Evening star. [volume] (Washington, D.C.) 1854-1972, 1931-03-08
CITIES AND RURAL AREAS
LACK HEALTH AGENCIES
Uneven Distribution of Physicians and
Cost of Medical Care Studied in
Survey of United States.

with q personnel OF 10, and several
Christian Science practitioners, several
chiropractors, one optometrist and one
osteopath. Some patients are attended
by physicians from outside the county,
go to specialists in indianapolis or are
sent to outside hospitals.
Physicians do not move around as
much as some of the rest of us. OF
those in Shelby County the latest ar
rival had been practicing there for two
years and the dean had been there for
SO years-the average was IS years.
Three-fourths Of the physicians had
been out of college for IS years or more.
Specialization has not gone far and
most Of the physicians look on them
selves as general practitioners.
Doctors Hours Long.
A Shelby County doctor does not lead
too easy a life. One mans average
working week was 98 hours, or IL hours
day, including Sundays. Eleven others
worked 10 hours a week. Except for a
few who do not make outside calls the
typical Shelby County physician spends
his mornings visiting patients, in their
homes or at the hospital, the early part
OF the afternoon at his office, the late
afternoon in calls, and the evenings in
his Office, with calls after $3.50 or
O'Clock II they are necessary.
One Shelbyville doctor had an aver
age of 800 ofice calls q week; four
others had 200 or more. Naturally this
left little time for medical or other
reading. The waking hours Of a con-
scientious and successful practitioner
were largely given over to his patients.
He was at their service to an extent not
equaled in any other profession. He
was probably more continuously at work
than any other man in the county, with
the possible exception of some Of the
more energetic farmers.
The IS resident dentists have an
easier time Of 1t, for they work on the
average only about A hours a week
very nearly union hours. The people
Of Shelby county, for the most part,
refrain from visiting the dentist at all
until their teeth ache or their faces
swell. Among the working people four
cut Of five do not come until extrac-
tons are necessary.
Nurses Prefer Cities.
Though Shelby County had but two
registered nurses when the survey was
made, others are often called from In
dianapolis when needed. But nurses,
like other people, feel the call of the
bright lights. Nurses" said one doctor,
prefer the city and regular hours at
less money" OF II practical nurses
who were interviewed only four had any
kind Of training. and the average age
was IS. On the whole, Shelby County
people do not receive skilled nursing
care unless they are sent to a public
institution or can afford 10 go to O
private hospital.
A great many Of the county's reA-
dents try to treat their own ailments,
at least UP to a certain stage. They
buy from drug stores, sometimes on
advice of the pharmacist, from mall
order houses, from house-to-house sales
men, and occasionally from the pro-
prietors Of travelling medicine shows"
These latter still flourish, though they
are probably not as common or as pros
porous in Shelby County or elsewhere
as they used to be. Some groce.S
stores sell patent medicines Of the
better advertised brands.
Altogether 1t Is estimated that Shell
by County spends each year about
$1S7 900 for medicines and drugs, or
nearly $50 for each family of four per-
sons. How much Of this does Shelby
County any good is debatable. Some
probably do more harm than good.
Less than one-sixth of the whole is pre-
scribed or furnished by physicians. The
rest represents the layman's guess as
to what will cure a cold, a stomach
ache or some serious ailment,
Health Agencies Few.
Public health agencies are few in
Shelby County There are no clinics
apart from a private diagnostic clinic
and a free tuberculosis clinic held
quarterly" There Is a county health
officer, q physician, but "a physician
receiving only S402 as his yearly salary
as county health officer cannot reason
ably be expected to devote much time
to the performance of his duties"
Health work among school children
is done almost entirely by the local
health nurse. In one school year she
tons to 1,400 of the 1000 school chill
dren of the county, and almost 1000
limited" inspections. The need of
service may be inferred from the fact
that In complete" inspections over
1900 defects of skin, ears and hearing,
nose and throat, teeth, vision and pos
ture were found, more than 1900 chill.
dren having dental defects.
Out of public funds in 1928 Shelby
County spent $4,000 for the care Of
illness, that is, for State and county
health departments, for local and State
hospitals and for the care of INDECENT
persons. Public health activities ac-
counted for barely per cent of
this total. The county health Office
spent $657, one-third of l per cent
of the total operating expenses of the
county. Shelbyville spent $1,411 on
its health department, one-half Of l
per cent Of the citys operating ex-
penses.
Situation is Typical
Such is the medicar situation in a
typical county in a State whose per
capita wealth is about the average of
County could afford better and better
organized medical care is a question
which there is no room to discuss here.
It is evident, however, that it Is not
getting the best that modern science
knows how to furnish. What we may
call its health standard of living is
well above that Of many counties in
the United States, but certainly well
below an ideal standard. The county
and an unnecessarily high death rate
what it does not pay in dollars. A
dictator with an unlimited budget
could perhaps make this community,
supposing no other communities were
being similarly dealt with, the health
lest In the world. But since dictatoIs
do not fit into anything that ran be
called an American plan the problem
of Shelby County's health remains an
open one.
So too. does the problem OF Americas
health In general. Our actual medi-
cal facilities are one thing. our poten-
tial medical facilities quite another.
Health Is one of our underdeveloped
resources. How much It is underdevel-
oped Is question which cannot be sta
tIstically answered without much more
knowledge chan we ut present have.
The conscientious physician may
know that he can do much more than
his predecessor of even 10 or 20 years