COLUMBIA LIBRARIES OFFSITE 
 
 HEALTH SCIENCES STANDARD 
 
 HX64170160 
 R A644.T7 N37 1 91 4 The effect of tuberc 
 
 437 
 191 
 
 <FECT OF TUBERCULOSIS 
 
 liNonTUTIONS ON THE VALUE 
 
 AND DESIRABILITY OF 
 
 SURROUNDING 
 
 PROPERTY 
 
 By 
 
 THE, NATIONAL ASSOCIATION FORTHE STUDY 
 AND PREVENTION OF TUBERCULOSIS 
 
 "The trouble with this matter is that 
 antiquated ideas and unfounded impressions 
 still prevail among those who have not made 
 a study of the subject." 
 
 Hamilton W. Mabie 
 
 105 East 22d Street 
 NEW YORK 
 1914 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/effectoftuberculOOnati 
 
£4 
 
TABLE OF CONTENTS 
 
 CHAPTER PAGE 
 
 INTRODUCTION 5 
 
 I. A REVIEW OP PREVIOUS STUDIES 7 
 
 Effect of Any Institution Upon Property Values (7) — Change 
 in Value of Property (8) — Attitude of the Community (8) — 
 Some Individual Instances (9) — A Little Knowledge Dan- 
 gerous (9) — Judgment in Selecting Sites (9) — Where the Danger 
 Lies (10)— A Later Study (10). 
 
 II. A QUESTIONNAIRE STUDY OF EIGHTY-FOUR INSTI- 
 TUTIONS 12 
 
 Length of Operation (12) — Density of Neighboring Population 
 (13) — Character of District (13) — Value of Institution Property 
 (13) — Increase of Surrounding Property (13) — Beneficial Effect 
 of Institutions (14) — An Aid to Health (14) — Increase in Prop- 
 erty Values (14) — No Danger of Infection Spreading (16) — 
 Opposition Does Not Last (18) — Hospitals Benefit Health of 
 Neighbors (19) — An Exception (19). 
 
 III. ASSESSED PROPERTY VALUES AROUND FIVE INSTI- 
 
 TUTIONS 21 
 
 Hospital Within Limits of Large City (21) — Hospital Within 
 City (24)— Hospital Within Half Mile of City (25)— Hospital 
 Near Village (27) — Hospital Located in Farming District (28). 
 
 IV. TYPICAL LAWS AND ORDINANCES COVERING THE 
 
 APPROVAL AND RESTRICTION OF HOSPITAL SITES 30 
 
 New York (30) — New Jersey (31) — Restrictive Ordinances (32). 
 
 V. SOME OPINIONS OF VALUE 34 
 
 Dr. E. L. Trudeau (34)— Hamilton W. Mabie (35)— Dr. E. 
 M. Mason (35) — California Association (36) — Opinions of Life 
 Insurance Companies (36) — San Francisco Health Board (38) — 
 New York State Health Department (39). 
 
 VI. COURT DECISIONS 41 
 
 Boston, Mass. (41)— Asheville, N. C. (41)— Orange, N. J. (41) 
 —Richmond, Va. (42)— Seattle, Wash. (43)— Redlands, Cal. 
 (43)— Houston, Tex. (44). 
 
VII. SUMMARY AND CONCLUSIONS 46 
 
 Hospital not a Menace to Health (46) — Hospital not Detri- 
 mental to Property (47) — Initial Opposition Seldom Lasts (48) 
 —Some Minor Objections to Sanatoria Refuted (49) — Hos- 
 pitals a Benefit to the Community (50) — Some General Sugges- 
 tions as to Location (51). 
 
 APPENDIX 54 
 
 Tables showing change in assessed valuation of surrounding 
 property of five hospitals. 
 
 MAPS facing pages 26-27 
 
 Showing property around Seton Hospital and Montefiore Sana- 
 torium. 
 
INTRODUCTION 
 
 The question of the effect of institutions for the treatment of 
 tuberculosis upon the value and desirability of surrounding 
 property has been and still is raised with almost every attempt 
 to locate a hospital, sanatorium, or dispensary. Nearly all 
 such attempts call forth the same objections which are met 
 with varying effectiveness depending upon the information 
 available. The National Association for the Study and Pre- 
 vention of Tuberculosis has prepared this report, in order that 
 the recital of experience and the opinions contained in it may 
 prevent needless discussion, and facilitate the locating of future 
 institutions by giving all parties concerned access to full and 
 authoritative information on the subject. 
 
 The study is divided into eight parts as follows: 
 
 I. A review of former investigations of this character, 
 including those by William H. Baldwin and Philip P. Jacobs. 
 
 II. Information obtained from a questionnaire study of 
 eighty-four hospitals and sanatoria in all sections of the United 
 States with regard to the change in surrounding property values ; 
 the effect of these institutions on the health of the neighbors; 
 the original reasons for opposition and the present feeling; 
 some material benefits of an institution to the neighborhood; 
 and many pertinent comments by superintendents on all phases 
 of the question. 
 
 III. Facts obtained in a first hand investigation of five in- 
 stitutions in different localities and of different types, to show 
 the rise or fall of assessed valuation of surrounding property; 
 the increase of property values indicated by known sales; the 
 expressed feeling of property owners; and the feeling of the 
 general public. 
 
 IV. A digest of several typical laws regulating the approval 
 of sites, and some restrictive ordinances. 
 
 5 
 
V. Some opinions of eminent men, boards of health, and 
 insurance companies. 
 
 VI. Court decisions relating to the location of hospitals, 
 sanatoria and dispensaries, including the possibility of their 
 being a menace to public health, or a nuisance. 
 
 VII. Summary and Conclusions. 
 
 VIII. Appendix, with assessment tables referring to hospitals 
 in Chapter II. 
 
CHAPTER I 
 
 A Review of Previous Studies 
 
 The first comprehensive investigation of the relation of 
 tuberculosis hospitals and sanatoria to surrounding property 
 was conducted by the questionnaire method, by William H. 
 Baldwin, of Washington, D. C. His report was read before 
 the Second Annual Meeting (1906) of the National Association 
 for the Study and Prevention of Tuberculosis, at Washington, 
 D. C. Liberal quotations presenting the most interesting facts 
 and conclusions from the fund of valuable information col- 
 lected by Mr. Baldwin, are presented here because the original 
 report is not generally available : 
 
 Effect of Any Institution Upon Property Values 
 
 " In studying this effect two elements are to be distinguished, the influence 
 of the building and improvements as such, and the purpose for which these 
 are used. 
 
 " It may be said that as a rule the erection of any building not in itself 
 objectionable, by taking up a certain amount of land and so decreasing 
 the remainder available, while increasing the purposes for which it may be used, 
 enhances the value of the surrounding land and so is an advantage to it. 
 The value of any piece of land is determined by many influences, depending 
 upon the various uses to which it may be put. Unoccupied land is likely 
 to be used first for grazing or farming, then, as population increases, for resi- 
 dences, and later for business purposes, manufacturing or trade, or both. 
 So far as the value of surrounding property is concerned, that building is 
 most desirable which best fulfills the general purpose for which land in the 
 vicinity is used — a good farm-house in the country, or a fine residence on an 
 improved street, or a large store in the business section. 
 
 "A building, no matter what its use, which is discordant in any way 
 lessens the desirability of contiguous property and so detracts from its value, 
 as a store in a residence street. Generally speaking, any large institution 
 of which the inmates are not united by association or community of interest 
 with the people of a closely settled neighborhood, in which it is placed, is a 
 detriment to property about it. Beauty of buildings or of grounds may 
 decrease this disadvantage in spite of the lack of connection between it and 
 its environment. 
 
 " Suburban or country property is not so much affected by such an insti- 
 tution because initial values are less, and may be so low that its presence 
 will cause values to rise. An increase in population, other things being 
 equal, helps values, and the institution may be relatively large enough to 
 
have this effect. Such improvement may be limited and should be compared 
 with what might have taken place or the extent to which it might hereafter 
 be likely to go if there had been no such institution. 
 
 " Hospitals of any kind would be objectionable to some people, partly 
 because of the reason given above and partly because the proximity of suffering 
 or sickness is in itself distasteful. A detention hospital raises this opposition 
 to the superlative degree, and prospective neighbors have been known to 
 fight off such a necessary refuge for the unfortunates requiring treatment 
 somewhere with all the fervor of a holy war. 
 
 " This leads us to the element in the problem of the effect of the institu- 
 tion on the value of surrounding property — the knowledge that it is for tuber- 
 culous patients. In itself, it must be objectionable, for tuberculosis is now 
 known to be communicable rather than hereditary, and those who know no 
 more are likely to fear and avoid it. Fuller knowledge dispels the fear and 
 shows that under the training of a well-conducted sanatorium, there is less 
 danger of infection from a hundred patients than from, two uninstructed 
 consumptives going at will about the streets and disposing of their sputum 
 in the way most convenient for themselves. We cannot overcome all the 
 disadvantages of an institution, as such, but we can and should be sure that 
 it is not in the slightest degree a menace to the health of those who live near 
 it. This danger being therefore imaginary rather than real, there remains 
 the interference with the serenity of people in the neighborhood who come 
 in contact with men and women whose appearance often discloses the struggle 
 for life they are making, in which some are not winning. 
 
 Change in Value of Property 
 
 " In order to learn the facts concerning sanatoria, already established, an 
 inquiry was addressed to seventy-seven of the largest of such institutions 
 throughout the United States and in Canada. 
 
 "Although the question as to any change in the value of the land owned 
 by the institution, measured either by its valuation for taxation when ac- 
 quired and now, or in other ways, bears directly on the subject and was plainly 
 asked, it was not answered in thirty of the responses, and four replied that 
 the land was not valued for taxation. The other twenty-five reported as 
 follows: 3 increased; 3 much increased; 10 doubled in value or more; 9 no 
 change. 
 
 " In no case is it stated that the land on which the institution is situated 
 has decreased in value, and as its worth depends largely upon the value of 
 surrounding property, there is nothing in this to indicate an unfavorable 
 effect of the sanatorium. 
 
 " Coming directly to the difference in the character of value of adjacent 
 property since the founding of the sanatorium, an answer more or less definite 
 has been obtained as to each. 
 
 " In 58 per cent, of the instances, there has been an increase in the value 
 of the land adjacent, accompanied in 17 per cent, by a change for the better 
 in the purposes for which it is used; in 35 per cent., there has been no change, 
 and in 7 per cent., a more or less marked depreciation in land immediately 
 adjoining is admitted. In one instance, this effect is for a distance of 400 to 
 800 feet, in another up to 1,500, while in the other two cases, the opinion is 
 given that the presence of the sanatorium has prevented or would prevent 
 sales. 
 
 Attitude of the Community 
 
 " Connected with the foregoing, both as cause and effect, is the attitude 
 of the community toward the institution. In one case it is not stated, in 
 thirty-seven it is said that there has been no opposition at any time, in two 
 that there was once vigorous opposition, in five that there is some objection 
 still, and in fourteen that there was once opposition, which has since disap- 
 peared." 
 
Some Individual Instances* 
 
 " Some reference to individual instances may be instructive. The Cullis 
 Consumptives' Home for Advanced Cases at New Dorchester, a part of 
 Boston, Massachusetts, was removed to its present location in 1871. There 
 was no opposition then, but there was considerable when a permit was asked 
 for the new building in 1896, due, probably, to the discovery meantime that 
 the disease is communicable. A careful examination showed that there was 
 no danger and proved that the death rate from tuberculosis in that ward was 
 the lowest in the city. Further experience has made warm friends of nearly 
 all those who were in opposition eight years ago. The assessed value of 
 surrounding land is about five times as great as it was in 1870. 
 
 " The Brooklyn Home for Consumptives was established in 1881 and has 
 been removed to another location since. There has been no objection to it 
 in either place. No employee, though some of them have served eighteen 
 years, has ever contracted the disease. The institution is well kept and one 
 of the board of health officers has expressed the wish that there were a hundred 
 more like it. 
 
 " St. Joseph's Hospital for Consumptives, in New York, started in 1882, 
 has apparently had no unfavorable effect upon values, perhaps because it 
 occupies an entire block and is surrounded by a garden which gives light and 
 air to the apartment houses which have since been built up around it. There 
 has never been any opposition to it, and values of adjacent property have 
 increased from one-fourth to one-half. 
 
 " These three are fair examples of the influence of a well-conducted sana- 
 torium in the city." 
 
 A Little Knowledge Dangerous 
 
 "A study of these various instances indicates that twenty years ago there 
 was indifference to the establishment in the neighborhood of an institution 
 for the treatment of tuberculosis. A partial knowledge of the nature of the 
 disease has produced a hyper-sensitiveness in regard to it and developed 
 opposition which a fuller experience removes in time. In some cases this 
 opposition is due to prejudice rather than to any feeling of danger or the 
 possibility of any considerable decrease in the commercial value of property. 
 
 " So in the establishment of a sanatorium, it sometimes seems that the 
 real obstacle is the prejudice, the groundless fear, the unreasonable and un- 
 reasoning opposition of the people, in comparison with which the raising of 
 funds, the removal of rocks, and the construction of buildings are trifles. 
 Where such antagonism exists, whether just or not, it demands consideration 
 and any needless interference with values should be avoided. Experience 
 has proved that there is absolutely no danger from a well-conducted sanator- 
 ium, and that there is no valid reason for fear in regard to it. Too much 
 emphasis cannot be laid upon this point; but it is easier to explain this to 
 the few people in the suburbs or in the country than to the many in a more 
 thickly populated section. Whatever damage there is will be less in the case 
 of property not already very valuable than in that of residential streets or 
 fine suburban homes." 
 
 In discussing this paper at the time it was read, Homer Folks, of New 
 York, said: 
 
 Judgment in Selecting Sites 
 
 " The chairman, Mr. Baldwin, did not refer to our experience in establish- 
 ing a tuberculosis dispensary in the Borough of Brooklyn. The health 
 department of the city endeavored to locate the first and only tuberculosis 
 dispensary in the Borough of Brooklyn. It selected a building and the 
 residents of the neighborhood protested vigorously and finally brought a suit 
 to enjoin the health department from establishing a dispensary at this place. 
 
 * These opinions were given in 1906, it should be noted. 
 
