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Columbiana counties -- the largest also. In this latter group the purdistrict in the state, in point of chase of the Rocky Glen Sanapopulation. The newest of the dis- torium, privately operated at Mctrict hospitals was opened in 1918 Connelsville, has been considered at Chillicothe by Ross, Jackson, as a possible solution of the disPike, Scioto, Highland and Fay- trict's problem. Other proposed ette counties.

districts, in some of which there is The two new districts recently an encouraging amount of interest organized comprise, respectively,

in tuberculosis hospitals, are inOttawa, Sandusky, Erie and

dicated on the accompanying map. Lorain counties and Wood, Han- The eleven existing state, county, cock, Seneca, and Crawford coun- municipal and district sanatoria, ties. Commissioners of the former according to as accurate an estigroup of counties have decided to

mate as can be made in the abappropriate $125,000 for their hos- sence of exact figures in many inpital, while the latter counties will stances, represent a capital investspend $100,000. The original pro- ment of over two and one-half posal for the former district in- millions of dollars (see the accomcluded Huron County and that for panying table for detailed figures the latter included Wyandot Coun- by institutions). Comparison bety, but these two counties have tween costs of various hospitals not yet decided to join the districts. are best made on the basis of cost Sites for these new hospitals have per bed, and even this comparison not yet been selected. When these is misleading in many instances. two hospitals are established, forty Butler County's hospital, for inmore Ohio counties will be

stance, while its cost is extremely equipped wtih municipal, county or low, lacks much of the equipment district tuberculosis hospitals, anil which is essential to efficient work, the total bed capacity available for and both it and the Lucas County public use in the state will be ap- institution are located on infirmary proximately 1,700. It has been

ground, involving no outlay for estimated that 5,000 beds is a site, power, water supply, sewage minimum statement of what the

disposal, laundry, etc. The low state should have to exercise a rea

cost of the Springfield hospital is sonably effective control Over attributable to the fact that it is tuberculosis.

housed in a former dwelling, purBesides these two proposed dis- chased at a low price but not entricts which have effected prelimi tirely satisfactory as a hospital nary organizations, establishment structure. While the Springfield of hospitals is being seriously con- Lake cost per bed runs abnormally sidered in two other groups of high on the basis of its originally counties. Tuscarawas, Harrison, designed capacity of 110, that inTefferson and Belmont counties stitution has succeeded in caring for have organized on a temporary 130 patients without increasing its basis, with Carroll considering the capital investment, making the question of joining them. Com- actual cost per bed little more than missioners representing Guernsey, half the sum stated in the table. Noble, Morgan, Monroe and The State Sanatorium has a heavy Washington counties last month investment in administrative buildformed a temporary organization ings and could make extensive ad

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ditions to its bed capacity with a lower in the large institution than comparatively small expenditure. in the smaller one. In this fact The new Dayton hospital includes lies one of the great arguments for a power plant and service building building district rather than county sufficient to supply the needs of a hospitals — the other

other important 100-bed hospital, and will have a point in favor of the large institucost per bed of approximately tion being that it can obtain a $1,750 whenever cottages higher grade of personnel than the erected (costing about $50,000) to small institution at a cost proporenlarge its capacity to that figure. tionately no greater.

The Dayton and Chillicothe The cost of constructing a hoscosts, since these institutions are pital (capital investment) is dividthe ones most recently constructed, ed among the counties of the disinay perhaps be taken as the best trict in aniounts proportionate to indication of the investment neces- their respective tax duplicates. sary at present to establish a satis- Maintenance costs for a given year factory tuberculosis hospital. In are apportioned according to the view of rising costs of construc- number of patient-days' treatment tion, these figures ($1,750 and received by patients from each $1,560 per bed, respectively) are county during the year. probably a little below the amount In the existing hospitals of the that would have to be spent now. state there is no uniformity in execIn general the State Department of utive and administrative organHealth is advising new districts to ization. In theory the administrafigure on a maximum expenditure tive authority rests with the board of about $2,000 per bed. On large

On large of trustees, which determines the institutions this cost can be reduced general policies for the conduct of somewhat, but it is probably a fair the institution and employs officials estimate of the cost on a moderate

to put these policies into execution. sized hospital such as most districts There is wide variation in the disprefer as a beginning. With the tribution of executive powers necessary administrative buildings

among these officials and in the deerected, cottages can be added at a gree of freedom from interference cost of about $500 per bed.

by the trustees which they enjoy. No definite statement of mainte- In the large municipal hospitals, nance cost can be made, as the entire executive authority centers hospital records are mostly incom- in the medical superintendent, who plete in this regard. The unit for controls both the medical and the comparing maintenance cost is the business sides of the hospital's accost per patient-day -- the average tivities, untrammeled as to methods cost of keeping one patient for one by the trustees but responsible to day. Such figures as are available them for the satisfactory carrying indicate that this item amounts to out of their policies. In the disnot less than $1.50 per patient-day. trict and county hospitals centralTwo dollars is considered a more ization of executive authority in the accurate estimate, taking into ac- superintendent is rare and there count the general rise in prices. is in most cases considerable disRelatively low overhead costs will position on the part of the trustees make the maintenance expense per to oversee in considerable detail patient-day, like the cost per bed, the methods followed by executive officials. In these institutions, the slight. It is safe to say, therefore,

