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covered and properly cared for, may carry the salient features of we may feel reasonably sure that each case in mind for a time, unfurther cases will not occur.

foreseen questions sometimes arise The determination of the source which memory can not answer. A of infection is sometimes easy, complete investigation is desirable often difficult, and frequently im- for the same reason. While it is possible, but it is always worth a

usually advantageous in a large good hard try. It is much more

outbreak to see a considerable numimportant than terminal fumiga

ber of cases within a short space tion, or concurrent disinfection, or

of time this should be followed by even a strictly maintained quarantine. Every large outbreak is

a more careful inquiry at the ear

liest opportunity. In the prelimifirst a small one and every small

nary investigation we seek the posone may be traced back to a single

sible source that is common to, say, case or carrier. Though it may be

the first ten cases and simply inless difficult to locate the sources

quire of another ten whether or not of infection of half a dozen cases than of one (provided the source is

they were exposed to this source of

infection. The purpose of this, as common to all) yet it is correspondingly more difficult to control the

must be apparent, is solely to in

sure that this highly probable half dozen and their contacts.

source shall be taken care of The investigation of cases for the

promptly. However, anyone who purpose of discovering the source

has encountered the "show-me” atof infection is perhaps the least titude of the well owner, or the understood procedure in the con- dairyman whose property, or the trol of communicable diseases. fond mother whose child, is acAside from the fault that they are

cused of transmitting disease, too frequently not even attempted will appreciate the comfort that the most frequent faults are that -

complete written records can give. 1 There is no written record

It is only by a record of the negamade at the time of investigation; tions as well as of the affirmations 2 The investigation or the record

that one can refute the sometimes or both are incomplete;

plausible, sometimes fanciful, 3 The investigator begins with a theories advanced by interested preconceived notion of the source

persons. and bends statements to fit the The written record serves the theory;

further purposes of disclosing sec4 Information is inaccurate :

ondary sources of infection when 5 The information obtained is

an outbreak is prevailing and of not tabulated and studied from a

being immediately available for statistical standpoint.

reference whenever needed. It Unless a written record is made frequently happens in "sporadic" at the time of investigation - put- cases that one is unable to definitely ting down each answer as it is trace the source. In a few days or . given -- the investigation and its a few weeks another case of the resulting conclusion are apt to be same disease may be reported. A most untrustworthy. An impor comparison of the data in the two tant feature of any investigation is cases may lead immediately to the not only the discovery of the prob- correct solution of the problem. able source but the ruling out of Inaccurate information is usually other possible sources. While one the result of the inability of the

tion

informant to remember, but not infrequently it is for the deliberate purpose of misleading. The investigator can generally determine whether it is purposeful or not, provided he discovers that the statements are incorrect. It is in order to check the more important items of information that one usually asks two or three questions along the same lines and compares the answers. For example, one inquires the date of onset of a case of scarlet fever; we are told it was on Wednesday, the 12th of the month. We ask the dates of going to bed and of the physician's first visit and learn that they were on the same day, but a reference to the health officer's record shows that the case was reported on Thursday, the twentieth, and that the case was quarantined that same day. Other incidents may then be called to mind which substantiate the later date as the correct one. Other items may be confirmed or their fallacy demonstrated in much the same fashion.

To overcome the handicap resulting from the deliberate perversion of truth, one must usually adapt himself to the circumstances, before him. As an instance the following experience may be related. A number of typhoid cases had suddenly appeared in a small town, all on one milk route. The source of infection, however, could not be located. Finally the health of

ficer, accompanied by a dairy inspector, visited the dairy farm for perhaps the fifth or sixth time. While the former engaged the family in conversation, the inspector wandered about the farm. The latter was an Irishman of no little wit and acuity and in his promenade he looked over the employes. Picking out the dullest-looking lout among them, he approached him as he was at work in a field and asked, "Where is the sick man?" The dull one replied that the sick man was gone; but beyond the fact that he had left a week before he could give no information. However, with the information in his possession, the inspector was able to secure a complete confession from the proprietor and the case was located in a hospital in another state.

The tabulation and interpretation of data suffer oftentimes by default, sometimes through a disregard of statistical methods, or through loose reasoning. Frequently the fault lies with the data collected, which is insufficient and difficult to tabulate. This is best avoided through the use of schedules or questionnaires, the investigator having a thorough understanding of the character of the information sought. The colection, tabulation, and interpretation of data, together with a description of the forms now being prepare by the State Department of Health will be considered in a later issue

.

DEPARTMENTAL REPORTS BY DIVISIONS

DIVISION OF COMMUNICABLE DISEASES. Reported Cases of Notifiable Diseases, Ohio, November, 1918.

Prevalence.-In order of greatest reported prevalence during the month of November the notifiable diseases list as follows, with comparative figures for October given:

Diseases.

1. Influenza
2. Pneumonia, Acute. Lobar.
3. Diphtheria
4. Smallpox
5. Scarlet Fever.
6. Gonorrhea
7. Tuberculosis, All Forms.
8. Whooping Cough
. 9. Chickenpox
10. Mumps
11. Syphilis
12. Measles
13. Typhoid fever.
14. Ophthalmia Neonatorum

Reported Cases. November. October. 53,664

51,612 1,241

1,994 462

549 434

226 362

571 290

349 256

329248

307 233

294 163

125 152

142 150.

