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The Tuberculosis Infirmary
OF THE
Metropolitan Hospital
Department of Public Charities
NEW YORK CITY
BY WALTER SANDS MILLS, A. B., M. D.
Chairman of the Tuberculosis Committee of the Medical Board; Associate
Member of the Association of Tuberculosis Clinics of New York City,
representing the Department of Public Charities; Member of the National
Association for the Study and Prevention of Tuberculosis; Member of the
New York State Committee of the International Congress on Tuberculosis.
New York:
MARTIN B. BROWN COMPANY, PRINTERS AND STATIONERS,
Nos. 49 to 57 PARK PLACE.
1 9 o 8.
'(INVTISI SATTIGHAASIOV ^I{I. -IO (INGH HILMION-GISIQOH LHOITI
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The Tuberculosis Infirmary of the
Metropolitan Hospital.
HISTORICAL SKETCH.
In 1875 the municipal charities and prisons of New York
City were, and had been for a number of years, administered
under a board of three members appointed by the Mayor and
known as the Commissioners of Charities and Correction. The
charities included a number of large hospitals. For several
years the homeopathic branch of the medical profession had en-
deavored to get a foothold in one of these hospitals through the
Commissioners, but without success. During the winter of 1874
and 1875 a more determined effort was made, and a petition
signed by six hundred and fifty-five taxpayers representing more
than half the estimated wealth of New York City, was presented
to the Commissioners of Charities and Correction asking that a
public hospital be set aside for the homeopathic treatment. There
was some delay in getting a favorable response, so the matter
was laid before Mayor William H. Wickham by a committee of
laymen headed by A. T. Stewart and William Cullen Bryant.
The Mayor took the matter under advisement, and shortly after
the request was granted ; a building on Ward's Island, in the
East River, to be known as the Ward's Island Homeopathic
Hospital, was assigned for the desired purpose. It was opened
for the reception of patients October 15, 1875.
The general administration was, like that of the other City
institutions, under the supervision of the Commissioners of Chari-
ties and Correction. A resident superintendent was appointed
to look after the local affairs of the new hospital. The medical
and surgical treatment was placed in the hands of a Medical
Board of twenty-five physicians and surgeons chosen from the
membership of the Homeopathic Medical Society of the County
of New York. As is the custom in the other hospitals belonging
:
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# 8,6405
I O
to the City, this Medical Board has since that time been self-
perpetuating. That is, candidates are recommended for appoint-
ment by the Medical Board to the Commissioners. The final ap-
pointing power rests with them. --
At the time the new hospital was organized the City cared
for its insane as well as for its physically sick, and there were
buildings for both classes of patients scattered about the different
City properties. In 1894 this was changed by law; thenceforth
all insane patients throughout the State were sent to State Hos-
pitals. The Manhattan State Hospital for the Insane was estab-
lished at Ward's Island and the entire island taken over by the
State. The insane in one of the City buildings on Blackwell’s
Island, further down the East River, were removed to Ward’s
Island, and the patients at the Ward's Island Homeopathic Hos-
pital were sent to Blackwell's Island. This necessitated a change
of name and the homeopathic hospital since then has been known
as the Metropolitan Hospital.
January 1, 1896, the Department of Charities and Correction
was separated into the Department of Public Charities, and the
Department of Correction, each with its own Commissioners
The first took control of all the eleemosynary institutions, the
second of all the criminal.
In 1901 the then Commissioner of Public Charities, the Hon.
John W. Keller, informed the Medical Board of the Metropolitan
Hospital that the remainder of the insane patients, occupying two
buildings adjacent to the hospital, were about to be removed,
and that he intended to add those buildings to the equipment of
the Metropolitan. The question arose as to what was best to
do with them. A large number of tuberculosis patients were in
the Metropolitan, as in all of the City hospitals. These patients
had been grouped by themselves first, as a matter of convenience,
in a part of a ward. Later, as the present ideas regarding the
communicability of tuberculosis became prevalent, the sufferers
from it were placed in wards by themselves. It was now decided
that this would be a good opportunity to put them in a separate
building. The idea was presented to Commissioner Keller and
met with his approval. Delays occurred in the removal of the
insane, however, and they did not get away until so near the
end of Commissioner Keller's term of office that he thought best
*... . . .
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* * * -
MAIN BUILDING—MAIN ENTRANCE

