Annual Report of the Board of Managers of the Maryland Tuberculosis Sanatorium for 1916-1917

-n

tLJ 1ffi1IRA\It~J:YOF THE

-Sch.col of ~edicine-

TENTH

ANNUAL REPORT of the
BOARD OF MANAGERS
OF THE

Maryland
Tuberculosis Sanatorium
\1

,

18134
OCTOBER 1, 1917

GENERAL INFORMATION

HISTORY

AND ORGANIZATION

The Maryland Tuberculosis Sanatorium was created by Act of
the General Assembly of Maryland at the Session of 1906 as a
distinctly State Institution.
The farm of 198 acres on which the Sanatoriwn buildings stand,
with the hospital group, appropriate farm buildings, power plant,
roads, walks, sewerage disposal plant, water system, etc., all
properly installed, furnished and equipped, were provided by the
State at an approximate cost of $465,000.
The Sanatoriwn is managed by a Board of Managers, of which
the members of the State Board of Public Works serve as exofficio members, with seven members appointed by the Governor
of the State, by and with the advice and consent of the State
Senate, for a term of six years.
The Sanatorium is situated immediately on the main line of
the Western Maryland Railroad, sixty-nine miles northwest of
Baltimore, upon the crest of the Blue fudge Mountains, 1,500
feet above sea level, in the extreme northwest corner of Frederick County, Maryland.
A railroad station, American Express office, and postoffice are
maintained at State Sanatorium, Maryland, for the use and accommodation of the patients and employees.
In 1912 a hospital building 520 feet long, with 200 beds for
patients, and with its kitchen, storage-rooms, patients' diningroom, operating room, and quarters for nurses and other employees, was opened. This building is separated from the original
sanatorium group and is designed for the use of patients who
need bedside care or who are of a more advanced type. It is a
complete hospital-of itself.
The original sanatorium group consists of nine pavilions or
cottages, which each accommodate twenty patients, and they are
used by incipient cases, or at least those in the earliest stages of
the disease, and who need but little nursing.
During the year 1913 a large two-story building with accommodations for forty-five beds, to be used exclusively for children,

4

~IARYLAND

TUBERCULOSIS

S....:-;ATOR!Ui\I

was built and furnished.
This building has a large recreation
room, a workroom and a schoolroom where the children are given
regular instruction.
The group of buildings also includes a large stone administration building, a central heating and lighting plant, and laundry.
All the buildings are thoroughly equipped with improved bathing, heating and plumbing fixtures and modern furnishings and
conveniences.
The normal capacity of the Sanntorium
is 435
beds, which, with a little crowding, can be increased to 450 beds.
The Maryland Legislature makes a direct annual appropriation of $140,000 for the support of the Sanatorium, which, howover, is insufficient for that purpose, and it is therefore supplemented by making a moderate charge to patients who are able
to pay.
DI HECTIONS

FOR ADMISSION

The Sanatorium is open to all white citizens of Maryland who
have been residents of the State for at least one year preceding
the date of application, and whose disease is in a stage to present
reasonable hopes or cure or material improvement.
THE SANATORIUM: IS IN NO SENSE A PROPER PLACE rou DESPERATE CASES, AND NONE SUCH WILL BE INTEN'l'IONALLY
OR IF RECEIVED

TJ-lRY CANNOT

OTHEH

BE

PATIENTS

WAHNED

KEPT.

NOT TO ENCOURAGE

IN JUSTICE

RECEIVED)

TO THEMSELVES

PHYSICIA..J.~S ARE

A:\'D

MOST EARNE!:;TLY

SUCH CASES TO HOPE FOR ADMISSION.

Patients, as the first step to admission, should apply to their
own physician to be examined.
The Medical Superintendent
will, at the request of any physician in good professional standing, resident of Maryland,
furnish bim with blank forms to be
filled in at the appropriate
places by him, with data regarding
tbe applicant's symptoms and physical condition.
After examining an applicant, the doctor making the examination should at
once send in his report of the result of his examination to the
MEDICAL

SUPERlNTENDENT1

STATE

SANATORIUM

POSTOFFICE,

MD., and this report, if properly prepared, will be considered
when received at the Sanatorium as an application for admission,
and will be so treated.
The Medical Superintendent,
assisted by Dr. H. Warren Buckler and Dr. Gordon Wilson, will promptly examine and pass. upon

"IARYLA",O

TUBERCULOSIS

5

SA::-
all such reports when received from physicians exanunuig applicants for admission as patients, and accept 01' reject the applicants as the facts stated in the reports in every case justify.
A pplications will be considered and acted upon in the order
in which they are received, and each accepted applicant will be
notified to report at the Sanatorium by the Superintendent in
the ardor in which his or her application is received.
No applicant will be admitted unless previously examined for admission
and his or he]' application accepted by the Medical Superintendent,

aided by Dr. Buckler and Dr. Wilson.
TEn~IS

AND CHARGES

Each patient will be charged a rate of $3.50 per week and upward, except as hereinafter stated, all bills payable in advance.
The Board of Managers have reserved 200 free beds for patients who are unable to pay. Holders of such beds must be
favorable cases, and must present to the Superintendent
two
letters from reputable persons (not relatives) or other satisfactory evidence that they are unable to pay, and worthy of the
privilege of such free treatment.
There are accommodations
for patients

desiring

private

rooms

at ~7.00 per week.
Patients leave the Sanatorium only upon the advice 01' consent
of the Superintendent.
No patient will be kept longer than SIX
months should the bed be needed for a new patient.
Visiting

days are Sundays

and Wednesdays.

Visitors

arc re-

qucsted to abide by the rules and regulations of the Sanatorium
at all times, especially as regards gifts of food, etc., to patients.
'f.HE POSSESSION OF LIQUOR BY PATTEN'l'S IS ABSOLUTELY FORBIDDEN)

and detection

thereof

will result

in immediate

dismissal

of

the patient.
The examing

office heretofore maintained at Room 607 Union
Baltimore,
has been abandoned j as its further
is unnecessary.

Trust Building)
maintenance
Posloffice-

Railroad Stotion-«

State Sanatorium,
Sanatorium,
Frederick County Md.
Western Maryland
Lone Distance Phone-Blue Ridge Summit, 39.
Western Union Telegraph Service-Blue
Ridge. Pa.

Railroad.

6

),IARYLAKD

TUBERCULOSIS

SANATORIU;\I

BOARD OF MANAGERS
JOHN WALTER SMITH, President, Snow Hill.
DR. I-I. "WARREN BUCKLER,
Vice-President, 806 Cathedral Street,
Baltimore.
SAMUEL K. DENNIS,
Secy.-Treas., 2 East Lexington Street, Baltimore.
I-lIs EXCELLENCY,
EMERSON
C. HARRINGTON,
Annapolis.
STATE COMPTROLLER HUGH A. McMULLEN,
Cumberland.
STATE TREASURER
JOHN M. DENNIS, Baltimore.
DR. C. H. CONLEY, Frederick.
DR. GUY STEELE, Cambridge.
DR. GORDON \\TILSON, 4 E. Preston Street, Baltimore.
DR. V. M. REICHARD,
Fair Play.

OFFICERS
Superintendent:
DR. VICTOR

F. CULLEN,

Assistant
DR. W. R. CLAYTON
DR. JOHN A. SMITH

State Sanatorium

P. O.

Resident Physicians:
DR. F. J. WILKENS
DR. R. H. OWENS
DR. S. SNYDER

Visiting Laryngologist:
DR. R. H. JOHNSTON
Baltimore, Md.
Superintendent

of Nurses:

MISS E. V. JOHNSON,

R. N,

Chief Clerk and Cashier:
MR. W. A. GARDNER
Chief Engineer:
MR. GEORGE

W. BOONE

:\lARYLAND

TUBI;:RCULOSIS

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SANATOHIUM

REPORT

October 1, 1917.
'Po His Excellency, Emerson C. Harrinqton,
Cooernor of Maryland:
The General Assembly of 1916 changed the Sanatorium's
fiscal year so as to make it end September 30th, coincident with
the State's fiscal year. Hence a report was heretofore submitted

to you covering the odd period of nine months [rom January 1,
1916, to September 30, 1916.
The work of the Sanatorium

has been successful.

The medi-

cal and financial record of the institution is fully covered by the
Superintendent's most excellent report; and by the Treasurer's
report herewith embodied, covering the whole period from January 1, 1916, (the date of the last published report) to September
30, 1916, and from October 1, 1916, to September 30,1917.
Thus

a complete public record of all the Sanatorium's business affairs
may be traced from its printed reports from the beginning.
The Sanatorium group of buildings is about complete,

and

your Board has no extensive addition or improvement to recommend. A minor though much needed improvement is an
X-Ray apparatus.
A commodious cottage for the medical staff
has heen recently built, and like-wise an up-to-date-sewage disposal plant.
The pipes that convey steam to heat the buildings
have been placed in concrete conduits.
The State has in all a

most excellent and modern hospital.
The maintenance cost for the fiscal year just ended is remarkably low, and much less than will be possible during the war
period hereafter.
The low maintenance cost (less than that of
any similar State institution in the U. S.) reflects the favorable

contracts for flour, coal, milk, canned goods and other staples,
now expired, and that cannot be renewed at the old figures,
The
added cost on three items, coal, flour and milk, lor the next fiscal
year will be about $19,050.00.
Thc Board acknowledges its thanks to Dr. V. F. Cullen, the

Superintendent. More trying problems in administration never
confronted the Sanatorium, High wages, the great scarcity of

8

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SANATQRIUl\!

all kinds of help, the trouble, greater than ever before, of obtaining
delivery of goods, &c., the increase in bed side cases, results all
more or less directly due to war-time conditions, presented difficulties in management that might well have discouraged 01'
crushed a less determined, capable man than Dr. Cullen ..
RECOMMENDA'l'IONS

