T T4425s 1911 UNIVERSITY OF CALIFORNIA LOS ANGELES LAW LIBRARY WISCONSIN LIBRARY COMMISSION LEGISLATIVE REFERENCE DEPARTMENT COMPARATIVE LEGISLATION BULLETIN N T o. 24 STATE LEGISLATION CONCERNING TUBERCULOSIS LEO. F. TIEFENTHALER MADISON, WISONSTN MARCH, mu INTRODUCTION. The Legislative" Reference Department has had many requests for information as to what other states are doing to prevent the spread of tuberculosis. The Wis- consin Anti-tuberculosis Association has furnisheji the data for this bulletin and 1 the Legislative Reference De- partment has cooperated in its publication. CHARLES MCCARTHY, Legislative Reference Department. STATE LEGISLATION CONCERNING TUBERCULOSIS LEO F. TIEFENTHALER COMPARATIVE LEGISLATION BULLETIN No 24 MARCH, 191 r Prepared with the co-operation of the Political Science Department of the University of Wisconsin, and the Wisconsin Anti-Tuberculosis Association WISCONSIN LIBRARY COMMISSION LEGISLATIVE REFERENCE DEP'T MADISON, Wis. 1911 CONTENTS Page General Tuberculosis Laws 3 District, County, and Municipal Hospitals,, Sanatories and .Dispensaries 16 'State Hospitals, Sanatoria and Dispensaries 24 Expectoration 33 ^Dissemination of Knowledge concerning Tuberculosis .... 37 Miscellaneous Provisions 39 Bovine Tuberculosis 40 Public and Private expenditures in 1909 and 1910 54 Bibliography 56 GENERAL TUBERCULOSIS LAWS Maryland in 1904 was the first 'state to enact a com- prehensive measure concerning tuberculosis. Similar laws were enacted in Wisconsin in 1905 and 1907, New York in 1908, Connecticut, Kansas, Maine and Michigan in 1909 and New Jersey in 1910. More limited laws have been passed by Washington in 1899, Vermont in 1902, New Hampshire and Utah in 1905, Alabama in 1907, Virginia in 1908, Pennsylvania and Rhode Island in 1909 and Mississippi in 1910. The Kansas statute is a good example of a compre- hensive measure: Chapter 227, Laws of Kansas, 1909 Relating to powers and duties of local -health officers and boards of health for the protection of people from tuberculosis. Senate bill No. 209 AN ACT defining the powers and duties of local health officers and board of health in the matter of the pro- tection of the people of the state of Kansas from the disease known as tuberculosis, and providing penalties for the violation of the provisions of this act, and re- pealing all acts and parts of acts in so far as they con- flict with the provisions of this act. Be it enacted by the Legislature of the State of Kan- sas. SECTION 1. Tuberculosis is hereby declared to be an infectious and communicable disease, dangerous to the public health. It shall be the duty of every physician in the state of Kansas to report in writing, on a form to be furnished as hereinafter provided, the name, age, sex, color, occupation, place where last employed, if known, and address of every person known by said physician to have tuberculosis, to the county health officer; or in cities of the first class to the city healh officer, in which said person resides within twenty-four hours after such fact comes to the knowledge of said physician. It shall also be the duty of the chief officer having charge for the time-being of any hospital, dispensary, asylum, or other similar private or public institution in said state of Kan- sas, to report in like manner the name, age, sex, color, occupation, place where last employed, if known, and previous address of every patient having tuberculosis who comes into his care or under his observation within twenty-four hours thereafter. SECTION 2. It shall be the duty of the bacteriologist of the laboratory of the State Board of Health, when so requested by any physician or by authorities of any hospi- tal or dispensary, to make, or cause to be made, a micro- scopical examination of the sputum forwarded to said bacteriologist as that of a person having symptoms of tuberculosis, which shall be forwarded to such officer ac- companied by a blank giving name,, age, sex, color, occu- pation, place where last employed, if known, and address LEGISLATION CONCERNING TUBERCULOSIS 5 of the person whose sputum it is. It shall be the duty of said bacteriologist promptly to make a report of the results of such examination, free of charge, to the phy- sician or person upon whose application the same is made. SECTION 3. It shall be the duty of every health of- ficer of a city or county to cause all reports made in ac- cordance with the provisions of the first section of this act, and also all results of examinations showing the pres- ence cf the bacilli of tuberculosis made in accordance with the provisions of the second section of this act, to be recorded in a register, of which he shall be the cus- todian. Such register shall not be open to inspection by any person other than the health authorities of the state and of said city or county, and said health authorities shall not permit any such report or record to be divulged so as to disclose the identity of the person to whom it relates, except as may be necessary to carry into effect the provisions of this act. SECTION 4. In case of the vacation of any apartment or premises by the death or removal therefrom of a per- son having tuberculosis, it shall be the duty of the attend- ing physician, or if there be no such physician, or if such physician be absent, of the owner, lessee, occupant, or other person having charge of the said apartments or premises, to notify the health officer of said city or county of said death or removal within twenty-four hours thereafter, and such apartments or premises so vacated shall not again be occupied until duly disinfected, cleansed or renovated as hereinafter provided. 'SECTION 5. When notified of the vacation of any apartments or premises as provided in section 4 hereof, the local health officer, or one of his assistants or depu- 6 LEGISLATION CONCERNING TUBERCULOSIS ties, shall within twenty- four hours thereafter visit said apartments or premises and shall order and direct that, except for purposes of cleansing or disinfection, no in- fected article shall be removed therefrom until properly and suitably cleansed 6r disinfected, and said health of- ficer shall determine the manner in which such apart- ments or premises shall be disinfected, cleansed or reno- vated in order that they may be rendered safe and suit- able for occupancy. If the health authorities determine that disinfection is sufficient to render them safe and suit- able for occupancy, such apartments or premises, together with all infected articles therein, shall immediately be disinfected by the health authorities at public expense, or, if the owner prefers, by the owner at his expense, to the satisfaction of the health authorities. Should the health authorities determine that such apartments or premises are in need of thorough cleansing and renova- tion, a notice in writing to this effect shall be served upon the owner or agent of said apartments or premises, and said owner or agent shall thereupon proceed to the cleans- ing renovating of such apartments or premises in accordance with the instruction of the health authorities, and such cleansing and renovation shall be done at the expense of the said owner or agent. SECTION 6. In case the orders or direction of the local health officer requiring the disinfection, cleansing or ren- ovation of any apartments or premises or any article therein, as hereinbefore provided, shall not be complied with within forty-eight hours after such orders or di- rections shall be given, the health officer may cause a placard in word's and form substantially as follows to be placed upon the door of the infected apartments or LEGISLATION CONCERNING TUBERCULOSIS 1 premises. "Tuberculosis is a communicable disease. These apartments have been occupied by a consumptive and may be infected. They must not be occupied until the order of the health officer directing their disinfection or renovation has been complied with. This notice must not be removed under the penalty of law, except by the health officer or other duly authorized official." SECTION 7. Any person having tuberculosis who shall dispose of his sputum, saliva or other bodily secretion or excretion so as to cause offense or danger to any person or persons occupying the same room or apartment, house, or part of house, shall, on complaint of any person or persons subjected to such offense or danger, be deemed guilty of an offense, and any person subjected to such offense may make complaint in person or writing to the health officer of any city or county where the offense complained of is committed. And 1 it shall be the duty of the local health officer receiving such complaint to investigate, and if it appears that the offense complained of is such as to cause offense or danger to any person occupying the same room, apartment, house, or part of house, he shall serve a notice upon the person complained of, reciting the alleged cause of offense or danger and requiring him to dispose of his sputum, saliva or other bodily secretion or excretion in such a manner as to re- move all reasonable cause of offense or danger. Any per- son failing or refusing to comply with orders or regula- tions of the local health officer of any city, county, or state, requiring him to cease to commit such offense, shall be deemed guilty of a misdemeanor, and on conviction thereof shall be fined not more than ten dollars. 8 LEGISLATION CONCERNING TUBERCULOSIS SECTION 8. It shall be the duty of a physician attend- ing a patient having tuberculosis to take all proper pre- cautions and to give proper instructions to provide for the safety of all individuals occupying the same house or apartment, and if no physician be attending such pa- tient this duty shall devolve upon the local health officer ; and all duties imposed upon physicians by any sections of this act shall be performed by the local health officer in all cases of tuberculosis not attended by a physician, or when the physician fails to perform the duties herein specified, and shall so report. SECTION 9. It shall be the duty of the local health officer to transmit to a physician reporting a case of tuberculosis, as provided in section 1 of this act, a printed statement and report, in a form approved by the secretary of the State Board of Health, naming such procedures and precautions as in the opinion of the said secretary are necessary or desirable to be taken on the premises of a tuberculosis patient. It shall be the duty of the local health authorities to keep on hand an ample supply of such statements and reports and to furnish the same in sufficient numbers to all local physicians. Upon receipt of such statement and report the physician shall either carry into effect all such procedures and precautions as are therein prescribed, and shall thereupon s'gn and date the same and return it to the local health officer without delay, or if such attending physician be unwilling or un- able to carry into effect the procedures and precautions specified, he shall so state upon this report and immedi- ately return the same to the local health officer, and the duties therein prescribed shall thereupon devolve upon said local health officer, who shall receive the fee herein- LEGISLATION CONCERNING TUBERCULOSIS 9 after provided as payment of the services of the physi- cian if he comply with the duties herein prescribed. Upon receipt of this statement and report the local health of- ficer shall carefully examine the same, and if satisfied that the attending" physician has taken all necessary and desirable precautions