and scarlet fever occurring among his customers. The number of customers served by each dairyman should be known. This system is without value if health officers do not investigate promptly when any dairyman shows any tendency to have too large a proportion of cases among his customers.

Milk supervision has reduced the prevalence of disease definitely in two cities according to the questionaire. In Toledo pasteurization reduced the number of cases of typhoid fever in one ward from 98 cases to I in two months. The disease had been unduly prevalent in this ward for years. A carrier was discovered and eliminated, and this, together with pasteurization, has caused the decrease. Pasteurization, together with rigid milk inspection and improved water supply, has decreased the number of typhoid cases in Cincinnati from 238 in 1911 to 141 in 1915. The spread of typhoid would have been tremendous without milk inspection, writes the health officer of Lima who has detected and stopped several milk outbreaks in their incipiency.

Prosecutions against dairymen have been brought by officials of 26 cities on more than five hundred and ninety occasions. The number of dairymen who have had their licenses revoked is not known.

The dates when milk supervision was begun are of, interest. In 1889 the first city began. In 1902 four cities were carrying on this work. In 1909 the work had been extended to 17 cities. Thirteen cities joined the colors in 1910 and 1911, making a total of 30 cities in which supervision was practiced. In succeeding years the remaining cities listed initiated the improvement, 3 joining in 1916. Let us hope that 1917 will break all records in the number of municipalities which place this long delayed reform in effect.

The pasteurization of milk is not the least important phase of the milk question. In 4 cities this treatment is mandatory, and I city requires it for the warmer months of the year. In 5 cities pasteurization ordinances are pending. This is another instance of knowledge of which the practical application finds postponement after postponement. The arguments against pasteurization are briefly that it is an unnatural process, that it kills organisms in milk necessary to its digestion, that it renders milk more liable to infection and that it is costly. The answers to these arguments are emphatic and based on the most rigidly controlled experiments. Cow's milk itself is not a natural food for babies. No one objects to cooking meat, why object to cooking milk! Experiments show that heated milk digests better than raw milk, that not only does it not cause scurvy but that it has cured scurvy when given without other form of treatment to afflicted children, that heating does not destroy the vitamines if pasteurization is done by the "holding" method, that it is better to kill the germs of typhoid fever, diphtheria and tuberculosis in milk rather than theorize about the possible entry of new ones after pasteurization. Pasteurization by the "holding" method has come to stay, and is recognized by all leading sanitarians as a practical and immensely useful health precaution. The health officer of a city of over thirty thousand population tells me that in a city of that size pasteurization is not necessary since the milk reaches the consumer from 6 to 8 hours

after milking.

My answer to that is that the milk does not reach the consumer in from 6 to 8 hours after milking, but that the evening's milk is distributed the next morning, and sometimes later. I would also like to ask this gentleman if all the herds are tuberculin-tested. It has been shown that about 25 per cent of all milch cows in Ohio are tuberculous. Much of this tuberculosis cannot be detected without the aid of the tuberculin reaction. Park, Krumwiede and others have shown that about 50 per cent of all tuberculosis in children under five years is of bovine origin and no one has arisen to dispute this. In my contention that all milk should be pasteurized but that small amount taken from tuberculin-tested cows, and conforming to the standard of milk certified by medical milk commissions, I am supported by all leading sanitarians, and a host of dealers. Over 50 per cent of the milk is pasteurized in cities the process is not mandatory. I am informed that in cities pasteurization exists, any attempt to rescind that ordinance lead to a storm of protest from all dealers, not to speak of

where

where

would consumers.

