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Looking After Ohio Soldiers Discharged

for Tuberculosis

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SYSTEM of following up cases of tuberculosis in

men discharged because of the disease from the military service, made possible by the co-operation of the military authorities in giving notifications of such discharges, was installed just before the beginning of the year by the Division of Public Health Education and Tuberculosis of the State Department of Health.

Notifications of tuberculosis discharges from Camp Sherman, Chillicothe, received direct from the disability board at the camp. Reports from other camps and posts reach the department through the National Association for the Prevention of Tuberculosis, which receives and classifies the army reports.

Follow-Up Methods If a reported case is within the jurisdiction of a public health nursing center, a notice, with an investigation blank for each case in the district, is sent to the public health nurse or superior officer. If the case cannot be reached by a public health nurse, a letter is sent from the department direct to the discharged man, offering advice and assistance.

It is hoped that the direct letter will elicit a reply from the subject and place the department in position to give such general advice as may be possible and to recommend consultation with a physician of known worth in tuberculosis cases.

It is also desired that physicians,

in case the discharged man is in poor circumstances, will agree to render free service. In some cases where it may appear advisable, representatives of the department's nursing service will probably visit the subjects.

Investigation By Nurses
Where cases

are referred to public health nurses, it is presumed that their investigations and visits will obviate any further direct action in the case on the part of the department until the subject becomes a patient in an institution for the public care of tuberculosis.

The investigation blank used in connection with this new branch of the department's work is the regular form used by the bureau of admissions and discharges, with the addition of questions bearing upon the industrial occupations of the subject, practically identical with the questions to be found on the certificate of industrial disease used by the department's Division of Industrial Hygiene.

Replies Come In Several replies were received shortly after the first letters to discharged men were sent out. It is believed that the department's offers of assistance will in general meet with a cordial reception.

Information regarding draft rejections on ground of tuberculosis infection was not at first available, an early order of Provost Marshal General Crowder making it available having been revoked. More

on

recently, however, authority to in- to getting well. Where this is not spect the draft records has been

possible, he should know how to granted the United States Public regulate his life, his work and his Health Service and by it delegated habits, and where to get such to the Commissioner of Health. medical advice as will give him the No detailed plan of collecting this best chance to get well, even if he information has yet been worked has to continue at his usual work. out.

“If you will write us, telling us Camp Sherman Discharges 27

what your circumstances are, we

will put you in touch with a good In December Camp Sherman doctor, and give you every assistmedical authorities recommended ance in our power in getting you discharge of 27 Ohio men because started the road to health. of tuberculosis. Twenty-three of There is no charge for anything these cases were referred by the we may be able to do for you, as Department of Health to public the state of Ohio has established health nurses and letters were sent this department and pays all the to the other four men. Notifica- expense of running it, so that we tions from all sources in Decem- may help to promote the health of ber gave information of 88 cases,

every citizen of the state. of which 67 were referred to pub- "Anything you may write us will lic health nurses and 21 were the

be considered as confidential, and subject of direct letters.

you need have no hesitancy in tellThe letters sent to men whose ing us just how you are situated, cases cannot be handled by public and just what you need in way of health nurses read as follows:

advice and assistance." Department's Services Offered

"In co-operation with the military authorities, this department is

CENSUS BUREAU ISSUES anxious to be of service to the men

WEEKLY DEATH FIGURES who have been discharged from As a health index, the Bureau the army because of lung trouble. of the Census is publishing each To the man with a touch of lung week mortality reports from 44 of trouble, nothing is as important as the largest cities in the United getting proper treatment immedi- States. ately. If taken in time, a large There are given for each city proportion of these cases can get the total number of deaths reabsolutely well, while, if neglected, ported (stillbirths excluded), the many will go down hill rapidly, death rate, the number of deaths and in a relatively short time be under one year of age, and the bevond the chance of final cure. proportion of infant deaths to total

"We are writing you, therefore, deaths. Where the data are obin the hope that we may be of

tainable for the previous five years, service to you in advising you as averages for the corresponding to what you should do to restore weeks are given for each city. yourself to full health and strength. These totals, rates, and percent

“If it is possible, a man who has ages permit valuable comparisons this trouble should give up his and serve as a ready health index business and give all his attention for health officers and others.

All States
States Asked to Work Together to

Control Venereal Diseases

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Memorandum Relative to the Control of the Venereal Diseases 1. Epidemiology.

(a) Peculiar to the human species.
(b) Chronic diseases.
(c) Spread by contact-not necessarily sex contact--chronic carriers.
(d) Very prevalent in all classes of society.

(e) Most prevalent in classes of low inhibition. 2. Control.

(a) Depends upon the control of infected persons.
(b) Control of infected persons depends upon knowledge of their where-

abouts.
This may be determined by:
(1) Morbidity reports by serial number (in the case of private prac-

titioners), name to be disclosed when infectious persons cease treatment. Case then followed up by health department which

enforces quarantine act. (2) Morbidity reports from venereal clinic and hospital. (3) Legal enactment necessary to secure morbidity reports. (4) Enact and enforce ordinance requiring pharmacists to keep

record (open at all times to health department) of sales of drugs for the prevention and treatment of gonorrhea and

syphilis. (c) Object of this control is to prevent contact between infected and

non-infected persons.
(d) May be obtained by:

(1) Quarantine of infected persons.
(2) Cure of infected persons.
(3) Education of general public to avoid direct and indirect con-

tact with persons infected or presumably infected. 3. Quarantine of infected persons.

