this Bureau was re- 
 cruited within the Department by the transfer of workers of special talent 
 as writers, compilers and lecturers, from existing branches of the service. 
 Its creation, therefore, committed the city to no new expense. The func- 
 tions of the Bureau of Public Health Education as thus far developed 
 may be briefly described as follows : 
 
 Publications: Preparation and issuance of press bulletins, of a 
 weekly bulletin sent to all physicians, school principals, clergymen, city 
 officials, etc., of a monthly bulletin containing special articles on public 
 health subjects, staff news for the information of employees of the 
 Department of Health, the Otisville Ray for the information of the 
 patients at the Municipal Sanatorium, reprints and monographs descriptive 
 of the Departmental activities, circulars of information, placards, etc. 
 
 Lectures: Organization and giving of educational lectures on health 
 topics for employees of the Department of Health and for high schools, 
 colleges, clubs, civic organizations, labor unions, etc. 
 
 Exhibits: The preparation and display of exhibits dealing with the 
 work of the Department. Such exhibits shown in schools, settlement 
 houses, clinics, vacant stores, etc. 
 
 Moving Picture Activities: The preparation and exhibition of films 
 devoted to public health topics, the holding of free moving picture exhi- 
 bitions in parks, recreation centers, play-grounds, etc. Co-operating with 
 moving picture theatres to display lantern slides dealing with matters 
 of public health. 
 
 Co-operating with other city departments and organizations inter- 
 ested in public health work and providing these with material suitable for 
 educating the public in health matters. 
 
11 
 
 Lectures for Department Employees. 
 
 A comprehensive course of lectures has been developed under 
 the direction of the Bureau of Public Health Education. These 
 lectures, designed to better fit the employees of the Department for 
 their work, are now in full swing. The courses include lectures for 
 the different groups of Department employees as follows: Medical 
 Inspectors, Sanitary and Food Inspectors, Hospital Nurses, Field 
 Nurses, Clerks. 
 
 Physical Examination of Department Employees. 
 
 In order to safeguard and improve the health of the employees 
 of the Department, the Department has undertaken to make a thor- 
 ough physical examination of all its employees. Originally regarded 
 with suspicion, these examinations are now eagerly sought by all 
 classes of employees. During the year 1,237 persons, 437 men and 
 800 women, were examined. The results have been invaluable; cases 
 of unsuspected disease have been discovered, and treatment and pre- 
 ventive measures have been inaugurated. Cases of absence on ac- 
 count of illness are investigated, emergency treatment to employees 
 taken ill while on duty is administered and constant supervision is 
 exercised over the health of the employees. The adoption of the 
 plan in all municipal departments is urged. 
 
 Other Welfare Activities. 
 
 The Department has completed arrangements for the establishment 
 of a lunch room where the employees of the Department will be fur- 
 nished wholesome and well-cooked food at reasonable prices. 
 
 The roof of the Department's building is now utilized for recrea- 
 tion during the noon hour. 
 
 The Department Becomes Interested in Industrial Hygiene. 
 
 Throughout this report evidence is presented of the increasing 
 emphasis which the Department places on education in matters of 
 sanitation and hygiene as the principal means for the accomplishment 
 of its ends. 
 
 An important new education activity is the work which the Depart- 
 ment has begun in relation to industrial hygiene. Education in matters 
 of industrial hygiene has hitherto been left entirely to private effort. 
 From time to time, legislation to promote occupational hygiene has been 
 prompted by private societies. This year the Department of Health of 
 the City of New York, for the first time ''n its history, has claimed 
 this field for its own. The method proposed, however, is wholly that 
 of education. No increase in the Department's force of inspectors is 
 contemplated. 
 
 Wherever the rate of sickness is unduly high because of insanitary 
 conditions of employment, there the Department is ready to enter. In 
 the first instance, it asks for the support of the individuals affected by 
 existing sanitary conditions, making its appeal both to employees and 
 
12 
 
 employers. In a bulletin which, on November 14th, was addressed to 
 numerous trade unions, the Department announced its readiness "to 
 undertake a sanitary survey of any industry, trade or group of manufac- 
 turing establishments in the city, with a view to appraising existing con- 
 ditions, and in order to show to employees and employers alike what 
 can be accomplished through a system of voluntary hygienic and sani- 
 tary control." Responses have been received from a number of trades 
 and plans are now afoot which will result in the formulation of sanitary 
 industrial standards and in measures for the prevention of industrial 
 diseases. 
 
 Periodic Medical Inspection of Workers. 
 
 The Department advocates the development of a system of periodic 
 medical inspection of workers in large establishments, similar to the 
 system of medical inspection of school children, which is now universally 
 recognized as an indispensable part of an effective public health program. 
 Employers and workers are urged to co-operate with the Department in 
 the establishment of medical inspection systems in industries in which 
 such inspection is especially important from the standpoint of communi- 
 cable disease. 
 
 Food Inspection Reorganized. 
 
 The Bureau of Food Inspection has been completely reorganized. 
 It is preparing to undertake the systematic inspection of all classes of 
 establishments in this city (except those under Federal or State inspec- 
 tion) where food is manufactured, prepared or sold. The effectiveness 
 of the work of the Bureau has been increased by the adoption of a plan 
 for the district assignment of inspectors; duplication and overlapping 
 have thus been avoided. 
 
 Additional Inspectors of Food. 
 
 The Department confidently predicts that 1915 will be a notable 
 year in its food inspection work in consequence of enhanced depart- 
 mental and public interest in this work, and in view of the appropriation 
 granted in this year's budget for the extension of food work. 
 
 All Milk Effectively Pasteurized. 
 
 The protection of the city through the pasteurization of the bulk of 
 its milk supply is now an accomplished fact. No raw milk is allowed 
 to be sold except that which is obtained from tuberculin-tested cows. 
 
 "Certified Milk" Supervised by the Department of Health. 
 
 Prior to 1914 the Department systematically avoided the inspection 
 of dairy farms which were conducted under the auspices of the Milk 
 Commissions of the various County Medical Societies. After due con- 
 sideration it w r as decided that, in view of the fact that the Department 
 is responsible to the city for the safety of the entire milk supply, the 
 dairy farms of the Milk Commissions were logically subject to the sys- 
 tem of examination and inspection which is carried on by the Depart- 
 ment elsewhere. It was ordered that these dairies should be inspected 
 
13 
 
 and their products examined periodically, that careful records should be 
 kept, and that suitable permits should be issued. This action has met 
 with the approval of the Milk Commissions, whose voluntary activities 
 have not been diminished, and which continue to "certify" milk which 
 conforms to their own high standard. 
 
