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cedures in connection with this and other prevailing communicable diseases. Both upstate and in the State as a whole fewer cases of typhoid fever were reported than in 1916. As compared with 1916, the death rate from this disease declined 0.3 per 100,000, while there was a decline of 4.9, or 46.7 per cent,

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vv. 14'E, The number of deaths from pneumonia following measles reported of late in military encampments has drawn popular attention to the seriousness of measles, a disease which can be combatted only through prompt and well-directed efforts. While there has been a decline in the number of cases reported and in the death rate, as compared with 1916 and with the preceding five-year period, it is felt that there is urgent need of more aggressive efforts to control this disease. Compared with the same five-year period, Scarlet fever shows a decline in death rate of 5.5, or 68.9 per cent, and diphtheria of 2.4, or 12.6 per cent. Poliomyelitis (infantile paralysis) shows a decline of .3, or 25 per cent over this period, but one of 32.5 per 100,000 over 1916. Whooping cough shows a slight decline in the number of cases reported, but a small increase in the death rate, which suggests the probability of unreported cases which should enter into the computation. Epidemic cerebrospinal meningitis shows an increased number of reported cases and deaths as compared with 1916, but a decrease as compared with the preceding five years. This disease is one peculiarly prevalent in military camps. During the year there has been a slight increase in the number of cases of baciliary dysentery recorded, accounted for by stimulation of reporting, resulting from an intensive investigation of outbreaks in several municipalities. The prevalence of smallpox, chiefly in two large and several small outbreaks, has drawn attention again to the danger of neglecting general vaccination. These outbreaks have been controlled through united and vigorous efforts on the part of State and local health officials to encourage vaccination and to locate and quarantine or vaccinate all exposed persons. During the year 316 cases of smallpox were reported. As usual the number of cases occurring among successfully vaccinated persons has been negligible. Realizing that opposition to vaccination has largely resulted from careless and unscientific methods, a definite procedure has been recommended, and physicians urged not only to adhere to it closely, but to maintain proper care and Supervision of vaccinated persons. During the year several of the Department’s communicable disease circulars have been revised, and a new circular prepared upon epidemic cerebrospinal meningitis. Syphilis, chancroid and gonorrhea are now included in the list of officially recognized communicable diseases, and circulars of instruction regarding these diseases are available for distribution by physicians. Through the inclusion of venereal diseases in the list of those which are communicable, it is now possible for health officers to control dangerous or negligent cases.

Division of Child Hygiene

During the first half of the year, child welfare campaigns were carried on in eighteen different localities, principally in Chautauqua and Niagara counties, where it was felt that the work was most urgently needed. Exhibits illustrating all phases of child welfare work were shown during the year in seventeen municipalities. A trained child welfare nurse was in daily attendance at the exhibits to explain to visitors the nature and purpose of each feature of the work. In conection with the exhibits, talks on child welfare were given daily by Dr. H. L. K. Shaw, Director of the Division, Dr. Edward Clark, then Sanitary Supervisor, or Mr. T. B. Peck, Supervisor of Exhibits.

During the year the so-called “Parcels Post” exhibits, consisting of a series of small panels illustrating child welfare work were placed on exhibition in a number of public libraries in the State. Another means of securing publicity has been through the distribution of child welfare pamphlets, posters, window cards, etc.

In the latter part of July, Dr. Shaw, Director of the Division, was called into military service, and Dr. Edward Clark, of Buffalo, one of the Sanitary Supervisors, was appointed acting director. Shortly after Dr. Clark took over the work the commissioner determined to have a series of food exhibits throughout

the State. These were shown at county fairs and in a large number of cities and towns, the acting director being assigned as one of the lecturers. One hundred and forty-six addresses were given by him at fairs, schools, clubs, boards of trade, etc., in thirtyfour different cities and towns. In connection with each lecture on food, a talk was also given by him on some phase of child welfare work. In addition to the above addresses, four talks exclusively on child hygiene, two on poliomyelitis and five on tuberculosis were given. During 1917 infant welfare stations have been established in Lackawanna, Dunkirk and Niagara Falls. Seventy-one infant welfare stations were in operation in different cities and towns during the whole or part of the year.

