City of Baltimore 128Th Annual Report

)

, iITY OF BALTIMORE

ONE HUNDRED AND TWENTY-EIGHTH

ANNUAL REPORT

OF THE

DEPARTMENT OF HEALTH

1942

BALTIMORE

To the Mayor and City Council of Baltimore for the Year Ended December 31, 1942 "This world is perishing for kindness."

From George Washington Carver a Biography by Rackham Holt DEPARTMENT OF IIEALTII

Commissioner, HUNTINGTON WILLIAMS, M.D., Dr.P.H. Assistant Commissioner, Ross DAVIES, M.D., M.P.H. Secretary, REED GAITHER

ADMINISTRATIVE SECTION Administration HUNTINGTON WILLIAMS, M.D., Dr.P.IL Vital Statistics W THLTRBER PALES, Sc.D. Health Information ESTHER S. HORINE DOROTHY REGINA KALBEN Laboratories C. LEROY EWING Eastern Health District C. Hown ELLER, M.D., Dr.P.H. Western Health District ALFRED C. MOORE, M.D. Druid health Center. II. MACRO WILLIAMS, M.D., 1\1.P.II. Southeastern Health District JOHN A. SKLADOWSKY, M.D.

MEDICAL SECTION Communicable Diseases DAVID II. ANDREW, M.D., C.P.H. Sydenham Hospital . MYRON C. Tom., M.D., M.P.H. HonAcE L. HonEs, M.D. Tuberculosis MIRIAM 13RAILEY, M.D., Dr.P.H. Venereal Diseases RALPH F. SIRES, M.D., 1\1.P.H. FERDINAND 0. REINHARD, M.D., M.P.H. Occupational Diseases JouNT M. McDONALD, M.D D.P.II. Child Hygiene WILLIAM K. SKILLING, M.D. School Hygiene II. WARREN BUCKLER, M.D. Public Health Nursing JANE B. LAIB, R.N.

SANITARY SECTION WILMER II. SCHULZE, Phar. D., Director Milk Control IVAN M. MARTY Food Control FERDINAND A. KORFF Meat Inspection WILLIAM BRENNER, D.V.S. Environmental Hygiene GEORGE W. SCHUCKER

Learn to Do Your Part in the Prevention of Disease

[ 3 ] Rational Urnlilt litutor aularbr6 lii 33altimort, illarRlaub Ior Public hrallh Sithitutuirut Purititi flit pear 11142 vrtgenteb bp Zr be Cbamber of Commerce of the ZLluiteb 6tateg anti Zbe American Public f)ealtb onation -

PLAQUE Presented to the Baltimore Association of Commerce in New York City, April 28, 1943.

[ 4 ] CONSULTANTS DR. THOMAS S. CULLEN, Member, Maryland State Board of Health. DR. ARTHUR G. BARRETT, President, Maryland Academy of Medicine and Surgery. DR. J. M. T. FINNEY, Professor Emeritus of Surgery, Johns Hopkins Medical School. On. ALLEN W. FREEMAN, Professor of Public Health Administration, Johns Hopkins School of Hygiene and Public Health. DR. ANDREW C. GILLIS, Professor of Neurology, School of Medicine, University of Maryland. D.LOUIS HAMBURGER, Associate in Medicine, Johns Hopkins Medical School. DR. ARTHUR J. LOMAS, Administrative Consultant, Catholic Hospitals of Maryland. DR. MAURICE C. PINCOFFS, Professor of Medicine, School of Medicine, University of Maryland DR. ROBERT II. RILEY, Director, Maryland State Department of Health. On. JAMES M. II. ROWLAND, Dean Emeritus, School of Medicine, University of Maryland. DR. ARTHUR M. SHIPLEY, Professor of Surgery, School of Medicine, University of Maryland. DR. SAMUEL WOLMAN, President, Maryland Tuberculosis Association.

ADVISORY COMMITTEE ON SANITATION DR. WILLIAM H. HOWELL, Chairman, Director Emeritus, Johns Hopkins School of Hygiene and Public Health. DR. ANNA M. BAETJER, Associate inlPhysiology, Johns Hopkins School of Hygiene and Public Health. DR. C. B. SPENCER, Passed Assistant Surgeon, United States Public Health Service, in charge of the Baltimore Quarantine Station. Mn. GEORGE COBB, Chief Engineer of Baltimore. DR. JAMES E. IVES, Senior Physicist of the Office of Industrial Hygiene and Sanitation, retired, United States Public Health Service. DR. ABEL WOLMAN, Professor of Sanitary Engineering, Johns Hopkins School of Hygiene and Public Health. [5 ] MEDICAL STAFF LYMAN ABBOTT, M.D. C laxity B. KOLB, M.D. h 0 EDITH R. ABRAHAMSON, M.D. C IRVING G. KROOP, M.D. s MAURICE L. ADAMS, M.D. v KENNETH KRULEWITZ, M.D. $ JOHN M. ASHWORTH, M.D. h o c ALBERT L. LAFOREST, M.D. v Louis V. Bi.um, M.D. t CHARLES D. LEE, M.D. v M. L. BREITSTEIN, M.D. ea ISIDORE I. LEVY, M.D. t HARRY BROWN, M.D. c LUCILLE LIBERLES, M.D. h 0 G. RAYNOR BROWNE, M.D. v HARRY LINDEN, M.D. v WILLIAM BERKLEY BUTLER, M.D. v AMELIA LINK, M.D. h o CHARLES R. CAMPBELL, M.D. v 0. L. LONG, M.D. h o JAMES D. CARR, M.D. v FRANCIS J-B. LUKE, M.D. v EARLE P. CLEMSON, M.D. v Huou B. MCNALLY, M.D. ID J. W. V. CLIFT, M.D. c JAY G. MCRAE, M.D. h 0 HENRY T. COLLENBERG, M.D. v ISRAEL P. MERANSKI, M.D. v JOHN COLLINSON, M.D. v EDGAR G. MILLER, M.D. h o C THEODORE COOPER, M.D. t MEYER MILLER, M.D. c ROSCOE Z. G. CROSS, M.D. h o M. ALEXANDER NOVEY, M.D. DI W. ALLEN DECKERT, M.D. ID GEORGE C. PAGE, M.D. v SOLON A. DODDS, M.D. c GEORGE II. PENDLETON, M.D..v HARRIS GOLDMAN, M.D. v D. MCKINLEY REESBY, M.D. h o HARRY C. GRANT, M.D. h 0 A. L. RETTALIATA, M.D. h 0 WALTER E. GREMPLER, M.D. C LEWIS J. ROSENTHAL, M.D. h 0 RICHARD DAVID HAHN, M.D. v ALBERT SCAGNETTI, M.D. c IIAROLD V. HARBOLD, M.D. ho J. DOUGLASS SHEPPERD, M.D. v Louis E. HARMON, M.D. v ERNEST W. SHERVINGTON, M.D. v JAMES B. HAwitixs, M.D. h 0 IsADouu A. SIEGEL, M.D. in JOHN M. HAWS, M.D. In GEORGE A. STRAUSS, M.D. v MANES S. HECHT, M.D. C J. WALKER THOMAS, M.D. h 0 WILLIAM G. HELFRICH, M.D. p HOWARD II. WARNER, M.D. h 0 BOWMAN J. How), M.D. V SAMUEL WEINBERG, M.D. h 0 LEON S. HonicA, M.D. h o ALEXANDER A. WEINSTOCK, M.D. t 'Irian P. HuanEs, M.D. h o II. WHITNEY WHEATON, M.D. h 0 HOWARD J. IcuEs, M.D. S MARY COOK WILLIS, M.D. C MEYER W. JACOBSON, M.D. t GUSTAV II. WOLTERECK, M.D. C ALBERT JAFFE, M.D. C CHARLES T. WOODLAND, M.D. v WILLIAM ATWELL JONES, M.D. v CELESTE WOODWARD, M.D. h 0 JAMES S. JULIAN, M.D. v RALPH J. YOUNG, M.D. v c = child hygiene, ea = ear clinic, ey = eye clinic, Ii o = health officer for communicable disease control and school hygiene, h o c = health officer-contract basis, m = maternity hygiene, p = post mortem physician, s = Sydenham Hospital, t = tuberculosis clinic, v = venereal disease clinic, bold type = full time.

[6] TABLE OF CONTENTS Page THE DEPARTMENT OF HEALTH 3

REPORT OF TIIE COMMISSIONER OF HEALTH 9

ADMINISTRATIVE SECTION Assistant Commissioner of Health 59 Vital Statistics 65 Health Information 71 Laboratories 79 Eastern Health District 95 Western Health District 101 Druid Health Center 101 Southeastern Health District 109

MEDICAL SECTION Communicable Diseases 117 Sydenham Hospital 129 Tuberculosis 139 Venereal Diseases 149 Occupational Diseases 157 Child Hygiene 163 School Hygiene 179 Dental Clinics 185 Public Health Nursing 189

SANITARY SECTION Sanitary Section 197 Milk Control 203 Food Control 211 Meat Inspection 221 Environmental Hygiene 227

VITAL STATISTICS TABLES 245

APPENDIX Ordinance: Milk Ordinance Amendment 311 Regulations: • Plumbing Regulation Amendment 312 Hygiene of Housing 312 Rooming Houses, Lodging Houses and Hotels 314 Maternity Hospitals 316 Trailer Camps 320 Milk Handling—Definitions 322

INDEX 323

[7 1 ORGANIZATION CHART - BALTIMORE CITY HEALTH DEPARTMENT

CONSULTANTS Mien

SECRETARY

MEDICAL SECTION

SUOMI OF BUREAU OT TUBLRGOLOSIS COLD IffSI/EPit

DIVISION OF nsg400ds.tor.mcf.:11 MONT Z ONE HUNDRED AND TWENTY-EIGHTH ANNUAL REPORT OF THE BALTIMORE CITY HEALTH DEPARTMENT

1942

REPORT OF THE COMMISSIONER OF HEALTH The Honorable, THE MAYOR AND CITY COUNCIL OF BALTIMORE GENTLEMEN: Pursuant to the provisions of Section 91 of the City Charter and also in accordance.with a resolution adopted by the City Council in the year 1817, I have the honor to transmit to you a summary of the one hundred and twenty-eighth in a series of consecutive annual reports of the work done by the Baltimore City Health Department, and by the several bureaus thereof, for the year ended December 31, 1942. Introduction In spite of the stresses and strains of war work the health of the city was good during the year. While severe housing shortages and increases in meningococcus meningitis and diphtheria were present the city achieved new low records in its maternal mortality and infant mortality rates. The former had never before been below 2.0, nor the latter below 40 per 1,000 live births. A primary Health Department effort in housing and slum eradication went forward during the year with the adoption and enforcement of new regulations under city ordinance, the doubling of the housing inspector staff, the codification and publication of the ordinances and regulations, and particularly with the success in test cases in court where the new legal and administrative procedures were sustained. The City Housing Authority assisted on the constructive side by building well baby clinics into two new projects that were opened to house families of war industry workers. Some approach was made through official and nonofficial channels to a more adequate dissemination of needed information on the important problem of nutrition and the Health Department strengthened its Bureau of Public Health Nursing by the appointment of a well qualified educational director. Other major advances were the opening on December 1 of a long needed chest clinic for Negroes at the Druid Health Center, the first night sessions for working persons at all the Department chest clinics and [9] 10 REPORT OF THE HEALTH DEPARTMENT-1942

the new facilities for mass X-raying of contacts and special groups at the Druid Health Center and at the Eastern Health District. Late in the year a new public health and social agency known as the Baltimore Venereal Disease Council was organized under the auspices of the Baltimore Mobilization Committee. The Council began by en- deavoring to assist the military authorities in their current venereal disease control program but planned also to lay sound foundations for a long-range attack on the problem in the city. As announced at the time "The new group came into being because it was felt that a modern attack on syphilis, gonorrhea and the other venereal diseases in any community is more than the task of its Health Department, or its Police Department, or its Law or Welfare or Liquor Control or Recreation Departments, or its Courts or social organizations; it is the common task of all these agencies, indeed of the community as a whole. To be effective each group must learn to • integrate its own contribution into a broader pattern; it must be sym- pathetic with the need for aid of all agencies and of its own. In other words, there must be genuine teamwork, and full knowledge of a many- sided problem and of the reasons for the failures in previous efforts to solve it." The Commissioner of Health presented an address on "Blitz Medical Services in England and What They Teach Us"at the 17th Annual Illinois Conference on Public Health which was held in conjunction with the annual meeting of the American Public Health Association at St. Louis, Mo., in October and a paper on "Health Problems in Suddenly Expanding Industrial Communities" before the 7th Annual Meeting of the Industrial Hygiene Foundation of America in Pittsburgh in November. He continued to serve as a member of the Advisory Medical Board of the U. S. Office of Civilian Defense and qualified with other Health Department members as an air raid warden and attended a short course of instruction for physicians in chemical warfare at Edgewood Arsenal. During the year the total city health effort won for Baltimore a place on The 1942 National Health Honor Roll of cities selected in the annual Health Conservation Contest which is conducted by the Chamber of Commerce of the United States and the American Public Health Associ- ation. The Health of the City

Population With the acceleration of war industries large numbers of new workers and families arrived in Baltimore during 1942. There was also a con- REPORT OF THE COMMISSIONER OF HEALTH 11

siderable exodus during the year. Therefore, the annual population estimates could not be made as readily as usual. A sample survey reported by the U. S. Bureau of the Census during the year gave some aid in reaching the estimated city population as of July 1, 1942 as follows: Total, 936,000; white, 754,400 and nonwhite, 181,600. The birth and death rates included in this report are based on these figures. Births, Maternal Mortality and Infant Mortality As in 1941, the most striking element in the vital statistics of Baltimore for 1942 was the increase in the number of births. A total of 19,720 resident births took place, an increase of 23.4 per cent over the preceding year and a 50.0 per cent increase over the average resident births for the three year period 1938-1940. In spite of the increase in deliveries, the maternal mortality rate set the new low record of 1.7 per 1,000 live births. The year 1942 was notable also for its low infant mortality rate of 39.5 per 1,000 live births, the lowest such rate ever recorded in Baltimore. This record was largely due to the unusually low rate, 56.4, for colored babies. The infant mortality rate is considered a most delicate index of effective community hygiene. Meningococcus Meningitis Meningococcus meningitis, often thought of as a crowd disease, increased from 72 cases in 1941 to 202 cases in 1942. Fortunately only 31 cases or 15 per cent died. In the outbreak of the disease during 1936-1937 there were 467 cases and 157 resident deaths, a percentage of 33.6. The improved recovery record for 1942 can be largely attributed to the use of sulfonamide drugs in the treatment of this disease which was first undertaken in this country at Sydenham Hospital in Baltimore. Syphilis and Gonorrhea War always emphasizes the importance of venereal diseases as a cause of disability. The number of cases of syphilis coming to the attention of the Health Department for the first time increased from 7,838 in 1941 to 11,293 in 1942; an increase of 44.1 per cent. An analysis of cases according to source of report indicated that this increase was primarily among Selective Service registrants as a result of examination prior to induction into the armed forces. The increase in reported cases of gonorrhea was somewhat less striking, although here again the greatest increase was for cases reported among Selective Service registrants. Because of the importance of the two diseases in wartime, the accompanying table is given to show sources of reports. 12 REPORT OF THE HEALTH DEPARTMENT-1942

CASES OF SYPHILIS AND GONORRHEA CLASSIFIED BY SOURCE OF REPORT,1941 AND 1942 AND PERCENTAGE CHANGE 1942 OVER 1041

PERCENTAGE CHANGE 1942 1941 1942 OVER 1941 DISEASE AND SOURCE OF REPORT 3 .9 LI E-4 Syphilis, total 11,293 2,475 8,818 7,839 1,765 6,074 +44.1 +40.2 +45.2

Private physicians 3,271 1,078 2,193 2,464 824 1,640 +32.8 +30.8 +33.7 Hospitals 2,035 401 1,634 1,902 433 1,469 +7.0 -7.4 +11.2 Health Department clinics 1,939 184 1,755 1,597 , 150 1,447 +21.4 +22.7 +21.3 Selective Service 3,242 681 2,561 1,001 207 794 +223.9 +229.0 +222.5 Other 808 131 675 875 151 724 -13.2 -6.8

Gonorrhea, total 3,388 1,180 2,190 2,940 884 2,056 +15.2 +34.5 +7.0

Private physicians 008 607 301 901 849 412 +3.9 +27.0 -26.9 Hospitals 380 162 227 351 122 229 +10.8 +32.8 -.9 Health Department clinics 1,193 156 1,037 1,231 132 1,099 -3.1 +18.2 -5.6 Selective Service 624 110 508 171 20 142 +264.9 +300.0 +257.7 Other 184 58 126 226 . 52 174 -18.0 i-11.8 -27.6

Tuberculosis The first year of the war showed a drop in the death rate for tuberculosis from 93.7 per 100,000 population in 1941 to 86.5 in 1942. The decrease was primarily in the rate for the colored population. The actual rates for the two years by race were as follows: White population, 49.6 in 1942 as compared with 50.9 for 1941; and colored population, 240.1 in 1942 as contrasted with 271.4 in 1941. Diphtheria and Certain Other Communicable Diseases There were 74 cases of diphtheria reported in 1942 as compared with 47 during 1941. The new war worker families in the city doubtless contributed to this increase. Next to syphilis, the disease of highest frequency in 1942 was measles. The usual periodic outbreak of this disease which started in 1941 continued during the spring months of 1942. There were 6,445 cases reported in 1942 as against 4,558 in 1941. Only 1 death occurred in 1942 in contrast to 3 during the preceding year. Scarlet fever, whooping cough and chickenpox continued with about the same frequency as during 1941. The number of reported cases of these diseases for 1942 were: Scarlet fever, 826 cases; whooping cough, 2,174 cases; and chickenpox, 3,007 cases. The figures for 1941 were 857; 2,560 and 3,045 respectively. REPORT OF THE COMMISSIONER OF HEALTH 13

There were only 3 cases of infantile paralysis reported in 1942 as compared with 101 cases in 1941. There was no case of smallpox in Baltimore during 1942. There were 31 cases of typhoid fever in 1942 or 4 less than the number reported in the previous year. Only 1 resident death occurred in 1942. The number of cases of dysentery also dropped from 148 in 1941 to 109 in 1942. The number of cases of diarrhea and enteritis in children under two years of age decreased from 193 cases in 1941 to 142 in 1942. A considerable portion of the low infant mortality recorded for 1942 was due to the decrease in resident deaths of colored babies under 1 year of age from diarrhea and enteritis. There were only. 35 of these deaths in 1942 as compared with 71 in 1941.

Principal Causes of Death "Heart Disease" in 1942 as in earlier years continued to be the leading cause of death for all segments of the population as shown in the accompanying table. The death rate for all forms of cancer decreased from 158.0 per 100,000 population in 1941 to 134.3 in 1942. The rates by color for the two years for the seven leading causes of death are given in the table.

RESIDENT DEATH RATES PER 100,000 POPULATION FOR THE SEVEN LEADING CAUSES OF DEATH; TOTAL, WHITE AND COLORED POPULATION; BALTIMORE 1941-1942

TOTAL POPULATION WHITE POPULATION COLORED POPULATION

Death Death Death Rate per Rate per Rate per CAUSE 100,000 CAUSE 100,000 CAUSE 100,000 1942 1941 1942 1941 1942 1941 -,---- Diseases of heart 379.9 388.7 Diseases of heart 390.5 397.3 Diseases of heart 335.9 353.0 Dancer, all forms 134.3 158.0 Cancer, all forme 142.0 160.5 Tuberculosis, all forms.240.1 271.4 Nephritis 106.7 118.1 Nephritis 91.7 103.2 Nephritis 169.1 180.4 perebral hemorrhage.... 88.0 88.6 Cerebral hemorrhage... 77.7 79.1 Pneumonia 150.9 151.8 Tuberculosis, all forms.. 86.5 93.7 Accidental causes 67.0 67.2 Cerebral hemorrhage... 131.1 128.0 ?neumonia 75.5 72.4 Pneumonia 57.4 53.3 Cancer 102.4 122.6 kocidental causes 68.8 67.3 Tuberculosis, all forms. 40.6 50.9 Accidental causes 76.5 67.9

Among accidental deaths in 1942 there was a decrease over earlier years in those due to automobiles, but increases among home and occupational accident deaths, many of which were doubtless preventable and due to carelessness. At the close of the report will be found certain selected tables that contain other important data on the vital statistics of the city for 1942. INALTIMORE CITY H BALTIMORE CONQUE \ TOTAL DEATH RATE.

1510 1820 1830 1840 1850 1860 1870 45 IFIT HI 1 1 1 1 1 V firirri urn via 1819 z 4o YELLOW FEVER 350 DEATHS 1832 1822 1 CHOLERA 35 MALARIA 853 DEATHS 370DEAT 1872 G. 1854 SMALL am 30 DIARRHEA 4. 1043 DI DYSENTERY* TYPHOID FEVE 1207 DEATHS o25 187 cc SCARLET UI z FEVER . 20 a 425 DEATHS ui a- '1 1 5 a- ta I 0

ict 5 0 1810 1820 1830 1840 1850 1860 1870 It CENSUS 62,738 80,425 102,313 169,054 212,418 267,354 3)1 POPULATION

( 14 1 LTH DEPARTMENT ES 1T5 PE5TILENCES E FA 11000 POPULATION

18L1890 1900 1910 1920 1930 1940 1950 Ti r wuTriTriTTrIII -iiI till T11Fl ifl i-i-i1F11 j iii 11111 45

35 V2 X

XLL POPULATfON 5 ogHS 30 1883 1918 INFLUENZA •174I DEATHS SMALLPDX ESS DEATHS 1,000 DIPHTHERIA`79 DEATHS PNEUMONIA-3149 DEATHS 2 5 is 20 PER

RATE.

10 DEATH

TOTAL itilitill ItIlitiii 010 1890 1900 1910 1920 1930 1940 1950 3013 434,439 508,957 558,485 733,82G 804,874 .859,100

„1"4"."..Mormow,■••■•••■■■■•■••■■•••■■•■■••• 10 REPORT OF THE HEALTH DEPARTMENT-1942

Administration There follows a financial statement for the Health Department for the fiscal year ended December 31, 1942. FINANCIAL STATEMENT As of December 31, 1942 Total City Appropriations $956,377.28 Total City Expenditures. 952,710.86 Appropriations by Ordinance of Estimates January 1,1942 $851,610.40 Appropriations for Transportation 25,467.14 Supplementary Appropriations for Sydenham Hospital, Health Districts, Clinics and Special Projects 79,299.74 $956,377.28 Expenditures of the Baltimore City Health Department* ADMINISTRATIVE SECTION Administration $ 28,345.47 Vital Statistics 31,243.59 Health Information 6,676.15 Laboratories 76,953.12 Eastern Health District 4,436.48 Western Health District 7,795.47 Druid Health Center 17,716.04 Southeastern Health District 7,714.40 $180,880.72 •Additional Non-Health Department Health Expenditures In connection with Baltimore's participation in the inter-city health contest of the Chamber of Commerce of the United States, certain tabulations were made of expenditures for health work in Baltimore in 1942 which were closely related to the work of the City Health Department, as follows: I OFFICIAL EXPENDITURES City Department of Education—high school medical service. $ 51,000.00 City Department of Welfare—city tuberculosis hospital... 100,174.75 State Tuberculosis Hospitals—Baltimore City cases 345,715.51 State Health Department—city venereal disease control 4,000.001' Federal Social Security funds 19,005.94 Federal WPA funds 25,000.00I 551,550.20I II NONOFFICIAL EXPENDITURES Babies Milk Fund Association $ 54,022.00 Eudowood Tuberculosis Hospital—city cases 106,725.22 Instructive Visiting Nurse Association 76,920.21 Johns Hopkins University—Eastern Health District 25,000.00 Laboratory services—hospital or private 50,000 .001' Maryland Society for the Prevention of Blindness 7,188.00 Maryland Tuberculosis Association—X-ray 8,000.001' Mount Pleasant Tuberculosis Hospital—city cases 65,436.01 Pasteurization plants—farm and laboratory control 30,600.001 Venereal disease control—hospital dispensaries 00,000. 0 01' $ 513,801.40

GRAND TOTAL $1,065,447.60 This $1,095,447.64 added to the City Health Department expenditures of $052,710.86 gives a grand total of $2,018,158.50. t Approximate figure. REPORT OF THE COMMISSIONER OF HEALTH 17

MEDICAL SECTION Communicable Diseases 16,408.28 Tuberculosis 14,931.59 Venereal Diseases 67,775.55 Occupational Diseases 5,500.77 Child Hygiene 31,218.09 School Hygiene. 11,773.13 Public Health Nursing 229,607.75 Medical Section Properties 483.39

377,698.55

SANITARY SECTION Supervision 10,590.48 Milk Control 37,871.24 Food Control. 17,115.65 Environmental Hygiene 57,706.17 Meat Inspection 52,299.91 Rat Control 2,021.45

177,604.90

Morgue and Public Cemetery 10,733.67 Sydenham Hospital 205,793.02

Total, Salaries and Expenses $952,710.86 Receipts Vital Statistics $ 35,978.01 Child Hygiene 337.00 Milk Control 11,234.00 Plumbing Permits 14,826.50 Rooming House Licenses 479.00 Meat Inspection 22,500.00 Miscellaneous License Fees 203.75 Sydenham Hospital. 4,555.53

Total $ 00,113.79 Personnel On War Duty Dr. Maurice C. Pincoffs, Consultant to the City Health Department, left with the University of Maryland Unit for active war duty and is in the Pacific area with the U. S. Army Medical Corps. In addition, there were thirty-three Health Department representatives on active war duty overseas or in this country, at the close of 1942, as follows: Bureau Of Vital Statistics Langdon B. Backus William G. Helfrich, M.D. 18 REPORT OF THE HEALTH DEPARTMENT-1942 Bureau Of Laboratories Guy C. Albaugh Henry 0. Schulze Robert S. Shaull Eastern, Western and Southeastern Health Districts Henry F. Buettner, M.D. Charlotte Miller, R.N. Irene Gladden, R.N. Winifred E. Miller, R.N. Elizabeth Guild Edwina C. Ozazewski, R.N. Ruby Jean Hays, R.N. Sarah E. Patterson, R.N. Bureau Of Communicable Diseases J. W. Ashworth, M.D. William A. Sinton, M.D. Sydenham Hospital Edna Ballard, R.N. Salvatore Giordano James Bryant Katherine Schmidt, R.N. Rebecca L. Schmidt, R.N. Bureau Of Venereal Diseases

Eugene A. Briscoe Lawrence Katzenstein, M.D. Thomas E. Fernandis George C. McDonald, M.D. George C. Grant, Jr. Israel P. Meranski, M.D. Bureau Of Child Hygiene loseph M. Cordi, M D. Manes S. Hecht, M.D. William C. Stiller, M.D. Sanitary Section Charles M. Kenealy William Sallow George 0. Motry George W. Schucker Vital Statistics Demands made upon the Bureau of Vital Statistics during 1942 brought into clear focus the double function performed by the bureau. As cus- todian of birth records for persons born in Baltimore, the bureau seeks to provide the individual with a document that furnishes identification of age, relationship and American birth. The bureau serves also as the statistical division for the health department and maintains an active interest in the collection and analysis of statistics dealing with the.population of the city. During 1942 the volume of work in issuing transcripts of birth certificates, making additions and corrections to birth records on file and placing de-

6 REPORT OF THE COMMISSIONER OF HEALTH 19 layed certificates of birth on file continued to increase. - There were issued during the year 52,572 copies of birth certificates as compared with 18,392 copies issued in 1941 and 11,028 issued in 1940. A total of 18,930 transcripts of death certificates was also issued in 1942 as compared with 17,311 during the preceding year. Delayed certificates of birth registration were placed on file for persons whose birth certificates were not recorded at the time of birth, provided the applicant submitted adequate evidence as required by State regulations, to establish that the birth occurred in Baltimore City. In 1942 there were filed 3,613 such delayed records as compared with 1,120 in 1941. The pressure of these demands for proof of age and citizenship created a major problem of reorganization in the bureau personnel and procedures. With the retirement of Howard A. Moore, Principal Clerk, on May 31 the bureau lost the services of its oldest employee. Of his 37 years of service he had been in charge of the entire statistical work of the bureau except for the last 8 years. With his retirement this position was abolished and that of an administrative assistant was created in its place. The new position was filled by Isadore Seeman under whose guidance a systematic program of reorganization of clerical procedures was begun. The bureau also lost through death the services of Robert R. Krauter, who for many years had served as chief burial permit clerk and who was largely responsible for the splendid cooperation that exists between the city's funeral directors and its Health Department. The nation-wide demand for vital records as proof of United States citizenship produced confusion in many vital statistics offices. In this connection during the months of July, August and September, the bureau director served as consultant to the U. S. Bureau of the Census with the approval of the Mayor. Under this arrangement the director assisted in the preparation of the Report of the Commission on Vital Records of the Federal Security Agency. The report dealt with the need for the establishment of a single Federal agency to coordinate the vital records of the country as well as its vital statistics. Records of current births filed during 1942 reached an all-time high. There were filed 24,366 such records of which 4,646 were for births to non- resident mothers. In 1941 there were filed 19,406 records of current births of which 3,600 represented births to non-Baltimoreans. In recent years the value of the birth certificate to the individual has been proven beyond question. With this fact in mind, every effort is being made to insure completeness of birth registration and the filing of full and accurate records. The Birth Registration Test conducted by the U. S. Bureau of the Census in connection with the 1940 Federal Census indicated that 97.7 per cent of the births occurring in Baltimore were reported. 20 REPORT OF THE HEALTH DEPARTMENT-1942

The bureau continued in 1942 to make weekly and monthly tabulations of natality, mortality and morbidity records and similar tables for the ANNUAL REPORT of the City Health Department, and to provide statistical services to the other bureaus in the department. Data on the population of Baltimore compiled by the bureau were furnished for use by the health department and other official and nonofficial agencies. The Low Rent Housing Survey of 1941 in which the bureau director collaborated with the Housing Authority of Baltimore City was published in 1942. The bureau director also assisted Dr. Lowell J. Reed and Dr. George F. Badger of the Johns Hopkins School of Hygiene and Public Health in a study entitled "General Characteristics of the Population of the Eastern Health District" which was submitted on July 3 for publication in the American Journal of Hygiene. • Health Information Literature racks were of great value in the distribution of the Depart- ment's printed pamphlets on the communicable, venereal and occupational diseases and on other subjects. In 1942 new racks were placed in the administrative offices of the Douglass Housing Project, the McCulloh Homes and in the Health Department's child hygiene clinics located in Public Schools No. 208 and No. 225. Other health information activities in 1942 included the following: 1. A health drama was broadcast each Saturday evening during the year in the "Keeping Well" radio series sponsored since 1932 by the Baltimore City Health Department and the Medical and Chirurgical Faculty of Maryland. Subjects were selected and scripts were adapted to meet the health needs of a large industrial city crowded with wartime newcomers. ' Emphasis was placed on the need for preventive measures against diphtheria, smallpox, meningococcus meningitis and tuberculosis. In July when rabid dogs made their appearance near Balti- more, radio spot announcements were prepared and the five radio stations located in the city broadcast the warning "spots" at intervals during each day for a period of two weeks. The radio stations also cooperated in the Health Department rat control program and broadcast special spot announcements on this difficult problem. 2. For the nineteenth consecutive year Baltimore Health News was issued monthly. In 1942 its pages clearly reflected the trend and importance of public health activities in times of war. Ten thousand five hundred copies were mailed or distributed

• REPORT OF THE COMMISSIONER OF HEALTH 21

each month to physicians and other persons engaged or interested in public health. The monthly issues for the years 1940-1941 were indexed, bound and distributed to librarians and other interested persons. 3. The local press gave the Department extraordinary support in the publication of news articles concerning urgent and vital health matters. "The Saturday Letter to the Mayor", released each week by the Commissioner of Health, was the basis for many news items. The Baltimore Transit Company used the "Saturday Letter" of October 17, which contained a warning about the possible spread of disease that might result from smoking in crowded vehicles and reproduced the letter in facsimile in 150,000 leaflets which were placed in the "take one" racks on all streetcars and busses. The transit company also used the following quotation from the same letter on "Do Not Smoke" posters which they placed in all of their public conveyances: The Commissioner of Health says: "When people near you on cars and busses have colds, your smoking may make them sneeze or cough, probably exposing you to germs." 4. The bureau edited twelve articles written by Department bureau directors and provided photographs for a special health section of the Baltimore News Post published on May 20 in connection with Child Health Day. News releases were prepared each month for two local church journals and two neighborhood newspapers. 5. The ANNUAL REPORT for 1941 was edited and prepared for printing. The Health Department staff wrote a number of articles which appeared in scientific and professional journals. Reprints of eight of the articles were mailed to the practicing physicians in the city. The bureau assisted the Sanitary Section in the printing of the City Housing Code and indexed the City Milk Code issued by the Bureau of Milk Control. 6. Bureau directors participated in the program of presenting health informational talks to the lay public. There were 1,045 talks and health addresses given in schools and to civic, church and similar groups. Talks on the subject of the Com- missioner of Health's trip to England in 1941 as Consultant to the U. S. Office of Civilian Defense and on the Emergency Medical Services there, and on housing, food and rat control were most frequently requested by the lay public. Seminars and field demonstrations were given for professional groups in 1942 as in years past. 22 REPORT OF THE HEALTH DEPARTMENT-1942

7. The Baltimore Adult Activities Council organized in 1940 for the coordination of all agencies in the city engaged in adult education work held a series of seminars on radio techniques. The third seminar was devoted to the study of the use of the drama for radio broadcasting. Mr. Bert Hanauer of Sta- tion WFBR was the speaker and to illustrate drama technique he used "Dr. Ashley's City", one of the Department's broadcasts in the "Keeping Well" radio drama series. • 8. The Sanitary Milk Production Contest was conducted by the Bureau of Milk Control for the eleventh consecutive year. A ten year review of the contest appeared in the August issue of Baltimore Health News and its value as an educational measure was aptly summed up in the closing line of the article as follows: "Many of the high school pupils who have participated in the contests are now milk producers on the Baltimore milkshed and have found the contest training of high school days to be of value in their occupation." 9. Assistance was given to bureaus of the Department and other agencies in the special observance of Syphilis Control Day, Na- tional Negro Health Week, Child Health Day, National Hear- ing Week and the 36th Annual Tuberculosis Seal Sale.

Exhibits Through the use of the silk screen printing process, the Health Depart- ment was able to increase its poster output. Through the cooperation of the Maryland Work Projects Administration Art Project, 3,200 copies of a new poster "Take No Chances Syphilis and Gonorrhea Can Be Cured" were made for the Bureau of Venereal Diseases. The Health Department purchased the inexpensive initial equipment for silk screen printing whereby reproductions could be made in various sizes and quantities and in a number of colors at a tremendous saving of time and money. Sixteen local exhibits were prepared, one each for the observance of National Negro Health Week, the science department of Western High School, and the annual Flower Show of the Cooperative Women's Civic League, nine at the Druid Health Center and four at the Health Depart- ment's chest clinic at 1516 Madison Avenue. Three posters preparatory to silk screen printing were designed on: "Prevent Trichinosis", "Give Yourself a Birthday Gift" (annual physical examination) and "Dr. Ashley to You"("Keeping Well" radio drama series). Four permanent exhibits, "Nutrition Needs", "Prevent Congenital Syphilis", "Keep Them Well" and "The Care of Children a Part of National Defense" were built. REPORT OF THE COMMISSIONER OF HEALTH 23

Laboratories As a result of the enlistment of laboratory bureau staff members in the armed forces and the employment of some of its workers in war industries an acute shortage of personnel developed in 1942. A total of twenty- eight resignations took effect during the year; twenty-six were from the technical staff and two from the clerical office. Four members entered the armed forces, two were married, two left because their husbands were transferred to other cities, fourteen accepted positions elsewhere, in most instances for higher salaries, and six left because of ill health or to return to college. This unusual wartime turnover in personnel had a marked influence on the operation of the bureau and towards the end of the year it became necessary to curtail some of the laboratory services. In the food laboratory a reduction was made in the number of platings of samples of milk and dairy products and tests for coliform bacteria were restricted to pasteurized milk samples. Previously these tests had also been made on pasteurized cream and pasteurized chocolate milk. These curtailments, while not desirable, were necessary and in order to make certain of adequate control of pasteurization procedures in the milk plants, beginning in October, additional samples were submitted for the phosphatase test. Besides these curtailments certain other procedures also had to be eliminated, as follows: STS—serologic tests for syphilis—on specimens of blood from U.S. Army and Navy recruits were discontinued October 26, when Selective Service STS work for Baltimore City was transferred to the State Depart- ment of Health; the routine examination of specimens of feces from food handlers, excepting employees handling selected raw milk; the use of tellurite culturing procedures in the laboratory diagnosis of diphtheria, tests for the diagnosis of whooping cough, streptococcus grouping procedures, agglutination tests for Weirs disease, heterophile antigen-antibody reactions for infectious mononucleosis, and culturing of the gonococci. There was a total of 153,877 specimens of blood or spinal fluid examined in STS work during 1942. This was an increase of 47,662 or 44.9 per cent over the total number of STS done in 1941. Out of this total number of Specimens, 153,368 were blood and 509 were spinal fluid. There were 51,123 specimens submitted by the examiners for the U. S. armed services, an increase of 22,330 or 77.6 per cent over the number submitted in 1941. This total of 51,123 specimens represents 40,838 individual Selective Service registrants of whom 29,535 or 72.3 per cent were white and 11,303 or 27.7 per cent were nonwhite. Of the total individual registrants tested, 4,257 or 10.4 per cent gave positive STS. Of the white individuals tested, 1,125 or 3.8 per cent were positive, while 3,132 or 27.7 per cent of the nonwhite persons tested were positive. 24 REPORT OF THE HEALTH DEPARTMENT-1942

The aggregate of 153,877 specimens submitted for STS was made up of specimens submitted from the following sources: 32,522 or 21.1 per cent from 633 different practicing physicians; 51,123 or 33.2 per cent from U. S. Army and Navy registrants; 48,098 or 31.3 per cent from employees of industrial or commercial plants, public utility corporations, and other agency groups; 15,551 or 10.1 per cent from the Health Department venereal disease clinics; and 6,583 or 4.3 per cent from hospitals. In spite of the curtailment of activities and the elimination of certain procedures toward the close of the year, the record shows that all bureau activities combined involved an all-time high record of 282,835 examinations of 191,178 specimens and samples. The increase, over 1941, in the work volume represents 4.1 per cent in examinations and 28.4 per cent in specimens and cultures, and was due chiefly to the increase in specimens for STS. Certain interesting results were obtained in connection with the routine activities of the bureau. Cooperation was given the Bureau of Com- municable Diseases in the discovery of seven typhoid carriers. The Division of Chemistry examined 223 specimens of blood as an aid in the diagnosis of lead poisoning. These specimens were submitted from 211 individuals of whom 142 were adults and 69 children. Concentrations of lead indicative of abnormal absorption were found in specimens from 27 adults and 14 children. Five of the children died, presumably of lead poisoning. This service and the chemical work involved in the examination of 147 samples of air, fumes, dusts or industrial solvents represented activities conducted either for the Bureau of Occupational Diseases or the Division of Industrial Hygiene. Another investigation involved an outbreak of gastro-intestinal dis- turbance among persons in a large downtown establishment. A total of 127 samples of water, 2 samples of ice, 1 specimen of urine and 2 specimens of feces were examined. The results of the laboratory work aided considerably in the Health Department investigation of the outbreak that was believed to have resulted from a temporary cross connection in the plumbing of the establishment. A laboratory service which was extended during 1942 involved the application of methods for the detection of filth including rodent excreta, rodent hairs and insect fragments in food products. Examinations were made of more than 360 samples obtained from over 70 local food establishments. More than 50 per cent of the samples were found to contain such filth. This type of service has become quite important and laboratory findings in many instances resulted in the detention and condemnation of contaminated food by the Bureau of Food Control. Among the samples submitted were candy, pickles, mayonnaise, baked products, dried fruit, cereal foods, noodles, sugar and flour. REPORT OF THE COMMISSIONER OF HEALTH 25

Two papers were completed as a result of investigation and research begun in 1941 and continued in 1942. These publications by T. C. Buck, Jr. and Emanuel Kaplan dealt respectively with the phosphatase test and blood lead. Other studies included: The effect and value of using paper towels for washing and chlorinating the udders of cows before milking in order to reduce bacterial counts, and laboratory work which lead to the development of an efficient and compact testing outfit to be used by inspectors of the Bureau of Food Control for the detection of cadmium- plated food utensils. There was an increase in the number of biologic products distributed during the year. The increases over 1941 included 912,000 units of diphtheria antitoxin, 10,390,000 units of pneumonia serum, 3,139,000 skin test doses of scarlet fever toxin, 2,924 tubes of smallpox vaccine, 359,000 units of tetanus antitoxin, 2,888 cubic centimeters of typhoid vaccine, 1,116 cubic centimeters of typhoid-paratyphoid vaccine, and 1,726 cubic ' centimeters of alum precipitated toxoid for the prevention of diphtheria. Eastern Health District An adjustment of major importance took place in the Eastern Health District on January 1 when certain clinic activities of the Babies Milk Fund Association located within the Eastern Health District were transferred to the City Health Department. This constituted the second in a series of ten annual steps as a result of which, at the end of the period, all Babies Milk Fund Association well baby clinic work will be conducted by the Health Department. According to present plans, the third and fourth transfers will also take place in the Eastern Health District. This will complete the transfer in the district. The areas affected by the change at the start of 1942 were Census Tract 1 of Ward 10 and Census Tracts 4 and 5 of Ward 6, all of which are contiguous to areas already served by the Health Department for child hygiene work. Four well baby clinic sessions per week were involved. Two additional clinic physicians and two new Public health nurses were added to the City Health Department staff in the Eastern Health District in order to provide for the increased service. The new type of school hygiene program which was developed in the Eastern Health District completed its first trial school year in June in Public School No. 27, at Fayette and Chester Streets. The general purpose of the plan was to increase the effectiveness of the school health work by bringing the health officer, the public health nurse, the teacher, the parent and the family physician into closer relationship in reference to the health of the child. Physical examinations, when done, are more complete. The Plan worked most successfully in 1942 and the results were approved by the school authorities and the parents. When schools opened in the fall 26 REPORT OF THE HEALTH DEPARTMENT-1942

of 1942 the new program was extended to Public School No.97A, at Central Avenue and Lexington Street, in the Eastern Health District, and was also inaugurated in selected public schools in the other Health District areas. In November a photoroentgen apparatus was installed in the Eastern Health District screening chest clinic as a gift of the Maryland Tuberculosis Association to the Johns Hopkins School of Hygiene and Public Health. Plans were made to hold regular screening clinics for the preliminary X-raying of special groups and family contacts of tuberculosis cases. These clinics will be conducted as a part of the work of the Health Depart- ment Bureau of Tuberculosis and will make inexpensive X-rays easily available to large groups. This will increase the case-finding facilities and at the same time lighten the work-load of other City Health Department chest clinics. The Eastern Health District completed its first ten years of service on September 1. Western Health District Affiliate instruction in public health nursing was given by the district staff to twenty-four student nurses from the University Hospital and to one graduate nurse. A course of instruction in communicable diseases for the undergraduate nurses of this hospital was also given by the District Health Officer. Seven hundred and forty-three Health Department pamphlets on public health topics were distributed from the pamphlet rack in the district office. There was also a total of 2,837 packages of biological products and 11,266 laboratory diagnostic outfits distributed to physicians from the health district office during the year. The new type of school health service tried in the Eastern Health Dis- trict a year earlier was first introduced in Public School No.34 at Washing- ton Boulevard and Carey Street, in September, 1942. The District Health Officer outlined the program to the faculty at the beginning of the school term. It was pointed out to the parents that it would be desirable to have the child examined by the family doctor in order to determine the status of the child's health and to assure remedial measures if necessary. The teachers were brought into the program by conferences with the school nurse in regard to the health of their respective classes. Of the 49 new pupils in Public School No. 34, 35 or 71 per cent were examined by their family physicians. This was a worthwhile achievement because of the health educational value and because the family physician was brought more closely into the public health program. The teachers, the principal, the parents, and the children were made conscious of health teaching to an extent greater than under the old system of routine school health service. REPORT OF THE COMMISSIONER OF HEALTH 27

Efforts to get in personal touch with new residents of the district who came to Baltimore to work in war industry plants were continued during the year. These families were provided with health service where needed. Druid Health Center In the December, 1940 issue of Baltimore Health News there appeared Dr. Allen W. Freeman's article entitled "Survey of the Facilities for the Prevention of Tuberculosis in Baltimore". Included in this survey was the recommendation that a chest clinic be established-at the Druid Health Center. Accordingly, on December 1, 1942, the new clinic staffed by all- Negro personnel, was inaugurated on the fifth floor of the Center at 1313 Druid Hill Avenue. In addition to routine clinic examinations, plans were made to conduct large scale case-finding procedures for the control of tuberculosis. During the first six months of 1942 the attendance at all the clinics located at the Druid Health Center continued to increase, but during the second half of the year clinic attendance dropped considerably, probably because of improved economic conditions. From January to June inclusive, the number of clinic visits was 40,168 while from July to Decem- ber inclusive, it was 36,868. A total of 18,532 laboratory outfits and 1,652 Packages of biologicals were distributed to physicians from the Druid Health Center. During the year the Monumental City Medical Society for Negro physicians continued to meet each month in the assembly room at the Druid Health Center. Many lay organizations also used the facilities of the building for meetings. The National Negro Health Movement again made the Center its headquarters. Probably one of the greatest contributions of the Druid Health Center is the dissemination of health information to the lay public in the area and the cooperation with schools, clubs and churches. As part of this effort there were 6,647 Health Department Pamphlets taken by the public from the several pamphlet racks in the Health Center building. Southeastern Health District The existing cordial relationship with the medical profession of the Southeastern Health District was further enhanced when on March 15 the district building was used as a meeting place for the newly organized East Baltimore Medical Society, composed of physicians practicing in the eastern half of the city. The society held monthly meetings and the District Health Officer attended each meeting in the capacity of host. As a result of the Baltimore Housing Authority and City Health Depart- ment collaboration, a new well baby clinic with two weekly sessions was Opened on May 6 in the Clarence Perkins Homes, a housing project for 28 REPORT OF THE HEALTH DEPARTMENT-1942 shipyard War workers, at 1411 Gough Street. Plans were also completed to open a similar clinic in the community building at the Armistead Gardens Housing Project at Philadelphia Avenue and Homer's Lane, in 1943. A nursery school under Work Projects Administration auspices, in operation since April 13, 1942, received preventive health services through the district medical and nursing staffs. A weekly diphtheria prevention and smallpox vaccination clinic had been in operation there since September 5, 1941. The new type of school hygiene program which had been conducted in the Eastern Health District since 1941 was inaugurated in the Southeastern Health District at the beginning of the school term in September in Public School No. 47 at Fleet Street and Linwood Avenue. The program was thus extended by the Commissioner of Health to determine its value and practicability for other schools in the Health District areas. Expectant mothers registered in the district prenatal clinic in 1942 continued to receive group instruction in the mothercraft class. Forty-nine classes were conducted with a total attendance of 631 mothers. Twelve undergraduate students from the Union Memorial Hospital completed a program of field work in the district during the year. Communicable Diseases A total of 34,642 cases of communicable diseases was reported in 1942 as compared with 36,556 cases during 1941. Meningococcus Meningitis There were 202 cases and 31 deaths of meningococcus meningitis recorded during 1942 as compared with 72 cases and 11 deaths for 1941. This was the largest number of cases of the disease reported in Baltimore in any one year since 1936. A large majority of the cases lived in the crowded sections of the city, that is within one and one-half miles of the center of Baltimore. In any individual household it is difficult to develop a good guide as regards overcrowding but using the ratio of 1.5 persons to each habitable room as a maximum allowance it was found that in 26 cases out of the 202 cases reported, or 12.9 per cent, there was evidence of overcrowding. It is interesting to compare this information with the 1940 U. S. Census data which showed that there was overcrowding in 3.4 per cent of the households of Baltimore. It was also found that 23.0 per cent of the cases of meningococcus meningitis were in patients who had lived in Baltimore for less than three years, and most of them had for less than one year. Forty-three of the patients or 21.4 per cent were employed in war industries. In addition, there were 28 instances or 13.9 per cent where a member of the household worked in a war industry. There was no evidence REPORT OF THE COMMISSIONER OF HEALTH 29

of crowding at places of employment, in fact, many of the patients worked out of doors. However, there was definite crowding at theaters, amuse- ment centers and on public conveyances which carried people to and from work. A larger number of adults were stricken with meningitis during the 1942 outbreak than in 1936. During 1942, 132 or 65.7 per cent of the patients were over 15 years of age whereas in 1936 only 51.9 per cent of the cases occurred in individuals over 15 years old.

DAVID II. ANDREW, M.D., C.P.I. Director of the Bureau of Communicable Diseases Since June 28, 1937

Diphtheria There were 74 cases and 2 resident deaths of diphtheria reported in Baltimore during 1942 as compared with 47 cases and 3 such deaths in 1941. The first death occurred in a man forty years old who had only been in Baltimore a short time and was employed in a war industry. The other death occurred in a four year old colored child. Neither of these individuals had any record of having received the preventive toxoid inoculation. Of the 74 cases 21 or 28.4 per cent were in families that had lived in Baltimore less than 3 years. The youngest child to develop the disease M'.-as only 27 days old. The policy of distributing the postcard form entitled "Parent's Register for Health Service" was continued in cooperation with the Division of Industrial Hygiene. As a result of this procedure, 10,136 postcards were received from new residents of Baltimore. Where there were young children in the families, the names and addresses were referred to the Bureau of Public Health Nursing for visits by the nurses. In the southernmost section of the city in close proximity to one of the larger war industries, two new defense housing projects were opened. During October the public health nurses made house-to-house visits in this area and diphtheria, prevention and smallpox vaccination clinics were held one day each week in the housing projects. As a result of these clinics, 203 children were given

1,141.0101.■ 30 GUARDING THE HEALTH OF BALTIMORE-1912 the preventive toxoid, all except 7 of whom were under five years of age; and 209 persons were vaccinated. Diphtheria toxoid was given to 18,582 children during the year as compared with 18,407 children in 1941 and 11,421 of the children were under one year of age as compared with 10,103 for the previous year. Private physicians reported the inoculation in their practice of 7,026 children as compared with 5,300 in 1941. The number of children recorded as having been inoculated against diphtheria by various agencies for the period 1938 through 1942 is shown by years in the following table:

DIPHTHERIA TOXOID INOCULATIONS RECORDED BALTIMORE, 1938-1942

AGENCY 1942 1941 1940 1939 1938

Physicians' Practice 7,026 5,300 3,975 4,000 2,774 Preschool Clinics 7,646 7,880 6,789 7,437 7,805 School Clinics 3,910 5,227 4,995 4,780 8,746

Total 18,582 18,407 15,759 16,217 19,325

It was estimated that 75.3 per cent of the child population in Baltimore under five years of age was inoculated against diphtheria at the end of 1942 as compared with 80.1 per cent at the close of 1941. In the group of children from five to nine years of age, the estimated percentage inoculated was 89.1 as compared with 94.6 per cent at the end of 1941. This is the first time on record that there has been a decline in these yearly percentage estimates and the decrease is perhaps due to the rapid rise in the city birth rate and to the influx of new families to the city for war work.

Typhoid Fever and Typhoid Carriers

There were 31 cases and 1 death of typhoid fever reported during 1942 as compared with 35 cases and 3 deaths during 1941. Each case was investigated by the bureau director and all the known adult contacts, including the food handlers, in the household were examined for the typhoid carrier state. As a result of these investigations, 5 new carriers were found. In addition, 2 new carriers were unexpectedly discovered through Health Department laboratory examinations made for nonrelated purposes in patients in two of the hospitals in the city. Another new carrier was referred by an out-of-state health department when the carrier moved to Baltimore. Two carriers were removed from the Health Department list by death. In sum, 75 typhoid carriers remained under the supervision of the Department at the close of the year. REPORT OF THE COMMISSIONER OF HEALTH 31

Rabies A number of rabid dogs were found in Baltimore County during the Spring months. This was the first time since 1931 that any rabid animal had been discovered near the city and it was felt that the dogs had come With war-worker families from other states. None were found within the city limits but during the latter part of May, a stray rabid dog was discovered in close proximity to the northwestern city line. Therefore, a guar- antme against dogs running at large was instituted on June 11 in the northwestern section of Baltimore City and in the adjoining Baltimore County area. This quarantine was established by Dr. Mark Welsh, Veterinarian Of the State Board of Agriculture, pursuant to State statute and was continued for a three month period ending September 11. One Baltimore resident while visiting in Baltimore County was bitten by a dog found to be rabid. This person received the antimbic treatment and did not contract the disease. The situation seemed to be under control at the end of the Year.

Smallpox The procedure of vaccinating individuals applying for work in war industries was continued throughout the year. Prior to 1941, few adults were vaccinated in the office of the bureau director but in 1942, 1,990 persons were vaccinated there. For the fourteenth consecutive year, no case of smallpox occurred in Baltimore. The last case was reported on March 9, 1928. Sydenham Hospital There were only 3 cases of poliomyelitis with paralysis admitted to Syden- ham Hospital in 1942 as compared with 97 in 1941. All 3 cases were city residents and recovered so as to allow of transfer to orthopedic hospitals for Special care. With the aid of funds furnished by the Baltimore Chapter of the National Foundation for Infantile Paralysis, Miss Irene F. Shea, Superintendent of Nurses, was sent to the University of Minnesota to study the treatment for poliomyelitis advocated by Sister Elizabeth Kenny. Upon her return Miss Shea gave several demonstrations of Sister Kenny's methods. Out of 132 cases of meningococcus meningitis treated at Sydenham Hospital there were only 11 deaths, which is a case fatality rate of 8.3 per cent. This low rate is the result of the use of the sulfonamide drugs as none of these patients received any serum. The corresponding rate had been about 30 per cent in previous years when serum was used alone. Twenty-eight of the 132 cases were received from the counties of Maryland. 32 REPORT OF THE HEALTH DEPARTMENT-1942

Five infants or young children suffering from influenza bacillus meningitis were admitted to Sydenham Hospital during the year and 4 recovered completely while 1 died on admission before treatment could be started. Thus during the years 1941 and 1942 every case of influenza bacillus meningitis treated at Sydenham Hospital with specific rabbit serum and sulfadiazine recovered. This is in sharp contrast to all prior experience when practically every case of the disease died. Eight cases of pneumococcus meningitis were treated with one of the sulfonamide drugs and the intravenous administration of specific rabbit serum and 6 of these recovered. Since 1938, when sulfapyridine was introduced, 18 of 36 patients treated for this disease at Sydenham Hospital have recovered. Previously there was rarely a recovery. There were 65 cases of diphtheria admitted during 1942 with 2 resident deaths. The adult death was a person who was in the hospital for less than twenty-four hours. Three of the 65 cases were received from the counties of Maryland. On October 1, Sydenham Hospital began an affiliation with the Johns Hopkins Hospital Training School for Nurses for instruction in the communicable diseases. The nurses came to Sydenham Hospital in groups of six. An instructor, Mrs. Gwendolyn Betz, was in charge and worked in cooperation with Miss Shea, Superintendent of Nurses at Sydenham Hospi- tal. This affiliation worked out to the mutual benefit and satisfaction of both institutions. There were 1,103 patients admitted to Sydenham Hospital during the year, which was a decrease of 259 as compared with 1941. Of the total, 136 cases came from the counties of Maryland and 5 from out of the State. There were 30 deaths from all diseases or a hospital death rate of 2.7 per cent as against 4.3 per cent for 1941. Deducting 17 deaths which occurred within twenty-four hours after admission, the hospital mortality rate was 1.1 per cent as compared with 2.7 per cent when calculated on a similar basis for 1941. The number of patient days decreased from 20,321 in 1941 to 16,840 in 1942. Diseases treated other than those mentioned above included bronchopneumonia, encephalitis, erysipelas, gonococcal ophthalmia, laryngotracheobronchitis, measles, mumps, Rocky Mountain spotted fever (all 4 cases from the counties), septic sore throat, scarlet fever, virus pneumonia and whooping cough. Tuberculosis The most important event of 1942 in strengthening the program for tuberculosis control was the opening of the new chest clinic on December 1 on the remodeled fifth floor of the Druid Health Center. This clinic serves Negro patients living west of Charles Street and ;ts establishment REPORT OF THE COMMISSIONER OF HEALTH 33

leaves the clinic at 1516 Madison Avenue for white patients. The X-ray equipment at the new clinic was a gift to the Health Department from the Maryland Tuberculosis Association and represents the contributions of hundreds of persons to the Annual Tuberculosis Seal Sale. The new Druid Chest Clinic was served by a competent Negro staff of two experienced chest specialists and three public health nurses. The physicians, Dr. C. Dudley Lee and Dr. George G. Adams, are members of the State Sanator- ium staff at Henryton, Md. The Health Department chest clinics at 28 South Broadway and 1516 Madison Avenue were working to capacity throughout the year. In the interest of public service, night sessions at all three Health Department chest clinics were inaugurated on December 1 and these have proven very successful. During 1942 the bureau received 1,686 reports of new cases of tuberculosis that were considered to be clinically active. This figure is somewhat less than for previous years because a more careful scrutiny is being given to the reports received by the bureau director. Eight hundred and eighty-two cases were among white persons and 804 among Negroes. During the year there were recorded 810 deaths from tuberculosis among city residents, 374 White and 436 colored. The total resident death rate for all forms of tuberculosis for the city in 1942 was 86.5 per 100,000 population. The rate for the white race was 49.6 and for the colored 240.1. In 1942 tuberculosis death rates were lower than those for 1941. In 1941 the total rate was 93.7, the rate for the white race 50.9 and for the colored 271.4 per 100,000 population. The reductions for 1942 may be more apparent than real, however, for the influx of population to defense industries was rapid and the population estimates for 1942 were probably mom accurate than for the earlier year. The tuberculosis death rate of 49.6 for white residents in the 'City, while not encouraging when compared with that of other large cities, is the lowest Baltimore has ever achieved. The corresponding rate of 240.1 for Negroes IS distressingly high, and is more than five times greater than that for the white race. Some satisfaction can be taken in the decrease from the Negro rate for 1941, but on surveying the rates of the past decade it is clear that no steadily-held advantage has been gained by the colored population in the city in their fight against tuberculosis. In 1932 the Negro resident death rate from tuberculosis was 285.9 but it was as low as 204.6 in both 1938 and 1939. Adequate numbers of hospital beds for colored patients ill with tuberculosis had not been provided by the close of 1942. With improved diagnostic services and an opportunity to do case-finding on a large scale among the Negroes of the city, it is quite clear that a great public health effort 0114 41: 4001oad .`iitils;noll oq4 It! poplool og 04 o!u!lo osButlp palimoA .t0J kipotony .tiu!snoll X4!) iltul Jo pp: 0114 tr4!:\\ poloiduloo °Jim stivid .ttopmod000 .1!og4 ponit!woo ptru 1! loom! pal!nho! 1111.11HIIIMI p101 100110I.00,1- • "01;411)10 t0 I4l101(IA'S (0.111100 01 WIFI 011 I III 841010 Sq SI:A\ '040.10110 .101[1.110 .11:).1. 0If1 :7011.111( • 1109001 III 10 HO0.010;-; JoAoos!!) ol 4.t0JJ) ;II!! 111 tquos.10(1 polouJo! mopu)pi! 11:4ills011 J0(10(1 Otp 4!s!A s.torpt`ripsontt! luougamlou tr4roll um!!! 04 40(l)o ootom(110 p.i!quioll oql 1(4!Ak opuul osp? atom s4uoula1Iiwy •uo!l)oiti! JO soo.nyr,; palitoo pul! slomploo 0011.14 04 4.10110 un UI HvA\ i1jJ •suimaom mom;41101111.111d -og 11411:011 alp itig motAdow! .10J o.totupplu 04 opyoiv., 4.!0,4 tu0.1.1 limuogiod An:4mm j)0 )U Tiottp inTIT: Jo u0!4(1)pu 0114 S11,11 SW1.010010 0i011 10 ic1.11:0 UV 'IMAJOS 1111001.1 ollgtid .11 0114 pt.ru Allay •fl oup `luotu

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11.1.1 VI■li 4 II-IJ. ON RDI VII!) REPORT OF THE COMMISSIONER OF HEALTH 35 corner of Orleans Street and Central Avenue. While quarters in this building were not available in 1942, the opening of such a clinic should provide adequate quarters for the treatment of colored patients living in East Balti- more. The new clinic, added to the active clinic services at the Druid Health Center in West Baltimore, should make the treatment facilities of the City Health Department much more nearly what they should be. There were 11,293 cases of syphilis reported for the first time in 1942 as compared with 7,838 in 1941 and 6,213 in 1940. There were 3,388 cases of gonorrhea reported in 1942 as compared with 2,941 in 1941. During the year 3,480 new cases of syphilis were admitted to the City Health Department clinics as compared to 3,075 in 1941. Of these, 2,045 had not previously been treated by any clinic or private physician. There were 525 cases of primary and secondary syphilis admitted to the clinics as compared with 495 in 1941. While this represents an increase in the number of early infectious cases, the percentage of early cases among the total shows a decrease because of the great increase of latent cases of syphilis that were found by Selective Service examinations. The total number of clinic visits for 1942 was 120,924, approximately the same as the 121,822 for the previous year. However, there was an increase in 1942 in the number of treatments given for syphilis, 90,694, as compared with 86,472 in 1941. Treatment procedures for syphilis were essentially the same as in 1941, except that mapharsen was made the routine drug in two of the clinics located at the Druid Health Center. The clinics there have also benefited by the services of a volunteer worker, Dr. C. L. E. Monroe of Morgan College, who made special studies on gonococcal cultures. There was an increase in the epidemiological work because of contacts reported by the Army and Navy for investigation. These studies were more difficult than usual due to the large transient population in the city. Results of investigations, nevertheless, were essentially satisfactory in spite of the increased caseload of the social workers. The Police Department cooperated in an effort to locate suspected migrants or vagrants and to send them to the Health Department clinics for examination. Three thousand and two hundred copies of a new poster entitled "Take No Chances--Syphilis and Gonorrhea Can Be Cured" were published. Copies of the poster were placed in.many of the night clubs, cafes and taverns where young people are apt to congregate. Pamphlets on the venereal diseases were distributed and informative letters were written to patients. Occupational Diseases The study of two factories in which there were dangers of exposure to selenium was completed during the year and several studies on lead exposure 30 REPORT OF THE HEALTH DEPARTMENT-1942

and one on arsenic were undertaken. The use of substitutes, as necessitated by priorities, increased the number of cases of occupational dermatitis which required investigation. The occurrence of occupational deafness in Baltimore was studied and it was concluded that this ailment might well be added to the schedule of diseases in the Maryland Occupational Dis- eases Law. In 1942 there were 118 requests for information on occupational diseases and 55 of these were made by practicing physicians. A total of 57 cases of occupational diseases was officially reported to the Health Department. The great majority of the reported cases carried the diagnosis of occupational dermatitis. Considerable time and effort was expended in getting in touch with the executives of local industrial plants with respect to a program for blood typing that was inaugurated at the request of the Maryland Council of Defense. However, because of difficulties in obtaining laboratory personnel and supplies this program had to be abandoned. During the year two papers on lead poisoning were published by the bureau director in collaboration with Emanuel Kaplan, Chief of the Divi- sion of Chemistry. Both papers were based on the Health Department's experience with blood lead determinations. Ramazzini's dissertation on the rinderpest was translated and published in the Bulletin of the History of Medicine. The bureau director attended the Fifth Annual Meeting of the National Conference of Governmental Industrial Hygienists which was held in Washington, D. C. on April 9-10, 1942. He was also present at a four-day course on chemical warfare at Edgewood Arsenal. The regular course of demonstrations of industrial environment and didactic lectures on occupational diseases was again given to the senior students of the University of Maryland School of Medicine during the first semester in 1942. Because of the acceleration of the medical program the course was then temporarily discontinued. The bureau director gave five lectuxes on occupational diseases to the senior students of the Medical School of the Johns Hopkins University but the demonstrations of industrial environment had to be omitted because of the curtailment of traveling facilities. Demonstrations and brief discussions of the functions of the Bureau of Occupational Diseases were again provided for three small groups of students from the Johns Hopkins School of Hygiene and Public Health. The bureau director also attended and participated in a class in industrial hygiene for medical practitioners under the sponsorship of the School of Hygiene. An educational poster on lead poisoning in children was prepared and distributed in an effort to decrease the number of these cases. Over 700 copies of the publication "Occupational Disease Control, REPORT OF THE COMMISSIONER OF II EALTo 37

Industrial Health Series-- No. 1" were distributed to hospitals in the city for the use of interns. Child Hygiene The resident maternal and infant mortality rates in 1 942 were the lowest ever to be recorded in Baltimore. The resident maternal mortality rate was 1.7 per 1,000 live births and the infant mortality rate was 39.5 per 1,000 live births as compared with the corresponding rates of 2.3 and 49.6 recorded in 1941. There were 19,720 resident births reported, an increase over the previous year of 23.4 per cent. The percentage of births occurring in hospitals in Baltimore was 79.9 which figure is the same as that for 1941.

