COLUMBIA LIBRARIES OFFSITE 
 
 HEALTH SCIENCES STANDARD 
 
 HX00030589 
 
 
 3- 
 
 HOME TREATMENT 
 
 OF TUBERCULOSIS 
 
 IN 
 
 NEW YORK CITY 
 
 Jan. 8, 1906— Oct. i, 1907 
 
 An Account of 20 months' experience of the Committee on the 
 Prevention of Tuberculosis of the New York Charity 
 Organization Soeiety. 
 
i^nL 
 
 nM3 
 
 COLLEGE OF 
 
 PHYSICLANS AND SURGEONS 
 
 LIBRARY 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/hometreatmentoftOOchar 
 
HOME TREATMENT 
 
 OF TUBERCULOSIS 
 
 IN 
 
 NEW YORK CITY 
 
 Jan. 8, 1906 — Oct. i, 1907 
 
 Being a R.eport of the Relief Committee of the Committee on 
 the Prevention of Ttibercnlosis of the New York Charity 
 Orgfanization Societ}^. 
 
 March, 1908 
 
C3 1J 
 
TABLE OF CONTENTS 
 
 PAGE 
 
 Org-anization of Relief Committee - - - - - 8 
 
 Plan of Operation -------- q 
 
 Medical Reports as a Basis ------ lo 
 
 Committee Recommendations ------ 12 
 
 General Scope of Relief - - - - - - -13 
 
 Forms of Relief - - - -- - - -16 
 
 Results Obtained -------- ig 
 
 Home Treatment - - - - -- - -21 
 
 Day Camp ---------24 
 
 Combined Treatment, Home and Day Camp - - - 28 
 Sanatoria Treatment -------29 
 
 Treatment in the Country - - - - - -31 
 
 A System of Tuberculosis Dispensaries - - - - 35 
 
 Extra Dispensary Treatment ------ 38 
 
 Conclusions --------- 3g 
 
 Financial Statement _______ 47 
 
COM.MITTEE ON THE PRE\'EXTION OF 
 TUBERCULOSIS 
 
 Edgar T. Levev, Cliairman 
 
 Hermann AI. Biggs, ]\I. D. 
 J. S. Billings, Jr., M. D. 
 David Blaustein 
 John W. Brannan, AI. D. 
 Herbert S. Brown 
 Joseph D. Bryant, 'M. D. 
 Edmond J. Butler 
 Charles F. Cox 
 Thos. Darlington, I\I. D. 
 Robert W. be Forest 
 Edward T. Devine 
 Homer Folks 
 Lee K. Frankel 
 Robt. W. Hebberd 
 L. Emmett Holt, AL D. 
 J. H. Huddleston, ]\L D. 
 A. Jacobi, ]\L D. 
 Walter B. James, ]\L D. 
 E. G. Janeway, ^l. D. 
 i\Iiss A. B. Jennings 
 
 S. A. Knopf, AL D. 
 
 Alexander Lambert, M. D. 
 
 Ernst J. Lederle 
 
 Egbert Le Fevre, M. D. 
 
 Henry I\L Leipziger 
 
 Alfred AIeyer, ]\L D. 
 
 James Alex. [Miller, AL D. 
 
 Thos. M. Mulry 
 
 Mrs. James E. Xewcomb 
 
 Eugene A. Philbin 
 
 T. IMitchell Prudden, M. D. 
 
 E. .Guernsey Rankin, M. D. 
 
 Andrew H. Smith, ]\L D. 
 
 Antonio Stela, M. D. 
 
 W. G. Thompson, M. D. 
 
 E. L. Trudeau, AL D. 
 
 Lawrence A'eiller 
 
 Fred'k L. Wachex'heim, AL D. 
 
 John' Seeley Ward, Jr. 
 
 B. H. Waters, Isl. D. 
 
 Paul Kennaday, Secretary - 
 Frank H. ]\L\nn, Assistant Secretary 
 
 co:\nnTTEE ox relief 
 
 James Alex. AIiller, AI. D., Chairman 
 
 R. A. Eraser, AI. D. 
 James C. Greenway, ]\I. D. 
 S. F. Hallock, ~\\. D. 
 J. H. Huddleston, ]\I. D. 
 Walter L. Niles, M. D. 
 
 W. F. Persons 
 
 Henry L. Shively, ]\I. D. 
 
 A. M. Shr.\dy, AI. D. 
 
 B. H. Waters, M. D. 
 Gaylord S. White 
 
 Henry S. Patterson. AI. D. Paul Kennaday, Secretary 
 Frank H. ]\Iann, Assistant Secretai-y 
 
HOME TREATMENT OF TUBERCULOSIS IN NEW 
 
 YORK CITY. 
 
 With the development of interest in the subject of tuberculosis, 
 in New York City in recent years and the accompanying increase 
 in the number of agencies caring for the tuberculous poor, physi- 
 cians and charity workers have been more and more impressed 
 that something further was needed in the treatment of this class 
 of the sick than had been heretofore had. While dispensaries 
 for the treatment of tuberculosis were each year increasing in 
 number, and clinic classes becoming larger, at the same time cases 
 of tuberculosis referred to organizations administering relief were 
 becoming more and more frequent. Lack of adequate funds 
 prevented the Charity Organization Society from providing the 
 special treatment necessary to enable it to co-operate effectively 
 with the dispensaries in the treatment of these cases ; the supplying 
 of special diet, the making good of the wage loss resulting from 
 the absence of the bread winner in a hospital or sanatorium, the 
 paying of rent in lighter and better rooms, were all out of the 
 question without the provision of special means to enable the 
 society to meet these needs. 
 
 Accordingly, in the early part of 1906 steps were taken to raise 
 sufficient funds to carry on this work on a large enough scale and 
 for a sufficient length of time to make the experiment worth while. 
 Through the generosity of eight men a fund of $20,500 was 
 subscribed for the first year's work ; of this $4,500 was renewed 
 during the second year, with $8,496.40 secured from special funds 
 of the society, small contributions and interest, making a total of 
 $33,496.40 available for the work during the entire twenty months 
 -of the experiment. 
 
8 
 
 ORGAXIZATIOX OF RELIEF CO.ALAIITTEE. 
 
 To the Committee on the Prevention of Tuberculosis, to whom 
 the administration of this fund was entrusted, it seemed that the 
 work might best be done through a sub-committee, composed on 
 the one hand of physicians directly responsible for the larger part 
 of the special tuberculosis dispensary work carried on in the city, 
 and on the other hand of such members of the Charity Organiza- 
 tion Society as could particularly well represent the general policy 
 of the Society in the matter of relief and charitable assistance.* 
 
 A Committee on Relief was therefore organized with the 
 following personnel : 
 
 Dr. James Alexander Miller, Chairman, Director Bellevue 
 Hospital Tuberculosis Clinic; 
 
 Dr. J. H. HuDDLESTON, A'isiting Physician Gouverneur 
 Hospital ; 
 
 Dr. B. H. Waters, Chief of Tuberculosis Clinics, Department 
 of Health ; 
 
 Dr. Hexry L. Shively, Physician in Charge Department of 
 Heart and Lungs, Presbyterian Hospital ; 
 
 Dr. S. F. Hallock, Chairman of C. O. S. Committee on 
 District Work ; 
 
 Mr. Gaylord S. White, Alember of Yorkville District 
 Committee of C. O. S. ; 
 
 *For the benefit of those not familiar with the work of the Charity Organization Society the 
 following statement is given of the methods employed with applicants for assistance: 
 
 In the first instauce, applicants for relief are reportel to the Registration Bureau. If they are 
 found to be cases already under the care of the Association for Improving the Condition of the 
 Poor, or Jewish cases, coming under the supervision of the United Hebrew Charities, they are 
 referred to one or the other of those societies, which then take entire charge of the case. If they 
 are new cases, or former C. O. S. cases, the Investigating Department makes such inquiry as is 
 necessary, and where the need is but tempoiary, keeps them under care until that need has been 
 met. If, on the other hand, the case is one requiring more or less extended treatment, it is then 
 made a -'district case" and sent for supervision, relief, if necessary, to one of the ten district 
 offices of the Society located in various parts of Manhattan and in the Bronx. 
 
 These district offices are each in charge of a district agent, who is advised, at stated times, by 
 her district committee. Through frequent discussions of individual cases by district agents and 
 the officer in the Central Office having general charge of the Society's "case work." bv regular 
 ^^•eekly meetings between all agents and the General Secretary of the Society and by a Committee 
 on District Work, meeting every two weeks and composed of representatives from district 
 committees, the general policy of the Society is kept uniform and at the same time latitude is 
 given to the districts to carry out such measures as they consider best fitted to the solution of 
 their individual cases. 
 
* Mr. C. C. Carstens^ Assistant Secretary of C. O. S. in 
 charge of the case work of the Society ; 
 
 fMR. Paul Kennaday^ Secretary of the Committee on the 
 Prevention of Tuberculosis of the C. O. S. 
 
 There were later added : Dr. R. A. Eraser, Attending Physi- 
 cian to New York Dispensary ; Dr. James C. Greenway, Chief of 
 Clinic and Associate Attending Physician to New York Hospital ; 
 Dr. Walter L. Niles, Physician in Charge of Christ Church 
 Tuberculosis Class ; Dr. Henry S. Patterson, Chief of Clinic 
 Department of Applied Therapeutics, Vanderbilt Clinic ; Mr. W. 
 F. Persons, Superintendent, Charity Organization Society ; Dr. 
 A. M. Shrady, Assistant Visiting Physician to Harlem Hospital. 
 
 To this Committee was turned over the relief work of the 
 Committee on the Prevention of TuTDcrculosis with no restrictions 
 other than that this fund should be used for the relief of those 
 suffering from tuberculosis. 
 
