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FATHERS' ROOM Expectant fathers will also have their own room, equipped with free hot coffee and cigarettes.

Planned by Dr. Sidney Garfield, medical director of the Kaiser Foundation, the new hospital has everything designed for the comfort of the patient.

The price for private rooms will be $20 a day, while semiprivate rooms will cost $15.50 to $17.50 a day, substantially lower than the price charged by many oldfashioned institutions.

Hospital officials claim the cost is being kept down by one part of the institution which few patients, and none of their visitors, will ever see. This is a long inside corridor running the length of each wing, and divided into streamlined units for each nurse, units which look like a cross between a new railroad compartment and the control room of a modern television station.


Working at her post, each nurse will be in charge of eight patients.

“There is no need for her ever to go to another part of the hospital while she is on duty,” Dr. Garfield claims. "She will always be near her patients."

Each nursing post. contains a desk and filing compartment for records, charts, X-ray photographs, medicines, food trays, and fresh linen for each patient. There are also telephones, intercoms, red lights, green lights, yellow lights, and other assorted signaling devices.

If the nurse needs drugs, these are delivered to her through a pneumatic tube.

If she leaves her desk to take care of an emergency with one of her patients, she pushes a button which sounds alarins in adjoining nursing stations.


“We've already tried this system in our new hospital in Los Angeles," says Dr. Garfield. “It seems to work efficiently, it gives each patient more nursing care per day, and per dollar, than any other system, and the nurses seem to like it, too. They spend their time nursing, not running all over the hospital like errand boys."

Hospital officials announced the building will be open to public inspection from this Sunday, August 23, through the following Sunday, August 30. Visiting hours will be from 1 to 9 p. m. on each Sunday and on Saturday, and from 5 to 9 p. m., Monday through Friday.

DOCTORS INVITED All doctors of east Contra Costa County were invited to a private preview showing from 1 to 9 this Saturday.

When the hospital opens for routine operations, it will be open to patients of all qualified physicians in the area.

“It has been built to bring the newest and best in modern hospital facilities to this rapidly growing suburban area,” Dr. Garfield said. “We hope it can help bring better health to our new neighbors."

(From American Journal of Public Health, vol. 42, No. 12, December 1952)





MILMORE, M. D., M. P. H., F. A. P. H. A. Medical consultant, San Francisco Labor Council;' chief, bureau of chronic

diseases, California State Department of Public Health ;' associate statistician, morbidity research project, California State Department of Public Health ; health educator, International Longshoremen's and Warehousemen's Union

1. Presented before the medical care section of the American Public Health Association at the 80th annual meeting in Cleveland, Ohio, October 22, 1952.

At time of survey, medical director, Permanente Health Plan. . On leave.

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Pacific Maritime Association Welfare Fund; and acting chief, bureau of chronic diseases, California State Department of Public Health and senior surgeon, United States Public Health Service; San Francisco, Calif.

In the past few years multiphasic screening has become a widely accepted procedure for the early detection of unsuspected disease among apparently healthy people. The combination of many different technical and laboratory procedures for mass screening grew out of the successful single-shot case finding programs for syphilis, tuberculosis, and, more recently, diabetes. Large-scale projects in many communities have demonstrated the feasibility of multiphasic screening as a public health technic.

Not previously investigated, however, has been the potentiality of multiphasic screening in medical care programs providing comprehensive services. As a method of preventing unnecessary complications of disease and of promoting the economy and effectiveness of medical service, the multiple testing procedure should offer many advantages to medical care organizations and to health-CODscious consumer groups.

The decision of the International Longshoremen's and Warehousemen's Union and the Permanente Health Plan to organize a multiphasic screening program fforded a unique opportunity to study:

1. The results of medical followup of multiphasic screening when there was no charge to the individual participant for diagnostic and treatment service, and when all records were available through one medical care organization.

2. The costs of the screening tests and of followup services.

ORGANIZATION OF THE PROJECT Special characteristics

Three features characterized the program as developed for the longshoremen in the San Francisco Bay area. First, a well-organized consumer group—the union—took the initiative in instituting the project and assumed a large share of the responsibility for its preparation and organization, thus providing the best possible foundaton for a successful public-health enterprise. Second, through the medium of a joint labor-management welfare fund," the workers were covered for comprehensive medical care under a prepayment plan which maintains group medical center facilities throughout the bay area. Thus, no financial barriers to complete follow-up of positive test findings faced the individual longshoremen, and one difficult problem of mass screening could be avoided. Third, a wide array of public and voluntary health agencies in San Francisco actively participated in the planning and conduct of the case finding endeavor. In this way, costs were spread, the scope of service was extended, and widespread coinmunity interest and support were developed.

Numerous special problems had to be solved. A group of skeptical workers scattered over 80 miles of waterfront had to be persuaded to travel to the union headquarters and undergo a battery of strange-sounding tests, often missing thereby a day's work. Many of these men had been unaccustomed to regular medical attention and were suspicious of health examination procedures because of their misuse in employment practices in the past. The workers represented many cultural and language groups and every level of education. The summer vacation period, plus heavy work schedules, added to the difficulty of getting the longshoremen to the test station. Men with positive tests had to be referred to one of several medical centers. Finally, the very proper insistence of the union on protecting the personal privacy and job security of its members necessitated special efforts to maintain the contidential nature of all records. Educational campaign

One early lesson of the project was that the educational campaign among the workers became effective only when the union itself assumed responsibility for disseminating information about the health tests and encouraging members to participate. As the regular channels and procedures of the union were opened up, the workers themselves using familiar language and accustomed approaches-carried on the campaign.

