A SANITARY SURVEY 0 F UTICA NEW YORK b y Arthur William Wright 1 9 2 3 INDEX PAGE INTRODUCTION J" History Geography Climate Geology Population Department of Health Other Information About the City WATER >5 Water shed, Sources of Pollution, Methods of collection, storage, and purification Public and Private Wells Analysis of Water and Interpretation Analysis of Water in Laboratory SWAGE System of Disposal Efficiency Relation to Health of this and Other Towns Criticism of the System GARBAGE, REFUSE, AND ASHES 4t Garbage - Method of Collection Disposal Relation to Health Criticism of Methods Refuse and Ashes - Method of Collection Disposal Relation to Health Criticism of Methods VITAL STATISTICS 47 Population Birth Rates Death Rates Infant Mortality Specific Rates for: Typhoid Fever Tuberculosis Measles Scarlet Fever Sanpies of Blanks used by Department of Health MILK 65 Source of milk, pasteurisation, etc. Grades of Milk, Milk certified, etc. Sanitary Condition of Farm (Score Card) Analysis of Milk in Laboratory PAGE SANITARY NUISANCES 7T Sources of Odors Dust Rubbish and General Cleanliness Flies and Mosquitoes Stables and Manure Rats and Vermin Smoke Unnecessary Noises Piggeries Legal Definition of ''Nuisance" and Method of Abatement• INDUSTRIAL HYGIENE 8o Report on visit to a Cotton Mill HOUSING 86 Sanitary Condition of a Tenement Ventilation of a Large Office Building INFECTIOUS DISEASES 91 List of Diseases Which Are Notifiable Quarantine Regulations Methods of Disinfection and Fumigation Measures Taken to Prevent Spread of Tuberculosis Measures Taken to Control Epidemics Venereal Diseases - Reporting and Control SCHOOLS 1015 Visit to Utica Free Academy Medical Inspection of School Children Diseases for Which Children are Excluded from School MISCELLANEOUS 11$ Markets Provision Stores and Soda Fountains Slaughter Houses and Meat Inspection Cold Storage Plants Kitchens of Hotels and Restaurants Wharves Barber Shops Distribution of Educational Pamphlets Other Activities of the Department of Health District Nursing and Social Service Charitable Institutions City Planning Food and Drug Administration GENERAL SUMMARY 1JG Conditions Found and Criticisms Recommendations B I B L I 0 G R A PHY Outline History of Utica and. Vicinity New Century Glut) The Upper Mohawk Valley Utica Gas and. Electric Co. Report of Survey of Utica School System 191$ State Dep't of Education The Second. Class Citie's Law of New York The Public Health Law of New York The Penal Law of New York The Sanitary Code Annual Reports of the State Department of Health, New York, 1910 to 1921 Medical Inspection in the Public Schools State Dep't of Education 3 INTRO I) U C T I 0 N 4 INTRODUCT ION HISTORY, Utica, the largest city or Oneida County and the "heart of the Empire State", was first settled a few years after the close of the Revolution when the tide of immigration began pouring into Central New York from New England, The soil was originally part of the vast domain over which the Iriquois Confederacy held sway, but the Iriquois became allied with Eng- land in the war which the colonists waged for independence, and as a result forfeited their lands to the victorious Amer- icans in 1778, "Old Fort Schuyler", the original settlement, was built in 1758 "by the English during the French and Indian Wars. Up to the Revolution this fort was nothing more than a small outpost with little in the way of natural advantages to attract the pioneer. Yet the excellent facilities afforded at this point for the transportation of supplies had early marked it as an important trading post. After the war for Independence this fording place on the Mohawk River gradually took upon it- self the character of a village as the early traders and mechan- ics began to locate in the vicinity of Old Fort Schuyler. In 1794- a new road was started by grant of the legislature into the "Genesee Country" and this was completed in 1797» The little settlement then began to grow more rapidly, The men of Old Fort Schuyler now felt the need of a formal organization and they, therefore, applied to the legis- 3 lature for an act of incorporation which was passed in The village took the name of "Utica", a name which, according to the story, was chosen hy lot. A second charter and a third charter followed in 1805 and 1B17, and by the third Utica was made a separate town. In 18}! the population of Utica was about ten thousand, having grown from "a pretty village con- taining fifty houses", (according to President Dwight of Yale), in 1798. In November, , a meeting of citizens was called to consider the subject of asking the legislature for city privileges with the result that, in 1832, Utica became in- corporated as a city under the laws of the state of New York. From this time on the city has grown steadily and rapidly, be- coming an important manufacturing city of the Mohawk Valley. It is today one of the great manufacturing centers of central New York, the seat of numerous cotton, woolen, and knitting mills. Its present population is ninety-five thousand, and in every way Utica is an active, progressive, and up-to-date city. GEOGRAPHY. Utica is situated in the south-east corner of Oneida County, lat, 45° 06* N, long. 75° 15' W of Greenwich. The city is built upon a side hill and the average elevation I above sea level is 500 feet. The upper sections are dry, but the lower parts are built on land that was originally swampy. There was a narrow, gravelly ridge running parallel with the river and a second slighter ridge at right angles to it extend- ing a short distance up the hill. With this exception the low- er part of the city was marsh land. The Mohawk is here a slow- 6 moving river laden with soil and running through broad, grassy meadows. These meadows are subject to overflow in spring and are very fertile. The historic Erie Canal, completed in tra- verses the city from southeast to northwest. Its opening gave a big impetus to the early growth of the valley in which Utica is situated. CLIMATE. The average temperature of the upper Mohawk valley is 45° but variations are marked, But the city is also on the east border of the lower Lake region and in summer has about the same temperature. In winter the temperature is considerably be- low that of the Lake region partly because Utica is exposed to northerly winds that have not passed over Lake Ontario, and part- ly because, being in a deep valley, it is subjected to local cooling by nocturnal downflow of cold air from the hills on all sides. The mean cloudiness is excessive, 6.4 on a scale of 10, as great as that of Oswego on Lake Ontario and greater than that of towns on the New England coast. The humidity is great. Pro- bability of rain on any day is greater in this region than else- where in the United States. The mean annual precipitation in New York State is 36.5 inches; that of Utica is 4J.0? inches. The average snow-fall is 153.? inches. The prevailing winds are easterly and westerly, GEOLOGY. *5The vicinity of Utica is one of the best localities in the United States for a young student to begin the study of stratigraphic geology and palaeontology," wrote C. D. Walcott, Director of the United States Geologic Survey. Of the fifteen 7 central counties of New York State, Oneida County has the great- est number of different kinds of rock. Sixteen fairly distinct geological horizons have representation in the region round about our city, and of these sixteen five, namely, the Trenton, the Utica, the Oriskany, the Clinton, and the Oneida, have their typ- ical development here and take their names from our local geo- graphy. Abundant evidence of glaciation exists in Utica, Great boulders both north and south of the Mohawk, kettle holes, sand plains, and drift benches all have their story to tell. The soil of Utica is of excellent quality due mainly to three causes: (a) the decomposition of shale so full of carbon, making the best dairy land in the state; (b) abundant glacial drift; (c) the rich deposits of the Mohawk, POPULATION. The population in 1890 was 4-4,007; in 1900, in 1910, 74,41?; and in , 94,156. In the last three years the city has grown greatly and the estimated population at present, (1923), is 104,000. Being on the eastern boundary of "the first westward extension of New England", Utica had, at the end of the last century, fewer people of Dutch and Palatine German, and more of English, ancestry than have the towns immed- iately east and "down the valley". The idiom of the people is that of New England rather than that of the Mohawk Valley or the Hudson Valley, and the pronunciation differs but little from that of New England. Of recent years, however, there has been an in- flux of Italian, German, and Irish immigrants keeping pace with the rapid growth of manufacturing, and these foreign-born now form a good proportion of the inhabitants. At the present time <8 nearly one-third of the inhabitants of Utica are for- eign-born. An- other third is composed of native- born of foreign or mixed parent- age. This fact that the native- born whites of native parents forms relatively the smallest port- ion of the pop- ulation in the city of Utica is unique and of comparatively recent development. The relation of this highly cosmopolitan type of population to the local education problem is evident. Binghampton The U. S. Schenectady N. Y. State Utica Chart showing the percentage of native and foreign population of Utica, 1510 ■■■Native white of native white parents Ezzzzzza Foreign horn white <in»un>Native white of foreign or mixed parentage ■■ Negro Chart showing the percentage of native white population of native parentage in three cities, New York State, and the United States. J THE DEPARTLENT OF HEALTH. There is no Board of Health as such in Utica. In 1%)€ the city was incorporated in the state of New York under the "Second Class Cities Law", and the org- anization formerly functioning as the Board of Health was a- holished and in its stead a Department of Public Safety was cre- ated at the head of which is a Commissioner of Public Safety who is appointed by the Mayor. The Commissioner may appoint a deputy and a Health Officer, and he has jurisdiction and control over the police, fire, and health departments. His authority is lim- ited only by ordinance of the Common Council and by the laws of the state of New York. The Department of Health, then, comes under the juris- diction of the Commissioner of Public Safety who ''shall exercise all the powers and be charged with all the duties conferred upon or required of local Boards of Health by the laws of the state in so far as the same pertains to cities" with certain limitations and additions which are specifically defined. The Health Officer, who is appointed by the Commissioner of Public Safety, must be a physician who has practised as such for at least ten years pre- ceding his appointment. The Health Officer may appoint a deputy and such other assistants and sanitary experts as may be required to carry into effect the work of the department. In Utica there are the following assistants in addition to the deputy Health Officer: two registrars, three milk inspectors, five meat in- spectors, a disinfector, a veterinary, five health nurses, three sanitary inspectors, and two plumbing inspectors who work through a plumbing board. The Health Officer may inspect and advise as to proper 10 heating, ventilation, and drainage of public buildings under the control of the city", and he may take such measures as he sees fit to enforce existing health laws. "All plans for sewers and drains" must be submitted to him for his approval and may not be carried out without such approval. The law also provides for the division of the city by the Commissioner of Public Safety into not more than twelve dis- tricts which are called "health districts", and a health physician is appointed by the Commissioner to serve in each district. Their duties are to render care and attention to the poor of the dis- trict. For this work they receive a salary which is fixed by the Commissioner of Public Safety. Utica is divided into five health districts and excellent work is being carried out by the district workers, both physicians and nurses. The Commissioner of Public Safety is also authorized to restrain and abate nusiances of all kinds whenever they threaten the health of the community. Finally,"in case of great and imminent peril to the public health of the city by reason of impending pestilence", the Commissioner may take prompt action with the sanction of the Common Council if great expenditures are needed. If the Council cannot be quickly convened, then action is taken and authority for expenditure of city funds is got from the Board of Estimate. The public health should be preserved at all costs. In all other ways the Health Officer works under the provisions of the Public Health Law of the state which defines all the duties and powers of the department of health. The state 11 is divided, into "sanitary districts" over which is a sanitary supervisor. This officer exercises a sort of general control over the work in his district and is responsible to the State Commissioner of Public Health in Albany. In this way, then, in the health of the city of Utica taken care of. The Commissioner of Public Safety is active and aggressive. The Health Officer, too, is a very busy man, thoro- ughly alive to the importance of his position. The whole de- partment gets great support and encouragement from the Mayor of the city who happens to be a practising physician of more than local repute. OTHER INFORMATION ABOUT THE CITY. Fire Department. This is a highly efficient and up-to-date organization of one hundred and fifty-four men, including a chief and his deputies. It, as well as the police department, is under the jurisdiction of the Commissioner of Public Safety. The apparatus is entirely motorized and there are ten fire stations equipped in the most modern manner. One hundred and eighty-four call boxes are dis- tributed throughout the city and these are tested at frequent intervals. An adequate water supply is assured through twelve hundred eighty-nine fire hydrants, the locations of which may be obtained by studying the appended map. In five hundred and seventy alarms were answered and of these four hundred and ninety-seven were actual fires. The fire loss for the year was two hundred eighty-seven thousand dollars on property beard- ing a total insurance valuation of very nearly six millions of dollars. 12 Police Department. This consists of one hundred twenty-two men and a matron. The organization is highly efficient and in 1922 ninety-six hundred cases of all kinds were taken care of. Parks and Playgrounds. Utica has over seven hundred acres of public parks which are under the control of the Department of Parks. Two of these parks are as old as Utica itself, but the majority represent the gift to the city by a prominent and pub- lic-spirited citizen who gave over six hundred acres to be used as parks and play-grounds. In all there are twelve or fourteen parks of which the largest are Roscoe Conkling Park, Thomas R. Proctor Park, and the Frederick T. Proctor Park. In addition to these public parks there are fifteen playgrounds under the dir- ection of a Recreation Commission, and children play here under the direction of trained workers. In 1?22 nearly a hundred thousand dollars were spent by the city in maintaining the parks and playgrounds. In summer all kinds of out-door sports may be played in the parks and in winter tobogganing, skiing, snowshoeing, and skating may be enjoyed without fear of accident from street traffic. Indeed the very environs of Utica are like a large park, and a short trip on foot or by trolley will take one into the open country. So there is no want of space for playgrounds for the children of the city. Industries and Banks, There are about four hundred manu- facturing plants in Utica, varying in size from very small ones to great factories which cover several acres of ground. Over eighty million dollars are invested in these enterprises and the value of the production is not far short of a hundred million dollars annually. More than twenty thousand persons are employed 13 Public parks Cihi Map showing the Public Parks and Playgrounds Maintained by the City of Utica 14 in these industries and the annual pay-roll nearly reaches the twenty-five million dollar mark. The materials produced in these great factories vary very much, but the great majority of the articles put out consist of highly specialized commodities such as fishing-rods, fire-alarm systems, police call systems, knit underwear (about one-tenth of all the knit goods manufactured in the United States), metal beds, tools, textiles, heating systems, steam boilers, and clothing. Utica is, therefore, an industrial city - one which has slowly grown to occupy a high position and which is going to keep it or grow still higher. These industries are backed by nine financial institutions of recognized standing which have a combined capital of nearly five millions of dollars. T5 WATER Map showing the Water Sheds, Storage Reservoirs, and pipe Lines of The Utica Consolidated water Company which supplies the city witn its complete water supply. W A T E R All the water used by the city of Utica is furnished by the Consolidated Water Company of Utica, a private enter- prise which has its offices in the city and which maintains a large staff of workers who keep the system in operation. THE WATER SHED. The water supply comes from three sources of which the first is by far the largest: (t) the Northern Water Shed of West Canada and Black Creeks, about twenty-five miles from the city, which covers an area of about four hundred square miles; (2) the Reel's Creek Shed, of about four and a half square miles; and (3) the Southern Water Shed, of six square miles. Of these the Northern Shed is the most important and it, along with the Reel's Creek area, furnishes over eighty per cent of the water supply of the city. The north and south branches of West Canada Creek join about ten miles from the big Hinckley Reservoir to form West Canada Creek into which, about five miles further down, Four Mie Creek runs. West Canada Creek empties its waters into the large storage reservoir called the Hinckley Reservoir which is about twenty miles from the city. This is the largest reservoir of the Consolidated Water Company's system. It is about eight miles long and from one-half to two or three miles in width. An eighty-foot dam has been built near the town of Hinckley and this has increased the capacity of the lake to 25,500,000,000 gal- IB Ions. The elevation of this reservoir is eleven hundred twenty- five feet above sea level. From this reservoir the water is carried through the Marcy standpipe about eight miles from Utica at an elevation of nine hundred fifty-five feet. Here the line divides into two branches, as shown in the maps which are in- cluded in this section. One of these branches enters the small Marcy reservoir which has a capacity of 15♦000,000 gallons, and the water is distributed from here to the city through a twenty- four-inch main. The second branch is carried to the Beerfield reservoir, the capacity of which is 106,500,000 gallons. This reservoir is at an elevation of seven hundred feet. It also re- ceives water from the small Reel* s Creek water shed which is close by. From this storage area the water is taken to the city by a twenty-inch main. This system takes care of by far the largest volume of water used by the city, usually about 9.000,000 gallons a day. The water is conducted to the city entirely by gravity and there is no pumping of water at any point. To the south of the city, however, to be used in case of necessity and when the amount of water consumption is large, is the Southern Shed which drains into three reservoirs, the Golden, Hopper, and Cascade storage areas with a total capacity of about 500,000,000 gallons. These reservoirs are kept filled by large pumping stations which are indicated on the map on the next page. When the load is high these reservoirs come in to help, but at night the system is entirely shut off. From this Southern system about 2,500,000 gallons of water are used daily. Elevation of these reservoirs is from six to seven hundred feet. 1? CONSOLI0 AT E t? Water Co OF UTICA.Nl V Scheme of water Supply September obo Scheme of Utica's Water Supply The large water shed is entirely too great to go over on foot since it covers such a vast area. The HinOkley Reservoir alone is six or eight miles long. But the water company is tak- ing many precautions to insure the purity of its water, and be- fore it enters the big reservoir its course and drainage areas have been carefully patrolled by men who are on the watch for sources of pollution. There are several towns and small com- munities scattered about in the northern shed, among these being 20 Hinckley Reservoir Gray, with a population of two hundred; Grant, with about the same population; Northwood, with about a hundred; Wilmurt, with twenty-five; and Ohio, with seventy. Hoffmeister, Moorehouse- ville, and Tarnesda are also included in the shed. The water- shed spreads out into part of three counties, Herkimer, Ham- ilton, and Oneida, but the largest portion is in Herkimer County. Most of the villages situated within the boundaries of the shed are well back from the creeks which empty directly into the Hinckley Reservoir, and every effort is being made to keep the streams and the storage areas free from contamination and poll- ution. A daily patrol is kept up along the borders of the re- servoirs and creeks and employes of the company take care of the disposal of refuse for all persons living in the vicinity of the reservoir or the streams which empty into it, and some idea of what is being done by the water company may be gained from a study of the tables which are included in this report. The northern water shed is patrolled by six men who make a daily trip over a certain area which is assigned to them. They note any sources of contamination or pollution that may be present and either get rid of the nuisance themselves.or bring it 21 to the attention of those who can see that the water supply is protected from ctmt amination. These men follow up the matter to see that it is promptly taken care of. All privies, garbage cans, cess pools, etc., which are located on the water shed or near the reservoirs are either removed to places where they will not be a source of danger, or they are taken care of by the em- ployes of the company if they cannot be moved to a suitable situation. A report for the year 1?21 showing what was done by the company to protect its water supply from contamination follows: Number of privies emptied. Number of .garbage barrels emptied Number of slop barrels emptied Number of cess-pools emptied Number of manure bins emptied Grant 371 346 34? 32 20 Gray 216 214 262 0 2 Northwood (not used in winter) 30 32 7 9 0 By keeping these sources of contamination away from the water supply the water company is doing its "best to give the city water which will satisfy all the conditions required by the Public Health Law for potable waters. On the Southern water shed there are no garbage bar- rels or slop barrels. Instead there are septic tanks which re- quire no emptying since they act as filters. There were, how- ever, 338 privies emptied and cleaned out and 3 manure bins emptied. In all the total number of receptacles emptied and cleaned out on the northern shed was 885, and on the southern shed, 341, making a total of 1230 cleaned in the year 22 The Southern Reservoirs with Water Shed in Distance The water shed to the south of the city is small, hav- ing a total area of about six square miles, and only a few people inhabit it. There were no sanitary nuisances found in this re- gion and the patrol apparently keeps the area in excellent con- dition. The three reservoirs, the Golden, the Hopper, and the Cascade reservoirs, shown in the illustration above, are well- constructed, in a good situation, and the nearest inhabitants live several hundred yards away. The surrounding country is hilly and rolling, with broad meadows and patches of woodland. There is little opportunity for pollution from this region. All the water of the Consolidated Water Company is treated by chlorination. This is done by the Wallace-Tiernan Apparatus, and the Sterilization Data for the year 1921 follows: Deerfield Reservoir Marcy Reservoir Southern Reservoirs Amount Chlorine used 5,067 lbs 5479 lbs 1,000 lbs Amount Water treated 1 ,455 M G 1 ,713 M G 724 M G Average dose (in pts) 1 pt Cl to 2 ,287,000 water 1 pt Cl to 3,500,000 water 1 pt Cl to 6,100,000 water Average dose 1 oz Cl to 18,000 gal water 1 oz Cl to 50 , 700 gal water 0,72 lb Cl to 1 ,000,000 gal water Average Bacteria count Raw Treated 65 39 39 71 69 Per cent reduction 40% 46% 23 At no point in its passage from the reservoirs into the mains of the city is the water filtered and frequently the water drawn from the tap presents a brownish, roily appearance, especially in the spring when the early thaw comes, and in the fall. This alters the taste of the water slightly hut it has caused many of the people of the city to give up using the water supply as a source of drinking water and bottled spring water is used by a large proportion of the people. Complaints are made occasionally to the water company concerning the water de- livered at the tap, but they are not numerous. As they come in the location of the place where the complaint is made from is indicated on a map and a representative is sent out immediately to see what the cause of the trouble is. Usually the trouble is local and easily remedied to the satisfaction of the individ- ual who made the complaint. A sample of the complaints made or the Utica water is given in the table below which gives all the reasons for complaining for the year 1?21: Total number of complaints IB Classification of complaints A. Complaints not justified as shown by investigation Water had bad odor or taste 5 Water tastes badly and cannot drink 0 Water has chlorine in it 0 5 B. Complaints justified Bad odor or taste 11 Muddy and roily water 5 Water has chlorine in it 1 Water has earthy and tarry taste 0 15 . Total IS How complaints were remedied By the manipulation of valves and hydrants By changing meters 24 The Water Company maintains a Sanitary Department which is presided over "by a Biologist who is in full charge of water ex- aminations and the efficient protection of the supply against con- tamination. Daily examinations of the water from all the reser- voirs are conducted to determine hardness, turbidity, color, alkalinity, and odor. A complete chemical examination is made every Saturday and the results are entered in a book provided for the purpose. Bacteriological examinations are made at frequent intervals and in 1?21, 1473 samples were tested bacteriologically both before and after chlorination of the water supply. These examin- ations are made by noting the number of colonies produced from 1 c.c. of the water on a sterile agar plate. The production of gas is also measured when this necessary. It was found in 1921 , for example, that in the reservoir of the northern shed there was an average reduction in the bacteria counts of 40% after chlorination of the water. In the southern system the average reduction was 46%. PUBLIC AND PRIVATE WELLS. These have been condemned complete- ly by the city authorities. In 1917 there were 184 wells in the city and most of these were in a state of questionable purity. At the present time I do not believe that there are any private or public wells in the city. Label used in making weekly examinations CONSOLIDATED WATER COMPANY OF UTICA, N. Y. Results of Bacterial Examination of Water Water From Date Time Counted J st. Plate 2nd. Plate Average Gas 1st Tube Gas 2nd. Tube Remarks 24 hrs. 48 hrs. 24 hrs. 48 hrs. Cat Tap 17 Hr ** S' (,77 k.) 2-0 iDl 5o / I.?* «A) fl (lu/uLt n H: 3o Z O 47 4 5 O &«) O a '7 4; 3 tr O 6?z b) O 1 £ • Z '- oo X o 3 O u 0 h.q. CtuHijt I'r (d ■ 00 "i- 0 H-z. Ho 0 0 t2<Jb i 8 2'00 "X D 0 7 • i % *.O0 1- o 4 s' 4s' / 3 taJciu, aX ofitu \itfLcAjL. 1 % -L0 U 3 5" 0 0 CH <X1xXa- ( i 8 1 0 %:oo S'. )0 Z 0 T. Z 37 46- 30" 0 0 / 0 hy e. I 0 4' s o 2 H-7 Hb 0 ( *1 2 0 tf:3b' z "2. 3? H-b 0 0 I 0 1- X g7 6 6 X 5 **tft» - HtciSa lo 4'3o 2 2. 0 0 1 0 H •' io 2 Z S' 3 0 I XaZa 2- 1 1 i 47 HS* 0 ( h .Y. c. X 1 Hjo > J Ho 0 0 OXCtft <<JU z / OOo x 3 7 II <Jrt-|3 X ( %'OOa. 2 * 43 0 1 WUa 2/ 23 ( 3 HtWzz X ( 23 (d*Z- (p 0 0 1 UZs X 2 S' To 0 0 h ,V • 2 2 3C B iT 0 0 G? > 2 z Zf :)D 2 Jf Sb /' 7 > 3 45 0 0 Y\ If. C , > 3 V; io 2 b 3S ¥0 0 0 41 1 *x 3 4-'/o 2 5' 6' 1 So 0 1 Ai- 4 HjU D6uU) 2 3 : i s' 2 S' % 7i>" ( 7 -Al 4- ${ji\ 23 4-'Of x s' 43 45' 0 0 -x. -*---< J Sample Record of the Bacteriological Examination of Water 26 AN ANALYSIS OF THE WATER AND ITS INTERPRETATION. The water which is stored in the reservoirs which empty immediately into the mains of the city is fairly clear but it usually has a faint yellowish color. It is not cloudy, but it apparently contains a small amount of organic material. This is especially so after a heavy rain or in the spring, and it seems as if quite a little of the water were surface water. Residue. The total residue after evaporation is 4-8 to So parts per million. This is due chiefly to inorganic matter. This is well below the allowable limit and it is probably due very largely to mineral constituents. Hardness. The hardness of any water is due to the presence of certain soluble salts of the alkaline earths, most important of which are calcium and magnesium. Hard water is objectionable for several reasons. It is very unpleasant to the skin and the amount of soap needed to get a lather is much greater that one would need in soft water. This is because "these salts form a curd with the soap instead of a lather, hence more or less of the soap must be wasted on decomposing the lime and magnesium compounds before a lather will form", (Rosenau). It is more ob- jectionable than soft water for both cooking and washing. The analysis of Utica water shows that the hardness varies from JO to 60 parts per million of CaCOj, or from 2.10 to 4.20 Clark degrees. This amount is not excessive, but 6c parts per million is per- haps a little high. Color and Taste. The water as drawn from the tap is fairly clear though slightly yellowish. It may even become more so on standing, a faint, rusty yellow. This is probably due to the *7 oxidation of ferrous salts which are present in very small amount to the insoluble ferric compounds. Organic Matter. The total amount of organic matter present in any sample of water may be determined by measuring the amount of nitrogen present as free ammonia and albuminoid ammonia. The nitrogen in the form of nitrates and nitrites shows the amount of self-purification which the water has undergone. Free Ammonia. The amount of free ammonia in the samples varies between .02 and .05 parts per million. This is well with- in the range of safe water and is well below the allowable limit of .055 parts of free ammonia per million. The free ammonia is, in general, less of a danger signal than the albuminoid ammonia. It means little unless the source of the water supply and the nature of the shed are taken into consideration. Free ammonia represents a late stage in putrifaction of organic matter, but since the shed is perfectly sanitary, we may conclude that the source of most of the free ammonia is mainly from the decomp- osition of chlorides and carbonates. Albuminoid Ammonia. The total amount of this averages between .06 and .OF parts per million, but as water is often called "pure" or sanitary when it contains as high as .54 parts per million, the Utica water is well within the normal limits. The nitrogen in the form of albuminoid ammonia is a fairly accurate index of the amount of organic matter of either animal or vegetable origin, which is held in suspension. The actual source, animal or vege- table, cannot be definitely determined, but one simple, though un- certain, test depends on the rate with which the ammonia comes over into the Nessler tubes in which it is collected. If it comes 2$ over slowly so that the second and third tubes contain gas, then the origin is presumably vegetable. But if it comes over quickly, filling the first tube but giving only a per- ceptible amount in the other two, it is presumably of animal origin. The source of the organic matter in the Utica supply is essentially vegetable in origin and is, therefore, of little significance. Nitrites. These, when present in the water, indicate that active putrifaction of organic matter by bacteria is going on. The presence of nitrites, then, is strong evidence in favor of organic pollution of the water supply. It is a danger signal of special note. They are rarely present in large amounts for they are oxidized to nitrates very readily and quickly. For this reason nitrites in even very small amount may mean pollution and the presence of these compounds may be ground for the con- demnation of the water. The analyses show that nitrites are entirely absent, so the Utica water supply suffers not al all from recent pollution with decomposing organic material. Nitrates. The presence of nitrates in water signifies distant or past pollution. If a water contains an appreciable amount of nitrates and no nitrites one may feel sure that the source of pollution was distant and that the organic matter has been com- pletely oxidized. The water supplied to the city of Utica con- tains from 1.0 to 1,2 parts per million of nitrates. In water considered pure and wholesome the amount of nitrates present is rarely less than 0.3 parts per million and they may run up to 1.6 parts. So the Utica water is an average water in this re- spect. Little is to be feared from the water on account of this amount of nitrates. 2<) Chlorides. To interpret the real significance of the amount of chlorides in any water one must know the normal amount of chlorine in the waters of that region. If there should then he an increase above the normal level, it usually means pollution chiefly from urine. According to the State Department of Health the normal amount of chlorides in water in the region of Utica is 1 to J parts per million. The Utica water supply contains an average of 0.7 to 1 .5 parts chlorine per million and is about normal• Iron. Practically all ground water contains iron and often in amounts which are very objectionable. Utica water contains 0.10 to 0.25 parts per million and since 1 part per million is the low limit of unsatisfactory water, this water is not ob- jectionable. Manganese. This is present in such small quantities that its determination is practically impossible. It forms no problem in the local water supply. Alkalinity. The alkaline reaction of most of the natural waters comes from calcium carbonate, calcium bicarbonate, mag- nesium carbonate, and magnesium bicarbonate. The Utica water has from 20 to 50 parts per million of these salts. Bacteriological Examination. The bacteria count of the water coming from any of the reservoirs after chlorination is anywhere from 20 to 100 per c.c. This is fairly high. In 1921 the general average for the year, in 295 examinations, was 41 bacteria per c.c. In the same year the average number of B. coli per 10 c.c. of water was 11, with an average of 0.9% production of gas. B. coli was, therefore, present in some of the samples, but the average was about 1 colony per c.c. B, typhosus is entirely absent. Conclusion. The water which is supplied to the city of Utica is, therefore, good. It is not as clear as it might be and the bacterial count is perhaps higher than that of the very best water, but is not dangerous. The B. coli are probably of the non-fecal type, but the count should, I believe, be still lower. The water sheds are well protected from pollution and the storage basins are good. Careful and frequent sanitary analyses are proving of great value in keeping the supply pure and wholesome at all times. ANALYSIS OF WATER IN THE LWWQITf. The following results were obtained on analysis of the water from two of the reservoirs of the Utica Consolidated Water Company: • Deerfield (North) Golden (South) Residue of evaporation Parts per 50.00 million 78.00 Free ammonia .02 .05 Albuminoid ammonia .07 .08 Chlorine .70 1.20 Nitrogen as nitrates 1 .00 1.10 Nitrogen as nitrites 0.00 0.00 Hardness 51.00 60,00 Iron .26 .11 Manganese 0.00 0.00 Alkalinity 22.00 46.00 JI SEWAGE y± SEWAGE The question of sewage disposal in Utica is one which has "been, for many years, a great problem, for the present system is quite out of date and not in accord with the most modern prin- ciples of sanitary engineering. It consists briefly of a series of pipes connected as shown in the map which is given on another page, and finally emptying into the Mohawk River through eight separate conduits which allow the diluted sewage, untreated and unstrained, to run into the river. This system has been in use for many years - just how many the city engineer did not know - and until this latest map of the layout was made no one knew exactly where all the conduits were situated. Even now the absolute accuracy of the map cannot be counted on. Up to l?10 plans for the laying of sewers in the city, and the permission to empty the untreated sewage into the rather sluggish and small Mohawk River were apparently approved unconditionally by the State Department of Health at Albany. No complaints about contamination of the river were received by the Health Department and the city simply continued to add new sewer connections to the old system as they were needed, first obtain- ing, of course, the necessary permission from the State Department of Health. In 1910, however, a request from the city of Utica for permission to add new sewer connections to the old system was made to the State De- partment of Health and plans for the new extensions were sub- mitted, The Division of Sanitation of the Health Department went over the matter carefully and finally approved the plans as submitted and issued a permit to carry on the work of building a new extension for the emptying of sewage into the Mohawk River, This permit, however, contained the following condition that, on or before May 1st, 1?H, the city authorities should submit to the State Department of Health for approval, ''satisfactory plans for intercepting and outfall sewers to convey the en- tire sanitary sewage of the city to a suitable site for disposal and that detailed plans pro- viding for partial treatment of the entire sanitary sewage and plans showing works for the complete treatment of the sewage should also be submitted." Accepting the condition as stated by the Health Department, the The 1912 Sewer Outlet into the Mohawk. The Slough near Sewer "C" (1912) 34 city went on with, the construction of the sewer extension which was wanted, at the moment and this was completed in 1912. The outlet of this extension into the river is shown in the first photograph on the preceding page. This sewage conduit is well con- structed and large and is shown on the large map at jC. Instead, how- ever, of emptying into the river itself as do the other two outlets pictured further on, it empties into a filthy, slough-like inlet of the river where the current is nil and the rate of flow of the sewage is very slow and sluggish. The second picture shows a view of this cess- pool of contamination, decomposition, and filth. The stench about the place was awful and the hanks on all sides of the outlet are marked with dirty, greasy lines indicating the height to which the water rose during the spring freshets. The sewage-filled water in the inlet is dirty, greasy, and has a thick, soup-like con- sistency. It seemed to he an ideal place for the breeding of flies and mosquitoes and a definite sanitary menace. The Mohawk River itself is beyond the stretch of land indicated by the arrow in the second picture and even there the current is very slow. Be- fore the sewage can reach the stream, however, it must move slow- ly down the dirty rivulet shown in the picture on this page. Here the current movement is so slow as to be almost imperceptible, and Decomposing matter and. filth near the 1912 outlet 35 the whole picture gives one a feeling of abhorrence and dis- gust. Here, too, is a splendid breeding place for flies and mosquitoes, and they carry up with them all the filth of a city's waste. Such, then is the sewer constructed in 1912 - not only a menace to health but an offence to the senses and a fertile soil for.the breeding of flies, mosquitoes, etc. By May 1st, 1911 , the date set for the submission of plans for a modern disposal plant by the provision in the permit issued in 1910, no plans for extensive improvements had been for- warded to the State Health Department. Time drifted on until June, 1917 when, on application of the city authorities, the time for submission of new plans was extended to May 1st, 1717. This date came and no plans were submitted, but on the 12th of May plans for further extension of the then existing sewer system were sent to Albany for approval. These were returned to the city engineer of Utica without approval and the report on the ex- amination 01 the plans stated that the approval of any method of sewage disposal from the city of Utica would not be considered until plans for the interception and treatment of the entire san- itary sewage of the city were submitted to the Department 01 Health. In June, 1919 the city authorities notified the Health Department that a consulting engineer had been engaged to draw up plans for the interception and disposal of the sewage of the city. With this assurance from the city authorities that a san- itary engineer had been consulted and was then at work, the Health Department issued a permit allowing the building of the extension asked ror in May, 1717 and permitting the discharge of that sewage into the Mohawk River as before. But this permit con- tained a proviso also - to the effect that on or before January 1st, 192C satisfactory plans for the interception and treatment or the sanitary sewage of the city should De submitted lor approval. This final extension or the original sewer system was completed in 192C or 1921 and is now in operation, January 1 st came around and no plans ror a new and approved disposal plant were submitted. The engineering rirm of Hill and Ferguson was engaged to draw up the necessary plans, but in 1920 when a new administration came into being, the work was held, up for some time. Finally, in 1921, the new authorities seemed to forget the old problem or providing a modern sewage disposal plant, and the services of the sonsulting engineers were dispensed with. Since that time no further action has been taken, but from all I could find out the city authorities are bestirring themselves pretty actively now and before long, I believe, plans for two large disposal plants one at the east end and the other at the west end of the city, will be sent to Albany for approval. Both plants will be neat the river and land is now being acquired by the city for this purpose. The village of New Hartford, annexed by the city of Utica in 1922, is provided with a sanitary sewage disposal system of its own in which all its sewage is intercepted, treated, and Outlet "A" on the Map 37 filtered. This, however, is hut a small part of the city system and it is really a separate unit. In every way this small system is highly efficient and is taking care of the sewage of the New Hartford section of the citv in an excellent manner. Just to see a few of the sewage outlets into the Ms- hawk I went down to the river and took several pictures of them. One has already been discussed. It was by far the filth- iest and most unsanitary, A smaller outlet is pictured on the next page back and on this page. It is an old brick conduit in poor state of repair about three feet in diameter. From it a dirty, foul-smelling, black effluent is noured. It does not mix promptly with the water of the river, and for some distance down stream the blackish sewage is quite distinct from the muddy water of the river itself. The bank of the river is filthy and greasy, and the outlet itself is blocked b? old tins, buckets, and a dirty, wooden tub. All in all the outlet gives one the appearance of a very unsanitary manner of sewage dis- posal . Showing line of demarcation "be- tween water of river and sewage General view of location of sewage outlet No. A. J'S The third outlet visited, is the largest of all, being about ten feet in diameter. It pro- jects out into the stream some ten or fifteen feet, and dips five or six feet into the water which must run some distance up into the conduit. The flow is not very rapid, but there is not as much stagnation as there was in the case of the first outlet described. However, the water is very dirty and greasy, and the banks, as shown in the picture, are lined with greasy borders showing the height to which the water rose at various times during the spring freshets. The stench in the air about the exit is bad, but since all these outlets are well away from the city across the freight yards of the New York Central Railroad, the unpleasant odor is not carried to the residential part of the city unless the air is moist and humid and a light wind is drifting from the north down across the river to the city. As far as the efficiency of the system is concerned, the present system is effective in that it gets the sewage into the river and there is little, if any, trouble from blocking of the conduits. All the houses and buildings in the city must by law have sewer connections and the system now takes care of the city's sewage fairly well. However, Utica is growing rapidly, Outlet "B", showing the greasy lines on the hank of the river and the strain will soon he too great. Then new arrangements will have to he made and this, I believe, will result in the building of the new and improved disposal plants. As far as the good health of the city is concerned the present system is cert- ainly not of maximum efficiency. There is no record in the office of the State Com- missioner of Health of any complaints made by villages on the Mohawk River below Utica, so apparently the discharge of sewage into the river has not proved to be as great a menace as it might appear from a visit to the river and the sewer outlets. Twenty- one miles below Utica, at Little Falls, the Mohawk River descends very rapidly, dropping forty-five feet in about half a mile and here the water is pretty well churned up and most of the con- taminating material is thoroughly diluted by that time so that other communities do not complain of the Utica sewage disposal system as a menace to health. No towns or cities below Utica, with the single exception of Cohoes, derive their water supply from the Mohawk. And Cohoes is nearly a hundred miles from Utica so that the river has naturally purified itself considerably before this city is reached. There, as a matter of fact, the water supply is thoroughly filtered and chlorinated before it is delivered into the city mains. Consequently the city of Cohoes has never made any complaint against Utica on account of its emptying untreated sewage into the river from which it gets its drinking water supply. The menace of this system to the health of Utica itself, it seems to me, is quite great. There is much decomposition and 40 putrifaction going on about the outlets and. the area covered, by the thick, soupy, filthy material is very large and. the moving current of the river does not come near it. There is also an objectionable stench which may be carried to the town and, while not actually harmful, perhaps, is not pleasant. Furthermore, some of the outlets and their environs serve as excellent breed- ing places for flies, mosquitoes, and other insects. The whole system, it seems to me, is antiquated and relatively inefficient. It is the easiest method of disposal so the conduits are built and left to operate by themselves with the minimum of worry to the city authorities. The empty- ing of untreated and unfiltered sewage from a large city like Utica into a small river is not a good thing from any point of view, and the sooner the city authorities discover this fact and realize the importance of providing the most modern system of disposal, the better it will be for all concerned. 