1010:0 • MIMIC 11114111411

WELL BABY CLINIC IS OPENED AT THE PERKINS 110MES

In accordance Nvith the provisions of the city ordinance controlling maternity hospitals, new regulations to govern the operation and conduct of these hospitals were adopted hy the Commissioner of I lealth on April 11 mid became effective on August .1. The Joint Committee on Maternal Mortality of the Baltimore City Health Department mid the City Medical Society continued to investigate each maternal death that was associated with childbearing. Cases were submitted for analysis and discussion at the monthly meetings of the Balti- more Physicians' Conference on Maternal Mortality \vhich were held at the Medical and ('hirurgical Faculty building on Cathedral Street. The infant and child hygiene clinic services were expanded into the eastern and southern sections of the city. On May 6 the City Housing Authority turned over for the use of the City I lealth Department quarters that had 38 GUARDING THE HEALTH OF BALTIMORE-1942

been specially built into the new Clarence Perkins Homes at 1411 Gough Street in order to provide a neighborhood well baby clinic. Two conferences were held there each week. In October similar clinics were opened in two more housing projects for shipyard war workers in South Baltimore. One with two sessions a week was inaugurated in the administration building of the Brooklyn Homes on October 26 and a similar clinic was opened October 28 at the Fairfield Housing Project. One new clinic physician and three new public health nurses joined the Health Department staff to carry on this added work. The plan to absorb one-tenth of the Babies Milk Fund Association activities annually was continued for the second year and on January 1 the Bureau of Child Hygiene took over the clinics located at 1927 East Monu- ment Street and at Valley and Eager Streets. Two clinic physicians and two public health nurses .were added to the Health Department personnel to complete the staff for these new clinics in the Eastern health District. At the end of the year the bureau operated infant and preschool hygiene clinics at twenty-nine locations and each week fifty-two conferences were being conducted. Return visits to the clinics were better spaced than formerly and efforts were made to encourage monthly visits by mothers and infants. There were 34,935 visits made to the clinics in 1942 as compared with 35,628 in 1941. The number of children on register at the close of the year was 14,906 as compared with 13,127 at the end of the previous De- cember. In an effort to prevent injury to eyesight the Health Department maintains a service for the care of infected eyes. The Western Health District, Druid Health Center and Southeastern Health District are responsible for the care of eye cases in their respective districts. The number of cases of sore eyes reported directly to the Bureau of Child Hygiene was 292 and of this number it was necessary to assign 185 cases for Health Department follow-up service. The other cases were referred to hospital clinics or to family physicians. In 1942 three hundred and seventy-four boarding homes for children were inspected by the bureau. TWO hundred and fifty-one of this number were licensed by the Commissioner of health. - Ninety-eight others exempt under law from Health Department license, were inspected for the De- partment of Public Welfare. The remaining 25 homes were refused licenses because they did not meet the Health Department requirements and were improper places for children. TWO thmsand, one hundred and eighteen visits were made by the assistant director of the bureau and by public health nurses in 1942 to these boarding homes. There was 1 death among the children living in homes licensed by the Commissioner of Health. This was a mongolian idiot. REPORT OF THE COMMISSIONER OF HEALTH 39

Six day nurseries were licensed in 1942. Many nursery schools have lengthened their hours to meet the needs of the working mothers. Forty- two of these schools were licensed during the year which was six more than in the previous year. One thousand and eighty children were enrolled in the licensed nursery schools in 1942. In November a meeting of the directors and representatives of the nursery schools was held in the office of the Commissioner of Health to discuss various health problems in relation to nursery schools. Upon request of the State Department of Public Welfare the Health Department inspected the child-caring institutions in Baltimore City. Reports of these inspections were sent to the State Department of Public Welfare through the Department of Public Welfare of Baltimore City, and to the superintendents of the institutions. School Hygiene In comparison with preceding years, 1942 was a satisfactory one in so far as the incidence of communicable diseases among children of elementary school age was concerned. The diphtheria record was extremely gratifying. While the total number of cases in all age groups in the city increased in 1942 over that of 1941, the prevalence of the disease among children between the ages of five to twelve was next to the lowest since the inauguration of the toxoid clinics in the schools in 1937. There were 26 cases of diphtheria reported among school children in 1942 as compared with 31 cases in 1941 and 23 cases in 1940. There were only 3 cases of diphtheria reported among the entire colored school population. It may be fair to assume that this gratifying result is due, in part, to the intensive campaign for toxoid administration carried on during the year among this group. Scarlet fever likewise showed a decrease over the preceding year with 457 cases reported in 1942 among children of school age as compared to 522 in 1941. This record is not as low as in 1940, when there were only 349 cases reported. Out of a total of 6,516 cases of measles reported in the city during the year 3,345 were among children of elementary school age. This outbreak was, on the whole, relatively mild and there was no death among school children. There were 78 cases of acute exanthema reported as Ger- man measles, but in view of the fact that there were 6,334 cases of this disease reported in 1941, it is quite probable that some of these cases were in reality mild cases of scarlet fever. There were no cases of poliomyelitis reported among school children in 1942. There were 18 cases of meningococcus meningitis reported, 10 in white schools and 8 in the colored schools With 2 deaths in the school age group. Monthly clinics were maintained in every public and parochial school for the purpose of immunizing both school and preschool children against 40 ItEPORT OF THE HEAI;TII bEPARTNiENT-104 diphtheria and smallpox. In 1942 there were 2,457 children Oi 8chdO1 ago and 1,453 children between the ages of one and fiVe years givdn ont dose alum precipitated tokoid at the school clinics. In 1941, 8,471 children ot school age and 1,756 ehildren Of preschool age were so protected. There were 2,223 children Vaccinated in the school clinics in 1942 of which 1,384 were of preschool age and 889 were 'of school age. While it is gratifying that the number of children applying for enrollment without the proper scar of vaccination becomes less almost every year, the year 1942 was an exception, owing to the large number of children of war workers who came to Baltimore from states which do not have the compulsory vaccination law that Maryland has had since 1864. The special study of the school health program made in Public School No. 27, based on a special demonstration study in the schools of Astoria in New York City, was extended to ten schools under the jurisdiction of the director and one school in each of the health districts with a full time health officer. The basic principles of this plan call for closer coordination between the work of the classroom teacher, the school nurse and physician by holding repeated conferences to discuss the health problems of the pupil, both as regards the physical findings of the physician and the daily observa- tions of the teacher. Parents are requested to be present at the time of the examination of their children so that the fundamentals of health as they apply to the latter can be explained directly. The family physician is brought into the picture if medical care is needed and the parent is encouraged to have the child examined by the family doctor. It is too early yet to give any evaluation of the new program other than to say that it has met with the widespread approval on the part of all concerned. The health officers made 41,423 health examinations during the year and 18,735 school children showed some form of defect. The commonest defects as usual were in teeth, tonsils, adenoids or in vision or nutrition. In the eye clinic maintained by the City Health Department a total of 1,740 school children was treated as compared with 2,000 in 1941. There were 14 children found to have defective vision of such a marked degree as to make them candidates for a sight saving class. In the school health service, hearing tests are conducted by a special group of trained observers with group audiometer recordings used as a basis for determining the hearing defects. Those presenting deafness of over 12 per cent are referred to the ear clinic maintained by the City Health De- partment. During 1942 there were 1,854 children treated in this clinic as compared with 1,799 in 1941. There were 457 new patients examined and of this number 81 were recommended for lip reading instruction and 16 for instruction in speech. The treatment of recurrent deafness with radium emanations was maintained and during 1942 there were 68 children given REPORT OF THE COMMISSIONER OF HEALTH 41

such treatment as compared with 75 in 1941. As heretofore, funds for the radium were furnished by the Baltimore League for the Hard of Hearing, to which due acknowledgement was made.

Dental Hygiene There were 3,965 children examined and treated for dental defects in the sixteen dental clinics located in the elementary schools by the four part time dentists (three white and one colored) and a part time supervisor. The majority of the pupils were treated for the relief of toothache, either by extraction, sedative treatment or fillings. Approximately 90 per cent of the children examined were found to need more extensive dental treatment and many of these children were referred to the Dental School of the Uni- versity of Maryland. The clinicians found very little time to give instruction in the care of the teeth but this was done whenever possible. The preschool dental clinic continued to function at the Dental School of the University of Maryland. This clinic cooperates with the Health De- partment infant and preschool hygiene clinic in the Western Health Dis- trict and children from eighteen months to school age are examined and treated by senior students under the supervision of a graduate dentist. In children of school age, the accomplishments for 1942, briefly summarized, were as follows:

Patients registered at clinics 3,965 Visits to clinics 5,035 Prophylactic treatments given 2,025 Teeth filled 1,088 Temporary teeth extracted 1 6,199 Permanent teeth extracted 1,855 Cases completed and discharged 3,405 Public Health Nursing An important advance was made in the Bureau of Public Health Nursing and a long recognized need was met by the appointment in August of an Educational Director. Miss Lilly Harman, formerly supervising nurse in the Eastern Health District, was selected under City Service Commission auspices and appointed to the new position. The educational program was expanded and should result in the growth and development of the nursing Personnel, in better working relationships with various bureau directors for whom certain phases of the field work is conducted, and in an improvement of the general services to the public. Approval was given by the Board of Estimates for the appointment of two Negro public health nurses for assignment to the new chest clinic established in the Druid Health Center. Three white nurses were appointed 42 REPORT OF THE HEALTH DEPARTMENT-1942

in October to newly created positions in order to meet the need for additional public health nurses in the new housing areas established in Brooklyn and Fairfield, and in the Perkins Homes in the Southeastern Health District. Two other new positions were also established and filled early in the year in connection with the transfer of Babies Milk Fund Association work to the City Health Department. Federal Social Security funds allocated to the State of Maryland again made it possible to offer one year of college work to four public health nurses. Ruth Collier, Henrietta Lagna and Ethel Kallinsky were matric- ulated at the University of Pennsylvania and Anita Keller attended New York University. Leaves of absence without pay were granted for these studies which began with the academic year in September. Early in the year, in order to meet the request for conservation of gasoline and tires, the bureau turned back to the Bureau of Transportation seven- teen of the thirty-four automobiles assigned to it. The remaining seven- teen automobiles, which were pooled for the use of the supervisors and public health nurses, were not sufficient to meet their needs and therefore two additional automobiles were made available for the part time use of the nurses. The loss of the cars and the inadequate transportation facilities necessarily curtailed somewhat the number of field visits made by the public health nurses. At the close of the year there were 130 staff nurses at work and in addition nine supervisors and three executive or director nurses. The total number of home visits made by public health nurses during the year was 199,300, besides a large amount of clinic service in the prenatal, child hygiene, venereal disease and chest clinics. In connection with the latter and with parent visits to the public and parochial schools there was in addition to the home visits a total of 24,500 public health nurse conferences with mothers or fathers. SANITARY SECTION Two series of regulations were adopted, in accordance with the provisions of Ordinances 384 and 507 approved March 6, 1941, and June 28, 1941, respectively, to govern the hygiene,of housing in general and also more specifically the rooming and lodging houses in the city. The need for these regulations, designed to set up minimum hygienic housing standards for occupied dwellings of all types, was increased by the in-migration of thousands of workers seeking employment in the war industries in the city. A mushroom growth of trailer camps occurred chiefly in proximity to industrial areas where trailers provided facilities for persons who came to the city for war work. Inspection of these camps showed the urgent need for sanitary control and resulted in the adoption of additional special regulations to govern trailer camps. REPORT OF THE COMMISSIONER OF 1-1 EAurit 43

Three new housing inspectors, classified as senior sanitary inspectors, were added to the staff of three inspectors who \yore already devoting full time to the study and improvement of housing conditions in the city. The ordinances and regulations referred to were upheld in instances where owners of properties and operators of trailer camps were tried in the Crim- inal Court for failure to comply with Health Department notices to correct insanitary or nuisance conditions. While every effort was made to have bad housing conditions corrected where this was possible, in forty-two instances dwellings were ordered vacated, under ordinance, because they were unfit for human habitation. As a result of the Health Department housing program, sanitary improvements were made in many dwellings and rooming houses where dangerous

ROOMING HOUSE TROUBLES-I

FOUR IN A BED

health conditions had been found. A major objective was the removal of rat-harboring frost-proof hopper nuisances from back yards wherever they were found. 'cite section director participated in the following important administra- : tive matters: The final removal from the city of a rendering plant which : for many years had been responsible for a very distressing atmospheric pollution itt a residential district; the cdmibination tinder a single Civil Service chissification of all the senior sanitary inspectors that had ft trincTly been 8 Pecialized for food Nnitrol, milk control, industrial hygiene and general sanitation; a program for the emergency chlorination of NVitter mains in ease of their damage by air raids, in cooperation with the Bureau of Water Sup- Ply ; a study of the relative adequacy of structures that might be used for emergency feeding and housing in cooperation with the Baltimore Commit- .: 44 titrARDING THE II EA Urli OF BA LTIMORE-- I 942

tee on Civilian Defense, consultations with industrial plant officials on general and specific health problems related to workroom environments, and 511I'Veyti of housing conditions in several congested sections of the city in cooperation with the City Buildings Engineer and the Fire 1)epartment.

ROOMING HOUSE TROUBLES-II

BED SPACE IN A BASE).!EN'!'

Milk Control 'flue milk plant permit of Kemp's Dairy, Incorporated, at 1200 Winches- t er Street, was revoked by the Commissioner of Health on February I 4. At a hearing preceding the revocation charges of persistent, repeated and willful violation of the city milk ordinance and regulations were substantiated. On November 28, the milk plant permit of the Bowman's Dairy, at 1800 North Aiken Street was cancelled, following a similar hearing. In this instance t he entire plant was purchased by another milk pasteurization COM- pally at the time of the permit cancellation. An important, amendment to the city milk ordinance was provided by Onlinance No. 747, at on May4. The amendment gives the I lealth Department, authority under very special circumstances to refuse an applicant it permit to handle or sell milk. During the latter part, of May Baltimore had a minor outbreak of milk- borne typhoid fever. Two and four patients in a nursing home situat NI just, inside the city limits contracted the disease from raw milk produced on the premises and handled by :t worker who was found to be a typhoid carrier. In only one prior instance in I 936 had there been disease traced to milk in Baltimore since the modernization of the city milk ordin- REPORT OF THE COMMISSIONER OF HEALTH 45

ance in 1917. Exception should be made in this comment for the oc- casional case of undulant fever in a city resident who drinks raw milk purchased usually at low cost in a neighboring rural area and brought into the city for consumption. The most acute shortage of milk on record in Baltimore made it necessary to bring nearly three million gallons of milk into the city from sources not under regular City Health Department inspection. The shortage which will probably continue throughout the war is due to the scarcity of farm labor, high cost of feed, increased population and perhaps a somewhat higher per capita consumption of milk than has been normal. An ordinance designed to permit the predating of milk pasteurized on Friday afternoons with Sunday's labels in order to assist the milk pasteurization plants in meeting government wartime delivery restrictions was

IVAN M. MARTY Food Inspector September 20, 1030-December 31, 1031 Dairy Plant Supervisor June 23, 1033-June 14, 1037 Director of the Bureau of Milk Control Since one 15, 1937

introduced in the City Council. Several civic organizations opposed the ordinance and it was defeated by unanimous vote of the Council. • On May 20 the Commissioner of Health amended Regulation 1 in the Health Department milk plant regulations in order to permit the distribution of milk in two-quart containers. The amendment changes the definition of bulk milk from milk sold in containers exceeding one quart in capacity to milk in containers exceeding two quarts in capacity. The Delta High School of Delta, Pennsylvania, was the winner of the 1942 Sanitary Milk Production Contest. There were 260 students from thirteen rural high schools on the Baltimore milkshed trained for the contest,. This brings the total number of students to 4,360 that have been trained during the eleven years in which the contest, has been held. Although the bacterial counts on the incoming raw milk and the bottled pasteurized inilk increased considerably (luring 1942, a generally satisfactory standard of sanitary quality of the city milk supply was maintained. The critical shortage of trained labor on farms and in milk plants and the 46 GUARDING THE HEALTH OF BALTIMORE-1942 large volume of milk brought into the city from sources under emergency permits were factors which contributed to the increased counts. Four samples only of bottled pasteurized milk out of a total of 939 samples tested showed evidence of improper pasteurization upon examination by the Bureau of Laboratories. The percentage of the city milk supply sold as pasteurized milk increased from 99.2 per cent in 1941 to 99.3 per cent in 1942. Food Control Three senior sanitary inspectors replaced retiring food inspectors in the bureau during the year. This change fortified the personnel of the bureau because of the better basic training of the new appointees, and it increased the usefulness of the bureau in protecting the consumer against impure and unwholesome food. The impact of the war accelerated the activites of the bureau which engaged in the following services designed to prevent food poisoning or related diseases: 1. Food handlers continued to change from their normal oc- cupations to more lucrative positions, which necessitated the employment of untrained and inexperienced workers in food establishments. To prevent the accidental contamination or improper handling of food by the untrained employee, a training school was established in the City Health Department for the purpose of instructing the novices. In this school more than 600 individuals were given personal instruction by the bureau director during the year. 2. Increased supervision was necessary in public eating places because equipment and facilities were taxed to capacity. Such eating places in the center of the city and around war production plants were kept under special health Department inspection. Added control was also exercised over restaurants in the vicinity of railroad and bus terminals, in conjunction with representatives of the Sanitary Corps of the U. S. Army. 3. Difficulty in obtaining new or replacement equipment for food handling brought into use substitute materials. The use of cadmium in place of chromium plate and aluminum, although not found in the city, was guarded against by adding a new testing outfit to the Health Department inspectors' field equipment. The use of difficult-to-clean wooden utensils, formerly discouraged, was kept under special scrutiny. 4. Municipal trash and garbage collection services were curtailed during the latter part of the year because of lack of personnel REPORT OF THE COMMISSIONER OF HEALTH 47

and trucks in the Bureau of Street Cleaning in the Department of Public Works. This caused excessive rat prevalence in and around food establishments. Instruction in building out and eliminating rodents was given to several hundred food establishment owners. Bakeries were particularly supervised in this activity and in general there was much cooperation in this difficult matter. 5. Rationing of certain foods led to better care of food in many homes. In connection with the nutrition and canteen classes of the Baltimore Chapter of the American Red Cross talks were given to more than twenty groups of women on the subject of food spoilage and the care of food in the home, particularly in regard to the prevention of food poisoning. Routine inspection of retail, wholesale and manufacturing food establishments was carried on actively. Retail food establishments were found for the most part to be operating under reasonably sanitary conditions. There was an increase in the number of complaints received because of improper trash and garbage storage and disposal. The increase in the number of condemnations of food was caused by the finding of infestation and of microscopic filth. Food poisoning outbreaks and the number of persons reported ill from food decreased in 1942 as compared with previous years. One investigation of an outbreak of illness alleged to have been caused by food was found to be water-borne. The bureau assisted in tracking down a small outbreak of typhoid fever which had been caused by the drinking of raw milk. All the public health nurses in the City Health Department were given instruction by the bureau director in the fundamentals of nutrition. Swabbings of food utensils used in restaurants showed that 60 per cent of this type of food establishment were complying with the regulations of the Maryland State Board of Health which govern food utensil disinfection. No wild rabbits were found to have been imported into the city, with the result that there were no cases 6f tularemia. Tinted nile-blue fluoride was found to be the only type of this poisonous insecticide being used in the city. Meat Inspection The enforcement of the meat inspection law and its regulations was again the major work of the Bureau of Meat Inspection. Included in the program was the inspection of livestock, before slaughter and at time of slaughter; and the inspection and control of establishments processing meat products and manufacturing meat food products, as well as those wholesaling Lmeat and meat products. There was also inspection of car-route ship- 48 REPORT OF THE HEALTH DEPARTMENT-1942

ments of meats into the city. Supervision was maintained over federally inspected establishments and rendering plants operating under license of the City Health Department. The bureau chief adjudicated seven appeal cases which involved five carcasses and 4,745 pounds of meat. All five carcasses and 2,190 pounds of the beef were condemned as unfit for human consumption. The slaughtering of cattle reacting to Bang's disease and tuberculosis was continued in certain plants under municipal inspection on authorization of the Federal and State agencies. It is gratifying that the standard of inspection of the bureau coincides with that of the U. S. Department of Agriculture, and the postmortem findings of the deputized veterinary inspectors were acceptable to the Federal and State authorities. In addition, service was rendered to (1) the O.P.A. regarding livestock slaughtered under the supervision of the City Health Department;(2) the Federal Bureau of Meat Inspection and the Union Stockyard Company of Baltimore in the handling and disposition of Bang reacting cattle slaughtered under local inspection;(3) the State Department of Health in the reinspection of turkeys; (4) the Food Control Bureau of the City Health De- partment in the examination of poultry; (5) the Bureau of Communicable Diseases in the examination of domestic animals for the control of rabies; (6) the Society for the Prevention of Cruelty to Animals in the housing and feeding of cattle; and (7) the United States Lines and local steamship lines in the reinspection of meat and meat food products on arrival at the port of Baltimore. Environmental Hygiene Housing The adoption under ordinance of special regulations to govern the hygiene of housing, rooming houses and lodging houses, and trailer camps, established much needed minimum standards of sanitation for all dwellings in the city. A critical housing shortage created by the continued influx of war workers and their families required concentration of supervision over rooming houses, furnished apartments and dwellings converted from single to multi-family use. Field investigations resulted in the issuance of 498 notices to property owners to correct such conditions as overcrowding, defective and inadequate plumbing, vermin and rat infestation, garbage and trash accumulations, blind sleeping rooms, occupancy of unfit basements and structural dilapidation. Three unwilling property owners and seven trailer camp operators were successfully prosecuted in the Criminal Court for failure to comply with Health Department notifications to correct housing conditions that were dangerous or detrimental to life or health. An increase in the staff of housing inspectors made possible a somewhat REPORT OF THE COMMISSIONER OF HEALTH 49

more adequate inspection service and many corrections of bad housing facilities were effected that NV011id otherwise have not been possible.

Sanitation

In addition to the handling of OVer 7,800 nuisance complaints special community sanitation activities engaged in were: The provision of inside toilets and sewer connections and the elimination of insanitary pit privies for a group of houses on Kelly Avenue in NH. Washington, the discontinuance of a bathing and picnic beach where adequate sanitary facilities could not be provided, the study of the water supply and plumbing system in a large establishment following the occurrence of an outbreak of gastro-enteritis \vhich from all indications was water-borne, the enlargement of the city-

HOONIINO HOUSE TROUBLES III

LODOINGS IN AN OLD STABLE wide rat control program, a series of inspections for report to railroad superintendents and to the State Department of Health and the U. S. Public I health Service on the sanitary quality of water sources used by train services, and a cooperative program with property owners for cutting down weeds particularly during the ragweed pollination period.

Industrial lIyoiene The vast expansion in local industries engaged in making \Val* materials increased the need for close supervision of health hazards in these plants. A close study and consultation relationship concerning exposures to specific toxic materials was established \Nall officials in a number of instances. These ivsulted in the improvement in the control of exposures to such ma- 50 GUARDING THE HEALTH OF BALTIMORE-1942 terials as benzol, lead, carbon monoxide, radium activated paints, and halogenated solvents. Other important accomplishments included improvements in lighting and ventilation, provision of adequate and sanitary drinking, washing and toilet facilities, arrangements for rest periods, elimination of accident hazards, and guidance in problems resulting from a large change-over from male to female workers.

Conclusion This brings to a close a review of the more important portions of the City health Department work of 1942. The task has been the more chal- lenging because of the war and the resulting new population coming into Baltimore, and because of such departmental staff losses as physicians, public health nurses, sanitary officers and trained laboratory workers. The Health Department has assisted in the community efforts in post- war planning and perhaps is closest to this matter in the fields of housing, slum clearance and population studies. In these it has affiliated itself with the Citizens' Planning and Housing Association, the Commission on City Plan and the Mayor's Committee for Post-War Planning. The Depart- ment is grateful to these and many other official and nonofficial and professional groups in Baltimore for their assistance in the health progress that has been made and that may now be possible in the city.

Respectfully submitted,

Nft

Commissioner of Health.

Baltimore, Maryland May 1, 1943 REPORT OF THE COMMISSIONER OF HEALTH 51

BIBLIOGRAPHY FOR THE YEAR 1942

BUCK, THEODORE C., JR False Positive Phosphatase Test from a Thermophil in Pasteurized Milk. Amer- ican Journal of Public Health, Novem- ber, 1942, Vol. 32, No. 11, pp. 1224-1236. CLARK, E. GURNEY and TURNER, THOMAS B Studies on Syphilis in the Eastern Health District of Baltimore City. III. Study of the Prevalence of Syphilis Based on Specific Age Groups of an Enumerated Population. American Journal of Pub- lic Health, March, 1942, Vol. 32, No. 3, pp. 307-313. CROWE, S. J.; GUILD, S. R.; LANGER, E.; LOCH, W. E. and Rommvs, M. II Impaired Hearing in School Children. The Laryngoscope, October, 1942, Vol. 52, No. 10, pp. 790-804. DowNits, JEAN Illness in the Chronic Disease Family. American Journal of Public Health, June, 1942, Vol. 32, No. 6, pp. 589-600. HODES, IIORACE L Review of Virus Diseases. Advances in Pediatrics, 1942, Vol. 1, pp. 57-89. Development of Anti-pneumococcus Im- munity in Infants and Young Children. American Journal of Diseases of Chil- dren, July, 1942, Vol. LXIV, pp. 189-190. HODES, HORACE L. and STRONG, PAUL S Treatment of Meningococcus Meningitis with Sulfonamides. The Journal of the American Medical Association, June 27,1942, Vol. 119, pp. 691-694. HODES, HORACE L.; RAKE, G. and SHAFFER, M F Isolation of Virus from a Patient with Fatal Encephalitis Complicating Measles. American Journal of Diseases of Children, November, 1942, Vol. 64, pp. 815-819. HORINE, ESTHER S. A Health Department Library. Special Libraries, November, 1942, pp. 336-339. KAPLAN, EMANUEL and MCDONALD, JOHN M. Blood Lead Determinations as a Health Department Laboratory Service. Amer- ican Journal of Public Health, May, 1942, Vol. 32, No. 5, pp. 481-486. 52 REPORT OF THE HEALTH DEPARTMENT--1942

"Pasteuriz- KORFF, FERDINAND A Instructions for Reheating or ing" Custard-filled Pastries. The Sani- tarian, June-July, 1942, Vol. 5, No. 1-2, pp. 157-158. Food Establishment Sanitation in a Municipality. American Journal of Public Health, July, 1942, Vol. 32, No. 7, pp. 739-744. Looking into the Future. Association of Food and Drug Officials of the United States, Quarterly Bulletin, October, 1942, Vol. 6, No. 4, pp. 33-36. KORFF, FERDINAND A. and KAPLAN, EMANUEL Field Equipment for Food Inspectors. American Journal of Public Health, October, 1942, Vol. 32, No. 10, pp. 1110- 1116. LANGER, ELLA. Impaired Hearing in Children and Size of Adenoids in Relation to Some Anthro- pometric Data and to Condition of Teeth. Annals of Otology, Rhinology and Laryngology, December, 1942, Vol. 51, No.4, p.931. LEMKAU, PAUL; TIETZE, CHRISTOPHER and COOPER, MARCIA Mental Hygiene Problems in an Urban District. Second Paper. Mental Hy- giene, January, 1942, Vol. 26, No. 1, pp. 100-119. Complaint of Nervousness and the Psycho- neuroses. The American Journal of Orthopsychiatry, April, 1942, Vol. 12, No.2, pp. 214-233. Loomis, C. D.; FALES, W. THURBER; SCHULZE, WILMER H. and BADGER, GEORGE F Low Rent Housing Survey. Baltimore, Maryland, 1941. Made by The Housing Authority of Baltimore City, The Balti- more City Health Department and The Johns Hopkins School of Hygiene and Public Health. MALDEIS, HOWARD J The History of the Medical Examiner System. Bulletin of the School of Medi- cine, University of Maryland, July, 1942, Vol. 27, No. 1, pp. 34-35. MARCY, K. F.; PHAIR, J. J. and SMITH, MARY H. Diphtheria in Baltimore: Tonsillectomies as Related to the Diphtheria Carrier REPORT OF THE COMMISSIONER OF HEALTH 53

Rates. The American Journal of Hy- giene, January, 1942, Vol. 35, No. 1, pp. 42-46. MCDONALD, JOHN M Ramazzini's Dissertation on Rinderpest. Bulletin of the History of Medicine, October, 1942, Vol. 12, No. 3, pp. 529- 539. MCDONALD, JOHN M. and KAPLAN, EMANUEL Incidence of Lead Poisoning in the City of Baltimore. The Journal of the Amer- ican Medical Association, July 11, 1942, Vol. 119, pp. 870-872. PHAIR, J. J Diphtheria Immunization: Reactions of Adults Following Intranasal Toxoid. The American Journal of Hygiene, March, 1942, Vol. 35, No. 2, pp. 292-306 Diphtheria Immunization: Secondary Stimulus in Guinea Pigs as a Test of Toxicogenicity of "Avirulent" C. Diph- theriae. The American Journal of Hy- giene, May, 1942, Vol. 35, No. 3, pp. 386- 392. PHAIR, J. J. and ROOT, CHARLOTTE M. Diphtheria Immunization: Simultaneous Active and Passive Immunization in Guinea Pigs. I. The Antigenicity of the Toxoids, Fluid and Alum Precipitated in the Presence of Passive Antitoxin. The American Journal of Hygiene, March, 1942, Vol. 35, No. 2, pp. 251-264. II. The Protective Power of Antitoxin Administered in the Presence of the Toxoids. The American Journal of Hygiene, May, 1942, Vol. 35, No. 3, pp. 377-380. PHAIR, J. J. and SMITH, MARY R. Diphtheria in Baltimore: The Carrier Rate in Twelve Surveys, 1921-1939. The American Journal of Hygiene, Janu- ary, 1942, Vol. 35, No. 1, pp. 47-54. PREAS, SALLY and PHILLIPS, RUTH The Severity of Illness Among Males and Females. The Milbank Memorial Fund Quarterly, July, 1942, Vol. 20, No. 3, pp. 221-244. TIETZE, CHRISTOPHER; LEMICAU, PAUL and COOPER, MARCIA Personality Disorder and Spatial Mobility. The American Journal of Sociology, July, 1942, Vol. 48, No. 1, pp. 29-39. 54 - REPORT OF THE HEALTH DEPARTMENT-1942

WARD, THOMAS G. and TURNER, THOMAS B. Study of Certain Epidemiological Features of Leptospiral Jaundice in Baltimore. The American Journal of Hygiene, Janu- ary, 1942, Vol. 35, No. 1, pp. 122-133. WILLIAMS, HUNTINGTON Report on the Administration of Medical and Allied Services as Observed in the Civilian Defense Program in England, July 16-August 15, 1941. Transmitted to F. H. LaGuardia, U. S. Director of Civilian Defense, pp. 42 with illustra- tions and appendix. (Not published) National Defense Migration. Hearings (Washington) before the Select Committee Investigating National Defense Migra- tion, House of Representatives, Seventy- Seventh Congress, January 13, 14, 15, 1942, pp. 9863-9873. Air Raid Medical Administration—Cur- rent British Practice. American Jour- nal of Public Health, February, 1942, Vol. 32, No. 2, pp. 137-141. .. . . Abstract in International Medical Digest, IIagerstown, Maryland, April, 1942, Vol. 40, No. 4, pp. 213-215. Protection of Hospitals. Medical Bulle- tin, No. 3, Report of a Joint Commit- tee, U. S. Office of Civilian Defense, Washington, D. C. (Joint author) Handbook for Civilian Defense. A review in the American Journal of Public Health, May, 1942, Vol. 32, No. 5, p. 546. Air Raid Medical Administration in Eng- land. The Journal of the American Medical Association, June 13, 1942, Vol. 119, No. 7, pp. 540-545. Housing as a Health Officer's Opportunity. American Journal of Public Health, Sep- tember, 1942, Vol. 32, No. 9, pp. 1001- 1004. Health Problems in Suddenly Expanding Industrial Communities. Proceedings of Seventh Annual Meeting of the Indus- trial Hygiene Foundation of America, Pittsburgh, Pennsylvania, November 10-11, 1942, pp. 66-71. The Improvement of Local Housing Regu- lation Under the Law. Committee Re- port of the American Public Health Association. American Journal of Pub- lic Health, November, 1942, Vol. 32, No. 11, pp. 1263-1277. (Joint author) REPORT OF THE COMMISSIONER OF HEALTH 55

Health Department Publications BALTIMORE HEALTH NEWS. Monthly, 1942; and bound volume of issues of 1940-1941, with index.

CITY HOUSING CODE CITY MILK CODE

REPORT OF TIIE SEROLOGICAL SURVEY FOR SYPHILIS IN SCHOOL 133, MAY, 1939

REPRESSION OF PROSTITUTION FOR VENEREAL DISEASE CONTROL

RULES AND REGULATIONS GOVERNING ROOMING HOUSES, LODGING HOUSES AND HOTELS

RULES AND REGULATIONS GOVERNING THE HYGIENE OF HOUSING RULES AND REGULATIONS GOVERNING TRAILER CAMPS 1 ADMINISTRATIVE SECTION

[571 EXECUTIVE OFFICE Personnel Huntington Williams, M.D., Dr.P.H., Commissioner of Health Ross Davies, M.D., M.P.H., Assistant Commissioner of Health Reed Gaither, Senior Account Clerk and Secretary to the Commissioner Sadie E. Figg, Senior Stenographer Helen vonWachter, Senior Stenographer Frank J. Feeley, Junior Clerk Dorothy I. Payson, Senior Stenographer Margaret Shaver, Senior Typist

Note: Personnel records as given here and at the close of each bureau report are in accordance with the Department staff roster as of December 31, 1942.

[58 ] ASSISTANT COMMISSIONER OF HEALTH

[59 ] . ASSISTANT COMMISSIONER OF HEALTH

Ross Davies, M.D., M.P.H.

The Assistant Commissioner of Health worked on assignments that were chiefly of an administrative nature in close relationship with the Commis- sioner of Health. The weekly conferences at Sydenham Hospital and the fortnightly conferences in the four district health offices were again conducted during the year. The meetings in the district health offices help to promote more efficient working relationships between the health districts and the central office bureaus and also between the different district offices. Special work for the Commissioner of Health included the following: Plans were made and schedules arranged throughout the year for health addresses and for talks on the City Health Department's program and activities which were given by staff members to official and nonofficial groups and to school, church and civic organizations in Baltimore; schedules were designed for individuals and groups who visited the Health Department so that the time spent by them in the Department would be profitably utilized; a program was arranged for field work in public health administration by student groups from the Johns Hopkins School of Hygiene and Public Health for Dr. Allen W. Freeman, Professor of Public Health Administration. The war brought in its wake problems new in the annals of public health administration, such as decreased facilities for transportation of field workers, oil heat for clinics under a rationing system, priority orders for many supplies, and other vital operational changes and substitutions. The majority of the bureaus of the Health Department were affected by an unusual number of shifts in personnel due to the enlistment of staff members in the armed services or to their leaving for other employment. Replacement by trained workers presented a difficult problem. In the solution of these and a multitude of other day-by-day bureau problems the Assistant Commissioner of Health played an important part. The Work Projects Administration program in the Health Department was changed and greatly diminished during the year. The Assistant Com- missioner had charge of this program. The number of persons in each of these Federal units was reduced and the type of occupation allowed for these units was confined to work in clinics and assistance in certification of birth records. Project No. 7135 was closed on July 3 and the services of the full time W. P. A. supervisor were discontinued at the same time. The Assistant Commissioner of Health cooperated with the W. P. A. Dis-

[61 ] 62 REPORT OF THE HEALTH DEPARTMENT-1942

trict Office in the direction of the work of eight persons who remained on Project No. 7271-2 assigned to Department clinics until the close of the year. Project No. 7130-8 which gave assistance on certification of births in the Bureau of Vital Statistics was also continued during the remainder of the year. Approximately $25,000 of W. P. A. funds were expended for City Health Department work during 1942. The sum of $19,065.94 secured from Federal Social Security Funds and made available through the Maryland State Department of Health was spent in four categories as follows: $9,524.64 was spent through the Health District offices, chiefly for clerical assistance; $6,515.26 was spent for salaries in the Bureaus of Health Information, Tuberculosis and Vital Statistics; $2,697.37 was used for the collegiate training of staff nursing personnel, and $328.67 was spent by the Bureau of Laboratories in clerical and other salary items in venereal disease control work. For the latter purpose an additional $1,184.46 of Social Security money was also expended during the year. BUREAU OF VITAL STATISTICS

[63]

BUREAU OF VITAL STATISTICS

W. Thurber Fales, Sc.D. Director The dual function of the Bureau of Vital Statistics was made very clear by the exigencies of the war. The demands for documentary proof of age, relationship and citizenship have emphasized the importance of its work in the field of registration and preservation of vital records. On the other hand, the many health and population problems arising out of war conditions and their solution now and after the war has increased the demand for specialized studies and services in the field of biostatistics. During 1942 there were issued 52,572 transcripts of birth records which represent about a threefold increase over the number issued in 1941 and almost a fivefold rise over the number issued in 1940. Accurate statistics of natality and mortality require registration of every birth and every death in the city promptly after the occurrence. In connection with the 1940 federal census, the United States Bureau of the Census conducted a test of birth registration throughout the country. The results of this test in Baltimore became available in 1942 and indicated that 97.7 per cent of the births occurring in the city were reported. It is one of the functions of the division of primary registration to see that every birth in the city is recorded. During 1942 the bureau received reports of 24,144 births as compared with 19,406 in 1941 and 16,478 in 1940. The number of births to nonresi- dent mothers was 4,646 in 1942 and 3,600 in 1941. These were almost entirely mothers who came from the counties of Maryland to Baltimore hospitals for delivery. During 1942 there also were filed with the bureau 11,803 death certificates. The bureau is charged with the preservation of vital records such as the original certificates of birth and death and the issuance of official transcripts of these records for governmental, social and legal purposes. This function is conducted by a division of archives and during 1942 the number of official copies issued increased very considerably as has been noted. The division issued 18,930 transcripts of death certificates during 1942 as compared with 17,311 in 1941. In addition to these official copies there were heavy demands for verification of both births and deaths by official governmental agencies, especially the Selective Service. It is also the function of the archives division to make corrections and amendments to the records already on file and to record delayed certifi- 66 REPORT OF THE HEALTH DEPARTMENY-1942

cates of birth registration. In making these corrections and in the filing of delayed records it is necessary to review carefully documentary evidence so that the integrity of the records already on file is protected. During 1942 the Bureau of Vital Statistics accepted 3,613 delayed certificates of birth registration as compared with 1,120 filed during the preceding year. The bureau prepared weekly reports of births, deaths and reported cases of communicable diseases. These reports formed the basis for the "Satur- day Letters to the Mayor" submitted each week by the Commissioner of , Health. Monthly reports of vital statistics were prepared for Baltimore Health News and for the information and guidance of the department. The statistical division completed the tabulation of data on housing secured in a special study of conditions conducted by the Housing Authority of Baltimore City in collaboration with the City Health Department and the Johns Hopkins School of Hygiene and Public Health. The findings of this survey were published during the latter part of the year in a report entitled "Low Rent Housing Survey." Personnel On May 31 Mr. Howard A. Moore, Principal Clerk, retired from active service with the bureau. His position was abolished and a new position of administrative assistant was created. Mr. Isadore Seeman was appointed on June 5 to this new post which was charged with the supervision of the clerical force in the bureau and with aid to the director in administrative procedures. Mr. Langdon G. Backus, statistician, left the bureau on February 5 to enter the United States Army. The bureau lost the services of Mr. Robert It. Krauter, chief burial permit clerk, through death on July 6. On May 26 the Board of Estimates approved the creation of two positions of senior clerk and of junior case worker to take care of the increased demands for birth certificates requested in connection with the prosecution of the war and especially with industrial employment. During the year the bureau received clerical assistance in the issuance of the transcripts of birth certificates from the Federal Work Projects Administration. Division of Morgue and Public Cemetery There were delivered to the morgue 1,403 bodies of which 1,211 were claimed by relatives or friends; the remainder were taken care of by the city. A summary of the work of the division of Morgue and Public Ceme- tery for the year appears in Table No. 1 at the close of this section. Personnel W. Thurber Pales, Sc.D., Director Isadore Seeman, Administrative Assistant BUREAU OF VITAL STATISTICS 67

James G. McLaughlin, Principal Clerk Margaret Amspacher, Statistical Clerk Ruth Gees, Statistical Clerk Elizabeth Steman, Statistical Clerk Ida S. Blum, Senior Clerk Gertrude Cordish, Senior Clerk Mary A. Hohrein, Senior Clerk Walter A. Just, Senior Clerk Rosalie Krause, Senior Clerk Fanny° G. Adler, Senior Stenographer Mildred S. Lochenauer, Senior Tabulation Machine Operator Helen Boesche, Key Punch Operator Ida M. Padgett, Key Punch Operator Ida M. Girshin, Junior Stenographer Gladys IIarback, Junior Stenographer Marian Kramer, Junior Clerk Lucia M. Irons, Junior Case Worker Katherine Smith, Junior Typist John P. Boyle, Chauffeur James II. Carter, Chauffeur C. L. Disney, Park Caretaker

TABLE NO. 1 ACTIVITIES OF DIVISION OF THE MORGUE AND PUBLIC CEMETERY-1942

WHITE COLORED TOTAL Male I Female Male I Female

BODIES DELIVERED TO ANATOMICAL BOARD

All bodies 070* 310 172 185 195 Stillbirths 497 148 107 24 110 Under 1 year 256 88 54 50 58 Other children ...... •• • Adults 217 74 11 105 27

BODIES BURIED IN PUBLIC CEMETERY

All bodies 36 16 0 6 5 Stillbirths 20 9 8 1 2 Under 1 year 6 3 1 2 ... Other children ...... • •• • •• • •• Adults 10 4 ... 3 3

BODIES RECEIVED AT MORGUE

All bodies 1,402** 644 173 410 163 Stillbirths 51 12 12 8 12 Under 1 year 73 11 15 26 23 Other children 60 19 11 21 9 Adults 1,216 602 135 355 124

* Includes 108 stillbirths (86 white and 22 colored), sex undetermined ** Includes 7 white stillbirths, sex undetermined

BUREAU OF HEALTH INFORMATION

69]

___

BUREAU OF HEALTH INFORMATION

Esther S. Horine, A.B. Chief Excellent support was given to the City Health Department by the local press throughout the year. One hundred and eighty-seven feature articles were published on significant health matters. Housing and rat control were the subjects most frequently featured and the articles were usually accompanied by striking photographs. The press also used the releases on the communicable disease situation from 'the reports made each week in the "Saturday Letter to the Mayor." This publicity was of unexcelled educational value in informing the public about the current health status of the city. The Baltimore Transit Company printed 150,000 leaflets on the possible spread of disease that might result from smoking in public conveyances. The leaflets were distributed through the means of the racks on streetcars and busses. The transit company also displayed posters which have been previously described in this report. The bureau prepared twelve health informational articles in observance of Child Health Day. These articles were released in a special health section of the Baltimore News Post published on May 20. For the second consecutive year news releases were sent each month to two local church Journals. Other articles on current health topics were prepared for neighborhood newspapers. Radio Broadcasts The "Keeping Well" radio broadcasts were continued each week in drama form. The series originated in 1932 with weekly five minute radio talks presented under the joint sponsorship of the Baltimore City Health Department and the Medical and Chirurgical Faculty of Maryland. On May 4, 1939 the style of the broadcasts was changed to fifteen minute weeldy dramas and on Saturday evening, December 26, 1942 the one hundred and eighty-seventh consecutive "Keeping Well" radio drama was presented. Following a notice about Volumes III and IV of the "Keeping Well" radio drama series under "Credit Lines" in the August, 1942 issue of the American Journal of Public Health, requests were received for copies of these books from numerous health agencies in the United States. Because of personnel difficulties and the scarcity of materials, it was not possible to mimeograph the scripts which were broadcast in 1942.

[71 ] 72 REPORT OF THE HEALTH DEPARTMENT-1942

Mr. Bert Hanauer, program director of radio station WFBR,conducted a class on radio techniques in a series of seminars sponsored by the Adult Activities Council. Mr. Hanauer used "Dr. Ashley's City," one of the "Keeping Well" radio broadcasts to illustrate the drama techniques. Special broadcasts were presented in the "Keeping Well" radio drama series in observance of Syphilis Control Day, nationally known as American Social Hygiene Day, National Negro Health Week, Child Health Day, National Hearing 'Week and the 36th Annual Tuberculosis Seal Sale. Radio spot announcements were prepared on rabies and on garbage, trash and rats. Each of the five radio stations located in the city cooperated with the Department and broadcast the spot announcements upon request. Department Publications Baltimore Health News,the Department's monthly publication, continued to be the chief liaison agent between the Department and practicing physicians, teachers in public and parochial schools, and official and nonofficial organizations. The monthly issues for 1940 and 1941 were indexed, bound and made available to libraries and selected interested persons. Clipping Service All local newspapers and the New York Times were clipped daily and duplicates were filed in the library. Two volumes of Health Department publicity items were indexed and bound for the Executive Office. Other Activities Health Department staff members wrote a number of scientific and technical papers which were published in professional journals. These are listed in the Bibliography. Eight reprints were mailed to the practicing physicians in the city during the year. Competent help was not available to assist with the library work during 1942 and the bureau chief routed periodicals and made inter-library loans. The bureau also handled the mailing of Baltimore Health News and reprints during the illness of the mailing room clerk. Visual Education Two new posters were designed, one for the Bureau of Occupational Diseases on lead poisoning and one for the Bureau of Venereal Diseases on syphilis and gonorrhea. These were reproduced by the silk screen process through the cooperation of the Maryland Work Projects Administration. In the latter part of the year the Department purchased the equipment for silk screen printing and reproductions were made at a saving of time and money. Sixteen exhibits were given during the year and eighty-eight units of BUREAU OF HEALTH INFORMATION 73 health exhibit material were loaned for a Boy Scout merit badge demonstration, a hobby show, two local parochial schools, for the observance of National Hospital Day in Washington and the annual meeting of Former Interns of Freedmen's Hospital, Washington, D. C. Thirteen exhibits were shown in the Department clinics. These included three-dimensional posters placed on the second floor corridor of the Druid Health Center, in the chest clinic and in the main corridor at 1516 Madison Avenue. The 1942 report of the local observance of National Negro Health Week was compiled, bound and presented to the U. S. Public Health Service. Three additional copies were prepared and bound, one for the Commis- sioner of Health of Baltimore, one for the local committee of the Negro Health Movement and the third for the bureau files. Personnel Esther S. Horine, Chief Dorothy Regina Kalben, Division of Publications Mildred S. Cohen, Junior Stenographer TABLE NO. 1 SUMMARY OF EDUCATIONAL WORK DONE BY THE HEALTH DEPARTMENT IN 1942

NEWS- PRINTED PAPER MATERIAL HEALTH ADDRESSES VISUAL PUBLICITY DISTRIBUTED AND SEMINARS EDUCATION NEWS REPORT SECTION OF BUREAU E u 2 o I HEALTH e 0 o CONTESTS . , Reached

Reached g Addresses OF - . Slides A v ... THE PUBLICATIONS BALTIMORE Persons Classes Persons Hours Health Films, Persons .-:4- 3 4 in HEALTH I Entire Department 44 1$7 1,520 58,739 328,307 66 1,045 279 46,971 24 23 1,945 53 2 211 983 301 780 1,717 HEALTH Administrative Section Commissioner of Health 10 25 178 365 5,000 10 240 48 12,700 3 15 750 1 1 15 500 40 210 420 Asst. Commissioner of Health .... 1 2 50 1,500 .... 4 1 306 31 255 Vital Statistics 2 55 225 582 1,890 14 26 200 60 220 Health Information 1 3,384 180,039 10 14 3 125 16 7 - 11 84 Baltimore Health News 424 134,578 Rack distribution 21 28,525 DEPARTMENT Radio broadcasts 2 11 47 93 Miscellaneous 2,892 16,843 Laboratories 4 215 215 2 4 16 285 1 .... 13 24 13 40 29 Eastern Health District 14 1 8 1,120 1,120 1 97 18 136 28 95 Western Health District 1,946 2,082 4 1 '40 33 84 Southeastern Health District.. 3,335 4,178 69 1 1,339 44 39 Druid Health Center 2 34 6,647 7,783 2 12 1,349 1 1 35 5 2 15 2 23 Medical Section

Communicable Diseases 25 235 404 75,277 6 7 11 667 15 3 17 -1942 Sydenham Hospital 3 1 11 91 1,253 ..:...... 53 57 53 12 13 Tuberculosis 4 28 1,580 1,580 2 11 4 1,260 ...... 2 .... 7 135 10 21 113 Venereal Diseases 1 2 14,398 16,075 1 1 2 103 56 Occupational Diseases 3 1 2 1,212 1,508 3 13 280 3 4 31 30 Child Hygiene 1 12 4 4 School Hygiene 15 215 Dental Clinics 1 15 Public Health Nursing 16,539 19,513 1 597 8 22,812 .... 1 125 1 .... 12 114 24 82 95 Sanitary Section Director 2 44 501 675 1,245 3 5 12 484 .... 1 : 35 8 .. . 2 12 3 26 75 Milk Control 1 22 256 53 213 5 13 277 1 I 12 27 Food Control 4 3 26 2,060 3,720 4 47 29 3,308 1 5 .... 7 121 7 8 33 Meat Inspection 3 4 Environmental Hygiene 4,174 5,369 1 2 71 5 1,000 3 5 5 BUREAU OF HEALTH INFORMATION 75

TABLE NO. 2 RADIO DRAMAS BROADCAST UNDER THE JOINT AUSPICES OF THE BALTIMORE CITY HEALTH DEPARTMENT AND THE MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND, 1942 "KEEPING WELL" SERIES

DATE TITLE SUBJECT

January 3 Overtime Rest, sleep 10 The Champ Pneumonia 17 The Danger Line Dental care 24 Famine Milk, nutrition 31 Wounds Without War Syphilis Control Day February 7 Without Warning Carbon monoxide 14 Dr. Ashley's Stratagem Public health nursing 21 'Hands of Destiny Dermatitis 28 They've Got to Have It Measles March 7 Love Is Not Enough Diphtheria 14 Milk Milk 21 The Scarlet Scourge Scarlet fever 28 Bright Poison Lead poisoning April 4 One More Easter Tuberculosis 11 The Life Savers Pneumonia; laboratories 18 Night Call Food Inspection 25 The New Magna Carta Child Health Day—May 1 May 2 Always Room for One More Meningitis and housing 9 The Stranger Maternal care 16 The Invaders Rat control 23 The Crystal Pool Typhoid vaccination 30 Storm signals Housing; diphtheria; smallpox vaccination June 6 A Little Dog Lost Rabies 13 Covered Wagons-1942 Trailer camps 20 Play with a Tiger Poisons in the home 27 The Basket's Secret Refrigeration July 4 The Dog "Star" Rabies 11 The Vampire Ticks 18 Baby Plague Diarrhea and dysentery 25 Crimson Lips Food handling August 1 It's Not the Heat Salt in industry 8 The Crossroads Undulant fever 15 Check and Double-Check Getting ready for school 22 The Terror Syphilis 29 Walking Plague Typhoid fever September 5 Salvage Rats 12 Hot Lead Industrial hygiene 19 Hungry Boy Nutrition 26 The Warm Room Carbon monoxide October 3 Death at IIer Door Diphtheria 10 Half Alive Hearing 17 Eight in a Room Meningococcus meningitis 24 Cowards Die War worry 31 Forty and Fit Keeping well November 7 Thar She Blows Common cold 14 Back Yard Nuisances Nuisances 21 The Rookery Housing 28 Postage Due Tuberculosis Seal Sale December 5 Mother, Beware Whooping cough 12 "Dr. Ashley's" City Garbage collection 19 White Christmas Safe Christmas 26 Your Health-1943 New Year's resolutions TABLE NO. 1 SUMMARY OF EDUCATIONAL WORK DONE BY THE HEALTH DEPARTMENT IN 1942

NEWS- PRINTED HEALTH ADDRESSES VISUAL PAPER MATERIAL AND SEMINARS EDUCATION PusLicrrv DISTRIBUTED NEWS REPORT SECTION OF BUREAU

HEALTH E -0 Inches

.- , Reached Reached

Addresses . E'a BROADCASTS Cl .. OF "E f.,

x . THE PUBLICATIONS Column Requests BALTIMORE Health Seminars Persons Persons RADIO Classes Persons CONFERENCES •51 4. l.-4 Hours I rr■ Entire Department 44 187 1,520 58,739 328,307 66 1,045 279 46,971 24 23 1,945 53 2 211 983 301 780 1,717 HEALTH Administrative Section Commissioner of Health 10 25 178 365 5,000 10 240 48 12,700 3 15 750 1 1 15 500 40 210 420 Asst. Commissioner of Health .... 1 2 50 1,500 .... 4 1 306 31 255 Vital Statistics 2 55 225 582 1,890 14 26 200 60 220 Health Information 1 3,384 180,039 10 14 3 125 16 7 - 11 84 Baltimore Health News 424 134,578 - Rack distribution 21 28,525 DEPARTMENT Radio broadcasts 2 11 47 93 ...... Miscellaneous 2,892 16,843 Laboratories 4 215 215 2 4 16 285 ...... 1 .... 13 24 13 40 29 Eastern Health District 14 1 8 1,120 1,120 1 97 18 136 28 95 Western Health District 1,946 2,082 4 1 40 33 84 Southeastern Health District. 3,335 4,178 69 1 1,339 44 39 Druid Health Center 2 34 6,647 7,783 2 12 1,349 1 1 . 35 ...... 5 2 15 2 23 Medical Section Communicable Diseases 25 235 404 75,277 6 7 11 667 15 3 17 -1942 Sydenham Hospital 3 1 11 91 1,253 • 53 57 53 12 13 Tuberculosis 4 28 1,580 1,580 2 11 4 1,260 2 .... 7 135 10 21 113 Venereal Diseases 1 2 14,398 16,075 1 1 2 103 56 Occupational Diseases 3 1 2 1,212 1,508 3 13 280 3 4 31 30 Child Hygiene 1 12 4 4 School Hygiene 15 215 Dental Clinics 1 15 Public Health Nursing 16,539 19,513 1 597 8 22,812 .... 1 125 1 .... 12 114 24 82 95 Sanitary Section Director 2 44 501 675 1,245 3 5 12 484 .... 1 . 35 6 .. . 2 12 3 26 75 Milk Control 1 22 256 53 213 5 13 277 1 I 12 27 Food Control 4 3 26 2,060 3,720 4 47 29 3,308 1 5 .... 7 121 7 8 33 Meat Inspection 3 4 Environmental Hygiene 4,174 5,369 1 2 71 5 1,000 3 5 5 BUREAU OF HEALTH INFORMATION 75

TABLE NO. 2 RADIO DRAMAS BROADCAST UNDER THE JOINT AUSPICES OF THE BALTIMORE CITY HEALTH DEPARTMENT AND THE MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND, 1942 "KEEPING WELL" SERIES

DATE TITLE SUBJECT

January 3 Overtime Rest, sleep 10 The Champ Pneumonia 17 The Danger Line Dental care 24 Famine Milk, nutrition 31 Wounds Without War Syphilis Control Day February 7 Without Warning Carbon monoxide 14 Dr. Ashley's Stratagem Public health nursing 21 'Hands of Destiny Dermatitis 28 They've Got to Have It Measles March 7 Love Is Not Enough Diphtheria 14 Milk Milk 21 The Scarlet Scourge Scarlet fever 28 Bright Poison Lead poisoning April 4 One More Easter Tuberculosis 11 The Life Savers Pneumonia; laboratories 18 Night Call Food Inspection 25 The New Magna Carta Child Health Day—May 1 May 2 Always Room for One More Meningitis and housing 9 The Stranger Maternal care 18 The Invaders Rat control 23 The Crystal Pool Typhoid vaccination 30 Storm signals Housing; diphtheria; smallpox vaccination June 8 A Little Dog Lost Rabies 13 Covered Wagons-1942 Trailer camps 20 Play with a Tiger Poisons in the home 27 The Basket's Secret Refrigeration July 4 The Dog "Star" Rabies 11 The Vampire Ticks 18 Baby Plague Diarrhea and dysentery 25 Crimson Lips Food handling August 1 It's Not the Heat Salt in industry 8 The Crossroads Undulant fever 15 Check and Double-Check Getting ready for school 22 The Terror Syphilis 29 Walking Plague Typhoid fever September 5 Salvage Rats 12 Hot Lead Industrial hygiene 19 Hungry Boy Nutrition 28 The Warm Room Carbon monoxide October 3 Death at Her Door Diphtheria 10 Half Alive Hearing 17 Eight in a Room Meningococcus meningitis 24 Cowards Die War worry 31 Forty and Fit Keeping well November 7 Thar She Blows Common cold 14 Back Yard Nuisances Nuisances 21 The Rookery 1-lousing 28 Postage Due Tuberculosis Seal Sale December 5 Mother, Beware Whooping cough 12 "Dr. Ashley's" City Garbage collection 19 White Christmas Safe Christmas 26 Your Health-1943 New Year's resolutions To.ni BUREAU OF LABORATORIES

[77 ]

- - ..■,. BUREAU OF LABORATORIES C. Leroy Ewing Director One major effect of the war was the establishment of an all-time record in STS work, that is serologic tests for syphilis. Specimens of blood from Selective Service registrants and,from employees of war industries were in a large measure responsible for the total of 153,877 specimens submitted for STS. In 1941 there were 106,215 such specimens submitted and the increase in specimens in 1942 was 47,662 or 44.9 per cent. Of the total number of specimens 153,368 were blood and 509 were spinal fluid. The following tabulation lists the sources of specimens for STS.

SOURCES OF SPECIMENS FOR STS

Total 153,877

Six hundred and thirty-three physicians 32,522 or 21.1 per cent Selective Service registrants 51,123 or 33.2 per cent Commercial firms, including war plants 48,098 or 31.3 per cent Venereal disease clinics 15,551 or 10.1 per cent Nonofficial hospitals 6,583 or 4.3 per cent

The service of testing specimens from Selective Service registrants was begun in November, 1940 and continued until November, 1942. In this two year period there were received 83,664 specimens representing 70,431 individuals. Because of the development of acute personnel shortages in the bureau it was necessary to discontinue this service in the latter part of the year and the STS work for the city was transferred to the Maryland State Department of Health. The table on the following page gives an analysis of the results of the STS made on Selective Service registrants. In the latter part of 1942 the STS service was extended to include the examination of specimens of blood from the local Red Cross Blood Donor Project. This activity was begun on a very limited basis and involved a total of 18 specimens in the months of November and December. Diagnostic and Other Services Including the STS work there were 282,835 examinations of 191,178 Specimens made by the Bureau of Laboratories during the year. Of this total, 243,000 examinations of 175,854 specimens were made in connection with the diagnosis and control of communicable diseases; and 22,166 bacteriologic and 17,669 chemical examinations were made of 15,324 samples

[79] _

80 REPORT OF THE HEALTH DEPARTMENT-1942

RECORD OF STS MADE ON INDIVIDUAL REGISTRANTS November 1940-November 1942

NUMBER TESTED NUMBER POSITIVE PER CENT POSITIVE

Taal White Negro Total White Negro Total White Negro

Nov.1940 through Nov. 1942 70,431 52,135 18,296 6,317 1,488 4,619 9.0 2.9 25.3 1940 November 410 310 100 21 4 17 5.4 1.3 17.0 December 1,508 1,173 335 108 14 94 7.2 1.2 28.6 1941 January 2,313 1,844 469 200 47 153 8.6 2.5 32.6 February 2,125 1,631 494 , 171 28 143 8.0 1.7 28.9 March 2,609 1,972 637 253 38 215 9.7 2.0 34.0 April 3,136 2,780 356 149 60 89 4.8 2.0 25.0 May 3,972 3,570 402 179 65 114 4.5 1.8 28.4 June 3,473 2,886 587 233 55 178 6.7 1.9 30.3 July 2,453 1,538 915 212 15 197 8.6 1.0 21.5 August 2,023 1,412 611 120 9 111 5.9 0.6 18.0 September 2,187 1,469 718 148 19 129 6.8 1.3 18.0 October 1,551 1,009 542 96 6 90 6.0 0.6 16.6 November 789 379 410 80 4 78 10.1 1.1 18.5 December 1,044 627 417 90 9 81 8.6 1.4 19.4 1942 January 217 151 66 16 1 15 7.3 0.7 22.7 February 215 192 23 8 5 3 3.7 2.6 13.0 March 4,030 2,651 1,379 486 73 413 12.1 2.1 29.9 April 1,962 1,275 687 260 50 210 13.3 3.9 30.6 May 2,252 1,578 674 267 72 195 11.1 3.9 28.9 June 4,058 2,909 1,149 406 100 306 10.0 3.5 26.6 July 4,961 3,944 1,017 358 104 254 7.2 2.6 25.0 August 6,657 4,757 1,900 733 220 513 11.0 4.6 27.0 September 8,020 6,130 1,890 792 231 561 9.9 3.8 29.7 October 7,850 5,508 2,342 861 258 603 11.0 4.7 25.7 November 616 440 176 70 11 59 11.4 2.5 33.5 of milk and food products and industrial or other materials. The grand totals as compared with 1941 increased 4.1 per cent in examinations and 28.4 per cent in specimens and materials. These figures set new records in volume of work performed. Bacteriology The unusual turnover in personnel had some influence on the operation of the bureau and certain services were curtailed in the latter part of the year. In the food laboratory a reduction was made in the number of platings of samples of milk and dairy products and tests for coliform bacteria were restricted to pasteurized milk samples. In previous years such tests had also been made on pasteurized cream and pasteurized chocolate milk. Certain other procedures were placed on a very restricted basis and examinations were made only in exceptional cases. In spite of the curtailment of work the records showed not only increases in routine activitiss but various interesting items. Among these were: Eberthella typhosa wae isolated on one hundred and eight occasions; in seven instances laboratory BUREAU OF LABORATORIES 81 work aided in the detection of typhoid carriers; bacteriologic work performed in an investigation of a gastro-intestinal outbreak among employees in a large downtown establishment revealed that there was sewage in the drinking water supply. Chemistry To offset the curtailments in bacteriologic procedures of milk and dairy products, the Division of Chemistry examined additional samples for the Phosphatase test in order to maintain adequate control of pasteurization Procedures in dairy plants. This phosphatase test which has been used in the bureau for many years is quite valuable and in the year 1942 approximately 1,000 samples were tested. Of these only 4 samples of bottled Pasteurized milk were found to have been improperly pasteurized. The laboratory service for the micro-analytical determination of filth in food was extended in 1942 to cover a wide variety of food products. Examinations were made of more than 360 samples of food obtained from over seventy food establishments and more than 50 per cent of the samples were found to contain such filth as rodent excreta, rodent hairs and insect fragments. There were 223 specimens of blood from 211 individuals tested for lead Poisoning. Concentrations of lead indicative of abnormal absorption were found in specimens from 27 adults and 14 children and 5 of the children died presumably of lead poisoning. Biologic Products As in previous years the bureau distributed antitoxins, vaccines and sera for the prevention and treatment of communicable diseases to physicians, hospitals and other institutions. A total of 20,057 packages of such products was distributed in 1942 which was 1,582 packages or 8.6 per cent more than in 1941.

