Minutes of the Meeting of the
COMMITTER ON ADMINISTRATIVE PRACTICE
November 22, 1926

Office of the Field Director, New York City

Present

Dr. Haven Emerson, Vice Chairman
Dr. Louis I. Dublin, Secretary

Dr, James Roberts

Dr. ¢, Hampson Jones
Mr. Homer N, Calver
Dr, Henry F, Vaughan
Dr. George T. Palmer
Dr, George C. Ruhland
Dr, W. F, Draper

Dr. E, L, Bishop

Dr, Michael M, Davis
Dr. George D, lummis

Dr. W. F. Walker, Field Director

He 2 oe aK oR a ok ok ok ak a ae ak ake 2k

The meeting was called to order at 10:00 A.M. and the Chairman at once
called for a report from the Field Director,

Dr, Walker, Field Director, referred to his report presented at the An-
nual Meeting of the American Public Health Association at Buffalo, copies of
which were already in the hands of the members of the Committee, This con-
tained a description of the work of the field service for the year ending
October 1, 1926. The report presented at this time covered activities since
the annual meeting, which were, briefly: A visit to the Texas cities as a
follow-up of Dr, Drake's extensive work there; Work with the sub-Committee
on Appraisal Form for Rural Health Work in Nashville, Tennessee; Attendance
at a meeting of Ohio Health Officers and some follow-up work in Springfield
and Preble County, Ohie, and Terre Haute, Indiana; Conferences with offi-
cials in Toledo, Ohio, and Washington, D. C., relative to a survey and ap-
praisal of these twe cities,

The Chairman in accepting this report called attention to the very val-
uable service which is being rendered cities through the Committee on Admin-
istrative Practice by surveys and apnraisals of city health departments. Hs-
pecial mention was made of the assistance rendered Chicago and Boston in
securing the reappointment ef their respective health officers and the de-
veloping of very excellent heaith departments.

Dr, Walker brought before the Committee at this point the question of
Dr. Drake's accepting the invitation from the Beard of Health of San Antonio,
Texas, and other interested groups in that city, to direct a Health Exposi-
tion for the City of San Antonio. This was a matter that had been discussed
at a previous meeting, at which time it was the general opinion that it would

 

 

 

 
22 «

be against the policy of the Committee to foster or approve of Health Exposi-
tions. The situation which existed in Texas at the time of the first request
for Dr, Drake's services in connection with the Health Exposition in San An-
tonio was reviewed to refresh the memory of the members on the question. Dr.
Dublin asked Dr. Walker to give his opinion upon the situation, in the light
of his recent visit to Texas. Dr, Walker said that there had been some im-
provement and that he was quite convinced that the Health Exposition in San
Antonio would be a means of arousing the city to its immediate needs in pub-
lic health work and would serve primarily the purpose of putting over the
results of the survey and appraisal made by Dr. Drake.

Mach discussion followed on the subject of health shows and health ex
positions in general. Dr. Vaughan was interested in knowing the ultimate
good which would result to the Committee from such a work, Mr. Calver spoke
at some length on the subject, touching upon the matter of coordinating the
work of the Association with that of the Committee and setting forth the ad-
vantages that would result both to the Association in its attempt to estab
lish a branch office in Texas, and to the Committee in participating in or
directing the Health Exposition in San Antonio. The question was then :
brought before the Committee of releasing the time of Dr, Drake through the
Central Office of the American Public Health Association rather than have
him represent the Committee in this work. After further discussion Dr.
Emerson moved, seconded by Dr. Vaughan, that the Committee release Dr. Drake 's
time through the Central Office of the Association for the work of putting on

the Health Exposition in San Antonio, if the Executive Board should so desire.
Carried.. .

Dr. Ruhland, Chairman of the sub-Committee on Record Fomms was asked to
give a report of the work of that Committee. In giving his report, Dr.
Ruhland went into the history of the Committee on Record Forms. Five meet-
ings were held by this Committee. Progress on the work of this committee
had been slow owing to the variety of questions to be considered in evolving
forms that could be recommended as standard, Dr. Ruhland presented for the
approval of the Committee as a whole forms for commmicable disease, labora~
tery, mursing service and school physical examination. The Committee on

Record Forms was authorized to continue its work for the remaining health
activities.