(a) Those who desire cure and can afford treatment.

(1) These are instructed by their physicians and theoretically are

thus quarantined.
(b) Those who desire cure and can not afford treatment.
(1) Means should be provided for the free treatment of this group.

(a) Accurate diagnosis.
(b) Dispensary relief.

(c) Hospital relief.
(c) Those who are careless or willful in the distribution of these infec-

tions through promiscuity. (1) These for the most part are the ignorant or the criminal classes.

Careful physical examination of all persons entering jails or other public institutions, those found infected to be isolated either in a special hospital or under a probation officer who

enforces dispensary relief. 4. Cure of infected persons.

(a) Establishment of venereal clinics by health authorities.

(1) Federal, in zones in close contiguity to cantonments.
(2) State, in situations where local authorities refuse or fail to

establish clinic.
(3) City, particularly those cities in which commercialized

clandestine prostitution flourishes for the patronage of soldiers

but are beyond the authority of the Secretary of War. (4) Country, in thickly settled rural communities. (b) By the creation of new or the utilization of existing hospital

facilities.
(1) For the treatment of those who volunteer for treatment.
(2) For the obligatory treatment of persons under control of the

courts.
(c) By legal enactment.

(1) Declaring the venereal infections to be quarantinable.
(2) By substituting confinement to hospital for confinement to jail

in the case of those convicted by courts and having venereal

infections. (3) By substituting remanding to a probation officer for the imposi

tion of fines. (4) To carry out 2 and 3 it is necessary that all persons arrested be

examined by the city physician or other authorized person. (5) By arrest of acknowledged and clandestine prostitutes by police

or

women.

5. Public education. (a) Relieve problem of all moral and social issues and place campaign

solely on basis of control of communicable disease.
(6) Propaganda of wisely conducted publicity.

(1) Through public meetings addressed by forceful speakers.
(2) Through public prints.
(3) By placarding public toilets, placards to emphasize danger of

venereal diseases and to recommend prompt treatment either

by competent physician or at the free venereal clinic.
(4) By follow-up work by social workers.
(5) By the education of infected persons.

(a) By physicians in private practice.
(6) By venereal clinic and hospital.

control of venereal diseases, provided for co-operation between state and city health officials and between these groups and the federal authorities, arranged for the installation in the state laborator

ies of facilities for Wasserman examinations and for free distribution of Salvarsan by the state if necessary appropriations could be obtained, and agreed that the state request municipalities to provide sufficient funds for their local other communicable infections. health departments' share of the This will permit the free and frank campaign.

discussion of this important ques

tion without offense to modesty. Civil Authorities' Responsibility “I shall be pleased to have your

"It is evident," said Surgeon views and suggestions as to the General Blue in his recent letter to prosecution of further work along state health officials, “that the pre

these lines. Whatever is to be vention of venereal infections in done must be initiated promptly if the military population is largely we are to prevent the next incredependent upon the degree with ment of the draft from having the which these infections are pre- high venereal rate of the last.” vented in the civil community. The accompanying “MemoranThis imposes upon the civil health dum Relative to the Control of the authorities the duty of forcefully Venereal Diseases" — the outline attacking the venereal problem referred to in the letted- was enupon the basis of the control of closed with the letter. communicable disease.

“There is forwarded you herewith an outline upon which it is ARMY SEEKING NURSES proposed to make this attack.

TO INCREASE CORPS BY Manifestly, no plan which can be

A THOUSAND PERCENT set forth at the present time can be complete in all its details nor

The Army Nurse Corps needs can a plan be devised which in all

37,500 nurses in addition to its its phases fits the requirements of

present strength of 3,800 to enable each state exactly. Therefore, in

it to meet the needs of an army of the plan which I am sending you

1,500,000 men. A call for this only the basic necessities have

number, which means a 1,000 perbeen stressed. Your co-operation

cent increase in the next year, was in putting this plan in force is re

issued just before New Year's

Day. quested.

The supply of nurses at the NaImportance of Education tional Guard and National Army "The Public Health Service in

camps in the United States at that

time was 371 short of the number co-operation with the Red Cross and the Medical Department of

necessary to provide the minimum the Army is establishing venereal

necessary quota of 65 nurses per camp.

The need clinics in cities in immediate con

will be much tiguity to the Army cantonments.

greater when the troops get into

action in France. There is even greater need for the beginning of an active antivenereal

The nursing committee of the campaign in those cities which are

General Medical Board of the outside of the military zones but

Council of National Defense estiinto which soldiers go in search of

mates that there are from 80,000 recreation. Most important of all,

to 90,000 registered nurses and perhaps, is the thorough education

200,000 other grauate and pracof the general public to the end

tical nurses in the United States. that this disease group will be considered in the same light as are the Bad teeth bring bad health.

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