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so called “boiler plate” has been sent to such papers as indicated their desire for the service.

Exhibits

Owing to the special importance of disseminating information regarding food, its nutritive values, and how food and health could both be conserved by wise selection and proper cooking, the food exhibit has been given first place in the attention of the supervisor of exhibits. This exhibit has been shown at all the county fairs held in the State and at all principal towns along the main line of the New York Central railroad, and will eventually be shown over the entire State. It is accompanied by two members of the staff who give public lectures in connection with the exhibit.

The Child Welfare exhibit has been shown in 11 places, the miniature traveling exhibits in 76 public libraries and the moving picture health plans in 40 towns and villages. Lantern slide lectures have been given in 39 towns and villages.

County Tuberculosis Hospitals

Chapter 469 of the Laws of 1917 made mandatory the erection of a tuberculosis hospital in every county of over 35,000 population, unless already having such a hospital approved by the Commissioner of Health. In all twenty counties were affected.

The law imposed on the State Department of Health, in conjunction with the health officer, the duty of approving the sites offered by the town supervisors. The plans for the building and the equipment to be provided are likewise subject to the approval of the Department. In order to aid the supervisors, who for the most part were unfamiliar with the matter, it was necessary to hold numerous interviews with such local county authorities. As a further aid to them, a printed circular was issued by the Department indicating the essential features of hospital sites, The Supervisor of Tuberculosis, in conjunction with the Engineering Division, made preliminary informal inspections of numerous sites in many counties, in some instances over 20 sites being appraised for this purpose in a single county. A total of 100 sites in thirteen counties has been inspected. (See report of Engineering Division.)

The approval of plans for these hospitals has been facilitated by the appointment of an architect by the Department, who has been in constant conference with the members of building committees of the boards of supervisors, and with architects employed by them, and who has prepared plans for tuberculosis hospitals of various capacities as a guide. Inspections of hospitals in course of construction have been inaugurated.

Action has been taken by all of the twenty counties affected by the law, either by the appointment of supervisors’ special committees, by the selection of sites, by the acquisition of sites already approved, by negotiating with architects, or by the letting of contracts. The Department has inspected sites in all of the twenty counties affected, with the exception of Sullivan and Washington, which counties have appointed site committees.

Site hearings have been held in thirteen counties, eleven sites being approved and two disapproved.

Plans are being prepared or considered in six counties, and have been approved in five others in four of which construction is already under way.

The tuberculosis committee appointed by the commissioner in July has held frequent meetings, at which the situation in various counties affected by this law has been carefully considered, action decided upon, and a Statewide program adopted for the coming year.

Poliomyelitis After-Care Clinics

The first series of after-care clinics, started during 1916, was continued during the early part of 1917 under the oversight of Dr. Robert Lovett and two assistants. In all 1,427 new and 315 old cases were examined and treatment prescribed. Early in the year field nurses were assigned to districts and the follow-up of the clinics was begun, the work being carried on entirely by the field nurses in their districts, assisted by two muscle testers.

The second series of clinics was started with two units and later reduced to one. In this series 858 patients were re-examined and 743 new patients were seen. Altogether a total of 3,379 individual examinations were made.

During these two series 178 pieces of apparatus were purchased by the patients or their families, or provided through the State Charities Aid Association, which has rendered most valuable assistance throughout the year in carrying on the after-care work. In some of the smaller and more compact districts all of the patients seen at the clinics were visited several times by the nurse during this period; in the larger and more scattered districts less frequent visits were the rule. On July 1, Dr. Le Roy Hubbard was appointed orthopedic surgeon. His duties consisted largely in visiting the different districts to assist the field nurses, in examining patients who had never been to a clinic but needed treatment, and in taking measurements for new apparatus or modifying the clinic instructions. During these three months practically the whole State was covered and more than 200 patients seen.

