over the camp and the surrounding territory, which made access to prostitutes a matter of considerable difficulty. All women known or suspected of being prostitutes were ordered away from the vicinity of the encampment and soldiers who were known to cohabit with prostitutes were penalized.

A practical suggestion made at the conference is that the state and local health authorities should be given control of the environs of a military camp, the distance being regulated according to circumstances. The purpose of this would be to expel from such prescribed territory all women of questionable reputation. The suggestion also includes the abolition of all places where intoxicating liquors are sold within such territory.

The editor of the Enquirer dealing with this subject hits the nail squarely on the head in his lead editorial of May 12 which we print in full:

"The Scourge of War."

"Let's look the situation squarely in the face. We're at war, and war is productive of unpleasant things at best. The glamour and panoply of conflict are fleeting, but the grim realities of war, disease, death and destruction leave livid scars for generations to come. Steeling our hearts against the certainty that they will be rent and torn by bereavement, we must at the same time gird up our loins to prevent, other than by the instrumentalities of war, the ruination and ultimate destruction of the strong, clean young bodies that are going to present themselves as living sacrifices on the altar of liberty.

"There is a peril of war greater than that of battle-more terrible in its effects than the ghastly carnage of canister and shell. It is the fury of the female harpy that has invested camps and barracks since man first adopted the barbarous art of war for the settlement of his arguments and contentions. This fury has brought to the armed camps of men the scourge of Babylon and Nineveh, the canker that devitalized the men of Pompeii and ancient Rome, the loathsome, perhaps ineradicable diseases that, according to authenticated medical reports, incapacitate more men than all the fighting they may do.

"What is the Government of the United States going to do to protect its soldiers from this alluring, seductive, scarlet peril? There is only one certain, sure, dependable prophylaxis, and that is to keep the harpies as far removed from camps as enemy spies. No one doubts the ability and power of military authorities and officers to cope with Secret Service operatives, nor does anyone believe that they are not competent to act against the fury which spreads the wasteful scourge that carries sorrow through unborn generations. "Let the Government act, and act quickly."

CONSULTED THE WRONG MAN.

Senator Erastus G. Lloyd, who is chairman of the Ohio Senate Finance Committee, is an attorney in Columbus, and his brother, Dr. William E. Lloyd, is a practicing physician in the same city. They bear a striking resemblance and the lawyer is not infrequently taken for the physician and vice versa. In fact, it happens so often that they seldom take the trouble to correct the mistaken identity.

In this connection the story is told on the lawyer that at a function attended by him, a lady, interested in health culture, mistook him for the doctor.

"Is it better," she asked confidently, "to lie on the right side or left ?"

"Madam," replied the senator, "if one is on the right side, it often isn't necessary to lie at all."

COORDINATION OF TUBERCULOSIS ACTIVITIES IN

OHIO.*

JOHN R. MCDOWELL, M. D.

Director, Division of Public Health Education, Ohio State Department of Health.

On looking into the immediate future of tuberculosis work in Ohio, one is inclined to be a little discouraged concerning equipment and probable results, but, after looking back over the progress of the past ten years, one's views should be somewhat more hopeful. It might be of interest, and possibly new to some of you, to go over briefly the history of the development of tuberculosis work in Ohio.

The movement had its beginning in 1894 when the communicability of the disease was first recognized by the State Board of Health, and agitation extending from this time up to 1901 resulted in the organization of the Ohio Society for the Prevention of Tuebrculosis. On April 23, 1902, the State Tuberculosis Commission was created by the legislature to urge the advisability of constructing a state sanatorium for tuberculosis, and this commission was appointed by the governor in September of that year. In April, 1903, the commission made a report recommending erection of a state sanatorium. One year later, April, 1904, the State Tuberculosis Sanatorium Commission was created by the legislature to erect the institution. Five years later, in October, 1909, the sanatorium was opened. In the meantime, in 1908, the county hospital law was passed, and amended in 1909, providing for district. hospitals. In 1910, the open air school law was passed. In 1911, the Ohio Society employed a secretary, and reorganized and incorporated in same year.

