A Compilation 
 
 OF THE 
 
 Laws, Regulations and Agencies 
 
 RELATING TO 
 
 Tuberculosis 
 
 H43S -■ 
 
 fiuW 
 
 NEW YORK STATE DEPARTMENT OF HEALTH 
 
 ALBANY, N. Y. 
 
 HERMANN M. BIGGS, M.D. 
 Commissioner 
 
 17.1. 
 
 A* I 
 
 ALBANY 
 
 J. II. LYON COMPANY, PRINTERS 
 
 1919 
 
 Digitized by Microsoft® 
 
Cornell University Library 
 RA 121.A51 
 
 A compilation of the laws, regulations a 
 
 3 1924 003 315 284 
 
 Digitized by Microsoft® 
 
A Compilation 
 
 OF THE 
 
 Laws, Regulations and Agencies 
 
 RELATING TO 
 
 Tuberculosis 
 
 NEW YORK STATE DEPARTMENT OF HEALTH 
 
 ALBANY, N. Y. 
 
 HERMANN M. BIGGS, M.D. 
 Commissioner 
 
 ALBANY 
 J. B. LYON COMPANY, PRINTERS 
 1919 
 
 Digitized by Microsoft® 
 

 A 5 /' 
 
 CONTENTS 
 
 Reporting and control of cases of tuberculosis: 
 
 Reports of tuberculosis by physicians and others •> 
 
 Examination of sputum 4 
 
 Protection of records \ 
 
 Disinfection of premises i 
 
 Health officer to direct disinfection j! 
 
 Prohibiting occupancy of premises ° 
 
 Prohibiting carelessness of person having tuberculosis o 
 
 Control of dangerous and careless patients ' 
 
 Protection of patient's family ° 
 
 Statement of procedure and precautions by physicians j> 
 
 Penalty for failure to perform duty or for false reports iu 
 
 Reporting recovery of patient lj 
 
 General penalty lj 
 
 Application of provisions H 
 
 Conditions in tenement houses: 
 
 Tenement houses in cities H 
 
 Course of instruction for county tuberculosis hospital superintendents 
 
 at Ray Brook 12 
 
 Admission of patients to Ray Brook 12 
 
 County tuberculosis hospitals: 
 
 Establishment 15 
 
 Board of managers: 
 
 Appointment and terms of office 21 
 
 General powers and duties 21 
 
 Superintendent, general powers and duties 24 
 
 Admission of patient from county in which hospital situated 26 
 
 Maintenance of patients in county in which hospital situated 27 
 
 Admission of patients from county not having hospital 28 
 
 Visitation and inspection 29 
 
 Maintenance of patients from county not having hospital 29 
 
 Hospitals at almshouses 30 
 
 Officers and employees exempted from board of supervisors' 
 
 jurisdiction 30 
 
 Special acts governing individual hospitals 31 
 
 Tuberculosis hospitals or camps in towns; consents requisite for 
 
 establishment 3 2 
 
 Tuberculosis hospitals, establishment by first-class cities 34 
 
 Iron stairways on outside of hospital buildings 35 
 
 Equipment must be purchased from Commission on Prisons unless 
 
 " released " 3 6 
 
 Workshops in connection with tuberculosis hospital 37 
 
 Furnishing of liquor prohibited except upon prescription 38 
 
 Regulations of State Sanitary Code regarding tuberculosis: 
 
 Communicable diseases designated 39 
 
 Right of entrance and inspection 40 
 
 Duties of physicians and other persons concerning tuberculosis 40 
 
 Duties of health officer receiving report of apparent case 40 
 
 Cleansing, renovation and disinfection required 41 
 
 Method and precautions in cleansing, renovation and disinfection.... 41 
 
 Destruction of furniture, clothing and other articles 42 
 
 Cleansing and disinfection of the person 42 
 
 Letting of rooms forbidden while contaminated with infective 
 
 material 43 
 
 Health officers authorized to permit inspection of tuberculosis 
 
 registers in certain cases 43 
 
 Tuberculosis records ][[ 44 
 
 Tuberculosis in boarding houses ' [\ 44 
 
 Special departmental regulations and instructions regarding cleansing, 
 renovation and disinfection: 
 
 Definitions 4 fi 
 
 Principles of disinfection , .....' 49 
 
 Cleanliness '// ' 50 
 
 Heat '.'."' 51 
 
 Chemical disinfectants used in solution '.'.'.'. si 
 
 Solutions used for disinfection * 50 
 
 Caution: poisoning and aritidotes . . . . 53 
 
 Disinfection of discharges . . 53 
 
 Disinfection of the person '.'..''' 5k 
 
 Disinfection of contaminated rooms and contents '.'.'.'.'' >;r 
 
 Disinfection of various articles and places ' ' ' gn 
 
 Conduct of the isolation period ' fi o 
 
 Chief cooperating agencies in tuberculosis work . . 64 
 
 Cooperation between county and city or village tuberculosis nurses 70 
 
 Blank for admission of patient to Raybrook ' - 
 
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REPORTING OF CASES OF TUBERCULOSIS AND 
 DUTIES OF HEALTH OFFICERS AND, OTHERS 
 CONCERNING REPORTED OR SUSPECTED CASES 
 
 Public Health Law, Sections 320 to 332, inc. 
 
 § 320. Reports of tuberculosis by physicians and others. Tuberculosis, 
 Tuberculosis is hereby declared to be an infectious and com- communicable; 
 
 . . J (See Ch, II, 
 
 mumcable disease, dangerous to the public health. It shall be the K <f, *. s <"\ 
 
 L Code, p. 39.). 
 
 duty of every physician in the state of New York, to report by tele- 
 phone or in person or in writing on a form to be furnished as here- 
 inafter provided, the name and address, of every person known by Ee ortin by 
 said physician to have tuberculosis, to the health officer of the city, ^hS^see'' 1 
 town or village in which said person resides or may be, within ££• s "i, 'Sw 
 twenty-four hours after such fact comes to the knowledge of said p ' 40-) 
 physician. It shall also be the duty of the chief officer having 
 charge- for the time being of any hospital, dispensary, asylum or 
 other similar .private or public institution to report the name, age, institution to 
 sex, color, occupation, place where last employed if known and the municipality 
 
 ... . _ . . where patient 
 
 previous address of every patient having tuberculosis who comes resided within 
 
 7 . ... . this state. 
 
 into his care or under his observation, within twenty-four hours 
 thereafter to the health officer of the city, town or village in which 
 said patient resided immediately previous to admission to said 
 institution; except that if such residence be outside of the state 
 of New York then such report shall be made to the state commis- 
 sioner of health. 
 
 Any physician, nurse, employer, teacher, head of a family, land- f e ^ nt of 
 lord, or other person may report in writing the name and address £"" l7 
 of any person coming under his observation who appears to be ^'oh. it,"' 
 suffering from tuberculosis to the health officer of the city, town or f^' £*Hi 
 village in which such person is, and the health officer shall there- p ' 
 upon take such steps as may be prescribed by the sanitary code pro- 
 vided the person making such report signs his own name and 
 address thereon. 
 
 Each registrar of vital statistics shall promptly report to the f'*^™^ £ 
 health officer the name and address of every person reported to 
 him as having died from tuberculosis. The health officer shall f;^^ 
 ascertain whether such person has been previously reported as was* MporteaT 
 
 Digitized by Microsoft® 
 
having tuberculosis by the physician signing the death certificate, 
 and if it appears that such physician has not so reported such per- 
 son, the health officer shall call the attention of such physician to 
 
 h. o.' S duty the provisions of this section: In case of repeated violations of the 
 
 violation.. provisions of this section by any physician the health officer shall 
 report such repeated violations to the board of health or other local 
 health authorities, who shall cause such steps to be taken as may be 
 necessary to enforce the penalty provided for such violation. 
 (Am'd by L. 1913, ch. 559 ; L. 1914, ch. 318 and L. 1916, ch. 370, 
 in effect May 1, 1916.) 
 
 eSTmin P a!ti!JS § 32 L Examination of sputum. It shall be the duty of every 
 health officer of a city, town or village, when so requested by any 
 physician, or by authorities of any hospital or dispensary, to mate 
 or cause to be made a microsco'pical examination of the sputum 
 forwarded to him as that of a person having symptoms of tubercu- 
 losis, which shall be forwarded to such officer accompanied by a 
 blank giving name, age, sex, color, occupation, place where last 
 employed if known and address of the person whose sputum it is. 
 
 h. o. to r - It shall be the duty of said health officer promptlv to make a report 
 
 port re sit t J . l l .- J. ^ 
 
 to physician. f the results of such examination free of charge, to the physician 
 
 or person upon whose- application the same is made. 
 h. o. to keep § 322 - Protection of records. It shall be the duty of every 
 health officer of a city, town or village to cause all reports made in 
 accordance with the provisions of section three hundred and 
 twenty, and also all results of examinations, showing the presence 
 of the bacilli of tuberculosis, made in accordance with the pro- 
 visions of section three hundred and twenty-one, to be recorded in 
 Protection of a register, of which he shall be the custodian. Such register shall 
 sf'sJ^'cfde^' not De °P ei1 t0 inspection by any person other than the health 
 Pi 43,) authorities of the state and of the said city, town or village, and 
 
 said health authorities shall not permit any such report or record 
 fsee ch. vii, to be divulged so as to disclose the identity of the person to whom 
 code, p.' 44.) ' it relates, except as may be authorized in the sanitary code. (Am'd 
 by L. 1913, ch. 559, in effect May 16, 1913.) 
 
 of vac"ttn 8 of § 323 - Disinfection of premises. I n case of the vacation of 
 
 premises. 2JCL j a p a rtment or premises by the death or removal therefrom of a 
 
 person having tuberculosis, it shall be the duty of the attending 
 
 physician, or if there be no such physician, or if such physician 
 
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be absent, of the owner, lessee, occupant, or other person having 
 charge of the said apartments or premises, to notify the health offi- 
 cer of said city, town or village, of said death or removal within 
 twenty-four hours thereafter, and such apartments or premises so 
 vacated shall not again be occupied until duly disinfected, cleansed 
 or renovated as hereinafter provided. 
 
 § 324. Health officer to direct disinfection, cleansing or reno- H _ t0 TiBit 
 vation. When notified of the vacation of any apartments or ch. m n'' nfg." 
 premises as provided in section three hundred and twenty-three f.'iiT' C ° i& ' 
 thereof, the local health officer or one of his assistants or deputies, 
 shall within twenty-four hours thereafter visit said apartments or 
 premises and shall order and direct that, except for purposes of 
 cleansing and disinfection, no infected article shall be removed Emulations* 1 
 therefrom until properly and suitably cleansed or disinfected, and mfMe'ctLn. 
 all apartments or premises shall be disinfected, cleansed or reno- P ' 
 vated in order that they may be rendered safe and suitable for 
 occupancy as prescribed by the sanitary code. If the health 
 authorities determine that disinfection is sufficient to render them Disinfection 
 safe and suitable for occupancy, such aipartments or premises expeme!" 
 together with all infected articles therein, shall immediately be 
 disinfected by the health authorities at public expense, or pro- 
 vided, however, that in any locality which in the judgment of the 
 state commissioner of health may be considered a Tesort for per- 
 
 d - 1 Except in 
 
 sons having tuberculosis, such disinfection may in the discretion resort f ? r . 
 
 *-^ ' ^ persons having 
 
 of the health authorities be done by such health authorities at the tu b « r <"d<>sis. 
 expense of the owner of the premises. Should the health authori- 
 ties determine that such apartments or premises are in need of 
 thorough cleansing and renovation, a notice in writing to this 
 effect shall be served upon the owner or agent of said apartments cleansing and 
 or premises, and said owner or agent shall thereupon proceed to 
 the cleansing or renovating of such apartments or premises in 
 •accordance with the instructions of the health authorities, .and 
 such cleansing and renovation shall be done at the expense of said 
 owner or agent. The public health council shall include in the 
 sanitary code regulations defining the methods and precautions to 
 be observed in disinfecting, cleansing, or renovating premises ° wn " or 
 under the provisions of this section. In any case in which the ^-^'san^ 
 owner is liable for the expense of such disinfection, cleansing or £$ e * pp ' 41 " 
 
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renovation by or pursuant to the provisions of this section, such 
 expense if not paid shall be a first lien upon such property, real or 
 Expense lien personal, so disinfected, cleansed or renovated, having preference 
 •o.pon property. oyej , aU Qthej , Hens and i ncum brances whatever. If the lien is 
 against real property, it may be foreclosed in the manner pre- 
 scribed in section thirty-two of the public health law; if the lien 
 is against personal property it may be foreclosed in the manner 
 prescribed in sections two hundred and six to two hundred and 
 nine, inclusive, of the lien law. (Am'd by L. 1909, ch. 2-iO ; L. 
 1910, ch. 427 and L. 1913, ch. 559, in effect May 16, 1913.) 
 occupancy of § 325. Prohibiting occupancy until order of health officer is 
 ST' (s"e complied with. In case the orders or directions of the local 
 
 Ch. II, Reg. . ,,..„. , . ,- e 
 
 49, san. code, health officer requiring the disinfection, cleansing or renovation ot 
 any apartments or premises or any articles therein as hereinbefore 
 provided, shall not be complied with within forty-eight hours after 
 such orders or directions shall be given, the health officer may cause 
 a placard in words and form substantially as follows to be placed 
 upon the door of the infected apartments or premises: 
 
 Notice to be " Tuberculosis is a communicable disease. These apartments 
 have been occupied by a consumptive and may be infected. They 
 must not be occupied until the order of the health officer directing 
 their disinfection or renovation has been complied with. This 
 notice must not be removed under penalty of the law except by the 
 health officer or other duly authorized official." 
 
 tunt le d S eci P area § 326. Prohibiting carelessness of a person having tuber- 
 
 o? a e nu?san 7 ce. culosis. Any person having tuberculosis who shall dispose of his 
 sputum, saliva or other bodily secretion or excretion so as to cause 
 offense or danger to any person or persons occupying the same room 
 
 complaint or apartment, house or part of a house, shall on complaint of any 
 
 to H. O. _ . n 1 ~ J 
 
 person or persons subjected to such ottense or danger, be deemed 
 
 guilty of a nuisance and any persons subjected to such a nuisance 
 
 may make complaint in person or writing to the health officer of 
 
 and"^?™ any city, town, or village where the nuisance complained of is 
 
 notice. committed. And it shall be the duty of the local health officer 
 
 receiving such complaint to investigate and if it appears that the 
 
 nuisance complained of is such as to cause offense or danger to 
 
 fa e iiuJe y to° r any person occupying the same room, apartment, house or part of 
 
 «der ly f H* h o. a house, he shall serve a notice upon the person so complained of 
 
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reciting the alleged cause of offense or danger and requiring him 
 to dispose of his sputum, saliva or other bodily secretion or excre- 
 tion in such a manner as to remove all reasonable cause of offense 
 or danger. Any person failing or refusing to comply with orders 
 or regulations of the local health officer of any city, town or village, 
 requiring him to cease to commit such nuisance, shall be deemed 
 guilty of a misdemeanor and on conviction thereof shall be fined 
 not more than ten dollars. 
 
 § 326-a. Control of dangerous and careless patients. When- H° m o ai re ard- 
 ever a complaint shall be . made by a physician to a health officer ™f 'i r 6 i i" s 1 s er 
 that any person is afflicted with an infectious, contagious or com- pa 16n ' 
 municable disease or is a carrier of typhoid fever, tuberculosis, 
 diphtheria or other infectious disease and is unable or unwilling to 
 conduct himself and to live in such a manner as not to expose 
 members of his family or household or other persons with whom 
 he may be associated to danger of infection, the health officer shall 
 forthwith investigate the circumstances alleged. If he shall find hTo."" 
 that any such person is a menace to others, he shall lodge a com- 
 plaint against such person with a magistrate, and on such com- 
 plaint the said person shall be brought before such magistrate. 
 The magistrate after due notice and a hearing, if satisfied that the ty magistrate, 
 complaint of the health officer is well founded and that the person 
 is a source of danger to others, may commit him to a county hos- 
 pital for tuberculosis or to any other hospital or institution estab- 
 lished for the care of persons suffering from any such disease or 
 maintaining a room, ward or wards for such persons. Such person 
 shall be deemed to be committed until discharged in the manner 
 authorized in this section. In making such commitment the magis- cabana 
 trate shall make such order for payment for the care and mainte- 
 nance of such person as he may deem proper. The chief medical Discharge ly 
 officer of the hospital or other institution to which any such person ^cer. medica! 
 has been committed, upon signing and placing among the perma- 
 nent records of such hospital or institution a statement to the effect 
 that such person has obeyed the rules and regulations of such hos- 
 pital or institution for a period of not less than sixty days, and that 
 "in his judgment such person may be discharged witriout danger to 
 the health or life of others, or for any other reason stated in full 
 which he may deem adequate and sufficient, may discharge the per- 
 
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neport to son so committed. He shall report each such discharge together 
 wa' of "man- w ith a full statement of the reasons therefor at once to the health 
 patent "dis" officer of the city, village or town from which the patient came and 
 at the next meeting of the board of managers or other controlling 
 authority of such hospital or institution. Every person committed 
 under the provisions of this section shall observe all the rules and 
 regulations of such hospital or institution. Any patient so com- 
 mitted who neglects or refuses to obey the rules or regulations of 
 the institution may by direction of the chief medical officer of the 
 institution be placed apart from the other patients and restrained 
 complaint ty from leaving the institution. Any such patient who wilfully vio- 
 offlclr ™o dKial 'lates the rules and regulations of the institution or repeatedly con- 
 disorferV " ducts himself in a disorderly manner may be taken before a magis- 
 patient. trate by the order of the chief medical officer of the institution, 
 
 The chief medical officer may enter a complaint against such per- 
 fo™dx moilt son for disorderly conduct and the magistrate, after a hearing and 
 disorderly 01 upon due evidence of such disorderly conduct, may commit such 
 person for a period not to exceed six months to any institution to 
 which persons convicted of disorderly conduct or vagrancy or of 
 being tramps may be committed, and such institution shall keep 
 such person separate and apart from the other inmates, provided 
 that nothing in this section shall be construed to prohibit any per- 
 son committed to any institution under its provisions from appeal- 
 ap'peai." ing to any court having jurisdiction, for a review of the evidence 
 
 on which commitment was made. (Added by L. 1913, ch. 559, in 
 effect May 16, 1913.) 
 Duty of h. o. § 327. Protection of patient's family. It shall be the dutv 
 physician is inof a physician attending a patient having tuberculosis to take all 
 
 attendance or . . 
 
 fails to per- proper precautions and to give proper instructions to provide for 
 the safety of all individuals occupying the same house or apart- 
 ment, and if no physician be attending such patient this duty shall 
 devolve upon the local health officer, and all duties imposed upon 
 physicians by any sections of this article shall be performed by the 
 local health officer in all cases of tuberculosis not attended by a 
 physician, or when the physician fails to perform the duties herein 
 specified, and shall so report. 
 S fur " § 328. Providing that physicians shall make a complete state- 
 
 physWans t>y ment of procedure and precautions on a blank to be furnished 
 
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9 
 
 by the health officer. It shall be the duty of the local health 
 officer to transmit to a physician reporting a case of tuberculosis 
 as provided in section three hundred and twenty, a printed state- 
 ment and report, in a form approved by the state commissioner of 
 health, naming such procedure and precautions as in the opinion 
 of the said commissioner are necessary or desirable to be taken on 
 the premises of a tuberculosis patient. The state department of *lj£** j™~ 
 health shall print an ample supply of such statements and reports Department, 
 and furnish the same in sufficient numbers to health officers for 
 all physicians. Upon receipt of such statement and report the 
 physician shall either carry into effect all such procedure and pre- 
 cautions as are therein prescribed, and shall thereupon sign and zi u sij ,. an 
 date the same and return it to the local health officer without delay, ^"flr^rase 
 or, if such attending physician be unwilling or unable to carry into £pon health 
 effect the procedures and precautions specified, he shall so state receives^ee. 
 upon this report and immediately return the same to the local 
 health officer and the duties therein prescribed shall thereupon 
 devolve upon said local health officer who shall receive the fee here- 
 inafter provided as payment of the services of the physician if he 
 comply with the duties herein prescribed. Upon the receipt of 
 this statement and report the local health officer shall carefully 
 examine the same, and if satisfied that the attending physician 
 has taken all necessary and desirable precautions to insure the F . ee for , v b * si - 
 
 <J *■ cian unless 
 
 safety of all persons living in the apartments or premises occupied ^£. ed 
 by the persons having tuberculosis, the said local health officer 
 shall issue an order upon the treasurer of the city, town or village 
 in favor of the attending physician, except where such physician 
 is employed by and receives a salary from the state of New York, 
 or is employed by and receives a salary from a hospital, sana- 
 torium, or other similar private or public institution in the state 
 of ISTew York, for the sum of one dollar thereupon to be paid out 
 of a fund which shall be provided by said city, town or village. 
 But no such payment shall be made to any physician for reporting 
 cases of tuberculosis elsewhere than in the city, town or village 
 where such patient resides. If the precaution taken or instructions require aaai- 
 
 ,.. ... .. „,..., tional precau- 
 
 given by the attending physician are, m the opinion of the local *». 
 health officer, not such as will remove all reasonable danger or 
 probability of danger to the persons occupying the said house or 
 apartments or premises, the local health officer shall return to the 
 
 Digitized by Microsoft® 
 
IT 
 
 nurse. 
 
