DEPARTMENT OF HEALTH, CONTAGIOUS DISEASE HOSPITAL BROADWAY AND SPRING STREET, BUFFALO, N. Y. STAFF. Contagious Disease Hospital. Walter S. Goodale, M. D., Superintendent. Jesse N. Roe, M. D., Resident Physician. Frank Walz, M. D., Interne. Miss Marjory Carney, Matron. Miss Helen Hart, Supervising Nurse. Miss Mabel Caldwell, Night Superintendent. Miss Sophia Wilson, Acting Housekeeper. + COMMITTEE ON SANITARY MEASURES. Board of Aldermen. William E. Shifferens, Chairman. George K. Staples. Elmer Harris. J. George Kelberer. Edward Stengel. BOARD OF HEALTH. Hon. Louis P. Fuhrmann, Mayor. Col. Francis G. Ward, Com. of Public Works. Francis E. Fronczak, M. D., Health Commissioner . August Schneider, Secretary. 4>W*c CONSULTING STAFF. Contagious Disease Hospital. PHYSICIANS. Charles G. Stockton, M. D. Henry 0 . Bus well, M. D. Nelson G. Russell, M. D. Archibald D. Carpenter, M. D. L. Bradley Dorr, M. D. ASSISTANT PHYSICIANS. George L. Fischer, M. D. John A. Ragone, M. D. Francis N. Pitass, M. D. Edward E. Koehler, M. D. Clarence L. Hyde, M. D. DISEASES OF THE SKIN. Grover Wende, M. D. Walter S. Good ale, M. D. DISEASES OF THE EYE. Lucien Howe, M. D. F. Park Lewis, M. D. Harry M. Weed, M. D. DISEASES OF WOMEN. Matthew D. Mann, M. D. James E. King, M. D. DISEASES OF THE NERVOUS SYSTEM. James W. Putnam, M. D. William Gaertner, M. D. DISEASES OF THE RECTUM. Edward Clark, M. D. Walter D. Greene, M. D. ORAL SURGERY. John H. Stackhouse, D. D. S. ORTHOPOEDICS. Bernard Bartow, M. D. Prescott LeBreton, M. D. SURGEONS. Roswell Park, M. D. Marcell Hart wig, M. D. Marshal Clinton, M. D. Joseph Burke, M. D. Edgar R. McGuire, M. D. ASSISTANT SURGEONS. Edwin L. Bebee, M. D. Thew Wright, M. D. Alfred Zittel, M. D. Harry R. Trick, M. D. James L. Gallagher, M. D. GENITO URINARY DISEASES. Thomas B. Carpenter, M. D. James A. Gardner, M. D. DISEASES OF THE NOSE, THROAT AND EAR. W. Scott Renner, M. D. James J. Mooney, M. D. OBSTETRICS. Ludwig Schroeter, M. D. Burt C. Johnson, M. D. DISEASES OF CHILDREN. DeWitt H. Sherman, M. D. Charles E. Abbott, M. D. Arthur C. Schaefer, M. D. PATHOLOGY. Herbert U. Williams, M. D. Burton T. Simpson, M. D. CLINICAL PATHOLOGY. John G. Hoeckh, M. D. Harry Ebberts, M. D. CHEMISTRY. H. M. Hill, A. M. BACTERIOLOGY. William G. Bissell, M. D. 2 TO THE MEDICAL PROFESSION OF BUFFALO, N. Y. O WING to the many false impressions which have been spread broad- cast either by accident or design regarding the Contagious Disease Hospital, I deem it wise to publish the results of the inspection which the Committee on Sanitary Measures of the Board of Aldermen made some weeks ago. Their report appears to be a plain statement of fact without .bias or prejudice. It upholds the position taken by the Board of Health in reference to the maintenance of the Hospital, which is, that an institution of this character either should be conducted properly or not at all. The Hospital buildings are not the tumble-down, disreputable, inade- quate structures that same would have ,us believe. Not having been erected for hospital purposes, their structural defects are many. In ad- dition they stood idle for two or three years and consequently were discovered in bad repair. Since a year ago last February, when we first took possession, the repairs and changes made have been many, so that now, barring fire protection, the Contagious Disease Hospital is in very fair condition when one considers that it is equipped to meet temporary . needs only. Many further improvements are necessary, however, before AQthe City of Buffalo could refute the charge of maintaining at the L corner of Broadway and Spring Street a hospital almost wholly lack- ing in the matter of fire protection. Structures which house the sick should be, above all others, fully protected from fire danger. About < $15,000.00 will be needed to put the buildings in proper condition. At ; least three-fourths of this will go toward protecting the inmates from ®\ possible incineration ; one-half of this amount, in the shape of a new K heating plant, can be utilized at the new Hospital. The Department takes this opportunity to disclaim any intention of ^ making repairs or alterations in the present buildings with a view to insuring their permanency. So far as possible every change con- templated is temporary in nature. It is hoped that the new hospital * will soon be a reality. Its need has been amply demonstrated during the past year and a half. The present institution has treated about 800 patients and even now there are over 90 people within its con- fines. The new edifice should be centrally located on ample grounds, but it must be borne in mind by those having the matter in charge that a modern Contagious Disease Hospital built on the pavilion system is necessarily costly to erect and expensive to maintain. As Mayor Fuhrmann aptly put it, “ Plain construction and adequate breathing space should not be confounded with extravagance of architecture and ex- pansiveness of lawn.” FRANCIS E. FRONCZAK, M. D., Health Commissioner. June 1, 1910. 