322 116

324 103

187

Out of a total of 57,945 cases of notifiable diseases recorded for the month of November, for no other one was a total of 100 or more cases reported.

Influenza. It is only since October 11, 1918, that influenza has been a notifiable disease in Ohio, and a comparative study of statistics over a longer period of time is therefore impossible. Available influenza mortality statistics for former years indicate that a recurrence of this disease for the months of January and February is not improbable. Statistical reports of this disease will prove a valuable health guide for the future. The completeness of these records depends to a great extent on the faithfulness of the health officers in the discharge of their duties.

Pneumonia.—For November of this year there were 1,241 reported cases of this disease, a decrease in prevalence of 753 cases as compared with reports for last month. This decrease would indicate that one crest of the influenza wave was well past, since the unprecedented increase of pneumonia prevalence for the past two months is undoubtedly due to epidemic influenza conditions. Reported cases of pneumonia for November, 1917, were 218, little more than 17 per cent of the number reported for November of this year although representative of pneumonia prevalence for pre-influenza statistics.

Diphtheria.—The 462 reported cases of this disease for November show a decrease of 87 cases, compared with reports for October. For November, 1916, there were reported 1,271 cases and for November, 1917, 1,050 cases. The expected and customary increase in reported cases of diphtheria for this month did not materialize but it is not improbable that this increased prevalence will be shown in reports for succeeding winter months.

Smallpox.—The November total of reported cases of smallpox exceeds that of the previous month by 208 cases. The reported smallpox total for November, 1915, was 230 cases; for November, 1916, 247 cases, and for November, 1917, (under epidemic conditions), 814 cases. The increase in this month's report indicates a higher smallpox prevalence for the winter months and an indifference on the part of the public to vaccination.

Venereal Diseases.—Gonorrhea reports for the month show a decrease of 59 cases, compared with last month's report, and an increase

a

of 200 in comparison with November, 1917. Syphilis shows an increase for the month, compared with October reports.

Scarlet Fever.-A total of 362 cases of scarlet fever was reported for November. Reported cases for the previous month numbered 511. This indicates a marked decrease in scarlet fever prevalence, in all probability accounted for by the fact that schools were closed generally throughout the State. Scarlet fever statistics for previous years show an increased prevalence of this disease in winter. For November, 1916, reported cases totaled 939, and for November, 1917, 955 cases-almost three times the recorded number for this November.

November Reports.—The reports for this month, as well as those for the month previous, were unduly late in reaching the State Departinent of Health. While epidemic influenza has created abnormal health conditions throughout the State and greatly taxed the public health service, promptness and completeness on the part of physicians and health officers in making their reports will contribute to the efficiency of the service the Department extends to the State of Ohio.

TABLE I. REPORTED CASES OF NOTIFIABLE DISEASES, OHIO,
NOVEMBER, 1916-1918, WITH DISTRIBUTION FOR CITIES AND
VILLAGES AND TOWXSHIPS, NOVEMBER, 1918, AND
CASE RATES PER 1,000 POPULATION,

NOVEMBER, 1916-1918 :

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All Sotifiable Diseases (In

fluenza excepted) † 2,600 1,675 1,281 7.070 6,904 Chickenpox

128 10.5 233 1,362 11,189 Diphtheria

368 94 462 1,050 1,271 Gonorrhea

218

290 90 128 Measles

73

1.50 48.5 1,157 Measles, German.

19 23 47 32 Meningitis, Cerebrospinal.

21 14 Mumps

31 132

103 132 114 Ophthalmia Neonatorum 100

103

121 118 Pneumonia. Acute Lobar.. 681 -560 1,241 264 278 Poliomyelitis

3 12 18 Scarlet Fever..

216 116 362 9JJ 939 Smallpox

2:53 181 434 814 247 Syphilis

116

152 68 76 Trachoma

2

28 Tuberculosis, All Forms. 211 13 2:36 190 Typhoid fever.

12 74 116 212 Whooping Cough

83 10.) 2:18 -390 500 Other Notifiable Diseases.. 14 19 33 35 15

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*Reported cases from Camp Sherman and Wright Aviation Field included in total figures.

+Xo influenza morbidity statistics for comparative study.

TABLE II. REPORTED CASES, TEN NOTIFIABLE DISEASES, TOTAL CASE RATE PER 1,000 POPULATION, OHIO CITIES,

NOVEMBER, 1918:

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62 20 2 1 4 2

.100 .111 .180 .268

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.189

.420 2.282

.187 11.060

.142 .300 1.197 .334 .444 .879 .300 .535 .410 .301 .272

.200 2.745

3 4 14

1 10

2 20 10 19 13 167

73 3 1 879 112 75 15 5 5 43 27 2 2 2 15 3

3 508

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1 8 3 48 1 41 130 63 24 5 17 1 5

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Akron
Alliance
Ashland
Ashtabula
Athens
Barberton
Bellaire
Bellefontaine
Bellevue
Bowling Green.
Bucyrus
Cambridge
Canton
Chillicothe
Cincinnati
Circleville
Cleveland
Columbus
Conneaut
Coshocton
Dayton
Defiance
Delaware
Delphos
Dover
East Cleveland.
East Liverpool ?
Elyria
Findlay
Fostoria
Fremont
Galion
Gallipolis
Greenville
Hamilton
Ironton
Jackson
Kenton
Lakewood
Lancaster
Lima
Lorain
Mansfield
Marietta
Marion
Martins Ferry
Massillon
Middletown

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