Although those who were interested in the establishment of the dispensary 
 felt no special concern over the suit, feeling sure that no court of high degree 
 would decide that such a dispensary would be dangerous to the health of the 
 residents, they were disappointed. Excellent medical authorities submitted 
 affidavits in evidence showing that such a dispensary would be of absolutely 
 no danger to the community, but in what I think I may call a most extra- 
 ordinary decision, it was held that the evidence of the physicians was not at 
 all conclusive and that there could be no doubt that such a dispensary would 
 be very dangerous indeed to the health of the neighborhood, and the depart- 
 ment was enjoined. That still stands and there is no dispensary there 
 today (1906)." * 
 
 Where the Danger Lies 
 
 Continuing the discussion, John H. Lowman, M.D., of Cleveland, President 
 of the National Association in 1914, remarked: 
 
 "A well-conducted sanatorium is almost absolutely free from danger and 
 it is in no degree a menace to the public. 
 
 " Turban of Davos (Switzerland) states that there has never been but one 
 case of tuberculosis that has developed among his employees — that of a maid 
 who washed the linen of the patients. Although 3,000 patients have been 
 treated in his institution, this is the only case in which there has been any 
 suspicion of contagion. Joel of Goerbersdorf (Germany) has failed to find 
 a single case of infection in the institutions there, although 13,000 patients 
 have been treated in them. 
 
 " Cultures have been repeatedly made from the walls of sanatoria in the 
 wards and rooms where patients stay, and in no case have the bacilli been 
 found. It would seem that a sanatorium is the place most free from dangers 
 of infection. 
 
 "According to Dr. Coate's (Manchester) experiments, 60 per cent, of the 
 houses in which consumptives live are infected. Thus it is the uninformed 
 patient who is a danger to the community and not the supervised patient 
 in a sanatorium. Were these facts known and understood by the public the 
 fear of contagion, which is the origin of the opposition to the sanatorium, 
 would disappear and the present difficulties would cease." 
 
 A Later Study 
 
 In 1909, Philip P. Jacobs, then Assistant Secretary of the Nat- 
 ional Association for the Study and Prevention of Tuberculosis, 
 conducted by the questionnaire method an investigation of 
 the effects of 37 institutions located in 22 different states in all 
 parts of the country. The findings of this investigation were 
 tabulated and given to the press of the country. Some quo- 
 tations are significant : 
 
 "According to information received from sanatorium superintendents, 
 real estate dealers, and various disinterested parties, 76.5 per cent, of these 
 tuberculosis sanatoria have had a favorable influence upon surrounding prop- 
 erty, and have been a benefit to the community in which they were located. 
 In the case of 23, or 62.2 per cent, of the institutions, the presence of the 
 sanatorium helped to increase the assessed valuation of surrounding property. 
 In only one instance has property decreased in value, and there it was due to 
 ignorance of the facts. In 22 out of the 37 cases, the presence of a sanatorium 
 has even been helpful in the recent sale of land, and in only four places has 
 
 * There are now several in other sections of the city, and in this same general neighbor- 
 hood. 
 
 10 
 
any detrimental effect on sales been shown. In 51.3 per cent, of the cases, 
 residents have been attracted to the community by the sanatorium, and in 
 only three localities have residents been repelled. Some examples show the 
 increase in the value of surrounding property. In the vicinity of a sanatorium 
 in Portland, Ore., land has more than doubled in value in three years, and 
 is in demand close to the sanatorium. At Aiken, S. C, property in the 
 neighborhood of the local sanatorium has increased 400 per cent, since the 
 institution was built. At Hebron, Me., surrounding property has increased 
 20 per cent, as a direct result of the presence of a tuberculosis sanatorium. 
 A similar effect upon land values has taken place in other towns, such as 
 Luzerne, Pa., Liberty, N. Y., Saranac Lake, N. Y., Pittsford, Vt., Mt. 
 Vernon, Mo., and Silver City, N. Mex. At Asheville, N. C, vacant lots 
 near one of the sanatoria in that city sell at four times their price in 1900 and 
 those farther from the institution but nearer the city are less valuable. 
 Not a single instance was reported where the presence of a tuberculosis sana- 
 torium, camp or dispensary in a large city has had a detrimental eflect on 
 the value of surrounding property." 
 
 11 
 
CHAPTER II 
 
 A Questionnaire Study of Eighty-four 
 Institutions 
 
 Dining 1913, the office of the National Association for the 
 Study and Prevention of Tuberculosis obtained by the ques- 
 tionnaire method a large fund of information relating to the effect 
 of tuberculosis institutions in all sections of the United States 
 on the value and desirability of surrounding property. The 
 questions, which were directed to the superintendents of in- 
 stitutions, were answered in a way that gives assurance of 
 their reliability, and in most instances were complete. Eighty- 
 four replied to some or all of the questions. The facts thus 
 obtained support those collected in the earlier investigations. 
 
 A review of this data shows that of the 84 institutions, 2 
 were federal sanatoria, 18 were state sanatoria, 10 were county 
 or municipal hospitals, 32 private charitable sanatoria or hos- 
 pitals, and 22 private commercial hospitals, operated for profit. 
 The institutions include tuberculosis sanatoria and hospitals 
 of all sizes and kinds, distributed geographically in almost 
 every section of the country. 
 
 Length of Operation 
 
 With regard to the length of operation, fourteen of the insti- 
 tutions have been running for ten years, thirty-one from five 
 to ten years, twenty from three to five years, seventeen from 
 one to three years and only two less than one year. Since 
 seventy-five per cent, of these institutions have been in opera- 
 tion five years or more, their influence has had time to become 
 well defined. 
 
 12 
 
Density of Neighboring Population 
 
 With regard to the density of population in the neighborhoods 
 where the institutions are located, fourteen of the eighty-four 
 are located in districts which may be called " thickly" settled, 
 while seventy are in sections that may be designated as " sparse- 
 ly " settled. These facts were checked for accuracy by replies 
 to a question which asked the superintendent to give the distance 
 from the sanatorium of the nearest dwelling. 
 
 Character of District 
 
 As to the character of the districts in which the various in- 
 stitutions are located, fifty-seven are situated in farming districts 
 and twenty-seven are situated in residential districts, while so 
 far as learned none of the eighty-four are in wholly industrial 
 districts. 
 
 Value of Institution Property 
 
 The value of the sanatorium property when the institutions 
 were opened is worthy of consideration. While exact figures 
 are not given in all cases, the designations are sufficiently 
 accurate for this purpose. The value of the sites at the time 
 of the opening of the sanatoria was in five cases less than $10 
 per acre; in twenty-eight, it was from $10 to $100 per acre; 
 in sixteen, it was from $100 to $300 per acre; in four, it was 
 from $300 to $500 per acre; in three, it was from $500 to $1,000 
 per acre; in five, it was from $1,000 to $3,000 per acre; in one, 
 it was over $3,000 per acre; and in twenty-two the value was 
 not specified. The information previously given as to the char- 
 acter of the districts is thus supported by these facts, that the 
 great proportion of the sanatoria were erected on property 
 which did not cost more than $300 per acre. 
 
 Increase of Surrounding Property Values 
 
 To ascertain whether the property surrounding the sanatoria 
 has increased or decreased in value, questions were asked not 
 only to determine the exact value of surrounding property at 
 the time of opening and the present value, but also whether or 
 not building operations have been carried on in the neighbor- 
 hood. A tabulation of the replies to these queries shows that 
 in sixty-four cases, the value of surrounding property has in- 
 
 13 
 
creased. In not a single instance of the eighty-four reported 
 has the value decreased, although in fourteen cases, the value 
 of the surrounding property has remained approximately the 
 same as it was when the sanatorium was opened. Six of the 
 answers to these questions were not sufficiently definite for 
 classification. 
 
 » 
 
 Beneficial Effect of Institutions 
 
 Each correspondent was asked whether his sanatorium has 
 had a beneficial or detrimental effect upon the value of sur- 
 rounding property. Answers to this question show that in 
 forty-eight cases sanatoria have had a direct beneficial effect 
 on the value of surrounding property. In only three cases was 
 any indication given that the presence of the sanatorium has 
 had a detrimental effect, although in twenty-one cases the pres- 
 ence of the sanatorium apparently has had no effect whatever, 
 and in four instances the possible effect has been doubtful. 
 Eight answers to this question were not definite enough for 
 classification. * 
 
 An Aid to Health 
 
 In answer to the question whether the sanatorium has had a 
 beneficial or detrimental effect upon the health of people living 
 near it, fifty-five replied, most of them with emphasis, that the 
 presence of the sanatorium has had a beneficial effect, while 
 not a single one testified to a detrimental effect. In ten cases, 
 there was some doubt as to the definite benefit of the institu- 
 tion on the health of the community, and in six it seemed to 
 have no effect, while thirteen did not answer this question fully. 
 
 Supplementing the foregoing tabular summary, a few of the 
 more interesting comments made by the correspondents in 
 answering the questions submitted are given : 
 
 Increase in Property Values 
 
 The following answers refer to the question asking for an 
 opinion on the effect of the sanatoria upon the value of sur- 
 rounding property. The figures in parenthesis refer to the date 
 of opening of the respective institutions : 
 
 * See page 19 for opinions on this subject. 
 
 14 
 
From A. H. Garvin, M.D., Superintendent of the State 
 Hospital for Incipient Tuberculosis at Ray Brook, New York 
 (1904) : 
 
 " The actual economic value of Adirondack forest land is, in my opinion, 
 about $4 an acre. I have known of large tracts to be for sale at $1 an acre. 
 A fair average value of land about the Saranac country is $5 an acre, I believe. 
 The fact that it sells for more is solely on account of Saranac Lake. The 
 hospital land cost $20 an acre, at least twice as much as it was worth. The 
 land in the immediate vicinity of the hospital has assumed values out of all 
 proportion to its actual worth. One farm, which, in the central part of the 
 State would not bring more than $6,000 or $7,000, is held at $15,000. Plots 
 of land near the hospital are selling for $100 an acre. One kind lady who 
 owned a small plot of five acres adjoining the Sanatorium property kindly 
 offered to sell it to me for $8,000. I offered her $50. 
 
 " Of course, I do not believe that Saranac experience or special health 
 resort experience would be necessarily paralleled through the country. 
 Falkenstein Sanatorium, of course, vastly increased the value of the property, 
 but this was the second pioneer establishment in Germany, and, as one would 
 say in business, the good will of the establishment was a very valuable asset. 
 
 " Farm lands, especially such as have a vantage point to the sanatorium 
 for supplies, would naturally increase very much in value." 
 
 From David Russell Lyman, M.D., Superintendent, Gaylord 
 Farm Sanatorium, Wallingford, Conn. (1904) : 
 "All land in our vicinity has more than doubled in value." 
 
 From F. H. Dillingham, M.D., Physician-in-chief, St. Joseph's 
 Hospital, now located in a thickly settled portion of New York 
 
 City (1882): 
 
 " Property increased very much. Was sparsely settled before hospital was 
 built." 
 
 From Samuel B. English, M.D., Superintendent, New Jersey 
 
 Sanatorium for Tuberculous Diseases, Glen Gardner, N. J. 
 
 (1907): 
 
 " Increased at least 50 per cent, or more than when the Sanatorium was 
 opened." 
 
 From Estes Nichols, M.D., Maine Sanatorium, Hebron, Me. 
 (1904): 
 
 " Increase of about 20 per cent, of valuation and tax." 
 
 From C. S. Butts, M.D., Superintendent, Philadelphia 
 
 Jewish Sanatorium, Eagleville, Pa. (1909) : 
 
 " Yes, 25 per cent, to 50 per cent. Property which had been long for sale 
 has all been sold. Now occupied. New homes have sprung up from time 
 to time and at present quite a large building operation within four squares 
 of the sanatorium is nearing completion, all residences." 
 
 From Ralph Hunt, M.D., Day Camp Anti-Tuberculosis 
 League of the Oranges (1909) : 
 
 "All property in the neighborhood has increased in value." 
 
 15 
 
From F. M. Pottenger, M.D., Pottenger Sanatorium, Mon- 
 rovia, California (1903) : 
 
 " It has increased. One piece of eleven acres was offered me at §4,000. 
 The same could not be purchased today for $30,000." 
 
 From H. V. Pettit, M.D., Superintendent, Ottawa Tuber- 
 culosis Colony, Ottawa, 111. (1904) : 
 
 " The value of adjoining property was temporarily depressed as a result 
 of our presence, but within two years afterward it commenced to increase in 
 value and now has increased over 33§ per cent, above its value at the time 
 of our inception (1904)." 
 
 From G. F. Sauer, Superintendent, The Hospital and House 
 of Rest for Consumptives, in a rapidly developing part of 
 New York City (1869) : 
 
 " Increased at least 100 per cent." 
 
 From Edward L. Trudeau, M.D., Adirondack Cottage 
 
 Sanatorium, Trudeau, New York (1885) : 
 
 " First purchase $25 an acre, last purchase $1,000 an acre. Land within 
 our gates sold to us for $1,000 an acre." 
 
 From Montgomery E. Leary, M.D., Superintendent, Monroe 
 
 County Hospital, Rochester, New York (1910) : 
 
 " Believe land has increased. A considerable number of new dwelling- 
 houses have been erected in the immediate vicinity since the institution 
 was started." 
 
 From Harry Lee Barnes, M.D., Rhode Island State Sana- 
 torium, Wallum Lake, R. I. (1905) : 
 
 " Land at least double what it was before sanatorium was erected." 
 
 From Henry D. Chadwick, Superintendent, Westfield State 
 
 Sanatorium, Westfield, Mass. (1910) : 
 
 " 25 per cent, to 30 per cent, increase. Two adjoining farms during the 
 past two years have sold for considerable advance over preceding sales." 
 
 No Danger of Infection Spreading 
 
 The most frequent objection to the proposed location of a 
 hospital is that it will be a menace to the health of the neigh- 
 boring inhabitants. The following interesting comments on 
 this point are in answer to a question asking directly if the cor- 
 respondents had ever known of any case of infection resulting 
 from the presence of the sanatorium: 
 
 From F. M. Pottenger, M.D., Medical Director of the Pot- 
 tenger Sanatorium, Monrovia, Calif.: 
 
 " I do not. The sanatorium patient is the best educated of all. He learns 
 in the sanatorium, from seeing the care that is taken, what care he himself 
 
 16 
 
should take; and even the most careless have this drilled into them to such 
 an extent that they will be more careful than they would otherwise be, with- 
 out such training. I consider a well-conducted sanatorium the least dangerous 
 of all places for people to live. It is far less dangerous than the average 
 hotel or boarding house." 
 
