COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX641 22557 RC309.A2 B73 a directory of insti RECAP ^ . - Y i A DIRECTORY OF INSTITUTIONS AND SOCIETIES DEALING WITH TUBERCULOSIS IN THE UNITED STATES AND CANADA COMPILED BY LILIAN BRANDT PUBLISHED BY THE COMMITTEE. ON THE PREVENTION OF TUBERCULOSIS OF THE CHARITY ORGANIZATION SOCIETY OF THE CITY OF NEW YORK AND THE NATIONAL ASSOCIATION FOR THE STUDY AND PREVENTION OF TUBERCULOSIS 1904 Copyright, 1904, BY THE CHARITY ORGANIZATION SOCIETY OF THE CITY OF NEW YORK Press of the Evening Post Job Printing House, Sew York. Lilian Brandt, Statistician Paul Kennaday, Secretary, 105 East 22d Street THE COMMITTEE ON THE PREVENTION TUBERCULOSIS OF THE CHARITY ORGANIZATION SOCIETY OF THE CITY OF NEW YORK OF Charles F. Cox, Chairman Otto T. Bannard Hermann M. Biggs, M.D. David Blaustein Herbert S. Brown Joseph D. Bryant, M.D. Thos. C. T. Crain Thos. Darlington, M:D. Robert W. de Forest Edward T. Devine Homer Folks J. H. Huddleston, M.D. Robert Hunter A. Jacobi, M.D. Walter B. James, M.D. E. G.Janeway, M.D. A. B. Jennings S. A. Knopf, M.D. Alexander Lambert, M.D. Ernst J. Lederle Frederic S. Lee, M.D. Henry M. Leipziger Egbert Le Fevre, M.D. Henry P. Loorais, M.D. James Alexander Miller, M. D. Mrs. James E. Newcomb Eugene A. Philbin Ernest Poole T. Mitchell Prudden, M.D. Andrew H. Smith, VI. D. W. G. Thompson, M. D. E. L. Trudeau, M.D. James H. Tully Frederick L. Wachenheim, M.D. Lillian D. Wald THE NATIONAL ASSOCIATION FOR THE STUDY AND PREVENTION OF TUBERCULOSIS OFFICERS President: Edward L. Trudeau, M.D. Vice-Presidents: William Osier, M.D. Hermann M. Biggs, M.D. Treasurer: Gen. George M. Sternberg, M.D. Secretary: Henry Barton Jacobs, M.D. BOARD OF DIRECTORS Howards. Anders, M.D. Robert H. Babcock, M D. Hermann M. Biggs, M.D. Vincent Y. Bowditch, M.D. Henry M. Bracken, M.D. Norman Bridge, M.D. Maj. George E. Bushnell, M.D. Edward T. Devine Lawrence F. Flick, M.D. John P. C. Foster, M.D. John S. Fulton, M.D. Frederick L. Hoffman John N Hurty, M.D. Henry Barton Jacobs, M.D. Arnold C. Klebs, M.D. Office: 105 East 22d Street, New York City. S. A. Knopf, M.D. Charles L. Minor, M.D. William Osier, M.D. Edward O. Otis, M.D. Leonard Pearson. M.D. William Porter, M.D. Charles O. Probst, M.D. Mazyck P. Ravenel, M.D. S. Edwin Solly, M.D. Matthew M. Smith, M D. Gen. George M. Sternberg, M.D. Edward L. Trudeau, M.D. Victor C. Vaushan, M.D. William H. Welch, M.D. Gen. Walter Wyman, M.D. Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/directoryofinstiOObran CONTENTS PAGE Map showing- the location of all institutions vi Introduction vii Part I.— SanatoriuiMS, Hospitals and Camps. I. — Essential Features in Sanatoriums for Incipient Cases. Edward L. Trudeau, M.D i II. — Essential Features in Hospitals for Advanced Cases. Law- rence F. Flick, M.D 7 III. — Institutions in the United States and Canada 13 Part II.— Special Dispensaries. I. — The Function of Special Dispensaries and Important Features in their Organization. Edward O. Otis, M.D 147 II. — Special Dispensaries in the United States 153 Part III.— The Tuberculous Insane. I. — Tent Treatment for Tuberculous Insane. A. E. Macdonald, M.D 169 II. — Hospitals for the Insane in which Special Provision is made for Consumptives 181 Part IV. — Tuberculous Prisoners. I. — Prevention and Treatment of Tuberculosis in Penal Institu- tions. J. B. Ransom, M.D 191 II. — Penal Institutions in which Special Provision is made for Con- sumptives 201 Part V.— Municipal Control of Tuberculosis. I. — Essential Features in a Municipal System for the Control of Tu- berculosis, Hermann M. Biggs, M.D 207 II. — Summary of Existing Measures in the Principal Cities of the United States. Lilian Brandt 217 Part VI. — Associations for the Prevention of Tuberculosis : Societies, Committees, State Commissions. I. — The Organization and Function of Associations for the Pre- vention of Tuberculosis. Edward T. Devine 223 II.— Associations in the United States and Canada 229 Index to Sanatoriums, Hospitals and Camps, and Summary 257 o U w o O h4 INTRODUCTION This Directory has been prepared with two objects in view. It is designed, first, to serve as a guide to the physicians and friends of consumptives, whether poor or well-to-do, by furnish- ing accurate information in regard to existing institutions. At the same time an attempt has been made to present a bird's-eye view of all the organized work that is being done in the United States and Canada for the cure and prevention of tuberculosis. While the inclusion of an institution in this volume is in no sense to be taken as a recommendation of it, by either the New York Committee or the National Association, still, on the other hand, the attempt has been made to exclude all sanatoriums of an undesirable character : one, for instance, has been dropped from the list because it advertises a new specialty every few months, although just at present the specialty is tuberculosis; another, because the m.ost prominent feature of the treatment provided is the injection of a serum of secret manufacture; another, because it has displayed such zeal and persistence in advertising its superlative excellences as to remove any possi- bility of confidence. Several others, it should be added, with which some correspondence has been had, have been excluded for no such reason, but merely because, while they do not refuse to admit consumptives, they make no special provision for the treatment of tuberculosis, and have an insignificant number of such cases among their patients. Boarding houses and hotels without medical supervision or sanatorium regulations have not been included. A reliable list of such as are open to consump- tives and can be recommended by a physician would be most useful. The introductory chapters in each section furnish a criterion for judging existing institutions and will in many particulars offer a guide to persons who are planning new ones. In regard to each institution the aim has been to give facts which will en- able the physician to form a just estimate of it and which will give the patient and his friends some idea of its character. In this connection it seems desirable to repeat the warning, which cannot be sounded too frequently or too emphatically, INTRODUCTION against leaving home for any place without counting the cost. From California, Colorado, New Mexico, Arizona, and the Carolinas, come protests against the barbarity of physicians who send patients in an advanced stage of consumption far from home and friends, and even from medical advice, with insuf- ficient means to supply the necessaries of life. There is no cli- mate which will avail to cure consumption if the other elements in the treatment are privation, worry, and homesickness. For a consumptive in any stage of the disease to go to a health resort with the idea of supporting himself while he gets well is folly, if not madness. There is always, at such places, an excessive supply of the kind of labor he can offer, and wages are pro- portionately low. The cost of living, on the other hand, is apt to be much higher than the average. Furthermore, it is neces- sary that exercise, even in the earliest stages of the disease, should be taken under the direction of a physician. It is use- less, in brief, to go to the most favorable climate unless one has the means to meet a year's expenses, including a reserve for emergencies. Hiow far the second object of the Directory has been attained it is difficult to judge. It is believed that the list of institutions exclusively or chiefly for the treatment of tuberculosis, and the list of associations for the prevention of the disease, are practi- cally complete. There may be, however — and it is to be hoped that there are — many omissions of almshouses, hospitals for the insane, and prisons and reformatories, in which consumptives are segregated and given special care. No attempt has been made to show what is done by charitable societies in caring for poor consumptives in their homes, because, although the work itself is extremely important, an account of the variations in method would be somewhat outside the scope of the present volume and a complete inventory would include practically all the relief giving societies in the country. The United Hebrew Charities of New York City may be cited as a conspicuous example of a society which has for sev- eral years been devoting special attention to the tuberculosis problem among the families under its care. All of the families in which consumption is the main problem are placed under the care of a special committee. The work of this committee begins with a careful medical examination, on the results of which subsequent action is determined ; treatment in a sanatorium is INTRODUCTION provided, when this is possible ; when the patient is obHged to remain at home desirable medical treatment is supplied and necessary food ; suitable work is secured for the improved con- sumptive, frequentlv in the suburbs or in country towns ; trans- portation is provided when a change of climate is advised ; and in all cases friendly visiting and instruction of the consumptive and his family are prominent features of the treatment. Much can be done for consumptives wdio cannot or will not leave home. For those in the early stages dispensary treatment, accompanied by proper living, may effect a cure, and sometimes it is not even necessary that the patient should stop working. Many of those in whom the disease is farther advanced are unwilling to leave home, and when there is little hope of recov- ery there is no reason w^hy they should be forced to do so, unless they are a menace to those about them. In all kinds of cases good results have been secured at home by providing suitable medical advice and necessary food and carefully supervising the family life. It may not be possible, in most instances, on ac- count of the advanced stage already reached by the consumptive before the family comes under the care of the society, to effect a permanent cure, but it is always possible to prevent the patient from being a source of danger to others and to teach his family what they should know for their own protection in the future. To point out the conspicuously weak spots in what the French would call our "armament against tuberculosis," would be practically to enumerate the different parts of the armament. For there is no class of institutions, wdth the possible exception of sanatoriums for the well-to-do, of which there is as yet any- thing approaching a sufficient number. More than a hundred thousand deaths are caused by consumption each year in the United States. The total number of beds for consumptives, in all kinds of institutions, is less than eight thousand, and almost one-third of them are in the state of New York. There is imperative need of free sanatoriums for early cases and of sanatoriums for persons who are able to pay five or six dollars a w^eek. Nor is it desirable that these should be massed in the Adirondacks, Colorado, and the southwest. They should be distributed over the country. In Massachusetts and New York, state sanatoriums are now in operation ; the Rhode Island buildings are completed and will be occupied in 1905 ; New Jersey has secured a site and has appropriated a sufficient INTRODUCTION amount to erect and equip buildings ; an initial appropria- tion has been made in Minnesota and in Ohio; and in sixteen other states more or less fruitful efforts have been made. What has been done is only a beginning. Each state should have its state sanatorium and each city of considerable size should provide its own municipal institution. There is need also of industrial colonies where persons in whom the disease has been arrested could be employed in light outdoor work, such as horticulture and the keeping of poultry, pigs, and bees, under conditions which would prevent relapse and would enable them to be at least partly self-supporting. There should be well-equipped free dispensaries in every city. There should be in every city a s^^stem of control by the department of health and a private organization to instigate and supplement public efforts. All these are pressing needs. But there are several other respects in which the United States is peculiarly negligent. One of these is the care of consumptives in public institutions. With an adequate sanatorium and hospital system there will be no reason why consumptives should be found in almshouses. Pending this solution of the question, however, they should be housed in a separate wing, if there is only one building available, or separate wards, or in tents. The extension of sanatorium provision will not solve the problem of the consumptive in hos- pitals for the insane and in correctional institutions. It is of the utmost importance to the welfare of the public that this question should receive intelligent consideration. There is the less excuse for neglect in this line of work for the control of tuberculosis because experience has already demonstrated that favorable results can be obtained from comparatively slight expenditures. Another glaring deficiency in the American armament is in provision for advanced cases. Houses of rest are urgently re- quired, where patients who are not suitable candidates for en- trance to sanatoriums for early cases and who cannot be cared for properly in their homes can be received and made comforta- ble in their last months. Ultimately, with the development of facilities for preventing tuberculosis and for curing it in its in- ception, the need for this class of institutions will be practically eliminated ; but for some time to come they will be essential. A third respect in which the United States is especially negli- INTRODUCTION gent is in its provision for children suffering from non-pulmon- ary tuberculosis. England has a large hospital for such cases at Margate and in France there are seaside hospitals for them with an aggregate capacity of four thousand beds. The only attempt to provide seaside treatment in America is the experimental camp of the New York Association for Improving the Condition of the Poor. At the Convalescent Home of the Children's Hos- pital of Boston the open-air treatment in the country has been inaugurated ; and at Loomis and Stony Wold Sanatoriums and Seton Hospital, in New York State, special provision is made for children. But these are the only efforts of the kind that have been discovered. There are many signs that interest in this work of control- ling and eradicating tuberculosis is only in the incipient stage, if a technical phrase may be used, and the indications are that it is rapidly developing. There is every reason to hope that the sec- ond edition of the Directory will be twice the size of this volume. It may not be out of place to express another hope, for which there is also a basis, that in the second edition it will not be neces- sary to vary the spelling of the word "sanatorium." It is intended to publish revised editions at whatever inter- vals may be demanded by the progress made. With this in view all readers are asked to send corrections of the material included in this issue, information in regard to new organiza- tions of any sort, and suggestions for increasing the value of the Directory as a book of reference. L. B, Paet I SANATORIUMS, HOSPITALS AND CAAIPS L— ESSENTIAL FEATURES IN SANATORIUMS FOR INCIPIENT CASES EDWARD L. TRUDEAU, M. D. PRESIDENT OF THE ADIRONDACK COTTAGE SANITARIUM SANATORIUMS FOR THE TREATMENT OF INCIPIENT TUBERCULOSIS Sanatoriums may be broadly divided into two classes : those which aim at the restoration of patients, and those which are merely designed on humanitarian principles to care for hopeless cases, and to prevent them from infecting others. Formerly a consumptives' hospital was regarded simply as an asylum for hopeless cases, and such institutions, for far advanced cases, are as much needed as ever on humanitarian grounds, and to prevent such cases from infecting those about them. The modern sanatorium, however, represents an attempt to cure, and keeps this end in view in limiting admission to favorable and early cases. It recognizes that what success is to be obtained in treating its patients is dependent on an early diagnosis, and on a thorough application of its methods of treatment before the general health has become much impaired and the organic damage extensive. The first requisite, therefore, for admission to these institu- tions is that the case should be a truly incipient one, or at least that there should be a fair prospect of arresting the disease. The earlier the tuberculosis is detected and the patient informed of the true nature of his malady, the better will be the chance of cure, for if he be deceived as to the serious meaning of his slight symptoms he is not likely to make willingly the necessary sacrifice of time and money, and would lose the opportunity for restoration. About seventy-five per cent of applicants are re- fused at the sanatoriums for the treatment of incipient tuberculo- sis because their cases are considered too far advanced, though some institutions take a fair proportion of advanced cases. The modern sanatorium represents the most favorable en- vironment attainable for the consumptive, and depends for its efficiency on the following factors : a good climate, buildings specially adapted for this method of treatment and for protecting its inmates from infection, facilities for living an outdoor life in all kinds of weather, good food, and strict medical discipline SAXATORIUMS FOR EARLY CASES SO far as rest, exercise, and the details of the daily life are concerned. Climate of late years has not been considered so essential as formerly. It has been shown undoubtedly that excellent results are obtained by the open-air method in sanatoriums situated in climates laying no special claim to any favorable influence on tuberculosis, but it cannot be denied that a good climate must be a factor of considerable value in securing the most favorable environment attainable for the consumptive, and that climate should always be utilized when available. The situation of the institution, so far as exposure, drainage, water supply, shelter from prevailing winds, and freedom from dust-laden air, are concerned, is universally recognized to be of the utmost importance, as well as the construction of the buildings. Either the tent, the cottage, or the pavilion plan is generally adopted by the most successful institutions, as tending to segregate patients and to afford them the best conditions of sunlight, ventilation, and convenience in living the outdoor life which is considered essential to cure. Special care of the expectoration, scrupulous cleanliness, sun- light, abundant air space and ventilation, are relied upon and have been proved thoroughly efficacious to protect patients from any evil effects of aggregation. There is much less chance for a susceptible individual to become infected in a well-planned and well-directed sanatorium than anywhere in the ordinary walks of life. Facilities that enable the patient to sit out of doors in any kind of weather, and to sleep out of doors on sheltered verandas at night when ordered by the physician, are among the important features of the modern sanatorium. An infirmary should also always be available, where the acute re- lapses and complications of the disease can be treated by keep- ing the patient in bed, often for weeks at a time, with good nursing, and yet not interfere with his open-air treatment. Ever\fthing is planned to encourage living out of doors with comfort in any kind of weather, and to render this in no way irksome. This habituation to an out-of-door life, and to the natural changes of temperature, and inclemencies of weather, is a potent factor in invigorating the patient and in increasing his resistance to a disease which is so largely due to an indoor life and its evil consequences. SANATORIUMS FOR. KARI^Y CASES Cold, tepid, or hot baths are an important element of the treatment, and should be easily available to every patient. The quantity and quality of the food, the intervals of rest and exer- cise, the occupations and amusements of the patients, are all under the control of the physician, and discipline is the keynote of success. The patient lives constantly under the direction of the physician. The duration of the patient's treatment should be from five to six months or more, as little that is permanent in the way of cure can be accomplished in most cases by a shorter stay. The education the patient receives in these institutions is of the utmost value to him in teaching him, as he can learn nowhere else so effectually, how to protect himself and others from infection, and how to live and care for himself if relapses occur after he has left the institution. E. L. Trudi^au. II.— ESSENTIAL FEATURES IN HOSPITALS FOR ADVANCED CASES LAWRENCE F. FLICK DIRECTOR OF THE HENRY PHIPPS INSTITUTE ESSENTIAL FEATURES IN HOSPITALS FOR ADVANCED CASES The success of the crusade against tuberculosis which now is being preached and inaugurated all over the civilized world will in a great measure depend upon the manner in which the resources at hand are put to practical use. Tuberculosis is so prevalent, so widespread, and so paralyzing in its influence that a movement for its extermination necessarily becomes a her- culean undertaking. So many things that could be done suggest themselves to one that one hardly knows what ought to be done first. With limited resources it is therefore of some importance to inaugurate first those measures which promise the best re- turns with the least outlay of money. Of the measures which may be classed as of importance the establishment of hospitals for advanced cases easily stands first. This does not appear to be so at first blush, but proves to be so upon analysis of the various measures in all their influences. Tuberculosis is a contagious disease which depends upon intimate contact for dissemination and which probably never is communicated except by intimate contact. This contact, more- over, must take place in an enclosure and vmder proper condi- tions. Among human beings the lower down in the scale of prosperity the better are the conditions for implantation, because not only are the dwellings in which the poor live the most ideal enclosures for the propagation of the disease, but the poor themselves constitute the most ideal soil for its implantation and growth. We know from clinical observations, moreover, that the last few months of life of a consumptive constitute the time when seed for new implantations is most generously given ofif. This is the time, too, when the person afflicted, on account of his symptoms, is apt to house himself closely and thereby create the contagious environment which is most potent for new implantations. Here, again, the lower in the scale of prosperity the greater the likelihood that the house occupied by the con- sumptive will be made a contagious environment capable of giv- ing implantations. In the crusade against tuberculosis the most important work is the prevention of implantations. When the tubercle bacillus H0SPITAI,S I^OR ADVANCED CASElS once has been implanted in a person it is a long and difficult process to get it out of him. Even when physical health has been restored to such a person he may contain tubercle bacilli in his tissues and at times give them off as a seed supply for new implantations. A person who never has had an implantation of tuberculosis is therefore in every way better off and is a more valuable citizen, other things being equal, than a person who has had tuberculosis, however well the latter may become. This, of course, is entirely from the viewpoint of preventive medicine. If the tuberculous matter given off by all tuberculous subjects in the world could be sterilized immediately when given off no new cases of tuberculosis could arise, and when all the present tuberculous subjects would have died human tuberculosis would be extinct. Whilst to accomplish this is theoretically possible, practically it is impossible. A very considerable proportion of the human race at the present time is tuberculous. Many of these people need only to be told what to do to make themselves harmless to others. Many more have the disposition to do what is necessary, but lack the intelligence, the knowledge, or the means. Some have the intelligence and the means, but not the disposition. Others, perhaps a fcAV only, lack the intelligence, the means, and the disposition. The health of a community is no more secure than is the sanitary guard around the humblest home. It is the poor and the lowly who serve the rich and. the proud, and it is therefore through the poor and the lowly that disease is most easily spread. A poor man not only comes in contact with those of his own class, but he is intimately associated with people of every class. He necessarily carries with him the disease-breeding environ- ment of his own home wherever he goes. If he has tuber- culosis in his home and preventive measures are not practiced in that home, his clothing is saturated with tuberculous matter in dried pulverized form and he is a source of danger to every one with whom he comes in contact intimately for a long enough period of time. The danger to the community from a contagious case of tuberculosis in a poor family grows in geometrical progression. Under the stress of poverty and deprivation and hardship such a case will give rise to new implantations in every member of that household during the time that the patient is confined to the 10 HOSPITALS FOR ADVANCI^D CASES house, and in a little while there will be a number of walking distributors of contagion instead of one. Each of these new cases in its turn becomes a propagator of a number of cases, and in this way the disease is spread on. The dying consumptive undoubtedly is the most prolific source of the spread of contagion. The beginning of a compre- hensive