A SURVEY 
□ F 
COLORADO HEALTH PROBLEMS AND FACILITIES 
BY 
LYNN J. LULL, M. D. 
DIRECTOR DF VENEREAL DISEASES 
CDLDRADD STATE BOARD OF HEALTH 
1340 A SURVEY OF COLORADO HEALTH PROBLEMS 
AND FACILITIES 
With suggestions for future programs 
By 
Lynn J. Lull, M. D. 
COLORADO STATE BOARD OF HEALTH 
1940 FOREWORD 
The author's frequent need for 
information on Colorado health facilities has 
lead to the preparation of the publication 
here presented. The statistical material 
was collected from many sources, none of 
which offered a public health interpretation. 
In the interpretations and con- 
clusions the author has been advised and 
assisted by many fellow workers in the field 
of public health. He wishes to express his 
appreciation to the faculty members of the 
Department of Public Health of Yale Univer- 
sity, School of Medicine, for their counsel 
in the planning and preparation of this 
dissertation; particularly to Mr. M. A. Pond 
for his criticism of structure and minor 
errors, to Dr. J. W. Watkins for his aid in 
statistical analysis, to Dr. Franz Goldman 
for advice on hospitals and physicians, and 
Professors Ira V. Hiscock, and C. E-A. 
Winslow whose inspiring lectures, seminars 
and conferences are responsible for many of 
the conclusions and recommendations expressed 
Further appreciation is expressed 
to the Misses Anna Hiesler and Ruth Phillips 
for advice on nursing problems, to Dr. Harry 
S. Mustard, a former teacher, and Dr. Carl E. 
Buck, for advice on Public Health Administra- 
tion, and to Dr. James S. Cullyford and 
Mr. Frank Morrison who furnished valuable 
data on vital statistics. 
L. J. L. TABLE OF CONTENTS 
Chapter I. Introduction Page 1 
Chapter II. General Description Page 5 
Chapter III. The Population of Colorado Page 14 
Chapter IV. Vital Statistics Page 22 
Chapter V. Health and Hospital Facilities Page 30 
Chapter VI. Financial Resources Page 42 
Chapter VII. Summary and Recommendations Page 45 
Bibliography Page 51 
Appendix Page i CHAPTER I 
INTRODUCTION 
Among the important duties of government are those which re- 
late to the health and welfare of the population living in the community. 
Democratic governments have always tried, however ineffectually, to pro- 
vide safeguards against the rampant spread of communicable diseases. In 
the American colonies one of the earliest concerns of the settlers was 
the preservation of health. They soon learned that epidemics followed 
migration, and filth contributed to ill health, and their early laws pro- 
vided for quarantine and environmental sanitation. 
The first state program of public health work began in Massa- 
chusetts with the establishment of a state board of health in 1869. The 
functions of this board were to "take cognizance of the interests of 
health and life among the citizens of the Commonwealth. They shall make 
sanitary investigations and inquiries in respect to the people, the 
causes of disease, and especially of epidemics and the sources of mortal- 
ity and the effects of localities, employments, conditions and circum- 
stances, on the public health; and they shall gather such information in 
respect to those matters as they may deem proper, for diffusion among the 
people." (1) 
Following the lead taken by Massachusetts the other states 
formed state health organizations and by the close of the century 38 
states had assumed similar functions for the protection of the health of 
their citizens. The last state health organization was established in 
New Mexico in 1919- 
Federal interests in public health began in 1798 with the 
establishment of the Marine Hospital Service. By an act of 1878 this body 
was authorized to impose quarantine to prevent entry of disease into the 
United States from abroad, and in 1893 this authority was extended and pro- 
vision was made for cooperation with state and local agencies (2) . In 1912 
the name of this agency was changed to the United States Public Health 
Service. 
The first financial aid to state and local health departments 
from federal funds came through an appropriation by Congress in 1917, for 
$25,000 to be administered through the United States Public Health Service. 
Comparable amounts were appropriated annually by Congress until 1935 when 
the Social Security Act was enacted. 
During the World War, United States Army officials became con- 
cerned with the high prevalence of venereal disease among the enlisted men 
of the army. Their action, supported by the American Social Hygiene 
Association (3) led to the adoption by Congress of the Chamberlain-Kahn 
bill (1919), creating the United States Interdepartmental Social Hygiene 2 
Board. Recommendations of this board resulted in an amendment (1921) to 
the original bill, for federal aid to states cooperating with the plans 
of the federal board. 
Concern for the health and welfare of mothers and children, by 
official and nonofficial agencies of the United States, led to the passage 
by Congress of the Sheppard-Towner Act (A) (1921). The Act provided for 
the creation of a Board of Maternity and Infant Hygiene to correlate the 
work of the United States Children's Bureau, United States Public Health 
Service, and the United States Bureau of Education, and to allot grants- 
in-aid to states cooperating with plans of the federal board. 
The Social Security Act evolved from the findings of the White 
House Conference on Child Health and Protection (1929), the Committee on 
the Costs of Medical Care (1932) and the National Health Inventory (1935- 
1936). A study of the findings of these committees demonstrated a lack of 
adequate and systematic control of public health functions of many local 
governments, an uneven distribution of services, a small portion of the 
tax dollar devoted to public health, and a deficiency of properly trained 
personnel to carry on such work. 
The Social Security Act (1935) under Title V appropriated 
$3,800,000 for maternal and child health and $A,000,000 for crippled 
children, to be distributed through the Children's Bureau and under Title 
VI appropriated $8,000,000 for local public health work to be distributed 
through the United States Public Health Service. These appropriations 
were to be distributed among the states on the basis of population, finan- 
cial needs, and special problems. In May 1938 Congress appropriated 
$3,000,000 to be distributed to the states through the United States Pub- 
lic Health Service for investigation, control, and treatment of venereal 
disease. This legislation was based on recommendations of the Conference 
of State and Territorial Health Officers, The American Social Hygiene 
Association and many other cooperating organizations. The method of dis- 
tribution was essentially the same as that used for Social Security funds. 
Following the July 1938 meeting of The Interdepartmental Com- 
mittee to Coordinate Health and Welfare Activities, recommendations were 
made to Congress for substantial increases in federal appropriations for 
health and welfare activities in local governments. The committee recom- 
mendations have been incorporated in Senate Bill 1620 now (1939) being 
considered by Congress. This bill provides grants-in-aid to states for; 
maternal and child health services, medical services for children and ser- 
vices for crippled and other handicapped children, public health work and 
investigations, hospitals and health centers, medical care, and temporary 
disability compensation. 3 
In discussing the state of the nation's health at the National 
Health Conference in 1938, Josephine Roche stated: 
"The existence of long standing and insistant needs of our 
people for more adequate health services and medical care has been recog- 
nized by every one who has spoken." (5) Discussions at the conference 
revealed that the largest population replacement reservoirs in the United 
States are those areas where economic conditions are poorest. Here also, 
morbidity and mortality rates are among the highest in the country. This 
part of the population receives about 30 per-cent of the needed medical 
attention, and few of the mothers receive either adequate prenatal or ob- 
stetrical care. 
The Technical Committee on Medical Care reported that a small 
part of the population of the United States is supplied with full time, 
competent, and well trained health officers with a professional point of 
view. About half the state health departments are not adequately staffed 
nor satisfactorily equipped to render services expected of them, and less 
than a third of the counties and cities of the United States employ full 
time professional health officers. 
Specific plans of the committee envisioned the eradication of 
tuberculosis, venereal disease, malaria, and certain occupational dis- 
eases, the lowering of mortality from pneumonia and cancer, the reduction 
of morbidity in the care of mental disorders, and the improvement of 
maternal and infant hygiene. 
Discussions on maternal and child health showed high puerperal 
and infant mortality rates throughout the United States, and the committee 
recommended national planning for the provision of adequate medical and 
nursing care and hospital facilities for all prenatal and obstetrical 
cases. 
That health is a purchasable commodity and that many of the 
nation's ills can be prevented by well conducted public health programs 
has been shown by many of the outstanding public health leaders of the 
nation. Winslow (6) has reminded us that, 
"We need economy in government as we need it in the conduct of 
odr individual lives; but economy is not synonymous with senseless panic 
of budget slashing.... It does not mean refusing to spend money.... Econ- 
omy means spending money wisely." Tax money in proper amounts wisely in- 
vested in public health procedure will return its value to the community 
many times over. 
In measuring the monetary value of health work, Dublin (7) 
states that one of the large insurance companies of the United States 
estimates that public health work conducted among its policy holders has effected savings in claim payments representing twice the sum expended 
for this service. He also points out, for example, that the estimated 
money value lost through sickness and death from typhoid fever in 
Pittsburgh in the period 1904-1907, if applied to the construction of 
water plants and filter beds, v/ould have sufficed to cover the entire 
existing installations for the Pittsburgh district in 1930. 
With many research activities in preventive medicine, the ad- 
ministrative studies of the Children’s Bureau and the United States 
Public Health Service, and the splendid work of our many foundations and 
voluntary health agencies, the horizon of public health activities is 
rapidly growing to unpredictable limits. With all of our resources and 
knowledge of public health we have failed to make these advantages avail- 
able to a great part of our population. 
If, in this widening program of public health work, v/e wish to 
make public health services available equally to all residents of a com- 
munity it is necessary to establish local administrative units with per- 
sonnel capable of studying the assets, characteristics, and problems of 
that community and planning programs to fit its needs. 
With this in mind the following chapters will be devoted to a 
study of the assets, characteristics, and problems of the state of 
Colorado and an applicable plan of local health administration that will 
bring the advantages of modern public health knowledge to every resident 
of the state. 5 
CHAPTER II 
GENERAL DESCRIPTION 
EARLY HISTORY 
The thousands of unexplored cliff houses of southwestern 
Colorado have yet to reveal the reason for the disappearance of the in- 
habitants whose culture antedates the Christian Era and who are the 
oldest race known to have lived there. At present this part of the state 
offers poor agricultural facilities, poor game refuges, and suffers from 
lack of water, yet 3,000 years ago it supported a race of people with a 
highly developed community culture. 
The first white man known to have visited this part of the 
state was Coronado (15-40) who describes the inhabitants as nomadic Indian 
tribes. He described the communal life of the Pueblo Indians whose build- 
ings, a few miles south of what is now the Colorado-New Mexico state line, 
are at present in a good state of preservation. 
Six Indian tribes, the Utes, Algonkians, Siouans, Kiowans, 
Arapahoes, and Cheyennes made their homes in the area which makes up the 
state of Colorado. Of these only the Utes remained on the western side of 
the Continental Divide, and now are the only tribe still remaining in the 
state. 
The Indians of the eastern plains built their culture around the 
buffalo. They made use of the hide, flesh, fat, sinew, and hair to pro- 
vide them with food, clothing, shelter, and instruments. All of these 
tribes were nomadic, following the changing seasons from Canada to Texas. 
There is little wonder that they resented the intrusions of the white men 
who slaughtered their buffaloes, fenced their lands, and introduced small- 
pox and measles that killed great numbers of their tribes. 
After Coronado’s explorations the Spanish established missions 
in the present state of New Mexico but it is doubted that they returned 
to Colorado until Governor Valverde led an expedition into the Arkansas 
valley in 1719 for the purpose of punishing Indian offenders. He re- 
turned with stories of the French pushing their trading west from the 
Mississippi and threatening the Spanish supremacy of the west. These 
stories stimulated Spanish explorations and in 1765 Rivera is known to 
have explored the San Juan and Gunnison valleys in search of silver. 
Within the next few years several Spanish groups, whose names still 
mark the country, visited the western slope. By the close of the 18th 
century the Spanish explorers were familiar with all the river valleys 
of western Colorado. 6 
The state is made up of portions of the Louisiana Purchase 
(1803), the Mexican Purchase (18/4$), and the Northwest Territory. The 
first United States’ exploration of the territory was made in 1806 by 
Lieutenant Zebulon Pike v/ho arrived at the present site of Pueblo on 
November 23rd of that year. With three of his men he explored the 
Fountain river to the present site of the City of Colorado Springs 
where he climbed Cheyenne Mountain and saw the majestic snow capped 
peak that bears his name. He continued his explorations up the Arkansas 
river valley, passed through the Royal Gorge, and turned south into the 
San Luis valley where he established a fort on the site of the present 
city of Alamosa which he later learned was in territory owned by Mexico. 
By the Treaty of 1819 the boundaries of the United States were 
definitely determined and Mexico, now a free country, became owner of the 
south quarter and the west half of Colorado. This land was acquired by 
the United States by purchase from Mexico in 184-8. 
The first commercial enterprises v/ere trapping and fur trading, 
beginning about 1821. Trappers and traders established the first in- 
habited settlement of the state on the present site of Pueblo about 1822. 
By 184-0 fur trading posts v/ere established throughout the state but within 
the next ten years fur had declined and the territory was considered re- 
mote and uninviting to settlers. 
In 18$8 gold was discovered in the South Platte river. When news 
reached the East there was a rush of men to the new gold fields, their num- 
bers being estimated at 100,000. Many new towns were established and for- 
tunes v/ere made overnight, not only in gold but in real estate and trading. 
The newcomers found gold but many were not able to mine it because of inex- 
perience. This, along v/ith high freight rates brought a slump in mining, 
and many idle camps. The territorial census of 1866 was reported as 28,000, 
By the end of the 60's mining was established on a sound basis and the agri- 
cultural possibilities of the territory were discovered. The railroad v/as 
extended to Denver and the land grant railroads developed agriculture. Agri- 
cultural colony methods were used to form many new towns. From 1870 to 
1876 the territory grew from 4-0,000 to 100,000. In 1876, just one hundred 
years after the Declaration of Independence, Colorado was admitted to state- 
hood . 
PHYSICAL CHARACTERISTICS 
Colorado lies in the center of that portion of the United States 
v/est of the Mississippi basin and on the east central edge of the Rocky 
Mountain region. It is bounded on the west by Utah, and on the north by 
Wyoming and Nebraska, and on the east by Nebraska and Kansas, on the south 
by Oklahoma and New Mexico, and the southwest corner touches the northeast 
corner of Arizona, The outline of the state, which is the 7th largest of 7 
the United States, is a rectangle with an area of 103,658 square miles of 
which 290 square miles are water surface. The area of the state is about 
twelve times the area of Massachusetts, or equal to the area of Ohio, New 
York, Connecticut, and Vermont combined. 
The state contains the highest portion of the Rocky Mountains 
in the United States, v/ith 4-9 peaks rising more than 14,000 feet above 
sea level. It also has the highest mean altitude of any of the United 
States, with only one fourth of its area below 5,000 feet and the lowest 
point in the state 3,385 feet above sea level. 
The state is divided through the center from north to south 
by the Continental Divide (see Figure I), so called because the drainage 
from its eastern slope flows into the Atlantic Ocean while the western 
slope is a Pacific water shed. 
The eastern slope levels off into a broken, flat prairie 
crossed in the north by the basin of the Platte river, and in the south 
by the basin of the Arkansas river. In the southwestern portion of the 
eastern slope the head waters of the Rio Grande del Norte river flow 
southward across the San Luis valley into New Mexico. 
The western slope is composed entirely of rough mountain 
areas, narrow fertile valleys, high mesas, and lofty rugged peaks. The 
northern part is crossed by the White and Yampa rivers, the central por- 
tion is drained by the Colorado river, and in the south the tributaries 
of the San Juan river flow southward into New Mexico. 
The source of Colorado streams is mainly the melting snow in 
the high mountain ranges providing a steady year around flow used to 
irrigate the arid, fertile, agricultural areas. Flowing wells and hot 
and cold springs add to the abundant water supply, one of the springs 
near Pagosa Springs having an average flow of 700 gallons per minute. 
The value of Colorado's water supply is shown in the 1930 census which 
reports 52.2 per-cent of the farms depending on irrigation. 
CLIMATE 
Colorado is well known for its delightful climate and‘many 
people enter it every year in quest of better health. The feeling one 
has of greater capacity for work is due to lessened atmospheric pressure 
which is accompanied by deeper breathing, in an effort to inhale the same 
amount of oxygen. Those who come to the state hoping to improve lung 
diseases may be disappointed because increased lung activity is thought 
by some authorities to aggravate such conditions. Rest is probably as 
great a factor in arresting lung disease in Colorado as it would be at 
a lower altitude. It is well known that available moisture is an im- 
portant factor in the growth of bacteria, and in this respect, Colorado 8 
climate is kind to the hosts of harmful bacteria. From personal observa- 
tion in medical practice, human infections appear to be more rare in Colo- 
rado than in the middle west. Putrefaction of organic material is much 
slower. The concentration of the actinic rays of the sun is higher here 
than in most of the United Stated because of the clear, dust free atmos- 
phere . 
Because of the large area of the state and its varying altitudes 
it is difficult to describe temperature variations in a general statement. 
The predominant factor is altitude, the average temperature varying inverse- 
ly with altitude. From weather bureau observations for the past 45 years 
the mean temperature is recorded as 44*9 degrees, with the highest temper- 
ature observed in 1888 as 115 degrees with the lowest temperature observed 
in 1913 and 1930 as 54 degrees below zero. The highest and lowest mean 
temperatures are reported from observations at the highest and lowest al- 
titudes. The lowest mean temperature of 32 degrees is reported from 
Fraser (elevation 8671 feet), in Grand County, while the highest mean 
temperature of 54.4 degrees comes from Lamar (elevation 3500 feet), in 
Prowers County. 
The mean annual precipitation on the state as a whole during 
46 years has been 16.62 inches. This varies widely in the different parts 
of the state from a low of 6.81 inches at Manassa in Conejos County to a 
high of 26.69 inches at Silverton in San Juan County. In Denver, precipi- 
tation of one inch in 24 hours is probable twice a year, v/hile at Grand 
Junction, in Mesa County, a one inch rainfall is probable once in two 
years. Snowfall in the mountains is more important to agriculture than 
rain. The summer melting of the hugh snow banks is the main source of 
water for irrigation and domestic use. Little snow falls on the eastern 
plains or in the low valleys but in many of the high mountains snow covers 
the ground the year around. At Denver there is measurable snow on the 
ground on an average of 54 days in the year, while Grand Junction averages 
32 snow days per year. The lightest average annual snow fall in the state 
is recorded as 11.1 inches in Utleyville in Las Animas County and the 
heaviest as 463.1 inches at Ruby in Gunnison County. 
Authoritative studies indicate that relative humidity has an 
important effect on the sensitiveness of the human body to temperature. 
Colorado is fortunate in this respect in having low relative humidity. 
The bitter cold of near zero weather found in high humidity areas is 
never experienced in the state. The relative humidity at noon in Denver 
from 15 years observations averages 39 per-cent. The same observations 
in other United States cities show relative humidities as: Albany 62 per- 
cent, Buffalo 73 per-cent, Chicago 63 per-cent, Kansas City 56 per-cent, 
New Haven 70 per-cent, Seattle 70 per-cent. 
The growing seasons in the state measured between killing frosts, 
vary considerably, the longest is 186 days, while the shortest Is 76 days. FIGURE I 
The “Front Range” of the Rockies running down the middle of the state from north to south rises abruptly, cutting the state in two. 
From this mountain barrier, level prairies stretch eastward into Kansas, broken only by a few shallow streams. To the west the 
Rockies continue across the border into Utah. Note the famous “Four Corners” in the Southwest, where Colorado, Utah, Arizona, 
and New Mexico meet at right angles. 
From Compton's Pictured Encyclopedia,courtesy of F.E, Compton 
and Company,Chicago,111. 9 
In the high altitudes where short growing seasons would make agriculture 
seem impossible, crops of potatoes, lettuce, and small grains mature 
under clear, cloudless skies in remarkably short periods. 
RAILROADS 
Railroad construction in Colorado is expensive and involves 
many different engineering problems with the result that facilities are 
inadequate in the mountain districts. Six railroads extend from the 
foothills of the mountains eastward across the plains, but westward only 
one railroad crosses the Rockies and reaches the west border of the state. 
Only one railroad route crosses the state from the north to the south 
border, along the eastern foothills of the mountains. 
Railroad travel through the mountains is slow because of tor- 
turous routes with steep grades and sharp curves. Wide use has been 
made of narrow gauge railroads in the mountains to carry the supplies 
and products of the mining industry, but in the past few years many 
mines have closed and the miners have migrated to other sections. Many 
miles of mountain narrow gauge track have been abandoned recently and 
those few surviving roads are now operating with light trains and in 
many places on weekly schedules. 
Improvement in automobile roads and truck competition on 
freight hauling has already doomed several lines and discouraged any 
plans of future rail developments within Colorado. 
HIGHWAYS 
Federal, state, and county funds are used to maintain Colorado 
highv/ays. In 1939 the state highway system included 12,210 miles of 
highway of which 3,694- miles are on the Federal-Aid system. In addition 
to this mileage there are about 50,000 miles of county roads of lesser 
importance. 