3 A Few Remarks About the Present Contagious Disease Hospital. The report of the Sanitary Measures Committee which appears on the fol- lowing pages contains enough statistical information to make it of value as the first yearly report of the Contagious Disease Hospital. The facts and figures in relation to this phase of the Hospital work are not so complete as they might be owing to the fact that on February 19, 1909, the institution was hurriedly opened with the idea that it would be conducted for a few months only. Hence the records in the beginning were either improperly kept or entirely lacking. There is enough information at hand, however, to prove that the affairs of the institution have, on the whole, been properly administered. The average reader will no doubt be surprised to learn the magnitude of the business conducted at the corner of Broadway and Spring Street for the year 1909. This applies both to the number of patients treated and the amount of money handled. The report for 1910, complete in every detail, will be even more surprising in this respect. During the past three or four months the institution has averaged from 75 to 100 patients daily. This entitles it to rank with the large institutions of the city. A word in reference to the character of the contemplated repairs will not be amiss. The charge has been made both publicly and privately that the im- provements asked for on the ground of temporary necessity were merely a cloak to cover the permanent establishment of the Hospital on its present site. This is most emphatically denied. The repairs recommended and approved by the Board of Health are as follows: 1 “A heating plant to replace coal stoves now in use. Fire-proof inside par- titions , steel ceilings, fire-escapes, repair grand staircase in the main building , install fire alarm box, fire hose and stand pipes.” The absolute necessity for these changes must be perfectly apparent to everyone. Furthermore, the entire heating plant can be removed and installed in the new hospital when that structure is built. 2 (( Eepair gutters and conductor pipes, and rear roof of the main building, also the annex roof.” Strange as it may seem, the Department of Health, in this respect, is vio- lating an ordinance which it insists all good citizens shall observe. In other words, sanitary inspectors appear in the City Court almost daily against citizens who maintain defective conductors and roofs on their homes. 3 ee Outside paint for all structures. Grass and trees for the yard.” The buildings and grounds at present are hideous in appearance. The psychological effect upon prospective patients is most depressing. 4 ef V entilating shy-light in the main building:’ An abundance of fresh air is a necessity for well persons, to say nothing of those who are sick. 4 5 “Monolith floors” ^ The present pine floors have been badly worn by the tread of many small feet during the past 25 years. They are hard to walk upon and the numerous cracks make them difficult to keep clean. Monolith means a thin layer of cement spread over the old flooring. 6 “Separate outside entrances for all wards on the ground floor. Install three new bathrooms in the Annex and re-arrange bathrooms in the main building so that wards can be isolated” Every physician will concede that the prime requisite of a Contagious Disease Hospital is proper isolation. Arguments to prove this point are un- necessary. 7. “A house telephone system” We have four separate buildings located on a lot which, including the Kreiner property, measures about 250 feet by 200 feet. We receive on an average from 50 to 100 telephone calls daily. At present the office attendants obtain the information necessary to answer these inquiries by scurrying about the premises. 8 “Re-arrange resident physician’ s quarters.” Two graduate physicians now reside in one old class-room in the main building. They are on duty 24 hours daily. They have neither a sitting- room nor a bathroom; not even a clothes closet. 9 “Repair foundation walls in the main buliding.” This means pointing up in just a few places to prevent seepage. 10 “Convert one ward into an operating-room and a drug-room.” Our present drug store does a thriving business in spite of the fact that it is located in an old bookcase left behind by the school authorities. We have had one operation for appendicitis and several others requiring a general anaesthetic. These were performed in the front hall under perfectly septic conditions. 11 “Provide suitable ambulances.” The remarks made in reference to the vehicles owned by Keller Bros, and used by us for ambulance purposes reflect in no wise upon the afore-mentioned firm. The City of Buffalo gets exactly what it pays for. The liverymen maintain four different carriages which are used for hospital ambulance work only. In addition there is a team of horses and a man on call day and night. Eor this we pay $2.50 per call, regardless of the distance covered. Manifestly it is absurd to expect that Keller Bros, would provide spirited steeds, magni- ficent equipages and perfectly groomed drivers under these conditions. The Health Commissioner has every reason to feel proud of the consulting staff of the Contagious Disease Hospital which will be found listed on another page of this pamphlet. Its personnel includes