• i>a '^-.'"^'-'S'*'' 
 
 The Public Health Committee 
 
 of 
 
 THL NLW YORK ACADEMY 
 OF MLDICINL 
 
 A Survey of Its Actwities During Five Years of Work 
 
 1911-1916 
 
 17 West Forty -Third Street 
 New York City 
 
 '/ 
 
Columtiia Winihtvsiitv 
 in tbt Citp of ^tD gorfe 
 
 CoUege of S^^pfiitmn^ anb ^urseon£S 
 
 3^ef erence %ihvaxv 
 
lililll 
 
 HX00059595 
 
 The Public Health Committee 
 
 of 
 
 THL NLW YORK ACADLMY 
 OF MEDICINE. 
 
 A Survey of Its Activities During Five Years of Work 
 
 1911-1916 
 
 17 West Forty-Third Street 
 New York City 
 
TABLL OF CONTENTS 
 
 Membership of the Public Health Committee, 1916 1 
 
 Foreword 3-4 
 
 Chapter I. — The Organization of the Committee 5-8 
 
 Chapter II.— Hospitals 9-20 
 
 Chapter III.— Protection of the Health of Children 21-33 
 
 Chapter IV.— Vital Statistics 34-37 
 
 Chapter V. — Improvement of I^iving and Working Conditions 38-55 
 
 Chapter VI.— Medical, Public Health, Dental and Nursing Education 56-63 
 
 Chapter VII. — The Care of the Mentally Defective, the Delinquent 
 
 and the Aged 64-69 
 
 Chapter VIII.— Out-Patient Clinics 70-74 
 
 Chapter IX.— Health Protection of the Port of New York 75-80 
 
 Chapter X. — Miscellaneous Activities and Reports 81-89 
 
 Chapter XI. — Municipal Budget 90-94 
 
 Chapter XII.— I^egislation 95-102 
 
 Index , 103-106 
 
Membership of the Public Health Committee, 1916 
 
 Charles I^oomis 
 JAMKS Alexander 
 
 T. Passmore Berens, M.D. 
 Nathan E. Brill, M.D. 
 Robert J. Carlisle, M.D. 
 Floyd M. Grand all, M.D. 
 G. A. Friedman, M.D. 
 Lewis Fox Frissell, M.D. 
 Arpad G. Gerster, M.D. 
 
 S. S. GOLDWATER, M.D. 
 
 Thomas W. Hastings, M.D 
 George B. 
 
 Dana, M.D., Chairman 
 Miller, M.D., Secretary 
 
 L. Emmett Holt, M.D. 
 Abraham Jacobi, M.D. 
 Howard Lilienthal, M.D. 
 William G, MacCallum, M.D. 
 Bernard Sachs, M.D. 
 Thomas W. Salmon, M.D. 
 W. Gilman Thompson, M.D. 
 Philip Van Ingen, M.D. 
 Karl M. Vogel, M.D. 
 Wallace, M.D. 
 
 E. H. Lewinski-Corwin, Ph.D., Executive Secretary 
 
Digitized by tine Internet Arciiive 
 
 in 2010 witii funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/publichealthcommOOnewy 
 
FORLWORD 
 
 The present Report contains a summary of the activities of the 
 Public Health Committee of the New York Academy of Medicine 
 during the first five years of its existence. In this period of time 
 the Committee has come into contact with so many problems con- 
 cerning the health of the City and has been called upon to express 
 its opinion on so many vital matters, that it has been thought 
 advisable to bring all the reports, suggestions and recommenda- 
 tions together, in the hope that in this readily available form they 
 might be of use to those interested in public health problems. 
 
 The material has been classified under twelve topical headings, 
 covering the main divisions of the field of public health endeavor. 
 Some problems which were of more immediate urgency have occu- 
 pied the attention of the Committee more than others, and a great 
 deal of time and attention was devoted in bringing about certain 
 administrative changes or reforms, notably that of the transfer of 
 the quarantine station at the Port of New York from State to Federal 
 control. The contagious disease hospitals in this City, child hygiene, 
 vital statistics and health publicity, and the budgets of the Depart- 
 ments of Health, Bellevue and Allied Hospitals and Public Charities 
 are matters which have claimed particular attention on the part of 
 the Committee. 
 
 The Committee acknowledges its deep appreciation of the 
 services rendered by former members who are no longer upon 
 the roll of membership. Dr. John H. Huddleston, whose untimely 
 death last year was a great loss to the entire community, was par- 
 ticularly unsparing in his devotion to the interests of the Commit- 
 tee which owes much to his ability, tact and wise counsel. The 
 Committee also wishes to acknowledge the hearty co-operation it 
 
has received in its work on the part of the Commissioners and em- 
 ployees of the several City departments with which it has dealt, and 
 of the various civic organizations and other associations interested 
 in public health work. 
 
 The Committee takes this occasion to acknowledge the gene- 
 rosity of the contributors to its financial support, Mrs. E. H, 
 Harriman furnished the fund which first established the work of 
 the Committee and has been very gracious in support ever since. 
 In addition, the following persons have contributed to this work 
 during the past five years: Mr. George Blumenthal, Dr. Charles 
 ly. Dana, Mr. Philip J. Goodhart, Mr. Edward S. Harkness, Dr. 
 E. Emmett Holt, Dr. Abraham Jacobi, Dr. Walter B. James, Mr. 
 Meyer H. Eehman, Mr. Adolph Lewisohn, Mr. Isaac N. Seligman, 
 Dr. Philip Van Ingen, and Mr. Charles A. Wimpfheimer. Two 
 anonymous contributions have also been received, one through Dr. 
 Nathan E. Brill and the other through Dr. T. Passmore Berens. 
 
THE ORGANIZATION OF THE, COMMITTLL 
 
 The Code of Medical Ethics, adopted in 1847 ^7 the American 
 Medical Association, recognizes physicians as conservators of pub- 
 lic health and declares that "it is a delicate and noble task, by the 
 judicious application of Public Hygiene to prevent disease and 
 lengthen life, and thus to increase the productive industry, and 
 without assuming the office of moral and religious teaching, to 
 aid the civilization of an entire people." 
 
 Early in its history the Academy of Medicine stated in its 
 constitution that one of its four objects was the promotion of public 
 health; and in 1852, following the precept already quoted, it created 
 a standing Committee on Public Health. In 1858 a Section on 
 Public Health and Legal Medicine was established, which existed 
 until April 26, 191 1 when at its own request it was abolished by 
 the Council of the Academy and replaced by a Committee on Public 
 Health. Prior to that a Committee on Hospitals was appointed 
 by the President of the Academy on March 25, 1908* and on May 
 25, 1910 another Committee was appointed to represent the Acad- 
 emy at the budget hearings before the Board of Estimate and Ap- 
 portionment. These two Committees were merged into one on May 
 I, 191 1 and on October 22, 191 1 the Committee on Pubhc Health 
 was merged with the joint Committee on Hospitals and Munici- 
 pal Budget into the Public Health, Hospital and Budget Committee 
 with the following membership : Dr. Charles L. Dana, Chairman, 
 Dr. James Alex. Miller, Secretary, Dr. Herman M. Biggs, Dr. John 
 Winters Brannan, Dr. Algernon T. Bristow, Dr. Robert J. Carlisle, 
 Dr. Arpad G. Gerster, Dr. S. S. Goldwater, Dr. L. Emmett Holt, 
 Dr. John H. Huddleston, Dr. Abraham Jacobi, Dr. Theodore C. 
 
 NOTE: — Under the Chairmanship of Dr. Charles L. Dana the Committee on Hos- 
 pitals did important work for over two years, until the organization of the larger 
 Committee. 
 
Janeway, Dr. Samuel Lloyd, Dr. W. Gilman Thompson and Dr. 
 Linsly R. Williams. Several changes in the membership have 
 been made since then. In 1912 Dr. Haven Emerson and Dr. Philip 
 Van Ingen were elected to the membership of the Committee ; dur- 
 ing 1913 Dr. Frank S. Meara, Dr. James Ewing, Dr. Egbert Le 
 Fevre and Dr. Frederic S. Lee served on the Committee ; and in 
 1914 Dr. Edward L. Keyes, Jr., was a member. Death has removed 
 Dr. Algernon T. Bristow, Dr. Egbert Le Fevre and Dr. John H. 
 Huddleston. In the early stages of the Committee Dr. Herman 
 M. Biggs and Dr. John Winters Brannan, both of whom were 
 officially connected with City Departments, resigned. Upon his 
 appointment as Deputy Commissioner of the State Department 
 of Health, Dr. Linsly R. Williams also resigned. In 1914 Dr. 
 S. S. Goldwater became Commissioner of the Department of Health 
 of New York City and Dr. Haven Emerson his Deputy, and both 
 severed their connections with the Committee. Since his resigna- 
 tion from the Commissionership, Dr. Goldwater has again joined 
 the Committee. E. H. Lewinski-Corwin, Ph.D. has been Executive 
 Secretary since May i, 191 1. On January 7, 191 5, at its annual 
 meeting, the Academy voted to change the name of the Committee 
 to the Public Health Committee and defined its status in the follow- 
 ing resolution : 
 
 RESOLVED : That the President be authorized to appoint each year 
 a committee to be known as the Public Health Committee, and to fill such 
 vacancies as may occur in it, or make such additions as may seem best. 
 This Committee shall be authorized to co-operate with public health ac- 
 tivities and to make studies of, and issue statements upon matters pertain- 
 ing to public health and hospitals ; but such statements shall not be issued 
 until approved by three-fourths of the Committee and by the President of 
 the Academy of Medicine. Subject to these provisions and in pursuance of 
 these objects the Committee is authorized to appear before any committee, 
 board, legislature or other body, in order to make statements and express 
 opinions on matters relating to public health and hospitals. 
 
 The membership of the Committee at the present time is as 
 follows : Dr. Charles Loomis Dana, Chairman, Dr. James Alexander 
 Miller, Secretary, Dr. T. Passmore Berens, Dr. Nathan E. Brill, 
 Dr. Robert J. Carlisle, Dr. Floyd M. Crandall, Dr. G. A. Friedman, 
 Dr. Lewis Fox Frissell, Dr. Arpad G. Gerster, Dr. S. S. Goldwater, 
 Dr. Thomas W. Hastings, Dr. L. Emmett Holt, Dr. Abraham 
 Jacobi, Dr. Howard Lilienthal, Dr. William G. MacCallum, Dr. 
 
Bernard Sachs, Dr. Thomas W. Salmon, Dr. W. Oilman Thompson, 
 Dr. Philip Van Ingen, Dr. Karl M. Vogel and Dr. George B. 
 Wallace. 
 
 The scope of the Committee's work has been very large, and 
 during the five years of its existence it has come into contact with 
 almost every phase of public health endeavor in this City. The 
 program of work as formulated by the Committee in 191 1, wide as 
 it was, failed to include all the fields into which the actual activities 
 of the Committee have been carried. 
 
 THE SCOPE OF THE WORK OF THE COMMITTEE AS 
 OUTLINED IN ITS ORIGINAL PROGRAM. 
 
 I. Public Health 
 
 (a) To maintain a bureau for the collection of facts in regard 
 to public health, sanitation, and hygiene. 
 
 (b) To endeavor to establish an active co-operation with all pub- 
 lic health activities in the City. 
 
 (c) To keep the medical profession advised of current public 
 health conditions. 
 
 (d) To render to the public authorities and to the community at 
 large an authoritative medical opinion on public health mat- 
 ters ; this to include conferences with officials of various City 
 Departments, the holding of public meetings, the giving of 
 lectures, the distribution of literature, and other methods of 
 publicity. 
 
 (e) To undertake and suggest special researches looking to the 
 solution of vital public health problems, such as an investiga- 
 tion of industrial diseases, etc. 
 
 (f) To make a comparative study of methods and results of 
 public health activities in other cities, both in this country 
 and abroad. 
 
 {g) To co-operate with the Library Committee in maintaining 
 the literature in the Academy Library upon the subjects of 
 public health, sanitation, and hygiene in a high degree of 
 efficiency. 
 
II. Municipal Budget 
 
 va) To utilize facts obtained by the study of public health and 
 hospital conditions for practical application in the preparation 
 of the annual municipal budget. 
 
 (b) To assist actively the various departments of the City govern- 
 ment which relate to public health and hospitals in the 
 preparation of their tentative budgets. 
 
 (c) To take an active part in the budget hearings before the 
 Board of Estimate and Apportionment. 
 
 III. Hospitals 
 
 \^z) To make a study of hospital and dispensary conditions in 
 New York City, including public health and private institu- 
 tions in all the boroughs, this study to be made from a stand- 
 point of : 
 
 1. Construction 
 
 2. Equipment 
 
 3. Administration 
 
 4. Medical efficiency 
 
 (b) To plan for the future development of hospitals and dispen- 
 saries according to the distribution of population, and to 
 further the efforts already being made to raise the standards 
 of dispensary work. 
 
 (c) To undertake a comparative study of hospital and dispensary 
 conditions in other cities, both in this country and abroad. 
 
 (d) To co-operate with the Library Committee in establishing 
 and maintaining a section in the Library of the Academy for 
 the collection of all forms of literature relating to hospitals 
 and dispensaries. 
 
 Rarely has a written program been more faithfully carried 
 out, as the following pages, outlining the various activities of the 
 Committee during the past five years will demonstrate. In addition, 
 it will be noted that the sphere of action of the Committee has 
 widened materially by a proportionate development, until, through 
 it, the Academy of Medicine may truly be said to be a potent force 
 in the public health movement, so that at the present time it more 
 nearly approaches the ideal expressed in the Code of Medical 
 Ethics in 1847, than at any previous period of its history. 
 
II 
 
 HOSPITALS 
 
 CONTAGIOUS DISEASE HOSPITALS OF THE CITY. 
 
 The first matter which claimed the attention of the Committee 
 was the contagious disease hospital situation in this City. During 
 the summer of 191 1 an intensive investigation was carried on with 
 the co-operation of Dr. Lederle, then Commissioner of Health of 
 the City of New York. It comprised a study of details of organ- 
 ization, construction and administration. The hospital facilities 
 were studied in connection with the hospital population and its 
 character; statistics o£ transfers of patients from borough of 
 residence to other boroughs, their condition on arrival at the hos- 
 pitals, were compiled and classified; age and sex statistics for each 
 disease were grouped separately; the degree of overcrowding was 
 analyzed by weeks and presented graphically on charts. The ques- 
 tion of cross infections was thoroughly studied in all its bearings. 
 Medical reports and records were examined. Comparative mortal- 
 ity rates in hospitals here and abroad, and in the City in general, 
 were compiled and analyzed. The results of the work of the hos- 
 pitals for a number of years were carefully compiled and studied. 
 A statistical study of the prevalence of the contagious diseases in 
 the City revealed the coincidence in the prevalence of measles and 
 scarlet fever and their epidemic nature in comparison with the 
 constancy of diphtheria for a number of years. The endemic nature 
 of this disease, as well as the large number of fatalities resulting 
 from it, in view of the fact that the cause of the disease and the 
 mode of transmission are known, was emphasized and recom- 
 mended for a special study. 
 
 The report on Contagious Disease Hospitals, and the Commit- 
 
tee's numerous recommendations with regard to them were sub- 
 mitted to the Department of Health and to the Board of Estimate 
 and Apportionment. A copy of the recommendations is herewith 
 appended. Many of the recommendations were adopted by the 
 Department. Others, although considered very desirable, could not 
 be adopted at the time because of the lack of funds for putting 
 them into practice. 
 
 RECOMMENDATIONS AND SUGGESTIONS REGARDING CON- 
 TAGIOUS DISEASE HOSPITALS. 
 Presented to the Department of Health in igii. 
 
 New Hospitals. 
 
 1. Two new hospitals for contagious diseases, especially for Scarlet 
 Fever and Diphtheria, should be provided for in the immediate future. 
 One in the Borough of the Bronx and one in Queens. These hospitals 
 should be located near congested centers or those which are apt to become 
 more thickly populated. 
 
 2. The majority of beds in these hospitals should be for scarlet fever 
 patients; a comparatively small number for diphtheria and for measles. 
 
 3. A special hospital for measles should be constructed in the Borough 
 of Manhattan. 
 
 4. Hospitals should be so located that the long ambulance rides which 
 at present often occur, should be eliminated. 
 
 The possibiHty of substituting automobiles for the horse ambulance is 
 recommended. 
 
 Details of Hospital Construction. 
 
 1. The wards in these hospitals should be small with a maximum 
 capacity of ten patients, with facilities for dividing the ward into alcoves by 
 glass partitions half the height of the room. 
 
 2. Sufficient accommodations should be provided for observation wards 
 in each hospital. 
 
 3. There should be in addition a number of small rooms for the segre- 
 gation of cases of mixed infection, doubtful cases and cases with compli- 
 cations. 
 
 4. Convalescent patients should be separated from those who arc 
 actively and acutely ill. 
 
 5. Children's wards for acute illness should be restricted for the use 
 of children only, and the beds should be of such size as to make doubling 
 up impossible. 
 
 10 
 
6. There should be a large number of water closets and linen closets 
 situated conveniently to the wards. 
 
 7. Every ward should have a small treatment room adjoining. 
 
 8. Elevators in the hospitals should be provided with safety devices 
 which would prevent the starting of them unless all the shaft-doors are 
 closed. 
 
 Quarantine and Sanitary Regulations. 
 
 1. Existing rules should be more strictly enforced. 
 
 2. Ward maids should not be allowed to come in direct contact with 
 the patients, and convalescent patients should not be permitted to enter the 
 diet kitchens. 
 
 3. The precautions already taken against vaginitis are to be commended 
 and should be extended as rapidly as possible. 
 
 4. It is suggested that smears should be taken by one or two especially 
 instructed and responsible persons, either physicians or nurses, and that they 
 should be specially trained in the most effective method of obtaining the 
 smears. 
 
 5. Cases with purulent discharge from the nose, throat, or ear should 
 be treated in special pavilions and provisions made for the retention of 
 these cases until danger from them has ceased. 
 
 Nursing. 
 
 1. Provisions should immediately be made for an increased number 
 of nurses with increased salaries, so that they may be of a higher grade 
 of women. 
 
 2. These nurses should be retained on the payroll for the entire year, 
 arrangements being made for their transfer to other divisions of the Health 
 Department when they are not needed during the light months of con- 
 tagious diseases. 
 
 3. There should be at least one nurse to every ten acute cases during 
 the day and to every fifteen such cases during the night. 
 
 4. Special nurses should be available for very sick patients. 
 
 5. It is suggested that the desirability of employing specially trained 
 nurses for some of the ambulance duty be considered. 
 
 Medical Care. 
 
 I. The recent change in the visiting medical staff at the Willard Parker 
 Hospital is highly recommended. It is urged that every facility be given 
 for the proper study and medical care of the patients, especially by prompt 
 attentiofi to requisitions for medical equipment. 
 
 11 
 
2. That the time of the internes be so arranged that they can give 
 a large proportion of it to ward duty rather than to ambulance duty. 
 
 3. That the internes should be impressed with the value of the clinical 
 and laboratory studies to a much larger extent than at present, instead of 
 the concentrated interest in the practice of intubation, and that proper 
 laboratory facilities be supplied for that purpose. 
 
 4. A Medical Board similar to that existing at Willard Parker should 
 be established at the Kingston Avenue Hospital. 
 
 After Care. 
 
 1. All cases discharged from the hospitals should be followed up in 
 their homes by visiting nurses to make sure of their complete recovery, to 
 provide for country convalescent care when necessary, and to discover when 
 possible secondary cases. 
 
 2. A social service department should be organized at each hospital for 
 this purpose. 
 
 3. The possibility of providing country convalescent branch hospitals 
 which relieve congestion in the acute service, should be considered. 
 
 Special Problems. 
 
 1. The high mortality in the hospitals from measles as compared with 
 the same disease in the home is very striking. We would recommend that 
 a careful study be instituted to ascertain the causes of this mortality, and 
 to obviate it if possible. It has been suggested that cases of measles should 
 never be sent to hospitals excepting when absolutely necessary because of 
 the environment in the home, for the reason that measles in an institution 
 always becomes a more serious disease. Should this be the case, the ap- 
 pointment of special nurses by the Department to care for measles in the 
 homes under the direction of the Department of Health should be care- 
 fully considered. Also in the hospital, special care against over-crowding 
 or close contact with other patients should be taken in the case of measles, 
 by introduction of glass partitions in the wards. 
 
 2. The persistently constant percentage of morbidity of diphtheria dur- 
 ing the last five years is worthy of note. This disease seems less influenced 
 by epidemics than the other contagious diseases, and inasmuch as the bac- 
 terial cause of infection and the method of transmission are well recognized, 
 it would appear as though a special study of this disease might lead to 
 fruitful results in the diminution of its prevalence. 
 
 12 
 
NEW CONTAGIOUS DISEASE HOSPITALS FOR THE 
 BOROUGHS OF BRONX AND QUEENS. 
 
 The studies made revealed the urgent need of additional hos- 
 pital facilities in the Boroughs of Bronx and Queens. The Com- 
 mittee urged the appropriation of funds for these two institutions 
 on the Board of Estimate and Apportionment. The money was 
 appropriated, but difficulties were encountered when plans were 
 being drawn for the erection of these hospitals on the sites owned 
 by the Department of Health because of the opposition of the 
 neighboring real estate interests, particularly in the Bronx, to the 
 erection of a contagious disease hospital near their properties. The 
 Committee then pubHshed a pamphlet entitled, "Argument for a 
 Contagious Disease Hospital in the Bronx," which emphasized the 
 availibility of the site owned by the Department of Health and 
 argued against the placing of the new hospital on North Brother 
 Island. At the same time the Committee emphasized the fact that 
 a hospital for diphtheria, measles and scarlet fever is not a danger 
 to the neighborhood ; that the theory that these diseases can be 
 transmitted through the air to persons in the vicinity is obsolete; 
 and that the prejudice against a properly equipped and admin- 
 istered contagious disease hospital as a danger to the neighborhood 
 has ceased to exist in many foreign cities and is without scientific 
 basis. The existence of an unfounded prejudice, however, was 
 allowed to thwart progress toward meeting a well recognized need, 
 and the hospital in the Bronx has not yet been constructed although 
 the new site selected is free from opposition on the part of the real 
 estate interests. 
 
 The present as well as the immediate future needs of the Bor- 
 ough of the Bronx call for a hospital, the size of which should be 
 considerably larger than it would be possible to build with the ap- 
 propriation of $125,000. Unless an adequate plant is constructed 
 it will be impossible to administer the institution economically, and„ 
 what is more important, the medical service will of necessity be 
 divided between the new hospital and North Brother Island, which 
 was pointed out by the Committee to be a most undesirable pro- 
 cedure, as the Island is needed for the isolation of numerous 
 
 13 
 
cases of advanced tuberculosis and venereal diseases which are of 
 particular danger to the community. 
 
 ARGUMENT FOR A CONTAGIOUS DISEASE HOSPITAL IN THE 
 
 BRONX. 
 
 Prepared by the New York Academy of Medicine Committee on Public 
 
 Health, Hospitals and Budget, in June, 1912, printed and distributed 
 
 among various civic and public health agencies of the city. 
 
 Number of Cases of Contagious Diseases. 
 
 By the Federal Census of 1910, the Borough of Bronx is credited with 
 a population of 430,942, or with about one tenth of the entire population 
 of Greater New York. 
 
 The Reports of contagious diseases made to the Department of Health 
 in 1910 and 191 1 furnish the following figures, indicating the prevalence of 
 the three common contagious diseases per 1000 of population in Greater 
 New York, and in the Bronx: 
 
 Greater New York Bronx 
 
 1910 1911 1910 1911 
 
 Diphtheria 3-53 2.7 3.86 3.0 
 
 Scarlet Fever 3.94 3.1 S.16 3.4 
 
 Measles 7.36 5.1 11.36 5.9 
 
 The share originating in the Borough of Bronx is somewhat in excess 
 of its population ratio, the birth rate of the Bronx being high in comparison 
 with the birth rates of other Boroughs. 
 
 Number Percent, of 
 
 in number in 
 
 Bronx Greater New York 
 
 1910 191 I 1910 1911 
 
 Diphtheria 1696 1499 10 11 
 
 Scarlet Fever 2264 1663 12 10 
 
 Measles 4988 2879 14 1 1 
 
 Disposition of Cases. 
 
