HOW THE sixers i *£ 'j)f ZOO N*> lb mi DEPARTMENT OF HEALTH OF THE CITY r OF NEW YORK IS FIGHTING TUBERCULOSIS PREPARED FOR THE INTERNATIONAL CONGRESS ON TUBERCULOSIS, WASHINGTON, D. C„ SEPT. 21 TO OCT. 12, 1908. BY THE^OARD OF HEALTH 19 0 8 2987, ’08, 250 Sets (P) PEDICAC DBRARY. ^cGILL UNIVERSITY. MONTREAL O'**" A Brief History of the Campaign Against Tuberculosis in New York City BY HERMANN M. RIGGS, M.D., General Medical Officer The publication in 1882 of the classical researches of Robert Koch on the Etiology of Tuberculosis definitely placed this disease in the group of infectious, communicable and pre- ventable diseases. It then logically became at once the duty of sanitary authorities to adopt, so far as possible, the measures necessary to restrict the prevalence of tuberculosis, but the full significance of the discovery was not at once appreciated, and some years elapsed before any serious attempt was made to apply the demonstrated scientific facts to the practical pre- vention of this disease. In 188/, the writer, at that time one of the consulting pathologists of the Department of Health ot the ( ity of New \ork, having felt for several years the primary importance and necessity for administrative action in relation to this disease, urged upon the Board of Health of New 1 ork City the immediate enactment of suitable regulations for the sanitary surveillance of the tubercular diseases. At that time, however, neither the medical profession nor the laity of the City of New York sufficiently appreciated the importance of the matter, and the Board of Health, after seeking advice from various sources, only considered it wise to adopt certain measures designed to extend information among the tenement house population as to the na- ture and the methods for the prevention of the disease. In 1892 and 1893 the matter was again brought up by the writer for serious discussion, but it was not until early in 1894 that the first definite steps were finally taken by the Board of Health to exercise a genuine surveillance over tuberculous persons. From the outset the writer has always insisted that a rational campaign for the prevention of tuberculosis (espe- cially pulmonary tuberculosis), must be primarily based on a system providing for the noti- fication and registration of every case of this disease. In accordance with his recommenda- tions, the Board of Health, early in 1894, adopted a series of resolutions providing for a sys- tem of notification, partly compulsory and partly voluntary in character. Public institutions of all kinds (hospitals, clinics, dispensaries, etc.) were required to report all cases coming under their supervision within one week, while private physicians were requested to do so. In view of what seemed at that time such a radical procedure as the notification of tuberculosis, it was deemed wiser to at first employ such a compromise scheme. The original plan (adopted in 1894 by the Board of Health) provided the following: First: An educational campaign through the use of specially prepared circulars of in- formation designed to reach different classes of the population (one of which was printed in i many different languages), and also the utilization of the public press and lectures for the dissemination of popular information. Second: Tlie compulsory notification of cases by public institutions and the request for the notification of private cases with all the data necessary for registration. Proper blanks, postal cards, etc., were provided for these reports. lliiid: 1 lie plotting of all reported cases on large maps specially prepared, showing every house lot in the Boroughs of Manhattan and The Bronx (then constituting the City of New York). Each case reported and each death occurring from tuberculosis was plotted by conventional signs showing the month and year that each came under the observation of the Department. Fourth : A special corps of medical inspectors was appointed, whose duty consisted in visiting the premises, where cases were reported as existing, and if the patients were not under the care of a private physician, leaving printed and verbal instructions informing the patient and family, what precautions should be taken to prevent the communication of the disease to others. Fifth: When premises had been vacated by the death or removal of the consumptive, the inspectors arranged for the removal of bedding, - rugs, carpets, clothing, etc., for disinfec- tion by steam, and for the cleaning, disinfection or renovation, as might be required, of the rooms occupied by the consumptive. Where it was considered necessary, the rooms were placarded, forbidding occupation by other persons until the order of the Board of Health, re- quiring their renovation, had been complied with. Sixth : Provision was made for the free bacteriological examination of the sputum from any suspicious case of tuberculosis in the bacteriological laboratory of the Department of Health. (The bacteriological laboratories were first opened in 1892, and were, I believe, the first municipal bacteriological laboratories in the world.) Facilities were provided for the convenience of physicians desiring to send specimens of sputum by the establishment of depots at convenient points throughout the city, where sputum jars and blanks for recording infor- mation could be obtained, and where specimens of sputum for examination could be left. These were collected each day by the collectors of the Department, taken to the laboratory, examined, and a report forwarded to the physician of the results of the examination the following day. This system of free examination of sputum for diagnosing tuberculosis was in harmony with the policy which the Board of Health adopted in 1892, namely, that “it properly comes within the functions of the sanitary authorities to furnish facilities of all kinds, which are useful or necessary in. the diagnosis, specific treatment and prevention of all the diseases which are at the same time infectious, communicable and preventable.” It was believed that the free ex- amination of sputum would materially assist in the early diagnosis of tuberculosis, especially ; among the lower classes, and would encourage physicians to report cases. An early condition was made that no specimens of sputum would be examined, which did not have accompanying them all the data necessary for complete registration of the case. The result of the first year’s work was, on the whole, gratifying. It covered only ten months of the calendar year, and during this time more than four thousand cases of pulmonary tuberculosis were reported, and about five hundred specimens of sputum were sent for exami- nation. As a result of the notification, accurate data as to the chief centres of infection became for the first time available, and thus the Department of Health was enabled to direct its efforts to the best advantage. The very striking existence of tuberculosis in certain localities was demonstrated in a remarkable way by the maps on which were plotted the cases and the deaths from this disease. A number of small sections from these maps were first published in 1892. In 1897, after three years of this preliminary and educational work, the time seemed ripe foi an extension of the regulations. In that year the Board of Health amended the Sanitary Code so as to require notification in all cases of tuberculosis, both private and public. San. Code. Sec. 133. It shall be the duty of every physician to report to the Department of Health, in writing, the full name, age and address of every person suffering from any one of the infectious diseases included in the list appended, with the name of the disease, within twenty-four hours of the time when the case is first seen. A. Contagious (very readily com- municable) B. Communicable typhoid fever tuberculosis (of any organ) epidemic cerebro-spinal meningitis puerperal septi- caemia, erysipelas C. Indirectly communicable (through intermediary host) malarial fever. This action at once aroused bitter opposition in the medical profession, and in 1898 the two largest medical societies in Jsew ^ork City adopted resolutions absolutely condemning the action ol the Board of Health, and the Medical Society of the County of New York appointed a special legislative committee for the purpose of obtaining legislation to withdraw from the Boai cl of Health the power to deal in any way with the tuberculous diseases. Such legislation was introduced at two successive sessions of the New York State Legislature, but was defeated each year, after much difficulty. A special committee appointed by the President of the New York Academy of Medicine considered the new regulations and after several prolonged meetings, in which there was marked division of opinion, compromised on a resolution declaring it to be the opinion of the committee that the procedure was at that time inexpedient and inadvisable. The usual objections which have been urged to notification were put forward in the discus- sions in the various medical societies. As a matter of fact, so carefully did the Board of Health protect the rights of both physicians and patients, that a constantly increasing proportion of the cases of tuberculosis were reported, while there was a steady decrease in the opposition to the regulations. At the present time it is estimated that at least 90 per cent, of the recog- nized cases of pulmonary tuberculosis are reported in the Boroughs of Manhattan and The Bronx. In 1902 the Board of Health adopted resolutions requiring the landlords and janitors of tenement and apartment houses to report to the Department the removal of any tenant suffer- ing from tuberculosis, in order that proper disinfection might be performed by the Depart- ment of Health. Physicians, too, were requested to report the removal of any of their patients from one address in the city to another, or the removal from the city itself. Continuous pressure was constantly exercised on all sides to secure increased accuracy in the reports, and comparisons were made of the deaths reported from tuberculosis with the re- ported cases of tuberculosis, to determine whether the cases had been reported previous to death. When deaths were found which had not been previously reported during life the physi- cians were requested to furnish an explanation for the failure, and, in some instances, were summoned before the Board and threatened with prosecution, but only rarely has it been nec- essary to begin legal action. A regular census of the tuberculous inmates of all public institutions admitting or caring for tuberculous patients was first taken in 1897 and has been taken semi-annually since that time. In 1897 only about one thousand beds were occupied by this class of cases, and these were largely in the general wards of the general hospitals. The Board then began to bring pres- sure upon the management of the various hospitals in the city to segregate their cases in sep- arate wards or in separate buildings, and a little later forbade the treatment of cases of pul- monary tuberculosis, in the general wards of the hospitals. Efforts have been constantly made to secure accommodations for and effect the removal of advanced cases from their homes to public institutions, and facilities for the care of these have been steadily increased. In con- trast to the one thousand beds occupied in 1897 by tuberculosis cases, in 1907, about twenty- five hundred were thus occupied, notwithstanding the fact that the actual number of deaths from pulmonary tuberculosis in New York City had increased but little during this period. The actual number of cases in the city is probably less, certainly not more, than in 1897 — the death rate having decreased more than enough to compensate for the increase of population. Still, the people and the medical profession have become so well educated now to demand hospital and sanatorial care, that the accommodations although nearly three times as great, are more inadequate than were the one thousand beds available in 1897. In 1903 the Department of Health set aside several pavilions in one of its hospitals for contagious diseases for the special care of cases of tuberculosis, which it might become neces- sary to remove and retain if necessary against their will. It was early recognized that the point of view of the hospital and of the sanitary authorities was radically different. The superintendent of a hospital will naturally insist on dismissing at once a patient who is in- subordinate or violates the rules of the institution, and, yet, from the sanitary point of view, such a patient is the most dangerous one to be at large. These pavilions wex*e opened par- ticularly for the care of such cases, at first with a capacity of forty-eight beds, which has since been increased to more than two hundred. Since May, 1902, whenever it has seemed necessary for the protection of the public health, cases of tuberculosis have been removed and retained, whether they have been willing to enter or remain in a hospital or not. In 1903, provision was also made for the employment of a corps of trained nurses, in ad- dition to the corps of special medical inspectors, in order that a closer and more continuous supervision of the cases remaining in their homes might be maintained. The nurses visit S’ such cases regularly, make record of the surroundings, mode of living, physical and financial condition, temperature, observance of instructions and of any special needs. When it seems desirable, recommendation for charitable assistance or for removal to a hospital is made. The work of the inspectors is now largely limited to visiting the premises to make a special examination of a case, or of the condition obtaining in the home, to recommend forcible re- moval, or to order disinfection or renovation of premises after their vacation either by death or x’emoval. It will be readily understood from what has been said that the work of the Department of Health has been closely affiliated with the Department of Public Charities, with various charit- able organizations, and with the Tuberculosis Committee of the Charity Organization Society, which has for its specific purpose the combat against tuberculosis. In 1904 the first clinic (dispensary) was opened by the Department of Health in a building specially constructed for the purpose in the Borough of Manhattan, and in 1906 and 1907 similar clinics were established in the Boroughs of Brooklyn and The Bronx respectively. These clinics have the usual purpose of such clinics and have attached to them the corps of trained nurses referred to above. They have been very largely patronized, and act as clearing houses for the disposition of all reported cases of this disease. Between 1904 and 1907 several other special tuberculosis clinics (dispensaries) were opened in connection with various city hospitals or dispensaries, and in 1897, under the pat- ronage of the Tuberculosis Committee of the Charity Organization Society, an association of tuberculosis clinics was formed, comprising not only the clinics of the Department of Health, but also all of those in the city which comply with certain requirements (including the pro- vision of trained nurses for visiting patients at their homes, etc.). The city has been divided into districts, each clinic being in charge of and control of the dis- trict in its immediate vicinity. All the clinics report their cases to the Department of Health, and all patients attending a clinic outside of the district in which they live are referred back to the clinic in their own district for treatment and supervision. This plan has worked extremely well, and has prevented the wandering of patients from clinic to clinic in the hope of finding relief, and has obviated much unnecessary duplication of work. In 1896 the Department of Health, after strenuous efforts continued over a number of years, obtained a site for the establishment of a tuberculosis sanatorium for incipient and early cases at Otisville in the Shawangunk Mountains, about seventy-five miles from New \ork City. A tract of more than thirteen hundred acres of land was obtained, lying at an elevation from nine to thirteen hundred feet above sea level. The development of this institution has gone on somewhat slowly, as it has been along new lines. The present capacity is a little less than two hundred patients, only males being accepted. It is hoped that eventually from six hundred to one thousand patients may be accommodated, in a number of separate units, each of which will provide for from one hundred and fifty to two hundred and fifty patients. Treatment is entirely free, but admission is restricted to residents of New York City, and is obtained through the clinics of the Department of Health. In its educational campaign the Department of Health has made use of all the various agen- cies whose aid it could enlist. In addition to the distribution of the circulars of information already referred to, a vigorous crusade has long been waged against the filthy habit of spitting in public places. All street cars, elevated and underground railways, ferryboats, public buildings, piers, etc., have been placarded with large signs prohibiting spitting. The sanitary police of the Department have constantly made arrests of persons violating the law, and the newspapers have aided by giving the matter proper publicity. As a result of these measures, spitting is much less prevalent than it was a few years ago, although still much re- mains to be desired. Another device employed to educate the public concerning tuberculosis is by means of exhi- bitions. The Department of Health first prepared a complete tuberculosis exhibit in 1903. This consisted of photographs, charts, circulars, and the various blanks, cards, etc., used by the De- partment. The exhibit was sent to various cities in New York and other states. A great deal of effective educational work has been done by means of public lectures. In 1906 lantern slides were prepared to illustrate the work of the Department. These consisted of pictures showing sanatoria and hospitals for the treatment of tuberculosis, tables showing the ravages wrought by consumption, photographs of sanitary and unsanitary dwellings, pic-, tures and sentences telling how a consumptive should look after himself, etc. These slides have been exhibited during each summer by means of stereopticon lanterns in the various parks of the city, and have always attracted large audiences. The Department of Education has also rendered valuable assistance in educating the public. A number of lectures in the Free Lecture Courses have been devoted each year to the consid- eration of tuberculosis, and in the classroom instruction in hygiene, special emphasis has been placed on consumption, and the spitting habit. Arrangements have also been completed for the distribution to each school child, of a “consumption catechism” prepared and supplied by the Department of Health. The tuberculosis work now being carried on by the Health Department of the City of New York may be summarized as follows: (1) Notification and registration of all cases of tuberculosis (inaugurated 1894 and ex- tended 1897). (2) Free bacteriological examination of sputum, to aid notification and to facilitate the early and definite diagnosis (1894). (3) Educational measures of various kinds, circulars, lectures, exhibits, newspaper articles. (4) Visitation of consumptives in their homes (1894). Continuous supervision of cases in tenement houses by the corps of trained nurses (1903). («)) b ree disinfection by the Department of Health, and issuance of orders for the reno- vation of rooms vacated by consumptives (1894). ( q xt Airof no m n tit H i l ■"AWoj over one iiiuum ■■ ■ ■ — A Atl 1 XT i l . i i ' PoH/iin it 1 i • — iseauing . 1 i —Renovation —Paster 1 l l ' * mended LVirnU.lD PnmnVfl 1 1 ' 1 i V * ' i eiinin □ Ll ! —Charity Renovation Voluntary 1 Rcinspected Performed 194 L— 1906 2517, ’06, 5,000 (P) department of health the CITY OF NEW YORK COMMUNICABLE DISEASES division ok borough ok Report of Case of Name - Address.. Care of Age Occupation Reported by Address...... Floor M. F., M. S. W. Nationality— Diagnosis Date ..Case No. Clinic No. I _ ^ tIipsp are not visited, except at tlie Oases Unpeb the Cabe of Pbivate i hysjoians. • request of the physician A letter (Form 16 L) is sent to the physician, acknowledge rece.pt 7Z*. calling his attention to the necessity for reporting any change o, address or d.scon tinnance of treatment on the part of the patient, and enclosing a circular of mstruct.on, w no (or its equivalent) the physician is requested to give to the family of the pa .en or o patient himself, and also a postal card on which to report change of address, d.scontun of treatment, etc. (Form 245 L.) r . — ,• \ 2236, ’07, 10,000 (P) 245 L— 1907 To the Department of Health, City of New York: The following patient is no longer under my professional care, or has changed his or her address: Name Age. Address A Reason : (Please indicate by checking appropriate number.) 1. Under care of another physician (name and address) 2 . 3 . 4 . 5 . 6 . 7 . 8 . Died out of N. Y. City (date) Recovered Entered Hospital or Sanatorium (name) Left City (present whereabouts) Discontinued treatment Change of address Miscellaneous M. I). Address The original report is filed under the physician’s name, thus constituting a Private Phy- sicians’ Index of cases reported. The large record card is then filed in the ‘‘private” case index according to patient’s address. Once a year a letter (Form 4 L) is sent to the attend- ing physician of every “private” case, asking for information as to outcome of case. If no answer is received, the case is followed up by the Department.. Such cases, if found (also all “private” cases later reported by institutions), come under the supervision of the Depart- ment, the “P. C.” on name card being stricken off, “A. H.” substituted, and the card appro- priately filed. 4 L — 1908 21-396, ’08. 6,000 (I>) Depart m eat of Health THE CITY OF NEW YORK DIVISION OF COMMUNICABLE DISEASES Borough of J90 _ Dr. _ Dear Sir : On you reported to the Department of Health the following case of pulmonary tuberculosis The Department is desirous of having its tuberculosis records complete and correct, and of eliminating therefrom those cases which have died or permanently left the city. Information as to the present condition of cases reported some years ago is also desired for statistical purposes The Department will, therefore, be under obligations if you will kindly send information on the following points It will be considered as strictly confidential. 1st. Whether the patient still lives at the address given, and if not, where? 2d. If the patient is worse or better, or has recovered? 3d. If the patient has since died, and if so, when ?_ 4th. If the patient has passed out of your supervision, are you willing that the Depart- ment should send a physician to ascertain the above facts ? Yes. No. Thanking you in advance, I am, Very respectfully, Chief of Division . M. D. Inspect or -iri- Charge of Borough. “At Home” Cases. — Reported by: (a) dispensaries and charitable organizations; (b) by laymen; (c) by physicians with request thai they be visited ; and (d) by hospitals as having been discharged therefrom. Such cases are at once assigned by telephone to the nurse in whose district the patient lives, and the result of investigation reported by telephone the fol- lowing day. The date of assignment and name of nurse are entered on blue record card by telephone operator and card is held as a tally in the tally box. If the patient is found, a pink “observation” card (Form 44 L) is filled out by the nurse and mailed at once, giving all essential data. (If not found, that fact is stated with the daily telephone report next day, the inspector endeavoring to obtain new address.) Observation cards are returned by mail on the day of inspection in addressed envelopes furnished (Forms 91 L, 100 L, 114 L). Any recommendations (hospital, charitable aid, etc.) are made by telephone and indicated by the telephone operator writing date in proper space on record card. 21-122. ’08. 15.000 (P) 44 L-190S DEPARTMENT OF HEALTH. THE CITY OF NEW YORK Division of Communicable Diseases His.ory of Case of Tuberculosis _M. F., M. S. W., No Yr._ Floor Nat Name.: No Age- . Street- Date. Occ._ . Insp. Nurse- _At. Work (Yes) (No) Where. Char. House Owner or Agent- No. Rooms Light .Condition (Good) (Fair) (Bad) Address No. Families- .Total Air Space_ Vent cu. ft., Heat. . Plumbing- -Boarders_ .Children- Any Work done there (Yes) (No) What Kind?— How long on Premises No. in Family. Adults. Circumstances Family (Good) (Fair) (Poor) Income Other Cases in Family (Yes) (No) Rep. (Yes) (No) In House (Yes) (No) Rep. (Yes) (No) Pt. has Sep. Bed (Yes) (No) Sep. Room (Yes) (No) Proper Food (Yes) (No) Duration Disease Fever (Yes) (No) Loss Weight (Yes) (No) Expect. (Yes) (No) Disposal. — Haem. Oes) (No) Pres. Condition — — ■ Phys. Exam. Chest — Under Treatment (Yes) (No) By Whom Addres * Previous Instructions Observed (Yes) (No) By Insp. (Yes) (No) K. U. O. (Yes) (No) Remarks 0 CB \ 0 0 CO b CO 0 _c -Q -M CB LO O 'E LO 3 E “O c~ 100 L.-1WT department of health THE CITY OF NEW YORK Sixth Avenue and 55th Street Borough of Manhattan PfSBrt 3 I-iXr-1 906 Note -A ll admis sions, disch arges and ftf JirTWHlfl flllllfiiiiiw l rn ™ <% ^ 114 L— 1804 DEPARTMENT OF HEALTH THE CITY OF NEW YORK Sixth Avenue and 55TH Street Borough of Manhattan 1 165, ’06, e,0000urtjtige unb Jtirjrnigrn, uu'h'hr ntit ilnirti Irhrn. abtbellunfl Ocr anateckenDen fvtankbetten bet ffieborbe fur offentUcbe Oesunbbelt, Sub«“CClest»Eche <5. avenue unb 55. Straaae, Hew Jifork. Scfewittbfuefet i»ir6 tneifteti* ucrurfacfct fcurd? We Mnfitte be» Jlu*fjmefcn*. $ie gdjtoiirbfudjt ift eine 2ungcnfrantl)cit, incite n;d)t burd) Grtaltung, fonbcrn nur burdj ■ilnftcdung berurfad)t toirb. (rinc ©rtaltung tann unter Umftanben bie Ifkrfoncn, tvcfdje ber Jnftedung burd) gcplomb* |u*t auSgcfctjt finb, fUr bicfelbe meljr empfanglid) madjen. _ Sie cigenttidjen Utljcber ber £d)toinbfud)t finb Heine, unfid)tbare $acidcn, bie geloofjn* lid) mit ber 2uft, bie loir einatf)men, in ben florper gelangen. £er SuSttmrf, welder bon Sd)toinbfiid)tigcn $eraufgcf)uftet <*> et auSgefpudt with, ent* bait biefe flcimc in fold)’ gro&cn aJiengcn, bafe 2Jlidionen babon oft an eincm eingigen Sage auSgcfpudt loerben. 3Bcitn biefer fcimrcid)e lilultourf auf ben gufebotcn, an bic 2Banbc ober fonft toof)in gcfpudi toirb, fo trodnet unb putbcrifirt betfclbe unb toirb bann bon ber 2uft alS Staub tociter getragen. . Selbft biefer feine gtaub cntfjalt bie flcime, tneldje auf bicfem ©ege nut ber ctngca©* metcn Cuft in ben Jtbrpcr gelangen. Sicfer gtaub ift l)auptfad)lid) int 3> mmet flefdfjrlid). Set aitfjem cineg gd)ioinbfiid)tigcn, auSgcnommcn tocnn cr fjuftct ober nieft, entt)alt feme iaciden unb ift an unb fur fid) nid)t gcfafjrlid) unb fann baljcr, fclbft toenn eingcatfjmet. bic firanff)cit nid)t iibcrtragen. ©cfunbc Ifkrfonen fbnncn bon eincm 8d)tmnbfud)ttgen nur bann ongeftedt tocrben, toenn ber SluStourf eine§ fold)en auf irgenb eine 2Betfe m tf)ten Hot* £d)ioinbfud>t lann oft gcf)cilt loerben, tocnn bic 9latur ber Hranfljcit ftiiltfeitig gcnug erfanut toirb unb fofort gecigncte JJlafsrcgcln fur bie SEcljanblung bcrfclbcn angetoanbt tocroeit. Sie meiften glide bon gd)toinbfud)t ncljmcn feinen tobtlidjen Scrlauf. ftur ©cfunbc ift e§ ungcfaljrlid), mit gdjioinbfttdjtigcn jufammen ju too^nen, fo lange ber aiustourf ber Jtraufcn fofort bernid)tct toirb. Xer SluStourf gd)ioinbfiid)tiget foil toebe. auf ben gufeboben, auf ben Scppid), an ben Cfen, an bie ©anbe ober auf bte etrafee ober SrottoirS nod) fonft toofiin gefpudt, fonbcrn fod in einem }u bicfem 3tocde bereit get)altc= nen ©efafe ober Saffc aufgcfangcn tocrben. Xamit ber aiuStourf nid)t trodnen lann, feden biefe ©efage cttoa§ ISkffer, ober nod) beffer eine Sprocentigc Gatbodofung entfjalten (C Sl)ctloffcl bod Gcrbolfaure ju einem $int SBaffer). Surd) biefe Garbollofung tocrben bie Jtcimc getobtet; ba bie 2ofung febod) gtfttg •ft, fodtc fie mit bcc grofeten gorgfalt gcbraud)t tocrben. Sic jur Slufnafjinc be§ WuStour* fes befiimmten ©cfafsc foden minbeftenS atoetmal tdglid) in bal ®affer=Glofct entteert unb jaitn forgfaltig mit fodjenbem Sffiaffcr gereinigt unb toieber mit etmaS bon oben geuaunter Garbollb)ung gefudt toerben. 8d)ioinbfud)iige tnuffen barauf ad)tcn, baf; fein UluStourf an tljren §atrben, ©cfidjt ober llleibungSftiiden l)aften bleibt, unb fotd)cn uorfommenben gadel fofort mit gcife unb peifeem 3$ a jfcr fcefettigen. 9lufjcrl)alb beS fjaufcS foden 8d)toinbfUd)tige eine befonbcrl fur biefen Stood au§ papier angefertigte Sai^enffafdje tragen, toeleftc 3 ur 9lufna!)me bc§ 'JIu§loutfe§ beftimmt ift. Sicfc $apicr=Qefa{sc fodten nad) bem 3iad)ftaufefominen famtnt 3nl)alt fofort oerbrannt loerben. SCcnn Safd)entUd)er jur 'dufnaljme be§ SluStourfcl gebraudjt toorben ftnb (toertl)= lofe 2appen, toeldje berbrannt tocrben liinncn, fmb febcnfadS botjujiClien), fo fodten bic)clben gan 3 bcfonberS fiir fid) Vz Stunbe in Scifentoaffcr ausgefoeftt toerben, bebor man fie mtt Dcr iibrtgen w i„ 6ftet§ “ einc S f ei,cl > en ©>'%<- «.tI 4 *r ®acitlen entfedit, bte -uft fl*gcn, fottte bet fitanre, um btefe! 3 U Benneiben, ftc^ ein Suefe borfeatten. Jn “ “ n . t . eC ‘" J““ en lft bec ® c6roud ) bon «•»«, ref*. 3:afd)entiicfeer, 3 »ed! Slufnafenie be! f ’ m r °i Il 5 ft 3 “ bmne,bcn - ba »« ^« § >BUtf an ben Siicfeern 3u fcfenett trotfnct, fid, Cb] l0] [ unb W fconn an etaub in bet Suft bertfecilt. £afeet fottte bet ucfnn|>f at.fgefangcn inetbcn. tpapier.-Saffen |mb anbetcn ©efafeen boqustefeen, ba bic erfteten naefe ©cbraud) mit Snt»alt berbrannt ieer= ben Ibnnen. ©in bittigc! unb braudjbare! ©cfdfe fiir biefcn Stocrf au! spapiet obet au§ tcte Ducfeer 3 U gebrauefjen. ^ SBcnn bet «u!tourf griinbtiefe berniefetet toitb, fo tann ein Sd)toiirbfiid)tiger fedufig im otanbe letn, fetnet getoofenten Slrbcit ltacfesugcfeen, ofene babei anbete Scute amuftetfen. ~ uvi> r tltbeit totrb bet 3 uftanb be! fltanfen auefe betbeffert unb bie ?tu!fid)t anf bottige ©enefung bergtofeert. 1 Siegt bec Skrbacfet bot, bafe 3entanb an gffetoinbfucfet leibet, fo fotfte 9tame unb Slbrcffe bet betreffetrben $erfon fofott feet ?oftfatte ter ©cfunbfecit! * 9M)orbe mit Slngabe be! 6 ad)bcrfealte! eingefanbt toetben. ©tn 9 lt 3 t bon bet ©efunbfecit!=33efeorbe toitb, fofern bie betteffenbe ifScrfon leinen tpribat= c ©aflcnftdnbe toerben bon bec ©efunbfeein . IBefebtbe unentgeltlicfe abgcfeolt be!= tnftgttt unb bem ©igentfeUmet toiebet sugcftellt obet ouf f^ietten iffiunfcfe bcrnid)tet. 