many of Buffalo’s most distin- guished physicians. It also compares favorably with similar bodies attached to other Hospitals in the city. 5 The Department of Health has endeavored in the past to make the Con- tagious Disease Hospital attractive to both physicians and public alike. This policy is especially desirable when one realizes that hospital quarantine is discretionary and not mandatory. It is attractive to the public for the reason that the prices charged are reasonable. The rates, $10.00 per week, include board, room and medical attendance if desired. Many citizens are awakening to the fact that quarantine cannot be kept in the home for $10.00 a week or less. Those who cannot afford to pay the above price have no difficulty what- ever in making satisfactory arrangements with the poor officers of the city or county. Many receive orders absolutely free. Patients are admitted to the institution on demand regardless of whether or not they are able to pay. The details are arranged later. The Hospital is attractive to physicians for the reason that it maintains an open house policy. In other words, a doctor may attend and have full charge of his own case, whether it be a city, county or pay patient. All receive the same treatment. House employees are in- structed to follow out to the letter the orders and instructions of all physicians having cases in the institution. Comment on the report contained in the following pages is unnecessary. It speaks for itself. To those who may question its verity a cordial invita- tion is extended to visit the Hospital and find out for themselves whether or not the statements contained therein are the truth, the whole truth, and nothing but the truth. WALTER S. GOODALE, M. D., Superintendent . REPORT. To the Honorable, the Board of Aldermen, Buffalo, N. Y. : Your Committee on Sanitary Measures, to which was referred the question of in- vestigating and reporting on the conditions found and the manner in which the Con- tagious Disease Hospital, at the corner of Broadway and Spring street, Buffalo, N. Y., is being conducted, reports that the following members of the Committee were present at the inspection which was made Thursday. May fifth. 1910: Messrs. E. Sten- gel, Kelberer, Harris and Staples; Chair- man Shifferens being absent on account of illness in his family. Health Commis- sioner Fronczak and Assistant Health Of- ficer Schaefer were in the party which was conducted by Dr. Walter S. Goodale, super- intendent. Our manner of entrance into the hospital shqwed that every precaution is taken be- fore outsiders are allowed to enter. We were equipped with duck gowns, extending from the neck to the floor, with hood at- tached completely covering the head; cot- ton gloves and arctics completed the cos- tume. These coverings, we were informed, are used only once before being fumigated. Main Building. The main hall of the building has been divided into two parts by a wooden parti- tion, one portion being used for a general office, the other constituting thq main hall of the hospital. Both have separate en- trances, the office door being used by the public and the doctors, while the hospital door is used for the reception of patients only. The main floor contains 4 wards, 1 small dressing room and 1 large water closet and bath room, in addition to the main hall. The grand stair case, which has badly worn treads, ascends to the second floor where are located 4 wards similar to those downstairs, in addition to 1 large water closet and bath room and the resident phy- sician’s quarters. The basement of this building contains a well equipped kitchen, with a dumb waiter running to all the upper floors adjoining; a drying room, an electric laundry consist- ing of one 64-inch gas mangle, two electric flat irons, 1 extractor, 1 washing machine and 1 5-horsepower motor. Here also are found a large laboratory, a water closet room for servants and nurses, a servants’ and nurses’ locker room, a 6 storeroom, a morgue and the staff dining room. Opening off of the main floor toward the rear is a series of 2 bath rooms, used for discharging patients, and immediately ad- joining is a formaldehyde chamber in which patients’ clothes are fumigated and disin- fected. This building is a two-story brick struc- ture with a flat slate roof. The walls are apparently solid and appear to be without cracks or other imperfections. The inter- ior of the building is divided longitudinally by 2 16-inch fire walls extending from the ground to the roof. The roof is in first class condition, but the gutters and con- ductors are badly rotted and broken. The foundation walls are in good condition but owing to the fact that there is standing- water outside of certain portions of the building, the basement is damp in spots. This latter condition is entirely due to the defective conductors. Apparently there is no weakness of the walls. There is one fire escape across the back of the structure which takes in the water closet and bath room and one ward on the second floor. The 7 other wards of the building are without fire protection of any kind. The interior of the edifice shows evidences of having undergone