 PLAN OF OPERATION. 
 
 Various methods for carrying on this work were open to the 
 Committee, all containing good points and all open to some objec- 
 tions. It was finally decided that on the whole the best results 
 were to be obtained through making use, as far as possible, of the 
 agencies already at hand in the Charity Organization Society and 
 in the tuberculosis dispensaries in the city. This decision was 
 based upon the conviction that the treatment of tuberculosis is a 
 municipal problem and that however large the relief fund at the 
 Committee's disposal, the individuals to be directly benefited 
 through financial assistance will necessarily be but a small portion 
 O'f the total of those requiring such aid. For this reason the 
 Committee felt that it should sO' plan its work that its influence 
 in the treatment of particular cases would be effective on the 
 larger problems of dispensary and charitable care of consumptives 
 in general. 
 
 It further believed that the plan thus adopted would prevent 
 the duplication of existing machinery, that there would be avoided 
 the unnecessary sending of additional visitors among the con- 
 
 * Mr. Carstens resigned on December 31st, 1906. 
 t Mr. Kennaday resigned on November 18th, 1907. 
 
lO 
 
 sumptive poor, and that also the expenses of administration would 
 thus be reduced to a minimum. 
 
 Such actual experience as was at hand to go by — that gained 
 in 1903, when for a short period the Committee on the Prevention 
 of Tuberculosis took over the relief work of the Charity Organi- 
 zation Society in families in which tuberculosis existed — seemed 
 to show that it would be best to leave the actual relief of persons 
 applying for aid to the usual agencies of the Society, and not to 
 try to separate the relief of the consumptive patient from the care 
 and continuing oversight of the consumptive's family. For, 
 tuberculosis among the poor of the New York tenements is inex- 
 tricably bound up with accompanying conditions requiring just 
 such care as the Charity Organization Society is designed to give. 
 
 MEDICAL REPORT AS A BASIS. 
 
 The Committee has carried on its work in the following 
 manner: As a basis for the consideration of a case the Com- 
 mittee has required a medical report showing the stage of disease, 
 whether the patient is ambulant or in bed, what the general 
 condition is, the patient's ability to work, the prognosis, whether 
 extra diet is being given and the examining physician's recom- 
 mendations. These facts were reported in the following manner 
 on a card schedule especially prepared for this purpose. 
 
 The reports were made out by the physicians and nurses at 
 the following dispensaries and were promptly forwarded to the 
 Committee on Relief: The Department of Health Tuberculosis 
 Dispensary, Bellevue Hospital, Presb}i;erian Hospital, Gouver- 
 neur Hospital, Harlem Hospital, New York Hospital and New 
 York Dispensaries and the Vanderbilt Clinic. 
 
 Although in some cases reports were received from other 
 dispensaries than those represented on the Committee, yet in order 
 to obtain, as far as possible, uniformity of standard, practically 
 all cases were laid before the Committee after physical examina- 
 tion at one or the other of those dispensaries which by the plan 
 of organization were brought into very close touch with the 
 relief work supervised by the Committee. Too much labor cannot 
 be asked from dispensary physicians already overworked, and so 
 
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 the report cards furnished to the dispensaries did not cah for 
 elaborate information or details of physical signs. Recommen- 
 dations as to treatment were, however, by means of these reports 
 suggested by an examining physician, who had full knowledge 
 of the physical condition of the patient, and who was himself 
 either a member of the Committee or was working under the 
 immediate direction of a member. It was these recommenda- 
 tions which the Committee tried to carry out so far as practicable, 
 modified as they were by the physician as he came more fully to 
 understand the various aspects of the problems of home relief. 
 
 CO:\IMITTEE RECOM^IEXDATIONS. 
 
 Once each week the Committee held a meeting at which new 
 and old cases, sent in by different departments of the Society, 
 came up for consideration. In going over these the Committee 
 made recommendations as to medical treatment and relief, which 
 as the work progressed became precedents by which the Secre- 
 tary was enabled to express the Committee's opinion on many 
 cases without laying them before the Committee itself. The num- 
 ber of new cases referred to the Committee, the number of cases 
 resubmitted at frequent intervals for further advice as changing 
 circumstances required, the general similarity of certain problems 
 presented, the need for opportunity to discuss questions of dispen- 
 sary treatment and administrative control, made this procedure 
 necessar}', and as the Secretary's recommendations were at all 
 times subject to review and revision by the Committee, each mem- 
 ber of which was provided with full copies of all decisions made, 
 the plan proved satisfactory as well as expeditious. Further, the 
 Secretary and other agents of the Society were in constant touch 
 with each other in reaching decisions. In order to obtain relief 
 from the Committee the advice of the Committee had to be 
 followed by the district committees, although these departments 
 retained full charge of the families referred to the Committee's 
 consideration. That the Committee might be able to judge for 
 itself whether this was being done, all cases referred to the 
 Committee were carefully indexed on card schedules on Avliich 
 were written a summarv of the social, housing and medical condi- 
 
13 
 
 tions in each case, together with its history from the time it was 
 referred to the Committee, as well as the Committee's decisions 
 and the amount of money expended. Furthermore, all requisi- 
 tions for funds to meet the Committee recommendations were 
 always accompanied by the "case record," giving- the full history 
 of the case and showing just what has taken place since the 
 last previous payment. A visitor working full time for the 
 Committee and a visiting trained nurse working half time visited 
 the patients. The Committee itself met once a week and had as 
 its executive, in constant touch with the situation, a secretary 
 who had general supervision and an assistant whose whole time 
 was devoted to the work. 
 
 GENERAL SCOPE OF RELIEF. 
 
 Underlying the Committee's recommendations for the treat- 
 ment of individual cases have run two main ideas ; the one, that 
 hopeful cases should be directly aided by the best treatment 
 practicable ; the other, that the consumptive's family should be 
 protected against infection, and that this could best be accom- 
 plished by segregation in a hospital or a country sanatorium. 
 Li the case of most of the second stage cases with unfavorable 
 prognosis, and in nearly all third stage cases the Committee 
 has advised hospital treatment and has stood ready to care for 
 the patient's family if the advice were followed. For, it should be 
 borne in mind that even the scanty and occasional earnings of a 
 consumptive are important to many a poor family, and often 
 objection to hospital care is raised for this reason by father, 
 mother, husband or wife, even though the bread-winning power 
 of the patient has been reduced to the lowest point, if not, indeed, 
 entirely taken away by sickness. In certain exceptional instances, 
 even in this apparently hopeless class, it has been found imprac- 
 ticable to advise hospital treatment ; for instance, where a sick 
 mother was needed to keep together a large family depending 
 upon her guiding care. In such cases pains were taken to reduce 
 the danger of infection to a minimum by insisting upon a separate 
 room for the sick one and by frequent visits on the part of the 
 nurse. 
 
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 Too frequently, however', nothing will induce a bed-ridden 
 patient to follow the Committee's advice and the urging of the dis- 
 trict agent to enter a hospital. Dread of hospital, pride against be- 
 coming a public charge, reports of the bad accommodations and the 
 low moral character of many of the patients at some hospitals, all 
 this stands in the way. For such objectors the Committee did not 
 feel that it could go beyond advice as to w^hat was regarded as 
 the proper treatment and the offer of assistance if this advice 
 were followed. These cases were, therefore, "closed" as Com- 
 mittee cases, and left in charge of the proper agencies of the 
 Charity Organization Society and of the inspecting force of the 
 Department of Health. 
 
 FORMS OF RELIEF. 
 
 While it has not been necessary to reject many cases, certain 
 subjects have been withdrawn from consideration as being 
 obviously inappropriate for treatment ; in so doing, only the broad- 
 est lines have been followed; hopeless third-stage cases, chronic 
 alcoholics, and the persistently incorrigible have been practically 
 the only subjects rejected. Some families have been self-sup- 
 porting, and have not needed relief, but only advice and direction. 
 A few non-tuberculous cases were referred to the Committee, but 
 naturally were not treated. During the Committee's twenty 
 months' work, 257 cases were excluded for the following reasons : 
 Hospital cases not needing home relief, 157; families self-support- 
 ing, not needing relief. 34 ; not tuberculous, 24 ; refused to follow 
 Committee's directions, 24 : supported by other relief funds, 12 ; 
 moved away from the city, 6. The Committee has administered 
 relief in one form or another during the period of its work to 355 
 dift'erent patients and their families; of these 166 were males and 
 189 females; while in these families there were 762 children 16 
 years of age and under. 
 
 The relief given has been in many dift'erent wavs. Money 
 frequently has been given to make up the loss to the family of 
 the patient's wages, while he has abstained from work or gone to 
 a hospital or sanatorium for treatment ; rent has frequently been 
 paid, especially for more expensive quarters where light and air 
 could be obtained ; special diet of milk and eggs have been 
 
17 
 
 furnished ; clothing and bedding have been suppUed ; special 
 employment suited to the patient's needs has been obtained; and, 
 in a word, all things done that could help the patient to recovery 
 or prevent the members of his family from becoming infected. 
 
 That suitable cases might leave their families to enter hospitals 
 or sanatoria, there has been given to 31 persons relief amounting 
 to $2,238.76 in the form of "wage loss," to make up the wages lost 
 by the consumptive through ceasing work in pursuance of advice 
 given. 
 
 Twenty-five other families have been moved into better rooms, 
 the Committee paying moving expenses and excess of the new 
 rent over the old, or all of the new rent, as the case might be. 
 
 Rent has been paid for 81 others in their former apartments, 
 where these rooms were suitable and where also there was a 
 separate room for the consumptive. 
 
 For 22 others beds have been supplied so that the patient 
 might have a^- separate bed in a separate room. 
 