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Istrnzioni per i Tisici e per Coloro che vi Coabitano. DIVISIONE DELLE MALATTIE COMUNICABILI DIPARTIMENTO D 1 SANITA. Angolo Sud-Ovest della 6a. Ave e 55a Strada, New York. La Tisi e’ Causata Principalmente’ dalla Immonda Abitudine di sputare per terra. La tisi e una malattia contagiosa che attacca i polmoni. Essa non e scmplicemente causata dai raffreddori, quantunque un raffreddore predisponga l’organismo alia tubercolosi. L'infezione e trasmessa dai microbi, i quali generalmente penetrano nei polmoni mediante l’aria respirata. La materia che i tubercolosi emettono negli accessi di tosse o negli spurghi contiene gran numero di questi microbi, spesso milioni ne vengono espettorati in un solo giorno. Questa materia sputata sul pavimento, sui muri od in qualsiasi altro luogo, si secca e tende a polveriz- zarsi ed in questo caso a rimaner sospesa nell’ aria in forma di minutissima polvere. Questa polvere contiene i microbi ed e cosi che essi penetrano nell’organismo insieme all’aria inspirata. Questa polvere puo divenire molto pericolosa specialmente nell’interno della casa. L alito del tubercoloso, eccetto quando questi tosse o starnuta. non contiene microbi e non puo essere il veicolo dell’infezione. Una persona sana e soggetta al contagio di un tubercoloso solamentese in qualche modo introduce in sc la materia spurgata od emessa nei colpi di tosse. La tisi spesso puo essere curata, purche la malattia sia avvertita nei primi stadii, ed inoltre mezzi adatti siano adibiti alia cura. NELLA MAGGIORANZA DEI CASI NON t UNA MALATTIA MORTALE. Non e pericoloso convivere con un tisico, se la materia spurgata viene prontamente distrutta. Questa materia non dovrebbe essere sputata sui tapped o sul pavimento, sulla stufa, contro il muro. o sul marciapiede, ma invece* se possibile in apposita tazza. Questi tazza dovrebbe contenere acqua, di modo che lo spurgo non si secchi, o meglio ancora, acido fenico in una soluzione del cinque per cento. (Sei cucchiaini in un mezzo litro d acqua.) Questa soluzione uccide i microbi, ma, essendo velenosa, deve usarsi con circonspezione. La tazza dovrebbe venire vuotata nella latrina almeno due volte al giorno, e poscia lavata con cura in acqua bollente. Molta attenzione dovrebbe essere prodigata, air uopo d’impedire che le mani, il yiso od il vestiario degli etici vengano imbrattati dalla materia espettorata. Quando cio avvenisse, la parte inquinata dovrebbe venir subito, lavata con acqua calda e sapone. I tubercolosi non dovrebbero laseiarsi crescere la barba e tutt^al piu i semplici baffi tenuti anch essi molto corti Fuori di casa i tisici dovrebbero spurgare in una fiaschetta tascabije, fatta ad uopo; se panno lini vengono usati, e necessario che il malato li bruci quando ritorna in casa propria. ^ Se l’ammalato si serve di fazzoletti, bisogna che li faccia bollire a parte almeno per una mezz ora prima che vengano lavati. Meglio pero sarebbe che usasse dei pezzi inutili di stoffa poco pregevole, onde potessero venire bruciati non appena avessero adempiuto il loro scopo. Un etico nei tossire o nello starnutare emette leggeri spruzzi od aspersioni sature i microbi. Cio rende necessario che egli, nei caso di questi accessi, tcnga dmanzi alia bocca un fazzoletto od un pannolino qualsiasi. In alt re circostanze Tuso di fazzoletti ^o di pezzuole come ricettari degli spurghi, dovrebbe essere evitato piu che fosse possibile perche la maters ivi $ secca, ed indi si volatilizza per l’aria. Percio tutte le volte che e possibile, lo spurgo an re ricevuto in tazze o fiaschette. w Le tazze o fiaschette di carta sono piu’ adatte perche in tal modo si possono bruciare volta per volta. Una fiaschetta di vetro, di metallo o di cartone e un recipiente adatto a ricevere gli spurghi dell’ammalato quando si trova fuori di casa. Fiaschette e tazze in forme convenient possono acquistarsi a basso prezzo da tutti i firmacisti. Quegli ammalati che fossero troppo deboli per servirsi di tazze, dovrebbero espettorare in stracci umidi da bruciarsi subito dopo. Se l’ammalato si serve di pannolini, non dovrebbe tenerli sciolti in tasca, ma rinchiusi in un recipiente impermeabile (una borsetta da tabacco) che andrebbe spesso sottoposto all azione dell - acqua bollente. Un tubercoloso non dovrebbe m:ii inghiottire lo spurgo. Un individuo ammalato di tisi polmonare, dovrebbe avere un letto a se, e possibilmente dormire in camera solo. Questa stanza dovrebbe essere abbondantemente arieggiata e venti- lata. Le finestre dovrebbero rimanere aperte giorno e notte. I panni sporchi e la biancheria tolta dal letto di un tubercoloso dovrebbero essere maneggiati ben poco, finche asciutti, ma al piu’ presto possibile andrebbero deposti neir acqua finche non venisse l’ora del bucato. Le stanze dovrebbero essere pulite ogni giorno. A scopo d’evitare che la polvere si span- da per Taria, si deve aspergere i pavimenti con acqua prima di spazzare, e poscia togliere la pol- vere sempre con panni umidi. Se lo spurgo viene reso innocuo l’ammalato puo non solo attendere ai lavori senza pericolo di contagiare gli altri, ma quanto puo’ migliorare la sua condizione ed aumentare la probability di guarigione. Quando si suppone che un ammalato sia colpito da tisi, dovrebbe subito venirne notificato il Dipartimento di Sanita. Un medico allora si rechera dall’ammalato (nel caso che egli non si trovi sotto cura di un altro) a stabilire il genere della malattia e fornira le istruzioni neces- sarie per la cura. Le stanze. state occupate da tisici, dovrebbero essere ripulite, lavate, imbiancate, inverniciate e coperte di carta nuova prima di essere nuovamente adibite ad abitazione. Tappeti, letti ecc, provenienti da stanze occupate da tisici, dovrebbero essere disinfettati. 1 ali oggetti, a richiesta del proprietario, sarantio mandati a prendere dall’Ufficio di Sanita , il quale si occupera gratis di disinTettarli e restituirli oppure di distruggerli a seconda dei desideri del propietario. Nel caso che gli ammalati di tubercolosi cambiino di residenza, sono pregati didarneawiso all’ Ufficio di Sanita. I tubercolosi sono prevenuti di non aspettar evidente miglioramento , nt guarigione da spe- cifici. nd dalle molte medicine annunciate dai giornali ed altrove. La cura riconosctuta mighorc d quel la di usare cibi sani e nutrient*,' e stare per quanto si pud all'aria aperta . I tisici, che hanno l’opportunita di entrare in un Sanatorio, dovrebbero farlo senza perdita di tempo. Specciali dispensarii sono stat? aperti a 6th Ave. e 55th St., Manhattan, 361 Jay St., Brooklyn, e Third Ave. e St. Paul’s Place, The Bronx. Qui i casi di consunzione ricevono consultazione e trattamento medicine incluse gratis— questi ammalati possono essere diretti cola da medici, societa di beneficenza o altri. In casi di neecessita, sara somministrato gratis anche latte e nova. Si possono ottenere cott anche sputacchiere tascabili ; ed a richiesta degli ammalati si puo anche avere la visita di speciale infermiere a casa. Orario : Manhattan : 10 a. m. alle 12 a. m. e dalle 2 alle 4 p. m. ogni giorno eccetto i giorni festivi dalle 8 alle 9 p. m. solo il Lunedi, Mercoledi e Venerdi. Brooklyn Dalle 2 alle 4 p. m. tutti i giorni nella settimana eccetto le feste. The Bronx : Dalle 2 alle 4 p. m. Lunedi, Mercoledi e Venerdi. I TUBERCOLOSI DOVREBBERO NOTIFICARE L’UFFICIO DI SANITA* DI QUALSIASI CAMBIAMENTO DI DIMORA. Coloro che desiderano maggiori schiarimenti od assistenza, si rivolgano al Capo Divisione del Dipartimento delle Malattie Contagiose Ufficio di Sanita’ 6a Ave. 55a Strada, o Society di carita o La Societa per migliorare la condizione dei poveri, 105 e 22d Strada, Oppure AU’Unione Ebraica di Carita, 356 Second Ave., New York. Per ordine dell’ Ufficio di Sanity. HERMANN M. BIGGS, M. D., THOMAS DARLINGTON. M. D., Medico Officiate. 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pnx ^yc'y^a’oypxB x px pya"!? ■ya iinyn iya*o lyyxo aix -rin px3 ;yinyppniy x’p xn D>nax3 jyiyn oajnaiya p”p3 x'P jyno )3 xp yai’xn x ojyoDJ’jyn x'p tyno (iyDDya bv'z jyp'p tpiyn 03yiaiya pni jysyp yaSyn yrxSnoiyn) ,oyoi3 jyr’no ysnp -tyoy'3 iyix jyoDin D"a .lytrxnyj jyiyn x'p ixaya jyiyn oaxpy3 lyDDxn px ^ 310 ^ lyoo'X y3'ODPi3'nt? jyaixi cnxi oaxiay3D'nx jyiyn jypp'yxa jyoPxno3y ya^yn o”p3‘DD'i)B jxa pixi 0D3XT iyax .jyDyo iyix jyoDin x'p jyn ino jixa pio ^yp'or x nrx iyix piciytaxo x jyo^xn •yjonx xn ;yony3 iy pnx pio pypp'otr iypx iya'03yc’xo jyamay: iy ;yi"ODix p'psyo o"n xni jyo &XT Diixi .O 01 P xn px o'nBDiy i3ix jyamy oiyn oy mx ,dix p«>3 o3ypno Dy f>m pya«p yoDin •Py>”'y^ jyDDxo yoy;3"xy3 iyxp px j‘ya - n jyoDinyoaix Dyn ;y"Et;' 3 , 'ix ,p'p3yo 113 anx /jyo jyoxny jyiyiaiyD jyo jyp y;yiyBxs xn > M n jyDDxo yan3nyny3 xn iyDDya jyi'p jyDDxo y3yiy'Bxs rx (nx30D”B) jxoixp iyix pxoyo -fx^j pa ^ytrypa eypxB x .jyoi>xno3y xn dxii j'ya'p xn o'o yoynpya px y3'^ra .D -, n iyppx 0*3 rx ;yo jyn jy^str iy j'nx cxn px pxr yoynpya x myr pnx CyxoTawrb MomHa 3ano6tHM h mxi> Bbi/itHHTH. Ho6pi paxibi -aJisi cyxiTHHKiBt h nnn Tbix-b, KTopi 3-b hhiyih MeuiKaioTb. flenapTaMeHT-b 3,qopoB/ifl South West Corner 55th Street and 6th Avenue, New York. IIoraHa HaBbim bcio^m iijiiobn.i sapo^KK (oaK- xiub', Korpi sbuuiio BxojtaTb 40 Tibia totj;u, kojih B.pjxaeMO noBbrpe. Cinna KTOpy BuitauuioioTb aito BuiuronafOTb cyxiTrara, Mtcmrb n coob ri sapoxirb bs BeauiciM -.nab M1.110UU Tauuxb .mpoAKui b itutuioBae cyxiTi.Hicb 11a OAHHb fleHb. O.iHHa, liuoioTa cy- xiTiiiKOMb na ni;uory, cTbtiy aoo AeHHfle 3acuxae, nepeirbiiioe ca bt> nopoxb, Korpuft BUTaK mracBae CBofiiflHO in, noBbrp.T. Ilopoxb ceft Mae B-b co6b 3ap04.cu, n Tain, ohm bxo- AHTb B-b T-b.10 3b BG^yxoMb, KOTpuft BAUxaeMo. Ilopoxb Tott Haii66.TMne neoeatie-iiiuft itb eepe.uint iioMeuiKana. BiAtuxb cyxit-HHica He Mae aa^nuxb aapo^si h ne mo ace Ti.My cnpu- hhhhth cyxoTb. 3AopoBufi HOJJOBb'Cb Moace totah To.ibico na6pam ca cyxorb, ko.th Bb flKiii iieoy^F, cnocioB BunaioTa c.imia cyxinniica bb fioro tLto. Cj xoru MOiKiia i iacTO totau nuxb i ibth, ko.th aaB'iaey pocni3iiaeMo xopo( 5 y h ico.tm B03BM6M0 ca 3 a B.iacTHfjft ciioco6u 40 hxb Bu.Tfcnentf. Bb Qi.Tbniifi nacTH cyxora ne cyrb fle 6 e 3 nenni. He ecTb He 6 e 3 nenno Menncara totau 3 B cyxiranKOMB, Ko.Tnt.THHy, nicy buib BHiuroe, mu cennacT, 3 am;HMo. Cvxotiihkb ne Monte namm naniAJiory, KapneTB, niqb, crfcny aoo TpoToapb (TaH^BOKB), aae Bee, ecjiH mohcjhbo, bb nocyAHny aoo qapicn yMueno a.th iiero 3 JaA»eny. Hapna nominna m£cthth BOAy TOMy, hj;o6t> ejinna ne sacuxajia, a6o, 111,0 at, rune, nnTb nponeHTOBy Kopoojiboby boav (•*> MaJiuxB jiuhcohokb na niBB Koapra). Ceft po3bhiib yGiiBan 3 apoAKH. l Iapny Tpeica BuiiopoauiHTH ,3,0 Buxo^ica 6oAaft £Ba pa3U na aghb, h bu MLITH. J1KB mUeiKHTb CH, ropilHOIO B ).TOIO. , 3 ,} ace na ce Tpe6a yBaacara, mo6u cyxiTniiKB He 3aBajrHBB co6n pyKB, jnma aoo OAeacH buii.tiotoio caHHuo. ()Anaico;Kb, kojihob tukb CTaao ch, to Tpeoa cen nacB naMUTH ropnwoio boaoio h mu.tomb. MymHHH-cyxoTHHKH He noBnnnn hochth aoBciMB 6opoA»J, aae, m,o nan i.Tbine, npHCTpnace nn Bycu. IIo- 3 a aomomb cyxoTnuicii noBHimi hjifoth BBnanepoBy (pjieimnny , jmucho aaAaeToro ajiaAaceny. Ho noBOpoTli ao A^My Tpeoa ceiinacB tvio (J).Te- ™y Bp*‘i 3 B 30 cjrnnoio cnaJiHTH. Ko.th cyxiTHHKB yacHBae xycraiiB 40 Hoca (xtnme, auu BiiiB jaciiBaBB nenoTpI>6nuxB mMaTHiiB, KTopn cennacb Moacna cnajinrii), to TiinKb Tpeoa OCl HO IX, ’.TOH nibBrOAHFIU BB ICHnyqin BOAii BapHTH, SaHiMB MOJKIia 1IXB lipaTH 3B npOHIIMB »abeMB. pn Kanurenio *ra cwapKanro Apioom.KiH nacTHHKii c.thiiu, mo MtcTeirb ifb co6I> 3 ap () AKH, yjliTai °Tb noBtope, h TOMy cyximHKB niAnacB icanunnn aoo cMapicann noBH- nenB ipHMain xjciKy aoo niMaTHiiy npn ycraxb; BnpoatMB, xycTOKB a^ inMaTHHB Tpe6a jibb HawMeme j .KiiBaTH, 60 c.thiui na hiixb sacuxbe cicopo, BiAA't-iHBniH on y.rlrrae bb bo3- AJ xb. OMy, ecjiu ce MoaciiHBe, cyxiTHHKB noBHiieiiB n.iroTH bb qapicy a6o ciuronanicy* IlanepBi qapoicn cyTb xbnmi, HKb BBHqaHHi, do axb Moauia pa30Mb H3b cjihhoio no yjkhtoio cna.iHTH. 3 obc'Ism'i> AeineBy Ta nwri^ny qapicy 3 b nanepy ado naneHAeKjno Moaua Ma&ace bt > KO^ift ariTHi^ii nicTara, a tvio cyxiTHHKb Mae yatHBaTH dyAyin no-aa a ( >mom'b. Xopi ? Koxpi cyTBsa CAadi, in,o6u Mor;ia yacHBara c(uein;niiy adoqapicy, MoatyrB yacHBara MOKpuxb niMaT'B, ^KOTpi ceftqacb Tpeoa cna^nra. niaaTb ne MoatHa hochth nicb-HedyAb Bb Keinemi, a.ie Tpeoa axb tphh&th be» nonpoMOKaAbHoii (waterproof) flopTMeTu. 1 i, Korpa Tpeoa qacTo BUMUBaTn bb ropaqift BOAb. CyxiTHHKB ne noBHneu b Hbaojia cnoea cjihiuk JioeKaacw. CyxiTiiHKB MycHTB Mara CBoe BJiacae aoatKO, a eejin MoatanBO, to h cBift BAacnuft noKift. IIoKift cea Mycarb Bee Mara iiobho CBbaioro B03Ayxa, a bokho Mae Oyra Bee otbo- peHe mvb jeHB, Taicb homb. Bpy^Hon 6bjiH3inj cyxiTnnica a npocTiipajib, ko.w onu cyxi, Tpeda nab naftaeHqe ^OTBiKaTa cn, a.ie ceftqacb bao/Kiith Bb boay, a BiATaKb Buupam KOjIH TaK r B BUHHATb Cfl CABUy 30BCt>Mb HeinKO^.lHBOK), CyxiTHHKb M0JK6 He TOJIBKO nacb BiAb qacy podnTn cboeo poooTy ne 3apa«aio i ia Apyraxb, aAe tuko JJ,eaapTa\feaTy 3 aopobah. Tor^t ao Ton ocodu npaaj,e Abrcapb, KOTpua npocAbAHfb crash 3 AopoBAa, Ta CKa;Ke, qn Ta ocoda Mae cyxoru, posyaite ch Torj;ti, koah oaa ne Mae AOKTopa, a Tor^t, ecAH OKaacecb norpeda, ^acTB BRa3iBKH, sab A'bqarn ch. IIoKot, bt> KTopMXb 6yBb cyxiTHHXb, Tpeda rpyHTOBaTO BhiqacTHTa, Bijqyxarn, bij- 61iahth, noMajiBOBaTa ado onanhpoBaTii, 3anb>ib Moataa bb imxb saMlmiKaTH. KapneTH, ftHBaHBi, nocrfejiB, a t. a*> 3b noKoiiBb, Ae 6ynb cyxiTHHKb, Tpeda noARaTH ijliAKOBaTia ac- 3HH(J)eKnia. Tpeoa TOAbao aoth 3naTH ^enap'raMeirry 3AopoB.ia, a /l,enapTMeHTb niin.ie caab no Ti p^qa, noAAacTb hxb Ae jan^eicuin Ta 3Bepne nxb B.iacTHTejieBH 30BctMb 3a Aap- mo, a6o Ha ataAaHn snaiitarb. Ec.ia cyxiraaRb iiepeiipoBaA^cye cn, to J^enapTaMeHTb o TiMb MVCHTB 3 HaTH. OcTeptraeivio xopbixb na cyxiTbi, modbi He yMHBa/in fioraTo tJ>a^bUJHBbixb, a nacTO Aoporuxb cpeACTBb h ^tKapcTBb, Ta modbi He noAAaBa/incb oro^oujyBaHHbiMb ,,cneui- a/ibHbiMb“ MeTOAaMb ^eneHia cyxiTb. BbMtneHiH cyxiTb He MOfflHa cnoA^BaTHCb BiAb caiviow oahoh weAHUHHbi, HKb Ta- Komb BiAb ocod^MBoro cnocody ^tneHa, a^e Ti^bKO BOAb nypauin BCWAbi y3HaHOM 3a bma- HOBtAHy* KOTpa no^arae Ha CBtmiMb B03byct, 3aHHTio no 3a AOMOMb ado Bb now m A odpbixb nomMBHbixb CTpaBaxb. flapoAna Jiiqnnuei (a dispensary ) 3icTaJia OTBopena na G-ia Avenue i 55-ift y.iau;H 7 Ae 6e3njiaTHO JiiqaTB cyxora, i AeJianapi, AodpoAifini TonapacTBa i iiiini MoacyrB 6 noAidHMb cjiyqaeix yAanaia cei. B paai noTpedi dpAe po3AaBaTHCb mojoko i JiHiti. Taa Tauoac MoxcHa OAepacaTH na- nepoBi n.ifOBaqKH, i tum MOiKiia npocHTH o iiieTynua (nurses) ao xo])iik b Aoaa. YpeiAOBi toamhh BiA Id pano ao 12 b no-iyAne, i BiA 3 a° ^ no odiAi KoacAoio Anei. BiA 8 — 9 BeqepoMb b none;uAOK, cpe,iy i neiTHHueio. JIioah, KOTpi du HOT'b.ia AOB’bAaTHcB AC‘in .0 di.iBUie, ado xoTfcJin dbi noMoqa, muiotb 3BepTaTH cn AO Department of Health, 55 lh Street and 6th Avenue, aoo AO The Charity Organization Society, 105 East 22nd Street. 3 a ypnAb SAOpoBJia T epMaHb M. Eirrct, M. ToMacb flapnuiHrTOHTD, M. A. Orapmm .1 i>Kapi». UpeActAaTej.b. 135 L — 1905 18a- 831, *05, 2,500 (P; CONSUMPTION IS A PREVENTABLE AND CURABLE DISEASE -» ■ < Information for Consnmpfives and Those Living with Them DIVISION OF COMMUNICABLE DISEASES department of health SOUTHWEST CORNER SIXTH AVENUE and 55* STREET NEW YORK nsumption is chiefly caused by the filthy habit of spitting caused by colds, althougtTcok! may'mS •“ take " fr ° m ° therS ’ and is not s ™ply very minute germs, which usually enter 7 W * tak ' e the diMa “- II * «-ed by consumptives cough or spit up contains tl the 3lr breathed ‘ The matter which discharged in a single day. This matter T gCrmS “ gfeat numb ers-frequently millions are apt to become powdered and float in the' ^ T" ^ fl00^, Wad ° r eIsewllcre dries and is they enter the body with the air breath^ ^ dUSt contains the germs, and thus in doors. The breath of a consumptive dn ^ HkeIy t0 be dan ^rous with- disease. A well person catches the disease 1”°' C ° m3in ** .* maa and wil1 not P™duce the in the matter coughed up by the consumptive. ° m 3 C ° nSUmptlve onI y b y in som c way taking “ “" ta ■ n< ' i( w Tt 1S not dangerous to live with a ™ c Promptly destroyed. Tbis “ pt,,e ’ ,[ > h ' "“Her couihcd „„ by | llm be if Porriblt, i„ , eu k . P " “ pon th ' ""or, cttrpct, Move, wall or side- '»< «k« matter will d ry , or b J, d T "' “ P ‘"°' M “”<*■ >« tcaspoonfuls i„ . p int r b ““ “ “,' d “ » P=r « watory , 0 |„,i„ n (.1.., «h water. beT, l7‘T, ’° >M Wi,h * hc “««H.\X7i.Vtt7“d hantlS - “0 olothing at all or~ C T ^ ' ,' C< WltI * soap and bot water. Kf cn w j. b ° ecome thus soiled, they should r : r r “-rr :r: r : "-nf ^ ^ receive" tl, " ' m ° Uth dUring these acts ! otherwise Th^ ^ *"*** h ° Id 3 hand kerchief -c >ve the matter coughed up should be a fl M Z ° f doths a " d handkerchiefs to ' CPara ‘ ed a " d scatter ed into a t S hT“r U ^ hlt ’ it readily dries CUPS ° r Hask *- Paper cups are h.u' .u . ^ p0Ssible ' thc matter better than ordinary cups, as the former SUCHOTINY gft nemoeou, ktor& inoze byt zamedzen& a ktora sa moze vyliecit. Uyravy pre suchotiMrov a tych ktori s niiui ziju. OD YRCIINOSTI YEREJNEIIO ZDRAYOTXICTYA, J 11 /no /apailur roll 55 ulice a 0 Avc. v New Xorku, X. 1. SUCHOTINY SA NAJCASTEJSIE ZAPRICINUJU SKRZ ZLOZVYK PLU VANIA. Suchotiny su liemocou pine, ktoro nie skrze prcchlndenie, ale leu skrze nakazenie sa zapincuiuju. Pri istych okolnostiach prechladnutia tym osobam, vystavene su, mozu sa t\c&6 lalisie cliityf. ktore nakazaniu suehotinami so CIll “Uj IliUZU t-tl UkZC lclIIOIV/ V '• . , . . / /. ... \ | / l y * Sucho.iny skutednezaprif-inuju male nevuhtelne zvicratka (bacilly) ktore obyeajne vzihichom, lctorf vdvcliujeme, do tela dostaueme. ... ^ i / / i ' * l . „ xl .... nU.l./, ifvi.rnT.ni/. .tlt.Miluiio i r eolin tieto Ked tato cnRiuuutuiiu, piuuuiuiJB mi ^ ^ — yy’ r ;t — , . . imle sa vypl’ujc, ona uscline a na prach sa obratiac s druhym prachom ovzuusia aalej zattasana byva. # . , . t , , . , i , , Sain lento utly prnce obsahuje tie zYieratka a ich zarody, ktore tuto cestou s vdychovanim povertia do tela sa dostarai. Tento prach je lilavne v izbc nebezpeenym. Dychanie suchotinara procz ked on kasle alebo kycha, nebsahuje v sebe ziadne bacilly a nni je ono, jak take, nie nicbezpecne a preto, ked by ono aj druhym ydychnute bolo, cho- roba sa tym neprenasa. Zdravym osobam sa suchotiny od suchotinara len tak enytit mozu, ked ich chrachotlina alebo jej eiastka sa do ich tela na dajaky sposob dosta e. Suchotiny sa mozu dasto vylieCit, ked dost veasne priroda nemoci sa spozoruje a ked lined potrebne prostriedky ku jej licdcniu sa upotrebia. V najviac padoch suchotiny su nie smrtonosne. . . Pre zdravych je nie nebezpeenym spolubyvanie so suchotinarmi, jest It ten char- chotlina sa lined’ zuifti Chrachotlina siichotinarov noma a by sa vyprayat ani na potllaliu, na ealuh na pec, na stem', ani na poulidne cliodbiStia, alebo kdekol’vck inde, ale mala by sa do ku tomato ciel’u vzdy napohotove stojacej osobytnej midoby alebo my sky sberat Aby chrachotlina nemohla uschnuf, masa dotakych nadob trocha vody, alebo esto lepsie 5 proccnto veho karbolovcho roztoku (6 kavovych lizieiek karbolovcj kyscltny na jeilnu pint u vody) vliat. Skrz tento karbolovy roztok sa zarodky zvieratok usmrtui a po- nevac roztok ten jc jedovatv, ma byf len vcl’mi pozorne upotrebovany. Kusberamu cltra- chotlin ust ano vend nadoby maju byf aspon raz denne do olnia alebo do zachodu rypraza- nend, potoin starostlive horucou vodou ocistene a zas trocha ton horezpomenutou karbo* lovun kyselinou naplnene. nUhn Suchotinari musia 11 a to daf pozor, aby chrachotlina na ich rukacli, tv art, aicoo na satoch sa neprilepila a v takom pade musi byf lined mydlotn a horucou vodou odstra- nena. Suchotinari by ncmali nosif bradu, ale len 11 a kratko obstrihane luzy. Suchotinari von z domu, mali by zvlastnu z papicru vyhotovemi, a ku pi .v.fnttAffnmi ftot-L'n cn «ohnn nnsi f [’uvaiiiu mracnoiun ustano>enu immvu bu atuuu f r Tato flaska ma sa lined po prijdeni domov, so vsetkym ako je, do olma nojut. jaui sa nl’uje do vrcckovych Sutak (bezccune liandry su ku tomu ciel’u naj|>rimcranej8K') tas .... v.» »-\rvt iwuim v v iinnwwi mvdlovci vodo vvvnrif a to nrv ne^ by as mai) vreckovych Satak pre pl’uvanic chrachotlin do mch, mabyt bytuie, poncvao clirachotliny mi satkach chytro sclmu, odpaduju a potom sa s ovzdusim mieSaju. Pravepreto chracho- tliny inajii sa, kcdje to Ten mozno do hrufcekov alobo do mysiek sberat. Papicrovh ta- niere majfi mat prednosf, prod druhymi nadobami, ponevah tic po uzivaniu, mozu byt zpalcne spolu aj s ich obsahom. Lactia a vhodna nadoba z papicru, alebo z papierovej lcpenky, pre tcnto ciel’ je skoro v kazdcj lckarni k dostnniu, a moze si ju nemocny aj so scl)Ou brat, ked ido na prechadzku. Nemocni, ktorisu prislabi ku toniu, aby flaSku alebo tanka* unotrebovat mohli, mozu upotrebovat mokre haudry, ktore po icli uzivaniu lined zpalene byt musia. Okrcm doinu, tieto mokre handrv alebo satky, musia bud ulozene do vodovzdornej obalky, prv nez by do vrccka ulozene boly. Tatoobalka, pripadue dohanove vrecko, alebo podobne, musi sa 6asto vyvarit. Suchotinari nesmeju clirachotliny nikdy prehit nut. Suchotinari maju mat ich osobytnu posted a kde mozno aj ich osobytnu izbu, ktor$ vzdy dobre prevetren, byt musi a obloky maju byt v nej den a noc otvorene. Zaspinene pradlo, postelina atd. nesmeju byt viac, lem jako treba dotkynane, ale sa maju lined do vody vlozif, Ked sa clirachotliny dokonale znicia, tak suchotinar 6asto moze byt v sfcavk aj svoju obyeanjnu robotu sprevadzot bez toho, aby i druhich ludinakazil. Skrze robotu sa stav liemocnclio aj slcpsuje aj zvacsuje vyhfcid na iiplne uzdravenie. Kcdje dakto v tom podozreniu, ze je na suchotiny nemoenym, taksama jehomeno a adress lined skrz postovu dopisnicu zdravotnickej vrehnosti pri opisaniu okolnosti oznamit. Icden lekarskv uradnik zdravotnickej vrehnosti, ked nemocny ziadnehoosobytneho lekara ncini, sa lined dostavi a suchotinara vrekuma; kcd je treba lined porobi poriadky pre zaobchad zanies nemoenym tak, aby sa choroba druhym nechytila. Izby, v ktorych suchotinar byval, prv nez by zas do uzitku vzate boly, musia sa zakladne vycistit, zamiest, znovu obielt, vymalovat, alebo vypapierovat; calunc, rohozc, postcle, periny a til. se musia z tych izieb, kde suchotinar byval odstranit a desintfeirovat. Take proilmety zdravotnickavrchnost bezplatue prevezne, dcsinficiruje a majitcTovi zas prinavrnti alebo na zvlastmi ziadost zniei. Ked suchotinari premehuju si byt, to ma byt lined zdravotnickej vrehnosti ozna- niene. Suchotinari su tymto vystryliane, aby tie innolie zavratnicke a ninolio raz vel’ini vychva lovane likely.a hojenia neuzivali, ale aby sa aj lined tym zvlastne ohlasovanym osobytnynt sposobom liecenia suchotiu nepodhodili, Vyliecenie suchotiu sa nemoze ocakavaf od jednolto jedineiio lieku, alebo zrlastneho liecivieho sposobu, ale leu skrze jednie za skrze povazovane liecenie to, ktord sa zaklada ua sviezom povetri, zamestuanie you z do mu, skrz pol’nu prficu a zazivne jedla. Suchotinari ktore moze vstopeni v sanatoria, musi robiz to odrazv. Slobodne lekarne (Dispensaries) su odkryfce : na Manhattan— na sestci avenue a 55 ulicy., Poradne liodiny od 10 pro pol. do 12 hod. do obeda, a od 2 do 4 hod. po pol. kazdelio robotnebo dha. Od 8 do 9 po pol. (vecer) v pondelek, vo stredu a v piatek. na Brooklyn — 361 Dzej (Jay) ulici. Poradne liodiny od 2 do 4 hod. po pol. kaz- deho robotneho dha. na Bronx— 3-tli avenue a St. Paul’s Plape. Poradne hodiny od 2 do 4 hod. po pol. kazdelio robotneho dha. V pade potreby budu rozdavane mlieko a vajee. Tiez kapesne phvatka mozno obdrzaf a ziadosti mozu byt podane o oSetrovatel’ov, aby cliori boli navstiveni v ich bytoch. Osoby, ktore by dalsie v.Csvetlenia ziadali, nech sa obratia na “The Department of Heath 55 ulica a 6 Ave.” alebo na: “The Charity Organization Society, 105 East 22 ulica,” v New Yorku X. Y. Na rozkaz zdravotnickej vrehonosti, HERMANN M. BIGGS, M.D. THOMAS DARLINGTON, M.D. hlavny. predseda lekar. JJ\ G H 0 T Y SA DO ZWALCZENIA I ULECZAN1A. Przepisy do zaciiowania dla suchotnikow i tycli ktorzy z nimi iyfa. Oddzial zarazliwych clior6b. URZAD ZDROW1A PUBLICZNEGO South-West, r6g 55th Street i 6th Avenue, New York, Suchoty rozpowszechniaja sie najwiecej przez nieodpowiedni zwyczaj plucia. Suchoty sg chorobg, ktorg sprowadza nie przezigbienie, lecz zarazenie. Przezigbienie moze, wcdtug okolicznosci, uczynic osoby, narazone na zakazenie su- chotami, do nich bardziej sktonnemi. Wiasciwg przyczvng suchot sg male niedostrzegalne zarodki [bakterye] ktore do* stajg sig do ciala zwykle razem z wzdychanem powietrzem. Plwociny, jakie suchotnicy wyrzucalg ze siebie przy kaszlu i pluciu, zawierajg w so* bie owe zarodki w takiej ilosci, zc nieraz w jednym jedynym dniu cale milionyich, razem z tymi plwocinami, wydziela sig. Jezeli owe plwociny, peine zarodkami, dostang sig na podtogg, na sciany, lub gdziekolwiek bgdz, wysychajg, proszkujg sig i w postaci pyhi dalej w powietrzu sig unoszg. I wlasnie ten delikatny pylek zawiera w sobie owe zarodki, ktdre tg drogg, razem z wzdychanem powietrzem dostajg sig do ciala. Ten pyl jest najbardziej niebezpiecznym w mieszkaniu. Oddeeli suchotnika, jezeli on nie kaszleje i nie kicha, nie zawiera w sobie bakcyli i sam sobg nie jest niebezpiecznym, stgd tez i nie moze, chocby nawet wdychauv, przeniesc dalej slabosci. Osoby zdrowe mogg zarazic sig od suchotnika tylko wowczas, jezeli do ich ciala dostang sig w jakikolwick sposob jego plwociny. Suchoty mogg bye czgsto wyleezone, jezeli tylko natura choroby zostanie zawczasu dostateeznie poznang i natychmiast uzyjesig odpowiodnich srodkow przeciw nim. W bardzo pielu wypadkach suchoty nie kodezg sig smiercig. Zdrowi mogg bezpiecznie mieszkac razem z suchotnikami, jezeli plwociny chorych natychmiast sig niszczy. Chorzy na suchoty nie powinni pluc ani na podlogg, ani na obiti, ze osoby, ktere se suchotinaH ziji, stanou se nakazc pristupnejsimi. PAvodci souchotin json male, pouhemu oku neviditelna zviratka (bacilly), ktere se dostanou do plic vdeehnutiin. Chrle, ktere souchotinari vykaslou aneb vyplyvnou, obsahuji takove ochromne mnofcstvi bacil, ze mnohdy milliony za jedcu den se jicli vyplyvne. Kdy2 tyto chrehle plue bacil sc vyplyvanou na zem, na steny, napodlaliu, aneb vi\bcc nekam, kde usclmou v prach, kiery pak vetrem odnescny, tuto nemoc rozSinye. Tento prach obsahujici vzduch do sebe dychame a jest nejiubezpccnejSi v po* kojich a loznicich. Dcch souchotinare bacilly neobsahuje a neni tedy sam v sob$ nebezpecny, i kdy2 se vdechne, jen kychuntim neb sakaslan&n pramo do obliCeje prijde nakaza. Zdrave osoby inoliou by tf jen tehda nakazenl, kdy2 se chrle souchotinare dostanou do jeho tela. Sruchotiny mohou by ti vyleSeny, kdyz se nedub v cas pozna a ihned se u6ini potrebne kroky k vyleceni. Yelke ninozstvi souchotin jest vyle6eno. Obcovani zdravych liki se souchotinari neni nebezpecne , kdyz se chrchle ihned zni6i. Chrchle souchotinaru nemaji scna zem, za kamna aneb jiuain vyplyvat, nybrz maji se vyplyvati do prichystand k tomu nadoby. A by chrchle nemohly uschnouti, ma sedati do nadob trochu vody, aneb jest lepe 5 proc. korbolku upoutrabiti. ( 6 lzic ciste karbolove kyseliny, do 1 pintu vody smesit). Y teto karbolove vodi bacilly zahynou. Protozd jest tato tekutina jedvata, musi se sin opatrnd zachazeti. Nadoby pro chrchle maji by ti 2 kratc denne vyjnozdnene a o2dy po upotrebem horkou vodou vymyte. Souchotinari maji na to dbati, aby se §aty chrchlemy neznecestily a kdybyse tak stalo, maji byti saty ihned horkou vodou umyte. Muzi, kteri souchotdmi stizeni jsou, nemaji nositi velky vousy, stodi maly knir pod nozau jest lepad zadny. Na ul ici meli by s uchotinari miti vzdy papirovou lahev, do ktere se chrchle vply- vati maji. Tyto papirove lahve maji byti po naratu do bytu lined spalcne. Kapesni satky do kterych se chrchle vplyvnou, maji byti noj drive nejmene V6 hodiny v mydlovc vodo vyvarene a potoin teprve maji sc z druhym pradlein smichati. Pri kaslani, anebo kyclian 1 vyplyvne souchotinar v innechych padech chrchle na zem. Aby to zamezil, ma si k ustam vzdy pridrzeti kapesni satek. Ye vsech jinych padech s$ kapesni satky uzivati nomaji, ponevad2 chrchle velmi rychle uschnou a nebezpe6i uozgireni se nemoceje v6lke. Chrchle se maji v&bec vyplyvati jen do nahorc zminenych nadob. Nejlepsi je, kdyz tyto nadoby jsau z papiru, poncvadi so mohou po upotrebeni hned spaliti. Takoveto papirove nadoby jsou velmi lacine a kazdy si je mftze v lekarnach koupiti a na ceste ssebou nositi. Ncmoc- nf, kieri jsov ptislabf, aby mohli takovouto nadobu sseboi nosi-i, mahou u2ivati i tylhke hadricky, ktere se maji po upotrebeni lined spaliti. Kdv2 se souchotinari nachazeji na prochazce, maji miti tyto liaddHsky uzavrene v nadobce (waterproof), a potom teprve maji se dati do kapsy. Spolknouti se chrchle nikdy nesmeji ! Kazdy souchotimir ma miti svoji vlastni postel a die moinoosti i svtij vlastni po- koj, ktery musi by ti vzdy dobre provc»treany . Okna maji byti dnem, i noci otevrene. Neciste pradlo, pod u sky na postel a j. nemaji byti nadarmo ochmatavane a majise dati lined do vody . Kdyz sc chrchle ilmed zuici, jo souchotinar v mnohych padcch vstavu, svoje za. mestnani vykonati, beztoho, aby nekoho nakazil. Pracovanim se vi\bec stav nemocneho polepsi a vyhledy na uzdraveni jsou vetsi. Kdyzje nekdo v podezreni, ze ma souchotiny, masc jeho jmeno a adressa lined oznamiti zdravotnimu ui-adu na postovnim listku, na kterem se maji v§echny okolnosti die moznosti popsati . Uredmk lekai-skeho ustavu takoveho nemocneho potom lined navstm a na soucho- tiny prezkouma. V pade, 2e by se podezreni potvrdilo, udela lined zaopatreni, aby se nakazcni jinych osob zamezilo. Pokoje, ktere byly souchotniari obydlene, musi byti dftkladno vy6ist6ne, prevap- nene a novymi tapety prelepone. Teppic’iy, postele, pradlo a jine podobne veei museji se dcsinfikovati. Takoveto ppedmety si zdravotni urad sam odnese a desinfikuje a posle zase zpet. Na itxdo t majitele je take zni Kdyz souchtinar zmeni svdj byt, musi to zdravotnimu uradu lined oznamiti. Svetnicc maji so eisiili kazdy den, aby se vsak zamezilo, aby pracli se nezvedl jest treba prel ci tenim prodlahu navlhditi co se muze nejlepe mokrym liadrem u6initi. Souchotinari jsou timto varovani, ruzne, v novinach nabizene leky a jin6 leceiii uzivati a nepodrovati se riizaym svindlerskyin zvlastnim inethodam. Suchotinar, kdo 111 a pribrihost jiti do Sanatorium ma jiti linet. Dispensaries byle zarizcny na seste avenue a 55 ulici, Maidiattan; 361 Jay ulici, Brooklyn a na 3 avenue a St. Paul’s PL, Bronx, kde za darmo lcceny jseu souchotiny (is leuy) a kam so mohou v podobnych pripad ch obratiti lek iri, dobrocinnc spole6nosti a pod. Paradni liodiny: Manhattan — CM 10 hod. rano do 12 v jioledne a od 2 do 4 hod. odpoleduo kazdeho vsedniho due. V ponedeli, ve strcdy a patek od 8 do 9 vecer. Brooklyn a Bronx: Od 2 do 4 hod. odpoledno kazdeho vsedniho due. V padech potreby rozdavaji se mleko u vejee. Tez kapesni plyvatka inozno ob- drzeti a zadosti ohleden osetrovatelu mohou byti podane, aby nemocni byli navgtiveni v jejich by tech. Takove osoby, ktere by si prali dalsi ponaueeni, aneb pomoc, nechtt se obrati na: The Department of Health, 55th st. & 6th avenue, anebo u The Charity Organization Society, 105 East 22 street. V narizeni zdravotniho liradu, HERMANN M. BIGGS, M. D. THOMAS DARLINGTON, M. D. vrehm lekaf. president. . iSi 4 38SB#ft4SI iWSS-MatIBW&StSiC fei^:^3fc:=*»BaKS4S#&30rEWt l^>SS&BW»r*-fr-»l3Brl l<4HMBSDr4S f$:«i&:&$tt£lil3»4# I S3*WH-^ iSs«©>*apH'»©*N-si3ff»©ae= >4* ^WiwK^n&SSlSSHf >«3ii£lse»» #n >ff a}®S±tS^>a»^Nl- ^S3e®^ ;-H*554 t E-h-£ffPi!SRSS&-M4tft3 ! ^WW^HoltSJWPHaSff^ffJSE :(g) (g) (g) (g) 176 L — 1908 21-460, ’08, 3,000 (P) DEPARTMENT OF HEALTH * THE CITY OF NEW YORK DIVISION OF COMMUNICABLE DISEASES SWEEPING AND DUSTING In sweeping a room raise as little dust as possible, because dust, when breathed in, irritates the nose and throat and often sets up catarrh. Some of the dust breathed reaches the lungs, making portions of them black and useless. If the dust breathed contains the germs of tuberculosis or consump- tion-tubercle bacilli— which come from persons who have pulmonary tuberculosis spitting on the floors, the risk is run of getting the disease. If the sick person uses proper spit cups and is careful to hold a handker- chief over the mouth when coughing or sneezing so as not to scatter spittle about in the air, the risk to others who live in the same rooms of getting the disease is inconsiderable. Before sweeping bare floors, sprinkle moist sawdust on the floor. When the room is carpeted, wet a newspaper, tear it into small scraps and scatter these over the carpet. In sweeping, brush these scraps of paper along with the broom and they will catch most of the dust and hold it fast, just as the sawdust does on bare floors. Do not have either the paper or the sawdust dripping wet, only moist. In dusting a room, do not use a feather duster or dry cloths, because these do not remove the dust from the room, but only brush it into the air. Do all dusting with slightly moistened cloths and rinse them out in water when finished. In rooms with bare floors [in houses, stores, shops, schoolrooms, etc.], all dust can be easily removed after it has settled, by using a mop, which has been wrung out so as to be only moist, not dripping wet. THOMAS DARLINGTON, M. D., President , Board of Health . Eugene W. Scheffer, Secretary . Hermann M. Biggs, M.D., Medical Officer . nrsbyn tin tMyDcriKBjn .pmijMinp mappyowa pa ai^nea* ♦IP^csty pN jyinyp P™ ^ /»»» nm •pburo xm bdxo pyoD’s x aanyp a?vx tyn ps nxn ojn B'o 1 x 3 ojn «px oy aaya aoynBxyjj”x wi a’lBw ayjyn 3’iBir jyBoynBxyj3”x oya ps V”nB x .aaxoxp is bsx [yasyaa typ oy .axasoaix pK aaxn ,pxiny "i pe jyV’na yo’iiya oaxo oy p* jyaii 1 ? xn ay"i ps jyaxap’o aSxnBjy bsi 1 ? ay a B'o p’x Boynax arpx oxn a’lBiy aya a'ix rp, x pr'siff ynya” 1 ? lytwjoxoaxp ps jyoip yoVyn ly'jS’sxa-oamyso’ix 0 ix) ,jyiyBoxo3Xp ;yoipya is anxsya px aoaSyj a’x B”i jxa pxxSe oya ( oannyx -3’ix jyj-i px iy'jaxppiBiy yBya»xya tysi3yaya3ya”‘nyiyBoxojxp a^x ■ijxn xh ayax -pB-jyiyxo x paSxn is |yoD’3 ayax jyoovt ”j :yn cxipayo B^pj'D’^sy-ijypyBiyjx yoayii jyB”78ttnsis B’3 oix hx S’va px jx: oya aya’x xh ”3 B«np)xnp ypa jyoipya is nnxsya n B’oxa rx ;xa ,bsi^> aya px •P3XBW vn payoo’s yaSyra px jyjnxu ya^yn yapynysjx B’o ayoo’s x panyp px 3"Eii’ jyo’iu x jya”oays is nix Bpynys aysaxp B’o rx ayoo’s oxa jyn .jXBwSyayj yoa”s Bs»ya oaxxSs iy?p'Biy y:”?p px oy ao”ais (J3 '.B”s) ays”s jyBpmya x B3”s oaxo ;xa on3 oya B’o D’ix aanyp panyp 0”3 .aysaxp oya aya’x oy B”asiyis ’ix djh ps yooanyo n [yony3is pSyn ”j px ays”s ayVp’oiy y3” l ?p yiyn yapyayasix ^eme [xsaWt 71 m r bi jyaVxn My# W m,£K ,B3”s 313 , 00 x 3 by'B is B'3 [xsiySyayt ’a "pix ’11 ays«s n oaxo .D'xxpc B'3 onyo”iny Dxa *?”ii pyaoirpyays p’p oxoya ayoo’s x lya’ioiy px Bsi3ya .p’ax osv? n px 3 ’ibw oya eanyp oy pyuxj ,on ps a’ia\y cya pyBDjys n -jaia cpix bsx Dy BSypxiy px jya’iDw 01 s asxiiya y 3 ypro yy^n an’X jyn ayoxn px ^aia oy Biyxn px a3xnya yByBa ,, Bya't3a' , S asi3ya ayax .ayoo’s ps o’iax a^Biy oya a,TX oaynp oax jytra ^’ix .B3'a3yya oxn pysyiy ,oaxBo ,ayi”n ps DBia px a’lBiy oya pyBrnay ay'b tyn ;yo , 0 ’ix awm [yo jyn ,DaxxSs yapyayasix jyaxn yaSyn .