THE REPORT OF THE COMMITTEE ON HYGIENE. MEDICAL SOCIETY OF THE STATE OF NEW YORK, In reviewing the events which have affected the public health in our State during the past year, your Committee observes that apparently a needless sacrifice of valuable lives has resulted from neglect of well-known methods for the prevention of the spread of acute infectious diseases. Much of the responsibility for this state of things must inevitably be borne by the medical profession of the State. It is not conceivable that physicians practicing their art under the present laws of our State are ignorant of the etiology, the mode of communication, and the methods of preventing the spread of infectious and contagious diseases. If not ignorant themselves it follows that either the profession has been remiss in the exercise of the highest functions of its calling, or that the people, and those who govern them, are not yet sufficiently acquainted with the demonstrated facts of scientific medicine, and are grossly neglectful of their duty. Because your Committee believes that both these factors are active in perpetuating the existing unsatisfactory conditions in the domain of public health, it desires to emphasize once more our duty as guardians of the public health and as instructors of the people in matters of hygiene. Typhoid Fever.-It seems improbable that we will ever have more definite knowledge of the cause and methods for the control of typhoid fever than we have at the present moment. And yet the report of the State Commissioner of Health for 1903 shows that there were nearly 25,000 cases in our State, with a mortality of 1,635 cases. Typhoid fever is most largely communicated by contaminated drinking water. Our intelligent Governor called attention to this in his message of January 6, and referred to the passage, by the last Legislature, of Chapter 464 of the Laws of 1903, entitled, “An Act to Amend the Public Health Law Relating to the Discharge of Sewage and other Waste Matter into the Waters of the State," the enforcement of which is vested in the State Department of Health. It is needless to emphasize the importance of such legislation. It is well known that *Advance Sheet from Transactions by courtesy of the Secretary. all our public waters, including the beautiful Adirondack lakes, are infected. To restore them to a condition of purity your Committee recommends that every city and village and house sewering into public waters, which are used as sources of water supply. shall be compelled by law to purify the sewage, by acceptable methods, before it is discharged into public waters. A bill has been introduced by Senator Stewart, of Ithaca, which proposes to place the water supply and sewer systems of the State under the control of a State Board of Sewer and Water Commissioners, which is to be appointed by the Governor, and which is to consist of three men, one of whom must be a competent civil and hydraulic engineer, and another a competent bacteriologist. The bill appropriates $75,000 to carry out the provisions of the act. The intent of this bill is good in so far as it emphasizes the necessity for such work to be attended to in an energetic and scientific manner, and at once. The best method of accomplishing this desirable object is a legitimate subject for debate. If we, in our State, had a system by which men were especially educated in matters of public hygiene and were compelled to earn the degree of Doctor of Public Health before exercising the function of Health Officer or Health Commissioner in any community, there would be no necessity for the creation of such a commission. In a previous report this Committee, and our then President, Dr. H. R. Hopkins, called attention to the desirability of thus elevating the standard of service in the Department of Public Health. Instead of creating new boards it seems to your Committee that the time has arrived when the State should demand the most intelligent and active service from its various health officers, and should proceed at once to afford such as desire to enter that service an opportunity for special preparation in accordance with the method so successfully employed in England. In the meantime the object desired could be accomplished under the direction of the State Commissioner of Health by the addition to the funds at his disposal of a sum much less than that called for in this bill. But of even greater importance than the purification of sewage, however valuable that may seem, is the perfect disinfection of all typhoid dejections before they are emptied into a sewer or privy or buried in the ground. For this the attending physician is directly responsible. The awful epidemic in Ithaca, and, indeed, all great epidemics, was directly due to the neglect of this very simple precaution. The false idea that frost kills typhoid germs must be intelligently combated, and the physician must be as alert in seeing that all dejections are sterilized before disposal during the cold months as he is during warm weather. If all typhoid dejecta were sterilized before disposal this disease would be eliminated as absolutely and as quickly as has been yellow fever from Cuba under the energetic and intelligent direction of General Leonard Wood. Tuberculosis.-The control of tuberculosis is less easily possible because of the nature of the disease. But the State and physicians have great responsibilities in this matter and can do much to forward the work by the early completion of the sanatorium in the Adirondacks for incipient tuberculosis, by the establishment in every community of a hospital for the tuberculous, and by the scientific care of those wards of the State who have developed tuberculosis while in public institutions for restraint or for treatment for special diseases, or in poorhouses. The antiquated buildings and unscientific housing of the dependent classes can no longer be tolerated by an awakened public conscience. Smallpox.