Within the state there are 14 National Forests and 7 National 
Parks covering 21,835 square miles. Roads in and adjacent to these 
areas are maintained by the Federal Government and 25 per-cent of the 
forest revenues are allotted to the highway funds of the counties lying 
within their borders. In 1935, 42 counties received such allotments 
ranging from $108.07 to $5,848.42. 
Highways maintained by the state in the eastern plains area 
are generally of concrete construction, while in the western mountain 
areas asphalt construction is used because of the extreme temperatures 
to which they are subjected. At present (1939), 539 miles of the 4,060 
miles of state maintained, hard surfaced roads are of concrete con- 
struction. 10 
The construction cost of a two lane highway in the eastern 
plains area varies from $7,000 to $13,000 per mile, while in the western 
mountain area the cost varies from $35,000 to $215,000 per mile because 
of the difficult engineering problems and heavy rock work. 
The average cost of maintenance of Federal-Aid highways for the 
entire state in 193B was $336.39 per mile, being about $200 per mile on 
the eastern plains and about $4-50 per mile in the western mountains. Heavy 
snow in the mountain areas from November 1st to May 1st adds to the cost 
of highway maintenance. Usual snow fall on the mountain passes will run 
from 200 to 300 inches total for the year. In 1937, on Wolf Creek pass, 
the snow fall in six months totaled 74 feet. Snow clearance of the high- 
ways costs about $150,000 annually and the state has $200,000 invested in 
snow removal machinery. 
Of the 27 passes on the state highway system, 10 are usually 
closed a part of the winter. With the exception of a few stormy days, all 
passes on the main highways are kept open throughout the winter. 
Only one state highway crosses the state from north to south, 
running along the edge of the eastern foothills of the Continental Divide. 
This highway (U.S.85) passes through Greeley, Denver, Colorado Springs, 
Pueblo, and Trinidad, connecting all of the heaviest populated areas of 
the state and crossing all the east-west highways. 
Five state maintained roads (U.S. Route Nos. 6,24,40,50,160) 
cross the state from east to west, each following the course of one of 
the river systems. 
Highway No. 6 enters the state along the Platte river, follow- 
ing it to its head waters, crosses Fremont pass into the upper reaches 
of the Arkansas river, over Tennessee pass into the valley of the Colo- 
rado river which it follows into Utah. 
Highway 24 enters the state along the southern edge of the 
Platte river valley and in El Paso County enters the Arkansas valley 
which it follows to Tennessee pass and into the Colorado river valley. 
Highway No. 40 enters the state on the northern edge of the 
Arkansas valley, runs northwest to cross into the Platte river valley 
which it follows to Berthoud pass, crossing into the Colorado valley 
through the upper reaches of it into the Yampa river valley and west 
into Utah. 
Highway No. 50 enters Colorado along the Arkansas river, fol- 
lows it to Monarch pass where it enters the Colorado river head waters 
to follow this river into Utah, Highway No. 160 begins in Colorado at Walsenburg on highway No. 
85 and passes westward into Utah passing through the upper reaches of the 
San Juan river throughout its course along the southern border of the 
state. 
Many hairpin curves and steep grades on the highways make auto- 
mobile travel slow in western Colorado. Air line distances on a map may 
be quite misleading because highways are more often built in the river 
valleys around the mountains rather than directly over them. As an ex- 
ample of this variation the following comparative air line and road 
mileages are cited: 
Air Line 
Road 
Ouray to Telluride 
A miles 
51 miles 
Ouray to Lake City 
10 miles 
115 miles 
Creede to Silverton 
18 miles 
82 miles 
Montrose to Norwood 
15 miles 
70 miles 
GOVERNMENT 
The constitution of the state as adopted in 1876, retained its 
original form and served its purpose well until 1915 when the legislature 
established a committee to survey the business methods of the state. The 
report of this committee led to the adoption of a budget system in 1919. 
In 1922, Governor-elect William E. Sweet with several members of the staff 
of the New York Bureau of Municipal Research Administration made a study 
of the state government organization and proposed a plan of consolidation 
into nine administrative departments. The legislature defeated this pro- 
posal but in 1933 adopted an administrative code under which the state 
now functions. 
The present state government is described by Buck (8) as 
follows; 
"The administrative code abolished some twenty-five boards and 
commissions and consolidated their functions into six departments. Six 
elective constitutional officials are made heads of these departments, 
namely, the governor, head of the executive department; the state treas- 
urer, head of the department of finance and taxation; the state auditor, 
head of the department of auditing; the attorney general, head of the 
department of law; the secretary of state, head of the department of 
state; and the superintendent of public instruction, head of the depart- 
ment of education. The heads of these departments, with the exception 
of the superintendent of public instruction, constitute the executive 
council. This council has authority to pass on the governor’s budget, 
review all purchases, establish a uniform system of accounting for all 
agencies, departments, and institutions, and approve their budgets and work programs. Fiscal control practically rests in the hands of this 
body. Directly under its supervision are three divisions: budgets, 
accounts and control, and purchases. 
"The executive department is large, consisting of about a 
dozen divisions and agencies, which perform the major part of the ad- 
ministrative v/ork of the state government. The principal divisions are 
agriculture, conservation, public welfare, industrial relations, public 
health, highways, and water resources. These divisions are in effect 
departments operating under the direction of the governor. The gover- 
nor, therefore, has the major responsibility for administration, the 
other elective officials, or so-called department heads, having in the 
aggregate fewer functions than has the governor. Nevertheless, the 
form of government, although admittedly in a transitional stage, is 
quite similar to the commission form of government in cities, tending 
to dissipate rather than to concentrate executive responsibility.” 
The budget commissioner and purchasing agent act as confi- 
dential advisors to the governor and their acts are reviewed by the 
executive council. The budget commissioner compiles budgets for all 
departments, based on their estimated needs. The budgets are passed 
by the executive council and presented to the legislature by the gov- 
ernor with suggestions for appropriations and revenues. 
The administrative code of 1933 has given a freedom of ad- 
ministration to each of the separate departments and has concentrated 
fiscal control in the executive council. 
The county is used as the unit of local government administra- 
tion. It is governed by a board of county commissioners consisting of 
three members, one elected each year by popular vote, for a three year 
term. V/ithin the county there may be incorporated towns or cities oper- 
ating under independent administrations. Eleven cities have elected 
to come under the provisions of the home-rule amendment of the state 
constitution, which grants them the privilege of enacting laws more 
stringent than those of the state. 
PUBLIC HEALTH ADMINISTRATION 
The public health functions of the state are administered 
through a board of nine members, three of whom are appointed every two 
years, by the governor. The qualifications specified for board mem- 
bers are that they be citizens and voters in the state. Every tv/o 
years the board elects a president and secretary from its membership 
and the secretary becomes the executive officer, except when the board 
is in session. Through 1934 the state board of health operated as a skeleton 
organization, but since 1935, stimulated by federal funds and larger 
appropriations by the state legislature, full time qualified personnel 
have gradually taken over the direction of the various divisions. 
The direction of the work of the board is carried on through 
eleven divisions with full time personnel. These divisions are Admini- 
stration, Bacteriology, Crippled Children, Food and Drugs, Maternal and 
Child Health, Plumbing, Public Health Nursing, Rural Health and Epidemi- 
ology, Sanitary Engineering, Tuberculosis Control, and Vital Statistics. 
Colorado statutes provide that the board of county commission- 
ers shall act as a local board of health within their jurisdiction, and 
in the case of cities and towns the city council or trustees shall act 
as a board of health. Local boards of health are required to appoint a 
physician, when available, to membership on the board. This appointee 
then becomes health officer within the jurisdiction of the board. CHAPTER III 
THE POPULATION OF COLORADO 
Many factors have entered into the change in population of 
Colorado counties since 1930. The fluctuation of metal prices has both 
decreased and increased mining activities at different times in the west- 
ern counties during this period, accounting for various population changes. 
The eastern counties, depending entirely on agriculture for an income, have 
suffered heavy losses from dust storms. Large numbers of the population 
have migrated to better agricultural lands. Federal aid is now attempting 
to stabilize this population. Federal rehabilitation projects -are devel- 
oping new agricultural projects in the middle western counties and are 
moving families into that area from the dust storm counties of Kansas, 
Oklahoma, and Colorado. Sharp changes in the prices of cattle and sheep 
have also affected the population of some counties. The central counties, 
from north to south, representing more than half the population of the 
state, have been least affected by economic changes. 
Considering these known changes in population it is assumed 
that any estimation of population of the separate counties is open to 
much criticism. In estimating the population, such factors as automo- 
biles, sales, products, or banking are of little assistance because of 
the marked changes in economic conditions during this period. Birth 
rates were considered but could not be used in the estimates because 
Colorado was not admitted to the birth registration area until 192B, and 
no accurate trend could be shown. 
Three estimates of the county populations were made: (l) on the 
basis of rural population growth from the 1930 United States census to 
the Works Progress Administration farm census of 1935, (2) on the basis 
of urban population growth from the 1920 to the 1930 United States census, 
and the rural population growth from the 1930 United States census to the 
1935 V/orks Progress Administration farm census, and (3) on the basis of 
the change in the school census. 
In the final estimates of county populations, the estimate made 
on the school census were accepted where one of the other two estimates 
did not vary more than 10 per-cent from it. In the remaining counties - 
the estimate used was the one showing the most likely trend of the popu- 
lation as shown by a comparison with other Colorado counties having a 
comparable source of income, and from other known general data. 
A study of population changes (see Table I) indicates that the 
population of the state has changed little from 1930 to 1938 but that 
there has been significant shifts in the population within the state TABLE I 
POPULATION OF COLORADO COUNTIES 
County 
1930 Census 
1934 Estimated 
1938 Estimated 
% Gain 8 Yrs. 
Adams 
20,245 
19,686 
21,115 
4.3 
Alamosa 
8,602 
8,275 
9,943 
15.6 
Arapahoe 
22,6^7 
22,964 
27,041 
19.4 
Archuleta 
3,204 
3,083 
2,962 
- 7.6 
Baca 
10,570 
11,490 
6,976 
-34.0 
Bent 
9,134 
9,023 
7,950 
-13.0 
Boulder 
32,456 
32,177 
34,695 
6.9 
Chaffee 
8,126 
8.034 
8,320 
2.4 
Cheyenne 
3,723 
3,861 
2,727 
-26.8 
Clear Creek 
2,155 
2,552 
3,603 
67.2 
Conejos 
9,803 
10,205 
10,626 
7.3 
Costilla 
5,779 
5,937 
6,096 
5.5 
Crowley 
5,934 
5,463 
5,712 
- 3.6 
Custer 
2,124 
2,265 
2,406 
13.3 
Delta 
14,204 
14,957 
14,602 
.8 
Denver 
287,861 
280,578 
298,512 
3.7 
Dolores 
1,412 
1,571 
1,730 
22.5 
Douglas 
3,498 
3,816 
3,631 
3.8 
Eagle 
3,924 
4,011 
4,098 
4.4 
Elbert 
6,580 
6,352 
5,323 
-19.1 
El Paso 
49,570 
49,917 
50,809 
2.5 
Fremont 
18,896 
17,757 
18,216 
- 3.6 
Garfield 
9,975 
10,623 
9,879 
- 1.0 
Gilpin 
1,212 
1,251 
1,290 
6.4 
Grand 
2,108 
2,266 
2,423 
14.9 
Gunnison 
5,527 
5,437 
6,306 
14.1 
Hinsdale 
449 
480 
511 
13.8 
Huerfano 
17,062 
17,346 
17,630 
3.3 
Jackson 
1,386 
1,356 
1,327 
- 4.3 
Jefferson 
21,810 
23,795 
26,477 
21.4 
Kiowa 
3,786 
3,619 
2,748 
-27.4 
Kit Carson 
9,725 
10,396 
7,479 
-23.1 
Lake 
4,899 
4,934 
4,987 
1.8 
La Plata 
12,975 
12,404 
13,935 
7.4 
Larimer 
33,137 
32,209 
33,601 
1.4 
Las Animas 
36,008 
35,902 
35,795 
- 0.6 
Lincoln 
7,850 
6,979 
5,400 
-31.2 
Logan 
19,946 
18,697 
17,824 
-10.6 
Mesa 
25,908 
27,307 
32,733 
26.3 
Mineral 
640 
651 
662 
3.4 
Moffat 
4,861 
4,764 
4,348 
- 9.8 
Montezuma 
7,798 
7,848 
7,897 
1.3 
Montrose 
11,742 
11,989 
13,503 
15.0 
Morgan 
18,284 
17,008 
16,099 
-12.0 
Otero 
24,390 
22,617 
24,129 
- 1.1 
Ouray 
1,784 
1,665 
2,121 
18.9 TABLE I - Continued 
POPULATION OF COLORADO COUNTIES 
County 
1930 Census 
1934 Estimated 
1938 Estimated 
% Gain 8 Yrs. 
Park 
2,052 
2,336 
2,620 
27.7 
Phillips 
5,797 
5,012 
5,575 
- 3.8 
Pitkin 
1,770 
1,866 
1,731 
- 2.2 
Prowers 
14,762 
13,792 
11,039 
-25.2 
Pueblo 
66,033 
59,296 
58,761 
-11.0 
Rio Blanco 
2,980 
3,060 
2,875 
- 3.5 
Rio Grande 
9,953 
10,451 
13,685 
37.5 
Routt 
9,352 
8,997 
9,772 
4.5 
Saguache 
6,250 
6,223 
6,288 
0.6 
San Juan 
1,935 
1,341 
2,608 
34.7 
San Miguel 
. 2,184 
2,135 
2,566 
17.5 
Sedgwick 
5,580 
5,264 
4,769 
-14.5 
Summit 
987 
935 
1,030 
4.4 
Teller 
4,141 
4,398 
4,655 
12.4 
Washington 
9,591 
9,585 
7,791 
-18.8 
Weld 
65,097 
63,333 
62,461 
- 4.0 
Yuma 
13,613 
13,472 
11,789 
-13.4 
COLORADO 
1,035,791 
1,017,049 
1,046,207 
1.0 15 
(see Figure II). No county on the eastern plains, unless adjacent to 
Denver, has shown a gain in population, and most counties have apparent- 
ly experienced a significant loss. This loss probably results from the 
discouraging agricultural returns of the past few years, due to drought 
and subsequent dust storms. 
The metropolitan area of Denver has shown an increase, although 
within the city the growth has been slow. From 1930 to 1938 the city has 
had a population increase of about four per-cent, while the three adjoin- 
ing counties have increased 15 per-cent in the same period. This would 
indicate that the suburbs of Denver are growing about four times as fast 
as the city itself. 
The San Luis valley, comprising Rio Grande, Alamosa, Conejos, 
and Costilla counties, shows a population increase of about 18 per-cent 
from 1930 to 1938. In this area most of the population depends on agri- 
culture for an income. The soil is highly productive, irrigation water 
is plentiful, and the surrounding mountains protect from severe weather 
conditions. 
The Colorado river valley counties including Mesa, Delta, 
Montrose, and Gunnison counties show an increase of 17 per-cent from 
1930 to 1938. Conditions in this valley are practically the same as in 
the San Luis valley, except that government rehabilitation projects have 
aided in increasing the rate of growth. 
Ouray, San Juan, and La Plata counties, high in the mountains, 
show a 12 per-cent growth in population from 1930 to 1938. The main 
source of income in these counties is mining, and the activities in min- 
ing are shown in the population changes. When metal prices are high and 
mining is active, there is a rapid increase in population in mining com- 
munities, and when mine labor demands decrease, miners must seek employ- 
ment in other communities. The shift of population in these three coun- 
ties (see Table I) reflects the mining activities of the past 8 years. 
It will be noted that these counties showed an 8 per-cent loss from 1930 
to 193A, but by 1938 they had regained the loss and gained 12 per-cent 
over the 1930 population. 
The significant change of population within the state from 1930 
to 1938 is a movement from the eastern drought-stricken areas into the 
fertile agricultural valleys of the western slope, the mining areas, and 
the metropolitan districts. 
The uneven distribution of the population within the state is 
due, mainly, to its topography. The eastern plains are inhabited in pro- 
portion to the availability of water supply for irrigation, while the 
western slope population is concentrated in fertile river valleys, leav- 
ing wide areas of rugged mountain districts sparsely populated, except in 
the prosperous mining communities. 16 
Denver, which is the only large city in Colorado, contains 28 
per-cent of the population of the state (see Figure III) and 50 per cent 
of the state population lives within a radius of 100 miles of it. 
The population density of the state averages 10 persons per 
square mile, but excluding Denver, the population density for the re 
mainder of the state is approximately 7 per square mile. Density by 
counties (see Table II) ranges from 4.>963 in Denver to 0.5 in Hinsdale 
County. There are five counties with a population density less than 
one person per square mile (see Figure IV), eight counties with densi- 
ties between one and two, and five counties with densities between two 
and three. Of these 18 counties, only two are on the eastern slope. 
The reason for their sparse population is scarcity of irrigation water 
to support agriculture on a profitable scale. The remaining 16 counties 
with densities under three, are located on the western slope in the rug- 
ged mountain districts. The small populations of these counties are con 
fined mainly to narrow river valleys where agriculture is profitable. 
Lake County stands out in population density on the western 
slope because of the concentration of population in Leadville. This com 
munity contains several large ore smelters, and functions as a wholesale 
and retail center for supplies to the nearby mines. 
The heaviest population density will be noticed in the eastern 
foothills and the plains adjoining them. In this district unlimited water 
is available for irrigation and domestic purposes, and junctions of trans 
continental roads, railroads, and airways furnish an ideal situation for 
wholesale and retail trade. The City of Denver, for this reason, contains 
more Federal Government offices than any city of the United States outside 
of Washington, D. C. 
The rural and urban distribution of the population in 1930, ex- 
clusive of Denver was as follows; 
No. Towns 
Population 
Population 
and Cities 
Per-cent 
Population under 1,000 
158 
59,893 
8.0 
Population, 1,000-2,500 
-42 
60,822 
8.1 
Population, 2,500-10,000 
19 
91,792 
12.3 
Population, 10,000-50,000 
6 
90,131 
12.1 
Population over 50,000 
1 
50,096 
6.7 
Total in towns and cities 
352,734- 
47.2 
Outside towns and cities 
395,197 
52.8 
Total 
74-7,931 
100.0 FIGURE II 
POPULATION CHANGE - COLORADO 1930 TO 1938 
LOSS MORE THAN 5 «7o 
GAIN MORE THAN 5 °7o FIGURE III 
STATE OF COLORADO 
WITH COUNTY AREAS REPRESENTING POPULATION OF 1930 TABLE II 
AREA AND POPULATION, COLORADO, 1930 
C ounty 
Area Sq. Miles 
Pop. Per Sq. Mile 
% State Pop. 
Adams 
1,262 
16.0 
1.95 
Alamosa 
727 
11.8 
.83 
Arapahoe 
842 
26.9 
2.19 
Archuleta 
1,220 
2.6 
.31 
Baca 
2,552 
4.1 
1.02 
Bent 
1,52-4 
6.0 
.88 
Boulder 
76-4 
42.5 
3.13 
Chaffee 
1,083 
7.5 
.78 
Cheyenne 
1,777 
2.1 
.36 
Clear Creek 
390 
5.5 
.21 
Conejos 
1,252 
7.8 ' 
.95 
Costilla 
1,185 
4.9 
.56 
Crowley 
808 
7.3 
.57 
Custer 
74-7 
2.8 
.21 
Delta 
1,201 
11.8 
1.37 
Denver 
58 
4,963.2 
27.79 
Dolores 
1,030 
1.4 
.14 
Douglas 
84.5 
4.1 
.34 
Eagle 
1,620 
2.4 
.38 
Elbert 
1,857 
3.5 
.64 
El Paso 
2,121 
23.4 
4.78 
Fremont 
1,557 
12.1 
1.82 
Garfield 
3,107 
3.2 
.96 
Gilpin 
132 
9.2 
.12 
Grand 
1,866 
1.1 
.20 
Gunnison 
3,179 
1.7 
.53 
Hinsdale 
971 
0.5 
.04 
Huerfano 
1,500 
11.4 
1.65 
Jackson 
1,632 
0.8 
.13 
Jefferson 
808 
27.0 
2.11 
Kiowa 
1,798 
2.1 
.37 
Kit Carson 
2,159 
4.5 
.94 
Lake 
371 
13.2 
.47 
La Plata 
1,851 
7.0 
1.25 
Larimer 
2,629 
12.6 
3.20 
Las Animas 
4,809 
7.5 
3.48 
Lincoln 
2,570 
3.1 
.76 
Logan 
1,822 
10.9 
1.93 
Mesa 
3,163 
8.2 
2.50 
Mineral 
866 
0.7 
.06 
Moffat 
4,658 
1.0 
• 47 
Montezuma 
2,051 
3.8 
.75 
Montrose 
2,26-4 
5.2 
1.13 
Morgan 
1,286 
14.2 
1.76 
Otero 
1,259 
19.4 
2.35 
Ouray 
519 
3.4 
.17 TABLE II - Continued 
AREA AND POPULATION, COLORADO, 1930 
County 
Area Sq. Miles 
Pop. Per Sq. Mile 
% State Pop. 
