[Public Health in New York State]
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[Edward S. Godfrey, Jr. M.D. Commissioner of Health]
We are convinced that full time health service can be rendered New York State citizens most effectively under a district plan of administration.
Ready? State health districts and subdistricts are now in operation or will be in operation at an early date.
[Map of health districts in New York State.]
The five county health departments are integral parts of their respective districts. Suitable quarters are provided for district offices, such as those at Albany and Buffalo.
A full time district state health officer is in charge of each district. Civil service qualifications for new district officers include a medical degree, a post graduate course in public health and five years full time experience.
[Organization chart of the District Health Service]
The district officer is the commissioner's representative and authorized to act for him. He has available for technical advice the directors of the eleven divisions and two district health directors.
Besides the district officer, the average district staff includes an assistant district officer, a district supervising nurse, one or more engineers, supervising-in-field public health nurses, and a clerical staff.
Full records are kept in all district offices, such as syphilis and tuberculosis registers, maintained and checked according to the status of each case.
District offices conduct the state program through seven hundred and ninety eight local health officers and five county health commissioners. There are frequent conferences with local health officers.
When serious epidemics or unusual circumstances occur, assistance is given to the district officer by temporary assignments from other districts, or the central office. District staffs are flexible and not subject to local authority.
An important function of the district officer is the preliminary field training of young physician and participation and selection for physicians for academic post graduate training and careers in public health.
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The district state supervising nurse supervises nurses employed by the department, as well as many employed locally. She has a responsibility for the training and selection of nurses similar to that of the district officer for physicians.
The district officer has a part in all the departments' major activity.
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[Maternity]
New York State is now conducting an experimental field study to determine the feasibility of nursing delivery service as part of the generalized nursing program in a rural county.
Because of persistently high infant mortality, preponderance of home delivery and maternal deaths chiefly in rural sections, St. Lawrence County was selected.
Conferences were held of state and local health officials and with local physicians, hospital and welfare representatives. The country was zoned for accessibility. Ten nurses and a supervising nurse who was mid-wife trained were assigned.
The nurses were equipped with cars, fitted bags, and electric lanterns as well as strong snow shovels. Nurses instruct prospective mothers and help them make their preparations.
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Obstetric packages for use by the doctors in home deliveries were made and assembled in WPA sewing rooms and by volunteer groups of women. The nurses supervised the work and assembled the packages for sterilizing at the local milk plant.
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The doctor, arriving for a delivery finds a nurse in charge, room and patient prepared, and hot water ready. Towels and sterile supplies are waiting in the package. The electric lantern is better than the kerosene lamp, and the nurse is a willing efficient helper.
Nurse returns next morning to bathe baby, care for mother, and instruct neighbor or relative. This doctor believes the service is meeting a real need and appreciates the work of the nurses,
who in addition to general duties, have assisted at eighty four home deliveries and supervised four hundred and thirty one patients during the first six months of the demonstration.
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[Sanitation]
Engineering is a major branch of public health work. Reduction in typhoid fever in New York State has been due in large measures to the control exercised by the Division of Sanitation over water, milk and sewage disposal.
Engineers supervise the sanitary quality of water supplied to more than twelve million persons.
Over ninety percent of the water consumed in New York State receives treatment. Many water purification plants have been constructed as a result of recommendations made by department engineers.
Water supplies are inspected frequently and subjected to routine bacteriological tests at regular intervals.
In milk-borne disease outbreaks, all suspected cows are examined by a department veterinarian. For assured safety the department urges the use of pasteurized milk. Pasteurizing plants are inspected frequently.
Routine tests used in laboratory-controlled milk supplies are the direct microscopic count to determine quality of the raw product, the phosphatase test to determine the thoroughness of the pasteurization of the milk, and the Coli test to detect contamination after pasteurization.
Pollution of streams is being abated by requiring install of sewage treatment plant, regularly inspected by department engineers. More than one hundred plants have been constructed in New York State since 1930.
Plans for all sewage improvements must receive approval of the Division of Sanitation prior to construction. In five years the value of works represented by such plans has amounted to more than one hundred million dollars.
Two thousand swimming pools throughout the state are supervised by the division as well as three thousand summer and tourist camps, which provide accommodations annually for two million persons.
Routine work of the Division of Sanitation is expedited by the assignment of district engineers and milk sanitarians through the staff of the various state health districts, enabling prompt service to be rendered in connection with any sanitary problems arising within the district.
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[Pneumonia]
New York State's program for the control of pneumonia embraces a variety of activities. Anti-pneumococcus serums for the treatment of the five types for which it has been proved of value are produced and dispensed at no cost to physicians.
Diagnostic serums for six types are dispensed to one hundred and twelve approved laboratories and typing stations. Sputum is examined immediately by the [Novale?] technique.
Virulent flecks are mixed with each type of serum and examined. Blood cultures are highly important in cases of pneumonia.
Extensive graduate medical education is being undertaken in cooperation with the New York State Medical Society.
Every available means of reaching the medical profession is being utilized in the belief that earlier diagnosis and wider and more adequate use of the serum is now available may result.
The need for teaching the general public the seriousness of certain of the early symptoms of pneumonia and the urgency of medical care is recognized. The mere availability of serum is insufficient, unless an enlightened public makes its early use possible.
Skillful nursing care is important. Public health nurses throughout the state are devoting increasing time to bedside care, as well as to teaching demonstrations for pneumonia cases.
The New York State Nurses Association is cooperating with the state health department in graduate education of its members.
Research has resulted in further advances in the methods of production and refinement of the therapeutic serums.