The union health committee of rank and file members assumed the main responsibility, with assistance from a full-time staff worker assigned by the

* The International Longshoremen's and Warehousemen's Union-Pacific Maritime Asso ciation welfare fund.

welfare fund and with technical guidance provided by a committee of professional health educators. Work priority was guaranteed to all men who lost job time because of participation on the health committee.

The committee utilized every possible aspect of usual union routine and invented some ingenious new techniques. The program was discussed at membership and officers' meetings; all regular publications of the union were used and a special health test bulletin issued; leaflets and posters concerning some of the diseases detectable by the tests were widely distributed on the waterfront and at the pay windows. Leaders of each work gang surveyed their members and reported to the cominittee on the levels of information and acceptance. A special mailing to each member's home, including a union-devised pamphlet entitled "Are You Shipshape?" preceded the opening date.

A fairly level rate of participation was maintained throughout the actual testing period by the continuous efforts of the union health committee. Members who had completed the tests wore special health test buttons. A prominent health test stamp placed in the union book of each man tested enabled gang stewards to check the members regularly. The entire machinery of the hiring hall and the dispatching system was utilized to encourage maximum participation : work gangs were actually dispatched to the tests according to a schedule; loudspeaker announcements were made regularly in the hiring hall; job dispatch slips were stamped with a health test reminder; and careful records of response were kept with followup letters sent to leaders of delinquent gangs.

Progress reports were prominently displayed so that the entire organization was stimulated to establish the best attendance record possible. As a result of this educational effort, some 4,000 out of an estimated 5,200 eligible and available members presented themselves for testing during the 7 weeks of the project. Organization of the screening program

The testing facilities were established on the second floor of the union hiring hall on the San Francisco waterfront. The union supplied furnishings, and technical equipment was provided by the Permanente Health Plan and the various cooperating community agencies. Permanente and the labor-management welfare fund defrayed expenditures for payroll and supplies. The statistical analysis phase of the program was conducted by the State department of public health.

Eight public and voluntary community agencies provided equipment and personnel for the testing program. Table 1 summarizes these contributions.

Under the overall direction op the medical director of the Permanente Health Plan, a committee of representatives from each of the participating agencies met frequently for the determination of general policy. The working staff consisted of 2 administrative supervisors, 12 full-time and a variable number of part-time and volunteer technicians, 5 clerks and a union volunteer group which maintained traffic control and assisted in general maintenance. A carefully designed record system facilitated the followup and the statistical evaluation of the project.

Men with positive test results were referred to the Permanente medical center nearest their homes, being given appointments either for confirmatory laboratory procedures or for appropriate medical visits. Further letters were sent and phone calls were made to nonresponders in a concerted effort to attain maximum medical followup. Thus 72 percent of those with positive test results responded for medical followup within 4 months after the tests were concluded. Table 1.-Contributions by Participating Community Agencies to Multiphasic

Screening of Longshoremen, San Francisco, 1951 California Bureau of Vocational Rehabilitation

Provided trainee personnel for clerical and semitechnical work in testing program. California State Department of Public Health

Provided consultants in organization, health education, statistical, and laboratory technics; performed serologic tests for syphilis; loaned Clintron blood sugar equipment: provided audiometry personnel and equipment; provided

health education materials; prepared statistical analyses. California State Harbor Commission

Renovated premises and installed special electrical wiring system. San Francisco City and County Health Department

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Provided public health consultants; performed serologic tests for syphilis ; loaned part-time audiometrist. San Francisco Heart Association

Provided equipment and paper for electrocardiograms. San Francisco State College

Provided audiometry supervisor and technicians. San Francisco Tuberculosis Association

Provided equipment, technician, film and radiological readings for 70 mm. chest X-rays. University of California School of Public Health

Provided general consultation; made available part-time laboratory technician and administrative supervisor.

CHARACTERISTICS OF THE POPULATION TESTED The San Francisco Bay area longshoremen cannot be considered representative of the urban labor force. Besides being entirely male, the group is characterized by a large proportion of workers in the older ages and by the particular conditions of longshore work.

As indicated in table 2 and figure 1, the group tested was significantly older than the employed male population in the area, with a median age of 49 years. In 1951 the average annual income of San Francisco longshoremen was about $5,000 and the economic status maintained since 1939 has compared favorably with other industrial workers in the area. Prior to this time, the income levels of these longshoremen had been relatively much lower. Almost 70 percent of the men tested work as basic cargo handlers, which involves heavy and often dangerous manual labor. A minority of the union membership is occupied in supervisory, clerical, or mechanical operations.

Over one-third of the members have longshore work histories of 20 years or more. Another large group came to the San Francisco docks during World War II, many of these already in the middle and later years of life. Thus, the group represents the somewhat unusual combination of relatively well-paid manual laborers in the older age brackets.









14 -24 25-34 35-44 45-64 65 YEARS

FIGURD 1-Age distribution of longshoremen tested and of employed males in San Fran-

cisco-Oakland metropolitan area. (Source : Table 2.)

TABLE 2.-Age distribution in percentages of 3,994 longshoremen tested and of

employed males in San Francisco-Oakland metropolitan area

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1 June 18 to Aug. 7, 1951. :U. S. Bureau of the Census, 1950 Census of Population, Preliminary Reports, Series PC-5, No. 45. 3 Less than 0.5.

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