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THIRTY-EIGHTH ANNUAL REPORT OF THE

STATE DEPARTMENT OF HEALTH

REPORT OF THE COMMISSIONER OF HEALTH

PART I

Letter of Transmittal

His Excellency, CHARLES S. WHITMAN, Governor of the State

of New York, Albany, N. Y.: SIR.--- In presenting the annual report of the State Department of Health I desire to call your attention to certain problems of vital importance to public health, caused, or emphasized by the world war.

The work of the Department, while somewhat handicapped by the absence of members of the administrative staff, employees and health officers because of military duty, and notably increased by the necessity for cooperating with the federal authorities, has on the whole suffered but little in efficiency, largely on account of the addition to the field force granted in the last budget.

Among the preventable causes of death showing an increase during the year are those due to injuries caused by automobiles, which were responsible in 1917 for over 1,000 deaths -- three times as many as in 1912 — and for more deaths than typhoid fever, scarlet fever and poliomyelitis combined. I earnestly recommend that educative and regulative measures for both pedestrians and drivers be introduced at the earliest possible moment as a means of reducing this unnecessary waste of life.

Among the problems emphasized by the revelations of the draft there is none of more importance to the people of this State and, indeed, to the world at large, than that of the control of venereal disease. A number of States have recognized this fact and have already appropriated large sums of money to be placed at the disposal of the departments of health to combat this menace to the progress of civilization. Thus far the State of New York has done very little in this field.

The State Department of Health, with such means as were available, has during the past year conducted a campaign of education by calling attention to the amendment to the Marriage Relations Law introduced at the last session of the Legislature, by the use of articles on social hygiene, which have been accepted by over 300 papers in the State for publication; by special articles on the subject of venereal disease in the Health News, and hy lectures by members of the staff to the general public and at stated meetings of groups of health officers. The work of the laboratory in the diagnosis of venereal disease has grown enormously, an evidence of the increasing interest which the medical profession and laity are taking in this subject.

The Federation of Women's Clubs and the New York State Woman Suffrage Party are cooperating with the State Department of Health at the present time preparatory to taking part in the future campaign against these diseases.

The Council of National Defense, the War Department, the Navy Department and the United States Public Health Service are all united in an effort to this end. The armies now fighting in Europe are literally riddled with venereal disease. A recent statement of Hecht of the Austrian Surgeon General's staff, made over his own signature in the Vienna Medical Journal, shows that up to the early part of last year 1,200,000 Austrian soldiers have been thrown out of the fighting by venereal disease. He recommends that men contracting these diseases behind the lines be sent to the firing line.

According to Stokes of the Mayo clinic at Rochester, Minnesota, prior to the war 10 per cent of all the entrants to the French hospitals were afflicted with syphilis. One and a half years after the war began the figure had risen to 16 per cent, and at the present time is 25 per cent. As the result of the disturbing reports coming from Europe, the Council of National Defense has divided this country into seven districts and has sent one physician into each of these districts to present to the State health departments a minimum program for the prevention and treatment of venereal disease, to the end that not only the army, but the civil population may be protected. The proposed program is, in brief, as follows:

1. Establishment of a bureau of venereal diseases for the State departments of health with an adequate personnel.

2. Provision for the commitment of prostitutes and of all feeble-minded.

3. Reporting of venereal diseases, supplying free Wassermann examinations and free salvarsan, or one of its recognized substitutes.

4. Campaign of education. Based on recent reports and investigations, it is my belief that at least 5 per cent of the total adult population of the State is affected with syphilis. Other estimates are much higher. Of the 40,000 insane approximate in the State, 13 per cent is known to be insane as a result of syphilis. From 20 to 25 per cent of all the adult persons who enter many of the hospitals in our large cities are afilicted with it.

While the importance of the prevention of venereal diseases as a sanitary problem can not be exaggerated, in the end the problem must be one affecting the civil population. Indeed, one has only to take the statistics of venereal disease among men entering the army from civil life in this country, to appreciate that this is the case.

Thus, according to figures prepared by the Surgeon General computed on the annual rate per thousand for the twelve week period, September 21 to December 7, 1917, 162.4 per 1,000 of the entrants to the National Army were afflicted with venereal disease; 115.2 of the National Guard; 88.0 of the Regular Army, and 121.9 of the three armies combined. These men entered the

. army from civil life from thousands of communities throughout the country. There can be little question that on their return there will be an equal or greater percentage of venereal disease among them, but even if happily this should not be the case, the evidence presented of the widespread prevalence of these diseases among the civil population makes the duty of the Federal and State governments perfectly clear; namely, to provide adequate means for an effective campaign for their prevention and adequate provision for the care and scientific treatment of those already afflicted. This is an obligation which the government cannot escape, and which it should be glad to assume in behalf of the thousands of diseased and suffering men, women, and children now crying out for relief which is unobtainable, and in behalf of the thousands not yet born who must inevitably suffer from the same cause if no relief is forthcoming.

I can not too strongly urge upon you to give this matter your most serious consideration, and feel confident that your interest in the public health of the State, which has been manifested on so many occasions, may be counted upon to provide means to carry on a campaign for the prevention and cure of venereal disease in the State of New York.

Very respectfully yours,
HERMANN M. BIGGS,

Commissioner of Health

ANNUAL FINANCIAL STATEMENT

The expenditures of the Department for the fiscal year, July 1, 1916, to June 30, 1917, were as follows:

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