The question was raised as to whether or not these forms had been sub-
mitted to persons familiar with mechanical tabulation in order to be abso-
lutely sure of its being possible to use them in this manner. Dr. Ruhland
assured the Committee that this particular point had been in mind in work-
ing out these forms. Dr. Emerson urged that these forms be put out as a
publication of the Association. Dr. Dublin pointed out the potential
value of the forms in money, the possible financial support te the Associa-~
tion, and suggested turning the matter of printing over to the Association,

Discussion arose as to the means of distributing these forms to mem-
bers of the Committee and Association for criticiem before final publication,
Mr. Calver suggested that Dr. Ruhland's report be published in the American
Journal of Public Health and a special appeal be made to the membership of
the Association to submit criticisms of the forms before a certain date.
Dr, Dublin called attention to the necessity of having the forms copyrighted.
It was suggested that to avoid undermining the copyright of the forms that
the idea be copyrighted. Dr. Dublin moved, and it was seconded, that the
Association be requested by the Committee to copyright the idea. Carried,

 
eis

Dr. Vaughan moved, seconded by Dr, Palmer, that the report of the sub-Committee
on Record Forms be published in the Journal, and then be distributed to the
health officers, Carried, Dr. Emerson moved, seconded, that the report of
the sub-Committee on Record Forms be received, Carried,

Dr. Vaughan felt that difficulties might arise in cities that had here-
tofore been printing their own record forms, and that they would not like to
feel forced to buy the forms from the Association. He suggested a solution
in that cities paying a retaining fee to the Association be furnished plates
from which to print the forms for their own use.

The Committee voted that the Report of the Committee on Record Forme
should be signed by all members of that committee, and that forms covering
other functions when ready be handled in the same manner, regarding distri-
bution, as those presented at the present time.

Dr. Bishop, Chairman of the sub-Committee on Appraisal Form for Rural
Health Work, was next to report, giving a resume of the work leading up to
the development of the tentative form. The minutes of the meeting of this
committee held in Nashville on November 4.5 were read by Dr. Bishop and the
appraisal form as worked out at this meeting offered for the approval of
the Committee for one year of exporimental use. Dr. Bishop said that there
was complete agreement among the sub-committee members as to the principles
underlying this tentative appraisal form for rural health work.

Dr, Palmer moved, seconded by Dr. Vaughan, that the report of the sub-
Committee on, Appraisal Form for Rural Health Work be received, and that the
Committees the form as submitted for publication, with the understand-
ing that when published the form will carry a statement that it is intended
for experimental purpose and has not yet been approved by the Committee on
Administrative Practice, The sub-Committee on Appraisal Form for Rural
Health Work was authorized to continue functioning for the purpose of re-
vision after a year of experimental use of the form,

Dr, Emerson suggested that since the sub-Committee on Appraisal Form
for Rural Health Work and the sub-Committee on Record Forms were composed
of a number of persons not members of the Committee on Administrative Prac-
tice, and in view of the valuable service rendered on these committees, a
resolution of appreciation be sent to the members of these sub-Committees,
with a copy of the resolution approving the publication of these tentative
forms. This was put in the form of a motion, seconded and carried.

Dr, Emerson asked that the Chairman be authorized to appoint a commit-
tes tO prepare an appraisal form for state and provincial health activities,
It was brought to the attention of the Committee that such a committes had
been appointed at the last meeting, but since Dr, Griswold, Chairman of that
committee, was not re-appointed as a member of the Committee on Administra- |
tive Practice, it would be necessary only to re-appoint the committee rather
than authorize a new committee. Dr, Bishop spoke briefly of the work al-
ready done in studying state health departments and suggested that it would
be wise to defer action of a committee on appraisal form for state and pro-
Vincial health activities until a report of this study is available. Dr,
Emerson agreed, but urged that the committee be appointed now before someone
else attempts the work, in order that the fundamental principles may be the
same as those developed in the other appraisal forms, Dr. Draper voiced

