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which is run for cash only, and bage collection, plumbing inspecwhich does not maintain an ef- tion, maintenance of city pound, ficiency record, so no comparison etc., but it relates only to expenwith previous years is possible. ditures on public health activities They can not tell whether an in- which have been outlined. dividual department is going ahead Where a city has been spending or falling behind, or whether the from $8,000 to $9,000 per annum business is succeeding or failing; and securing a department that is such is the situation in the average probably 50 to 70 per cent efficient, city of today.

and they are asked to spend $17,Plumbing inspection is usually 000, they would either ignore the imposed upon the health depart

request, or raise an awful storm ment; this should be turned over

of protest. How can we demonto the building department.

strate such expenditure to be warNuisance abatement should be ranted ? For example, examine under the control of the police de- the death records of your city for partment, and garbage disposal deaths from typhoid fever; rememshould be taken care of by the de- ber the death rate of typhoid is partment of public works.

under 10 per cent; that is, for Passed Assistant Surgeon Paul every ten reported deaths from this Preble, of the United States Public disease there must have been over Health Service, last year completed 100 cases; more than likely less a survey of 330 cities in the United than one-half of these were ever States. He found that the average reported. Ascertain the expenses city of from 25,000 to 50,000 in

incurred for nurse, medicine, hoshabitants spent an average of 24.6 pital, and funeral expenses for cents per capita per year on public these cases that have died. Ashealth and that the health Officer certain or determine the expenses received an average of $100 per incurred for the cases that have month.

recovered, and as I have said be

fore, we have nine times as many “Public Health Is Purchasable" recoveries as we have deaths. DePublic health is as purchasable

termine the financial loss in wages as any other commodity. For ex

during illness and long convalample, in the construction of the

during illness and long convaPanama Canal, it was necessary to

lescence of those that have recovpay a very high price for public

have been only two or three deaths health — $3.65 per capita per an

from typhoid in your community, num. Consensus of opinion of

you will find that enough money those competent to discuss the mat

has been lost to pay for your health ter gives 50 cents per capita per an

department several times over. num as the amount necessary to

Seriousness of Whooping Cough maintain an efficient health control of a city from 20,000 to 35,000. Or again, consider the so-called That would mean an expenditure minor diseases, say

whooping of $17,500 per annum for health cough. Possibly no actual money protection. This, of course, bars was spent or time lost while baby unforeseen emergencies, and does had whooping cough, still I know not include such activities as gar- of a family where many hundreds

of dollars were spent on hospital, Effect of War Sanitation
physicians, nurses and medicines
during the eight or ten years fol-

Today many, many thousands of lowing an attack of whooping and in army cantonments. They

our young men are "over there" cough in a small child, which was

are receiving instruction not only contracted in a small town where

in the arts of war, but also in the no control was exercised over this

arts of peace. Sanitation plays a disease; this case is not unique. In figuring the expense from whoop- greater part in the present war than

ever before in the history of the ing cough, the medical expense

world, and the sanitation of camps and funeral bills in deaths from

today is the most efficient the world whooping cough should be in

has ever known. The greater numcluded. Whooping cough in chil

ber of these men will in time redren under two kills more than

turn home, and when they do so, all other communicable diseases

they will demand that typhoid be put together.

eliminated, that better sanitary conAgain, if some article be pur

veniences be supplied; in short, chased in a foreign land, a large they will demand that the sanitary freight bill paid, and after the efficiency of the army camp of toarticle has been received, it is un- day be maintained in their civilian fortunately broken while being homes of tomorrow. Speed the day adapted to the purpose for which they return! it was purchased — the purchase How shall we organize our health price, the freight bill, to say noth- departments to do all of these ing of the time and disappointment, things which we have outlined, and would all be considered an irrevo

at the same time keep within the cable loss. The same is true in all estimated 50 cents? First, by emdeaths from communicable disease ploying a health officer trained and in childhood. For all money spent experienced in public health, and during the life of each fatal case, one who devotes his entire time to all money spent for the mother's the duties of his office; $2,400 per care during her pregnancy and at vear should secure such a person the time of her child's birth, should for a city the size we have in mind. be included, because it represents He should be supported by a corps something just as irrevocably lost of experienced or trained public as the article purchased in the health nurses. A city of 35,000 foreign land. Many other exam- gives a population of about 7,000 ples could be mentioned, the items children of school age. In the of which could be easily enu- organization of Health District No. merated, but considerable work

i in New York City, three nurses would be required to determine the were assigned to estimated actual money expended.