41 GARBAGE, REFUSE, AND ASHES GARBAGE, B E P U S E, AND ASHES GARBAGE, This is collected "by the city and the work is in charge of the Department of Public Works. Collections are made from private homes and apartments twice a week and the work is done with large, horse-drawn trucks which are usually not covered. The garbage must be placed by the householders in large, covered pails or buckets, not too heavy for a man to lift, and these are called for at the back doors of individual houses or in the basements of apartments or tenements. The receptacles are then returned by the garbage collector. There are usually two men on a team and each team has a prescribed district which it patrols twice a week. From provision houses, markets, and restaurants daily collections are made so that there is adequate removal of organic refuse from these places. This garbage is carried to a large pig farm just out- side the city limits in the village of Deerfield where it is fed to some thousands of hogs. The city is paid for this garbage by the owner of the pig farm and he has a contract with the city to dispose of all its garbage in such a way that it will never be- come a nuisance or be carelessly and indiscriminately thrown away. After each day's work the wagons in which the garbage and city offal have been collected are supposed to be thoroughly washed out, but I am not sure that this provision is carefully carried out, There seemed to be a lack oi' careful supervision of this work. From the standpoint of the individual home-owner this method is efficient in that the garbage is removed from his house twice a week, but the cleanliness of the removal is questionable. The carts should be covered, especially in the summer when flies are prevalent, and at night, when the work for the day is over, the interior of the wagons should be thoroughly cleansed with water and a stiff brush. REFUSE AND ASHES. The collection of refuse and ashes is also under the supervision of the Department of Public Works, but the actual work is let out to a private individ- ual or concern. At the present time Mr. Larry Sullivan is the city ash collector. How much he receives for this work I do not know for the appropriation no one seemed to be able to give me. However, Mr. Sullivan has a large number of trucks which call once a week on a definitely set day for each community, and the ashes and refuse are removed and disposed of as stated below. The materials collected by the Contractor for the Removal of Ashes and Refuse must be segregated into three separate groups or bundles, according to an ordinance passed in 1914 by the Common Council of the City. These three Where the city* s ashes are being dumped, into the old Erie Canal 44 classes are the following: I. This class contains all ashes, street dirt, lawn cut- tings, which must be placed in ash receptacles made of galvanized iron or wood, thoroughly sound and strong. These receptacles must not be too large or too heavy for two men to Lift. 2. The second class consists of all other refuse, in- cluding crockery, stovepipe, discarded tinware, rags, paper, tin cans, bottles, paper boxes, broken glassware, etc. These materials must be placed in strong gal- vanized iron cans or wooden barrels, and they must not be too heavy for two men tc lift. J. The last group consists of con bustible material, such as old fur- niture, wooden boxes, broken barrels, etc., which must be broken up and tied in compact bundles or otherwise arranged so as to be conveniently handled. If there is any violation of this city One of the City Dumps Another City Dumping Ground 45 ordinance, the individual who is guilty of the misdemeanor shall "be punished hy a fine not to exceed fifteen dollars for each offense. The containers mentioned in the above paragraphs must be placed on the sidewalk near the curb in front of the residence on the morning of the day set lor the collecting and they are emptied by the drivers of the wagons. The wagons are large and deep, usually uncovered, and they often cause much dust on windy days. The refuse listed under two above is piled on one of the big dumps on the outskirts of the city. There are three of these and two are illustrated herewith. They are on the banks of the Mohawk River and are not near any habitation. They are in fairly good condition. The ashes are usually employed for filling-in work in the city wherever this may be necessary. Just at present all the ashes are being dumped into the condemned Erie Canal and the sight of this historic old landmark filled with piles of ashes and dirt is wretched indeed. But we are advised to wait until the filling is completed and then the old canal will be trans- formed into a beauty spot'. At the present time it is nothing but an eyesore. This method of ash and refuse collection is working well and the service, as far as I could determine, is very efficient. All combustible material is burned at a central place or the wood given away to the poor. The cost to the city is probably greater under the contract system than it would be 46 if the city handled its own ash and refuse collecting. The system seems to he good from a sanitary point of view and few complaints, if any, are sent into the health officer. 47 VITAL STATISTICS POPULATION Year New York State Utica Albany Syracuse 1910 9,158,52® 74,879 100,35s 138,087 1911 9,271,885 77,088 100,859 142,110 1912 9,402,865 79,297 101,469 146,135 1913 9,555,847 80,246 102,344 146,480 1914 9,664,828 81,060 102,961 146,555 1915 9,795,«io 81,589 107,979 145,293 1916 9,926,791 81,751 109,503 146,754 1917 10,490,680 82,873 111,027 148,175 1918 10,681,667 84,015 112,551 149,616 19-19 10,873,661 85,157 114,075 151,057 1920 10,450,716 95,568 114,018 172,859 4<8 V I TA L STATISTICS The Vital Statistics section of Utica's Health Depart- ment is under the charge of the Division of Vital Statistics in the State Department of Health and the latter organization is one of the most highly organized and efficiently conducted depart- ments of Vital Statistics in the United States, Under the di- rection of this department information of great value is heing collected and compiled, and since 1920 a monthly as well as the regular annual review of Vital Statistics is being issued. In this way the trend of events in the state and all its subdivisions is being carefully followed, and methods of improving hygienic conditions, etc., are being1 introduced with marked effect on the morbidity and mortality rates in the case of specific diseases, on the rate of infant mortality, and on the general death rate. In the tables and charts presented herewith Utica is compared with New York State and two other cities approximately in its own class, although larger, namely, Albany and Syracuse. The population of the state and of these three cities from 1*910 to 1920 inclusive, the years for which statistics were studied, is given on a table which is appended elsewhere. A detailed study of the composition of the population was not made. BIRTH RATES 4? BIRTH rates New Yorl £ State Utica Albany Syracuse Year Total Rate Total Rate Total Rate Total Rate Births per Births per Births per Births per per yr 1000 per yr 1000 per yr 1000 per yr 1000 t9W 213235 23.3 1902 25.4 1369 20.3 1911 221678 23.9 2074 26.9 1404 13.9 3044 21 .4 1912 227120 24.2 2101 26.5 1918 18.9 3065 21 .0 1913 22S713 24.0 2350 29.3 1899 18.6 3084 21.1 1914 240038 24.8 2434 30.8 2115 21.3 3358 24.1 1915 242930 24.8 .2414 30.0 2230 20.7 3535 24.3 1916 240817 24.3 2441 29.9 2283 20.8 3851 26.2 1917 246453 23.5 2561 30.9 2254 ?o.3 4218 28.5 1918 242704 22.7 2517 30.0 2275 20.2 4354 29.1 1919 226269 20.8 2293 26.9 2117 18.6 3992 26.4 1920 235460 22.5 2442 26.2 2294 20.1 4191 24.2 DEATH RATES 50 DEATH RATE New York State Utica Albany Syracuse Year Total Rate Total Rate Total Rate Total Rate Deaths per Deaths per Deaths per Deaths per per yr 1000 per yr 1000 per yr 1000 per yr 1000 1910 147629 16.1 1297 17.3 1943 19.4 2124 15.4 1911 143912 15.7 1442 18.7 2063 20.5 2030 14.3 142377 15.1 1503 19.0 2046 20.2 2177 14.9 1913 145274 15.2 1554 19.4 2025 19.8 2298 15.7 1914 145476 15.1 1547 18.5 1993 20.7 2221 14.1 1915 146?92 15.0 1423 17.7 2075 19.2 2012 13-8 1916 151543 15.3 1635 20.0 2040 18.6 2361 16.1 1917 154127 14.7 1577 19.0 2029 18.3 2438' 16.5 1918 19231*6 18.0 1862 22.2 2555 22.7 3269 21.8 1919 143401 13.2 1218 14.3 1856 16.3 2186 14.5 1920 144466 13.*8 1246 13.3 1786 15.7 2634 15.2 51 BIRTH RATES, DEATH RATES, AND INFANT MORTALITY. Utica has far and away the highest Birth rate of the three cities, for its rate varies from 2J to JI per 1000 living population, while Syracuse is considerably lower, and Albany so low that for sev- eral years its birth rate was well below the death rate. What the cause of this condition in Albany was, I do not know. The probable cause of Utica's high birth rate is the foreign pop- ulation, especially the Italians, for over ten per cent of the city is Italian, and this race is a particularly prolific one. The figures for births in Utica are well above the death rates, even though, in 19lS, the death rate soared to 22 per 1000 living population on account of the fatalities accompanying the influr- enza epidemic. The birth rate curve of the state is about average and it varies within only 4 per 1000 during the eleven years which were studied. After the war, in both cities and state, there was a decline in births generally, and although this de- cline has persisted even through 1920 in both Syracuse and Utica, there is an upward tendency in the birth rate for the state and this has gone on through 1921. Why the sudden jump in the birth rate for Utica should have taken place in 1914 and again in 1917 I do not know. In 1917 the war, bringing with it so many war marriages, might account for a small amount, and in 19lS, this must have been an important factor. After the war, in 1919 and 1920, the local birth rate fell J or 4 per 1000 living population. In Syracuse the peak of the birth rate comes in 1918, when the war influence must have been inportant. The Death Rates of Albany and Utica run strangely par- allel for the period of eleven years studied. All three cities, INFANT MORTALITY >2 INFANT MORTALITY New York State Utica Albany Syarcuse Year Deaths under 1 year Rate per 1000 Deaths under 1 year Rate per 1000 Deaths under 1 year Rate per 1000 Deaths under 1 year Rate per 1000 1910 27534 129 314 165 257 188 448 160 1911 23316 114 320 154 257 183 583 125 1912 24681 109 300 142 262 136 411 134 1913 25044 109 340 144 270 142 447 145 1914 23731 99 288 118 267 126 419 125 1915 24079 99 299 124 274 123 348 98 1916 22731 94 272 111 222 97 383 99 1917 22473 91 259 101 245 109 430 102 1913 23524 97 306 122 244 107 516 119 1919 18976 84 198 86 171 81 365 91 1920 20326 86 202 83 178 81 437 104 53 and the state as well, show the marked rise in death rate in 191$ when the influenza epidemic worked such great havoc. And a study of the death rates of 1918 hy months, shows that there was a tremendous Jump during the months of October and November when the epidemic was at its height. In general, in the cities and the state, there has been quite a decrease in the death rate in 1920 as compared with 191c, Infant Mortality has shown a striking decrease during the eleven years from 1910 to 1920, inclusive. In Utica it dropped from 165 per 1000 living births to 85 per 1000. The infant mortality rate, therefore, has been cut In half in ten years and this may be taken as evidence of excellent work in the spreading of information concerning the early care of the infant, both with respect to feeding and general care. Prenatal and postnatal clinics have been of importance, and baby hygiene sta- tions have done wonderful work. Further evidence of greater knowledge on the part of the mothers and greater care of infants on the part of hygiene stations, etc,, is shown by the fact that in all three cities the decline in infant mortality has been strikingly parallel. In the case of the state, which includes hamlets, villages, and towns, as well as cities, the fall is marked, but not so striking, suggesting that the greatest infant mortality was formerly in the cities and not in the country and small town districts, and that most of the preventive work has been done in the larger centers, especially, in all probability, among the poor working or laboring classes, for these collect in the cities. The infant mortality in Utica has fallen steadily, TYPHOID FEVER T Y PHOID FEVER New York State Utica Albany Syracuse Year Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 1910 1374 15.0 5 6.7 15 14.0 38 27.5 1911 1316 14.0 8 10.4 18 17.8 22 16.1 1912 1128 11.8 5 6.3 18 17.7 24 16.4 1913 1018 10.5 8 10.2 28 26.7 19 13.0 1914 878 8.9 6 7.6 17 16.0 15 10.4 1915 775 7.7 3 3.7 14 13.0 9 6.2 1916 603 5.9 9 11.0 9 8.2 19 12.9 1917 593 5.7 11 13.3 13 11.7 10 6.7 1918 575 5.4 7 8.3 12 10.7 14 9.4 1919 574 5.4 1 1 .2 9 7.9 12 7.9 1920 371 3-5 1 1 .1 4 3.5 7 4.1 TUBERCULO 515 55 TUBERCULOSIS New York State Utica Albany Syracuse Year Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 1910 14059 155.5 94 125.5 259 258.1 125 89.1 1911 14205 151.5 99 128.4 245 240.9 157 96.4 1912 I?7t6 142.9 97 122.5 207 205-9 129 88.2 1915 14096 144.9 90 114.9 225 212.5 142 99.7 1914 14586 147.1 111 159.7 248 255.0 164 114.0 1915 14512 145.6 121 150.1 271 251.0 152 90.9 1916 14069 156.6 *84 102.8 221 201 .8 156 92.7 1917 14795 141 .0 90 108.6 212 190.9 141 95.2 1918 15052 140.9 88 104.7 208 184.8 145 95.6 1919 12814 117.9 70 82.2 165 144.6 90 59.6 1920 11050 105.5 57 61.0 155 118.4 81 46.9 56 and. our city compares favorably with the other two cities with which it is studied. In 1920 the infant mortality of Utica was less than it was in the state itself. TYPHOID FEVER. In Utica the specific rate for typhoid fever has been very erratic. In 1911 and 1913 there were slight exacerbations, and in 1917, when the water supply was polluted by filthy water from the Erie Canal by the backing up of this water into the city mains through a two-way valve in one of the city mills when things went wrong during a fire, the specific mortality rate rose to 13 per 100,000 living population. In 1919 and 1920, however, the Utica mortality rate for typhoid fever was very low, only one person dying of the disease in each year. The general trend of the disease in the state has been to diminish steadily. Typhoid fever could be wiped out entirely if compulsory inoculation were in force in the state. TUBERCULOSIS. The most striking thing on this chart is the tremendous mortality for this disease in Albany. I do not know the reason for this high rate, unless there are tuberculosis san- itoria within the city limits where deaths would be frequent. Utica compares very favorably with the rate for the state, being below this every year but one, and the state rate may be taken as a good average. Syracuse, however, has a rate which is consider- ably lower than the rate for the whole of New York state and this rate is still diminishing. Just why there should have been a big increase in mortality from tuberculosis in both Utica and Albany in 1915 I do not know. The general tendency in all three cities and in the state as well since 1918, is down, and all the rates MEA5LE5 51 MEASLES New York State Utica Albany Syracuse Year Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 1910 12?5 14.0 11 14.7 24 23.9 9 6.7 19H 977 10.5 26 34.2 0 0.0 15 10.5 1912 1050 11 .0 19 23.9 2 1.9 6 4.1 1913 1072 11.0 15 18.7 7 6.8 22 15.0 1914 839 8.5 24 29.2 3 2.9 4 2.7 1915 844 8.3 0 0.0 2 1.8 9 6.2 1916 928 9.0 20 24.5 23 21 .0 0 0.0 1917 8.6 6 7.2 34 30.6 15 10.1 >91*8 1281 12.0 22 26.2 1 0.9 54 36.1 1919 355 3.3 6 7.0 6 5.2 2 1.3 1920 1101 10.3 5 5.5 2 1.7 22 12.7 SCARLET FEVER 5$ SCARLET FEVER New York State Utica Albany Syracuse Year Number of Deaths Rate per 100000 Number of Deaths Rate per 1CCCCC Number of Deaths Rate per 100000 Number of Deaths Rate per 100000 1910 1617 17.7 0 0.0 9 8.9 22 16.0 1?11 1149 12.4 1 1 .2 1 0.9 57 26.2 1912 789 8.4 2 2.5 0 0.0 10 6.8 1915 857 8.8 2 2.4 4 5-9 25 5.7 1914 687 7.1 4 4.9 10 9.7 15 8.7 1915 413 4.2 4 4.9 5 2.9 0 0.0 1916 178 1.8 1 1.1 0 0.0 1 0.6 1917 259 2.6 1 1 .1 0. 0.0 11 7.4 1918 297 2.9 1 1 .1 0.9 4 2.6 1919 268 2.6 2 2.3 0 0.0 10 6.6 1920 450 4.5 2 2.1 2 1.7 16 9.2 5? in 192C were much lower than they had ever "been previously. This is good evidence of the work that is being done all over the state to prevent not only the spread of this disease, but also the prog- ress of the disease in those who are suffering from it. MEASLES. The curves for the three cities in this disease are very erratic and the most marked feature of this chart is the great evenness of the rate for the state as compared with the jumps in the mortality in the three cities. In 1911, I?! 4, 1916, and 191S there were apparently epidemics of this disease in Utica and the specific mortality increased considerably. The chart seems to indicate that all the preventive measures that have been tried have failed to cut down the incidence, virulence, and mortality of measles. In 1915 there were no deaths attributable to measles in Utica. SCARLET FEVER. The general tendency of this disease is down, although in Utica the curve, with the exception of the years 1914 and 1-915, is curiously flat. The general statistics for the state, however, show a decrease in the mortality from scarlet fever which is not only marked but quite persistent. A slight rise is seen in 1'920, In contrast to the chart for measles this chart seems to show that some agency has been at work with con- siderable effect on scarlet fever, and in all probability this agency is the introduction of new and improved methods of treat- ment of the disease. Convalescent serum is, perhaps, of some importance. At any rate the trend of mortality is distinctly down and this is most encouraging. In 1911 there was apparently an epidemic of scarlet fever with considerable mortality in Syracuse. 60 Herewith are submitted samples of blanks used by the Deaprtment of Health of Utica. The morbidity, mortality, and other statistics in the city are reported with great thoroughness to the State Department of Health, and from the Vital Statistics Division very complete and accurate reports are sent out. In the Vital Statistics office in Utica, however, the work is done by individuals who have only a very hazy conception of the scope of the work, and the impression I obtained was that the definite requirements of the law were being adhered to in a rather blind, ignorant, and innocent way. 10-18-18-100,000 (21 273) STATE OF NEW YOKK Affidavit for License to Marry STATE OF NEW YOKK County of. No.. .of.. and GROOM applicants for a license for marriage, being severally sworn, depose and say, that to the best of their knowledge and belief the following statement respectively signed by them is true, and that no legal impediment exists as to the right of the applicants to enter into the marriage state. BRIDE Full name. FKOM THE GROOM: Full name. FROM THE BRIDE: Color. Color Place of residence. (street address) Place of residence . (street address) (city, town or vJiage) (state) (city, town or village) (state) Age Occupation.. Age. Occupation Place of birth. Place of birth Name of father. Name of father.. Country of birth. Country of birth. Maiden name of mother Maiden name of mother. Country of birth Country of birth Number of marriage. Number of marriage.. I have not to my knowledge been infected with any venereal disease, or if 1 have been so infected within five years 1 have had a laboratory test within that period which shows that I am now free from infection from any such disease. I have not to my knowledge been infected with any venereal disease, or if I have been so infected within five years 1 have had a laboratory test within that period which shows that 1 am now free from infection from any such disease. Former wife or wives living or dead Former husband or husbands Is applicant a divorced person living or dead Is applicant a divorced person. If so, when and where divorce or divorces were granted If so, when and where divorce or divorces were granted GROOM BRIDE Subscribed and sworn to before me this FUTURE ADDRESS .day of .19 (Enter here EXACT FUTURE ADDRESS after marriage if known) (street address) Clerk (city, town or village) (state) WNOTICE TO TOWN OR CITY CLERK. Please have marriage license and certificate fastened SECURELY to affidavit for license and consent, before filing with county clerk. CERTIFICATE OF CONSENT This is to certify that... who have hereto subscribed. .. name, do hereby consent that ( Name of Minor) who is (My or our Son, Daughter or Ward) ..and who is under the age of years, shall be united in marriage to by any minister of the gospel or other person authorized by law to solemnize marriages. Witness my hand this.. .day of. A. D. 19. (Signatures of Parents or Guardian) CERTIFICATE OF CONSENT This is to certify that who have hereto subscribed name, do hereby consent that (Name of Minor) who is and who is under the age of ..years, shall be united in marriage to (My or our Son, Daughter or Ward) by any minister of the gospel or other person authorized by law to solemnize marriages. Witness my hand this.. ...day of A. D. 19. (Signatures of Parents or Guardian') THIS IS A MARRIAGE LICENSE, AND NOT A MARRIAGE CERTIFICATE. The Marriage Certificate on the reverse side should be filled out and filed promptly by the Clergyman or Magistrate as required by law, with the Town or City Clerk who issued the License. See that your marriage is thus recorded. > place of Registry STATE OF NEW YORK NEW YORK STATE DEPARTMENT OF HEALTH Division of Vital Statistics County of. MARRIAGE LICENSE Registered No. Town or City of. IKtlUtU all mint by tlys (totifiratF, that any person authorized by law to perform marriage cere- monies within the State of New York to whom this may come, he, not knowing any lawful impediment thereto, is hereby authorized and empowered to solemnize the rites of matrimony between- .and State of New York and .of in the county of. .of and State of New York and to certify the same to be said parties or either of them under his hand and seal in his ministerial or official capacity and thereupon he is required to return his certificate in the form hereto annexed. The statements endorsed hereon or annexed hereto, by me subscribed, contain a full and true abstract of all the facts concerning such parties disclosed by their affidavits or verified statements presented to me upon the application for this license. in the county of. 3h (Jrfiitittntty WlpMTnf, I have hereunto set my hand and affixed the seal of said Town or City at ..this. day of. nineteen hundred and. SEAL The following is a full and true abstract of all the facts disclosed by the above-named applicants in their verified statements presented to me upon their applications for the above license: Clerk From the Groom: From the Bride: Full name. Full name. Color. Color. Place of Residence. Place of Residence. (city, town or village) (street address) (state) (city, town or village) (street address) (state) Age. Occupation. Age Occupation. Place of birth Place of birth.. Name of father. Name of father. Country of birth. Country of birth. Maiden name of mother. Maiden name of mother. Country of birth. Country of birth. Number of marriage I have not to my knowledge been infected with any venereal disease, or if I have been so infected within five years I have had a laboratory test within that period which shows that I am now free from infection from any such disease. Number of marriage.. I have not to my knowledge been infected with any venereal disease, or if I have been so infected within five years I have had a laboratory test within that period which shows that I am now free from infection from any such disease. Former wife or wives living or dead. Former husband or husbands living or dead.. Is applicant a divorced person. Is applicant a divorced person. If so, when and where divorce or divorces were granted If, so, when and where divorce or divorces were granted. FUTURE ADDRESS (Enter here EXACT FUTURE ADDRESS after marriage if known) (street address) (city, town or village) (state) The written consents of the Parents, Guardians or Persons under whose care and government the Minor or Minors may be has been filed in the Town or City Clerk's office in... as provided by Section 15, of Article 3 of the Domestic Relations Law. MARRIAGE CERTIFICATE TO CLERGYMEN AND MAGISTRATES The license and certificate duly signed by the person who shall have solemnized the marriage therein authorized shall be returned by him to the office of the town or city clerk who issued the same on or before the tenth day of the month next succeeding the date of the solemnizing of the marriage therein authorized and any person or persons who shall wilfully neglect to make such return within the time above required shall be deemed guilty of a misdemeanor and upon conviction thereof shall be punished by a fine of not less than twenty-five dollars or more than fifty dollars for each and every offense. I,. .a. city in the town of. village in county of. residing at.. (street address) and State of New York, do hereby certify that I did on this ..day of. in the year A. D. 19. .at ..in the county of. ..and State of New York, solemnize the rites of matrimony between. of. in the county of. and State of New York, and. of. ..in the county of.. ..and State of New York in the presence of. .and.. as witness, and the license therefor is hereto annexed. WtttWfifi my hand at. .in the county of. this. .day of.. .A. D. 19. In presence of (Signature of Person Performing Ceremony) (Signature of Witness) (Address of Person Performing Ceremony) THIS CERTIFICATE IS THE PROPERTY OF THE FAMILY, IT MUST NOT BE RETAINED BY A NV nw PT.SE NEW YORK STATE DEPARTMENT OF HEALTH DIVISION OF VITAL STATISTICS ALBANY Shia is tn ffiertifu that a -&OC1T f i fcb botH Oil 19 .wnooe pcvrenio cure (Month) (Day) (Year) STlotFie'r (Maiden Name) (Local Registrar) (City, Town, Village) .19. MARGIN RESERVED FOR BINDING WRITE PLAINLY, WITH DURABLE BLACK INK-THIS IS A PERMANENT RECORD N. B.-In case of more than one child at a birth, a SEPARATE RETURN must be made for each, and the number of each, in order of birth, stated 1 PLACE OF BIRTH Dist. No.. (To be inserted by Registrar New York State Department of Health DIVISION OF VITAL STATISTICS County. CERTIFICATE OF BIRTH Township. or Village- Registered No.. City. No. .St; Ward 2 Full name of child (If birth occurred in a hospital or institution, give its NAME instead of street and number) If child is not yet named, make supplemental report, as directed 3 Sex of child To be answered ONLY in event of plural births 4 Twin, triplet or other- 6 Legitimate? 7 Date of birth -- I 5 Number, in order of birth- (Month) (Dav) .19. (Year) 8 Full name FATHER 14 Full maiden name MOTHER 9 Residence (Usual place of abode) If nonresident, give place and State 15 Residence (Usual place of abode) If nonresident, give place and State 1 0 Color or race 1 6 Color or race 11 Age at last birthday- (Years) 17 Age at last birthday. ..(Years) 12 Birthplace (city or place) (State or country) 18 Birthplace (city or place). (State or country) 13 Occupation Nature of industry 1 9 Occupation Nature of industry 20 What preventive for Ophthalmia Neonatorum did you use?- Number of children born to this mother, including present birth- If none, state the reason therefor- CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE* Number of children of this mother now living- I hereby certify that I attended the birth of this child, who was. on the date above stated. .at.. ,.M.» ' *When there was no attending physician or I midwife, then the father, householder, etc., ! should make this return. A stillborn child is I one that neither breathes nor shows other I evidence of life after birth. (Signature).. (Born alive or stillborn) Dated. 19- (Physician, Midwife, Father, Etc) Given name added from a supplemental Address.. report... (Month, day, year) Filed.. IQ- Registrar Registrar This certificate must be FILED with the Local Registrar within FIVE (5) days after birth (See instructions, and additional data required for STILLBIRTHS on other side) Carefully preserve this certificate by having it framed The official record of birth of which this is a certificate is very valuable as a proof of age and citizenship; it is necessary to have such proof in the future life of this child for the purpose of enter- ing or leaving school, obtaining working papers or marriage license, inheriting property, holding public office, entering civil or military service, and for many other important objects. If the child's given name does not appear on this certificate a special "supplemental report" blank will be enclosed, upon which the parents must report the given name as soon as possible to the local registrar. They should also report to him any mistakes in dates or spelling on this certificate. EXTRACTS FROM THE VITAL A STATISTICS LAW § 382. Registration of Births. The birth of each and every child born in this state shall be registered within five days after the date of each birth, there shall be filed with the registrar of the district in which the birth occurred a certificate of such birth, which certificate shall be upon the form prescribed therefor by the state commissioner of health ******* § 384. REGISTRATION OF NAME OF CHILD SUBSE- QUENT TO FILING OF BIRTH CERTIFICATE. When any certificate of birth of a living child is presented without the state- ment of the given name, the local registrar shall make out and deliver to the parents of the child a special blank for the supple- mental report of the given name of the child, which shall be filled out as directed, and returned to the local registrar as soon as the child shall have been named. Section 389 of this law makes it the duty of the local registrar within ten days after receiving the certificate of any birth to mail to the parents or guardian of the child a certificate of regis- tration, to be made out on a form which shall be furnished by the state commissioner of health. Carefully preserve this certificate by having it framed Form V. S. No. 68. 9-22-20-150,000 (21-2180) Carefully preserve this certificate by having it framed IMPORTANT NOTICE TO PARENTS Carefully preserve this certificate by having it framed Physicians are required to report ophthalmia neonatorum (babies' sore eyes) to local health officer within 24 hours. from the time when first seen.-Sanitary Code, Chap. II, Reg., i. A midwife, nurse, or other person having charge, must report immediately to health officer or physician inflamed, reddened eyes of infant under 2 weeks.-Penal Law, §428. UNITED STATES STANDARD CERTIFICATE OF BIRTH All births in the State of New York (exclusive of New York City) are to be registered on this blank. This includes not only all living births (children born alive) but also all stillbirths (children dead when born) provided that the latter (stillborn) need not be registered unless advanced to the fifth (5th) month of uterogestation. Stillbirths must be registered as births, upon this blank, and also as deaths, upon the Standard Death Certifi- cate, and a burial permit issued in the regular way. See extracts from the law below. . . All birth certificates (including those of stillbirths) must be FILED with the Local Registrar of the town, village, or city in which the birth occurred within five (5) days thereafter. Note that the certificate must be filed; it may be mailed, at the risk of the sender, but to mail as late as the fifth day after birth does not comply with the law unless the certificate actually reaches the Local Registrar within five days from the date of These certificates form the Legal Records which, may be of great importance to the children born. __ It is essential that they be complete and correct when filed, because no alteration or erasures will be permitted after they become a part of the State Records. Hence Registrars are instructed to refuse certificates- (1) Omitting information required by law; (2) Not written throughout " legibly, in durable black ink," as the law expressly requires; (3) Mutilated, grossly soiled or defaced, inaccurate; (4) Containing any erasure, interlineation, correction, or alteration of anything printed or written upon the certificate. Note.-If a mistake is made and observed before the certifi cate is accepted for registration, another blank may be filled ou1 correctly and substituted for the erroneous certificate; but no certificate of birth or death after its acceptance for registration by the registrar, and no other record made in pursuance of this article, shall be altered or changed in any respect otherwise than by amendments properly dated, signed and witnessed. (See § 387.) A blank (Form VS No. 33) will be supplied by the Local Registrar or State Department of Health for the lega correction of an erroneous birth record. CHAPTER 619 OF THE LAWS OF 1913 upon the birth, it shall be the duty of such physician, midwife or person acting as midwife, to file said certificate. In each case where there was no physician, midwife, or person acting as mid- wife, in attendance upon the birth, it shall be the duty of the father or mother of the child, the householder or owner of the premises where the birth occurred, or the manager or superin- tendent of the public or private institution where the birth occurred, each in the order named, within five days after the date of such birth, to report to the local registrar the fact of such birth. In such case and in case the physician, midwife or person acting as midwife in attendance upon the birth is unable, by diligent inquiry, to obtain any item or items of information required in this article, it shall then be the duty of the registrar to secure from the person so reporting, or from any other person having the required knowledge, such information as. will enable him to prepare the certificate of birth herein required, and it shall be the duty of the person reporting the birth or who may be interrogated in relation thereto to answer correctly and to the best of his knowledge all questions put to him by the registrar which may be calculated to elicit any information needed to make a complete record of the birth as contemplated by this article, and it shall be the duty of the informant as to any statement made in accordance herewith to verify such statement by his signature, when requested so to do by the local registrar. § 376 Registration of Stillborn Children. A stillborn child shall be registrated as a birth and also as a death, and separate certificates of both the birth and the death shall be filed with the registrar of vital statistics in the usual form and manner, the certificate of birth to contain in place of the name of the child, the word "stillbirth"; provided, that a certificate of birth and a certificate of death shall not be required for a child that has not advanced to the fifth month of uterogestation. The medical certificate of the cause of death shall be signed by the attending physician, if any, and shall state the. cause of death as " stillborn," with the cause of the stillbirth, if known, whether a premature birth, and, if bom prematurely, the period of utero- gestation, in months, if known; and a burial or removal permit of the prescribed form shall be required. Midwives shall not sign certificates of death for stillborn children; but such cases, and stillbirths occurring without attendance of either physician or midwife shall be treated as deaths without medical attendance as hereinafter provided in this article. „ . . § 382. Registration of Births. The birth of each and every child born in this state shall be registered within five days after the date of each birth, there shall be filed with the registrar of the district in which the birth occurred a certificate of such birth which certificate shall be upon the form prescribed therefor by the state commissioner of health. In each case where a physician, midwife or person acting as midwife, was in attendance [This is NOT a Certificate of Birth, and must not be used for the registration and return of a birth. It is to be employed solely for the amendment or correction of a Certificate of Birth already recorded, and of the Local Record copied therefrom, said Certificate and Record as originally made and filed being, either in whole or in part, incorrect and untrue.l CORRECTION OF CERTIFICATE AND RECORD OF BIRIH Note.