Your Board urges upon the General Assembly and cannot
exaggerate, the justice of making some siutable provision for the
colored people of the State suffering from tuberculosis.
This
subject has been agitated for years.
Time and again the ablest
physicians of the State, among them, Dr. Welch, Dr. Janeway,
Dr. Fulton, Dr. Thayer, and others, have expounded and demonstrated the necessity and expediency of such action.
The conservative,
thoughtful
and remarkably
clear report of
Dr. Louis V. Hamman and Dr. V. F. Cullen (aided by Mr. Robert
C. Powell) on the subject is appended, as it is believed that their
report covers the case thoroughly, and that the information and
ideas therein bear the endorsement of the medical profession as
being accurate, sane and practical.
As the matter now stands, outside of penal institutions, asylums and alms houses, the colored people furnishing nearly onefifth the population of the State and nearly one-third the deaths
from tuberculosis have no substantial
facilities open to them for
treatment of tubercular cases; and the whites are subjected to
infection from them.
Your Board will undertake, if desired, to aid in the construction and management
of Sanatoria for colored tubercular cases
and the experience heretofore had will doubtless be valuable,
Small Sanatoria
for advanced
cases of tuberculosis
should
not be a nuisance in any community and should certainly be far
less objectionable
than having the same patients improperly
cared for and left to wall del' at will.
It is hoped and believed that if given the power and the money,
that your Board can possibly effect some working arrangement
in co-operation with the managing boards of many of the existing
State aided general hospitals to add a building or unit housing
from 20 to 40 colored tubercular patients.
Such all arrangement
would have the advantage of saving the construction of special

31'lOH

S35~nN

I'lO~,j

M31A

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SANATORIUM

sewage, heating, power, water, laundry and administration facilities, and the further advantage

of each community,

so to speak,

having at hand facilities to care for a fair share of its own advanced
colored tubercular

cases.

Experience

has shown that the colored

people, as a rule, will not, and cannot ordinarily afford to go far
from home for treatment. Negroes are extra susceptible to
tuberculosis. Few of them consult a capable doctor early enough
to get a diagnosis

in the incipient

stage.

Generally,

when dis-

covered, the disease is advanced, the patient too often beyond
hope.

Climate

plays a small part at that

stage.

To make the

patient comfortable, and to prevent infecting others, his family,
employer,

etc., is about all that can be done.

Therefore

to build

and equip and maintain under State control a sufficient number
of local hospitals for advanced cases, preferably attached to, or
(if necessary) independent
of, existing local hospitals, seems the
logical and obviously proper step to take first toward the solution

of the problem, rather than one large Sanatorium, necessarily remote from some parts of the State, expensive to get to, and beyond
the reach of visiting friends.
It is to be remembered that virtually all colored tubercular patients must be treated free.

Your Board recommends as a start on this most important
work, so long neglected, an appropriation of $100,000 for buildings
and equipment, and $50,000, for the fiscal year beginning October 1, 1919, for maintenance.
With such an amount your Board
is of the opinion buildings can be built and equipped to house
about 75 patients by October 1, 1919, a mere drop in the bucket
to be sure, but a healthy start.
The precise attitude of the public
and especially of the negroes themselves, cannot be fully deter-

mined except by actual experience as to the encouragement and
use of such Sanatoria.
The most thorough study and thought
cannot supply the knowledge to be had only from actual ex-

perience in working out this plan, hence your Board feels that,
as in establishing

the

Maryland

Tuberculosis

Sanatorium,

a

modest beginning offers many advantages.
VISITING NURSES

Yom Board

should

have

in the

field about

fifteen

visinng

nurses. The good such nurses might do in getting curable cases
interested in accepting treatment at the Sanatorium and in

10

).lARYLAND TUBERCULOSIS

SANATORIUM

following up old discharged cases is most important. Your
Board has always recognized the value, even necessity, for such
work, but has not had sufficient money to carry it on.
TUBERCULOSIS

AND THE WAR

It is well for all to recognize the tremendous burden tbc war,
if long continued, will cast upon us in fresh tubercular cases.
Already its effect is distinctly felt. We have never had so many
advanced cases, so many deaths at the Sanatorium as in the
fiscalyear just closed, due to the temptation offeredby high wages,
or the greater necessity, we think, to stay at work until growing
weakness intervenes. The experience in EUTOPC, especially of
France, is that trench war-fare is peculiarly conducive to the
development of tubercnlar trouble. It is unlikely that om soldiers, more carefully culled, and better fed and prepared, will
have an experience as bitter. Nevertheless to an extent, doubtless to a substantial extent, om soldiers will likewise suffer. To
that end it is wise that the State add to its tubercular hospital
facilities, co-ordinate and strengthen those it now has, and especially provide additional room for advanced cases. There
mnst in all human probability be a large increase in tubercular
patients during the next few years; and Maryland is not doing
its share to meet the emergency.
The example of a community like Rochester County, N. Y, is
uplifting. That one county has spent, and is spending, more
than the State of Maryland for the care of its tubercular people.
We have one really splendid State Sanatorium, but that does not
begin to furnish reasonably adequate means for the thousands
of cases now in need of treatment, to say nothing of the increase
in the disease the war will doubtless develop.

Respectfully,
JOHN WALTER

SMITH,

PRESIDENT

H. WARREN BUCKLER, VICE-PRESIDENT
SAM'L K DENNIS, SEcy.-TREAS.
DR. CHARLES H. CONLEY

DR.

DR. GUY STEEL)'
DR. GORDON WILSON
DR.

V. M. REICHARD

MARYLAND

TUBERCULOSIS

II

SANATORIUM

APPENDIX
REPORT

O}~DRS.

HAMlIo'lAN AND CULLEN

ANT> MR.

ROBERI.

C.

POWELL

November 18, 1915.
The Committee appointed to suggest to the Governor's
State-Wide Commission, a plan for the control of tuberculosis
amongst the Negroes of Maryland has given the problem thoughtful consideration, and submits the following brief report as an
outline of how existing conditions may best be met. Since the
time at its disposal has been limited it is impossible to advance
convincing evidence to support each step in the argument; but
the Committee feels confident, had they sufficient 'time for such
arduous investigation, that the necessary evidence could be produced. The report is merely an outline of what a more extended
presentation should be, but it represents the conclusions of years
of interest and labor in the field of tuberculosis codtrol.
1.
It is hardly necessary to lay emphasis again upon
the prevalence of tuberculosis in Maryland and the
economic loss its incidence entails. The cost of those
measures which are directed toward the control of
this infection, is equivalent to a very small part of the
annual loss from untimely death and prolonged incapacity from tuberculosis. Still from our knowledge
of the disease, and more pointedly from actual experience, we arc assured that such an outlay is doubly
repaid the State, by the restored earning capacity of
the afflicted, without regard to the income derived
from those spared the infection through the efficacy
of anti-tuberculosis measures. Nor need we dwell
upon the fertility of the Negro population in our State
as a soil for maintaining and spreading tuberculosis.
All statistics show that the disease is particularly prevalent among them, and since they enter in close and
intimate relation with the white people of the State
they are potent channels of infection, not only for their
families and neighbors, but for their masters and employers as well. An anti-tuberculosis campaign to be

12

MARYLAND

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effectual must therefore he directed against the stronghold of the disease.
II.
It must be evident, even to lay intelligence, that
there arc only two ways in which tuberculosis can be
controlled, namely:
1.
To cure the infection after it has become manifest.

2.

To prevent the occurrence of infection, or at
least of manifest disease.
Up to the present time the State has devoted its
attention almost entirely to the cure of tuberculosis.
Its energy was guided in this direction by confident
predictions of the success of treatment in the antituberculosis campaign and by a strong humanitarian
appeal. To witness the glowing results of treatment,
to see an afflicted brother, as it were, snatched from
the grave, is a satisfaction that the cold mathematical
demonstration of the fruits of prevention can never
uisprre.
However, the treatment of tuberculosis has
not becn nearly so successful as was at first promised.
Experience at our State Sanatorium, as well as the
results obtained elsewhere in this country and abroad
have firmly established the followingfacts:
1.
Tuberculosis is curable only in the earliest
stage of the disease. In this statement "curable"
is used in its ordinary practical significance, not
in a strictly scientific sense; that is, to mean that
the patient loses all symptoms of the infection, is
able to return to accustomed ways of living and is
no longer a source of contagion to his associates.
2.
The diagnosis of pulmonary tuberculosis in
an early stage is beset with such difficulties that
its practical application on a large scale has completely failed. This failure has been due to two
factors.
a.
The lack of skill in early diagnosis displayed by the medical profession and
b.
The nature of the disease.
Pulmonary diagnosis is the most difficult province of internal medicine. Skill in this field requires

:MARYLAND

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13

prolonged and constant
application,
a specialiaztion
we have no right to ask of the profession as a whole.
The demands of modern practice each day require a
more elaborate training in every department
of medieine, and the physician cannot master them all. It
wonlel be impossible to have the general popnlation
of the State submitted
to the constant vigilance of

trained physicians watching in each member for the
early manifestation of tuberculosis infection. However, were such surveillance feasible, still its purpose
would in large measure
of the infection.

be defeated

by the very nature

As everyone knows, tuberculosis is unduly prevalent, indeed, it is almost universal, for four-fifths of
all adults are infected.
However,
of those infected
relatively a small number actually develop tuberculous
disease. Fortunately, in most of us the infection passes
unnoticed.
It is highly important,
therefore, in considering tuberculosis,
to distinguish
between infection
.and disease, a distinction that has no parallel in other
infections and which introduces great difficulties in the
. way of diagnosis.
We have very accurate and ready
means of discovering tuberculous
infection, but this
disclosure is of little practical value since its astonishing

revelations would require, were we to undertake to treat
infection,
detained

that the vast majority of mankind should be
in sanatoria or spend the larger part of their

existence in quiet repose free from the duties and cares
with which life at present besets us. However, no such
absurd extreme need be fancied, for in the great majority of people the infection gives us no serious concern.
Treatment is required only when the infection passes
from a latent stage into threatening activity, obtruding
its presence through the manifestations
of disease. An
appreciation of these simple and generally known facts
at once makes clear all the difficulty of the situation.
Were a large number of people to undergo examination
today it would be easy to indicate the infected, but

even though the examination were ever so rigid and skillful, it would

be impossible

to predict

which of these,

MAHYLAi\"D TUBERCULOSIS

SANATORIUM

after six months, would be down with manifest tuberculous disease. To our great mischance the transition
from quicscence to activity is not always made in easy
stages, is not always heralded by unmistakable warnings
of the approaching

disaster.