 Special diet, usually in the form of milk and eggs, has been 
 provided in 154 cases, where the residence of the patient was so 
 far removed from a dispensary or diet kitchen station that the 
 patient was thus practically cut off from this needed form of 
 treatment at these agencies, or where it could not be secured 
 through them. 
 
 Clothing has been supplied to 75 patients and sometimes to 
 their families and was a regular method of relief by the Committee 
 in cases going to hospitals and sanatoria. 
 
 Through the aid of the Committee on Employment for the 
 Handicapped several consumptives have been provided with em- 
 ployment of a character that seemed suited to their physical con- 
 dition, such as doorkeepers, messengers; newsdealers, handy men, 
 etc. 
 
 Ten patients have been maintained in whole or in part at pay 
 sanatoria at a cost of $1,451.43 for periods averaging from i^^ 
 to 9 months. This was done because such treatment, though 
 expensive, seemed the only method open of effectually returning 
 these patients to wage-earning power, and the refusal to give 
 such treatment seemed likely to lead to unavoidable physical 
 decline along with the possibility of infection to others of the 
 patient's family. 
 
19 
 
 Thirty-seven other patients, through the instrumentahty of the 
 Committee, were sent to the New York State Sanatorium for 
 Incipient Tuberculosis at Ray Brook, to the Municipal Sana- 
 torium at Otisville and to private sanatoria as free patients, and 
 provided with clothing or such other assistance as was necessary. 
 In one of these cases, a young girl of 17 years, whose parents were 
 continually insisting on her working to add to the small family 
 income, the family was prevailed upon to let her stay at the sana- 
 torium for six months by the payment to them each week of $5, 
 the amount that the girl was earning before taken out of work by 
 friends who brought the case to the Committee's attention. In 
 another case the mother of five children was enabled to go to this 
 same institution in the Adirondacks after her children had been 
 sent to a reliable home in the country, where their board was paid 
 by the Committee for five months. 
 
 Seventy patients have been sent tO' the country for stays 
 varying from one week to five months and lasting in 33 cases for 
 three months or more, in 25 cases for two' months and a fraction, 
 in 9 cases for one month or one month and a fraction, in 2 cases 
 for one-half a month, and in i case for one week. This has 
 cost $5,417.61. 
 
 RESULTS OBTAINED. 
 
 While a full understanding of the results obtained from the 
 Committee's work can be best had from a study of the detailed 
 tables accompanying this report, the following synopses of a 
 few case records throw much light on this whole subject: 
 
 A widow with four children was forced to receive aid 
 when her eldest boy, the main bread-winner of the family, 
 was compelled to give up his work on account of tuber- 
 culosis. The Committee paid his wage loss while he took 
 the cure at Otisville Sanatorium. An examination of the 
 other members of the family revealed that two of the 
 children were in the early stages of the disease. The 
 pension in the home was increased and these two were 
 sent to Ray Brook. The mother bore up bravely under 
 her misfortunes and after a few months the family was 
 reunited and the two boys resumed their work. 
 
20 ■ 
 
 A young girl 20 years of age who, with her sister, was 
 the main support of a feeble grandmother, after remaining 
 a short while in one of the city hospitals, was referred to 
 the Committee for charitable assistance. She was sent 
 into the country for three months at the Committee's 
 expense and returned in excellent condition, having gained 
 20 pounds. A suitable position was soon secured for her 
 and the family was put on an independent basis. 
 
 A young man, 25 years of age, with a wife and one 
 small child, presented quite a problem, after having refused 
 treatment in a sanatorium because there were "too many 
 sick people there" and after giving up several positions in 
 the city. For nearly a 3^ear his rent was paid and food 
 was supplied to the family. At last a position was secured 
 for him in the country, where he established himself and 
 later moved his wife and child, becoming independent of 
 any charitable assistance. 
 
 A father, 53 years of age, suffering with advanced 
 tuberculosis, filthy in person, living with a wife and nine 
 children in three small, dirty rooms, was a dangerous 
 source of infection when the case came to the Committee's 
 notice. When persuasion failed to induce the man to 
 enter a hospital, the law was appealed to and the man 
 was forcibly removed to Riverside Sanatorium. The 
 wage loss of the wife, now forced to give up her work to 
 care for the children, was made up by the Committee and 
 the rent was paid. The man's removal was the family's 
 redemption. The whole tone of the household was elevated 
 and at the end of ten months, though the woman was 
 faithful in visiting "her man'' at the hospital, she would 
 not listen for a moment to his entreaties to return home. 
 
 A widow with two children, unable to do a full amount 
 of work and yet unwilling to have her home broken up, that 
 she might go into a hospital, was paid three days' wage 
 loss each week, which enabled her to take "the cure" at 
 home. During the summer she spent at least three days 
 a week at the camp, improving steadily, and when the 
 Committee's work ceased she was quite ready to resume 
 the full support of her family. 
 
21 
 
 A young woman, 24 years of age, living with distant 
 relatives, who were unwilling to keep her longer unless 
 she could work and pay her way, was forced in her ex- 
 tremity to apply for assistance. When she first came 
 under the Society's care, she had been rejected by one of 
 the sanatoria as an unsuitable case for sanatorium treat- 
 ment. Her board was paid, milk and eggs were supplied, 
 the home was frequently visited by an experienced nurse, 
 the girl attended clinic regularly each week and was so 
 improved at the end of three months that a position was 
 secured for her as a domestic at the Municipal Sanatorium 
 at Otisville. 
 
 A young man, 22 years of age, boarding with friends, 
 was forced to give up his work on account of tuberculosis 
 and was referred by one of the clinics to the day camp. 
 After eight weeks' treatment there, during which time the 
 Committee paid his wage loss, he was so improved as to 
 be able to resume his work as street car conductor. 
 
 A young girl, 21 years of age, broken down through 
 hard work in a tobacco factory and suffering with tuber- 
 culosis in the incipient form, was referred by one of the 
 clinics to spend her vacation of one week at the day camp. 
 She was persuaded to continue treatment, the Committee 
 paying her wage loss, and after fourteen weeks, having 
 gained twelve pounds, she was so improved that she could 
 not be persuaded to remain longer at the camp. 
 
 The Committee's main activities have been in five directions — 
 Home Treatment ; the Day Camp ; Country Treatment ; Sana- 
 torium Treatment ; and the Establishment of a Proper System 
 of Tuberculosis Dispensaries : 
 
 HOME TREATMENT. 
 
 For the hundreds who either will not or cannot go to a 
 hospital or sanatorium, home treatment is essential. Here, not- 
 withstanding the limitations under which we are working in 
 New York City, everything possible must be done for the patient 
 
22 
 
 to restore him to his position as a useful member of society, and 
 more especially to protect the members of his family and of the 
 other families living in close proximity to him, from the disease. 
 Here, too, must the patient be taught those essentials as to the 
 nature of his disease, and the means of combating it which 
 ordinarily would be learned in the sanatorium. 
 
 The Committee during the period of its activity has adminis- 
 tered Home Relief to 127 families; that is, the patients were 
 treated not in hospitals, sanatorium, or day camps, but exclusively 
 in their own homes. 
 
 In every case efforts were made to secure the most sanitary, 
 wholesome and propitious living conditions for the patient. The 
 sunniest and airiest room was always reserved for him, a sep- 
 arate bed was considered essential and a separate room was the 
 rule with but few exceptions. In a word, everything affecting 
 the life of the patient was carefully supervised — from the social 
 side by the districts of the Charity Organization Society, from the 
 medical side by the nurses and physicians of the special tubercu- 
 losis clinics — and the life of the patient brought to as high a 
 degree of regularity as the conditions and circumstances permitted. 
 
 The following table shows the results obtained from this 
 method, so far as it is possible to state statistically the results of 
 such treatment : 
 
 Table I. ■ • 
 
 Home Treatment — 127 Cases. 
 
 Been Its 
 Obtained 
 
 
 
 Condition at 
 
 Bbqinning 
 
 
 
 35 
 
 Incipient 
 
 80 Moderately Ad- 
 vanced 
 
 12 Far Advanced 
 
 Total 
 
 Percent- 
 age 
 
 
 Good 
 
 Pair f Poor 
 
 Good Fair Poor 
 
 Good Fair I'oor 
 
 
 
 Appstrently cured . 
 
 2 ' \ 
 
 1 
 
 
 3 
 
 2 
 
 Arrested 
 
 8 
 
 1 i 1 
 
 4 3 
 
 
 17 
 
 18 
 
 
 
 Improved 
 
 7 
 
 4 
 
 12 1 19 1 2 
 
 1 
 
 45 
 
 36 
 
 Progressive 
 
 8 
 
 4 
 
 9 23 4 
 
 5 6 
 
 r>2 
 
 49 
 
 Total 
 
 25 
 
 9 1 
 
 25 ! 49 1 6 
 
 6 (5 
 
 127 
 
 100 
 
 
 
23 
 
24 
 
 It appears from this table that with the 127 patients treated 
 exclusively in their homes, excellent results have on the whole 
 been obtained, in view of the obstacles that exist to this method 
 of treatment. For instance, out of 35 incipient cases thus treated, 
 in but 12 or 34 per cent, did the disease progress, while in 23 cases 
 or 66 per cent, the patient's condition materially improved. 
 
 Of the 80 cases originally diagnosed as "moderately ad- 
 vanced," such favorable results naturally could not be expected, 
 yet even here good results have been achieved. In but 39 
 cases or 49 per cent, did the disease progress, while in 41 cases or 
 51 per cent, the patient's condition improved. In the 12 cases 
 originally diagnosed as "far advanced," the story is of course 
 different; of these but one case improved. 
 
 Of the total 127 cases, considered irrespective of their original 
 condition, in 62 cases or 49 per cent, the disease progressed, while 
 in 65 or 51 per cent, the patients improved. 
 
