DIVISION OF LABORATORIES AND RESEARCH

HERMANN M. BIGGS, M. D., Commissioner of Health, Albany, N. Y.:

DEAR SIR.I have the honor to submit the following report of the work of the Division of Laboratories and Research for the year 1917.

During the year the organization of the work of the laboratory which was begun in 1914 has approached fulfillment. Attention was directed afresh at the beginning of the year to the ideas and aims formulated in 1914, and especially to the need of extending the work to meet the demands of health officers and physicians throughout the State. The work was proceeding, when suddenly war was declared, followed by all the disorganization and stress which it has occasioned. Thus the year 1917, while showing progress along lines originally laid out and in the research problems already started, is characterized chiefly by the development of many new and important interests and activities.

The main work of the laboratory falls naturally under two distinct heads: the examination of specimens and samples for diag nosis and report, and the preparation of antitoxins, serums, vaccines and other products for prophylactic and therapeutic use in the prevention and cure of disease and in the control and spread of epidemics. Other branches and phases of the laboratory work are closely related to these main activities, but they are of sufficient importance to receive separate consideration.

Examinations of specimens for diagnosis and report

Bacterial diagnosis. The number of routine and special examinations which have been made in the bacterial diagnosis of communicable and other diseases has increased steadily each year. The rate of increase as shown in the tables on page 271 for the year 1917 corresponds to that shown in previous years. The most

marked and striking increase in the work as a whole is in connection with the extension of the scope of the work to include the miscellaneous new diseases which only in recent years have been examined, and others which require more than usual time and painstaking skill for their diagnosis. The practical value of this work to physicians and the great need of it throughout the State is well shown by the fact that in the ten years during which this work has been done by the State Laboratory, the examinations in diphtheria have increased approximately 2300 per cent, tuberculosis nearly 800 per cent, typhoid fever approximately 1000 per cent. During the year 1908 the bacterial diagnosis was limited to diphtheria, tuberculosis, and typhoid fever by the Widal test.

Serum diagnosis. Serum diagnosis of syphilis has been established three years. The number of specimens has increased about 75 per cent each year, as shown in the tables on page 272 — a most striking indication of the great and increasing demand for this laboratory diagnosis. The first year, over 12,000 examinations were made, the next year more than 22,000, and this last year 37,222. For a little more than two years a test has also been made, when requested, for the diagnosis of gonorrhea, but the significance and practical value of the results of the examination in the diagnosis of this disease is not so clearly established or so sharply defined as it is in the diagnosis of syphilis. The great practical value of the laboratory diagnosis of the venereal diseases will become increasingly apparent each year, especially in view of the extensive educational propaganda which has spread throughout the country, taking its origin in the efforts to protect the Army and the civil population from the disastrous effects of the spread of these diseases among the troops, and throughout the civil population wherever the troops are quartered.

The serum diagnosis of tuberculosis having reached a stage of experimental development which the laboratory could not entirely ignore, a special investigation of this method of diagnosis in tuberculosis was taken up early in the year 1917, but owing to the withdrawal of Mr. Maltener from the staff for war service, it is doubtful if this work can be brought to any satisfactory conclusion at the present time.

Examinations of water, sewage, ice, and milk

The laboratory has cooperated, as heretofore, with the Division of Engineering in the examination of samples of water which have been sent in by the sanitary engineers on tours of inspection of the municipal water supplies of the State. The significance of the results of these examinations has been greatly enhanced by a more complete knowledge of the conditions at the sources of the waters, which the engineers have made possible by more extensive and more numerous inspections. The chief interest in the work of 1917 lies not in the number of examinations, but in the character and significance of the examinations due to the careful field inspections.

Preparation of antitoxins, serums, and vaccines, and other

products for prophylactic and therapeutic use in the prevention and cure of disease and in the control of epidemics Diptheria and tetanus antitoxin. The number of packages which have been prepared and distributed by the laboratory during 1917 has steadily increased as compared with the previous years, and approximates the uniform rate. Owing to the war and the difficulty of obtaining supplies, the distribution of antitoxins in syringes was at first curtailed and then stopped. It will be resumed only to a small extent to meet very urgent demands of the health officers.

Antipneumoccus, antimeningococcus and antidysentery serums. The preparation and distribution of these serums has increased enormously during the year 1917. The preparation was begun and carried through in a limited way in the year 1916, but the demands of the Army were so great that the supply in this country was completely exhausted, and this laboratory was called upon to furnish its entire surplus which could be spared from the State service. The laboratory was further urged to produce as large a quantity of these serums as possible for future use.

Receiving unsatisfactory reports from the use of some of the commercial antipneumococcus and antimeningococcus serums offered for sale in the State, a careful examination of all of these serums was made by Miss Kirkbride and Miss Gilbert, and as a result of this investigation it was found necessary to call the

attention of the Public Health Council to the fact that these serums lacked potency and that no standards of potency were required of such serums which are offered for sale. The Hygienic Laboratory in Washington inspected and tested the purity of all biological products and licensed their sale, but no attempt was made to control their potency. Accordingly Regulation 1, Chapter IX, of the Sanitary Code, "Sale of Antipneumococcus and Antimeningococcus Serum Regulated ", was added to the Sanitary Code of the State, and the rules and regulations providing standards of potency and methods of testing were submitted for the approval of the Commissioner.

Similarly it was found necessary to test the purity of commercial smallpox vaccines, which are offered for sale in the State of New York. This need was occasioned by the report of an outbreak of tetanus following the use of a commercial smallpox vaccine, although no reliable evidence that the smallpox vaccine was contaminated could be obtained even after prolonged investigation. In order to confirm the tests of other laboratories, and in order to be in a position to insure the purity of the vaccine which was distributed in the State, these tests were made and continued for some months without obtaining any evidence that the smallpox vaccine in question had ever been contaminated with

tetanus.

In ordinary times any hygienic laboratory would be supposed to lead public opinion and to create the demand which it is able to supply; but since the beginning of the war the Division of Laboratories and Research has been compelled to shape its policy to meet one emergency after another.

Owing to the scarcity of salvarsan and the impossibility of securing any further supplies of the German product after the declaration of war, the practicability of its manufacture in the laboratory was carefully considered as a special investigation or research problem. Patent literature was consulted and many helpful suggestions were obtained from Dr. Lithgow of the Massachusetts State Department of Health where this work was under way. The progress of the work has been slow owing to the exigencies under which the work has been done,― space and equipment making it necessary that the work be done one step