 Many of these cases are obliged to go to the contagious disease hos- 
 pitals, and as there is no such hospital in the Bronx, with the exception of 
 one consisting of three wards on North Brother Island, almost all the 
 Bronx Patients are sent either to Willard Parker Hospital, at the foot of 
 East i6th Street, Manhattan, or to Kingston Avenue Hospital in Brooklyn. 
 
 14 
 
Number of Patients from the Bronx. 
 
 At 
 
 Diphtheria 
 
 Scarlet 
 Fever 
 
 Measles 
 
 other 
 Cases 
 
 Percentage of 
 patients coming 
 from the Bronx 
 
 Willard Parker Hospital 
 
 Kingston Avenue Hospital... 
 
 155 
 
 218 
 
 191 
 
 21 
 
 9.26 
 7.00 
 
 During the period from January i, 1911 to May i, 1912, the number of 
 diphtheria cases removed from the Bronx to the Willard Parker Hospital 
 was 2044, or 9.6 per cent, of all the diphtheria cases treated in the Hospital ; 
 the number of Bronx scarlet fever cases at the Hospital being 2779, or 10.9 
 per cent, of the total cases treated. 
 
 The necessity of this disposition of cases must be considered as un- 
 fortunate. The long ambulance ride, amounting in some instances to eighteen 
 miles, has been shown to be exhausting to many and fatal to some. Cases 
 are recorded which did not survive 24 hours after they had been subjected 
 to this experience. 
 
 Furthermore, Willard Parker and Kingston Avenue Hospitals are 
 crowded to a dangerous point during the months of the greatest prevalence 
 of contagious disease, that is, from December to May. Additional hospital 
 accommodation for contagious disease is, therefore, a serious need. 
 
 Appropriation for the New Contagious Disease Hospitals. 
 
 A study of the hospital care for contagious diseases in New York was 
 made in 191 1, by The New York Academy of Medicine Committee on Public 
 Health, Hospitals, and Budget, and the need of additional contagious disease 
 hospitals so revealed was presented to the Board of Estimate and Appor- 
 tionment, following which an appropriation of $250,000 was immediately 
 made for the construction of two contagious disease hospitals, one in the 
 Borough of Bronx, and one in the Borough of Queens. 
 
 Opposition of Real Estate Owners. 
 
 The City Department of Health has owned for the last ten years two 
 sites, one in the Bronx, and one in Queens. These sites are well adapted 
 for the location of contagious disease hospitals, both in the character and 
 area of the site, and in their positions with reference to their respective 
 Boroughs. As soon as the money for the construction of new hospitals 
 was appropriated, the Department of Health asked the Corporate Stock 
 Budget Committee to be allowed to utilize the sites for that purpose. Im- 
 mediately a protest was made by the neighboring real estate owners on the 
 ground that their property would lose in value because of popular preju- 
 dice against the neighborhood of contagious disease hospitals. A public 
 
 15 
 
hearing on the matter was held in the City Hall in December, 191 1, at 
 which the protestants received some assurance that the sites under consid- 
 eration would not be used for contagious disease hospitals, and a commit- 
 tee of the residents of the Bronx was appointed to find another suitable 
 site in the Bronx. In spite of statements then made that another site 
 could be found within a very short time, the committee did not report until 
 after several weeks, and then recommended as a site for a Contagious 
 Disease Hospital for the Bronx, North Brother Island, owned by the City, 
 and controlled by the Department of Health since 1871. 
 
 North Brother Island. 
 
 The New York Academy of Medicine Committee on Public Health, 
 Hospitals and the Budget, is opposed to the use of North Brother Island 
 as a contagious Disease Hospital, for the following reasons : 
 
 /. Need of this Island for other purposes. 
 
 (i) A need of the City, now well recognized, partly met and of 
 increasing urgency, is for a hospital for compulsory detention of certain 
 cases of tuberculosis. An island furnishes much the most available site 
 for such a hospital, and it has been for several years, and now is the 
 policy of the City to use North Brother Island for this purpose. With 
 this intention new tuberculosis pavilions have been built and others are in 
 the process of construction. It seems probable that before many years 
 practically the whole of the island will be needed for this class of cases. 
 
 (2) In the meantime a new hospital for venereal diseases, authorized 
 last year, is to be placed there. 
 
 (3) The present buildings, the extensions planned for the immediate 
 future, and the pavilions for smallpox and for certain unusual infectious 
 diseases, which should be taken care of there, so take up the island area 
 that it would be difficult to place effectively the number of pavilions neces- 
 sary to accommodate the measles, scarlet fever and diphtheria cases from 
 the Bronx. 
 
 II. Disadvantages of an Island for Contagious Diseases. 
 
 (i) The transfer to a hospital of cases of measles, scarlet fever and 
 diphtheria, in their early febrile stages is attended with risks which should 
 be minimized in every way possible. 
 
 (2) For the use of an island for such cases there should be supplied 
 a completely equipped reception hospital on the mainland, ferryboats, each 
 large enough to carry an ambulance, the necessary docks and piers, and a 
 service of frequent trips during the entire twenty-four hours. This is 
 necessary for the parents of the children as well as for the children. The 
 expense of the installation of a proper system for an acute children's 
 
 16 
 
service would be exceedingly large, and would involve the acquirement of 
 water-front property on the mainland. 
 
 (3) The use of an island for chronic adult cases of infection such 
 as syphilis and tuberculosis does not make the demand for rapid, well 
 protected and frequent transportation involved in its use for acute cases of 
 infection in children. The present transportation to North Brother Island 
 may be called adequate for its chronic cases. 
 
 ///. Need of a hospital near the future centre of population. 
 
 The population of the Bronx is increasing rapidly, and the occupied 
 sections cannot extend in other than a northerly direction. The new sub- 
 way extensions which are planned to supply future demands will materially 
 help in their production. The population centre of the Borough is from 
 year to year moving northeast. A hospital which will serve the future 
 needs of the population best, should be located on the line of anticipated 
 growth. 
 
 IV. Availability of Proposed Site. 
 
 The site now owned and recommended by the Health Department is 
 opposite the Westchester station of the N. Y., N. H. & H. R. R. Co., and a 
 few blocks away from the projected extension of the subway. It is appar- 
 ently conveniently placed with reference to the needs of the Bronx, and 
 should not be abandoned by the City unless an equally good substitute can 
 be immediately found. It should be noted too that the purchase of any new 
 site would undoubtedly be rendered difficult by the same objections of 
 neighboring real estate owners, as are now raised against the desired utiliza- 
 tion of this property of the City. 
 
 The New York Academy of Medicine Committee on Public Health, 
 Hospitals and Budget, would emphasize at this time that a hospital for 
 diphtheria, measles and scarlet fever, is not a danger to the neighborhood. 
 The theory that these diseases can be transmitted through the air to persons 
 in the vicinity is obsolete. The prejudice against contagious disease hospitals, 
 properly equipped and administered, as sources of danger to the neighbor- 
 ing residents has ceased to exist in many foreign cities, and is without 
 scientific basis. The existence of an unfounded prejudice should not be 
 regarded as a reason against the provision of a necessity for a whole com- 
 munity. 
 
 In view of the above considerations, we respectfully urge that the 
 Board of Estimate and Apportionment take active and immediate steps to 
 erect a contagious disease hospital in the borough of the Bronx, and that 
 the site now owned by the City be used for this purpose unless another one 
 that is equally desirable can be immediately secured. 
 
 17 
 
CONSOLIDATION OF MUNICIPAL HOSPITALS. 
 
 The proposed charter changes during Mayor Gaynor's admin- 
 istration, in so far as they related to city hospitals, were studied with 
 a great deal of care. The Committee actively opposed the contem- 
 plated substitution of a Department of Hospitals administered by 
 a single paid commissioner for the efficient and unpaid Board of 
 Trustees of Bellevue and Allied Hospitals. The Committee pointed 
 out the need of the consolidation into one department of all the 
 City Hospitals, including the Tuberculosis Sanitorium at Otisville, 
 but excluding the hospitals of the Department of Health, because 
 of the special police powers exercised by the Board of Health in 
 cases of contagious disease. The Committee also recommended 
 that the powers and duties of the Board of Ambulance Service and 
 of the Board of Inebriety be transferred to the Department of 
 Hospitals and that these two boards be abolished. 
 
 THE HOSPITAL SITUATION IN THE LOWER PART OF 
 
 MANHATTAN. 
 
 In the fall of 1912 the Committee made a study of the need 
 of additional hospital accommodations in the lower part of Man- 
 hattan. In this connection the House of Relief and the Volunteer 
 Hospital were visited. The statistics of cases treated in these in- 
 stitutions were studied and information was obtained from the 
 Board of Ambulance Service relative to the distribution of ambul- 
 ance calls during the preceding two years. On the basis of this 
 investigation a report was prepared showing that there was no need 
 of an additional general hospital in the lower part of Manhattan. 
 The Committee suggested the establishment of a few first aid 
 stations to give relief in emergency cases which occurred in the 
 congested parts of the district, pending the arrival of an ambulance. 
 
 A MUNICIPAL HOSPITAL FOR CHILDREN. 
 
 The urgent need for proper hospital provision for children 
 has been well recognized in this City for some time past. In 19 13 
 the Committee was called upon by the State Charities Aid Associa- 
 tion to express an opinion as to the advisability of establishing a 
 
 18 
 
large children's hospital on Blackwell's Island. The Committee con- 
 sidered the matter very carefully and expressed a unanimous opin- 
 ion against such a plan for taking care of the sick children of the 
 City. It was pointed out that separate children's services at the 
 general hospitals are preferable, provided such services are con- 
 stituted as distinct departments with a single head and continuous 
 medical service. 
 
 CHILDREN'S PAVILION AT THE METROPOLITAN 
 
 HOSPITAL. 
 
 At the request of Mr. John A. Kingsbury, Commissioner of 
 the Department of Public Charities of the City of New York, in 
 the latter part of 19 14 the Committee made a study of his plan for 
 transferring the mentally normal children from Randall's Island 
 to a Special Pavilion recently constructed, in connection with the 
 Metropolitan Hospital on Blackwell's Island. After having made 
 a thorough study of the plan and having visited both Randall's and 
 Blackwell's Islands, the Committee approved of the plan under the 
 following conditions : 
 
 1. That the transfer of the mentally normal children from 
 Randall's Island be considered a temporary measure; it should not 
 imply that the policy of the Department of Charities will be to 
 convert Randall's Island permanently into an institution for the 
 mentally defective. 
 
 2. That this plan be not carried out until the money for the 
 new tuberculosis pavilions at Sea View Hospital has been definitely 
 released and their construction consequently assured. 
 
 3. That the number of beds available at the present time for 
 tuberculosis patients at the Metropolitan Hospital be not diminished. 
 
 4. That a suitable detention and observation ward be pro- 
 vided for all children on admission. 
 
 5. That the plan include definite assurances that a compe- 
 tent and expert medical board of visiting physicians will be appoint- 
 ed to this new children's service, and also that proper and adequate 
 care of the surgical cases will be assured. 
 
 6. That the medical board at present in charge of the men- 
 
 19 
 
tally normal children be continued at Randall's Island, so that the 
 methods of medical supervision for the mental defectives can be 
 re-organized in such a way as to provide systematic general medi- 
 cal care for these children. 
 
 This Report was submitted to the Commissioner of Public 
 Charities and all of the above conditions were observed. Referring 
 to the first condition in a recent letter to the Committee, Mr. 
 Henry C. Wright, First Deputy Commissioner, writes that "all of 
 the normal children were taken away from Randall's Island, and 
 whether or not it may be necessary or advisable to change this 
 policy will be determined by further experiment." 
 
 20 
 
Ill 
 
 PROTLCTION OF THE HEALTH OF CHILDREN 
 
 HEALTH CONDITIONS IN PUBLIC SCHOOLS. 
 
 The matter of the health conditions in the pubHc schools and 
 the methods of medical inspection in the schools have been very 
 carefully studied by the Committee. A report was prepared and 
 pubHshed in the New York Medical Record of August 31, 1912. 
 It dealt with such problems as the efficiency of the nurses' and 
 physicians' work, the proper division of work among them, the 
 exclusion of contagious disease cases, the frequency and thorough- 
 ness of medical examinations, the ratio of medical inspectors and 
 nurses to school children, home visits and school and dispensary 
 co-operation. 
 
 The report contained a number of constructive recommenda- 
 tions, some of which are given herewith : 
 
 1. That in addition to their regular work, the school inspec- 
 tors should make a routine inspection of every class at the begin- 
 ning of each term, in order that the control of tuberculosis and 
 some contagious eye and skin diseases may be made more rigid. 
 
 2. That for every 2500 children there should be one nurse, 
 and for every 7500 children one medical inspector; and that the 
 budget of the Division of Child Hygiene be based upon the census 
 of school population. 
 
 3. That physical examinations be made more thorough and 
 more frequently; that the children, or at least the boys at first, be 
 stripped to the waist at physical examinations ; and that a child 
 be examined when it enters school and then every two years. 
 
 4. That in the nurses' work special emphasis be laid on the 
 
 21 
 
follow up work ; and that the burden of clerical work be lightened. 
 
 5. That the salaries of nurses be graded. Instead of receiv- 
 ing a uniform wage of $900 a year, the initial wage should be $800, 
 after a certain period of time increased to $900 and then again to 
 $1000. The gradation will act as a stimulus to efficient work. 
 
 6. That medical inspection be instituted in the high schools. 
 
 7. That the City appropriate money for the enlargement of 
 the force of the Division of Child Hygiene, so as to enable them 
 to undertake the inspection of parochial and other free schools. 
 
 8. That the medical practitioners and the dispensaries be 
 impressed with the importance of this work to the community and 
 be urged to co-operate; and that provision for dental clinics be 
 made, this being done if possible through the existing dispensaries. 
 
 9. That in the Department of Education the responsibility 
 for the conditions affecting the health of the school child be con- 
 centrated. An improved organization should be worked out, which 
 would bring under the jurisdiction of one committee the sanitary 
 conditions in schools, the instruction of children in physical train- 
 ing and personal hygiene, the segregation and treatment of back- 
 ward and mentally defective children, and co-operation with the 
 Department of Health, which is an indispensable condition for suc- 
 cessful medical work in the schools. 
 
 10. That a larger corps of physicians be employed by the 
 Department of Education in order that facilities for the examina- 
 tion and study of backward children may be extended. 
 
 EYE DEFECTS IN SCHOOL CHILDREN. 
 
 At the request of the Department of Health the Committee 
 has prepared a report on the relation of seating and lighting facili- 
 ties in school rooms to the incidence of myopia among school 
 children. The report showed that conditions in many of our public 
 schools are unsatisfactory and conductive to the impairment of 
 vision. The report was submitted to the Department of Health 
 in September, 1914, with the recommendation that a careful study 
 of this question be made by the Department of Health and the De- 
 partment of Education. 
 
 22 
 
REPORT OF THE SUB-COMMITTEE ON MYOPIA IN SCHOOL 
 
 CHILDREN TO THE PUBLIC HEALTH COMMITTEE OF THE 
 
 NEW YORK ACADEMY OF MEDICINE. 
 
 The standard works on Diseases of the Eye bear out the statement 
 made concerning the casual relation between poor nutrition, unsatisfactory 
 school environment, spinal curvature and visual defects. 
 
 S. D. Risley in Norris and Oliver's System of Diseases of the Eye, 
 states "Observation has shown that a considerable percentage of those who 
 enter upon the educational process in apparently good health soon manifest 
 impaired general vigor, acquire distorted spines and develop nearsight." 
 
 The same author states the results of an analysis of more than 200,000 
 published examinations of the eyes of students, as follows : "Stated in 
 general terms ... it was shown . . . that myopia, extremely rare 
 or entirely absent before the beginning of the educational process was found 
 to advance steadily in percentage with the progress of the pupils in the 
 school." 
 
 Erismann's figures for St. Petersburg show 13.6 per cent, of myopia 
 in the 1st grade, and 42.8 per cent, in the 8th. 
 
 Risley in Philadelphia, found 4.27 per cent, of myopia at 8.5 years 
 and 19.33 at 17.5- 
 
 Cohn in Germany showed 1.4 per cent, in 5 village schools as against 
 26.2 per cent, in 2 gymnasia, and 59.5 per cent, in the University. 
 
 Loring and Derby in New York found 7 per cent, in the primary 
 schools and 27 per cent, in the normal schools. 
 
 In speaking of the causes of the development of myopia Risley says, 
 "The myopic eye results only under the stress of those employments which 
 require the protracted use of the eyes at near work." 
 
 The general concensus of opinion among all authorities seems to be 
 that bad illumination, improper position in using the eyes, and all forms of 
 eyestrain are factors of importance in the development of myopia. 
 
 The Committee has visited three public schools in Manhattan during 
 school hours. A moderately dull day was selected in order to estimate the 
 lighting under medium conditions. The three schools selected were No. 9 
 at 82nd Street and West End Avenue, No. 166 at 89th Street between 
 Columbus and Amsterdam Avenues, and No. 54 at 104th Street and Ams- 
 terdam Avenue. These represented the old style, modern and intermediate 
 types of building. The class rooms of grades two to five inclusive, were 
 visited in all three schools and the upper grades in one. 
 
 Two styles of adjustable seat and desk were found in these schools 
 varying only in slight and unessential details. The seats and desks are 
 adjustable as to height only. The seat and the desk behind it form one piece 
 of furniture although the height of each is adjustable separately. In some 
 the top of the desk turns up so that the under side can be used as a rack 
 for reading. The only way it is possible to adjust the distance between 
 seat and desk is by moving the seat and the desk behind it, which if done 
 
 23 
 
for each .child would spoil the alignment. The seat and desk slide up and 
 down, being held in position by a nut which requires a wrench to tighten 
 and loosen. 
 
 Another type of adjustable seat is used in a few of the schools and 
 here the seat and the desk are separate pieces of furniture so that the 
 knee space can be adjusted for each child. 
 
 All seats and desks are fastened to the floor. The Bureau of Fire Pre- 
 vention has forbidden the use of unfastened school furniture. The old 
 style of unadjustable desks and seats is the same as has been used for many 
 years and with which everyone is familiar. Some of the desks of this type 
 are built so that the top may be used as a reading desk if desired. 
 
 The proportion of adjustable and non-adjustable furniture in the various 
 schools differed. In Nos. 9 and 166 they were almost all adjustable. In 
 No. 54 only five rooms out of thirty-four used for the four lower grades 
 were provided with adjustable seats and desks. The lack of adaptation of 
 the desk and seat to the child also varied in the two schools. Both were 
 in charge of unusually intelligent, capable and interested principals. In 
 School No. 9 where the principal said she had a most excellent and in- 
 terested janitor who did everything he was asked, the conditions found 
 were very bad. In one room in which forty-four girls were at work, 
 fourteen were found to be sitting at desks at which there was so little 
 knee space that they had to sit sideways with their knees in the aisle. As a 
 good deal of attention is paid to requiring the children to sit straight in 
 their seats, this forced the child to twist her body in order to appear to be 
 sitting straight. Two seats were found where one end had slipped and was 
 at least two inches lower than the other. At one of these desks was found 
 a pale girl, over tall for her age, seated at a desk with at least six inches 
 too little knee space with one end of the seat lower than the other, and in 
 such a stage of chorea that she was unable to hold her body still a moment. 
 
 It is customary, as a matter of routine, to adjust the seats at the begin- 
 ning of the year. The children are promoted in the middle of the year and 
 change their grades. No adjustment of seats is made except occasionally 
 when a teacher makes a special request. On questioning the teachers in 
 several of these classrooms where the most striking examples of faulty 
 position, etc. were found, they admitted readily that very few of the girls' 
 desks and seats were suited to them, but that they were seated as well as 
 the teachers could arrange it. 
 
 At school No. 166 on the other hand, which was not overcrowded, 
 there was not nearly the same amount of bad seating noticed, especially as 
 far as it related to knee room. 
 
 In all the schools seen, there was a very great deal of bad position due 
 to improper height of seat and desk. It was impossible for a large propor- 
 tion of the children — probably a majority — to read and write at their desks 
 without a certain amount of eye-strain. 
 
 To add to these unfavorable conditions, the seating is very badly ar- 
 ranged in many class rooms in relation to light. In many cases the children 
 
 24 
 
were seen doing their sums or writing with the page in the shadow owing 
 to the light coming from the right. The blackboards were very trying from 
 certain parts of the room, owing to the glare from the side light and to 
 make matters worse, certain of the teachers were using red and green 
 chalks for writing figures on the board. 
 
 In several of the class rooms the attempt was made to put the children 
 with known defects of vision in the front row, but as the front desks were 
 always the smallest and the defects were often in the largest children, the 
 result was not satisfactory. 
 
 In one of the schools the only light was gas, which on a dark day, 
 gave, according to the testimony of the teachers a very poor illumination. 
 
 From their own investigation, therefore, this Committee finds that 
 the present method of seating children, the desks and seats provided for 
 them, and the illumination of their classrooms all are tending to produce 
 spinal curvature and eyestrain in a very large number of school children. 
 
 So long as desks and seats are made as difficult to adjust as possible, 
 so long as the adjusting depends upon the good-will of a janitor, so long 
 as the adjustment can only be made for height without regard to the distance 
 of seat from desk, the children will be subjected to conditions sure to re- 
 sult in spinal curvature and occular defects. 
 
 The matter is of sufficient importance to demand a careful and thought- 
 ful study. 
 
 GONORRHEAL VAGINITIS IN CHILDREN. 
 
 The wide prevalence of the disease has lead the Committee 
 to emphasize the need of certain protective measures and the fol- 
 lowing recommendations were made which were submitted to the 
 Department of Health and published in the medical press. 
 
 1. That systematic examinations of all female inmates of 
 institutions or homes for children be made on admission and re- 
 peated from time to time, in order to determine the prevalence of 
 the disease, the method of introduction and spread, and the possi- 
 bility of spontaneous recovery where no treatment is given. 
 
 2. That those in charge of Day Nurseries should be informed 
 of the great danger of infection and taught what precautions are 
 necessary. 
 
 3. That systematic examination of babies in Day Nurseries 
 be undertaken by the Health Department to determine the fre- 
 quency of infection and the measures necessary to diminish it. 
 
 25 
 
4- That the only way of protecting the city hospitals from 
 the blame of having been the source of infection is to make the 
 examination of smears compulsory in the case of every female 
 child admitted. 
 
 5. That patients discharged from hospitals, who are found to 
 be infected, be followed to their homes and an effort made to secure 
 proper treatment for them. 
 
 6. That it is inadvisable at the present time to attempt to 
 determine the prevalence of the disease in the schools. 
 
 WHOOPING COUGH. 
 
 The Committee made an inquiry aimed at ascertaining the 
 facilities for isolating children suffering from Whooping Cough 
 and finding that there were absolutely none, called this fact to the 
 attention of the Department of Health. The Committee also ad- 
 dressed all the railroad and ferry companies having terminals in 
 this City asking that discarded ferryboats be loaned to the De- 
 partment of Health for the purpose of segregating children with 
 whooping cough and accommodating them during the day. Sub- 
 sequently, the Department secured the use of such a boat from 
 St. John's Guild. 
 
 EMPLOYMENT CERTIFICATES. 
 
 The Committee investigated in 19 12 the methods of examina- 
 tion of children applying for employment certificates. Several con- 
 ferences were held on the subject and various suggestions for 
 stricter physical examinations were made. 
 
 STANDARDS FOR PHYSICAL EXAMINATION OF CHIL- 
 DREN BETWEEN THE AGES OF 14 AND 16 YEARS 
 WORKING IN FACTORIES. 
 
 In response to a request from the New York Child Labor 
 Committee and the Advisory Council of the State Department of 
 Labor, the Committee prepared a report on the standards of physi- 
 cal examination of children between the ages of fourteen and six- 
 
 26 
 
teen years, working in factories. A recent amendment to the Labor 
 Law empowers the Labor Commission to cancel the working papers 
 of children found working in factories, who are sickly and whose 
 health is likely to be impaired seriously as a result of the work in 
 factories. The report on the standards of physical examination to 
 be adopted for such children was submitted by the Committee to 
 the New York Child Labor Committee and to the Advisory Council 
 of the Department of Labor in January, 19 14. The report is as 
 follows : 
 
 Report o'n Standards of Physical Examination of Children Between 
 Ages of 14 and 16 Working in Factories. 
 