 Conferences of Food Inspectors. 
 
 In view of the many new activities of the Bureau of Food Inspection, 
 and in order to insure uniformity of action by the various inspectors of 
 the Bureau, arrangements were made for bi-weekly conferences of 
 inspectors, at which the rules and regulations of the Department and 
 their interpretation and application are discussed. 
 
 Veterinarians to Inspect Cattle for Slaughter. 
 
 Laymen who had been employed for some time in the inspection 
 of cattle at the Brooklyn slaughter houses were replaced by veterinarians, 
 with resulting improvement in the service. 
 
 Advisory Council Formed. 
 
 Early in the year an Advisory Council was organized, consisting of 
 representatives of the various trades that regularly come under the 
 supervision of the Department, and including in its membership as well 
 persons identified in some way with public health administration, and 
 those connected with institutions and private societies whose objects are 
 akin to those of the Department of Health. 
 
 The Advisory Council is divided into committees corresponding to 
 the several bureaus of the Department. It has rendered valuable assist- 
 ance to the Department throughout the year in the critical study of 
 established procedures and in the consideration of proposed new measures. 
 Its most important services were performed in connection with the revi- 
 sion of the Sanitary Code. The devotion of the members of this volun- 
 tary body to the tasks assigned to them merits the thanks of the 
 Department and of the city. 
 
 The Weekly Bulletin Sent to All Physicians. 
 
 The circulation of the Weekly Bulletin of the Department has been 
 increased from two thousand to twelve thousand copies, making it pos- 
 sible to send it regularly to every practising physician in the City of 
 New York, and to all institutions with which the Department has offi- 
 cial relations. The physicians and institutions have responded by a 
 more willing co-operation due, as one of them wrote, to their better 
 understanding of "what the Department is doing and why it is doing 
 it." ; 'HI 
 
 Filing Birth Certificates. 
 
 An active campaign has been carried on against physicians and mid- 
 wives for failure to file certificates of birth. A special investigation in 
 the entire city and covering several thousand babies selected at random 
 showed that over 98 per cent, of all births had been reported according 
 to law. 
 
- 14 
 
 Central List of Delinquent Physicians. 
 
 A central delinquent list has been established of physicians who have 
 failed to comply with regulations of the Department of Health. The 
 Department regrets the necessity for this list, and hopes to see it reduced 
 to a minimum this year and ultimately to be abolished. 
 
 Infants' Milk Stations. 
 
 In addition to the fifty-six infants' milk stations maintained by the 
 Department of Health throughout the year, private philanthropists do- 
 nated the rent and equipment of seven stations, for which the Bureau of 
 Child Hygiene provided doctors and nurses. Of these seven stations, 
 one is in the Bronx, one in Brooklyn, and five in the hitherto neglected 
 Borough of Queens. Two new Department stations have been authorized 
 f P r 1915. 
 
 The Breast Feeding of Infants. 
 
 It is gratifying to report that there was a marked increase in the 
 number of breast-fed babies in attendance at the milk stations, namely, 
 63 per cent, in 1914 as compared to 55 per cent, in 1913. 
 
 Success of Prenatal Work. 
 
 The experimental prenatal work carried on by the Bureau of Child 
 Hygiene reached 500 mothers, among whom there were no maternal 
 deaths. Ninety-six per cent, of the babies born are still living. The 
 deaths under one month per thousand births were 16, as compared with 
 37 for the city as a whole. 
 
 Baby Week. 
 
 Traditional methods of appeal in order to arouse interest in infant 
 mortality having become outworn, New York determined to advertise 
 for her babies. A Baby Week was organized which applied all the 
 approved and up-to-date methods of advertising to the business of 
 spreading abroad throughout the city what was done and what was 
 needed to be done to save babies. Newspapers, bill boards, car adver- 
 tisements, window posters, movies, baby parades, Better Mothers Contest, 
 the distribution of two million pieces of educational literature, etc., were 
 some of the means employed to arouse popular interest. 
 
 The Department of Health was but one of many public and semi- 
 public agencies which participated in this campaign. Important aid was 
 rendered by the Babies' Welfare Association, the Chamber of Commerce, 
 the Merchants' Association, the Advertising Men's League, the New 
 York Milk Committee and many other associations and committees. 
 
 School Medical Inspection. 
 
 The school registration in the elementary, public, parochial and 
 high schools of the city has reached 912,583. To look after the 
 health of these children, there is an inspection staff under the direc- 
 tion of this Department, in the proportion of one medical inspector 
 for each 9,300 children, and one nurse for each 4,700 children. A 
 
15 
 
 sharp watch is kept on contagious diseases, and that this has been 
 effective is demonstrated by the fact that during 1914 it was unneces- 
 sary to close any school building in the city on account of contagious 
 diseases. 
 
 Efforts to Increase the Efficiency of School Medical Inspection. 
 
 In order to increase the efficiency of the school work of the Depart- 
 ment without materially increasing the working force, two sets of experi- 
 ments were started. In the first an effort is being made to secure the 
 use of teachers as the first diagnostic line; in other words, the teach- 
 ers have been instructed in the methods of examination for minor and 
 major contagious diseases as well as in the detection of gross physical 
 defects of vision and hearing. Children who are selected for attention 
 are referred immediately to the nurse or the school inspector, the 
 latter making the diagnosis and suggesting the appropriate care. 
 
 The second experiment has for its object the wider use of private 
 physicians, without expense to the city, in the work of physical ex- 
 amination. 
 
 Employment Certificates. 
 
 Owing to the new child labor law, which now requires children to 
 pass through six full years of elementary public school work before a 
 school record can be issued, thus adding a year and a half to the former 
 requirements, there was a marked diminution during the past year of 
 the number of children to whom employment certificates were refused 
 because of insufficient education. 
 
 The New Policy of the Sanitary Bureau. 
 
 In the Sanitary Bureau an effort has been made to replace spora- 
 dic inspections based upon citizens' complaints by systematic inspec- 
 tion work, which has for its object the abatement of nuisance by the 
 initiative of the Department itself. Accordingly a house and block 
 survey of the entire city is now in progress. It is worthy of note 
 that during 1914, 18,863 complaints of nuisances were lodged by 
 inspectors spontaneously, as against 32,571 made by citizens. A 
 continuance of the present plan of action should result in a steady 
 diminution in the number of complaints of a legitimate character 
 made by citizens. 
 
