lation).

A preliminary announcement recently issued by the bureau of the census with reference to 1916 mortality statistics shows that the "registration area," containing approximately 70 percent of the population of the United States, in that year reported 1,001,931 deaths.

Of these deaths, nearly onethird were due to three causes— heart diseases, tuberculosis and pneumonia and nearly another third were charged to the following nine causes: Bright's disease and

nephritis, cancer, apoplexy, diarrhea and enteritis, influenza, arterial diseases, diabetes, diphtheria, and typhoid fever.

The deaths from heart diseases (organic diseases of the heart and endocarditis) in the registration area in 1916 numbered 114,171, or 159.4 per 100,000 population. The death rate from this cause shows a marked increase as compared with 1900 (the earliest year for which the annual mortality statistics were published), when it was

only 123.1 per 100,000. The increase has not been continuous, however, the rate having fluctuated from year to year.

Tuberculosis Declining Tuberculosis in its various forms caused 101,396 deaths in 1916, of which 88,666 were due to tuberculosis of the lungs. Because of progress in the prevention and treatment of tuberculosis of all kinds, the decline in the tuberculosis death rate in recent years has been most pronounced, having pronounced, having fallen from 200.7 per 100,000 in 1904 to 141.6 in 1916, a decrease of nearly 30 per cent. Before 1904 the rate had fluctuated, starting at 201.9 in 1900. Even yet, however, tuberculosis causes more deaths annually than any other malady, except heart diseases, and about 37 per cent more than all external causes-accidents, homicides, and

suicides combined.

Pneumonia (including bronchopneumonia) was responsible for 98,334 deaths in the registration area in 1916, or 137.3 per 100,000. This rate, although lower than that for any year from 1900 to 1910, inclusive, with the single exception. of 1908, is higher than that for any of the years from 1911 to 1915, inclusive. The lowest recorded rate for all forms of pneumonia was 127 per 100,000 in 1914. The mortality from this disease, like that from tuberculosis, has shown a marked decline since 1900, when it was 180.5 per 100,000. Its fluctuations from year to year, however, have been pronounced, whereas the decline in the rate for tuberculosis has been nearly continuous.

Bright's Disease Higher The only remaining death rate higher than 100 per 100,000 in 1916 was that for Bright's disease and

acute nephritis, 105.2. The total number of deaths due to these maladies in 1916 was 75,316; of this number, 69,395 were caused by Bright's disease and 5,921 by acute nephritis. The mortality rate from these two causes has increased from 89 per 100,000 in 1900, with some fluctuations from year to year.

Cancer and other malignant tumors caused 58,600 deaths in 1916. Of these, 22,480, or nearly 39 per cent, resulted from cancers of the stomach and liver. The death rate from cancer has risen from 63 per 100,000 in 1900 to 81.8 in 1916. The increase has been almost continuous, there having been but two years, 1906 and 1911, which showed a decline as compared with the year immediately preceding. It is possible that at least a part of this increase is due to more correct diagnosis and to greater care on the part of physicians in making reports to registration officials.

Apoplexy was the cause of 58,233 deaths, or 81.3 per 100,000. The rate from this disease increased gradually, with occasional slight declines, from 1900 to 1912, and since 1913 the increase has been continuous.

Enteritis Kills Babies

Diarrhea and enteritis caused 56,763 deaths in 1916, or 79.3 per 100,000. The rate from these diseases has fallen somewhat in recent years, having been 90.2 in 1913, and is very much lower than the corresponding rate for 1900, which was 133.2. Nearly fivesixths of the total number of deaths charged to these causes in 1916 were of infants under 2 years of age.

Influenza was responsible for no fewer than 18,886 deaths in the

registration area in 1916, or 26.4 per 100,000. The rate from this malady, which fluctuates very considerably from year to year, was higher in 1916 than in any preceding year since and including 1900, with the single exception of 1901, when it stood at 32.2.

Arterial diseases of various kinds-atheroma, aneurism, etc.were the cause of 17,115 deaths in 1916, or 23.9 per 100,000. This rate, although somewhat lower than the corresponding ones for 1912 and 1913, is higher than those for 1914 and 1915. The rate for these causes increased continuously from 6.1 in 1900 to 25.6 in 1912.

Diabetes Rate Up

Deaths from diabetes numbered 12,199, or 17 per 100,000. The rate from this disease has risen almost continuously from year to year since 1900, when it was 9.7.

No epidemic disease, with the exception of influenza, produced a death rate as high as even 15 per 100,000 in 1916. The fatal cases of diphtheria and croup which are classed together in the statistics, but practically all of which are cases of diphtherianumbered 10,367, or 14.5 per 100,000 population. The rate for diphtheria and croup in 1900 was 43.3, and the decline of nearly 67 per cent from that year to 1916 is relatively greater than that shown by any other important cause of death. The rate fluctuated somewhat from 1900 to 1913, but has fallen continuously since the latter year.

The mortality rate from typhoid fever has shown a most remarkable and highly gratifying decline since 1900, having dropped from 35.9 per 100,000 in that year to 13.3 in 1916. The proportional decrease in the rate, amounting to

63 per cent, is a close second to that shown for diphtheria and croup. The efficiency of the antityphoid vaccine and of the many improvements in methods of sanitation has been demonstrated in a striking manner by this great reduction in the typhoid death rate.