Health officials of the cities in which dairy supervision is not practiced should begin this work at once. The board of health should adopt regulations governing the collection and distribution of milk.

is impossible to secure a full-time dairy inspector, the board of health may appoint the health officer to carry on this work. All dairi es supplying milk to the city should be inspected. To do this intelligently the score card system should be used. The Dairy and. Food Bureau of the Agricultural Commission will send a trained inspect or to assist you, if you will provide him with a conveyance. Authority for appointment of milk and food inspectors, for entry to premises of dairy or plant and other means of controlling the milk supply are found in Sections 4458 to 4462 of the General Code of You must require that every person selling milk or its products in your city secure a license from the health department at stated intervals. If you cannot have bacteriological tests of the milk made you can at least use the sediment test. Public sentiment can be fostered by short articles in the press, and dairymen stimulated by the publication of their scores.

Ohio.

not

In order to secure the co-operation of dealers and dairymen, do insist upon revolutionizing their business during the first six months. Have a definite program of reasonable gradual improvement. Expensive equipment is not needed to produce clean milk neither is clean milk always produced from an expensively equipped dairy. Be sure to check against each dairyman the cases of typhoid fever, diphtheria and scarlet fever occurring in his practice. Investigate as soon as the second case is reported.

Finally let me again call your attention to the fact that in only 36 of the 62 cities reporting, are all dairies regularly inspected, that in at least 14 cities no attempt at milk supervision is made, that in only 19 cities do health officials consider dairy supervision efficient, and that it is improbable that more than 12 cities have systems of supervisions which really mean clean disease-free milk. From a

superficial survey I have found that cities with proper supervision of milk have low typhoid fever and infant mortality rates, while those cities without proper supervision have as a rule high typhoid and infant mortality rates. Supervision of the milk supply or the lack of it does not furnish the only reasons for these high or low rates, but they are extremely important factors.

In the present year I hope to be of assistance to those of you who contemplate inaugurating supervision or improving it. Please call upon the State Department for whatever information you require. If we cannot furnish it we can perhaps refer you to the proper authority.

Lastly, how long are you as health officials going to postpone applying the knowledge we have gathered at the expense of such painful experiences? How long are you going to withhold from your people the benefits to be derived from even the most superficial system of dairy supervision?

NOTE. Dr. Boudreau will publish a tabulation of the results of the questionaire when all cities have reported.

ASSOCIATION URGES HIGHER DEVELOPMENT OF DAIRY AND MILK INSPECTION.

The following resolutions were adopted by the International Association of Dairy and Milk Inspectors at its fifth annual convention in Springfield, Mass., last October:

1. WHEREAS, The United States Government and the government of various States and cities have recognized our association by sending representatives to attend this convention; therefore be it

Resolved, That the International Association of Dairy and Milk Inspectors express its thanks to the U. S. Department of Agriculture, the U. S. Public Health Service, and to the various State and city authorities for their continued interest and active cooperation.

2. WHEREAS, This Association heartily favors the development of dairy inspection to the highest degree of efficiency; therefore be it

Resolved, That the International Association of Dairy and Milk Inspectors recommend that no dairy or milk inspector be employed by any State or city who derives any private income from the owners or employees of those dairies over which he exercises supervision.

3. WHEREAS, States and cities are apparently slow to recognize the need for well qualified and expert men for dairy and milk inspection; therefore be it Resolved, That the International Association of Dairy and Milk Inspectors endorse the application of intelligent Civil Service regulations for the appointment of dairy and milk inspectors; and be it further

Resolved, That this Association urge that State and city departments be given authority to offer such salaries as may be necessary to secure thoroughly competent inspectors.

Plans for a health survey and campaign in Tiffin were made by the Civic Improvement league at a special meeting held recently in the auditorium of the Columbian high school. - Tiffin Advertiser.

PROGRESS AND PRESENT STATUS OF THE WORK OF THE STATE HEALTH DEPARTMENT.*

H. T. SUTTON, M. D.,

Vice President, State Board of Health.

In dealing with the progress made in public health work in Ohio, I will divide my subject into the subdivisions in which it naturally falls. and according to the divisions of the State Department of Health.

