tory hygiene and the danger of the common cold.

4. Administrative procedures, taken up in detail under the following heads:

Laws, properly enforced, forbidding the use of common cups, requiring proper washing of glasses at public drinking places and requiring proper ventilating facilities.

Closing: "The limitation of gatherings with respect to size and frequency, and the regulation of the conditions under which they may be held, must be regarded as an essential administrative procedure. Nonessential gatherings should be prohibited. Necessary gatherings should be held under such conditions as will insure the greatest possible amount of floor space to each individual present, and a maximum of fresh air, and precautions should be taken to prevent unguarded sneezing, coughing, cheering, etc. Where the necessary activities of the population, such as the performance of daily work and the earning of a living, compel considerable crowding and contact, but little is gained by closing certain types of meeting places. If, on the other hand, the community can function without much of contact between individual members thereof, relatively much is gained by closing or preventing assemblages."

Schools: The committee discusses the following points which must be considered in regard to the closing of schools: (a) Probability of increasing or decreasing number and degree of contacts between children by closing; (b) weather and transportation conditions affecting children enroute to school; (c) nursing and inspection system in the schools; (d) possibility of diagnosing and segregating case in school before child has made a number of contacts; (e) release of personnel and facilities for fighting epidemic by closing schools; (f) possible lowering of educational standards by absence of teachers if schools remain open; (g) possible drag on classes, constituted by children who remain at home because of illness or fear; (h) possibility of outbreak occurring, despite closing, when schools reopen.

Churches: If churches remain open, services should be as few as

possible and intimacy and frequency of personal contacts should be reduced to a minimum.

Theaters: Reliance upon ejection of careless coughers, with theaters remaining open, is discouraged. "The closing of theaters may have as much educational value as their use for direct educational purposes. Discrimination as to closing among theaters, movies, etc., on the basis of efficiency of ventilation and general sanitation, may be feasible."

Saloons and Other Drinking Places: Closing should depend upon the probability of the spread of the disease through drinking utensils and crowding.

Dance Halls, Billiard Rooms, etc.: Such places should be closed where their operation causes considerable personal contact and crowding.

-Street Cars, etc.: "Ventilation and cleanliness should be insisted upon in all transportation facilities. Overcrowding should be discouraged. A staggering of opening and closing hours in stores and factories to prevent overcrowding of transportation facilities may be cautiously experimented with. In small communities where it is feasible for persons to walk to their work it is better to discontinue the service of local transportation facilities."

Funerals: Public funerals should be prohibited.

Masks: Wearing of masks should be compulsory in hospitals and for all who are directly exposed to infection. It should be compulsory for barbers, dentists, etc. Compulsory wearing of masks by the entire population is of doubtful value, according to evidence before the committee, which says it was not encouraged by the evidence to suggest the general adoption of the practice. Voluntary wearing of masks should be encouraged.

Isolation of influenza patients should be practiced. In cases of unreasonable carelessness it should be legally enforced.

Placarding should be practiced in cases of unreasonable carelessness.

Hospitalization cannot be depended upon to eliminate influenza unless every infective person can be detected as such

and removed to the hospital before he has infected others. Home treatment is advised where medical, nursing and other facilities are adequate and where home treatment is not directly contraindicated by the danger of infecting others. Hospitalization in any case, mild or severe, is recommended only where facilities for home treatment are inadequate. Routine hospitalization in mild cases may expose patients to secondary infections in the hospital, and in severe cases may endanger the patient during the transfer from home to hospital.

Coughing and Sneezing: "Laws regulating coughing and sneezing seem to be desirable for educational and practical results."

Terminal Disinfection was found to have no advantages over cleaning, sunning and airing.

Alcohol was declared to be of no preventive value.

Sprays and Gargles were declared to be of no protective value, reasons stated being: (a) no germicide known to the committee and strong enough to destroy infective organisms can be applied to the nose and throat without injury to the mucous membranes; (b) irrigation to remove the infective organism by mechanical means is impracticable; (c) their use tends to remove the protective mucus, to spread the infection and to increase the liability of actual entrance of the infective organisms; (d) their domestic use encourages the common use of utensils in families; (e) their futility has been demonstrated with respect to known organisms such as the diphtheria bacillus and the meningococ

cus.

