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The Cleveland year book 1921- online

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scbo<^, financed through the Board of Education; three health centers,
for which an appropriation is made in the Community Chest; and in
the City Hospital. The clinics in the Dental School ars self-supporting.

It is surprising and deplorable that the hospitals of Cleveland have
not yet learned to appreciate the necessity of having a dentist on their
staffs. Very little provision of any kind is made for dental work in the


Pharmacy in Cleveland deserves high commendation. Most of the
practicing pharmacists have had a college course of two or three years.
Although Cleveland has no rules, laws, or regulations governing drug
stores, except the narcotic and sanitary ordinances, the druggists
have a splendid spirit of co-operation with the Division of Health.
They inform officers of common dangers and have agreed to refuse to
offer patent medicines for sale until they have been analyzed by the
City Chemist.

The Western Reserve University School of Pharmacy, which should
stand on a plane with the Medical School, suffers by its location in a
depressing down-town section. It is suggested that the school come
into doser relationship with the hoq;ritals, thus enabHng both to render
a higher type of service. It is also recommended that seniors serve
an intemeship in the hospitals.

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240 The Cleveland Year Book


Not one of the thirteen training schools for nurses in Cleveland can
be pointed to as a model institution. Each has its special virtues,
of course. Even the City Hospital, against which so much has had
to be said, has excellent provisions for training in contagious diseases,
and an especially well-arranged and equipped nurses' home. If the
hospitals showed inclination to affiliate for education of nurses, each
would have the benefit of the others' strong points.

In most of the schools the teaching of the fundamental sciences is
weak, because of the lack of good teachers who can devote their entire
time to teaching. As things are, jeither their routine work or their
teaching must suffer, and as the work must be done, the teaching is

Another fault, common to practically all of the hospitals, is the aver-
emphasis of surgical training. When medical cases are crowded out,
the training cannot be well-rounded.

Cleveland has an excellent opportunity to take a leading place in the
country in the training of nurses. The proposed University School of
Nursing has so many advantages that its adoption seems only a ques-
tion of time. Such a plan would attract to the profession a better
class of students, who would be considered university students; the
instruction, equipment and teaching force would be of a higher qaulity;
and the independence of the training school and of the hospital would
be established. Cleveland should be anxious to make this important
contribution. The Visiting Nurse Association has already seen the
wisdom of uniting with Western Reserve University, and its admirably
organized course has achieved a high measure of success.

In her public health nursing Cleveland leads, thanks to the unique
Central Committee on Public Nursing. No other dty has ventured to
adopt a generalized municipal system, that is, the scheme of dividing
the dty into small sections, each watched over by a nurse. Where
there has been failure in the plan, the blame may be laid to the in-
adequate number of nurses. They are so overloaded with work that
they cannot be equal to their ideals. There should be 118 more than
are at present employed.

Cleveland school nursing, through the agency of the Central Nursing
Committee, is of high standard. There is a fine spirit of application
among the workers, but because of the usual lack of numbers in this
department, there is little time to be given to home inspection.

Thirty-«ix plants in Cleveland provide industrial nursing. As it is a
new field, the nurses are not yet certain of what should be expected
of them.

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Public HeaUh Work 241


Cleveland hospitals care for 10 per cent, of the 20,000 people who
are ill at any one time. Hospitals furnish facilities unavailable other-
wise, and through them doctors can render better service to a larger
group than in any other way.

Cleveland falls far below other large cities, however, in the number
of hospital beds for its population. On the basis of five beds for each
thousand population, there should be 1,500 more. The use of the
present beds, as well as the new ones, must be more widely varied.
Now nearly half of them are devoted to surgical cases, only 115 to
obstetrical cases, four to eye diseases, and none especially to oar, nose,
or throat troubles. The City Hospital, which has 100 beds for con-
tagious diseases, should have 400.