Water Supply and Sewerage.

very considerable advance has been made during the past year in securing the installation of water supplies of good quality and in the installation of systems of sewers, with sewage treatment works where necessary. While our present laws, designed to insure the installation of improvements to protect the public from typhoid fever

and

are

other water-borne disease as well as stream pollution nuisances, ite broad and comprehensive, they should be amplified and strengthened in several details to enable the health administrative agencies in the state to perform their work more completely and efficiently.

We propose to devote some attention during the coming year to sanitation of bathing places. We also hope to have our Bense Act amended so as to give to the State Board of Health the initiative in the investigation of the condition of public water supplies and of case s of stream pollution where it is evident that correction is needed and the local authorities for one reason or another refuse to file the written complaint which the law now dentands, and which must be filec 1 with the State Board of Health before this Board can assume juriiction.

Plumbing Inspection.

With the three plumbing inspectors now employed, it has been impossible to carry on the work required of the State Board of Health and the state plumbing inspector as promptly as necessity demands. If the state is to exercise jurisdiction in the matter of plumbing inspection, it must provide the facilities so that such inspecmay be carried on with the least inconvenience to contractors ire engaged in plumbing installation.

tio

who

The laws providing for plumbing inspection need amendment in Some particulars. The trend of sentiment in regard to inspection of any kind is that the expense of inspection should be met by the interests involved and not be made a charge against the public in general. It would be advisable to have the plumbing inspection laws amended to provide for a graduated scale of fees which will cover the cost of inspection. The law as it now stands requires that the same fee be paid for a small building with a few plumbing fixtures

* Read at Health Officers' Conference, Columbus, January 18 and 19, 1917.

as is required where the building to be constructed may contain several hundred such fixtures.

It is also necessary that the restriction in the law as to the salary of the state plumbing inspector be changed. The state plumbing inspector now receives a salary that is not equal to the wages of a good journeyman plumber. It is obvious that the kind of work this inspector must perform and the responsibility attached to the office. require that he must be better informed than the average plumber and he should be compensated accordingly.

Communicable Disease.

An epidemic of typhoid fever in Darke County September has directed the attention of the State Board of Health to the sanitation. of county fair grounds, chatauqua grounds and other places where large numbers of people congregate. We have sufficient evidence to show that some condition on the Darke County fair grounds, probably a polluted well, was responsible for this outbreak of typhoid fever, comprising over one hundred cases. It is very essential that the health of people who congregate together at fairs, chatauquas, etc., should be protected. We believe it the duty of the local health officers having jurisdiction over such grounds, to make a survey of the sanitary conditions prior to the assembling together of the people. The water and food supplies should be investigated, the system of sewage disposal should be studied and rules should be formulated providing for screening of food, disposal of sewage, and other matters of vital concern to the health of the people. Representatives of the State Board of Health will be glad to give assistance in this work whenever called upon. A repetition of the Darke County epidemic in this or other counties must be avoided.

Our Division of Communicable Diseases has been attempting to educate health officers in the advantages of anti-typhoid vaccine and diphtheria antitoxin for the prevention and cure of cases of typhoid fever and diphtheria. Through correspondence, an attempt has also been made to show health departments the necessity of taking measures to prevent the spread of measles and whooping cough, diseases, which, together, take a toll of lives equal or greater than the number of lives lost through typhoid fever.

The Legislature has laid upon the State Board of Health the burden of preventing blindness in infants. The State Board of Health has also concerned itself with trachoma, which has been shown. to be prevalent in certain centers of population. This disease is one which is spread through contact, which slowly and insidiously destroys the eyesight of its victims, having, as a rule, done a great deal of damage before the unsuspecting victim realizes that his eyesight is defective. Trachoma is quite prevalent in states adjoining Ohio, particularly Kentucky and West Virginia, and there is reason to believe that the disease is much more prevalent in Ohio than we have suspected heretofore. Realizing these facts, the Division of Communicable Diseases has inaugurated a survey of the school children of Ohio to determine the extent of this sight-destroying disease.