VOL. VIII DECEMBER, 1917 No. 12 Two More Department EDITORIALS Since the November issue of THE PUBLIC HEALTH JOURNAL appeared, giving the State Department of Health's "Honor Roll" of staff members who have enlisted for army service, two more men have donned Uncle Sam's uniform, bringing the number of stars in the department's service flag up to seven. J. F. Granger, assistant engineer in the division of sanitary engineering, has been commissioned a first lieutenant in the sanitary forces and is now in service. J. R. Russell, assistant chemist in the division of laboratories, has joined the sanitary branch of the service as an enlisted man and will see service as a chemist. Mr. Russell has been acting chief chemist for several weeks, in the absence of J. S. McCune, now a lieutenant in the army. Other men in the department are considering entering the service and it is likely that there will be more names to be recorded when the JOURNAL goes to press the next time. As was remarked last month, each departure weakens the staff available for the heavy duties which fall upon the department, but necessary sacrifices are gladly made and everyone is willing to shoulder a little extra work to keep things moving as usual. .Ohio's Death Rates and the Country's * Ohio's death rates from the more important diseases in 1916 show few notable variations from the rates for the entire registration area of the country, as these are presented in a preliminary report of the bureau of the census, details of which are given elsewhere in this number of THE PUBLIC HEALTH JOURNAL. Among the few important differences noted, however, the marğın by which the Ohio tuberculosis rate falls below that for the country is encouraging, offering as it does evidence of tangible results in the fight which has been waged against the disease. Statistics for single years are often misleading, inasmuch as they make no allowance for differences due to unusual circumstances. In this case, however, the low tubercu losis rate is especially worth noting, when one remembers that such a rate has prevailed in Ohio for several years, and that not since 1911 has the Ohio rate been as high as the registration area's 1916 rate. Pneumonia's jump of last year, noted in last month's issue of the JOURNAL, brought its rate above the country-wide average. The inroads of this disease will be watched with interest the next few years, to ascertain the strength of the grip which it threatens to get on Ohio's population. A heavy death toll of apoplexy, as compared with the registration area figures, marked the year in Ohio. Other figures which were markedly high were those of cancer, influenzia and arterial diseases. On the other hand, Bright's disease and diarrhea and enteritis (the latter taking almost all its toll from children under two years old) dealt lightly with Ohio. Typhoid fever and diabetes were very slightly higher in Ohio than elsewhere. The childhood epidemics, whose rates fluctuate greatly, occupied their usual place in the 10 to 15 rate range of the table, with diphtheria low in Ohio and measles and whooping cough high, as compared with the rest of the country. Ohio's infantile paralysis rate, although increased over 1915, did not share in the 900 percent jump which epidemics elsewhere caused the figures for this disease to take. Careful Work Needed * * * Smallpox is on the increase in Ohio. That statement, made last month, needs to be repeated this month. The November reports of communicable diseases, published in this issue, show a smallpox total well above October's, and in addition show a much larger number of counties reporting cases. In other words, both the number of cases and the extent of the infected area are increasing. The situation calls for watchful care from health officers, but there is no need for hysterical alarm. Smallpox is a disease so easily controllable and so well understood that a widespread epidemic is unthinkable. All that is needed is thorough application of the knowledge which we have. Unfortunately such application has been absent from the methods with which many communities have met the situation. Through lack of information or through carelessness victims of smallpox have not recognized their disease or have not reported it. Wrong diagnoses and failure to enforce the quarantine regulations of the state rigidly enough have permitted the disease to spread in many cases. Compulsory vaccination, where such compulsion is possible, has not in all cases been insisted upon. Faithful, thorough co-operation of local health officers and physicians is needed and expected by the State Department of Health, and for its part it is willing to aid local health workers in every way possible. Smallpox MUST be stamped out in the state, and it CAN be stamped out if all work together, with the utmost care and determination to accomplish that result. New-Year Resolves on School Sanitation * School authorities and teachers and others charged with looking after the health of Ohio's school children might do well to read over this statement of the standards of school hygiene and sanitation which have been established by the New York City health department's bureau of child hygiene. Then if they are thinking of making any New Year's resolutions, they might incorporate one announcing their determination to strive toward this as an ideal during the coming year: Classrooms should be large enough to provide at least 300 cubic feet of air space for each pupil. Each room should have direct sunlight at some period of the school day. Each child should have an individual desk with aisles at least two feet wide between the rows. Dry sweeping and dusting must be prohibited and proper oil dressing provided for the floors. Pencils should be individual and collected at the end of each day, in separate stout manila envelopes, marked with the name of the child, so that distribution may be made each morning. Lastly and most important, adequate and free ventilation, with the