Jnst as frequently,

indeed

more often, the dividing ground is passed over in one
bound, and the individual is carried at once from apparent well-being to what is technically spoken of as a
moderately or far advanced stage of tuberculous disease.
The failure of early diagnosis is sufficiently illus-

trated in our own State Sanatorium

and in all other

sanatoriums

Of the definitely

throughout

the

country.

tuberculous patients relatively only a small number
have

the disease

in an early

or curable

stage.

The

reason for this resides more in the nature of the disease
than in lack of professional skill and interest.
3.

Tuberculosis

is a disease very amendable

to treat-

ment; even in moderately advanced stages of the
disease the immediate results arc excellent. However, the permanency of the results depends upon
factors

that

cannot

be maintained

by the

people

at large, ancl on this account treatment, as a broad
method

of prevention,

has failed.

Most

patients

with moderately advanced pulmonary tuberculosis
respond in a very satisfactory manner to sanatorium treatment. After a few months many lose
their symptoms, gain in weight and strength, and
to an untrained observer present the appearance
of robust health. However, the medical examination
still reveals evidence of gross pulmonary disease,
and experience has taught us that such patients
almost invariably relapse if after so short a period
of treatment they abandon tbe carefully regulated
life tbat has restored their health.

The permanent success of treatment in moderately
or far advanced stages of pulmonary tuberculosis depends
mainly upon two factors:
a.

b.

The length of time treatment

can be followed.

The general conditions under which the patient
live'Safter the disease has been arrested.

�IARYLAND

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15

Six months or a year is seldom long enough to establish the measure of healing that is necessary to permit
the patient to return, even with a reasonable degree
of assurance, to his accustomed mode of living.
However, in order to give an equal opportunity
of recovery
to all the afflicted, State Sanatoriums
cannot prolong
unduly
the period of residence.
Most sanatoriums
have an cvarage limit of six months, and will not accept
the same patient the second time, should the disease
return after discharge.
Such brief periods are acknowledged to be altogether
inadequate,
but expediency
requires a quick shifting of patients.
Those who may
spend years at the cure have quite a different chance
of gaining permancnt recovery.
Of still more importance than the length of treatment upon the outlook for enduring results is the living
conditions to which the patient leaving the sanatorium
must return.
After all the sanatorium is only the school
fOT teaching the principles 01' right living, but the practice of these principles requires a certain amount of
leisure, freedom from worry, and a measure of physical
comfort.
If the bare necessities of life cost a daily
struggle with fatigue and care, the worn patient has
neither the courage nor the weapons to fight successI'nlly against
disease.
Unfortunately,
tuberculosis
is
mainly a SCOlU'gC to the poor, and experience demonstrates that the discharged sanatorium patient, buoyant
with renewed health and vigor, returning to the vicious
surroundings
that betrayed him to the disease, rapidly
succumbs
in the unequal conflict with poverty
anel
ill health.
In thus briefly demonstrating
why diagnosis and
treatment
have failed as broad measures of attacking
tuberculosis
amongst
the masses, we desire earnestly
to avoid creating the impression that 'we are directing
criticism against the sanatorium .. In our opinion this
institution
has done an invaluable service in the antituberculosis
campaign, but it would be inappropriate
to dwell further upon the value of the sanatorium
in
this report.
This much is certain:
That under exist-

16

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SANATOHIUl\1

mg conditions treatment as at present pursued has
proved unavailing to stem the spread of tuberculosis
as a. social disease, and since Negroes possess a much
lower resistance to the advance of the disease than
the white population, it would be futile to emphasize
this part of the campaign as the permanent feature of
a plan to eradicate tuberculosis from amongst them.
Every

individual,

white or black, unfortunate

enough

to contract tuberculosis, should be given a reasonable
chance to recover, but this chance may be accorded
them without making it the dominant note of the program.
III.
We come now to consider the prevention of infection and what success prevention promises as a means

of combating tuberculosis.
To tuberculosis, lTI01'C than to any other infectious
disease, the parable of the seed and the soil is strictly
applicable. Without the tubercle bacillus there can
be no tuberculosis, but for tuberculosis to develop
many factors of great complexity and as yet but littlc
understood must facilitate the implantation of the
bacillus and augment its growth. It is true that though
we may emphasize the role of the bacillus, still we cannot

completely ignore those personal factors that contribute
to make the infection fruitful, and likwise though we
focus OUT attention upon individual resistance, still we

cannot keep out of sight tho invader that is being resisted.
The two viewpoints meet and run together but arc
sufficiently separate to lead the different methods in
1

our efforts to eradicate tuberculosis.

On the one hand arc those who direct their efforts
towards cultivating the soil. Reliable studies inform
us that ninety per cent. of the human race is tuberculosis infected, and that infection occurs at a very
early age, so that at twelve years few children have
escaped it. Relatively a small number of those infected
subsequently become tuberculous, so that something
more than infection is necessary for tuberculosis to
develop.
What this something is we do not know. Time
manner,

frequency

important part.

ancI intensity

of infection

play an

Apparently, too, there is a wide per-

MARYLAND

TUBERCULOSIS

SANATORIUM

17

sonal variation in susceptibility,
To just what this
personal factor is due we are not in a position to say,

but eertain general facts known about the distribution
of tuberculosis afford as a clue to its interprctation.
Tuberculosis, like most infectious diseases, thrives under
thc conditions that poverty induces. Inadequate housing facilities, insufficient food, filth, and sordid care are
If, as all must admit, the tubercle
bacillus is more or less ubiquitous
and few escape
contact with it, then an important part of our campaign
of prevention will be the raising of personal resistance

a few of those.

so that when infection occurs it may be successfully
overcome. Here is the field for wide social activity.
Everything that makes for higher standards of living
and for improved personal hygiene is a valuable arm
against tuberculosis. Housing laws, child-labor laws, the
wage question, municipal recreation centres, the liquor
question, social service in all its departments, vacation
lodges, open-air schools, factory inspection,

arc

all

indirectly

and so all,

reliable anti-tuberculosis agitation.

However, as valuable as such measures unquestionably are, their interest is too general to make them

specific objects of an anti-tuberculosis campaign by
the State.
On the other hand arc those who direct their efforts
towards the annihilation of the tubercle bacillus. We
are sufficiently instructed about the life history and
habits of this organism to build our plan upon sound
principles. It is only necessary to guard against the
dissemination of the bacillus through the sputum of
tuberculous patients. Simple as this measure appears
to be in principle, it is nevertheless so difficult to practice that wide experience has taught us the futility of
attempts to render patients innocuous in their homes.
Efficient sputum prophylaxis is seldom carried out even

under favorable conditions by the moderately intelligent, and amongst Negroes such educational measures
would surely be doomed to fail. Satisfactory isolation
of patients can only be attained either by removung
the healthy from the environment or by removing the

18

MARYLAND

TUBERCULOSIS

SANATOHIUM

patient from the surroundings where his presence is
a serious menace. The first plan has been practiced

in a measure by the establisbment of institutions for
tbe children of tuberculous parents. Undoubtedly
this procedure offers satisfactory protection, but it is a
round-about and cxtravagant road to a goal that may
be reached by a direct and economical way. The only
efficient manner in which to isolate the tuberculous
and prevent them from doing harm is to confine tbem
in suitable institutions. Of course, all tuberculous
patients cannot and need not be thus removed, but a
large number might be accomi odated, and amongst
these should be those whose surroundings make them
particularly fertile sources of infection. All antituberculosis measures thus far utilized in our fight
against the disease are valuable weapons, but the Committee is strongly of the opinion tbat the most potent
force against the spread of tuberculosis is the hospital
for advanced cases. Particularly is this true when tbc
question of prevention touches upon the Negro. We
therefore strongly urge that all tbe efforts of the State
be directed towards providing institutional care for
Negroes with advanced pulmonary tuberculosis. Tbe
remainder of this report shall deal briefly with the main
features of such institutions.

IV.

The establishment of hospitals being accepted as
the best method for the State to deal with the problem
of tuberculosis in the Negro, it becomes an important
task to decide specifically upon the character, plan,
location and management of such institutions. Your
Committee feels that certain broad principles of policy
should be decided at once, but the details should be
exhaustively studied before a de nite plan is accepted.
Concerning the broad principles of policy, the following questions demand an immediate answer:
• be one or two large, or a number
1.
Shall there
of smaller institutions?
This question cannot be considered in detail,
but your Committee commits itself unhesitatingly
to a plea for County Hospitals. The advantages

i\IARYLAND

TUBEHCULOSIS

SA ...
N"ATORJU.:\!