-(1) Read carefully the instructions on other side of this blank; then (2) fill out a complete and correct certificate in | the form below; [or, when sent from State Health Department for correction of particular items only, fill out those indicated by an X]; (3) sign below, with date and signature of witness; and (4) fill out Amendatory Statement (Form A) or Affidavit (Form B), as | provided on the other side of this blank, giving full information as to the fact that the original Certificate and Record were INCORRECT, the reasons therefor, and the knowledge of the person making the correction as to the facts. £jy~RegistrarB are instructed to refuse to accept this blank, or original Certificate*, containing any erasures or alterations. It must be written LEGIBLY, IN DURABLE BLACK INK. State Registered No..., I MARGIN RESERVED FOR BINDING \ WRITE LEGIBLY, WITH DURABLE BLACK INK-THIS IS A PERMANENT RECORD ' If. B.-In case of more than one child at a birth, a SEPARATE RETURN must be made for • each, and the number of each, in order of birth, stated , PLACE OF BIRTH Dist. No.. (To be inserted by Registrar) New York State Department of Health DIVISION OF VITAL STATISTICS County of. Town of... or Village of or City of CERTIFICATE OF BIRTH Registered No. No.. St. Ward) Full Name of Child If child is not yet named, make supplemental report, as directed SEX OF CHILD Twin, Triplet, or other? Number in order ef bkilj legitimate? DATE OF BIRTH 19 FULL NAME (To be answered only in event of plural births) FATHER FULL MAIDEN NAME MOTHER (Month) (Day) (Year) RESIDENCE (ADDRESS) RESIDENCE (ADDRESS) COLOR OR RACE COLOR OR RACE AGE AT LAST BIRTHDAY - (Years) AGE AT LAST BIRTHDAY . Years) BIRTHPLACE BIRTHPLACE OCCUPATION (and industry) OCCUPATION (AND industry) What preventive for Ophthalmia Neonatorum did you use?- Number of children born to this mother, including- present birth. If none, state the reason therefor Number of children of this mother now living... I hereby certify that I attended the birth of this child, who was. on the date above stated. CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE* ..at M„ ; Signature, (Born alive or stillborn) ♦When there was no attending physician or midwife, then the father, householder, etc., should make this return. Dated 19 Given name added from a supplemental report19 Address. (Physician, Midwife, Father, Etc.) Filed IQ Registrar Registrar This certificate must be FILED with the Local Registrar within FIVE (5) days after birth (See instructions, and additional data required for STILLBIRTHS, on other side) All of the above statements are true to the best of my knowledge and belief. (Signed). Dated. .191 (Witness) Dist. No- THE ABOVE CORRECTIONS, with Declaration on back of this blank, accepted and entered in red ink, with reference to this Amendatory Statement, with date and my signature (or initials) as Registrar, on the LOCAL RECORD, this day, for permanent preservation and CORRECTION OF THE OFFICIAL RECORDS OF THE STATE. 191 , and mailed to the State Department of Health, Albany,. , 191 (Signed) Registrar Entered as Correction of State Registered No... Deted. , 191. Director, Division of Vital Statistics, New York State Department of Health Form VS No. 33. 9-21-17-10,000 (21-9931) Jgy'Vital Records should be correct and complete when presented to the Local Registrar for filing. They must be written legibly, in durable black ink, otherwise the Registrar is instructed to REFUSE TO ACCEPT THEM FOR RECORD. No certificates with erasure j or written in pencil should be accepted under any circumstances. NEW YORK STATE DEPARTMENT OF HEALTH ALBANY To Local Registrars, Physicians, Midwives, Undertakers, and Others: 1 If the Law and Instructions from this Department are strictly followed, there should be no imperfect and inaccurate cer- tificates filed. As Registrars sometimes fail to examine all certificates presented for registration, incorrect certificates are recorded and should be corrected in legal form wherever possible, following the form below. The correction should be made by the person who filed the certificate, with statement to that effect and explanation, if any; any expense of affidavit should be. borne by that individual. No charge should be made for Amendatory Statement before, or witnessed by, the Local Registrar, and the Registrar should endeavor to secure complete legal correction of all errors, since by his negligence or inattention to duty in accepting an incomplete certificate the majority of the corrections are made necessary. 2 When a legal correction cannot be obtained, in the form indicated below, on account of death or absence of person originally certifying or for other reasons, then the Registrar should endeavor to secure the facts as a statistical correction, return- ing them over his official signature. 3 This blank is sent to physicians, midwives, and undertakers, as well as to Registrars, to show them the necessity for the utmost care in filling out a certificate of birth or death. 4 Registrars will treat certificates mailed to them precisely as if FILED as the law requires; and refuse acceptance and permit unless complete and correct. 5 Children's names cannot be changed, after they are once legally registered and recorded, except by due process of law, unless there was an error in making out the original certificate. CORRECTION OF RECORD OF BIRTH Note-Use either Form A, Amendment, or Form B, Affidavit, crossing out the side not used. Do not use both.* FORM A-AMENDMENT* FORM B-AFFIDAVIT I,. State of New York >55: residing at.. County of.. do hereby certify that I am the person who as- (Physician, midwife, or parent) made out the original Certificate of Birth recorded as- being duly sworn, deposes and says that he resides at.. -, that he is the person who as (Physician, midwife or parent) made out the original Certificate of Birth recorded as- [ 'KST'Give name of child, exactly as recorded on original cer- tificate, in space below.] That of. filed.. „..I9I. in the Office of the Local Registrar of Vital Statistics of the.. (Town, village or city) .of.. County of.. State of New York, and therein Recorded as Registered No.. , Births of 19.... Further, That certain statements contained in said Original Certificate are untrue and incorrect, or that certain information required by law is not given therein, and therefore, for the purpose of affording a COMPLETE AND CORRECT OFFICIAL RECORD, the correct statements or the omitted information has been supplied on the form of certificate on the other side of this blank, and the same properly dated, signed, and witnessed. Further, That the reason for the incorrect statements or omitted information in the Original Certificate was as follows: (Signed). Sworn to before me, this. ..day of (Witness). I9i Dated. (Address of Witness) .191 Notary Public or other Officer authorized to administer an oath) *" No certificate of birth or death, after its acceptance for registration by the Registrar, and no other record made in pursuance of this article, shall be altered or changed in any respect otherwise than by amendments properly dated, signed and witnessed."-Section 387, Chap. 619, Article 20, Laws of 1913. N. B.-According to an opinion of the Attorney-General dated August 15, 1914, FORM A should be employed only for corrections of births or deaths registered since January 1, 1914; FORM B may also be used under the new law, but should be used exclusively for all legal corrections of births or deaths registered prior to January 1, 1914. 62 1 PLACE OF DEATH Dist. No... To be inserted by Registrar Ww Ji)ork State department of Tbealtb DIVISION OF VITAL STATISTICS N. B.-WRITE LEGIBLY, WITH DURABLE BLACK I N K-TH IS ISi A.PERM Every .tem S'aUSE OF DEATh" Exact amtament of OCCUPATION is very important. See instructions on back of certificate. __ _ - County- STANDARD CERTIFICATE OF DEATH STATE OF NEW YORK Town - or Village or City Registered No... (No. [If death occurred in a hospital or institution, give its NAME instead of street and number] .st.; -Ward) 2 FULL NAME.. (18a) Residence No.- (Usual place of abode) St.,.. ...Ward. "(if nonresident, give city or town and State) ds. Length of residence in city or town where death occurred PERSONAL AND STATISTICAL PARTICULARS yrs. mos. ds, How long in U. S., if of foreign birth? MEDICAL CERTIFICATE OF DEATH yrs. mos. 3 SEX 4 COLOR OR RACE 5 SINGLE, MARRIED,. WIDOWED, OR DIVORCED (Write the word) 16 date of death 19 (Month) (Day)' (Ye£r) 5a if MARRIED, WIDOWED OR DIVORCED HUSBAND OF . . 17 | HEREBY CERTIFY, That I attended deceased from ,19. , to. 19..! 6 DATE of birth that I last saw h ...alive on 19 (Month) "(Day)" (Year) and that death occurred on the date stated above, at. The CAUSE OF DEATH * was as follows: .M 7 AGE Years Months Days If LESS than 1 day, how many hrs, or min.? 8 OCCUPATION (a) Trade, profession, or particular kind of work - (b) General nature of industry, business, or establishment in which employed (or employer). ..(Duration) yrs.. . mos. .. ds (c) Name of employer CONTRIBUTORY (secondary) 9 BIRTH PLACE (City or Town) (State or Country) 18b Where was disease contracted, if not at place of death? .(Duration) - yrs.- mos.- ds 10 name of FATHER -Date of- PARENTS 11 BIRTHPLACE OF FATHER (City or Town). Did an operation precede death ?- Was there an autopsy ?- (State or Country) 12 MAIDEN NAME OF MOTHER What test confirmed diagnosis 1 13 BIRTHPLACE OF MOTHER (City or Town) (Signed)- (Address)- M. D. (State or Country) *State the Disease Causing Death, or,in deaths from Violent Causes, state (1) Means and Nature of Injuey, and (2) whether Accidental, Suicidal, or Homicidal . 19- 14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 19 PLACE OF BURIAL,CREMATION OR REMOVAL DATE OF BURIAL (Informant). (Address) - Form VS No. 60b. 15 Filed- ,19- 20 UNDERTAKER ADDRESS Registrar Burial or Transit Permit issued by.. See Instructions on Other Side Date of Issue- CORRECTION OF CERTIFICATE AND RECORD OF DEATH Read these directions carefully 1 Write legibly with durable black ink. 2 Fill only lines indicated by "X" on form below if blank is sent from the State Department of Health. If obtained from the Local Registrar, fill only lines for particular items which require correction. 3 Make out Form A Amendment or Form B Affidavit on the other side of this blank, as the case may require; read carefully directions at head of forms on other side. 1 PLACE OF DEATH (Dist. No. Ww l£ork State Department ot Ibcaltb DIVISION OF VITAL STATISTICS State Registered No. n .b - Write legibly, with durable black ink-tHis is a i shoul.d be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCU PAT!ON is very important. See instructions on back of certificate. County Town or Village or City To be inserted by Registrar STANDARD CERTIFICATE OF DEATH STATE OF NEW YORK Registered No.. No. ..St. Ward) 2 FULL NAME [If death occurred in a hospital or institution, give its NAME instead of street and number] (18a, Residence No (Usual place of abode) St., Ward. Length of residence in city or town where death occurred yrs. mos, ds, How long in U. S., if of foreign birth? (If nonresident, give city or town and State) yrs. mos. ds. PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH 3 SEX 4 COLOR OR RACE 5 SINGLE, MARRIED, WIDOWED, OR divorced (Write the word) 16 DATE OF DEATH (Month) 19 (Year) 17 I HEREBY CERTIFY, That I attended deceased from '(Day) 5a IF MARRIED, WIDOWED OR DIVORCED HUSBAND OF (or) WIFE OF 19. , to. 19.. 6 DATE OF BIRTH 1 that I last saw h. and that death occurred on the date stated above, at alive on 19... M. 7 AGE Years (Month) Months Days (Day) If LESS than 1 day, how many hrs. or min.? (Year) The CAUSE OF DEATH * was as follows: 8 OCCUPATION (a) Trade, profession, or particular kind of work - (b) General nature of industry, business, or establishment in which employed (or employer).. (c) Name of employer CONTRIBUTORY (srcoNoarv) (Duration). -yrs.. mos,. ds. 9 BIRTH PLACE (City or Town) (State or Country) ..(Duration) yrs,. -mos,. -ds. 10 NAME OF FATHER 18b Where was disease contracted, if not at place of death? PARENTS Did an operation precede death?. Date of.. 11 BIRTHPLACE OF FATHER (State or Country) (City or Town) Was there an autopsy?. 12 MAIDEN NAME OF MOTHER What test confirmed diagnosis?... (Signed). ,M.D. 13 BIRTHPLACE OF MOTHER (City or Town) ,19.. (Address) 14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (State or Country) ♦State the Disease Causing Death, or, in deaths from Violent Causes, state (1) Means and Nature of Injury, and (2) whether Accidental, Suicidal, or Homicidal (Informant) 19 PLACE OF BURIAL,CREMATION OR REMOVAL DATE OF BURIAL (Address) 20 UNDERTAKER ADDRESS , 19 15 Filed 19- Registrar Burial or * Transit I Permit issued by Date of Issue See Instructions on Other Side The above corrections with reference to statement on the back of this blank have been entered in red ink on the local record. Signed. Registrar Entered as correction of State record. Date. .19. Director, Division of Vital Statistics, New York State Department of Health WRITE LEGIBLY WITH DURABLE BLACK INK FILL OUT THIS FORM IF THE DEATH WAS REGISTERED BEFORE JANUARY 1, 1914 FILL OUT THIS FORM IF THE DEATH WAS REGISTERED SINCE JANUARY 1, 1914. FORM B-AFFIDAVIT FORM A -AMENDMENT I, County of... State of New York, 55.7 residing at do hereby certify that I am the person who made out on the reverse side of this blank the correction of a death certificate recorded as that of being duly sworn, deposes and says that he resides at (Give name of decedent exactly as that he is the person who made out on the reverse side of this blank, the correction of a death certificate re- corded as that of.' recorded on the original certificate) filed. 19- in the office of the Local Registrar of Vital Statistics of the (Town, Village or City) (Give name of decedent exactly as recorded on the original certificate) of. filed. in the office of the Local Registrar of Vital Statistics of the.- 1. County of. State of New York, and therein recorded as Registered No.. .Deaths of 19 (Town, Village or City) Further, That certain statements contained in the said Original Certificate are incorrect, or that certain informa- tion required by law is not given therein and therefore, for the purpose of affording a COMPLETE AND COR- RECT OFFICIAL RECORD, the correct statements or the omitted information has been supplied by me on the form of certificate on the other side of this blank. Further, That the reason for the incorrect statements or omitted information in the Original Certificate was as follows: of. County of... State of New York, and therein recorded as Registered No.. ..Deaths of i. Further, That certain statements contained in said Original Certificate are incorrect or that certain informa- tion required by law is not given therein and therefore, for the purpose of affording a COMPLETE AND COR- RECT OFFICIAL RECORD, the correct statements or the omitted information has been supplied by him on the other side of this blank. Further, That the reason for the incorrect statements or omitted information in the Original Certificate was as follows:..... (Signed). Witness Address. (Signed). Dated. 19 Sworn to before me, this. day of 19- (Notary Public or other Officer authorised to administer an oath) NOTICE No charge should be made by anyone for witnessing Amendatory Statement. Expense of affidavit should be borne by the individual making this blank. NOTICE Form VS No. 64. 8-10-18-5G00 (21-19275) & MILK 64 MILK Utica is situated in the very center of the richest dairy region in the state and a constant supply of milk can he had from the out-lying towns and villages. So the milk that is used in the city comes from close hy and the dangers incident to transportation from a distance are eliminated, and an abun- dant supply of rich, fresh milk should always he on hand. And yet, even with such a source close hy, the milk of Utica is not, it seems to me, quite as much protected as it might he. There are sixty-nine licensed dealers in milk and cream in the city, from the small producer to the hig milk concerns like Borden's and the Dairymen's League which pool milk from many sources. Of these only four or five have pasteurizing apparatus, and the health officer told me himself that out of from 4-5,000 to 48t000 quarts of milk used every day in Utica, only 5,000 or 10,000 quarts are pasteurized. No more than 500 or 600 quarts of certified milk are produced, and this milk is sold from only three dairies. All the dealers selling milk or cream must hold a per- mit from the local health officer. This must he renewed annually as of the 50th of April. It may he revoked at any time for cause hy the state commissioner of health or the local health officer after a hearing on due notice. This permit must he applied for 65 in writing on a special form prescribed, by the state commissioner of health. The application must give the names of the producers from whom the milk comes and the approximate amount received from each producer. If the source of supply of the milk changes then the local health officer must be notified immediately of that fact. The permit is not granted to the applicant unless the premises are, in the opinion of the local health officer or his representative, clean and sanitary as shown by thorough in- spection; and unless the producers who supply him have scored at least 40% on the score card prescribed by the commissioner of health. No permit, once it has been issued, shall be renewed unless an inspection of dealer's and producers' premises have been made within the preceding six months. These permits must be publicly displayed by the dealers to whom they are issued. The milk and cream must be kept only under the best of sanitary conditions. The containers must be covered so that the contents will not be exposed to sun, dust, dirt, and flies, or other insects. The milk must be kept cool at all times. Bottles and cans must be thoroughly scalded and cleaned before milk is put into them, and the caps or lids must fit* tightly. Caps on all bottles must bear the name of the producer and the place of bottling. In the case of certified milk the date of bottling must also be indicated. Three milk inspectors assist the health officer in the important work of protecting the milk from contamination. They are required by law to make a sanitary examination and scoring of of every dairy farm within the jurisdiction of the city once a 66 year, and. "between November 1st and. April 30th only. Just how well fitted, these inspectors are to fo their work I cannot say, but one whom I met in the office of the health officer failed to impress me at all favorably. One felt that he was a political appointee rather than an efficient and intelligent milk inspector. He talked as if his responsibility meant little to him and his grasp of the situation and its seriousness was very meagre in- deed, And yet he is part owner of a large dairy which supplies milk to the city. The grading of milk in New York state is carefully and minutely set forth in the Sanitary Code, No term other than one of the following may be used to designate milk offered for sale in the state of New York: "Certified" "Grade A raw" "Grade A pasteurized" "Grade B raw" "Grade B pasteurized" "Grade C raw" "Grade C pasteurized" There are only 500 or 6C0 quarts a day of certified milk produced in the environs of Utica and marketed in the city. The minimum requirements for the production of certified milk are these: The dealer must hold a permit from the local health officer. All cows in the herd must have been tuberculin tested in the preceding year and found negative for tuberculosis. Re- ports of these tests must be filed with the health officer and the milk commission of the county medical society in the muni- cipality and county respectively where the milk is delivered to the consumer. This milk should not have more that 1C,000 bacteria 67 per c,c. and cream not more than 50,000 per c.c. before being delivered to the consumer, The farm producing must have a total score of at least 90 of which 55 mast be for methods. The milk must be delivered within 36 hours of milking. Caps must bear the mark ''Certified" with the certification of the county medical society and the name and address of the dairy as well as the date of milking. All employes must be examined by a physician and a report of the examination sent to the county medical society. Finally, all persons handling the milk should have suits that are clean and washable. These garments should be worn only when milking and they should be changed at least twice a week. Hands should be washed in soap and hot water before each milking. It was impossible to visit a farm producing certified milk, but the dairies from which the milk comes are in excellent condition and their reputation is great, Bordens is the most prominent seller of certified milk in the city. Grade A raw milk must also be from tuberculin tested cows, but the bacteria count may be as high as 6c ,000 for milk and 300,000 for cream. A total score of 75 is necessary instead of 90, Physical examinations for employees and reports to the county medical society are not needed as is the case with certified milk, but all possible care should be taken in produc- ing the milk, ''Grade A raw" must be printed in black on the caps of the bottles along with name and address of dairy. Grade A pasteurized milk must be produced by cows 'which have not necessarily been tuberculin-tested, but which have been given a thorough physical examination. Before pasteurization the milk must not contain more that 200,COO bacteria per c.c., and 6$ after pasteurization not more than JO ,000» A total of 68 is required of the farm that produced the milk and it must he de- livered within J6 hours of pasteurization. Caps must hear the words, "Grade A pasteurized" in hlack letters. Grade B raw milk must come from healthy cows not necessarily tuberculin tested. The milk must not have more than 200,000 bacteria per c.c. and the cream not more than 750,000 bacteria per c.c. as deltrered to consumer. A total score of 6c is required of the farm producing the milk. The caps must bear the words, "Grade B raw" in large green type. Grade B pasteurized milk must come from healthy cows and must not contain more than 1,JOO,000 bacteria per c.c. before pasteurization. After pasteurization it must contain less than 100,000 bacteria per c.c., and cream not more than 500,000. A total score of 55 is necessary for the farm producing this milk. Caps must bear the words, "Grade B pasteurized" in large green type and the name of the dealer. Grade C raw must come from farms whose total score is not less than 40 per cent, and it must be delivered within 48 hours from the time of milking. The caps should bear the words, "Grade C raw" in large red type. Grade C pasteurized milk must come from farms whose total score is not less than 40 per cent. It must be delivered within 48 hours after milking. Caps must bear the words, "Grade C pasteurized" in large red type. The total amount of milk pasteurized, as stated earlier, is only from 5,000 to 10,000 quarts daily, or from 1J to 25 per cent of the total supply. This is a very small amount of milk 69 thus treated. The method of pasteurization used is the "holding" method, and it is uniform for the state. The milk must be sub- jected to a temperature of 142 to 145 degrees Farenheit for not less than JC minutes and under the most sanitary conditions. No milk or cream heated under any other method may be sold in the state. After pasteurization the milk mast be immediately cooled, . placed in clean containers and immediately sealed. No milk or cream may be pasteurized more than once. This method of pasteurization is an excellent one, but I feel that too small an amount of our milk is being pasteurized today. This method of treatment of the milk should be more generally adopted. Even the milk inspector did not seem to con- sider pasteurization as a very important measure. They test the milk of every one of the dealers once a month and then examine it at the city laboratory at the state hospital for number of bac- teria per c.c. If the count is high an investigation is made immediately. The farm of William Kitchen was scored ana the score sheet is included herewith. This farm is a fair-sized one with a herd of twenty-five cows, twenty of wnich were milking. The cows were in good condition, the stable equipment good. There was too little chance to get adequate boiling, water for the clean- sing of utensils and the milk pails were the old, wide-mouthed variety. The milk house was clean and in good condition. The cows were quite clean, but the teats and udders were not wiped off before milking. The hands of the milker were washed before milk- ing began but they looked rather dirty, especially under the nails. The utensils into which the milk was put were clean but not Form No NEW YORK STATE DEPARTMENT OF HEALTH ALBANY Dlst. No. DAIRY INSPECTOR'S REPORT Score Card for Market Milk Inspection No. . Time. .A. M .1*. M. Date.. Dairyman Address Owner Party interviewed. . Creamery Address . Operated by No. cows25No. milking. . . .20Quarts milk produced daily. .2.0.0 Cows examined physicially on. JMarch .26th,. . 1 22J. ... By licensed veterinarianIL.. IE. . DAViS All persons in households of those engaged in producing or handling milk arcfree from listed diseases (tuberculosis, typhoid fever, scarlet fever, septic sore throat, diphtheria, infantile paralysis and dysentery). Date and nature of last case,-tQPP. Water supply for utensils is from a. . . . A® . I, located.... near . tarnfeet deep and apparently is. r.eaSPXlAhly.pure and wholesome. State any possible contamination located within 200 feet of source of water supply or if water supply is not pro- tected against surface drainageThe. .harp. .18. QXlite. Xiear the. we 1.1. and..contamination . .might .conaievahly. rasu.lt.... .The .well .is. .protested. Xrorn. .surface..drainage, EQUIPMENT Perfect Score Allowed Score METHODS Perfect Score i Allowed Score COWS (2) COWS (12) Cows apparently healthy and in good condi- Belly, flanks, udder and teats clean at tion 2 ...2.. time of milking 8 COW STABLE (8) Udders, teats and flanks wiped with clean Cow stable adequately lighted (2 sq. ft. of damp cloth before milking 4 ...P... windows for each 600 cu, ft. of air space! 2 ...2... COW STABLE (4) o ...1... Cleanliness of stable (a) floors 2 2 Floors sound and capable of being kept clean 1 J. (b) walls and ceiling 1 . . . .1. . . Drops constructed of concrete or some non- Manure removed daily to at least 50 feet absorbent material 2 ...a.. from stable and not accessible to cows 1 . . . .1. . . (Constructed of wood and watertight, 1) UTENSILS (12) 1 ... .i... Utensils rinsed with clean cold water UTENSILS (20) promptly after using 2 ....2.. Milk pails of metal, smooth, in good repair; Utensils scrubbed with brush and soln- seams soldered flush 2 ...2.. tion of alkaline washing powder and Milk cans and lids of metal, smooth, in good rinsed with clean water 2 ... 2.. repair; seams soldered flush 2 ...2.. Utensils scalded with boiling water or Strainers in good repair (cotton or cheese- live steam immediately before use.. 5 ...2.. cloth preferred) 2 ... 2.. (Sterilized with boiling water or live Racks provided in a clean, light place to hold steam and kept in clean place until cans, pails and strainers when not in use 2 ... 1... used, 2). Ample supply of boiling water 3 ...J... Utensils used for no other purpose than Milking pails of small mouth design, top the care and handling of milk 3 ...3.. opening not exceeding 8 in. in diameter 6 ...o... MILKING (11) (If milking machine is used, 6) Milkers' hands clean and kept dry dur- Cooling tanks of cement, metal or wood, ing milking 5 ...2... with capacity for all milk cans and (If milking machine used, 5). depth to bring water to neck of cans... 3 ... 3 • • Milk strained in milk house or other MILK HOUSE (7) clean place removed from cows 2 ...2.. M>Ik house (a.) sufficient light. 1 ...J... Milkers wear clean clothing 2 ... J... (b) sufficient ventilation 1 ...1... Milking stools clean 2 ...Q.. (c) properly screened to ex- COOLING (17) elude flies 3 Ice supply sufficient for entire season... 5 ... 5... (d) no direct opening into cow Night's milk cooled with ice immediately 1 . .1... after milking and maintained at a (e) floor properly graded and temperature of 50 degrees F 8 ..J... water-tight 1 ... J... (With running water and maintained COW YARD (3) at a temperature of 60 degrees F., 4) Cow yard graded, drained 2 ... 0... Morning's milk cooled to a temperature of 60 degrees F 4 0 to cowyard 1 ...a.. m"|LK HOUSE (2) Clean 2 ...2.. COW YARD (2) Clean 1 .....0. Privy - clean 1 ....Q.. Total 40 ..2.7.. Total 60 ..4.4.. Total for the farm and dairy 70 scalded immediately "before use as there was not an adequate supply of "boiling water present. The cow yard was dirty and moist, not properly drained and not in a sanitary condition. The privy which was some distance off was not screened and was not clean. The cleanliness of the whole place showed that there was still much to "be desired, but tor the production of Grade A pasteurized or any of the lower grades of milk this dairy would suffice. A sample of Grade B pasteurized milk was examined in the laboratory. The bacterial count was $7»000 per c.c,, still well below the limit allowed by the Sanitary Code. There were 8 or 9 colonies in the 1 to 10,000 dilution, and numerous colonies on the plates containing the 1 to 100 and 1 to 1,000 dilutions. There was 2.9 per cent of fat in the sample, and this is really quite low, not coming up to the United States Standard of 5,2%, The specific gravity of the sample was 1.051, which is about normal, or perhaps at the lower limit of normal. Total solids were 12.56, waich is just over the border line of the allowable limit. The ratio of 1:4 is about normal, although the fat seems to be lower than it should be. This sample, then, is low in fat but about average in the other constituents. The bacteria count is within normal limits and on the whole the sample is not a bad one. SANITARY NUISANCES Td SANITARY N U I S A N C E S SOURCES OE ODORS. The city is quite iree from odors that might "be prevented. The manufacturing industries in Utica are not the type which produce unpleasant odors. The three slaughter houses must by law provide some efficient method of getting rid of the odors incident to the preparing of meat for market and the city is not disturbed by the typical stench from these abattoirs. The foulness of the river from sewage, especially in certain places as described and pictured in the chapter on sewage is a definite source and plans should be made immediately to eliminate these sources of foulness. They are not only unpleasant but definitely unhealthful. To be sure, odors from the sewage do not usually reach, the higher and better section of the city, but the stench of decomposing matter is easily noticed on humid days in the lower section of the city and it forms a distinct" nuisance. This problem is discussed more at length in the chapter on sewage. DUST. There are several industries in Utica which cause the production of dust and which therefore endanger slightly the lives of the workers, or their health. The most im- portant of these is the cotton industry. Especially in ''card- ing'', ''spinning", and "winding" of the cotton in the preparation of yarn, fine organic dust is formed and it may fill the air of the workroom. In the mill visited and described in the section on industrial hygiene the carding machines are entirely covered in so as to minimize the production of dust, and in other ways the quantity of dust formed is cut down, but the rooms are still very full of fine particles. However organic dust is not a severe menace. I could find no complaints on record concerning dust injuries to the lungs and I conclude, therefore, that damage to health, if any, is negligible. Stone cutting trades are not common and so are not a menace, and a state law provides for the protection of the workers in such industries with a mask which will strain the dust out of the inspired air. Outside of the industries mentioned the only source of dust is the streets and these are effectively cared for by treating the streets with asphalt or tar oils. A few of the less used streets are watered daily in the summer, but this method is less effective than the oil. On the whole, the street dust problem has been efficiently solved and no complaints may be made on this score. RUBBISH AND GENERAL CLEANLINESS, In general the city is very clean and tidy, and especially in the residential section is the beauty of the city evident. Up Genesee Street, for ex- ample, with its tall elms shading the street, the tidiness of the town is worthy of comment. The streets are patrolled by cleaners who remove all refuse, rubbish, etc. The school yards are clean for the school children are encouraged to be tidy. The parks are well kept and orderly, and one does not find the 74 "bushes and gardens filled with old newspapers and boxes. Even the summer -playgrounds of the children are neat and clean, and one enjoys watching the games of the young folk in such pleasant surround- ings. All in all there is a general civic pride on the part of the people living in the res- idential part of the city. In the poorer parts of the city, however, the same neatness is not seen. Yet no gross negligence is noted. The picture reproduced herewith shows the refuse and manure which I found piled in a small lot on one of the main down-town streets, Hotel Street. It is an eve-sore to the passer-by and should not be allowed. It is only a few steps from this lot to the bus- iness section of Genesee Street. A pic- ture of one of the big city dumping grounds is also shown. This is on the bank of the Mohawk River and all kinds of non-decomposing refuse is deposited here. I found, however, that in one place a quantity of manure had been emptied And the pile is shown in the Pile of Manure and. Old Rubbish in Vacant Lot on Hotel Street Dump near the Bank of the Mohawk, Showing the Manure Piles. 75 photograph. It is a definite menace as a "breeding place for flies and other insects and measures should he taken to keep such piles from being exposed in this way. Another dumping ground is illustrated in this picture. Herf tin cans, old iron, ashes, and other re- fuse may be dumped, and all in all the dump is in good con- dition. Another eye- sore and blot on the city's beauty is the Erie Canal. Three years ago the canal was in a wretched state, with foul, dirty, sluggish water which was stained with the grease and dirt of many industries and filled with refuse. Many a visitor to the city commented on the shame- ful state of decay to which .the historic, old canal had been allowed to deteriorate. It was not only unpleasant to look at, but it was a menace to the public health as well. Within the last two years, how- ever, the Utica authorities have pur- chased from the state the part of the canal which is within the city limits and a great boulevard is now being proposed which One of the City Dumping Grounds on the Bank of the Mohawk River View Down the Erie Canal to Show the Filling In Process 76 will run where the canal now is. The filling of the canal is now under way and all the city's ashes are being dumped into the waters of this ancient landmark. The present condition of the canal, then, is wretched, as may be judged from the picture, which is taken less than, ten minute's walk from Genesee Street, This state of affairs, we hope, is only temporary, and will soon be remedied. Whether or not the boulevard project will go through time alone will tell. FLIES AND MOSQUITOES. There is a mosquito commission at Albany which operates under the Public Health Law. It has a branch in Utica which is active in destroying all the breeding places of mosquitoes which can be found. Systematic searches are made for all stagnant pools or streams and these are then treated with oil, or some oily preparation and the larvae or wigglers are then destroyed before they become real mosquitoes. An attempt is made to see that no water is allowed to become stagnant and literature is sent out all over the state warning the inhabitants of the dangers that come with the mosquito. This insect is thus being effectively eliminated and, even though they are still present, their number is being greatly diminished and are much less of a menace to health than they used to be. A crusade against flies has been waged in New York state for years and pamphlets describing the fly as one of the great enemies of man have been distributed broadcast all over the state. "Swat the Fly" campaigns are carried on and in some cities a reward has been offered for all the dead flies which were brought to one central office. Unfortunately this plan de- feated its own end by degenerating into an encouragement for the 77 "breeding of flies to obtain the reward. All provision stores and restaurants and ice cream parlors must have screen doors and screens in the windows and all the food which is not covered by glass mast be screened from flies. Garbage pails and slop buckets must always be covered. All in all an effective ed- ucational campaign is being waged against the fly. One bad breeding place for flies and mosquitoes is the stagnant pool or slough near one of the sewage outlets along the river. This has been carefully described in the shapter on Sewage. It should be eliminated at the earliest possible time and replaces by a ipodem sewage disposal plant. STABLES AND MANURE. The stables which I visited were kept in a clean and orderly condition and the manure was piled in a special place outside where it was not kept for long periods of time. It was usually sold for manure fertilizer. Each stable is inspected once a month and the cleanliness checked up. RATS AND VERMIN. Extermination of rats and vermin is carried on under the direction of the health officer who has an assistant who looks after this kind of work. There are also several professional exterminators in the city. If property owners wish advice as to methods for exterminating these pests they may obtain it from the health officer or his assistant. Statistics concerning this type of work were not available, but much is being done to cooperate with the people of the city to rid the dwelling houses of rats, and the charitable institutions are doing much to get rid of vermin that may be found on the dirtier class of individuals who come for treatment to these places. 78 SWKE. The factories of Utica are required to provide means of getting rid of the smoke produced by the boilers of the mills, and on the whole this procedure is well carried out. However, once in a while one sees a chimney belching forth great clouds of black smoke like that shown in the picture. This, however, is not very often. But the pro- ■ duction of smoke should be stopped completely. UNNECESSARY NOISES. No ordinance could be found prohibiting unnecessary noises except in the neighborhood of hospitals where all loud noises are forbidden. The whole matter of un- pleasant noises is left largely to the discretion of the Police Department and if any noise is thought to be a disturbing element to the enjoyment of peace and comfort on the part of another then the noise becomes a nuisance and can be prevented. The police handle the matter pretty efficiently. PIGGERIES. I could find none in the city. There is one large pig farm some distance outside the town limits in the village of Deerfield where the garbage of the city is delivered. This farm was not visited, but the condition of the place is said to be good as inspection of the premises is made quite regularly by the local health officer or one of his represent- atives. A Smoky Factory LEGAL DEFINITION OF "NUISANCE". The Penal Law of the State of New York thug defines a nuisance: "A 'public nuisance' is a crime against the order and econony of the state, and consists in unlawfully doing an act, or omitting to perform a duty, which act or omission: 1. Annoys, injures, or endangers the comfort, health, repose, or safety of any considerable number of persons, or, 2. Offends public decency, or, Unlawfully interferes with, obstructs, or tends to ob- struct, or renders dangerous for passage, a lake, or a navigable river, bay, stream, canal, or basin,".....etc..