 The Department of Labor was authorized by the Legislature, in 1913, 
 to make a physical examination of all children between the ages of 14 and 
 16 who were employed in factories in the State. Failure on the part of 
 the child to submit to this examination may result in the revocation of his 
 or her working papers by the Commissioner of Labor. If the results of 
 this examination convince the medical inspector that the child is unfit for 
 work in a factory, he must submit a detailed report to the Commissioner 
 of Labor, stating his reasons for this opinion, and the Commissioner may 
 cancel the working papers of the child. In either case such child is for- 
 bidden to work in any factory in the State until a subsequent physical 
 examination convinces the Inspector that he is fit to do so, when the work- 
 ing papers may again be issued to the child. 
 
 A complete record of each examination is to be forwarded to the De- 
 partment of Labor and kept on file there. 
 
 According to the Census figures, in 1910 there were 8264 persons 
 between the ages of 14 and 16 employed in factories in the State of New 
 York, of whom 3955, or 47.8 per cent., were males. The Industrial Direc- 
 tory issued by the State Department of Labor gives the total for 1912 as 
 13.519, of whom 5173, or 38 per cent., were males. 
 
 It is understood that the Department is planning to detail two Inspec- 
 tors for this work. If all these children were examined it would mean 27 
 examinations a day, on the basis of the Census figures, or 45 a day on the 
 Industrial Directory figures. If only boys were examined, it would mean 
 13 or 17 a day. It is not known whether the Department intends to have a 
 woman inspector or only men. 
 
 As any examination which is of any value must involve the removal of 
 part of the clothing, it would seem that it would be better to confine the 
 examination during the first year to the boys. If the results of these 
 examinations warranted it, they could be made the basis for demanding that 
 the girls be given the same privilege. In such case a woman inspector should 
 
 27 
 
make the examination, or a woman be present at, and prepare the girl 
 for the examination. 
 
 The examination should be made in a quiet room, with a good light. 
 The child should be stripped to the waist. Girls should be covered with a 
 cape during examination. 
 
 Examination should include: 
 Height. 
 Weight. 
 
 General condition of nutrition. 
 
 Evidences of deformity of the limbs, spine, either anatomical or postural. 
 Evidences of marked nervousness, or Chorea. 
 Skin, pallor, cyanosis, jaundice, eruptions, and skin disease. 
 Eyes and eyesight. 
 Condition of the eyelids. 
 
 Condition of the Mouth, Teeth, and Tonsils. 
 Ears and Hearing. 
 
 External signs of obstructed breathing, probably due to adenoids. 
 Examination of the Heart, both by percussion and Auscultation. 
 Examination of the Lungs, percussion. Auscultation, and determination of 
 
 chest expansion. 
 Examination for Herniae. 
 
 Cancellation of working papers should be recommended under any of 
 the following conditions : 
 Weight — If child is 2 years below the average for his supposed age, or 
 
 when weight is markedly below normal for height. 
 Condition of Nutrition — Evidence of marked malnutrition. 
 Deformity — If due to his employment, and likely to be made worse by it. 
 
 This alone is difficult to estimate as a cause for cancellation, as certain 
 employments might not in any way affect the child adversely. The Depart- 
 ment of Labor is not given any authority to regulate the character of em- 
 ployment of the child. 
 
 Nervousness — or Chorea — If marked nervousness, or if evidence of Chorea. 
 
 Cervical Glands — If Tuberculous. 
 
 Eyes — Serious defects of vision until corrected. 
 
 Eyelids — If Trachoma. 
 
 Mouth and Skin — If evidence of Syphilis. 
 
 Obstructed Breathing — If marked, should exclude until remedied. 
 
 Heart — Any signs of organic Heart Disease, on account of this being the 
 time when a lame heart is most likely to break down. The character 
 of the lesion, and the nature of the employment would have an influence 
 in the decision. 
 
 Lungs — Any evidence of Tuberculosis. 
 
 Hernia — Unless controlled by a truss, and in every case of irreducible Hernia. 
 
 28 
 
OPEN AIR CLASSES IN SCHOOLS. 
 
 In response to a request from the Board of Education as to the 
 relative values of open air and open window class rooms, in Novem- 
 ber, 1914 the Committee made a study in which the merits of the 
 two types of classes were carefully examined. A comparison of 
 the results obtained in these types of classes in the public schools 
 shows very little, if any, difference in favor of the open air classes. 
 
 In view of this and inasmuch as the money available for effi- 
 cient air classes is limited and the expense of construction of open 
 air classes is relatively large, the Committee recommended that the 
 Board of Education provide a large number of open window rooms 
 with pivoted windows and suitable awnings instead of the more 
 expensive open air rooms. 
 
 In this connection the Committee also recommended that the 
 Board of Education encourage the practice among teachers of open- 
 ing the windows in all regular schoolrooms. The attached report 
 sets forth in greater detail the basis for the Committee's conclusions. 
 
 Definition — 
 
 1. Open air classes : by this term is meant classes of children taught in 
 specially constructed rooms or houses which are practically open air pavilions. 
 
 2. Open window classes : by this term is meant classes taught in 
 regular rooms of school buildings, but where the windows have been altered 
 to open on pivots, thus securing the full benefit of the window openings, 
 and where these windows are kept open all the time. 
 
 Types of Children — 
 
 It is understood that, for the most part, classrooms of both the above 
 types are designed for children who are anaemic or otherwise below par 
 in physical condition. 
 
 Desired Condition in These Classes — 
 
 One of the main features of these classes is a relatively low tempera- 
 ture, probably best ranging from 40 degrees to 50 degrees F. There is 
 no evidence to show that any increased advantage is obtained by tempera- 
 tures below 40 degrees F. Also, it is desired to maintain a relative humidity 
 more nearly normal than is usual in steam heated rooms, and in addition, 
 adequate but not excessive air movement. A maximum amount of sunlight 
 in the winter months is desirable, and protection from the sun, preferably 
 
 29 
 
by awnings, in the spring and autumn. Freedom from dust and noise is 
 important, and for that reason the rooms should be at least three floors 
 from the ground. In winter more protection from wind is needed, while 
 in the spring and autumn the maximum of air movement that can be ob- 
 tained is usually desired. 
 
 In addition to these physical conditions it is understood that there 
 should be a special regime in these classes providing especially for more 
 relaxation from the strain of regular classes, and increased periods for 
 rest. In addition to this, adequate clothing for the comfort of the children 
 is understood to be necessary. 
 
 Objection to Open Air Classes — 
 
 1. That there is needless and possible harmful exposure to cold in 
 winter, and the storms in all seasons. 
 
 2. That there is too great exposure to sun and heat in the spring and 
 autumn. 
 
 3. That the cost of construction and equipment is considerable. The 
 cost of construction of one of these rooms frequently amounts to several 
 thousand dollars. The cost of necessary equipment and clothing for children, 
 on the basis of that found necessary in the best private open air rooms 
 and in the Chicago public schools, is $20 per child, as opposed to about $S 
 per child in open window rooms. 
 
 Objection to Open Window Rooms — 
 
 1. Too little air movement in spring and autumn. 
 
 2. Too great exposure to the sun in the spring and autumn, because 
 of the southern exposure of such rooms. This objection, however, could 
 adequately be met by awnings. 
 
 3. Unequal distribution of air movements in the room, particularly 
 in the winter, exposing the children near the windows to too great drafts 
 and colds. 
 
 All these objections appear to be of minor importance. 
 
 Comparative Results in the Physical Condition of Chidren — 
 
 Any opinion upon the relative advantages and disadvantages of these 
 two types of rooms must ultimately rest upon a careful review of the 
 actual results obtained with the children. 
 
 Probably the best results have been obtained in open air classes situated 
 in the country or small towns, where suitable but inexpensive types of 
 construction are possible, and where facilities for exercise and play in the 
 open immediately adjoin the school room. The forest schools of Germany 
 are ideal examples of this class of school. 
 
 Reports based on a careful study of the results obtained in the im- 
 proved physical condition and increased mental efficiency of the children 
 
 30 
 
in large cities shows a slight balance in favor of the open air classes. 
 These reports, however, do not indicate sufficient difference to demonstrate 
 any marked superiority of open air classes over the open window classes. 
 
 Conclusion — 
 
 In the public schools of large cities the provision of open air classes 
 presents considerable difficulties and objections, especially in a climate with 
 such variations of temperature as obtain in New York City. A com- 
 parison of the results obtained in these two types of classes in the public 
 schools shows very little, if any, difference in favor of the open air classes. 
 
 Consequently, inasmuch as the money available for fresh air classes 
 is limited and the expense of construction of open air classes very con- 
 siderable, we recommend that the Board of Education provide a larger 
 number of open window rooms with pivoted windows and suitable awnings, 
 rather than the so-called open air rooms. 
 
 We would also recommend that the Board of Education encourage 
 the practice among teachers of opening the windows in all regular school 
 rooms. 
 
 MENTAL FATIGUE IN SCHOOL CHILDREN. 
 
 In view of the differences of opinion among educators as to 
 the question of half time schooling of young children, the Bureau 
 of Municipal Research submitted the matter to this Committee 
 for an opinion. Careful consideration of the problem led the Com- 
 mittee to express an opinion that an ordinary full school day is not 
 detrimental to the brain power and health of the children provided 
 the physical conditions of the school rooms are satisfactory and 
 arrangement of the school tasks is wisely planned. 
 
 The following is the brief report of the Committee on the 
 subject. 
 
 A careful study has been made of the special questions : First, whether 
 the mental activity involved in the five hours daily of modern school life 
 causes mental fatigue and if so whether such fatigue is serious, passing 
 beyond safe physiological limits. Second, whether such mental fatigue if 
 found is due to excessive mental work, or to other causes in part or whole. 
 
 The Committee has reached the conclusion that there is no serious 
 degree of mental fatigue produced by school work in the usual five hour 
 limit, and that it is unnecessary to shorten school hours on account of this 
 school work. A certain degree of mental fatigue is found towards the end 
 of the morning and of the day's tasks, but it is small in amount and unim- 
 
 31 
 
portant. This fatigue such as it is, is enhanced and mainly caused by 
 poor ventilation and ill-arranged tasks. More than normal fatigue may 
 also occur in children who are poorly nourished, not entirely well, or are 
 under unfavorable home conditions. 
 
 It is believed, therefore, that if all these factors be attended to no 
 shortening of school hours need be attempted. 
 
 It is also believed that some summer work can be carried on with- 
 out danger and even to the great advantage of the child. 
 
 These views are based upon the personal experiences of some of the 
 members of the Committee, but more especially upon the results of con- 
 ferences with physiologists, physicians and teachers who have made a 
 special study of this subject. 
 
 We refer especially to the works of Professor Frederic S. Lee on 
 Fatigue, and on Ventilation ; to those of Prof. Edward Thorndike on Mental 
 Fatigue, Psychological Review, November 1900; and to recent personal com- 
 munications from him. We have also consulted the work of Whipple on 
 Mental Tests ; the article of Dr. R. G. Freeman on Fatigue in School 
 Children, American Journal of Medical Sciences, November 1908; the study 
 of Mental Fatigue by Prof. W. H. Heck of Lynchburg, Va., 1913, and a 
 Second Study by Prof. Heck, the Psychological Clinic, April 15, 1913. 
 
 The Committee has also conferred with Prof. George V. N. Dearborn 
 of Tufts Medical College and a number of other physicians and teachers. 
 
 It is not denied that children do get tired at the end of school hours, 
 that in the spring and towards the end of a school term, chorea is seen 
 more frequently and that evidence of overwork and fatigue is observed. 
 
 The position taken is that these conditions are not necessary to a five 
 hour school day, but are due to unwise methods of teaching, poorly ar- 
 ranged schedules, bad air, and various causes other than legitimate school 
 work. 
 
 It is again strongly urged that shorter vacations or an almost continu- 
 ous yearly school work, if the work is wisely planned, would be advantag-- 
 ecus to many children as has been already demonstrated in certain public 
 schools of this country. 
 
 The above observations apply to the ordinary school work done between 
 the ages of six and fourteen. 
 
 CARE OF CARDIAC CASES. 
 
 (a) The problem of proper medical and educational care of 
 children suffering from chronic valvular disease of the heart has 
 been discussed by the Committee and a preliminary study made 
 which showed that inadequate provision exists for their care in 
 the hospitals of this City and similarly, inadequate attention is 
 being paid to children suffering from heart disease who attend the 
 
 32 
 
public schools. The report was submitted to the recently organized 
 society for the care and provision of heart disease in children. 
 
 (b) The matter of a study of occupations best suited to the 
 cardiac patients was suggested by the Committee to the School of 
 Philanthropy. Such a study was made on the basis of records of 
 discharged patients from Bellevue Hospital. 
 
 OVERCROWDING IN INSTITUTIONS FOR INFANTS. 
 
 The attention of the Committee has been called to the existing 
 overcrowding in institutions for the care of infants. It was stated 
 that one of the reasons for this condition is the inadequacy of the 
 present law regulating the cubic space allottment per child. The 
 law is not based on any scientific premises. 
 
 The matter was referred for study to the Section on Pediatrics 
 of the New York Academy of Medicine and is being considered by 
 a special committee of the Section. 
 
 GARY SYSTEM. 
 
 The Committee has taken an interest in the health possibilities 
 which the so-called Gary System of school instruction affords, and 
 held two conferences with Mr. William Wirt, originator of the 
 plan. As there have been no studies made of the effect of the 
 system upon the health of the school children, the Committee sug- 
 gested to the Department of Health the desirability of making a 
 study of the hygienic aspects of the system and offered its co- 
 operation in such a study. 
 
 33 
 
IV 
 
 VITAL STATISTICS 
 
 VITAL STATISTICS IN THE CITY OF NEW YORK. 
 
 The Committee made a study of the reports of the Department 
 of Health, particularly the reports on vital statistics. The study 
 revealed the fact that there was a large field for improvement in the 
 scope of the reports and the methods of procedure. The study was 
 pubHshed in the Medical Record of November 23, 1912, and the 
 following were the chief recommendations : 
 
 1. That the Department of Health re-organize and enlarge the Bureau 
 of Records in accordance with the recommendations of the Advisory Com- 
 mittee of Statisticians made in 191 1, and subdivide the Bureau into three 
 divisions : of Records, properly, of Research and of Publicity. 
 
 2. That the Board of Estimate and Apportionment appropriate the 
 money necessary for the enlargement of the Bureau of Records in the in- 
 terests of efficient administration and the public health movement and that 
 the salaries fixed for the responsible officers of the Bureau be such as to 
 enable the Department to secure vi^ell trained men for the positions. 
 
 3. That the work of the re-organized Bureau be undertaken on a com- 
 prehensive scale and in accordance with modern scientific methods. 
 
 4. That all the statistical work of the Department be done under the 
 direction of the Bureau of Records to secure accuracy and uniformity of 
 method, and that the records be promptly available. 
 
 5. That the reports of the Bureau of Records be published independ- 
 ently of the annual report of the Department of Health and be ready for 
 distribution early every year. 
 
 6. That the city undertake a local population census every ten years, 
 beginning in 1915, and that the 40 acre tract unit of the last federal census 
 be made the basis for tabulation. 
 
 7. That the medical colleges instruct their students in the methods and 
 principles of medical and vital statistics. 
 
 8. That the medical press give more analysis to public health reports 
 
 34 
 
and vital statistics and impress the profession with the importance of exact 
 vital statistics, urging them to co-operate vi^ith the Bureau of Records in 
 making prompt, careful reports. 
 
 9. That the Department of Health make greater efforts to issue prompt- 
 ly its annual, monthly and weekly reports. 
 
 ID. That the weekly report be changed from a purely statistical sheet 
 to an educational pamphlet intended primarily for the general public, and 
 that arrangements be made with the newspapers of the city for periodic 
 reproduction of the essential parts of the report. 
 
 II. That more and better means of contact between the Department 
 of Health and the public be established in the interest of efficient adminis- 
 tration and of the public health movement, and that the public regularly 
 receive information regarding the Department's most vital functions — food 
 and milk inspection, prevention of disease and care of babies and school 
 children. 
 
 MORBIDITY STATISTICS. 
 
 The need of morbidity statistics outside of contagious diseases 
 has been recognized by the Committee and the plan of Dr. Charles 
 F. Bolduan of the New York City Department of Health, pub- 
 lished as a special bulletin of the Department has been carefully 
 studied by the Committee and endorsed. Some method of hospital 
 registration of morbidity seems to be necessary and highly desir- 
 able, as studies made in various places by Dr. Frederick L. Hoff- 
 mann and others have demonstrated. 
 
 NEW YORK STATE CENSUS, 1915. 
 
 In response to a request from a conference called to consider 
 the matter of the State Census to be taken in the year 191 5, the 
 Committee took up the matter carefully and recommended that 
 the Legislature appropriate sufficient funds to enable the State au- 
 thorities to undertake a census, which would add materially to our 
 knowledge of social, economic and public health conditions of the 
 State, and that the work of taking the Census be entrusted to the 
 police departments in large cities and be carried out throughout the 
 State with the co-operation of the State Department of Labor and 
 the State Department of Health which is charged with the duty of 
 collecting and publishing the vital statistics of the State. 
 
 35 
 
REPORT ON THE NEW YORK STATE CENSUS. 1915 
 
 I. Historical : 
 
 The constitution of the State of New York, as adopted November 3, 
 1846, provides that a census be taken everj' ten years, for the purpose of 
 ascertaining the increase and distribution of the population, to serve as a 
 basis for assembly and senate districts. Usually, in addition to the essential 
 facts called for in a census — namel}-, the number of inhabitants by counties 
 and their subdivisions, by sex and citizenship, censuses contain additional 
 information of social value. Thus, the New York State censuses for 1855, 
 1865 and 1875 contained additional information as to sex, marriages, deaths, 
 dwellings, agriculture, manufactures, public debt, churches, school houses, 
 the blind, deaf and dumb, occupations, and other information. In 1885 no 
 census was taken. It was ordered, however, in 1892. The next census 
 was taken in 1905 and it was a mere enumeration of the population by 
 counties, cities, towns and election districts of citizens and aliens and also 
 an enumeration of Indians, and a count of inmates in institutions. 
 
 II. Facts to be Ascertaixed by the Census : 
 
 A State census is important for many other than political reasons. 
 When taken five years after the Federal Census it gives an accurate count 
 of the population at a time when estimates become unreliable. In a dynamic 
 community with considerable internal and foreign migrations, neither the 
 arithmetical nor the geometrical method of estimating the population for a 
 period of ten years, is satisfactory. The death rates, morbidity rates and 
 marriage rates, based on untrustworthy estimates of population, are not 
 only valueless but misleading. 
 
 To enhance the value of a State census such facts as have a bearing on 
 the social and economic status of the population, and may be helpful in 
 determining social politics, should be ascertained. 
 
 The fundamental questions in such a census should, in addition to county 
 distribution and citizenship of the population, deal with such factors as : 
 I. Sex. 
 
 Color. 
 
 Age. 
 
 Nativity. 
 
 Marital condition. 
 
 Occupation. 
 
 Fecundity of marriage with reference to the nativity of both parents. 
 
 Sickness in the family during the year previous to the taking of the 
 
 census. 
 
 Unemployment during the year preceding the census, due 
 
 (a) to sickness. 
 
 (b) to other condition. 
 
 The census should also ascertain the number of persons living in insti- 
 tutions throughout the State. 
 
 36 
 
III. By Whom Should the Census be Taken : 
 
 The State Law provides that the census should be taken under the 
 direction of the Secretary of State. The experience of the Federal and 
 State authorities demonstrates the inadvisability and costliness of employing 
 casual census enumerators. Many of the enumerators have proven to be 
 incapable and dishonest in carrying out their duties. Moreover, the control 
 of their work is very difficult and costly. It would be much more satisfactory 
 if the police forces of the large cities of the State could undertake the task 
 of census taking in their respective cities. In the smaller towns or in rural 
 sections, the task should be entrusted to letter-carriers if the consent of the 
 Federal Government could be obtained. The work should be carried out 
 under the direction of a Board appointed by the Secretary of State and 
 should include representatives of the State Department of Health and the 
 State Department of Labor. The co-operation of the State Department of 
 Health is especially desirable as this Department is charged with the duty 
 of keeping the Vital Statistics of the State. Moreover, the direct contact 
 with the people all over the State, which the taking of the Census would 
 afford, would give the Department of Health direct knowledge of conditions 
 responsible for the public health in the State. 
 
 IV. Recommendations: 
 
 In view of the facts presented, it would be helpful and advantageous 
 if the Academy of Medicine would urge upon the State Legislature that suf- 
 ficient funds be appropriated to enable the State authorities to undertake 
 a census which should add to our knowledge of the social, economic and 
 public health conditions of the State. (2) That the Census contain questions 
 bearing on the age, sex, color and nativity distribution of the population, as 
 well as on the marital state, fecundity, morbidity and extent of non-employ- 
 ment within the State. (3) That the work of taking the Census be entrusted 
 to the police departments in large cities, and be carried out with the co- 
 operation of the State Department of Health and the State Department of 
 Labor. 
 
 37 
 
V 
 
 IMPROVLMLNT OF LIVING AND WORKING 
 CONDITIONS 
 
 OCCUPATIONAL DISEASES. 
 
 Recognizing the importance of prevention of the so-called Oc- 
 cupational Diseases, the Committee has co-operated with the Spe- 
 cial Committee of the American Association of Labor Legislation 
 in drafting Legislation aimed at the registration and prevention of 
 Industrial Diseases. To stimulate the general interest in the mat- 
 ter among the profession and the public at large the Committee 
 arranged a meeting at the Academy of Medicine, which was held 
 on January 4, 1912, and which was devoted to the consideration 
 of the problem. 
 
 At that meeting Dr. W. Oilman Thompson spoke on the im- 
 portance and prevalence of Occupational Diseases ; Dr. Leonard W. 
 Hatch, Statistician of the New York State Department of Labor 
 read a paper on the "State Control of Occupational Diseases;" 
 Dr. George T. Elliot discussed "Occupational Skin Diseases ;" Dr. 
 M. Allen Starr, "Occupational Neuroses." 
 
 The Committee endorsed the establishment of the Division of 
 Industrial Hygiene in the Bureau of Preventable Diseases of the 
 Department of Health and followed with interest the development 
 of the work of the Division. It has also kept in touch with the 
 useful activities along similar lines that have been carried on by 
 the American Museum of Safety and their plans of extension. 
 
CHRONIC CARDIO-VASCULAR DISEASES. 
 
 The apparent increase in the rate of mortality of persons in 
 the age group from 45 to 55 has been investigated by the Com- 
 mittee and a recommendation made to the Commissioner of Health 
 to the effect that an active campaign 'on the part of the Depart- 
 ment of Health be undertaken toward the instruction of the public 
 in matters of personal hygiene by means of tracts, pamphlets, lec- 
 tures and the like, as it was the belief of the Committee that such 
 a campaign would have a definite influence in securing a diminution 
 in morbidity and mortality from cardio-renal and the vascular dis- 
 eases at the age periods of greatest economic efSciency. 
 
 PERIODIC PHYSICAL EXAMINATION OF CITY 
 EMPLOYEES. 
 
 The attention of the Committee to this matter was first called 
 by the statement that a great deal of tuberculosis is prevalent 
 among school teachers, and led the Committee to make inquiries of 
 the Board of Education as to whether or not provision is being 
 made for the periodic physical examination of school teachers. It 
 was the Committee's belief that such examinations are particularly 
 indicated in the case of teachers who come into contact with 
 children at the ages in which they are most susceptible to the con- 
 tracting of disease. The inquiry revealed the fact that no provision 
 has been made for such systematic examinations. The Committee 
 urged that examinations of a standard form be introduced in the 
 schools and has recommended to the Committee on the Prevention 
 of Tuberculosis of the Charity Organization Society that the matter 
 receive careful attention on their part and that some form of co- 
 operation with the Department of Education be established. 
 
 The Committee believes that the principle of periodic physical 
 examination should be extended to all City employees, and the 
 suggestion made to the Health Department that this be first intro- 
 duced in the Department charged with the control of the City's 
 health has been favorably acted upon and such examinations are 
 now being regularly made. Since that time two other City De- 
 partments have followed suit. 
 