« .r .x pyo'rSwo B’3 px jyaa”3 x B’o caxx^s xn ^jypya oxn a’lBw aya ’11 Dyaaxs «(BXO) |yBX*7 jyoxs •“» *0 DNONfTD •yeSyn nx aaxxa ps asyaayas ■1 .0 DJ’3 *0 fNOl^n .ayooxyaays’s’ayo 2>ie <5esunbbeitsbeb6rt>e bcr Stabt IFlew l^orlu • * i » 5lt>tbcilun« fiir aitftccfcnbc Kvanf^Ucit. jfegen unb Hbstauben. Seim gegen eine§ 3immer§ ntufj moglidjft mcnig ©taub per- urfadjt tDerbcit, ba biefer ©taub, roenn eingcatbmet, bic 9?afc unb bie 5?e£)Ie ongreift unb einen Catarrh oerurfadicn fnnn. ©in Sdjeif biefer ftaubbelabenen Sufi gctangi in bic Sungen unb madji fie tfyeiU roeife fd)iuar3 unb nu($Io§. SBenn biefe ftaubige Suft $eime ber Suberculofe obcr ©djminb* fucbt — tubercle bacilli — cntbdlt, iveldje bic @d)tpinbfiid)tigen burd) baB SfuSfpuden auf ben gufeboben Derbreiten, ift eB befonber£ gefabrlid), bie ^ranf^eit 311 befommen. SBenn ber ®ranfe gecignctc ©pudnapfe gebraudjt unb beim §uften unb 9?icfen ein Safdjentud) bor bem SMitnb f)alt, um ben ©peid)el nidjt in bie Suft fliegen 311 laffen, ift bie ©efaljr fiir anbcre, in bemfelben 3inuner SBofjnenben, non ber Sfranfbeit ongeftcdt 311 luerben, dufeerft gering. 93or bem gegen blofjer gufjbobeit tncrft feudjtc ©agefpane nuf ben guffbobcn. S3 bet Soben jebod) mit eincnt Seppid) belegt, ge» braudjt naffe 3000 (p) Reference of Case to Executive Office for Hospital, Charitable Aid, Etc. No Name. -Age. Address. Rec. to. Floor. -Hospital. To (C. 0. S.) (A. I. C. P.) (U. H. C.) (B. B. C.) Remarks Date — _ — -Referred by. 214 L — 1908 21-481, *08, 3,000 (P) WA I T I N G LIST ( Institution ) Name M. F. Address Borough Date Clinic No. Recommended by Examined by • Accepted— Rejected igo , by M.D. Admitted to Date l (a) Riverside Sanatorium for Advanced Cases, on North Brother Island, East River- All cases are admitted through the Division of Communicable Diseases, the names and ad- dresses of applicants being placed upon waiting lists (Form 214 L), kept in each Borough. Each Borough has its own allotment of beds and its own waiting list, which is filed in the respective Borough office. When a vacancy occurs an admission card (Form 32 L) is filled out, for the first eligible case. (“Forcible removal” cases alone take precedence.) This is assigned to a nurse for delivery, who obtains data called for on card, and leaves same with patient. If coupe or ambulance is necessary, the Department Borough Hospital is requested to remove the patient. jU * «rt ;^t 32 L— 1907 21a-317, ’07, 2,000 (P) DEPARTMENT OF HEALTH CITY OF NEW YORK Division of Communicable Diseases BOROUGH OF- .190 Name Age....... Removed from Floor. Care of.. Recommended by Color Sex. Single Mar. Wid. Occupation Diagnosis Remove to. Hospital. Ambulance or Coupe. Chief of Division , •i B 9 V 9 9 & 9 H i* £ 0 H c J) H H r j) c\ H % a H <1 o o 0 (V r3 bC .s o £ a a> o 0 TEL s ! ! . 13 ; S .1=: M. ital M. ; > A i *E t/> ! 5 o © i® W B : « ! § © 3 © : P a >* 4-> ; “ +-* • a q, 5 : CC c — GQ .2 .S bC o 0 Li s 00 00 J? Ui ^3 a? o ^3 Li S Li a? X3 c3 "3? §! L-« o ^ L a o o * £ e o a > o g 3 B rQ 2 T3 o ‘3 o © PS o 0 © o £ £ a, a o B All cases must reach Reception Hospital at East 16th Street, Manhattan, by 1 P. M., as the boat leaves at that hour. Walking cases may cross at East 132d Street, whence a boat leaves every hour between 9 A. M. and 5 P. M. Information regarding visiting days and hours is given in four languages on a special card (31 L). 31 L— 1908 275, ’08, 2.000 (P) This card to be retained bif visitors Department of Health RIVERSIDE SANATORIUM, NORTH BROTHER ISLAND VISITING DAYS AND HOURS TUESDAYS AND THURSDAYS— Boat leaves landing at foot of East 132d Street, The Bronx, at 10:15 and 11:15 A.M. Returning leaves Sanatorium at 11 A.M. and 12 Noon. SUNDAYS— Boat leaves landing at 1:15 and 2:15 P.M. Returning leaves Sanato- % rium at 2 and 3 P.M. Dlrae Karfe soli d»-r Jicsuchcr behalten Sanitats - Department RIVERSIDE SANITORIVM VON NORTH BROTHER ISLAND BESUCHE-TAGE UND STUNDEN DIENSTAGS UND DONNERSTAGS -Das Boot verlasst die Landung am Fusso der Ost 132. Strasse, in The Bronx 10:15 und 11:15 ' ' T 'is Boot kchr* zuriiek vom Sanitorium 11 und 12 Uhr Vorpittags. SONNTAGE — Das Boot verliisst die Landung 1:15 und 2:15 Uhr Nachmittags und kehrt zuriiek vom Sanitorium 2 und 3 Uhr Nachmittags. Quanta carta dcve csscre ritcncsta dal vlsitaton Departimento di Sanita RIVERSIDE SANATORIUM, NORTH BROTHER ISLAND GIORNI E ORE DI VISITA MARTEDI E GIOVEDI — II vapore parte al piede di E. 132d St., The Bronx, alle ore 10:15 e alle 11:15 A.M. Al ritorno pane dal Sanatorio alle 11 A.M. e 12 M. DOMENICA — II vapore parte alle 1:15 e alle 2:15 P.M. Al ritorno alle 2 e all 3 P.M. iioum an jyEnxi yo-ixp y?jm . t]R Djjwwari .{inaitaw -nix 3;D-yaii"3 "ijnsoa onxi jib nnxo’jKD T'Dijwn ”3 ojn jib ek enyi ( -tc ) en»3 kh .DJKDttnjnjO px Disown nne pR ll * 5 pR lo 15 cr /Dp:R-n rh pr jtdd&iw ijro‘132 .JtRD'H 12 pR 11 cr dihrd^rd DJH pfl er cpt? rh pms pniY .DJRB'DDRJ 2 13 PR 1 15 CR JH5R? Opl ps ER S\'V RH . DJSRB’DDRJ 3 pR 2 DR BR R»T t2n*tt DRHRDORD 0JH pfi (b) Otisville Sanatorium for Incipient and Favorable Cases, at Otisville, Orange County, N. Y. Applicants must be examined at one of the Tuberculosis Clinics of the Department. If suitable, their names and addresses are placed on a waiting list, with the date of applica- tion (Form 214 L, see page ). 58 bi I When vacancies occur, notice is sent them and they are furnished with a printed slip giv- ing rules and requirements (Form 227 L). Transportation is furnished by the Department. No patients are allowed to travel to or from the Sanatorium unless accompanied by a physi- cian of the Department. Patients leaving on passes must pay their own way. The same primary and later history, throat, clinical record and diagram cards are used in both insti- tutions as in the tuberculosis clinics (q. v.). In addition temperature records (Form 210 L) are used in the sanatoria. 227 L — 1908 21-485, ’08, 1,000 (P) DEPARTMENT OF HEALTH THE CITY OF NEW YORK DIVISION OF COMMUNICABLE DISEASES -T UBERCULOSIS CLINICS= NOTICE TO ACCEPTED CANDIDATES FOR OTISVILLE SANATORIUM READ THIS NOTICE CAREFULLY Yon have been accepted as a suitable case for treatment at Otisville Sanatorium. Your name has been placed upon a waiting list. When a vacancy occurs you will be notified to present yourself at the Tuberculosis Clinic, 55th Street and 6th Avenue, Borough of Manhattan. If under the influence of liquor or smelling of the same, you will be rejected. You must not take liquor with you. You must take with you tooth brushes and powder, and a hair brush and comb. In addition to a suit of working clothes, heavy shoes and a cap, you should have three suits of underclothes at least, three pairs of socks or stockings, a cardigan jacket or sweater, and arctics. All shirts must be of soft cotton or flannel. Mittens are necessary in winter. While at the Sanatorium you will be expected to do light work, according to your ability, as directed by the Resident Physician. You will receive no remuneration for such work. You must agree to remain at the Sanatorium for at least three months, and as much longer as may be thought necessary by the attending physician. No patient in Riverside Sanatorium is allowed out on pass or is discharged, until the con- ditions at his home have been investigated and found satisfactory. A daily report of all deaths, discharges, and admissions (Form 209 L) is received each day, and added to daily report to Sanitary Superintendent. A weekly report of condition of patients: weight, tem- perature, etc. (Form 208 L), is received each Saturday. Both are kept on file in the Execu- tive Office. 209 L— 1908 21-477, ’ 08 , 5,000 (P) DEPARTMENT OF HEALTH THE CITY OF NEW YOKE (Name of Institution) (Address) 190 To the Chief of Division of Communicable Diseases, Department of Health, 55th Street and Sixth A\enue, Nfa\ York. Sir: I have the honor to submit the following report of admissions, discharges and deaths from tuberculosis in this Institution for the 24 hours ending at 4 p. m. 190 Name Admitted Discharged Died Address Rp.roarVs A patients are not receiving the proper ^me*eal ^ card to one ot the choice terming the Association ot ^ ^ t „ the (Form 48 L) being used, one-halt tang g.ven to the pat.ent, clinic. Assigned to Date " To visit and ascertain why patient has not applied at clinic for treatment. ist Visit 2d Visit Signature (Nurse) Clinics for the Treatment of Tuberculosis MANHATTAN Departm ent or Health 907 H °" day9 ; BELLEVuV^O Yp^M^Cta^atteirt De^artmiatt. footof East 26th Street. Daily, except Sundays and Go u v E R H NEUR Hos P ital; Water Street, foot of Gouverneur Street. Monday. Wednesday and Harlem ' Hoipi^tf 'x»6th Street and Lenox Avenue. Daily, except Sundays and Holidays. 3 to Presbyterian Hospital. Madison Avenue and 70th Street. Daily, except Sundays and Holidays. VANDERBlLT^CumC. Amsterdam Avenue and 60th Street Daily, except Sundays and Holidays. 2 to 3 I>. M. Monday. Wednesday and ^^• ^‘S^ays and Holidays. 11 A. M. to 12.30 P.M. S-?- MT SinaT Hospital D, s pens ary. Madison Avenue and 100th Street. Daily, except Sundays GERMA^hXTtAlD.SPeYsARY. Park Avenue and 76tb Street. Daily, except Sundays and Holidays. 2to 4 P.M. BROOKLYN Department or Health, 361 Jay Street. Week days. 2 to 4 P. M. Brooklyn City Dispensary. 11 Tillary Street. Week days. 2 to 4 P. . THE BRONX . _ „ Department or Health, Third Avenue and St. Paul’s Place. Weekdays,, o 4S L— 1908 DEPARTMENT OF HEALTH THE CITY Or NEW YORK DIVISION OF COMMUNICABLE DISEASES 21-424, ’08, 6,000 (P) ASSOCIATION OF TUBERCULOSIS CLINICS Carefully fill out this Card and forward at once to the Dispensary to which patient Is referred. Date 190 We have this day referred to the Clinic for Tuberculosis Name Address Doz. Eggs I -PER WK. qts M I LK J NOW GIVEN BV DlSP. MEDICATION riOWGIVEN BY DlSP. M. D. .Clinic Bring This Card With You fringe Diese Karte Jedesmal Mil Portate Questa Carta Con Yoi W *P ** *** 01 VB THIS HALF OF CARD TO PATIENT. Doz. Egg | pERWR Qts. milk) NOW GIVEN BY DlSP. M E DICATION NOW GIVEN BY DlSP Name— “ Address . j . _ Clinic is referred to Address By JVI. D. 67 Discharge from Hospital. — Every hospital must report by telephone all cases of tubercu- < losis discharged, transferred and allowed out on pass. Every case returning home is at once i visited to see if treatment is being continued, instructions observed, etc. The cases to be discharged within three days or allowed out on pass are noted by telephone operator on a nurse’s discharge card” (Form 190 L), and each case assigned at once by telephone to a district nurse for investigation as to whether patient should he allowed to return home. She reports by telephone within twenty-four hours, her report being entered on the same card ■which is filed, and the hospital is notified of the result. Should a patient proposing to re- turn to unfavorable home surroundings, or giving a wrong address, insist on being discharged, said patient can be transferred to Riverside Sanatorium and there detained. ( 0 > b! 5 — — — - - i ^ 5 o 0 a* i i M •■At ; » f a i l>j ! ) t U a ttSl: ■ ili-l X 6* > r i\l Ji \ lot o °t * to 1 r n n { s pO 4 0 0* 190 L — 1908 21466 , ' 08 , 6,000 (P) INVESTIGATION OF HOME CONDITIONS OF CASE OF TUBERCULOSIS PREVIOUS TO DISCHARGE FROM HOSPITAL. Name — Address . _ Date. To be discharged from- on Assigned^ t°- -Nurse Report received- -.Result- Hospital notified — - zzrsz-zzzz .ti tions, and muses, aie . ,, j nature of ailment on obser- triet inspector, who reports rase” and filed separately ration card. The ongmal report cards ma TOtiM „f result. If the „ nti , the case has been ^“onlne is followed, except that when the in- zz — - - - - - r „ . a „ white nurs e’s card filled out and sent to the district nur Hhylrt attendance who has faded to report the ease, he Is visited hy an Inspector and a special report submitted (Form 203 L). 203 L— 1906 1461, ’06, 2,000 (P> DEPARTMENT of health THE CITY OF NEW YORK division of communicable diseases Borough oi New York,. 190 Investigation of a Case of Name of Patient Reported as Reported as Duration of attendance Assign ed by by no t Reported by Attending Physician. Age Sex Address Address Address Date Date AxUlx-ess **r Physician’s ex When made Inspector. planation of his failure to make a report of the case to the Department Diagnosis to c K.cpor\.« Name of Attending Physician Duration of attendance Diagnosis Address When made Assigned Physician’s explanation t Inspector. of bis failure to make a report of the case to the Department Returned b y M. D. Medical Inspector. I S 73 y i cn P“ O o I— K o If not a case of tuberculosis, it is classed as “no case,” so recorded in name index and filed. All complaints by citizens (as to spitting, necessity for hospital treatment, etc.) are in- vestigated by a district inspector, who submits a formal report (Form 3 L). If there is a physician in attendance, he is visited and requested to see that the nuisance is abated, if one exists. Incipient Cases and Sanatorium Treatment. — All apparently incipient cases seen by nurses and inspectors, or calling at Borough offices, are referred by card (Form 48 L) to one of the Tuberculosis Clinics of the Department for examination as to their eligibility for sana- torium treatment. Very incipient cases are referred to the New York State Hospital for In- cipient Tuberculosis at Raybrook, N. Y. — others to the Sanatorium of the Department at Otis- ville, N. Y. Waiting lists are kept for Raybrook (Form 207 L) and Otisville and Riverside (Form 214 L). Suitable cases are also referred to the Stonywold, Loomis, Bedford, and Adi- rondack Sanatoria. Patients are notified by mail (Form 217 L) when to call for examination. 21-475, ’08, 2.000 (P) 207 L— 1908 No DEPARTMENT OF HEALTH Cl. No Tuberculosis Clinic Borough of EXAMINATION FOR RAY BROOK Name - Address Examination To Dept, of Charities Exam, ordered Bill received Admitted Remarks Examiner Borough i go Accepted Rejected i go Accepted Rejected __ igo Forwarded I 9° returned Acc. Rej i go Discharged *9° — 217 L — 1908 Name 21-483. ’08. 3,000 (P) Date Address No. Please call at Tabercalosis Clinic of Department of Health on admission to at to be examined for Chief of Clinics. BRING THIS CARD WITH YOU School CHliaiEBN.-Only in the most exceptional cases ace children with pulmonary tuberculosis allowed to attend school. Such cases are excluded from school by medical school inspectors, pending their examination at one of the Tuberculosis Clinics of the Department, whence a report is sent to the Division of Medical School Inspection. Every effort is made to have such children enter a sanatorium or hospital. Hospital CasES-Every hospital in New York City is required to report all cases of tuber- cnlosis Each hospital and dispensary is called up by telephone at regular intervals daily, tri- weekly, bi-weekly or weekly, depending upon the size of the institution, the larger hospitals (Bellevue, Metropolitan, etc.) reporting daily. The admissions, discharges and deaths are re- corded on cards (Form 204 L, see page—), which are finally filed under the name of the institution. The yearly totals are compared with the number of cases in the annual report of each institution. Census -Twice a year (March 1st and August 1st) a census is taken of all cases of tuber- cnlosis' in institutions in New York City-a special blank (Form 18 L) being supplied to each institution with a stamped envelope to insure its prompt return. These censuses are compared with the “hospital index,” i. e„ the cases supposed to be in each hospital, an a discrepancies investigated, the results for each institution being recorded. Every case reported as catering a hospital is at once assigned by tele- Disinfectio . wb<) reeommcnds the necessary renovation, fumigation, and dis- ph0ne t0 a d beddino . suoU recommendations being recorded in the proper infect, on of the rooms am “ ^ where re n 0V ati„n has been ordered, the bine spaces on the record car- >.' ""' an order is received (It is also stated if patient - 1S - - in tai, — ::: ‘-I of L premises the inspector WiU "*“ t0 t Idling need be done , this is most exceptional, oniy hoiding good nray recommend. ( ^ ^ the patient only spent one or two nights on the fM ^ X) Z the' 1 room occupied by the patient be fumigated with formaldehyde; (c) premises; (b) tha r atent 8 J a wo ; dwork and floors be washed and repainted, the rest of papered or repainted, a . ,, t the who i e apartment be reno- the apartment being fumigated with " J 8olu . -■ — ^ . — - <*- tion, repaperm e , l “ , inspector-in-Charge and journalised (Foim 19 47 L)„ which, after being app-uve Sul>erintendent ,„ r enforcement. Where can- LL) ’ , iS f °7tt ZtL H modification of order is asked for, the original order is sent collation, extension t , of retaspecti(> n 0 n same, and on attached apph- t° a differeut mspector . wm en ^ ^ be granted . The papers are then returned cation he states whethe thcre is reason to believe that renovation to the Assistant Sanitary Superintenden . . ^ removal of wi „ be evaded, and in every case where the premises are door of the the patient and renovation has been ordered, the inspector must placard apartments with a poster (Form 113 L). Department of Health Division of Communicable Diseases BOROrGH OF iijS* illtS Mt' lekyfoif No. New York, 190 and Approved and respectfully forwarded. iepro[« On 190 M. D. Inspector -in- Charge. or 47 L — 1 908 21-423, ’08. 1 ,600 (P) Department of Health, The City of New York Division of Communicable Diseases BOROUOH OF.. Complaint and Report of Inspection in reference to premises By the Inspector. Record No „ Xo tlie Board of Health s holding the position of a Medical Inspector in the Department of Health of The City of New York, do report: That on the day of 190 , I personally examined and carefully inspected the premises and found the facts as follows: Said premises consist of a (Tenement) (Private) House, of which of is (owner) (agent), and in violation of Section 146 of the Sanitary Code, were found in a condition dangerous to life and detrimental to health, for the following reasons, viz. : Suite of rooms on the floor consists of a parlor, bedroom .., a kitchen, a bathroom, and a (lining room The walls of parlor are ; the floor ; the floor The walls of kitchen are The walls of bedroom 1 >eilv< >ot Tile walls of arc ; the floor : the floor* The walls of dining: room are • t j ie fl oor The walls of are ; the floor are ; the floor. The walls of The woodwork is painted — varnished. In view of the fact that ' . . was ill with consumption in the apartments on the si ,| e „[ the . floor consisting ol a parlor, herlroom a kitchen, bathroom, an d a dining room 1 recommend that the kalsonvined or whitewashed walls of the be washed with a solution of washing soda (one-half pound to three gallons of hot water) and then be rekal- somined or rewhitewashed ; That the papered walls of the he washed with a solution of washing: soda (one-half pound to three gallons of hot water), that the old paper be then removed, and the walls be painted and kalsomined or repapered ; That the painted walls of the be repainted, or that they be washed and scrubbed with a solution of washing soda (one-half pound to three gallons of hot water) ; That all tire woodwork and the bare floors be painted or varnished, or be washed and scrubbed with a solution of washing soda (one-half pound to three gallons of hot water). Respectfully submitted, M. D„ Medical Inspector. ■ 113 L— 1908 21-447, '08, 300 (P) Department of Health S. W. Corner 55th Street and 6th Avenue, New York NOTICE Consumption is a communicable disease. This apartment has been occupied by a consumptive and may have become infected. It must not be occupied by persons other than those now residing here until an order of the Board of Health, directing that the apartment be cleansed and renovated, has been complied with. NAME OF OCCUPANT Floor No. Street Ordered by M.D., Inspector. This notice must not be removed until the order of the Board of Health has been complied with. By order of the Board of Health EUGENE W. SCHEFFER Secretary The premises are visited three days later by a sanitary policeman. "When owner or agent voluntarily performs renovation, that fact is reported, a yearly record being kept of the num- ber 0 f SU ch voluntary renovations. Fumigation with formaldehyde and disinfection of bedding is ordered by telephone and entered on a card (Form 232 L), on which number and size of rooms, date fumigation is to be performed, etc., is noted. GOODS TO BE REMOVED FOR DISINFECTION AND FUMIGATION Mattresses — Bolsters Pillows Comfortables Coats Waistcoats Trousers ... Overcoats Hats Waists Dresses Carpets Rugs Curtains Pillow-slips Sheets — Blankets Portieres Al, fumigation orders for the day are noted on a slip which is forwarded with the fumi- gation cards to the Division of Contagions Diseases, and also in a book as a matter o recor - Fumigation orders are not forwarded anti, the day before fumigation rs to be done. M e. pension to fumigate is refused, or the fumigation interfered with it can e en or b L sanitary police. All bedding is fumigated before it is removed for — n, for ^e protection of the Department employees. It is returned in tw . ntj our 10 1 „ n . • Diseases after the recommendations have tion card is returned by Division of Contagious Diseases, been complied with, checked off in book and tiled according to date. All recommendations, orders, filed according to date. All recommendations orders, etc of inspectors having been entered on blue record card by telephone operator, ,t - filed in “hospital index” under name of hospital, which is also written on small name car . in “private” cases, with the exception of those in tenement houses, disinfection can e car- ried out under the supervision of the attending physician, but he must su m.t a cer i^ (Form 117 J). Lodging houses are not disinfected, such disinfection iein^ managers of such houses. -*■ 117 J — 1907 21C-811, '07. 1.000 (P) DEPARTMENT OF HEALTH BOROUGH OF BROOKLYN DIVISION OF CONTAGIOUS DISEASES REPORT OF DISINFECTION IN A PRIVATE HOUSE This certifies that the premises named herein have been disinfected, as noted, and in compliance with the regulations mentioned below. New York,. 190 Name of Patient. Disease. -Age. .Duration of Sickness. Residence No. of Rooms disinfected Disinfectant used: Formalin oz. ; Suiphur 0 Paraform _grs. Time room left exposed fectant hrs. Disinfecting solution employed. lbs. ; to disin- Name M. D. Residence — In every case of disinfection the following regulations must be com- plied with: All cracks or crevices in rooms to be disinfected must be sealed or calked, to prevent the escape of the disinfectant. The following disinfectants may be used in the quantities named: Sulphur, 4 lbs. for every 1,000 cubic feet, 8 hours exposure. Formalin, 6 oz. for every 1,000 cubic feet, 4 hours’ exposure. Paraform, 1 gr. to every cubic foot, 6 hours’ exposure. Carbolic Acid, 2 per cent, to 5 per cent, solution, and Bichloride of Mercury, 1-1000, may be used for disinfecting solutions. The Department of Health will remove any goods that may require further disinfection. * Found” CASBS-When an inspector or nurse reports that no record can be found a case at the address given, the name card is marked ”N. F„» and the record card filed in the annual “not found” index. At the end of three years, the record cards are stored away and the name cards removed from the name index and filed in an “old not found name in- dex.” A daily record is kept of the number of “not found” cases reported. Dead Cases.-A 11 deaths from tuberculosis, occurring during the preceding twenty-four hours, are reported by the Bureau of Records on a special list (Form 7S L, see page ). The record cards are stamped “Dead,” and assigned by telephone to inspectors to order the necessary fumigation, etc., the small name cards being removed from name index and filed separately. On return of information all cards of the case are filed in “dead” index, a rec ord being kept of the number of previously unreported dead cases. In all previously unre- ported cases where the physician signing the death certificate had been in attendance one week or more, letters (Form 25 L) are written to said attending physician calling then- at- tention to the violation of the Sanitary Code and requesting an explanation. 18(1-81 5, ’05, 250 (P) 25 L— 1905 _ department of health Borough of - - - division of communicable diseases TELEPHONE 1204 COLUMBUS Laboratory No. - N ,„ Yo rk, — J - - '9° Dear Sir : The death certificate signed by you in the case of ^ aged states that the cause of death was (tuberculosis), (typhoid fever), (cerebro-spinal meningitis) As no report of the case was received from you while the patient was alive and presumably under your professional care your attention is called to the following section of the Sanitary o e. Sec 133. It shall be the duty of every physician to report to the Department of Health, in writing, the full name, age and iddress of every person suffering from anv one of the infectious diseases included in the list appended, with the name of the disease, within twenty- four hours of the time when the case is first seen . A — Contagious (very readily communicable) : Measles, rubella (rotheln), scarlet fever, small -pox, varicella (chicken-pox), typhus fever, relapsing fever. B. — Communicable : Diphtheria (croup), typhoid fever, Asiatic cholera, tuberculosis {of any organ), plague, tetanus, anthrax, glanders, epidemic cerebro-spinal memn - iritis leprosy, infectious diseases of the eye (trachoma, suppurative conjunctivitis), puerperal septicaemia, erysipelas, whooping cough. C Indirectly Communicable (through intermediary host) : Yellow fever, malarial fever. Please forward to this Department, at your earliest convenience, a written statement as to why case was not reported by you. M. D. Should no answer be received within two weeks to two such letters, a letter is sent, bv I ’ J a sanitary policeman, demanding an explanation on pain of prosecution. A record (Form 181 L) is kept under each physician’s name of all such unreported cases, nature of explana- tion, etc. Department of Health, Division of Communicable Diseases NON-REPORTED CASES Borough of Dr. Address PATIENT’S NAME ADDRESS DIS. NOTICES 1 2 3 ANSWER DATE 181 1^1907 2ta-404. '01. 1.000 (P) All deaths from pneumonia are daily compared with tuberculosis records. If one is found to have been previously reported during life as a case of tuberculosis, an inspector visits the physician who signed the death certificate and obtains an explanation of the apparent discrepancy, submitting a report on special blank (Form 144 L). The same is done for all cases of tuberculosis reported as having died from some other cause. The Bureau of Rec- ords is also notified of any change of diagnosis, and death certificate corrected. Map. Every new case of tuberculosis reported in Manhattan is plotted on a lgxge map of the Borough which shows each house lot, different colored ink being used for each year. The maps cover five year periods. “Not found” cases are, of course, not entered. The ad- dress is written on a small, white card (of private cases, on receipt of postal or sputum report; of all others, on receipt of inspectors’ or nurses’ report stating that patient did live at address given). In the other Boroughs, the cases are plotted on compo-board map by means of colored pins. Special Regulations. — All inspectors and nurses bear in mind that the Department of Health pledges itself not to interfere in any way with cases of pulmonary tuberculosis under the care of private physicians, except where a complaint is made. Even then the at- tending physician, if there is one, is first visited. The source of complaint is never divulged. The Inspector-in-Charge supervises daily all reports, etc., of inspectors and nurses, sees that the various recommendations are carried out, and various records, map cards, etc., are kept. When reports are incorrect or incomplete, the district inspector or nurse is summoned to the Borough office. All cases reported as living in other Boroughs, are reported daily to the office of the Borough in which they live, on special card (Form 194 L). When a patient moves to another Borough, all cards and records of the case are forwarded to the office of that Bor- ough. / 21a-416, '07. 6.000 (P) DEPARTMENT OF HEALTH THE CITY OF NEW YORK DIVISION OF COMMUNICABLE DISEASES BOROUGH OF — - Report of Case of Name — Address. Care of Age Occupation. Reported by Address M F., M. S. W. .Case No, Clinic No. Floor Nationality Diagnosis - - Date JI. D. Inspectors.— Inspectors report at Borough office every Monday at 9:30 A. M., bringing with them their note books and any incompleted assignments. Every day except Saturdays and holidays, each inspector is communicated with by telephone, at a specified hour, when he returns the information for the previous day’s assignments and receives new assignments. Should an inspector be away from home at the specified hour he must call up the Department as soon thereafter as possible before 3:30 P. M. All inspections are made within 24 hours. Inspectors are furnished with special note books, in which they keep a record of all assign- ments and findings (Tuberculosis, Form 219 L). An observation card (Form 44 L, see page — ) is made out by the inspector for every case seen, whether one of tuberculosis or not, the result of physical examination written in space “present condition,’’ and cards forwmrded by mail on day of inspection. 2849, ’00, 1,500 BkB. (P) Complaint Vol.Renov. Fumig. To be done Char. Premises 1 o o Ctf d 6 W s O Bedding Destroy Return . Will Patient Return ? Should he do so? At Home Obs.Card K.U.O.? Not Found * TUBERCULOSIS NAME ADDRESS _ FLOOR m CompJaii Complaint Not Found In ordering fumigation, the date on which it is to be done is always to he given on card, but cards are not to he forwarded until the day before that date. Unless the premises are in very had condition, it is usually sufficient to renovate the room occupied by the patient, and to fumigate the rest of the apartment. Where the entire prem- ises are probably infected, renovation should he complete. In cases where the premises are in very good condition, fumigation of the room occupied by the patient may be all that is necessary. Great care and accuracy are necessary in recommending the kind and amount of renova- tion necessary, both for the sake of justice to the owner and because an error means a rein- spection, probably rescindment of the order for renovation and the submitting of a new com- plaint. The floor and position of rooms are always to he ascertained. The full name of owner or agent is given in complaint; if it cannot be obtained, the fact is stated. Care of Janitor” is not accepted in lieu of owner’s name or address. All complaints and reports, without exception, are mailed on the day the inspection is made. The regular blank (Form 3 L) is used for all reports. Nurses.