to insure the safety of all persons living in the apartments or premises occupied by the person having tuberculosis, the said local health officer shall issue an order upon the treasurer of the city or county in favor of the attending physician for the sum of one dollar, thereupon to be paid out of the general fund of said city or county. If the precautions taken or instructions given by the attending physician are. in the opinion of the local health officer, not such as will remove all reasonable danger or probability of danger to the per- sons occupying the said house or apartments or premises, the local health officer shall return to the attending phy- sician the report with a letter specifying the additional precautions or instructions which the health officer shall require him to take or give : and the said attending phy- sician shall immediately take the additional precautions and give the additional instructions specified and) shall record and return the same on the original report to the local health officer. It shall further be the duty of the local health officer to transmit to the physician reporting any case of tuberculosis a printed requisition, in a form approved by the secretary of the State Board of Health. Upon this requisition blank shall be named the materials kept on hand by the local health officer for the prevention of the spread of tuberculosis, and it shall be the duty of the local health officer to supply such materials as may be specified in such requisition. Any physician may return 10 LEGISLATION CONCERNING TUBERCULOSIS a duly signed requisition to the local health officer for such of the specified materials and in such amount as he may deem necessary to aid him in preventing the spread of the disease, and all local health officers shall honor, as far as possible, a requisition signed by the at- tending physician in such case. It shall be the duty of every local health officer to transmit to every physician reporting any case of tuberculosis, or to the person re- ported or suffering from this disease, provided the lat- ter has no attending physician, a circular of information approved by the secretary of the 'State Board of Health, and which shall be provided in sufficient quantity by the local authorities. This circular of information shall in- form the consumptive of the best methods of treatment of his disease and 1 of the precautions necessary to avoid transmitting the disease to others. Any physician who shall certify falsely as to any of the precautions taken to. prevent the spread of infection shall be deemed guilty of a misdemeanor, and on conviction thereof shall be sub- ject to a fine of not more than fifty dollars. SECTION 10. Upon the recovery of any person having tuberculosis, it shall be the duty of the attending physi- cian to make a report of this fact to the local health officer, who shall record the same in the records of his office, and shall relieve said person from further liability to any requirements imposed by this act. SECTION 11. It is hereby made the duty of the local health officer to return to the State Board of Health on or before the tenth day of each month, a copy of each report of tuberculosis received and recorded by him dur- ing the preceding month. LEGISLATION CONCERNING TUBERCULOSIS 11 SECTION 12. Any person violating any of the pro- visions of this act shall be deemed 1 guilty of a misde- meanor, and upon conviction thereof shall be punished, except as herein otherwise provided, by a fine of not less than five dollars nor more than fifty dollars. SECTION 13. All acts and parts of acts in .conflict with the provisions of this act are hereby repealed in so far as they conflict with the provisions of this act. SECTION 14. This act shall take effect and be in force from and after its publication in the official state paper. Approved February 26, 1909. Published in official state paper March 2, 1909. The principl differences beween the laws of Connecti- cut, Michigan, Maine, Maryland, New York and New Jersey and that of Kansas are as follows: New York. (Consolidated Laws, Public Health Law, Chapter 45, Sections 320 to 331; Chapter 351, 1908.) The examination of sputum made by the health officer of the county, town or village. Duties that fall to the health officers of counties or cities in Kansas fall to the health officers of the county, town or village. A'Vzt' Jersey. (Chapter 169, 1910.) Physicians are to receive ten cents from the local authorities for each name reported. Examination of sputum is made by the local health officers. Disinfection at public expense only is provided -for. Requisition for materials, the report of recovery and the transmission of the circular of infor- mation are omitted. Maryland. (Public General Law, Article 43, Sections 56 to 65: Chapters 412 and 399, 1904.) No provision is made for the examination of sputum nor for the clean- 12 LEGISLATION CONCERNING TUBERCULOSIS ing and renovation of apartments when these are vacated by death or removal. The physician shall receive one dollar and fifty cents from the state board of health for filling out the report required. Report of recovery is not required. All institutions receiving state, city, town or county aid are required to report cases to the state board of health, but no mention is made of private insti- tutions. The state board of health is required to keep a register of persons affected' with tuberculosis. The state board of health is authorized to issue circulars regarding the prevention and cure of tuberculosis. The use of the placard is not required. Maine. (Chapter 78, Public Laws, 1909.) Reports of the cases of tuberculosis are to be made to the state board of health, which is to keep a record of such cases. No provision is made for the examination of sputum. The report by physicians regarding the care of patients and the circular of information are not required. Michigan. (Act 27, Public Acts 1909.) For the re- port of each case of tuberculosis a physician is to receive fifty cents from the state treasury. The local health of- ficer is required to make the examination of sputum or other bodily secretion or discharge. The disinfecting shall be done at public expense. No provision is made for the requisition for supplies or the report to be filled out by the physician regarding the care of the patient. Report to the state board of health is nor required. Connecticut. (Chaper 79, 1909.) No provisions are made for the examination of sputum, requisition for sup- plies, physician's report regarding the care of the patient, report of recovery and report to the state board of health. LEGISLATION CONCERNING TUBERCULOSIS 13 The provisions of the laws of more limited' scope are as follows : Mississippi. (Chapter 130, 1910.) Physicians are re- quired to report cases of tuberculosis to the state board of health. The board shall send to patients thus reported informal on on the care and treatment of patients, the prevention of the spread of tuberculosis and such other matter as may be prescribed by the board. Death or recovery shall be reported by the physician to the state board of health. Penalty for violation shall be a fine of from ten dollars to fifty dollars. AYu- Hampshire. (Chapter 17, 1905.) It shall be the duty of the attending physician or a member of the patient's family or household to report every death from pulmonary consumption, or the removal of a consump- tive patient, to the local board of health within one week of death or removal. It shall be the duty of the local board of health within one week after such notice or information from any other source to cause the infected premises to be thoroughly d'sinfected and cleaned. The methods are to be endorsed and recommended by the state board of health. Rhode Island. (Chapter 386, 1909.) All physicians and the superintendent of institutions deriving part or the entire support from the state shall report cases to the state board of health. The board shall keep a register of cases reported. The register shall not be open to public inspection. Virginia. (Chapter 41, 1908.) The person in charge of any institution (including prisons and almshouses> supported entirely or in part by state, city, town or county funds shall report cases of tuberculosis to the state board 14 LEGISLATION CONCERNING TUBERCULOSIS of heailth. Tuberculosis patients in such institutions shall be separated from the other inmates. The house- holder, physician or other person having knowledge thereof shall inform the local board of health of apart- ments vacated by death or removal of persons affected with tuberculosis. The local board of health shall dis- infect such premises. Washington. (General Statutes, Sections 5550 to 5554, p. 117, 1899.) All practicing physicians in cities of the first and second class sha'll report cases of tuberculosis within five days to the local board of health. The board shall keep a record of these cases which shall not be open to public inspection. The board shall furnish each patient with printed instructions unless the attending physician shall request it not to do so. When the infected premises are vacated the owners shall disinfect them at his own ex- pense. Upon the owner's failure to comply with this re- quirement the board of health shall disinfect and the costs thereof shall be a lien against the premises. Wisconsin. (Chapter 93, 1907, amending Chapter 192, 1905.) Every physician, or person, or owner, agent, manager, principal or supeintendent of every public or private institution or dispensary, hotel, board'lng or lodg- ing house, in any such town, incorporated village, or city shall report to the department of health thereof, in writ- ing, or shall cause such report to be made by some proper and competent person, the name, age, sex, occupation, and latest address of every person afflicted with tubercu- losis, who is in their care, or who has come under their observation, within one week of such time. Upon the vacation of any apartment or premises by death or removal of any person sick with tuberculosis, the person or physician or person in charge shall notify the local commissioner of health within twenty-four hours. The health commissioner or health officer shall order and direct disinfection. In case there is no other occupant in premises or apartment he shall order renovation and disinfection of such. If orders or directions are not complied with the health commissioner or health officer shall cause a placard as follows to be placed upon the door: "Tuberculosis is a communica- ble disease. These apartments have been occupied by a consumptive and may be infected. They must not be occupied until the order of the health commissioner or health officer directing their renovation and disinfec- tion has been complied with. This notice must not be removed under a penalty of law, except by the commis- sioner of health, or an authorized officer." A person afflicted with tuberculosis of the lungs or larynx shall not dispose of his sputum, saliva or other infectious secretion in such a place as to cause offense or clanger of contracting the disease to any person. A per- son affected with tuberculosis shall provide himself with a sputum flask or other receptacle to deposit his sputum, saliva or other infectious secretion while traveling in any public conveyance or attending any public place. The contents shall be burned or otherwise disinfected. The patient and the person in attendance and authorities of institutions or dispensaries shall take precautionary measures preventing the spread of pulmonary