scheme for the prevention of tuberculosis should there- fore be with him. To make him absolutely innocuous in his own home is difficult and expensive. It means the provision of a skillful attendant to watch over him, ample bed linen for change when the bed linen has been soiled, and such preventive measure supplies as spit-boxes and napkins. The difficulty of keeping him sterile can only be appreciated by those who have tried it. The expense is high, even in a hospital where a num- ber of patients are under the supervision of a single attendant. Without an attendant it cannot be accomplished. The patient grows so weak toward the last that he can no longer avoid soil- ing his bed linen with sputum and just in proportion as he grows weak the amount of broken down tissue which he ejects in- creases in quantity. One of the first things to do then in every community in the crusade against tuberculosis is to establish wards or hospitals for poor dying consumptives. In the larger cities one or more special hospitals should be built and equipped. In smaller cities and towns where the size of the population would not warrant such an expense a ward in some general hospital may be set aside for this purpose Whether a ward be set aside or a hospital built, the equipment should be for the treatment of the patient along modern scientific lines, and not for the mere main- tenance of dying people. Even the dying consumptive should be given every opportunity for recovery, and when recovery is no longer possible should nevertheless be made to feel that he is treated with hope and not left an outcast of human sympathy. There need be no hesitancy on the score of contagion in set- ling aside a ward in a general hospital for the treatment of con- sumptives. The dying consumptive can be so cared for and watched over even to his last breath that he is absolutely harm- less to those in his immediate environment. The contagion of tuberculosis is only in the expectoration or broken-down tissue, and this can easily be sterilized as it comes from the patient if he is under proper supervision and has good care. 11 HOSPITALS FOR ADVANCED CASES Military discipline is necessary and the nurses and attendants must be especially trained for the work. Until the patient be- comes helpless in bed he usually can be taught to keep himself sterile and generally he does so when he is helped and watched over. It is only when he becomes helpless that there is any difficulty. At this time it must be accomplished by the attend- ants altogether independently of him. The bed linen must be changed every time it is soiled, even though it be a half dozen times a day. In doing so it must not be agitated, and it should immediately be put into a laundry bag and removed before the broken-down tissue has thoroughly dried. Cleanliness is the watchword. Rooms in which dying consumptives live must be scrubbed daily, and everything in them must be kept absolutely clean. With such care there can be no contagion, either to people in the rooms or to people elsewhere in the same building. In cities and towns where a hospital cannot be built for dying consumptives, and where wards for their maintenance cannot be obtained, an ordinary house can be turned into a hospital for consumptives and can be equipped for the best scientific care of such patients if only a little common sense is used. After all it is more the intelligence and devotion of attendants than it is the character of the building which counts in the prevention of the disease. It is true the maintenance of a consumptive in a building which has been adapted for his treatment is less expen- sive than it is in a building which is improvised for such a pur- pose, but the difference in cost is not prohibitive. The influence which the care of dying consumptives in hospi- tals exercises for prevention is well illustrated in the reduction of the death rate from consumption in London during the last fifty years. A little over fifty years ago the English people be- gan to establish hospitals for consumptives in London as a mat- ter of humanity. The work met with favor and the beds gradu- ally increased until they numbered thousands. At that time the death rate from consumption in London was about the same as that in Paris and all the large cities in the world, namely about four per thousand. No other preventive measure was intro- duced in London. At the end of fifty years, London, the largest city in the world, had the lowest death rate from consumption of all, about two per thousand, and Paris, where no consumption hospitals had been established, still had its four deaths per thousand from the disease. The reduction in London undoubt- edly had been due in large part to the segregation of the con- sumptive poor in hospitals. Lawrence F. Flick. 12 III.— INSTITUTIONS IN THE UNITED STATES AND CANADA Arranged in alphabetical order according to states, and within each state ac- cording to location, except that where state sanatoriums exist they are placed first. ARIZONA ARIZONA PHOENIX. PaIvM Lodge; (1902) : For persons who are in the very early stages and are able to move about. Capacity: In Palm Lodge, 30; in the colony, 25. Terms : $25 to $35 per week ; in the tent colony, $9. Resident Physician and Superintendent: Henry M. Stone, M. D. Palm Lodge is two miles out of Phoenix, within one block of the trolley. The altitude is -about 1,150 feet. There is a main building of stuccoed brick, containing fifteen rooms, and eight two and four room cottages, each supplied with its own bath- room. A tent colony is now being constructed, two miles distant from Palm Lodge, which will also be under Dr. Stone's manage- ment. There will be accommodations for twenty-five and the rate of nine dollars per week will include medical attendance. It is expected that this colony will be completed by December i, 1904. Applications for admission to either of these places should be addressed to Dr. Henry H. Stone. Mkrcy Hospitai, (1893) : Not exclusively for the treatment of tuberculosis, but cases of consumption are received at any stage of the disease, and cared for in separate wards and rooms. There is accommodation for 20 consumptives. Terms : $14 per week; there is no provision for free treat- ment, but exceptions are occasionally made in cases of extreme poverty. No resident physician, but there are about forty on the visiting and consulting staff. The hospital is in charge of the Sisters of Mercy and is supported by fees from patients. It is housed in a large brick building, surrounded by attractive grounds, five blocks out of the city proper. Application for admission should be made to the Sister Su- perior. 15 ARIZONA TUCSON. St. Mary's HospiTaIv (Tuberculosis annex opened in De- cember, 1900) : All stages of pulmonary tuberculosis are admitted, and are cared for in a separate building, called St. Mary's Sanatorium, Capacity: 30. Terms: $15 per week; arrangements are made to receive free of charge a few patients unable to pay anything. There is no resident physician. The location is two miles from the city, at an altitude of 2,400 feet. The tuberculosis sanatorium is a brick building built around an open court, with a porch on both sides. There are no wards. Each patient's room is 17 by 14 feet, and has two windows and a double door. The institution is under the charge of a Roman Catholic sisterhood, the Sisters of St. Joseph. Application should be made to the Sister Superior. 16 CALIFORNIA CAUFORNIA. State; Sanatorium : The establishment of a state sanatorium is being pressed by the State Medical Society, through its Tuberculosis Com- mittee. (See page 233.) ALTADENA. Espi^ranza, a sanatorium for bronchial and pulmonary af- fections, conducted by the Altadena Health Resort Company (February, 1903) : All stages of consumption are received. Capacity : 50. Terms : $25 per week. Resident Physician : F. C. Melton, M. D. The Altadena Health Resort Company has established this sanatorium on a tract of 160 acres, half a mile east of Altadena, which may be reached from Pasadena by electric car in twenty miinutes. On the north the place is protected by a semi- circle of mountains, while it is open to the south and west, com- manding a wide view of the San Gabriel Valley. The altitude is 1,800 feet. A central building contains offices, dining-room and parlors. Most of the patients live in tent cottages. The lighting is by electricity and all the buildings are connected by telephone. Application should be made to Dr. F. C. Melton. 17 CAUI^ORNIA INDIO. Health Camp (January, 1903) : Primarily for consumptives, but exceptions are sometimes made in favor of applicants who need an out-door life for other reasons. Capacity: practically unlimited, as there are 125 acres available for the extension of the tent colony. Terms : no one is excluded on account of either poverty or wealth ; those able to pay something are charged $1 per week or more for the use of a furnished tent and $3 for board. There is no resident physician. This novel adventure is supported by Mr. N. O. Nelson, a Saint Louis manufacturer, who bought for the purpose 200 acres just at the entrance of the Great Desert. Indio is on the Southern Pacific Railway, half-way between Los Angeles and Yuma. The land is 20 feet below sea level, in the Coachella Valley, protected from wind and fog on both sides by moun- tains. The average rain fall for the year does not exceed one inch, and all winter days are comfortably warm. The ranch is being irrigated and beautified and buildings are being erected for the use of the colonists. Their individual homes are floored tents of various sizes. Seventy-five acres are now under culti- vation, and it is hoped that the produce will supply the camp. The work on the place is done chiefly by the able-bodied colonists. Hospitality is extended to whole families, not merely to the invalid member, and provision is made for a permanent home for convalescents. Application should be made to N. O. Nelson, either at Indio or at Leclaire, Illinois. 18 CALIFORNIA LOS ANGELES. Thu Barlow Sanatorium, Incorporated (September, 1903) : For consumptives who have been residents of Los An- geles County for at least one year and who are without the means to go elsewhere ; persons in all stages of the disease have been admitted, but it is desired to receive in the future none who are bed-ridden. Capacity: 15. Terms : $5 or $7 per week for those who are able to pay ; others are cared for free of charge. There is no resident physician, but the three visiting phy- sicians are within easy reach. The plant at present consists of 25 acres of rolling land, on the Chavez Ravine Road, adjoining the large city park and sur- rounded by it on three sides, an administration building with detached kitchen and laundry, a one-and-a-half-story dormitory for patients, and one tent cottage. It is located within the city limits, but away from car lines and buildings. The altitude is about 400 feet. Voluntary contributions are practically the only source of support. Thus far no debt has been incurred and an endowment fund of $6,000 has been secured. The average cost per week per patient during the first year was $12.35. Seventy- five applications were received and thirty-four patients cared for during the year. These patients came originally from eleven states of the union and eight European countries. Application should be made to Dr. W. Jarvis Barlow, 328 330 Wilcox Building, Los Angeles. 19 H CALIFORNIA MENTONE. The Mentone Sanatorium (1903) : Exclusively for early cases of consumption. Capacity : 50. Terms: $12.50 per week and upward for board; $10 per week for medical treatment. Resident Physician : Fred J- Koepke, AI. D. Visiting Physicians : Hoell Tyler, M. D. ; C. A. Sanborn, M. D., and S. Y. Wynne, M. D. ; all of Redlands. Mentone is one mile from Redlands, in a valley protected on three sides by mountains, while to the west stretch miles of orange and lemon groves. The altitude is 1,700 feet. This sanatorium is, strictly speaking, a hotel where well-to-do patients can have sanatorium treatment and where their relatives and friends are also received. Tents are provided on the grounds for patients who prefer to sleep out of doors. Applications should be addressed to A. R. Schultz, Manager. 21 The Pottenger Sanatorium. Distant View of the Pottenger Sanatorium. CMvlFORNIA MONROVIA. The Pottknger Sanatorium for Diseases of the Lungs AND Throat (December, 1903) : For the treatment of cases of pulmonary and laryngeal tuberculosis which offer a fair chance of permanent and material improvement ; no patients are received in whom the disease is so far advanced that their condi- tion will discourage those who are in the early stages. Capacity : 26 ; by January, 1905, there will be room for 40. Terms : a few at $25 per week, the rest $30 and up. Resident Physician : F. M. Pottenger, M. D. This sanatorium is sixteen miles east of Los Angeles, in the foot hills of the Sierra Madre Mountains, at an elevation 'of 1,000 feet above the sea. Monrovia is on the main line of the Monrovia and Duarte branch of the Southern Pacific Railway, and the Monrovia branch of the Pacific Electric Railway. The site is a natural park of over eight acres, occupy- ing an eminence 400 feet above the town, above the fogs and protected from storms. From its commanding location there is an uninterrupted view of the San Gabriel valley, with its world- famed orange groves, and the Sierra Madre Mountains. There are at present a central administration building, one cottage, a sun parlor and open-air pavilion, and a number of tent houses. The plans for further buildings contemplate three pavilions, con- nected by corridors and balconies, and containing sixty rooms facing south. One of these pavilions will be ready for occu- pancy in January, 1905. All the buildings and furnishings are in accordance with the latest dictates of sanitary science. There- is a well-equipped clinical laboratory, and a laboratory for ex- perimental and research work will soon be constructed. Application should be made to Dr. F. JNL Pottenger. 23 CALIFORNIA REDLANDS. The Settlement (1901) : For needy consumptives already in Redlands, in any stage of the disease ; no one from outside can be received. Capacity : 17, Terms : those v^ho are able to pay something are ex- pected to do so, up to a maximum of five dollars per week; for the destitute care is entirely free. Medical Directors : Drs. ]\Ioseley and Ide. The Settlement is located on forty acres of rolling land, not under irrigation, six miles from the city, at an elevation of 1,500 feet. All patients live in tents, which are supplied with the ordi- nary necessities, but of a verv primitive kind. A wooden build- ing contains the dining room, kitchen, store room, and bath. This sanatorium camp was established, and is maintained, exclusively for consumptives who find themselves stranded in Redlands without funds, or with insuinficient money to provide themselves with proper care. It is supported chiefly by contri- butions ; there are countv and city appropriations aggregating $75 per month ; and a small, irregular amount is derived from patients' fees. The demands of the locality absolutely prohibit the reception of patients from any other place. Residents of the town who desire to be admitted should apply to the ]\Iatron or to one of the INIedical Directors. 24 COLORADO COLORADO AMITY (Prowers County). Emma Booth Tucki^r Mijmorial Sanitarium for Con- sumptives (November, 1904) : Exclusively for early cases of pulmonary tuberculosis. Capacity: 100, but this can be increased almost indefinite- ly by the addition of tents. Terms :$25 per month, including all expenses except laun- dry ; there will probably be arrangements for admit- ting needy patients free of charge. Resident Physician : Dr. Greenard. This sanatorium has been established by the Salvation Army in memory of Mrs. Booth Tucker. It is located on an isolated part of the Salvation Army Farm Colony in southeastern Colo- rado. It is in the midst of the great plains and has an altitude of 3,500 feet. The Administration Building is a large three- story structure of rock. It will contain, in addition to the din- ing room, library, and other public rooms, some sleeping accom- modations. Most of the patients, however, will be housed in substantially built tent cottages. Application for admission should be made to the Secretary. 25 COLORADO COLORADO SPRINGS. NoRDRACH Ranch (November, 1901") : For early cases of consumption excliisivel}^ Capacity: 35 at present, with plans to enlarge soon to accommodate 50. Terms : $60 per month, which includes everything except a special nurse in case one is needed. Resident Physician : John E. White, M. D. Nordrach Ranch is fortunate in its location. At an altitude of 6,000 feet, quite removed from the dust and smoke of the city, it is protected on the north by Austin Bluffs, and lias in front an uninterrupted view of Colorado- Springs, three miles distant, and the range of mountains. The central building is of red stone and contains twenty-four rooms, six of which are reserved for patients who may tem- porarily need hospital care. The ordinary sleeping apartments for the patients are octagonal tents, communicating directly with the nurses' tent by electric bells. Practically all the time is spent in the open air. The resident physician sees each guest at least twice a day and the physicians in Colorado Springs are always available for consultation. The only source of income so- far has been the fees from patients. An endowment is much desired, in order that some charitable work may be done. Applications should be addressed to M. E. Harper, Business Manager. Glockniir Sanitarium (1888) : Not especially for tuberculosis, but consumptives in any stage are received. Capacity : 50. Terms : $8 to $40 per week. There is no resident physician; the management is in the hands of a Roman Catholic Sisterhood. Applications should be addressed to Sister Rose Alexius. 27 -It < 'J-. < s i a 12; "m COI^ORADO DENVER. The Agnes Memorial Sanatorium (September, 1904) : Exclusively for early cases of pulmonary tuberculosis ; when accommodations are limited, preference will be given to candidates from western Pennsylvania. Capacity: 100; this number is to be increased by the use of house tents. Terms: $7 to $10 per week, which includes medical attendance and ordinary nursing. Superintendent and Medical Director : G. Walter Hold- en, M. D. This Sanatorium has been erected by Mr, Lawrence C. Phipps, of Pittsburg, as a memorial to his mother. There are five buildings — a three-story administration building, an infirm- ary, two pavilions and a power house — all in the old Spanish Mission style of architecture. In the administration building are the reception room, board room, offices, dining rooms and kitchen, besides a library of 1,500 bound volumes for the use of the patients. In this build- ing also are the quarters of the administrative staff and at- tendants. The medical building contains on the first floor, besides a very complete laboratory and treatment rooms, reception and consultation rooms. The second floor is devoted entirely to an infirmary, which is provided with a well-equipped operating room. There are two pavilions, one for men and the other for women, opening upon wide porches, divided by canvas partitions for sleeping purposes. The power house furnishes electricity, ice and refrigeration, together with power for an electric laundry. This laundry is equipped with the most modern appliances, including a complete sterilizer. Sputum, garbage and sweepings are disposed of in a special device for cremation. The grounds include 160 acres of dry, sandy soil on the plains east of Denver, at the highest elevation near the city, about 5,400 feet. The distance from the heart of the city — over seven miles — and the extent of the estate, ensure against smoke and dust. The Sanatorium is at Sixth and Hyde Park Avenues, reached from Denver in thirty minutes by electric cars. Application should be made to Dr. G. Walter Holden, Mont- clair Station, Denver. 29 COIvORADO The Association Health Farm (May, 1903) : Especially for early cases of pulmonary tuberculosis, but occasionally others in need of out-door life are received. For young men of limited means who have a good prospect of recovery ; preference is given to members of the Young Men's Christian Association. Capacity : 45, one man in each tent. Terms : $25 per month ; light work in partial payment of this charge is provided for many, but cannot be guar- anteed until the physical condition of the applicant is fully understood; the patient's knowledge of farm work is also taken into account. Resident Physician : John Wethered, M. D. This Kealth Farm originated in the experience of the Colora- do Young Men's Christian Association in dealing with the prob- lem of finding suitable places for the young men who go to Colorado from all parts of the country in search of health. Funds for the execution of the plan to its present stage have been provided by friends in various parts of the country, the principal gifts having been made by Mr. and Mrs. David Brothers and Dr. E. P. George. Many of the Young Men's Christian Associations throughout the country have given tents completely furnished and others are planning to do the same. The value of the present equipment is $45,000. The Farm consists of two tracts of land. The tract which is now being improved contains thirty-four acres of fruit land five and one-half miles northwest of the city, on the Denver, Lakewood and Golden Railroad. There is a station at the corner of the farm. The sixty acres of unimproved land will be developed whenever the funds allow. The site of the present farm is 5,400 feet above sea level and has a diversity of natural features. The improvements include an administration build- ing, stables, forty-five cottage tents, a water-tower observatory, and a tent hospital. From the first the number of applicants has far outnumbered the places for them. Inquiries should be addressed to W. M. Danner, Secretary, 1 73 1 Arapahoe Street, Denver. 30 The San Francisco Tent, Association Health Farm. The Saint Louis Tent, Association Health Farm. COI^ORADO FoxHALiv, 133 West Colfax Avenue (1901) : For a few selected patients who offer reasonable pros- pects of ultimate recovery. Capacity: 10-15. Terms : $25 per week. Resident Physician : Wm. N. Beggs, A. B., M. D. Foxhall is located opposite the public library, three blocks from the Capitol. It is a single large house, the home of Dr. Beggs, who is one of the physicians to the National Jewish Hos- pital for Consumptives and editor of the Colorado Medical Jour- nal. No patient is allowed to remain who refuses absolute obe- dience to directions. Application should be made to Dr. Wm. N. Beggs. The: Home: "The only rec[uirements for admission are that a person is worthy of a Christian home and presents a good chance of being benefited by the climate, and presents a letter from some clergyman or from some one the superintendent knows." Capacity: 150. Terms : $25 per week for those who require a nurse ; there is one building, accommodating 40 persons, in which the charges are $25 per month. There is no resident physician. The Home comprises four buildings : St. Andrew's House for men, Grace House for mother and son or husband and wife. Emily House for women, and Heartsease for the very sick. These cover an entire block of land, and are connected by glass covered porches. The Home is ten minutes' ride by three car lines to the Denver post office, and is so situated that it com- mands a view of the entire city, the plains for hundreds of miles, and the Rockies for one hundred and fifty miles. It is under the direct ownership and management of the Episcopal Church of the Diocese of Colorado. Application should be made to Rev. Frederick W. Oakes, Superintendent. 33 COIvORADO The NationaIv Je;wish Hospitai, for Consumptive;s (1899): For "indigent consumptives of whom the examining phy- sicians give a fair or good prognosis." Capacity : 88. There is no charge of any kind. Superintendent: Moses ColHns, M. D. While this institution is within the Hmits of Denver, it is nevertheless sufficiently removed from the congested part of the city to have an abundance of the sunshine and the pure, invigor- ating air for which Colorado is noted. The altitude is about 5,200 feet. The buildings are on the pavilion plan, containing rooms of from one to four beds and twelve-bed wards. Application for admission must be made from the city where the applicant resides, on prescribed forms. The applicant must be examined by the physician appointed by the hospital authori- ties at the place where he resides, and the application must be sent on blanks provided for that purpose. No other form of medical examination will be accepted, nor any made by other than the regularly appointed physician. The patient's charac- ter must be investigated and endorsed by the local trustee. Each application must be accompanied by a guaranty, approved also by the local trustee or director, that the patient shall not become a charge upon the community after he leaves the hospi- tal, and that in case his return may be advisable at any time his transportation will be furnished. No applicant should be sent to Denver, or allowed to go, until he has received official notice of his admission. For the name and address of the examining physician in any city, inquiry should be sent to Alfred Muller, Secretary, Ernest and Cranmer Building, Denver. 