 The cost of securing these results has been $12,907.34. This 
 has been for a total of 4,343 weeks. The average treatment per 
 patient has been for 34 weeks, the total cost per patient, $101.63, 
 and the average cost per patient but $2.97 per week. In this 
 connection it should be remembered that this cost includes not 
 only the money spent specifically for the patient, but that spent for 
 the family as well. 
 
 THE DAY CA:\IP. . ■ 
 
 The experience of others pointed out the "day camp"" as an 
 essential part of any adequate scheme of home relief for con- 
 sumptives. \^arious plans were considered by the Committee ; 
 vacant lots in the Bronx, a part of Blackwell's Island, unused 
 corners of some of the far uptown parks, hospital roofs, boats and 
 recreation piers and finally one of the old Staten Island ferr\-boats 
 that since the building of the new ferryboats by the city had been 
 lying idle at one of the Xorth River piers. Through the courtesy 
 of Hon. John A. Bensel, Commissioner of Docks and Ferries, the 
 "Southfield" was thus put at the Committee's disposal free of all 
 expense and with the privilege of making such minor alterations 
 and repairs as were necessary for the new and strange use to 
 
25 
 
 which the old boat was to be put. Moored at the end of the 
 dock at the foot of West Sixteenth Street, in the Hudson River, 
 exposed to the cool summer river breezes, with constantly shifting 
 scenes furnished by the passing river craft, the decks of the 
 "Southfield," liberally supplied with steamer chairs and ham- 
 mocks, gave relief from the stifling heat of the tenements to 
 many a poor consumptive who could not go to a sanitorium be- 
 cause too sick or because needed at home. From every point of 
 view, health, happiness, comfort and economy, the boat has been 
 a success. It received only those sent by the associated dispen- 
 saries, paying carfares for those whom investigation by relief 
 societies showed to be too poor to pay these themselves; it gave 
 them an abundance of milk and eggs and bread and butter, adding 
 to this in the last month and a half, a simple cooked dinner. 
 Every patient was carefully watched by the Committee's efficient 
 nurse, Mrs. Helen Smith; their temperature was taken twice a day 
 and their weight and pulse every morning. This care, added to 
 such advice as the visiting physician might give in individual 
 cases or as the examining dispensary physician might have noted 
 on the patient's record card when sending him to the boat, 
 furnished satisfactory medical oversight. 
 
 While the general success of the camp may be thus almost 
 unqualifiedly commended, the attendance was regrettably small. 
 The camp was opened on June 13, 1907, and closed on October 31, 
 1907. Out of 242 different patients who presented themselves at 
 one time or another during the 141 days in which the camp was in 
 operation, only 87 attended for 20 days or more. The average 
 daily attendance at the camp was 39.4 — a very small figure when 
 we consider that there were accommodations for at least 100 
 patients and that the Manhattan tenements hold 30,000 tubercu- 
 lous patients, a large number of whom might have availed them- 
 selves of the privilege of the camp. The meagre attendance is 
 at least partly explained by the fact that this was the initial year 
 of the work and the camp had established no prestige which 
 would appeal to health seekers who must limit their search to the 
 City of New York. This, however, is probably the least reason 
 to which we may appeal in explanation of why 242 patients, who 
 for at least a few hours tested the merit of the "Southfield," did 
 
26 
 
 not make a better showing of attendance. Some found it impos- 
 sible to make the long journey, either from the upper east side or 
 the upper west side or from the lower east side, and some living 
 in the Bronx found, of course, the same difficulty — a reason foi 
 the establishment of a number of camps which would be readily 
 accessible to the various crowded tenement sections. Some had 
 duties at home which made more than a very occasional attend- 
 ance impossible: they consequently never contracted the habit 
 of coming — a reason for providing in connection with the camp 
 for the home relief and home supervision of all those who 
 attend. Quite a number, through one agency or another, found 
 their wa}" to the country for the summer months and not a few 
 through their association with the camp secured admission to 
 Rav Brook or Otisville Sanatoria and were transferred there. A 
 few suffered from seasickness on board the "Southfield" and pre- 
 ferred to tr}' the parks and roofs. The rest may be classified as 
 those who for no apparent reason simply did not care to come. 
 
 The camp was open Sundays as well as week days, and while 
 the attendance was unusually small on those days, the number of 
 Sundays as compared with the other da}'s was so few, that it made 
 no considerable difference in the average attendance. The aver- 
 age attendance on Sundays was 24.4, the average attendance on 
 week day? was 41.9, the general average attendance was 39.4. 
 
 Table IL . ' - 
 
 Day Camp — Results with %j Patients for 20 Days or ]\Iore. 
 
 Condition ox Admission 
 
 Results 
 
 
 
 
 
 
 Obtained 
 
 97 Incipient 
 
 47 Moderately Ad- 
 vanced 
 
 13 Far Advanced 
 
 Total 
 
 Percent- 
 age 
 
 
 ■ Good : Fair Poor 
 
 Good' Fair i Poor 
 
 Good Fair Poor 
 
 
 
 Improved 
 
 17 : 4 
 
 8 23 3 
 
 1 4 
 
 60 
 
 m 
 
 Progressive 
 
 5 1 
 
 1 8 4 
 
 e 4 -2 
 
 -7 
 
 31 
 
 Total 
 
 ■3-:! 5 
 
 9 31 7 
 
 ■2 5 6 
 
 87 
 
 100 
 
 It appears from this table that of the 87 patients who came 
 to the day camp for 20 days or more, very satisfactory results 
 
27 
 
 have been secured. Out of 27 incipient cases there treated in but 
 6 or 22 per cent, did the disease progress, while in 21 cases or 
 78 per cent, the patient's condition improved. 
 
 Of the 47 cases originally diagnosed as "moderately ad- 
 vanced," but 13 or only 2'j per cent, progressed while 34 or 72 
 per cent, improved. 
 
 Even among the cases diagnosed as "far advanced," good 
 results were obtained; out of 13 cases of this kind but 8 were 
 progressive, while 5 of them, improved. 
 
 The following summary of the results of the day camp 
 treatment and the cost of running the camp with other details 
 is of interest : 
 
 * Summary of 87 Cases Who Attended 20 Days or More. 
 General Condition. 
 
 Improved 60 69% 
 
 Progressive 27 31% 
 
 Weight. 
 
 Gain 66 
 
 lyoss 19 
 
 Stationary 2 
 
 General Statistics of Day Camp. 
 
 Total number of days open 141 
 
 Total number of patients treated — • 
 
 Male 144 
 
 Female 98 
 
 Number of cases who attended 20 days or more during 
 
 season 87 
 
 Male 49 
 
 Female 38 
 
 Total number of attendances 5,567 
 
 Average attendance per day 39.4 
 
 Average attendance on Sundays 24.4 
 
 Average attendance on week days 41.9 
 
 Maximum attendance 70 
 
 Total cost $2,790.21 
 
 Equipment — 
 
 Supplies $515.82 
 
 Wages ■ 51.56 
 
 Total $567.38 
 
 *It may be interesting to note that of these 87 cases treated at the day camp for 20 daye or 
 more, 30 improved as to their pulmonary condition; 50 were stationary and only 17 progressed. 
 
28 
 
 Maintenance — 
 
 Supplies 474-5<J 
 
 Medical Supplies 32-51 
 
 Wages '. . 806.13 
 
 Contingent 25.00 
 
 Milk, eggs 686. 19 
 
 Washing 16.7S 
 
 Carfares , 181.75 
 
 Total $2,222.83 
 
 Total cost per day 15-76 
 
 Total cost per patient 56.41 
 
 Total cost per patient per day .40 
 
 A comparison of the results obtained with the 87 day camp 
 patients and the 127 cases treated at home, is of interest. 
 
 Out of 127 cases treated exchtsively m their homes, 65 
 improved, and in 62 the disease progressed. Out of 87 cases 
 treated at the camp 60 improved, in 27 the disease progressed. 
 That is, 69 per cent, improved under camp treatment as against 
 51 per cent, improved under home treatment. 
 
 COMBINED TREATMENT— HOME AND DAY CAMP. 
 
 Out of 87 patients treated at the day camp for a period of 
 20 days or more, there were 12 who received rehef and supervi- 
 sion in their homes b}^ this Committee. In each instance these 
 patients came to us originally because they had been referred to 
 the camp by the clinics, and were able to attend the camp because 
 of the relief which was given them in their homes. Although the 
 number of cases treated both at home and at the camp is very 
 small, it is added here for the comparison with the figures of the 
 two methods taken separately. 
 
 Table III. 
 Combined Day Camp and Home Treatment — 12 Cases. 
 
 
 CONDITION ON ADMISSION 
 
 Eesnlts 
 Obtained 
 
 4 Incipient 
 
 8 Moderately , 
 Advanced 
 
 12 Total 
 
 Total 
 
 Percent- 
 age 
 
 
 Good Fair ! Poor 
 
 Good Fair ! Poor 
 
 Good 1 Fair , Poor 
 
 
 
 Improved 
 
 3 
 
 j 4 : 2 
 
 3 1 4 ' 2 
 
 9 
 
 75 
 
 Progressive 
 
 1 
 
 ■ 2 
 
 11 12 
 
 3 
 
 25 
 
 Total 
 
 4 
 
 4 4 
 
 4 4 4 
 
 12 
 
 100 
 
29. 
 
 Out of 12 cases of this combined treatment 9 improved and 
 in 3 the disease progressed, a per cent, of 75 improved under 
 combined treatment. 
 
 Cost of Home Relief of 12 Patients Who Attended Day Camp. 
 
