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The Health Officer's Responsibility in the

Enforcement of the Venereal

Disease Regulations

By James E. Bauman, Deputy Commissioner of Health

TH

HE enforcement of measures ficer his responsibility in the en

for the prevention and con- forcement of regulations adopted

trol of venereal diseases by the State Department of Health, gives opportunity, very naturally, it is not seemly to present argufor inquiries as to the authority for ment as to the necessity for the the adoption of such regulations. regulations, the authority for their If there is authority for adopting adoption or as to their validity, but regulations, it follows that there is there are some who seem inclined authority for their enforcement. to gauge their responsibility by

The history of legislation for the their own opinions on these points. prevention of venereal diseases For such as these we ask that you closely follows that of legislation bear in mind that there are propfor the control of other diseases erly created courts of law to anthat have been determined to be swer such questions, and until comcommunicable and a menace to the petent authority determines a law public health. Only a few years or regulation to be invalid it is of ago the same questions that are full force and effect and those renow being raised in regard to regu- sponsible for its enforcement are lations for the prevention of vene- under legal compulsion to carry out real diseases were raised when the to the fullest extent the duty laid attempt was made to require reports of cases of pulmonary tuber- Regulations are adopted by the culosis and, from the standpoint State Department of Health under of the sanitarian, the answers to authority specifically delegated by those questions are the same; e. g., the legislature. As it is necessary we are dealing with a disease that that there shall be a legislative causes untold suffering; it is com- body for the purpose of passing municable from one person to an- laws of a general nature for all the other, therefore a menace to the state, so is it necessary that there public health, and the person who shall be a central body to legislate willfully aids in transmitting the with reference to sanitary matters disease is a criminal and should be of such nature that it is not adpunished; it is preventable, and visable to have them made the subthose with authority to act have ject of laws. To provide for this not done their full duty until they the Ohio laws declare that "the have gone to the limit of their au- State Department of Health shall thority in devising and carrying out have supervision of all matters remeasures to prevent the spread of lating to the preservation of the the disease.

life and health of the people and In discussing with a health of- have supreme authority in matters

upon them.

of quarantine, which it may declare and enforce, when none exists, and modify, relax or abolish, when it has been established." In furtherance of this object and to provide the means whereby results can be secured, it is provided that the State Department of Health may make special or standing orders or regulations for preventing the spread of contagious or infectious diseases and for such other sanitary matters as it deems best to control by a general rule. The Department of Health is given specific authority to require reports of diseases not only by physicians, boards of health and health officials, but by other persons who stand in such relation to the patient that the requirement would be reasonable.

To provide the machinery for enforcing the special and general regulations of the State Department of Health, the statutes require that "local boards of health, health authorities and officials, officers of state institutions, police officers, sheriffs, constables and other officers and employees of the state or any county, city or township, shall enforce the quarantine and sanitary rules and regulations adopted by the state board (department) of health.” (Sec. 1238 G. C.)

The penalty for failing to obey the regulations of the State Department of Health is the same as that provided for failing to obey the regulations of a municipal or township board of health and the modes of procedure, courts, practice, etc., are the same. This penalty is as follows: "Whoever violates any provision of this chapter, or any order or regulation of the board of health made in pursuance thereof, or obstructs or interferes with the execution of such order, or wilfully

or illegally omits to obey such order, shall be fined not to exceed one hundred dollars or imprisoned for not to exceed ninety days, or both, but no person shall be imprisoned under this section for a first offense, and the prosecution shall always be as and for a first offense, unless the affidavit upon which the prosecution is instituted, contains the allegation that the offense is a second or repeated offense.” (Sec. 4414 G. C.)

Careful consideration of the above sections and other provisions of law referred to above will disclose the fact that the members of a board of health or a health official may be prosecuted for failure to perform a duty laid upon them by law just as effectually as would be the case if an individual failed or refused to observe an order or regulation of a local board of health.

