THE RELATION BETWEEN FOLLICULOSIS AND ERRORS IN REFRACTION.

If folliculosis is an affection involving any damage to the eye it should be evident in the visual acuity of the children involved. In our entire study we were unable to find any case which presented external evidence of damaged vision. Analyzing the findings of eye-chart readings in 6,029 school children (Table VIII), we do not find folliculosis increasing with a corresponding decrease in visual acuity. In fact, the percentage of folliculosis is least in the group having the poorest vision. Similarly, in Table IX 6,063 children are studied with regard to astigmatism, the extent of the astigmatic error being determined on the basis of symptoms alone. The findings do not reveal any significant figures. There is only a suggestion of a slight correlation between folliculosis and astigmatism. The 2,394 children examined in Missouri (Table X) are arranged by age groups. After ruling out the influence of age, we do not find any constant or significant correlation between folliculosis and astigmatism. A group of 3,004 children, of whom 129 wore glasses, was studied to determine whether the correction of errors in refraction had any effect on the folliculosis. The wearers of glasses showed 7.8 per cent with advanced folliculosis, against 14.8 per cent in those who did not wear glasses. However, when these children were divided into age groups. the determining factor was found to be the older age of the children with glasses and not the corrective influence of glasses.

TABLE VIII.-Relation between folliculosis and vision as determined from reading the vision chart.

TABLE IX.-Relation between folliculosis and astigmatism as measured by symptoms

TABLE X.-Relation between folliculosis and astigmatism in Missouri children, by

The following conclusions seem warranted as applying to the cases considered in this study:

Age apparently is the predominating factor in the prevalence of folliculosis. For children of school age the peak of the curve of prevalence occurs at the time of admission to school. From this maximum incidence at 5 and 6 years of age there is a constant and rapid decrease, so that we find the affection disappearing before the child leaves high school; in fact, approximately 90 per cent of the cases had cleared up by the time of completion of grammar school.

There is apparently a correlation between folliculosis and tonsillar pathology. Whether folliculosis is a direct secondary result of tonsil infection, or whether certain children show a predilection to general ized lymphoid hyperplasia was not shown in this study.

There is no evidence that folliculosis is influenced by the social or economic status of the wage earner or by sex; and, contrary to general opinion, the state of nutrition showed no bearing on its prevalence.

The size of the family, as measured by the number of children attending school, is of no influence, but rather the age of the schoolattending members is the deciding factor.

There seems to be no relation between errors in refraction (myopis or astigmatism) and folliculosis. Our study did not show the influ ence of wearing glasses on folliculosis.

From the foregoing study of folliculosis it seems reasonable to conclude that it is an affection of early childhood, occurring somewhat more frequently in children with hypertrophied tonsils, developing no symptoms, running a very brief course as compared with trachoma, and disappearing spontaneously without sequelæ.

References.

(1) McMullen, John: Trachoma. A Public Health Problem of the States. Jour. A. M. A., 75: 1109, Oct. 23, 1920.

(2) Lamb, H. D.: Blindness in Missouri. Jour. A. M. A., 79: 1305, Oct. 14, 1922.

TUBERCULOSIS MORTALITY IN COLORADO.

It is well known that the mortality rates from tuberculosis in certain western States have been greatly affected by the immigration of tuberculous persons, who frequently arrive in the last stages of the disease. A study made by a committee commissioned by the National Research Council and approved by the Governor of Colorado has given definite statistical knowledge on this subject, so far as Colorado is concerned. The report of the study is published in the American Review of Tuberculosis and reprinted by the National Research Council.1

Certificates of deaths attributed to tuberculosis were studied. covering a period of 13 years-23,608 certificates in all. Where there was any ambiguity in the information on the certificate, a letter was sent to the physician who had prepared it, to secure, if possible, the missing data. In only 3,044 out of the total number of certificates was it impossible to determine whether the disease developed in Colorado or not.

The average death rate for tuberculosis. (all forms) in Colorado for the period of this study (1908-1920) was 208.9 per 100,000 persons, against 147.5 for the registration area of the United States during the same period. However, when the number of deaths of persons whose cases arose outside of the State was deducted, a striking difference was noted. These deaths numbered 17,080. Deaths of individuals whose cases were known to have developed in Colorado numbered 3,484, giving a rate of 30.8 per 100,000. This rate is evidently somewhat too low, because no account has been taken of the deaths of persons for whom the place of development of the disease was unknown. But even including these deaths, the rate would offer a remarkable contrast with that for the registration area.