recent re- pairs. The plaster is in good condition and has received two coats of water color paint very recently. The woodwork including the wainscoting has been neatly done in oil. All blackboards have been removed and replaced by plaster, wainscoting and mould- ing, thus removing all traces of the uses to which the building was formerly put. Floors, made of pine, are badly worn. In some places they are less than an eighth of an inch thick. Were it not for the fact that the biiilding is double-floored a person of ordinary weight would break through. In many spots the pine knots protrude from half to three-fourths of an inch. LIGHTING— The 4 front wards are lighted by 6 large windows each. The rear wards have 5 windows each. Each window has an area of 31 square feet. Thus the win- dow area in front is 25.91 per cent, of the floor space. Owing to the fact that the building has a southern and western ex- posure, these rooms are unusually bright and sunny. ARTIFICIAL LIGHTING— The entire building is lighted by electricity. PLUMBING— The following plumbing has been installed in the main building: BASEMENT — 1 water closet for physi- cians. 1 for nurses and 1 for servants: 1 large laboratory sink and 2 kitchen sinks. FIRST FLOOR — 1 large room containing the following fixtures, each fixture in a small Compartment made of matched boards and built head high; all except 2 end compartments are without communica- tion to the outer air: Two water closets and 2 bathtubs for men; 1 water closet, 1 bath tub and 1 slop sink for women; 2 bath tubs and 1 water closet for discharging patients; 1 dressing room sink and 1 office sink. SECOND FLOOR— 1 water closet and 1 bath tub for men; 1 water closet and 1 bath tub for women; 1 dressing room sink. 1 wash stand in resident physician’s room. This makes 5 water closet bowls and 5 bath tubs for the use of patients. At the time of the inspection there were 73 pa- tients housed in this portion of the hospital. In other words, there is only 1 water closet for every 14 patients. As before mentioned, all plumbing com- partments, except the 2 end ones, have no direct communication with the outer air, which makes them most unsanitary and very often a nuisance. VENTILATION — This is of the natural variety, reinforced by ducts built in the chimneys. Owing to the fact that the hos- pital is almost square, each ward being on a corner with windows on either side, th > air supply is ample. Each ward measures 32x23x14 feet and averages about 1,030 cubic feet of air space per patient not al- lowing for hallways. ODORS. — There is absolutely no odor per- ceptible upon entering the building, for the air space is liberal and the windows are unusually large. HEATING. — The heating system consists almost entirely of coal stoves of the old- fashioned railroad station type. They are dangerous, dirty and dU^’^t to manipulate. Unquestionably, it is nothing short of crim inal to heat a non-fireproof hospital by such methods in the year 1910. There is one range in the kitchen, 3 gas stoves and 14 coal stoves scattered about the building. Like the old-fashioned fire-place these stoves have the effect of roasting nearby patients if those in more distant portions of the room are to be kept comfortable. Each stove is provided with a heavy zinc fire screen. NOISE. — There were no noises audible within this building except the ordinary street clatter. CLEANLINESS. — The entire building from top to bottom we found as clean as it could be made with the aid of soap, water and paint. Annex. Adjoining the main building on the east is a one-story wooden structure, 85 feet by 42 feet. It is badly in need of paint and is covered by a well worn gravel roof, very leaky in spots. There is no cellar. It con- tains 4 large wards, all opening into a main hall. Toward the east just off of this hall is a small serving room, from the walls of which large chunks of plaster have fallen down caused by a leak in the roof. The walls and the ceilings are in good condition, the plaster having recently re- ceived two coats of water color paint and the woodwork 2 coats of oil paint. \ 7 PLUMBING. — There is 1 bath tub, 1 water closet and 1 sink. At the time of inspection there were 27 patients in this building, making 1 water closet for every 27 people. VENTILATION. — rr, ~ building has a nat- ural system of ventilation aided by a large ventlating tower in the main hall and regis- ters built in the chimneys of each ward. Each ward is 30x20x12 feet making the air- space 1,066 cubic feet per patient. HEATING. — The structure is heated by 5 coal stoves of the same type as those in the main building. Owing to the fact that it is made of thin wood walls and has no cellar, this building is extremely difficult to heat during the cold weather. LIGHTING. — Each ward contains seven windows, whose area is 125 square feet, making the window area 20.85 per cent, of the floor space. ARTIFICIAL LIGHTING.— Natural gas is in use at night. ODORS. — No unpleasant odor of any nature whatever could be detected in tlie building. NOISES.