tubercu- losis. For the purpose of this act railroad conductors or other persons in charge of common carriers may ex- ercise the powers of sheriffs and constables. The pen- alty of violation of the act shall be a fine of not less 16 LEGISLATION CONCERNING TUBERCULOSIS than five dollars or more than one hundred dollars or imprisonment in the county jail for not less than five days nor more than ninety days. Alabama. (Page 893, General Acts, 1907.) Tubercu- losis is named among a list of diseases to be reported. Utah. (Chapter 55, 1905.) Every physician and ev- ery superintendent of hospital or public institution shall report to ;the state board of health every case of tuber- culosis which he is called upon to treat or which is in such hospital or public institution. Vermont. (No. 117, 1902.) Every physician shall report to the secretary of the state board of health all cases of tuberculosis that come under his treatment. The secretary shall keep a careful record of all reported cases. Pennsylvania. (Page 855, 1909.) Physicians shall re- port cases of communicable diseases, among which tu- berculosis is named. DIS^JIICT, COUNTY AND MUNICIPAL HOSPITALS, SAN- ATORIA AND DISPENSARIES New York. (Chapter 341, 1909.) The board of supervisors of any county may vote to establish county hospitals for tuberculosis. The board shall then have power to acquire property, to erect buildings (if ap- proved by the board of health), to cause to be assessed, levied and collected such sums as it shall deem neces- sary, to borrow money, to issue county obligations there- for. Detailed provisions are made for the management of the hospitals. The patients or relatives shall pay according to their ability to pay. If the patient or rela- LEGISLATION CONCERNING TUBERCULOSIS i? tives are unable to pay in whole or in part the differences shall be paid by the county. Patients from other coun- ties not having a hospital, shall be admitted to the county hospital on the application of the superintendent of poor of his own county if there is a vacancy in the hospital. Such patient is a charge against his home county. He or his relatives shall pay, in whole or in part according to their financial ability, the cost of the maintenance of the patient. When a tuberculosis hospital exists in con- nection with a county almshouse the board of supervisors may appoint a board of managers for the hospital. They shall be subject to the provisions of this act. (Consolidated Laws, Public Health Law; Chapter 45, Section 319, Consolidated Laws; Chapter 171, 1909.) A hospital for tuberculosis shall not be established in any town, unless an application is filed with the commissioner of health giving the location and char- acter of the proposed hospital. A day shall be fixed for a public hearing before the state commissioner of health and the local health officer. Notice hereof shall be pub- lished. The determination of the state health commis- sioner and the local health officer is final. If these are unable to agree then the state commissioner of health, lieutenant governor, and speaker of the assembly shall decide, (with or without a hearing). Such determina- tion shall be final and conclusive. (Chapter 21, Sections 140, 141, 142, Consolidated LI.WS, General City Law.) Cities of the first class may maintain outside their limits, but not within the corporate limits of any other city or any village, with the approval of the state board of health, hospitals for tuberculisis. All tuberculosis hospitals now or hereafter maintained 18 LEGISLATION CONCERNING TUBERCULOSIS by cities of the first class shall be subject to the local board of health. New Jersey. (Chapter 88, 1910, as amended by Chapter 207, 1910.) The New Jersey law for the erec- tion and maintenance of county hospitals is almost iden- tical with the New York law. A limit is set to tne bond issue at one-tenth of one per cent of the total taxable ratables of such county. (Chapter 66, 1910). The consent of the state board is ^necessary to establish hospitals and sanitaria for tu- berculosis. Application shall be made to the state board of health giving the name of the city, town, borough, township or other municipality and with a descriptive map of the premises. A pub'ic hearing shall be held on the application, after which the board grants or with- holds consent and approval. The consent of the local boards is not necessary for the erection of the institu- tion or for bringing persons to such institutions from points within or without the state. Ohio. (Page 62, 1908, as amended, page 86, 1909, and page 363, 1910. ) It shall be unlawful to keep a person suf- fering from pulmonary tuberculosis in any county infirm- ary except in separate buildings to be provided and used for that purpose only. The board of county commission- ers may construct a county hospital for tuberculosis. If the funds are not available the county commissioners shall levy and set aside a sum necessary, and may issue and sell bonds in anticipation of the levy. The commission- ers and infirmary directors of any county may contract with another county or municipality, when such hospital has been constructed, for the care and treatment of resi- dents of the former county at actual cost. The probate LEGISLATION CONCERNING TUBERCULOSIS 19 judge may remove a patient of an infirmary if suffering from tuberculosis to a county hospital for tuberculosis of some other county. Patients admitted otherwise then from an infirmary shall pay not more than three dollars per week. The state board of health has general supervision over county hospitals. The commissioners of any two or more counties not to exceed five may form themselves into a joint board and establish a district hospital. The formation of a board of trustees and detailed pro- visions for the conduct of the hospital are given. The division of the cost among such counties shall be by the total number of days the patients from each county spent in the hospital, but the sum paid by patients from each county shall be deducted. Illinois. (Page 162, 1909.) Each county shall have power to purchase and hold real estate upon which may be erected and maintained by the county a sanatorium for the treatment of the residents of the coiinty who may be afflicted with tuberculosis, to purchase, hold and use all necessary personal property for the proper care and maintenancee of such real estate and' sanatorium, and to cause to be erected and maintained all suitable buildings for a tuberculosis sanatorium. Minnesota. (Chapter 347, 1909.) The board of county commissioners in any county in the state shall have power to maintain a public sanatorium for the treat- ment and care of persons afflicted with tuberculosis. In such case a county sanatorium commission shall be chosen by the county commissioners and approved by the state board of health, one of which commission shall be a physi- cian. Two or more counties may unite in acquiring, es- tablishing, equipping and maintaining such a sanatorium. The appropriation for establishing and equipping the sanatorium shall not exceed twenty thousand dollars. The tax levy for the equipment and maintenance shall not exceed four tenths of one mill on the dollar of as- sessed valuation. Iowa. (Chapter 26, 1909.) Counties are empowered to establish public county hospitals. The board of trus- tees are authorized to provide a department for the treat- ment of persons suffering from tuberculosis. The board of trustees shall determine whether the patients are sub- jects for charity. The board of supervisors of any county, when no suitable provision has been made for the care of its indigent tuberculous residents, may con- tract with the board of hospital trustees of any public hospital for the care of such persons in -the sanitorium department of said hospital, upon such reasonable terms as may be agreed upon. Oregon. (Chapter 198, 1909.) Any county or city of ten thousand may levy a tax to establish and maintain- a tuberculosis sanitarium. Upon the application of one hundred voters the question shall be referred to the people at election. The sanitarium shall be free to the inhabi- tants of the city or county. It shall be subjec to the rules and regulations of the state board of health. The county court with the approval of the county commissioners or the mayor with the approval of the council shall appoint a board of three directors. This board, shall have power to purchase a site and erect the hospital with the approval of the state board of health and to appoint persons to have charge of the hospital. LEGISLATION CONCERNING TUBERCULOSIS 21 Connecticut. (Chapter 120, 1909.) As necessity arises there shall be erected in each county a home to be used for the care and treatment of persons afflicted with tuberculosis. Three of these shall be erected as soon as poss ble after the appointment of a board of directors of three by the governor. The homes in the other counties shall be erected when the recommendation of the board therefor has been approved- by the general assembly. The cost of construction and equipment necessary for the work of the homes shall be paid by the state. Patients in town almshouses or county temporary homes suffering with tuberculosis shall be removed to a reception home for tubercular patients. Any resident of the state afflicted with tuberculosis shall be admitted to the home in the county of his residence or in some other county. If patients are able they shall pay the full cost of their treat- ment. Patients who are unable to pay full cost shall pay a minimum rate of two dollars per week, and of the balance of the cost of the treatment and care of each such patient the city or town shall pay the difference between the actual rate per week paid by the patient and four dollars per week, and the state shall pay the balance of such cost over and above four dollars per week; but the total cost of the treatement and care of each of such patients shall not exceed ten dollars per week. If a patient is unable to pay, the cost of treatment shall be four dollars per week to the town or city from which such patient is sent. Patients of filthy or immoral habits shall not be received or retained unless separate accom- modation is provided them. The management of the homes shall be under the direction of the board of di- rectors, and the board shall appoint the necessary, as- 22 LEGISLATION CONCERNING TUBERCULOSIS sistants. Each member of the board shall receive a salary of twenty-five hundred dollars. The board shall recommend state aid for sanatoria under private manage- ment. The act carries with it an appropriation of one hundred and seventy-five thousand dollars. California. (Chapter 591, 1909.) The state board of health is authorized to enter into contracts with tuber- culosis hospitals for the treatment at public expense of indigent residents of the state afflicted with incipient pulmonary tuberculosis. Each county of the state is given the privilege of maintaining at its own expense in these institutions such a number of indigent patients as its board of supervisors may determine. No county shall be required to pay more than one dollar per day per patient for all medical and other services. Only incipi- ent cases shall be admitted. Georgia. (Page 137, 1909.) Municipalities of a pop- ulation between fifty-four thousand arid seventy-five thousands may establish, alone or with the county, a tu- berculosis sanatorium. They may establish two depart- ments, one for indigent and the other for pay patients. Illinois. (Page 43, 1908, as amended, page 