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 CONSUMPTrOIS 
 IN DELAWARE 
 
 By JOHN J. BLACK. M. D. 
 
 Member of the College of Physicians, Philadelphia 
 Member of the Delaware State Medical Society, Etc. 
 
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 Published for the Author. 
 1902 
 
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 pruface:. 
 
 Delaware, from her geographical position, from the intelli- 
 gence of her citizens, and from the productiveness of her soil, has 
 always held a commanding' place in the Union of States. 
 
 To hold this place secure, it is necessary for her to keep step 
 with all advancement, both of material and thought. To assist in 
 furthering this end, this brochure has been written. 
 
 Ji\0. J. BLACK. 
 New Castle, Delaware, October, 1902. 
 
Consumptives in Delaware. 
 
 Consumption has been well termed the Great White Plague, 
 and has probably been coexistent with animal life on the earth! 
 and is as common, if not more common, among the lower animals 
 than it is among human beings. It has been noted and described 
 by Hippocrates as far back as 460 B. C, but it was not until the 
 year 1882 that we knew surely its real cause. Then it was tiiat 
 
 ^^LS 
 
 Robert Koch gave to the world his great discovery of the Bacillus 
 Tuberculosis, and since that day we have known that this little 
 microscopic rod-shaped body, a body of the vegetable kingdom, 
 but so close to the animal kingdom as to be almost of it. is the 
 active cause of all tuberculous troubles, in fact, is tuberculosis it- 
 self, is consumption itself. Probably every seventh person who 
 dies, dies of some form of tuberculosis, and most of these die from 
 tuberculosis of the lungs, which we commonly call consumption. 
 Many years ago the geographies told us that forty-five i)eople 
 
died in the world every minute. To-day it is estimated that two 
 people die of tuberculosis in the world every minute. It is indeed 
 the Great White Plague, and yet the average man takes little or 
 no account of it. Surely there is an awakening going on and the 
 fight against these parasitic diseases is just beginning, and in one 
 or two hundred years we may hope to see them in a great measure 
 banished from the world, provided the battle is properly waged, 
 and the weapons in our hands are diligently used. Tuberculosis 
 is not nearly so controllable as cholera, yet what a panic cholera 
 creates when it attacks a community. Tuberculosis is carrying 
 off millions where cholera is carrying off thousands, yet how su- 
 pine has man been in waging war upon tuberculosis, his worst of 
 earthly enemies. 
 
 My object in writing this brochure is tO' bring this matter of 
 the contest againsit consumption before the people of Delaware, 
 and to urge that they be not laggards in this fight, which in the 
 end must do so much toward the upholding and even the preser- 
 vation of the human race. In the treatment of her unfortunate 
 citizens who have been deprived of the use of their reason this 
 State has taken an advanced step, and any one who may visit the 
 State Hospital at Farnhurst cannot but feel that we in Delaware 
 are among the most advanced of civilized communities in our 
 care of these unfortunate people. When the new building for the 
 tuberculosis cases of this hospital, now about to be contracted for, 
 has been completed, we will be among the very first in the world 
 to carry out this great reform. The insane and all defectives are 
 very obnoxious tO' the tubercle bacillus, and it is surely within our 
 province and duty to protect these poor creatures and at the same 
 time help stamp out a horror and menace to all the world. 
 
 At the present time the condition of the consumptive is most 
 deplorable, and every day it is becoming more pitiable. Since the 
 infectious nature of the disease has become known, his home, if he 
 is among friends, is his only refuge, and here in many cases he is 
 only tolerated. He is an unwelcome visitor in social life; he is 
 not wanted in hotels or in vehicles of travel, and the wards of the 
 general hospitals are becoming more and more shut against him. 
 Who is more to be pitied than the consumptive; who is so much 
 to be pitied as he or she who has consumption and at the same 
 time is without money and without friends? It may well be said 
 that the hand of every man is against them, and may God help 
 the man who will not do all in his power to alleviate their helpless 
 condition. Help is at hand, and I trust the good people of Dela- 
 ware, both those in her legislature and those who have means be- 
 yond their own necessities, will open their hearts and their purses 
 to these unfortunate people. Consumption is as much a social as 
 
it is an individual affliction, and it behooves the State to act for 
 its suppression as a menace to human happiness and human ex- 
 istence. Consumption is an infectious disease, and is undoubtedly 
 communicable from one human being to another, and notwith- 
 standing the unfortunate break of the great Koch, I believe every- 
 thing points to the communicability to man of the disease from 
 the lower animals. 
 
