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TABLE No. 4.District of Columbia death rates and estimated number of lives

saved, 1937-46

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TABLE No. 5.Relative rank (from low to high) of Washington, D.O., among large

cities from selected causes of deaths, 1937 and 1945

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Number of deaths were obtained from the Census Bureau. Rates were computed by the District of Columbia Health Depart mert from its own population estimates.

Data collected by means of a questionnaire sent to the 31 largest cities by the Bureau of Vital Statistics of the Health Department.

Consists of typhoid fever, meningococcic meningitis, scarlet fever, diphtheria, influenza, poliomyelitis, whooping cough, and measles.

(Functional outline chart furnished is on file with the committee.)

Mr. Bates. The next witness is Mr. Ray Huff of the Welfare Department.

While Dr. Ruhland was on the stand I asked him a question, and I would like to ask you a question and would like to have you answer that question in front of Dr. Ruhland. Are there any persons on the welfare rolls who are eligible and qualified for the type of work that they are doing in these hospitals for which there is a great demand! I am speaking now of the fact that I forgot that you were in the room when Dr. Ruhland was here, and I am asking about the availability of anybody on the welfare rolls who is qualified and available in every respect for a position that you have available, and if so, what has been done about getting them off the relief rolls and on your pay roll ?

(Statements later received for the record from the District of Columbia Health Department covering a 10-year period follow.) District of Columbia Health Department (excluding hospitals )—Number of

employees and amount of appropriations, 1937 to 1946

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1 $13.000 deducted from Gallinger and added to Health Department for out-patient relief. ? $26,760 deducted from Gallinger and added to Health Department for out-patient relief.

EXPLANATION OF INCREASES

1938: In this year Gallinger Municipal Hospital, Glenn Dale Tuberculosis Sanatorium, and certain aspects of medical charities were transferred to the Department of Health. 12 employees in the Hospital Permit Bureau were transferred to the Health Department proper. In addition to these increases, the following new positions were also created :

Food inspection : 4 inspectors.
Laboratory: 4 techniciains, and 1 clerk.
Nursing : 10 nurses, and 1 clerk.

Medical inspection of schools: 6 physicians, 4 dentists, 2 hygienists, and 1 clerk. The dog pound was transferred away from the Health Department, thus offsetting some of the increases mentioned above.

1939 : In this year positions were created for a business manager, 5 Public Health nurses, and 4 physicians for tuberculosis and renereal-diseases control.

1940: A Superintendent of Health Department Buildings was added and the business manager's position was eliminated. In the Bureau of Maternal Child Welfare the basis of counting special class physicians was changed, thus showing a reduction in the number of positions.

1941: Positions were set up for the following employees: 1 telephone operator, 1 dentist, 2 nurses, 1 physician and 2 clerks for tuberculsosis control, and 1 technician and 1 laborer for the laboratories. 1942: The following positions were created :

Administration : 1 clerk.

Hospital Permit Bureau: 2 field workers and 2 clerks to investigate patients desiring free medical care.

Nursing Bureau: 3 nurses.
Preventable diseases : 1 clerk.

Tuberculosis control: 2 physicians (part time), 1 X-ray technician, and 2 clerks.

Venereal diseases control: 4 physicians and 1 clerk.
Laboratory: 1 technician and 2 laborers.

Sanitary inspection : 2 inspectors.
1943: In this year the following additional positions were created :

Administration: 1 medical officer for the Southwest Health Center, 1 clerkstenographer for the Southwest Health Center, 1 junior clerk for the Polk Health Center, and 1 messenger.

Hospital Permit Bureau: 2 field workers to investigate persons requesting free medical care, 1 pharmacist, 1 clerk-stenographer.

Vital Statistics : 1 clerk.
Dental: 7 dental hygienists, 2 clerks.

Medical inspection of schools: 2 audiometer technicians to make hearing tests, 1 attendant.

Nursing: 1 assistant director, 52 nurses, 4 clerk-stengraphers.

