His Excellency, CHARLES S. WHITMAN, Governor of the State of New York, Albany, New York:

SIR. The Public Health Council has the honor to submit its fourth annual report covering its work for the year 1917.

As outlined in the reports heretofore made to you, the Council, immediately upon its formation, proceeded to establish sanitary regulations in the form of a sanitary code with the intention of providing for the State of New York a modern, uniform and scientific system of public health law in more detail than was practicable by direct and occasional enactments by the Legislature. The original code was adopted on April 7, 1915. Since then, from time to time, it has become necessary to adapt the code to changing conditions through amendments; to revise its provisions so as to meet the new requirements of science and experience; and to develop such additional safeguards to the public health as seemed urgent and practicable.

During the past year the situation forced by the great war upon this State, as well as upon the rest of the country and the rest of the civilized world, has largely commanded the attention of the Council. The great cantonments established by the Federal Government in the State of New York gave rise to many pressing public health problems with which we had not hitherto been called upon to deal. The health of the inhabitants of the cantonments while within the same is, of course, subject to the control of the Federal military authorities; but the health of the soldiers within these cantonments, as affected by conditions outside the cantonments proper, presents a condition which is peculiarly within the province of the Public Health Council.

The fact that the Council meets frequently and can thus deal with these suddenly arising emergencies, illustrates the wisdom of the Legislature in providing this machinery for the immediate study of new conditions and problems and the establishment of fitting and effective regulations to meet them.

The Council provided for the establishment by the State Commissioner of Health of cantonment zones in the neighborhood of

the great military cantonments of the State and also provided that in these zones no articles of food should be sold or offered for sale except by licensed dealers, it further provided that no person should be licensed unless the local health officer had issued a permit to him which could only be issued after an inspection of the plant which disclosed that sales were conducted under sanitary conditions. This permit may be revoked at any time for cause either by the local health officer or the State Commissioner of Health.

The question of the standardization of antipneumococcus and antimeningococcus serums became especially acute in view of the vast concentration of men within the State of New York. The Council immediately proceeded to provide for the standardization of these serums so that our soldiers, as well as the public at large, would be assured of serums of standard potency and not, as has often been the case, be treated with serums entirely worthless.

The conditions of life in the camps during the Winter conduce to the rapid spread of pneumonia and for this reason the Council amended the sanitary code declaring pneumonia a reportable disease, to the end that its control might be more speedy and effective.

As has been evidenced by many of the reports of the Federal authorities, the question of venereal diseases has become acute. The Council therefore has indicated in the code that venereal diseases are communicable diseases and has formulated certain methods tending towards their control and the education of the public in reference thereto.

The amendments to the code already touched upon cover the work of the Council undertaken with a view of meeting war conditions, although some of them, of course, would be important even in normal times. Other amendments to the code which have been adopted and which have no direct connection with the war were the revision of its provisions in reference to certified milk, so as to provide for a greater certainty of the purity of the same; the provisions for the inspection of children's boarding houses and of boarding houses taking tuberculous patients; the immediate reporting to health officers by local registrars of deaths from communicable diseases; and the reporting of persons bitten by

dogs supposed to be rabid. Many minor changes were also made with reference to poliomyelitis as a result of experience gained during the great epidemic of that disease in 1916. In addition to this the Council has amended the code by varying slightly the qualifications for midwives.

Despite the adoption of the sanitary code throughout the State of New York, it became obvious during the poliomyelitis epidemic of 1916 that there existed throughout the State a deplorable confusion and uncertainty with reference to local health ordinances. No two local boards of health in the State had similar ordinances and in many cases the provisions of the ordinances of a village were in conflict with the provisions of the ordinances of the town. While it is impossible to say that the public health in this epidemic directly suffered by reason of this conflict and confusion, it is easily conceivable that it might. These considerations led the Council during the past year to prepare a set of model regulations. which they recommended for adoption by all of the local health boards of the State outside of cities of the first and second class. Up to December 31, 1917, although the model regulations were not sent out until sometime in November, approximately one-third of all the local health boards in the State had adopted them. It is felt that a great step in advance will have been taken when there exists throughout the State uniformity of local health regulations, these, in turn, being consistent with and complementary to the provisions of the sanitary code.

This prompt adoption of the model sanitary code by so many of the more alert and intelligent communities, and the fact that in several instances two or more small communities in the State have united in the selection and support of a local health officer, thus securing more effective service than has hitherto seemed practicable, are some of the most encouraging features of the advance made during the year.

Pursuant to the provisions of the Public Health Law the Council has fixed the qualifications of the Sanitary Supervisors of the State Department of Health as follows:

1. They shall be physicians.

2. They shall, when appointed, be not less than twentyeight nor more than fifty years of age.

3. They shall either (a) have served as a health officer of a city, town or village having a population of not less than 5,000 persons for a period of at least four years; or (b) shall have received instruction approved by the Public Health Council, or a duly authorized committee thereof, in sanitary science, including five hours' instruction per week during the school year, in an educational institution, and shall have had at least two years' experience in public health work; or (c) shall have received a degree, certificate or diploma in public health granted after the completion of a course approved by the Public Health Council, in an educational institution, at least one year's practical experience in public health work; or (d) shall have submitted proof satisfactory to the Public Health Council, or a duly authorized committee thereof, that they have actually engaged in public health work of such a character as shall qualify them for the duties of the position.

In addition to these qualifications the Council recommended the following:

1. They shall not be allowed to engage in the regular practice of medicine or in any other regular occupation or business which will interfere with the full discharge of their duties.

2. The salaries of sanitary supervisors shall be $3000 per

innum.

3. The examination shall consist of (a) a written examination pertaining to the duties of the position, with a weight of 2; and (b) an oral examination at which the candidate will probably be required to appear for an interview, in order to determine his experience and personal qualifications, with a weight of 3.

In a previous report the Council has called to the attention of your Excellency the great importance of the local health officer in the far-reaching and promising movement now under way to secure to all citizens of the State in the country as well as in the cities—the larger measure of health and the prolongation of