 How far have we progressed in the treatment of consump- 
 tion as to its cure? Well, thus far, consumption is undoubtedly a 
 curable disease. Oh, what hope, what joy this conveys to the 
 sufiferer, when heretofore all before him had been a cloud of de- 
 spair, as impenetrable as a rock and as black as Erebus. If a pa- 
 tient with consumption comes to a physician now there is a very 
 strong probability that the physician may to-day tell him with 
 truth that he has a good chance to get well. What would be the 
 methods the good physician would use, would it be potions and 
 pills? No. Thank God the science of medicine is fast getting 
 away from potions and pills. He would tell the patient to go to 
 the Sanatorium and get well. Even ten years ago he would prob- 
 ably have told him to go home, his end from consumption would 
 be the usual end of all such sad cases, and be a mere question of 
 time. 
 
 From the statistics of the State Board of Health there were 
 in 1891 nineteen hundred and fifty-one deaths in Delaware. Of 
 these, ninety-four were reported as from consumption, seventy- 
 four from tuberculosis, and fifty-seven from phthisis, making in 
 all two ihundred and twenty-five deaths from tuberculosis. Un- 
 doubtedly nearly all of these deaths were from pulmonary tuber- 
 culosis, or consumption, and show more than one death in eight 
 from tuberculous troubles. In 1900 the population of Delaware 
 was: New Castle county, 109.697; Kent county, 32.762. and Sus- 
 sex county, 42.276. making the total population of the State 184.- 
 735. In 1892 with a population of 61.431 Wilmington city re- 
 ported 127 deaths from tuberculosis. In 1892 New Castle county 
 reported 160 deaths. Here is the bad showing for the congested 
 centre and in these congested centres our fight must be waged the 
 hardest. In 1882 there were 253 deaths reported from consump- 
 tion. In 1889 there were 237 deaths reported. In 1890 there were 
 239 deaths reported. In i8gi there were 319 deaths reported 
 from consumption, being 164 in New Castle county, 61 in Kent 
 county, and 94 in Sussex county. I quote these statistics to show 
 the necessity of action on the part of our people to stay this ter- 
 irble scourge. I'oston statistics show that the mortality from 
 consumption has decreased six per cent in the last twenty years. 
 
6 
 
 This is encouraging. Boston is away up head both in her sta- 
 tistical methods and in her fight against consumption. 
 
 What is the modern method of fighting consumption? First, 
 commence the fight in the incipient stages and keep it up bravely 
 until one party yields. The great remedies are fresh and pure air, 
 sunlight, amusement and employment for the mind and body, 
 water in its various forms and uses, massage, pneumatics and 
 gymnastics and forced feeding. These combine the chief weap- 
 ons. Drugs take a secondary place and are only used on certain 
 occasions and under special conditions. Serum treatment for 
 tuberculosis is not yet encouraging. Inject Koch's tuberculin, 
 which is a toxin and not an antitoxin, into a consumptive, and 
 you get a rise of temperature and confirm the diagnosis and you 
 do the patient no injury whatever. Continue this injection and 
 this toxin you inject is aided by the toxin of secondary infection 
 already in the consumptive's blood and you do him harm. This 
 is why Koch's tuberculin failed and we witnessed the solemn 
 spectacle of disappointment among consumptives and their 
 friends. The bacillus itself is a parasite and lives on the animal 
 body. The problem before us is to destroy it and its toxin de- 
 veloped by it in the animal body and yet not destroy that animal 
 body. The successful serum will not be a toxin serum as are the 
 tuberculins, but an antitoxin serum like diphtheria antitoxin. 
 Some animal will be rendered immune to the toxin and its serum 
 will be the antitoxin to the tubercle bacillus toxin and also if to 
 the bacillus itself, then we will have it. 
 