Childhood Diseases' Toll

The principal epidemic maladies of childhood-measles, whooping cough, and scarlet fever-were together responsible for 17,586 deaths of both adults and children, or 24.6 per 100,000, in the registration area in 1916, the rates for the three diseases separately being 11.1, 10.2, and 3.3. As in 1913, measles caused a higher mortality than either of the other diseases, but in 1914 and 1915 whooping cough had first place. In every year since and including 1910, as well as in several preceding years, measles has caused a greater number of deaths than scarlet fever. The rate for scarlet fever in 1916 was the lowest on record, while that for whooping cough, although considerably below the highest recorded rate for that disease, 15.8 in 1903, was far above the lowest, 6.5 in 1904.

7,000 Die of Polio

Acute anterior poliomyelitis, commonly called infantile paralysis, caused 7,130 deaths in 1916, representing a rate of 10 per 100,000 population. This disease developed in epidemic form in that year, and the resultant mortality showed an enormous increase. The rate from infantile paralysis declined from 2.7 per 100,000 in 1910-the first year in which this malady was reported separately as a cause of death-to 1 per 100,000 in 1915, the decrease having been continuous from year to year except for an increase between 1911

and 1912. The rate for 1916, however, was ten times as great as that for the preceding year.

Of the 26 states in the registration area in 1916, the 5 showing the highest rates reported 75 per cent of all the deaths from this cause. These states, with their rates, were New Jersey, 41; New York, 32.8; Connecticut, 19.2; Massachusetts, 12.5; and Maryland, 8.1. The next highest 5 rates appear for Pennsylvania, 7.8; Rhode Island, 7; New Hampshire, 5.6; Montana, 5.2; and Michigan, 4.9.

Heat Deaths Numerous

The deaths resulting from accidents in 1916 numbered 60,071, corresponding to a rate of 83.9 per 100,000 population. This rate is considerably in excess of that for 1915 (76.3). The most marked increases appear for deaths due to railroad and to automobile accidents and for those resulting from the effects of heat.

The rate for deaths from railroad accidents in 1916 (11.3) exceeds the corresponding rates for 1914 and 1915 (10.7 and 9.9, respectively), but with these exceptions, is the lowest one recorded since 1906, the first year for which deaths from this cause were reported separately.

Deaths from automobile accidents and injuries in 1916 totaled 5,193, or 7.3 per 100,000 population. As might be expected, in view of the enormous increase in the number of automobiles in use, the death rate due to these causes has advanced continuously since. 1906 the first year for which they were reported separatelywhen it stood at 0.4 per 100,000 population.

Street-Car Accidents

Deaths resulting from street-car accidents in 1916 numbered 1,775,

or 2.5 per 100,000. This rate is the same as that for 1914, but shows an increase as compared with 1915. During the past 10 years, however, there has been a material falling off in the rate for this cause. Machinery

accidents caused 1,624 deaths in 1916, or 2.3 per 100,000 population, this rate being somewhat greater than those for the preceding two years-1.9 for 1915 and 2 for 1914.

The number of deaths from mine accidents and injuries in the registration area in 1916 was 2,119, corresponding to a rate of 3 per 100,000. The deaths from these accidents for the last three years show a material decline as compared with those for the preceding 10 years.

There were 2,056 deaths in 1916 from the effects of heat, the rate being 2.9 per 100,000 population. This is the highest rate shown for this cause in the last 15 years, with the exception of that for 1911, which was 5.3.

Suicides Number 10,000

The sumber of suicides reported for 1916 was 10,162, or 14.2 per 100,000. This rate is the lowest for the past 10 years.

The total number of deaths due to the use of firearms in the registration area in 1916 was 8,240, corresponding to a rate of 11.5 per 100,000. Of these deaths, 3,386 were suicidal, 3,241 were homicidal, and 1,613 were accidental. The suicidal use of firearms shows a decline as compared with 1915 and 1914; their homicidal use decreased as compared with 1914, but increased as compared with 1910, 1911, 1912, and 1915, and the rate was the same as for 1913; and the frequency of accidental deaths due to their use shows a slight decline during recent years.

Feeling a need for special protection for Ohio's women and children during the war, the State Department of Health is about to launch a new enterprise a bureau of registration for mothers. The field of pre-natal work, rather sparingly tilled thus far, offers one of the greatest opportunities for constructive public health work, and this opportunity is made even greater by war conditions. No great emergency faces us now in the state, but to be sure none will arise in the future, we must be alive to all of the possibilities which may exist.

The United States does not stand high among the nations from the standpoint of loss of life from childbirth. More than 15,000 American women's lives a year go out under circumstances which are largely preventable. We stand thirteenth in a group of fifteen countries with regard to these deaths. Furthermore, nearly half of our deaths from childbirth are due directly to sepsis. This would indicate that in the country at large we have not advanced very får beyond the standards which obtained at the time when Oliver Wendell Holmes first waged the fight which has resulted in the almost complete elimination of puerperal sepsis from the hospital records of our great cities. We must begin to handle the problem in the smaller places as well. There are two outstanding causes for existing con

ditions: First, the lack of available facilities for many women: second, the almost dense ignorance upon the part of some women in all walks in life.

Physicians at Work

The first problem has been attacked forcibly by the State Medical Association through its obstetrical clinics and it is the province of the State Department of Health to attempt at least to overcome the second difficulty by a campaign of education. The first step in the pre-natal campaign will be that of establishing in the State Department of Health a confidential registration of mothers — a bureau where pregnant women may register and from which information may be sent out. As long as possible, the answers to questions and information given out will be of a purely personal nature. determined effort will be made to bring to the knowledge of as many Ohio women as possible the realization that the pregnant period may be fraught with danger and that during this period every woman. should subject herself to thorough and recurrent examination.

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The woman will be urged to place herself under the care of the best physician obtainable. Should she be wanting from the financial point of view an effort may be made to get her in touch with local physicians and agencies which will look after her. In every commu