MONTHLY BULLETIN VOLUME XXIII. INDIANAPOLIS, DECEMBER, 1920.

Transcription

1 MONTHLY BULLETIN Indiana State BoardofHealth [Entered as second-class matter at the Indianapolis Postoffice] [Acceptance for mailing at special rate of postage provided for in Section 1103, Act of October 3, 1917, authorized August 9, 1918.] VOLUME XXIII. INDIANAPOLIS,. NUMBER Cents a Year HUGH A. COWING. M. D., PRESIDENT Muncie JOHN H. HEWITT. M. D., VICE-PRESIDENT Terre Haute FREDERICK HENSHAW, D. D. S Indianapolis J. N. HURTY, M. D., Phar. D., SECRETARY Indianapolis CHAS. BRUCE KERN, M. D Lafayette WM. F. KING, M. D., ASST. SECRETARY AND DIRECTOR BUREAU OF VENEREAL DISEASES. H. R. CONDREY ACCOUNTANT H. M. WRIGHT REGISTRAR-STATISTICIAN WM. SHIMER, A. B., M. D..SUPT. BACTERIOLOGICAL LABORATORY J. P. NICODEMUS, M. D ASSISTANT BACTERIOLOGIST I. L. MILLER, A. B...STATE FOOD AND DRUG COMMISSIONER AND CHEMIST. V. C. STARNER, B. S ASSISTANT CHEMIST JOHN C. DIGGS, B. S SANITARY ENGINEER ADA E. SCHWEITZER, M. D., DIRECTOR, DIVISION OF INFANT AND CHILD HYGIENE H. W. McKANE, M. D, DIRECTOR DIVISION OF TUBERCULOSIS LEO J. RAIL STATE INVESTIGATOR The MONTHLY BULLETIN will be sent to all health officers and deputies in the State. Health officers and deputies should carefully read and file each copy for future reference. This is very important, for we expect to print instructions, rules and general information, which it will be necessary for officers to preserve. CONTENTS, Births for December Abstract of Mortality Statistics for December Summary of Morbidity and Mortality for December Health Officers, Attention Report of Bacteriological Laboratory for December Things of Interest from the Laboratory Report of the Department of Foods and Drugs for December.. Report of the Division of Infant and Child Hygiene for December Report of Tuberculosis Division for December Report of American Red Cross Chart Showing Geographical Distribution of Deaths Table I, Deaths and Births in Indiana by Counties Table II, Deaths and Births in Indiana by Cities Summary of Weekly Disease Reports Weather Bureau Report BIRTHS FOR. births 4,717 (stillbirths excluded); State rate, Males numbered 2,459; females, 2,258. White males, 2,396; white females, 2,180. Colored births, 141; males, 63; females, 78. Stillbirths, 176; white, 164; colored, 12. The Northern Sanitary Section, population, 1,042,514 reports 1,802 births; rate, The Central Sanitary Section, population, 1,219,131, reports 1,889 births; rate, The Southern Sanitary Section, population, 686,443, reports 1,026 births; rate, The highest birth rate, Howard County, The lowest birth rate, LaGrange County, 8.7. births to date for 1919, 58,690. births to date for 1920, 64,180. ABSTRACT OF MORTALITY STATISTICS FOR. deaths reported, 2,871; state rate, In the preceding month 2,656 deaths; rate, In the same month last year 2,931 deaths; rate, Deaths by important ages were: Under 1 year of age, 421 or 14.6 per cent of total; 1-10, 198; 10-20, 131; 65 and other, 1,096 or 38.1 per cent of total. SANITARY SECTIONS. The Northern Sanitary Section, population 1,042, 514 reports 989 deaths; rate, In the preceding month 933 deaths; rate In the same month last year, 1,026 deaths; rate, The Central Sanitary Section, population, 1,219,131, reports 1,231 deaths; rate, In the preceding month 1,109 deaths; rate, In the same month last year, 1,288 deaths; rate, The Southern Sanitary Section, population 686,443, reports 651 deaths; rate, In the preceding month 614 deaths; rate, In the same month last year, 617 deaths; rate, REVIEW OF SECTIONS: The Central Section presents the highest death rate, 12.1, which is.4 higher than that for the entire state. The Central Section also presents the highest death rate for measles, whooping cough, cerebrospinal fever, poliomyelitis, and puerperal septicemia. The Northern Section presents the highest death rate for typhoid fever, scarlet fever, cancer and external causes. The Southern Section presents the highest death rate for tuberculosis, diphtheria and croup, lobar and broncho-pneumonia, diarrhea and enteritis, influenza and smallpox. RURAL: Population, 1,701,179 reports 1,448 deaths; rate, In the preceding month, 1,383 deaths; rate, 9.8. In the same month last year, 1,568 deaths; rate, URBAN: Population, 1,246,909, reports 1,423 deaths; rate, In the preceding month, 1,273 deaths; rate, In the same month last year, 1,363 deaths; rate, The cities named present the following death rates: Indianapolis, 12.9; Fort Wayne, 12.2; Evansville, 15.5; South Bend, 9.2; Terre Haute, 13.8; Gary, 14.3; East Chicago, 13.2; Muncie, 19.9; Hammond, 17.2; Richmond, 9.9.; Anderson, 14.2; New Albany, 12.7; Elkhart, 13.2; Kokomo, 20.7; Michigan City, 14.5; Lafayette, 15.5; Logansport, 14.4; Marion, SUMMARY OF MORBIDITY AND MORTALITY FOR. Scarlet fever, as in the preceding month, was reported as the most prevalent infectious disease. The order of prevalence was as follows: Scarlet fever, smallpox, diphtheria, syphilis, gonorrhea, measles, tuberculosis, influenza, typhoid, pneumonia, meningitis, poliomyelitis, trachoma. SMALLPOX. 794 cases in 51 counties with 4 deaths.