34 COLORADO EDGEWATER. Sanitarium of The Jewish Consumptives' ReeiEE Socie- ty (September, 1904) : For destitute Jewish consumptives. Capacity: 12. There is no resident physician at present. This society was formed a few months ago by Jewish resi- dents of Denver, most of whom were cured consumptives, with the object of helping- their co-reHgionists who have gone to Colorado in the hope of regaining their health, but have come to want before they have recovered. A tract of twenty acres of land has been purchased in the suburbs of Denver, three-quar- ters of a mile out of the city, a dining-room and a kitchen have been erected, and twelve tents have been installed and furnished. It is hoped to increase the capacity to one hundred by the end of the first year. It is planned to establish a dairy, a poultry yard, and vegetable, fruit and flower gardens, the produce from which will, it is expected, supply the camp. Patients who are able will do light work connected with these enterprises, but under the direct supervision of a physician. Applications should be addressed to Dr. C. D. Spivak, Sec- retary, 142 1 Court Place, Denver. 35 Resthaven in the Pines. DiNiNG-RooM, Resthaven. COLORADO MORRISON. ResthavjJn, Sunrise Mountain Park (June, 1901) : For young men and women of limited means, in the in- cipient stage of tuberculosis. Capacity : 50. Terms : $25 per month. There is a permanent resident physician ; Dr. I. Single- ton Garthwaite, of Denver, visits frequently, and to him all applicants must present themselves before ad- mission will be granted. Sunrise Mountain Park, the site of Resthaven, has an alti- tude of 5,800 feet, and all the advantages in the way of scenery that the Rockies and the great plains can provide. Morrison, the nearest station, on the Colorado and Southern Railroad, is five miles distant. The buildings are one-room cottages and tents scattered among the pines and bearing- the names of the states which have donated them. An endowment from Lillian Garthwaite-^^■ylie and various other gifts supplement the fees received from patients. Heretofore Resthaven has been open only from June i to October i , but a building- is now being erected which will permit an all-year season. Applications should be made to Dr. I. Singleton Garthwaite, 322 Temple Court Building, Denver. 37 Dr. Brooks's Sanatorium. The Veranda, Dr. Brooks's Sanatorium. CONNECTICUT COXXECTICUT State vSaxatorium : Agitation for a state sanatorium was begun by the state Board of Health and others three years ago. Twenty-five thou- sand doUars was granted by the legislature to a private institu- tion, the Gaylord Farm Sanatorium (See page 41 j, but no state institution has yet been established. NEW CANAAN. Dr. Brooks' Sanatorium (1897") : For consumptives whose condition does not preclude the possibility of at least an arrest of the disease. Capacity : 24. Terms : $25 to v$35 per week, including everything, ac- cording to the room chosen ; no free beds. Resident Physician : ~Sl. ]. Brooks, ^M. D. This institution is situated one mile from the village, on a ridge of the Berkshire foothills, at an altitude of about 800 feet. The grounds cover about eighteen acres, part of which is wood- land. The individual sleeping apartments are 10 by 16 feet and 10 feet high. There are no wards. Patients are under the strictest hygienic routine, constant medical supervision and con- stant efficient nursing. The average course of treatment covers twelve weeks ; no patients are retained longer, and a total arrest of the disease is expected within this period. Application for admission should be made to either of the following: Dr. ^I. J. Brooks, New Canaan, Conn.; Dr. Hubert Arrowsmith, 170 Clinton Street, Brooklyn, X. Y. 39 COXXECTICUT WALLINGFORD. Gaylord Farm Sanatorium (September, 1904) : Exclusively for persons in the early stages of pulmonary tuberculosis who are of very moderate means and resi- dents of the state. Capacity : 30. Terms : $7 per week. ^Medical Superintendent : David R. Lyman, M. D. This sanatorium is due to the efforts of the Xew Haven County Anti-Tuberculosis League, and is under its management. Situated on a plateau two miles from the town and above it, and fourteen miles inland from New Haven, the Sanatorium over- looks the towns of Wallingford and Meriden and the valley in which they lie. The altitude is 390 feet. There is an adminis- tration building, containing offices, rooms for the doctor and matron, recreation hall and accommodations for fourteen pa- tients. Four cottages provide for four patients each, in rooms opening on porches. The kitchen, dining room, and laundry are in separate buildings. There is electric lighting and steam heat throughout and the water supply is from artesian wells. In connection with the Sanatorium is a farm of 250 acres. The charge to patients does not cover the cost of mainten- ance. A'oluntary contributions are the chief source of income. Applications should be addressed either to Dr. David R. Ly- man, Wallingford, or to one of the consulting physicians, as fol- lows : Dr. C. \\'. Gaylord, Branford ; Dr. S. D. Otis, ]\Ieriden ; Dr. J. P. C. Foster, Xew Haven ; Dr. O. T. Ostborne, Xew Haven : Dr. Henry L. Swain, X^ew Haven ; Dr. F. \\'. AA'right,. X^ew Haven ; Dr. Carl E. ]\Iuno-er. AVaterburv. 41 DISTRICT OF COLUMBIA, FLORIDA DISTRICT OF COLUMBIA WASHINGTON. Washington Asylum Hospital: A general hospital for the poor of the District ; consump- tives are treated in tent wards. Capacity of tents : 34. There is no provision for pay patients. Visiting Physician : D. Percy Hickling, M. D. Consulting Board : Drs. G. Lloyd Magruder, W. P. Carr, W. S. Bowen, J. Tabor Johnson, H. L. E. Johnson, H. S. Dye, Swan M. Burnett, F. T. Chamberlain, George M. Kober. There are three resident physicians. The first ten was erected in April, 1904. Three others have been added since, until there is provision for both white and colored men and women. Three of the tents are entirely of wood, open on the south side, and with an elevated roof for A'entilation. The tents have been erected on the hospital grounds in the eastern part of the city, near the Anacostia River. Application for admission should be niade to the Board of Charities of the District of Columbia. FLORIDA PENSACOLA. Naval Hospital : A tuberculosis camp, consisting of tents accommodating fifty patients, has been established in the grounds of this hospital, as a temporary device for meeting the exigent needs of the Depart- ment of the Navy. The Bureau of Medicine and Surgery of the Department is making a study of the various abandoned army posts which have favorable locations, with a view to the establishment of a sanatorium for the treatment of cases of tuberculosis arising in the United States Navy and United States Marine Corps. The authority of Congress will be neces- sary before title to any selected post can be acquired by the Department and work begun. 42 HAWAII, Illinois HAWAII HONOLULU. Honolulu Home; for Incurables (1902) : Patients are received in any stage of the disease and are cared for in a separate building. Capacity : 24. Terms : there are 8 free beds ; for others the charge is $1.50 per day. Medical Superintendent: A. H. Sinclair, M. D. The situation is two miles from the sea, at an elevation of 300 feet. The building for consumptives contains a free ward and separate rooms for pay patients. Support is derived partly from endowments and partly from a territorial appropriation. Application should be made to Dr. A. H. Sinclair. ILLINOIS Statl Sanatorium : A committee of the State Medical Society has been ap- pointed with the express object of securing the establishment of a state sanatorium. (See pages 45, 236.) CHICAGO. St. Ann's Sanitarium, 49th and Thomas Streets (1903) : For early cases of consumption. Capacity: 128 at present; accommodation for 350 pro- posed. Terms: $8 to $20 per week, with the exception of 15 free beds. Medical Director: A. F. Kramps, M. D. This, the first institution in Chicago devoted exclusively to the treatment of pulmonary tuberculosis, is located northeast of the suburb of Austin. Funds for the building were supplied by gifts secured mainly through the efforts of the Roman Catholic sisterhood in charge of the sanatorium. Current ex- penses are met by fees from patients and contributions. Application should be made to the Sister Superior. 43 ILLINOIS DUNNING. Cook County Hospital for Consumptives (1899) : For poor consumptives of Cook County; patients ad- mitted are presumably dependent, but in consideration of the slight provision for this disease in Chicago no- close inquiry is made on this point; all stages are treated. Capacity : in old building, 400 ; in new modern hospital^ opened in April, 1904, 160. All beds are free. Resident Physician : ^I. G. McHugh, M. D. This hospital is seven miles west of Lake [Michigan, on the highest point in the county, 800 feet above sea level. Other natural features are the same as are found in Chicago. The original building is of brick, three stories high ; the new hospital consists of four frame one-story wards, connected by a large solarium-hall, and a two-story administration building. Application for admission should be made to the County Agent, 185 South Clinton Street, Chicago. OTTAWA. Text Colony (July, 1904) : For early cases of pulmonary tuberculosis. Capacity : 40. Terms: for those who can afford to pay $10 per week is charged, which about covers cost of maintenance. Aledical Director: J. \V. Pettit, ^[. D. This little experimental colony, under the auspices of the Illinois State ^Medical Society, is located on a bluff, 120 feet above the Illinois River. The tents are arranged around a quadrangle in the center of the ten-acre tract which constitutes the grounds. The kitchen, dining-room, and parlor, as well as the sleeping rooms, are separate tents, of waterproof cloth, with wood floors, and lighted by electricity. Patients are received from any part of the state. Applications for admission should be addressed to Dr. J. W.. Pettit. 45 INDIANA, IOWA INDIANA State Sanatorium Efforts to secure the establishment of a state sanatorium have been made by the State Medical Society during the last four years. In 1903 a resolution appointing a commission to investigate the subject was defeated in the legislature. A state association (see page 237) has recently been formed with the primary object of securing a state institution. FORT WAYNE. St. Rochus Hospital is a small building where ten consump- tives can be cared for by the Sisters of "The Poor Hand Maids of Jesus Christ." It is hoped by the Sisters that in the course of lime they will be able to erect a hospital worthy of the name. INDIANAPOLIS. Flower AIission Pavilion eor Incurables, City Hospital (January, 1904) : For incurable cases of consumption who are recom- mended by the Flower Mission Society and approved by the Superintendent of the Hospital. Capacity : 26. There are no charges. Superintendent: Paul Frederic Martin, M. D. The new pavilion occupies the northern part of the City Hospital grounds, which have an altitude of 822 feet. It is a one-story brick building, surrounded by a veranda, containing two wards for ten beds each and six private rooms. Applications should be addressed to Mrs. John L. Griffith, President of the Flower Mission Society. IOWA State Sanatorium : At the last session of the legislature the Board of Control of State Institutions was requested to make an investigation in regard to the treatment of tuberculosis in sanatoriums, as a pre- liminary step to considering the establishment of a state institu- tion. One thousand dollars was appropriated for the expenses of the inquiry. 46 IOWA, KANSAS, KENTUCKY, LOUISIANA FORT DODGE. Boulde;r Lodge: Sanatorium (July, 1901) : Exclusively for the treatment of early cases of all forms of tuberculosis. Capacity: 15. Terms : $20 per week. Medical Director: J. W. Kime, M. D. The building is of unshaped field boulders, two stories high, in a wooded tract of 15 acres, 1,200 feet above sea level. The surrounding country is wild woodland, sloping down to the Des Moines River on the west. Application should be made to Dr. J. W. Kime. KANSAS State Sanatorium : A committee of the State Medical Society is framing a bill to present to the legislature. The State Board of Health and others interested will co-operate in supporting the measure. KENTUCKY State Sanatorium : For the past four years the establishment of a state sana- torium has been recommended to the general assembly, but no action has vet been taken. LOUISIANA State Sanatorium : Agitation for a state institution has been begun by the State Board of Health, but little progress has yet been made. 47 Ground Plan of the Maine Sanatorium. f ■- ^' ^/#rrTf|ii|^jli^ij s^^ ' ■- 'V*-""'^ ''^■'f! fl^ZI'"'!' i^^' "jragiLi^fffJ^^""^**** ,„t: ,M^^^ 1H... TE/APOPfARr HEADQUARTERS MAIME STATE 5AniTARlU/A AT HEBROh ■ - JOHKCAiVm SrEVtlS-.IOHnHOWRDiTEVtMS - The Maine SanatoriuiM. MAINE MAINE HEBRON. The; Maine Sanatorium, Greenwood Mountain (Novem- ber I, 1904) : Nearest stations : West Minot, on Portland and Rumford Falls Railroad ; Paris, on Grand Trunk. Exclusively for incipient cases of pulmonary tuberculosis. Capacity: ultimately 100; at present there is room for 30. Terms : 6 free beds ; $10 per week for the others. Medical Director: Estes Nichols, M. D. The State Association for the Treatment of Tuberculosis, to v/hose efforts this sanatorium is due, has secured 330 acres on a southern slope in the foothills of the White Mountains, at an altitude of 1,200 feet, near the Poland Spring- region. A public highway runs through the center of the tract. Over a third of tlie estate is fertile arable land, which will make it possible to produce the required supplies of milk, fruit and vegetables. One hundred and thirty-five acres are woodland. The build- ings are on the cottage system with individual sleeping rooms,, hog camps, open on one side, are to be constructed for winter sitting-rooms. The sleeping pavilions have across the entire front double glass doors which are closed only while patients are rising and retiring. Patients do not, however, dress in these pavilions, but go directly from them into heated dressing-rooms. It is hoped that the endowment will soon allow an increase in the number of free patients who can be received. Applications should be sent to Dr. Estes Nichols. 49 MARYLAND MARYLAND State Sanx\torium : The State Tuberculosis Commission (see page 237) is au- thorized to consider the question of state sanatoriums and report to the General Assembly in January, 1906. BALTIMORE. City Hospital for Consumptives, in connection with Bay View Asylum (to be opened in 1905) : For the phthisis patients in the City Hospital. There will be accommodation for 100 of the poor con- sumptives of the city. No pay patients are received. Chief Resident Physician : William H. Smith, M. D. There is a small two-story building for women on the grounds of the City Almshouse and Hospital. The new build- ing for men, now in process of erection, will be 150 feet long and two stories high. The hospital buildings are 160 feet above tide water. Admission is through the Supervisors of City Charities. 50 MARYLAND TOWSON. The Hospital for Consumptives of Maryland (1896) : Exclusively for white patients, preferably in the early stages of the disease, though under pressing circun> stances far advanced cases are received. Capacity: 35. Terms: $3 to $10 per week to those able to pay; free to others. Resident Physician : Harry S. Jarrett, M. D. The visiting physicians are : Dr. J. Miiton Linthicum, Dr. H;. Warren Buckler, Dr. W. \\'ayland Frames, Dr. A. Duval Atkinson. Towson is in Baltimore County, eight miles from Baltimore,. from which it is reached by electric cars in thirty minutes. The hospital is known as the Eudowood Sanatorium. It is at an altitude of 500 feet among forest-covered hills. There is a large main building, containing five private rooms and tv^ro wards, one for men and the other for women, one memorial cottage of four rooms and another of six rooms, all with porches looking to the south and west ; two or three shacks and two or three army tents. The memorial cottages were built by the daughters of Mr. Theodore Hopper in memory of their brother and by Mrs. Nelson Perin in memory of her husband. A fund is being accumulated for the extension of the hospital in some favorable situation in the Blue Ridge ]\Iountains, where only hopeful cases are to be received. The hospital is supported by state and city appropriations^ but chiefly by voluntary contributions. The fees from patients are inconsiderable. The officers are : Dr. Henry Barton Jacobs, President ; Rev. Arthur Chilton Powell and Robert Garrett, Esq., Vice-Presi- dents ; Rev. A. Guttmacher, Secretary ; David H. Carroll, Esq., Treasurer. The management of the hospital is in the hands of a Board of Directors and a Board of Lady Managers, of whom Mrs^ Thomas B. Gambel is President. Application for admission should be made to the Visiting: or the Resident Physician. 51 MASSACHUSETTS MASSACHUSETTS Massachusetts State Sanatorium (October, 1898) : Situated at Rutland : nearest station, Muschopauge, Mas- sachusetts Central Railroad, a mile and a half distant. For earlv cases of pulmonary tuberculosis ; patients must be residents of the state and not too far advanced to admit of reasonable hope of radical improvement. Capacity : 250. Terms : $4 per week ; there are no free beds, but the trustees are empowered to allow a few cases to remain at public expense ; in many cases the bills are paid by cities or charitable organizations. Superintendent : Walter J. Marcley, M. D. To Massachusetts belongs the honor of having established the first state sanatorium in the country. It is located near the center of the state, about 50 miles from Boston and 11 miles from Worcester, at an elevation of 1,000 feet. The build- ings are on a southern slope, protected on the northwest by a wooded hill. The pavilions for patients are one or two stories high, extending to the south, each terminating in a solarium and piazza, and all connected on the north by a covered corridor. Dr. Mncent Y. Bowditch and Dr. Herbert C. Clapp, of Boston, have supervising charge of the medical treatment. Besides Dr. Alarcley there are three assistant resident physicians. A point of interest to all who are engaged in planning similar institutions is the opinion of the superintendent, after five years' experience at Rutland, that open wards, containing from fifteen to twenty-five beds, are preferable to individual sleeping-rooms. Of the incipient cases discharged in the last four years, 73 per cent have been arrested or apparently cured. The uniform charge of $4 per week covers less than half the actual expense for each patient. An annual appropriation is m.ade by the legislature ; the amount in 1903 was $90,000. Patients desiring admission to the sanatorium in Dr. Bow- ditch's service may apply at the Boston office of the sanatorium on Wednesdays, or at the sanatorium in Rutland on Fridays. Patients desiring to enter in Dr. Clapp's service may apply at the Boston office of the sanatorium on Saturdays, or at the sanatorium in Rutland on Mondays. 53 MASSACHUSETTS The Boston office is at the new Out-Patient Department of the Massachusetts General Hospital on North Grove Street, where examination of applicants is made on Wednesdays and Saturdays from 1.30 to 3 o'clock p. m. Examination of applicants is also made at the following places : Worcester, at the Worcester City Hospital, Wednesdays and Saturdays, 9 to 10 a. m. Springiield, by Dr. Everett A. Bates, 57 Chestnut Street, Wednesdays and Saturdays, 2 to 3 P. m. Pittsfield, by Dr. J. F. A. Adams, 114 Wendell Avenue, Wednesdays and Saturdays, 2 to 3 p. m. Fall River, by Dr. A. S. MacKnight, 355 North Main Street, Wednesdays and Saturdays, 2 to 3 p. m. Lowell, by Dr. Boyden H. Pillsbury, 58 Kirk Street, Wednesdays and Saturdays, 2 to 3 p. m. Any further information will be given by the Superintendent, Dr. Walter J. Marcley, Rutland, Mass. 54 o H < < w H H CO (/: ■ H H W CO t3 O < -1 a. O H ^. --J ■Hi' Mk. c c .».,^£i ^B^mT^ '/: ■^^^ .. 1 \i rfe"*^ kj:-i S.-.- -^ nf 4 'i&^m Ik'' '* r^» # ^J ,f ^ m i Stoxy Wold as Seen from the Traix. Sux Parlor at Stoxy Wold. NlCW YORK LIBERTY, Sullivan County. LvOOMis Sanatorium (1896) : Exclusively for the treatment of tuberculosis. Capacity : 100 in the cottages ; 40 in the Annex. Terms : in the Annex, $5 per week ; in the cottages, $10 to $35 per week ; there are 14 supported beds. Physician in Chief: Herbert Maxon King, M. D. ; there are three assistants, who are also in residence at the sanatorium. Two miles from the village of Liberty, on the southern slope of a range of hills, at an altitude of 2,300 feet, are located the buildings which constitute Loomis Sanatorium. The adminis- tration building is of stone and half timber, heated by steam and hot water, lighted by electricity, and containing, besides the offices, reception rooms, and dining hall, a laboratory and a number of rooms equipped for different kinds of treat- ment. There is an infirmary for the treatment of patients more advanced with the disease or temporarily confined to bed. The patients are housed in fourteen cottages, of varying size, scattered over the grounds. There are several cottages adapted for independent housekeeping, which may be taken by a patient and his family, enabling them thus to live apart while at the same time under sanatorium care and regime. A casino, a library, and a chapel, complete the group of buildings. Applications should be addressed to Dr. Herbert Maxon King, Physician in Chief. 91 Lean To " at the Annex, Liberty. Interior of "Lean To." Xi;w YORK NEW YORK CITY. TuBERCUivOSis Ixfir:mary oi^ thi; ^Metropolitan HospitaIv^ D^PARTMEXT OE PuEEic CHARITIES (^January, 1902) : For the consumptives of Xew York City who are with- out resources to procure suitable private treatment; all stages of the disease are received, and the advanced cases isolated. Capacity : 450. There is no provision for pay patients. Chief of Resident Staff: J. B. Mickle, ^L D. The history of the Tuberculosis Infirmary on Blackwell's Island is of sufficient interest to justify the following quotations from the Annual Report of the Department of Public Charities of the City of New York, for the year 1902 : "On January i, 1902, there was no hospital set apart for consumptives in the Department, though there were 318 con- simiptive patients in Bellevue, City, ^Metropolitan and Almshouse Hospitals, of Avhom 155 were distributed through wards occupied by other patients, while 163 were in wards devoted to this disease, but in the same buildings as wards occupied by other patients. On Blackwell's Island, near the ^Metropolitan Hospital, there were three buildings formerly occupied by the Man- hattan State Hospital for the Insane, but vacated by that hospital in October, 1901. On January 31, 1902, one of these buildings was opened as a hospital for consumptives, and within a week all consumptive patients not in wards set apart exclu- sively for consumptives were transferred from Bellevue, Cit}' and ]\Ietropolitan Hospitals to this new hospital. A second building was subsequently put in order by this Department through its own labor, the bars being removed from the win- dows, the gratings removed from over the doors, the walls painted, new floors laid and the buildings otherwise made fit for habitation, and as rapidly as the buildings could be put in order the phthisis patients were removed from the former phthisis vv-ards in the Metropolitan main building and at the Almshouse. All phthisis patients received by the Department subsequent to the opening of this hospital were sent there directly." "The Deputy Superintendent of the 2\Ietropolitan Hospital was . . . assigned to the Tuberculosis Infirmary, with instruc- tions to give special attention to personal acquaintance with the 94 NEW YORK patients and to the social life of the institution, and also study the sociological aspects of the tuberculosis problem." The building for women has room for 90 patients. The men's building is much larger and consists of wide, light halls with rooms for one and two beds opening off them. There are no doors between the rooms and the corridors, and the free circulation of air is thus unhindered. Tent cottages provide for 125 men and 25 women. They weie in use all through last winter. Patients who are able to work, generally about one- third of all, are assigned some definite duty. Recently a solarium has been added to the equipment. Application should be made to the Superintendent, Bureau of Dependent Adults, foot of East 26th Street. RiVE^RSiDEi Sanatorium i^or Pulmonary Dise:ase;s (1903) : For poor consumptives of New York City in any stage of pulmonary tuberculosis. Capacity : 68. There are no charges. Resident Physician : Samuel T. Watson, M. D. The Riverside Sanatorium is located on North Brother Island, East River, in three one-story pavilions divided into two or more wards. It is supported by the city, and is under the direct management of the Department of Health. Application for admission should be made to the Depart- ment of Health, 55th Street and Sixth Avenue. Se;ton Hospital, Spuyten Duyvil Parkway (1895) : For all stages of pulmonary tuberculosis, and for other forms of tuberculosis in children. Capacity : in Seton proper, 200 men ; in new annex, Nazareth, 150 women and children. The wards of the hospital are generally kept filled with patients dependent on the Department of Public Chari- ties, and the cost of their treatment is met by the city. There are also 25 or 30 private rooms for persons able to pay from $10 to $20 per week. Resident Physician : B. B. Steedly, M. D. The site is an eminence of about 200 feet elevation over- looking the Hudson. The buildings are of modern type in 95 NEW YORK regard to sanitation and ventilation. A maximum amount of sunlight and fresh air is available both in wards and in private rooms. The institution is in charge of the Sisters of Charity. There are two resident physicians, and a number of the specialists of the city are on the visiting and consulting staff. The chief source of income is the fees paid by the city, but the institution receives some funds also from private patients, voluntary con- tributions and endowments. Private patients should apply directly to the Superintendent of the Hospital; by others appHcation should be made to the Superintendent, Bureau of Dependent Adults, foot of East 26th Street. St. Joseph's Hospital eor Consumptr'ES, St. Ann's Ave- nue and 143d Street (1882) : For poor consumptives, irrespective of nationality or religion; patients in all stages are received, but the majority are advanced cases. Capacity : 300. There are 280 free beds; the charge in private wards is $5 per week; in private rooms, $10. Physician in Chief : Charles :\I. Cauldwell, M. D. Physician in Charge : Henry A\'ollner, ]M. D. Consulting Physicians : Drs. John Doming and Frank E. Miller. Visiting Physicians : Drs. H. L. Shively, A. Spence, J. H. Larkin, E. AA'. Perkins, J. L. Dinning, A. Muller, F. H. Dillingham, T. H. Curtin, ']. B. Mannmg, J. J. Morrissey, C. E. Banker, A. R. Braunlich and J. F. Holmes. Visiting Surgeons : Drs. W. J. Furness, M. J. Schwerd, C. H. :\lcllwaine. This institution covers the entire block between St. Ann's and Brook Avenue and 143d and 144th Streets. It is owned and conducted by the Roman Catholic order of The Sisters of the Poor of St. Francis. There is a garden attached to the grounds. The main building is a four-stor\- structure, facing south, with east and west wings. It is lighted by gas and heated by steam radiators. The ground floor is divided into waiting- rooms, sitting-rooms, offices, examining-rooms and small wards. The three upper stories are each divided into five large wards, 96 N^W YORK five small wards and a few single rooms. The chapel occupies a separate extension. In the rear of the main building, but separated from it, is a house devoted to the use of incipient and arrested cases of consumption. An average of 1,500 patients i.