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UNITED STATO ERICA

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CONTENTS

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INTRODUCTION.

CANCER. By Harold R. Sandstead, Assistant Surgeon.--.

COMMUNICABLE DISEASE CONTROL. By Robert Olesen, Assistant Surgeon

General..

DENTAL HYGIENE. By F. C. Cady, Dental Surgeon.--

EDUCATION, HEALTH. By Philip Broughton, Office of Health Education.

Food INSPECTION (MILK AND FOOD CONTROL). By A. W. Fuchs, Senior

Sanitary Engineer; F. J. Moss, Sanitary Engineer; and L. H. Male,

Assistant Public Health Engineer --

HOSPITALS. By F. C. Smith, Medical Director; and V. M. Hoge, Passed

Assistant Surgeon.-

LABORATORIES. By Wm. G. Workman, Passed Assistant Surgeon...

MATERNAL, INFANT, AND PRESCHOOL CHILD HEALTH SERVICES. By Ethel

C. Dunham, M. D., Marian M. Crane, M. D., and collaborators,

Children's Bureau, Department of Labor---
MENTAL HYGIENE. By G. A. Kempf, Senior Surgeon; J. G. Wilson,

Senior Surgeon; and L. M. Rogers, Surgeon..

MORTALITY TRENDS. By Harold F. Dorn, Economist.

NURSING, PUBLIC HEALTH. By Mary J. Dunn, Regional Public Health

Nursing Consultant..

PNEUMONIA CONTROL. By Robert K. Maddock, Passed Assistant Surgeon.

SANITATION (SANITARY CONTROL). By Charles T. Wright, Passed

Assistant Sanitary Engineer; and L. M. Fisher, Sanitary Engineer----

SCHOOL MEDICAL INSPECTION. By J. O. Dean, Passed Assistant Surgeon.

TUBERCULOSIS CONTROL. By Albert E. Russell, Surgeon..

VENEREAL DISEASE CONTROL. By A. J. Aselmeyer, Surgeon.

VITAL STATISTICS. By Dr. Halbert L. Dunn, Chief Statistician for Vital

Statistics; and Dr. John Collinson, Assistant Chief Statistician for

Vital Statistics, Bureau of the Census.-

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REPORT OF A SURVEY OF THE HEALTH DEPARTMENT AND OTHER HEALTH AGENCIES IN THE DISTRICT OF COLUMBIA?

By ROBERT OLESEN, Assistant Surgeon General, United States Public Health

Service, and collaborators

SUMMARY OF RECOMMENDATIONS

The recommendations in this report are presented in two summarized sections: A, those of an outstanding character, involving in some instances, considerable expenditures, and B, the more detailed suggestions, many of an adminstrative type, for the improvement of the several activities of the health department.

A. Principal Recommendations

1. Provide a separate building of appropriate design and adequate size for housing the various overcrowded and scattered activities of the health department. 2. Build four units of hospital beds as follows:

(a) Pediatrics, 100 beds, Gallinger hospital;
(6) General medicine, 250 beds, Gallinger hospital;
(c) Tuberculosis, 150 beds, Gallinger hospital ;

(d) Tuberculosis, 150 beds, Freedmen's hospital.
3. Reopen and use old Upshur Street tuberculosis hospital, 200 beds.

4. Provide additional personnel, living quarters, service facilities, and supplies for operation of new hospital units.

5. Decentralize the work of the health department by providing a total of three health centers, coordinating the activities with the local medical schools. 6. (a) Provide trained, full-time directors for each of the following activities :

Cancer control.
Dental hygiene.
Laboratories.
Mental hygiene.
Sanitary inspection.
Tuberculosis clinic.
Venereal disease control.
Vital statistics.
Maternal, infant, and preschool services—Child health.

1 Without the very helpful information received from the official health agency and the numerous voluntary organizations operating in this field, it would have been impossible to secure a clear conception of the local health and hospital situations. That necded data were always freely and cordially forthcoming will account for such interest and value as this report may have for its readers.

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7. Make available 110 additional public health nurses. 8. Employ eight additional trained sanitary inspectors.