. medical head is ordinarily a part- that during the past three years time man, and he usually controls more than two-thirds (possibly only the medical side of the hos- three-fourths would be a nearer pital, business administration being estimate) of our hospital facilities ordinarily in the hands of a ma- have been devoted to the care of tron. Each of these officials is in- cases not capable of cure. The dependent of the other and respon- figures on discharges during the sible only to the trustees. In the same period bear out this stateDayton district, which comprises ment, showing that 367 cases were only two counties and therefore pronounced

pronounced arrested upon dishas only two trustees, this reten- charge, 994 improved and 924 untion of control by the trustees improved, and that 847 cases works well enough, because of the (more than twice as many as were small size of the board. In a large arrested) died in the hospitals. . district, however, such as all the That some of these cases proother districts are, division of ex- nounced "improved" would have ecutive authority and detailed su- been arrested had they remained in pervision by the trustees naturally the institutions longer, is a reasonhinder efficient management of the able assumption. The explanation hospital, inasmuch as minor ques- for this situation, of course, is the tions of management, which could inadequacy of our present hospital be settled instantly by an able su- capacity; the immediate need for perintendent, must be threshed out taking care of advanced patients in a meeting of a half-dozen trus- causes them to be sent to the hostees.

pitals, while many in earlier stages Passing from methods to have to remain on the waiting lists sults, one need not go deeply into

as long as they are able to support the subject to see that the full pur

themselves. Hospitalization of adpose of the tuberculosis sanatorium

vanced tuberculosis cases is a valuis not being achieved in most cases.

able public health measure, inasThe hospitals are devoting a far

much as it removes dangerous cengreater share of their time to ad

ters of infection from the comvanced, incurable patients than

munity, but the arrest of cases bethey are to those in the incipient,

fore they reach the stage of menace curable stages of the disease. A to other persons is equally imsummary of hospital admissions portant. during the three years 1915, 1916, The preceding paragraphs outand 1917, classified according to line the hospital equipment availdegree of advancement, gives the able for anti-tuberculosis work in following statistics : early cases Ohio. Roughly speaking, we may 580, moderately advanced 1,117, say that we have about one-third advanced 924, far advanced 51. the equipment which we should The early cases and a certain un- have. The two main needs, thereknown percentage of the moder- fore, to be considered in discussing ately advanced cases may be con- the future of Ohio's tuberculosis sidered reasonably curable; the hospitals are these: the district syschances for cures in the remainder tem of organization must be exof the moderately advanced and in tended until every county has a the two other advanced classes are share in a hospital, and the useful

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ness of each hospital in its own dis- death (probably much too low an trict must be greatly increased. estimate), the suggested minimum The increase in the number of

standard will mean that the hosdistricts, as has been noted, has pital can give six months' care per been unusual in recent months and year to forty percent of the cases can be expected to continue

in the district. Six months, again, steadily through the next few

is a minimum estimate of the averyears. The accompanying map

age time which the patient ought shows where the field for extension to spend in the hospital to attain a lies, and work which has already

reasonable degree of improvement, been done in some of these pro

although it is more than the present posed districts has been outlined average stay in Ohio. Forty perin the foregoing paragraphs. With

cent of the existing cases is probthe law making organization of a

ably quite a reasonable estimate on hospital district a purely voluntary

the number which should have hosmatter for the counties involved, pital care, both for their own prothe work of the State Department

tection and for that of the public. of Health is of necessity confined

This estimate of needed bed capacto the spreading of propaganda to

ity, therefore, must not be taken impress upon county commission- as a statement of the ultimate goal ers and the general public the need toward which a district should for such institutions. Representa

strive; it is rather a statement of tives of the Department's Division

the smallest amount of equipment of Tuberculosis are always ready

with which the district should be to attend joint meetings of commis- content to operate for any considsioners to discuss hospital projects.

erable length of time. Local organizations of persons in- Extension of the sanatorium terested in promoting the public within its district means the carryhealth can render valuable service ing out of the full intent of the in arousing the public to the im

district hospital law. The plan portance of anti-tuberculosis meas- which such extension should folures.

low is, in brief, as follows: ReExtension and enlargement are striction of the district hospital's means by which the hospital can facilities to incipient cases; estabincrease its usefulness to the dis- lishment in each county of a branch trict. Enlargement of bed capacity of the district hospital, under the is an obvious need in most district jurisdiction of the district hospital's hospitals, the initial work having medical superintendent, for the been done on a small scale with the care of that county's advanced idea of gradual development. Just cases; establishment in each county, how much enlargement is neces- also subject to the medical superinsary in a given case depends upon tendent's control, of a tuberculosis many individual individual considerations. dispensary, with

more In general, however, it may be said nurses attached to it. This broadthat the minimum standard for a ening of activities

activities should be district hospital's capacity should preceded or accompanied by a rebe a number of beds equal to the organization of the hospital manannual total of tuberculosis deaths agement so as to give entire execuin the district. Figuring on the tive control to a full-time medical estimate of five living cases to each superintendent. Such a plan of

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