— All district nurses report at their Borough Office at 9:30 A. M. every Tuesday, bringing with them their note hooks (Form 221 L) and any incompleted assignments. Every day, except Saturdays and holidays, each nurse telephones the Department between 11:30 A. M. and 12:30 P. M. when she returns the information regarding the previous day’s assign- ments and receives new assignments. Each nurse is expected to make at least eighty inspec- tions a week. All new cases are visited within 24 hours, and all information called for on observation card obtained, special attention being paid to: physical condition of patient; whether he is a menace to those about him; sanitary condition of premises; domestic and financial circumstances; need of assistance; knowledge on the part of the patient of the nature of his disease; the care taken to prevent spread of disease; previous or simultaneous occurrence of other cases on the premises or in same family; if patient is under treatment, with name and address of physician or institution. In giving instructions, the nurse is guided by the patient’s knowledge of the nature of the disease. When the patient knows that he is suffering from pulmonary tuberculosis, full instructions are given. In every case, however, the danger of promiscuous spitting and the necessity for the destruction of sputum is clearly pointed out, and the nurse leaves a copy of the “Circular of Information to Consumptives and Those Living With Them,” each of which is printed in English and the language spoken by the patient. [German, Form 23 L., Italian, Form 35 L., ^ iddisli. Form 36 L., Bohemian, Form 37 L., Polish, Form 333 L., Slovak, Form 134 L., Ruthenian, Form 135 L., Chinese, Fo v m 162 L., see page to .] a 821 L— 1807 NURSE NAME ADDRESS TTOOR REPORTED B Y .1 p Age M.F. * CO a Nation, Occup. * c REM YRKS REM YRKS REM YRKS REM YRKS « REM. YRKS T A postal card (Form 171 L) on which to report change of address is left with each family. An observation card is forwarded for every case living at home, even if the patient is out or is to leave th.e premises at once. Where information cannot be obtained as to a particu- lar point, a ? is used. The name and address of the owner or agent of premises occupied by patient is obtained in every instance. Every observation card is dated and signed by the person filling it out, and it is stated if the patient is to be kept under observation (KUO ? yes or no). All cases under observation are visited once every week or ten days, the date of each visit and the condition of the patient being noted on the white card. These cards are gone over every two weeks by the Inspector-in-Charge. The following circulars, etc., are issued by the Department to physicians and others in- terested: Leaflet in Reference to the Reporting of Cases of Tuberculosis by Physicians (Form 0 L). Circular of Information Regarding Measures Adopted for the Sanitary Super- vision of Tuberculosis (Form 66 L). Circular Regarding Importance of Early Diagnosis of Tuberculosis (Form 75 L). “Sweeping and Dusting,” (Forms 176 L, 177 L, 200 L, see Spit” Circulars in various languages (Forms 231 L, 236 L, 238 L, 240 L, 241 L). Con- sumption Cures (Form 229 L). Handbook of Help for Consumptives (Form 2 L). Consump- tion Catechism (Form 246 L) for use in public schools. DEPARTMENT OF HEALTH Regarding the Reporting of Cases of Tuberculosis are not visited by the Inspectors of this Department, nor are they interfered with in any way, except upon the request of the attending physician. . . The residences of all cases of tuberculosis reported to this Department by public institutions are visited by Medical Inspectors or Nurses, who there give information with regard to the nature of the disease and the precautions necessary to prevent the infection of others. When residences occupied by consumptives are vacated through the death or removal of the patient, the Inspectors recommend such renovation or disinfection as may be required to free them from infection. The orders for such renovation are enforced by the Board ot Health. Postal cards for the notification of cases of tuberculosis, and circulars of information for physicians and for the public, can be obtained from this Department upon application. For further information, apply to the Chief of the Division of Communicable Diseases, Department of Health, Sixth Avenue and 55th Street, New York City. to ). Circular of Information to Consumptives and Those Living With Them (Forms 23 L, 35 L, 36 L, 37 L, 133 L, 134 L, 135 L, 162 L; see pages to ). “Don’t 9 l — 1907 21C-846, *07. 3,000 (P) THE CITY OF NEW YORK DIVISION OF COMMUNICABLE DISEASES Section 133 of the Sanitary Code classes pulmonary tuberculosis “an infectious and communicable disease.” Under the provisions Section 133 tuberculosis coming under their proiessiuncti * thus received is SOLELY FOR REGISTRATION, and cases so reported THOMAS DARLINGTON, M. D., President HERMANN M. HIGGS, M. D., Medical Officer . -ID- 66 L— 1908 21-432, ’08, 3,000 (P) DEPARTMENT OF HEALTH THE CITY OF NEW YORK Sixth Avenue and 55th Street 65 n DIVISION OF COMMUNICABLE DISEASES Circular of Information Regarding the Measures Adopted by the Board of Health for the Sanitary Supervision of Tuberculosis in The City of New York. 1908 I ft * [ lull TTH JJIM Jiuuiu — ir. >nartmpnf unnn annlication. CIRCULAR OF INFORMATION REGARDING THE Measures Adopted by the Board of Health for the Restriction and , Prevention of Tuberculosis in The City of New York It is well known to the physicians of New York City that for a number of years the Department of Health has been earnestly engaged in the study of Tuberculosis, the most widespread and fatal disease occurring in this city, and in the initiation of such measures for the curtailment of its ravages as seemed practicable and imperative. After a period of preliminary study and obser- vation lasting seven years, the Board of Health passed a series of resolutions on February 13th, 1894, designed to assist in the accomplishment of its aims for the suppression of this disease. One of these resolutions involved the reporting of certain classes of cases of tuberculosis. In compliance with it, 4,166 cases were reported in 1894, 5,818 in 1895, and 8,344 in 1896, and the Depart- ment was enabled without opposition, or the imposition of hard- ship upon individuals, to extend its educational work and protect a large number of persons from exposure to infection. In order to more firmly establish and extend the work carried on under the resolutions above mentioned, on January 19th, 1897, the following amendment to the Sanitary Code was adopted by the Board of Health: “Section 153. — That pulmonary tuberculosis is hereby declared to be an infectious and communicable disease, dangerous to the public health. It shall be the duty of every physician in this city to report to the Sanitary Bureau in writing the name, age. 3 sex, occupation and address of every person having such disease who has been attended by, or who has come under the observation of, such physician for the first time, within one week of such time. It shall also be the duty of the commis- sioners or managers, or the principal, superintendent, or physi- cian of each and every public or private institution or dispen- sary in this city to report to the Sanitary Bureau, in writing, or to cause such report to be made by some proper and com- petent person, the name, age, sex, occupation, and last address of every person afflicted with this disease, who is in their care or who has come under their observation within one week of such time. It shall be the duty of every person sick with this disease, and of the authorities of public and private insti- tutions or dispensaries, to observe and enforce all the sanitary rules and regulations of the Board of Health for preventing the spread of pulmonary tuberculosis.” (In the present Sanitary Code, sections 133 and 138, all forms of tuberculosis are considered to be infectious and communicable.) The objects in view were both to prevent the extension of pulmonary tuberculosis, and also to promote the recovery of those already stricken with the disease. The result is shown in the following table. The incidence of pulmonary tuberculosis is best estimated by its death rate, for, although as will be shown later, the Department of Health has every reason to be satisfied with the success attained in connec- tion with the registration of tuberculosis, yet under the most favorable circumstances a certain number of cases are not re- ported duri life. In 1881 the death rate in New York City from pulmonary tuberculosis per 1,000 inhabitants was 4.27. As shown in the fol- lowing table it has steadily fallen since then, until in 1907 it was only 2.10 per 1,000, a reduction of over 50 per cent. In other words, in 1881, with a population of 1,244,511 there were 5,312 deaths from pulmonary tuberculosis, while in 1907, when the 4 population had increased to 4*285,435, there were only 8,999 deaths from this disease, an increase of less than 70 per cent, in the deaths, although the population had increased almost 300 per cent. TABLE GIVING DEATH RATE, NUMBER OF DEATHS, AND OTHER DATA CONCERNING TUBERCULOSIS IN TIIE CITY OK NEW YORK FROM 1 88 1 TO I907. I . — MANHATTAN AND THE BRONX. YEAR General Population Total Deaths All 0 si fi ex — O *g?i re* u — cn £ re 0 a s c ' A ~j Causes n re r* r \ Sa QB. = — 0 re re CO . u ~ 3 Q 3 H Q< V 3 Qh Q=> H C 3 «Q Q 4 l88l 1*244,511 38,624 31.04 6,123 4.92 5,312 8ll 15.85 4.27 1882 1,280.857 37,924 29.61 6,052 4.72 5*247 805 15.96 4.10 1883 1,318,264 34,01 1 25.80 5*943 4.51 5,290 653 17.47 4.01 1884 1,356.764 35*034 25.82 6,039 4.45 5*235 804 17.28 ,3-86 1885 I.396.388 35.682 25.55 5,945 4.26 5,196 749 16.66 3.72 l886 1 , 437,170 37,351 25.99 6,349 4.42 5,477 872 16.99 3.81 1887 1 , 479*143 38,933 26.32 6,007 4.06 5,260 747 15.43 3.56 1888 1,522,341 40,175 26.39 6.073 399 5,260 813 15.12 3.46 1889 1,566.801 39,679 25.32 6,041 3.86 5,179 862 15.22 3.30 I89O 1,612,559 40,103 24.87 6,409 3-97 5,492 917 15.98 3.41 I89I 1 , 659,654 43,659 26.31 6,109 3.56 5.160 949 13.99 3 - II I892 1,708,124 44,329 25.95 6,061 3.55 5*033 1,028 13.67 2-95 1893 1,758,010 44,486 25.30 6,163 3-51 5,124 i ,039 13.85 i2.9I 1894 1 * 809,353 4 M 75 22.76 5,720 3.16 4,658 1,062 13.89 2.57 4,166 511 1895 1,873,201 44,420 23.18 6,283 3.35 5*205 1,078 14.47 2.78 5,824 1,147 I896 1,906,139 41,622 21.84 5,926 3 - II 4,994 932 14.24 2.62 8,334 1,856 1897 1 , 940,553 38,877 20.03 5 , 79 i 2.98 4,843 948 14.89 | 2.50 9 , 735 | 2,703 1898 1,976,527 40,438 20.46 5 , 90 i 2.99 4,957 944 14.59 2.51 10,798 2,239 2,920 1899 2,014,330 39 , 9 H 19.81 6,209 308 5,238 971 15.56 2.60 10,484 2,472 3. IIS 1900 2,055,714 43,227 21.03 6,179 3.00 5,278 901 14.29 2.56 9,639 2,436 3.512 1901 ! 2,118,209 43,307 20.44 6,049 2.85 5,233 816 13.97 2.47 12,135 3 , 005 : 4-397 1902 1 2,182,836 41,704 19. II 5,744 2.63 4*893 851 13.77 2.2 4 13,383 3*738 4.631 1903 2,241 ,680 41,749 18.56 6,086 2.70 5,250 836 14.60 2.33 15*787 4,698 7.764 1904 2,318,831 48,693 21.00 6,275 2 . 7 1 1 5,495 780 12.89 2.37 20,451 6,638 9,606 1905 2,390,38 2 * 45,199 18.91 6.348 2.66 5,678 670 14.04 2.38 24,142 9,106 .H, 43 I IQ 06 2,464.4 32 46,108 18.71 : 6.696 2.72 5*900 796 14.52 2.39 22,092 8,201 l6,003 1907 2,541,084 47*698 18.76 1 6.809 2.68 6,030 779 1 13.49 2.37 10,746 20,595 1 I.— GREATER NEW YORK I898 3,272,418 66,2 -4 20*26 9-265 2.69 7.724 1*541 13-97 2.25 3,945 1899 3,356,722 65,344 19.47 9,575 2.70 8,Ol6 i *559 1465 2.26 • X. Vi ON 4,500 1900 3,446.042 70,872 20.57 9.630 2.79 8,154 1*476 13.59 2.37 M ,433 5,289 1901 3 , 554,079 70,717 19.91 9,389 2.64 8,135 1,254 13.28 2.29 17,588 4,191 6,744 1902 3,665,825 68,112 18.58 8,883 2.42 7,571 1,312 13.44 2.07 16,614 4,268 7,820 1903 3,781.423 67*923 17.96 9,287 2.46 8,001 1,286 13.70 2.12 20,266 5,052 11,859 1904 3,901.023 77*985 19.99 9,744 2.50 8.495 1,249 12.49 2.18 -r 00 9,721 16,971 1905 4,024,780 73 , 7 U 18.31 9,658 2.40 8,535 1,123 13.10 2.12 31*963 11,132 18,639 1906 4,152,860 76,203 18.35 10,194 2.45 8,955 i ,239 13.38 2 .l 6 30,826 10,741 21,779 1907 4.285,435 79.205 18.76 10.262 2.26 8,009 1,263 12.96 2.10 32,730 13.005 27*277 5 The procedure followed by the Board is as follows : 1st. All cases of pulmonary tuberculosis occurring in The City of New York are registered at the Department of Health. 2nd. Every person suffering from pulmonary tuberculosis is furnished with instructions as to the measures to be taken to pre- vent its extension. 3rd. All . premises which have been occupied by persons suf- fering from pulmonary tuberculosis are, on death or removal, dis- infected with formaldehyde, or renovation is ordered. 4th. Charitable assistance or hospital care is provided so far as is possible for all cases wishing or requiring such assistance or care. 5th. The general public is educated as to the nature of the disease, the precautions to be taken against its spread, the advis- ability of institution and sanatorium treatment, etc. These measures may be considered somewhat more in detail : 1st. The Department of Health registers the name, address, sex, age, color, and nationality, and the character of the dwelling of every person suffering from tuberculosis in this city. The in- formation reaches the Department in several ways, appropriate action being taken in each. (a) Private cases reported by the attending physician. These ca^es are reported in two ways : by the postal cards furnished by the Department for that purpose; and by the forwarding of speci- mens of sputum for examination by the Department, when such examination shows the presence of tubercle bacilli. (See special r> note.) A positive result constitutes an official report of a case, but when the microscopical examination is negative, the mere sending of a specimen of sputum is not considered as a notification. The information thus obtained regarding private cases is FOR RECORD, AND IN NO INSTANCE ARE VISITS MADE TO SUCH PER- SONS BY THE INSPECTORS OF THE DEPARTMENT, NOR DOES THE Department of Health assume any sanitary surveillance OF SUCH CASES (unless THE PERSON RESIDES IN A TENEMENT HOUSE OR LODGING HOUSE, OR UNLESS THE ATTENDING PHYSICIAN REQUESTS THAT AN INSPECTION OF THE PREMISES BE MADE). In NO CASE WHERE THE PERSON RESIDES IN A TENEMENT HOUSE WILL ANY ACTION BE TAKEN, IF THE PHYSICIAN REQUESTS THAT NO VISITS BE MADE BY INSPECTORS AND IS WILLING HIMSELF TO DELIVER CIRCULARS OF INFORMATION OR TO FURNISH SUCH EQUIVA- LENT INFORMATION AS IS REQUIRED TO PREVENT THE COMMUNICA- TION OF THE DISEASE TO OTHERS. « In all private cases the attending physician is notified of the receipt of his report, and a copy of the circular “Information for Consumptives or Those Living with Them” is sent him with a request that it, or its equivalent, be given to the patient. Once a year the attending physician is requested by letter to inform the Department whether the patient is still living; if so, where, and whether his condition has changed for the worse or better. Physicians are also required by the Department to report any change of address or discontinuance of treatment on the part of their consumptive patients. ( b ) Cases reported by institutions: The authorities of all public or private institutions, such as hospitals, sanatoria, dispen- saries, asylums, prisons, homes, etc., are required to furnish the 7 necessary data concerning every consumptive coming under their observation, within seven days of such time. They must also furnish the same information, together with the duration of resi- dence in the institution of every case of tuberculosis discharged from the institution or transferred to another institution, previous to or en the day of such discharge or transfer. These reports are obtained by telephone. All the larger institutions report daily and twice a year a census is taken of all cases of pulmonary tuberculosis which are inmates of the public institutions of the city. ( c ) Cases reported by citizens’ complaints or by the inspec- tors or employees of other Departments and Charitable Organiza- tions (Tenement House Department, Department of Charities, Charity Organization Society, United Hebrew Charities, Asso- ciation for Improving the Condition of the Poor, etc.). 9 W hen the name and address of the attending physician of such cases can be ascertained, lie is visited and inquiry made as to whether the case is one of pulmonary tuberculosis, and if so, why it was not reported to the Department. If no physician is in at- tendance, and the case, on being visited, proves to be one of tuber- culosis, it is so reported by the Inspector, and taken charge of by the Department of Health, being either referred to one of the Tuberculosis Clinics of the Department, kept under observation at home, or admitted to a hospital. „ A certain number of deaths from pulmonary tuberculosis are reported to the Bureau of Records which have not been previously reported to this Department while living. In these cases the physician signing the death certificate must furnish a valid reason for not having reported the case in accordance with the require- ments of the Sanitary Code. 8 TmoiwinmicaHoH? Investigation has shown that in only a very small percentage of fatal cases of pulmonary tuberculosis, is the cause of death ascribed to some other condition. Through these various channels about 85 per cent, of all living cases of tuberculosis are reported to the Department of Health. The non-reported cases fall into two categories — patients of the better class, whose physicians fail to obey the law, and those of the poorest class, who have no attending physician. On the whole, the results obtained have been very satisfactory. 2nd. All cases of pulmonary tuberculosis residing in tenement houses or lodging houses are visited by nurses of the Department, unless the attending physician has requested that no visits be made. The nurses visit the premises, note the precautions taken against the spread of the disease, the character of the ventilation, lighting and sanitary arrangements; whether there is overcrowding and whether work (tailoring, etc.) is being done on the premises. Re- ports as to unsanitary conditions of the premises are referred to the Tenement House Department for appropriate action. The patient and the family are instructed as to the chief dangers in con- nection with pulmonary tuberculosis, and how they may be avoided, care being taken if patients are ignorant of the nature of their disease, not to unduly alarm them. When the patient is at work and his condition is such that his presence may be a danger to his fellow employees, an inspection is made of the work place, necessary instructions given, and cuspidors and placards installed. In suitable cases they advise hospital care, and in worthy cases, recommend that charitable aid be given (see below). They give full instructions, both verbally and by circular, as to the measures which should be taken to prevent the spread of the disease, and as to the proper disposal of the sputum. The Department sup- plies suitable paper sputum cups, free of charge, to persons unable 9 to buy them. Where patients are incapacitated for work the De- partment nurse repeatedly visits the case, ascertains whether in- structions are being observed, distributes sputum cups, and makes herself generally useful. In suitable cases where it is certain that renovation will be required on removal of the patient, the owner or agent is instructed to notify this Department when such removal takes place and also of the new address of the family. In infective cases, where it is necessary, periodic disinfection of rugs, clothing and other articles likely to be soiled by sputum, is done from time to time. Previous to the discharge of all cases of pulmonary tuberculosis from hospitals or other institutions, a nurse visits the premises to which the patient expects to go, in order to learn whether he is known there, if his return is desired, if proper care will be taken of him, and if the premises are in good sanitary condition. If the conditions are satisfactory, the patient is allowed to leave the hospital, but he is at once visited by a nurse in order to ascertain if he has returned to address given and if he lias been properly in- structed as to the nature of his disease. \ 3rd. In all cases in which it comes to the knowledge of the Department of Health that rooms or apartments which have been occupied by a person suffering from pulmonary tuberculosis have been vacated by death or removal, an inspector visits the premises and, when necessary, directs the removal of infected articles, such as carpets, rugs, bedding, etc., for disinfection, and makes such written recommendations as may be required regarding the cleans- ing and renovation of the rooms or apartments or their fumigation w ith formaldehyde. When cleansing and renovation are required, an order embodying the recommendations is issued on the owner of the premises, and compliance with this order is enforced. No oilier persons than those there residing at the time are allowed to 10 occupy such rooms or apartments until the order of the Board has been complied with. When there is reason to suppose that this regulation will be disregarded, a paster stating the facts is affixed to the door. Infected articles, such as mattresses, pillows, carpets, rugs, etc., are removed by the Department of Health, disinfected and returned without charge to the owner. All bedding is fumi- gated before removal. If the owner or occupant of the premises desires to carry out the necessary disinfection himself, he may do so, providing^that he satisfy all the requirements of the Depart- ment, and furnish the Department with a statement from the at- tending physician, showing the number of rooms disinfected, the cubic feet of air space, and the kind and amount of disinfectant used. A special blank has been prepared for this purpose, and will be furnished on application. 4th. When application is made to the Department for the admission of a case of pulmonary tuberculosis to a hospital, or when the nurse finds that the patient cannot receive proper care, food, or medical attention at his home, or when, either wilfully or otherwise, the patient constitutes a danger or menace to those about him, the case is referred to the Department of Charities, with the recommendation that he be sent either to the Metropoli- tan Hospital for Tuberculosis on Blackwell's Island, or to Seton Hospital, where the city maintains a number of free beds. When such a case refuses to go to a hospital, the patient may be forcibly removed or may be referred to a charitable organization for as- sistance, in the shape of food, fuel, or medical attention. In instances where a person suffering from pulmonary tuber- culosis absolutely refuses to take the necessary precautions as to the proper disposal of the sputum, etc., the Department of Health will enforce removal. It has fitted up special pavilions for ad- vanced cases at Riverside Hospital (the Riverside Sanatorium for 11 Pulmonary Diseases), where such cases may be sent at a few hours' notice and detained if necessary. The Department nurses visit all indigent cases and those that are unable to work; they recommend charitable assistance, and see that it is given. In addition to the staff of regular inspectors and nurses, the Department also has special inspectors, who make house to house visits, following up previously reported cases, and looking for new ones. Clinics for the treatment of pulmonary diseases have been established at 967 Sixth Ave., Manhattan, 361 Jay St., Brooklyn, and 3731 Third Ave., The Bronx, where every facility is afforded for the proper study and treatment of pulmonary tuberculosis. The Manhattan clinic is open from 10 A. M. to 4 P. M. every week day, and from 8 to 9 P. M. on Mondays, Wednesdays and Fridays. The Brooklyn and Bronx clinics are open daily from 2 to 4 P. M. The objects in view are as follows: (tf) The medical care and supervision of all cases of tuber- culosis applying for treatment; thorough instruction as to the dangers to themselves and others, and as to the necessary prophy- lactic measures; the provision of medicines and sputum cups. ( b) The continued observation at their homes of all indigent, needy and ambulatory cases and those discharged from the public institutions of the city. Nurses detailed for this special purpose visit such patients at their homes, see that instructions are carried out, that the sanitary surroundings are satisfactory, and render assistance in every way possible. (0 The provision of a municipal institution to which all cases of tuberculosis may be referred by the various charitable 12 organizations throughout the city, and from which suitable cases may be referred to various public institutions for their care. ( d ) The prompt recognition of incipient cases, so that they may be sent as early as possible to sanatoria outside the city. ( e ) The supplying of proper food, in the form of milk and eggs, to favorable, indigent cases. 5. Everything possible is done to educate the public, not only as to the precautions which should and must be observed by per- sons suffering from pulmonary tuberculosis, but also as to the harmlessness to the community of patients who are careful as to their expectoration, etc.* Circulars have been prepared and widely distributed dealing with: (a) the dangers of dusting; ( b ) pul- monary tuberculosis, its nature and treatment; (c) how to keep from contracting the disease; ( d ) the free tuberculosis clinics; ( e ) instructions to patients therein; (/) tuberculosis catechism for the 650,000 school children of New York; ( g ) early diagnosis of tuberculosis ; and ( h ) what the Department of Health does to prevent the spread of the disease. All of the above are printed in several languages (English, German, Italian, Yiddish, etc.) and will be sent free of charge on application. Stereopticon exhibi- tions are given during the summer in the parks and recreation piers, and during the winter in halls, parish houses, etc. Travel- ling exhibits of apparatus, photographs of sanatoria, explained by lectures, etc., are also given in the schools, parish houses, etc. Note: Sputum Examinations. For the prevention and suc- cessful treatment of pulmonary tuberculosis it is of vital import- ance that a positive diagnosis be made at the earliest possible moment. The Department of Health is prepared to examine 13 specimens of sputum for the presence of tubercle bacilli from any person residing in New York City. Samples of the sputa, freshly discharged, should be furnished in clean, wide-necked, well-stop- pered bottles, accompanied by a blank giving the name, age, sex, color, nationality, occupation and address of the patient and the character of the premises, etc. Bottles for collecting the sputa, with blank forms to be filled in, can be obtained without charge at any of the drug stores now used as stations for the distribution and collection of serum tubes for diphtheria cultures. After the sputum has been obtained, if the bottle with the accompanying blank filled out be left at any of these stations, it will be collected by the Department of Health, the sputum examined microscopical- ly, and a report of the examination forwarded to the attending physician, free of charge. The hi formation regarding cases of pulmonary tuberculosis obtained by the Department of Health through such bacteriological examination of sputum is solely for registration, and cases of pulmonary tuberculosis thus reported will not be visited by inspectors of the Department of Health, nor will circulars be forzvarded to them, without the special permis- sion of the attending physician . This service is being more and more appreciated and utilized by physicians every year. During 1907 27,277 specimens of sputum were submitted for examination, an increase of 5,498 over 1906. Tubercle bacilli were found in 7,546 specimens (27 per cent.). It is the earnest wish of the Board of Health that all practicing physicians in this city co-operate with the Board in an intelligent and sustained effort to restrict the ravages of this, the most preva- lent and formidable disease with which we have to deal. For any further information apply to J. S. Billings, Jr., M. D., Chief of 14 Division of Communicable Diseases, Department of Health, 969 Sixth Avenue, New York. Telephone, 4900 Columbus. THOMAS DARLINGTON, M. D„ President . Eugene W. Scheffer, Hermann M. Biggs, M. D., Secretary. Medical Officer. 15 DEPARTMENT OF HEALTH CITY OF NEW YORK SIXTH AVENUE AND FIFTY-FIFTH STREET DIVISION OF COMMUNICABLE DISEASES 21-435, ’08, 1,000 (P) CIRCULAR OF INFORMATION regarding the IMPORTANCE OF BACTERIOLOGICAL EXAMINATION OF THE SPUTUM IN THE EARLY DIAGNOSIS OF PULMONARY TUBERCULOSIS 1908 CIRCULAR OF INFORMATION REGARDING the Importance of Bacteriological Examination of the Sputum in the Early Diagnosis of Pulmonary Tuberculosis T-HE symptoms of incipient pulmonary tuberculous are few m ^erand T quently not characteristic. They are often not sufficiently marked to a the attention of the affected individual, and their significance may not he recogn by physicians, as there are other conditions which closely resemble incipient pul- monary tuberculosis. * Tuberculosis results from the reception of tubercle bacilli into the system o a susceptible person. The bacilli are usually inspired with the air and fin o g- ment in some portion of the respiratory passages. There, when favorable con i- tions exist, they increase in number, and by their growth set up an inflammation which becomes evident in the formation of new tissue, the so-called tubercle. Tie inflammatory changes are usually at first very slight and the effects entirely local. Moreover, in this early stage there is a marked tendency to localization and re- striction of the process and' to entire recovery. Many persons recover without treatment In such cases the bacilli die or are rendered harmless, and the tubercles are gradually replaced by fibrous tissue. At this time,— i. e., when an individual has tuberculosis, but when the disease is confined to a small, sharply circumscribed area _there is the best opportunity for successful treatment. On the other hand, in a large percentage of the unrecognized and neglected cases, recovery does not take place, but the tuberculous process extends, the bacilli multiply, new tubercles form, the old ones become necrotic, and there is a coa- lescence of separate foci of infection, forming larger and larger areas of disease until a great part of one or both lungs is affected. At the same time, the bacilli in their growth form poisons, which are absorbed by the system, and other bacteria are deposited in the diseased or necrotic tissues, producing so-called * 1 mixed in- fection.” The disease has now nizable and constitutes what 18 J mpt0 ms commonly assigned to pul- gress to a fatal termination. The classical y P of appe tite and monary tuberculosis, i. e., persistent cough wit not G f the incipient weight, and hemoptysis, are really symptoms m “ diagnosis is affection, but of the advanced disease In the <*rly “ " There is a often possible only when tubercle bacilli are fou * ^ ^ ^ ad _ common impression that tubercle baci 1 physical examination are them- vanced to a point at which the signs presented on a phy^ ^ ^ ^ selves almost conclusive. Such, however, is *> ^ indicat5ve on l y 0 f a quently found in the ^^etre ateohitely no abnormal physical signs observable, slight bronchitis, or when t -a-ted ar ea is always considerable, When signs of consolidation are obtai ned on and usually far greater than would be inferred from the Phy r!sTft^e importance that the diagnosis should be possible moment. The expectoration should be examine^ ear y, an^ ^ & not found immediately, it with expectoration, persisting nature. In all cases, also in w unex plained pallor, loss of for more than a few week , and m even if the cough appears to absent, tuberculosis should be suspected, and tubercle bacilli “ — facts : First— Incipient tuberculosis tends to recovery. . Second. — Advanced tuberculosis, with or without mixed mfeotton, all coughs Which last mo,, than • few weeks, and which at. DO. associated with asthma, emphysema or cardiac disease, tubereulosts >s to be s - “suLsftd treatment and prophylaxis demand the earliest possible d *^.