2 134 MONTHLY BULLETIN, INDIANA STATE BOARD OP HEALTH. In the preceding month 452 cases in 35 counties with no deaths. In the same month last year 513 cases in 46 counties with 3 deaths. The counties reporting smallpox present were: Adams, 5; Allen, 1; Bartholomew, 5; Benton, 4; Carroll, 11; Clay, 3; Clinton, 19; Daviess, 2; Dearborn, 4; Decatur, 34; Dekalb, 2; Delaware, 2; Elkhart, 15; Grant, 5; Hancock, 5; Henry, 2; Howard, 13; Huntington, 2; Jackson, 3; Jay, 1; Jennings, 5; Knox, 8; Kosciusko, 7; La- Grange, 2; Lake, 17; Laporte, 3; Lawrence, 16; Madison, 3; Marion, 30; Marshall, 11; Miami, 6; Montgomery, 4; Orange, 5; Owen, 9; Parke, 1; Pulaski, 4; Putnam, 15; Randolph, 39; Rush, 3; Shelby, 21; Steuben, 3; St. Joseph, 229; Tippecanoe, 44; Tipton, 2; Vanderburg, 1; Vigo, 15; Warren, 4; Warrick, 4; Washington, 5; Wayne, 2; White, 2. TUBERCULOSIS: 200 deaths, of which 167 were of the pulmonary form and 33 other forms. The male tuberculosis deaths numbered 92, females, 108. Of the males, 16 were married in the age period 18 to 40 and left 32 orphans under 12 years of age. Of the females, 35 were married in the same age period as above, and left 70 orphans under 12 years of age. number of orphans made in December on account of this preventable disease, 102. Number of homes invaded, 185. PNEUMONIA: 354 deaths, rate per 100,000. In the preceding month 210 deaths, rate In the same month last year 329 deaths; rate, Males numbered 193; females, 161. INFLUENZA: 113 cases in 13 counties with 32 deaths. In the preceding month 79 cases in 10 counties with 17 deaths. In the same month last year 90 cases in 27 counties, with 33 deaths. TYPHOID FEVER: 74 cases in 26 counties with 26 deaths. In the preceding month 112 cases in 34 counties with 29 deaths. In the same month last year 74 cases reported in 29 counties with 14 deaths. SCARLET FEVER: 1,085 cases in 74 counties with 16 deaths. In the preceding month 829 cases in 66 counties with 17 deaths. In the same month last year 683 cases reported in 52 counties with 9 deaths. DIPHTHERIA: 515 cases in 57 counties with 67 deaths. In the preceding month 483 cases in 52 counties with 46 deaths. In the same month last year 304 cases in 50 counties with 36 deaths. MEASLES: 137 cases in 26 counties with 3 deaths. In the preceding month 151 cases in 17 counties with 2 deaths. In the same month last year 659 cases in 40 counties with 5 deaths. POLIOMYELITIS: 1 case in 1 county with 1 death. In the preceding month 2 cases in 2 counties with 1 death. In the same month last year 2 cases in 2 counties with 1 death. SYPHILIS: 198 cases in 33 counties with 17 deaths. In the preceding month 167 cases in 32 counties with 17 deaths. In the same month last year 449 cases in 33 counties with 20 deaths. GONORRHEA: 195 cases in 26 counties. In the preceding month 263 cases in 29 counties. In the same month last year 549 cases in 55 counties. DECEMBER. EXTERNAL CAUSES, 171; males, 117; females, 54. SUICIDE, 18; males, 13; females, 5. Suicide by poison, 4; by asphyxia, 1; by hanging or strangulation, 3; by drowning, 2; by firearms, 7; by crushing, 1. ACCIDENTAL OR UNDEFINED, 145; males, 96; females, 49; Poisoning by food, 2; other acute poisonings, 4; conflagration, 4; burns, (conflagrations excepted), 17; absorption of deleterious gases, 8; accidental drowning, 1; by firearms, 10; by fall, 18; in mines, 6; in quarries, 2; by machinery, 2; railroad accidents, 19; automobile accidents, 35; injuries by other vehicles, 1; motorcycle accidents, 1; injuries by animals, 3; starvation, 1; fractures, cause not specified, 2; other external violence, 9. HOMICIDE, 8; males, 8. Homicide by firearms, 7; by other means, 1. HEALTH OFFICERS ATTENTION Delayed Birth and Death Returns. Each month the statistical department receives certificates for births and deaths that have occurred during the preceding month, which are not sent to this department in time to be tabulated with the report for the current month. With the report for December, the following counties named below were delinquent in this matter: Births. Adams, 