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The nursing service will continue its work of enlarging the scope of public health nursing through the state, despite the serious scarcity of nurses with which it must contend.

Extend Tuberculosis Work

Through the division of public health education and tuberculosis, the department is undertaking to obtain proper care for men discharged from military service on account of tuberculosis. This is being done in co-operation with the public health nurses and local health authorities. Because of the need for stringent anti-tuberculosis measures which conditions in Europe have demonstrated accompanies the war, this division will also push strenuously the work of encouraging more counties to combine for the establishment of district tuberculosis hospitals.

The engineering division is now equipped with an emergency chlorination apparatus for use in temporarily sterilizing water supplies which have been exposed to contamination. This, it is expected. will greatly heighten the usefulness of the division. The chlorinator has already been used in meeting a

serious emergency in one southern Ohio city.

Rural Hygiene Plans

Incomplete as to details but nevertheless occupying an important place in the department's future plans is a program for work in rural hygiene. An educational propaganda for the improvement of sanitary conditions in the rural dis tricts will be undertaken, but the precise methods to be followed have not yet been worked out. In any event only small beginnings can be made in a new work of this kind before the end of the war.

Beginning its first New Year, the reorganized Health Department of Ohio is going to work with a determination to give its best possible service both to state and to nation. In some of the projects outlined it has already made a veginning; in others the beginning is still to come. In all fields, however, it is keeping clearly in mind, and would call to the attention of its coworkers in the state, the fact that, great as are the demands of war, they must be considered as extra demands and must be met without relaxing in the least the care and faithfulness with which regular duties must be performed.

A survey of the munition industry in Ohio, from the standpoint of health hazards to workers, is to be undertaken by the division of industrial hygiene of the State Department of Health, as a feature of the department's war program. With the idea of investigating first the places in which

the greatest number of men is incapacitated the quickest by health hazards, a preliminary survey will be undertaken in a large manufacturing plant whose owners have promised their full co-operation.

From this plant the scope of the investigation will be extended to include other large establishments

in the same class. Other establishments, both large and small, whose health hazards most severely affect the workers, will next be dealt with. The ultimate ideal beyond this procedure is the completion of an intensive survey of every Ohio plant engaged in the manufacture of munitions - the term munitions being used in its broadest sense, as inclusive of all products of military use in the prosecution of the

war.

Method a Practical One

The ideal way to conduct the survey, it has been pointed out by Dr. R. P. Albaugh, director of the division of industrial hygiene, would be to divide the munitions industry into several fields, such as "explosives," "ammunition," ordnance and firearms," etc., and then to survey all plants in each of these fields in turn. The magnitude of the task, however, is too great to make this method practical, with the limited working force available for the undertaking. As a matter of practical necessity, therefore, the work will be taken up in the order outlined, in an effort to do the most good in the quickest way possible to the greatest number.

The proposed survey will differ in its intensive nature from the general industrial survey of the state carried out by the State Board of Health in 1914 under the direction of Dr. E. R. Hayhurst. That survey was extensive in its nature, having as its object the collection of certain desired data on occupational diseases and industrial health hazards. The munitions survey will be a series of intensive surveys of individual plants, with the object of ascertaining the degree to which these plants adhere to recognized standards of sanitation.

Project Is Huge

The amount of work which faces the division of industrial hygiene as it undertakes this investigation is enormous. It is admitted that with the present facilities and personnel of the division the completion of the task lies far ahead. At the same time, however, it is evident that much good can be done in whatever portion of the field it is possible to cover immediately, and the portions first selected for investigation will, as has been explained, be those in which the opportunity appears to be the great

est.

Co-operation in the survey is to be given by the United States Public Health Service. This service has on its staff at the present time, however, only a few men engaged in industrial work, although a few additions are to be made in this

regard. Dr. J. W. Schereschewsky of the Public Health Service in November attended a conference in the office of the Commissioner of Health at which the munition survey was discussed. Dr. C. D. Selby, former health commissioner of Toledo, has been appointed to the Public Health Service staff for work of this kind.

Sources of Information

Information as to the field to be covered by the survey will be obtained from the files of the division of industrial hygiene, the War Industries Board, the army ordnance department and the Industrial Commission of Ohio. The committee on labor of the Council of National Defense has already established certain standards for sanitation in munition plants, and these will be observed so far as they have been established by the investigators of the State Department of Health.

A preliminary announcement recently issued by the bureau of the census with reference to 1916 mortality statistics shows that the "registration area," containing approximately 70 percent of the population of the United States, in that year reported 1,001,931 deaths.

Of these deaths, nearly onethird were due to three causesheart diseases, tuberculosis and pneumonia and nearly another third were charged to the following nine causes: Bright's disease and

nephritis, cancer, apoplexy, diarrhea and enteritis, influenza, arterial diseases, diabetes, diphtheria. and typhoid fever.

The deaths from heart diseases (organic diseases of the heart and endocarditis) in the registration area in 1916 numbered 114,171, or 159.4 per 100,000 population. The death rate from this cause shows a marked increase as compared with 1900 (the earliest year for which the annual mortality statistics were published), when it was

only 123.1 per 100,000. The increase has not been continuous, however, the rate having fluctuated from year to year.