 10 
 
 attending physician the report with a letter specifying the addi- 
 tional precautions or instructions which the health officer shall 
 require him to take or give ; and the said attending physician shall 
 mmediately take the additional precautions and give the addi- 
 tional instructions specified and shall record and return the same 
 visits by pub- on the original report to the local health officer. A health officer 
 shall have authority to cause all reported cases of tuberculosis 
 within his jurisdiction to be visited from time to time by a public 
 health nurse. In every case in which a physician reporting the 
 case has elected to carry into effect the procedure and precautions 
 Nurse under required by this section, the public health nurse shall act under 
 phyYilian . 11 ° the direction and supervision of the physician. It shall further be 
 the duty of the health officer to transmit to the physician reporting 
 any case of tuberculosis a printed requisition, to be supplied by 
 the state commissioner of health, and issued in sufficient number 
 Requisition to health officers to supply physicians. Upon this requisition blank 
 supplies. shall be named the materials kept on hand by the local health officer 
 
 for the prevention of the spread of tuberculosis and it shall be the 
 duty of the local health officer to supply such materials as may be 
 specified in such requisition. Any physician may return a duly 
 h. o. to fur- signed requisition to the local health officer for such of the specified 
 
 nish materials , • n -i ■ i , i t , • -i -t • 
 
 to physicians, materials and m sucn amount as he may deem necessary to aid him 
 in preventing the spread of the disease, and all local health officers 
 shall honor, as far as possible, the requisition signed by the attend- 
 ing physician in such case. It shall be the duty of every local 
 h, o. to fur- health officer to transmit to every physician reporting any case of 
 "" information tuberculosis, or to the person reported as suffering from this dis- 
 bercuiosis. ease, provided the latter has no attending physician, a circular of 
 information approved by the state commissioner of health and 
 which shall be provided in sufficient quantity by the local health 
 authorities. This circular of information shall inform the con- 
 sumptive of the best methods of treatment of his disease and of the 
 precautions necessary to avoid transmitting the disease to others. 
 (Am'd by L. 1909, ch. 426 ; L. 1911, ch. 490, and L. 1913, ch 559* 
 in effect May 16, 1913.) 
 
 fa e i°e state- § 329. Penalty for failure of physician to perform duties 
 
 marts n-> ra. v»*3 
 
 ments or re- 
 
 or 
 
 ports. for making false reports. Any physician or person practicing 
 
 as a physician who shall wilfully make any false statement com 
 
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11 
 
 cerning the name, age, sex, color, occupation, place where last 
 employed if known, or address of any person reported as affected 
 with tuberculosis, or who shall certify falsely as to any of the pre- 
 cautions taken to prevent the spread of infection, shall be deemed 
 guilty of a misdemeanor, and on conviction thereof shall be sub- 
 ject to a fine of not more than one hundred dollars. (Am'd by L. 
 1913, ch. 559, in effect May 16, 1913.) 
 
 § 330. Reporting recovery of patient. Upon the recovery of Recovery of 
 
 i i i c n tuberculosis 
 
 any person having tuberculosis, it shall be the duty of the attend- patient to be 
 ing physician to make a report of this fact to the local health officer, H ' o. 
 who shall record the same in the records of his office, and shall 
 relieve said person from further liability to any requirements. 
 imposed by this article. 
 
 § 331. General penalty. Any person violating any of the pro- Penalty for 
 visions of sections three hundred and twenty to three hundred and 
 thirty, both inclusive, of this article, shall be deemed guilty of a 
 misdemeanor and upon conviction thereof shall be punished, 
 except as in this article otherwise provided, by a fine of not less 
 than five dollars nor more than fifty dollars. 
 
 § 332. Application of provisions. No portion of section three 
 hundred and twenty to three hundred and thirty-one, both inclu- ^ty, 
 sive, shall apply to the city of New York, nor shall the passage of 
 said sections modify or repeal any of the provisions of the charter 
 of the city of New York, or any rule or regulation issued by the 
 department of health of said New York city. (Am'd by L. 1909, 
 ch. 240, in effect April 22, 1909.) 
 
 Conditions in Tenement Houses 
 § 13. Tenement houses in cities. The commissioner shall have Housing. 
 power to examine into the enforcement of the laws relating to 
 tenement houses in any city. Whenever required by the governor, 
 he shall make such an examination and shall report the results 
 thereof to the governor within the time prescribed by him there- 
 for. (Am'd by L. 1913, ch. 559, in effect May 16, 1913.) 
 
 Exception of 
 New York 
 
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12 
 
 STATE CHARITIES LAW 
 Article X 
 New York State Hospital for the Treatment of Incipient Pul- 
 monary Tuberculosis 
 
 Course of instruction for county hospital superintendents 
 
 § 157. Duties of superintendent. The superintendent shall, 
 ******** *" 
 
 10. Give to superintendents of county tuberculosis hospitals- 
 courses for courses in the diagnosis and treatment of tuberculosis and in hos- 
 
 superintend- 1 - , . ,. -i 
 
 ents of county p ital administration. The board and lodging oi such supenn- 
 
 tuberculosis x 1 , 
 
 hospitals. tendents of county hospitals, while actually in attendance at such 
 courses, shall be charged as an expense of conducting said hos- 
 pital." (Am'd by L. 1917, ch. 241, in effect April 23, 1917.) 
 
 Admission of Patients 
 § 160. Free patients. The trustees of said hospital to be 
 
 Free patients, appointed under and pursuant to the provisions of this article,, 
 and their successors, are hereby given power and authority to 
 receive therein patients who have no ability to pay, but no person 
 shall he admitted to the hospital who has not been a citizen of 
 this state for at least one year, excepting that a female who has- 
 been a resident of the state for at least five years preceding the 
 date of the application may be so admitted, though not a citizen. 
 
 Application to Every person desiring free treatment in said hospital shall apply 
 to the health officer of his or her village, town, city or county who 
 f-hnll thereupon issue a written request to the superintendent of 
 said hospital for the admission and treatment of such person, 
 which request and statement shall be kept on file by the super- 
 intendent of the hospital. Such requests shall be filed by the 
 superintendent in a book kept for that purpose in the order of 
 
 H. 
 
 notify poor 
 
 fy poor their recei P t ^ him - Tbe h^b officer shall notify the local 
 authorities. authorities of the town, city or county in which the person desir- 
 ing free treatment resides, having charge of the relief of the poor 
 of every request issued to the superintendent of the said hospital 
 
 * See subdivision 10 of section 48 of County Law, p. 26, making traveling 
 expenses of superintendent in attending such course a countv charcre " 
 
 f See application blank, p. 72. J b ' 
 
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13 
 
 in accordance with the provisions of this section. The said local 
 authorities of the poor may make such investigation as they deem 
 proper as to the ability of said person to pay for treatment, and 
 if said person has already been transferred to said hospital at 
 Haybrook the superintendent of said hospital shall co-operate and 
 assist the said local authorities in obtaining such information. 
 Provided, however, nothing herein contained shall be construed to 
 •delay the immediate forwarding of said person to the said hospital 
 whenever there are facilities there for his reception. Whenever 
 there are vacancies caused by death or removal, the said super- 
 intendent shall thereupon issue a request to an examining physi- 
 cian, appointed as provided for in section one hundred and fifty- 
 nine, in the same city or county, and if there be no such examining 
 physician in said city or county then to the nearest examining 
 physician, for the examination by him of said patient. Upon the ^"^j?^^ 
 Tequest of such superintendent said examining physician shall 
 •examine all persons applying for free admission and treatment 
 in said institution, and determine whether such persons applying 
 are suffering from incipient pulmonary tuberculosis. No person 
 .shall be admitted as a patient in said institution without the 
 certificate of one of said examining physicians certifying that such 
 applicant is suffering from incipient pulmonary tuberculosis,, and 
 if upon the reception of a person at such hospital, it is found by 
 the authorities thereof that he is not suffering from, incipient 
 pulmonary tuberculosis, or is suffering from pulmonary tuber- 
 culosis in such an advanced stage as to prevent his deriving any 
 "benefit from care and treatment at such hospital, he shall be 
 Teturned to the place of his residence, and the expense of trans- 
 portation to and from the hospital shall be paid by said local 
 authorities. Admissions to said hospital shall be made in the 
 ordeT in which the names of applicants shall appear upon the 
 application book to be kept as above provided by the superintend- 
 ent of said hospital, insofar asi such applicants are subsequently 
 certified by the said examining physician to be suffering from 
 incipient pulmonary tuberculosis. Every person who is declared 
 as herein provided to be unable to pay for his or her care or treat- 
 ment shall be transported to and from the hospital at the expense 
 •of said local authorities, and cared for, treated and maintained 
 "therein at the expense of the municipality which would otherwise 
 
 Digitized by Microsoft® 
 
14 
 
 be chargeable with the support of such poor or indigent person ; 
 and the expense of transportation, treatment, maintenance and the 
 actual cost of articles of clothing furnished by the hospital to such 
 poor or indigent person shall be a county, city or town charge, 
 as the case may be. (Am'd L. 1917, ch. 241, in effect April 23, 
 1917.) 
 
 patTmts § 1^1. Private patients. Applicants for admission to this insti- 
 
 tution who are able to pay for their care and treatment are not 
 required to obtain a written request from the local authorities 
 having charge of the relief of the poor, but shall apply in person 
 to the superintendent, who shall enter the name of such applicant 
 in a book to be kept by him, for that purpose, as provided in sec- 
 tion one hundred and sixty ; and when there is room in said hos- 
 pital for the admission of such applicant, without interfering with 
 the preference in the selection of patients, which shall always be 
 given to the indigent, such patient shall be admitted to the hospital 
 upon the certificate of one of the examining physicians, which 
 certificate shall be kept on file by the said superintendent. 
 
 fwe P °j£tunts. § 162 - Su PP° rt of free Patients. At least once in each month 
 the superintendent of the hospital shall furnish to the comptroller 
 and to the local authorities of each county, city or town, as the 
 case may be, having charge of the relief of the poor, a list of all 
 the free patients in the hospital that are accredited each respective 
 county, city or town and who are shown by the statement of such 
 local authorities to be unable to pay for their care, treatment and 
 maintenance, under the provisions of section one hundred and 
 sixty of this chapter. He shall accompany each such list with a 
 bill of charges for care, treatment and maintenance at a rate not 
 exceeding five dollars per week for each such free patient, together 
 with items of expense of transportation, fee of the examining phy- 
 sician and the actual cost of articles of clothing furnished by the 
 hospital to each such free patient. The treasurer of the hospital 
 shall thereupon collect from the said local authorities of the county, 
 city and town such sums as may be due therefrom, and pay the 
 same over to the state treasurer. (Amended by L. 1910, ch. 449 ) 
 
 support „ f § 163. Support of private patients. The trustees 'shall have 
 
 power and authority to fix the charges to be paid by patients who 
 are able to pay for their care and treatment in said hospital or 
 who have relatives bound by law to support them, who are able 
 to pay therefor. 
 
 Digitized by Microsoft® 
 
 patients. 
 
15 
 
 COUNTY TUBERCULOSIS HOSPITALS, ESTABLISH- 
 MENT, MANAGEMENT, ADMISSION OF PATIENTS, 
 MAINTENANCE OF PATIENTS, ETC. 
 
 County Law, Sections 12, and 45 to 49-e, inc. 
 
 Establishment 
 
 § 45. The board of supervisors of every county in the state ?f county 
 
 A d J tuberculosis 
 
 containing a population of thirty-five thousand or more, as deter- J}°*£j.^'j n 
 mined by the latest state census, shall establish, as hereinafter 36 ' 00<) or Ino^e • 
 provided, a county hospital for the. care and treatment of persons 
 suffering from the disease known as tuberculosis, unless there 
 already exists in such county a hospital or institution provided by 
 the county or other authority and caring for persons suffering 
 from tuberculosis, which is approved by the state commissioner of 
 health, or the board of supervisors of such county except in a contract with 
 
 .... . 1 adjoining 
 
 county wherein a site for such hospital has been approved by the county or 
 
 " J- a. x u private sana- 
 
 state commissioner of health prior to the taking effect of this act, ^Jj™ n " ^° in 
 shall have entered into a contract prior to November first, nine- more countl6S ' 
 teen hundred and nineteen, for the care of its tuberculosis patients 
 with an adjoining county having such county hospital or with a 
 private sanatorium within its county or shall join prior to Novem- 
 ber first, nineteen hundred and nineteen, with one or more other 
 counties in the establishment and maintenance of such county hos- 
 pital as hereinafter provided. Such county hospital, except a hos- 
 pital established and maintained by two or more counties, shall be 
 available for patients on or before the first day of July, nineteen 
 hundred and eighteen. If the board of supervisors of any such by state com- 
 
 '1 c ^ i missioner of 
 
 county shall have failed to secure a site for a county tuberculosis health. 
 ' hospital, and to have awarded contracts for the erection of suitable 
 buildings thereon by the first day of January, nineteen hundred 
 and eighteen, it shall be the duty of the state commissioner of 
 health forthwith to proceed to locate, construct and place in 
 operation a tuberculosis hospital in and for such county, the 
 capacity of which shall not exceed the average number of deaths 
 per annum from tuberculosis in such county during the past five 
 years. For such purposes the state commissioner of health shall 
 possess, and it shall be his duty to exercise all the powers which 
 would have been possessed by the board of supervisors of such 
 county, had such hospital been established and placed in operation 
 by the board of supervisors thereof. All expenditures incurred Expenditures. 
 by the state commissioner of health for and in connection with 
 
 Digitized by Microsoft® 
 
1G 
 
 Board of 
 
 managers. 
 
 the location, construction and operation of such hospital, shall 
 be a charge upon the county, and provision shall be made for 
 the payment therefor by the board of supervisors of such county 
 in the same manner as in the case of other charges against the 
 county. At any time after such hospital has been in operation, 
 the board of supervisors in such county may appoint a board of 
 managers for such hospital, pursuant to the provisions of this act 
 and thirty days after the appointment of such board of managers 
 by such board of supervisors, such hospital shall be transferred 
 to such board of managers, and such board of managers shall 
 thereafter possess and exercise all the powers of the board of 
 managers of a county hospital for tuberculosis under this act, 
 and the state commissioner of health shall be relieved from any 
 responsibility therefor except such responsibility as he exercises 
 in regard to all county tuberculosis hospitals under the provisions 
 
 •Two or more of thlS act. 
 hospitals. 
 
 When deemed advisable by the board of supervisors and 
 
 approved by the state commissioner of health, any such county 
 
 Establishment may maintain more than one county hospital for the care and 
 
 less than " treatment of persons' suffering from tuberculosis. The board of 
 
 35,000. . 
 
 supervisors of any other county shall have power by a majority 
 vote to establish a county hospital for the care and treatment of 
 persons suffering from the disease known as tuberculosis; or it 
 Referendum, may submit the question of establishing such a hospital to the 
 voters of the county at any general election, and in any county 
 in which town meetings at which all the voters of the county may 
 vote are held in the spring of the year, the board of supervisors 
 of such a county shall have authority also to submit the qiiestion 
 of establishing such a hospital at said town meetings to the elec- 
 tors of the county who are qualified to vote at a general election. 
 The board of supervisors shall fix the sum of money deemed nec- 
 essary for the establishment of said hospital. The form of the 
 proposition submitted shall read as follows: " Shall the county 
 
 of appropriate the sum of 
 
 dollars for the establishment of a tuberculosis hospital V The 
 clerk of the board of supervisors, immediately upon the adoption 
 of such resolution, shall forward to the duly constituted election 
 authorities of the county a certified copy of said resolution provid- 
 ing for the submission of the proposition. The election notices 
 
 Digitized by Microsoft® 
 
17 
 
 shall state that the proposition will be voted upon and in the form 
 
 set forth above. Such proposition shall be submitted on a distinct Proposition 
 
 submitted 
 
 and separate ballot without any other question being printed £" U ot Parate 
 thereon, any general or special law to the contrary notwithstand- 
 ing. Provision for taking such vote and for the canvassing and 
 Teturning of the result shall be made by the duly constituted elec- 
 tion authorities. 
 
 If a majority of the voters voting on such proposition shall 
 vote in favor thereof then such hospital shall be established here- 
 under and the sum of money named in the said proposition shall 
 he deemed appropriated, and it shall be the duty of the board of 
 supervisors to proceed forthwith to exercise the powers and author- 
 ity conferred upon it in this section. 
 
