the state. Since 1911, in this city, there have been no deaths of infants under two years of age from diarrhea and enteritis. During the same period the deaths of no less than 5,528 infants under two years of age, in California, were due to this cause. The health department of Palo Alto cost $3,310 last year- 56 cents per capita. At the beginning of 1918 there were three known cases of tuberculosis in Palo Alto, There was not a single case of diphtheria there during 1917.” Would it be worth 56 cents per inhabitant to your community to have such a record to present to the world? Baby Needs Protection * Public health workers who are interested in the campaign to lower infant mortality must busy themselves this summer in efforts to lower the appalling yearly total of deaths from diarrhea, the greatest scourge of babyhood. More babies healthy at birth die of diarrhea than from any other single cause. This situation can readily be improved, largely through educating mothers in proper care of their babies. The baby should be breast-fed and must be protected from the heat, if it is to be kept out of grave danger during the summer months. These two facts must be constantly and emphatically kept before the notice of mothers. The chances the breast-fed baby has of escaping summer diarrhea are infinitely better than those of the bottle-fed infant. For the protection, so far as possible, however, of the many infants who will be bottlefed, for one reason or another, despite this warning, rules for bottlefeeding must be expounded. Proper modification of milk under the physician's direction, use of milk of known purity and thorough sterilization of bottles and nipples are the principal considerations under this head. The ice supply must also be watched. Protection from the heat is largely a matter of clothing. Most mothers put too much clothing on their babies. They must be educated up to a recognition of the fact that light clothing is perfectly safe and desirable. Frequent bathing, avoidance of the direct sun and provision of a plentiful supply of fresh air must also be urged. Finally, mothers must be taught that if the baby develops diarrhea. despite these warnings, immediate consultation with a physician is essential. "Proper treatment at the beginning of a diarrheal attack," a recent discussion of the subject has said, "is worth more than many days' treatment later. Competent physicians, not gossiping neighbors, know what is best for the baby," Typhoid Fever in Ohio, 1909-1917: Some Statistical Observations First Diagram— A glance at the first of the accompanying diagrams, showing the monthly distribution of typhoid fever, makes quite evident how appropriate at this time of year is any consideration of the prevalence and control of this disease. Note the first five months' rather uneventful course of the lower curve in the diagram, representing the average number of deaths during the past nine years of accurate record in Ohio. June marks the beginning of the increase in the toll of deaths and sickness, which is doubled in the latter half of the year in spite of the totals for the first half being entirely too high. An average of 58 deaths a month. prevailed from January to July and 112 from July to the end of the year. That the maximum toll is exacted in September and October is quickly noted. The upper curve, representing the monthly average of reported cases, while quite striking in showing seasonal prevalence, fails to show the true number of cases. If health officers had successfully secured reports of all cases, then, on as conservative an estimate as eleven percent of cases dying, the diagram would have been drawn with proportions to represent for the year, in round numbers, 11,000 cases, rather than the 5,000 actually indicated. In other words, the lower curve, the death curve, is accurate but the upper curve, the reported case curve, tells only half the tale. The other half must be told before the death curve is materially lowered. It is not true that dead dead men tell no tales health officers tell no tales. Second Diagram Figured on the basis of the conservative eleven-percent case fatality rate, the probable number of cases of sickness from typhoid fever each year is shown in the second diagram for the nine-year period 1909-1917, in order to make amends for the misrepresentation from incomplete reports of cases. Reported cases prior to 1912 are not indicated because of absurdly inaccurate returns from health officers. What happened to reports in 1917? Is the war affecting reports of cases of notifiable diseases? Unfortunately the war is, in two marked ways, if not in more. During 1917 there occurred a larger number of changes and vacancies in the ranks of the health officers than for at least four years previously. Physicians called to service have in many cases been succeeded as health officers by laymen uneducated as to the value and necessity of reports, in addition to the appointment of health officers having been made, throughout 1917, with frequent delays and consequent lapses in reports. In many instances of failure to report, the increased postal rates have been used as an excuse by health officers, physicians and others required to report. Space has been left in this sec ond diagram to fill in the record for 1918. Health officers should keep the diagram in an accessible place as a reminder that the 1918 record should be filled in with more credit to themselves and more profit to the state. It should be noted that the deaths for 1916 were as much below the 1,000 line as above in 1909 and 1910. The block for 1918 should be still lower; the deaths should be below the 682 registered for 1917, rate 13.1 per 100,000 population, as recorded in Table I, - the lowest rate on record for Ohio. Third Diagram The excessive toll exacted by typhoid fever within the draft age TYPHOID FEVER, OHIO, 1909-1917 CURVES SHOWING AVERAGE DEATHS 1909-17 JAN FEB MAR APR MAY JUNE JULY AUG. SEPT. OCT NOV DEC. |