-The prevalence of smallpox in many communities this year is sufficient commentary on the laxity with which our good laws for the control of this disease are carried out. Such a state of things cannot exist in a vaccinated community. We must repeat the demonstration of Jenner of the value of vaccination. And we must insist that vaccination be performed by public officers with as great attention to surgical asepsis as is demanded in major operations. If life insurance companies, including the industrial companies, would ask the date of the last successful vaccination, instead of "Have you been successfully vaccinated?" and refuse to issue policies except to those who show evidence of competent and recent vaccination, much help would be given. The re-vaccination of children after the age of puberty is neglected, and it is our duty to see that this is carried out systematically. Because of the want of uniformity in the vaccine laws of different communities, and of the fraudulent certificates of vaccination issued by those opposed to vaccination, your Committee recommends that no child shall be admitted to any public or private or parochial school, until his scars have been examined by the public vaccinator, or other competent authority, and have been pronounced to be those of successful vaccination. The State distributes diphtheria anti-toxin and anti-tetanic serum to those physicians who make requisition for it through their local health officers. Your Committee recommends that under the direction of the State Department of Health, vaccine lymph is produced and distributed in the same manner, for it believes that in no other way can standardized and effective vaccine be uniformly supplied. Tetanus. The relation of tetanus to accidents with toy pistols and blank cartridges has been demonstrated in recent years to the satisfaction of all surgeons. This Society should give support to a measure to be introduced by Senator McCabe of Brooklyn, this winter, which prohibits the sale of blank cartridges to minors. School Hygiene.-One of the most effective methods of educating the public as to the nature of infectious diseases and how they can be controlled is the teaching of the essential elements of this subject in our public schools. The medical inspection of public schools has been recognized throughout the land as of the greatest importance. Its primary aim is to aid in the control of the infectious diseases, and to safeguard the individua! victim of physical conditions which interfere with his development from the harm which must inevitably follow. But possibly of greater value than the direct practical benefit to the individual, and to the community, resulting from the early detection of infectious diseases, or of crippling physical conditions, is the object lesson to both teachers and pupils of the importance of accurate observation of disease conditions. Your Committee recommends that physicians in every community urge the benefit of such inspection, and by every legitimate means try to secure competent medical inspection of every school in the State. State Laboratory for Bacteriological Diagnosis.—In this connection it is fitting that the Committee gives its unhesitating support to the maintenance of the State Laboratory for Bacteriological Diagnosis. The practical value of such a laboratory to physicians practicing their art away from medical centers cannot be exaggerated. Public Buildings and Tenements.-The recent holocaust in a Chicago theater has again called attention to the criminal neglect of public authorities in guarding the lives of the people in public buildings. Not only should the laws for protection from fire be stringently enforced in every community, but the equally important laws requiring sufficient air space and competent ventilation and plumbing in all buildings in which men and women are employed or are permitted to congregate be looked after. There is no question but that a greater loss of health and life results annually from neglect of these requirements than is caused by such fires as that of the Iroquois Theater, though the result is not so dramatic. The constitutionality of the TenementHouse Act has been upheld by a decision of the Court of Appeals handed down on January 8, 1904. The provisions of this act should be extended by legislation to cities of the second and third classes, for in them, as in New York and Buffalo, the tenementhouse problem is coming up, and must be met by energetic action at the start. Your Committee urges the utmost vigilance on the part of every member of this Society in maintaining what has already been accomplished for the better housing of the poor. Child Labor.-Chapter 255 of the laws of 1903 amends the labor laws relative to the employment of women and children. The provisions of this law limit the hours of employment of women and of children between the ages of fourteen and sixteen, and prohibit the employment of children under fourteen in any establishment except during the summer vacation in cities of the third class. The provisions of this law are humane and right, and it is our duty as physicians to aid the Commissioners of Health in enforcing it. Your committee in reiterating what is known to most of you, and what has been said often enough before, has no apology to make. It is only by constant repetition that we can keep before the public the importance of the subjects under our jurisdiction, and only by repeated recalls to our duty as citizens that we can disentangle ourselves from the engrossing cares of the daily routine of our lives. JOHN F. HEFFRON, M. A. VEEDER, AN ALCOHOL SUBSTITUTE.-Alcohol, suitable as a substitute for ordinary alcohol, is obtainable, according to a German inventor, from fæces by submitting the fæces to dry distillation, absorbing the gases produced in water, and distilling the mixture thus obtained. The residues from this last distillation may be used as the medium for absorbing the gases. |