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death totals, which have also risen. To July 1, 406 deaths had been reported — two-thirds as many as in the entire year of 1917 and within 67 of the yearly average for nine years.

The totals, by months, for the earlier half of the present year are as follows:

Reported
Month.

Cases. Deaths.
January

810

48 February

899

54 March

1,141

83 April

945

71 May

1,341

80 June

1,656

70

Totals

6,792

406

There is little reason to doubt that the year's totals will exceed those for 1913, and if the situation continues as serious as it has been, the record for the twelve months will reach 14,000 cases and 700 deaths – surely a high price for a state to pay for failure to prevent a preventable disease!

The source of hope in the situation is the new regulations for the control of whooping cough, which went into effect July 1. They provide for quarantine of all cases of whooping cough and for quarantine or striet medical supervision of non-immune children who have been exposed to whooping cough ; provision is made that children under quarantine may go into the streets if they wear armbands marked "whooping cough." These regulations are designed to put a stop to the indiscriminate exposure of hundreds of children to this dangerous disease which has resulted from the failure of local health authorities to adopt quarantine regulations when it was left to their discretion to do so.

Putting the regulations down on paper, however, does not accomplish automatically a decrease in whooping coughi prevalence. To achieve this result, the regulations must be enforced, and the duty of enforcing them rests with the local health officials of the state. The safekeeping of the lives of hundreds of little children — 95 per cent of those dying of whooping cough are under five years old — is in their hands.

Negligence of Some Physicians A recent study of whooping cough Is Costing Baby Lives

death certificates for four months, in

which these reports were checked with case reports for the same period, brought to light the fact that twenty-eight per cent of these deaths had no corresponding case reports on file. Attending physicians in twenty-eight per cent of these fatal cases had disobeyed the regulation requiring that all whooping cough cases be reported. What proportion of the non-fatal cases for the same period was not reported is of course unknown, but it is probably even greater than twenty-eight per cent, since many light cases are not attended by physicians.

Similar studies are being made in other diseases, with like results. The whooping cough instance is cited because of the great seriousness of this disease, despite which many physicians continue to refuse to cooperate with the health authorities in checking its prevalence and thereby saving the lives of scores of children.

Reporting communicable diseases is not only a legal duty but a moral duty as well. The man who fails to make the required reports is not only breaking the law but is refusing to protect his neighbor against a serious menace.

"Who should be blamed?” is the question every doctor who doesn't report whooping cough should ask himself when he reads that four hundred babies have died of this disease thus far this year.

*

Why Don't Communities Prevent Aside from the interest which the Preventable Baby Deaths?

statistics on infant mortality pub

lished in this magazine may have as indicating Ohio's score to date in the baby-saving campaign, these figures teach a great lesson -- that preventable diseases are responsible for a large number of baby deaths.

When pneumonia was prevalent, during the winter and early spring, the infant death rate was high. When pneumonia prevalence dropped off and enteritis failed to make a strong early start, the death rate was low. As the whooping cough epidemic developed, many babies were sacrificed to this cause. Pneumonia, enteritis and whooping cough are largely preventable, and the influence they, with other preventable diseases, exert on the infant death rate is enormous.

If babies continue to die of whooping cough during the remainder of the summer, as they died during the earlier months of the year, and if diarrhea and enteritis claim their victims by scores, as in previous years, it will be because the communities in which these babies reside are neglecting the duty of saving them.

The process of preventing a large share of the enteritis deaths is a simple one: educate mothers to nurse their young babies and to give proper food - largely milk -- to older babies, and provide plenty of pure milk at a low price — free if necessary -- for carrying out this direction . The means for stamping out whooping cough are provided by the new state regulations, discussed elsewhere in these columns.

Theoretically no one would estimate the value of a baby's life in dollars and cents, yet in practice communities are indicating every day that they do not consider such lives worth even the slightest expenditure.

*

Schools Must Be Equipped to How well are the schools of

your comCare for Children's Health munity adapted to the work of building

up the bodies, as well as the minds, of their pupils ? · As the schools reopen for the winter term it will be worth any community's while to consider this question.

While the well-designed, sanitary schoolhouse has gradually been coming into its own in recent years — while medical supervision is being introduced into more and more schools each year, nevertheless the unhealthful school, whose dangers are made even greater by failure of the school authorities to exercise any physical supervision over the pupils, has by no means passed out of existence.

No school authorities should be pardoned for maintaining a school which deprives the pupils of the fresh air they need for their growth, which forces them to strain their eyes because of inadequate light, which carelessly permits them to be exposed to contagious diseases, which forces them to drink water of uncertain purity or which makes no attempt to remedy their physical defects.