 Survey of Lodging Houses. 
 
 Nearly 6,000 inspections of lodging houses were made during the 
 year, and these led to the issuance of 600 notices to abate nuisances. An 
 effort was made to encourage cleanliness on the part of lodgers. At the 
 Municipal Lodging House a daily bath is required. In other lodging 
 houses, having 14,223 lodgers, it was found that only 2,000 baths were 
 taken daily. 
 
 Common Drinking Cup and Common Towel. 
 
 Vigorous efforts were made in theatres, department stores, public 
 institutions, public lavatories and wash rooms to obtain compliance with 
 
16 
 
 the ordinance which forbids the use of common drinking cups and com- 
 mon towels. 
 
 Comfort Stations and Railway Toilets. 
 
 An effort to obtain improvement in the comfort stations, which are 
 maintained by the transit companies, was followed by decided improve- 
 ment, which, however, is not being maintained. The Department will 
 continue its efforts in this direction. 
 
 Common Horse Troughs Abolished. 
 
 The prevalence of glanders necessitated an order for the abolition 
 of common horse troughs and the substitution of drinking fountains hav- 
 ing a system of water supply which requires the use of individual pails. 
 The Board of Aldermen co-operated in this work. 
 
 River Bathing Restricted. 
 
 The increased pollution cf river and harbor waters necessitated the 
 
 suppression of some of the river baths as a measure of safety. To 
 
 replace discontinued river baths, the municipality is urged to hasten the 
 construction of additional interior baths and pools. 
 
 Roof Tanks Regularly Inspected. 
 
 Periodic inspection of roof tanks was inaugurated by the Depart- 
 ment in 1914. In consequence of the conditions revealed in the course of 
 4,000 inspections of these tanks, it became necessary to issue 3,000 orders 
 requiring compliance with existing regulations. 
 
 Mosquito Swamps Drained or Oiled. 
 
 Large areas of salt marsh and inland swamps in the Greater City 
 have been filled, drained or oiled. Wherever the ownership of property 
 could be determined, suitable orders and notices to abate mosquito- 
 breeding nuisances were issued. 
 
 Improved Conditions at Maspeth. 
 At Maspeth, in the Borough of Queens, a shocking condition which 
 had existed for many years was effectually dealt with. Formerly sewage 
 direct from privies, sinks, wash tubs, and cesspools was permitted to 
 flow from houses into the street gutter, and after crossing the high road 
 to find its way into Newtown Creek. Pending the construction of per- 
 manent sewers under the direction of the proper authorities, this long- 
 standing nuisance was abated by securing the co-operation of the resi- 
 dents bordering the polluted streets, who were persuaded to install, at 
 their own expense, temporary drains and sewers. 
 
 Conditions at Barren Island. 
 Court proceedings begun against the corporations operating at Barren 
 Island were temporarily suspended during the latter part of November, 
 at the request of the President of the Board of Aldermen, pending inves- 
 tigation and report by an expert engineer in the employ of the Board of 
 Estimate and Apportionment. 
 
17 
 
 Smoke Nuisance. 
 
 A series of convictions was obtained in the several boroughs for vio- 
 lation of the section of the Sanitary Code relating to smoke nuisance. 
 One case against the New York, New Haven and Hartford Railroad 
 resulted in a fine of $500; in a second case against the same company 
 sentence was suspended. In Brooklyn, out of 13 cases taken to court, 
 9 were fined; in 3 cases, sentence was suspended, and in one case the 
 offender was imprisoned in jail for three days. Like results were obtained 
 in the other boroughs. 
 
 Chicken Complaints Diminished. 
 In ten months prior to November 1st, 1914, 4,702 complaints were 
 received from citizens who were annoyed by sound, smell or vermin 
 from neighbors' chickens. New Department regulations were then 
 adopted, and during November and December only 263 complaints of 
 citizens due to this cause were received. 
 
 The Police Squad Handles 147,727 Items. 
 Fifty policemen assigned to this Department by the Commissioner 
 of Police, in accordance with the terms of the Charter, handled 147,727 
 items and reported upon the same; they arraigned in court and disposed 
 of 4,263 cases. 
 
 Co-operation with Police Department Extended. 
 
 The Department was fortunate enough to obtain the sustained co- 
 operation of the Police Department in the enforcement of certain sec- 
 tions of the Sanitary Code. The police officers assist either by making 
 arrests for obvious violations or by reporting such violations to this 
 Department; each patrolman on his regular "beat!" acts as an auxiliary 
 health officer. Valuable aid has thus been rendered. 
 
 Cleaner Streets. 
 
 Inspectors and field workers in the Sanitary Bureau have been 
 instructed to co-operate with the Department of Street Cleaning in pre- 
 venting the throwing of ashes, garbage and other refuse into the streets. 
 
 Clean-up Week. 
 
 The annual Clean-Up campaign was conducted in record-breaking 
 time. It commenced at a conference held at the Department of Health 
 on April 29. On May 1, $15,000 was set aside for special clean-up pur- 
 poses for the use of the Department of Street Cleaning. The week of 
 May 11 to 17 was devoted to an energetic campaign of publicity and 
 the actual removal of accumulated rubbish was accomplished from May 
 18 to May 23. 
 
 Altogether 1,750,000 circulars of information were distributed 
 throughout the Boroughs of Manhattan, The Bronx and Brooklyn. 
 Official notices of the date of removal of rubbish, 1,500,000 in number, 
 were distributed through the Police Department two days before the 
 actual clean-up began. 
 
18 
 
 A large bill-posting firm posted notices calling attention to clean-up 
 week; these were placed on all the wagons of the Street Cleaning Depart- 
 ment. Eight hundred mcving-picture theatres in the city displayed spe- 
 cial slides supplied by the Department of Health, announcing "Clean-Up 
 Week," and the newspapers rendered valuable assistance. 
 
 The following figures represent the excess loads of dirt and rubbish 
 collected during Clean-Up Week, as reported by the Commissioner of 
 the Department of Street Cleaning: 
 
 Manhattan. The Bronx. Brooklyn. Total. 
 
 May 18 467 65 . 567 1,099 
 
 May 19 451 74 805 1,330 
 
 May 20 362 83 858 1,303 
 
 May 21 359 80 670 1,109 
 
 May 22 194 68 690 952 
 
 May 23 28 92^ 301 421^ 
 
 Total 1,861 46214 3,891 6,214j4 
 
 Contagious Disease Hospitals for Queens and The Bronx. 
 