• or street, or highway, or, 4. In any way renders a considerable number of persons insecure in life, or the use of property," The method of stopping or abating a nuisance varies with the nature of the offence. In cases where the nuisance affects the life or health of a citizen or citizens, the matter is reported to the health officer who investigates the complaint and reports to his superior. The latter takes steps to supress the nuisance. If no action is taken locally the health officer reports to the State Commissioner of Health who examines into the complaint and taken the necessary action. So INDUSTRIAL H Y C I E N E Bl INDUSTRIAL HYGIENE There are several large and well-equipped knitting mills In Utica and for the purpose of this report the mill of the Onelta Knitting Company was visited. This is a large plant shown in the acc- ompanying illustration. It employs, when work- ing at full capacity, from fifteen to eighteen hundred workers, "both wo- men and men, who operate the machines which take the raw cotton as it comes from the cotton gins and fabricate it through all the intermediate processes to the production of cotton underwear, cotton sweaters, etc. The buildings are brick of old design constructed about a quarter of a century ago. There are many windows but they are at greater intervals apart than is usual in the more modern mills. But most of the windows are of the transom variety, both the upper and lower portions swinging outward so that circulation of air is always assured when the windows are open. Ventilation is, therefore, very good, even in cold weather when only the upper transoms are kept slightly open. There is no effort to produce Mill of the Oneita Knitting Company <82 mechanical ventilation on a large scale although fans are pro- vided in a few of the rooms to withdraw vitiated air from the building. The main ventilation is via the windows. The mill is heated by steam and although the humidity is quite high due main- ly to processes necessary to the manufacture of the yarn, it is not high enough to be detrimental to the health of the employees. Temperature is not automatically regulated, but an attempt is made to keep the working rooms comfortably heated and the air fresh. The buildings are well protected against fire and the whole mill is fitted with the Grinnell overhead automatic sprink- ling system. Fire hydrants are scattered about at frequent inter- vals and arrangements are made to made to have a great supply of water on hand in case of need. All combustible rubbish is removed immediately and disposed of in such a way as not to be a fire men- ace. All these measures are enforced by frequent inspections made by the insurance companies and a committee of the workers. Sanitary arrangements about the mill are good. The toilets for the workers are simple with somewhat antiquated facilities, but the rooms have stone floors and clean plastered or metal walls which are looked after by a lavatory worker. The stools are of old design and there is no hiatus in the front part of the seat as there is in newer appliances. The stools are flush- ed with water. All the toilets are light and airy and there is no foul odor produced. Furthermore, certain patented disinfect- ing devices are placed in all the toilets. Cold running water is provided for washing purposes and tin basins to wash in. These were not very clean. Otherwise the toilet facilities were fairly S3 good, although of old design. Since this is a textile mill, the workers are open to various industrial accidents and dangers, especially those coming from the operation of machines; those coming from organic dust which is an inevitable product in the manufacturing of cotton goods; and those due to the humidity necessary in a textile mill. Against the first all the protection required hy law and the in- surance companies is adhered to. All belts over three inches in width are protected by a shield. All cog-wheels and saws are guarded with metal or wooden frames. The "winding" machines, while not a great source of accident, are not protected by guards, but within arm's length of every spindle there is a lever for stopping the machine instantly. In the "sewing" rooms the revolv- ing shafts under the tables are protected by a screen so that the skirts of the girl or women operators can not be caught. These shafts, which give motive power to the sewing machines, are not protected at the ends of the tables, however, and injury to a person standing too close to the table could concievably result. In the "spinning" room most of the great rolling frames used in drawing out the yarn are built so that no injury can result in connection with them. The wheels on which these frames travel back and forth run in a small track, and the wheel is guarded by a buffer device designed to push the foot of a worker off the track so that the wheel will not run over it. On several of the carriages, however, these guards were missing, and damage to the feet might easily result, especially since many Of the operators in this room were working in their bare feet. This working in bare feet in such a dangerous surrounding should be prohibited. $4 One machine, a ''hydro-extractor ', used to extract water from gar- ments that have been washed, consists of a large drum which is revolved at great speed on a vertical axis. The water from the clothing is thrown out of openings at the periphery or the drum. Originally these urums were protected by a cover which could be removed while the machine was in motion, and the operator would try to rearrange the contents while the drum was still turning. Two years ago an operator had his arm torn from the shoulder by being caught in the garments in the drum and died as a result of the accident. Now these drums are protected by covers which cannot be opened when the machine is in operation and which pre- vent the drum from starting unless they are closed. Thus most of the ordinary industrial accidents are guarded against. The danger from organic dust produced in ''carding", "spinning", and "winding" the cotton is still a real though not a severe danger. A little is done to prevent the production of dust by the complete covering in of all the machines which "card" the cotton, but the air is still pretty well filled with dust. The factory rooms are quite humid and the operatives are apt to be warm when they quit work. There are rooms provided for the changing of the moist garments so that the individuals will not be chilled on going out into the open air. All in all, then, the industrial hygiene or the Oneita Mill is good. The Plant is old but the best use is being made of the facilities at hand. Accidents are rare and there is no evidence that ill effects are being produced by conditions which could well be remedied. Although there are many different types or industries 35 in Utica, the industrial hygiene practised in all of them comes under the state department of Health and rules and regulations are put out which govern the procedure in all cases. The Oneita Knitting Mill is not the most modern knitting mill in the city and conditions are not quite as up-to-date as they are, perhaps, elsewhere, hut from a sanitary point of view the Oneita Mill is fairly representative of these industries. In other in- dustries the conditions are good from all I can gather although I made no personal investigations. Frequent inspections should be made by the Health Department, but whether or not these are made I cannot say. I found, however, that so many aspects of the Health situation in the city are taken care of by the state that sanitary conditions could not remain bad very long before the matter reached the attention or the proper authorities. <86 HOUSING $7 HOUSING * SANITARY CONDITION OF ONE TENEMENT. The four tenements here reported on are located at 8?4, 8%, 8"98, and 8?? Catherine Street, in the Italian Quarter of the city. They are all owned by one man, an Italian who is not one of the grasping, tight-fisted variety of landlords, but one whose interest is in maintaining good houses at the minimum of rent- al. He has built large and airy tenements and has equipped them with the best of necessary conveniences. He charges four dollars a month rental for each room, and since most of the apartments have four rooms, the average rental is sixteen dollars a month. Each suite is supplied with a water closet. The four buildings are similar in general plan and con- Sample Floor Plan Tenement at Catherine St. "8B struction. They are wooden houses finished in gray clapboard. They are divided into twelve apartments each with the exception of No. which is a six-family block. Each apartment is arranged about the kitchen which is very large and roonjy, being about twenty by twenty feet. From this room the other rooms of the house open off. There is no central heating system for the building. The suite is heated by the kitchen range which is very large and efficient. In nearly all cases this range is of the coal and gas burning variety. In summer, therefore, unnecessary overheating is avoided by using gas instead of coal. A rough plan of a specimen apartment is shown on the preceding page. It is to be noted that each room has two large windows and that the toilet has one. Thus every room in the suite is light, airy, and large. All the rooms are lighted by gas and the halls are kept illuminated until ten o'clock every night by electricity. The water supply is the regular city water which is piped to each apartment. Hot water is available from a boiler attached to the kitchen range. Fresh air can easily enter through the large windows. The toilet arrangements are excellent. The bath-room Itself, while not fitted with the usual tub and basin, is large enough for connections to be made if the tenant cares to have these conveniences. The toilet is of modern design, made of the usual enameled cast iron with a flushing system which is op- erated by a push-button. The usual system of local venting em- ployed for toilets in private dwellings is in use, and there is every evidence of clean, healthy, and sanitary facilities. The grounds about the tenements are not in any sense decorative, yet there is no evidence of gross neglect of sanitary $9 rules and regulations. Old papers, tin cans, and ashes are piled up in the back yards and the street is littered with old tin cans. The general impression of the whole neighborhood, however, is good and the owner of the houses said that he never has complaints from either the tenants or the Health Officer. All the evidence points to a healthy group of tenants, happy and contented, and buildings which are excellently fitted for the purpose for which they are used. VENTILATION OF A LARGE OFFICE BUILDING. For this purpose the Utica City National Bank Building was visited. This is a ten- story structure, one of the largest office build- ings in the city, owned, I believe, by the bank which occupies the first floor. It is well-con- structed and protected against fire. Two elevators serve the upper floors. The building is heated by steam and origin- ally the rooms on the north side of the building, especially above the fourth floor, were quite cold in winter due to insufficient heat and the exposure to high northern winds. This was remedied by running an extra steam pipe up the elevator shaft and piping steam into these rooms. Floor Plan City National Bank Building 90 The ventilating system is simple for it depends entirely on the windows of each office. There is no mechanical system in the building, although the engineer told me that two fans had been 'used once to force air into the offices of the bank on the lower floors, but this fan is not now employed. The steam radiators in each office were put in for the convenience of the steam-fitter rather than the maintenance of a healthy atmosphere in which to work, for they are built as shown in the diagram on the next page back. The radiators are built against the wall dividing two offices and they can thus be supplied easily from one riser which is placed at X. Thus the radiator is not as near the window as it should be to aid in increasing air circulation in the room as in the syst- em first employed in Fairfield, Connecticut. Each office has at least two windows and some have four. Consequently there is, I believe, sufficient ventilation for the sixe of the rooms. The corner rooms are apt to be somewhat dark, however, due to a long stretch of wall unbroken by windows and rooms A and B are not quite as well supplied with air as they should be. The halls are well aired because the elevator shaft, the stairways, and the win- dows on each floor in the back of the shaft take care of that. The whole system of ventilation in the building, then, is simple, not quite as efficient as it might be, yet not bad enough to be a menace to the health of the occupants. 91 INFECTIOUS DISEASES HERMANN M. BIGGS, M. D., Commissioner State Department of Health Albany, N. Y. COMMUNICABLE DISEASE REPORT CARD DIVISION OF COMMUNICABLE DISEASES Form C. D. 103 . 3-23-22-50,000 (21-2834) (See list on back of card) (Report tuberculosis on special card) Town Village City ..County.. .Dist, No. Disease. Name of Patient- ..Occupation... -Age. Sex.. ..Color.. Patient's address.... ..♦married; single; widowed Date of first symptoms.. ....Where did infection occur, if not in your municipality.. Was diagnosis confirmed by bacteriological exam- ination (for 1, 4, 5, 6, 8, 10, 12, 13, 16, 17, 18, 23, 29, 31). Date reported.. Reported by.... (♦Attending physician, head of household, hospital sup t) By blood examination (for 17, 29).. Address Date of last successful vaccination (for 25). ♦Cross out words not applying Health Officer *List of communicable diseases 1 Anthrax 2 Botulism 3 Chickenpox 4 Cholera, Asiatic 5 Diphtheria (membranous croup) 6 Dysentery, amoebic and bacillary 7 Encephalitis lethargica 8 Epidemic cerebrospinal meningitis 9 Epidemic influenza 10 Epidemic (septic) sore throat 11 German measles 12 Glanders 13 Malaria 14 Measles 15 Mumps 16 Ophthalmia neonatorum 17 Paratyphoid fever 18 Plague 19 Pneumonia (a) lobar 20 Pneumonia (b) bronchial or lobular 21 Poliomyelitis, acute anterior (infantile paralysis) 22 Puerperal septicemia 23 Rabies (Person bitten by rabid or supposedly rabid animal) 24 Scarlet fever 25 Smallpox 26 Tetanus 27 Trachoma 28 Tuberculosis (report on special card) 29 Typhoid fever 30 Typhus fever 31 Vincent's angina 32 Whooping cough * Regulation 8, Chapter II, Sanitary Code, applies to diseases set in black type. 92 I-N _E_E C T _1 OUS D LU E_ A 5 E S LIST .Qi?: .THE DISEASES wHICH ARE HOTIrlAjoLE. In the Sanitary Code established by the Public Health Council of the State of New York the following diseases are listed as infectious, con- tagious, or communicable and are classified in two groups: Group A Anthrax Botulism Chicken pox Cholera, Asiatic Diphtheria Dysentery, Amoebic and bacillary Encephalitis lethargica Epidemic cerebrospinal meningitis Epidemic influenza Epidemic or streptococcus (septic) sore throat German measles Glanders Malaria Measles Mumps Ophthalmia neonatorum Para-typhoid fever Plague Pneumonia a. acute lobar b. bronchial or lobular Poliomyelitis, acute anterior (infantile paralysis) Puerperal septicemia Rabies Scarlet Fever Small pox Tetanus Trachoma Tuberculosis Typhoid fever Typhus fever Vincent's Angina Whooping cough Group B Syphilis Gonorrhoea Chancroid REPORT OF COMMUNICABLE DISEASES Utica, N.Y.- -192 Diseases to be reported to the Health Officer: Anthrax, Chicken-pox, Cholera Asiatic, Diphtheria (Membranous Croup), Dysentery, Amoebic and Bacillary, Epidemic Cerebrospinal Meningitis, Epidemic or Streptococcus (septic) Sore Throat, German Measles, Glanders, Measles, Mumps, Ophthalmia neonatorum, Para-typhoid Fever, Plague, Poliomyelitis, Acute Anterior, (Infantile Paralysis), Puerperal Septicaemia Rabies, Scarlet Fever, Small Pox, Trachoma, Tuberculosis, Typhoid Fever, Typhus Fever, Whooping Cough, Syphilis, Gonorrhea, Pneumonia, Influenza, Encephalitis Lethargic. A case of exists in the person of Age.. liesiding at. ..Duration of illness.. .days Are premises in sanitary condition?. Probable source of contagion. Do they use well or city water?.. Name of milk man. Name of School. Residence.. .jf. i). Blank for reporting a Communicable Disease to the Health Officer Notice to Quarantine Premises for Contagious Disease. Inspector A case of .. has been reported at name. age by Dr. See that the premises are quarantined at once, and instruct the persons so quarantined that the notice must be strictly obeyed, giving such instructions from time to time as you may receive from the Health Officer. BY ORDER OF THE HEALTH OFFICER. This is to certify that the above instructions have been this day enforced. Dated.. 19 Signed Inspector. Notice to District Inspector to Quarantine Premises for a Contagious Disease 94 It is further provided that "it shall be the duty of every physician to report to the local health officer, within whose jurisdiction such patient is, the full name, age, and address of every person affected with a communicable disease enumerated in Group A, together with the name of the disease, within twenty-four hours from the time the case is first seen by him". Reporting of cases listed under Group B is considered at length later in this section. QUARANTINE REGULATIONS . The quarantine regulations which govern the procedure in Utica are those issued by the State Depart- ment of Health and which apply to the whole of New York State. They are concisely given in the Sanitary Code, issued in latest amended form in November, 1922. The code states that "it shall be the duty of every physician, immediately upon discovering a case of communicable disease,to secure isolation of the patient," or to take such other action as may be required by special rules of the Health Department. "Whenever a person affected with a com- municable disease other than small pox is properly isolated on the premises, adult members of the family or household who do not come in contact with the patient or with his secretions or ex- cretions, may continue their vocations unless forbidden by the Health Officer." But if the patient cannot be properly isolated on the premises and cannot be removed to a suitable hospital, then the Health Officer must forbid all other members of the household from leaving the premises. When a house is quarantined by the local Health Officer, no person may remove from the palce any articles that were in the vicinity of the patient. A person ill with a communicable disease, especially those diseases common to children, may not be removed from one house to another without express permission from the Health Officer. It is also the duty of the Health Officer to remove to a suitable hospital all persons with any of the following diseases: diphtheria, encephalitis lethargica, measles, scarlet fever, or poliomyelitis. Further- more, no one except the physician and -the nurse in attendance may be permitted to visit a patient with any one of the diseases named above, The law requires these houses to be placarded with nane of the disease* For the purposes of the Sanitary Code the incubation periods of the following diseases is declared to be as follows: Chicken pox .21 days Measles 14 days Mumps • 21 a ays 14 days Scarlet lever 7 aays Small pox 2C days Whooping cough . 14 days The minimum period of isolation is also definitely stated in the Code: Chicken pox, until twelve days after the appearance oi the eruption and until the crusts have fallen ana the scars completely healed. Diphtheria, until two successive cultures taken irom the nose and throat at intervals of not less than twenty-four hours, have been examined and found negative, the lirst or the cultures being taken not less than nine days from the day of onset of the disease. Epidemic cerebro spinal memingitis., until two weeks after the temperature has become normal or until three successive cult- ures, obtained from the nasopharynx at intervals of not less than five days, shall be found free from meningicocci. Measles, until at least five days after the appearance of the rash. Mumps, until two weeks after the appearance of the disease and one week after the disappearance of the swelling. Poliomyelitis, until three weeks from the day of onset of the disease. Scarlet fever, until thirty days after the development of the disease and until all discharges from the ears, nose, throat, or suppurating glands have ceased. Small pox, until fourteen days after the development of the disease and until scabs have all separated and the scars com- pletely healed. 96 Typhoid or para-typhoid fever, if the patient's occupation involves the handling of milk, dairy products, or other food, until all signs of the disease, or all secondary or complicating in- fections incited "by the agents of these diseases have disappeared, and until two successive specimens of the intestinal discharges and urine of the patient have "been taken at an interval of not less than seven days and have been examined in an approved lab- oratory and found to be free from typhoid or para-typhoid bacilli. Whooping cough, until eight weeks after the development of the disease or until one week after the last characteristic cough. METHODS OF DISINFECTION AND FUMIGATION. Cleansing, renovation, and disinfection are required by law in the State of New York. The cleansing and renovating of rooms, furniture, and belongings, when deemed necessary by the Health Officer or required by the Sanitary Code, ''shall immediately follow the recovery, death, or removal of a person affected by a communicable disease". These processes shall be carried out at the expense of the occupant of the premises. Adequate disinfection, however, must be done under the direction of the Health Officer in accordance with regulations of the Sanitary Code and at public expense. The cleansing, renovation, and disinfection of premises on which a communicable disease has been found or cared for must be carried out in a very thorough manner. The following methods and precautions, according to the Sanitary Code, shall be observed in cleansing, renovation, and disinfection: (a) Cleansing shall be secured by the thorough removal of dust and other contaminating material in such a way as to prevent the entry thereof, as far as may be possible, into other rooms or dwellings; washing with soap and water; scouring; airing; and ex- posure to sunlight; in accordance with the special rules and reg- ulations of the State Department of Health. (b) Henovation shall be secured by removing old paper from walls and ceilings, and repainting, re-calcimining, or repapering of walls, ceilings, and woodwork as may be ordered by the local Health Officer in accordance with the special rules and regulations of the State Department of Health. (c) Disinfection of rooms shall be secured by the use of such disinfecting agents in such quantities and in such manner and of such sterilizing procedures as may be ordered by the local. 97 health officer, in accordance with the special rules and regu- lations of the State Department of Health. When gaseous dis- infectants are to be used, all cracks, crevices, and openings into the room shall first be pasted over with paper. There- after, all rugs, upholstered furniture, carpets, and such tex- tile fabrics in the said room as cannot, in the opinion of the local health officer, be washed or soaked in a disinfecting solution, may be removed for disinfection by steam when ordered by the local health officer, in accordance with special rules and regulations of the State Department of Health. **Thorou$i cleansing, the use of soap and water, and full exposure to fresh air and sunlight are the most efficient means of removing infective material, not only from the walls and floors of rooms, but also from furniture and other articles.** Any furniture, bedding, clothing, carpets, rugs, or other articles which cannot, in the opinion of the local health officer, be properly cleansed, disinfected, or sterilized after being contaminated by a person ill with diphtheria, small pox, or scarlet fever, shall be destroyed in a manner decided upon by the health officer. Every patient who has had a communicable disease, and every person who has nursed such a patient, must disinfect themselves thoroughly in a manner which is prescribed in detail by special regulations of the State Department of Health, before mingling with persons who have not had the disease. By these uniform regulations, therefore, which are applicable to the whole state and which require that adequate re- novation, cleansing, and disinfection must follow the release from isolation of all cases of communicable or contagious dis- ease, spreading of the disease is rapidly checked if action is taken promptly. As far as I could find out the regulations of the State Department of Health with regard to the isolation and subsequent thorough disinfection of patients with a contagious ?<8 disease are being carefully carried out. The system of report- ing diseases which are communicable is excellent and adequate, and there is hearty cooperation on the part of the physicians of the city with the Health Officer in all matters relating to contagious diseases. LEASURES TAKEN TO PREVENT THE SPREAD OF TUBERCULOSIS. The Public Health Law defines tuberculosis as "an infectious and com- municable disease", and requires that every physician in the state of New York report to the Health Officer of the city on the form herewith submitted, the name and address of every person HERMANN M. BIGGS, M. D., Commissioner STATE DEPARTMENT OF HEALTH ALBANY, N. Y. DIVISION OF TUBERCULOSIS TUBERCULOSIS STATEMENT AND REPORT Patient's name. .Sex. ..Color. ■Age. Present address Street number or R. F. D. Town ..in Village of. City ...County of.. fFormer address (if any) ..How long ago?. Occupation. .Place where last employed?.. (Give address and name of firm) Sputum examined?.. ...Date.. ..Result. Type of disease Will you enforce the procedures and precautions named on the reverse side of this card? (Answer "Yes" or ..Stage.. "No") Health Officer to countersign here: *Attending physician. Address.. .M. D. Address. „N. Y. Date.. .N. Y. Date. flf possible, give street and number when former address is in a city. *If patient is in an institution, chief officer should sign here. 8-18-19-100,000 (21-1402) known to have tuberculosis within twenty-four hours of the time that this fact comes to the knowledge of the physician. All patients in hospitals, asylums, or similar institutions who have tuberculosis must be promptly reported, by the superintendents of these institutions. To confirm the diagnosis the Health Officer of the city must examine the sputum from all suspected cases of 99 tuberculosis when requested to do so by a physician or a hospital or other institution, and he must report the result promptly to the physician or person who sent in the specimen. All records of the health officer with regard to tuberculosis must be carefully guarded and not disclosed except to persons authorized to examine them. All persons with tuberculosis must, under penalty of the law, dispose of sputum, saliva, and other bodily excretions or secretions in such a way that no other person is exposed to in- fection. If this provision of the Public Health Law is not com- plied with and complaint is made, then an investigation is immediately carried out by the health officer and, if found guilty, the person is notified that he must dispose of sputum, etc., in a manner which will not cause danger to others. If he does not then comply, he is guilty of a misdemeanor and if con- victed shall be fined not more than ten dollars. If such a per- son then continues to be a menace to the public safety he may be committed to a county or state hospital for tuberculosis after a hearing before a magistrate. Whenever premises formerly occupied by a patient with tuberculosis shall have been vacated by the patient, it is the duty of the patient* s physician or the owner of the house if there be no physician, to notify the health officer who sees that the premises are adequately disinfected, cleansed, and renovated as provided by law. These provisions are stated in detail in the preceding section. If the orders of the health officer re- quiring disinfecting, cleansing, and renovation are not complied 100 with within forty-eight hours, the health officer may place a placard on the infected premises stating that: "Tuberculosis is a communicable disease. These apartments have been occupied by a consumptive and may be infected. They must not be occupied un- til the order of the health officer directing their disinfection or renovation has been complied with. This notice must not be removed under penalty of the law except by the health officer or other duly authorized official.** In this way the spread of tuberculosis is prevented in a most thorough manner since the State Department of Health is in charge of the work. In fact there is a special Division of Tuberculosis in the State Health Department and at present this work in being carried on in a most persistent way. The state cooperates with the local authorities in every way and statistics show a marked decrease in the morbidity and mortality rates for this disease as a result of the excellent work that is being done, MEASURES TAKEN TO CONTROL EPIDEMICS. Should diseases other than tuberculosis be prevalent in any considerable portion of the state the State Commissioner of Health takes charge of the situation and makes inquiries as to the cause of the epidemic and takes ubatever measures he deems necessary to prevent the spread of the disease to neighboring communities. Through his local representatives he may "prohibit and prevent all inter- course and communication with or use of infected premises, places, and things, and if necessary, provide means for the thorough purification and cleansing of same before general intercourse with the same or use thereof be allowed." All cases of commun- 101 icable disease are reported promptly by the physician who dis- covers them, but when any considerable number of cases of the disease are found then the town is placed under quarantine and persons going into or coming away from the place are examined if necessary. The Commissioner or Health may declare that no public carrier shall take on a passenger from a quarantined municipality without the presentation to the agent of the rail- road of a certificate signed by the local health officer that the bearer is free from disease and may travel in public con- veyances without danger to the general public. Furthermore, when a common carrier is notified of the existence of an ep- idemic in a certain municipality, it is the duty of the carrier to post placards in the conveyances, stations, etc., warning travellers of the fact that there is an epidemic of a certain disease in the town named, and cautioning them to beware. If necessary, house to house canvas may be made to 4 determine if there any ill there. Hospitals are fitted out for the specific disease alone. Laboratory facilities are increased, if this becomes an important factor in diagnosis and treatment. And, if the need is very great, the county, state, or the city itself provides the money necessary to carry on the work which is directed largely by the state Department of Health. Of re- cent years a new blank called the "Report of Imported Infection" blank has been in use by the State Department of Health, and by it the health officer or an area in which a case of a disease like typhoid fever turns up, notifies the authorities at Albany that the disease came from such and such a town, indicating the place from which the patient came. From Albany, then, the 102 matter in investigated through the local health officer in the town from which the original case was supposed to he imported, and in this way more than once hot-beds of typhoid infection have been unearthed. Often the original cases come from some unauthorized camp where sanitary conditions are worse than bad. Here, then, the situation is taken in hand and after a few weeks this source of infection has been cleared up. The matter of the control of epidemics in the state of New York is handled in the most efficient manner possible, and the success of the system has been proved many times when threaten- ing epidemics have been limited to a small area and the morbidity and mortality have been relatively low. VENEREAL DISEASES - REPORTING AND. CONTROL. As soon as a physician finds a case of syphilis, gonorrhoea, or chancroid, it is his duty to submit promptly to the laboratory of the state department of health or to a laboratory approved by thp state department of health, any specimens of blood, discharges, etc., which may be examined to make the diagnosis sure. Along with these specimens the physician sends along any other necessary data such as name of patient, address, place and date of ex- posure, etc. In this way the health authorities have accurate information concerning those affected with these venereal diseases. It is the duty of every physician when first attending a person infected with one of the three venereal diseases named above, to instruct this person in the precautions to be taken to avoid the communication to others, and to inform him of the absolute necessity of sticking to treatment until he is cured. 103 Every physician is also provided, with literature from the state department of health containing information and advice for those suffering from these diseases, and he is obliged to give to his patient whatever literature he may need on his first visit. If any person who is affected with one of these diseases, then, violates any of the regulations of the Sanitary Code whereby he is ordered to take certain precautions, and thus becomes a pub- lic menace, his physician reports him to the local health officer immediately. The latter takes such action as may be necessary to prevent this person irom being a menace to others. At the same time a report is sent to the Bureau of Venereal Diseases 01 the State Department of Health, and if necessary this bureau may act if the local health officer is unable to carry out effective- ly the provisions of the Public Health Law. In order to prevent the spread of these diseases esp- ecially when they are in their infective stages, no person who is infected with syphilis in the infective stage may engage in the occupation of nurse, nursemaid, domestic servant, barber, hair-dresser, chiropodist, manicure, bath attendant, or masseur, or any other occupation in which he comes into contact with others, or with the food which they eat. No personsAffected with gonorrhoea in the infective stage may engage in any occupation which brings them into intimate contact with children. Whenever there is reason to believe that any person has a venereal disease, the local health officer is empowered to make a physical examination or that person especially if it is thought that the individual who is suspected is a menace to the health of the community. Before the examination is made, however, 104 the person may apply to a magistrate for an order restraining such examination, but if evidence is strongly in favor of his being in- fected, then the examination may be ordered by the magistrate. If a person so examined is found to be suffering from a venereal di- sease, he must be treated by a physician approved by the local health officer. Free treatment is given by specified physicians to all persons who are infected and cannot afford to pay for it, and this is usually carried out in the local clinic. This clinic is open three days a week and any person who is suffering from one of these diseases may be taken care of free of charge or for a nominal fee. A laboratory for the diagnosis of these diseases is run in connection with the health office in the city hail, and laboratory tests are also carried out in connection with the clinic. The records of all persons affected with these diseases are to be kept secret, and no unauthorized person is to have access to them. If, however, a person becomes a public menace, and' disobeys the rules and regulations of the state and local officials, any action that may be necessary with regard to his records may be taken by the health authorities in an endeavor to enforce the law. In the State of New York there is hearty and cordial cooperation of the Department of Health with the United States Public Health Service and literature, information, and good ad- vice are sent broadcast all over the state. Letters are sent to physicians advising them of the serious dangers to life and esp- ecially the future generation, which the venereal diseases bring in their train and the State Health Department sends to all the W5 physicians of the state letters which give the opinions and ad- vice of the "biggest authorities in these fields, or which in- clude one or two of the case records from the IMssachusetts General Hospital which give the typical story of syphilis and the anatomical findings out at necropsy. Samples of these letters and of the literature which is distributed free to victims or all those interested in the great problem of sex health are included in this report. All in all the problem of the control of venereal diseases is being handled in a masterly fashion by the state of New York, and the results are very gratifying, and in many in- stances, astonishing. PUBLIC HEALTH IS PURCHASABLE. WITHIN NATURAL LIMITATIONS ANY COMMUNITY CAN DETERMINE ITS OWN DEATH RATE UNITED STATES PUBLIC HEALTH SERVICE COOPERATING WITH THE NEW YORK STATE DEPARTMENT OF HEALTH DIVISION OF VENEREAL DISEASES Joseph s. Lawrence, M.D. A.A.S., U.S.P.H.S. DIRECTOR " KNOW SYPHILIS IN ALL ITS MANIFESTATIONS AND RELATIONS AND ALL OTHER THINGS CLINICAL WILL BE ADDED UNTO YOU "-OSLER 132 STATE STREET ALBANY, N. Y. November 14, 1922. To His Honor The Mayor- Sir: As guardian of the hones and. promoter of the welfare of your city, you have been interested in the achievements of your health department in reduction of cases of venereal diseases and the treatment and elimination of. uhe infected vagrants. We are eager that your interest in the work should continue and at the suggestion of the Surgeon General of the United States Public Healthy Service, we are forwarding to you under another cover an exhibit, in the form Ox a book, of the work being done in this connection throughout the United States. May we take this opportunity to say a wprd about the future aspect of this health activity? Evefy person infected with syphilis or gonorrhea, unless thoroughly treated, becomes a carrier of the disease and may, under suitable conditions, infect others years after the acuteness of his infection aas passed. As with all other contagious diseases it is desirable to prevent the infected from becoming carriers of the diseases and to provide effective treat- ment for such carriers as exist* The venereal disease clinics have oeen doing corns endable work in this capacity and merit whole-hearted support. Their usefulness is now being extended to the treatment of babies infected congenitally with syphilis* . There is no more pitiable sight than to see an innocent babe suffering from a disease its father and mother contracted. Much can be done, too, toward preventing the birth of infected children by having the mothers treated during the time they are pregnant* The Clinics are prepared to do this also. Ybu muy Well feel proud of youf venereal disease clinic and safely undertake its further development• Respectfully, Director> Division of Venereal Diseases, A. A. Surgeon. JSL/H PUBLIC HEALTH IS PURCHASABLE. WITHIN NATURAL LIMITATIONS ANY COMMUNITY CAN DETERMINE ITS OWN DEATH RATE UNITED STATES PUBLIC HEALTH SERVICE COOPERATING WITH THE NEW YORK STATE DEPARTMENT OF HEALTH DIVISION OF VENEREAL DISEASES Joseph s. Lawrence, m.d. A.A.S., U.S.P.H.S. Director " KNOW SYPHILIS IN ALL ITS MANIFESTATIONS ANO RELATIONS AND ALL OTHER THINGS CLINICAL WILL BE ADDED UNTO YOU "-OSLEH 132 STATE STREET ALBANY, N. Y. December 14, 1922* EFFECTS CD SYPHILIS ON CHILDBEARING i The effects of syphilis on childbearing are several and vary in severity. I Sterility, abortions, miscarriages, stillbirths, and syphilitic living progeny result from parental syphilis. As an illustration of what syphilis may do to tne progeny the following case is given: ''Emil Lachine was a druggist by trade and on acquiring thought he could treat himself. That his treatment was inadequate was.shown by the xact that he infected his wife. He again attempted therapy by giving her pills and nostrums. She was not cured, however, and many years later had sypnilitic liver disease. The effect of syphilis on the next generation is quite, significant. lae first pregnancy was terminated by a miscarriage; the second one. reached term but the child lived only five weeks. Tne third and feurtn pregnancies were of boys who were seen by us at the respective cLges of 19 and 15 years. x>oth showed numerous signs of congenital syphilis, were deficient mentally, and nad defective vision. The younger child was also deaf. The fifth pregnancy resulted in a child who died at five weeks. The result of the sixth pregnancy was a cmla who was apparently normal and non-syphilitic when seen at 11 years . Ox age. , seventh pregnancy produced a child who oieu at nine months. In this family the fruition of seven pregnancies was three children, two definitely feeble-minded, with defective vision and physical inferiority, /and only one normal child. The above history is given by Solomon and Solomon in their recent bock "Syphilis of the Innocent". It not only demonstrates pointedly the effects of syphilis on child bearing, but also the results of ineffective treatment. Vfe shall follow this letter at irregular intervals with others bearing on "Congenital uphills". Yours very truly, Jos. S. Lawrence, Director Division Venereal Diseases. A, A. Surgeon. jsl/md. PUBLIC HEALTH IS PURCHASABLE. WITHIN NATURAL LIMITATIONS ANY COMMUNITY CAN DETERMINE ITS OWN DEATH RATE UNITED STATES PUBLIC HEALTH SERVICE COOPERATING WITH THE NEW YORK STATE DEPARTMENT OF HEALTH DIVISION OF VENEREAL DISEASES Joseph s. Lawrence. M .D. A.A.S., U.S.P.H.S. DIRECTOR " KNOW SYPHILIS IN ALL ITS MANIFESTATIONS AND RELATIONS AND ALL OTHER THINGS CLINICAL WILL BE ADDED UNTO YOU "-OSLER 132 STATE STREET ALBANY, N. Y. November 6, 1922. Dear Doc tor In that part of life where the tragedy of syphilis holds forth the principal victims are the infants born and unborn., Hb'v nany are more denied entrance to this beautiful world and how many/are given a Pandora's box as their natal gift by this ruthless villain, no one knows better than you.. Attached are copies of a letter written by Dr. D.D- Stetson and a memorandum by Dr. J_ Williams, which convey much hope "toward the eventual annihilation of the power of this destroyer of infants. # Proper antiluetic treatment of the prospective mother when undertaken before or soon after conception has been most fruitful of good results. Knowledge of a syphilitic parent should be considered a warning of the danger threatening the offspring. Yours very truly, 3o s. S« Lawi err. e, Birec tor, Djvis ion Venereal Diseases. A. A. VENEREAL DISEASE CONTROL AND INFANT WELFARE Notwithstanding the