particular group in the classification followed by the survey cities of from 300,000 to 500,000 population-Cincinnati stands second 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 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."2 * * 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, 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. Dayton 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. DEPARTMENTAL REPORTS BY DIVISIONS DIVISION OF COMMUNICABLE DISEASES 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: 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 II. 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 each, 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 not 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. 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 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. |