The younger children of pre-school age of the ordinary or common primary schools are probably more frequently infected because of practically incessant contact with brothers and sisters and with neighbors' children. After the fifth year, however, less than 10 per cent contracted whooping cough, in sharp contrast with the 35 per cent contracting the disease at school age among the better class of schools. Similar results are shown in the analysis of mortality among children of families from which children attend the different schools. Percentage of deaths in children of families from which children attended the various classes of schools. These figures seem to show, at least for the group of children studied, that among children attending the ordinary primary school, whooping cough claims victims even after their fifth year, the percentage decreasing slowly but gradually with increase in age. Among children of the better class (advanced school, first class) nearly twothirds of the deaths are found in infants inder 1 year, and no fatal case occurred after the third year. The information given in these two tables is summarized by the statement that the children of the poorer class contract the disease earlier than do those of the better class, resulting in a higher mortality in the first year of life and a slower decrease in the rate at the older age groups. Size of family. The average size of family in the three groups of school children studied were 4.37 in the ordinary primary group, 2.65 for the advanced first class, and 2.58 for the advanced second class. As a rule, last or later born children in a family run more risk in contracting whooping cough than do first born. The following table gives the percentage incidence of whooping cough by age groups and school (social status) groups according to sequence of birth: Influence of size of family on morbidity rate, with reference to sequence of birth. In all three classes of schools the percentage in the first age group (under 3 years) in first-born and only children is lower than that recorded for the second and third child of the family. The favorable condition for first and only children apparently becomes more pronounced as they rise in the social scale. Effect of difference between age of infective case and susceptible contact. In 106 infected families there were 353 susceptible children. At the time of the investigation only one child in each family had contracted the disease, leaving 247 contacts, of which number 114, or 46.2 per cent, subsequently developed whooping cough. The following table shows the number of susceptible contacts and the number of resulting infections grouped according to the difference in age between the infective patient and the contact. Nationality and death rate.-It is stated that the death rate among non-Jewish children was at least three and one-half times the rate recorded for Jewish children, comparison having been made in both the poorer and the better quarters of Amsterdam. Among the suggestions offered for the control and diminution of the disease are direct measures, such as effective compulsory notification, segregation, especially exclusion of patient and contacts from school, "whooping cough homes," and improved home nursing. More drastic measures are recommended in the case of kindergarten schools and day nurseries. As for indirect measures, improved housing conditions, the encouragement of breast feeding of infants, and a better knowledge of hygiene and dietetics in the household are recommended. A STUDY OF AFTERCARE IN POLIOMYELITIS INSTITUTED IN NEW YORK CITY. The office of the New York City Department of He: 1th in Queens Borough is attempting a study of the aftercare of poliomyelitis patients covering cases reported between June 1 and September 1, 1923, a satisfactory percentage of the parents of these patients having agreed to accept the advice of orthopedists or orthopedic clinics in regard to the aftercare of their children.1 The list comprises 40 cases, of which number 4 patients died in the acute stage of the illness. A few, as will be noted, had no paralysis persisting. It is stated that these may have been questionable cases. The following data are given regarding the remainder of the cases, with special reference to the amount of paralysis persisting at the time of the tabulation and whether or not lumbar puncture was performed to confirm the diagnosis: Number of reported cases.. Number of cases which died.. Number of cases in which some paralysis now exists. Number of cases in which no paralysis exists...... Paralysis persisting: 1 upper limb paralyzed.. 2 upper limbs paralyzed.. 1 lower limb paralyzed.. 2 lower limbs paralyzed. Bilateral paralysis... Unilateral paralysis.. Number of cases which have been warned as to proper aftercare...... 1 Weekly Bulletin, Department of Health of the City of New York, Nov. 3, 1923. 40 4 30 6 4 0 12 7 5 30 5 15 10 19 DEATHS DURING WEEK ENDED NOVEMBER 10, 1923. Summary of information received by telegraph from industrial insurance companies for week ended November 10, 1923, and corresponding week of 1922. (From the Weekly Health Index, November 15, 1923, issued by the Bureau of the Census, Department of Commerce.) Deaths from all causes in certain large cities of The United States during the week ended November 10, 1923, infant mortality, annual death rate, and comparison with corresponding week of 1922. (From the Weekly Health Index, November 15, 1923, issued by the Bureau of the Census, Department of Commerce.) 1 Annual rate per 1,000 population. 20 8.2 13.4 0 3 88 10.5 9.7 18 30 9.8 10.4 4 11 53 25 43 78 39 50 68 59 2 Deaths under 1 year per 1,000 births-an anuual rate based on deaths under 1 year for the week and estimated births for 1922. Cities left blank are not in the registration area for births. Deaths for week ended Friday, Nov. 9, 1923. Deaths from all cavses in certain large cities of the United States during the week ended November 10, 1923, infant mortality, annual death rate, and comparison with corresponding week of 1922. (From the Weekly Health Index, November 15, 1923, issued by the Bureau of the Census, Department of Commerce)—Continued. |