 How and where are these remedies best applied? At home, 
 in the Sanitarium or in the Sanatorium. Home treatment is a 
 possibility under two conditions. First, where the patient has 
 means and a proper home with proper medical supervision. Sec- 
 ondly, where the patient has advanced to the stage of secondary 
 infection in the disease he may have to do the best he can at his 
 home. There is a possibility of one going to one of the numer- 
 ous Sanitaria in the country and getting good care and good at- 
 tention, but these institutions no longer want tuberculous cases 
 and many won't take them, and very properly so. Next we come 
 to the Sanatoria. Here is the proper place to treat the consump- 
 tive, and if all incipient cases to-day could get such treatment I 
 have little doubt but in twenty-five years the mortality from con- 
 sumption would fall ofif fifty per cent. While the first great use of 
 the Sanatorium is probably for treatment, it is of almost as great 
 use as an educator. Here is where it comes in as a factor in po- 
 litical economy. A patient at a Sanatorium soon learns how to 
 care for himself as to reinfection of his own system and the infec- 
 tion of others, and w*hen he goes home to his family he carries out 
 
 
these rules, and even if not cured he so Hves as to make himself 
 little or no menace to the lives of others. Thus in the end Sana- 
 toria will save many lives to the State, and each of these lives ih 
 worth $5,000. There comes in the economical factor. It is the 
 cold-blooded way to look at it, but it is nevertheless true. The 
 State gets back in dollars and cents more, much more, than she 
 expends in thus protecting her citizens. 
 
 My chief object in writing this article, I may say, after bring- 
 ing the matter of the modern treatment of consumption before 
 the people of Delaware, is to call the attention of the coming 
 Legislature to not only the advisability, but to the necessity of 
 providing a State Sanatorium for Consumptives for the use of the 
 citizens of the State, and I trust the medical profession, the State 
 Board of Health and the different local Boards of Health and all 
 the good people of Delaware will second this appeal with all the 
 strength and all the force they can command. I can only imagine, 
 I can only hear one objection, — money. It is not a matter of dol- 
 lars and cents, it is a matter of absolute necessity to relieve the 
 horrors of a situation no one has yet stopped to consider, a situa- 
 tion, if not taken in hand, is sooner or later destined to undermine 
 the human race and make defectives and pigmies of us all. IMassa- 
 chu setts, probably the most democratic in her State government 
 of all the States, I mean by that, that her people are more largely 
 represented in her State Senate and House than are the people of 
 any other State, has taken the lead in this matter, as she does in 
 all matters pertaining to the good of her citizens, and has estab- 
 lished at Rutland, Massachusetts, a Sanatorium for the treatment 
 of consumption, with a capacity of two hundred and fifty patients. 
 Our neighbor. New Jersey, has through her last Legislature, 
 made a large appropriation and the site for the building has just 
 been chosen on the high ground of upper Jersey. Ohio has also 
 moved in the matter, and she too will soon have her State Sana- 
 torium for Consumptives, as surely every State in the Union 
 must, sooner or later. Those who lag must bear the burden. 
 Since my last writings on this subject in the latter part of 1899 
 the knowledge of treatment has, of course, made some advances, 
 rapid advances indeed. To-day the high elevation is not con- 
 sidered of such great importance. Open air. sunlight and feeding 
 are of the greatest importance. Cases do well with these remedies 
 properly applied even if near the sea level. Put the Sanatorium 
 in the most available place your State affords, treat the patient in 
 his own natural environment so that when he gets well lie makes 
 no radical change in his surroundings. These are probably the 
 latest and best ideas. Another point. Will the establishment of a 
 Sanatorium in a community raise a local panic of fear of infection 
 
of the neighborhood? On first thought such might be the effect, 
 but experience of the Sanatoria in Germany where they have been 
 estabHshed for fifty years, and of all the Sanatoria that have been 
 established in England and in the United States, in fact all every- 
 where, teach just the opposite. In all neighborhoods where con- 
 sumptives congregate in Sanatoria, or in towns and villages 
 where they congregate for private treatment, the mortality from 
 consumption among the old residents has visibly declined and the 
 general death rate has declined. The reason is this: The com- 
 munity has been educated as to how to treat the consumptive and 
 how to avoid infection from resident consumptives. A higher 
 civilization has dethroned the sign "don't spit on the floor," as 
 useless, just as in the far West, the same hig'her civilization has 
 dethroned the sign of the red lantern saloons, "don't shoot the 
 musician, please, he is doing all he knows." Any community 
 may welcome a Sanatorium for consumptives as an educator and 
 purifier and in many ways desirable. 
 