great activity which exists in the domains of venerea-1 disease and infant welfare, the relation of the first to the second does not seem to be properly appreciated. Probably no one factor in infant morbidity and mortality is of as great importance as syphilis. Jeans gives the following startling statistics in American Journal of Syphilis, . Jan. 1919. ''Among 5383 married pregnant women in four cities of this country, 9.66$ were syphilitic as shorn by the Tassermann reaction". To this must be added the large but unknown number who although syphilitic, gave negative reactions. "In a syphilitic family 30$ of the pregnancies terminate in death at or before term, a waste three times greater than is found in nonsyphilitic families". He says that syphilis is the most frequent cause of premature birth which occurs two ahd one half times more frequently in syphilitic than in nonsyphilitic families. He found that in the syphilitic families only 16/6$ of the pregnancies result in living, healthy children, whereas in the nonsyphilitic families 76$ of the preg- nancies result in living, healthy children. "The infant with syphilis has just half the expectation of life as does a nonsyphilitic infant leaving out of .consideration all other factors". * ♦ This lack of appreciation of the importance of syphilis is especially deplorable in view of the splendid results which have been obtained when the disease has been recognized in pregnant women and properly treated. It is well known that a syphilitic mother in whom treatment is begun before the fifth month, will almost Certainly give birth to an apparently healthy child; and a child which although it may be luetic, hasrevery prospect of developing into a healthy individual on account of its ability to withstand the rigors of further treatment. Inquiry among prominent obstetricians, as well as among general practi- tioners, reveals that too great reliance is placed on the negative Tassermann test. Among many the Wassermann test is the sole criterion for or against treatment. Syphilis is too serious a disease tp.be dismissed from further consideration on the *********** evidence of a single/passermann reaction. A negative reaction should only stimulate further research for positive evidence to be obtained from the history and physical examination not only of the patient but of the husband and the other children. The routine history of the pregnant woman, should include a history taken from the especial standpoint of lues, and should include marital and family history, as well as personal. If lues can be established in the husband or previous children, the patient should be considered a luetic and treated accordingly, even though she have a negative "'assermann reaction. If the patient gives a history of luetic infection, she 'should be treated even though the infection may have occurred many years previously and notwithstanding efficient previous treatment and many negative Fassermann reactions. -2- The physical examination of the patient should also be made with the possibility of syphilis always in mind, and should include examination of the reflexes and the cranial nerves. Routine tests should be the universal and inviolable rule in both clinic and private patients. Owing to the variability of the Y'assermann test, the practice should b>o, a test done at the first visit and again in two weeks. The provocative injection of arsphenamine is of little value as a diagnostic aid, and of no value if negative. In cases of doubt the decision should always be in favor of treatment rather than against it, and this even in instances in which in the absence of preg- nancy treatment would not be given. In this connection Stokes has said: ''The institution of therapy for the protection of the child seems to me Justified in women in whom evidence of syphilitic infection is so doubtful that the advisability of treatment would be questionable under other circumstances". (Archives of Derm. & Syph. Dec. 1921) Attention is especially called to the fortunate fact that pregnant women Dear anti syphilitic treatment very well. Arsphenamine maj be used at any end is the drug of choice when the time is short. Mercury may be given in any of the usual ways, but the injection of insoluble mercurials is probably least ad*./a de on account of the pain and uncertainty of even absorption. Neither of- these d~ugs should be used in excessive doses, especially at the beginning of treatment Evi- dences of toxicity must be routinely and carefully looked for. Examination of the urine at weekly intervals should always include microscopical examinatioh. Syphilis in infants and children is only second in importance to svp.rlis in the pregnant. Physicians, nurses, social -orkers and all who come in corsac4, "ith children should be constantly on the alert to detect indications of th', disease. In the newly born the •"assermann test is notoriously unreliable, but examin.ui of the placenta gives important information and should be the routine in all institu- tions and adopted in private practice where at all possible. Breast feeding of the syphilitic infant is of the utmost importance as these children are usually undernourished and their digestive powers are impaired. The follow up on the child should be continued for years, as it is not uncommon for syphilis to reveal itself after long periods of quiescence. Maternity institutions are urged either £o institute special provision for the diagnosis and treatment of syphilis under the direction of an expert, or to form a definite working arrangement with institutions doing this work. Dudley D. Stetson, Special Consultant, Venereal Disease Division, U.4§. Public Health Service. VM 536 Copied MD. ACTUM In our material at the Johns Hopkins Hospital we have found, that syphilis is the most common single cause of foetal deaths, being responsible for 34$ of the entire number. This is due in great part to the fact that about half of our material is made up of black women in whom syphilis is much more common than in whites. Our figures show that positive Hassermanns occur in every sixth black woman as contrasted with every fortieth white woman. As the result of our experience I feel that the routine employment of the Vlassermann reaction and the treatment of all patients with a positive reaction, has given extraordinarily good results, and in clinics such as ours should be continued. Cn the other hand, where the service is made up almost exclusively of white patients in whom the incidence of syphilis is so much lower, £ am not sure that it is necessary. Moreover, in private services among the better class of patients I consider it in great part a waste of time and money, as in my entire experience in private practice, I can only recall two or three syphil- itic new born children. Accordingly, I would say that it is difficult to lay down specific rules, but that the course to be followed should differ in differ- ent communities, and be adjusted to the conditions there obtaining, rather than to follow slavishly any rule. I agree with Hr. Stetson that in a considerable proportion of cases pregnant women may have syphilis and give birth to definitely syphilitic children without presenting a positive Tassermann. Such cases would escape detection when the Wassermann is relied upon as the sole means of diagnosis. For this reason I agree with him jthat the history of the patients should be taken with gre- : care and a careful search made for any stigmata of the disease. Such histories, however, do not give very positive information as in 96 women whose histories I have just studied, only 12 presented a positive history of preceding infection and 5 a history of possible infection. The balance pre- sented a negative history and no signs of the disease which could be detected upon careful examination, so that the diagnosis was made either upon the basis of a positive Tassermam or upon the demonstration of syphilitic lesions in the new bom child. During the past two years I have obtained great satisfaction from the X-ray examination of the long bones of the babies, as described by Drs. Shipley and Pierson in the Bulletin of the Johns Hopkins Hospital for February 1921. If syphilis is present, Magner's bone disease can always be found at the epiphyseal junctions and as a result I have made a routine • practice of having X-rays taken of all dead babies, as well as of all live * babies in whom there is a suspicion of syphilis on the part of the mother, as shown by the presence of lesions, the existence of a positive yassermann, or a suggestive history. This has served a most useful purpose and has enabled us to diagnosticate the existence of the disease in the child when autopsy was not available. I agree with Dr. Stetson as to the prospects of treatment, as I have found in pregnant women that an amount of treatment which would be negligible in men or in mon-pregnant women, frequently leads to the disappearance of the Wassermann and to the birth of apparently good babies, so that there would sean to.be something about syphilis in pregnant women which renders them particularly susceptible to treatment. I am now writing an article based upon the study of 114 pregnancies which have occurred in the two years ending December 31st, 1921, among the -3- 449 womeh upon which my 1920 paper was based. The results of treatment were unusually satisfactory and in the entire series I was able to find in •'•'he treated women only 3 cases of congenital syphilis. All of the babies .rich were bom alive have been traced as far as possible, and Wassermanns taken during the . ast few months. Of the 65 Ithose mothers were created either well, fairly, or indifferently, ever:/ child presented a negative VTassermann and none showed clinical signs of congenital syphilis. This result is so satisfactory that I feel it gives us the greatest encouragement and makes it mandatory to search out syphilitic women and to treat theri during pregnancy. J. Vhitridge Williams, Obstetrician in Chief, The Johns Hopkins Hospital. VM 537 MD Vol. IV No. 49, Part22 DECEMBER 3, 1918 CASE RECORDS (ANTE-MORTEM AND POST-MORTEM) AS USED IN WEEKLY CLINICO- PATHOLOGICAL EXERCISES AT THE MASSACHUSETTS GENERAL HOSPITAL EDITED FOR THE USE OF PRACTITIONERS BY RICHARD C. CABOT, M. D., AND HUGH CABOT, M. D. F. M. PAINTER, ASSISTANT EDITOR CASE 4492 A three-months-old boy of American parentage entered Jan. 28. F. H. His father was alcoholic. His mother died of eclampsia following the birth of the patient. She had had no miscarriages. P. H. He was delivered at full term by Cesarean section, after unsuccessful manipulation, by a physician at home. The child, was apparently healthy at birth. When he was four days old a. nasal discharge appeared. At one month a rash was noticed over his body. A week before entrance he began to cough, became hoarse, and later developed aphonia, which persisted. He had been fed by a formula of whole milk § 5? lime water 5 2, lactose 5 2, sterile water 5 5, and had been given as much as he would take. He seemed hungry, but the nasal obstruction interfered with his nursing. He had been treated at the Homeopathic Hos- pital and by two private physicians. P. I. He was brought in because of the respiratory difficulty and a " convulsion " January 27th. P. E. Showed a poorly developed and nourished infant 1 foot 8y4 inches long, weighing 4,800 gm. pounds), with senile facies, aphonic cry, labored respiration, and occasional paroxys- mal cough with mucopurulent expectoration. The head was retracted, the anterior fontanelle 4x5 cm. The posterior admitted the tip of the finger. There was marked temporal bald- ness extending to the vertex, " cradle-cap," and marked promi- nence of the superficial temporal veins, a pea-sized gland over the left orbit and one over the left temporal region, definite, thin- ning of the eyebrows. There was mucopurulent discharge at the Published weekly by the Massachusetts General Hospital, Boston, Mass. Dr. F. A. Washburn, Administrator. Subscriptions $5.00 per year. Entered as second clasa matter May 31, 1916, at the post office at Boston. Mass., under the act of March 3, 1879. Acceptance for mailing at special rate of postage provided for in Section 1103, Act of October 3. 1917, authorized AUgust 13. 1918. Reprinted by New York State Department of Health, Bureau of Venereal Dis- eases with permission of publishers. inner canthi. The base of the nose was depressed; there was moderate discharge. The lips showed transverse fissures, and shagades at the left angle. The tongue presented a raised papule 1 cm. in diameter. There were two mucous patches on the hard palate. The throat showed mucopurulent pharangeal secretion. There were pea-sized posterior auricular, occipital, and inguinal, and shotty cervical and axillary glands. The chest was emaciated. There was marked supraclavicular, substernal, and intercostal retraction with each inspiration. There was pigeon breast, and slight rosary. The heart was normal. Both lungs showed many fine and medium moist rales, and occasional sibilant rales, anterior and posterior. There was slight dullness at the angle of the right scapula, and exaggerated bronchovesicular breathing high in the right axilla. The abdomen showed evidence of marked emaciation. The recti was prominent. A soft liver edge is felt 5 cm. below the costal margin. There were no masses, spasm, or tenderness. The lower legs showed the remains of an old maculo-papular eruption. There were several pigmented areas on the buttocks. There was slight scaliness of both soles, and a fissure on the right knee. T., P. and R. are shown in the chart. There is no record of the urine. Blood. Hgb. not recorded. Leucocytes 30,000. Polynuclears 33%, lymphocytes 66%. Throat culture negative. Stools: Pea green, with mucus, small curds, few soaps. The child was given whole milk a 12, lime water § 3, sterile water a 12ss, lactose one level tablespoon- ful, in seven feedings of 4 ounces each. He took his feedings well, but lost weight. The respiratory difficulty cleared up considerably. It was im- possible to feed him a formula of sufficient caloric value because of his poor digestive powers. February 2d the right ear drum ruptured. Next day the left drum was red and Paracentesis gave blood and pus. There was dullness over the left chest from the apex to the third rib in front, with bronchial breathing. February 6th the child's condition in the morning was apparently good. In the evening he suddenly became cyanotic, and died in an hour. DISCUSSION By Dr. Fritz B. Talbot This is fairly typical text-book picture of congenital syphilis. What are the ear-marks in the physical examination ? Students: Senile facies, snuffles, mucous patches, shagades, maculo.-papular eruption, fissures on the lips, enlarged liver, lymphocytosis. Dr. Talbot : All except the last two. An enlarged liver goes with so many conditions that it is not characteristic. An enlarged spleen would be more important. The differential count of 33% of polynuclears and 66% lymphocytes is normal for a child of this age. You have left out " marked temporal baldness extend- to the vertex " and " marked prominence of the superficial tem- poral veins." Those are both characteristic. A Student : Do they not come in rickets too, ? Dr. Talbot : They may, but they are characteristic of specific, as is also thinning of the eyebrows. We could almost read through this record word for word and say that is a text-book picture of congenital specific. We have, however, some findings that need explanation. What do the lung findings suggest ? A Student : Bronchopneumonia. Dr. Talbot: Yes, this child should have bronchopneumonia. What does the " marked supraclavicular, substernal, and inter- costal retraction with each inspiration " mean? A Student: Inspiratory obstruction. Dr. Talbot: We have evidence of an aphonic cry. That may be connected with the respiratory obstruction, or it may not. The obstruction may be high up in the pharynx, or it may be lower down. What may cause inspiratory obstruction lower down in the pharynx? ■ A Student : A thymus gland. Dr. Talbot: The obstruction may be in the region of the larynx or in the region of the thymus. Evidently when the child was being treated they were suspicious of the larynx, because they took a culture. The formula given is not consistent. It amounts to only twenty-seven ounces, and the record says that he was given seven feedings of four ounces each. There are twenty-one calories in an ounce of whole milk, or two hundred and fifty-two in the whole milk that was being given to this baby. There are sixty calories in a rounded tablespoonful of milk sugar, or 312 in all. He is getting in the neighborhood of sixty calories per kilogram, if his weight was 4,800 grams as recorded. This is too little for a baby of his age and weight. The latter part of the record shows an increase in the amount of solidified lung. Why did he suddenly die? Considering the positive diagnosis that we can make it can be explained in two ways, either by pneumonia, in which the heart and respiration suddenly stopped, or by a thymus, to which most cases of sudden death are due; that is, the case might have been one of status lymphaticus. Cur diagnosis in this case is congenital syphilis, bronchopneumonia, otitis media, and inspiratory obstruction, probably thymus. \ A Student : Is retropharyngeal abscess a possibility ? Dr. Talbot: Whenever you get an infection in the nasoph- arynx there is always a possibility of a retropharyngeal abscess; but although it is a possibility here, there is nothing in the record which would give us any positive evidence of it. Dr. Richardson : In most cases where there is marasmus or a condition of malnutrition the thymus gland is quite small. Con- versely, most of the status lymphaticus cases are fairly well nour- ished. The thymus gland in this case was represented by a very small remnant. Cases of congenital syphilis in infants show great variation in the extent of the manifestations. They run the gamut from cases in which we find spirochetes, typical lesions, where the clinical history is typical, and a positive Wassermann is obtained, to cases with very slight lesions, frequently confined to some one tissue, and with entire absence of the spirochetes, like this one. From the character of the lesions in the skin the diagnosis would surely be written down as congenital syphilis. When you come to examine the organs of the body there seems to be no additional evidence. No treponemata were found by the dark field illumina- tion test or by microscopical examination of tissue sections from the liver, spleen, kidney, aorta, pancreas, and region of the larynx stained by Levaditi's method. So that in this particular case direct evidence of the presence of the spirochetes is wanting, and the only things we have on which to base our diagnosis of congeni- tal syphilis are the lesions of the skin and the mucous patches mentioned. The lungs showed some areas of bronchopneumonia scattered here and there. There was also a small amount of atelectasis and emphysema. The middle ears showed pus. The organism isolated from the blood stream was the streptococcus. Dr. Talbot: Do you think it was part of the disease or a terminal infection? Dr. Richardson : I think it was a terminal infection. I also think, however, that this infant may have had recurring infections from time to time. I believe that in these cases of syphilis, whether the manifestations be very evident or only slight, the child usually dies with an intercurrent infection, due of course to the condition of malnutrition. Dr. Talbot: I should like to call attention to the chart. You can see that the temperature, pulse, and respiration rates were coming down to normal, and yet the child suddenly died. If the chart alone were taken as a basis for the prognosis one would say the child was doing well. The general appearance, of course, gives the best idea of how well a baby is doing. CLINICAL DIAGNOSIS (from hospital record) Congenital lues. Pneumonia. DR. FRITZ B. TALBOT'S DIAGNOSIS Congenital syphilis. Bronchopneumonia. Otitis media. Inspiratory obstruction, probably thymus. 1. Chemical or physical origin of fatal ill- ness. ANATOMICAL DIAGNOSIS Congenital syphilis. Marasmus. Bronchopneumonia. Syphiloderma. Hydropericarditis. Otitis media, double. Septicemia streptococcus. 2. Secondary or termi- nal lesions. DIVISION O ENEREAL DISEA-.. oseph s. Lawrence, m.d. a.a.s.. u.s.p.h.s. DIRECTOR AND 8 -ATIONS AND ALL OTHER THINGS CLINICAL WILL BE ADDED UNTO YOU "-OSLER : STREET ALBANY, N. Y. Decord #4492 April 30,1923 Dear Doctor: In this case the symptoms of syphilis were so plentiful .namely, a positive Vhssermann reaction in the blood of both child and mother, prom- inence of f ronto-t emporal bones and veins, mucous patches, desquamating palms and soles, rash on buttocks and finally improvement under specific treatment; that the diagnosis should not have been mistaken. Mercury was given by month for awhj.le but ".'as discontinued. Perhaps it was thought to be interfering with the child's digestion which may have been true but treatment very often is discontinued too soon, the disappearance of the symptoms being interpreted as signifying a cure. If mercury is to be given it should be used either as an inunction or as an intramuscular injection. If the inunction be used, a piece of Ung. Hydrarg. about the size of a pea should be rubbed into the skin for 10 or 15 minutes daily, using the skin of the abdomen, the back, each axilla and each groin in succession and then giving a warm bath on the seventh day. This weekly program should be continued until a cure is achieved or inter- rupted by contraindications. If intramuscular treatment is preferred, it may be secured by employing neo-arsphenamine and bichloride 1. The drugs are injectedn intramuscularly. Treatment by this method is less troublesome than by inunction and can be administered by the physician. The injections are- made at weekly intervals following, in general, the scheme of treating adults except, of coursem that the dosage is smaller, being determined by.the weight and age of the child. If you wish to' know more about this method of treatment I shall be glad to give you additional information. Very truly yours Director, Division of Venereal Diseases A.A.Surgeon JSD-EOC PUBLIC HEALTH IS PURCHASABLE. WITHIN NATURAL LIMITATIONS ANY COMMUNITY CAN DETERMINE ITS OWN DEATH RATE NEW YORK STATE DEPARTMENT OF HEALTH UNITED STATES PUBLIC HEALTH SERVICE COOPERATING WITH THE DIVISION OF VENEREAL DISEASES Joseph S. Lawrence, m. d. a.a.s., u.s.p.h.s. DIRECTOR "know syphilis in all its manifestations AND RELATIONS AND ALL OTHER THINGS CLINICAL WILL BE ADDED UNTO YOU"-OSLER 132 STATE STREET ALBANY, N. Y. March 12, 1923. Dear Do ctor:- Attached, we have the pleasure of forwarding to you a copy of a ''Summary of Treatment as Employed in the Department of Dermatology and Syphilis at the College of Physicians and Surgeons, Hew York", prepared by Dr. Jbrdyce for his classes at Columbia University, Tlie treatment of syphilis is a very serious undertaking. The infection is localised about the Portal of entry for a very brief period, perhaps shortly after the -.ppearance of the chancre, and certainly before the rash appears the spirochetes have entered the blood stream and by it have been distributed through the system, If the proper treatment was begun before the spirochetes invaded the blood stream, the prognosis is very excellent, but after the spirochetes have been carried to every part of the body, it is much more difficult for drugs to reach them., and so long as they remain alive the possibility of the disease progressing remains. Inadequate treatment in the early stages may result in the eradication of symptoms only, and inspire false security. The spirochetes, which early take up their abode in the vessel walls, the heart walls, or neural system, often do not produce symptoms tive of their presence until years after the inoculation. Spirochetes located in places where the circulation is meagre are difficult to reach with drugs unless the system is pretty thoroughly saturated. Knowing that you are interested in the treatment•of syphilis, we feel you will appreciate Dr, Fordyce's generosity in permitting us to circulate this paper. Jojirs very/'tjruly, Jos. S. Lawrence, Director, Division Venereal Diseases. A, A* Surgeon, jsl/md» PUBLIC HEALTH IS PURCHASABLE. WITHIN NATURAL LIMITATIONS ANY COMMUNITY CAN DETERMINE ITS OWN DEATH RATE NEW YORK STATE DEPARTMENT OF HEALTH COOPERATING WITH THE UNITED STATES PUBLIC HEALTH SERVICE DIVISION OF venereal DISEASES Joseph s. Lawrence, m. d. a.a.s., u.s.p.h.s. DIRECTOR "KNOW SYPHILIS IN ALL ITS MANIFESTATIONS AND RELATIONS AND ALL OTHER THINGS CLINICAL WILL BE ADDED UNTO YOU"-OSLER 132 STATE STREET ALBANY, N. Y. May 10, 1923. Deo.r Doctori- ?/e are eager to knew the approximate number of cases of congenital syphilis seon by each physician in a year and ask you to be good enough to assist us by ent ering devta on the attached sheet and returning it to us at your earliest convenience. There are reported annually between 800 and 1000 deaths from syphilis in the entire State of New York. An analysis of those deaths from the State exclusive of New York City shows that between one-third and one-half occur in infants one year of age or under, These were children congenitally infected and with- out a doubt are but a portion of those whose lives were terminated because of the presence of the infection. Syphilis way so reduce the vitality of a child that it can, with difficulty, survive the usual children's diseases* Very encouraging therapeutic results are being achieved by the intramuscular injection of neo salvarsan and mercury. We shall be glad to tell you more about the technique if you are int erested. Yours very truly. Jo s. S» Lawr ence, Director Division Venereal Diseases, A2* A, Surgeon, JSL/MD, Public Health Is Purchasable. Within Natural Limita- tions any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. A Talk With Mothers Pamphlet 12 HEALTHY MOTHERS AND BABIES-THE NATION'S HOPE HERMANN M. BIGGS, M.D. Commissioner 3 -14-22-20.000 Public Health Is Purchasable. Within Natural Limita- tions Any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. FACTS FOR PARENTS ABOUT SYPHILIS, GONORRHEA AND CHANCROID * HEALTHY MOTHERS AND BABIES-THE NATION'S HOPE HERMANN M. BIGGS, M. D. Commissioner Pamphlet 2 Public Health Is Purchasable. Within Natural Limita- tions Any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. Syphilis, Gonorrhea and Chancroid Pamphlet 1 HEALTHY MOTHERS AND BABIES-THE NATION'S HOPE HERMANN M. BIGGS, M. D. C ommissioner Public Health Is Purchasable. Within Natural Limita- tions Any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. Syphilis, Gonorrhea and Chancroid Pamphlet 1 HEALTHY MOTHERS AND BABIES-THE NATION'S HOPE HERMANN M. BIGGS, M. D. Commissioner SEX HYGIENE PAMPHLETS The several pamphlets of this series the titles of which are given below, may be ob- tained from the State Department of Health, Albany, N. Y., on request. 1 Syphilis, Gonorrhea and Chancroid 2 Facts for Parents 3 Facts for Young Men 4 Facts for Young Women 5 Facts for Public Officials and Business Men 6 Keeping Fit 9 Man Power 10 Mothers of America 11 Facts for the Adult Public 12 A Talk with Mothers 13 Passing on the Torch 14 Come Girls Circular No. 26 - Information for physicians regarding syphilis, gonorrhea and chan- croid Syphilis (public health poster) Gonorrhea (public health poster) Healthy Manhood (poster in colors) Healthy Womanhood (poster printed on paper and cardboard) Compilation of laws Relating to Syphilis, Gonorrhea and Chancroid The Modem Treatment of Syphilis, Gonor- rhea and Chancroid (for physicians) GONORRHEA, SYPHILIS MVD CHANCROID* I Instructions for those having gonorrhea Gonorrhea, also known as clap and gleet (the chronic form), is a highly contagious disease caused by germs which enter the urinary canal (usually as the result of unlawful sexual intercourse), and attack the local organs. Very often, by traveling in the circulating blood, these germs affect other and more distant parts of the body. The first symptom of the infection is, ordinarily, a burning pain in the penis on urination. This occurs usually three to fourteen days after intercourse with a woman who has the disease. The urine at this time contains small fine flakes or is opaque or cloudy when voided. A thick yellowish matter or pus comes from the mouth of the urinary canal. This matter or pus contains millions of germs (gonococci') in every drop and is very infectious. A small particle of it getting into the eye may cause blindness. If properly treated at this time by a compe- tent physician the disease may be cured; but *Formerly these diseases were called "The Venereal Diseases." There seems to be no adequate reason for retaining this term. 2 3 if proper treatment is neglected, gonorrhea may become one of the most dreadful dis- eases which anyone can have,- and one of the most difficult to cure. Deep-seated abscesses; a painful form of rheumatism affecting many points at the same time; inflammation of the organs making and storing the seminal fluid; in- fection of the testicles, causing sterility; bladder inflammation; abscess of the kidneys,- these are some of the effects of this disease. Stricture is another serious complication fol- lowing gonorrhea. This is caused by the formation of a scar in the urinary canal, partly or completely closing it and preventing the flow of urine. This can only be relieved by a painful and often serious operation. Gonorrhea can be cured, but it takes time and patience to cure it. When the discharge stops, it is not cured. Frequently there re- mains a slight drop at the mouth of the canal on arising in the morning, and the urine, when passed into a glass, is a little cloudy from the numbers of small shreds or particles floating in it. Such cases are as dangerous as those having abundant discharge. The germs of gonorrhea often remain in the body for years after the discharge has stopped. A man in this stage, thinking he is cured, may marry, and thus give the disease to his wife. Gonorrhea is often a very serious disease in women. It is responsible for many mutilating operations and much permanent ill health among innocent wives. It is the greatest single cause of childless marriages. If a mother has the disease she may give it to her helpless baby and blindness may result. If you have gonorrhea what should you do to protect yourself and others? 1 Wash your hands thoroughly after touch- ing the diseased parts or handling anything soiled with the discharge. Remember that the pus contains millions of germs and that a small drop of it carried on your fingers to the eyes may cause blindness in a few days. 2 Be clean; do not let the discharge soil the toilet, wash basin, bath tub, etc. 3 Sleep alone. 4 Have no sexual intercourse. Avoid sexual excitement; it will aggravate your disease. 5 Allow no one else to use your toilet articles, particularly towels, wash clQths, etc. 6 Burn all soiled cloths, cotton and gauze, etc., after use. 7 Never lend anything used in your treat- ment to anyone else. Destroy such things when you are through with them. 8 Do not marry if you have, or ever had, gonorrhea until you are pronounced well by a reliable physician, only after the necessary laboratory tests have been made. 9 Do not use alcohol in any form. 10 Do not be discouraged at the length of the treatment. Keep it up until the labora- tory tests show that you are cured. 11 Do not neglect treatment until the dis- 5 4 ease has become chronic. If you do, it may take months and even years to cure it. 12 If you can not afford to pay for treat- ment, apply to your local board of health and state the conditions, and treatment will be provided. 13 'Never allow anyone except a reputable physician to prescribe for you. Follow his directions strictly. Do not attempt to treat yourself. Shun patent medicines and advertis- ing medical " quacks" or "specialists;" they are all fakes. Syphilis and gonorrhea may both be con- tracted at the same time and may exist to- gether. beneath the skin they are at first few in number and do not set up any irritation, but in from two to eight weeks there appears a little red spot, a pimple or an ulcer, known as the " chancre " or hard sore - the sign or symptom of the first stage of syphilis. Some- times the chancre is so small and so slightly inflamed that no heed is paid to it. Any small ulcer or sore spot on the sex organs should be carefully watched, as it may be a chancre, if there has been exposure to infection. This is the time for treatment. The germs now spread through the general circulation of the body, continue to increase in number, and in six weeks to three months enough have developed to cause the second stage symptoms. These are of great variety. They may be very severe, or they may be so slight as to pass un- noticed by anyone but an experienced physi- cian. They are found in all parts of the body-such symptoms as headache, bone-pains, fever, sores in the mouth and throat, skin rashes, swelling of the glands, etc. All of these may be present in some severe cases, or only one of two of the signs may appear. The thira stage develops very slowly. It takes from .one to twenty years or more to show itself. This stage should never be allowed to develop. The proper treatment of the first and second stages will prevent the terrible ravages of the third stage which may destroy the nerves, blood vessels, bones and II Instructions for those having syphilis Syphilis, also known as pox, lues, hard chancre, etc., is a contagious blood disease caused by a germ, the poison of which circu- lates through the blood to all parts of the body. If neglected it may reach and destroy the various vital' organs. The disease is con- tracted as a rule through illicit sexual inter- course, but it is also transmitted by kissing and contact with the articles used by syphi- litic people, such as eating utensils, etc. The germs causing the disease only enter the body through a break in the skin or mucous membrane. This break in the skin may be so small that it can not be seen with the naked eye. When the germs get 6 7 other tissues. Locomotor ataxia, certain forms of paralysis, saddle nose, paresis or softening of the brain, some forms of insanity, deformities of the bones and joints, w'hich result from neglected or third stage cases of syphilis, do not appear in well treated and early treated cases. If a man with syphilis marries before he is completely cured he may not only infect his wife but his children may be diseased. This is known as hereditary syphilis, and is the cause of many physically deformed, mentally defective and idiotic children. The first and second stages of syphilis are highly infectious. The third stage is very slightly infectious, but it is the most danger- ous for the patient. There should be no third stage if the treatment is begun at the right time and continued long enough under proper medical direction. If a person has syphilis it shows in his blood. The symptoms together with the blood test made in the laboratory, known as the " Wassermann test," leave no doubt. The mere fact that the symptoms may not show at different times for several years, however, and that the disease, without much treatment may seem to be cured, does not mean that it is cured. It is still in the system. The germs may be present in the body for many years without producing any outward signs or symptoms. Thus after a month's treatment a man may feel well; but he is not well. Not only is he still affected with the disease, but he can infect others in many ways. He must not marry until his physician says he can do so without danger. If uncured, the disease may strike him down suddenly after 15 or 20 years of apparently good health. Syphilis can be cured, but not in a week or a month. A patient must be under the care of a competent physician for a period of one to three years before a cure is certain. By the Wassermann blood tests the physician can determine the patient's condition, regulate the treatment, and decide when the treatment can safely be stopped. No case is cured until the blood tests show clear for a long time. While not absolutely necessary in all cases for the cure of syphilis, the use of salvarsan (606) or its substitutes, greatly hastens the recovery, and for the complete and permanent cure of many cases it is necessary. It should be used repeatedly to get the best results. If you have syphilis, what should you do to protect yourself and others, including future generations? 1 Be clean. 2 Sleep alone. 3 Have no sexual intercourse. 4 Do not kiss anyone. 5 Have separate towels, brushes, soap, razors, etc., and never let anyone else use these or any other articles which you use habitually. : 8 ; 9 6 If you go to a dentist, tell him about your disease before he examines your teeth. Whenever you consult a physician for any other complaint, tell him you have had syphilis. 7 Always burn the dressings that have been used on sores. 8 Never use drinking utensils in public places. Avoid alcoholic drinks entirely. 9 Do not marry until you have been for a long time free from any symptoms, and also free from any blood infection as shown by the Wassermann blood tests. 10 Do not be discouraged at the length of the treatment. Keep it up until the labora- tory tests show that you are cured, or it may be too late to be cured at all. 11 If you can not afford to pay for treat- ment, apply to your local board of health and state the conditions, and treatment will be provided. 12 Never allow anyone except a reputable physician to prescribe for you. Follow his directions strictly. Shun patent medicines and advertising medical " quacks " or " special- ists"; they are fakes. ft is often difficult to determine whether the sore is the true chancre of syphilis or not, without laboratory tests. A person having such a sore should therefore place himself under the care of a reputable physician and continue under his observation until it can be decided by laboratory tests whether the chancre is true or false. The disease is infec- tious and may readily be given to others, at times with serious results. All the necessary laboratory tests are made without charge by the State or City Health Departments. Domestic relations law Under an amendment to the Domestic Rela- tions Law, in effect May 16, 1917, no marriage license may be issued until the applicant shall have subscribed to the following statement: " I have not to my knowledge been infected with any venereal disease, or if I have been so infected within five years 1 have had a labora- tory test within that period which shows that I am now free from infection from any such disease." Ill Instruction for those having chancroid Chancroid, also known as " soft chancre " or " false chancre," is a germ disease, contracted in the same way as syphilis, and producing an ulcer or sore, usually on the genital organs. : 10. 11 Syphilis causes: Stillbirths. Miscarriages. Imbecile and crippled children. Paralysis in early life. Locomotor ataxia. Paresis, or softening of the brain. Disease of the heart. Disease of the blood vessels. Disease of the bones. Blindness. Gonorrhea causes: Stricture of the urinary canaL Serious joint disease. Mutilating operations upon the vital organs of women. Blindness. Sterility. Heart disease. These diseases cost the state millions of dollars each year. Persons seeking advice may write to the State Department of Health, Bureau of Venereal Dis- eases, Albany, N. Y. Public Health Is Purchasable. Within Natural Limita- tions Any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. FACTS FOR PARENTS ABOUT SYPHILIS, GONORRHEA AND CHANCROID HEALTHY MOTHERS AND BABIES-THE NATION'S HOPE HERMANN M. BIGGS, M. D. Commissioner Pamphlet 2 SYPHILIS, GONORRHEA AND CHANCROID FACTS FOR PARENTS A message The several pamphlets of this series the titles of which are given below, may be ob- tained from the State Department of Health, Albany, N. Y., on request. 1 Syphilis, gonorrhea and chancroid 2 Facts for parents 3 Facts for young men 4 Facts for young women 5 Facts for public officials and business men G Man power 7 Your country needs you, a talk with girls 8 The nation's call to young women 9 Keeping fit Circular 26 - Information for physicians regarding syphilis, gonorrhea and chan- croid Venereal Diseases, a poster for the education of women Venereal Diseases, a poster for the education of men Compilation of laws relating to syphilis, gon- orrhea and chancroid SEX HYGIENE PAMPHLETS Do you know that syphilis and gonorrhea are a peril to the family, a menace to the vitality, health and physical progress of the race, and are justly regarded as the greatest of modern plagues ? Do you know that gonorrhea is the most widespread of all diseases except measles? Do you know that a large majority of abdominal and pelvic operations on women are the result of gonorrheal infection, in many cases ignorantly transmitted by the husband to the wife? Do you know that gonorrheal infection is responsible for more than ten per cent of all blindness and for at least twenty per cent of blindness in children ? Do you know that gonorrhea is the princi- pal cause of sterility or childless marriages? Do you know that gonorrhea is the cause of many chronic diseases of the joints, bladder and generative organs? Do you realize the extent and danger of gonorrhea in high schools, private and prepar- atory schools, colleges, universities, in stores, mills, shops, offices and homes? 