Park 
2,2^2 
0.9 
.20 
Phillips 
688 
8.4 
.56 
Pitkin 
1,019 
1.7 
.17 
Prowers 
1,630 
9.1 
1.42 
Pueblo 
2,433 
27.1 
6.37 
Rio Blanco 
3,223 
0.9 
.29 
Rio Grande 
898 
11.1 
.95 
Routt 
2,309 
4.1 
.90 
Saguache 
3,133 
2.0 
.60 
San Juan 
453 
4.3 
.19 
San Miguel 
1,301 
1.7 
.21 
Sedgwick 
531 
10.5 
.54 
Summit 
6i9 
1.5 
.10 
Teller 
547 
7.6 
.40 
Washington 
2,521 
3.8 
.93 
Weld 
4,022 
16.2 
6.28 
Yuma 
2,367 
5.8 
1.31 
COLORADO 
103,658 
10.0 
100.00 FIGURE IV 
CONCENTRATION OF POPULATION - COLORADO 1930 
UNDER 3.0 
3.0-5.9 
PERSONS PER SQUARE MILE 
6.0-8.9 
9.0-11.9 
2.0 & OVER For the entire state approximately 50 per-cent of the popula- 
tion lives in cities over 2,500; but if Denver is excluded, 63 per-cent 
of the remaining population may be classified as rural, with 16 per-cent 
of the rural population living in 200 towns under 2,500; and 19 cities 
over 2,500; 6 of them exceeding 10,000 in population; while the western 
slope, representing 18 per-cent of the population, has 72 towns under 
2,500 and 8 cities over 2,500 and only one city over 10,000. 
RACE AND NATIVITY 
In 1930, the while population of Colorado represented about 
93 per-cent of the total. The native whites made up 8-4-5 per-cent, and 
foreign born whites 8.2 per-cent. For the United States, 77.8 per-cent 
of the population was native white, and 10.9 per-cent foreign born v/hite. 
The state has drawn a relatively small portion of its population from 
foreign countries. As approximately 30 per-cent of the residents have 
been born in other parts of the United States, it would appear that im- 
migration to Colorado has been mainly of native born Americans. 
The foreign born v/hite population within the state (see Table 
III) shows a concentration within the mining regions. Of the seven 
Colorado counties with a foreign born v/hite population greater than 12 
per-cent, all are on the western slope in mountainous districts where 
mining is the principal occupation. 
Race problems in Colorado are of little importance, with the 
exception of the Mexican population. The 1930 census lists the follow- 
ing races comprising more than one per-cent of the state population; 
White --------- 92.7 per-cent 
Mexican -------- 5.6 per-cent 
Negro --------- 1.1 per-cent 
Previous to 1930, Mexicans were listed among the white popula- 
tion and consequently only one official tabulation of them has been re- 
corded. Instructions given to the enumerators of the 1930 census v/ere 
that, "all persons born in Mexico, or having parents born in Mexico, who 
are not definitely White, Negro, Indian, Chinese or Japanese should be 
returned as Mexican" (9). Under these instructions 65,968 persons of 
Mexican birth or parentage were returned as white. There apparently 
was some confusion in the minds of the enumerators in making the Mexican 
classification, and from the writer's personal observation in frequent 
travels through Colorado he would place the figure higher than the cen- 
sus. Waller (10) in 1931, estimated that 15 per-cent of the permanent 
Colorado population was Spanish speaking, but gave no basis for his esti- 
mate. Apparently, some of the Mexicans have been classified as v/hite, 
and the official census figures are not a true picture of the situation. 
From available data, it would appear that perhaps a five per-cent increase 18 
in the Mexican enumeration would more nearly approach the true numbers. 
Assuming that the error in tabulation was made in the same proportion 
throughout the state, although the total numbers may be error, the con- 
centration in the counties will still give a true picture of their dis- 
tribution over the state. 
The census figures show only three Colorado counties with no 
Mexican population (see Table III), 21 counties with less than three per- 
cent, 18 counties with three to six per-cent, 8 counties with 6 to 9 per- 
cent, and 13 counties with 9 per-cent or more. The heaviest concentra- 
tion is in Archuleta County where 48.6 per-cent of the population is 
Mexican. The migration of agricultural laborers into the United States 
from south of the border has been encouraged for many years by farmers 
of the western states because Mexicans are generally satisfied with low 
wages. This has resulted in a concentration of the racial group in 
those counties where agriculture is the main source of income. 
Much of the Colorado Mexican population is found in the river 
valleys v/ith the exception of the Yampa and White rivers in the north- 
west corner of the state (see Figure V). Here, few farm crops are grown 
which require much labor, most of the land being used for grazing. On 
the eastern slope, the concentration in the north parallels the Platte 
river, and in the south follows that of the Arkansas river. On the west- 
ern slope, in the central portion, it follows the course of the Colorado 
river, and in the south is in the San Luis and San Juan valleys. 
The Mexican population of the state is of special interest in 
public health because of its low economic status, poor environmental con 
ditions, high incidence of illness and nutritional disturbances, and mi- 
gratory habits. Special studies of this group have been rarely attempted 
because of the difficulty in separating them from the remaining white pop 
ulation. 
No data are available to study trends of any factors of this 
group because the United States census of 1930 was the first attempt to 
separate them from other whites. • 
Comprising approximately one per-cent of the state population, 
Negroes are of little importance except in the city of Denver, where 
7,204 Negroes make up 2.5 per-cent of the population. Negroes residing 
in Denver, El Paso, and Pueblo counties represent 31.4 per-cent of the 
Negro population of the state. The state Negro population increased 4.5 
per-cent from 1920 to 1930. 
Negroes do not live comfortably in the usual Colorado climate 
and rarely is one seen in the cool mountain districts. Practically all 
of them are employed as servants or by the railroads. TABLE III 
RACE AND NATIVITY, COLORADO, 1930 
County 
% Native White 
% Foreign Born White 
% Mexican 
Adams 
BO.8 
10.5 
5.9 
Alamosa 
90.8 
2.5 
5.9 
Arapahoe 
90.9 
7.3 
1.0 
Archuleta 
4-9.4 
1.5 
48.6 
Baca 
98.7 
0.8 
0.5 
Bent 
85.7 
2.6 
9.5 
Boulder 
85.6 
8.3 
5.2 
Chaffee 
79.0 
9.5 
10.9 
Cheyenne 
93.8 
4.9 
1.2 
Clear Creek 
86.6 
12.5 
0.3 
Conejos 
98.1 
0.9 
2.7 
Costilla 
92.4 
1.1 
3.3 
Crowley 
72.2 
4.9 
20.9 
Custer 
86.2 
7.9 
4.2 
Delta 
88.8 
3.9 
6.9 
Denver 
84.0 
10.9 
2.4 
Dolores 
91.1 
6.4 
2.0 
Douglas 
90.4 
6.3 
3.2 
Eagle 
82.4 
7.5 
9.9 
Elbert 
93.5 
5.4 
0.7 
El Paso 
89.6 
6.6 
1.5 
Fremont 
84.6 
9.3 
4.9 
Garfield 
88.9 
7.5 
3.4 
Gilpin 
84.9 
14 *4 
0.7 
Grand 
90.0 
8.3 
1.3 
Gunnison 
82.2 
12.9 
4.6 
Hinsdale 
89.5 
6.5 
3.3 
Huerfano 
73.6 
10.5 
14.2 
Jackson 
89.8 
8.2 
2.1 
Jefferson 
89.2 
9.7 
4.2 
Kiowa 
95.3 
2.3 
1.6 
Kit Carson 
96.4 
3.5 
1,2 
Lake 
73.7 
20.1 
5.8 
La Plata 
76,7 
6.0 
13.5 
Larimer 
85.2 
8.5 
6.2 
Las Animas 
77.3 
9.5 
13.2 
Lincoln 
95.4 
3.5 
1.1 
Logan 
86.7 
8.5 
4.1 
Mesa 
90.9 
4.9 
3.8 
Mineral 
88.4 
6.6 
4.8 
Moffat 
94.5 
4.7 
0.7 
Montezuma 
81.0 
2.6 
11.1 
Montrose 
84.5 
4.7 
10.1 
Morgan 
82.6 
9.4 
7.6 
Otero 
78.2 
3.1 
16.2 
Ouray 
87.0 
12.8 
0.0 TABLE III - Continued 
RACE AND NATIVITY, COLORADO, 1930 
County 
% Native White 
% Foreign Born White 
% Mexican 
Park 
90.8 
5.8 
3.3 
Phillips 
95.3 
4.5 
0,0 
Pitkin 
77.6 
22.1 
0.0 
Prowers 
87.3 
2.5 
9.7 
Pueblo 
80.1 
9.6 
8.1 
Rio Blanco 
94-.9 
3.5 
1.1 
Rio Grande 
93.3 
2.3 
4.3 
Routt 
86.4 
9.0 
2.4 
Saguache 
88.9 
3.0 
8.1 
San Juan 
67.9 
23.8 
8.1 
San Miguel 
85.7 
10.8 
3.3 
Sedgwick 
84.8 
6.6 
6.9 
Summit 
86.7 
12.6 
7.1 
Teller 
89.2 
10.3 
0.3 
Washington 
93.7 
4.7 
1.1 
Weld 
75.6 
9.5 
13.5 
Yuma 
96.9 
2.8 
0.2 
COLORADO 
84.5 
8.2 
5.6 
UNITED STATES 
77.8 
10.9 
1.2 FIGURE V 
DISTRIBUTION OF MEXICAN POPULATION — COLORADO. 1930 
NONE 
0 - 2.9 *7o 
3 - 5.9 °7o 
6 - 8.9 °!o 
| 9 °7o 8. OVER A few Japanese reside in the state, their total number being 
3,213. Most of them follow agricultural occupations, and they are gen- 
erally found in small colonies in the fertile river valleys. Approxi- 
mately 10 per-cent of the state's Japanese population resides in Denver 
where many of them are engaged in business. 
Indians have almost vanished from the state. Of the 1,395 re- 
siding there in 1930, about 60 per-cent of them lived in La Plata and 
Montezuma counties on, or close to the state's only Indian reservation. 
From 1920 to 1930 the Colorado Indian population increased about one 
oer-cent. 
AGE AND SEX DISTRIBUTION 
Age distribution of the population is of importance in survey- 
ing the health status of a community and predicting future births, 
deaths, and fertility. It is obviously not good practice to compare 
death rates of population groups having widely different characteris- 
tics. Likewise, it is not desirable to compare crude birth rates of 
groups having different, proportions of individuals of reproductive ages. 
Unfortunately, age data of our population are available only 
for census years and specific rates can be computed only for those 
years. For intercensus years, the common practice is to compute crude 
death rates, but these must not be interpreted without the last known 
age distributions. 
The United States, from 1920 to 1930, showed a decrease in 
the proportionate number of individuals in the population under 15 
years of age (see Table IV), and an increase in the group over 4-5 years 
of age. The productive age groups (15-4-4- years) have shown slight 
increases. 
Colorado, from 1920 to 1930, showed one per-cent decrease in 
the age groups under 15 years, while this classification for the United 
States decreased 1.4- per-cent during the same period. The increases in 
the groups over 45 years of age were: Colorado 2.8 per-cent, the United 
States 1.9 per-cent. The reproductive age population (15-4-4-) of Colo- 
rado decreased 1.0 per-cent while in the United States it increased 0.4 
per-cent. 
The age problem of Colorado is that of a population growing 
older at a more rapid rate than the United States, with a decreasing re- 
productive age population reproducing at a greater rate than the United 
States where the reproductive age group is growing. 
The age groups under five years and over 65 years are impor- 
tant to public health administrators because they may be used as an 20 
index of the problems of infancy and senility. The separate Colorado 
counties show a wide variation in the distribution of these groups within 
their total population. 
The population under five years of age varies from 7.0 per-cent 
in Denver (see Table V) to 14.4- per-cent In Conejos and Costilla counties. 
There are 8 Colorado counties with less than 8.0 per-cent under five years 
22 counties with 8.0 to 9.5 per-cent, 12 counties with 9.5 to 11.0 per- 
cent, 15 counties with 11.0 to 12.5 per-cent, and 6 counties with 12.5 per 
cent or more. 
The geographical distribution (see Figure VI) of this group 
shows the heaviest concentration in the San Juan and San Luis valleys in 
the southwest corner of the state and the smallest group in the White and 
Yampa river valleys in the northwest corner of the state. All of the 
counties with less than 8 per-cent under five years of age either have 
a high concentration of urban population, or are in high mountain dis- 
tricts where female population is low. 
The population over 65 years of age varies from 3.2 per-cent in 
Alamosa county (see Table V) to 11.3 per-cent in Pitkin county. There are 
five counties with less than four per-cent under 65 years, 22 counties 
with four to five per-cent, 13 counties with five to six per-cent, 9 coun 
ties with 6 to 7 per-cent, and 14- counties with 7 per-cent or more. 
The geographical distribution (see Figure VII) of this group 
shows a concentration in the central part of the state, extending west- 
ward along the Colorado river valley. There is a marked concentration in 
the high mountain counties. The lowest concentrations extend over the 
eastern plains area, and along the entire southern border, reaching the 
lowest in the Arkansas river valley. 
Sex enumeration is probably the most dependable item recorded 
in the United States census, because rarely does an enumerator have any 
difficulty in determining the sex of an individual. Sex ratios show the 
highest excess of males in the foreign born population, but males also 
outnumber females in all other classes. The male excess reached its 
highest proportion in the United States in 1910 and has been decreasing 
since that time. In 1920, the male population was 51.0 per-cent of the 
total and in 1930 it was 50.6 per-cent. 
For many years Colorado has had a male population slightly 
higher than the United States. This is probably due to large areas of 
the state where living is hazardous and which women tend to avoid. The 
male population of Colorado in 1920 was 52.4 per-cent of the total and 
by 1930 had dropped to 51.2 per-cent. TABLE IV 
AGE DISTRIBUTION 1920 AND 1930 
COLORADO 
UNITED 
STATES 
Age 
i 1220 ... %_ 
1930 
* 1920 
% 1930 
Under 5 
10.3 
9.2 
10.9 
9.3 
5-9 
10.1 
10.1 
10.8 
10.3 
10-U 
9.5 
9.5 
10.1 
9.8 
15-19 
8.4 
9.2 
8.9 
9.4 
20-24 
8.3 
8.4 
8.8 
8.9 
25 29 
8.4 
7.4 
8.6 
8.0 
30-34 
8.0 
7.2 
7.6 
7.4 
35 44 
14.3 
14.2 
13.4 
14.0 
45' 54 
10.7 
11.2 
10.0 
10.6 
55 64 
6.8 
7.5 
6.2 
6.8 
65 and over 
4 -4 
6,0 
4.7 
5.4 TABLE V 
SEX AND AGE DISTRIBUTION, COLORADO, 1930 
% Females 
Both 
Sexes 
County 
% Males 
15-44 Yrs, 
% Under 5 Yrs 
. % Over 65 Yrs. 
Adams 
54-9 
21.0 
9.4 
4.9 
Alamosa 
51.7 
24.0 
12.4 
3.2 
Arapahoe 
52.0 
22.1 
9.4 
5.7 
Archuleta 
52.9 
19.9 
13.5. 
5.1 
Baca 
54.0 
21.0 
12.4 
3.5 
Bent 
54.6 
21.6 
10.4 
4.0 
Boulder 
49.8 
22,U 
8.1 
7.7 
Chaffee 
53.7 
21.0 
9.3 
6.3 
Cheyenne 
54.3 
20.7 
10.2 
4.6 
Clear Creek 
52.4 
19.9 
7.2 
10.8 
Conejos 
51.4 
21.1 
14.4 
4.1 
Costilla 
51.6 
20.2 
14.4 
4.3 
Crowley 
52.9 
20.8 
11.8 
4.6 
Custer 
54.5 
19.6 
9.7 
8.4 
Delta 
51.9 
21.0 
10.1 
6.7 
Denver 
48.5 
25.9 
7.0 
6.9 
Dolores 
54.7 
20.5 
11.7 
4.5 
Douglas 
55.0 
21.0 
8.6 
5.8 
Eagle 
57.8 
21.5 
9.9 
5.5 
Elbert 
54.0 
20.7 
10.4 
4.8 
El Paso 
47.8 
23.8 
7.0 
8.8 
Fremont 
53.6 
20.6 
8.3 
7.3 
Garfield 
53.1 
21.7 
9.3 
6.9 
Gilpin 
55.9 
18.8 
8.7 
8.7 
Grand 
58.4 
18.2 
8.8 
5.9 
Gunnison 
55.6 
21.0 
10,3 
5.7 
Hinsdale 
58.6 
18.5 
7.4 
6.0 
Huerfano 
52.7 
21.6 
12.6 
3.9 
Jackson 
58.0 
19.3 
9.6 
5.6 
Jefferson 
51.6 
22.5- 
7.9 
6.4 
Kiowa 
54.6 
20.1 
9.2 
4.7 
Kit Carson 
52.7 
21.0 
11.2 
4.2 
Lake 
54.5 
21.0 
7.8 
7.4 
La Plata 
53.1 
21.9 
11.1 
5.7 
Larimer 
50.7 
22.0 
9.3 
6.5 
Las Animas 
51.8 
21.9 
12.2 
4.2 
Lincoln 
52,9 
21.0 
10.1 
4.7 
Logan 
51.9 
22.3 
11.2 
3.8 
Mesa 
51.5 
22.1 
9.4 
6.6 
Mineral 
56.9 
19.5 
8.3 
8.6 
Moffat 
55.9 
20.0 
9.3 
5.2 
Montezuma 
53.5 
20.3 
12.6 
4.9 
Montrose 
53.9 
20.9 
10,8 
6.1 
Morgan 
51.8 
21,9 
11.5 
4.7 
Otero 
51.2 
22.4 
11.0 
4.8 
Ouray 
58.3 
19.8 
8.7 
10.2 TABLE V - Continued 
SEX AND AGE DISTRIBUTION, COLORADO, 1930 
% Females 
Both 
Sexes 
County 
% Males 
15-44 Yrs. 
% Under 5 Yrs 
. % Over 65 Yrs. 
Park 
58.8 
19.3 
8.2 
7.0 
Phillips 
53.5 
21.6 
10.0 
4.8 
Pitkin 
55.3 
18.2 
8.2 
11.3 
Prowers 
52.8 
21.8 
11.2 
4.3 
Pueblo 
51.1 
23.8 
9.1 
5.5 
Rio Blanco 
57.7 
20.7 
9.4 
5.9 
Rio Grande 
51.3 
21.2 
11.8 
5.5 
Routt 
56.3 
20.5 
9.3 
4.8 
Saguache 
55.6 
20.7 
13.0 
4.6 
San Juan 
65.i 
18.3 
7.1 
4.7 
San Miguel 
55.3 
18.8 
9.3 
7.4 
Sedgwick 
53.5 
21.4 
11.2 
3.8 
Summit 
59.1 
19.5 
6.5 
8.9 
Teller 
55.0 
19.5 
8.5 
9.6 
Washington 
54.1 
20.8 
11.3 
4.8 
Weld 
52.3 
21.7 
11.2 
4.3 
Yuma 
52.8 
21.2 
10.9 
5.3 
COLORADO 
51.2 
23.0 
9.2 
6.0 
UNITED STATES 
50.6 
23.8 
9.3 
5.4 FIGURE VI 
DISTRIBUTION OF POPULATION UNDER 5 YEARS OF AGE 
COLORADO (930 
UNDER 8% 
3-9.4% 
9.5- 10.9% 
II- 12.4 °7o 
2.5 •foL OVER FIGURE VII 
DISTRIBUTION OF POPULATION 65 YEARS & OVER 
COLORADO 1930 
UNDER A°To 
4 - 4.9 °To 
5-5.9 °7o 
6 - 6.9 °to 
7 °To L OVER Distribution of male population varies from 65-4- per-cent in 
San Juan county to 47.8 per-cent in El Paso county. There are 17 coun- 
ties with over 55.0 per-cent male population (see Table V), all of which 
are located on the western slope in rough mountain districts where mining 
and grazing are the principal occupations. Only two counties, El Paso 
and Denver, have a male population less than 50 per-cent. 
The portion of the female population of reproductive age 
(15-44 years) is of particular interest to public health administrators. 