!)NICITIQºI NIVIN-TVILI ISOH NV LITO, IOȘILTIIN

I 5
merely to endorse the proposition and leave the final decision for
his successor. *
January I, 1902, the Hon. Homer Folks became Commissioner
of Public Charities. During his first week in office a committee
of the Medical Board of the Metropolitan Hospital waited on
him and presented their views regarding the above matter. Com-
missioner Folks gave his approval and the recently vacated build-
ings were prepared for the reception of patients.
January 31, 1902, all of the tuberculosis patients from the
main hospital were removed to the new buildings, and New York
City became possessed of a special hospital for consumptives.
At that time the Medical Board thought it was the first municipal
hospital for such purpose in the United States. It has since
learned that the City of Cleveland came first in 1897. Almost
immediately after the opening of the new buildings for consump-
tives, the tuberculosis patients from the other charity hospitals
of the City were removed there, and this department of the in-
stitution became known as the Tuberculosis Infirmary of the
Metropolitan Hospital. .
From the above brief account it will be seen that the credit
for this step forward belongs primarily to the members of the
Medical Board of the Metropolitan Hospital who proposed it,
next to Commissioner Keller, who approved of it, and finally to
Commissioner Folks, under whose administration it was carried
Out.
It will also be seen that the Infirmary is an outgrowth from,
and an integral part of the Metropolitan Hospital. The tubercu-
losis patients at first were distributed throughout the general
medical wards of the hospital; then they were grouped in a part
of a ward; later they were segregated in separate wards; and,
finally, when the opportunity offered they were placed in build-
ings by themselves.
LOCATION.
The Metropolitan Hospital has an ideal location for a hos-
pital. It is on the north end of Blackwell's Island in the East
River, overlooking the famous Hell Gate and between the Bor-
oughs of Manhattan and Queens. The hospital grounds are half
a mile long, and an eighth of a mile wide—the full width of the
I6
Island. The grounds are well laid out and beautifully kept.
The river, with the hundreds of boats passing on either side of
the island every day, is a never-ending panorama of interest.
The air is as pure as can be got so near the great City. It
is so open that the wind has full sway, and in summer the tem-
perature is always lower than in New York City. Every build-
ing has all the advantages that can be gotten from fresh air and
Sunlight. There is ample room for out-door treatment.
With all these advantages the place is accessible to the City.
A ferry runs from the foot of East Seventieth street, Man-
hattan, every half hour. The river is not over a thousand feet
wide at this point so that the boat trip is very brief. .
The Seventieth street ferry is for the use of doctors, attend-
ants, and visitors. Patients and supplies are carried on a large
boat which makes three trips a day from the Department head-
quarters at East Twenty-sixth street.
It is proposed to extend the lower end of Blackwell's Island
a few hundred feet South, and have a subway station connecting
with one of the East River tunnels. This will give still better fa-
cilities of communication. .
HOSPITAL AND BUILDINGs.
The Metropolitan Hospital is the largest general hospital in
the United States. During the past winter it has housed as many
as fourteen hundred and fifty patients at one time, about half of
whom were tuberculosis cases. At present—July 25, 1908—there
are seven hundred and twenty-five cases of tuberculosis in that
department of the hospital, the largest number of such cases
under one administration anywhere in the world. -
The administrative staff, internes, nurses, and employees,
number more than five hundred, so that all told the population
of the institution numbers nearly two thousand persons.
The buildings for patients are: The main building, containing
surgical wards for men and women; Obstetric ward, medical
ward for women, and alcoholic ward for men ; the men's medical
building; the lepers' pavilion; the children's pavilion; the erysip-
elas pavilion ; the pavilion for nervous diseases; the pavilion for
skin diseases; the men's tuberculosis building; two pavilions and
IN OOXH O NIJL VYHOEI）（IO–） I CIRIVAA

TIVOICIGHIN GITIVIN-’S GIN V L SCIſIVAA

2 I
twelve tents for men tuberculosis patients; the Solarium, a recrea-
tion building for men tuberculosis cases; the building for women
and children suffering from tuberculosis; two tents for women
tuberculosis cases. There are also separate buildings for men
employees, women employees, the nurses' home, morgue and
pathological department, electro-therapeutic department, stables,
laundry, kitchen building, etc. Contracts have been let and work
started on a new pathological and morgue building, a building as
a home for the internes, and two new buildings each to accom-
modate two hundred and fifty tuberculosis patients. One of these
latter will be fitted with a complete operating-room and acces-
SOI 162S.
ADMINISTRATION.
The Commissioner of Public Charities is the administrative
head of the Department. The office is an appointive one, and
the officer is appointed by the Mayor to serve at his pleasure,
usually during his own term of office. The present Commissioner
is the Hon. Robert W. Hebberd. The Department includes hos-
pitals in each of the Boroughs, the Home for the Aged and
Infirm, and has general supervision over public charities of va-
rious kinds.
The Metropolitan Hospital, like the other institutions in the
Department, has its own Superintendent. Patients are sent from
the central office. The money to run the hospital is in charge of
the Commissioner, and the central office provides all supplies and
equipment.
The medical administration of the Metropolitan is under the
control of a Medical Board of twenty-five physicians and sur-
geons. This Board is appointed by the Commissioner, but is
practically self-perpetuating, as vacancies are always filled on its
recommendations. It is divided into various committees to look
after the various branches of the work. There are also some
fifty specialists and assistants to help care for the patients. These
are appointed for a year at a time by the Commissioner on recom-
mendation of the Medical Board. The various members of the
Board and assistants serve without pay. They serve two months
and are off four, so that the visiting is done in rotation. A man
may take a longer term of service if he so desires, and some do.
22
Besides the above, there are twenty-one resident physicians
or internes who serve eighteen months each: six months as
junior assistant, six months as senior assistant, six months as
house physician or surgeon.
The nursing in the tuberculosis department is done by per-
manent nurses. In the other departments of the hospital by nurses
in the training school. The period of training extends over three
years.
The pathological work is in charge of two visiting pathol-
Ogists, and of a resident pathologist.
THE TUBERCULOSIS INFIRMARY OF THE METROPOLITAN HospitaL.
The largest building at the Tuberculosis Infirmary is used
for men patients. It is a massive stone structure nearly four
hundred feet long and three stories high. Built originally for
an insane asylum, it has thick walls. Wide corridors run through
the centre of each floor, with numerous small rooms opening off
either side. Some of the rooms are large enough for only one
patient, others for two. There are large alcoves in the middle
Of each floor that are utilized as small wards.
Each floor will accommodate in comfort about one hundred
patients. During the past winter, however, the influx of pa-
tients was so great that two hundred extra cots had to be placed
in the corridors. To relieve the congestion as much as possible
two temporary Ducker cottages were erected by Commissioner
Hebberd, each holding forty patients. These are only for tem-
porary use until permanent structures can be put up.
In 1903 a tent was erected as an experiment. Since then
others have been added until now there are twelve tents for men,
each accommodating twelve patients. These tents are rectangu-
lar in shape, with wooden floors raised above the ground to allow
of a circulation of air underneath. A wooden wainscoting three
feet high runs around the four sides. Above that on two sides
are sashes fitted with canvas that can be raised or lowered like
ordinary windows. At the two ends are similar sashes fitted with
glass. This arrangement permits of enclosing the tents in bad
weather without shutting out the light. Outside of these again
are canvas frames swung from the top that can be raised or low-
TIVOICIGHIN GHTWIN-JL CIRIVAA JO RIO INICILNI