Preventable diseases : 4 physicians and 2 clerks to operate foodhandlers' clinic.

Tuberculosis control: 1 X-ray technician, 4 clerks.
Venereal diseases control: 3 medical attendants, 2 clerks, 1 custodian.

Laboratory : 5 laboratory technicians to make serological tests, 1 laborer, 1 clerk.

Food inspection : 21 inspectors and 2 clerks (to inspect establishments which store, process, or serve food).

Public health engineering: 8 inspectors and 3 laborers (to make inspections of environment conditions and perform rodent-control work). 1944: In this year increases were allowed for the following purposes :

Bureau of Public Health Engineering: 1 sanitary engineer to direct the activities of the Bureau.

Nursing: 3 nurses.
Medical service: 2 clerk-stenographers.

Housekeeping assistance: 1 supervisor, 2 field workers, 1 clerk, 30 housekeeping aides to give assistance in homes where the mother is ill and thus eliminate the need for breaking up the family and institutionalizing the children and sick mother.

Legislation granting an increase in salaries also became effective this year, thus increasing the cost of operation. 1945: In this year additional personnel were provided in the following Bureaus:

Administration : To assist in preparing pay rolls.

Hospital Permit Bureau: To investigate patients requesting free medical care.

Dental: To provide improved dental service in dental clinics. Nursing Bureau: To provide additional public health nurses for field and clinic work.

Tuberculosis: To provide additional physicians and technicians to assist tuberculosis control work.

Laboratory: To provide technicians for serological examinations.

Publ'c-health engineering: To provide inspectors and laborers to make inspections of environmental conditions and assist in rodent control work. 1946 : In this year the number of part-time physicians was increased to provide improved medical service in clinics of the Department. In this year an increase of salaries was also granted to employees, thus increasing the cost of operations.

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1938: The fiscal year 1938 was the first year of the operation of the sanatorium as one unit, prior to that time it had been operated as two units, the adult hospital at Upshur Street and the children's sanatorium at Glenn Dale. The increase of seven employees in this fiscal year is the beginning of the expansion necessary to take care of the new sanatorium as it was opened up and began to be filled with patients.

1939: The addition of 28 employees in this year was necessary to more nearly complete the staff of the sanatorium to care for the increased number of patients. These increases were principally for increased ward care and the increased work in preparation of food.

19 10: The addition of 54 employees was necessary so that the entire hospital could go from a 56-hour week to a 44-hour week and to allow for full-time vacations in compliance with the leave laws. These positions were principally lowgrade positions in the ward service and dietary service both of which have to function 24 hours a day 7 days a week. In addition this was the first year that the sanatorium operated at approximately its capacity.

1941: There was an addition of 32 positions, which the experience of the year before indicated was necessary to provide proper care for the patients with the sanatorium in full operation at the reduced working hours.

1912: There was an increase of 10 positions in this fiscal year. Two were in the treatment service and the remainder were in the dietary service to provide further improvement in the preparation and serving of food to the patients. The increases in this year also begin to reflect increases in the cost of food and other maintenance items, which were very substantial and continue to the present time. Also in this year an attempt was begun to improve the quality of the food that was provided the dietary service to meet demands of the patients and the public.

1943: There was an increase of only one position in this fiscal year, however, there was a very large increase in the salary appropriation due to two acts of Congress in this year which materially affected the salaries of employees. The first was Public Law 694, effective August 1, 1942, by reason of which the C. U. classification was changed to the C. P. C. classification and the annual salaries of this group, which comprises more than 50 percent of the employees, were raised. There was also a large increase due to Public Law 821 effective December 1, 1:942, paying a bonus to all employees in lieu of overtime.

1944 : There was an increase of only one employee in this year; however, the increases in the cost of food and maintenance materials for a plant, which now is part of it 10 years old, is beginning to be felt. There is also an increase in salaries reffected since the two increases in salaries of the year before were in effect only part «f the year.