 No better testimony as to the safety of an institution could 
 be found than in the attitude of life insurance companies as 
 indicated in the remarks of H. V. Pettit, M.D., Superintendent 
 of the Ottawa Tuberculosis Colony, Ottawa, 111.* 
 
 "As far as I know there have been no cases of tuberculosis which have re- 
 sulted from residence in or near this institution. In fact, there have been 
 several of our officers who have taken out life insurance with one of the most 
 conservative companies in this country and have been advised by the life 
 insurance company that, other things being equal, their risk is better than 
 that of the average person." 
 
 From Martin F. Sloan, M.D., Superintendent of Eudowood 
 Sanatorium, Towson, Md. 
 
 " I believe the wide spread fear of tuberculosis patients and institutions 
 to be not only unjust but unfounded. The public should be willing to believe 
 that sanatorium directors fully appreciate the gravity of the situation and 
 therefore do every thing to minimize contagion. They should also know 
 that 80 per cent, of those having tuberculosis and knowing it, will exercise 
 prophylaxis. It is the person who has the undiagnosed tuberculosis lesion 
 that is to be feared." 
 
 From Montgomery E. Leary, M.D., Superintendent of the 
 
 Monroe County Hospital, Rochester, N. Y. : 
 
 "A well-conducted sanatorium is the safest place to live in. You know 
 what you have; on the outside you do not know who you are meeting or 
 what they are doing. With properly educated patients and rules which are 
 enforced, there are more dangers on the street than in the sanatorium." 
 
 From Edward L. Trudeau, M.D., Medical Director, Adiron- 
 dack Cottage Sanitarium, the first of its kind in America, 
 opened in 1884: 
 
 " If employees don't develop the disease while in the institution, how 
 could the sanatorium possibly endanger anyone outside of its gates. To 
 my knowledge, no healthy employee has developed the disease while in our 
 institution." 
 
 From J. W. Coon, M.D., Superintendent of the State Sana- 
 torium, Wales, Wis. : 
 
 " It may be worthy of note that among the two hundred persons who 
 have been employed at the sanatorium since its opening, by far the larger 
 proportion of whom were young men and women, at the most susceptible 
 age for contracting tuberculosis, not one, so far as I am aware, has ever 
 developed tuberculosis, although one or two had already contracted it before 
 coming to the institution. It seems to me this speaks well for the care exer- 
 cised in preventing the spread of the disease from the institution." 
 
 * See page 36. 
 
 17 
 
From Guy L. Kiefer, M.D., Health Officer of Detroit, Mich.: 
 
 " I am sure that our sanatorium has had no ill effect on the health upon 
 the immediate surrounding community and I am equally sure all the prop- 
 erty surrounding our hospital has advanced in value." 
 
 Opposition Does Not Last 
 
 That the chief opposition to a hospital will die out after it 
 has been established and the people understand its functions is 
 amply attested by the following quotations: 
 
 From Robert A. Peers, M.D., Medical Director, Colfax 
 
 School and Hospital for the Tuberculous, Colfax, California 
 
 (1908) : 
 
 " When we first commenced our work here, there was a good deal of oppo- 
 sition and it was even made a political issue, but now people try to secure 
 patients and their families as tenants and as a result many new houses have 
 been built that would not otherwise have been erected. Directly and indi- 
 rectly the town, which has about 750 steady inhabitants, profits to the extent 
 of several hundred dollars a month and there has been no mortality or morbid- 
 ity amongst the local inhabitants. In the fourteen years I have been here, 
 but two of the townspeople have died from tuberculosis." 
 
 From Ralph H. Hunt, M.D., Day Camp Anti-Tuberculosis 
 
 League, Orange, N. J. (1909) : 
 
 "At the time of the establishment of our camp, there was very marked 
 objection to it on the part of the neighbors, which was so acute that it took 
 the form of an injunction. We, however, beat the injunction.* Since that 
 time the whole attitude of the neighbors has changed, and many of them 
 are good friends today, and so far as I know at the present time there is 
 no objection at all." 
 
 From Charles S. Millet, M.D., Medical Director, Millet 
 Memorial Hospital, East Bridgewater, Mass. (1900) : 
 
 " There was considerable opposition among the neighbors to the sana- 
 torium when it was first established, on account of their fears, but that has 
 long since disappeared." 
 
 Herbert Maxon King, M.D., Loomis Sanatorium, Liberty, 
 New York (1896), testifies that in spite of initial opposition, 
 property surrounding the hospital has increased in value and 
 that the institution has had a beneficial effect, and sums up his 
 remarks thus : 
 
 " I am, of course, a prejudiced party to such an inquiry, but my state- 
 ments have been acceded to by business men, railway officers, local resi- 
 dents, etc., in this vicinity, notwithstanding many bitter attacks upon the 
 sanatorium in times past." 
 
 * See page 41. 
 
 18 
 
From Isaac W. Brewer, M.D., Superintendent of the Tomp- 
 kins County Tuberculosis Hospital, Ithaca, N. Y. (1913): 
 
 " There has been considerable opposition to the establishment of sana- 
 toria for the treatment of tuberculosis, on the grounds that the value of 
 the local property will be depressed. When this site was chosen, there was 
 the usual objection. However, that seems to have passed away for during 
 the past three months both of the farms that adjoin the sanatorium have 
 been sold. The one directly opposite the buildings, a fruit farm, sold for 
 $200 per acre, and the one that adjoins us on the south sold for $4,500, and 
 would have brought $5,000 but for a matter of personal feeling between cer- 
 tain persons. All those who live in this community believe that both farms 
 brought all that they were worth. 
 
 " The secretary of one of the largest real estate companies in Ithaca in- 
 forms me that he does not think the sanatorium has in any way changed 
 the values of the land in its vicinity." 
 
 Hospitals Benefit Health of Neighbors 
 
 A few answers to the question "Has your institution had any 
 beneficial effect upon the health of those living near it by educating 
 them to open their windows, etc.," may well be included. 
 
 From John C. King, M.D., Superintendent of Dr. King's 
 Sanatorium, Banning, California: 
 
 " The beneficent sleeping-porch fad has become general in the town." 
 
 From Henry D. Chadwick, M.D., Superintendent, Westfield 
 
 State Sanatorium, Westfield, Massachusetts: 
 
 " I am sure that it has. Many new dwelling houses are adding sleeping 
 porches and outdoor sleeping is becoming quite common." 
 
 From Theodore B. Sachs, M.D., Edward Sanatorium, Naper- 
 
 ville, 111.: 
 
 " Less indiscriminate expectoration in public places. Windows kept 
 open at night in the majority of residences. Residences built with sleeping 
 porches. I believe that the nearness of a tuberculosis sanatorium to a com- 
 munity has a beneficial effect upon the standard of health of said community 
 as well as a tendency to increase the value of surrounding property." 
 
 From Thomas N. Hay, M.D., River Pines Sanatorium, 
 Stevens Point, Wisconsin: 
 
 " Yes, a large number of sleeping porches have been built in the town.-' 
 
 An Exception 
 
 The following statement by W. M. Mills, M.D., formerly 
 Medical Director of the Camp of the Topeka (Kansas) Asso- 
 ciation for the Study and Prevention of Tuberculosis gives the 
 only experience of the kind out of the eighty-four institutions. 
 
 19 
 
The small temporary camp, located in a growing section of the 
 city, was already in operation when some question of adminis- 
 tration aroused opposition. To quote Dr. Mills: 
 
 " We have been compelled to abandon our camp on account of pressure 
 brought to bear by neighboring property owners on the owner of the land 
 we lease. They t hink that their property values would have increased if 
 we had not been near them. Property owners say that property around the 
 camp, which was in a 'fairly well settled' section, had not decreased in value 
 but became more difficult to sell." 
 
 20 
 
CHAPTER III 
 
 Assessed Property Values Around Five 
 Institutions 
 
 In order to verify as accurately as possible existing informa- 
 tion with regard to the effect of a tuberculosis hospital upon the 
 value and desirability of surrounding property, as summarized 
 in preceding chapters, a first-hand investigation was made of 
 five institutions which seem to be typically located in relation 
 to city, village, or farming district, for the particular purpose 
 of studying assessed valuation and special factors affecting the 
 problem.* Of the five hospitals considered, one was located 
 within limits of a large city; one just within limits of a city of 
 85,000; one just outside the limits of a city of 35,000; one on 
 the outskirts of a village of 300; and one in a farming district 
 2 1 miles from a village of 8,000. 
 
 Information in each case was collected covering the following 
 points : 
 
 (1) The change in assessed valuation of surrounding property 
 after the locating of a hospital ; 
 
 (2) Actual sales of surrounding property; 
 
 (3) Expressed feeling of nearby property owners; and 
 
 (4) Expressed feeling of general public. 
 
 Each hospital will be considered where information is available 
 individually under these four heads : 
 
 I. HOSPITAL WITHIN LIMITS OF LARGE CITY 
 
 Seton Hospital, New York City. 
 
 This semi-charitable hospital, located within the limits of 
 New York City and opened in 1894, accommodates 375 men, 
 women and children, largely indigent, and chiefly in the advanced 
 
 * The investigations noted in this chapter were made for the National Association by 
 Dixon Van Blarcom, Field Secretary. 
 
 21 
 
stages of the disease. The grounds comprise a city block in 
 the centre of a high class residential section. Roads have been 
 cut through part of the section and part still remains wooded. 
 The hospital is situated on a ridge which slopes on the one hand 
 to the Hudson River and on the other to a more thickly settled 
 portion of the city. Real estate firms and individuals have 
 improved their holdings with privately built roads and sewers. 
 The whole crest of the ridge is not immediately accessible by 
 public transportation facilities and since property owners have 
 opposed the building of a street car line through the section, 
 the property has been acquired and is being built up by the more 
 well-to-do class. Many fine homes have been built in the 
 direction of the river and to the south of the hospital. There 
 are also a number of residences to the north. 
 
 The main building of the hospital is located within 200 feet 
 and in full view of the street which runs along the crest of 
 the hill. The hospital was erected when surrounding property 
 was comparatively cheap and the neighborhood sparsely settled. 
 The property has increased enormously in value and has become 
 more and more desirable for residences which are being grad- 
 ually built. 
 
 1. Assessed Valuation* 
 
 Since 1900 (the earliest figures obtained) adjoining and nearby 
 property has increased from two to six times in assessed valua- 
 tion. The hospital was given as the reason in the applications 
 for reductions of assessed valuation recently by the owners of 
 two or three small parcels of land directly across the street from 
 the hospital. It will be noted from the figures of one of these 
 parcels given in the following table that the decrease in assess- 
 ment was preceded by a marked increase, which is typical of 
 other surrounding property : 
 
 Year 1900 1905 1910 1913 
 
 Valuation $2,200 $5,500 $8,500 $7,000 
 
 A county official's comment on these applications was: "Any 
 excuse is sufficient grounds upon which to base an application 
 for a reduction in assessment." 
 
 An examination of the tables in the Appendix will show that 
 an occasional property some distance from the hospital has 
 
 * See Appendix, page 54, for tables giving detailed figures. 
 
 22 
 
decreased in assessed valuation after a remarkable increase, so 
 that no importance can be attached to similar changes in ad- 
 joining property. 
 
 2. Actual Sales 
 
 The sales have not been numerous, because as one man, 
 whose father lives within a block of the hospital, expressed it, 
 " The people who own property there would not sell at any 
 price." And again, some large tracts belong to old estates and 
 other owners have built homes in which they now live. One 
 residence recently constructed within 200 or 300 feet of the 
 hospital has remained unrented for about four months because 
 prospective occupants object that it is too near the hospital. 
 It had been occupied by a man who left, not because of the 
 hospital, but for an extended trip in Europe. A member of 
 the real estate firm which controls the house says that this is 
 the only instance of the kind of which he knows. It is one of 
 the two or three homes which are so close to the hospital that 
 the coughing of patients is sometimes audible in summer. 
 
 3. Feeling of Property Owners 
 
 The head of one realty company with considerable interest 
 in nearby property, gave the impression that the hospital has 
 some undesirable influence upon the immediately adjoining 
 property, but that it probably does not extend any considerable 
 distance from the grounds. 
 
 In 1910, Mr. B built a fine new home about 200 yards from the 
 hospital. He has no objection except to the appearance of an 
 unkempt incinerator on the grounds. 
 
 Mr. C lives in a home just beyond Mr. B and owns some prop- 
 erty in the vicinity. He does not object to the hospital but 
 believes it affects somewhat the value and chances of sale of 
 adjoining property. Mr. D, who lives in the vicinity and holds 
 considerable property, believes the hospital has some depre- 
 ciating effect but cannot say how much. 
 
 Mr. E in 1910 built a new home nearer the hospital by the 
 width of the street than Mr. B, after he had lived in a rented 
 house on the hill for a year. The building of a home so near 
 the hospital by this intelligent lawyer after he had lived in the 
 
 23 
 
neighborhood long enough to become thoroughly familiar with 
 the situation is the best possible comment on the effect of the 
 hospital on the desirability of surrounding property. 
 
 4. Feeling of General Public 
 
 Little opportunity was had for obtaining general sentiment, 
 but those interviewed at random expressed friendly feelings. 
 The tax assessor said that the hospital was taken into consider- 
 ation in fixing the assessments of adjoining property. 
 
 II. HOSPITAL WITHIN CITY OF 85,000 
 
 Sprain Ridge Hospital, Yonkers, New York. 
 
 This semi-charitable and splendidly equipped hospital; 
 located in a sparsely settled section within the limits of a city 
 of 85,000 population, was opened in 1908 with a capacity for 
 twenty-five incipient cases, who are charged a nominal rate for 
 treatment. The buildings are set some distance back from the 
 road and are visible from a few points only. Adjoining the 
 property is a cemetery which property owners say depreciates 
 the value of all land in the neighborhood. 
 
 1. Assessed Valuation * 
 
 Both the adjoining and nearby property has increased steadily 
 in assessed valuation since the hospital was erected. The ad- 
 joining property increased fifty-seven per cent, from 1907 to 
 1914. Property not adjoining the hospital grounds, but in the 
 immediate vicinity increased fifty-one per cent, during the same 
 period. 
 