provision of air at the right temperature and degree of humidity, is imperative. In the school building, cloakrooms with individual ventilated lockers, or hooks placed at wide enough intervals so that the children's outer garments shall not be in contact, are essential. The further installation of drinking fountains or the use of the individual drinking cup, the elimination of the common towel and the provision of adequate and cleanly toilet and washing facilities will all provide the needed surety of the first line of defense against the spread of infection in the schools. Nurses' Reports * * * There appears in this issue of THE PUBLIC HEALTH JOURNAL a monthly report of the nursing service of the state. This report will hereafter be a regular feature of the magazine. The monthly summary is published with a view to informing the people of the state of the extent of the work which this branch of the State Department of Health is doing. It must be remembered in considering the figures, however, that the report is incomplete. The department has no power to compel the regular sending of reports by the public health nurses in the various localities, and the reports summarized in the table are voluntary ones. It is hoped by the department that with the starting of a regular publication of this summary the importance of submitting reports will become more evident to the nurses of the state. The object is to promote the cause of public health nursing-a most important work in raising the health standards of the state. And to accomplish this object the monthly summary should be as complete as possible which completeness can be obtained only by the willing assistance of individual nurses. It is important also that reports be sent soon enough. The report of any nurse for a given month should be in the office of the department not later than the sixth day of the month immediately following, if it is to be certain of inclusion in the monthly summary in the latter month's JOURNAL. The report here published, it will be noted, is a month later than such reports ought to be. To all public health nurses of the state, then, the word is: Report regularly and promptly on each month's work, and by so doing help to advertise the cause in which you have enlisted. Garage Exhaust-Pipes * * * That there is need for a further word of caution with regard to gasoline engine exhaust-gas poisoning, especially as regards commercial garages and automobile factories, is demonstrated by the report of an investigation made by the division of industrial hygiene of the State Department of Health in November. An investigator was sent to a large automobile plant in the state, when a case of exhaust-gas poisoning was reported from the plant. He found 75 men exposed to exhaust fumes in the room where motors are tested, and practically all had symptoms of carbon monoxide poisoning. An installation designed to carry off the fumes was in operation and the proprietors evidently believed necessary precautions were being taken. This protective installation, however, consisted of only a two-inch. pipe leading outdoors, to which all motors being tested were attached by rubber-hose connections. It was evident to the investigator that the exhaust-pipe was too small for the number of engines being tested at one time. The installation has been changed, upon his recommendation, to an eight-inch exhause-pipe, with a fan to draw out the gas. * * * Cleveland Also Cleveland also has a scorecard system for rating food handlers, THE PUBLIC HEALTH JOURNAL is reminded by Wilbur S. White, city chemist in the Sixth City, who is inspired to mention this fact by reading in the October Journal of the similar system in vogue in Portland, Ore. A store displaying the Health Department's white card thereby indicates that its score has been "good" (above 90 percent). A blue card indicates a grade of "fair" (80 to 90), and red registers "bad" (under 80). The grading covers in great detail the condition of salesrooms, rear rooms, toilet, cellar and basement and rear lot, buildings and barns. The system has been in operation nearly two years. Pulling Together * * Ohio physicians are responding eagerly to the call for men of their profession which the government has sounded, and are entering army work in large numbers. Their colleagues who are remaining at home, however, are offering no less inspiring a picture of willingness to serve, as they set themselves to taking care of the interests of the ones who are in uniform. The doctors at home are assuming the practices of those who have entered the army and are turning over 40 percent of the receipts to the absent members' families. In addition emergency funds are being raised in all localities, to which doctors remaining in practice contribute monthly amounts of from $2 to $10 each. By means of this fund, each enlisted physician is insured for $10,000, his uniform and equipment are purchased and his outstanding obligations are assumed. In some cases wealthy doctors at home are advancing money on accounts due to enlisted colleagues and making the collections themselves. When the physicians return from the war, they will find their practices intact, their families well cared for and their financial affairs in good shape. The families of those who may not return will not be cast upon the world, destitute and confused. In the meantime the nation has been provided without delay with the services of thousands of well-trained medical men. An unselfish, sacrificing spirit of co-operation has made all this possible. Conservation of * * * Now Those of us who like fresh air dread a winter ride in a street car or train. We know how carefully the original air supply with which the car started out is guarded to insure its arrival intact at its destination. and then we muster up courage enough to open a window and bring down upon our heads the wrath of other passengers, transmitted by the conductor. Ordinarily, however, we suffer in silence and comfort our |