-- treated each year. Apart from the individual good which these consumptives may derive from hospital care the public at large is benefited by the removal of the invalids to a place where they cease to be centers of infection, and where they no longer hamper the wage-earning capacity of the remaining- members of their families. (This paragraph is substantially a quotation from Dr. S. A. Knopf's Prophylaxis and Treatment of Pulmonary Tuberculosis, p. 160.) The institution is supported by voluntary contributions and appropriations from the city. Application should be made to the Sister Superior. The: Home for Incurabi,es, occupying an entire block at Third Avenue and i8ist Street: Receives a few consumptives in single rooms. Not more than 12 can be accommodated at one time, and the usual proportion is about 6 out of 250 patients. The rates are $10 per week and up, in single rooms. Applications should be addressed to Israel C. Jones, M. D.. Medical Superintendent. The House of Rest for Consumptives, Bolton Road and 209th Street (1869) : Chiefly for advanced cases of consumption. Capacity : 39. There are no charges, the institution being supported by endowments and voluntary contributions. There is no resident physician. For ten years previous to January, 1902, the House of Rest arranged for its beneficiaries to be cared for at St. Luke's Hospi- tal. At that time the estates at Inwood were purchased and the necessary alterations begun. The primary object is to provide a refuge for incurable consumptives, but hopeful cases are not excluded. Application should be made to George F. Sauer. Super- intendent. 97 NEW YORK Lincoln Hospital and Home;, East 141st Street and South- ern Boulevard (1839) • A general hospital, with separate provision for about 40 consumptives in wards and private rooms ; patients are received in all stages of pulmonar)^ tuberculosis. Terms : for those able to pay, $1 per day in the wards, and from $15 to $35 per week in private rooms; man)^ free patients are accepted who are sent by the Department of Public Charities, The resident staff consists of six physicians. This institution was originally a Colored Home, with an at- tached hospital, chiefly for chronic cases. About two years ago it was changed to a general hospital, for both white and colored. The buildings occupy an entire block on high ground in the Bronx, overlooking the East River and Long Island Sound. AppHcations should be made between 8 A. M. and 6 P. M., at the office of the Superintendent. MoNT:eFiORE HoiMi; for Chronic Invalids, Broadway and 138th Street (188/1) : One ward is reserved for patients in advanced stages of consumption who are unable to pay for treatment. Capacity of the consumptive ward: 40. There are no charges. Superintendent: A. Haussman; there are four resident physicians. Montefiore Home occupies an entire block in the northwest- ern part of the city, near the Hudson River, and not as yet crowded with high buildings. This, and the Country Home at Bedford Station, are charities supported by the Jewish philan- thropists of the city. Application for admission should be made to the Super- intendent. 98 Ni;w YORK SiiASiDi: TjiNT- Camp for children suffering from tuberculosis in bones and glands (June, 1904) : For children from three to ten years of age, suffering from non-pulmonary tuberculosis. Capacity : 54. There are no charges. Resident Physician : M. Burnham, M. D. This experimental sanatorium, the first of its kind in' America, was established and is maintained by the New York Association for Improving the Condition of the Poor. It is located on the Coney Island shore, at Surf Avenue and Thirty- lirst Street, just west of Sea Breeze, the Association's fresh-air home, and is sufficiently far removed from the amusement halls and gaieties to be undisturbed by the noise of the usual Coney Island crowd. The tent camp consists of ten rectangular tents with wooden floors, raised a sufficient distance above the ground to allow ventilation and prevent dampness. Eight of the tents are arranged in the figure of an octagon, with a board walk connecting them, enclosing a playground of sand some thirty feet wide. Four of these tents are accommodat- ing fifty children, one is for nurses and administration, one with open sides is a playroom, and one is used for a dining-room. The dining tent is connected with a small, single-storied, wooden structure, used in part for a kitchen and pantry, and in part for a wash-room for the children. In this building there is also a small room utilized for dressing abscesses and wounds resulting from necessary operative treatment. Two smaller tents, situated at a little distance, are used, one for attendants and one as an isolation ward. The scope of the hospital is limited to the treatment of non- pulmonary tuberculosis in children from three to ten years of age. It is not expected to carry out major surgical operations, such as are often necessary in some forms of tuberculosis, nor is it feasible to make all the appliances necessary for the treat- ment of joint and spinal cases. It is rather intended to prevent the use of the surgeon's knife and to hasten convalescence when operations have been necessary, and to prove to the community that hygienic means may avail in some cases which otherwise would be relegated to the surgeon or considered hopeless. A 99 NE;w YORK public school teacher has been assigned to the camp by the New York Board of Education. It is proposed to continue this work throughout the winter, but no longer. The purpose of the Association is to make a demonstration which will induce public authorities and private organizations or individuals to establish permanent hospitals for this class of cases. Application should be made to The New York Association for Improving the Condition of the Poor, 105 East 226. Street, New York Citv. 100 ^^^Mri ^4 F iJU'^5^Hflfc^^^i^^^ ^^^^^^■Mjj^^^^B H T ■. ' - ■ 1 ;- _., — B! § j^^HBB^^HPS^^^^'^T^^^ ^O^E !■ 1 '"* 3^^^^^^"*^^*3l i Vi j^^ ^^^»sjr^^ ^^r^^S^^^^^^H I HBPHpRpp "'^^S^HHIJ^I^^^^^^BH^H ^H ■^^Bjr^ ^ BH^^HhnsixiE.''" °*^" ^^^Bw^gfc- --.^:sr». ■ '?! Roche;ster Hospitai, for Incipient Cases. NEW YORK PAUL SMITHES (P. O. Gabriels). Sanatorium GabrieIvS (1897) : For early cases of consumption and convalescents from other pulmonary diseases. Capacity: 70. Terms : From $10 to $18 per week, according to location of rooms ; one free patient is taken in every ten. Resident Physician: R. L. Strong, M. D. The location is a broad park of undulating ground, rising gradually to Sunrise Mount (altitude 2,000 feet), which shelters the building from the north winds, and surrounded b}^ pine and spruce forests. The sanatorium consists of an administration building, surounded by cottages. A special feature is the sys- tem for heating and ventilation, by which air from outside is continually being warmed and introduced into the rooms. The entire volume of air throughout the buildings is changed in the course of five minutes. The Sisters of Mercy are in charge. A small magazine. Forest Leaves, is published quarterly by the Sanatorium. Application should be made to the Mother Superior. ROCHESTER. Hospital for Incipient Cases oe Tuberculosis (May, 1904) : Capacity : 40. Charges are according to the ability of the patient, up to $7 per week ; most of the cases pay a little. This hospital is maintained by the Rochester Public Health Association, as part of its work against tuberculosis. Its quar- ters are a building known as the Municipal Hospital, the use of which has been granted by the city authorities. It is situated in twenty-six acres of ground, and is well adapted to the pur- pose for which it is being used. Applications should be addressed to G. W. Goler, M. D., Physician in Charge. 102 NEW YORK SANTA CLARA, Franklin County. HiLiv Crest and Uplands, summer vacation houses, not sanatoriums (June, 1895) : For working girls and women who are threatened with tuberculosis or are in the incipient stage. Capacity : 56 : Terms : full board, $7 per week, sometimes paid by friends of the girls; others are allowed one month free, after which they pay whatever they can afford, usually from $3 to $5 per week. Resident Physician : Caroline M. Stengel, M. D. The Working Girls' Vacation Society exists, as its name indicates, for the purpose of making suitable vacations possible for working girls who are broken down in health. The two houses at Santa Clara are used for those who have tubercular tendencies or are already in the first stages of the disease. The length of stay is determined by the examining physician. In the summer of 1903 it averaged over five weeks for the 120 girls cared for. Santa Clara is located in the Adirondacks, 40 miles north- west of Saranac, on the New York and Ottawa Railroad, at an altitude of 1,800 feet. The vacation houses are open from June I to November i. Application should be made to Miss E. A. Buchanan, 361 West 34th Street, New York City. 103 5 s w < o u o <1 NEW YORK SARANAC LAKE (P. O. Trudeau.) Adirondack Cottage Sanitarium (1885) : For persons who cannot afford to pay more than $5 per week and who are in the very early stages of pulmonary tuberculosis or are at least favorable types. Capacity: 100; 112 in summer, by the use of tents. The uniform charge is $5 per week; there is a free bed fund, the interest of which is applied to prolonging the stay of needy patients. President: Edward L. Trudeau, M. D. Resident Physicians : Lawrason Brown, M. D., and David C. Twitchell, M. D. From a one-room cottage heated by a wood stove and lighted by a kerosene lamp Adirondack Cottage Sanitarium has grown to a small village of twenty-five or more buildings — the main building, twenty-one cottages, an infirmary, a pavilion, a chapel, a library, and a post-office — situated in the Adirondacks, a mile from Saranac Lake, at an altitude of 1,650 feet. In the first years of the existence of this sanatorium it was a problem to induce patients to go to it and to stay. Now not one in twenty of the applicants can be received, and the waiting list of successful applicants is usually long. For the benefit of persons who are attracted to Saranac Lake, either in the hope of gaining admission to the sanatorium or through confidence in the climate, two unusual accessories have been developed. A Bureau of Information is maintained in the village, for the pur- pose of advising strangers, and helping them to find boarding- places, and an Out-Patient Department has, for over three years, given free medical advice to patients on the waiting list and to unsuccessful applicants for admission who cannot afford to pay for medical treatment. An attempt is made, through the Co- operative Employment Bureau conducted by the institution, to find suitable work in healthful regions for patients when they leave. A monthly magazine. The Outdoor Life, is pviblished at the sanatorium. The uniform fee of five dollars per week does not cover much more than half the cost of maintenance. The deficit is made up by gifts and subscriptions. From the beginning the summer residents have been an important source of contributions. Application should be made to any of the following physi- cians : Dr. Lawrason Brown, Saranac Lake ; Dr. James Alex- ander Miller, New York City: Dr. Linsly Williams, New York City. 105 NEW YORK Reception Cottage (April, 1901) : For "tuberculous patients who come with the expectation of admission to the sanitarium, but because of acute or advanced ilhiess are refused admission and are unable to receive suitable care at a cost within their means." Capacity: 15. Terms : $7 per week. Medical Director: Edward R. Baldwin, M. D. This is a house maintained chiefly by Miss Mary R. Prescott, of New Bedford, Massachusetts. The fee charged is almost $5 less per week than the actual average cost of maintenance. The building occupied at present is a three-story modern dwelling, rented from year to year and not well adapted for hospital pur- poses. A new building for fifteen patients has just been com- pleted and will be occupied January i, 1905. Admission is not granted by letter ; patients must be in Saranac Lake village at the time of application, which should be made to Dr. Edward R. Baldwin. Raymond Cottage (June, 1902) : For early cases of pulmonary tuberculosis and moder- ately advanced ones if there are no complications. Capacity : 14 in summer ; 10 in winter. Terms : $10 per week and up. There is no physician in residence, but the visiting staff consists of Drs. E. L. Trudeau, E. R. Baldwin, Charles C. Trembly and Lawrason Brown ; Mrs. Josephine R. Raymond, who is in charge, is a trained nurse with ten years' experience in the care of tuberculosis cases The location is the southwestern slope of Mt. Pisgah, three- quarters of a mile from the post office, and 100 feet above the village. In the main building there are eight bed-rooms for patients and in a smaller building, four. Three tents are used- There are well-protected porches, and a sun parlor 24 feet; by 10. Application should be made to Mrs. Josephine R. Raymonds 107 NE:w YORK RuMANAPP Cottage (July, 1902) : Patients are received in all stages of pulmonary tubercu- losis. Capacity : 14 in winter, 20 in summer. Terms: $8 to $12 per week; there are extra charges for meals served in the patient's room and for special nursing. There is no resident physician ; Miss Rumanapp is a trained nurse, and the visiting staff consists of Drs. Brown, Twitchell, Baldwin, Trembly and Kinghorn. The house is a two-story cottage with porches on two sides, situated in the village, facing Lake Flower. Tents are used in the summer. Application should be made to Miss Edith Rumanapp, Lock Box 596. VERBANK, Dutchess County. All Saints' Homk (1886) : For men only; not exclusively for consumptives, but early cases are received. There is room for 10 tuberculous patients, in a pavilion reserved for them. Terms : $14 per week if the applicant is able to pay ; otherwise there is no charge. There is no resident physician, nor any regularly ap- ; pointed visiting physician. The place is in charge of the Brothers of Nazareth. It is three miles from the railroad station, among the hills, at an altitude of about 1,000 feet. Applications should be addressed to the Brothers of Nazareth. 108 NORTH CAROLINA NORTH CAROLINA ASHEVILLE. The: Winyah Sanitarium (October, 1888) ; For diseases of the lungs and throat; far advanced or hopelessly exhausted cases of consumption are not admitted. Capacity: 80. Terms : $30 per week. Medical Director : Karl von Ruck, M. D. In January, 1900, the Winyah Sanitarium took possession of a new establishment. The site "is a wooded park of 20 acres, well sheltered, and just outside the limits of the city of Ashe- ville, so far removed from the center of the town as to be free from noise and dust, and yet of easy access by a branch of the Asheville electric street-car system, which passes directly through the grounds." The buildings "consist of a main structure, a large annex, and two cottages, all connected by glass-enclosed steam-heated porches and passages." There are piazzas with exposure in all directions, some of them enclosed in glass with movable win- dows. In addition to the indirect method of steam heating extending to all parts, there is also an open fireplace in each room. The lighting is by electricity; the water supply is from an artesian well. A laboratory for clinical work and for sci- entific research is a feature of the ec[uipment, also special de- partments for laryngology and for physical and electro-thera- peutics. Applications should be addressed to Dr. Karl von Ruck. . St, Josi;rn Sanitarium (1902) : For all forms of tuberculosis. Capacity: 25. Terms : $15 per week and upwards. There is no house physician ; any physician of the city is at liberty to send patients to the sanitarium. At present there is one building, with a wide veranda, sur- rounded by a shaded lawn. A new equipment, more complete and extensive, is planned. The sanitarium is in charge of the Sisters of Mercy, to whom application for admission should be made. 109 NORTH CAROLINA Dr. Ste;ve;ns' Home; (May, 1903) : For non-surgical cases of tuberculosis in the early stages. Capacity : 8 ; others can be accommodated in a boarding house near or in tents during the summer. Terms : $20 to $25 per week. Physician in charge : Martin L. Stevens, M. D. Dr. Stevens' Home is within the town limits, but away from the busy and dusty streets, and is surrounded by a large, shady lawn. For further information application should be made to Dr. Stevens. Ill Franklin Humanitarian Home. PiNESHiRE Sanitarium. NORTH CAROLINA BLACK MOUNTAIN. Franklin Humanitarian Home; (June, 1902) : For "working- people whose lives are worth saving," in early stages of pulmonary tuberculosis. Capacity: 12. Terms : $3 per week. There is no resident physician. Here is an attempt to provide for a few of the many persons who go to Asheville for the sake of the climate, but have little or no money with which to meet the expenses of board and treat- ment after they arrive. The price charged for board does not cover expense of maintenance, and the deficit is made up through the efforts of Mrs. M. Franklin Mallory, the founder and man- ager of the Home. Each patient is required to do some regular daily work, unless his physician advises against it. The "Home" is situated on the western slope of the Blue Ridge, twelve miles east of Asheville, at an altitude of about 2,400 feet. At present it consists of a twenty-room, two-story house, on a farm of 200 acres. Shack tents are being erected in the pine groves on the grounds, and by means of these the accommodations can be increased almost indefinitely. Applications should be sent to Mrs. M. Franklin Mallory, SOUTHERN PINES. Pineshire Sanitarium for Diseases oe the Lungs and Throat (November, 1901) : Patients are received in the first and second stages of pulmonary tuberculosis. Capacity : 30. Terms: $17.50 to $35 per week. Resident Medical Director: Louis Fielding High, M. D. Southern Pines is about 100 miles from the coast, in the sandy, turpentine pine belt which extends south to Florida, and has an altitude of 700 feet. The sanitarium is a large building on a western slope, in the suburbs. Most of the bedrooms are heated by open fire-places and all have large windows, some as many as six. A wide veranda extends around the building, with ;i sun-parlor on the first floor. In this climate life in the open air is attractive at all seasons. Modern facilities for scientific hydrotherapy have recently been added. Application should be made to Dr. Louis F. High. 113 Branch Hospital for Consumptives. OHIO OHIO State vSanatorium : Thirty-five thousand dollars was appropriated by the legis- lature in 1904, to begin work on a state sanatorium. It is hoped that this initial sum will suffice for the purchase of land and for the preparation of architect's plans, and that an appropriation for construction and equipment will be made during the legisla- tive session, 1904-1905. (See pages 246, 247.) CINCINNATI. The: Branch Hospital for Consumptives (July, 1897) : For persons in any stage of pulmonary tuberculosis who have been residents of the city for at least one year. Capacity: 120 in winter; in summer it can be extended indefinitely by the use of tents. There are no charges to residents of the city ; for patients coming from outside, or for those who wish private rooms, the rate is $14 per week. There is no physician in residence ; the visiting physician is B. F. Tyle, M. D. This is a city institution, but it is situated outside of the city in its own grounds of 52 acres. The altitude is 850 feet. The main buildings consist of nine wards ; the solarium has one large ward and five private rooms ; tents are used, also, in what- ever number is required. Applications should be addressed to the Cincinnati Hospital. CLEVELAND. Tuberculosis Sanatorium oe the City Hospital (Octo- ber, 1903) : For poor consumptives in any stage of the disease. Capacity : 75. There are no charges. Resident Physician : J. C. Placak, M. D. The Sanatorium is one building two stories high and 200 feet in length, situated 600 feet from any other building, on the brow of a hill overlooking the city. There are four wards and sixteen private rooms, and twelve-foot porches on three sides of the building. Application should be made to Fred. C. Emde, Superin- tendent. 115 o -J u on w m o H Q < w > OHIO DAYTON. The Miami Vaij.ky Hospital has, for two years, reserved for consumptives a small isolation building, with accommoda- tions for three patients. These beds are free. One tent also is used. There are two resident physicians in the Hospital. Applications should be made to the Superintendent. PRICE HILL, Cincinnati. Western Hill Hospital and Sanitarium (1894) : Exclusively for early cases of tuberculosis. Capacity : 30. Terms : ten patients are treated free of charge ; for others, $10, $15 or $25 per week. Resident Physician : Oswald Katz, M. D. The Hospital is located on an eighty-acre plot 900 feet above sea level, near the Ohio River. There are twelve specially con- structed cottages arranged in a semi-circle on the crest of a hill and separated from one another by a ten-foot space ; also other cottages for diet kitchen and nurses. All the buildings have adjustable glass roofs and verandas extending entirely around. Application should be made to Dr. Oswald Katz. 117 PENNSYLVANIA PENNSYLVANIA State; Sanatorium : Attempts to secure the establishment of a state sanatorium have been made at various times by the Pennsylvania Society for the Prevention of Tuberculosis, but they have not been suc- cessful. The state contributes, however, to the support of cer- tain private institutions. GREENTOWN, Pike County. Privatk Tent Camp (June, 1904) : Exclusively for early cases of pulmonary tuberculosis.. Capacity : 4 in winter ; 7 in summer. Terms : $80 per month. Resident Physician : Albert S. Ashmead, M. D. The Camp is situated in the Pocono Mountains at an altitude of 2,000 feet. Each patient has his own tent or wooden chalet, facing east, as the storms are generally from the northwest. Greentown is reached by stage from Gouldsboro, the nearest railroad station, which is on the Delaware, Lackawanna and Western Railroad. Application should be made by the patient's physician to Dr. Albert S. Ashmead. LANSFORD (P. O. Summit Hill). Mt. Jefferson Sanatorium (1904) : For all stages of pulmonary and laryngeal tuberculosis. Capacity : 25. Terms : $10 per week. Resident Physician : W. H. Clewell, M. D. During the first summer of its existence this sanatorium has consisted of a tent camp on the top of Sharp Mountain, 1,600 feet above sea level. It is the intention to erect dormitories and administration buildings for winter use. The institution is de- signed to meet the needs of that large class of consumptives who are able to pay a moderate fee for treatment, but not the ordinary sanatorium prices. Application should be made to Dr. W. H. Clewell. 118 PENNSYLVANIA MONT ALTO, Franklin County. South AIountain Camp Sanatorium (March, 1903) : For consumptives in the early stages of the disease who are citizens of Pennsylvania and not able, financially, to go elsewhere. There are accommodations for 38 persons. Terms : shelter and fuel are free of charge, but every- thing else must be provided by the campers. There is a resident physician, and the consulting physi- cians are easily accessible. This is, as its name indicates, merely a camp in the woods. Its existence is due to the interest and initiative of Dr. Rothrock, the State Commissioner of Forestry. The land and buildings are state property. All that the state furnishes, however, is ''shelter, fuel, air, and water." Campers are expected to make their own arrangements about food and other provisions. There are eleven plain board cabins, ten feet square, intended for two men each, and seven cottages for women, each with two rooms and a small kitchen. Cots and stoves are the only furniture pro- vided. A large assembly building has been erected for the use of all. From the beginning the number of applications has far ex- ceeded the accommodations, in spite of the slight attractions offered and the strict enforcement of certain rules in the camp. Applications should be addressed to Dr. J. T. Rothrock. Private Sanatorium (to be opened June, 1905) : A private sanatorium, intended to be a comfortable home for about ten patients, will be opened, in the summer of 1005, within half a mile of the South Mountain Camp Sanatorium, by Drs. J. T. and A. M. Rothrock. Inquiries should be addressed to Dr. J. T. Rothrock, Mont Alto, Franklin County. 