1; Allen, 1; Bartholomew, 2; Benton, 2; Boone, 2; Carroll, 1; Cass, 3; Clark, 5; Clay, 4; Clinton, 1; Dearborn, 1; Decatur, 1; DeKalb, 7; Delaware, 6; Dubois, 5; Fayette, 1; Floyd, 4; Franklin, 1; Fulton, 3; Gibson, 3; Grant, 1; Greene, 7; Hamilton, 1; Hancock, 3; Harrison, 3; Hendricks, 1; Henry, 8; Jefferson, 7; Knox, 11; Lake, 19; Laporte, 6; Madison, 6; Marion, 5; Martin, 1; Miami, 7; Monroe, 3; Montgomery, 1; Morgan, 4; Newton, 13; Noble, 4; Orange, 1; Parke, 1; Pike, 1; Porter, 3; Posey, 4; Randolph, 22; Ripley, 7; Rush, 1; Shelby, 3; Spencer, 4; Starke, 3; Steuben, 2; St. Joseph, 5; Sullivan, 5; Tippecanoe, 1; Vanderburgh, 5; Vermillion, 1; Vigo, 2; Wabash, 2; Warrick, 7; Washington, 1; Wayne, 1; White, 1; Whitley, 1. Deaths. Adams, 1; Allen, 1; Benton, 4; Blackford, 1; Boone, 3; Clay, 3; DeKalb, 7; Delaware, 2; Floyd, 1; Fountain, 1; Franklin, 1; Fulton, 1; Gibson, 1; Greene, 5; Hamilton, 1; Hancock, 1; Hendricks, 1; Howard, 1; Johnson, 1; Kosciusko, 4; Lagrange, 1; Lake, 2; Laporte, 1; Madison, 4; Miami, 3; Morgan, 9; Ohio, 2; Owen, 1; Perry, 5; Posey, 3; Randolph, 14; Ripley, 7; Spencer, 1; St. Joseph, 1; Sullivan, 7; Tippecanoe, 1; Vigo, 4; Warren, 1; Warrick, 3; Washington, 1; Wayne, 2; White, 2. REPORT OF BACTERIOLOGICAL LABORATORY, INDIANA STATE BOARD OF HEALTH, FOR. Will Shimer, M.D., Superintendent. Sputum for tubercule bacilli Pleural fluid for tubercle bacilli Spinal fluid for tubercle bacilli

3 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 135 Pathological tissues Carcinoma: Carcinoma of breast Carcinoma of back Carcinoma of omentum Carcinoma of uterus Carcinoma, location not given Miscellaneous tissues Gasserian ganglions Pus for tubercle bacilli Feces for tubercle bacilli Urine for tubercle bacilli Throat cultures for diphtheria bacilli Suspicious Unsatisfactory Epidemic cultures for diphtheria bacilli Widal tests for typhoid fever Wasserman tests for syphilis Anticomplementary Brains for rabies Dogs: Cows: Blood for counts Blood for malaria plasmodia Pus for gonococci Females: Suspicious Unsatisfactory Males: Suspicious... Sex not given: Cerebro-spinal fluid for meningococci Feces for amoeba Urine for general analysis number examinations made OUTFITS PREPARED AND SENT OUT DURING. Tuberculosis Diphtheria Diphtheria epidemic Widals Wassermanns Malarias Blood counts Gonococci number... PATIENTS TAKING "PASTEUR TREATMENT" DURING THE MONTH OF Katherine Jones... Joseph Murray Bicknell.. Bicknell.. Knox.. Knox.. THINGS OF INTEREST FROM THE LABORATORY. Encephalitis Lethargica. There is at the present time considerable difference of opinion concerning the etiology of Encephalitis Lethargica and the relationship of it to influenza and anterio poliomyelitis. The following is a brief outline of the various theories on the etiology of these three diseases: 1. Same virus as anterior-poliomyelitis. 2. Modified strain of anterior poliomyelitis virus. 3. Virus of same nature as anterior-poliomyelitis virus but having entirely different and specific disease producing characteristics. 4. Same as influenza virus. 5. Influenza weakens resistance so that encephalitis lethargica virus is able to infect. Characteristics of influenza virus: 1. Filter passer. 2. Exists in mucus membranes of nose and throat. 3. Exits in and produces lesions in brain and spinal cord. 4. Grows on same media as influenza and anterior-poliomyelitis virus. 5. Glycerine preserves, drying kills virus. 6. Will kill rabbits but not monkeys. Microscopic Pathology of Encephalitis Lethargica Anterior-Poliomyelitis and Rabies. Marked infiltration of interstitial tissue about the blood vessels by plasma cells in mild cases, in the more acute cases polynuclear cells or even hemorrhage may be present about the blood vessels. Ganglion cell degeneration is present and in chronic cases proliferation of neuroglia cells. Pathological change may be due to: 1. Soluble toxins circulating in the blood. 2. Invasion of brain cells by parasites. 3. Inflammatory reaction and repair of blood vessels may shut off blood supply and thus cause nerve cell degeneration.

