An examination of the books of the Lima District Tuberculosis Hospital by state examiners shows aggregate expenditures from July 22, 1909, to April 1, 1916, for all purposes to be $185,796.73.

The Ohio State Sanatorium had a daily average of 166 patients during 1916. This is an increase of 11 patients per day over 1915.

Owing to the necessity of cutting down the requests for appropriations to meet the income of the state, the board of administration has had to cut out many of the requests for buildings for tuberculosis. The final requests are:

1917. Athens 1918. Massillon

1 cottage for tuberculous men, capacity 50.... $20,000

1 tuberculosis shack

12,000

10,000

Institution for the Feeble-Minded, 1 tubercu

losis hospital

25,000

REPORT OF DIVISION OF COMMUNICABLE DISEASES FOR

JANUARY.

The following is a brief summary of investigations made and work done by this division during January.

On January 5th, the diphtheria situation at Troy was investigated because of complaints received from citizens. Monthly and weekly. reports had not been submitted by the health officer, so that the members of this division were ignorant of the true situation. Diphtheria has prevailed since October. Many cases developed among the pupils of the Forest school. No accurate record of the number of cases has been kept. Measures of prevention have been arbitrary and insufficient. A new health officer has been appointed, and he was given instructions regarding the measures to be taken, such as enforcing reports, the use of antitoxin, and the bacteriological control of the disease. The physicians of Troy have not used the laboratory to assist them in diagnosis or release. The present health officer promised to remedy conditions, and since his appointment the situation has improved.

On January 10th, a case of suspected smallpox at Wooster was examined and pronounced chickenpox. At the same time an investigation of the local health departments was undertaken. The health officer has never reported to the state board of health. His records were found to be in a chaotic condition. Deaths from typhoid fever, tuberculosis, scarlet fever and other notifiable diseases had occurred, but the cases had never been reported, or at least no record of such report was kept. .The mayor was asked to have an office for the health department maintained in the city hall. The clerk of the board was requested to keep a record of all reported cases and to report weekly and monthly to the State Board of Health. The Wooster Health Department has a small appropriation, but even this is not properly utilized.

The prevalence of scarlet fever in Peebles, caused an investigation on January 12th. At the beginning of December several cases of what must have been scarlet fever, were wrongly diagnosed. Exposure was general, on account of school and church attendance.

Over twenty-eight cases resulted. The mayor and health officer were given instructions in regard to the prevention of the disease. It was suggested that a regulation requiring a thirty days' quarantine be adopted. The opening of schools and churches was discussed. The mildness of the disease has been responsible for its spread.

On January 12th, an address was given before the Logan County Medical Society on public health problems, past and present. On January 15th, a conference of the health officials of Logan county was attended, and a lecture on communicable diseases given before the Public Health Exhibit.

An investigation for suspected smallpox was made at Waldo on January 16th. The suspected case of smallpox was found to be chickenpox, and a number of other individuals with eruptions were. examined and also found to have chickenpox. The health officer was instructed to require reports of all cases of chickenpox, and to have adopted a regulation requiring a modified quarantine for such cases. On the same date a conference of Clarke county health officials was attended in Springfield. An address on the subject of smallpox was given. The health officials of this county decided to organize, and to meet monthly to discuss health problems. This step meets with the approval of all public health workers, and will no doubt result in the establishment of similar organizations in other counties. Logan county. health officials have decided to take the same step. Following the conference a number of cases of smallpox were examined with the Springfield health commissioner.

On January 17th, cases of suspected smallpox in Pleasant township, Madison county, were examined. The suspects were members of one family and ranged in age from two to forty. A diagnosis of chickenpox was made in each case.

The presence of diphtheria in Mutual, caused an investigation on January 25th. As usual, the cases of diphtheria had been preceded by cases called tonsilitis. A death in November directed suspicion towards these cases. Only one family is under suspicion at present, and no evidence of diphtheria was found in any of the members. Swabs were taken and submitted to the Division of Laboratories. Instructions as to quarantine and release were left with the health. officer.

An outbreak of smallpox in Barberton caused an investigation on January 31st. Five cases had developed among the colored employees of two large plants. Exposure was widespread. Sixty-five colored men were quarantined. Physicians and health officer were vaccinating exposures as rapidly as possible. One case of smallpox developed in Akron as a result of exposure in Barberton. Those in charge of plants in Barberton were requested to make vaccination of employees compulsory. The usual instructions were given to local officials at a meeting of the board of health.

