Monthly Bulletin New York State Department of Health MATTHIAS NICOLL, Jr., M.D., Éditor TABLE OF CONTENTS What the State Department of Health Is Doing, Linsly R. Williams, M.D..... Review of Infantile Paralysis in New York State, Exclusive of New York City, PAGE SEPTEMBER, 1916 THE LESSON OF AN EPIDEMIC The pitiable record of suffering, crippling and death caused by the prevailing epidemic of infantile paralysis will not have been wholly a vain sacrifice if the lesson that it is teaching be taken to heart and not soon forgotten, namely, the utter inadequacy of most health districts throughout the State outside of the larger cities to meet great emergencies. This is attributable to factors which are common to all rural health districts and also to those which are peculiar to individual districts. Among the first is the lack of county health organization with provision for concerted and uniform action of all local districts within a county during an emergency, instead of, as at present, the promulgation of a multiplicity of ordinances, rules and regulations often contradictory and enforced to a varying degree with the resulting conflict of authority, ill feeling and reprisals among the different communities, all to the detriment of efficient sanitary methods. The need for county isolation hospitals has been thoroughly demonstrated and urged by the State Department of Health, but in only one instance, that of Westchester county, has this been met, although in Nassau county some steps have been taken in this direction. Certain communities, happily a minority, have been brought by sad experience to a realization of the duties of the local health officer, and to an appreciation of the vast powers that have been granted to him by the Public Health Law, as well as the personal qualifications needed to exercise those powers efficiently for the protection of the public health. Local Boards of Health have also been placed on trial and in a great majority of instances have measured up to their responsibility. In localities in which they have shown themselves out of sympathy with measures essential to the welfare of the public health, or actually obstructive in their attitude toward such measures, it is safe to predict that the people of that community will not fail to record the fact and that they will take action to prevent its recurrence at their earliest opportunity. WHAT THE STATE DEPARTMENT OF HEALTH IS DOING LINSLY R. WILLIAMS, M.D. Deputy Commissioner of Health The present epidemic of poliomyelitis had its apparent origin in the waterfront section of Brooklyn and as soon as it had assumed alarming proportions offered many opportunities for spreading the disease throughout the State. It was the season when many residents of the City of New York leave for their summer outing and a great many persons took their children from the city unmindful of the fact that an epidemic existed and that the latter had been exposed to the disease. When the number of new cases reported began to reach one hundred a day in New York City and alarming headlines appeared in the New York press, additional numbers of people left the city in order to prevent their children from becoming infected. On the other hand a number of visitors from other parts of the State to the City of New York found on returning to their homes that their children had become infected. As might have been expected the disease made its most rapid progress along the main highway of travel and in those districts which large numbers of persons from New York City visit in the summer, especially Long Island, Westchester county, the cities and towns along the Hudson and the counties of Ulster, Sullivan and Orange. As usual with rapidly extending epidemics neither the State nor local authorities were equipped with the necessary organization to provide adequate diagnostic facilities and take proper quarantine precautions for preventing the spread of the disease. Owing to a decreased appropriation the State Department of Health of New York had only ten Sanitary Supervisors on July 1, who were districted in such a way that each was required to supervise the work of the health officers in five or six counties. instead of only three as previously, an average of over 110 health districts apiece. The redistricting of the State from twenty to ten had been accomplished in the first week of July and the ten Sanitary Supervisors given their new assignments. On July 24, Sanitary Supervisor Dr. Paul B. Brooks was transferred from his district, consisting of the counties of Broome, Chenango, DelaWare, Otsego and Tioga to take charge of the townships of North Hempstead and Hempstead in the county of Nassau, and Dr. Frank Overton from the counties of Rockland, Westchester, Nassau and Suffolk to the town of Oyster Bay in the county of Suffolk. It soon became evident that it was not possible for the Sanitary Supervisors to make prompt diagnoses on early cases of infantile paralysis, to visit health officers and also to attend to the usual routine of their work. Therefore, on July 26, Dr. George Draper of the Presbyterian hospital, New York, and formerly of the Rockefeller Institute, an acknowledged authority on the disease, was retained by the Department for diagnostic work on Long Island. The number of calls made