 2. Active Sales 
 
 Several adjoining and nearby tracts have changed hands or 
 have been divided into building lots which are now on the 
 market. One adjoining plot of over 200 acres was bought in 
 1905 at about $500 per acre and in 1910, thirty-three acres of it 
 were sold for about $2,000 an acre. One part of an adjoining 
 property of forty-five acres, which cost $800 an acre in 1911 , 
 has been cut up into one-quarter acre lots and sold at the rate 
 of $2,000 to $2,800 an acre. Seventy one-quarter acre lots 
 
 * See Appendix, page 56, for detailed figures. 
 
 24 
 
nearby have brought from $250 to $500 each in the past five 
 years. Thirty new homes valued at from $8,000 to $15,000 
 each, including the lots, have been erected in the past two years 
 on one plot three-quarters of a mile from the hospital grounds. 
 These transactions are typical of the activity of both adjoining 
 and nearby property. 
 
 3. Feeling of Property Owners 
 
 Owners of adjoining and nearby property are nearly unani- 
 mous in stating that the hospital has very little if any effect 
 upon their property. The owners of fifty acres adjoining did 
 not mention the hospital as a reason in their application for a 
 reduction of assessed valuation in 1913. Both owners said 
 they thought the hospital had no effect. 
 
 The owner of a thirty-eight acre adjoining plot recently gave 
 the cemetery, water works and hospital, all of which adjoin him, 
 as reasons for a reduction in assessed valuation. 
 
 Another man owning a large tract across the road from the 
 hospital said it has not had any serious effect. The owner of 
 eighteen acres adjoining made favorable comment upon the 
 improvement of the hospital tract with the coming of the insti- 
 tution. 
 
 III. HOSPITAL WITHIN HALF-MILE OF CITY 
 OF 35,000 
 
 Bowne Memorial Hospital, Poughkeepsie, New York. 
 
 This is a public hospital, built as a memorial and given to the 
 county, with accommodations for seventy-five adults in all 
 stages of the disease and twenty-five children. It is located 
 one-half mile outside the limits of the city of Poughkeepsie. 
 The buildings are on an eminence about one hundred yards from 
 one of two crossing highways and about one hundred feet from 
 the other and in full view from both of them. Property toward 
 the city is built up here and there with homes chiefly of work- 
 ing men, while on the other side it is divided into small farms. 
 A camp opened upon the site in January, 1910, gave way to 
 permanent hospital buildings in 1911, which were enlarged in 
 1913. 
 
 25 
 
1. Assessed Valuation 
 
 The assessed valuation of the surrounding property rose 
 uniformly from 1908 to 1912, as is indicated in the tables shown 
 in the appendix. * 
 
 2. Actual Sales 
 
 There have been few changes in ownership of surrounding 
 property since the institution was opened as the owners do not 
 seem desirous of selling. 
 
 Mr. A recently refused $3,500 for a four-acre plot now ad- 
 joining the hospital grounds and for which he paid about $2,000 
 before the hospital was built. Mr. B lately declined an offer 
 of $20,000 for eighty acres of adjoining property assessed at 
 $6,600. Mr. C recently refused $30,000 for forty-one acres 
 located one-quarter of a mile from the hospital in the direction 
 of the city and assessed for $10,000. 
 
 3. Feeling of Property Owners 
 
 One man owning eighty acres across the road from the hos- 
 pital thought that it made no difference whatever. However, 
 a man owning twelve acress across the road in another direction 
 claims that the hospital injures his property and strongly dis- 
 approves of its location. The owner of a small plot about one- 
 quarter of a mile from the hospital stated that a prospective 
 buyer objected to the hospital on the grounds that it would be 
 a danger to her child. He further stated, however, that he knew 
 there was no danger and had no complaint to make, but was in 
 entire sympathy with the hospital. The head of one improve- 
 ment company with large tracts one-quarter of a mile from the 
 hospital said that he was sure it made no difference whatever. 
 The other property owners interviewed agreed that the hospital 
 is no detriment. 
 
 4. Feeling of General Public 
 
 One county official was of the opinion that the hospital af- 
 fected immediately adjoining property to some extent. Other 
 opinions obtained were favorable. 
 
 * See Appendix, page 56, for detailed figures. 
 
 26 
 
5ET0N 
 HOSPITAL 
 
 Nrw "Ti.HK Ciry 
 r/»C n»m*«/j frfa f« talk* oft PSl 
 
IV. HOSPITAL NEAR VILLAGE OF 300 
 
 Montefiore Home Country Sanatorium, Bedford 
 Station, New York. 
 
 This Jewish charitable hospital of 170 capacity primarily 
 for incipient cases, is located upon a hill overlooking a village 
 of 300 population. The institution is one-half mile from the 
 railroad station and some thirty miles from New York City, 
 from which practically all of its patients come. The village 
 lies on one side of the sanatorium, while on the other three sides 
 the land, which is of rough, hilly formation, is occupied by a 
 few country homes and a number of somewhat unproductive 
 farms. The buildings of the institution are located in full view 
 of the highway. 
 
 1. Assessed Valuation 
 
 Since 1903, the adjoining and nearby property has increased 
 in assessed valuation at a rate normal for its type. It will be 
 noted that the assessment figures* do not date from the opening 
 of the hospital, 1897, but from a period several years later. The 
 rise in assessed valuation does not seem to have kept pace with 
 the increase in estimated value of the property or with the in- 
 crease as indicated by sales. 
 
 2. Actual Sales 
 
 While a large amount of surrounding property belongs to 
 old estates and is not for sale, land which has been sold has 
 brought an increase over the purchase price, and in some in- 
 stances a marked increase. 
 
 One plot of seventy-six acres adjoining the hospital was 
 purchased for $12,500 after the hospital was erected and sold 
 shortly afterward for $22,000. Three parcels of nearby prop- 
 erty which was purchased ten years ago for $18,000 were sold 
 recently for $73,000. Three parcels remain. Mr. X claims 
 that his eighty-five acres of adjoining property bought about 
 thirty years ago for $10,000 is now worth $40,000. 
 
 Mr. C values at $18,000 eighty acres of adjoining property 
 for which he paid $9,000. One owner values at $70,000 one 
 hundred and forty acres of adjoining land for which he paid 
 
 * See Appendix, page 57, for detailed figures. 
 
 27 
 
$35,000. Another owner questions if he would now take $400 
 an acre for seventy acres of adjoining property for which he paid 
 about $75 an acre a few years ago. 
 
 The property of a real estate development company one-half 
 mile from the hospital which cost $16,000 ten years ago is now 
 valued at about $60,000. 
 
 3. Feeling of Property Owners 
 
 While property owners were somewhat divided in their 
 opinions as to the effect of the hospital upon the surrounding 
 property, the majority were firm in believing that it has no mat- 
 erial effect. For example, one owner of adjoining property 
 believes the hospital has an undesirable effect and says he is 
 anxious to sell; another expressed the wish that it be removed 
 from the locality; while the owner of 130 acres adjoining held 
 that the hospital had very little if any effect; and another said 
 it had none at all. 
 
 4. Feeling of General Public 
 
 The attitude of the villagers is friendly with a few exceptions 
 in which the feeling of opposition is in no sense bitter or strong. 
 The type of friends of the patients, who visit patients at the 
 hospital, and their actions in the village, were the chief target 
 for such criticisms and objections as were offered by both prop- 
 erty owners and villagers. This is a situation which would 
 probably not be duplicated in any other part of the country, 
 owing to the fact that the sanatorium population is largely 
 Jewish, from congested portions of New York, and the visitors 
 are of a similar descent. 
 
 V. HOSPITAL LOCATED IN FARMING DISTRICT 
 
 Gaylord Farm Sanatorium, Wallingford, Conn. 
 
 This semi-charitable institution strictly for incipient cases, is 
 located in the country about two and one-half miles from a 
 village of 8,000 inhabitants and a few miles from New Haven. 
 Patients are charged a nominal rate and the deficit is made up 
 by private subscriptions and state subsidy. The buildings are 
 one-eighth of a mile back from the road and in full view from it. 
 Possible future complaints are eliminated by the fact that the 
 
 28 
 
hospital owns the property across the highway. Small farms 
 and wooded land comprise the adjoining and nearby property. 
 
 1. Assessed Valuation * 
 
 The largest part of the surrounding property shows an in- 
 crease in assessed valuation from 1903, the year before the insti- 
 tution was opened, to 1913. The unchanged assessment of a 
 few parcels of land is not unusual for this type of property, which 
 increases in value slowly and at infrequent intervals. 
 
 2. Actual Sales 
 
 Little of the property in the neighborhood has changed 
 hands in the past few years with the exception of that bought 
 up at times by the hospital. 
 
 An adjoining farm which cost $25 an acre the year before the 
 hospital opened brought $50 an acre six years later. Sixty 
 acres of nearby property assessed for $1,797 was sold for $2,900 
 two years ago. Recently a property within a mile of the hos- 
 pital assessed at $7,788 was sold for $9,000. 
 
 3. Feeling of Property Owners 
 
 The property owners interviewed did not feel that the hospital 
 had a detrimental effect upon their property nor did they feel 
 that it was undesirable. 
 
 4. Feeling of General Public 
 
 It is worthy of note that the feeling in the village seemed 
 to be entirely friendly. The institution was frequently re- 
 ferred to witn some pride. This friendly feeling may be due 
 in some degree to the fact that the hospital, partly with its own 
 money, has made improvements in nearby highways. The insti- 
 tution doubtless helps also to relieve the loneliness of the district. 
 
 * See Appendix, page 58 for detailed figures. 
 
 29 
 
CHAPTER IV 
 
 Typical Laws and Ordinances Covering 
 
 the Approval and Restriction of 
 
 Hospital Sites 
 
 The rapid increase in the number of hospitals and sanatoria, 
 particularly in New York and New Jersey, combined with a 
 constant succession of local conflicts over the location of such 
 institutions has led several states and a number of cities to enact 
 legislation bearing on this problem. The laws of New York 
 and New Jersey are the most comprehensive and suggestive 
 ones on this subject, and on this account are given in full.* As 
 most of the restrictive ordinances are similar in general form 
 only one of them is given in full. 
 
 New York 
 
 The New York State law covering the approval of sites for 
 tuberculosis hospitals was enacted in 1909, after a vain attempt 
 had been made to secure a site for a sanatorium on Long Island 
 under then existing legislation. As a result of this law, this 
 sanatorium and many others have been established without 
 recourse to the somewhat burdensome machinery of the courts. 
 The law provides: (1) that the State Commissioner of Health 
 and the health officer of the locality in which it is proposed to 
 locate the institution shall sit as judges at a previously advertised 
 public hearing on the question and render a decision within 
 thirty days; and (2) that if they are unable to agree, an appeal 
 may be made to a committee comprised of the State Commis- 
 sioner of Health, the Lieutenant Governor and the Speaker of 
 the Assembly, who constitute a final court for the decision of 
 matters pertaining to the location of tuberculosis hospitals and 
 sanatoria. 
 
 The text of the law, which is Section 319 of Chapter 49 of 
 the Consolidated Laws of 1909, follows: 
 
 * Rhode Island also has a special law passed in 1909, dealing with this problem. 
 
 30 
 
Section 319. Consents requisite to the establishments 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 munici- 
 pality 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 commissioner 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 establishment 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, association, 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 hearing, and also publish twice 
 in a local newspaper of the town, or if there is no such paper published there, 
 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 commissioner of health and the local health officer shall hear the peti- 
 tioner 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 disapprove of 
 the location thereof and shall notify the person, association, corporation or 
 municipality of their determination. The determination of the state com- 
 missioner of health and local health officer shall be final and conclusive; 
 but if within thirty days after the hearing they are unable to agree, they 
 shall within such thirty days notify the person, association, corporation or 
 municipality, proposing to establish such hospital, camp or other estab- 
 lishment that they are unable to agree. Within ten days 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-governor, the speaker of 
 the assembly and the state commissioner of health. Such officers shall ap- 
 prove 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 
 to the health officer and to each member of the board of health of the town, 
 or without a hearing, upon the evidence, papers and documents filed with the 
 state commissioner of health or that 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 
 commissioner of health and cause a copy thereof to be mailed to the person, 
 association, corporation or municipality proposing to 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. 
 
 New Jersey 
 
 The New Jersey law is significant in that it provides for a 
 somewhat simpler procedure. The State Board of Health is 
 
 31 
 
the only and final court for the decision of questions relating 
 to tuberculosis institutions. The text of the law, which is 
 contained in Chapter 88 of the laws of 1910, follows: 
 
 1. Hereafter no person or persons, corporation or association shall locate, 
 construct or establish in any city, town, borough, township or other muni- 
 cipality of this State any hospital, sanatorium, preventorium or other insti- 
 tution to be used for the care, board or treatment of any person or persons 
 afflicted with the disease known as pulmonary tuberculosis, without first 
 obtaining the consent and approval of the State Board of Health so to do. 
 
 2. All applications under this act shall be made to the State Board of 
 Health in writing, signed by the applicant, shall give the name of the city, 
 town, borough, township or other municipality in which it is proposed to 
 locate the same, and shall be accompanied with a descriptive map of the 
 premises proposed to be devoted to the uses authorized by this act. 
 
 3. The State Board of Health shall fix a time and place for the hearing 
 on such application, of which hearing the applicant shall give at least two 
 weeks' notice in some newspaper published and circulating in the munici- 
 pality named in the application, and if none be published therein, then by 
 posting in such municipality at least ten notices for fifteen days before such 
 hearing, giving notice of such application. 
 
 4. At the time and place so fixed for said hearing the State Board of 
 Health shall hear all parties, both for and against said application, and said 
 board shall thereupon either grant or withhold the consent and approval 
 asked for. 
 
 5. After the passage of this act the State Board of Health shall have the 
 sole authority to grant or refuse the consent and approval to the erection, 
 construction, and establishing of any and all hospitals, sanatoria, preven- 
 toria, or other institutions designed for the care, board or treatment of any 
 person or persons afflicted with the disease known as pulmonary tuberculosis. 
 
 6. After the passage of this act no consent shall be required from any 
 officer or board of the State of New Jersey or any of the municipalities there- 
 of, except the State Board of Health as aforesaid, to the erection, construc- 
 tion or establishment of any of the institutions aforesaid, or to the bringing 
 of persons to such institutions from points within or without the State. 
 