It has been found that the best system for conducting a hospital is
through a Board of Trustees. This Board should include representatives
of all elements, not merely doctors and nurses, and not business men
exclusively. They must select a superintendent who is in every way
suited to the office and must then give her sufficient authority. The
superintend«it's lack of proper authority has been observed, as has
also the fact that the nursing schools are being used as a means of
obtaining cheap nursing labor. If this persists, the relation of such
schools to the hospital must be as distinct as that of the medical schools
at the present time.

Each ho^ntal must have its regular staff of doctors. Only 29 per
cent, of Cleveland doctors are affiliated with any hospital. The foreign-
bom physicians have almost no representation, and the one negro
doctor on the staff of Lakeside Hospital is the sole representative of
his race on a Cleveland hospital staff.

Every hospital should have a complete system of accounting and
bookkeeping, employing experts if necessary. There should be an
investigator on the staff to ascertain the financial condition of patients.
It would be possible for several hospitals to engage the same in-

The Purchasing Department of the Hospital Council is a distinct and
notable achievement, characteristic of Cleveland. Through co-
operative buying the hospitals are able to take advantage of seasonable
markets for canned goods and other provisions, and the purchasing
of drugs and surgical supplies in large quantities naturally reduces the
cost. It is surprising that some hospitals do not welcome the oppor-
tunity of using this department.

The problem of getting patients to hospitals is one that has received
almost no attention in Cleveland. There are three agencies through
which ambulance service may be obtained: the police patrol, the private

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242 The Cleveland Year Book

undertaking establiahments, and the City Hospital, which |
one ambulance. While the police patrols are prompt, they carry no
first aid Idt, an inexcusable omission, and there is a natural aversion on
the part of the dticens to riding in a poKoe emergency ambulance.
Nor do they rdish being carried through the streets in the undertaker's
''dead wagon." The City Hospital ambulance gives most unreliable
service, even postponing a call two days. There is complaint, too,
about the failure to fumigate the ambulance after use. Each large
hospital needs its own ambulance, and the smaller ones could maintain
such service by combining.

Eighty-seven and a half per cent, of the patients who leave the
hospitals go home to unfavorable surroundings. It is the duty of the
hospital to give instruction for home convalescence and to make
definite suggestions for use of the dispensary. A dty as large as
Cleveland should have institutional accommodations for 12,000
convalescents during a year. Such a home should be in the country.
The building need not be new or expensive and the cost, which is
only half that of hospital care, could be borne by charging $1.76 per
day. At present the hospitals must take care of convalescents, as is
proved by the fact that 12.5 per cent, of the hospital cases observed
had been in the institution over two months.

Sodal service in hospitals and dispensaries of Cleveland has beeii
only slightly developed. Those organizations that are in existence are
too dosely confined to hospital admission and dispensary records. It
should not be the province of social service workers merely to be kind
to the patients, that is the general duty of the hospital, nor should these
workers have to spend their time admitting patients and learning their
finandal status, important as this work is. Their distinct duty is to
be an adjunct to medical treatment, a link between the hospital and
the home.

Fordgners are prone to think of hospitals as "places where you go
to die." It devolves upon the hospital to quiet their fears, not only to
make them understand but to render them understood. It is excellent
practice to provide interpreters and foreign visitors who contribute
valuable help.

Cleveland's lack of appredation of dispensary service is indicated
by the fact that there are only twelve calls at dispensaries per 100
population here, while in New York, Boston and Chicago, there are
dghty , fifty, and forty, respectively. Six hospitals conduct dispensaries
and each of the seven health centers supports one.

It is evident that the hospitals and dispensaries of Cleveland were
planted, not planned. Each has grown without any relation to the
other. The time has come when a community plan should be realised.

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Public Health Work 243

so that the preeent neglect of care of children, and of eye, ear and nose
diseases will be impossible.

Too much cannot be said of the good work do&e by the Cleveland
Hospital Council. Organization is only machinery, however, to make
the road smoother. Ultimate success depends upon the individual
soul, dvic pride, and spirit of co-operation, qualities which Cleveland
has always manifested in a very large degree.