Type 13 Influenza Bacillus Serum Type B influenza bacillus serum from rabbits which was first made available in February, 1941 was used at Sydenham Hospital and other hospitals during the year for the treatment of 13 cases of influenza bacillus meningitis. One hundred and fifty-six packages or 780 c.c. at a cost of $2,940 were distributed. In the preceding year, during the period from February through December, only 61 packages or 305 c.c. at a cost of $1,342 were used in the treatment of 8 cases. Pneumonia Serum In spite of a more extensive use of the sulfa drugs there was an increase in the amount of pneumonia serum furnished hospitals for medically indi- 82 REPORT OF THE HEALTH DEPARTMENT-1942

gent patients. A total of 28,440,000 units of this material was supplied in 1942 for 100 cases of pneumonia at a cost of approximately $6,363.24 in contrast to 18,050,000 units of serum used in 1941 for 75 cases at a cost of approximately $4,500.00. There were 34,390,000 units of serum distributed in 1940 for 116 cases at a cost of approximately $7,661.00. Other Products There were also increases recorded in the distribution of other biologic products. Among these were 912,000 units of diphtheria antitoxin,1,726 c.c. of diphtheria toxoid, 3,139,000 skin test doses of scarlet fever toxin, 2,924 tubes of smallpox vaccine, 359,000 units of tetanus antitoxin, 2,888 c.c. of typhoid vaccine and 1,116 c.c. of typhoid-paratyphoid combined vaccine. As in the past years a small quantity of Rocky Mountain spotted fever vaccine was given out. This latter material was obtained through the Maryland State Department of Health. Special Investigations The investigation of factors that might produce the so-called false positive phosphatase tests begun in 1940 was completed in 1942. As a result of this study on the phosphatase test and pasteurized milk, conducted jointly in the divisions of bacteriology and chemistry, two papers were prepared for publication. One of these papers by T. C. Buck, Jr. dealt with the work involved in the isolation from pasteurized milk of a thermophilic organism which produces the enzyme phosphatase and the article was printed in the November issue of the American Journal of Public Health. As a result of the chemical investigations which were made as part of this joint study, Dr. Emanuel Kaplan submitted an article on the false positive phosphatase tests to the Journal of the Association of Official Agri- cultural Chemists. This paper presents the development and use of certain very important control procedures which must be employed in testing milk and dairy products for the presence or absence of phosphatase. Because of the widespread use of the phosphatase test as a control procedure in determining whether or not milk has been properly pasteurized, it is believed that the results of the investigations will be of very great value to milk control officials. Information is now available that the milk phosphatase present in raw or improperly pasteurized milk is a different substance from bacterial and other phosphatases that may be present in properly pasteurized milk where there has been a growth of non-pathogenic thermophilic organisms. Utmost care should be taken not only in the performing of the phosphatase test but in the interpretation of laboratory findings. Certain other studies of lesser importance were conducted in the bureau. BUREAU OF LABORATORIES 83

Included among these was the work that was done on the use of individual paper towels for washing and chlorinating the udders of cows before milking in order to reduce bacterial counts. This investigation was not completed at the end of the year. Another study which was conducted in the chemical laboratory was instituted following a warning by the Federal Security Agency concerning the possible occurrence of poisoning from the ingestion of foods and beverages stored in cadmium-plated utensils. The results of this study led to the preparation of an efficient and compact testing outfit to be used in the field by inspectors of the Bureau of Food Control for the detection of such utensils. Personnel C. Leroy Ewing, Director Theodore C. Buck, Jr., Assistant Director Emanuel Kaplan, Sc.D., Chief of the Division of Chemistry IIarry L. Carman, Principal Clerk Laura B. Grim, Senior Clerk Gertrude C. Lipp, Senior Stenographer Kathryn M. IIasler, Senior Stenographer IIarriett II. McCawley, Senior Stenographer Lula M. Weibe, Senior Clerk Edith Silverman, Junior Stenographer John J. Dunn, Senior Bacteriologist Grace L. Bauer, Senior Bacteriologist Katharine E. Welsh, Senior Bacteriologist Anna V. Burkhard, Senior Bacteriologist Harriet Storm, Senior Bacteriologist Mary L. McCauley, Senior Bacteriologist Elizabeth G. Fisher, Junior Bacteriologist Mildred II. Fleischman, Junior Chemist M. J. Doonan, Senior Storekeeper Melissa II. Pyle, Laboratory Assistant Ruth Gorray, Laboratory Assistant Josephine Asendorf, Laboratory Assistan Byrd G. Wenke, Laboratory Assistant Beryl R. Metzger, Laboratory Assistant Thomas II. Hale, Laborer Isaac P. Hornstein, Laborer Arthur P. Hundley, Laborer Louis Svatora, Laborer Tony Kostelak, Laborer 84 REPORT OF THE HEALTH DEPA1TMENT-1942

TABLE NO. 1 SPECIMENS SUBMITTED AND THE NUMBER OF LABORATORY PROCEDURES PERFORMED FOR EACH TYPE OF SPECIMEN

NUMBER or NUMBER OF TYPE OF SPECIMEN SPECIMENS PROCEDURES

Total 175,854 243,000 Animal heads 53 Animal inoculation • • 41 Microscopic test •. 53 Bile 3 Culture test 15 Blood 154,602 Agglutination test. 5,457 Culture test 3,607 Microscopic test 80 Serologic test 199,070 Direct cultures 2,980 Agglutination test 104 Animal inoculation 219 Culture test 1,026 Microscopic test 4,829 • Feces 2,118 • Animal inoculation Culture test 6,659 Microscopic test 265 Fluid (chest, knee, etc.) 57

Animal inoculation • • 29 Culture test 13 Mocroscopic test 128 Helminths 7 • Microscopic test • Pus 8,064 Animal inoculation Culture test 3 Microscopic test 8,093 Serum 60

Microscopic teat • • Dia Spinal fluid 524 • • • Animal inoculation • 6 Culture test 29 Microscopic test 80 Serologic test 2,173 Sputum 7,314 Animal inoculation 1 Culture test 273 Microscopic test 9,368 Urine 92 Agglutination test Animal inoculation 15 Culture test 205 Microscopic test 89 BUREAU -OF LABORATORIES 85

TABLE NO. 2 EXAMINATIONS FOR PHYSICIANS CLASSIFIED BY RESULTS AND TYPE OF EXAMINATION

UrANcTSA0TRIS; TYPE OF EXAMINATION TOTAL POSITIVE NEGATIVE DOUBTFUL

Total 230,153 60,885 155,746 12,507 1,015

DIPHTHERIA Total 2,885 376 2,485 .. 24 Animal inoculation • Virulence test 232 108 124 .. Microscopic Diagnostic 769 96 659 .. 14 Initial 72 .. 72 .. .. Institution 411 73 335 .. 3 Release 1,401 99 1,295 .. 7

DYSENTERY, amebic Total 125 .. 125 .. Microscopic Feces 125 .. 125 .. ••

ENTERIC INFECTIONS . Total 6,279 355 5,610 292 22 Agglutimation Blood, H antigen 1,077 142 1,630 108 7 Blood,0 antigen 1,082 65 923 94 • • Culture Blood 15 14 .. 1 Blood clot 1,078 8 1,068 .. .. Duodenal content 1 1 ...... Feces 2,093 133 1,947 13 Urine 35 6 28 .. 1

GONOCOCCUS INFECTIONS Total 8,018 2,156 4,624 1,215 23 Culture Exudates 76 8 52 •• 18 Microscopic Exudates 7,942 2,150 4,572 1,215 5

INTESTINAL PARASITES Total 134 7 124 .. Microscopic Feces 134 7 124 .. 3

MALARIA Total 31 2 25 2 2 Microscopic Blood smear 31 2 25

METALLIC POISONING Total 248 84 111 39 14 Biochemic Arsenic Cleaner 2 1 1 .. .. Hair 7 7 ...... Hair dressing .. Medicine 1 1 .. .. Nails(human) 3 1 1 1 Spinal fluid 1 .. 1 .. .. Urine 5 5 • • .. .. 86 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 2—Continued EXAMINATIONS FOR PHYSICIANS CLASSIFIED BY RESULTS AND TYPE OF EXAMINATION

UNSAPIS- TYPE OF EXAMINATION -. TOTAL POSITIVE NEGATIVE DOUBTFUL FACTORY

METALLIC POISONING---(COHL) Lead Blood 223 68 103 • 39 13 Spinal fluid 1 .. 1 .. .. Urine 4 - 2 2 • .. ..

PNEUMONIA Total 153 55 98 .. Typing Spinal fluid 153 55 98 .. Sputum 152 55 97 .. - RABIES Total 89 .. 89 .. • • Animal inoculation Brain emulsion 38 .. 38 .. .. Microscopic Animal brain 53 •. 53 .. ..

STREPTOCOCCUS INFECTIONS Total 198 58 140 .. Culture Blood 21 2 19 .. .. Exudates 1 .. 1 .. .. Sputum 18 18 .. .. Swab 151 33 118 .1 • • Precipitin Culture 7 5 2 .. ..

SYPHILIS Total 202,202 56,306 134,176 10,783 847 Biochemie Globulin 509 74 428 4 3 Gum mastic 509 66 421 17 5 Alicroscopio Dark field 63 15 45 3 Precipitin Kline exclusion Blood 82,704 19,254 59,252 3,981 307 Spinal fluid 509 123 361 22 3 Kline diagnostic Blood 23,298 11,785 9,134 2,363 16 Spinal fluid 509 98 386 22 3 Eagle flocculation Blood 93,878 24,910 65,096 3,372 500 Kahn diagnostic Spinal fluid 133 71 53 2 7 BUREAU. OF LABORATORIES 87

TABLE NO. 2—Continued EXAMINATIONS FOR PHYSICIANS CLASSIFIED BY RESULTS AND TYPE OF EXAMINATION

EXAMINATION TOTAL POSITIVE NEGATIVE DOUBTFUL TYPE OF UNSATIS■FACTORY

TUBERCULOSIS Total 7,242 1,272 5,746 149 75 Animal inoculation Exudates 56 8 48 .. .. Microscopic Exudates 66 14 50 2 .. Sputum 7,120 1,250 '5,648 147 75

TULAREMIA Total 212 1 211 .. Agglutination Blood 212 1 211 .. ..

TYPHUS GnouP Total 1,283 29 1,235 19 .. Agglutination Blood Proteus X20 643 13 618 12 .. Proteus X190 640 16 617 7 ..

UNDULANT FEVER Total 847 8 837 2 .. Agglutination Blood 844 8 834 2 .. Culture Blood 1 .. 1 .. .. Feces 1 .. 1 .. .. Urine 1 .. 1 .. ..

VINCENT'S ANGINA Total 39 18 17 2 2 Microscopic Exudates 39 18 17 , 2

WHOOPING COUGH Total 12 " 12 .. .. Microscopic Cough plate 12 .. 12 •. ..

OTHER Total4 156 68 81 4 3 Culture 69 62 4 .. 3 131ochemic Urine (sugar) 2 2 ...... Microscopic 24 3 21 .. .. Serologic 61 1 56 4 .. ss REPORT OF VIE • HEALTH, DEPARTMENT-1942

TABLE NO. 3 CLASSIFICATION OF AGGLUTINATION AND BACTERIOLOGIC TESTS FOR ENTERIC ORGANISMS AGGLUTINATION TESTS

Unsatis- . Organisms Total • Positive Negative Doubtful factory

Total agglutination 3,059 207 2,551 295 6

Eberthella typhosa* 1,957 175 1,569 207 Salmonella choleraesuis 29 .. 29 .. '• Salmonella paratyphi 2 .. 1 Salmonella achottmuelleri 2 .. .. 2 S. paratyphi and echottmuelleri 953 31 837 85 .. Salmonella enteritidis 1 .. 1 • • .. Salmonella (Newport type) 1 .. 1 .. .. Salmonella typhimurium 4 .. 4 .. Shigella dysenteriae, polyvalent 110 .. 110 .. ..

BACTERIOLOGIC TESTS

Total tests 3,122

Positive results 148

Eberthella typhosa 108 Salmonella aertrycke 1 Salmonella enteritidis 1 Salmonella ap. (Newport type) 3 Unidentified salmonella 3 Shigella alkaleacene 2 Shigella madampensis (dispar) 1 Shigella munitissima 1 Shigella paradysenteriae 11 Shigella sonnei 6 B. aerogenes 1 Douglas and Colebrook No. 6 4 Douglas and Colebrook No. 9 6

Negative results 2,959

Unsatisfactory results 15

* Nomenclature adopted from Bergey's Manual of Determinative Bacteriology, Fifth Edition, 1939. Includes all organisms except Douglas and Colebrook No. 6 and No. 9 which are from A System of Bac- eriology, British Medical Research Council, 1931. BUREAU OF LABORATORIES 89

. TABLE NO. 4 BIOLOGIC PRODUCTS DISTRIBUTED TO PHYSICIANS, HOSPITALS AND INSTITUTIONS

PRODUCT NUMBER or PACKAGES BASIC CONTENT TOTAL AMOUNT Total 20,057 Diphtheria products Alum-precipitated toxoid 2,890 Cubic centimeter 26,264 c.c. Antitoxin 338 Unit 5,385,000 units Toxin for Schick test 236 Test 2,420 tests Toxin for Schick test control 238 Teat 2,425 tests Horse serum for conjunctival test 189 Test 1,512 tests Immune globulin for measles 677 Cubic centimeter 1,738 me. Influenza serum, anti H, type 11 156 Cubic centimeter 780 0.0. Meningitis serum 14 Cubic centimeter 300 0.0. Pneumococcus curative serum 1,446 Unit 28,440,000 units Rocky Mountain spotted fever vaccine 40 Cubic centimeter 160 c.c. Scarlet fever products Antitoxin 43 Unit 219,000 units Antitoxin for Schultz-Charlton test 5 Test 5 tests Toxin for Dick test 30 Test 1,105 tests Toxin for prophylaxis 19 Skin test dose 11,835,300 e.t.d. Silver nitrate solution, one per cent 201 Ampule 5,107 ampules Smallpox vaccine 6,195 Point 29,083 points Tetanus products Alum-precipitated toxoid 1 Cubic centimeter 2 c.o. Antitoxin 5,975 Unit 9,775,000 units Tuberculin, Koch's old 312 Cubic centimeter 1,560 c.o. Tuberculin for von Pirquet test 26 Test 66 tests Typhoid vaccine 818 Cubic centimeter 11,107 0.0. Typhoid-paratyphoid vaccine 118 Cubic centimeter 1,600 0.0. -

TABLE NO. 5 SUPPLY MATERIALS AND OUTFITS PREPARED AND DISTRIBUTED

Glassware and material cleaned (units) 1,147,729 Sterilized 832,634 Bottles 64,054 Petri dishes 79,836 Pipettes 388,521 Tubes 311,948 Miscellaneous 8,275 Media prepared Liters 2,531.6 Bottles 11,997 Petri dishes 21,493 Tubes 75,172 Outfits Prepared 199,927 Distributed 195,354 Culture stations 2,196 Health districts 58,572 Laboratory 134,586 Stains prepared Liters 79.9 Water distilled (gallons) 1,699 90 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 6 FOOD AND OTHER SAMPLES SUBMITTED FOR BACTERIOLOGIC ANALYSIS AND EXAMINATIONS PERFORMED

NUMBER OF NUMBER OF TYPE OF SAMPLE SAMPLES PROCEDURES

Total 11,777 22,166 Cream, pasteurized (dairy, store, truck) 525 Plate count Microscopic count 326 Coliform count 200 Cream, raw 35 Plate count io Microscopic count 7 Equipment for sterility (bottles, caps, dippers, spoons) 3,421 Plate count 3,42i Food products 43 Plate count ao Microscopic count 4 Coliform count 24 Special tests 26 Food poisoning 25 Culture test 70 Plate count 24 Shellfish 8 Plate count 8 Coliform count 16 Ice cream 705 Plate count 76 Coliform count 33 Milk, pasteurized (dairy, store, truck) 039 Plate count 1,415 Microscopic count 703 Coliform count 888 Resazurin test 338 Special tests 87 Milk, chocolate, pasteurized and ingredients 612 Plate count 1,01.50 Coliform count 314 Breed count 11 Milk, raw (batch, certified, selected, shippers') 1,340 Plate count 2,706 Microscopic count 1,219 Coliform count 28 Resazurin test 591 Special tests 2 Miscellaneous samples 38 • • Plate count Coliform count 33 Special tests 4 Swabbings from utensils and equipment 1,432 Plate count 1,432 Water 2,654 Plate count 2,513 Coliform count 2,054 Special tests 283 BUREAU OF LABORATORIES 91

TABLE NO. 7 SAMPLES SUBMITTED FOR CHEMICAL ANALYSIS AND THE NUMBER OF LABORATORY PROCEDURES PERFORMED FOR EACH TYPE OF SAMPLE

NUMBER OF NUMBER OF TYPE OF SAMPLE SAMPLES PROCEDURES

Total 6,618* 17,669

Body fluids and excreta 311 Lead test 684 Arsenic test 224 Unclassified biochemio tests 224

Dairy products (milk, cream, chocolate milk, ice cream) 4,551 Butterfat test 4,686 Refractive index (added water) 709 Phosphatase test 3,476 Sediment test 1,062 Unclassified tests 079

Food products 513 Filth test (rodent and insect infestation) 1,165 Adulteration tests 244 Decomposition tests 83 Unclassified tests 43

Miscellaneous samples (air, dusts, solvents, sterilizing solutions, etc.) 175 Industrial poison tests 871 Unclassified tests 918

Solutions and outfits 576 Unclassified tests 1,544

Water samples 402 pH 244 Sanitary analysis 423

* Of this number, 3,547 were submitted for chemical analysis only; the other 3,071 samples were submitted for bacteriologic and chemical analysis.

EASTERN HEALTH DISTRICT

[93]

EASTERN IIEALTH DISTRICT C. Howe Eller, M.D., Dr.P.H. Health Officer The Eastern Health District completed its first ten years of health service in 1942 and a review of the activities was published in the September, 1942 issue of Baltimore Health News. This was the first health district to be organized in Baltimore to provide public health service on a neighborhood basis; it was the first health center to house both administrative offices and clinics; it had the first full time health officer and held the first Health Department meeting for physicians practicing in the neighborhood. Dur- ing 1042 the Eastern Health District continued to provide routine public health services to the people. In the field of public health professional education, the Eastern Health District continued to serve the Johns Hopkins School of Hygiene and Public Health, the Johns Hopkins Medical School, the Johns Hopkins School of Nursing, the Sinai Hospital School of Nursing and the City Health Department. The use of the Eastern Health District for field research in public health increased progressively during the ten years of the District's existence. Of the forty-five scientific reports on research either carried out in the Eastern Health District or based on Eastern Health District material, thirteen were published in 1942. Two new studies of interest were begun in the Eastern Health District in 1942. Both were under the direction of the Harriet Lane Home of the Johns Hopkins Hospital. One of these was a field study of a measles vaccine which, it is hoped, provides immunity to the disease by producing an extremely mild case in the individual to whom the vaccine is given. The other new study provides for the trial use, under controlled conditions, of a fortified evaporated milk which includes all the necessary vitamins and minerals. If satisfactory, this milk will be of the greatest value for infant feeding in war zones and other areas where necessary vitamin and mineral containing foods have been almost completely absent. The Eastern Health District Conference Committee continued to meet regularly during the year. A new plan was adopted by the committee to review outlines for all contemplated studies to be carried out in the Eastern Health District so that duplication and overloading can be avoided. Personnel C. Howe Eller, M.D., Dr.P.II., Health Officer, Full Time IIugh P. Hughes, M.D., Health Officer

1 951 96 REPORT OF THE HEALTH DEPARTMENT-1942

Lucille Liberles, M.D., Health Officer John Constantini, M.D., Medical Investigator Dorothy Shaw, Secretary Olga Carr, Junior Stenographer Helen C. Reddish, Junior Stenographer Virginia Monouydas, Clerk Winifred Newberry, Supervisor of Nursing Elizabeth Schweikert, Assistant Supervisor of Nursing Alice Sundberg, Assistant Supervisor of Nursing Gertrude Boquist, Assistant Supervisor of Nursing Charles Desmond, Janitor Public Health Nurses Catherine M. Backus Linda E. Hartung Olive T. Berman Lillian Kemp Mary E. Clifford Margaret King Margaret T. Ellis Wilda L. Snyder Mildred E. Foster Maude C. Suter Margaret D. Galbreath Virginia R. Struve Mildred L. Gambrill Berta II. Taylor Teresa Griffin 0. Ruth Thompson Nell Urbana IIammer Martha C. Wilson Elizabeth Wolfe EASTERN HEALTH DISTRICT 97

TABLE NO. 1 RESIDENT BIRTHS, EASTERN HEALTH DISTRICT-1942

PLACE OF DELIVERY AND ATTENDANT TOTAL Warm COLORED

All births 2,700 1,620 1,080

Hospital 2,048 1,293 755 Home 652 327 325 Out-patient delivery service 7 2 5 Private physician 502 299 203 Midwife 143 26 117

TABLE NO. 2 RESIDENT DEATHS ACCORDING TO MAJOR GROUPS OF CAUSES AND COLOR EASTERN HEALTH DISTRICT-1942

CAUSES OF DEATH TOTAL WHITE COLORED

All Causes 1,459 889 570

I. Infectious and parasitic diseases (exclusive of tuberculosis and syphilis) 29 12 17 Tuberculosis (all forms) 137 42 95 Syphilis 33 12 21 II. Cancer and other tumors 152 118 34 III. Rheumatism, diseases of nutrition and of the endocrine glands, other general diseases and avitaminoses 50 37 13 IV. Diseases of the blood ana blood-forming organs 10 7 — 3 V. Chronic poisoning and intoxication 13 8 8 VI. Diseases of the nervous system and sense organs 108 70 36 VII. Diseases of the circulatory system 408 291 117 VIII. Diseases of the respiratory system 113 51 62 IX. Diseases of the digestive system 73 50 23 X. Diseases of the genito-urinary system 150 94 58 XL Diseases of pregnancy, childbirth and the puerperium 5 1 4 XII. Diseases of the skin and cellular tissue .. • • •• XIII. Diseases of the bones and organs of movement 2 .. 2 XIV. Congenital malformations 17 11 6 XV. Diseases peculiar to the first year of life 48 24 22 XVI. Senility • • • • • • XVII. Violent and accidental deaths 114 80 54 XVIII. Ill-defined or unknown 1 1 • • 98 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 3 COMMUNICABLE DISEASES REPORTED IN THE EASTERN HEALTH DISTRICT-1942

DISEASE CASES

TOTAL 1,384

Chickenpox 325 Diphtheria German measles 19 Measles 472 Meningococcus meningitis 31 Poliomyelitis 1 Scarlet fever 84 Whooping cough 446

TABLE NO. 4 DIPHTHERIA TOXOID AND SMALLPDX VACCINE ADMINISTERED TO RESIDENTS OF THE EASTERN HEALTH DISTRICT-1942

DIPHTHERIA INOCULATION SMALLPDX VACCINATION AGE AT DATE OF INOCULATION OR VACCINATION TOTAL WHITE COLORED TOTAL WHITE COLORED

Total 2,448 1,346 1,102 2,247 037 1,310

Under 1 year 1,808 1,089 719 676 262 414 1 185 83 102 407 127 280 2 02 28 64 244 99 145 3 63 26 37 179 02 87 4 70 25 45 175 83 92 5 103 45 58 274 139 135 6 76 33 43 170 80 90 7 25 9 16 44 17 27 8 12 4 8 23 7 16 9 7 1 6 7 3 4 10 years and over 7 3 4 48 28 20 9

WESTERN HEALTH DISTRICT

I U9 I ■

. WESTERN HEALTH DISTRICT

Alfred C. Moore, M.D. Health 0tiSr.er The Western Health District completed its seventh year of service during 1942, and continued to offer health services on a neighborhood basis to the people living in the district. The office is in the immediate vicinity of the University of Maryland School of Medicine and the Uni- versity Hospital which makes it convenient for physicians to avail them- selves of the services provided by the district office. One graduate nurse and twenty-four undergraduate nurses were affiliated for instruction in public health nursing. They came from the city schools of nursing as follows: Nine from the University of Maryland; six from St. Agnes Hospital; and nine from Provident Hospital. Public health educational activities were conducted for professional groups, the lay public living in the district and for the staff., These services included a course in communicable disease control for the undergraduate nurses of the Univer- sity of Maryland School of Nursing, talks to lay groups on the program of the Health Department, distribution of. Health Department pamphlets, and conferences and discussions for the staff nurses of the district. During the year the new type of school health service which had been inaugurated in the Eastern Health District in 1941 was introduced in School No. 34 located at Washington Boulevard and Carey Street. During the Year special emphasis was placed upon diphtheria prevention and newcomers to the district were sought out and every effort was made to provide them with health service. Special attention was given to the detection of insanitary, defective and overcrowded • housing conditions which were dangerous or detrimental to life or health. Druid Health Center The Chest Clinic, removed from 1516 Madison Avenue, was opened at the Druid Health Center on December 1, 1942 with a schedule of two afternoon and three weekly night sessions. In addition to the regular routine of the clinic, a systematic program for case finding of tuberculous school children and student nurses was planned and will eventually be expanded to include the X-raying of other groups. The new type health program was instituted at School No. 100 located at Mount and Saratoga Streets. Evidence was shown that this method of examination was to prove an effective one. 102 REPORT OF THE HEALTH DEPARTMENT-1942

Twenty-four Health Department clinic sessions were conducted each week at the Druid Health Center. There was a total of 77,036 clinic visits during 1942 which was a decrease of 1,180 from 1941. From its establishment in 1939 until the end of 1942, a total of 224,305 clinic visits have been made to the Druid Health Center. In addition to the Health Depart- ment clinics the Mental Hygiene Society of Maryland conducted sessions each Wednesday night. The Center has become the hub of health and civic activities and organizations that have used its facilities for meeting purposes include the Monumental City Medical Society,the Women's Cooperative Civic League, the Graduate Nurses Association, the National Negro Health Week Com- mittee, the• Clean Block Campaign Committee and the Colored Municipal Employees Association. In addition, Boy Scouts, school children, student nurses from various hospitals and medical students assembled at the Druid Health Center for health instruction and study and the Baltimore League for the Hard of Hearing held classes each Monday night for those with impaired hearing. Nine student nurses from Provident Hospital Training School for Nurses completed student affiliate courses in public health nursing. Personnel Alfred C. Moore, M.D., IIealth Officer, Full Time II. Maceo Williams, M.D., M.P.II., Health Officer, Full Time J. Walker Thomas, M.D., Health Officer James B. Hawkins, M.D., Health Officer J. G. McRae, M.D., Health Officer D. McKinley Reesby, M.D., Health Officer Zelda Goldsmith, Junior Stenographer Paula E. Wild, Junior Stenographer Lauline Beckwith, Junior Stenographer Margaret Dorsey, Junior Stenographer Anna Persch, Senior Supervisor of Field Nurese Dorothea Tag, Senior Supervisor of Field Nurses Bernard A. Smith, Janitor Public Health Nurses Genevieve Beaton Mary Sewell Jenkins Frances T. Brown Bess C. Lang Theresa Byrne Margaret L. Lockerman Olga M. Chambers Mary C. Malone Florence Collins Beulah B. McCausland Minnie Leah Corbin Ella McKenna Ethelyn Dever Sylvia Miller M. Fanida P. Friend Elizabeth Moore Carolyn Gail Ella T. Nichols Margaret S. IIarper Cecelia Nossell WESTERN HEALTH DISTRICT 103

Katherine Nutto neva Rosenfeld Cornelia Phillips Bertha Schrock Agnes C. Pilgrim Anne Smith Ruth B. Pyle Pearl L. J. Smith Julia Quental Grace S. Volmar Gladys M. Redmond Dorothie Williams Sara Sigel Rice Ethel G. Young Florence Roberts Mathilda E. Young 104 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 1 RESIDENT BIRTHS, WESTERN HEALTH DISTRICT-1942

PLACE Ow DELIVERY AND ATTENDANT TOTAL WHITE COLORED

All births 4,523 1,605 2,918

Hospital 2,454 1,073 1,381 Home 2,069 532 1,537 Out-patient delivery service 1,117 96 1,021 Private physician 789 423 366 Midwife 163 13 150

TABLE NO. 2 RESIDENT DEATHS ACCORDING TO MAJOR GROUPS OF CAUSES AND COLOR WESTERN HEALTH DISTRICT-1942

CAUSE OF DEATH TOTAL WRITE COLORED

All Causes 3,048 1,118 1,930

I. Infectious and parasitic diseases (exclusive of tuberculosis and syphilis) 54 19 35 Tuberculosis (all forms) 331 62 269 Syphilis 80 12 68 IL Cancer and other tumors 279 135 144 III. Rheumatism,diseases of nutrition and of the endocrine glands, other general diseases and avitaminoses 63 27 36 IV. Diseases of the blood and blood-forming organs 13 7 6 V. Chronic poisoning and intoxication '15 7 8 VI. Diseases of the nervous system and sense organs 266 77 189 VII. Diseases of the circulatory system 828 399 429 VIII. Diseases of the respiratory system 274 93 181 IX. Diseases of the digestive system 142 61 81 X. Diseases of the genito-urinary system 295 67 228 XI. Diseases of pregnancy, childbirth and the puerperium 14 3 11 XII. Diseases of the skin and cellular tissue 4 1 3 XIII. Diseases of the bones and organs of movement 1 .. 1 XIV. Congenital malformations 21 10 11 XV. Diseases peculiar to the first year of life 111 35 76 XVI. Senility 2 2 .. XVII. Violent and accidental deaths 253 99 154 XVIII. Ill-defined or unknown 2 2 .. WESTERN HEALTH DISTRICT 105

TABLE NO. 3 COMMUNICABLE DISEASES REPORTED IN THE WESTERN HEALTH DISTRICT-1942

DISEASE CASES

TOTAL 1,301

Chickenpox 261 Diphtheria 20 German measles 11 Measles 566 Meningococcus meningitis 38 Mumps 1 Poliomyelitis 2 Scarlet fever 76 Typhoid fever S Whooping cough 321

TABLE NO. 4 DIPHTHERIA TOXOID AND SMALLPDX VACCINE ADMINISTERED TO RESIDENTS OF THE WESTERN HEALTH DIST1tICT-1942

DIPHTHERIA INOCULATION SMALLPDX VACCINATION AGE AT DATE OF INOCULATION OR VACCINATION TOTAL WHITE COLORED TOTAL WHITE COLORED

Total 4,393 702 3,601 2,221 443 1,778

Under 1 year 1,927 144 1,783 1,052 100 052 1 270 45 225 188 37 151 2 184 40 144 167 43 124 3 142 39 103 145 37 108 4 117 28 80 176 49 127 5 376 66 310 251 59 102 6 468 140 328 128 44 84 7 236 55 181 20 15 14 8 200 48 152 10 12 7 9 168 36 132 17 11 6 10 years and over 305 61 244 49 38 13 r -

■

, SOUTHEASTERN HEALTH DISTRICT I

[ 107]

SOUTHEASTERN IIEALTII DISTRICT

John A. Skladowsky, M.D. Health Officer Particular effort was directed during the year to caring for the public health needs of war workers who came to live in the district area and to provide preventive health services for persons in the two defense housing projects located in the district. At the Armistead Gardens Homes located at Philadelphia Road and Homers' Lane, in addition to the weekly diphtheria prevention and vaccination clinics held in the recreation building of this project since 1941, preschool hygiene services were given to the nursery school operated by the Work Projects Administration soon after its establishment on April 13. In March, an intensive house-to-house canvas was made by the district nurses to urge diphtheria toxoid inoculation and smallpox vaccination for the newcomers who had never received these protective health measures. The manager of the Armistead Gardens Homes also cooperated and submitted a list of new tenants each week so that they could be visited by the public health nurses. Plans progressed for the establishment early in 1943 of an infant and preschool hygiene clinic in this project. On May 6 a neighborhood infant and preschool hygiene clinic was opened in specially built quarters in the Clarence Perkins Homes at 1411 Gough Street. At this well baby clinic, which began two weekly sessions on July 14, toxoid for the prevention of diphtheria and vaccination against smallpox are given. A new school hygiene program was put in operation in School No. 47, Meet Street and Linwood Avenue, with the opening of the school term in September. The public health nurse interviewed the parents of children entering school for the first time to explain the new program and advised them to have their children examined by their private physicians. About one half of the total number of these children were taken to private physicians for examination and the others were examined by the health officer in the school in the presence of the parents. Encouraged by this response, expansion of the program was planned for another school in the district. In order to improve the services for tuberculosis control, biweekly evening clinics serviced by the Southeastern Health District public health nurses were established on December 1 at the Municipal Chest Clinic at 28 South Broadway. This was done in accordance with the new city-wide clinic schedule of the Bureau of Tuberculosis.

[ 109 1 110 REPORT OF THE HEALTH DEPARTMENT-1942

A joint gathering of the nursing staffs of the Eastern and Southeastern Health Districts was addressed in the district assembly room on Decem- ber 11 by Mrs. Eleanor Blake, District Secretary of the Family and Chil- dren's Society, on the new program and work of that organization. Ar- rangements were made by the Bureau of Public Health Nursing for the placement early next year of a field supervising nurse to give public health nursing instruction to newly assigned staff nurses and also to other affiliate nurses. Personnel John A. Skladowsky, M.D., IleaIth Officer, Full Time 0. L. Long, M.D., Health Officer Lewis J. Rosenthal, M.D., Health Officer Margaret M. Caruso, Junior Stenographer Veronica K. Satterfield, Junior Stenographer Mary I. Streckfus, Senior Supervisor of Field Nurses Blanche C. Craig, Assistant Supervisor of Nursing Jerome Johnson, Janitor Public Health Nurses Florence P. Colburn Tillie Krucoff Helen Collins Loretto C. Link Margaret Duddy Zena T. Mattie Agnes Emerson Virginia S. Pendleton Edna Faith Grace B. Ridgaway Helen F. Fluskey Ruth E. Rouse Zazel Gonyou Rose Shenk Julia R. lIagenbuch Alice Stevenson Florence Zinz SOUTHEASTERN HEALTH DISTRICT 111

TABLE NO. 1 RESIDENT BIRTHS, SOUTHEASTERN HEALTH DISTRICT-1942

PLACE OF DELIVERY AND ATTENDANT TOTAL WHITE COLORED

All births 2,348 2,265 83

Hospital 1,752 1,701 51 Home 596 564 32 Out-patient delivery service Private physician 481 466 15 Midwife 115 98 17

TABLE NO. 2 RESIDENT DEATHS ACCORDING TO MAJOR GROUPS OF CAUSES AND COLOR SOUTHEASTERN HEALTH DISTRICT-1942

CAIIBE OF DEATH TOTAL WAITE COLORED

All Causes 1,122 1,036 86

I. Infectious and parasitic diseases (exclusive of tuberculosis and syphilis) 15 14 1 Tuberculosis (all forms) 90 71 19 Syphilis 24 14 10 II. Cancer and other tumors 116 113 3 III. Rheumatism,diseases of nutrition and of the endocrine glands, other general diseases and avitaminoses 49 46 3 IV. Diseases of the blood and blood-forming organs 4 4 .. V. Chronic poisoning and intoxication 5 5 .. VI. Diseases of the nervous system and sense organs 76 69 7 VII. Diseases of the circulatory system 360 341 19 VIII. Diseases of the respiratory system 86 78 8 IX. Diseases of the digestive system 61 61 X. Diseases of the genito-urinary system 83 77 XI. Diseases of pregnancy, childbirth and the puerperium 5 5 XII. Diseases of the skin and cellular tissue .. .. XIII. Diseases of the bones and organs of movement 1 1 • . XIV. Congenital malformations 19 19 . • XV. Diseases peculiar to the first year of life 27 26 1 XVI. Senility • • • • • • XVII. Violent and accidental deaths 101 92 9 XVIII. Ill-defined or unknown .. • • • • ,112 REPORT; OF THE HEALTH DEPARTMENT-1942

TABLE NO. 3 COMMUNICABLE DISEASES REPORTED IN THE SOUTHEASTERN HEALTH DISTRICT-1942

DISEASE CASES

TOTAL 1,284

Chickenpox 273 Diphtheria 11 German measles 20 Measles 888 Meningococcus meningitis 20 Meningococcus septicemia 1 Mumps 1 Scarlet fever 143 Typhoid fever 4 Whooping cough 143

TABLE NO. 4 DIPHTHERIA TOXOID AND SMALLPDX VACCINE ADMINISTERED TO RESIDENTS OF THE SOUTHEASTERN HEALTH DISTRICT-1942

DIPHTHERIA INOCULATION SMALLPDX VACCINATION AGE AT DATE OF INOCULATION OR VACCINATION TOTAL WHITE COLORED TOTAL WHITE COLORED

Total 1,732 1,840 92 1,726 1,637 89

Under 1 year 747 708 41 415 376 39 1 188 179 9 289 282 7 2 109 • 104 5 220 212 ' 8 3 77 74 .3 172 188 4 4 72 72 0 190 187 3 S 149 148 1 221 211 10 6 163 144 19 131 117 14 7 77 71 6 27 25 2 8 46 45 1 6 6 0 9 39 38 3 4 4 0 10 years and over 57 53 4 51 49 2 County cases 8 8 .. •• .. .. o•— •••■•••■■■11.

MEDICAL SECTION

1 113

BUREAU OF COMMUNICABLE DISEASES

[115] ■.■ BUREAU OF COMMUNICABLE DISEASES

David H. Andrew, M.D., C.P.H. Director A total of 31,734 cases of communicable diseases was reported during the year as compared with 36,556 cases in 1941. However, while this was a decrease in the total number of cases reported, there was a relatively sharp increase in the incidence of meningococcus meningitis and diphtheria. Meningococcus Meningitis There were 202 cases and 31 deaths of meningococcus meningitis reported in 1942 as compared with 72 cases and 11 deaths in 1941. This was the largest number of cases of this disease reported in Baltimore in any one year since 1936. Further mention of the disease appears in other sections of the REPORT. Diphtheria Out of the 74 cases of diphtheria reported in 1942, there were 2 resident deaths, those of a forty year old white man and a four year old colored child. There was no record of either patient ever having received the preventive toxoid inoculation. The form entitled "Parent's Register for Health Service" was distributed again in 1942 to new employees of industrial plants in cooperation with the Division of Industrial Hygiene. There were 10,136 forms returned to the Health Department by these new employees. When there were children under twelve years of age in the families, the names and addresses were referred to the Bureau of Public Health Nursing for home visits so that toxoid might be given and also other health services. Two new defense housing projects were opened in the southernmost part of the city in close proximity to one of the larger war industries. Diph- theria toxoid clinics were held one day each week in the administration buildings of the housing projects and 203 children were given the preventive toxoid. One hundred and ninety-six of the children were under five years of age. There were 18,582 children inoculated against diphtheria Siring the year as compared with 18,407 children in 1941. A total of 11,421 children under one year of age received preventive toxoid inoculations during the year as compared with 10,103 children for the previous year. While this was a moderate increase in the number of the young children under one year of

[ 117] 118 REPORT OF THE HEALTH DEPARTMENT-1942

age who were given the toxoid inoculation, 3,864 more births occurred in 1942 than in 1941. Private physicians reported that they had inoculated 7,026 children in their private practice as compared with 5,300 in 1941. Practically all of these children were under one year of age. A study of the 74 recorded cases of diphtheria showed that in 28 instances or for 37.8 per cent of the total number of cases there were records to show that the patient had been previously inoculated against diphtheria. In 23 of these cases alum-precipitated toxoid had been given; in 4 cases Ramon toxoid was used and 1 had been given toxin-antitoxin. In the remaining 46 cases there was no record in the City Health Department to show that any type of inoculation had been given. At the close of 1942 it was estimated that 75.3 per cent of the child population of Baltimore under five years of age had been inoculated against diphtheria as compared with 80.1 per cent at the end of 1941. The estimated percentage of the group of children from five to nine years of age who had been inoculated at the close of 1942 was 89.1 as compared with 94.6 per cent at the end of 1941.

Typhoid Fever

A total of 31 cases and 1 death of typhoid fever was reported during 1942 as compared with 35 cases and 3 deaths in 1941. The following summary shows the probable source of infection of the cases reported during 1942: Probable method of infection a. Contact with active case 3 b. Contact with hitherto unknown carrier 11 c. Contracted out of town 2 d. Swimming in polluted streams 4 e. Method of infection undetermined 11

Eight new typhoid fever carriers were added to the Health Department list during 1942 and 2 were removed making a total of 75 carriers under supervision by the Department at the end of the year. Five of the new carriers were found to have been the cause of 10 cases. One carrier who worked as a milk handler in a private institution within the city limits was the cause of 6 cases of typhoid fever. One of the cases reported during the year was, contracted from a grandmother who was a typhoid carrier when she visited in Baltimore for a short time. Two carriers were found as a result of laboratory examinations of patients who were ill with other diseases. Another carrier was referred by an out-of-state Health Depart- ment when she moved to Baltimore. Two carriers were removed from the list by death. BUREAU OF COMMUNICABLE DISEASES 119

Rabies For the first time since 1931 a number of rabid dogs were found in Baltimore County near Baltimore City. A quaratine against dogs running at large was instituted from June 11 to September 11 in northwest Balti- more and in the adjoining Baltimore County area. One Baltimore resident while visiting in Baltimore County was bitten by a dog found to be rabid but the antirabic treatment was given and the disease was not contracted. There were 1,838 cases of dog or other animal bites reported to the Health Department in 1942 as compared with 1,854 cases for the previous year. Whooping Cough There was a slight decrease in the incidence of whooping cough during 1942 as compared with the previous year. A total of .2,174 cases and 9 deaths was reported during 1942 as compared with 2,560 cases and 30 deaths during 1941. Of the 9 deaths, 6 were children under one year of age and 3 were slightly over one year of age. Five of the deaths were among colored children and 4 were white children. The decrease in the incidence of the disease continued during the first part of the year but in October a definite increase was noted. Poliomyelitis Only 3 resident cases and no resident death of paralytic anterior poliomyelitis were reported in Baltimore in 1942 as compared with 101 cases and 3 deaths in 1941. All 3 of the cases occurred within a three week period during the late part of the summer. Measles A total of 6,445 cases and 1 death of measles was reported during 1942 as compared with 4,458 cases and 3 deaths during 1941. Practically all of the cases occurred during the first five months of the year. Smallpox The procedure of vaccinating individuals who applied for work in the war industries was continued throughout the year. There were 1,990 persons vaccinated against smallpox during the year in the office of the bureau director. For the fourteenth consecutive year, no case of this disease was reported in Baltimore. The last recorded case was reported on March 9, 1928. Personnel David II. Andrew, M.D., C.P.II., Director Anthony L. Rettaliata, M.D., Health Officer, Pull Time 120 REPORT OF THE HEALTH DEPARTMENT-1942

Roscoe Z. G. Cross, M.D., Health Officer Harold V. Harbold, M.D., Medical Investigator L. S. IIorka, M.D., Health Officer Henry B. Kolb, M.D., Health Officer Amelia Link, M.D., Health Officer IIoward Warner, M.D., Health Officer Samuel Weinberg, M.D., Health Officer Celeste Woodward, M.D., Medical Investigator Alice V. Owings, Senior Clerk Grace E. Herbert, Senior Stenographer M. Loucille Thompson, Junior Stenographer BUREAU OF COMMUNICABLE DISEASES 121

TABLE NO. 1 CASES AND RESIDENT DEATHS OF REPORTABLE DISEASES-1939-1942

1942 1941 1940 1939 DISEASES Cases Deaths Cases Deaths Cases Deaths Cases Deaths

Chancroid 162 .. Er88 .. 198 .. 167 .. Chickenpox 3,007 .. 3,045 2 3,289 .. 2,231 1 Conjunctivitis, acute 154 .. 150 .. 132 .. 154 .. Diarrhea and enteritis Under 2 years of age 142 102 196 144 110 54 156 45 Two years and over 11 13 22 15 13 17 30 17 Diphtheria 74 2 47 3 49 1 67 3 Dysentery Amebic 11 2 11 2 4 .. 13 1 Bacillary 84 3 105 13 73 7 134 12 Unspecified 14 1 32 4 20 1 43 .. Encephalitis lethargica 3 • • 4 .. 2 2 1 1 Erysipelas 40 4 35 .. 40 1 89 German measles 195 • • 7,865 .. 42 .. 48 .. Gonococcus infection 3,362 12 2,906 8 2,326 8 2,252 12 Gonorrheal ophthalmia 26 .. 35 .. 43 .. 27 .. Impetigo contagiosa 9 .. 10 .. 35 .. 59 .. Influenza 130 60 509 67 505 56 562 63 Leprosy ...... 1 ...... Malaria 11 1 15 .. 12 .. 3 .. Measles 6,445 1 4,458 3 88 .. 11,833 9 Meningococcus meningitis 202 31 72 11 13 5 18 6 Mumps 2,194 .. 1,711 1 193 .. 1,054 1 Other venereal diseases 36 .. 22 2 49 1 30 .. Paratyphoid fever 1 1 ...... 2 Pellagra .. .. 4 i 3 2 3 19 6 Pneumonia Bronchopneumonia 722 373 534 277 704 308 740 363 Lobar pneumonia 1,069 331 930 341 1,191 317 1,041 305 Unspecified 343 3 293 9 269 3 100 .. Poliomyelitis (paralytic cases) 3 .. 101 3 4 .. 20 .. Rabies in man ...... Rocky Mountain spotted fever 4 1 2 .. 2 .. 1 .. Scarlet fever 826 .. 857 .. 571 2 598 1 Septic sore throat 143 .. 110 3 95 3 97 1 Smallpox ...... Salmonella infection 4 .. 17 .. 19 .. 8 .. Syphilis 11,293 201 7,838 198 6,213 219 7,507 258 Tetanus 11 7 4 1 5 .. 8 3 Trachoma ...... 3 .. 3 .. Trichinosis ...... 12 .. 1 .. Tuberculosis Pulmonary 1,631 749 1,842 760 1,474 769 1,430 631 Other forms 55 61 61 51 69 47 85 42 Tularemia .. 1 .. 9 2 31 8 Typhoid fever 31 1 35 3 23 1 24 1 Typhus fever 2 .. 2 1 .. .. 6 2 Undulant fever 1 .. 7 .. 3 .. 9 1 Vincent's angina 14 16 .. 25 .. 24 .. Whooping cough 2,174 9 2,560 30 5,258 24 1,575 9 122 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 2 CASES AND RESIDENT DEATHS OF CERTAIN DISEASES ACCORDING TO MONTHS-1942 -

1 il IA DISEASES f8 4 1 R,3 tjZ ' tgg:gg,?;i 1-4 •4 r44 .4 r4.' 4D1 g .4 en" 0 Z A

Typhoid fever Cases 31 3 . 1 1 5 7 4 2 1 4 3 .. Deaths 1 Paratyphoid fever Cases 1 1

Meningococcus meningitis Cases 202 18 12 18 18 21 22 11 10 16 15 13 28 Deaths 31 3 2 3 5 3 2 2 .. 2 2 2 5 Scarlet fever Cases 826 78 97 09 117 124 70 34 18 25 39 52 75 Deaths Whooping cough Cases 2,174 100 126 110 141 139 165 165 161 174 271 303 319 Deaths 9 .. .. 1 1 .. .. 1 2 1 1 .. 2 Diphtheria Cases 74 10 3 6 2 7 10 7 8 2 5 9 5

Tuberculosis, pulmonary Cases 1,031 124 110 130 149 140 139 174 157 133 115 112 142 Deaths 749 59 71 77 82 65 61 56 66 57 48 51 58 Tuberculosis, other forms Cases 55 4 5 4 3 1 5 9 4 8 5 4 3 Deaths 61 3 1 2 5 8 6 10 5 4 5 7 5 Influenza Cases 130 22 11 23 14 5 2 6 6 4 12 7 18 Deaths 60 10 10 3 8 4 2 1 3 .. 6 2 11 Measles Cases 6,445 767 955 1,738 1,684 016 280 57 17 14 6 5 8

Poliomyelitis (paralytic cases) Cases Deaths Encephalitis lethargies Cases Deaths German measles Cases 195 18 34 30 40 38 13 3 4 2 5 4 4 Deaths .. Chickenpox Cases 3,007 196 419 576 493 508 269 46 19 3 18 89 171 Deaths Rocky Mountain spotted fever Cases

Bronchopneumonia Cases 722 70 105 96 49 39 22 36 20 38 61 60 117 Deaths 373 39 39 45 30 10 10 26 23 24 30 34 63 Lobar pneumonia Cases 1,069 141 148 140 143 90 57 61 46 35 50 66 85 Deaths 331 41 33 59 27 26 12 14 15 10 24 20 50 Pneumonia, unspecified Cases 343 24 41 57 41 26 20 12 12 13 16 34 47 Deaths 3 1 ...... 1 1 ...... ,. .. BUREAU OF COMMUNICABLE DISEASES 123 ;-

TABLE NO. 3 DIPHTHERIA PREVENTION SUMMARY

PERSONS HAVING RECEIVED THE REQUIRED DOSAGE OF AN APPROVED IMMUNIZING AGENT-YEARS IN WHICH TREATED TOTAL AT SPECIFIED AGES, AGE AT TIME AS OF DECEMBER 31, 1942 PROTECTED WHO HAVE RECEIVED 1036 TOXOID and 1937 1938 1939 1940 1941 1942 Prior Under 1 year 5,925 5,5341 7,349 8,786 8,389 10,103 11,421 11,421 1 year 6,749 1,289 1,302 1,079 951 1,131 1,260 11,363 Total under 5 yrs. 2 years 6,935 653 745 555 492 637 697 10,217 53,833 3 years 7,056 536 585 421 394 528 518 10,892 4 years 6,689 489 553 400 390 556 492 9,940 5 years 7,307 1,152 1,368 1,241 1,165 1,176 1,074 9,415 8 years 8,526 1,723 1,940 1,640 1,446 1,393 1,266 11,212 Total 5-9 yrs. 7 years 8,908 1,084 1,073 706 671 669 536 11,481 55,999 8 years 8,564 1,049 1,044 493 509 560 393 11,772 9 years 8,392 1,128 1,130 337 432 553 335 12,119 10 years and over. 54,708 3,172 2,194 502 832 1,041 564 125,752 Grand Total Unstated 490 105 42 57 89 60 26 869 236,453

NOTE: Figures in column headed "1936 and prior" are the number of children at specified ages in 1936 who had been inoculated that year or prior. 124 REPORT OF THE HEALTH--DEPARTMEN1.942

TABLE NO. 4 DIPHTHERIA CASES AND PERCENTAGE OF POPULATION (BY AGE GROUPS) GIVEN AN IMMUNIZING AGENT-1925-1942

NUMBER GIVEN PERCENTAGE GIVEN NUMBER ESTIMATED POPULATION IMMUNIZING AGENT IMMUNIZING AGENT DIPFITRERIA AS OF DECEMBER 31 AS OF DECEMBER 31 YEAR CASES REPORTED Age Group Age Group Age Group Age Group Age Group Age Group 0-4 5-9 0-4 5-9 0-4 5-9

1942 74 71,510 62,813 53,833 55,999 75.28 89.12 1941 47 59,622 58,771 47,786 55,603 80.15 94.61 1940 49 55,459 56,557 43,601 53,510 78.62 94.61

1939 67 56,403 58,259 41,372 51,802 73.35 89.07 1938 125 57,313 59,935 38,155 50,538 66.57 84.32 1937 257 58,243 61,585 35,186 47,351 60.41 76.80 1936 146 59,138 63,209 33,354 41,697 86.40 65.97 1935 119 60,017 64,807 28,080 40,907 46.80 63.12

1934 108 60,879 66,379 25,644 38,754 42.12 58.38 1933 137 61,725 67,928 19,611 35,360 31.77 52.06 1932 254 62,555 69,444 15,194 35,407 24.29 50.99 1931 416 63,368 70,938 10,489 30,630 16.55 43.18 1930 522 64,165 72,406 6,776 35,223 10.56 48.65

1929 547 64,874 73,265 5,824 30,290 8.98 41.34 1928 829 65,409 72,368 3,334 25,277 5.10 34.03 1927 1,619 65,925 71,476 3,438 18,358 5.21 25.68 1926 837 66,422 70,589 2,449 11,340 3.69 16.06 1925 897 66,901 69,706 1,660 5,458 2.48 7.83 4

BUREAU OF COMMUNICABLE DISEASES 125

TABLE NO. 5 INOCULATION HISTORIES OF DIPHTHERIA CASES-1942 CASES WITH INOCULATION HISTORY CASES WITH- CONFIRMED OUT HISTORY - GROUPS OF PREVIOUS Alum- UNCON- INOCULATION TOTAL Precipi- Ramon Toxin- FIRMED Total tated Toxoid Antitoxin Toxoid

TOTAL CASES 34 40 28 23 4 1 12

A. CLASSIFIED BY AGE

Age Groupe 0-2 years 4 2 2 2 0 0 0 3-4 years 8 4 1 1 0 0 3 5-0 years 5 18 16 15 1 0 2 10-14 years 1 13 7 5 1 1 8 15 and over 16 3 2 0 2 0 1

B. CLASSIFIED BY TIME SINCE INOCULATION

Time Since Inoculation 0-3 months 1 1 1 0 0 4-11 months 1 1 1 0 0 1 year 4 3 3 0 1

2 years 2 2 2 0 0000 0

3 and over 22 21 16 4 . 1

Unspecified 10 0 0 0 0 10

SYDENHAM HOSPITAL

[127 1 ■ SYDENHAM HOSPITAL

Myron G. Tull, M.D., M.P.H.