„LN GIL S. NGINI (ITIIHO
ºs-
&
-
º

27
ered at will. These double sashes are so constructed that even
when closed there is a current of fresh air passing constantly be-
tween them from out-doors into the tent as through a chimney,
thus insuring a thorough ventilation at all times. The roof is
double, the inner layer being of canvas, the outer of shingles,
with a twelve-inch space between. Steam-heating pipes run
around the sides of the tents for use in cold weather. Even so
the temperature in them is frequently as low as forty-five de-
grees Fahrenheit during the winter months, and sometimes fifteen
or twenty degrees lower. The twelve tents are connected with
each other and with the stone building by a covered passageway.
The patients on the ground floor and in the tents have a
dining-room most attractively located near the river. On the
upper floors most of the patients are in bed and of necessity their
food is served to them in bed. A few of the men, able to be up,
have a small alcove dining-room.
During Commissioner Folks’ administration a solarium was
built for the men. This building is two hundred feet long, twenty
feet wide, and entirely enclosed in glass set in window frames.
A broad piazza runs entirely around it. This building serves as
a recreation room and sitting room. During inclement weather
the patients sit inside. The windows on the weather side are
kept closed, on the opposite side are kept open. In good weather
the men use the piazzas. There is an ample supply of comfortable
chairs to sit on. There are magazines and books to read. A
shuffle board, cards and dominoes are provided to play with.
Altogether, patients strong enough to avail themselves of it have
a very comfortable and pleasant place in the solarium.
The building for women and children is of brick, about one
hundred and fifty feet long, and two stories high. Each floor
accommodates about forty patients. The upper floor forms one
large open ward. The lower floor is divided in two, the larger
end for women, the smaller end for children of whom there are
about twenty. The children's ward was started in 1907, with
Commissioner Hebberd’s permission. Just at present there is
room for no more, but when the new buildings now under way
are completed it is hoped to make the children's department a
feature of the institution.
28
Besides this building there are two tents for women con-
nected with it by a passageway, and of the same general con-
struction as the tents used by the men. Each ward has its own
dining-room.
Ever since the Tuberculosis Infirmary was opened it has been
filled. Lately the crowding has been very great. The present
Commissioner of Public Charities, the Hon. Robert W. Hebberd,
has taken much interest in this branch of his department, and has
succeeded in getting money appropriated for new buildings to
cost nearly half a million dollars. In a general way the plans
call for stone buildings of architectural merit that will be a credit
to the City. The patients will be accommodated in small wards,
holding twenty-eight patients each. Broad piazzas will run en-
tirely around each floor, and every window will be wide enough
and low enough to permit a bed to be passed through it onto them.
In this way bed patients as well as walking patients will have the
benefit of the out-door air at any time, while in bad weather they
can be kept indoors. During cold weather it will be possible for
patients to dress and undress, or to have their bedding changed,
indoors, where there can be a comfortable temperature. At pres-
ent bed patients are indoors all the time, because there is no
way to get them out. The windows are always open, but that is
not quite the same. In cold weather the tents are too cold to
dress and undress in in safety. During the winter time each tent
patient is supplied with a hot-water bag, to take the chill Off the
bed.
TUBERCULOSIS PATIENTS.
Persons applying to the Department of Public Charities for
hospital treatment and sent to Blackwell's Island, are assigned
pro rata, according to the number of vacant beds, to the
City Hospital at the south end of the island, and to the Metro-
politan Hospital at the north end. This is done without con-
sulting the prospective patient as to his desires, and has been the
custom of the Department from the beginning.
In the hospital proper, at the Metropolitan, all classes of
medical and surgical diseases are treated, excepting only tubercu-
losis and the contagions. All contagious diseases are sent to the
hospitals of the Department of Health.
SISOTIQ OXIGIRIOJ, GITIVIN — NGIYICIT IHO-SNOITIA VAI