Accomplishments Since Survey Was Made
It is too soon to estimate the results of the Survey, which was
not published until December, 1920, or to expect any radical
changes in health work following recommendations made by the
Survey. Progress has, however, been made, a part of which may
be credited to the Survey and a part to the initiative of existing
health agencies and individuals whose interest in the subject has
built up the extensive organizations, both public and private,
which promote health work in the community.

The following is a partial inventory of these accomplishments:
As a result of conferences with the Survey Staff in the fall of
1919 the Board of Education was able to incorporate their recom-
mendations in its 1919-1920 school program.

The Departments of Physical Training and Medical Inspection
of the public schools have been co-ordinated and physical examina-
tion of all the children entering school is made and records kept
on cards which call for both physical and social data. Examina-
tion is made of all children in the third grade, and when time
permits, of children in the fifth grade.

School physicians working on regular schedules among the 125
schools, three hours per day, have examined 96,485 children
during the current year. A staff of thirty- two nurses working
full time made 15,546 home visits, gave 10,799 class talks and
cared for 81,192 dressings and 85,783 treatments. A total of
6,033 have been treated in the school dental clinics.

A physician devotes full time to children seeking working
permits. A physician skilled in the treatment of trachoma was
appointed upon the medical staff in the fall of 1919 to meet the

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244 The Cleveland Year Book

emergency of a trachoma outbreak at the Murray Hill Sqhool.
One hundred and seventy-eight cases were treated. A total of
3,031 patients have been treated in the school eye clinics. Nutri-
tion clinics have been started where under-nourished children in
groups of twenty meet once a week and are instructed in proper
diet and general health habits. Each child is given a complete
physical examination in the presence of the mother. Advice is
given to mothers of children over ten years of age in methods of
goitre prevention.

The work of the Medical Inspection Department of the sdiools
is now correlated with other activities such as open-^air rooms,
sdiools for crippled children, classes for the handicapped, and
classes for defectives, and with the attendance department. The
work is also correlated with all those agencies having to do with
^ child welfare.

Progress is being made in orthopedic work, as the following
report of the Secretary of the Association for the Crippled and
Disabled indicates. ''An Orthopedic Council has been formed
having on its membership orthopedic surgeons of the city. The
location for the establishment of an Orthopedic Center is being
sought. Plans are being made to arrange for a Central Brace
Shop. Rainbow Hospital has opened its doors to patients from
all the hospitals of the city. An orthopedic surgeon has been
put on the staff of City Hospital. The public school is enlarging
its work for the crippled school children, is arranging for home
teachers for home-bound children, is having children given a
physical examination for the detection of orthopedic difficulties,
is extending its physiotherapy work for the children at the school
for the crippled, and is interested in posture work and special
corrective exercises for the children in the regular school. The
public school is also about to begin work on the construction of a
new special school for crippled children which is expected to be a
model of its kind."

Nursing activities have been centered in the Perry Hoiise, 2157
Euclid Avenue, where are located the offices of the Visiting Nurse
Association, the Anti-Tuberculosis League, Central Committee

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Public Health Work 245

on Public Health Nursing, Central Registry for Nurses (open
day and night), the editorial office of the Public Health Nurse
magazine, and the Ohio State Committee of the National Organiza-
tion for Public Health Nursing.

The Central Committee on Public Health Nursing, created for
the maintenance of uniform standards of training and of public
health nursing throughout the city, receives all nurse applicants
for public health work and secures credentials, accepts or rejects
applicants, assies them to various public health organizations
and transfers applicants from one organization to another; dis-
cusses and recommends uniforms, recommends salary schedules
and studies equipment. The following organizations are rep-
resented on the committee by one lay-member and the superin-
tendent of nurses, the Division of Health of the City Welfare
Department, Board of Education, the Babies' Dispensary, The
Visiting Nurse Association, the Western Reserve University
Teaching District, the Outpatient Department of Maternity
Hospital and of Lakeside Hospital.

