Is Whooping Cough About every three or four years we have an Coming Back? epidemic of whooping cough in the state and a review of notifiable diseases reported for August, published elsewhere in the OHIO PUBLIC HEALTH JOURNAL would indicate that we are again threatened with a return of the disease this year.

Reports would indicate that we have escaped an epidemic of infantile paralysis this year. There were 75 cases reported for August. Wherever it was reported citizens and health authorities put into operation all the machinery available to check its spread. Each case was given publicity.

If parents and others would show half as much concern about whooping cough it would be comparatively easy to control this disease which kills many more children than infantile paralysis. For the present, whooping cough is confined chiefly to four cities of the state, Cleveland reporting 608 cases; Toledo, 138; Cincinnati, 78 and Springfield, 48 cases for August, being a total of 872 cases or 75 percent of all the cases reported last month.

There were 674 deaths from whooping cough in Ohio last year. Surely any preventable disease that causes such a harvest of sickness. and death is worth becoming alarmed over.

Whooping cough is spread by contact. To prevent it every child with the disease should be isolated. Use every possible means to prevent children under 5 years of age from taking it for it is more fatal to the little ones than the older children.

Death Removes
Dr. Matson.

**

Public health officials who have had the pleasure of the acquaintance and association with Dr. George H. Matson, Secretary of the State Medical Board, learned with deep regret of his sudden and untimely death in Columbus. August 21.

Dr. Matson died in the harness. He was a slave to work. He devoted every energy he possessed to the cause of raising the standards of the profession which he represented.

His fight against nostrums and the charlatans who prey upon the credulous and the sick poor, robbing them of money and precious time which might be devoted to scientific treatment, was a valuable contribution to humanity and to the cause of public health.

Scrupulously honest, conscientious and frugal, even denying himself the ordinary comforts in travelling, Dr. Matson made a splendid public official. The State has suffered a distinct loss in his demise.

The State Medical Board is fortunate in being able to secure the services of Dr. H. M. Platter of Columbus to take up the work where Dr. Matson left off. Dr. Platter is not unfamiliar with the work, having formerly been an assistant in the office and having been engaged in public health work for several years. He was formerly connected with the State Board of Health but more recently was medical inspector for the Columbus public schools.

Sleep Out of Too many people make the mistake of moving in the Doors. house and closing the doors and windows with the arrival of the first frosty nights. Now is the time to begin sleeping out of doors if you are not already doing it and to stay out on the porch if you have been sleeping out during the summer. You will soon get used to the outdoor air and you will be ready for the real winter weather when it comes. Make use of the porches in the day time as well as night. Some people think porches are only made to sit on in the hot summer weather. They should be used the year round. It has taken centuries for us to find out that fresh air is the cure for consumption, pneumonia and colds. It should not require another century to teach us to use fresh air as a preventive of these and other diseases.

Through the courtesy of the National Association for the Study and Prevention of Tuberculosis, the State Department of Health has reprinted the national society's splendid pamphlet, entitled "Sleeping and Sitting in the Open Air" and has a limited supply on hand for free distribution. The department has also replenished its supply of the pamphlets "Tuberculosis and What You Should Know About It."

Stark Co. School
Survey Explained.

* * *

In the August number of the OHIO PUBLIC HEALTH JOURNAL there was published a report of a sanitary survey made of the Stark County schools. This survey was made in 1915, being a part of a general sanitary survey of the county. It was not the intention that it should be published, but unfortunately, through a misunderstanding, the article was used, without explanation as to when the survey was made.

Mr. J. J. Armstrong, county superintendent of schools of Stark county, in a letter to the State Department of Health, takes exceptions to the article, and justly so, pointing out that while it may be a very true description at the time the survey was made, which was during the first year under county and district superintendents, and before time was afforded to correct many defects, it does not represent conditions today as might be inferred from the article in question.

"Many of the defects have been remedied, some of them after a long, hard struggle on the part of school officials," says Superintendent Armstrong.