 I have spoken of the Massachusetts State Sanatorium for 
 Consumptives at Rutland. This institution is known officially as the 
 Rutland Sanatorium. The word consumptive in connection with it 
 is referred to as little as possible. This is in keeping with the gen- 
 eral idea prevailing to-day. The Delaware State Hospital for the 
 Insane is known now as the Delaware State Hospital atFarnhurst. 
 It is not known bv its designation as an insane asylum. I recently 
 visited Rutland with a letter from Dr. Osier to Dr. Walter J. 
 IMarcley the efficient superintendent. I spent a pleasant and 
 profitable day there and was shown marked attention by Dr. Mar- 
 cley and his assistants. Doctors Dunham and Lapham. The in- 
 stitution at present accommodates 250 patients, about equally di- 
 vided between male and female. Most of them appear to be be- 
 tween twenty and thirty years of age. I noticed one case, a fe- 
 male, 57 years of age. The elevation here is about 1200 feet and 
 the buildings are so placed on the southern declivity as to leave 
 a well wooded hill behind them which serves to keep off the 
 northern storms. The proper railroad station is ^luschopauge, 
 one station nearer Worcester than Rutland, and where a good 
 conveyance is usually found to convey persons to the Sanatorium. 
 The State owns about 250 acres of land and is about erecting 
 farm buildings. This land cost about $5,500. The structures are 
 frame, with of course, much glass. Outside is frame with metal 
 laths and over this slap dash cement finisih. Inside are metal 
 laths, hard plaster and enamel paint. This gives a hollow and en- 
 tirely dry wall. The Hospital was opened in the fall of 1898. The 
 act creating it was passed in 1895. Recently a new^ addition has 
 been added. The State has already spent on this institution near- 
 
9 
 
 ly a half million of dollars. There are a series of two-story build- 
 ings built in a semi-circle with the administration building in the 
 centre. There are two kinds of pavilions. One kind has seven 
 small rooms and a large ward accommodating twenty-two pa- 
 tients. The other kind of pavilion has seven rooms and a ward 
 accommodating only ten patients. Each pavilion has a glass so- 
 larium or sun parlor and large verandas encircle all the buildings. 
 In the pavilions the sexes are separated by the administration 
 building. The idea at the start at this Sanatorium was to receive 
 only incipient cases, and not make it in any way a home for the 
 hopelessly sick. Patients who do not improve after a sufBcient 
 trial are advised to leave and take treatment elsewhere more 
 adapted to their cases. I may say while passing, many private 
 Sanatoria are being started in many parts of the country and those 
 who have means will be amply provided for in all stages of the 
 disease. But the poor, where is their refuge? 
 
 An incipient case is one where the physical signs are confined 
 to small areas in one or both apecis and where the 3 p. m. tem- 
 perature is not marked. All patients take their own temperature 
 on rising in the morning and at 3 p. m. the temperature of every 
 patient is very carefully taken by a trained nurse and noted on the 
 card. This is the temperature that tells the story. After the in- 
 cipient comes the well "marked incipient cases." Here the phy- 
 sical signs are a little more marked. A moderately advanced case 
 is one when we have dullness, mucous and bubbling rales and 
 bronchial breathing. The advanced cases have the well marked 
 cavities, with secondary infection, with all that this implies. Dr. 
 Vincent Y. Howditch of Boston, one of the visiting physicians, 
 says, that although the Hospital is primarily for incipient cases, a 
 large number in whom the disease was well marked and even ad- 
 vanced have been received when there was a prospect of improve- 
 ment. The results in the latter he says have often been most sur- 
 prising and gratifying. No patient can take a private room and 
 thus there arc no privileges that money can buy that give one pa- 
 tient favors over another patient. The private rooms are under the 
 care of the physicians ancl a patient is put in one of these rooms 
 for cause. They are isolation rooms as it were, and are used for 
 acute illness, etc. Most of the professions are represented among 
 the inmates. Many are school teachers and many tradesmen and 
 tradeswomen and many laborers. No distinction whatever is 
 made. It is altogether a democratic institution. From October 
 I, 1900, to October i, 190 1. Dr. Bowditch rc])orte(l 201 cases con- 
 sidered. Men. 102; women, 99. Average age. 28 years. Average 
 length of stay in institution, six months. Eighty-five left with tlie 
 disease arrested. .\n arrested case is where the cough, expectora- 
 