In October the third series of clinics was started, the unit consisting of the orthopedic surgeon, an executive nurse, a chief

examiner, and two muscle testers who also acted as assistant examiners. Since that date clinics have been held in 38 cities and towns, and 923 patients have been examined. There were 337 pieces of apparatus ordered and 311 pieces delivered during the last series of clinics. The problem of the old cases, most of which had serious deformities requiring operations, was finally solved by referring many of them to the State Hospital for Crippled Children at West Haverstraw, and the Hospital for Ruptured and Crippled in New York City. The results of these operations have been most gratifying. Many patients who had not walked for years are now able to walk with the aid of braces and crutches and are thus permitted to attend school or partially to earn a living. Other old and neglected cases, not so serious, have been made more comfortable by the application of proper braces and shoes. It is safe to state that at least 75 per cent of the 1916 cases could not, for financial or geographical reasons, have received expert orthopedic treatment and care unless the State had brought it to them. Without such treatment the ultimate result would have been deformities or crippling which, in many cases, would have made the individual a charge on his respective community. Of the cases attending clinics regularly, the examinations made

during the last series showed 82 per cent recovered or materially improved.

The constant and regular supervision by the field nurse has prevented the occurrence of permanent deformities and contractions, as they were discovered early when they could be easily corrected, thus preventing serious and extensive operations.

The same kind of work and supervision should go on, or what has been done in many cases will be rendered useless. Babies are now reaching the walking age and must be assisted; children who are wearing braces are growing, and the apparatus must be lengthened or modified in order to be efficient. The critical period is when improvement begins and the child is allowed, and perhaps encouraged, to overexercise the weakened muscles and nerve cells. The parents become discouraged unless there are frequent visits from the nurse, and an opportunity is given to attend clinics and to learn the condition of the child by re-examinations and the comparison of records. The State Hospital, with its limited capacity, can not take care of all the patients needing treatment. Unless the home treatment is continued, many will lose what they have gained or grow worse.

Bureau of Habit-forming Drugs

Following the report of the Special Joint Legislative Committee to investigate habit-forming drugs, the Legislature of 1917 enacted a bill generally amending the public health law in reference to the sale and use of such narcotics. To meet the requirements of this law, the Department organized the Bureau of HabitForming Drugs. On June 28, 1917, the Bureau sent out to wholesale and retail druggists, physicians, dentists and veterinarians over 27,000 letters enclosing the necessary forms and blanks for registry and for inventory of habit-forming drugs in stock as of July 1, 1917, following these later with the same number of copies of the law. Since that date there have been filed 16,200 applications and inventories. The same number of official registry numbers have been assigned and books of 50 official order blanks issued in triplicate to each purchaser bearing his name on each blank.

The law states that the triplicate copy of each order for drugs must be “forthwith ” filed with the State Department of Health, except in cities of the first class — New York, Buffalo and

Rochester. (In these cities the copies must be filed with the local departments of health.) About 10,000 of these copies have been received in the last four months and filed by the Bureau. A file is also kept of all physicians and institutions reporting treatment of addicts, with a separate file of all addicts so reported. That all physicians, dentists, veterinarians and druggists have not fully understood the necessity of filing applications and inventories is evidenced by the continued daily receipt of requests for forms and blanks. Under the provisions of the law the Commissioner of Health has adopted rules and regulations governing the dispensing of habit-forming drugs by local health boards.

Public Health Nursing

During the past year the State has been divided into thirteen districts, each in charge of a public health nurse and a nurse trained in the after-care of infantile paralysis. The nurses, working in cooperation with the sanitary supervisors of their respective districts, have investigated 49 outbreaks of communicable disease, have made tuberculosis surveys of five different counties, and have conducted child welfare exhibit in 16 different municipalities, at which addresses were made by these nurses on the subject of child welfare. Little Mothers' Leagues were formed by nurses in ten municipalities, making a total of 18 leagues now established in the State, having a total membership of 486. In addition, the registration of births has been investigated in 17 municipalities in the State and rural health surveys have been conducted in 15 others. A rural obstetric investigation was made in Dutchess County. Two nurses have been in attendance upon the food exhibits shown in 25 municipalities during the summer and fall. One of these nurses has continued with a traveling exhibit, giving talks and exhibits daily, visiting a different municipality each week. The after-care nurses in charge of their respective districts have an average of 293 poliomyelitis cases to visit for instruction in muscle training, adjustment of braces, and application of plaster. In addition 72 of these patients have been brought to hospitals

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