A series of sixteen hundred and sixty Type 1 pneumonia cases treated with serum produced and dispensed by the department was accumulated during the first twenty months of the program.
Fairly complete data are available on all of these and their careful analysis gives promise of adding substantially to our knowledge of the limitations, requisites and potentialities of serum treatment as a method of pneumonia control.
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[Cancer]
The state of New York owns and maintains the oldest cancer research laboratory in the world, established in 1898.
This hospital located in Buffalo, and called The State Institute for the Study of Malignant Disease, has research facilities in all branches of science and a bed capacity of a hundred and thirty after completion of a new wing.
The state institute is equipped with a complete surgical department and modern X-ray and radium appliances for the diagnosis and treatment of malignant disease.
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There are eight grams of radium at the state institute-- two in solutions and six grams of the insoluble salt. As much radium as is possessed by any hospital in the world.
As radium in solution disintegrate, it gives off a gas which can be utilized only after visiting move from solution by means of oil and mercury pumps.
Modern shock proof x-ray machines are available for the treatment of malignant growth.
Last year three thousand six hundred and forty five new patients were admitted to this hospital for diagnosis and treatment. This service is free to all residents of New York State who I recommended for examination and treatment for their family physicians.
An expensive educational program is being carried on for the purpose of dispelling fear of cancer, and impressing upon the laity that there is a cure if the disease is recognized in its early stages.
It is always born in mind that this is primarily an institute for the study of malignant disease and every opportunity is embraced to conduct a continuous program of research in the unsolved problems of cancer control.
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[Orthopedics]
Since 1916, New York state has been re-building its crippled children and now spends more than one and a half million dollars annually on their rehabilitation and education.
Through efforts of the orthopedic nurses and family physicians, they are brought to clinics for examination by an orthopedic surgeon.
If a child has a condition that can definitely be improved, arrangements are made to admit the youngster to a local institution that meets the state requirements, or to the New York State Reconstruction Home at West Haverstraw.
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Here specialized surgery is available when needed. Hospital care by specially trained nurses guards the child if an operation is necessary. Physiotherapy aids his recovery.
Trained teachers work with him so that when he goes home he will be able to follow along with this schoolmates. Outside activities keep the youngsters busy and happy.
Some of them have reached a point where their physical condition will permit them to carry on restricted activities on the playground.
A twelve-piece orchestra furnishes music at the institution and plays at the annual state health conference at Saratoga Springs.
You are listening to it now, playing a selection which is used as a theme music of the state health department's weekly radio program.
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When the patient is ready to leave the reconstruction home, she is returned to her home and family physician under the care of the orthopedic nurse and a field clinic service conducted by the State Department of Health.
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[Tuberculosis]
New York state's tuberculosis case finding program is based on the fact that the control of tuberculosis depends on the prevention of spread of tuberculosis infection.
This can be accomplished by segregation, treatment, and education of the open cases of tuberculosis and by going out into the field and finding cases.
Tuberculosis is a family problem and the most fertile source for finding new cases is among close household contacts of those having the disease.
Early discovery of tuberculosis means early recovery. To that end our efforts should be devoted. Early tuberculosis is not characterized by any special signs or symptoms.
And we should investigate other possible fertile sources for finding early cases. These men have been x-rayed. X-ray is our most valuable ally in discovering the disease in its earliest stages.
And these workers too have been x-rayed.
These normal school students, mostly young women at the age of greatest perceptibility to adult type pulmonary tuberculosis are tuberculin tested and x-rayed yearly until graduation. Consecutive admissions to general hospitals are x-rayed.
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This patient had advanced disease when discovered. His treatment is prolonged, his prognosis is dubious. The cost to himself, family, and community is great.
On the other hand, this patient was discovered early and after a suitable length of observation and treatment is well on the road to complete rehabilitation. It is real economy to spend money and effort to find the early case.
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[Education]
Public health programs are effective only so far as they are taken to, understood, and accepted by the public.
Frequent press stories are released to news services, local correspondents and the one hundred and thirty dailies and five hundred and forty weeklies in New York State.
Health news is sent every week to fourteen thousand physicians, nurses, hospitals, libraries, public health workers, and other in directed individuals and agencies. Qualified experts prepare special stories and pamphlets on health subjects.
During the first nine months of 1937, one million two hundred and seventy five thousand of these educational pamphlets were distributed. From the beginning, visual instruction has been foremost among health education aids in New York.
Now sixteen and thirty five millimeter cameras record the progress of public health and silent and sound projectors spread the story as told in a library of fifty film subjects.
The health-mobile rolls over paved roads and country lanes with this equipment, as well as exhibits and displays and other portable educational material.
Probably the most intimate approach into the homes of the people with the state's health message is radio. Each week since August 1933, health plays written, acted and produced entirely within the State Department of Health have been presented by WGY Schenectady.
Now, by means of electrical transcription recordings, these programs are broadcast throughout the state over a chain of nineteen other radio stations.
Then these electrical transcriptions are available by means of portable sound equipment for use before granges, parent-teacher associations, school classes, women's organizations, service clubs, and similar groups.
From radio alone, since the beginning of the weekly play series, responses have been received from seven hundred and forty five different cities and villages in the state. Health education is reaching the people of New York State.
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[This picture was prepared for the 66th annual meeting of the American Public Health Association to indicate certain of the significant activities of the New York State Department of Health at that time.
It should not in any way be considered as outlining the entire public health program in New York State nor as being complete in every detail of the subjects presented.]
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[The End]
[Produced by Division of Public Health Education New York State Department of Health Copyright, 1937]