An association of 104 nurses, employed in industrial plants, has
been formed to confer regarding standards of work for the nurses
employed in the thirty-six industrial plants of the city and to make
an effort to extend their work to more plants.

In April, 1920, the voters of the city authorized a bond issue
of $2,500,000 to be vised for a new City Hospital. Work was
begun in November and it is planned to have the new buildings
ready for occupancy by January, 1922. The present number of
800 beds will be increased to 1,500 with ample provision for many
classes of cases. Fresh air treatments are to receive particular
attention, all of the wards being built on the fresh-air plan.

Plans are drawn for a group of buildings on the University
campus to consist of the Medical School, Lakeside Hospital,
Babies' Dispensary and Hospital and Maternity Hospital.

Lakeside Hospital is in the process of re-organization. The
Board of Lady Managers has been discontinued and women are
now serving on the Board of Trustees. The Dispensary has in-

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246 The Cleve land Year Book

creased its staff of social workers from three to nine and the present
staff includes a Director, four nurses and five lay social workers.
The position of Medical Director of the Dispensary was created
during the past year.

St. Alexis Hospital is remodeling a building, on the groimd
floor of which will be opened a dispensary in connection with its
new laboratory. The laboratory will be equipped with modem
apparatus for which an appropriation of $10,000 has been made.
Steps have been taken to secure a resident pathologist who will
have a competent staff. The hospital staff has been re-organized
so that there are three major divisions, that of medicine, surgery
and laboratories, with a director in charge of each.

At Huron Road Hospital the dispensary work is now being
followed up by home investigation and a technician has been
employed for the pathological department.

Charity Hospital is expanding its dispensary work and home
investigations through an increased staff and change in record

A cardio-vascular clinic has been established at Mt. Sinai
Hospital, with a full-time physician in charge.

The Babies' Dispensary and Hospital has changed its admission
policy and now accepts children up to the age of fourteen instead
of limiting its service to the child imder three. The year has
marked three new activities of the Dispensary:

(1) The operation of the Babies' Special, an automobile
clinic which tovas the outlying districts and the rural com-
mimities of the county.

(2) The establishment of a dental clinic for the pre-school
age child.

(3) A campaign for the vaccination of children against
diphtheria. The campaign is being maintained during its
first year with funds privately contributed but it is hoped
later to have it taken over by the Division of Health of the

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Public HeaUh Work 247

The Community Chest has appropriated fimds to finance a
Public Health Council as recommended in the Survey and plans
are imder way for the formation of this Coimcil.

On February 26th the Cleveland Clinic, an institution for the
diagnosis and treatment of the sick and for medical research was
opened by four Cleveland physicians, who have pledged one-
fourth of their net income and that of their successors to its

Dr. Greorge W. Crile, in announcing the clinic foundation, sum-
marized the founders' ambitions and purposes and the f oimdation's
duty as being, "not only to provide every means in its power to
further the perpetuation of the clinic as an aid to those needing its
assistance in solving the problems of the patient of today, but
through its investigations, its statistical and clinical records,
through its chemical, serological, bacteriologic and physics
laboratories, seek new light and new facts that they may aid in
taking care of the patient of tomorrow."

The Sanitary Code which was the result of two years' work of
the committee on Housing and Sanitation of the Chamber of
Commerce was passed July 12, 1920, after being before the city
Council for consideration for two years. This code regulates the
maintenance of existing buildings, controls the practice of trades
and occupations, the manufacture and sale of food, the keeping of
animals, the disposal of city waste and the abatement of nuisances
as well as the control of commimicable disease. It is one of the
first attempts to codify all of a city's health and sanitary regula-
tions, and it constitutes a forcible weapon, providing adequate
provision is made for its enforcement. This has not as yet been