119 The Sheppard Cottage, Hospital for Diseases of the Lungs. WiLSTACH COT'J'AGE, HOSPITAL FOR DISEASES OF THE LUNGS. PKNNSYL,VANIA PHILADELPHIA. PhiIvAdelphia General HospitaIv, 34th and Pine Streets : For the poor of the city ; consumptives are segregated. Capacity of the tuberculosis buildings: 174. All beds are free. Chief resident physician : M. H. Biggs, M. D. For ten years the consumptives have been isolated in wards. New buildings have just been constructed, especially designed for the treatment of tuberculosis. They include a hospital of 66 beds and six pavilions made entirely of glass and steel, each accommodating 18. These buildings are on the highest part of the hospital grounds, not far from the river. During the summer of 1903 the hospital roof was converted into a ward where as many as possible of the patients in the earlier stages of consumption were kept night and day. Application should be made to the Chief Resident Physician. The Henry Phipps Institute maintains a hospital for ad- vanced cases of tuberculosis, at 238 Pine Street. (See page 248.) Hospital for Diseases oe the Lungs, Chestnut Hill (1876): For women unable to pay for proper treatment ; all stages of pulmonary tuberculosis are received, and cases of bronchitis, but most of the patients are consumptives in an advanced stage. Capacity: 60; there is room in tents for 14 more. There are no fixed charges, but patients and their friends are expected to contribute, according to their means, toward the support of the hospital. Consulting Physician : J. Solis Cohen, M. D. Resident Physician : Anna L. Bacon, M. D. Visiting Physicians : Drs. Wm. M. Angney, Charles A. Currie, J. Clinton Foltz, Myer Solis Cohen ; Arthur W. Watson, laryngologist ; Robert L. Pitfield, bacteri- ologist. This Hospital, and the House of Mercy (see page 122) were established by the Philadelphia Protestant Episcopal City Mis- 121 PENNSYLVANIA sion in 1876, and were the first institutions in Pennsylvania especially for consumptives. More than 3,500 patients have been cared for by this organization, either at home or in the hospital. No distinction is made on account of nationality, creed, or color. At Chestnut Hill buildings designed especially as a hospital for consumptives have been erected. They are located on an elevated piece of ground, 500 feet above tide water, one of the highest points near Philadelphia. There are four hospital build- ings and one administration building. The institution is con- ducted on the separate principle, each patient having her own room. All bedrooms face due south. Two of the hospital buildings have been furnished with wide open porches, on which the beds of the patients are placed. In stormy weather heavy awnings are dropped to the floor. The fresh-air treatment has been in force for nearly ten years. In the summer of 1903 tent life was introduced; this was tried again in 1904, and in both years was continued until high winter winds rendered the tents insecure. Application should be made to Rev. H. L. Duhring, D. D., Old St. Paul's Church, 226 South Third Street, Philadelphia. The House; of Me:rcy, 411 Spruce Street (1876) : For consumptive men, in all stages of the disease, who are unable to procure suitable care elsewhere. Capacity: 12. There are no charges ; patients are requested to make some contribution if they are able to do so. House Physician : William Muir Angney, M. D. Almost all of the patients here are advanced cases. They are cared for in four small wards in a city house. A roof gar- den is used for open-air treatment. This institution is main- tained by the Protestant Episcopal City Mission. ( See page 121 ) . Application should be made to Rev. H. L. Duhring, D. D., Old St. Paul's Church. 225 South Third Street. 122 ,Jfl^lp^ •fi ^-im' milt ": > tVH i^tii^^iJ'U.iii^^ ^^-Uk < O PENNSYLVANIA Rush Hospital, Lancaster Avenue and Thirty-third Street (1892): Exclusively for treatment of pulmonary and laryngeal tu- berculosis; patients in all stages are received. Capacity: City Hospital, 40; Country Branch, 25. Terms : $5 per week in the wards ; $10 to $20 in private rooms. There is no resident physician, but the visiting physicians, S. Solis Cohen, M. D., and T. Mellor Tyson, M. D., are always accessible. The City Hospital consists of two wards, an open-air pavilion, and private rooms. The Country Branch, at Malvern, Pennsylvania, accom- modates 25 patients in small rooms, open-air shelters, and tents. A larger city hospital, with provision for at least 80 patients, is now building. The institution is supported by a state en- dowment, fees from patients, and voluntary contributions. Application should be made to the Superintendent. LuciEN Moss Home;, Jewish Hospital, York Pike and Tabor Road (June, 1900) : For poor consumptives of Jewish faith, in any stage of the disease. Capacity : 3 1 . There are no charges. Chief Resident Physician : Edwin D. Jarecki, M. D. The building is of brick, four stories high, with sun parlors and separate rooms for patients. All the sleeping rooms have a southern exposure. Application should be made to Dr. Edwin A. Jarecki. 124 rENNSYI^VANIA The; Dermady Sanatorium, Gowen Avenue and Sprague Street, Mt. Airy (June i, 1904) : Exclusively for pulmonary tuberculosis. Capacity : 25. Terms: $12 to $27.50 per week. There is no resident physician ; patients can have the advice of Drs. Lawrence F. Flick, William B. Stanton, Joseph Walsh, D. J. McCarthy, H. M. B. Landis, and Charles Hatfield. This sanatorium is twelve miles from Philadelphia, at an altitude of 500 feet. The main building is a three-story house of gray stone, and the annex, which will accommodate twelve patients, is a smaller building, of stone and wood. Over two acres of wooded lawn surround the houses. Graduate nurses and a graduate in hydrotherapy are in attendance. Any phy- sician may place and treat patients in this institution. Application for admission should be made to Miss Margaret G. O'Hara. PITTSBURG. The Tuberculosis Hospital (projected) : For poor consumptives of Pittsburg and Allegheny, in any stage of the disease. ■ Capacity : at least 50. There will be no charges. An association has been formed by prominent citizens of Pittsburg for organized and systematic work among the con- sumptive poor of the city. The first efforts will be directed toward establishing a free hospital. Four acres of land on a hill in the city, with buildings easily adaptable to the require- ments of a hospital, have been given for the purpose. The altitude is about 1,200 feet, and the buildings command a view of the Allegheny and Ohio River valleys. For the present inquiries should be addressed to Dr. Henry Martyn Hall, Jr., 253 Shady Avenue, Pittsburg. 126 The Dermady Sanatorium. PENNSYIvVANIA SCRANTON. West Mountain Sanatorium (August, 1903) : For poor consumptives resident in Scranton ; all stages are received. Capacity : 24. Terms: there is a maximum charge of $5 per week for those who are able to pay ; others are admitted free. There is no physician in residence, but an attending staflf of six. This institution is located on a sixty-acre farm, just outside the city limits, on a mountain side, at an elevation of 1,600 feet. It is expected that when the land is fully developed it will fur- nish all the milk, eggs, and garden produce needed. Patients able to work are required to do so. The hospital building has two wards of ten beds each, and is heated by steam. There are also four shacks for two patients each, which can be used all winter ; nine others for summer ; a farmhouse, a barn and a laundry. The funds for construction and maintenance are derived wholly from voluntary contributions, the fees from patients be- ing practically a negligible amount. The sanatorium was estab- lished and is maintained by the Scranton Society for the Preven- tion and Cure of Consumption (see page 250). Applications should be addressed to Dr. J. M. Wainwright, d^"] Linden Street. 128 PENNSYLVANIA WHITE HAVEN. Free H/jspital for Poor Consumptives (1901) : For residents of Pennsylvania in the early stages of tu- berculosis who are not financially able to provide pro- per treatment for themselves. Capacity : 100. There are no charges. Superintendent : James H. Heller, M. D. President of the Board of ^Managers : Lawrence F. Flick, M. D. ; there are two resident physicians. The grounds include 215 acres in the Blue Mountains, at an altitude of about 1,500 feet. The Hospital was founded in 1895, but for the first six years its beneficiaries were boarded in existing institutions. The nucleus of the present equipment was a barn, which in 1901 was transformed into a pavilion accommodating sixty patients. There have been built, since, three cottages, wath a capacity of sixteen each. An administration building and superintendent's quarters are almost ready for occupancy. Funds for maintenance are provided by contributions from the public and a state appropriation. Application should be made to Miss Helen C. McDevitt, Sec- retary, 204 South Seventh Street, Philadelphia. SuNNYREST SANATORIUM f November, 1901) : For early cases of pulmonary tuberculosis. Capacity : 50. Terms: $15 to $25 per week. The place of resident physician is supplied by a physician in the village. Visiting staff: Drs. Lawrence F. Flick, Joseph AA^alsh,. \Vm. B. Stanton, Henry ^L Xeale, Chas. J. Hatfield, N. M. R. Landis, D. A. McCarthy, A. M. Shoem.^.ker. This private sanatorium is situated among the mountains, overlooking the Lehigh Valley, 1,200 feet above sea level. The soil is dry, porous shale. The main building contains adminis- tration of^ces and twelve bedrooms. There are also three cot- tages and a central dining hall, and from April to November tents are used. Application should be made to Elwell Stockdale, Superin- tendent. 129 RHODE ISLAND RHODE ISLAND State; Sanatorium for Consumptives (to be opened in IQOS). situated at Pascoag: Exclusively for early cases of tuberculosis. Capacity : loo. Terms : not yet fixed, but all will be expected to pay something. There will be resident physicians. The buildings, which were completed in the spring of 1904^ consist of a three-story administration building, connected by covered corridors with a two-story pavilion on each side. The site, near Wallum Pond in the extreme northwestern part of the state, has an elevation of about 600 feet. It is expected that the state will assume one-half the expense of support, the other half to be borne by the patient. Application should be made to the Commission on a State Sanatorium for Consumptives. FOSTER. Pine Ridge Camp eor Consumptives (1903) : Capacity : 25 in winter, to be increased this year ; 60 from early spring until late fall. Terms : each patient is expected to pay what he can, up to a maximum of $7 per week. Superintendent: William H. Peters, M. D., 21 Waterman Street, Providence. A physician is in residence during the summer, and there is a large consulting and visiting stafif ; both men and women nurses are always in attendance. A New England farm of 50 acres is the site of this camp. It has a southern exposure, is almost surrounded by pine forests, and has an altitude of 600 feet. The soil is porous ; there is spring water on the place, and trout streams and hunt- ing near. The plant consists of an administration building of rough boards, ten cabins 10 by 12 feet, accommodating two patients each, a separate kitchen and dining-room, and twenty- two tents. Abandoned trolley cars have also been pressed into service, and transformed into bed-rooms, one patient in each,. as a step toward solving the problem of economy. Application should be made to Dr. William H. Peters, 21 Waterman Street, Providence. 131 Shack at Pine Ridge Camp. Abandoned Trolley Car in Use at Pine Ridge Camp. KHODU ISLAND HOWARD. State Almshouse. Tuberculous patients, in whatever stage of advancement, are separated from the others. Capacity of tuberculosis buildings : 40. There are no charges. Physician in Charge : George F. Keene, M. D. For eight years the tuberculous patients in this institution have been cared for in a separate building. There are two long wards, one for men and one for women. Patients are kept out of doors as much as possible. PROVIDENCE. St. Joseph's Hospital : Two wards are reserved for tuberculosis ; all stages of advancement are admitted. Capacity of the tuberculosis wards : 24. The hospital is primarily for the poor ; if a patient is able to do so he pays a small sum, never more than $7 per week. Resident Physician : William Hindle, M. D. The hospital is a six-story brick building, situated on a slight elevation in a residence district of the city. Its chief source of support is voluntary contributions. Application should be made to Sister M. Eulalia. 133 SOUTH CAROI.INA SOUTH CAROLINA AIKEN. The Aiken Cottages (October, 1896) : For men in reduced circumstances with incipient pul- monary tuberculosis. Capacity: 15. There are two free beds ; for others the charge is $5 per week. Medical Director, in residence : Charles F. McGahan, M. D. The Aiken Cottages originated with a group of Massa- chusetts men and women who were impressed with the need of some place where yovmg men attracted to Aiken by the climate, but friendless and unable to pay for proper care, might find a chance for health. Of the eight directors, four are residents of Massachusetts, so that it is largely a New England enter- prise. Aiken is a small village located on a sand ridge running from east to west across the state. The sanatorium is at the western edge of the town, on the highest point of ground, at an altitude of 565 feet. Artesian wells, sunk to a depth of 800 feet, supply the water. The main building contains the adminis- tration offices, general rooms and bedrooms for seven patients. A smaller cottage, accommodating four, has been added; and recently two tents, for two men each. Each patient has his own room, but sleeps on the piazza outside. The aim of the founders and directors has been from the beginning to keep the characteristics of a home rather than of an institution. The charge of five dollars per week represents less than half the cost of maintenance, the deficit being supplied by gifts. Application should be made to Dr. Charles F. McGahan. 135 TEXAS TEXAS COMFORT, KendaU County. Camp Reuanck (May, 1902) : For early cases of tuberculosis. The capacity can be indefinitely increased by the addition of tents. There were 25 residents in February, 1904. Terms : $1 per day ; $25 per month. Manager and owner : C. H. Wilkinson, M. D. Camp Reliance is pitched near the Guadeloupe River, on the summit of a hill, two miles from the German village of Kendall. There is a flag station at the Camp for the benefit of residents. The elevation is 1,700 feet. In the main building, 70 by 40 feet, are the dining-room, parlors and baths. The bed-rooms are tents, well ventilated and built on floors six inches above the ground. Application should be made to Dr. C. H. Wilkinson. EL PASO. Sisters' Hospital, Hotel Dieu (1894) : A general hospital, but consumptives are cared for in a separate wing. Capacity of tuberculosis wing : 50. There is always a resident physician. The hospital is situated on a hill in the residence portion of the town. It is a five-story brick structure, heated by steam, lighted by gas and electricity. The Sisters of Charity are in charge. Application should be made to Sister Regina, 136 VERMONT, VIRGINIA, WASHINGTON VERMONT State Sanatorium : The State Tuberculosis Commission (see page 251) is re- quested to incorporate in its report to the legislature recom- mendations in regard to sanatorium provision ; and the State Society for the Prevention of Tuberculosis (see page 252) will use all its influence to support such recommendations. SOUTH HERO. Champlain Open-Air Sanitarium (1903): Not exclusively for consumptives, but early cases are re- ceived and accommodated in separate cottages. Capacity : 30. Terms: $15 to $35 per week. Resident Physicians : H. E. Lewis, M. D., and F. C. Lewis, M. D. This institution is open only during the summer months, from May i to November i. It is on the cottage plan. Application should be made to Dr. H. E. Lewis, Burlington. VIRGINIA State Sanatorium : A bill for the establishment of a state sanatorium has re- ceived consideration in the legislature, but failed of passage. SEATTLE. WASHINGTON King County Hospitae, tent colony for consumptives (started in July, 1903) : For const\mptives without resources who have been in King County at least six months. Capacity of tent hospital : 15. All beds are free. Superintendent :William P. O'Rourke, M. D. The tents are located on the grounds of the County Hospital, four miles from Seattle, in the Valley of the Duwamish River. They are so constructed that the canvas forming both the roof and the side walls can be raised and lowered, as sun or wind dictate. All the tents are supplied with hot and cold water. Patients are given five meals daily, and all their eating utensils are kept separate. Application should be made to the Board of County Com- missioners, j^g- WISCONSIN WISCONSIN Stats Sanatorium : The State Tuberculosis Commission (see page 252) will recommend to the legislature the establishment of a state sana- torium for early cases. LAKE NEBAGAMON. Evergreen Park Cottage Sanatorium (Ma)^, 1903) : For early cases of pulmonary tuberculosis, and for children with tubercular glands or joints. Capacity: 12, in cottages. Terms : $15 per week in cottages ; persons unable to meet this expense are allowed to build their own shacks or pitch tents on the grounds, provided they comply with the same regulations as the regular patients, and are given medical attendance at the rate of $10 per month. Medical Director: W. B. Hopkins, M. D. The sanatorium is open from May i to November i. It is thirty miles from Lake Superior, on the Duluth, South Shore and Atlantic Railroad, in the extreme northwest of the state, and the altitude is 1,106 feet. The cottages are situated on a gentle slope of sandy soil facing southwest. They are so constructed that the occupants practically sleep out of doors, and all are required to be in the sunshine all day. The life is simple and informal, but implicit obedience to the general sanitary regulations and to the individual advice of physician and nurses is insisted upon. Application should be made to Dr. W. B. Hopkins, Cumber- land. 138 WISCONSIN, CANADA TOMAHAWK, Lincoln County. The Wisconsin Health Park Association was organ- ized in ]\Iarch, 1902, "to establish and maintain a Health Park or Parks in northern Wisconsin where invalids (especially incipient cases of tuberculosis) may be sent for improvement and recovery." A tract of 240 acres, chiefly pine-covered hills, at Tomahawk, in Lincoln County, has been donated, and the work of clearing parts of it for cultivation and for the erection of cottages has been begun. The plan is to provide for all who wish to go to it, giving to those with limited means an opportunity to pay for their maintenance by working a few hours a day. It is expected that a few patients can be received in the spring of 1905. The funds for the work of the Association are derived en- tirely from voluntary contributions. Over three hundred and fifty men and women of Wisconsin are enrolled as members. This is a charitable enterprise ; none of the officers receives any pay and all the gifts are used to improve the land. Inquiries should be addressed to Dr. W. P. Roberts, Field Secretary, Janesville. CANADA BRITISH COLUMBIA. A Provincial Sanatorium is projected. It is hoped that work may be begun during the course of the year. MANITOBA. A Provincial Sanatorium, to be built in the vicinity of Winnipeg, is projected, but no action has yet been taken by the legislature. 139 CANADA NOVA SCOTIA. ProvinciaIv Sanatorium (now building) : For early cases of pulmonary tuberculosis. Capacity: i8. A site has been secured at Kentville, on a bluff 250 feet above sea level, and open to the south and southwest. The first build- ing will be two stories high and will contain 18 rooms for patients, general rooms, sun-parlors, apartments for officers and staff. It is hoped that it will be ready for occupancy this summer. The sanatorium will be supported by the provincial and municipal governments. Inquiries should be addressed to Dr. George L. Sinclair, 25 Tobin Street, Halifax. Woh^vih'LZ Highlands Sanatorium (May, 1902) : Exclusively for early cases of tuberculosis. Capacity : 8. Terms : $8 per week ; but when an applicant is not able to pay he is received free of charge if there is a vacancy. Medical Director : G. E. De Witt, M. D. The sanatorium consists of two cottages, connected bv a solarium, and supplied on the west, north and south with verandas, some of which are enclosed. It is on the Wolfville Ridge, a spur of the South Mountain, and has an altitude of 300 feet. Application should be made to Dr. G. E. De Witt. 140 CANADA ONTARIO. MusKOKA Cottage Sanatorium, Gravenhurst (1897) : Primarily for early cases of pulmonary tuberculosis, but those moderately advanced are admitted if they have a fair chance for recovery. Capacity : 75 in winter, 85 in summer. Terms : $12 and $15 per week. Physician in charge: J. H. Elliott, M. B. The sanatorium was established through gifts from indi- viduals and from the town of Gravenhurst. Funds for mainte- nance are supplied by the fees from patients and a small grant of $2,000 from the provincial government. It is situated in a wooded park of 50 acres, sheltered on the north and northwest by rocky ridges and pine forests. Toward the south and southwest it overlooks the southern arm of Lake Muskoka. The district is rocky ; the soil porous and dry. The mean relative humidity is 70 to 75 and the mean annual tempera- ture is 42 degrees. There is a central building which contains, besides the offices, reception and dining-rooms, and three solaria, accommodations for 27 patients ; the other buildings are five cottages, with an aggregate of 28 beds, and ten roofed tents for two patients each. The buildings face southwest, are lighted by electricity and heated by steam and hot water. The interior finish is hard wood, with rounded corners. The walls are either cement plaster or are painted. Both Muskoka Cottage Sanatorium and the Free Hospital at Gravenhurst were established by and are under the direction of the National Sanitarium Association. Application should be made to the Physician in charge or to J. S. Robertson. Secretary, National Sanitarium Association, IMail Building, Toronto. 141 MusKOKA Cottage Sanatorium. Cottage Tent, Muskoka Cottage Sanatorium. CANADA MusKOKA Free Hospital for Consumptives, Gravenhurst (April, 1902) : . For persons in the early stages of consumption who are unable to pay for sanatorium treatment. Capacity : 75. Treatment is entirely free to those who cannot afford to pay ; any contribution that a patient is able to make is accepted, but this is rarely more than three or four dollars a week. Physician in charge : Charles Daniel Parfitt, M. D. This, the second institution established by the National Sanitarium Association, has the same advantages of climate and general situation as the Muskoka Cottage Sanatorium. Its most important source of income is voluntary contributions ; it is subsidized by the provincial government to the amount of &1.50 per week for each patient; subscriptions are made by patients and municipalities ; and there is a small endowment. The administration building has room for 47 patients ; there are four roofed tents for four patients each ; and a pavilion for twelve. The lighting is by electricity, the heating by steam and hot water. Patients who are considered physically able have been given light work to do, either in the house or out of doors. It has been the aim to give work to graduate patients, who, being unable to remain longer as patients, are thus enabled to prolong their life under sanatorium conditions, and at the same time become self-supporting. A small poultry-breeding plant has been started, and it is proposed to keep pigs and start a vegetable garden as soon as funds are available. Application should be made to J. S. Robertson, Secretary, National Sanitarium Association, Mail Building, Toronto. 143 "^ Main Building, Muskoka Free Hospital. The Veranda, Muskoka Free Hospital. CANADA Toronto Frke Hospital for Consumptive Poor, four miles from Toronto, on the Weston Trolley Road (September, 1904) : Especially for advanced cases, but patients in earlier stages will not be refused. Capacity : 50 at present ; to be increased to 100. There is no charge for patients who cannot afford to pay. Resident Physician : Dr. Allan Adams, B. A. Forty acres of wooded land on the bank of. the Humber River are the site of this new hospital. The management is in the hands of a Trust Board, of which the chairman is Mr. W. j. Gage, to whom the National Sanitarium Association, with its two Muskoka institutions, largely owes its existence and growth. The buildings include an administration building, pavilions, and roofed tents. It will be supported mainly by voluntary contributions. Application should be made to J. S. Robertson, Secretary to Trust, Mail Building, Toronto. QUEBEC A Provincial Sanatorium, for early cases only, is pro- jected. A grant of 500 acres of land, in Trembling Mountain Park, has been made by the Government to the Montreal League, for the erection of the necessary buildings. The Park of which this land is a part is a natural preserve of 100,000 acres, enclosing many lakes and mountains. The site of the projected sanatorium is at the entrance to the Park. LahIv Ghur, Ste. Agathe des Monts (1901) : For early cases of pulmonary tuberculosis. Capacity: 16. Terms : $14 per week. Physician in charge : Howard D. Kemp, M. D. Lahl Ghur, The Red House, is a private sanatorium, situ- ated at Ste. Agathe, on a gentle slope, at an elevation of about 1,300 feet. The buildings, facing south, are three semi-detached cottages, with a central dining-room and sitting rooms. There are electric lights throughout, hot and cold baths, hot water heating, and long distance telephones. Veranda life is provided for throughout the year. Application should be made to Dr. Howard D. Kemp. 145 Toronto Free Hospital. Part II SPECIAL DISPENSARIES I.