— Upon listening intently a faint drowsy hum could be heard coming from the machine shop next door. Nurses’ Cottage. To the rear of the Annex and facing east on Tousey alley stands a one-story and half cottage, containing 6 rooms. This is used for nurses’ quarters. At the time of inspection it housed 10 nurses. It is heated and lighted by natural gas and has been neatly painted in parts. It is sorely in need of paint on the outside and the roof should be shingled. It has a bath room recently installed, which is done off in white enamel with fixtures in first class condition. The cottage is neatly furnished and scrupulously clean. It is however, much too small for the use to which it is put. It was originally built as a janitor’s cottage for the school house. General Location of Buildings. These structures stand on the north- easterly corner of Broadway and Spring street. The lot is 185 by 190 and is bound- ed as follows: On the south by Broadway; on the west by Spring street; on the north by the Kreiner residence and on the east by Tousey alley. The percentage of lot occupied is 29.23 per cent. The committee, in walking around the yard paid particular attention to the matter of unpleasant or disagreeable odors. They were unable to detect any. Apparently the air surrounding this hospital is just as pure as the air surrounding the City Hall. The vegetation in the yard is scant for the reason that the top layer of the soil is composed of 6 inches of cinders surmounted by a thin layer of gravel. The Kreiner yard ad- joining, which has been well cared for ex- hibits a beautiful lawn, a tulip tree in full bloom and several other shrubs and trees, all in first class condition. Your Committee was particular to notice the presence or absence of unpleasant noises. When we arrived at our meeting place outside of the hospital, it was noted that the. windows of the Wendt machine shop were closed. Shortly after our ap- pearance they were opened one by one, un- til almost the whole side of the building was dotted with open windows. In spite of this fact, as we listened in the yard, we could detect no unusual noises or any loud clanging or banging. There were sounds issuing from the factory but none of an unpleasant or annoying character. Patients and Nurses. At the time of inspection, there were 73 patients in the main building and 27 patients in the Anntx, making a total of 100. It has a capacity of about 150. At no time has it been filled. This makes the Contagious Disease Hospital rank fourth in point of size among the hospitals of Buffalo. The County Hospital, the Gen- eral Hospital and the Sisters’ Hospital are the only ones having a larger attendance. During certain seasons of the year even the Sisters’ Hospital has a smaller num- ber of beds occupied than are at present filled in the institution at the corner of Broadway and Spring street. The patients were exceedingly neat and clean and had a well fed and well cared for look. The convalescents appeared to be enjoying themselves and were as happy as one could be in an institution of this char- acter. The nurses bore evidence of being com- petent, careful, intelligent women, and the wards had a well ordered look generally. The beds and bedding were in first class shape, the linen white and clean and the white enamel bedsteads bore not the slightest trace of dirt or neglect. In fact, barring structural defects and lack of heat- ing facilities, the wards and patients com- pared favorably with those of any hospital in the city, barring none. There is one nurse on duty who acts as dietitian. She does not prepare the food but devotes her time exclusively to seeing that all patients are fed and fed properly. The dishes used we found in first class condition and the manner of handling the same is to be highly commended. Enamel ware is in use throughout the hospital. These dishes are done off in various colors, one color for each disease. The silver ware is stamped with a die, each piece con- taining the name of the disease for which it is to be used. By this system the scar- let fever patients have their own dishes, while the measles patients have still an- other kind. This system reduces the dan- ger from cross-infection by means of dishes to a minimum. The milk supply of the hospital is delivered in the yard where it Is poured directly from the milk dealers’ 8 cans into the hospital cans, the former never entering 1 the hospital building. The main building is used exclusively for scarlet fever, while the Annex is used for measles, erysipelas and diphtheria. Each building has its own set of nurses. Thus every precaution is taken to guard against cross-infection. Visiti ng. Arrangements have been made so that parents may visit those children who are up and dressed. A specially constructed screen door in the office permits parents to see their children, the latter remaining on the hospital side. Precautionary Measures. Every possible care and precaution is taken in the discharge of cured patients from the hospital. There are two sets of bath rooms used for this purpose. The nurse in charge of the ward from which the patient is leaving, removes the hospi- tal clothes from the patient and gives him a cleansing bath. He is then seat down a narrow passage to a bath room located lust outside