 Total number of weeks 113 
 
 Total amount expended $434.75 
 
 Average length of treatment in weeks per patient 9.4 
 
 Average cost per patient $36.23 
 
 Average cost per patient per week 3.84 
 
 The statement of expenses given above in connection with the 
 12 day camp patients refers only to the amount expended in the 
 home in behalf of these patients. In order to know the total 
 amount expended in behalf of these 12 patients, we must add to 
 the above cost $303.95, which is the pro rata cost for their camp 
 treatment. Assuming that the results obtained in treating even so 
 small a group of patients is of some value, the figures show that 
 a patient may be given the advantages of day camp treatment 
 and at the same time adequate home care at a cost of $6.53 per 
 week. The number of cases treated at home and at the same time 
 attending the day camp is hardly large enough to be very valuable 
 for purposes of comparison, but it may be noted in passing that 
 75 per cent, of those so treated improved as against 51 per cent, 
 improved of those who did not have the advantages of the camp 
 life. 
 
 It may also be of value in considering the percentages of 
 improved cases to compare also the average cost of treatment : 
 
 The average cost per patient per week for home treatment $2.97 
 The average cost per patient per week for day camp 
 
 treatment 2.80 
 
 The average cost per patient per week for combined treat- 
 ment 6.53 
 
 SANATORIUM TREATMENT. 
 
 As must naturally be expected, both because of a more careful 
 selection of cases and because of better facilities, the sanatorium 
 
30 
 
 cases show greater improvement than those treated at home. The 
 following table shows the results with 47 cases treated at 
 sanatoria : 
 
 Table IV. 
 
 Sanatorium Treatment of 47 Cases. 
 
 Results 
 Obtained 
 
 CONDITION ON ADMISSION 
 
 36 Incipient 
 
 31 Moderately Ad- 
 vanced 
 
 Total 
 
 Total 
 
 Percent- 
 age 
 
 
 Good Fair 
 
 Poor 
 
 Good 
 
 Fair Poor 
 
 Good 1 Fair , 
 
 Poor 
 
 
 
 Apparently cured. 
 
 8 f 3 
 
 
 1 
 
 ' 
 
 9,3- 
 
 13 
 
 25 
 
 Arrested 
 
 3 1 
 
 1 2 
 
 3 2 
 
 2 
 
 7 
 
 15 
 
 Improved 
 
 8 2 
 
 6 3 1 
 
 14 5 
 
 1 
 
 30 
 
 43 
 
 Progressive 
 
 1 
 
 3 4 
 
 4 j 4 1 
 
 8 
 
 17 
 
 Total 
 
 20 6 
 
 10 8 3 
 
 30 14 
 
 3 
 
 47 
 
 100 
 
 It appears from this table that out of 47 cases treated at sana- 
 toria 39 cases or 83 per cent, improved, while in 8 cases or 17 per 
 cent, the disease progressed. The cost to the Committee in this 
 instance, with the exception of the amount expended for 10 pay 
 patients and that expended for outfits and transportation, went to 
 the families of the patients in their absence at the sanatorium 
 and was as follows : 
 
 Cost of Treating 47 Cases in Sanatoria. 
 
 Total number of weeks i,ii6 
 
 Amount expended $3,849.50 
 
 Average length of treatment in weeks per patient. . . . 21.6 
 
 Average cost per patient $81.90 
 
 Average cost per patient per week $3-45 
 
 Of these 47 cases, 37 were treated in public sanatoria, or in 
 free beds in private institutions; the other 10 were maintained 
 wholly or in part at private sanatoria for 227 weeks at a cost of 
 $1,451.43. Deducting this from the above figures, the amount 
 actually expended in the homes of patients cared for in sanatoria 
 is as follows : 
 
31 
 
 Amount of Relief Required in Homes of 37 Patients in Order that 
 They Might Be Treated at PubHc Sanatoria. 
 
 Total number of weeks 889 
 
 Total cost $2,398.07 
 
 Average length of treatment in weeks per patient. ... 24 
 
 Average cost per patient $64.81 
 
 Average cost per week per patient $2.69 
 
 It will be noticed by comparison that the cost of home treat- 
 ment is very nearly the same as the amount of relief required in 
 the homes of patients in order that they may receive treatment at 
 free sanatoria. This amount, of course, represents the cost to 
 the Committee that makes sanatorium treatment possible and does 
 not include the cost of treating the patient at the institution. 
 Comparing the results obtained by sanatorium treatment with the 
 results obtained through treatment exclusively in the home, it 
 appears that by the former method 83 per cent, of the cases 
 "improved," while under home treatment but 51 per cent, 
 improved. 
 
 Under sanatorium treatment, in but 17 per cent, of the cases 
 the disease progressed, while under home treatment the number 
 of progressive cases was 49 per cent. 
 
 TREATMENT IN THE COUNTRY. 
 
 Many physicians, as well as charitable persons and interested 
 friends, and nearly always the sufferers themselves, seem to con- 
 sider that once the city consumptive is taken from his overcrowded 
 tenement and placed in the country the problem is solved. Often 
 it is thereby merely made more complicated. On the other hand, 
 undoubtedly there are many consumptives who will profit greatly 
 by a' carefully supervised residence in the country. 
 
 In the year 1906 the Committee decided to send to the country 
 such patients as, in its opinion, were suitable for this kind of 
 treatment. For the most part they were first-stage cases, with 
 good or fair general condition, well instructed, and willing and 
 anxious to follow advice as to treatment and mode of life. They 
 were all patients whose clinic physicians had recommended the 
 
32 
 
 countty and whose condition was such that an arrest of the disease, 
 or at least a material prolongation of life, might reasonably be 
 looked forward to if they could be taken away from their tenement 
 homes during the hot summer months, always a critical period 
 for the consumptive. 
 
 The first step in planning for this country care of consump- 
 tives was to send letters to some 600 boarding-house keepers and 
 farmers living in places within 140 miles radius of the city, asking 
 if they would furnish separate, well-ventilated rooms and give 
 good, wholesome, plain food to a few consumptives whom the Com- 
 mittee desired to maintain in the country during the summer. Of 
 those who were willing and seeming able to offer proper accommo- 
 dations such were selected as charged not more than $6 a week, 
 exclusive of laundry. These were visited by the Agent of the 
 Society's Committee on Employment for the Handicapped, who 
 took notes as to the situation of houses, location of rooms, food 
 and apparent characteristics of boarding-house keepers, and also 
 made observations on the opportunities for employment. In this 
 manner, after twelve days spent in driving around the country 
 looking up addresses furnished to him, reports were submitted on 
 28 houses, from w^hich were selected as suitable, 10 houses with 
 accommodations for about 60 patients. The next thing was to 
 secure a competent physician who would regularly call upon the 
 cases to make physical examinations, watch for the infraction 
 of rules laid down, reiterate recommendations as to disposal of 
 sputum, and generally give medical care and oversight and hear 
 and determine complaints. Dr. P. E. Garlock, who, under Dr. 
 Miller, of the Committee, and others, had had previous training 
 in the diagnosis and treatment of tuberculosis as resident physi- 
 cian at Seton Hospital among the ver}^ class of consumptives with 
 whom, for the most part, the Committee was dealing, was selected 
 to do this Avork, and it was due in no small degree to his judgment 
 and skill that the summer's experiment was carried through with 
 such benefit to the patients and satisfaction to the Committee. 
 
 Of the 70 patients sent to the country, 16 were children, and 
 were cared for in various places already favorably known to the 
 Charity Organization Society, and were not visited by the Com- 
 mittee's physician during their country stay. Of the remaining 
 
33 
 
 54 adults, 50 were under medical supervision while in the country. 
 As to the 48 who remained in the country from one to five months 
 the following table shows the results of this form of treatment : 
 
 Table V. 
 Country Treatment — 48 Cases, Treated from One to Five Months. 
 
 
 
 
 
 CONDITION A^T 
 
 BEGINNING 
 
 
 
 Results 
 
 10 Incipient 
 
 38 Moderately Ad- 
 vanced 
 
 48 Total 
 
 Tbtal 
 
 Percent- 
 age 
 
 
 Good 
 
 Fair 
 
 Poor 
 
 Good 
 
 Fair 
 
 Poor 
 
 Good 
 
 Fair 
 
 Poor 
 
 
 
 
 3 
 
 1 
 
 
 1 
 
 3 
 
 
 4 
 
 4 
 
 
 8 
 
 17 
 
 
 
 Imjiroved 
 
 6 I 
 
 i; 13 
 
 8 
 
 1 
 
 19 
 
 8 
 
 1 
 
 38 
 
 58 
 
 Progressive 
 
 
 ij 3 
 
 9 
 
 
 3 
 
 9 
 
 
 13 
 
 35 
 
 Total 
 
 9 1 
 
 ^1 17 
 
 30 
 
 1 
 
 26 
 
 31 
 
 1 
 
 48 
 
 100 
 
 
 
 
 
 
 
 It appears from this table that out of 48 cases thus treated in 
 the country, out of 10 incipient cases all improved, and out of 38 
 "moderately advanced" cases in but 12 or 31 per cent, did the 
 disease progress — and out of the total 48 cases in but 12 or 25 
 per cent, did the disease progress, while in 36 or 75 per cent, the 
 patients improved. 
 
 The cost of this treatment and the detailed facts connected 
 with the experiment are as follows : 
 
 Cost of Country Treatment. 
 
 Number of children treated in country. . . 16 
 Number of adults treated in country 54 
 
 Total number of weeks 
 
 Total cost 
 
 Average number of weeks per patient . . . . ' 
 
 Average cost per patient 
 
 Average cost per week per patient 
 
 70 
 
 
 821 
 
 
 
 $5,417.61 
 
 II-5 
 
 
 
 77-39 
 
 
 6.59 
 
 This total amount and the averages include seven cases in which 
 
34 
 
 a small amount of relief ($144.38) was given in the home during 
 the patients' stay in the country. 
 
