The State Board of Health has been supplying a prophylactic for the treatment of the eyes of the new born since 1910. Since the act under discussion went into effect 35,000 treatments have been distributed from the State Board of Health laboratory. The monthly distribution at this time is approximately 3,000.

In order to make it convenient for physicians and others to secure these outfits some three hundred stations have been provided. Usually, these are at drug stores. The outfits are also supplied on request to health officers, dispensaries, physicians, nurses and others. who apply to the State Department of Health. There has been a very general distribution of a circular containing a list of these outfit stations.

A more general use of the prophylactic is desirable. As noted above the law requires that a prophylactic shall be used in the eyes of each child born in a maternity home, hospital, public or charitable institution. No distinction is made as to the person in attendance, whether it be a physician, midwife, nurse or other person. It is also required that a midwife shall use the prophylactic in each case of childbirth she attends. It would be of distinct benefit to use a prophylactic in every case of childbirth, no matter by whom attended or where the birth occurs.

Following is a brief summary of 1,649 cases of inflammation of the eyes of the newborn reported during the period August, 1915,December, 1916.

The monthly average of cases reported and investigated in 1916 was more than double the average for the five months of 1915.

Of the 1.649 cases reported during the seventeen-month period. August, 1915-December, 1916, 914 were boys and 735 girls. Slightly less than 5% were colored. Two of the reported cases occurred in Mongolian infants.

In over 28% of all cases the infants were under four days old at day of report. These were cases of inflammation of the eyes of the

new born as defined by the legislation and required to be reported but investigation reports indicate that for the most part they were cases of reaction of the silver nitrate and occurred particularly in the practice of midwives. This latter fact might be considered as evidence that midwives have a much larger number of silver reactions than do physicians were it not also evident from other facts at hand. that many physicians do not report the slight reaction cases.

Physicians were in attendance at birth in 68% of the cases and used a prophylactic in 78% of all cases attended by them. There were only eleven reported instances of the failure of midwives to use prophylactic in the 512 cases attended by midwives at birth. In 26 instances, however, it could not be positively ascertained whether the midwives did or did not use the prophylactic.

The investigation reports indicate specific infection in 902 cases, less than 55% of all cases. The eye specimens examined totaled 452.

There were 37 cases of impairment or probable impairment of vision in the total of 1,649 reported cases, 2 1/5% of all cases suffering impairment or probable impairment. The probable impairment cases numbered 6 in all, and are included in the total of 37 cases although the physicians in attendance in each instance reported the damage to sight, if any, as slight. The following analysis of the impairment cases would indicate the effectiveness of the work for the prevention of blindness.

7 cases of impairment in 251 cases reported August-De-
cember, 1915

3%

24 cases of impairment in 673 cases reported January

June, 1916

31%

ber, 1916

......

of 1%

6 cases of impairment in 725 cases reported July-Decem

During the last three months of 1916 in which 373 cases were reported no positively impaired vision case resulted and but one probable impairment case was recorded.

Of the 31 impairment cases 24 occurred in cities and 7 in villages and townships. From one city 7 cases were recorded, from a second city 4 cases, from 3 cities 2 each, and one from the remaining 7 cities in which the infants were born. Of the 6 probable impairment cases, 5 occurred in cities and the other in a township.

The following table summarizes the impairment or probable impairment of vision in the 37 cases reported:

Impairment or probable impairment of vision in 37 of the 1,649
cases of inflammation of the eyes of the new born reported
August 1915 tot December 1916.

Total loss of vision both eyes..

Probable loss of vision both eves..

Total loss of vision, one eye with partial loss of other eye.

Total loss of vision one eye..

Partial loss of vision both eyes.

Probable partial loss of vision both eyes.

21641

Partial loss of vision one eye..

Probable partial loss of vision one eye.

Cases of impairment...

Cases probable impairment.

Total cases, Impairment.

Total cases, reported.

Per cent impaired vision.

1

7

31

37

1.649

022

The history of the 37 cases of impaired vision as to attendance at birth and the use of a prophylactic is as follows: Physicians at birth with Prophylactic Reported.

Unattended at birth by physician or midwife with no Pro-
phylactic used

Total

Total

4

2

37

The figures show that physicians were in attendance upon 84% of the impaired vision cases, using prophylactic in 65% of such cases. Midwives attended only 11%, leaving 5% unattended at birth. While physicians attended at birth slightly over twice as many of the 1,649 cases reported of inflammation of the eyes of the newborn as did midwives they had in proportion 32 times as many cases of impaired vision as did midwives. It should be noted the prophylactic was not used by the physicians in 35% of the blindness cases, and in 22% of all the reported cases of inflammation occurring in the practice of physicians.