The first state visiting nurse was employed by the Ohio Society in 1912, and the next year, May 2nd, 1913, county and district visiting nurses were provided by law. Previous to this, however, as early as 1898, Columbus and Dayton had formed Visiting Nurses' Associations, followed, in 1901, by Toledo; 1902, by Cleveland; 1904, by Youngstown. The first local organization was the Cleveland Anti-Tuberculosis League, in 1905; and these have increased until today we have 89 organizations, employing 463 nurses.

In 1913, the county hospital law was repealed, and the district law was amended.

In May of the same year, an appropriation of $20,000 per year, for a period of two years, was made to the State Board of Health to establish a Division of Tuberculosis, which division was created the same year, and the secretary of the Ohio Society appointed chief of the division. The name of the division was changed the next year to Division of Public Health Education and Tuberculosis.

The equipment and the agencies at work in Ohio today rank well toward the top in comparison with other states, and as compared with

* Read before the Conference of Ohio Tuberculosis Hospital Superintendents at Columbus, Ohio, March 30, 1917.

many states might make us reasonably proud, but there is much to do and the facilities with which to do it are still very inadequate. Our present equipment consists of 463 nurses in 68 stations, 27 free dispensaries in 19 cities, open air schools in at least 4 cities, possibly 3 fresh air summer camps for children. There are 2 municipal hospitals, with a total of 770 beds, 3 county hospitals, with 286 beds, 4 district hospitals, supplying 16 counties, with 237 beds, one semi-public sanitarium, with 30 beds. St. Anthony's Hospital, Columbus, Ohio, with 18 beds, Dr. Rockhill's Sanatorium, 20 beds, and the State Sanatorium, with 166 beds, making a total of 1527 beds to supply in the neighborhood of 30,000 cases annually, or about twenty patients for each bed. On the basis that only one-third of these cases would need hospital care, it still leaves us 10,000 patients, or 7 patients to each bed.

This brings us to consideration of plans for the future. What seems best, in my estimation, is to center our efforts upon two or three definite plans and push them through.

Since we are agreed that a large percentage of our tuberculosis infection occurs during childhood, logically, provision for the pretuberculous and tuberculous children should have first place in our program. This means the establishment of more open air schools, provision for segregating the tuberculous from the well children in our county children's homes and in our different state institutions, and provision in all our sanatoria for special equipment for tuberculous children.

As a means of linking our already established hospitals and those to be established with the different counties, it seems to me that the organization of the work with the county as a unit will bring the best results. During the last session of the legislature, an amendment was passed to the district tuberculosis hospital law, permitting the district and county hospitals to establish dispensaries in their respective territories, to be maintained from hospital funds. In those counties in which there is not a hospital, the county commissioners were permitted to establish such dispensaries. By voluntary services of physicians, through the County Medical Society, in such a dispensary, a place will be furnished for the examination of many cases that will not or do not go to a physician. The dispensary would also serve as a means of entrance to our hospitals. They need not interfere with those dispensaries already established in our larger towns and cities.

We are laying our plans to discover more cases and are undoubtedly getting more and more cases reported by physicians. This means that a very strenuous campaign must be waged for the establishment of more district tuberculosis hospitals.

The provision for pretuberculous and tuberculous children, the establishment of county units with dispensaries, the extension of the district hospital system and the establishment of uniform methods in our already existing hospitals seems to me to be an entirely adequate program for the next two years. What part then do you, as hospital superintendents and workers, have in this program?

In the first place, it means agitation on the part of all of you at your board meetings for equipment for children. Some have

already taken this step. It means that we will need your influence with your boards for the establishment of county dispensaries and for tthe placing of nurses who will be able to take charge of the dispensaries. A close connection must also be established between these dispensaries, as receiving stations, and your hospitals. Under the law, the superintendents of the hospitals are given supervision over these dispensaries.