 When the board of supervisors of any county shall have voted 
 to establish such hospital, or when a referendum on the proposi- 
 tion of establishing such a hospital in a county, as authorized 
 •above, shall have been carried, the board of supervisors shall : 
 
 1. Purchase or lease real property therefor, or acquire such f££etty. m ° f 
 real property, and easements therein, by condemnation proceed- 
 ings, in the manner prescribed by the condemnation law, in any 
 town, city or village in the county. After the presentation of the 
 petition in such proceeding prescribed in section three thousand 
 three hundred and sixty of the code of civil procedure and the 
 filing of the notice of pendency of action prescribed in section 
 three thousand three hundred and eighty-one thereof, said board 
 of supervisors shall be and become seized of the whole or such 
 part of the real property described in said petition to be so 
 acquired for carrying into effect the provisions of this act, as such 
 board may, by resolution adopted at a regular or special session, 
 ■determine to be necessary for the immediate use, and such board 
 for and in the name of such county may enter upon, occupy and 
 use such real property so described and required for such pur- 
 poses. Such resolution shall contain a description of the real 
 property of which possession is to be taken and the day upon 
 which possession will be taken. Said board of supervisors shall 
 •cause a copy of such resolution to be filed in the county clerk's 
 office of the county in which such property is situate, and notice 
 of the adoption thereof, with a copy of the resolution and of its 
 
 Digitized by Microsoft® 
 
IS 
 
 Erection of 
 
 buildings, 
 
 Approval by 
 state coni- 
 .missioner of 
 health of 
 buildings and 
 equipment.* 
 
 Borrowing 
 money. 
 
 intention to take possession of the premises therein described on 
 a day certain, also therein named, to be served, either personally 
 or by mail, upon the owner or owners of, and persons interested 
 in such real property, at least five days prior to the day fixed in 
 such resolution for taking possession. From the time of the serv- 
 ice of such notice, the entry upon and appropriation by the county 
 of the real property therein described for the purposes provided 
 for by this act, shall be deemed complete, and such notice so served 
 shall be conclusive evidence of such entry and appropriation and 
 of the quantity and boundaries of the 'lands appropriated. The 
 board of supervisors may cause a duplicate copy of such papers 
 so served, with an affidavit of due service thereof on such owner 
 or person interested, to be recorded in the books used for record- 
 ing deeds in the office of the county clerk of its county, and the 
 record of such notice and such proof of service shall be prima 
 facie evidence of the due service thereof. Compensation for prop- 
 erty thus acquired shall be made in such condemnation proceeding. 
 
 2. Erect all necessary buildings and alter any buildings on the 
 property when acquired for the use of said hospital, provided that 
 the location of the buildings and the plans and such part of the 
 specifications as shall be required by the state oommissioner of 
 health for such erection or alteration together with the initial 
 equipment shall first be approved by the state commissioner of 
 health. Any changes in such location or plans shall also be first 
 approved by the state commissioner of health and the state com- 
 missioner of health and his duly authorized representatives shall 
 have the power to inspect such county hospitals during the course 
 of their construction for the purpose of seeing that such plaus are 
 complied with. (Am'd by L. 1913, ch. 379 and L. 19 IT, ch. 469, 
 in effect May 15, 1917.) 
 
 3. Cause to be assessed, levied and collected such sums of 
 money as it shall deem necessary for suitable lands, buildings and 
 improvements for said hospital, and for the maintenance thereof, 
 and for all other necessary expenditures therefor; and to borrow 
 money for the erection of such hospital and for the purchase of a 
 site therefor on the credit of the county, and issue county obliga- 
 tions therefor, in such manner as it may do for other county pur- 
 poses. 
 
 * See also County Law, § 48, p. 24, and Prison Law, § 182, p. 36 
 
 Digitized by Microsoft® 
 
19 
 
 4. Appoint a board of managers for said hospital as hereinafter ^ r a d e ° r f s 
 provided. 
 
 5. Accept and hold in trust for the county, any grant or devise H ° ldin s 
 
 x j ; j o property. 
 
 of land, or any gift or bequest of money or other personal prop- 
 erty, or any donation to be applied, principal or income, or both, 
 for the benefit of said hospital, and apply the same in accordance 
 with the terms of the gift. 
 
 6. Whenever it shall deem it in the public interest so to do, and {^"f^ of 
 notwithstanding the provisions of any other general or special act, 
 change the location of such hospital and acquire a new site by 
 purchase, lease or condemnation, as provided in this section, and 
 establish the hospital thereon. The board of supervisors of any 
 county of the state, including a county in which the provisions 
 
 of this chapter are not mandatory, subject to the approval of the 
 Btate commissioner of health, may enter into a contract prior to 
 November first, nineteen hundred and nineteen, for the care of 
 its tuberculosis patients with the board of supervisors of an adjoin- 
 ing county having such county hospital or with a private sana- 
 torium within its county, or may, subject to like approval, jointly ^V"* wi& 
 with the boards of supervisors of one or more other adjoining °°™^f s * m . 
 counties, establish prior to November first, nineteen hundred and '°"" t y, '"/ )™il 
 nineteen, and thereafter maintain such county hospital. In the bounty n °n ther 
 establishment and maintenance of such joint county hospital, hospital, 
 the boards of supervisors so uniting, in accordance with such rules 
 and regulations as may be prescribed by the state commissioner of 
 health, shall have jointly, except as provided in this section, all 
 the power and authority conferred and obligations imposed upon 
 boards of supervisors by this chapter for the establishment and 
 maintenance of such county hospital in a single county and, for 
 that purpose, each board of supervisors in such county shall 
 appoint severally three of its members, who collectively shall be a 
 commission, to select a site for such joint county hospital in any f ° r m ™\Vction 
 town, city or village in one of such counties and, when the neces- °J^f tSpitat- 
 sary real property so selected by such commission shall have been 
 acquired, purchased or leased as herein provided, to erect all 
 necessary buildings, and alter any buildings, on such property for 
 the use of such joint hospital. Such commission shall have all 
 the powers and duties conferred or imposed upon boards of super- 
 
 Digitized by Microsoft® 
 
20 
 
 Nnrse for 
 each county. 
 
 visors by sections forty-live to forty-nine inclusive of this chapter, 
 except as in this section expressly otherwise provided. Every such 
 joint county hospital shall be completed and ready for occupancy 
 prior to November first, nineteen hundred and twenty. When 
 completed, each board of supervisors in such counties shall appoint 
 severally three citizens of its county, of whom at least one shall 
 Board of be a practicing physician, who collectively shall constitute a board 
 joint hospital, of managers of such joint county hospital and shall exercise the 
 functions and powers granted and be subject, so far as practicable, 
 to the provisions of this chapter applicable to boards of man- 
 agers of a county hospital established under this chapter in a 
 single county and said board of managers shall appoint at least 
 one nurse in each county for the discovery, visitation and care of 
 persons affected with tuberculosis and may appoint such addi- 
 tional nurse or nurses as it may deem necessary. The representa- 
 tion and voting power of each manager in such joint board shall 
 be upon the basis and at the rate of on« vote for each one thou- 
 sand and major fraction of the population of the county from 
 which such manager shall be chosen as determined by the latest 
 state census.. The superintendent appointed by such board shall 
 have the powers and perform the duties which are prescribed in 
 this chapter for superintendents of hospitals in a single county 
 and the other employees of such board shall perform such duties 
 as the board shall prescribe. The expense of the establishment 
 and maintenance of a joint county hospital as herein provided 
 shall be paid by such counties in proportion to the assessed value 
 of the taxable property of each such county as it appears by the 
 assessment rolls of such eounties on the last assessment for state 
 or county taxes prior to the incurring of such expense and the 
 board of supervisors of each county so combining, is hereby 
 authorized to borrow money to defray its share, estimated as 
 herein provided, for the erection of such hospital and for the 
 purchase of a sit© therefor on the credit of the county and issue 
 county obligations therefor in such manner as it may do for other 
 county purposes. All provisions of sections forty-five to forty- 
 nine inclusive of this chapter not in conflict with the provisions 
 of this section shall apply to sueh joint hospital, its establishment 
 maintenance and operation, except that for the purpose of the" 
 
 Expense. 
 
 Borrowing 
 money. 
 
 Digitized by Microsoft® 
 
21 
 
 admission of patients to such hospital each of the counties so com- 
 bining shall be considered the county in which the hospital is 
 situated. (Added by L. 1915, eh, 427; am'd by L. 1918, ch. 268, 
 iu effect April 19, 1918.) 
 
 (Section added by L. 1909, oh. 341; ami'd by L. 1913, chs. 166, 379; L. 
 1914, ch. 323; L. 1915, chs. 132, 427; L. 1917, ch. 469 and L. 191S, ch. 268, 
 and L. 1919, ch^57, in effect March 13, 1919.) 
 
 § 2. The amendments made by this act shall not apply to 
 counties in which a site for a tuberculosis hospital has been 
 selected by any county and a petition for the approval of such 
 site has been presented to the state board of health pursuant to the 
 provisions of this chapter. 
 
 § 46. Appointment and terms of office of managers. When 
 the board of supervisors shall have determined to establish a hos- 
 pital for the care and treatment of persons suffering from tuber- 
 culosis, and shall have acquired a site therefor, and shall have 
 awarded contracts for the necessary buildings and improvements 
 thereon, it shall appoint five citizens of the county, of whom at 
 least two shall be practicing physicians, who shall constitute a 
 board of managers of the said hospital. The term of office of each manages, 
 member of said board shall be five years, and the term of one of 
 such managers shall expire annually; the first .appointments shall 
 be made for the respective terms of five, four, three, two and one 
 years. Appointments of successors shall be for the full term 
 of five years, except that appointment of persons to fill vacancies 
 occurring by death, resignation or other cause shall be made for 
 the unexpired term. Failure of any manager to attend three con- 
 secutive meetings of the board shall cause a vacancy in his office, 
 unless said absence is excused by formal action of the board of 
 managers. The managers shall receive no compensation for their 
 services, but shall be allowed their actual .and necessary traveling 
 and other expenses, to be audited and paid, in the same manner as 
 the other expenses of the hospital by the board of supervisors. 
 Any manager may at any time be removed from office by the board manner. ° £ 
 of supervisors of the county, for cause after an opportunity to be 
 heard. (Added by L. 1909, ch. 341, in effect May 13, 1909.) 
 
 § 47. General powers and duties of managers. The board 
 of managers : 1. Shall elect from among its members, a president 
 
 ° D . Superintendent 
 
 and one or more vice-presidents. It shall appoint a superintendent of iu»pitai. 
 
 Digitized by Microsoft® 
 
22 
 
 Removal or 
 
 suspension. 
 
 ■Qualifications. 
 
 Salaries. 
 
 B.uies and 
 regulations. 
 
 Inspections. 
 
 Meetings . 
 
 Annual 
 meeting. 
 
 Uecord of 
 iprucee dings. 
 
 Certify 
 accounts to 
 board of 
 supervisors. 
 
 of the hospital who shall be also the treasurer and secretary of 
 the board, and it may remove him for cause stated in writing and 
 after an opportunity to be heard thereon after due notice; and 
 may suspend him from duty pending the disposition of such 
 charges. Said superintendent shall not be a member of the board 
 of managers, and, except in the county of Monroe, shall be a 
 graduate of an incorporated medical college, with an experience 
 of at least three years in the actual practice of his profession. 
 (Am'd by L. 1915, ch. 132, and L. 1917, ch. 701, in effect June 1, 
 1917.) 
 
 2. Shall fix the salaries of the superintendent and all other 
 officers and employees within the limits of the appropraition 
 made therefor by the board of supervisors, and such salaries shall 
 be compensation in full for all services rendered. The board of 
 managers shall determine the amount of time required to be spent 
 at the hospital by said superintendent in the discharge of his 
 duties. 
 
 3. Shall have the general superintendence, management arid 
 control of the said hospital, of the grounds, buildings, officers 
 and employees thereof; of the inmates therein, and of all matters 
 relating to the government, discipline, contracts, and fiscal con- 
 cerns thereof; and make such rules and regulations as may seem 
 to them necessary for carrying out the purposes of such hospital. 
 
 4. Shall maintain an effective inspection of said hospital, and 
 keep itself informed of the affairs and management thereof; shall 
 meet at the hospital at least once in every month, and at such 
 other times as may be prescribed in the by-laws; and shall hold 
 its annual meeting at least three weeks prior to the meeting of 
 the board of supervisors at which appropriations for the ensuing 
 year are to be considered. 
 
 5. Shall keep in a book provided for that purpose, a proper 
 record of its proceedings which shall be open at all times to the 
 inspection of its members, to the members of the board of super- 
 visors of the county, and to duly authorized representatives of the 
 state board of charities. 
 
 6. Shall certify all bills and accounts including salaries and 
 wages and transmit them to the board of supervisors of the county, 
 who shall provide for their payment in the same manner as other 
 
 Digitized by Microsoft® 
 
23 
 
 charges against the county are paid. The board of supervisors 
 of a county not having a purchasing agent or auditing commission 
 may make an appropriation for the maintenance of such hospital 
 and direct the county treasurer to pay all bills, accounts, salaries 
 and wages which are approved by the board of managers, within 
 the amount of such appropriation, subject to such regulations as 
 to the payment and audit thereof as the board of supervisors may 
 deem proper. (Am'd by L. 1913, ch. 40, in effect April 2, 1913.) 
 
 7. Shall make to the board of supervisors of the countv Report to 
 
 ... ± J board of 
 
 annually, at suck time as said supervisors shall direct, a detailed supervisors, 
 report of the operations of the hospital during the year, the num- 
 ber of patients received, the methods and results of their treat- 
 ment, together with suitable recommendations and such other 
 matter as may be required of them, and full and detailed estimates Estimates of 
 
 J appropria- 
 
 of the appropriations required during the ensuing year for all tions - 
 purposes including maintenance, the erection of buildings, repairs, 
 renewals, extensions, improvements, betterments or other neces- 
 sary purposes. 
 
 8. Shall notwithstanding any other general or special law erect 
 
 all additional buildings found necessary after the hospital has Additional 
 been placed in operation and make all necessary improvements improvf* an 
 and repairs within the limits of the appropriations made therefor m8n 
 by the board of supervisors, provided that the location of the 
 buildings and the plans and such part of the specifications as shall 
 be required by the state commissioner of health for such additional 
 buildings, improvements or repairs shall first be approved by the 
 state commissioner of health. Any change in such location or Api)roval by 
 plans shall also be first approved by the state commissioner of l^li c ° f mmis ' 
 health and the state commissioner of health and his duly author- healthi 
 ized representatives shall have the power to inspect such county Inspeotions 
 hospitals during the course of the construction of such additional gtnwtLm! " 
 building for the purpose of seeing that such plans are complied 
 with. (Added by L. 1913, ch. 379, and am'd by L. 1917, ch. 
 469, in effect May 15, 1917.) 
 
 9. Shall employ a county nurse, or an additional nurse or 
 
 • c • c l t (• i Nurses for 
 
 nurses if it deems necessary, for the discovery of tuberculosis discovery and 
 
 ■' 7 ' visiting of 
 
 cases and for the visitation of such cases and of patients dis- "a*"- 
 charged from the hospital and for such other duties as may seem 
 
 Digitized by Microsoft® 
 
Examination 
 of suspected 
 cases. 
 
 Supervisors 
 may appoint 
 nurses. 
 
 Superintend- 
 ent tho 
 executive 
 officer of 
 hospital. 
 
 Equipment. 
 
 General 
 supervision 
 and control 
 of hospital, 
 otc. 
 
 Appoint resi- 
 dent officers 
 and employees 
 and discharge 
 at his 
 discretion, 
 
 24 
 
 appropriate; and shall cause to be examined by the superintend- 
 ent or one of his medical staff suspected cases of tuberculosis 
 reported to it by the county nurse, or nurses, or by physicians, 
 teachers, employers, heads of families or others; and it may take- 
 such other steps for the care, treatment and prevention of tuber- 
 culosis as it may from time to time deem wise. In cases, however, 
 where it is not mandatory to establish a county tuberculosis hos- 
 pital and no board of managers has been provided, the board o£ 
 supervisors shall have the power to appoint and employ such- 
 nurse or additional nurse or nurses, and appointments heretofore- 
 made by boards of supervisors in such cases are hereby ratified,, 
 confirmed and legalized. (Added by L. 1914, ch. 323, am'd by 
 L. 1917, ch. 469, and L. 1918, ch. 284, in effect April 19, 1918.) 
 
 (Section added by L. 1909, ch. 341, am'd by L. 1913, chs. 40, 379; L. 1914,. 
 ch. 323; L. 1915, ch. 132; L. 1917, chs. 469, 701 and L. 1918, ch. 284, in effect- 
 April 19, 1918.) 
 
 § 48. General powers and duties of superintendent. The- 
 
 superintendent shall be the chief executive officer of the hospital 
 and subject to the by-laws, rules and regulations thereof, and to 
 the powers of the board of managers: 
 
 1. Shall equip the hospital with all necessary furniture, appli- 
 ances, fixtures and other needed facilities for the care and treat- 
 ment of patients and for the use of officers and employees thereof,, 
 and shall in counties where there is no purchasing agent purchase- 
 all necessary supplies.* 
 
 2. Shall have general supervision and control of the records,, 
 accounts, and buildings of the hospital and all internal affairs, 
 and maintain discipline therein, and enforce compliance with,, 
 and obedience to all rules, by-laws and regulations adopted by the 
 board of managers for the government, discipline and manage- 
 ment of said hospital, and the employees and inmates thereof. 
 He shall make such further rules, regulations and orders as he- 
 may deem necessary, not inconsistent with law, or with the rules, 
 regulations and directions of the board of managers. 
 
 3. Shall appoint such resident officers and such employees as 
 he may think proper and necessary for the efficient performance 
 of the business of the hospital, and prescribe their duties ; and for 
 
 •See Prison Law, § 182 p. 36, requiring use of prison made articles fox- 
 county institutions, and County Law, subd. 2, § 45, p. 18. 
 
 Digitized by Microsoft® 
 
25 
 
 cause stated in writing, after an opportunity to be heard, discharge 
 any such officer or employee at his discretion. 
 
 4. Shall cause proper accounts and records of the business and Accounts ana 
 
 j. -. , . _ records to be 
 
 operations of the hospital to be kept regularly from day to day, ks vt. 
 in books and on records provided for that purpose; and see that 
 such accounts and records are correctly made up for the annual 
 report to the board of supervisors, as required by subdivision 
 seven of section forty-seven of this chapter, and present the same 
 to the board of managers, who shall incorporate them in their 
 report to the said supervisors. 
 
 fCiin •• ii ■ i • i i <• • Admission of 
 
 5. ibnall receive into the hospital m the order of application patients, 
 any person found to be suffering from tuberculosis in any form 
 
 who is entitled to admission thereto under the provisions of this 
 chapter, excepting that if at any time there be more applications 
 for admission to said hospital than there are vacant beds therein, 
 said superintendent shall give preference in the admission of 
 patients to those who in his judgment, after an inquiry as to the 
 facts and circumstances, are more likely to infect members of 
 their households and others, in each instance signing and placing 
 among the permanent records of the hospital a statement of the 
 facts and circumstances upon which he bases his judgment as to 
 the likelihood of transmitting infection, and reporting each 
 instance at the next meeting of the board of managers; and shall 
 also receive persons from other counties as hereinafter provided. 
 Said superintendent shall eause to be kept proper accounts and 
 records of the admission of all patients, their name, age, sex, 
 color, marital condition, residence, occupation and place of last 
 employment. (Added by L. 1909, ch. 341; am'd by L. 1912, 
 chs. 14-9, 239; L. 1913, ch. 379, and L. 1915, ch. 132, in effect 
 March 29, 1915.) 
 