3 Do you know that syphilis probably affects at least eight per cent of the total adult population ? Do you know that syphilis is transmitted to the offspring, and that the consequences of this disease are frequently more severe upon the children than upon the syphilitic parent, often resulting in their death? Do you know that syphilis is the cause of a large percentage of insanity? Do you know that syphilis is one of the causes of mentally deficient children, idiocy, imbecility and the like? Do you know that syphilis lowers the stand- ard of health and paves the way for many other diseases? Do you know that syphilis, gonorrhea and chancroid greatly decrease one's earning capacity ? Do you know that syphilis, gonorrhea and chancroid are the underlying cause of untold misery and suffering? Do you know that practically all prosti- tutes, public and clandestine, are infected with gonorrhea, and nearly all of them with syphilis ? Do you know that syphilis, gonorrhea and chancroid are preventable? You are asked the foregoing questions in order that you may be brought to realize the wide extent to which the homes of the Ameri- can people are being invaded by one or other of these diseases, the most dangerous to the human family of all diseases known. The so-called " social diseases " have so long been shielded by what is termed the " Anglo- Saxon sense of prudery " that few people know the enormous amount of damage they are doing to the race The lack of correct infor- mation among the masses of the population as to their extent and danger constitutes one of the most menacing problems of civilization. Has not the time come for parents, and in fact all thoughtful citizens, to abandon this false delicacy, this absurd prudery, which by sur- rounding sex nature with an atmosphere of mystery, has invited the destruction of the national health? The parents' responsibility in this matter can not be overlooked. They must make every DO YOU KNOW THAT SYPHILIS IS THE CAUSE OF PARESIS OR SOFTENING OF THE BRAIN, AND OF LOCOMOTOR ATAXIA? Do you know that syphilis is .the chief cause of apoplectic and paralytic strokes in early life? Do you know that syphilis is the cause of nearly one-half of all abortions and mis- carriages? Do you know that syphilis decreases the length of life about one-third? Do you know that a husband may infect his wife with either gonorrhea or syphilis long- after he may think himself free from the dis- ease ? 4 5 effort to educate their children who will soon be young men and women. It is not fair to allow their children to grow up into manhood or womanhood in ignorance of the dangers which confront them or until they find them out from bitter experience. Parents often say: " Let our children remain innocent." By all means; but inno- cence is not synonymous with ignorance. In the past most children have obtained from their older companions in the school or on the street what information they had, much of it false and harmful, about these subjects which have been tabooed in the home. It is surely better and safer for them to receive wholesome instruction from their parents. The parents are the proper persons to give early sex in- struction; indeed, such instruction can only be given properly in the home, individually and privately. As to the suitable age at which to begin teaching children, and what to tell them, it may be said that they should be gradually told the truth, commencing at the time when the child asks the first questions concerning his origin. It is not advised that the whole truth be told at that time, but his confidence should not be shaken; and if false- hoods are told or the question evaded this confidence may be broken. Such fairy tales as that of the " stork " or the " doctor's satchel " should be consigned, where they belong, to the waste basket. Life itself is mysterious enough; there are too many unknown things connected with the origin of life for us to cloak the facts that are known, in a fabulous story. One of the best pamphlets which has been written for the information of mothers, in teaching their children about the functions of the reproductive organs, is " The Mother's Reply," by Nellie M. Smith, published by The •American Social Hygiene Association, 105 West 40th Street, New York City,- a pam- phlet which mothers are advised to read. By the time the boy or girl reaches the age of adolescence, say at sixteen or eighteen years of age, the facts relative to the dangers of syphilis, gonorrhea and chancroid should be explained. These diseases are social assassins. They spare neither virtue nor innocence. Why deny the existence of an assassin by pro- fessing to ignore his presence? Is that wise, or brave, or in any sense good policy ? It would seem to be rather like the policy of the ostrich, stupidest of birds, which, hiding its own eyes to danger, believes itself to be secure from harm. This self-deceptive stupidity is cer- tainly not worthy of imitation by intelligent human beings, by parents who are morally and physically responsible for the health and luture welfare of their children. If everyone realized the vast amount of un- happiness, of misery and of suffering that is due to syphilis and gonorrhea, the problem of their final suppression would be made much easier. These diseases, it must be remembered, have existed from time immemorial. They can not be readily suppressed, but they can be con- trolled, and after a time, through education of G 7 the people, they may eventually be suppressed Syphilis, gonorrhea and chancroid are prct ventable. They are spread by personal conta for which man alone is to blame. In nature animal contracts these diseases. Of the hum family, parents, being the most deeply inteijr ested in the prevention of these diseases, shouli consider themselves directly responsible fcl neglect of duty if they fail to instruct theil children and warn them of their peril. They should learn what to teach and how to teacli it; how to guide their children along the straight and narrow path of sexual cleanli] ness. They should train them in sex hygiene' They should make boys and girls understand! that " you can not touch pitch without being' defiled; " and that they will derive health happiness and prosperity from being moralh clean. For do what we may for the benefit oi humanity, the fact remains that the reproduc tion of a physically and mentally, as well at morally strong and vigorous race, will com only from the sexually clean. Under an amendment to the Domestic Reh - tions Law, in effect May 16, 1917, no marriag | license may be issued until the applicant shal . have subscribed to the following statement: " I have not to my knowledge been infectec, with any venereal disease, or if I have beer, so infected within five years I have had < laboratory test within that period which showt , that I am now free from infection from any such disease." Parents, do your duty 8 Public Health Is Purchasable. Within Natural Limita- tions any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. A Talk With Mothers Pamphlet 12 HEALTHY MOTHERS AND BABIES-THE NATION'S HOPE HERMANN M. BIGGS, M.D Commissioner 3-14-22-20.000 SEX HYGIENE PAMPHLETS A TALK WITH MOTHERS The several pamphlets of this series, the titles of which are given below, may be ob- tained from the State Department of Health, Albany, N. Y., on request. 1 Syphilis, Gonorrhea and Chancroid 2 Facts for Parents 3 Facts for Young Men 4 Facts for Young Women 5 Facts for Public Officials and Business Men 6 Keeping Fit 9 Man Power 10 Mothers of America 11 Facts for the Adult Public 12 A Talk with Mothers 13 Passing on the Torch 14 Come Girls Circular No. 26 - Information for physi- cians regarding syphilis, gonorrhea and chancroid Syphilis (public health poster) Gonorrhea (public health poster) Healthy Manhood (poster in colors) Healthy Womanhood (poster printed on paper and cardboard) Compilation of Laws Relating to Syphilis, Gonorrhea and Chancroid The Modern Treatment of Syphilis, Gonor- rhea and Chancroid (for physicians) Preventing disease There is probably no other line of human endeavor concerning which our ideas have changed so materially in the past few years as in regard to preventive medicine. Both physi- cian and layman realize that the work of the medical man is far greater in scope than was formerly supposed. . Until recently the physi- cian's whole work was thought to be the treat- ment, and if possible, the cure of existing dis- ease, but now no one feels more keenly than he that his first and greatest duty lies in pre- venting disease. Glancing over medical history we find the scientific discoveries of recent years have shown that most diseases formerly considered as dis- pensations of Providence are really avoidable. Where vaccination has become almost univer- sal, smallpox is rarely found; diphtheria can be prevented and controlled by antitoxins, and hydrophobia by antirabic virus. Since we have learned to insist on clean milk and drink- ing water uncontaminated by sewage, typhoid fever no longer exacts so terrible a toll of life. Venereal diseases Still more recently and particularly since the beginning of the war, in no line has more work been done than in regard to 3 2 lines except regarding their sexual and emo- tional lives; they did not understand how they were made, or why, or the meaning of the great emotions that, at certain times, went surging through their bodies. Being ignorant concerning these things, and curious about life, they had tried experiments, had wasted their powers on weak and loose women, and had be- come infected with these terrible diseases. Such an awakening as our government ex- perienced could lead only to one result, and that was to drag these conditions out of the darkness and secrecy in which they were hid- den, and to hold them up in the clear sunshine of knowledge, that our young people might learn the seriousness of such dangers, and unite in their elimination. the prevention of the venereal diseases. These dread scourges, previously almost un- recognized by the laity, are now becoming quite generally understood; the fact that they are unnecessary and preventable and that chiefly those who are willing to take chances and to expose themselves are liable to contract them, is becoming everywhere known. For years men have preached clean living as a moral duty, and have accomplished little; but now we are beginning to grasp the fact that clean living is essential to health, and that health is the greatest blessing we can enjoy. Before the United States entered the world war no health census of our young people had ever been taken. We had assumed that a young man or woman, born in this country and enjoying its advantages, would naturally be of a fine physical type. Therefore the results of the draft examinations were a great shock to the government and to the nation at large. It was found that many of our boys had bad teeth, poor eyesight, adenoids, enlarged and dis- eased tonsils, crooked spines, diseased hearts, and, worst of all, we were horrified to learn that many of the unfit were infected with onO or both of the venereal diseases - syphilis and gonorrhea. These were not boys from the slums, but were from your town and from mine,- the average American boy. What, then, did such a condition mean? It meant that our young men had been educated along all An awakening The double standard One of the greatest factors aiding in the spread of syphilis and gonorrhea has, been the age-honored double standard of morality. We have demanded clean living from our girls, and taught them to bring clean bodies to their husbands, but have made no demands upon our boys as to the cleanliness of their lives. Parents have believed that their son's anatom- ical build made sex relations necessary to health. If a young man tried to lead a clean sex life many of his boy friends called him a " sissy." If the boy, in the process of wild- oat sowing, had too much to drink, and brought serious trouble into some girl's life, his par- ents in many cases, failed to feel that he had done anything particularly reprehensible; his 5 4 no vocabulary in which to present such facts as are known to them. They have also a feel- ing of timidity that makes it more difficult to talk to their own daughters than toothers. All these things have helped to keep girls in the dark concerning what it is vitally important for them to know. V\ hen a child comes to her mother and asks where the new baby came from it means one of two things; either that the child has developed enough mentally to think things out for herself, or that she has heai d snatches of conversation that have made her curious to know more. In either event she is entitled to a clear, true statement that will give her the right outlook on life and life's reproduction. If the mother answers that the stork brought the baby, or that it was found in the cabbage patch, or in the heart of the rose, or uses any of the other fables that for generations have been told to children in place of the truth, that mother loses the chance of a wondei ful companionship with her daughter. There can exist no closer relationship than that based on confidence. The knowledge that she can always depend on mother to tell her the real truths will lead her all through life to bring questions of real importance to the one person upon whose word she can rely. It is not neces- sary for the mother fully to instruct the child concerning sex matters at one time, but she may enlighten her little by little as the neces- sity arises. The young girl should easily un- derstand that sex matters are to be discussed only with her mother who will tell her all she young men friends thought he had vindicated his manhood; the girls of his acquaintance were willing to accept invitations from him and to be seen in his company. But what about the girl in the case? Did her girl friends rally around her and appear proud of her ? No, indeed; her former friends forgot that they were accustomed to associate with her, and, whispering, gathered in corners to discuss her condition. In other words, the girl's life was ruined by the very thing that in the boy was barely criticized. The old idea of judging the boy by one standard and the girl by an- other is now considered fallacious, and health authorities, in general, are now teaching that a single standard of morality should prevail and that the health of a young man is im- proved, and not injured, if he lives as clean a life as does his sister. While our boys have been suffering from neglect and misinformation, our girls have been kept in ignorance of many important facts which it is their right to know. Every girl ought to know in a general way how she is built, her function in the world, what men- struation is and its influence over her whole life. The ideal teacher of such things is the mother. But because mothers have not been in the habit of talking to their girls concern- ing such matters, many willing mothers have themselves received no real instruction, and, being ignorant, are unable to teach their daughters. Except for vulgar terms they have Mothers, the ideal teachers 7 6 should know as soon as she is old enough tc require it. suffer also from physical injuries and ailments. Two serious diseases lurk in waiting for those who transgress health laws. These diseases, syphilis and gonorrhea, (called the venereal diseases from Venus, the goddess of love) are not new, but have been known to the medical profession for centuries. Other generations have known about them, but have not fully realized their seriousness. Since they are usu- ally contracted by immoral sex relations and men desire to save their wives knowl- edge of unpleasant things, the average ■woman knows little or nothing about them. Many people believe that syphilis and gonorrhea are different manifestations of the same disease, but they are two definite diseases, each caused by a specific germ, and running its own course and having its own symptoms. Wrong ideas of life AH this would be less important if girls did not get sex knowledge elsewhere; but if the mother withholds the desired information our girls are going to piece together what they hear from older girls, from stories told by boys, from bits of conversation overheard from the grownups, until they get an altogether wrong idea of life, and feel that there is some- thing secret, vulgar and almost indecent about all sex matters - a feeling which they may never outgrow or overcome. Too long our girls have been kept ignorant in an effort to keep them innocent, and the result has not been a success. Often they go through sad sex ex- periences that might have been avoided, and that leave bitter memories. When we hear of some little twelve or fourteen year old girl becoming a mother we appreciate the result of the old-fashioned policy of reticence. Youth is the most emotional period of life, when feelings, rather than cold judgment, regulate actions. Instead of being protected by knowledge, our girls have been blindfolded by ignorance and compelled to grope their way through their early years, with only their inherent fineness of character keeping them clean at the time of their temptation. Gonorrhea Gonorrhea, caused by the germ known as the gonococcus, as it occurs in woman is an inflammation of a woman's child-bearing and urinary organs, and occurs in varying degrees of intensity. Sometimes it is very mild, and the only symptom which the woman notices is a vaginal discharge. This she may attribute to some uterine trouble, and never realize that her infection is of gonorrheal origin. But all the time the inflammation is gradu- ally destroying the delicate tissues that line the pelvic organs, until finally they are no longer able to perform their functions, so that even though the woman may greatly desire children, she often remains sterile. Gonorrhea Beside the moral scars which young people sometimes carry as penalty for ignorance they Two serious diseases 8 9 is one'of the most common causes of childless marriages. When the disease extends into the tubes and ovaries, it causes pus tubes and ovarian abscesses. Then the woman may be obliged to undergo a severe abdominal opera- tion, and to have part or all of the child- bearing organs removed; after which she may not be able to bear children. If the inflammation be less acute the woman may become a chronic invalid and undergo great suffering. The long continued pain wears upon the nervous system, and the woman be- comes a bed-ridden, nervous wreck, unable to enjoy life, or bring happiness into the lives of others - a truly pitiable invalid. At other times the infection is not severe enough to destroy the uterine lining, and the woman may have a child. When the head of this little unborn child comes down the wonderful birth canal that is built in the body of every woman, if that canal is infected by the gonococcus, these germs may get into the eyes of the baby and infect them, so that a few days after birth the baby may become totally and incurably blind. When one understands that gonorrhea is the most common communicable disease that exists except, perhaps, measles, he will realize how serious this matter is. Even to this day many boys say that they are as willing to have a " dose of gonorrhea " as a cold, and do not realize that they may be laying up' for their future wives years of invalidism, severe ab- dominal operations and sterility, or blindness for their unborn children, or life-long invalid- ism for themselves. Babies so frequently be- came blind shortly after birth that long ago it became the practice for careful physicians or midwives attending childbirths to put drops of an antiseptic solution into the babies' eyes as a preventive of possible blindness. Gonor- rhea is also responsible for heart disease and for much joint rheumatism, which is often severe enough to cripple its victim for life. Syphilis Syphilis is a constitutional disease, caused by germs called the Rpirochetae pallida. It may attack any organ or tissue of the human body. It causes three groups of symptoms, called the primary, secondary and tertiary. Its first appearance is a sore, called a chancre, which occurs usually on the private parts, or on the lips, and is very slow and difficult to heal. Two or three months after its appear- ance the secondary symptoms may come on. The patient begins to feel ill. He or she may have a fever, headache, backache, loss of appetite, falling out of the hair, the face and body may break out with a skin eruption, while the mouth and throat may contain sores and ulcers. It is at this time that the disease is most virulently infectious, and that the inno- cent may be infected from mouth secretions. That is one of the reasons why we have done away with the common drinking cup in fac- tories and all public places, and have put in the bubbling fountain or the paper cup. Any person who ever saw a syphilitic mouth will be very careful about being kissed, unless it is 10 11 known that the other person has no such dis- ease. A recent medical journal reports that in a little country town a party was given at which one of the lads had an infected mouth. The young people amused themselves playing kissing games, and as a result fourteen inno- cent girls were infected with syphilis. Even without treatment the secondary symp- toms will eventually clear up, and sometimes months, or even- years later, often after the patient thinks he has entirely recovered, the tertiary affections appear. These are in the bones, muscles, the nervous system, internal organs and other parts of the body, resulting in loss of tissue, formation of ulcers, deformi- ties, locomotor ataxia and general paralysis of the insane. The involvement of the nervous system is always a serious matter. Every one has seen cases of locomotor ataxia, which are due to syphilis, as is also paresis, often popularly re- ferred to as softening of the brain, and gen- eral paralysis of the insane. Many of the cases of insanity which come to our state hospitals are insane as the result of syphilis. The effects of diseases such as these, which cause untold mental and physical agony, sterility or repeated miscarriages, and which bring innocent babies into being only to suffer from blindness and loss of intellect, is too great a price for our country to pay for the ignorance concerning the facts of life in which we have kept our boys and girls. We con- sider New York a progressive state, and yet in this state every day of the year many babies die at birth or before they are a year old as the victims of syphilitic infections. This infant mortality should make us realize that there is a great work ahead of us, and should make mothers see that they have a responsi- bility to teach their daughters to respect their bodies, and to lead clean lives. Our responsibility Remedies If taken early, syphilis and gonorrhea are curable diseases, and even when incurable the symptoms they produce may be greatly re- lieved. Treatment must be thorough, and con- tinued until laboratory tests, made by a quali- fied bacteriologist, prove that the disease is no longer present. It often takes three or four years of constant care to cure syphilis, and gonorrhea requires months of careful attention, and even then may reappear after being dor- mant. Many persons who become infected feel they can not afford the long expensive course of treatment necessary for cure, and neglect it, so that instead of being useful to the com- If the victim of syphilis has children during the early stages of the disease, these children are likely to come into the world diseased, and if they live, to become crippled, deformed, feeble-minded, or even idiotic. The children of such women are often born dead and the women suffer from one miscarriage after another if they be untreated. Syphilitic offspring 12 13 munity and an asset to the state, their lives become a liability and an economic loss. For such persons New York state is now doing a noble work by furnishing free treatment. Clinics have been opened in many towns and cities, where properly qualified physi- cians administer treatment at the expense of the municipality and the state. If cases exist in a town which has no clinic, they may report to the health officer, whose duty it is to see that they are properly cared for. In this way broken lives are being re-built, families reunited, and men and women who would other- wise become charity charges are rehabilitated and enabled to support themselves. VENEREAL DISEASE CLINICS Albany: South End Dispensary, 2 Ash Grove and Trinity Place. Albany Hospital, New Scotland Ave. Amsterdam, 22 Market Street. Beacon, Highland Hospital. Binghamton, 71-73 Collier Street. Buffalo : Health Center No. 5, 51 Court Street. Mrtnicipal Hospital, 770 E. Ferry St. Buffalo City Hospital, Urologic Clinic, 462 Grider Street. Corning, City Hall. Cohoes, Cohoes Hospital. Dunkirk, Public Health Center, 554 Deer St. Elmira, East Market and William Streets. Gloversville, 19 West Fulton Street. Glens Falls, Health Center. Hornell, Health Dispensary, 108 Broadway. Hudson, 234 Warren Street. Ithaca, 125 Farm Street. Jamestown, Market Bldg., Roosevelt Square, 2 Forest Avenue. Little Falls, City Hall. Middletown, 35 South Street. New Rochelle, New Rochelle Hospital, Union Street. Niagara Falls, 598 Pine Avenue. North Tonawanda, 40 Webster Street. Olean, City Hall. Oneonta, Aurelia Osborn Fox Memorial Hospital. Oswego, Health Center Bldg., W. 1st St. Plattsburg, City Hall. How mothers can help How long will these diseases continue to ruin adult lives, to maim and kill our little children? Just so long as the mothers of our country neglect to instruct the young, to teach them to control their sexual passions and to care for their bodies. The standing of our country must necessarily depend upon the national health. No nation of in- valids can hold a foremost place in world history. In other words, the future of the United States is in the hands of the mothers of to-day. What are they going to do about it? A work of the highest patriotism is ready at the hands of the American mothers. : 14 15 Port Chester, 112 Purdy Avenue. Poughkeepsie, 24 Washington. Street. Rochester: Health Bureau Consultation Clinic, 82 Chestnut Street. Baclen Street Dispensary, IGO Baden Street. General Hospital, 501 West Main Street. Highland Hospital, Rockingham Street. Homeopathic Hospital, 224 Alexander Street. Rome, 245 East Dominick Street. Schenectady, Health Center, 508 Union St. Saratoga Springs, Saratoga Hospital. Syracuse: Free Dispensary, 610 East Fayette Street. Detention Home, 116 Noxon Street. Troy, Samaritan Hospital. -Utica, Free Dispensary, 224 Mary Street. White Plains, 45 Hamilton Avenue. Yonkers, Public Health Clinic, City Hall. 1G 10? KEEPING FIT (FO.R, .BOYS) THE U.S. PUBLIC HEALTH SERVICE TREASURY DEPT WASHINGTON 1919. Issued by New York State Department of Health, Division of Venereal Diseases in cooperation with The United States Public Health Service, Washington, D. C. Revised June 22, 1922 WHAT FITNESS DEMANDS 1. Muscular Strength 2. Endurance 3. Energy 4. Will Power 5. Courage 6. Self-Control KEEPING FIT Manpower is the thing most needed in the world to-day. Our supply is not limitless. We shall need it all at full capacity for service in factory, mine, and farm and in constructive and healing scientific and professional pursuits. It is important that every man and boy in America keep his body in good working trim. Whether you are at school or at work it is necessary that you should know the laws of physical and mental efficiency and live up to them. That means not only the avoidance of diseases and defects, but positive efforts on your part through self-discipline and healthy activities to put your mind and body in prime condition. FOUR GREAT HANDICAPS Army records show that among the causes producing the greatest number of military "ineffectives" and rejections, aside from wounds, are defective eyesight, poor teeth, bad feet, and venereal diseases. The same causes probably handicap industry just as much or more than they do actual fighting. The following facts and warnings are aimed to reduce inefficiency due to these four causes, by means of education and prevention. Defective Eyes The human eye is one of the most marvelous and delicate mechanisms known, and, next to the vital organs, the most important part of the body. Yet most of us abuse our eyes unmercifully. Close your eyes and for a half minute imagine yourself blind. . . . In modern life false eyesight is almost as useless 'as blindness. Certain defects in the original structure of the eye itself can not be cured, and can only be corrected by glasses properly fitted by a com- petent oculist. Certain other defects, due to mistreatment of the eyes, can be cured by proper glasses, which, so to speak, "train" the eye back to normal. Some kinds of defects, such as certain cases of "cross-eyes," may be helped by a slight operation. Slight muscular defects often cause severe eyestrain without the patient's knowing what is wrong. Still other eye troubles affect chiefly the lids, or attack the lids first and only later affect the eyesight itself. Proper medical treat- ment will usually cure these conditions, although certain infected cases may leave permanent scars. There are so many varieties of eye trouble that they can not be described here, nor would it be wise for you to try to treat yourself, 4 KEEPING FIT for the symptoms of very different complaints are often so nearly alike - headache, redness, dimness, etc.- that only a physician can prescribe properly. For any continued discomfort, go to a reliable eye specialist (opthalmologist or oculist). It is possible, however, to tell you how to avoid preventable eye trouble, which has handicapped many a man's career because he neglected these apparently simple rules: 1 When reading, writing, etc., be sure to have good, clear light, preferably over the left shoulder if writing, and not directly in the eyes nor reflected sharply from the paper. 2 Do not hold the eyes less than 12 inches from your work. 3 Do not use the eyes too long continuously •- rest them a few minutes, occasionally, by closing them or looking into the distance to relax them. One should do this at least every hour, especially if reading fine type or doing intense, delicate work. 4 Do not use your eyes much on a vibrating train or car, nor go too often to motion pictures. They strain the eyes. 5 Keep away from places where stone chips, sparks, or emery dust is flying, or wear goggles. 6 If strong light bothers you, wear slightly brown non-magnifying glasses outdoors, with a broad-brimmed hat. 7 Avoid the common towel and do not rub the eyes with dirty hands. Contagious eye disease is spread in these two ways. It should hardly be necessary, in this day, to emphasize the impor- tance of clean teeth. Bad teeth are not only important as producers of toothache but also as harborers of disease germs. The mouth is the gateway to the throat and stomach, and it pays to keep it clean. Poisons absorbed from diseased teeth may cause intense suffering and loss of health. The correct way to brush teeth is with a medium soft brush, with an up-and-down stroke, bearing away from the gums toward the points of the teeth, so as to get the food from between the teeth without violently pushing back the gums. Even if you keep teeth properly cleaned daily, it pays to have them examined and cleaned by a good dentist once in six months to prevent decay and avoid disease. Defective Teeth Defective Feet In battle an army gets from where it is to where it is going on feet. A good general takes almost as much care for his men's feet and stomachs as he does for their powder and shot. KEEPING FIT 5 Men are not disabled by corns and bunions, unless they interfere with wearing a shoe, or with weight-carrying power; but they are a nuisance, and they can be avoided by having properly fitted shoes, snug but no pressing or stubbing the joints or toes. The so-called army " last " is a safe and a good-looking shoe for ordinary wear. Cleanliness is of the utmost importance in keeping the feet in con- dition. Unless this is attended to systematically the skin becomes softened and irritated by cast-off particles of skin, dirt, and perspira- tion; hence blisters and abrasions are more likely to form. The most frequent foot trouble, serious enough to cause a real handicap, is the fallen arch, or "flat foot." This may be prevented by wearing shoes which do not put too heavy a strain on the " arch " of the foot, but give it mild support. Many things besides shoes may cause flat foot, and a doctor should always be consulted for any con- tinuous foot discomfort. Foot strain is also a cause of some kinds of backache and other nervous trouble. The straight position of the foot - that is, with the feet parallel - is the proper one for both standing and walking. If a shoe threatens to injure your foot, it is poor economy to keep it. Don't buy a misfit just because it is cheap or fashionable - it doesn't pay. Remember the doctor's bills! HOW VIGOROUS MANHOOD IS ACHIEVED Those who would achieve the maximum vigor must observe at least five essentials. The first of these is sufficient exercise of the right kind. Reading the sporting page, yelling in the grandstand, and watching the baseball bulletin boards may be enjoyable, but will never make a man vigorous. He himself must take daily exercise. Hiking, baseball, rowing and canoeing, skating in the open air, swimming, if taken moderately, general gymnasium work, boxing and wrestling where the air is fresh, are among the most beneficial forms of exercise. A young man's daily exercise should be vigorous enough to cause him to perspire freely. This helps his body to throw off certain waste products which would act as poisons if they were allowed to accumulate. After exercise a bath should be taken. A shower is better than a tub bath. A washbowl or any contrivance is better than nothing. Warm water should be used first, then cold. The bath should be followed by a vigorous rub-down with a coarse towel, the whole process taking no longer than four or five minutes. The bath and rub-down should produce a healthy glow of the body and a general feeling of well-being. Second, young men should sleep in the fresh air, work and exercise in the fresh air as much as possible, and be sure to have the indoor air kept fresh. Fresh air is often more valuable than any quantity of medicine. 6 KEEPING FIT Tn the third place, most young men need at least eight hours' sleep every night, and most boys between the ages of 13 and 16 need from eight and one-half to nine and one-half hours. With less, one can get along, but he can not keep himself in the best possible physical condition. One should not lie in bed after waking up, but should jump out and dress imme- diately. Proper food is another requirement. One should eat chiefly fresh vegetables, cereals (wheat, oatmeal, and rice), bread and butter, eggs, and fruit, with fresh meat or fish not oftener than once a day. The system needs not only the kind of food that is rich in nutriment, but vegetables and other coarser food to give bulk and stimulate the action of the intestines. All food should be chewed to a pulp. Kot only is it necessary to eat wisely, it is also important to pass off the waste materials by regular movements of the bowels. When this is not done, one becomes constipated and is likely to have headaches and general ill health. Regular movements of the bowels are aided by abundance of exercise and by eating plenty of fruit and drinking plenty of pure water. Finally, if one is to gain maximum efficiency and retain it, it is important that he should understand the relationship of the reproductive, or sex organs, to the development of vigor. This needs to be carefully explained, because, while the facts are important, they are not generally understood. TRAINING RULES 1 Exercise Wisely 2 Eat Wholesome Food 3 Get All the Fresh Air Possible 4 Take Sufficient Rest 5 Keep Clean SEX HEALTH Sex is what makes a man a man and a woman a woman. It accounts for the differences and attractions in mind as well as body between men and women. The ways a person behaves in relation to such matters are called his sex habits. A man's sex habits have much to do with his health and efficiency. Most men have received their first information about sex from lies, half-truths, and smutty stories, from pictures or shows, or from other boys or men who thought they knew it all, but had only filthy ideas about sex, and laughed at it. Most people were never told in a serious way 'by their parents or by a doctor what maturity, marriage and having children really mean. KEEPING FIT 7 All that is best in modern life and civilization has grown mainly out of the sex impulses. Hunger and sex are the two great driving forces in the world. The hunger motives have given rise to our economic or self-seeking life; the sex or love motives have given rise to the spiritual and social aspects of life, aspects which find their highest satisfaction in the happiness and service of others. Human affection, which is the finest and often the most powerful motive in life, is the highest product of sex in the world. That is why defiling of the affections so completely destroys character and manhood. With sex destroyed or debauched we should lose nearly all that is beautiful in art, poetry, music, and literature - for courtship, marriage, father- WHAT GLANDS ARE FOR ANATURALT*ROCES$ IN MEN About once or twice a month a fluid from up inside the body is discharged during sleep. This is called a seminal emission. Glands make secretions needed in a healthy body. Iftcreliiin from salivary glands aids in digesting food.' 2. *• * oil glands helps keep hair and scalp healthy. 3. • • tear glands moistens and cleans eyes. 4. " * /thyroid glands aids in brain development 5. ■ ' testicles aids in body development >N?4 and N°5 make secretions that go directly into the blood. DO NOT WORRY This is natural and happens to all healthy men and older boys. Think no further about them. The fluid discharged during sleep is not the secretion that goes io ihe muscle and brain. hood, motherhood, birth, true family life, and all our most generous impulses are due to sex. It would not be possible for a boy to achieve the full vigor of man- hood were it not for the reproductive or sex organs. This fact may be made clear by referring to the activity of the various glands in the body. You are probably acquainted with salivary glands and the glands in the stomach which secrete the gastric juice. There are also glands which make secretions that are absorbed by the blood. One of these glands is called the thyroid. If a boy were seriously injured so as to necessitate the removal of the thyroid gland it would probably retard the development of his brain. 8 KEEPING FIT The testicles are glands which, like the thyroid glands, secrete an exceedingly important substance, which is absorbed into the blood; the blood carries this substance or secretion all through the body. It gives tone to the muscles, power to the brain, and strength to the nerves. It is what caused your voice to change, your shoulders to square out, your beard to start growing. It literally makes a man out of you. For the above reasons it is of paramount importance to a man's efficiency and happiness that his sex organs be kept healthy. Physical cleanliness is the first essential. WATCH WHERE THE BLOOD FLOWS Tests by Prof Anderson of Yale University Before the Test, Man Perfectly Balanced THE CONTROL OF THE TRAIN Test N? |. Thinking of a Boxing Matcbi (Bleed flews to the hands)- THE ENGINEER, is responsible for the passengers behind him Test M?2. Thinking of a Footrace (Blood flows to the feet) Suggestive sex thoughts cause, the blood to flow to the sex organs and produce excitement and temptation. THE YOUNG MAN is responsible for the generations to follow. Inside the body, near the bladder, are certain small glands which, when a boy reaches the age of 15, 16, or 17 (though it may be earlier or later), become filled with a fluid which is occasionally discharged in the night. This discharge is called a seminal or nocturnal emission, or " wet dream." It is a perfectly healthy experience. It may come two, three, or four times a month, or only once in two or three months. To prevent too frequent emissions, it is well not to lie on the back when sleeping, nor to drink much water late in the evening. If you keep yourself clean in mind and body, however, and ordinarily feel no ill effects after natural emissions, you need not and should not worry. KEEPING FIT 9 Some ignorant men or quack doctors may tell you that the sex organs must be used if they are to be kept healthy. This is a lie. Manhood is not lost by not using the sex organs. Real lost manhood is usually due to venereal disease or long abuse of the sex organs. Famous boxers and wrestlers, explorers, and athletes, who want their bodies in perfect condition for a great struggle, keep away from women as part of their training. Even the ancients recognized this in training their gladiators and athletes, and reputable doctors agree that sex indulgence is not necessary to health. CONTROL AND CONSERVATION OF MANHOOD Over-exercise or excitement of the sex glands may exhaust them and weaken a man. If a boy or man himself stimulates his sex organs it is called "self-abuse" or "masturbation." It does not make a man insane, but it is so weakening both to the body and to the will- power that manv bovs and men worry themselves sick over the habit. If a man or boy who abuses himself stops immediately, once and for always, nature comes to his rescue and aids him in recovering self- respect, courage, and vigor of mind and body. If you are tempted to abuse yourself, or have acquired the habit, you can cure yourself by athletics, fun, and your own self-respect and will-power. Most boys who masturbate quit the habit before lasting injury has been done. Going to a prostitute instead does not really break the habit. It makes matters worse. Needless to say, neither kind of habit helps to make self respecting able men. MIND AND BODY The condition of the mind has considerable to do with sex health. Various mental conditions often cause bodily changes. For instance: sorrow, a mental condition, may cause loss of appetite. The smell of a lemon makes the saliva flow more freely. Likewise, if a boy or man frequently permits himself to look at suggestive pictures, to listen to vulgar stories, and to indulge in lewd thoughts, he brings about a mental condition which may lead him some day later into a house of prostitution. Furthermore, such indulgence develops a low attitude toward sex, which (as we shall see) ought to be associated with the finest and most beautiful relationships in life. While it is not always possible to prevent lewd ideas coming to one's attention, it is possible, by using one's will-power, to direct the attention away from them and center it on wholesome subjects. Some young men will need to learn the trick of switching the thoughts away from vulgar subjects quickly to sports, school work, or other helpful activities. The mind should not be made a cesspool, but a reservoir. 