One point brought out in the study is the large number of deaths occurring within a very short time after the patient arrives in Colorado. From 1908 to 1920 the total number who died within three months after arrival in Colorado was 4,848, and the number who died within one year after arrival, 9,539. The report protests against

A Statistical Study of Tuberculosis Mortality in Colorado for the Thirteen Years 1908 to 1920. Conducted by a committee of the Denver Sanatorium Association, under a grant from the National Research Council, and with the cooperation of the Colorado State Board of Health. The American Review of Tuberculosis, Vol. VII, No.6, August, 1923. Reprinted by the National Research Council, Reprint and Circular Series, No. 47.

the practice, common alike to individuals and organizations throughout the more populous areas of the country, of sending away from home tuberculous persons so far advanced in disease as these figures show, especially since so many of them are indigent. It is suggested that the large number of deaths so soon after arrival is due partly to overexercise, more or less united with privations and worry, on the part of immigrants who have active disease and who do not allow themselves a period of rest for acclimatization to an environment which specifically stimulates to exercise and at the same time renders reaction to it more acute.

The committee hopes that future investigation will furnish data as to the numbers of male and female tuberculous persons who enter the State each year. Such information is required for a thorough statistical study of the subject.

VITAL STATISTICS FOR ENGLAND AND WALES, 1922.

The following information regarding the vital statistics record for England and Wales for the year 1922 is taken from a summary of Part I of the Registrar General's Statistical Review for 1922, published in The Medical Officer for November 10, 1923.

The salient features of the year's record are briefly summarized as follows: The lowest birth rate recorded in any year, excepting the war years 1917, 1918, and 1919; the lowest death rate, excepting the years 1920 and 1921; and the lowest infant mortality ever recorded. Births. The births numbered 780,124, giving a birth rate of 20.4 per 1,000 population. This number was 68,690 less than that for 1921, and, excepting the years 1917, 1918, and 1919, was the lowest number recorded since 1869, when the population was approximately 22,000,000 as against 38,000,000 in 1922.

Before the war the proportion of male to female births was 1.039 to 1,000; but from 1916 on the plurality of males over females has showed a decided increase, the average ratio for the five years from 1916 to 1920 being as high as 1,051 to 1,000, at which figure it remained in 1921. The proportion fell slightly in 1922 to 1,049 to 1,000. The proportion of illegitimate to total births fell slightly, from 45 per 1,000 in 1921 to 44 per 1,000 in 1922.

Deaths. The deaths in 1922 numbered 486,229, equivalent to a death rate of 12.8 per 1,000 population, an increase in number of 27,600 over 1921, which year had the lowest death rate on record. If the population is standardized to the sex and age composition obtaining in 1901, the rate is reduced to 11.9.

The number of deaths in males exceeded that in females, the actual numbers being 246,670 males and 239,559 females, or a ratio of 1,029

males to 1,000 females. As there is a large excess of females over males in the general population, this ratio does not give a true proportion. The actual death rate for males was 13.6 per 1,000 population, and that for females 12.0, giving an actual ratio of about 1,130 to 1,000.

Infant mortality rate.-A most favorable record for 1922 is shown in the infant mortality rate of 77 per 1,000 births, the lowest ever recorded, the rate of 80 for the year 1920 being the lowest previously on record. The progress made in saving the lives of infants is shown. more clearly by going back to the beginning of the present century. In 1901 the rate was 151, or nearly double that for 1922. The importance of this saving of infant life may be more fully appreciated when it is noted that in 1901 the actual number of births was 150,000 more than in 1922, whereas the actual number of survivors in 1922 was only 60,000 less than that in 1901. Thus, by reducing the infantile death rate, more than half of the decline in the number of births has been made up.

Causes of death.-The most important single cause of the increased death rate for 1922 over that for 1921 was stated to be influenza, which was held responsible for 21,498 deaths in 1922 as against 8,995 in 1921, accounting for nearly one-half of the total increase in the number of deaths. Diseases of the heart caused 59,837 deaths, an increase of 6,127 over the number for 1921; bronchitis caused 40,912 deaths as compared with 33,684 in 1921; and the pneumonia deaths numbered 40,930 as compared with 34,708 for 1921.

AUTOMOBILE FATALITIES IN THE UNITED STATES, 1917-1922.

The Department of Commerce announces that the returns compiled by the Bureau of the Census show that during the year 1922 11,666 deaths resulting from accidents caused by automobiles and other motor vehicles (excluding motor cycles) occurred within the death registration area of the United States (exclusive of Hawaii), which area contains 85 per cent of the total population. This number represents a death rate of 12.5 per 100,000 population, as against 11.5 in 1921, 10.4 in 1920, 9.4 in 1919, 9.3 in 1918, and 9 in 1917. In the 27 States for which data for 1917 are available the actual number of these deaths increased from 6,014 in that year to 9,581 in 1922, the corresponding rates for these two years being 8.7 and 12.9.