In 1930, this group comprised 23.8 per-cent of the United States popula- 
tion, and 23.0 per-cent of the Colorado population. Among the Colorado 
counties, only Denver (see Table V) had a higher per-cent in this group 
than the United States. Two counties, El Paso and Pueblo, equalled the 
United States and the remaining counties were lower. As might reasonably 
be expected, the counties having the lowest ratios of females of repro- 
ductive age to the total population are those in which there is an excess 
of males. 22 
CHAPTER IV 
VITAL STATISTICS 
The basic figures from which mortality, natality, and morbidity 
rates are computed are rarely accurate. Population figures are reason- 
ably accurate only for the census years, and rates based on population 
estimates of intercensus years are subject to variations depending on the 
method selected for the estimations. The rates referred to in the fol- 
lowing paragraphs are based on population estimates taken from Chapter 
III, and although they are subject to the usual errors of any population 
estimates they will be used throughout the following discussions. 
The author realizes that rates calculated for the separate 
Colorado counties are open to criticism because of the small samples in- 
volved in the sparsely settled counties. Because of this, due consid- 
eration was given to setting up the county rates on the basis of five 
year average experiences, but this plan had to be abandoned because 
allocations for residence of births and deaths were first made in the 
state for the 1938 records. It was thought that a better picture of 
county rates could be obtained from one year of allocated reports than 
from a five year average of recorded experiences. 
NATALITY 
Although Colorado was admitted to the United States Registra- 
tion Area in 1928, Whelpton (11) estimated that not more than 83.16 per- 
cent of its 1929 births were reported. On this basis the true birth 
rate for the state, in 1929? would be 20.99 per 1,000 population rather 
than 17.4-6 computed from the registered births. 
Whelpton (11) also indicates that the completeness of birth 
registrations in the states increases with the length of time that a 
state is listed in the Registration Area. The increase, as shown by the 
United States Census Bureau, in Colorado birth rates from 1930 to 1938 
may be due to better reporting of births rather than an actual increase 
in the rate of reproduction. 
The resident live birth rate for the state, in 1938 was 19.5 
per 1,000 population. The rates in the separate counties (see Table VI) 
varied from 9.8 in Hinsdale to 37.4 in Park County. The geographical 
areas showing the heaviest birth rates are (see Figure VIII) the San 
Juan valley and the northern half of the western slope of the Continental 
Divide,, These areas in general have a large portion of the population 
engaged in mining and have an excess of male population, but the young 
adult portion of the population is a little higher than the state /is a 
whole. It is interesting to note too, that some of the counties with TABLE VI 
NATALITY, FERTILITY, AND INFANT DEATHS, COLORADO COUNTIES, 1938 
COUNTIES 
BIRTHS ALLOCATED 
NUMBER RATE/iOOO POP. 
FERTILITY RATE 
ALLOCATED INFANT'DEATHS 
NUMBER RATE/l,000 BIRTHS 
Adams 
318 
15.1 
44.7 
20 
. 62.9 
Alamosa 
210 
21.1 
51,6 
30 
142.9 
Arapahoe 
4U 
15.3 
42.6 
16 
38,6 
Archuleta 
74 
25.0 
67.8 
10 
135.1 
Baca 
119 
17.1 
59.1 
7. 
58,8 
Bent 
182 
22.9 
48. 4 
16 
87.9 
Boulder 
705 
20.3 
36.2 
41 
58.2 
Chaffee 
133 
16,0 
74.6 
11 
82.7 
Cheyenne 
53 
19.4 
49.4 
3 
56.6 
Clear Creek 
94- 
26,1 
36. 4 
8 
85.1 
Conejos 
222 
20,9 
68.2 
21 
94.6 
Costilla 
104- 
17.1 
71,2 
6 
57,7 
Crowley 
131 
22.9 
56.6 
16 
122.1 
Custer 
4-7 
19.5 
49,2 
3 
63.8 
Delta 
370 
25.3 
48,1 
16 
43.2 
Denver 
5,299 
17.8 
27,0 
263 
49.6 
Dolores 
47 
27.2 
56.9 
5 
106.4 
Douglas 
61 
16.8 
41.0 
2 
32.8 
Eagle 
113 
27,6 
48.0 
13 
115.0 
Elbert 
92 
17.3 
50.4 
2 
21.7 
El Paso 
850 
16,7 
29.7 
39 
45,9 
Fremont 
291 
16.0 
40,4 
15 
51.5 
Garfield 
244 
24,7 
42,8 
11 
45.1 
Gilpin 
18 
14.0 
<*6.5 
— 
— 
Grand 
59 
24.3 
48.3 
— 
— 
Gunnison 
133 
21.1 
49.2 
2 
15.0 
Hinsdale 
5 
9.8 
39.8 
— 
— 
Huerfano 
249 
14.1 
58.6 
31 
124.5 
Jackson 
45 
33.9 
49.6 
2 
44 »4 
Jefferson 
371 
14.0 
35.3 
13 
35.0 
Kiowa 
48 
17,5 
45.7 
— 
— 
Kit Carson 
135 
18.1 
53.4 
11 
81.5 
Lake 
165 
33.1 
37.4 
25 
151.5 
La Plata 
380 
27.3 
50.8 
30 
78.9 
Larimer 
655 
19.5 
42.2 
33 
50.4 
Las Animas 
719 
20,1 
55.6 
69 
96,0 
Lincoln 
129 
23 o9 
•c 
< 47.6 
5 
38.8 
Logan 
425 
23.8 
50,1 
18 
42.4 
Mesa 
656 
20.1 
42,5 
41 
62.5 
Mineral 
16 
24.2 
42.4 
1 
62.5 
Moffat 
79 
18.2 
46,6 
—. 
— 
Montezuma 
279 
35.3 
62,1 
31 
111.1 
Montrose 
282 
20.9 
51.6 
22 
78,0 
Morgan 
396 
24.6 
52.4 
16 
40.4 
Otero 
551 
22,8 
49.3 
42 
76.2 
Ouray 
45 
21,2 
44.1 
3 
66.7 TABLE VI - Continued 
NATALITY, FERTILITY, AND INFANT DEATHS, COLORADO COUNTIES, 1938 
COUNTIES 
BIRTHS. ALLOCATED 
NUMBER ’ RATE/1,000 POP. 
FERTILITY 
ALLOCATED INFANT DEATHS 
RATE NUMBER RATE A. 000 BIRTHS 
Park 
98 
37.4 
42.3 
8 
81.6 
Phillips 
104 
18.7 
46.2 
6 
57.7 
Pitkin 
29 
16.8 
45.0 
1 
34 *4 
Prowers 
274 
24.8 
51.2 
15 
54.7 
Pueblo 
1,192 
20.3 
38.3 
67 
56.2 
Rio Blanco 
38 
13.2 
45.3 
2 
52.6 
Rio Grande 
236 
17.2 
52.9 
32 
135.6 
Routt 
242 
24.8 
45.4 
16 
66.1 
Saguache 
153 
24.3 
62.8 
15 
98,0 
San Juan 
50 
19.2 
38.7 
2 
40.0 
San Miguel 
49 
19.1 
49.6 
5 
102.0 
Sedgwick 
107 
22.4 
52.5 
7 
65. u 
Summit 
13 
12.6 
33.3 
3 
23.0 
Teller 
141 
30.3 
43.4 
15 
106.4 
Washington 
156 
20.0 
54.6 
7 
44.9 
Weld 
1,330 
21.3 
51.6 
63 
47.4 
Yuma 
225 
19.1 
51.6 
10 
44 • 4 
COLORADO 
20,450 
19.5 
40.2 
1,243 
60.8 FIGURE VIII 
THE BIRTH RATE - COLORADO 1938 
ALLOCATED FOR RESIDENCE 
UNDER 17 
17- 19.9 
BIRTHS PER 1,000 POPULATION 
20-22.9 
23 - 25.9 
26 & OVER 23 
an unusually low birth rate are also in the mountain districts, with most 
of the other low rate counties following pretty generally the areas of 
heaviest population concentration and urbanization. 
Considering the state by districts, (see Appendix) we note that 
the western slope birth rates average about four births per thousand pop- 
ulation more than the eastern slope. The east central plains area pre- 
sents the lowest birth rate of 17.4- per 1,000 population, with the City 
and County of Denver a close second with a rate of 17.8. 
FERTILITY 
It is only for the census years that we have accurate data 
on the age and sex distributions of our population and our latest avail- 
able census records are those of 1930. The best analysis of the fertil- 
ity of the populations of the state would be a study of the ratio of the 
births in a population to the number of females of reproductive age in 
the same area. To get a true picture of such a ratio it would be neces- 
sary to use allocated births. Colorado birth reports were not allocated 
for residence of the mother in 1930, and therefore are not available. 
The next best ratio of fertility is the comparison of the children under 
five years of age to the females 15 to X4- years of age, for which all 
data are available from the United States census reports of 1930. 
The fertility rate expressed as the number of children under 
five years of age per hundred females, ages 15 to 4-4- years, for the 
United States in 1930 was 39.1 and for the State of Colorado was 
4-0.2, This would indicate that Colorado women were reproducing at a 
slightly faster rate than the average for the United States. 
The fertility rates in the separate counties (see Table VI) 
ranged from 27.0 in Denver to 74-.0 in Chaffee County. The most highly 
urbanized areas have the lowest fertility rates. This is probably ac- 
counted for by the large numbers of young women who live in such areas 
for the purpose of employment. Many such young women are unmarried, or 
if married tend to avoid pregnancy because it interferes with their in- 
come. This phenomenon is most striking in the City and County of Denver 
where we find a smaller proportion of the population under five years of 
age, a lower birth rate, and a lower fertility rate than any other dis- 
trict of the state (see Appendix). 
A study of the county distribution of fertility (see Figure IX) 
indicates that most fecund women of the state are concentrated along its 
entire southern edge extending northward through the San Luis valley. In 
comparing this distribution with the birth rates (see Figure VIII) it is 
observed that high fertility does not necessarily follow high birth 
rates. This is especially noticeable in the southern part of the Arkansas 
Valley where fertility is high but the birth rate is low, and in the group of counties in the northern half of the v/estern slope of the Conti- 
nental Divide, v/here the birth rates are high but the fertility rates are 
not. 
We must give full consideration to the fact that birth rates of 
1938 have been compared to fertility rates of 1930, but both rates can not 
be computed for the same year. Referring to the changes of population 
within the separate counties during an eight year period (see Figure II), 
it is readily seen that conclusions based on these comparisons might be 
subject to significant errors. 
INFANT MORTALITY 
The infant mortality rate for Colorado has been decreasing 
rapidly over the past decade, but as pointed out previously, this may be 
due to the better reporting of live births, upon which this rate is com- 
puted. Even with the great increase of expenditures in Child Welfare 
work in the state during the past few years, it is doubtful if there has 
been any appreciable savings in children's lives. Child health programs 
to date have only scratched the surface of the problem and much remains 
to be done in reducing the present rate of infant mortality. 
Colorado's infant mortality rate of 60.B deaths per 1,000 live 
births is high compared to the other states. In 1938 it was exceeded by 
only 9 other states of the nation. Many communities of the United States 
have been able to demonstrate rates below 30.0 which means that a child 
born in these communities has twice the chance of reaching its first birth 
day as a child born in Colorado. 
Only eight of the separate Colorado counties, in 1938, had an 
infant death rate under 30.0 (see Table VI) with five of these reporting 
no infant deaths. Since all counties reporting no deaths or a rate less 
than 30.0 have small populations, these rates representing a single year 
can not be considered as highly significant, because in four of the coun- 
ties, one additional infant death, and in the other four counties, two 
additional deaths would have given an infant death rate over 30.0, 
In the geographical distribution of infant death rates (see 
Figure X) we see the lowest county rates concentrated in the eastern and 
northern portion of the state, and the highest rates concentrated in the 
San Luis valley and extending along the southern border. 
In areas where birth rates are high, infant mortality rates are 
generally expected to be high. The Colorado counties with high birth 
rates (see Figure VIII) do not coincide with those of high infant mortal- 
ity. There is however, a suggestion of a direct relation between fertil- 
ity (see Figure IX), and infant mortality in Colorado counties. FIGURE IX 
COLORADO -1930 
RATIO OF NUMBER OF CHILDREN UNDER 5 YRS. TO FEMALES 15-44 YRS. 
UNDER 40 
40-44.9 
45-49.9 
50 - 54.9 
55 i OVER FIGURE X 
INFANT MORTALITY — COLORADO 1938 
ALLOCATED FOR RESIDENCE 
DEATHS UNDER ONE YEAR PER 1,000 LIVE BIRTHS 
UNDER 30 
30-59.9 
60-89.9 
90-119.9 
120 & OVER 25 
GENERAL MORTALITY 
The United States Census Bureau reports (see Table VII) indi- 
cate that from 1930 to 1938 the Colorado death rates for each year ex- 
ceeded that for the United States. Over this period there was an annual 
average in Colorado of more than one death per thousand population than 
in the United States registration area. 
In a previous chapter it was pointed, out that Colorado has more 
of its population in the older age groups, and that the population was 
growing old faster than the whole United States. This may be one of the 
reasons for a comparatively high death rate. Another factor to be con- 
sidered is that the state has long had the reputation throughout the 
United States of having an ideal climate for those afflicted with tuber- 
culosis and other lung diseases. This has attracted many morbid persons 
from other states who have made Colorado their permanent residence and 
have probably increased its mortality rates. Against these factors is 
the small negro population of Colorado which should have a tendency to 
decrease the death rate. The state’s Mexican population, of which little 
mortality experience is known, may replace the small negro factor affect- 
ing mortality. 
The death rates of the separate counties (see Table IX), show 
a range from 5.9 in Hinsdale County to 25.7 in Lake County. However, 
the small population on which these rates are based must be considered, 
especially so in Hinsdale County where a single death will change the 
rate approximately two deaths per thousand population. Here again the 
average of several years can not be demonstrated because only one year 
of residence allocated data is available. 
The geographic distribution of mortality rates by counties 
(see Figure XI), show the highest rates along the Continental Divide 
about the center of the state, and in the southwest corner in the San 
Juan valley. The effect of age on the death rates in these areas is 
apparent by comparing the distribution of the population over 65 years 
(see Figure VII) with the distribution of high mortality rates. The 
highest death rates generally coincide with the counties having the 
greatest portion of old persons in their populations. 
In studying the leading causes of death in Colorado in 1938 
(see Table VIII), v/e see that diseases of the heart cause more than 
twice the number of deaths as cancer, which is the second in frequency. 
Little has been accomplished in the study of the causes of 
heart disease, and consequently health organizations are hindered in 
planning a preventive program. Some health agencies have attempted to 
reduce the mortality and morbidity of cardiac diseases but to date no 
practical results have been reported. The atmospheric conditions 26 
peculiar to the high altitudes of Colorado may contribute to the great 
number of cardiac deaths in the state. 
Since cancer is more common in the older age groups, Colorado 
should be expected to have a large number of deaths from this cause. If 
cancer deaths could be standardized for ages, Colorado rates would prob- 
ably compare favorably with other states. Because of the lack of knowl- 
edge of the causes and treatment of cancer, very little has been accom- 
plished in its prevention by health organizations. The high costs of 
diagnosis and treatment has lead most official health agencies to spend 
their appropriations on programs that will yield more practical results 
in reducing mortality. Activities in Cancer Control by the Colorado 
State Board of Health have been confined to surveys and education of 
physicians and the public. 
Pneumonia is probably the greatest mortality problem of Colo- 
rado in which official health agencies can offer a practical control 
program. The pneumonia death rate for the state, in 1938, was 104.6 
per 100,000 population, and the rates of the counties (see Table IX) 
ranged from no deaths in five counties to a rate of 681.8 in Lake 
County. The statistical significance of this rate may be justly crit- 
icized because it applies to a small population for a single year, but 
reviewing the last five years mortality records of the county, we find 
that 124 pneumonia deaths have been reported in a population of about 
5,000 persons, which would mean a five year average pneumonia mortality 
rate of approximately 500 per 100,000 population. The explanation of 
this unusual rate is probably due to the fact that practically all the 
population of the county lives at an altitude over 10,000 feet above sea 
level. The relatively small amount of oxygen in the atmosphere at this 
altitude embarrasses the already impaired respiration of pneumonia vic- 
tims and case fatality rates approach 100 per-cent. 
All Colorado counties reporting high pneumonia death rates in 
1938, are located in the high mountain areas (see Figure XII). The 
highest rates are concentrated along the high ridge of the Continental 
Divide, and in the San Luis and San Juan districts in the southwest 
portion of the state. 
In 1938 the Colorado State Board of Health began a pneumonia 
control program. This program has established 19 pneumonia typing sta- 
tions at key locations in the state to aid physicians in diagnosis, and 
is supplying several of the common types of anti-serum and drugs to 
medically needy victims of the disease. The results of this program 
have not as yet been appraised but the belief has been expressed by the 
director of the program that the money expended on this program has been 
a practical venture in reducing pneumonia mortality. 
Accidents occupy a relative high place among the leading 
causes of death in Colorado in 1938. The State Board of Health at TABLE VII 
ANNUAL DEATH RATES, COLORADO AND UNITED STATES, 1930-1938 
FROM UNITED STATES CENSUS BUREAU 
YEAR 
COLORADO 
UNITED STATES 
1930 
12.7 
11.3 
1931 
11.9 
11,1 
1932 
12,0 
10.9 
1933 
11.4 
10,7 
1934 
11.8 
11,0 
1935 
12.4 
10.9 
1936 
12.8 
11.5 
1937 
12.9 
11.2 
1938 
12.4 
10.6 
TABLE VIII 
TEN LEADING CAUSES OF DEATH, RESIDENCE ALLOCATED, COLORADO, 1938 
NUMBER 
RATE PER 100.000 
POPULATION 
1, 
Heart 
2688 
256.9 
2. 
Cancer 
1315 
125.7 
3, 
Pneumonia 
1094 
104.6 
4. 
Accidents 
1031 
98.5 
5, 
Cerebral Hemorrhage 
938 
89.7 
/ 
o. 
Nephritis 
918 
87.7 
7. 
Tuberculosis 
540 
51.6 
8 
Prematurity 
350 
33.5 
9. 
Arteriosclerosis 
218 
20.8 
0. 
Appendicitis 
197 
18,8 TABLE IX 
RESIDENCE ALLOCATED MORTALITY AND RATES} COLORADO COUNTIES, 1938 
COUNTIES N 
ALL DEATHS 
PNEUMONIA DEATHS 
TUBERCULOSIS DEATHS 
fUMBER RATE/1,000 POP. 
NUMBER RATE/100,000 POP. 
NUMBER RATE/lOO,000 POP. 
Adams 
201 
9.5 
23 
108.9 
13 
61.6 
Alamosa 
135 
13.6 
18 
181.0 
1 
10.0 
Arapahoe 
261 
9.7 
17 
62.9 
19 
70,3 
Archuleta 
32 
10.8 
3 
101.3 
— 
— 
Baca 
37 
5.3 
5 
71.7 
— 
— 
Bent 
73 
9.2 
5 
62.9 
4 
50.3 
Boulder 
429 
12.4 
29 
83.6 
12 
34.6 
Chaffee 
107 
12,9 
11 
132.2 
2 
24.0 
Cheyenne 
19 
7.0 
1 
36.7 
1 
36.7 
Clear Creek 
70 
19.4 
6 
166.5 
3 
83.3 
Conejos 
108 
10.2 
15 
141.2 
4 
37.6 
Costilla 
42 
6.9 
4 
65.6 
]. 
16.4 
Crowley 
53 
9.3 
2 
35.0 
2 
35.0 
Custer 
27 
11.2 
5 
207.8 
— 
— 
Delta 
158 
10.8 
15 
102,7 
3 
20.5 
Denver 
3,856 
12,9 
281 
94.1 
213 
71.4 
Dolores 
18 
10.4 
3 
173.4 
— 
— 
Douglas 
33 
9^1 
1. 