19

of such a plan are 80 important and so numerous
that they outweigh the one valid objectiou, namely,
the increased cost of construction and maintenance, that can be urged against it. Chief amongst
the advantages is the desirability of having an
institution for sick and dying patients near their
borne, where relatives and friends may conveniently visit them. The hardship of sending patients off to a distance to linger in illness and die
away from family and friends would create such
unpleasant associations about the institution that
only the law could force patients to enter and remain.
2.
Should such Hospitals be separate institutions,
or should they be linked with existing institutions?
It would be economical to have them connected with existing institutions, and no doubt
satisfactory plans could be devised for associating
them with the numerous County Hospitals that in
other directions are performing such valuable service.
Each County, or each two or three Counties have
their own local Hospital for the treatment of other
diseases. Here we have the organization, and all that
would be necessary would be to construct separate
quarters for tuberculous patients.
The food could be supplied from the same kitchen,
and a small sterilizer installed to disinfect soiled dishes.
The staff could be chosen from the visiting physicians
of the Hospital. It would fill a great need to give the
nurses in training at these small hospitals the opportunity to become familiar with nursing tuberculous
patients.
Wards of twenty beds could be constructed in conjunction with the Hospitals at Cumberland, Hagerstown, Frederick, Annapolis, Elkton, Easton, Cambridge,
Salisbury and larger wards in conjunction with Hospitals in Baltimore receiving State aid. We believe
that Negroes would go to these places, whereas they
would not go far from home.
In the Pennsylvania State Sanatorium at Mont
Alto, the average number of colored patients is 80

20

MARYLAND

TUBERCUI.OS1S

S..\NATORIUM

out of a total capacity of 1,200 beds. Wc havc had
access to copies of their waiting lists, and in the last

two weeks the number of Negroes on thc waiting list
has varied from 0 to 2. This is certainly satisfactory
evidence that Negroes will not go far from home.
If each of the above namcd eight Hospitals wore
given $20,000 to construct wards for male and female

Negroes, the total outlay would be $160,000; if Iurther $50,000 werc given the hospitals in Baltimore to
construct wards, and an allowance of $1.00 a day for
maintenance,

this

would

certainly

be the most

eco-

nomical way for the State to meet the situation. These
institutions could be placed under one central Board,
and a representative of the Board visit them at stated
intervals.

This plan is similar to the plan of the County Hospitals already operating in a number of Northern States.
3.
What patients should be admitted to the
Hospital?
All Negroes with satisfactory evidence of pulmonary tuberculosis. If there is a doubt as to thc
nature of the disease the patient might be admitted
for a period of observation. Those with early
lesions could be admitted for treatment, and thus
be given a satisfactory

4.

opportunity

to recover.

Would patients be willing to go to such Hospitals?
If properly managed) we arc SW'C they would.
However, no doubt, in many instances where circumstances and surroundings would make it particularly desirable that the patient be removed he
would refuse to go.

To cover such instances there

should be a law giving health officers the authority to compel removal when existing conditions
render a patient a serious menace to those about him.

The very existence of such a law would make its enforcement unneccesary

5.

in all but isolated instances.

How long should patients be kept in the Hospitals?
This is perhaps the most important question

;o.,IARYLAND TUBERCULOSIS

SANATORIUM

21

of policy. We should answer it by saying that the
patient should be retained until he either dies or
else loses all the symptoms of the disease and is
apparently cured. Since the latter alternative will
seldom come up for consideration we may direct
our attention solely to the former. It will be remembered that the whole object of our campaign
is to remove as many foci of infection as is possible
from the associates to whom they are a danger.
We will accomplish this purpose better by taking
a single infectious patient and permanently guarding
him from infecting those about him than by accepting ten patients, each fOT a brief period of
time, and at the end of this period sending them
back to again infect the surroundings from which
they were removed. However, experience points to
one serious difficulty in the way of carrying out the
plan to keep infectious patients during their lifetime. ' conditions of institutional C3J:ea certain proportion perhaps one-third, instead of rapidly advancing to death, will show unexpected improvement
and regain a large measure of strength and vigor.
If such patients are discharged and return to their
unfavorable home surroundings, they quickly relapse, and soon are numbered amongst the victims
of the disease. However, as long as they stay at
the institution, although they do not recover from
the disease, they remain in a state of reasonable
well-being. Therefore, since we insist that a patient who once comes under hospital control must
be guarded until death releases him, some special
provision must be made for those patients who
neither get well nor die. Otherwise the institution
wonlel soon be blocked. How to solve the difficulty is not clear. Perhaps an industrial colony
connected with the Hospital might prove to be a
satisfactory solution of the difficulty.
In this brief outline your Committee has aimed only

22

:\IAHYL:\;\'D

TUBJ::HCULOSIS

SA!\"ATORIL"M

to touch upon the main points at issue. The report is
merely " framework for fuller discussion. Should the
objects here endorsed be approved by the State-Wide
Committee it would then be necessary to elaborate the
details of construction, management and cost of such
institutions as we have proposed.
(Signed) LOUIS V. HAMMAN
VICTOR F. CULLEN
R.OBT C. POWELL

,
•

e
a

",
c

u

o

,
o"
,
o

�IAHYLAr\D

TUBERCULOSIS

23

SANATOHIUM

TREASURER'S REPORT (No.1)

1\1ID1• OCTOBJ<::R 25, 1916.

EAL'L'IMORF.J

To THE BOARD

OF l\1ANA.GERS

OF THE MARYJ~AND TUB.F":RCULOSIS

SANA'l'ORlU~I:

Gentcemen: I herewith beg to submit my report showing the
accounts of the lVIARYLAND TUBEIWULOSIS SANA'l'ORIUM for the
nine months ended September 30th. 1916, including the following Exhibits and Schedules:
Exhibits
"N'

"B"

SUMMARY

CASH

STATEMENT

OF CASH

RECEIPTS

AJ"O DISBURSE),IENTS,

For the nine months

ended September

ron SUNDRY

FUHNISJ-IED

RECEIVED

1TEI\IS

30th, 1916.

PATIENTS

AND

OTHEHS,

For the nine months

..C'.

CASH

SUMMAHY OF F Aln1 REVENUE

PATIEKTS

30th, 1916.

ACCOUNTS

EXPENSE

end'ed September

Suth, 1916.

ACCOUNTS RECEIVABLE,

At September
No.2

ended September

AND

For the nine months
Schedules
No. I

30th, 1916 .

OISBUHSEMENTS,

For the nine months
"D"

ended September

30th, 1916.

(VOUCHERS)

At September

PA v ABLE.

30th, 1916.

Cash:
Cash on hand at the Sanatorium was counted on October 21st, 1916;
Cash on Deposit was verified through reconciliation and by certification
as La the balance at September 23rd, 1916, received from the MerchantsMechanics First National Bank; Lhe total was found lo bc in agreement
with the office records, by The American Audit Company.
Farm Operations:
The farm continued to show increased earning capacity as evidenced
by the profit of $2,251.45 for the nine months ended September Suth, 1916.
A Summary of farm revenues and expenses is given herewith in Exhibit
"0". Farm profit for the year 1915 was 81, 672.22.
The American Audit Company reported the books and records were
found to be in excellent condition.

24

1\lARYLAND TUBEHCULOSIS

EXHIBIT
MARYLAl'lD

STATEMEXT
NINE

"A"

TUBERCULOSIS

State Sanatorium,
SUMMARY

SANATORIUM

OF' CASH

SANATORiU1\l

Montland

RECEIPTS

!VI ONTIIS EKDED

AND DISBURSE:>lEXTS

SEPTEJI,l

BEll. 30,

January 1, 1916Balance:
On hand. . . . . . . . . . . ... . . . . . . . . . . . . . . . . . .
On Deposit in Merchants-Mechanics
First
National Bank..

FOB

-ruu

1916

82,893.56
. 12,295.83
815,189.39

RECEIPTS

March 2-Recei\"cd
from discount of draft of
815,000.00, anticipating
appropriation
per
Chapter 386. Acts 1914, Maintenance
.
March 31-Received
from discount of draft of
$20,000.00. anticipating
appropriation
per
Chapter 386. Acts 1914, Maintenance .......
April 21-Receivcd
from State Treasurer, appropriation
per Chapter
386, Acts 1914.
Maintenance
.
July 29-Receivcd
from State Treasurer. Balance of appropriation
to September 30th,
per Chapter 386, Acts 1914, Maintenance.
September
September

30-Board
SQ.-Sundry

received from Patients.
Items, per Exhibit "Btl

815,000.00
20,000.00
25,000.00
100,000.00
$160,000.00
21,579.18
6,541.36

----

8188,120.54

Total Receipts ...
Sept. So--Disbursements
per Exhibit "C" ..
Sept. SD-Balance:
On Hand
.
On Deposit
in Merchants-Mechanics
First National Bank.
EXHIBIT
MARYLAND

TUBERCULOSIS

Slate Sanatorium,
CASH

820:1,309.93
127,894.26
S2,562 21
72,85:1 ,16

"B"
SANATORIUM

Maryland

RECEIVED
FOR SUNDRY ITEMS FUHN"ISHED
PATIENTS
FOR THE NINE
MONTHS
EKDED
SEPTEMBER
SO,

Atomizers.
.
Brooders
.
Commission on express
.
Commission on Freight Station.
Commission on Post Office.
Coal and Oil.

.

875,415.67

AND OTHERS

1916
85!. 20
17.50
125.92
360.00
947.43
98.79

MARYLAND TUBERCULOSIS

Cement, Sand and SLone
Class Pins (Nurses Graduation)

Cotton..

25

SANATORIUM

.

69.57
58.50
27.43

.

.

.