10 
 
 tion, bacilli and fever have disappeared and where the patient 
 looks healthy. If this arrested condition continues two years the 
 case is pronounced cured. Only eight cases left not improved. 
 There were no deaths. Eighty-five cases were arrested, forty-five 
 very much improved, thirty-one much improved, improved, 
 thirty-two. Of the arrested cases, the longest stay was 14 months 
 7 days. The average stay of these cases was 5 months and 12 
 days. The shortest stay was one month and 8 days. Of the very 
 much improved cases the longest stay was 22 months and 22 
 days. Of the much improved cases the longest stay was 16 
 months. Average gain in weight of all cases was 14.2 pounds. 
 Greatest gain in weight of arrested cases was 36 pounds. Every 
 year more favorable results are obtained in all cases. Of 35 cases 
 tabulated as arrested in 1898-1899 all are alive except two. Of 
 33 remaining 26 are known to be well and are at work. Dr. Bow- 
 ditch has recently examined many of these. It may be stated here 
 that circulars of inquiry are constantly sent to the discharged 
 cases and replies are received regularly, thus keeping the run of 
 the cases. 
 
 Seven cases discharged as improved in 1898-1899 are still in 
 good shape. Of 56 cases arrested and discharged in 1899-1900 
 all are in good shape except 4, relapsed. These are wonderful re- 
 sults and most encouraging. 
 
 During my visit I dined with Dr. Marcley and his family, 
 composed of his mother. Doctors Dunham and Lapham and 
 about two hundred and fifty consumptives. I hope I will not ex- 
 ceed the bounds of social etiquette if I tell what we had for din- 
 ner. First, every one appeared to have a good appetite and did 
 ample justice to a good soup, roast beef, potatoes, beets, bread 
 and butter and milk, followed by a cornstarch pudding. Here we 
 had nitrogen carbohydrates and fats in a well adjusted ration. 
 Every one was cheery and there was little or no coughing. The 
 day was frosty and just before dinner the temperature of the room 
 was run up to 60 degrees Fah. and again opened up after dinner. 
 The patients get up at 7 a. m., take a cold bath and breakfast at 
 7.30; luncheon, 10.30; dinner at 12; luncheon, 3.30; supper, 6: 
 luncheon, 8.30; lights out at 9.30. If cold in the morning the 
 watchman shuts doors and windows of rooms and wards at 6 a. 
 m. and runs temperature up to 60 degrees Fah. to dress by. When 
 this is over they are immediately opened up again. All windows 
 and doors of rooms and wards are open when patients are in bed, 
 even if the thermometer goes below zero. If cold, use more 
 clothes and coverings. No carpets or hangings allowed. When 
 not in bed patients are out on the grounds or piazzas or in the 
 sun parlors. Rules as to expectorating are absolute. Always ex- 
 
