their dismay found that this was situated in the town of Poundridge, whose Board of Health promptly adopted a resolution to prevent the establishment of any contagious disease hospital within the limits of their township. The Department was then consulted and it seemed desirable to take steps to induce the county to provide for such cases as might need immediate isolation, and also to employ an expert diagnostician to assist with the work in Westchester county. Through the courtesy of the Rockefeller Institute and its director, Dr. Simon Flexner, Dr. Harold L. Amoss of the Rockefeller Institute was assigned to the State Department of Health, and was appointed Sanitary Supervisor to assist Dr. Hubbard with the work in Westchester county. Dr. Hubbard had formerly exercised supervision over the counties of Dutchess, Putnam and Westchester, but there had been such a large increase in the work that it was necessary to limit his duties to Westchester county. Dr. Amoss began his work on July 26, and on Monday, August 7, at a meeting of the Board of Supervisors held at White Plains, representations were made to the Board by the Deputy Commissioner, Dr. Williams, Sanitary Supervisor, Dr. Hubbard, Dr. Amoss, Commissioner of Charities, Mr. Macy, and others, and that Board promptly voted the sum of $10,000 for the construction of a temporary isolation hospital and $20,000 for maintenance, and appointed a committee of three to cooperate with the hospital building committee and established a hospital on the Cochran property adjoining the county farm. The hospital was opened on August 16, and is being managed under the direction of the State Department of Health. The board of trustees of the New York State Hospital for Incipient Tuberculosis loaned the services of its superintendent and several nurses to open the hospital, and Dr. A. H. Garvin, the superintendent of Raybrook, was placed in charge of the new isolation hospital. The services of Dr. Noe were obtained and he became resident interne. On August 19 there were 44 patients in the hospital. The increasing demand made upon Dr. Amoss on account of the increased number of cases occurring in various parts of the county made it necessary to appoint an extra diagnostician to assist the physicians in the towns, cities and villages along the eastern shore of the county, and on August 13, Dr. Philip Van Ingen was appointed diagnostician to take charge of this work, and also to act as visiting physician to the hospitals recently established in the town of Mamaroneck and cities of Mt. Vernon and New Rochelle. The demands for diagnosticians in Westchester county kept Dr. Amoss and Dr. Van Ingen so busy that on August 21 it was necessary to appoint an additional diagnostician, Dr. Aycock, stationed at Tarrytown, to assist in the work in the cities, towns and villages along the Hudson river. Ulster, Sullivan, Orange and Rockland Counties This section of the State is a natural playground for many residents of New York City and other places. In different parts of this section there are many of the highest class hotels and summer cottages as well as many boarding houses and farm houses where persons of moderate means spend their vacations. In some of the townships in the western part of Ulster and in the eastern part of Sullivan there are large colonies of people coming from the congested districts of New York City. As was expected the disease promptly broke out among the visitors in these boarding houses, causing much consternation among them and creating many difficulties for the local Health Officers. These difficulties increased, making it necessary for the Department to call back from the Texas border Capt. Charles W. Berry of the 14th Infantry, Sanitary Supervisor of the Department, who took charge of the work on July 30. Dr. Berry soon found it impossible for him to cover the district satisfactorily, and on August 12 the Department transferred to this district Dr. Edward Clark, who had formerly maintained supervision of the counties in the neighborhood of Buffalo, and Dr. John A. Smith, who had formerly charge of the Adirondack district and more recently of the Hudson river district. Dr. Clark was authorized to establish a branch office of the State Department of Health at Middletown, and enter into contracts with the laboratories at Tuxedo Park, Newburgh and Kingston for any laboratory work that might be necessary. Dr. Wadsworth, director of the Laboratory of the State Department of Health, entered into negotiations with these laboratories and also with the laboratory connected with the Loomis Sanatorium at Liberty, N. Y. The increasing number of cases and the consequent increasing demands made upon these three men by the health officers and physicians of the district made it necessary to secure for this district an extra diagnostician to assist in that work. And on August 28 Dr. Smith was transferred from the Long Island office to work under the direction of Dr. Clark as on Long Island, it was found necessary to have all reports of cases in this section immediately sent to the Middletown office in order that quarantine might be more promptly instituted and more efficiently maintained. Syracuse An additional number of cases developed in Syracuse and Oswego county, making it necessary