In the June issue of this JOURNAL are printed the regulations for the prevention of venereal diseases as adopted by the Public Health Council May 2, 1918. Following the instructions of the Council, its secretary has caused the regulations to be published in the OHIO Public HEALTH JOURNAL and a copy of the issue of the JOURNAL containing the regulations has been sent to each health officer in the state. This information is given for the reason that everyone concerned is entitled to know that the provisions of law relating to the adoption of sanitary regulations by the State Department of Health have been observed.

These regulations will be printed in pamphlet form and distributed

request. Correspondence in regard to the provisions of the regulations or any matter relating thereto will receive prompt and careful attention.

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Reported Prevalence vs. True Prevalence

of Venereal Diseases in Ohio

By Sara Kerr, Statistician, Division of Communicable Diseases,

State Department of Health

IN

N February, 1917, health of- and addresses of patients, and conficers of the largest ten cities sequently would be more inclined

of the state were asked their to neglect reporting. opinion as to the advisability of It was not, however, so much amending the regulations providing the question whether or not the for reports of gonorrhea and amendment should be adopted at syphilis in Ohio by requiring that this time, as what seemed to be names and addresses of patients be the attitude of the health officers given, the morbidity report regula- on the whole subject of venereal tions of the Ohio State Board of disease reports, that caused the Health passed on October 21, 1914, special inquiries to be directed to carrying the proviso that “in re- the ten cities. In February, 1917, ports of cases of the venereal dis- the great emphasis which war has eases the name and address of

since placed upon the necessity for patient need not be given." This controlling venereal diseases was question of amendment was raised lacking and the problem of securin addition to sending to physicians ing reports was more difficult than and health officers of the state cus- it should be at present. Knowing, tomary form letters for improved however, the attitude of the health reporting of venereal diseases af- officers in the ten largest cities, ter the tabulation of morbidity re- comprising over a quarter of the ports for 1916 showed marked de

population of the state, it was creases in reported cases of gonor- hoped that some light upon solvrhea and syphilis compared with ing the problem might be obtained. returns for 1915. The suggested No reply to the question of amendment by requiring names amendment was reecived from and addresses could conceivably Akron and Columbus. Akron reproduce further decreases in the ported five cases of gonorrhea and number of cases reported, such a two cases of syphilis in three years, result being probable in the opinion 1915-1917. Reports for Columbus of two of the eight health officers

compare more favorably with rereplying to the question of amend- turns from those cities making ment, but these two health officers some effort to secure compliance were giving the least attention of with requirements. Of the eight the ten to securing any reports of answers received, it was gratifying venereal diseases. The belief is that five favored the amendment. just as tenable that physicians These five affirmative answers could see little value other than for were from the health officers who statistics, inaccurate at that, in were securing the larger number submitting reports without names of reports, Toledo with the highest

one

case report rates sending the most diseases in three years, casts a most enthusiastic reply in favor of the serious reflection upon physicians amendment. By way of contrast of the state who are entrusted with with our present recognition of the the responsibility of reporting disabsolute necessity of securing re- eases dangerous to the public ports today to safeguard army, health. In the same three years navy and nation, the following syphilis alone caused more than statements from city are 1,200 deaths in Ohio directly regisquoted: "We all know that the tered as due to this disease, with great majority of physicians would

over 400 more deaths under the refuse to report the name and ad- title of locomotor ataxia to be dress of a venereal case" and "I added, with the total number more believe the requirement would than doubled by the many deaths penalize reputable practitioners of from general paralysis of the inmedicine and that it could not be sane, cerebral hemorrhage, paresis, en forced.” On the contrary, we certain diseases of the heart and all know today that physicians can- blood vessels, and other causes, for not refuse to report and that it will which syphilis is or may be responnot be the reputable practitioners sible, although the classified statewho will be penalized.