 Children. 
 
 Number of children 16 
 
 Total number of weeks . . . 234 
 
 Total cost $793-56 
 
 Average number of weeks per child 14.6 
 
 Average cost per child. 49-59 
 
 Average cost per week per child 3.39 
 
 Adults. 
 
 Number of adults 54 
 
 Total number of weeks 587 
 
 Total cost $4,623.95 
 
 Average number of weeks per patient 10.8 
 
 Average cost per patient 85.62 
 
 Average cost per week per patient 7.78 
 
 A large majority of these patients have come back to the city 
 improved in health, hopeful and realizing the value of fresh air, 
 quiet, rest and food, knowing how to protect their families against 
 infection, and detennined to do their part in the long struggle 
 toward health. It is, however, the Committee's opinion that 
 ordinarily only a small number of those suffering from tuber- 
 culosis and seeking charitable assistance are fitted for residence 
 in the country, and that of these a very much smaller number 
 may safely take such form of treatment without medical 
 supervision. 
 
 Table VI. 
 Comparative Results from Various Methods of Treatment. 
 
 Results 
 
 127 Home 
 
 87 Day Camp 
 
 12 Combined 
 
 47 Sanatorium 
 
 48 Country 
 
 
 Percentage 
 
 Percentage 
 
 Percentage. 
 
 Percentage 
 
 Percentage 
 
 Improved 
 
 51 
 
 69 
 
 75 
 
 &3 
 
 75 
 
 Progressive 
 
 49 
 
 31 
 
 25 
 
 17 
 
 25 
 
35 
 A SYSTEM OF TUBERCULOSIS DISPENSARIES. 
 
 One of the most important results that has grown out of the 
 Committee's work has been the establishment of a system of 
 tuberculosis dispensaries in New York City. It has been the 
 natural result of the coming together once a week in the Confer- 
 ences of the Committee, of the physicians representing all of the 
 public tuberculosis dispensaries and the largest private ones in 
 the city. 
 
 In this way there has been put into effect a dispensary district 
 plan designed to give more prolonged and satisfactory observation 
 and treatment at each dispensary^ to simplify the work of visiting 
 patients in their homes and to put a stop to the practice, more or 
 less common on the part of patients, of attending for short 
 periods one clinic after another. Having in mind the location of 
 the dispensaries represented on the Committee, the density of the 
 neighboring population and the number of patients being treated at 
 each, the city was divided into appropriate districts and apportioned 
 among the following clinics : Department of Health Clinic, 
 Bellevue, Gouverneur, Harlem and Presbyterian Hospitals 
 Dispensaries. 
 
 It was agreed on behalf of the above named dispensaries to 
 pursue in general the following plan for the treatment of cases 
 of tuberculosis calling at these dispensaries for treatment : 
 
 (a) In case of new applicants, only such shall be treated at 
 the dispensary applied to as are living within the district assigned 
 to such dispensary. 
 
 (b) In case of new applicants living outside of the dispensary 
 district wherein they seek dispensary care, they shall be refused 
 treatment at such dispensary of original application, and shall be 
 referred by card to the dispensary assigned to the district of their 
 residence. 
 
 (c) Old cases already in attendance at these dispensaries shall 
 be continued under such treatment without reference to their 
 place of residence. 
 
36 
 
 W5Q&I 
 
 HEALTH DEFT 
 
 ., E.545t 
 
 MANHATTAN. 
 
 Note. — Manhattan applicants for examina- 
 tion or treatment should apply at the dis- 
 pensary in the district in which they live. 
 The dispensary districts are shown on the 
 map. 
 
 Dispensaries. 
 
 Department of Heaeth, 
 55th St. and 6th Ave., 
 
 Week days 10 A. M. to 4 P. M. 
 Mon., Wed., Fri., 8 to 9 P. M. 
 
 Bellevue Hospitae Dispensary, 
 Foot of East 26th St., 
 
 Week days i to 3 P. M. 
 
 GouvERNEUR Hospitae Dispensary, 
 Gouverneur Slip, 
 
 Mon., Wed., Fri., 2 to 4 P. M. 
 
 Presbyterian Hospital Dispensary, 
 70th St. and Madison Ave., 
 
 Mon., Wed., Fri., 1.30 to 3 P. M. 
 
 Hareem Hospital Dispensary, 
 I36tli St. and Lenox Ave., 
 Week days 3 to 4 P. M. 
 
 Vanderbiet Ceinic, 
 
 60th St. and Amsterdam Ave., 
 Week days 2 to 3 P. M. 
 Mon., Wed., Fri., 9 to 10.30 A. M. 
 
 New York Dispensary, 
 137 Center St., 
 
 Week days 11 A. M. to 12.30 P. M. 
 
 New York Hospital Dispensary, 
 8 West i6th St., 
 
 Week days 2 to 4 P. M. 
 
 Mt. Sinai Hospital Dispensary, 
 Madison Ave. and looth St., 
 Week days 10 to 11 A. M. 
 
 German Hospital Dispensary, 
 76th St. and Park Ave., 
 
 Week days 2 to 4 P. M. 
 
 Health Department, Bronx, 
 
 3d Avenue and St. Paul's Place, 
 Week days 2 to 4 P. M. 
 
 The Clinics and Districts of the Association of Tuberculosis 
 Clinics — An Outgrowth of the Committee's Work. 
 
37 
 
 Since the beginning of this plan it has been further extended 
 to take in Vanderbilt CHnic, New York Dispensary and New York 
 Hospital Dispensary, and at present a number of other dispen- 
 saries have under consideration the Committee's invitation to join 
 the group of "The Association of Tuberculosis Clinics," as these 
 dispensaries are now called. The requirements for admis- 
 sion are that the dispensary shall agree to treat only appli- 
 cants living within the district which by mutual consent 
 may be apportioned to it, that patients shall be regularly 
 visited in their homes, and that a representative of the 
 dispensary shall be appointed as a delegate to attend the 
 meetings of the Association. The experience of those who 
 have already been members of this group for twelve months 
 proves that the system is simple and effective, that it gives the 
 physician a better knowledge of his patient than he had before, that 
 it makes attendance of patients more regular and is a great time 
 saver to the nurse, that it is easier and more satisfactory to the 
 patient and that far from reducing the number of cases which 
 will be available for teaching purposes, it increases this number. 
 As a matter of fact, the attendance at the clinics as a whole has 
 been considerably increased since the district system was put into 
 operation. Many of the clinics are overcrowded, and, while the 
 work of the nurses has been greatly facilitated by the district plan, 
 the work of the doctors at the clinics has been somewhat 
 increased. This calls for an increase in the number of dispen- 
 saries having special classes for the treatment of tuberculosis. 
 
 During the past year 1,163 patients have been referred to 
 their proper districts among the eight dispensaries now forming 
 the Association, in accordance with this district plan. 
 
 At a recent meeting "The Association of Tuberculosis Clinics" 
 was formally organized, for the purpose of promoting co-opera- 
 tion between the tuberculosis dispensaries and to further the devel- 
 opment of tuberculosis dispensary work. It is hoped through 
 this association to largely increase the number of special clinics 
 treating tuberculosis and so to reduce the present congested 
 situation in the tuberculosis clinics. 
 
38 
 
 EXTRA-DISPENSARY TREATMENT. 
 
 The work that the members of the Committee have performed 
 together has strengthened their behef that for the satisfactory 
 hospital and dispensary treatment of tuberculosis in New York 
 City, there must be brought about a closer co-ordination than 
 now exists between the dispensaries and hospitals and that certain 
 changes in hospital and dispensary methods are essential. 
 
 In the segregation of advanced cases and the care of the desti- 
 tute and needy, in the physical improvement of some patients and 
 in lessons in prevention and cure offered in the daily experience 
 of institutional life, hospitals play an important and necessary 
 part in au}^ scheme for the municipal control of tuberculosis. But 
 there are certain patent defects that must be remedied before 
 these hospitals will do that which it is not unreasonable to expect 
 of them. Over- feeding and fresh air methods are not sufficiently 
 carried out in hospitals, instruction to patients and their visiting 
 friends is many times not thoroughly given, under one roof are 
 often cared for vagrants, vicious, alcoholic and respectable work- 
 ing people, chronic, advanced and early cases. At present we 
 build expensive institutions, we elaborate a costly method for 
 detecting cases that need hospital treatment, public and private 
 energy is expended to induce the consumptive poor to enter 
 hospitals. Too often finding, however, that the hospital is not 
 what he had expected, the patient's one desire is to get away, and 
 this, even though destitute and homeless, he does as soon as possi- 
 ble, taking with him a story of dissatisfaction which spreads 
 among his neighbors. And thus are kept from the hospitals others 
 whom physicians, nurses, inspectors and charity visitors have been 
 urging to leave their homes for the fresh air, the good and 
 abundant food and the rest and quiet of the hospital. 
 
 With the dispensaries the case is somewhat analogous — 
 patients are treated, but not as experience and observation show 
 is necessary if results are to be obtained most helpful to patients 
 and satisfactory to clinic physicians. To secure this there are 
 needed, in the first place, salaried dispensary physicians, clerical 
 help and more nurses. The salaries required to attract to this 
 service competent young physicians need not be large. But for 
 
39 
 
 the lack of a medical service that might be obtained at a modest 
 price several dispensaries are now^ badly crippled and dependent 
 upon the entirely fortuitous circumstance, that they are being- 
 served by enthusiasts who are now much overworked and quite 
 unable to give that detailed attention to their patients which in 
 tuberculosis is particularly essential to adequate treatment. To 
 the young practitioner in search of a livelihood the examination 
 and diagnosis of tuberculosis after a very few months seems of 
 comparatively little practical value and he abandons it for the 
 study of more widely varied types and for a service that does not 
 carry with it such feared possibility of infection. 
 