school population of 7,000. BeIf your citizen is willing, and sides school inspection and visits, does actually spend $1.50 per these nurses do a great deal of discapita per annum for fire protec- trict nursing work, taking up baby tion, and $1.00 for police protec- welfare work and prenatal guidtion for mere property, surely he ance, control of communicable should be willing to spend 50 cents diseases, and sanitary supervision; per capita for life and health pro- therefore I would suggest that a tection.

minimum number of three nurses

an

be employed in our suggested de- end of the school period; to build partment at a salary not less than up a first-class milk inspection ser$100 per month. To have control vice; to supervise the production of of meat and milk inspection, a vet- meat and other foodstuffs; to have erinarian should be employed on a laboratory that would be of infull time at a salary not less than estimable value to the physicians of $1,200 per year. A housing inspec- the community; to carry on a contor, trained in housing, sanitation tinuous campaign of education; and and social problems, at the same finally, to have a system of public salary. An office force of secretary health bookkeeping, from which and stenographer at a minimum at all times could be determined the salary of $75 and $64 per month, health situation of the community, respectively.

as well as the efficiency of the pub

lic health work in all departments. Compensation for Skilled Workers

ARMY LOWERS DEATH Laboratory. It is difficult to ob

RATE FROM DISEASE tain a person trained in chemistry and bacteriology of public health Annual rates for deaths in battle without offering adequate pay;

and deaths from disease among the $150 per month would be a mini- American Expeditionary Forces mum rate. There would not be were exactly equal for the first ten enough work in a city of this size months of American participation to keep such a person busy all the in the war, according to figures time, so he could devote part of his compiled by the War Department. time to foodstuffs and to food es

Both rates stood at 8 per 1,000 per tablishments; for the laboratory he year. would receive $100 per month, and In previous wars of the United for the food inspection $50. An

States the deaths from disease have untrained laboratory assistant at

far exceeded the deaths in battle. $50 per month would be found nec

In the Mexican War 15 per 1,000 essary to make media, wash glass- died annually in battle and 110 ware and other menial work.

from disease. In the Civil War the Field workers should be supplied rates were: 33 in battle, 65 from with automobiles of the Ford type;

disease; in the Spanish War: 5 in this would increase their efficiency

battle, 26 from disease. fully 50 per cent. With the upkeep Statistics of the French and of automobiles, laboratory supplies, British armies for four years of maintenance items, such as office the war, as given out in a statesupplies, printing and other sundry ment from the American chief of items, the health officer would be staff, show that only fewer than compelled to figure very closely in one in twenty wounded men sent order to come within the suggested to hospitals die. The average of appropriation.

British and French statistics is as With such an organization it follows: Returned to service, 810 would be possible to reduce com- per 1,000 wounded; discharged municable disease to the minimum ; from service because of physical to secure the reporting of all births ; disability or other cause, 145 per to maintain close supervision of 1,000; died from wounds, 45 per child life from before birth to the 1,000.

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The 12,738 patients under care were grouped as follows, according to the nature of their cases, with the exception of 2,297 patients, 996 of whom were “not listed” and 1,301 of whom (Akron) were listed as 558 tuberculosis patients, 713 child welfare, and 30 general nursing service:

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GIVE EXPERT ADVICE ON capital expenditures - road

road imSANITARY BOND ISSUES provements, school buildings and The United States Public Health

public buildings is being fur

nished to the committee by other Service has promised to assist the Capital Issues Committee by fur

government departments and bu

reaus. nishing it information in regard to To prevent injurious competition municipal bond issues for sanitary

with the Liberty Bond issues by purposes which the committee may postponing all non-essential bond be asked to approve. Expert ad- issues, the Capital Issues Commitvice in regard to the other three tee has been given power to review important classes of municipal all proposals for capital issues.

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