In the 20 cases of blindness in physicians' practice, with prophylactic used, the infants were with but one exception over four days old at date of report. From this evidence and from consideration of age of infants in reported cases of inflammation of the eyes of the newborn it seems probable that physicians may not watch closely enough for secondary infection and that the midwife's case of secondary infection is more quickly discovered and reported, the latter by reason of the more careful supervision of the midwife's cases by the public health nurse.

While the State health department realizes that it has not secured anything like complete reports, it has been more successful in this respect than it has been in securing the prosecution of those who have failed or refused to make reports, when evidence sufficient to warrant prosecution has been furnished.

Information has been furnished the prosecuting attorney in 53 cases; against physicians 36, midwives 17; these were for failure to report 47, failure to use prophylactic, 6. In 33 cases no criminal action was instituted by the prosecuting attorney; in three cases sthe grand jury failed to return an indictment.

In the 17 cases prosecuted, 3 were dismissed and I has not been decided, 13 were convicted.

The state health department has not filed information in all cases where there was a technical violation of the law, but has been satisfied to warn the offender. In most cases this has been sufficient to insure future reports.

The work that has been done in the prevention of blindness under the authority of this act, has not reached as far as the necessities of

conditions demand. With the active co-operation of physicians and others in securing early reports of cases and assistance, and the means to promptly provide treatment much greater success may be expected for the future. The State health department has reason. to be encouraged in this phase of the work by the fact that there has been an increasing interest manifested as the work has become better understood. The cost has been trifling when consideration is given to the fact that vision has been saved in many cases where failure to provide treatment would have meant life-long affliction - the greatest affliction that can befall an individual, the loss of sight. If you have suggestions to make that wil tend to increase the effectiveness of this work, you will find that the State health department will welcome your aid.

Smallpox

THE TRAMP AND THE SMALLPOX.

Is a disease

That is easy to avoid
And particular people
Get vaccinated.

But smallpox germs,
And others too,
Are no respectors.
Of persons.

As proof of this
A seedy tramp
Who had spent the night
In a side-door pullman
Was all broken out
When he dropped off
In an Ohio town.
The other day.
He took a drink
At the town pump;
He wanted a chew,
And tramp-like
He begged the same
From a young man
On the street.
Two weeks later
The young man

Was broken out

And he thought.

It was chickenpox.

A "wise" doctor agreed.
Every night

DON'T IMITATE THE TRAMP GET VACCINATED.

THE STATE BUREAU OF TUBERCULOSIS HOSPITAL ADMISSIONS AND DISCHARGES.*

AMY L. MERCER,

State Department of Health, Columbus, Ohio.

Ohio has a tuberculosis hospital law which says in part, "The State Board of Health shall have general supervision of all county and district hospitals for tuberculosis, and shall prescribe and enforce such rules and regulations for their government as it deems necessary. In consequence, a regulation was adopted in October, 1915, by the State Board of Health, which provides for the reporting, by the superintendents, of all cases admitted to or discharged from tuberculosis hospitals. A Bureau of Tuberculosis Hospital Admissions and Discharges was establihed by the State Board of Health, with a public health nurse in charge, to receive and handle these notifications. This bureau is part of the organization of the Division of Public Health Education and Tuberculosis.

All the tuberculosis hospitals in the state, with the exception of two institutions maintained by municipalities and one privately owned, have been making these reports to the bureau since it was established. There are ten such institutions: One state sanatorium; three county hospitals; five district hospitals; and one general hospital that maintains a male ward for advanced cases. These institutions have a total capacity for 740 patients. The state sanatorium is not under the supervision of the State Board of Health, but at the beginning of this system the superintendent volunteered to send us current information about patients admitted and discharged.

The blank forms used for these notifications are prepared and supplied by the bureau. The "Notifications of Admission" contains the Hospital and State Board of Health case numbers; the name of the institution; the patient's name, age, sex, color, social condition, nativity and length of residence; ten questions about addresses; eleven about occupation; type of disease; number in family; whether or not there is or has been tuberculosis in the family or associates; previous sanatorium treatment - - where and when; and the name of the physicians admitting the case.

The "Notification of Discharge" contains the case numbers; the name of institution; name, age and home address of patient; the cause of discharge; the condition on admission and on discharge; the condition of the sputum; address to which the patient is returning ; name of prospective employer and occupation; by whom supported, and conduct while in the institution. These forms are filled in, signed and mailed to the bureau by the superintendent or some other responsible officer of the institution. To date. over 5,000 of these notifications have been received. They include 2,768 patients, who come

*Read before the Sociological Section of the Annual Meeting of the National Association for the Study and Prevention of Tuberculosis, Cincinnati, Ohio, May 9th to 11th, 1917.