-Th« diagnosis of incipient pulmonary tuberculosis properly so called. • mad . oos itive when tubercle bacilli are found in the expectoratio . Sixth -Repeated examinations of the expectoration are frequently necessary to demonsirate the presence of the tubercle bacilli in incipient cases of pulmonary tn ~7n order that bacteriological examinations of the sputa may beat the service t ■ cions in all cases the Health Department is prepared to make such exam- ° Ta ll 7 sf.hr, freshly discharged. are famished in ,Ua. mid,- ZZ lZZ L M ies, accompanied by the name, aye. s„ and address of tpaZXln a, .he disease, and .he name and address a, ,he adendmg physician . Free Dispensaries and Clinics for the Treatment of Tuberculosis DISPENSARIES at^hjd'isp^^ry t in n the^'str?cti^wWcS 1 toeyBve r XhVdT* 8houl £ apply are shown on the map. wnicn tliey live. The dispensary districts MANHATTAN Harlem Hospital Dispensary, 136th St. and Lenox Ave. Week days, 3 to 4 p. m. Mt. Sinai Hospital Dispensary, Madison Ave. and 100th St. Week days, 10 to German Hospital Dispensary, 76th St. and 1 ark Ave. Week days, 2 to 4 p. m. Vanderbilt Clinic, 60th St. and Amsterdam Ave. Week days, 2 to 3 p. m. Mon., VV ed., F n. , 9 to 10.30 a m. Presbyterian Hospital Dispensary, 70th St. and Madison Ave. Mon., Wed., Fri 1.30 to 3.30 p. m. Department of Health, 55th St. and 6th Ave. Vv 5 k 10 A - to 4 P. M. Mon., Wed., Fri., 8 to 9 p. m . Bellevue Hospital Dispensary, Foot of East 26th ot. Week days, 1 to 3 p. m. New York Hospital Dispensary. 8 West 16th St. Week days, 2 to 4 p. m. Gouverneur Hospital Dispensary, Gouver- neur Slip. Mon., Wed., Fri., 2 to 4 p.m. T°f k Dispensary, 137 Centre St. Week days, 11 a. m. to 12.30 p. m. THE BRONX °* Health, 3d Avenue and St. Paul s Place. Week days, 2 to 4 p. m. BROOKLYN Department of Health, 361 Jay St. Week days, 2 to 4 p. m. Brooklyn City Dispensary. 11 Tillary St. Week days, 2 to 4 p. m. For further information apply to Dr. J. S. Billings, Jr., Chief of Division of Communicable Diseases, Department of Health. 55th St. and 6th Ave., N. Y. City. Ml L— 1WS 21-483, ’08, 260,000 (P) PULMOHABY TUBERCULOSIS OR Consumption HOW TO KEEP FROM GETTING IT HOW TO KEEP FROM GIVING IT DON’T SPIT DEPARTMENT OF HEALTH THE CITY OF NEW YORK THOMAS DARLINGTON, M. D. Commissioner of Health EUGENE VV. SCHEFFER HERMANN M. BIGGS, M. D. Secretary General Medical Officer 1908 Pulmonary Tuberculosis or Consumption Is chiefly caused by the Filthy Habit of SPITTING TAKE THIS CARD HOME, READ IT CAREFULLY, And show it to your family, friends and neighbors. Pulmonary tuberculosis or consumption is a disease of the lungs. It is taken from other people who have it, and is not simply caused by a cold, although a cold may make it easier to tlic disease. The matter coughed up and sneezed out by people who have the disease is full of living germs or “tubercle bacilli” too small to be seen. These germs are the cause of tuberculosis and when they are breathed into the lungs of weakened and debili- tated people, they set up the disease. DON’T GET TUBERCULOSIS YOURSELF Keep as well as possible, for the healthier your body, the harder for the germs of tuberculosis to grow therein To keep healthy observe the following rules: DON'T live, study or sleep in rooms where there is no fresh air. Fresh air and sunlight kill the tubercle bacilli and other germs causing other diseases, therefore have as much of both in your room as possible. DON'T live in dusty air; keep rooms clean; get rid of dust by cleaning with damp cloths and mops. DON’T • sweep with a dry broom. KEEP one window partly open in your bedroom at night and air the room two or three times a day. DON'T eat with soiled hands. Wash them first. DON'T put your hands or pencils in your mouth or any candy or chewing gum other persons have used. DON'T keep soiled handkerchiefs in your pockets. TAKE a warm bath with soap at least once a week. DON’T neglect a cold or a cough, but go to a doctor or dispensary (see last page). HOW TO GET WELL IF YOU HAVE TUBERCULOSIS If you or anyone in your family have tuberculosis must obey the following rules if you wish to get well: you DON'T waste your money on patent medicines or adver- tised consumption cures, but go to a doctor or dispen- sary (see last page). If you go in time, you can be cured ; if you wait, it may be too late. DON'T drink whiskey or other forms of liquor. DON’T sleep in the same bed with anyone else and. if possible, not in the same room. Good food, fresh air and rest are the best cures. Keep out in the fresh air and in the sunlight as much as possible. KEEP your windows open winter and summer, day and night. IF properly wrapped up you will not catch cold. GO to a sanatorium if you can and_before it is too late. A person who has pulmonary tuberculosis or con- sumption is not dangerous to those with whom he lives and works, if he is careful and clean. DON’T GIVE TUBERCULOSIS TO OTHERS Many grown people and children have pulmonary tuber- culosis or consumption without knowing it, and can give it to ° 1 _ tlle f rs - Therefore every person, even if healthy, should observe the following rules: DON'T swallow your expectoration, but— DON’T SPIT on the sidewalks, playgrounds, or on the floors or hallways of your home or school. It spreads disease, and is dangerous, indecent and against the law. lUU MUM SP IT, spit in the gutters or into spittoon half filled with water. DON’T COUGH OR SNEEZE without holding a hand- kerchief or your hand over your mouth of nose. DON T blow your nose on your fingers. Take This Card Home and Show It to Your Family, t Fria dispensarler och klinlker f6r behandling af lungsiktiga. . _ DISPENSARIER. OBS. ! For undersokning eller behandling m&ste man anmala sig i det distrikt, dar man bor. MANHATTAN. Harlem Hospital Dispensary. 136th St. och Lenox Ave., S&ckendagar 3-4 e. m. Hit. Sinai Hospital Dispensary. Madison Ave. och 100th St., Sockendagar 10-11 f. m. German Hospital Dispensary. 76th St. och Park Ave., Sockendagar 2-4 e. m. Vanderbilt Clinic. 60th St. och Amsterdam Aye., Sockendagar 2-3 e. m.; Mandag, Ons- dag, Fredag ocks«i 9-10.30 f. m. Presbyterian Hospital Dispensary. 70th St. och Madison Ave., Mandag, Onsdag, Fredag 1.30-3.30 e.m. Department of Health. 55th St. och 6th Ave., Sockendagar 10 f. m.-4 e. m.; Mandag, Onsdag, Fredag ocksa 8-9 e. m. Bellevue Hospital Dispensary. East 26th St., Sockendagar 1-3 e. m. Netv York Hospital Dispensary. 8 West 16th St., Sockendagar 2-4 e. m. Gouverneur Hospital Dispensary. Gouverneur Slip, Mandag, Onsdag, Fredag 2-4 e. m. New York Dispensary. 137 Center St., Sockendagar 11 f. m.-12.30 e. m. Department of Health, BRONX. 3rd A ve. och St. Paul’s Place, Sockendagar 2-4 e. m. BROOKLYN. Department of Health. 361 Jay St., Sockendagar 2-4 e. m. Brooklyn City Dispensary. 11 Tillary St., Sockendagar 2-4 e. m. For vidare upplysningar han- vande man sig till Dr. J. S. Billings, Jr., Chief of Division of Communicable Diseases, De- partment of Health, 55th St. och Sixth Ave., New York City. LUNG5QT HURU MAN UNDVKER ' ATT FA DEN. HURU MAN UNDVIKER ATT SPR1DA DEN. Spotta icke! HALSOVARDSNAMDEN I NEW YORK CITY. THOMAS DARLINGTON, M. D. Commissioner of Health EUGENE W.SCHEFFER Secretary HERMANN M. BIGGS, M.D. General Medical Officer 1908 LUNGSOT sprides hufvudsakligen genom den smutsiga ovanan att * SPOTTA. VISA DETTA KORT FOR DIN FAMILJ, dina vanner och grannar. LAS DET MYCKET NOGA ! Lungsot ar en sjukdom, som man adrager sig genom smitta. Den fororsakas icke- ensamt genom forkylning, ehuruval man lattare smittas, di. man hr forkyld. De smapartiklar, som upphostas eller nysas ut af en lungsiktig, innehalla talrika mikrober eller luugsotsbacil- ler, hvilka aro osynliga for blotta ogat. Dessa mikrober at- folja alltid lungsot, och da de inandas i lungorna, gifva de ofta upphof till sjukdomen. AKTA DIG FOR LUNGSOT! Skot dig val, ty ju friskare kroppen ar, desto svirare ar det for lungsotsbacillerna att fa. fotfaste. Foljande regler bora iakttagas af alia : BO icke, studera icke, arbeta icke, sof icke i rum, som sakna frisk luft. Frisk luft och solljus doda lungsots- och andra sjukdomsbaciller; gif darfor bada s& mycket som moj- ligttilltra.de till ditt rum. VISTAS icke i dammig luft; hall rummen rena; aflagsna dammet med en fuktig trasa eller dammviska (s. k. mop). Sopa icke med en torr kvast. LAT ett fonster i din sangkammare sta halfoppet under natten och vadra rummet flera ganger om dagen. AT icke med handerna smutsiga. Tvatta dem forst. STOPPA icke fingrar eller blyertspennor i munnen, ej ^heller sotsaker, som n&gon annan bitit i. BAR icke smutsiga nhsdukar i fickan. BADA i varmt vatten itminstone en gang i veckan. X^NSKOT icke en forkylning eller en hosta, g& till en s eller ett dispensary (se sista sidan). HURU KAN LUNGSOT BOTAS? Om du sjiilf eller n&gon i din familj har lungsot, maste foljande regler iakttagas i och for tillfrisknande: SLOSA icke bort pengar till patent mediciner eller annonserade lungsotskurer, utan ga till en lakare eller ett dispensary (se sista sidan). Om du gar genast, kan du "blifva frisk; vantar du, ar det kanske for sent. DRICK icke whiskey eller andra starka drycker. SOF icke tillsammans med nagon i samma badd och, om mojligt, icke i samma rum. Kraftig foda, frisk luft och hvila aro de basta botemedlen. Hall dig i friska luften och i solsken si i mycket som mojligt. LAT fonstren sta oppna vinter och sommar, dag och natt HAR man tillrackligt klader pa sig, forkylerman sigej. GA till ett sanatorium om sa ske kan, och innan det ar for sent. En lungsiktig, som ar renlig, ar icke farlig for sin omgifning i hemmet eller i arbetet. SPRID ICKE LUNGSOT. Fullvuxna saval som barn hafva ofta lungsot utan att veta af det och kunna darfor sprida smitta. Darfor b° r och eu, afven den som ar frisk, iakttaga foljande fbrhill- ningsregler : SVALJ ICKE edra upphostningar— men SPOTTA ICKE pa trottoaren, pa, lekplatsen eller pa golfvet eller i forstugan, i hemmet eller i skolan. Dara sprides sjukdom; det ar farligt, opassande och olagligt. OM DU AR TVUNGEN ATT SPOTTA, gor det i rann- stenen eller i en med vatten halffylld spottliida. HOSTA ELLER NYS ICKE utan att hdlla en nasduk eller handen for mun eller nasa. PETA EJ nasan med fingrarna. Visa dessa foreskrifter for din familj. Dispensarii Gratuiti e Cliniche per la Cura dei Tubercolosi DISPENSARII . Coloro che desiderano farsi csaminare o curare nel Man- PqqV f° Ugh devono rivolgersi al Dispensario del Distretto in cui vbbl VlYOiiO, MANHATTAN Dispensario Harlem Hospital, 136th St. e Lenox Ave., ogni glorno dalle 3 alle 4 p. m., eccetto le feste. Dispensario Mt. Sinai Hospital, Madison Ave. e 100th St., ogni giorno dalle 10 .alle 11 a. m., eccetto le feste. Dispensario German Hospital, Park Ave. e 76th St., ogni giorno dalle 2 alle 4 p. m., eccetto le feste. Dispensario Presbyterian Hospital, 70th St. e Madison Ave., ogni Lunedi, Mercoledi, e Venerdi, dalle 1.30 alle 3.30 p. m. Vanderbilt Clinic, 60th St. e Amsterdam Ave., ogni giorno dalle 2 alle 3 p. m. eccetto le feste. Lunedi, Mercoledi, Venerdi, 9-10.30 a. m. Dipartimento di Sanita, 55th St., e 6th Ave., 10 a. ni. alle 4 p. m., ogni gior- no eccetto i giorni festivi, e dalle 8 alle 9 p. m. solo il Lunedi, Mercole- di e Venerdi. Dispensario del N. Y. Hospital, 8 West 16th St., tutti i giorni dalle 2 alle 4 p. m., eccetto le feste. Dispensario Bellevue Hospital, Orario dall’l alle 3 p. m., ogni giorno, ec- cetto i giorni festivi. Dispensario Gouverneur Hospital, Gou- verneur Slip, Lunedi, Mercoledi- e Venerdi dalle 2 alle 4 p. m. N. Y. Dispensario, 137 Centre St., ogni giorno dalle 11 a. m. alle 12.30 p. m., eccetto le feste. BROOKLYN Dipartimento di Sanita, 361 Jay St., ogni giorno dalle 2 alle 4 p. m., eccet- to le feste. Dispensario Brooklyn City, 11 Tillary St., dalle 2 alle 4 p. m., ogni giorno, eccetto i giorni festivi. THE BRONX Dipartimento di Saniti, 3d Ave. e Saint Paul’s Place, ogni giorno dalle 2 alle 4 p. m., eccetto le feste. Per altre informazioni rivolgersi al Dr. J. S. Billings, Jr., Capo per le Divisioni delle Malattie Contagiose. Di- partimento di Sanita, 55th St. e 6th Ave., Citta di New York. 238 L— 1903 21-492. ’08, 50,000 (P) La Tubercolosi Polmonare o Consunzione Come si deve fare per non contagiarsi. Quale e il mezzo per non contagiare gli altri NON SPUTATE DIPARTIMENTO DI SANITA CITTA DI NEW YORK THOMAS DARLINGTON, M. D. Commissario di Sanita EUGENE W. SCHEFFER HERMANN M. BIGGS, M. D. Segretario Medico Ufficiale Generale 1908 La Tubercolosi Polmonare Qni TTA DP 6 principalmente causata ^ 1 J J_ /\ fx r. daila brutta abltudlne di PORTATE QUESTA CARTA A CASA e fatela leggere alia vostra famiglia, amici e vicini La tubercolosi polmonare e una malattia dei irolmoni, che e presa da altre persone, che nc sono malate e non e semplice- mente causata dai raffreddori, quantunque un raffreddore pos- sa favorire lo sviluppo della malattia. Lo sputo emesso dai tis'ici per mezzo della tosse o detlo starnuto, e pieno di germi viventi o bacilli della tubercolosi, troppo piccoli per essere visibili. Questi germi sono la causa della tubercolosi polmonare, e quando sono inspirati nei pol- moni, producono la malattia. Cercate di non ammalare di tubercolosi polmonale Mantenetevi sani il piu che sia possibile, poiche quanto piit forti voi siete, tanto piu difficile sara per i germi della tuber- colosi di guadagnar terreno su di voi. Ogni persona dovrebbe osservare le seguenti norme: Cercate di non vivere, studiare o dormire in camere dove non vi sia aria fresca. L’aria fresca e la luce del sole ucci- dono i germi della tubercolosi, ed altri germi causanti altre malattie, percio abbiate il piu che sia possibile di aria e di lu- ce nelle vostre stanze. Non vivete in ambienti polverosi, mantenete le stanze pu- lite, liberatevi della polvere coll’usare panni o stracci umidi. Non spazzate con scope asciutte. Mantenete una finestra nella vostra stanza da letto in par- te aperta la notte, e date inoltre aria alia stanza due o tre volte al giorno. Non mangiate con mani sporche. Lava tele prima. Non mettete in bocca le mani, le matite o qualsiasi candy o chewing gum usati da altre persone. Non conservate fazzoletti sporchi nelle vostre tasche. Prendete un bagno caldo con sapone almeno una volta la settimana. J Non trascurate un raffreddore o una tosse, ma andate a trovare un dottore o recatevi a un dispensario (vedi lulti- ma pagina). QUALE E IL MODO DI STAR MEGLIO SE VOI SIETE MALATI DI TUBERCOLOSI Se voi o qualsiasi altra persona della vostra famiglia soffre di consunzione, dovete obbedire alle seguenti regole per star bene: Non consumate danaro in medicine patentate o specifici per la tubercolosi, ma andate a trovare un dottore, o recatevi a un dispensario (vedi rultima pagina). Se voi andate in tem- po, voi potete essere curati ; se voi aspettate, puo essere trop- po tardi. Non bevete whiskey o altri liquori. Non dormite ncllo stesso letto con qualsiasi altra persona e see possibile, non dormite nella stessa stanza. Buon nutrimento, aria fresca e riposo sono le mi- gliori cure; state fuori all’aria fresca e alia luce del sole il piu che sia possibile. Tenete le vostre finestre aperte inverno e estate, giorno e notte. Se siete ben coperti non prenderete raffreddori. Andate in un sanatorio per curarvi, quando la malattia e solo al suo principio, prima che sia troppo tardi. L’ammalato di tubercolosi che abbia cura di se e sia pulito, non e pericoloso per quelli coi quali egli vive e lavora. NON DATE LA TUBERCOLOSI AGLI ALTRI Molte persone adulte e bambini sono malati di tubercolosi senza saperlo, e possono darla agli altri. Percio, ogni perso- na, anche sana, dovrebbe osservare le seguenti norme: Non inghiottite l’espettorato o il catarro, ma non sputate pero neppure sui marciapiedi, in ritrovi pubblici, o sui pavi- menti della vostra casa o delle scuole. Lo sputare diffonde la malattia ed e pericoloso, indecente, e contro la legge. Quando dovete sputare, sputate fuori del marciapiedi quan- do siete in istrada, e nelle sputacchiere riempite a meta di acqua in casa. Non sputate e non starnutate senza tenere un fazzoletto o la vostra mano sulla bocca o sui naso. Usate soltanto il fazzoletto per soffiarvi il naso; non ado- perate le dita. Portate questa carta a casa e fatela leggere alia vostra famiglia. 21-493, '08, 60,000 (P) Bczplatnd nmbulandni kliniky (dispcnaarle), ve kterycli se soucliotd ledi se zvldStirim nspdchem. DISPENSARIE. Manhattan. Harlemskd mmocnice, roh 136. ulice a Lenox ave. Dennfc vyjma nedSle od 3 do 4 hod. odpol. Mt. Sinai netnocniCni klinika (dispen; serie). Na Madison ave. a 100 ulici v§ednf dui od 10 . — 11. hod. rdno. Nemeckd nemocnice a klinika (dispen- serie) v 76. ul a Park Ave., v§ednl dni od 3—4 hodin odpol. Pispensarie PresbiterianskG ntooc- nice, roh 70. ulice a Madison ave., v pondelt, ve stfedu a v pdtek od 1*30 do 3.30 hod. odpoledne. Vanderliltova klinika, 60. ul. a Am- sterodam Ave. Pcnu6 vyjma nedfele od 2—3 hodin odpol. V pond£H, ve stf£du av p&tek od 9-10 30 hod. dop. MSstsk^ zdravotnf tifad. 967 §est£ Ave.. roh 55.nl. Kazdtf den vyjma ne d§li od 10 — 12 hod aop. a od 2—4 odp. V pond£lf. ve stfedu a v pdtek jc§td od 8—9 hod. vefcer. N. Y, Nemocnice, odd£lenf pro ven* kovskd pacienty, 8 zdp. 16 xilice. Ve v§edn/ dny od 2 do 4 hod. odpoledne. Bellevue nemocnice. Odddlcnf pro ven- kovsk£ pacienty tipatf 26. ul. Denne vyjma neddlc od 1 do 3 hod. odp. Dispcnserlev Gouverneur nemocnice Water ul., roh Gouverneur. V pon- d£lf, ve stfedu a v pdtek od 2 do 4 hod. odp, N. Y. Dispenaerie 137 Centre ulice. Denn£ vyjma ned£le od 11 dop. do 12.30 odpoledne. Y Brooklyn^. Mestsk# zdravotnf tifad 361 Jay ul. Vsednf dny od 2 do 4 hod. odp. Brooklynskd m5stsk£ nemocnlee 11 1 illary ul. VSednf dnj r od 2 do 4 hod, odpoledne. Y Bronx. M2stsk£ zdravotnf drad 3. ave* a St* Paul PI. (ndmSstf). v§ e dnf dny od 2, do 4 hod. odpoledne. DalSfimforroaee sddlf Dr. J. S. Billings, vrclinf lC*kaf naka51ivj*cli nemocf m£st-. sk£ho zdravotnfho dfadu roh 55, ul, a 6, Ave- New York City, PLICNI TUBERCULE — neb — Souchote. JSOU PRENASENY HLAVNE Plivanim C-ttte pozorne. Yezmdte tento Hstek s sebou domfi, *t$tc, uka2te ho cel6 roiling ft pah sousedum. SouchotS jest plicnl neduh, prenSLSen? z jednS osoby na druhou a nenl’ pouze nasledkem nastuzenl, avsak kaz- dd nachlazenl Cini z&rodek i ndkazu muZnSjslm. Chrchle a vftbec v§e co soucliotinafi vyplijt neb vy- k^chnou, jsou piny nakazliv^ch zarodku. Tyto zdrodky jsou pfldinou souchotin, jsouli vd^cbdny lidem vysilen^m. NENECHTE SE SAMI NAKAZIT. Drztc se die ndsledujirich pravidel: Dr2te svoje telo v nejlepSi mlfe zdravf, tak aby se V&s nic nechytlo. Nespete v mlstnostech, kde nenl distdho vzduohu. Nepracujte ani nejezte v mlstnostech naplndn^ch pra- cliem. M6jte v loSnici jedno okno otevrend ve dne I v noci. Neplivejte na chodnlk neb podlahu ve svdtnicfch neb vefejnych mlstnostech, poulidnlch vozecb atd. jest to pro jine nebezpednd a proti z&konu. Musite-li plivati, tedy plivejte do pllv&tka naplndndho do polovice vodou a vyplachujte dasto horkou vodou. Neeliovejtc dlouho suchy kapesnfk pfi sobd. Nejezte se dplnav^ma rukama ani ned&vejte penlze paplrovd nebo tu2ky do ust. Koupejte se v tepid vodd s m^dlem alespoii jednou t^dnd. Nezanedbejte nastuzeni.Nemflzete-li jiti k ldkafi, jdd- te do jednd z dispensed! (adresy na posledn! strand.) :»39 L— 1908 SOUCHOTfc JAK SE JIM UBRANITI, ^ JAK JE NEROZNASET. Neplivejte ZDRAVOTNI URAD MESTA NEW Y0RKU. Dr. Thomas Darlington, komisar. Eugene W. Scheffer, Dr. Herman M. Biggs, Secretary. Vrcbni lekar. 1908. JAK SE VYLECITI. MA-LI KDO JIZ SOUCHOTE. Mdte-li eouchote, neb ngkterj Clen Vast rodiny a clicete-li se vylecit, muslte se fiditi die n&sledujlclch pravidel: Nevyhazujte pendz na patentnl ldky a vselijakd v no- viudch ohlasovand prostfedky a tak zvand balsdray, ale jddte k ldkafi neb na kliniku do nemocnice. uemlte-11 taa v cas, muzete b^ti vylddeni. Budete-li vsak odkUdat az nebudete moci chodit neb pracovat, pak bude JiZ pozde se ledit. Nepijte koralku ani jind lihoviny. Nespfte v jednd posceli s nemocofmi a pokud moino ani v jedn<5 svetnici. Dobri straTft, Jerstif vzduch a klid jsou nejtopSim lekem. Bud’te 11 a vysluuui co nejrice muiete a pobybujt* se na 6erstv6m vzducbu. Nechte okna pootevFend v zim6 v ldt8, ve dne 1 v noci, Cerstv? vzduch jest nejlepsl ldk. M6jte vzdy tepl? oblek neb pokrj'vku. Odhodlejte se do sanatoria jlti v Cas, mu2ete-li. Pozomy a elstotnf soucbotJnaf neni nebezpcFny t£m, s kteryml bydli a pracujc. Opatruosti nikdy nezbyva — neuakaztc svojl vlastnl linn. Mnozi dospdlf lidd i ddti maji souchotd, ani2 by o tom d61i a mohou jind nakazit, proto kaW Clovgk, treba iobrdm zdravl se md fldlt die ndsledujfctch pravidel. Neplivejte vsude na vSech mlstech, tn§jte vidy na my- , ze se mflze nakazit u Vds jests jind Cdst pile, as istnfru chrchlem. Nepolykejte chrchle. Nekycliejte pfes stul neb do obligeje jindbo, ami byste rdnili fista rukou neb kapesntkem. Nentirejte nos sv£mi prsty. Jt£TE POZORNE A DEJTE PAK TENTO LfSTEK tsrki'evTw: UV I^TKVfw 3t* nv. Berman m* Bigg#/ SefretSr. f^auptOlrjt. CHBfltn=tubcrculo(t tutr $d>windfu(l>t ttitrb mciftcntcllS burtfj Spndcn bcrBrcitct. 92cijmen 8tc btcfc8 itacfj ^aufc, Icfcn 3tc c8 aufmcrffam, acigcu 3tc 3^cr gaitscn 3'0«iiHc mtb 30rcu 9incf)6arn. 5?urtgcn^uBercuTof e obor ©djtuinbfudfit ift etnc .^ranfT)cit bcr fiungen. r belaftct ift, auf bic anbcrc iibertragen, unb ift uirfjt blo^ cine 9tad)foIgc bon (Srfdltung, bodj iebe (Srfdltung ermiiglidjt cine SInftedung. S)cr 0 peid)cr, ubcrljaupt allc§, lna» 0 d)linnbfud)tige au§^ fpittfen ober niefen, ift Dou anfterfenber Acinic, 311 Hein, gc^ fefjcn 3 U merben. S)iefc 5lcime. finb bic Urfadjc bott (5d)tuinbfud)t. £afjet fatten (Sic in ^ rcn i (Sdjlafgimmer ftet^, Bet ^ag unb bet 9 cad)t, cin genfter ctma» gcbffnct. ltm gefunb 3 U blcibcn, bcfolgen (Sic bic folgcnbcn 9iegcln: gfrifdje 2 uft unb SonncnIid)t finb bic Jycinbc bcr ^uber^ cu(ofi»'S 3 acillcn unb anberer ^rani^cit§!cimc. fid? vet 5(nftccfung. ^altcn Sic fteta ^ren ^brper im beften ©efunbljeitSau* .ftanbe, bafe fid) 3 v n cn nidjtS anljaftc. ^c gefiinber bcr ^orber, um fo fd)tuicrigcr ift e§ fiir bic Saciden, in iljm 3 U iuad)fcn. Sd)tafcn Sie nic in dldumTic^fciten, \vo unreine i?uft ^crrfd)t. Sfrbcitcn unb fbeifen Sic nic in fRaumlidjfeiten, iuo Staub fid) anfammclt. Stauben Sie mit cittern feud) ten £udj, nic mit cincm trodenen ^efen. ©ffen Sic nic mit itnrcincn fianben unb fteden Sic nic ^apicrgelb ober 23leifebcrn in ben 3?iitnb. 23cfjaften Sic nic Tange cin fc§tnufeige£, trodenen Safdjcn^ tud)*bei fic^. 5 ?aben Sic guminbeft cittmaT modjentlid) in rnarmcm SSaf^ fer mit Scifc. $crnad)Tdffigen Sic nic cine SrfdTtung. ^onnen Sic nid)t 311 cittern 2 (r 3 te geben, gcTjcit Sic in cine &i3penfart). ^Ibreffett auf bcr lenten Scitc. lUie Cungeii-^ubcrculofe Oder £cf^tt>inN fuctrt geheilt tt>er5ctt famt* Sinb Sie fdjloinbfudjiig, ober irgenb cin G5Xieb ^brer Samilic, unb too Hen Sie toteber gefunb toerben, miiffcn Sic folgenbc ^afjrcgclrt bcfolgen: GJcbett Sie !cin uttrtuj 3 C§ (SJcTb aug fiir ^Patcnt' 2 )iebi 3 incn uttb aUerbattb in Qcihittgcn angcpricfcttc Vittel unb fogenanute ^alfame, fottbern gcbcit Sic fofort 311 cincm 5tr^t ober in bic Mini! in cittern XTrattfcnbau». Sbuen Sie bie 0 31 a* rcdjten Qcit, bantt Tonnen Sic gebcilt toerben. ^rinfen Sic Tcinc geiftigett ©ctrdnfc. SdjTafcn Sic nidit in cincm $3ettc mit cittern $ranfen unb toombglid) audj uid)t im fclbcn yimntcr. Q5ittc 9Taftruttg f frtfd)c fiuft unb Hiubc ftnb bic Dcftcit fitter. ^oTten Sic ftd) miJgfidjft OteT ait bcr Soitncnfcitc auf unb betuegen Sic fttb ftetS in frifeber £uft. ^altctt Sic bic genfter cin iocnig offen, Sommer unb 5Bitt^ ter, bci £ag unb bci i)tad)t — rcittc fiuft ift bie befte StTZebi^in. ^ragen Sie ftctg marine £Icibung uttb ioarmc ^edett. Sntfd)Iicf^cn Sic fid) 31 a rcd)tcn 3^^ in cine .^cilanftaTt 311 geben, fat(^ Sie c§ fonnen uttb bcoor. e» 311 fpdt ift. (fin borftdjtigcr unb reittHtber Scbminbfucbt=^ran!cr ift nic benen gcfdbritcbf mit benett cr mobnt unb orbeitet fBorfidft fd)ttbet nte. Steefen Sie nieftt eigene SVamiiic atu ^tcTc erloadjfcnc Ccutc unb aud) ^tnber Icibcn an Sdjtoinb* fud)t, obttc 311 loiffctt, unb fonnen anbcrc anfteden, baber foil jcbcrmattn, and) cin ©efunber, bic folgcnbcn SRcgeln mabren: SdiTudctt Sic itid)t ^b^ett cigcnctt Spcid)el, jebodj fpuden Sie nid)t auf gufefteige, ben gufeboben bcr 3intmcr, ober offent^ lidje dlduttte, Straf$enbal)nen it. f. m., ift fiir anbcrc ge= fdbrlid), unfd)ott unb ungcfe^Iid). Buffett Sie fpuden, bann tbuen Sic e§ blofe in Spudnapfc, * angcfiillt jur $alfte mit SBaffer, unb fpulen Sic biefc bfterg mit beifeem Sfiaffer au§. 9ficfen Sic ntdjt iiber ben ^ifd), ober jemanbem in’§ ©c? fiebt, fonbern batten Sic ftet3 cin ^afebentudj, ober bic £>anb oor. Hlcinigett Sic bic ^afe nid)t mit ben gittgern. Cefett Sic biefed aufmcrffam burrfj, unb rcicbcn Sic c^ bann gbrer gamitic junt Cefen. 241 L — 1908 21-495, ’08, 50,000 (P) > ^ ^'3 D^T D'K "Y’t SptjYO ''TS ' 1 1 .lyayapya’K is tav Dtji din ,jyta^yn -jv tpfcn'n ’’•ts mi rr; tamer iili natyrniK tMjjDBiK&jn pny V3 riy 'ta'D .1 .o ,^ti33^i«“T DStaynia nttfyn vstf ‘lyjtj’ty’oo^P .1 .b ,D33'3 .» psonsn .nyo'B« ‘wpnyo lyDDyty .11 ptyni’ .nytaynpyo 1908 »&V uftjaass>\ivD jyp^? r* wssaafla gwSainCiff Tiirtrcr8nT8"«^ ?3y&DH r ^HD'BDijJl^Dy^snf op*ay*? nn yDombv yel36 f ynyD' jyjHjyijrn lyny* iye# - ; Wyny w .ano’oaHa mi» 4 to 3 PC a#o -oh 5KD'9D#n ^i%o orio hh vaytty njonyo • .ynyoiyB' -ay:*n ih tyc* ; yooHiuc yclOO .ai#o imn 11 tn 10 pc iy;no. w :yDDH ^«D'9D»n ppwn P^b ^h yocHiur ■ yc76 ’.ynyo pc npHeay:#p ]* iyc* ; vr;wj .D;KO’o:na irm< 4 t»2 2 ■yocmttv yo70 • f m*vo*3bih8' -aw: p$ iy®v ; v«my ptonyo \\* pc ^O'HC^PK itfnsi® vjw? w " " J.jhg’b:h: 1.30- *3 * yo60 » V *P ! btovuim ; payfiy omiycDDK pin yootnotf 2 pc anta lyanysKVi uny* lycn •a»o .ansa^o os .oaHO'D:^a 3 to 9 pcjyc# inn ano»HD n« uni ^hc imn 10.30 to yp55',no^yn p# o:yooi«syi lycK " vayny yu6 p* yoonier 4 iif riP6 nyn pn ->mH,10 pc tyanyr^i iyiy'*. ;wo'o:havpk •’HD pn 'pjvitt'b ,3Hca$o oh .a^j .oiayan 9 to 8 pc iyc« VVH ans coyn 8.^KOOD#n PitPiVJ •y:*m tynyi lycn ; yoon-isr yel6 \aHta'o:Ha 4 to 2 pc 3«e jyayj A-iyoayDDH 5KO'30#n ntfys • yoDH-iov ys26 eonoyi pc yiiy 1 pc a^o lyany:^ tinyvjw * \aHtp$:*a 3 to ■nycKP' ,$«D'BD»n;Hy'nyp»3 hy^nyPBa pc m# P« ycon-ie* pnoaHD lye# ; ypoins® r;n: nmn 4 to 2 pc 3HO>h» pn, v ^ho^o 137' ;HyD3yBDH' i^V,V3v rnai iyny 1 P’oh ; yoDHnta«oytt3?w ,u:h; 12.30^LlljlLi«Oi^Sfi 'lytK fay St, ypDK^tti* '"ytrn 361 1 .nb^yilT^ OSynoiKByi - 7 .aHb’ocHa 4 pa 2 PC W lyanyomj |yiyj TillafySu 'yooH^ hh^po 11 .Hyoiyso^ 'o'D y ^HB'OSW- 4 P3 2 pc *& jm ;• c p a » h 3 h ' r: • D'^ftr-sc pHMaypy yo3 ,nof>yn w piyottWyV- • aHB'ttsn: 4 to 2 pc tyanysfii uny* oapSVo^jT.tn m o ip *ny? v^ytt’j^ vc catfomsW ,r;o”np.3H^ ynaypyotran pc lyriMPj 12L2 \;2 ptt’O P VLfiy^l^ y^6 P« yooH^uy y»55* V I .'jyu'cyDa^p tsyn nn's* 3 '*k naatya ijnyn _* s V,TB ,11 -««d 3 kp r **» v"« v* w - =;;« nniK an* VW*V * ^’ nBS ,;’J„ ’^’sraa’as- « ,m w .»■«•” ’ in ’ s 3 ’ 1tt t ;, t Ira' 1 ? u>b-i«d n^:« c ^' : - i” p B,J “f R 5 ’?“ *■«. r» tri* -„n yooya -n W”t vnit n« astf W"'' Mm !”tTM 1W b»> WH ^ 1 » ,”' D ,n«m l'« w»«' IW W a '“ a!J „ 3 u >3 i't m'K cjni ,Dp?iy« , ’« BU " n3 B ’ n " ,n ’ H a ^^ n ,p is 1« 3 “ 3 >’P ww ™ -vi D'3 t'« “lya'DamiMiB’ “iy3' l, "i PK pyj'tip’tiss 8 PV 0"3*W PK n n ’ 3 ,jyuC?T .iynyi:» ’V eainjMitr ts’3 uayjnya'K .linrB*DS*p ty=«n WP n* v** .\v»m jns’tw ***t ms r’« B”»» ■’jw .rsy«»» n y n,< n;? 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n ; pn unya»* n °dv-i Vk ba’J ; lyonp-trun P« ^= y ® wm « e’B bo W? U , D « SyD’a K nyaoB^tt- n 5r’’^ J, 1 * B 1 n S ^iV7iR B ;«w , « ,w ^ >,d ^ “S? s ,s mKn tany ' / - 240 i-— lyuo DO NOT SPI l 229 L— 1908 1870, *08, 10,000 (P) DEPARTMENT OF HEALTH THE CITY OF NEW YORK Sixth Avenue and 55th Street DIVISION OF COMMUNICABLE DISEASES Circular of Information ON Special Methods of Treatment for PULMONARY TUBERCULOSIS “CONSUMPTION CURES" 1908 OC bl 2 DC Q. O z < s < * et absence of tubercle bacilli does not mean freedom iIZm the In conclusion, therefore, all persons suffering from tuberculosis are warned against the innumerable quacks and charlatans and their fraudulent cures and methods of treatment. Not only do they waste their money, but also that which is more precious— their time; for early treatment is essential to recovery. They should consult their own family physician or any reputable doctor. There are a number of special dispensaries throughout the city, where patients unable to obtain private care may go for diagnosis and treatment 6 free of charge. In suitable cases arrangements are made for admis- sion to sanatoria in the country. In other cases remaining at their homes, the patients are given free treatment and many are sup- plied with special diet. The addresses of the various tuberculosis dispensaries in New York City are given on the last page of this circular. For any further information, apply to the Division of Communicable Diseases, Department of Health. Thomas Darlington, M. D., President . Eugene W. Scheffer, Hermann M. Biggs, M. D., Secretary . Medical Officer . 7 246 L— igo8 2518. '07. 650,000 (P) DO NOT SPIT A TUBERCULOSIS (CONSUMPTION) CATECHISM AND PRIMER FOR SCHOOL CHILDREN ISSUED BY The Division of Communicable Diseases OF Till: DEPARTMENT OF HEALTH CITY OF NEW YORK THOMAS DARLINGTON, M. J>. President HERMANN M. BIGGS, M* I>, EUGENE W. SCHEFFER Medical Officer Secretary 1908 Take This Book Home and Show It to Your Family and Friends. TUBERCULOSIS. WHAT IT IS. L What is Pulmonary Tuberculosis or Tubercu- losis of the Lungs? Tuberculosis is a very common and often fatal disease of the lungs, which is given by the sick to the well. It is largely spread by the filthy habit of spitting. 2. What is it often called? Consumption, The disease “consumes” you. 3. What are some of the early symptoms of the disease? Cough, fever in the afternoon and loss of appetite, strength and weight. Sputum or phlegm is coughed up, and sometimes there is hemorrhage (bleeding) from the lungs. 4. What causes Tuberculosis? A tiny living germ or bacillus, called the tubercle bacillus, too small to be seen without a powerful microscope. 5. Does Tuberculosis affect other parts of the body besides the lungs? Yes; the bones, joints, glands of the neck, and other parts are often attacked. 3 HOW ONE GETS TUBERCULOSIS OF THE LUNGS. i. How does one person “infect” or give Tubercu- losis of the Lungs to another? By means of the Tubercle Bacilli in the matter (phlegm, sputum) coughed up from the diseased lungs, which often contains millions of the germs. a, How do the germs get out of the body of one who has Tuberculosis? In the phlegm or sputum which is coughed up, and in the little drops, too small to be seen, which are sprayed out when persons with Tuberculosis cough or sneeze. 3. Can the Tubercle Bacillus live outside the body? Yes. If the sputum is discharged on the floor or on carpets or clothing, the germs may live for months, especially if they lodge in a dark, moist place. But out of doors, in the sunshine and free air, they quickly die. 4. How does one get Tuberculosis of the Lungs? Tubercle Bacilli, coming from the diseased lungs of some person who has Tuberculosis, are taken into the healthy lungs, and growing there, cause the disease. 5. How do the Bacilli get into the lungs? They are breathed in, either in dust which contains dried and powdered sputum, or in the tiny drops of 4 sputum sprayed out by persons with tuberculosis when they cough. The bacilli sometimes enter the body in food and drink, especially milk. 6. What kind of people are most likely to get Tuberculosis? Those who are sickly and run down from other diseases; from intemperance; from poor or insuffi- cient food; from living in dark, overcrowded rooms; or from overwork. Their weakened systems cannot resist the bacilli. 7. What common sickness frequently favors the development of Tuberculosis of the Lungs? An ordinary cold or cough which is neglected. A cold does not cause Tuberculosis, but it helps the germs to get a foothold in the lungs and to multiply there. 8. What else may lead to the disease? Studying, working or living in dusty rooms, especially where the air is bad from poor ventilation and overcrowding. Tubercle Bacilli are often present in such rooms, especially where a careless person has spit on the floor. 9. Is it safe to move into a house or rooms in which a person with Tuberculosis has lived? No, not until the house or rooms have been thor- oughly cleaned and disinfected or renovated. b HOW TO KEEP FROM GETTING TUBERCULOSIS. 1. What is the first and most important rule to keep from getting Tuberculosis? Keep as strong and healthy as possible. 2. Why? When the Tubercle Bacilli get into the body or lungs of a healthy person, they do not multiply, and are usually soon killed; while in the lungs of a weak or sickly person, they often increase in numbers and produce Tuberculosis. 