CIRIVAA SNIGHEIGHT


33
Since the Tuberculosis Infirmary was established all of the
tuberculosis patients applying to the Department of Public Chari-
ties for treatment have been sent to it. From the time the first
building was opened, January 31, 1902, to July I, I908, there
have been 16,122 cases admitted. Of these Io,589 were dis-
charged, 4,826 died, and 707 remained. The death rate was 29.9
per cent. for the entire period.
During the year 1907 there were 2,795 admissions. During
the first six months of 1908 there were 1,555 admissions.
As diagnosis becomes more accurate and the sufferers learn to
appreciate the advantages of hospital treatment, the demands Or,
the City for help increase. The present Commissioner has planned
to have a consumptive hospital on Blackwell's Island ultimately to
accommodate fifteen hundred patients. Plans have also been
formulated and work is in progress for a City tuberculosis hos-
pital on Staten Island that is to be even larger. Both will be filled
with patients probably as soon as completed.
The municipal hospital facilities of New York City have never
yet been adequate to house in comfort all the sick poor seeking
municipal aid. The main reason of this is the great influx of
foreigners each year who never get any further into the United
States than New York City. A glance at the nationality of the
patients in the Tuberculosis Infirmary will show this.
Effort is made to keep certain general statistics of all the pa-
tients, but for various reasons they cannot be kept complete for
every separate individual. Many of the patients do not know the
answers to some of the questions, others cannot understand be-
cause they are foreigners and cannot speak English, some are
not of sufficient intelligence to supply the requested information.
The sum total of the information that is gotten will give an idea
of the work.
Up to January 1, 1908, there were admitted I4,372 patients of
whom II,734 were men, and 2,638 were women.
Of 13,610 patients whose nationality was recorded
5,832 were born in the United States.
2,978 were born in Ireland.
I, Io9 were born in Germany.
959 were born in Russia.
896 were born in Italy.
34
366
346
189
I25
99
94
84
8I
74
74
55
54
49 were born
22
I9
I4.
I3
I3
IT
IO
.
were born
were born
were born
were born
were born
were born
were born
were born
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were born
were born
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were born i
were born
were born i
were born
were born i
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were born
were born
were born
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
in
Austria.
England.
Scotland.
Sweden.
Roumania.
Hungary.
the West Indies.
Canada.
Greece.
Switzerland.
France.
Poland.
Norway.
Turkey.
Bohemia.
Denmark.
China.
Holland.
Spain.
Syria.
Belgium.
Japan.
Nova Scotia.
the Philippines.
Newfoundland.
Palestine.
South America.
Porto Rico.
the Canary Islands.
Finland.
was born in India.
I was born in Bavaria.
A glance at the thirty-seven nationalities noted shows the cos-
mopolitan character of the population from which the tuberculosis
patients are drawn.
Natives of the United States head the list with 43 per cent.
of the cases—many of them born of foreign parents. Natives of
Ireland come next with 22 per cent. Natives of Germany third
with 8 per cent. Natives of Russia fourth with 7 per cent. Prac-
AXIOLIIN RIOCI SŌICH W OTI， IINH GHTWIN

ÄXIV W XII， INI SISOTIIT OXIGIRIOJL-8) NICITIT 18I NIVIN

39
tically all of the Russians are Jews. These figures are very sig-
nificant for two reasons: First, the Jews are supposed to be less
Susceptible to tuberculosis than other races; second, the Jews are
more or less clannish and the needy are said not to find their
way as a rule to public charities, but are looked after by their own
people. It would seem as though placed under the same con-
ditions as other races both contentions were wrong. Natives of
Italy are fifth with 7 per cent. Natives of Austria and natives of
England are sixth and seventh respectively, each with something
more than 2 per cent. of the cases.
There were 9,903 patients classified by ages in ten-year pe-
riods.
Under IO years of age, 20 cases.
II-20 years of age, 869 cases.
2I-30 years of age, 2,222 cases.
3 I-40 years of age, 2,513 cases.
4I-50 years of age, 2,027 cases.
51-60 years of age, I,269 cases.
6I-70 years of age, 616 cases.
7I-80 vears of age, 345 cases.
8I-90 years of age, 2O C2S6S.
9I-IOO years of age, 2 C3, SéS.
The youngest baby girl was three weeks old, the oldest
woman 97 years. The youngest baby boy was eleven months old,
the oldest man 92 years.
The fourth decade of life—31 to 40 years of age—leads with
25 per cent. of the cases, next comes the third decade—21 to 30
years—with 22 per cent. of the cases, third, the fifth decade—41
to 50 years—with 21 per cent. of the cases. Before 2 I and after
50 the percentages are much less. Or, in other words, 68 per
cent, or a trifle more than two-thirds of the cases develop tuber-
culosis at what is normally the most active and useful part of
human life.
The Infirmary is a charity institution and its clientele is drawn
from the very poor; most have never been anything else, many
have seen better times but are down and out. Nearly all trades
and some of the learned professions are represented in the I3O
recorded occupations. Artists, actors, actresses, bakers, book-
binders, blacksmiths, butchers, barbers, barkeepers, carpenters,
4O
cooks, cigarmakers, dyers, decorators, doctors, drivers, express-
men, electricians, engineers, firemen, furniture polishers, garden-
ers, icemen, ironworkers, jewelers, janitors, kitchen men, labor-
ers, lawyers, laundrymen, lithographers, merchants, musicians,
machinists, nurses, newsdealers, Oystermen, peddlers, printers,
plumbers, porters, painters, plasterers, photographers, roofers,
sailors, salesmen, stonecutters, teachers, tailors, tanners, tinsmiths,
upholsterers, weavers, woodworkers, waiters—all of these and
many more callings are represented.
The following callings were represented by more than one
hundred patients: Laborers, 2,131; domestic servants, 949;
drivers, 433; hotel help, 307; waiters, 294; tailors, 264; opera-
tors on machines, 195; clerks, I94; cooks, IQI ; porters, I39;
peddlers, I25; carpenters, I I5. -
It would be difficult to form any conclusions as to just how
much these various callings had to do with the development of
tuberculosis in the subjects. Laborers and drivers and peddlers
spend much of their time out of doors, and for that reason should
be less liable to the disease. The difficulty with them must be
partly exposure to all sorts of weather and bad conditions, partly
to bad housing. The other prominent occupations listed keep the
patients indoors. Another factor that makes it difficult to draw
conclusions from the above list is that an unskilled man may be
a laborer at one time, a porter at another, a waiter at another,
and so on. Many of them when questioned have worked at a
given occupation for but a short time, and before that many have
tried a hand at many callings.
Another item of information tabulated since July 1, 1906, is
the professed religion of the patients. This is required by the
Department. Clergymen representing the different great faiths
are on constant duty and do much to administer to the mental
and spiritual comfort of the patients.
Of 4,095 patients admitted July 1, 1906, to January 1, 1908,
there were:
2,642 Roman Catholics.
I,OI2 Protestants.
428 Hebrews.
I 3 'Unclassified.

