REPORT OF THE DIVISION OF COMMUNICABLE DISEASES FOR THE MONTH OF FEBRUARY, 1917.

The following is a brief summary of the investigations made by members of the division.

On February 1st, an investigation of the prevalence of typhoid fever at Bucyrus was made. During January, 1917, fifteen cases of typhoid fever were reported to the local health officer. An epidemiologic investigation of these cases revealed that the city water supply was the only common source and was probably responsible. On February 8th and 9th this investigation was continued and an assistant engineer was also present. The previous conclusion that the public water supply was responsible was confirmed. Certain changes in the operation of the plant were recommended, and pending these changes the health officer was instructed to issue public warning as to the danger of using the public water supply without first boiling.

The presence of smallpox in Freeport was investigated on February 13th. About the first of February two male adults developed the disease. Only one of these patients was found at that time. The other, whose business consisted of daily trips through the rural districts to collect cream, continued his occupation until his wife contracted the disease, when both were quarantined. One other case has since developed. The usual instructions in regard to quarantine isolation, and the vaccination of exposures was given.

On February 13th, a conference was had with the health officer of Cincinnati in regard to the prevalence of trachoma. He was requested to request the medical inspectors of schools to evert the eye lids of school children while conducting the routine physical examination, in order to detect trachoma prior to the discovery because of serious complications. The prevention of trachoma was also discussed. On February 14th, the prevalence of trachoma in Dayton was discussed with several local oculists, and measures for its prevention were outlined. It is the purpose of this division to request the health officials and medical school inspectors of the cities of Ohio to inaugurate a trachoma survey while the rural districts of several selected counties are being investigated for the same disease. In pursuance of the latter purpose, conferences were had with district and county superintendents of schools, in Butler and Erie Counties. on February 13th and 21st, respectively. Butler, Erie, Belmont, Pike and Muskingum counties have been selected for the survey of rural school children. While the inspectors are examining the children for trachoma, other defects of the organs of special senses will be noted, so as to accomplish the maximum of good.

On February 14th, the presence of typhoid in Pultney Township, Belmont County, was investigated. The cases occurred in the village. of Neffs. Thirteen cases developed between November 24th and January 19th. The water of a semi-public well used by all the patients was suspected, and when examined in the Hygienic Laboratories proved to be contaminated. No other sources common to all the cases

were found. This and another well, similar in construction, and from the same neighborhood were ordered closed.

The prevalence of smallpox in Cardington and Lincoln Townships, Morrow County, was investigated on February 17th. Five cases were found. There had been a dispute among physicians as to diagnosis, but the diagnosis of smallpox was confirmed in each instance by the investigator. Meetings were held with the township health officials and members of boards of education. The vaccination of school chidren was urged. During this investigation cases of smallpox in four families were also found in Mt. Gilead. It is probable that the cases contracted the disease through exposure in Cleveland.

On February 26th the prevalence of smallpox in Cygnet was investigated. Members of two families had been quarantined for smallpox, the first case dating from February 1st. The disease was very mild and cases of chickenpox were also found. The usual instructions were given.

In addition to these routine inspections, several lectures were given. Two of these, at Croton and West Liberty, were before farmers' institutes, and the subject of rural health was presented. Special emphasis was laid upon the necessity for physical supervision of rural school children. On February 23rd, an address on communicable diseases and their prevention was given before a popular audience at West Jefferson, under the auspices of the Grange. On February 16 a conference of Marion County health officials was held at Marion. A league of county health officials was formed. On the same day a lecture was given before the public health exhibit.

A great deal of business dealing with the routine administration of communicable disease control was transacted by correspondence and telephone. A large number of requests for statistical information were also complied with.

In the month of January, 1917, 8532 reported cases of notifiable diseases were recorded. This is a reduction of 2166 reported cases when compared with January, 1916, and 602 cases when compared with January, 1915. This is an actual decrease in the amount of preventable sickness, inasmuch as the required reports are becoming more complete, year by year and month by month. Compared with January, 1916, measles shows the largest decrease with smallpox and typhoid fever showing pleasing decreases from both 1916 and 1915 monthly totals. In January, 1913, there were 22 cases of tuberculosis reported, to contrast with the 459 reported in January, 1917, the latter number still a serious understatement and a decrease from 1915 and 1916. Cancer stands today in the same relative position as dic tuberculosis four years ago, only seventeen reported cases for the month of January, 1917. Efforts must be made to secure recognition on the part of physicians of the requirement to report cancer, as has been more satisfactorily secured in the instance of tuberculosis.

The following table records case reports for January received by March 8th. There were on that date 305 of the 2141 required reports for that month missing. In 36 districts there were no health officers

during the month. The division will not be satisfied until reports are submitted by the 269 delinquent health officers or explanations given for their failure to report.

Reported Cases of Notifiable Diseases, January, 1915-17, Showing Distribution January, 1917, for Cities and for Villages and

Townships.

JANUARY 1917.