4 136 MONTHLY BULLETIN, INDIANA STATE BOARD OP HEALTH. Clinical Symptoms. Paralysis first symptoms of anterior-poliomyelitis with considerable fever. Mentality little affected. In Encephalitis lethargica paralysis develops slowly, fever moderate and mentality is markedly affected. Atypical and mild cases numerous in anterio-poliomyelitis and encephalitis lethargica. No form of treatment yet devised seems to affect the course of the disease in either of these two diseases. REPORT OF THE DEPARTMENT OF FOODS AND DRUGS; WATER AND SEWAGE; WEIGHTS AND MEASURES FOR THE MONTH OF. I. L. Miller, State Food and Drug Commissioner. Two bakeries, one grocery and one restaurant were graded "bad" by inspectors representing the food and drug division of the Indiana State Board of Health, during the month of December. This quartet of establishments stands the "horrible examples" of the 1,291 first inspections and 18 "follow-up" inspections made by the field force of the division during the month. Of the establishments graded "poor" which means that they are given a definite period of time in which to make specific alterations in the sanitary condition of their establishments, 10 were bakeries, 1 a bottling plant, 1 canning factory, 1 confectionery, 1 creamery, 11 cream stations, 1 dairy, 3 drug stores, 9 groceries, 14 hotels and restaurants, 6 meat markets, 1 milk plant, and 5 poultry and produce houses. Of the inspected establishments 788 were rated "good" and 435 "fair," which is a "passing" grade. Condemnation notices, which means warnings against specific violations of the sanitary laws of the State, were issued to 19 bakeries, 1 bottling plant, 12 cream stations, 2 groceries, 1 meat market, 1 poultry house and 3 restaurants. Of 73 food samples analyzed during the month 54 were found to be illegal. Of these 45 were milk samples and 8 samples of cider. Of the 7 drug samples analyzed, 3 of whiskey were found to be illegal. One successful prosecution for selling oleomargarine as butter, was reported during the month. Twelve gallons of "Kick-On", 2 kegs of cider and 2 kegs of cordials were ordered off the market because of having benzoate of soda in their contents, in violation of the Indiana law. The following tables indicate the work of the food and drug division for December, 1920, in detail: SUMMARY OF CONDEMNATION NOTICES ISSUED DURING MONTH CLASSIFICATIONS Bakeries Bottling Works... Confectioneries Cream Stations... Dairies Groceries Meat Markets Poultry Houses.. Restaurants No. Issued Reasons for Condemnation Unsani- Improper No No tary Con- Health Bread Con- struc- Certifi- Labels ditions tion cates OF Orders complied with and Cases Closed SUMMARY OF SANITARY INSPECTIONS MADE DURING THE MONTH OF Bakeries Bottling Works Canning Factories Candy Factories Cold Storage. Confectioneries Creameries Cream Stations Dairies Drug Stores Fish Stores Fruits and Vegetables.., Flour Mills Groceries, Hotels and Restaurants, Ice Plants, Ice Cream Factories Ice Cream Parlors Meat Markets, Milk Plants Poultry and Produce... Slaughter Houses Soft Drink Parlors Follow-up Number Number Number Number Number Number Inspected Excellent Good Fair Poor Bad SUMMARY OF FOLLOW-UP INSPECTIONS MADE DURING THE MONTH OF Bakeries Canning Factories Creameries t Cream Stations. Dairies Hotels and Restaurants.. Number CLASSIFICATIONS Number Inspections Number O. K. Not Satisfactory ANALYSIS OF FOODS AND DRUGS MADE DURING THE MONTH OF Beverages Cider Root Beer Figs Flour (Buckwheat) Glucose Meat Products Bacon, Lard Sausage, Milk Products- Butter, Cream Ice Cream Milk Pepper (Powdered) Vinegar, Vegetable Products- Canned Peas, Miscellaneous Paste Soap Chips DRUGS Alcohol (Ethyl) Drug Mixture Whiskey Unknown Mixture, Foods Foods and Drugs Number Number Legal Illegal

5 MONTHLY BULLETIN, INDIANA STATE BOARD OP HEALTH. 137 PROSECUTIONS MADE DURING THE MONTH OF Name and Address Date Final COUNTY of Defendants Why Prosecuted of Trial Disposition Marion., Wm. Fielder, Indianapolis, Ind. Sold 1 lb. oleomargarine for butter. GOODS ORDERED WITHDRAWN FROM SALE DURING THE MONTH OF 12 gallon "Kick-On". 2 Kegs cider 2 Kegs cordials GOODS Why Withdrawn from Sale Contained benzoate of Soda. Contained benzoate of Soda. Contained benzoate of Soda. WEIGHTS AND MEASURES DEPARTMENT. The personnel of the State Department of Weights and Measures consists of a chief inspector and one assistant inspector. The department owns two automobiles, fully equipped for the inspection of gasoline pumps, measures, and scales of every variety from a small counter scale to a large truck scale. The inspectors test at least once annually all weighing and measuring devices of the State Institutions under the jurisdiction of the Board of Charities. They also check the standards of all local, city and county departments. In addition to this work the state department during the last fiscal year tested 1,839 scales, 13,950 weights and 183 gasoline pumps. Three hundred and seventy-five complaints were investigated. Local departments of Weights and Measures in cities and counties employ twenty-four inspectors whose duty it is to check at least once annually all weighing and measuring devices in their respective jurisdictions. The following table shows a summary of the work done by all inspectors both State and local during the fiscal year ending October first, nineteen hundred and twenty: those supplies which are entirely unfit for drinking purposes