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organization has not yet been put into operation, in any of the districts, although it has been urged by the State Department of Health. Organization on this basis would bring the district hospital, through its dispensaries, into close touch with tuberculosis sufferers, who would be likely to receive hospital care at an earlier stage of their disease than now. By segregating the advanced cases in their home counties, the district hospital would be made primarily a curative institution, freed from the necessity of putting applicants in incipient stages on the waiting list because of the immediate necessity for looking after the incurables. This plan of organization recognizes the twofold purpose of tuberculosis hospital work the segregation of advanced cases dangerous to the public health and the restoration of incipient cases to health, and makes the hospital adapt itself to this dual need. The adoption of some such plan of organization as this can be expected to take place as Ohio's district hospitals develop.

Both these principal phases of the building up of the district hospital system will be aided and supplemented by wider education of the public in regard to sanatoria and their work, by the provision of a plentiful supply of trained per sonnel for the hospital staffs, by the improvement and standardization of hospital records and by the continued deevlopment of thorough co-operation between the hospital managements and the State Department of Health,

Educational methods, carried out on both a state-wide and a local scale, can be credited with much of the progress which has been made and their continuance may be expected to bring still further prog

ress. The place of the sanatorium in an anti-tuberculosis program and the need of the state for an effectively working system of such institutions must be made clear to the public.

Provision of trained workers for the hospitals will mean that each sanatorium can have attached to it an adequate staff of physicians skilled in the diagnosis and treatment of tuberculosis, in addition to the necessary force of nurses and other employees.

tion of methods of keeping records Improvement and standardizaOhio's sanatoria. Many hospitals is a highly important need for are now without adequate and accurate information as to work done and as to costs. Even where such information is available, each hospital has followed its own methods of compiling data, with the result that no basis for comparisons between institutions the only sound method of judging the work of a given hospital - can be found. With standard records, such as it is hoped may be installed soon, the State Department of Health could make compilations of statistics which would be of real value to every hospital in the state.

The installation of such a system presupposes a spirit of co-operation between the hospital staffs and the state tuberculosis workers — a

spirit the further development of which has been suggested as another need in promoting the efficiency of the state's hospital equipment. This does not mean the assumption of any supervisory powers by the state over institutions now under local control. The most thorough co-operation in matters of general interest can be achieved without weakening the authority of any hospital superin

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Organization of a District Tuberculosis Hospital

The above diagram shows the ideal plan of organization, with the interrelations of the various persons and agencies affected, as described in the article.

tendent or board of trustees. It must not be assumed, of course, that a high degree of co-operative spirit does not already exist. The conferences of hospital superintendents which are held from time to time demonstrate the willingness of the hospital heads to work to

gether and with the state. There is still room for progress along this line as along all others, however, and all the sanatoria will benefit from any progress which is made.

This sketch of Ohio's tuberculosis hospital hospital equipment has

brought out the facts that the state possesses or soon will possess a system of district sanatoria, together with a few institutions of other classes, which is serving which is serving about half of the counties of the state, including about three-fourths of the state's population. The success of these institutions has demonstrated the desirability of the district plan of organization and offers a better argument than any theoretical discussion for the extension and improvement of the district hospitals until the entire. state is provided with hospitals adequate to care for a reasonable proportion of Ohio's tuberculosis cases and organized along lines of highest efficiency.

The state is not compelling any county to make provision for a tuberculosis hospital. It offers, however, to every county an opportunity to join in this work of great civic value. The State Department of Health is ready to give all possible advice and information to any county officials interested in the establishment of a district hospital, leaving the county free to settle the question for itself after the case has been presented to it.

GOVERNMENT HEALTH

ACTIVITIES COMBINED All health activities of the Federal Government, except the purely military health functions of the War and Navy departments and the industrial hygiene activities of the bureau of labor statistics, have been concentrated under the control of the Treasury Department, of which the United States Public Health Service is a bureau. The President's order prescribing this reorganization is as follows:

WHEREAS, In order to avoid confusion in policies, duplication of

effort, and to bring about more effective results, unity of control in the administration of the public health activities of the Federal Government is obviously essential, and has been so recognized by acts of Congress creating in the Treasury Department a Public Heatlh Service, an despecially authorizing such service "to study the diseases of man and the conditions influencing the propagation and spread thereof" and "to co-operate with and aid state and municipal boards of health":

Now, therefore, I, Woodrow Wilson, President of the United States, by virtue of the authority vested in me as Chief Executive, and by the act "authorizing the President to co-ordinate or consolidate executive bureaus, agencies, and offices, and for other purposes, in the interest of economy and the more efficient concentration of the Government," approved May 20, 1918, do hereby order that all sanitary or public health activities carried on by any executive bureau, agency or office, especially created for or concerned in the prosecution of the existing war, shall be exercised under the supervision and control of the Secretary of the Treasury.

This order shall not be construed as affecting the jurisdiction exercised under authority of existing law by the Surgeon General of the Army, the Surgeon General of the Navy, and the Provost Marshal General in the performance of health functions which are military in character as distinguished from civil public health duties, or as prohibiting investigations by the Bureau of Labor Statistics of vocational diseases, shop sanitations, and hygiene.

WOODROW WILSON. The White House, July 1, 1918.

First Figures on 1917 Mortality in Ohio

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HIO'S death rate rose from 14.4 per 1,000 population in 1916 to 14.8 per 1,000 in 1917. The total of deaths in 1916 was 74,230 and 76,893 in 1917. Statistics for the 1917 deaths have been partially compiled by the Bureau of Vital Statistics at date of publication, and totals and rates by counties, the earliest figures available, are given in the attached table. It is expected that statistics of deaths in the cities and of deaths from separate causes will be ready for publication in the next issue of the OHIO PUBLIC HEALTH JOURNAL.

TOTAL NUMBER OF DEATHS IN EACH COUNTY IN THE STATE FOR THE YEARS 1916 AND 1917, FROM ALL CAUSES, AND THE VARIOUS DISEASES, WITH RATES PER 1,000 POPULATION.

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Counties.

TOTAL NUMBER OF DEATHS IN EACH COUNTY IN THE STATE FOR THE YEARS 1916 AND 1917, FROM ALL CAUSES, AND THE VARIOUS DISEASES, WITH RATES PER 1,000 POPULATION—Continued.

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Rate 1917.

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