143, 1909.) Cities and villages shall have power to establish and maintain public sanatoria for persons afflicted with tu- berculosis and to levy a tax not to erxceed one mill on the dollar annually on taxable property of the city or village. Upon the petition of one hundred voters the question of the tax for a sanatorium must be referred to vote. Upon a majority vote such tax shall be levied. The mayor or president of the board of trustees shall ap- point a board of three directors. This board shall make by-laws and rules and regulations, appoint assistants LEGISLATION CONCERNING TUBERCULOSIS 23 and carry out the spirit of the act. The sanatorium shall be free for inhabitants of the city or village. The board shall prescribe terms for the admission of non-resi- dents. The board shall make an annual report to the council or board of trustees. All reputable physicians shall have equal privileges in treating patients in these sanatoria. Donations, bequests or devices may be ac- cepted. Nebraska, (Chapter 88, 1909.) The state board of health shall provide a list containing hospitals suitably equipped and willing to accept patients afflicted with tu- berculosis. It shall send a copy of the list to each county clerk in the state. It shall prescribe regulations for the care, housing and nursing of such patients and see that they are complied with. The modern treatment by im- munigation (vaccine therapy) is made obligatory in ad- dition to the open air and other sanitary methods. The charge shall not exceed seven dollars a week. Any in- digent patient who is afflicted with tuberculosis disease of the respiratory organs of a curable nature, and who has been a resident of the state for one year may be admitted to one of these hospitals. The county board shall pay for the care and treatment at one of these hospitals. No patient shall be admitted unless the writ- ten application has been approved, after an examination and hearing by the county judge and unless he has re- ceived a certificate from a practicing physician. *, New Hampshire. (Chapter 152, 1909.) The state board of health shall establish one or more dispensaries for the more thorough detection or discovery of tubercu- losis and for the free treatment of indigent cases of tuberculosis upon the petition of the selectmen of any 24 LEGISLATION CONCERNING TUBERCULOSIS town, or of the mayor of any city, or upon its own mo- tion. The examining physician selected by the state board of health shall examine applicants. He may for- ward sputum for examination to the state board of health. The examination shall be free of charge. The physician making the examination shall receive from the state one dollar for each examination in which germs are detected. Treatment shall be free to all indigent patients. The work shall be carried on in two sections for the care and treatment of incipient cases and for advanced cases. Cities and towns are authorized to raise a tax not to ex- ceed one tenth of one per cent of the assessed value of the taxable property of the city or town. The act pro- vides for an annual aporopriation of five hundred dollars. Rhode Island. (Chapter 400, 1909.) No person, corporation, city or town shall establish any hospital for the treatment of patients suffering from tuberculosis un- less the board of health of the city or town authorizes the same. STATE HOSPITALS, SANATORIA AND DISPENSARIES. Alabama. (Page 705, 1907.) Alabama sanatorium for consumption and tuberculosis, established for the study of tuberculosis, disseminating the results of the study, showing the best methods of treating it and preventing its spread and for the care and treatment of such per- sons as may be admitted to the sanatorium. The gover- nor, the state health officer and five other members ap- pointed by tbe governor, three of whom shall be physi- cians, shall constitute the board of trustees. The board selects a superintendent. Only curable cases are admit- LEGISLATION CONCERNING TUBERCULOSIS 25 ted. Charges for pay patients shall be determined by the board. Indigent patients may be received; the cost of maintenance of these shall not exceed four dollars and twenty cents per week. Ten thousand dollars is appropriated annually. The state shall pay not to ex- ceed sixty cents per day for each indigent patient. .-Irkansas. (Act 378, 1909.) The Arkansas Tubercu- losis 'Sanatorium established. Appropriations are made for sum of fifty thousand dollars for the site, construc- tion and equipment and for sum of thirty thousand dol- lars for its maintenance. A board of trustees of six mem- bers shall be appointed by the governor. The board shall appoint a medical superintendent. Indigent and pay pa- tient may be admitted. The charge shall be determined by the board. Connecticut. (Chapter 120, 1909.) The state shall pay the cost of the construction and equipment of homes to be erected in the various counties. The state shall also pay the cost over and above four dollars per week of those patients who pay only the minimum rate of two dollars per week, provided that the total cost shall not exceed ten dollars per week. Delaware. (Chapter 74, 1909.) The Delaware State Tuberculosis Commission shall consist of nine members, three from each county, appointed by the governor. The commission shall have power to send indigent patients to sanatoria for treatment, and shall pay for the c*re, treatment and support of these patients. Persons able to pay only a part of the cost of their maintenance may be assisted by the commission. The commission shall make an annual report to the governor. The commission is directed to establish at least one 26 LEGISLATION CONCERNING TUBERCULOSIS dispensary in each county for the treatment of indigent consumptives and to employ the necessary assistants. Fifteen thousand dollars is appropriated annually. Georgia. (Page 101, 1908.) The act establishes a 'State Sanitarium for patients afflicted with tuberculosis. The board of managers, two from each congressional district, shall be appointed by the governor. The board shall appoint a doctor to take charge of the institution and other assistants? There shall be two departments, one for pay and 'the other for indigent patients. Charges shall be fixed by the board. Indiana. (Chapter 125, 1907. ) The act establishes the Hospital for Treatment of Tuberculosis. The governor shall appoint a board of trustees of three mem- bers. They shall receive three hundred dollars a year and one hundred dollars expenses. The board shall ap- point a superintendent. Only incipient cases are ad- mitted. Indigents shall be county charges. The cost of maintenance shall not exceed five dollars a week. The county shall pay the part of the cost that is unpaid by the partial pay patients. Pay patients may also be ad- mitted. The appropriation is thirty thousand dollars. Chapter 189, 1909, makes an appropriation of one hun- dred thirty thousand dollars. loiua. (Chapter 120 1906, as amended by Chapter 147, 1907.) State sanatorium for the treatment of incipient tuberculosis is established. The board of con- trol of state institutions shall appoint a superintendent and other employees. The per capita cost shall not ex- ceed thirty dollars per month. The patients shall pay if they are able. LEGISLATION CONCERNING TUBERCULOSIS 27 Kentucky. (Page 44, 1908.) Appropriations were made to private sanatoria. Maine. (Chapter 50, Resolves 1907.) Fifty thousand dollars appropriated for a building for the isolation of the tuberculi insane of the two state asylums. Maryland. (Chapter 308, 1906.) The Maryland Tu- berculosis Sanatorium is established. The board of man- agers shall consist of the governor, state treasurer, comp- troller of the treasury and six other persons appointed by the governor. The appropriation is one hundred thousand dollars. (Chapter 429, 1906.) The act makes an appropriation of thirty-five thousand dollars to the Hospital for con- sumptives of Maryland. Massachusetts. (Revised Laws, 1902, Chapter 88.) Massachusetts state sanatorium was established in 1895. (Chapter 474, 1907.) The act establishes three sana- toria for tubercular patients. The governor shall appoint a board of trustees of seven members. The trustees may appoint physicians and the necessary assistants. The charges are four dollars per week. Charges for an in- digent not having a known settlement shall be paid by the state, for an indigent having a known settlement, by the place of settlement. Patients or persons bound by law to maintain them shall pay if they are are able to pay. When the sanatoria are completed the trustees shall as- sume the powers and duties of the Massachusetts state sanatorium. Michigan. (Page 363, 1905.) A state sanatorium for tuberculous persons is established. The governor shall appoint a board of trustees of six citizens, four of whom shall be physicians. The board shall appoint a 28 LEGISLATION CONCERNING TUBERCULOSIS medical superintendent, who shall be a physician. The superintendent shall appoint all assistants. Both indi- gent and pay patients shall be admitted. Indigent patients are county charges. The rate for these shall not be less than five dollars, or more than seven dollars a week ; the rate for pay patients shall be determined by the board. Minnesota. (Chapter 316, 1903.) The governor shall appoint five licensed physicians as the advisory com- mission of the state sanatorium for consumptives.. The state board of control shall appoint a licensed physician as superintendent. The board shall fix the amounts to be charged. Indigent patients shall be county charges. Only incipient cases shaill be admitted. Missouri. (Revised Statutes, Sections 1454 to 1469; page 306, 1907.) The Missouri state sanatorium is estab- lished. The governor shall appoint a board of managers of five members, not less than two of whom shall be practicing physicians. The board shall elect a superin- tendent and other employees. The superintendent, the steward and the treasurer shall make biennial reports. Free patients shall be charged upon the counties or the city of St. Louis. The rate shall not exceed five dollars a week. Pay patients are admitted, but preference is given to the indigent patients. The board shall fix the charges for pay patients. Only incipient cases are ad- mitted. New Hampshire. (Chapter 92, 1905.) The act es- tablishes the New Hampshire State Sanatorium. The governor, with advice and consent of -the council, shall appoint a board of trustees of five persons. The board shall appoint a superintendent, who shall be a physician, and other necessary employees. Pay and free patients LEGISLATION CONCERNING TUBERCULOSIS 29 shall be admitted. Charges for pay patients shall be fixed by the board. The state shall pay the amount nec- essary to make up the deficit of those who are able to pay but a part of their maintenance. The trustees shall make an annual report to the governor and council. Neiv Jersey. (Chapter 126, 1902, as amended by Chap- ter 178, 1907.) The New Jersey Sanatorium for Tuber- culous Diseases is established. The governor with the advise and consent of the senate, shall appoint a board of eight managers at least four of whom shall be physicians. The board shall appoint a superintendent, who shall be a physician, and other assistants. The board shall make an annual report to the governor. Any person who has been a resident of the state for a year and is afflicted with tuberculous disease of the respiratory organs of a cur- able nature may be admitted. Persons of sufficient abil- ity to pay shall pay for their care and treatment