Douches.
.
.
Drugs-Claim
on Alcohol and Sundry Sales.
Deposits on Reclining Chairs.
.
.
Freight, Express, Hauling, etc ..
Gauge
.
Groceries and Provisions.
Housekeeping Supplies ..
Ice.
.
.
Iron, Pipe, Tank and ".'ire ..
Labor Refunds..
"
.
Live Stock
.
Meals
.
Miscellaneous
.
Mules Sold.. .
.
.
NoLary fees and Death Cert.ificates (Laboratory
Nurses Dress Goods, etc .
Nurses Special Board
.
Power (Electric Current Sold).
Recovery on Bad Account. ..
Railroad Tickets ...
Rental of Buildings ..
Reclining Chairs.
Staticnerv and Postage
Sputum Cupa.. . .
Sputum Fillers ....
Sputum Frames ..
Syringes. . .
.
.
Transpor-tation-c-Doctors
and Nurses.
Thermometers.
Wood Sold
.

.20

90.30
420.00
89.03
119.86
254.07
2.05
1.27
62.85
72.26

280.77
20.50
19.78
200.00
94.32
75.61
309.00
700.00
51.00
420.00
122.00
14.00
3.52
45.07
33.30
64.95
.10
381. 55
549.91
287.75

Fund) ..

$6,5/11.36

Total, per Exhibit "A" ..

EXHIBIT "C"
MARYLAND

TUBERCULOSIS

SANAl'ORIUi\l

State Sanatorium, Maryland
CASH DISBURSEl\IENTS

FOR THE NINE

ConslruclionFarm Improvements
New Sewerage Plant.
Incinerator..
.
.
Reception Hospital.: .....
Railroad Siding.
Water 'Works and Pipe Lines
Construction Total.
EquipmenlAdministration BuildingCrockery and Glassware
Furniture.
General
.
Kitchen Utensils
.
Linen and Bedding ..
Silverware ..

MONTHS

ENDED

SEPTEMBER.

.
.
.

.
.

30, 1916

$169.83
8,732.09
1.50
16.75
25.53
324.76
59,270.46

.

5

68.56
1,060.90
10.00
30.70
587.06
12.85
51,770.07

26

:'IAHVLAND

TUBERCULOSIS

SANATORlUl\1

5 00

Laboratory.
Reception Hospital-sCroc~e ry and Glassware
Furniture.
General.
.
Kitchen Utensils.
Linen and Bedding
Silverware ..

840.18
105.38
16.52
5.94
979.05
12.50

.

.

81,159.57
Generat-eHorses, Wagons and Harness.
. .. , .....
Laundry Machinery
.
Live Stock
.
Motive Power Machinerv
.
Surgical Instruments ... :
.
Stock of j Icusekeeping Supplies ..
Tools and Implements.
Reclining Chuirs .

8

374.21
460.93
13fi.55

185.44
7.99
1,902.98
427.19
168.00
83,662.29

Equipment

Total.

86,596.93

.

"e"

EXHIBIT
1\11
ainlcnunceRepairs and RcncwalsAdministration Buildings.
.
Administration Equipment.
.
Administration Refrigerator Plant. ..
Farm Buildings
.
Farm Equipment.
.
Laundry Machinery
.
Motive Power Machinery.
._
Power House.
.
Reception Hospitnl-c-Buildings
Reception Hospital-s-Equipment.

8266.'11
925.16
48.37
6.95
77.20
27.23
460.57
17.07
345.62

.

.
.
.
.

755.54

56.46
~~~I~~.:
319.66

~~~%~i~.n.
~-~~s.~i
~~l.~~~~r.i~~~~t.o.r.

Sewerage Plant.
Walks and Gradings
Water Plant.

37.83
427.57
475.74

.
, ..
.

84,244.38
Salarics-c-Adrninistration
Doctors and Officials.

Building.

'

.

Salaries-Reception
HospilalDoctors and Officials
Fuel.

$2,087.50

.

810,659.49

.

Running ExpensesAdministration-Housekeeping
Administration-Labor.
.,
Adruinis tration-N urses.
Bake Shop
Drugs.
. . . . .. . .. . . ..
Freight

85,382.8'1

Supplies ..
.
.
.
.
.
.
.

S

23.17
4,072.58
2,000.33
855.25
2,070.71
1,215.02

::\lAHYLA1\"D

TUBERCULOSIS

27

SANATORIU:\1

Farm Expense.
Farm Labor ....
General Expense
.
Groceries and Provisions
.
Laundry Supplies
.
Laundry Labor
.
Power House Supplies. .. .
.
.
Power House Labor.
.
Reception Hospital-s-Housekeeping
Sup.
Reception Hospital Labor
.
Reception Hospital-Nurses
.
Sanatorium and Medical Supplies.
Stationery and Postage.
Stable Expense ..

281.73
1,105.75
1,101.33
53.336.72
485.59
1,479.10
256.74
3,229.50
186.47
5,238. 9~
:\420.92
1,158.60
779.77
117 61
920

Trnnsportnuon .

88/1.425.08

1\ I iscellancous-cCommission on Freight Station.
Commission on Post Office
.
Employees Accommodation Accounl. .
Interest.
.
Railroad Tickets
.
Refund of Deposit on Reclining Chairs ..
Hefund of Board.
. ... _.....

S

20.00
411.50
266.98
2,902.10
1,000.00
359.00
268.00
$:':.227 58

Maintenance

$112,026.87

Total.
EXI [[BIT "C"

Recapitulation-sConstruction.
Equipment
Maintenance

..

.

6,596.93
112,026.87

.

Cash Disbursements

per Exhibit "A"
EXIIIBIT

.:'VIAH,YLAKD

Of' FAR;'I

REVENUE
ENDED

AND

SI 27,891. 26

.

"I)"

TUBERCULOSIS

State Sanatorium.
Su;,nIAK'{

s 9,270.46

.
.

SAI'ATOnILJ!l1

i'''aryland

EXPEKSE

SEPTE1'I1DER

RevenueHauling
.
Hogs and Pigs Sold,
n ogs and Pigs Killed.
Produce
.
lncrease in Live Stock Valuation .. , ..
Increase in Inventory of Straw, l l ay,
Feed, etc.. . ,

POR TilE

NINE

i\IONTTlS

30, 1916
$

480.25
286.63
1,863.44
95.79
406.26
968.91
S4,101.30

28

MARYLAND

TUBERCULOSIS

SANATQFlIUM

ExpenseLabor. . .
.
.
Miscellaneous Supplies and Expense ..
Salaries-e-Supt.
and Office Force .....
Stable Expense.
Repairs and Renewals of Farm Buildings
and Equipment ....

81,105.75
382.35

165.01
141.66

55.08
81,849.85

Excess of Farm Revenue.

82,251.45

SCHEDULE
MARYLAND

TUBEHCULOSIS

State Sanatorium,
PATIENTS

ACCO~TS

No.

RECEIVABLE

SANATORIUM

Maryland
30, 1916

AT SEPTEMBER

Credits

8163.50

•
SCHEDULE
),lARYLAND

ACCOUNTS

(VOUCHERS)

PAYABLE

$1,228.00

No. 2

TUBERCULOSIS

State Sanatorium,

Debits
81,391.50
163.50

SANATORIUM

Maryland

AT SEPTEMBER

30, 1916, 810,781.68

All the books, vouchers and accounts of the Sanatorium are audited
periodically by the State Auditor and in addition by the American Audit
Company twice a year.
Respectfully,
SAMUEL K. DENNIS,
Treasurer.

TREASURER'S

REPORT (No, 2)

BALTIMORE,

To THE BOARD

MD"

OCTOBER

22, 1917.

OJ.<'"
MANAGERS

OF THE MARYLAND

TUBERCULOSIS

SANATORIUM:

Gentlemen: I herewith beg to submit my report showing the
accounts of the MARYLAND TUBERCULOSIS SANATORIUM for the
year ended September 30, 1917, including the following Exhibits
and Schedules:
Exhibits
"At>

SUMMARV STATEMENT OF CASH RECEIPTS

AND DISBURSEMENTS,

For the year ended Seplember 30, 1917

"B"

CASH

MARVLAND

TU13EHCULOSIS

RECEIVED

FOR SUXDHY

29

SANATORIUl\1

ITEl\lS FUHNISHED

PATIENTS

AND

OTHERS,

For the year ended September

30,1917.

For the year ended September

30,1917.

FAR~I r{EVEXUE AND EXPENSE,
For the year ended September

30,1917.

-c-

CASH DISBunSE~1ENTS,

"D"

SUMi\lAHY

Schedules
No.
1

PATIENTS

OF

ACCOUNTS

At September
No.

2

ACCOUKTS

RECEI\'ABLE,

30th, 1917.

(VOUCHERS)PAYABLE,

At September

30th, 1917.

Cash:
Cash on hand at the Sanatorium was counted on October 21sl, 1917.
Cash on deposit at September 29th, 1917, was verified through reconciliation and by certification
received from the Merchants-Mechanics
First National Bank.
The total was found to be in agreement with the
office records, by the American Audit Company.
.
Farm Operations:
As shown in Exhibit "D" the earnings derived fron the operation
of the farm continue to show an increase.
For the year 1915 the farm
profit was S1,672.22; for the nine months ended September 30th, 1916,
the profit was $2,251.45, and for the year ended September 30th, 1917
the profit was $3,793.73.
The American Audit Company reported that the books and records
were found to be in excellent condition.
EXHIBIT "A"
MA1WLAND

TUBERCULOSIS

Slate Sanatorium,
SU~L'IAflY

STATE:\IENT

SANATORIUM

Maryland

OF CASH RECEIPTS

YEAH

ENDED

AND DISBURSEME::\TS

FOR THE

SEPTEMBER 30, 1917

October I, 19]6Balance:
On hnnd
On Deposit in Merchants-Mechanics
National Bank
.

$2,562.21

.

