SECTION I - SURVEY AREA A - The Hospital Survey Area Determined. To be selected as the "Hospital .A.rea 11 for survey purposes, the population of the "Area" must now or soon will be, routinely and in large proportions, cared for in the area's hospitals and health units. Frequent ly a close analogy exists between the "retail trade area" and a "hospital area", but in this instance we find the Chamber of Commerce defin ing the Houston retail trade area as consisting of 32 adjoining counties extending as far North as Cherokee County and as far Southwest as Victoria County. It was immediately apparent that such a territory was too large for the natural "hospital area". While undoubtedly the most complex medical eases would come for hospital care to Houston from the extreme districts, the more normal habit would be to be oared for closer to hame when hospitals were so constructed in the future. Therefore the boundaries of the retail trade area were not considered synonomous with the perimeter of the "hospital area". An analysis of hospital admissions ttby residence•1 , for the year ending June 30, 1946, admitted to St. Joseph's Infirmary, Hermann Hospital, Memorial Hospital and Methodist Hospital were studied. The total number of admissions to these hospitals amounted to 40,740 and with the 13,000 admissions to City-County institutions and to the Southern Pacific Hospital where the admission-ranges were known, there were left only 17,124 admissions to all Harris County registered hospitals unidentified as to residence. Exhibit I has been prepared to reflect a recap5. tulation of the analysis made of 40,740 admissions and it is to be noted that the percentage distribution shown in the table below follows a reasonably olear-cut pattern in all four hospitals. SA .. I It is to he noted that Memorial and Methodist Hospitals seemingly draw from a wider area than the other hospitals, with Methodist ad~itting patients representing 112 Texas counties, 105 o£ which were beyond the peripheral area. However, the number o£ admissions from any one County was noted to be very small. PERCEN TAGE DISTRIBUTION OF ADIEISSIONS BY PLACE OF RESIDENCE Year Ending June 30 1 i946 St.Joseph's Hermann Memorial Methodist Total Houston 84.6 88.2 81.4 84.7 85.3 Other Harris County 8.1 6.3 8.8 4.4 7.4 Peripheral Counties 5.0 1.2 2.8 3.3 3.3 Non-Peri~heral 2.0 3.8 6.4 7.1 3.4 Coun ... ias Other States .3 .5 .5 .5 .5 Other Countries .o .o .1 .o .1 Total 100.0 100.0 100.0 100.0 100.0 In aooepting recant experience of hospitals in dis- tribution by residence of patients, it was recognized that heavy demands on hospital facilities by local residents in the past faw years might have left fewer beds available for non-residents. Greater inquiry determined that this policy did not carry suf ficient weight for further consideration. Hence, it was finally concluded that the study of admiss i ons, as made, reflect ed a fair picture of all conditions and should primarily determine the "hospital arean and thus the "survey area u. Certain thcught was given to using the City of Houston as the Survey Area but on the strength of the closel y inter-l ocked problems of public health and by reason of joint controls of City- County Hospitals, as well as by reason of the 7.4% of patients comi ng from the area outside Houston but winhin Harr is county, it was £inally determined that the area should be that of Harris County representing 92.7% of admissions studied. SA-2 C -General Harris County, determined to be the Survey .Area, has an area of 1747 square miles of gentle to rolling terrain, traversed by numerous bayous and fronting on Galveston Bay. It is the largest county in East Texas and is vitally rich in natural resources, pro- ductive crops and valuable livestock. It is bounded by seven Texas counties, and arcs drawn from Houston strike the county perimeter at distances varying; from 15 to 45 miles; hence points along the Fort Bend - Harris County line 'fary fran. 15 to 25 miles in their distance from the center of Houston. The following table sets forth these distances: Countr Line Distance To Houston Minimum Maximum. Ft. Bend-Barr is 15 25 Waller-Harris 25 45 Montgomery-Harris 20 45 Liberty-Barr is 25 30 Chambers-Harris 25 30 Galveston-Harris 25 30 Brazoria-Harris 15 20 The history of Harris County is in ef fect the history of Houston, the growth and development of which has influenced the entire area. The Allen Brothers bought a tract of land at the head waters of Buffalo Bayou for $5,000 and established the town of Houston on August 30, 1846. At that t~e, in a nawspaper announcement offer- ing lots for sale, they made this prophetic declaration: "The town of Houston is located at e. point on the river whioh must ever command the trade of the largest and richest portion of Texas, and when the rich lands of that section have been settled, SA.