closing, on behalf of the State Health Department, I desire to commend society, and especially your committee on the Relation of Sewerage Water Supply to the Public Health, for the very able assistance which have voluntarily rendered in the education of the people on subjects aining to those branches of public health work which properly belong our profession. I sincerely trust that our future relations may be stronger more intimate, and that our united efforts may speedily result in a factory solution of the question to which I have made brief reference, of many other problems which have an important bearing upon the th and well being of the inhabitants of this Commonwealth. 1 COMMUNICABLE DISEASES IN MICHIGAN DURING THE YEAR ENDING DECEMBER, 31, 1905, AND IN PRECEDING YEARS. INTRODUCTION. This article is the twenty-fifth in a series upon the same general subject, begun in 1882. It presents a summary of the compilation of the reports received from health officers relative to certain communicable diseases in Michigan during the year 1905, together with a review of some of the information obtained from similar compilations in preceding years. The most dangerous diseases are treated in detail in the order of their importance as causes of deaths, as shown by the diagram below: DEATHS IN MICHIGAN 6 YEARS, 1898-1903. MENINGITIS TYPHOID FEVER DIPHTHERIA WHOOPING-COUCH SCARLET FEVER I SMALLPOX [PLATE 1232] PNEUMONIA TUBERCULOSIS SOME OF THE PURPOSES OF THIS COMPILATION. In the law establishing the State Board of Health, the Secretary of the Board is required to collect information concerning vital statistics and knowledge respecting diseases, and to disseminate such information among the people. In compliance with this requirement, it has heretofore been the custom to collect, compile, tabulate and publish information relative to the causes, and methods of prevention and restriction, of the dangerous communicable diseases, under the following general heads: The diseases which cause the most sickness and deaths; The general prevalence of each disease; The methods of communication, periods of incubation and duration of sickness, of each disease; The season of the year when each disease is usually most prevalent or likely to be contracted; The ages at which persons usually die from or are liable to contract these diseases; The comparative susceptibility of the sexes to contraction of each disease; The localities in this State where the several diseases are known to be the most prevalent; The comparative prevalence of each disease in urban and rural districts; The death rates and sickness rates of each disease; The prevention and restriction of each disease by isolation and disinfection, coupled with vaccination in smallpox and antitoxin treatment in diphtheria and The beneficial results of preventive and restrictive measures. For the reason that the information already obtained from the study of certain phases of these diseases during a long series of years is believed to be sufficient for the purposes of this compilation, departures have been made in this article from the usual form of the tabular work in similar articles in preceding reports. For example, the period of incubation, duration of sickness, and age influence, of many of the most prominent diseases have been well established, by the statistics of this Department, by contemporaneous observations in other departments of public health work, and by medical and scientific research, therefore the study of these phases of many of the diseases was discontinued with the annual report for 1905. METHODS OF COMPILATION. With the exception of pneumonia, consumption, meningitis and typhoid fever, which have been studied by individual cases, and of diphtheria, which has been studied by households, the diseases have been compiled by outbreaks, as defined in the following paragraph: An outbreak is considered as the existence of one or more cases of a particular communicable disease within any health officer's jurisdiction, whether city, village or township. All cases of the disease occurring within the jurisdiction during the outbreak are considered as part of the outbreak, unless the contagium cannot be traced to cases within the jurisdiction, and can be clearly traced to cases outside of the jurisdiction, in which instance they are considered as constituting a separate outbreak. When a period of over sixty days has elapsed since the last case (in a given jurisdiction) died or recovered, the outbreak is considered as ended-unless new cases occur the contagium of which can be traced back to the preceding cases, in which instance the latter cases are considered as part of the same outbreak. GENERAL PLAN OF THE REPORTS. Upon the receipt of information at this office that tuberculosis, diphtheria, typhoid fever, scarlet fever, measles, whooping-cough, meningitis, smallpox, German measles (rötheln), rabies or glanders, was present, or had recently been present, in any locality in the State, a letter was sent to the health officer, or, in his absence, to the president of the board of health, mentioning the reported existence of the disease within his jurisdiction, indicating his duties and powers, and the proper measures to be taken in restricting the disease, transmitting documents of instruction relative to the prevention and restriction of the disease for distribution among the neighbors of families in which the disease is present, and asking for reports relative to the methods employed for the restriction of the disease, the results of efforts for suppressing it, and the number of cases and deaths in each outbreak. With this letter, in each instance, except in the case of rabies and glanders, there was sent a sufficient number of blanks for the preliminary report, and also for weekly reports during the continuance of the outbreak. At the close of each outbreak, a blank for a special final report was sent, and at the close of the year an annual report, covering all the cases and deaths in each outbreak during the year, was asked for on blanks sent from this office. The information contained in the several reports, together with other correspondence relative to outbreaks of such diseases, are the bases on which the statements made in this article are founded. PNEUMONIA IN MICHIGAN IN 1905 AND IN THE PRECEDING YEAR. GENERAL PREVALENCE. Table 1 shows that in 1905 the numbers of cases and deaths from pneumonia were considerably less than in the preceding year. It is believed that, in both years, many cases of this disease were not reported either to the local health officials or to this Department, and it is known that only the fatal cases were reported by the health officers of Detroit and Grand Rapids, therefore the numbers of cases shown in the table are much too small. Notwithstanding the efforts put forth by this Department in the past two years for the proper recognition of the dangerous character of this disease, many physicians fail to recognize the necessity for reporting cases under their care to the local health officials. It frequently happens that the first information of cases of pneumonia is received by this Department from the deaths returned to the Secretary of State, and by the time this Department has been able to notify the local health officials of the occurrence of the cases, it is too late for them to take the necessary measures for the restriction of the disease. Pending a more general recognition of the fact of the communicability of pneumonia, local boards of health should require from physicians and householders reports relative to every case of this disease in their jurisdictions, and should take all precautions necessary for the restriction and prevention of the disease. TABLE 1.—The prevalence of pneumonia, in Michigan, in each of the two years, 1904–5. *From Detroit and Grand Rapids, and probably many other localities, only the fatal cases were reported, so that the figures in this column do not represent the numbers of cases which actually occurred. †Estimated. GEOGRAPHICAL DISTRIBUTION. In the consideration of this phase of the study of pneumonia, the State was divided into eleven geographical divisions,* the counties in each of which would be likely to have somewhat similar climatic conditions. Judging *The boundaries of the several divisions may be seen by reference to the annual report of the Michigan Department of Health for 1886, pages 201 and 217. |