 Examination 
 
 6. Shall cause a careful examination to be made of the physical a ?<i treatment 
 
 x ^ of patients. 
 
 condition of all persons admitted to the hospital and provide for 
 the treatment of each such patient according to his need ; and shall 
 cause a record to be kept of the condition of each patient when 
 admitted, and from time to time thereafter. 
 
 Discharge of 
 
 7. Shall discharge from said hospital any patient who shall patients, 
 wilfully or habitually violate the rules thereof; or who is found 
 
 not to have tuberculosis ; or who is found to have recovered there- 
 
 Digitized by Microsoft® 
 
26 
 
 from ; or who for any other reason is no longer a suitable patient 
 for treatment therein; and shall make a full report thereof; at 
 the next meeting of the board of managers. 
 
 Collection of 
 moneys. 
 
 Superintend- 
 ent to give 
 bond. 
 
 Superintend- 
 ent may- 
 attend courses 
 at Hay Brook, 
 
 Expenses. 
 
 Admission of 
 patients from 
 -county. 
 
 8. Shall collect and receive all moneys clue the hospital, 
 
 L:ec- 
 
 an accurate account of the same, report the same at the monthly 
 meeting of the board of managers, and transmit the same to the 
 treasurer of the county within ten days after such meeting. 
 
 9. Shall before entering upon the discharge of his duties, give 
 a bond in such sum as the board of managers may determine, to 
 secure the faithful performance of such duties. 
 
 10. *May attend such courses in the diagnosis and treatment of 
 
 tuberculosis and in hospital administration at the state hospital 
 
 for the treatment of incipient pulmonary tuberculosis at Eay- 
 
 brook as may be established and which he may be authorized to 
 
 attend by the board of managers of his hospital. The necessary 
 
 expenses in traveling to and from the said state hospital for the 
 
 treatment of incipient pulmonary tuberculosis at Raybrook for 
 
 the purpose of taking such courses shall be a county charge. 
 
 (Added by L. 1917, ch. 469, in effect May 15, 1917.) 
 
 (Section added by L. 190!), ch. 341; and amended by L. 1912, chs. 149, 239; 
 L. 1913, ch. 379; L. 1915, ch. 132, and L. 1917, ch. 469, in effect May 15, 1917.) 
 
 § 49. Admission of patients from county in which hospital is 
 situated. Any resident of the county in which the hospital is 
 situated desiring treatment in such hospital, may apply in person 
 to the superintendent or to any reputable physician for examina- 
 tion, and such physician, if he find that said person is suffering 
 from tuberculosis in any form, may apply to the superintendent 
 of the hospital for his admission. Blank forms for such applica- 
 tions shall be provided by the hospital, and shall be forwarded 
 by the superintendent thereof gratuitously to any reputable phy- 
 sician in the county, upon request. So far as practicable, applica- 
 tions for admission to the hospital shail be made upon such forms. 
 The superintendent of the hospital, upon the receipt of such 
 application, if it appears therefrom that the patient is suffering 
 from tuberculosis, and if there be a vacancy in the said hospital, 
 shall notify the person named in such application to appear in 
 person at the hospital. If, upon personal examination of such 
 
 * See State Charities Law, § 157, subdivision 10, p. 12. 
 
 Digitized by Microsoft® 
 
27 
 
 patient, or of any patient applying in person for admission, the 
 superintendent is satisfied that such person is suffering from 
 tuberculosis, he shall admit him to the hospital as a patient. All 
 such applications shall state whether, in the judgment of the phy- 
 sician, the person is able to pay in whole or in part for his care 
 and treatment while at the hospital; and every application shall 
 be filed and recorded in a book kept for that purpose in the order 
 of their receipt. When said hospital is completed and ready for 
 the treatment of patients, or whenever thereafter there are vacan- 
 cies therein, admissions to said hospital shall be made in the order 
 in which the names of applicants shall appear upon the applica- 
 tion book to be kept as above provided, in so far as such applicants 
 are certified to by the superintendent to be suffering from tuber- 
 culosis. No discrimination shall be made in the accommodation, 
 •care or treatment of any patient because of the fact that the 
 patient or his relatives contribute to the cost of his maintenance 
 in whole or in part, and no patient shall be permitted to pay for 
 his maintenance in such hospital a greater sum than the average 
 per capita cost of maintenance therein, including a reasonable 
 allowance for the interest on the cost of the hospital; and no 
 ■officer or employee of such hospital shall accept from any patient 
 ■thereof any fee, payment or gratuity whatsoever for his services. 
 ■(Added by L. 1909, chap. 341; in effect May 13, 1909.) 
 
 § 49-a Maintenance of patients in the county in which hos- Maintenance 
 
 ^ iv a,, r j f patients in 
 
 pital is situated. Wherever a patient has been admitted to said^ t h ym 
 hospital from the county in which the hospital is situated, the^ 1 ^ 13 
 superintendent shall cause such inquiry to be made as he may 
 deem necessary, as to his circumstances, and of the relatives of 
 such patient legally liable for his support. If he find that such 
 patient, or said relatives are able to pay for his care and treatment 
 in whole or in part, an order shall be made directing such patient, 
 or said relatives to pay to the treasurer of such hospital for the 
 ■support of such patient a specified sum per week, in proportion 
 to their financial ability, but such sum shall not exceed the actual 
 per capita cost of maintenance. The superintendent shall have 
 the same power and authority to collect such sum from the estate 
 •of the patient, or his relatives legally liable for his support, as is 
 possessed by an overseer of the poor in like circumstances. If the 
 
 Digitized by Microsoft® 
 
28 
 
 Malignance superintendent find that such patient, or said relatives are not 
 SatSn{r n able to pay, either in whole or in part, for his eare and treatment 
 
 charge upon X J 7 x , ^^ 
 
 c ° unt ™ ( l oe in such hospital, the same shall become a charge upon tne county- 
 
 Sec. 30, Poor Jr 7 ■. 
 
 Law ' ) When any indigent patient shall have been admitted to any suck 
 
 indigent hospital as a resident of the county in which the hospital is 
 
 patient who I " * 1 
 
 SukeV located, and it shall be found that such patient has not acquired a 
 
 in'oZty* settlement within such county under the provisions of the poor 
 
 4o-« S6 poor law, the superintendent of such hospital shall collect from the 
 
 l: "' ; county in which such patient has a settlement the cost of his 
 
 maintenance in such hospital, or may in his discretion return such 
 
 patient to the locality in which he has a settlement. (Added by 
 
 L. 1909, chap. 341, and am'd L. 1912, chaps. 149 and 239; L. 
 
 1913, chap. 579; in effect April 28, 1913.) 
 
 Patients from « 49-b. Admission of patients from counties not having a hos- 
 
 county not <-> 
 
 iloJpitV pital. In any county not having a county hospital for the care 
 
 and treatment of persons suffering from tuberculosis, a county 
 superintendent of the poor, upon the receipt of the application 
 and certificate hereinafter provided for, shall apply to the 
 superintendent of any such hospital established by any other 
 county, for the admission of such patient. Any person residing 
 in a county in which there is no such hospital, who desires to 
 fo PP superhitend- receive treatment in such a hospital, may apply therefor in writ- 
 eat of poor. j n g ^ Q ^ ie SU p er i n tendent of the poor of the county in which he 
 resides on a blank to be provided by said superintendent for that 
 purpose, submitting with such application a written certificate 
 signed by a reputable physician on a blank to be provided by the 
 superintendent of the poor for such purpose, stating that such 
 physician has, within the ten days then next preceding, examined 
 such person, and that, in his judgment, such person is suffering 
 from tuberculosis. The superintendent of the poor, on receipt 
 of such application and certificate, shall- forward the same to the 
 superintendent of any hospital for the care and treatment of tuber- 
 culosis. If such patient be accepted by such hospital, the super- 
 tionTn°a ta " intendent of the poor shall provide for his transportation thereto, 
 maintenance. ^^ ^ Qv ^ mam t e nanoe therein at a rate to be fixed as herein- 
 after provided. (Added by L, 1909, ch. 341, am'd by'L. 1912, 
 chs. 199 and 239; L. 1913, ch. 579; L. 1917, ch. 469, in effect 
 May 15, 1917.) 
 
 Digitized by Microsoft® 
 
29 
 § 49kj. Maintenance of patients from counties not having a Maintenance 
 
 . of patients 
 
 hospital. Whenever the superintendent of such a county hospital, n™^?™" 83 
 shall receive from a superintendent of the poor of any other county hos s ital - 
 an application for the admission of a patient, if it appear from 
 .such application that the person therein referred to is suffering 
 from tuberculosis, the superintendent shall notify said person to 
 appear in person at the hospital, provided there be a vacancy in 
 such hospital and there be no pending application from a patient 
 residing in the county in which the hospital is located. If, upon 
 personal examination of the patient, the superintendent is satisfied 
 that such patient is suffering from tuberculosis, he shall admit him 
 to the hospital. Every patient so admitted shall be a charge againsl charge upon 
 the county sending such patient, at a rate to be fixed by the 
 board of managers, which shall not exceed the per capita cost of 
 maintenance therein, including a reasonable allowance for interest 
 on the costs of the hospital ; and the bill therefor shall, when veri- 
 fied by the superintendent of the poor of the county from which 
 said patient was sent, be audited and paid by the board of super- 
 visors of the said county. The said superintendent of the poor 
 shall cause an investigation to be made into the circumstances of 
 such patient, and of his relatives legally liable for his support, and 
 shall have the same authority as an overseer of the poor in like 
 circumstances to collect therefrom, in whole or in part, according 
 to their financial ability, the cost of the maintenance of such per- 
 son in said hospital. (Added by L. 1909, chap. 341 ; in effect 
 May 13, 1909.) 
 
 § 49-d. Visitation and inspection. The resident officer of the yisTfnT "' 
 hospital shall admit the managers into every part of the hospital 
 and the premises and give them access on demand to all books, 
 papers, accounts and records pertaining to the hospital and shall 
 furnish copies, abstracts and reports whenever required by them. 
 All hospitals established or maintained under the provisions of inspection by 
 sections forty-five to forty-nine-e, inclusive, of this chapter, shall charities 
 he subject to inspection by any duly authorized representative of department 
 the state board of charities, of the state department of health, of charities 'aid 
 
 ' x ' association and 
 
 the state charities aid association and of the board of supervisors l " ,ar ' 1 ° : 
 
 a supervisors. 
 
 of the county ; and the resident officers shall admit such representee 
 lives urto every part of the hospital and its buildings, and give 
 
 Digitized by Microsoft® 
 
Hospitals at 
 almshouses 
 subject to 
 provisions of 
 this act. 
 
 30 
 
 them access on demand to all records, reports, books, papers and 
 accounts pertaining to the hospital. (Added by L. 1909, chap. 
 341 ; in effect May 13, 1909.) 
 
 § 49-e. Hospitals at almshouses. Wherever a hospital for the 
 care and treatment of persons suffering from tuberculosis exists 
 in connection with, or on the grounds of a county almshouse, the 
 board of supervisors may, after sections forty-five to forty-nine-e of 
 this chapter take effect, appoint a board of managers for such 
 hospital and such hospital, and its board of managers, shall there- 
 after be subject to all the provisions of this act, in like manner as if 
 it had been originally established hereunder. Any hospital for the 
 care and treatment of tuberculosis which may hereafter be estab- 
 lished by any board of supervisors shall be subject to all the pro- 
 Hospitai not to visions of said sections. ISTo hospital authorized under the pro- 
 grounds "of an visions of this chapter shall hereafter be located on the grounds 
 
 almshouse. .,-,-*- . „ 
 
 of an almshouse. (Added by L. 1909, chap. 341 ; am'd by L. 1913, 
 chap. 379; in effect April 28, 1913.) 
 
 § 12. General powers. The board of supervisors shall : 
 
 Employees 
 county 
 tuberculosis 
 hospital 
 excepted 
 from juris- 
 diction of 
 board of 
 supervisors. 
 
 of 
 
 5. Have power to fix the amount and the time or manner of 
 payment of the salary or compensation of any county officer or 
 employee, except a judicial officer or an officer or employee of a 
 county tuberculosis hospital and the term of office and mode of 
 appointment, number and grade of any appointive county officer, 
 and of the clerks, assistants or employees in any county office, 
 except an officer or employees of a county tuberculosis hospital, 
 notwithstanding the provisions of any general or special law fixing 
 the amount of such salary or compensation or the time or manner 
 of payment thereof, or fixing the term of office or providing for the 
 mode of appointment, number or grade of any such county officer 
 or of the clerks, assistants or employees in any county office, or 
 vesting in any other board, body, commission or officer authority 
 to fix such term of office, or the amount of such salary or compen- 
 sation or the time or manner of payment thereof or to provide for 
 the mode of appointment, number or grade of such officers or of 
 the clerks, assistants or employees in any county office; and the 
 power hereby vested in the board of supervisors shall be exclusive 
 of any other board, body, commission or officer, except the authori- 
 
 Digitized by Microsoft® 
 
31 
 
 ties of a county tuberculosis hospital, notwithstanding any general 
 or special lav/. The salary or compensation of an officer or 
 employee elected or appointed for a definite term shall not be 
 increased or diminished during such term. (Am'd by L. 1911, 
 ch. 359, L. 1913, ch. 742, and L. 1914, ch. 358, in effect April 15, 
 1914.) 
 
 Special Acts Govebstixg Individual Hospitals 
 
 Buffalo, J. 1ST. Adam Memorial Hospital, L. 1909, ch. 115 ; 
 L. 1910, chs. 26 and 405; L. 1911, ch. 50; L. 1912, chs. 553 and 
 530. 
 
 Chautauqua county, L. 1914, ch. 147. 
 
 Chemung county, L. 1916, ch. 102. 
 
 Clinton Prison Tuberculosis Hospital, L. 1910, ch. 509 ; L. 
 1917, ch. 181. 
 
 Dutchess county, L. 1918, ch. 363. 
 
 Herkimer county, L. 1915, ch. 362. 
 
 Jefferson county, L. 1914, ch. 27; L. 1915, ch. 57. 
 
 Lockport, L. 1911, ch. 870. 
 
 Manhattan State Hospital, L. 1911, ch. 819; L. 1912, ch. 530. 
 
 Niagara county, L. 1917, ch. 393. 
 
 Oneida county, L. 1912, ch. 218. 
 
 Oswego county, L. 1916, ch. 38. 
 
 Poughkeepsie, L. 1910, ch. 465; L. 1914, ch. 426. 
 
 Rensselaer county, L. 1909, ch. 197. 
 
 Yonkers, L. 1910, ch. 586; L. 1917, ch. 445. 
 
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32 
 
 Establish- 
 ment of 
 tuberculosis 
 hospitals, 
 camps, etc, 
 in towns. 
 
 Petition de- 
 scribing site. 
 
 Notice of 
 hearing:. 
 
 Publication 
 of notice. 
 
 CONSENTS REQUISITE FOR ESTABLISHMENT OF 
 HOSPITALS OR CAMPS FOR TREATMENT OF 
 TUBERCULOSIS IN TOWNS; APPROVAL OF SITE, 
 ETC. 
 
 Public Health Law, Section 319. 
 § 319. Consents requisite to the establishment of hospitals or 
 camps for the treatment of pulmonary tuberculosis. A hospital, 
 camp or other establishment for the treatment of patients suffering 
 from the disease known as pulmonary tuberculosis, shall not be 
 established in any town by any person, association, corporation or 
 municipality except when authorized as provided by this section. 
 The person, association, corporation or municipality proposing to 
 establish such a hospital, camp or other establishment shall file 
 with the state commissioner of health a petition describing the 
 character thereof, stating the county and town in which it is to 
 be located and describing the site in such town for such proposed 
 hospital, camp or other establishment, and requesting the com- 
 missioner to fix a date and place for a hearing on such petition 
 before the state commissioner of health and the local health officer, 
 who shall constitute a board to approve or disapprove the establish- 
 ment of such hospital, camp or other establishment in accordance 
 with such petition. The state commissioner of health shall fix a 
 date and place for a hearing on such petition, which date shall 
 be not less than thirty nor more than forty days after the receipt 
 thereof. A notice of such hearing specifying the date and place 
 thereof and briefly describing the proposed site for such hospital, 
 camp or other establishment shall be mailed to the person, associa- 
 tion, corporation or municipality proposing to establish the same 
 and to the health officer and each member of the board of health 
 of the town in which it is proposed to establish such hospital, 
 camp or other establishment at least twenty days before the hear- 
 1 ing, and also published twice in a local newspaper of the town, or if 
 there is no such paper published therein, then in the newspapers 
 of the county designated in pursuance of law to publish the session 
 laws. At the time and place fixed for such hearing the state com- 
 missioner of health, or his deputy when designated by the commis- 
 sioner, and the local health officer shall hear the petitioner and 
 any person who desires to be heard in reference to the location of 
 such hospital, camp or other establishment, and they shall within 
 thirty days after the hearing, if they are able to agree, approve or 
 Digitized by Microsoft® xt 
 
33 
 
 disapprove of the location thereof and shall notify the person, notification 
 association, corporation or municipality of their determination. S? 
 At any time after the filing of such petition and before the acquir- 
 ing of the title of such site, the state commissioner of health, on the 
 written request of the person, association, corporation or munici- 
 pality filing such petition, may modify the description of such 
 proposed site as stated in such petition by omitting therefrom any ration 
 portion of the site so described not yet acquired which he shall may 'be 
 determine to be unnecessary for the purposes of such hospital, 
 camp or other establishment. The state commissioner of health 
 shall within thirty days after such determination to modify 
 such description notify the petitioner thereof in writing. 
 The determination of the state commissioner of health, or his 
 deputy as the case may be, and the local health officer shall be 
 final and conclusive; but if within thirty clays after the hearing 
 they are unable to agree, they shall within such thirty clays notify 
 the person, association, corporation or municipality proposing to 
 establish such hospital, camp or other establishment that they are * f ™ nable t0 
 unable to agree. Within ten clays after the receipt of such notice, 
 such person, association, corporation or municipality may file in 
 the office of the state commissioner of health a request that the 
 petition be referred to a board consisting of the lieutenant-gover- 
 nor, the speaker of the assembly and the state commissioner of 
 health. Such officers shall approve or disapprove of the proposed 
 location of such hospital, camp or other establishment after a 
 hearing of which notice shall be mailed to the person, association, 
 corporation or municipality proposing to establish the same and ^"^ s ty 
 to the health officer and to each member of the local board of 
 health of the town, or without a hearing, upon the evidence, papers Deois;(>n wit]l . 
 and documents filed with the state commissioner of health or that out hearln »- 
 may be submitted to them, as the board shall determine. They 
 shall make their determination within thirty days after the request 
 for such submission has been filed in the office of the state com- 
 missioner of health and cause a copy thereof to be mailed to the 
 
 , . . . . notification 
 
 person, association, corporation or municipality proposing to of decision. 
 
 establish such hospital, camp or other establishment and to the 
 
 health officer of the town in which it is proposed to establish the 
 
 same. Such determination shall be final and conclusive. (Am'd 
 
 by L. 1909, ch. 171 and L. 1916, ch. 291, and L. 1919, ch. 421, in^™ 
 
 effect May 5, 1919.) _. ... .. ... ,,~ 
 
 J ' } Digitized by Microsoft® 
 
Establishment 
 of tuber- 
 culosis 
 hospitals. 
 