27,5 
3 
82.6 
Eagle 
52 
12.7 
5 
122.0 
1 
• 4 
Elbert 
40 
7,5 
4 
75.1 
— 
— 
El Paso 
650 
12.8 
40 
78.7 
55 
108.2 
Fremont 
198 
10,9 
20 
109.8 
6 
32.9 
Garfield 
108 
10.9 
. 8 
81,0 
3 
30.4 
Gilpin 
20 
15.5 
3 
232.6 
1 
77.5 
Grand 
19 
7.8 
— 
— 
— 
— 
Gunnison 
58 
9.2 
8 
126.9 
2 
31.7 
Hinsdale 
3 
5.9 
— 
— 
— 
— 
Huerfano 
198 
11.2 
21 
119.1 
11 
62.4 
Jackson 
17 
12.8 
1 
75.4 
— 
— 
Jefferson 
307 
11.6 
24 
90.6 
13 
49.1 
Kiowa 
21 
7.6 
2 
. 72.8 
— 
— 
Kit Carson 
72 
9.6 
6 
80.2 
1 
13.4 
Lake 
128 
25.7 
34 
681.8 
— 
— 
La Plata 
153 
11.0 
30 
215.3 
4 
28.7 
Larimer 
375 
11.2 
25 
74.4 
9 
26.8 
Las Animas 
399 
11.1 
43 
120.5 
18 
50.3 
Lincoln 
53 
9,8 
4 
74.1 
1 
18.5 
Logan 
146 
8.2 
14 
78.5 
1 
5.6 
Mesa 
323 
9.9 
21 
64.2 
5 
15.3 
Mineral 
14 
21.1 
3 
453.2 
— 
— 
Moffat 
34 
7.8 
— 
— 
1 
23.0 
Montezuma 
122 
15.4 
18 
227.9 
4 
50,7 
Montrose 
148 
11.1 
18 
133.3 
5 
37.0 
Morgan 
162 
10,1 
11 
68,3 
8 
49.7 
Otero 
281 
11,6 
27 
111,9 
18 
74.6 
Ouray 
42 
19.8 
2 
94.3 
2 
94.3 TABLE IX - Continued 
RESIDENCE ALLOCATED MORTALITY AND RATES, COLORADO COUNTIES, 1938 
COUNTIES 
ALL DEATHS 
PNEUMONIA DEATHS 
TUBERCULOSIS DEATHS 
NUMBER 
RATE/l,000 POP. 
NUMBER RATEAOO,000 POP. 
NUMBER 
RATE AOO. 000 POP. 
Park 
A3 
17.2 
5 
190.8 
1 
38.2 
Phillips 
6A 
11.5 
6 
107.6 
1 
17.9 
Pitkin 
20 
11.6 
1 
57.B 
— 
— 
Prowers 
1AA 
13.0 
13 
117.8 
2 
18.1 
Pueblo 
6a6 
11.0 
5A 
91.9 
36 
61,3 
Rio Blanco 
26 
9.0 
— 
— 
1 
3^.8 
Rio Grande 
153 
11.2 
37 
270. A 
8 
58.5 
Routt 
93 
9.5 
6 
61. A 
— 
— 
Saguache 
71 
11.3 
10 
160.6 
1 
15.9 
San Juan 
17 
6.5 
1 
38.3 
1 
38.3 
San Miguel 
35 
13.6 
6 
233.8 
1 
39.0 
Sedgwick 
35 
7.3 
2 
A1.9 
— 
— 
Summit 
20 
19.A 
2 
19. A 
— 
— 
Teller 
92 
19.B 
11 
236.3 
A 
85.9 
Washington 
62 
8.0 
1 
12.8 
1 
12.8 
Weld 
536 
B.6 
60 
96.1 
16 
25.6 
Yuma 
107 
9.1 
B 
67.9 
1 
8.5 
Res.Institutions3B0 
— 
35 
— 
16 
— 
COLORADO 
12?3AB 
11.8 
1,09A 
10A.6 
5 AO 
51.6 FIGURE XI 
MORTALITY FROM ALL CAUSES - COLORADO 1938 
ALLOCATED FOR RESIDENCE 
DEATHS PER 1.000 POPULATION 
UNDER 9 
9-10.4 
10.5- 11.9 
12- 13.4 
13.5 & OVER FIGURE XII 
MORTALITY FROM PNEUMONIA - COLORADO 1938 
ALLOCATED FOR RESIDENCE 
DEATHS PER 100,000 POPULATION 
lUNOER SO 
SO-99.9 
100- 149.9 
ISO- 199-9 
200 & OVER 27 
present, has no program for the prevention of accidents, yet of all the 
leading causes of death, accidents present the largest group of unques- 
tionably preventable deaths. The ages at which accidental deaths are 
most frequent is of interest. The Colorado state registrar reports 
accidents the leading cause of death in Colorado age groups 2 to 19 
years. This would suggest that an accident prevention program could be 
practically included in child health and school programs through the 
state, 
Tuberculosis has, for many years, been a special problem for 
the State of Colorado because of the reputation of the effect of its 
climate on lung diseases. This reputation v/as probably acquired be- 
cause of the inhibiting effect of the arid atmosphere on all bacterial 
growth. This story has been responsible for the immigration of many per- 
sons infected with tuberculosis, and considering this, it is remarkable 
that the tuberculosis death rate for the state, in 1938, is down to 51.6 
per 100,000 population. 
Fifteen counties of the state representing approximately, 
50,000 population report no deaths during 1938, (see Table IX), and 11 
more counties have a rate less than 20 per 100,000 population. Twelve 
counties have a rate greater than 60, the highest rate being 108.2 in 
El Paso County. The counties having tuberculosis death rates over 60 
are all along the eastern foothills of the Continental Divide (see Fig- 
ure XIII) with the exception of Ouray County. These counties with high 
rates correspond generally to those with the highest concentration of 
population (see Figure IV). 
The Colorado State Board of Health, recognizing the problem 
of this disease in the state, has since 1936 employed a full time di- 
rector of Tuberculosis Control. The work of this division has consisted 
of tuberculin testing, physicial examinations, X-ray, and education. The 
state does not maintain hospitals for the isolation and treatment of 
tuberculosis patients, but does appropriate $50,000 annually thru the 
V/elfare Department to match local funds spent for hospitalization in the 
many privately owned tuberculosis hospitals in the state. 
i 
Prematurity is recorded as one of the ten leading causes of 
death in 1938, but this group has been shown ly Bundenson (12) to gener- 
ally include many deaths due to other causes. Regardless of the true 
cause of death, they do represent a group that preventive medical pro- 
cedures can reduce with adequate programs. The Colorado State Board of 
Health is attempting to reduce all infant and maternal mortality through 
the Division of Maternal and Child Health. Programs now directed espe- 
cially at this cause of death consist mainly of prenatal- clinics, ob- 
stetrical home nursirig, and the use of portable incubators in rural areas. 28 
Cerebral hemorrhage, nephritis, arterio-sclerosis, and appendi- 
citis are all included among the ten most common causes of death in Colo- 
rado, in 1938, but because of the little knowledge of the etiology and 
prevention of these diseases Colorado, as most other states, has been 
unable to suggest any practical program that might reduce these causes 
of death. 
COMMUNICABLE DISEASES 
The case reports of communicable diseases depend entirely on 
the practicing physicians. If they are faithful in their reporting., the 
resulting statistics present a true picture of disease incidence of a 
community, and if they are negligent the picture is distorted. The ef- 
ficiency of the physicians can not be measured, but it is reasonable to 
suppose that in every part of the United States many cases of communi- 
cable disease are never reported. In interpreting health department 
reports, then we should not consider the number of reported cases as a 
true picture of morbidity but rather an index of morbidity. The real 
value of these statistics is in the rise and fall through consecutive 
seasons and years, rather than the total number of cases recorded for 
any given period. 
The trends of reportable diseases rates in Colorado compared 
to the United States from 1930 to 1938 (see Table X and Figure XIV) in- 
dicate that the most important disease problems of the state are typhoid, 
smallpox and diphtheria. The other diseases seem to have followed the 
same trends in both areas. In the case of Syphilis, it is interesting 
to note that the trends are the same in both areas, but in the United 
States there has been a report rate double that of Colorado through all 
of the years observed. 
Reports of communicable disease per death, in 1938, compared 
to the standards of the appraisal schedule of the American Public Health 
Association are as follows: 
Disease 
Colorado 
Reports per death 
Expected 
Reports per death 
Measles 
269 
150 
Scarlet Fever 
131 
150 
Whooping Cough 
50 
37 
Diphtheria 
13 
15 
Typhoid Fever 
8 
7 
This would indicate that physicians report well on typhoid fever, 
measles, and whooping cough, but should do better on scarlet fever and 
diphtheria. FIGURE XIII 
MORTALITY FROM TUBERCULOSIS (all forms)-COLORADO 1938 
ALLOCATED FOR RESIDENCE 
DEATHS PER 100,000 POPULATION 
NONE 
0-199 
20 - 39.9 
40- 59.9 
«0 L OVER TABLE X 
COMMUNICABLE DISEASE REPORT RATES PER 100,000 POPULATION 
COLORADO AND UNITED STATES, 1930-1938 
1930 
COLORADO 
1931 1932 
1933 
1934 
1935 
1936 
1937 
1938 
Diphtheria 
_ 45 
33 
37 
25 
33 
44 
27 
29 
64 
Measles 
1189 
469 
191 
36 
1278 
1619 
66l 
114 
850 
Poliomyelitis 
7.3 
0.9 .. 
0.9 
0.7 
2.0 
2.1 
3.1 
22.8 
1.2 
Scarlet Fever 
108 
133 
153 
126 
296 
750 
373 
153 
176 
Smallpox 
56 
22 
8 
12L. 
15 
20 
21 
21 
27 
Syphilis 
61 
88 
72 
42 
56 
43 
39 
114 
163 
Typhoid & 
Paratyphoid 
22 
22 
18 
22 
19 
10 
7 
8 
17 
Who opine: Cough 
218 
187 
125 
116 
361 
73 
171 
160 
153 
Diphtheria 
54 
UNITED STATES 
57 48 40 
34 
31 
23 
22 
24 
Measles 
340 
382 
323 
319 
631 
583 
233 
249 
641 
Poliomyelitis 
7.6 
12.7 
3.0 
4.0 
5.9 
9.0 
3.5 
7.0 
1.3 
Scarlet Fever 
141 
162 
168 
169 
174 
205 
190 
177 
148 
Smallpox 
40 
24 
9 
5 
_ 4 
6 
6 
9 
12 
Syphilis 
180 
193 
202 
175 
192 
207 
224 
330 
371 
Typhoid & 
Paratyphoid 
22 
21 
21 
19 
18 
14 
12 
12 
12 
Whooping Cough 
135 
136 
171 
143 
209 
142 
115 
166 
177 FIGURE XIV 
REPORTED MORBIDITY FROM CERTAIN CAUSES 1930-38 
COLORADO UNITED STATES 
TYPHOID FEVER 
POLIOMYELIT IS 
MEASLES 
SCARLET FEVER 
SMALL POX 
DIPHTHERIA 
WHOOPING COUGH 
SYPHILIS 29 
From 1930 to 1936 typhoid fever has shown a downward trend in 
Colorado, following closely the United States reports. From 1936 to 
1938 there is a sharply increasing report rate in Colorado while the 
United States trend continues downward. This sharp rise may be due to 
better epidemiological work and a more complete knowledge of where the 
cases are occurring. 
Since 1934- smallpox has been consistently reported in Colo- 
rado at a frequency about twice that of the United States. The increase 
occurred two years before the Social Security Act stimulated local health 
work and consequently the high rate can not be attributed to better re- 
porting or better epidemiological work. The high incidence can more 
properly be charged to lack of widespread vaccination. 
Colorado diphtheria reports from 1930 to 1937 have remained at 
about the same level, while during the same period United States re- 
ports have been consistently reduced. In 1938, while the United States 
reports remained at about the same rate, Colorado reports doubled those 
of 1937. Since diphtheria is a definitely preventable disease, this 
would indicate that local health authorities of Colorado are doing a 
very poor job of protecting its people against this disease. 
Whether or not the reporting of these diseases is complete is 
not as important as the fact that preventable diseases are definitely 
endemic in the state and it is the duty of the Colorado State Board of 
Health to attempt to reduce these diseases through its own action, or 
by the stimulation of local health authorities. CHAPTER V 
HEALTH AND HOSPITAL FACILITIES 
HOSPITALS 
The many hospital studies available agree that adequate facil- 
ities depend on many factors which vary widely in each community. Race,, 
age, sex, morbidity, topography, climate, industry, and many other fac- 
tors must be considered in attempting to determine the number of beds or 
type of service desirable for any given community. Due to the wide vari- 
ability of the determining factors, it is obviously not wise to designate 
the hospital facilities of any area as adequate on a single factor such 
as population or air line distances. 
The urban hospitals of Colorado are probably reasonably ade- 
quate. The real hospital problem is in the rural areas, especially where 
the population is widely scattered. 
Detailed studies of the factors involved in developing adequate 
hospital facilities for the sparsely settled mountain communities, are 
not available, but a recent study of a rural New York hospital service 
(13) revealed the following; 
1. A relatively large portion of the population under 15 years 
of age is hospitalized. 
2. The female population between 15 and 35 years show the 
highest hospital rate. 
3. The predominating occupations of those admitted are house- 
wives, students and infants. 
4-. The leading primary diagnoses are trauma, pregnancy, and 
newborn infants. 
5. Diseases requiring skilled treatments lead in causes. 
6. The most common surgical conditions are appendicitis, 
cholecystitis and salpingitis. 
7. Ninety-four per-cent of patients come from within a 30 mile 
radius. 
8. Thirty-eight per-cent of the accidents are from highways, 
19 per-cent from homes, and 18 per-cent from farms. 9. Fifty-two per-cent of the patients require less than one 
hour ride to the hospital. 
10. Twenty-three per-cent of the bills are uncollected. 
Comparing the above findings to Colorado, the age, sex, occu- 
pation, and diagnosis figures might apply, but not those of distances 
and travel time. The population of the rural portions of the state is 
so scattered that it would not be practical to establish hospitals serv- 
ing areas having radii of 30 miles or less. In some parts of Colorado 
such areas would have populations of less than 1,500 persons (see Table 
II), and if three beds per thousand population are sufficient for ade- 
quate rural service, theoretically, a five bed hospital would adequately 
serve any such community. A hospital twice this size is not a practical 
investment because the expensive equipment necessary for complete ser- 
vice would find little use among such a small group of patients, and the 
few physicians making use of such facilities could not confine themselves 
to any specialty. Medical practice in sparsely settled communities must 
be left entirely to the general practitioner. 
Title XII of the Wagner Bill (14.) now being considered by 
Congress suggests grants-in-aid to states for hospitals and health cen- 
ters. Mustard (13) has said that the rural "hospital regards itself as 
an instrument in maintaining the public health and, as a corollary, con- 
siders the matter of public health of serious concern to itself." This 
suggests the possibility, in future plans, of establishing combined 
nursing homes and health centers at convenient intervals in sparsely 
settled areas. Such a center could be used by health workers for well 
baby conferences, tuberculosis clinics, and all other preventive medical 
services. It could also provide facilities for obstetrical care, minor 
surgery, and general medical care. Ambulance service to hospitals 
equipped for expensive diagnostic facilities and major surgery, could be 
provided. Such a plan would serve several purposes, it would: 
1. Provide sterile materials for the use of general practi- 
tioners . 
2. Provide good nursing care for otherwise isolated patients. 
3. Provide the rural physician with a close contact and bet- 
ter understanding of the exact function of the health department. 
4. Provide the public health field worker with the consulta- 
tion and advice of the practicing physician. 
A complete study of present Colorado hospital facilities is 
beyond the scope of this thesis, but an attempt will be made to indi- 
cate the distribution of the present hospitals and the number of beds 
available to the population. 32 
Because of the sparse population of some Colorado counties, 
it is not practical to consider service within the separate counties. 
Hence, the state is divided into seven districts based primarily on the 
natural topographical divisions. The sites of hospital facilities are 
indicated and the state is divided into the following districts: (see 
Figure XV) 
1. Denver city and county. 
2. The Platte river valley. 
3. The eastern central plains area. 
X. The Arkansas river valley. 
5. The San Juan and San Luis valleys. 
6. The Colorado river valley. 
7. The White and Yampa river valleys. 
Reference to preceding chapters indicates that transportation 
facilities, population, race, mortality, natality, and other factors 
divide the state into these natural divisions. 
The American Medical Association (If) reports that in 1938, 
Colorado had 101 hospitals and related institutions containing 13,4-33 
beds, and 24- hospitals of unknown size that have refused registration. 
The state has only one hospital specializing in maternity, If specializ- 
ing in tuberculosis, none of which are owned and operated by the state 
or local governments, and 69 general hospitals. In 1938 Colorado hospi- 
tals admitted 9f.f7 persons per thousand population. Of these 91.38 per 
thousand were admitted to general hospitals, 2.4-7 to nervous and mental 
hospitals, .39 to industrial hospitals and .30 to maternity hospitals. 
A study of the general beds available to Colorado residents 
within the separate counties (see Figure XV) shows there are 30 counties 
without hospitals, 12 counties with less than three beds per thousand 
population, 12 counties with three to six beds per thousand, 6 counties 
with 6 to 9 beds per thousand, and three counties with more than 9 beds 
per thousand. The three counties with more than 9 beds per thousand 
are in mining districts where hospital needs are greatest because of the 
hazardous occupations. The lack of hospital facilities is most prominent 
in the northwest corner of the state. 
Considering the hospital facilities on the basis of topograph- 
ical districts (see Table XI) we find, in Denver, the largest number of\ 
beds, the largest number of beds per population, and the largest hospitals FIGURE XV 
DISTRIBUTION OF HOSPITAL FACILITIES - COLORADO. 1938 
FROM AMERICAN MEDICAL ASSOCIATION 
O REGISTERED HOSPITALS V NON-REGISTERED HOSPITALS 
|NO BEDS 
]UNDER 3 
BEDS PER 1,000 POPULATION 
3- 5.9 
6-8.9 
9 8. OVER TABLE XI 
GENERAL HOSPITAL FACILITIES AND PHYSICIANS, COLORADO, 1938 
Hospitals 
Phys 
icians 
Per-cent of 
District 
Number 
Total 
Beds 
Median 
No. Beds 
Beds per 
1000 Poo. 
Pop. Per 
Number Physician 
Births in Regis 
tered Hospitals 
Denver 
11 
2120 
160 
7.1 
74-8 
399 
91.6 
Platte 
Valley 
14 
535 
32 
2.5 
231 
934 
28.3 
East- 
Central 
8 
4-53 
20 
3.2 
192 
735 
50.8 
Arkansas 
Valley 
9 
691 
50 
3.6 
194. 
986 
32.8 
San Luis- 
San Juan 
Valley 
10 
279 
27 
3.6 
70 
1,099 
31.4 
Colorado 
Valley 
12 
330 
IB 
3.8 
86 
1,010 
29.6 
White- 
Yampa 
Valley 
5 
69 
11 
1.9 
41 
872 
21.2 33 
Most of the specialists have located in Denver, Pueblo, and Colorado 
Springs and their services attract many patients from all over Colorado 
and several of the adjoining states. The hospital census (see Table XI) 
indicates that Denver has 7.1 beds per thousand population, but these 
beds are not all used by Denver residents, except those of Denver Gener- 
al Hospital. A survey of the 1938 admissions to three general hospitals 
(Presbyterian 150 beds; St. Anthony, 154- beds; St. Lukes, 219 beds) repre- 
senting approximately 25 per-cent of the general hospital beds in the city, 
reveals that 4-2.6 per-cent of the admissions are from outside the city. 
If we apply this rate to all Denver hospitals except Denver General, then 
we can estimate that approximately 14-50 (68 per-cent) of Denver's general 
hospital beds are used by its residents. On this basis there would be 
4-.9 beds per thousand population in Denver actually available to its res- 
idents. The remaining districts of the state, with the exception of the 
White and Yampa river valleys, show from 2.5 to 3*8 beds per thousand 
available. In the usual rural communities this would be considered ade- 
quate but since some parts of these districts have a large proportion of 
the population employed in mines the present facilities may not be ade- 
quate. This question can be settled only by careful local surveys. 
The greatest need in the state is indicated in the White and 
Yampa river valleys. In this district there are only five hospitals, 
the largest having 21 beds. Transportation facilities make Denver the 
nearest place where these patients may find adequate diagnostic facili- 
ties and the services of specialists. The most distant point in the 
district is approximately 24-0 miles air line and much farther by road 
to Denver. 
Hospital admissions to general beds are difficult to determine 
for Colorado because many of the general hospitals have part of their 
beds for tuberculosis patients, and the admissions to tuberculosis and 
general beds are difficult to separate. Thus the only available data 
to use as an index of the use made of hospitals by the people of Colorado, 
are the hospital confinements. The data used here (see Table XI) are the 
number of births recorded in registered hospitals, and the per-cent is 
based on the total number of births recorded. In interpreting the fig- 
ures one must bear in mind that the final figures do not show the per-cent 
of mothers in a district who sought hospital care, but do indicate where 
they sought it. In Denver, 91.6 per-cent of the recorded births occurred 
in registered hospitals, v/hile the Colorado state registrar of vital sta- 
tistics reports that 15.5 per-cent of the recorded births were allocated 
out of the city, and 77.0 per-cent of the resident births were hospital 
deliveries. This should not lead us to the conclusion that such a high 
per-cent of Denver residents were able to have hospital care, but rather, 
that many mothers from other parts of the state came to Denver for their 
confinements because they preferred the best available hospital service 
and medical care. The picture of hospital confinements in other parts of the 
state (see Table XI) is probably somewhat distorted because quite a 
number of confinements were conducted in small unregistered hospitals, 
so actually more mothers, not residents of Denver, received hospital 
care than the data show. It must be remembered too, that by using the 
recorded births we are not considering those mothers who left the dis- 
trict in seeking better service. It is interesting to note in the 
White and Yampa river valleys that 21.2 per-cent of the mothers who re- 
mained in the district sought hospital care in spite of the lack of 
satisfactory facilities available. 