at a rate to be determined by the board. The charges of persons who have had a residence in any municipality of the state for one year and who are received at the request of the overseer of the poor of that municipality, shall be paid by that municipality; the sum shall not exceed five dollars per week. Persons in indigent circumstances who have had a residence in the state for one year and who do not come within the foregoing two classes shall be treated without cost. Xcw York. (Consolidated Laws, State Charities Law, Sections 150 to 163.) New York state hospital for the treatment of incipient pulmonary tuberculosis is estab- lished. The governor, with the advice and consent of the. senate, shall appoint a board of trustees of five citi- zens, two of whom shall be physicians. The board shall 30 LEGISLATION CONCERNING TUBERCULOSIS appoint a superintendent who shall be a physician. The superintendent shall appoint the other employees. The expense of transportation, treatment, maintenance and the actual cost of articles of clothing furnished by the hospital to poor or indigent patients shall be a county, city or town charge, as the case may be. Pay patients shall be admitted if there is room in the hospital, but preference shall be given to indigent patients. The trus- tees shall fix the charges to be pa-id by pay patients. Charges for free patients shall not exceed five dollars per week. North Carolina. (Chapter 964, 190T, as amended Chapter 845, 1909.) The act establishes the North Caro- lina sanatorium for the treatment of persons afflicted with tuberculosis. A board of directors of twelve members shall be appointed by the general assembly. The super- intendent shall be a skilled physician. He shall appoint the subordinate officers and employees. The board shall make an annual report to the governor and the general assembly. The act carries an annual appropriation of five thousand dollars besides the appropriation of fifteen thousand dollars for the establishment of the sanatorium. North Dakota. (Chapter 137, 1909.) The North Da- kota Tuberculosis Sanitorium is established by the act. Ten thousand dollars is appropriated. Ohio. (General Code 1910, Sections 2052 to 2072.) The Ohio state sanitorium for incipient cases is estab- lished. Patients shall be apportioned among the several counties in proportion to their population. The gov- ernor, with the advice and consent of the senate shall appoint a board of trustees of five members. The board shall appoint a superintendent and other necessary em- LEGISLATION CONCERNING TUBERCULOSIS 31 ployees. The charges shall be five dollars each week. The trustees may accept a limited number of suitable pa- tients, not to exceed two per cent of the total capacity, for any sum less than five dollars per week. All patients admitted shall be received upon probation for a period of four weeks. If they are suitable cases for sanitorium treatment they shall be regularly admitted. Compensa- tion for outdoor work done by patients shall be deducted from the weekly charge. The superintendent shall make monthly reports to the auditor of state. Pennsylvania. (Number 157, 1907.) The depart- ment of health with the approval of the governor, shall establish one or more sanatoria or colonies for the recep- tion and treatment of indigent persons affected with in- cipient tuberculosis, and those so far advanced with the same disease, that may be made comfortable, and re- moved from their families and the people at large to pre- vent the spread of tuberculosis. Six hundred thousand dollars is approriated. (Number 673, 1907.) Four hundred thousand dollars is appropriated to enable the department of health to establish and maintain dispensaries for the free treat- ment of indigent persons affected with tuberculosis, for the dissemination of knowledge and for the study and ex- periment of the disease. By the last report one hundred and fifteen dispensaries have been established. (Number 518, 1909.) Fifteen thousand dollars is ap- propriated to the Tuberculosis League, Pittsburg. Rhode Island. (General Laws, 1909, Chapter 112.) The governor with the advice and consent of the senate shall appoint a board of trustees for the state sanatorium of 32 five members only, one of whom shall be a physician. The board shall appoint all physicians and other em- ployees. Patients who are able to pay for their support shall pay at a rate to be determined by the board. The board of such patients as have a legal settlement in some city or town shall be paid by that city or town, if the patients are received on the request of the overseers of the poor of the city or town. The board may receive other indigent patients whose board shall be paid by the general treasurer. The board shall fix the charges for board. The board shall make an annual report to the general assembly. South Dakota. (Chapter 68, 1909.) The act .estab- lishes a sanitorium and farm for persons afflicted with tuberculosis and for the study of the disease. Ten thou- sand dollars is appropriated for the building and five thousand dollars annually for maintenance. Virginia. (Chapter 361, 1908.) The state board of health shall begjin the erection of temporary or permanent buildings or camps for the treatment of the tubercular patients in the state at a minimum expense to the patient. Forty thousand dollars is appropriated annually for the above and other provisions of the act. Wisconsin. (Statutes, Supplement, Sections 1421 1 to 14218 as amended by Chapter 442, 1909.) The act establishes the Wisconsin state tuberculosis sanatorium for the treatment of pulmonary tuberculosis, especially for cases in the incipient stages' of the disease. The ad- visory board shall consist of five members appointed by the governor, at least two of whom shall be physicians and another a member of the state board of health. The board shall make a biennial report to the state board of LEGISLATION CTTKVERNIN$ TUBERCULOSIS 33 control. The board of control shall appoint the superin- tendent. Subject to. the approval of the board of control the superintendent shall appoint medical assistants and other emplyees. The superintendent and board of con- trol shall determine the sum to be paid by pay patients. Only incipient or slightly advanced cases shall be re- ceived. Each county shall be charged with the mainte- nance of indigent patients whose application has been approved by the county judge of that county. Such charge shall be five dollars per week. Any person who may be unable to pay the full charge of maintenance may be received upon payment of the amount charged for county patients. LAWS RELATIVE TO EXPECTORATION. California. (Chapter 82, 1907.) It shall be a misde- meanor for any person to discharge mucus from the nose or mouth or spit upon any sidewalk, of any public street or highway or upon any part of any public building or vessel or vehicle used for the transportation of the pub- lic. Connecticut. (Chapter 166, 1909.) No person shall spit on the paved walk of any public street, park or square or upon the floor of any hall or office in any hotel, restuarant, apartment house, tenement or lodging house which is used in common by the guests or tenants thereof or upon the floor, platform, steps, or stairs of any public building, church, theater, railway station, store or factory or street car or other conveyance. Penalty, one to five dollars or not more than thirty days, or both. Delaware. (Chapter 253, 1907.) Spitting on the 34 LEGISLATION CONCERNING TUBERCULOSIS floor in any public conveyance or car upon any railway operating by any other power than steam shall be a mis- demeanor. Penalty, five or not more than ten dollars. Kansas. (Chapter 122, 1909.) No person shall spit upon any part of any theater, public building, or public conveyance or any sidewalk. Spittoons shall be pro- vided in theaters and public buildings and when re- quested, in smoking cars. The dry sweeping of railroad coaches or cars on electric or interurban lines, while in transit and containing passengers, is prohibited. Fine, one to five dollars. Louisiana. (Chapter 91, 1908.) Any person who shall spit upon the floor or walk of any passenger car, street car, depot, or waiting room or any public building whatever, shall be deemed guilty of a misdemeanor. Fine, five to twenty-five dollars. Railroad companies shall supply every passenger car and depot or waiting room with spittoons and keep them in a sanitary condi- tion. They shall post notices, worded as follows: "Spitting upon the floor and walk forbidden under pen- alty of the law." The police jury of each parish shall have the same duties in relation to the court house of that parish. Maine. (Chapter 76, 1909.) No person shall ex- pectorate on any, public sidewalk, street crossing or cross walk, or upon the floor in any city or town hall, or court house, in any factory, public library or museum, church, theater, lecture or music hall, ferry boat or steam boat, in any railroad car, (except smoking car), street or in- terurban railway car, railway station, or on any side track or platform connected therewith. Fine, not more than twenty dollars, LEGISLATION CONCERNING TUBERCULOSIS 35 Maryland. (Article 27, Section 238, Public General Laws, 1904.) It shall be unlawful to expectorate on the floor or any part of a railroad or passenger car. Fine, three and one half dollars, one half of which shall go to the informer or party giving evidence. Conductors and brakemen shall be empowered to arrest and take before a justice of the peace any offender. Smoking cars in which no cuspidors are provided are exempt from the operation of the law. Massachusetts. (Chapter 410, 1907.) The Mary- land and Massachusetts expectoration laws are similar but Massachusetts makes provision, that an offender may be arrested by an officer authorized to serve criminal process in the place where the offence is committed and kept in custody until he can be taken before a court which has jurisdiction of such offence ; and, if his name is un- known to the officer, he may be arrested without a war- rant. (Chapter 104, 'Section 41, Revised Laws, Supplement.) Cuspidors shall be provided in all factories and work- shops, in such form and number as shall be satisfactory to the local board of health. Michigan. (Act 210, Public Acts, 1909.) Expector- ation is prohibited in any railroad, passenger or street railway car, in any passenger station cr public waiting room. The law does not apply unless placard is posted and cuspidors furnished. Xac Hampshire. (Chapter 2, 1903.) It shall be un- lawful for any person to spit upon any sidewalk, in the compact part of any city, village or town, or in any rail- way station, hall or public place, or in any street or steam railway car other than smoking cars, except into 36 LEGISLATION CONCERNING TUBERCULOSIS receptacles provided for that purpose. These receptacles shall be kept clean and wholesome. Fine, not exceeding ten dollars. New Jersey. (Chapter 260, 1903.) Any person who shall spit on any part of any railroad or railway pas- senger car shall be deemed to be a disorderly person; this shall not apply to smoking cars when these are not provided with cuspidors. (Chapter 204, 1910.) Any person who shall spit on any part of any trolley passenger car shall be deemed to be a disorderly person. Fine, not more than ten dollars. Rhode Island. (Title XV, Chapter 110, Section 33, General Laws, 1909.) No person shall spit upon any part of any public conveyance, not exclusively devoted to smoking, or of any shop, store, hall, church, school-house, railroad