 Early in the year the Board of Estimate and Apportionment author- 
 ized the construction of the first unit of a new hospital for contagious 
 diseases in the Borough of Queens. The contract was promptly signed 
 and the building is nearing completion. The site in use for this purpose 
 zvas purchased by the city more than eleven years ago. 
 
 An important step forward was made when the Board of Estimate 
 and Apportionment and the Board of Aldermen sanctioned the purchase 
 of the Seton Falls site in The Bronx, for the purpose of hospital develop- 
 ment. There is available for the construction of this hospital the sum 
 of $125,000. Request has been made for a sufficient sum, in addition, 
 to render possible the construction in the first instance of a group of 
 three buildings, the completion of which will enable the Department 
 to discontinue the transfer of sick children to North Brother Island — a 
 practice which has been much criticized. 
 
 The Future of North Brother Island. 
 The bulk of the hospital population at Riverside Hospital, North 
 Brother Island, consists, at the present time, of adults affected with 
 tuberculosis. There is under construction on the Island a pavilion for 
 the care of cases of venereal diseases. The plan of the Department is to 
 devote this Island in the future wholly to the care of adults suffering 
 from tuberculosis and venereal diseases. 
 
 Following Up Hospital Cases. 
 
 During the year a system of follow-up work to ascertain the after 
 effects of contagious diseases upon patients discharged from the hospitals 
 of the Department was inaugurated. 
 
 Whooping Cough Clinic. 
 A special clinic for the intensive study of the ciuse and treatment of 
 whooping cough has been established at the corner of Avenue C and 
 
19 
 
 16th street, in the vicinity of the Willard Parker Hospital. In the con- 
 duct of this clinic the Bureau of Hospitals and the Bureau of Labora- 
 tories have collaborated. Early reports indicate that some progress has 
 been made in the treatment of this disease. 
 
 New Buildings. 
 
 Construction work has proceeded steadily throughout the year. Five 
 new ward buildings were completed, two at Otisville, one at Kingston 
 Avenue Hospital, one at Willard Parker Hospital and one at Riverside 
 Hospital. 
 
 Charges Against Department Hospitals Refuted. 
 
 Sensational charges having been made that children treated in the 
 hospitals of the Department of Health were illegally and cruelly inocu- 
 lated at these hospitals with loathsome diseases, and the charge having 
 further been made that the children were being experimented on, and 
 that the alleged infections were the result of such experimentation, the 
 Department investigated the published allegations and on February 27th, 
 in an open letter, completely refuted the charges in question. 
 
 Clinical Organization Improved. 
 
 A model form of medical organization, designed to meet the present 
 and future needs of the Department in its hospitals for contagious dis- 
 eases, was adopted during the year. Daily attendance, by visiting physi- 
 cians, in all the wards of the hospitals, is now the rule. 
 
 Post-Graduate Work in Hospitals. 
 
 A society for clinical study has been organised in each of the hos- 
 pitals of the Department. Each member of the staff is expected to devote 
 himself, during his spare hours, to the pursuit of some special topic or 
 branch of medicine, and is granted leave of absence from the hospital 
 during stated hours each week for the practical pursuit of the special 
 subject assigned to him. A higher grade of medical service is expected 
 to be the result of this post-graduate work. 
 
 Social Betterment of Hospital Nurses. 
 
 With the object of affording stimulation to the nursing staffs of the 
 hospitals, a committee has been formed to institute lectures, sources of 
 study, forms of entertainment and tours of observation for the nurses 
 employed in the several hospitals of the Department. 
 
 Contagion Among Hospital Employees to Be Analyzed and Checked. 
 
 The Superintendent of Hospitals now reports, month by month, the 
 number of contagious disease infections occurring among the physicians, 
 visiting physicians, resident physicians, nurses and other hospital employees 
 of the Department, presumably from contact with hospital cases. Based 
 upon these reports, investigations have been made for the purpose of 
 lessening the dangers of contact wherever possible. 
 
20 
 
 Hospital Visits by the New York City Visiting Committee. 
 
 The State Charities Aid Association was invited and accepted the 
 invitation to make periodic inspections of the hospitals of the Depart- 
 ment. This work has been done by members of the Association's New 
 Y~ork City Visiting Committee. 
 
 Comprehensive Plan for the Development of the Otisville Sanatorium. 
 
 A committee was appointed to prepare a general plan for the layout 
 of the Otisville Sanatorium, showing the grouping of future buildings, 
 service roads, paths and other approaches, disposition of lawns, terraces, 
 etc., and the general location of plantations. The plan which has been 
 adopted is sufficiently flexible to permit of minor changes from time to 
 time as new conditions arise, but is definite enough to serve as a prac- 
 tical guide in the location of future buildings. 
 
 Maintenance Allowed Employees at Otisville Sanatorium. 
 
 From time to time "maintenance" has been allowed to various em- 
 ployees at the Otisville Sanatorium. The practice was to consider each 
 case individually, and great discrepancies resulted. A study has been 
 undertaken which has for its object the standardization of "maintenance." 
 In this pursuit the Department has the aid of the Bureau of Standards of 
 the Board of Estimate and Apportionment. 
 
 Departmental Dietitian. 
 
 Authority was obtained for the employment of a Departmental 
 dietitian, who has been made responsible for the care, character and 
 proper distribution of food supplies in the hospitals of the Department, 
 and for educating those who, have charge of food supplies, in habits of 
 economy and efficiency. 
 
 Exemption of Alcohol from Taxation. 
 
 Arrangements were made for obtaining, without payment of the 
 Internal Revenue Tax, the Department's supply of alcohol for its hospitals 
 and clinics. 
 
 A New System of Health Administration Experimentally 
 Inaugurated. 
 
 At present the activities of the Department are functionally classified 
 and are controlled by Bureau Chiefs. The field workers of the Depart- 
 ment are directed from headquarters. To this system, advantageous as 
 it is in many ways, there are three principal objections : 
 
 1. The Director of a bureau is too far removed from those who 
 do the field work of the bureau. 
 
 2. Where there is a high degree of differentiation of function, the 
 individual worker ceases to see things in their true proportion, and fails 
 to grasp or apply the broad principles by which the Department is gov- 
 erned. Mental and professional development are inhibited by the repeti- 
 tion of detail work of a monotonous character. 
 