 7. This act shall not be construed to require any of the institutions afore- 
 said which may have been used prior to the passage of this act during the 
 summer only to obtain any consent or approval for reopening said institu- 
 tions from year to year as heretofore. 
 
 Restrictive Ordinances 
 
 In July, 1911, the City Trustees of South Pasadena, California, 
 passed an ordinance forbidding the establishment within the 
 city of any sanatorium, asylum or retreat where consumptives 
 are received or treated under penalty of $300 and three months 
 in jail. The ordinance is typical of similar attempts to restrict 
 the establishment of hospitals and sanatoria by local regulation. 
 Whenever these ordinances have been tested in court, as in 
 Richmond, Virginia, and Redlands, California, they have been 
 held to be unconstitutional. The text of a typical ordinance 
 adopted in Redlands, California, in 1910, and later declared 
 null and void by the courts, is given in full:* 
 
 * See page 43. 
 
 32 
 
Section I. Every hospital, sanitarium, pest house, asylum or other 
 place maintained or conducted for the purpose of caring for or treating per- 
 sons afflicted with any contagious or infectious disease, for or without reward 
 or charge, located within four hundred (400) feet of the dwelling of another 
 person, or within two thousand six hundred forty (2640) feet of a school 
 house or within thirteen hundred twenty (1320) feet of a flowing stream of 
 water, water ditch or open water conduit from which water for domestic pur- 
 poses is taken, is hereby declared to be a menace to the public health and 
 safety, and a public nuisance, and shall be abated by civil action brought 
 in the proper court. 
 
 Section II. Provides that violation of the foregoing is a misdemeanor, 
 punishable by a fine of not more than $500, or imprisonment in the county 
 jail not exceeding six months, or by both such fine and imprisonment. 
 
 33 
 
CHAPTER V 
 
 Some Opinions of Value 
 
 Opposition to the location of hospitals and sanatoria at various 
 times has called forth published opinions from a number of emi- 
 nent men in different parts of the country. The few quotations 
 chosen have been selected primarily because they accurately sum 
 up the situation. Letters from five of the largest life insurance 
 companies in the country expressing their attitude on the ques- 
 tion of the danger of infection spreading from a hospital, and the 
 opinions of health officers who have been asked to decide ques- 
 tions of location of sanatoria are also included in this chapter. 
 
 Dr. E. L. Trudeau 
 
 The selection of a site for the Onondaga County (N. Y.) 
 Tuberculosis Hospital raised opposition which was overcome 
 with difficulty. In connection with this controversy the 
 Syracuse, N. Y., Journal, on March 1, 1913, published a letter 
 from Dr. Edward L. Trudeau, the pioneer of the open air treat- 
 ment of tuberculosis in America, and the founder of the first 
 tuberculosis sanatorium in America, in which he said in part : 
 
 " When I bought the first land on which the Adirondack Cottage Sani- 
 tarium is built (in 1885) I paid $25 an acre for it, because it was a small 
 piece and a selected site, but the price was then thought absurdly high. 
 Every time I have purchased more land the price has risen steadily and my 
 last purchase of five acres cost me $5,000. Meanwhile the village of Saranac 
 Lake, whose limits were nearly a mile away from the sanatorium, has steadily 
 crept up toward the institution, until now private residences are built at its 
 very gates and rent and sell for prices which are far in excess of similar prop- 
 erties in small ;owns elsewhere. Of course we doctors know that the idea 
 of a sanatorium's being any danger to the community in which it is located 
 is simply absurd and that, on the contrary, the education which comes from 
 in its walls, is an immense protection to the neighborhood. Tuberculosis 
 is a communicable disease under certain conditions, but it is not at all like 
 any of the highly infectious diseases, such as smallpox, measles, etc. It 
 is a disease where any danger of infection is within doors, and even this, 
 with the simplest precautions, can be obviated. To my knowledge there 
 has never been an employee who came to the Adirondack Cottage Sana- 
 torium in sound health who developed tuberculosis while there; and a sana- 
 
 34 
 
torium can no more endanger the health of the neighborhood in which it 
 is built, even if the residences are at its very gates, than it could if it were 
 placed on top of a high mountain, miles away from habitation." 
 
 Hamilton W. Mabie 
 
 In reply to those opposing the location of a tuberculosis 
 hospital at Summit, New Jersey, several years ago, Hamilton 
 W. Mabie, the well-known journalist, wrote a long letter published 
 in the Summit Herald, November 27, 1909, taking up the 
 question from a slightly different angle. One of the principal 
 objections to the hospital was that it would advertise the fact 
 that there is an undue amount of tuberculosis in Summit, and 
 would thus injure property. Quoting from his letter : 
 
 " Not only is a sanitarium for tubercular patients a distinct aid to the 
 healthfulness of a community, but it is also a distinct addition to property 
 values. This will probably strike many people as an unwarranted state- 
 ment, but the trouble with this matter is that antiquated ideas and unfounded 
 impressions still prevail among those who have not made some study of the sub- 
 ject. It is a matter of history that communities in which sanitariums are 
 established have experienced a rise in values in consequence. If this matter 
 were thoroughly discussed, I am sure that both the Board of Trade and the 
 town would take a very different attitude toward the possibility of introduc- 
 ing a sanitarium here. It would be as logical to hold that the Overlook 
 Hospital (a general hospital) is an injury to the town because it advertises 
 the fact that there are accidents and sickness here, as to hold that a sani- 
 tarium for tubercular patients would advertise the fact that there is danger 
 of tubercular trouble here. As a matter of fact, the presence of such a sani- 
 tarium would advertise the extreme healthfulness of this locality. That 
 has always been the special claim of Summit on people looking for homes, 
 and the more widely the impression can go abroad the greater will be its 
 prosperity. 
 
 " This question ought not to be left without a word about its higher as- 
 pects. Summit cannot afford to settle such a question as this on business 
 grounds alone. There are other things in life besides real estate, and a com- 
 munity cannot have a better asset than the reputation for large-hearted 
 generosity and courage. Everyone respects a community which, when an 
 infectious disease breaks out, does not conceal the fact, but pursues a policy 
 of complete publicity. Courage is always the best policy, and so is generosity. 
 No one can forget the contempt and indignation which was aroused by the 
 refusal of a few settlers on Fire Island to allow women and children who 
 had come from Europe on a steamer in which there was two or three cases 
 of cholera to land and take temporary shelter, but sent them back to an 
 excursion boat lying in the open sea, with the possibility of bad weather." 
 
 Dr. E. M. Mason 
 
 During 1911, objection to the location of the Red Mountain 
 
 Tuberculosis Camp at Birmingham, Ala., called forth an open 
 
 letter from Dr. E. M. Mason of that city. Some of his well 
 
 stated comments accurately sum up the situation: 
 
 " Patients are taught the nature of the disease which they have to combat, 
 and soon learn the precautions that must be observed to prevent reinfection 
 of themselves as well as transmission of the disease. Tuberculosis cannot 
 
 35 
 
arise it novo, nor can one contract it as one would contract, for instance, 
 smallpox, by mere proximity to a patient. One can only acquire the tuber- 
 culosis germ from the excreta of a patient, chiefly sputum. If these be de- 
 stroyed, there can be no tuberculosis. It is axiomatic that if every tubercle 
 bacillus could be killed there would never be another case of consumption. 
 
 "At the camp we are enabling patients to throw off the infection already 
 existing and are destroying all infected matter from each patient. Therefore, 
 no tuberculosis can be disseminated from the camp nor from any other prop- 
 erly regulated institution for its treatment. So true is this, that no well- 
 informed person would deny that the citizens would be in less danger of 
 contracting this disease if our camp occupied the most central business block 
 pf the city than they are as the conditions now exist in this and every other 
 city. Every properly isolated case of tuberculosis ceases to be a menace to 
 the community, while every recognized, uncontrolled, infected individual 
 casts off daily in his excreta millions of tuberculous germs. 
 
 " Every broad-minded humanitarian movement in the history of the 
 world has been opposed by ignorance and prejudice; the effect to control 
 tuberculosis can hope for no exemption; but our cause is good, our work 
 is based on a scientific study of the disease, and the results obtained speak 
 ::: the—selves. 
 
 California Association 
 
 Opposition to the location of a tuberculosis hospital in Men- 
 tone, California, within a certain distance of residences, a 
 school-house, and other buildings, elicited the following well 
 stated resolutions from the California Association for the Stud} 7 
 and Prevention of Tuberculosis: 
 
 " Resolved, That it is the sense of the members of the Executive Board 
 ::' the California Association for the Study and. Prevention o: Tuberculosis, 
 that those who attempt to prevent the establishment of properly conducted 
 sanatoria, are not only in opposition to scientific facts, but that such per- 
 sons are sacrificing human life on the altar of supposed material prosperity, 
 (although it has been shown that property values in the neighborhood of 
 crccerly conducted sanattria really inirease in value : and be it further 
 
 " Resolved, That this Executive Board deprecates the unwise action 
 of all such persons as being unscientific, inhumanitarian and illogical; and 
 that all persons who will really study this question must come to the con- 
 clusion that the action of such persons is nothing else than an expression 
 of tuberculo-phobia, and to that extent a menace to the great movement 
 now in progress, which has as its end, the doing away with tuberculosis as 
 a scourge to the human race." 
 
 Opinions of Life Insurance Companies* 
 
 In March, 1914, The National Association for the Study and 
 Prevention of Tuberculosis addressed communications to five 
 of the largest life insurance companies in the country, requesting 
 answers to the following questions: 
 
 1. Is residence or employment in a tuberculosis hospital, 
 sanatorium or dispensary counted as an adverse factor in 
 
 *See remarks of Dr. Pettit, page 17. 
 
 36 
 
considering the issuance of a life insurance policy to a doctor, 
 nurse, attendant or other employee of such institution, who 
 upon examination is non-tuberculous ?* 
 
 2. Is residence in the neighborhood of such an institution 
 as above mentioned considered as an adverse factor in issuing 
 a policy to a non-tuberculous applicant ? 
 
 Two of the companies answered the first question in the nega- 
 tive and two in the affirmative, while one indicated an affirma- 
 tive attitude, though not stating definitely. The answers to 
 the second question were unanimously in the negative. 
 
 It should hardly be necessary to say that life insurance com- 
 panies would have most rigid and conservative ideas as to what 
 is and what is not an adverse factor in issuing a policy. Their 
 error, if any, would certainly be on the side of conservatism. 
 That they do not consider residence near a tuberculosis sana- 
 torium as an adverse factor must quiet the fears of reasonable 
 men and women who have believed a danger existed or might 
 exist from the presence of such an institution. The fact that 
 some companies look with a degree of suspicion upon employees 
 of tuberculosis institutions, in the light of so much testimony 
 supporting an opposite opinion, indicates their extreme care- 
 fulness and accordingly gives additional support to their con- 
 viction that residence near a tuberculosis institution is not an 
 adverse factor. 
 
 To emphasize this point, the answers to the questions, giving 
 the name of the company except where it has been requested 
 to withhold it, are given below: 
 
 From Arthur B. Wright, M.D., Medical Director of The 
 
 Travelers' Insurance Company, Hartford, Connecticut: 
 
 " This Company has not modified in any way the form of policy 
 
 issued to a doctor, nurse, attendant or other employee of a tuberculosis 
 hospital or sanitarium provided examination is first class in every other 
 respect, the assumption being that such employee would be in better posi- 
 tion to follow out principles of precaution than others. Our experience with 
 this class of risks has been very favorable. 
 
 " In regard to Question 2 would state that we do not consider as an ad- 
 verse factor residence in the neighborhood of such an institution. The same 
 principle would prevail as regards this feature, inasmuch as proper precau- 
 tions would be followed by the institution itself." 
 
 * A recent report by Dr. Hamel, published in the Medico-Statistical Contributions of 
 the Imperial Health Office of Germany, gives the results of an investigation into the 
 incidence of tuberculosis among physicians and nurses employed in German sanatoria and 
 hospitals. Dr. Hamel's report, which embraces 549 institutions and clinics, 2,861 
 physicians and 14,140 nurses of all types, shows that the rate of infection among these 
 healthy employees of tuberculosis sanatoria and hospitals is no larger and is even slightly 
 less than a similar rate recognized by insurance companies for New York City. 
 
 37 
 
From Dr. Lee K. Frankel, Sixth Vice-President of the Metro- 
 politan Life Insurance Company of New York City: 
 
 " Referring to the two questions asked I can answer these only 
 
 as far as the Metropolitan Life Insurance Company is concerned. 
 
 " 1. Residence or employment in a tuberculosis hospital, etc., is not 
 counted as an adverse factor in considering the issuance of a life insurance 
 policy to a doctor, nurse, etc. 
 
 "2. Residence in the neighborhood of a sanatorium is not considered 
 an adverse factor in issuing a policy to a non- tuberculosis applicant." 
 
 From a high official of a company which does not wish its 
 name used in connection with this report : 
 
 "Applicants for insurance who reside near or are employed in a tuber- 
 culosis hospital, sanatorium, or dispensary, are considered on their individual 
 merits. Of course, no applicants are accepted for insurance who on examina- 
 tion are found to be tuberculous. The practice regarding the acceptance of 
 applicants of this class varies according to local circumstances. The pos- 
 sible risk of tuberculous infection is carefully taken into account. 
 
 " The results of the German Collective Sanatoria Experience establishing 
 for employees a varying degree of liability to infection, are evidently sugges- 
 tive of an extra risk, which it would not be proper for us to ignore. 
 
 " Residence in the neighborhood of tuberculosis hospitals or sanatoria is 
 not considered an adverse factor in the issuing of a policy to a non-tuber- 
 culous applicant. There is no evidence to prove that the disease is spread 
 by infection from a well managed institution to the population of the sur- 
 rounding community, but, of course, there is a certain degree of risk in the 
 case of indiscreet treatment of tuberculous patients in boarding-houses or 
 private homes, not under proper medical supervision and control. All of 
 the American life insurance companies transact business without discrimina- 
 tion in localities which for climatic or other reasons are particularly suitable 
 for the treatment of tuberculosis patients, and as far as known, they have 
 not experienced an appreciably higher mortality from tuberculosis among 
 their policyholders living in such localities when compared with those living 
 elsewhere." 
 