 39 
 
In co-operation with the Health Department and other medical 
 agencies on which this Committee was represented, a uniform ex- 
 amination card was devised. The card and the introductory notes 
 in connection with it are given herewith. 
 
 Explanatory Notes to Accompany Medical Examination Card 
 
 The Doctor is asked to read the explanatory notes which go 
 with the Medical Examination Card in order that some uniformity 
 of answers may prevail. 
 
 The sub-headings listed below suggest the minimum amount 
 of information that should be given regarding each individual ex- 
 amined. Anything of significance not included in the sub-head- 
 ings, should, of course, be stated. 
 
 These notes have been contracted as much as possible so that 
 a Doctor may be able to perform an examination in from 20 to 30 
 minutes. 
 
 Use the plus sign ( + ) up to four plusses to indicate much or 
 little, as : "Tonsils hypertrophied + +." 
 
 Where there is nothing of importance to be recorded use the 
 word "negative." 
 
 40 
 
S31T3a 
 
 
 
 > ^ .a 
 
 ^5 
 
 o e 
 Hal 
 
 
 >* <; > 
 
 
 
 ;-i 111 
 
 W 3 
 
 ^ O 
 
 w a 
 
 •• -M CO 
 
 ffi < O 
 
 Xjo^sxh 
 
 ^UaS3J(£ 
 
 hJ 
 
 <Li "—I 
 
 
 •3 p=J 
 
 CS 
 
 > 
 
 be tuo 
 
 W 
 
 
 14 ^3 
 
 w 
 
 ^ s 
 
 ."TJ 'S ^3 
 
 ccQ 
 
 oj (u o 
 
 O < h^ 
 
 P.p^ 
 ^ -i-i 
 
 
 CO 
 
 O »J 
 
 i(ao:^stH I'BOipaH 
 
 O 
 
 'cd T3 
 
 c o 
 
 o o 
 
 (X, fL, 
 
 B E 
 
 ■ioqBi 
 
 
 41 
 
HOUSING PROBLEMS. 
 
 The matter of housing conditions of the congested sections of 
 the City received a great deal of attention on the part of the Com- 
 mittee. Numerous conferences were held on the subject and the 
 advantages and disadvantages of the so-called "Open Stair Tene- 
 ments" built by the Tenement Economies Society were carefully 
 investigated and various legislative proposals discussed. 
 
 The proposal of the Tenement Economies Society to create a 
 Board of Appeals from the decisions of the Tenement House De- 
 partment was deemed inadvisable and contrary to the proposal of 
 fixing responsibility in the administrative branches of the Govern- 
 ment. The Committee was not certain whether the other proposal 
 of the Tenement Economies Society, aiming at the reduction of 
 the legal minimum width of tenement house rooms from 7 to 6 
 feet was a rational measure. 
 
 The whole problem of housing is so interrelated with various 
 economic and social problems that the purely public health aspect 
 of it cannot be separated from the other considerations. For that 
 reason the Committee did not feel justified in endorsing the Marsh 
 Bills, which were introduced at the last session of the Legislature, 
 and which aimed at the abolition of certain types of cellar dwellings. 
 
 The Committee, protested however, against the recent attempt 
 to amend by ordinance of the Board of Aldermen the recently en- 
 acted Building Code of the City so as to permit the reduction of the 
 required four feet width of side yards to three feet. 
 
 STREET CLEANING. 
 
 The neglect of the streets and pavements of the City on ac- 
 count of imperfect and antiquated methods of cleaning and build- 
 ing, and also because of the numerous building and excavating 
 operations led the Committee to present a statement of the condi- 
 tions observed to the City Department on Street Cleaning, with the 
 request that steps be taken to improve the existing conditions in the 
 interests of health, welfare, and decency. The report of the Com- 
 mittee led to a series of conferences on the subject with the repre- 
 
 42 
 
sentatives of the City Government, such as the Street Cleaning 
 Department, the Police Department, the Health Department, the 
 Department of Water Supply, and the presidents of the various 
 boroughs of the City who have jurisdiction over the paving of the 
 streets. 
 
 At these conferences the various matters entering into the 
 situation were thoroughly discussed and a policy of procedure 
 agreed upon. The Committee strongly urged the appropriation of 
 money for the model districts in order to test out the efficiency of 
 the various mechanical street cleaning contrivances in the market. 
 
 The Committee also urged the covering of garbage and ash 
 carts during the collection of refuse and during the process of 
 carting it through the streets of the City. 
 
 It was also urged that the Police Department co-operate in 
 enforcing City ordinances concerning the covering of ash and gar- 
 bage cans and the cleaning of sidewalks. 
 
 The Health Department was urged not to issue permits to 
 private ash-cart men who would employ in their work uncovered 
 carts. The Committee feels that its efforts in this direction have 
 been partially successful as the conditions of the streets have some- 
 what improved. No important improvements, however, can be 
 made until the public takes more interest in the appearance of the 
 streets and refrains from littering them with paper, fruit peels, 
 and other kinds of refuse. 
 
 The Committee has endorsed the organization of the Anti- 
 Litter League whose aim it is to educate the people in taking pride 
 in the clean appearance of the City streets. 
 
 The Committee has published in the Nezv York Medical Record 
 of December i8, 1915, a report on the pathogenicity of street dust, 
 which is a summary of the existing literature on the subject. A 
 concensus of scientific opinion on the matter based on tests shows 
 that the City dust contains very large quantities of pathogenic bac- 
 teria which may be responsible for a large amount of illness of the 
 respiratory tract. 
 
 43 
 
Report on Street Cleaning by the Public Health, Hospital 
 AND Budget Committee. 
 
 The Committee find that the streets of Greater New York, 
 with few exceptions, are, and have been much neglected. This is 
 due not only to imperfect and antiquated methods of cleaning 
 streets, but to the imperfect state of the pavements, to the numerous 
 building and excavating operations, and to the general indifference 
 of the public who seem to regard the street as the proper place 
 for the dumping of litter and refuse. H the conditions are to be 
 improved, the Committee feels that it is necessary to secure the 
 active co-operation of the Street Cleaning Department, of the Police 
 Department for the enforcement of ordinances, of the Department 
 of Health, of the Department of Water Supply, Gas and Electricity, 
 which controls the issuing of permits for the opening of streets 
 and of the Presidents of the various Boroughs who have jurisdic- 
 tion over the paving of the streets, and also to arouse public senti- 
 ment to a conviction that clean streets are essential to health and 
 welfare. 
 
 Street Cleaning Methods 
 
 We protest against the present antiquated, expensive and 
 Tunsatis factory methods of street cleaning as practised in this City. 
 Dirt and refuse are often collected only to be scattered again. 
 Dustless sweeping should be enforced. We urge liberal flushing 
 with water and a more general use of machine sweepers. The 
 Board of Estimate and Apportionment should be induced to pro- 
 vide proper facilities and sufficient equipment including horse- 
 drawn or motor sweepers and squeegees, such as are in use in 
 London, Berlin, Paris, Washington, St. Louis and many other cities. 
 
 We maintain that the streets should be sprinkled before sweep- 
 ing, if the thermometer register 38 degrees F. or above, the tem- 
 perature approved by the experience of other cities, and also that 
 the sweeping be done vigorously. 
 
 We urge the amendment of Section 39 of the Sanitary Code 
 of the Department of Health so as to permit of flushing the streets 
 before sweeping. H necessary, sewers should be screened to avoid 
 blocking. 
 
 44 
 
Instruction of Sweepers 
 
 Manual sweeping is essential, but as done at present is ex- 
 tremely unsatisfactory. The street-cleaning force should be im- 
 proved and increased, and definite sweeping methods established 
 and taught. 
 
 The Collection of Sweepings 
 
 We protest against leaving the gathered sweepings in heaps in 
 the streets, and against the prevailing neglect in gathering up gross 
 refuse matter, and we urge that covered receptacles be supplied 
 for sweepings and that these be kept covered while awaiting the 
 arrival of carts. 
 
 Covered Ash and Garbage Cans 
 
 The . open ash and the carelessly covered garbage cans and 
 barrels are a disgrace to the city and a menace to public health. 
 In the warm months open garbage cans attract and support the 
 housefly in great numbers and facilitate the dissemination of dis- 
 ease. The Police and Health Departments should enforce existing 
 ordinances regarding the use of covered garbage cans. 
 
 Covered Carts 
 
 The uncovered cart for the removal of ashes, garbage and 
 rubbish is a public nuisance. We urge that this matter, which has 
 been referred to in reports of the Street-Cleaning Department and 
 considered by the present Commissioner, be settled by the adoption 
 of a suitable and practical covered cart. 
 
 The private ash-cart men are the worst offenders and yet they 
 carry prominently on the sides of the wagon a permit from the 
 Board of Health. We suggest that the Board of Health refuse a 
 permit unless the cart be covered, and the private cart-men con- 
 tract to collect and remove ashes and garbage, only during the 
 night or early morning hours. 
 
 We recommend the compulsory use of some standard ash can 
 and the introduction of well-known modern methods for the final 
 disposal of ashes and garbage. The City should erect a sufficient 
 number of modern incinerators. 
 
 45 
 
Snow Removal 
 
 The slow removal of snow has been in the past extremely un- 
 satisfactory and insanitary. We urge that the Street-Cleaning De- 
 partment make such provision that with every fall of snow its 
 removal may be begun immediately. 
 
 Street Encumbrances 
 
 We protest against the unlawful blocking of streets by build- 
 ing material and the frequent and uncontrolled destruction and ob- 
 struction of the highways by the public service corporations. 
 
 Co-operation of City Departments 
 
 We urge that the other city departments co-operate with the 
 Street Cleaning Department in a general movement for out-door 
 cleanliness. Filth, dust, and dirt on the streets, especially near the 
 markets and in the crowded quarters of the City where food-stufifs 
 are long exposed on the streets, call for the intervention of the 
 Health Department. 
 
 The Presidents of the several Boroughs should be urged to 
 co-operate by continuing and increasing their efforts to provide 
 better pavements and prompt repair of any defects. 
 
 Control of Streets 
 
 We urge a concentration of authority over the highways under 
 one head. This change should be incorporated in a revision of 
 the Charter — Sanitary cleanlifiess and efificiency involve the single 
 control of pavements, streets excavations and encumbrances, the 
 cleaning of streets as well as the gathering and disposal of refuse. 
 
 TEACHER MOTHERS. 
 
 At the request of the Department of Education the Committee 
 prepared a report on the Teacher-Mother problem in relation to 
 health, of which the following is a summary: 
 
 I. No woman should be permitted to teach after the sixth month 
 of her pregnancy. 
 
 46 
 
2. The ability of a woman to teach during this time is an indi- 
 vidual question, each case to be determined by its own merits. 
 
 3. The average time of the return to school after confinement is 
 not to be less than three months. 
 
 4. While a healthy child may interfere very little with a teacher's 
 work, the care of a delicate child at home may totally unfit 
 her for her duties at school. 
 
 The attached report was submitted to the Board of Education 
 and also to the Commissioner of Education of the State of New 
 York for information and guidance. 
 
 The question of teacher-mothers is an important one and the decision 
 of New York is certain to be influential throughout the whole country in 
 forming opinion on this matter. The subject should therefore be considered 
 on the broad plan of the welfare of the entire community. 
 
 The inquiries made by the Board of Education are not simple but 
 involve a consideration of a complex question which must be taken up from 
 at least three points of view which are quite distinct from one another, 
 viz: I. that of the school pupils; 2. the teacher-mother; 3. her child. 
 
 The Pupils — On the ground of appearance alone, quite apart from every 
 other consideration, it is undesirable to retain a woman in her capacity as 
 teacher after she has passed the sixth month of her pregnancy. 
 
 Another and more important question relates to the efficiency of a 
 woman as a teacher during the debated period. While pregnancy is a 
 physiological process, most women of the class from which teachers are 
 drawn, even under the most favorable condition, exhibit some impairment 
 of nervous and physical efficiency which would influence their work as 
 teachers. 
 
 The Mother — If a married woman be retained as a teacher we believe 
 that no Board has the right to bar her from maternity. A consequence 
 of such a policy is to encourage criminal abortion. The ability of a woman 
 to perform during pregnancy her duties as a teacher is an individual ques- 
 tion. No absolute rule can be laid down. It is the view of the committee 
 that many women are incapable of giving satisfactory instruction during 
 this period; others may be able to do their work in a satisfactory manner 
 for the first six months. 
 
 After confinement the usual time of return to her full school duties 
 should be placed at three months. Under exceptional conditions, however, 
 as when the woman is the only wage earner in the family, this time might 
 be shortened to six weeks, but should never be less, for the sake both of 
 the mother herself and her work. 
 
 The Child — The infant also has rights in this discussion which cannot 
 
 47 
 
be ignored. We do not believe that the regular routine work of the teacher- 
 mother during pregnancy has any prejudicial effect upon the child. 
 
 The health of the child after it is born has much to do with the 
 capacity of the mother to do her work properly. The time after confine- 
 ment when she resumes her work has an important bearing upon the 
 child's welfare. This has been placed at three months with the conviction 
 that every mother who can should nurse her baby for this period. If this 
 is done, part nursing can usually be continued for a considerably longer 
 period, bottle feedings being substituted while the mother is in school. 
 Such a plan is entirely feasible and if well carried out will go far to secure 
 to the mother a strong, healthy infant. On the other hand, the absence of all 
 maternal nursing, or the early resort to bottle feeding, greatly increases 
 the chances of a child's being delicate or sickly. The care of such an 
 infant, the inevitable loss of sleep which it entails, will of itself, go far to 
 render the mother unfit for the proper performance of her school duties. 
 
 PURE FOOD AND PROPER NUTRITION. 
 
 The problem of pure food and proper nutrition has received 
 a great deal of thought and investigation on the part of the Com- 
 mittee. In 1913 Commissioner Lederle requested the Committee 
 to investigate the food inspection work of the Department of 
 Health. In view of the lack of a staff of investigators, the Com- 
 mittee asked the co-operation of the Bureau of Municipal Research 
 and worked out a detailed schedule of investigation. 
 
 The Committee obtained expert information with reference to 
 the physiological effects of non-nutritious substances in foods con- 
 nected with or arising from methods of preservation. The Com- 
 mittee pointed out the need of standardizing preserved foods and 
 indicating their nutritive value. The Committee also pointed out 
 the need of educating the public with reference to the caloric value 
 of foods and the utilization of certain foods which are very in- 
 expensive and yet contain a great deal of nutritive value. 
 
 On March 19, 1914, a conference was held at the Academy of 
 Medicine on the cost of clean and wholesome food, at which mat- 
 ters such as the relation of storage to cost of food, the responsi- 
 bility of the consumer and food cost, the sanitation of bakeries and 
 other food factories and stores were discussed. 
 
 A public meeting was held under the auspices of the Com- 
 mittee at which the "Nutritive Significance of Food" and "Food 
 
 48 
 
from the Energy Standpoint" were discussed by Dr. Lafayette B. 
 Mendel and Dr. Graham Lusk. The two papers were reprinted by 
 the Committee for distribution. 
 
 CERTIFIED MILK. 
 
 In view of the misconception of the medical valuation of certi- 
 fied milk as evidenced in some statements of the public press, the 
 Committee has prepared a statement recording its estimate of certi- 
 fied milk. The following is the report which in part was published 
 in the Survey of May 15, 191 5. 
 
 The Public Health Committee of the New York Academy of Medicine 
 has noted recent statements in the public press which seem to imply a mis- 
 conception of the medical valuation of certified milk, and would therefore, 
 record what it believes to be the real medical estimate. 
 
 Dangers of Ordinary Milk. Milk, as ordinarily handled, is a food 
 exposed in a very notable degree to the dangers of dirt in the various stages 
 of its collection and transference to the consumer. The dirt is always 
 objectionable for reasons of decency, and may be positively dangerous 
 because it contains the micro-organism of one or another infectious disease. 
 Until within a few years the only control exercised over this food was the 
 business desire of the producer to deliver to the consumer a product which 
 should not be obviously objectionable, and therefore unsalable. Attempts 
 at cleanliness in production and in transference of the product to the con- 
 sumer have been made with greater and greater diligence during the past 
 few years. These attempts have been inspired partly by business ambition, 
 and partly by the insistence of physicians and the public at large, upon a 
 greater degree of safety in this food so generally and often exclusively used 
 by infants and invalids, that is, by those in the condition most susceptible to 
 infection. 
 
 Origin of Certification. Various milk commissions, made up of prac- 
 ticing physicians, have formulated standards with which milk should comply, 
 and have rewarded the supposed attainment of these standards by permis- 
 sion, now legalized in many places, to brand the milk as "certified" by this 
 or that commission. These standards are not uniform although they have 
 been, it is believed, invariably an advance on previously existing standards. 
 The product naturally varies to some extent with the standard, and medical 
 men generally have not at any time insisted that the brand "certified" makes 
 it certain that the milk so branded is without the possibility of danger. 
 
 Maintenance of Standards of Certification. The standards adopted 
 by the various commissions have related to the methods of ordinary clean- 
 
 49 
 
liness, to the production of milk from animals free from disease, and to the 
 transference of the milk under such conditions that it may remain free from 
 contact with disease-bearing persons or utensils, and from any risk of 
 deterioration. Compliance with the standards can be determined only by 
 the imperfect means of intermittent inspection, and it cannot be stated too 
 strongly that the advantage of certification is an attainment of a relative 
 degree of safety and not of absolute safety. The degree of safety depends 
 on the care exercised by those responsible for the production and trans- 
 portation of the milk, and on the character and amount of inspection. Abso- 
 lute safety can not be obtained by any known means. Even sterilization 
 does not insure it. Milk which, by reason of the presence of dirt, has 
 undergone bacterial changes, cannot be made absolutely safe by any process 
 of pasteurization or sterilization, for, although these processes kill the 
 disease-producing germs, they do not destroy the poisons produced in the 
 milk by the bacteria before they were killed. It is the present medical 
 belief that a combination of pasteurization with inspection, such as is 
 required in certified milk production, presents the highest degree of safety 
 for milk now attainable. 
 
 Use of Raw Milk. It is, however, also believed that certain infants are 
 nourished more successfully on milk which has not undergone pasteurization, 
 and that it is therefore desirable that milk should be provided in as clean 
 a condition as possible, and accordingly as fit as possible for use without 
 pasteurization. Such milk can be obtained only from reputable contractors 
 and through faithful, frequent, and intelligent inspection, and is invariably 
 expensive as compared with milk not so guarded. 
 
 Certified Milk in New York City. In New York City "certified" 
 milk means usually milk "certified by the Milk Commission of the Medical 
 Society of the County of New York" which is a Commission composed 
 of physicians appointed by the President of the County Medical Society. 
 The standards set by this Commission relate especially to cleanliness of the 
 milk which can be judged approximately by the bacterial content, at present 
 determined weekly, the amount of fat in the milk, which is tested by 
 chemical analysis, the absence of tuberculosis and disease of the udder in 
 the cows producing the milk, and the absence of disease in those who handle 
 the cows and the milk. The control of cleanliness is exercised chiefly by 
 inspection made by paid experts at regular intervals, averaging once in 
 three weeks. 
 
 Detection of Tuberculosis in Cattle. The presence of tuberculosis 
 in cattle is now investigated by injecting the animals in a prescribed manner 
 with tuberculin and then taking the temperature of the animals at regular 
 intervals for a prescribed period to determine whether fever does or does 
 not develop as a result of the injection. A characteristic fever is regarded 
 as indicative of tuberculosis. This test, now in use for many years, has 
 been modified considerably since its introduction, and may be modified yet 
 
 50 
 
further, or some other test may come to be regarded as more convenient 
 or reliable. The length of time during which the temperature should be 
 repeatedly taken is one of the still uncertain factors of the test, but the 
 former medical belief that eighteen hours is a sufficient period has yielded, 
 as a result of observation, to the present demand for twenty-four hours. 
 Observation too has shown a need not formerly recognized for a more fre- 
 quent tuberculin test, but those most experienced differ in their recommenda- 
 tions as to the proper interval between tests. The present practice follows 
 the medical recommendation that a test shall be administered to every animal 
 within one month previous to admission to a dairy herd, and that thereafter 
 a test shall be made annually, and if reactors are found in a herd, shall be 
 repeated in six months. Excellent authorities, however, believe that a 
 test every six months should be the routine practice. These examinations 
 provide a great safeguard against tuberculosis, but as they depend on the 
 honesty of agents, they are not infallible. A single performance of the 
 tuberculin test puts the animal for a time in such a condition that it may 
 not, after a second injection, even if tuberculous, develop a characteristic 
 fever. The duration of the period during which a second test is unreliable 
 is at present uncertain. It is, however, clear that repetition of this test 
 after too short an interval may not show an existing infection and may 
 therefore give a false sense of security. 
 
 Typhoid fever, scarlet fever and diphtheria have occasionally been com- 
 municated (though as far as known not in New York City) by certified milk, 
 which has been exposed after bottling to persons suffering from these 
 diseases, and infectious sore throat has been communicated through milk 
 from cows suffering from an infection of the udder. Inspection cannot en- 
 tirely remove these possibilities, but precautions exercised by conscientious 
 contractors may reduce them to a minimum. The milk rated by the New 
 York City Health Department as "Grade A Raw" differs from "certified" 
 milk chiefly in being less controlled by inspections. 
 
 The Medical Estimate of Certified Milk. The present medical belief 
 is that certified milk is the safest raw milk to be obtained, but that the safety 
 of such milk depends upon the standards of certification, the amount and 
 character of the inspection, and the precautions adopted to exclude diseased 
 animals and to protect the milk from contamination by diseased human 
 beings and from deterioration in transit. Finally, it is believed that pas- 
 teurization of certified milk provides an additional safeguard. It is under- 
 stood that the maintenance of precautions against these dangers is the 
 special function of the milk commissions. 
 
 TURBIDITY OF THE CROTON WATER. 
 
 When during the summer of 19 12 the Croton water supply 
 became turbid, the Committee inquired into the cause of it and 
 ascertained that the discoloration of the water was due to the fact 
 
 51 
 
that on the Croton water shed there were large areas in which the 
 soil has been broken up and pulverized with fine silt of top soil 
 by cultivation. This fine material is carried by the water when 
 the reservoirs are low, and this accounted for the turbidity of the 
 water supply in the summer of 1912. 
 
 The Committee also ascertained that the water had been an- 
 alyzed daily, treated with the hypochlorid of lime and was free 
 from pathogenic organisms. 
 
 SEWAGE DISPOSAL INTO MOHANSIC LAKE. 
 
 At the request of the City Commissioner of the Department 
 of Water Supply, Gas and Electricity, the Committee gave care- 
 ful consideration to the matter of discharging sewage from the two 
 recently built institutions (State Hospital for the Insane and the 
 Yorktown Training School for Boys) into Mohansic Lake. After 
 carefully weighing the arguments for and against such a procedure, 
 the Committee took the stand that inasmuch as doubt exists as 
 to the certainty of rendering sewage effluent harmless, it would be 
 unwise to add a possible source of pollution to the Croton Water 
 Supply and recommended the alternative of draining the sewage 
 into the Hudson River which, according to the estimates of the 
 Department of Water Supply, Gas and Electricity, could be done 
 at a cost of $120,000. The Committee felt that such a relatively 
 small expenditure of money should not stand in the way of an 
 absolutely safe method of sewage disposal. 
 
 SANITARY ASPECTS OF THE SUBWAY. 
 
 In 1913 when the plans for the new subways had been con- 
 sidered, the Committee called to the attention of the Public Service 
 Commission, the Department of Health, the Board of Estimate 
 and Apportionment, and the members of private public health 
 agencies of the City to the need of so planning the projected sub- 
 ways as to provide for adequate ventilating and cleaning facilities, 
 for a reduction of the noise in the subways and for the construction 
 
 52 
 
of sanitary comfort stations, arranged in such a way that they 
 may be available for the use of the patrons of the subway and for 
 others as well. 
 
 STREET ACCIDENTS. 
 