Superintendent Sydenham Hospital began an affiliation on October 1 with the Johns Hopkins Hospital Training School for Nurses for instruction in the communicable diseases. The nurses continued to live at their respective training schools and reported in groups of six for lectures and practical work from 7:30 A.M. to 2:30 P.M. While on duty at Sydenham Hospital, they worked under the supervision of Mrs. Gwendolyn B. Betz. In September, 1942 Miss Irene F. Shea, Superintendent of Nurses, went to the University of Minnesota to study the treatment for anterior poliomyelitis under the direction of Sister Elizabeth Kenny. Upon her return to Baltimore, Miss Shea gave several demonstrations of the application of hot packs as used in the Sister Kenny method of treatment. The total number of patients admitted to Sydenham Hospital during 1942 was 1,103 a decrease of 259 cases as compared with the previous year. Of this total, 136 cases came from the counties of Maryland and 5 from out of the State. The principal diseases and the number of patients with each were as follows: Diphtheria 65 Scarlet Fever 369 Pertussis 104 Meningitis (all kinds) 159 • There were 65 patients admitted with diphtheria, 6 of whom had the laryngeal type requiring tracheotomy. Of the 2 resident deaths which occurred from diphtheria, 1 was an adult male who died of acute myocardial failure less than twenty-four hours after admittance. The other was a three year old colored child who had no history of ever having received the preventive toxoid inoculation. There was a decrease in the number of patients with scarlet fever as compared with the previous year. Only 369 patients were admitted for this disease during 1942 while there were 474 in 1941. There was a sharp increase in the number of patients admitted to Syden- ham Hospital with all types of meningitis. A total of 159 patients was

[129 ] 130 REPORT OF THE HEALTH DEPARTMENT-1942 admitted which was an increase of 70 over the previous year. The types of meningitis cases admitted to Sydenham Hospital were as follows:

Meningococcus 132 Pneumococcus 8 Influenzal 5 Lymphocytic choriomeningitis 4 Tuberculous 4 13. Alkaligenes 1 Undetermined 5

A review of the cases of meningococcus meningitis treated at Sydenham Hospital showed that there were 11 deaths out of a total of 132 cases or a case fatality rate of 8.3 per cent. All of the patients with this disease received some form of the sulfonamide drugs while anti-meningococcus serum was given to none of them. This death rate is a very favorable reflection on the efficacy of the drug therapy since the death rate under serum treatment alone was approximately 30 per cent. Eight patients suffering from pneumococcus meningitis were treated with one of the sulfonamide drugs and the intravenous administration of specific rabbit serum. Six of these patients recovered. In the treatment of influenza bacillus meningitis, the use of the specific rabbit serum, developed by Dr. Hattie Alexander, proved to be very satisfactory. Four infants recovered from influenza bacillus meningitis following treatment with this serum combined with sulfadiazine. One patient died within twenty-four hours after admission and before treatment could be administered. During 1941 and 1942 every case of this disease treated at Sydenham Hospital recovered while before the development of the specific rabbit serum practically every case died. Forty-two surgical operations were performed at Sydenham Hospital of which there were 19 tracheotomies, 15 tonsillectomies and adenoidectomies, and 8 operations for other conditions. There were 415 chest X-rays taken in 1942. The total number of deaths of all diseases was 30 and the death rate was 2.7 per cent. Deducting 17 deaths which occurred within twenty-four hours after admission, the mortality rate was 1.1 per cent as compared with 2.7 per cent when calculated on the similar basis for 1941. There was a total of 23 postmortem examinations performed which was 76 per cent of the total number of deaths. The third floor of the hospital was not in operation at any time during the year. This was due to the shortage of nurses and also to the fact that there were no strenuous demands made upon the facilities. SYDENHAM HOSPITAL 131

Personnel Myron G. Tull, M.D., Superintendent Horace L. Hodes, M.D., Director of Medical Research Keacial ICrulevitz, M.D., Hospital Intern M. C. Schwartzman, Senior Clerk Edna E. IIerget, Junior Clerk Jeanette L. Rothstein, Senior Stenographer Lulu N. Rocco, Municipal Exchange Operator Ruth Jones Erich, Municipal Exchange Operator Esther C. lIaas, Municipal Exchange Operator Gladys S. Rowe, Telephone Branch Operator Edwin Whittemore, Pharmacist Alice S. Myers, Junior Bacteriologist Irene F. Shea, Superintendent of Nurses Dorcas Johnson, Assistant Head Hospital Nurse Agatha M. Cook, Night Supervisor of Nurses Alice S. Montell, Housekeeper Charles Wright, Laundryman Anna Emrick, Laundress Mary Barry, Laundress Eva B. Shuff, Laundress Lola Roxie Kimmel, Laundress Pauline 0. Muse, Laundress Rose Gasser, Laundress Pearl E. M. King, Seamstress Walter C. Wain, Laundryman Walter Wagner,[lead Cook Raymond Seabrease, Cook Louis Thomas, Storekeeper Nathan M. Crow, Painter John W. Diller,[Tandy Man Paul Franklin, Gardener and Primer Adam IIelinski, Watchman Ferdinand Hammett, Chauffeur G. W. Ilgenfritz, Chauffeur Melvin Creamer, Chauffeur Thomas Grady, Chief Engineer W. M. Tracy, Shift Engineer Hans G. Kohman, Shift Engineer Spence Spry, Shift Engineer Timothy O'Neill, Oiler Ethan Kline, Oiler Benhard Nelson, Steam Fireman George Ott, Steam Fireman James Warren Bryant, Steam Fireman Charge Nurses Lorraine II. Ashley Lois M. Montgomery Mary T. Cook Rosa Robinson Alice Akre Ferraro Mildred E. Sandel Phyllis Y. Mathias Edna Saunders ,132 REPORT OF THE HEALTH DEPARTMENT-1942

Graduate Nurses Clara M. Alexandrowicz Ruth Virginia Kopplin Minna Mae Blake Mary E. Mullan Minna K. Christ Dorothy E. Pfanneschlag Betty Jane Grese Elizabeth L. Porter Marian M. Gross Catherine II. Reichert Margaret J. IIenkel Eula May Respess Margaret P. Kenny Dorothy Lee Smith Ester Della Wallace Hospital Workers Ella May Bellingham Pearl Hamlin Caroline E. Brenner George W. Hasley Bertha Burch Frank T. IIooper Clara Butz Margaret Kinkle Edwin A. Clay Charlotte E. Kohl Richard Chester Dean Nellie E. Lake Florence J. Domozych Anthony A. Morris John Arnold Elder Harry W. Poole Anna Mae Englen Kert E. Roger Charles Escarzaga John F. Smith Mary Jo Fairhurst Florence L. Taylor Joseph E. Farrell Thomas F. Travers Adeline Fisher Betty Walls Lillian G. Fisher Josephine Williams James 0. Fitzgerald Ethel Woods Catherine Zang

TABLE NO. 1 HOSPITAL CENSUS

Patients in hospital at beginning of year 50 Patients in hospital at end of year 49 Maximum number of patients in hospital at one time 88 Minimum number of patients in hospital at one time 24 Total number of admissions 1,103 Daily average number of patients 48.1 Average number of days stay of patients: Scarlet fever 21.4 Diphtheria 27.9 Whooping cough 16.7 Meningitis (all kinds) 15.2 Total number of days maintenance given patients 18,840 Total number of days maintenance given employees 32,359

Total number of days maintenance given patients and employees 49,199 SYDENHAM HOSPITAL 133

TABLE NO. 2 ADMISSIONS, DEATHS AND DEATHS WITHIN 24 HOURS BY COLOR AND DIAGNOSIS

ADMISSIONS DEATHS DEATHS WITHIN ADMISSION 24 Houns DIAGNOSIS Total White Colored Total White Colored Total White Colored

Total 1,103 850 253 30 23 7 17 12 5

Measles 55 44 11 Scarlet fever 367 311 56 Whooping cough 102 44 58 1 1 1 1 Diphtheria 65 52 13 1 1 1 1 Diphtheria carrier 19 16 3 Erysipelas 22 20 2 Poliomyelitis 4 4 Meningococcus meningitis . 132 99 33 11 8 3 9 6 3 Tuberculous meningitis 4 4 4 4 Gonococcal ophthalmia 15 7 Chickenpox 12 7 5 Mumps 15 15 Influenzal meningitis 5 1 4 1 1 1 Pneumococcus meningitis 8 5 3 2 1 1 1 Meningitis, cause unknown 5 4 1 Meningitis, B. Alkaligenes. 1 1 Lymphocytic choriomeningitis 4 4 • • Bronchopneumonia 20 14 6 Lobar pneumonia 9 7 2 1 1 Streptococcus sore throat 70 54 16 Pharyngitis. 0 6 3 Tonsillitis 7 5 2 Other conditions of upper respiratory tract 28 24 4 Encephalitis 8 7 1 Laryngotracheobronchitis 19 15 3 2 2 1 1 Gastroenteritis 9 9 Meningocoecemia 3 3 1 1 1 Brain abscess 1 1 1 Cardiovascular disease 1 1 1 1 1 Cerebral accident 1 1 1 1 1 Rocky Mt. spotted fever... 4 4 1 1 Other conditions 78 59 19 No disease 2 2 134 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 3 LABORATORY EXAMINATIONS

Total 15,156

CULTURES Spinal fluid 299 Urine 16 Blood 427 Pus 82 Nose and throat for Klebs-Loeffler 4,281 Throat for streptococcus 1,095 Stool 42 Sputum 3 Nasopharynx for streptococcus 311 Gonococcus 25 Pertussis 6

SMEARS Spinal fluid 205 Mouth for Vincent's 6 Gonococcus 41 Acid fast for tuberculosis 34 Pus 80 Giemsa (inclusion body blenorrhea) 2

ANIMAL INOCULATION TESTS FOR DIAGNOSTIC PURPOSES Mice for pneumococcus 27 Mice for virus 12 Guinea pigs for virulence 102 Guinea pigs for tuberculosis 18 Guinea pigs for streptobacillus moniliformis 2 Mice for lymphocytio choriomeningitis 33 Mice for streptobacillus moniliformis 13

SEROLOGY Influenza 51 Meningococcio 48 Heterophile antibody 9 Patient's serum with pneumococci 343

MISCELLANEOUS Pneumococcus typing 158 Routine urine examinations 3,900 Tuberculin tests 703 Sulfonamide determinations and levels 283 Phenolsulphonphthalein tests 608 Non-protein nitrogen (blood) 23 Blood counts 1,778 SYDENHAM HOSPITAL 135

TABLE NO, 4 POSTMORTEM EXAMINATIONS

Total 23

Diphtheria and diphtheritic myocarditis 1

Meningococcic meningitis 9 Pertussis 2 Suspected tick bite fever 1 Tuberculous meningitis 4 Brain abscess 1 Influenzal meningitis 1 Meningococcic septicemia I Pneumococcio meningitis 2 Cerebral accident •

_ BUREAU OF TUBERCULOSIS

[ 1371 IP- BUREAU OF TUBERCULOSIS

Miriam E. Brailey, M.D., Dr.P.H. Director The total resident death rate for all forms of tuberculosis in Baltimore in 1942 was 86.5 per 100,000 as compared with 93.7 in 1941. The rate for the white population, the lowest on record, was 49.6 per 100,000 population, just a little below the rate of 50.9 in 1941; and for the Negro the rate was 240.1 per 100,000 as compared with 271.4 in 1941. The lowered total tuberculosis death rate in Baltimore in 1942 was almost entirely due to a decrease in the risk of death among Negroes. The rate for Negroes is still distressingly high and is five times that of the white population. Inspection of the rates for the colored over the past decade shows fluctuation but no steadily-held gain. Diagnostic services and hospital facilities for tuberculous Negroes, though more nearly adequate in recent years, have not yet sufficed to neutralize the effects of serious overcrowding and poor housing Upon the colored population. Reported Cases During 1942 there were reported 1,686 cases of tuberculosis,including 133 reported after death. The corresponding number of cases for 1941 was 1,903 with 136 reported after death. The smaller number of reports in 1942 is explained by the more careful scrutiny given by the bureau director to reports and in particular the decision not to count or to send a public health nurse to visit children reported as having healed mediastinal tuberculosis. In Table No. 1 the 882 cases among white persons and 804 among colored persons are classified according to location and extent of lesion as nearly as could be obtained at the time of report. The proportion of minimal cases reported for either race is discouragingly small and indicates an urgent need for case-finding. The pulmonary and non-pulmonary cases are classified in Table No. 2 according to sex, race and whether below fifteen years of age or fifteen years and older. There were 51 cases in children under fifteen years of age or 6 per cent of the 882 cases among the white population, and 118 cases or about 15 per cent of the total of 804 cases among Negroes. The most interesting feature shown in Table No. 2 is the predominance of pulmonary cases among males in both races. This characteristic of reported tuberou- losis was noted long before the war but was accentuated during 1942 by

[1391 140 REPORT OF THE HEALTH DEPARTMENT-1942

the extensive number of males with unsuspected tuberculosis discovered by the routine chest X-ray examination given to inductees of the armed forces. The table indicates that reported tuberculosis is 2.7 more frequent in white males than in white females 15 years of age and over, while in the colored race the corresponding ratio of males to females is 2.2. One obvious conclusion is that as a medical necessity provision should be made for more sanatorium beds for males than for females. It is hoped that the sanatoria or tuberculosis hospitals in Maryland will make such provisions. In Table No. 3 the sources of case reports are shown. When the first report of a case is sent from a sanatorium or from the Tuberculosis Division of the Baltimore City Hospitals, it means that the physician or clinic making the diagnosis took no responsibility to notify the Health Depart- ment before hospitalization of the patient. An opportunity for health instruction of the patient and X-raying the other members of the household was lost to the public health nurse when several weeks elapsed between diagnosis and hospitalization. In 1942 there was a total of 220 such cases as compared with 282 in 1941. Diagnostic Services The most important event of 1942 in strengthening the program for tuberculosis control was the opening of the Druid Chest Clinic on Decem- ber 1, 1942 at 1313 Druid Hill Avenue. This clinic was designed for Negro patients living west of Charles Street and its establishment at the Druid Health Center made possible the use of the clinic at 1516 Madison Avenue for white patients. The X-ray equipment at the Druid Health Center was a gift to the Health Department from the Maryland Tuberculosis Associa- tion and represented a cost of about $8,400. The Druid Chest Clinic began operation with a competent Negro staff of three public health nurses and two experienced chest specialists. The latter were Dr. C. Dudley Lee and Dr. George G. Adams, both from the staff of the State Sanatorium at Henryton, Maryland. Better service to the public was made possible by the inauguration of twice weekly night sessions in all three chest clinics on December 1, 1942. These were welcomed by referring agencies and by patients. The numbers of white and colored persons examined at the Health Department chest clinics during 1942 are shown in various classifications in Table No. 4 and certain percentages are presented in Table No. 5. During the year 6,257 individuals were examined. Of these, 4,468 or 71 per cent were new registrants and of these 2,232 were white and 2,236 were colored. In 1941 there were 4,235 new registrants. The Druid Chest Clinic opened too late in 1942 to increase clinic attendance appreciably. BUREAU OF TUBERCULOSIS 141

Table No.5 indicates that for both races about 50 per cent of the number of individuals examined for the first time were ill persons referred for diagnosis and the other 50 per cent were apparently well individuals X-rayed because of household contact with a case of tuberculosis. There should be many more contacts attending the Health Department clinics for they considerably outnumber ill persons suspected of having tuberculosis. When the 1942 clinic registrants are divided into groups of children under fifteen years of age and persons fifteen years of age and older, Table No. 5 shows that more than 80 per cent of the individuals examined belonged to the older age group. Private physicians referred 72 per cent of white individuals examined and 54 per cent of the colored. Public health nurses were responsible for the attendance of about 18 per cent of white registrants and for 39 per cent of the colored; while other agencies arranged for the remaining 9 per cent of white persons and 6 per cent of the Negroes. Collapse Therapy for Ex-sanatorium Patients During 1942 treatments with artificial pneumothorax were given to 254 patients as shown in Table No. 4. Of these, 138 were white and 116 were colored. New registrants numbered 80 and treatment was continued for 174 former registrants. Case-Finding Projects During May 1942, the 379 senior students of the Douglass and Dunbar Negro High Schools were given Patch tuberculin tests and those with Positive reactions were X-rayed at the clinics at 1516 Madison Avenue or at 28 South Broadway. Among 154 students found to be tuberculin- positive or 41 per cent of the tested group, there were 25 whose X-rays showed well-healed primary tuberculosis and 1 with an inactive re-infection lesion. Two other students were found to have enlarged hearts. During the year the Medical Division of the Maryland Selective Service Board at the Fifth Regiment Armory collaborated closely with the Bureau of Tuberculosis in reporting all abnormal chest films of rejected registrants. The first half of the year the X-ray reports were made available by the Local Boards to the Bureau of Tuberculosis but by July 1 the bureau director was invited to review the films regularly at the Armory examination center. This enabled the bureau director to decide which rejected men were in urgent need of follow-up and which ones offered no significant public health problem. The rejected men with lesions of consequence were urged by letter from the director of the bureau to have a medical examination. Responses to letters were excellent and the Health Department chest clinics examined those who could not afford private medical service. 142 REPORT OF THE HEALTH DEPARTMENT-1942

Hospital and Sanatorium Facilities Facilities for bed care for tuberculous persons remained unchanged numerically during 1942. Of the 445 beds at the State Sanatorium at Henryton, there were 65 for Negroes which could not be used because of inadequate appropriations and scarcity of nurses and attendants. For the State as a whole, there were available for white patients only 2.26 beds per fatal tuberculosis case and for Negro patients only 1.1 beds per tuberculous death. All sanatoria in the State and the Tuberculosis Division of the Baltimore City Hospitals developed long waiting lists for male patients, and this again emphasized the fact that the routine provision of equal numbers of beds for the two sexes is unsound since tuberculosis attacks a greater number of adult males than females. Nursing Service In the latter part of 1942 about one hundred and fifty public health nurses were available for tuberculosis field visits as part of a generalized service and Negro nurses were assigned to some of the new positions. There was evidence of improved interest and efficiency in tuberculosis public health nursing, but with a city population close to 1,000,000 people the number of public health nurses was still inadequate. Extraordinarily heavy tuberculosis case-loads for the public health nurses remained the rule in the densely populated Negro area included in the Western Health District. Personnel Miriam E. Brailey, M.D., Dr.P.II., Director George G. Adams, M.D., Clinic Physician Louis V. Blum, M.D., Clinic Physician Theodore Cooper, M.D., Clinic Physician Meyer W. Jacobson, M.D., Clinic Physician C. Dudley Lee, M.D., Clinic Physician A. A. Weinstock, M.D., Health Officer Dolores Thompson, Senior Stenographer Helen Stindt, Junior Stenographer BUREAU OF TUBERCULOSIS 143

TABLE NO. 1 REPORTED TUBERCULOSIS CASES, ACCORDING TO LOCATION EXTENT OF LESION AND RAM-1942

LOCATION AND EXTENT OF LESION TOTAL WHITE 'COLORED

Total reported cases 1,686 882 804

Pulmonary lesions (total) 1,631 865 766 Minimal 258 157 101 Moderately advanced 397 251 146 Far advanced 449 206 243 Mediastinal 119 36 83 Extent not specified 408 215 193

Non-pulmonary lesions (total) 55 17 38 Meningitis 18 9 9 Disseminated 12 3 9 Spinal 6 2 4 Peritonitis 11 .• 11 Other forms 8 3 5

TABLE NO. 2 PULMONARY AND NON-PULMONARY REPORTED CASES OF TUBERCULOSIS CLASSIFIED BY RACE, SEX AND BROAD AGE GROUP-1942

WHITE COLORED CLASSIFICATION AND AGE BOTH RACES Male Female Male Female

Total reported cases 1,686 630 252 530 274

Pulmonary lesions All ages 1,631 622 243 508 258 Under 15 years of age 148 21 20 52 55 15 years and over 1,483 601 223 456 203

Non-pulmonary lesions All ages 55 8 9 22 16 Under 15 years of age 21 4 6 6 5 15 years and over 34 4 3 16 11

Pulmonary lesions, persons 15 years and over; Ratio of male to female cases 2.5 2.7 2.2 144 REPORT OP THE HEALTH DEPARTMEN1'-1942

TABLE NO. 3 TUBERCULOSIS CASES CLASSIFIED BY RACE AND REPORTING AGENCY-1942

TOTAL WHITE COLORED REPORTING AGENCY Number Per Cent Number Per Cent Number Per Cent

Total cases 1,686 100.0 882 100.0 804 100.0

Private physicians 247 14.7 159 18.0 88 10.9 General hospitals 321 19.0 104 11.8 217 27.0 Health Department clinics 475 28.2 203 23.0 272 33.8 Selective Service* 271 18.1 201 22.8 70 8.7 Sanatoria 77 4.5 69 7.8 8 1.0 Baltimore City Hospitals 143 8.5 74 8.4 69 8.6 Other agencies 19 1.1 7 0.8 12 1.5 Reported after death 133 7.9 65 7.4 68 8.5

* Selective Service reported a much larger number of clinically active cases than indicated here. Where the selectee reported at once to a physician or clinic and the diagnosis of active tuberculosis was confirmed, his ease has been classified as reported by the physician or clinic.

TABLE NO. 4 DISTRIBUTION OF WHITE AND COLORED CLINIC REGISTRANTS CLASSIFIED AS TO AGE, REASON FOR REFERRAL, REFERRAL AGENCY, SERVICE RENDERED AND LOCATION OF CLINIC-1942

ALL CLINICS EAST BALTIMORE WEST BALTIMORE

Total White Colored Total White Colored Total White Colored

Diugnoctic cervicec Total examined, first time, 4,468 2,232 2,236 1,823 1,438 385 2,645 794 1,851 Referred for diagnosis 2,253 1,232 1,021 1,041 870 171 1,212 362 850 Referred as "contacts" 2,215 1,000 1,215 782 568 214 1,433 432 1,001 Age distribution, 15 years and over 3,640 1,845 1,795 1,540 1,202 338 2,100 643 1,457 Under 15 years 828 387 441 283 236 47 545 151 394 Referred by: Physicians 2,835 1,616 1,210 1,271 1,079 192 1,564 537 1,027 Public health nurses 1,280 409 871 354 201 153 926 208 718 Other agencies 353 207 146 198 158 40 155 49 106 Persons examined who registered in clinic before 1942 1,789 1,027 762 801 669 132 988 358 630 Total individuals examined 6,257 3,259 2,998 2,624 2,107 517 3,633 1,152 2,481 X-ray examinations 6,006 3,312 3,594 2,579 2,069 510 4,327 1,243 3,084

Pneumolhorax clinic services Total patients 254 138 116 106 81 25 148 57 91 New in 1942 80 38 42 27 21 6 53 17 36 Registered before 1942 174 100 74 79 60 19 05 40 55 BUREAU OF TUBERCULOSIS 145

TABLE NO. 5 PERCENTAGE DISTRIBUTION OF WHITE AND COLORED PERSONS EXAMINED IN TUBERCULOSIS CLINICS CLASSIFIED AS TO REASON FOR REFERRAL, AGE AND REFERRING AGENCY-1942

TOTAL WHITE COLORED

Number Per Cent Number Per Cent Number Per Cent

Clinic registrants New in 1942 4,468 71.41 2,232 68.49 2,236 74.58 Registered before 1942 1,789 28.59 1,027 31.51 762 25.42

Total 6,257 100.00 3,259 100.00 2,998 100.00

1042 registrante: reason for referral Patients for diagnosis 2,253 50.42 1,232 55.20 1,021 45.66 Tuberculosis contacts 2,215 49.58 1,000 44.80 1,215 54.34

Total 4,468 100.00 2,232 100.00 2,236 100.00

1940 registrants: age 15 years and over 3,640 81.47 1,845 82.66 1,795 80.28 Under 15 years 828 18.53 387 17.34 441 19.72

Total 4,468 100.00 2,232 100.00 2,236 100.00

1042 registrants: referring agency Physicians 2,835 63.45 1,616 72.40 1,219 54.52 Public health nurses 1,280 28.65 ' 409 18.32 871 38.95 Other 350 7.90 207 9.28 146 6.53

Total 4,468 100.00 2,232 100.00 2,236 100.00

- - BUREAU OF VENEREAL DISEASES

[ 1471

BUREAU OF VENEREAL DISEASES

Ralph F. Sikes, M.D., M.P.H. Acting Director The activities of the Bureau of Venereal Diseases continued to increase during 1942. The reported number of cases of syphilis and gonorrhea again showed a rise. As a result, the clinics gave more treatments and the social workers made more investigations than in the previous year. Work in the office increased so much that the staff had difficulty in keeping up with routine duties. There were 153,877 specimens of blood examined for syphilis by the Bureau of Laboratories as compared to 106,215 during 1941. Of the total number of specimens examined 51,123 from 40,838 individuals were submitted by the medical examiners of the Selective Service registrants. Of the white registrants 1,125 or 3.8 per cent were positive, while 3,132 or 27.7 per cent of the nonwhite were positive. The increased percentage of positives over the number in the previous year was probably due to the older age group which was examined for the armed services. Industrial plants showed greater interest in the City Health Depart- ment's plan to control syphilis in industry. Efforts continue to be made by the bureau, in cooperation with the Bureau of Occupational Diseases, to put this program into operation in various industries in the city. The plans for a new clinic to be located in the new housing project on the corner of Orleans Street and Central Avenue were completed in cooperation with the Baltimore Housing Authority. It is felt that such a clinic should furnish adequate diagnostic and treatment facilities for colored patients living in East Baltimore. Morbidity and Mortality There were 11,293 cases of syphilis reported for the first time in 1942 as compared with 7,838 in 1941; and 3,388 cases of gonorrhea as compared to 2,941 eases in the preceding year. A total of 162 cases of chancroid, 17 cases of granuloma inguinale and 9 cases of lymphopathia was recorded in 1942. There were 149 deaths from syphilis. Venereal Disease Clinics There were 3,480 new cases of syphilis admitted to the city clinics in 1942 as compared to 3,075 in 1941. Of these, 2,045 had not previously

149 150 REPORT OF THE HEALTH DEPARTMENT -1942

been treated by any clinic or private physician. Five hundred and twenty- five cases of primary and secondary syphilis were admitted as compared with 495 in 1941. While this represented an increase in the number of early infectious cases in the City Health Department clinics, the percentage to the total cases of syphilis showed a decrease and is accounted for by the fact that a greater increase of latent cases of syphilis were found due to the Selective Service registrants. The total number of clinic visits was approximately the same as in the previous year. There was, however, an increase in the number of treatments for syphilis given, 90,694 as compared with 86,472 in the previous year. The treatment procedures remained unchanged except in two of the clinics located at the Druid Health Center where mapharsen was made the routine drug. Diagnostic service was improved in the clinics in the Druid Health Center by the volunteer service of Dr. C. L. E. Monroe of Morgan College who cultured gonococcal specimens of patients registered there.

Epidemiology Epidemiological procedures were carried out essentially as they had been in previous years. Slightly more emphasis was placed on the follow-up of contacts named by Health Department patients or by those patients who were referred from outside agencies. Results of contact investigations were satisfactory in spite of the large transient population in the city. The social investigators discovered 78 new cases of infectious syphilis among the nonwhite population during 1942 as compared to only 48 in the previous year; and the total number of new cases discovered among the colored population with 144 as compared to 95 in 1941. There was a tremendous increase in the number of contacts referred to the Health Department for investigation from outside sources and the social investigators followed up 587 contacts in 1942 as compared to 216 in 1941. The Police Department cooperated with the Health Department to locate individuals who were named as contacts. Health Information A new poster was published entitled "Take No Chances—Syphilis and Gonorrhea Can Be Cured." This poster was placed in many of the night clubs, cafes and taverns where young people are likely to congregate. There were 21,386 Health Department pamphlets on the venereal diseases distributed and 9,739 letters written to patients. Talks were given and a venereal disease film shown to organizations requesting it. BUREAU OF VENEREAL DISEASES 151

Personnel Ralph F. Sikes, M.D., M.P.H., Acting Director Ferdinand 0. Reinhard, M.D., M.P.II., Director Richard D. Hahn, M.D., Medical Supervisor Louis E. Harmon, M.D., Medical Supervisor Bowman J. Hood, M.D., Medical Supervisor William Berkley Butler, M.D., Health Officer G. Raynor Browne, M.D., Health Officer Earle P. Clemson, M.D., Health Officer ITarris Goldman, M.D., Health Officer Albert L. Laforest, M.D., Health Officer George C. Page, M.D., Health Officer J. Douglass Shepperd, M.D., Health Officer Charles T. Woodland, M.D., Health Officer Ralph J. Young, M.D., Health Officer Maurice L. Adams, M.D., Clinic Physician Charles R. Campbell, M.D., Clinic Physician James D. Carr, M.D., Clinic Physician Henry T. Collenberg, M.D., Clinic Physician John Collinson, M.D., Clinic Physician James S. Julian, M.D., Clinic Physician William Atwell Jones, M.D., Clinic Physician Harry Linden, M.D., Clinic Physician Francis J-B. Luke, M.D., Clinic Physician George H. Pendleton, M.D., Clinic Physician Edith Rodler, M.D., Clinic Physician Ernest W. Shervington, M.D., Clinic Physician George A. Strauss, M.D., Clinic Physician Odessa D. Benton, Social Worker Elsie B. Sessoms, Social Worker Elsie S. Brown, Social Worker William P. Duffy, Social Worker T. Evans Fernandis, Jr., Social Worker Osborne B. Dixon, Social Worker Reginald P. Jefferson, Social Worker Mildred I. Purnell, Social Worker Shirley T. Goodrich, Social Worker Mattie May Gwynn, Senior Stenographer Beatrice ICravetz, Senior Stenographer C. Richard Martin, Jr., Senior Stenographer Bessie Knipp Sothoron, Junior Stenographer Ednamae Webb, Junior Stenographer Eugene A. Briscoe, Clinic Clerk James P. Lynch, Jr., Clinic Clerk Mildred V. Robinson, Clinic Clerk Daisy H. Barnes, Clinic Clerk Leo M. White, Clinic Clerk Rosalie Krause, Junior Clerk William B. Lucas, Janitor 152 REPORT OF THE HEALTH• DEPARTMENT-1942

TABLE NO. 1 RESIDENT DEATHS ATTRIBUTABLE TO SYPHILIS BY COLOR-1938--1942

1942 1941 1940 1939 1938

CAUSE OP DEATH CERTIFIED 1 1 1 Z 1 2 1 E-i R "CS g % dgR- dgR3gR 3

Total 201 94 107 198 62 136 219 84 135 329 94 235 316 104 212

Syphilis under one year of age 8 .. 8 4 .. 4 5 1 4 6 1 5 18 5 13 General paralysis of the insane 56 26 30 55 14 41 53 15 38 51 15 36 31 10 21 Tabes dorsalis 10 7 3 1 1 .. 7 5 2 4 4 .. 1 1 .. Aneurysm of the aorta. 53 30 23 46 15 31 48 25 23 16 13 3 1 1 .. Other forms of syphilis 74 31 43 92 32 60 106 38 68 252 61 191 260 83 177

TABLE NO. 2 REPORT OF VENEREAL DISEASE CLINICS FOR 1942

A FA" N 4 4 AND 11 O E.1 X i 6 'lt STATED 0z . SECONDARY A L'i NOT PRIMARY cs. . .„ 1. Total new cases admitted 720 999 1,363 116 282 1,464 177 13 8

(a) Not previously treated by any clinic or private physician 525 518 670 75 257 1,190 148 6 6 (b) Previously treated by a clinic or private physician 171 466 677 34 15 150 13 6 1 (c) No information as to previous treatment 24 . 15 16 7 10 124 16 1 1 2. Total patients under treatment or observation during year 9,418 12,930 15,175 1,848 804 11,688 1,244 211 33

ARSENICAL HEAVY METAL OTHER, TREATMENTS 3. Total treatments 47,954 42,740 22,392 4. Total clinic visits 120,924 BUREAU OF VENEREAL DISEASES 153

TABLE NO. 3 CONSOLIDATED SOCIAL SERVICE REPORT-1938-1942

ACTIVITIES 1942 1941 1940 1939 1938

Number of visits made during year 18,273 17,647 17,954 17,117 17,345 Number of patients referred to Health Department venereal disease clinics.. 13,099 12,200 11,738 11,925 10,419 Number of returns among patients so referred 9,181 7,675 7,433 6,216 6,393 Number of patients referred to other clinics or private physicians 1,032 863 744 1,169 872 Moved, not located 1,416 1,395 1,628 1,721 1,958 False addressed 1,057 769 733 809 799 Left city 484 272 210 335 366 Visits of cooperation to other agencies 120 140 380 98 76 Summons 327 335 209 273 168 Number of hours spent in clinics 2,487 2,573 3,029 2,589 2,547

TABLE NO. 4 CONTACT INVESTIGATION OF INFECTIOUS CASES

ON ORIGINAL DATA ON CONTACTS DATA RATIO - CASES Diagnostic Classification 100 0 to

RACE AND SEX Contact Original Infectious Infectious Cases •C Known 100 Cases

0.0 Cases of of Contacts Contacts cd Syphilis to

. Latent 'C° New Contact Original Cases Cases Named and Examined Number Number Total Number Number Latent Previously Negative Number [5.

Total 404 428 304 89 70 71 74 159 22 39

White male and female 29 34 29 11 4 7 7 15 38 52 Colored male 209 188 133 42 38 23 30 80 20 38 Colored female 166 206 142 36 28 41 37 64 22 38

TABLE NO. 5 RESULTS OF INVESTIGATION OF CONTACTS REFERRED BY OUTSIDE AGENCIES

NUMBER Nusimut NEW CASES POUND k PREVI- &MOMS OF OF No OUSLY ORI1INAL CASE EEXAMINED DISEASE KNOWN CONTACTS Syphilis Gonorrhea Other 1

Total 587 287 80 75 0 127 14

Syphilis 206 118 58 4 0 46 12 Gonorrh a 358 159 27 70 0 72 2 Other ve lereal diseases 23 10 4 1 0 9 0

BUREAU OF OCCUPATIONAL DISEASES

155.1 i

/ BUREAU OF OCCUPATIONAL DISEASES

John M. McDonald, M.D., D.P.H. Director The trend to convert industrial plants to the manufacture of war goods previously referred to in the ANNUAL REPORT of 1941 was markedly accelerated during 1942. This work required a considerable amount of time as well as extra vigilance in order to keep abreast of current industrial hygiene problems. Education The director was appointed Assistant in Preventive Medicine on the staff of the Johns Hopkins Medical School and gave fifteen hours instruction on occupational diseases to the senior medical students of that institution. In addition, three lectures on the same subject were given to the senior medical students of the University of Maryland School of Medicine. The director attended a course on Industrial Health for Physicians and Surgeons given by the Johns Hopkins School of Hygiene and Public Health and participated in the discussions. A new educational poster on the danger of lead poisoning in children was prepared for use in the Health Department well baby clinics and other Pediatric clinics in the city. Visual education material was furnished to the Baltimore Polytechnic Institute for exhibit purposes. Scientific papers were written by the bureau director and are listed in the Bibliography. Meetings The Fifth Annual Meeting of the National Conference of Governmental Industrial Hygienists held in Washington, D. C., April 9-10, was attended by the director. The director also was present at a course on chemical warfare at Edgewood Arsenal. Assistance was given to the medical staff of Cleveland Clinic, Ohio, in a study of suspected beryllium poisoning. At the Cleveland Clinic, the director was shown roentgenograms of a chemical pneumonia tentatively attributed to the inhalation of beryllium oxyfluoride fumes. A digest of the literature on beryllium poisoning was furnished to the physicians in attendance on the patient. Special Activities The study of the effects of exposure to selenium begun in 1941 was completed with the examination of records of the results found in the

[ 157] 158 REPORT OP THE TiEALTH DEPARTMENT-1942

regular periodic physical examination made by the physician in the plant. No signs or symptoms attributable to the effects of selenium were found. A small factory where benzol was used to apply synthetic rubber to metallic objects was carefully studied. Hematological examinations were made of exposed employees and recommendations made to overcome the potential hazard. Blood lead examinations were made for two employees engaged in drossing operations in two printing plants. The analyses showed only minor lead absorption in each case. At the request of a subcommittee of the Emergency Medical Services of the Maryland Council of Defense, visits were made to a large number of industrial plants in an effort to have the blood of employees typed. The purpose was to establish a large reservoir of typed persons who could be used as blood donors in case of a bombing incident. A study was also made of the potential exposure to carbon monoxide poisoning from tugboats operated by Diesel engines. The engineering portion of this work was done by Charles E. Couchman, Chief of the Division of Industrial Hygiene, while the director examined the blood samples. Investigations were made of occupational deafness and it is believed that this ailment should be added to the schedule in the Maryland Occupational Diseases Law. A copy of a book on "Chronic Nephritis and Lead Poison- ing" was received from its author, Dr. L. J. J. Nye, of Brisbane, Australia, who had read the article on "Incidence of Lead Poisoning in the City of Baltimore" in the July 11, 1942 issue of the Journal of the American Medical Association. The annual tour was made of stores to detect toys which might cause lead poisoning in children. It was evident that metals formerly used in toys had been replaced mainly by wood and paper. At the suggestion of Dr. Edwards A. Park, Pediatrician-in-Chief of the Johns Hopkins Hospital, work was started on an article about the dangers of lead poisoning in children for publication in one of the popular women's magazines. Cases Reported Two cases of arsenic poisoning occurred during the year. The first was in a man who had been exposed for a brief time to a low concentration of arsenic. Abnormal amounts of arsenic were found upon urinalysis but further study of the case was prevented when the patient left the city. In the second case, the arsenic poisoning was found to have come from a source other than the industrial environment. In 1940 the number of occupational diseases officially reported to the department was 37 while in 1941 there were 65. Cases officially reported to the Health Department in 1942 were as follows: BUREAU OF OCCUPATIONAL DISEASES 159 OCCUPATIONAL DISEASES REPORTED-1942

Dermatitis 51 Chrome 1 Cyanide 3 Oil 8 Poison ivy 3 Solvents 3 All others 33 Ganglion 1 Lead poisoning 2 Pneumonoeonioses 4 — Total 58

Personnel John M. McDonald, M.D., D.P.II., Director Selma Aebli, Senior Stenographer

BUREAU OF CHILD HYGIENE

William K. Skilling, M.D. Director The number of resident births in 1942 increased approximately 24 per cent over the number recorded in 1941. Of the 19,859 resident births, 79.9 per cent occurred in hospitals which is the same percentage as in 1941. The percentage of births reported by midwives was 2.1 in 1942 as compared with 2.2 in 1941. The resident maternal mortality rate and the resident infant mortality rate were the lowest in their respective groups ever to be recorded for Baltimore. The resident maternal mortality rate was 1.7 per thousand live births and the resident infant mortality rate was 39.5 per thousand live births in 1942 as compared with the corresponding rates of 2.3 and 49.6 in 1941. The decrease in the number of new patients registered in Health Depart- ment prenatal clinics undoubtedly reflected the improved economic conditions brought about by the employment of large numbers of people in war industries. The investigation of deaths associated with childbearing was continued by the Joint Committee on Maternal Mortality of the City Health Department and the Baltimore City Medical Society. Cases were submitted for analysis and discussion to the monthly meetings of the Baltimore Physicians' Conference on Maternal Mortality held in the Medical and Chirurgical Faculty Building. New regulations to govern the operation and conduct of maternity hospitals in Baltimore, made in accordance with the provisions of the city ordinance controlling these institutions, were adopted on April 11 by the Commissioner of Health and became effective on August 1, 1942. An increase in the activities of the Bureau of Child Hygiene in the eastern and southern sections of the city resulted from the plan to have the Health Department absorb each year one-tenth of the service rendered by the Babies Milk Fund Association and the provision of quarters by the Baltimore Housing Authority for neighborhood well baby clinics in new city housing projects. The number of infant and preschool hygiene clinics operated by the bureau had increased to twenty-nine by December 31, 1942 and fifty-two conferences were held weekly.

[163 ] 164 REPORT OF THE HEALTH DEPARTMENT-1942

Public Health Nursing Activities A change in the method of assigning neonatal visits was made so that all children born in Baltimore City might be visited by a public health nurse. For ten years it had been the policy to consult all physicians who reported births before assigning a public health nurse to deliver the notification of birth registration and, as a result of this policy, neonatal visits were made to about 80 per cent of the babies born in Baltimore. Under date of February 20, 1942 the Commissioner of Health sent to practicing physicians in the city a communication to the effect that after March 1, 1942 public health nurses would visit all children born in the city and deliver notifications of birth registration to the parents. The disposition of Records of Child Under Six Years by the clerical staff of the bureau in 1942 compared with 1941 is shown in the following tabulation:

DISPOSITION OF RECORDS OF CHILD UNDER SIX YEARS 1942 1941 Records of Child Under Six Years received 17,962 19,135 Records of Child Under Six Years assigned and mailed. 17,801 19,091 Assigned to the Bureau of Public Health Nursing 14,624 Notification of birth registration mailed to residents 458 Notification of birth registration mailed to non-residents 2,719

17,801 Records of Child Under Six Years assigned for diphtheria prevention visit 12,793 11,587 Corrections on Notifications of birth registrations 5,451 6,147_ (3 months*) Notifications of birth registrations copied and mailed to non-residents 1,303 *Beginning September 28, 1942 addressograph plates were not made for non- residents and notifications of birth registration were typed from the birth certificates. Ophthalmia Neonatorum The responsibility for the direction of adequate treatment of all cases of infected eyes reported to the Health Department was assigned to the Bureau of Child Hygiene. A special service was maintained to provide prompt assistance and instruction in the care of infected eyes of infants to whom the service of a private physician was not available. Public health nurses, nurses of nonofficial organizations, midwives and the out-patient departments of hospitals were urged to report immediately by telephone to the Bureau of Child Hygiene any case of an infant with sore eyes. BUREAU OF CHILD HYGIENE 165

There were 292 cases assigned to this service in the Western and South- eastern Health Districts. Gonococci were reported in 9 cases and 17 cases were referred to hospitals. A summary of the activities of the Bureau of Child Hygiene in the care of ophthalmia neonatorum cases is given in the following tabulation: 1942 1941 Cases reported to Bureau of Child Hygiene 292 316 Cases assigned to Health Department service 185 228 Total visits by public health nurse 943 1,185 Average number of visits per case 5.1 5.1 Number of smears made 107 93 Number of smears showing gram-negative intracellular diplo- cocci 1 5 Cases in which prophylactic was said to have been used 183 197 Cases sent to hospital for treatment 2 1 Unreported Births The bureau secured natal histories from parents of children born in Baltimore for whom no certificate of birth could be found. With the information obtained it was possible to put on record in the Bureau of Vital Statistics 56 cases of delayed birth reports. Thirty-two births were so verified in 1942 as compared with 12 in 1941, 7 in 1940, 1 in 1939, 2 in 1937 and 2 in 1936. Infant and Preschool Hygiene Clinics The first City Health Department infant and preschool hygiene clinic to occupy quarters provided by the Baltimore Housing Authority was opened at the Clarence Perkins Homes on May 6. Officials of the Balti- more Housing Authority and of the Health Department were present on the opening day and motion pictures of the clinic in action were made. Similar new infant and preschool hygiene clinics were opened in the Brook- lyn and Fairfield Housing Projects in October. Two weekly conferences were held in each of these housing project clinics. Three public health nurses and a pediatrician were added to the bureau staff to conduct these clinic services. Two clinics with two weekly conferences each were transferred to the City Health Department by the Babies Milk Fund Association on January 1, 1942. This transfer was the second to be made in accordance with the plan to absorb one-tenth of the Association's clinics each year. Both clinics were located in the Eastern Health District, one at 1927 East Monument Street and the other in the basement of St. John's Church at Valley and Eager Streets. Two public health nurses and two pediatricians were added to the Health Department staff to conduct these new clinics, 166 REPORT OF THE HEALTH DEPARTMENT-1942

Diphtheria Prevention There were 1,492 more children in the city inoculated against diphtheria in 1942 than during the previous year. In the Health Department infant and preschool hygiene clinics and including 929 inoculations given in the clinics of the Babies Milk Fund Association, there were 7,646 children inoculated against diphtheria as compared with 7,880 in 1941. However, private physicians reported that they had inoculated 7,026 children in 1942 as compared with 5,300 in 1941. The diphtheria prevention clinic conducted in conjunction with the Free Summer Excursion Society was discontinued in 1942. There were 6,223 children vaccinated against smallpox in the infant and preschool hygiene clinics in 1942 as compared with 8,327 in 1941. In the early part of the year many special clinics for smallpox vaccination were conducted as a result of an outbreak of smallpox in a neighboring state.

Licensed Children's Institutions There were three hundred and seventy-four boarding homes for children inspected by the Bureau of Child Hygiene. Of the total number of inspected homes, two hundred and fifty-one were licensed by the Commis- sioner of Health and ninety-eight homes were inspected by the bureau and licensed by the Department of Public Welfare of Baltimore. Twenty-five homes were inspected but refused licenses because they did not meet the City Health Department requirements. Forty-five homes formerly licensed by the Commissioner of Health were transferred to the Department of Public Welfare when their licenses expired in 1942 because they boarded children only for that Department. During the summer of 1942 the Henry Watson Children's Aid Society and the Family Welfare Association were combined to form the Family and Children's Society. The new Society continued to cooperate with the Bureau of Child Hygiene in the same manner and spirit as the former two separate agencies. In 1942 there was only 1 death among the children living in homes licensed by the Commissioner of Health. One new day nursery was licensed and five licenses were renewed in 1942. Six additional nursery schools were licensed in 1942, maldng a total of forty-two. Many of the nursery schools lengthened the school hours to meet the need of working mothers and by the end of the year 1,080 children were enrolled in the nursery schools. On November 21, 1942 a conference to discuss health problems with nursery school directors was held in the office of the Com- missioner of Health. The work in the child-caring institutions followed the same plans as in 1941. Several of the large institutions were reinspected at the request of BUREAU OF CHILD HYGIENE 167

the State Department of Public Welfare by the Bureaus of Child Hygiene, Environmental Hygiene and Food Control of the City Health Department. Maternity Hygiene In 1942 there were 1,279 patients delivered at the Baltimore City Hos- pitals who had received prenatal care at the Health Department clinics. These clinics were held thirteen times each week at eight locations in various parts of the city. Two deaths occurred among these registered patients and the maternal mortality rate for this group was 1.5 per 1,000 live births. There were 162 new prenatal care cases referred by midwives to the Health Department clinics. This was approximately a 25 per cent increase over that of 1941. Maternal Mortality The following are case histories of the two patients registered with the Division of Maternity Hygiene who died: MATERNAL DEATHS 1. Health Department Registration No. 13,467: Pulmonary Embolism. Age 36, white, multipara in her eleventh pregnancy (para 10-0-0-10), serologic test for syphilis negative, pelvis normal, estimated date of confinement September 9, 1942. Past history is of interest in that the patient had numerous perineal operations with her last five pregnancies. Patient fell into labor spontaneously at 1:40 A.M. September 16, 1942 and was admitted to the hospital in active labor. Patient's condition was good and after a normal labor of 21 hours and 21 minutes, she was delivered by breech extraction under GOE anaesthesia. A second degree laceration was in the process of being repaired when the patient suddenly became pulseless, cyanotic, and her blood pressure could not be obtained. After instituting anti-shock measures the patient looked better, but after several minutes again relapsed into complete shock from which she did not recover. Respira- tions ceased at 7:45 P.M. Examination of the uterus postpartum showed no tears or lacerations. A postpartum urine specimen showed nothing unusual and death was probably due to pulmonary embolism. 2. Health Department Registration No. 13,748: Cardio-respiratory Failure Due to Spinal Anaesthesia. Age 30, colored, multipara in her sixth pregnancy (para 3-0-2-1), serologic test for syphilis negative, pelvis normal, estimated date of confinement February, 1943. Family history non-contributory. Her past history is of interest in that patient gave birth to a 7 pound living baby in 1930. This delivery was supposed to be rather difficult and prolonged. Between 1930 and 1939 patient had two miscarriages. In 1939 patient had a prolonged labor resulting in a stillborn baby weighing 8 pounds. In 1941 she was delivered of a 9 pound, 2 ounce baby by Craniotomy and decapitation, following a prolonged labor due to cephalo-pelvic disproportion. Her prenatal course was negative prior to December 28, 1942, which was four days prior to her admission to the hospital. At this time she began vomiting all 168 REPORT OF THE HEALTH DEPARTMENT-1942

solid foods. Following this G.I. upset, patient developed a bad upper respiratory infection. Patient presented herself to the prenatal clinic for the first time weighing 2194 pounds when she was approximately 34 weeks pregnant; blood pressure and urine normal. On admission to the hospital, patient presented a marked upper respiratory infection accompanied with abdominal pains and nausea; B.P. 140/108; urine negative; Hgb. 72 per cent. Rectal examination revealed presenting part not in the pelvis. An X-ray was taken and revealed fetus lying in vertex presentation, presenting part not engaged. Because of the patient's previous obstetrical history and the estimated size of this unborn child, it was decided that she should be delivered by an elective caesarean section. Patient was grouped and matched and prepared for operation. On account of the upper respiratory infection, spinal anaesthesia was decided upon. Therefore, at 4:18 p.m. the day of admission, December 31, 1942, spinal anaesthesia was started after local anaesthesia with 1 per cent novocaine; 20 mg. of pontocaine in 3 C.C. of spinal fluid was injected into the spinal canal between the fourth and fifth lumbar vertebrae (thirty seconds required for administration). Patient was immediately placed on her back and kept lying flat with two pillows under her head. Immediately after administration of the anaesthesia, blood pressure dropped to 100/70 and a M ampule of ephedrine was administered. Five minutes later blood pressure had risen to 130/100. Approximately ten minutes after administration of pontocaine and while the operative field was being prepared, patient became cyanotic and all respiratory and cardiac action ceased. Blood pressure could not be obtained and pulse could not be felt. Patient was immediately placed in Trendelenburg position and stimu- lants administered, but all attempts ai resuscitation failed. About 30 c.c. of spinal fluid was rembved in an attempt to remove some of the anaesthetic agent, but this was of no avail and patient was pronounced dead at 4:30 p.m. December 31, 1942. An attempt was made to save the fetus so an incision was made in the abdomen and a full term stillborn male child was removed at 5:05 p.m. December 31, 1942 weighing 9 pounds 153/i ounces. The death of the child undoubtedly occurred following the death of the mother. No postmorten examination was obtained and this death was attributed to the spinal anaesthesia.

Maternity Hospitals The following tabulation gives a summary of the maternity hospitals inspected and licensed in 1942: Licensed as of Decembet 31, 1942 19 New licenses issued 1 Relicensed 18 Inspected 19 Discontinued 1 Midwives There were no midwives licensed to practice in Baltimore City in 1942. BUREAU OF CHILD HYGIENE 169

Personnel William K. Skilling, M.D., Director Mary C. Willis, M.D., Assistant Director M. Alexander Novey, M.D., Chief, Division of Maternity Hygiene John M. IIaws, M.D., Acting Chief, Division of Maternity Hygiene Isadore Siegel, M.D., Health Officer W. Allen Deckert, M.D., Health Officer Hugh B. McNally, M.D., Health Officer D. F. Kaltreider, M.D., Clinic Physician Walter E. Grempler, M.D., Health Officer J. W. V. Clift, M.D., Health Officer Harry F. Brown, M.D., Health Officer Albert Jaffe, M.D., Health Officer Meyer Miller, M.D., Health Officer Albert Scagnetti, M.D., Health Officer Gustav H. Woltereck, M.D., Clinic Physician Edith Rodler, M.D., Clinic Physician Solon A. Dodds, M.D., Clinic Physician Mary L. Hayleck, M.D., Clinic Physician Anna M. Schmidt, Senior Stenographer Catherine L. Lilley, Senior Clerk Lillian Marley, Senior Clerk Mary A. Atkins, Statistical Clerk Hannah E. Schneider, Junior Typist Josephine Roemer, Addressograph Operator 170 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 1 REPORT OF INFANT AND PRESCHOOL HYGIENE CLINICS

NEW TOTAL CHILDREN %.,,-, %.,11ILDREN CLINIC VISITS ON 11ILDREN CHILDREN ON REGISTER REGIS- REGIS- REGISTER JAN. 1, DEC. 31, 13rl'iitI1l% 131I=G 1042 CLINIC 1942 1942 1942 Return Total 1 1 yr. yr. yr. yr. yr. yr. 1 1 1 1 1 1 8 0 i 5. V,, 5. 5. I 13 T T T Under Under Under Under . Under Under. '2 ,, ..., .

ALL CLINICS 4,721 8,171 3,750 364 8,371 6,535 5,880 5,259 20,199 10,622 23,949 10,980

WHITE Total White Clinics 2,248 2,159 1,289 171 3,537 2,330 2,433 2,055 7,319 4,080 8,608 4,251

Valley and Eager Streets 92 217 87 21 179 238 179 238 618 428 705 447 Public School No. 86 166 33 61 1 227 34 182 1 425 171 486 172 Public School No. 60 291 114 109 15 400 129 295 58 405 281 514 298 Public School No. 65 170 90 135 13 305 103 98 243 615 305 750 318 1923 East Monument Street 51 154 35 6 86 160 83 165 337 224 372 230 2817 Oakley Avenue 204 300 128 13 332 313 268 225 847 499 975 512 Public School No. 225 89 1 22 5 111 6 98 3 71 62 93 57 Pratt Library, Branch 12 90 46 85 3 175 49 75 79 391 268 476 269 Public School No. 68 165 80 63 5 228 85 197 44 374 269 437 274 University of Maryland 89 108 82 5 171 111 55 107 329 235 411 240 Public School No. 220 131 178 29 11 160 189 153 176 321 192 350 203 Public School No. 98 298 76 111 8 409 84 290 63 619 239 730 247 Public School No. 76 27 212 58 7 85 219 52 182 428 419 486 426 Public School No. 6 199 380 158 18 357 398 253 437 1,069 313 1,227 331 Perkins Housing Project* 112 35 62 18 174 53 139 37 165 90 227 108 Brooklyn Housing Project** 0 0 8 5 8 5 8 5 3 4 11 9 Fairfield Housing Project** 0 0 8 12 8 12 8 12 1 7 9 19 Pratt Library, Branch ll***, 74 137 48 5 122 142 0 0 301 88 349 93

COLORED Total Colored Clinics 2,473 4,012 2,461 193 4,834 4,205 3,447 3,204 12,880 6,542 15,341 6,735

Valley and Eager Streets 158 399 133 17 291 418 291 416 743 400 876 417 Public School No. 140 74 290 113 14 187 304 73 398 509 359 622 373 Public School No. 176 272 292 330 9 602 301 304 151 1,704 726 2,034 735 Metropolitan Church 318 549 387 13 705 562 305 261 1,896 993 2,282 1,006 Public School No. 122 289 422 418 13 707 435 286 404 2,191 824 2,609 837 Douglass High School 282 644 277 36 559 680 551 205 1,319 879 1,598 715 Public School No. 106 116 184 99 21 215 185 209 77 376 312 475 333 Public School No. 104 159 117 109 9 268 126 285 144 589 240 698 249 University of Maryland 176 256 234 19 410 275 249 239 918 521 1,152 540 1923 East Monument Street 93 322 43 5 136 327 136 327 458 300 501 305 Public School No. 116A 168 33 40 8 206 41 184 454 628 361 688 369 Druid Health Center 284 448 217 13 401 461 493 72 1,101 612 1,318 625 Pratt Library, Branch 11 69 62 49 11 118 73 83 41 344 75 393 86 Public School No. 158 17 14 12 5 29 19 18 15 105 140 117 145

*Perkins Housing Project opened May 6. **Brooklyn Housing Project and Fairfield Housing Project opened October 26 and October 28, respectively. ***Pratt Library, Branch 11, white children transferred to Perkins Housing Project October, 1942. BUREAU OF CHILD HYGIENE 171

TABLE NO. 2 SUMMARY OF THE ACTIVITIES OF SUPERVISION OF BOARDING HOMES,DAY NURSERIES, AND NURSERY SCHOOLS AND CHILDREN'S INSTITUTIONS-1942

DAY NURSERIES LICENSES AND VISITS BOARDING AND NURSERY CHILDREN'S HNSTITUTIONSomes SumoLe IA NSTITUTIONS

Total licensed 251 48 0 White 219 41 o Colored 32 7 0 New licenses issued 67 13 0 White 58 11 0 Colored 9 2 0 Homes reopened 11 0 0 White 10 0 0 Colored 1 0 0 Homes inspected for Department of Public Welfare 98 0 0 Visits 2,118 226 54 By assistant director 287 93 7 By nurse 1,831 133 47

SUMMARY OF CHILDREN IN LICENSED BOARDING HOMES-1942

TOTAL DURING ;YEAR REMAINING DECEMBER 1942 AGE Total White Colored Total White Colored

All Ages 726 612 114 413 333 80

Birth to 6 months 20 16 4 11 7 4 6 months to 1 year 26 16 10 13 .8 5 1 to 2 years 57 48 9 25 17 8 2 to 3 years 45 41 4 27 20 7 3 to 6 years 85 71 14 54 45 9 6 veare and over 493 420 73 283 236 47 172 • REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 2—Continued BOARD/NG HOMES, NURSERY SCHOOLS AND INSTITUTIONS REFERRED TO BUREAU FOR SUPERVISION AND NEW CHILDREN PLACED IN BOARDING HOMES IN 1942

NEW ORGANIZATIONS HOMES NURSERIES INSTITUTIONS CHILDREN REFERRED REFERRED REFERRED PLACED

AU organizations 190 20 5 202

Babies' Milk Fund Association 1 o o o Baltimore County Children's Aid Society 1 o o o Baptist Children's Society 1 o o o Bureau of Catholic Charities 28 o o 31 Bureau of Communicable Diseases o o 1 o Bureau of Public Health Nursing 2 1 o o Bureau of Vital Statistics o 1 o o Children's Home of Baltimore 5 o o 4 Children's Home Society of Virginia 1 o o o Department of Public Welfare 36 o o o Druid Health Center 8 o o o Eastern Health District 3 o o o Florence Crittenton Home 1 o o o Family and Children's Society 42 o o 76 Jewish Family and Children's Bureau 22 o o 24 Juvenile Court 1 o o o Maryland Children's Aid Society 1 o o o Police Department 1 o o o Private Individuals 27 6 o 66 State Department of Public Welfare 4 o 4 o Southeastern Health District o 3 o o The Sun 5 o o o Work Projects Administration o 9 o o

SUMMARY OF CASES OF COMMUNICABLE DISEASES IN LICENSED DAY NURSERIES AND NURSERY SCHOOLS, TOGETHER WITH AVERAGE MONTHLY ENROLLMENT AND AVERAGE DAILY ATTENDANCE IN 1942

DAY NURSERIES NURSERY SCHOOLS ENROLLMENT AND DISEASE Total White Colored Total White Colored

Average monthly enrollment Winter months 287 200 87 520 339 181 Summer months 286 201 85 906 715 191 Average daily attendance Winter months 213 148 65 431 272 159 Summer months 209 140 69 690 534 156 Communicable diseases 8 8 o 282 259 23 Chickenpox o o 0 86 75 11 German measles o o o 5 5 Impetigo contagiosa o o o 1 1 Measles 5 5 0 104 93 11 Mumps 3 3 o 63 83 Scarlet fever o o o 6 Whooping cough 0 o o 17 16 1 TABLE NO. 3 REPORT OF PRENATAL CLINICS

SOUTTI Soum- .,... Damn 914 W. BALTIMORE PUBLIC EASTERN rIIBLIC WOMEN'S EASTERN ALL CLINICS HEALTH 36mis GENERAL &mom SCHOOL HOSPI- HEALTH GRAND CENTER STREET No. 99 '-',-.."'— No. 220 mem Manner CASES AND VISITS .2aIST. TOTAL HOSPITAL

White Colored Colored White White Colored White White White White White Colored Cases as of January 1, 1942 268 86 182 145 9 9 3 9 29 5 9 16 34 New cases admitted 1,335 410 925 661 39 49 48 59 102 38 48 75 216 Transferred from other clinics 3 1 2 0 0 0 0 1 0 0 0 0 2 Total case load 1,606 497 1,109 806 48 58 51 69 131 43 57 91 252 DISCHARGED CASES Total 1,326 399 927 673 36 48 43 61 103 38 46 67 211 VallilEt Not pregnant 6 1 5 2 0 0 0 0 0 0 1 0 3 fl Delivered in hospital* 1,279 387 892 652 34 47 38 60 96 38 45 67 202 Delivered at home 3 8 4 1 11 0 0 0 3 0 0 0 3 30 Transferred 27 7 20 13 1 1 4 1 4 0 0 0 3 Transferred to other climes 3 1 2 2 1 0 0 0 0 0 0 0 0 Cases carried over to January 1943 280 98 182 133 12 10 8 8 28 5 11 24 41

Cumc Vnirrs MHO Total 9,149 2,645 6,504 4,748 300 255 505 196 431 718 204 291 1,501 -1 Antepartum First visits 1,335 410 925 661 39 49 48 59 102 38 48 75 216 Revisits 6,793 1,950 4,843 3,734 148 238 193 326 532 146 213 347 916 Postpartum Registered 530 149 381 181 5 6 7 24 42 11 15 46 193 Unregistered 5 3 2 0 0 0 0 1 2 0 0 0 2 1MaIi9A1 Infanta, neonatal 486 133 353 172 4 7 7 21 40 9 15 37 174 ANALYSIS or NEW CASES Duration of pregnancy Not pregnant 2 0 2 1 0 0 0 0 0 0 0 0 1 Under 12 weeks 19 8 11 9 0 0 0 2 2 1 0 3 2 12-23 weeks 208 105 103 65 11 14 10 13 31 8 13 15 28 24-27 weeks 262 107 155 95 14 14 20 16 27 6 3 27 40 28-31 weeks ... 171 48 123 77 4 8 3 7 12 2 8 7 43 32-35 weeks 364 83 281 212 5 8 10 12 19 10 16 13 59 36 weeks and over 309 59 250 202 5 5 5 9 11 11 8 10 43

*Baltimore City Hospitals.

CAD TABLE NO. 4 REPORT OF MIDWIFE CA ---

Daum 914 Boum Bovril- , W. BALTIMORE PUBLIC ....,„, x IIBLIC WOMEN'S EASTERN ALL CLINICS HEALTH 36ra Scaom. E'''. '' GENERAL ,,,, HsALTH'RN Smoot. HOSPI- HEALTH Cams A-ND VISITS GRAND CENTER STREET No. 220 TAL Maya= Toni, Hoscrrel, ‘11°'" DIST. REPORT White Colored Colored White White Colored White White White White White Colored

Cases as of January 1,1942 66 4 62 2 0 0 4 2 1 0 0 1 56 New cases admitted 126 14 148 17 0 2 0 1 8 0 1 2 131 Total case load 228 18 210 19 0 2 4 3 9 0 1 3 187 OF DISCHARGED CASES THE Total 125 9 116 13 0 1 0 2 3 0 0 3 103 Delivered by midwife 104 7 97 11 0 0 0 2 3 0 0 2 86 Transferred 13 2 11 2 0 1 0 0 0 0 0 1 9 HEALTH Not pregnant 8 0 8 0 0 0 0 0 0 0 0 0 8

Cases carried over to January 1943 103 9 94 6 0 1 4 1 6 0 1 0 84 Guam VISITS Total 690 46 644 92 0 12 0 2 24 0 1 7 - 552 DEPARTMENT Antepartum First visits 162 14 148 17 0 2 0 1 8 0 1 2 131 Revisits 505 30 475 73 0 10 0 1 14 0 0 5 402 Postpartum Registered 11 1 10 1 0 0 0 0 1 0 0 0 9 Unregistered 1 0 1 0 0 0 0 0 0 0 0 0 1 Infants, neonatal 11 1 10 1 0 0 0 0 1 0 0 0 9 -1042 ANALYSIS OF NEW CASES Duration of pregnancy Not pregnant 4 0 4 0 0 0 0 0 0 0 0 0 4 Under 12 weeks 6 0 6 0 0 0 0 0 0 0 0 0 6 12-23 weeks 16 1 15 2 0 1 0 0 0 0 0 0 13 24-27 weeks 38 3 35 3 0 1 0 0 2 0 0 0 32 28-31 weeks 33 2 31 2 0 0 0 0 2 0 0 0 29 32-35 weeks 30 4 26 5 0 0 0 1 2 0 1 0 21 36 weeks and over 35 4 31 5 0 0 0 0 2 0 0 2 26 BUREAU OF CHILD HYGIENE 175

TABLE NO. 5 ANALYSIS OF PHYSICAL EXAMINATIONS ON REGISTRATION AT PRENATAL CLINICS

NUMBER PERCENTAGE DISTRIBUTION FINDINGS ' Total White Colored Total I White Colored

REGISTERED FOR DELIVERY AT HOSPITALS*

Primipara 324 100 224 24.3 24.4 24.8 Multipara 1,009 310 699 75.7 75.6 75.2

PELVIS Normal 1,210 371 839 00.8 90.5 00.9 Borderline 88 28 60 6.6 6.8 6.5 Contracted 31 9 22 2.3 2.2 2.4 Funnel 4 2 2 .3 .5 .2

SEROLOGIC TEST FOR SYPHILIS Negative 1,221 399 822 91.6 97.3 89.1 Positive 108 11 •97 8.1 2.7 10.5 Not taken 4 0 4 .3 .. .4

OTHER FINDINGS Toxemia 143 49 94 10.7 10.2 10.2 Heart murmur 187 33 154 14.0 8.0 16.6

REGISTERED FOR DELIVERY BY MIDWIFE

Primipara 38 3 35 24.0 21.4 24.2 Multipara 120 11 109 76.0 78.6 75.8

Plums Normal 149 14 135 94.3 100.0 93.7 Borderline 6 0 6 3.8 .. 4.2 Contracted 3 0 3 1.9 .. 2.1

SEROLOGIC TEST FOR SYPHILIS Negative 143 14 129 90.5 100.0 89.6 Positive 15 0 15 9.5 .. 10.4

OTHER FINDINGS Toxemia 15 2 13 9.5 14.2 9.0 Heart murmur 16 2 14 10.1 14.2 9.7

* Baltimore City Hospitals. ,

# SCHOOL HYGIENE

[1771

..■■•

DIVISION OF SCHOOL HYGIENE

H. Warren Buckler, M.D. Chief During the summer of 1936, a survey was made of a group of schools in the Borough of Queens in the City of New York. This survey, which was completed in 1940, was made by a committee of experts, including school physicians, school nurses, psychiatrists and teachers of health education, and the results were published by the Commonwealth Fund in a volume entitled Solving the School Health Problems. In 1941, under the guidance of Dr. C. Howe Eller, Health Officer, a public school was selected in the Eastern Health District and an experimental school hygiene program based on this plan was inaugurated. Part of this plan had already been given a trial in the Baltimore school health service. Many years ago, the division chief requested some of the school physicians, on a voluntary basis, to have the parents present at the time the pupil was examined. After giving this plan a more or less thorough trial, it was abandoned for the following reasons: (1) it consumed too much of the limited time the school physician was allowed for his school work and (2) it was next to impossible to adopt any standard method of evaluating this service, inasmuch as the child was not seen by the doctor in some instances for a year or more after the initial visit. If corrections of existing defects were the chief objective, there was no apparent increase in the number of corrections as compared with the regular routine of examining the child and notifying the parents in writing of existing defects that needed correction. For many years, the physical examinations of the school children have been divided into two groups, (1) routine examinations of entering pupils in the kindergarten, first, third and fifth grades and (2) special examinations of any pupil of any grade upon the request of the principal, classroom teacher or director of physical education. The patronage in this second group varied considerably in different schools depending upon the interest manifested by the principal or classroom teacher in the health problems of their pupils. The initiative was always taken by them. In the plan put into effect based on the New York study, to induce closer participation in the health program by the classroom teacher, the initiative was taken by the school physician or nurse and the results of the examination were not given to the classroom teacher, but request was made that she, in her daily observation of the pupil,note whether or not there were any untoward

[179 ] 4:1144e.'

180 REPORT OF THE HEALTH DEPARTMENT-1942 effects from the abnormal physical conditions found. Likewise, she was requested to note any subjective symptoms that might be caused by some defect that had been overlooked by the physician. As a result of this "give and take" program, conferences are arranged between the nurse, physician and classroom teacher to discuss the health problems of their respective pupils. This part of the program seemed advisable and accordingly, at the onset of the present school year, the director not only put it into effect in all the public schools under his immediate jurisdiction, but authorized a similar program in schools in other districts manned by both full time and part time physicians, upon the request of the school principals or the advice of the supervising nurse. In all, twenty-seven schools adopted this procedure. The school physician gives at least one day each month to these special conferences and discussion with the principal or the teacher of the physical condition of various pupils brought to his attention. When defects remained uncorrected by the usual procedures, the physician or the principal summons the parent to the school for joint conference with the doctor, nurse or classroom teacher regarding the health problem of the child. Mile it is too early to tabulate the concrete benefits of this procedure, it is meeting with the approval of all parties concerned and it would seem advisable to institute this part of the program in all the elementary public schools of the city at the onset of the next scholastic year. In the schools in which this plan has been put into effect, the director has addressed the school faculty and explained to them in detail the part each should play to make it effective. There is no doubt in the mind of the division chief that consultation with parents of children who have already been in school for a year or more is productive of better results than having the parents present at the initial examination of the child, inasmuch as both the school physician and class-. room teacher have definite reasons why the existence of certain defects have a, deleterious effect upon the child, both as a pupil and as an individual. The time limit makes both procedures impossible. The value of the part of the program involving the attending physician varies considerably in different schools, depending upon the economic status of the parents. In schools where the population is of high economic status and where parents not only uniformly have a regular physician, but oftentimes an excellent pediatrician, the program will be eminently successful and where the oppo- site is true the program will be of doubtful value. As the survey made last year by the division chief showed that a relatively small number of new defects were found at the time of the routine examination of the fifth grade pupils, this examination has been eliminated in the schools selected for this study. It is the feeling of the division chief that it is impracticable, owing to SCHOOL HYGIENE 181

the limited personnel, at any time to put into effect in any school the entire recommendations of the New York study. The trend of the modern school health service tends towards emphasizing the importance of the educational side of the program whereas in a health service under the jurisdiction of a department of health, it is quite natural that the communicable disease control part of the program is emphazised. Tuberculosis always has been an important health problem in the colored schools of Baltimore. To date, there is no definite program in effect towards its control, nor are there any adequate figures to indicate the incidence of the disease among the colored children other than reports from the State Tuberculosis Sanatorium for Negroes, where 29 cases of primary tuberculosis and 19 cases of the reinfection type of tuberculosis were admitted during 1942. In a small colored school under the jurisdiction of the director, with an enrollment of 68 pupils, 65 parents at a Parent-Teacher meeting signed a request to have their children tested for tuberculosis. This was done by the Vollmer Patch method and 15.4 per cent were positive reactors. All of these positive reactors were subsequently X-rayed and only one case of reinfection type of tuberculosis was discovered. This procedure would be practical for all the elementary public schools of the city. There were no other changes in the scope and plan of the work of the Division of School Hygiene during 1942. A summary of the physical defects and corrections made among school children is herewith appended.

