perintendents and enclosures such as the following for use in pay envelopes: "Venereal diseases (clap and syphilis) must be wiped out in this plant-it's up to you to help. Read the notice posted today." "It takes a year or more to cure an ordinary case of syphilis bad case is often, incurable." a "Most cases of venereal disease come from prostitutes. Seventy to ninety-five percent of all women of this sort have clap or syphilis or both." Arrangements can be made to have representatives of the Bureau of Venereal Diseases give lantern slide talks to employees, and clinics. which have been, or soon will be, established in most communities will provide treatment for men who can not afford treatment by private physicians. Manufacturers and other employers should encourage the establishment of venereal clinics in their communities. The prevention of venereal diseases among Ohio's industrial workers will mean a profit in dollars and cents for employers and employees, and will greatly strengthen America's material resources for carrying on the war. Commissioner and One of * Still the war continues to make its demands upon the staff of the State Department of Health. The most recent mem bers to leave are Dr. Allen W. Freeman, commissioner of health and head of the Department, and Dr. Frances M. Hollingshead, director of the Division of Child Hygiene. Dr. Freeman has received a major's commission in the Medical Reserve Corps and Dr. Hollingshead, has been appointed to a place in the children's bureau of the American Red Cross in France. Both have been granted leaves of absence for the period of their war service. Major Freeman entered upon active service July 5, when he reported at the Army Medical School in Washington. Dr. Hollingshead sailed for France a week later. The supervision of the Department's activities will be in the hands of Deputy Commissioner James E. Bauman during the Commissioner's absence. Dr. Freeman's departure interrupts for the present the progress of plans which he was formulating for improvements and extensions, but his subordinates are continuing their duties with a resolution to keep the machinery moving at the highest possible efficiency in the absence of the chief. The management of the Children's Year campaign had been occupying most of Dr. Hollingshead's attention for the past six months. She had perfected a strong statewide organization for this work, and it is to be hoped that her body of workers will continue in her absence to carry out the comprehensive program which was mapped out under her supervision. Dr. Hollingshead's successor in the Department has not yet been chosen. In her position as state child welfare chairman of the Women's Council of National Defense she has been succeeded by Miss Lucy Buell. Co-operation between the defense council and the health department in carrying out the Children's Year program will be continued. Vaccination Should Be Required of Munitions Workers The United States Public Health Service in June addressed to manufacturers producing war materials a communication urging that vaccination against smallpox and inoculation against typhoid fever be required of all employees, as they are now required of all men in the military forces of the United States. Such a proposition needs no argument. If it is reasonable to demand that soldiers take these precautions against having their efficiency undermined by disease (and objections to that requirement are negligible), it is just as reasonable to demand similar precautions of the workmen who produce the munitions these soldiers use. Many Ohio manufacturing plants have already established rules requiring smallpox vaccination. Few, if any, have taken such action. regarding typhoid inoculation. Both these lists ought to be extended. Lack of vaccination from January, 1912, to May, 1918, cost Ohio more than 600,000 working days of citizens at the most productive period of life, statistics in last month's JOURNAL showed. A highly disproportionate share of this enormous loss has come during the present epidemic, and the cost to the munitions industry, it can not be doubted, has been great. Typhoid fever, as figures in the JOURNAL for May demonstrated, caused a loss of more than 33,000 working days last year. Again the munitions industry must have suffered. Local health officials have in many cases been instrumental in obtaining vaccination requirements in industrial plants. Other such officials should likewise grasp the opportunity to do a valuable piece of war service. Duties Imposed by the Venereal Disease Upon Physicians: To report every known or suspected case of venereal disease which they treat, stating the name, age, address, sex, color and occupation of the patient, the date of onset of the disease and, if ascertainable by reasonable diligence, the probable source of infection. To instruct venereal disease patients in measures for preventing the spread of the disease and in the necessity for continuing treatment until cured, and to furnish patients with information relating to the disease, the literature for this purpose being furnished by the State Department of Health. To issue no certificate of freedom from venereal disease except after careful clinical and laboratory examination and unless certain that the certificate is not to be used for immoral solicitation. Upon City, Village and Township Health Officers: To use every available means to discover and investigate cases of venereal disease in their respective jurisdictions, and to ascertain the sources of infection. To have examinations made by licensed physicians of all persons reasonably suspected of having a venereal disease, in which suspected class are to be considered all known prostitutes and persons associating with them; the health officer may make such examinations himself if he is a licensed physician. To co-operate with other officials in repressing prostitution and to use every other proper means to that end. To quarantine any person having, or reasonably suspected of having, a venereal disease, when so directed by the State Commissioner of Health. To protect records of venereal disease cases from being made public, except upon court order. Upon Venereal Disease Patients: To refrain from exposing any other person to the disease. The