OFFICES.

Headquarters, S. W. corner Centre and Walker Streets, Manhattan.
Telephone-6280 Franklin.

Borough of The Bronx.3731 Third Avenue....

Telephone 1975 Tremont. Borough of Brooklyn..Flatbush Ave. and Willoughby St.Telephone 4720 Main. Borough of Queens....372-374 Fulton St., Jamaica, L. I..Telephone 1200 Jamaica. Borough of Richmond. 514-516 Bay St., Stapleton S. I.... Tel. 440 Tompkinsville. Office Hours-9 a. m. to 5 p. m. Saturdays, 9 a. m. to 12 m. HOSPITALS FOR CONTAGIOUS DISEASES.

Manhattan.

Willard Parker Hospital. Foot of East 16th Street. Telephone 1600 Stuyvesant. The Bronx.

Riverside Hospital. North Brother Island. Telephone 4000 Melrose. Brooklyn.

Kingston Ave. Hospital. Kingston Ave. and Fenimore St. Tel. 4400 Flatbush. LABORATORIES.

Diagnosis Laboratory, Centre and Walker Streets. Telephone, 6280 Franklin. Serological Laboratory, Centre and Walker Streets. Telephone, 6280 Franklin.

Manhattan.

Research Laboratory.
Vaccine Laboratory.
Foot of East Sixteenth Street:

I. 172 East 3d Street 2. 513 East 11th Street 3. 281 Avenue A 4. 240 East 28th Street 5. 225 East 107th Street 6. 241 East 40th Street 7. 174 Eldridge Street 8. Vanderbilt Clinic 9. 326 East 11th Street Brooklyn.

Chemical Laboratory.
Drug Laboratory.
Telephone 1600 Stuyvesant.

INFANTS' MILK STATIONS.
10. 114 Thompson Street
II. 315 East 112th Street
12. 244 Mulberry Street
13. 508 West 47th Street
14. 78 Ninth Avenue
15. 421 East 74th Street
16. 205 East 96th Street
17. 209 Stanton Street
18. 2287 First Avenue

I. 268 South 2d Street 2. 660 Fourth Avenue 3. 208 Hoyt Street 4. 176 Hudson Avenue 5. 2346 Pacific Street 6. 184 Fourth Avenue 7. 359 Manhattan Avenue 8. 49 Carroll Street The Bronx.

I. 511 East 149th Street Queens.

9. 69 Johnson Avenue
10. 233 Suydam Street
II. 329 Osborne Street
12. 126 Dupont Street
13. 651 Manhattan Avenue
14. 185 Bedford Avenue
15. 296 Bushwick Avenue
16. 994 Flushing Avenue

2. 1354 Webster Avenue

1. 114 Fulton Avenue, Astoria, L. I.

Richmond.

1. 689 Bay Street, Stapleton, S. I.

Manhattan

Gouverneur Slip

19. 108 Cherry Street
20. 122 Mulberry Street
21. 207 Division Street
22. 73 Cannon Street
23. 110 Suffolk Stree
24. 96 Monroe Street
25. 251 Monroe Street
26. 289 Tenth Avenue
27. 74 Allen Street

17. 176 Nassau Street
18. 129 Osborn Street
19. 698 Henry Street
20. 552 Sutter Avenue
21. 167 Hopkins Street
22. 604 Park Avenue
23. 239 Graham Avenue
24. 49 Amboy Street

CLINICS FOR SCHOOL CHILDREN.

Hours: 2-5 p. m. Saturdays, 9-12 m.

Pleasant Ave. and 118th St..

164 Second Ave.

449 East 121st St....

Refraction eye work only.

Refraction eye work. Nose and throat clinic, including operation. Trachoma operative

treatment.

Dental work only.

Dental work and treatment of contagious eye disease.

P. S. 144, Hester and Allen Sts. Clinic and classes for chronic contagious eye

P. S. 21, 222 Mott St..

diseases.

.. Clinic and classes for chronic contagious eye

diseases.

Centre and Walker Streets. Week days, 9 to 10 a. m.

307 West 33d Street. Wednesdays, 8 to 9 p. m.

Brooklyn.

29 Third Avenue. Week days, 9 to II a. m. Tuesdays and Fridays, 8 to 9 p. m. CLINICS FOR THE PASTEUR TREATMENT FOR THE PREVENTION OF RABIES.

Manhattan-Center and Walker Streets. Week days, I to 4 p. m.
Brooklyn-29 Third Avenue, Week days, 10 a. m. to I p. m.

The Bronx-Third Avenue and St. Paul's Place. Week days, II a, m. to I p. m.
Queens-Patients attend Brooklyn or Manhattan Clinic.
Richmond-Patients attend Manhattan Clinic.

On Sundays and holidays, patients of all Boroughs attend the Brooklyn Clinic. Hours on these days, 10 a. m. to 12 noon.

Manhattan.

TUBERCULOSIS CLINICS.

