Chickenpox. For two months chickenpox has headed the notifiable diseases listed as to greatest reported prevalence. The December total exceeded the November reports by 220 cases and as shown by the table for December, 1915-17, was higher than the totals for the month both years. Toledo recording 388 cases in November, reported 279 cases for December. Cleveland recorded 119 cases for December, Cincinnati 99, Akron 80 and Columbus 62 cases. Complete reports for Dayton have not been received to date but at least 50 cases were recorded during the month. The six cities reported 689 of the 1,438 cases for the month, 48 percent. Diphtheria. Excluding the 435 cases in the eight cities listed immediately following, the remainder of the December cases, 317, were scattered, having been reported from 140 health districts in 58 counties. Cleveland reported 176 cases, Cincinnati 81, Toledo 46, Akron 43, Dayton 36 (incomplete), Columbus 29, Lima 17 and Findlay 7 cases. The latter two cities have had high case rates for three months past, the reduction for Lima for December not being so marked as the reduction for November, Lima having reported 32, 19 and 17 cases, Findlay 17, 12 and 7 cases for the three months. Scarlet Fever. The total of 752 cases recorded to date of January 15, for scarlet fever was the same figure recorded for diphtheria for the month and 6 cases less than reported for November, although previous years of record show tendency for increase in December over November. Meningitis, Epidemic Cerebrospinal. The reports for December, 1917, more than double the figure for December, 1916, 30 cases against 13. The cases were reported as follows by counties and health districts; Adams Co., Winchester Tp. 1; Athens Co., Nelsonville 1; Cuyahoga Co., Cleveland 5; Franklin Co., Columbus 1; Madison Tp. 3; Hamilton. Co., Cincinnati 1, Addyston I; Lucas Co., Toledo 3; Mahoning Co., Smith Tp. 1; Medina Co.. Wadsworth 1; Montgomery Co., Dayton 4: Ross Co., Camp Sherman 8. In Providence, in sixty years, there has been a decrease in the annual number of deaths amounting to about 600 per hundred thousand living and confined practically to typhoid fever, smallpox, scarlet fever, diphtheria, tuberculosis, diarrheal diseases and other diseases of infants. It is not claimed that all of this reduction is due to conscientious effort on the part of the community, though the figures in Table 2 appear reasonable as a statement of the deaths prevented by official control, and also of the chief means by which the lives were saved. By putting the facts in a different form, it appears that community activities have been effective in saving these 345 lives in the ratios given in Table 3. These are old and tried lines of public health work and must hold the largest place in apportioning the activities of a municipal health department. Of fundamental importance is the collection and tabulation of vital statistics. Only by this means can evils be located and remedies. found. Education of the public in matters pertaining to health is another basic function, which until recently has been much neglected and even now is often injudiciously performed. The leaders of thought and action in each community should be made familiar with the successes of modern sanitary science and the means by which they are obtained. Literature and motion pictures help but the personal influence of the school teacher, the nurse, and the social visitor have thus far seemed to accomplish most. The great leavening force in modern health work is the diagonstic laboratory. To control disease, either by prevention or cure, we must first find it. This the laboratory helps us to do. The remarkable decrease in the case fatality of typhoid fever during the last twenty years or so is almost entirely a result of better diagnosis by the help of laboratory methods. The care of the indigent ill should be considered a public health function. Sickness and poverty are closely related and the poor, both from necessity and indifference, neglect sickness. Medical care of the sick poor is in a chaotic or experimental state this is a function which should be performed by the health department. Closely connected with the care of the indigent ill is the elimination or restriction of the nostrum evil. To accomplish the latter, good medical service must be supplied in its place. A conscientious and efficient medical service for the poor will do more than anything else to wean them from nostrums. Sanitation and food control are usually considered the principal functions of a city health department. By many people, municipal housecleaning is considered the chief duty of the "board of health." Some municipal sanitation is of great importance in the prevention. of disease. Where there is no system of sewage disposal, as in some of the rural portions of our country, this subject may well have a large part of the health department's attention. However, the department. should not be charged with the removal of refuse and garbage this has an indirect connection with health but is essentially a function of the department of public works. Control of food supply is a time honored means of promoting public health. This control is divided into the prevention of adulteration and the promotion of cleanliness. Milk should be considered apart from other foods. The most effective way to eliminate the danger from this source is to require the pasteurization of all milk. Since all medical activities of the municipality should center around the health department, the medical inspection of schools becomes a proper function of this department. This is or should be a co-operative undertaking neither the school department nor the health department can obtain satisfactory results without the free and generous assistance of the other. Efforts directed toward the prevention of infant mortality show more apparent results than any other form of child welfare work. In practically every instance in which a community has undertaken to save the lives of its babies it has been successful. The chief means has been the education of the mother wherever that has been successfully accomplished the infant death rate has fallen. - The direct control of communicable diseases by isolation and immunization is an important duty of the health department. Among methods of control, isolation in the home is probably the most important. Hospital care should be furnished for those so situated that isolation in the home is impossible. Vaccines and curative serums have proven their value in the control of infectious disease, and experience has shown that the successful use of these agents depends to a great extent on the initiative of the city or state. A modern campaign against tuberculosis makes use of many means and is often correlated with various private agencies. The most important municipal activities are nursing, dispensary service and hospitalization; the latter, which a few years ago was considered of first importance, has been given a secondary place. The protection of the water supply is a function of the state department of health rather than a municipal department. However, it is the duty of the health officer to show by his morbidity statistics whether or not the water is above suspicion. If the future health work is to be successful we must remember that the health work is not centered upon the environment -- but that it is concerned directly with men and women. Community health work must have a broader outlook it must do more than cleanse and isolate it must educate and make use of the best medical knowledge to prevent and cure disease. With limited money and talent, a municipal health department must earnestly study to do that which pays best. AMONG TUBERCULOSIS HOSPITALS OF STATE Springfield Lake District. Application by the commissioners of Summit County for permission to add to the cottage colony at Springfield Lake District Tuberculosis Sanatorium has been formally granted by the commissioners of Columbiana, Mahoning, Portage and Stark Counties. All expenses will be borne by Summit County, if the plan is carried out. Lima District. The board of county commissioners of Auglaize County has applied to the courts for the transfer of $4,295.32 from the county dog fund to the tuberculosis hospital fund. It is represented that the tuberculosis fund is overdrawn to the extent of $2,824.35 and the status of the dog fund is such as to permit of the withdrawal of the amount petitioned for. Chillicothe District. At a meeting of the board of trustees of the Chillicothe District Tuberculosis Hospital December 28, it developed that the opening of the hospital had been delayed because. ture. Springfield District. Dr. R. R. Richison, superintendent of the Springfield District Tuberculosis Hospital, submitted his first report since his appointment, to the board of trustees at its regular meeting. The patients in the hospital at the end of the year 1917 were 34. The per capita per diem cost was $1.98. Physical examination of 1,700 men, women and children at Framingham, Mass., showed 82 percent with various diseased conditions. Many of these defects were such as could be prevented from becoming serious by early discovery and treatment. |