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3 LABORATORY FACILITIES, ETC.-continued

Distribution, therapeutic outfits:

Antitoxins, diphtheria and tetanus, 10

Serums, antimeningococcus, antipneumococcus, 5
Vaccines:
Typhoid, pertussis, smallpox, rabies, silver nitrate

solution (ophthalmia neonatorum), 10
Miscellaneous, 5
Local laboratory (approved by State Health Com-

missioner).

Total...

4 MEDICAL INSPECTION OF SCHOOL CHILDREN
(a) Physician (full time, 1 to 6000 children or equivalent)

(half time, allow 8; less than half time in proportion)
(b) Nurse (full time, 1 to 3000 children, or equivalent).

Nurse (full time, 1 to 6000 children, or part time, 1 to

3000 children, allow 15)
(c) Effective“ follow up ” system.
(d) Provision for isolation of sick children before each

daily assembly of school..
(e) Medical clinic, including care of eye, ear, nose and

throat, teeth, orthopedic work, etc.
(f) Open air school, special provision for crippled children,

mental defectives or other like activity..

Total...

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5 INFANT AND MATERNAL WELFARE WORK

(a) Infant welfare station for each 25,000 people
(b) Nurse, full time, each station.
(c) Physician in charge.
Cities under 25,000 population, full credit for a, band

c if public health nurse gives one-third time to in

fant and maternal welfare work
(d) Little Mothers' League, one for each 25,000 popula-

tion.
(e) Day nursery

Total..

6 MILK AND FOOD INSPECTION
(a) One full-time inspector for each 150 dairies (propor-

tional time for less than 150 dairies).
(b) One inspector is a veterinarian..
(c) Inspections made quarterly (semi-annually, allow 5).
(d) All milk, certified, or Grade A,

or

Certified with Grades A and B, bottled and pas

teurized.
Grade B, bottled and pasteurized, allow 20

Grade B, bottled and not pasteurized, allow 10
(e) Regular inspection of meat and other foods..
(f) All foods exposed for sale adequately protected from

dust and flies. ...

Total.

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7 WATER SUPPLY
(a) Supply ample

From springs and wells not subject to pollution.

or

Any proper source with efficient filtration and

chlorination
Any proper source with efficient filtration or

chlorination, allow 20
(b) No auxiliary pipe lines from source open to pollution

(for temporary use).
(c) Adequate patrol and protection of watershed.

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8 SEWAGE, GARBAGE AND MANURE (a) Sewage.

City completely sewered, allow 20; one-half

sewered, allow 10
No outside privies or cesspools, allow 10
Sewage treated so that bacterial content is reduced

95 per cent, allow 10
Sewage treated so that bacterial content is reduced

75 per cent, allow 5
(b) Garbage

Collection
Efficient

(1) Municipal, allow 12

(2) Licensed collectors, allow 8
Disposal
(By reduction, incineration, burial or piggery)
Efficient

(3) Municipal, allow 8

(4) Private, allow 4 (c) Manure.

Collection weekly during summer months and fly

breeding prevented by use of insecticides or other-
wise

Total.

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RECORD KEEPING

(a) Ample stenographic and clerical force..
(b) Efficient system of records (for statistical purposes)..
(c) System of recording or charting so that the following

special information is immediately available.
1 Number and location of cases of communicable)

diseases
2 The establishment and termination of quarantine
3 The location of cases on milk routes
4 The number of secondary cases
5 Complete record of complaints of nuisances re-

ceived and action taken
(d) Effective measures in use to insure complete registra-

tion of births and deaths..

otal.

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10 PUBLIC HEALTH EDUCATION
(a) Distribution of public health literature.

1 Homes of newborn
2 Infant welfare stations
3 Through organizations and meetings

4 Homes of cases of communicable diseases, etc.
(b) Public health lectures (12) annually under lay or

'Health Department auspices.
(c) Exhibits (2).
(d) Public health newspaper article of local interest

weekly..
(e) At least one newspaper actively cooperating with

Health Department.
(f) At least one lay organization cooperating with Health

Department.
(g) Clean-up week campaign or other equivalent educa-

tional activity.

10

15

20

15

10

Total...

103

100

11 APPROPRIATION FOR PUBLIC HEALTH FUND.

50 cents per capita or over, allow 100
Allow 2 points for each cent per capita appropriated below

50 cents

Total...

100

12 EFFICIENT ENFORCEMENT OF REGULATIONS RELATIVE TO

BARBER SHOPS, COMMON TOWELS AND DRINKING AND
EATING UTENSILS.

