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particular group in the classifica-
tion followed by the survey
cities of from 300,000 to 500,000
population-Cincinnati stands sec-
ond only to Newark, N. J.

Cleveland is fifth among the
nine cities with more than 500,000
population. Lower

rates than Cleveland's are reported in Chicago, Boston, New York and Philadelphia. Cleveland was ahead of Philadelphia in 1916. Regarding the slight rise which is seen in Cleveland's 1917 rate, the Journal remarks: “The chlorination of the Cleveland water continues to prove a source of trouble and complaint.

Early in the year the chlorine dosage was materially reduced against the protest of the city health authorities. It is possible that the slightly increased typhoid rate

may be connected with this action."

Columbus is ranked seventh among the ten cities of from 200,000 to 300,000 population. Cities with better records, in this group, are: St. Paul, Rochester, Jersey City, Denver, Providence and

Portland, Ore. Columbus' rank in the group was ninth in 1916.

Toledo rose from eleventh place in 1916 to ninth place in 1917 among the fourteen cities in the 125,000-200,000 group.

It was outranked last year by Oakland, Worcester, Scranton, Syracuse, Omaha, Richmond, Spokane and New Haven.

Dayton, the only Ohio city with a rate of more than 10.0, was fifth from the bottom of the cities from 100,000 to 125,000 in 1917. Salt Lake City was the only nonSouthern city in this group with a rate higher than Dayton's. Day. ton was sixth from the bottom of this group in 1916, but her 1917 rate, it will be noted by reference to the table, showed a slight improvement over the 1916, even though her relative position dropped. In the entire list of sixty cities, the only cities outside the South with higher rates than Dayton's were Baltimore, Fall River, Detroit and Salt Lake City. Seven Southern cities also had lower rates than Dayton.




Baby Death Total Little Reduced in February


HIO failed again in Febru- Ohio lost 2,433 children, whereas ary to achieve a death total 1,804 is the maximum two months' of children under five years

average possible under the babyold which would compare favor- saving plans which the state is enably with the goal set for Chil- deavoring to carry out. Stated in dren's Year. The deaths num- terms of "saving," the situation is bered 1,201 in February. To that the state saved only 123 "save" 4,510 babies this year, as babies in a period in which the compared with the 1916 losses, the Children's Year program demands monthly average of these deaths the saving of 752. must be kept down to 902. The It was hoped, as mentioned in January total was 1,232.

last month's On10 PUBLIC HEALTH In these two months, therefore, Journal, to have statistics for both

, * NOTE - Cleveland's new filtration plant has been put into operation within the past few weeks.-Ed. 0. P. H. J.

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Population 5,000 to 8,000.

Population 2,500 to 8,000.
Cuyahoga Falls

Franklin (northern half).
Trumbull (part month)

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The 9,867 patients under care were grouped as follows, according to the nature of their cases : Communicable Diseases Tuberculosis

4,196 All others

123 Maternity Prenatal

193 Postnatal

210 Infants under two years of age (except eye)

2.876 Eye — Infants under two years of age..

36 All others

60 Other Diseases Medical

1,482 Surgical Social Service






Reported Cases of Notifiable Diseases, April, 1918 Prevalence. With the exception of smallpox, April reports do not indicate any one notifiable disease markedly prevalent comparing with records for April during the last five years. The total of 10,526 reported cases gives a much lower reported case rate for the month this year than prevailed in April, 1917, or April, 1916 (Table I, 2.000, 2.302 and 3.763 per 1,000 population, all notifiable diseases, April, 1918, 1917 and 1916, respectively). There is a total reduction for the month of 3,049 cases from March figures. In order of greatest reported prevalence for April, the diseases list as follows, with totals given for March, including delinquent March reports:

1. Measles
2. Measles, German
3. Smallpox
4. Mumps
5. Whooping cough
6. Scarlet fever
7. Tuberculosis
8. Pneumonia

9. Chickenpox
10. Diphtheria
11. Ophthalmia neonatorum
12. Typhoid fever
13. Gonorrhea

REPORTED CASES. April. March. 2,294 2,286 2,205 3,137 1,115 1,644 1.023 1,420

865 1,134
754 927

540 475
375 735

585 112

130 99

119 66


For no other one notifiable disease was a total of 50 cases or more recorded for April. The cities reported 5,394 cases, 51 percent of the state total, as compared with 48 percent recorded for cities in March and 56 percent in February.

Smallpox. The 1,115 reported cases of smallpox for April are 529 cases fewer than the number recorded for March, but almost three times the number in April, 1917, and five times the April, 1916, figure. From October 1, 1917, to the end of April, 8,695 cases have been reported, an average of 1,242 cases a month for the seven months of the present epidemic.

Typhoid Fever. The 99 cases recorded give a case rate for April of .019 per 1,000 compared with .037 and .034 for the same month during the two years past (Table I), and a reduction from .022 per 1,000 in March of this year. The cities reported 58 of the 99 cases as recorded in Table IÍ. Ironton, with nine cases, reported more than any other one city, Cleveland following with eight, East Liverpool next with


six, Defiance, Sandusky and Zanesville recording four cach, Chillicothe and Tiffin, three each, 41 cases in the eight cities, the remaining 17 cases in cities being distributed by ones and twós in 12 cities as tabulated in Table II.

The low figure for April would give greater satisfaction were it not certain that a number of cases are now being reported. A preliminary tabulation of death certificates for January and February gave a total of 81 deaths for the two months caused by typhoid fever. In the same two months only 220 cases were reported, a fatality rate so high that it must be inferred that physicians and health officers are disregarding the requirements as to reports. Health officers should take timely warning before the summer typhoid period and inaugurate another campaign

for reports.

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Meningitis, Cerebrospinal. The 37 reported cases of meningitis occurred as follows: Belmont Co., Richland Tp., one; Cuyahoga Co., Cleveland, 13; Erie Co., Sandusky, one; Franklin Co., Columbus, one; Hamilton Co., Cincinnati, 10; and Lake Co., Perry Tp.; Licking Co., Lima Tp.; Madison Co., Mt. Sterling ; Montgomery Co., Jefferson Tp.; Ottawa Co., Port Clinton; Ross Co., Franklin Tp.; Scioto Co., Portsmouth, Sciotoville and Vernon Tp.; Trumbull Co., Warren, and Wood Co., Plain Tp., i case each.

Poliomyelitis. Columbus reported three of the nine cases of poliomyelitis recorded for April. Bloom Township, Fairfield County reported two cases and the remaining four cases were reported from Delphos, Portsmouth, Warren and Liberty Township, Knox County.

Case Reports. The spread of an unreported disease was never prevented. Health officers, however, are becoming more lax in securing prompt case reports on the cards supplied by the State Department of Health to every physician or other person required to submit reports. These case history reports are absolutely essential for effective public health work. So many newly appointed health officers are serving in the state today that certain allowance must be made until they become familiar with the aims and requirements of preventive work but little success will come to their work if in the very beginning the importance of securing complete and accurate case reports is not realized. Another word of warning. The State Department of Health can be of little assistance for early preventive measures if the case reports are not mailed promptly on Monday of each week by health officers to the department, that they may be quickly recorded and studied for any undue prevalence.

Summary Reports. Why delay sending your monthly report summary? The franked card should be received by the collaborating epidemiologist not later than the fifth of the succeeding month. Why not count correctly the cases reported to you for the month? There are many instances each month of health officers recording, for example, 15 cases of smallpox, when case cards received during the month total 18 with no duplicates.

The footnote to Table II carries the names of the cities delinquent in reporting by date of going to press. Usually the same cities are listed in the footnote, it will be noticed.

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