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At present the allowance for expense for clerical and stenographic service is such that it is only possible for a supervisor to employ a clerk or stenographer for a few hours weekly and in many instances it is extremely difficult to secure such temporary services. We are of the opinion that to make it possible for each supervisor to employ a permanent clerk and stenographer would contribute materially to the latitude and effectiveness of the work of the staff of supervisors.

Time spent in "travel” will vary greatly with individual supervisors, depending upon the character and area of district covered. Naturally the amount of time thus spent will be in inverse proportion to the number of supervisors during any period.

While the detailed statistical report required of sanitary supervisors is of distinct value, it is obvious that no such report can indicate clearly all of the important service rendered. Not the least important among the duties of the sanitary supervisor is that of maintaining cordial relations and a spirit of cooperation among the various elements in his district. The skill and tact with which such inconspicuous service is rendered contribute materially to the support accorded to the Department and its activities.

The following field note which appeared in the October number of HEALTII Veis, shows concretely some of the numerous kinds of service which a sanitary supervisor may be called upon to render.

Activities of a sanitary supervisor An outbreak of 21 cases of typhoid fever in the village of Willbrook and town of Washington, Dutchess county, in July, furnished an opportunity for a State sanitary supervisor to do some effective epidemiological work and at the same time to render valuable service to the community. When the call came for assistance, one local plıysician had been called for military duty and the rest, including the health officer, were ill. It was necessary to assign the sanitary supervisor of the district to other important work in the district, and Sanitary Supervisor Ball of Glens Falls was assigned to take charge of the situation. The outbreak was

The outbreak was promptly checked through the discovery of a typhoid carrier on a dairy farm supplying milk for sale, and the pasteurization of the milk supply.

Owing to the lack of physicians, Dr. Ball was given permission to respond to emergency sick calls, and on one occasion, after a busy day, devoted the night to attending a maternity case.

While at Millbrook, the attention of the sanitary supervisor was called to the prevalence of whooping cough in the village. A house-to-house canvass brought to light 72 cases, none of which had been reported. Pertussis vaccine was administered to 135 children and necessary isolation instituted. At about this time the manageinent of Hope Farm, an institution for children at Verbank, reported the existence of 24 cases of whooping cough in the institution. All of the 185 inmates were vaccinated against the disease, isolation established and the outbreak checked.

Dr. Ball was also assigned to inrestigate conditions at the Farm Camp of the East Side Home for Destitute Children, at Sylvan Lake, 16 miles from Millbrook, from which four cases of diphtheria had been reported. Four diphtheria carriers and five scarlet fever cases were discovered and isolated.

In this connection, it has been the constant aim of the Division to respond promptly and cheerfully to all requests for assistance from local officials and in no instance now recalled have we failed to render the service requested. Aside from the relatively small number of such requests which come directly to this office, health officers are constantly calling directly upon their sanitary supervisors for advice and assistance. It is no reflection upon the ability of local health officers, most of whom are busy practitioners, to say that their close association with specialists in health work is contributing materially to the improving standards of local health work.

Acting with the approval of the Department certain of the supervisors are serving as members of or examiners for local selection boards. In this connection, during the closing weeks of 1917 and thereafter, the writer served during evenings, Saturday afternoons and during a vacation period of a week, upon the Albany County Legal Advisory Board.

Several of the supervisors have served during the year upon special committees, reports of which appear elsewhere. In one instance — that of the supervisor made secretary of the Venereal Disease Committee - work in this capacity has required a considerable part of his time.

On two occasions during the year the sanitary supervisors were called to the Albany office for conferences. Such conferences are of great value in that ther offer opportunities for free and “first hand” discussion of field problems, policies and methods of procedure, and might advantageously be held at regular and more frequent intervals.

During the latter part of the year the supervisors met with a large number of local health boards, primarily for the purpose of securing adoption of a uniform sanitary code, but usually taking the opportunity to discuss other matters of importance and mutual interest.

During the winter conferences have been held in most of the sanitary districts. So far as possible a representative of the central office has attended each conference. At most of the later conferences the subject of venereal disease control was discussed. In several instances a stenographer has been furnished, and the detailed record of discussions thus obtained has been interesting and instructive. It is the general feeling among the health officers of the State that these local conferences are of the greatest value.