 Very little attention has been paid by those interested in pub- 
 lic health to the matter of street accidents and no attempts on their 
 part have been made to find out accurately the extent of this 
 source of mortality and injury of the population of the City, al- 
 though the deaths from street accidents exceed those from typhoid 
 fever. To stimulate interest in this important matter the Commit- 
 tee has made a study of the available statistics of street accidents 
 occurring in the City of New York. It was found that during the 
 year 191 5 the total number of accidents was 22,540 of which 659 
 were fatal. The report prepared gives an analysis of the statistics 
 by ages, by sexes and by the months in which the accidents oc- 
 curred. It also gives the chief causes of the accidents caused by 
 special types of vehicles, such as ambulances, fire engines, mail 
 wagons, busses, etc. Although the total number of accidents caused 
 by these vehicles is, in the opinion of the Police Department, too 
 small to warrant separate headings, at the request of the Com- 
 mittee such statistics were obtained for the month of February of 
 this year and an analysis showed that out of the total of 1,407 
 highway accidents, only two were caused by ambulances, one by 
 fire engines, three by busses and five by mail wagons. 
 
 The Committee recommended to the Department that in view 
 of certain misapprehensions existing, it would be desirable to ana- 
 lyze the statistics in greater detail than has been done hitherto, and 
 also to give more newspaper publicity to the whole question of 
 street accidents as a step toward the prevention of street accidents 
 through the education of the public. 
 
 HEALTH INSURANCE. 
 
 The matter of social health insurance has received thorough 
 consideration on the part of the Committee. Recommendations 
 were made to the Special Committee of the American Association 
 
 53 
 
for Labor Legislation at whose invitation the Committee interested 
 itself in the matter. The Recommendations were: 
 
 1. Provision should be made for periodic medical examination of all 
 persons insured under the Act. If this be impossible of introduction at 
 the outset, provision should be made to compensate those who voluntarily 
 submit to examinations, either by a reduction in their premiums or an 
 increase in their benefits. 
 
 2. Medical, surgical and nursing aid should be afforded to the wives 
 and children of insured persons. The inclusion of dependent wives and 
 children as beneficiaries under the Health Insurance Act would advance 
 materially public health, as many infectious diseases would early be dis- 
 covered and reported, and early home quarantine enforced. 
 
 3. Close co-operation with the State and Local health authorities should 
 be established, for example by making the State Commissioner of Health 
 a member of the State Insurance Board and the sanitary supervisors mem- 
 bers of district insurance committees ; also. Health Officers of the cities and 
 towns might be members of the local supervising insurance authorities. 
 
 4. Utilization of existing dispensaries for the administration of medical 
 benefits in cities well provided with institutions of this type should be 
 encouraged. Arrangements made by insurance carriers with dispensaries 
 for the care of the insured in certain sections would enable the dispensaries 
 to increase their efficiency and would provide controlled medical service. 
 Ambulatory cases would be treated at the dispensaries, and other cases could 
 be cared for in their homes by visiting physicians and nurses under proper 
 control. Both physicians and nurses would be compensated at a rate uni- 
 form to all dispensaries, out of the proceeds received by the institutions 
 from the insurance carriers. The equipment of the dispensaries would make 
 possible proper care of patients requiring special therapeutic facilities and 
 apparatus. Through this means the patients would also be able to obtain 
 services of specialists in various branches of medicine without increased cost 
 to themselves and to the insurance carriers. Such a scheme would also be 
 beneficial to the advancement of medical science through carefully super- 
 vised work and through the keeping of exact records. 
 
 5. Where physicians practice under the Act outside of dispensaries 
 and in localities where no dispensaries exist, arrangements for medical and 
 surgical care should be made through the State medical society or the vari- 
 ous county medical societies who would assume responsibility over the 
 medical work performed by the physicians. Payment by the insurance 
 carriers should be made through such State or county societies to the in- 
 dividual physicians in accordance with the services rendered. Such arrange- 
 ment would also provide for adequate medical control in the prevention of 
 malingering, which has been universally recognized as a serious deterrent 
 to efficient health insurance administration. 
 
 6. The administrative scheme adopted for carrying out the medical 
 provisions of the Act should prevent the drafting into the service of 
 
 54 
 
graduates of less than three years' standing unless they have had at least 
 one year of hospital service. 
 
 Care should also be taken that the provisions of this Act do not tend 
 to keep at home patients who need hospital treatment. 
 
 Administrative arrangements should be of such a nature as to compen- 
 sate through the management of the hospitals the physicians attending 
 insured persons in institutions. 
 
 7- The effect of the legislation advised should be such as not to lower 
 the present economic status of the medical profession. 
 
 It is very probable that certain objections will be raised to these recom- 
 mendations. The Committee have considered this and still feel that such 
 objections are overbalanced by the arguments in favor of the recom- 
 mendations. 
 
 55 
 
VI 
 
 MLDICAL, PUBLIC HEALTH, DENTAL AND 
 NUR5ING EDUCATION 
 
 PUBLIC HEALTH INSTRUCTION IN MEDICAL SCHOOLS. 
 
 In the course of the Committee's various activities and studies 
 it has been apparent that however good the intentions of the City 
 and State and however willing the body of private citizens which 
 undertakes public health activities, their efforts prove unneces- 
 sarily expensive, and in certain instances futile, because of the lack 
 of trained experts, sanitarians, public health physicians and social 
 workers to carry out the admirable and altogether possible plans 
 which they wish to put into force. The supply of such experts, 
 as we find a dearth of and a need of, can come only from among 
 the graduates in medicine or sanitary engineering, who are trained 
 especially by post-graduate courses in existing universities and 
 medical schools in this country. 
 
 The Committee made a review of the courses offered in the 
 various universities leading to a degree of doctor or master of 
 public health. The courses were found to be excellent but not 
 sufficiently inclusive. Subjects such as the principles of organiza- 
 tion and administration of public health departments, efficiency 
 methods and practices, applied sociology and social legislation, the 
 technicalities of budget making, and the preparation of statistics 
 and reports, are not included in the curricula of the schools. 
 
 In view of this the Committee worked out a plan of study 
 which would meet the manifold requirements, and submitted it to 
 the Council on Medical Education of the American Medical Asso- 
 ciation, and also the deans of the medical schools of the City of 
 
 56 
 
New York. As a consequence plans for public health instruction 
 are being discussed in the several medical schools with a view 
 to the early establishment of courses. A School of Hygiene and 
 Public Health has recently been established at the Johns Hopkins 
 Medical School at Baltimore under a grant from the Rockefeller 
 Foundation. 
 
 AUTOPSIES. 
 
 In co-operation with the Russell Sage Institute of Pathology, 
 the Committee investigated the extent of performance of autopsies 
 in the main hospitals in this country and abroad. From the study 
 it became apparent that the small number of autopsies performed 
 in our hospitals, despite the efforts made by many to obtain per- 
 missions for performing them, proves very forcibly that some 
 changes in the public mind and in the existing laws must be brought 
 about in order that medical education and medical progress in this 
 country may not be seriously hampered. 
 
 With this in view the Committee recommended: 
 
 1. That effort be made on the part of various medical bodies 
 to interest the press in the matter of autopsies with a view of 
 presenting to the public the absolute dependence of medical progress 
 and education on the regular performance of post-mortem exam- 
 inations ; 
 
 2. That effort be made to secure legislation relative to autop- 
 sies, similar to that of European countries, which would obviate 
 the necessity of securing written permissions and at the same time 
 safeguard all the present rights of the relatives ; 
 
 3. That the law should be so amended as to recognize the 
 difference between anatomic dissection and pathologic autopsy made 
 for scientific purposes; 
 
 4. That until such legislation is secured, the boards of mana- 
 gers of all our private hospitals be urged to have the hospital rules 
 so changed as to remove as much as possible the obstacles now 
 placed in the way of securing autopsies. 
 
 Following the publication of the report in the Journal of the 
 American Medical Association of June 7, 191 3, attempts were made 
 to put the recommendations of the Committee into effect. 
 
 57 
 
Efforts have since been made to interest hospital trustees and 
 other hospital officers in this subject, in order that they may better 
 appreciate the handicap to medical progress that results from the 
 small percentage of autopsies obtained in the hospitals. Frequent 
 conferences have been held with representatives of several hos- 
 pitals, as well as of the pathological and anatomical departments of 
 the medical schools, in an effort to draft a bill for the State 
 Legislature which would embody the recommendations made by the 
 Committee. 
 
 THE CORONERS. 
 
 The New York Academy of Medicine at various times in the 
 last twenty years has gone on record as opposed to the present 
 coroner's system. During 1914 the Committee revived the discus- 
 sion of the matter and has arranged a series of conferences on the 
 subject at the Academy. 
 
 It has actively assisted in the formulation of a bill providing 
 for the abolition of the office of coroner, which was introduced 
 in the Legislative Assembly in 19 14 but failed of passage. 
 
 The matter was subsequently taken up by the Commissioner 
 of Accounts of the City and a thorough investigation has been 
 conducted by his office. The Committee co-operated with the com- 
 missioner and was represented at the hearing held in Albany 
 during the session of the Legislature in 191 5. 
 
 The bill abolishing the coroner's office was passed and begin- 
 ning with 1918 special well qualified medico-legal officers will be 
 in charge of the cases that hitherto came under the coroner's 
 jurisdiction. 
 
 FIFTH MEDICAL YEAR. 
 
 Over a year ago the attention of the Public Health Committee 
 was called by the Department of Health of this City to the need 
 of amending the laws of the State in such a way as to afford pro- 
 tection to the public from incompetent physicians. It was sug- 
 
 58 
 
gested that legislation, similar in principle to that of Pennsylvania, 
 Rhode Island and New Jersey should be enacted, demanding at 
 least a year of hospital experience from all candidates for medical 
 licensure. Before attempting to advise legislation of this sort the 
 Committee endeavored to find out how many prospective physi- 
 cians failed to secure such experience before entering into the prac- 
 tice, and also what would be the attitude of the medical schools of 
 the State toward such an amendment to the law. 
 
 From the statistics available it was ascertained that a large 
 proportion of medical students of New York State secure hospital 
 positions immediately after graduation. It was also ascertained 
 that those who do not receive hospital appointments do not fail to 
 do so because of any lack of hospital accommodations in this State, 
 but because of the character of the applicants or on account of 
 their economic status, which forbids them from delaying any longer 
 than they are legally obliged to do so, their entrance into practice. 
 
 The attitude of the schools was unanimously favorable toward 
 the principle of requiring a minimum of a year of hospital experi- 
 ence of an educational character, but numerous difficulties were 
 pointed out in the realization of such a plan. The foremost diffi- 
 culty is the lack of standardization of hospitals ; a second is the 
 relation of the school to the hospital. A year's hospital experience 
 may mean much or little, the pivotal point being efficiency in the 
 organization of the hospital. Then, many medical schools have no 
 control over hospitals and they are loath to have their students 
 pursue so important a part of their medical education outside 
 of the control of the faculty. It is feared that in some instances 
 students would work under the guidance of men not properly quali- 
 fied to teach. Some of the schools feel that should a fifth year 
 be added it should not be given over entirely to clinical work, but 
 that the curriculum of the school should be recast and the clinical 
 Avork distributed over two or three years, and that in a part of the 
 fifth year certain theoretical studies be pursued. It was also point- 
 ed out that many students do not intend to practice, but prepare 
 to take up laboratory work and that they should not be compelled 
 to take a year of clinical work in a hospital. 
 
 Realizing that many of these objections were valid, the Com- 
 mittee, after conferences with the deans of some of the medical 
 schools and the Assistant Commissioner of the State Department 
 
 59 
 
of Education proposed a simple amendment, which retained the 
 essential principle, but which was so worded as to allow sufficient 
 elasticity to meet the various plans which the medical schools might 
 wish to adopt. The proposal provided that in addition to meeting 
 existing requirements, an applicant may apply for a license, 
 only after completing twelve months of satisfactory clinical work 
 in a hospital having a daily average of not less than thirty patients 
 and having not less than fifty beds devoted to the treatment of 
 medical and surgical diseases and registered by the Regents as 
 maintaining at the time satisfactory clinical and laboratory stand- 
 ards. 
 
 The proposal made in no way affects the granting of the 
 medical degree ; the twelve months of clinical work may or may 
 not be included in the college curriculum, according to the judg- 
 ment and desire of college authorities ; the student will be free if 
 he chooses, to do a large part of the required clinical work during 
 his second and third college vacations and therefore, the entry 
 of the student into practice need not be long deferred. Under the 
 law as proposed, a college may or may not add a fifth year to its 
 curriculum, but at all events, the public will be protected by the 
 requirement that each applicant for a license shall spend at least 
 twelve months in clinical work before coming up for examination. 
 Those who do not intend to practice medicine need not, of course, 
 take the examination for licensure but if they should at any fu- 
 ture time decide to take up the practice of medicine they will be 
 compelled to meet this requirement of a year of clinical experience. 
 This requirement will be applicable to graduates of schools in other 
 States and the law, therefore, will not impose a handicap on the 
 medical colleges of New York to the advantage of competing 
 schools elsewhere. 
 
 The Committee avoided any attempt to define "satisfactory" 
 hospital standards, believing it wise to permit the Regents to feel 
 their way in this new field, guided by the authorities of the medical 
 schools. The proposal that the hospitals in which clinical work is 
 done shall maintain "satisfactory" clinical and laboratory stand- 
 ards corresponds to that part of the present law which declares 
 that the professional requirement shall include four "satisfactory" 
 courses in medical schools maintaining "satisfactory" standards. 
 
 60 
 
One of the medical schools in this State has objected to this 
 proposed amendment on the ground that it compels the applicant 
 for a license to keep fresh in his mind for another year the in- 
 formation necessary to pass the present style of examination. In 
 this respect the College referred to stands alone ; all the others 
 have endorsed the recommendation fully and some went so far 
 as to advocate even more rigid requirements. 
 
 In view of the fact that the State Medical Society of New 
 York has planned to devote one of the sessions of its annual 
 meeting to the subject of medical legislation, the Committee voted 
 to submit this proposal for the consideration of the Society and 
 to get the benefit of its opinion concerning the matter. It has 
 been submitted to Dr. W. Stanton Gleason, President of the So- 
 ciety, and has received the careful consideration and unanimous 
 approval of the Society at the meeting in Saratoga on May i6, 
 1916. No changes have been suggested in the amendment as sub- 
 mitted. It is probable that legislation along the lines suggested by 
 the Committee will be enacted into the law of the State in the near 
 future and will redound to the benefit of the public as well as to 
 the medical profession. 
 
 DENTAL EDUCATION. 
 
 The matter of the present status of the dental schools in this 
 City and State and the desirability of recommending the establish- 
 ment of universities and schools of dentistry was taken up by the 
 Committee and an investigation of the situation was made. 
 
 A report has been prepared and the conclusion reached that 
 there is a distinct need of additional dental colleges in this City 
 which it would be preferable to establish in connection with uni- 
 versities having medical schools. 
 
 The following is the report : 
 
 There are three dental schools in the State of New York, two in New 
 York City, the College of Dental and Oral Surgery and the New York Col- 
 lege of Dentistry, and the third in Buffalo, conducted under the auspices of 
 the University of Buffalo. 
 
 The New York College of Dentistry is the oldest and largest, having 
 been established in 1886 and registering 845 students, male only, for the 
 present year, 326 freshmen, 274 juniors and 245 seniors. Since the death 
 
 61 
 
of Dr. Weisse last year, Dr. Alfred R. Starr has been Dean. The main 
 building and the annex occupied by the school are inadequate to accommo- 
 date all the applicants. About 70 were refused admission last year. The 
 College is proprietary, having no endowment. The tuition fee is $200, and 
 the proceeds from the fees more than cover the costs of maintaining the 
 institution. The college is endeavoring to raise money for a new building 
 in East 42nd Street where it owns a considerable piece of property. 
 
 The College of Dental and Oral Surgerj', founded and conducted by 
 Dr. William Carr occupies a new and well equipped building in East 35th 
 Street. Its registration is over 500 students, both sexes, and owing to the 
 limitation of facilities, they too have been compelled to refuse 50 applicants 
 last year. This school is also proprietary, having no endowment and the 
 tuition fee is similar, $200. 
 
 The Buffalo School obtained its charter in 1892 and now has an enroll- 
 ment of about 500 students. 
 
 At the present time the course is three years, but beginning with the 
 1917 session all the Colleges holding membership in the National Associa- 
 tion of Dental Faculties have agreed to adopt the four years' course. This 
 means that all the schools in this State will have a four years' course. The 
 additional year will make possible a more thorough education in the funda- 
 mental sciences. 
 
 The requirements for admission to the schools of dentistry in the State 
 are either possession of a high school diploma or an equivalent certified 
 to by the Board of Regents. Persons holding an M. D. degree are admitted 
 and may complete their work in two years. 
 
 In addition to the purely technical work required in dentistry, the cur- 
 riculum includes Instruction, chiefly by lecture, in anatomy, pathology, bi- 
 ology, histology and bacteriology ; X-ray photography, the use of the micro- 
 scope ; laboratory work in chemistry and metallurgy ; and practical instruction 
 in oral surgery, pathology, therapeutics and materia medica. 
 
 The college clinics receive many patients and the work is done under 
 the guidance of instructors. The New York College has a small infirmary, 
 work in which is optional. 
 
 The Deans of the two Colleges in the City expressed the opinion that 
 there is a need for another school in this City. Both favored University 
 connections for their own schools and stated that in case such connections 
 latitude, and would also wish to protect the present members of their 
 were made they would wish to reserve for themselves a certain degree of 
 Faculties, who have served them faithfully and efficiently in the past. 
 
 In view of the fact that the schools are overcrowded, and in view of 
 the further fact that many New York students seek instruction in university 
 schools outside of the State, fout of the enrollment of 722 at the School of 
 Dentistry of the University of Pennsylvania, 206 or about 30 per cent, come 
 from New York State) there seems to be a well recognized need for an 
 additional school, preferably in connection with a university. 
 
 The only information which could be obtained regarding dental schools 
 
 62 
 
under university control was with regard to the Philadelphia School, the 
 Harvard University School, the University of Maryland School in Balti- 
 more and the Ann Arbor School. 
 
 NURSING EDUCATION. 
 
 The matter of the training of nurses has received a great deal 
 of attention on the part of the Committee. Numerous conferences 
 with representatives of hospitals, training schools, and agencies 
 interested in public health were held. In view of the fact that 
 there is no uniformity of standards among the training schools and 
 that the requirements for nursing education are at great variance 
 in the several states of the Union, and also in view of the fact that 
 the fields of usefulness of the nurses have become broadened and 
 require special training, in 1914 the Committee recommended to 
 the Carnegie Foundation for the Advancement of Teaching, the 
 urgent need of a comprehensive study of the problems of Nursing 
 Education. At that time the Carnegie Foundation was not able 
 to undertake it. Recently, Mr. Pritchard, the President informed 
 the Committee that the Foundation had undertaken such a study in 
 co-operation with the American College of Surgeons. 
 
 The Committee had also under advisement the question of 
 legislation in regard to the Practice of Nursing. The Bill intro- 
 duced into the State Legislature during the session of 1912 was 
 opposed by the Committee because of the attempt to copyright the 
 term "Nurse" and to make it apply only to graduates of registered' 
 nurses' training schools. The majority of the Committee, however, 
 was in favor of the principle of the bill which aimed at securing 
 greater protection for the profession of trained nurses and of the 
 public at large. When a new bill was introduced in 19 16 free from 
 the objections raised by the Committee in the past, the Committee 
 voted to support it. 
 
 63 
 
VII 
 
 THL CARL OF THE, MENTALLY DLFLCTIVL, 
 THL DLLINQULNT AND THL AGED 
 
 CARE OF THE MENTALLY DEFECTIVE. 
 
 One of the problems which has received a very large amount 
 of time and consideration on behalf of the Committee was the 
 problem of the segregation and care of the mentally defective. The 
 lack of adequate control over this class of unfortunates and the 
 serious social consequences that this lack of control entails led the 
 Committee to investigate the matter in a very thorough fashion 
 and to formulate a series of recommendations. 
 
 The discrepancy between the number of feeble minded in this 
 State and the facilities for institutional care of them is so large as 
 to make the matter one of grave public concern. 
 
 The plan as formulated by the Committee embraces the policy 
 of procedure which covers the whole life of the feeble minded. 
 The Committee believes that some such program must be adopted 
 in order to combat the situation effectively. The following is the 
 program outlined by the Committee and published in the Survey 
 of June 21, 1913: 
 
 "We believe that the interests of the state and of the individuals con- 
 cerned would be best served if the care of the feeble minded should be 
 dealt with as follows : namely, That the organization of a State Board of 
 Control, analogous in function to the State Board of Lunacy, be so author- 
 ized by law that it shall be empowered to have charge of all feeble minded 
 from birth to death with the exception of that part of the lives of the 
 educable feeble minded which comes within the usual school ages in such 
 municipalities as make proper provision for the training of the feeble minded. 
 
 Before school age the care of the feeble minded would naturally fall 
 
 64 
 
to the family under the supervision of such a state board, with the addi- 
 tional observation of specifically qualified private agencies. 
 
 Race, religion and economic status should not relieve the family from 
 the supervision of state authorities or the restrictions vi^hich might be neces- 
 sary to be imposed for the public welfare. During this period the records 
 should be made which should be permanently under the State Board of 
 Control or under some State Bureau of Statistics if such should later be 
 established. 
 
 During school age all educable children should be educated as far as 
 possible to be self-supporting if possible, either by private means, or in 
 existing public schools, or in special institutions if they are later provided. 
 During school age the children's records should still be kept up and form a 
 part of the permanent files of the State Board of Control. 
 
 After school age the feeble minded who are non-selfsupporting should 
 be cared for by the State or by private means under State supervision. 
 Those who are self-supporting might be allowed under certain restrictions 
 to live outside of institutions, but it would be the ultimate ideal to so 
 supervise all feeble minded in or out of State institutions that propagation 
 of their kind may be prevented. 
 
 In order that this may become a fact and not merely a hope, it is 
 probable that some kind of custodial care for women and men in farm 
 colonies will have to be provided. 
 
 The criminal feeble minded should be referred by the courts to the 
 State Board of Control, rather than to reformatories or prisons for criminals, 
 for detention and care, separate from the feeble minded who have no anti- 
 social tendencies. 
 
 We believe that there is now and will be for some time, and probably 
 always, a need for the so-called Ungraded Classes of the public schools. 
 Our criticism of such work as is done by the Department of Education of 
 New York City is that the examinations and tests of the children have 
 not been under adequate medical direction, and that the equipment and 
 organization are insufficient. A further criticism of the care of children 
 by the Department of Education is the lack of provision for the morally 
 defective. 
 
 We believe that the Department of Charities of New York City is not 
 a suitable department of City government to take upon itself the permanent 
 control of the great problem of the feeble minded, in spite of the fact that 
 at present many of such cases come upon the city as public charges and 
 although under existing conditions there is a legitimate field for the 
 activities of this Department. 
 
 Any thoroughgoing reorganization of the care of the feeble minded and 
 the protection of the State from their incapacity or criminal tendencies 
 should contemplate: 
 
 1. State rather than local or municipal control. 
 
 2. A permanent bureau of life records. 
 
 3. Self support where possible. 
 
 65 
 
4- Segregation and detention if necessary. 
 
 5. Prevention of propagation of their kind. 
 
 6. Organized campaign for the prevention of the causes which lead to 
 feeble mindedness." 
 
 On August 18, 191 5 the Committee brought to the attention 
 of the Constitutional Convention the need of formulating a definite 
 policy for dealing with mental deficiency and of amending the 
 constitution in a manner which will allow the adoption of such a 
 policy. The Committee advocated the establishment of a Central 
 Board of Control, similar to that recommended by the English 
 Royal Commission, with power to register all of the mentally de- 
 ficient of the State, to supervise the work performed by local au- 
 thorities and the public institutions caring for this class of the 
 socially unfit, to license and inspect private institutions for the 
 mentally defective, to enforce the provisions of the law relating 
 to their commitment, registration and protection, and to ascertain 
 in a scientific manner facts which shall become the basis of a com- 
 prehensive method of dealing with the problem. 
 
 PRISON HOSPITAL WARDS. 
 
 At the request of Mrs. E. H. Harriman for an opinion as to 
 the need of funds to pay the salaries of the resident staff of the 
 Hospital at the Workhouse on Blackwell's Island, for whom no 
 provision has ever been made in the City Budget, a special Sub- 
 Committee visited the Hospital in March, 191 5, and made a report 
 on the conditions existing there and the need of improving the 
 medical service. 
 