to provide assistance to Sanitary Supervisor Sears in making diagnoses of cases outside of Syracuse in the counties of Onondaga and Oswego, Cortland and adjacent counties. Early in August Dr. W. S. Ayer was appointed Sanitary Supervisor to work under the direction of Dr. Sears. Transfer of Supervisors and Appointment of Additional Men As stated above, the Department early in July was obliged to enlarge the districts of the Sanitary Supervisors, but the outbreak of the disease in Utica and in other places made it necessary to curtail the district of Dr. Joseph E. Clark, and to appoint Dr. Clifford R. Hervey to take the counties of St. Lawrence, Jefferson and Lewis. Dr. C. C. Trembley of Saranac Lake was appointed Sanitary Supervisor of the Adirondack district vacated by Dr. Smith. Owing to the increase of work it was found impossible to enlarge the district assigned to Dr. Walton, and he is retained in his former district, Montgomery, Fulton and Hamilton counties. To cover the counties made vacant after diminishing the number of Supervisors in July, Dr. Wakeman was transferred from Jefferson and St. Lawrence to the counties of Wyoming, Livingston and Ontario. In order to cover the district vacated by Dr. Edward Clark, Dr. John W. Le Seur of Batavia was appointed Sanitary Supervisor to take his district. On August 21 two important districts were still uncovered, as it had been impossible up to that time to find men living in those districts suitable for Sanitary Supervisors. One is needed for Otsego and Delaware, one for the counties of Dutchess and Putnam. These vacancies will be filled as soon as possible. This work has been made possible only by the hearty support of the Governor and the State Comptroller, who have on account of the extraordinary emergency placed certain funds at the disposal of the Department. The Civil Service Commission also, in accordance with the Civil Service Law and its rules and regulations, has authorized the Department to appoint temporarily the necessary experts and clerical help to carry on the work. REVIEW OF INFANTILE PARALYSIS IN NEW YORK Director, Division of Communicable Diseases The following table indicates the number of cases and deaths from infantile paralysis which have occurred in New York State exclusive of New York City. The cases are located principally in counties adjoining New York City, extending up the Hudson river and through the central and southern parts of the State along railway lines. AUGUST (including Aug. 23) Deaths of several cases transferred to New York City are not included. A glance at the maps will indicate the lines along which the outbreak seems to be extending. The counties most heavily infected are the following: Nassau, Suffolk, Westchester, Dutchess, Ulster, Sullivan, Columbia, Greene, Orange, Oneida and Onondaga. Counties free of the disease are: Franklin, Clinton, Essex, Cattaraugus, Livingston, Ontario, Orleans, Yates, Schuyler and Seneca. There are thirteen counties which have less than four cases. An analysis of 452 cases indicates that 245 are among males and 207 among females. The age distribution indicates that most of the cases have occurred in children under five years of age, 14 under one year of age; 45 one year of age; 97 two years of age; 64 three years of age; 48 four years of age; 40 five years of age. One case was over fifty years of age; I between thirty-six and forty, and 3 between twenty-six and thirty years of age. One hundred and ten of these cases were nonresident and came from New York City. Most of the cases have occurred among families that are in moderate circumstances, only 45 being among the well-to-do. The cases were located, in 69 instances, on premises where the sanitary conditions were excellent; in 262 where the sanitary conditions were good or fair, and in 81 where the conditions were bad. In the majority of instances the previous health of the patient had been excellent. Only a very few had been in poor health previous to the onset of the disease. Associated with these cases were 1,053 children and 1,429 adults. The cases occurred in American families in 248 instances; in Italian 43, and in Polish 28. Symptoms of high fever occurred in 177 instances, a moderate fever in 193. Fever was not observed in a few cases. Severe headache was complained of in 103 cases and moderate in 72 cases. No headache was observed in 113 cases. Constipation was present in 238 cases. Vomiting was noted in 159 cases. Pain in the affected limbs was reported in 242 cases. There was noted stiffness of the neck or retraction of the head in 167 cases. Restlessness was reported in 271 cases; drowsiness in 225. Paralysis began for the most part before the fifth day of the disease. It was observed on the first day in 79 cases; second day in 100 cases; third day in 53 cases; fourth day in 43 cases; fifth day in 19 cases; on the twentieth day in I case. Among the 452 cases which this study covers were 67 cases which had associated definitely with other cases. Twenty-six of these cases were secondary in the same family. Cases of Poliomyelitis in New York State, according to Weeks, (Exclusive of New York City) MUNICIPALITY Albany county: Village of Ravena Chenango county: Town of New Berlin.. Town of Norwich.. Columbia county: Town of Austerlitz. |