First
72,853.46
$75,415.67

RECEIPTS
October
10, 1916-Received
from
Stale
Treasurer
Appropriation
per Chapter 684
Acts 1916, Maintenance ....
January
16, 1917-neceived
from
State
Treasurer
Appropriation
per Chapter 684
Acts 1916, Maintenance......
.
.
April 2-Received
from State Treasurer Ap-

K1~E~t:~i~~c/~~
.~~~~~e.r .. 684 Acts 19] 6,

$35,000.00
$35,000.00
$17,500.00

30

:\lARYLAND

July

2-Hct:cived

TUBEI~CULOSJS

from Slate

Treasurer

$A:-
Ap-

~~fl~'~~~i~II:ccl~~I:
. ~]l.~l~~c.r
..~~ .~.C.l~.
,191,6:
July 13-Recci\'cd from State Treasurer Ap-

propriation
Maintenance

per
....

Chapter

684 Acts

.'17,500.00

1916,
$05,000.00

September 3D-Board received from patients.
Septem bel' 3D-Sundry l tcms, per Exhibit "B"
Total Receipts ....

$140,000.00
S06,4 76.33
SIO,780.50
S187,256.80

September 30-Disbmscmenls,
pCI' Exhibit "C" ..
September 3D-Balance on hand..
S3,264. 00
On Deposit in Merchants-Mechanics
First
National Bank.
S70,440.01

$262,672.50
188,968.49

$73,704.01
EXIIIBlT

"B"

l'VIAI~YLf\ND TUBERCULOSIS

State Sanatorium,
C"SII

HECEI\'ED
FOR

FOR SUNDRY
THE

YEAH

SANATORIUM

JVfaryland

ITE:\IS FUHNlSIIED
ENDED

SEPTEMBER

PATIENTS

AND

OTI-IERS

$

08.40
171.58
128.00
1,265.04
183.25
111.17
44.22
26.00
1.05
11 .31
483.00
20.00
318.36
159.26
456.~2
487.74
20.56
605.43
57.40
13.75

30, 19]7

Atomizers .. " .
.
.
Commission on Express.
.
.
Commission on Freight Stnticn .
Commission on Post Office ..
Coal, Oil and Gnsoline .
Cement, Sand and Stone
.
Cotton
.
Construction
Refunds.
Droppers
.
Drugs
.
Deposits on Reclining Chairs
.
Entertainment
and Gratuities-refund.
Freight, Express, Hauling, etc ..
Gauze
.
Groceries and Provisions
.
General Expense Refund
.
Housekeeping
Supplies
.
Interest on Bank Deposits
.
.
Junk.
Linen and Bedding ..
Labor Refunds
Power l louse.
Farm
.
Laundry
.
Administration
Building.
.
. Reception Hospital
.
LI\·c Stock.
........
.
.
Lard Sales ..
Medicine Glasses .. ,
.
Miscellaneous.
... ...... ... .. .... . .. . ... .
.
Notar-y Fees & Death Certificates (Laboratory Fund)
Nurses' Dress Goods, etc ..
4.

.
.

22.50
12.20
8.50
33.73
92.20
468.06
292.1/1
A5
12.65
106.75
2~8.88

MAH.YLAND

TUBERCULOSIS

31

SANATOHIUM

647.00
10.00
J ,579.83
73.45
618.00
208.75
33.75
37.20

Nurses' Special Board.
Nurses' Salaries
,.
Power (Electric Current Sold)
.
Petty Cash Check (not used-deposited).
Railroad Tickets
.
Renlal of Buildings ..
Reclining Chairs
.
Hepairs & Renewals, Sundry.
Stationery and Postage
.
Sacks returned
.
Sputum Cups ..
Sputum Fillers.
Sputum Frames ..
Syringes
,
,.,
.
Transportation-Doctors
and Nurses.
Thermometers.
.
,....
.
,.
Wood Sold ..
Total,

pCI' Exhibit

L12.22

99.00
50.99
35.80
78.70
1.75
179.88
696.25
167.63
S 0,780.50

"A" ..

EXHIBIT "C"
]VIARYLAND

TUBERCULOSIS

SANATORIU:l1

State Sanatorium, Moruland
CASH

DISBURSE:\1ENTS

FOR

'r-ue

YEAR

ConslruclionBaler Shed. .
.
Doctors' Collage.
..
.
Furnigaf.ing House. .
.
Farm Buildings.
.
.
Farm Improvements.
New Sewerage Plant.
Labora tory
.
Post Office
.
Reception Hospital. .
.
Railroad Siding.
. ..
Stearn Pipe Line-New.
.. . .. . . . . . . . . . . .
Underground Heating System-Extension.
General Construction
.
Construction

SEPTEi\lHEH

EXDED

HH 7.

200.34
4,715.45
48.60
902.86
704.68
7,894.61
7.80

.

37.50
.
.

.

31.22

7.50
2,036.25
2,463.30
48.41
$19,098.52

Total.

EquipmentAdministration BuildingCrockery and Glassware.
Furniture.
.
General.
Kitchen Utensils.
Linen and Bedding
Silverware

S
.

245.36
268.15
150.55
73.99
1,942.97

.

80.07

----

$2,761.09
S13.90

Laboratory.
Reception HospitalCrockery and Glassware

30

.

$

212 09

32

!'-IAHYLAND

TUBERCULOSIS

SAKATORIUi\!

135.10
150 I,)
220,06
1,545,91
94.42

Furniture.

General. '"
.. ,
Kitchen Utensils. .. .
Linen and Bedding
Silverware ....

.
.

.
.

82,380.53
New Cottagc-cFurniture.

. .....

8

Linen and Bedding.

283.60
15,50
8299.10

Recreation 11::l1lFurniture.

812.50

GencralHorses, Wagons and Harness.
Live Stock
.
Miscellaneous Material
Motive Power Machinery.
Stone Crusher
.
Surgical Instruments
.
Steele of Housekeeping Supplies
Tools and Implements.
.
Reclining Chairs.
Equipment

8

.
.

400.42
111.80
847.90
380,00
7,50
20,30
2,374.02
150.63
246,70
84,539.27
810,014.19

Total.
EXIIlBIT "C"

Mointenance-«
Repairs and HenewalsAdministration Building ....
Administration Equipment. ...
Administration Refrigerator Plant
Farm Buildings
..
.
..
Farm Equipment
.
Laundry Machinery
.
Motive Power Machinery.
Power House.
.
.
Reception Hospital-c-Buildings
.
Reception Hospital-Equipment

