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installation of the Department’s emergency chlorine apparatus and to assist in such work in eight municipalities. In One case where a considerably increased number of cases of typhoid fever were occurring, it was necessary for extensive detailed Supervision to be given by the division to the operation of the chlorine apparatus, in order to sterilize the water supply which was found to be contaminated. This supervision continued over a period of two months pending the introduction of a new water supply and required daily visits to the municipality. Other special work carried on by the division during the year has consisted in cooperation with the State Architect and State Engineer in determining upon feasible plans for water supply and sewage disposal for state institutions, including those at Wingdale, the Marcy Division of the Utica State Hospital, Kings Park, the Creedmoor Division of the Brooklyn State Hospital and at various other state institutions. This work has also involved numerous conferences with reference to estimates of appropriations needed to carry out the work. During the year also the services of a temporary inspector employed in the Department were loaned to the Lake George Association for a period of eight weeks during which time a detailed sanitary survey of some 500 properties adjoining and adjacent to the lake were made. Another special line of work carried on during the year has been in reference to sites for county tuberculosis hospitals. In order to expedite the work of establishing these hospitals in counties having populations of over 35,000, inspections have been carried on by the Engineering Division, under arrangements made for such cooperation, covering 100 possible sites for hospitals in thirteen counties; the work of the Division relating to the provision for adequate water supplies of satisfactory sanitary quality and the question of proper disposal of sewage at the sites under consideration. Attention is again called to the serious handicapping of the work of the Division on account of the inconsistencies, ambiguities and deficiencies in existing laws which limit the effective work which might be done in improving the sanitary quality of public water supplies and in the removal of stream pollution. Legislation, which has been asked for in the past two sessions of the legislature, but not passed, is greatly needed to accomplish more effective results in these lines of work. It is expected that bills will be again introduced in the legislature during the present session looking toward a more rational and effective basis of control by the State Department of Health.

Division of Vital Statistics

The improvement of the fundamental data upon which death and birth rates are based is necessary to real progress in the vital statistics field. Such advance is dependent not only upon more comprehensive population statistics, but also upon better and more complete birth and death records. Progress in the latter respect was systematically promoted throughout the year 1917, and studies have been made for improved statistical tables. Birth registration has been given special attention.

Such efforts are an essential preliminary to any experiment in the deduction and transfer of nonresident deaths. On July 1, 1916, a very important beginning was made by the establishment of separate registration districts for certain state institutions and the separate tabulation of their returns. During 1918, this experiment will be extended, if possible, to include all primary districts. If this can be done comprehensively, and without disturbing comparability of future tables with those of former years, the correction will improve the practical value of the rate of various large communities, which are now obscured by reason of many deaths of nonresidents.

The supervision of midwives, including the issuing of midwives’ licenses, has been transferred to the Vital Statistics Division during the past year. Systematic steps were taken to bring about the discovery and registration of unlicensed midwives. A beginning was made in the carrying out of a statewide plan for courses of instruction for midwives in the larger communities, by cooperation between the sanitary supervisors, local health officers, and nurses — the detailed field work being conducted by a special nurse from the Division’s staff. This method should result during 1918 in marked improvement in the standards of practice among midwives. It will greatly enhance the value of oversight by the state and local health authorities, and practically eliminate the unlicensed midwife.

The Division has regularly pursued a policy of issuing carefully prepared monthly press statements on subjects of practical importance disclosed by the monthly statistical analyses. The value and interest of these have been apparent as shown by the very extensive space allotted by the newspapers. The direct result has been to make the analyses of birth and death return of practical educational value to the public. Original statistical studies, including a new table for special use in infant mortality work, have been undertaken by the Division’s staff, and these will be available for publication during 1918. Numerous details of the Division’s organization and procedure have been improved, which have increased the accuracy of its work and greatly facilitated its service. Close cooperation and cordial relationship have been promoted between the Division and the many local registrars and deputies which has resulted in good team work and a splendid morale. The Division extends to them its compliments and gratitude for the very efficient manner in which they have cooperated and performed their duties as a group of public health workers.

Mortality review of the year 1917

The year 1917 was marked in New York State by excessive mortalities from a number of important causes, notably by an unusual prevalence of pneumonia during the winter and spring; by a period of excessive heat in midsummer; a decided increase in the number of fatalities from accidental causes; and by a generally increasing mortality from the degenerative conditions of adult life, particularly the diseases of the heart and kidneys.

Despite these excesses, however, the reductions achieved in the more preventable diseases against which public health efforts have in the main been directed — infantile diarrhea, the common infectious diseases, typhoid fever and tuberculosis — have resulted in a general death rate for the State as a whole, during 1917, of 14.6 per 1,000 persons living. This compares favorably with the death rate of 1916 (14.7), and the average for the preceding five-year period (14.9). It is only slightly higher than the 1915 death rate (14.5), which was the lowest in the history of the State. 2

REPORT OF PUBLIC HEALTH COUNCIL

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