 
= 4s

the same opinion as that of Dr. Bishop in postponing the activities of such

a committee until material gathered in the study of state health departments
be made available. The entire Committee agreed to this. Dr. Vaughan moved,
and it was seconded, that the Committee on Appraisal Form for State Health
Work be re-appointed, Carried, Dr. Winslow appointed Dr. Draper chairman
of this committee, with power to coopt members, subject to his approval,

Dr, Davis was asked to make a report of a preliminary study on the Re-
lation between Health Departments and Hospitals. Dr, Tavis told of the
questionnaires sent out jointly by the Committee on Dispensary Development
and the office of the Field Director on this subject, the results of which
brought out the need and advisability of pursuing the study more systemati-
cally. To that end funds have been secured to carry on the study during
the coming year. Dr. Davis said it was not intended that this should be
Gn elaborate study; it would still be carried on by the questionnaire method,
but in greater detail than the first questionnaire, The sum of $1,500 was
considered by Dr. Davis to be sufficient to pay the expected expenses in
this study. This amount has already been pledged,

In discussing this work Dr, Emerson recalled a similar suggestion made
previously by Dr. Craster as a possible plan for expanding the work of the
Committee and gathering information on supervision of hospitals through such
a committee, It was moved and carried that a committee be appointed to
study the Relation between Health Departments and Hospitals. Dr, Davis was
appointed chairman of this committee with Dr. Ruhland and Dr. Emerson members,

The latest information regarding the Report of the 1923 Surveys as re=
ported by Dr. Walker and other members present indicated that practically
all the sections have been proof-read and returned to the printer and that
the book may be expected for distribution at an early date,

Dr, Walker next presented the program of the Committee for 1927, the
first subject for consideration being the "Plan for Coéperation with the
U.S. Chamber of Commerce", Some time was spent in giving the details of
how this contact with the Chamber of Commerce Originated and the specific
items in the plan for cooperation requiring the approval of the Committee
were the following: — 7

1. Tabulation and summarization of replies from local chambers
of commerce, indicating items in which interest is expressed
and type of service needed,

é. Issuing @ bulletin by the Chamber of Commerce of the United
States setting forth these results,

3. To furnish blank copies of the Appraisal Form to those cities
interested in analyzing their health activities, to give an

idea of the scope and type of appraisal and surveys made by
the Committee,

4, Educational bulletins to be prepared for distribution through=
out the year:

a. Community health and commimity prosperity

b. Place of public health in the tax dollar

CG, Essential items in the health Organization of
the typical American City

Gd. How the Chamber of Commerce can assist in bring-
ing about improved community health

 
~5-

5. Special bulletins, possibly prepared and sponsored by other
agencies on such items as: Periodic physical examination;
Venereal Disease from the standpoint of the patient; and
others,

6. To carry items in the Health Officers' News Letter on affilia-
tion of the Committee on Administrative Practice with the
United States Chamber of Commerce and the possibilities of
local application.

7, The publication under joint editorship of a News Letter for
public health comnittees of local chambers of commerce setting
forth activities and results obtained by other chambers and
the relation of the U.S. Chamber of Commerce and the Committee
on Administrative Practice.

8. To encourage the members of the Committee on Administrative
Practice to establish strong contact with their local chambers,
possibly acting as chairman of the public health committee of
same, and to build up an active affiliation between the chamber
and the local health work, urging Committee on Administrative
Practice members to advise the Field Director, so far as pos-
sible, of visits to other cities sufficiently in advance so
that contacts with both the health officer and the chamber
of commerce secretary may be made, in order that the program
of the Committee may be stimulated in advance.