The committee recommends institutional quarantine of colleges, asylums and similar establishments against the outside world, such quarantine to be instituted early in an epidemic. The recommended measures, it is pointed out, even if they do not accomplish the desired end, should at least be instrumental in distributing the epidemic over a longer period of time. The keeping and study of detailed statistics of the epidemic is emphasized as of great value.

Measures for Relief.

The subcommittee on administrative measures for relief recommends the following measures, all of which are discussed in detail in the report:

1. General rules, including such compulsory reporting and degree of isolation and placarding as will not discourage reporting of cases.

2. Preliminary measures -listing and distribution of resources, centralization of resources under one control, maintenance of the system on a twenty-four hour basis and constant co-operation with state and national agencies.

3. Current and continuous analysis of case situation.

4. Analysis, augmentation and organization of principal facilitities, including field nursing, emergency medical service and hospital facilities.

5. Social and relief measures. 6. Provision of facilities for preparing and distributing food.

Provision for laundry work. 8. Provision for care of the dead.

9. Education, instruction and publicity on various phases of the situation.

Bacteriology.

The subcommittee on the bacteriology of the epidemic discusses in its report the nature of the infective organism, the organisms causing the complicating infections and the value and use of vaccines. Under the head of "Recommendations," the sub-committee made the following report:

Your committee recommends that until such time as the efficacy, or lack of efficacy, of prophylactic vaccination against influenza is established, vaccine if used should be employed in a controlled manner, under conditions that will allow a fair comparison of the number of

cases and of deaths among the vaccinated and nonvaccinated groups. Particular attention should be directed to securing data as to the period in the epidemic at which vaccinated and novaccinated persons developed the disease.

Your committee is of the opinion that the indiscriminate use of stock vaccines against influenza and influenza and pneumonia cannot be recommended.

Nothing in these recommendations should be interpreted as discouraging the use of a pneumococcus stock vaccine against lobar pneumonia.

This epidemic emphasizes the importance of properly equipped laboratories.

History and Statistics. Pointing out that at this early period no positive statement can be made as to the incidence of in

fluenza in the American popula

tion, the subcommittee on the history and statistics of the epidemic estimates that there were not fewer than 400,000 deaths from the disease in the United States during September, October and November. The major portion of this mortality occurred between the ages of 20 and 40 years econom

ically the most important period of human life. The statistical subcommittee and a committee representing the section on vital statistics of the Association will co-operate in the statistical study of the epidemic and will submit standard forms for tabulation, analysis and graphic presentation in a supplementary report.

Suggestions.

The following important suggestions close the report:

"In view of the probability of recurrences of the disease from time to time during the coming year, health departments are advised to be ready in advance with plans for prevention, which plans

shall embody the framework of necessary measures and as much detail as is possible. Laws plainly necessary should be enacted and rules passed now. Emergency funds should be held in reserve or placed in special appropriations, which appropriations can be quickly made available for influenza prevention work.

"The probability that as an aftereffect of the influenza epidemic. there will be an unusually high pneumonia rate for several years should be taken into consideration.

"Of measures for the control of the disease, bacteriologic studies as to the nature of the organisms causing the primary infection and as to bacteriologic associations, and improved procedures leading to the production and use

new

of effective vaccines and curative sera, and the fresh air treatment of the infected, appear to offer most promise."

WANTED-COPIES OF MARCH JOURNAL.

The unusual demand for copies of the OHIO PUBLIC HEALTH JOURNAL for last March, the Child Hygiene Number, reduced the Department's supply of this issue to a point below the minimum number ordinarily kept on hand for reference purposes.

If any readers have extra copies of this number, or copies which they do not intend to preserve, the Department would greatly appreciate having such copies mailed to its office in Columbus. Any postal charges incurred will be refunded to the senders.