Published weekly by the Department of Health, City of New York, 505 Pearl St., New York, N. Y. Entered as Second-Class matter October 16, 1917, at the Postoffice at New York, N. Y. Under Act of March 3, 1879. Subscription, 10 cents per annum. ROYAL S. COPELAND, M. D., Commissioner of Health. NEW SERIES, Vol. XI. JANUARY 14, 1922. No. 2. 1 EXTENSION OF PRENATAL WORK. The Maternity Center Association of New York City is co-operating with the Department of Health in extending its prenatal service in the Borough of Manhattan. The Association will furnish doctors and nurses to hold clinics for expectant mothers in certain Baby Health Stations maintained by the Department, as follows: Tuesday-326 East 11th Street and 43 East 133rd Street, 2 to 4 p. m. Thursday-214 Monroe Street and 289 Tenth Avenue, 2 to 4 p. m. Friday, 315 East 12th Street and 2842 Eighth Avenue, 2 to 4 p. m. The doctors and nurses attached to the Baby Health Stations will co-operate in the maintenance of these prenatal clinics. It has been amply demonstrated that proper prenatal instruction has a definite effect in reducing the maternal mortality rate and the infant death rate during the first month of life. At the present time, the deaths occurring in the first month of life furnish, approximately, 45 per cent of our total infant mortality rate or deaths under one year of age. Definite and decided decreases in the infant death rates from diarrhoeal, respiratory and contagious diseases have occurred during the past twenty years. The death rate from congenital diseases, which occur mainly during the first month of life, has shown little, if any, decline. Numerically, the number of deaths from this cause is higher for 1921 than for 1920, notwithstanding that the infant death rate, as a whole, was 71 for 1921, as against 85 for 1920. As a sufficiently large appropriation to extend the prenatal service of the Department's Bureau of Child Hygiene is not, at present, available, we welcome the cooperation of interested organizations who are working to reduce the maternal death rate and the early infant death rate by furnishing instruction to expectant mothers during the prenatal period. FURTHER CLINICS FOR THE CRIPPLED. Further Lorenz Clinics will be held for the general public according to the following schedule: Queens Richmond January 27 January 30 These clinics will begin at 10 a. m., and are to be held at the various Borough headquarters of the Department, except in The Bronx, where the Baby Health Station, at 428 East 133rd Street, has been selected for the purpose. An operative demonstration clinic for physicians was held at Gouverneur Hospital, yesterday (January 13). NEW REGULATIONS FOR BATHING ESTABLISHMENTS. At a meeting of the Board of Health of the Department of Health of the City of New York, held in the said city on the 22nd day of December, 1921, the following resolution was duly adopted: RESOLVED, That the regulations governing the establishment and maintenance of bathing establishments, and relating to sections 340 and 341 of the Sanitary Code, be and the same are hereby amended by the addition of a new regulation to read as follows: Regulation 7-A. No bathing establishment shall be maintained or conducted in any building, structure, room, enclosure, place or premises wherein bathing suits are hired out or which for hire are used for the purpose of dressing or undressing in connection with the wearing, putting on or taking off of bathing suits unless the proprietor of such establishment submit proof satisfactory to the Board of Health that the patrons of same shall have access to a pool or beach which is provided with life lines and life saving appliances as required by the Sanitary Code and the rules and regulations of the Board of Health. A TRUE COPY, CHARLES L. KOEHLER, Secretary. FOOD POISONING. As the Department is desirous of securing reports of cases of food poisoning, as stated in a recent number of the Bulletin, we quote the following for the information of readers: "Food Infections." "Students of the. subject now believe that practically all instances of food infections are due to the bacillus of Gaertner (B. enteritidis), which is taken as the type of a group of closely allied organisms. Instances of food "poisoning" caused by B. enteritidis are rare in this country; at least very few outbreaks have been described. They occur more frequently on the continent of Europe and occasionally in England. "The symptoms of food infection are essentially those of an acute gastro-intestinal irritation, namely, nausea, vomiting, abdominal pain and diarrhea. The onset is usually sudden. The attack may be ushered in with headache and a chill. The abdominal pain is frequently the first symptom, and may be griping and severe. The diarrhea usually consists of repeated bowel actions, which as a rule are offensive. Later in the attack, the stools become more watery and are frequently of a green color. Faintness, muscular weakness and prostration may be quite marked. Thirst is always present. There is almost always a rise of temperature, usually to about 102 or 103 F. Various nervous manifestations, such as restlessness, muscular twitchings and drowsiness, may occur, but these symptoms are not constant or marked. Oliguria is often present. Herpes and other skin rashes have been noted. The clinical picture is that of an acute, self-limiting febrile infection. "The severity of the symptoms varies greatly in different outbreaks, and even in the same outbreak. All degrees are encountered, from fulminating cases, fatal within twenty-four hours, to those of slight diarrhea and malaise, insufficient to keep the patient from work. Usually the attack is over in a day or two, with prompt recovery, although occasionally marked prostration may persist. The severity doubtless depends on the virulence of the particular strain of bacilli concerned, the length of time it had to grow upon the incriminated food before consumption, and the temperature of growth. The symptoms vary with the dose, that is, with the number of bacteria ingested with the food. The susceptibility of the individual also plays an important role in this, as in other infections. The severity of the symptoms, therefore, may be due to a number of complicating causes, some of which are not understood. "Usually from six to twelve hours elapse between the ingestion of the food and the onset of symptoms, though occasionally the period of incubation is four or less, and it may be seventy-two hours or more. Not only does the incubation period vary in different outbreaks, but in the same outbreak widely different incubation periods have been noted. It is natural to accuse the food vomited as the food responsible for the trouble, but frequently