10 KEEPING FIT VENEREAL DISEASES The venereal diseases (syphilis, gonorrhea, and chancroid) cause great loss of time, money, and efficiency, besides untold misery. They are as bad as smallpox and almost as "catching." Yet every day many men and boys are exposing themselves to venereal diseases, largely through ignorance of the laws of health and lack of self-respect and decency. False modesty has caused silence about venereal dis- eases because they are usually caught from immoral relations with I RAINIMw .RULES QUACK DOCTORS Tty to frighten men by imtruthful advertisements. They get large sums of money for treating diseases that do not exist. Patent Medicines and "Favorite Prescriptions" ARE DANGEROUS FIT /or War or Peace by adopting these 5 Rules: 1. Exercise Wisely 2. Eat Wholesome Food, 3. Get All the Fresh Air Possible 4. Take Sufficient Rest 5. Keep Clean women and girls, who in turn have caught one or both of the diseases from some other man. Here are a few facts about venereal diseases which you should know for the protection of yourself and others: 1 Gonorrhea (sometimes vulgarly called "clap" or "a dose") can usually be cured, if promptly and thoroughly treated, without apparent loss of health, but it always has serious possibilities. In many cases it causes chronic pain and distress in the sexual organs, with severe mental depression. It often produces conditions, which later may cause loss of health or even death; it injures sexual power and fertility in many cases, and it occasionally cripples a man for life (gonorrheal rheumatism). The loss of health, time, and money caused by these sequels and their treatment may far exceed that caused by the original disease, which is bad enough in itself. 11 KEEPING FIT The widespread notion among the uninformed that gonorrhea is a mere annoyance, "no worse than a cold," is based entirely upon lamentable ignorance, and it is absolutely false. 2 This disease persists in the deeper parts long after it is appar- ently cured. It thus often happens that a man may, years later, give the disease, without knowing it, to his wife, who thereupon enters upon a period of ill health that may end in an operation involving the mutilation of her sexual organs in order to save her life, or perhaps actually killing her. Much of the surgery performed on the repro- ductive organs of women is made necessary by gonorrhea contracted from the husband. Often such women can never have children. Should the wife while infected with this disease give birth to a child, the baby's eyes may be attacked by gonorrhea germs and blindness result. 3 The other serious venereal disease, syphilis, infects the blood and therewith all parts of the body. It is as bad as gonorrhea, if not worse. For months after infection with this disease a person may communicate it even by personal contact, such as a kiss; and articles touched by his saliva or urine or skin - towels, drinking glasses, pipes, etc.- may sometimes carry infection to others. Although the disease, under proper treatment, is not dangerous to life in the earlier years of its progress, the possibilities of transmitting it should forbid the marriage of the individual until a competent physician certifies to his freedom from disease. 4 The most serious results of syphilis may appear years after its beginnings, when the individual has been lulled into a false sense of security by long freedom from its manifestations, and considers him- self cured. It may attack any organ of the body; among the diseased conditions produced in various cases are apoplexy,1 paralysis,2 insanity,3 and locomotor ataxia,4 and these often appear after the man has a family dependent upon him for support. The injury to the individual caused by syphilis is shown in the attitude of some insurance companies toward those so infected - a purely business matter, devoid of all sentimental considerations. They refuse to insure the life of a syphilitic person for four or five years after the disease has been contracted, and then only upon special terms; for their records prove that syphilis tends to shorten life, and that the death rate for those who have had syphilis is double the rate for those who have never contracted it. 6 That the syphilitic parent may transmit the disease to his offspring is common knowledge; some of his children are destroyed by the disease before birth; others are born to a brief and sickly span 1 Apoplexy refers to sudden paralysis and deep stupor caused by bleeding into the brain or spinal cord. 'Paralysis means a loss of motion or sensation in some part of the body. 3 Insanity means disorder of the mind, more or less permanent, but without loss of consciousness or will. ■•Locomotor ataxia means failure of muscular control and other changes due to degeneration of certain parts of the spina Icord and nerves. 12 KEEPING FIT of life; others attain maturity, seriously handicapped by a burden of ill health, incapacity, and misery produced by the inherited taint; others apparently escape these evil effects. 7 The above facts show why a father has a right and duty to demand a health certificate from any man who asks for his daughter in marriage. 8 The only safe way to avoid venereal diseases is to keep away from prostitutes and loose girls. Between syphilis and gonorrhea, choose neither. 91 If a man contracts gonorrhea or syphilis he will save money and time by consulting a competent physician as soon as symptoms of the infection appear. Medical institutes and quack doctors are far more interested in your pocketbook than in your health. To rely on drug store remedies for self-treatment is equally dangerous. They do not eradicate the infection, and it should always be remembered that merely to cover up a disease is not to cure it. Unless freedom from the disease is shown by repeated laboratory tests it may smolder and break out years later. In many cases attempted self-treatment permits the infection to secure such a hold on the system that a cure becomes impossible. The sufferer's condition eventually drives him to a reputable physician, only to find that he has come too late. For the individual to rely on drug store remedies or quack doctors is to gamble his whole future, with the odds all against him. 10 Do not be fooled by " quacks " and " medical institutes." In many cities these unscrupulous quacks advertise to cure "lost man- hood," "nervous debility," "spermatorrhea," "pimples," and things which have nothing to do with sexual health. They try to frighten the ignorant into paying large sums of money for the "cure" of diseases which do not exist, and the lies they disseminate help to spread venereal diseases. They have been actually run out of some parts of the country. The first function of the sex or reproductive organs is to develop the boy into a vigorous man. The other function is to enable him to reproduce himself when he becomes matured and the head of a family. By the process of reproduction, all forms of life - flowers, trees, birds, fish, wild and domestic animals, and human beings - are perpetuated on the earth. If the function of reproduction did not exist in life, the earth would soon become barren. Since reproduc- tion is essential in human life, it is important to understand how life is passed from one generation to another. REPRODUCTION In many forms of plant life the flower contains the reproductive organs. In its center is a single central organ called the pistil. REPRODUCTION IN PLANT LIFE KEEPING FIT 13 Around it are several stems, called stamens, on the top of which is the yellow dust, or pollen. At the base of the pistil is a receptacle, called the ovary, in which are very small particles, called germ cells or ova. Cells of a different kind develop from the pollen. The ova may be called the female cells, and the cells which develop from the pollen the male cells. When the flower is in full bloom it is ready to do its part in reproducing the plant. As bees fly about from one plant to another they carry pollen from flower to flower. Part of this pollen is brushed off on the tops of the pistils. Germ cells from the pollen go down through the pistil into the ovary, wfliere they fertilize the ova; that is, they make the ova capable of growing. After the ova are fertilized, they slowly develop into seeds. The upper Pollen earned from another (lower by, a bee to the top of pistil • .Pollen containing a / sperm' or male cell Pidil fSUraeny Sp«rrn cell from pollan traveling'' through pistil to an ovum .rOvum or female cell The parts of the (lower dre the sex organs of the plant part of the flower dies and drops away. The ovary becomes a seed pod, in which several fully matured seeds can be found. These may be kept through the winter. When planted in the spring they produce other plants like the one from which they came. REPRODUCTION IN ANIMAL LIRE The salmon of the Pacific ocean furnish interesting examples of reproduction in animal life. In the spring they swim into the rivers and find shallow, sheltered places for nests. There the female lays a large quantity of eggs. She then swims away and the male comes to the nest and deposits from his body a quantity of fertilizing fluid, containing cells called sperms. Thus they work back and forth until the female has laid several thousands of eggs. Many are fertilized by the sperms and develop into young fish. The parent fish, however, are exhausted by the process of reproduction. They drift down the stream in a helpless condition and very few ever reach the ocean alive. They give up their lives in producing their young. 14 KEEPING FIT REPRODUCTION IN HUMAN LIFE Human reproduction is similar in many ways to reproduction in the flower. Inside the human mother's body are minute germ cells, called ova. In the male sex glands a whitish thick fluid is made con- taining other minute germ cells, called sperms. When a sperm cell comes in contact with an ovum inside of the mother's body, it fertilizes it, thus making it capable of growing. It slowly develops, being con- stantly protected by the mother's body and continually nourished by the blood from her heart. It slowly takes the form of a human being, until, after nine months of growth, it has sufficient strength to live without the direct protection of the mother's body, and then is born a new human life into the world. Both before and after birth the mother sacrifices much for the new life. THE SUPERIORITY OF MAN Reproduction in plant life is largely dependent upon the action of bees, the wind, and other natural forces. In animal life reproduction is almost automatic. The salmon simply obeys the reproductive instinct when the springtime comes. Man has the reproductive instinct, but he has acquired the power to control it to a far greater extent than have the animals. The sex instinct may be a source of destruction or a great blessing. If it be abused, disease and suffering may result for the man and his wife and children. If it 'be understood and controlled, it becomes a source of added strength and a richer and fuller life. The nature of the sex instinct may be understood by comparing it with other forces in life. Fire is a great blessing to mankind. By means of it machin- ery is made to perform gigantic tasks. It warms our houses and cooks our food. The warmth and glow of a camp fire is a source of great pleasure to campers. When fire is controlled it is a valuable aid to man, but when it gets beyond control it may cause ruin. The water above a dam becomes a source of power when directed into the turbines which run dynamos. If it be only held back by the dam it may accumulate and cause a break, resulting in a flood. To be useful it must not only be held back; it must also be directed into the turbines. So sex energy must be controlled and directed. The youth entering into manhood needs the full power of his will to keep his sex desires from leading him into practices that weaken and damage himself and others. But the truer way of wisdom is in the occupation of the mind with healthful interests and the turn- ing of the growing powers of youth into athletics, work, study, art, music - any constructive social activity. Thus life may be made much richer because of the sex instinct in us. Activities which give opportunities for wholesome associations with girls and women are helpful to tli>e youth and should be encouraged. KEEPING FIT 15 While it is important for a youth to understand the facts herein stated, it is not necessary for him to concern himself further with the facts about glands, germs, and other details referred to. In fact, he will be wise to dismiss such matters from his mind. The impor- tant thing for him to do is to lead an active, vigorous life, and nature, as a rule, will take excellent care of him. EVERY CHILD HAS THE RIGHT TO BE WELL BORN WILL YOU GIVE YOUR CHILDREN HEALTHY BODIES A FAIR START IN LIFE ? THE YOUNG MAN'S RELATIONSHIP TO GIRLS The young man should think of all girls as the future mothers of the race and understand that one of their most important functions in life is to become the mothers of healthy children who will make useful citizens. A nation may be well judged by its attitude toward women. The youth who is fair will treat every girl as he expects other boys and men to treat his own sister, his girl friend, or his sweetheart. The craving for the companionship of girls and women should be satisfied. The man who keeps away from all girls usually has a harder fight against sex temptation than the man who seeks friends among girls of the kind he wants later to marry and whom he treats 16 KEEPING FIT in. a courteous and manly way. A young man's plan for marriage will often help to keep him straight when nothing else would. In an accident at sea, when everyone is anxious to reach the life- boats, the rule for all men is " women and children first." If a man rushes in ahead of them he is looked upon as a coward. It is more important for men to protect girls and women from other dangers, especially from those dangers which threaten to ruin their lives. Every man who has any principle believes in fair play. lie despises cheating. The young man who is fair will adopt for his own life the same standard he demands of the woman he expects to marry some day. Each youth who grows up and marries becomes a link in a great chain of human beings. This chain reaches back into the past for thousands of years, and it may reach forward into the future for an even longer time. One false step may infect the racial stock and blight the lives of generations to come. If the young man keeps his body in good condition and lives a clean life, his descendants will in all probability be vigorous and useful citizens. The spark of life is to be accepted as a sacred trust to be transmitted undimmed to future generations. 107 10® SCHOOLS 109 g _C, H 0 .O._L_S. The problem of education in Utica is a complicated one, especially in view of the unevenness of the population as des- cribed in the Introduction. The administration of the school system of the city is under the control of a Board of Education which consists of six members, two being elected annually by pop- ular vote for a term of three years. The organization of the Board of Education, and its powers are derived from the state and are fixed by the Education Law, The responsibility of ed- ucational work rests with the Superintendent of Schools and his general powers and duties are fixed by a uniform law for all the cities of the state. The annual school budget approximates $500,000. There are twenty-five school buildings in the city, all but one or two now being used as part of the regular equipment. One of these, the Utica Free Acadenjy, is the city high school, accommodating 1700 or 1800 pupils. In 1?l8, in a survey made by the state Department of Education, a score of the school buildings was made, Strayer's "Score Card for City School Buildings" being used. This card assigns 1000 points as maximum score of the pei>- fect school plant and divides the credits as follows: Site 125 Building 165 Service Systems 280 Class Rooms 2?0 Special Rooms 140 Total 1000 1 10 In the scoring of eighteen of the Utica schools the ratings range from 463 to 679 points and. taken as a unit they are given 12,214 points out of a possible l8,0C0, or 67.% of the maximum rating. As compared, with the schools of St. Paul, Minnesota, the schools of our city rank a little higher since the St. Paul general av- erage was only 57% of the maximum rating, but in the latter re- port the school accommodations were referred to as "most inadequate." The rating of the schools of Binghamton, New York, done on the same basis as the Utica schools, was 71*3%, slightly higher than our own. VISIT TO THE UTICA FREE ACADEMY. The academy is situated most favorably in the residential section of the city and has the advantage of facing three streets. The building itself is three stories high, built of yellowish brick, and it comprises an old and a new part which are united to form one large struct- ure. The school takes up a ground space of about half an acre of the three-and-a-half acre plot on which it is built. There are ninety-six principal rooms, all well equipped. These include recitation rooms, science laboratories, lecture rooms, and com- mercial rooms. Rooms for vocational and industrial training have recently been fitted up and these are all well-equipped. One serious handicap is the lack of a gymnasium. The auditorium, too, is in the old building and is entirely inadequate for the present number of pupils. The Monarch system of ventilation is in use and in gen- eral the ventilation is good. The building is heated by direct- indirect steam with thermo-static control. The temperature is 111 The Utica Free Acadenjy kept fairly regular at 68° to 70°, the extremes being 64° and 73 °* Lighting might be improved. Class room window space does not conform strictly to rule and bad shadows are thrown by too great distance between the windows. On the third floor the dis- tance from ceiling to the tops of the windows is so great that the efficiency is greatly impaired. Sanitary conditions are, on the whole, good. Hot water is supplied to the one hundred twenty- one wash bowls. There are twenty-two bubbling fountains. Boys' and girls' toilet rooms are clean but the fixtures are not of the most modern design and the toilet facilities are really not adequate for the capacity of the building. There is ample play- ground facility about the school, but no attempt has been made to fit out a special field for the pupils and there is no gymnasium at all. 112 MEDICAL INSPECTION OF SCHOOL CHILDREN. The medical inspec- tion of all school children in the state of New York is required by the State Medical Inspection Law, passed in on the ground that it is not only an important phase in the health supervision program, but that it ''maintains high standards of sanitary conditions in the schools and worthy ideals of bodily health and growth for children". The law provides for one annual physical examination of every school child in the state, for school inspection whenever necessary, and for "preventive care of all children suffering from disease or physical defect". Not only the children but teachers and janitors may be examined, if neces- sary. The law requires the employment of Medical Inspectors, and in a city these inspectors must be residents of the city in which they are serving. Experience has shown that there should be at least one inspector for each three thousand school child- ren, and at least one additional physician for each additional three thousand children. Furthermore, in a city of from 60 ,000 to 100,000 inhabitants there should be at least one full-time Medical Inspector and one or two others as part-time assistants. In Utica there are 17,565 children registered in the pub- lic schools of the city, and for these children the city provides four part-time Medical Inspectors who give two hours a day to visiting the schools and conducting necessary physical examin- ations, inspections, etc. There are four school nurses who are on a full-time basis and these are registered nurses, licensed to practise as such. They assist the school Medical Inspectors in M3 every way possible, followup suspicious cases, and. make frequent visits to the homes of children who are under the care of the Ifedical Inspectors. The salaries of the inspectors are one thou- sand dollars a year, but the senior physician, who exercises a sort of general supervision over the whole medical inspection work, receives a salary of eleven hundred twenty-five dollars. The school nurses receive a salary of fifteen hundred dollars a year. A carefully prepared health record is on file for every child in the schools of the city. When a child enters one of the schools of the city for the first time he must present a certifi- cate of good health signed by his family physician. Subsequently he presents a certificate of health at the beginning of each sch- ool year. If no such certificate is presented and no record is on file then an examination of the pupil may be made by the School Inspector. In this way a concise record of the health of every child in the schools is on file and any additions or changes may be made as occasion demands In Utica a sincere attempt is being made to live up to the requirement that each child be given a thorough physical exam- ination each year, but the number of inspectors and nurses will not permit of an annual examination of all the children. At pres- ent each pupil who appears to be in any way ill is given a thoro- ugh examination immediately and recommendations made according to the findings. All new pupils who come to the city schools for the first time are also subjected to a complete examination and a re- cord made. Eyes are examined, throats looked at, and teeth are carefully gone over. If conditions which should be corrected are 114 found, a note is sent to the parents advising that prompt action he taken. In 1920-21 there were pupils registered in the schools of Utica. 12,?Q3> of these were examined by the school 1/led.ical Inspector or other physicians. The type of examination is indicated hy the sample blank on the next page. The child is gone over very completely and parents advised if there are any ab- normal conditions present. The child may then be treated by any physician the parents may select. If the family cannot afford to pay for the services of a private physician, then many local agencies help out. Prominent among these are the Utica Dental Dispensary, the Utica Medical and Surgical Dispensary, the local Tuberculosis clinic, and the Associated Charities. The latter organization furnishes glasses whenever they are needed. For children suspected of tuberculosis there are two open air rooms at one of the city schools and a summer camp - Camp "Healthmore". Here the children work and study during the school session in the open air and much is being accomplished in the prevention of the progress of incipient tuberculosis. A careful watch is kept at all times for the appear- ance of any communicable diseases in the schools, and when any appear the child affected is promptly taken home and the city Health Officer notified. When the child has recovered from such a disease he is readmitted to the school only on presentation of a certificate signed by his family physician and countersigned by the Health Officer. In this way, then, everything possible is being done to protect the health of the younger generation in the schools of the city. 115 History of operations Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Date of examination 1 Height 192 192 192 192 .192 192 192 192 192 2 Weight 3 Nutrition 4 Teeth 6 'Tonsils 7 Lymph glft/ncjs 8 Goiter Q Nerymis system 10 Speech ,, f R 11 Eyes s 12 Ears a j 13 Heart 15 Orthopedic conditions ... 1 16 Hernia 17 Skin or scalp conditions . 18 Other conditions 1 Code: D = dentist; F = family doctor; G -glasses; I = institution; M = medical; N = normal; O = operation; O.K. - cured or corrected; R-treatment refused; T = treatment pending X = improved; -= unimproved ; V or V V = degree of defect. This Pupil's Health Record is recommended by The University of the State of New York for use throughout the State. Sex Scarlet fever Health Health .192 Transferred Date of birth Mumps In associates Age (or date of death) Age (or date of death) Measles In family Birthplace Influenza County Tuberculosis (date) in self Birthplace Birthplace Inf. paralysis Ger. measles City, village or town Whooping' cough Address Address Address 2 <5 x: s Q Q Typhoid o a C O o La o Tonsilitis Name of pupil (last name first} HISTORY (dates if possible) Name of mother School Name of father Vaccination I Smallpox Teacher - Nurse Informant. Part II - Filled in by physician whose name is signed on reverse side of this card .192. I Filled in by. Part I Specimen of School Physical Examination Record. 116 In spite of all the good work that is being done, how- ever, it is a perfectly evident fact that the facilities for the careful and complete carrying out of the law do not as yet exist in Utica. There are no offices, examination rooms, rest rooms, etc., in the schools, and there seems to be a lack of interest on the part of the school authorities in the efficient realization of the health program. In fact the Superintendent of Schools told me himself that the law was not being carried out as thoro- ughly as it should be, and the Chief Medical Inspector, while not stating that there was lack of cooperation from the school officials, implied as much when he spoke of the active and effect- ive way in which the school medical inspection is being carried on in the near-by city of Syracuse. There, he said, the Medical Inspector got about all he wanted in the way of whole-hearted cooperation from the higher authorities. The Inspectors and School Nurses are doing all that they can do under the conditions, and this is much, but in a city of 105,000 inhabitants with more than 17,000 school children, there should be at least one full- time and two part-time Medical Inspectors and from ten to twelve full-time nurses. The equipment, too, should be added to and improved in order that the best results may be obtained. The city owes it to its school children to see that they are kept in the best of health during these formative years in the schools. DISEASES FOR WHICH CHILDREN ARE EXCLUDED FROM SCHOOL. When- ever a pupil in one of the public schools shows any symptoms of one of the following diseases he must be excluded from the school: Small Pox Chicken Pox Influenza Whooping Cough Scarlet Fever Tuberculosis Tonsillitis Scabies Measles Diphtheria Mumps Trachoma 117 If the child has any other communicable disease he may also be excluded, but in the case of the above diseases the pupil affect- ed must be taken to his home immediately "in a safe and proper conveyance" and the school authorities must hotify the Health Officer. Before a child who has been ill with some communicable disease or who has been absent for some unknown cause can be re- admitted to the school he must be examined as directed on the third page back, or by the Medical Inspector connected with the school. 11® MISCELLANEOUS 119 M I S C E PLANE OUS MARKETS. The markets of the state are under the general con- trol of the Department of Farms and Markets at the head of which is a Commissioner of Farms and Markets. The duties and functions of this department are very wide-spread and it cooperates in every way with the local authorities to maintain high standards in the production and marketing of food. In Utica there is only one market near the old canal and it is under the control or the Department of Public Works. This department has control over the granting and revoking of licenses to sell in the market, and over the construction, maintenance, and management of this market. Inspections must be carried out by the Health Officer, but the present Health Officer in Utica seems to have only a very vague idea of the matter and is inclined to leave the management en- tirely to the department of Public Works. PROVISION STORES AND SODA FOUNTAINS. The provision stores in Utica are in charge of and licensed by the city authorities. Six meat inspectors who are connected with the local department of health make inspections twice a week of all these places and report to the Health Officer. In general they are in good condition. Screen doors and screens in the windows are required in summer, and no food is exposed open for long periods of time. 120 Soda fountains also operate under licenses granted by the city through the local health officer and they are supposed to be in- spected once a month by the health officer or his representative. Whether or not these inspections are made regularly, I do not know, but the general condition of the soda fountains of the city is good. SLAUGHTER HOUSES AND MEAT INSPECTION. There are three slaugh- ter houses in Utica, licensed by the city and the state. They are situated at a distance from the residential part of the city and they do not form a nuisance so far as objectionable odors or the spreading of filth is concerned. They are inspected at frequent intervals by the meat inspectors of the city and also by the state authorities. Meat inspection is done by two veterinarians who are appointed meat inspectors by the local health officer. Up to recently these were assisted by three in- spectors who were not veterinarians, but there are now four assistants. The inspection of the meat of the city is carried on under a local ordinance enacted by the city common council in 1?17, and it requires that strictest watch be kept on the city meat supply and lays down very stringent rules which must be followed by the owners of slaughter houses. Odors must be destroyed and all refuse and offal mast be disposed of in a manner which shall be approved by the health officer. The buildings mast be of a certain type with cement floors, and killing may be done only between the hours of 7 a.m. and 6 p. m, daily except Sundays. Screens on doors and windows are re- quired at all times to keep flies from reaching the meat. lid COLD STORAGE PLANTS. There are many of these in the city, chiefly in connection with meat and provision markets and the slaughter houses of the city. They consist of places where articles of food may be stored in a place the temperature of which is artificially "cooled to or below a temperature above zero of 45° Farenheit." These plants are operated under a pro- vision of the Public Health Law and the Farms and "Markets Law of the State of New York. Unless they are for the storage of * nuts, fruits, cheese, ice cream, or vegetables, they must be operated under a license issued by the Department of Health and the Department of Farms and Markets. These licenses are renewed annually. The State Commissioner of Health is invested with full power and authority to supervise and inspect all cold storage plants in the state or to delegate this authority to his local representative. Inspections may also be made by the Commissioner of Farms and Markets. Inspections are made every month or more often by the local health officer, and the con- dition of these places is good. KITCHENS OF HOTELS AND RESTAURANTS. These are inspected and supervised by the State Commissioner of Health through his re- presentative, the local health officer. Access to all kitchens of hotels, public restaurants, and public dining rooms is given to all authorized representatives of the State Commissioner oi Health and inspections are made frequently. On the whole con- ditions are good in Utica. There are several large hotels of which the Hotel Utica is the largest and most modern. Its kitchen is well-kept, clean, and orderly, and the food is prepared under 123 No person shall act as a barber who is affected with syphilis in the infective stage or with any other communi- cable disease enumerated in the Sanitary Code, in acute form, or with any communicable affection of the skin. The hands of the barber shall be washed with soap and water before serving each customer. Brushes and combs shall frequently be cleansed with soap and water. Shaving mugs and brushes shall be thoroughly rinsed after each use thereof. There shall be a separate clean towel for each customer. The head rest shall be covered by a clean towel or paper. Alum or other material used to stop the flow of blood shall be applied in a powdered or liquid form only. After the handling of a customer with any eruption, or whose skin is broken out, or is inflamed or contains pus, the hands of the barber shall be immediately disinfected. This shall be done by thorough washing with soap and water, followed by rinsing in alcohol (70 to 80 per cent) or in a solution of corrosive sublimate (1 to 1,C00), or by the use of some equally efficient disinfectant. The instruments used for a customer affected with the above named disorders shall be made sale immediately after such use by washing in soap and water and dipping for one minute in a ten per cent solution of commercial (40 per cent) formaldehyde; or dipping for three minutes in alcohol (70 to SC per cent), or by the use of some equally efficient disinfectant. No cup, brush, or other instrument which has been used in the shaving of a customer affected with any of the above infectious disorders of the face shall be used for another customer unless the cup shall have been emptied and cleansed by boiling water and furnished with fresh soap, and the brush has been sterilized by a three minutes exposure to alcohol or to corrosive sublimate (1 to 1,C0C), or by the use of some equally efficient disinfectant," (From the Sanitary Code) These regulations must be posted in every barber shop in a con- spicuous place. I visited one of the barber shops in the Hotel Utica and found the place in an excellent condition from every point of view. The shop is of most modern design, in white tile, and the general atmosphere of the place is cleanliness. The individual barbers and all the instruments used in the shop are clean. Brushes and combs are washed at frequent intervals, and all the regulations of the Sanitary Code are strictly adhered to. 124 DISTRIBUTION OF EDUCATIONAL AKD OTHER PAWHLETS. Educational and other pamphlets are distributed by various agencies in the city and most of these publications originate from the State De- partment of Health, This department cooperates cordially with the United States Public Health Service and the result is that, in New York state, every phase of health and hygiene is covered in a very thorough manner. Physicians are furnished by the Health Department with pamphlets concerning all the important contagious diseases, including tuberculosis, and these are for free distribution to patients. Some of these pamphlets are sub- mitted herewith. Then to the physicians themselves are sent out letters concerning the importance of early recognition and adequate, intensive treatment of venereal diseases, and pam- phlets for free distribution to parents, children, and young men and young women are issued. Some of these are submitted in the section on the Venereal Diseases. Pamphlets containing advice to the expectant mother on prenatal care are to be had for the asking; and the young mother does not have to go with- out help in caring for her baby when there are numerous pam- phlets published by the Health Department to give her advice and assistance. All aspects of personal, home, and public hygiene are covered, and a few of the publications obtainable from the State Health Commissioner are listed further on in this section, of the pamphlets are printed in several languages, esp- ecially those relating to the care of mother and baby during confinement and thereafter. Publications are also issued to the health officers of the state giving them examples of the effect of prompt action in an emergency on the part of some other health 1<5 Public Health Is Purchasable. Twentu-fa,? Thn it- *. r» NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. HERMANN M. BIGGS, M.D. Commissioner , SCARLET FEVER-SCARLATINA information for parents, physicians and HEALTH OFFICERS is usinUv ™ 7 iS V> 7 retdi£ but its striking distance susceptible th', alnl)S l®; Clnldren' exeeP' ™rsing infants, are more v/f , dU ! and 111 very -Voui« children especially (1 to 5 x- ' ; 1S a most senous disease. The protection of voung children fiom exposure is, therefore, most important. Scarlet fever varies grea ly in its severity. Death may ensue within two or three da vs- or a mild case may develop complications, in which the kidneys, the heart, J ie ears, and the brain are involved; or the case may remain so mild ' that the patient is ill for only two or three days. Discharges from these ■mild cases may cause severe disease in the next case. The infectious agent which causes the disease is chiefly located in discharges from the nose and throat, and is most dangerous during the first few days of illness. The infectious agent is transmitted by droplets in coughing or sneezing or by the fingers which easily become soiled with dis- charges from the nose, mouth or ears. If there is no catarrh of the nose and throat the peelings from the skin will not transmit the in- fectious agent. Milk may become contaminated and transmit the infection. A single attack of the disease usually protects from a second one. The earliest symptoms are a sudden change from health to illness, accompanied by vomiting, high fever, and sore throat followed by a punctate scarlet rash on the neck and chest which spreads over the whole body. Occasionally this rash may be but a blush which is slight •and fleeting, but practically always persists for at least 24 hours. The so-called " strawberry " tongue appears a little later. When such ■symptoms appear in a child it should be put to bed and a physician immediately summoned. Directions to parents 1 Protect your family by sending the patient to a hospital if the family physician approves this course. If hospital accommodations cannot be provided, the patient must be isolated at home under the ■direction of the attending physician. If convenient send the other Circular No. 15, 1916 edition Samples of Literature Issued By the State Department of Health for Free Distribution by the Local Health Officers Public Health Is Purchasable. Twenty-five Thousand Lives Can Be Saved In New York State Within The Next Five Years NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. HERMANN M. BIGGS, M.D. Commissioner SCARLET FEVER-SCARLATINA INFORMATION FOR PARENTS, PHYSICIANS AND HEALTH OFFICERS Scarlet fever is very readily communicated, but its striking distance is usually only arms' length. Children, except nursing infants, are more susceptible than adults, and in very young children especially (1 to 5 years) it is a most serious disease. The protection of young children from exposure is, therefore, most important. Scarlet fever varies greatly in its severity. Death may ensue within two or three days, 01 a mild case may develop complications, in which the kidneys, the heart, the ears, and the brain are involved; or the case may remain so mild that the patient is ill for only two or three days. Discharges from these ■mild cases may cause severe disease in the next case. The infectious agent which causes the disease is chiefly located in discharges from the nose and throat, and is most dangerous during the first few days of illness. The infectious agent is transmitted by droplets in coughing or sneezing or by the fingers which easily become soiled with dis- charges from the nose, mouth or ears. If there is no catarrh of the nose and throat the peelings from the skin will not transmit the in- fectious agent. Milk may become contaminated and transmit the infection. A single attack of the disease usually protects from a second one. The earliest symptoms are a sudden change from health to illness, accompanied by vomiting, high fever, and sore throat followed. b\ a punctate scarlet rash on the neck and chest which spreads over the whole body. Occasionally this rash may be but a blush which is slight •and fleeting, but practically always persists for at least 24 hours. The so-called " strawberry " tongue appears a little later. When such •symptoms appear m a child it should be put to bed and a phvsician immediately summoned. 1 Protect your family by sending the patient to a hospital if the family physician approves this course. If hospital accommodations cannot be provided, the patient must be isolated at home under the direction of the attending physician. If convenient send the other Directions to parents Circular No. 15, 1916 edition 2 children to the home of adult friends or relatives, where there are no children, and have them watched closely for the above-mentioned symptoms for seven days. 2 The law requires that when no physician is in attendance the head of the household must report at once to the health officer that the person is or may be affected with scarlet fever. A penalty may be imposed for violation of this regulation. (See Sanitary Code, Chapter II, Regulation 5. Also Penal Law, Section 1740.) 3 If the child is attending school you should notify the principal of the school. If the child has recently been to Sunday school notify the Sunday school teacher so that she can inform the parents of the other children that they may have been exposed. If the patient is employed, the employer also should be informed. 4 Isolate the child as completely as possible from the other parts of the house for at least 30' days according to instructions from your physician. 