at all times, with groups II, III, and IV including waters intermediate in character. The table below shows the classification of the 211 water supplies of the State and the typhoid death rate per hundred thousand for each class. I II III IV V TABLE No. 1 No. of Plants Typhoid Death Hate Obviously there is a very evident need for the concentration of the efforts of the State Board of Health upon improvement of waters falling in Classes III, IV and V. Field inspections during the month were made at Richmond, Hagerstown and Greenwood. The first two of these cities were visited in carrying out the certification of waters used on passenger trains engaged in interstate traffic. The survey was made at Greenwood, Indiana, in response to town officials who complained that contaminated water had been turned into the mains of the town without proper purification. Investigation disclosed the fact that the complaints were justified. During the month the Water and Sewage Laboratories made an examination of 211 samples. One hundred and fifty of this number were examined both bacteriologically and chemically and 61 submitted to a bacteriological examination only. A tabulation of the samples analyzed as to source and quality is shown in the accompanying table. TABLE No. 1 TOTAL SAMPLES ANALYZED SUMMARY OF INSPECTIONS OF WEIGHTS AND MEASURES FOR THE YEAR ENDING OCTOBER 1, 1920 Con- Con- Rein- Correct Adjusted demned fiscated spected Deep Wells Shallow Wells Cisterns Springs Ponds and Lakes Streams Miscellaneous Ice Com. and B. W. Scales Weights Dry Measures Liquid Measures. Linear Measures. Gasoline Pumps.. Meters Good Bad Doubtful Miscellaneous articles reweighed 23,964; number found short 142 WATER AND SEWAGE LABORATORIES FOR. J. C. Diggs, Sanitary Engineer. Investigations carried on by the Water and Sewage Laboratories during the several past weeks shows a very great variation in the quality of the public water supplies of the State. A classification of these supplies has been made according to source of supply, danger of contamination, purity as indicated by laboratory examination, equipment for purification and character of personnel responsible for purification of these supplies. The public supplies are divided into five groups according to quality. The first group comprised of those supplies which are entirely safe at all times and the fifth group of REPORT FOR THE DIVISION OF INFANT AND CHILD HYGIENE, INDIANA STATE BOARD OF HEALTH FOR THE MONTH ENDING DECEMBER 31, By Ada E. Schweitzer, M. D., Director. The chief activities of the Child Hygiene Division during December have been lectures with and without moving pictures, and the examination of all the children in Chester township schools, including the North Manchester schools in Wabash County. At a called meeting of their local Medical Society, December 6th, the standards of physical defects used by the Child Hygiene Division were discussed and a daily program arranged for the physicians. The children in the Central School and in the ward schools were to be examined in five rooms at the Central Building and

6 138 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. those in the Chester Schools at the township building. Over six hundred children were weighed and measured, given vision and hearing tests and physical examinations in three and one-half days. The nature and importance of the work was brought before the public by moving pictures, lectures and by good newspaper publicity. The Director of the Child Hygiene Division supervised and assisted with the work of physical examinations, while the taking of histories and the directing of routine were in charge of Superintendent Humpke and Miss Ullery, R. N., and of Superintendent Earle. So accurately were the movements of the children timed, that the doctors who worked in squads of from four to six were always busy. Local members of the school board, business men, and others expressed themselves as pleased with the expedition and thoroughness of the work. At Shelbyville, talks on Personal Hygiene were given by the Director to Departmental, Junior High, and High School girls. The girl president of the High School Club introduced the Director. A conference luncheon was held by the Parent-Teachers Club. At Edwardsport illustrated talks were given to school children and to the Parent-Teachers Association on invitation of Doctor Reeve, Local Health Officer. The staff has been urged to arrange later for the examination of the school children. The importance of Prenatal Supervision was emphasized in a talk by the director of the Division before the Stilesville Home Economics Club. This was the first of a series of talks arranged for the Clubs of Hendricks County by Miss Pansy Norton, Home Demonstration Agent. It is hoped that as a result of this campaign, every expectant mother in Hendricks County will place herself at once under the supervision of the physician she expects to attend her at her child's birth. By this plan both the infant and maternal death rates will be lowered. Talks to school children were also given at Stilesville. Representatives of all the Ft. Wayne Womens Clubs met at a banquet at the Wolf & Dessauer Assembly hall, where the President of the Club League had arranged for a varied program. An address on practical phases of the Child Hygiene work for Indiana was given by the Director. The office work for the month included the report for the