I\ I\ I\IVT10S （10 V (IN V RIGIA NO SLNGAI LV, I SISO （II) ON1，1，1，1）L

45
HOSPITAL ROUTINE.
On admission each patient has a card made out giving name,
age, whether single or married, nativity, religion, and name and
address of nearest relative or friend. His or her clothing is
taken away, the patient is bathed, hospital clothing supplied, and
a bed assigned. The pulse, temperature, and respiration are
recorded by a nurse. As soon as possible an interne takes the
history of the case and makes an examination.
Each patient is given a copy of the following:
Regulations of the Tuberculosis Infirmary of the Metropolitan Hos-
pital. Promulgated by the Commissioner of Public Charities, July, 1903:
CONSUMPTION.
NOTE-Consumption is a communicable disease. Many cases can be
cured; many others can be improved. The City has established this In-
firmary to cure such cases as can be cured, to improve such as can be
improved, and to relieve the sufferings of others. It is also for the pur-
pose of preventing the spread of the disease.
The City provides free of charge, physicians, nurses, food, clothing,
medicine, shelter and all other necessaries. It expects from the patients
for their own protection and for the protection of others, prompt and
explicit obedience to these rules.
Consumption is usually communicated from one person to others by
means of the sputum (spit). This is full of the germs of the disease, and
every bit of it must be collected and destroyed.
The principal means of cure or improvement are out-of-door air, rest,
food, sleep and freedom from worry.
A careful, conscientious and obedient patient has fifty times as many
chances of cure as a careless and disobedient one.
Rules.
I. Never Spit on the floor, walks, grass, nor anywhere except in a
cup or bottle provided for that purpose. The cup must be used indoors
and the bottle out of doors.
2. Spend as much time as possible out of doors, even in cold weather.
3. When indoors, get as much fresh air as possible. Never close the
windows, night or day.
4. Take moderate exercise daily and do such work as the physician
directs. It is for your own good.
5. Sleep at least nine hours a night.
6. Be hopeful and cheerful; be helpful to others; assist in enforcing
the rules, for by so doing your chances of cure are increased.
7. Never swallow your spit. Don't cough unless you have to. Hold a
handkerchief before your face when coughing or sneezing.
Male patients should wear neither beard nor mustache.
8. Eat slowly. Chew your food well. Drink milk in slow swallows.
Rinse out the mouth after each meal.
9. Never sit or lie upon the grass or walks.
Io. Boisterous conduct, profanity, and loud talking or quarrelling are
strictly prohibited.
II. Always keep a copy of these rules with you. .
Wilful or repeated violation of these rules must result in the discharge
of the patient.
46
For the first three days all patients are kept in bed for special
observation. During this time a specimen of sputa is sent to the
pathological laboratory for examination. When a positive diag-
nosis of tuberculosis is made the Department of Health is no-
tified. With this notification is sent the name and age of the
patient, and the place of last city address. Later, if a patient
leaves the Hospital, the Department of Health is again notified,
and One of its inspectors tries to keep track of the case. All
houses or apartments vacated by removal or death of tuberculosis
patients are fumigated by the Department of Health.
Each bed patient at the Infirmary has a sputum cup to ex-
pectorate in, each walking patient has a glass bottle which he
carries about for the same purpose. These receptacles are
changed twice a day, the contents destroyed, and the vessels
Sterilized. Of I I,592 cases of tuberculosis where the examina-
tion of the sputa was recorded, the tubercle bacillus was found
present 8,731 times, absent 2,861 times. If all of the physical
signs and symptoms point unmistakably to tuberculosis the diag-
nosis is certain whether the bacillus is found or not.
Two other prominent symptoms of tuberculosis have been
recorded often enough to be of value. Of Io,072 cases hem-
orrhage had occurred in 4,432 cases, had not occurred in 5,640.
Of 9,696 patients night sweats were present in 5,876, were
absent in 3,82O.
CLASS OF CASES.
The Tuberculosis Infirmary is a charity hospital. Its pa-
tients, therefore, are of the poorest. Most of them are hard-
working people who have kept at their various occupations until
unable to work longer. Others are of the lowest and most dissi-
pated, the flotsam and jetsam of the social life of a great city,
who finally have become knocked out by their vicious habits.
Nearly all of them enter the institution in an advanced stage of
the disease. Comparatively few are in the incipient stage.
In a rough way, the patients are classified according to the
severity of the lesions. Of 12,872 cases so classified, 950 or
7 per cent. were in class A–the incipient stage; 5,486 or 43 per
cent. were in class B–had fever, cough, sweats, and presented
the tubercle bacillus, but had a fair amount of strength, and had

