REPORT OF THE COMMITTEE ON SANATORIA FOR CONSUMPTIVES. To the State Board of Charities: Your Committee on Sanatoria for Consumptives submits herewith its annual report. During the year widespread attention has been given in the State to the proper treatment and prevention of tuberculosis. Conspicuous among the agencies engaged in a campaign to educate the people on the subject are the State Charities Aid Association and the State Board of Health. In their campaign of publicity methods were used which appealed to the wideawake American public. Advertisements were used, the psychological principles of interest and attention were followed, art was called in, the lecture platform was employed, and folders, leaflets and newspaper articles were widely circulated. Besides these an emblem was adopted to serve as a reminder that tuberculosis is a preventable disease, terse mottoes were repeated and reprinted until they have become known everywhere in the State. Thus by persistent work with pictures, lantern slides, models, charts, statistics, talks, sermons, committees, day camps, open air schools, clinics and sanatoria these societies and many others are teaching the great public the prophylaxis of the disease. Physicians, social workers, clergymen, laymen and other public spirited persons are joined in the great work. The President of the United States and the Governor of the State have spoken in behalf of the propaganda and important legislation has been enacted looking to the proper care of the disease. Labor organizations have started day camps to care for their own members, and industrial and other corporations have established sanatoria for tuberculous employees and policy holders. The slogan "No Uncared-for Tuberculosis in New York State in 1915" and the more sanguine watchword "No Tuberculosis in 1920" are heard now on every side. Cities with high death rates from tuberculosis are now accorded unpleasant publicity and other communities in which the disease is prevalent are under close scrutiny. A clean bill of health is a matter of civic pride, and an epidemic of a preventable disease a disgrace. During the year 1909, more than 41,000 patients were under treatment in institutions, clinics and dispensaries in this State for tuberculosis in its various forms, and $1,669,179.76 was expended by public and charitable agencies in the treatment and prevention of the disease. The State maintains at Raybrook, Essex county, New York, a State Hospital for the Treatment of Incipient Pulmonary Tuberculosis, with a capacity for approximately 200 patients. The average number of patients during the year was 166, at an average weekly cost of $8.95 for support. The 274 patients discharged during the year claimed residence in the following counties of the State: Of these, 272 were medical discharges and 2 for discipline. Two hundred thirty-one of these patients remained three or more months with the following results: A hospital created solely for the treatment of incipient disease should above all things be able to receive its patients as soon as they make application. This has not been the case at Raybrook. The average length of time which elapses between the receipt of an application and the actual admission of the patient is one hundred days, long enough for the disease, if active, to become fastened on the patient. This anomalous situation will presently be remedied, for plans are under way to double the capacity of the hospital. Chapter 154, Laws of 1909 (special act) appropriated for the west pavilion with connecting corridor, laundry and connecting porches, and for alterations in the main building to provide additional kitchen, dining room, and storeroom facilities, $99,500; for a new power-house, coal pockets and stack, $33,000; for a railroad switch into the coal pockets, $3,000; for conduit and piping from main building to the new power-house, $16,100; for new power plant equipment, $8,400; for new electric unit, new electric feeder cables, moving present electrical equipment and installing switchboard, $4,800; for additional sewage disposal bed, $3,000; for equipping the west unit, $8,000; for east pavilion with connecting corridor and connecting porches, $87,500; for additional power equipment, including two additional boilers, etc., $10,000; for the construction of a reservoir to contain one million gallons, and for repairs to present dam, including fire pump and new water lines, $26,000; and for equipping east unit, $8,000. The hospital will have an ultimate capacity of 340 patients. City, county and State authorities must work together if tuberculosis is to be eradicated. The State hospital at Raybrook was intended as an object lesson to the counties and cities in the treatment of tuberculosis by proper outdoor life, rest, nourishment, and constant medical supervision. It is located in the Adirondacks at an altitude of 1,625 feet, and has 516 acres of land adjoining the forest preserves. While a change of climate is often beneficial, especially in incipient cases, it is not practicable to remove many consumptives to places distant from their homes. The majority of those who need public care belong to the laboring classes and as soon as recovered they must return to their work. It is best to cure these people in a climate the same or nearly the same as that in which they must work, for experience has shown that while this kind of cure may take a little longer, the danger of relapse is decreased. In locating a county or city sanatorium the following rules, laid down by an authority on the subject, should be borne in mind: "The patient will do better in the outskirts of the city than in the city proper; better in the higher parts of the locality than in the lower; better in a clear or relatively clear, dustless atmosphere than in a dusty one; better in a pure, smokeless, or relatively pure and smokeless locality, than in one full of smoke and odors; better in a locality where he may get the benefit of whatever sunshine there is than in a valley, cañon, or narrow street surrounded by high buildings; better where there are few houses than many; better where there are relatively few people than where there is overcrowding; better where there is little traffic and little noise than the reverse." Chapter 341, of Laws of 1909, amended the County Law by adding ten new sections relative to the establishment and management of county hospitals for the care of consumptives. By it boards of supervisors are empowered, by a majority vote, to establish county hospitals for tuberculosis, to acquire land therefor, erect all necessary buildings, provided that the plans are approved by the State Commissioner of Health, to levy taxes for the maintenance thereof, appoint a board of five managers for the term of five years each, and accept gifts and bequests for the benefit of the hospital. Henceforth no special legislation will be required before a county can establish a tuberculosis hospital. New York State is not alone in this matter. Five other States Illinois, Iowa, Ohio, Minnesota, and Virginia - have passed laws giving power to erect local hospitals for tuberculosis. In New York State county hospitals have already been provided for in Ontario and Monroe counties, and they are being considered in Onondaga, Oswego, Cortland, Albany, Jefferson and Schenectady counties. Erie, Oneida, Chemung and Rensselaer counties have already established hospitals. Tuberculosis hospitals were given to the cities of Elmira and Newburgh through private philanthropy, to the former by Mr. and Mrs. Rapelyea, and to the latter by ex-Governor Odell. In the fall of 1909 the New York City board of health had record of 20,000 cases of tuberculosis, whose whereabouts were unknown, and estimated that not less than 8,000 cases of the disease were at large in the most crowded parts of the city. In view of this, prominent physicians asked the Board of Estimate and Apportionment for an additional appropriation of $487,250 to fight the disease. The money, if granted, would be distributed as follows: Department of Health, $372,660; Board of Education, $22,140; Bellevue and Allied Hospitals, $17,460, and the Department of Charities, $75,000. The economic loss in New York City due to tuberculosis is estimated to be $15,000,000 annually. A law is needed to permit health officers to remove tuberculosis patients from their homes to hospitals, unless they are convinced that the home care of patients is satisfactory, and such as not to spread the disease. Compulsory care and segregation of tuberculosis patients is necessary, and to this end every community should have adequate hospital facilities for the treatment of the disease. In the fifth annual report of the Henry Phipps Institute it is stated that 25.81 per cent. of the patients treated by the institute during the year contracted tuberculosis from the preceding generation, 29.37 per cent. from the immediate generation, 3.55 per cent. from a succeeding generation, 8.87 per cent. from consort's family, 11.06 per cent. from fellow employees, and 4.64 per cent. from contaminated houses. Thus over 55 per cent. gave a family relationship of some kind as a cause for their disease. This leads to the conclusion that education by itself cannot accomplish much in the prevention of tuberculosis. For effective prevention isolation of the advanced cases is necessary, and your committee recommends that steps be taken in New York State to provide treatment for and enforce the isolation of all advanced cases of tuberculosis. Respectfully submitted, STEPHEN SMITH, M. D., Albany, New York, October 1, 1909. Committee. |