Penalty for Failure to Perform These Duties Is a fine of not more than $100 for a first offense, and a similar fine or imprisonment for not more than ninety days or both for a subsequent offense, if the allegation states that such offense is a second or repeated offense. NOTE. The venereal disease regulations, which went into effect July 1, were published in full in the June OHIO PUBLIC HEALTH JOURNAL. Leaflets containing the regulations can be obtained free from the State Department of Health. Ohio's Venereal Disease Program By H. N. Cole, M. D., Director, Bureau of Venereal Diseases, State Department of Health. IN N line with a general Government campaign, the State of Ohio has instituted a campaign against venereal diseases. Our great war is opening the eyes of the people to the fact that we have another great plague on hand. Thus far, the subject of venereal disease has never been mentioned in the homes, the pulpits have been silent and nothing has been said concerning them in our schools. The result has been appalling. Many young men and young women have been ruined for life before they really realized the cause and result. This war has given us an excuse and a startingpoint for launching a nationwide and statewide campaign. campaign in Ohio is under the general direction of the United States Public Health Service and is somewhat along the following lines: This Beginning July 1, all cases of venereal disease in the State of Ohio must be reported by name to the State Commissioner of Health. This will serve several purposes. The Department of Health will have a better idea of the amount of venereal disease within our borders and, also, it can, in a way, keep these cases under observation and follow up their future to see that they get proper and sufficient treatment. In addition, physicians are required by law to report not only the cases but also the source of the infection. This is perhaps even more important, Another part of our program consists in more careful diagnosis and treatment of these cases. The State of Ohio already is doing the Wassermann test for syphilis, and any physician, on writing to the State Department of Health at Columbus, can obtain containers and proper directions for sending specimens to the State laboratory for examination. The Wassermann test will also be done on spinal fluids and microscopic examination of smears for gonorrhea will be made. at the State laboratory. It is the plan of the State to open, or have opened, carefully organized clinics for the diagnosis. and treatment of venereal disease. These clinics are to be run by experts in this line and will fill a longfelt want. Several clinics are already in operation and we hope within the next few months, to increase this number and enlarge their facilities. Another need which is very necessary in connection with a campaign against venereal diseases is hospital beds. Without these beds it is impossible properly to care for some of our acute cases of syphilis, gonorrhea and chancroid. Moreover, these beds must be at hand for the proper care of prostitutes and street-walkers whom we wish to withdraw withdraw from their from their nefarious trade. This part of the campaign is slower and harder to obtain, yet some of our cities are responding nobly and we trust that very soon there will be ample hospital facilities in every city for the care of these cases. We cannot too urgently recommend that all communities think over this part of the program very carefully and provide sufficient beds for these cases. We always insist on hospitalizing a case of smallpox or scarlet fever, yet thousands of prostitutes with acute syphilis and gonorrhea are walking our streets plying their trade and nothing is done with them. It would pay the communities in dollars and cents, if we look at it in a financial way alone. In connection with all dispensary and hospital cases, careful records are to be kept of diagnoses and treatments given to patients and the Department of Health urges all such institutions to have a trained social service nurse in connection with the clinic. It is in this way only that we can hope to succeed in making proper progress against these diseases. It need hardly be mentioned that the United States Government looks askance at such a thing as a regulated "red light district. There is no such thing. And it is the aim of this Bureau of Venereal Diseases to suppress prostitution, street-walkers and houses of ill-fame without a moment's delay. The Department also plans a survey of our jails and peniten tiaries, as Snow has shown that positive Wassermanns were found in from ten to forty-eight per cent of all these inmates.* It is generally recognized that venereal disease is all too frequent in our convict population. We hope very soon to have examinations for venereal disease of all persons brought into criminal court. This is being done very successfully in some cities and there is no reason why it should not be done everywhere in Ohio. A little later it is also hoped to do something with our venereal quack problem and also with drugstore prescribing for venereal dis ease. We have no doubt that all fair-minded druggists will gladly co-operate with this part of our campaign, for there is no question but that it is the cause of much trouble, of mistaken diagnoses and of many uncured cases of syphilis and gonorrhea with their resultant after-effects in future years. The last part of our campaign consists in a statewide propaganda. of education for both the laity and the physician. How many physicians are there at present who treat their cases with the protoiodid tablet alone? Unfortunately, we see too many examples of this every day and the result is sad indeed. The public will soon begin to demana that they get a certain type of treatment or they will see another physician, and they are right in this demand. No man should treat a case of gonorrhea or syphilis unless he is willing to take the time to keep up to date on the subject. For the public, we propose putting out placards all over the city, in toilets of saloons, barber shops, hotels. etc. There will also be lec * Snow, "Public Health Measures in Relation to Venereal Diseases," Journal of the American Medical Association, LXVI, 1008 (April 1, 1916). |