Calendar year. Valuable statistics taken from 3,225 examination schedules are being visualized on illustrated charts. Summary of Work. Meetings attended Talks given Conferences Exhibit shown times Audience Towns visited Children examined Doctors assisting Club women and teachers assisting Invitations from Superintendents of Schools Y. W. C. A Parent-Teachers Home Economics Clubs Health Officers Womens Club League Literature distributed.. Form letters sent Charts loaned (sets) Films loaned Meetings in school houses. Meetings in Hotel Meetings in Banquet Hall Meetings in Hotel Meetings in Private Home Meetings in Moving Picture House... Films shown times Car mileage, Talks to School Children Talks to High School Girls Talks to Womens Club League Talks to Home Economics Club Talks to Mixed Audiences Talks to State Mental Hygiene REPORT OF THE TUBERCULOSIS DIVISION FOR. Dr. H. W. McKane, Director. On the first of this month the Division started a campaign of visiting the public schools in the larger centers of population in the central part of the State. The plan was to visit the school, making short health talks to the high school and all the grades, and then to give a public entertainment in the school auditorium or some other convenient place for the general public. The first meting was held at Amo on December 1. The schools were visited and a public meeting held in the High School Auditorium at night. A large audience was present, 200 men, women and children being present. On the 2nd, the schools were visited and a public meeting held at Clayton where two hundred persons were in attendance. Brazil was the next town visited, on December 7. The schools were visited and moving pictures and lecture given to the Junior and Senior High School students in the afternoon in the High School Auditorium, the director, Dr. Mc- Kane, speaking. More than nine hundred pupils and teachers were present. On December 8, Waveland was visited. When closing the campaign in Montgomery County in November, the Division was unable to visit Waveland and New Ross, but promised to return later, hence this visit. The meeting at Waveland was held in the Methodist Church, about one hundred being present. On the 9th, New Ross was visited, and the division was greeted by an audience of 250 persons. Noblesville was visited on the 13th. Short talks were made to the pupils in the grades and to the junior and senior high school pupils. At night the usual entertainment was given to which the public was invited. On account of weather conditions only one hundred and twentyfive were present. Mr. Frank Tucker, an inspector for the State Board of Health was present and made a short talk. On the 14th, Cicero was visited and the usual talks to the schools were given. The public meeting at night was held in Collins Hall, over two hundred people being in attendance. On the 15th the Division was in Arcadia, where talks were given to the schools and in the evening the usual public entertainment was held in the High School Auditorium.

7 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 139 On account of inclement weather only one hundred persons were present. The Division was tendered a very hearty reception on the 16th at Tipton. Professor Dixon, Superintendent, went with us to visit all of his school. A public meeting was held in the Public Library Building at night. The room was too small to accommodate the audience of 250. We were at Kokomo on Friday the 17th. The Director, Dr. McKane spoke to 800 high school pupils, and Miss McKane spoke to 300 Junior High School pupils. These meetings were held in the afternoon. We gave our public entertainment in the High School Auditorium at night to 125 people. This closes our work until after the holiday season. Summary. Ten public schools were visited; 12 lectures were given by the Director to 1,600 people this does not include the schools; 800 pieces of literature were distributed. We assisted the Marion County Tuberculosis Society in two meetings at New Bethel, and Valley Mills. AMERICAN RED CROSS DEPARTMENT OF NURSING BUREAU OF PUBLIC HEALTH NURSING REPORT OF WORK DONE BY TWENTY-THREE NURSES, INDIANA. PUBLIC HEALTH NURSING SERVICE DURING MONTH OF NOVEMBER, 1921 CASE RECORD Summary of cases treated: Number of cases under care first of month Number new cases, Number readmitted cases number cases during month Number cases dismissed Number cases remaining end of month ANALYSIS OF DISMISSED CASES Condition on discharge: Recovered Improved Unimproved Died.,. Nurse not needed Discharged: To family or self To hospital. To hospital dispensary To other care Died RECORD OP VISITS MADE Nursing visits Infant welfare visits Prenatal visits. Tuberculosis visits Child welfare visits Visits to schools Home visits to school children Social service visits Office treatments Attendance at clinics Sanitary inspection visits Friendly visits Other visits ANALYSIS OF NEW AND READMITTED CASES By whom reported: Reported by families Reported by physicians Reported by M. L. I. Co. agents Reported by others Found by nurse Ages of patients treated: Under 2 years 2 to 6 years 6 to 20 years, Over 20 years. Nature of cases: Prenatal cases Obstetrical cases Delivered by nurse Nurse present at delivery Post partem care only Opthalmia neonatorum Pneumonia Typhoid Tuberculosis Malaria Gastro-intestinal diseases of infants... Well babies under supervision Chronic illness, Surgical dressing cases '. Accident cases. Communicable diseases All others. FINANCIAL Number Metropolitan cases during month Number paying patients Number free patients Money due from Metropolitan \ Fees collected Cost of transportation Talks given Night calls after 8 p. m MISCELLANEOUS