Personnel II. Warren Buckler, M.D., Chief Harry C. Grant, M.D., Health Officer M. L. Breitstein, M.D., Health Officer Lyman Abbott, M.D., Clinic Physician 182 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 1 REPORT OF PUPILS EXAMINED AND DEFECTS FOUND PUBLIC ELEMENTARY ScHooLs PAROCHIAL SCHOOLS DEFECTS TOTAL White Colored White Colored

Number of pupils examined 41,423 22,206 10,550 8,223 444 Number of pupils defective 18,735 9,294 5,637 3,578 226

Throat—tonsils 8,755 4,644 2,472 1,527 112 Nose—adenoids 8,755 4,644 2,472 1,627 112 Mouth—teeth 10,436 5,100 3,100 2981 155 Eyes 2,541 1,156 910 464 11 Ears 95 78 9 8 • • Heart 505 300 89 116 .. Cases of malnutrition 2,993 1,768 659 640 26

TABLE NO. 2 REPORT OF CORRECTIONS OF PHYSICAL DEFECTS OF SCHOOL CHILDREN PUBLIC ELEMENTARY SCHOOLS PAROCHIAL SCHOOLS DEFECTS CORRECTED TOTAL White Colored White Colored

Tonsils and adenoids 2,169 1,391 180 598 .. Other operations 108 60 21 27 .. Teeth 4,508 2,327 995 1,172 14 Eyes refracted and glasses obtained 1,6-97 1,011 300 382 4 Eyes refracted and glasses not necessary 64 40 4 10 .. Skin eruption 164 106 27 31 .. Pediculosis 448 358 ... 90 .. Children treated for minor ailments, accidents and emergencies 182 35 120 18 .. Children sent to dispensaries 709 469 82 178 .. DIVISION OF DENTAL CLINICS

[183 1

DIVISION OF DENTAL CLINICS

Morris Cramer, D.D.S. Supervisor There were fewer requests received for dental treatments in the Division of Dental Clinics during 1942 than in previous years. This was no doubt due to the favorable employment situation now prevailing in Baltimore. However, the staff consisting of four part time dentists, three white and one colored, and a part time supervisor who operated the sixteen dental clinics located in the public schools, were unable to care for all the children who applied. The majority of the pupils were treated for the relief of toothaches, either by extractions, sedative treatments or fillings. Approximately 90 per cent of the children examined were found in need of extensive treatments and because of the limited staff, many of these children were referred either to their private dentists or to the Dental School of the University of Maryland. The clinicians found very little time for dental health education, but whenever possible, pupils were instructed in the proper care of their mouths. A brief summary of the work accomplished during the year in the public schools is as follows: Patients registered at clinics 3,965 Visits to clinics 5,035 Prophylactic treatments given 2,025 Teeth filled 1,088 Temporary teeth extracted 6,199 Permanent teeth extracted 1,855 Cases completed and discharged 3,405 Special Preschool Dental Study in Western Health District The preschool dental clinic at the Dental School of the University of Maryland continued to function during 1942. This clinic cooperated with the Health Department infant and preschool hygiene clinic in the Western Health District and children from eighteen months to school age were examined and treated by senior students of the dental school under the supervision of a graduate dentist. Recommendations During the year, many of the notification cards sent to parents concerning the condition of the child's teeth, were returned to the public health

[1851 186 REPORT OF THE HEALTH DEPARTMENT-1942 nurse with a notation that child would be taken to a private dentist. Upon examination of the mouths of these children months later, it was found that the parents neglected to carry out their intention and because of this neglect, many permanent teeth were badly broken down, infected and far beyond repair which necessitated extraction of the teeth. This situation could be remedied by the inauguration of a regular follow-up program conducted by the public health nurses and the teaching staff, by urging the parents to send their children to private dentists for the necessary dental treatment and by the properly signed return of the cards when the work is completed. A program of dental health education for teachers, parents and children should also be developed. This program could be correlated with the school work in the classroom. Four points should be stressed as a basis for dental health education, namely, proper food, exercise, cleanliness and early dental care. Personnel Morris Cramer, D.D.S., Supervisor John H. Hoffman, D.D.S., Dentist Charles Highstein, D.D.S., Dentist Nathan Scherr, D.D.S., Dentist Lucius A. Butler, D.D.S., Dentist

TABLE NO. 1 REPORT OF THE WORK DONE IN THE DENTAL CLINICS—YEAR 1942 I DIS-

??, s TEM- or AND z 6 TEETH

PATIENTS 41.1 E [li PORARY CHARGED NEW Cearo-EuaowoL COMPLETED 1 a,i 1 ExTrAortoN Taal 3,965 5,035 2,025 833 211 6 72 38 144 1,855 8,199 3,405

January 461 820 265 117 28 1 8 9 24 316 797 418 February 434 594 229 89 8 1 7 8 13 239 821 384 March 541 687 252 86 27 .. 4 5 16 249 870 433 April 465 609 240 109 29 .. 7 2 10 175 779 418 May 466 622 252 100 30 .. 8 3 24 231 802 454 June 197 282 105 58 16 2 7 4 15 101 316 205 October 519 563 279 84 29 .. 10 3 15 177 686 380 November 495 588 228 107 27 .. 10 3 14 204 744 396 December 387 470 175 83 17 2 11 1 13 163 584 310 BUREAU OF PUBLIC HEALTH NURSING

[187] .

. BUREAU OF PUBLIC HEALTH NURSING

Jane B. Lath, R.N. Director The educational program of the Bureau of Public Health Nursing was greatly strengthened by the appointment of an Educational Director in August. This appointment met a long recognized need in the bureau and has resulted in the coordination of all educational activities under one leadership. Plans have been made for an intensive and continuous staff educational program. The rapid and large turnover of nursing personnel during the year, due to the war emergency, presented a serious administrative problem. The difficulty in securing qualified nurses to fill vacancies made it necessary to make adjustments in order to maintain the standards and objectives of the bureau. In many instances, newly appointed nurses resigned before they had an opportunity to complete the introductory period of training. During the year the bureau continued to use the services offered by the Baltimore Social Service Exchange. Cases were registered on a selective basis and the information received was used by the public health nurses in their home visiting. There were 986 such clearances for the City Health Department in 1942, of which 717 were for the Eastern Health District. In 1940 there had been 1,110 clearances, 1,023 of which were for the Eastern Health District; and in 1941 there were 1,160 clearances, 889 of which were for the Eastern Health District.

General Services Maternity Hygiene The public health nurses were gratified with the part they played in establishing the maternal mortality rate of 1.7 per 1,000 live births. This is the lowest rate ever recorded in Baltimore. Because of personnel difficulties and the increased caseload in other services, the number of home visits by the field nurses decreased but educational instruction in the clinics was increased. Infant and Preschool Hygiene During the year 78,008 visits were made to infant and preschool hygiene cases as compared with 89,436 visits during 1941. Three public health

[1891 190 REPORT OF THE HEALTH DEPARTMENT-1942 nurses were placed in the newly established infant and preschool hygiene clinics in the Perkins and the Brooklyn-Fairfield housing projects. The attendance at these clinics has increased and there has been a splendid spirit of cooperation by the parents. Due to the change of policy in the Bureau of Child Hygiene in the assignation of neonatal and diphtheria prevention cases for home visits, the public health nurse who had been handling this work for a number of years was given other duties. The transfer of two nurses from the Babies Milk Fund Association has been referred to elsewhere in this report.

School Hygiene The public health nurses participated in the new school hygiene program which was put into effect on an experimental basis in twenty-seven of the public schools during the year. Conferences were held with the teachers at frequent intervals to discuss the health problems of the pupils and it was felt that this part of the program had greatly strengthened the relationship between the nurses, school principals and teachers. Children needing emergency dental treatment were either taken or referred by the public health nurses to one of the sixteen dental clinics located in the public schools. Public health nurses also assisted the dentists in these clinics on scheduled days.

Communicable Diseases In January, because of an anticipated measles outbreak, public health nurses were requested to make one additional visit to children under three years of age who were contacts of cases of measles and where there was no family physician. This additional visit was made between five and seven days following the appearance of the rash and was for the purpose of detecting and preventing pneumonia or other serious complications. Unfavorable findings were reported immediately to the Director of the Bureau of Communicable Diseases or to the district health officer. Because of the increase in the number of cases of meningococcus meningitis reported during the year, the nurses noted and reported insanitary and overcrowded housing conditions in their respective districts. Special attention was paid to newborn babies in these homes and every possible effort made to have them protected against smallpox and diphtheria. A neighborhood campaign for diphtheria prevention was held during October in the Brooklyn-Fairfield housing project and 203 children were given diphtheria toxoid; all except 7 were under five years of age. In addition, 299 children were vaccinated against smallpox. BUREAU OF PUBLIC HEALTH NURSING 191

Tuberculosis Public health nurses assisted the Director of the Bureau of Tuberculosis in the expanded program for case finding and examination of tuberculosis contacts. As far as possible, cases were referred to their own physicians. In September, when the position of X-ray technician in the Bureau of Tuberculosis was abolished, one of the senior colored nurses in the Druid Health Center was given special training in X-ray work at the Johns Hop- kins Hospital for a period of three months and assigned to the new chest clinic which was opened in the Druid Health Center in December. Two other nurses were also given full time duty in this clinic. Educational Program The undergraduate student affiliation has been carried on with the four hospital schools of nursing during the year. A detailed study of this program was made with the idea of offering an opportunity for a limited number of undergraduate students to observe the public health nursing field activities rather than the two months' affiliation as offered in the past. One of the semimonthly meetings of the supervisors was devoted entirely to the study of supervision. A year's program was planned by a special committee. The discussion method was used, with each supervisor having an opportunity to participate. Each supervisor also worked out with her group of staff nurses a series of conference for the year. The subjects for these conferences were selected on the basis of the particular needs of the group. Four supervisors and fifteen public health nurses completed a course in the supervision of public health nursing at the Johns Hopkins University. Thirteen other nurses studied Educational Psychology in a course given under the auspices of Morgan College at the Douglass High School. Members of the bureau attended various professional meetings held in Baltimore and other cities during the year. Personnel Jane B. Laib, Director Lilly Harman, Educational Director E. M. H. Brown, Assistant Director Grace S. Eyler, Senior Stenographer Sara H. Ford, Senior Stenographer M. Alice Caron, Senior Supervisor of Field Nurses Adelaide G. Smith, Senior Supervisor of Field Nurses Ethel G. Gluck, Senior Supervisor of Field Nurses Ola C. Early, Senior Supervisor of Field Nurses Marie Dandridge, Senior Supervisor of Field Nurses _

192 REPORT OF THE HEALTH DEPARTMENT-1942

Public Health Nurses Marianna P. Aiau George A. Hutton Mary Bacon Constance Jacobs Romaine S. Basford Ruth K. Jones Ruth C. Bennett Ethel L. Kallinsky Grace Berger Edna Kenney Mary T. Brown Elsa C. Kittel Marie V. Buckless Jane ICreitz Elevian R. Carter Rose B. McDonnell Sarah V. Case Elizabeth McGovern E. Murray Cox Frieda E. Moore Vera M. Craig Winifred Moore Grace C. Crawford Edwinia Ozazawski Bertie Davidson Roberta S. Pinckard Alice E. Diver Carolyn Kling Preston Emily L. Ely Helen B. Reutter Ruth Eckman Elizabeth Rutter Hattie S. Ennis Ingrid Selkamaa Rose M. Fields Carolyn M. Shaffer Ethel V. Finneyfrock Helen B. Sharpe Virgie M. Finneyfrock Ruth Stoneham Helen H. Galloway Marian E. Stromberg Geneva Gartside Mary B. Tewell Mary A. Goldberg Birdie M. Thearle Marian Hagan Violet Weber Rose M. Hoffman Helen L. Wells Margaret B. Hoyt Alva M. Williams Edna V. Yates SANITARY SECTION

[103]

SANITARY SECTION

Personnel Wilmer II. Schulze, Phar.D., Director Elizabeth M. Truxal, Senior Stenographer George Boteler, Messenger

[ 1951

SANITARY SECTION Wilmer H. Schulze, Phar.D. Director The war emergency intensified existing problems and created many new ones in the administration of the activities of the Sanitary Section. Expan- sion of many industries, the inmigration of thousands of workers and their families, labor turnovers and shortages of critical materials made impera- tive closer concentration of attention on sanitary housing, industrial workroom environments, milk and food control and general community sanitation. Advancement in the control of sanitary housing was accomplished by the adoption, as provided for in existing ordinances, of regulations governing the hygiene of housing, rooming houses, lodging houses and hotels; and trailer camps, respectively; and by the filling of three new positions in the classification of senior sanitary inspector, for the enforcement of the housing ordinances and regulations. Insanitary housing conditions multiplied as additional war workers and their families were crowded into any available spaces in rooming houses and converted multiple family dwellings, particularly in the older sections of the city and in proximity to industrial areas. Such conditions as overcrowding, defective and inadequate plumbing, rat and vermin infestation, accumulations of garbage and rubbish, poorly lighted and poorly ventilated sleeping rooms and general dilapidation and disrepair were prevalent in many of these places. Attention was concentrated on improving sanitary housing conditions where the greatest need existed. Owners were notified to correct existing hazards to health and life and when they failed to comply with notices within a reasonable time legal action was taken. In all such instances, including three cases in the Criminal Court, the ordinances and regulations were upheld by the court. A chief objective of the housing program is to remove all of the rat-harboring frost-proof hopper nuisances from the back yards of houses in the city. The establishment of sixty-four trailer camps within the city, most of which were located on unsuitable sites lacking necessary facilities, presented a major potential health hazard. Operators of these camps were required to conform with the trailer camp regulations or to discontinue operation. By the end of the year practically all were closed except about ten whose Proprietors made every effort to conform with sanitary requirements. The rapid expansion of many industrial plants and the conversion of others for the manufacture of war materials increased already existing health problems and created some new ones. A marked increase in the

[107] 198 REPORT OF THE HEALTH DEPARTMENT-1942 number of requests for information and guidance on industrial health subjects on the part of plant managements demonstrated the interest taken in the preservation of the health of the workers. Studies were made of exposures in workrooms to such dusts as asbestos, chromium,lead, manganese, phenolic plastics, silica and zinc, to benzol and halogenated hydro- carbon vapors, to lead, zinc and welding fumes, and to carbon monoxide gas. In addition other problems involving ventilation, illumination, sanitation and accident hazards were studied. Industrial executives in most instances gave prompt attention to correcting health and accident hazards reported to them. The abnormal increase in the city population because of the war emergency taxed the community sanitation services and caused a marked increase in the number of nuisance complaints, particularly types involving plumbing defects and garbage disposal. An outstanding achievement was the elimination of insanitary privies and provision of inside toilets with sewer connections for a group of houses on Kelly Avenue in the Mt. Washington district of the city. Members of the staff participated in such civilian defense activities as: Preparation for emergency chlorination of water mains in the event of damage by air raids in cooperation with the Bureau of Water Supply; inspections and grading of shelters that might be used for emergency feeding and housing; training for duties as air raid wardens; attendance at a Civilian Protection Physicians' Course, Chemical Warfare School and talks on nutrition to canteen classes of the Baltimore Chapter of the Ameri- can Red Cross. Some of the more important educational activities of the Sanitary Sec- tion included the inauguration of a course of training for food handlers, in-service training for new members of the staff, display of the department's educational films on rat control and carbon monoxide hazards to various civic groups, and the distribution of numerous health department publications on sanitation and health subjects. Cooperation and assistance was given other bureaus or departments in such matters as: Reports to the Bureau of Communicable Diseases about children who had not been given toxoid or who had not been vaccinated when discovered while making sanitary housing inspections; reinspections of sanitary conditions of child-caring institutions for the Bureau of Child Hygiene and of Homes for the Aged for the Department of Public Welfare; investigations of cases of typhoid fever attributable to the drinking of raw milk at a private institution and an apparent water-borne outbreak of gastro-intestinal illnesses among employees of a mercantile establishment in cooperation with the Bureau of Communicable Diseases; and joint sur- SANITARY SECTION 199 veys of housing conditions in several sections of the city with representatives of the Bureau of Buildings and the Fire Department. Many of the activities mentioned above are enlarged upon in the reports of the bureau directors which follow. Although considerably handicapped by loss of personnel because of war conditions and the impossibility of making satisfactory personnel replacements, the bureau directors and the entire staff worked arduously to maintain a high standard of sanitary services in the city.

BUREAU OF MILK CONTROL

[201 ] 0 BUREAU OF MILK CONTROL

Ivan M. Marty Director On February 14 the Commissioner of Health revoked the milk plant permit of Kemp's Dairy, Incorporated, 1200 Winchester Street. This action followed a hearing before the Commissioner of Health at which time the milk plant was charged with persistent, repeated and willful violation of the city milk ordinance and Health Department regulations adopted thereunder. At a similar hearing before the Commissioner of Health on November 24, the Bowman Dairy, 1800 North Aiken Street, was also charged with persistent and willful violation of the city milk ordinance and Health Department regulations. The charges were substantiated and the milk plant's permit was cancelled on November 28 at which time the plant, equipment and entire business was purchased by another company. Ordinance No. 747 approved on May 4 added an important amendment to Section 52 of Article 16 of the Baltimore City Code of 1927. The ordinance empowers the Commissioner of Health to refuse an applicant a milk plant permit where in his opinion the equipment, personnel or managerial control of the applicant is inadequate and where a permit has been revoked for violation at the plant of the applicant or for violations for which the applicant was responsible. Regulation 1 of the Health Department milk plant regulations was amended by the Commissioner of Health on May 20 in order to change the definition of bulk milk from milk sold in containers exceeding one quart in capacity to milk sold in containers exceeding two quarts in capacity. The purpose of the change was to permit the use of two-quart glass milk bottles for the distribution of milk. ,Baltimore had its second outbreak of milk-borne communicable disease since the milk ordinance was passed in 1917. During the latter part of May two nurses and four patients in a small nursing home situated just inside of the city limits developed typhoid fever. The illness was caused by the consumption of raw milk produced on the premises and handled by an employee who was a typhoid carrier. The annual Sanitary Milk Production Contest was won for the third time by the Delta High School of Delta, Pennsylvania. Two hundred and sixty students from thirteen rural high schools were trained for the contest bringing the total number of students instructed during the eleven years in

[203 ] 204 REPORT OF THE HEALTH DEPARTMENT-1942

which the contest has been held to 4,360. Although several high schools were forced to withdraw from the contest in 1942, the Taneytown High School, located in the heart of the milkshed, entered the contest for the first time and made an excellent showing. An ordinance designed to assist the milk pasteurization plants in meeting Federal restrictions on tires and gasoline was introduced in the City Council and,if adopted, would have permitted the predating of milk pasteurized on Friday afternoon with Sunday's labels. The measure was opposed by several civic organizations and was defeated by unanimous vote of the City Council. On September 2, because of personnel difficulties in the Bureau of Labora- tories, examination of culture specimens of employees of milk plants was discontinued. The Maryland Medical Milk Commission agreed to examine cultures for all certified milk farm employees and the Health Department arranged to continue to make the necessary examinations for employees of selected raw milk farms.

Dairy Farm Inspection Incoming Milk The dairy farm construction program which was progressing satisfac- torily until the United States entered the war, has been seriously affected by the wartime shortage of labor and critical building materials. Many farmers who were willing to make the necessary alterations to their milking stables and dairy houses in order to comply with the construction requirements within the two-year period established by the Commissioner of Health which ended October 1, 1942, found it impossible to secure the labor and building materials. These producers by signing an agreement of their intention to meet the requirements when possible were assured of their 1943 Dairy Farm Permits. During the late summer and fall Baltimore experienced the most critical milk shortage on record, making it necessary to import from sources not under regular City Health Department inspection approximately three million gallons of milk. The scarcity of farm labor, high cost of feed, increased population and perhaps a higher per capita consumption were the contributing factors'responsible for the shortage. In spite of the shortage of competent farm labor and although it was necessary to use a large volume of milk from emergency sources a generally satisfactory standard of sanitary quality of the city milk supply was maintained throughout the year. The average cubic centimeter bacterial plate count on the incoming raw milk supply increased from 87,300 in 1941 to 135,800 in 1942. BUREAU OF MILK CONTROL 205

The total number of holders of Dairy Farm Permits decreased from 3,234 on December 31, 1941 to 2,960 at the end of 1942. It is of interest, however, that during the same period there was an increase of nearly 2 per cent in the milk produced on the local milkshed.

Pasteurizing Plant Inspection Pasteurized Milk The average bacterial plate count on the pasteurized milk delivered to the doorstep increased from 1,300 in 1941 to 2,100 in 1942. Out of a total of 939 samples of bottled pasteurized milk examined by the Bureau of Laboratories only 4 indicated improper pasteurization. The percentage of the city milk supply sold as pasteurized milk increased from 99.2 per cent to 99.3 per cent. Ice Cream During November and December the Federal Office of Price Administra- tion rationed the milk products for use in the manufacture of ice cream thereby making it necessary for the ice cream plants to substitute large quantities of sherbet in order to supply the public demand for frozen products. On the basis of bacterial counts a satisfactory sanitary standard of quality of the ice cream supply was maintained. The bacterial count on ice cream manufactured by the pasteurizing ice cream plants increased from 1,800 in 1941 to 2,100 in 1942 and the count on the ice cream manufactured by the group of plants which did not pasteurize their products on the premises where frozen decreased from 14,000 in 1941 to 10,800 in 1942.

Personnel Ivan M. Marty, Director Marie Huppman, Senior Stenographer Lillian Rodbell, Senior Stenographer Jennie G. Moore, Senior Clerk Robert F. Gaddis, Dairy Farm Supervisor Courtney C. Buck, Dairy Farm Supervisor Leroy C. Shearer, Dairy Farm Supervisor Harry H. Shaffer, Dairy Farm Supervisor Charles H. O'Donnell, Dairy Farm Inspector John J. McKann, Dairy Farm Inspector Lawrence Wagner, Dairy Farm Inspector Vernon L. Corey, Senior Milk Plant Inspector Gulius D. D'Ambrogi, Senior Milk Plant Inspector William M. Iioffacker, Food Inspector Clarence L. Scheiblein, Food Inspector Philip H. Strauss, Food Inspector REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 1 SUMMARY OF DAIRY FARM ACTIVITIES FOR 1942 AS COMPARED WITH 1941 Area of Baltimore milkshed 2600 square miles (approximate) Active shippers 2960

ACTIVITIES 1942 1941

DAIRY FARM INSPECTIONS Total 8,040 8,420 Routine inspections 6,521 8,577 Special inspections 1,164 1,547 Application inspections 355 296

OTHER ACTIVITIES Violation notices issued 1,611 3,144 Milk returned for high temperature 818 2,856 Permits issued 83 Cl Permits cancelled 357 307 Hearings 17 84 Permittees warned at hearings 12 82

SUSPENSIONS OF PERMITS Total 107 325 Department 13 25 Field 94 300

TABLE NO. 2 BACTERIAL COUNTS AND PERCENTAGE BUTTERFAT FOR PREPASTEURIZED AND PASTEURIZED MILIC-1942 AND 1941

SELECTED MILK PREPASTEURIZED SELECTED MILK PASTEURIZED (BOTTLED) ,

Average Bacterial Average Per Cent Average Bacterial Average Per Cent MONTH Count Butterfat Count Butterfat

1942 1941 1942 1941 1942 1941 1942 1941

Entire Year 134,000 89,700 3.96 3.99 2,100 1,300 3.96 4.01

January 63,000 55,000 3.98 4.01 1,900 1,100 3.98 4.02 February 63,000 51,000 3.99 4.00 1,600 1,300 3.98 3.99 March 82,000 48,000 3.08 4.02 1,600 1,300 3.98 4.02 April 93,000 73,000 3.00 3.96 1,600 1,300 3.09 4.03 May 110,000 83,000 3.06 3.95 1,000 1,200 3.98 3.98 June 160,000 120,000 3.92 3.97 1,500 1,700 3.96 4.04 July 220,000 160,000 3.92 4.01 3,200 1,800 3.93 4.02 August 180,000 160,000 3.96 3.96 2,900 1,600 3.93 4.02 September 220,000 130,000 3.90' 3.97 2,600 1,500 4.00 3.96 October 120,000 100,000 4.22 4.02 2,700 1,400 4.01 4.01 November 160,000 52,000 3.99 4.07 2,700 800 3.98 4.08 December 140,000 45,000 3.88 4.02 2,400 1,100 3.84 3199 BUREAU OF MILK CONTROL 207

TABLE NO. 3 AVERAGE BACTERIAL COUNTS OF ICE CREAM 1942 AND 1941

AVERAGE BACTERIAL COUNT AVERAGE BACTERIAL COUNT FOR PLANTS FOR PLANTS BUYING MONTH PASTEURIZING ON PREMISES PASTEURIZED INGREDIENTS

1942 1941 1942 1941

Entire Year 2,100 1,800 10,800 14,000

January 1,000 2,200 2,900 5,800 February 1,900 1,100 2,500 12,000 March 700 1,200 6,900 10,000 April 700 1,600 4,300 24,000 May 800 1,300 2,400 4,500 June 2,000 1,500 13,000 38,000 July 1,500 2,500 14,000 14,000 August 7,600 2,100 17,000 32,000 September 3,000 2,200 24,000 10,000 October 3,300 4,700 17,000 8,200 November 1,400 1,100 22,000 5,600 December 1,700 700 3,800 7,100

TABLE NO. 4 SUMMARY OF INSPECTIONS OF CITY MILK PLANTS-1942 AND 1941

AVERAGE NUMBER OF CORRECTION TYPE OF PLANT INSPECTIONS INSPECTIONS NOTICES PER MONTH ISSUED PER PLANT

Milk plants 1942 3,086 12.49 986 1941 2,825 10.72 1,228

Tee cream plants pasteurizing on premises 1942 1,209 5.61 680 1941 1,295 6.23 637

Ice cream plants buying pasteurized ingredients 1942 1,108 4.88 517 1941 1,160 4.43 552 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 5 SUMMARY OF MILK AND MILK PRODUCT SAMPLES COLLECTED-1942 AND 1941

TYPE OF SAMPLE 1942 1941

ALL SAMPLES 8,801 9,275

Milk 3,678 3,911 Cream 574 672 Ice cream 1,156 1,224 Ice cream mix, evaporated and condensed milk 75 55 Empty bottles 3,131 3,156 Water samples 106 126 Miscellaneous samples 81 131 Dairy products cans inspected 12,207 17,724 c--

BUREAU OF FOOD CONTROL

[209]

BUREAU OF FOOD CONTROL

Ferdinand A. Korff Director The growth of new industries in the city because of the war with a corresponding increase in population required stricter supervision over food establishments in the city. Although there was no marked increase in the number of food establishments, food handlers left their employment and obtained jobs in war industries and untrained personnel were of necessity employed in their places. To supplement the inspection activities of representatives of the bureau a course of instruction was inaugurated during the year for untrained food handlers. Starting with drug stores, in cooperation with local retail druggists, and extending the course to restaurant, hotel mid food plant employees, over 600 individuals were given this instruction. The classes varied from one to four hours depending upon the type of establishment in which the trainee was employed. Supervisors and key workers were particularly encouraged to take advantage of the training that included fundamentals of bacteriology and chemistry and practical demonstrations in the prevention of food infection and food poisoning. Other preventive measures were taken, such as concentration of restaurant inspection in those areas of the city where large manufacturing plants were located, and the testing in the field for harmful metals such as cadmium that could have been substituted for the pre-war aluminum. Food Establishment Inspection Retail Food Establishments Restaurants, drug store soda fountains, grocery stores and similar food establishments were found during inspection to be operating under sanitary conditions. Of this type of food establishment, 58.4 per cent were found to be operating under excellent conditions and 75.6 per cent were found to be clean and in a sanitary condition with undesirably conditions found in 25 per cent. The following table shows the sanitary conditions found in retail food establishments during the past ten years: Per Cent of Retail Food Establishments Year Entirely Satisfactory 1942 58.4 1941 61.2 1940 60.1 1939 48.8

[211 ] 212 REPORT OF THE HEALTH DEPARTMENT-1942

Per Cent of Retail Food Establishments Year Entirely Satisfactory 1938 58.4 1937 57.1 1936 52.7 1935 50.9 1934 55.0 1933 41.9 Food utensils such as drinking glasses and cups were swabbed as in past years, five utensils constituting a sample. The bacteriologic examination of the samples obtained since 1939 are given in the following table:

NUMBER OF BACTERIA PER RIM OF GLASS

UNDER 100 101 TO 600 501 TO 1000 1001 TO 10,000 Oren 10,000 NUMBER YEAR OF SAMPLES Num- Per Num- Per Num- Per Num- Per Num- Per ber cent ber cent ber cent ber cent bar cent

1942 1,300 576 44.3 191 14.7 78 6.0 207 15.9 - 249 19.1 1941 2,121 1,235 58.2 254 11.9 124 5.8 212 9.9 206 13.9 1940 1,376 739 53.7 163 11.8 61 4.4 172 12.5 241 17.5 1939 94 32 34.0 16 17.0 6 6.3 20 21.3 20 21.3

Specific instructions were given to all food establishment operators who were not complying with regulations of the Maryland State Board of Health governing food utensil washing and disinfecting as judged by bacteriologic examination of swabbings. This instruction to all operators whose utensils contained 500 or more bacteria per rim was given at hearings and at the foodhandler training course. Wholesale Food Establishments There was a diminution of the number of inspections in wholesale food establishments during the year primarily because of the practical elimination of toxic spray residues on fruit and vegetables which were brought into the city and because of the quick sale of the food to retail establishments when the merchandise arrived. This diminution in inspections was also made necessary by personnel vacancies in the bureau following the retirement of two inspectors and the death of one. Manufacturing Food Establishments During 1942 the drive to free food establishments of rats and mice was extended to bakeries. A procedure of inspection, sampling and detention of raw materials and finished products, resulting in the. condemnation of the filthy foods, urged owners of bakeries to rat-proof and thoroughly clean BUREAU OF FOOT) COMOL 213 their plants. Other food establishments such as pickle and mayonnaise factories were also surveyed thoroughly for possible rodent infestation. The building out procedure was urged in the rat extermination campaign. A breakdown in the municipal trash and garbage collection during the year necessitated greater supervision over this type of food establishment as well as of the surroundings of the plants. Special Activities Cooperating with the Baltimore Chapter of the American Red Cross and other agencies twenty groups of women were given instruction on the care of food in the home. The public health nurses of the City Health Department were instructed in the fundamentals of nutrition. Eleven hundred chemical tests were made in the field by the food inspectors of the bureau. These included testing of the strength of chlorine solutions, the detecting for cyanides, arsenic, cadmium, sulphites, pH of oyster liquor and fluoride. The director attended a course of instruction in chemical warfare pre- cautionary methods at Edgewood Arsenal, preparatory to assuming the responsibility of decontaminating chemically contaminated food incident to enemy air raids. Instruction was given by the director at the School of Public Health of the University of Michigan to representatives of the food industry who were assembled at Ann Arbor, Michigan. Food Poisoning There was a decrease in the number of food poisoning investigations during the year with a decrease in the number of persons involved. Of the nineteen alleged outbreaks investigated three were proved to have been caused by specific foods. Case histories of these outbreaks are summarized below: Outbreak No. 1. Three persons purchased imperial crabs from a local restaurant and ate the food in their respective homes. About four hours later vomiting and diarrhea occurred together with the usual symptoms following ingestion of Staphylococcus enterotoxin. Imperial crabs purchased from the restaurant, upon bacteriologic examination, showed the presence of Staphylo- cocci in relatively large numbers. It was learned during the investigation that this food was made hurriedly and was not heated so that the entire crab meat filling was raised to at least 180° Fahrenheit as recommended. Outbreak No. 2. Fifteen employees of a local ihstitution were served turkey meat that had been left over and stored in a refrigerator for several days. About three and one-half hours after eating the turkey meat that had been handled by several of the cooks and not heated thoroughly before serving, all of the fifteen persons became ill with vomiting, diarrhea, headache and pains in the lower abdomen. Bacteriologic examination of some portions of the 214 Rupora OF THE HEALTH DEPARTMENT-1942

turkey meat showed the presence of millions of Staphylococci, some of the enterotoxin type. During the investigation it was found that one of the cooks had several cuts on his hands and the bacteriologic examination of swabs made of the cuts showed the presence also of enterotoxin-producing Staphylococci. Outbreak No. 3. Turkey with dressing was served to thirty or more inmates of a children's hospital on a holiday. About eight to fourteen hours later thirty of the children and nurses became ill with diarrhea and some with vomiting. No food was available for laboratory examination, but during the investigation it was learned that the dressing was not refrigerated during the overnight storage and handwashing facilities for foodhandlers were not as convenient as they should have been. The following table summarizes the investigations of food-poisoning outbreaks made by the Department team of investigators during the past ten years:

ALL OUTBREAKS MAJOR OUTBITEAKS

YEAR Persons made ill PUBLIC Persons EATING Number made ill Number PLACES Each Outbreak Total INVOLVED

Total 271 1,779 37 937 16

1942 19 166 3 3; 15; 30 48 1941 20 280 4 3; 74; 23; 70 170 2 1940 29 95 4 8; 4; 4; 9 25 2 1939 36 213 43; 38; 5; 8; 12; 13 117 2 1938 41 333 7 2; 100; 15; 100; 9; 5; 40 271 1 1937 21 108 5; 17; 10; 22; 4 84 2 1936 33 137 3 15; 12; 8 35 3 1935 23 106 2 27; 9 36 2 1934 29 197 1 102 102 0 1933 20 138 1 69 69 1

Two additional investigations were made in cooperation with other bureaus of the Department, one of which involved intestinal disturbances among employees of a department store due to contamination of the water supply in the store. The other involved raw milk which had caused several cases of typhoid fever in a small institution. Tularemia continued to be nonexistent in the city because of the local ordinance prohibiting importation and sale of wild hares or rabbits. Insecti- cides tinted Nile blue were the only fluoride-containing insecticides sold in the city. Two articles written by the director about food establishment inspection and field testing were published during the year. These papers give in detail the general activities of the bureau and will be found listed in the Bibliography. BUREAU OF FOOD CONTROL 215

Personnel Ferdinand A. Korff, Director Etta Levin, Senior Stenographer John Behr, Food Inspector Morris Cohen, Food Inspector William Sallow, Senior Sanitary Inspector Paul T. Parrish, Senior Sanitary Inspector Benjamin Ginsberg, Senior Sanitary Inspector Lemuel Cookman, Senior Sanitary Inspector

TABLE NO. 1 INSPECTIONS OF RETAIL, WHOLESALE AND MANUFACTURING FOOD ESTABLISHMENTS, 1942 AND 1941

INSPECTIONS 1942 1941

All Inspections 36,499 37,065

RETAIL ESTABLISHMENTS Total 8,772 9,106 Initial inspections 7,229 7,331 Special inspections including school cafeterias and homes 417 1,061 Reinspections 1,126 714 Ratio of reinspections to initial and special inspections 0.15:1 0.085:1

MANUFACTURING ESTABLISHMENTS Total 1,122 2,290 Initial inspections 989 849 Special inspections 57 50 Reinspections 76 1,397 Ratio of reinspections to initial and special inspections 0.072:1 1.5:1

WHOLESALE ESTABLISHMENTS Total 7,233 10,603 Initial inspections 1,785 2,749 Special inspections 52 201 Reinspections 5,396 7,653 Ratio of reinspections to initial and special inspections 2.94:1 2.6:1

MARKET STALLS Total 18,924 15,343 Initial inspections 2,800 , 2,759 • Reinspections 14,124 12,584 Ratio of reinspections to initial inspections 5.04:1 4.6:1

■ MISCELLANEOUS ESTABLISHMENTS Total 448 617 216 REPORT OF THE HEALTH DEPARTMENT--1942

TABLE NO. 2 ACTIVITIES IN RETAIL, WHOLESALE AND MANUFACTURING FOOD ESTABLISHMENT INSPECTION, 1942 AND 1941

ACTIVITIES 1942 I 1941

RETAIL ESTABLISHMENTS

Violation notices issued 55 37 Items on violation notices 111 91 Percentage of items issued for: Insanitary premises 19 20 Delinquent permits 10 2 Insanitary utensils 14 26 Uncleanliness of personnel and protection of food 14 23 Unwholesome food 43 29 Number of condemnations of food 181 108 Hearings within bureau 284 380 Samples of food obtained for examination 1,657' 2,309 Complaints received and investigated 667 533

WHOLESALE ESTABLISHMENTS

Violation notices issued 7 8 Number of condemnations of food 105 99 Hearings within bureau 12 25 Samples of food obtained for examination 37 152

MANUFACTURING ESTABLISHMENTS

Violation notices Issued 3 10 Number of condemnations of food 27 30 Hearings within bureau 25 17 Samples of food obtained for examination 213 297 BUREAU OF FOOD CONTROL 217

TABLE NO. 3 POUNDS OF FOOD CONDEMNED IN WHOLESALE, MANUFACTURING AND RETAIL FOOD ESTABLISHMENTS, 1942 AND 1941

FOUND BY REQUESTED TYPE OF FOOD TOTAL INSPECTIONS FOR DECISION

1942

ALL TYPES or FOOD 179,649 26,438 153,211

WHOLESALE FOOD ESTABLISHMENTS All types of food 74,159 19,279 54,880* Vegetables and fruit 46,776 6,890 39,886 Meats 189 125 64 Seafood 14,435 2,859 11,576 Poultry and game 271 121 150 Groceries, canned and bottled goods 6,731 4,240 2,491 Baking supplies, nuts and candies 2,754 2,379 375 Milk and dairy products 3,003 2,665 338 , MANUFACTURING FOOD ESTABLISHMENTS AU types of food 78,685 2,758 75,927 Vegetables and fruit 17 17 .. Meats 98 .. 98 Groceries, canned and bottled goods 65,820 50 65,770 Baking supplies, nuts and candies 12,747 2,688 10,059 Milk and dairy products 3 a ..

RETAIL FOOD ESTABLISHMENTS AU types of foods 26,805 4,401 22,404** Meats 411 388 23 Seafood 118 118 .. Poultry and game 21 21 .. Groceries, canned and bottles goods 23,698 1,382 ' 22,316 Baking supplies, nuts and candies 1,271 1,216 65 Milk and dairy products 1,276 1,276 ..

1941

ALL TYPES or FOOD 235,011 111,545 123,466

WHOLESALE FOOD ESTABLISHMENTS All types of food 115,714 102,343 13,371 Vegetables and fruit 14,175 14,175 .. Mesta 1,004 963 41 Seafood 11,571 1,227 10,344 Poultry and game 558 280 278 Groceries, canned and bottled goods 34,548 31,840 2,708 Baking supplies, nuts and candies 53,858 53,858 ..

MANUFACTURING FOOD ESTABLISHMENTS All types of food 83,003 7,271 75,7321* Vegetables and fruit 200 200 .. Baking supplies, nuts and candies 82,803 7,071 75,732

RETAIL FOOD ESTABLISHMENTS All types of food 36,294 1,031 34,363tt Meats 4,868 540 4,328 Seafood 60 60 .. Poultry and game 70 70 .. Groceries, canned and bottled goods 20,374 539 28,835 Baking supplies, nuts and candies 1,427 227 1,200 Milk and dairy products 495 405 ..

*Includes 405 pounds damaged at fires. t Includes 75,732 pounds damaged at fires, **Includes 22,316 pounds damaged at fires. tt Includes 32,257 pounds damaged at fires. 218 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 4 DISTRIBUTION OF INSPECTIONS OF WHOLESALE AND MANUFACTURING FOOD ESTABLISHMENTS ACCORDING TO TYPE OF ESTABLISHMENT, 1942 AND 1941

NUMBER OF NUMBER OF INSPECTIONS ESTABLISH- TYPE OF ESTABLISHMENT MENTS IN Cm,1942 1942 1941

TOTAL 6,022 25,747 28,859

Wholesale and distributing establishments 1,785 7,233 10,603

Hucksters and loaded trucks 1,500 2,471 2,573 Commission merchant houses 132 3,992 6,625 Wholesale groceries and warehouses 54 241 325 Candy jobbing houses 45 52 119 Wharves 13 202 609 Butter and egg distributing and breaking plants 14 10 27 Auction houses 10 190 190 Cold storage warehouses 6 14 5 Railroad terminals 7 61 130

Manufacturing food establishments 989 1,122 2,296

Bakeries 430 627 1,245 Poultry killing—wholesale and retail ' 214 155 197 Candy manufacturing plants 95 144 440 Oyster packing plants 92 18 77 Soft drink bottling plants 29 26 67 Pickling plants 22 41 44 Canning plants , 22 11 72 Salad manufacturing plants 17 27 57 Noodle and potato chip plants 10 6 24 Cod fish cake manufacturing plants 8 12 29 Extract bottling Planta 11 20 42 Ice cream cone plants 5 1 2 Caterers and sandwich manufacturing plants 34 34 ..

Market stalls 2,800 16,924 15,343

Others, refineries, empty buildings and so forth 448 448 617 BUREAU OF MEAT INSPECTION

[219 ...**Isne,..,.....eprerl.gaffieMIVROP4 BUREAU OF MEAT INSPECTION

William Brenner, D.V.S.

Chief Wartime measures adopted by the Federal government in 1942 were necessary in order to provide an ample supply of meats for the armed forces. Slaughtering of livestock was limited by the Office of Price Admin- istration, and the packers were restricted to the following amounts of their 1941 quota: beef 70 per cent, veal 100 per cent, lamb and mutton 95 per cent and pork 75 per cent. If packers exceeded their 1941 quotas, based on the last three months of that year, they were prohibited from slaughtering any livestock for an indefinite period. These restrictions on the packers together with instances of noncompliance with 0.P. A. regulations resulted in a decrease of approximately 741 per cent in the number of lambs, sheep and swine slaughtered as compared with the preceding year. The slaughter record for 1942 showed a marked increase in the number of cattle and calves slaughtered over a five year period, a decrease in the number of lambs and sheep over a five year period and a decrease in swine over a three year period. The meat inspection service was called upon to protect the community at large against consumption of meat products unfit for human food. Due to the lack of manpower in meat plants and to delayed shipments of livestock, over which the packer had no control, it was necessary for nine packers to request the veterinary inspectors of the bureau to work overtime. This caused an increase of approximately 103 per cent in the extra hours of operation granted in excess of the usual working time and under Health Department inspection. The principal prevailing diseases and conditions found in livestock as causes of condemnation on inspection included hog cholera, pyemia, pneumonia, septicemia, immaturity and peritonitis in whole carcasses, and parasites, cirrhosis, actinomycosis, bruises and hydromas in parts of carcasses. A summary of the routine activities of the bureau during the year follows:

Establishments provided inspection service 157 Out-of-state shippers provided inspection service 85 Federally inspected establishments under City supervision 11 Establishments supplied inspection service for first time 1 Establishments discontinued 6 Establishments with change in classification 1

[221 ] 222 REPORT OF THE HEALTH DEPARTA1EN1'-1942

Personnel

William Brenner, D.V.S., Chief Charles D. Skippon, D.V.M., Veterinary Inspector John R. Saunders, D.V.M., Veterinary Inspector Franklin C. Herndon, D.V.S., Veterinary Inspector Robert M. Cory, D.V.M., Veterinary Inspector Edward J. Moylan, D.V.M., Veterinary Inspector Theodore S. List, D.V.M., Veterinary Inspector Edward P. Roberts, D.V.M., Veterinary Inspector William J. Gallagher, D.V.M., Veterinary Inspector Charles W. Smith, Meat Inspector Matthew N. Bean, Meat Inspector Henry A. Miller, Meat Inspector Lawrence Stettmeier, Meat Inspector Philip A. Ottenritter, Meat Inspector Thomas J. Morris, Meat Inspector Ernest H. Smith, Meat Inspector Lewis A. List, Meat Inspector Adolph Wobbeldng, Jr., Meat Inspector Elmer Frederick, Meat Inspector Helen B. Siemers, Senior Clerk Marie E. Cerney, Senior Stenographer BUREAU OF MEAT INSPECTION 223

TABLE NO. 1 LIVESTOCK INSPECTED, CONDEMNATION OF ANIMALS, PRIMAL AND EDIBLE PARTS

CATTLE CALVES SHEEP SWINE GOATS

Condemned Condemned Condemned Condemned YEAR 1 ' 'A. 1 Parte Condemned .- 6 0 fa, ,-. C.) PA . C.) Parts 1 e) P4 1942 41,600 104 2,492 92,838 75 382 83,587 120 10,819 06,625 229 34,001 89 .. 1941 35,579 83 2,111 91,174 101 352 90,912 209 11,214 121,791 296 59,726 10 .. 1940 27,672 96 2,457 91,825 90 731 95,067 70 3,391 143,235 262 43,636 15 .. 1939 26,827 91 1,424 90,118 62 586 104,188 29 4,269 100,853 139 33,589 36 14 1938 20,346 18 1,010 87,854 68 756 106,594 36 4,945 81,103 129 28,256 33 .. 1937 22,472 28 1,997 97,372 82 543 94,834 22 5,142 86,769 179 26,004 18 .. 1936 23,211 38 2,303 95,987 74 717 97,275 19 4,946 81,739 126 24,558 15 .. 1935 27,707 90 4,939 95,017 36 1,158 117,284 23 7,290 81,569 474 28,077 92 .. 1934 27,355 175 5,448 94,002 56 1,302 97,854 39 5,773 138,116 870 44,105 10 .. 1933 16,632 68 3,125 83,278 53 2,211 114,782 30 8,783 148,960 320 49,179 41 .. 1932 21,028 101 3,269 85,618 42 2,328 134,380 23 13,363 167,782 384 51,813 14 .. 1931 22,403 159 3,286 87,117 67 1,287 130,494 55 10,161 162,312 525 45,344 12 .. 1930 27,131 248 6,629 89,420 76 825 129,185 47 12,827 153,755 551 34,145 6 .. 1929 22,837 154 4,119 78,400 44 915 105,548 63 17,827 137,374 774 41,990 13 .. 1928 10,885 81 1,141 31,857 13 430 51,616 54 8,292 122,939 893 30,232 .. ..

TABLE NO. 2 POUNDS OF MEAT CONDEMNED ON REINSPECTION

TOTAL PORK BEEF MUTTON VEAL MEAT MIXED YEAR PRODUCTS PRODUCTS 1942 39,261 7,261 22,984 2,167 851 2,949 3,049 1941 58,200 14,765 21,043 2,009 629 7,409 12,345 1940 37,779 20,316 7,564 677 791 5,054 3,357 1939 30,630 10,604 7,384 570 497 3,799 7,676 1938 41,021 7,243 11,704 1,926 3,726 8,685 7,727 1937 35,324 9,450 15,414 454 657 7,707 1,742 1936 41,413 10,628 16,413 443 588 2,885 10,458 1935 33,024 10,511 7,888 1,202 503 6,374 6,546 1934 86,038 49,139 16,094 1,884 877 4,332 12,712 1933 38,967 20,761 5,456 307 283 2,509 9,651 1932 60,306 21,155 10,196 278 250 4,154 24,273 1931 50,202 20,528 9,349 1,134 1,003 4,070 13,218 1930 58,467 30,383 5,937 485 116 5,738 15,808 1929 32,861 16,056 4,754 309 45 11,697 .. 1928 42,270 15,147 6,617 1,272 161 19,073 ..

TABLE NO. 3 POUNDS OF MEAT AND MEAT FOOD PRODUCTS PREPARED

TYPE OF MEAT PRODUCTS CITY COUNTIES Total pounds 11,226,281 2,621,433 Meat products (fresh) 491,198 Meat products (smoked) 1,793,331 548,279 Meat food products (fresh) 1,584,779 435,940 Meat food products (smoked) 4,599,356 599,500 Meat food products (cooked) 1,255,213 314,320 Meat food products (boiled) 640,176 226,435 Lard 709,468 496,959 Lard compound 152,760 / BUREAU OF ENVIRONMENTAL HYGIENE

[225 ]

BUREAU OF ENVIRONMENTAL HYGIENE

Wilmer H. Schulze, Phar.D.* Acting Director Industrial Hygiene Conversion of numerous local industrial plants for the manufacture of products for the armed forces and further expansions of many plants already engaged in war contracts created a number of industrial hygiene problems that were studied as rapidly as possible. Two hundred and ninety-four plants which employed a total of 46,146 persons were inspected. Forty- five studies were made of industries where exposures to toxic materials existed in the workroom environment. Industrial plants made 618 improvements for the health and welfare of a total of 72,998 employees. Toxic Dusts Exposures in the workroom to the following toxic dusts were studied and evaluated: Asbestos, chromium compounds, lead, manganese, phenol, silica and zinc. Where maximum allowable concentrations were found, recommendations for adequate control measures were submitted to the plant managements and were carried out promptly in most instances. Hazardous Fumes and Vapors Welding operations and the handling of molten metals led to the study of exposures to lead and zinc fumes in several plants to determine whether concentrations were above the physiological limit. The extensive use of organic solvents resulted in evaluation of exposures to benzol and chlori- nated hydrocarbons. In practically every instance, the plant management was interested in the studies and took prompt action to eliminate hazardous health conditions. Miscellaneous Activities and Studies 1. Technical studies were made of the working environment of the expanded shipbuilding plants. These included evaluation of exposures to fumes created by welding operations, to silica dust and to carbon monoxide. Attention was also given to sanitation problems including drinking, washing and toilet facilities.

*George W. Schucker, Director, on military leave.

[227 ] 228 REPORT OF THE HEALTH DEPARTMENT-1942

2. Two incidents of carbon monoxide poisoning, involving about twenty employees in a new plant engaged in production of war materials, were studied. Incomplete gas combustion was found to be the causative factor and corrective measures were adopted. 3. Cooperation was given to a number of plant managements in problems dealing with the employment of female workers. 4. A rendering plant responsible for an atmospheric pollution nuisance for a number of years in a residential section of the city was moved as a result of orders to abate the nuisance issued by the City Health Department.

Gas Appliance Ordinance Activities engaged in to enforce the Gas Appliance Ordinance are shown in the following summary:

GAS APPLIANCE ORDINANCE—ENFORCEMENT ACTIVITIES

ACTIVITIES 1942 1941

Inspections 2,782 2,494 Violations 117 132 Detentions of unapproved appliances 707 44 Hearings of violations Gas appliances registered 309 664 Gas fitters registered 74

GAS APPLIANCE DEALERS

LICENSES ISSUED 1942 1941

Total 288 486

New 0 2 Renewals 288 484

Community Sanitation Nuisance complaints increased from 6,849 in 1941 to 7,831 in 1942. This unusually large number was probably attributable to the marked increase in population due to war conditions which resulted in many sanitary problems associated with housing conditions.

Sewer Connections and Water Supplies Provided An outstanding improvement in sanitary conditions was accomplished in an outlying section of the city. A group of fifteen houses where pit privies were in use and where in several instances no water supply was piped into the house, were improved by the removal of the privies, the BUREAU OF ENVIRONMENTAL HYGIENE 229 provision of inside flush toilets with connections to the sewerage system and the supply of inside water for the tenants. Rodent Control Much time was devoted to rat control surveys. One hundred and sixty neighborhood investigations were made and where tenants or owners were found to be negligent in matters of proper garbage and refuse disposal they were notified to correct such conditions. Health Department circulars on rat control procedures were distributed to over 3,000 persons and efforts were continued to gain the interest and cooperation of the citizens in the elimination of rats from their premises. Toward the close of the year the Board of Estimates provided Dr. Curt Richter of the Johns Hopkins Hos- pital with a sum of $5,000.00 to inaugurate a rat poisoning campaign. Cooperation was given Dr. Richter in field activities by both the Health Department and the Bureau of Street Cleaning. The Board of Estimates also provided the Health Department four new positions for rat control work under the classification of senior sanitary inspector. Water Supplies The sanitary quality of the city water supply as delivered to the con- curners was evaluated by the collection and Health Department testing of 1,369 samples from taps throughout the distribution system. The percentage of 10 c.c. portions showing the presence of coliform bacteria was 0.22 as compared to 1.93 for 1941. Other water supplies inspected and sampled included public and semi-public springs and wells, private wells on request commercial bottled waters and industrial plant supplies other than city water. Swimming Pools Indoor and outdoor swimming pools were inspected periodically and samples of water were tested throughout the operating season. All of the pools operated in such a manner as to merit satisfactory sanitary ratings. The swimming pools in the public city parks, apparently because of difficulty in obtaining the necessary employees, were not opened. Miscellaneous Activities 1. Cooperation was given the Director of the Bureau of Commu- nicable Diseases in the investigation of an outbreak of gastro- intestinal illness among employees of a large mercantile establishment. While contamination of the water supply within the building was apparently the causative factor a subsequent careful survey of the plumbing system failed to reveal a definite source of the pollution. 230 REPORT OF THE HEALTH DEPARTMENT-1942

2. At the request of the Chief Engineer of the Maryland State Department of Health, cooperation was given the U. S. Public Health Service in the sanitary inspection of local railroad watering point stations. Reports of these inspections together with recommendations for improvements were sent to the railroad division superintendents. In each instance provisional certification was recommended to the U.S. Public Health Serv- ice pending reinspections at a later date. 3. A circular letter which explained the public health reasons for the need of cutting and removing weeds from lots was sent to property owners.

Housing The promulgation of regulations governing respectively the hygiene of housing, rooming houses, lodging houses and hotels, and the sanitation of trailer camps, together with the provision of three additional inspectors to the housing inspection staff, made possible a marked advancement in the hygienic housing program. Because of the increased use of many old houses for housing immigrant workers and the conversion of many houses to multiple family dwellings, chief attention was given to the inspection of houses in the sections of the city where these practices were prevalent. A long range program designed to ultimately eliminate the yard frost-proof hoppers by replacement with inside flush toilets was begun. There were 627 dwellings inspected and defective plumbing, rat infestation and carelessness in methods of garbage disposal existed in approximately 50 per cent of them, and overcrowding of dwelling units was found in more than 25 per cent of them.

Houses Unfit for Human Habitation • Forty-two houses were found on inspection to be in such an insanitary condition and state of disrepair that the Health Department posted notices to have them vacated. Two of these were subsequently demolished, nine were renovated and permission for occupancy was granted, and a number of the remainder are in the process of being made habitable.

Rooming Houses and Lodging Houses The number of applications for housing permits to operate rooming houses, lodging houses or hotels was 1,331 or an increase of more than 50 per cent as compared with 860 in 1940. The need for sanitary inspections of such places was indicated by the disapproval of over 64 per cent of the applications at the time of first inspections. BUREAU OF ENVIRONMENTAL HYGIENE 231

Trailer Camps The adoption of needed rules and regulations for the control of sanitation in trailer camps made possible regulatory action where the need was indicated. Sixty-four camps, varying in trailer site capacity from one to over fifty were inspected. Of this number fifty-three were subsequently discontinued because the operators could not conform with the regulations. In a number of instances it was necessary to resort to legal procedures and in seven cases operators were tried in the Criminal Court for failure to conform with the Health Department requirements. The courts sustained the regulatory provisions and the operators either discontinued the camps or proceeded to comply with the regulations. Owner and Tenant Responsibilities In making sanitary housing inspections the bureau endeavored to dif- ferentiate between owner and tenant responsibilities. Notices sent to owners numbered 498 and to tenants 375. In multiple family dwellings tenant responsibility for insanitary conditions was difficult to place except where it was confined to the individual dwelling unit. Housing Surveys In cooperation with the Bureau of Buildings and the Fire Department three surveys were made of housing conditions in different sections of the city where insanitation, hazardous structural conditions and fire hazards were reported. A total of 149 dwellings were inspected during these joint inspections and in many instances insanitary housing conditions were found to exist and steps were taken to have them corrected. Plans for Conversion of Dwellings By an arrangement with the Buildings Engineer 269 plans for recon- struction or conversion of dwellings of the multiple family type were submitted to the Housing Division for review. This procedure made possible the assurance of conformity to Health Department hygienic housing requirements before actual work was started. Legal Procedures While in most cases owners and tenants cooperated toward compliance with notices to correct unhealthful housing conditions in 81 instances it was necessary to resort to the issuance of summons to the police magistrate courts. Six cases were sent to the Grand Jury where indictments resulted and three came to trial in the Criminal Court before the close of the year. In all instances the regulatory action of the Health Department was upheld by the courts. 232 REPORT OF THE HEALTH DEPARTMENT-1942

Plumbing There were 519 potential cross connections prevented or eliminated during 1942. Studies of the plumbing systems were made of several institutions, food handling establishments and industrial plants and where defects were found steps were taken to have them corrected. Plumbing regulation No. 26 which required separate toilet facilities for nonwhites in all places of employment was amended and this requirement was eliminated. Because of the need of certain critical materials in the production of war products it became necessary to waive certain requirements in plumbing materials until after the war. In no instance, however, have such waivers jeopardized the sanitary operation or safety of plumbing systems.

Percentage of Sewer-connected Properties Records kept of properties connected to sewers during the year and of properties disconnected because of demolition showed that at the end of the year 99.6 per cent were connected within the old city limits and 90.9 per cent were connected in the area annexed in 1918. For the city as a whole 97.5 per cent of all buildings were provided with connections to the sanitary sewer system.

Personnel George W. Schucker, Director* Charles E. Couchman, Chief, Division of Industrial Hygiene G. Yates Cook, Senior Sanitary Inspector Julius A. Messina, Chief, Division of Community Sanitation Carroll H. Reynolds, Chief Inspector of Plumbing Anne E. Alpert, Senior Clerk Phyllis C. Beck, Senior Stenographer Mary L. Rentz, Senior Stenographer Ruth Rubin, Senior Stenographer Irma E. Wehn, Principal Clerk Albert J. Grossman, Senior Sanitary Inspector Felix H. Pretsch, Senior Sanitary Inspector Jacque G. Ayd, Senior Sanitary Inspector William R. Dunaway, Senior Sanitary Inspector Milton Friedman, Senior Sanitary Inspector John F. Block, Senior Sanitary Inspector Joseph H. Bunzel, Senior Sanitary Inspector Elbert II. Cohen, Senior Sanitary Inspector William F. Stettmeier, Senior Sanitary Inspector Howard R. Goggins, Food Inspector John A. Zerhusen, Food Inspector *On military leave. BUREAU OF ENVIRONMENTAL HYGIENE 233

Charles B. Creighton, Plumbing Inspector Joshua L. Norris, Plumbing Inspector John II. Pike, Plumbing Inspector Henry G. Rausch, Plumbing Inspector Joseph P. Reynolds, Plumbing Inspector Benjamin F. Schwarzmann, Plumbing Inspector Walter Underwood, Plumbing Inspector William J. Wheeler, Plumbing Inspector Daniel B. Yeagle, Plumbing Inspector Jacob G. Vogtmann, Principal Clerk Joseph B. Finnan, Senior Clerk Donald A. Stockley, Senior Clerk Frederick Sauers, Laborer

.e.#4".../41■■•■■■■-_ TABLE NO. 1 HEALTH AND ACCIDENT HAZARDS ELIMINATED IN INDUSTRIAL PLANTS

TYPE OP. IMPROVEMENT Number Population

Total 618 72,998

Health-occupational hazards Atmospheric pollution corrected 16 106 Exposure to toxic materials controlled by Materials discontinued 4 38 Protective clothing 1 10 Installation of local exhaust systems 19 1,082 Provision of masks or respirators 20 45 Segregation of operations 7 29 Substitution for harmful materials 2 21 Exposure to carbon monoxide controlled by Correction of defective appliances 2 110 Approved venting 8 47 Exposure to radiant energy controlled by Provision of salt tablets 2 425 Provision of goggles for ultra-violet and infra-red rays 1 50 Lighting improved • Artificial 23 5,252 Natural 1 128 Noise eliminated 1 Ventilation improved Artificial 16 410 Natural 3 180 Sanitation Drinking facilities improved 76 5,342 Cross connections eliminated 12 383 Insanitary premises cleaned 14 848 Insect, vermin and rodent control instituted 1 64 Janitor services provided 2 486 Lunch rooms provided 8 3,180 Lockers provided 23 3,700 Rest-rooms provided 10 2,277 Seats, or rest-periods for females provided 3 360 Toilet facilities provided or improved 106 8,982 Washing facilities provided or improved 63 3,923 Water provided on premises 4 124 Personnel Service First aid equipment provided 28 2,853 First aid attendants employed 1,051 Nurses employed 4 2,879 Medical examinations instituted 4,911 Physicians employed 2 2,540 Safety program instituted or improved 1 5,000 Safety engineer employed 1 360 Sickness records instituted 8 973 Syphilis control instituted 4 494 Accident hazards Building defects corrected 10 316 Good housekeeping instituted 319 Goggles provided 3 9 Fire hazards eliminated 890 Interiors painted or cleaned 2 260 Machinery guarded 26 730 Obstructed passageways cleared 5 1,116 Other improvements New buildings and equipment 52 7,069 Heat provided on premises 1 160

*Area in which the residing public was affected.