3. What things help in keeping one well? Fresh, pure air in the home, school room and work room, proper food, cleanliness, temperance in all things, leading a regular life, and living out of doors as much as possible. 4. How can one get fresh, pure air? (a) By keeping out of doors and avoiding dust as much as possible, (b) By admitting plenty of fresh air several times a day to the rooms, in which one lives or works or studies, (c) By keeping at least one window of the bedroom open all night, (d) By cleaning with damp cloths and brooms (never using a dry broom or duster) to prevent dust from floating in the air of the room. 6 M 5. What ought one to do when a cough lasts more than two weeks? Go to a doctor or a dispensary and have the lungs examined. 6. What habits of school children are dirty, dan- gerous and to be avoided? (a) Putting the fingers, coins, pencils or playthings in the mouth, (b) Eating candy or chewing gum which other children have had in their mouths, 7. Is bathing a necessity? Yes. Every one should take a warm bath with soap at least twice a week, and those who can should have a cold bath every morning. (See list of public free baths at the end of this book.) 8. Is the drinking of whiskey and other forms of alcohol injurious? Yes. They weaken the body so that it cannot re- sist disease germs. Many drunkards have Tuberculosis. g. How can one keep from catching cold? (a) By always having plenty of fresh air night and day, and taking a cold bath every morning, (b) By keeping away from, and complaining of, persons who have a cough and who spit on the floor or sidewalk, (c) By avoiding exposure to cold and damp after such diseases as measles and whooping cough, (d) By keeping the feet dry and avoiding exposure to cold or winds, when very warm or very tired, (e) By avoiding close, overheated rooms, crowded with people. 7 HOW TO KEEP PERSONS WITH TUBER- CULOSIS FROM SPREADING THE DISEASE. 1. Is it dangerous to live or work with a person who has Tuberculosis? No, not if he is careful and cleanly. 2. Of what must he be careful? To destroy all the sputum coughed up. 3. What is the best way to do this? A person with Tuberculosis must never spit on the floor or sidewalk or in street cars, but always into a cuspidor or into a paper cup, which he should have with him at all times, and which can he burned. Old rags or cheese-cloth squares which can be easily burned, may also be used. 4. How can he keep from spraying out tiny drops of sputum when he coughs, laughs or sneezes? By holding a handkerchief or a square of cheese- cloth in front of his mouth whenever he coughs or sneezes. 5. Should a person with Tuberculosis sleep in the same bed with any one else? No, and if possible, not even in the same room. 8 HOW TO CURE TUBERCULOSIS 1. Can Tuberculosis be cured? Yes, if treatment is begun early* 2* How? By good food, fresh air and rest, and such medi- cines as the doctor may prescribe. 3* Where are these best obtained? In hospitals located in the country and called sanatoria. 4. When a person learns he has Tuberculosis, what should he do? Go at once to a doctor or dispensary, and do as advised. DO NOT WASTE TIME AND MONEY on patent medicines, advertised cures or advertising doctors. THEY ARE WORTHLESS. 9 tuberculosis kills more people THAN ANY OTHER DISEASE. MANY GROWN PEOPLE AND CHILDREN WHO HAVE COUGHS, HAVE TUBERCULOSIS WITHOUT KNOWING IT, AND THEY CAN AND DO GIVE IT TO OTHERS. SO YOU MUST NOT SPIT ON THE SIDEWALKS, PLAYGROUNDS OR ON THE FLOORS OR HALLWAYS OF YOUR HOME OR SCHOOL. NOT ONLY TUBERCULOSIS, BUT OTHER DISEASES, ARE SPREAD IN THIS WAY, SPITTING IS DANGEROUS, INDECENT AND AGAINST THE LAW. For further information, literature, etc., apply to Dr. J. S. Billings,. Jr., Chief of Division of Com- municable Diseases, Department of Health, 55th St. and Sixth Ave New York City. 10 PUBLIC BATHS: LOCATION AND HOURS. 324*326 Rlviniiton Street, near Coerck Street. WOMEN. 6 a* m. to 9 f. m., Mondays, Wednesdays and Fridays. MEN* 6 a. m. to 9 f. h., Tuesdays, Thursdays and Saturdays. CHILDREN, 3 to S ?■ daily. 133 Allen Street* near Rlviudfon Street* WOMEN, 6 a. m. to 9 f. m.* daily. MEN, 6 a. m. to g f. si., daily. CHILDREN* 3 to 5 r daily. 538 East Eleventh Street, near Avenue B. WOMEN, 6 a. m. to 9 f. daily. MEN. 6 a. m. to 9 f. if., daily. CHILDREN, 3 to s f. m. Corner Avenue A and East Twenty-third Street. WOMEN, 7 A. m, to 9 p. m., Mondays, Wednesdays and Fridays, MEN, 7 a. h. to 9 f. M., Tuesdays, Thursdays and Saturdays. CHILDREN, 7 a. m. to 5 p. dally. 347 West Forty-first Street* near Ninth Avenue. WOMEN, 6 a. m. to 9 f, m., daily. MEN, 6 a. h. to 9 p. m daily. CHILDREN* 6 a. m. to s P. m., daily. 232 W est Sixtieth Street, near West End Avenue. WOMEN, 7 a. m. to g f. k., Mondays, Wednesdays and Fridays. GIRLS. 3^ to s p. m., Mondays, Wednesdays and Fridays. MEN, 7 A. u. to 9 p. m., Tuesdays, Thursdays and Saturdays. BOYS, 3 to s f. m., Tuesdays, Thursdays and Saturdays. 573 East Seventy -sixth Street, near Avenue B. WOMEN, 6 a. h. to 9 F. if., daily. % MEN, 6 a. m . to 9 p. m., daily. CHILDREN, 9 a. 11. to s p. m„ daily. 243 East One Hundred and Ninth Street, near Second Avenue. WOMEN, 7 a. m. to 9 f. m,, daily. MEN, 7 a. m. to 9 f. m., daily CHILDREN, 9 a. m . to s F. m., daily. 11 CLINICS FOR THE TREATMENT OF COMMUNICABLE PULMONARY DISEASE. . The Manhattan Clinic for the Treatment of Communicable Pulmonary Diseases of the De- partment of Health was opened March 1st, 1904, at No. 967 Sixth Avenue (adjom.ng the head- quarters of the Department at Sixth Avenue and 55tli Street), in a building especially de ® ,gI,e for the purpose. Since that date similar clinics have been opened at 361 Jay Street, .00 - lvn, and 3731 Third Avenue, The Bronx. Each contains a registration room, a drug room, waiting rooms, throat department, and two clinics for male and female patients, respectively, each with its examination room e Manhattan Clinic has also a complete radiographic department. The clinics were established . with the following objects in view : (a) The early recognition and accurate diagnosis of pulmonary tubeiculosis. (b) The careful supervision of persons receiving treatment, including not only medicinal treatment, hut also the furnishing of circulars of information in various languages, of paper sputum cups and gauze handkerchiefs, and proper food (milk and eggs) in indigent and needy cases. (c) The continued observation at their homes by a special staff of nurses, of indigent, needy and ambulatory cases, including all those discharged from public institutions of the city. (d) The removal to hospitals or sanatoria of (1) advanced or bedridden cases, with pro- fuse expectoration, whose presence at home is a menace to others in the family, (3, ease able to get about hut who are unable to work, and who are entirely dependen upon earnings for their livelihood; (3) incipient cases, who stand a fair chance of .ecoieiy removed to sanatoria outside of the city, and (4) lodging house, or homeless cases. (e) Provision of municipal institutions where cases of tuberculosis may be referred (1) bv Physicians, (2) by institutions on discharge therefrom, (3) by the various charitable or- " 1 ‘ ’ ' q t±\ hv persons doing individual charitable woik. ganizations throughout the city, and (4) by persons „ (f) The extension and strengthening of the sanitary control of tubeiculosis amon„ poor by the Department of Health. (g) The care of laryngeal cases-one of the saddest complications of pulmonary tu er- culosis. <• Note: Association of Tuberculosis Clinics: The Manhattan clinic forms one of a group^ v • 1 Vh divide the Borough into districts, all applicants being ie « ir tuberculosis clinics which divide tlie tfoioug to clinic caring for patients from the district in which the apt cant live : , a attend the clinics are visited by inspectors or nurses o, the Depnrtme t Health, ^ ^ need of treatment, are notified that they must either attend the chn.ca ' ^ care of a private physician or enter a hospital or : lanatonuim ^examina- patients found to be tuberculous, are examined in t lix gimip o tion being recorded on a special history card (Form 248 L). To insure the attendance of such children, the nursing staff of each clinic is used, supple mented liy the tuberculosis nurses of the Department of Health. 95 248 L — 1 1)07 2569. 07, 5.000 (P) gtkeiai ^Bro4 m ft vmedicit recovery j ises. wort r $ DEPARTMENT OF HEALTH, DIVISION OF COMMUNICABLE DISEASES CHILDREN’S CLINIC RECORD . Date. Mother HISTORY Father Dispensary No. Surname Given Name Address Floor School, Yes, No. Number. Date of Birth Child No. Country of Birth.. Feeding During 1st Year. Breast, Yes, No. Bottle, Yes, No. Modified Milk, Yes, No. Raw Milk, Yes, No. Weaned Months Feeding After 1st Year. Satisfactory in Amount, Yes, No. Good. Bad. Weight lbs. Height Cm. Chest Measures : Contracted..; Cm. Expanded Cm. Diameter: Aut. Post. Cm. Trans Cm. Index | Rachitic: Yes, No. Symmetry Temp. ° Pulse Resp. Yes, No. Yes, No. Yes, No. Yes, No. Yes, No. Symptoms : _ Birthplace Hebrew Tuberculous Alcoholic Clean Dirty Yes, No. Yes, No. Yes, No. Yes, No. Yes, No. Whooping Cough, Yes, No. Pneumonia, Yes, No. Measles, Yes, No. Adenitis, Yes, No. Operation, Yes, No. Examination Shows Abnormalities of: Lungs, Yes, No. Heart, Yes, No. Glands, Yes, No. Bones and Joints, Yes, No. Ears, Yes, No. Nose and Throat, Yes, No. Abdomen, Yes, No. Sputum, Yes, No. Ofiudignt Diagnosis fas of flit M. D. Boutin. P-oc^m-The Manhattan clinic is open daiiy, except Stmdays and holidays, ip a P M to 9 P M., oil Mondays, Wednesdays and Fn from 9 A. M. to 4 P. M, and from 8 P. M. to J 1 • M R ^ Broffit days, classes being conducted morning, afternoon and even. g. clinics are open from 2 to 4 P. M. daily. 4,1 floors and meta, furniture are cleaned every morning and the building is disinfected Is. radiographer; various nnrses on duty in the men, c.inics, the women, clm.c , the registration Jn, and the throat rooms; drug eierhs; hospital clerhs, watchmen; matrons; and scrubwomen. The name, address, age, sex, nationality, employment, history, number, and clinic class of every patient is entered in a journal (Form 218 L) ; also the history number, sex, class and diagnosis of every patient returning for treatment. i . An admission card (Form 7 L) numbered to correspond with history, with an envelope (Form 92 L), a sputum jar and a handkerchief are given to each new patient, together with instructions as to the care of the expectoration. V v 1 1 ALWAYS BRING THIS CARD 7 I.- 1907 DEPARTMENT OF HEALTH, THE CITY OF NEW YORK DIVISION OF COMMUNICABLE DISEASES BOROUGH OF CLINIC FOR THE TREATMENT OF COMMUNICABLE PULMONARY DISEASES Keep card clean. Come only on appointed days and hours, Come alone, if possible. Halte diese Karte sauber. Komme nur an den vorgeschrieb- enen Tagen und Stunden. Komme allein wenn irgend moglich. Tenete questa carta pulito. Venite soltento al giorno ed all’ora fissi. Venite solo se possibile. naiK ijwkb nu been? ytrwp X'l cpan Ta •in v'Q op”? riTY OF NEW YORK, BOROUGH DEPARTMENT OF HEALTH, Cl , n st,tut,on ^ xsm tof.l* Floor Ca " “ f 21-433, ’08, 10,000 (P) Class Dr. Religion jf parents Formerly Final Diagnosis M. Gm . (/>. M-) Boarders Pertussis Influenza Nationality Occupation Tentative Diagnosis Family History. F. S. D. Gf ' ^ Contact. Family Fast History. Measles Pneumonia Pleurisy Other Diseases, operations or injury to chest , , Tobacco, none, mod., exc. Personal habits Previous treatment Present Illness. Began ( date ) Initial Symptom How complains of Weight , normal ^ fl,u Indigestion Appetite Chills Fever Cough Haemoptysis, Date and Amt. B. Reason Jor coming to Clinic In N. r. City How long in U. is. Stopped work Prognosis Stage s. HW - A. IP. MS tt O’- m At work Typhoid T raumatism Friends Bronchitis Fistula Alcohol , none, mod., exc. Supposed exciting cause Disease first recognized Present height. Ft. Bowels Night-Sweats Expectoration, Amt,, etc . Sufficient Food Duration Mental condition In. Throat Symptoms Sleep Diarrhoea Weakness Dyspnoea Pain Con hint o 0 <-r- O •-b B p o p CL. ^3 o o tr* o cr 1 tained by tbe registration room nurse. General Condition. Subjective Anaemic Objective ; Stout , Wei l -nourished, Spare , Emaciated _ . , -*•— - ■*»« - — u *.*<:*. ~ - t t T ^ ^ ro/ “ w ft *o__ URINE Datei Amount In 24 hours Color . Transparency Reaction and per cent — Spline Gravity Albumi n - Urea Sug ar Plazo Reaction Indlcan Microscopical blood Date. Rrvthrocytes (p er c.mm.) T.p>iicocytes (per c.mm.)_ Haemoglobin Color Index Differential Count ol Leucocytes vrAflb Undrled Speci men^ Stained Specimen Mume 53 L — 1908 NURSE’S CARD DEPARTMENT OF HEALTH, CITY OF NEW YORK Division ol Communicable Diseases Rorough of CLINICS FOR THE TREATMENT OF COMMUNICABLE PULMONARY DISEASES Diagnosis c/o No— Name Address Assigned To Age . Occupation.. Nationality.. Character of House, P. H.. B. H„ H., L. H., A., F., T How long resident there Improved. Previous Treatment No. of Rooms — -Light- Floors (Clean, Dirty) Total Air Space Condition of Rooms (Clean, Dirty) . Any work done there ,Cu. ft. Light.. ..Ventilation.. W. C. (Kind of Location) No. in Family. . Adults.. Plumbing Children Boarders... Location Patient’s Room - - A ' r Space, Cu. ft ~ Windows Open .. No. Windows, Air Shaft — - - Front — Sunli^ t Separate Room Separate Bed Available Fire Escape Owner or Agent Present Work Since Bath — -Nearest Park — School No.. Address - Previous Work Effect Effect Hours Place- Other Exercise . .. Hours in Bed Hours Out of Doors -Personal Cleanliness Disposal of Sputum Observation of Instructions Circumstances Cuspidors Burnt- Food, Quantity. Income Change of Residence Contemplated Quality- Clothing (Clean, Dirty, Soiled with Sputum, Insufficient)- Bed Clothing (Soiled with Sputum) Assistance Needed- Other Cases, Family Source of Infection.. .House- Friends. The following system of filing is used, all history cards being filed in special envelopes with opening cut to show name and address. (1) active cases under observation; (2) cases in hospital; (3) cases not found at ad- dress given; (4) cases discharged as non-tuberculous ; (5) inactive tuberculous cases; (f>) dis- trict nurses’ reports; (7) dead cases (obtained from daily tuberculosis death list). All his- tories are examined by the Chief of Clinic before being filed. A name index card (Form 242 L) is filed alphabetically for each case. In all cases referred to the clinic, a re- port (Form 79 L) is mailed to the physician or institution giving the result of the examina- tion. 242 L— 1908 Name - - Address Occupation Institution Discontinued Readmitted Transferred Not found — Discharged 21-496, ’08, 15,000 (P) No. Floor Recommendations by tbe attending physicians for the admission of cases to Metropoli- tan, St. Joseph’s, Lincoln, Seton and St. Vincent’s (S. I. Branch) Hospitals are referred to the executive offlce on card (Form 42 L, see page ), whence they are referred to the Department of Charities by double postal (Form 81 L, see page ). Arrangements for the admission of patients to Riverside, Otisville, Raybrook and other sanatoria are made through the Division of Communicable Diseases. Each Monday a report (Form 156 L) is made by the Chief of Clinic to the Division of Communicable Diseases, giving the number of patients seen during the previous week, classi- fying them as old, new, male and female, under observation at home, receiving extra diet 01 - ref erred to hospitals and charitable organizations and the number of prescriptions issued. 156 L— 1908 department of health tub CITY OF new YORK Division ol Communicable Diseases tuberculosis clinics To Director of Clinics 2985, ’08, 500 (P) Clinic for week ending 190 Report of DIAGNOSIS: Under observation for diagnosis, Date_ New patients examined, Readmitted for diagnosis, Found not tuberculous and transferred or discharged, Found tuberculous, • • * * ... * Diagnosis tuberculosis, sputum positive, Diagnosis tuberculosis, sputum negative, Discontinuing, not coming for diagnosis, • • Under observation for diagnosis, Date CASES UNDER TREATMENT : Under treatment, Date - New cases under treatment, . Old cases readmitted, • • • • Total cases under treatment during week, Found not tuberculous and discharged, Deaths, . • • / Transferred to other clinics, Entered hospitals, . Entered sanatoria, . Discontinuing, not found, Discontinuing, not coming for treatment, TottrnShsTll ’patients under treatment by clinic, Total treatments of patients, n8IT ^lmo A nths 8 all patients under observation by clinic nurses. Visits to patients under observation, . Other visits to cases under clinic treatment, Total visits by clinic nurses, ‘ ' Visits by clinic physicians, MISCELLANEOUS : Prescriptions filled for clinic patients, . Quarts of milk supplied, Number of eggs supplied, Referred for hospital treatment, • Referred for charitable aid Chief of Clinic m All deaths from tuberculosis, as reported daily by the Registrar, are looked up in the clinic records; such histories are filed separately. Sputum, blood and urine specimens are sent to the Diagnosis Laboratory at the close of the day’s classes, duplicate slips (Form 261 L) accompanying each and numbered to corre- spond with the patient’s history number. All results of examination are noted in a sputum record book and on a clinical record card (Form 212 L, see page ), which is filed with patient’s history. (If an applicant for examination is apparently not tuberculous, a skeleton history is made out and sent to the physician who decides as to the final disposition of the All new cases of tuberculosis are reported by card (Form 194 L, see page ) one week after their visit, to the office of the Division of Communicable Diseases of the Borough in which they reside. Doubtful cases, later proving tuberculous, are similarly reported. All records of the clinic are filed in the registration room, and from there, all reports and rec- ommendations are forwarded. In the examining rooms the patients at their first visit are weighed, the body temperature, pulse and general condition, noted on the history card; a complete physical examination made, the results noted on history card and also on diagram card (Form 211 L, see page ), and a record made of treatment ordered or of recommenda- tions for x-ray examination, extra diet (milk and eggs), admission to hospitals, or dis- ease.) charge. 275, *08, 500 Bka. (P) Otisville Riverside DUPLICATE SLIPS MUST BE SENT WITH EACH SPECIMEN SANATORIA AND CLINIC SPUTUM SLIP Riverside Manhattan Cl. The Bronx Cl. Brooklyn Cl. No. of Spec . a 3 4 5 6 8 Date. Name Address ... Received . t,ab. No. Prepared Day No. Result of Exam, Num . Mod. Few The result of the physical examination is dictated to the following system of abbreviations being used: Only the extent of lesion is shown on diagram card. X. MENSURATION (as indicated). II. INSPECTION. Expansion. Normal * Diminished ^ Absent III. PALPATION. Fremitus. Normal -r Increased Diminished o Absent IV. PERCUSSION. Normal " " Slightly dull — • Dull Flat Hyper-resonant • Tympanitic V. AUSCULTATION. Respiration. Normal the clinic nurse by the physician, + Harsh Diminished Absent Broncho-vesicular Bronchial 0 . Br.v ...Br Amphoric or cavernous Am Cy Cog wheel Expiration. , Epr Prolonged High pitched Voice. Normal . . Increased ■4 r o Diminished Absent Bronchial or tubular Br-Tb Aegophonv A eg Rales. Crepitant Cp.oKv: Sub-crepitant -Sep-or.«« Creaking Friction sounds Ck The patient receives thorough instruction from the attending physician as to diet, mode of living, and exercise; special effort being made, where hospital care is indicated, to induce the patient to enter an institution; in addition, a circular of instruction printed m the language that the patient speaks is supplied-Gennan (Form 139 L), Hebrew (Form 147 L), Italian (Form 155 L;, English (Form 172 L). 0 Bp k noisM' a tpr ft k j M ..M 172 L — 1 908 2113, '08. 5 000 (P) ADVICE FOR PATIENTS ATTENDING TUBERCULOSIS CLINICS ISSUED BY THE DEPARTMENT OF HEALTH CITY OF NEW YORK Division of Communicable Diseases 1908 Printed for the Association of Tuberculosis Clinics DEPARTMENT OF HEALTH, THE CITY OF NEW YORK ADVICE FOR PATIENTS SUFFERING WITH PULMONARY TUBERCULOSIS (CONSUMPTION) Be hopeful and cheerful*, for your disease can be cured, although it will take some time. Carefully obey your physician’s instructions. You may improve steadily for months, and lose it all by carelessness. Improvement does not mean cure; therefore continue to come to the Clinic as long as you are directed to do so. I >o not talk to anyoue about your disease, except your physician or nurse. Do not listen to tales of other patients, or follow their suggestions or those of others concerning the treatment of your disease. Report to the Clinic when directed. Report immediately if you have fever, indigestion, diarrhcea, constipation, pain, increased cough or reddish expectoration. If you are too ill to come to the Clinic, send word. If you have a hemorrhage do not become alarmed ; keep quiet and send for some doctor,- or notify the Clinic. In the treatment of your disease, fresh air. good food, and a proper mode of life are more important than medicines. Take no medicine that is not ordered by your physician. If you are offered admission to a sanatorium, accept at ouce. Advise any of your family, friends, or neighbors, who have a per- sistent cough, and have no doctor, to come to the (’link*. Try to control your cough as much as possible. You should only cough when you have to expectorate. Cover your mouth with your handkerchief or hand when you have to cough. Your expectoration or spit contains germs and is dangerous to yourself, your family and your neighbors when not properly taken care of. When in the house always spit into a spittoon half full of water; empty the vessel into the closet at least once a day hnd rinse it with boiling water. It is much better, however, to use paper spit cups which can be burned after use. The Clinic will supply you with these. When outdoors, spit in one of the paper pouches furnished by the < linic, and burn it after use. You may also use pieces of muslin, carrying them in a paper bag and burning bag and all on your return home. If you should he outdoors and have nothing with you to receive your expectoration, spit into the gutter. Never spit on the sidewalk N ever swallow your expectoration. BY THE GENERAL. COUGH AND EXPECTORATION. PURE FRESH AIR. Stny in the open air as much as yon oan ; if possible, in the parks ixls or fields. Do not be afraid of /-old water. Avoid draughts rlnaf ami cvw.w.-. . _ Uh 1W ' own bed. TT ■ ■ ** ''<11 unmiuiii niLTin "hod a r °°“ • VOm-Se,f - ir possible; if not, be sure to have your When indoors, remain in the sunniest and best ventilated room. The room should preferably be without carpets; small rugs may be allowed. . No dusting or cleaning should be done while the patient is in the room. Cleaning should be done only with mops or moist rags. Draperies, velvet furniture and dust-catching materials should not be in the patient’s room. FOOD AND FEEDING. Take a half hour's rest on the bed or the reclining chair before and after the principal meals. Avoid eating when bodily or mentally tired, or when in a state of nervous excitement. Eat plenty of good and wholesome food. Besides your regular meals take a quart of milk daily, from three to six fresh eggs, and plenty of butter and sugar, provided they do not disagree with you. Eat slowly; chew your food well; avoid anything which causes indigestion. See that your eating utensils are thoroughly washed after use. Do not smoke and do not drink liquor, wine or beer, except by special permission; but drink plenty of good, pure water between meal times. _ , Always wash your hands thoroughly before eating, and clean your finger nails. REST. Avoid all unnecessary exertion. Never ruu ; never lift heavy weights Never take any kind of walking, breathing or other exer- cises when you are tired, nor take them to the extent of getting tired. The kind and amount of exercise which you should take will be prescribed for you by your physician. Go to bed early and sleep at least eight hours. If you have to work take every chance to rest that you can when ° tT When the physician prescribes a rest cure, either in bed or on a reclining chair, it must be carried out, either on the veranda, hre escape, roof or in front of an open window. CLOTHING. Wear underwear according to the season. Don’t wear chest pro- tectors Dress comfortably and sensibly, and avoid garments constricting Ue< Koep\v(!urf«‘t dry and warm. Wear overshoes in snowy or damp weather - ’ personal hygiene. Keen vour bodv clean and take a warm bath with soap once a week; take cold douches or cold baths according to the directions of your physician. Avoid all bad habits. f . . Keep your teeth in good condition by brushing them regulaily. See that your bowels move regularly every day. ghave vour beard or wear it closely clipped. Do not kiss anyone. Handle the soiled personal and bed linen, especially handkerchiefs, as little ns possible in the dry state. When soiled, place these articles in water until ready to be washed. DON’T WASTE TIME OR MONEY ON PATENT MEDICINES OR ADVERTISED CURES FOR YOUR DISEASE: 1HIA ARE WORTHLESS. GENERAL INFORMATION FOR THE PATIENT. AND HIS FAMILY AND FRIENDS. If the matter coughed up he promptly destroyed, a person suffer- in" from pulmonary tuberculosis or consumption may frequently not only do his usual work without giving the disease to others, but may also thus improve his own condition and bis chances of getting well. If all the above precautions are observed, there is no danger to the healthy iu the ordinary intercourse of the family or society. / r ii2 2113, 08, 5,000 (P) 139 L — 1908 HattfdiUtac fiW £ati««tcn y{ iV Cuttaei* * Ejerausgegeben con bet * . .bcs. . bet 5«»6* We® *>*** N 1908 v*n * cw . , si- mt SunnctuSMcrfutofe (Sditoinbind)!) MMU* »* * flticnten ' b,C Uiben 8 ** „ w mm. JX?* ^ mm ' e "* '»“» *“ ® spen, “' 1 “I nut mil tmm Sits. »»<■ >“ mit Wemcmb. . ^ anIe nod , fofotflt bcrcn M. lCU ' ie 4 S^ Annlt ^i%^mur?anflfti 0 t Gnd, nW; ^ Gnd, tuft. «W* •“ ^ Sv tg fifties SeibenS roi^tia«, at§ m - W rieben. . «►*& *- •*“ s ibcnn man v simtu , ncbmcn Sic benfelben fofort an. ^ ^mnilie ober greunbcn, ober 3 sns *“ * •** iuijtcn anb Syucfen. riuftcn an* ml8js pallet ben £mften mbglid)ft auriid. £ujtci nnr, i,, “ , a.S 6 &t P“, luet ©petAel enttjatt Kctme. unb tft Gu« \-m o ^ ftadibain ci«fabtlirfi, menu er md^t nfflhfl 8 J ^ SBaifer, leert tljn 3u ^auicjpudt tets tit i etnen L ^nb^putt Urn mit lodienbent tdfllid) mcnitftenS einmat tn ben abort uno ipu S ttfjtex au§. ~ rt^ftmu^ipn. mcldie taflUO) IDCTU01WIW tiumu. i.. ni ri.« «... nadi ©enitijtmg uerbrannt loerben tonnen. ~tc » mit benfclben oetforgen. twitiiotenen ©euteln, tocldie ®cnn btemfeen, ftude tn etnen non ^2j^. C We then. Sic mogen i ber .mini! beiored loerben tmb bann ® t e ^i Bmriewiwn fficutetn ge= * iRH’irfp non SDhtelin aebtaudieu, tncldic an papaerencii u non ber mini! befargt loerben, tmb bann ? T 2?^(S«^'®eutefn"fle'» audt ©Wide non SSluSItn gebrqndicn tocldie mj&xamm UC rbrenncn traejen merben, unb nadjbem ©ac nad) $au?c auructGCtom (Sic 33 cut el mab 3Ulc§. . «. ru/>?»o ntM ctr^ ftrtf faurfr mit bac vs3ai c, aa a e i traQcn rocxoeu, uuu uuujucm mvivij o « Sic 33cutel mab 3Ulc§. ^ r . c s . m-r:. „ ; c a at f ’ ^ 3Scr braufeen , nid)t§ bei pd) tjat, ftmefe auf bac C^iap . Xrottoir 1 Sd)Iudt Suren Speid)cl nic tjcruntcr. Ucinc Cuft. 3BIeibe mbc^tidpt bid in freicr Shift, menn mbc^tid) in ^artv, -baU obet Selb. ^urdjtct ba§ taltc Setter aaidit. ^ . s ^etmeibet 3 uq, Scaid)tic^teit. (Staub unb 9taud). Staub unb Jaauo linb fair Sud) fditimmer ate 9tcc\cn unb Sdiaaec. . ^iirdatc nid)t ^adittuft; biefc ift aaid)t fd)dbli(fi uiab cntt)alt mcnagci Staub ate bie ^aflcgtuft. W ■ ; : I'll iil tilElir Senn moglut), qaue cm ^ 0 * «»» »> nabtutt$* . - «_ „J, >e n wl* ’ >m »>■» ®“* sSnS * f **** 8, ” B “ Itlcibung. ben S?t e Gute giifee troefen tmb matnt. iExaflt «a ofocn *-*« "-™ M, w* -r 6 a„„ euttn mm, »« ' — « ***** """sSlimi elsj^dfuMtu ' '»»" »«“*""«• ® U 6 ““ ~"T' *“ «*' ,»n MMMW §Mtf aHQtmt\ntn « CMn ‘”\^ c „ Cct»«n^«- * — felbctt »cp«» vvh * )m m , 147 L— 1908 2118. -08.5,000 (P) jysMjmNB ts nto&n sp'r^p j's ta'j’yrjsnjn fy-nyn ys^yn TB MinrwayMV? pa jyDyjvsD’ns cyrsn ^"p^i'c^p tin jsTvin n ns? ntatyn lit? DiyDBigBjn K'” piy' i’j n$ 'D'D ys 1908 113 tyvs an* iyi px pa’ip iynx pants* an ixb tya .pn payo aaxi /lyraap px nx aayisxs iyi .1*113 ptSSUB X am 113 nro no p3’ip nyaya TOn^irinov yix i:ix /na*anix£ ynyayaxa .onyann /poop a'aaypxs px pn an pix? n*aniXB iaix yiayaa* .yaEKD^Da:nn«: Tna iyocy lyaayiyanx x flnx lyix aya t'snx yiaia* yaixn x ax in ami .lya’pinxa tsann xn 1 x 3 iaix ixb ima* Tjm lyix ; lym ansDiu iaix i>iiysiyp am m’x pn an a ay /ragatm pwyiyaanx ppmya x px am in»x yanayatryn yiynx lyanx .pigy yaDgmxa iaix yaia id x aoy 13' x iynx yrne 6 P3 ? ns /jim ci$np x miaya apano .pausings .paxiaiys axi aayp imx nnx ,iypp i:ix iyais id x " iixiys axn ayix ayi’miyr) .pia* lyn# Dnpi* ; ax.aax- aoy . 331 x 1 myc3*x aax? 1 x 3 jyiyn pawpaonx an pix? iyi*ya-aay yiynx dxi any? lyix lym .piyp’i yanp an apana laix an aiyani .pamaya oyi apana : paaxpya dnnniiy yiitfpysD x ayn i.mx pn lyanx pm .paipinxa yiyn# penny lyaxn yain yan id x lyax aixn 13', x .pooy ayi ixsya layn yiynx iyanr lyaa’x atrxn .iyaya-iyaan yiynx pn .ynn •anp aann .an esni .aauayiayax yamayaaix yiy’ ayinaiys layamx lyix aaxaiiyxsir pip an aonya .paaxi yiymr an inxa am mix pn paaiaynya yiyiax i3',x paynax px tupiyapy yaiyn 13*1 x aix xn /tym piyn aix? mix vz an Dy aina inx .iym lyainnys ayix i^x ay*n paxa aix? mix tnoiyopy iyn xm y?’m .ixapxi lynx .piaia* 8 paaanyn dx BExi* iaix mis ayn is any 3 mix axn annayajrtya yiyi onx ayn .panmx acio mix anx .pnn iy pnxn a:yp lyix.ayn px lyiynaay ,pmi iy inx aaynxiyc ixapxi lyi iyn flux .xiaxiyn lyi flnx lynytyya Dyryn r'.a x: ,iy?ra lyaaniyaax x fli*x .lyaaayfi cyaycx pix x>n lyix -v,i cyi ,j:n”5p -xi5 aona 11 ip an a.ixia . 1 x 3 ;xtid ayi 1 x 3 e»yn lyaaix aaxia "ii^p ayinaiys laix .i^iayatriyc i3ix oynpya in ayimp .Dixapya .aona lyi xna i3',x ?^xn ana aay nmn ynyvi lyi lyaixyyatr x px oiyaxi aaxia .Dixn px iypna an yiynx a^xn .lyaayn jya isaxi lyix .tD^pb^rn yE^aynys : ixr, x ixa3nt< i«a yayixn x Danya ia*ix iy»iyp lynx pn aixn lynx 1x3 1 yan y 3 m'x aixr ayaxn yaixp lyix lyiya yansr ya^xp .33mixiyr Dixapxi pyann3nxviya yaayir yi^x ainaiyc inxy x ai» xin aanin .I3xaa**iy *yan px iy3ny yiynx aixn .3 1 oyciynyi iyanya annty .axa ^yiyi asxaimav aioyaiy3yi iyaxn aiixr mix any; aio in aanp .]yi xtry3 n*P cy aaxia lyix nxa lynx fainxi*) .an oyanp lyaiaayvxa iiisytasnn .tryviaya i3',x a*yvi yaianp yiynx aixn x ’ it xm infitf .i:xaa**,y ayaypna x px am* lyanyn iiiayo Dm D*iy aiaiyfi aiyn ay na lybDX'i px pnx xin a3yi 3iyaiar lyiy^i py-xr, C3iynyr3 yana3yays ?nx liya i3',x any iynx an aiayntnys lyanp ;yrxn xm : annp3xip iynx ixe tyiaiainn yaiiaxipyi lyix .naiyn yi^D«s yru .rytD^y'VKB ayi yr'oytfs .yirn 2 ayo ayaamyc iiy3tr aiy*n amx aom iya ax*n yyan** iyi an.x -ix yaiianynya mix p.ia in an aani3mr pe ;xnys yi 3 yini xn -nx mix lyiyoyaiys imx :xp nyi:v? 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nm -1 ix ayii pniip xn pyyiaya ayi ixa lyayiaiyB pp pya L py^xnyB mix axn iyann ayayiynxB ayi px angy pann an? "mix pn inx aayp i.i’x pyynya ayi 1 x 3 ay a3yiaiys laix pn'ip px aoipya i3i x .iyann lynxs x nx aixn mix yaiyn ryirxa -yipiair paniaya ' .tnn iif aaip mix xm inia iyann px pi?xo iy:yiaiy£ aDm mix ,pngtypn«nyn axn px an axn px anaa px an? imx pn pip aaaiity .pxmno p»nx an inxa pip angty .pxatran px ansa* .rsyngp yiynx lyaailyn an inxa .dd^ ya’ns ya^i .apixg px miays aiix : asii ping i'snx iya3yi axn aanin aiimiyB .lyaaxn ayaixp ixb xim an axn .lyiiys i3ix lyiiyn lyaiy pam nnay iaix mi .ini iaix anaa* .anpamans .pasiiaiv xn .asii aax: iyi ixb xno an axn .yyaa* iaix payi aix inx ixb xh xm anaa* lyanmi m px aixnaay xn inn paxa* an inx ayn .yanxann -ixb lyix iyann x px pn lyix pcxia* an ixaanp ai^? mix .aiyasiiya an aii iynx inxa yix aixn .an pap’ a a* .aaxa xnn ninya iynx px lyaaayB pix pex paaannn ax aixn a*axa anyt .an anx . 1 ’iaya pn .p’ix in ixb lyaai^ x aixn .P’ix in ixb aya x paxn n? - 9.1 i la ix peDama’i ayi px aaninyg y?nn iv an? mix pm y3*’ip .aysixp inx .pn lyaya 11 x 1 lyao's axi .iyaan* lyaaam 114 Stampata pet la tola* Me Clmiche per la ttercota A CURA DEL 0IP1RTINIEHTQ 01 SlHlU BU GllTi 01 K» KOOK mmmm per w mm* ruoam iohk «*“ rM xs« ^£g£«rsr£& r .