— THE FUNCTION OF SPECIAL DISPENSA- RIES AND IMPORTANT FEATURES IN THEIR ORGANIZATION EDWARD O. OTIS SUPERINTENDENT OP THE BOSTON DISPENSARY DISPEXSARIES FOR TUBERCULOSIS Dispensaries exclusively devoted to the treatment and care of tuberculous patients are of recent origin, one of the first having been established by Calmette, of Lille, France, whose work and aims still stand as a model and inspiration to those contemplating similar enterprises. Since that time many such establishments have sprung up on the continent of Europe as well as in this country. There are various conceptions of what an anti-tuberculosis dispensary should be. All, however, are agreed that its scope should be wider than that of an ordinary clinic or out-patient department. The majority of such institutions on the continent are independent establishments and occupy separate buildings, while in England the consumptive hospitals have out-patient departments which may be considered, in a general sense, to be tuberculosis dispensaries. Heretofore, in this country at least, it has always been the custom, and for the most part is now, to treat tuberculous patients in the general medical clinics, and only from a medical standpoint. They were examined more or less thoroughly and prescribed for, the attention devoted to them depending on the interest of the physician in the patient and his disease and the time at his command. It is obvious that, in a large medical clinic, a tuberculous patient could receive but scant attention. With the great interest and activity in the relief and control of tuberculosis now existing, and the recognition of what can be accomplished in the way of prevention and the curability of the disease, every additional measure calculated to further these objects is to be commended, and from what it has already accom- plished in the short time of its existence the anti-tuberculosis dis- pensary has proved itself to be an exceedingly valuable addition to one's armamentarium in the tuberculosis warfare, and has abundantly justified its existence. The role of the anti-tuberculosis dispensary, as formulated by the French, is threefold : prophylactic, therapeutic and social ; under social being included material aid to the poor consump- tive on the one hand, and protection of the public from the 149 SPECIAL DISPENSARIES disease on the other. By instruction of the patient as to the proper disposal of his sputum and in regard to disinfection, by showing in simple language how to avoid contracting the dis- ease, that it is curable, and in what way, one fulfils the prophy- lactic role. The therapeutic role is fulfilled by the more directly medical treatment of the patient, the diagnosis, prognosis, and the prescription of any drug that is considered necessary. The social role comprises personal investigation of the patient and his home by a special visitor or trained nurses, providing proper food when necessary, and in other ways supplying the material wants of the patient as the emergency of the special case demands. This latter role — the social — is carried out, at least in this country, by associations already established in a number of cities for the prevention, relief and control of tuberculosis, and such associations work in close touch with the anti-tuberculosis dis- pensary. Further, they assist the patient in being admitted to the sanatorium when the case is a curable one, or mto a con- sumptives' hospital when it is too far advanced to enter a sana- torium ; and, through the instrumentality of the board of health, when a patient becomes a menace to the other members of his household, they see that he is removed to some institution. There are advantages in having a tuberculosis clinic under the same roof with a general dispensary, as well as in devoting a special building to it as is done in France and elsewhere. In tlie former case it is easier, for instance, to refer to other depart- ments for advice and examination, to the laryngological, the X-ray, or general medical department, for example ; and other departments can, in their turn, refer cases to the tuberculosis room for an opinion or examination. The expense, moreover, is far less, for this is under the same administration with the other clinics, and all the machinery of the general dispensary can be utilized, so that to establish a tuberculosis department in an already existing dispensary a staff of physicians has only to be appointed and one or several rooms set apart for the purpose. snd even a 'single room can be made to do. House visitation through a special visitor or district nurses can as well be conducted from a department of this kind as from a special establishment. Such is the plan of operation at the Boston dispensary, and it has worked successfully. On the other hand, a separate establishment emphasizes the 150 SPECIAT. DISPENSARIES importance of the cure and control of the disease, and lends dignity to the work. Moreover, larger facilities can be afforded in increased room, and the construction of the building can be especially directed to the treatment of this one disease. Ventila- tion, disinfection, special methods of treatment, can all receive careful consideration ; more ample facilities for laboratory work can also be offered in the way of animal experimentation, bacteriology, and other lines of special research. In such a build- ing an ofifice for the visitor or district nurse would find a place. Another room might be devoted to the exhibition of various material bearing upon the causes, prevention and cure of tuber- culosis, such as photographs of unsanitary tenement-houses and bed-rooms, statistics graphically illustrated, methods of obtain- ing fresh air and devices for utilizing existing conditions for the same, models of tents, photographs of sanatoriums, and very many other exhibits, as will readily suggest themselves. In a large city one or more special tuberculosis dispensaries on this extensive scale might become of inestimable value as a great anti-tuberculosis center. The simplest equipment of the tuberculosis dispensary should consist of a separate waiting-room and receiving or consulting- room v/here histories are taken, together with the pulse, tempera- ture, respiration and weight ; several small examining rooms ; a small room for the examination of the sputum and other bacteriological investigations ; a dark room for laryngoscopic examination, unless a throat department exists in the same build- ing ; and, possibly, an X-ray room. Rooms should be well ventilated and periodically disinfected. . Circumstances would determine the arrangement of the personnel of the staff', but as the careful examination of the consumptive requires consider- able time, there should at least be several skilled assistants while the clinic is going on. To formulate the objects of such a dispensary my own ex- perience and thought would suggest the following: (i) As complete an investigation of the patient as possible, including history, physical and bacteriological examination, and when the diagnosis is doubtful, the tuberculin test and an X-ray examination. (2) Investigation of the patient and his surroundings at his home, including the hygienic condition of his domicile. (3) Instruction both of the patient and his household in 151 SPECIAI. DISPENSARIES personal and domiciliary hygiene, and the safe disposal of the sputum. (4j The free supply to poor patients of pocket and house spittoons. (5 J Securing entrajice into sanatoriums for curable cases, and into consumptives" hospitals for incurable ones when they can- not be properly treated at home ; or, when neither is possible, to treat the patient at his home as well as the conditions will permit. {6) Aiding poor patients to obtain suitable food and other articles necessary for their proper care. (7) Affording opportunity to physicians to send their poor patients for diagnosis when desired as well as advice and assistance in treatment. (8) The examination and oversight of patients who have returned from sanatoria. (9) Opportunity for the scientific investigation and study of tuberculosis and various methods of treatment. (10) Clinical instruction to students and physicians in the examination of tuberculous patients. Of course, as has been mentioned above, some of these objects are already fulfilled b}^ tlie existing associations for the relief and control of tuberculosis. They investigate the patient and his home ; the}' supply him with food and other needed articles, and obtain mone}' with which to send him to a sana- torium or hospital. And the association of this nature in Bos- ton, at least, is proposing to investigate and look after those patients discharged from the state hospital for consumptives at Rutland. After an experience of several years with such a clinic, the writer is profoundly impressed with the great good that can be accomplished by it, and believes that the time will come when entirely separate establishments of this kind will be founded in every large city and that they will play no insignificant part in the general crusade against consumption. Edward O. Otis. 152 II.— SPECIAL DISPENSARIES IN THE UNITED STATES Arranged in alphabetical order, according to cities. BALTIMORE, BOSTON, CHICAGO BALTIMORE, Maryland. Out-Patient Department, Johns Hopkins Hospital, Xorth Broadway : A new building devoted to the tuberculosis work of the out-patient department has been made possible by a gift of S20,ooo from Henry Phipps, of Pittsburgh. The plans for this building contemplate a class room and small examining rooms en the first floor, with a library and special work rooms above. A special medical officer will be detailed for service, and a nurse to look after the patients in their homes. BOSTON, Massachusetts. Tup.KRCULOsis Clinic, Boston Dispensary, Bennet and Ash Streets : Every day, 9-1 1 A. M. Physician in charge : Edward O. Otis, M. D. There are no charges. Children and adults are treated in separate classes. There are no nurses especially for consumptives, but the fourteen dis- trict nurses visit such cases as w^ell as other patients. Dr. Otis has three assistants in the Tuberculosis Clinic, and there are district physicians to treat patients not able to go to the dis- pensary. Printed instructions are given to patients and it is planned to supply sputum cups for use at home. Of the 29,438 new patients in the dispensary last year 275 were treated in the Tuberculosis Clinic. CHICAGO, Illinois. Dispensaries oe the Committee on the Prevention oi? Tuberculosis oe the Visiting Nurse Association OF Chicago (1903) : Central Office: 1414 Unity Building, 79 Dearborn Street. ]\Iedical Director: Arnold C. Klebs, M. D. ; Assistant Secretary, Caroline Hedger, M. D. There is a physician in charge of each district office, a general consulting stafif of seventeen members, and nineteen nurses for visiting the homes. Advice is free. The Tuberculosis Committee has established, in co-operation with the Bureau of Charities, a special district service for poor tuberculosis patients. In the district offices of the Bureau of 155 CHICAGO Charities rooms are set aside and utilized by the district physi- cians as consultation offices. Every case of manifest or sus- pected tuberculosis coming to the notice of the committee or the lelief agencies associated with it is referred to the office of the district in which he resides. Then the patient is visited at home by either a charity worker or one of the district nurses, for the purpose of ascertaining the patient's condition and that of his home, of which a report is made to the district physician. The patient is also instructed as to sputum disposal, general hygiene and similar matters. All patients able to be out of bed are then sent to the district office, where at fixed hours they are seen by the physician in charge, who examines and advises them. He also visits bed-ridden patients in their homes and directs the nurses as to special requirements. He reports each case and makes recommendations to the central office in regard to removal to hospital, transportation, disinfection, supplies and relief. The intention of the committee is primarily to educate, through trained assistants, the patients and their families, and in this way to improve insanitary conditions in the homes. The treatment of patients is undertaken only on general lines (open- air, over-feeding and specific hygienic directions) ; for special treatment patients are referred to other dispensaries. In the education of patients and their families preference is given to repeated personal interviews rather than to printed circulars. Over 400 patients were treated in this way during the first eight months after the establishment of the system. The addresses of the district offices are as follows : Central District, 1500 Wabash Avenue. South Central District, 291 East Thirty-first Street. Stock Yards District, 716 West Forty-seventh Place. Woodlawn District, 337 East Sixty-third Street. Englewood District, 333 West Sixty-third Street. West Side District, 181 West Madison Street. Northwestern District, 1235 Milwaukee Avenue. Ravenswood District, Foster Avenue and E. Ravenswood Park. North Shore District, Foster Avenue and E. Ravenswood Park. Northern District, 1140 North Halsted Street. Lower North District, 365 Wells Street. Southwest District, 946 South Ashland Avenue. 156 CT^EVliLAND CLEVELAND, Ohio. TuBivRCULOSis Dispensary, Wh;stern Resi:rve Medicai. College, corner St. Clair and Erie Streets (August, 1904) : Daily, 3 to 6 p. m. Physicians in charge : Drs. T. H. Lowman, G. W. Moore- house, T. B. Austin. Advice is free; a prescription fee of 10 cents is charged when medicines are needed. The entire time of one nurse is available for visiting patients in their homes, and part of the time of several others. Sputum cups and pocket flasks are supplied, and printed as well as oral instructions are given. 157 MINNEAPOLIS MINNEAPOLIS, Minnesota. Clinic for the Tuberculous Poor, Medical Department of Hamline University, Fifth Street and Seventh Avenue, South (April, 1904) : Monday and Thursday : i to 2 p. m. Physicians in charge : F. T. Poehler, M. D., and C. H. Bradley, M. D. There are no charges. By co-operation with the Tuberculosis Department of the Associated Charities it is possible to send a nurse to the home. Printed instructions are supplied and sputum receptacles for the pocket and for use at home. Twenty patients were treated in the special clinic in the first six months of its existence. Free Dispensary Eor Tuberculosis, University of Minne- sota (organized September, 1903; opened January, 1904) : 18 10 South Washington Street. Monday, Wednesday, Thursday and Saturday, 12 to I p. M. A committee of five physicians is in charge, of which Henry L. Ulrich, M. D., is chairman. There are no charges. In the first ten months of the special clinic for tuberculosis fifty patients were treated. By co-operation with the Tubercu- losis Department of the Associated Charities, sputum cups and printed instructions are provided and a nurse is available for visiting patients in their homes. The Associated Charities, in turn, can secure from this dispensary an expert diagnosis in all doubtful cases coming to their attention. There is a well- equipped laboratory for bacteriological and experimental work. In addition to the usual clinical history of the patients informa- tion in regard to their social and industrial conditions is recorded. 158 JTONTREAL. XEW HAVEX MONTREAL, Canada. A Special Dispensary for the treatment of tuberculosis was opened on Xovember 2, 1904, by the Montreal League for the Prevention of Tuberculosis (see page 254) at 691 Dorches- ter Street. Three physicians are in attendance. Foods, as well as medicines, will be supplied free of charge, and visits will be made to the patients in their homes. NEW HAVEN, Connecticut. Tuberculosis Clinic, New Haven Dispensary: Tuesday, 3 p. m. Physician in charge : H. ]Merriman Steele, M. D. There is no charge for advice. The special clinic was established in the fall of 1903. Printed instructions are given to patients and sputum cups are provided. There is as yet no visiting nurse, but it is planned to develop the department as rapidly as possible, until it shall include all the features recognized as desirable. 159 NKW YORK NEW YORK CITY, New York. Clinic of the Department of Health for the Treat- ment OF Pulmonary Diseases (March, 1904) : 967 Sixth Avenue. Director: Hermann M. Biggs, M. D. Associate Directors : J. S. BilHngs, Jr., M. D., and S. A. Knopf, M. D. Daily, except Sunday: 10 to 12 a. m. and 2 to 4 p. m. ; Monday, Wednesday and Friday, also 8 to 10 p. m. Advice and medicine are free. The Municipal Clinic is housed in a new building especially designed for the purpose, adjoining the headquarters of the Department. The building contains a registration room, drug room, two waiting rooms, an X-ra}^ room, throat department, and two clinic rooms, for male and female patients, respectively, each with its examination room. Physical examination, repeated sputum examinations and, when required. X-ray examination, may all be used in making the diagnosis, in order to guard against missing incipient cases. Instructions, both verbal and by means of circulars printed in nine or ten languages, are given as to the nature of the disease, and the necessary personal and hygienic precautions to be taken to prevent the infection of others. Paper sputum cups are supplied to needy cases. A special staff of trained nurses visits the patients at their homes to see that the instruc- tions are being observed, that the sanitary surroundings are satisfactory, and that such assistance is given as is required. Suitable cases are referred to charitable organizations for as- sistance. Every effort is made to prevent the infection of the children in the family and to bring about the removal tO' hospi- tals or sanatoriums of the dispensary patients who require such care. Double reference cards, one-half to be filled out and given to the patient, the other to be sent to the Department of Health bearing the patient's name and address, are furnished to physi- cians, charitable organizations, or any one else who has occasion to use them. If the patient does not report within a given time he is visited from the dispensary. The number of patients seen between the opening of the Clinic, March i, and September 15, was 1,837. 160 Tent at Bellevue, Showing Proximity TO River. Patient from the Bellevue Clinic on Fire Escape. NEW YORK Out-Patiknt Department of BeeeEvue Hospital (December, 1903) : Foot of East Twenty-sixth Street. Special clinic for tuberculosis, daily except Sunday,. from I to 4 p. M. Director: James Alexander Miller, M. D. Attending Physicians : Haven Emerson, M. D. ; Frederick L. Keyes, M. D. ; Wm. S. Cherry, M. D. ; F. Grosvenor Goodridge, M. D. Nurse in charge : Miss Annie Damer. The proper regulation of the home conditions is especially emphasized. Two visiting nurses are attached to the clinic and close co-operation with the physicians and with relief societies is obtained. Milk and eggs are given, as a part of the treatment, after thorough investigation has established the need of such assistance. Printed instructions and sputum cups are dis- tributed. In some instances reclining chairs and sleeping bags are given for open-air treatment on the roofs and fire-escapes. Tent cottages have been erected upon the hospital grounds for favorable cases who cannot obtain suitable sanatorium or home treatment. About fifty new cases are received each month. The total number of cases treated since the opening of the clinic (ten months) is 440. The accompanying illustrations of devices resorted to by the director of the special clinic at Bellevue first appeared in connection with an article by Dr. Brannan in the Medical hlews of September 24, 1904. GouvERNEuR Dispensary, Gouverneur Slip, New York City (October, 1903) : Special class for tuberculous patients. Monday, Wednesday and Friday, 11 to i. Clinical assistants in charge of tuberculosis work ; Stella S. Bradford, M. D., and N. Gilbert Seymour, M. D. There are no charges for treatment. During the first five months of this special class the average number of patients per month was 13. During September, 1904, 85 patients were treated, 30 of whom were new. Simple verbal advice is given. Sputum cups are supplied for use at home. Since June the work in the clinic has been supplemented by the services of a visiting nurse. 162 Patient from the Bellevue Clinic in Extension Chair on Roof. Patient from the Bellevue Clinic in Hammock on Roof. Ni:w YORK Harlsm Hospital Dispe^nsary (August, 1904) : Foot of East 1 20th Street. Monday, Wednesday and Friday, 3 p. m. Physician in charge: Charles H. Moak, M. D. There are no charges. The special class here has just been started, and the organiza- tion is not yet complete. Verbal instructions only are given, and there is no arrangement for visiting patients in their homes. In the first six weeks after the opening of the special clinic about fifty tuberculous patients were treated. Post-Graduate Hospitat DispiJnsary: Dr. Russell's Class, Room 4. Daily : 7 to 8.30 a. m. and 7 to 8 p. m. ; patients reporting for the first time should go at the evening hour. Medicine and advice are free. Dr. Russell accepts for treatment adults in any stage of pulmonary tuberculosis, provided it is imcomplicated with any other disease, and provided the patients are able to go to the dispensary twice a day and to secure suitable food, clothing and shelter. During 1903 there were treated in this class 74 cases ; in the first nine months of 1904, 62. The treatment consists largely of careful questioning and advice in regard to food, sleep, and general habits of life. The Russell Emulsion of mixed fats is administered at the dispensary. Each patient is required to report at the dispensary twice each day, and the hours are arranged for the convenience of working men and women. Irregularity of attendance or failure to obey directions is followed by dismissal from the class. Physicians of the city are invited to send suitable cases and to visit the class any' Sunday morning at nine. Reports of the results obtained are published annually in the Post-Graduate Journal, by a committee of inspection appointed by the Executive Committee of the Post-Graduate Medical School for the purpose of reviewing Dr. Russell's work. An annex to the Dispensary has just been added, in the shape of a small hospital for twelve patients in the advanced stages of the disease. The hospital is at 322 East Nineteenth Street. 164 NKW YORK, ORANGE The Prksbyterian Hospital Dispensary, Madison Ave- nue and 70th Street : Daily, except Sunday and legal holidays, 1.30 to 3 p. m. Eight physicians are in charge. Ten cents is collected for each prescription from those able to pay ; otherwise no charge is made. Children and adults are treated in separate classes. There are three nurses who visit patients in their homes. Printed in- structions are distributed and sputum cups are supplied. Dur- ing 1903 the total number of patients treated for tuberculosis was 410. A'andercilt Clinic (January, 1903), Amsterdam Avenue and Sixtieth Street : There is no special department for tuberculous patients attending the Clinic, but for nearly two years a certain number of them have been given special attention. The work was begun by Dr. J. A. Miller, now in charge of the Tuberculosis Classes in the Out-Patient Department of Bellevue, in January of 1903, and it is now being carried on by Dr. Linsly R. AMlliams, under the supervision of Prof. James of the Depart- ment of ^Medicine. Patients are given verbal and printed instructions about the care of sputum and they also receive advice as to diet and hygiene. Sputum pouches are supplied. A special record of their clinical history is kept and a report of the home and linancial conditions. All patients in Manhattan are visited and further instructed by a nurse supplied by the Presbyterian Hospital. Patients from other boroughs are visited by the Board of Health nurses. Between February i, 1904, and the end of October 415 new cases were treated, of whom 125 were under care at the latter date. ORANGE, New Jersey. Tuberculosis Department, Orange Memorial Hospital Dispensary (April, 1904), 224 Essex Avenue: Daily, 12 to i p. m. Chief of the Clinic : Henry A. Pulsford, M. D. Those who can afford to do so pay ten cents at their first visit : there are no other charges. The special clinic was organized April 1, 1904. One visiting nurse is attached to this department and printed instructions are distributed to patients. 