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NOTHER serious typhoid fever epidemic, due to the importation of a case of typhoid into a community devoid of necessary sanitary safeguards, has been investigated by the State Department of Health. The outbreak occurred at Connorville, an unincorporated community of about 250 inhabitants in Jefferson County. Conditions were similar in many respects to those prevailing in the epidemic at Coitsville, Mahoning County, investigation of which was reported in the June OHIO PUBLIC HEALTH JOURNAL.

A representative of the Department went to Connorville July 2, after information of the outbreak had been transmitted to the Department by the health officer of Warren Township, in which the hamlet is located. Ten cases of typhoid fever had been reported to the health officer, it was learned, but five unreported cases were dis

closed in addition to these. The fifteen cases had occurred since March 6, in three groups about one month apart: March 6 to March 22, April 28 to May 7 and June 5 to June 15. None of the cases had been reported to the State Department of Health, the call for investigation having been brought about by the superintendent of a hospital at Martins Ferry, whose wards were being crowded with typhoid patients.

The first case, appearing on March 6, was in a man whose occupation of drayman caused him to travel over the country and drink water from many sources. The second and third cases followed in his household March 22. The fourth case (April 28) and the fifth case (May 1) were in a man and wife residing at a distance. from the first three cases, but indirectly connected with them by marriage. Other cases also were

Rate 1917.

scattered here and there over the community. Family relationships and an intimate degree of contact, however, were established in ten of the cases; of the remaining five cases, two were children in a household which purchased milk from the family first affected, two others were children who had been in close contact with children numbered among the first ten cases and the fifth was an older brother of one of these latter two children. Contact is therefore established as the probable source of infection in twelve of the fourteen cases which followed the first case, and either milk infection or contact in the remaining two cases children who were in the habit of playing with the other children in the community.

Lack of sanitary precautions with regard to wells and privies makes these probable additional sources of typhoid infection also. The water supply of the community comes from wells and from a spring, all of which were found to contain B. coli, indicating human contamination. None of the cases could under the circumstances be definitely traced to water supply, but it is almost certain that some of these wells, after the epidemic had prevailed for some time, were capable of transmitting the disease. Carelessness in looking after patients, evidenced by the prevailing lack of cleanliness among the residents, and the presence of leaching privy vaults close to wells and usually on higher ground than the well, made the spread of the disease certain after one case was introduced.

The two later periods of the epidemic, including twelve of the fifteen cases and two deaths, would almost certainly have been avoided had proper precautions been taken.

in the control of the first three cases, according to the investigator who reported upon the epidemic.

Recommendations made for the prevention of further typhoid outbreaks in Connorville included: Disinfection of all wells and abandonment of the spring, anti-typhoid inoculation of residents, improvement of wells by grading of surrounding ground to carry surface water away from the well and by installing concrete curbs and tight concrete covers to keep out surface contamination, reconstruction of all privies so as to provide water-tight vaults with flyproof superstructures and covered seats, screening of doors and windows of all houses, allowing of no person to be connected with the handling or distribution of milk or other raw food supply until he has complied with the other recommendations stated.

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URING the first three months of Children's Year 663 babies were saved in Ohio, basing comparisons with 1916 on the average three months' period in that year. The state's three months' quota is 1,128-465 in excess of the actual saving. Deaths of children under five years old during these three months totaled 3,174; for the average three months' period of 1916 the total was 3,837.

During the six months from January 1 to July 1, 1918, a saving of 683 was attained, by comparison with the average six months of 1916. The quota assigned to be saved in six months under the Children's Year program is 2,255. Children's Year did not formally open until April 1, the anniversary of America's entrance into the war.

The monthly savings for the six months as follows (the monthly quota is 376):

were

activities, when as a matter of fact a certain amount of these savings is due to the fact that the average monthly mortality is normally considerably higher than the actual totals for May and June. The

truth of this statement is evident in the fact that May and June come after the period of high pneumonia mortality and before the period in which the toll of diarrhea and enteritis rises. The fact that no detailed statistics on infant mortality by months in Ohio are available, however, makes it necessary to base computations of savings on average figures.

Since the Children's Year quotas were apportioned, on the basis of the 1916 mortality in the various counties and cities, the 1917 infant mortality figures have been compiled by the State Bureau of Vital Statistics. The total of deaths under five years of age in 1917 was 15,373. In 1916 the total was 15,349. In view of this slight difference between the two years, quotas based on 1916 mortality are practically as well-adjusted to the situation as if they were based on the 1917 deaths. The second of the attached tables shows infant mortality figures by counties for both 1916 and 1917.

While the infant death total remained practically the same in 1917 as in 1916, the rate showed a decrease. In 1916, 298 children. under five years old in every 100,000 of the population died in 1917, 295 per 100,000. Deaths of children under five years old in 1916 represented 20.7 percent of

County.

pected in May and June because of the low prevalence of pneumonia and diarrhea and enteritis. It appears to be a fact, however, upon hasty survey of the death certificates for June, that enteritis deaths were even less numerous this year than they ordinarily are in June. At the same time whooping cough was unusually prevalent and this prevalence continued through July. Whooping cough is a disease which is especially fatal to babies. The chief work which needs to be done during the summer to keep the infant mortality rate low, therefore, comes under two heads:

First, the enteritis rate must be kept down by educating mothers in proper methods of clothing and feeding their babies and by providing adequate nursing and medical care for sick babies.

Second, the whooping cough epidemic must be brought under control a result which can be accomplished by strict enforcement by local health authorities of the new regulations for the control of whooping cough which went into effect July 1.

Adams

5,420

April.

May.