[234 1 BUREAU OF ENVIRONMENTAL HYGIENE 235

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All dial4A8AAe2444 TABLE NO. 3 Co.) SUMMARY OF INDUSTRIAL PLANTS SURVEYED, CLASSIFIED ACCORDING TO TYPE OF PLANT, C) AND POTENTIALLY HAZARDOUS MATERIALS

HAZARDS

DUST GASES I VAPORS METALS MISCELLANEOUS

REPORT 1-3 Hydrocarbons PLANTS EMPLOYEES OF Products Cyanide Nitrogen Hydrocarbons Hydrocarbons OF OF Dioxide

Dioxide . Monoxide ea Disulphide Compounds Z of

C THE Inorganic

Er "6 Irritants S d N ..= ,c .4t ..4. :-..-., Other Carbon Dyes Skin NUMBER NUMBER ■- Acetylene Ammonia Carbon Chlorine Sulphur Aromatic Carbon Cadmium Selenium Alkalis Tars Hydrogen Oxides Alcohols Aniline Halogenated petroleum Lead Mercury Tellurium Others Acids Wax Aliphatio HEALTH

I I I I I I I I I All Plants Surveyed 294 46,146 156679 30 2 1 71 4 2 20 1 9 12 10 540 4 1 9 16 1 74 1 3 1 15 3638 4 12 3946 18 8 Advertising goods manufacturing Aircraft manufacturing Automotive

Brick, clay, cement, and asphalt products, mfg 10 210 A 4.. 1 ...... e 2.. DEPARTMENT Brush and broom manufacturing 1 160 Chemical manufacturing 13 28412 Aii..ii.. _1..2.. 1 4iiii.. 2ii....LA2.. .. A .. .. Clothing manufacturing Dry cleaning plants Electrical apparatus manufacturing Electroplating plants Food industry Furniture manufacturing Laundries

Leather goods manufacturing 2 101 -1942 Metal goods fabrication 63 5,048 i AO 2 ii i ..28.. .. o .. i 2 i .. i. .. i i .. .7 .. i i. i i .... i A i Paint manufacturing Paper goods manufacturing Printing plants Quarrying Rag industry Rubber goods manufacturing Shipbuilding 22 26,565 .. ii 16 e ...8.. .. Jo...... 1 ..i ...... i i .... 7 14 e .. Textile manufacturing Upholstery and bedding manufacturing Woodworking plants Wrecking and junk 2 142 Other industries 4 455 i 3 i ...... i ...... 1 .. i .. i i i ...... i BUREAU OF ENVIRONMENTAL HYGIENE 237

TABLE NO. 4 ACUTE CASES OF CARBON MONOXIDE POISONING (ILLUMINATING GAS) 1923-1942

YEAR SUICIDES AND TOTAL CASES ATTEMPTED SUICIDES ACCIDENTS

1942 123 68 55 1941 137 95 42 1940 174 102 72 1939 202 77 125 1938 130 82 48 1937 114 71 43 1936 218 63 155 1935 130 80 50 1934 154 100 54 1933 157 • 100 57 1932 172 101 71 1931 152 03 59 1030 184 96 88 1929 142 78 64 1928 136 75 61 1927 154 81 73 1926 211 87 124 1925 130 60 70 1924 166 49 117 1923 241 75 166

TABLE NO. 5 NON-FATAL AND FATAL ACCIDENTS FROM ILLUMINATING GAS AND DEFECTIVE APPLIANCES FOUND 1930-1942

ACCIDENTS ACCIDENTS FROM FROM INCOMPLETE COMBUSTION DEFECTIVE UNBURNED GAS OF GASES APPLIANCES YEAR TOTAL CAUSING ACCIDENTS Non-Fatal Fatal Non-Fatal Fatal

1942 55 28 9 16 2 8 1941 42 22 6 14 0 3 1940 72 45 6 19 2 5 1939 125 32 9 83 1 7 1938 48 30 12 6 0 0 1937 43 31 11 1 0 1 1036 155 131 , 22 2 0 0 1935 50 33 17 0 0 1 1934 54 41 13 0 0 3 1933 57 36 21 0 0 2 1932 71 36 29 a 1 6 1931 59 36 20 3 0 5 1030 88 65 28 2 3 9 238 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 6 COMPLAINTS, PATROL AND SPECIAL INVESTIGATIONS

PATROL AND SPECIAL COMPLAINTS RECEIVED INVESTIGATIONS MADE TYPE OF CONDITION 1942 1941 1942 1941

Total 7,831 6,849 2,236 3,580

Complaints Ashes and garbage 734 521 7 10 Building defects 9 26 6 3 Choked sewers 81 139 12 14 Dead animals 13 29 2 2 Defective drainage 198 136 41 46 Defective plumbing 586 346 68 42 Defective toilet facilities 1,193 745 33 26 Fowls and animals 113 67 20 56 Grass and weeds 441 336 65 74 Insanitary conditions 1,958 2,177 338 383 Insects 249 153 10 15 Insufficient heat 39 51 0 1 Miscellaneous 298 359 173 23 Privies and cesspools 48 36 24 23 Rats 781 830 58 51 Water in cellar 1,090 898 67 58

Special investigations Barber shops .. .. 0 1 Carnivals .. .. 3 0 City dumps .. .. 0 2 Color tests .. .. 247 206 Filling stations .. .. 0 0 Garbage grinders .. .. 0 0 *Homes for the aged .. .. 0 56 *Housing inspections .. .. 288 1,284 *Housing reinspections .. .. 155 279 Incinerators ...... 0 Moving picture houses .. • • 8 5 Night soil dumps .. .. 0 4 Parks and squares .. .. 0 1 Pet shops .. 8 34 Private dumps .. .. 10 0 Railroad stations .. .. 5 0 Rat surveys .. .. 160 53 Rat resurveys • • .. 16 21 *Rooming houses ' New .. .. 44 309 Renewal .. .. 158 393 Refused permits on first inspection .. .. 7 41 Schools .. 2 1 Blum area surveys .. .. 0 5 Trailer camps .. .. 191 1 Unsewered area surveys .. .. 8 2 Vacant building .. .. 2 4

* Includes only first two months of 1942. Tabulated completely in Housing Report. BUREAU OF ENVIRONMENTAL HYGIENE 239

TABLE NO. 7 COMPLAINT, PATROL AND SPECIAL INSPECTIONS

TYPE OF INSPECTION 1942 1941 Total 13,380 12,308 Complaints 8,883 6,878 Patrol and special 2,236 3,589 Reinspection 2,261 1,841

TABLE NO. 8 COMPLAINTS

ACTION TAKEN 1942 1941 Handled by inspectors 7,631 6,151 Referred direct to other bureaus or departments 19 • - 114 Investigated and referred to other bureaus or departments 1,934 1,506 Investigated and referred to police for follow-up 4,364 2,270 Notices issued to abate nuisances 4,173 2,445 Hearings for failure to comply with notices 350 135 Summonses issued for failure to comply with notices 28 9 DISPOSITION Total 7,650 6,205 Abatement by inspector 817 858 Cancelled (withdrawn or corrected before inspection) 4,248 2,723 Conditions of no health significance 632 1,064 Direct reference to other bureaus or departments 19 114 Investigated and referred to other bureaus or departments 1,034 1,506 Reported abated by police 3,807 2,360 TABLE NO. 9 DWELLING INSPECTIONS '

STATE OP REPAIR

Minor Major Satisfactory Repairs Repairs Unfit for Needed Needed Habitation

1942

Number of dwellings inspected 627 197 314 90 26 Maintenance defects Overcrowding 168 43 97 21 7 Basement occupancies 61 23 30 6 2 Trash accumulations 403 73 221 86 23 Improper garbage disposal 318 46 177 75 20 Rat infestation 346 31 208 84 23 Vermin infestation 129 8 59 46 16 Plumbing defects 325 46 184 75 20 Inadequate toilet facilities 149 30 85 24 10 Inadequate washing facilities 148 38 75 24 11 Fire hazards 73 4 32 20 17 Defective drainage 197 23 100 55 19 Inadequate ventilation 167 72 66 21 8

1941

Number of dwellings inspected 292 61 146 68 17 Maintenance defects Overcrowding 26 4 17 5 0 Basement occupancies 16 3 11 2 0 Trash accumulations 139 4 78 43 14 Improper garbage disposal 103 3 51 35 14 Rat infestation 149 2 78 55 14 Vermin infestation 84 0 43 28 13 Plumbing defects 153 4 76 59 14 Inadequate toilet facilities 49 5 31 10 3 Inadequate washing facilities 60 14 32 9 5 Fire hazards 104 10 62 28 4 Defective drainage 34 0 12 18 4 Inadequate ventilation 14 5 9 0 0

TABLE NO. 10 HANDLING OF DWELLING INSPECTIONS

ACTION TAKEN 1942 1941

Notices issued To owners 498 • 194 To tenants 566 73 To vacate premises or dwelling unit 42 5

Notice disposition Complied with 102 32

Housing permit applications approved 95 Housing permit applications disapproved 191

Hearings for failure to comply with notices 222 44 Summonses issued for failure to comply with notices 81 2 Cases tried in the Criminal Court 3

DISPOSITION

No violations found 34 21 Dwelling units improved 332 81 Dwellings vacated 42 2 Dwellings demolished 2 9 Referred to the Bureau of Buildings 2 12

[240 ] BUREAU OF ENVIRONMENTAL. HYGIENE. 241

TABLE NO. 11 HOUSING INSPECTIONS

TYPE OF INSPECTION 1942 1941

Total 2,378 637

Dwellings 627 292 Rooming houses 281 62 Homes for the aged 28 40 Special investigations 140 3 Reinspections 1,230 240 Trailer camps 64

TABLE NO. 12 METHODS OF SEWAGE DISPOSAL

'DOTAL TO NEW OF DISPOSAL DECEMBER n DISCONNECTEDArISCONNECTED 10421942 vONNECTIONS

Connections to sanitary sewers 172,317 3,423 761 Private drains to sanitary sewers 15,126 0 • • • Connections to storm water outlets 11,787 439 "• Privies .. .. 27 Cesspools .. .. 53

TABLE NO. 13 PERMITS, PLUMBING INSPECTIONS AND PLUMBING FIXTURES INSTALLED

GROUP .1942 1941

Total permits issued 8,306 12,997 Permits for sanitary sewer connections 2,479 3,677 Permits for plumbing installation 5,917 9,320

Inspections of plumbing 28,041 20,727

Plumbing fixtures installed 50,138 27,051 Bathtubs 9,817 4,675 Miscellaneous 1,487 1,100 Sinks 9,809 4,859 Slophoppers 72 35 Urinals 239 208 Wash basins 11,628 6,484 Water closets 13,482 7,747 Wash trays 3,808 2,143 242 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 14 CROSS CONNECTIONS PREVENTED OR CORRECTED

TYPE 1942 1941

Total '519 2,088

Air conditioning unit 1 12 Frost proof closets 278 1,772 Drinking fountain 1 11 Bar and soda fountain 7 Water closet 15 13 Bathtub 03 93 Wash basin 101 98 Dish washer 3 3 Steam table 4 Cellar drainer Industrial 83 Laundry type 2 Washing machine 2 Sterilizers Wash tray VITAL STATISTICS TABLES

[ 243]

Vital Statistics Tables 1942

TABLE NO. 1. ESTIMATED POPULATIONS AND RECORDED DEATH RATES; TOTAL, WHITE, COLORED, BALTIMORE-1930- 1942. TABLE NO. 2. ESTIMATED POPULATION, MARRIAGES, RECORDED AND RESIDENT BIRTHS AND DEATHS BY RACE AND CORRESPONDING RATES PER 1,000 POPULATION-1930- 1942. TABLE NO. 3. MONTHLY DISTRIBUTION OF RESIDENT LIVE BIRTHS AND STILLBIRTHS CLASSIFIED ACCORDING TO COLOR AND SEX-1942. TABLE NO. 4. LIVE AND STILLBIRTHS CLASSIFIED ACCORDING TO ATTENDANCE, IIOSPITALIZATION, TERM, PLURALITY AND NATIVITY-1942. TABLE NO. 5. RESIDENT DEATHS CLASSIFIED BY COLOR, SEX, AND AGE AND DISTRIBUTED BY COLOR AND AGE BY MONTHS-1942. TABLE NO. 6. INSTITUTIONAL DEATHS OCCURRING IN BALTIMORE CLASSIFIED ACCORDING TO COLOR AND SEX-1942. TABLE NO. 7. RESIDENT DEATHS UNDER ONE YEAR FROM CERTAIN CAUSES ACCORDING TO AGE AND MONTH OF DEATH -1942. TABLE NO. 8. RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942. TABLE NO. 9. RECORDED AND RESIDENT DEATHS AND DEATH RATES PER 100,000 POPULATION FOR CERTAIN CAUSES AND GROUP OF CAUSES, CLASSIFIED BY COLOR-1942. TABLE NO. 10. ALLOCATION OF DEATIIS BY COLOR AND CAUSE OF DEATH ACCORDING TO PLACE OF DEATH AND PLACE OF RESIDENCE, BALTIMORE-1942. TABLE NO. 11. RESIDENT AND RECORDED DEATHS AND DEATH RATES PER 100,000 POPULATION FOR CERTAIN IM- PORTANT CAUSES FOR TOTAL, WHITE AND COLORED POPULATIONS-1932-1942. TABLE NO. 12. RESIDENT AND RECORDED DEATHS UNDER ONE MONTH OF AGE, DEATIIS UNDER ONE YEAR OF AGE, AND MATERNAL DEATHS WITH CORRESPONDING DEATH RATES-1932-1942. TABLE NO. 13. CASES OF REPORTABLE DISEASES CLASSIFIED AC- CORDING TO SEX, COLOR AND AGE PERIODS-1942. TABLE NO. 14. REPORTED CASES AND CASE RATES PER 100,000 POPU- LATION FOR CERTAIN COMMUNICABLE DISEASES FOR TOTAL, WHITE AND COLORED POPULATION-1930- 1942.

[ 245] 246 REPORT OF THE HEALTH DEPARTMENT-1942

TABLE NO. 1 ESTIMATED POPULATIONS AND RECORDED DEATH RATES; TOTAL, WHITE, COLORED, BALTIMORE-1930-1942

ESTIMATED POPULATION DEATH RATES PER 1,000 AS OF Jumc 1 POPULATION YEAR Total White Colored Total White Colored

1942 936,000 754,400 181,600 12.61 11.90 15.57 1941 866,000 698,000 168,000 13.40 12.46 17.32 1940 860,456 693,268 167,188 13.43 12.67 16.60 1939 855,033 690,318 164,715 12.72 12.13 15.21 1938 849,610 687,348 162,262 13.05 12.38 15.91 1937 844,187 684,361 159,826 13.97 13.09 17.72 1936 838,764 681.356 157,408 13.73 12.64 18.45 1935 833,341 678,332 155,009 13.38 12.31 18.04 1934 827,918 675,291 152,627 13.43 12.46 17.68 1933 822,495 672,232 150,263 13.13 12.26 17.00 1932 817,072 669,155 147,017 13.19 12.04 18.35 1931 811,849 666,059 145,590 14.20 12.91 20.07 1030 806,226 862,946 143,280 13.94 12.70 19.65

For corresponding figures from 1890 to 1920, see Annual Report of 1939, page 263. TABLE NO. 2 ESTIMATED POPULATION, MARRIAGES, RECORDED AND RESIDENT BIRTHS AND DEATHS BY RACE AND CORRESPONDING RATES PER 1,000 POPULATION, 1930-1942

TOTAL WHITE COLORED YEAR Number Rate Number Rate Number Rate Estimated population as of July 1, 1942 936,000 .. 754,400 .. 181,600 .. MARRIAGES RECORDED 1942 19,595 20.9 15,167 20.1 4,428 24.4 1941 15,966 18.4 12,256 17.6 3,710 22.1 1940 11,305 13.1 8,658 12.5 2,647 15.8 1939 8,501 9.9 6,589 9.5 1,932 11.7 1938 8,521 10.0 6,578 9.6 1,943 12.0 1937 8,849 10.5 6.763 9.9 2,086 13.0 1936 , 8,134 9.7 6,208 9.1 1,926 12.2 1935 I 7,254 8.7 5,695 8.4 1,559 10.0 1934 7,235 8.7 5,494 8.1 1,741 11.4 1933 5,804 7.0 4,278 6.4 1,526 10.2 1932 5,345 6.5 4,069 6.1 1,276 8.6 1931 6,116 7.5 4,720 7.1 1,396 9.6 1930 6,557 8.1 5,159 7.8 1,398 9.8 BIRTHS RESIDENT 1942 19,720 21.2 15,076 20.1 4,644 25.6 1941 15,995 18.5 11,886 17.0 4,109 24.4 1940 13,712 15.9 10,105 14.6 3,607 21.6 1939 12,525 14.6 9.211 13.3 3,314 20.1 1938 13,208 15.5 9,892 14.4 3,316 20.4 1937 12,516 14.8 9,370 13.7 3,146 19.7 1936 11,801 14.1 9,956 13.1 2,845 18.1 1935 12,332 14.8 9,363 13.8 2,969 19.2 1934 12,201 14.7 9,196 13.6 3,005 19.7 1933 12,189 14.8 9,130 13.6 3,059 20.4 1932 12,785 15.6 9,737 14.6 3,048 20.6 RECORDED 1942 24,144 25.8 19,224 25,5 4,920 27.1 1941 19,406 22.4 14,992 21.5 4,414 26.3 1940 16,478 19.2 12,582 18.1 3,896 23.3 1939 14,887 17.4 11,350 16.4 3,637 21.5 1938 15,275 18.0 11,763 17.1 3,612 21.6 1937 14,272 16.9 10,921 16.0 ' 3,351 21.0 1036 13.277 15.8 10,272 15.1 3,005 19.1 1935 13,641 16.4 10,521 15.5 3,120 20.1 1934 13,453 16.2 10,308 15.3 3,145 20.6 1933 13.409 16.3 10,211 15.2 3,198 21.3 1932 14,007 17.1 10,833 16.2 3,174 21.4 1931 14,186 17.4 11,012 16.5 3,154 21.7 1930 14,948 18.5 11,698 17.6 3,252 22.7 DEATH

RESIDENT 1942 11,347 12.1 8,397 11.1 2,950 16.2 1941 11,160 12.9 8,132 11.7 3,028 18.0 1940 11,096 12.9 8,243 11.9 2,853 17.1 1939 10,386 12.1 7,907 11.4 2,479 15.0 1938 10,618 12.5 8,034 11.7 2,584 15.9 1937 11,244 13.3 8,415 12.3 2,829 17.7 1936 11,058 13.2 8,134 11.9 2,924 18.6 1935 10,707 12,8 7,917 11.7 2,790 18.0 1934 10,764 13.0 8,049 11.9 2,715 17.8 1933 10,505 12.8 7,923 11.8 2,582 17.2 1932 10,309 12.6 7,622 11.4 2,687 18.2 RECORDED 1942 . 11,803 12.6 8,976 11.9 2,827 15.5 1941 11,609 13.4 8.700 12.7 2,909 17.3 1940 11,557 13.4 8,782 12.7 2,775 16.6 1939 10,879 12.7 8,374 12.1 2,505 15.2 1938 11,091 13.0 8,509 12.4 2,582 15.9 1937 11,790 14.0 8,958 13.1 2,832 17.7 1936 11,516 13.7 8,612 12.6 2,904 18.4 1935 11,149 13.4 8,352 12.3 2,797 18.0 1934 11,116 13.4 8,417 12.5 2,699 17.7 1933 10,797 13.1 8,243 12.3 2,554 17.0 1932 10,775 13.2 8,060 12.0 2,715 18.4 1931 11,522 14.2 8,600 12.9 2,922 20.1 1930 11,238 13.9 8,422 12.7 2,816 19.6

[247 ] 248 REPORT OP THE HEALTH DEPARTMENT-1942

TABLE NO. 3 MONTHLY DISTRIBUTION OF REsi DENT LIVE BIRTHS AND STILLBIRTHS CLASSIFIED ACCORDING TO COLOR AND SEX-1942

LIVE BIRTHS STILLBIRTHS

WHITE COLORED WHITE COLORED MONTH z. 41 1 I t" Ti El 2 7ri El sex Unknown Total TOTAL I Total 19,720 15,078 7,768 7,310 4,644 P 2,394 2,250 779 244 169 49 153 122 31

January 1,483 1,111 569 542 352 165 187 68 24 12 1 17 12 1 February 1,357 1,026 513 513 331 193 138 49 20 5 4 9 6 2 March 1,628 1,235 628 609 393 209 184 59 15 12 7 13 7 5

April 1,279 947 482 465 332 173 159 58 24 10 1 14 7 1 May 1,470 1,098 584 514 372 202 170 70 25 13 8 11 11 2 June 1,494 1,083 570 513 411 189 222 72 23 18 8 12 9 1

July 1,735 1,300 671 629 435 223 212 78 22 22 7 13 10 3 August 1,823 1,409 725 684 414 211 203 66 18 13 2 17 10 3 September 1,884 1,448 754 692 438 224 214 67 18 18 1 14 11 4

October 1,910 1,525 821 704 385 103 192 65 14 18 4 12 15 2 November 1,857 1,466 718 750 391 211 180 61 18 12 5 9 12 5 December 1,820 1,430 735 695 390 201 189 88 23 18 1 12 12 2

* Stillbirth total includes 11, color unknown. t Included in colored total are: 3 male, 7 female Chinese. 1 male Filipino. BUREAU OF VITAL STATISTICS 249

TABLE NO. 4 LIVE AND STILLBIRTHS CLASSIFIED ACCORDING TO ATTENDANCE, HOSPITALIZATION, TERM, PLURALITY AND NATIVITY-1942

, RECORDED RESIDENT GROUP Total White Colored Total White Colored

PLACE OF BIRTH, ATTENDANCE AND PERIOD OF GESTATION Live Births Total 24,144 19,224 4,920 19,720 15,076 4,644 Physician 23,630 19,014 4,616 19,207 14,868 4,339 Home 4,404 2,684 1,820 4,384 2,569 1,815 Hospital 19,228 16,430 2,796 14,823 12,299 2,524 Midwife 614 210 304 513 208 305 Born in hospital 19,226 16,430 2,796 14,823 12,299 2,524 40 weeks or more 17,640 15,300 2,240 13,490 11,454 2,036 36-39 weeks 1,014 645 369 776 453 323 28-35 weeks 502 348 156 394 257 137 Lees than 28 weeks 61 47 . 14 49 37 12 Unspecified 109 02 17 114 98 16 Born at home 4,918 2,794 2,124 4,897 2,777 2,120 40 weeks or more 4,105 2,402 1,703 4,101 2,399 1,702 36-39 weeks 464 223 241 454 215 239 28-35 weeks 115 53 62 112 • 51 61 Less than 28 weeks 23 16 7 23 16 7 Unspecified 211 100 111 207 06 111 Stillbirths Total 917* 582 324 779* 461 307 Physician 871 563 308 733 442 291 Home 264 110 154 263 109 154 Hospital 607 453 154 470 333 137 Midwife 35 19 16 35 19 16 Foundlings* 11 .. .. 11 .. .. PLURAL BIRTHS Sets of twine 235 189 46 182 141 41 Both born alive 217 178 39 166 132 34 One born alive, 1 stillborn 18 11 7 18 9 7 Set of triplets Two born alive, 1 stillborn 1 1 ...... NATIVITY Live births, total 24,144 19,224 4,920 19,720 15,076 4,644 Both parents, native-born 22,638 17,983 4,655 18,431 14,027 4,404 One parent, native-born one parent foreign-born 910 882 28 771 743 28 Both parents, foreign-born 215 215 .. 192 192 .. One or both parents' birthplace . unknown 381 144 237 326 114 212 Stillbirths, total 917* 582 324 779* 461 307 Both parents, native-born 770 503 267 644 393 251 One parent, native-born one parent foreign-born 25 22 3 19 16 3 Both parents, foreign-born 7 7 .. 6 6 .. One or both parents' birthplace unknown 115 50 54 110 46 53

* Total stillbirths include 11, color unknown. TABLE NO. 5 tsz RESIDENT DEATHS CLASSIFIED BY COLOR, SEX AND AGE AND DISTRIBUTED BY COLOR AND AGE BY MONTHS-1942 crt

Ermaz YEAR JAN. FEB. MAR. APRIL MAY JUNE JULY AUG. SEPT. . Nov. DEC. War= COLORED AGE TOTAL 2 2 . to .4 Colored Colored Colored Colored Colored Colored Colored Colored Colored Colored White Colored Colored White White White White White GRAND

Total, all ages 13,347 8,397 4,618 3,779 2,950 1,626 1,324 797 272702237786 282716 251 644 262617 234649 223613235540 220714 254 716 206 903 274

Under one month 489 349 224 12.5 140 83 57 24 12 21 4 27 11 21 7 29 10 23 11 31 18 35 13 28 16 39 9 30 11 41 18 1 to 2 montha 110 65 39 26 45 25 20 4 4 7 7 3 5 7 .. 1 3 3 1 2 2 7 4 6 6 10 3 4 1 11 9 3 to 11 months 179 102 57 45 77 35 42 9 7 18 7 4 11 6 3 6 9 3 5 7 5 8 4 10 6 10 9 9 4 12 7 Total under 1 year 778 516 320 196 262 143 119 37 23 46 18 34 27 34 10 36 22 29 17 40 25 50 21 44 28 59 21 43 16 64 34 1 year 62 30 17 13 32 15 17 3 4 3 1 .. 2 4 1 2 3 4 2 2 1 2 4 2 3 4 4 1 2 3 5 Total under 2 years 840 546 337 209 294 158 136 40 27 49 19 31 29 38 11 38 25 33 19 42 26 52 25 46 31 63 25 44 18 67 39 2 to 4 years 73 37 24 13 36 14 22 4 1 5 1 4 3 .. 8 2 4 .. 2 4 6 2 2 1 1 4 4 7 3 4 1 Total under 5 years. 913 583 361 222 330 172 158 44 28 54 20 38 32 38 19 40 29 33 -.21 46 32 54 27 47 32 67 29 51 21 71 40 5 to 9 years 61 38 21 1723 14 9 1 .. 2 2 6 1 2 3 3 1 4 5 1 3 2 4 2 5 .. 3 .. 3 6 10 to 14 years 53 29 17 12 24 11 13 2 1 2 1 1 4 4 1 1 1 4 3 3 3 3 2 4 5 1 3 .. 2 .. 15 to 19 years 166 75 38 37 91 52 39 3 9 7 5 4 1 4 9 6 3 12 9 12 8 10 4 6 11 5 6 3 7 4 20 to 24 years 232 107 57 50 125 71 54 11 9 6 11 6 11 12 7 6 14 11 13 11 11 11 14 6 9 12 13 7 6 8 7 25 to 29 years 259 133 80 53 126 74 52 16 9 7 8 8 9 12 11 12 19 14 8 13 11 14 14 6 8 9 8 6 9 16 12 30 to 34 years 299 157 103 54 142 88 54 14 9 12 9 13 10 15 10 17 16 15 15 15 14 7 10 11 9 11 17 10 11 17 12 35 to 39 years 438 254 167 87 184 104 80 22 14 17 16 25 21 29 20 14 13 21 13 24 15 16 14 21 17 21 16 18 9 26 16 40 to 44 years 608 323 201 122 285 172 113 34 16 25 28 37 28 38 25 14 29 19 24 25 16 25 22 23 28 24 29 27 16 32 24 45 to 49 years 733 455 296 159 278 162 116 34 31 30 22 46 30 40 21 35 27 38 22 42 20 43 20 27 23 35 20 46 16 39 26 50 to 54 years 933 613 376 237 320 180 140 61 31 43 25 58 36 48 36 49 16 59 25 39 21 55 28 43 21 43 33 52 25 63 23 55 to 59 years 970 727 457 270 243 131 112 65 31 62 16 77 17 78 20 57 16 57 17 57 16 53 21 43 20 59 24 58 19 61 26 60 to 64 years 1,167 945 565 380 222 113 109 102 32 79 17 78 13 86 21 69 19 71 16 78 14 61 16 67 15 82 17 83 17 89 25 65 to 69 years 1,242 997 537 460 245 131 114 83 29 92 22 103 26 83 22 68 22 70 20 74 13 58 16 74 11 86 24 95 22111 18 70 to 74 years 1,165 1,008 506 502 157 80 77 105 16 94 17 89 12 69 14 83 16 79 13 77 10 69 9 51 8 78 7 86 14 128 21 75 to 79 years 930 851 410 441 79 33 46 93 3 82 9 82 10 68 6 73 8 54 3 55 8 50 4 52 3 81 8 62 12 99 5 80 to 84 years 698 657 284 373 41 19 22 69 2 57 3 68 5 48 3 56 5 34 4 49 5 50 2 32 2 51 1 72 4 71 5 85 to 89 years 340 320 110 210 20 12 8 27 1 21 4 32 1 28 3 28 2 3 .. 17 1 23 1 20 2 25 1 25 .. 43 4 90 to 94 years 110 100 24 76 10 4 6 8 1 7 .. 13 6 1 .. 9 1 5 .. 9 .. 7 1 1 13 .. 95 to 99 years 24 19 7 12 5 3 2 3 .. 2 2 1 .. 1 .. 1 .. 1.. 1 .. 3 1 1 .. 3111 1.. 100 years and over .. Age not specified BUREAU OF VITAL STATISTICS 251

TABLE NO. 6 INSTITUTIONAL DEATHS OCCURRING IN BALTIMORE CLASSIFIED ACCORDING TO COLOR AND SEX-1942

WRITE COLORED INSTITUTION GRAND TOTAL Total Male Female Total Male Female

Hospital and Institutional deaths 6,548 4,872 2,973 1,899 1,676 1,029 647

Baltimore City Hospitals Residents 1,040 580 411 169 460 276 184 Non-residents 33 29 24 5 4 4

Sydenham Hospital Residents 24 19 13 6 5 3 2 Non-residents 6 4 2 2 2 1 1

Other Hospitals Residents 3,727 2,696 1,641 1,055 1,031 637 394 Non-residents 1,237 1,082 692 390 155 93 62

City Jail and State Penitentiary Residents 13 6 6 .. 7 7 .. Non-residents 8 1 1 .. 7 7

Other Institutions Residents 395 390 156 234 5 1 Non-residents 65 65 27 38 .. TABLE NO. 7 . RESIDENT DEATHS UNDER ONE YEAR FROM CERTAIN CAUSES ACCORDING TO

AGE AND MONTH OF DEATH-1942 11 11

AGE GROUPS MONTH OP DEATH

LIST LIST I I

CAUSE OF DEATH t.

day day 74 UNDER UNDER 1 1 VI d

CA Months Months

Months Months -

Numaza Numaza

December December

November November

October October

March March

1-2 1-2

Under Under

3-5 3-5

TOTAL TOTAL

INTERNATIONAL INTERNATIONAL

I I

I I I T 778 204 147 138 110 87 92 6064 61 44 5846 65 71 7280 59 98 All Causes W 516 150 100 99 65 54 48 37 46 34 34 36 29 40 5044 5943 64 C 262 54 47 39 45 33 44 23 18 27 10 22 1725 21 28 21 1834 Meningococcus meningitis W 3 ...... 1 2 .. 2 .. .. 1 ......

Whooping cough C

12 Tetanus C 1 .. .. 1 .. .. 13 Tuberculosis of the respire- W 4 ...... 1 3 .. 2. .. 1 .. _ 1 .. _ .. _ tory system ...... 14 Tuberculosis of the meninges C 2 ...... 1 1 .. 27a Dysentery, bacillary . C 1 ...... 1 ...... —

30f Syphilis: congenital C 8 3 1 2 2 .. . .. 1 1 .. 2.. 1 .. .. 2 1 .. 83 Influenza W 4 ...... 1 2 1 2 1 .. ..

370 Acute infectious encephalitis C 1 ...... _ 1 .. 52a Cancer of kidney W 1 _ 1 .. 64 Diseases of the thymus gland 67 Scurvy .. .. .

80a Intracranial abscess 81a Simple meningitis • • • • • • • • • • •

84a Mental deficiency 87e Other diseases of the ner- C I ...... 1 ...... vous system 89a Otitis and other diseases of W .. 1 2 1 the ear 92d Disease of mitral valve W 1 ...... 100b Other diseases of reins C 1 .. .. 1 ,...... 104a Disease of the nasal fosse° W 1 ...... 104b Diseases of the accessory W . .. 1 sinuses 160 Bronchitis W 3 .. . 1 1 1 1 2 . .. . .

107 Bronchopneumonia W 4613 7 13 12 10 6 8 3 3 .. 2 2 2 4 4 4 8 C 48 .. 2 8 13 11 14 6 3 8 2 1 .. 2 2 2 4 5 13

108 Lobar pneumonia W 14 .. .. 1 4 5 4 1 3 2 2 .. .. . 2 1 .. 1 2

118 Other diseases of stomach W 1 _ ,. .. 1 .. . .. 1 ...... 119 Diarrhea and enteritis W 64 ., .. 25 18 9 12 1 2 1 3 1 1 7 11 9 10 6 12 C 35 — .. 811 4 12 3 2 1 .. 4 .. 3 3 6 7 2 4

[252 1 BUREAU OF VITAL STATISTICS 253

TABLE NO, 7—Continued RESIDENT DEATHS UNDER ONE YEAR FROM CERTAIN CAUSES ACCORDING TO AGE AND MONTH OF DEATH-1942

F.1 2 AGE Gnours MONTH OF DEATH 1-1 I 1-i X X CAUSE OF DEATH a g ; a' V, a . N

E Months z P. ,°4' September October November December June July 0 3-5 1 I I I I I I 122a Hernia 122b Intestinal obstruction

128 Diseases of the pancreas W 1 ...... 1 ...... 1 ...... 130 Acute nephritis 153 Other diseases of the skin W 1 .. .. 1 ...... 1 and cellular tissue 157a Congenital hydrocephalus W 12 4 .. 3 1 2 2 1 .. 1 4 1 ...... 3 .. 2

157b Spina . bifida and meningo- W 10 1 .. 6 2 1 1 2 1 .. .. 1 1 1 .. .. 2.. 2 cele 157c Anencephalus . 157e Congenital malformations of W 35 6 10 10 6 3 2 1 1 4 5 2 4 1 2 4 3 1 7 • the heart C 12 2 2 2 1 2 3 2 2 .. 1 1 1 2 2 .. 1 .. .. 157f Other congenital malforma- W 11 1 1 6 1 2 .. .. 2 .. 1 2 1 .. .. 1 3 1 .. • tions of cardiovascular C 3 .. .. 1 .. 2 .. 1 ...... 1 1 ...... system 157h Congenital malformations of W 2 .. .. 1 1 ...... •. .. .. 2 ...... the genito-urinary system 157m Other and unspecified con- W 6 3 .. 2 1 .. .. 1 2 ...... 1 .. 1 1 .. .. genital malformations 158 Congenital debility

169 Premature birth W 152 86 50 16 .. . , .. 9 8 17 11 12 12 13 19 12 15 16 8 C 67 34 19 11 3 .. .. 3 1 7 5 3 8 10 6 12 3 3 6 160a Intracranial or spinal hem- W 37 16 16 5 ...... 3 3 1 3 3 3 3 2 1 7 4 4 orrhage C 16 3 11 .. 2 .. .. 1 1 2 2 1 .. .. 2 2.. 1 4 160c Other injuries at birth W 12 11 1 ...... 1 1 .. .. 1 . 2 1 1 1 1 3

161a Asphysia, atelectasis W 34 15 14 2 2 1 .. 6 2 .. 1 4 .. 4 4 6 2 1 5 C 12 6 3 1 2 ...... 1 .. 1 .. 3 .. 3 1 1 2 161b Infection of the umbilicus; W 1 ...... 1 ...... , .. ,. .. 1 ...... pemphigus 161e Other diseases peculiar to W 11 3 3 5 ...... 1 .. 1 .. 2 1 1 2 .. 1 1 1 the first year of life C 9 2 5 1 1 .. .. 2 1 1 .. 2 .. .. 2 .. 1 .. .. 168 Infanticide 180 Conflagration 182 Accidental mechanical suf- W 9 .. .. 3 2 3 1 .. . 2.. 1 .. 2. .. 1 1 2 f°cation 195d Accidental obstruction, suf- W 6 .. .. 4 1 1 .. .. 1 ...... 1 1 2 1 f°cation or puncture by C 1 ,. .. .. 1 ...... 1 ingested objects 200o Unknown cause TABLE NO. 8 RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS AGE GROUPS I I

CAUSE Year CD III 0

NUMBER >0

Grand By By 1 ri Years Years Over Years Years Years Years >.)1 '>CA '..' >4 >4 Years >4 4 Total Color Sex 1..., a >'.■

a REPORT E ›., . .sI,, ,t4 CA C:0 Not Years LIST Specified Year Years 1 and 1 10-14 INTERNATIONAL Under 3 20-24 35-39 40-44 45-49

.00 60-64 70-74

C•1 er CV 85

c0 ;; Age

W 8,397 M 4,618 320 17 9 9 6 21 17 38 57 80 103 167201 296 376 457 565 537506 410 284 142 .... F 3,779 196 13 7 3 3 17 12 37 50 53 54 87 122 159 237 270380460 502 441 373 302 1 All Causes 11,347 OF C 2,950 M 1,626 143 15 7 6 1 14 11 52 71 74 88 104 172 162 180 131 113 131 80 33 19 19 ....

F 1,324 119 17 13 5 4 9 13 39 54 52 54 80 113 116 140 112 109 114 77 46 22 16.... THE W 560M 380 9 3 1 ... 1 3... 6 6 12 20 30 50 49 44 49 38 24 21 10 2 2 .... F 180 7 4 2...... 4 2 5 19 19 7 12 15 13 13 15 11 13 8 6 5 ...... I Infectious and parasitic diseases 1,169 HEALTH C 609 M 375 10 7 2 1 ... 2 3 30 31 27 31 42 51 44 33 26 13 15 3 2 2...... F 234 12 5 3 2... 2 7 29 27 29 23 19 24 14 15 8 9 2 2 2...... 1 Typhoid fever 1 W 1 51 2 Paratyphoid fever 1 C 1 M DEPARTMENT

F 6 Meningococcus meningitis 31 C 8M F W 4M F

9 Whooping cough 9 -1942 C SM F W 1M 10 Diphtheria 2 C 1M 11 Erysipelas 4 W 4 M F

3M F 12 Tetanus 7 • 4M II W 374 M 261 3 2...... 1 ...... 4 11 16 24 41 36 32 35 18 17 13 6 1 1 .... F 113 1 2...... 3 1 4 15 17 6 10 9 8 8 9 3 9 3 4 1 ...... 13-22 Tuberculosis, all forms 810 C 436 M 273 2 5 2...... 2 3 25 28 24 27 35 29 33 21 14 12 8... 1 2 ...... F 163 2 1 2 1 ... 2 7 28 26 26 22 11 10 9 7 4 2 1 1 1 ......

354 M 252 3 2...... 1 ...... 3 11 15 24 41 35 32 35 17 13b 16 10 5 1 1 .... Tuberculosis of the respiratory F 102 1 1 ...... 1 4 14 17 6 9 8 8 8 9 3 7 2 3 1 ...... system without mention of 748

occupational diseases of the a 394 M 245 1 4 1 ...... 1 2 19 23 21 26 33 27 33 21 14 11 6... 1 1 ...... lungs F 149 1 1 2 1 ... 1 6 24 25 25 20 10 10 9 7 3 2 1 1 ...... I 13c Tuberculosis of the respiratory 1 C 1 M - system of unspecified site W 7M F ■Cr 14 Tuberculosis of the meninges 20 and central nervous system C 13 M 00 " F I nvaung W 15 Tuberculosis of the intestines 12 O and peritoneum C 10 M F W 3M 16 Tuberculosis of the vertebral F column 8 IVIIA C 17a Tuberculosis of the bones 2 C 2 F W 17b Tuberculosis of the joints 3 C 1M 19 Tuberculosis of the lymphatic SOLLSIIVIS system (except bronchial, 2 C 2 M mediastinal, mesenteric and F retroperitoneal lymph nodes)

W 3M 1 ...... 20 Tuberculosis of the genito- F urinary system 4 C 1M W 1 F 21b Tuberculosis of other organs 4 C 3M F TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS AGE GROUPS I I I I 32 3.: 3.: Year 5 5 5 5 53 53. 53

NUMBER CAUSE 0 REPORT Grand By By 1 ■ Years Years ... >420 >': >l >4 >'44 >'-', '.,' Years ''4 >'1. >u4 '41 Years Total Color Sex S Not Over to: Years o1,! 75 Years LIST Years Years 2. Fo' i. t. is , Specified INTERNATIONAL Under 2 3 5-9 t...r' 25-29 35-39 Z' 55-59 k- 80-84 85 and Age

W 1M OF 22a Acute (generalized) milary 4 tuberculosis C 3 M THE W 1M 22b Other and unspecified general 2 tuberculosis (b, c) C 1 M HEALTH W 5M F 24a Septicemia (non-puerperal) . . 6 C 1M

W 1 F DEPARTMENT 25 Gonococcus infection 12 - C ..„. 11 M F W 2F 27a Dysentery, bacillary 3 C 1 M . W 1 M 27b Dysentery, amebic 2 -1942 C 27c Other and unspecified forms 1 W 1 M of dysentery 28c Malaria, tropical (malignant 1 W 1 F .- tertian) W 7M F 30a Syphilis: locomotor ataxia 10 C 3M F 30b Syphilis: general paralysis of 56 the insane F W 14M F 30c Syphilis: other syphilis of the 21 central nervous system C 7 M F

F 30d Syphilis: aneurysm of the 53 aorta F W 11M F

30e Syphilis: other syphilis of the 35 1lVattfla circulatory system F JO 30f Syphilis: congenital 8 C 8 M F W CM

30g Syphilis: other and unspeci- 18 'IVIIA fled forms of syphilis C 12 M F

F 33a Influenza with respiratory 37 complications specified C 15 M F SOLLSIIVIS W 12M F 33b Influenza without respiratory 23 complication specified C 11 M F 35 Measles 1 C 1 F 37c Acute infectious encephalitis: 2 C 2 F Unqualified 390 Rocky Mountain spotted fever 1 W 1 M 43 Mycoses 3 W 3 M F TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS AGE GROUPS

Year 1 EII 2aa Fa 2 0 0

NUMBER CAUSE 1

Grand By By Over Years Years Years Years Years Years Years Years Years A A A AS

Sex REPORT Total Color '73 r's c3 ,es Not Years F.,3 .a. Years Specified LIST and Years 10-14 INTERNATIONAL Under 3 5-9 55-59 85 Age 25-29 30-34 35-39 40-44 45-49 50-54 60-64

W 7M

F OF 44b Lymphogranulomatosis 11 (Hodgkin's disease) C 4 M F THE W 1,099 M 533 1 1 ... 2...... 2 3 7 5 14 15 28 59 61 80 89 73 49 36 8.... F 566 ...... 1 2 4 11 18 29 51 62 65 76 76 68 48 35 20

.... HEALTH II Cancer and other tumors 1,302 C 203 M 96 ...... 1 ...... 1 2 2 2 7 10 16 10 16 15 11 1 2...... F 107 ...... 1 ... 2 ... 1 ... 1 3 3 11 17 14 16 11 9 9 5 4 ...... 1,071 M 522 1 1 ... 2...... 2 1 4 5 14 12 28 59 61 80 89 72 48 35 8.... F 549 ...... 2 3 9 18 26 47 60 64 74 75 68 48 35 20 ....

45-55 Cancer and other malignant 1,257 DEPARTMENT tumors 186 M 89 ...... 1 1 2 1 6 10 14 9 16 15 11 1 2...... F 97 ...... 1 ... 2... 1...- 1 3 3 7 15 12 14 11 9 9 5 4...... 45a Cancer of the lip 2 W 2 M W 9M 45b Cancer of the tongue 10 C 1M

W 4M -1942 45c Cancer of the mouth 7 C 3M F W 2M 45d Cancer of the jaw bone 3 C 1 F

F 45f Cancer of the pharynx 12 C 1M F 46a Cancer of the esophagus 30 C 12M F W 154 M 95 ...... 2 2 2 11 16 19 12 13 10 8...... F 46b Cancer of the stomach 186 F 46c Cancer of the duodenum 3 W 3 M F

46d Cancer of the rectum and anus 79 C 15M

F RVaIIIIU W 111 M 58 ...... 1 1 2 1 1 3 10 9 12 9 6 2 1 .. . . F 30 46e Cancer of the intestines (ex- 119 cept duodenum and rectum) C 8 Ig F rIVIIA

46f Cancer of the liver and biliary 70 passages C

46g Cancer of the pancreas 50 C 4M ......

...... SOLISIIVIS F ...... 46h Cancer of the mesentery and 2 W 2 F peritoneum W 7M 46m Cancer of unspecified diges- F tive organs 8 C 1 M

F 47a Cancer of the larynx 28 C 1 M ts3 TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942 G")

TOTALS AGE GROUPS I I I rj

Year .1E74, EEEa Fs Ea CAUSE .. >. a 4' 4' NUMBER 14'

Grand By By 1 Over Years ■ 'Years Years Years Years -' S'-i . :1 c-, Years Total Color Sex rrE 8 ' >-, >4 Y■

c y., -a cb ,t. Not Years LIST Specified Year and INTERNATIONAL 1 Under

CI 25-29

.,-4 45-49 55-59 60-64 80-84 N ev) el. VD CO ri v i kt 75-79 85 Age *

F a,uoaau 47c Cancer of the bronchus 23

C 5M ao F

W 58M 48 ...... 2 3 5 9 6 511 4 1 1 1.... F lulL 47d Cancer of the lungs 66 C SM F 47e Cancer of the pleura 2 W 2 M

47f Cancer of the mediastinum mvivall and unspecified sites of 5 W 5 M respiratory system

48a Cancer of the cervix 59 C 13F

48b Other cancer of uterus 75 C 11 F

49a Cancer of the ovary 32 C 4F gt6T--man1uvaaa 49c Cancer of the vagina 1 W 1 F W 3F 49d Cancer of the vulva 6 C 3F Cancer of female genital or- 1 W 1 F 49e gans (site unspecified) W 111 no ...... i i 8 8 8 16 ii ii io 18 8 6 6.... 50 Cancer of the breast 128

C 17 ■=1

51b Cancer of the prostate 54 C 6M 51c Cancer of the testes 3 W 3 M Md Cancer of the penis 2 C - 2 M

F 52a Cancer of the kidney 20 C 4M F avating F 52b Cancer of the bladder 50 C SM 30

W 15 M 53 Cancer of the skin (except F vulva and scrotum) 16 C 1M W SM F Ma Glioma 7 C 2F

54h Other and unspecified cancers F SDLLIEVIS of the brain and central ner- 18 vous system C 2 F 55a Cancer of adrenal glands 1 W 1 M W 7M Mb Cancer of bones (except jaw F bone and accessory sinuses) 8 C 1M W 1M 55c Cancer of the thyroid gland 2 C 1 F b., 0-3 TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS AGE GROUPS 1 1 1 1 1 I ' CI 0 00 L's E Yeatl 5 3 a 2 CAUSE Nindann 1

Grand By By Over Years . 3 Years 'A A Years Years A A A A Years A Years A

Total Color Sex til A Not Fs 4, 71, 2 2 1.. 2 . .

r.. Years REPORT Specified and

LIST 1 Year A Years 1 10-14 Under 3 80-64 80-84 85 Age 25-29 30-34 70-74 INTERNATIONAL

W 3M 55d Cancer of the nasal cavity and F accessory sinuses 4 C 1M OF I THE F 55e Cancer of other and unspeci- 60

find organs o 8 M F HEALTH W " 6 F 56a Nonmalignant tumors of the 8 ovary C 2F W 3F 56b Nonmalignant tumor of uterus 10 DEPARTMENT C 7F 56c Nonmalignant tumors of other 1 W 1 F female genital organs [__4 W 9M ......

56d Nonmalignant tumors of brain F and other parts of the cen- 12 "

tral nervous system C 3 M -1942 F

W SM 56e Nonmalignant tumors of other F and unspecified organs 6 C 1 M W 3M 57d Tumors of unspecified nature F of brain and other parts of 5 central nervous system C 2 M 57e Tumors of unspecified nature W 1 M of other and unspecified or-I 3 gans ,. C 2M W 293M 82 4...... 1 2 1 2 1 2 4 2 2 8 8 10 14 13 8...... III Rheumatism, diseases of nu- F 211 4 1 ...... 2... 2... 4 ... 2... 8 15 18 40 41 37 23 7 7 .... trition and of the endocrine 354 glands, other general dig- C 61 M 24 6...... 2...... 1 1 1 1 2 1 1 1 4 1 ... 2...... eases and avitaminoses F 37 2 1 ... 1 ... 1 ...... 1 ... 2 3 3 5 3 4 9 1 ...... 1 .... 58a Acute rheumatic pericarditis I W 1 M W 4M F 5813 Acute rheumatic endocarditis : 5 C 1M 58c Acute rheumatic myocarditis 1 W I F W 2M 58(1 Other acute rheumatic heart 3 diseases C 1M W 1M 554 Other forms of acute rheuma- 5 tic fever C 4 M F f1Vallf1[[

W 11.1 30 59a Rheumatoid arthritis 2 _ C 1 F 59b Other chronic articular rheu- 10 W 10 M

matiBm F rIV,LIA

W 249M 62 ... .'...... • •...... I I 3 I 2 6 6 9 13 12 8...... 61 Diabetes mellitus 290

62 Diseases of the pituitary gland I W 1 M SDII,SIIVIS 63a Simple goiter I C I F W 7M F 63b Exophithalmic goiter 9 C 2M F 63c Myxedema and cretinism 3 W 3 F W 6M F 64 Diseases of the thymus gland 13 C 7M F 7.°

264 REPORT OF THE HEALTH DEPARTMENT-1942

pamoods • • qom oil/ ". . Jan° putt .• .• • • . . . . • • • 9039A. t8-08 .• .• .• .• .• .• • • • • • • • • 64,10A. 62,-94 • • . . . . • ""• ' • • • "'Ga.& t2.-02, • • • ...... "13°.A. 69-99 • • • • • •••••■ ful'a.A. t9-09 .• .• .• .• .• .• .• .• .• .• . .• .• . • g•ItiaA 69-99 .• .• .• .• • • • • • • • • • • • ...... goia..I. t9-09 ...... • .• .• .• .• .• .• .• .• • • • • . • • . • 6.1"A 617-91, • • . . .• . • . • Livait tt-Ot .• .• .• .• .• .• .• .• .• .•

GROUPS GROUPS • • ...... BluaA. 6E-9E .• .• .• .• .• .• .• .- .• .• • • • • •

AGE AGE "ga2. tE-OE .• .• • • .• . . . 9raaA. 6Z-9E • • • • • - • • • • • • • • • • • "ga.A. tZ-on • • : : .

• • WM.& 6T-9I • • • • • • • - • • • • • • • • • • • • • • • • • • • • • • • • • • • ona..I. tI-OT • • • • • • • • • • • • 6-42 .• .• exuax • • . • . • • • • • • • • • • • • • • • • • • • . . • • • • • ...... salaAt ...... • • ...... max c • • ...... •. . • • • • • ...... • • • • • • • croaA z ...... • ...... :. roadt i .• .• ...... • • • • • • • • Inax / Joplin .• .• .• • • WV N .. .W .. N J J ...Co . .. .up= .C1

;VA ','4 44 'A 44 A AN N 'AN AN N AN AN AN N Z.. ...M.N. WOVN WN. V %., 10 . ›...2, 9:1 d TOTALS TOTALS 0 :1- 0 0 0 0 0 co 0 0 co ccl ... v 0

C4o F

pri-

and and

adrenal adrenal

anemias anemias

blood blood

the the alcoholic) alcoholic)

r4 organs

of of

conditions, conditions, diseases diseases P the .1

C.) anemia

unspecified unspecified

of of

disease disease

(except (except

purpuras purpuras

-forming -forming

hyperchromic hyperchromic

diseases diseases

and and

general general

mary mary

blood

glands glands

Other Other

Pernicious Pernicious

Diseases Diseases

Hemorrhagic Hemorrhagic

Pellagra Pellagra

Other Other

Addison's Addison's

Scurvy Scurvy 1 uativaaN a,srf 0 0 0 t, en 01 Co 1.. 73d pazoia,vxuaasi 0'0 0 0 0 W 36M 11 11. F 25 ... 1 ...... 1 1...1. 3 1 3 ... 1 1 2 2 3 1 ...... 74a Leukemia 41 C SM F 75o Other diseases of the spleen 1 W 1 F SF 76a Agranulocytosis 4 o 1M II

F V Chronic poisoning and intosi- 42 cation 0 14 M F I 77c Acute alcoholism 3 W 3 M

F !Waling 77d Chronic alcaolism 31

C 7M 30 F 77e Other and unspecified alco- 1 W 1 M holism rIVIIA 78b Lead poisoning, not specified 7 C 7 M as occupational F 652 M 298 5 .. ... 1 ...... 2... 2 1 4 4 9 15 16 29 44 38 38 52 28 10 .... F 354 2 1 ... 1 ... 1... 3 4 3 3 3 6 9 25 23 45 48 62 53 37 25 .... VI Diseases of the nervous system 918 0 and sense organs 266 M 122 1 ...... 2 1 3 3 5 15 13 19 12 15 12 12 3 3 3.... F 144 3 1 1 ...... 1 1 ... 2 1 3 4 11 12 19 20 14 26 14 9 1 1.... SOLLSIIVIS 1 W 2F 80a Intracranial abscess 3 C 1 F W 2M 80b Other encephalitis (nonepi- F demic) 3 C 1M W 10 M F 81a Simple meningitis 20 C 10 M F 0)- C..rt TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS AGE GROUPS I I

i ri Fi g CI CAUSE Year NUMBER REPORT Red 1

Grand By By Over Years Years Years ■ Years Years Years Years Years Years ... ,...: ri. :,) - A' '‘.■ :-1.

Total Color Sex zs 0 et. 05 Ca Not Years •I■ Years LIST and Years 10-14 85 Age 50-54 55-59 80-84 70-74 75-79 80-84 INTERNATIONAL Under 2 5-9 e, .4, 2. 30-34 35-39 et• en 0 • n

W 11M OF 82 Diseases of the spinal cord (ex- F cept locomotor ataxia and 12 disseminated sclerosis) C 1 M THE 509 M 228 ...... 2 1 1 4 6 11 10 22 37 34 29 44 21 6....

F 281 ...... 2... 2 3 2 4 8 21 19 39 42 45 44 32 18 .... HEALTH 83a Cerebral hemorrhage or effu- 725 Dion (excluding birth injuries) 216 M 96 ...... 1 2 3 12 11 17 9 14 10 11 2 2 2.... F 120 ...... 2 4 11 11 15 19 12 22 13 9 1 1 ....

83b Cerebral embolism and throm- 76 DEPARTMENT—Or bosis C 18M F 83c Cerebral softening 4 W 4 M F W 15 M F 83d Hemiplegia and other paraly- 19 sis of unspecified origin C 4 M

F -1942 84a Mental deficiency (except gen- 2 W 2 M eral paralysis of the insane) F W 1 F 84b Schizophrenia (dementia prae- 5 cox) C 4M 84c Manic-depressive psychosis 1 W 1 F 84d Other mental diseases 1 C 1 M -1 W 6M F 85 Epilepsy 11 C SM F 87b Neuritis (except rheumatic 1 C 1 F and alcoholic) 87c Paralysis agitans (except re- 15 W 15 M suit, of encephalitis) F 87d Disseminated sclerosis 6 W 6 M F W 1 F 87e Other diseases of the nervous 3 system C 2M F

88 Diseases of the organs of vision 1 W 1 F nvauna W 7M 89a Otitis and other diseases of the F ao ear 8 C 1 F W 1M

89b Diseases of the mastoid process 2 rivJAA C 1M 3,056 M 1,734 ...... 1 5 6 9 17 39 54 109 149 184 261 240245 202 132 81 .... F 1,322 1 ...... 1 2 10 7 6 8 19 27 46 69 93 121 164 199 205 179 165 ....

VII Diseases of the circulatory 3,697 0 system 641 M 319 ...... 3 2 3 10 16 27 37 52 36 35 42 30 13 4 9.... F 322 1 ...... 2 4 1 10 17 29 40 42 38 38 34 31 15 11 9 .... I W 2,946 M 1,683 ...... 1 5 6 8 16 39 54 107 146 182 254 232238 195 128 72.... sousuvxs F 1,263 1 ...... 1 2 10 7 6 8 19 27 44 69 90 117 159 193 194 169 147 .... 90-95 Diseases of the heart 3,556 C 610 M 305 ...... 2 2 3 9 16 26 37 50 36 32 41 28 10 4 9.... F 305 ...... 2 4 1 9 16 28 39 40 37 36 34 29 11 10 9 .... W 1 M 90a Chronic rheumatic pericarditis 2 C 1M

F 91a Bacterial endocarditis (acute, 26 subacute or unspecified) C 5 M ...... F TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTAIA AGE GROUPS

Ei I! Year E CAUSE NUMBER 1

By Over Grand By REPORT Years Years Years Years Years Years Years Years Years Y, Years

Total Color Sea Not Years

; Years Specified and LIST Year ! 1 Age Under 75-79 80-84 85 5-9 50-54 60-64 70-74 INTERNATIONAL 02 4:1. 20-24 25-29 CV 30-34 35-39 40-44 v co

91b Other acute or subacute endo- 1 W 1 F carditis OF

28M 16 ...... THE 92a Diseases of the aortic valve F

(without mention of diseases 56 ° of mitral valve or rheumatic fever) F HEALTH

78M 37 ...... 1 1 .. 1 3 1 5 4 2 5 2 4 4 4...... 92b Diseases of the mitra 'valve (whether or not specified as 109 rheumatic) DEPARTMENT 11M 92c Diseases of other and unspeci- F fled valves and chronic endo- 14 carditis specified as rheu- 3 M matic F

92d Diseases of other and unspeci-

fied valves and chronic en- 122 -1942 docarditis, not specified as C 36 M 18 ...... 1 ... 2 1 ... 3 1 2 5 1 1 .. 1 .... rheumatic F W 6M 92e Endocarditis (not specified as F acute, chronic or rheumatic) 7 C IF I 11M F 93a Acute myocarditis (except 17 rheumatic) 6 M F

W 17M ...7

930 Chronic myocarditis and F 0 myocardial degeneration, 20

specified as rheumatic C 3 M 1-•

F t•D 1,698 M 856 ...... 2 4 5 15 33 49 75 120 131 146 122 96 58 .... 93d Chronic myocarditis and F 842 ...... 2 2 1 2 3 10 27 38 59 80 109 127 139 127 116 .... myocardial degeneration, 2,052 0 not specified as rheumatic 354 M 168 ...... 1 1 4 6 14 18 24 22 17 20 23 8 3 7.... F 186 ...... 1 ... 2 11 17 19 21 23 25 25 20 8 7 7.... 1

93e Other myocarditis (not specified as acute, chronic or 71 rheumatic) C 14 M F

W 805 M 596 ...... 2... 3 3 17 28 59 74 87 110 77 63 49 16 8.... 94a Disease of the coronary arteries 893 1 W 25M 17 . 1 4 1 3 4 1 1 1....

F ■-•

94b Angina pectoris 28

C 3M : F • : • ...... • - •. •... W 14M 95a Functional diseases of the F heart (without mention of 15 organic lesion) C 1 M

95b Other diseases of the heart, 57 specified as rheumatic C 11 M F

F 95c Other diseases of the heart, 66 not specified as rheumatic F W SM F 96 Aneurysen (except of the heart 12 and aorta) C 4 M F TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS .1 g AGE GROUPS I I Re

OS 03 Year m •!.Z CAUSE 4.14 Grand By By 1 Over Years r.., Years '1'. Years ''' Years Years 0• E, GI t Total Color Sex ti '7i m m Z a 11 -,t■ ; Years OD rn and Years , to ICI 2 71 p Under 3 85 20-24 70-74 75-79 el, .4 30-34 40-44

F 97 Arteriosclerosis (except coro- 97 nary or renal sclerosis) . C F W 7M F 98 Gangrene 12 C SM W 4M F ...... 99 Other diseases of the arteries 5 C 1M 100a Diseases of the veins, varices 3 W 3 M W 6M F 100b Other diseases of the veins 8 - • •"-" ' • •• • •" • C 2F W 2M 102 High blood pressure (idio- 4 pathic) C 2M F 491 M 271 32 6 4 4 1 3 ... 3 2 3 7 11 22 18 17 28 21 18 25 15 14 17 .... F 220 33 4 1 ...... 4 1 3 6 2 8 2 9 7 7 7 11 24 24 18 23 26 .... VIII Diseases of the

respiratory 786 O system 295 M 162 24 3 2 3... 1 ...... 4 7 7 10 18 21 20 11 6 9 9 4 1 2 .... F 133 33 3 2...... 1 1 6 2 4 4 6 13 16 7 11 5 4 7 5 3 .... I 104a Diseases of the nasal fossae 1 W 1 M 104b Diseases of the accessory 3 W 3 M sinuses 105 Diseases of the larynx 1 C 1 M W 8M F 106a Bronchitis, acute 12 C 4M F W 14M F 106b Bronchitis, chronic 15 C 1 F 107c Bronchitis, unspecified 3 W 3 M F

W 433 M 232 27 5 3 4 1 1 ... 2 1 2 5 10 19 14 13 27 19 14 22 14 13 16 .... a F 201 33 4 1 ...... 3 1 3 6 2 6 2 8 6 6 7 8 21 22 16 22 24 .... 107— Pneumonia, all forms 707 C 109 274M 150 23 3 2 1 ... 1 ...... 3 7 7 9 17 20 18 10 5 8 9 4 1 2.... Vall11 F 124 31 3 1 ...... 1 1 6 2 4 4 5 12 16 5 11 4 3 7 5 3.... 11 W 243M 118 21 2 3 4... 1 ...... 1 6 5 4 8 4 8 18 12 7 14 .... F 125 25 3 1 ...... 2...... 2 1 2 1 5 3 4 4 3 11 15 7 13 23 .... 30 107 Bronchopneumonia (including 373 capillary bronchitis) C 130 M 69 21 2 2 1 ... 1 ...... 3 2 6 8 5 2 2 3 7 3 1 ......

W 187 M 112 6 3 ...... 1 ...... 1 1 2 5 9 13 9 8 19 15 6 4 2 6 2.... TYLLIA F 7581...... 1 1 3 4 1 4 1 3 3 2 3 5 10 6 9 9 1.... 108 Lobar pneumonia 331 C 144M 8121...... 3 7 4 7 11 12 13 8 3 5 2 1 ... 2.... F 63 4 ... 1 ...... 1 1 4 2 4 2 5 10 10 3 8 1 2 3 2...... 109 Pneumonia (unspecified) 3 W 3 M F

110a Pleurisy (not specified as tu- 1 W 1 M SOLLSLLVIS berculosis), empyema 110b Other and unspecified forms 2 W 2 M W 4M Illb Hemorrhagic infarction, acute 8 edema of the lungs C 4 M F W 2M F 111c Chronic and unspecified con- 5 gestion of the lungs C 3 Id F TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS AGE GROUPS I I I • ,„ 5;;; Year 5 555 55 l./ALTSE ZI) CD 0., NUMBER

Grand By By 1

,... Years Years ,.. ,t, 'il. A A A A A A A Years A A Total Color Sex c el c3 D., Not el, CI el, CI C/ •S Ca :it. ICO Over CP CU 1-1 .-I 0.1 Cs1 Years LIST Specified A Years INTERNATIONAL Under 2 30-34 50-M 70-74 85 and Age

W 3M

F mioaau 112 Asthma 6 -• - • - • •• • • - • • • • • •• •• C 1 F ao 113 Pulmonary emphysema 3 W 3 M F aIU. 114b Other and unspecified forma 1 C 1 M of pneumoconiosis 114o Gangrene of lung 2 W 2 M W 7M F ...... ILL'IVall 114d Abscess of lung 12 C 3M F W 3M 114e Other and unspecified diseases F of the respiratory system 4 C 1M W 393 M 248 48 1 1 ...... 1 1 2 4 4 5 16 9 13 25 32 27 24 16 10 9...... F 145 20... 3... 1 ... 3 3 2 4 2 5 9 9 11 11 14 12 16 5 7 8.... IX Diseases of the digestive sys- 512 tern C 119M 69 22 2...... 1 ...... 3 2 4 1 6 8 2 8 3 6... 1 ...... F 50 14 2 1 1 ... 3 1 2 1 3 1 4 2 6 3 4 1 1 ...... 3t6I--INaPallYclaa W 1 F 115a Diseases of the teeth and gums 2 C 1 F 4M F 115b Septic sore 8

throat 0 4M F ,

II W 3M F 115c Diseases of the pharynx and 6 tonsils C 3M 1 1 F 116 Diseases of the esophagus 1 W 1 F I

W 35M NJ

F C.5 ...... 117a Ulcer of the stomach 45

C 10 M c0 F ' W 12M F •• • • - • •• - • • • • - • 11713 Ulcer of the duodenum 13 C 1 F 118 Other diseases of the stomach 7 W 7 M (except cancer) F

119a Diarrhea and enteritis (under 102 2 years of age) F W 6M F 120a Diarrhea and enteritis(2 years 9 of age and over) C 3 M F W 3M 120b Ulceration of the i nteatines F (except duodenum) 4 C IF

F 121 Appendicitis 37 C 11M F

122a Hernia 41 C 2M F

ts,

Specified Specified

Not Not Age Age

Over Over and and

Years Years 85 85

- 70 74 74 Years Years I I

L'•

7.4

7,"

-1942

GROUPS

AGE

°' 17

AGE

AND

■T:

AAAAAAAAA

'C'

COLOR

:It

10-14 10-14 Years Years I I

SEX,

cl`

I,'

3 3 Years Years

CAUSE,

8—Continued

''',

NO.