1945 : There was an increase in this fiscal year of 18 employees. Four were to collect garbage on the various floors, four to take care of increased demands on the laundry, three to provide a bus service for employees due to the isolation of the sanatorium from population centers of the Metropolitan area of Washington and the remainder scattered in the various services to improve their efficiency. In this fiscal year a considerable additional amount was necessary in repairs and improvements to buildings and grounds due to the deterioration of the entire plant for lack of preventive maintenance.

1946: In this fiscal year there was an increase of 44 in number of positions allowed. This amounted to a pretty thorough reorganization of the staff particularly those who come in direct contact with the patients. The ward service was relieved of all responsibility of cleaning the wards and supervising the diet kitchens. A completely separate housekeeping service was set up with complete and exclusive responsibility for cleaning the buildings including the patients rooms, accounting for 24 of the new positions. The dietary service was reorgan zed to allow the dietitians to give much more attention to the individuals needs of the patients accounting for 13 of the new positions. The remainder of the positions were created to improve all services on the same scale. The appropriation this year also reflects partially the increases due to the Federal Pay Act effective July 1, 1945 ; however, it is not all reflected due to the fact that more than half of these increases were paid out of lapses of positions which could not be filled during the year. In addition there were 30 positions which lay dormant during the year and for which no money was appropriated.

Gallinger Junicipal and Tuberculosis Hospitals-Vumber of employees and

amount of appropriations, 19.37-16

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$13.000 deducted from Gallinger and added to Health Department for out-patient relief of the poor, 2 $26,760 deducted from Gallinger and added to Health Department out-patient relies of the poor.

1938: The trend toward steady increase in patients called for additional personnel to care for them. The daily average for 1938 was 833.6.

1939: The daily average patient load increased from $33,6 in 1938 to 879.2 in 1939. Six physicians and five nurses were provided to aid in caring for this additional load.

1940: A total of 97 new employees distributed throughout the hospital was provided for this year. The patient load increased from 879.2 in the preceding year to 910.7.

1941: A total of 72 new employees was provided for this year. The patient load, still on the rise, had now increased to 1,0.52.7. Effective October 1, 1941, the Meade-Ramspeck bill provided for periodical within-grade salary increases for all hospital personnel. This not only caused an increase this year but was reflcted in subsequent years.

1912: This year, two new buildings were put into service. The medical building with a bed capacity of 226 and the tuberculosis building with a bed capacity of 225. A total of 135 new employees, largely to staff these new buildings were provided. In addition, effective August 1, 1942, all employees in the civil-service classification, “Crafts, protective and custodial" under grade 9, received an approximate 10 percent salary increase. Employees in this classification comprise 29 percent of the total hospital personnel.

1943 : 1 he old hospital at Fourteenth and l'p hur Streets NW, was reopened this year under the administration of Gallinger Municipal Hospital. As the buildings were ready for occupancy late in the fiscal year, only a part of the full number of employees required to staff it were provided. An additional 55.8 employees were provided for this hospital. An additional 12.2 employees were provided for Gallinger proper. Effective July 1, 1943, legislation provided for a flat $300 annual increase in lieu of overtime over 3) hours a week.

1944: With the l'pshur Street Hospital operating the full year, an additional number of employees were provided for a full-year staff. Costs of supplies and materials has now begun to increase operating costs because of wartime higher prices.

1945: With the patient load remaining about where it was in the preceding year, only 17 new employees were added to the staff this year. Effective July 1, 1945, the civil service salary reallocations provided a grade increase for all professional nursing personnel. Public Law 106 also became effective July 1, 1945, providing an approximate 11 percent increase to all personnel. Legislation, again effective this same date, provided a differential salary increase of 10 percent to all employees working between the hours of 6 p. m. and 6 a. m. This effected about one-fourth of the total hospital personnel.

1946 : No increase in personnel was granted for this year. Daily patient average decreased from 1112.5 in 1945 to 1037.1 in 1946. The drop in patient load, however, was due to the closing of floors because of inability to secure nursing personnel to care for them. July 1, 1946, Public Law 390 provided the salary increase to all hospital personnel of 14 percent.

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