11 
 
 pectorate in the pocket flask or in cuspidors in the house appoint- 
 ed for the purpose. Never even expectorate on the ground in the 
 woods on pain of dismissal, and never swallow expectoration, 
 never. Through the woods are many huts and tents open to the 
 south where patients spend much time, and some are even pro- 
 vided with improvised stoves where they may toast their feet. 
 There is a large and well appointed amusement room seating sev- 
 eral hundred attached to the Sanatorium and there are many very 
 bright people among the patients. They give entertainments and 
 many outsiders come to them. One may ask, are they not afraid 
 of taking the disease? No. Tubercle bacilli have no show in this 
 institution. They never get loose and there is no infection of 
 other people. It is far safer for a healthy stranger in the theatre 
 of the Rutland Sanatorium with a crowded audience than it is for 
 him in any average place of amusement, or hotel dining room in 
 any part of the world. After ten years education by Sanatoria 
 and such, these average places of amusement and hotel dining 
 rooms will be much safer than they are now. Here is one of the 
 great reasons for the States imitating Massachusetts in starting 
 Sanatoria for consumptives. October, 1900, to October, 1901, 
 the cost per patient per week was in all $9.47. The patients each 
 pay $4 per week and the State pays the remainder, being that 
 year $5.47 per week. Many of the patients work out their board 
 and there will be more of these when the farm buildings have 
 been finished. There are six trained nurses employed at $30 per 
 month. As a rule, with their life in the open air night and day, 
 patients never get a cold. Here is an object lesson for us. The 
 poor consumptive always tells us how he took his cold. He is in 
 error. He has not taken cold out of doors. Tubercle bacilli get 
 in their work in the house and in crowded rooms. There are 
 colds. We take them from going from hot to cold, from dry 
 to wet. A part becomes chilled, here is a local congestion, be it 
 in the lungs or some other place, here is a focus of infection, the 
 pathogenic germ does his work here and the kind of germ domi- 
 nates the coming illness. This is taking cold. I visited the model 
 dairy farm owned by a gentleman from Hartford. Here were 
 stabled sixty Holstein and Guernsey cows, as fine as I ever saw. 
 and the surroundings were perfect for such an establishment. 
 Each cow is tested by tuberculin every six months and any sus- 
 picious cow is at once eliminated. From this dairy about 400 
 quarts of milk go to the Sanatorium daily. Tuberculin is some- 
 times used in the institution as a diagnostic test on patients with 
 satisfactory results. An an illustration of how the patients are 
 fed. Dr. Marcley told me some individuals took as much as 24 
 glasses of milk in 24 hours. This amounts probably to five 
 
12 
 
 quarts. Many take six raw eggs and would take more, but the 
 supply is limited. Of course cases with poor digestion, with a 
 tendency to diarrhoea and similar troubles showingthe mesentery, 
 intestinal tract, and such parts involved, do not do well. The cure 
 of consumptives showing these sysptoms is usually hopeless. 
 
13 
 
 A Delaware State Sanatorium for Consumptives. 
 
 There are probably at the present time in Delaware 5,000 
 persons suffering from tuberculosis in its graver or lesser forms. 
 Dr. Vincent Y. Bowditch says there are probably 200,000 cases of 
 consumption in ^Massachusetts to-day. Massachusetts has a pop- 
 ulation of nearly 3,000,000. The same population would give 
 Delaware over 12,000 cases, but as Massachusetts is full of con- 
 gested centres of population I should say 5,000 might cover the 
 number of cases of tuberculosis of all grades in Delaware. Some 
 authorities say tuberculosis is some form attacks fully one-third 
 of all the people in overpopulated countries. What an object les- 
 son to spur us on to active work for the preservation of the race. 
 
 It is neither practical nor desirable that all of these people 
 should go to a State Sanatorium. The Sanatorium should be 
 started to aid as many as possible of the cases fit for hospital 
 treatment, and especially should it be started to commence to 
 educate not only the sick but the general public as to the possi- 
 bility and feasibility of the cure of consumption to prevent its 
 communication to healthy persons. Here are the uses of the 
 Sanatorium for Consumptives and sooner or later every State 
 must take this matter up and act favorably, liberally and intelli- 
 gently upon it. Why should Delaware delay? Why should her 
 people falter in a matter so vital to the preservation of the race 
 and to their temporal prosperity? Let Delaware become an ad- 
 vanced State in all matters pertaining to the prosperity of her in- 
 habitants, and see how soon intelligent people from other com- 
 munities will seek homes within her borders and thus pay many 
 fold for all money expended in such laudable progress. To make 
 a beginning in this great work I believe the State should accjuire 
 the proper amotmt of land and put up proper buildings to ac- 
 commodate thirty patients. Tt would be possible to increase this 
 number for at least eight months in the year l)y forming a camp 
 of tents and huts on the grounds of the Sanatorium proper. Thus 
 great good would be done and the campers would be so educa- 
 ted as not to be a menace to themselves and others when they re- 
 turn to their homes. See the possibility here. This education 
 commencing and going on constantly must in a very few years 
 
14 
 
 go far to stamp out this horrible affliction, and oh the hope it 
 brings to those Hves we prize so dearly when overtaken by this 
 Great White Plague. Don't go home to die, go to the Sanator- 
 ium and get well. God hasten the day when every physician in 
 Delaware can thus lift the great load from his own conscience 
 and gladden the hearts of his consumptive patients. Is there any 
 point to-day which comes up to the well versed physician and 
 vexes more in its solution that what to do with our consumptive 
 patients? We know what we ought to do, but we are helpless 
 and the poor patients are helpless and a menace to themselves 
 and others. 
 