upon him and the increasing anxiety of the people of Long Island soon made it necessary to make additional provisions. On August 5, Mr. Henry D. Walbridge and Mr. Frank A. Bailey of Nassau county requested the Deputy Commissioner to assign Dr. Draper as Sanitary Advisor to a part of Nassau county. After giving the matter mature consideration it was decided to establish a branch office of the State Department of Health on Long Island and to furnish diagnostic service for all persons on the island. Dr. Bert W. Caldwell, superintendent of the Alleghany hospital, Pittsburgh, was placed in charge of the office. The Department felt itself extremely fortunate in securing his services through a leave of absence granted by the Alleghany hospital, as he had been for nine and one half years in the Panama Canal Zone as Sanitary Officer and Hospital Superintendent under Surgeon-General Gorgas, and had also seen service in Serbia. The diagnostic work was placed in charge of Dr. Draper. Within a few days the Department also secured the services of the following men to serve as diagnosticians on the island, namely: Dr. Wm. P. St. Lawrence, Dr. James W. Babcock, Dr. C. J. Dalton, and temporarily transferred from the State Laboratory, Dr. W. E. Youland, and Dr. H. L. Van Winkle to assist. Under the direction of Mr. Walbridge the local committees in the northern part of Nassau county provided a residence for the staff on the Roslyn estates at Roslyn Heights, Long Island, and automobile transportation for the diagnosticians. The house and branch office were opened on Wednesday, August 9. During the first few days it was impossible. to answer all the calls and demands made upon this office by the physicians for diagnosis and by the laity for advice as to what action they should take in protecting their families. It therefore became necessary to place one of the diagnosticians, Dr. Babcock, at Islip. On August 19, Dr. Youland was assigned to Southampton, and on August 21, Dr. Van Winkle to Cedarhurst. Their piaces were taken at the branch office by Dr. Sawyer and Dr. W. H. Leake. Under the direction of Dr. Caldwell, a sanitary survey of the county was inaugurated, beginning in the congested districts of Roslyn, Glen Cove and Oyster Bay, and three sanitary inspectors were obtained for this purpose, Mr. H. E. Smith, Mr. Grover E. Rickard and Mr. J. W. Naughton. The Department also assigned two nurses to assist the local health officers and see that the quarantine was maintained. Supervision of the work of the Health Officers of Nassau county was given to Dr. Brooks, leaving Dr. Overton free to attend to the needs of Suffolk county. Hospital Accommodations Through the efforts of the local committees who had been appointed at various meetings to do what they could to help the situation, the Roslyn Neighborhood House was transformed into a temporary hospital with accommodations for 25 patients. A temporary hospital was also estab lished in Locust Valley. By joint action of the town boards of North Hempstead and Oyster Bay sufficient space was made available at the Jones Institute in the town of Oyster Bay for the care of 25 additional patients. Medical care was not retained for these institutions but it was soon found that the local physicians and the health officers were so busy that it was impossible for them to attend to their practice and also take care of the patients in these hospitals. The Department felt it necessary, therefore, to install a resident interne in each one of these institutions, and the following men were assigned: Dr. F. W. Fiedler, Jones Institute, and Dr. J. R. Gorman, Locust Valley the salary of the physician at the Locust Valley hospital being paid by the local committee. One of the diagnosticians of the Department located at Roslyn was assigned as visiting physician to these hospitals in order to give such advice as was necessary, to see that the children were properly fed, as many of them were infants requiring special feeding, and that the nursing service was adequate and the proper sanitary precautions taken. Clerical Work In order to more promptly establish quarantine, it was deemed advisable to have all cases of Poliomyelitis occurring on Long Island reported immediately to the branch office instead of to the Albany office. And in order to maintain the records and to see that each case was promptly followed up by the local Health Officer and quarantine instituted and maintained, stenographers, clerks and telephone operators were needed and were immediately engaged. Westchester County During the month of July several scattered cases occurred in the towns of Poundridge, Bedford, the village of Mt. Kisco, and in other residential sections of Westchester county, as well as a number of cases in the city of New Rochelle, and in some of the larger cities and villages of Westchester county. A group of citizens interested in the Westchester County Visiting Nurses' Association, particularly Mr. and Mrs. Henry G. Marquand, Mr. Robert S. Brewster, Dr. Rufus Cole, director of the Rockefeller Institute Hospital in New York, Mr. V. Everit Macy and others, immediately began to take steps to provide an isolation hospital. The Nursing Association took it upon themselves to rent a small building for the purpose of an isolation hospital, but to |