ing as the sick, a situation which is bad for both. Likewise, the 

 tubercular must be lodged in the same building with the surgical 

 and medical cases, another bad feature. Tuberculosis pavilions 

 and cottages for the indigents should be built. The accomoda- 

 tions for the insane are unsatisfactory. Provisions for their 

 treatment should be made the subject of a special study. These 

 are the most pressing and immediate needs. Ninety per cent, of 

 the cases now treated at the County Hospital are from the city 

 rather than the county. A natural division of responsibilities 

 requires that the city should do its part by erecting a modern 

 and adequate hospital for contagious diseases. When tubercu- 

 losis cottages are provided there should be an increase in capac- 

 ity to care for more patients than is now possible at the hospital. 

 Separate cottages should be built for the treatment of incipient 

 and advanced cases if the best results are to be attained. The cost 

 of these cottages need be very little, — certainly no cause for de- 

 lay. The care of the tubercular is one of the most pressing needs, 

 and the first step in the campaign to reduce San Diego's enorm- 

 ous death rate from this disease. For the protection of the lives 

 of residents, visiting nurses also should be provided, in order that 

 those who can be treated properly in their homes may be left 

 there, and those who can not be so left with safety may be taken 

 to the hospital. A minor factor, but one of importance if the 

 most dangerous cases are to be reached, is the changing of the 

 name of the institution for such treatment from "County Hos- 

 pital" to "Sea View Sanatorium," or some such equally appealing 

 name. 



No County Hospital can be most efficiently managed without 

 a Social Service Department, with a trained worker to weed out 

 such appHcants as do not need hospital treatment, to supply the 

 facts concerning the conditions causing the disease, and also to 

 follow up the convalescents when they leave the hospital, in 

 order that they may not again become sick, necessitating renew- 

 ed costly hospital treatment. The Associated Charities does 

 give some such service as this to the hospital when called upon 

 but if the county had a trained investigator for this work as well 

 as the care of indigents, with visiting nurses connected with the 

 dispensary in the city such work could be most effectively done. 

 A dispensary or out-patient department has been well equipped 

 and started in the old jail building. Likewise, physicians visit 

 the homes of the indigent sick. Visiting nurses could add much 

 to the present efficiency of the medical service, and without doubt 

 could actually save money by giving proper care, with the advice 

 of the dispensary doctors, to people in their own homes. This at 

 present seems not to be done because the county insists that the 

 city should do this, and the city, in turn, insists that the county 

 is responsible. San Diego is now in a position to avoid the bad 

 conditions to be found in many other cities, i. e., several bodies 

 of visiting nurses more or less duplicating each others' work, and 

 employed by different agencies. All work of such nurses should 

 be centralized from the dispensary, and under the management 



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