of the main building where a nurse clothed in sterile garments receives him and he is given another cleans- ing bath. This is followed by a bichloride bath. During all of these ablutions, spe- cial attention is paid to the scalp. An electric hair dryer has been installed in the latter bath room. The patient is then arrayed in clothing which has previously been brought from home that morning by parents or friends. If this last is not possible, he is fitted with clothing which has been well fumigated the night before. He is then discharged through a door which is used for no other purpose. That the same care and precaution is taken in reference to nurses leaving the building after their day’s work, is attested by the following set of rules which your committee found posted on the walls of the Nurses’ Cottage: ‘Notice’ “Nurses in the employ the Contagious Disease Hospital, Broadway and Spring- street, Buffalo, N. Y., either on day or night diity, will sleep in the dormitories provided. Nurses on leaving the hospital buildings will wash their hands and face with soap and Avater, and follow the same with an ap- plication of 1-2000 bichloride solution. They will also leaA’e their caps, gowns and shoes in the room proA'ided for this purpose. Nurses will not leaA r e hospital grounds Avearing any part of their uniforms. Washing the hands and face, applying 1-2000 bichloride solution to the same, and making an entire change of clothing aapII be deemed a sufficient precaution Avhen any of the nurses wish to take exercise but do not intend to enter any public place or private dwelling. In case a nurse desires to avail herself of the latter privilege she Avill take a full cleansing bath, a full 1-2000 bi- chloride bath (which also includes washing and disinfecting the hair and scalp) and make an entire change of clothing before leaving the premises. Any nurse a\’1io disregards the aboA’e rules will be instantly dismissed. She will fur- ther be prosecuted to the full extent of the laAv for Aiolating the rules and regulations of the Department of Health and the Char- ter and Ordinances of the Oity of Buffalo which provides for the maintenance and regulation of quarantine.” (Signed), Supt. Contagious Disease Hospital. Reception of Patients. At the time of inspection, your Committee had an opportunity to note the manner in which patients are received at the institu- tion. The ambulance appeared to be an ambulance in name only. As a matter of fact the vehicles used for transporting pa- tients are second-hand carriages while the horses are Avorn out old plugs. In short, the equipages are a discredit to the City of Buffalo. A nurse or physician accom- panies the ambulance on each call. The patient upon being brought into the building is halted in the front hall Avhere he is examined by the physician on duty and the diagnosis of the physician committing the patient confirmed. A culture is then taken from the throat after A\ r hich the pa- tient visits the bath room AA T here he is thor- oughly scrubbed. He is then put to bed. His history and record is brought in by the am- bulance attendant. Apparently extreme care is taken to prevent errors in diagnosis. Number of Employes. There are 32 employees on the payroll of the hospital. Their title and number fol- io avs: 1 Superintendent. I Resident Physician. 1 Matron. 1 Supervising Nurse. 1 Night Superintendent. 14 Nurses. 1 Dietitian. 1 Bookkeeper. 1 Cook. 3 Maids. 3 Laundresses. 2 Janitors. 1 Fumigator. 1 Painter. Bookkeeping System. The book and record keeping system of the hospital seems to haA*e been A'ery Avell worked out. The Patients’ Register con- tains the complete family history of every person in the hospital. It is numbered ser- ially and shows that up to date the hospital has received 789 patients. From here the patient is then recorded in the time book where a record of his entire stay in the 9 hospital is kept. There is also a ledger, a cash book, and a patients' daily report book, showing the number of patients in each ward at the close of every day. There is a daily roster kept of the nurses, showing the wards in which they are on duty, the amount of daily, weekly and Sunday time they have off, the time spent on night duty and the number of days they are ill. A similar book is also kept showing the ser- vants’ records. After a patient is discharged, the fever charts and bedside notes are fumigated and turned into the office, where they are cor- rected and annotated by the resident physi- cian. They are then placed in a large en- velope numbered with the patient's serial number taken from the register and filed away in a cabinet in numerical order. These record envelopes are indexed according to name in a card index. Thus, if any in- formation should be desired a year hence regarding John Smith, his name could be looked up in the card index, his serial num- ber ascertained, the proper envelope located and every scrap of information regarding the patient’s medical history and treat- ment during his entire stay in the hospital could be ascertained. AH goods and supplies received at the hos- pital must be accompanied by a memoran- dum bill, the same to be