ments of death conceal its identity. Despite the recognized value of

Records show that the so cities reports and the great advantage

of the state have reported 86 per if such were being regularly re

cent of the cases of syphilis and ceived as we entered upon the war,

62 per cent of the cases of gonorletters, circularizing, proposed

rhea. The cities at the last cenamendments and other available

sus comprised 51.8 per cent of the methods failed to produce im

total population of the state. It is provement in reporting during quite possible to count, however, 1917. The record for the state for

usually upon the fingers of one the three years during which

hand, the physicians in a city who gonorrhea and syphilis have been

comply with requirements governreportable diseases in Ohio fol- ing reports. Toledo's records inlows:

dicate that the responsibility of 1915 1916 1917 Total submitting reports is more deeply Gonorrhea 2,649 1,701 1,454 5,804

felt and observed by her physicians Syphilis .. 1,061 804 814 2,679 than by other physicians of the

state. In the three year period, It has been conservatively esti- Toledo reported 1,307 cases of mated that annually about one per- gonorrhea out of the total of 5,804 son in every forty in the United cases for the state and 653 cases States is treated for venereal dis- of syphilis, with the state reporting ease. Military medical, supervision 2,679 cases, 22 and 24 per cent, rewill give more definite figures of spectively, of the state totals. It incidence, particularly for the age is not to be understood that these group of highest susceptibility to higher case rates for Toledo would infection, but using the estimate of indicate higher incidence. The one in forty annually seeking treat- evidence on reports shows instead ment, with Ohio's population ex- better reporting in Toledo. In the ceeding 5,000,000, the table above, majority of cities, it is probable with fewer than 8,500 cases for that any one physician will recall, the two most prevalent venereal in his practice alone, more cases in one year than reported by all eases reported for 1917, 4,663 physicians in the city, during the cases, was more than twice Ohio's period in which regulations for re- total of 2,268 cases in the same ports have been in effect.

year. California's population is The state of California suc- only half the population of Ohio. ceeded in 1917 in doubling vene- For the first six months of this real disease reports of the previous year, 2,801 cases of venereal disyear, presenting figures with the

eases have been recorded for statement that "the venereal dis- Ohio, 1,966 being reports of gonoreases are now being placed on the rhea and 835 of syphilis, an aversame plane as any other reportable age per month of 328 and 139 communicable disease.” The cases cases, respectively. Higher averof gonorrhea reported in California

ages were reported than for the in 1917 numbered 2,873 against past two years but not beginning 1,091 during 1916, with the in

to approach the averages which crease in the reports of syphilis will obtain when physicians report from 1,538 cases in 1916 to 1,790 all cases as required by regulations in 1917. The total of the two dis- effective on and after July 1, 1918.

Venereal Disease in Relation to Child

Hygiene

By Frances M. Hollingshead, M. D., Director, Division of Child

Hygiene, State Department of Health

I"

T is, of course, an old and trite were due to unknown causes. Of

statement that the relationship these unknown causes, Doctor Wil

between venereal disease and liams believes that syphilis was rechild hygiene is a close one. The sponsible for at least 40 deaths or fact that syphilis plays a very im- one-third of the series. In this portant part in the infant mortality group of 10,000 cases nearly half rates is well known. It remained, were colored and this would perhowever, for a recent study to give haps account for the high syphilitic us actual findings in a large group death rate. In the 705 foetal of cases. Whitridge Williams deaths the rate was: black 9.4 perfound in a careful study of 705 cent, white 5.1 percent. The same foetal deaths occurring in 10,000 held true of the incidence of obstetrical cases admitted to Johns syphilis among the women, negro Hopkins Hospital that the connec- syphilitics representing 35 percent tion is very vital. Of the 705 and whites making up 14 percent, foetal deaths intensively studied by In addition to these 186 foetal the best diagnostic methods and by deaths, microscopic examination of pathological examinations, syphilis all placentas showed thạt 350 chilwas the cause of death in 186 dren with syphilis were born to the cases or 26.4 percent of the total, 10,000 women.

This leaves 164 while 127 deaths or 18 percent children who were still alive at the

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