Dr, Emerson in discussing the question pointed out that the primary
interest of the chamber of commerce in the Committee was as a means of pre-
senting the human assets of the community on the same basis as the fire pre-
vention work. He also stated that this plan for cooperation would not al-
ter the policy of approaching a city through the health officer,

Dr. Dublin in discussing the plan pointed owt to the Committee that
this was an excellent opportunity for cooperation. The local chambers of
commerce have no desire to do the technical work which this Committee is
prepared to do but are willing to put every facility at the disposal of this
Committee. Dr, Jones spoke of the danger in local chambers of commerce in
undertaking this work unless it comes directly threugh the local health of-
ficer. Dr, Walker said it was not the intention of this plan of coopera-
tion to take the work out of the hands of the health officer, but it is 4
splendid opportunity to guide local chambers of commerce in their health
programs. He cited work already accomplished in Springfield, Ohio, 4s
an example of what might be done by a local chamber, and said that under
such guidance and advice which can be given by the U.S. Chamber of Commerce
through well selected local men this health committee of the local chamber
can become a tremendous power in the community. Dr. Palmer suggested that
each item in the plan for cooperation as presented by Dr. Walker should be
considered and acted upon separately by the Committee.

Items 1 and 2 required no action by the Committee, Item 3 was the
subject of considerable discussion and it was agreed that if in furnishing
the Appraisal Forms to local chambers of commercs the following statement
contained in the Introductory Statement be underlined in red and the health
officer be advised by letter of such action the Committees saw no objection
te this part of the plan for cooperation: "The Committee believes that

 
A atm AP

- 6 =

eee

there should be no appraisal of the health work of a city on this plan except
with the approval of the health officers concerned; and that in no event should
there be any publication of the appraisement of the health work of a city ex
cept with the consent of the health officer," Dr. Ruhland put this into the
form of a motion, which was duly seconded and carried,

Item 4 was approved by the Committee. Dr, Winslow believed this point
to be really a function for Mr, Calvex's office and it was moved and carried

that the Committee approve this project but that it be referred to the Execu-~
tive Board for carrying out.

Items 5 and 6, It was moved and carried that the person responsible
for the present Health Officers? News Letter should de delegated to carry
out these two items, of which the Committee as a whole approved,

In discussing Items 7 and &, the question of the original purpose of the
Health Officers' News Letter was set forth and it was felt that in undertaking
this plan for cooperation no departure would be made from the original purpose.
Dr. Dublin pointed out in his discussion of Item & that the contacts to be
made through this plan would not be essentially new contacts. It is the
present policy of the field staff to make contact in cities with influential
persons, such as managers of chambers of commerce and leading business men's
clubs, It would simply be a question of furthering the work of the Committee
in a community. Dr, Dublin moved that these two items be approved. Carried,

Dr. Ruhland moved, seconded by Dr. Bishop, that the Committee approve
the plan for Cooperation with the U. 8. Chamber of Commerce, as outlined by
Dr. Walker, subject to the action of the Executive Board, Carried,

The need for model ordinances as indicated by the numerous requests re-
ceived in the office of the Committee and the Association was brought to the
attention of the Committee by Dr. Walker. This was deemed a most important
work which could be undertaken by the Committee during the coming year, Af-
ter the discussion of the subject, Dr, Vaughan moved that a committee be ap-
pointed by the Chairman to formate model health ordinances. Carried,

Dr, Winslow appointed the following committee: Dr, Vaughan, Chairman, Dr,

Emerson, Dr, Bishop, and gave the chairman permission to appoint other mem
bers, subject to his approval ,

A letter was read from Prof, Hiscock requesting that the Committee give
scme thought to the question of standardization of health department reports.
This matter had been discussed at the annual meeting in Buffalo, Dr. Vaughan
moved that the Chairman appoint &@ committee to develop a standard form for
he@lth department reports. Carried. Dr, Jones was appointed chairman with

permission to coopt such other members for his committee as needed, with the
approval of the Chairman.

Dr. Winslow presented for the consideration of the Committee the question
of revising the Appraisal Form for City Health Work, Though the time set for
such @ revision is 1929 it was believed that a committee should be appointed
to makes @ study of the Appraisal Form during 1927, receive the suggested
changes and criticisms offered and incorporate them in a tentative form for
experimental use in 1928, then be prepared for the revision in 1929, Dr,
Vaughan distributed to the members of the Committee charts showing the appli-
cation of the Appraisal Form to the work ef the Detroit Health Department for
& period of five years and gave a brief discussion of various items, pointing

 
aos

out specific items which he felt from this extensive study should be revised,
Dr. Emerson presented criticisms of the laboratory section as set forth in a
letter from Dr, Wadsworth of the New York State Health Department.

