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Typhoid Fever in Ohio, 1909-1917:

Some Statistical Observations

no

First Diagram

told before the death curve is mateA glance at the first of the ac- rially lowered. It is not true that companying diagrams, showing the

dead men

tell tales dead monthly distribution of typhoid health officers tell no tales. fever, makes quite evident how appropriate at this time of year is

Second Diagram any consideration of the prevalence

Figured on the basis of the conand control of this disease. Note servative eleven-percent case the first five months' rather un- fatality rate, the probable number eventful course of the lower curve of cases of sickness from typhoid in the diagram, representing the

fever each year is shown in the average number of deaths during second diagram for the nine-year the past nine years of accurate period 1909-1917, in order to make record in Ohio. June marks the

amends for the misrepresentation beginning of the increase in the toll from incomplete reports of cases. of deaths and sickness, which is Reported cases prior to 1912 are doubled in the latter half of the

not indicated because of absurdly year in spite of the totals for the inaccurate returns from health offirst half being entirely too high.

ficers. An average of 58 deaths a month What happened to reports in prevailed from January to July 1917? Is the war affecting reports and 112 from July to the end of of cases of notifiable diseases ? the year. That the maximum toll Unfortunately the war is, in two is exacted in September and Octo- marked ways, if not in more. ber is quickly noted.

During 1917 there occurred a larThe upper curve, representing ger number of changes and vacanthe monthly average of reported cies in the ranks of the health ofcases, while quite striking in show- ficers than for at least four years ing seasonal prevalence, fails to previously. Physicians called to show the true number of cases. If service have in many cases been health officers had successfully succeeded as health officers by laysecured reports of all cases, then, men uneducated as to the value on as conservative an estimate as and necessity of reports, in addieleven percent of cases dying, the tion to the appointment of health diagram would have been drawn officers having been made, throughwith proportions to represent for out 1917, with frequent delays and the year, in round numbers, 11,000 consequent lapses in reports. In cases, rather than the 5,000 actually many instances of failure to reindicated. In other words, the port, the increased postal rates have lower curve, the death curve, is been used as an excuse by health accurate but the upper curve, the officers, physicians and others rereported case curve, tells only half quired to report. the tale. The other half must be Space has been left in this sec

ond diagram to fill in the record for 1918 should be still lower; the
1918. Health officers should keep deaths should be below the 682
the diagram in an accessible place registered for 1917, rate 13.1 per
as a reminder that the 1918 record 100,000 population, as recorded in
should be filled in with more credit Table I, the lowest rate on
to themselves and more profit to record for Ohio.
the state. It should be noted that
the deaths for 1916 were as much

Third Diagram -
below the 1,000 line as above in The excessive toll exacted by ty-
1909 and 1910. The block for phoid fever within the draft age

TYPHOID FEVER, OHIO, 1909-1917
CURVES SHOWING AVERAGE DEATHS 1909-17
AND AVERAGE REPORTED CASES 1913-17

DEATHS — REPORTED CASES –

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JAN FEB MAR APR MAY JUNE JULY AUG. SEPT. OCT. NOV. DEC.

TABLE 1. TYPHOID FEVER, OHIO, 1909-1917: DEATHS AND DEATH

RATES PER 100,000 POPULATION FOR STATE, CITIES, VILLAGES AND TOWNSHIPS,

State.

Cities.

Villages.

Townships.

Year.

Deaths. Rate. Deaths. Rate. Deaths. ) Rate. Deaths. Rate.

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TABLE 2. TYPHOID FEVER, 1909-1917, BY COUNTIES OF OHIO;

AVERAGE DEATH RATES, TWO YEARS, 1909-1910, FIVE YEARS, 1911-1915, AND TWO YEARS, 1916-1917.

Counties.

State Adams Allen Ashland Ashtabula Athens Auglaize Belmont Brown Butler Carroll Champaign Clark Clermont Clinton Columbiana Coshocton Crawford Cuya hoga Darke Defiance Delaware Erie Fairfield Fayette Franklin Fulton Gallia Geauga Greene Guernsey Hamilton Hancock Hardin Harrison Henry Highland Hocking Holmes Huron Jackson Tefferson Knox Lake Lawrence

Counties.

27.1 19.1 11.0. 36.4 19.4 20.3 29.2 22.3 12.8 34.9 18.7 10.3 37.0 16.4 14.6 36.8 18.3 16.7 16.0 11.5 8.0 30.1 28.1 17.6 32.2 23.4 18.1 22.2

15.1 8.8 19.0 10.1 15.8 17.0 13.7 17.2 12.9 18.4 19.6 37.2 19.0 13.5 21.1 16.0 6.3 49.8 39.2 22.5 33.2 27.7 11.3 36.7

12.4 19.0 15.0

9.7 6.1 30.3 13.0 25.4 38.8 18.0 4.1 534 16.8 18.0 24.8 19.7 6.4 15.4 12.2 4.7 43.7. 12.9 27.5 19.3 14.5 10 9 27.2 14.8 8.1 23.3 31.1

15.5 13.7 9.5 3.4 23.5 22.2 6.7 29.4 22.5 18.5 13.7 8.3 3.4 26.4 18.0

7.9 31.2

27.6 21.3 31.5 23.2 23.6 29.9 14.3 8.0 41.8 21.6 19.1 29.6 11.9 29.6 19.5 12.3

5.6 22.0 16.1 1 5.6 48.7 24.0 17.7 41.4 44.3 / 27.6 26.6

14.2 12.5 39.3 24.1 I 16.8 45.6 1 57.2 / 60.7

Licking

17.1 22.3 18.8 Logan

30.0 15.3 11.6 Lorain

25.9 22.0 11.0 Lucas

39.2 30.1 14.8 Madison 30.2 22.9 15.1 Mahoning 39.0 28.3 28.2 Marion

24.8 20.8 26.6 Medina

17.2 13.2 16.1 Meigs

51.0 26.6 25.4 Mercer

24.1 16.7 9.0 Miami

20.0 20.2 11.8 Monroe

28.9 20.6 8.2 Montgomery 20.0 12.0 15.6 Morgan

27.9 22.4 3.1 Morrow

38.6 16.6 11.9 Muskingum 41.4 46.4 27.2 Noble

29.5 15.1 13.4 Ottawa

11.1 19.6 8.9 Paulding 50.6 21.9 8.8 Perry

26.6 17.6 13.2 Pickaway 32.5 19.1 22.9 Pike

22.2 26.7 44.5 Portage 34:7 1 26.7 19.3 Preble

27.2 10.9 10.4 Putnam

38.4 28.0 10.0 Richland 43.1 16.9 7.9 Ross

59.9 31.4 21.2 Sandusky

22.7 | 32.7 22.4 Scioto

48.6 1 64.9 1 37.2 Seneca

17.7 1 13.1 11.5 Shelby

30.4 1 24.3 14.2 Stark

22.9 15.1 13.6 Summit

28.4 26.7 27.4 Trumbull 62.6 22.2 26.3 Tuscarawas .' 39.5 13.4 1 12.6 Union ... 1 38.8 1 19.2 1 13.7 Van Wert...) 29.2 / 15.8 1 17.1 Vinton

61.1 1 24.4 7.6 Warren

34.7 I 12.3 1 20.4 Washington . 35.2 | 24.2 12.1 Wavne

25.0 l 14.7 14.4 Williams 19.8 1 19.0 1 11.8 Wood

35.6 | 26.0 I 11.9 Wyandot 33.7 25.0 9.6

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