receipted by the department head receiving the goods. These are placed on file and used in check- ing up the monthly vouchers which are transmitted to the Common Council. These vouchers are entered in a suitable record, item for item, and properly priced. Thus a complete record of everything bought and paid for by the hospital is on file. There is also another record k,ept of these vouch- ers, wherein the amounts are charged to the ' various departments using the goods. Here one may find the exact cost of each branch of the service. This last book has been specially devised and in addition to containing a record of the vouchers for the amount of moneys disbursed, it also con- tains a record of all receipts either by cash or by warrant. Upon consulting this book, the hospital authorities can immediately determine their balance with the Comptrol- ler. It furthermore has the advantage of being a record of all outstanding and un- paid vouchers. This seems to be a decided advantage as most City Departments have no means of knowing the amount of their indebtedness. At the time of inspection Expert Account- ant Cowles was engaged in examining the books. All figures and statistical informa- tion recorded in this report have been re- ceived from the superintendent of the hos- pital and the Committee relies upon Mr. Cowles’ report for their confirmation. A combined statement of the hospital fi- nances for the year 1909 follows: Hospital expense $21,283.77 General Fund 4,989.45 Accounts due (pay cases) 817.42 Accounts due (City cases) 2,165.98 Accounts due (County cases).... 6.28 Cash on hand (Dept, of Health). . 65.71 Cash on hand (Comptroller) 12,443.09 Bureau of Buildings 9.02 $41,780.72 L. F. Anderson $10.00 Pay cases (Total amt. reed.) 3,472.53 City cases (Total amt. reed.) 11,891.37 County cases (Total amt. reed.).. 6.28 Appropriations (Total amt. reed.) 26,391.52 Special repairs 9.02 ,$41,780.72 Note:— The sum of $1,530.08 should be added to hospital expense, making the total for the year $22,813.85 instead of $21,283.77. This is necessary on account of the out- standing vouchers Jan. 1, 1910, unpaid at that time. Your Committee wishes to call attention to the fact that this institution last year handled $41,780.72, of which amount $22,- 813.85 was spent in maintaining the hos- pital. An itemized account of this expenditure follows: Groceries $746.86 Meat and fish 754.61 Bread and milk 1,501.02 Butter, eggs, cheese and ice 1,082.22 Fruit and vegetables 474.24 Drugs 621.18 Surgical and w'ard supplies 757.38 Linen, tablew r are, dishes and bed- ding 2,100.84 Clothing 236.48 Kitchen utensils 267.33 Repairs 391.90 Construction 1,118.19 Paints, oils and maintenance sup- plies 541.54 Heat and light 992.49 Laundry 165.32 Laboratory 100.55 Ambulance 695.00 Office expense 228.28 Miscellaneous 447.63 Pay roll 9,591.29 $22,813.85 Repairs (Bureau of Buildings)... $3,000.00 The comparatively small amount spent for construction and repairs is ample evi- dence that more money ought to be spent in this direction. The statement also dis- closes the fact that there were received from paid patients $3,472.53 and from the Overseer of the Poor for City patients $11,- 891.37. The Superintendent of Poor con- tributed $6.28. There was appropriated by the Common Council of the City of Buf- falo in all $26,391.52. Of this amount there was on hand in the office of the Comptrol- ler $12,443.09. These last figures represent the money available for hospital mainten- ance from -January 1, 1910, to July 1, 1910, beginning the next fiscal year. The following report gives the number of patients received during the year and the number on hand December 31, 1909: 10 Admitted: Scarlet fever 437 Measles 12 449 Discharged : Cured 379 Improved 6 Trans 1 Died: Scarlet fever 26 412 On hand Dec. 31, 1909 37 Manner of Maintenance: City cases 365 County cases 3 Pay cases 81 449 Average number of patients per day, August 1, 1909, to January 1, 1910. . 36 Average number of days in hospital per patient for year 1909 38 Sex: Male 315 Female 234 449 Number of days board in year. . 16018 Daily cost of raw food per pa- tient 28% cents It also contains information of value to those interested in the construction, erec- tion and maintenance of a new hospital. It shows, for instance, that the average num- ber of patients per day from August 1, 1909, to January 1, 1910, the only period during which this information was avail- able, was 36. Since January 1, 1910, this figure would probably be considerably larger. The average number of days each patient was in the hospital was 38. The number of days board in the year was 16018. From these latter figures and the amount spent for edibles, we are enabled to compute the cost per capita of raw food for each patient daily. It amounts to 28% cents. A hospital report of the Presbyterian Hospital, New York City, one of the larg- est and best regulated in the country, shows the per capita cost to be 32 cents. The mortality rate is 5.79%. The mor- tality rate of the Boston City Hospital, one of the oldest and best contagious dis- ease hospitals in the country is 11.84%. Conclusions. In view of the above facts which your Committee