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5 I
a fighting chance; 5,351 or 41 per cent. were in class C—all the
Symptoms more marked than in the preceding class; I,085 or 9
per cent. were in class D—absolutely hopeless.
Cases of this kind make the Infirmary a hospital. The pa-
tients are sick, most of them very sick, and they must be treated
as sick people. Therein the Tuberculosis Infirmary differs from
most institutions devoted to the care of tuberculosis, which ac-
cept only incipient cases, turn out those who show a tendency
to get worse on the ground that they are not suitable cases, and
never have a death except by accident.
TREATMENT.
The three great essentials in the treatment of tuberculosis in
any stage are (I) rest, (2) fresh air, and (3) an abundance of
nourishing food. These are all utilized to the fullest at the Met-
ropolitan. The first requisite, rest, is too frequently neglected
The tendency for most tuberculosis patients is to try to do too
much. Every patient at the Infirmary with a temperature of
IOoº Fahrenheit or more is obliged to lie down. If the tempera-
ture is below that early in the day he is sometimes allowed up
in the morning. The very sick patients are in bed all the time.
The strongest ones sleep in the tents.
The second requisite, fresh air, is obtained in abundance. Pa-
tients able to use the solarium, and patients housed in the tents
are out of doors practically all the time. Patients unable to get
out receive a maximum of fresh air through the always-open
windows. In very cold weather, the wards are not allowed to
get too cold, as very sick consumptives are extremely susceptible
to cold. They are susceptible to extremes of either heat or cold,
in fact, and a very hot or a very cold spell of weather lasting
during two or three days will invariably kill off numbers of the
weakest. -
During the summer months parties of patients able to be up
are taken about the harbor on one of the Department boats twice
a week. The boat has to make these trips to the various islands
and boroughs on Department business, and the patients are car-
ried for the benefit to be derived from the outing. The benefit
is not only physical, it is mental as well, because it adds a pleas.
ant variety to the ordinary routine of hospital life.
52
In the third requisite, an abundance of nourishing food, the
City is very liberal. The dietary has been improved during the
administration of Commissioner Hebberd. At present the pa.
tients receive a different bill of fare every day for two weeks and
then repeat. The dietary follows:
FIRST WEEK.
Sunday.
Breakfast: Rolled wheat, 8 oz. ; milk, 4 oz. ; 2 eggs; bread, 4 oz. ; butter
% Oz. ; coffee, 16 oz. ; sugar, 94 oz.
Dinner: Beef stew, I2 oz. ; roast beef, 6 oz. ; potatoes, 6 oz. ; vegetable,
4 oz. ; blanc mange, 6 oz. ; bread, 4 oz.; butter, V4 oz.
Supper: I egg; stewed prunes, 6 oz. ; tea, I6 Oz. ; bread, 4 oz. ; butter, 9% oz. .
corn starch pudding.
Monday.
Breakfast: Farina, 8 oz. ; milk, 4 oz. ; 2 eggs; bread, 4 oz. ; butter, 9% oz. .
coffee, I6 oz. ; sugar, V4 oz.
Dinner: Vegetable soup, 12 oz. ; beef stew, with potatoes, 16 oz. ; I egg:
bread, 4 oz. ; butter, V4 oz. ; bread pudding, 6 oz.
Supper: Apple sauce; bread, 4 oz. ; butter, V4 oz. ; tea, 16 oz.
Tuesday.
Breakfast: Oatmeal, 8 oz. ; milk, 4 oz. ; meat, 4 oz. ; bread, 4 oz. ; butter,
% oz. ; coffee, I6 oz., Sugar, Ø oz.
Dinner: Pea soup, 12 oz. ; roast mutton, 6 oz. ; potatoes. 6 oz. ; vegetable
4 oz. ; bread, 4 oz. ; butter, 9% oz., tapioca pudding, 6 oz.
Supper : 2 eggs; stewed prunes, 6 oz. ; bread, 4 oz. ; butter, 9% Oz. ; tea
* 16 oz.
Wednesday.
Breakfast: Rolled wheat, 8 oz. ; milk, 4 oz. ; sugar, V4 oz. ; bread, 4 oz. .
butter, 94 oz. ; coffee, 16 oz.
Dinner: Vegetable soup, 12 oz. ; roast beef, 6 oz. ; potatoes, 6 oz. ; bread.
4 oz. ; butter, 9% oz. ; vegetable, 4 oz. ; farina pudding, 6 oz.
Supper: 2 eggs; rice, 6 oz. ; milk, 4 oz. ; bread, 4 oz. ; butter, 9% oz. .
tea, 16 oz.
Thursday.
Breakfast: Oatmeal, 8 oz. ; milk, 4 oz. ; sugar, Ø Oz. ; bread, 4 Oz. ; but
ter, 94 oz. ; coffee, 16 oz.
Dinner: Mutton broth, 12 oz. ; mutton, 6 oz. ; potatoes, 6 oz. ; vegetable.
4 oz. ; bread pudding with currants, 6 oz. ; bread, 4 oz. ; buter, 9% oz. .
Supper: 2 eggs; bread pudding, 6 oz. ; bread, 4 oz. ; butter, 9% oz. ; tea.
I6 oz.
（IOINICIJLXGI—:0NICITII(18I WOONI ON INICI-ARIVINXII， INI SISOTOONIGISIQJL
）
（） （>