 The following is a summary of the observations made during 
 the visit to the hospital wards at the Workhouse : 
 
 THE WORKHOUSE AT BLACKWELL'S ISLAND. 
 
 The Special Committee visited the Workhouse at Blackwell's Island on 
 March 24, 1915. They were met by the Commissioner, Dr. Katherine B. 
 Davis, and were shown through the Institution and the hospital wards by 
 her and Warden Fox. 
 
 The total number of inmates in the workhouse averages 3000. Of this 
 number, approximately 1300 are in other institutions of the Department of 
 
 66 
 
Correction because of lack of space at the workhouse. The hospital pro- 
 visions consist of eight wards, four for men and four for women. The 
 wards are divided as follows : one for medical cases, one for surgical 
 cases, one for active syphilitic cases and one for drug addictions. The 
 wards are light, airy and clean, each containing about 20 beds. The wards 
 are always full and often are very much overcrowded. There is an operat- 
 ing room where operations are done on inmates of the workhouse and also 
 where the operative work of the Penitentiary is done. There is a room 
 called the clinic room where all new prisoners are examined physically, 
 and where all cases of alleged sickness and injury are examined. 
 
 The medical service consists of a visiting board of physicians and sur- 
 geons and of a staff of four internes. The internes are supposed to serve 
 a year in periods of three months. During the first three months the 
 interne is a senior medical student who receives his board and lodging. 
 
 This staff of internes has to do a great deal of routine and uninterest- 
 ing work. In the morning they must make the rounds of the wards ; between 
 and II o'clock they must examine patients who are applying for relief 
 in the hospital wards, and from 40 to 50 patients are examined every morn- 
 ing; from II to I o'clock they must examine all the new male prisoners 
 arriving each day. these averaging from 15 to 30 or 40. The female prison- 
 ers, also about 40 a day, are examined by a woman physician who is espe- 
 cially paid for this service, but the male prisoners must be examined by the 
 staff of internes. In the afternoon the staff must attend to the operative 
 work and make its rounds again. Owing to the lack of pay and the 
 monotonous and routine character of a large amount of the work, it is 
 extremely difficult to get physicians on the service. We have been told 
 that since December, 1914, there have been six new physicians on the staff 
 of internes. Also, these physicians are not very amenable to discipline, and 
 if much fault is found with them they resign. 
 
 There are one or two trained nurses m connection with the wards, but 
 most of the nurses are trained attendants. 
 
 It was thought by Dr. Davis that if there were enough money to pay 
 the staff as follows : the first three months, nothing ; the second three 
 months, $25; the third three months, $25; and the fourth three months, $50; 
 competent medical service could be secured. The Board of Estimate re- 
 fused to appropriate any money this year. The total money needed for the 
 whole year under this plan would be $900. The Committee is very de- 
 cidedly of the opinion that the medical and surgical service at the work- 
 house should be made more attractive in order to secure competent medical 
 help. The value of the service might be increased by the appointment of a 
 medical superintendent who could organize the service and have it con- 
 ducted upon regular hospital methods. Until this is done there is no other 
 way of supplying the service with properly equipped ohysicians than by 
 paying the staff of internes for their work, and this policy is recommended. 
 
THE PROBLEM OF DRUG ADDICTION. 
 
 The State and Federal laws, providing stringent checks to the 
 illicit traffic in habit-forming drugs, have created a problem of pro- 
 viding adequate facilities for the treatment of drug habitues. The 
 number of cases that applied for treatment at the various institu- 
 tions after the Boylan and Harrison laws went into effect became 
 so large as to create a serious situation for the City hospitals. 
 The matter was brought to the attention of the Committee and an 
 investigation of the whole subject was undertaken and a number 
 of conferences were held with representatives of the Courts of 
 General and Special Sessions, District Attorney's office, Board of 
 Inebriety, and the City Department of Public Charities, Correction 
 and Bellevue and Allied Hospitals. 
 
 These conferences as well as the investigation that was made 
 revealed very plainly that there is a lack of constructive social 
 policy with reference to the problem of drug addiction. 
 
 The investigation made apparent the fact that the three City 
 hospitals which have been receiving drug cases, Bellevue, Metro- 
 politan and Kings County were unable to handle all the cases. 
 The hospital at the Workhouse has been similiarly overtaxed. 
 
 The Committee recommended the development of the Farm 
 Colony for Inebriates at Warwick, New York, bought by the City 
 several years ago, to enable that institution to care adequately for 
 the male cases of drug addiction committed to it. The Committee 
 also recommended changes in the present court procedure with 
 reference to commitments and the adoption of a uniform method 
 in all of the courts with reference to drug addicts. 
 
 The need was pointed out for the establishment of a colony 
 for female cases and for the organization of a follow-up service 
 that would take care of all the discharged patients by Social Service 
 workers, would guide them in procuring employment and prevent 
 them from falling again into associations or conditions which were 
 responsible for the development of their drug habit. 
 
 The Committee also pointed out the need of so amending the 
 present law as to allow utilization at the City hospitals of the drugs 
 confiscated and taken away from dishonest dealers. 
 
 A law to this effect has been passed by the Legislature. 
 
 68 
 
HOMES FOR THE AGED. 
 
 At the request of the Department of Health, the Committee 
 undertook to ascertain the existing conditions with reference to 
 the medical and sanitary care of the inmates in the Homes for the 
 Aged. An analysis of available reports showed that the homes 
 vary greatly in sanitary conditions and in the medical care afforded 
 to the inmates ; and in some of them conditions appear to leave 
 much to be desired. The Committee recommended that a sanitary 
 survey and more rigid supervision of these Homes be made by the 
 Department of Health. 
 
 69 
 
VIII 
 
 OUT-PATIENT CLINIC5 
 
 ASSOCIATED OUT-PATIENT CLINICS. 
 
 Very early in the work of the Committee the importance of 
 the dispensary in preventive medicine and in the public health 
 movement was recognized and special attention paid to the 
 work of the Associated Out-Patient Clinics. It became apparent 
 that there existed a great discrepancy of standards and procedure 
 and little or no co-operation between the various institutions. The 
 possibility of an association of dispensaries was suggested to a num- 
 ber of trustees of hospitals and a call issued for a meeting to dis- 
 cuss the possibility and advisability of such an association. 
 
 The first meeting was held on February 29, 1912. It was 
 attended by representatives of 26 institutions and the following 
 resolution was adopted at that meeting: 
 
 Whereas, The out-patient departments of hospitals and dis- 
 pensaries represented at this meeting acknowledge their common 
 responsibility for the proper treatment of the sick, who are too 
 poor to pay for medical advice and treatment, and are not eligible 
 for hospitals, and 
 
 Whereas, Their work hitherto has not been co-ordinated, 
 neither has it been effectually regulated either by law or by the 
 voluntary adoption of suitable standards, and 
 
 Whereas, The volume of dispensary work, in the absence of 
 suitable checks, tends constantly to increase, while its quality, in 
 the absence of recognized standards and for want of sufficient 
 means, does not improve as rapidly as does the quality of other 
 forms of recognized medical or other charitable relief: 
 
 70 
 
Therefore, be it Resolved, That the dispensary representa- 
 tives present favor the formation of a co-operative dispensary as- 
 sociation, which shall have for its immediate objects the co-ordina- 
 tion of the work of the existing dispensary and out-patient depart- 
 ments in the City of New York, the elimination of unworthy appli- 
 cants for medical treatment, the promotion of proper standards 
 of treatment and the furthering of such changes in methods as 
 shall make for economy and efficiency in dispensary management; 
 and 
 
 Be it Further Resolved, That a Committee of Five, to be 
 appointed by the Chair, be invited to serve as a Committee on 
 Temporary Organization with power to add to their number as 
 many representatives of dispensaries and of hospital out-patient 
 departments as may signify their willingness to co-operate in this 
 movement. 
 
 As a result of the activities of the Committee on Temporary 
 Organization a permanent organization was established with the fol- 
 lowing general aims : 
 
 1. The co-ordination of the work of existing dispensaries and out- 
 patient clinics, 
 
 2. The elimination of unworthy applicants for treatment, 
 
 3. The promotion of proper standards of treatment, and 
 
 4. The promotion of economy and efficiency in dispensary man- 
 agement. 
 
 The membership of the Association includes the most import- 
 ant clinics of the City. In Manhattan 40 institutions hold mem- 
 bership in the Association and the Brooklyn chapter is composed 
 of 12 members. The work of the Association has been along con- 
 structive lines. A series of standards dealing with equipment and 
 organization have been formulated with painstaking care and a well- 
 recognized gap in the science of hospital administration has been 
 filled. 
 
 VENEREAL DISEASES. 
 
 When in the Fall of 19 12 the Health Department made a re- 
 quest of the Board of Estimate and Apportionment for funds to 
 establish Venereal Disease clinics, the Committee opposed the 
 
 71 
 
granting of this request on the ground that insufficient effort had 
 been made to use the resources already at hand and that there was 
 no evidence of the expediency of the Department of Health assum- 
 ing additional therapeutic activities. 
 
 The money was not granted and the Committee, realizing the 
 responsibility it had assumed and the urgent need of improving 
 the existing dispensary and hospital facilities for the treatment of 
 Venereal Diseases in this City, arranged for a public meeting 
 which took place at the Academy on February 20, 1913. At this 
 meeting the following matters were discussed: 
 
 The attitude of the Department of Health in relation to Venereal 
 
 Diseases, by Dr. Hermann M. Biggs. 
 Dispensary facilities for the treatment of Syphilis, by Dr. Homer 
 
 F. Swift. 
 Adequate dispensary facilities for the treatment of gonorrhea, by 
 
 Dr. E. L. Keyes, Jr. 
 Hospital accommodations for acute Venereal Diseases in New York 
 
 City, by Dr. S. S. Goldwater. 
 Relation of Syphilis to Internal Medicine, by Dr. Warfield T. 
 
 Longcope. 
 
 The papers presented at that meeting were subsequently pub- 
 lished in book form. 
 
 Several informal conferences followed the meeting, and at the 
 request of the Committee the Associated Out-Patient Clinics took 
 up the study of Dispensary facilities for the treatment of Venereal 
 Diseases and formulated a set of constructive recommendations. 
 
 Unfortunately only a few of the institutions in this City have 
 lived up to the standard recommended, and recently the Commit- 
 tee has again endeavored to bring the matter to the attention of the 
 hospital trustees through the means of a questionnaire addressed to 
 the hospitals of the City. 
 
 Realizing the need of a better control of Venereal Diseases in 
 this City, the Committee unanimously recommended to the Acad- 
 emy the adoption of the following resolutions, which, however, 
 though endorsed by the Council of the Academy, failed of passage. 
 
 72 
 
Resolved, That the New York Academy of Medicine 
 
 1. Is opposed to the establishment of a clinic for the treatment of 
 venereal diseases by the Department of Health until it is proved that the 
 existing dispensaries, public and private, cannot be made adequate to the 
 needs of the city. 
 
 2. Approves the facilities for the diagnosis of venereal diseases which 
 the Department of Health affords through its laboratories. 
 
 3. Is in favor of reporting all cases of gonorrhea and communicable 
 syphilis to the Department of Health under such regulations as will insure 
 privacy. 
 
 4. Urges action on the part of the general hospitals leading to the 
 admission under suitable precautions of persons in the active stage of 
 syphilitic infection. 
 
 5. Urges action on the part of the general hospitals, leading to the 
 admission under suitable precautions of persons in the active stage of 
 gonorrheal infection. 
 
 6. Strongly urges upon the general dispensaries which wish to treat 
 syphilis, the absolute necessity of providing special adequate facilities for 
 its diagnosis and treatment. 
 
 7. Approves the action of the Associated Out-Patients Clinics in direct- 
 ing the formation of an Association of Genito-Urinary and Syphilitic Depart- 
 ments of general dispensaries in this City for the purpose of co-ordinating 
 and standardizing the medical and administrative work in connection with 
 venereal diseases. 
 
 TONSIL AND ADENOID OPERATIONS. 
 
 In 191 3 the Committee made a study of the extent and the 
 prevailing methods of procedure with regard to Adenoid and Tonsil 
 Operations in the dispensaries of the City and having found them 
 insufficient and inadequate has referred the matter to the Associated 
 Out-Patient Clinics with the request for action in the matter. 
 
 The Association obtained advice from the Section on Laryn- 
 gology of the New York Academy of Medicine to the effect that 
 both tonsillectomy and tonsillotomy are operations requiring the 
 facilities of a hospital. 
 
 Recommendations of the Association based on this opinion 
 were sent to the dispensaries of the City. However, not many of 
 them found it possible to change their previous methods. Conse- 
 quently, in 1914 the Committee called a conference at which the 
 Department of Health, the Laryngological Section of the Academy, 
 
 73 
 
The Associated Out-Patient Clinics and the State Charities Aid 
 Association were represented. 
 
 The representative of the Health Department explained that 
 the inadequacy of the existing facilities for the treatment of tonsils 
 and adenoids as well as the unsatisfactory methods were chiefly 
 responsible for the Department of Health establishing clinics of its 
 own to treat the large number of school children in need of relief. 
 At this conference the conclusions of the report made by Dr. G. H. 
 Cocks for the State Charities Aid Association were discussed and 
 endorsed. In view of that, the Committee recommended that oper- 
 ations on the tonsils be performed under complete anaesthesia; 
 that the private hospitals of the City be requested to co-operate 
 with the Health Department in the operative care of children with 
 enlarged tonsils and adenoids; that the hospitals provide proper 
 and adequate facilities for such cases and that the City compensate 
 the hospitals for this special service; and further that the public 
 hospitals be requested to provide similar facilities without special 
 compensation. As a result of the pressure brought to bear upon 
 the dispensaries, conditions have improved in some instances and 
 the Committee felt justified in endorsing the action of the De- 
 partment of Health in discontinuing these five special nose and 
 throat clinics after January i, 1916. 
 
 It is the opinion of the Committee that the functions of the 
 Department of Health should be restricted to the prevention of 
 diseases and that no therapeutic activities should be carried on in 
 the Department. 
 
 74 
 
IX 
 
 HEALTH PROTECTION OF THE PORT 
 OF NEW YORK 
 
 QUARANTINE. 
 
 In 1912, during the State inquiry into the management of the 
 quarantine Station at Rosebank, the Committee undertook an in- 
 vestigation of the problem in its broader bearings. Upon ex- 
 amination of the existing literature on the subject, the Committee 
 was struck by the scarcity of material relating to the history of 
 quarantine development in this country as well as with reference 
 to the problem of quarantine administration. Extept in 1892 when 
 the port was threatened with cholera and committees of the New 
 York Chamber of Commerce and of the New York Academy of 
 Medicine were appointed to advise with reference to immediate 
 measures to be taken to relieve the grave situation that existed at 
 the time, no public interest has been taken in the matter of quaran- 
 tine in the last two or three decades. 
 
 Realizing that the matter of quarantine and its administration 
 are matters of vital importance to the public health interests of the 
 community, the Committee made a study of the problem in its vari- 
 ous relations. The report contains an elaborate discussion of the 
 relative advantages and disadvantages of Federal and Local control 
 of quarantine at the Port of New York. After a thorough con- 
 sideration of the various arguments the Committee reached the 
 conclusion that in the interest of the City and State as well as the 
 country at large it is of importance to effect a change of the control 
 of the Station from the State to the Federal Government. The 
 report was published in the Journal of the American Medical Asso- 
 
 75 
 
elation on January i8, 19 13. It has received wide and favorable 
 comment in the medical, public health and lay press and stirred up 
 public opinion to the realization of the dangers of inadequate con- 
 trol which may result from exigencies of State politics. 
 
 After the war broke out it became apparent to the Committee 
 that some radical steps should be taken with reference to quaran- 
 tine, to protect the community from the possible dangers of import- 
 ing disease from the infected areas of Europe. The following reso- 
 lution has been adopted in April, 1915: 
 
 Whereas, Maritime quarantine, like over-sea commerce, is not a matter 
 of local, but of national and international interest and importance ; and 
 
 Whereas, The modern tendency in quarantine administration all over 
 the world has been from local to national and international rules and regu- 
 lations which insure uniformity of system and practice ; and 
 
 Whereas, Quarantine work is essentially scientific in its nature, and 
 cannot be carried on efficiently unless the tenure of office be independent of 
 changes in administration and of politics ; and 
 
 Whereas, The United States Public Health Service, by its organization, 
 the character, training and experience of its personnel and its opportunities 
 for constant communication with all foreign ports, is admirably equipped 
 to administer quarantine in a most efficient manner, as attested by the 
 satisfactory results obtained in San Francisco, New Orleans, Mobile, Manila 
 and the 50 or more other stations administered by the Service in the United 
 States and its dependencies ; and 
 
 Whereas, The history of local quarantine, including that of the port of 
 New York, has shown that in times of crisis the local stations have been 
 unable to cope with the situation without the assistance of the Federal 
 Government ; and 
 
 Whereas, There exists in Europe at the present time wide-spread 
 quarantinable disease which will become a source of grave danger to this 
 country when immigration resumes its usual course at the termination of 
 the war ; and 
 
 Whereas, The opening of the Panama Canal will bring New York into 
 direct shipping contact with South American and Asiatic countries, thus 
 increasing the possibilities for the introduction of endemic tropical diseases ; 
 and 
 
 Whereas, Of all ports of this country that of New York ranks first as 
 a receiving station for foreign goods and immigration, as well as a dis- 
 tributing center for the entire country; and 
 
 Whereas, The Federal government controls all the services incident to 
 the administration of the port of New York with the single exception of 
 the quarantine, which is logically a part of the immigration service; and 
 Whereas, The United States as a party to international quarantine 
 
 76 
 
agreements cannot guarantee their uniform observance unless all quaran- 
 tine stations are under Federal control ; and 
 
 Whereas, The expenses for health protection, the benefits of which 
 are shared by all parts of the nation, should not be borne by one city or 
 state ; and 
 
 Whereas, All the ports of this country with the exception of Baltimore 
 and New York, for the reasons above cited have already ceded their quaran- 
 tine functions wholly or in part to the Federal government, 
 
 Therefore be it Resolved, That the economical and efficient administra- 
 tion of the quarantine service, and above all the safeguarding of public 
 health, demand the transfer of the quarantine station of the port of New 
 York from the State to the National Government ; and 
 
 Be it further Resolved, That the Governor of the State of New York 
 be and hereby is respectfully and earnestly urged to take immediate steps to 
 secure such transfer. 
 
 In order to find out the extent of public approval of the policy 
 advocated by the Committee, this resolution was sent to a large 
 number of persons interested in public health, such as citizens of 
 prominence, educators, men of large affairs, physicians, social 
 workers, health officers and others. Over i,ooo replies were re- 
 ceived endorsing the suggestion, and but two or three persons ques- 
 tioned its advisability. 
 
 Impressed by the extent of unanimity in public sentiment with 
 reference to this matter, the Committee took steps to bring it to 
 the attention of the Governor. It is a source of gratification to be 
 able to record that the matter has received very careful and sym- 
 pathetic consideration on the behalf of Governor Whitman who on 
 many occasions has shown an enlightened interest in public health. 
 After having satisfied himself with the advisability of making the 
 proposed change, the Governor incorporated the suggestion in his 
 message to the Legislature at the beginning of the present year. 
 Following this message the Committee took steps to have a bill 
 introduced in the Legislature transferring the quarantine station 
 to Federal control. 
 
 Senator Ogden L. Mills introduced such a bill in the Senate 
 and Mr. Adler introduced the same bill in the Assembly. While 
 the bill was in Committee many hundreds of persons wrote to 
 Albany urging its passage. The bill was favorably reported, passed 
 both Houses of the Legislature and was signed by the Governor. 
 
 Pending the arrangements which the commission created by 
 
 77 
 
the bill is to make with the Federal Government concerning the 
 disposal of the real estate and other property connected with the 
 station at Rosebank, an officer of the United States Public Health 
 Service has been appointed by the Governor and confirmed by the 
 Senate to take charge of the Station. 
 
 PHYSICAL AND MENTAL EXAMINATION OF 
 IMMIGRANTS. 
 
 The great decline in immigration caused by the present war 
 has suggested to the Committee the desirability of establishing a 
 system of thorough physical and mental examination of the immi- 
 grants with a view of ascertaining the prevalence of various dis- 
 eases among them. From a conference with the Chief Medical 
 Officer of Ellis Island, the Committee learned that such intensive 
 examinations have been started and that the percentage of defects 
 noted has increased from the former two or three per cent, to 
 about seven per cent, ascertained by this more careful scrutiny. 
 This difference of results obtained suggested the desirability of 
 asking the Surgeon General of the Public Health Service to attach 
 a larger number of physicians to the medical corps at Ellis Island 
 when immigration resumes its normal course, and to ask the De- 
 partment of Labor to increase the detention facilities at the immi- 
 gration station. 
 
 HARBOR POLLUTION. 
 
 At the time the Metropolitan Sewerage Commission completed 
 its work, in May 1913, the Committee made a study of the avail- 
 able reports and arranged for a meeting at the Academy on the 
 subject at which the various problems involved were discussed by 
 Dr. Soper and other members of the Commission. As no steps 
 were taken by the City to relieve the heavy pollution of the harbor 
 and as conditions are becoming aggravated, the Committee has re- 
 cently brought this matter to the attention of the Board of Esti- 
 mate and Apportionment in the form of the following letter: 
 
 78 
 
To the Board of Estimate and 
 Apportionment, New York City: 
 
 Gentlemen : — 
 
 From various studies that have been made of the sewage problem of 
 this City it is evident that some comprehensive plan must be adopted in 
 the near future to prevent the surrounding waters from becoming so foul 
 as to constitute a serious nuisance and a danger to health. It has been 
 ascertained that the harbor is heavily polluted with sewage, that the organic 
 matter discharged into the waters has drawn heavily upon the natural 
 assimilative capacity of the water and that tidal action does not sufficiently 
 flush out the harbor. The flushing action of the tide is slightest in the 
 East and Harlem Rivers and the pollution has become particularly heavy 
 in these waterways. Tests made in 1913 showed that the Harlem River 
 was 82 per cent, polluted and that at various times during the hot weather 
 there was practically no free oxygen in the water of the Harlem River. 
 If the supply of oxygen in the waters surrounding the City is ever allowed 
 to become exhausted the water will turn black, offensive gases will be 
 given off and the harbor will resemble a huge septic tank. 
 
 Without presuming to advise as to the standards of cleanness and as 
 to what would be the most practical way of attacking the problem, the Com- 
 mittee, after an inquiry into the matter, has resolved to urge upon the 
 Board of Estimate and Apportionment the initiation of immediate steps to 
 prevent the further pollution of the harbor and the formulation of plans 
 for dealing with this important problem in a comprehensive fashion. 
 
 It is the belief of the Committee that the initial steps in a matter of 
 such vital importance to the health of the City should not, and cannot, 
 with safety, be entrusted to local improvement boards or to the individual 
 boroughs. In the Committee's opinion it is a City problem which should be 
 dealt with by the City as a whole. In appropriating money out of the 
 general tax funds some years ago for the investigation by the Metropolitan 
 Sewerage Commission, the Board of Estimate and Apportionment tacitly 
 accepted the principle that harbor pollution is a City matter, and not a 
 matter of local district concern. 
 
 We respectfully bring this matter to the attention of the Board in the 
 hope that it will receive early consideration. 
 
 Very truly yours, 
 
 (Signed) E. H. Lewinski-Corwin, 
 Executive Secretary. 
 
 The Board of Estimate requested the Chief Engineer to re- 
 port on immediate steps to be taken to relieve the situation. The 
 plans submitted call for the construction of a trunk sewer, by 
 means of which the sewage from the Bronx and the northern part 
 of Manhattan will be diverted from the East and Harlem Rivers 
 
 79 
 
to the Hudson River. There are also two other schemes proposed. 
 The Committee has held several conferences with the Chief Engi- 
 neer of the Board of Estimate and Apportionment and with the 
 Chief Engineer of Sewers of the Borough of Manhattan. The 
 matter is still receiving the attention of the Committee. 
 
 80 
 
X 
 
 M15CLLLANLOU5 ACTIVITIL5 AND REPORTS 
 
 THE FORMATION OF A HEALIH FEDERATION OF THE CITY 
 
 OF NEW YORK. 
 
