in Ohio with a total bed capacity for 1,500 patients. Practically all of these institutions are full and have waiting lists. Of the 279 reports of discharged tuberculous soldiers received, five men have been admitted as patients to these institutions and approximately twelve men have their applications for admission on file and are waiting for a vacant bed. It is to be presumed that the number of men who desire institutional treatment will constantly increase as the size. of the problem continues to grow.

How to Meet the Problem

The State Department of Health knows full well that this problem must be met either by the State of Ohio or by the Federal government. It knows that the two agencies upon which we must depend are to increase the public health nursing service and the number of institutional beds. Tentative steps were taken to discover whether the State of Ohio itself, the state and the American Red Cross in cooperation or the Federal government could and would assume responsibility for meeting the problem. The following correspondence with the Federal government indicates that it disclaims any responsibility in the matter:

MARCH 1, 1918.

Re: Tuberculous soldiers.

HON. NEWTON D. BAKER,
Secretary of War,
Washington, D. C.

MY DEAR MR. BAKER:

I desire to call your attention to a condition now existing in the Army in which it seems to me a grave injustice is being done to certain soldiers.

This Department has received from the Red Cross, the National Association for the Study and Prevention of Tuberculosis and the Disability Board at Camp Sherman, the names and addresses of two hundred and seventy

nine soldiers who have been discharged from the National Army or the National Guard on account of tuberculosis. We have endeavored to get in touch with all of these men, sending one of our nurses to visit them, wherever possible, and to find out from them what possibility there is of their securing the necessary treatment for their condition. From most of the men so far communicated with we have received very distressing stories. Almost all of them are without means and but few are able to secure sanatorium treatment.

Of the two hundred and seventy-nine men referred to above, our records show that so far only five have been admitted to tuberculosis sanatoria. The military authorities seem to have assumed, up to this time, that this disease existed in these men prior to their enlistment and that for that reason the Government had no responsibility for their care. They have accordingly been summarily discharged and sent home. While it is true, of course, that some of these men would, if allowed to remain in civil life, have developed tuberculosis, the history of a number of cases which we have investigated would seem to indicate that a healed or quiescent lesion which would undoubtedly have given no trouble under ordinary conditions of civil life has been lighted up by the unusual exertion of the intensive training, and that these men have tuberculosis at present, therefore, because of their military service.

I feel very strongly that the Government should do something more for these men, who have given their health for its service, than merely discharge them without further consideration. Many of them can be restored to health if treatment is begun promptly and the lives of all can be prolonged and the danger to their families greatly diminished if they can receive sanatorium

treatment.

Would it be possible to retain these men in the service, sending them to an institution for treatment, and continue their dependency allowance until they are at least able to return to their ordinary occupation in civil life?

The problem is, of course, a large one and its solution will be difficult and expensive. I believe, however, that it is a proper charge against the military establishment of the United States and that its solution should be undertaken along with the other large problems that have been so successfully solved by your administration.

not

In reply to your letter addressed to General Gorgas, in which you enclose a letter addressed to the Secretary of War, the Surgeon-General directs me to say that it is not understood why the fact that a man is discovered to have tuberculosis should make any considerable difference in his health. The men who were rejected for tuberculosis were at the time serving in the ranks and it was only discovered by means of physical examination; they were sick in hospital or broken down, as a rule; and though you state you have evidence which points to the fact that quiescent lesions have been lighted up by the exertion of intensive training, the facts in many other instances would seem to show that this is rarely the case. The man who has active tuberculosis will do badly in the army, as he will everywhere if he does not rest. It is not fair to charge the army with the sole responsibility of his state. It is believed that these men discharged for tuberculosis were in practically the same condition before they entered the service that they were after they entered it, except that being aware that their cases are known, they do the best they can to secure assistance. That is only natural and allowance should be made for it.

What can be done with this class of patients is a matter which is regulated by law and is not under the control of the Secretary of War nor the SurgeonGeneral. The situation is very confused at the present time on account of the fact that the Bureau of War Risk has been charged with a certain responsibility. Just what it is going to do is not known.

Yours very truly,

(Signed) G. E. BUSHNELL, Colonel, U. S. Army, Retired.

As a result, the State of Ohio is face to face with the decision whether to ignore the situation entirely or whether it is to assume the full responsibility for the situation. In the event that the latter decision is made it will mean the appropriation of $50,000 for the erection of a cheap type of building somewhere in Ohio, preferably on the grounds of the Ohio State Sanatorium, Mt. Vernon, Ohio, to accommodate 100 patients; $40,000 for maintenance, and $10,000 for additional public health nurses to devote their entire time to the problem of the discharged tuberculous soldiers. The State Department of Health is now taking steps to see to what extent the State of Ohio itself can meet the problem.

SCHOOL EPIDEMIC

SCATTERS SCARLET

FEVER OVER OHIO Twenty-one potential sources of scarlet fever infection came into Ohio in February, when more than 100 boys, students at Mercersburg Academy, Mercersburg, Pa., left that institution for their homes in several states after fifteen cases of scarlet fever had broken out among the student body.

The twenty-one boys who came to Ohio represented fourteen different towns and cities scattered over the state. A list of the Ohioans, with their respective residences, was furnished to the State Department of Health by the Pennsylvania health department.

The Ohio department, in turn, transmitted to the health officer of each of the fourteen municipalities involved a list of the exposures in his jurisdiction.

Cases were investigated by the municipal health officers, but of those who reported their findings back to the State Department of Health, only one announced that he had found a positive case.

Following investigation of reports that the boys had been sent home by the school authorities and had not fled to escape quarantine, as first information indicated, the Pennsylvania authorities stated that the officials of the school had probably been guilty of a technical violation of the quarantine law.