NGIHO LIXI LOEIIGI XXIV IN HIĢINI SISOTIQ OXIGIRIOJ,

57
Friday.
Breakfast: Hominy, 8 oz. ; Milk, 4 oz. ; sugar, V4 oz. ; 2 eggs; bread, 4 oz. ;
butter, V4 oz., coffee, 16 oz.
Dinner: Pea Soup, 12 oz. ; baked fish, 6 oz. ; potatoes, 8 oz.; bread, 4 oz.;
butter, 9% oz., vegetable, 4.oz. ; rice pudding, 6 oz.
Supper: I egg; prunes, 6 oz. ; milk, 4 oz. ; bread, 4 oz., butter, WA oz. .
tea, I6 oz.
Saturday.
Breakfast: Hominy, 6 oz. ; milk, 4 oz. ; sugar, V4 oz. ; 2 eggs; bread, 4 oz. .
butter, V4 oz., coffee, 16 oz.
Dinner: Barley Soup, I2 oz. ; roast beef, 6 oz., potatoes, 6 oz. ; vegetable
4 oz. ; bread, 4 Oz, ; butter, 9% oz., cracker pudding, 6 oz.
Supper: Hominy, 8 oz. ; milk, 4 oz. ; bread, 4 oz. ; butter, 9% oz. ; tea, 16 oz
SECOND WEEK.
Sunday.
Breakfast: Rolled wheat, 8 oz. ; milk, 4 oz. ; sugar, V4 oz. ; 2 eggs; bread,
4 oz. ; butter, 9% oz. ; coffee, 16 oz.
Dinner: Vegetable soup, I2 oz. ; fricasee of chicken, 8 oz. ; potatoes, 6 oz. ;
vegetable, 4 oz. ; corn starch pudding, 6 oz. ; bread, 4 oz. ; butter, 9% oz.
Stºpper: I egg; potatoes, 6 oz. ; apple sauce, 8 oz. ; bread, 4 oz. ; butter,
% Oz. ; tea, 16 oz.
Monday.
Breakfast: Oatmeal, 8 Oz. ; milk, 4 oz. ; sugar, /3 oz. ; 2 eggs; bread, 4 oz. ;
butter, 9% oz. ; coffee, 16 oz.
Dinner: Beef stew with barley, 12 oz. ; hash, 6 oz. ; vegetable, 4 oz. ; bread,
4 oz. ; butter, 9% oz. ; bread pudding, 6 oz.
Supper: Dried apples, 6 oz. ; I egg; bread, 4 oz. ; butter, V4 oz. ; tea, 16 oz.
Tuesday.
Breakfast: Indian meal, 8 oz. ; milk, 4 oz. ; sugar, 9% oz. ; bread, 4 oz. ;
butter, 9% oz. ; coffee, I6 Oz.
Dinner: Mutton broth, 12 oz. ; roast mutton, 6 oz. ; potatoes, 6 oz. ; vege-
table, 4 oz. ; bread, 4 oz. ; butter, V4 oz. ; rice pudding, 6 oz.
Supper: 2 eggs; apple sauce, 8 oz. ; bread, 4 oz. ; butter, 9% oz. ; tea, I6 oz.
Wednesday.
Breakfast: Hominy, 8 oz. ; milk, 4 oz. ; sugar, /3 oz. ; meat, 4 oz. ; bread,
4 oz. ; butter, 9% oz., coffee, I6 oz.
Dinner: Barley soup, 12 oz. ; pot roast with potatoes, 16 oz.: I egg; bread,
4 oz. ; butter, V4 oz. ; cracker pudding, 6 oz.
Supper: I egg; farina, 6 oz. ; milk, 4 oz. ; bread, 4 oz. ; butter, 9% oz. ;
tea, 16 oz. ©
58
Thursday.
Breakfast: Rolled wheat, 8 oz. ; milk, 4 oz. ; sugar, V4 oz. ; 2 eggs; bread,
4 Oz. ; butter, V4 oz. ; coffee, 16 oz.
Dinner: Vegetable soup, 12 oz. ; mutton, 6 oz. ; bread, 4 oz. ; butter, 9% oz. ;
potatoes, 6 oz. ; vegetable, 4 oz. ; farina pudding, 6 oz.
Supper: I egg; butter, V4 oz.: tea, 16 oz., bread, 4 oz., Indian meal, 6 oz. .
milk, 4 oz.
Friday.
Breakfast: Oatmeal, 8 oz. ; milk, 4 oz. ; sugar, /3 oz. ; 2 eggs; bread, 4 oz. ;
butter, V4 oz. ; coffee, 16 oz.
Dinner: Pea Soup, I2 oz. ; baked fish, 6 oz. ; potatoes, 8 oz. ; vegetable, 4
Oz. ; tapioca pudding, 6 oz. ; bread, 4 oz. ; butter, 9% oz.
Supper: I egg; prunes, 6 oz., bread, 4 oz. ; butter, V4 oz.: tea, 16 oz.
Saturday.
Breakfast: Hominy, 8 oz. ; milk, 4 oz. ; sugar, 94 oz. ; meat, 4 oz. ; bread,
4 oz. ; butter, 9% oz., coffee, I6 oz.
Dinner: Beef Soup, I2 oz. ; boiled beef, 6 oz. ; potatoes, 6 oz. ; vegetable,
4 Oz. ; bread, 4 oz.; butter, V4 oz.: cracker pudding, 6 oz.
Supper: 2 eggs; farina, 6 oz. ; milk, 4 oz. ; bread, 4 oz. ; butter, 9% oz. ;
tea, I6 Oz.
Besides the three meals, hot milk is served at 6 A. M., milk,
chocolate or egg nog, at IO A. M. and 3 P. M., and milk again
at 8 P. M.
The above is the regular diet for the patients up and able
to eat. It includes three eggs and forty ounces of milk daily.
Light diet calls for four eggs and sixty-four ounces of milk,
toast and articles selected from an extra list.
Liquid diet calls for forty-eight ounces of milk, broth,
Scorched farinaceous food and albumen water.
Extra diet is selected from the following: Beef, mutton,
chicken and clam broth. Beef juice, scraped beef, steak, chops,
bacon, custard, simple puddings, wine and lemon jellies, junket,
fresh fruits, emulsion and sherry as per doctor's order.
Stimulants and cod liver oil are not used as a routine.
The therapeutic treatment includes all accepted methods, plus
the homeopathic. Extensive experiments have been made with
the various sera. The class of cases is not the kind that responds
readily to any treatment; the majority are too far gone. A few
can be, and are, cured. The others are prescribed for symptom-
3tically... : :
sº t
jº,
tº ge * s” e tº
（IOINIGH LNI-IALO ORI ON INICI-A RIVIA （II） INI SISOTII] OXIGH81|Il-L

