of Governor Herbert R. O'Conor 291

typhoid fever occurring in epidemic proportions. Nearly all the cases have
been traced to either chronic carriers or to the close association with acute
cases of this disease.

Diphtheria—Diphtheria, which so many years ago was the dread of
mothers, has now declined to an almost insignificant position among the mor-
bidity rates of the State. There were 98 cases reported and 5 deaths. The
investigation of many of the deaths has revealed that these cases were not
brought to the attention of the attending physician early enough for antitoxin
to be effective. The program of immunizations against this disease has re-
sulted in approximately 90 per cent of the school children in the counties of
Maryland being protected. This activity, with the careful isolation of acute
cases, is responsible for the low morbidity rate.

Tuberculosis—Tuberculosis continues to occupy an important place in the
organized public health program. Clinics are conducted in all the counties of
Maryland and X-ray facilities are now provided in the clinics. In the 284
clinics held during the year, there was an attendance of 5, 000 patients. There
were 629 patients hospitalized in the several State Tuberculosis Sanatoria
from the counties of Maryland.

Venereal Diseases—The venereal disease program has been developed to
a marked degree of efficiency and the public clinics conducted by the State
Department of Health have resulted in more than 70, 000 treatments for cases
of syphilis during the year. Six hundred and seventeen clinics • were held
during the year, with an attendance of 85, 230. The attendance at the venereal
disease clinics has materially increased due to the fact that in several localities
transportation to and from the clinics has been furnished by the Health
Department.

Pneumonia—Your body in 1939 appropriated $10, 000. 00 for the control of
pneumonia and the State Board of Health appointed a Committee to formulate
a program for this activity. During the winter of 1939-40 the pneumonia con-
trol program was received most favorably by the practitioners throughout the
counties and in cooperation with the County Health Officer and public health
nurses, it was possible to distribute sulfapyridine to between seven and eight
hundred patients who were unable to purchase this drug. The program in-
cluded not only the free distribution of drugs and serum, but also systematic
laboratory tests as a means of checking any untoward effects of the drug.

During the first year of the use of sulfapyridine in the treatment of pneu-
monia, the data covering last winter shows that fewer persons died of pneu-
monia in the counties of Maryland than in any of the five previous winters.
The death rate per 100, 000 population dropped from a five-year average of 108. 5
to 80. 7, while the case fatality rate (deaths per 100 cases) fell from a five-year
average of 30. 7 to 17. 9 per cent. These results are encouraging and because
of them the State Department of Health will continue to distribute sulfapyri-
dine and sulfathiazole (a newer preparation) in the counties of Maryland for
the treatment of pneumonia in patients who are unable to pay for the drug.

Service for Crippled Children—Sixty-five clinics were conducted in the
counties of Maryland during the past year and at the present time there are
2, 700 crippled children on the official State register, all of whom have received
some aid. During the year 28, 132 hospital days were provided and the ortho-