 In the course of the Committee's activities it became apparent 
 that there are many organizations in this city whose work is similar 
 in scope and method and yet there is no endeavor to co-operate. 
 It occurred to the Committee that to save energy and also to 
 bring about a greater concentration of effort on certain matters 
 it might be advisable to form an organization comprised of repre- 
 sentatives of the various civic agencies interested in public health. 
 Upon investigation it was found that there are in this city over 
 one hundred private agencies which are interested in various phases 
 of public health work. 
 
 The Committee thereupon called a meeting of these organiza- 
 tions in the hope that such a conference might reveal not only 
 aims held in common but also methods of co-operation. In par- 
 ticular, it was thought that any opinion of such a conference 
 representing the wishes of so many organizations would be wel- 
 come and effective at budget hearings. 
 
 The response to the invitation was encouraging and generous. 
 At this gathering held at the Academy of Medicine on June 4, 
 1913, the following resolution was adopted: 
 
 Whereas, There are in the City of New York about one hundred and 
 twenty-five private organizations interested in various phases of Public 
 Health work; and 
 
 Whereas, The existing lack of close co-operation and co-ordination 
 permit duplication, and waste of effort as well as a distinct loss in the 
 effectiveness of the various independent endeavors, 
 
 81 
 
Therefore, be it Resolved, That a Central Committee on the Public 
 Health of New York City, composed of representatives of the various or- 
 ganizations, be chosen to act as a clearing house for the exchange of ideas 
 and information and for the co-ordination of the varied private health ac- 
 tivities of the City and to provide for the Institution of an Annual Con- 
 ference of the organizations. 
 
 A committee was elected with Dr. John H. Finley chairman. 
 The committee proposed that the association be known as the 
 Health Federation of the City of New York, and that it be gov- 
 erned by a board of fifteen persons, known as the Central Council 
 of Public Health of the City of New York. 
 
 The general aims and purposes of the Federation had been 
 formulated as follows : 
 
 1. To provide for conferences of private health organizations. 
 
 2. To act as a clearing house for the exchange of ideas and in- 
 formation in reference to the public health of the City. 
 
 3. To co-ordinate and prevent duplication of the various public 
 health activities of the City. 
 
 4. To promote co-operation in the investigation and study of 
 health problems. 
 
 5. To study the City Budget in its relation to public health. 
 
 6. To take an active interest in the administration of all such 
 branches of the City government as have a direct bearing on 
 public health ; and, 
 
 7. To provide for a combined expression of opinion on matters 
 relating to public health. 
 
 After the appointment of Dr. Finley as Commissioner of Edu- 
 cation of the State of New York, Dr. John H. Huddleston was 
 president until his death on October 30, 191 5. The Federation 
 held annual meetings devoted to the consideration of the municipal 
 budget. In addition, several meetings were held which were de- 
 voted to reaching a better understanding of the work done by the 
 various organizations and also to the consideration of certain 
 special and timely problems such as fire prevention, and unem- 
 ployment. 
 
 During the typhoid fever outbreak in this city, in the summer 
 of 1913, the Council of the Federation decided to make a study of 
 the epidemic with a view of ascertaining the cause of it and the 
 
 82 
 
degree of observance of quarantine rules in the homes of typhoid 
 fever patients, and also to discover the proportion of cases which 
 were unknown to the Department of Health, because of the failure 
 of the physicians to report. 
 
 Twelve sections of the city were selected for a house to house 
 canvas by trained nurses, loaned for this work by the Henry Street 
 Settlement and by the Department of Social Welfare of the New 
 York Association for Improving of the Condition of the Poor. A 
 report based upon results of this investigation was prepared and 
 published in the Nezv York Medical Record, January lo, 1914. 
 The numerous practical recommendations made by the Council 
 proved of great service to the Department of Health in focusing 
 attention upon the matter of typhoid prevalence in this City. 
 
 OPINION WITH REFERENCE TO TYPHOID 
 IMMUNIZATION. 
 
 During the Typhoid Fever epidemic in Manhattan in 19 13 the 
 Committee considered it its duty to advise the public with reference 
 to typhoid immunization, and the following resolution of the Com- 
 mittee endorsed by the Academy has been published in the lay press 
 of the City: 
 
 Whereas, An epidemic of typhoid fever has been in active 
 existence during two months of the fall of 1913 in the Borough 
 of Manhattan of the City of New York; and 
 
 Whereas, Immunization against typhoid fever by the injection 
 of typhoid vaccine has become medically recognized as a prophy- 
 lactic measure of great value ; and 
 
 Whereas, The Department of Health of the City of New 
 York now holds itself ready to perform immunization on request. 
 
 Be it Therefore Resolved, That The New York Academy 
 of Medicine recommend this method of prevention of the disease 
 to the attention of the public and urge that all persons in an in- 
 fected family and any persons who have been exposed in any way 
 to the disease follow up the sanitary precautions usually taken in 
 such cases by subjecting themselves to immunization at the hands 
 either of their private physician or of the Department of Health. 
 
 83 
 
RESUSCITATION OF THE APPARENTLY DROWNED. 
 
 At the request of the U. S. Volunteer Life Saving Corps, the 
 Committee made inquiries as to the best method of resuscitating 
 the apparently drowned. Opinions were secured from Prof. W. B. 
 Cannon of the Department of Physiology of Harvard University, 
 Prof. Frederick S. Lee of the Department of Physiology of 
 Columbia University, and Prof. Graham Lusk of the Department of 
 Physiology of Cornell University. 
 
 The information received very strongly favored the so-called 
 Schaefer method. The following is the information given to the 
 U. S. Volunteer Service, based on the opinions received from the 
 three sources above quoted : The Schaefer method is far prefer- 
 able to the Sylvester method, and the Committee heartily approves 
 its adoption. The advantages of the Schaefer method are : 
 
 1. It is very efficient. To prove this it is only necessary to 
 quote the results of careful measurements made under Schaefer's 
 direction. In a series of experiments on the relative efficiency of 
 different methods of respiration, he found the air exchange per 
 minute to be as follows : Natural respiration 5850 cc ; artificial 
 respiration by Sylvester method 2280 cc; artificial respiration by 
 Schaefer method, 6760 cc. This shows that by the Schaefer 
 method, exchange of air is three times the amount by the Sylvester, 
 and considerably greater than even in natural respiration. 
 
 2. It can be performed without fatigue by a single individual 
 for hours. The ease of application is considerably greater than 
 in the other method. 
 
 3. It is simple and easily learned. It can be taught to laymen 
 in a few minutes. 
 
 4. Its employment is less liable to result in fracture of the 
 ribs than in the employment of the other method, and 
 
 5. It gives complete ventilation of the lungs, and thus it 
 prevents the falling back of the tongue into the respiratory pas- 
 sages. It allows the tongue to fall forward, and the mucus and 
 water to escape from the mouth, so that the tendency of this to 
 block to passage of air, which is inherent in a supine method, is 
 altogether obviated. 
 
 84 
 
RESTRICTIONS OF THE SALE OF HABIT-FORMING 
 
 DRUGS. 
 
 In 1913 the District Attorney of the County of New York 
 pointed out the difficulty of controlling the illicit sale of drugs with- 
 out an amendment to the law which would put certain control over 
 the dispensation of drugs by physicians. The bill tentatively pre- 
 pared by the office of the District Attorney has been submitted to 
 the Committee for criticism. 
 
 After numerous conferences with the Assistant District At- 
 torney, with the representatives of the Comitia Minora and with 
 the Committee on Legislation of the New York County Medical 
 Society, with representatives of the State Medical Society and the 
 Section on Laryngology of the Academy as well as with represent- 
 atives of the College of Pharmacy, the Committee agreed on the 
 inclusion in the law of certain regulative provisions. The Com- 
 mittee felt that physicians should be willing to submit to the incon- 
 veniences placed upon them by the proposed law, such as detailed 
 record-keeping, in order to afford to the State the protection re- 
 quired from the evils following in the wake of the promiscuous sale 
 and use of habit-forming drugs. 
 
 QUACK TREATMENT AND PATENT MEDICINE 
 ADVERTISEMENTS. 
 
 The Committee was instrumental in bringing about the adop- 
 tion by the Board of Aldermen of a City ordinance forbidding 
 misrepresentation in advertisements and making it a misdemeanor 
 to advertise the sale of merchandise or personal service which is 
 deceptive or misleading. The Committee's special reason for sup- 
 porting this ordinance was to discountenance the practice of dis- 
 honest physicians and the sale of harmful drugs. The ordinance 
 is, however, insufficient to protect the public and the Committee 
 has therefore given its support to the Health Department ordinance 
 demanding the printing of a description of all the ingredients of 
 the various patent medicines, and endorsed the so-called Hamilton- 
 
 85 
 
Fertig bill introduced in the State Legislature during 1912 Session 
 which aimed at extending the principle of the City ordinance to 
 the State. 
 
 TWILIGHT SLEEP. 
 
 Twilight sleep was a matter of inquiry on the part of the 
 Committee. Opinions were obtained from a number of obste- 
 tricians and gynecologists and a report on the subject prepared, 
 which was, however, never made public because of the still exist- 
 ing difference of opinion among obstetricians and gynecologists as 
 to the value of the drug used and the methods pursued. 
 
 VACCINATION. 
 
 (a) At the request of the Citizens' Union of New York the 
 Committee very carefully considered the Bill introduced in the 
 Legislature during the 191 5 session, modifying the existing law 
 with reference to vaccination in several aspects. One of the 
 striking features of the bill was its provision that no requirement 
 of vaccination certificate be made of children entering public 
 schools, and made no exemption for the cities of the first and second 
 classes. 
 
 The Committee was very much opposed to the principle of the 
 bill but, apprised of the peculiar conditions prevailing in the rural 
 sections of the State, did not oppose the bill except to insist upon 
 an amendment exempting the City of New York from its pro- 
 visions. The following is the resolution adopted and forwarded to 
 the Citizen's Union. 
 
 Resolved, That the Public Health Committee of the New York Academy 
 of Medicine opposes Assembly Bill, Int. No. 125, entitled "An Act, to amend 
 the public health law in relation to vaccination," in so far as it applies to 
 New York City, for the reason that present conditions in regard to vaccina- 
 tion and the control of smallpox appear to be entirely satisfactory in this 
 City at the present time, and therefore should not be changed. 
 
 86 
 
(b) At the request of the State Department of Health the 
 Committee carefully considered a circular letter of instruction pre- 
 pared by the State Department of Health and intended to guide 
 physicians in the performance of vaccination. The Committee 
 made a number of suggestions, some of which were adopted. 
 
 (c) The Health authorities of the City have called the atten- 
 tion of the Committee to the fact that there is a generally imperfect 
 practice of vaccination among physicians. The Committee made an 
 inquiry of the medical schools of this City with reference to the 
 matter and found that all of the colleges give a certain amount 
 of theoretical instruction in vaccination. The Committee felt that 
 the theoretical instruction should be supplemented by more practical 
 experience than has been hitherto afforded to students, and made 
 such a recommendation to the medical schools of the City, advis- 
 ing them to give more opportunity to their students for practical 
 work in vaccination under adequate supervision. 
 
 FREE DIAGNOSIS OF SUSPECTED CANCER TISSUE. 
 
 In November, 191 5, the Commissioner of Health of the City 
 asked the advice of the Committee as to whether the Department of 
 Health should add to the list of diagnostic services offered for 
 public benefit free diagnosis of suspected cancer tissue. The Com- 
 missioner stated that an appeal for the establishment of such a 
 service has been made by the American Society for the Control 
 of Cancer. 
 
 Before offering an opinion on the matter the Committee made 
 an investigation regarding the existing facilities for laboratory diag- 
 nosis of cancer in this City. It was found : 
 
 1. That there are three private laboratories which do this kind 
 of work. 
 
 2. That there are four medical school laboratories whose 
 pathologists examine specimens both free of charge and for pay. 
 
 3. In addition there are 24 hospitals where work of this kind 
 is done but limited to hospital and dispensary patients and prob- 
 ably also for the attending physicians. 
 
 4. Then there is the State Institute for study of malignant 
 
 87 
 
diseases at Buffalo which does work of this kind gratuitously. 
 The work of the Institute covering the whole State is unavoid- 
 ably delayed in some instances. 
 
 The Committee felt that the stimulus offered to physicians by 
 the establishment of ample facilities for the analysis of cancer 
 specimens is so important from a public health as well as a medical 
 point of view that the City should establish a special branch in its 
 laboratory and afford to the practitioners the opportunity for ex- 
 amination of these specimens without cost, under certain safe- 
 guards. 
 
 The following is the summary of the Committee's attitude con- 
 cerning the matter and its recommendations. 
 
 1. Since the present facilities for obtaining free diagnosis of suspected 
 cancer tissue are limited to the gratuitous work of the pathologists of the 
 various medical schools, and to the State Institute for the study of malig- 
 nant disease at Buffalo, the establishment of such a service by the City De- 
 partment of Health is highly desirable and would be of value in promot- 
 ing the early diagnosis of cancer and in encouraging practitioners not to 
 temporize with new growths of doubtful nature. 
 
 2. Such a service should, however, be safeguarded in all possible ways, 
 tb^ prevent its abuse to the detriment either of the patient or of the pro- 
 fession. With this end in view specimens of tissue submitted should be 
 accompanied by a written declaration from the physician to the effect that 
 the patient's circumstances do not permit of the payment of a fee for 
 the examination. Furthermore, specimens should not be sent directly by the 
 practitioner, but should be brought to the laboratory by the patient or one 
 of the patient's family or friends, who should there receive a printed form 
 stating the fact that the examination is made without charge; or what is 
 preferable, that specimens may be sent directly by the physician, but the 
 laboratory should then send a statement to the patient to the effect that the 
 examination is made without charge. 
 
 3. To prevent over-burdening of the laboratory, it is suggested that in 
 announcing the inauguration of the service, attention be called to the fact 
 that it is limited to residents of the City of New York and that practitioners 
 be urged not to make demands upon it unnecessarily. 
 
 4. Report should be made to the physician in the case 
 
 The recommendations of the Committee were adopted by the 
 Department of Health. 
 
 CO-OPERATION WITH THE POLICE DEPARTMENT. 
 
 The Committee has considered with great interest the sug- 
 gestion of Police Commissioner Woods, that the members of the 
 Police Force could be made efficient agents towards the promotion 
 
 88 
 
of public health and street sanitation. A number of conferences 
 with the Commissioners of Police and Health and representatives 
 of various civic organizations has been held. In addition, a num- 
 ber of the Committee made a personal tour of inspection of Police 
 Headquarters and certain representative districts of the City. This 
 tour was personally directed by Commissioner Woods and resulted 
 in a very much better appreciation of the problem involved, on 
 both sides. 
 
 CO-OPERATION WITH THE MUNICIPAL CIVIL 
 SERVICE COMMISSION. 
 
 At the request of the Municipal Civil Service Commission the 
 Committee has prepared standards for physical examinations 
 for the position of clerk, second grade ; has advised with the Com- 
 mission in preparing standards for the position of resident physi- 
 cian in the City hospitals ; has criticized the standards set by one of 
 the expert examiners for the position of coroner's physician and 
 has rendered a detailed opinion thereon; has examined and critic- 
 ized a plan for the reorganization of the Bureau of Physical Ex- 
 amination of the Municipal Civil Service Commission and has, 
 from time to time, given to the Commission the names of those 
 whom it considered best qualified to act as expert examiners for 
 the purpose of rating experience papers, preparing the examination 
 and rating the answers of candidates for various important posi- 
 tions. 
 
 In appreciation of the service of the Committee, the Munici- 
 pal Civil Service Commission has, at its meeting on July 15, 1914, 
 passed the following resolutions : 
 
 Whereas, The Public Health Committee of the Academy of 
 Medicine has rendered the Municipal Civil Service Commission of 
 New York valuable co-operation, therefore, be it 
 
 Resolved, That the Municipal Civil Service Commission of 
 New York hereby records its grateful acknowledgment and appre- 
 ciation of the service which have thus been rendered at a personal 
 sacrifice ; and be it further. 
 
 Resolved, That these resolutions be noted on the minutes of 
 the Commission and a copy thereof forwarded to the said Com- 
 mittee. 
 
 89 
 
XI 
 
 MUNICIPAL BUDGET 
 
 MUNICIPAL BUDGET. 
 
 One of the aims of the Committee has been the constructive 
 study of the budgets of those of the City Departments whose 
 work deals directly or indirectly with public health. Accordingly 
 every year a study of the needs of the various Departments is 
 being made with a view of advising and assisting the heads of the 
 departments and the City authorities as to the desirability of 
 changes or additions in the established lines of work. 
 
 1911 
 
 In 191 1 the Committee was chiefly interested in the contagious 
 disease hospitals of the City and upon the basis of a study made, 
 a summary of which was given above, it made certain recommenda- 
 tions to the Health Department and to the Board of Estimate and 
 Apportionment. It also urged the appropriation of funds for the 
 construction of two new hospitals, one in the Bronx and one in 
 Queens. 
 
 1912 
 
 In 1912 the chief studies of the Committee in relation to the 
 Department of Health were in connection with the Division of 
 Child Hygiene and the Bureau of Records. A number of other 
 items in the budget were also taken up. The Committee urged 
 upon the Health Department the preparation of Budget requests 
 for personal service in many of the divisions of the Department 
 on a population basis. The suggestion was adopted, particularly in 
 school inspection work and in the control of contagious diseases. 
 
 In the Division of Child Hygiene the ratio of physicians and 
 
 90 
 
nurses to school children in medical inspection work was found 
 to be too low and the Committee recommended an increase in ac- 
 cordance with the standard which it formulated on the basis of 
 minute studies of the work and duties of the physicians and nurses. 
 Similarly, it was found that the staff of the Bureau of Records 
 was entirely inadequate to allow for any extension of the work 
 of the Division in the direction of statistical research and the en- 
 largement of the number of tables published by the Bureau. 
 
 The Committee recommended the establishment of dental 
 clinics and supported the budget requests of the Health Depart- 
 ment for the equipment and operation of these clinics. 
 
 The Committee urged the granting of the request of the De- 
 partment of Health for the employment of physicians and nurses 
 to be used in the control of venereal diseases. The requests for 
 the establishment of clinics for the treatment of venereal diseases, 
 however, was opposed on the ground that there was no evidence 
 at the time to show that sufficient effort had been made to use 
 the resources already at hand and that there was also no evidence 
 as to the expediency of the Health Department assuming any addi- 
 tional therapeutic activities. 
 
 The Committee has consistently advocated the extension of 
 milk stations over the City, particularly in congested districts and 
 in districts where the infant mortality was particularly high. 
 
 The Committee opposed the request of the Department for an 
 increase in the number of inspectors in the Division of Milk In- 
 spection on the ground that the method of milk inspection by 
 itinerant inspectors was not as effective as the bacteriological ex- 
 amination of milk when delivered to the City. 
 
 The Committee opposed the budget requests of the Division 
 of Contagious Diseases, recommending an increase in the number 
 of nurses and a decrease in the number of new physicians, on the 
 ground that a great deal of routine work in the home quarantine of 
 contagious disease cases could be done efficiently by nurses at a 
 lower cost to the City. 
 
 With regard to the Department of Public Charities the only 
 study undertaken in connection with the work of that Department 
 was the investigation of the need of a hospital in the lower section 
 of Manhattan. On the basis of this investigation the Committee 
 felt that there was no need for a hospital in that Section of the 
 
 91 
 
City and suggested that instead an emergency station be organized 
 in connection with Bellevue Hospital, which, as is well known, 
 carries on a very active service. 
 
 The Committee made a study of the distribution of the nurs- 
 ing staff at Bellevue Hospital and found that the charge that an 
 undue number of nurses was assigned to duties other than nursing 
 was unsubstantiated. The Committee found that some of the wards 
 were undermanned, but that this was due to a lack of available 
 funds for a sufficiently large nursing staff. 
 
 1913 
 
 In the budget of the Department of Education the Committee 
 supported the request for three physicians to be attached to the 
 Division of Physical Training, a physician for the open air classes 
 which are designed for anemic children, and two physicians for 
 school hygiene work in the Department. Five of these physicians 
 were granted after several presentations by the Committee. 
 
 In 1913 the Committee again reiterated its belief in the need 
 of increasing the staff of the Division of Child Hygiene for school 
 inspection work and for the operation of dental clinics; also for 
 an increase in the staff of the Bureau of Records. 
 
 The proposal on the part of the Board of Estimate and Ap- 
 portionment to reduce the minimum salaries of medical inspectors 
 of the Department of Health was studied, and the Committee 
 opposed this action in the belief that such a reduction would lower 
 the standards of efficiency of the work. 
 
 The Committee similarly opposed the budget requests of the 
 Department of Health for additional surgeons and anaesthetists 
 for the throat clinics operated by the Department. The Commit- 
 tee took the stand that no extension of the therapeutic activities of 
 the Department of Health should be encouraged. 
 
 With reference to the budget of Bellevue and Allied Hospitals, 
 the Committee supported the request for additional nurses and for 
 a larger staff in the pathological laboratory. After carefully ex- 
 amining the various recommendations of the Board of Estimate 
 Committee on Hospitals, the Committee endorsed the recommen- 
 dation made for the establishment of paid resident internes at 
 Bellevue Hospital. 
 
 Because of the difficulty in obtaining the desired information 
 
 92 
 
as to the plans of the Department of Public Charities, the Commit- 
 tee was unable to take action with reference to the budget of the 
 Department, except to endorse the plan for a clearing house for 
 mentally defectives in connection with the institution at Randall's 
 Island. 
 
 1914 
 
 During the budget hearings in 1914, the Committee advocated 
 the establishment of additional milk stations and the appropriation 
 of funds for additional medical inspectors and nurses to bring the 
 ratio of children to physicians and nurses nearer to the standards 
 set for school inspection work. 
 
 The Committee endorsed the requests of the Department of 
 Bellevue and Allied Hospitals, which were drawn in accordance 
 with recommendations of the Committee on Hospital Inquiry of 
 the Board of Estimate and Apportionment. The need of ade- 
 quate funds to allow for the employment of a sufficient number 
 of nurses to conform with the minimum ratios, adopted by the 
 Committee on Hospital Inquiry, was urged. 
 
 The Committee made a study of the situation with reference 
 to the plans of the Board of Inebriety and urged the development 
 of the Farm Colony. 
 
 1915 
 
 There were numerous constructive changes in the budget re- 
 quests of the Department of Health as presented in 191 5. The 
 Committee endorsed all of the changes and requests with one ex- 
 ception. It strongly advocated the establishment of two new milk 
 stations and the extension of the force of visiting nurses for 
 tuberculosis cases and it endorsed the requests for an additional 
 clerical staff to attend to the enforcement of the new patent medi- 
 cine regulations. 
 
 The discontinuance of nose and throat clinics of the Depart- 
 ment of Health for reasons of economy has met with the approval 
 of the Committee who consistently discouraged the therapeutic ac- 
 tivities on the part of the Department of Health. 
 
 The matter that met with the opposition of the Committee 
 was the proposed reduction in the staff of the Division of Labora- 
 tories which if carried out would have made impossible any re- 
 
 93 
 
search work on the part of the Division. In the opinion of the 
 Committee the research work of the City laboratories should not 
 be curtailed. The Committee urged upon the Commissioner the 
 utilization of a sufficient amount from the antitoxin fund to make 
 good the contemplated reduction in the tax-levy appropriation. In 
 accordance with this recommendation of the Committee, the Com- 
 missioner made such use of the antitoxin fund and the Laboratory 
 Division was able to continue its routine as well as research work 
 on an undiminished scale. 
 
 The budget of the Department of Public Charities was care- 
 fully examined and the requests for additional nurses in the several 
 hospitals of the Department to bring the ratio to the minimum 
 standards was strongly endorsed. The request for a Deputy Super- 
 intendent to supervise the children's service at the Metropolitan 
 Hospital, which received a special study on the part of the Com- 
 mittee, was similarly endorsed. 
 
 The budget for the service on Randall's Island, which has 
 undergone a thorough re-organization was strongly supported by 
 the Committee, as was also the request for $3,960 to be expended 
 for medical examinations at the Municipal Lodging House, at the 
 rate of $4.00 a day per physician. 
 
