Looking After Ohio Soldiers Discharged for Tuberculosis A cases SYSTEM of following up 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, are 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 recently, however, authority to inspect the draft records has been granted the United States Public Health Service and by it delegated to the Commissioner of Health. No detailed plan of collecting this information has yet been worked out. Camp Sherman Discharges 27 In December Camp Sherman medical authorities recommended discharge of 27 Ohio men because of tuberculosis. Twenty-three of these cases were referred by the Department of Health to public health nurses and letters were sent to the other four men. Notifications from all sources in December gave information of 88 cases, of which 67 were referred to public health nurses and 21 were the subject of direct letters. The letters sent to men whose cases cannot be handled by public health nurses read as follows: Department's Services Offered "In co-operation with the military authorities, this department is anxious to be of service to the men who have been discharged from the army because of lung trouble. To the man with a touch of lung trouble, nothing is as important as getting proper treatment immediately. If taken in time, a large proportion of these cases can get absolutely well, while, if neglected, many will go down hill rapidly, and in a relatively short time be bevond the chance of final cure. "We are writing you, therefore, in the hope that we may be of service to you in advising you as to what you should do to restore yourself to full health and strength. "If it is possible, a man who has this trouble should give up his business and give all his attention to getting well. Where this is not possible, he should know how to regulate his life, his work and his habits, and where to get such medical advice as will give him the best chance to get well, even if he has to continue at his usual work. "If you will write us, telling us what your circumstances are, we will put you in touch with a good doctor, and give you every assistance in our power in getting you started on the road to health. There is no charge for anything we may be able to do for you, as the state of Ohio has established this department and pays all the expense of running it, so that we may help to promote the health of every citizen of the state. "Anything you may write us will be considered as confidential, and you need have no hesitancy in telling us just how you are situated, and just what you need in way of advice and assistance." CENSUS BUREAU ISSUES WEEKLY DEATH FIGURES As a health index, the Bureau of the Census is publishing each week mortality reports from 44 of the largest cities in the United States. There are given for each city the total number of deaths reported (stillbirths excluded), the death rate, the number of deaths under one year of age, and the proportion of infant deaths to total deaths. Where the data are obtainable for the previous five years, averages for the corresponding weeks are given for each city. These totals, rates, and percentages permit valuable comparisons and serve as a ready health index for health officers and others. All States Asked to Work Together to Control Venereal Diseases S URGEON General Rupert Public Health Service in January called upon health officials of all the states for co-operation in controlling venereal infections. Such control in connection with the prosecution of the war, he declared, "constitutes the most important sanitary problem now confronting the public health authorities of the United States." He recommended that venereal infections should be made reportable and quarantinable, that means of diagnosis and cure should be provided and that a campaign of wisely conducted publicity should be launched. What Ohio Is Doing State and city health officials of Ohio have already undertaken measures for the suppression of venereal diseases, in accordance with plans agreed upon at a conference in November, as outlined in the November issue of the OHIO PUBLIC HEALTH JOURNAL. The program adopted at this conference declared the present statutes of Ohio inadequate for the 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 whereabouts. This may be determined by: (1) Morbidity reports by serial number (in the case of private practitioners), 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. (c) Object of this control is to prevent contact between infected and (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 contact with persons infected or presumably infected. 3. Quarantine of infected persons. (a) Those who desire cure and can afford treatment. 4. 5. (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) Those who are careless or willful in the distribution of these infections 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. Cure of infected persons. (a) Establishment of venereal clinics by health authorities. (2) State, in situations where local authorities refuse or fail to (3) City, particularly those cities in which commercialized or 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 imposition 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 Public education. women. (a) Relieve problem of all moral and social issues and place campaign solely on basis of control of communicable disease. (b) 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. 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 health departments' share of the campaign. Civil Authorities' Responsibility "It is evident," said Surgeon General Blue in his recent letter to state health officials, "that the prevention of venereal infections in the military population is largely dependent upon the degree with which these infections are prevented in the civil community. This imposes upon the civil health authorities the duty of forcefully attacking the venereal problem upon the basis of the control of communicable disease. "There is forwarded you herewith an outline upon which it is proposed to make this attack. Manifestly, no plan which can be set forth at the present time can be complete in all its details nor can a plan be devised which in all its phases fits the requirements of each state exactly. Therefore, in the plan which I am sending you only the basic necessities have been stressed. Your co-operation in putting this plan in force is requested. Importance of Education "The Public Health Service in co-operation with the Red Cross and the Medical Department of the Army is establishing venereal clinics in cities in immediate contiguity to the Army cantonments. There is even greater need for the beginning of an active antivenereal campaign in those cities which are outside of the military zones but into which soldiers go in search of recreation. Most important of all, perhaps, is the thorough education of the general public to the end that this disease group will be considered in the same light as are the other communicable infections. This will permit the free and frank discussion of this important question without offense to modesty. "I shall be pleased to have your views and suggestions as to the prosecution of further work along these lines. Whatever is to be done must be initiated promptly if we are to prevent the next increment of the draft from having the high venereal rate of the last." The accompanying "Memorandum Relative to the Control of the Venereal Diseases" - the outline referred to in the letted was enclosed with the letter. ARMY SEEKING NURSES TO INCREASE CORPS BY A THOUSAND PERCENT The Army Nurse Corps needs 37,500 nurses in addition to its present strength of 3,800 to enable it to meet the needs of an army of 1,500,000 men. A call for this number, which means a 1,000 percent increase in the next year, was issued just before New Year's Day. The supply of nurses at the National Guard and National Army camps in the United States at that time was 371 short of the number necessary to provide the minimum necessary quota of 65 nurses per camp. The need will be much greater when the troops get into action in France. The nursing committee of the General Medical Board of the Council of National Defense estimates that there are from 80,000 to 90,000 registered nurses and 200,000 other grauate and practical nurses in the United States. Bad teeth bring bad health. |