several meals elapse between the ingestion of the infected food and the onset of symptoms. It is a common mistake to accuse the wrong food. "The case fatality rate varies greatly in different outbreaks. In the 112 British outbreaks studied by Savage, there were some 6,190 cases with ninety-four deaths, a case fatality rate of 1.5 per cent. "The age and sex distribution depends entirely on the accidental age and sex distribution of those who eat the infected food. "Most cases occur in the summer time, the disease corresponding in seasonal prevalence to typhoid fever, cholera, dysentery and other intestinal infections. The bacilli responsible for food infection grow in the food before it is eaten, and therefore temperature is a very important factor. The greater multiplication of these bacteria in hot weather also increases the opportunities for transmission of infection through flies and other means. Secondary infections rarely occur. There is the same potential possibility of contact infection as in typhoid fever, but the cases of food infection are for the most part acute and of short duration, so that there is little opportunity for secondary infection. Furthermore, human carriers are very infrequent. "The great majority of outbreaks of food infections are due to meat foods; hence, the frequent use of the term "meat poisoning" in this connection. Of the 112 British outbreaks, in twenty-one the vehicle was a non-flesh food; that is, milk, one; cream, one; ice cream, six; potatoes, two; pineapple jelly, one; peaches, one; rice cooked in fat, one. The remaining ninety were all due to flesh meat. The meat of the pig or ox accounts for 68 per cent. of the British and 61 per cent of the continental outbreaks. The almost complete absence of outbreaks due to the meat of the sheep is striking. The number of cases ascribed to fish is small. "Most outbreaks are due to some form of prepared meat foods, such as brawn, meat pies, sausage and chopped meat. When the nature of the infection is considered, it becomes obvious that the more the food is handled and the longer it lies around, the greater the opportunity for it to become contaminated and for the bacteria to grow and multiply. "It cannot be too strongly emphasized that in the vast majority of outbreaks of food infection the food affected is not noticeably altered in either appearance, taste or smell. The prevalent idea that poisonous food must be 'tainted' still persists, although long exploded. Bacilli belonging to the Gaertner bacillus group cannot be detected in food or water, any more than the typhoid bacillus, dysentery bacillus or cholera vibrio can be detected with the unaided senses. "In the Ghent outbreak, investigated by van Ermengem in 1895, a slaughterhouse inspector (a veterinary surgeon) was so certain that the suspected meat (saveloy), in the absence of any abnormal signs, could have no connection with the trouble that he ate two or three pieces of it to demonstrate its harmlessness. He was attacked with severe cholera-like symptoms and d`ed five days later, the Gaertner bacillus being recovered postmortem. "In a few outbreaks, however, minor peculiarities of the food have been noted, These clinics will begin at 10 a. m., and are to be held at the various Borough headquarters of the Department, except in The Bronx, where the Baby Health Station, at 428 East 133rd Street, has been selected for the purpose. An operative demonstration clinic for physicians was held at Gouverneur Hospital, yesterday (January 13). NEW REGULATIONS FOR BATHING ESTABLISHMENTS. At a meeting of the Board of Health of the Department of Health of the City of New York, held in the said city on the 22nd day of December, 1921, the following resolution was duly adopted: RESOLVED, That the regulations governing the establishment and maintenance of bathing establishments, and relating to sections 340 and 341 of the Sanitary Code, be and the same are hereby amended by the addition of a new regulation to read as follows: Regulation 7-A. No bathing establishment shall be maintained or conducted in any building, structure, room, enclosure, place or premises wherein bathing suits are hired out or which for hire are used for the purpose of dressing or undressing in connection with the wearing, putting on or taking off of bathing suits unless the proprietor of such establishment submit proof satisfactory to the Board of Health that the patrons of same shall have access to a pool or beach which is provided with life lines and life saving appliances as required by the Sanitary Code and the rules and regulations of the Board of Health. A TRUE COPY, CHARLES L. KOEHLER, Secretary. FOOD POISONING. As the Department is desirous of securing reports of cases of food poisoning, as stated in a recent number of the Bulletin, we quote the following for the information of readers: "Food Infections." "Students of the, subject now believe that practically all instances of food infections are due to the bacillus of Gaertner (B. enteritidis), which is taken as the type of a group of closely allied organisms. Instances of food "poisoning" caused by B. enteritidis are rare in this country; at least very few outbreaks have been described. They occur more frequently on the continent of Europe and occasionally in England. "The symptoms of food infection are essentially those of an acute gastro-intestinal irritation, namely, nausea, vomiting, abdominal pain and diarrhea. The onset is usually sudden. The attack may be ushered in with headache and a chill. The abdominal pain is frequently the first symptom, and may be griping and severe. The diarrhea usually consists of repeated bowel actions, which as a rule are offensive. Later in the attack, the stools become more watery and are frequently of a green color. Faintness, muscular weakness and prostration may be quite marked. Thirst is always present. There is almost always a rise of temperature, usually to about 102 or 103 F. Various nervous manifestations, such as restlessness, muscular twitchings and drowsiness, may occur, but these symptoms are not constant or marked. Oliguria is often present. Herpes and other skin rashes have been noted. The clinical picture is that of an acute, self-limiting febrile infection. "The severity of the symptoms varies greatly in different outbreaks, and even in the same outbreak. All degrees are encountered, from fulminating cases, fatal within twenty-four hours, to those of slight diarrhea and malaise, insufficient to keep the patient from work. Usually the attack is over in a day or two, with prompt recovery, although occasionally marked prostration may persist. The severity doubtless depends on the virulence of the particular strain of bacilli concerned, the length of |