Notwithstanding the relatively small population more cases were intubated in The Bronx than in any other Borough, with a lower case fatality (20.9). This speaks well for the work of the antitoxin inspectors in that Borough. The highest case fatality occurred in the Borough of Richmond, where 8 out of the 10 cases died.

Only two-thirds as many immunizations were performed during 1909 as during the previous year, and the number of children contracting the disease after such immunization was reduced to 50 per cent.

The

The total number of visits paid by inspectors to diphtheria cases was increased over 1908, also the total number of injections. average number of visits per case was the same as 1908 (2.8).

DIAGNOSIS LABORATORY.

(See Table 20.)
Tuberculosis.

The steady increase in the number of specimens of sputum submitted to the Diagnosis Laboratory for examination continued during 1909, 6,000 more specimens being sent in during that year. The number showing tubercle bacilli was about the same both during 1909 and 1908 (8,000), so that the increased number of specimens was not due to any increase in the prevalence of the disease, but entirely to more physicians availing themselves of the services of the laboratory.

Typhoid.

About 8,000 specimens of blood were examined for the presence of the Widal, with a corresponding increase in the number of specimens showing positive reaction. The number of doubtful results showed a decided decrease. A similar increase took place in the number of specimens of urine submitted for examination for the Diazo reaction.

Malaria.

About 200 more specimens of blood were examined for the presence of malarial organisms but the relative increase in the number of positive results was much greater, due to improved methods and greater experience on the part of the examiners for cerebro-spinal meningitis. Although this disease was much less prevalent during 1909, yet almost twice as many specimens of spinal fluid was submitted for examination for the presence of the meningococcus.

Miscellaneous.

Twenty-four additional culture stations were established during 1909 and 8,000 more visits made to collect specimens.

Corresponding to the decreased prevalence of diphtheria, there was a decrease in the number of culture tubes and swabs prepared. Three thousand more Widal outfits were prepared and distributed and there was a moderate increase in the number of the various other outfits distributed.

The number of laboratory preparations made was about the same during 1909 as 1908, 116,000.

SPECIMENS SUBMITTED BY INSPECTORS AND PRIVATE PHYSICIANS.

As shown in Table 21, the percentage of specimens submitted for diagnosis by private physicians was about 47 per cent., as compared with 53 per cent. of specimens submitted by inspectors of the Department of Health.

The inspectors gain their advantage only because of the great number of "later diphtheria cultures taken and submitted by them.

The relative number of specimens submitted by each was about the same as during 1908; there was, of course, a marked increase in the number of specimens of sputum submitted by each.

Of the total number of specimens of sputum submitted, 19,000 were submitted by physicians, and 16,000 by inspectors.

Four-fifths of the typhoid specimens were submitted by private physicians, while of the malarial specimens only 136 were submitted by inspectors. The marked diminution in the number of specimens of glanders submitted during 1909 is accounted for by the fact that the routine examination for the glanders agglutination reaction were carried out at the Research Laboratory, during almost the whole of 1909.

DIVISION OF LABORATORIES.

RESEARCH LABORATORY.

A brief summary of the work accomplished by the Research Laboratory during the past year may be found in the following report:

The bacterial products which it has been customary for the Department of Health to prepare have continued to be produced as in previous years.

The most important of these products, diphtheria antitoxin, has been produced to the extent of 546,000,000 units. This amount combined with what remained at the end of the past year was the stock on hand for 1909. Of this amount 575,000,000 units have been used in the refining process, yielding 388,000,000 units. Of this amount 331,000,000 units have been distributed throughout the city to stations and hospitals to be used in the treatment of cases of diphtheria. The latter quantity expressed is equivalent to approximately 110,000 average doses of antitoxin.

The laboratory has continued its regular production of tetanus antitoxin, 16,000,000 units of which were used for refining and 11,000,000 units for therapeutic purposes. 6,000,000 units have been bottled for distribution. The latter has been used largely for immunizing in order to prevent the development of tetanus, although a very considerable quantity has also been used in cases in which the disease has clearly declared itself, in which cases very successful results have been obtained.

Large amounts of diphtheria and tetanus toxins have been produced (463 and 55 liters, respectively) in order to inject horses to produce antitoxins.

Practically, the usual amounts of tuberculin and mallein have been produced. There has been distributed 1.700 c. c. of tuberculin, which represents approximately 3,700 doses, and 2,800 c. c. of mallein, representing 950 doses.

The first of these substances has been largely used in cattle as well as in man, and the second, of course, in horses suspected for glanders. Numerous patients have been received for the Pasteur treatment on account of the rather large number of people having been bitten by rabid dogs. 746 new cases have been reported during the year, of which 14 lived in New York, who received treatment free of charge. Of the total number indicated 65 were bitten in the head and 477 at some other point on the body; the remainder were endangered by having had wounds come in contact with the virus. Most of those who lived out of the city received treatment by mail. There were reported

only two deaths from hydrophobia of these 746 cases. Both of these were bitten about the head in several places and did not begin treatment for three to nine days, respectively, after having received the wounds. One of these cases occurred so shortly after finishing the treatment that there was no time for the immunizing process to become effective, while the other developed the disease before the treatment was finished. The number of animals received for suspected rabies was 248, 97 of which were found to have rabies upon examination.

Division of Laboratories-Research Laboratory; Production of Antitoxic Serums and Diagnostic Toxins.

VACCINE PREPARATION.

During the past year vaccine has been produced in a quantity sufficient to vaccinate 375,000 persons. Until the beginning of the second half of this year vaccine had always been prepared and collected in the Vaccine Stable on the grounds of the Research Laboratory. At the time indicated, however, the Vaccine Stable was transferred to Otisville, where vaccine is now prepared in a temporary structure. A suitable stone building to properly accommodate calves and facilitate the preparation of the vaccine is in the course of construction.

Vaccine Laboratory: Virus Produced, Tested, and Issued.

Antistreptococcus serum has been prepared to be used in severe cases of scarlet fever and sepsis. In a few cases this serum has been employed with apparently beneficial results.

Besides the preparation of bacterial products the Laboratory has continued to perform the regular examinations of samples of milk and of water as well as to examine the serum of animals suspected to have glanders. The latter test has proved to be of importance as a preliminary diagnostic measure. 605 serum specimens have been examined. Those horses, the serum of which shows above 1/1,000 dilution, are then tested with mallein before the final decision is rendered.