 And further, between hospitals and dispensaries there is not 
 now that amount of co-operation that is desirable and might be 
 had without much added effort or expense. Dispensary cases do 
 not enter hospitals with any dispensary report, and each case 
 must, therefore, be taken up by the hospital physicians without 
 the help that such reports might furnish. On the other hand, 
 cases are discharged from hospitals and left to report to dispen- 
 saries, or not, as they may choose, no especial effort being made 
 to secure the continuance at dispensaries of medical supervision 
 carried out at hospitals, and no report of observations made at 
 hospitals is given to patients to aid the clinic physician in diagnosis 
 and recommendation as to treatment. 
 
 CONCLUSIONS. 
 
 I. Home Relief in Advanced Cases Dangerous Substi- 
 tute FOR Isolation in Hospital. — As a general rule, subject 
 to but few exceptions, so far as the Committee's experience is 
 concerned, applicants for charitable aid because of tuberculosis 
 have the disease in such marked form, that the main considera- 
 tion, from a medical point of view, is one of preventing them 
 from infecting the other members of their households. The 
 attempt at cure or arrest of the disease is not infrequently fur- 
 ther greatly complicated by the ignorance, bad habits and the 
 poverty of the applicants. The Committee is therefore strongly 
 of the opinion that in New York City relief in the homes of con- 
 sumptives in a far advanced stage, is from the medical point of 
 view for the most part an unsatisfactory and dangerous substi- 
 
40 
 
 tiite for the isolation provided by the hospitals. But it is one thing 
 to advise a patient to go to a hospital, it is quite another to get 
 him there. Often he will not believe he is sick enough for a 
 hospital, or if he has not been able to live comfortably he wants 
 at least to die in peace with his family around him. Often the 
 going means that none are left at home to "mind the children" 
 or that the home will be broken up. 
 
 We strongly urge the importance of gradually overcoming 
 those natural objections by persistent effort. Of foremost nec- 
 essity is the improvement in the care and comfort aflorded such 
 patients in the various hospitals devoted to their use, and the 
 erection of an additional number of such hospitals. 
 
 II. Home Relief Inevitable. — Home relief and home 
 treatment are inevitable in the solution of New York City's tuber- 
 culosis problem. Avoid it by better things as often as we can, 
 we must at last face the constantly recurring problem of "home 
 relief of consumptives." Is it a problem impossible of solution? 
 Yes, in an overwhelming and appalling majority of cases, if 
 by relief is meant cure and given only the means and methods 
 now available. It is time that this be realized and ackno^vl- 
 edged, that there are over 30,000 tuberculous persons in the New 
 York Citv tenements, the most of whom will never see the m- 
 side of a hospital, though a smaller, yet still large number, will 
 enter the hospitals only to die there, and that such treatment as 
 the great army of sufferers is to receive is to be given in the 
 New York City tenements. 
 
 The selection of cases suitable for home relief should be made 
 very carefully after combined medical and social investigation. 
 AA'^hen once such relief is determined upon it is necessary for 
 anv permanent effect in these cases that it should not merely be 
 adequate to relieve want, but that it should be abundant enough 
 to make the patient gradually recover his lost strength and thus 
 overcome his disease. And furthermore, such relief must be 
 continued over a long period of time. It is especially important 
 that patients returning home from sanatoria with their disease 
 apparently cured or arrested, should be given every necessary 
 aid to secure favorable environment or employment in order to 
 guard against relapse. 
 
41 
 
 III. Cure in the Tenement Most Difficult. — The cure 
 of tuberculosis in a New York City tenement is far more difficult 
 to accomplish than it is under any other conditions. We have 
 only to compare the treatment given in the best sanatoria with 
 the best treatment that is possible in the tenements to demonstrate 
 the fact. The sanatorium provides for its patients, day and 
 night, an abundance of air — good, fresh, bracing air; food is 
 given of the best quality and in large quantities, and milk and 
 eggs between meals is usually added. Freedom from work is 
 an essential part of the treatment, even many times to the ex- 
 tent of complete rest and the avoidance of the slightest exercise ; 
 the patient is carefully watched from day to day by a physician 
 and every little idiosyncrasy of the patient, mental as well as 
 physical, is observed in suiting the treatment to his various and 
 changing needs. Life is made easy and comfortable for him, 
 and every attempt is made to banish worry from his mind. Even 
 with such treatment success can be the outcome only if the sick 
 man was not too sick when he entered the sanatorium and even 
 then only if he has the will to get well and the intelligence to do 
 his part during the institutional training. And if worries are 
 present while he is "taking the cure," and if he must go back 
 into his old manner of life, even of this carefully selected and 
 carefully treated group, the number is few of those who will even- 
 tually retain the modicum of health they have fought hard and 
 bitterly to regain. 
 
 The mere statement of what are regarded as essentials ior 
 such success as the sanatoria can show is sufficiently con- 
 vincing for those who know the New York City tenement and its 
 life. Air really fresh ; food, good and abundant ; freedom from 
 work and worry ; constant medical oversight ; intelligence and 
 ability to co-operate with the physician ; and then suitable em- 
 ployment when the cure shall have been effected and an income 
 therefrom sufficient to provide the air and food necessary if a 
 relapse is not to be after all the final outcome of the long, hard 
 struggle, where are these to be found by the crowded and con- 
 stantly more crowded New York City tenement dweller ? The 
 problem, though difficult, is not altogether impossible, and already 
 we may see glimpses of hope for the future. It is very gratify- 
 ing to note that despite the unfavorable conditions under which 
 
42 
 
 we labor in New York City more than 50 per cent, of the cases 
 which the Committee treated in their homes during the past year 
 improved. Three were apparently cured, and in seventeen cases 
 the disease was arrested. This is at least an earnest of what might 
 be accomplished if the treatment might be continued over a longer 
 period of time. Undoubtedly patients can be cured in the City 
 of New York, by patient and persistent care under prope** 
 medical supervision. 
 
 I\^. Day Camp A'aluable in Solutiox of Tuberculosis 
 Problem.- — If our short experience this summer in connection 
 with our day camp is of value and if the results as presented 
 bear any significance, and if, as we believe, the home treat- 
 ment of great numbers is necessar}-, then we are forced to admit 
 that the day camp or day sanatorium must in the future play 
 an important part in treating the tuberculous thousands of New 
 York, who must or will remain at home. It is evident from 
 our experience of last summer that many patients would attend 
 day camps if they were located in positions which could be 
 easily reached. 
 
 AVe would recommend, therefore, the establishment of a num- 
 ber of day camps, accessible to the various tenement sections of 
 the city with provision in connection therewith for careful home 
 treatment and adequate relief for needy cases, under care of one 
 or more of the special tuberculosis clinics. 
 
 V. CouxTRY Care of Consumptives. — Our experience with 
 the care of 70 patients in the country confirms more strongly the 
 opinion that this method of treatment is neither safe nor satis- 
 factory as a general practice. It is very difficult to keep any care- 
 ful and adequate supervision of persons thus sent out and as a rule 
 those who are dependent upon charitable organizations cannot 
 be relied upon to observe the proper and necessar\- precautions 
 when once they have tasted the freedom of countri- life. Liberty 
 with these persons too frequently leads to indulgence and has a 
 bad result. Although every possible precaution was taken in 
 instructing the patients and supplying them with the proper means 
 of disposing of their sputum, numbers of complaints were re- 
 ceived from the boarding-houses where the patients were sent. 
 
43 
 
 We, therefore, urge that the greatest precautions be observed in 
 recommending or advising the use of this popular method of 
 treating tuberculous patients. While the fresh air of the country 
 is splendid for any sufferer from lung diseases, it is not the best 
 course of treatment when medical and other supervision is want- 
 ing or inadequate. It seems to us that the only instances in which 
 it is safe or desirable to pursue this method of treatment are 
 arrested or early stage cases who have been thoroughly trained 
 through a long period of time and who can be relied upon to 
 observe the precautions necessary to prevent the infection of 
 those with whom they live, and in whom proper care of their 
 own health has become a fixed habit. 
 
 VI. Church Classes. — The principle of "giving a large 
 amount of attention to a small number of patients" has been best 
 exemplified in the church tuberculosis classes. The results ob- 
 tained by this method have been excellent and undoubtedly excel 
 those obtained by the larger dispensaries even with the present 
 district plan. This Committee wishes, however, to emphasize 
 its belief that such classes are necessarily very limited in their 
 sphere of usefulness and offer no solution of the great problem 
 of the home care of the whole mass of tuberculous poor, unless 
 they should be willing to take charge of a definitely defined dis- 
 trict or unless they should be run in connection with one of the 
 tuberculosis dispensaries. We believe by the establishment of 
 more and more special dispensaries and the subsequent division 
 of the city into small districts, that eventually quite as good 
 results can be obtained by the dispensary as by the church class. 
 The underlying principle of class work could even now be very 
 easily carried out by special workers, voluntary or otherwise, 
 devoting their time to a special group of patients in any dispensary. 
 