Tuberculosis Declining Tuberculosis in its various forms caused 101,396 deaths in 1916, of which 88,666 were due to tuberculosis of the lungs. Because of progress in the prevention and treatment of tuberculosis of all kinds, the decline in the tuberculosis death rate in recent years has been most pronounced, having fallen from 200.7 per 100,000 in 1904 to 141.6 in 1916, a decrease of nearly 30 per cent. Before 1904 the rate had fluctuated, starting at 201.9 in 1900. Even yet, however, tuberculosis causes more deaths annually than any other malady, except heart diseases, and about 37 per cent more than all external causes-accidents, homicides, and

suicides combined.

Pneumonia (including bronchopneumonia) was responsible for 98,334 deaths in the registration area in 1916, or 137.3 per 100,000. This rate, although lower than that for any year from 1900 to 1910, inclusive, with the single exception. of 1908, is higher than that for any of the years from 1911 to 1915, inclusive. The lowest recorded rate for all forms of pneumonia was 127 per 100,000 in 1914. The mortality from this disease, like that from tuberculosis, has shown a marked decline since 1900, when it was 180.5 per 100,000. Its fluctuations from year to year, however, have been pronounced, whereas the decline in the rate for tuberculosis has been nearly continuous.

Bright's Disease Higher The only remaining death rate higher than 100 per 100,000 in 1916 was that for Bright's disease and

acute nephritis, 105.2. The total number of deaths due to these maladies in 1916 was 75,316; of this number, 69,395 were caused by Bright's disease and 5,921 by acute nephritis. The mortality rate from these two causes has increased from 89 per 100,000 in 1900, with some fluctuations from year to year.

Cancer and other malignant tumors caused 58,600 deaths in .1916 Of these, 22,480, or nearly 39 per cent, resulted from cancers of the stomach and liver. The death rate from cancer has risen from 63 per 100,000 in 1900 to 81.8 in 1916. The increase has been almost continuous, there having been but two years, 1906 and 1911, which showed a decline as compared with the year immediately preceding. It is possible that at least a part of this increase is due to more correct diagnosis and to greater care on the part of physicians in making reports to registration officials.

Apoplexy was the cause of 58,233 deaths, or 81.3 per 100,000. The rate from this disease increased gradually, with occasional slight declines, from 1900 to 1912, and since 1913 the increase has been continuous. .

Enteritis Kills Babies

Diarrhea and enteritis caused 56,763 deaths in 1916, or 79.3 per 100,000. The rate from these diseases has fallen somewhat in recent years, having been 90.2 in 1913, and is very much lower than the corresponding rate for 1900, which was 133.2. Nearly fivesixths of the total number of deaths charged to these causes in 1916 were of infants under 2 years of age.

Influenza was responsible for no fewer than 18,886 deaths in the

registration area in 1916, or 26.4 per 100,000. The rate from this malady, which fluctuates very considerably from year to year, was higher in 1916 than in any preceding year since and including 1900, with the single exception of 1901, when it stood at 32.2.

Arterial diseases of of various kinds-atheroma, aneurism, etc.were the cause of 17,115 deaths in 1916, or 23.9 per 100,000. This rate, although somewhat lower than the corresponding ones for 1912 and 1913, is higher than those for 1914 and 1915. The rate for these causes increased continuously from 6.1 in 1900 to 25.6 in 1912.

Diabetes Rate Up

Deaths from diabetes numbered 12,199, or 17 per 100,000. The rate from this disease has risen almost continuously from year to year since 1900, when it was 9.7.

No epidemic disease, with the exception of influenza, produced a death rate as high as even 15 per 100,000 in 1916. The fatal cases of diphtheria and croupwhich are classed together in the statistics, but practically all of which are cases of diphtherianumbered 10,367, or 14.5 per 100,000 population. The rate for diphtheria and croup in 1900 was 43.3, and the decline of nearly 67 per cent from that year to 1916 is relatively greater than that shown by any other important cause of death. The rate fluctuated somewhat from 1900 to 1913, but has fallen continuously since the latter year.

The mortality rate from typhoid fever has shown a most remarkable and highly gratifying decline since 1900, having dropped from 35.9 per 100,000 in that year to 13.3 in 1916. The proportional decrease in the rate, amounting to

63 per cent, is a close second to that shown for diphtheria and croup. The efficiency of the antityphoid vaccine and of the many improvements in methods of sanitation has been demonstrated in a striking manner by this great reduction in the typhoid death rate.

Childhood Diseases' Toll

The principal epidemic maladies of childhood-measles, whooping cough, and scarlet fever-were together responsible for 17,586 deaths of both adults and children, or 24.6 per 100,000, in the registration area in 1916, the rates for the three diseases separately being 11.1, 10.2, and 3.3. As in 1913, measles caused a higher mortality than either of the other diseases, but in 1914 and 1915 whooping cough had first place. In every year since and including 1910, as well as in several preceding years, measles has caused a greater number of deaths than scarlet fever. The rate for scarlet fever in 1916 was the lowest on record, while that for whooping cough, although considerably below the highest recorded rate for that disease, 15.8 in 1903, was far above the lowest, 6.5 in 1904.

7,000 Die of Polio

Acute anterior poliomyelitis, commonly called infantile paralysis, caused 7,130 deaths in 1916, representing a rate of 10 per 100,000 population. This disease developed in epidemic form in that year, and the resultant mortality showed an enormous increase. The rate from infantile paralysis declined from 2.7 per 100,000 in 1910 the first year in which this malady was reported separately as a cause of death-to I per 100,000 in 1915, the decrease having been continuous from year to year except for an increase between 1911