The Community Betterment Council has continued the smoke
tests which were begun by the Hospital and Health Survey,
carrying them through the winter months. It has completed the
report on the smoke nuisance and will soon start upon its program
of working toward the abolishment of this nuisance through
education and prosecution. The Community 6etterment,Council

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248 The Cleveland Year Book

has also taken steps to co-operate with city officials in alleviating
some of the conditions ari^g from the inadequate work in street
cleaning and the disposal of city waste, and the abatement of
other nuisance. It is accomplidiing its work through neighborhood
organizations and an annual clean-up campaign, which in turn
make a demand upon the city for better service and a higher
standard of municipal sanitation. Because this City Betterment
Council opposed an ordinance introduced into the Council that
would make null and void very important sections of the new
sanitary code, such ordinance was not passed.

Notwithstanding that Cleveland paid more than fifty thousand
dollars for the Hospital and Health Survey and that the Survey
showed that the Division of Health does not expand its activities
because it does not have sufficient budget to allow for such ex-
pansion, the appropriation for the Division of Health was cut
more proportionately than that in any other important city
division. Increases over last year's appropriations for the Depart-
ment of General Administration were 35 per cent., for the Depart-
ment of Public Service 17 per cent., for the Department of Public
Welfare 9 per cent, but for the Division of Health, within the
Department of Public Welfare, an increase of only 3 per cent,
was appropriated. No group of persons representing health
interests in Cleveland attended the Council hearings to protest
the cutting of the budget, to point out the findings of the Survey
and to urge an appropriation of sufficient amount to carry out the
recommendations of the Survey.

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The report of the Recreation Survey conducted under the
auspices of the Cleveland Foundation was published early in
1920. The report is divided into seven parts, and each part is
published in a separate volume as follows: Delinquency and
Spare Time, by Henry W. Thurston; School Work and Spare Time,
by F. G. Bonser; Wholesome Citizens and Spare Time, by John L.
Gillin; Commercial Recreation, by Charlotte Rumbolt and Raymond
Moley; Sphere of Private Agencies, a compilation by experts;
Public Provision for Recreation, by Rowland Haynes and Stanley
Davies; A Community Recreation Program, by Rowland Haynes.

The result of the Survey is the establishment of the Recreation
Council whose purpose it is to make effective the community
recreation program. The following section was prepared by its
director, Rowland Haynes:

The recreation problems of the city fall under eight heads:

(1) How may the play hours of children under sixteen years of
age be used for real education? The average child spends nearly
twice as much time in play as in school. The lessons of play time
for the growth of habits which use or waste the school training
hold quite as much for future success or failure as the lessons of
the class room.

(2) How many young people over sixteen years of age get
active athletic sports necessary for body building? Two factors
especially influence this problem. Physiologically, during this
period the body machine is filling out and hardening to meet the
strenuous work of adult years. Most young people are beginning
the more conflning occupations of wage-earning-. How can we
build the body under conditions of wage-earning?

(3) How may we provide under city conditions more active
recreation for those over thirty-five years of age? After thirty-
five comes the period of greatest danger from organic diseases of
heart , lungs , kidneys and the digestive tract . Insurance and public

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250 The Cleveland Year Book

health statistics show that we are winning our fight against the
germ diseases, but are not being so successful in our fight against
organic diseases. Lack of exercise is a very large contributing
cause to the prevalence of organic diseases after the age of thirty-
five. The needless decline of working power of our middle-aged
group, richest in experience, is an incalculable loss to the city.

(4) How may we guide the spare time activities of delinquents
and near delinquents, especially among the juvenile group, to
prevent the fixation of habits of law breaking? The percentage of
apprehended juvenile delinquents compared with the total
population is small, but equally delinquent habits are in formation
among a considerable group of the population.

(5) How may we provide adequate opportunities imder whole-
some conditions for young men and women in the later teens and

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Online LibraryCleveland FoundationThe Cleveland year book 1921- → online text (page 20 of 26)