165 PHII.ADELPHIA, PROVIDENCE PHILADELPHIA, Pennsylvania. The Henry Phipps Institute maintains a free clinic at 238 Pine Street. (See page 249.) Rush Hospital Dispensary, Lancaster Avenue and 33d Street : Daily : 2.30 p. m. Physicians in charge : John D. McLean, M. D. ; Charles A. E. Codman, M. D. ; Ross K. Skillern, M. D. Advice is free. There is no provision for visiting the homes or for exercis- ing any further influence on the patients after they have left the dispensary. About 500 patients were treated last year, PROVIDENCE, Rhode Island. Out-Patient Department oe Pulmonary Tuberculosis OE THE Rhode Island Hospital (Jnly, 1900) : Monday and Thursday : 9 a, m. Physician in charge: Jay Perkins, M. D. ; assistant phy- sician, Pearl Williams, M. D, Advice is free, A special clinic for tuberculosis was established July i, 1900. In the year ending September 30, 1903, the patients examined or treated for tuberculosis numbered 1,337, of whom 1,074 were old patients, 263 new. Three nurses, employed by the Providence District Nursing Association, visit the homes, as requested. Printed instructions and sputum cups are supplied. All patients applying in the other departments of the dis- pensary are referred here when they show anv indications of tuberculosis. The chief difficulties encountered are the lack of provision for patients needing sanatorium or hospital treatment, and the securing of proper nourishment at home. 166 SCRANTON, WASHINGTON, WORCESTER SCRANTON, Pennsylvania. Free Dispensary for Diseases of the Lungs, 207 Linden Street (January, 1903) : Wednesday and Saturday : 7 to 9 p. m. Advice is free. In charge of four physicians and conducted by the Scran- ton Society for the Prevention and Cure of Consump- tion. About one-third of the patients last year were treated for tuberculosis. Printed instructions are given to patients, sputum cups are supplied, and a nurse visits those who need special care. "Of the fifty-three consumptives" (treated in 1903), reads the first annual report of the society, "it is probable that nearly all have been so taught that they will not spread the disease to others." WASHINGTON, District of Columbia. A Free Dispensary for the examination and treatment of those who are suffering from tuberculosis or suspect that they may have contracted it has been opened by the Associated Charities' Committee on the Prevention of Consumption, at 605 Four-and-Half Street, S. W. WORCESTER, Massachusetts. TuBERCUEOsis Ceinic, Out-Patient Department, City Hospital (January i, 1904) : Wednesday and Saturday : 9 to 10 a. m. Physician in charge : Albert C. Getchell, M. D. There is no charge for advice. Special diet when the patient is unable to procure it for him- self, and whatever care in the home is indispensable, are pro- vided by co-operation with the Associated Charities, the District Nurse Association and the Worcester Association for the Relief and Control of Tuberculosis. A small card folder of "rules for consumptives" is given to patients and sputum cups are supplied for use at home. Residents of Worcester County who desire admittance to the State Sanatorium are examined here. The number of patients treated in the Tuberculosis Clinic, in the first nine months after it was opened, was 46. 167 Part III THE TUBERCULOUS INSANE I.— TENT TREATMENT FOR TUBERCULOUS INSANE A. E. MACDONALD, LL.B,, M.D. MEDICAL SUPERINTENDENT, MANHATTAN STATE HOSPITAL, EAST. TEXT TREATMENT FOR THE TUBERCULOUS INSANE \The illustrations which accompany this article are from the Annual Report for 1903 of the Manhattan btate Hospital, East, the use of the original plates having been kindly accorded by the General Manager of the State Printer's Office, Mr. Charles M. Winchester, Jr.) That consumptive insane patients may be kept, and treated, to their advantage and incidentally to the advantage of their fellow-inmates, in canvas tents, and throughout the several sea- sons of the year, has been demonstrated in the recent history of the Alanhattan State Hospital, East. The experiment upon the success of which this claim is advanced has, at the date of this writing, September 30, 1904, covered a period of forty months, the camp having been first established and occupied by patients on June 5, 1901. The serious problem of caring for this class of patients had, prior to that date, embarrassed this particular hospital with others, and with added seriousness from the fact that insane men had to be dealt with, and that the form of construction of the hospital buildings was such that no smaller wards or sections, adaptable to necessary isolation, were available. In all hospitals for the insane the form of insanitv properly constitutes the pre- vailing basis for classification, modified, of course, b_y such sec- ondary considerations as the patient's physical condition, pro- gress toward recovery or the reverse, and other elements. To set up another standard — the presence of a bodily diseased con- dition — and to assemble all patients suffering from it, without regard to any associated conditions or circumstances, is a dif- ficult undertaking, involving, among other departures from routine practice, the association of disturbed and dangerous with demented and harmless patients, and so on through all the inter- mediate degrees. This, too, has been accomplished, and with unexpected ease and success. ]\Iy first intention and expectation were that, by possibility, the consumptive insane patients, or a majority of them, might be removed from contact with their fellows for some months, perhaps as many as five months, during the milder season of the year, with the attendant advantage of freeing, for the time being, 171 TUBERCULOUS INSANE corresponding space in the permanent buildings, and affording opportunity for disinfection and renovation. Study was made of the arrangement of hospital tents and accessories in the exhibit by the United States Army Hospital Corps at the Pan-American Exposition then in progress at Buf- falo, and visits were made, for the same purpose, to army posts in the vicinity of New York City. The camp first established consisted of two large dormitory tents — twenty by forty feet — each containing twenty beds, with smaller tents of different shapes, about ten by ten feet, for the accommodation of the nurses, the care of hospital stores, pantries and a dining-tent for such patients as were able to leave their beds and tents, and go to the table for their meals. Running water was secured by means of underground pipes, and the safe disposition of waste and sewage was also specially provided for. As has been said, it was expected to continue the camp only through the summer and as far into the autumn as favorable weather might render justifiable. But when in the late autumn it was found that the favorable experience continued, it was de- cided to attempt to carry the experiment, on a modified scale, into, or even through, the approaching winter. The Camp, as first established, had been placed upon an elevated knoll adjacent to the river side and purposely exposed to the full force of the summer breezes. For the winter experiment its site was re- moved to the center of the island, where trees and buildings interposed to act as a wind-break to the severe storms from the east and northeast which are tO' be expected in that locality. The number of patients was reduced to twenty, those in whom the disease was most active being retained and the others being returned, for the time being, and much against their will, to the buildings. One large tent sufliiced for the housing at night of the reduced number of patients, and one was set apart as a sitting-room for day use, with the accessory tents before men- tioned,' and large stoves were placed in them, here and there, with wire screens surrounding them to protect the patients, and a liberal use of asbestos and other fireproof material and arrangements for the prevention of fire. Better resistance to the force of the expected gales was secured by stronger and more numerous guy-ropes and anchorages, and slatted wooden mova- ble pathways were prepared which might furnish means of pas- sage between the tents when snow and slush should come. Thus 173 TUBERCULOUS INSANE equipped the coming of midwinter was awaited with the ex- pectation that the twenty survivors must sooner or later follow their fellows into the shelter of the permanent buildings, and with every preparation made for immediate evacuation and re- treat. The most sanguine hope did not go beyond this point. As the weeks passed, however, and the patients continued com- fortable, evacuation was deferred until a severe storm occurred. Then it was found that, in spite of high wind and snow, a more equable temperature had been maintained and less discomfort caused in the tents than in the hospital wards most exposed to the force of the gale. From that experience, followed by other confirmatory ones, resulted the reconsideration of the design to evacuate the Camp. To make a long story short, it has remained in continuous use, not only throughout the first winter, but through the two succeeding winters and intervening seasons, up to the date of the present writing. The scope of its employment has been gradu- ally enlarged until all patients in whom there are active mani- festations of phthisical processes — an average of forty-three out of a total census of about two thousand — are isolated therein, and there has been parallel enlargement of the elements of the plant. While not properly coming within the scope of this writing, it may not be out of place to make brief mention of the fact that the success of the first established Camp — that for the tubercu- lous insane — has led to the extension of the tent treatment for the insane, at this hospital, to several other classes of patients. Following the experiences and results of the first winter, as above summarized, the tuberculosis Camp was in the spring re- enlarged to its full capacity, and has remained in full use ever since, so that every patient showing the least activity of symp- toms is not only afforded for himself the advantage of the outdoor treatment, but is removed from possible danger of in- jurious influence upon his neighbors. Each year also an addi- tional camp for another class of the insane has been put in com- mission : one in 1901, Camp "B," for demented and uncleanly men, many of them bedridden, whose emancipation from the wards was a great gain, both for themselves and for the hospital conditions generally; one in 1902, Camp "C," for feeble and decrepit women, who were losing the benefits of outdoor life be- cause the high levels and long stairways of the buildings were a 175 TUBERCULOUS INSAXTv prohibition to egress and ingress ; one in 1903, Camp "D," for convalescing patients, and those mainly from among the work- ers in the printing office, the shoe shop, and the tailor shop^ so that they might enjoy, in .the non- working hours, and tspecially at night, the advantages of which their indoor em- plovments deprived them during the greater portion of the day ; and, lastly, one in 1904, Camp '■£,'' of forty beds, as an acces- sory to the acute hospital service, where patients for the most part confined to bed, and suffering from various concurrent dis- eases added to their insanity, find an agreeable and beneficial change from the ordinary surroundings of the hospital sick- room. In all, during the summer just past, and at this date, two hundred and sixty patients have been, and are. undergoing tent- treatment, an average of forty-three — all consumptives — re- maining in Camp "A" throughout the year, and the others as long as favorable weather continues. In 1903 Camp "B" con- t'nued in commission from Jime i to November 30, Camp "C^ from June i to October 15, Camp "D" from June i to Novem- ber 30. and Camp ■'■£''" was opened on July i, 1904, and. with the several others, is still f September 30) in use. It is not proposed to follow here in detail the history of the Camp for tuberculous patients. Neither the purpose of this communication nor the lim.itation as to space will permit of it, and the reader who may desire further information in that direc- tion must be referred to the annual printed reports of the hospi- tal, and to special articles by members of the hospital staff which have, from lime to time, appeared in the Journal of Insanity and other professional pviblications. It must suffice to summarize results. The isolation of the tuberculous patients has reduced to a minimum the danger of infection of other patients and of emplovees. The patients themselves have suffered no injury or hardship, but have, on the contrary, been unmistakably bene- fited. This is shown, among other ways, by a decrease in the death-rate from pulmonary tuberculosis, both absolute and rela- tive, and by a marked general increase in bodily weight, amount ing in the case of one patient to an actual doubling of weight — from eightv-three to one hundred and sixty-six pounds — in fourteen months of Camp residence. I prefer to advance these proofs, as they depend upon fig- f.res which are not capable of manipulation, rather than the usual percentage calculations of '"improvements,'' and especially 17G \ ^ -^ ^ t} ^.\ Pi < TUBKRCUIvOUS INSANE of "recoveries," which are for the most part notoriously unrelia- ble. Several patients whose mental improvement permitted of their absolute discharge have left the hospital with the pulmon- ary disease also, to all appearances, completely arrested. Others whose condition in the latter respect was similar have been re- turned, their insanity still continuing, from the tent to the ward, and after periods extending in individuals as long as two years, continue, as far as can be found upon most thorough investiga- tion, immune from reappearance of the disease. In other such cases again, but these are fewer in number, confinement to the wards has resulted in return of phthisical manifestations ; but even in this most unfavorable class the benefits of the outdoor system have been demonstrated, for invariably improvement has again speedily followed upon their prompt return to the Camp. Mental improvement has as a general rule been the concomitant of physical, not only among the patients in the Tuberculosis Camp, but also in the others, and in the former class this has been somewhat of an anomaly. My experience, and I think that of others, has been that when phthisis and insanity co-exist they are apt to alternate as to the prominence of their several mani- festations — the mental symptoms being more pronounced whilst the physical are in abeyance, and vice versa. Under the tent- treatment we have found a general disposition toward accord in the manifestations, improvement in both respects proceeding concurrently, and some of the discharges from the hospital which gave most satisfaction to us at the time, and most assur- ance for the patient's future, were of inmates of the Tuber- culosis Camp. The mental improvement, even in cases where recovery was not to be looked for, has been a gratifying feature of the Camp experiment, and depending largely, as it has, upon the patient's satisfaction with his new surroundings, has served to dispel one of the doubts with which the experiment was undertaken. It was apprehended that not only might the patients themselves resent their transfer, but that similar objection might come from their relatives and friends, since innovations, even progressive ones, are apt to be frowned upon by those who constitute the majority in the clientele of a public hospital in a cosmopolitan city. Even at the outset, however, the protests, whether from patients or their friends, were surprisingly few, and latterly they have been more apt to arise, if at all, over the patient's return to the buildings when that became necessary. Through- 178 w H o > Q > TUBERCULOUS INSANE out the winter months constant and anxious inquiries have been made, both by patients who had been in the non-tuberculosis camps and by their visitors, as to how early in the spring the former might expect to resume their camp life. The question of medication may in the present writing be dis- missed with a very brief reference. It has been found unneces- sary to extend it greatly, and it has been limited mainly to the treatment of symptoms. Stimulation — alcoholic and the like — has been found of but little demand or use, and the quantities consumed — always under individual medical prescription — have been insignificant. On the other hand the dietary has been made as liberal as the imposed restrictions of the State Hospital sched- ule have permitted, both in the way of regular diet and extras, and in the leading essentials — milk and eggs — private donations have supplemented the regular supply. But dependence, after all, has been mainly placed upon rigid isolation and disinfection, and upon the unlimited supply of fresh air. As an interesting incidental fact it may be mentioned that not only the patients, but also the nurses living in the Camp have enjoyed almost com- plete immunity from other pulmonarv diseases. Not a single case of pneumonia has developed in the Camp in its existence of over three years, though it caused 131 deaths in the hospital proper in that time. The "common colds" so frequent among their fellows living upon the wards, or in the Attendants' Home, have been unknown among the tent-dwellers. The popular idea that the consumptive is a doomed man un- less he can at once abandon home and family and business and betake himself to some remote region would seem to be nega- tived by our \\''ard*s Island experience. So also with the strenu- ous claims for high altitude. The Ward's Island Camp is but a few feet above the tide-water level, its site is swept in winter by winds of high velocity, coming over the ice-bound waters of the rivers and the sound which > surround it, and it suffers as much as, or more than, any other part of the city of New York from the trying changes of temperature and humidity which are so characteristic of its climate. If, in spite of all these drawbacks, what has been done can be done, and that for insane patients, what may not be hoped from the extension of the same methods to the ordinarv^ consumptive of sound mind, anxious for recovery, and capable of giving intelligent assistance in the struggle? A. E. Macdonaed, September 30, 1904. 180 II.— HOSPITALS FOR THE INSANE IN WHICH SPECIAL PROVISION IS MADE FOR CONSUMPTIVES Arranged in alphabetical order, according to states. HOSPITALS FOR THE; INSANEj CALIFORNIA Mendocino State Hospital for Insane, Talmage : Seven tents have just been erected tor the tuberculous patients. Three are for dormitories, accommodating fifteen patients, one is a sitting-room, one a kitchen, one a lavatory, and one is for attendants. Most of the food will be supplied from the main building, but a kitchen has been provided for the purpose of preparing the extra food that will be required. It is planned to keep patients in the tents throughout the winter. The Superintendent is E. W. King, M. D. DELAWARE State Hospital for the Insane, Farnhurst: In 1903 a separate building, with accommodations for twenty patients, was provided, exclusively for the tuberculous inmates of the institution. This is the first instance of the erection and equipment, by a state insane hospital, of a new building especially for this purpose. The construction cost was about $1,000 per bed. There is a sun parlor at each end of both floors, and the building is thoroughly equipped with modern apparatus. The Superintendent is William H. Hancker, M. D. DISTRICT OF COLUMBIA Government Hospital for the Insane, Washington : A separate building is used for the accommodation of twenty of the consumptive men in this hospital. The rest of the forty-five or fifty tuberculous patients are isolated in single rooms or small wards whenever this is possible. The Superintendent is William A. White, M. D. 183 Tuberculosis Building, Delaware State Hospital for THE Insane. HOSPITALS FOR THE INSANE LOUISIANA State Insane Asylum, Jackson : Two one-story pavilions for the white male and white female consumptives of this institution are nearly completed. The building for women will accommodate thirty-two patients ; the one for men, forty. Both are isolated and have been con- structed with special regard to thorough ventilation. The tuberculous patients will be kept entirely separate from the others ; they will have their own recreation grounds, will receive special treatment and diet, and will lead an out-of-door life as much of the time as possible. The Superintendent of the Insane Asylum is George A. B. Hays, M. D. MARYLAND Springeield State Hospital eor the Insane, Sykesville: For three years tuberculous patients have been kept in tents for about eight months during the year. On account of the high rate of improvement in the patients under this regime it is planned soon to extend the outdoor treatment throughout the year. The Superintendent is J. Clement Clark, M. D, MISSISSIPPI State Insane Hospital, Jackson : Separate buildings, accommodating about 40 patients, were set aside in 1897 for the consumptives of the institution. They are brick buildings two stories in height, located on elevated ground. The Superintendent is T. J. Mitchell, M. D. NEW YORK Manhattan State Hospital, East, Ward's Island (a state institution for the insane) New York City: Tuberculous cases are isolated in tents. In the winter of 1903-04 there were over forty patients treated in this way. The system of tent treatment was inaugurated in June, 1901, and each year it has been extended, either in time or in the number of patients included, until at present all the active cases of tuberculosis in the institution are kept in tents throughout the year. 185 HOSPITALS FOR THi: INSANE The colony is situated on sloping ground about 60 feet above sea level, and has a moderate amount of shade. The soil is dry and well drained, over a rock bottom. There are two tents, accommodating twenty beds each, 20 by 40 feet and 14 feet high, with the wall 6 feet high. A smaller square tent provides three beds for critical cases. Similar square tents serve as dining-rooms, while smaller ones are used for linen rooms, storerooms and bath rooms. It has been found that the tuberculous insane improve, under this system of care, both mentally and physically, and it has been adopted in other states. Since the retirement, on October i, of Dr. A. E. Macdonald, the acting superintendent has been J. T. W. Rowe, M. D. WiivivARD State; Hospitai, for the; Insane;, Willard, Se;ne;ca County : During the summer of 1903 life m a tent colony was tried for about fifty tuberculous men and women. Each of the two sets of tents included a dormitory for twenty or twenty-five pa- tients, a bathroom, a dining-room, and a small tent for storage. There was a telephone in each tent and running water. Here, as on Ward's Island, it was found that the patients liked their out- door life and gained in every way. The experiment lasted from early summer until extremely cold weather, and was repeated and extended in the summer of 1904. It is hoped to extend and develop the system until all the tuberculous patients can be kept out of doors practically throughout the year. The Superintendent is Robert M. Elliott, M. D. State Hospitals for the Insane, at MiddlETown^ Ogdens- burg and binghamton : The State Commission in Lunacy is planning the erection, within the present year, of a large pavilion in connection with each of these hospitals, for the special treatment of insane per- sons suffering from tuberculosis. They are designed to accom- modate 100 patients each, and are modelled after the plans awarded the first prize in the contest for plans for the King Edward Sanatorium in England. 186 o X w H the desirability of establishing a sanatorium for the treatment of the disease, with recommendations as to a site. Statistical data as to the prevalence and distribution of the disease in Wisconsin are being collected. A report showing the need of establishing a sanatorium is to be presented to the legis- lature. An eligible site for its location will be recommended by the Commission, after studying the conditions which should be considered in making such selection. Inquiries should be addressed to H. L. Russell, Secretary, University of Wisconsin, Madison. 252 CANADA CANADA TnK Canadian Association for the: Pri^vi^ntion of Con- sumption AND Other Forms of Tuberculosis (April, 1901) : Object: "To prevent the prevalence of consumption and other forms of tuberculosis in Canada : " ( I ) By enlisting the co-operation of the people general- ly with the medical profession, and by increasing the interest in means for lessening the ravages of the disease; "(2) By investigating into the prevalence of tuberculosis in Canada and by collecting and publishing use- ful information ; ''(3) By advocating the enactment of appropriate laws for the prevention of the disease ; "(4) By co-operating with governments and other organizations in measures adopted for the pre- vention of the disease ; ''(5) By promoting the organization and work of Pro- vincial Associations and their affiliation with the Canadian Association ; "(6) By encouraging all concerned to provide suitable accommodation for consumptives, in hospitals, sanatoria, and otherwise ; "(7) By such other methods as the Association may from time to time adopt." Since its organization the Association has put into circulation T. 250,000 pages of literature relating tO' the cause and prevention of tuberculosis, and lectures have been given by the secretary in about seventy-five towns and cities. Provincial associations, and associations in cities and towns located in provinces in which there is no general organization, are affiliated with the Canadian Association. The affiliated organizations include the Ontario League, the Montreal League, and the St. Francis District League, the Toronto Anti-Consumption League, and the British Columbia Association for the Prevention and Treatment of Consumption. It is planned to continue the work for all objects on an in- creasingly large scale, as the liberality of the government and of private contributors permits. Communications should be addressed to the secretary. Rev. William Moore, D. D., 128 Wellington Street, Ottawa, Ontario. 