 With reference to the budget of Bellevue and Allied Hospitals, 
 the Committee voted to support the request for additional physi- 
 cians in the alcoholic and psychopathic service and a request for 
 a supervisor at Bellevue Settlement House which is carrying on 
 very useful educational work and which provides quarters for 
 women and girls in the early stages of pulmonary tuberculosis. In 
 this respect, the service is similar to that of the boat "Southfield" 
 for male tuberculosis patients. 
 
 The Committee also endorsed the request for the required 
 staff for the conduct of the Clearing House for atypical children, 
 which was transferred from the Department of Public Charities 
 to Bellevue. 
 
 The request for paid physicians in the out-patient department 
 of Gouverneur and Fordham Hospitals has also been endorsed as 
 well as the request for paid physicians in the night tuberculosis 
 and children's clinics at the Harlem Hospital. 
 
 94 
 
XII 
 
 LLGI5LATION 
 
 The Committee has been interested in a number of legislative 
 projects bearing on public health and cognate subjects. In most 
 Instances the action of the Committee was limited to expressing 
 either approval or disapproval of the proposed measures, but in 
 several instances, as in the matter of transferring the quarantine 
 service at the Port of New York from State to Federal control 
 or the checking of the evil arising from the consumption of habit 
 forming drugs, for example, it took part in framing the bills and in 
 soliciting the support for them on the part of medical and general 
 public opinion. The measures with reference to which the Com- 
 mittee expressed an opinion are as follows: 
 
 (Federal) 
 
 I. The Owen Bill. At the time the so-called Owen Bill was 
 introduced in Congress, establishing a Federal Department of 
 Health, the Committee took active interest in the subject and made 
 inquiries of various public men in Washington and elsewhere. After 
 a thorough consideration of the matter the following resolution was 
 adopted : 
 
 "Whereas, There has been a distinct movement in the medical 
 profession for some years past for the conservation of the national 
 health ; and 
 
 Whereas^ There have been a number of bills introduced in 
 Congress tending toward the amalgamation of the public health 
 functions of various departments of the United States Government; 
 
 Be it Therefore Resolved, That the Committee on Public 
 
 95 
 
Health, Hospitals and the Budget of the Academy recommend to 
 the Council of the Academy that they urge the formation of a 
 National Department of Health; 
 
 And be it also Resolved, That a copy of this resolution be 
 sent to the President of the American Medical Association." 
 
 2. The Henry Resolution. In May, 1913, Congressman 
 Henry introduced a resolution in the House providing that Rule 10 
 of the House of Representatives be amended so as to provide a 
 standing committee on Public Health and National Quarantine to 
 which all proposed legislation affecting the Public Health shall 
 be referred instead of to the Committee on Interstate and Foreign 
 Commerce. 
 
 The Committee unanimously endorsed this resolution and sent 
 copies of this endorsement to a number of representatives of the 
 House. 
 
 3. The Committee endorsed the Bill, introduced at the same 
 session of Congress, reducing the tariff duties on drugs and scien- 
 tific instruments of precision. 
 
 Prior to this action a thorough investigation was made of the 
 tariff rates on drugs and scientific apparatus under the Dingly 
 (1895) and Payne-Aldrich (1909) acts. 
 
 4. In reply to a request from the Committee of One Hundred 
 on National Health as to the lines of extension of the health work 
 of the Federal Government, the following four activities were sug- 
 gested by the Committee: 
 
 1. Interstate control of sources of disease infection, such as 
 cattle, milk, oysters, shell fish, vegetables, etc. 
 
 2. The extension of the Federal power over the quarantine 
 stations of the ports of New York, Boston and Baltimore. 
 
 3. The extension of the registration area and the improve- 
 ment and standardization of vital statistics ; and 
 
 4. The improvement of the medical examinations at immi- 
 gration stations, particularly with reference to more rigorous physi- 
 cal examinations and mental tests of the aliens. 
 
 5. Recently the Committee expressed its disapproval of the 
 resolution introduced by Senator Works, limiting the rights of the 
 United States Public Health Service to join Medical, Public Health 
 and other private scientific bodies. 
 
 96 
 
The following is the resolution that was forwarded to the 
 Senate Committee on Public Health and National Quarantine on 
 May 5, 1916: 
 
 Whereas, the Joint Resolution introduced by Senator John D. Works 
 of California, in Congress, making it unlawful for any officer or employee 
 of the United States Public Health Service to be or to become a member 
 or officer of, or in any way connected with, any medical or private health 
 association or organization of any kind, if passed by Congress, would limit 
 the usefulness of a very important branch of government service ; and 
 
 Whereas, it would deprive medical, public health and other scientific 
 bodies of the benefits derived from association and interchange of ideas 
 with the officers of the Public Health Service who have contributed, indi- 
 vidually and collectively, much to the progress of medical and public health 
 science ; and 
 
 Whereas, it would dissociate the members of the United States 
 Public Health Service from the rest of the medical and public health 
 professions and would deprive them of the benefit accruing to them, as 
 officers and administrators, from direct contact with other workers in the 
 same field of usefulness ; and 
 
 Whereas, it is generally recognized that government administrative 
 endeavors can be most successful only when cordial co-operation is given 
 to them on the part of the public ; and 
 
 Whereas, Mr. Works' resolution expressly forbids direct associa- 
 tion of the officers of the United States Public Health Service with the 
 members of the medical and public health professions as organized in na- 
 tional bodies where they can be most easily approached and induced to 
 co-operate with and assist in the work of the Service ; and 
 
 Whereas, by this prohibition, if enacted into law, the public would 
 materially suffer by being deprived of the advantages that accrue to public 
 benefit from the present close association of the officers of the United 
 States Public Health Service with scientific associations ; and , 
 
 Whereas, the principle of this resolution may serve as an entering 
 wedge for encroachments of a similar nature upon all other scientific 
 workers in government service, to the detriment of the efficiency of govern- 
 ment and to the public welfare at large ; and 
 
 Whereas, the statement in Senator Works' resolution concerning the 
 aims of the American Medical Association is not correct, for it omits to 
 say that a main purpose of the Association is to weed out from the medical 
 profession dishonest practitioners and to raise the standard of medical 
 education and practice in this country, 
 
 Therefore, be it resolved, That the Committee on Public Health of the 
 New York Academy of Medicine expresses its emphatic opposition to the 
 passage of the joint resolution of Senator Works; and 
 
 97 
 
Be it further resolved, That copies of this resolution be sent to the 
 members of the Congressional Committees to which this resolution was 
 referred, and to the daily press of New York City. 
 
 Representatives of the Committee had an opportunity of pre- 
 senting the views of the Committee to the Chairman of the Senate 
 Committee on Public Health and National Quarantine in Washing- 
 ton. The resolution of Mr. Works failed to receive the endorse- 
 ment of the Senate. 
 
 6. The Committee approved of the principle of the Kern- 
 McGillicuddy bill M^hich provided compensation for injured em- 
 ployees in the Federal Government. 
 
 (State) 
 
 In 1912 the Committee urged upon the Governor the veto of 
 the amendment to the Agricultural law embodied in Assembly Bill 
 No. 154, which passed under special rules and without discussion in 
 either branch of the Legislature, exempting from punishment any 
 person who sells or exchanges milk actually produced by a cow or 
 dairy which is a fair sample of the milk produced daily by such 
 cow or dairy and which has not been adulterated, shall not be guilty 
 of any crime on account of the lack of proper proportion of food 
 elements in the milk. In the opinion of the Committee the law so 
 amended would have materially weakened the protection afforded 
 to the public against impure and adulterated milk and would have 
 rendered the punishment for violations of the law very difficult if 
 not impossible. As a consequence of the efforts of this Committee 
 and other civic bodies, Governor Dix disapproved of the measure 
 and an attempt to lower the milk standards was definitely defeated 
 in this State. 
 
 1912 
 
 The Committee took active interest in the revision of the City 
 Charter, attempted during Mayor Gaynor's administration. It op- 
 posed the abolition of the Board of Trustees of Bellevue Hospital 
 and the substitution of the Board by a commissioner. 
 
 The Committee advocated the establishment of a Department 
 
 98 
 
of Hospitals, which would have under its jurisdiction all of the 
 hospitals of the City with the possible exception of the hospitals 
 for contagious diseases because of the present police power exer- 
 cised by them under the authority of the Department of Health. 
 
 1913 
 
 The Committee helped the District Attorney in drafting, and 
 afterward supported the bill establishing a better control over the 
 sale and disposition of cocaine, eucaine and other habit-forming 
 drugs, which was presented to the Legislature and passed. 
 
 The Committee took an active interest in the hearings and 
 work of the Commission appointed by Governor Sulzer, in 1913, 
 to draft recommendations with reference to the re-organization of 
 the State Department of Health. 
 
 1914 
 
 In 1914 the Committee opposed the so-called Nelson Bill (As- 
 sembly No. 453) prohibiting dispensaries from charging any fees 
 to anybody for anything. This bill, if enacted into law would 
 have proved prejudicial to the interests of the sick poor of the 
 City, because it would have deprived them of the possibility of 
 obtaining medicine at very low prices. The measure would also 
 have afforded an opportunity for diminished control over dis- 
 pensaries. As a result of the opposition registered by the Com- 
 mittee, as well as other civic and medical bodies, the bill was 
 defeated. 
 
 1915 
 During the 191 5 session of the Legislature, the Committee was 
 forced to oppose several of the measures because of the detri- 
 mental character of the proposed legislation. Among these meas- 
 ures were the so-called Hinman Bills (Assembly No. 1600-1601- 
 1602-1603) which provided for a series of amendments to the new 
 health law which has been considered by sanitarians the country 
 over as one of tlie most constructive and progressive health laws. 
 In the opinion of the Committee the amendments were ill-advised 
 and particularly at the time when the State Department of Health 
 had just passed through a period of re-organization in accordance 
 
 99 
 
with the provisions of the new law and was just beginning to de- 
 velop its activities. Owing to the almost unanimous opposition to 
 the bills on the part of public health and civic bodies, the bills 
 failed of passage. 
 
 The Committee also opposed a bill (Assembly No. 863) in- 
 troduced by Mr. Thorn, which intended to free from the limita- 
 tions of medical practice those engaged in "the practice of Chris- 
 tian Science for the prevention and cure of disease." The Com- 
 mittee pointed out that such an amendment to the law would per- 
 mit the treatment of contagious diseases, such as diphtheria and 
 scarlet fever by persons whose capacity for diagnosis and knowledge 
 of the treatment and means of limiting the spread of these diseases 
 has not been submitted to examination, and are most doubtful. The 
 Committee regarded these contemplated amendments to the law as 
 a distinct menace to public health. The bill was lost. 
 
 During the preparation of the bill abolishing the ofifice of the 
 coroner, the Committee gave advice and help in drafting some of the 
 provisions of the bill, which was enacted into the law the next 
 year. During the same session of the Legislature, a bill was in- 
 troduced in the Assembly by Mr. Tallet (No. 125) amending the 
 health law by striking out the provisions for compulsory vaccina- 
 tion of school children. The Committee opposed the principle of 
 the bill and its application to New York City. As a result an 
 amendment was made exempting from the bill, cities of the ist 
 and 2nd class. In the amended form, the bill passed and became 
 law. 
 
 1916 
 
 In 1916 the Committee took active steps in urging upon Gov- 
 ernor Whitman the veto of the so-called Simpson bill, which passed 
 the Legislature and the purpose of which was to deprive the boards 
 of health of the right possessed by them to regulate traffic condi- 
 tions so as to prevent overcrowding in public conveyances. The 
 Committee pointed out that such a measure would be prejudicial to 
 the public health interests and would, moreover, establish a dan- 
 gerous precedent for further encroachments upon the jurisdiction 
 and powers of municipal boards of health. The Governor vetoed 
 the bill. 
 
 The Committee supported the Hamilton-Fertig bill which aimed 
 
 100 
 
at extending^ the New York City regulations with reference to 
 patent medicines to the whole State. The bill was referred to the 
 Public Health Committees of the Legislature. It has not been re- 
 ported out of Committee. 
 
 The Committee very actively supported the bill for the trans- 
 fer of the quarantine station at the port of New York from State 
 to Federal control and was able to persuade the majority of the 
 legislators of the desirability of the measure. The bill, appointing 
 a Commission to negotiate with the Federal Government for the 
 transfer of the state quarantine establishment was passed on April 
 19th and approved by the Governor on April 27, 1916. 
 
 (Municipal.) 
 Antitoxin. 
 
 In 1912 a resolution was introduced in the Board of AJdermen 
 to discontinue the free distribution of antitoxin on the part of the 
 Board of Health. The Committee appeared before the Board of 
 Aldermen and urged that the resolution be withdrawn. 
 
 Deceptive Advertising. 
 
 The Committee supported the resolution introduced in 1916 
 by Alderman Chorosh making it a misdemeanor to place misleading 
 or deceptive advertisements. 
 
 Sanitary Code. 
 
 In 1912 the Committee called the attention of the Commis- 
 sioner of Health to the insanitary conditions prevailing in certain 
 types of bakeries, food product factories, and stores where food 
 is sold, and to the lack of protection of food products from con- 
 tamination, and suggested that an amendment be added to the 
 Sanitary Code, which would provide that no food shall be offered 
 for sale, be displayed or transported unless adequately protected 
 from dust, flies, or other kind of contamination. 
 
 This suggestion was favorably received by the Board of 
 Health and incorporated into the Sanitary Code. The Committee 
 also co-operated with Dr. Lederle in drawing up regulations for the 
 sale of "loose" or "dipped" milk. 
 
 101 
 
In 1913, during Dr. Lederle's administration the Committee 
 suggested that a clause be added to the City Sanitary Code for the 
 protection of food exposed to contamination by flies and other 
 sources. Accordingly, section 142 of the Sanitary Code was amend- 
 ed to meet the demand. The Committee was also responsible for 
 the inclusion in the Code of another provision regulating the sale 
 of bichloride of mercury. 
 
 The clause dealing with this matter provides that no person 
 shall offer bichloride of mercury for sale except upon a written 
 prescription of a physician or veterinary, and that the tablets be of 
 a distinctive form and color and labeled "poison." 
 
 When in 1913 the matter of granting to the osteopaths the 
 right to sign death certificates came before the Board of Health, 
 the Committee opposed this request on the ground that such a grant 
 of privilege to the osteopaths would lessen the qualification re- 
 quired of those who sign death certificates and that such an ex- 
 tension of the right would tend to make the statistics of the causes 
 of death still less reliable than they are at the present time. 
 
 During the recent revision of the Sanitary Code the Commit- 
 tee took an active interest in the process and gave advice whenever 
 requested by the Commissioner of Health. 
 
 102 
 
INDLX 
 
 Accidents, Street 53 
 
 Adenoid and Tonsil Operations 73 
 
 Advertisements, Patent Medicine and Quack Treatment 85 
 
 Advertising, Deceptive 101 
 
 Aged, Homes for the 69 
 
 Agricultural I^aw, Amendment with reference to Milk 98 
 
 Antitoxin, (Municipal Legislation) 101 
 
 Associated Out-Patient Clinics 70 
 
 Autopsies 57 
 
 Bellevue Hospital, proposed Abolition of Board of Trustees 98 
 
 Bichloride of Mercury, Sanitary Code regulating sale 102 
 
 Blackwell's Island, Workhouse at, (Prison Hospital Wards) 66 
 
 Boards of Health, Bill regulating overcrowding in public conveyances by 100 
 
 Bronx, Contagious Disease Hospital in the 13 
 
 Budget, Studies 1911, 1912 90 
 
 1913 92 
 
 1914, 1915 93 
 
 Cancer Tissue, Free Diagnosis of Suspected 87 
 
 Cardiac Cases, Care of 32 
 
 Cardio-Vascular Diseases, Chronic 39 
 
 Census, New York State, 1915 35 
 
 Certified Milk 49 
 
 Children, Eye Defects 22 
 
 " Gonorrheal Vaginitis 25 
 
 " I/egislation regarding Vaccination 100 
 
 Mental Fatigue 31 
 
 " Municipal Hospital 18 
 
 " Pavilion at the Metropolitan Hospital 19 
 
 " Protection of Health 21 
 
 " Standards for Physical Examination 26 
 
 Christian Science, Thorn Bill regarding 100 
 
 Chronic Cardio-Vascular Diseases 39 
 
 City Employees, Periodic Physical Examination of 39 
 
 Clinical Instruction (Fifth Medical (Student) Year) 58 
 
 Clinics, Associated Out-Patient 70 
 
 Cocaine and Eucaine, Legislation 99 
 
 Committee of One Hundred on National Health 96 
 
 Consolidation of Municipal Hospitals 18 
 
 Contagious Disease Hospitals of the Citj' 9 
 
 " " " in the Bronx and Queens 13 
 
 103 
 
Conveyances, Simpson Bill regarding passenger regulation by Health 
 
 Boards 100 
 
 Coroners 58 
 
 " State Law Abolishing Office of 100 
 
 Croton Water, Turbidity of the , 51 
 
 Death Certificates, Sanitary Code regarding Issue byOsteopaths 102 
 
 Deceptive Advertising 101 
 
 Defective, Care of the Mentally 64 
 
 Degenerative Diseases (Chronic Cardio-Vascular Diseases) 39 
 
 Dental Education 61 
 
 Diseases, Occupational 38 
 
 Dispensary Fees, L/egislation regarding 99 
 
 Drugs, Problem of Addiction 68 
 
 " Restriction of the Sale of Habit Forming 85 
 
 " State Legislation regarding Sale of 99 
 
 " Tariffon 96 
 
 Education, Dental 61 
 
 " Medical 58 
 
 " Nursing 63 
 
 Public Health 56 
 
 Employment Certificates.. 26 
 
 Eucaine and Cocaine, Legislation 99 
 
 Eye Defects in School Children 22 
 
 Factories, Standards for Physical Examination of Children Working in. 26 
 
 Fatigue, Mental . . in School Children 31 
 
 Federal Legislation 95 
 
 Fees, Legislation regarding Dispensary 99 
 
 Fertig-Hamilton Bill regarding Patent Medicines 100 
 
 Fifth Medical (student) year 58 
 
 Food, Pure 48 
 
 " Clause in the Sanitary Code 101 
 
 Free Diagnosis of Suspected Cancer Tissue 87 
 
 Gary System 33 
 
 Gonorrheal Vaginitis in Children 25 
 
 Habit Forming Drugs, Restriction of Sale of 85 
 
 State Legislation 99 
 
 Hamilton-Fertig Bill regarding Patent Medicines 100 
 
 Harbor Pollution 78 
 
 Health, Conditions in Public Schools 21 
 
 " Federation of the City of Nevy York 81 
 
 " Hinman Bills regarding State Law 99 
 
 " Instruction in Medical Schools 56 
 
 " (Sickness) Insurance 53 
 
 of Children 21 
 
 " Re-organization of State Department of 99 
 
 Henry Resolution, Federal Legislation, Standing Committee on Public 
 
 Health and National Quarantine 96 
 
 104 
 
Hinman Bills, regarding New York State Health Law 99 
 
 Homes for the Aged 69 
 
 Hospitals 9 
 
 Children's Pavilion at the Metropolitan Hospital 19 
 
 Consolidation of Municipal Hospitals 18 
 
 Contagious Disease Hospitals for the Boroughs of the Bronx and 
 
 Queens 13 
 
 Municipal Hospital for Children 18 
 
 New York City Contagious Disease Hospital 9 
 
 Proposed L/egislation regarding a Department of Hospitals 98 
 
 Situation in lyower Manhattan 18 
 
 Housing Problems 42 
 
 Immigrants, Physical and Mental Examination of 78 
 
 Immunization, Typhoid 83 
 
 Infants, Overcrowding in Institutions for 33 
 
 Insurance, Health (Sickness) 53 
 
 Kern-McGillicuddy Bill relating to Compensation of Federal Employees 98 
 
 Ivegislation, Federal 95 
 
 " Municipal 101 
 
 State 98 
 
 Manhattan, Hospital Situation in the l/ower Part of 18 
 
 Medical Schools, Public Health Instruction in 56 
 
 Mental (and Physical) Examination of Immigrants 78 
 
 Mental Fatigue in School Children 31 
 
 Mentally Defective, Care of 64 
 
 Metropolitan Hospital, Children's Pavilion at 19 
 
 Milk, Certified 49 
 
 " City Sanitary Code regarding 101 
 
 " State Ivegislation regarding 98 
 
 Mohansic Lake, Sewage Disposal into 52 
 
 Morbidity Statistics 35 
 
 Municipal Budget, Studies, 1911, 1912 90 
 
 1913 92 
 
 1914, 1915 93 
 
 Municipal Civil Service Commission 89 
 
 Municipal Hospitals, Consolidation of 18 
 
 for Children 18 
 
 Municipal Legislation 101 
 
 Myopia in School Children 22 
 
 National Health, Committee of One-Hundred on 96 
 
 Nelson Bill regarding Dispensary Fees 99 
 
 New Contagious Disease Hospitals for the Boroughs of the Bronx and 
 
 Queens 13 
 
 New York City Charter, Revision of 98 
 
 New York City Sewage Problem 78 
 
 New York State Census, 1915 35 
 
 Nursing Education 63 
 
 Nutrition, Pure Food and Proper 48 
 
 Occupational Diseases 38 
 
 Open Air Classes in Schools 29 
 
 Operations, Tonsil and Adenoid 73 
 
 105 
 
Organization of the Public Health Committee 5 
 
 Scope of the Work 7 
 
 Osteopaths, Sanitary Code regarding 102 
 
 Out-Patient Clinics Associated 70 
 
 Overcrowding in Institutions for Infants 33 
 
 Overcrowding in Public Conveyances 100 
 
 Owen Bill, Federal Department of Health 95 
 
 Patent Medicine and Quack Treatment Advertisements 85 
 
 Hamilton-Fertig Bill 100 
 
 Periodic Physical Examination of City Employees 39 
 
 Physical and Mental Examination of Immigrants 78. 
 
 Physical Examination of Children between the ages of 14 and 16 years 
 
 Working in Fcatories, standards for 26. 
 
 Police Department, Co-operation witli 88. 
 
 Pollution of the Harhor 78, 
 
 Prison Hospital Wards (Workhouse on Blackwell's Island) 66 
 
 Protection of the Health of Children 21 
 
 Public Health Instruction in Medical Schools 56 
 
 Public Schools, Health Conditions in 21 
 
 Pure F< od and Proper Nutrition 48 
 
 Quack Treatment and Patent Medicine Advertisements 85 
 
 Quarantine 75 
 
 State Legislation 101 
 
 Queens, Contagious Disease Hospitals in 13 
 
 Regulation of Patent Medicines 100 
 
 Re-organization of State Department of Health 99 
 
 Resuscitation of the Appa ently Drowned 84 
 
 Revision of the Sanitary Code 101 
 
 Sanitary Aspects of the Subway 52 
 
 Sanitary Code, Revision of •. 101 
 
 Sewage Disposal into Mohansic Lake 52 
 
 Sickness (Health) Insurance 53 
 
 Simpson Bill regarding Boards of Health and PuMic Conveyances 100 
 
 Standards for Physical Examination of Children between the ages of 14 
 
 and 16 years working in Factories 26 
 
 State Health Legislation 98 
 
 Statistics in the City of New York, Vital 34 
 
 " " " " " " Morbidity 35 
 
 Street Accidents 53 
 
 Street Cleaning 42 
 
 Student Year (Fifth Medical Year) 58 
 
 Subway, Sanitary Aspects of the 52 
 
 Tallett Bill regarding Vaccination 100 
 
 Tariff on Drugs and Scientific Instruments 96 
 
 Te.cher Mothers 46 
 
 Thorn Bill regarding Christian Science 100 
 
 Tonsil and Adenoid Operations 73 
 
 Turbidity of the Croton Water 51 
 
 Twilight Sleep 86 
 
 Typhoid Immunization 83 
 
 Vaccination 86 
 
 " Tallett Bill (State) regarding 100 
 
 Vaginitis, Gonorrheal, in Children ....• 25 
 
 Venereal Diseases 71 
 
 Wards, Prison Hospital 66 
 
 Water, Turbidity of the Croton 51 
 
 Whooping Cough 26 
 
 Workhouse on Bl^ckwell s Island, Hospital Wards at 66 
 
 Work's Resolution, Senator 96 
 
 106 
 
J