So far little has been said as to the co-ordination of work in our hospitals already in existence. We have taken some halfway steps along this line, but have arrived at no definite conclusions. On account of the differences in size of the institutions and the different amounts appropriated, it would be difficult, and probably not advisable, to establish a uniform system throughout, but there are a few fundamentals that it seems to me must be put upon a uniform basis if we are going to be able to compare our work, or to arrive at any conclusions as to results. I will mention these briefly, and then bring out for discussion the results of the questionnaire circulated in January among the different hospitals.

It seems to me of the greatest importance to adopt uniform classifications for patients on admission and discharge, and no classification offered thus far has proven more satisfactory than that of the National Society for the Prevention of Tuberculosis. This will, of course, necessitate periodic physical examinations, so that at all times you will know the condition of your patients. It will also necessitate either the equipping of your institutions with a laboratory, which there is no doubt should be done, or using the laboratories of the State Board of Health. We are glad to supply you with containers and examine sputum at any time free of charge.

As a means of interpreting results and furnishing information for a complete follow-up system, the admission and discharge blanks submitted to the State Board of Health are going to prove of immense value, but only if each institution will furnish complete information and in a uniform manner. These are being used as an estimate of the amount and class of work being done in Ohio among our sanatoria. If they do not correspond with your individual records, or the follow-up system is hampered by incomplete or inaccurate infirmation, they are valueless and will furnish nothing on which to base changes in our present methods.

Another item, which in my estimation we could make uniform in our county and district hospitals, is the hospital admission blank and method of admission. Such blank would give each hospital information of value from history, and sociological standpoint, and would furnish material for our State Board admission blanks, which it is oftentimes very difficult to get from a patient after admission.

One other item which it seems to me should be uniform if we are to obtain any information as to what is being accomplished in the state, and that is, the form of annual report. A tentative form was drawn up at one time by the State Board of Health, but has never been adopted universally because the information was not available in some of the institutions. We should begin working toward some

uniform results, and a report should be adopted containing at least a minimum amount of information.

It seems advisable to standardize these few points at once if our work is to prove of any value. There are numerous other matters which I will merely mention for your discussion, and which were brought out in the questionnaire.

Three meals per day in the hospitals were practically agreed upon by all. Forced feeding was pronounced by all as not beneficial and not used except in certain cases. The time allowed after admission before the examination of the patient varied from 24 hours to 2 weeks, a majority stating from 24 to 72 hours. Hours for rest varied, of course, with the condition of the patient, but the minimum was two hours per day. The temperature indicating full time in bed was stated as 99.6° in four institutions, 100° in four and 101° in one. Recreation of some sort was provided in six hospitals, and none but walking in three. Recreation consisted of music, concerts, lectures, entertainments, light sports, etc. Six institutions have one or more resident physicians, five have none. In one, the physician spends from 6 to 8 hours per day and is subject to call at night. In one, he gives one to four hours. One physician calls three times per week. and two have physician only subject to call. Six have physicians as superintendents, while three employ graduate nurses in that capacity. One hospital employs no graduate nurses, one employs only one, while all the rest have, at least, two.

I have given you briefly a resume of what the records show has been accomplished, and only an outline of a plan for the future. I have not attempted a final solution of any of the problems, but hope that the paper will at least concentrate our discussion and our plans along definite lines.

A CURE FOR WORRY.

Worry digs more graves in a month than any sexton ever dug in a life time. Every time you worry, you are frittering away your health-you are spoiling your chances-you are making yourself a fidgety old duffer, writes Arthur Feehan.

Worry never solved a problem. It has never yet helped a man up from the sick bed or smoothed out the cares of his business or the wrinkles on his brow. It has not soothed the pain of disappointment. If you don't kill that habit of worrying, it will kill you; and that's a poor finish to the grand adventure of life.

Whenever you start worrying, remember what it means to youso much needless waste of nervous force, so much happiness thrown away, so much less faith in yourself.

There is only one cure for worrying. The cure is based on the following principle: What made you frown yesterday will make you smile tomorrow. All you have to do is to look at every trouble from the standpoint of the future. Smile at it today instead of tomorrow.