 VII. The Evolution of the Dispensary District Plan. — 
 Bearing in mind as we do the infectious nature of tuberculosis 
 and what few resources the tenement house dweller has for suc- 
 cessfully overcoming all the many disadvantages under which 
 he labors in fighting this ''disease of the tenements," we lay 
 especial stress upon the extension and perfection of the dispensary 
 system of which the foundations have already been laid ; and 
 
44 
 
 this despite the fact that the members of this Committee as chiefs 
 of the associated tuberculosis chnics are only too conscious of 
 the meagre results obtained and obtainable in endeavoring to 
 effect permanent cures at dispensaries. It is believed, however, 
 that the dispensary in charge of a district ever growing smaller 
 as new dispensaries undertake this work, with its visiting nurse 
 making more and more frequent inspections of the home condi- 
 tions of the patients, with examinations made compulsory of all 
 members of a household in which a case of tuberculosis shall be 
 registered, with emplo3'ers and employees co-operating with the 
 dispensaries to secure competent and early examinations of the 
 greatest possible number of employees, with school and health 
 authorities working for the thorough examination of school chil- 
 dren, it is believed that along these lines will be found the greatest 
 promise of satisfactory- results in the treatment of tuberculosis 
 in the New York City tenement. Thus will be detected early 
 cases among those whose labor is of a character favorable to 
 the contracting of tuberculosis, whose homes are unsanitary and 
 further endangered by the presence of tuberculosis, and who badly 
 nourished and badly housed now too often work too long in badly 
 ventilated shops until tuberculosis claims them as its victims. 
 A dispensar}- system thus examining and advising where 
 experience tells tuberculosis will be found, will cure because 
 it will detect cases in time to send them away to city hos- 
 pitals and countrv sanatoria, and it will prevent because it will 
 so carefully instruct its patients and so diligently keep watch and 
 ward over its neighborhood that infection will not be spread 
 broadcast as now it is by careless consumptives and those ignor- 
 ant that they have consumption. That this is not to be accom- 
 plished at once is recognized, that it will cost is admitted, but 
 that it is to the dispensary that appeal must be made to find 
 the curable and guide the incurable, we insist. Thus will the 
 30.000 sources of infection in this city be brought under con- 
 trol and prevented from carelessly spreading their disease. While 
 the diverse forces that are working for prevention are slowly 
 accomplishing their results the dispensary system will be holding 
 out a promise of cure to the sick and a hope of safety to the 
 healthv. 
 
45 
 
 VIII. Educational and Preventive Measures. — We be- 
 lieve that every energy and much more than is now used must be 
 bent toward the prevention of this preventable disease. The solu- 
 tion of the tuberculosis problem lies here, rather than in the cure of 
 those who are now suffering with the disease. We recommend, 
 therefore, the continuance and development of the educational 
 agencies already at work, together with such new methods as 
 may from time to time become expedient ; and the legislative 
 control of such recognized causes of contagion as spitting in 
 public places, dry sweeping of streets, use of dark rooms in 
 tenements for sleeping purposes. 
 
 IX. Examination of Families. — Of first importance in 
 preventing the spread of contagion is the careful supervision of 
 the homes of consumptives. Probably the persons most exposed 
 to contagion from tuberculosis are those who are constantly 
 associated with persons suffering from the disease and under 
 conditions which for persons with strong constitutions are not 
 propitious. These conditions undoubtedly prevail to a very con- 
 siderable extent in thousands of tenement homes in New York 
 City. Something should be done not alone to educate the con- 
 sumptive and those associated with him, but to discover in the 
 early stage those who are infected with the disease and then by 
 careful instruction and persistent watching either effect a cure, 
 or at least prevent the persons from becoming careless sources 
 of infection. No preventive measure is sO valuable as the proper 
 protection against the source of infection. We recommend, 
 therefore, that upon the first discovery of tuberculosis in the 
 home,- whether by private physician or public dispensary, every 
 member of the household should be immediately examined and 
 carefully instructed as to precautions necessary to prevent or 
 cure the 'disease. A beginning along these lines has been made 
 by the establishment of the children's clinics. 
 
 X. Co-Operation. — Too much cannot be said of the results 
 accomplished during our past two years' work in the establish- 
 ment of co-operative relationship between the several tuberculo- 
 sis clinics and between these clinics and the social workers. The 
 mutual education has been exceedinglv valuable. The difficul- 
 
46 
 
 ties confronting social workers have been brought very clearly 
 and forcibly to the attention of the clinic physicians and on the 
 other hand the problem of medical treatment at public dispen- 
 saries has been newly impressed upon those engaged in the solu- 
 tion of the social problem. This more accurate understanding 
 of their respective problems has brought these two essential 
 forces into very sympathetic relationship and has established the 
 basis for a common standard in the management of dependent 
 families, whose main cause of dependence is tuberculosis. 
 
 Reviewing the work of the Committee, which has extended 
 over a period of 20 months, and summing up the results of its 
 efforts, we believe that we have made the following contributions 
 to the solution of the tuberculosis problem : 
 
 1. A demonstration of the methods of relief necessary for 
 proper Home Treatment^ together with a comparative study of 
 the results obtained and expenses entailed by this and other 
 methods of treatment. 
 
 2. The establishment of a Dispensary District system 
 looking forward to the ultimate dispensary control of tubercu- 
 losis. 
 
 3. The demonstration of the feasibility of the use of the Day 
 Camp in connection with home treatment of tuberculosis in New 
 York City. 
 
 4. A careful study of the actual value that can be attached 
 to the ordinary country care of consumptives. 
 
 5. The establishment of Co-Operative Relationship be- 
 tween the tuberculosis clinics and social workers. 
 
 James Alex. Miller, M. D., Chairman. 
 R. A. Fraser, M. D. W. F. Persons, 
 
 James C. Greenway, M. D. Henry L. Shively, M. D. 
 S. F. Hallock, M. D. A. M. Shrady, M. D. 
 
 J. H. Huddleston, M. D. B. H. Waters, M. D. 
 
 Walter L. Niles, M. D. Gaylord S. White, 
 
 Henry S. Patterson, M. D. - Paul Kennaday, Secretary. 
 Frank H.Mann, Asst. Secretary. 
 
47 
 
 TUBERCULOSIS RELIEF FUND. 
 
 Receipts and Disbursements. 
 February 28 to September 30, igo6. 
 
 ■ Receipts. 
 Contributions : 
 
 Robt. S. Brewster $2,500.00 
 
 Andrew Carnegie 1,000.00 
 
 Harvey E. Fisk 500.00 
 
 Edward S. Harkness 5,000.00 
 
 John S. Huyler 500.00 
 
 V. Everit Macy 1,000.00 
 
 John D. Rockefeller 7.500.00 
 
 Grant B. Schley 2.500.00 
 
 20,500.00 
 
 William R. Woods 10.00 
 
 St. George's Society 8.00 
 
 Refunds 70.80 
 
 Unexpended balances 162.08 
 
 Interest 423.57 
 
 $21,174.45 
 
 Disbursements. 
 
 Administration Expenses : 
 
 Salaries $705.40 
 
 Printing and stationery 47.60 
 
 Petty expenses 156.37 
 
 Relief : 
 
 Transportation 404.35 
 
 Food 1,967.04 
 
 Clothing 426.49 
 
 Furniture, etc 193-45 
 
 Medical supervision and supplies 522.72 
 
 Nurse's salary and expenses 187.81 
 
 Care in sanatoria 657.91 
 
 Country board 3.909.58 
 
 House cleaning 206.13 
 
 Wage loss 750.98 
 
 Miscellaneous 88.24 
 
 $909-37 
 
 510,996.6 1 
 $11,905.98 
 
 Loan for expenses of Committee on the Prevention of 
 
 Tuberculosis 1,000.00 
 
 Balance on hand September 30, 1906 8,268.47 
 
 $21,174.45 
 
 I have examined this account with vouchers and find same correct. 
 (Signed) Frederick C. Manvee, Auditor. 
 Certified Public Accountant of the State of New York. 
 
48 
 
 TUBERCULOSIS RELIEF FUND. 
 
 Receipts and Disbursements. 
 
 October i, 1906 to November 30, 1907. 
 
 Receipts. 
 
 Balance on hand October i, 1906 $8,268.47 
 
 Contributions : 
 
 Brewster, Robert S $2,542.22 
 
 Harkness, Edward S 1,000.00 
 
 Macy, V. Everit 1,000.00 
 
 -. 4,542.22 
 
 Special contributions to Day Camp 1,210.15 
 
 Interest on bank balances 136.20 
 
 Return of Loan from C. P. T., General. 1,000.00 
 
 Refunds 168.23 
 
 Transfers : 
 
 From Provident Relief Fund 3,844.00 
 
 From C. P. T., General 2,421.15 6,265.15 13,321-95 
 
 $21,590.42 
 Disbursements. 
 Administration: 
 
 Salaries and wages 2.840.76 
 
 Furniture and fittings 90.00 
 
 Sundry 263.85 
 
 3,19461 
 
 Relief : 
 
 Rent 4,382.55 
 
 Furniture 334-84 
 
 Medicine 89.22 
 
 Clothing 984.61 
 
 Food 4,210.95 
 
 Board 1,630.64 
 
 Transportation 410.28 
 
 Sanatorium 278.04 
 
 Wage loss 1,487-78 
 
 Miscellaneous 190.91 
 
 Washing 52-44 
 
 Pensions and grants 1,553-34 
 
 15,605-60 - 
 
 Day Camp. 
 
 Equipment : 
 
 Supplies $515-82 
 
 Wages - 51-56 
 
 567.38 
 
 Maintenance : 
 
 Supplies 474-50 
 
 Medical supplies 32-51 
 
 Wages 806.13 
 
 Contingent 25. co 
 
 Milk and eggs 686.19 
 
 Washing 16.75 
 
 Carfares 181.75 2,222.83 2.790.21 
 
 $21,590.42 
 
 We have audited the receipts and disbursements of the Tuberculosis 
 Relief Fund of the Charity Organization Society of the City of New York 
 for the period ended November 30, 1907, and 
 
 We Hereby Certify that the foregoing statement is correct. 
 
 (Signed) Haskins & Seles, 
 New York, February 21, 1908. Certified Public Accountants. 
 
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