A study of the above data would suggest that more hospital 
confinements could occur in Colorado hospitals, outside of Denver, if 
better facilities were available and the number would undoubtedly be in 
creased by the use of some plan whereby those of the lower income classes 
would be able to meet the costs of such service. 
PHYSICIANS 
In recent years the conduct of medical practice has been severe 
ly criticised by some laymen who do not believe the physicians have tried 
to keep pace with the changing world in administering medical services. 
The physicians on the other hand have attempted to preserve a code of 
ethics supported by more than 2,000 years of tradition. This problem has 
become increasingly complex in the past few years by the introduction of 
many improved and expensive diagnostic and treatment facilities which the 
physician finds he is unable to use because his patients are not able to 
pay for them. 
The writer, having practiced medicine for approximately 10 
years, is fully aware of the helpless feeling of the physician who makes 
endless calls on a patient, knowing that if the patient could afford 
hospital care, expensive diagnostic procedures, and treatment, he could 
soon be returned to good health. This situation is not the fault of the 
physician, nor can the patient be blamed for his limited earning capacity 
Laymen, not knowing the problems of the physicians, have at- 
tempted to solve the problems of medical practice through legislation and 
governmental group activities without perhaps seeking the proper consul- 
tation of the physicians. This has resulted in forcing some physicians 
to practice medicine under a condition which they resent, and has made 
many other physicians suspicious of any activity in the medical field by 
the Federal Government. Meanwhile, in some quarters the rank and file of 
physicians have not studied the problems nor read reports which describe 
all aspects of the situation. 
A stated amount of medical care can not be considered adequate 
for all communities. The needs depend on factors that vary in each local 35 
situation, and the individuals experiencing those needs should be the 
ones best qualified to express them. Recognizing medical care and pub- 
lic health as purely local problems, the Social Security Act and the 
proposed Wagner Bill allot grants-in-aid to the separate states, on the 
basis of their needs, in order that they may spend their allotment on 
programs best suited to their own problems. 
In Colorado, these grants are handled through the state board 
of health by physicians with medical and administrative training. In 1938, 
the state medical society, representing 1,088 members among Colorado's 
1,562 registered resident physicians, had adopted an advisory system to 
aid the state board of health in administering their program. Under this 
system the society has appointed committees from its membership, on can- 
cer, tuberculosis, venereal disease, pneumonia, maternal and child health, 
crippled children, industrial health, and milk. These committees act in 
an advisory capacity to the division directors of the state board of 
health, assisting the directors in shaping their programs and policies to 
meet the needs of the practicing physicians and their patients. The 
chairman of each of these committees make up a committee on public health, 
acting in a general advisory capacity to the state board of health. 
There has been a growing tendency in the United States toward 
group practice. Under such a system a group of physicians pool their ser- 
vices, equipment, office space, and in many cases their income. At the 
same time they are able to reduce expenses, hire skilled personnel, and 
use equipment which they could not afford in individual practice; and the 
patient can be offered better diagnostic facilities and his costs may be 
somewhat reduced in proportion to the service he receives. At the close 
of 1938, four such plans were in operation in Colorado, located at Greeley, 
Pueblo (two groups), and Denver. 
Group schemes are applicable only to well populated centers 
that can support several doctors. This eliminates a large part of Colo- 
rado from such plans because of its scattered population. In future 
plans of rural hospital development, it may be well to keep in mind the 
possibility of using these hospitals as the nuclei for group practice. 
In a large proportion of American families, costly illness has 
become a financial catastrophe, and for this reason many plans for 
spreading the cost of medical care have been tried. The tax plan used 
by many foreign countries is not applicable to the United States, and 
so all of our American plans have been based on voluntary prepayment. 
This system consists of the pooling of monthly payments by a large group 
to pay for the medical care of the members of that group suffering any 
illness. Prepayment plans have been sponsored in the United States by 
physicians, patients, other persons or groups, and by the government. There are only three physician sponsored prepayment plans in 
Colorado. Two of these are located in Denver and one in Greeley. All 
are relatively recent and no information is available on their progress. 
No known patient sponsored prepayment plans have been operating 
in the state, 
Two ventures in prepayment plans by Denver insurance companies 
have failed, but several large insurance companies operating in the state 
are now conducting a prepayment plan on a reimbursement basis. 
The only government prepayment plan operating in Colorado, has 
been that sponsored by the Farm Security Administration. This plan, in 
most places has been very unsatisfactory to the physicians because the 
government representatives attempt to determine the fees. In some cases 
the fees have been only 20 per-cent of the usual charges by the physi- 
cians, and the physicians have stated that they would rather do the work 
free (16). 
Physicians in rural practice find it extremely difficult to 
leave their practice to obtain post-graduate training and become ac- 
quainted with new methods in medical practice. To aid such physicians, 
the Colorado State Medical Society has sponsored post-graduate clinics 
and visiting symposium teams. 
0 
Each year, three day post-graduate clinical conferences are 
held in Denver, Pueblo, and Grand Junction. Physicians of national repu- 
tation supervise the clinics, and the expenses are borne by the state and 
county societies, a two dollar fee from attending physicians, and some 
financial aid from the Colorado State Board of Health. In 1938, 610 
Colorado physicians attended these clinics. 
The symposium teams are made up of physicians interested in 
cancer, venereal disease, pneumonia, and tuberculosis. These teams visit 
any local medical society in the state, on invitation, and direct dis- 
cussions on their chosen subject. Travel expenses of these teams have 
been financed by the Women’s Field Army, The American Society for the 
Control of Cancer, The State Tuberculosis Association, The Colorado 
State Board of Health, and the Colorado State Medical Society. The 
physicians have generously donated their time and the symposia have been 
given to the local societies at no cost to them. In 1938, approximately 
-400 Colorado physicians attended these symposia. 
The American Medical Association reports 1,923 physicians in 
Colorado in 1938 (17). Based on their Colorado population estimate of 
1,069,000 for 1937, this would be one physician for each 556 persons in 
the state. The source of the physicians census and the day of the year 
that it was taken is not indicated. From the annual report of the Colorado State Board of Medical 
Examiners, as of December 31, 1938, there were 1,562 resident physicians 
licensed in the state (see Table XII). Based on the population estimates 
in Table I, there would be one physician for each 670 persons in the state. 
The American Medical Association has pointed out that physicians 
tend to concentrate in the large communities where hospital facilities 
and educational opportunities are best (18). This is well illustrated by 
Denver having one physician for each 399 population, the highest physician 
concentration in the state (see Table XII). Gilpin and Hinsdale counties 
have no physicians and their populations are 1,290 and 511 persons re- 
spectively, but medical services are supplied to these counties by the 
physicians located in adjacent counties. Since the practice of many Colo- 
rado physicians extends over several counties, the population per physi- 
cian in each county, which ranges from 399 to 2,639; is not a true meas- 
ure of the county's medical facilities. 
Considering the physician distribution by districts, outside 
of Denver, we find the population per physician ranging from 735 to 1,099 
(see Table XI). It is noted that the poorest distribution of physicians 
is in the San Luis, San Juan, and Colorado river valleys. This suggests 
the medical services might be least adequate in these districts, because 
all of this area has scattered population and poor transportation facili- 
ties and much of the physician's time must be taken up in travel. 
OSTEOPATHIC PHYSICIANS 
Doctors of osteopathy are licensed in Colorado by the State 
Board of Medical Examiners and are granted the same privilege of practice 
as doctors of medicine. At several places in the state they have estab- 
lished hospitals for medical, surgical, and obstetrical care of their 
patients. There are 180 (see Table XII) osteopathic physicians regis- 
tered in the state, and their mutual consideration for the doctors of 
medicine is illustrated by the agreement on policies (19) between the 
State Medical Society, and the State Osteopathic Physicians Society. 
Osteopathic physicians have approved the policies of the state board 
of health and have aided indirectly in the administration of local 
health activities. 
MIDWIVES 
Midwives attend a very small number of Colorado births. In 
1930, there were 25 midwives registered in the state, 21 in 1934, and 
21 in 1938. Of the 21 registered in 1938, (see Table XII) 11 were in 
Denver, two in Pueblo and not more than one was registered in any of the 
other counties. 38 
NURSES 
Public Health Nursing probably had its beginning in Colorado 
when, after the Armistice in 1918, some of the Red Cross Chapters used 
left over war funds to pay a few nurses for preventive services in con- 
trast to the pre-war methods of nursing the sick poor. Funds were soon 
exhausted and preventive nursing service was curtailed until 1922 when 
the Sheppard-Towner Act provided funds for Maternal and Infant Welfare. 
With this federal aid, a traveling Child Clinic visited a large part of 
the state. Later, some nursing was provided by the Federal Relief Ad- 
ministration. 
In 1936 when Social Security funds were allotted to the Colorado 
State Board of Health, an official state public health nursing division 
was established. During the first year of its existence, 35 official Pub- 
lic Health Nurses were placed in counties, and 26 nurses were sent to 
training centers for special public health training. The first six 
nurses were placed in counties where the greatest maternal and child 
problems were indicated, and the other nurses were placed in areas where 
the citizens requested such service. By the end of 1938, 72 official 
nurses were assigned to local health work throughout the state, 58 nurses 
were employed by voluntary health agencies, and 39 nurses v/ere employed 
by Colorado schools. 
No detailed study of the public health nursing needs of the 
state has ever been made, consequently the present distribution of nurs- 
ing service is the result of public interest within the local communities 
rather than the actual need for such services. This has resulted in a 
fairly even distribution on a population basis, (see Figure XVI). The 
question arises here as to whether or not a better attack might be made 
on the health problems of the state by concentration of efforts in those 
areas where need is most important. Such areas may not coincide with the 
areas of greatest interest in the service, but might it not be more prac- 
tical to invest public health funds in awakening a community with diffi- 
cult health problems and lagging interest in them, rather than in an 
alert community with high ideals and minimal problems? 
Establishing a basis for the distribution of nursing service 
is difficult. Most authorities on the subject select population as the 
factor for distribution, and various authors designate from 1,500 to 
5,000 persons per nurse as an adequate public health service. If we con- 
sider as adequate, the often quoted figure of one nurse per 3,000 popu- 
lation, and apply this to Colorado counties (see Table XIII), we find 
that only three counties, Cheyenne, Grand, and Rio Blanco have such con- 
centration of service (see Figure XVII) . The three counties referred to 
have a total area of 6,866 square miles which exceeds the area of the 
state of Connecticut, and one of them, Rio Blanco County has an area 
approximately half that of Connecticut. A single nurse attempting to TABLE XII 
DISTRIBUTION OF PHYSICIANS AND MIDWIVES, COLORADO, 193B 
County 
Midwives 
Osteopathic 
Physicians 
Doctors of 
Medicine 
Population 
Per M.D. 
Adams 
0 
1 
8 
2,639 
Alamosa 
0 
3 
12 
829 
Arapahoe 
0 
2 
16 
1,690 
Archuleta 
0 
0 
2 
1,481 
Baca 
1 
0 
4 
1,744 
Bent 
0 
0 
6 
1,325 
Boulder 
1 
u 
54 
643 
Chaffee 
0 
0 
10 
832 
Cheyenne 
0 
0 
2 
1,363 
Clear Creek 
0 
0 
3 
1,201 
Conejos 
0 
0 
6 
1,771 
Costilla 
0 
0 
3 
2,032 
Crowley 
0 
0 
4 
1,428 
Custer 
0 
1 
1 
2,406 
Delta 
0 
3 
16 
913 
Denver 
11 
76 
748 
399 
Dolores 
0 
0 
2 
865 
Douglas 
0 
0 
4 
908 
Eagle 
0 
0 
4 
1,024 
Elbert 
0 
1 
5 
1,064 
El Paso 
1 
9 
121 
421 
Fremont 
0 
6 
23 
792 
Garfield 
0 
3 
12 
823 
Gilpin 
0 
0 
0 
— 
Grand 
0 
1 
3 
80S 
Gunnison 
0 
0 
7 
901 
Hinsdale 
0 
0 
0 
— 
Huerfano 
0 
0 
11 
1,603 
Jackson 
0 
1 
1 
1,327 
Jefferson 
0 
3 
19 
1,394 
Kiowa 
1 
0 
2 
1,374 
Kit Carson 
0 
0 
7 
1,608 
Lake 
0 
1 
6 
831 
La Plata 
1 
1 
16 
871 
Larimer 
0 
11 
44 
764 
Las Animas 
1 
1 
20 
1,790 
Lincoln 
0 
1 
7 
771 
Logan 
0 
3 
16 
1,114 
Mesa 
1 
9 
27 
1,212 
Mineral 
0 
0 
0 
662 
Moffat 
0 
0 
4 
1,087 
Montezuma 
0 
1 
10 
790 
Montrose 
0 
2 
14 
965 
Morgan 
0 
4 
15 
1,073 
Otero 
0 
4 
24 
1,005 
Ouray 
0 
0 
2 
1,060 TABLE XII - Continued 
DISTRIBUTION OF PHYSICIANS AND MIDWIVES, COLORADO, 193B 
Osteopathic 
Doctors of 
Population 
County 
Midwives 
Physicians 
Medicine 
Per M.D. 
Park 
0 
0 
O 
1,310 
Phillips 
0 
1 
6 
929 
Pitkin 
0 
0 
1 
1,731 
Prowers 
0 
0 
11 
1?004 
Pueblo 
2 
3 
88 
668 
Rio Blanco 
0 
1 
3 
958 
Rio Grande 
0 
2 
10 
1,368 
Routt 
0 
1 
12 
756 
Saguache 
0 
1 
5 
1,258 
San Juan 
0 
0 
3 
869 
San Miguel 
0 
0 
3 
355 
Sedgwick 
0 
1 
2 
2,384 
Summit 
0 
0 
2 
515 
Teller 
0 
0 
6 
776 
Washington 
0 
0 
6 
1,299 
Weld 
0 
8 
71 
880 
Yuma 
1 
0 
9 
1,310 
COLORADO 
21 
180 
1,562 
670 FIGURE XVI 
STATE OF COLORADO 
WITH COUNTY AREAS REPRESENTING POPULATION OF 1930 
DISTRIBUTION OF NURSES - COLORADO 1938 
• -OFFICIAL O-VOLUNTARY A-SCHOOL TABLE XIII 
PUBLIC HEALTH NURSES, COLORADO, 1938 
County 
Official 
Voluntary 
School 
Pop. Per 
Nurse 
Sq. Miles 
Per Nurse 
Adams 
1 
0 
0 
21,11.5 
1,262 
Alamosa 
0 
0 
1 
9,943 
727 
Arapahoe 
1 
0 
0 
27, 041 
842 
Archuleta 
0 
0 
0 
— 
— 
Baca 
0 
0 
0 
— 
— 
Bent 
1 
0 
0 
7,950 
1,524 
Boulder 
2 
0 
2 
8,674 
191 
Chaffee 
0 
0 
1 
8,320 
1.083 
Cheyenne 
1 
0 
0 
2,727 
1,777 
Clear Creek 
1 
0 
• 0 
3,603 
390 
Conejos 
0 
0 
0 
— 
— 
Costilla 
1 
0 
0 
6,096 
1,185 
Crowley 
1 
0 
0 
5,712 
808 
Custer 
0 
0 
0 
— 
— 
Delta 
1 
0 
0 
1-4,602 
1,201 
Denver 
12 
-49 
19 
3,731 
0.73 
Dolores 
0 
0 
0 
— 
— 
Douglas 
1 
0 
0 
3,631 
845 
Eagle 
0 
0 
0 
— 
— 
Elbert 
1 
0 
0 
5,323 
1,857 
El Paso 
5 
5 
0 
5,081 
212 
Fremont 
1 
0 
0 
18,216 
1,557 
Garfield 
1 
0 
0 
9,879 
3,107 
Gilpin 
0 
0 
0 
— 
— 
Grand 
1 
0 
0 
2,423 
1,866 
Gunnison 
1 
0 
0 
6,306 
3,179 
Hinsdale 
0 
0 
0 
— 
— 
Huerfano 
1 
0 
0 
17,630 
1,500 
Jackson 
0 
0 
0 
— 
— 
Jefferson 
2 
0 
0 
13,238 
404 
Kiowa 
0 
0 
0 
— 
— 
Kit Carson 
0 
0 
0 
— 
— 
Lake 
1 
0 
0 
4,987 
371 
La Plata 
2 
0 
1 
4,645 
617 
Larimer 
1 
0 
3 
8,400 
876 
Las Animas 
6 
0 
1 
5,H4 
687 
Lincoln 
1 
0 
0 
5,400 
2,570 
Logan 
1 
0 
1 
8,912 
911 
Mesa 
1 
0 
1 
16,361 
1,581 
Mineral 
0 
0 
0 
— 
— 
Moffat 
0 
0 
0 
— 
— 
Montezuma 
1 
0 
0 
7,897 
2,051 
Montrose 
0 
0 
1 
13,503 
2,264 
Morgan 
1 
0 
1 
8,050 
643 
Otero 
5 
0 
2 
3,447 
180 
Ouray 
0 
0 
0 
— 
— TABLE XIII - Continued 
PUBLIC HEALTH NURSES, COLORADO, 193B 
County 
Park 
Official 
Voluntary 
School 
Pop. Per 
Nurse 
Sq. Miles 
Per Nurse 
0 
0 
0 
Phillips 
0 
0 
0 
— 
— 
Pitkin 
0 
0 
0 
— 
— 
Prowers 
1 
0 
0 
11,039 
1,630 
Pueblo 
5 
4 
2 
5,342 
221 
Rio Blanco 
1 
0 
0 
2,875 
3,223 
Rio Grande 
1 
0 
1 
6,842 
449 
Routt 
2 
0 
0 
4,886 
1,155 
Saguache 
0 
0 
0 
--- 
San Juan 
0 
0 
0 
— 
— 
San Miguel 
0 
0 
0 
— 
— 
Sedgwick 
0 
0 
0 
— 
— 
Summit 
0 
0 
0 
— 
— 
Teller 
1 
0 
0 
.4,655 
547 
Washington 
1 
0 
0 
7,791 
2,521 
Weld 
3 
0 
2 
12,492 
804 
Yuma 
1 
0 
0 
11,789 
2,367 
COLORADO 
72 
58 
39 
6,154 
610 FIGURE XVII 
POPULATION PER PUBLIC HEALTH NURSE-COLORADO 1938 
NO NURSE 
UNDER 3.000 
3,000-6.499 
6^)00-9.999 
10.000 &OVER 39 
extend public health services to a population of 2,875 persons distrib- 
uted over an area of 3*223 square miles would be expected to spend an 
unusually large part of her working time in travel. An inspection of the 
Rio Blanco County nurse's time distribution shows that she spends ap- 
proximately IB per-cent of her working time in travel. This would not be 
considered excessive in the average rural community where the population 
is more concentrated, and would suggest that a nurse working under such 
circumstances has a tendency to concentrate her services among those per- 
sons who are reached with less travel. It must then be assumed that a 
public health nurse can not adequately meet the needs of a population of 
3*000 persons if they are distributed over too large an area. 
Sixteen counties of the state, exclusive of Denver, had one 
public health nurse for each 6,000 population or less in 1938. Of these 
16 counties, six had an area of more than 1,000 square miles, (see 
Table XIII), and five had an area between $00 and 1,000 square miles. 
Of the X2 Colorado counties having nursing service in 1938, three coun- 
ties had areas exceeding 3*000 square miles per nurse, five counties had 
from 2,000 to 3,000 square miles per nurse, 13 counties had from 1,000 
to 2,000 square miles per nurse, and 20 counties had less than 1,000 
square miles per nurse. 