 Site outside 
 of city or 
 vi.lage. 
 
 Approval 
 of state 
 department 
 of health. 
 
 Jurisdiction 
 of local 
 board of 
 health. 
 
 Separate 
 
 nurses, 
 
 utensils, 
 
 washing and 
 
 plumbing- 
 
 facilities. 
 
 GENERAL CITY LAW 
 
 (L. 1909, ch. 39, const, ch. 34 of Cons. Laws.) 
 
 Article X 
 Hospitals for Treatment of Pulmonary Tuberculosis 
 
 § 140. Establishment of hospitals. A city of the first class 
 shall have power whenever its board of health shall deem it neces- 
 sary for the promotion of the health of its inhabitants, to establish, 
 equip and maintain, outside of its corporate limits, and not within 
 the limits of any other city or any village, a hospital or hospitals 
 for the regular treatment of the disease known as pulmonary 
 tuberculosis. 
 
 § 141. Selection of site. Whenever a city of the first class 
 shall desire to exercise the power conferred by this article it shall 
 through its board of health, select such locality outside of its cor- 
 porate limits, but within the state, and not within the corporate 
 limits of any other city or any village, as it may consider best 
 adapted by reason of climatic and other conditions for the treat- 
 ment of such disease, and shall make application to the state 
 board of health for the approval of the site so selected. Upon 
 such approval being given the city may acquire title to such lands 
 as its board of health may designate, within the limits of the 
 locality submitted to and approved by the state board of health. 
 The provisions of law relating to the acquiring of private prop- 
 erty for public purposes are hereby made applicable as far as 
 may be necessary to the acquiring of title to such lands. 
 
 § 142. Jurisdiction of local board of health. AH hospitals or 
 institutions now or hereafter established or maintained by any 
 city of the first class for the regular or special treatment of per- 
 sons suffering from the disease known as pulmonary tuberculosis 
 shall be subject to the approval of the local board of health; special 
 wards or pavilions for the treatment of cases of pulmonary tuber- 
 culosis in existing hospitals shall be provided with separate 
 nurses, cooking utensils, washing and plumbing facilities. 
 
 Digitized by Microsoft® 
 
FIRE ESCAPES ON HOSPITAL BUILDINGS 
 Public Health Law, Section 334 
 § 33i. Iron stairways on outside of hospital buildings. Allure escapes 
 
 on hospital 
 
 hospital buildings used for general hospital purposes, or hospitals 1)Uiiain s s ' 
 or asylums for the insane, or any hospital buildings which are 
 more than two stories high, other than those which are fireproof 
 in their construction, shall have properly constructed iron stair- 
 ways on the outside thereof, with suitable doorways leading thereto 
 from each story above the first, for use in case of fire. It shall be 
 the duty of the trustees, managers, owners or proprietors of such 
 hospitals or asylums to cause such stairways to be constructed and 
 maintained. If the trustees or owners of any hospital as herein 
 described, except those owned and maintained by a city, a county, 
 or the state, shall fail to provide such stairways before the first 
 day of October, eighteen hundred and ninety-six, then the local 
 authorities shall proceed to erect such stairways, and the cost 
 thereof may be recovered by an action at law from the property of 
 said hospital. 
 
 The district attorney of each county is hereby charged with 
 the execution of this statute, except in the case of hospitals 
 erected or maintained by the state, city or by a county. 
 
 The provisions of this section shall not apply to any institution 
 in any of the cities or counties of this state, which the fire depart- 
 ment of said city or district attorney of the county shall certify Excepting 
 in writing to be fireproof to an extent which will not require the building, 
 appliances and fixtures provided for in this section. The certifi- 
 cate exempting institutions from the operations of this section 
 shall be filed during the month of January in each year, in the 
 office of the county clerk of the county. 
 
 Digitized by Microsoft® 
 
36 
 
 PRISON LAW 
 
 Equipment of Hospitals to be Purchased from Commission of 
 
 Prisons * 
 
 Prison made § 182. Articles manufactured to be furnished to the state or 
 
 vso of public division thereof. The superintendent of state prisons, and the 
 
 institutions. , - ... ,.-, 
 
 superintendents of reformatories and penitentiaries, respectively, 
 are authorized and directed to cause to be manufactured by the 
 convicts in the prisons, reformatories and penitentiaries, such 
 articles as are needed and used therein, and also such as are 
 required by the state or political divisions thereof, and in the 
 buildings, offices and public institutions owned or managed and 
 controlled by the state, including articles and materials to be used 
 in the erection of the buildings. All such articles manufactured 
 in the state prisons, reformatories and penitentiaries, and not 
 required for use therein, shall be of the styles, patterns, designs 
 and qualities fixed by the board of classification, and may be 
 furnished to the state, or to any j>olitical division thereof, or for 
 or to any public institution owned or managed and controlled by 
 the state, or any political division thereof, at and for such prices 
 as shall be fixed and determined as hereinafter provided, upon 
 the requisitions of the proper officials, trustees or managers 
 thereof. No article so manufactured shall be purchased from any 
 other source, for the state or public institutions of the' state, or 
 the political divisions thereof, except uniforms for the inmates 
 of the New York State Soldiers and Sailors' Home or of the New 
 York State Women's Eelief Corps Home, unless said state com- 
 mission of prisons shall certify that the same can not be furnished 
 waiver. upon such requisition, and no claim therefor shall be audited or 
 
 paid without such certificate. (Am'd by L. 1916, ch. 533, in 
 effect May 12, 1916.) 
 
 See also County Law, § 45, subd. 2, p. IS, and § 48, p. 24. 
 
 Digitized by Microsoft® 
 
37 
 
 WORKSHOPS IN CONNECTION WITH TUBERCULOSIS 
 
 HOSPITALS 
 
 General Municipal Law, Section 135-a 
 
 Workshops in Connection With Tuberculosis Hospitals 
 
 § 135-a. Workshops in connection with tuberculosis hospitals. ^°j£|j£L s in 
 Any municipal corporation maintaining a hospital or a sanatorium SjeUniosis 
 for the treatment of tuberculosis may establish and maintain counties!' 
 workshops in connection therewith for the production of articles ana viiiatres. 
 or supplies required by such hospital or sanatorium, or by any 
 other institution or department of such municipality. Except in a 
 supervisory capacity no person shall be employed in such work- 
 shop or workshops unless he is or shall have been a patient suffer- ^"SJJ™ be 
 ing from tuberculosis in such hospital or sanatorium. The appro- em 5 1 °5 red - 
 priate municipal authorities may appropriate or provide funds 
 for the establishment and maintenance of the said workshops in 
 the same manner as for the establishment and maintenance of such 
 hospitals or sanatoria. Notwithstanding the provisions of the 
 prison law in relation to the sale of articles manufactured in the £ e rt £^! ;™ ay 
 state prisons, the products of such workshop may be used in such ^"Spauty. "* 
 hospital or sanatorium or by any other institution or department 
 of such municipality. Such workshops shall be under the direc- 
 tion and control of the municipal authority having direction and 
 control of the hospital or sanatorium to which they may be attached- 
 (Added by L. 1913, ch. 341, in effect April 19, 1913.) 
 
 Digitized by Microsoft® 
 
LIQUOR TAX LAW 
 (L. 1909, ch. 39, const, ch. 34 of Cons. Laws.) 
 Liquors Not to be Furnished to Patients Without Prescription 
 § 29 Persons to whom liquor shall not be sold or given away.f 
 
 ceiling or ° * ill 
 
 h ™l?u s ^° corporation, association, copartnership or person, whether taxed 
 inSitutiof or una,er tllis chapter or not, shall sell, deliver or give away or cause 
 
 Selling or 
 
 ,,,, np ,... or permit or procure to be sold, delivered or given away any 
 
 forwdden. liquors to : \ 
 
 * -:■:- ******* 
 
 6. To any person confined in or committed to a state prison, 
 jail, penitentiary, house of refuge, reformatory, protectory, indus- 
 trial school, asylum or state hospital, or any inmate of a poor- 
 house, or any patient in any colony or institution established for 
 the care or treatment of epileptics, or any patient affected with 
 tuberculosis in a camp, colony or hospital established by state, 
 county or municipal authority and under the management and 
 control thereof, except upon a written prescription from a physi- 
 cian to such institution, colony, camp or hospital, specifying the 
 cause for which such prescription is given, the quantity and kind 
 of liquor which is to be furnished, the name of the person for 
 whom and the time or times at which the same shall be furnished. 
 Such prescription shall not be made unless the physician is satis- 
 fied that the liquor furnished is necessary for the health of the 
 person for whose use it is prescribed, and that fact must be stated 
 in the prescription. 
 
 § 1912, Penal Law makes violation of this section a misdemeanor. 
 
 Digitized by Microsoft® 
 
30 
 
 REGULATIONS OF STATE SANITARY CODE REGARD- 
 ING TUBERCULOSIS 
 
 CHAPTEE II 
 
 Regulation 1. Communicable diseases designated. For the 
 purpose of this code the term communicable disease shall he held 
 to include the following diseases, which are hereby declared to be 
 communicable through the conveyance of infective organisms. 
 
 The communicable diseases for convenience of administration, 
 are divided into two groups : 
 
 A. Anthrax Communicable 
 
 Diseases ttes- 
 ChickenpOX ignated. 
 
 Cholera, Asiatic 
 
 Diphtheria (membranous croup) 
 Dysentery, amoebic and bacillary 
 Epidemic cerebrospinal meningitis 
 Epidemic or streptococcus (septic) sore throat 
 German measles t 
 
 Glanders 
 
 • Measles * 
 
 Mumps 
 Ophthalmia neonatorum (suppurative conjunctivitis of the 
 
 new-born) 
 Para-typhoid fever 
 Plague 
 Pneumonia 
 
 a. acute lobar 
 
 b. bronchial or lobular 
 
 Poliomyelitis, acute anterior (infantile paralysis) 
 
 Puerperal septicaemia 
 
 Rabies 
 
 Scarlet fever 
 
 Smallpox 
 
 Tetanus 
 
 Trachoma 
 
 Tuberculosis 
 
 Typhoid fever 
 
 Typhus fever 
 
 Whooping cough 
 
 Digitized by Microsoft® 
 
4-0 
 
 B. Syphilis 
 
 Gonorrhoea 
 
 Chancroid 
 
 (Adopted April 7, 1914, am'd March 20, 1917, December 
 18, 1917, and June 25, 1918, in effect August 1, 1918.) 
 
 Ei E ht of Eegulation 15. Right of entrance and inspection. Xo person 
 
 H.%T'nurse, sna n interfere with or obstruct the entrance to any house, build- 
 ing, or vessel by any inspector or officer of the state or local health 
 authorities, in the discharge of his official duties, nor shall any 
 person interfere with or obstruct the inspection or examination of 
 any occupant of any such house, building, or vessel by any inspector 
 or officer of the state or local health authorities, in the discharge 
 of his official duties. (Adopted April 7, 1914; in effect May 1, 
 1914.) (§ 1741, Penal Law, makes obstruction of health officer 
 or physician in performance of duty a misdemeanor. ) 
 physicians Regulation 42 Duties of physicians and other persons con- 
 
 and others t> ' . 
 
 tSwo/ws cerning tuberculosis. It shall be the duty of every physician or 
 other person required to perform any duty under sections three 
 hundred and twenty to three hundred and thirty, both inclusive, 
 of article sixteen of the public health law, providing for the 
 reporting and control of cases of tuberculosis, to take all steps 
 incumbent on him and necessary to carry into effect the pro- 
 visions of the said law. (Adopted April 7, 1914, in effect May 
 1, 1914.) 
 
 Duty of ii. o. Regulation 42-a. Duties of health officer on receiving report 
 
 regarding ° . . . 
 
 apparent case. f a n apparent case of tuberculosis. Upon receiving a report 
 in writing of an apparent case of tuberculosis, as authorized by 
 section 320 of the public health law, the health officer shall there- 
 upon take the following steps : 
 
 If pr ? T i°' Jsly 1- If the alleged case has been previously reported to him by 
 a physician as having tuberculosis and the latter has elected to 
 assume the sanitary supervision thereof as permitted in section 328 
 of the public health law, the health officer shall ascertain promptly 
 whether such physician is maintaining proper sanitary supervision. 
 
 If not 2. If the alleged case has not been previously reported to him 
 
 previously as having tuberculosis, the health officer shall take proper measures 
 to determine whether there is reason to believe such person is 
 
 Digitized by Microsoft® 
 
41 
 
 affected with pulmonary tuberculosis and if by suitable physical 
 or sputum examination, or both, he ascertains that the person i. ; . 
 affected with pulmonary tuberculosis he shall then proceed in 
 accordance with the provisions of the public health law and the 
 rules of the state department of health. 
 
 This regulation shall take effect throughout the state of l\e\x 
 York, except in the city of Xew York, on the first day of March, 
 1916. (Eeg. added Dec. 1, 1915.) 
 
 Regulation 45. Cleansing, renovation, and disinfection re- cicansine, 
 
 & °' ' renovation and 
 
 quired. Adequate cleansing of rooms, furniture and belongings, ^fi^ " 
 when deemed necessary by the local health officer, or required by 
 this code or otherwise by law, shall immediately follow the recov- 
 ery, death, or removal of a person affected with a communicable 
 disease. Such cleansing shall be performed by and at the expense ^S™/* 
 of the occupant of said premises, upon the order and under the ° 0Cllpa " t ■ 
 direction of the local health officer, in accordance with the regula- 
 tions of the sanitary code. 
 
 Adequate renovation of premises, when deemed necessary by f*™™f™ at 
 the local health officer, or required by this code or otherwise by law, ownor 01 ' aEent • 
 shall immediately follow the recovery, death, or removal of a per- 
 son affected with a communicable disease. Such renovation shall 
 be performed by and at the expense of the owner of said premises 
 or his agents, upon the order and under the direction of the local 
 health officer, in accordance with the regulations of the sanitary 
 code. 
 
 Adequate disinfection of premises, furniture and belongings, Jf^i* 10 ' 1 
 when deemed necessary by the local health officer or required by e *2° nsc ' 
 this code or otherwise by law, shall immediately follow the recov- 
 ery, death, or removal of a person affected with a communicable 
 disease. Such disinfection shall be performed by or under the 
 direction of the local health officer in accordance with the regula- 
 tions of the sanitary code and at the public expense unless other- 
 wise provided pursuant to law. (Adopted April 7, 1914, in effect 
 May 1, 1919.) 
 
 Regulation 46. Methods and precautions in cleansing, renova- 
 tion and disinfection. The following methods and precautions 
 shall be observed in cleansing, renovation and disinfection : 
 
 (a) Cleansing shall be secured by the thorough removal of cleansing' 
 
 v J •* , ^ '-' methods and 
 
 dust and other contaminating material in such a way as to prevent precautions. 
 
 Digitized by Microsoft® 
 
Renovation, 
 methods and 
 precautions. 
 
 Disinfection, 
 
 methods and 
 precautions. 
 
 Destruction 
 furniture, 
 clothing-, etc. 
 upon order of 
 H, 0. 
 
 of 
 
 Cleansing- and 
 disinfection 
 of person 
 "by patient, 
 nurse, etc, 
 
 42 
 
 the entry thereof, as far as may be possible, into other rooms or 
 dwellings; washing with soap and water; scouring; airing; and 
 exposure to sunlight; in accordance with the special rules and 
 regulations of the state department of health. 
 
 (b) Renovation shall be secured by removing old paper from 
 walls and ceilings, and repainting, recalcimining, or repapering of 
 walls, ceilings, and woodwork as may be ordered by the local health 
 officer in accordance with the special rules and regulations of the 
 state department of health. 
 
 (c) Disinfection of rooms shall be secured by the use of such 
 disinfecting agents in such quantities and in such manner and of 
 such sterilizing procedures as may be ordered by the local health 
 officer, in accordance with the special rules and regulations of the 
 state department of health. When gaseous disinfectants are to be 
 used, all cracks, crevices and openings into the room shall first be 
 pasted over with paper. Thereafter, all rugs, carpets, upholstered 
 furniture, and such textile fabrics in the said room as cannot, in 
 the opinion of the local health officer, be washed or soaked in a dis- 
 infecting solution, may be removed for disinfection by steam when 
 ordered by the local health officer, in accordance with the special 
 rules and regulations of the state department of health.* (Adopted 
 April 7, 1914, in effect May 1, 1914.) 
 
 Regulation 47. Destruction of furniture, clothing and other 
 articles. Furniture, bedding, clothing, carpets, rugs and other 
 articles, which may have been contaminated with infective 
 material from any case of diphtheria, scarlet fever, or smallpox, 
 and which are of such a nature or in such condition that they 
 cannot, in the opinion of the local health officer, be properly 
 cleansed, disinfected, or sterilized, shall upon his order be 
 destroyed in the manner designated by him. (Adopted April 7, 
 1914, in effect May 1, 1914. ) 
 
 Regulation 48. Cleansing and disinfection of the person. It 
 shall be the duty of the patient, upon convalescence or recovery 
 from any communicable disease, and of the nurse or persons in 
 attendance on such case, throughout the course of the disease 
 
 * Thorough cleansing, the use of soap and water, and full exposure to fresh 
 air and sunlight are most efficient means of removing infective material, not 
 only from the walls and floors of rooms, but also from furniture and other 
 articles. 
 
 Digitized by Microsoft® 
 
43 
 
 as well as at its close, suitably to cleanse and, when necessary, 
 to disinfect their persons in accordance with the manner pre- 
 scribed by the special rules and regulations of the state department 
 of health.* (Adopted April 7, 1914, in effect May 1, 1918.) 
 
 Eegulation 49. Letting of rooms forbidden while contain- Oo< . upatl0I1 of 
 inated with infective material. No proprietor of a hotel, boarding forbidden until 
 house, or lodging house shall let for hire or cause or permit any- " 8 
 one to occupy a room or apartment previously occupied by a 
 person affected with diphtheria, epidemic cerebrospinal meningitis, 
 measles, poliomyelitis (infantile paralysis), scarlet fever, small- 
 pox, tuberculosis, or typhus fever, until such room or apartment 
 has been cleansed, renovated, or disinfected, under the direction 
 of the local health officer. 
 
 When an order requiring the cleansing, renovation, or disin- 
 fection of articles or premises is not complied with, the local 
 health officer shall post a placard on the premises, reading as 
 follows : 
 
 " Notice : These apartments have (or this room has) been Kealth offioar 
 
 occupied by a person affected with "rSnfiTs?"* 
 
 They (or it) must not again be occupied until orders for cleans- 
 ing, renovation, or disinfection have been complied with. This 
 notice must not be removed under penalty of the law. 
 
 Date 
 
 Health Officer." 
 
 (Adopted April 7, 1914, in effect May 1, 1914.) 
 