A special effort has been made to increase the educational work carried on by and at the instigation of the supervisors. А.

Lecture Program " presenting a general outline of several subjects pertaining to public health, has been prepared and multigraphed copies sent to supervisors, with the understanding that it will be sent to others upon request. Of late two subjects, Venereal Diseases and Food Conservation and Health have been especially emphasized. Several county medical societies have been addressed by sanitary supervisors and by the writer, on the subject of control of venereal diseases. The writer feels that an important feature of the campaign against venereal disease is the stimulation of interest on the part of the medical profession.

Special attention has been given to measures for improving “lines of communication” between the sanitary supervisors and this office. For their general information press clippings received at this office and formerly destroyed after having been examined hy directors of divisions, are now collected promptly, sorted, and sent to the various supervisors.

At the last conference of sanitary supervisors methods for keeping them informed as to prevalence of communicable diseases in their districts was discussed. In the past each supervisor has received weekly a sheet for each county in his district, giving the number of cases of each disease in each municipality by approximate dates of onset. For this it was decided to substitute similar weekly reports, but indicating cases by dates reported, thus simplifying the report, reducing the amount of labor involved in this office, and avoiding duplications. A weekly report alone brought information to the supervisors too late to be of practical value. As a temporary expedient to meet the need, a postal card is now sent to each supervisor whenever an unusual prevalence of a communicable disease is noted in any municipality in his

Postal card report sent to Supervisors

FOR YOUR INFORMATION

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cases of have been reported from. within the past

days.

PAUL B. BROOKS, M. D.,
Acting Director, Division of Communicable Diseases.

(listrict. A present "unusual prevalence” is determined arbitrarily depending for its relative accuracy upon the experience and judgment of those under whose surveillance the records pass. Consideration has been given to the idea of formulating a “normal endemic index" for the larger municipalities of the State, based upon morbidity records for each of the more important diseases for a period of several years. After due consideration it is felt that the use of such an index would be impractical and misleading, and even less satisfactory than the present arbitrary method.

Local health activities Local health officers are required by Reg. 7, Chap. VII of the Sanitary Code to file monthly reports with the Department. At present the custody and consideration of these reports rests with this Division, An effort is made, through a series of form letters and other correspondence, to follow up delinquencies. This has been particularly difficult during 1917 owing to frequent and sudden changes in the personnel and the fact that in many instances, health officers are carrying on work formerly divided among two or three practitioners, in addition to their official duties.

In the past, although the Sanitary Code does not exempt city health officers, reports have not been required of them. It is plamed to require such reports, but to provide a special form which can be used also for monthly reports to local departments or officials, a copy being sent to this office. The preparation of such

a form will be deferred, however, pending an opportunity for discussion at a conference of city health officers.

During the year a score sheet for health activities in cities, begun by Dr. Veader, has been completed.

SCORE OF HEALTH ACTIVITIES IN CITIES OF NEW

YORK STATE

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15

15

COMMUNICABLE DISEASES
1 TUBERCULOSIS

(a) Cases reported promptly and immediate action taken
(b) Hospital facilities (city or county). As many beds as

annual deaths from tuberculosis...
(c) Nurse, full time for tuberculosis work in cities of over

25,000 population and one for each 100,000 popula

tion..
(In cities of less than 25,000 population full credit for c

if public health nurse gives one-third time to

tuberculosis work)
(d) Dispensary one in every city of 35,000 and one for

each 100,000 population.

20

10

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10 20

10 20

2 OTHER THAN TUBERCULOSIS

(a) Cases promptly reported and immediate action taken
(b) Efficient investigation and control of cases.
(c) Systematic and effective cooperation between health

and school authorities...
(d) Hospitals or wards for communicable diseases.

One bed for each 2000 population, allowed 20

One bed for each 6000 population, allowed 10
(e) Nurses nurse full time for communicable

diseases for each 25,000 population.
(In cities of less than 25,000 population full credit if

public health nurse is giving one-third time to com-
municable disease work)

one

20

.

Total. ....

80

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3 LABORATORY FACILITIES, LOCAL OR STATE, fully utilized for.

Bacterial examination

Water, 5

Milk, 10
Diagnostic service

Diphtheria, 5
Typhoid fever, 5
Tuberculosis, 5
Pneumonia, 5
Venereal diseases, 10
Miscellaneous, 5

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