In 1938, public health nursing service throughout the state 
were administered by 72 official agency nurses. Forty-seven of the 
nurses employed by official agencies were under the jurisdiction of the 
advisory service of the State Board of Health, Division of Public Health 
Nursing, This group recorded 31,3X4- field visits divided into the fol- 
lowing services: 
NO.VISITS 
PER-CENT 
OF VISITS 
Communicable Disease 
3,287 
10.49 
Venereal Disease 
624 
1.99 
Tuberculosis 
1,626 
5.19 
Maternity 
7,767 
24.78 
Infant 
6,455 
20.59 
Preschool 
2,574 
8.21 
School 
14.18 
Morbidity 
3,228 
10.30 
Crippled Children 
1,337 
4.27 
Total 
31,344 
100.00 
These nurses averaged field visits per nurse annually, 
and time studies indicate that 30 per-cent of the nurses total time 
was spent in field visits. The average length of field visits would 
be approximately 50 minutes and if we assume 275 working days per year 
per nurse, then each nurse would average approximately 2-J field visits 
per day. The length and volume of nursing services are easily measured 
and appraised, but no satisfactory method of measuring the quality of 
the services has been devised. The only present measure of the quality 
of service is the opinion of advisory or supervisory personnel from 
which personal equations can not be separated. 
With its special problems of population concentration, the 
nursing service of the state can not be determined on the basis of popu- 
lation or area served. Each county seems to present individual problems 
of health service needs and if one were to set an ideal goal of nursing 
service, it must be on the basis of detailed studies of the needed ser- 
vice in each community. In a later chapter, nursing services on the 
basis of community needs will be discussed. 
STATE BOARD OF HEALTH 
Before Social Security funds v/ere granted to the State Board 
of Health, health services in the state were very limited. Little health 
work was accomplished in the state, other than the care of routine office 
matters carried on by a very small personnel. Since 1936, with federal 
aid, the work of the board has expanded rapidly. A comparison of the 
technical personnel employed the year before federal assistance, and 
three years later, shows the following: 
Physicians 
1935 
1 
1938 
u 
Nurses 
0 
u 
Social Workers 
0 
5 
Engineers 
1 
r' 
Sanitary Officers 
2 
10 
Statistician 
1 
c 
Bacteriologist 
1 
2 
Medical Technician 
1 
3 
Laboratory helper 
1 
U 
Chemists 
0 
1 
Plumbing Inspector 
1 
1 
9 
38 
When the board first had funds available to extend its services 
into local communities, it had limited trained personnel available to ad- 
minister the program. During 1936 the board financed post graduate train 
ing for 26 nurses, and employed 3$ field nurses. With this small group 
of public health nurses, interest in public health problems in local com- 
munities was stimulated, and early in 1938 the first full time county 
health unit was established. Since that time two other counties have 
established health units and several others are planning units in the 
near future. The plan of the past three years, in which only nursing ser- 
vices were conducted in the counties, was necessary because of lack of 
trained health officers, as well as the lack of interest by local gov- 
ernments. The work of the nurses in the counties has, in most cases, 
made the citizens appreciate the value of health and made them under- 
stand their own health hazards. 
The establishing of health units has brought supervision and 
consultation of medical problems into the nurses del Tv routine and has 
relieved the advisory personnel of the board from frequent and prolonged 
field trips throughout the state. 
The State Board of Health is now offering advisory services 
to local governments by specially trained personnel through the follow- 
ing divisions: 
Administration 
Epidemiology 
Crippled Children 
Food and Drugs 
Laboratories 
Maternal and Child Health 
Plumbing 
Nursing 
Sanitary Engineering 
Tuberculosis 
Vital Statistics 4-2 
CHAPTER VI 
FINANCIAL RESOURCES 
COUNTIES 
Each Colorado county has its own system of recording and clas- 
sifying expenditures. Since all items are not classified the same in 
each county, it is impossible to show the portion of county funds spent 
on public health without a detailed audit in each county. Time will not 
permit such a study, and so the possibility of financing health work in 
the separate counties will be considered on the basis of the ability of 
the counties to raise funds for such work. 
The assessed valuation of a community, from which taxes are 
collected, is best visualized on the per capita basis. When this is cal- 
culated on the basis of the 1938 estimated populations we see that 8 coun- 
ties (see Table XIV) have an assessed per capita valuation over $2,000; A 
counties have from $1,600 to $2,000; 18 counties have from $1,200 to 
$1,600; 21 counties have $800 to $1,200 and 12 counties have less than 
$800. With the exception of Arapahoe County, all counties with a per 
capita assessed value under $800 are on the western slope. Five of 
these counties are in the San Luis valley, three in the San Juan valley, 
and three in the Colorado valley. The highest per capita assessed values 
are along the northern part of the Continental Divide and the central 
eastern plains area. 
The bonded debt of the counties is an important factor to con- 
sider in determining the amount of money a county can reasonably spend 
on any activity. The per capita bonded debt of Colorado counties in 1937, 
based on the 1938 population estimates (see Table XIV) ranged from $2.6l 
in Lake County to $150.12 in Denver County. Large or small per capita 
debts do not seem to effect any particular group of counties, but a larger 
portion of the western slope counties have relatively lower per capita 
debt than those in the eastern portion of the state. 
The per-cent of taxes collected in a county is an indication of 
the economic status of the community and must have full consideration in 
determining the ability of that community to support adequate public health 
protection. The five year (1932-1936) average tax collections of Colorado 
counties show (see Table XV) a range from 37.89 per-cent in Hinsdale County 
to 97.68 per cent in Jackson County, The highest per-cent of collections 
are made in the counties in the north-central part of the state and the 
poorest collections in the San Luis, San Juan and Colorado valleys. 
Mustard (20) indicates that the present average per capita ex 
penditures of approximately forty cents for public health in rural areas TABLE XIV 
ASSESSED VALUE AND BONDED DEBT - COLORADO COUNTIES, 1937 
COUNTY 
TOTAL 
ASSESSED VALUE 
PER CAPITA 
ASSESSED VALUE 
TOTAL 
BONDED DEBT 
PER CAPITA 
BONDED DEBT 
Adams 
$ 23,479,854 
$ 1,112.00 | 
1,018,050 
$ 48.21 
Alamosa 
7,274,235 
731.59 
619,810 
62.34 
Arapahoe 
18,578,329 
687.04 
1,241,150 
45.89 
Archuleta 
3,070,661 
1,036.69 
104,300 
35.21 
Baca 
10,281,771 
1,473.88 
408,160 
58.51 
Bent 
10,684., 621 
1,343.97 
193,700 
24.36 
Boulder 
36,791,675 
1,060.43 
1,598,900 
46.08 
Chaffee 
7,795,951 
937.01 
273,500 
32.87 
Cheyenne 
8,289,368 
3,039.74 
222,000 
81.41 
Clear Creek 
4,788,620 
1,329.06 
101,500 
28.17 
Conejos 
6,864,010 
645.96 
366,990 
34.54 
Costilla 
4,015,103 
658.64 
131,050 
21.50 
Crowley 
5,564,268 
974.14 
524,900 
91.89 
Custer 
2,248,140 
934.39 
34,500 
14.34 
Delta 
10,626,243 
727.73 
576,690 
39.49 
Denver 
394,279,4-83 
1,320.82 
44.812,500 
150.12 
Dolores 
1,207,650 
698.06 
76,950 
44.48 
Douglas 
7,704,528 
2,121.87 
122,700 
33.79 
Eagle 
8,938,979 
2,181.30 
101,650 
24.80 
Elbert 
9,961,386 
1,871.39 
100,300 
18.84 
El Paso 
52,890,883 
1,040.97 
3,804,500 
74.88 
Fremont 
14,977,141 
822.20 
1,335,200 
73.30 
Garfield 
12,998,090 
1,315.73 
927,250 
93.86 
Gilpin 
3,024,295 
2,344.41 
59,000 
45.74 
Grand 
6,466,898 
2,668,96 
139,000 
57.37 
Gunnison 
9,880,608 
1,566,86 
615,100 
97.54 
Hinsdale 
556,784 
1,089.59 
16,500 
32.28 
Huerfano 
9,878,606 
569.50 
722,000 
40.95 
Jackson 
2,616,815 
1,971.98 
58,000 
43.71 
Jefferson 
23,337,228 
883.30 
1,020,070 
38.53 
Kiowa 
7,533,308 
2,741.38 
145,600 
52.98 
Kit Carson 
10,802,456 
1,444.37 
605,000 
80.89 
Lake 
7,650,610 
1,534.H 
13,000 
2.61 
La Plata 
10,460,626 
750.67 
847,090 
60.79 
Larimer 
36,463,062 
1,085.18 
3,722,500 
110.79 
Las Animas 
28,953,297 
806.45 
2,120,500 
59.24 
Lincoln 
10,211,474 
1,891.01 
284,750 
52.73 
Logan 
22,352,347 
1,254.06 
1,227,500 
68.87 
Mesa 
21,293,084 
650.73 
1,850,950 
56.57 
Mineral 
1,215,514 
1,836.12 
8,000 
12.08 
Moffat 
5,495,261 
1,263.86 
124,300 
28-. 59 
Montezuma 
4,329,031 
548.19 
293,500 
37.17 
Montrose 
8,553,039 
633.42 
441,600 
32.70 
Morgan 
18,415,848 
1,143.91 
903,820 
56.14 
Otero 
21,972,789 
910,64 
1,378,560 
57.13 
Ouray 
2,994,949 
1,412.05 
95,100 
44 • 84 TABLE XIV - Continued 
ASSESSED VALUE AND BONDED DEBT - COLORADO COUNTIES, 1937 
COUNTY 
TOTAL 
ASSESSED VALUE 
PER CAPITA 
ASSESSED VALUE 
TOTAL 
BONDED DEBT 
PER CAPITA 
BONDED DEBT 
Park 
$ 7,012,553 
$ 2,676.55 $ 
34,000 
I 12.98 
Phillips 
7,071,123 
1,268.36 
437,100 
78.40 
Pitkin 
2,315,248 
1,337.52 
89,500 
51.70 
Prowers 
U, 719,906 
1,333.45 
1,080,050 
97.84 
Pueblo 
58,^86,040 
995.22 
4,257,900 
72.45 
Rio Blanco 
3,830,863 
1,332.47 
296,000 
102.96 
Rio Grande 
8,132,116 
594.24 
551,970 
40.33 
Routt 
12,485,082 
1,277.60 
462,150 
47.29 
Saguache 
6,825,402 
1,085.46 
151,200 
24.05 
San Juan 
3,049,413 
1,169.25 
94,000 
36.04 
San Miguel 
3,420,603 
1,333.05 
110,500 
43.06 
Sedgwick 
7,625,995 
1,599.08 
563,000 
118.05 
Summit 
3,700,657 
3,592.87 
64,000 
62.14 
Teller 
5,118,815 
1,099.64 
118,900 
25.54 
Washington 
10,351,720 
1,328.68 
295,000 
37.86 
Weld 
68,061,829 
1,091.91 
2,733,290 
43.76 
Yuma 
10,840,763 
944-98 
523,950 
44 *44 TABLE XV 
POSSIBLE COUNTY REVENUES FOR LOCAL PUBLIC HEALTH PURPOSES, COLORADO, 1937 
5 Yr. AVERAGE % TAX 
COUNTY COLLECTION 1932-1936 
ESTIMATED FUND AT 
50<2 PER CAPITA 
MILL LEVY REQUIRED 
FOR 50<t PER CAPITA 
Adams 
85.92 
t 10,558 
.5 
Alamosa 
69.81 
5,971 
1.2 
Arapahoe 
87.07 
13,521 
.8 
Archuleta 
88.17 
1,A81 
.6 
Baca 
72.08 
3,488 
.5 
Bent 
87.33 
A,975 
.5 
Boulder 
93.28 
18,348 
.5 
Chaffee 
87.19 
A, 160 
.6 
Cheyenne 
83.49 
1,364 
.2 
Clear Creek 
68.52 
1,802 
. 6 
Conejos 
66.66 
5,313 
1.2 
Costilla 
A3. AO 
3,048 
1.8 
Crowley 
70.50 
2,856 
.7 
Custer 
84.52 
1,203 
.6 
Delta 
78.10 
7,301 
.9 
Denver 
95.17 
149,256 
• A 
Dolores 
52.90 
865 
l.A 
Douglas 
91.52 
1,816 
' .3 
Eagle 
92.61 
2,0A9 
.3 
Elbert 
83.42 
2,662 
.3 
El Paso 
93.05 
25,A05 
.5 
Fremont 
90. AA 
9,108 
.7 
Garfield 
88.88 
5,9AO 
.5 
Gilpin 
65.06 
645 
.3 
Grand 
90.13 
1,212 
.2 
Gunnison 
80.75 
3,153 
• A 
Hinsdale 
37.89 
256 
1.2 
Huerfano 
79.07 
8,815 
1.1 
J ackson 
97.68 
66a 
.3 
Jefferson 
89.77 
13,239 
.6 
Kiowa 
85.91 
1,37A 
.2 
Kit Carson 
72.96 
3,7A0 
.5 
Lake 
7A.1A 
2,A9A 
.5 
La Plata 
85.52 
6,968 
.8 
Larimer 
90.58 
16,800 
.5 
Las Animas 
76.51 
17,898 
.8 
Lincoln 
69.59 
2,700 
• A 
Logan 
88.37 
8,912 
.5 
Mesa 
81.69 
16,361 
.9 
Mineral 
84.93 
331 
.3 
Moffat 
77.96 
2,17A 
.5 
Montezuma 
60.27 
3,9A9 
1.5 
Montrose 
85.53 
6,752 
.9 
Morgan 
91.90 
8,050 
.5 
Otero 
89.66 
12,065 
.6 
Ouray 
78.06 
1,061 
.5 TABLE XV - Continued 
POSSIBLE COUNTY REVENUES FOR LOCAL PUBLIC HEALTH PURPOSES, COLORADO, 1937 
COUNTY 
5 Yr. AVERAGE % TAX 
COLLECTION 1932-1936 
ESTIMATED FUND AT 
50tf PER CAPITA 
MILL LEVY REQUIRED 
FOR 50(25 PER CAPITA 
Park 
90.19 
1,310 
.2 
Phillips 
87.46 
2,788 
.5 
Pitkin 
75.76 
866 
.5 
Prowers 
84.19 
6,420 
.5 
Pueblo 
87.59 
29,384 
.4 
Rio Blanco 
79.44 
1,438 
.5 
Rio Grande 
74.59 
6,843 
1.1 
Routt 
84.81 
5,386 
.5 
Saguache 
82.46 
3,144 
.5 
San Juan 
61.45 
1,304 
.7 
San Miguel 
63.42 
1,283 
.6 
Sedgwick 
86.05 
2,385 
.4 
Summit 
69.86 
515 
.2 
Teller 
78.53 
2,328 
.6 
Washington 
84.30 
3,896 
.5 
Weld 
90.62 
31,230 
.5 
Yuma 
87.60 
5,895 
.6 43 
is "distressingly low" and that "a quite satisfactory service may be 
operated for about one dollar per capita", On the basis of the present 
policy of the United States Public Health Service matching local ex- 
penditures for health activities each county supporting a full time health 
unit would have to raise fifty cents per capita. Only ten counties,ex- 
clusive of Denver, have a population over 20,000 persons which is the min- 
imum population in which a full time health unit can operate on a prac- 
tical basis. If the remaining 52 rural counties desire full time health 
it will be necessary for two or more adjacent counties to pool 
their resources and form district units. 
To determine the mill levy necessary for Colorado counties to 
raise fifty cents per capita, the following formula was used; 
Desired Revenue (Table XV) — 
Assessed Valuation (Table XIV) X Average % Collection (Table XV) 
Necessary Mill Levy (Table XV) 
Of the ten counties with a population great enough to support 
a full time health service, the necessary mill levies for a complete 
service would range from .4 mill in Pueblo County to .9 mill in Mesa 
County. Of the remaining 52 rural counties, only 8 would require a levy 
of more than one mill to raise fifty cents per capita. 
A per capita expenditure of one dollar has been suggested here 
as a goal rather than a starting point for public health work in Colorado 
counties. It would probably be unwise policy to start full time health 
work with more than half of this amount, adding to the beginning expen- 
ditures as the public health personnel determine the need, by the con- 
ditions which they meet. In some areas the public health needs may be 
adequately cared for with less than the suggested goal, while in others, 
the needs may far exceed the expenditure of one dollar per capita. 
The median county levy necessary to raise fifty cents per 
capita would be .57 mill on the basis of the 1937 assessments. Other 
median mill levies for 1937 in Colorado counties were as follows; 
Welfare ------ -----1.18 mill 
Roads & Bridges ------- 1.62 
General School -------5.00 
Ordinary ----------6.04 
Thus it is seen that a very small increase in county levies 
would adequately provide a good local health service. STATE 
The Colorado state legislature at its biennial meeting sets a 
two year appropriation for the State Board of Health, the money coming 
from the state general fund. Other funds are collected by the Restaurant 
and Plumbing divisions for license fees and expended by them. The total 
state expenditures including collected fees, in the fiscal year 1938-1939 
(see Table XVI) amounted to $138,4-08.4-4- and state, plus federal fund ex- 
penditures, amounted to $425?848.12. On a state per capita basis, state 
and federal expenditures were 40.70 cents of which 13.22 cents or 32.$ 
per-cent was of state origin. Epidemiology, Cancer, Pneumonia, Industrial 
Hygiene, Nursing Administration, Trainees, and County aid during this fis- 
cal year were financed entirely by federal funds. If it were not for fed- 
eral allotments, the Colorado State Board of Health would be able to do 
very little public health work. 
Nursing administration includes principally, the state admin- 
istration office expense. Advisory nursing services are maintained by the 
divisions of Maternal and Child Health, and Venereal Diseases, and field 
nursing services are paid out of Maternal and Child Health and Field Nurs- 
ing items listed in Table XVI. TABLE XVI 
STATE AND FEDERAL HEALTH EXPENDITURES IN COLORADO, FISCAL YEAR 1938-39 
SERVICE 
STATE 
EXPENDITURES 
STATE AND FEDERAL 
EXPENDITURES 
STATE AND FEDERAL 
CENTS PER CAPITA 
Administration $ 
8,300.55 
| 17,587.73 
1.68 
Maternal and Child Health 
15,631.23 
92,768.64 
8.87 
Crippled Children 
46,084.35 
124,390.58 
11.89 
Bacteriology 
5,916.81 
16,787.03 
1.60 
Vita] Statistics 
6,798.99 
10,682.64 
1.02 
Venereal Disease 
806.40 
12,605.59 
1*20 
Sanitation 
5,831.33 
19,404.18 
1.85 
Epidemiology 
— 
8,709.29 
0.83 
Tuberculosis 
772.62 
6,691.21 
0.64 
Nursing Administration 
— 
9,272.40 
0.89 
Field Nursing Service 
10,693.26 
25,654.67 
2.45 
Food, Drug, and Restaurant 
31,643.59 
31,643.59 
3.02 
Trainees 
— 
18,834.36 
1.80 
Pneumonia 
-- 
5,023.32 
0.48 
Plumbing 
5,929.31 
5,929.31 
0.57 
Industrial Hygiene ' 
— 
3,819.53 
0.37 
Cancer 
— 
2,225.35 
0.21 
County Aid 
15,604.18 
1.49 
TOTAL $ 
138,408.44 
$ 425,848.12 
40.70 4-5 
CHAPTER VII 
SUMMARY AND RECOMMENDATIONS 
In the four preceding chapters dealing with the physical 
characteristics, experiences, and health facilities of the 63 counties 
of Colorado, the most constant observation is the wide variation of 
of these factors among the counties. The problems considered tend to 
localize in certain areas that correspond generally to those suggested 
in the description of Colorado hospital facilities. This provides for 
seven districts, one metropolitan district including the City and County 
of Denver, and six rural districts corresponding in general to the river 
valleys within which transportation facilities are convenient. If the 
problems are considered on the basis of these districts, the populations 
(estimated 1938) for each range from 35?752 to 298,512 persons. In these 
larger population groups statistical data become more significant and 
errors of dealing with small numbers are lessened. 
On the basis of district statistical studies (see Appendix) the 
main public health problems of the state are distributed as follows: 
DENVER The death rate is high, especially for tuberculosis, 
but the birth and infant death rates are low. Hospital facilities and 
physicians' services are in general on a higher level than elsev/here in 
the state. Public health nursing per population is probably adequate 
and the area per nurse is very small, but only 15 per-cent of the nurs- 
ing services are financed by official agencies. The assessed valuation 
is $1,320.82 and the bonded debt is $150.12 per capita. This is the 
highest per capita bonded debt in the state. 
PLATTE DISTRICT The infant death rate, general death rate, 
and tuberculosis death rate are low. Hospital facilities, physicians'- 
and public health nursing services are insufficient in proportion to the 
population. Approximately half of the nursing services are sponsored by 
official public health agencies, and half by the schools. The assessed 
valuation of this district is $1,119.30 and the bonded debt is $60.37 per 
capita. 
EAST-CENTRAL DISTRICT The general death rate and tuberculosis 
death rate are high. The infant ‘death rate is low. Seventy-four per- 
cent of the nursing personnel is sponsored by an official public health 
agency. The assessed valuation is $1,14.6.86 and the bonded debt is 
$54.69 per capita. 