8

333.12
995.28
788,04
3,24
5,50
95.09
1,283.06
23.50
458,18
.
1,444.71
101,79
~~;~~~i~.n.
~-~~~~i
~~l.~~~~r.i~:~~t.o.r.
~~~~~
..
13.58
Sewerage Plant. ....
9.72
Walks and Gradiugs .
210.80
\Yat.cr Plant.
184,59
85,950.20

Salaries-Administration
Doctors ancl Officials

Building.

87,720.00

Salaries-Reception
I Iospital-eDoctors and Officials.

83,040.00

Fuel.
Running ExpenseAdministration-Housekeeping
Administrntion-c-Labcr
.... .

818,194,40
Supplies..

S

3.80
5,618.93

MARYLAND TUBERCULOSIS

2,722.42
1,180.37
3,751.07
1,304.45
337.67
1,695.02
1,826.8\
77,'142.58
570.51
1,919.58
1,988.64
293.15
4,666.08
240.88
7,067.77
7,258.38
949.52
152.37
12.30

Admi nistra tion-N urses
.
Bake-shop.
.
Drugs.
.
.
Freight.
.
Farm Expense.
.
.
Farm Labor ..
General Expense. . . . . . . . .
. ....
Groceries and Provisions
.
Laundry Supplies
.
Laundry Labor
.
Medical and Sanatorium Supplies.
Power House Su\)plies ..
Power I-louse La )01'. . . .
. .....
Reception Hospital-Housekeeping
Sup
Reception Hospital-Labor
.
Reception Hospital-Nurses
.
Stationery and Postage.
Stable Expense. . .. .
.
Transport.a tion ....
0.

0

••

0

0

33

SANATORIUM

•

8120,902.32
Misccllancous-cCommission on Express
.
Commission on Post Office
.
Entertainment and Gratuities
.
Employees Accommodation Account..
Petty Cash Check (Not used-deposited)
Railroad Tickets.
. .....
Refund of Deposits on Reclining Chairs ..
Refund of Board.
.
.

S

3.2:,
552.58
775.00
572.83
73.45
1,406.00
390.25
275.50
84,048.86

Maintenance

8159,855.78

Total.

"e"

EXIITBIT
RecapilulationConstruction.
Equipment.
Maintenance ..

.

819,098.52
10,014.19
159,855.78

per Exhibit "A" ..

188,968.49

.

Cash Disbursements.

.

EXHIBIT
IVIARYLAND

"D"

TUBERCULOSIS

State Sanatorium.
SUMMARV

OF

FARM

REVENUE
AND
SEPTEMBER

RevenueHauling
Hogs and Pigs Sold
Hogs and Pigs Killed.
Lard Sold. .. .
.

SANATOFI.IUM

Maryland'

EXPENSE

1"01{ THE

30, 1917
.

S
0

••••••

.

583.45
381.06
3,328.06
292.U

YEAR

ENDED

34

:MARYLAl'o:D TUBERCULOSIS

SANATOHIUi\,l

Produce.
, ...
Increase in Live Stock Valuation.
Increase in Inventory,
Straw, Hay, Feed, etc.

602.49
916.51
254.09
$6,357.80

ExpenseFarm Labor ...
Miscellaneous Expense.
Miscellaneous Supplies.
. ..
Salaries. Supt. and Office Force
Stable Expense
.
Repairs and Renewals of Farm
and Equipment. ..

s 1,695.02
371.07
120.01
240.00
129.23

.
Buildings

8.74
52,564.07

. ........

Excess of Farm Hoven uc.
SCTIEDULE
MARYLAND

53,793.73

No.

TUBERCULOSIS

SANATOHIUJ\I

Stale Sanatorium, M w'uland
PATlE:-ITS

ACCOUNTS

RECEIVABLE

AT

SEPTEMBER

30, 1917
Debits
$1,356.66
225.50

Credits
.225.50

$1,131.16
SCHEDULE
IVIAHYLAND

No. 2

TUBERCULOSIS

SANATORIUM

Stoie Sanatorium, Maryland
ACCOUNTS

(VOUCHEHS)PAYABLE AT SEPTEMBER

30, 1917
$12,980.53

The usual semi-annual audit was made by the American Audil Company
of all the books of account and vouchers for the year.
Respectfully,
SAMUEL K. DENNIS,
Treasurer.

Nf:W

Sf:WAGE

DISPOSAL

PLANT

MARYLAND

TtlBERCULOSIS

SANATOAIU"l

SUPERINTENDENT'S

REPORT

OCTOBER

35

1, 1917.

To tlie Board of Managers of the
N!aryland Tuberculosis Sanosorium,
GENTLEMEN:-

I beg to hand you herewith the report of the Maryland Tuberculosis Sanatorium for the Twenty-one months ending September
30, 1917, with the ususal statistical and financial tables.
On January], 1916 as can be seen from the tables, there were
414 patients in the Sanatorium. During the Twenty-one months
there have been 1788 admitted and 1788 discharged, and thc
Sanatorium has been filled to capacity during the entire period.
All applicants have been admitted in the order that their applications have been received, and no one eligible for admission
bas been turned away; the average time patients had to wait
for admission 'vas three weeks.
A number of old patients have applied for re-admission, and as
we have always had a waiting list, varying from 25 to 100, we have
not been able to re-admit them except into private rooms where
we have had some vacancies.
A place is certainly greatly needed where these patients who have
just begun to relapse, could be sent. In many of these patients,
a stay of two or three months, in a Sanatorium, would put them
back on their feet again and restore them to their working capacity. We have not been able to re-admit them on account of
our waiting list, as it has always been the policy of the institution
to educate the patient how to take care of himself and not to readmit him as long as new patients, who have not been educated,
are on the waiting list.
1

RESUL'l'S

The results of treatment are tabulated according to the scheme
of the National Association, which was adopted by the American

36

"'IAHYLAND TUBERCULOSIS

SANATORIUM

Sanatorium Association, and which is published in another part
of this Report.
Five hundred and ninety-three remained under 90 days, average
stay 41.25 days.
Eleven hundred and ninety-five remained over
90 days, average stay 211.9 days.
On admission 233 cases were Incipient,
670 moderately
advanced, 865 far advanced,
14 unclassified, and 6 non-Tubercular.
On discharge, niue had their disease arrested; 28 apparently
arrested; 300 quiescent; 749 improved; 494 unimproved; 194 died,
and 14 unclassified.
Of the 494 unimproved cases, 239 remained
less than 90 days, and of the 194 deaths, 117 were at the Sanatorium less than 90 days.
During the past twenty-one months, we have received a greater
number of far advanced cases than in any previous year, and many
of these were moribund
on arrival at the Sanatorium.
Our
average number of bed cases has hcen 175, and 576 of our far
advanced cases had Tuberculosis of the Larynx.
Dr. Richard
Hall Johnston,
our Consulting
Laryngologist,
spent 21 days at the Sanatorium in the past Twenty-one months,
and thc Diagnosis of all Laryngeal cases was confirmed by him.
Practically all occupations have been represented, and we have
had patients from every County in the Statc, the admissions
have been the greatest in the Counties having Public Health
Nurses.
These Nurses have been the greatest help to us in getting patients ready and bringing them to the Sanatorium, and
also in aiding the patient after discharge from the Sanatorium.
The ages have ranged from 5 to 77 years.
The treatment has been the same as followed in previous years,
and all patients who arc free from fever, whose pulse rate is not
increased, and are having no active symptoms of their disease,
save cough and expectoration, and are in good physical condition, are required to do some work about the Institution.
This work has been graded, and it is our aim to discharge
favorable cases able to work five hours daily, and then send them
back to their original occupations,
provided their work is not
too injurious.
Better results have been obtained in this manner,
as the patient knows how to do his work, and is able to make more
money at his original occupation than at any other, and does not
have to go through the mental strain of learning something new.

�IARYLAND

TUBERCULOSIS

SANATORIUM

37

All of our employees, outside of those doing heavy work in the
Power House, and the employees in the Kitchen, have been patients at the Sanatorium.
Tuberculin has been used in 93 cases with apparently favorable
results, and artificial Pneumothorax has been given to suitable
cases with most favorable results.
The family physician has been notified upou the arrival of
each patient, and a copy of the physical examination sent him.
IMPRovE?o.'IEN1'S

A Double Imhoff Tank with Stone Sprinkling Filter and four
Sand Filters has been completed in the past year and is working
very satisfactorily. We now have one of the most modern Sewage
disposal plants in the country and have done away with our old
waring system which gave us no end of trouble.
A new Cottage to be used as a Staff house for the doctors has
also been completed. All of our heating lines have been put down
in a Concrete tunnel and the pipes covered with asbestos. The old
Wycoff Covering had all decayed and we were losing a quantity
of heat by radiation.
This should now give no further trouble.
CHANGE IN MEDICAL STAFF

Dr. H. C. Bridgers resigned to accept a position in Baltimore;
his place was filled by Dr. Samuel Snyder.
Dr. J. D. Reichard resigned to enter the United States Public
Health & Marine Hospital Service.
Dr. W. Howard Yeager, who has had charge of the hospital
building, resigned to accept a commission as 1st. Lieut. in U. S.
M. R. C. and is now doing Tuberculosis work in thc various Camps
throughout the Country. We regret very much the loss of these
men, but all have obtained better positions and we wish them
every success.
FARM:

The farm shows a profit of $6045.20. This has been the most
successful period, that we have ever had. A detailed report is
found in the Treasurer's report.

38

MARYLAND

TUBERCULOSIS

PER

SANATORIUM

CA PI1'A COST

The Per Capita cost was 93)1c pel' day from Jan. 1, 1916, to
Oct. 1st. 1916, and 98)1c from Oct. 1, '16 to Oct. 1, '17.
Total Hospital clays, 115,198.
Total Maintenance end Running Expenses, $107,727.73.
Cost per clay per paliclll93)1ic.
See Tables at end of Report.

1917--Total maintenance and running expenses $153,804.26
Total Hospital Days 156,227.
REPORT

OF TRAlN1NG

SCHOOL

We graduated this year thirteen nurses; making a total of 57
nurses graduated since the School was established.
During the year 20 pupil nurses have been admitted,

5 from

Md., 5 from Pa., 4 {rom New York, 2 f1'0111 Conu., 2 from Washington, 1 from Va., and 1 from Del. Following OUl' established custom preference has been given applicants

who arc residents

of

Md., and particularly those who were patients of this Sanatorium.
Miss Mary P. Weaver, one of our Assist. Supt. of Nurses, who
had been with us since the opening of the Training School, re-

signed last July to accept the position of Supt. of Nurses at Suffolk Sanatorium, Holtsville, New York.