«» etc w , a TcnS C «a^Ui. e mandate per ^rnrTTHR A 7 TONE. di :a se * TOSSE ED ESPETTO'RAZIONE. Ccrcate rfi JZ - - » - V * ^ ■nssfs ffiKfflSw? ssvftjSF^r** * voia " n ' II vostro espettorato con^i- se n0 n avete acqua . Vuotatela alia vostra famig a ,, sp utacchiera piena P^ r nlt acqua bollente. A casa spUtate nella ^uat £ lavatela con acqua^n ^ ^ nella tatrina ima volta 6 are se mpre sputacchier mrin do vi servano. ... *** ~ f »■: .ir*'" NoiOneWM * 0 ” ai lo S,mt0 * ARIA PURA “■ ; . , ta , c nci parcl.i. „ » fsasr • tt la nolv abbiate timore dell aria re sonQ p iu dannosi ': in n oeeia o la neve. ^ U1 ‘ o„a 11 ;i diurna. renti, lumiuita, m ™ 0 n temiatc i «■ .« •• srtiufiKSK. „ ^SV£r-«. ««« «* •— -r* * TT Mantenete almeno • v ; £ possilnle, di notte. per v oi soli se e possilnle ; se , UlU A S!^ra%rXe^ un letto per voi sol,. . . u medio vent data ; malrS^'^j^.^^^gpQjyg^^^ebbOTO^esser^fatte ^f^iH n a S r^^^‘c?® , p°^' Drappcrie, portiere e ™ ob ne lla camera del malato. ^4irzi - «-■ • • ji — • - - - fe«r»' rr^r^ r&r. s°K^ fSSIt — t “ ,, ° ci6 cl ", puo procurarvi ^ngstmne. mangia te siano bene lavati dope che avete Assicuratcvi che i ptatti m s „ e ciale per- ■ • ' ;'S*3?£ , 2 Vestitevi bene, evitando g one c la resptrazione^ go mma ,0 ’ %£££ iTeSrasclnt^e caldi. Portate le soprascarpe quando ,,io, ' ‘ ll “ , " 1 ° “giene personage. a „, srt . -- - * " ”' d ““ " vostro tnedico. abitudim. . m ,i; t eli regolarmente. "Si^irirr 83 ® riiiaiiS^s« S. „ materia T^^^ClTSS ' g peri ”’° p " Medicines, when ordered on prescription (Form 39 LL) from the clinic formulary (Form 258 L), are supplied from the drug room, patients being instructed to wash empty bottles before returning same ; special prescriptions for medicines not in the formulary, are obtained from the Drug Laboratory. s •J UJ I- u. O o 13 O f- _J < X \- (0 Q z < h* UJ u GC I- X H 10 10 <5 « 4 i pa 258 L— 1908 3527. ’07. 1.000 (P) PROPERTY OF DEPARTMENT OF HEALTH FORMULARY Department of Health / NEW YORK 1908 NOT TO BE TAKEN OR GIVEN AWAY I FORMULARY OF THE DIVISION OF COMMUNICABLE DISEASES Department of Health THE CITY OF NEW YORK 1908 THOMAS DARLINGTON, M. D. President EUGENE W. SCHEFFER HERMANN M. BIGGS, M. D. Secretary General Medical Officer J. S. BILLINGS, Jr.. M. D. Chief of Division of Communicable Diseases COUGH MIXTURES Ilero in Hydroch 1 orate Dilute Sulphuric Acid Glycerin Cherry Laurel Water Syrup of Wild Cherry Distilled Water, To Grains 2 Minims 45 Ounces 1 Drams 4 Drams 4 Ounces 3 One teaspoonful three or four times a day. Codein Dilute Sulphuric Acid Glycerin Cherry Laurel Water Syrup of Wild Cherry Distilled Water, To Grains 3 Minims 45 Ounces Drains Drams Ounces One teaspoonful three or four times a day. 4. Ileroin Tablets, each Grains 1-12 12 Tablets. One tablet three or four times a day. G. Morphine Sulphate Tablets, each Grains % 4 Tablets. One at bedtime. 3 46. Terpine Hydrate Glycerin Syrup of Wild Cherry One teaspoonful three Grains 64 Drams 4 Ounces 1 y 2 or four times a day. 84 Compound Licorice Mixture r> TW ° Spoons, u. three Times a day.* 1 " 08 8f. ' of Colomba Ounces q ' ° f Gentian, To Ounces teasp° on ( u i I Ounces water before meals. " ee tabIes P°onsful t0 - Rhubarb and ' TW ° ^meals. Ounces 4 223. Precipitated Calcium Carbonate. Precipitated Calcium Phosphate. Sodium Chloride, each Drams 2 30 Capsules. One capsule after meals. 25. Maltiue with Cod Liver Oil Ounces S Two to four teaspoonsful after meals. 23. Mai tine, plain Ounces 8 Two to four teaspoonsful after meals. 9. Quinine Sulphate Tablets, each Grains 3 12 Tablets. One three times a day after meals. 24. Maltine with Hypophosphites Ounces S Two to four teaspoonsful after meals. 05. Emulsion of Mixed Fats. Olive Oil, Almond Oil, Peanut Oil, with Suet. One tablespoonful three times a day. 31. Creosote Pills, each Grains 2 (Keratin Coated) 18 Pills. One three times a day after meals. •■’•2. Liquor Potassium Arsenite Drams Distilled Water ^ y; , Drams - me drops m oue tablespoonful of water tu-eh- h 1116111 f01 0Ue week ; increase to d ons t^-r 8eC0Dd week -‘*1 fifteen with nine 6 1 Week> Then recommence no diops and increase as before. 2 % 5 V2 i»iiov.e.i_LA1NEOUS 13 A SXS ,|>l ” ,0 ' rrtl «’--<* 0»l» MOO One tablet at bedtime. (For excessive sweating.) 13 - Stypticin Acetate of Lead Drains 2 i*‘>wd. Digitalis Drains 18 Po\vd. Opi um Drains 9 A'ine capsules °"e every r ollr hom . g Drains 5 or Pulmonary hemorrhage.) “ 22S,*- S,Hliu,n B ‘carbo„ate 0ne capsule. (For headache. G Drains 1 Drains 5 Drains 10 DIGESTIVE MIXTURES 48. Salol Capsules, each Grains 2 Twelve capsules. One three times a day. 81. Liquor Peptone and Beef Extract, Ounces 8 One tablespoonful three times a day after meals. $S. Peptenzyme Drams Sodium Bicarbonate Drams Aromatic Powder Drams Powd. Rhubarb Drams Twenty-four capsules. One three times a day after meals. 4 4 4 1 02. Tinct. of Xux Vomica Drams 2 Sodium Sulphocarbolate Drams 2 Grains 40 Glyeerinum Ounces l 1 /* Aqua Distillata, To Ounces '4 One teaspoon ful three times a day after meals. 124. Elix. of Pepsin Lactate Ounces G One teaspoonful three times a day after meals. LAXATIVES 130. Ext. of Cascara Sagrada Tablets, each Six Tablets. Grains, 5 18. Aloin Strychnin Kxt * of Belladonna Leaves 1 pecac Ten pills. Two at bedtime. Grains 34 Grains 1-60 Grains y 8 Grains 1-16 L>. Calomel Tablets, each Twelve tablets One every hour for five or six doses. Grains % -0- Castor Oil Tnke directed. Ounces % CARDIAC mixtures I’tatllkM Wa^rTo Minim, 30 °"« tUtM or foiir UlM o ™^ ^ SMInm ss “5 ; r ”' ul S, 2 ute • lor p Y t„ ao >' «« t«,i,„e. " temlon p„,„. 8 ANTI-RHEUMATIC MIXTURE 222. Sodium Salicylate Drams 3 Sodium Phosphate Drams 4 Distilled Water, To Ounces 4 Two teaspoonsful three times a day. DIARRHOEA MIXTURE Powd. Opium Grains 3 Bismuth Subnitrate Drams iy 2 Sodium Bicarbonate Grains 45 Nine capsules. One capsule three or four times a day. FOR EXTERNAL USE 20. Tinct. of Iodine Drains 4 Use externally with a brush as directed. 27. Chloroform Liniment Ounces 2 Rub over painful parts as directed. Mustard Plaster. One plaster. Apply as directed. Zinc Oxide Adhesive Plaster. One plaster. Apply as directed. 0 224. for throat and nose Boric Acid Glycerite of Tannic Acid 0,1 of Gauitheria Distilled Water, To Jo be used in atomizer after Drams 1 Ounces y 2 Minims 10 Ounces 4 cleaning. 225. Menthol Camphor Albolene, To To be used iag nose. oil atomizer Grains 20 Grains 6 Ounces 1 after clenns- JoO. Menthol Olive Oil, To For injection or spray “»S into larynx. Grains 25 Ounces 1 Grains Grains Grains 220 ' i;° Cai " Hydrochloride T vn elve tablets. ms Dissolve in S Ute8bef °-eaC 227 ' Chlorid e r>isIolf e ICarb0nate ° Unces "•arm water a!!!-!' teas Poonful j u ? UUces USC f °i' cleansing. ‘ ° f Vi 10 38. Seiler’s Tablets. Twenty-one tablets. Dissolve one In two ounces of water and use as directed. 228. Potassium Permanganate Tablets, each, Grains 2 Six tablets. Dissolve one in two ounces of water and use as directed. 229. Tinct. of the Chloride of Iron Minims 3 Mercuric Chloride Grains 1-100 Tinct. of Aconite Minims 2 Sugar of Milk Q. S. Twelve tablets. To be taken for acute inflammation of tonsils and pharynx. One dissolved in two ounces of water and used as directed. 230. Tinct. of the Chloride of Iron Drams Potassium Chlorate Drams Glycerin Ounces Distilled Water, To Ounces Take one teaspoonful in tablespoouful of water every three or four hours for acute inflammation of tonsils and pharynx. 2 % % 1 4 11 $ f i to the throat room for examination and treatment. Cases ^ ^ “ ; r " tful are re ferred to the x-ray room, where a radiograph is made in which the diagnosis is o patient continuing pagl— 1 y*bL returned in envelope fnrnished (Form 91 L, see page ) * submitted to H I ,J ding phvsician for his information and signed by him. It is then «,ed separaWy, Lia, i flatten being added to the patient, history card for the informat, on o, the III. The Chief of CUnie indicates how fluently her visits are to be repeated creep in urgent cases, this not oftener than once a week). Suggestions as to d.et and genera ment are noted by the physician for the nurse’s informal, on. An index is kept of cases under observation and of those receiving extra diet. T„ connection with the examination and treatment of cases, the following points arc oh served : Each new patient is carefully studied, and at the first and subsequent v,s,ts an earn- est effort is made by the physician to gain that confidence, and to exercise that more con re „f bis patient, which is so necessary to good results. To this end, if it seems adv, sable, the patient is frankly told the nature of the disease, the result of the sputum Light, and the general prognosis. This information is, however, g.ven only to pat, eats to those accompanying them. The great importance of proper and sufficient food, fresh air, and hygienic daily living is emphasized. A temporary, tentative diagnosis is made for each patient and written in ink in the proper space on the history card. Ike final diagnosis is added as soon as possible thereafter, also entered in the journal. At each subsequent visit of the patient, the body temperature, weight, pulse, and general condition are noted on later history card (Form 68 L, see page — )• A c- plete re-examination of the chest, with entry on diagram card, is made at .east once m ^ two months. Patients are advised to return as frequently as the physic, an cons, dersn^ ^ sary, the interval between visits not being longer than one week. \\ hen >e ■ " . . . clous lesion are referred to genera, hospitals and dispensaries. If for any reason tin £ T clan considers that a tuberculosis patient should not receive further treatment, the m. ^ referred to the Chief of Clinic, with a brief statement of the facts in the case. . o pa i discharged as free from tuberculosis if there is cough and expectoration, unless three nega.i sputum reports have been received, and the physical signs and general history fully wanan sucli action. Deserving patients who are in need are recommended for financial assistance by the at- tending physician, and such recommendations are forwarded, through the executive office, to the Charity Organisation Society, Association for Improving the Condition of the Poor, TTviHrari TTmhvow Hilarities. Brooklyn Bureau of Charities, etc. 5 L— 1008 2970, ’08, 2,500 (P) ALWAYS BRING THIS CARD DEPARTMENT OF HEALTH, THE CITY OF NEW YORK Division of Communicable Diseases BOROUGH CLINIC FOR THE TREATMENT OF COMMUNICABLE PULMONARY DISEASES Number.. Date To return . 10 A. M. 2 P. M. For Milk and eggs — milk — 2 quarts daily for one month, eggs — 3 daily for two weeks, are is- sued in deserving eases, to patients attending the tuberculosis clinics of the Department, as part of their treatment, and on recommendation of the clinic physicians. The case is investi- gated by a nurse and given a monthly order. (Manhattan, 182 L, Brooklyn, 189 L.) A record is kept of recommendations. All such cases in Manhattan are also referred to the Charity Organization Society (Hebrews to The United Hebrew Charities) for further investigation; in Brooklyn to the Brooklyn Bureau of Charities. MANHATTAN DIET KITCHEN ASSOCIATION. Wickham Diet Kitchen 137 Centre Street. Busch Diet Kitchen 146 East 7th Street. • Hackley Diet Kitchen 26 Barrow Street. Freeman Diet Kitchen 335 East 21st Street. Raymond Diet Kitchen 423 West 41st Street. Gibbons Diet Kitchen 140 East 97th Street. Anna Barbara Diet Kitchen 205 West 62d Street. Kitchens are open from 9 A. M. to 1 P. M. BROOKLYN BUREAU OF CHARITIES. 1660 Fulton Street. 191 Marcy Avenue. 69 Schermerhorn Street. Cases not returning for treatment within two weeks, and those in which notice of refer- ence to the clinic has been received and which have not applied for treatment, are investigated by the clinic nurses. 2H-410, ’07, 3,000 (P) 189 L— 1907 F HEALTH DEPARTMENT o CITY OF NEW YORK N OF COMMUNICABLE DISEASES Divisior Borough of_ . 190 Kindly furnish. .(quarts of milk), (eggs), daily to Address from Recommended by. .to. 190. No. M. D. Chief of Clinics .Nurse Delivered by to be re turned with Both attached vouchers correct y 1 monthly bill, the latter to be in triplicate. ___ „ BROOKLYN BUREAU OF CHARITIES 0 9 Schermerhorn ; 1660 Fulton ^ i^Marcy^Ave^ No. to the DEPARTMENT OF HEALTH, CITY OF NEW YORK * n f ...we have furnished to Upon your requisition .(Address). BROOKLYN BUREAU OF CHARITIES No - 69 Schermerhorn ; 1660 Fulton; 191 Marcy ? Ave. to the DEPARTMENT OF HEALTH, CITY OF NEW YORK Delivered by . . ... Both attached vouchers correctly filled out to be returned with monthly bill, the latter to be in triplicate. NEW YORK DIET KITCHEN ASSOCIATION No — to the DEPARTMENT OF HEALTH, CITY OF NEW YORK Upon your requisition of we have furnished to (Address) during the month of. MILK. EGGS. MILK. EGGS. 18 4 A •7 ft .... T n tt . T O I *3 T 1 ▼ £ I 5 . ... l6 No.- NEW YORK DIET KITCHEN ASSOCIATION to the DEPARTMENT OF HEALTH, CITY OF NEW YORK Upon your requisition of we have furnished to (Address) during the month of MILK. EGGS. MILK. c IO 17 18. 19. 20. 21 22 23 24 25 26 27 28 EGGS. 29. 30 31 Rules for Attending Physicians.— Tlie attending physicians should arrive punctually at 10 A. M., 2 1 . M., and 8 P. M., and must enter their names and the time of their arrival and dcpaituie in the time book in the registration room. It for any reason a physician is pre- vented from attending his class, he should notify the clinic promptly by telephone. Xo tuberculous patient may be discharged except by their own request, and previous to discharge patients considered to be cured must be examined and their discharge approved by the Chief of Clinic. Prescriptions must show the date, patient’s clinic number, and the physician’s signature, t.aeli prescription must be recorded on the history card in every instance. If the physician desires that the patient should be revisited by the nurse, enter a hospital, receive charitable aid, be discharged from treatment or transferred to other classes, he must state this fact on the history card. Each new patient must be referred to a throat class for examination, report, and treat- ment if needed. All patients must attend the classes to which they have been assigned on their first visit. Patients applying for emergency treatment, however, must be examined and treated by the physician to whom they may be temporarily assigned. Medicines will be supplied only to bona fide patients of the clinic. They will not as a rule be renewed except for patients per- sonally attending the clinic or on presentation of their admission card, but exceptions may be made for good reasons and at the discretion of the attending physician. When the clinic for- mulary is not used, prescriptions must be approved by the Chief of Clinic. Nurses.— (a) Nurses must report promptly at 1) A. M. and remain until 4 P. M. or later, if necessary. At the night classes, nurses on duty report at 7:30 P. M. (l>) One hour is allowed for lunch, but at least one nurse must always be in the clinic between 12 M. and 2 P. M. (c) Each clinic nurse must see that the supplies and instruments of the room under her charge are in good order. (d) Thermometers must be kept in a solution of 1 to 100 carbolic acid. (e) All diagnostic instruments must be wiped each day with a cloth wet with a solution of 1 to 100 carbolic acid. (f ) During the noon hour all the windows and inside doors must be opened for the airing and ventilation of the rooms. (g) At the close of each class all histories must be returned to the registration room. All sputum specimens must be placed in the collection box and the rooms left in good order. Sec. 184. The following circular is issued by the Department, and distributed to physi- cians and those interested: Ciicular of Information Regarding the Clinics for the Treatment of Pulmonary Dis- eases.”— (Form 60 L). department of health the CITY OF new YORK Sixth Avenue and 55*^ Street DIVISION of communicable diseases Circular of Information Regarding the Clinics for the Treatment of Communicable Pulmonary Diseases Tunics of the department of health FOR THE TREATMENT OF PULMO- nary diseases .. • r„ r t j, e treatment of pulmonary On March W’ a c "> o£ Health at No. 967 Sixth female P«‘“ ts j d are all lighted by skylights, the The rooms are well venti a Trained nurses are always bunding being ody one story m beg ^ ^ ^ and in attendance The want) that similar clinics have lasting, and * filled such g ^ and The Bronx (373I been opened in Brooklyn (3 J y orfran ization and purpose Third avenue), uniform in equipment, organization with the Manhattan Clinic. ment were as follows: The objects in view in their D i aa nosis of Pultnon- , admitted .ha, tuberculosis ary Tuberculosis It incipient tuberculosis, 3 in arriving at an early and correct diagnosts. a The Careful Supervision of Perseus Reeewing Treatment - This supervision includes not only medicinal treatment but ^ th furnishing of circulars of information in vanous langu g (EnZ Gennan, Yiddish, Italian, Chinese, Rutheman, Pohsh, Hungarian and Russian) containing careful and thorough mstjuc^ tion as to the nature of the disease and the to be taken to prevent the infection of others aper P and paper handkerchiefs are supplied, and also proper food (milk and eggs), to indigent and needy cases. , The Continued Observations at their Homes of Indigent, Needy and Ambulatory Cases, including all those Discharged from the Public Institutions of the City— A special staff o trainee nurses visit the patients at their homes to see that the instruction given are being observed, that the sanitary surroundings are sa is- factory and that such assistance as is required is afforded. m able cases are referred to the various charitable organizations or food, fuel, ice, etc. Special attention is paid to the children in the families of patients and every effort is made to prevent their infection. In suitable cases periodic formaldehyde disinfection of infected rugs, bed quilts, dressing gowns and clothing is carried out ever) few weeks. 4. The Removal of Cases Requiring Such Care to a Hospital 0? Sanatorium — These cases fall under four heads: (a) advanced or bed-ridden cases, with profuse expectoration, who will not or can- not take the necessary precautions against spreading the disease, and whose presence at home is a menace to others in the family ; (b) cases able to get about, but who are unable to work and who 4 and others having no homes. , Th* T uberculosis may bo reft discharge of consumptive «■— . -*•> - < b ) b >' w various charitable patients from bospi.a, or sana-a ^Lve tuberculous cases organiaattons through individual charita- rrX^ri^twhhsuri, persona. Special double cards tor ™ applica- have been prepared and will ^ of the tion. One-half the card givi g n or inst itution for- patient and the date and name ^ tQ ^ patient , and the warding it, should be fi ^ ^ tQ ^ Department other half, giving sinnla ’ j clinic within two ot Health. H the pa« Receiving proper weeks he is visite mo necessary precautions, food, medical care, etc., and ts takmg the necessa y P 6 The B* eusiou mi S — 190S 21-446, ’08, 1,000 department of health THE CITY OF NEW YORK SIXTH AVENUE AND 55th STREET DIVISION OF COMMUNICABLE DISEASES THE WORK AND THE PRODUCTS OF THE DIAGNOSIS, RESEARCH AND VACCINE LABORATORIES OF THE DEPARTMENT OF HEALTH List of Department Stations in All Boroughs 1908 CIRCULAR OF INFORMATION Re.„tor the Work and the Products of the Dkfrnosis R 'f" ch “ J Vaccine Laboratories of the Department of Health of The City of New York The following circular is published for SC ^ of the York, and the Products issued tec these Laboratories. Bacteriological Examinations for the Diagnosis o Infectious Diseases 1. DIPHTHERIA. Bacteriotopcal examnaUon^^f suspected diphtheria are made daiy ( un^y Manhattan. All cultures nosis Laboratory, 55 th Street a . , morn j n g of the following day, received during any given day are examine attending physician and the results of the examinations are reported by ma ^ o t {or diag . before i p. m. Results of examinations of pnra. ^ c«Uu« *1 ^ when his tele . nosis) will be telephoned to the atten mg » requested that physi- — and a,so state ^""^ures will ST?S tUblaL should be given in full in every CaStul) attached to the blank must be signed by the physician, or his representa tm, and is retained by the druggist, as a voucher, for the antitoxin delivered fr ee - 6 Antitoxin will be administered free to > any n C a s * n 0 | h J^"g h Manhattan city, upon the request of the atten in ^ y ’ Division of Contagious Diseases, such requests should be made to office of ^he Tfae Medical In- Sixth Avenue and Fifty-fifth Strc ( 0 { ^itoxin in this Borough are on jgTJfSSi d°aVand St -d requests for their services will receive prompt “T 1 other Boroughs o, ft. Cttx ~~ <« - “““ ”*7" — ft. Borough 0*00. 3731 Third Avenue (Telephone 975 Melrose). Borough or Brookevn: To the Borough office, 38 and 40 Clinton (Telephone 4720 Mam). Jamaica Borough of Queens: To the Borough office, 372 4 (Telephone 1200 Jamaica). Stapleton, Borough of Rxchmonp: To the Borough office, 54 S 6 S. I. (Telephone 440 Tompkinsv, e). admin ister the antitoxin, as It is advised that the attending physician^mis^ ^ thg services of the valuable time is thus saved; or if »> y^phone and as early in the day as Department, that such requests be made oy possible. < Stations tor the Collection of Specimens from Cases of Diphtheria. Tubercutosis the Distribution of Diagnostic Outfi , Antitoxin and of Vaccine Virus. Outfits tor the preparation of meutagife‘C«h«' 1 ’« i, J' *" tuberculosis, typhoid fever, m / la ” a :.^ d th T necessa ry data, may be procured at the the blank forms required m g 1 Moratory Products of the Depar - :: w bc tf^LTrSe^tous noted in ft. «-** "« 7 LIST OF CULTURE STATIONS BOROUGH OF MANHATTAN 131st St. and Madison Ave 125th St. (bet. Lexington and Park Aves.), Miner 121st St. and Lexington Ave llalpern 2396 2d Ave Aronstam 120th St. and 2d Ave Watkins 119th St. and 1st Ave Hasselbach 116th St. and 3d Ave Trau & Co. 116th St. and Lexington Ave Usbkow 115th St. and 1st Ave Di Dario 113th St. and Lexington Ave Meyrs 112th St. and Madison Ave., Leibovich & Itobens 110th St. and 3d Ave Romlein & Fuchs 109th St and Madison Ave Perla 108th St. and 2d Ave Do Maio 107th St. and Madison Ave., Newman &. Finestone 106th St. and Lexington Ave Boetzel 105th St. and 3d Ave Aronstam 101st St. and Madison Ave Picker 101st St. and 2d Ave Halpern 97th St. and Madison Ave Levitas 97th St. and Lexington Ave Larkin 96th St. and Park Ave Streiffer 96th St. and 2d Ave Berger 1679 3d Ave Beck 92d St. and Lexington Ave Steinman 92d St. and Madison Ave Dauscha 91st St. and 3d Ave Frohwein 90th St. and 1st Ave Eichler 89th St. and Park Ave Gies 87th St. and 2d Ave Roediger 87th St. and Park Ave Ulfelder 87th St. and Ave. A Bauman 8Gt.h St. and Lexington Ave Foucar 83d St. and Lexington Ave LascofT 1591 1st Ave. (nr. 83d St.) Koehler 79th St. and 2d Ave Lassas 78th St. and Avenue A Kimmel & Bro. 76th St. and Lexington Ave Plump <3d St. and Park Ave Cramer 73d St. and 1st Ave Castka 72d St. and 2d Ave Davidson 149 E. 71st St Roediger Bros. 67th St. and 3d Ave Zinckgraf 64th St. and 1st Ave Wurthman 64th St. and Park Ave Timmerman G2d St. and 2d Ave Dittmar 1020 3d Ave. (nr. 60th St.) .. Schwarz Bros. Lexington Ave., bet. 59th and 60th Sts., Nauheim Madison Ave., bet. 59th and 60th Sts.. Smith 59th St. and Madison Ave Kalish 56th St. and Lexington Ave., Block Deshell Co. 54th St. and 2d Ave Bogathy 53d St. and Madison Ave Larimore 52d St. and 3d Ave Schaub 964 2d Ave Katzman & Co. 50th St. and 1st Ave Edlich 49th St. and 2d Ave Joffe 46th St. and 5th Ave Fraser & Co. 45th St. and 3d Ave Brandt 537 Fifth Ave Larimore 4 2d St., 40 E. (nr. Turk Ave.) .Schoonmaker 42d St. and 3d Ave BohmfalK 39th St. and Lexington Ave Herz 34th St. and 3d Ave Suchy 31st St. and 4th Ave Reeder Bros. t29th St. and 4th Ave Bagoe 375 3d Ave. (bet. 27th and 28th Sts.) Lehman |445 2d Ave. (bet. 25th and 26th Sts.) Jarchow ■{•23d St. and 4th Ave Kalish •{■21st St. and 4th Ave IIoas 15th St. and 1st Ave Gregorius •{•University PI. and 13th St. . . Watling & Co. •{•13th St. and 2d Ave Walters 13th St. and Ave. A Low in 162 Ave. C (cor. 10th St.) Robinson fOth St. and 2d Ave Weiss f6th St. and 2d Ave Rosenthal -{•88 1st Ave. (bet. 5th and 6th Sts.) .Nemser •{•5th St. and Ave. A Klingelboeffer •{•5th St. and Ave. Shapiro f3d St. and 2d Ave Fuehrer •{•443 E. Houston St. (cor. Cannon).Goldblatt fRivington and Norfolk Sts Lewin 71 E. Houston St Colonello •{•Broome and Cannon Sts Decker •{•Spring St. and the Bowery Miner •{•220 E. B’way (cor. Clinton St.) . . Mamelok •{•Grand and Henry Sts Gilbert Grand and Mott Sts Uo Finto fBroome and Ludlow Sts Walker 58 Henry St Weinstein -{•172 Orchard St. (cor. Stanton) . . .Robinson 40 Stanton St Rosenberg 214 Monroe St Rickey EAST SIDE . .Erb 8 BOROUGH OF MANHATTAN— Continued Broadway, Kingsbridge *j«iroiQnn 185th St. and Amsterdam Aye Ne ^®° 166th St. and Amsterdam Ave Slmon 155th St. and Amsterdam Ave . . . . Hegeman 781 St. Nicholas Ave Jacobson 149th St. and Amsterdam Ave. . .Henrichsen 145th St. and Edgecomb Ave Uau 143d St. and 7th Ave. . .Rosemary Pharmacy 141st St. and 7th Ave •' Fer ^““ •>413 7th Ave University Drug Shop -, 4 4.”s“ 137th St. and Lenox Ave ? b , ! 8th Ave., bet. 135th and 136th Sts.-Rawlin^ 135th St. and Broadway siiverman 132d St and 7 th Ave 130th St. and 8th Ave • ‘ ' 130th St and Amsterdam Ave 2343 8th Ave. (nr. 126th St.) • • • • •Soublceh 320 St. Nicholas Ave. (nr. 1.6th St.) . 125th St. and 8th Ave Kinsman & Co. 1308 Amsterdam Ave. (bet. 124th and M "'’ ks 125th St. and 7th Ave Kinsman 125th St. and 8th Ave. p(aff 124th St. and Lenox Ave * * * Amsterdam Ave. and 122d St..... • ** ® 120, h St. and 8th A ve .... Koehler &WoeU 119th St. and 5th Ave. ...... • • ' ' “ook 118th St. and Manhattan Ave. .Pope A Cook 118th St. and 7th Ave * * ’’ 116th St. and Manhattan Ave . . . . Herman 116th St. and Lenox Ave 114th St. and Broadway diamond 114th St. and Lenox Ave D 113th St. and 8th Ave * ‘ *n Bros 112th St. and 7th Ave Robin prounc j 107th St. and Broadway . , 105th St. and Amsterdam Ave 104th St. and Columbus Ave Kerlev 102d St. and Broadway ... ** tting 100th St. and Amsterdam Ave . . . • getting 262i Broadway Keogh 98th St. and Broadway • • • • • * * _ 96th St. and Columbus Ave..Greenbe g ^ 95th St. and Amsterdam Ave ** hel 94th St. and Columbus Ave 92d St. and Columbus Ave. . WEST SIDE 88th St. and Broadway .Buck 85 h St and Amsterdam Ave Schwarz 82d St. and Columbus Ave Spangcferg 80th St. and Broadway KInsm 76th St. and Broadway.^ & ^ 74th St. and Broadway (Ansonla) . .Bol8hot 7->d St. and Columbus Ave 70th St. and & CartwrIght ccfh West End Ave & L * Se \ e .^ 61st St’& Columbus Ave..Dougan & Mcrr^ 57th St. and Oth Ave Q Smith 57th St. and 7th Ave «elntvre & Son 52 E ^^f^anment o^ 52d St. and 6th Ave. .... Rob ens 778 9th Ave. (nr. »-d St.) Pundt 51st St. and Oth Ave ; Jame9 46th St. and Broadway — Icr B ros. 683 10th Ave. ..... James ♦580 10th Ave. (nr. 4-d 39th St. and 6th Prot zmann & Co. .... Haas ^^th^Ave. ^bet. '37th and 38th ®ts. • Blomeier Upset 648 439 Oth Ave 34th St. and 10th Ave-. • • • • • • • "\"^ cUereT +366 9th Ave. < nr ’ 30th ® '' " . . .Gregorius 369 8th Ave. (nr. .8th St.) .. Rlker 23d St. and A . V ®. ‘ . Schleussner |22d St. and Oth Ave Qi eg 22d St. and 7th Ave.. ■ • • • ” ' ' . Lln3 +157 8th Ave. (nr. 18th St.) . . • Jacobson •{•51 9th Ave * * Fritz 624 Hudson St Bicclow 48th St. and 6th Ave.. * * * * * * ’ |463 Hudson St. (cor. arr ^ lower ’ Drug Co. +362 Hudson St. (cor. King Bt) ^rg 4° Qnnd St • •• ••;• cuariton St.) tl72^arick St. Kiennlnger . Higginbotham |106 W. Houston St. (cor. Thompson St) Gebicke Q BOROUGH OF THE BRONX Wakefield Becker Williamsbridge J. W. Fincke Williamsbridge Chas. Humbert Bedford Park (So. Boulevard, nr. Webster Ave.) C. Loeber Fordham (Kingsbridge Rd. and Marion Ave.) R. J. Hof Webster Ave. and Fordham Rd Jones Morris Heights (21 Cedar Ave.) Clark 961 E. 184 th St Schneider Bathgate Ave. and 180th St Stacom 2007 Boston Road Miller Westchester G. W. Smith Westchester Connolly Westchester Pierson Morris Park Ave Buehrle 2691 Tremont Ave Ilerriman Tremont and Clinton Lins 2435 Jerome Ave Rosenbaum 174th St. and Bathgate Ave Stechcr Washington and Wendover Aves., Romonoff Bros. 170th St. and Prospect Ave Schultze 169th St. and Jerome Ave Treutler 169th St. and 3d Ave Huether 712 Tremont Ave Miller 166th St. and 3d Ave Schaaf Bros. 165th St. and Forest Ave Koehler 162d St. and Morris Ave Wurm 3d Ave. and St. Paul’s Place, Borough Health Office 158th St. and Courtlandt Ave Ilirseman 951 E. 156th St Hafferberg 156th St. and Melrose Ave Jorgensen Westchester and Tinton Aves Rothman 155th St. and 3d Ave Schmidt 149th St. and 3d Ave liegeman 793 Westchester Ave Bleidner 145th St. and Brook Ave Soskin 3d Ave., near 143d St Goldwater 140th St. and Willis Ave McKane Alexander Ave. (nr. 141st St.) Cherey Prospect Ave and Beck St. . .Romanoff Bros. 138th St. and Brown PI Picker 858 E. 138th St « ie & el 134th St. and St. Ann’s Ave Valerius BOROUGH OF 037 Manhattan Ave. (bet. Java and Kent), Opper 578 Driggs Ave. (cor. N. 6tli St.), Vossler & Ilauck 139 Broadway (bet. Bedford and Driggs Avcs *) Gollobin 579 Broadway (cor. Lo rimer St.) H. J. Kempf 130 Graham Ave. (cor. Boerum St.) Mendel & Mendel 969 Broadway (bet. Myrtle and Ditmars), H. J. Scheldt 756 Myrtle Ave. (cor. Nostrand Ave.), W. J. Hackett 1366 Broadway (cor. Gates Ave.) .E. J. Huel 4247 Fulton St Qimsman 2780 Atlantic Ave. (cor. Georgia), R. C. Werner such as Tbe foI lowlng°cIrculars of Information are issue,! and will be sent on request . * 1, ^^^ ta o5«2iS e rulm^ nary Diseases.” '•Regarding Measures Adopted by the Hoar,! rf Health for the Sanlta^ Supervision of Tuberculosis In New lork Cl y. ••Importance of Bacteriological Ex " ml " n tlons In the Early Diagnosis of lui monary Tuberculosis. •• Administrative Control of Tuberculosis ’ “ Don’t Spit” Circular. (5 languages. » • Tuberculosis Catechism for 8chool Chil- dren.” “Dangers of Dry Sweeping and Busting. (•> languages.) ••Information Regarding Consumption Cures.” '•Regarding the Causation, Prevention am, Treatment of Diphtheria.” DnrABTAlENT OF HEALTH. 7 “Regarding Typhoid Fever, The Widal Test, The DIazo Reaction and the Impor- tance of Disinfection of Urine.” “How to Avoid the Contraction and Pre- vent the Spread of Typhoid Fever.” “The Causation and Prevention of Malaria and the Life History and Examination of Mosquitoes.” “Regarding Notification and Microscopical Diagnosis of Malarial Fever.” “Regarding the Causation and Prevention of Cerebro-splnal Meningitis.” What the Department of Health Re- quires of Physicians: 1. In accordance with Section 133 of the Sanitary Code, physicians are required to report to the Department of Health, among other diseases, all cases of tuber- culosis, typhoid fever, cerebro-splnal men- ingitis, pneumonia, erysipelas, malaria, and puerperal septlcmmla, within one week of the time the case comes under observation. 2. All changes of address on the part of their ^consumptive patients are to be sim- ilarly reported. 3. All necessary precautions must be taken to prevent the spread of the dis- ease, e. g., Isolation and quarantine of cases of cerebro-splnal meningitis, disinfec- tion of typhoid excreta and of tuberculous sputum, etc. 8 Bobough of Manhattan. CULTURE STATIONS. Ten. to a regular station. S. & U. Sundays and Holiday*. BOKOCGH or MANHATTAN. Boat Bide. m S2T*- »* ".'S To Miner, 4.30 p.m, S. & H. 4.4o p.m. MINEE^KcEcUr. ^ Ux j ag ton and Tark VMM 4.55 pjn.. S. & H. 4.45 AnONSTAM,' J. C., Substation. 2308 2d Avenue, To Miner. nAl ™S““. I— «...•■ To Miner. WATKINS, Substation. l^Oth Street and 2d Avenue, To Trau A Co., 4.15 p.m. daily. nASSELBACH, Substation. 119th Street and 1st Avenue, To Trau ft Co. Bobough of Manhattan. • TRAU & CO., Regular. HGth Street and Third Avenue, Visited daily 4.85 p.m. USIIKOW, Substation. 110th Street and Lexington Avenue, To Trau ft Co. 1)1 DARIO, Substation. 115th Street and First Avenue, To Trau ft Co. MEYERS. Substation. 113th Street and Lexington Avenue, To Trau ft Co. LEIBOWICH ft ROBENS, Substation. 112th Street and Madison Avenue, To Trau ft Co. ROMLEIN ft FUCHS. Substation. 110th Street and Third Avenue, To Trau ft Co. PERLA, Substation. 109th Street and Madison Avenue, To Aronstam, 4.10 p.m. daily. DE MAIO, Substation. 