 CHAPTER VII 
 
 Eegulation 8. Local health officers authorized to permit in- Inspeotion of 
 spection of tuberculosis registers in certain cases. -J- Local health regSsTy 
 
 . , ,. r il nurses, etc., 
 
 officers are hereby authorized to permit the inspection oi the approved by 
 
 J , . commissioner 
 
 reports of cases of tuberculosis and of the registers mentioned m of hea.th. 
 section 322 of the public health law by any duly authorized 
 representative of an organization engaged in work for the preven- 
 tion of tuberculosis, who has been approved for this purpose by 
 the state commissioner of health. 
 
 * See p. 46. 
 
 t See section 322, P. H. L., p. 4. 
 
 Digitized by Microsoft® 
 
44 
 
 K, O, to keep 
 record. 
 
 confidential. 
 
 Tuberculosis 
 records to 
 be predvced 
 only u^oii 
 
 subpoena. 
 
 Local health officers shall keep a record of all persons having 
 access to such reports or registers, stating their names, addresses, 
 and official positions or relations to the state department of health 
 or said organizations. 
 
 Such persons shall not publish or divulge for publication or 
 communicate to any other person the identity of the persons to 
 whom such reports or registers relate. 
 
 This regulation shall take effect throughout the state of New 
 York, except in the city of JSTew York, on the first day of March, 
 1915. (Regulation added Feb. 2, 1915.) 
 
 Regulation 14. Tuberculosis records. In any action or prose- 
 cution for violation of any of the provisions of the public health 
 law, of the sanitary code, or of the ordinances or regulations of 
 any local board of health, the person in charge of tuberculosis 
 records or reports made in pursuance of the provisions of sections 
 twenty-five or three hundred and twenty of the public health law 
 may in obedience to a duly issued and served subpoena produce 
 and allow to be placed in evidence the whole or any part of such 
 records insofar as the same shall be deemed relevant by the court 
 or by the judge presiding. 
 
 (Added June 25, 1918, in effect August 1, 1918.) 
 
 Inspection 
 of boarding 
 house recs: 
 ino- tuber- 
 en Ions 
 patients. 
 
 H. 0. to 
 
 furnish 
 
 literature. 
 
 Proprietor 
 to post 
 re~u"atioiis. 
 
 CHAPTER VIII 
 
 Eegulation 4. It shall be the duty of every health officer to 
 inspect in the municipality under his jurisdiction every boarding 
 house or lodging house where a person or persons affected with 
 tuberculosis may be boarded or lodged and it shall be his duty to 
 see that the requirements of the public health law and the sanitary 
 code are complied with. 
 
 This regulation shall take effect June 1, 1917. (Added March 
 20, 1917.) 
 
 Regulation 5. It shall be the duty of every local health officer 
 to furnish the proprietor or other person in charge of such boarding 
 house or lodging house with such sections of the sanitary code 
 and the public health law as may be required by the state com- 
 missioner of health. 
 
 This regulation shall take effect June 1, 1917. (Added March 
 20, 1917.) 
 
 Regulation 6. It shall be the duty of the proprietor or other 
 person in charge of any boarding or lodging house in which a 
 
 Digitized by Microsoft® 
 
45 
 
 person or persons affected with tuberculosis may be boarded or 
 lodged to post in a conspicuous place such provisions of the san- 
 itary code and public health law as may be required by the state 
 commissioner of health. 
 
 This regulation shall take effect June 1, 1917. (Added March 
 20, 1917.) 
 
 Digitized by Microsoft® 
 
46 
 
 Infectious 
 disease. 
 
 Infection, 
 
 Infective 
 agent. 
 
 SPECIAL DEPARTMENTAL REGULATIONS AND IN- 
 STRUCTIONS REGARDING CLEANSING, RENOVA- 
 TION AND DISINFECTION 
 
 Promulgated by the Commissioner of Health, July i, 1914 
 
 Definitions 
 
 One of the minor handicaps of medicine is the use of words 
 whose meaning is neither precise nor constant. Many of these 
 are the heritage of an earlier day when the ideas which the words 
 were framed to convey were vague from lack of knowledge. 
 Among such words are those which relate to infection and to 
 infective agents and their modes of conveyance. The words con- 
 tagion, contagious and infection, for example, are now used in 
 several senses and often with entire lack of precision. Infection 
 may mean a process or the thing which incites the process. Con- 
 tagion may be a process, a thing, or a capacity. The word con- 
 tagious connotes a conception of disease and its mode of incite- 
 ment which has long since passed away. 
 
 The knowledge of to-day regarding infection and the infective 
 agents is sufficiently definite to permit and to require the use of 
 precise terms. It has therefore seemed to the officials of the 
 Department of Health of the State of 'New York that clearness 
 of thought and record, and precision and efficiency of action, 
 might be fostered by the formal definition of some of the words, 
 relating to the germ diseases .and their control, which are used in 
 the sanitary code and in various rules and regulations and sug- 
 gestions of the department. 
 
 Such definitions follow : 
 
 An infectious disease is a disease which is incited by the 
 entrance into the body and multiplication therein of' pathogenic, 
 that is, disease-inciting microorganisms. 
 
 Infection is the act or process of the incitement of an infectious 
 disease. The process of infection marks the interaction between 
 the invaded animal organism and the attacking microorganism. 
 
 An infective agent is a living microorganism, capable under 
 favorable conditions of inciting infectious disease. 
 
 Digitized by Microsoft® 
 
47 
 
 Infective agents, under the usual conditions of life, are most 
 often transmitted in the secretions or excretions of those affected 
 by communicable infectious diseases, or to those who, though 
 themselves not affected, harbor pathogenic microorganisms. 
 
 A communicable disease is an infectious disease the inciting ° i ° s ™ nicabla 
 agents of which may, under usual conditions, be transmitted 
 from those affected with the disease, or from those otherwise 
 harboring these agents, to others with the incitement of the disease 
 in fresh cases as a result. 
 
 Since disease is not a thing but a process, a reaction of the 
 body to injurious agencies, it is evident that disease cannot actu- 
 ally be transmitted or communicated. What, however, is fre- 
 quently communicated in infectious disease is the inciting agent, 
 whether such agent be a representative of the bacteria, yeasts, 
 moulds, protozoa or other minute organisms. If this be clearly 
 understood, the now sanctioned usage of the word " communica- 
 ble " in relation to disease serves in an important way to center 
 attention upon that factor in these diseases, namely, the definite 
 transmissible infective material, which is largely subject to control 
 through the principles of hygiene and sanitation and the ministra- 
 tions of health officials. 
 
 A " carrier " is an individual who, though not at the time him- " carrier." 
 self affected, harbors in his body, or in his secretions or excretions, 
 microorganisms which under favoring conditions may incite infec- 
 tious disease in himself or in others. 
 
 The incubation period is the interval which elapses between the iicniation 
 
 period. 
 
 entrance into the body of infective agents and the manifestations 
 of the symptoms or the development of the lesions which the germs 
 incite. 
 
 This period varies with the different infective microorganisms, 
 and with the differing susceptibilities of individuals. During the 
 period the infective organisms are passing through developmental 
 cycles or are increasing sufficiently in numbers or in virulence 
 within the body to induce the symptoms and lesions. These 
 symptoms and lesions are due to the reaction of the host, and, 
 together with the inciting agents, characterize the disease. 
 
 Epidemic disease. A disease may be said to be epidemic when f? idemio 
 for a limited period it is abnormally prevalent in a community, so 
 
 Digitized by Microsoft® 
 
48 
 
 Cultures, 
 
 Exposure. 
 
 Isolation. 
 
 Sterilization, 
 
 Disinfection. 
 
 Antiseptic. 
 
 as to involve a considerable number of persons. A disease ordi- 
 narily present and prevalent in a locality is said to be endemic. 
 
 Cultures are growths of microorganisms, usually carried on 
 under artificial conditions, for the purpose of studying their char- 
 acters; or, when derived from cases of suspected communicable 
 disease, to identify forms whose nature must be definitely known, 
 in order that the proper treatment and effective safeguarding of 
 the community may be secured. 
 
 Exposure to a case of communicable disease means the coming 
 of an individual into such direct relationship to the patient or to 
 materials from his body which presumably contain infective 
 agents, as to render liable the conveyance of the latter, directly or 
 indirectly, from one to the other. 
 
 Isolation of a case of communicable disease is the separation of 
 the case from those not concerned with its care or with the protec- 
 tion of the public health, under conditions which so far as possible 
 will prevent the spread and secure the destruction of all infective 
 material coming from the patient. At the termination of the isola- 
 tion period, such measures of cleansing and disinfection of the 
 person and of the surroundings of the patient and of his attendant 
 should be taken as will safeguard associates and the community 
 against infective material which from some inadvertence or neglect 
 may linger undestroyed. 
 
 Disinfection and sterilization. The killing of all microorgan- 
 isms is called sterilization, and it may be accomplished either by 
 the use of physical or chemical agents. These processes are of 
 importance because the central aim in the control and suppression 
 of comnxmiicable diseases is to prevent the spread and to destroy, 
 so far as possible at their source, the life of the microorganisms 
 which incite them. 
 
 The term disinfection implies the destruction of pathogenic 
 organisms (which are more easily killed than many other forms). 
 It indicates particularly the use of chemical agents in killing 
 germs. There are many chemical disinfectants and some of these 
 are used in the liquid, some in the gaseous, form. 
 
 An antiseptic is an agent which inhibits the growth and mul- 
 tiplication of microorganisms, but does not definitely destroy their 
 life. 
 
 Digitized by Microsoft® 
 
49 
 
 A deodorant is a substance which destroys or masks offensive Deodorant. 
 odors. Sueh substances may act upon the sources of the offensive 
 gases, or upon the gases themselves. They are sometimes, but not 
 always, antiseptic or disinfectant in action. 
 
 Among the physical agencies injurious to microorganisms are 
 heat, sunlight and desiccation. 
 
 Principles of disinfection 
 
 Knowledge of the inciting agents of the infectious diseases and dissection. 
 of the ways in whieh they may be transmitted from one individual 
 to another is now so precise that the measures for the limitation 
 of such maladies, through cleanliness and disinfection, are well- 
 defined, and in comparison with those in vogue at an earlier day, 
 extremely simple. 
 
 The purpose of disinfection in the control of communicable dis- 
 eases, is to kill the pathogenic microorganisms. This is most easily 
 and effectively done at their source, that is, in the secretions and 
 excretions of those affected with disease. In so far as this destruc- 
 tion of disease germs at their source is incomplete or neglected, in 
 such measure does disinfection become more complex, more costly 
 and less efficient. 
 
 When, for example, cases of such diseases as diphtheria, scarlet 
 fever, measles, cerebrospinal meningitis and poliomyelitis, are 
 properly isolated and attended, and the discharges are received 
 on cheap fabrics and promptly burned, or in suitable xeeeptacles 
 and treated with strong disinfecting solutions ; and when in such 
 diseases as typhoid fever and dysentery, whose infective agents are 
 harbored by the excreta from the intestines or bladder, these 
 excreta are properly and promptly cared for ; then the subsequent 
 general disinfection of garments, utensils and rooms, is of rela- 
 tively slight importance and easily accomplished. 
 
 On the, other hand, when through lack of proper isolation of a 
 case of communicable disease, or of intelligent and adequate 
 attendance, infective material has been permitted to contaminate 
 garments, bedding, utensils, rooms and their furnishings, ox the 
 persons of the attendants ; not only is the most effective safeguard 
 lost, but such procedures as in the end may be necessary to seeure 
 the required safety are roundabout, beset with difficulties and lia- 
 
 Digitized by Microsoft® 
 
50 
 
 ble to many failures. Thus effective and economical disinfection 
 is not a matter of the routine application of a set of traditional 
 formulae and procedures; but an operation requiring knowledge, 
 intelligence and alertness, together with a study of the specific 
 problems of every case. 
 
 Of course particular operations in disinfection may be carried 
 out by any person capable of following directions, if he have ade- 
 quate facilities. So in institutions and in the larger way routine 
 disinfection is practicable. But in the household, in institutions 
 not regularly caring for disease, in general assembling places and 
 in public conveyances, the problem requires special care, the intel- 
 ligent study of conditions, and always strict attention to the pre- 
 cise aim of all disinfection, namely, the killing of disease germs. 
 
 The efficiency of a disinfectant depends not only upon its intrin- 
 sic power as a germicide, but upon the physical condition and 
 accessibility of the germs, the temperature and the length of the 
 contact period. 
 
 Cleanliness 
 
 Of all the above agencies cleanliness is, in the long run, perhaps, 
 the most important. But the cleanliness required is informed, 
 intelligent and alert, and assumes infective material of all kinds to 
 be a peculiar and sinister form of dirt. Thus applied, fresh air, 
 sunlight, and the generous use of soap and water are important 
 factors in warding off and suppressing communicable diseases. 
 
 In order that cleanliness may be more readily secured, it is 
 desirable that rooms which harbor cases of communicable disease 
 should be cleared so far as practicable of all unnecessary articles — 
 bric-a-brac, furniture, carpets and curtains. All the things which 
 are left should be kept clean, as should the person of the patient, 
 the persons and garments of his attendants, and all the utensils 
 with which he is served. 
 
 A large measure of effective cleanliness can be secured by the 
 discreet use of the following soapsuds and soda solutions : 
 
 1. Soapsuds solution. This is made by adding one ounce of 
 common soda to twelve quarts of hot soapsuds. This is useful for 
 ordinary cleansing as well as for the washing of articles which 
 have been disinfected by the special methods presently to be 
 described. 
 
 Digitized by Microsoft® 
 
51 
 
 soda 
 solution. 
 
 2. Strong soda solution. This is made by dissolving one-half jf^f 
 pound of common soda in three gallons of hot water. This 
 solution, applied with a hard scrubbing brush, is both an effective 
 cleanser and a disinfectant of considerable value. 
 
 Heat 
 
 Burning. The most prompt and efficient method of disposal of 
 infective material or articles contaminated with infective dis- 
 charges, is by burning. This, when not too costly, should be 
 resorted to as often as practicable. 
 
 Steaming. Live steam delivered into suitably constructed f£e°!u£j.° 
 closed chambers, is highly effective, for exposure to live steam for 
 half an hour kills all infective germs. Steam sterilizing chambers, 
 commonly maintained by municipalities or institutions, are of 
 especial value in treating such contaminated fabrics, bedding, 
 clothing, hangings, etc., as will not be injured by the temperature 
 and moisture. 
 
 Boiling. Actual boiling in a closed vessel for half an hour will Bolhns • 
 kill all disease germs and should be resorted to whenever practica- 
 ble, in the disinfection of small articles, fabrics, eating utensils, 
 dishes, etc., which are frequently and repeatedly contaminated in 
 the course of some communicable diseases. When such boiling is 
 feasible, it is usually a more simple, direct and certain method of 
 killing germs, and often less objectionable to the patients and 
 attendants, than is the use of disinfectant solutions. 
 
 Chemical disinfectants used in solution 
 
 Among the many chemical agents which are efficient disinfect- auiSectlnta. 
 ants, there are a few which owing to their efficiency and adapta- 
 bility for practical purposes, as well as their cheapness, are in gen- 
 eral use. The most important of these are carbolic acid; corrosive 
 sublimate; chloride of lime; alcohol, and formaldehyde, the latter 
 being commonly used in gaseous form, and the others in solution. 
 The choice of these disinfectants and the way to use them will 
 depend upon the source and kinds of the infective material and its 
 physical conditions when subject to the action of the disinfectant. 
 
 Disinfection by chemical substances can only be effected by 
 solutions of sufficient strength, remaining in contact with the infec- 
 tive organisms long enough to kill them. The presence of other 
 
 Digitized by Microsoft® 
 
52 
 
 5 par cent 
 carbolic acid 
 solution. 
 
 2.5 per cent 
 carbolic acid 
 solution. 
 
 1-500 bichlcrid; 
 of meroury 
 solution. 
 
 1-1,000 
 
 bichloride 
 
 mercury 
 
 solution. 
 
 Alcohol 
 solution, 
 
 10 per cent 
 chloride of 
 lime solution, 
 
 Milk of lime. 
 
 substances, especially of organic matter, often weakens the disin- 
 fectant through 'combination with it, or protects the organisms from 
 its access. To secure efficient action the disinfectant should diffuse 
 readily into the material in which the infective organisms are, 
 and be thoroughly mixed with it. The disinfectant should be in 
 excess and time allowed for its action. 
 
 Solutions for disinfection 
 
 1. Strong carbolic acid solution (5 per cent). Add one pint or 
 a pound of either the crude or purified liquid carbolic acid to two 
 and one-half gallons of hot water and stir frequently until no red 
 or •eolariiess droplets remain in. the bottom of the mixture. 
 
 2. Carbolic acid solution (2.5 per cent). To one part of car- 
 bolic acid solution number 1, add an equal amount of water. 
 
 3. Strong bichloride of mercury {corrosive sublimate) solution 
 (1-5-0O). Dissolve one ounce of bichloride of mercury in four 
 gallons of hot water. A little blueing should be added to color the 
 solution and indicate its poisonous '.character. Bichloride of mer- 
 cury solutions must be made in glass, enameled or earthenware 
 vessels .as they corrode metals. 
 
 4. Bichloride of mercury (-corrosive ewbUwccte) solution 
 (1-1,000). Dilute one part of bichloride of mercury solution 
 number 1 (paragraph 3, above) with an equal quantify of water. 
 
 5. Aloonol solution. Four parts of §5> per cent alcohol and one 
 part of water. 
 
 6. Chloride of lime solution (10 per cent). Prepare by adding 
 % pound of good chloride of lime to one gallon of water and mix- 
 ing thoroughly. This should be prepared only as needed. 
 
 7. MiTIc of lime. Owing to the importance of nsing freshly pre- 
 pared solutions and the favorable effect of the heat produced hy 
 slaking upon the efficacy of the disinfection, the following method 
 is recommended: 
 
 (a) Add unslaked lime directly to the infective material, sus- 
 pended in water, in the proportion of one part to eight parts of the 
 material. 
 
 (h) When a solution is required the lime should he slaked fey 
 mixing one part of lime with four of water and adding one part 
 of this solution to one part of the material disinfected; hut this 
 solution TErnst be used promptly. 
 
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53 
 
 Air-slaked lime will not serve.. 
 
 Preparation of liquor cresolis compositUs. Mix 1 pound green w<n">r c«Mii« 
 soap with IT ounces cresol and sufficient water to make: 3-i ounces 
 of solution. -The preparation should be made in wooden bucket 
 or an earthenware jar. For economy this should be purchased in 
 barrel lots by the local board of health. 
 
 Caution: poisoning and antidotes 
 
 Carbolic acid and bichloride of mercury are violent corrosive Antidotes - 
 poisons and great care should be taken to see that disinfectant solu- 
 tions are kept out of the reach of children. If, by accident, a dis- 
 infectant solution is swallowed, a physician should be sent for at 
 once. Do not wait until he arrives, but give the proper antidote 
 as quickly as it can be prepared. 
 
 Antidotes for carbolic acid. Olive oil, and castor oil. cirque acid. 
 
 Antidotes for bichloride of mercury. Eaw eggs, flour paste, S^" 6 of 
 and milk. 
 