253 CANADA Thd British Columbia Society for the Prevention of Tuberculosis (Organized February, 1904) : Object : To secure the establishment of sanatoriums. Several local societies have been formed throughout the province, and appeals for support, both moral and financial, have been widely published. Communications should be addressed to Dr. C. J. Fagan, Secretary Provincial Board of Health, Victoria. The Montreal League for the Prevention of Tubercu- losis, 691 Dorchester Street (December, 1902) : Objects: To educate the public upon the most simple methods for preventing the ravages of tuberculosis ; to establish, as soon as possible, a home for the incura- ble cases of the disease, and a sanatorium or sana- toriums for the hopeful cases ; pending the establish- ment of these institutions, to care for indigent cases in their own homes, in co-operation with the city board of health ; to disinfect every house in which a death from tuberculosis has occurred. During the year ending June, 1904, 200 cases were cared for, 1,300 visits were paid by the inspector, 8,000 cuspidors were distributed, and 30 patients were supported at institutions and given various other forms of assistance. In the course of the seven months between March i and October i, 1904, 359 dis- mfections were made. Every house in which a death from tuberculosis occurs is visited and formalin disinfection is urged upon the occupant. In nearly all cases the advice is acted upon. A special dispensary for the treatment of tuberculosis has been opened (see page 159). It is to be hoped that shacks and barracks may soon be erected, near the city, where patients in all stages of the disease can be treated. Communications should be addressed to the Honorary Sec- retary, 691 Dorchester Street, ]\Iontreal. The District of St. Francis League for the Prevention OF Tuberculosis (Organized July, 1903) : Object : To prevent the spread of tuberculosis, by enlist- ing the co-operation of the public, by rendering assist- ance to indigent consumptives, and by promoting de- sirable legislation. 254 CAN MM Local societies have been formed in each city and town in the district, the chairman of each being a member of the execu- tive committee of the district league. A lecture tour of the district has been made by the secretary of the Canadian Asso- ciation, in the course of which io,ooo leaflets were distributed. Lectures have been given by physicians on Sunday afternoons in all of the churches and on week days to advanced classes in the public schools and colleges. As a preliminary step toward establishing a free dispensary for consumptives arrangements have been made for two phy- sicians to act as examining and treating physicians for two months at a time. These physicians give their services free to indigent patients. A laboratory is established, where sputum is examined, and where X-ray examinations are made. It is planned to secure the passage of an anti-expectoration law, and to arouse public sentiment for a sanatorium for the con- sumptives of the eastern townships of Quebec. Communications should be addressed to the secretary, Dr. E. J. Williams, Sherbrooke, Quebec. The Anti-Consumption League; of Toronto (1889) : Object : To secure a municipal sanatorium for the treat- ment of consumption. The efforts of this League have been devoted to arousing public interest in the establishment of a sanatorium. Through its efforts provincial legislation was secured in 1900 in the form of an act permitting any municipality to establish such a sana- torium and providing that grants may be made from the revenues of the province to the amount of $4,000 for construction and a per capita allowance of $1.50 per week for maintenance. The question of an appropriation of $50,000 by the city was submitted to the people in January, 1904, and approved by a majority of 403 votes, but the appropriation has not yet been made. The League continues its agitation. Communications should be addressed to E. J. Barrick, M. D., President, 60 Bond Street. 255 INDEX TO SANATORIUMS, HOSPITALS AND CAMPS, CLASSIFIED ACCORDING TO CLASS OF PATIENTS RECEIVED AND CHARGES, AND SUMMARY OF EXISTING PROVISIONS FOR THE TREATMENT AND THE PREVENTION OF TUBERCULOSIS IN THE UNITED STATES AND CANADA I K 33 E X . SANATORIUMS, HOSPITALS AND CAMPS, CLASSIFIED AC- ACCORDING TO CLASS OF PATIENTS RECEIVED AND CHARGES Some institutions are necessarily indexed in more than one class. ''Denotes a general hospital, with a separate building, tents, or wards, for tuberculosis. PAGE I. All Stages of pulmonary tuberculosis received. a. Free. I. Colorado : Jewish Consumptives' Relief Society, Denver. 35 *2. District of Columbia : Washington Asylum Hospital. ... 42 *3. Florida : Naval Hospital, Pensacola 42 *4. Hawaii: Home for Incurables, Honolulu 43 5. Illinois: Cook Co. Hospital for Consumptives, Dunning. 45 6. Indiana: St. Rochus Hospital, Ft. Wayne 46 7. Maryland: City Hospital for Consumptives, Baltimore. . 50 *8. Massachusetts: Almshouse and Hospital, Boston 57 9. " Channing Home, Boston 57 10. •' Free Home for Consumptives, Boston . . 59 *ii. " House of the Good Samaritan, Boston. . 59 *I2. " State Hospital, Tewkesbury 62 *I3. Michigan: Wayne County House, Eloise 64 *I4. Missouri: Emergency City Hospital No. 2, St. Louis. ... 67 15. New Me.xico: St. Joseph Sanatorium, Albuquerque 69 16. " " U. S. General Hospital, Ft. Bayard 71 17. " " Public Health and Marine Hospital Serv- ice Sanatorium, Ft. Stanton 72 18. New York: Home for Consum.ptives, Brooklyn 85 Kings County Hospital, Brooklyn 85 St. Peter's Hospital, Brooklyn 86 Erie County Consumption Hospital, Buffalo. 87 Westchester County Hospital, East View. . . 87 23. " " Tuberculosis Infirmary, New York City. .. . 94 24. " " Riverside Sanatorium , New York City 95 25. " " Seton Hospital, New York City 95 *26. " " Lincoln Hospital,^ New York City 98 27. Ohio: Branch Hospital for Consumptives, Cincinnati. . . 115 28. " Tuberculosis Sanatorium, Cleveland 115 *29. " Miami Valley Hospital, Dayton 117 *3o. Pennsylvania: General Hospital, Philadelphia 121 31. " Hospital for Diseases of the Lungs, Phila- delphia 121 32. Pennsylvania: House of Mercy, Philadelphia 122 33. " Lucien Moss Home, " 124 34. " Tuberculosis Hospital, Pittsburg 126 a. A few pay patients are received. 259 ■*i9. *20. 21. *22. PAGE *35. Rhode Island: State Almshouse, Howard 133 *36. Texas: Sisters' Hospital, El Paso 136 *37- Washington: King County Hospital, Seattle 137 b. Charges not more Ihan^io per week. 1. California: The Settlement,'^ Redlands 24 2. Colorado: The Home, Denver. 33 *3. Hawaii: Home for Incurables, Honolulu 43 4. Maryland: Hospital for Consumptives of Maryland, Towson 51 *5. New Jersey: Memorial Hospital, Orange 69 6. Pennsylvania: Mt. Jefferson Sanatorium, Lansford 118 7. " West Mountain Sanatorium, Scranton. . . 128 *8. Rhode Island: St, Joseph's Hospital, Providence 133 c. Charges over $10 per week. *i. Arizona: Mercy Hospital, Phoenix 15 *2. " St. Mary's Hospital,'' Tucson 16 3. California: Esperanza, Altadena 17 *4. Colorado: Glockner Sanitarium,'^ Colorado Springs 27 5. " The Home, Denver 33 6. Missouri: Mt. St. Rose Sanatorium," '^ St. Louis 67 7. New Mexico: St. Joseph Sanatorium, Albuquerque 69 8. " " St. Anthony's Sanitarium,'^ E. Las Vegas. 71 *9. " " St. Vincent Sanitarium," Santa Fe 75 10. New York: Seton Hospital, New York City 95 11. " " Rumenapp Cottage,'^ Saranac Lake 108 *I2. North Carolina: St. Joseph Sanitarium, Asheville : 109 13. Pennsylvania: Rush Hospital,*^ Philadelphia 124 14. " Dermady Sanatorium, Philadelphia 126 II. For early cases of pulmonary tuberculosis, exclusively or chiefly. a. Free. 1. Colorado: National Jewish Hospital, Denver 34 2. Illinois: St. Ann's Sanitarium, Chicago 43 3. Maine: Maine Sanatorium, Hebron 49 4. New York: Montefiore Country Sanitarium, Bedford Station 84 5. New York: Loomis Sanatorium, Annex, Liberty 91 6. " " Sanatorium Gabriels, Paul Smith's 102 *7. " " All Saints' Home, Verbank 108 8. Ohio: Western Hill Hospital, Price Hill 117 9. Pennsylvi-nia: Free Hospital for Poor Consumptives, White Haven 1 29 10. Wisconsin. Health Park; Tomahawk 138 11. Canada: Provincial Sanatorium, Kentville, N. S 140 12. " Muskoka Free Hospital, Gravenhurst, Ont 143 13. " Provincial Sanatorium, Quebec 145 a, A few pay patients are received, b. A few patients received free of charge, c. A few patients received at less than $io. 260 PAGE b. Charges not more than %\o per week. 1. Arizona: Palm Lodge, Tent Colonv, Phoenix 15 2. California: Health Camp.'' Indio 18 3. " Barlow Sanatorium/' Los Angeles 19 4. Colorado: Emma Booth Tucker Memorial Sanatorium/' Amity 25 5. Colorado: Agnes Memorial Sanatorium, Den\er 29 6. " Association Health Farm, Denver 30 7. " Resthaven, Morrison 37 8. Connecticut: Gaylord Farm Sanatorium, Wallingford. . . 41 9. Illinois: Tent Colony,'' Ottawa 45 10. Maine: Maine Sanatorium, Hebron 49 11. Massachusetts: State Sanatorium, Rutland 53 12. " Sharon Sanatorium, Sharon 62 13. Minnesota: State Sanatorium, Walker .... 64 14. New Jersey: State Sanatorium, Glen Gardner 68 1 5. New York: State Hospital, Ray Brook 'j'j 16. " " Stony Wold Sanatorium, Lake Kushaqua. . . 88 17. " " Loomis Sanatorium, Annex, Liberty 91 18. " " Hospital for Incipient Cases,'' Rochester. .. . 102 19. " •' Hill Crest and Uplands,'' Santa Clara 103 20. '■ " Adirondack Cottage Sanitarium, Saranac Lake 105 21. North Carolina: Franklin Humanitarian Home, Black Mountain 113 22. Pennsylvania: South Mt. Camp Sanatorium.^'Mont Alto, 119 23. Rhode Island: State .Sanatorium, Pascoag 131 24. " " Pine Ridge Camp,'' Foster 131 25. South Carolina: Aiken Cottages,'' Aiken 135 26. Texas: Camp Reliance, Comfort 136 27. Canada: Wolfville Highlands Sanatorium,Wolfville, N. S. 140 c. Charges over $10 per week. 1. Arizona: Palm Lodge, Phoenix 15 2. California: Mentone Sanatorium, Mentone 21 3. " Pottenger Sanatorium, Monrovia 23 4. Colorado: Nordrach Ranch, Colorado Springs 27 5. " Foxhall, Denver 33 6. Connecticut: Dr. Brooks' Sanatorium, New Canaan. ... 39 7. Illinois: St. Ann's Sanitarium,'^ Chicago 43 8. Iowa: Boulder Lodge Sanatorium, Ft. Dodge 47 9. Massachusetts: Millet Sanatorium, E. Bridgewater , 60 10. " Rutland Cottages, Rutland 61 11. Minnesota: Luther Hospital Sanatorium,'' St. Paul 65 12. New Hampshire: Pembroke Sanatorium, Pembroke. ... 68 13. New Mexico: Las Cruces Sanatorium, Las Cruces 72 14. " " The Montezuma, Las Vegas 75 b, A few patients received free of charge. c. A few patients received at less than |io. d. Shelter and fuel free. 261 PAGE 15. New Mexico: St. Joseph's Sanatorium, Silver City 76 16. New York: Springside Sanitarium, Auburn 83 17- " " Loomis Sanatorium, Liberty 91 18. " " Sanatorium Gabriels,*^ Paul Smith's 102 19. " " Raymond Cottage,- Saranac Lake 107 20. North Carolina: Winyah Sanitarium, Asheville 109 21. " " Dr. Stevens' Home, Asheville iii 22. " " Pineshire Sanitarium, Southern Pines. . 113 23. Ohio: Western Hill Hospital,'^ Price Hill 117 24. Pennsylvania: Private Tent Camp, Greentown 118 25. " Private Sanatorium, Mont Alio 119 26. " Sunnyrest, White Haven 129 27. Vermont: Champlain Open Air Sanitarium, S. Hero. ... 137 28. Wisconsin: Evergreen Park Cottage Sanatorium, Lake Nebagamon 1 38 29. Canada: Muskoka Cottage Sanatorium, Gravenhurst, Ont. 141 30. " Lahl Ghur, Ste. Agathe, Que 145 HL — For advanced cases of pulmonary tuberculosis, exclusively or chiefly. a. Free. *i. Indiana: Flower Mission Pavilion, Indianapolis 46 2. Massachusetts: CuUis Consumptives' Home, Boston. ... 57 3. New York: House of Rest, New York City 97 *4. " " Montefiore Home, New York City 98 5. " " St. Joseph's Hospital, New York City 96 6. Pennsylvania: Henry Phipps Institute, Hospital, Phila- delphia 121 7. Canada; Free Hospital, Toronto 145 b. Charges not more than $10 per week. *i. Massachusetts: Holy Ghost Hospital,'' Cambridge 60 2. New York: St. Joseph's Hospital, New York City 96 3. " " Reception Cottage, Saranac Lake 107 c. Charges over Sio per week. *i. New York: Home for Incurables; New York City 97 IV. For non-pulmonary tuberculosis in children. *i. Massachusetts: Convalescent Home of the Children's Hospital, Wellesley Hills 63 2. New York: Seaside Tent Camp, New York City 99 b. A few patients received free of charge, c. A few patients received at j}io per week or less. 262 •sisopo.iaqnj jo nonnaAajd aq; joj s'aoijBpossv OJ - " •JJ ej " - TT «! " I! - -r 1? cc " ■jj - iC \ •sa nois s8Aijdiunsuoo JOJ noisiAOJd )ads qii.vi snosiJj - - - - - ^^ i- Aijdransnoo joj lAOJd [Bioads miAi ! aqj joj si^jidscH " „« - - - lO - - ^„ in a "-A si H 3 •JB8i{ jad pajB^aj; s;na[;Bd jo jaqrann ps}Bui(jsa j ^ •~ s O o •o § oo of ^ 1 en •jaqinnx - - •s i-i« C3 " J- ^«^ - CO ■sasBO i[B JOJ spaq JO jaqtann i^iox ss SiNM.-. 05inxoQC>in!30co"*>nioo of •spaq JO jaquin^ najpiiqo ni S!SO[nojaqn5 .'iJBtioniind-non jo^ lO § For advanced cases ex- clusively OR CHIEFLY. Number of beds. ■3iaa.il jad 01$ jaAQ « OJ g •iqsaAi jad j ajoni jo^ 1 o CO iS in 1 Hospitals and ■aajj g , s Fob early casfis ex- clusively OR CHIEFLY. Number of beds. ■3[aaAi jad 01$ J8A0 eo iO CO ■XI in e^i-iT-i g .. 1 Sanatoriums, ■3[a9Av jad 1 >o u- Lc o ajotn aojtj o OJ S S o ■gg^s •aaj^ s lO 5D s CO § i All stages received. Number of beds. ■3iaaA\ jad g g § 0I$J9AO 1 "" s coiin =-. COOJ 3 'IT* •jjaaAi jad 01$ uBqj ajoxu :jo^ SS :o X ^s 1 1 ■aajj OJ ;ss XOO OTccm T— 1 CO M 1-1 CO s ^ co" m c5 < _a _c ? £ c c 2 J '5 o 1 B 1 o > c 4) ^5 J '5 o 1 f 5 a to 1 c g as a c S P P '5 a "a g 3 p .z > s > 1 4) S s 2; o 2 .a "i > c c Pi 0) c J ^ .5 1 1 j'5 c cS a s s a S ir. 1 ■a 'S o H 05 _ 0) Qgb 263 A HANDBOOK ON THE PREVENTION OF TUBERCULOSI ISSUED BY THE Committee on the Prevention of Tuberculosis of the New York Charity Organization Socie CONTRIBUTORS A. J.ACoBi, M. D., IIkxry P. Loomis, M. D., Homer Folks, Hkkmann M. Biggs, M. D., Lilian Brandt, Ernst J. Ledkrle, J. H. HiDDLESTON, M. D., T. Mitchell Prudden, M. D., Ernest Poole, S. A. Knopf, M. D., James Alexander Miller, M.D., Charles H. Johnson. This volume is a contribution of the New York Charity Organization Society toward the world-wide movement to put an end to the most deadly and most needless scourge with which humanity is afflicted. It is inspired by a confident hope for the success of this movement. The committee aims to diminish, not in- crease, the hardships of those who are ill; but it insists that it should be the duty of the community to give them a chance to get well while they are curable, and to iso- late such as, through carelessness or for other reasons, are really a source of danger to their fellows. From the Preface. The Hatidbook was selected for the Model Public Library exhibited at the Louisiana Purchase Exposi- tion. This library contains a collection of some seven or eight thousand volumes, comprising in proper pro- portion the best books in every department, as deter- mined by the consensus of a large number of librarians and university specialists. It is also recommended for addition to libraries in the Cumulative Book Index for September, 1904, and the annual bulletin issued by the New York State Library includes it among its list of the 100 best books published in the United States in 1903. CLOTH, $1.00. PAPER, 50 Cents. MAIL ORDERS 15 CENTS ADDITIONAL On sale at office of the Charity Organization Society, 105 East 22d Street, New York City. 265 OPINIONS OF PHYSICIANS AND SOCIAL WORKERS The Hand book" I?, a valuable, if not Dr. Arnold C. the most valuable", contribution to the Klebs, problem of preventing tuberculosis. Chicago. Education in the prevention of disease, and especially in the prevention of tuberculosis, which so essentially is a disease of the poor and ignorant, has to reach primarily those who come incontact with them, physicians, social workers, teachers, ministers and nurses, so that they may in turn translate the truths in plain and practical language. For such a purpose the Handbook is admirably suited, and no one interested in public questions should be without it. I think the Handbook on the Pre- Dr. William ventiofi of Tubercttlosis will be of the Osier, greatest service. It contains much Baltimore. material necessary for use in the cam- paign, and as a work of reference it will be simply invaluable. The papers are all from eminent Dr. Edward O. sources, presenting with great per- Otis, spicuity the various aspects of the Boston. tuberculosis problem. It ought to have the widest circulation. This book is destined to become one Dr.A. J. Richer, of the most useful publications in the Montreal. anti-tuberculosis movement. It should prove particularly useful for organiza- tion work, as it embraces the whole of the subject, treated in a masterly way and by several of the masters. A very commendable feature is that it covers practically every phase of the subject. Fragmentary literature upon the subject of tuberculosis is dangerous. Dr. H. Long= It is one of the most valuable contri- street Taylor, butions to the subject of the suppres- Saint Paul. sion of tuberculosis. This book makes the initiatory step Dr. William for civic work easy and points out the Porter, needs, the methods, and the results, so Saint Louis, plainly that it should be a part of every family library. It is not a book for the physician and the scientist alone ; they must have it ; but it is one of the most interesting presentations of this important subject for general use that I know of. 266 Not only is the book interesting to Dr.G.W.Holden, medical men as representing the latest Denver. ideas on the prevention of tuberculosis and the necessity of organizing socie- ties to carry out these ideas, but if it can be placed in the hands of the reading public it will materially assist in demonstrating the need for the establishing of sanatoria in every state and city. The public has heretofore had very little information except meagre and sensational newspaper articles ; but in the publica- tions of this society the necessary information is clearly and concisely given by recognized authorities. The issuing of this volume marks Dr. F. M. Pot= an epoch in the fight against tubercu- tenger, losis in the United States, and it is to Los Angeles, be hoped that the book will be a stimulus to others in this great work. Dr. Albert C. The book contains all one needs for Qetchell, a comprehensive and intelligent work- Worcester, ing knowledge of the subject. It is an able and scholarly work, Jane Addams, presenting in a clear and easily avail- Hull House, able manner the results of recent in- Chicago. vestigations made by New York ex- perts in medical and social science. Those who have struggled long for cleaner streets and better tenements, for public baths, small parks and playgrounds, will find help and encouragement in this stimulating and interesting record. Every social worker who wishes to Alice L.Higgins, do his part toward the cure and pre- Associated vention of tuberculosis may learn from Charities, this Handbook how to make his work Boston. effectual. Those who own the book have valuable data for reference, and all readers will be highly rewarded, for the information proves of almost daily use. PRES5 C0nnENT5 The Haiidbook will prove of value American to those who are contemplating similar Medicine. organizations and also as a means of general education. The committee, which consists of sixteen physicians and sixteen laymen, is to be congratulated upon the work accomplished dur- ing its first year. This Handbook constitutes one of The Outlook, the most complete and thorough studies of this terrible disease and its prevention that have been published in this country. It contains over three hundred pages, is handsomely printed and illustrated, includes historical, statistical, hygienic and pathological papers by experts, and pre- sents to the reader a valuable bibliography and useful index. We can think of no single work of public 267 philanthropy which is of greater importance or of more widespread public benefit, than such intelligent efforts to check the ravages of tuberculosis as are typified by this Handbook of the Charity Organization Society. It approaches the subject, both from The the medical and the sociological side, Churchman. with important illustrations showing both how things are and how they ought to be, gathering together a multitude of useful ideas that have heretofore been scattered in perishable leaflets or in inaccessible reports. Obviously such a book as this is little New York suited for a review dealing in extracts Evening Post, or condensations. It deserves to be read, and no intelligent reader will lay the book down without a feeling of joy that the outlook is so inspiring. There is no human sufferer who needs more to hear the note of hope than the consumptive, and it should be sounded more and more frequently and with greater insistence. It ought to be a great pleasure to every reader to learn that we have now the right to sound this note as never before. It is an attractive volume of three Brooklyn hundred and eighty-eight pages, well Eagle. printed and plentifully illustrated, and covers , in papers by well-known special- ssts, most of the phases of the subject on which everyone Jhould be informed. The names of Biggs, Huddleston, sacobi and Knopf, Loomis, Prudden and Trudeau are iufficient guarantee of the book's authority on the med- ical side, while de Forest, Devine, Folks and others, by their membership in the committee or by contributions to the volume, vouch for its social value. The book emphasizes the prime es- Boston sentials of proper care, including right Transcript. food and rest, good air, abstention from stimulants and tobacco, allays needless alarm as to the fear of contagion from those afflicted, yet, rightly, insists on the isolation of such as are really a source of danger to the community. Besides information for the afflicted' Philadelphia the publication shows how organiz" Record. ations for fighting consumption may be effected and the problems with which they should deal. It is to the multiplication of anti-tuberculosis societies that we must look for the final eradication of consumption. This excellent work should be in the Baltimore hands of every legislator and public Sun. official, of every physician and head of family, being invaluable for the prac- tical and sensible guidance which it affords in controlling an ever present danger. 268 For the first time an attempt has Washington been made to supply those who are Post. working to put an end "to the most deadly and most needless scourge with which humanity is afflicted" with something in the nature of a text-book. The Handbook on the Prevention of Cleveland Tuberculosis is a timely contribution Leader. to the literature of a subject fast be- coming one of universal interest. This valuable pamphlet should have Pittsburgh wide circulation, not only in view of Telegraph. the need for more general knowledge on the subject of consumption, but by reason of the fullness, clearness and accuracy of the data collected on its pages. It is a comprehensive, non- technical study of the disease in relation to the causes and treatment. It is among the most interesting Chicago books of the month and carries com- Inter=Ocean. fort to the consumptive and to those who fear' that they may become con- sumptives through inherited tendency. The book brings comfort and hope San Jose to the consumptive and to those friends Mercury. who anxiously watch the indications of the destructive disease. Dr. Huddleston gives a clear and New Orleans readable description of the germs of Picayune, consumption, how they enter the body, what they do there and what natural protections there are against them. Dr. Biggs and Dr. Prudden write of the causes of tuberculosis and of the methods of preventing and controlling it, while Dr. Knopf points out the duties of different classes of the community and of the government in combating this dread disease. The forms which tuberculosis assumes when it attacks children and the ways of safeguarding them from it, are treated by Dr. Jacobi. Dr. Loomis describes modern sanatorium treatment and discusses the question of climate. A valuable contribution on a much neglected means for fightmg consumption is made by Dr. Miller in his article on the management of such cases in the dispensary. -260 CtiARITlES A BROAD FIELD A SHORT NAME A PRACTICAL VIEWPOINT Charities is a weekly journal, a monthly review, of things charitable and social In its capacity as a weekly newspaper Charities reports and dis- cusses new movements and legislation. In its monthly magazine it continues the weekly news service with fifty or more additional pages of thorough, suggestive matter on the general trend of affairs, conspicuous movements and things accomplished — a fully illustrated monthly magazine. The current events — men, measures, methods — of the movement for the Prevention of Tuberculosis are chronicled every week in brief, labor-saving but comprehensive form. Once or more monthly, longer articles are published, treating specific phases of the problems presented by tuberculosis in different states and cities, invariably written from first- hand information. Some Recent Articles in Charities. A French Society for^ the Protection of Children Against Tuberculosis. The Tuberculosis Exposition at Baltimore. Marshall Lang- ton Price, M. D. The Handbook on the Prevention of Tuberculosis. Reviewed by Arnold C. Klebs, M. D. Tuberculosis and the Italians of the United States. Antonio Stella, M. D. To Fight Tuberculosis on National Lines— Organization of the National Association for the Study and Prevention of Tuberculosis. Dispensaries for Tuberculosis. Edward O. Otis, M. D. A Seaside Tent Camp for the Treatment of TulDerculosis in Children. Lmsly R. "Williams, M. D. The Spirit of a Sanatorium. Christopher C. Easton. A Simple Sanatory Tent. Henry L. Ulrich, M. D. A Roster of the Anti-Tuberculosis Campaign. Mountain View Farm. Rev. Robert P. Kreitler. The Reception Hospital at Saranac Lake. The Prevention and Treatment of Tuberculosis in Penal Institutions. J. B. Ransom, M. D. "Lean-To's" at the Loomis Sanatorium, Liberty, N. Y. Herbert Maxon King, M. D. EDWARD T. DEVINE, . _ _ - Editor. Published at 105 East 2 2d Street by the Charity Organization Society of the City of New York. Subscription price, $2 yearly. Single copies, 10 cents. Special trial rate to new readers, 8 months; 33 issues, $1. 270 [O 4.352] DUE DATE : ' Printed in USA COLUMBIA UNIVERSITY LIBRARIES L_ 60223188