That wrong impressions gained from reading the article and that the Stark County school officials may not have to suffer any unjust or undeserved criticism because of it, the OHIO PUBLIC HEALTH JOURNAL takes this first opportunity to make this explanation and correction.

THINGS YOU OUGHT TO KNOW.

Is your town a good place to raise babies?

Is the milk supply carefully inspected and controlled?
Is dirty milk with a sediment sold from dirty dairies?
Is the water supply protected or is it polluted by sewage?

HEALTH SURVEY OF PORTSMOUTH, OHIO.

H. J. SOUTHMAYD.

Early in May, 1917, the State Department of Health at the request of the mayor and the Bureau of Community Service undertook a health survey and suggestive program of co-operation for the city of Portsmouth, Ohio. The object in view was to collect data upon which to base recommendations for more adequate municipal sanitation and more efficient public health administration. The following is an abstract of the report:

Portsmouth is a prosperous and growing city located on the southern boundary line of Ohio and of Scioto County, at the confluence of the Ohio and Scioto rivers. The estimated population to the midyear period 1916 is 28,740, and 1917, same period, 29,354. The 1910 census showed the negro population to be 3 1/3 per cent of the total. Industries The principal industries of Portsmouth are the manufacture of steel, steel products, shoes, and bricks.

Administration - The form of city government is that provided by the statutes for cities not operating under home rule charters. The mayor is the chief executive officer, and a council composed of seven members, four elected from wards and three at large, constitutes the legislative branch of the city government.

Physicians At the present time there are 42 physicians practicing in Portsmouth. Physicians in private practice have an official relation to local health departments in that the law requres reports. of certain diseases coming within their practice. Among these diseases are typhoid fever and tuberculosis. From 1913 to 1916, inclusive, Portsmouth physicians reported but 145 cases of tuberculosis. In the same time the Bureau of Vital Statistics reported 197 deaths from this cause. At present the local health officer has records of 33 cases of tuberculosis while the Bureau of Community Service has 82 cases on its books. Making a very liberal estimate in favor of physicians, it is probable that less than 20 per cent of the cases of tuberculosis in Portsmouth are reported by physicians as required by law. From 1912 to 1916, inclusive, there have been reported by physicians 668 cases of typhoid fever; 104 deaths have been registered in the same time. This indicates that reports of typhoid are very incomplete. Inasmuch as practically all of the physicians in Portsmouth are members of the Hempstead Academy of Medicine, this disregard of law naturally reflects upon the Academy.

Housing - The director of the Bureau of Community Service is authority for the statement that Portsmouth is badly in need of 200 houses to care for 1000 people. The local board of health has authority under Section 4421 to order a house vacated in the event that the owner does not abate a nuisance therein when ordered by the health officials to do so. The writer would recommend that building and housing ordinances be passed by the council and that the board of health take advantage of Section 4421 and remedy insanitary housing conditions immediately by ordering vacation.

City Hospital This institution is a general purpose hospital under the supervision of the director of public safety, as provided by the General Code. The hospital has a bed capacity of 32 and is known as the Hempstead Hospital. It is ostensibly a charitable institution, being maintained and operated by public funds. The operating expenses for the year 1916 were $15,411.69, while the receipts from pay patients were $10,322.94, leaving a balance of $5,088.75, which represents the cost of this institution to the city. The institution maintains no contagious ward or isolaton hospital, fire having destroyed the building which in the past had been used for that purpose. To date this building has not been replaced. Provision should be made in the near future for the care of smallpox patients and the indigent, ill with contagious diseases.

Milk Supply - The Portsmouth milk supply comes from a pasteurization plant and a few dairymen who deliver raw milk. The plant pasteurizes by the holding method, and has a capacity of 1200 gallons per day. It is estimated that Portsmouth consumes somewhere between 924 and 2155 gallons per day. It is evident that at least the greater part of the milk consumed in the city is pasteurized. Probably 75 per cent of the milk consumed is the product of the pasteurization plant. It is recommended that council pass an ordinance requiring the pasteurization of all milk marketed in the city.