 Try to provoke vomiting so as to empty the stomach. For this 
 purpose give mustard and water, or salt and water, or tickle the 
 back of the throat. 
 
 The disinfection of discharges 
 
 The disinfection of sputum and of discharges from the mouth, 
 throat and nose, and from the eyes and ears. The communicable 
 diseases in which these discharges are to be regarded as of especial 
 significance as the conveyors of infective agents are: diphtheria., 
 measles, mumps, chiekenpox, whooping cough, tuberculosis, epi- 
 demic cerebrospinal meningitis, poliomyelitis, epidemic strepto- 
 coccus or septic sore throat, scarlet fever and smallpox. 
 
 Sputum and other discharges from the mucous membranes are Disinfection of 
 
 ■*- , sputum and 
 
 not easy to disinfect because the disease-inciting organisms are apt discharges 
 
 d . cj u ± from mucous 
 
 to be enveloped in mucus, which disinfectants do not readily pene- Inem,,, ™ i ' 
 trate. The strong carbolic solution, 5 per cent,, is most efficient 
 for this purpose. Sublimate solution is not so effective because in 
 its presence a layer of albuminate of mercury is formed about the 
 microorganisms, preventing' access to them. 
 
 Sputum, when in considerable quantity, should be received, if 
 practicable, in paper cups which with their contents may be burned. 
 If this is not practicable it may be received in ordinary cups con- 
 
 Digitized by Microsoft® 
 
Discharges 
 from 
 
 e'imentary 
 canal and 
 urinary tract. 
 
 CD is charges 
 from genital 
 tract. 
 
 Discharges 
 from oTien 
 wounds. 
 
 54 
 
 taining the strong 5 per cent carbolic solution. When not in large 
 quantities, sputum and other infective discharges from the mouth, 
 throat and nose, and discharges from the eyes and ears should be 
 received on cheap cloths or soft paper, and promptly burned. If 
 handkerchiefs are used to receive infective discharges, they should 
 be immersed in the carbolic solution, before the discharges dry. 
 After immersion for one hour in an abundant volume of the solu- 
 tion, handkerchiefs or other contaminated fabrics may be 
 laundered. 
 
 The disinfection of discharges from the alimentary canal and 
 urinary tract. The communicable diseases in which these dis- 
 charges are especially significant are typhoid fever, and para- 
 typhoid fever, in both of which the urine as well as the intestinal 
 discharges may harbor infective agents, dysentery, and Asiatic 
 cholera. In the latter cases vomited material may also be infective. 
 
 In the above diseases the discharges from the bowels, and the 
 urine should be received in bed-pans or other vessels containing a 
 small amount of chloride of lime solution.* A quantity of chloride 
 of lime solution, eqtial to twice the volume of the discharge, 
 should at once be added, and fecal lumps broken up and thoroughly 
 mixed. The receptacle with its contents, covered to exclude flies, 
 should stand for at least an hour before being emptied into the 
 water-closet, privy or trench! The trench should be 1 foot wide, 
 3 feet deep, 4 feet long, covered with a plank to exclude flies or 
 snow. 
 
 After emptying the pans or other vessels which have received 
 such discharges, they should be immersed in a disinfecting solu- 
 tion, and the hands of the attendant should at once be carefully 
 cleansed or disinfected. Neither the disinfection of the discharges 
 nor the cleansing of the hands should be delayed. 
 
 The disinfection of discharges from the genital tract. If copi- 
 ous, these should be collected on dressings of sterile absorbent 
 cloths and burned. 
 
 The disinfection of discharges from open ivounds and from 
 ulcerating surfaces on the skin. These discharges also should be 
 collected on dressings of sterile, absorbent cloths and hurned 
 
 One-half pound to a gallon of water. 
 
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55 
 
 The disinfection of clothing, bed linen, towels, napkins, and $$$?*' eto 
 similar articles which have been contaminated with infective dis- 
 charges. Such articles should be soaked in carbolic solution (2% 
 per cent) for one hour or longer. Then, after wringing out, they 
 should be boiled for twenty minutes in the soapsuds solution, and 
 laundered as usual. 
 
 Outer garments of woolen stuffs, mattresses, pillows and similar 
 articles which it would be a hardship to destroy, should be disin- 
 fected by exposure to formaldehyde gas, in a closed room (see 
 p. 59) or in special receptacles or chambers designed for this pur- 
 pose; or, they may be sterilized by steam, when the facilities for 
 such form of disinfection are available. 
 
 The disinfection of the person 
 
 the skin. 
 
 The disinfection of the skin. The disinfection of the skin D f isi,f Hl *' 
 
 requires special procedures, for in the calloused or roughened 
 areas, dirt secretions and microorganisms collect and the fatty or 
 sebaceous material present prevents the penetration to the organ- 
 isms of aqueous solutions of disinfectants. 
 
 Simple but thorough cleansing with soap and water is the most 
 important feature in skin disinfection and must suffice for much 
 of the general routine in the care of the patient. But any part of 
 the surface of the body of the patient or of his attendants which 
 has been contaminated with infective discharges should at once 
 be washed with the carbolic solution (2% per cent) or with the 
 1 to 1,000 sublimate solution, and then washed with soap and 
 water. Alcohol (75 per cent) is also a most serviceable disin- 
 fectant for the skin and will remove the sensation of numbness 
 induced by carbolic solutions. 
 
 A basin of carbolic solution (2% per cent) or of sublimate 
 solution 1 to 1,000, as well as soap and water, should always be 
 accessible to a room in which a case of communicable disease is 
 isolated, so that nurses and attendants may quickly rinse and dis- 
 infect and wash their hands after attending to the patient. 
 
 By the use of rubber gloves much of the discomfort from fre- Eubb8r & l0Te »- 
 quent cleansing and soaking of the hands in disinfectants may be 
 avoided. Bubber gloves are readily disinfected in the strong car- 
 bolic solution, 5 per cent, or in the strong bichloride solution' 1 to 
 
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56 
 
 For 
 
 hypodermic 
 injection. 
 
 Disinfection of 
 
 mucous 
 
 membranes. 
 
 Alkaline 
 mouth wash. 
 
 Acid mouth 
 wash. 
 
 500 j or sterilized by five minutes' boiling. After disinfection or 
 sterilization they should be dried and kept well-powdered. 
 
 For hypodermic injection, or similar treatment, the site of pane- 
 tare or erosion, after cleansing with soap and water, may be dis- 
 infected with alcohol, or alcohol and ether, or by the application of 
 tincture of iodine, U. S. P. 
 
 The procedure required for such disinfection of the hands, as is 
 necessary in surgical operations, is outside the scope of these 
 regulations. 
 
 The disinfection of mucous membranes. Owing to the delicacy 
 of these structures and the inconvenience and risk involved in 
 their injury, it is impracticable to bring disinfectant solutions into 
 sufficiently close contact with microorganisms which they may har- 
 bor in their various recesses and to secure the necessary time of 
 exposure to the solutions, to obtain even approximate disinfection. 
 Here, therefore, as in the case of the skin, it is intelligent cleansing 
 rather than technical disinfection which must be relied on. 
 
 Though antiseptics may be used for cleansing purposes, in the 
 mouth for example, the period of contact between them and the 
 germs is at best too short for the development of their inhibitory 
 effects. 
 
 For the cleansing of the mouth, an alcoholic wash or gargle is 
 among the most serviceable of the antiseptic solutions. A con- 
 ventional formula for such a purpose, made either alkaline or acid 
 as may be desired, is as follows : 
 
 Alkaline solution 
 
 Sodium bicarbonate 0.5 
 
 Glycerine 10 
 
 Alcohol 30 
 
 Water 60 
 
 Acid solution 
 
 Vinegar 10 
 
 Glycerine 10 
 
 Alcohol 30 
 
 Water 50 
 
 These as well as many other bland solutions in common use, are 
 Digitized by Microsoft® 
 
especially valuable in connection with, the frequent aiad intelligent 
 toilet of the month. By care exercised in this way one may best 
 safeguard' himself and others against the distribution and the 
 reception of the infective microorganisms which are so frequently 
 harbored in the mouth both by the victims of infection and by 
 " carriers." 
 
 While the cleansing of the mouth with or without antiseptics, 
 is important, it in no way supersedes the necessity for the careful 
 disinfection of the sputum or other discharges from the mouth in 
 cases of communicable disease. 
 
 The mucous membrane of the nose is less tolerant than that of 
 the mouth and throat to efficient disinfecting solutions or processes. 
 Here also the simple measures of cleansing with bland washes, 
 which may or may not be antiseptic, must suffice. 
 
 The mucous membranes of the female genital tract which may 
 harbor infective organisms may be cleansed with antiseptics, but 
 cannot be effectively and safely disinfected. 
 
 Disinfection of instruments. Instruments may be sterilized by ^^"ant™ ° f 
 boiling for five minutes in water to which about 1 per cent of 
 sodium carbonate has been added. 
 
 Thermometers, when in frequent use in the sick room, should 
 be kept in a 2% per cent carbolic solution. 
 
 Disinfection of foods. Thoroughly cooked foods and drinks f™ff Mti0B of 
 which have been boiled for ten minutes are free from all disease 
 germs. 
 
 Remnants of food from the sick room should be burned ; or, if 
 more convenient, soaked for an hour in 5 per cent carbolic solu- 
 tion or in milk of lime. 
 
 Disinfection of eating utensils. Eating utensils Used by a patient Sth5° ctlon ° f 
 affected with a communicable disease, such as knives, forks, spoons, lItendlSi 
 dishes, etc., should be reserved for him and after use should either 
 be boiled for ten minutes in soapsuds, or washed first in 5 per cent 
 carbolic solution, then in hot soapsuds and rinsed in water. 
 
 Disinfection of the person at the end of the isolation period. peSon "after ° f 
 If all necessary precautions have been earried out during the isola- periS™ 1 
 tion period, additional measures of disinfection are unnecessary 
 on release, except in cases of scarlet fever, smallpox and chicken- 
 pox. After these diseases the person of the patient and his 
 
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58 
 
 Disinfection of 
 rooms. 
 
 Cleansing: 
 
 Renovation. 
 
 attendants should be cleansed by washing the entire body and 
 hair with soap and water; brushing the teeth, rinsing the mouth 
 and gargling the throat with an antiseptic solution (see p. 56). 
 There should also be a complete change of underclothing. 
 
 The disinfection of contaminated rooms and their contents 
 
 Rooms in which floors and walls or contents have been contam- 
 inated with infective discharges through occupancy by a case of 
 communicable disease, should be cleansed and if necessary disin- 
 fected and renovated before being occupied by others. While all 
 such rooms and their contents should be cleansed, the necessity for 
 rigorous disinfection will depend upon the degree of intelligent 
 care which has been exercised in the disposal of infective discharges 
 during the progress of the disease. If these have been properly 
 cared for, thorough cleansing and airing will in most instances 
 suffice. In other cases, in addition to cleansing, renovation or dis- 
 infection may be required. 
 
 It will be remembered that during prolonged drying and expos- 
 ure to sunlight pathogenic microorganisms tend to die and become 
 less virulent. So that exposure of rooms and their contents to air 
 and sunlight both during and after their occupancy by a case of 
 communicable disease, is an important factor in maintaining as 
 well as in restoring the healthful conditions of the place. 
 
 The necessary cleansing and disinfection of rooms will be the 
 more easily accomplished, the more completely they have been 
 freed at the commencement of the case, from upholstered furniture, 
 carpets, rugs and curtains and the like. If these are present and 
 there is reason to suspect their serious contamination, recourse to 
 disinfection by formaldehyde gas (see page 59) may be necessary. 
 This may be done either in the room or elsewhere in specially pro 
 rided chambers. 
 
 Cleansing. After the destruction of such contaminated material 
 as may remain, and such airing and exposure of the room to sun- 
 light, as may be practicable, and after the dust has settled, the 
 woodwork and plain furniture should be washed and the floor 
 scrubbed with soap and water. 
 
 Renovation. When in the opinion of the health officer the paper- 
 ing or the walls of the room are contaminated, through long occu- 
 
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 pancy of the room by a case of communicable disease from which 
 a general dispersal of infective material is probable, renovation of 
 the room may be required. 
 
 Disinfection. When disinfection of a contaminated room and Disinfection, 
 its contents is required, it should first be cleaned as above 
 described. Then, if its finishing and furnishing permit, the wood- 
 work and the floor should be washed with bichloride solution 
 (1-1,000). After this has dried the powdery residue of sublimate 
 may be wiped from the woodwork and floor with a moist cloth. 
 
 If the finish of the walls and the presence of such furnishings 
 and hangings as cannot be disinfected by solutions prevent the use 
 of the above simple method, recourse may, if deemed necessary, be 
 had to gaseous disinfection with formaldehyde. 
 
 Disinfection with formaldehyde gas. This requires the pres- reinfection 
 ence of moisture, free access of the gas to all the surfaces of the formaldehyde 
 room and its contents, and a prolonged exposure to standard per- 
 centages of the gas at a moderately elevated temperature. It is 
 essential for this operation that the room be completely sealed dur- 
 ing the exposure to the gas. 
 
 Preparation of the room. Except one door for the exit of the Preparation of 
 
 L ' x the room. 
 
 operator, all doors, windows and flues should be closed and sealed 
 from the inside by pasting paper over all the holes and cracks. All 
 closets, drawers, trunks and boxes and the like should be opened, 
 and all clothing and fabrics shaken out and hung about the room 
 on chairs or clothes horses, to secure free access of the gas since its 
 penetrative power is not great. Books may be held open by turn- 
 ing back the covers till they touch and clamping them in this posi- 
 tion with a wooden clothespin. The room should be heated to 60 
 degrees Fahrenheit and sufficient moisture (60 per cent) satura- 
 tion obtained by boiling water in a large, open receptacle in the 
 room. (These requirements are important only in cold winter 
 months. ) 
 
 Preparation of the disinfectant. The quantities of disinfectant „ f re ^ e rati ° n 
 to be used are computed by measuring the room. By multiplying disinfectant. 
 the length, the breadth and height together and dividing by 1,000 
 the number of thousand cubic feet is determined. For example : 
 A room 24 feet long, 13% feet wide and 12% feet high, disregard- 
 ing fractions, contains (24 x 13 x 12) 3,744 cubic feet or 3.7 
 (3%) thousand cubic feet. 
 
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Take ten ounces of a 40 per cent solution of formaldehyde and 
 five ounces of crystalline permanganate of potassium for each 1,000 
 cubic feet. The room mentioned above would need 38 ounces of 
 formaldehyde-, and 20 ounces of permanganate. Place the perman- 
 ganate in a dishpan or similar vessel large enough to hold as many 
 gallons as there are pints of formaldehyde, to make sure the liquid 
 will not boil over. This pan is set inside a slightly larger wooden 
 pail, tub or crock, to retain tie heat generated in the mixture. 
 These vessels containing the permanganate are placed in the center 
 of the room. 
 
 The process of disinfection. The formaldehyde is then poured 
 from a pitcher onto the permanganate. The evolution of the gas is 
 immediate and rapid and the gas is an irritant to mucous mem- 
 branes so that the operator must instantly retire from the room, 
 close the door and seal the cracks and keyhole. The room is kept 
 closed and sealed for at least six hours. The room then may be 
 opened, thoroughly aired and cleansed. 
 
 Formaldehyde gas disinfection is fairly effective if applied as 
 above directed, with strict attention to all the details of the opera- 
 tion. Some pathogenic bacteria, even non-spore-bearing forms, 
 are very resistant and may escape destruction in the usual pro- 
 cedure. Its highest efficiency is secured in specially constructed 
 chambers where the conditions of moisture, temperature and pene- 
 tration can be controlled. Properly constructed steam disinfect- 
 ing chambers are adapted to this purpose. There are numerous 
 modes of liberating the gas and various machines and devices for 
 the purpose, but the above method is on the whole the most simple 
 and effective. The gas thus applied does not injure delicate 
 fabrics or books. 
 
 The disinfection of various articles and places* 
 
 The treatment of the body of one dead of a communicable 
 disease. The nose, mouth and rectum should be packed with 
 absorbent gauze or cotton soaked with the strong bichloride solu- 
 tion, 1-500. The body, without washing, should then be wrapped 
 in a sheet saturated with bichloride solution, 1-50O and placed at 
 
 * The routine practice- ef disinfection in institutions is often subject to 
 modifications which are to be found in other publications of the Department. 
 
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61 
 
 once in a sealed coffin or casket which should foe immediately and 
 permanently closed. 
 
 Cleanliness and disinfection of toilet ■apartments, spittoons, cleanliness ana 
 sinks, surfaces, etc. The seats of waterclosets and privies, the n ^f ! * t 5 part " 
 bowls of water-closets or other receptacles for human excreta, 
 spittoons, sinks and the woodwork about them, refrigerators, dumb 
 waiters and all articles frequently used or handled by the public, 
 such as woodwork, seats, floors, desks, door handles and the like, 
 in schools, stores, factories, shops and all public conveyances and 
 assembly places should, when practicable, be frequently scrubbed 
 with hot soapsuds or strong soda solution. 
 
 Cesspools and privy vaults should be frequently cleaned and if 
 necessary deodorized. 
 
 The dwdwization of foul and offensive material. When, Deodomation. 
 through the neglect of cleanliness and the common decencies of 
 sanitation, garbage, sewage, manure heaps, cesspools, privy vaults, 
 stables, etc., have become foul and offensive, they may be treated 
 (in accordance with the experiments and recommendations of 
 Doty), with a mixture of slaked lime and copper sulphate. This, 
 when properly applied to ' or mixed with offensive surfaces and 
 substances, acts as a powerful deodorant. 
 
 The formula for this mixture, called the " copper lime mix- '^ t ^^ ime 
 tare," is: 
 
 Sulphate of copper One pound 
 
 Fresh unslaked lime One pound 
 
 AYater Ten gallons 
 
 To prepare it, slake the lime by stirring in two gallons of water. 
 Dissolve the copper sulphate (" blue vitriol "), in eight gallons of 
 water. This is most easily done by suspending the crystals, tied 
 in a thin cloth just heneath the surface of the water, since in this 
 way they dissolve more readily than if lying at the bottom. 
 
 jSTow mix the slaked lime and the copper solution with stirring. 
 A copious precipitate forms which should remain, and hef ore using 
 the mixture this should he stirred up and kept in suspension, so as 
 to he delivered with the fluid. 
 
 This copper-lime mixture should be stirred in with the offensive 
 material in the proportion of ahout one gallon to thirty or forty 
 of the material, fluid or semi-solid. It may also he applied to 
 
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62 
 
 Disinfection 
 nostrums. 
 
 Preparation 
 and care of 
 sickroom. 
 
 surfaces, such as foul boarding, urine-soaked stable floors, gutters, 
 etc., with a white wash brush, or it may be delivered from a garden 
 watering pot, with the holes at the spout slightly enlarged. 
 
 Disinfection nostrums. The use of proprietary and widely 
 advertised so-called disinfectants, is not recommended. They are 
 usually of little or indeterminate value, often rank nostrums and 
 wholly useless. They are unnecessarily costly, and commonly 
 serve only to divert attention from that simple cleanliness and the 
 adequate use of soap and water through which alone proper sani- 
 tary conditions can be secured and the spread of communicable 
 disease prevented. 
 
