THE 1I

Lack Of The Proper Data On
Many Problems Is Impediment
To Medical Committee's Work
Editor's Note: This is the ei-;hth of a series of articles, written
by Profcsscr Wesley H. iMaurer o' the Department of Journaliszn at-
the University of Michigan, concerning a survey; of medical serv-
ices and health agencies made )y a group of physicians. for -the
Michigan State Medical Society. The committee, headed by Dr.
W. H. Marshall, Flint, is comprised oif Dr. F. C. Warnshuis, Grand
Raplds, seoretary ex-officio; Dr. L. G. Christian, Lansing; Dr.
Bert Estabrock, Detroit; Dr. C# t. Gorsline, Battle Creek; and Dr.
F. A. Baker, Pontiac. The study was directed by Dr. Nathan Sinai,
professor of public health at the University..
By WESLEY H. MAURER
The final chapter of the survey of medical 'care and health agencies
recently made for the Michigan State Medical Society for its annual con-
vention in Lansing, July 12, brings the study to a close with such a picture
of needs in the field of cancer, indigent cases, tuberculosis, and medical
care for negroes that one wonders, with some despair, at the countless
problems in public health yet to be surveyed and discussed with the public
and the profession.
In this chapter, as in other chapters, the committee struggles with
incomplete data. Aside from the information given in these miscellaneous
ieports of subcommittees, the concluding study is a plea for more accurate
systems of record keeping, more in- -- -

on an average of 16 to 18 months of
hospital care while the early case
requires only about 9 months.
Clinics Serve,18 Per Cent
The study of free and part-pay
clinics in Detroit'shows, aaout
18 per cent of .the total population
of Detroit attended in 1931 the free
and part-pay clinics. Visits to the
clinics associated with the Commu-
nity Fund ai iountedc to, according
to the committee's estimates, $450,-
000 to $500,000, to which the com-
munity fund appropriated $310,000
to $360,000 in 1931. The service of
physicians, given gratis, is estimated
to raise the cost from $500,000 more.
In a report prepared for the study
by a sub-committee on the medical
care of negroes, the desperate need
of hospitalization for. the 120,QOQ
negroes is shown. There are only five
hospitals for negroes exclusively, and
these five hospitals provide for only
250 to 300 beds. In addition to this
need, there is. also necessary more
negro training nurses an0 nrio e negro
internes, the report declares. At the
present time there are 80 negro phy-
sicians in Detroit.
"One of the larger and well-ap-
pointed hospitals in Detroit,"" reads
the report, "welcomes the negro on
equal terms with other races. Other
hospitals that have taken negro pa-
tients in fairly large numbers in-
variably require them, to pay for pri-
vate rooms at an expense which they
can ill afford. It is seldom that their
private physicians, thereafter, can
care for them,.since negro physicians
are not welcome on. the staffs: of
these hospitals."
"Uncared-for diseases in a poor
and neglected section ,of a commu-
nity," the- report declares, "may'be-
come a menace to the best .section
of the same community. The care
of the least fortunate insures the
well-being of the more fortupate and

tegrity in the making out of vital
statistics forms. It does seem a
trgedy that in so vital a problem
as medical care those who would
know the facts should find in their
search that our social record keeping
is so inaccurate and incomplete. The
survey as a whole is in itself a dem-
onstration of how effective is the elo-I
quence of facts, for it goes to the
convention with data as the defen-
sive and offensive of the' commit-
tee's recommendations. What future
progress is made by the medical pro-
fession in co-operation with the pub-
lic will depend upon the availability
of more facts of problems toward
which the survey committee points.'
Cancer Toll Great
The sub-committee .on cancer in
the state does. not, for instance,f
know what is the actual toll of can-
cer each year. According to the vital
statistics, there were reported .in
1931, 4,610 deaths from cancer. The
committee believes, however, that the
actual number was in excess of
6,000.
The vital statistics are considered
by the committee as inaccurate, be-
cause a great many deaths from can-
cer in the aged are very likely un-
diagnosed. Moreover, cancer is very
seldom given as a contributory cause
of death. In addition to this, physi-
cians, the committee contends, are
often prevailed upon to falsify death
returns because of the layman's be-
lief that cancer carries with it a so-
cial stigma. This leads the sub-com-
mittee to recommend that "physi-
cians should endeavor to improve ac-
curacy with which death certificates
reveal cancer mortality, by stating,
the true cause of death when known
to be from cancer, by greater atten-
tion to the diagnostic problems in
the senile, and by more frequent au-,
topsies."
Citing further figures on cancer,
the report points out that there must
be at least 15,000 persons in Michi-
gan now suffering from the disease.
To these, the report adds, must be
added the unknown number who
suffer f r o m malignant diseases
though they will die from other
causes.