Public Schools Portsmouth has one high and eleven grade schools. The number of pupils in grade schools on May 18, 1917, was 4,071. Four of these grade schools are not accessible to sanitary sewers and are compelled to use septic tanks or cesspools for sewage disposal. A recent physical examination of nearly 300 pupils by the Bureau of Community Service nurses with the permission of the school board showed that nearly one-third of this number were in need of medical attention. This condition is to be found to a greater or less extent in any school where physical supervision of the pupils is not practiced. The writer would strongly recommend that the school board seriously entertain the proposition of instituting this service in the Portsmouth schools.

In

Registration of Births and Deaths - The registrar of vital statistics for this district is also the clerk of the board of health. checking over the death certificates for 1916, several instances were noted where burial permits were issued after burial. The explanation given was that the attending physician was out of the city and could not sign the certificate until his return.

Water Supply - Portsmouth is supplied with water from a municipally owned and operated plant. The source of the supply is the Ohio River at a point about five miles from the city. The raw water is subject to sedimentation, coagulation, filtration and treatment with hypochlorite. Lime and ferrous sulphate are used as coagulants. The finished water is of good quality and at present the city is consuming about 4,000,000 gallons per day. The pumping and filtration plants have a normal capacity of 8,000,000 gallons. This plant was first put into permanent operation November 7, 1914. On several occasions since that time it has been necessary to supplement the filtered

supply with raw water pumped by the old plant. As the raw water furnished the city on these occasions is through an intake located in close proximity to sewer outlets just off the business district of the city, it is grossly polluted. For this reason it is imperative that the water works, including the distributing system, be so equipped and strengthened as to preclude the necessity of using raw water. The old intake and station should be permanently abandoned. It is a matter of record that typhoid epidemics may result from polluting a city water supply in this way.

In connection with the water supply there is a practice among a large number of house holders of storing filtered city water in cisterns for use at times when the city supply is considered too warm. This practice cannot be too strongly condemned, especially in a community which disposes of its sewage by vault and cesspool to the extent that Portsmouth does.

Sewage Disposal — The method of sewage disposal practiced to a notable extent in Portsmouth ranges from the primitive to the most approved. To the casual observer the common method seems to be by means of outhouse with dug vault. It is impossible to say just how many dispose of their sewage in this or other improper manner. Seventy per cent of the city is accessible to the sanitary sewers which are available for approximately 6,400 connections. Records in the office of the service director show that at present only 1757 permits to tap sanitary sewers have been taken out. One hundred and twelve of these are due to activities in the past month. There is an unknown number of taps without permits and illegal taps to storm sewers. These conditions prevail as a result of indifference on the part of the people and neglect heretofore on the part of officials.

The evidence of improper sewage disposal is to be seen in all parts of the city including the business section. Aside from the great number of outhouses, the method of disposing of household wastes is the most noticeable. Dish water, laundry water, bath water, and all liquid household wastes that ordinarily pass into a sewer from the kitchen or basement sink are conducted by means of open ditch or tile drains to gutter in front of place of business or residence where they originate. Where an alley is convenient, the course is the shortest distance through the yard to the alley thence to street gutter. When an alley is not close, the ditch or tile runs through the yard and under or over the sidewalk, as the case may be.

Garbage and Refuse This phase of municipal sanitation is under the supervision of the service director as provided in the statutes. In 1903, council of Portsmouth passed the following section of an ordinance:

"Section 88. All slips, tree trimmings, ashes, cinders, tin cans, broken crockery and glassware, refuse vegetable matter and offal from animals, except coal and wood ashes and cinders from manufactories where steam engines are used, are hereby designated and shall be known as garbage."

It will be noted that this ordinance makes no distinction between rubbish and garbage. This ordinance also provides that the city should be divided into districts for the collection of garbage as defined in the