-4 a trade will flow into it, making it beyond all doubt the great interior commercial emporium of Texas. Situated at the head of navigation on Buffalo Bayou, its advantages are now for the first time brought to pub lie notice. Houston combines two important advantages, a communication with the coast and with different portions of the Republic of Texas. As the country shall improve, railroads will come in use and will be extended from this point to the productive sections of the State, and in a few years the whole trade of the Upper Brazos will make its way through Houston, Buffalo Bayou and Galveston Bay.n This prediction was soon known to be quite correct. People were swarming into Texas. The streets were. little better than muddy roads, but many wagons made their way into Houston and remained. uVord about the growth and possibilities of Houston trickled to other parts of the country, and in 1850 the United States Census Bureau counted 1396 persons. The need for improvement s of navigable waters was laid before the Texas Legislature. The State spent $4,000 to improve Buffalo Bayou. A contract for $22,000 was let to clear sailing through Morgan's Point. A central Railroad was persuaded to lay its tracks to Houston and the city secured its first tele­ graphic link with the seacoast in 1854. But the growth of Houston was not accomplished without a struggle. Population growth took a downward turn from 1859-1870, for a fire had swept Houston, and ten dark years of reconstruction followed. Commerce was abnost nothing, and in 1870 there were only 9.382 persons in Houston. SA-5 Then a new cry sprung up - a cry that did not quiet itself until the great idea was carried tr...rough -- "Deep Water -­ Give Houston a deep water highway to the seas.n On June 13, 1902 a bill calling for an appropriation of $1,000,000 for the development of the Houston Ship Channel from Galveston to Harrisburg was signed, and as a result of this progress of ship channel ~provement, Houston is now the second port in the nation in deep seas tonnage and third in total tonnage. The Ship Channel connects Houston with deep water in Galveston. Its length is 50 miles, bringing an enormous consuming territory 50 miles nearer tide water than any of the other Gulf ports. From an historic and romantic past, Houston has developed into a great industria 1 center. Industries include oil refining, oil field and refining tool and equipment manufacture, steel, shipbuilding, rice milling, cotton compressing and warehousing, iron product fab­ rication; flour milling, cement making, container manufacture, and chemical production. The founders of Houston were guided by a prophetic vision, the fulfillment of which is today manifested on every side. SA-6 D -Population Characteristics. An understanding of population facts and trends is essential to proper hospital planning as the distribution, as well as the size of hospitals • must be related to the distribution and density of population, while facts on age groups and. to same degree, on sex composition of the population will dictate the type of facilities. Experience indicates definite yardsticks of measure far rural and urban areas while economic variations in the survey area may point out still other cons idera.tions. Employment has a bearing since certain industries represent hazards a.nd particular policies of manage­ ment which thus create an urge, as well as furnish, better health progrsns and benefits than do others. Consideration must be given to race and group problems to assure ample hospital service. 1 - Rural and Urban The character of the population of Harris County can be seen from the following table to be 77 .7'%urban in 1940, a 6% pro­ portionate decrease fram 1930. This trend does not follow that of the county a.s a. whole, where rural areas surrounding metropolitan centers have shown proportionate declines. However, it is believed that in Harris County, there have been shifts of population to the fringe areas of Houston and of Metropolitan Houston and the statistics prove the point· in that the gain in rural percentage is almost entirely within rural non-farm. areas. SA-7 Harris County 1940 1930 Population Percent Population Percent Urban 410,884 77.7 301,012 83.7 Rural '118,077 22.3 58,316 16.3 (a) Rural Non-Farm 86,855 16.4 38,272 10.6 (b) Rural Farm 31,222 5.9 20,044 5.7 Total 528,961 100.0 359,328 100.0 The Agricultural Division of the CED released data in February of this year that reflects a sharp drop in the number of farms in the county, which is the factor most closely keyed to the farm population trend.