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Relative Values of Public Health

Procedures

*

By Charles V. Chaplin, M. D., Supt. of Health, Providence, R. I.

The following table of values is intended to indicate roughly the health conserving value of certain common functions of municipal health departments. The necessity of perspective in planning health work is evident - however, the apportionment must vary according

, to location, stage of sanitary development, character of population, etc.

60 80 50 50 50

0 10

60

Relative Values of Health Work.
Vital statistics
Education
Laboratory
Control of nostrums.
Care of sick poor....
Food -

Adulteration

Sanitation Milk

Adulteration

Sanitation
Nuisances

Privy sanitation
Housing
Plumbing
Nuisances
Refuse removal

Fly and mosquito control.
Infant mortality

Nurses
Supervision of midwives.
Babies' boarding houses.
Milk stations
Consultations

Prenatal clinics
School inspection
Contagious diseases

Home isolation
Hospitalization
Immunization

Venereal diseases
Tuberculosis -

Nurses
Dispensaries
Hospitalization

10

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5

10 80

100 50 50 20

60

40

1,000

* Abstract from The Journal of the American Medical Association, July, 1917.

In Providence, in sixty years, there has been a decrease in the annual number of deaths amounting to about 600 per hundred thousand living and confined practically to typhoid fever, smallpox, scarlet fever, diphtheria, tuberculosis, diarrheal diseases and other diseases of infants. It is not claimed that all of this reduction is due to conscientious effort on the part of the community, though the figures in Table 2 appear reasonable as a statement of the deaths prevented by official control, and also of the chief means by which the lives were saved.

Table 2. Means of Saving Life. Typhoid fever

10 by direct control. Typhoid fever

50 by privy control. Scarlet fever

60 by direct control. Diphtheria

20 by direct control. Diphtheria

30 by free antitoxin. Diarrhea, over year.

15 by privy control. Tuberculosis, pulmonary

65 by direct control. Tuberculosis, other

15 by direct control. Infant mortality

70 by nurses, etc. Infant mortality

10 by milk control.

Total

345

By putting the facts in a different form, it appears that community activities have been effective in saving these 345 lives in the ratios given in Table 3.

Table 3. Relative Values of Community Activities.
Direct control .of contagious diseases..
Direct control of tuberculosis..
Antitoxin
Control of privies.
Prevention of infant mortality.
Control of milk...

26 23

9 18 21 3

Total

100

These are old and tried lines of public health work and must hold the largest place in apportioning the activities of a municipal health department.

Of fundamental importance is the collection and tabulation of vital statistics. Only by this means can evils be located and remedies found.

Education of the public in matters pertaining to health is another basic function, which until recently has been much neglected and even now is often in judiciously performed. The leaders of thought and action in each community should be made familiar with the successes of modern sanitary science and the means by which they are obtained. Literature and motion pictures help — but the personal influence of

the school teacher, the nurse, and the social visitor have thus far seemed to accomplish most.

The great leavening force in modern health work is the diagonstic laboratory. To control disease, either by prevention or cure, we must first find it. This the laboratory helps us to do. The remarkable decrease in the case fatality of typhoid fever during the last twenty years or so is almost entirely a result of better diagnosis by the help of laboratory methods.

The care of the indigent ill should be considered a public health function. Sickness and poverty are closely related and the poor, both from necessity and indifference, neglect sickness. Medical care of the sick poor is in a chaotic or experimental state — this is a function which should be performed by the health department.

Closely connected with the care of the indigent ill is the elimination or restriction of the nostrum evil. To accomplish the latter, good medical service must be supplied in its place. A conscientious and efficient medical service for the poor will do more than anything else to wean them from nostrums.

Sanitation and food control are usually considered the principal functions of a city health department. By many people, municipal housecleaning is considered the chief duty of the board of health." Some municipal sanitation is of great importance in the prevention of disease. Where there is no system of sewage disposal, as in some of the rural portions of our country, this subject may well have a large part of the health department's attention. However, the department should not be charged with the removal of refuse and garbage — this has an indirect connection with health but is essentially a function of the department of public works.

Control of food supply is a time honored means of promoting public health. This control is divided into the prevention of adulteration and the promotion of cleanliness. Milk should be considered apart from other foods. The most effective way to eliminate the danger from this source is to require the pasteurization of all milk.

Since all medical activities of the municipality should center around the health department, the medical inspection of schools becomes a proper function of this department. This is or should be a co-operative undertaking — neither the school department nor the health department can obtain satisfactory results without the free and generous assistance of the other.

Efforts directed toward the prevention of infant mortality show more apparent results than any other form of child welfare work. In practically every instance in which a community has undertaken to save the lives of its babies it has been successful. The chief means has been the education of the mother -- wherever that has been successfully accomplished the infant death rate has fallen.

The direct control of communicable diseases by isolation and immunization is an important duty of the health department. Among methods of control, isolation in the home is probably the most portant. Hospital care should be furnished for those so situated that isolation in the home is impossible.