ĀNIVINXII， INI SISOTOOXIGIRIOJL-8) NICITIŒI GITVINGIGH

63
RESULTs.
As noted above, the mortality to July 1, 1908, is 4,826 or 29.9
per cent. Of these, more than half died less than thirty days
after entrance. Of those discharged—IO,589—more than half
left in less than thirty days. The patients are free to come and
go. If they wish to leave they cannot be compelled to stay.
Tuberculosis is a more or less chronic disease, and its cure means
months of constant care and attention. Very few of the patients
admitted to the Infirmary are willing to give sufficient time for
a C111 e.
Nearly all the patients show improvement at first. The
change from their ordinary surroundings to the hospital where
everything is provided for them, nurses to wait on them, a
clean and comfortable bed to sleep in, with an abundance of fresh
air and good food, benefits them right away. As they feel better
and stronger many insist on leaving. Those with families de-
pendent on them feel that they must get to work again if pos-
sible. Some of the others cannot stand the strain of being good
and must get out to indulge in their favorite form of dissipation.
In either case the result is equally disastrous in the majority of
cases. Sooner or later the patients return in worse condition than
at first, and many of them die soon after their readmission.
A few cases have remained at the Infirmary long enough to
be permanently cured. Others undoubtedly would be if they
could be persuaded to stay longer.
ÅRIVIN （II） INI SISOTO ORIGI8IOJL-T (INIVAA JO BIOINIGILNI

NGTINOAA-‘HOIMIGIL NI ‘JLN GIL V NI VINXII， INI SISO （InoxIGIĶIn L.

0penedförſhlients.January.jſ!!”
Zoſals—January,3/1902 to July//908.
– 29.9
-
-
§
§
<
awheat/ or socyozog/cal ºf 5f Arch
**o ºwnarraw st cer affoºr, Av. r


Proportion of Sexes.
- - -
Toſal act in i the cy – /4372
tº ſº ſºlº/1.
A/APFA/ or JOC/0/0.7/CA/ /ſ/.5AA/PC//
/30/A/V//477A/ 57 cor &A'04/7/r4). AMY


Mafforza Mities.
Black line undereach flag indicates proportion of given nationality in
Wew York City agording to U.S. Census of 1900
-583?or-42.6%
Maſſpes of Ireland-2978ar:/9%
BUPEAU or, SOCIO/OGICAL APESEARCH
/30 AMA/WHATTAW ST cor. BROADWAY, WY



ACES:903&ses classified Ú/decadés.
31.40 ºars
25.30-35%
Allother ag&S
3.141 or 3.7%










Occupations represeillafly/lor////m/eſ//3.
| 2,131 |- Zaborers.
| 949 | - Domestic Jervan/s.
| - 433 - Drivers.
3oz Hoſe/ //eſp.
|29% , Waiſers.
264 - 72 FAors:
-- Operators on Jºwing Machines
C/erks.
- 79 f - - Cooks.
- Porfers.
Aea/cſ/er:y.
Caryoen fers.
A/AAAvor SOC/OZoo”CAA A'5 SAEAA’C//
/30/MA/y//477//57 co, AAEM/AM MY
8.73/ or 75.2%
tubercle 6aci/ſi present.
286/or-24.7%
ſaloºza/ Z/.






Hemorrhage fivuthelungs.
/OOZ2 cases ſaz, zz/aferaſ.
%432 oz-44.2% 3, 640 or 56.2%
Žemorrhage/adazzmaſ Memorrhagehad not occurred.





Might Swcaſs.
&696 cases Azz/ºzz/a fecy.
3.826 or 60& 24 3820 or 39.4%
Might Saveats oresent LWight Sweats absent.







Classification asſoscuerí ſy.
/2.872 cases. -
Bºx A 950 or /.4%
Morcadiana.
B. 5486 …
—aditedillful
sureat.
cºilſ worse º
abºdania C. J.351 or 4/.3% -
Absolutely
ſoºo-ºº:
hopeless |




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