station or other public building, or in the hall- ways of any private office building, except into suitable receptacles provided for that purpose. Fine, not ex- ceeding twenty dollars. Tennessee. (Chapter 594, 1907.) The proprietor or manager of any building where business with the public is conducted, and the owner of steam railway passenger coaches, shall provide cuspidors and keep them disin- fected to meet the approval of the local board of health, in the former and of the state board of health in the latter case. It shall be unlawful to spit upon any part of these buildings, public buildings, street cars or steam railway passenger coaches. The proprietors, managers or owners shall post the notices prescribed and supplied by the state or local board of health. Penalty for spit- ting as provided above, fine, two to five dollars ; genera.1 LEGISLATION CONCERNING TUBERCULOSIS 3? penalty, fine, ten to twenty dollars, or imprisonment in the county jail for not more than three months or both. I'ennont. (No. 70, 1902.) If a person shall spit upon any part of a steam railroad, passenger car or street railway car or upon any part of any railroad passenger station or public waiting room he shall be fined not more than ten dollars, provided that no prosecution shall be commenced unless notice of the provisions of this act is posted and suitable cuspidors furnished, excepting' in street railway cars. (No. 187, 1906.) A person who expectorates on a pub'ic sidewalk or in a public building, except in re- ceptacles provided for the purpose, shall be fined not more than ten dollars. Virginia. (Chapter 302, 1906.) No person shall spit upon any part of any theater, public building, or public conveyance, or upon any public sidewalk of any town or city. The owner or lessee of every theater, public hall, or building shall provide cuspidors. Every railroad or steamship company shall provide cuspidors in each smoking car when so requested. Copies of this act shall be posted in all public buildings and railway and street cars. Penalty, fine of from one to five dollars, together with costs and in default of payment, imprison- ment in city or county jail for not more than five days. DISSEMINATION OF KNOWLEDGE CONCERNING TUBERCU- LOSIS. California. (Chapter 242, 1909.) The state board of health shall disseminate knowledge concerning tubercu- losis, its danger, means of prevention and cure. Two thousand dollars is appropriated. 38 LEGISLATION CONCERNING TUBERCULOSIS Connecticut. (Chapter 120, 1909.) The board of di- rectors (for county homes) shall take measures to cause instruction to be given in all schools of the state on the suppression of tuberculosis and the maintenance of pub- lic health, and to that end it may publish tracts and leaflets. The board shall encourage the giving of public addresses and the formation of local organizations to fur- ther that end. loiva. (Chapter 147, 1907.) Five thousand dollars is annually appropriated for the collection and dissemina- tion of information regarding tuberculosis. Massachusetts. (Chapter 181, 1908.) In each of the subjects of physiology and hygiene, special instruction as to tuberculosis and its prevention shall be taught as a regular branch of study to all pupils in all schools which are maintained wholly or in part by public money, ex- cept schools which are maintained solely for instruction in particular branches. (Chapter 65, Resolves 1910.) One thousand dollars is appropriated for the formation of small travelling school tuberculosis exhibits to be used in the public schools for purposes of instruction in hygiene and the prevention of tuberculosis. Montana, (Chapter 27, 1909.) There shall be taught in every public school the principal modes for the preven- tion of certain diseases including tuberculosis. Data and statements shall be supplied by the state board of health. New Jersey. (Chapter 12, 1910.) Ten thousand dol- lars is appropriated annually to be available by the state board of health for educational and practical purposes in the study, treatment and prevention of tuberculosis by LEGISLATION' CONCERNING TUBERCULOSIS 39 (1) publication and distribution of literature, (2) crea- tion and maintenance of a state tuberculosis exhibit, (3) and in the maintenance of a special tuberculosis inspector or inspectors, to be appointed by the state board of health whose duties shall be to enforce existing laws concerning registration of tuberculous cases, to advise local boards of health concerning disinfection, to inspect hospitals and sanatoria treating tuberculosis patients and to report on the same to the state board of health, and to perform such other duties as may be ordered by the state board. MISCELLANEOUS PROVISIONS. Connecticut. (Section 2570, General Statutes, 1902, as amended by Chapter 120, 1909.) No employer shall per- mit any person afflicted with pulmonary tuberculosis to work in any factory for the preparation of food stuffs, tobacco and cigars. If the factory inspector suspects that an operator has pu'monary tuberculosis, he shall .have authority to cause an examination to be made. Massachusetts. (Chapter 537, 1907.) The governor shall appoint in each health district one state inspector of health. He shall gather all information possible concern- ing the prevalence of tuberculosis, shall disseminate knowledge as to the best methods of preventing its spread and shall take such steps as shall be deemed advisable for its eradication. (Chapter 428, 1910.) The state board of health may prohibit the use of common drinking cups in such public places, vehicles or buildings as it may designate. Missouri. (Revised Statutes, 'Section 7866.) No em- ployer shall knowingly permit any person to work in his 46 LEGISLATION CONCERNING TUBERCULOSIS bake or confectinery shop who is affected with tuber- culosis. Xcw Jersey. (Chapter 47, 1909.) Physicians shall report to the state board of health within twelve hours cases of tuberculosis on any dairy premises where milk is produced for sale. North Carolina. (Chapter 567, 1907.) Prisoners in county or state prisons who are affected with tuberculosis shal be confined in separate eel's, rooms or places. These shall be used only for this purpose. Ohio. (Page 319, 1910.) The board of education in any city school district may establish such special ele- mentary schools as it deems necessary for youth of school age who are afflicted with tuberculosis and may cause all youth, within such district so affected, to be excluded from the regu'ar elementary schools, and may provide for and pay from the school fund, the expense of the transportation of these to and from the special schools. Utah. (Compiled Laws, Section 746x19.) It shall be unlawful for any person affected with tuberculosis to be employed in any bakery, hotel, or restaurant as cook, or waiter, or in any other capacity that requires the handling of food. BOVINE TUBERCULOSIS. Connecticut. (General Statutes, 1902, Section 2591.) The sale of milk from a cow affected with tuberculosis is prohibited. Delaware. (Chapter 122, 1909.) The importation of dairy cows and other cattle for breeding purposes is pro- LEGISLATION COXCERXIXG TUBERCULOSIS 41 hibited unless they have been subjected to the tuberculin test. Kansas. (Chapter 169. 1909.) The live stock sani- tary commissioner when he believes or receives notice that tuberculosis exists in any of the domestic cattle of the state, shall make invesigation and if necessary call upon the professor of veterinary science of the State Agricultural College at Manhattan, who. himself or thru a competent veterinarian, shall make an exanrntion. The tuberculin test may be used. The decision of the professor or of the state veterinarian shall be final. The commissioner shall quarantine and brand or mark all in- fected animals until disposed of. The owner of any such animals may sell them subject to post mortem inspection, or sell them as diseased animals undei federal or state inspection, or deliver them to the live stock sanitary com- missioner in consideration of an order on the county board for fifty per cent of their appraised value if they were not diseased. The appraisement shall not exceed titty dollars for each pure bred and registered animal au-i thirty dollars for grade or common cattle. The appraise- ment shall be made by the commissioner, or his deputy, and the owner. If they cannot agree the chairman of the county board or some one appointed by him shall act as a third appraiser. The commissioner is authorized to ?ell animals turned over to him for slaughter. The pro- ceeds he shall turn over to the treasurer of the county. The owner shall disinfect the premises at his own ex- pense. Fine, twenty-five to one hundred dol'ars. Cities are authorized to require the examination and test for tuberculosis, under the direction of the commis- sioner, of cows from which milk is supplied to the cities. 42 LEGISLATION CONCERNING TUBERCULOSIS Maine. (Revised Statutes, Chapter 19.) Upon the discovery of the existence of tuberculosis the Maine Cattle Commission shall establish such quarantine of ani- mals, premises and localities as it may deem necessary to prevent the spread of the disease. The commission- ers shall cause the appraisal of the animals affected with the disease and shall cause the same to be destroyed. The appraised value of an animal with pedigree shall not exceed one hundred dollars and of an animal without pedigree, fifty dollars. The transportation within the state or into the state of animals affected with tubercu- losis is forbidden. The carcasses of animals killed under the provisions of this law shall be treated by injection with kerosene oil. The carcasses shall further be buried or reduced for fertilizer. (Chapter 133, Public Laws, 1910.) All pure blood or registered and all grade cattle shown in competition for prizes at state agricultural shows shall be tested with tuberculin by the cattle commission. The cattle commis- sion shall cause tuberculin tests to be made at the ex- pense of the state, when owners of cattle make applica- tion for the same. All grade cattle slaughtered under orders of the commission shall be paid for at the ap- praised value out of the funds appropriated for the use of the commissioners. The commissioners shall disinfect the stables where diseased cattle have been kept. The owner of cattle shipped to the quarantine station at Brighton, there tuberculin tested and condemned, shall be entitled to receive not to exceed fifty dollars for each animal, but the amount received for the sale of such part of the animal as may be sold shall be deducted from the appraised value. One hundred thousand dollars is ap- propriated. Maryland. (Chapter 365, 1908.