Health news. 1915-16

When the people of a county have declared by their vote that they are in favor of establishing a tuberculosis sanatorium, much hard work remains to be performed and constant care exercised if the proposed sanatorium is to be promptly constructed upon a suitable site and later, by efficient administration and public support, become a real factor in the fight against tuberculosis rather than a useless burden on the taxpayers of the community.

The establishment of such a sanatorium is very definite evidence of civic enlightenment and broadminded public sympathy. It should be a matter of pride to all the people of the county, yet in nearly every instance selfish and unreasoning opposition occurs among the few whose property interests are alleged to be directly or indirectly affected. "Inability to agree on a site" is the most common excuse for delay in building, a plea which often covers real estate deals, petty politics, and ignorant fear of disease. Thus in one of the wealthy counties of this State a large appropriation has been held up for two years in defiance of the direct mandate of the people.

There is not a county in the State in which suitable land may not be purchased at a reasonable figure, and upon which the establishment of a tuberculosis sanatorium will have the slightest deleterious effect on the monetary value of surrounding property.

The site finally chosen and approved, it remains for the county officials to assume responsibility for faithful adherence to the building. specifications. If, however, experience should show that this responsibility is frequently shirked it may be necessary for the State to exercise supervision of the work until its completion. Finally, in order that the sanatorium may exert a real influence on public health, it is absolutely essential that an efficient, suitably compensated staff be installed, which shall include a physician with special knowledge in the diagnosis and treatment of tuberculosis, and that the greatest economy compatible with the welfare of the inmates be put into practice. Only thus may the work obtain the support of the medical profession and the public at large, without which it will be of little value.

THE REFERENDUM AND TUBERCULOSIS

Results continue to demonstrate the efficacy of the referendum in the establishment of county tuberculosis hospitals. The following table shows the results since the amended law providing for the referendum went into effect.

† Several election districts missing

In addition to $15,000 already appropriated

This year, for the first time in the history of tuberculosis hospital referendums, the movement was obliged to meet organized opposition. This appeared in Rensselaer County in the form of a taxpayers' association which based its opposition chiefly upon the expense of the project. The election results, however, demonstrated that the majority of voting citizens thought the proposed expenditure justifiable.

The results in Livingston County were particularly gratifying as the community is largely rural in character, a population to which the subject of tuberculosis does not appeal so strongly as to city people. Also the farmer is more disposed to make searching inquiry before supporting measures which may tend to increase taxation. But here again a community at first indifferent to the subject became thoroughly aroused, and by a decisive vote supported the county tuberculosis hospital appropriation.

Exclusive of New York City, of the 52 counties which need local tuberculosis hospital facilities, 33 now have institutions in operation or assured, which leaves 19 without any. These 19 counties contain only 18 per cent of the up-state population but 51 per cent of the annual upstate tuberculosis deaths. If, however, county hospitals are established in the future as rapidly as they have been in the past, these 19 counties will

have hospitals in operation or assured in just 7 years more. This can be accomplished only by intelligent, aggressive, and systematic effort. There must necessarily be complete cooperation between all public and private agencies concerned.

WOMEN'S CLUBS AND TUBERCULOSIS*

OTTO R. EICHEL, M.D.

Supervisor of Tuberculosis, State Department of Health

. It would be difficult to find a more appropriate field for the public activities of women, and especially for women's organizations, than the tuberculosis campaign.

...Of all the problems of modern life none is more predominant than that of tuberculosis. Here is a malady absolutely preventable which destroys no less than 14,000 lives annually and claims. 30,000 new victims each year in this State alone.

.. This State was afflicted last summer with a great epidemic. Dramatically, suddenly, the unexpected happened. In 5 months there died outside of New York City 845 of 3629 victims of infantile paralysis. Fear aroused the public conscience. Each individual citizen assumed a personal responsibility. The people demanded and supported most drastic regulations, and money was freely appropriated. Having seen the paralysis epidemic controlled, will the public again settle down in stolid indifference to its 14,000 annual deaths in this State from tuberculosis? While those 845 children were dying of paralysis, outside of New York City, 2,358 people died of tuberculosis; and when this year has ended, the latter will have claimed two and one-half times as many victims in the whole State as infantile paralysis, and will have. caused four and one-half times as many deaths.

... If the individual had as keen a sense of responsibility for the control of tuberculosis as he did for infantile paralysis the great scourge would be stamped out in a generation. The average citizen can be stimulated to activity only by intensive education. Perpetual agitation will be the price of success in the antituberculosis movement. The individual must be trained to feel a stern sense of civic duty.

The belief that tuberculosis can be prevented and abolished by persistent effort is fully justified by results already obtained. Nineteen years ago Dr. Hermann M. Biggs predicted that before another generation had passed away its death rate in cities with the best sanitation would be less than one-third of what it then was in New York. The death rate in New York City itself has fallen from 406 to 184 since 1887-largely

* Abstracts of an address delivered at the Convention of the New York State Federation of Women's Clubs. Rochester, N. Y., November 17, 1916

through his efforts a reduction of three-fifths. His prophecy is being fulfilled.

...But first and foremost you must fight for adequate hospital facilities in your communities,- cities and counties. This is one of six definite activities urged in your last Federation Handbook, and of all it is the most vitally important. The public health campaign everywhere is definitely committed to the local or district hospital plan as the best means for combatting the disease. This was the one great constructive measure agreed upon at the famous International Congress of 1908. New York City has set a wonderful example in hospital facilities. Outside of New York there are 57 counties in the State,-5 are too small to need sanatoria. Of the remaining 52 at the present time 33 have some form of institution established or assured; and this magnificent progress has been made almost entirely in the last 8 years, since the Congress of 1908. But this still leaves 19 counties which today have no hospital beds whatever for this disease. A year ago 5 counties voted on a referendum to establish county hospitals, and this month 3 more voted likewise. Such a proposition has never failed when submitted to the people for decision by ballot.

What does it mean to have 33 counties out of 57 with hospitals in operation or assured? We have set before us a task of providing a bed to the number of one for each of the 5,400 annual tuberculosis deaths outside of New York City. Both experience and practice have shown this to be the best measure of a community's needs its death rate. We have in operation or assured today beds for 2,685 or 49 per cent of the deaths just one-half in 8 years. And the counties which have made this brilliant progress contain 82 per cent of the up-state population. We still have before us therefore, the task of obtaining hospitals in 19 counties. These contain only 18 per cent of the up-state population but 51 per cent of the annual deaths. If our past rate of development is maintained we should have a hospital in operation in each of these 19 counties in just 7 years. The chief factor in this progressive work has been the New York State Charities Aid Association and its local committees of which many of you are members. But Women's Clubs have been a potent force in the past,- and your continued efforts are essential to success in the future.

...Education and legislation have been your chief civic weapons. You cannot make these more effective than by aiding the county tuberculosis hospital movement, and supporting adequate public health appropriations. In no better way can the 330,000 members of the New York State Federation of Women's Clubs carry out their exalted purpose of promoting a "higher type of citizenship, a better public spirit, and a more alert social consciousness."

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