DIVISION OF COMMUNICABLE DISEASES.

The following is a brief resume of the investigations made during March by members of the Division of Communicable Diseases:

Diphtheria.

On March 28th suspected cases of diphtheria in Wayne Township, Champaign County, were investigated. Cultures from all suspected cases resulted negatively. Two clinical cases of diphtheria have occurred. There does not appear to be danger of any further spread of the disease.

Infantile Paralysis.

On March 6th a suspected case of infantile paralysis at Fostoria was examined. The patient was an adult male who gave a history of injury to the spine and the paralysis did not at all resemble that resulting from infantile paralysis.

Scarlet Fever.

On March 5th the prevalence of scarlet fever in Elizabeth Township, Miami County, was investigated. Two families with scarlet fever were found. The centralized school had been closed. A meeting of the township board of health was called and measures of prevention were discussed. The school was reopened, arrangements were made for inspection of pupils, and a meeting of teachers, pupils and parents was addressed on the subject of scarlet fever prevention.

The prevalence of scarlet fever at Perrysburg was investigated on March 13th. Twelve cases were reported in the village and adjoining township from March 1st to the date of the investigation. Two deaths had resulted. The residents were dissatisfied with the steps that had been taken by the health officer to prevent the spread of the disease. A meeting of the local boards of health was called and the measures to be taken were thoroughly discussed. The spread of the disease appears to have been checked.

The prevalence of scarlet fever in Union Township, Mercer County, caused an investigation on March 14th. The first cases were quarantined on February 22nd, but one of them developed prior to this, and owing to a mistake in diagnosis was not quarantined until a number of susceptible children had been exposed. There were altogether twelve cases in six families. The usual instructions were given to the health officer.

Smallpox.

On March 1st the smallpox situation in Akron was investigated., A case of smallpox developed in an individual sent from the Summit County jail to the Ohio Penitentiary, shortly after his admission to the latter institution. It was found that a case of smallpox was diagnosed as chickenpox in the Summit County jail about February Ist. On February 18th the nature of the disease was suspected on account of another case developing. Prior to the diagnosis two prisoners were sent to the Ohio Penitentiary and both developed smallpox. The proper meaures were taken and no more cases are expected to develop. Besides the county jail two dwellings in Akron are now quarantined for smallpox.

On March 6th cases of smallpox at Newark were examined. There were four mild cases in two families. The disease was traced to a servant employed in a private hospital, who had passed through an attack of the disease without medical attention. All employes and inmates of the hospital were vaccinated immediately and the same precaution was taken with exposures outside of the hospital.

On March 15th the presence of small pox at Sidney was investigated. The disease has been traced to a focus in Piqua. There have been five cases in four families. As usual the mildness of the

disease caused a mistake in diagnosis in the first case and a number of exposures resulted. The local board of health and health officer were called together and instructed to require prompt reports of all cases of chickenpox and smallpox and to have the former cases investigated when reported.

On the same date an investigation for smallpox was made in Loramie Township, Shelby County. Smallpox in a mild form has prevailed since January 13th. A number of suspected cases were examined and the diagnosis confirmed. The local health officials were called together and the situation discussed. Adequate measures of prevention were taken immediately.

An investigation for smallpox was made at Adams Township, Champaign County, on March 19th. Three families with smallpox were found, there being a total of six cases. The source of the disease was thought to be cases at Bellefontaine but the health officer of that city has been unable to locate these.

On March 27th cases of smallpox at Greenville were examined. Six cases of smallpox were found in six families. One case was quite severe, the eruption being semi-confluent. Two of the cases were removed from the streets by the health officer. The origin of the cases could not be definitely traced and it appears that mild unrecognized cases have existed for some time. Adequate precautions are now being taken.

Trachoma.

On March 7th several suspected cases of trachoma were examined and definite diagnosis made in two persons at Salem. The health officer took precautions to prevent the spread of the disease.

During the month of March the trachoma survey, authorized by the Board, was begun in five counties of the state, Belmont, Butler. Erie, Muskingum and Pike. Arrangements had been made with the county and district superintendents to provide for conveyance and all necessary co-operative measures. The number of cases and suspected cases of trachoma found varied from one to twelve per cent of the children examined. Letters from superintendents, teachers and examiners show great enthusiasm as to the work done. It is hoped that this survey will result in complete physical supervision of all rural school children in these counties, as well as demonstrate the need for trachoma prevention in rural as well as urban districts. In connection with the survey conferences were had with examiners and county superintendents at Dayton, Hamilton and Waverly.

Typhoid Fever.

March 8th the source of typhoid fever was investigated in a family located in Walnut Township, Pickaway County. Nine members of the family contracted the disease from January 12th to February 27th. The infection was unusually virulent, and seven of the patients died. The sources of the disease were the private water supply and contact infection.

On March 21st, 22nd, 23rd and 27th, the source of a typhoid fever outbreak at Bucyrus was investigated. During January, Feb