I

Fact-finding surveys are asked for by
the committee so that present needs
may be revealed and. future neces-
sities may be anticipated. The estab-
liehment of diagnostic clinics in the
larger hospitals is advocated by the
committee, and treatment centers,
adequately equipped, are recom-
mended. In this connection, the
committee points out that in Michi-
gan .there are only three grams of
radium available. There should be,
the committee explains, about ten
grams in the state. The committee
also warns against. renting or lend-
ing of radium to persons untrained
in its use. At least two cancer insti-
tutes, where original research in
capcer may be directed, should be
set up, the report recommends.
In contrast to the dismal picture
which the cancer problem presents,
the declining death rate of tubercu-
losis .presents real. hopes .of virtual
eradication of the disease. If the
present rate of decline continues in
Michigan; the death rate at the end
of 1957 is likely to be 5.7 per 100,000
persons.
Report On Tuberculosis
Some of the facts brought out in
the report on tuberculosis in the
state are:
1 Of the cases diagnosed at the
Herman Kiefer Hospital Clinic, 20
per cent were in the early stages, 30
per cent were moderately advanced,
and 50 per cent: were far advanced.
Because of the : difficulty in persuad-
ing the patients .to take sanatorium
care, 62 per cent, of the cases go to
advanced 'stages.
2.. About 90 out of every 100 pa-
tients< received in a sanatorium in
the-state are moderately advanced
or far advanced cases.
3. With sanatorium care costs
ranging from $20 to $25 and more
per week, only a small fraction of
the patients can pay their own way.'
In Wayne County less than 10 per
cent of the 2,400 patients hospital-
ized pay even a part of their main-
tenance cost. Yet the sanatorium
literally offers their one hope of life
and death to most of the patients it
hospitalizes.
4. From 20 to 40 per cent of many
thousands of high school students
tuberculin tested, give positive tu-
berculin reaction showing infection.
5. The moderately advanced-ad-
vanced and advanced cases require

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Death Rate Increases
The number of ;cancer deaths has
been steadily. rising since 1900, the
report continues, showing that in
1900 the cancer death rate per 100,-
000 persons was 60.3; in 1910, 74.9;
in 1920, 84.9; in 1930, 91.3, and in
1931, 93.5, or an increase of 53 per
cent in 31 years. It is likely that
better diagnosis is responsible for
this increase, although the commit-
tee explains, this must yet be proved;
it is probable that there may be an
actual increase in malignant diseases.
The death rates of other diseases
have meanwhile fallen. Typhoid
fever, which in 1900 took a toll of.34k
persons per 100,000, in 1931 took
only 1.5. Diphtheria fell from 19.6 to
35; tuberculosis fell from 102.4 to
45.9.
It is altogether likely, the commit-
tee believes, that cancer is on the
increase because the population isj
becoming older, for cancer, the re-
port reads, is :considered a disease
of later maturity and senility. The
committee quotes Dr. Louis I. Dublin
in his estimate that by 1950, 23.6.
per cent of the total population will
be over 50 years of age, as compared
with 15.4 per cent of the population
in 1920. On the basis of the present
trend of cancer the past 30 years,
considering the population as stable,
there will, it is believed, be 22,000
cases of cancer in Michigan by 1963."
i Sufficient Radium Unavailable-
It is recommended in the report
that there be more adult education
for lay adults and school children,,
and moredhighly specialized cancer
education for the medical profession.

i
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