9. Especially intensify the efforts for the control of syphilis, tuberculosis, cancer, pneumonia, and diphtheria, and for reduction of maternal and infant mortality.

B. Detailed Recommendations for Each Activity Cancer:

Establish a cancer-control section in the health department.

Provide a physician, expert in cancer diagnosis and treatment, to direct the efforts at cancer control.

Establish a tumor clinic at Gallinger Hospital.
Coordinate all agencies engaged in cancer control work.

Educate medical profession and lay public in prevention, early recognition, and early treatment of cancer.

Communicable disease control:

Provide more suitable office space, with private room for director.
Provide full-time instead of part-time medical inspectors.
Completely revise sanitary code.

Improve office and field procedures connected with control of acute communicable diseases.

Establish venereal-disease work in a new and separate section.
Provide better control of typhoid carriers.
Consolidate ambulance services.
Discontinue disinfection after communicable disease.
Inaugurate continuous effort in combatting diphtheria.
Issue instructive literature dealing with communicable-disease control.

Dental hygiene:

When practicable, encourage dental care from private professional sources.
Substitute dental-health education for routine cleaning of teeth.
Confine dental service to every other school grade.

Employ full-time dental supervisor to coordinate all activities designed for the benefit of school children.

Education, health:

Provide decent quarters for this activity.
Increase the staff by an associate director and two stenographer-clerks.
Provide at least $4,000 a year for the printing of instructive literature.

Utilize the facilities of the bureau for instruction in all phases of public health.

Food inspection (milk and food control):

Adopt the Public Health Service standard milk ordinance.

Apply the frozen desserts and restaurant ordinances shortly to be released by the Public Health Service.

Promote an educational campaign for the consumption of the highest grade of milk.

Laboratory:

Provide additional and more suitable quarters.
Consolidate the three laboratory services under a single trained director.

Within next 6 years add two additional technicians in serology and one each in chemical and bacteriological laboratories, in view of continued increase of work.

Maternal, infant, and preschool child health services :
A. General recommendations-

Create a committee representing the health department, hospitals, med

ical schools, medical societies, nursing agencies, and social agencies to coordinate all medical, nursing, and social-work programs in the

field of maternal, infant, and child health. Consider carefully the social and economic aspects of the problem in

expanding the program. B. Specific recommendations

Provide adequate office space for the bureau of maternal and child

health. Develop a plan for more active interbureau coordination of services

related to maternal and child health. Develop a demonstration center in which the suggestions in the

report may be put into immediate effect. Provide for a well-rounded program conforming with modern public

health practice and coordinate the activities of the bureau of
maternal and child hygiene by adding the following personnel :
Assistant directors for maternity hygiene, infant and child

hygiene, and crippled children's program.
Assistant nutritionist.
Medical social workers.
Additions to staff for development of mental hygiene, dental

hygiene, and health education. C. Detailed recommendations, by activity. (Presented in special text, p. 145.) Mental hygiene:

Enact a new lunacy law.
Abolish mandatory jury trials for all commitments.

Change commitment laws to allow voluntary patients, certified patients, and nondelinquent mental defectives to go directly to St. Elizabeths Hospital for treatment.

Use the Gallinger Hospital wards only for emergency admissions.
Establish social service in the Gallinger psychiatric department.
Modernize the psychiatric wards in Gallinger Hospital.
Transfer suitable patients from Gallinger to St. Elizabeths by certification.

Establish principle of sufficiency of examination by qualified psychiatrist and physician for information of court.

Furnish clerical assistance to Board of Public Welfare for deportation activities.

Establish a bureau of mental hygiene in health department. Marshal public and private forces in community for amelioration of adverse mental situations. Nursing (public health):

Provide 110 additional public health nurses.
Strengthen and improve out-patient department services.
Provide nursing assistance for home deliveries and pneumonia patients.
Prevent duplication of efforts, conflicts, and lapses in nursing service.

Work out a completely generalized nursing service in a selected district of the city.

Conserve nursing time. Pneumonia control:

Increase the appropriation for purchase of antipneumonococcus sera and make the sera more generally available.

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