A lecture on pasteurization was given at a public meeting of the Elyria board of health on January 31st. An ordinance prescribing the methods of pasteurizing has been adopted, and has met with considerable opposition.

In addition to these investigations, meetings of the Municipal Health Officials' Conference with the State Board of Health were attended. Addresses on the present status of milk supervision in Ohio, and on preventable blindness were given.

Members of the division have also been engaged in preparing for the survey of the health of rural school children with particular reference to the eyes and trachoma.

Steps are being taken to improve the present system of morbidity reports.

* *

Summary of Notifiable Diseases Reported During December, 1916. The number of reported cases of notifiable diseases for December was 6,064, as compared with 8,593 for December 1915. The most prevalent diseases were diphtheria, scarlet fever, and measles. All three showed a marked decrease when compared with December 1915, and with the exception of measles, a decrease when compared with November 1916. Typhoid fever reports showed a further decline, only 135 cases being reported, as compared with 375 cases in December 1915, and 327 in November 1916. Of these cases, 60 were reported from the cities of the state, and 75 from the rural sections of the state.

Smallpox reports increased from 126 to 205. Of these cases, 61 were reported from Cuyahoga county, and 97 from Trumbull county. One case of malaria was reported from Fairfield county, and a query has been directed to the health district in regard to this report. The following tables summarize the December reports:

TABLE I.

Reported Cases of Notifiable Diseases, by Urban and Rural Districts.

December, 1916.

Villages
and

Cities. Townships. Total.

TABLE II.

Reported Cases of Notifiable Diseases for November and December, 1916.

Measles and Scarlet Fever Too Prevalent.

In round numbers, 54,000 cases of measles were reported in Ohio during 1916. Health officers need not expect as many cases in 1917, but the outlook from January reports indicates that the measles toll in the state will be high another year. Reports complete at date of going to press already show an increase for January over December of 1,113 cases, promising the same relative increase as occurred in January, 1916, over December, 1915. Jackson County is in the midst of an epidemic, every health district reporting to date having recorded the presence of measles. Wellston alone reported 296 cases for the month. Adams, Brown, Cuyahoga, Franklin, Guernsey, Highland, Ottawa, Richland, Scioto and Warren County health officers have reported relatively large numbers of cases, and should be taking special precautionary measures. Surrounding health officers should be on the alert.

Scarlet fever is particularly prevalent in the following counties; Allen, Delaware, Franklin, Hamilton, Hardin, Knox, Lorain, Lucas, Miami, Montgomery, Muskingum, Preble, Seneca, Trumbull and Wood. The city of Toledo shows the greatest prevalence, 284 reported cases for the month. In the village of Peebles, Adams County, a high case incidence rate is noted.

Health officers should be aware that February, March, April and. May call for special efforts in the prevention of measles, and March, April, May and June, in the prevention of scarlet fever. During the 5-year period, 1909-1913, the latest period for which are available published figures of the Bureau of Vital Statistics showing the number of deaths in Ohio by months, a total of 2,443 deaths from measles and a total of 1,664 deaths from scarlet fever were registered.

The following table shows the distribution of these deaths by months.

Remember, 2,443 deaths from measles, 1,664 deaths from scarlet fever, in five years in Ohio, and 37 deaths from smallpox during the same five years.

Tuberculosis. A yearly average of 6,800 deaths from tuberculosis has occurred in Ohio for the past nine years, a monthly average of 566 deaths. The monthly average of reported cases for 1916 scarcely reached the monthly average of deaths, even after intensive followup work in securing tuberculosis case reports. Incomplete reports for January total 443 cases. Of these cases, 326 were reported from the four largest cities of the state, leaving 117 cases reported from the rest of the state. The four largest cities together show an annual average of 2,500 deaths from tuberculosis for the past nine years or a monthly average of 208 deaths. This is not 40 per cent of the monthly average for the state, 566., The 326 cases reported from the four cities for January make up over 70 per cent of all the cases of tuberculosis reported for the month. Through 1916 these four cities averaged the same compared with the rest of the state. Will health officers outside these four cities figure out how many cases they should be reporting proportionately. Keeping in mind the reports for the four cities are not considered complete, how many cases of tuberculosis should be reported? Watch the monthly totals for 1917. Make them complete.