108th Street and Second Avenue, To Aronstam, 4.10 p.m. daily. NEWMAN ft FINESTONE, Substation. 107th Street and Madison Avenue, To Aronstam. BOETZEL, Substation. 106th Street and Lexington Avenue, To Aronstam. 10 BOBOUGn OP MANHATTAN. ARONSTAM. Regular. 105th Street and Third Avenue. Visited daily 4.30 p.m., S. & II. 4.:;i) p.m. PICKER, Substation. 101st Street and Madison Avenue, To Aronstain. IlAI.rERN, Substation. 101st Street and 8eeond Avenue, To Aronstain. LE VITAS, Substation. 07th Street and Madison Avenue. To Aronstam. LARKIN, Substation. 07th Street and Lexington Avenue, To Aronstam. STREIFFER, 8ubstatlon. 96th Street and Park Avenue, To Aronstam. BERGER, Substation. 96th Street and Second Avenue, To Aronstam. BECK, Substation. 94th Street and Third Avenue. To Lascoff, 4.10 p.m., S. &H.4.30 p.n DAUSCllA, Substation. 02d Street and Madison Avenue, To Lascoff, 4 p.m. dally. Borough op Manhattan. 11 STEINMAN, Substation. 92nd Street and Lexington Avenue, To Lascoff. FUOHWEIN, Substation. 91st Street and Third Avenue, To Lascoff. EICHLKR, Substation. 90th Street and First Avenue, To Lascoff. GIES, Substation. 89th Street and Park Avenue, To Lascoff. ROEDIGER, Substation. 87th Street and Second Avenue, To Lascoff. ULFELDER, Substation. 87th Street and Fark Avenue, To Lascoff. BAUMAN, Substation. 87th Street and Avenue A, To Lascoff. FOUCAR, Substation. 86th Street and Lexington Avenue, To Lascoff. LASCOFF, Regular. 83d Street and Lexington Avenue, Visited daily 4.20 p. m. S. & H. 4.20 p. m. 12 Bohough of Manhattan. KOEHLER. Substation. 83d Street and First Avenue. To LascofT. ROBBINS, Substation. 81st Street and Lexington Avenue, To Lascoff. LASSAS, Substation. 79th Street and Second Avenue, To Lascoff. KIMMEL, Substation. 78th Street and Avenue A, To Lascoff. PLUMP, Substation. 76th Street and Lexington Avenue, To Lascoff. CASTKA, Substation. 73d Street and First Avenue, To Zlnckgraf. CRAMER, Substation. 73d Street and Park Avenue, To Zlnckgraf. DAVIDSON, Substation. 72d Street and Second Avenue, To Zlnckgraf. ROEDIGER BROS., Substation. 71st Street and Lexington Avenue, To Zlnckgraf. ZINCKGRAF, Regular. 67th Street and Third Avenue, Visited daily 4.10 p.m., S. & H. -1 o p.m. Borough of Manhattan. 13 WURTIIMAN, Substation. 64th Street and First Avenue, To Zlnckgraf, 3.50 p.m., S. & H. 4.10 p.m. TIMMERMAN. Substation. 64th Street and Park Avenue, To Zlnckgraf. DITTMAR, Substation. 62d Street and Second Avenue, To Zlnckgraf. SCHWARZ BROS., Substation. 60th Street and Third Avenue, To Dept, of Health, 6 p.m. dally. NAUHEIM, Regular. Lexington Avenue bet 59th and 60th Streets, Visited daily 4 p. m., S. & H. 4 p. m. SMITH, Substation. Madison Avenue, bet. 59th and GOth Streets. To Nauheim, 3.55 p.m. dally. KALISH, Regular. 59th Street and Madison Avenue, Visited daily 5.30 p.m., S. & H. 4.00 p.m. BLOCK, DESHELL CO., Substation. 56th Street and Lexington Avenue, To Department of Health, 6 p.m. BOGATHY, Substation. 54th Street and Second Avenue, To Department of Health, 6 p.m. dally. 14 Bobodoh or Manhattan. LARIMORE, Substation. 63d Street and Madiaon Avenue, To Department of Health, G p.m. dally. SCHAUB. Substation. R2d Street and Third Avenue, To Nauheim. KATZMAN. Substation. 51st Street and Second Avenue. To Nauheim. EDLICH, Substation. 60th Street and First Avenue, To Nauheim. JOFFE, Substation. 49th Street and Second Avenue, To Nauheim. itraSER k CO.. Substation. 46tb Street and Fifth Avenue, To Department of Health. To Schoonmaker. BOHMFALK, Substation. 42d Street and Third Avenue, To Schoonmaker. LARIMORE & CO.. Substation. 537 Fifth Avenue, To Department of Health, 6 p dally. Bobouqh or Manhattan. 15 SCHOONMAKER, Regular. 40 E. 42d Street, Visited daily 5.25 p.m., S. A H. 3.50 p.m. HERZ, Substation. 39th Street and Lexington Avenue, To Schoonmaker. SUCIIY, Substation. 34th Street and Third Avenue, To Reeder Bros. REEDER BROS., Regular. 31st Street and Fourth Avenue, Visited daily 5.20 p.m., S. A H. 3.45 p.m. BAGOE, Regular. 29th Street and 4th Avenue, Visited daily 5.15 p.m., S. A H. 3.45 p.m. LEHMAN, Substation. 27th Street and Third Avenue, To Bagoe. JARCIIOW, Substation. Second Avenue bet. 25th and 26th Streets, To Kallsh. KALIS II, Regular. 23d Street and Fourth Avenue, Visited daily 5.05 p.m., S. A H. 3.40 p.m. 16 Bobocgh op Manhattan. HAAS, Substation. 21st 8treet and Fourth Avenue, To Kalish. GREGORIUS, Substation. 15th Street and First Avenue, To Walters, 4.40 p.m., 8. & H. 3.15 i>. m. WATLING A CO., Substation. 13th Street and University Place, To Bigelow. LBWIN, Substation. 13th Street and Avenue A, To Walters. WALTERS, Regular. 13th Street and Second Avenue. Visited dally 4.55 p.m., 8. A II. 3.30 p.m. ROBINSON, Substation. 10th Street and Avenue C, To Walters. WEISS, Substation. 9th Street and Second Avenue, To Walters. ROSENTHAL, Substation. 6th Street and Second Avenue, To Walters. NEMSER, Bubstatlon. 88 First Avenue (near Fifth Street To Walters. Bobouqh of Manhattan. 17 KLINGELnOEFER, Substation. Fifth Street and Avenue A, To Walters. SHAPIRO. Substation. Fifth Street and Avenue C, To Walters. FUEHRER, Substation. Third Street and Second Avenue, To Miner, 4.35 p.m., S. A H. to Walters, 8.15 p.m. GOLDBLATT, Substation. Houston and Cannon Streets, To Miner, S. & H. to Walters. LRWIN, Substation. Rlvlngton and Norfolk Streets. To Miner, S. A H. to Walters. DECKER, Substation. Broome and Cannon Streets, To Miner, S. A H. to Walters. MINER, Regular. Spring Street and Bowery, Visited dally except S. A H. 4.45 p.m., S. A H. sends to Walters. MAMELOK, Substation. East Broadway and Clinton Street, To Miner, S. A H. to Walters. RICKEY, Substation. 216 Monroe Street, To Miner, S. & H. to Walters. 18 Borough of Manhattan. GILBERT, Substation. Grand and Henry Streets, To Miner, S. A H. to Walters. LO PINTO. Substation. Grand and Mott Streets, To Miner, S. A □. to Walters. WALKER, Substation. Broome and Ludlow Streets, To Miner, S. A H. to Walters. WEINSTEIN, Substation. 58 Henry Street, near Market. To Miner, S. A H. to Walters. ROBINSON, Substation. Orchard and Stanton Streets, To Miner, S. A H. to Walters. ROSENBERG, Substation. 40 Stanton Street, To Miner, S. A H. to Walters. West Side Btatiom. BUCK, Substation. Klngsbrldge, To Raub, 4.40 p.m. daily. NEVELSON, Substation. 185th Street and Amsterdam Avenue, To Raub. SIMON’S PHARMACY, Substation. 166th Street and Amsterdam Avenue, To Raub. Borough of Manhattan. 18 HEGEMAN, Substation. 155th Street and Amsterdam Avenue, To Raub. JACOBSON, Substation. 781 St. Nicholas Avenue, To Raub. FIENRICHSON, Substation. 149th Street and Amsterdam Avenue, To Raub. RAUB, Regular. 145th Street and St. Nicholas Avenue, Visited dally 5.05 p.m., except S. A H. S. A FI. sends to Roublcek. ROSEMARY PHARMACY, Substation. 143d Street and Seventh Avenue, To Raub. FERGUSON, Substation. 141st Street and Seventh Avenue, To Rawlins, 4.40 p.m. dally. UNIVERSITY DRUG SHOP, Substation. 2413 Seventh Avenue, To Rawlins. KLINGMAN, Substation. 140th Street and Eighth Avenue, To Rawlins. ROBBINS, Substation. 137th Street and Lenox Avenue, To Rawlins. 20 Borough or Manhattan. RAWLINS. Regular. 135th Street, near 8th Avenue, Visited dally except S. & IT. 5.00 p.m. S. & H. sends to Roublcek. BANK, Substation. 135th Street and Broadway, To Roublcek. SILVERMAN, Substation. 132d Street and Seventh Avenue. To Hegeman 4.50 p.m., S. & II. 5.1i p.m. LAIJER. Substation. 180th Street and Eighth Avenue, To Ronbicek, 4.40 p.m., dally. MYERS. Substation. 130th Street and Amsterdam Avenue. To Roublcek. DORB, Substation. 3103 Broadway, To Roublcek. ROEBICEK, Regular. 8th Ave., bet. 125th & 12Gtli Sts., Visited daily 4.55 p. m. S.&H. 5.00 DINER, Substation. 126th St. and St. Nicholas Avenue, To Roublcek. MARKS, Substation. Amsterdam Ave., bet. 124 th & 125th Streets. To Roublcek. Borough of Manhattan. 21 KINSMAN, Substation. 125th Street and Eighth Avenue, To Roublcek. HEGEMAN, Regular. 125th Street and Seventh Avenue. Visited daily 4.50 p.m., S. & H. 4.55 p.m. PFAFF, Substation. 124th Street and Lenox Avenue, To Hegeman. FRIEDGEN, Substation. 122d St and Amsterdam Avenue, To Roublcek. KOEHLER A WOELL, Substation. 120th Street and Eighth Avenue, To Roublcek. KOIIOSOFF, Substation. 119th Street and Fifth Avenue, To Miners. POPE A COOK, Substation. 118th Street A Manhattan Avenue, To Roublcek. REED, Substation. 118th Street and Seventh Avenue, To Hegeman. I HERMANN. Substation. 116th Street and Manhattan Avenue, To Roublcek. 22 Bobough of Manhattan. ALBERT, Substation. 116th Street and Lenox Avenue, To Tran. KLIPP, Substation. 114th Street and Broadway, To Grube, 6 p.m. dally. DIAMOND, Regular. 114th Street and Lenox Avenue, Visited daily 4.30 p.m., S. & II. sends to Hegeman. GEETY, Substation. 113th Street and Eighth Avenue, To Grube. ROBINSON BROS., Substation. 112th Street and Seventh Avenue, To Grube. FREUND, Substation. 107th Street and Broadway, To Grube. GEISLER, Substation. 105th Street and Amsterdam Avenue To Grube. GRUBE, Regular. 104th Street and Columbus Avenue, Visited dally 5.20 p.m., S. & H. 5.10 p.m. Bobouoh of Manhattan. 23 KERLEY, Substation. 102 d Street and Broadway, To Grube. GOETT1NG, Substation. 100th Street and Amsterdam Avenue, To Grube. CONGLETON, Substation. 99th Street and Broadway, To Grube. KEOGII, Substation. 98th Street and Columbus Avenue, To Grube. GREENBERG & CO., Substation. 96th Street and Columbus Avenue, To Grube. FELS, Substation. 95th Street and Amsterdam Avenue, To Grube. MICIIEL, Substation. 94th Street and Columbus Avenue, To Grube. HIGINBOTEAM, Substation. 92d Street and Columbus Avenue, 1 To Spangenberg, 5.10 p.m. daily. BREITING, Substation. 88th Street and Broadway, To Spangenberg. 24 Bobouoh of Manhattan. SCHWARTZ, Substation. 85th Street and Amsterdam Avenue, To Spangenberg. SPANGENBERG, Regular. 82d Street and Columbus Avenue, Visited daily 5.20 p.m. KINSMAN DRUG CO., Substation. 80th Street and Broadway. To Spangenberg. CARPENTER, WALLINGTON & CO.. Sub- station. 76th Street and Broadway, To Spangenberg. BOISNOT, Substation. 74th Street and Broadway, To Cassebeer, 5.15 p.m. dally. CASSEBEER, Regular. 72d Street and Columbus Avenue, Visited dally 5.25 p.m. POND, BOWES A CARTWRIGHT, Sub station. 70th 8treet and Broadway, To Cassebeer. SELEY, Substation. 68th Street and West End Avenue, To Cassebeer. Bobouoh of Manhattan. DOUGAN & MERRITT, Regular. 61st Street and Columbus Avenue, Visited daily 5.30 p.m. COHEN, Substation. 10 Amsterdam Avenue, To Dougan & Merritt QUENCER, Substation. 67th Street and Ninth Avenue, To Dougan & Merritt. SMITH, Substation. 57th Street and Seventh Avenue, To Department of Health. McINTYRE, Substation. 56th Street and Sixth Avenue, To Department of Health. OFFICE DEPARTMENT OF HEALTH, Sixth Avenue and 55th Street. Cultures received day or night. NEERGARD, Substation. 52d Street and Sixth Avenue, To Department of Health. ROBENS, Substation. 52d Street and Ninth Avenue, To Department of Health. PUNDT, Substation. 51st Street and Ninth Avenue, To Department of Health. 20 Bobooqh OF MANHATTAN. ■lAMRS, Substation. To 1 ' T. Street and Broadwav T » James, 44th Street. "iwasr- JA MES. Regular. — daW and holidays 3.00 p. m . long acre riiAinnm, 43d Stree sna t ' Su ^tatl.,,, To James* Broaa "«y. Mcr a E Subst#t ; on ^ and ^nth Avenue. I tA 38th s, reet l “•■I BOBonon of Manhattan. 27 BLOME1ER, Regular. 439 Ninth Avenue. Visited daily, except S. & H. 4.05 p. m. S. & H. to James. UPSET, Substation. 34th Street and Tenth Avenue, To Blomeier. SCHIERER, Substation. Ninth Avenue and 30th Street, To Blomeier, 4.00 p. m. daily. Sundays and Holidays 3.00 p.m. GREGORIUS. Substation. Eighth Avenue, bet. 28th & 29th Sts., To Schleussner. RIKER, Substation. 23d Street and Sixth Avenue, To Kalish. SCIILEUSSNER, Regular. 22d Street and Ninth Avenue, Visited daily 4.10 p.m., Sundays and Holidays 3.10 p m. GIES, Substation. 22d Street and Seventh Avenue, To Schleussner. LINS, Substation. Eighth Avenue near 18th btreer. To Schleussner. Bobocoh of Manhattan JAGObson, Substation. 1 Eighth Avenue Sunrt' gel ° W ’ 4 15 Pm-. ""A CC IToI, ' , “ ),! ' 3 n r.m b,«,? bSS ° S ""'' BIGELOW, Regular 5ffi Sr.r «*»• Sundays ami £ ,5 pzn -» FLOw f drug co Re aya , 3 - 20 p - m - '““a .M itS, 1 ''"- s „ ” £ "wSSS?* ,M s '~'- a-ai^sst 8 ,_ Borough of Tnn Bronx. 29 BOROUGH OF THE BRONX. Borough Office— 3d Ave. & St. Paul’s Place. BECKER. Substation. Wakefield, To Fincke 5 p.m. daily, S. & n. to Loeber. FINCKE, Regular. Wllllamsbrldge. Visited daily at 5.15 p.m., S. & n. sends to Loeber 4 p.m. HUMBERT, Substation. White Plains Road. To Fincke, S. & H. to Loeber. LOEBER, Regular. 200th Street. Bedford Park, Visited daily 5.30 p.m., S. &. H. 4.0o p.m. HOF, Substation. Ford ham, „ „ _ _ _ To Jones 4.50 p.m. daily. S. & H. 3.oO p.m. JONES, Regular. . r Webster Avenue and Fordham i Road Visited daily 4.55 p.m., S. & H. 3.oa p.m. 30 Bobouqh of The Bbonx. CLARK, Substation. Morris Heights, T ° Miner 5.30 p.m. daily, s. & n 4.15 p.m, SCHNEIDER, Substation. Ml East 184th Street, To Jones. STACOM, Substation. io°M..f e r. Cet “ n<1 Ba,hga,e • PIERSON, Regular. Westchester. s - s ■>. “ Westchester. paxtx To Plers °n. CONKOIiLY, Substation. Westchester. PTT _ r To Pierson. b UBHHI.e. Substation. miller, Rewu r Bo8ton “o*- 1 - vwt A° ,ton Road - p m "any 4.30 p . m „ s . 4 „ 4 3 , HEBB K Station. romC nt Aven "'- Borough of Tub Bronx. SI LINS, Substation. Tremont and Clinton Avenues, To Miller. ROSENBAUM, Regular. Jerome Avenue and Fordham Road, Visited daily 4.45 p.m., S. &. II. 3.40 p.m. STECHER, Substation. 174th Street and Bathgate Avenue, To Department of Health. OFFICE DEPARTMENT OF HEALTH. Third Avenue & St. raul’s Place, Cultures received day or night. ROMANOFF BROS., Substation. Wendover & Washington Avenues. To Department of Health by 0 p m. SCHULZE, Substation. 170th Street and Prospect Avenue, To Department of Health. TREUTLER, Regular. . Jerome Are.. near 169th Street Visited daily 4.30 p.m., S. & H. 3. p.m. HUETIIER. Regular. . 169th Street and Third Av « n • 35 .Visited dally 5.45 pm-. s - & ’ * p.m. 32 Borough or Tub Bronx. MlIXElt. Regular. 712 Tremout Avenue, dally 5 ' 45 P S. &. ii. SCHAA i6efh R °.. 8. * U. to Hughes. 0ADJ1A v\, ^street and Tompkins Avenue. vCted at ^Op.m. S.& H. to Hughes. 36 BoaoDcn or Bbookl™. HUGHES, tted a t t r 5 45 a “ d m NO " trand Aven » e . 0sb ORN, Be^ar ’ S ’ 4 a 5 «*•»■ ItliltTi p"m 46 s h Str£et ' 5.30 p>rn P ' *’ S * & H. to < orn 08bor n. Regula ;. Streets! 011116 ***’ 55th and 50th Visited at 4 on p.m. * 0 p,m * S. & h. , 1( , W0LF *. He eular . ^tVaT 1 ci?* 6 ° th Street - Osborn. * > ‘ no, » S. & h. t0 4 L R ^ ,ar - Vl r at <^ 8 8 4 l! n n A ' bom. pna ** S. & H. to ( P T; Rc sular. v >8lt h ed A at ei 5 e and 17th Street ^ * * "w y nn Mrtment Of Heaut 8 e 4 p H- to D <“- Bobouqh of Brooklyn. 87 ABRAMSON DRUG CO., Regular Fiftli Avenue and President St , Visited at 5.20 P-m., S. & H. to Vinlcombe. SCHEIDT, Regular. 969 Broadway, Visited at 4 p.m. dally. CLASSEN, Regular. 457 Knickerbocker Avenue, n t0 Visited at 4.15 p m.. 8. * H- Huel. KLEIN, Regular. 412 Central Avenue - H t o ViBlted at 4.25 p.m., S. & «• Huel. HEIMERZHEIM, Regular. 567 Central Avenue, . H . to Visited at 4.35 p.m., B. * Huel. MERRITT. Regular. 1563 Broadway. t H . to Visited at 4.45 pm.. S. Huel. JiELHOEFFER. Regular. 772 Halsey Street, Visited at 6 P-m.. 8. * H. to Huel. VAN Street' and Washington Ave., atto5 P-m-. B. A B. to Hughes. 38 Borovoh or Brooklyn. MARSbAND, Regular vS c D TT n « st -«. Vlnlcombe P m ’ S - & " to GOLLOB 1 N. Refii] ar J 30 Broadway. VOSSLER S ‘ * H ' ‘° SCh0l< " Visited dan” U at a 4 <, io N °' C,h Street ' t° Scheldt 4 ' 10 Pm > S. & °BPER, Regular. V™”- Scheidt. pm - s. & n. f, mm ZT' “«*t. vi 0 ;^ Scheldt. p,rn ** s - * n. to V*1!M „ . ^ Sir.., ' “ ‘ " - VLMtcd' a a V’^o°p mCr Street - Scheldt P m, » S. 4 a to Borough of Brooklyn. HACKETT, Regular. Myrtle and Nostrand Avenues, Visited at 5 p.m., S. & H. to Schelde. KLOPSCFI, Regular. Myrtle Ave. and Cumberland Street Visited at 5.10 p.m., S. & II. to Department of Health, 0 p.m. CANTOR, Regular. Van Brunt and Sullivan Streets, Visited at 3.30 p.m., S. Sc II. to Department of Health, C p.m. WISBECn, Regular. Carroll and Henry Streets, Visited at 3.45 p.m., S. & H. t* Department of Health. KOEHLER’S PHARMACY, Regular. 316 Court Street near Sackett, Visited at 3.55 p.m.. S. & H. t* Department of Health. REED, Regular. Baltic and Clinton Streets, Visited at 3.55 p.m., S. & II. Dept of Health. JlHEYDENREICn, Regular. Atlantic Avenue and Clinton Street, Visited at 4.05 p.m., S. & H. to Department of Health. 40 Boboogh OF Brooklyn ^MB, Regular. 84 Court Street. V HX at41 ° P ' m -’ S - &H - *> vinicombe, Regu , ar . t1„f' at ^»h Avenue, visited daily a or 5-25 p.n, “ 425 P ”-. S. A II WE iss. Rros Pcct Pla Hughes. 825 S. & If . BANCR ^. Aguiar. V 5" a M 1 Aven " ,84B - to ^ v lalted 4n 8 p h m A vc nues . combe. P ‘ m, » 8 - & H. to VJui- Bobougu of Buooklyn. 41 DEPARTMENT OP HEALTH, Clinic. 361 Jay Street, Visited dally 6 p.m. NRANDER, Substation. Bay 18th Avenue near 86th Street, Bath Beach, Sends to Wolff, 4 p.m. WHITLEY, Substation. 91st Street and Third Avenue, To Wolff. PR ACER, Substation. 780 Gravesend Avenue, To Roeder 3.30 p.m. dally. 42 Bobocgh of Qoeens. borough OP queens. Borough Office, MFRPTvn FQltp To Sehnitzler dally 4 p.m. TEWES, Substation. 8t uT , C,^ enUe and Broadway, KlElir Se c d9 *° Cabeen - 425 Dm. “1EI1I,, Substation. “sKS."”* '■ c». CABE SN. Kecular. Vw,2? Ckson Avenue, fjo P “ 3 50 p “- »■ 4 n. BLICHEtt, Substation. Sends to°Schn?tz]"r. *' Clt7, MUNK » Substation. „„„„ 7 4 05 S. & H. tad. BOBOUGU OF QOKBNS. 4? ZIEGLER, Substation. 331) Webster Avenue, To Cabeen. COLLINS, Substation. 433 Steinway Avenue. L. I. City, To Cabeen. REILLY. Substation. 81 Flushing Avenue, L. I. City, To Cabeen. SCHROEDER, Substation. 253 Grand Avenue, L. I. City, To Cabeen. BEHN, Regular. 306 Fulton Street, Jamaica. GOLDMAN, Regular. Jamaica and Park Avenues, Visited daily at 4.50 p.m. S. A H. 5.50 p.m. WOOD, Substation, Richmond Hill. To Bacon. BACON, Regular. Richmond Hill, Visited daily at 4.55 p.m., S. A. H. Incl. EXAMINATION OF SPUTUM FOR TUBERCLE BACILLI. Sputum Outfits.— The sputum outfit furnished by the Department consists of a well-corked „.lass jar, bearing the name of the Department in raised letters, with a blank label, and a sputum slip (Form 38 L) on which the required data are to be given; it also gives instruc- tions for obtaining the specimen. as i 1907 , sum V. worn THIS SLIP SHOULD BE FILLED OUT BY PHYSICIAN jpjg- See other side for information regarding Collection and Examination of Sputum PLEASE SECURE AGAINST LEAKAGE DEPARTMENT OF HEALTH CITY OF NEW YORK Division of Communicable Diseases DIAGNOSIS LABORATORY Sixth Avenue and 55th Street SPUTUM FROM A CASE OF SUSPECTED TUBERCULOSIS Date of collection of specimen_ iyo No. of specimen. 1st, 2d, 3d, 4th, 5th, 6th, Tth. Name of Patient — — Address. Attending Physician (Give full name and address) Name - — - — — — Address.. _ Clinical diagnosis — - Was this blank filled out by attending Physician ? Should result of examination be positive, do you wish an Inspector to call and instruct patient and family as to prophylaxis, etc.?_ If result of examination is negative, do you wish this Department to consider the case as one of pulmonary tuberculosis? (Answer Yes or No.)_ pW" This Blank to be filled out to this point by Physician Received Prepared Lab. No Day No Result of Examination — Numerous— Moderate — Few — Negative. Examined by Date reported — — — NO SPECIMEN WILL BE EXAMINED IF LEAKING HAS OCCURRED (OVER) At 6 A. M. the Manhattan sputum specimens collected the day before are prepared foi examination, the necessary data being entered on the “laboratory” lists. Brooklyn speci- mens are brought to the laboratory by 8 A. M. Bronx, Queens and Richmond specimens and lists are prepared at 9 A. M. All slips after being marked and dated are sterilized one hour in an Arnold sterilizer. Each sample of sputum is poured into a Petri dish and a moderately thin smear of select- ed portions, representing in area two cover-glasses, is spread on a new glass slide, the “day” number being marked with a diamond. The slides are dried on an Ehrlich plate, and placed in aluminum racks, fitting in aluminum trays. The racks hold twenty-four slides. The trays are filled with fresh aniline fuchsin water, and heated to steaming for two minutes, washed in water, decolorized in acid alcohol (3% hydrochloric acid in 70% alcohol) counterstained with alkaline methylene blue, and a blank label for result of examination is affixed. Watery, oily or dried samples receive special attention the following morning. Leaky or improperly preserved specimens are not examined, notice of that fact being sent to the physician (Form 173 L). Microscopical examinations begin at 9 A. M. A rapid, superficial examination is first made to ex dude all specimens showing a large or moderate number of tubercle bacilli. The remainder receive a millimetre search, a mechanical stage being used. Results of examin-^ ation are marke l upon the slide, upon the proper place in the slip, together with the initials of the exar and upon the laboratory list, the terms used being “numerous,” “mod- erate,” “i~. nd “negative.” All slides are stored in a special cabinet twenty days for possible refei 5. « 173 L — 1907 Dr. 21a-397, ’07, 2,000 (P) DEPARTMENT OF HEALTH City of Mew York Sixth Avenue and. 55th. Street Division of Communicable Diseases DIAGNOSIS LABORATORY 190 I I Dear Sir: We have received a specimen of the sputum of your patient, of but no examination can be made, as the container reached this laboratory in a bad con- dition, the sputum having leaked out. If you will send another specimen, in a strong, tightly corked bottle, such as may be obtained at any of the Department of Health Stations (see enclosed list), an examina- tion will be made and the result reported to you. Respectfully. J. S. BILLINGS, Jr., M. D., Chief of Division. M. D. Assistant Director Diagnosis Laboratory. (Enclosure) 128 m- v. a copy of the ■•Ctrcularof ^ ^ g . ve .* „ eqD ivalent instructions to hi S (Form 3o L, see page >. ^ to send ^ name or add ress of patient, the nussrng patient. When the P J- ' ^ ^ ^ o( ftc attcnd i ng physician is not information is requested (Form. ) given, it is asked for (Form 247 L). it ?.oob ~ — — ■ — 97 L— 1907 21a-360, ’07, 15,000 (f>) DEPARTMENT OF HEALTH, CITY OF NEW YORK. Division of Communicable Diseases* DIAGNOSIS LABORATORY* SIXTH AVENUE AND 55th STREET. Telephone 4900 Columbus. LABORATORY Na.„ .190 Dr.. Dear Sir : The examination of the sputum from received on - shows the presence of tubercle bacilli. The case is therefore one of pulmonary tuberculosis. If you desire to have the family instructed as to methods of cleansing the apartments and as to general prophylaxis, kindly notify this Department. Unless so requested the De- partment will not visit or interfere with the case in any way. The attending physician will kindly see that his patient is sup- plied with one of the enclosed circulars of instruction or its equivalent. Physicians are required to at once notify the Department of Health of any change of address on the part of their con- sumptive patients, in order that the vacant premises may be disinfected. SJ J. S. BILLINGS, Jr., M. D., Chief of Division. 39 L — 1907 21a-324, '07, 20,000 (P; DEPARTMENT OF HEALTH DIAGNOSIS LABORATORY DIVISION OF COMMUNICABLE DISEASES Sixth Avenue and 55th Street Telephone 4900 Columbus Laboratory No. _ New York, 190 Dr . Dear Sir : — The examination of the sputum from received on nc *. s!. >w the presence of any tubercle bacilli. DO YOU STILL WISH THIS DEPARTMENT TO CONSIDER CASE ONE OF TUBERCULOSIS ? If so, please report on postal in regular way. This Department has found that it is practicable to examine (if necessary with a mechanical stage) one large prep- aration of each specimen of sputum made directly upon a microscopical slide. Such a preparation equals in area three of the ordinary cover glass preparations. This is usually sufficient to demonstrate the presence of tubercle bacilli in fairly well developed cases of pulmonary tuberculosis, and in many cases which are only in the incipient stage. There are, however, undoubted cases of incipient pulmonary tuberculosis which re- quire the examination of many preparations before the tubercle bacilli can be found. Cases also occur in which the sputum for a time does not contain the bacilli, which were, however, present at an earlier period, and which reappear again later. If this case be still regarded as possibly one of tuber- culosis, other specimens should be sent for examination. It should be constantly remembered that the demonstration of the presence of tubercle bacilli in the sputum proves conclusively the existence of tuberculosis ; but that the absence of tubercle bacilli or the failure to find them microscopically does not positively exclude the existence of the disease. J. S. BILLINGS, Jr., M. D. Chief of Division. 45 L — 1908 2985. ’08. 250 (P) DEPARTMENT OF HEALTH, CITY OF NEW YORK, DIVISION OF COMMUNICABLE DISEASES, SIXTH A\ ENUE AND 5.5th STREET, Telephone 4000 Columbun. To Dr. Dear Sir: A specimen of sputum marked. was . 4 eived from you on the — ^ and — but , —of the patient did not accompany the specimen. Under the rules of the Board, a report of the examina- tion cannot be sent to you until these data are furnished. Please fill out name and address on enclosed blank and return, when result of examination will be at once forwarded. Respectfully, _M. D., Chief of Division. 247 L-1907 2297, ’07, 1,000 (P) DEPARTMENT of health CITY OF NEW YORK s. yf. Cot. S5 cept Manhattan). The written reports of the results of the examination are compared with the original slip by the examiner before being signed and mailed. S-S 18 < a aj a £ OJ yyr ro-a 193 L — 1907 21a-414, *07, 5,000 (P) Division of Communicable Diseases DAILY LIST EXAMINATIONS IN THE DIAGNOSIS LABORATORY Specimens from Borough Instructions to Collectors Mantatton.-Onc Diph.WU Uta-jj* -Eft Widal, Diazo, Sputum, Malaria and C c * f — A ‘ “• n; ''”' rt « 5 « • -aWat. Richmond. — Diphtheria, same as I list of all other specimens made out i Diagnosis Laboratory each morning, i true Diphtheria; No La, another c ---» , - . No L5, another culture requested, no growth on culture medium. Name and Address Doctor or Inspector Making Culture Address or Tel. No. Report Rec’d bv Dr. Result Tiip nam e and address of all eases showing “true” or “positive” results, and of negative eases which the attending physician wishes considered “true,” are reported to the Inspector- in Charge of the Borough in which the patient resides (Form 11 L see page ). A daily record (Form 22 LL) is kept for each Borough of the number of primary (positive, negative and doubtful) , and later specimens examined, including diphtheria, and also the number of visits made to stations, number of culture tubes, swabs, sputum jars and other outfits prepared. Coi lection of Specimens and Supervision op Culture Stations.- Various pharmacies throughout New York City keep on hand sputum outfits, culture tubes, diagnostic outfits and diphtheria antitoxin and vaccine, supplied by the Department of Health. These pharmacies are designated as “Culture Stations.” A full description of these outfits and the various grades of antitoxin, together with a full list of “culture stations,” is found in the circular entitled “Work and Products of the Diagnosis, Research, and Vaccine Laboratories” (Form 105 L, see page ). These “culture stations” are of two kinds: (a) “Regular stations” visited daily by collectors and supplied directly by them (in all Boroughs). (b) “S„b-stations,” obtaining supplies on requisition (Form 148 L) forwarded by mail in directed envelope furnished for the purpose or through the “regular” stations, and deliv- ering specimens daily to these stations before the collector calls (in Manhattan, Bronx and QUe< All repositions after being honored are stamped with the date and the initials of the employee who put up the order and are filed for reference. 1 ' £4 uu c-u 4> UU .<£ eu 0 Q S* 0 o a o £ c < » as g a) ^ £ 0) 0 C o •tS (S J O . t w w u pD £ C o >l » Cu T5 h-I d 8 a 05 E as _ o 0 id if) TS X O cfl nM 0 0 ».S -oSoiCs t.« C O ® o T3 .« C. cn q 03 © « 0 Q® ® «n>Q « - « 3 •5 <1 ^3 * 05 s> ffi aii sat feo! M gH- (iit ojfe ms « •« i, ' * \ Culture stations” are established on application in writing, after approval by the Chief of Division and the Chief Clerk (as to antitoxin and vaccine contract), and after signing an agreement in duplicate. I’he location and character of all “culture stations” are indicated upon maps of the different Boroughs by means of colored tacks. Supplies carried by “regular stations” in Manhattan (minimum): Sputum jars j DozcI1 Sputum blanks (Form 38 L) 2 Dozen Culture tubes i Dozen Swabs 1 Dozen Culture envelopes i Dozen Typhoid outfits (Widal) 1 Dozen Typhoid outfits (Diazo) i Dozen Meningitis and malaria outfits, each y 2 Dozen Primary diphtheria blanks (Form 21 L) 1 Dozen Later diphtheria blanks (Form 26 L) 1 Dozen Antitoxin 6 Bottles Vaccine 10 Tubes 1 he blanks for Widal, Diazo and malaria specimens accompany each outfit. Supplies carried by “sub-stations” (minimum): Sputum jars g Sputum blanks (Form 38 L) g Culture tubes 20 Swabs 20 Culture envelopes 20 Typhoid outfits (Widal) 4 Typhoid outfits (Diazo) 3 Meningitis and malaria outfits, each 2 Primary diphtheria blanks (Form 21 L) 10 Later diphtheria blanks (Form 26 L) 10 Antitoxin 6 Bottles Vaccine 10 Tubes The proprietors of “sub-stations” agree to deliver all specimens to the “regular stations” b\ the appointed time each day, and to send for their packages of new supplies within 48 horns after notice has been received. Such notice is sent by postal card (Form 145 L). All regular stations” are visited every two weeks to inspect same and to replenish supplies. “Sub-stations” are inspected and supplied monthly, a record of each inspection being kept in a special card index (Form 199 L). 21a-382, ’07, 3,000 (P) 145 L— 1907 department of health CITY OF NEW YORK* 5ixth Avenue and 55 th Street Division of Communicable Diseases diagnosis laboratory a package of supplies has been delivered at Please call for same without delay. Present this card at the collecting station. 21a-417 f ’07, 2,500 (P) CULTURE STATION REPORT .Date assigned _.Bad - Fair... .Diazo C. S. M. Name. Address — No. C Tubes Good . No. Sp. Jars Widal.. No. Malaria Swabs Suff. Blanks ? „_Envs.?_ Remarks — — Box in good order? .190 Was req. for supplies made out attime of Insp.. Date Insp - 1#0 * Nurse ~ Co,— o— All BonouOBS.-Col, colors leave fte Borough offices promptly and visit the .‘culture stations” according to soheduie; . is a station to be left before the schedule time. Each station is visited daily and the eolleetor always carries the hand-hag to*** * the Department and a full stock ot supplies. Telephoning to “culture stations to there is any necessity to call, is strictly forbidden. The stock of supplies in each station is to be carefuily examined daily, especially the cuh ture tubes, and all spoiled tubes replaced. If the number of other outfits .sec, , made up to the required amount. If packages for sub-stations remain at the regular stations more than forty-eight hours, the fact is reported to the Assistant Director of the Diagnosis Laboratory. All carfare vouchers for the preceding month, properly made out in duplicate and sworn to, are submitted to the proper official for his approval, on the first day of the moil i 8 B). In Manhattan the collectors report at the Diagnosis Laboratory daily at 3:30 P. M, an put up all orders for supplies which may have been received after 3 o’clock. One bacteriological diagnostician must be constantly in the laboratory between and 4 P. M. There must always he a full stock of all outfits kept in the Divisions of C ontagious an Communicable Diseases, in each Borough, in the boxes placed there for that purpose. 185 137 138 140 148 147 150 WF 300 N4 2 h 1908 Medical ove New York (City) Board of Hea How the department of health of the city of New York is f < l i farf t \ Djf # S3D/49 0fr 71974197 SC&HZIH 160958 160S58 »ew York (City) Board of Health, alhhor How the department of health °. - f o ty ° f " e " York ls fiehtir title tuberculosis " Min ill DATE T- LOANED BORROWER'S NAME DATE RETURNED — DATE DUE CARR McLEAN, TORONTO FORM #38-297