West Side Clinic, 307 West 33d Street. Telephone 3471 Murray Hill.
Lower East Side Clinic, III East 10th Street.

Middle East Side Clinic, 229 East 57th Street.

Harlem Italian Clinic, 420 East 116th Street. Telephone 2375 Harlem.
Southern Italian Clinic, 22 Vandam Street. Telephone, 412 Spring.

Day Camp, Ferryboat “Middletown," foot East 91st St. Telephone 2957 Lenox. The Bronx.

Northern Clinic, St. Paul's Place and 3d Avenue. Telephone 1975 Tremont. Southern Clinic, 493 East 139th Street. Telephone 5702 Melrose.

The Bronx.

Main Clinic, Fleet and Willoughby Streets. Telephone 4720 Main.
Germantown Clinic, 55 Sumner Avenue. Telephone 3228 Williamsburg.
Brownsville Clinic, 64 Pennsylvania Avenue. Telephone 2732 E. N. Y.
Eastern Dist. Clinic, 306 S. 5th Street, Williamsburg. Tel. 1293 Williamsburg.
Bay Ridge Clinic, 215 60th Street. Telephone 2434 Sunset.
Parkville Clinic, 974 West Street. Telephone 1866 Bath Beach.

Day Camp, Ferryboat "Rutherford," foot of Fulton Street. Tel. 1530 Main. Queens.

Jamaica Clinic, 10 Union Avenue, Jamaica. Telephone 1386 Jamaica.
Flushing, 110 Broadway, Flushing. Telephone, 731 Flushing.

Richmond.

Richmond Clinic, Bay and Elizabeth Streets, Stapleton. Tel. 1558 Tompkins. SANATORIUM FOR TUBERCULOSIS.

OTISVILLE, ORANGE COUNTY, N. Y. (via Erie Railroad from Jersey City). Telephone 13 Otisville.

TUBERCULOSIS HOSPITAL ADMISSION BUREAU.

Maintained by the Department of Health, the Department of Public Charities, and Bellevue and Allied Hospitals, 426 First Avenue. Telephone 8667 Madison Square. Hours 9 a. m. to 5 p. m.

The O'Connell Press, 176 Park Row, N. Y.

604-a-'15-13,500

Public health is purchasable. Within natural limitations
a community can determine its own death rate.

PUBLISHED MONTHLY BY THE DEPARTMENT OF HEALTH

NEW YORK, N. Y.

149 CENTRE STREET

OF THE

Department of Health of the City of New York

All communications relating to the publications of the Department of Health should be addressed to the Commissioner of Health, 149 Centre St., N. Y.

Entered as second class matter May 7, 1913, at the post office at New York, N. Y., under the Act of August 24, 1912.

Vol. V.

NEW YORK, FEBRUARY, 1915.

No. 2

CHRONIC DISEASE OF THE HEART, ARTERIES AND KIDNEYS. By Dr. A. E. Shipley, Chief, Bureau of Research and Efficiency.

Part I. General Discussion.

Preliminary to the general discussion, a very brief consideration is necessary of the modern interpretation of disease affecting this group of organs.

In acute disease each organ may be affected by itself, as, for instance, in an acute rheumatic infection of the heart, or an acute nephritis of post-scarlatinal type. In disease of a chronic nature, however, these organs must be viewed as a unit.

Animals much lower in the evolutionary scale possess blood vessels in which the normal muscular coat at various points is greatly thickened, thus forming elementary hearts. In the human being this thickening is enormously developed at one point, producing what is known as the mammalian heart. Essentially, the latter is only a higher development of the more elementary form, and from this viewpoint, the heart and the blood vessels are seen to be practically one organ. And as the kidneys may be regarded as a concentrated group of blood vessels for filtration purposes, this should be included as part of the same 'organ.

We must consider, as an entity, then, Cardio-Vasculo-Renal diseases, with emphasis, if any, placed upon the vascular element. Dr. L. F. Bishop applies to this composite group the name Chronic Bright's Disease, which, however, is a confusing term, as it is used commonly to indicate a kidney affection only. This concept of the disease is basic, in discussing its etiology and prevention, and for guidance in applying measures to educate the public, and control its spread.

1

As a rule, chronic disease of this type develops insidiously. Due to various causes, irritation of the muscular coat of the arteries is produced, which results in an increased blood pressure. This is intermittent in character in the early stages, but if the cause of the irritation is not abated, the effect upon the vessels is more prolonged, until finally a state of chronic hypertension is reached. Muscle tissue thus constantly in action finally degenerates and is replaced by fibrous or sclerotic tissue. Nutrition of the vessel walls being impaired, results also in atheromatous changes of their inner coat, or endothelium. The pressure exerted by muscular tissue in a state of tension, or by nonelastic fibrous tissue, is felt at both ends of the vascular system, that is, by the heart and the kidneys. The heart being a mass of this muscular tissue is