 Especially to be avoided are the hosts of highly vaunted aro- 
 matic substances which dropping from one form of fancy recep- 
 tacle or another, give forth a more or less pungent odor. These 
 aromatic odors set free in toilet or other rooms are wholly void 
 of sanitary virtue. They neither kill nor incommode disease or 
 other germs which indeed do not inhabit the air. They serve only 
 to conceal offensive odors from decomposing or otherwise foul 
 material, which should be removed by cleansing, not masked by 
 the infliction of more potent smells. 
 
 The conduct of the isolation period 
 
 Preparation and care of the sick room. A room apart from 
 others so far as practicable should be chosen. Upholstered furni- 
 ture, carpets, rugs, curtains and the like, and everything which is 
 not necessary for the care of the patient and which is liable to 
 become contaminated should be removed. Throughout the course 
 of the disease attention should be directed to cleansing, airing, and 
 ventilation. The routine washing and scrubbing of woodwork and 
 floors should be done with soapsuds. (See page 58.) Dusting 
 should be carried out with moist cloths which have been wrung 
 out in sublimate solution (1-1,000) ; special attention being given 
 to the door knobs and neighboring woodwork, owing to their pos- 
 sible contamination from unwashed hands. In case of accidental 
 contamination of any object or surface in the sick room by infec- 
 tive discharges the discharge should be wiped up by cloths soaked 
 in strong carbolic solution, 5 per cent, and the contaminated sur- 
 face covered with strong carbolic solution, 5 per cent, for an hour. 
 
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63 
 
 Attendants and nurses. The choice of attendants and nurses, and nurses, 
 and the admission of visitors, should be influenced by their relative 
 insusceptibility to the more readily communicable diseases; also, 
 the practicability of artificial immunization should be considered, 
 as in smallpox, diphtheria and typhoid fever and whooping cough. 
 In order to protect the clothing and safeguard the person, caps, 
 gowns, rubber aprons and rubber gloves are desirable for all 
 attendants, since they can be frequently changed, cleansed and 
 disinfected. 
 
 The spread of infective material from acute cases of communi- 
 cable disease would be greatly limited if physicians, nurses, and 
 attendants, as a matter of routine, would wash their hands when- 
 ever they leave the sickroom, and in cases of obvious contamination 
 disinfect them. 
 
 At the conclusion of the case those measures for the cleansing 
 and disinfection of the person and of the premises should be prac- 
 ticed which are given in detail on pages 57 and 55. 
 
 The risks from carriers would be diminished if at the close of f x a a c ^J ions 
 convalescence, especially in diphtheria and typhoid fever, bac- H*/^™. 
 terial examinations were made, not only of the patient, but of the 
 nurses also, to determine in what cases special precautions should 
 be taken in the care of the discharges and excreta. 
 
 to detect 
 carriers. 
 
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64 
 
 CHIEF CO-OPERATING AGENCIES IN TUBERCULOSIS 
 WORK IN NEW YORK STATE 
 
 1 The Physician 
 
 Physicians are required to 
 
 (a) Report every case of tuberculosis to the local Health 
 Officer within twenty-four hours after the diagnosis is 
 made, upon an official report card. 
 
 (b) Advise the Health Officer at once whether or not you 
 wish to care for the patient and will maintain constant 
 supervision. 
 
 (c) Take all necessary precautions to prevent the spread 
 of the disease and instruct the patient and family in 
 the requirements of the law. 
 
 (d) Requisition from the Health Officer the supplies — 
 sputum cups and holder, disinfectant, water-proof bags 
 and paper napkins — necessary to prevent the spread 
 of the disease. 
 
 (e) Complain to the Health Officer of dangerous and 
 careless patients. 
 
 (f) Notify the Health Officer when any premises are 
 vacated by death or removal of any patient having 
 tuberculosis. 
 
 (g) Report to the Health Officer the recovery of any 
 patient. 
 
 2 The Public : 
 
 Any member of the community may 
 
 (a) Send a signed report to the Health Officer of any 
 persons who appear to be suffering from tuberculosis. 
 
 (b) Complain in writing to the Health Officer of any 
 person who disposes of his sputum in such a way as 
 to be dangerous or offensive to his associates. 
 
 (c) Notify the Health Officer of the death or removal of 
 any tuberculous patient. 
 
 All should study the official circular of information on 
 tuberculosis and observe all precautions advised therein. 
 
 3 The Local Health Officer 
 
 The local health officer is charged with the enforcement of 
 the tuberculosis law and certain sections of the Sanitary' 
 
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61 
 
 Code relating to tuberculosis. The more important of these 
 duties include the following: 
 
 (a) Keeping a record of all cases of tuberculosis, the re- 
 porting of which is mandatory upon physicians. 
 (Section 320, Public Health Law.) 
 
 (b) Inspecting premises after death or removal of tuber- 
 culous patients, and directing proper cleansing and 
 disinfection of these premises. (Section 323, Public 
 Health Law.) 
 
 (c) Investigating all complaints of dangerous and care- 
 less- tuberculous patients when complaint is made 
 to him. (Sections 326 and 326-a, Public Health 
 Law.) 
 
 (d) Providing prophylactic supplies, su|ch as sputum 
 cups, holders, paper napkins, etc., upon request of a 
 physician. (Section 328, Public Health Law.) 
 
 (e) Furnishing circulars of information regarding tuber- 
 culosis to physicians for their patients, and to patients 
 themselves when no physician is in attendance. (Sec- 
 tion 328, Public Health Law.) 
 
 (f ) Furnishing free laboratory examination of specimens 
 of sputum. (Section 321, Public Health Law.) 
 
 (g) Maintaining sanitary supervision of patients where 
 there is no physician in attendance, or where the 
 attending physician delegates that duty to the health 
 officer. (Sections 327 and 328, Public Health Law.) 
 
 (h) Investigating any suspected or apparent tuberculosis 
 case reported to him. (Section 320, Public Health 
 Law.) 
 (i) Making application for admission of patients to Ray- 
 brook when applied to. (Section 160, State Charities 
 Law.) 
 Tuberculosis Visiting Nurse 
 
 The tuberculosis visiting nurse is charged with the discov- 
 ery, supervision, and after-care of tuberculosis cases. Such 
 nurses may be employed by : 
 
 (a) Board of health of a city, town, or village. (Section 
 21-c, Public Health Law.) 
 
 (b) Local tuberculosis association or kindred organization, 
 in a city or village. 
 
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 (c) Jointly by local board of bealtb and local tuberculosis 
 organization in a city or village. 
 
 (d) County tuberculosis hospital. (Section 47, subd. 9, 
 County Law.) 
 
 (e) Board of supervisors in a county not having a hospital 
 for tuberculosis established under the county law. 
 (Section 47, subd. 9, County Law.) 
 
 (f) County tuberculosis committee or kindred organiza- 
 
 tion. 
 Free Dispensaries and Clinics 
 
 Such dispensaries and clinics are maintained by local 
 boards of health, hospitals, or by local tuberculosis committees 
 or kindred organizations. Their purposes are to provide for 
 the medical examination, advice, treatment, and assistance 
 of patients who do not, for one reason or another, go to 
 tuberculosis institutions or who have been discharged there- 
 from; and to act as a bureau of admission to hospitals and 
 sanatoria for such patients as can and will go. 
 Local Tuberculosis Associations 
 
 The local tuberculosis association may be a village, city, 
 or county group. Its work is usually supported through the 
 annual sale of the Red Cross Christmas Seals. 
 
 Its activities may include among others some or all of the 
 following ; 
 
 The employment of nurses to visit and instruct cases of 
 tuberculosis and to discover new cases. 
 
 Maintenance of free tuberculosis dispensaries or clinics. 
 
 Maintenance of fresh air classes or open air schools for 
 pretuberculous children. 
 
 Visitation of county tuberculosis hospitals. 
 
 A campaign of public education as to tuberculosis. 
 Charitable Associations and Charity Organization Society 
 
 A charity organization society usually has in its directing 
 board representatives from the various churches and chari- 
 table agencies in a city. Its objects are to promote harmoni- 
 ous cooperation between these organizations, prevent the evils 
 of duplication and imposition, insure adequate relief, assist 
 in the reconstruction of disorganized family life, and insti- 
 
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67 
 
 tute movements for the general welfare of the poor, or induce 
 others to do so. 
 
 8 Confidential Exchange Registration Bureau 
 
 Such exchanges usually maintain a catalogue of the names 
 and addresses of all dependent families under the care of 
 cooperating agencies using the exchange. Thus the privacy 
 of the family is safeguarded and at the same time it is pos- 
 sible for one agency to learn what other agencies are helping 
 or have helped the family or person who has come to it for 
 assistance. Duplication is minimized and a maximum 
 amount of cooperation between the organizations is promoted. 
 
 9 Overseer of the Poor 
 
 The overseer of the poor provides outdoor relief for indi- 
 gent tuberculous cases in counties where the maintenance of 
 the poor is a town or city function. 
 
 10 County Tuberculosis Hospital 
 
 The county tuberculosis hospital provides hospital care for 
 tuberculous cases, and through its superintendent receives 
 applications for admission from patients residing within the 
 county, or from superintendents of the poor of other counties 
 desiring to place their patients in such institutions. The 
 medical superintendent is the executive officer of the hospital. 
 
 11 County Superintendent of the Poor 
 
 The county superintendent of the poor may provide out- 
 door relief for indigent tuberculous cases in counties where 
 the maintenance of the poor is a county function. Provides 
 transportation to, and maintenance in hospitals for patients 
 from county having no hospital. 
 
 12 County Agent for Dependent Children 
 
 A county agent may be employed by a board of supervisors, 
 or by a county committee on dependent children, or kindred 
 organization. Such a county agent has the supervision of all 
 dependent children, and the investigation of cases where 
 children are in danger of becoming dependent, prosecuting 
 parents for neglect, securing court action for the removal of 
 children from improper guardianship, and supervising board- 
 ing homes for children. 
 
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 13 State Charities Aid Association, Committee on the Prevention 
 
 of Tuberculosis 
 This Committee is engaged with the cooperation of the 
 State Health Department in organizing, coordinating, unify- 
 ing, and giving leadership and direction to the tuberculosis 
 movement in the state exclusive of New York city. The 
 Committee, for the most part, works directly with the 150 or 
 more local tuberculosis committees which it has organized. 
 Its activities include: 
 
 Carrying on a campaign of public information regarding 
 
 tuberculosis. 
 Urging the provision by proper authorities of hospitals for 
 
 tuberculous patienta 
 Securing the employment of visiting nurses by public or 
 
 private groups. 
 Securing the establishment of preventoria, dispensaries, 
 
 and fresh air classes by public or private groups. 
 Promoting the sale of Eed Cross Christmas Seals through- 
 out New York State, the proceeds of which finance in 
 large measure the antituberculosis work carried on by 
 its affiliated organizations. 
 Serving as a bureau of advice, information, and assistance 
 to local committees and individuals seeking such help in 
 matters relating to tuberculosis and the tuberculosis 
 movement. 
 Advising and assisting in the preparation and presentation 
 of constructive legislation. 
 
 14 State Department of Health 
 
 (a) Furnishes expert assistance and advice to local health 
 authorities, health officers, physicians, nurses and anti- 
 tuberculosis organizations. 
 
 (b) Has authority to inspect local tuberculosis hospitals 
 and dispensaries. 
 
 (c) Employs supervising nurses to aid and advise local 
 health officers, nurses, etc. 
 
 (d) Furnishes literature for distribution on the subject of 
 tuberculosis. 
 
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69 
 
 (e) Supplies report cards for cases and requisition cards 
 for supplies to health officers and physicians. 
 
 (f) Maintains state registration of all tuberculosis cases 
 reported from the State outside city of New York. 
 
 (g) Furnishes educational matter in the form of slides, 
 exhibits and lectures for the dissemination of knowl- 
 edge regarding tuberculosis. 
 
 (h) Furnishes free laboratory examination of specimens 
 of sputum or pathological material submitted by 
 physicians through local health officers. 
 
 (i) Approves location, plans and equipment for county 
 tuberculosis hospital and approves site for any 
 tuberculosis hospital or camp located in a town. 
 
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10 
 
 COOPERATION BETWEEN COUNTY AND, CITY OR 
 VILLAGE TUBERCULOSIS NURSES 
 
 For the success of any tuberculosis campaign not only are nurses 
 a vital necessity but their harmonious cooperation is absolutely 
 essential. In order to secure the results obtainable by this means 
 alone, the respective spheres of action and scope of duties of 
 county nurses and of city or village nurses in the counties must 
 be clearly denned. 
 
 With reference to the records the county nurse should have a 
 file card for every known case of tuberculosis in the county, includ- 
 ing the cities and villages thereof. In those cities and villages 
 where a nurse is employed for or by the municipality to perform 
 tuberculosis duties such nurse keeps a complete history and record 
 of local patients and their families. The county nurse keeps a 
 file card of such cases — the data for which she obtains from 
 the local nurse — merely to be informed as to the actual number 
 of cases in the county. The complete history, family contact 
 cards, etc., of all cases in the county, other than those in the 
 municipalities specified, are kept by the county nurse. 
 
 With regard to the care and supervision of patients, the local 
 nurse is responsible for all cases in her locality during the stay 
 of such patients at home, including the period prior to admission 
 to an institution (when this is being sought) and that following 
 discharge therefrom. The supervision of the local patients' 
 families is the duty of the local nurse at all times, regardless of 
 where the patients may be. All contacts should be examined at 
 the local dispensary if one is in operation. The care and super- 
 vision of all other patients in the county and of their families is 
 the duty of the county nurse. 
 
 When a patient is to be admitted to the county institution this 
 matter should be referred to the county nurse who makes appli- 
 cation to and all other necessary arrangements with the institu- 
 tion's superintendent. 
 
 USTo patient, under the jurisdiction of a local nurse, should be 
 visited by the county nurse except after consultation with the 
 former. In the case of patients returned to their homes after dis- 
 charge from the county institution — in which instances the county 
 nurse is responsible to the superintendent of the sanatorium, for 
 
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 a monthly statement as to the condition of such patients — said 
 information may be obtained from the local nurse or by a direct 
 call upon the patient, if the superintendent so directs, and after 
 conference with the local nurse. 
 
 Wherever there exist local conditions tending to, or actually 
 hindering . the desired harmonious cooperation between county 
 nurses and local nurses in their counties, and where no satis- 
 factory arrangement can be arrived at by the superintendent and 
 board of managers of the county tuberculosis institution on the 
 one hand, and the local health officer, local board of health, local 
 tuberculosis committee, or other agency employing the local nurses 
 on the other, the State Health Department's Sanitary Supervisor 
 for the district and its Supervising Tuberculosis Nurse should be 
 called in consultation with a view to their assisting in the necessary 
 adjustment. 
 
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72 
 
 Note. — The Health Officer is required by law to notify the 
 local poor officer of the town, city or county in which the person 
 desiring free treatment resides, of every application issued by him 
 to the Superintendent of the Hospital. 
 
 APPLICATION OF HEALTH OFFICER* 
 
 FOR ADMISSION OF PATIENT TO 
 
 NEW YORK STATE HOSPITAL FOR INCIPIENT PUL- 
 MONARY TUBERCULOSIS AT RAY BROOK, N. Y. 
 
 Date 
 
 Name of applicant 
 
 Residence 
 
 Occupation 
 
 Habits 
 
 Appearance 
 
 How long ill 
 
 Ceased work when . . . . 
 
 Physician and address 
 
 Age 
 
 Ancestry or race 
 
 Birthplace 
 
 Married or single 
 
 How long a citizen of United States 
 
 How long a citizen of New York State 
 
 Dependents 
 
 Is patient unable to pay for maintenance 
 
 Note. — Children under sixteen years of age not accepted for 
 treatment. 
 
 Signature of Health Officer M, D, 
 
 City or town of 
 
 Post office address 
 
 * See p. 12. 
 
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Tuberculosis Advisory Committee 
 
 John S Billings, M. D., New York City 
 Lawrason Brown, M. D., Saranac Lake 
 Albert H. Garvin, M. D., Ray Brook 
 Horace J. Houk, M. D., Mt. McGregor 
 Walter B. James, M. D., New York City 
 A. Clifford Mercer, M. D., Syracuse 
 DeLancey Rochester, M. D., Buffalo 
 Charles Stover, M D., Amsterdam 
 
 Tuberculosis Committee of the New York State Department of Health 
 
 John A. Smith, M. D. 
 
 Secretary, State Department of Health, Chairman 
 Otto R. Eichel, M. D. 
 
 Director, Division of Vital Statistics, State Department of Health, 
 Vice Chairman 
 M. Edgar Rose, M. D. 
 
 Supervisor of Tuberculosis, State Department of Health, Secretary 
 Edward S. McSweeney, M. D. 
 
 Medical Director, New York Telephone Co. 
 William A Howe, M. D. 
 
 State Medical Inspector of Schools, State Education Department 
 George J. Nelbach 
 
 Executive Secretary, Tuberculosis Committee, State Charities Aid 
 Association 
 Charles E. Holmquist, C. E. 
 
 Assistant Engineer, State Department of Health 
 Frederick Sprenger 
 
 Supervising Inspector, State Department of Health 
 James D. Burt 
 
 Field Agent, State Department of Health 
 
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That, in order to meet the essential indications presented 
 by the tuberculosis problem, namely the prevention, as far as 
 possible, of infection, and, when this has occurred, of the de- 
 velopment of active disease, the securing of arrest of such 
 disease, and the guarding against recurrences, necessitates 
 the effective and harmoniously co-operative functioning of 
 many agencies and the utilization of numerous procedures is 
 generally understood. That of all of the measures the most 
 fundamental and vital is early diagnosis, is obvious. 
 
 The interests of the individual and those of the commu- 
 nity demand such early diagnosis, for it is by means of the 
 discovery of the disease in its incipiency, and by the placing of 
 the patient under proper medical and sanitary supervision that, 
 in the great majority of instances, the patient is practically 
 assured of an arrest of his disease and the other members of 
 the community are protected against infection (efficient 
 pasteurization of all milk and its fresh products, disposing of 
 the bacilli derived from bovine sources). 
 
 Yet, self-evident as is the preceding, it must be acknowl- 
 edged, — and the actual facts are conclusively demonstrated of 
 the truth of this statement, — that such diagnosis is being se- 
 cured in but a small minority of cases. 
 
 It should be thoroughly appreciated that no efforts look- 
 ing to the betterment of the public health which do not take 
 cognizance of man's inherent selfishness — manifested by his 
 desire to benefit personally, specifically and in an appreciable 
 manner, — can hope for the necessary measure of success. The 
 failure to determine the existence of tuberculosis in an indi- 
 vidual until the disease is so far advanced as to make the out- 
 look for apparent recovery practically hopeless will obviously 
 not provide the benefits expected and properly so by those 
 affected. 
 
 A sincere and earnest concentration of effort on this phase 
 of the tuberculosis problem should, and most probablv will be 
 productive of greater benefits, directly and indirectly, than 
 any other procedure. Without early diagnosis, all other meas- 
 ures must, of necessity, fail of any but very partial results. 
 
 M. EDGAR ROSE 
 
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