1 1 Year Year

Under Under 1 1 Year Year

TABLE

CLASSIFIED

Sex

F F

F M

4 4M

20M

DEATHS

TOTALS

Color

C C

15 73

Total

Grand

RESIDENT

the

with

without

liver

intestines

liver,

the

liver,

atrophy

the

alcoholism;

alcoholism

the

-puerperal)

CAUSE

obstruction

calculi

yellow

(non

diseases

mention

mention liver

Acute

Other Cirrhosis

Cirrhosis Biliary

Other

Intestinal

Lim Lim En En Nolan

-- INTERNATIONAL INTERNATIONAL

125a 126

124b 125b

124a

123

122b 127a Cholecystitis (without men- 8 W tion of biliary calculus) F W SF 127b Other diseases of the gallblad- 6 der and billiary ducts C 1 M W 8M 128 Diseases of the pancreas (ea- F cept diabetes mellitus) 10 C 2M 129 Peritonitis (cause not stated) 1 W 1 F W 763 M 375 1 1 ... 1 ...... 1 2 3 4 12 8 16 25 35 40 59 50 47 51 19 .... F 388 ...... ,, ...... 1.. . 1 1 1 1 6 16 8 25 29 44 58 60 57 53 27 X Diseases of the genito-urinary 1,091 system C 328 M 157 ...... 3 1 2 1 2 6 21 11 22 15 21 23 11 8 5 5.... 5 F 171 ...... 1 ... 1 ...... 2 2 6 11 14 13 24 18 21 25 18 8 5 2.... ry Pa. W 692 M 324 1 1 ... 1 ...... 1 2 2 4 8 8 16 23 31 36 49 40 42 43 16 .... F 368 ...... 1 ... 1 ... 1 1 6 14 7 22 26 41 55 58 55 53 27 .... 130— Nephritis, all forms 999 0 132 C 307 M 144 ...... 3 1 2 1 1 6 20 9 21 11 20 20 10 8 5 5 .... 11 F 163 ...... 1 ... 1 ...... 1 1 1 9 14 12 23 17 21 25 18 8 5 2.... " W 13M F , 130 Acute nephritis 21 tl C SM F W 588 M 280 ...... 1 1 5 5 12 18 30 32 47 38 39 39 13 .... F 308 ...... 1 ... 1 ... 1 1 5 12 5 15 20 31 48 48 49 46 25 .... 1..4 131a Chronic nephritis, arterio- 836 ro sclerotic kidney C 248 M 116 ...... 1 ... 1 1 2 5 14 5 15 11 18 17 9 8 5 4.... F 132 ...... 1 1 4 8 11 10 21 14 17 19 14 6 4 2.... ?c W 89M 37 ...... 2 1 1 3 3 4 4 1 4 2 2 3 4 3.... 131b Other chronic nephritis 138

W 2F 132 Nephritis unspecified (10 years 4 of age and over) C 2 F W 9M F 133a Pyelitis, pyelonephritis, and 14 pyelocystitis C 5 M F TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942 —4

TOTALS AGE GROUPS I I A 0 1 I I .4 0 Z 0

Year 5 5 5 CsusE t,.z 1 Grand By By Over Years Years Years A A A A Years A A A A A A

1 F. Total Color Sex .,. Not g 4. 5 5 .5 Years Years Specified and

...... 1 Year z A A A 1 2 I 953 1 II:11 1 85 Age Under 5-9 60-84

,-. 30-34 35-39 ._. C4 013 .4. .-I CI C•1 mr 45-49 :IC' up t• is oo I W 9M 133b Other diseases of the kidneys F and ureters 10 aamaau C 1M W 10 M ao F 134a Calculi of the kidneys and 12 ureters C 2M ara F 134b Calculi of the bladder 1 W 1 M 135a Diseases of the urinary blad- 2 W 2 M der, cystitis =wall 135b Other diseases of the bladder 1 C 1 M W 1 F 136a Stricture of the urethra 2 C 1M W 2M 136b Other diseases of the urethra 4 (except calculus) C 2 M

137a Hypertrophy of the prostate 37 C 5 M

137b Other diseases of the prostate 4 W 4 M gt6I--ssalumva11a W 1 F 139a Diseases of the ovaries, fallop- 4 ian tubes, and parametria C 3 F 139b Diseases of the uterus 1 C 1 F W 18 F XI Diseases of pregnancy, child- 35 birth, and the puerperium C 17 F 140a Abortion with mention of 1 W 1 F pyelitis W IF 140b Abortion with mention of 6 infection C 3F 140c Abortion, sell-induced 1 C 1 F 140d Criminal abortion with men- 3 C 3 F tion of infection 142b Ectopic gestation, without 1 C 1 F mention of infection 144a Eclampsia of pregnancy 1 W 1 F 144d Other toxenias of pregnancy 1 C 1 F 145 Other diseases and accidents of pregnancy (death before 1 W 1 F

delivery) IlVaUlla 146a Placenta praevia 1 C 1 F ._... ,r10 146b Premature separation of pin- 1 C 1 F cents,(with childbirth) 146c Other and unspecified hemor- W 4 F

rhages of childbirth and the 5 rIVILIA puerperium C 1 F W 2F 147b General or local puerperal in- 4 fection (except pyelitis) C 2 F 1470 Puerperal thrombophlebitis 1 W 1 F

147d Puerperal embolism and Bud- 2 W 2 F SOLLSaVIS den death 148a Puerperal eclampsia 1 C 1 F 1 149a Laceration, rupture, or other trauma of pelvic organs and 1 W 1 F tissue W 2F 149b Other specified conditions of 3 childbirth C 1 F 150c Other and unspecified conditions of childbirth and 1 C 1 F puerperium TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942 00

TOTALS AGE GROUPS I I I

CAUSE Year 1 i F. E ra E. Fg rg I F. rig NUMBER

Grand By By 1 Over Years Years Years Ili A A A Atm lcA, ',1,A ,. .7nA .A,, ,z ,A:, , Years Total Color Sex E ›.■ •14 Not

g Years c:. Years LIST Specified and Years INTERNATIONAL Under 10-14 3 5-9 25-29 85 35-39 70-74 Age

I W 6M F XII Diseases of the skin and c,ellu- 9 lar tissue C 3M F W 4M 152 Phlegmon and acute abscess 6 C 2F W 2M 1 ...... 153 Other diseases of the skin and F cellular tissue 3 C 1M W 7M F XIII Diseases of the bone and 12 organs of movement C 5 M F ...... — — 154a Osteomyelitis, acute 1 C 1 M W 1 M 154b Osteomyelitis, chronic or un- 2 specified C 1 M 155 Other diseases of the bones 4 W 4 M (except tuberculosis) F 156a Diseases of the joints (except tuberculosis and rheuma- 1 W 1 F tism) _ W 1M 156b Diseases of other and unspeci- 4 fled organs of movement C 3 M F W 83M 535011.1. F 30291. XIV Congenital malformations 103 C 20M 12 9 1 ...... F W 13M F 157a Congenital hydrocephalus 14 C 1M 15713 Spinabufida and meningocele 10 W 10 M F 1570 Anencephalus 3 W 3 M F 157d Other congenital malformations of the central nervous 1 C 1 M ...... •.. • •. .• ...... system nvaung

F o 157e Congenital malformations of 52 the heart C 14 M F W 11M

F TVZIA 157g Congenital malformations of 14 the digestive system C 3 M F 157h Congenital malformations of 2 W 2 M the genito-urinary system F W 6M 157m Other and unspecified con- F genital malformations 7 C 1M

XV Diseases peculiar to the first 365 year of life

4M F 158 Congenital debility (cause not stated) 4M F TABLE NO. 8—Continued RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942 00,

Tcrxxxs AGE GROUPS I

4 sel eS OS fif Year oi f. O 0,

NUMBER CAUSE Grand By By 1 Over Years Years Years Years Years Years i 4 r. v. ...1 -'4' `.'-', 1.4' '-.) Years ?I: Total Color Sex ca co 0 CS p., .14 Not REPORT Years LIST and ".' P•'4 :'' CA, g 1 Specified :143 75 INTERNATIONAL Under 30-34 20-24 40-44 85 60-64 80-84 65-69 75-79 Age

--.

159 Premature birth (cause not 219 OF stated) F THE

160a Injury at birth, intracranial 53 HEALTH or spinal hemorrhage C F . _ - F 160c Other injury at birth 18 C 6M DEPARTMENT F

F 161a Asphyxia (cause not sped- 46 fled), atelectasia C 12 AI F 161b Infection of the umbilicus; pemphigus and other infec- 1 W 1 F -1942 tions (nonsyphilitic) W 11 NI F 161c Other specified diseases pecu- 20 liar to the first year of life C 9 M F — — — XVI Senility 8 W 8 M F 162a Senility with mention of senile 1 W 1 F dementia 162b Senility without mention of 7 W 7 M senile dementia F W 627 M 427 10 2 2 1 4 13 10 17 30 39 35 33 23 38 33 24 38 27 23 12 10 3.... F 200 7 1 1 2 1 3 3 6 4 4 10 13 8 6 7 6 13 18 22 10 24 20 1 XVII Violent or accidental deaths 872 C 245 M 202 1 ... 2 2 .. 6 4 15 27 26 28 21 22 13 14 10 3 4 3 1 ...... F 43 3 1 1 1 I1 2 ... 6 7 3 3 4 ...... 2 2 3 2 1 ...... W 103M 73 ...... 1 1 2 4 9 9 7 7 6 8 8 5 6 ...... 163— 164 Suicide 109 C 6M 163a Suicide by arsenic and corn- 4 W 4 M pounds 163b Suicide by barbiturie acid and 2 W 2 F deritives 163d Suicide by mercury and corn- 3 W 3 M pounds F IlValMa or liquid 2 W 2

163g Suicide by other solid F 30 poisons 163h Suicide by illuminating gas F

163m Suicide by motor vehicle ex- 6 W 6 M rIVIIA haust gas F

164a Suicide by hanging or stran- F gulation 22 C 2M

W 4M SOLLSIIVIS 164b Suicide by drowning 5 C 1 M

164c Suicide by firearms and ex- F plosives 23 C 1M 164d Suicide by cutting or piercing 2 W 2 M instruments - W 6M 164e Suicide by jumping from high F places 8 C 2M TABLE NO. 8—Continued • 00 RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942

TOTALS AGE GROUPS

Year il CAUSE E. ti NTJIIIIIER Grand By By 1 Over Years Years Years Years Years Years Years Years Years Years Years Years Years Total Color Sex REPORT Fi ca Not

'- Years Specified LIST and Year Years Years : 1 Under 15-19 INTERNATIONAL 3 4 20-24 75-79 80-84 85 N 25-29 30-34 35-39 40-44 45-49 50-54 55-69 60-64 70-74 Age I ,

F OF 165- Homicide • 118 168 C 100 M 86 ...... 1 5 10 19 16 13 10 4 3 3 1 ... 1 ...... F THE W 3M F 166 Homicide by firearms 52 HEALTH F W SM F

167 Homicide by cutting or pierc- 47 DEPARTMENT ing instruments F W 10 M F 168 Homicide by other means 19 C 9 M F

W 501 M 336 9 2 2 1 4 13 8 15 26 34 24 21 15 31 23 14 30 22 17 12 10 3.... -1942 F 165 7 1 1 2 1 3 3 6 3 4 7 4 4 3 4 5 12 12 20 19 23 20 1 169- Fatal accidents 634 195 C 133 M 104 1 ... 2 2... 6 3 10 15 6 10 8 11 9 10 6 1 2 2...... F 29 3 1 1 1 1 2 1 ... 2 4 ... 3 1 ...... 1 2 3 2 1 ...... • F 169 Railway accidents (except col- 23 lisions with motor vehicles) C 8 M F 170a Collisions between antomo- 3 W 3 M biles and trains F W 3M 170b Collisions between automo- 5 biles and streetcars C 2 M W 126M 97 ...... 1 3 8 4 4 6 9 4 8 2 7 7 7 9 8 6 1 2 1.... 1700 Automobile accidents (except collisions with trains or 163 streetcars) C 37M 31 ...... 2 2 3 3 1 ... 4 5 1 4 2 1 2 1 ...... F 170c1 Motorcycle accidents (except 7 W 7 M collisions with automobiles) F

171a Streetcar accidents (except F collisions with trains or 22 motor vehicles) C 1 M 172 Water transport accidents 7 W 7 M W SM 173 Air-transport accidents 9 C IM 175a Accidents involving agricul- 1 W 1 M tural maehinery and vehicles W SM 176 Other accidents involving ma- 13 chinery C 5 M 177 Food poisoning 1 W 1 M 178a Accidental absorption of illuminating gas F W IF 179a Accidental poisoning by arse- 2 nie and compounds C 1 M 179d Accidental poisoning by mer- 1 W 1 F cury and compounds 179g Accidental poisoning by lye 1 W 1 F and potash 179m Accidental poisoning by other 2 W 2 M and unspecified substances TABLE NO. 8—Continued b.5 CO RESIDENT DEATHS CLASSIFIED BY CAUSE, SEX, COLOR AND AGE-1942 14=•• TOTALS AGE GBOLTPS

: a,e : 4 4 4 4 4 : E CAUSE Year E E NUMBER 1

Grand By By Over Years Years Years . 1.2 E Le '1?1 '''-4 Years 74 ›Ti >4.: ›Ti ''.I .:L '.14 '.Il

Total Color Sex a p.4 •,:s a, Not Years Specified and LIST '121.4 ›''T. Years ''''4 .-I' !2 1 2..g' 2!2 Under 3 80-84 70-74 85 Age 20-24 25-29 INTERNATIONAL CI CQ <14 et, .5 .0 CD CO lt--e4 H 15M F 180 Conflagration 24 9M I W 13M F 181 Accidental burns (except con- 21 flagration) C 8 M F W 9M F 33 182 Accidental mechanical suffo- 12 cation C 3M F W 47M 40 ... 1 1 ... 1 2 2 3 4 6 4 1 3 5 4 1 1 ...... 1 ...... • - F 183 Accidental drowning 77 F W 7M 184 Accidental injury by firearms 10 C 3M 185 Accidental injury by cutting 1 C 1 F or piercing instruments W 157M 75 ...... 1 1 2 6 3 5 8 7 3 6 7 10 7 8 1.... 186a Accidental injury by fall 176 F 186b Accidental injury by crushing 5 W 5 M 188 Injury by animals (not specified as venomous or occur- 1 W ring in the course of agricultural and forestry operations) W 191 Excessive heat 2 C 1M 193 Accidents due to electric cur- 3 W 3 M rent (except lightning) W 12M 195d Other accidents due to obstruc- F tion, suffocation or puncture 15 by ingested objects C 3 M F

195e Other and unspecified acci- F dents 12 IlVallaa C 1M 196 Death of military personnel 1 W 1 M 30 during operations of war W 41.1 197 Deaths of civilians due to 6 operations of war C 2 M riv,LIA 198 Legal executions 4 C 4 M XVIII Ill-defined and unknown causes 7 W 7 M I' 199 Sudden death 1 W 1 M sousia,vIs 200a Ill-defined cause 2 W 2 M F 200c Unknown of unspecified cause 4 W 4 M

NorE:—Deaths by color, include the following non-Negro races Tuberculosis of the respiratory system without mention of occupational diseases of the lungs-1 male Chinese,67 years of age;1 male Filipino,49 years of age. Cancer of the tongue-1 male Chinese, 73 years of age. Cancer of the kidney-1 male American Indian, 46 years of age. Cancer of other and unspecified organs-1 male Siamese, 29 years of age. Cerebral hemorrhage or effusion-1 male Chinese, 58 years of age. Chronic myearditis and myocardial degeneration, not specified as rheumatic-2 male Chinese, 70 years of age. Bronchopneumonia (including capillary bronchitis)-1 male Chinese, 69 years of age. 00 Other diseases of the liver-1 male Chinese, 48 years of age. 280 REPORT OP THE HEALTH DEPA.RTMENT-1942

TABLE NO. 9 RECORDED AND RESIDENT DEATHS AND DEATH RATES PER 100,000 POPULATION' FOR CERTAIN CAUSES AND GROUP OF CAUSES, CLASSIFIED BY COLOR-1942

RECORDED RESIDENT

RATE PER RATE PER NUMBER 100,000 NUMBER 100,000 Cx.usu POPULATION POPULATION MI 1 7 74 g § -a A t. 1 ,..9 t. • A '? 0 3

AL CAUSE 11,803 8,976 2,827 12.6 11.9 15.5 11,3478,397 2,950 12.1 11.1 16.2

Typhoid fever (1) 3 3 .. 0.3 0.4 .. 1 1 .. 0.1 0.1 .. Meningoeoccus meningitis (6) 37 28 9 4.0 3.7 4.9 31 23 8 3.3 3.0 4.4 Scarlet fever (8) Whooping cough (9) 11 5 6 1.2 0.7 3.3 9 4 5 1.0 0.5 2.7 Diphtheria (10) 2 1 1 0.2 0.1 0.5 2 1 1 0.2 0.1 0.5

Erysipelas (11) 4 4 .. 0.4 0.5 .. 4 4 .. 0.4 0.5 .. Tetanus (12) 7 3 4 0.7 0.4 2.2 7 3 4 0.7 0.4 2.2 Tuberculosis, respiratory system (13) 509 249 260 64.4 33.0 143.2 740 354 305 80.0 46.0 217.5 Tuberculosis, other forms (14-22) 61 27 34 8.5 3.6 18.7 61 20 41 6.5 2.7 22.6 Gonococcus infection (25) 12 1 11 1.3 0.1 6.1 12 1 11 1.3 0.1 6.1

Dysentery (27) 6 4 2 0.6 0.5 1.1 6 4 2 0.6 0.5 1.1 Syphilis (30) 140 74 75 15.9 9.8 41.3 201 94 107 21.5 12.5 58.9 Influenza (33) 62 35 27 6.6 4.6 14.9 60 34 26 6.4 4.5 14.3 Smallpox (34) Measles (35) 1 .. 1 0.1 .. 0.5 1 .. 1 0.1 .. 0.5

Acute poliomyelitis (36) infectious encephalitis (37a) ...... Rocky Mountain spotted fever (30e) 6 5 1 0.6 0.7 0.5 1 1 .. 0.1 0.1 .. Diller infectious and parasitic diseases 34 20 8 3.6 3.4 4.4 24 16 8 2.6 2.1 4.4

Dancer and other malignant tumors (45-55) 1,482 1,277 205 158.3 169.3 112.9 1,257 1,071 186 134.3 142.0 102.4 rumors, nonmalignant (56, 57) 61 45 16 6.5 6.0 8.8 45 28 17 4.8 3.7 9.4 Thronie rheumatism and gout (59, 60) 14 13 1 1.5 1.7 0.5 12 11 1 1.3 1.5 0.5 Diabetes mellitus (61) 320 274 46 34.2 36.3 25.3 290 240 41 31.0 33.0 22.6 Pellagra (69) 3 2 1 0.3 0.3 0.5 3 2 1 0.3 0.3 0.5

Alcoholism, acute and chronic (77) 38 30 8 4.1 4.0 4.4 35 28 7 3.7 3.7 3.9 Dther general diseases and chronic poisonings 150 113 37 18.0 15.0 20.4 121 86 35 12.0 11.4 19.3 Derebral hemorrhage, cerebral embolism and thrombosis (83) 825 504 231 88.1 78.7 127.2 824 586 238 88.0 77.7 131.1 )ther diseases of nervous system 112 85 27 12.0 11.3 14.9 94 66 28 10.0 8.7 15.4

*Except that death rates for all causes are per 1,000 population and for puerperal causes are per 1,000 live births. BUREAU OF VITAL STATISTICS 287

TABLE NO. 9-Continued RECORDED AND RESIDENT DEATHS AND DEATH RATES PER 100,000 POPULATION• FOR CERTAIN CAUSES AND GROUP OF CAUSES, CLASSIFIED BY COLOR-1942

RECORDED RESIDENT

RATE PER RATE PER NUMBER 100,000 NUMBER 100,000 CAUSE POPULATION POPULATION

i 73 73 A -0i A Colored Colored Colored Colored Total '.? E-. White '4 4 g

Diseases of the heart (00-95) 3,546 2,961 585 378.8 392.5 322.1 3,556 2,946 610 379.9 390.5 335.9 Other diseases of the circulatory system (96-103) 128 105 23 13.7 13.9 12.7 141 110 31 15.1 14.6 17.1 Bronchitis (106) 33 28 5 3.5 3.7 2.7 30 25 5 3.2 3.3 2.7 Pneumonia (107-109) .748 469 279 79.0 62.2 153.6 707 433 274 75.5 57.4 150.9 Other diseases of the respiratory system 62 44 18 6.6 5.8 9.9 49 33 16 5.2 4.4 8.8

Diarrhea and enteritis Under two years of age (119). 128 84 44 13.7 11.1 24.2 102 64 38 10.9 8.5 20.9 Two years and over (120) 18 14 4 1.9 1.9 2.2 13 9 4 1.4 1.2 2.2 Appendicitis (121) 51 38 13 5.4 5.0 7.1 37 26 11 3.9 3.4 6.1 Hernia, intestinal obstruction (122) 119 06 23 12.7 12.7 12.7 96 74 22 10.3 9.8 12.1 Cirrhosis of the liver (124) 120 108 12 12.8 14.3 6.6 117 105 12 12.5 13.9 6.6 Other diseases of the digestive system 185 149 36 19.8 19.7 19.8 147 115 32 15.7 15.2 17.6

Nephritis (130-132) 1,019 703 316 108.9 93.2 174.0 099 692 307 106.7 01.7 169.1 Diseases of the genito-urinary system (133-139) 126 102 24 13.5 13.5 13.2 92 71 21 9.8 9.4 11.6 Puerperal septicemia (140, 147). 26 15 11 1.1 0.8 2.2 18 9 . 9 0.0 0.6 1.0 Other puerperal causes (141-146, 148-150) 24 13 11 1.0 0.7 2.2 17 9 8 0.9 0.6 1.7 Diseases of the skin, bones, etc. (151-156) 26 15 11 2.8 2.0 6.1 21 13 8 2.2 1.7 4.4

Congenital malformations (157). 145 122 23 15.5 16.2 12.7 103 83 20 11.0 11.0 11.0 Congenital debility, premature birth and other diseases of early infancy (158-161) 467 332 135 49.9 44.0 74.3 365 251 114 39.0 33.3 62.8 Senility (162) 7 7 .. 0.7 0.9 .. 8 8 .. 0.9 1.1 .. Suicides (163, 164) 119 113 6 12.7 15.0 3.3 109 103 6 11.6 13.7 3.3 Homicides (165-168) 117 14 103 12,5 1.9 56.7 118 18 100 12.6 2.4 55.1 Other violent and accidental deaths (169-198) Home accidents 228 193 35 24.3 25.6 10.3 219 182 37 23.4 24.1 20.4 Occupational accidents 79 67 12 8.4 8.9 6.6 93 75 18 9.9 9.9 9,9 Automobile accidents 222 180 42 23.7 23.9 23.1 177 138 39 18.9 18.3 21.5 Other public accidents 138 100 38 15.8 14.6 20.9 149 109 40 15.0 14.4 22.0 Other violent deaths 11 4 7 1.2 0.5 3.9 7 2 5 0.7 0.3 2.7 Cause not specified or ill-defined (199-200) 2 2 .. 0.2 0.3 .. 7 7 .. 0.7 0.9 ..

•Except that death rates for all causes are per 1,000 population and for puerperal causes are per 1,000 live births. TABL E NO. 10 ALLOCATION OF DEATHS BY COLOR AND CAUSE OF DEATH ACCORDING TO PLACE OF DEATH AND PLACE OF RESIDENCE, BALTIMORE-1942 11 BALTIMORE RESIDENTS TOTAL RESIDENTS OF DYING ELSEWHERE TOTAL RECORDED RESIDENT CAUSE DEATHS DEATHS No. COUNTIMS OF OTHER COUNTIES OF OTHER BALTIMORE •,.AIARYLA_ND r STATES MARYLAND STATES REPORT LIST White Cord White Col'd White White Cord White Col'd White Cord

INTERNATIONAL White Cord Cord ALL Ceusrs* 8,976 2,827 7,717 2,656 895 149 364 22 562 269 118 25 8,397 2,950

I-INFECTIOUS AND PARASITIC DISEASES OF 1 Typhoid fever 3 .. 1 . 2 ...... 1 ..

2 Paratyphoid fever 1 1 THE 6 Meningococcus meningitis 28 9 ii 8 5 1 ...... •. — • • ii 8 9 Whooping cough 5 6 4 5 1 1 •. •. • • •. •• • • 4 5 10 Diphtheria 1 1 1 1 1 11 Erysipelas 4 .. 4 - • •• • • •• • • • • • • • • • • 4 .. HEALTH 12 Tetanus 3 4 3 4 ...... 3 4 13b Tuberculosis of the respiratory system 249 260 231 249 ii ..94.. 2 109 140 14 5 354 394 13c Tuberculosis of the respiratory system,site unspecified ...... 1 .. . 1 14 Tuberculosis of the meninges and central nervous system 11 13 6 12 3 1 1 1 7 13 15 Tuberculosis of the intestines and peritoneum 2 7 2 i .. .. 2 10 DEPARTMENT 18 Tuberculosis of the vertebral column 6 4 3 4 i .. i .. .. 3 5 17 Tuberculosis of bones and joints (except vertebral column) _ 2 2(b) 2 2 3 19 Tuberculosis of the lymphatic system 1 .,. 2 20 Tuberculosis of the genito-urinary system 3 2 3 1 ...... i 1 21b Tuberculosis of other organs 2 3 1 3 .. .. 1 ...... 1 3 22a Acute (generalized) miliary tuberculosis 2 . 2 ...... 1 1 3 22b Other and unspecified generalized tuberculosis 1 .. 1 1 5 1 24a Septicemia (nonpuerperal) 6 1 4 ..i. i i. .. i .. .. -. -1942 25 Gonococcus infection 1 11 1 11 ...... 1 11 Dysentery 27a Bacillary 2 1 2 1 ...... 2 1 27b Amebic 1 1 1 • • - • • • • • • • 1 1 27c Other and unspecified forms of dysentery 1 .. 1 • • • • • • • • • • • • • • • • • • 1 28c Malignant tertian (estiro-autumnal) malaria 1 .. Syphilis 30a Locomotor ataxia (Tabes dorsalis) 7 2 7 1 ... .. 7 3 30b General paralysis of the insane 7 2 5 2 i .. i .. o 28 1 .. 26 30 30c Other syphilis of the central nervous system 7 7 7 7 ...... 7 30d Aneurysm of the aorta 35 24 30 23 3 1 2 ...... 30 23 30e Other syphilis of the circulatory system 12 20 10 20 2 ...... 1 1 11 24 30f Congenital syphilis 2 10 .. 8 2 2 ...... 8 30g Other and unspecified forms of syphilis 4 10 3 9 1 1 • • •. 3 3 .. .. 6 12 Influenza 33a With respiratory complications specified 23 15 21 15 2 1 22 15 33b Without respiratory complications specified 12 - 12 12 11 •i 12 11 35 Measles 1 1 1

370 Encephalitis lethargies (unqualified) 2 • • 2 2 38f 1 •. •• • i 39c Rocky Mountain spotted fever 5 1 •i .• 4 •i 1 43 Mycoses 6 1 3 2 1 1 3 44 Hodgkin's disease 12 3 7 •a 1 4 •i 7 .4 II—Ce.weva ALND OTHER TErmons Cancer of the buccal cavity and pharynx

45a Lip 5 2 • • 1 2 2 • • 45b Tongue 10 •i 9 1 1 9 1 Mouth

45e • 5 3 4 3 • 1 4 3 Jawbone 45d 3 1 2 1 • • 1 2 1 45e Unspecified parts of buccal cavity 1 1 1 1 451 Pharynx 12 2 11 •i • • 1 1 Ii •i Cancer of the digestive organs and peritoneum 46a Esophagus 27 14 18 12 3 2 6 18 12 46b Stomach 176 149 36 32 15 4 12 *i 1 154 32 aVallrla 46c Duodenum 3 3 3 463 Rectum and anus 84 15 63 15 15 1 64 15 46c Intestines (except duodenum and rectum) 128 8 109 8 13 6 2 111 8 JO 46f Liver and biliary passages 67 10 58 10 8 1 2 80 10 46g Pancreas 55 7 45 4 8 2 1 1 46 4 46h Mesentery and peritoneum 4 2 1 1 2 46m Other and unspecified sites 9 •i 7 2 7 •i IVIIA

Cancer of the respiratory system r 47a Larynx 33 1 27 1 3 3 27 1 47c Bronchus 34 5 22 5 9 3 1 23 5 47d Lung 67 8 55 2 10 3 58 8 47e Pleura 2 2 • • 2 471 Mediastinum and unspecified sites 5 •i 4 1 5 Cancer of the uterus 48a Cervix 49 12 44 12 4 1 2 1 46 13 48b Other and unspecified sites 70 11 61 11 5 4 3 64 11 Cancer of other female genital organs gOLLSTIVIS 49a Ovary 33 4 27 4 1 1 28 4 490 Vagina 1 1 1 49d Vulva 3 3 'a 3 49e Other and unspecified sites 1- 1 1 50 Cancer of the breast 120 18 106 17 io • 1 5 111 17 Cancer of the male genital organs 51a Scrotum 1 1 • • 51b Prostate 51 8 44 •fi • 3 3 3 1 1 ia •6 51c Testes 4 3 1 3 51d Penis 1 •i •i 1 2 Cancer of the urinary organs (male and female) 52a Kidney 21 15 4 2 1 4 1 16 4 52b Bladder 54 9 41 8 1 5 42 8 00 c.C) * There are no deaths from causes not listed in this table. TABLE NO. 10—Continued t.D c.0 ALLOCATION OF DEATHS BY COLOR AND CAUSE OF DEATH ACCORDING TO PLACE OF DEATH AND PLACE OF RESIDENCE, BALTIMORE-1942

A BALTIMORE RESIDENTS ! RESIDENTS OF N TOTAL DYING ELSEWHERE TOTAL 26 RECORDED RESIDENT CAUSE DEATHS DEATHS t4Z COUNTIES OF OTHER COUNTIES OF OTHER REPORT Z E., BALTIMORE g fp. MARYLAND STATES MARYLAND STATES

El-4 White Col'd White Cord White Cord White Col'd White Col'd White Cord White Cord

11—CANCER AND OTHER Tumons—Cont.

53 Cancer of the skin (except vulva and scrotum) 20 1 14 1 5 .. 1 .. 1 OF Cancer of the brain and other parts of the central nervous system THE Ma Glioma 11 3 5 2 3 1 3 • - • • • - • • • • 5 2 Mb Other and unspecified cancers 36 2 16 2 2 Cancer of other and unspecified organs

gland HEALTH 55a Adrenal • 1 • • • • • • 1 • • (except jawbone and accessory sinuses) 7 1 Mb Bone 6 1 1 - - - - • • • • - • 7 1 Mc Thyroid gland 1 1 1 1 ...... 1 1 cavity and accessory 2 1 Md Nasal sinuses 1 2 1 .—• - - • - 1 - - • • • • 3 55e Other and unspecified organs 62 10 52 8 5 1 5 1 ...... 52 8 Nonmalignant tumors 6 2 5 2 1 1 2 56a Ovary • • 6 • • • • • • • • • • DEPARTMENT 56b Uterus 9 7 3 7 6 3 7 • • • • • • • • • • • • 56e Other female genital organs ...... 1 ...... 1 .. 56d Brain and other parts of the central nervous system 13 3 6 3 4 3 9 3 " Me Other and unspecified nature 11 1 ,5 1 4 5 1 '• • • " • • '• Tumors of unspecified nature 57d Brain and other parts of the central nervous system 4 2 2 2 1 .. 1 ...... 1 .. 3 2 57e Other and unspecified organs 1 1 .. .. 1 1 .. 1 2 -1942 III—RHEUMATISM, DISEASES OF NUTRITION AND OF THE ENDOCRINE GLANDS, OTHER GENERAL DISEASES AND AVITAMINOSES Acute rheumatic fever Ma Acute rheumatic pericarditis 1 . 1 ...... 1 .. 58b Acute rheumatic endocarditis 5 i 4 1 ...... 4 1 58c Acute rheumatic myocarditis 2 .. 1 ...... 1 .. 58d Other acute rheumatic heart disease 3 1 2 1 1 ...... 2 1 58e Other forms of acute rheumatic fever 1 5 1 ...... 1 4 Chronic rheumatism and other rheumatic diseases 59a Rheumatoid arthritis 2 1 1 1 .. .. 1 ...... 1 1 59b Other chronic articular rheumatism 11 . .. 10 1 ...... 10 61 Diabetes mellitis 274 46 241 il 31 4 2 1 6 .. 2 .. 249 a 62 Diseases of the pituitary gland 1 ...... 1 Diseases of the thyroid and parathyroid glands 63a Simple goiter 3 1 .. 1 1 .. 2 ...... 1 63b Exophthalmic goiter 11 2 7 2 2 1 ...... 7 2 cretinism 63c Myxedema and 3 .. 3 ..._ ...... • - • • 3 • • 64 Diseases of the thymus gland 7 7 6 7 1 ...... 6 7 Diseases of the adrenal glands (not specified as tuberculosis) 65a Addison's disease 1 .. 1 . 1 65b Other diseases of the adrenal gland 1 .. 1 ...... 1 66 Other general diseases 1 .. 1 .. 67 Scurvy 3 1 3 • • - • •...... 3 1 69 Pellagra (except alcoholic) 2 1 2 1 2 1 IV—DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS Hemorrhagic conditions 72a Primary purpuras 6 3 4 2 2 1 4 2 Anemias (except splenic anemia) 73a Pernicious anemia 6 1 5 1 1 1 1 6 2 flVallfla 73b Other hyperchromic anemias 1 1 .. •• •...... 1 •• Other and unspecified anemias 5 .. 73d .. .. 1 ...... 4 .. JO 74a Leukemias 47 6 36 5 9 2 1 36 5 Diseases of the spleen 75h Splenomegaly (of undetermined nature) • • • • ...... • • 75c Other diseases of the spleen 1 .. \ ...... 1 .. 76a Agranulocytosis 3 1 3 1 3 1 Tir■LIA V—CHRONIC POISONING AND INTOXICATION Alcoholism (ethylism) 77c Acute alcoholism 4 3 •. • • 3 • • 77d Chronic alcoholism 25 8 22 7 3 1 1 .. 1 .. 24 7 77e Other and unspecified alcoholism 1 . 1 ...... 1 • • 78b Lead poisoning (non-occupational) ...... 7

VI—DISEASES OF THE NERVOUS SYSTEM AND SENSE SDILSIIVIS ORGANS Encephalitis (nonepidemic) 80a Intracranial abscess 5 1 2 1 1 .. 2 ...... 2 1 80b Other encephalitis (nonepidemic) 4 2 2 1 1 1 1 ...... 2 1 Meningitis (not due to meningococcus) 81a Simple meningitis 11 1 12 10 10 1 2 ...... 10 10 82 Diseases of the spinal cord 13 2 10 1 3 1 1 11 1 Intracranial lesions of vascular origin '• '- • • 83a Cerebral hemorrhage or effusion 517 210 481 206 26 4 10 .. 28 9 2 1 509 216 83b Cerebral embolism and thrombosis 58 18 55 18 1 2 3 ...... 58 18 83c Cerebral softening 3 3 1 ...... 4 .. 83d Hemiplegia and other paralysis of unspecified origin 16 3 15 3 1 1 15 4 cs:.) 1—• TABLE NO. 10—Continued ALLOCATION OF DEATHS BY COLOR AND CAUSE OF DEATH ACCORDING TO PLACE OF DEATH AND PLACE OF RESIDENCE, BALTIMORE-1942

A ..4 RESIDENTS OF BALTIMORE RESIDENTS Zo TOTAL DYING ELSEWHERE TOTAL 26 RECORDED RESIDENT (4Z CAUSE DEATHS DEATHS Z E, Bei, cam COUNTIES OF OTHER COUNTIES OF OTHER

MARYLLND STATES MARYLAND STATES REPORT .9 1 White cad White cad White Cad white cord White cad White cad White cord

VI—DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS—COHL Mental diseases and deficiency OF 84a Mental deficiency • ••• •• •• •• •• •• •• 2 • • 84b Schizophrenia (dementia praecox) .. .. 1 4 .. .. 1 4 THE 84c Manic-depressive psychosis 1 84c1 Other mental diseases • • - • • • • • • • • • • • • • • - - - - • • 1 • • • • 1 • • 85 Epilepsy 9 5 6 4 1 1 .. .. 6 5 HEALTH Other diseases of the nervous system 87b Neuritis (except rheumatic or alcoholic) 1 1 1 87c Paralysis agitans 16 .. ii ...... 87d Desseminated sclerosis 6 .. 6 ...... 6 87e Other diseases of the nervous system 3 2 1 •• • - • - • • 2 1 • • • • • • • • • • 1 88 Diseases of the organs of vision 1 .. Diseases of the ear and •• • - • • • • • • • • ••

mastoid process DEPARTMENT 89a Otitis and other diseases of the ear 10 1 7 1 2 '• ...... 7 1 89b Diseases of the mastoid process 3 1 1 1 1 .. 1 ...... 1 1 VII—DISEASES OF THE CIRCULATORY SYSTEM Pericarditis (except acute rheumatic) 90s Chronic rheumatic pericarditis 1 1 1 • • • • - •• • • • • •• • • .. 90b Other pericarditis 1 1 1 ...... 1 1 Acute endocarditis (except rheumatic) 91a Bacterial endocarditis 24 7 20 5 1 2 1 ...... 21 5 91b Other acute or subacute endocarditis ...... 1 1 .. -1942 Chronic affections of the valves and endocardium -• 92a Diseases of the aorta valve 27 26 26 26 . .. 1 2 1 .. 28 28 92b Diseases of the mitral valve 86 31 77 31 31 92c Diseases of other and unspecified valves (rheumatic) 13 3 10 3 3 92d Diseases of other and unspecified valves (non- rheumatic) 78 35 77 35 . .. 7 1 2 .. 86 36 92e Endocarditis (not specified as acute, chronic or rheumatic) 6 1 6 6 1 Diseases of the myocardium 93a Acute myocarditis (except rheumatic) 6 6 6 6 ...... 2 .. 3 .. 11 6 93c Chronic myocarditis (rheumatic) 20 5 16 3 4 2 .. . 1 . 17 3 93d Chronic myocarditis (non-rheumatic) 1,690 338 1,570 329 99 . 7 21.12 119 ii 1,698 354 93e Other myocarditis 58 13 55 13 1 1 1 57 14 Diseases of the coronary arteries and angina pectoris 94a Diseases of the coronary arteries 821 79 746 79 42 .. 33 .. 43 8 16 1 805 88 94b Angina pectoris 25 2 25 1 .. .. 25 3 Other diseases of the heart 95a Functional diseases of the heart 14 1 14 1 ...... 1 95b Other diseases of the heart,specified as rheumatic 49 11 44 11 4 1 .. .. 1 .. 46 11 95c Other diseases of the heart, not specified as rheumatic 42 25 40 25 1 41 25 96 Aneurysm (except of heart and aorta) 9 4 8 4 ...... 8 4 97 Arteriosclerosis 70 11 69 11 .. .. 1 .. 10 6 1 .. 80 17 98 Gangrene 7 3 5 3 1 1 .. 2 2 .. .. 7 5 99 Other diseases of the arteries 5 1 4 1 4 1 Diseases of the veins 100a Varices 3 .. 3 ...... 3 .. 100b Other diseases of the veins 8 2 6 2 .. .. 6 2 102 High blood pressure (idiopathic) 3 2 2 2 1 ...... 2 2 VIII-DISEASES OF THE RESPIRATORY SYSTEM 104a Diseases of nasal fossae 3 1 .. 2 ...... 1 .. IlVatifla 10413 Diseases of the accessory sinuses 7 .. 3 .. 3 ...... 3 .. 105 Diseases of the larynx 1 .. 1 . 1 106a Acute bronchitis 10 4 8 4 ...... 8 4 30 106b Chronic bronchitis 13 1 13 1 ...... 1 106c Bronchitis, unspecified as to acute or chrome 5 ,,. 3 2 ...... 3 107 Bronchopneumonia 246 131 221 12i 24 4 20 3 2 .. 243 lie.) 108 Lobar pneumonia 217 148 177 141 32 7 8 9 3 1 .. 187 144

109 Pneumonia, unspecified 1 .. 3 .. rIVIIA Pleurisy (not specified as tuberculosis) 110a Empyema 1 ...... • • 1 .. 110b Other and unspecified pleurisy 3 .. 2 •. .. 2 .. 111b Acute edema of the lungs 5 4 4 4 4 111c Chronic and unspecified congestion of the lungs 2 3 2 ...... 2 3 112 Asthma 7 1 5 5 1 113 Pulmonary emphysema 3 .. Other diseases of the respiratory system 114b Other and unspecified pneumoconioses 1 ...... 1 SOLLSIIVIS 114c Gangrene of lungs 1 ...... 2 .. 114d Abscess of lungs 9 i 6 5 2 2 7 5 -114e Other and unspecified diseases of respiratory system 3 1 3 3 1

IX-DISEASES OF THE DIGESTIVE SYSTEM . 115a Diseases of the teeth and gums 2 1 1 1 ...... 1 1 115b Septic sore throat 5 4 3 4 4 4 115c Diseases of the pharynx and tonsils 4 4 3 3 i . .. 3 3 116 Diseases of the esophagus •• " 1 117a Ulcer of the stomach 42 11 33 10 9 1 .. .. io 117b Ulcer of the duodenum 19 2 12 1 6 1 12 1 118 Other diseases of the stomach 7 .. TABLE NO. 10—Continued ALLOCATION OF DEATHS BY COLOR AND CAUSE OF DEATH ACCORDING TO PLACE OF DEATH AND PLACE OF RESIDENCE, rC) BALTIMORE-1942 14=.•

BALTIMORE RESIDENTS TOTAL RESIDENTS OF DYING ELSEWHERE TOTAL RECORDED RESIDENT CAUSE DEATHS DEATHS No. " COUNTIES OF OTHER COUNTIES OF OTHER

BALTIMORE REPORT MARYLAND STATES MARYLAND STATES LIST

INTERNATIONAL White Cord White Cord White Cord White Cord White Cord White Cord White Cord

IX—DISEASES OF THE DIGEST/YE SYSTEM—CORI.

119a Diarrhea and enteritis under two years of age 83 44 62 38 19 6 2 ...... 64 38 OF 119b Ulceration of the intestines under two years of age. 1 ...... 120a Diarrhea and enteritis, two years of age and over 6 3 5 3 1 ...... 6 3 120b Ulceration of intestines, two years of age and over. 8 1 3 1 3 ...... 3 1 THE 121 Appendicitis 38 13 25 11 9 2 . .. 1 .. 26 11 122a Hernia ■ 44 2 37 2 4 .. .. 39 2

122b Intestinal obstruction 52 21 33 20 17 1 i. .. 35 20 HEALTH 123 Other disease of the intestines 13 6 10 5 3 5 Cirrhosis of the liver 124a With mention of alcoholism 39 4 38 4 .. .. 1 .. 40 4 124b Without mention of alcoholism 69 8 63 8 5 .. 8 125a Acute yellow atrophy of the liver 2 .. 2 . 2

• • • • • • • • • • • • • •• • • DEPARTMENT 125b Other diseases of the liver 2 4 2 4 . - • • • • • • .. .. 3 126 Biliary calculi 21 1 15 1 1 127a biliary Cholecystitis (without mention of calculus). 8 .. 8 .• • • •• • • " 8 .. 127b Other diseases of the gall bladder and biliary ducts. 7 1 4 1 " •' ..• • ..•• 5 1 128 Diseases of the pancreas 15 2 8 2 8 2 129 Peritonitis (cause not specified) ...... 1 .. X—DISEASES OF THE GENITO-URINARY SYSTEM 130 Acute nephritis 16 9 13 8 2 1 8 Chronic nephritis . 131a Arteriosclerotic kidney 589 256 556 246 23 9 10 1 30 1 2 1 588 248 -1942 131b Other chronic nephritis 96 49 87 48 6 1 3 2 1 . .. 89 49 132 Nephritis, unspecified (10 years of age and over) 2 2 1 2 ...... 2 2 133a Pyelitis, pyelonephritis 13 5 9 5 .. .. 4 .. .. 9 5 133b Other diseases of the kidneys and ureters 14 1 9 . 1 9 1 134a Calculi of the kidney and ureters 13 2 10 2 2 134b Calculi of the bladder .. 1 .. 135a Cystitis 2 .. 2 ...... 2 .. 135b Other diseases of the urinary bladder 1 ...... 1 136a Stricture of the urethra 1 .. 1 .' •• • • " '• • • i .. .. 1 1 136b Other diseases of the urethra 2 2 2 2 .• • - •• .. 2 2 137a Hypertrophy of the prostate 48 7 32 5 14 2 '• " '• 5 137b Other diseases of the prostate 5 „ 1 1 4 .. 138 Diseases of other male genital organs .. .. Diseases of the female genital organs 139a Of ovaries, fallopian tubes 1 1 3 139b Of uterus 1 1 1

XI—DISEASES OF PREGNANCY, CHILDBIRTH AND THE PUERPERIUM Abortion with mention of infection 140a Spontaneous, therapeutic or unspecified (with

pyelitis) 1 1 • • 140b Spontaneous, therapeutic or unspecified (other infection) 3 5 3 3 2 140c Self-induced 1 1 140d Other abortion 3 3 Ectopic gestation 142a With mention of infection 1 1 142b Without mention of infection •2 •1 Toxemias of pregnancy (death before delivery) 144a Eclampsia of pregnancy 1 144d Other toxemias of preg,anacy 145 Other diseases and accidents of pregnancy (death before delivery) 1 1 Hemorrhage of childbirth and the puerperium 146a Placenta praevia • 1 • • 146b Premature separation of placenta • 1 • • 1 146c Other and unspecified hemorrhages 5 3 4 1 •i .2 Infection during childbirth and the puerperium 147b General or local puerperal infection 8 2 2 2 6 147c Puerperal thrombophlebitis 1 147d Puerperal embolism and sudden death 2 2 148a Puerperal eclarnpsia (death after delivery) 2 Other accidents and unspecified conditions of childbirth 149a Lacerations, rupture or trauma 1 1 149b Other specified conditions of childbirth 2 2 150c Other and unspecified conditions of childbirth and puerperium 1 1

XII—DISEASES OF THE SKIN AND CELLULAR TISSUE 151 Carbuncle and furuncle 1 152 Phlegmon and acute abcess 5 2 4 2 1 2 153 Other diseases of the skin and cellular tissue 2 2 2 1 2 1

XIII—DISEASES OF THE BONES atliD ORGANS OF MOVEMENT 154a Acute osteomyelitis and periostitis 2 1 1 154b Chronic or unspecified osteomyelitis 2 1 1 1 1 1 155 Other diseases of the bones 4 4 4 156a Diseases of the joints 1 1 156b Diseases of other and unspecified organs of movement 2 3 1 3 1 3 TABLE NO. 10—Continued t.2 tO ALLOCATION OF DEATHS BY COLOR AND CAUSE OF DEATH ACCORDING TO PLACE OF DEATH AND PLACE OF RESIDENCE, Cx BALTIMORE-1942 11 BALTIMORE RESIDENTS TOTAL RESIDENTS OF DYING ELSEWHERE TOTAL RECORDED RESIDENT CAUSE Drams DEATHS No. COUNTIES or OTHER Courrrias or OTHER REPORT BALTIMORE MARYLAND STATES MARYLAND STATES LIST White Cord White Col'd White Cord White Cord White Col'd White Col'd White Cord INTERNATIONAL

XIV—CONGENITAL MALFORMATIONS OF 157a Congenital hydrocephalus 19 1 12 1 2 .. 1 .. 13 1 157b Spina bifida and meningocele 14 .. 4 .. 1 ...... 1 .. 10 .. 157c Anencephalus 1 ...... 3 .. THE 157d Other congenital malformations of the central nervous system 2 1 1 157e Congenital malformations of the heart 50 13 ia 13 1.2 ...... 1 aa 14 157g Congenital malformations of the digestive system 17 6 11 3 3 3 3 ...... 11 3 HEALTH 157h Congenital malformations of the genito-urinary system 5 .. 2 .. 3 ...... 2 .. 157m Other and unspecified congenital malformations 11 2 6 1 4 1 1 ...... •. 6 1 XV—Diewesza PECULIAR TO THE FIRST YEAR OF

Lira DEPARTMENT 158 Congenital debility (cause not stated) 4 5 4 4 .. 1 .. 4 4 159 Premature birth (cause not stated) 201 78 151 67 49 11 i •- •- • • • • •1 • • 152 67 160a Intracranial or spinal hemorrhage 55 18 37 16 17 2 1 ...... 37 16 160b Other injuries at birth 14 6 10 6 1 ...... 2 .. 12 6 Other diseases peculiar to the first year of life 161a Asphyxia, atelectasis 45 13 34 12 11 34 12 161b Infection of the umbilicus, pemphigus, other infections 1 4 1 .. .. 4 ...... 1 .. 161c Other specified diseases 12 11 11 9 1 2 ...... 11 9 -1942 XVI—SENILITY 162a Senility, with mention of senile dementia 1 • • 162b Senility, without mention of senile dementia 7 • • " • • •' • • • • •• XVII—VIOLENCE OR ACCIDENTAL DEATHS Suicide 163a By arsenic and compounds 1 4 .. 163b By barbituric acid and derivatives 1 ...... 1 '• '• -• •• " 2 .. and compounds 5 .. - • '• • • 3 .. 163d By mercury • • '• •' •' •' 163g By other solid or liquid poisons • • " " • • " 2 .. 163h By illuminating gas 33 .. 32 ...... 32 .. 5 . 163m By motor vehicle exhaust gas 5 .. 1 • - • • • • 6 • • 164a By hanging or stragulation 20 1 18 • •• •• .2 •..• 2 1 .. .. 20 2 164b By drowning 6 1 4 1 1 . 1 ...... 4 1 164c By firearms and explosives 23 2 21 1 1 i 1 .. 1 ...... 22 1 164d By cutting or piercing instruments 2 .. 1 .. — .. 1 .. 2 .. 164f By crushing 9 2 6 2 1 .. 2 .. — — ...• 6 2 166 Homicide by firearms 51 .. 49 1 .. 1 2 .. 1 .. 3 49 167 Homicide by cutting or piercing instruments 4 43 4 41 ..• • 1 ., 1 1 1 .. .. 5 42 168 Homicide by other means 10 9 9 9 . 1 .. 1 ...... 10 9 169 Railway accidents 12 7 8 6 2 .. 2 1 3 2 4 .. 15 8 Motor vehicle accidents 170a Collision between automobile and trains 2 .. 1 . 1 ...... 2 .. 3 .. 170b Collision between automobile and streetcars 5 2 3 2 •i •.: 1 ...... 3 2 170c Other automobile accidents 168 40 108 32 40 6 20 2 13 1 5 4 126 37 170d Motorcycle accidents 5 .. • 2 ...... 7 171a Streetcar accidents 23 1 20 .. i '..' 'i *j. 1 1 .. .. 21 1 172 Water transport accidents 5 • ...... • .. 2 .. 7 • • 173 Air transport accidents .. .. 1 2 .. 6 1 8 1 175a Accidents involving agricultural machinery ...... 1 • • 175b Injury by animals in agriculture 1 1 .. — 1 1 • • .. • • •. • • .. • • - • 176 Other accidents involving machines 8 5 8 5 • • • • • • • • • • • • • • •• 8 5 177 Food poisoning 1 ..

• -• •• •• • ••• -• •• flValllla 178a Accidental absorption of illuminating gas 14 .. 14 .. .. • • • • • • 1 .. .. 15 .. Acute accidental poisoning

179a By arsenic and compounds 1 1 1 ...... 1 1 30 179d By mercury and compounds I 1 ...... 1 .. 179g By lye and potash 1 ...... 1 .. 179m By other and unspecified substances 1 . 1 ...... 2 .. 180 Conflagration 16 6 15 9 1 ...... 15 9

181 Accidental burns 22 7 12 7 10 ...... 1 1 .. .. 13 8 '1VIIA 182 Accidental mechanical suffocation 10 3 9 3 1 .. 9 3 183 Accidental drowning 38 26 25 26 1 .. ii..• • io *i '6 'i. 47 30 184 Accidental injury by firearms 8 3 6 3 2 ...... 1 ...... 7 3 185 Accidental injury by cutting or piercing instruments 1 .. 1 ...... 1 186a Accidental injury by fall 144 18 142 17 19 1 3 .. 15 2 .. .. 157 19 186b Accidental injury by crushing 1 ...... 5 .. 188 Injury by animals 2 .. 1 .. 1 ...... 1 191 Excessive heat 1 1 . 1 1 • - • • • • 1 ...... 1 193 Accidents due to electric currents (except lighting)" 3 .. .. 3 .. SOLLSIIVIS 195b Accidents due to medical or surgical intervention. 1 ...... I - • ...... •. 195d Onstruction, suffocation or puncture by ingested objects 12 2 10 2 1 .. 1 • • 1 12 13 195e Other and unspecified accidents 12 1 8 1 3 .. 1 .. 1 196 Deaths of military personnel during war • • - • • • • - • i .. 1 • • 197 Deaths of civilians due to operations of war 1 ...... 4 2 4 2 198 Legal executions 4 -.. • • I •• • • • • • • • • • • • • 4 XVIII—ILL-DEFINED AND UNKNOWN CAIMIES

death 1 .. 1 199 Sudden '• • • • • • • • • • • • • • • • • 200a Ill-defined cause of death 1 .. 1 ...... 1 2 .. Unknown or unspecified cause of death 4 200e • '- • - " • - • • • • TABLE NO. 11 RESIDENT AND RECORDED DEATHS AND DEATH RATES PER 100,000 POPULATION FOR CERTAIN IMPORTANT CAUSES FOR TOTAL, WHITE AND COLORED POPULATIONS-1932-1942

TYPHOID FEVER MEASLES SCARLET FEVER

RATE PER 100,000 RATE PER 100,000 YEAR NUMBER NUMBER RATE PER 100,000 NUMBER POPITLATION POPULATION POPULATION Total White Cord Total White Cord Total White Col'd Total White Col'd Total White Cord Total White Cord

RESIDENT 1942 1 1 .. 0.1 0.1 1 .. 1 0.1 0.5 ...... • • • - 1941 3 1 2 0.3 0.1 1.2 3 2 1 0.3 0.3 0.6 . .. .. 1940 1 .. 1 0.1 0.6 ...... 2. 1 1 0.2 0.1 olo REPORT 1939 1 1 0.1 oli. .. 9 7 2 1.0 1.0 1.2 1 1 .. 0.1 0.1 .. 1938 8 5 3 0.9 0.7 1.8 ...... 3 3 .. 0.4 0.4 1937 7 4 3 0.8 0.6 1.9 le 9 3.0 2.3 5.6 4 3 1 0.5 0.4 016 1936 8 2 6 1.0 0.3 3.8 7 6 1 0.8 0.9 0.6 5 5 .. 0.6 0.7 .. 1935 9 8 1 1.1 1.2 0.6 2 2 0.2 0.3 .. 13 10 3 1.6 1.5 1.9 1934 10 4 6 1.2 0.6 3.9 91 70 11.0 10.4 13.8 10 10 .. 1.2 1.5

2i. OF 1933 2 2 . 0.2 0.3 ...... 22 19 3 2.7 2.8 2.0 1932 1 .. l. 0.1 oli 1 .. oli oli. .. 17 16 1 2.1 2.4 0.7 THE RECORDED 1942 3 3 .. 0.3 0.4 1 .. 1 0.1 0.5 ...... 1941 6 4 2 0.7 0.6 1.2 6 4 2 0.7 0.6. 1.2 1 1 0.1 016 1940 3 2 1 0.3 0.3 0.6 ...... 2 1 0.2 0.1. 0.6 HEALTH 1939 5 2 3 0.6 0.3 1.8 io 8 2 1.2 1.2 1.2 1 1 .. 0.1 0.1 .. 1938 13 8 5 1.5 1.2 3.1 .. 3 3 .. 0.4 0.4 1937 10 7 3 1.2 1.0 1.9 Z4 i io 313 2.6 6.2 4 3 1 0.5 0.4 016 1936 8 2 6 1.0 0.3 3.8 8 7 1 1.0 1.0 0.6 8 8 .. 1.0 1.2 .. 1935 12 11 1 1.4 1.6 0.6 4 4 0.5 0.6 16 13 3 1.9 1.9 1.9 1.4 1.8 .. 1934 11 5 6 1.3 0.7 3.9 97 75 22 11.7 11.1 1414 12 12 .. DEPARTMENT 1933 3 3 .. 0.4 0.4 ...... 28 25 3 3.4 3.7 2.0 1932 6 4 2 0.7 0.6 1.4 1 1 .. oii oli .. 19 18 1 2.3 2.7 0.7

WHOOPING COUGH DIPHTHERIA INFLUENZA RESIDENT C.R 1942 9 4 5 0.5 2.7 2 1 1 0.2 0.1 0.5 60 34 26 6.4 4.5 14.3 1941 30 3 27 0.4 16.1 3 2 1 38 29 7.7 5.4 17.3

00 0.3 0.3 0.6 67 ci 1940 24 11 13 1.6 7.8 1 1 .. 0.1 0.1 .. 56 41 15 6.5 5.9 9.0 0 1939 9 4 5 0.6 3.0 3 3 .. 0.4 0.4 .. 63 37 26 7.4 5.4 15.8 -1942 1938 19 7 12 1.0 7.4 3 3 .. 0.4 0.4 .. 53 37 16 6.2 5.4 9.9 ,t■ 1937 35 17 18 2.5 11.3 7 5 2 0.8 0.7 1.2 104 68 36 12.3 9.9 22.5 Tr■ 1936 36 13 23 1.9 14.6 8 3 5 1.0 0.4 3.2 76 57 19 9.1 8.4 12.1 0 1935 8 3 5 0.4 3.2 2 .2 0.2 0.3 .. 103 65 38 12.4 9.6 24.5

C9 .. 1934 56 32 24 4.7 15.7 6 5 1 0.7 0.7 0.6 63 42 21 7.6 6.2 13.8 Tr 1933 39 15 24 2.2 16.0 6 4 2 0.7 0.6 1.3 112 90 22 13.6 13.4 14.6 Tt■ 1932 36 23 13 3.4 8.8 10 3 7 1.2 0.4 4.7 127 92 35 15.5 13.7 23.7

RECORDED 1942 11 5 6 1.2 0.7 3.3 2 1 1 0.2 0.1 0.5 62 35 27 6.6 4.6 14.9 1941 34 7 27 3.9 1.0 16.1 5 3 2 0.6 0.4 1.2 72 41 31 8.3 5.9 18.4 1940 30 17 13 3.5 2.4 7.8 3 2 1 0.3 0.3 0.6 58 43 15 6.7 6.2 9.0 1939 11 5 6 1.3 0.7 3.6 9 9 .. 1.0 1.3 69 40 29 8.1 5.8 17.6 1938 21 9 12 2.5 1.3 7.4 6 5 1 0.7 0.7 0.4 57 39 18 6.7 5.7 11.1 1937 42 24 18 5.0 3.5 11.3 11 9 2 1.3 1.3 1.2 112 78 34 13.3 11.4 21.3 1936 39 , 15 1 24 4.6 2.2 15.2 10 5 5 1.2 0.7 3.2 83 64 19 9.9 9.4 12.1 -tw.V., \ 6 \ 4 k 5 13. 0.6 1 3.2 1 6 6 1 (Il 00 103 AR 37 12.4 9.7 23.9 - 21 TUBERCULOSIS, Au,FORMS PULMONARY TUBERCULOSIS CANCER RESIDENT 1942 810 374 436 86.5 49.6 240.1 749 354 395 80.0 46.9 217.5 1,257 1,071 186 134.3 142.0 102.4 1941 811 355 456 93.7 50.9 271.4 760 339 421 87.8 48.6 250.6 1,368 1,162 206 158.0 166.5 122.6 1940 816 393 423 94.9 56.7 253.0 769 378 391 89.4 54.5 233.9 1,294 1,081 213 150.4 155.9 127.4 1939 673 338 337 78.7 48.7 204.6 631 316 315 73.8 45.8 191.2 1,237 1,060 177 144.7 153.6 107.4 1938 711 379 332 83.7 55.1 204.6 668 359 309 78.6 52.2 190.4 1,217 1,054 163 143.2 153.3 100.4 1937 861 452 409 102.0 66.0 255.9 810 427 333 96.0 62.4 239.6 1,205 1,034 171 142.7 151.1 107.0 1936 836 433 403 99.7 63.5 256.0 790 417 373 94.2 61.2 237.0 1,114 948 166 132.8 139.1 105.4 1935 SOS 416 392 96.9 61.4 252.9 757 400 357 90.8 59.0 230.3 1,146 984 162 137.5 145.1 104.5 1934 813 411 402 98.2 60.9 263.4 751 393 358 90.7 58.2 234.6 1,125 973 152 135.9 144.1 99.6 1933 816 453 363 99.2 67.4 241.6 755 431 324 91.8 64.1 215.6 1,084 940 144 131.8 139.8 95.8 1932 870 447 423 106.5 66.8 285.9 803 412 391 98.3 61.6 264.3 1,006 863 143 123.1 129.0 96.7 RECORDED 1942 000047000000000000000 276 294 60.9 36.6 161.9 509 249 260 54.4 33.0 143.2 1,482 1,277 205 158.3 169.3 112.9 BUREAU 1941 247 300 63.2 35.4 178.6 490 230 260 56.6 33.0 154.8 1,593 1,370 223 183.9 196.3 132.7 1940 297 307 70.2 42.8 183.6 554 276 278 64.4 39.8 166.3 1,488 1,262 226 172.9 182.0 135.2 1939 267 294 65.6 38.6 178.5 512 244 268 59.9 35.3 162.Z 1,400 1,207 193 163.7 174.8 117.2 1938 273 275 65.0 40.4 169.4 505 256 249 59.4 37.2 153.4 1,352 1,184 168 159.1 172.2 103.5 1937 335 343 80.3 48.9 214.6 620 304 316 73.4 44.4 197.7 1,376 1,182 194 163.0 172.7 121.4 1936 338 342 81.1 49.6 217.3 627 316 311 74.8 46.4 197.6 1,269 1,095 ' 174 151.3 160.7 110.5

1935 326 350 81.1 48.1 225.8 617 305 312 74.0 45.0 201.3 1,284 1,114 170 154.1 164.2 109.7 OF 1934 300 350 78.5 44.5 229.3 579 276 303 69.9 40.9 198.5 1,277 1,115 162 154.2 165.1 106.1 1933 342 305 78.6 50.8 203.0 - 581 315 266 70.6 46.8 177.0 1,185 1,035 150 144.1 154.0 99.8 1932 342 365 86.5 51.1 246.7 628 299 329 76.8 44.7 222.4 1,140 983 157 139.5 146.9 106.1 VITAL