21 
 
 3. Various bureaus send their representatives into the same districts, 
 often into the same houses, which results in undue expenditure of time 
 and energy and in annoyance to the individual citizen. 
 
 Can these disadvantages be overcome? How far can the work of 
 the Department be improved by the substitution of a system of local 
 or district administration for the present purely functional administra- 
 tion? Can field workers be trained to perform, and can they actually 
 perform in a satisfactory manner, a variety of functions? 
 
 In order to answer these questions intelligently, an experimental 
 health district has been established, where all the activities of the Depart- 
 ment are locally directed by a single district chief, who represents all of 
 the bureaus which are engaged in field work. That there is much promise 
 in this experiment is shown by the preliminary reports. For example, 
 during the last week of the year, seven agents of the Department made 
 177 visits in 99 houses. 
 
 In 61 houses, 1 health function was served. 
 
 In 18 houses, 2 health functions were served. 
 
 In 8 houses, 3 health functions were served. 
 
 In 7 houses, 4 health functions were served. 
 
 In 1 house, 5 health functions were served. 
 
 In 4 houses, 6 health functions were served. 
 This study will be continued during the coming year, and with the 
 co-operation of heads of other Departments, may even be carried beyond 
 the strict limits of our own work, so as to include in its operation the 
 local administration of all of the health and related activities of the 
 municipality within the experimental district. 
 
 Useless Fumigation Discontinued. 
 
 Investigation having shown that fumigation was being extensively 
 practiced by the Department without sufficient evidence to warrant the 
 practice, arrangements have been made to reduce the Department's fumi- 
 gation activities to a minimum. The present program is discussed fully 
 in the report of the Bureau of Infectious Diseases. 
 
 The Reporting of Venereal Diseases. 
 
 The number of cases of venereal disease reported in 1914 was approx- 
 imately double that reported in the previous year; this shows an increased 
 willingness on the part of institutions and physicians to co-operate with 
 the Department in its efforts to gather complete statistics of these diseases. 
 
 Transmission of Disease Through the Unnecessary Overcrowding of 
 
 Passenger Cars. 
 
 After pointing out the readiness with which certain communicable 
 diseases are transmitted from person to person when in such contact as 
 exists between passengers in overcrowded public conveyances, the Depart- 
 ment sought to ascertain whether the Public Service Commission had 
 seriously endeavored to prevent unnecessary overcrowding. A public 
 presentation of the issue was made, following which certain members 
 
22 
 
 of the Public Service Commission manifested a lively interest in the 
 question. At the time of this writing, the matter is under investigation 
 by the Grand Jury of Kings County. The advisability of attempting to 
 regulate transportation from a public health standpoint, by means of a 
 suitable amendment to the Sanitary Code, is now under consideration. 
 
 Handbook of Infectious Diseases. 
 
 The handbook of the Bureau of Infectious Diseases was entirely 
 rewritten. This manual for employees serves also as a reference book 
 for those who desire to make an intimate study of the functions of the 
 Bureau of Infectious Diseases. 
 
 Numerous monographs and circulars in regard to contagious diseases 
 were issued during the year. 
 
 Investigation to Determine the Financial Status of Patients. 
 
 An investigation was made to determine whether patients entering 
 the hospitals of the Department could pay for the care which they re- 
 ceive. It was found that very few could do so. 
 
 Home Supervision of Whooping Cough. 
 
 New procedures for the home supervision of cases of whooping 
 cough reported by dispensaries and institutions were adopted in August. 
 
 Investigation of Scarlet Fever Outbreaks. 
 
 Two outbreaks of scarlet fever, which for a time were alarming, 
 occurred during the year, one at Bayside, L. I., and the other at Staten 
 Island. Investigation showed that in both instances the local epidemics 
 were due to the failure of parents to summon physicians. 
 
 Ambulance and Truck Service Reorganized. 
 
 Three new motor ambulances were purchased and put in operation, 
 two in Brooklyn and one in The Bronx. The ambulance stable and dis- 
 infecting plant service was entirely reorganized. 
 
 New Tuberculosis Clinics. 
 
 New tuberculosis clinics were opened in Flushing, L. I., and in 
 Parkville, Brooklyn. The tuberculosis clinics in Manhattan, which were 
 formerly conducted by the New York* Nose, Throat and Lung Hospital 
 and the Good Samaritan Dispensary, respectively, were taken over by the 
 Department and installed in new quarters. 
 
 Investigation of Tuberculosis Clinics. 
 
 At the request of the Commissioner of Health an investigation of 
 the tuberculosis clinics of the Department was made by the Executive 
 Secretary of the Association of Tuberculosis Clinics, who concluded her 
 report with the recommendation that additional nurses be employed. 
 This, however, has not been done. 
 
23 
 
 Investigation of Discharged Sanatorium Cases. 
 
 A systematic investigation by field nurses is being made of all cases 
 discharged from the State Sanatorium at Raybrook and from the Depart- 
 ment of Health Sanatorium at Otisville, the object being to ascertain the 
 final results of treatment, its social as well as its personal value. 
 
 Typhoid Fever at Hart's Island. 
 
 In consequence of an outbreak of typhoid fever at Hart's Island in 
 August and September, 700 inmates were immunised against the disease 
 by the physicians of the Department. 
 
 Anti-Rabic Clinics Reorganized. 
 
 The anti-rabic clinics of the Department were reorganized and meth- 
 ods made uniform in all boroughs. A new clinic was opened at 29 Third 
 avenue, Brooklyn. 
 
 Foot and Mouth Disease. 
 
 Late in the year foot and mouth disease appeared in Long Island 
 and all the cattle in a number of stables in the Borough of Queens were 
 destroyed by state inspectors. Two suspected cases of human foot and 
 mouth disease zuere observed. A general order was issued for the pas- 
 teurization of all milk during the continuance of the epidemic. 
 
 Diagnosis of Venereal Diseases Now a Municipal Activity. 
 
 The special fund from the Bureau of Social Research which has 
 hitherto been used for the support of diagnostic laboratory work in 
 venereal diseases was exhausted at the end of the year. Provision having 
 been made in the budget for 1915, this work will be carried on as a 
 municipal activity. 
 
 Examination of Applicants for Peddlers' Licenses. 
 
 In co-operation with the Bureau of Licenses, a clinic for the exami- 
 nation of applicants for peddlers' licenses was established at 49 Lafayette 
 street, where applicants undergo examinations for tuberculosis and other 
 communicable diseases. 
 
