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EDITORIALS – Can Ohio Reduce Baby Deaths as New Zealand Has Done?

- Prevention of Blindness Law Must Be Enforced — Measles and

Whooping Cough Are Notifiable Diseases — Municipal Child Hygiene Di-

visions Will Help — Baby-Saving Campaign as an Educational Force —

Smallpox Is Repulsed but Not Yet Defeated — “Vaccination Has Again

Been Proved Successful” – Shipments of Chemicals for Water Purifica-

tion Expedited — Department Man Will Help Clean Up Holy Land and

Egypt — Life of Service Ends for Pennsylvania Health Commissioner. 90

Local Health Organization in Ohio....

96

State Program for Child Welfare - Outline...

97

Proposed Children's Welfare Program, by FRANCES M. HOLLINGS HEAD, M. D. 99

Physician Is Blamed for Serious Epidemic...

100

County and City Quotas Apportioned for Ohio's Child-Saving Campaign.... 101

"Where Babies Never Die"....

104

Pigs Is Pigs...

105

Public Health Service Considers Malnutrition..

105

The Part of the Public Health Nurse in Child Welfare, by HELENA R.

STEWART, Ph. B., R. N.........

106

The Organization of a Municipal Bureau of Child Hygiene, by RICHARD A.

BOLT, M, D., Gr. P. H.......

108

Child Hygiene Activities of Municipal Health Departments of Ohio: Cin-

cinnati, Dayton, Akron, Toledo.....

111

Ask Health Officers' Aid...

115

War Increases Ophthalmia Neonatorum.....

115

The Discharged Tuberculous Soldier in Ohio, by ROBERT G. PATERSON, Ph. D. 116

Baby Mortality Gains Reported in Germany...

119

Why Ohio's Babies Die.....

120

Medical Examination of Food Handlers.

120

State Quotas of Babies to Be Saved in Children's Year Campaign..

121

School Epidemic Scatters Scarlet Fever Over Ohio.....,

121

Ohio Mortality Statistics, November and December, 1917.

122

Public Health Nursing Service, Report for January, 1918.

123

Violator - Plan New Laboratory Work..

Public Health Notes From Over the State...

135

136

Vol. IV

MARCH, 1918

No. 3

EDITORIALS

Can Ohio Reduce Baby Deaths Why should not Ohio enter the race As New Zealand Has Done? with New Zealand in saving the lives

of babies? We paraphrase a recent bulletin of the Federal Children's Bureau, which, after remarking that Minnesota had the lowest infant death rate in the United States registration area, asked: “Why should not Minnesota enter the race with New Zealand ?"

To be sure, there are certain facts which would constitute handicaps to Ohio in such a race. Ohio is more thickly settled than New Zealand, and has larger cities. The character of her population is not the same as that of New Zealand.

Handicaps, however, ought only to make the handicapped one exert a little more effort. They ought not to discourage him from entering.

The statistics which enter into a comparison between Ohio and New Zealand in the matter of infant mortality are given elsewhere in this issue. In general, Ohio has a rather high baby death rate, but nevertheless one which is somewhat lower than that for the registration area of the United States as a whole. Her rate is considerably higher than the rate which New Zealand was enjoying at the beginning of thar dominion's remarkable decrease.

In other words, if Ohio were to reduce her infant mortality to a level equal to New Zealand's present rate, in a period of time equal to that covered by New Zealand's reduction, she would make a much greater proportionate decrease than New Zealand has made.

Ohio will, however, deserve much credit if she shows reductions approximately. equal to those of New Zealand, even though the final result is a rate still a little higher than New Zealand's.

Speaking in generalities, one might say that the higher the initial rate, the greater is the chance for reduction. This may not be statistically correct, but the principle of it is reasonable.

In short, the situation is this:

Our rate is too high now. New Zealand's was not so high in the beginning, yet New Zealand has achieved a remarkable record. With our greater number of preventable deaths, why should we not achieve at least an equal reduction?

Prevention of Blindness Blindness, due to carelessness of physicians Law Must Be Enforced or other attendants at birth, is one of the

handicaps against which many children must struggle in their fight to reap the full fruits of life. To prevent such unnecessary, easily preventable blindness, the state of Ohio has enacted a law, which, however, is not unfailingly enforced.

The blindness which these laws are designed to prevent results from an inflammation, which is, in turn, caused by germs that get into the eyes at birth. These germs can be killed by putting a prophylactic into the child's eyes immediately after birth.

The law of Ohio for the prevention of blindness from this inflammation provides in part as follows:

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Any inflammation, swelling or redness in either one or both eyes of any infant, either apart from or together with any unnatural discharge from the eye or eyes of such infant, independent of the nature of the infection, if any, occurring any time within two weeks after the birth of such infant, shall be known as “inflammation of the eyes of the new born."