The question was raised relative to whether the Committee on Analysis
of Public Health Procedure could not do this work of revising the Appraisal
Form, It was pointed out that this committee was appointed to investigate
the validity of the criteria as a true measure of health services and that
though it should furnish material for the revision of the Appraisal Form a
special committee to undertake this work was necessary, and should be ap-
pointed, It was the opinion of the Committee that close cooperation should
be established between this committee on revision and the chairmen of the
various sections of the American Public Health Association, such as the
nursing section, laboratory, child hygiene section, and others. Dr. Vaughan
moved, seconded by Dr, Palmer, that a committee be appointed to study and
prepare material for the revision of the Appraisal Form for City Health Work,
Carried, The following were appointed on this committee: Dr. Palmer, Chair-
man, Dr. Hoberts, Dr. Freeman, Dr. Iummis, Dr, Vaughan, Mr. Platt.

Owing to contimied illness, Dr, Freeman, Chairman of the Committee on
Analysis of Public Health Procedure, was not present and there was no report

from this committee, The Committee voted to authorize the continuation of
Dr, Freeman\s committee,

Dr, Lummis introduced a blanket motion making Dr, Walker member ex-
officio of all sub-committees. Carried. , :

Dr, Winslow called to the attention of the Committee a resolution
passed by the Governing Council of the American Public Héalth Association
requesting the Committes on Administrative Practice to consider undertaking
with the American Medical Association a systematic study for better organi-
zation of medical service, looking toward the checking of incipient disease.
The scope of such & study was discussed, ideas and opinions expressed as to
how far ths Committee should go in work of this kind, the ultimate good
which would rasult in the field of public health and the medical profession,
the educational value attached to such a study, and many other phases of
the question, It was the feeling of the entire Committee that the initial
step in undertaking such a study should be the appointment of a committee ~
to confer with representatives of the American Medical Association upon
the feasibility of the plan, and that the committee thus appointed should
report at the end of one year, Di. Vaughan put this into the form of a
_ motion, seconded by Dr. Ruhland, Carried. Dr. Emerson was appointed

Chairman of this committee, with Dr. Draper, Dr, Rankin, Dr. Bishop and
Dr. Davis members,

Dr, Dublin gave a report of the finances of the Committee. He gave
a& comparison of the expenditures for the past ten months and the budget for
ten months, which showed an unexpended balance for ten months of $1,046.74,
The budget for 1926 amounted to $25,900. The budget for the year 1927 in
the sum of $33,800 was presented for the consideration of the Committee.
Dr, Dublin went over each item of the proposed budget and pointed out the
necessity for the increases. He also called attention to the expected in-
comé for 1927, based upon expected g ants from the Metropolitan Life Insur-
ance Company and the Milbark Memorial Fund, $7,500 each, and the income
which would result from the sale of consultant service, surveys and ap-
praisals by the Field Staff, some of which are definite commitments.

 
Dr, Winslow went inte considerable detaii concerning the relation of the Com-
mittee and the Milbank Memorial Fund, explaining the conditions upon which
previous grants from the Fund had been made and also touched upon the fact
that the Metropolitan pledge has been contingent upon the sun granted by the
Milbank, Dr. Walker felt that it was quite possible that within a few years
the Committee on Administrative Practice would be self-supporting,

After this report was received Dr. Emerson brought before the Committee
the question of full-time, trained public health personnel, and Suggested
that some credit should be allowed for this in the Arpraisal Form. The feel-
ing of the Committee after discussing the matter briefly was that this should
be referred to the committee appointed for the purpose of revising the Ap-
praisal Form for their consideration, This was done,

Dr. Winslow called attention to the fact that the positions of Field
Director and Associate Field Director are annual appointments and some action
should be taken by the Committee regarding these appointments. Dr. Emerson
moved, seconded by Dr, Dublin, that the Committee re-appoint the present
Field Director, Dr, Walker, and Associate Field Director, Dr, Drake, at the
salaries as listed in the budget for 1927, Carried,

Meeting adjourned,