 Care of Contagious Diseases in Institutions. 
 
 A special inspection of each general and special hospital, home for 
 incurables, orphan asylum, dispensary and similar institution in the city, 
 was undertaken for the purpose of ascertaining the manner in which 
 these institutions are complying with the Sanitary Code, which requires 
 that in every public hospital and dispensary in the City of New York 
 there shall be provided and maintained a suitable room or rooms for the 
 temporary isolation of persons suffering from infectious diseases. On 
 the basis of this study, suitable regulations were adopted for the care oj 
 contagious diseases in all public and semi-public institutions in the city. 
 
24 
 
 Cases of Contagion in Out-of-Town Institutions. 
 
 The Department has discontinued the practice of transferring patients 
 
 ill with contagious diseases from out-of-town institutions to the city, 
 
 on the principle that such institutions, in justice to their inmates, should 
 
 be provided with suitable facilities for the isolation of contagious diseases. 
 
 Vaccination of Children in Parochial Schools. 
 
 The State Law makes compulsory the vaccination of children attend- 
 ing public schools. This law does not apply to the parochial schools, 
 which are under the jurisdiction of the Catholic School Board; the vacci- 
 nation of the children attending parochial schools has hitherto been 
 neglected. The great danger involved in this neglect was pointed out 
 to the officials of the Catholic School Board, who promptly and cordially 
 offered to co-operate with the Department. During the summer, there- 
 fore, 69,354 children attending the parochial schools in the five boroughs 
 were vaccinated against smallpox. 
 
 Control of Tuberculosis in Lodging Houses. 
 
 Managers of lodging ho'uses are now requested to notify this Depart- 
 ment of the .removal of all persons ill with tuberculosis. Lodging house 
 cases furnish one of the most difficult problems in the tuberculosis work 
 of the Department. This new procedure will make it possible to keep 
 them under closer observation. 
 
 Examination of School Lunch Employees. 
 An examination of attendants and student helpers engaged in the 
 public school lunch service was made, with especial reference to tubercu- 
 losis, syphilis, diphtheria, typhoid and other infectious diseases. 
 
 Additional Vaccination Centres. 
 
 Additional vaccination centres were established without cost by includ- 
 ing all milk stations and children's clinics in this classification, in addi- 
 tion to public schools. 
 
 Tetanus Antitoxin for the European Armies. 
 
 From the surplus product of the laboratory, tetanus antitoxin 
 sufficient to immunize 200,000 wounded men was sent abroad for dis- 
 tribution among nearly all of the armies engaged in the war. For of 
 all this supply payment is to be made to the city at cost. 
 
 Increased Use of Smallpox Vaccine. 
 
 The amount of smallpox vaccine prepared and distributed during 
 1914 show-ed a large increase over that of previous years, due to the 
 active campaign in favor of general vaccination, carried on by both the 
 New York City and State Departments of Health. 
 
 The Use of Anti-Meningitis Serum. 
 The report on meningitis shows that 202 cases were treated during 
 the year 1914 as against 131 during the previous year; 170 intraspinal 
 injections of anti-meningitis serum were performed. 
 
25 
 
 Pasteur Treatment. 
 
 Pasteur anti-rabic treatment was given to 852 patients during 1914 
 as against 975 during the previous year. 
 
 There were three human deaths from rabies during the year. 
 
 During the last six months of the year, 42 persons who had been 
 bitten by cats received Pasteur treatment. Of this number 33 patients 
 were bitten by 12 cats that were proven to be rabid by a microscopical 
 examination of their brains. This indicates clearly that stray cats, as 
 •well as stray dogs, should be captured and destroyed. 
 
 Consolidation of Department Laboratories. 
 
 The laboratory work of the Department has hitherto been under 
 divided control. The Research Laboratories, so-called, were in charge 
 of the Director of Laboratories, while the Diagnostic Laboratories were 
 "nder the supervision of the Director of the Bureau of Infectious Dis- 
 eases. At the close of the year the laboratories were consolidated, and 
 the entire laboratory organization placed in charge of the Director of 
 Laboratories. Certain economies will result from this consolidation. 
 
 Critical Studies of Laboratory Work. 
 
 At the request of the Commissioner of Health, critical studies of 
 various phases of the technical work of the Bureau of Laboratories were 
 undertaken independently by three different members of the Advisory 
 Council. All pronounced the work performed to be of a very high 
 quality. Some valuable suggestions were adopted. 
 
 Analysis of Drugs for the Police Department. 
 
 Owing to the very large number of samples of narcotic drugs sub- 
 mitted for analysis by the Police Department, the Board was obliged to 
 ask to be relieved of this work, which was accordingly transferred to 
 the Standard Testing Laboratory, to which chemists were assigned for 
 the purpose by the Board of Estimate and Apportionment. 
 
 Standardization of Drugs and Chemicals. 
 
 A committee of Department employees has been appointed to pass 
 on specifications for drugs and chemicals submitted by the Board of 
 Standards and Supplies. 
 
 Bacteriological Examination of Milk. 
 
 Arrangements were made whereby the number of milk samples exam- 
 ined bacteriologically was more than doubled. This was accomplished 
 without any increase in the force of the bacteriological laboratory. 
 
 Analytical Work for the Milk Commission. 
 
 For years part of the bacteriological work of the New York County 
 Milk Commission was carried on in the laboratories of the Department. 
 
26 
 
 The Corporation Counsel, who was consulted in regard to the legality 
 of this arrangement, expressed the following opinion : 
 
 "The provisions of the law do not require the City of New York to 
 bear any part of the expenses connected with the activities of the Milk 
 Commission, or, in strictness, warrant the arrangement whereby the Milk 
 Commission makes use of the employees, supplies and apparatus of the 
 Department of Health." 
 
 In view of this decision, an amicable arrangement with the Milk 
 Commission was made for the withdrawal of its work from the labora- 
 tories of the Department. 
 
 Efficiency Studies in Co-operation with the Commissioners of 
 
 Accounts. 
 
 Through the assignment of a representative of the Commissioners 
 of Accounts to this Department, by request, several fruitful investiga- 
 tions were made, among which are the following : 
 
 (a) It was discovered that in a number of instances physicians had 
 
 obtained laboratory products from the Department ostensibly 
 for use among the poor, but that such products had not been 
 used for the purpose indicated. The Department was advised 
 that the evidence obtained would not warrant legal action. 
 Twenty physicians, were, however, sharply warned. 
 