-) The importation of dairy cows and meat cattle for breeding purposes is pro- hibited, excepting when they have been tuberculin tested by the proper authorities in the state from which the cat- tle came. In lieu of the above the cattle may be examined at the owner's expense at stock yards near the state line, or they may be shipped to their destination and there quarantined until properly examined at the owner's expense and released by the state live stock sanitary board. Massachusetts. (Revised Laws, Chapter 90.) The board of cattle commissioners or any one of its members or agents may kill cattle afflicted with tuberculosis. The full value thereof at the time of condemnation, not ex- ceeding forty dollars for any one animal, shall be paid to the owner by the commonwealth. Animals brought into the state which, in the opinion of the board, are infected may be seized and quarantined and, if safety so requires, may be killed without appraisal or payment. Animals believed to be diseased may be quarantined. If the owner cannot agree with the commissioner as to the value of an animal the value shall be determined by arbitrators. Tuberculin shall be used only upon cattle brought into the commonwealth and upon cattle at Brighton, Water- town and 'Somerville; but it may also be used on any animal in any other part of the commonwealth with the consent of the owner and upon animals which have been condemned as tuberculous upon physical examination by a veterinary surgeon, 44 LEGISLATION CONCERNING TUBERCULOSIS (Amendment Chapter 322, 1903.) Such tests by the use of tuberculin shall be made without charge to citizens of the commonwealth, and in all other cases the expense of such tests shall be paid by the owner of such animals. Michigan. (No. 172, Pub'ic Acts, 1909.) In case of the killing of tuberculous cattle as diiected by the state live stock sanitary commission, it shall appraise the ani- mals condemned. The owner shall receive fifty per cent of the value of the animal as though not diseased, such per cent in no case to be reckoned on a sum over fifty dollars, provided that premises have been kept in sani- tary condition, nor shall they receive compensation until the infected premises have been disinfected. The com- mission shall have power to order the slaughter, under federal inspection, of cattle that have reacted to the tuberculin test. If the cattle are not condemned the owner shall receive the proceedfe less the cost of shipping, etc., If the cattle are condemned the owner shall receive the proceeds from the sale of the hide, tallow, etc., after de- ducting the cost of handling, etc., in addition to the above mentioned fifty per cent of the appraised value. The importation of cattle into the state is prohibited unless tuberculin tested sixty days prior to shipment. Minnesota. (Revised Laws, Chapter 30.) When a veterinarian appointed by the state live stock sanitary board has inspected .cattle for tuberculosis and has pro- nounced them diseased they shall be killed. Appraisers appointed by the state board and owners shall fix the value of the cattle. The value of the carcass shall be deducted from ithat of the living animal, and three- fourths of the remainder shall be paid to the owners by LEGISLATION CONCERNING TUBERCULOSIS 45 the state, provided that the appraised value shall not exceed thirty-five dollars. (Chapter 355, 1907.) It shall be unlawful for any transportation company to bring into the state any cattle unless they have been examined and found free from tuberculosis by the proper authorities of the state from which they are shipped, or by a veterinarian of the United States bureau of animal industry or by a veteri- narian acting under the direction of the live stock sani- tary board of th's state. In any case where cattle are brought into the state without examinaion transportation companies shall hold the cattle at the first station within Minnesota where there are suitable facilities for inspect- ing them. This inspection shall be made at the expense of the owner. (Chapter 445, 1909.) The board shall furnish tuber- culin and mallein among licensed veterinarians regardless of whether such are graduates of a veterinary college or not. The board shall keep record of all applications. Montana. (Revised Codes. Sections 1884 to 1903.) Animals determined by either the state veterinary sur- geon or a deputy to be affected with tuberculosis may be slaughtered. No animals of this class shall be paid for, save when a mistake as to the existence of a slaughter- able disease is discovered upon autopsy. The valuation shall not exceed the following : For common bloods, not exceeding thirty-five dollars, for any male animal, four years old and upwards, and for any female animal four years old and upwards, not exceeding twenty-five dol- lars and proportionately less for lesser ages. For graded stock, not exceeding forty dollars for any male animal four years old and upwards, and for any female animal 46 LEGISLATION CONCERNING TUBERCULOSIS four years old and upward not exceeding thirty-five dol- lars, and proportionately less for lesser ages. And for all full bloods, for any male animal four years old and upwards not exceeding one hundred dollars, and for any female animal four years old and upward not exceeding seventy-five dollars and proportionately less for lesser ages. New Jersey. (Chapter 317, 1894, as amended by chapter 148, 1898, and chapter 80, 1901.) Whenever the state tuberculosis commission shall be requested by the secretary of the state board of health or the dairy com- missioner or any owner of dairy animals, it shall desig- nate a person to inspect the animals supposed to be diseased with tuberculosis. If these cannot agree on a valuation each shall choose one disinterested freeholder,, who shall choose a third and these shall appraise the value of the animals. If the animal is slaughtered the owner shall receive three-fourths of the appraised value,, but the appraised value shall not exceed forty dollars. 'New York. (Consolidated Laws, Agricultural Law, Sections 93, 94, 64-a.) The commissioner of agriculture may have tuberculous animals killed if found so by physi- cal examination. The tuberculin test may be applied if the owner desires. If the animal responds the commis- sioner shall cause it to be slaughtered or held in quaran- tine. If it is held in quarantine the milk may be used if pasteurized. The young of such, animals shall be separ- " ated from the mothers, but they may be fed the pasteur- ized milk. Upon the application of the owner of a herd of cattle and "his agreement to improve faulty sanitary conditions, to disinfect his premises should tuberculosis be found and to follow the instructions of the commis- LEGISLATION CONCERNING TUBERCULOSIS 47 sioner, the commissioner shall cause the ntrd to be ex- amined. No person shall sell any animal known to have a communicable or infectious disease except for immedi- ate slaughter unless such sale be made under a written contract signed by both parties, specifying the disease of the animal. One copy shall be filed with the commis- sioner of agriculture. Any person making a tuberculin test shall report the results to the commissioner of agri- culture. No certificate shall be given unless the charac- ter of such test is stated, and unless it failed to give a proper reaction. Tubercular bovine animals shall be branded on the forehead or on the right side of the neck from six to ten inches back of the jaw bone with a capi- tal "T" not less than two inches high, one and one half inches wide, with a mark one fourth of an inch wide. If the animal reacted to the tuberculin test and appears physically sound it may be retained for breeding or dairy purposes without such branding, but a description of the animal must be furnished to the commissioner of agri- culture, and the animal cannot be removed without the written permission of the commissioner. Persons selling or giving away tuberculin shall report the amount sold or given away to the commissioner of agriculture. No person shall treat bovine animals so as to prevent normal reaction. No animal that has reacted to the test shall be sold or removed without permission in waiting from the commissioner. No person shall sell or offer for sale an animal that has responded to the test without giving this information to the buyer. (Consolidated Laws, Agricultural Law, Sections 99 to 102, as amended by Chapter 670, 1910.) An appraiser appointed by the commissioner of agriculture, shall deter- 48 LEGISLATION CONCERNING TUBERCULOSIS mine the value of the animal to be slaughtered, but the appraised value shall not exceed seventy-five dollars, ex- cept in the case of registered thoroughbred animals, when it shall not exceed one hundred and twenty-five dollars. In case of dispute arbitrators shall be selected to" decide. If the animal is found to have localized tuberculosis the owner shall be paid eighty per cent of the appraised value," if generalized tuberculosis, fifty per cent. If the meat of the slaughtered bovine animal shall be passed fro use as food, under official regulation, the commis- sioner is authorized to sell the same and the proceeds shall be paid into the staite treasury. North Dakota. (Chapter 160, 190 ( J.) Cattle that have been proven to be tubercular by the tuberculin test after having been tested by a legally qualified and duly authorized veterinary surgeon or the owi;er of such cattle or his agent shall be immediately marked by punching the letter "T" in the left ear, the letter not to be les^ than one inch in height and breadth. Penalty, fine of from ten to fifty dollars or confinement in the county jail from ten to twenty days or both. Oregon. (Chapter 213, 1909.) The state or county veterinarian is empowered to kill animals afflicted with a dangerous or incurable disease, provided that tubercu- losis be not considered a slaughterable disease, unless the animal shows visible symptoms of the disease. No ani- mal shall be tested with tuberculin unless request is made by the owner. The importation of no cattle for breeding or dairy purposes shall be permitted unless they shall be accompanied by 'a certificate of a tuberculin test made by an employee of the United States Bureau of' Animal Industry or by any other approved veterinarian, LEGISLATION CONCERNING TUBERCULOSIS 4& showing that they are free from tuberculosis or unless the cattle be tested with tuberculin by the proper officer within ten days after arrival within the state. The state veterinarian or county veterinarian shall test all cows that supply milk to state institutions, at least once a year. If they react to the tuberculin test the sale of the milk .shall be prohibited and the animals removed from the dairy herd. Officers of such institutions shall report every six months the names of persons supplying milk to these institutions. Every veterinarian practicing shall report to the state veterinarian or the state board of health all cases of tuberculosis he may find. Pennsylvania, (Purdons Digest, Page 1259.) The importation of dairy cows and meat cattle for breeding .purposes is prohibited, excepting when they are accom- panied by a certificate from the proper authority in the state whence the cattle came, certifying that they had been subjected to the tuberculin test and are free from disease. In lieu of this certificate the cattle may be detained at suitable stock yards nearest to the state line and there examined at the expense of the owner, or they may be shipped to their destination, there to remain in quaran- tine until properly examined a" the owner's expense, and released by the state live stock sanitary board. Rhode Island. (General Laws, Chapter 120.) When- ever an animal is suspected by either of the cattle com- missioners to be affected with tuberculosis, the commis- sioner of the county shall notify the secretary of the state board of agriculture who shall fix a day when the appraisers shall appraise the animal. If it is affected the animal shall be killed, and the state shall pay the owner one half of the appraised value; if it is not affected the 50 state shall pay the full appraised value. The cattle com- missioners of the counties shall see that the premises be cleaned and disinfected. A person shipping cattle into the state must produce a certificate that the animal is free from tuberculosis as determined by a physical ex- amination