 From F. C. Wells, Senior Medical Director of The Equitable 
 
 Life Assurance Society of the United States, New York City: 
 
 " I beg to say that, first — we look with much suspicion and dis- 
 favor upon any doctor, nurse, attendant or other employee who is spending 
 his time in a tubercular hospital. Second, we cannot see how residents in 
 the neighborhood of such an institution as a tuberculosis hospital would be 
 an adverse factor in issuing policies to non-tubercular applicants, provided 
 they do not come in contact with the disease in any form." 
 
 From the Medical Director of a company which does not 
 wish its name used in connection with this report: 
 
 "1. Residence or employment in a tuberculosis hospital, sanatorium or 
 dispensary would be regarded as an adverse factor in considering the issuance 
 of a life insurance policy to an applicant. 
 
 " 2. Residence in the neighborhood of such an institution would not be 
 regarded as an adverse factor." 
 
 San Francisco Health Board 
 
 In 1909, the San Francisco Board of Health expressed a favor- 
 able decision on the question of permitting the local anti- 
 
 38 
 
tuberculosis society to operate a dispensary in a two-story 
 building especially constructed for the purpose, located in a 
 fairly prosperous and thickly settled residential section of that 
 city. The following extract of an account of the decision is 
 taken from the " San Francisco Call," September 8, 1909: 
 
 " That a tuberculosis dispensary in a densely populated district is not a 
 menace to public health was the verdict of the sanitation and legislation 
 committee of the health board yesterday, this decision being the direct out- 
 come of the controversy between the Jackson Street Association and the 
 San Francisco Association for the Study and Prevention of Tuberculosis. 
 
 The property owners maintained that a dispensary of that character 
 
 was a public menace, while the others held that far from being a danger 
 to public health, it would be a public benefit." 
 
 New York State Health Department 
 
 A summary of the decisions rendered by the New York State 
 Department of Health under the law of 1909 (see page 31) shows 
 that in the first three years, 1909-1911, twenty-seven cases 
 were decided. Of this number eighteen applications were grant- 
 ed, six were withdrawn before decision was rendered, and only 
 six were denied. 
 
 Two of the applications denied were for locations at Liberty, 
 New York, and one at Narrowsburg in the same region. Some 
 years ago the village of Liberty was a summer resort, but like 
 many another interior resort, it had to yield its popularity to 
 the seashore and the mountain playgrounds with special attrac- 
 tions, which have been made accessible to the public in recent 
 years by railroads. The village apparently owes its present 
 prosperity to the fact that it has become within the last ten years 
 a well-known refuge for consumptives. Some of the inhabitants 
 of Liberty fail or refuse to face the very apparent facts of the 
 case and continue to oppose the influx of consumptives. 
 
 The application of Brith Abraham, a Jewish insurance order, 
 in 1910, was denied on the grounds that the village and town of 
 Liberty were already bearing their share of the burden of caring 
 for tuberculosis cases and that the time had come when those 
 desiring to erect sanatoria should be pointed in another direc- 
 ton. The application of Dr. Horace Greeley to establish a 
 sanatorium at Liberty at a later date was denied on the same 
 grounds, with the exception that Brith Abraham asked for 
 permission to erect a sanatorium on unimproved property, 
 while Greeley asked for permission to establish a sanatorium 
 
 39 
 
in a well adapted farmhouse on improved property of sixty- 
 acres just outside of the village. 
 
 At the Greeley hearing it developed that if he (Greeley) 
 wished to conduct a boarding house for tuberculosis cases or 
 other persons or both, he might do so without asking permission 
 from the local or state authorities. He might use sanitary 
 precautions or he might not, provided he did not wish to conduct 
 a " sanatorium " for tuberculosis cases. The residents of 
 Liberty who opposed the location seemed indifferent as to whether 
 the applicant conducted a boarding house, but they did object) 
 to a sanatorium on the grounds that it would give Liberty am 
 undesirable reputation as a resort for consumptives, because 
 of the advertising that would be used.* 
 
 * Copies of the opinion of Commissioner Porter in the Greeley case are on file in the 
 office of the National Association. 
 
 40 
 
CHAPTER VI 
 
 Court Decisions 
 
 Where the location of hospitals has been so bitterly opposed, 
 it is natural that in a number of instances recourse should have 
 been had to the courts. Some of their decisions rendered in 
 cases of this character are particularly pertinent. 
 
 Boston, Mass. 
 
 The courts of Massachusetts were among the first to give 
 recognition to the status of a tuberculosis sanatorium in a given 
 community. In 1893, the Supreme Court of Massachusetts, 
 in the case of the Free Hospital for Consumptives of Boston, 
 decided that this institution was not a menace either to property 
 or to health The decision which was based upon the testimony 
 of the best experts that could be secured, has since been sus- 
 tained by the benefit which the institution has been both to 
 the health and property of the community. 
 
 Asheville, N. C. 
 
 In January, 1909, the Sisters of Mercy of Asheville, N. C, 
 were temporarily enjoined by the courts from operating a 
 sanatorium for tuberculosis sufferers. Later, the injunction 
 was removed and the Sisters were permitted to operate their 
 sanatorium. 
 
 Orange, N. J. 
 
 In 1909, a temporary injunction was issued against continuing 
 the tuberculosis camp at Orange, N. J., but motion for a perma- 
 nent injunction was later denied. The camp consisted of a 
 remodelled barn located on the rear of the property of the 
 Orange Memorial Hospital and near to the abutting property 
 
 41 
 
of residents whose homes faced on the street back of the hospital. 
 The residents maintained that the camp was a nuisance and 
 menaced both their property values and their health. 
 
 Vice- Chancellor Howell's opinion on the case (Brikholz vs. 
 Lindsley), is contained in a letter to the defendant's lawyer, 
 A. F. Skinner, Newark, N. J., which is printed in full:* 
 
 " In the case of the tuberculosis camp in Orange, I have come to the con- 
 clusion that an injunction should not issue, and I give you very shortly my 
 reasons for denying the motion, and will ask you to send a copy of this letter 
 to Mr. Lord. 
 
 " Hospitals and pest houses are not nuisances per se. Their character as 
 nuisance depends upon their manner of operation, and that operation, in order 
 to be liable to the injunction process of the court, must be of such character 
 as to damage the complainant, not generally, but with respect to the use of 
 his property. There are many things, which a person does not like to have 
 planted next door to his residence, but which are entirely beyond the reach 
 of the law of nuisances. The Camp, so-called, seems to be conducted with 
 great care and propriety. The answering affidavits are very full, and while 
 they show a situation which is unpleasant and which no one would like to 
 have next door to him, yet, I think that the affidavits show that the business 
 is so carefully carried on and the rights of the adjacent property owners so 
 well observed that it is impossible for me to say that the complainants are 
 suffering any special damage over and beyond that is suffered by every mem- 
 ber of the community. 
 
 " There is another argument, which comes to mind from the character of 
 the neighborhood; if the camp should be enjoined, there still remains in the 
 same neighborhood, the tuberculosis ward of the Orange Memorial Hospital. 
 It is true, that the hospital patients do not enter and leave the premises 
 from the street, on which the complainants live, but it is there and the in- 
 junction in this case would not remove any objection to the operation of a 
 hospital. 
 
 " I have come to this conclusion without any reference to the statutes, 
 which were cited, because I do not see anything in either of these three acts 
 can result in giving the complainants, as private suitors, any new or additional 
 right or cause of action. It may be that these statutes would be available to 
 the public in a public prosecution, but I fail to see how the complainants 
 can derive any benefit from them in this private action. 
 
 "As I look at the complainants' case, it is and must be directed to show 
 facts, which will convince the court that the camp is being conducted in such 
 a way as to make a nuisance. This is the question of fact, which ought to 
 be investigated on the final hearing. 
 
 " I will advise an order denying the motion." 
 
 Richmond, Va. 
 
 In an effort to prevent Dr. William Parker, of Richmond, 
 Va., from operating the Chimbarazo Sanatorium, the city 
 council passed an ordinance requiring a license from the Board 
 of Health to operate such an institution within the city limits. 
 The courts declared the ordinance null and void on the grounds 
 that the council had no power to enact it. 
 
 * Copies of the petition and other papers in the case are on file in the office of the 
 National Association. 
 
 42 
 
Seattle, Wash. 
 
 In the case of Everett vs. Paschall, (61 Wash. 47) the 
 Supreme Court of the State of Washington in 1910 issued a 
 permanent injunction restraining Paschall from operating a 
 private tuberculosis sanatorium in the residential section of 
 Seattle. The sanatorium which accommodated about ten 
 patients, was located directly across an alleyway from the 
 property of the plaintiff. The lower court denied an injunc- 
 tion but the supreme court reversed the decision on the 
 grounds that the sanatorium constituted a nuisance. The de- 
 cision apparently applies only to hospitals in residential sec- 
 tions. Following is a digest of the court's opinion: 
 
 Defendant maintained a private sanatorium for the treatment of persons 
 afflicted with tuberculosis, and plaintiff prays for an injunction. The lower 
 court found as follows: That the danger zone of tuberculosis is about three 
 feet, beyond which there is no danger of infection or contagion; that defendant 
 conducted his sanatorium with a due regard for the safety of his patients and 
 the v public, that it was a great benefit to the community for the disease is 
 very prevalent, one-seventh of the deaths in the United States being caused 
 thereby; that it was not a nuisance per se; and that plaintiffs were not enti- 
 tled to an injunction. The Supreme Court of Washington held that the 
 hospital is not a nuisance within the definition of the common law, for it 
 created no physical inconvenience whatever; that but a new element in the 
 law of nuisance has been developed, namely, the comfortable enjoyment of 
 one's property; that under this law the maintenance of the sanatorium is a 
 nuisance. In reaching this conclusion, the court says that, in determining 
 what is a nuisance, regard should be had for the notions of comfort and con- 
 venience entertained by persons generally of ordinary tastes and suscepti- 
 bilities. The discomfort must affect the ordinary comfort of human exis- 
 tence as understood by the American people in their present state of en- 
 lightenment. The neighbors have dreaded and fear contagion. Such fear 
 detracted from the comfortable use of their property, so an injunction is 
 allowed. 
 
 Redlands, Cal. 
 
 In 1910, an effort was made to prevent Dr. G. F. Moseley 
 from operating the Mentone Sanatorium at Redlands, Cali- 
 fornia. The buildings had previously been used for a sanatorium 
 but the people objected to their being used again for the purpose. 
 In order to restrain Moseley, the Board of Supervisors of San 
 Bernardino County, in July, 1910, passed an ordinance with a 
 fine and imprisonment penalty attached, declaring tuberculosis 
 hospitals located in residential districts a menace and a public 
 nuisance and prohibiting their location. 
 
 As a test case, Dr. Moseley was put in jail and applied for a 
 writ of habeas corpus. On December 21, 1910, Judge Frank 
 F. Oster rendered a decision* in favor of the defendant on the 
 
 * Copies of this decision are on file in the office of the National Association. 
 
 43 
 
grounds that the Board of Supervisors exceeded their authority 
 in passing the restrictive ordinance. The question of whether 
 the hospital was a menace was not decided or considered by 
 the court. The decision on this point reads: 
 
 " Now, while there has been much evidence introduced here on the theory 
 of a public nuisance, we have no concern in that matter on this hearing. It 
 is simply a question of whether the board of supervisors have the constitu- 
 tional legislative power to enact this particular ordinance, and inasmuch as 
 they have sought to make that a public nuisance which, by their own specifi- 
 cations, constitutes only a private nuisance, it seems to me their authority | 
 is absolutely null and that they have no such power, and that the ordinance 
 is, therefore, unreasonable. It follows that the defendant must be discharged 
 from custody." 
 
 Houston, Tex. 
 
 A more recent and far more pertinent and explicit decision 
 was rendered in August, 1913, in connection with the attempt 
 of the Anti-Tuberculosis League of Houston, Texas, to locate 
 a tuberculosis dispensary in that city. Permission was gained 
 from the county authorities to erect a special building for the 
 purposes on the grounds of the county jail in the business dis- 
 trict of the city. Property owners and some physicians, in- 
 cluding the local health officer, protested against the site and the 
 case was taken into court. After an extended hearing, in which 
 evidence of every possible nature bearing on the case was 
 admitted, Justice Kittrell* rendered a decision in favor of the 
 League, which is of more than ordinary and local significance. 
 Part of the opinion is quoted herewith: 
 
 " In this case, the evidence manifestly preponderates in favor of the defend- 
 ants. Under that point, there is no reasonable grounds for difference of! 
 opinion. 
 
 " The question involved is whether the establishment of a clinic for the 
 treatment of persons afflicted with either incipient or clearly developed^ 
 tuberculosis will in all probability be so harmful to property owners and resi- 
 dents in the section of the city adjacent to the site of the proposed clinic, asi 
 to give them the right to injunctive relief. The case is one in which the pref- 
 erences and interests of the few must yield to the welfare of the many. In! 
 every part of the United States, warfare is being systematically and scien- 
 tifically waged against tuberculosis, both for the purpose of prevention and 
 cure. The results achieved in New York show a reduction in the number 
 of cases of something like 30 per cent., and the increase of the dreadful disease 
 makes it necessary for the protection of society that all reasonable means be 
 resorted to in order to accomplish its extermination or at least such mitiga 
 tion of its ravages as can be brought about by advanced methods of treatment. 
 
 " The work must be done somewhere or be stopped altogether, and the 
 highest interests of society demand that it should not be stopped and the 
 power of the court should not be put in motion to arrest such work except 
 upon the clearest proof that its prosecution will inevitably result in injury 
 to petitioners. 
 
 * Copies of the opinion in this case are on file in the office of the National Association. 
 
 44 
 
" The proximity to the county jail is also urged as a ground for relief, but 
 the hygienic conditions of that institution are far better than are those of 
 many homes, and the evidence is not sufficient to show that such danger 
 exists as is alleged. 
 
 " The evidence, the far greater part of which was not only heard but taken 
 down in writing with my own hand, convinces me that a clinic, such as is 
 proposed, when conducted along the lines marked out, will not imperil the 
 health of the neighborhood, or result in any depreciation of the value of 
 property, and because of the preponderance of the evidence is against the 
 contention that it will, a permanent injunction is refused, and the temporary 
 injunction will be, and is, dissolved." 
 