 Incidentally this investigation showed that diphtheria anti- 
 toxin had been used in many cases which had not been reported 
 to the Department as cases of diphtheria. In future, systematic 
 comparison will be made between antitoxin receipt stubs and 
 the records of the Bureau of Infectious Diseases, in order to 
 insure promptness and accuracy on the part of the medical pro- 
 fession in the reporting of diphtheria. 
 
 (b) A study was made of the telephone requirements in the various 
 
 offices of the Department in the Boroughs of Manhattan and The 
 Bronx. Some saving has resulted. 
 
 (c) It was discovered that condemned food supplies were being sur- 
 
 reptitiously removed from the offal dock. The Police Department 
 was asked to co-operate with this Department in its efforts to 
 prevent this practice. 
 
 (d) Comparative studies were made of the work performed by physi- 
 
 cians, nurses, nurses' assistants and cleaners in a number of milk 
 stations. 
 
 (e) The use of motor and horse-drawn vehicles in the Department was 
 
 studied and facts ascertained which will be of assistance to the 
 Department. 
 
 (f) A report was made upon the work of the Supervisor of Buildings 
 
 and Grounds. 
 
 (g) A study was made of the work of all of the employees attached to 
 
 The Bronx Borough office. In one Bureau a top-heavy organiza- 
 tion was revealed; suitable changes followed. 
 
27 
 
 Accounting Methods at the Otisville Laboratories. 
 
 At the request of the Commissioner of Health, a study of the 
 accounting methods, care of valuable stock, etc., at the branch laboratory 
 at Otisville was made by the Office of the Commissioners of Accounts. 
 Based upon this investigation were recommendations in relation to account- 
 ing methods, etc., which were adopted. 
 
 Sales of Laboratory Products. 
 
 In view of the frequency of requests for the free distribution of 
 laboratory products to municipalities and hospitals outside of the City 
 of New York the Department has adopted the policy of using "all its 
 resources for the protection of the health of the city," at the same time 
 declaring its willingness "to co-operate with other municipalities and 
 states in special emergencies." It has been ordered also that "services 
 performed for other communities shall be duly compensated." 
 
 Stenographic Division Organized. 
 
 The organization of a stenographic division at headquarters into 
 which have been gathered the stenographers and typists, heretofore scat- 
 tered throughout the various bureau offices, is one of the most notable 
 of a series of measures inaugurated during the year to increase the 
 efficiency of the Department. 
 
 Office Congestion Avoided. 
 
 An agreement was made with the Department of Education whereby 
 children seeking admission into the public schools may be entered tem- 
 porarily on the rolls pending the receipt from the Department of Health 
 of a certificate of birth in each case. This has had the effect of avoiding 
 congestion at the Health Department offices in the city. 
 
 Study of Pension Problem. 
 
 A committee of employees was named to study the pension problem 
 and to submit suggestions to the Mayor's Pension Committee, from the 
 standpoint of participants of the pension fund of the Department of 
 Health. The preliminary reports show that on the present basis the early 
 exhaustion of the pension fund is inevitable. 
 
 The Use of Public School Telephones. 
 
 Through the courtesy of the Board of Education, permission was 
 obtained to use, for any official business connected with this Department, 
 the telephones which are now being installed in all public schools of the 
 city. Reports concerning cases of acute contagion found in school or in 
 absentee visit are now telephoned to the Borough offices and to the in- 
 spector on the day found. 
 
 Definition of Part-time Service. 
 
 Many of the professional workers of the Department long have been 
 employed oh a part-time basis. An official definition of part-time service, 
 
28 
 
 applicable throughout the Department, was, however, lacking. Such a 
 definition has now been promulgated. 
 
 The Avoidance of Conflict with Otjier Departments. 
 
 During the year a careful study was made of the Sanitary Code, 
 of the regulations of the Department, and of all forms of Board orders 
 which prescribe or require any kind of alteration to buildings, with a view 
 to establishing perfect consistency between the regulations of the Board 
 of Health and those of other City and State Departments. As a result 
 of this study conflict of orders, confusion, and unnecessary expense to 
 citizens will be avoided. 
 
 Department Employees and Private Business. 
 
 An order was issued forbidding employees of the Department to 
 enter into or to maintain business relations with, or to accept any fee for 
 the performance of professional services for any milk or other firm 
 whose activities are under the supervision of the Department of Health. 
 
 Division of Research and Efficiency. 
 
 The Chief of the Division of Research and Efficiency in the 
 Bureau of Child Hygiene was detached from that Bureau and assigned 
 to the office of the Commissioner, where his services will be utilized for 
 the benefit of the Department as a whole. 
 
 Per Capita Cost of Operating Clinics Reduced. 
 
 The high per capita cost of operating the Department clinics for 
 school children was materially reduced by arranging for surgical opera- 
 tions in these clinics every week day in place of every other day. 
 
 Co-operation with Private Physicians. 
 
 In every possible way efforts have been made to lighten the burdens 
 of the Department and incidentally of the taxpayers, by transferring to 
 private physicians clinical and other functions which such physicians are 
 able to perform without danger to the public health. A notable instance 
 of the application of this new policy is acceptance on a child's admission 
 to school of the certificate of a private physician in lieu of examination 
 by the Department's own medical inspectors. 
 
 Office Consolidation Saves Men and Money. 
 
 Throughout the year studies of the various activities of the Depart- 
 ment were made, with a view to the more effective utilization of available 
 means and forces. In consequence of these studies, a number of unpro- 
 ductive activities were discontinued. By means of office consolidation in 
 the Richmond Borough office, several valuable employees, who, owing to 
 the limited amount of work to be done in the Richmond Borough office, 
 were little more than supernumeraries there, were transferred to branches 
 of the service where their help was badly needed. A similar study of 
 the work of the Queens Borough office has since been undertaken. 
 
29 
 
 The New Board of Promotions. 
 
 The departmental Board of Promotions, which previously consisted 
 of three individuals, was reorganized early in the year, so as to include as 
 members of the Board all Bureau chiefs. 
 
 Uniform Absence Rules. 
 
 A uniform method of dealing with requests for "leave of absence 
 with pay" was inaugurated. 
 
 Bonding of Employees. 
 
 Instructions were issued to protect the city by bonding a number of 
 Department employees who handle considerable amounts of cash money. 
 