HEART DISEASE BRONCHOPNEULIONIA LOSER PNEUMONIA RESIDENT STATISTICS 1942 3,556 2,946 610 379.9 390.5 335.9 373 243 130 39.9 32.2 71.6 334 190 144 35.7 25.2 79.3 1941 3,366 2,773 593 388.7 397.3 353.0 277 191 86 32.0 27.4 51.2 350 181 169 40.4 25.9 100.6 1940 3,331 2,761 570 387.1 398.3 340.9 308 211 97 35.8 30.4 58.0 320 203 117 37.2 29.3 70.0 1939 2,970 2,536 434 347.4 367.4 263.5 363 249 114 42.4 36.1 69.2 305 182 123 35.7 26.4 74.7 1938 2,916 2,461 455 343.2 358.0 280.4 405 278 127 47.7 40.4 78.3 359 217 142 42.2 31.6 87.5 1937 2,758 2,369 389 326.7 346.2 243.4 481 350 131 57.0 51.1 82.0 557 333 224 66.0 48.6 140.2 1936 2,602 2,145 457 310.2 314.8 290.3 474 316 158 56.5 46.4 100.4 549 289 260 65.4 42.4 165.2 1935 2,334 1,956 378 281.3 238.4 243.8 485 345 140 58.2 50.9 90.3 499 280 219 59.9 41.3 141.3 1934 2,297 1,933 364 277.4 286.2 238.5 456 306 150 55.1 45.3 98.3 524 325 199 63.3 48.1 130.4 1933 2,256 1,887 369 274.3 280.7 245.6 477 346 131 58.0 51.5 87.2 483 277 206 58.7 41.2 137.1 1932 2,139 1,765 374 261.8 263.8 252.8 482 344 133 59.0 51.4 93.3 503 284 219 61.6 42.4 148.0 RECORDED 1942 3,546 2,961 585 378.8 392.5 322.1 377 246 131 40.3 32.6 72.1 371 223 ..... ■TPC...MMCON...N 39.6 29.6 81.5 1941 3,386 2,800 586 391.0 401.1 348.8 288 201 87 33.2 28.8 51.8 365 194 42.1 27.8 101.8 1940 3,357 2,785 572 390.1 401.7 342.1 319 225 94 37.1 32.5 56.2 347 232 40.3 33.5 68.8 1939 2,978 2,550 428 348.3 369.4 259.8 376 259 117 44.0 37.5 71.0 333 202 38.9 29.3 79.5 1938 2,910 2,463 447 342.5 358.3 275.5 424 297 127 49.9 43.2 78.3 391 246 46.0 35.8 89.4 1937 2,757 2,376 381 326.6 347.2 238.4 504 365 139 59.7 53.3 87.0 609 375 NNNNNN 72.1 54.8 146.4 1936 2,608 2,154 454 310.9 316.1 288.4 498 340 158 59.4 49.9 100.4 592 324 70.6 47.6 170.2 1935 2,314 1,937 377 277.7 285.6 243.2 499 357 142 59.9 52.6 91.6 548 319 65.8 47.0 147.7 1934 2,297 1,925 372 277.4 285.1 243.7 485 328 157 58.6 48.6 102.9 544 340 65.7 50.3 133.6 t\D 1933 2,255 1,887 368 274.2 280.7 244.9 503 372 131 61.2 55.3 87.2 503 298 61.8 44.3 139.8 1932 2,170 1,789 381 265.6 267.4 257.6 508 362 148 62.2 54.1 98.7 540 312 66.1 46.6 154.1 TABLE NO. 11-Continued RESIDENT AND RECORDED DEATHS AND DEATH RATES PER 100,000 POPULATION FOR CERTAIN IMPORTANT CAUSES FOR TOTAL, WHITE AND COLORED POPULATIONS-1932-1942

DIARRHEA AND ENTERITIS NEPHRITIS BIRTH UNDER Two YEARS CHRONIC PREMATURE RATE PER 100,000 RATE PER 100,000 YEAR NUMBER RATE PER 100,000 NUMBER NUMBER

POPULATION POPULATION POPULATION REPORT Total White Cord Total White Cord Total White Cord Total White Col'd Total White Cord Total White Cord RESIDENT 1942 102 64 38 10.9 8.5 20.9 974 677 297 104.1 89.7 163.5 219 152 67 23.4 20.1 36.9 1941 144 66 78 16.6 9.4 46.4 1,008 713 295 116.4 102.1 175.6 219 131 88 25.3 18.8 52.4 1940 54 32 22 6.3 4.6 13.2 1,169 820 349 135.8 118.3 208.7 206 132 74 23.9 19.0 44.3 OF 1939 45 24 21 5.3 3.5 12.7 1,017 790 227 118.9 114.4 137.8 163 105 58 19.1 15.2 35.2

1938 80 51 29 9.4 7.4 17.9 1,033 770 263 121.6 112.0 162.1 183 118 65 21.5 17.2 40.0 THE 1937 69 51 18 8.2 7.4 11.3 1,037 828 259 128.8 121.0 162.0 198 128 70 23.4 18.7 43.8 1936 90 60 30 10.7 8.8 19.0 1,046 800 246 124.7 117.4 156.3 196 131 65 23.4 19.2 41.3 1935 65 41 24 7.8 6.0 15.5 1,042 793 249 125.0 116.9 160.6 223 150 73 26.8 22.1 47.1 1934 108 67 41 13.0 9.9 26.9 1,090 819 271 131.6 121.3 177.6 251 179 72 30.3 26.5 47.2 HEALTH 1933 60 38 22 7.3 5.6 14.6 1,187 911 276 144.3 135.5 183.7 252 157 95 30.6 23.4 63.2 1932 84 54 30 10.3 8.1 20.3 1,083 827 256 132.5 123.6 173.1 262 168 94 32.1 25.1 63.5 RECORDED 1942 128 84 44 13.7 11.1 24.2 990 685 305 105.8 90.8 168.0 279 201 78 29.8 26.6 43.0 1941 192 95 97 22.2 13.6 57.7 1,019 715 304 117.7 102.4 181.0 276 178 98 31.9 25.5 58.3 1940 63 41 22 7.3 5.9 13.2 1,183 820 363 137.5 118.3 217.1 250 165 85 29.0 23.8 50.8 DEPARTMENT 1939 56 32 24 6.5 4.6 14.6 1,052 805 247 123.0 116.6 150.0 196 131 65 22.9 19.0 39.5 1938 94 60 34 11.1 8.7 21.0 1,090 820 270 128.3 119.3 166.4 221 151 70 26.0 22.0 43.1 1937 91 67 24 10.8 9.8 15.0 1,121 853 268 132.8 124.6 167.7 238 163 75 28.2 23.8 46.9 1936 103 67 36 12.3 9.8 22.9 1,066 813 253 127.1 119.3 160.7 222 155 67 26.5 22.7 42.6 1935 70 45 25 8.4 6.6 16.1 1,042 791 251 125.0 116.6 161.9 242 187 75 29.0 24.6 48.4 1934 129 84 45 15.6 12.4 29.5 1,098 820 278 132.6 121.4 182.1 254 181 73 30.7 26.8 47.8 1933 75 50 25 9.1 7.4 16.6 1,210 920 290 147.1 136.8 193.0 254 158 96 30.9 23.5 63.9 1932 99 64 35 12.1 9.6 23.7 1,092 836 256 133.6 124.9 173.1 265 170 95 32.4 25.4 64.2 -1942 TABLE NO. 12 RESIDENT AND RECORDED DEATHS UNDER ONE MONTH OF AGE,DEATHS UNDER ONE YEAR OF AGE,AND MATERNAL DEATHS WITH CORRESPONDING DEATH RATES-1932-1942

DEATHS UNDER ONE MONTH OF AGE DEATHS UNDER ONE YEAR OF AGE MATERNAL DEATHS

YEAR NI:mama RATE PER 1 000 NUMBER RATE PER 1,000 RATE PER 1,000 LIVE BIRTHS Lurs BIRTHS NUMBER LIVE Brarao Total White Cord Total White Cord Total White Cord Total White Cord Total White Cord Total White" Cord

RESIDENT E1 1942 489 349 140 24.8 23.1 30.1 778 516 262 39.5 34.2 56.4 35 18 17 1.7 1.3 3.7 1941 422 271 151 26.4 22.8 36.7 794 451 343 49.6 37.9 83.5 36 21 15 2.3 1.8 3.6 1940 382 241 141 27.8 23.8 39.1 641 387 254 46.7 38.3 70.4 28 15 13 2.0 1.5 3.6 RVallf1 1939 300 194 106 24.0 21.1 32.0 511 302 209 40.8 32.8 63.1 45 28 17 3.6 3.0 5.1 1938 364 239 125 27.6 24.2 37.7 683 429 254 51.7 43.4 76.6 44 29 15 3.3 2.9

4.5 30 1937 348 223 125 27.8 23.8 39.7 664 393 271 53.1 41.9 86.1 42 28 14 3.4 3.0 4.4 1936 381 250 131 32.3 27.9 46.0 763 461 302 64.7 51.5 106.2 49 35 14 4.2 3.9 4.9 1935 392 273 119 31.8 29.2 40.1 673 432 241 54.6 46.1 81.2 67 40 27 5.4 4.3 9.1

1934 419 307 112 34.3 33.4 37.3 803 536 267 65.8 58.3 88.9 71 52 19 5.8 5.7 6.3 riva,IA 1933 429 286 143 35.2 31.3 46.7 749 484 265 61.4 53.0 86.6 59 39 20 4.8 4.3 6.5 1932 464 320 144 36.3 32.9 47.2 805 528 277 63.0 54.2 90.9 62 46 16 4.8 4.7 5.2

RECORDED . 1942 635 468 167 26.1 24.1 33.9 981 677 304 40.6 35.2 61.8 50 28 22 2.1 1.5 4.5 1941 536 365 171 27.6 24.3 38.7 987 600 387 50.9 40.0 87.7 44 27 17 2.3 1.8 3.8 1940 477 319 158 28.9 25.4 40.6 785 507 278 47.6 40.3 71.4 41 25 16 2.5 2.0 4.1 sousuvIs 1939 367 251 116 24.7 22.1 32.8 640 401 239 43.0 35.3 67.6 59 38 21 4.0 3.3 5.9 1938 431 296 135 28.2 252 38.4 815 535 280 53.4 45.5 79.7 56 36 20 3.6 3.1 5.7 1937 427 289 138 29.9 26.5 412 817 512 305 57.2 46.9 91.0 64 43 21 4.5 3.9 6.3 1936 437 299 138 32.9 29.1 45.9 894 568 326 67.3 55.3 108.5 62 44 18 4.7 4.3 6.0 1935 440 315 125 32.3 29.9 40.1 775 519 256 56.8 49.3 82.1 82 47 35 6.0 4.5 11.2 1934 434 320 114 32.3 31.0 36.2 877 601 276 65.2 58.3 87.8 83 60 23 6.2 5.8 7.3 1933 441 295 146 32.9 28.9 45.7 824 544 280 61.5 53.3 87.6 75 54 21 5.6 5.3 6.6 1932 477 329 148 34.1 30.4 46.6 869 571 298 62.0 52.7 93.9 79 59 20 5.6 5.4 6.3 TABLE NO. 13 CASES OF REPORTABLE DISEASES CLASSIFIED ACCORDING TO SEX, COLOR AND AGE PERIODS-1942

TOTALS AGE GROUPS

,r8

< 04

Zn 2 g E ... CAUSE Year

By 1

Grand Years Years Years Years Years Years Years Years Years Years

Years Years '6'4 Z E., '''■ ''-1 P'.: re54`i

Total Color Over Z

Years ., R

,-■ Years

Year A6 'A's .0 85 and 50-54 75-79 80-84 1 10-14 55-59 80-84 05-89 70-74 5-9 25-29 40-44 .4 Under 01 C0 V 20-24 30-34 : 24M 11 1 1 2 1 1 2 1 Typhoid fever 31

o 7M 4 ...... 1 2 1 F 3 1 1 1 ...... 2 Paratyphoid fever 1 C 1 M 1 1 ...... 5 Undulant fever 1 W 1 M 1 1 150 M 97 5 3 5 3 3 4418 10 8 15 6 5 5 2 .. 1 ...... F 53 6 2 5 2 1 3 2 5 8 3 2 1 6 ... 4.2.1 ...... 6 Meningococcus meningitis 202

o 52M 33 2 1 2 1 1 3 3 2 4 4 3 4 .. 1 1 . 1 .. 1 1 724 M 357 ... 9 17 30 32 184 58 10 9 3 3 1 1 ...... F 367 ... 5 12 19 44 195 66 9 7 2 4 2... 1 ... 1 ...... 8 Scarlet fever 826

o 102 M 38 ... 3 2 4 9 18 2 ...... F 64 ...... 5 11 10 25 7 1 2 2 1 ...... W 1,504 M 700 79 80 81 71 80 279 21 ... 1 1 F 804 93 72 84 78 83 345 28 3 3 2 2...... i ...... 9 9 Whooping cough 2,174 C 670 M 313 68 50 50 40 36 63 3 . 1 F 357 81 56 59 34 39 75 9 ... 1 ...... 3 11 62M 27 1 1 1 3 3 5 5 2 F 35... 2 1 2 2 1453

10 Diphtheria 74 c.) 12M 4 ...... 2. 2 ...... F 1 ......

I ' W 37M 15 ...... 1 1 1 1 3 2 ...... 1 1 1 2 1 ...... F 22 3. 2 2 1 3 3 2 2 1 .. 1 1 1.... 11 Erysipelas 40 C 3 M 1 F 2

W 3 M 2 1 1 F 1 1 12 Tetanus 11

F 1 l W 865 M 622 4 5 3 1 3 4 1 17 57 70 76 79 112 51 3840 26 19 9 3 2 .... 2 F 243 3 2 6 1 2 4221 50 40 26 20 13 8 13 11 3 9 1 5 1 .... 2 13 Pulmonary tuberculosis 1,631 C 766 M 508 3 12 6 4 7 9 11 30 60 53 70 60 63 41 34 16 14 6 6 .. 2 .... 1 F 258 5 4 5 5 8 13 15 20 43 40 33 25 15 12 6 4 2 1 1 ...... 1

W 17M 8 1... 1 2 Vaalla

F 9 ... 1 1 ...... 3 1 2 11 14-22 Tuberculosis, other forms 55 C 38M 22 1 1 1 ...... 1 2 4 1 2 2 1 2 1 1 1 1 ...... 30 A 24a Salmonella infection 4 W 4 M 3 1 ...... 1. 1 . F 1 ...... 1 .... W 1,178 M 883 ... 1 1 ... 1 1 1 71 276 229 115 88 41 25 14 6 1 2 1 ...... 9 av.u F 295 3 1 2... 3 12 11 46 99 53 24 14 10 3 4 2 1 ...... 7 25 Gonococcus infection 3,362 C 2,184 M 1,843 ... 1 1 ... 1 10 12337 684 309 243 130 60 18 2 2 2...... 31 F 341 5 4 21 12 13 38 22 66 79 39 14 10 11 1 4.. 1 ...... 1 W 11 M 7 6 1 . F 4 3 1 25c Gonococcic ophthalmia 26 C 15M 7 6...... 1 ...... sousung F 8 5 1 1 1 W ;5 M 19 3 2 2... 1 3 1 2 F 36 8 2... 2 1 3 2 5 2 2 27a Dysentery, bacillary 84 C 29 M 13 2 3 2 4... 1 1 F 16 2 2 2... 1 4 2 1 2 1 F 4 2 1 1 27b Dysentery, amebic 11 C 3M 2 F 1 1 CAD TABLE NO. 13—Continued FP". CASES OF REPORTABLE DISEASES CLASSIFIED ACCORDING TO SEX, COLOR AND AGE PERIODS-1942 TOTALS .7 0 AGE GROUPS

.. E Z 4 03 . 0 a Year 55

CAUSE REPORT t 4 ' z 1 Grand By tj Over Years Years Years Years , a. zi Years Years Years Years Years S Total Color a

a A Not • E.A Years Specified and z Years Years Under 2 10-14 . 3 25-29 40-44

. Va Ci 35-39 50-54 55-59 80-84 85 Age .. 1■1 CO 70-74 75-79

W 4M 3 .. ... 2...... 1...... OF F 1 1 . 27c Dysentery, unspecified 14 • • •" '•• • . _ C 10 Al fill.. .. 1 1. THE F 5 1 ... i 1 .

28 Malaria 11 W 11 Al 9 ...... 2 1 1 2 1 ... 1 .. .. 1 ...... HEALTH F 2 1. W Al 1,718 ...... 1 1 1 4 4 35 169 242 283 277323 110 944630 17 14 7 6.... 54 F 757 2 1...... 2 5 60 137 134 112 90 73 34 312216 9 2 3 1.... 23 30 Syphilis 11,293 C M 5,860 15 2 4 3 4 12 22 270 1,007899 1,010 952906 302 140 89 46 2710 8 4 1 127 F 2,958 8 2 2 1 ... 15 50452 724 614 387 291 156 89 50 28 15 13 6 .. 1 .... 54 DEPARTMENT 32a Weirs disease 1 C 1 M 1 1 ...... 32b Rat bite fever 2 C 2 M 2 1 1 ...... W 12M 3 •• •• • • ...... F 9 1 1 1 1 32b Vincent's angina 14 C 2 F 2 1 1 ...... -1942 W 93M 65 4 1 1 2 4 5 4 6 6 3 4 5 4 4 3 4 3.. 1 1 F 28 5 1 . 1 1 2 2... 1 1 1 3 1 3 2 2 2 ...... 33 Influenza 130 C 37M 18 5. 1 2 2 1 1 4 1 .. . F 19 5 2 1 2 1 W 6,155 M 3,073 99 210 228264 321 1,745 116 30 26 9 9 3 4 ... .. F 3,082 81 195 240 310 320 1,706 140 30 24 13 8 4 4 1 ...... 5 35 Measles 6,445 C 290 M 160 16 25 26 19 18 45 6 2 1 1 1...... F 130 12 19 25 10 14 42 4 1 3 ...... 36 Poliomyelitis (paralytic cases) 3 W 3 M 2 ... 1 ... 1. F 1 1 37 Lethargic encephalitis 3 W 3 M 1 1. F 2 2 W 184 M 94 5 11 1 5 3 28 11 13 12 2 2... 1 ...... • F 90 5 7 4 3 5 2999 11 3 1 1 1 ... 1 ...... 1 38d German measles 195 C 11M 5 ... 1 3... 1 F 6 1 ...... 2... 2 1 W 2,410 M 1,205 43 56 64 86 87 780 61 5 2 3 2 1 2...... 13 F 1,205 46 62 57 77 91 764 76 8 3 5 3...... 1 ...... 12 38e Chickenpox 3,007 C 597 M 274 30 36 26 29 20 105 9 7 3 4 4...... 1 F 323 38 31 27 30 25 139 20 3 3 2 1 1 ...... 3

39b Typhus fever 2 W 2 M 1 1. rivaung F 1 1 IO 39c Rocky Mountain spotted fever 4 W 4 M 3 1 1. 1 F 1 1 . W 7M 7 44a Chancroid 162 VJIA C 155 M 142 1 34 57 29 7 7 2 3...... 1 ...... 1

W 1M 1 44e, f Other venereal diseases 36 kg C 35M 21 F 14

W 2,149 M 1,212 4 23 42 50 67 623 227 65 34 28 17 5 3 5 3.. 1 ...... 15 SOLLSIIVIS F 937 4 13 21 32 42 503 185 47 26 19 12 8 6... 5 1 1 ...... 12 44o Mumps 2,194 C 45M 26 1 .. ... 1 4 11 4 1 3 1

82M 47 47 ...... 88 Ophthalmia neonatorum, ex- F 35 33 1 1...... elusive of gonococcic oph- 153 thalmia 71M 26 26 F 45 45 88 Acute conjunctivitis 1 W 1 M 1 1 TABLE NO. 13—Continued CASES OF REPORTABLE DISEASES CLASSIFIED ACCORDING TO SEX, COLOR AND AGE PERIODS-1942

TOTALS AGE GROUPS I I I

ct3 rkt REPORT CAUSE Year NUMBER 1

Grand By ei Over Years Years Years Years Years Years Years Years A A Years A A A A Total Color g E Not Years Specified LIST and Year A A Years :g SC INTERNATIONAL 1 10-14 60-64 65-69 70-74 75-79 80-84 85 Under Age 4 40-44 CV CO 2 25-29 35-39

— W 410 M 222 37 13 5 9 4 8 9 3 9 4 7 4 12 11 10 16 7 7 16 11 7 12 1 OF F 188 40 9 9 5 4 1151 4 3 7 3 10 6 8 7 310 11 7 8 17....

107 Bronchopneumonia 722 THE C 312M 172 54 20 8 6 5 9 2 1 22 7711 8 5 4 2 6 8 2 2.... 1 F 140 53 18 7 10 2 6... 1 82 2 1 3 3 5 1 4 4 1 3 2 3 1

W 489 M 317 10 16 6 7 4 16 4 17 23 18 18 25 29 24 24 24 22 11 8 3 6 2 .... HEALTH F 172 8 6 5 3 5 1374 12 8 12 7 5 9 9 6 813 9 12 8.... 3 108 Lobar pneumonia 1,069 C 580 M 389 30 36 16 19 15 33 12 8 14 33 28 28 27 37 15 16 8 7 3 2 .. 2 .... F 191 20 25 18 8 13 20 8 3 3 9 10 4 9 13 11 3 6 3 .. 3 1 1 ....

W 190M 125 13 5 2 4 1 1146 15 8 1057 8 4 6 4 3 2.. 1 .... 6 DEPARTMENT F 65 11 3 2 4 2 8 3 4 3 4 1 2 1 4 44..121 .. 1.... 109 Pneumonia, unspecified 343 C 153M 114 16 8 7 5 3 4 7 6 5 7 7810 8 4 2 2.. 2...... 3 F 39 8 2 5 4 3 2 ...... 1 2 3 2 1 1 1 1 ...... 1 2 W 115M 51 2 4 1 4 2 8 1 5 9 9 2 1 1 ...... 2 ...... F 64 1 4 2 3 1 5 5 7 16 7 2 4 5 1 1 ...... 115b Septic sore throat 143 C 28M 10 1 1 1 1 1 2 1...

F 18 ... 1 1 ... 1 3 1 2 2 4 1 .. . i .. . I...... •. •...... -1942 84M 53 48 2...... 1 _ F 31 23 3 1. 1 1 1 1 .... 119 & Diarrhea and enteritis 153

120 a 69 M 42 37 3...... F 27 24 1 1 . 1... W 6M 3 .. 1 ...... 2 153 Impetigo contagiosa 9 C 3M 3 ...... 1 ... 2 - •••441„.;

BUREAU OF VITAL STATISTICS 307

TABLE NO. 14 REPORTED CASES AND CASE RATES PER 100,000 POPULATION FOR CERTAIN COMMUNICABLE DISEASES FOR TOTAL, WHITE AND COLORED POPULATION-1930-1942

WHITE COLORED PER TOTAL RATE f4 100,000 RATE PER YEAR REPORTED POPULA- ,-. RATE PER CASES TION REPORTED 100,000 REPORTED 100,000 1:1 CASES POPULA- CASES POPULA- TION TION

1942 31 3.3 24 3.2 7 3.9 1941 35 4.0 21 3.0 14 8.3 1940 23 2.7 15 2.2 8 4.8 fever) 1939 24 2.8 14 2.0 10 6.1 (not 1938 51 6.0 35 5.1 16 9.9 1937 68 8.0 40 5.8 28 17.5 1936 49 5.8 32 4.7 17 10.8 FEVER 1935 69 8.3 58 8.6 11 7.1 paratyphoid 1934 81 9.8 58 8.6 23 15.1 1933 53 6.4 46 6.8 7 4.6

TYPHOID 1932 85 10.4 64 9.6 21 14.2 1931 107 13.2 75 11.3 32 22,0 including 1930 132 16.4 96 14.5 36 25.1

1942 6,445 632.6 6,155 815.9 290 159.7 1941 4,458 514.8 3,572 511.7 886 527.4 1940 88 10.2 76 11.0 12 7.2 1939 11,833 1,383.9 10,663 1,544.6 1,170 710.3 1938 1,119 131.7 861 125.3 258 159.0 1937 9,227 1,093.0 8,140 1,189.4 1,087 680.1 1936 4,361 519.9 4,050 594.4 311 197.6 1935 533 64.0 453 66.8 80 51.6 MEASLES 1934 18,612 2,248.0 16,307 2,414.8 - 2,305 1,510.2 1933 128 15.6 100 14.9 28 18,6 1932 165 20.2 150 22.4 15 10.1 1931 15,019 1,850.4 13,654 2,050.0 1,365 937.6 1930 451 55.9 400 60.3 51 35.6

1942 826 88.2 724 96.0 102 56.2 1941 857 99.0 689 98.7 168 100.0 1940 571 66.4 459 66.2 112 67.0 1939 598 69.9 477 69.1 121 73.5 1038 1,092 128.5 954 138.8 138 85.0 1937 810 96.0 737 107.7 73 45.7 FEVER 1936 1,046 124.7 979 143.7 67 42.6 1935 1,699 203.9 1,595 235.1 104 67.1 1934 1,358 164.0 1,258 186.3 100 65.5

SCARLET. 1933 2,075 252.3 1,948 289.8 127 84.5 1932 2,094 256.3 2,011 300.5 83 56.1 1931 1,245 153.4 1,171 175.8 74 50.8 1930 1,777 220.4 1,700 256.4 77 53.7

\ 308 REPORT OF THE HEALTH DEPARTMENT-1942 TABLE NO. 14-Continued REPORTED CASES AND CASE RATES PER 100,000 POPULATION FOR CERTAIN COMMUNICABLE DISEASES FOR TOTAL, WHITE AND COLORED POPULATION-1930-1942

WRITE COLORED TOTAL RATE PER 14 YEAR REPORTED 100,000 RATE PER RATE PER POPULA- REPORTED 100,000 REPORTED 100,000 CASES TION 9 CABER CASES POPULA- POPULA■TION TION

1942 2,174 232.3 1,504 149.4 670 368.9

- 1941 2,560 205.6 1,672 239.5 888 528.6 1940 5,258 611.1 4,124 594.9 1,134 678.3 1939 1,575 184.2 1,138 164.6 439 286.5 1938 1,548 182.2 897 130.5 651 401.2

COUGH 1937 3,661 433.7 3,184 465.2 477 298.4 1936 3,570 425.6 2,443 358.5 1,127 716.0 1935 1,100 132.0 998 147.1 102 65.8 1934 4,566 530.6 4,035 597.5 531 347.9 1933 2,059 250.3 1,398 208.0 661 439.9 WHOOPING 1932 3,759 460.0 3,384 505.7 375 253.5 1931 3,294 405.8 2,661 399.5 633 434.8 1930 1,028 127.5 961 145.0 67 46.8 1942 74 7.9 62 8.2 12 6.6 1941 47 5.4 36 5.2 11 6.5 1040 49 5.7 37 5.3 12 7.2 1939 67 7.8 61 8.8 6 3.6 0, 1938 125 14.7 103 15.0 22 13.6 fti 1937 257 30.4 198 28.9 59 36.9 :1F4 1936 140 17.4 118 17.3 28 17.8 in 1935 119 14.3 100 14.7 19 12.2 A 1934 108 13.0 91 13.5 17 11.1 1033 137 16.6 122 18.1 15 10.0 1932 254 31.1 196 29.3 58 39.2 1931 416 51.2 318 47.7 98 67.3 1930 522 64.7 437 65.9 85 59.3

1 .. 1942 1,631 174.3 865 114.7 766 421.8 1941 1,842 212.7 885 128.5 957 569.6 1940 1,474 171.3 755 108.9 719 430.0 1939 1,430 167.2 678 98.2 752 456.5 1938 1,613 189.8 875 127.3 738 454.8 1937 1,755 207.9 1,012 147.9 743 464.9

TUBERCI7LOBIS 1936 1,497 178.5 862 126.5 635 403.4 1035 1,708 205.0 982 144.8 726 468.4 1934 1,372 165.7 811 120.1 561 367.6 1933 1,375 167.2 880 130.9 495 329.4 1932 1,187 145.3 720 107.6 467 315.7

PULMONARY 1931 1,391 171.4 903 135.6 488 335.2 1930 1,254 - 155.5 803 121.1 451 314.8 APPENDIX

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APPENDIX 311

AMENDMENT TO THE CITY MILK ORDINANCE* CITY ORDINANCE No. 747 An ordinance to repeal and re-ordain, with amendments, Section 62 of Article 16 of the Baltimore City Code (1927 Edition), title "Health", sub-title "Food Products", sub-heading "Milk", relating to the power of the Commissioner of Health to refuse a permit to pasteurize, bottle, sell, offer for sale, distribute or otherwise dispose of milk, cream or milk products, under certain conditions. SECTION 1. Be it ordained by the Mayor and City Council of Baltimore, That Section 52 of Article 16 of the Baltimore City Code (1927 Edition), title "Health," sub-title "Food Products," sub-heading "Milk," be and it is hereby repealed and re-ordained, with amendments, to read as follows: 52. (a) Every person or corporation desiring to bottle or handle for sale, or to offer or expose for sale, or to sell, dispose of, exchange or deliver milk or cream (the words "milk or cream" as herein used being intended to mean milk, cream, skimmed milk, buttermilk or other fermented milk) or to manufacture for sale ice cream or butter, in the City of Baltimore, shall make application to the Commissioner of Health for a permit so to do. Such application shall be made on a printed form to be furnished by the Commissioner of Health upon demand, and the applicant, if an individual, shall state therein his full name and residence, and if a corporation, shall state therein the name of such corporation and the full name and residence of each of its officers. Such application shall also state the location of the place at which it is proposed to carry on the business, and whether the applicant desires to pasteurize or bottle milk or cream, to sell milk or cream in the original unbroken package, or to manufacture for sale ice cream or butter. Such application shall also contain a statement of the number and character of wagons or other vehicles, if any, to be used by the applicant in or about his business; also the number of cows, if any, owned or controlled by the applicant, and such other data concerning the conduct of such business as the Commissioner of IIealth may require. The Commissioner of Health, upon receipt of such application, shall cause to be investigated the place of business described in such application, and the wagons and other vehicles, if any, intended to be used by such applicant. If such places of business and such wagons and other vehicles are found upon such investigation to be in a sanitary condition and fit for the uses and purposes to which they are intended to be put, said Commissioner of Health shall forthwith register said applicant in a proper record to be kept for the purpose, and issue a permit authorizing such applicant to carry on, engage in and conduct the business applied for in Baltimore City at the place designated in such application. Such permits shall specify the kind or kinds of business to be conducted. The Commissioner of Health may refuse any applicant a permit to pasteurize, bottle, sell, offer for sale, distribute or otherwise dispose of milk, cream or milk products where, in the opinion of the Commissioner of Health, the equipment, personnel or managerial control of the applicant is inadequate to assure physical or working conditions which would render such milk, cream or milk products suitable for consumption as human food and where a permit, after a hearing in accordance with the provisions of this section, has been revoked for violations at the place of business described in the application or for violations for which the applicant was responsible. (b) All permits granted pursuant to this ordinance may at any time be revoked by the Commissioner of Health for the persistent, repeated or willful violation of any law or ordinance, or of any regulation of the Commissioner of Health, governing the handling or sale of milk or cream, or the manufacture for sale of ice cream or butter in Baltimore

• The amendment consisted only in the addition of the new material indicated in italics and in a repara- graphing of Section 52 of Article 18 of the Baltimore City Code, 1027 Edition. 312 REPORT OF THE HEALTH DEPARTMENT-1942

City; provided, however, that no such permit shall, at any time, be revoked by the Commissioner of Health unless he shall first have given the holder of the same not less than ten days' notice in writing of his intention to revoke such permit, and an opportunity to be heard by him as to why such should not be done, this proviso not to bS taken to apply to cases where the sale of milk or cream or the manufacture for sale of ice cream or butter may be temporarily prohibited by the Commissioner of Health because of disease, temporary insanitary condition or similar causes. Such permits shall be non-transferable, and no permit issued hereunder shall entitle or authorize the holder thereof to carry on, engage in or conduct the business in any place or places other than that described and set out in such permit. (c) If any person or corporation having a permit, as aforesaid, shall change the location of his or its place of business, notice of such proposed change shall be given to said Commissioner of Health, and his consent in writing received to conduct such business at such new location; and no business shall be conducted or carried on at such new location until such new consent has been received. (d) Any person or persons or any corporation, or officer, agent or servant thereof, who shall bottle or otherwise handle for sale, or offer or expose for sale, or sell, dispose of, exchange or deliver, or who shall cause to be bottled or otherwise handled for sale or offered or exposed for sale or sold, disposed of, exchanged or delivered (or with intent so to do shall have in his, its or their possession, care, custody or control in Baltimore City) milk or cream, or who shall manufacture for sale ice cream or butter, in Baltimore City, without having a proper permit so to do, as herein required, shall be fined not less than five ($5.00) dollars nor more than one hundred ($100.00) dollars for each offense. (e) The provisions of this section shall not be construed to apply to milk or cream which has been denatured in a manner satisfactory to the Commissioner of health and which is not intended for human food. SEC. 2. And be it further ordained, That this ordinance shall take effect from the date of its passage. Approved May 4, 1942.

HOWARD W. JACKSON, Mayor.

PLUMBING REGULATION AMENDMENT* REGULATION 26. Toilet rooms for sexes. Water closets are to be constructed in such a manner as to provide separate facilities for each sex in all buildings used as work- shops, factories, hotels, schools, institutions and all places where persons are commer- cially employed. The approaches or entrances of said toilet rooms are to be separated as far as practicable. h Date adopted: February 13, 1942. rvilita.uu- Date effective: February 13, 1942. Commissioner of Health.

REGULATIONS GOVERNING THE HYGIENE OF HOUSING REGULATION 1. Definitions. When used in these regulations, the term "dwelling" means any house or building or portion thereof which is occupied in whole or in part as a home, residence or sleeping place of one or more human beings, either permanently or

•Pursuant to authorization of Ordinance No. 1251, approved April 10, 1031, Plumbing Regulation No. 20 was amended on February 13, 1942. APPENDIX 313

transiently; the term "dwelling unit" means a room or group of rooms intended to be occupied by one family or household as their home and where they sleep; and the term "habitable room" means a room which is designed or may be used for living, sleeping, eating or cooking. Store rooms, bathrooms, toilets, closets, halls or spaces in attics or in basements are not habitable rooms except as permitted in Regulation 6 in this series, entitled "Basement dwelling units." REGULATION 2. Basement or cellars. The basement or cellar of any dwelling shall be dry and ventilated and shall be kept free from rubbish accumulation and rodent infestation. REGULATION 3. Heating. Every dwelling and every dwelling unit shall be weather- proof and capable of being adequately heated, and the heating equipment in every dwelling or dwelling unit shall be maintained in good order and repair. REGULATION 4. Dampness. The floors and walls of every dwelling and every dwelling unit shall be kept free from dampness. REGULATION 5. Lighting and ventilation. Every habitable room in a dwelling or dwelling unit shall contain a window or windows, opening directly to the outside air, and the total area of such window or windows shall not be less than 10 per cent of the floor area of such room. All window sash shall be glazed and provided with suitable hardware, and shall be made to open to the extent of not less than 5 per cent of the floor area of such room.

REGULATION 6. Basement dwelling units. No room in any basement or cellar shall be occupied as a habitable room unless: 1. The clear inner height is at least 7 feet 6 inches, and 2. The uppermost 3 feet of the required clear inner height is above the average outside ground level, and 3. The floors and walls are water and damp proof in accordance with an approved method, if in contact with earth. Such water proofing shall be between the floor or wall finish and the ground. REGULATION 7. Sleeping rooms. No room shall be used for sleeping purposes unless there are at least four hundred (400) cubic feet of air space and 50 square feet of floor space for each adult and at least two hundred (200) cubic feet of air space and 30 square feet of floor space for each child under the age of twelve years occupying such room. No room used for sleeping purposes shall have a floor area of less than 60 square feet. REGULATION 8. Overcrowding. The occupancy of any dwelling unit having more than one habitable room shall not exceed an average of one and one-half persons per habitable room. For the purpose of this regulation any child under one year of age shall not be counted and any child more than one year old but under twelve years of age shall be deemed to be one-half person. REGULATION 9. Water supplies and sinks. In every dwelling unit containing two or more rooms there shall be running water and at least one sink connected to the public sewer or to an approved sewage disposal system. REGULATION 10. Cooking of food prohibited in sleeping rooms. Where more than two persons occupy any dwelling unit food shall not be prepared or cooked in any room used for sleeping purposes. 314 REPORT OF THE HEALTH DEPARTMENT-1942

REGULATION 11. Toilet facilities. There shall be at least one water closet for each ten (10) persons or fraction thereof occupying a dwelling, which water closet shall be within and accessible from within the building. REGULATION 12. Plumbing. All plumbing, water closets and other plumbing fixtures in every dwelling or dwelling unit shall be maintained in good order and repair and in accordance with the requirements of the city plumbing code and regulations. REGULATION 13. Lighting and ventilation of toilets and bathrooms. Every toilet and every bathroom in a dwelling shall be provided with adequate light and ventilation. REGULATION 14. Garbage, rubbish and ash receptacles. Every dwelling and every dwelling unit shall be provided with such receptacles to contain all garbage, rubbish and ashes as may be necessary, and all such receptacles shall at all times be maintained in good order and repair. Receptacles for garbage shall be made of metal, water-tight and provided with tight covers. REGULATION 15. Entrances. There shall be for each dwelling unit a separate access either to a hallway, landing, stairway or street. REGULATION 16. Drainage. All courts, yards or other areas on the premises of every dwelling shall be properly graded and drained. Date adopted: March 11, 1042. Date effective: March 12, 1942. Commissioner of Health.

REGULATIONS GOVERNING ROOMING HOUSES, LODGING HOUSES AND IIOTELS

REGULATION 1. Fire protection. Every applicant for a permit to conduct, keep, manage or operate a rooming house, lodging house or hotel shall procure from the Board of Fire Commissioners a certificate to the effect that the building and premises for which the permit is desired are free from fire hazards and comply with all fire laws, ordinances, rules and regulations applicable thereto and designed for fire prevention and control. Such certificate shall be filed with the Commissioner of Health at the time the application for permit is made. REGULATION 2. Permit to be posted. The permit issued by the Commissioner of Health to conduct, keep, manage or operate any rooming house, lodging house or hotel shall be conspicuously posted and displayed in the office, public corridor or hallway of the rooming house, lodging house or hotel for which it is issued and shall remain so posted at all times. REGULATION 3. Cleanliness of premises. Every rooming house, lodging house or hotel and every part thereof shall be kept clean and free from any accumulation of dirt, filth, rubbish, garbage or similar matter, and shall be kept free from and effectively protected against vermin or rodent infestation. REGULATION 4. Responsibility for insanitary conditions. The permitee of any rooming house, lodging house or hotel shall be responsible for any insanitary condition upon the premises and shall be charged with the responsibility for the proper observance of the provisions of these regulations and of the ordinances pertaining thereto. APPENDIX 315

REGULATION 5. Occupancy of sleeping rooms. No room in any rooming house, lodging house or hotel shall be occupied as a sleeping room unless there are at least four hundred (400) cubic feet of air space and 50 square feet of floor space for each adult and at least two hundred (200) cubic feet of air space and 30 square feet of floor space for each child under the age of twelve years occupying such room for sleeping purposes. No room used for sleeping purposes shall have a floor area of less than 60 square feet. REGULATION 6. Ventilation of sleeping rooms. Each sleeping room in any rooming house, lodging house or hotel shall be adequately ventilated and shall have window space, opening on street, yard or court, of not less than one-tenth of the floor area of such room, and windows shall be made to open to the extent of not less than one- twentieth of the floor area of such room. REGULATION 7. Toilet facilities. In every rooming house, lodging house or hotel there shall be at least one water closet for each ten (10) persons or fraction thereof, which water closet shall be within and accessible from within the building. REGULATION 8. Washing and bathing facilities. In every rooming house, lodging house or hotel there shall be provided an adequate number of wash basins and baths. REGULATION 9. Water supplies and sinks. In every rooming house, lodging house or hotel there shall be a water service with sink and drain within every dwelling unit containing two or more rooms where there are facilities for the preparation and cooking of food. REGULATION 10. Cooking. Where more than two persons occupy any dwelling unit in any rooming house, lodging house or hotel, the preparation and cooking of food shall not take place in any room used for sleeping purposes. REGULATION 11. Plumbing. All plumbing, water closets and other plumbing fixtures in every rooming house, lodging house or hotel shall be maintained in good order and repair and in accordance with the requirements of the city plumbing code and regulations. REGULATION 12. Occupancy of basement rooms. No room in the basement or cellar of any rooming house, lodging house or hotel shall be occupied for sleeping purposes unless: 1. The clear inner height is at least 7 feet 6 inches, and 2. The uppermost 3 feet of the required clear inner height is above the average outside ground level, and 3. The floor and walls are water and damp proof in accordance with an approved method, if in contact with earth. Such waterproofing shall be between the floor or wall finish and the ground. REGULATION 13. Garbage, ash and rubbish receptacles. Every rooming house, lodging house or hotel shall be provided with a sufficient number of receptacles to contain all garbage, ashes and rubbish that may accumulate during the usual interval between collections thereof, and all such receptacles shall at all times be maintained in good order and repair. Receptacles for garbage shall be made of metal, water-tight and provided with tight covers. REGULATION 14. Heating equipment. The heating equipment in every rooming house, lodging house or hotel shall be maintained in good order and repair. 316 REPORT OF THE HEALTH DEPARTMENT-1942

REGULATION 15. Lighting of public halls. In every rooming house, lodging house or hotel where the public halls and stairs are not, in the opinion of the Commissioner of Health, sufficiently lighted by natural daylight, the permitee shall keep such adequate lights burning in the hallways and near the stairs as may be necessary day or night in order to prevent fire hazard or other accident. REGULATION 16. Exits and fire protection equipment. In every rooming house, lodging house or hotel there shall be such exits and fire protection equipment as may be required by the City Buildings Engineer or the Fire Department. Date adopted: March 11, 1942. Date effective: March 12, 1942.

Commissioner of Health.

MATERNITY HOSPITAL REGULATIONS GENERAL PROVISIONS REGULATION 1. Fire protection. Every applicant for a license to conduct a maternity hospital shall procure from the Board of Fire Commissioners a certificate to the effect that the building and premises for which the license is desired are free from fire hazards and comply with all fire laws, ordinances, rules and regulations applicable thereto and designed for fire prevention and control. Such certificate shall be filed - with the Commissioner of Health at the time the application for license is made. REGULATION 2. License to be posted. In each maternity hospital the license from the Commissioner of Health shall be kept posted by the licensee in a conspicuous place and a copy of the rules and regulations governing maternity hospitals shall be kept on file by such licensee.

MATERNITY AND DELIVERY ROOM UNITS REGULATION 3. Separate maternity unit. The maternity ward or unit shall be maintained separate and apart from any medical, surgical or gynecological service not intimately concerned with the delivery or puerperal period. REGULATION 4. Isolation quarters. There shall be adequate isolation quarters for infected mothers in every maternity hospital. A mother shall be deemed infected (1) if she is a carrier or suspected carrier of or affected with a communicable or suspected communicable disease or condition in which case she should be removed, if possible, to a communicable disease hospital; or (2) if she nurses an infected baby; or (3) if she is not delivered in the maternity hospital in which she later receives care. Infected mothers shall be immediately isolated. REGULATION 5. Examination of personnel on maternity or associated service. All personnel on duty on any maternity service or on any associated service such as that provided for the newborn, when these regulations take effect, shall be examined promptly by a physician designated by the hospital superintendent and be certified by him as showing no evidence of communicable disease or respiratory disease in a communicable state. All new personnel shall be similarly examined prior to assignment to any maternity or associated service. All personnel on duty on any maternity or associated service shall report immediately to some physician who shall be available at all times under designation from the hospital superintendent the presence of any communicable disease APPENDIX 317 in the infectious stage, as in the case of sore throat or common cold; such individual or any individual absent from duty because of any communicable disease or exposure thereto shall be excluded from the maternity or associated service until examined by the physician designated for the purpose and certified by him to the superintendent as not suffering from any condition that may endanger the health of the mothers or infants. REGULATION 6. Examination of maternity patients. All maternity patients shall on admission or as soon thereafter as possible have a complete history taken and a thorough physical examination made. An inquiry shall also be made on admission as to any infection or exposure to infection. All newborn infants shall have detailed case history records kept of their progress while in the hospital. REGULATION 7. Visitors and visiting hours. Visiting hours to maternity services shall be set at times so as not to coincide with the hours when the newborn infants are in the maternity ward or rooms for nursing by their mothers. Visiting permitted on maternity services shall be kept to a minimum. Visitors or individuals or staff members such as physicians and nurses not connected with the direct care of infants shall not be permitted at any time to enter any nursery for the newborn. Children under twelve years of age shall be prohibited admittance to any maternity ward at any time. REGULATION 8. Maintenance. All maternity, nursery, or isolation quarters and the halls adjacent thereto shall be adequately and properly lighted, ventilated and heated, and shall be kept free from insects and vermin and in compliance with the provisions of Section 148 of Article 16 of the Baltimore City Code of 1927 and with the provisions of Baltimore City Ordinance No. 384, approved March 6, 1941. These rooms and hallways shall at all times be maintained in good repair and in a clean and sanitary condition. Their walls and ceilings shall be so constructed as to be easily cleaned and washed. Each nursery shall be provided with running hot and cold water faucets with foot or elbow control. All nurseries and isolation quarters shall be provided with covered receptacles, with foot control, containing a cloth or paper bag for the temporary disposal of soiled linen, diapers and waste. There shall be separate receptacles for soiled diapers and linens. Such soiled articles shall be removed at least three times a day from the nursery or isolation quarters. Dry dusting or sweeping shall not be permitted in any nursery or adjoining hallway. REGULATION 9. Sanitary equipment. All nurseries, isolation quarters, formula rooms, examining rooms, labor and delivery rooms, and maternity rooms or wards, shall have adequate facilities for the scrubbing of hands, suitable disinfectant solution, and receptacles for the efficient temporary disposal of soiled linens and waste. All plumbing, plumbing fixtures, sterilizers and other similar equipment shall be so constructed, installed and maintained as to prevent cross connections or other sanitary hazards, as required by State and city regulations. REGULATION 10. Equipment. Equipment of delivery rooms shall be limited to instruments and supplies necessary for immediate use. All other equipment and supplies shall be kept in outside supply rooms. All labor and delivery room units shall be equipped with adequate and proper apparatus and supplies for safeguarding the lives of the mothers and the newborn infants, such as suction facilities, oxygen, facilities for transfusion of mother or infant and a warm bed for the infant. REGULATION 11. Maternity ward technique. All physicians, nurses and other hospital personnel before attendance on maternity patients shall remove coats or other outer clothing, wash hands, and put on clean gowns or coats. 318 REPORT OF THE HEALTH DEPARTMENT-1942

REGULATION 12. Labor and delivery unit. There shall be provided and maintained a separate labor and delivery room unit with separate equipment for the delivery of normal or clean operative obstetric cases. Another such unit for the delivery of ill or infected mothers should be provided, but if the latter is not practicable and the delivery of an ill or infected mother is carried on in the unit used for normal or clean operative obstetric cases, the same shall be immediately and thoroughly cleansed, closed for twenty-four hours if possible, and the equipment resterilized. REGULATION 13. Delivery room technique. Delivery room technique shall be in accordance with recognized and approved surgical operative technique. NURSERIES FOR THE NEWBORN REGULATION 14. Medical staff. The hospital medical board or other governing body shall designate whether the nurseries for the newborn are under the supervision of the obstretric or pediatric service. Such designation shall be available for the information of any representative of the Commissioner of Health. REGULATION 15. Number of nurseries. Every maternity hospital shall maintain in good order at least two separate nurseries, one for the care of normal newborn infants, and a separate nursery for the care of premature or immature infants, and such separate nurseries shall be used for such infants. In addition, provision shall be made for the isolation and separate observation of infants infected or suspected of being infected with any communicable disease, and for the separate observation of infants which have had ritual circumcision. Infected infants shall not be kept in any room or nursery where there are non-infected infants. An infant shall be deemed infected (1) if born to a mother who is a carrier or suspected carrier of or affected with a communicable or suspected communicable disease or condition, (2) if born with a communicable disease, or (3) if a communicable disease has been acquired after birth. REGULATION 16. Equipment. Equipment of the nurseries shall be limited to furnishings and supplies necessary for the immediate care of the infants. REGULATION 17. Outside deliveries. Infants delivered outside of the maternity hospital shall not be admitted to the nursery for normal newborn infants. They shall be kept isolated from all other infants for not less than 72 hours after admission and until the period of possible infectivity is over. REGULATION 18. Spacing of bassinets. The spacing between bassinets in all nurseries or isolation quarters shall be maintained at a distance of not less than six inches, with the provision of adequate aisle spacing of not less than two feet. The suspension of bassinets on double tier racks shall be prohibited. REGULATION 19. Formula room. A formula room or suite shall be maintained in all maternity hospitals, specifically for its own purposes, completely separated from any diet kitchen, pantry, scullery or,. other place of food storage or preparation. Such formula room or suite shall be provided with adequate refrigeration facilities for formulas and milk supplies, and with adequate sterilization facilities for the sterilization of bottles, nipples, bottle caps and other formula preparation utensils. Any nurse or dietitian preparing or assisting in the formula room or suite in the preparation of formulas for infants in a nursery for the newborn shall, before beginning such duties, remove her outer garments, scrub and disinfect her hands and put on, for single use only, a clean gown and cap and mask. An aseptic technique shall be maintained at all APPENDIX 319 times. Each infant shall have its individual set of properly labeled bottles sufficient for a day's feeding. The storing of formula feedings in bulk is prohibited.

REGULATION 20. Sterilization. All bottles used for feeding infants shall be cleaned before return to the formula room or suite for sterilization. Anything coming in contact with or introduced within the infant's nose or mouth must be made sterile and handled only by a person who has scrubbed and disinfected the hands with 70 per cent alcohol or by using some other approved method. All tongue depressors, applicators, ear specula and other examining instruments shall be standard nursery equipment and separate sets shall be maintained for each nursery and for isolation quarters, and shall be sterilized before use for each baby. The bowls of stethoscopes shall be cleaned with a proper solution of alcohol, cresol or other disinfectant before use for each baby. All gauze, cotton, swabs or other materials intended for use in the care of an infant shall be sterilized and kept or stored in sterile containers.

REGULATION 21. Nursing staff. A separate nursing staff, under the supervision of a registered graduate nurse, shall be maintained both day and night in the nurseries used for the care of the newborn. Not more than twelve infants shall be under the care of any one individual nurse at any time. In the care of premature or immature infants in special nurseries as required in Regulation 15 one nurse shall be assigned full time to the care of these, both day and night, when the number of these shall reach 4, and a second nurse when the number shall reach 8, and in this proportion thereafter. In this regulation and Regulation 15 an infant shall be considered a premature infant if its weight at birth is less than 53/ pounds. Nurses assigned to formula room duty shall not do any type of work which may bring them in contact with septic or infected infants or adults in any part of the hospital. Where it is impossible to supply graduate or student nurses in the number required in this regulation auxiliary nursing personnel may be used provided there is adequate supervision.

• REGULATION 22. Technique. A common dressing, bathing or diapering table may be used if such table is draped with sterile linen or suitable clean paper sheeting for each infant immediately before use. The weighing scale shall be draped with sterile linen or suitable clean paper sheeting for the weighing of each infant immediately before each use. Individual sterilized rectal thermometers shall be provided for each infant while in the hospital. The thermometers shall be sterilized after each use by washing thoroughly in soap and water and thereafter by wiping with alcohol.

REGULATION 23. Nurses technique. Nurses assigned to the nurseries shall wash their hands thoroughly with soap and running water immediately after changing or diapering each infant and before making preparations for feeding the infant. If at any time during the feeding of any infant it becomes necessary to handle or change the nipple of a feeding bottle, the nurse in order to prevent the spread of communicable disease shall scrub her hands thoroughly with soap and running water. All nurses assigned to the isolation quarters shall be prohibited from entering any nursery for newborn or premature infants, and shall not be assigned to such duty for at least seven days following completion of service in any isolation nursery. No private nurse may be admitted to any nursery unless she complies fully with Regulation 24 next below. No person shall enter the nurseries or the isolation quarters except those immediately concerned with the care of the newborn. 320 REPORT OF THE HEALTH DEPARTMENT-1942

REGULATION 24. Technique for attendants In nursery. All physicians, nurses, and other hospital personnel in attendance on infants in any of the nurseries or isolation quarters for the newborn shall remove coats or other outer clothing, bare their arms to the elbows, wash their hands and arms thoroughly with soap and running water and put on clean gowns and masks. In addition, they shall wash their hands with soap and running water and immerse them in a suitable disinfectant solution before the handling of each infant. Infants shall be handled as little as possible and in strict accordance with aseptic procedure. REGULATION 25. Feeding technique. The mother's breasts shall be thoroughly cleansed with boric acid or some other suitable substance before each nursing and she shall wash her hands with 70 per cent alcohol before receiving the infant. A clean towel shall be spread out on which to place the infant while nursing. REGULATION 26. Laundry. All nursery linens, including diapers and articles of infant's clothing, shall be laundered separately from linens from other parts of the hospital, in a separate apparatus, or in the same apparatus at definite periods set aside for the laundering of these nursery linens only. Such sterilization shall consist of boiling the linens in water for fifteen minutes and thoroughly rinsing them in clean water; or of any other method of sterilization that has been approved. REGULATION 27. Ritual circumcision. In maternity hospitals where ritual circumcision is done, a room shall be maintained for this purpose which shall be separate from all other rooms occupied by any infant and separated from the family and visitors by a glass partition. The infant shall not be returned to the regular nursery for newborn but shall be kept under observation in separate quarters for at least forty-eight hours after circumcision. Date adopted: April 11, 1942. Date effective: August 1, 1942.

Commissioner of Health.

TRAILER CAMP REGULATIONS REGULATION 1. Definitions. When used in these regulations, the term "trailer camp" means any tract or parcel of land, maintained, offered, or used for the parking or camping of any house trailer, house car, or similar mobile dwelling; and the term "house trailer" means any house trailer, house car, trailer home or similar mobile dwelling, whether on wheels or from which the wheels have been removed. REGULATION 2. Regulations to be posted. A copy of these regulations shall be conspicuously posted and displayed in every trailer camp and shall remain so posted at all times. REGULATION 3. Supervision.- Every trailer camp shall have at least one competent attendant or caretaker whose duty it shall be to maintain the camp, its facilities and equipment in a clean and sanitary condition. A written record shall be kept of each house trailer in any such trailer camp, including the name and address of the owner of such house trailer, the license number and state of origin of each car and house trailer, and the full names and ages of all the occupants of each house trailer. Such records shall be available at all times for the inspection of the Commissioner of Health. APPENDIX 321

REGULATION 4. Sanitation of premises. Every trailer camp and all structures and equipment therein shall be kept in a clean and sanitary condition at all times. REGULATION 5. Drainage. Every trailer camp site shall be located on a well drained area and shall be properly graded J3o as to prevent the accumulation of storm water or other water or liquid wastes. REGULATION 6. Water supply. An adequate and approved supply of safe water under pressure shall be provided to meet the requirements of every trailer camp. The water supply shall be placed so that no house trailer is located more than 100 feet from a water supply outlet. REGULATION 7. Toilet facilities. Toilet facilities of a design and construction approved by the Commissioner of Health and marked by appropriate signs shall be provided at every trailer camp so there shall be at least one for males and one for females. There shall be provided one such toilet for each 20 males or fraction thereof and one for each 20 females or fraction thereof occupying any trailer camp. No house trailer shall be located more than 200 feet from the required toilets. REGULATION 8. Sewage disposal. In any trailer camp where the city sewage disposal system is not accessible sewage shall be disposed of in a manner that will not create a nuisance or a health hazard and by methods approved by the Commissioner of Health. \ REGULATION 9. Slop sinks. There shall be at least one slop sink with running water for every 30 persons or fraction thereof occupying any trailer camp. No house trailer shall be located more than 200 feet from a slop sink. REGULATION 10. Washing facilities. There shall be provided one shower bath or one bath tub with hot and cold water for each 30 males or fraction thereof, and separately provided one such shower bath or bath tub for each 30 females or fraction thereof occupying any trailer camp. There shall be one wash basin with running water for each 15 persons or fraction thereof occupying any trailer camp. REGULATION 11. Garbage and rubbish. Every trailer camp shall be provided with a sufficient number of receptacles conveniently located to contain all garbage and rubbish, and all such receptacles shall at all times be maintained in good order and repair. Receptacles for garbage shall be made of metal, water-tight and provided with tight covers. REGULATION 12. Refuse and waste disposal. No waste material of any kind shall be thrown or deposited on a trailer camp site or on any adjoining property. Garbage and rubbish shall be disposed of in a manner that will not create a nuisance or a health hazard and by methods approved by the Commissioner of Health. Plumbing fixtures in house trailers when in use shall be connected to the city sewer system or the drainage therefrom shall be disposed of in a manner approved by the Commissioner of Health. REGULATION 13. Lighting. All toilets, showers, tubs and washing facilities in every trailer camp shall be provided with artificial illumination that will be continuously available between sunset and sunrise. REGULATION 14. Communicable diseases. It shall be the duty of the owner or operator of every trailer camp to report immediately to the Commissioner of Health all known or suspected cases that shall occur in such trailer camp of any communicable disease which is listed on the standard communicable disease report card for Baltimore City. 322 REPORT OF THE HEALTH DEPARTENT--1942

REGULATION 15. Construction permits. Every trailer camp shall be established and constructed under the necessary permits and in accordance with all existing ordinances, codes and regulations. REGULATION 16. Fire protection. The owner or operator of every trailer camp shall prior to any use or occupancy thereof procure from the Board of Fire Commissioners a certificate to the effect that the premises are free from fire hazards and comply with all fire laws, ordinances, rules and regulations applicable thereto and designed for fire prevention and control. A copy of such certificate shall be filed with the Commissioner of Health prior to any use or occupancy of any such trailer camp. Date adopted: April 23, 1942. Date effective: April 30, 1942. / 111 Commissioner of Health.

REGULATION GOVERNING THE HANDLING AND SALE OF MILK AND MILK PRODUCTS REGULATION 1. Definitions. When used in these regulations, the term "person" means a corporation, association, firm or individual; the term "producer" means a person who maintains cows for the purpose of obtaining milk for sale as such; the term "milk plant" means any place where milk or cream is received, processed, stored, pasteurized, bottled or otherwise handled; the words "milk or cream" mean milk, cream, sour cream, skimmed milk, chocolate milk, buttermilk or other fermented milk; the term "bulk milk" means milk sold or delivered in containers exceeding two quarts in capacity. Date adopted: November 23, 1928. Dates amended: August 15, 1936; March 13, 1939, and May 20, 1942. Date effective: May 25, 1942.

Commissioner of Health. INDEX Page Accidental deaths 13 Adams, George G. 140 Administration 16 Advisory Committee on Sanitation 5 Andrew, David H 29 Appendix 311 Armistead Gardens 28, 109 Arsenic poisoning 158 Assistant Commissioner of Health . 61 Babies Milk Fund Association. 38, 163 Backus, Langdon G 66 Bacteriology 80 Badger, George 1? 20 Baltimore Health News 20, 72 Baltimore Housing Authority 9, 27 Mobilization Committee 10 Venereal Disease Council 10 Beryllium poisoning . 157 Betz, Gwendolyn B 32, 129 Bibliography 51 Biologic products 81 Births certificate transcripts 18 records 19 reported 65 unreported 165 Blake, Eleanor 110 Blood lead examinations 158 Boarding homes for children 38, 166 Bowman Dairy 203 Brooklyn-Fairfield housing project 190 Buck, T. C., Jr 25, 82 Cancer 13 Chemistry 81 Chickenpox 12 Child hygiene 37, 163 City Housing Authority. 9, 27 Collapse therapy for ex-sanatorium patients 141 Collier, Ruth 42 Commissioner of Health 10 Communicable diseases 28, 117, 190 Community sanitation 228 Consultants 5 Couchman, Charles E 158 Dairy farm inspection 204 Deaths causes 13 diphtheria 29 rate 32, 33 Dental hygiene 41, 185 Diarrhea and enteritis 13 Diphtheria 12,29, 117 prevention 28,29, 166 resident deaths 29 toxoid 30 Division of Morgue and Public Cemetery 66 Druid health Center 9,27, 101

[323] 324 REPORT OF THE HEALTH DEPARTMENT-1942

Page Dysentery 13 Eastern Health District 25, 95 Educational director 9, 189 Environmental hygiene 48, 227 Exhibits 72, 22 Financial statement 16 Food control 46, 211 poisoning 213 Freeman, Allen W. 27, 61 Hanauer, Bert 72 Harman, Lilly 41 Hazardous fumes 227 Health Conservation Contest 10 IIealth Districts See Eastern, Western and Southeastern Health Districts Health information 20, 71 Health of the city 10 Heart disease 13 Housing 9, 20, 28, 43, 197, 230 Hygiene of Housing, regulations 312 Ice cream. 205 Industrial hygiene • 10, 49, 117, 227 Infant mortality 11, 13, 163 Infant and preschool hygiene clinics 163, 165, 189 Influenza bacillus meningitis 32, 81, 130 Johns Hopkins School of Hygiene and Public Health 61, 95, 157 Kallinsky, Ethel 42 Kaplan, Emanuel 25, 36, 82 "Keeping Well" drama series 20, 71 Keller, Anita 42 Kemp's Dairy 44, 203 Krauter, Robert R. 19, 66 Laboratories 23,79 Lagna, Henrietta 42 Lee, C. Dudley 140 Licensed Children's Institutions 38, 166 Low Rent Housing Survey 20 Manufacturing food establishments 212 Marty, Ivan M. 45 Maryland Tuberculosis Association 26 Maternal mortality 11, 163, 167 Maternity hospitals 168 Maternity hygiene 167, 189 Measles 12, 119 Meat inspection 47, 221 Medical staff 6 Meningococcus meningitis 11, 28, 117, 130 Midwives 168 Milk control 44, 203 Milk ordinance, amendment 311 Monroe, C. L E. 35 Moore, Howard A. 19, 66 Morgue and public cemetery 66 National Health Honor Roll 10 Occupational diseases 35, 157 Ophthalmia neonatorum 38, 164 Ordinance, milk 311 Parks Edwards A. 158 Pasteurized milk 205 Perkins Homes 37, 109 Personnel on war duty 17 INDEX 325

Page Pestilences, Baltimore Conquers Its 14, 15 Physicians' Conference on Maternal Mortality. 37, 163 Pincoffs, Maurice C. 17 Plumbing 232, 312 Pneumococcus meningitis 32, 130 Pneumonia, serum for. 82 Poliomyelitis ,. .13, 31, 119 Population 10 Prenatal clinics 28, 163 Preschool hygiene clinics 109 Principal causes of death 13 Public health nursing 9,41, 164, 189 Publications, Health Department 55 Rabies 31, 119 Radio broadcasts 20, 71, 75 Reed, Lowell J 20 Regulations IIygiene of housing 312 Maternity Hospital 316 Milk, handling and sale of 322 Plumbing 312 Rooming Houses 314 Trailer Camps 320 Reinhard, Ferdinand 0 34 Resident births 163 death rate 13 Retail food establishments 211 Rodent control 229 Sanitary Milk Production Contest. 203 Sanitary section 42, 197 Scarlet fever 12 School health service 25,26,28, 101, 109 School hygiene , 39, 179, 190 Seeman, Isadore 19, 66 Selenium 157 Serologic tests for syphilis 23 Sewer connections 228 Shea, Irene F. 31, 129 Smallpox 31, 119 Vaccination clinic 28, 29 Social Security funds 16, 62 Southeastern Health District 27, 109 Sydenham Hospital 31, 129 Sulfonamide drugs 11, 31 Swimming pools 229 Trailer camps 231, 320 Toxic dusts 227 Tuberculosis 12, 32, 139, 191 Typhoid fever 13, 30, 118 U. S. Office of Civilian Defense 10 Venereal diseases 11, 34, 149 Visual education 72 Vital statistics 18, 65, 245 War, Personnel on Duty 17 Western Health District 26, 101 Wholesale food establishments 212 Whooping cough 12, 119 Work Projects Administration 61, 66