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Typhoid Fever in Ohio, 1909-1917: Some Statistical Observations

First Diagram

Note

A glance at the first of the accompanying diagrams, showing the monthly distribution of typhoid fever, makes quite evident how appropriate at this time of year is any consideration of the prevalence and control of this disease. the first five months' rather uneventful course of the lower curve in the diagram, representing the average number of deaths during the past nine years of accurate record in Ohio. June marks the beginning of the increase in the toll of deaths and sickness, which is doubled in the latter half of the year in spite of the totals for the first half being entirely too high. An average of 58 deaths a month prevailed from January to July and 112 from July to the end of the year. That the maximum toll is exacted in September and October is quickly noted.

The upper curve, representing the monthly average of reported cases, while quite striking in showing seasonal prevalence, fails to show the true number of cases. If health officers had successfully secured reports of all cases, then, on as conservative an estimate as eleven percent of cases dying, the diagram would have been drawn with proportions to represent for the year, in round numbers, 11,000 cases, rather than the 5,000 actually indicated. In other words, the lower curve, the death curve, is accurate but the upper curve, the reported case curve, tells only half the tale. The other half must be

told before the death curve is materially lowered. It is not true that dead men tell no tales dead health officers tell no tales.

Second Diagram

Figured on the basis of the conservative eleven-percent case fatality rate, the probable number of cases of sickness from typhoid fever each year is shown in the second diagram for the nine-year period 1909-1917, in order to make amends for the misrepresentation. from incomplete reports of cases. Reported cases prior to 1912 are not indicated because of absurdly inaccurate returns from health officers.

What happened to reports in 1917? Is the war affecting reports of cases of notifiable diseases? Unfortunately the war is, in two marked ways, if not in more. During 1917 there occurred a larger number of changes and vacancies in the ranks of the health officers than for at least four years previously. Physicians called to service have in many cases been succeeded as health officers by laymen uneducated as to the value and necessity of reports, in addition to the appointment of health. officers having been made, throughout 1917, with frequent delays and consequent lapses in reports. In many instances of failure to report, the increased postal rates have been used as an excuse by health officers, physicians and others required to report.

Space has been left in this sec

ond diagram to fill in the record for 1918. Health officers should keep the diagram in an accessible place as a reminder that the 1918 record should be filled in with more credit to themselves and more profit to the state. It should be noted that the deaths for 1916 were as much below the 1,000 line as above in 1909 and 1910. The block for

1918 should be still lower; the deaths should be below the 682 registered for 1917, rate 13.1 per 100,000 population, as recorded in Table 1, the lowest rate on record for Ohio.

Third Diagram

The excessive toll exacted by typhoid 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 -

1200

1100

1000

900

800

700

600

500

400

300

200

100

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.

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