 Control of Appropriations for Supplies Established. 
 
 In order to show each chief of Bureau precisely where his Bureau 
 stands in the matter of supplies, and whether in a given month goods 
 have been consumed in excess of the available appropriations for any 
 particular purpose, a form was inaugurated for monthly distribution 
 showing the following facts : 
 
 1. Amount of annual appropriation for supplies (each appropriation 
 
 item to be separately stated). 
 
 2. Amount of monthly appropriation calculated as one-twelfth of annual 
 
 appropriation. 
 
 3. Amount of requisitions, item by item, during the month covered by 
 
 the report. 
 
 4. Amount available for the period since the beginning of the fiscal year 
 
 (on a pro-rata basis). 
 
 5. Amount actually used since the beginning of the fiscal year. 
 
 Substitution of Written for Oral Orders. 
 
 Inquiry having indicated that in some of the divisions of the Depart- 
 ment important instructions to groups of workers had been given orally, 
 in so informal a manner that it would be impossible to prove conclusively 
 when such instructions were issued, to whom issued and with what 
 emphasis, heads of Bureaus were instructed that all orders which are 
 equivalent to rules and which affect groups of workers should invariably 
 be reduced to writing and formally promulgated. 
 
 Authority Fixed in Cases of Absence. 
 
 Bureau heads were requested to designate subordinate officers to act 
 as chiefs when prompt bureau action is required on such matters as may 
 come up during the absence of the titular chief. 
 
 Unit Cost of Various Functions Ascertained. 
 
 Statements have been completed showing the unit cost of functions 
 and activities of the Department; these figures will prove of value to 
 
30 
 
 the Department. Departments of Health in other cities will be urged 
 to follow suit, and valuable and instructive comparative data will, it is 
 hoped, thus be obtained. 
 
 Printed Codes for Field Workers. 
 
 Many inspectors and other field workers of the Department were 
 without comprehensive printed codes of instructions. Inspectors were 
 expected to carry in their minds many of the instructions given them. 
 Each Bureau chief was therefore directed to formulate a code of in- 
 structions applicable to the field workers of his particular Bureau. 
 
 Prompt Answers to Correspondence. 
 
 It was ordered that "any inquiry addressed to the Department by a 
 citizen should be answered, or at least tentatively acknowledged, on the 
 day of its receipt, that such acknowledgment should invariably be made 
 within twenty-four hours, and that all communications received from 
 outside sources by the Department or by any of its Bureaus should 
 receive prompt attention." 
 
 Official Representation at Conventions, etc. 
 
 In order to meet the frequent requests from Department employees 
 for permission to attend conventions and conferences in this city and 
 elsewhere in the Department's time and at the expense of the Depart- 
 ment, a committee was appointed to prepare an official list of annual 
 conventions and meetings representation at which is clearly desirable in 
 the interest of the Department. 
 
 Acknowledgments. 
 
 This report cannot properly be concluded without an expression of 
 gratitude and obligation to those who have upheld the hands of the 
 Department during what has been perhaps the busiest year in its history. 
 
 Many of the procedures of the Department this year have been new. 
 In all of the bureaus, the pace has been quickened. A serious effort has 
 been made to hold each employee of the Department up to a high standard 
 of personal achievement. Officers and employees have been asked to make 
 sacrifices to which they have not been accustomed. In some instances 
 salaries have been reduced: and except in a few cases, it has been im- 
 possible, owing to the financial stringency, to reward zealous and efficient 
 workers according to their merit. Under these circumstances, eagerness 
 to serve the Department could not reasonably have been anticipated. 
 Nevertheless, there has been manifested throughout the Department a 
 steadfast devotion to duty, and in many instances even a high degree of 
 enthusiasm. For their loyalty to the best traditions of the Department, 
 the employees as a body merit the thanks of the Board. 
 
 The Department has enjoyed in a large measure, the support of the 
 press. The daily press of the City, as a whole, has been generally fair 
 and often generous in its treatment of the Department, and medical, trade 
 and technical papers have devoted a large amount of space to the discus- 
 
31 
 
 sion of departmental matters of special interest to their readers. A De- 
 partment of Health cannot satisfactorily perform its educational func- 
 tions without the help of the press; and it is fitting that this help should 
 be suitably acknowledged. Especially is the Department grateful to the 
 following publications : 
 
 To The Globe for its aid in the pure food campaign, and for 
 its willingness to devote extended space to the weekly bulletins in 
 which the Department has endeavored to expound the Sanitary Code; 
 To The Tribune for its exposure of fraudulent medicinal prep- 
 arations ; 
 
 To The World for its articles in relation to the Sanitary Code, 
 and for its active part in the fight for subway sanitation; 
 
 To The American and The Journal for a series of illuminating 
 articles on rabies; 
 
 To The Evening Post for its generous allotment of space for the 
 subject matter of the Department's bulletins: 
 
 To The Times for its Sunday articles treating of various phases 
 of the Department's educational program, and for its editorial support 
 and sound criticism ; 
 
 To The Sun for its helpfulness in the vaccination campaign con- 
 ducted by the Department last spring, and for many illuminating 
 editorials on the medical policies of the Department; 
 
 To The Press for a series of special articles in its Sunday edition 
 on the health movement; 
 
 To The Brooklyn Eagle for bringing home to the citizens of 
 Brooklyn the essential things in the Department's program; 
 
 To The Standard Union for enabling the Department to explain 
 the significance of anti-typhoid inoculation; 
 
 To Harper's Weekly for seconding the efforts of the Department 
 to obtain national legislation for the regulation of proprietary 
 medicines ; 
 
 To The Mail for its interest in clean milk and pasteurization; 
 and to newspaper writers and publishers too numerous to mention 
 who have been painstaking in their efforts to promote the health of 
 the city. 
 
Public health is purchasable. 
 Within natural limitations a 
 community can determine its 
 own death rate. 
 
COLUMBIA UNIVERSITY LIBRARIES 
 
 Thi& book is due on the date indicated below, or at the 
 expiration of a definite period after the date of borrowing, 
 as provided by the rules of the Library or by special ar- 
 rangement with the Librarian in charge. 
 
 DATE BORROWED 
 
 DATE DUE 
 
 DATE BORROWED 
 
 DATE DUE 
 
 . 
 
 RECD 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 C28I 1 UOIMIOO 
 
 
 
 
RA122.C1 
 
 197 
 
 Hear Izrlz (City) Dept, of health 
 
 5pvl