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organization has not yet been put ress. The place of the sanatorium into operation in any of the dis- in an anti-tuberculosis program tricts, although it has been urged and the need of the state for an by the State Department of Health. effectively working system of such Organization on this basis would institutions must be made clear to bring the district hospital, through the public. its dispensaries, into close touch

Provision of trained workers for with tuberculosis sufferers, who

the hospitals will mean that each would be likely to receive hospital

sanatorium can have attached to it care at an earlier stage of their

an adequate staff of physicians disease than now. By segregating skilled in the diagnosis and treatthe advanced cases in their home

ment of tuberculosis, in addition counties, the district hospital would

to the necessary force of nurses be made primarily a curative in- and other employees. stitution, freed from the necessity of putting applicants in incipient tion of methods of keeping records

Improvement and standardizastages on the waiting list because of the immediate necessity for

is a highly important need for

Ohio's sanatoria. Many hospitals looking after the incurables. This

are now without adequate and acplan of organization recognizes the

curate information as to work done twofold purpose of tuberculosis

and as to costs. Even where such hospital work --- the segregation of

information is available, each hosadvanced cases dangerous to the

pital has followed its own methods public health and the restoration of incipient cases to health, — and

of compiling data, with the result

that no basis for comparisons bemakes the hospital adapt itself to this dual need. The adoption of

tween institutions — the only sound

method of judging the work of a some such plan of organization as this can be expected to take place țith standard records, such as it

given hospital - can be found. as Ohio's district hospitals develop.

is hoped may be installed soon, the Both these principal phases of State Department of Health could the building up of the district hos

make compilations of statistics pital system will be aided and sup- which would be of real value to plemented by wider education of

every hospital in the state. the public in regard to sanatoria The installation of such a system and their work, by the provision presupposes a spirit of co-operaof a plentiful supply of trained per

tion between the hospital staffs and sonnel for the hospital staffs, by the state tuberculosis workers - a the improvement and standardiza

spirit the further development of tion of hospital records and by the which has been suggested as ancontinued deevlopment of thor

other need in promoting the efough co-operation between the hos

ficiency of the state's hospital pital managements and the State

equipment. This does not mean Department of Health.

the assumption of any supervisory Educational methods, carried out powers by the state over instituon both a state-wide and a local tions now under local control. The scale, can be credited with much

most thorough co-operation in matof the progress which has been ters of general interest can be made and their continuance may be achieved without weakening the expected to bring still further prog. 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 tubercuilosis hospital

hospital equipment has brought out the facts that the state effort, and to bring about more efpossesses or soon will possess a fective results, unity of control in system of district sanatoria, to- the administration of the public gether with a few institutions of health activities of the Federal other classes, which is serving Government is obviously essential, about half of the counties of the and has been so recognized by acts state, including about three-fourths

of Congress creating in the Treasof the state's population. The suc- ury Department a Public Heatlh cess of these institutions has de- Service, an despecially authorizing monstrated the desirability of the such service "to study the diseases district plan of organization and of man and the conditions influencoffers a better argument than any ing the propagation and spread theoretical discussion for the ex- thereof” and “to co-operate with tension and improvement of the and aid state and municipal boards district hospitals until the entire of health": state is provided with hospitals Now, therefore, I, Woodrow adequate to care for a reasonable Wilson, President of the United proportion of Ohio's tuberculosis States, by virtue of the authority cases and organized along lines of vested in me as Chief Executive, highest efficiency.

and by the act "authorizing the The state is not compelling any

President to co-ordinate or concounty to make provision for a solidate executive bureaus, agentuberculosis hospital. It offers, cies, and offices, and for other purhowever, to every county an op- poses, in the interest of economy portunity to join in this work of and the more efficient concentragreat civic value. The State De- tion of the Government," approved partment of Health is ready to give May 20, 1918, do hereby order that all possible advice and information

all sanitary or public health acto any county officials interested in tivities carried on by any executhe establishment of a district hos- tive bureau, agency or office, espepital, leaving the county free to set- cially created for or concerned in tle the question for itself after the the prosecution of the existing war, case has been presented to it.