It shall be the duty of any physician, surgeon, obstetrician, midwife, nurse, maternity home or hospital of any nature; parent, relative and any persons attendant on or assisting in any way whatsoever, any infant or the mother of an infant at childbirth or any time, within two weeks after childbirth, knowing the condition, hereinabove defined, to exist, within six hours thereafter, to report such fact, as the state board of health shall direct, to the local health officer of the city, town, village or whatever other political division there may be, within which the infant or the mother of any such infant may reside. For such services the attending physician, surgeon, obstetrician, midwife, nurse, maternity home or hospital shall receive from the state treasurer a fee of fifty cents.

The law further directs the State Department of Health to distribute free of charge to physicians and midwives a prophylactic for inflammation of the eyes of the newborn, with directions for its use. The prophylactic distributed is a one percent solution of silver nitrate. Supplies may be obtained by any physician or midwife direct from the Department or at any of the 300 distributing stations scattered over the state.

In the case of births in maternity homes, hospitals, public or charitable institutions, the use of some prophylactic is made compulsory by law, and record must be made of the kind of prophylactic used. All midwives are required by law to use, at all births attended by them, such prophylactic as the State Department of Health may direct.

The duties of the local health officer are listed as follows in the law : 1. To investigate or to have investigated, each case as filed with him in pursuance with the law, and any other such case as may come to his attention.

2. To report all cases of inflammation of the eyes of the new born and the result of all such investigation as the state board of health shall direct.

3. To conform to such other rules and regulations as the state board of health shall promulgate for his further guidance.

A nursing service for the prevention of blindness is maintained by the State Department of Health to assist local health authorities in caring for cases of inflammation of the eyes of the newborn. With the limited appropriations at its disposal, however, the Department is able to care for emergency cases only. A large share of the work of guarding the children of the state against preventable blindness must rest with the local health authorities.

The health officer who wishes to do his part toward making the next generation able to bear the burdens to which it will fall heir, must exert every effort to see that the law for the prevention of blindness is enforced within his district and that every case of inflammation of the eyes of the newborn receives proper attention.

Measles and Whooping Cough One important source of danger to Are Notifiable Diseases

the health and lives of Ohio children

is the laxity of many physicians in reporting cases of measles and whooping cough — the commonest of the childhood diseases.

A very liberal estimate places the number of reported cases of measles at about two-thirds of the number of recognized cases. The proportion of whooping cough cases reported is little higher.

It needs to be impressed upon the minds of physicians that these are reportable diseases, for despite the efforts of the State Department of Health to make this fact clear, there are still many doctors who think they need to report only those diseases in which state and local regulations require quarantine.

As Ohio laws now stand, the question of quarantining these diseases is left to the local health authorities for decision. In many communities,

. the health board allows them to go unquarantined, and physicians erroneously believe that they need not be reported.

The truth of the matter is, however, that measles and whooping cough, like numerous other diseases for which Ohio statutes do not require quarantine, nevertheless are on the list of notifiable diseases.

The importance of the reporting of communicable diseases is emphasized in the statement of the United States Public Health Service that “no health department, state or local, can effectively prevent or control disease without knowledge of when, where and under what conditions cases are occurring.'

The physician who fails to report measles and whooping cough is therefore hampering the state and local health authorities in their efforts to control diseases which in 1916 killed 1,456 Ohioans.

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Municipal Child Hygiene One step in Ohio's campaign to conserve Divisions Will Help her children should be the organization of

more municipal bureaus and divisions of child hygiene than now exist. Through such organization, giving the movement official standing in the cities, child welfare efforts can be more efficiently directed and better co-ordinated 'than where they are left entirely to volunteer enterprise.

This does not mean that the work of volunteer organizations should in the least be belittled. Such bodies are doing valuable work in many communities, and to eliminate them would be to give child hygiene work a serious setback.

A private association, however, though its work be ever so valuable, can never have the weight of authority which is possessed by a governmental agency - national, state or city. Neither does it always make possible such concentration and centralization of effort as does the official bureau.

The ideal plan, therefore, is to install the city child hygiene division, to direct child welfare work in the city and to co-operate with and coordinate the activities of such private agencies as are working along similar lines. Suggestions for such organization are given in Dr. Bolt's article in this number.

A half-dozen cities of the state have placed such control in the hands of their municipal health departments and have, more or less completely, organized divisions in the departments to carry out this function. In the other municipalities, however, methods to fit the local situation must be carefully worked out and put into operation before the problems of child hygiene can be most effectively met.

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Baby-Saving Campaign To preserve for lives of worth and service as an Educational Force to society 4.510 babies who under our

"normally abnormal" conditions of infant mortality would be prematurely and unnecessarily taken away is an inspiring goal. But in the final analysis, even more important than the

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