and tuberculin test. If the importer has no certificate he shall give a written notification and descrip- tion of the an : mals to the commissioner of the county who shall make a physical examination and if necessar)' apply the tuberculin test. If the animal responds it shall be slaughtered, and no compensation shall be made by the state. If upon slaughter no affection is shown the owner shall receive the full appraisal value. Utah. (Compiled Laws, Section 746.) No person selling or furnishing milk or dairy products shall have in his possession, at any place where milch cows are kept, any cattle having tuberculosis. The dairy and food commissioner shall cause all cattle, kept in violation of this act, to be killed. Vermont. (Number 163, 1908.) All cattle brought into the state shall be examined by the cattle comrnis^- sioner. He shall if he deems necessary apply the tuber- culin test. Those found diseased shall be deported or slaughtered. The owner of diseased cattle shall notify the commissioner who shall make a physical exami- nation, and if necessary he may apply the tuberculin test. If the animals are affected he shall cause them to be killed or disposed of. Whenever the cattle commissioner has reason to believe that tuberculosis exists in any herd he may order a thorough examination and, if necessary, apply the tuberculin test. The same proceedings shall apply as in the case above. All barns in which diseased LEGISLATION CONCERNING TUBERCULOSIS 51 -animals have been kept shall be disinfected at the owner's expense. The expense of the slaughtering and disin- fecting shall be paid by the owner. The value of cattle condemned shall be appraised by the owner and the commissioner and if they cannot agree a third party shall be selected. The appraised value shall not exceed fifty dollars. The owner shall receive seventy-five per cent of the appraised value, and in addition, the hide of the slaughtered air'mal. The commissioner may dispose of animals affected with tuberculosis at some fertilizer or rendering plant or at any place where they are in- spected under federal authority. The proceeds of the sale of the carcass shall go to the state. If a person ships milch cows to Massachusetts, subject to the tuber- culin test, and if the cows respond to the test and the Massachusetts board of cattle commissioners condemns or refuses to accept them, he may sell them at the highest price obtainable under the Massachusetts regulations. The cattle commissioner of this state shall then draw an order for a sum equal to seventy-five per cent of the purchase price of such animals, less the amount received for them in Massachusetts ; but this shall not be reckoned on more than fifty dollars for each animal. Any resident of this state who slaughters an animal for human con- sumption and finds after slaughter that it is tuberculous may notify the cattle commissioner, who, after an ex- amination, shall draw an order in favor of the owner for the sum of seventy-five per cent of the appraised value thereof ; the appraised value shall not exceed fifty dollars. The commissioner shall have an ear tag inserted in the ear of every animal that was tuberculin tested under the provisions of this act and passed the test satisfac- torily. Forty thousand dollars is appropriated annually. Virginia. (Chapter 335, 1910.) Under the direction of the live stock sanitary board and the state dairy and' food commissioner, the state veterinarian and the vet- erinarian of the Virginia experiment station shall apply the tuberculin test to breeding or dairy cattle if the owners so request. If the animal reacts it shall be sur- rendered to the state. The owner shall receive a sum not to exceed forty dollars, but if it a pure-bred and regis- tered animal, unless segregated under the Bangs method, the owner shall receive not to exceed eighty dollars. The dairy and food commissioner shall make an annual report of examinations and tests made. West Virginia. (Code 1906, 'Sections 368, 371, 372.) The state veterinarian may kill animals affected with tuberculosis if he finds it necessary or expedient to prevent a spread of the disease. The -disinterested per- sons shall appraise the value of the animals. The owner shall receive the full appraised value. Wisconsin. (Chapter 542, 1909.) When the live stock sanitary board shall deem it necessary to slaughter a diseased animal the owner and three disinterested citi- zens shall appraise the value thereof. The appraised value shall not exceed fifty-five dollars. In case of tu- berculosis the live stock sanitary board may ship the an- imal at the expense of the state to some abattoir to be killed under federal inspection. The net proceeds of such sale shall go to the state. If the animal reacts to the tuberculin test, but no lesions are found upon slaugh- ter, the owner shall receive 'the full amount of the ap- LEGISLATION CONCERNING TUBERCULOSIS 53 praisal ; the owner shall receive three-fourths for all other animals so slaughtered. It shall be unlawful to sell any cow, bull or heifer of the bovine family, over six months old, unless to be exported or slaughtered, if it has not been tuberculin tested and found to be free from tuberculosis by the proper authorities within two years prior to the sale. The evidence of such test shall ac- company the animal. (Chapter 304, 1907.) Any person who shall use tuber- culin or any other agent upon cattle for the purpose of preventing a proper reaction when the tuberculin test is made shall be guilty of a misdemeanor and subject to the penalty of a fine of from two hundred to five hun- dred dollars or imprisonment for six months to one year or both. (Chapter 272, 1905, as amended by Chapter 542, 1909.) No cattle shall be brought into the state for other pur- poses than to be slaughtered, unless they are accompanied by a certificate showing that the catt'e were subjected to the tuberculin test within six months pnor to the ship- ment a.nd were free from tuberculosis. In leiu of such an inspection certificate the cattle shall, upon request of the owner, be shipped in quarantine into the state to be examined, at the expense of the owner, by an inspector appointed by the live stock commission. If cattle are "brought into the state for breeding or dairy purposes without a certificate of inspection the railroad company and the owner shall notify the secretary of the live stock sanitary board at Madison, Wisconsin, and these cattle shall be examined by an inspector, at expense of the owner or shipper. The owner may re-ship affected ani- mals. The owner or shipper shall receive no indemnity if cattle are slaughtered. 54 LEGISLATION CONCERNING TUBERCULOSIS EXPENDITURES FOR TUBERCULOSIS WORK IN 1910. 1 State. Public. " Private. Total. Alabama $2,000 $5.500 87,500 Alaska 1,000 1,000 Arizona 4,000 76.000 80.000 Arkansas 68,OOJ 1,000 69,000 California 88.000 316,000 4(M,(KX> Colorado 105,000 731.000 836, 000. Connecticut 338,500 167,500 506,000 Delaware 15,500 18.000 33,500- District of Columbia 41,000 8,500 49, 500 Florida.. . . 500 500 (ieoryia 54,500 46,500 101,000- Hawaii 6,000 9,000 15,000 Idaho... . Illinois 245.000 208.000 453. 000' Indiana 157.000 48.000 205,000 Iowa 119.500 11.500 131,000- Kansas 10,500 1,500 12,000 Kentucky 127,000 42.000 169.000 Lou siana 16. 000 62,000 78.000 Main* 5 .. 62,000 54,000 116,000 Maryland 130,500 95.000 225.500 Massachusetts Michigan 1 118.000 8(5,000 400, 000 85,000 1.518,000 171,000- Minnesota 126.000 65,000 191,000 Mississippi 5,000 500 5,500 Missouri 200,000 35.000 235.000 Montana ... 100 400 500- Nebraska 1,000 1,000 2,000 Nevada New Hampshire 23,000 7.000 30.000 New Jersey. 255,000 130,700 385,700 New Mexico 250,000 251.000 501,000 New York 3,039,000 1.206,000 4,245.000 North Carolina 42,000 168,000 210,000 North Dakota 1,000 1.000 Ohio 573,500 76,000 649.500 Oklahoma . 1.500 300 1,800 Oregon 56.000 25,550 81,550 Pennsylvania 1,431,000 673.000 2,104,000 Philippine Islands 20,000 100 20,100 Porto Rico 23,300 5,000 28,300 Rhode Island 81,500 51,500 133,000' South Carolina 1.000 6,700 7,700 South Dakota . 10,000 15,000 25,000 Tennessee 16, 500 54,000 70.500 Texas.,.. 46,000 122,000 168,000 Utah Vermont 2.000 20,500 22,500 Virginia 45,500 55,500 101,000 Washington. 13.000 73,000 86,000 West Virginia 1.100 2,500 3,600 Wisconsin 210,000 99,000 309,000 400 400 Total....... S9.267.900 2 $5. 532. 250 $14,800,150- 1 Journal of Outdoor Life, January. 1911, Philip P. Jacobs. * This includes not only state appropriations but the expenditures from, all public sources. LEGISLATION CONCERNING TUBERCULOSIS 55 The following table gives the amount in each group for 1909 and 1910 : Class. Money spent in 1910. Money spent in 1909. Sanatoria ill, 376. 500 15,300.000 Associations 760,500 975,000 Dispensaries SS9 000 650 000 Municipal work. . ... 1,055.000 1 115 000 State work 719,000 Total $14,800,000 $8,180,000 56 LEGISLATION CONCERNING TUBERCULOSIS BIBLIOGRAPHY. Bardswell, Noll D. The consumptive working man; what can sanatoria do for him ? The Scientific Press, limited, London, 1906. . Behring, E. von. The suppression of tuberculosis. New York. J. Wiley & sons, 1904. Brisco, Charles F., and MacNeal, W. J. Tuberculosis of farm animals. University of Illinois, Agricul- tural experiment station, bulletin no. 149. Urbana, 111., 1911. Control of bovine tuberculosis. Report of the Interna- tional commission of the American veterinary medical association, 1910. United States department of ag- riculture, Bureau of animal industry, circular 175. Fanning, F. W. Burton. The open air treatment of pul- monary tuberculosis. Cassell and Company, Lim- ited, London, Paris, New York and Melbourne, 1905. Francine, Albert Philip. Pulmonary tuberculosis, its modern and specialized treatment. Philadelphia and London, J. B. Lippincott Company, 1907. Huber, John Bessner. Consumption ; its relation to man and his civilization ; its prevention and cure. Phil- adelphia and London, J. B. Lippincott Company, 1906. Jacobs, Philip P. The campaign against tuberculosis in the United States, including a directory of institu- tions dealing with tuberculosis in the United States and Canada ; compiled under the direction of the LEGISLATION CONCERNING TUBERCULOSIS 5T National association for the study and prevention of tuberculosis. New York, Charities publication com- mittee, 1908. Klebs, Arnold Carl. Tuberculosis. New York and Lon- don. D. Appleton and Company, 1909. Knopf, S. A. Tuberculosis as a disease of the masses,, and how to control it. New York, M. Firestack,. 1905. Melvin, A. D. Economic importance of tuberculosis of food-producing animals. United States department of agriculture, 25th annual report of the Bureau of animal industry. National association for the study and prevention of tuberculosis. Annual transactions. 105 Bast 22d Street. \e\v York. Newsholme, Arthur. The prevention of tuberculosis. E. P. Dutton and company, 31 West 23d street, New York, 1908. Pearson, Leonard and Ravenel, M. P. Tuberculosis of cattle and Pennsylvania plan for its suppression. Pennsylvania department of agriculture, bulletin 75. Sixth International congress on tuberculosis. Proceed- ings, 1908. Tscholl Rev. John. War on the white plague. Chris- hold. Minn. Tuberculosis in the United States. Department of Com- merce and labor. Bureau of the census. 1908. pp. 41-45. Walters, F. R. The open-air or sanatorium treatment of pulmonary tuberculosis. Bailliere, Tindall and Cox. 8. Henrietta Street, Covent Garden, 1909, Lon- don. loret ; GAYLAMOUNTd PAMPHLET BINDER Syracuse, N.Y. Stockton, Colif.l