8 140 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. AMERICAN RED CROSS DEPARTMENT OF NURSING BUREAU OF PUBLIC HEALTH NURSING X NURSES, INDIANA. NURSING SERVICE DURING MONTH DAILY RECORD OF SCHOOL NURSING DONE BY TWENTY-SI OF NOVEMBER Eyes Ears Nose Throat Mouth Skin Infectious Diseases Miscellaneous NAME OF COUNTY Defective Vision Conjunctivitis Trachoma Defective Hearing Nasal Obstruction Enlarged Tonsils Cervical Adenitis Defective Teeth Ring Worm Scabies Eczema Pediculosis Impetigo Chicken Pox Diphtheria Scarlet Fever Measles Whooping Cough Mumps Tuberculosis Cardiac Diseases Chorea Deformities Malnutrition Mentally Defective Suspicious Symptoms Adams Allen, (4 Nurses). Benton Dearborn County- Aurora Lawrenceburg.. Dekalb, (2 Nurses) Goshen Floyd. Franklin Fulton Hamilton Henry Huntington Johnson LaPorte Lawrence... Putnam Tippecanoe Tipton Washington Wayne White s Clark Jefferson Newton Orange Wells Elkhart s... Miscellaneous Other Information NAME OF COUNTY Exposed to Contagion Cultured for Diphtheria Infected Tonsils Goitre Time Spent in School Hours Examined by Physician Examined by Nurse Room Inspection of Pupils Number Excluded Number Re-Admitted New Cases Dismissed, Cured or Corrected Dismissed Improved Dismissed Unimproved Refused Treatment Cases carried End of Month Surgical Operation Referred to Dentist Referred to Oculist or Optician i Referred to Physician Referred to Dispensary I Referred to Hospital Treatments by Nurse Home Visits Miscellaneous Visits Talks to Pupils in Class Parents' Meetings Addressed Inspection of School Building and Premises Miscellaneous Talks Adams., Allen, (4 Nurses) Benton Dearborn County Aurora Lawrenceburg DeKalb, (2 Nurses,... Goshen Floyd Franklin, Fulton Hamilton Henry Huntington Johnson LaPorte Lawrence Putnam Tippecanoe Tipton Washington Wayne White s Clark Jefferson Newton Orange Wells Elkhart s

9 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH. 141 CHART SHOWING GEOGRAPHICAL DISTRIBUTION OF DEATHS FROM IMPORTANT CAUSES FOR. NORTHERN SANITARY SECTION. population deaths Death rate per Pulmonary Tuberculosis rate per Other forms of Tuberculosis rate per Typhoid Fever rate per Diphtheria and Croup rate per Scarlet Fever rate per Measles rate per Whooping Cough rate per Lobar and Broncho-Pneumonia rate per Diarrhoea and Enteritis (under 2 yrs.) rate per Cerebro-Spinal Fever rate per , Acute Anterior Poliomyelitis rate per Influenza rate per Puerperal Septicemia rate per Cancer rate per External causes rate per Smallpox rate per CENTRAL SANITARY SECTION. population, deaths Death rate per Pulmonary Tuberculosis rate per Other forms of Tuberculosis rate per Typhoid Fever rate per Diphtheria and Croup rate per Scarlet Fever rate per Measles rate per Whooping Cough rate per Lobar and Broncho-Pneumonia rate per Diarrhoea and Enteritis (under 2 yrs.) rate per Cerebro-Spinal Fever rate per Acute Anterior Poliomyelitis rate per Influenza rate per Puerperal Septicemia rate per Cancer rate per Externalcausesrate per Smallpox rate per SOUTHERN SANITARY SECTION. population deaths Death rate per Pulmonary Tuberculosis rate per Other forms of Tuberculosis rate per Typhoid Fever rate per Diphtheria and Croup rate per Scarlet Fever rate per Measles rate per Whooping Cough rate per Lobar and Broncho-Pneumonia rate per Diarrhoea and Enteritis (under 2 yrs.) rate per Cerebro-Spinal Fever rate per Acute Anterior Poliomyelitis rate per Influenza rate per Puerperal Septicemia rate per Cancer rate per External causes rate per Smallpox rate per INDIANA,

10 TABLE 1. Deaths and Births in Indiana, by Counties and Sections, During the Month of December, (Stillbirths Excluded.) STATE AND COUNTIES. State of Indiana. Northern Counties.. Adams Allen Benton Blackford Carroll Cass Dekalb Elkhart Fulton Grant Howard Huntington Jay Jasper Lagrange Kosciusko Lake Laporte Marshall Miami Newton Noble Porter Pulaski Starke Steuben St. Joseph Wabash Wells White Whitley Centra! Counties... Bartholomew.. Boone Brown Clay Clinton Decatur Delaware Fayette Fountain Franklin Hamilton, Hancock Hendricks Henry Johnson Madison Marion Monroe Montgomery.. Morgan Owen Parke Putnam Randolph Rush Shelby Tippecanoe... Tipton Union Vermillion Vigo Warren Wayne Southern Counties.. Clark Crawford Daviess Dearborn Dubois Floyd Gibson Greene Harrison Jackson Jefferson Jennings Knox Lawrence Martin Ohio Orange Perry Pike Posey Ripley Scott Spencer Sullivan... Switzerland Vanderburgh... Warrick Washington... Estimated Population, Deaths Reported for December, Deaths Reported for December, Deaths Reported for the Year 1920 to Date. Deaths Reported for the Year 1919 to Same Date. ANNUAL DEATH RATE PER Nov. t his Year. Nov. Last Year. IMPORTANT AGES. Under 1 Year. Age 1 to 10. Age 10 to Years and Over. Pulmonary Tuberculosis. Other forms of Tuberculosis. Typhoid Fever. Diphtheria and Croup. Scarlet Fever. DEATHS FROM IMPORTANT CAUSES. Measles. Whooping Cough. Lobar and Broncho- Pneumonia. Diarrhoea and Enteritis (under 2 years) Cerebro-Spinal Fever. Acute Anterior Poliomyelitis. Influenza. Puerperal. Septicemia. Cancer. External Causes. Smallpox. Syphilis. Births. BIRTHS Rate per 1,000 Population.