ARKANSAS DISTRICT The infant death rate and the pneumonia 
death rate are high. Physicians services and hospital services are 
fairly well developed. Nursing services are more concentrated per population than in any of the rural districts, but the area per nurse 
is large. Seventy per-cent of the nursing services are sponsored by an 
official public health agency. The assessed value is $968.29 and the 
bonded debt is $63.76 per capita. 
SAN LUIS-SAN JUAN DISTRICT The birth rate , infant death rate , 
and pneumonia death rate are high* the pneumonia and infant death rates 
being the highest of all districts. Physicians' and public health nurs- 
ing services are insufficient in proportion to population, and the area 
per nurse is large. Sixty per-cent of the nursing services are spon- 
sored by an official public health agency. The assessed valuation is 
$750.82 and the bonded debt is $42.39 per capita. 
COLQPlADO DISTRICT The birth, death, and pneumonia death rates 
are high. The distribution of nurses and physicians are low in pro- 
portion to population, and the area per nurse is large. This district 
has the lowest distribution of public health nursing per population with 
57 per-cent of the services furnished by official public health agencies. 
The assessed value is $858.07 and the bonded debt $46.81 per capita. 
WHITE-YAMPA DISTRICT The birth rate of this district is the 
highest in the state with general death and infant death rates close to 
the average for the state. Available hospital beds in proportion to 
population are the lowest in Colorado. Public health nursing per popu- 
lation is fairly well developed, but the area per nurse is the largest 
in the state. All public health nursing is sponsored by official agen- 
cies. The assessed value is $1,581.24 and the bonded debt is $60.76. 
The above summary of the various districts of the state indi- 
cates some of the specific problems of these areas that should receive 
immediate attention. These problems are not simple enough to be solved 
by the citizens of the community, but require the careful analysis and 
planning of a trained administrator. 
In Denver, the main problem is an attack on tuberculosis, and 
an analysis of the specific causes of the high death rate followed by a 
plan to reduce its causes. A lack of interest in the health of its citi- 
zens is suggested in the small portion of its nursing services now spon- 
sored by its government. In spite of the large per capita debt, the 
assessed valuation is still capable of producing a revenue sufficient 
for better health protection. 
In the Platte district vital statistics indicate a good state 
of health, but if this good record is to be maintained, more public 
health nursing service is recommended. The assessed value and bonded 
debt of this district would suggest an ability to increase nursing ser- 
vices by 50 to 100 per-cent. In the East-Central District the health problem is almost 
identical with that of Denver. The problems of this district can be 
better supported by local governments* because with approximately the 
same per capita valuation as Denver* it is burdened with only about one 
third of the per capita bonded debt. 
The Arkansas District presents a special problem in infant 
deaths and a high pneumonia death rate. The keen interest of the citi- 
zens of this district in the protection of their health is evidenced in 
the concentration of the nursing service. In spite of this effort to 
improve their healthy there are many problems not yet attacked. While 
nursing services are in need of some increase it would probably be more 
practical to expend some of the available funds for the services of ad- 
ministrative personnel well trained in modern methods of appraisal and 
program planning. 
The San Luis-San Juan District presents the greatest health 
problems of the state. Its birth* death* pneumonia death* and infant 
death rates are high. The nursing service should at least be doubled* 
and other public health personnel are badly needed. The assessed valua- 
tion is lower per capita than any of the other districts and little 
support for health work can be obtained from a tax levy. The local gov- 
ernments of this district are more in need of state and federal aid than 
in any other part of the state. 
The Colorado District presents special problems of high birth* 
death* and infant death rates. These problems are being met with the 
poorest distribution of public health nursing in the state. If the nurs- 
ing service of this area were increased to three times its present 
strength* it would still be hardly adequate to meet the public health 
problems with good nursing service. The assessed value of this area is 
low but the bonded debt is low* and some local funds could be raised by 
taxation to protect local health. The low assessed value of this dis- 
trict should have consideration in the distribution of state and federal 
allocations for local health work. 
The White-Yampa District presents only the problem of a high 
birth rate. In this district it would appear that the nursing service 
per population is fair, but when we consider that each nurse has approx- 
imately six times as much area to cover as those in the Arkansas dis 
trict and that hospital services are inadequate* then the high birth rate 
becomes a major problem* and a more concentrated nursing service in this 
district than in any of the others should be recommended. 
The State Board of Health* since 1936* has been able to organize 
only two full time local health units because of the lack of trained med- 
ical personnel to organize and direct them. Lacking medical directors 
for local administration the policy was adopted of introducing public health nursing services in the counties without full time medical super- 
vision. Under such a system it has been necessary for nurses to assume 
all administrative activities. The result of this has been demonstrated 
in the previous discussion of Colorado public health nursing services. 
It has been shown that Colorado public health nurses averaged 
64.7 field visits per nurse per year. The author has reviewed field 
nurses5 reports from health units directed by full time medical admin- 
istrators from all parts of the United States and finds a range from 900 
to over 1900 field visits per nurse* per year* averaging about 14.00. 
This would indicate that nurses without medical supervision could double 
their field visits if they could be relieved of administrative duties* 
for which they are not specially trained. 
In a preceding chapter it was pointed out that neither popula- 
tion nor area can be practically used as a measure of required personnel 
to meet the public health needs of a community. A good picture of health 
service requirements can be obtained only by an analysis of community ex- 
perience in morbidity* natality* and mortality* plus a consideration of 
available facilities and the ability of the citizens to pay for needed 
services. It is readily seen that each locality will require different 
types and quantities of health services and the final answer can be ob- 
tained only by careful local appraisals. 
As an estimated comparison of what portion of the state's 
health needs are being met at the present time* the author has selected 
natality. In selecting this single factor it is evident that the use of 
other factors may increase or decrease the estimates* but a complete 
appraisal is beyond the scope of this study and the example is presented 
as a method of approach rather than a conclusive fact. 
Within the state* in 1938* there were recorded 20*958 live 
births and stillbirths of which approximately 50 percent occurred in 
hospitals and maternity homes. If we expect public health nurses to 
average four visits per home confinement* then there should have been 
4.1*916 home maternity visits. In a preceding chapter it was shown that 
4-7 Colorado public health nurses averaged 137.3 maternity visits per 
year working outside an organized health unit. On this basis it would 
have required the services of 305 nurses to make the expected number of 
home visits* and we see (see Table VIII) that there were 72 nurses em- 
ployed by official agencies during this period. Some consideration must 
also be given to nursing service furnished by voluntary agencies and 
schools. These* however* are hard to measure in the generally accepted 
definition of public health because the nurses of voluntary agencies 
devote a large part of their time to bedside nursing recognized as an 
essential community health function but only rarely carried as a major 
activity of a health department at present. School nurses are often 
expected to do truancy and other work not considered as health measures. It has also been shown that field visits can be materially increased if 
nurses can be relieved of administrative duties. On this assumption 
Colorado nursing needs could be met on a minimum basis with 153 field 
nurses if they were under the supervision of trained public health ex- 
ecutives . 
The nursing personnel represents the front line troops of the 
public health army. It is they who actually deliver health services to 
the consumers* and make most of the direct contacts with the citizens 
who are served. Since their work is easier measured and because they 
are in the most direct contact with the community* the author has* in 
previous discussions* measured health services on the basis of nursing 
facilities. 
On the basis of foregoing discussions* it would seem most 
practical at the outset to extend the organized health services of Colo- 
rado by adding local full time trained medical health administrators 
rather than increasing nursing personnel. Medical officers assigned to 
local areas would have the advantage of close contact with local problems* 
and would be able to appraise and recommend health programs far better 
than a representative of the state office making short* periodic visits. 
Any local area requiring the services of six nurses with no full time 
health officer should be able to produce the same or more health work at 
approximately the same cost by replacing three nurses with a health of- 
ficer and sanitarian to form a health unit capable of offering a wider 
and more complete service. 
The more complete and wider variety of health service that can 
be offered by an organized health unit at approximately the same cost 
leads the author to recommend that the future policy of the State Board 
of Health be directed toward the establishment of full time health unit 
service for the entire state. 
Ten* or possibly 12 of the Colorado rural counties have a pop- 
ulation and taxable wealth within which it would be practical to operate 
a full time health unit. In some of these it would be of mutual advan- 
tage to join with one or more adjacent counties in the interests of 
economy in operation. *A11 other counties would find it necessary for 
several adjacent counties to form an administrative district if they 
are to receive complete* full time health service. 
The author had planned on presenting a plan of local full time 
health administration in which all counties of the state would be grouped 
into districts on the basis of proximity* transportation facilities, 
assessed valuation* bonded debt and other factors. Field experience has 
shown that such well laid plans are of little value. The deep rooted and fixed lack of confidence of one county 
group in another, or the staid resolve not to cooperate with neighbors 
even though it be for mutual benefit, will often require redistribution 
of counties within the proposed districts. For these reasons the author 
will leave to the organizer of local health administration the proposal 
of which counties shall be included in the various districts after he has 
learned the wishes of the counties through personal contact. 
It is hoped that the studies here presented will be used to 
show the citizens of Colorado some of the health problems of the state 
and will stimulate their desire to attack these problems with full time 
health services in all parts of the state. BIBLIOGRAPHY 
1. Massachusetts, Acts of 1869, Chapter 420, Cited; 1st Annual Re- 
port of the Massachusetts State Board of Health, Boston 1870, Page 7. 
2. Bulletin No. 184, United States Public Health Service, Government 
Printing Office, Washington, D. C., 1929, Page 1. 
3. Social Hygiene Legislation Manual, The American Social Hygiene 
Association, N. Y„, 1921, Page 28. 
4. S. 1039 - Sheppard-Towner Act; Public 97 - 67th Congress of the 
United States; 42 Stat., 135. 
5. The Nation’s Health; United States Printing Office, 1939, Page 1. 
6. Winslow, C. E. A.; The Challenge Of Today, Public Health Nursing, 
26: 283-290, 1934- 
7. Dublin, L. I. & Lotka, A. J.; The Money Value of a Man, The Ronald 
Press, N. Y., 1930. 
8. Buck, A. E.; The Reorganization of State Governments in the 
United States, Columbia University Press, N. Y., pp. 66-69. 
9. Fifteenth Census of the United States, 1930; Vol. II, Population, 
United States Government Printing Office, Washington, D. C., 
1931, P. 27. 
10. Waller, C. E„; Supplement No. 101 to the Public Health Reports, 
United States Government Printing Office, Washington, D. C., 
1931, P. 3. 
11. Whelpton, P. K.; The Completeness of Birth Registration in the 
United States, Jr. Am. Stat. Association, 29:125, June 1934. 
12. Bundeson, H. N., et al; Factors in Neonatal Deaths, Jr. American 
Medical Association, 111; 134, 1938, 
13. Discussion of Papers on Rural Morbidity and Rural Medicine, Pro- 
ceedings of the Conference Held at Cooperstown, N. Y., Oct. 7 & 8, 
1939, C. C. Thomas, Baltimore, 1939. 
14. S. 1620 - The National Health Act; 76th Congress, Feb. 28, 1939. 
15. Hospitals Registered by the American Medical Association; Journal 
of the American Medical Association, 112: 939, 1939. 52 
16. Proceedings of the House of Delegates of the 69th Annual Session of 
the Colorado State Medical Society; Rocky Mountain Medical Journal, 
36: 882, 1939. 
17. American Medical Directory; American Medical Association, Chicago, 
1938, p. 375. 
18. Factual Data on Medical Economics; Bureau of Medical Economics, 
American Medical Association, Chicago, 1939 P 13. 
IQ. Memorandum of Agreement; Proceedings of the House of Delegates, 
69th Annual Session of the Colorado State Medical Society, Rocky 
Mountain Medical Journal, 36: 890, 1939. 
20. Mustard, Harry S., Rural Health Practice, The Commonwealth Fund, 
N. Y., 1936. DISTRICT 
DENVER 
PLATTE 
EAST-CENTRAL 
ARKANSAS 
SAN LUIS- 
SAN JUAN 
COLORADO 
WHITE-YAMPA 
COUNTIES 
Denver 
Adams 
Boulder 
Larimer 
Logan 
Morgan 
Phillips 
Sedgwick 
Washington 
Weld 
Yuma 
Arapahoe 
Cheyenne 
Clear Creek 
Douglas 
Elbert 
El Paso 
Gilpin 
J efferson 
Kit Carson 
Lincoln 
Park 
Teller 
Baca 
Bent 
Crowley 
Custer 
Fremont 
Huerfano 
Kiowa 
Las Animas 
Otero 
Prowers 
Pueblo 
Alamosa 
Archuleta 
Conejos 
Costilla 
Dolores 
Hinsdale 
La Plata 
Mineral 
Montezuma 
Rio Grande 
Saguache 
San Juan 
Chaffee 
Delta 
Gunnison 
Lake 
Mesa 
Montrose 
Ouray 
Pitkin 
San Miguel 
Eagle 
Garfield 
Grand 
Jackson 
Moffat 
Rio Blanco 
Routt 
Summit 
Number of Counties 
1 
10 
12 
11 
12 
9 
8 
Population, 1930 
287,861 
223,74-6 
13k,963 
208,70k 
68,800 
76,17.4 
35,573 
Population, 1938 
298,512 
215,719 
141,055 
191,368 
76,943 
86,858 
35,752 
Per-cent of State 
Population, 1930 
27.79 
21.59 
13.05 
20.1k 
6.63 
7.33 
3.k3 
Per-cent Population 
Gain, 1930-1938 
3.7 
- 3.6 
k-5 
- 8.3 
11.8 
lk.l 
— 
APPENDIX 
COLORADO DISTRICTS DISTRICT 
DENVER 
PLATTE 
EAST-CENTRAL 
ARKANSAS 
SAM LUIS 
SAN JUAN ' 
COLORADO 
WHITE-YAM?A 
Area, Square Miles 
58 
17,892 
16,290 
20,617 
15,637 
11,100 
19,061 
Population Density 
Per Square Mile, 1930 
5,14-7 
12 
9 
9 
5 
6 
2 
Number of Towns Under 
1,000 Population, 1930 
0 
13 
32 
21 
21 
20 
18 
Number of Towns 1,000 - 
2,500 Population, 1930 
0 
13 
10 
6 
1 
3 
6 
Number of Towns 2,500 - 
10,000 Population, 1930 
0 
5 
1 
6 
3 
1 
0 
Number of Cities 10,000 - 
50,000 Population, 1930 
0 
3 
1 
1 
0 
1 
0 
Number of Cities over 
50,000 Population, 1930 
1 
0 
0 
1 
0 
0 
0 
Per-cent Males, 1930 
18.6 
52.0 
51.1 
52.2 
53.0 
52.8 
55.9 
Per-cent Females, 
15-11 Years, 1930 
25.9 
21.8 
22.3 
22.3 
21,1 
21.2 
20.6 
ii DISTRICT 
DENVER 
PLATTE 
EAST-CENTRAL 
ARKANSAS 
SAN LUIS- 
SAN JUAN 
COLORADO 
WHITE-YAM?/ 
Per-cent Native 
Born White, 1930 
84. .0 
S3-3 
90.8 
80.9 
85.8 
86.0 
88.8 
Per-cent Foreign 
Born White, 1930 
10.9 
8.4- 
7.0 
7.3 
3.5 
7.5 
7.4 
Number of Mexicans, 1930 
6,837 
16,448 
1,467 
21,137 
6,067 
U, 637 
1,083 
Per-cent Mexican, 1930 
2.4 
7.4 
10.9 
10.1 
8.8 
6.1 
3.0 
Number Under 5 Years 
Age, 1930 
20,113 
23,004 
11,395 
21,987 
8,529 
7,341 
3,301 
Per-cent Under 5 Years 
Age, 1930 
7.0 
10.3 
8.4 
10.5 
12.3 
9.6 
9.3 
Number Over 65 Years 
Age, 1930 
19,884- 
11,756 
9,403 
10,302 
3,273 
5,096 
2,073 
Per-cent over 65 Years 
Age, 1930 
6.9 
4.9 
7.0 
4.9 
4.8 
6.5 
5.8 
Number of General 
Hospitals, 1938 
11 
14 
8 
Q 
y 
10 
12 
5 
iii DISTRICT 
DENVER 
PLATTE 
EAST-CENTRAL 
ARKANSAS 
SAN LUIS- 
SAN JUAN 
COLORADO 
WHITE-YAMPA 
Number of General 
Hospital Beds, 1938 
2,120 
535 
453 
691 
279 
330 
69 
General Hospital Beds Per 
1,000 Population, 1938 
7.1 
2.5 
3.2 
3.6 
3.6 
3.8 
1.9 
Median Number of Beds Per 
General Hospital, 1938 
160 
32 
20 
50 
27 
18 
11 
Number of Recorded Births in 
Registered Hospitals, 1938 
4,749 
1,206 
952 
1,246 
554 
549 
163 
Per-cent of Recorded Births in 
Registered Hospitals, 1938 
91.6 
28,3 
50.8 
32.8 
31.4 
29.6 
21.2 
Number of Physicians, 1938 
748 
231 
192 
194 
70 
86 
41 
Population Per Physician, 1938 
399 
934 
735 
986 
1,099 
1,010 
872 
Official Public Health 
Nurses, 1938 
12 
11 
14 
21 
5 
4 
5 
Voluntary Public Health 
Nurses, 1938 
49 
0 
5 
4 
0 
0 
0 
IV DISTRICT 
DENVER 
PLATTE 
EAST-CENTRAL 
ARKANSAS 
SAN LUIS- 
SAN JUAN 
COLORADO 
WHITE-YAMPA 
School Nurses, 1938 
19 
9 
0 
5 
3 
3 
0 
Total Public Health 
Nurses, 1938 
80 
20 
19 
30 
8 
7 
5 
Population Per Public 
Health Nurse, 1938 
3,731 
10,786 
7,1.24 
6,379 
9,618 
12,408 
7,150 
Square Miles Per 
Public Health Nurse, 1938 
.73 
895 
857 
687 
1,955 
2,014 
3,8X3 
Residence Allocated 
Births, 1938 
5,299 
4, 4^-1 
2,456 
3,803 
1,776 
1,862 
833 
Residence Allocated 
Birth Rate, 1938 
17.8 
20.5 
17.4 
19.9 
23.1 
21.4 
23*3 
Fertility Rate, 1930 
27.0 
47.2 
37.8 
43.3 
58.0 
45.5 
45.1 
Residence Allocated 
Infant Deaths, 1938 
263 
221 
122 
231 
183 
126 
47 
Residence Allocated 
Infant Death Rate, 1938 
49.6 
50.0 
49.7 
73.9 
103.0 
67.7 
56.4 
V DISTRICT 
DENVER 
PLATTE 
EAST-CENTRAL 
ARKANSAS 
SAN LUIS- 
SAN JUAN 
COLORADO 
WHITE-!AMPA 
Residence Allocated 
Deaths, 1938 
3,856 
2,117 
1,662 
2,077 
868 
1,019 
369 
Residence Allocated 
Death Rate, 1938 
12.9 
9.8 
11.8 
10.9 
11.3 
11.7 
10.3 
Residence Allocated 
Pneumonia Deaths, 1938 
281 
179 
122 
197 
142 
116 
oo 
Residence Allocated 
Pneumonia Death Rates, 1938 
94.1 
83.G 
86.$ 
102.9 
184.6 
133.6 
61.5 
Residence Allocated 
Tuberculosis Deaths, 1938 
213 
62 
102 
97 
20 
6 
Residence Allocated 
Tuberculosis Death 
Rates, 1938 
71.A 
28.7 
72.3 
50.7 
31.2 
23.0 
16.8 DISTRICT 
DENVER 
PLATTE 
EAST-CENTRAL 
ARKANSAS 
SAN LUIS- 
SAN JUAN 
COLORADO 
WHITE-TAMPA 
Total Assessed 
Value , 1937 
1 394,279,483 
1 
24.1,4-54-, 217 
$ 161,769,935 
$ 185,299,887 $ 
57,000,545 # 
74,530,335 
$ 56,532,645 
Per Capita 
Assessed 
Value, 1937 
$ 
1,320.82 
$ 
1,119.30 
1 
1,146.86 
1 
968.29 
1 
740.82 $ 
858.07 
1 
1,581.24 
Total Bonded 
Debt, 1937 
44,812,500 
$ 
13,023,110 
$ 
7,713,870 
* 
12,201,070 $ 
3,261,360 | 
4,065,940 
1 
2,172,350 
Per Capita 
Bonded Debt, 
1937 
1 
150.12 
1 
60.37 
54.69 
£ 
63.76 
1 
42.39 $ 
46.81 
$ 
60.76 
vii 
(State Multigraphing Department)