Total number of babies reported at stations. . . . . . . . . . 56,886 Total attendance at clinics . . . . . . . . . . . . . . . . . . . . . . . 27,763 Total number of babies examined. . . . . . . . . . . . . . . . . . 9,141 Total number nursing visits . . . . . . . . . . . . . . . . . . . . . . 73,196 Total number of stations reporting. . . . . . . . . . . . . . . . . 43

The work of supervising and organizing Little Mothers' Leagues was kept up during the year, with the result that new leagues were established in eight municipalities. These new leagues have a membership of four hundred and eighty-six. Iantern slide exhibits illustrating various phases of child welfare work were given at thirty-nine different places. A few years ago the Department established the custom of sending to each mother in the State, as soon as the birth certificate of her baby was received in the Department, a copy of the Department’s booklet, “Your Baby. How to Keep it Well.” This custom has been continued during the past year, and over 104,000 of these booklets have been sent out. In addition, approximately 250,000 child welfare leaflets and pamphlets have been distributed throughout the State. During the first week of May, a State Child Welfare day was observed generally, and letters were sent to clergymen, women’s clubs, etc., urging them to cooperate in making this day a success. Letters were sent out to the number of approximately 2,000 in answer to inquiries regarding matters pertaining to the work

of the division. Many of these letters were sent to different States in the Union and to foreign countries, in reply to requests for information as to the work of this division, and for Child Welfare pamphlets and circulars issued by the Department.

The infant mortality statistics for the years 1916 and 1917 are as follows:

Infant mor

Year Births Death tality rate 1916 . . . . . . . . . . . . . . . . . . . . 103,530 9,912 96.

1917 . . . . . . . . . . . . . . . . . . . . 104,200 9,846 94.

The infant mortality rate for 1917–94—is the lowest in the history of the State. In estimating this rate, New York City, of course, is excluded.

Division of Laboratories and Research

The work of the laboratory during the year 1917 has continued to increase with scarcely any interruption. With the declaration of war and the support of the Adjutant General’s special fund for preparatory service, the work was extended in scope and new branches of activity were taken up. Thus the most striking features of the work during 1917 are the phenomenal growth of the diagnostic service, together with the increased distribution of antitoxins, serums, and vaccines, and the expansion of the work for the purpose of meeting emergencies likely to arise in connection with the war situation.

Physicians and health officers demand each year the examination of an increasing number of specimens such as have hitherto been handled by the laboratory and also the examination of specimens of a kind not previously undertaken, thus adding not only to the volume of the work of bacterial diagnosis, but also to the scope. The growth of the Wassermann work has exceeded all expectations. Each year the number of specimens has nearly doubled. Requests have been received for complement fixation diagnosis of tuberculosis, and other laboratories have undertaken the work. An investigation of these methods is now in progress to determine the practicability of this method as a routine procedure.

The distribution of diphtheria and tetanus antitoxins alone has increased 13 per cent, whereas the distribution of serums used in the treatment of pneumonia, meningitis and dysentery has increased 410 per cent. Considerable progress was made during the summer in improving the methods of preparing pure smallpox vaccine by the method of Noguchi, but owing to the pressure of work and lack of appropriations it was necessary to discontinue it. However, at no time in these investigations were results secured which would warrant the general distribution of the vaccine because it invariably failed to maintain as uniform a degree of potency as the standard calf vaccine. The laboratory, however, has been exceedingly fortunate in producing antimeningococcus and antipneumococcus serums of high potency. An investigation of many commercial serums sold in the State revealed the fact that many of them lacked potency, and to such an extent that it became necessary to request the recall of these serums from the State. The Public Health Council found it necessary to pass a regulation requiring the serums offered for sale in the State to exceed minimum standards of potency. The expansion of the work in preparation for emergencies likely to arise in connection with the war situation comprised the organization of a mobile laboratory adapted for service in almost any emergency. This unit was nearly completed when the appropriations for this purpose were exhausted. Owing to the great difficulty of securing salvarsan and similar products the attempt was made to prepare it in the laboratory. Considerable progress has been made, but there is some question whether it will be possible to complete the last stages with the present laboratory facilities. To meet any large demands for antitoxins, serums and vaccines immediately after war was declared, the production and reserve supply of these products was enormously increased as far as was possible with present facilities. This was done in order to serve the National Guard and the camps where large numbers of men were to be concentrated. Although no serious outbreaks or epidemics occurred in connection with the mobilization of troops

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