11 TABLE 2. Deaths and Births in Indiana, by Cities and Groups, During the Month of December, (Stillbirths Excluded.) STATE AND COUNTIES. State of Indiana. Rural.. Urban. Cities of First Class Population 100,000 Indianapolis Cities of the Second Class Population 45,000 to 100,000 Fort Wayne Evansville South Bend Terre Haute Gary Cities of the Third Class Population to East Chicago Hammond Muncie Richmond Anderson New Albany Elkhart Kokomo Michigan City Lafayette Logansport Marion Cities of the Fourth Class Population 10,000 to 20,000, Mishawaka Vincennes New Castle Laporte Peru..... Bloomington Crawfordsville Shelbyville Huntington Elwood Bedford Brazil, Jeffersonville Cities of the Fifth Class Population 5,000 to 10,000., Frankfort Columbus... Goshen Wabash.. Connersville. Clinton Whiting.. Washington Linton Valparaiso Lebanon Madison Princeton Hartford City Seymour. Kendallville Mt. Vernon Greensburg Estimated Population, Deaths Reported for December, Deaths Reported for December, Deaths Reported for the Year 1920 to Date. Deaths Reported for the Year 1919 to Same Date. ANNUAL DEATH RATE PER Nov. This Year. Nov. Last Year. IMPORTANT AGES. Under 1 Year. Age 1 to 10. Age 10 to Years and Over. Pulmonary Tuberculosis. Other Forms of Tuberculosis. Typhoid Fever. Diphtheria and Croup Scarlet Fever. DEATHS FROM IMPORTANT CAUSES. Measles. Whooping Coungh. Lobar and Broncho- Pneumonia. Diarrhoea and Enteritis (under 2 years) Cerebro-Spinal Fever. Acute Anterior Poliomyelitis. Influenza. Puerperal Septicemia. Cancer. External Causes. Smallpox. Syphilis BIRTHS. Births. Rate per 1,000 Population. Failed to report. Mortality of Indiana, December, (Stillbirths Excluded.) DEATHS AND ANNUAL DEATH RATES PER 100,000 POPULATION FROM IMPORTANT CAUSES. POPULATION BY GEOGRAPHICAL SECTIONS AND AS URBAN AND RURAL. State of Indiana. Northern Counties Central Counties.. Southern Counties All Cities Over 100,000 45,000 to 100, ,000 to 45, ,000 to 20,000.. Under 10,000 Country Estimated Population Pulmonary Other L Diph- Whoop- Lobar and and Cerebro- Acute Puer- Tuber- Forms Typhoid theria Scarlet. Measles. ing Broncho- Enteritis Spinal Anterior Influenza. peral Cancer. External Smallculosis. Tuber- Fever and Fever Cough. Pneumonia. (Under Fever. Polio- Septi- Causes. pox. culosis. Croup 2 Years.) myelitis. cemia.

12 144 MONTHLY BULLETIN, INDIANA STATE BOARD OF HEALTH, December, Summary of Weekly Disease Reports From Health Officers. Tuberculosis Diphtheria Influenza Measles Meningitis Poliomyelitis Pneumonia Scarlet Fever Smallpox Typhoid Trachoma Syphilis Gonorrhea Tuberculosis Diphtheria Influenza Measles Meningitis Poliomyelitis Pneumonia Scarlet Fever Smallpox Typhoid Trachoma Syphilis Gonorrhea Adams Allen Bartholome\ Benton Blackford... Lawrence Madison Marion Marshall Martin Boone Brown Carroll Cass Clark Miami Monroe Montgomery Morgan Newton Clay Clinton Crawford... Daviess Dearborn.. Noble Ohio Orange Owen Parke Decatur Dekalb Delaware... Dubois Elkhart... Perry Pike Porter Posey Pulaski Fayette Floyd Fountain.. Franklin..., Fulton Putnam Randolph.. Ripley Rush Scott Gibson Grant Greene Hamilton Hancock Harrison Hendricks.. Henry Howard Huntington Jackson... Jasper Jay Jefferson... Jennings... Johnson Knox Kosciusko.. Lagrange.. Lake Laporte... s... Shelby Spencer Starke Steuben St. Joseph Sullivan Switzerland Tippecanoe Tipton Union. Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley s s s... U. S. Department of Agriculture, Weather Bureau. Condensed Summary for Month of December, TEMPERATURE-IN DEGREES FAHRENHEIT. Section Average. Departure from the Normal Station.* Temperature extremes. Highest. Date Station.* Lowest. Date. Three Stations.. Collegeville PRECIPITATION-IN INCHES AND HUNDREDTHS. Section Average Departure from the Normal Station.* Precipitation extremes. Greatest monthly Amount. Station.* Least monthly Amount. Salomonia Dam 39.. Always use plus sign (+) before positive departures. When more than one station reports the same, state, infigures,the number of stations, lf more than one date, use the earliest; placing a dagger after it.