20

Total.

20

13 SPECIAL PUBLIC HEALTH WORK OF VALUE ALONG New

OR UNUSUAL LINES OR SPECIALLY EFFICIENT AND
UNUSUAL RESULTS WITH OLD METHODS ADD POINTS
UP TO..
(Example:- Control of venereal diseases; hospital facili-

ties; dispensary; effective follow-up system)

35

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Copies of the score cards have been sent to the sanitary supervisors, with the request that scores be made by city health officers and their sanitary supervisors, acting jointly.

While the score system is still experimental and while without doubt its continued application will result in desirable changes being suggested, the interest it has already aroused indicates that it will have a marked influence in stimulating local health activities in New York State cities.

Communicable diseases

GENERAL ACTIVITIES

On March 13, Dr. Meader, Director of the Division, addressed the Women's Club of Sidney on " Simple Methods of Controlling Communicable Diseases.” On April 1 and 15 he attended meetings in New York City of a committee, of which he was a member, appointed by the American Public Health Issociation to formulate minimum measures for the control of communicable diseases. A report of this committee was adopted by the American Public Health Association at its meeting at Washington in October. On April 20, Dr. Meader attended a meeting of the American Statistical Association held in Ner York city. It this meeting changes to be suggested in the 1920 Census were discusserl. On April 24 he presented a paper on “Diphtheria in New York State" at the meeting of the State Medical Society, at Utica. On April 27 he attended a meeting called by the Surgeon General of the Public Health Service for the discussion of public health problems. On June 1 the present acting Director assumed charge of the Division.

In October the acting Director attended the meeting of the American Public Health Association at Washington. On December 11 he addressed the Chautauqua County Medical Society, at Jamestown, on “The Control of Venereal Disease."

During the year certain of the Department's communicable disease circulars have been revised and a new circular, a copr of which follows, has been prepared upon epidemic cerebrospinal meningitis.

EPIDEMIC CEREBROSPINAL MENINGITIS

General statement

Epidemic cerebrospinal meningitis is an acute communicable disease characterized by inflammation of the meninges (covering membranes) of the brain and spinal cord. The organism which is the inciting agent of the disease, the meningococcus, enters the brain and spinal cord through the nose and throat. It is usually present in the secretions of the nose and throat of those suffering from the disease or recently recovered from it and frequently in the nose and throat of those who have been in contact with cases. It is present in the spinal fluid of those who have the disease, and is discovered upon microscopical examination of specintens of spinal fluid withdrawn by lumbar puncture.

A person who has been closely associated with one ill with the disease may acquire the germs in his own nose and throat without himself contracting the disease, thereby becoming a carrier.” It is possible for one to become a carrier from contact with another carrier.

The disease is communicated from one person to another through transfer of the discharges from the nose and throat of cases and carriers. The carrier, if undiscovered, continues to mingle with others as usual, and for this reason is a greater source of danger than one who is actually ill.

Children are most susceptible to infection, resistance increasing gradually up to middle life. Adults are equally liable to become carriers.

Overcrowding or close contact greatly favors the spread of epidemic meningitis, owing to the greater likelihood of the transfer of secretions from one person to another under these conditions. On this account it is apt to be prevalent in military camps, where men are brought together in large numbers from widely separated localities, in some of which the disease prevails.

The disease is treated by the injection of antimeningococcus serum which is most effective when administered early, and becomes less effective with each day's delay. In most cases an early diagnosis can be made only through examination of the spinal fluid. An excessive amount of fluid is frequently present, and the mere withdrawal of fluid may gire immediate temporary relief from severe headache or other so-called pressure symptoms. If the attending physician suggests lumbar puncture, therefore, this should be done promptly.

Diagnosis and treatment

The onset of cerebrospinal meningitis may be gradual or abrupt depending upon the virulence of the infective agent. Severe headache, associated with an elevation of temperature, is usually present. Frequently early in the disease an eruption appears. Vomiting, rigidity, and pain in the neck, retraction of the head, stupor or delirium, or Kernig's sign, are common. The pulse is apt to be relatively slow and in the later stages irregular while the pupils may be dilated after the first stage. Muscular twitchings or rigidity, convulsions, strabismus, and paralysis of facial muscles are among the symptoms which may appear.

Diagnosis is usually difficult and at times impossible without resort to laboratory aid. Meningeal symptoms associated with epidemic poliomyelitis

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