Vaccines and curative serums have proven their value in the control of infectious disease, and experience has shown that the successful use of these agents depends to a great extent on the initiative of the city or state.

A modern campaign against tuberculosis makes use of many means and is often correlated with various private agencies. The most important municipal activities are nursing, dispensary service and hospitalization; the latter, which a few years ago was considered of first importance, has been given a secondary place.

The protection of the water supply is a function of the state department of health rather than a municipal department. However, it is the duty of the health officer to show by his morbidity statistics whether or not the water is above suspicion.

If the future health work is to be successful we must remember that the health work is not centered upon the environment — but that it is concerned directly with men and women. Community health work must have a broader outlook — it must do more than cleanse and isolate — it must educate and make use of the best medical knowledge to prevent and cure disease. With limited money and talent, a municipal health department must earnestly study to do that which

pays best.

AMONG TUBERCULOSIS hospital had been delayed because

HOSPITALS OF STATE of lack of a water supply. ArSpringfield Lake District. Ap

rangements had been made with plication by the commissioners of

the Chillicothe Water Company to Summit County for permission to

furnish water, but when Camp

Sherman was located outside of add to the cottage colony at Springfield Lake District Tuber

Chillicothe, the water company culosis Sanatorium has been

failed to complete arrangements

The formally granted by the commis

for the hospital supply. sioners of Columbiana, Mahoning,

board of trustees have plans for Portage and Stark Counties. All securing water within the near fu

ture. expenses will be borne by Summit County, if the plan is carried out.

Springfield District. Dr. R. R.

Richison, superintendent of the Lima District. The board of

Springfield District Tuberculosis county commissioners of Auglaize Hospital, submitted his first report County has applied to the courts since his appointment, to the board for the transfer of $4,295-32 from of trustees at its regular meeting. the county dog fund to the tuber

The patients in the hospital at the culosis hospital fund. It is repre- end of the year 1917 were 34. The sented that the tuberculosis fund

per capita per diem cost is overdrawn to the extent of

$1.98. $2,824.35 and the status of the dog fund is such as to permit of the Physical examination of 1,700 withdrawal of the amount peti

men, women and children at Framtioned for

ingham, Mass., showed 82 percent Chillicothe District.

with various diseased conditions. meeting of the board of trustees Many of these defects were such of the Chillicothe District Tuber- as could be prevented from beculosis Hospital December 28, it coming serious by early discovery developed that the opening of the and treatment.

was

At a

Ohio Mortality Statistics for Month of September

Furnished by Dr. J. E. Monger, Registrar, Bureau of Vital Statistics,

Department of State.

The following table shows the number of deaths and the monthly death rate per 1,000 population, in each county of Ohio, for the month of September, 1917.

224

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Counties. Adams Allen Ashland Ashtabula Athens Auglaize Belmont Brown Butler Carroll Champaign Clark Clermont Clinton Columbiana Coshocton Crawford Cuyahoga Darke Defiance Delaware Erie Fairfield Fayette Franklin Fulton Gallia Geauga Greene Guernsey Hamilton Hancock Hardin Harrison Henry Highland Hocking Holmes Huron Jackson Jefferson Knox Lake Lawrence Licking

Number Rate.

19 .8 77 1.1 19 .8 67 1.0 62 1.1 36 1.2 126 1.4

1.1 77 .9

6 .4 35 1.3 98 1.4 23 .8 28 1.2 98 1.2 12 .4 32 .9 944 1.2 35 .8 17 .7 33 1.2 70 1.8 40 .9

30 1.4 304 1.2 16

.6 29 1.1 16 1.1 28 .9 38 .8 543 1.1 32 .8 38 1.2 17 .9 13 33 1.1 18 .8 24 1.3 40 1.1 34 1.1 101 1.2 23 28 1.2 48 1.2 55 .9

Counties. Logan Lorain Lucas Mahoning Madison Marion Medina Meigs Mercer Miami Monroe Montgomery Morgan Morrow Muskingum Noble Ottawa Paulding Perry Pickaway Pike Portage Preble Putnam Richland Ross Sandusky Scioto Seneca Shelby Stark Summit Trumbull Tuscarawas Union Van Wert. Vinton Warren Washington Wayne Williams Wood Wyandot

Number Rate.

26 .9 97 1.1 269 1.2

1.4
10 .5
50 1.3
21 .8
25 1.0
20 .7
56 1.2
20 .8
213 1.1
23 1.4
11 .7
69 1.1
23 1.2
24 1.1
11 .5
43 1.1
30 1.1
15 1.0
21 1.7
16 .7
18 .6
70

1.4
55 1.4
41 1.1
63 1.2
35 .8
26 1.1
204 1.4
251
65 1.2
56 .9
17 .8
24 .8
12 .9
17 .7
41 .9
49

1.3
24 .9
52 1.1

.9

1.8

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