 45 
 
CHAPTER VII 
 
 Summary and Conclusions 
 
 Hospital not a Menace to Health 
 
 Among the many conclusions which may be drawn from th 
 array of facts presented in the preceding chapters, none is moi 
 evident than that a tuberculosis hospital in itself is not a menac 
 to the health of those living near it. This is the most frequer 
 and, in practically all cases, the basic objection to the locatio 
 of tuberculosis hospitals or sanatoria. Obviously, if there wei 
 no fear of infection, the hue and cry frequently raised relati\ 
 to the probable damage to property through the location of a 
 institution for tuberculosis would be largely dissipated an 
 would lose its force. 
 
 That such an objection, however, is not a valid one, is show 
 in the first place by the testimony of practically every supe] 
 intendent who has expressed an opinion with reference to tb 
 effect of his particular institution upon the health of thos 
 living near it. In not a single case has the National Associs 
 tion been able to find evidence that would indicate the slightes 
 danger of infection from a tuberculosis sanatorium to those wh 
 live on surrounding property, or who pass the doors of th 
 institutions at frequent intervals. The testimony of America 
 hospital superintendents is borne out furthermore by that ( 
 similar officers of European institutions who have been aske 
 about this question. In addition, it is greatly strengthened b 
 proof submitted from many other sources, which demonstrate 
 that the infection of healthy employees through associatio 
 with patients within a well-regulated sanatorium is almost ur 
 known. 
 
 In the second place, this conclusion is affirmatively recognize 
 in opinions by various courts of law and official bodies such < 
 local and state boards of health, that have been asked to pa 
 
 46 
 
upon the question of the infectiousness of tuberculosis. The 
 unanimous opinion expressed in practically every court decision 
 on this point, is that there can be no danger of infection from 
 a tuberculosis sanatorium to those who live near it. Even the 
 courts that have held adversely on the question of the location 
 of particular institutions, have taken pains to emphasize the 
 lack of danger of infection to the community. 
 
 Again, authorities are substantially agreed in the conclusion 
 that this disease is not transmitted from an institution to a 
 nearby dwelling nor from patients in passing a residence or 
 business establishment, nor from ordinary momentary contact 
 with tuberculous individuals in the streets and business places 
 where a tuberculosis institution is located. Medical science, 
 reinforced by pathological and bacteriological research, is almost 
 unanimous in the opinion that infection from tuberculosis can 
 be contracted only through intimate contact, directly with the 
 infectious discharges of a consumptive, and not through germs 
 that are blown through the air and inhaled now and then by 
 the chance passer-by. This experience, coupled with the well- 
 known and easily demonstrable fact that the rules of a tuber- 
 culosis institution forbid uncleanliness and promiscuous spitting, 
 and thereby provide against the carriage of germs from such 
 an institution to neighboring dwellings, should be conclusive 
 proof of the lack of danger to those who are afraid to have a 
 tuberculosis institution located in their neighborhood for fear of 
 possible infection. 
 
 Hospital Not Detrimental to Property 
 
 A second conclusion, which is obvious from a study of the 
 preceding pages, is, that except in rare instances a tuberculosis 
 institution does not diminish the value of surrounding property. 
 It is true, as Mr. Baldwin pointed out in his study of this sub- 
 ject, that any building, no matter what its use may be, which 
 is not in harmony with the other buildings of a particular neigh- 
 borhood, whether of a residential or business character, detracts 
 from the value of surrounding property. This would be true 
 whether the building were a church, a school, a jail, or a hospital. 
 
 On the other hand, the answers to the various questionnaires 
 sent out in the different studies which are outlined in this pam- 
 phlet indicate that, for the most part, a tuberculosis hospital 
 or sanatorium has little or no effect upon the value of property 
 
 47 
 
immediately surrounding it. In some instances property values 
 have risen or have decreased, but in the former cases usually 
 it has been in spite of the sanatorium, and in the latter, the 
 influences at work would have diminished property values 
 whether the tuberculosis institution were in existence or not. 
 There are hardly any cases on record where conclusive evidence 
 is at hand that a tuberculosis hospital or sanatorium has had 
 any permanent and lasting effect upon the value of surrounding 
 property. In a few instances, which have already been noted, 
 the sanatorium has apparently had an immediate effect, but 
 this has not lasted. If other influences in the general neigh- 
 borhood have tended to raise property values, the lots and 
 farms in the vicinity of the sanatorium have risen in price 
 along with those farther removed. 
 
 This conclusion is affirmed by a careful study of the property 
 values around the five institutions which were studied in care- 
 ful detail. Even in the neighborhoods where local opposition 
 had originally been strong and in districts where to some extent 
 opposition is at present manifest in a few quarters, no evidence 
 could be found that the tuberculosis sanatorium as such had 
 any serious effect upon the value of surrounding property. In 
 the case of Seton Hospital, or the Sprain Ridge Sanatorium, 
 where the population is growing rapidly around the institutions, 
 the hospitals have had no apparent effect upon land values, even 
 though some effort has been made on the part of certain prop- 
 erty owners to utilize the institution as a means for decreasing 
 their assessments. A study of the tables appended to this 
 report will further demonstrate this fact. 
 
 Initial Opposition Seldom Lasts 
 
 There are few cases on record where the initial opposition, 
 which would have prevented the location of a given institution, 
 lasted more than a year after the institution was opened. As 
 soon as the neighbors of a tuberculosis sanatorium realize its 
 true character and see that it does not have the harmful effects 
 which they had believed it would, the opposition generally 
 dies out. With the disappearance of the opposition, the land 
 usually continues to increase or decrease in value according to 
 its normal tendency. There can be no stronger evidence as to 
 the foolishness of the opposition of those who object to the 
 location of tuberculosis sanatoria than this fact, that not a 
 
 48 
 
single instance can be found where continuous organized oppo- 
 sition has existed for more than two years after the establish- 
 ment of a sanatorium, although in scores of instances such 
 organized opposition prior to the establishment of the institu- 
 tion was apparently strongly intrenched. 
 
 Some Minor Objections to Sanatoria Refuted 
 
 In addition to these main arguments advanced by those 
 who object to the location of sanatoria in their neighborhood 
 there are a number of objections of a minor character which 
 should be mentioned. 
 
 It is frequently said that the sight of sick persons wandering 
 about a neighborhood is disquieting and depressing. In a few 
 instances, where sanatoria or hospitals have been located un- 
 fortunately near public highways, this objection has some weight. 
 Where it is proposed, however, to establish a modern institu- 
 tion, under modern conditions, and with modern methods of 
 supervision, this objection can have little or no value. Tuber- 
 culous patients in sanatoria and hospitals are not allowed, as 
 a common practice, to roam around at will. The most funda- 
 mental principle of method in the treatment of tuberculosis is 
 that of a rigid regime where every movement of the patient is 
 under absolute control and supervision. In the regime of most 
 tuberculosis hospitals it is an offense punishable by discharge 
 for a patient to leave the grounds without special permission. 
 When patients are allowed to exercise sufficiently so that they 
 may walk beyond the limits of the hospital grounds, and where 
 they will be seen by the general public, they are not usually 
 in such physical condition as to present an unpleasant appear- 
 ance to anyone whom they are liable to meet. Neither can it 
 be said that they are in such instances liable to transmit tuber- 
 culosis to those with whom they come in contact. If a tuber- 
 culous patient is impressed with one thing more than another 
 from the very day he enters a sanatorium until he leaves it, 
 it is the danger of infecting others and the methods of protect- 
 ing those with whom he associates. 
 
 There are others who raise the objection that tuberculosis 
 sanatorium buildings are not attractive and therefore are ob- 
 jectionable. This is an objection which has little or no weight 
 at the present time. A few years ago, when the "shack" 
 type of construction was employed with too much frequency, 
 
 49 
 
this might have been said. The present tendency, however, 
 in tuberculosis hospital construction is to provide buildings 
 which are not only utilitarian in purpose, but which are durable 
 and possess real architectural merit and beauty. 
 
 The objection has also been raised that tuberculous patients 
 traveling to and from railroad stations or from central points 
 of transportation are a menace to those with whom they come 
 in contact. There is some division of opinion upon this subject. 
 It would seem to be unwise in many instances for a consider- 
 able number of tuberculosis patients to travel in a public con- 
 veyance if some other form of conveyance could be procured. 
 As a general rule, however, tuberculous patients do not travel 
 in public conveyances in any such numbers as to create a reason- 
 able fear in the minds of those with whom they come in con- 
 tact. In Boston, where an effort was made at one time to pre- 
 vent the local association from allowing tuberculous patients to 
 travel on the street cars to and from the day camp, it was 
 demonstrated that the very persons who had complained were 
 the worst offenders in promiscuous spitting, and that there 
 was practically no danger from the tuberculous patients. 
 The presence of an educated patient, who has been to a tubercu- 
 losis sanatorium, or who is going to one after having submitted 
 to an examination for admission, is far less dangerous to the 
 traveling public than the presence of an ignorant one who 
 does not know that he has the disease, and who takes no 
 pains to dispose of his sputum in a sanitary manner. The 
 National Association has still to discover any case of infection 
 from tuberculosis which may be traced directly or indirectly 
 to contact with patients traveling to or from a tuberculosis 
 sanatorium in a public conveyance. 
 Hospitals a Benefit to the Community 
 
 The testimony of tuberculosis sanatorium superintendents 
 confirmed by first-hand investigation and opinions of others 
 who are in a position to know, suggests that in many cases a 
 tuberculosis institution is a real benefit to the community in 
 which it is located. This is a question upon which it is difficult 
 to secure accurate and reliable information. If, however, the 
 reports of those who have had experience along this line may be 
 relied upon, it would indicate that in more than one-half of the 
 cases, tuberculosis institutions have directly helped those living 
 in the neighborhood in one way or another. 
 
 50 
 
A tuberculosis sanatorium has frequently proved a blessing, 
 possibly in disguise, by educating almost unconsciously the 
 people living near it to live and sleep out of doors. The testi- 
 mony of superintendents and others to the effect that the build- 
 ing of a tuberculosis sanatorium has created a demand for 
 sleeping porches and other forms of outdoor appliances, is what 
 one might expect from the presence of such an institution. 
 Naturally, such a practice has a marked benefit upon the 
 health of those who employ it. Statistics are lacking to demon- 
 strate conclusively the relative value of a tuberculosis sana- 
 torium upon the death rate of the persons living in and around 
 it. The experience, however, of such health centers as Rut- 
 land, Mass., Asheville, N. C, Saranac Lake, N. Y., and else- 
 where, would indicate that the death rate of longtime residents 
 is apparently lower since the coming of institutions for tuber- 
 culosis than previous to their presence. This experience is 
 shown by the much more careful statistics of various German 
 and English sanatoria. 
 
 A second benefit which a tuberculosis sanatorium often brings 
 to the community is, that it provides a market for the supplies 
 of farmers and tradesmen and for the labor of the men and 
 women in the neighborhood. The testimony of a score of super- 
 intendents, confirmed by the published annual reports of their 
 institutions, demonstrates the validity of this conclusion. A 
 tuberculosis sanatorium, whether it be a private institution for 
 patients of means, or a public institution with a large pay roll 
 and a considerable number of patients, brings money into the 
 community in which it is located, and thus adds not a little 
 to the material prosperity of the district. The expenditure of 
 sums ranging from $20,000 to $150,000 a year in a given town 
 or city, must have a beneficial effect upon the business life of 
 that community. 
 
 Some General Suggestions as to Location 
 
 It is difficult in a report of this character to offer suggestions 
 with regard to the location of a sanatorium or hospital that 
 will fit all sorts of conditions, since it is obviously necessary 
 that some institutions be located in urban districts, while others 
 may just as well be located in rural neighborhoods. Further- 
 more, in many instances, considerations other than those which 
 would relate merely to the possible opposition of neighbors 
 
 51 
 
would require the location of a sanatorium in one place as 
 opposed to another. 
 
 In general, however, it is obvious that the location of a tuber- 
 culosis sanatorium in a rural rather than an urban district is 
 preferable. The majority of institutions in this country are so 
 located. The very fact that it is desirable to have plenty of 
 room, unrestricted light, and ventilation in and around a tuber- 
 culosis institution makes a site of this character almost a 
 necessity. 
 
 ' It is desirable that a tuberculosis institution should not 
 be located too near a public highway or road. Satisfactory 
 landscape gardening, or the location of the institution at 
 a distance from the road will prevent much unpleasantness 
 and opposition. A site which affords advantages of this char- 
 acter should be sought for. Nearly every strong objection to 
 a tuberculosis institution recorded in the preceding pages was 
 entered by a resident immediately across the road from an 
 institution which was unfortunately situated too near to the 
 highway. An inconspicuous and tastefully arranged institu- 
 tion, even in a suburban district, will not cause opposition, 
 while the same grade of institution, considered merely from 
 the clinical point of view, if located in a conspicuous place and 
 surrounded by residences, might meet with violent opposition. 
 
 Wherever possible an institution for tuberculous patients 
 should provide its own conveyance to and from the nearest 
 railroad station. Many institutions have made this mistake 
 and have located in places where it has been necessary to trans- 
 port patients in conveyances along with the residents of the 
 district. While the danger from such a course as this can be 
 minimized and may not exist at all, it is sure to cause friction 
 if the practice continues, and it is decidedly better to avoid 
 this possible opposition by providing an ambulance or some 
 other attractive vehicle. 
 
 In the location of a given sanatorium, hospital, dispensary, 
 open air school, or other tuberculosis institution, three factors 
 should determine finally the selection of a site. These are: 
 
 (1) The suitability of the land for the buildings which it is 
 proposed to erect, considered merely from the point of view of 
 physical advantages, grouping, attractive surroundings, and 
 future economic administration. 
 
 52 
 
(2) The attitude of those who live and own property in the 
 neighborhood of the suggested site. 
 
 (3) The accessibility of the proposed institution to the cen- 
 ters of population considered from the point of view (a) of the 
 future patients, their friends and relatives; (b) the physicians 
 and anti-tuberculosis organizations who must co-operate with 
 it; and (c) the economical purchase and delivery of supplies. 
 
