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for operations for the correction of deformities as a result of the after effects of the disease. These supervising after-care nurses also secured the attendance at clinics of all cases in need of further examination by the orthopedic surgeons of the Department. One of the nurses has been permanently assigned to the supervision of midwives and has arranged for classes of instruction to be conducted for the proper training of all midwives in the State. Midwife prosecutions have been conducted in two municipalities. The Department contemplates, during the coming year, the holding of a series of tuberculosis clinics throughout the State, in order to render assistance to local physicians in the early diagnosis of their cases and to afford them access to the newer methods of diagnosis and treatment. The State supervising nurses will cooperate with the physicians in securing the attendance of their patients at these clinics, when physicians desire it, and will also maintain a proper system of follow-up of the cases in their homes.

Consolidated Health Districts

During the year 11 health districts have been consolidated through the efforts of the Department. By such consolidation, it is possible to secure greater coordination and also greater efficiency. A total of 1,449 health districts in the State are now represented by 1,076 health officers. Seventy-seven districts have the question under advisement.

Hearings It becomes necessary from time to time for the Commissioner or Deputy to hold quasi-judicial hearings on violations of the sanitary code, the pollution of streams, etc., under powers conferred on them by the public health law. Forty-five such hearings have been held during the year.

Venereal Diseases In years past, progress in preventing venereal disease has been unsatisfactory, owing to the general feeling that the subject should not be publicly discussed. This attitude has been gradually changing, until now, with the startling disclosures of the selective draft, the public is in a receptive state. At the suggestion of the Commissioner, a committee on venereal disease, composed of certain of the administrative officers, was appointed in August. It was decided that the most effective method of making progress would be by the means of education and treatment. With this in view an active campaign of education was instituted, directed toward the medical profession and the public by means of addresses before medical societies, mass meetings, etc. Venereal disease clinics have been started in three cities. Lecture material has been collected for the use of health officers and others. Several thousand copies of the pamphlet “Over the Top ’’ were sent to the various exemption boards throughout the State and distributed by them to the men appearing before them. Venereal disease circulars have been widely distributed. Placards calling attention to venereal diseases have been ordered and will be put up in various public places. Also placards have been furnished mar. riage license clerks throughout the State, calling attention to the amendment to the Marriage Relation Law. A series of six newspaper articles on social hygiene has been published by over 300 newspapers in the State.

Courses in Public Health

Over one-third of the health officers of the State have completed or are now taking one of the courses in public health offered by four of the universities. As a certificate in public health is now prerequisite for appointment, this number should be materially increased by the end of another year. As a factor in increasing efficiency and enthusiasm this requirement can not be overestimated.

Routine Matters

The general routine clerical work of the Department is under the supervision of the Executive Clerk who also is in charge of the nontechnical employes. The Executive Clerk also audits the accounts of the Department.

The constant increase in the routine work of the Department is evident from the following table:

Mail Record

INCREASE IN ACTIVITIES OF THE DEPARTMENT SINCE THE REORGANIZATION IN 1913 As SHowN BY THE FOLLOWING

TABLE.
Mail received 1913. 1914 1915 1916 1917

First class mail —pieces. 56,624 80, 837 113, 907 138, 373 16.2, 381

Reports from local registrars . . . . . . . . . . . . . . . 15, 630 17, 150 17, 273 18, 7.59 17, 513

Reports from local health officers . . . . . . . . . . . . . 15, 575 15, 897 21, 206 24, 602 19, 118 87, 829 113, 884 152, 386 181, 734 199,012

Shipments First class . . . . . . . . . . . . 77, 182 120, 550 174,206 184, 860 226, 889 Second class ... . . . . . . . . . 119, 263 206, 745 302, 885 468,060 479,395 196, 445 327, 295 477,091 652, 920 706, 284 Receipts

Increase — 1914 over 1913 — 26,055 pieces, or 30 per cent.

Increase — 1915 over 1914 – 38,502 pieces,
Increase — 1916 over 1915 – 29,348 pieces,
Increase – 1917 over 1916 — 17,278 pieces,
Increase — 1917 over 1913 — 111,183 pieces,

Shipments
Increase — 1914 over 1913 — 130,850 pieces,
Increase — 1915 over 1914 — 149,796 pieces,
Increase — 1916 over 1915 — 171,752 pieces,
Increase — 1917 over 1916 – 53,364 pieces,
Increase — 1917 over 1913 – 509,839 pieces,

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Division of Communicable Diseases

During 1917 the supervision of the activities of the staff of district sanitary supervisors has devolved upon the Director of the Division of Communicable Diseases, as has also the custody and supervision of the monthly reports of the 1,076 local health officers. The numerous routine duties resulting have necessitated curtailment of some of the intensive work which might otherwise have been done in connection with the study and control of communicable diseases.

In June Dr. Fred. M. Meader, Director of the Division, was called into military service as a captain in the Medical Officers Reserve Corps, and Dr. Paul B. Brooks, of Norwich, N. Y., Sanitary Supervisor, was appointed acting director. A number of temporary changes, largely incidental to the war, have also occurred in the staff of sanitary supervisors. During the year two epidemiologists have been appointed and have already rendered valuable service.

Activities of Sanitary Supervisors

During the widespread epidemic of poliomyelitis in 1916 there was for the first time a general appreciation of the advantage of having a corps of trained sanitary officers stationed throughout the State. During 1917 the field staff has rendered no less effective, if somewhat less conspicuous, service. In numerous other instances the efforts of sanitary supervisors, at times assisted or directed by epidemiologists, have contributed materially to the control or suppression of outbreaks of communicable disease. One instance is worthy of mention: In a municipality in which an outbreak of typhoid fever occurred, the health officer himself was found ill with the disease, and the other local physicians were either in military service or incapacitated. The sanitary supervisor discovered the source of infection and brought the outbreak under control. While so engaged he acted for the health officer, investigated several other outbreaks in the vicinity—one in an institution for children — and on several occasions acted as medical attendant in emergencies, in one of which he spent the night attending a maternity case.

With the present number of sanitary supervisors the average number of local health units in each district is eighty. The average population of each sanitary district is 316,200, and each has approximately seventy-two health officers. Several of the supervisors are required to cover districts of not less than 360 square miles.

During 1917 the supervisors have investigated 832 outbreaks of communicable disease, have advised or assisted local health officers in 3,980 instances, have given 389 addresses on subjects pertaining to public health, have met with 361 local boards of health and held 12 district conferences of health officers, while the records of their activities show innumerable other important duties performed. The constant and increasing demand on the part of local health officials for advice and assistance from their sanitary supervisors indicates in some degree the value of the service rendered. On the other hand, opportunity for frequent association with skilled sanitarians is having an appreciable influence in improving the standards maintained by local health officers.

During the year several of the supervisors have served as members of or medical examinel's for local selection boards. Several have also served upon State advisory committees for the consideration of special phases of public health work. In this connection those supervisors who have evinced particular interest and ability in certain fields of public health activity are being encouraged to develop such special talents to the greatest possible degree. Thus the State is in a position, when occasion requires, to furnish highly specialized service in the field.

Communicable Disease Control

During the year the frequent changes in local health officers, the establishment of army camps and movement of large bodies of men, changes in the Department’s field staff, and other conditions incidental to the war, have given rise to new problems and have made the control of communicable diseases particularly difficult.

Not only have outbreaks of typhoid fever been investigated and controlled, but, so far as practicable, individual cases have been investigated with a view to determining and eliminating sources of infection. A special effort has also been made to encourage local health officers to investigate such cases, and where necessary they have been instructed in epidemiological pro

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