 As to the location of the Sanatorium the southern slope of 
 Iron Hill would be an ideal site. It is among the highest points 
 in the State, about 340 feet above tide water, and in every way 
 desirable. It should be possible to acquire land there, say one 
 hundred to two hundred acres, at a reasonable rate and placing 
 the buildings at a reasonable distance from the top, well wooded, 
 would give a windbreak sufficient to make the surroundings all to 
 be wished for in a Sanatorium. The location of the institution, 
 wherever it may be, will in every way add tO' the importance, the 
 development and the material advance of the neighborhood. The 
 cost of buildings should not be great. Four hundred dollars per 
 patient for thirty patients would be a fair estimate. To provide 
 for something extra for the administration building, I should 
 think $15,000 would be sufficient to start the enterprise so far as 
 the buildings are concerned. Exclusive of salaries and some 
 other items, I believe one dollar per day per patient should cover 
 the expenses of the institution. For thirty patients this would 
 amount to say $11,000 per year. Let the patients pay 50 cents 
 per day board. This should cover salaries and the other items. 
 One physician and two trained nurses should be able to carry on 
 the work at the start. The patients need very little nursing. 
 Much of the other help can be obtained by persons willing to 
 work for their board and treatment. These estimates I know are 
 shaved very close, but if the State will purchase the site and ap- 
 propriate $25,000 the first year I believe the buildings can be built 
 and the undertaking be fairly launched to run to January i, 1904. 
 An appropriation of $12,000 more would carry it up to the time 
 of the next Legislature, January, 1905. Now let the Legislature 
 act and their names will go down in the history of Delaware as 
 the creators of the grandest work of the century! I repeat, this is 
 not a question of dollars and cents, it is a question of happy 
 homes, of lives plucked from fires fed by the parasites around us, 
 a question of very salvation to the human race. 
 
 ■a 
 
15 
 
 The State Board of Health of Delaware is composed of gen- 
 tlemen taken from among our best and ablest citizens, and I be- 
 lieve the Legislature, if in its wisdom it should see fit to enact a 
 law establishing this great charity, would in every way do the 
 right and proper thing did it enthrone them with the power to 
 erect and carry on a Sanatorium for the treatment of unfortunate 
 citizens of this State suffering from consumption. Let us have a 
 Delaware Sanatorium, or an Iron Hill Sanatorium, or a Sanator- 
 ium by any other name, so the word consumption has no share in 
 it. Then we can say to the wayfarer who hitherto has only been 
 treading the downward path, don't go home to die, take hope, go 
 to the Sanatorium and get well. God speed the day. 
 
 Note. — For an object lesson as to what can be accomplished by the 
 establishment of a Sanatorium for Consumptives, see an illustrated article 
 in the Philadelphia Medical Journal, November 8. 1902, by Dr. Lawrence 
 F. Flick, entitled, "A Year's Work at the White Haven, Pa., Sanatorium 
 of the Free Hospital for Poor Consumptives." 
 
SUNDAY STAH PRINT. 
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 .*A 
 
 r * "^ 
 
 C28 ( 946) MlOO 
 
GAYLAMOUNT 
 
 PAMPHLET UNDER 
 
 ManufacluteJ bu 
 
 GAYLORD BROS. Inc. 
 
 Syracuts, N. Y. 
 
 Stockton, Calif 
 
 
 f 
 
 
 RC313.D37 
 
 656 
 
 ( 
 
 Black 
 
 i 
 
 Consumptives in Delaware. 
 
 
 WAV 1 g 
 
 ^94« C. U. Hl^.o^ 
 
 
 
 J 
 
 
 
 ^ 
 
 
 
 RC3/3'.D3>'7 
 
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