discovered during its inspection and investigation of the Contagious Dis- ease Hospital we would express ourselves as being heartily in favor of the repairs and alterations which were recently recom- mended by the Board of Health of the City of Buffalo. After a careful survey of the entire situation we are convinced that these improvements are necessary for the decent maintenance of a temporary hospital and will in no wise effect its permanency or the proposition of the erection and con- struction of a new Contagious Disease Hos- pital. We feel with the Health authorities that the City of Buffalo should either main- tain a hospital properly or else close it up. Furthermore, after a careful study of the situation which includes numerous consul- tations with a large number of Buffalo’s leading physicians we are of the opinion that these improvements should be carried forward at once. Many of them can only be perfected during the mild weather and as the town still seems to be in the grasp of an epidemic, we consider it would be very dangerous to delay this matter so that another school year would be upon us with nothing done. The repairs recommended and approved by the Board of Health are as follows: A heating plant to replace coal stoves now in use. Repair gutters and conductor pipes and rear roof of the main building and the an- uex roof. Outside paint for all structures. Monolith floors. Grass and trees for the yard. Ventilating skylight in the main building. Fire-proof inside partitions. Steel ceilings. Fire escapes. Separate outside entrances for all wards on the ground floor. A house telephone system. Iron stairway in the main building. Rearrange resident physician’s quarters. Repair foundation walls in the main building. Install fire alarms, also fire hose and stand pipes. Convert one ward into an operating room and a drug room, which will allow room for enlarging present public office. Provide suitable ambulances. Install 3 new bath rooms in the Annex and rearrange bathrooms in the main build- ing so that wards can be isolated. We feel that it is only just and proper to recommend the splendid work that has been accomplished by Walter S. Goodale, Supt. of the Hospital, in perfecting the organization which your Committee discov- ered during its investigation on May 5th last. This institution was opened in an abandoned school building on the 22d of February, 1909. At that time the late Health Commissioner, Ernest Wende, planned to maintain it for a month or two, and then close it up. Hence, no great plans or preparations were made for an extended stay. As time went on, however, it soon became evident that the hospital could never be closed without discharging a large number of sick patients upon the commu- nity. It was then determined to make such temporary repairs as were deemed neces- sary. This task was rendered doubly dif- ficult owing to the fact that the hospital was practically filled with patients who 11 had to be properly cared for while altera- tions and repairs were being made. At the present time the organization is a model of efficiency, and patients and nurses alike bear every evidence of discipline and control. In short, an organization which will compare favorably with many of the older institutions of the City has been es- tablished in a building which was never designed for the uses to which it has been put. Report of City Chemist Hill. Dr. F. E. Fronczak: Dear Sir— Examination of the condition of wards selected at random at the hospital for contagious diseases on the morning of May 10 gave results as follows: Ward on second floor, southwest corner, main building. Windows, 6. Windows open, 2, about 5 inches each at top. Children, 12. Ages, 4 to 10 years. Air outlets, 2 near top of room, one in outer and one in inner wall; one in inner wall connects with chimney stack; outer one ends in garret. Size of outlets, 176 square inches. Air delivered by outlets, 37,020 cubic feet per hour. Air delivered for each patient, 3,085 cubic feet per hour. Carbon dioxide in air of room, 6.43 parts in 10,000. Ward in northeast corner of annex: Windows. 7. Windows open, 3 about 3 inches each at top. Patients, 6 children, 2 adults. Air outlets, not in operation. Carbon dioxide, 5.20 parts in 10,000. Carbon dioxide in outer air, 4.84 parts in 10,000. The main building if continued in use as a hospital should have all its air ducts from the wards carried through the roof, a central ventilating shaft in the hallway, so heated as to produce a good draft and a bathroom and water closet for each ward; the closet and bathroom separate from each other. HERBERT M. HILL, City Chemist. Signed, GEO. K. STAPLES, Acting Chairman. ELMER HARRIS, J. GEORGE KELBERER, EDWARD STENGEL, Committee on Sanitary Measures. Note.— Chairman Sliifferens did not take part in the above inspection on account of illness in his family. Note.— The daily cost of raw food per patient in above schedule is too high, owing to the fact that the total cost of edibles includes patients and employees, while the num- ber of boys’ board in the year refers to patients only. This error was discovered after the Committee had made its re- port. 12