 In conclusion it should be borne in mind that tuberculosis 
 hospitals may be located in such a manner that the opposition 
 which exists prior to their establishment will pass away after 
 they have been established. It is not well, to countenance 
 unreasonable fear and prejudice. Neither, on the other hand, 
 is it wise to run counter entirely to the expressed wishes and 
 feelings of those who live in the neighborhood of the proposed 
 institution. There is a happy medium and a real propriety 
 which will show those who wish to establish tuberculosis insti- 
 tutions how they may turn these energies of fear and prejudice 
 to the support of their own work. 
 
 53 
 
APPENDIX 
 
 TABLES SHOWING CHANGE IN ASSESSED VALUA- 
 TION OF SURROUNDING PROPERTY OF 
 FIVE HOSPITALS 
 
 The figures of the following tables are for land alone, with 
 the exception of those for Hospital No. Ill, which include 
 buildings. Some of the tables are not complete because the 
 figures were not available. 
 
 Hospital No. I (Seton Hospital, New York City)* 
 
 The numbers indicate city blocks of irregular shape and 
 of greatly varying size. The plots of Table 1 are separated 
 from the hospital grounds only by the width of the street and 
 are considered adjoining property. The hospital grounds 
 themselves comprise an entire city block. 
 
 TABLE 1 
 
 Assessed Valuation of Adjoining Property, Showing Price 
 by Plots 
 
 Plot No. 
 
 1900 
 
 1905 
 
 1910 
 
 1913 
 
 1914 
 
 Hospital 
 
 1 
 
 $ 80,000 
 
 17,700 
 
 14,050 
 
 16,090 
 
 9,500 
 
 2,200 
 
 13,000 
 
 7,100 
 
 17,500 
 
 $110,000 
 30,000 
 24,800 
 28,200 
 18,000 
 5,500 
 23,000 
 14,000 
 38,000 
 
 $175,500 
 48,000 
 73,900 
 91,400 
 27,900 
 8,500 
 34,400 
 20,000 
 68,300 
 
 $385,000 
 
 86,800 
 
 145,700 
 
 157,000 
 
 33,000 
 
 7,000 
 
 39,600 
 
 32,800 
 
 87,000 
 
 $383,000 
 86,800 
 
 2 
 
 145,700 
 
 3 
 
 157,000 
 
 4 
 
 33,000 
 
 5 
 
 7,000 
 
 6 
 
 29,600 
 
 7 
 
 32,800 
 
 8 
 
 83,900 
 
 
 
 *See Map facing page 27. 
 
 54 
 
TABLE 2 
 Property One Block Removed 
 
 Plot No. 
 
 1900 
 
 1905 
 
 1910 
 
 1913 
 
 1914 
 
 I 
 
 $ 10,600 
 
 21,080 
 
 13,505 
 
 10,000 
 
 6,500 
 
 6,500 
 
 7,800 
 
 4,250 
 
 8,500 
 
 10,300 
 
 15,950 
 
 18,850 
 
 6,300 
 
 $ 20,000 
 31,400 
 28,300 
 22,000 
 12,000 
 12,000 
 11,200 
 7,200 
 14,000 
 17,700 
 27,100 
 42,700 
 21,500 
 
 $ 32,200 
 54,300 
 52,400 
 30,800 
 16,500 
 15,800 
 17,700 
 8,800 
 25,700 
 28,200 
 38,200 
 45,150 
 26,800 
 
 $ 53,300 
 101,800 
 76,700 
 51,300 
 33,000 
 31,600 
 29,600 
 15,700 
 46,500 
 49,000 
 61,600 
 82,100 
 47,700 
 
 $ 53,300 
 
 II 
 
 98,600 
 
 Ill 
 
 73,900 
 
 IV 
 
 51,300 
 
 V 
 
 33,000 
 
 VI 
 
 31,600 
 
 VII 
 
 29,600 
 
 VIII 
 
 15,700 
 
 IX 
 
 46,500 
 
 X 
 
 49,000 
 
 XI 
 
 62,200 
 
 XII 
 
 82,100 
 
 XIII 
 
 47,700 
 
 
 
 TABLE 3 
 Property Two Blocks Removed 
 
 Plot 
 
 1900 
 
 1905 
 
 1910 
 
 1913 
 
 1914 
 
 A 
 
 $ 23,500 
 
 15,905 
 
 18,700 
 
 13,000 
 
 18,000 
 
 6,000 
 
 5,500 
 
 7,000 
 
 4,100 
 
 6,160 
 
 9,050 
 
 9,900 
 
 4,000 
 
 4,000 
 
 7,000 
 
 7,500 
 
 14,700 
 
 4,400 
 
 40,250 
 
 $ 40,000 
 
 33,900 
 
 35,000 
 
 18,000 
 
 30,000 
 
 9,000 
 
 8,000 
 
 11,000 
 
 6,300 
 
 12,300 
 
 19,500 
 
 19,300 
 
 8,000 
 
 7,000 
 
 14,000 
 
 12,460 
 
 22,800 
 
 6,500 
 
 61,800 
 
 $ 70,000 
 53,500 
 59,600 
 47,200 
 66,500 
 14,000 
 12,200 
 20,100 
 
 9,100 
 24,110 
 33,900 
 28,800 
 13,500 
 13,500 
 19,300 
 16,500 
 30,800 
 
 9,700 
 124,800 
 
 $109,700 
 
 108,500 
 
 103,000 
 
 114,700 
 
 138,900 
 
 25,000 
 
 21,800 
 
 33,700 
 
 14,500 
 
 30,300 
 
 51,500 
 
 40,600 
 
 27,000 
 
 25,000 
 
 39,500 
 
 32,000 
 
 56,200 
 
 22,000 
 
 183,600 
 
 $108,000 
 
 B 
 
 96,700 
 
 C 
 
 88,000 
 
 D 
 
 111,300 
 
 E 
 
 141,500 
 
 F 
 
 25,000 
 
 G 
 
 21,800 
 
 H 
 
 32,800 
 
 I 
 
 14,500 
 
 J 
 
 30,300 
 
 K 
 
 51,500 
 
 L 
 
 40,200 
 
 M 
 
 27,000 
 
 N 
 
 25,000 
 
 O 
 
 39,500 
 
 P 
 
 32,000 
 
 Q 
 
 56,200 
 
 R 
 
 22,000 
 
 AA 
 
 131,100 
 
 
 
 55 
 
Hospital No. II (Sprain Ridge Hospital, Yonkers, N. Y.) 
 
 TABLE 1 
 
 Assessed Valuation of Adjoining Property, Showing Prices 
 per Acre 
 
 Plot No. 
 
 1906 
 
 1969 
 
 1912 
 
 1914 
 
 Hospital 
 
 1 ; 
 
 $ 450 
 
 380 
 
 200 
 
 200 
 
 1,000 
 
 630 
 
 1,000 
 
 1,275 
 
 1,310 
 
 $ 450 
 
 380 
 
 200 
 
 200 
 
 500 
 
 815 
 
 1,000 
 
 1,220 
 
 1,190 
 
 $ 450 
 400 
 300 
 300 
 500 
 815 
 1,000 
 
 $ 450 
 500 
 
 2 
 
 300 
 
 3j 
 
 300 
 
 4 
 
 1,000 
 
 5 
 
 1,185 
 
 6 
 
 1,000 
 
 7 
 
 8 
 
 1,963 
 1,686 
 
 
 
 TABLE 2 
 Nearby Property 
 
 Plot No. 
 
 1906 
 
 1909 
 
 1912 
 
 1914 
 
 9 
 
 $ 550 
 
 425 
 
 500 
 
 1,500 
 
 1,125 
 
 1,150 
 
 650 
 
 1,000 
 
 $ 550 
 
 425 
 
 500 
 
 1,500 
 
 1,525 
 
 1,600 
 
 650 
 
 1,000 
 
 $ 550 
 
 425 
 
 500 
 
 2,000 
 
 1,525 
 
 1,600 
 
 650 
 
 1,000 
 
 $ 1,000 
 425 
 
 10 
 
 11 
 
 1,000 
 
 12 
 
 2,000 
 
 13 
 
 1,525 
 
 14 
 
 15 
 
 1,600 
 1,150 
 
 16 
 
 1,175 
 
 
 
 Hospital No. Ill (Bowne Memorial Hospital, Poughkeepsie, 
 
 N. Y.) 
 
 TABLE 1 
 
 Showing Assessed Valuation of Adjoining Property per 
 Plot, with Acreage of Plots 
 
 Plot No. 
 
 Acreage 
 
 1908 
 
 1909 
 
 1910 
 
 1912 
 
 1 
 
 2 
 
 3 
 
 4 
 
 7 A 
 80 
 
 59 
 
 12 
 
 4 
 
 (21 
 
 \60 
 
 $1,000 
 6,000 
 
 3,600 
 1,600 
 1,500 
 2,500 
 3,500 
 
 $1,000 
 6,000 
 
 3,600 
 1,600 
 1,800 
 2,500 
 3,500 
 
 $6,600 
 
 3,860 
 1,760 
 2,000 
 2,750 
 3,850 
 
 $1,200 
 
 6,600 
 
 / 55 acres \ 
 
 \ 2,500 / 
 
 1,760 
 
 5 
 
 2,000 
 
 6 
 
 2,8001 
 3,800/ 
 
 56 
 
TABLE 2 
 Nearby Property 
 
 Plot No. 
 
 Acreage 
 
 1908 
 
 1909 
 
 1910 
 
 1912 
 
 7 
 
 30 
 10 
 
 20 
 /22 
 
 119 
 
 $ 800 
 
 500 
 3,500 
 2,200 
 5,000 
 
 $ 800 
 
 /374 acres) 
 
 \ 20,000 / 
 
 11,000 
 
 4,500 
 
 500 
 
 4,000 
 
 2,200 
 
 5,000 
 
 $ 800 
 
 /200 acres) 
 
 \ 15,000 / 
 
 12,100 
 
 4,950 
 
 550 
 
 4,400 
 
 2,420 
 
 6,600 
 
 $ 900 
 
 /100 acres) 
 
 \ 5,000 J 
 
 12,100 
 
 5,000 
 
 550 
 
 8 
 
 9 
 
 10 
 
 11 
 
 12 
 
 4,000 
 2,400 
 6,600 
 
 13 
 
 
 Hospital No. IV (Montefiore Home Country Sanatorium, Bed- 
 ford Hills, N. Y.)* 
 
 TABLE 1 
 
 Assessed Valuation of Adjoining Property, Showing Price per 
 
 Plot, with Acreage of Plots 
 
 Plot 
 
 Acreage 
 
 No. 
 
 
 1 
 
 83 
 
 2 
 
 75 
 
 3 
 
 
 4 
 
 122 
 
 5 
 
 60 
 
 6 
 
 130 
 
 7 
 
 75 
 
 8 
 
 21 
 
 9 
 
 71 
 
 10 
 
 68 
 
 10. .... 
 
 
 12 
 
 80 
 
 11 
 
 185 
 
 1903 
 
 1906 
 
 1908 
 
 1911 
 
 1913 
 
 $7,000 
 
 6,450 
 6,000 
 3,500 
 
 15,000 
 189 acres) 
 12,250 / 
 
 $15,000 
 
 12,500 
 
 3,500 
 
 10,000 
 25,000 
 
 $15,000 
 
 7,000 
 
 85 acres 
 
 4,700 
 
 12,000 
 
 7,000 
 
 10,500 
 
 3,500 
 20,000 
 151 acres 
 11,000 
 10,000 
 25,000 
 
 $15,000 
 7,000 
 
 85 acres 
 4,700 
 12,000 
 7,000 
 9,000 
 5,000 
 
 ' 3,500 
 25,000 
 /151 acres 
 \ 15,000 
 
 35,000 
 
 $15,000 
 
 7,000 
 
 85 acres 
 
 7,000 
 
 12,000 
 
 7,500 
 
 10,000 
 
 7,000 
 
 5,000 
 
 3,500 
 
 35,000 
 
 /151 acres\ 
 
 20,000 / 
 
 16,000 
 
 50,000 
 
 TABLE 2 
 Nearby Property 
 
 Plot 
 
 Acreage 
 
 1903 
 
 1906 
 
 1908 
 
 1911 
 
 1913 
 
 No. 
 
 
 
 
 
 
 
 I 
 
 40 
 
 
 $ 2,400 
 
 $ 2,400 
 
 $ 4,000 
 
 $ 7,500 
 / 73 acres \ 
 X 22,000 / 
 
 III 
 
 150 
 
 $12,000 
 
 
 20,000 
 
 30,000 
 
 IV 
 
 120 
 
 
 15,000 
 
 15,000 
 
 15,000 
 
 15,000 
 
 V 
 
 76 
 
 12,000 
 
 
 25,000 
 
 30,000 
 
 30,000 
 
 II 
 
 34 
 
 
 7,500 
 
 6,500 
 
 10,000 
 
 7,000 
 
 *See map facing page 26. 
 
 57 
 
Hospital No. V (Gaylord Farm Sanatorium, Wallingford, 
 
 Conn.) 
 
 TABLE 1 
 
 Showing Assessed Valuation of Adjoining Property per 
 Plot, with Acreage of Plots 
 
 Plot No. 
 
 Acreage 
 
 1903 
 
 1905 
 
 1910 
 
 1913 
 
 l : 
 
 34 
 70 
 12 
 
 44 
 
 92 
 123 
 
 70 
 38 
 
 $ 640 
 
 460 
 
 1,800 
 1,050 
 
 $ 600 
 840 
 
 525 
 
 1,800 
 1,800 
 
 1,190 
 494 
 
 $ 811 
 
 2,200 
 
 204 
 
 972 
 (84§ acres\ 
 \ 2,320 / 
 
 4,200 
 /108 acres) 
 \ 1,920 / 
 
 865 
 
 $ 810 
 
 2 
 
 2,200 
 204 
 
 3, 
 
 4 
 
 / 30 acres \ 
 \ 600 I 
 
 5 
 
 /84| acres\ 
 { 1,555 / 
 
 4,200 
 /108 acres\ 
 I 1,920 / 
 865 
 
 6 
 
 7 
 
 8 
 
 
 
 TABLE 2 
 Nearby Property 
 
 Plot No. 
 
 Acreage 
 
 1903 
 
 1905 
 
 1910 
 
 1913 
 
 9 
 
 68 
 62 
 
 $ 800 
 1,035 
 
 $ 800 
 1,035 
 
 $1,765 
 1,797 
 
 $1,7-65 
 
 10 
 
 1,800 
 
 
 
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