shall be exercised under the supervision and control of the Secretary

of the Treasury. GOVERNMENT HEALTH

This order shall not be construed ACTIVITIES COMBINED

as affecting the jurisdiction exerAll health activities of the Fed- cised under authority of existing eral Government, except the purely law by the Surgeon General of the military health functions of the Army, the Surgeon General of the War and Navy departments and Navy, and the Provost Marshal the industrial hygiene activities of General in the performance of the bureau of labor statistics, have health functions which are military been concentrated under the con- in character as distinguished from trol of the Treasury Department, civil public health duties, or as proof which the United States Public hibiting investigations by the BuHealth Service is a bureau. The reau of Labor Statistics of vocaPresident's order prescribing this tional diseases, shop sanitations, reorganization is as follows:

and hygiene. WHEREAS, In order to avoid con

WOODROW WILSON. fusion in policies, duplication of The White House, July 1, 1918.

First Figures on 1917 Mortality in Ohio

O

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 VARI-
OUS DISEASES, WITH RATES PER 1,000 POPULATION.

Counties.

No. Deaths

for 1916.

No. Deaths

for 1917.

Rate 1916.

Rate 1917.

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

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12.2 14.0 14.6 14.3 12.6 12.5 14.3 12.7 14.2 13.1 14.5 15.1 16.2 13.7 13.7 11.6 12.7 14.7 11.4 13.4 14.1 17.6

434 11,233

493 329 390 683 420

267 3,942

298 428 195 465

485 7,654

492 475

494
12,153

503
291
381
740
490

294
4,060

284 423 184 440

493
7,728

420
401

9.9 12.3 15.3 12.1 16.6 13.3 15.6 10.1 15.5 13.0 15.6

11.3 14.6 12.6 14.4 13.0 10.1 14.2 13.2 13.9 10.8 13.8 15.8 12.9 12.3 14.3 10.5 14.5 15.5 11.6 11.9 13.7 19.1 11.4 13.5 15.4 11.5 16.4 12.5 14.8 10.1 15.5 11.1 13.2

TOTAL NUMBER OF DEATHS IN EACH COUNTY IN THE STATE FOR

THE YEARS 1916 AND 1917, FROM ALL CAUSES, AND THE VARI-
OUS DISEASES, WITH RATES PER 1,000 POPULATION - Continued.

Counties.

No. Deaths

tor 1916.

No. Deaths

for 1917.

Rate 1916.

Rate 1917.

Harrison Henry Highland Hocking Holmes Huron Jackson Jefferson Knox Lake Lawrence Licking Logan Lorain Lucas Madison Mahoning 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

206
238
398
284
199
457

330
1,05:

391 335 523 807

395 1,149 3,849

265 2,499

494 344 330 313 609

213 3,018

219 230 829 222 246 194 345 303 188 468 330 335 626 540 464 807 610

315 2,034 2,541

891 724 272 253 165 403

256 10.8 13.4 248

9.5 9.9 391 13.9 13.6 281 12.0 11.9 221 11.1 12.3 482 12.9 13.5

422 10.7 13.7 1,063 13.4 13.2

365 12.3 11.4 357 14.1 15.0 631 13.2 16.0 759 13.2

12.3 368 13.1

12.2 1,021 12.9 11.2 3,879

17.7

17.5 214 13.3 10.8 2,731 17.2 18.2

551 13.2 14.6 328 14.0 13.2 381 12.9 14.9 307 11.4 11.1 679 13.2 14.6

231 8.8 9.5 3.227 16.3 17.1

258 13.6 16.0 195 13.7 11.6 876 13.8 14.4 240 11.9 12.9 288 11.0 12.8 183 8.5 8.1 367 9.2 9.7 359

11.6 13.7 196 12.0 12.5 473 15.1 15.2 277 13.8 11.6 303 11.2 10.1 671 12.6 13.4 598 13.5 14.9 399 13.0 11.1 883 15.2 16.4 633 14.1 14.6

296 12.8 12.0 2.277 14.4 15.9 3,070 19.4 22.8

969 1 15.7 16.9
676 1 12.3 11.4
286 12.4 1 13.1
264
8.7 1

9.1 171 12.6 13.1 352 16.5 1 14.4

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