5 If other children in the family are attending school and are at once sent to live with adult friends during the patient's isolation, they may return to school if well, after one week's observation. But if they remain at home even if they do not come in contact with the patient they must be excluded from school until one week after quarantine is raised. 6 The proper disposal of discharges from the nose, throat and ears is of the greatest importance in preventing the spread of the disease. Pieces of cloth which can be burned should be provided in abundance to receive all such discharges. The cloths after using should be placed in a wash basin and covered with 5 per cent, carbolic acid solution for one hour, or they may be placed in a paper bag and subsequently burned. A fresh supply of clean cloths should always be available. The discharges from the bowels may be deposited as usual in a toilet or privy vault. Remnants from the meal should be burned or covered with boiling water. Dishes should first be covered with boil- ing water before being washed, and should not be taken from the room. Door knobs should be wiped daily with a cloth wrung out in a disin- fecting solution. 7 It is often difficult to keep children in isolation during convales- cence unless something is available to occupy their minds. A pamphlet on the subject "Amusements for Convalescent Children " may be obtained from the State Department of Health upon the receipt of a two-cent stamp. 8 The physician and health officer are required by the law to per- form certain duties. In the interest of public health the parent should give every possible assistance and not cherish ill feelings against them, on account of inconvenience from these necessary requirements. 3 Duties of physicians 1 When a physician makes a diagnosis of scarlet fever he must at once notify the health officer. Notification, including full name, age, address, disease, milk and water supply must be given within 24 hours from the time the case is first seen. 2 The physician must arrange for the carrying out of proper isolation; enforce rules for protecting the remaining members of the family; and give minute directions for the care of discharges from the nose and throat. Special pamphlets on " The Conduct of an Isolation Period for Communicable Disease in the Home " and on " Cleansing and Disinfection " may be obtained from the State Department of Health upon the receipt of a two-cent stamp. (See directions for dis- posal of discharges from nose, throat and ears on page 2 of this circular.) 3 If, after thirty days he considers that the patient has recovered and if there is no discharge from the nose, throat or ears, the physician should advise the health officer that in his opinion it is safe to release the patient from isolation. 4 He should warn the parents that if a convalescent child soon contracts a cold the discharges from the nose, throat or ears may again contain the infectious agent of scarlet fever and be a source of danger to children who have not had the disease. 1 The health officer must mail within 24 hours to the State Depart- ment of Health the official blank which has been filled in by the physi- cian. If the patient is on a dairy farm the report must be telegraphed or telephoned to the State Commissioner of Health, stating name of patient, farm, whether patient is isolated according to Regulation 37 of the Sanitary Code, and where the milk is distributed if the sale is not prohibited. 2 In order to protect others, a placard stating that a case of com- municable disease is present must be posted .near the entrance to the house, apartment or room in which the patient is isolated. 3 When the well children of this household are sent to live tempo- rarily in the homes of adults residing in another municipality the health officer of that municipality must be notified. 4 If the patient lives on a dairy farm or at a factory where dairy products are produced the sale of milk or milk products must be stopped unless it is certain that Regulation 37 of the Sanitary Code is being observed. This reads as follows: Duties of health officers Regulation 37. Sale of foods forbidden in certain cases. When a case of diphtheria, epidemic or septic sore throat, amoebic or bacillary dysentery, epidemic cerebrospinal meningitis, scarlet fever, smallpox, or typhoid fever 4 exists on any farm or dairy producing milk, cream, butter, cheese, or other foods likely to be consumed raw, no such foods shall be sold or delivered from such farm or dairy, except under the following conditions: (a) That such foods are not brought into the house where such case exists; (b) That all per- sons coming in contact with such foods eat, sleep and work wholly outside such house; (c) That such persons do not come in contact in any way with such house or its inmates or contents; (d) That said inmates are properly isolated and separated from all other parts of said farm or dairy, and efficiently cared for; and (e) That a permit be issued by the health officer. 5 The local health officer is empowered by Regulation 38 of the Sanitary Code to destroy food products from a farm or dairy where a case of scarlet fever exists if such foods have been so contaminated as to be a source of danger. The section reads as follows: Regulation 38. Destruction of foods in certain cases. When a case of diphtheria, epidemic or septic sore throat, amoebic or bacillary dysentery, epidemic cerebrospinal meningitis, scarlet fever, smallpox, or typhoid fever exists on any farm or dairy producing milk, cream, butter, cheese, or other foods likely to be consumed raw, the state commissioner of health or the local health officer may destroy or order the destruction of any such foods which in his opinion may have been so contaminated as to be a source of danger, and the local authorities may compensate the owner for foods so destroyed. 6 The health officer must distribute the rules, regulations and cir- culars of information issued by the State Department of Health or local health authorities on the subject of scarlet fever, not only to the family involved but to all families living in the house. 7 He must either assure himself that the case is properly isolated or remove it to a suitable hospital. 8 When notified by the attending physician that the patient has recovered, the health officer must inspect the patient and if satisfied that the patient has recovered, and has no catarrhal condition of the nose, throat and ears, after proper cleansing, renovation or disinfection, he may remove the placard. (See Special Bulletin on Regulations for Cleansing and Disinfection.) 9 In order to keep scarlet fever from gaining headway in a com- munity, all susceptible persons who have associated with the patient should be isolated and observed for seven days. If this is done with the first case the extension of the disease may be prevented and the community as a whole protected from serious hardship. 10 On general principles it is better to keep the schools ripen, if the children are inspected for sore throat or general illness every morning before entering. Those pupils found with any symptoms of illness must be excluded and isolated for seven days. If the children cannot be thoroughly inspected each day, and isolation is difficult to enforce, it may be necessary to close not only the schools but all places of public assembly where children meet, for one week after the onset of the disease in the last case. Issued by the Division of Public Health Education Public Health Is Purchasable. Within Natural Limitations Any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ALBANY, N. Y. HERMANN M. BIGGS, M.D. Commissioner DIPHTHERIA INFORMATION FOR PARENTS, PHYSICIANS AND HEALTH OFFICERS Diphtheria is a readily communicable disease most commonly affecting the throat and nose. It is caused by the bacillus or germ of diphtheria which, finding lodgment in the throat or nose of a sus- ceptible person, begins to multiply rapidly. The diphtheria bacillus has the faculty of forming a toxin or poison which circulates in the blood and has the power of combining with and destroying tissues of the body, especially nerve tissues. Where the Joss of tissue is very great the function of the part to which it belongs is lost and in the case of a nerve the result of this is a paralysis of the parfiof the body supplied by the nerve; if it is the heart muscle which is attacked there may be sudden death. Diphtheria antitoxin will combine witli the toxin before it can attack the tissues, thus rendering it harmless; but it can not break the toxin away from the tissues once it has combined with them. For this reason antitoxin should be given early in a dose sufficiently large to combine all the toxin then existing in the blood and to leave an addi- tional amount capable of combining with the toxin which may be formed afterwards. The membrane which is formed as the result of the action of the bacilli and their toxins is in itself dangerous only when it is located in the larynx or trachea (air passages) where it may so narrow the opening as to make breathing difficult or impossible. Such cases are nearly always the result of neglect - of failure to use antitoxin early. Nearly all of the symptoms of the disease are due to the poison and only in small part to the inflammation in the throat or nose. The disease usually begins with a sore throat, a feeling of weakness and more or less fever. The condition of the throat may vary from a slight redness of the mucous membrane to being completely covered by the so-called " false membrane" produced by the destructive action of the bacilli and their toxins. An extensive membrane is seldom seen except as the result of neglect to administer antitoxin in the early stages. In cases involving the larynx there may be no membrane visible except by the use of special instruments. In these cases, how- ever, there is usually hoarseness and a " croupy " cough. Headache, chills and sometimes vomiting may occur but these are very inconstant symptoms. Unless treated all the symptoms usually increase in Circular No. 23, 1919 edition. 2 severity and great muscular weakness develops. Later there may be paralysis of the muscles of the throat, back, heart or other parts of the body. On the other hand, the symptoms may be only those of a rather mild sore throat. But it is these cases that are most likely to spread the disease, because unrecognized. The only way by which such a case can be distinguished from an ordinary sore throat is through having a culture taken and submitting this to a laboratory for examination. Nasal diphtheria, in which a membrane is formed on the lining membrane of the nose, usually first manifests itself as a severe " run- ning nose " with considerable quantities of thick mucus which may be blood stained. Susceptibility. There are two factors which largely determine whether or not an exposed person will contract the disease: (1) the virulence of the germ; and (2) the relative resistance or susceptibility of the individual. A majority of people are not susceptible to diph- theria because they have in their blood natural or " native " antitoxin which neutralizes any diphtheria toxin that may be formed in their bodies. This immunity may be slight or very pronounced and the severity of a given case depends largely upon the balance between the virulence of the germ and the immunity of the patient. The immu- nity does not interfere with the growth of diphtheria bacilli, but pro- tects the body against the destructive etfects of their toxins. Children between the ages of 3 years and 10 years are most susceptible to diphtheria. Nursing infants under six months are relatively immune. One attack of this disease does not prevent its reoccurrence. In some people haying a high degree of immunity these germs grow in the throat or nose without making them ill. Such persons are called " carriers." About one per cent of the general population are "carriers" of virulent diphtheria organisms. However, among persons in close contact with patients suffering with diphtheria, who do not observe proper precautions, a large percentage may become for the time being "carriers" or become ill.* IIow diphtheria is spread. The germs enter the body through the mouth or nose. They may be transferred by ki 'sing, or by receiving the mouth spray thrown out in coughing, sneezing and talking; or they may be carried to the lips by use of a common drinking cup or other utensil, or by fingers soiled by touching some object which an infected person has just touched with fingers soiled from his own lips or his infected handkerchief. It is very difficult for a person who has these germs in his mouth to avoid infecting his fingers with them. Sometimes those who work in dairies are "carriers" or have the disease. They may sneeze or cough into the milk pail or the fingers of the milker may readily transfer the germs to the milk utensils or to the milk and the milk may become contaminated and cause an epidemic of diphtheria. * See " Diphtheria Carriers," page 107, Manual on the Prevention and Control of Communicable Diseases. 3 Directions to parents or nurses 1 If your child or other member of the family is sick with a sore throat, call your physician. A considerable number of deaths from diphtheria are caused every year by delay in calling the physician in such cases. Regulations 4, 5, 6 and 7, Chapter II, Sanitary Code, -require that when there is no physician in attendance principals or other per- sons in charge of schools, the heads of private households, the pro- prietors or keepers of hotels, boarding houses, etc., persons in charge of labor or other camps, masters or other persons in charge of vessels shall report all essential facts relative to causes of presumably com- municable disease to the local health officer. 2 The physician will take a culture from the patient's throat if he is suspicious of diphtheria. The patient should be isolated at once and antitoxin administered if the physician deems it necessary. If antitoxin is given early it may save the life of the patient. Do not insist on waiting if the physician advises its use. Such interference may lead to a fatal result. 3 The infectious agent is contained in the mucus (phlegm) of the nose and throat and if it is destroyed at once, the spread of infection will be checked. A large supply of clean, cheap cotton or linen cloths about one foot square should be provided for use in place of handker- chiefs. The discharges (phlegm or mucus) from the nose and throat should be wiped away with these cloths. The soiled cloths should be placed immediately in a basin containing 5 per cent carbolic acid or in a paper bag and later burned. 4 The dishes, knives, forks and spoons which have been used by the patient should be immersed in boiling water before being removed from the room. Remnants of food should be burned. 5 The mother or nurse must not leave the room without first wash- ing her hands thoroughly with soap and water and wiping them with a clean towel. When caring for the patient the mother or nurse should wear a washable gown or apron which should be removed before she leaves the room. 6 The isolation period may be tedious to nurse and child unless suitable occupation is provided. The State* Department of Health therefore provides a circular entitled "Amusements for Convalescent Children " which may be obtained from the health officer or will be sent to any address in the State on request directed to the State Depart- ment of Health, Albany. The physician and health officer are required by law to perform certain duties for the protection of the community and parents should comply with these necessary requirements. 4 1 When the physician suspects a case to be one of diphtheria he ■must isolate it and at once take cultures from the throat and nose of the patient. (Regulation 10 and 11, Chapter II, Sanitary Code.) If a diagnosis of diphtheria is probable, it is usually safe to give antitoxin in liberal dose without awaiting a bacteriological diagnosis. This is especially important if the case is seen late or the symptoms are severe. It requires from 12 to 24 hours for antitoxin to be absorbed if given subcutaneously. If immediate results are essential the anti- toxin should be administered intramuscularly or. if the physician is familiar with the technique, intravenously - the latter with due caution.* , If the report of a culture is negative and especially if there is sloughing or the membrane involves the pillars, soft palate or other parts of the mucous membrane of the oral cavity, the possibility of the condition being Vincent's angina should not be forgotten. Tn case this disease is suspected a smear should be made upon a glass slide and submitted to the laboratory for examination. The swab should be pressed more deeply into the membrane than is necessary in making a culture. 2 Upon making a diagnosis of diphtheria the physician is required to report the full name, age, and address of the person affected to the local health officer. This report must be made within 24 hours by telephone or telegraph when practicable, but in any event a written report must be made except in cities of the first class. (Regulation 2, Chapter IT. Sanitary Code.) Regulation 3. Chapter IT, Sanitary Code, requires the reporting to the health officer of cases of com- municable disease occurring in hospitals, institutions and dispensaries by the superintendent or other persons in charge thereof. 3 When a case of diphtheria occurs on any farm or dairy producing milk, cream, butter or other dairy products for sale the physician in attendance must report immediately such facts to th? local health officer. (Regulation 8, Chapter II, Sanitary Code.) When no physician is in attendance the owner or person in charge of a dairy or dairy farm shall report forthwith the facts relative to any person affected with a presumably communicable disease who is employed or resides on such dairy or farm. (Regulation 9, C hapter IT. Sanitary Code.) The purpose of such immediate reports is to insure the prompt interdiction of the sale of dairy products except under the conditions specified in Regulation o7, Chapter II, Sanitary Code. 4 On his first visit the physician must instruct the mother or nurse regarding the proper disposal of discharges from the nose and throat. (Regulation 17. Chapter II, Sanitary Code.) If strong commercial carbolic acid is ordered from which to make up a 5 per cent carbolic acid solution, minute directions in regard to its"care and the preparation of the solution should be given. Directions to physicians 6-12-19-20.000 (21-5430) * See Laboratory Manual, pp. 35-37. Public Health Is Purchasable. Within Natural Limitations Any Community Can Determine Its Own Death Rate NEW YORK STATE DEPARTMENT OF HEALTH ' ALBANY, N. Y. HERMANN M. BIGGS/M.D. Commissioner MEASLES Measles is a highly communicable disease. The first symptoms are those of a severe cold in the head. The eyes are usually red and sen- sitive to light. A diagnostic sign of value during this stage is the appearance of so-called Koplik spots, minute grayish spots surrounded by a reddish halo, upon the mucous membrane of the cheek and lips opposite the margins of the teeth. An elevation of temperature may usually be detected at Ifeast 48 hours before the appearance of the erup- tion. On the fourth or fifth day the eruption appears, usually behind the ears and about the neck, spreading rapidly over the face and body. The infective agent is contained in the discharges from the nose, throat, eyes and ears, and is most active during the early catarrhal stage. It is during this stage that efforts to prevent the spread of the disease are of greatest value. The infective agent is transmitted from one person to another through the discharges, most often by coughing and sneezing. The spread of the disease can be prevented only by prompt isolation of each case upon the appearance of the first suspicious catarrhal symptoms, several days before the eruption appears. The disease usually develops in from 9 to 14 days after exposure. The disease varies greatly in severity, mild cases often giving rise to severe infections in others. Among children it is most serious in those under 5 years of age. In 1918 there were 1293 deaths in the State directly attributable to measles. More serious than the disease itself are its complications and sequelae. It is often indirectly responsible for pneumonia and ear infections, and may stir up latent tuberculosis. School outbreaks The most extensive measles outbreaks are usually among school children, its rapid spread resulting from the dissemination of secretions of children during close contact in the early stage of the disease. When the disease is prevailing, school children should be kept under close observation. General statement Circular No. 17, 1921 edition 2 If possible a nurse or physician should visit each school daily, exclud- ing and causing the isolation of all children presenting suspicious symp- toms. Absences from school should be investigated. If daily obser- vation by a nurse is impossible, teachers should be instructed to exclude children with suspicious symptoms. Experience has demonstrated that the spread of measles may be largely prevented through prompt and efficient action on the part of school and health officials, working in cooperation. (See Circular Ao. 13, " Cooperation in the Control of Communicable Diseases Among School Children.") Under regulation 4, chapter II of the Sanitary Code, when no physician is in attendance, it is the duty of the principal or person in charge of a school, upon discovering that a child appears to be suffering from a communicable disease to immediately exclude or isolate the child and to report immediately to the local health officer all the facts relating to the illness of the child, together with the name, age and address. Advice to parents If your child presents symptoms suggestive of measles, he should be kept in bed and a physician should be called. The law requires that when no physician is in attendance the head of a household must report immediately to the local health officer all the facts relating to the illness of any member of the household who appears to be suffering from a communicable disease. (Sanitary Code regulation 5, chapter II.) If a physician is called to attend one case in a household, and subse- quent cases occur for whom no physician is called, it becomes the duty of the head of the household to report the subsequent cases. Per- sons wilfully violating this and other health regulations are criminally liable. (Penal Law, sec. 1740.) If the child has recently attended school or Sunday school, the super- intendent or teacher should be immediately notified, as should the employer if the patient has been at work. The patient should immediately be isolated in a room apart from other members of the household. Ask the health officer for Circular Ao. 14, " The Conduct of an Isolation Period in the Home." Handkerchiefs, dishes, etc., soiled by the patient's secretions, should be boiled or otherwise disinfected before again being used. Soiled linen may be conveniently kept in a paper bag until it can be burned or disinfected by boiling. 3 A permit, countersigned by the health officer or medical school inspector, is required before the patient, if a school child, may return to school. Other children in the family who have not had measles must be kept out of school for two weeks from the time they last saw the patient. Those, who have had measles, upon receiving permission from th<i health officer, may continue in school. Remember that your physician and the health officer are required by law to perform certain duties. You are urged to cooperate with them, cheerfully in the enforcement of necessary regulations and to carry out as specifically as possible the instructions which they will give you. Duties of physicians The physician is required to report each case within 24 hours to the local health officer. Pending the arrival of the health officer, the physician should give detailed instructions in regard to isolation and precautions to be observed, including the disposal of discharges. The minimum period of isolation is 5 days after the appearance of the eruption. 1 Report each case to the State Department of Health immediately. 2 Give detailed instructions in regard to isolation and disinfection, assuring yourself so far as practicable that they are understood. Such instructions should include the issuance of copies of this or an equiv- alent circular. 3 Placard the entrance to the house, apartment or room in which the patient is isolated. 4 Isolate the patient for not less than 5 days from the date of appearance of the eruption and until all discharges from the nose and throat have ceased. 5 See that other children in the'family who have not had measles are excluded from school and kept under observation for 14 days from the time when they last saw the patient. 6 Cooperate with school authorities in detecting, excluding from school and isolating all children suspected of having measles in the catarrhal stage, and in excluding and keeping under observation from the eighth to fifteenth day after exposure all nonimmune children specially exposed. 7 Inspect places under quarantine from time to time to insure the carrying out of instructions in regard to isolation, etc. Duties of health officers 4 8 Give the prevalence of measles reasonable publicity, instructing the public as to the nature of the disease, methods of prevention and requirements in regard to reporting. 9 When the attending physician or family reports that patient has recovered, if the minimum period of isolation has expired, examine to insure freedom from discharges from ears, eyes and nose. 10 Give instructions as to cleansing and airing rooms, bedding, etc., and insure the carrying out of such- instructions before removing quarantine. Publications which may be obtained from the New York State Department of Health Special Bulletin No. i (Revised)-Child Hygiene Stations Special Bulletin No. 2 - Regulations for Cleansing and Disinfection Special, Bulletin No. 3 -Lethargic Encephalitis Circular No. i - The Fly Circular No. 2-'Before the Baby Comes Circular No. 3 - The New-Born Baby Circular No. 4 - The Food of the Baby Circular No. 5 - The Summer Care of Babies Circular No. 6-Care of Milk in the Home Circular No. 7-'From the Bottle to Table Food Circular No. 8 - Avoid Infection Circular No. io - Your Baby -How to Keep it Well (English and Italian) Circular No. ii-'Smallpox Circular No. 12 - Vaccination Circular No. 13 - Cooperation in the Control of Communicable Diseases among School Children Circular No. 14 - The Conduct of an Isolation Period in the Home Circular No. 15 - Scarlet Fever Circular No. 16 - Typhoid Fever Circular No. 17-'Measles Circular No. 18 - Whooping Cough Circular No. 19 - Amusements for Convalescent Children Circular No. 20 - Cancer Circular No. 21 - Pneumonia Circular No. 22 -■ Diphtheria Carriers Circular No. 23 - Diphtheria Circular No. 24-'Septic Sore Throat Circular No. 25 - Poliomyelitis Circular No. 26'-Information for Physicians Regarding Syphilis, Gonor- rhea and Chancroid Circular No. 27 -Milk and Its Relation to Public Health Circular No. 28-Epidemic Cerebrospinal Meningitis Circular No. 29-Epidemic Influenza Disposal of Human Excreta and Sewage of the Country Home Sitting and Sleeping in the Open Air What You Should Know about Tuberculosis Suggestions for Prospective Mothers Outlines for Organizing and Directing Little Mothers' Leagues The Public Health Nurse and the Work She Does A Problem for Parents Maternity Care Printed in English Italian, Polish and Slovak 11-30-21-5000 (21-1041) 126 officer and -urging them to he on the watch all the time, The system has been worked out to such perfection that the effect of the spreading of health propaganda throughout the state of New York has been remarkable. The titles of a few of the pub- lications which may be had for the asking from the New York State Department of Health follow: The Fly Before the Baby Comes The New-born Baby The Food of the Baby The Summer Care of Babies Care of Milk in the Home From the Bottle to Table Food Avoid Infection Your Baby - How to Keep it Well Smallpox Vaccination Cooperation in the Control of Communicable Diseases among School Children The Conduct of an Isolation Period in the Home Information for Physicians regarding Syphilis, Gonorrhoea, and Chancroid Milk and its Relation to Public Health What You Should Know About Tuberculosis Suggestions for Prospective Mothers The Public Health Nurse and the Work She Does Maternity Care And in addition there are pamphlets on all of the common com- municable diseases of childhood, similar to those which are submitted herewith. OTHER ACTIVITIES OF THE DEP*T OF HEALTH. There is a diagnostic laboratory connected with the local health department wnich is fully equipped to carry out all the important tests which phy- sicians may need to have done, such as those for presence of B. diphtheriae in throat cultures; for gonococci in smears from genitalia or eyes; for syphilis, etc. The department also co- operates with the school physicians in the carrying out of a health program among the school children. 127 DISTRICT NUBSING .AND SOCIAL SERVICE. The city is divided into five health districts, each presided over "by a district physician. Nurses are also assigned to the districts and they care for the indigent sick and look after expectant mothers if necessary just preceding confinement. They care for the mother and baby during the puerperium and see that the baby is well started on its way in life. There is also a Baby Welfare Committee in the city which gives advice to Mothers concerning the proper care and feeding of their children, and the local Red Cross chapter does efficient and valuable social service work in the city. The Door of Hope takes in fallen girls, gives them a home during their confinement and the best of care, and then tties to start them in life again with something to make the struggle worth while. There is a Department of Recreation in the city government which conducts six community centers in six of the city schools. At these centers classes are conducted by the local Red Cross one or two nights a week from October to March. Classes in ed- ucational subjects such as domestic science, English, sewing, care of babies, etc., are given for adults. Games and sports under trained supervisors are arranged for the children. In May the playgrounds, of which there are fourteen, open up for the summer. (These are indicated on a map which is presented in the Introduction). Here the Department of Recreation carries on a great work among the children of the city. There is also educational extension work done under the direction of this department in the Italian settlement of the poorer section of Utica. The churches of the city unite to help out in every way they can with the care of the poor of the city. 1Z8 CHARITABLE INSTITUTIONS OF IMPORTANCE TO PUBLIC HEALTH, There are many charitable institutions in the city both for the care of the sick and for those who are in distress. In 1922, through the Community Chest the people of Utica contributed over two hundred fifteen thousand dollars for the support of charitable and civic organizations which serve the public independently of the city government. There are several institutions which care for the sick, such as the Utica Medical and Surgical Dispensary; the Utica City Dispensary, founded in 1870, which pays much attention to tuberculosis; the Utica Dental Dispensary; the Venereal Disease clinic held at the Dispensary; and the General Hospital. In addition there are several other hospitals in the city: Faxton, St, Luke's, St. Elizabeth's, and the Homeopathic, These are in reality private institutions but they have also public wards. Their combined capacity is about five hundred beds. In the city, also, is the big Utica State Hospital for insane patients, and the state Memorial Hospital of the Masons for indigent soldiers and sailors. There are three orphan homes, the Children's Home, St. John's Orphan Asylum, and St. Joseph's Infants' Home. These, along with the House of the Good Shepherd, all care for little tots who are homeless. There are also four homes for the aged: the Home for the Homeless, the Home for Aged Men and Couples, the Old Ladies* Home, and St. Luke's Home. CITY PLANNING. There is a City Planning Commission in Utica with headquarters in the city hall. It is actively at work on the problems of the city and is doing much in the way of con- structive and sanitary laying out of the newer parts of the city. It is a great asset to the city. \Z3 FOOD AND DRUG ADMINISTRATION. The sale of food and beverages is under the general control of the Health Department of the State, and permits are required from the local health author- ities before any person may set up a place for the sale of these things. The sale and use of drugs is under the charge of the Federal government and the state which cooperates with the Federal authorities. No druggist may sell any habit-forming drug except on written prescription of a ''duly licensed physician, veterinarian, or dentist." A record must be kept of every sale of certain drugs like morphine and cocaine by both the physician and the druggist. 1 JO GENERAL SUMMARY GENERAL S U M M A R I All in all Utica is a pleasant city of some 105,000 inhabitants, beautifully situated as far as natural surroundings are concerned and capable of expanding and becoming one of the greatest cities in the state of New York. At the present time, however, it is in a rather lethargic condition governmentally, and apparently it has been for some time, even while within its borders commerce and industry hummed away like bees busy with their honey-making while the hive is dilapidated and worn. CONDITIONS FOUND AND CRITICISMS. The Department of Health is founded on the very excellent plan of the Second Class Cities Law and it should function exceptionally well provided the right man is appointed as local health officer. In Utica the health department is supposed to cooperate in every way with the state department and to carry out efficiently the program outlined by the State Commissioner of Health, This is being done only in a half-hearted way, it seems to me. The health officer, a physician whose details so clutter up his mind that the larger aspects of the situation pass by without his knowing it, is always busy. He was too busy to talk about the work of his department, too busy to advise one just how to go about getting certain infor- mation, too busy even to answer a few short questions. The Committee 1922-23 Secretary G. V. Smith, M 2. A. W. Wright, M 4., Chairman. W. S. McClellan, M4. A. M. Walker, M 4 R. S. Buol, M 4. R. H. Goodale, M3. M. C. Jobe, M 3. R. J. Kirkwood, M2. C. L. Lumb, M 2. P. S. Dickinson, M 2. G. M. Morrison, M 1. T. C. Pratt, M 1. W. S. Burrage, M 1. Harvard University Phillips Brooks House Association Medical School Society 240 Longwood Avenue BOSTON, MASS. James Smith Hall C 21 , Harvard University, Cambridge, Massachusetts, May 1st, Dr. Shaw, Health Officer, Utica, New York. Dear Sir,- In connection with a survey of Utica which I have been making I wonder if it would be possible to obtain from you briefly answers to the following questions which you were too about busy to go into in detail/when I was in your office a week or two ago? Are there any public markets in the city? If so, the number and the department of the city government having them in charge. The number of slaughter hohges in the city afid the frequency , of inspection of same.- Under whose control are provision hoifses And soda fountains? How frequently are inspections madezof £hese places by the Health Officer? What laboratory tests are carried out in the laboratory of the city department "*"t Would it be possible for me to get from you a/Copy of the report of the Health Officer of the city of Utica for the year 1?22? If this cannot be obtained from you whore might I be able to get a copy? Thank you for your kindness in this matter. Yours very truly, krhe reply to a letter which I sent ,tQ Abe asking for informat ion which he could not give me when I was in his office?~~A typical example of the order and efficiency which .pre- vailed in his office. 1J2 longest visit I had. with him lasted, approximately three minutes and. then he referred, me to the Sanitary Code for practically every- thing, Since I could not obtain from him the information I de- sired when I was in his office, I wrote to him, and the reply came back as a few pencilled notes on the letter which I had written to him', A splendid example of the order and efficiency that prevailed in his department from all I could see. All in all the whole place was poorly run and badly managed. The Vital Statistics Bureau was run by individuals who knew only that certain figures were wanted at Albany, and they were sent in. The broader aspects of the situation escaped them entirely. The water supply is good and a survey of the shed showed that the conditions were good. Sanitary engineers of the state department of health go over the shed at intervals and re- port on its condition. The water company, by means of patrols, is protecting the supply from pollution and its efforts are meeting with success. The sewage disposal system is wretched. It consists of a series of pipes which empty into the Mohawk River the untreated and unstrained sewage of the city. In one place the outlet opens into a bog or slough where stinking filth stagnates under the summer sun while the river runs by some distance away. A source not only of foul odors but flies, mosquitoes, and other insects, in spite of the grease on the surface of the sluggish stream. The city has put off all too long the making of the sanitary sewage disposal plants. The present system is not only unclean and unsanitary, but a disgrace to a modem, up-to-date city. 155 The city government and the city engineer* s office have failed to keep numerous promises made to the state department or health and no further delay should he allowed. The present condition is a blot on the name of the city. The new plants should be installed as soon as is humanly possible. Garbage, refuse, and ashes are cared for in a fairly efficient way. Garbage wagons did not look as clean and well- kept as they should be and were not always covered. The milk of Utica comes from the surrounding country, but pasteurization is not yet a general enough procedure, only 15 or 25 per cent of the milk being pasteurized. The milk ir>- spector whom I saw impressed me as a political appointee rather than a man chosen for his special fitness for the position. He sat about the office with his feet on the desk and looked quite unlike an inspector of the city's milk. The industrial hygiene of Utica is good. Housing is also excellent and we may congratulate ourselves on this when conditions elsewhere are not what they might be. There is not enough civic pride in the poorer sections of the city. Old lots are dirty and messy and sometimes manure is piled indescriminately around. The prevention and control of communicable diseases in Utica is well carried out. The schools of Utica are good and instruction, especially in the academy, is excellent. But several criticisms may be made. In the first place, that most important adjunct to the school system, the school physician, is not encouraged and helped as much as he should be. There is only half-hearted cooperation on the 1J4 part of the school authorities. This is entirely wrong. Further- more, there should he at least one full-time physician with two assistants and now we have only four part-time men who give two hours a day to school work. There should he from ten to twelve full-time school nurses and at present there are only four. Second, a medical examination is not as yet being given to each pupil annually as required hy state law. Third, there is no gymnasium in the Free Academy. Fourth, the old, out-of-date school houses should he dispensed with, for they are a menace to both life and health. The dispensaries of the city are doing excellent work among the indigent sick and results are astonishing. The work of the Recreation Commission is being carried on in an excellent manner and is giving healthy, out-door exercise to hundreds of children, RECOMMENDATIONS. In conclusion, I should make the following recommendations: 1. That a new health officer be appointed in Utica to replace the present incumbent, 2. That a more intelligently run vital statistics bureau be built up to replace the present bureau. 5. That the present sewage outlets, especially the one described at length, be immediately cleaned up and put in a sanitary condition. 4. That a new sewage disposal plant, or perhaps two disposal plants, be built to replace the antiquated system which is now in use. 5. That there be better garbage collection supervision, 135 and that the wagons he thoroughly washed at night and covered when garbage is being collected. 6. That the condition of the Erie Canal be improved as soon as possible. 7. That milk inspectors be appointed because of their fitness to be good inspectors and that the milk supply be more carefully watched, 8. That pasteurization be required as a more common procedure than it is at present, 5. That empty lots be kept clean and free from all dirty rubbish, manure, etc. 10. That there be greater cooperation on the part of the Board of Education and the Superintendent of Schools with the school physicians, and that the work of these inspectors be aided in every way possible. 11. That there be at least one full-time school phy- sician and two part-time assistants. 12. That there be at least ten or twelve full-time school nurses instead of the lour as at present. 1J. That each child in the public schools be given a thorough medical examination once each year. 14, That a gymnasium be built as a part of the Free Academy, 15. That the old and dilapidated school buildings in the city be done away with. -- Ynap "Ihe 5ewaqe -System - O-tica , He io Lfork