School officials who wish to develop their schools along hygienic lines but are uncertain as to what is needed and how to make improvements can obtain advice on these points from the State Department of Health. The Department has a variety of literature on school topics, and will be glad to make special suggestions to fit individual cases.

Draft examinations prove that many American men are unfit for military service because their health was not properly looked after in childhood. The responsibility for such a situation must rest largely with the public schools, which, while training the pupils' minds to fit them for citizenship, have neglected their bodies -- an equally important factor in performing the greatest of all the duties of citizenship.

*

Venereal Sufferer Forbidden A method of excluding venereally to Handle Food Supplies diseased persons from work in food

handling establishments without the enactment of any local regulations is provided by Section 7 of the State Dairy and Food Department's "Regulations to Promote the Sanitary Condition of Food Establishments.” This regulation reads as follows:

"No employer shall require, permit or suffer any person to work nor shall any person work in a building, room, vehicle or any place occupied or used for the production, preparation, manufacture, handling, packing, storing, sale, distribution or transportation of food who is afflicted with any venereal disease, smallpox, diphtheria, scarlet fever, yellow fever, tuberculosis or consumption, bubonic plague, Asiatic cholera, leprosy, trichina, typhoid fever, epidemic dysentery, measles, mumps, German measles, whooping cough, chickenpox or any infectious or contagious disease."

Venereal disease, it will be noted, is placed on the same basis as any other communicable disease as á cause for excluding its victims from employment in handling food. Every health department should see that this regulation is properly enforced - that the syphilitic or gonococcus-infected food-handler be put under the ban as promptly as one afflicted with smallpox.

Enactment of a regulation requiring proof of health by a medical examination as a prerequisite to employment in a food establishment will make the enforcement of this existing regulation a simple matter. Many local boards have already taken action providing for such examiuations, and others should fall into line.

*

Typhoid Prevalence Is High Figures on typhoid fever case reports but Much Can Yet Be Done for July, as given in the report of the

Division of Communicable Diseases in this magazine, do not afford a great deal of hope that this year's typhoid rate will fall to a new low record, unless we assume that local health authorities are going to do far more in typhoid prevention during the next month or two than they have done thus far.

The case total for July went as high as that for July of last year. Some of this apparent equality in prevalence between the two years may be due to more complete reporting this year, as a number of the cases recorded last month were reported only after strenuous effort on the part of the Division of Communicable Diseases. Despite this possibility, however, the decrease, if there has been one, cannot be considered large.

Far from discouraging efforts to reduce typhoid fever in Ohio, this report should merely increase our determination to bring about that result. Most important of all, remember that the month of greatest normal typhoid prevalence — and therefore the most fruitful month for preventive work -- is just ahead. August normally doubles the July total, and September normally rises still more to the high mark of the year. August will be past by the time this issue of the JOURNAL reaches its readers, but much effective work can yet be done in September.

The season is late for the most possible good to be accomplished by general campaigns of sanitary improvement — this should have been done several months ago, although effort now will show up in the remaining

months of normally low prevalence and in future years. Prompt reporting of cases by physicians, however, and prompt action by health officials upon such reports can still wipe out to a large extent the grave danger of contact infection.

If the physicians who now refuse to obey the law for reporting typhoid cases will immediately turn over a new leaf, and if health authorities will institute careful supervisory methods over all typhoid cases and will carefully instruct those in charge of cases in the need for extreme cleanliness to protect other members of the household, then the threatened high typhoid death total may yet be warded off.

*

Be Ready for Poliomyelitis An increase in poliomyelitis prevalence is Epidemic If It Appears becoming noticeable, although there is as

yet no definite indication that the disease will reach an abnormally high total this summer. Health officials, however, should be on their guard against possible serious local outbreaks and, if they are not conversant with the latest developments in poliomyelitis prevention, should make some study of the subject.

This disease has come into prominence so recently that our experience in controlling it is somewhat limited. The fact that the period of contagion begins before the symptoms of the disease appear also causes difficulty in checking it.

The regulations prescribed by the State Department of Health for the control of poliomyelitis, however, represent our latest knowledge on the subject and should be strictly carried out in every outbreak. Steps should also be taken, when poliomyelitis appears, to acquaint parents with the precautions which should be observed to protect children from the disease. Briefly stated, these precautions are as follows:

Keep children away from all cases of sickness of any kind.

Keep them away from public gatherings, such as theaters, picnics, churches and school.

Don't take them on street cars, on trains or out of town.

Don't allow them to come into contact with persons from localities where the disease is prevalent.

Keep them at home in well-screened rooms, until the outbreak is over.

There is no need to become hysterical over poliomyelitis, as communities too often do, but preparation beforehand to meet the disease if it appears is likely to mean a much lower cost in deaths and crippled bodies than would otherwise be paid.

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