Miss Gertrude Wadland will be able to resume her duties as
Assist. Supt. of Nurses on June 1st. Since her illness last January her place has been ably filled by her sister, Miss Helen
Wadland. Miss Helen Wadland has since accepted the position
of Supt. of Nurses at Olean New York.
The death of Miss Elizabeth Binstead (Class 1915) in March
of this year and of Mrs. Grubbs in August, (Class 1913) marks the
first deaths among om graduates.
In our Reception Hospital we have, during the past year, required the services of 25 Special Nurses in addition to om regular
nursing force.

As an indication of the necessity of special trained nurses for
the handling of tubercular patients, we are constantly receiving
requests from the principal Sanatoria throughout the country
for graduate nurses; and it is impossible for us to supply the demand
Our graduates are now nursing in 14 different Sanatoria.
The constantly increasing number of Far Advanced Cases ad-

MAR\'LAKD

TUBERCt;LOSIS

SAX,\TORIUi\l

:l9

mitted to this Sanatorium, while adding greatly to the duties of
the nursing force, at the same time affords excellent opportunities
for the more thorough training of om' nurses on account of the
various complications frequently incident to such cases.

The fact that tuberculous children can continue their school
work without detriment to their physical condition while "Taking
the cure" is practically demonstrated by the continued successful work of Miss Swain in the Open Ail' School connected with
our Children's Hospital; and the opportunity afforded out' nurses
to observe the methods pursued in handling these children, is
of great value.
To my mind this is one of the bcst works that we are doing in
the fight against Tuberculosis and the success with which our
Nurses have met in other institutions has bccn due to the splendid
training given them by Miss Johnson and her assistant s,
The list of graduates is given below:

Mrs. Marion Bridgett, Wallingford Conn., Gaylord Farm San.
Miss Clara Muller,
}
Met. Life Ins. Co. San., Mt.
M·ISS M argare t N 0 Iauc I,
McGregor, New York.
Miss Theresa Fallon,

Miss Sophia Schwartz, Reisterstown San.
Miss Eliz. Eyster, Olean, New York, Rocky Crest San.

Miss Leyl Van Hoesen, Md. State San.
Miss Dora Owen, Elmwood, W. Va.
Miss Catherine Murphy, New York.
Dr. V. M. Reichard presided at the commencement.
The address to the graduate, was made by Dr. J. Mc.P Scott,
Hagerstown, ]\Id.
RECOi\lMENDA'l'IONS

The installation of an X-ray plant is now a necessity.

In the

past few years the X-ray has become a most valuable aid in diag-

nosis of Tuberculosis and also valuable in tbe treatment

of cer-

tain forms.

The establishment of some County Sanatoria throughout the
State to take care of advanced cases close to thei.r homes. These
are at present a great need not only for white people but also for
negroes as at present we do not have any place outside of Baltimore City to sent Tuberculous negroes.

40

:MARYLAND TUBERCULOSIS

SANATORIUM

The employment of visiting nurses as a part of the Sanatoria
to aid in tracing the old patients of the Sanatorium throughout
the State.
ACKNOWLEDGMENTS

I wish to gratefully acknowledge my appreciation of the hearty
support and co-operation of your Board, who have shown me every

consideration.

I take this opportunity of expressing my appre-

ciation of the co-operation of the resident staff, nurses, employees

and patients of the Institution, as our results could not have been
attained save through the interest and co-operation of all associated with the Institution. .
I wish to express my appreciation of the co-operation of the
Visiting Nurses, Phipps Dispensary, City Tuberculosis Dispensaries, the Charity Organizations throughout the State, and the
Medical profession, all of whom have aided us greatly in our work.
Respectfully submitted,
V,CO'OR F. CULLEN, Superiniendent.

l\IAHYLAi',D

TUBERCULOSIS

11

SANATORIUM

MAINTENANCE SHEET
The Following Accounts Figure in Maintenance
Sepl. 30, 1916.
Groceries & Provisions..
.
JIoll?c-keeping Supplies
:
.
Motive Power Machinery Supplies
.
Laundry Supplies.. . . . . . . . . . . . . . . . . . . . . . . . . .
Salaries-Doctors
& Officials.
.
Salaries of Nurses.. . . . . . . . . . . . . . . . . . . . . . .
Labor (Including Laundry & Power-house)..
Stationery & Postage.. . . . . . . . . . . . . . . . . . . .
General Expcnse.. . . . . . . . . . . . . . . .
.
Fuel.. . . . . . . . . . . ..
.
,
Drugs... .. . . .. .. .. . . ..
.
Interest & Discount. ..
.
.
Freight & Discount...
.
.
Bake Shop
.
Thermometers supplied patients free of charge .
SputU1TIFrames
Transportation. . . . . . . . .
.
.
Rep. & Hen. Furniture
.
Linen & Bedding
.
Crockery & Glassware
.
Building Repairs ..
Equipment-Repairs
.
1\11. P. Machinery-Repairs
.
Laundry Machinery Repairs
.
Water Plant Repairs.
.. ..
.
.
Refng. & Ice Plant Repairs
General MateriaL... . . . .. .
,.
.
Walks & Grading Repairs,
.
Sewage Plant Repairs
.
Road Repairs..... . .
.
Kitchen Utensils & Equipment Renewals
.
Silverware.. . . .
.
.
Repairs to Reclining Chairs
.
Surgical Instruments & Appliance Renewals ..
Horses, Wagons & Harness Renewals ..

from Jan. 1, 1916,10
. $54,008.62
1,683.00
241.08
127.38
.
.
7,308.33
.
.
. 7,413.25
.
. 13,984.17
775.18
.
.
1,027.91
.
. 6,873.25
1,775.77
.
2,357.65
772.54
2,905.71
147.00
29.25
.
171.60
. . . . . . . ..
1,095.37
1,309.54
137.28
834.52
1,529.41
648.75
36.03
509.31
%.98
.
201.2,
.
272.94
37.83
350.11
.
97.51
25.00
140.98
7.99
8.00
.

SI08,940.51
CHEDITS-Current
Sold.
Board of Nurses, etc
Board of Engineer
.
Supplies Sold Patients

.

... S700.00
329.50
136.00
47.38
SI,212.88
1,212.88
115,198 ) SI07,727.73
93Y,

Hospital

Days-Reception
Hospital..
Pavilions.. . .
Total.
..

.. 60,121
.55,077
115,198

42

MARYLAND TUBERCUI.OSIS

SANATORIUM

Accounts which Figure in Maintenance
Oct. 1, 1916-0ct

1,1917

G roceries & Provisions
.
Housekeeping
Supplies.
.
.
Motive Power, Machinery Supplies.
Laundry Supplies
.
.
Salaries Doctors & Officials
.
Salaries of Nurses. . .
....
. .
Labor including Laundry & Power-house
Stationery & Postage.. . .
.
.
General Expense
.
Fuel..
.
.
Drugs..
.
Freight & Dlscount..
.
Bake Shop.
.
Thermometers
supplied patients free.
Sputum frames supplied patients Iree..
.
Transportation.
........
.........
Rep. & Hen. Furniture.. .
Linen &. Bedding..... . . . .
.
Crockcrv & Glassware.
Building Hcpairs..
.
Equipment
Repairs... . . . . .. .
.
M. P. Mnchincry Repairs
,
Laundry Machinery Repairs ..
Water Plant Repairs.
.
Hef rig. & Ice Plant Repairs ..
Walks &. Grading repairs ..
Sewage Plant repairs.
Hoad Hepairs.:
.
.
Kitchen Utensils & Equipment-c-Henewals
..
Silverware
.
Hepairs to reclining chairs
.
Surgical Instruments
& Applianccs-c-Henovatcd
Horses. Wagon, & Harness-Renewals.
Repairs to H. 11. Siding
.
T ools- I rn plcrnen ls- Hepai ra-e-Renewals ..
Medical &. Sanatorium Supplies
.
Steam Pipe Line repairs
.

. ....

.
.
.
.
.
.

..

$74,849.02
2,821.78
248.73
748.50
10,520.00
10,093.67
18,999.43
.
750.20
1,315.77
17,692.27
2,854.25
.
773.78
5,173.26
'"
199.15
.
38.55
218.35
.
256.76
.
1,548.67
91.77
515.86
2,467.97
1,473.41
.
113.24
126.13
.
889.33
210.80
9.72
13.58
165.25
94.42
246.70
16.51
24.00
7.50
35.03
135.86
897.30
$156,636.52

CHEOITS-Currcnt
Solei
Allowance on pump.
Board of Nurses
Interest & Discount. ..

.

.31,479.83
100.00
647.00
605.43
$2,832.26
156,227 ) Sl53,80'l.26
98}1

Bcccution Llospital-c-Hospital
Days ..
Pavilions-e-Hospital
Days ....

.81,75"1
.74,473

Total l lospital

.156,227

Days.

�IARYLAND TUBERCULOSIS

SA.."l"ATORIUl\l

13

ACKNOWLEDGMENTS
RELIGIOUS

SERVICES

Rl. Rev. O. B. Corrigan •.......
.............
Rt. Rev. John Gardner Murray, ..
.
.
Rev. G. 1-1. Tragesser •......
Rev. M. L. Firor •...
..........
Rev. J. McCarthy •...
.
Rev. F. W. Meyer, .....
........
Rev. L. Paul Rennolds ..
.
Rev. C. E. Shaw, ..
Hey. Davis 1\'lay,.
.
.
He\·. R. K. Lewis,.. . . . .
'.'
.

Baltimore,
Baltimore,
Emmitsburg,
. .. Sabillasville,
Baltimore.
. .. Baltimore.
Emmitsburg.
. Westminster,
. Glyndon,
. .. Kingston,

Md.
Md.
Md.
Md.
wId.
Md.
Md.
Md.
Md.
Md.

ENTERTAINMENTS

Organ Recital, by Mr. Perry Orem... .
. . . . . . . . .. . Baltimore. Md.
A Kentucky Belle, by Players.: . . . . . .. .
Blue Hidge Summit. Pa.
Recital through Mr. Atkinson, by Miss
Margaret lngle (Organ) & Miss Helen
Broemer (Cello), of the Peabody Institute,
Baltimore, Md.
Minstrel Show, (Patients),.
.
Sanatorium, l\lId.
Smithsburg Band,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Smithsburg, Md.
The Courtship of Lucille (Play) by Sanatorium Players, under direction of Mrs.
May Standish-Hose
& Daughter,.......
.
Baltimore, Md.
Hallowe'en Party, Pauents..
.
Sanatorium, Md.
The Dixie Minstrels,....
.
Sanatorium, Md.
Ventriloquist,..
.
J. D. Henderson.
Moving Pictures (Weekly),
Sanatorium Co-operative Store Co.
Moving Pictures
L. A. DeHoIT, New Theatre. Baltimore. Md.
Expenses of all Ent.ertainments
were paid by the Sanatorium
Co-operative Store Co.
CLOTHING

Needlework Guild of America,
through Mrs. James Findlay •....
. .. Hagerstown. Md.
Clothing, through A. D. Sheppard,
.
. .... Baltimore, Md.
Mr. Guy K. Molter, Secty .• Elks' Club,
........
Frederick, Md.
Miss Nellie M. Casey,..
.
.
. Hagerstown,
Md.
Mrs. S. K. Dennis,
.
. ..... Baltimore. Md.
Needlework Guild of America,
through Mrs. Robert A. Boyle •........
-1- ••••
Hagerstown. Md.
Mrs. James Findlay,
Hagerstown. Md.
Mrs. Marion Hargis... . . . . . . . . .
. . Snow Hill, Md.
Mr. S. K. Dennis.. . . . . . . . .. . . . . . . . . . . .... . . . . .
. Baltimore. Md.
Mr. Thomas Gavin.r.v.: . . . . . .
. •........
_.. . .. Baltimore, Md.
Mr. Walter A. Frey •................
,
Baltimore, Md.
Mrs. A. Brllne,..
.
Baltimore, Md.
Mr. R. T. \Vaters...
.
Baltimore. Md.
Mrs. A. D. Fosler •................................
Roland Park, Md.
Miss E. R. Crisfield.v.. . . . ....•.................
Princess Anne, Md.
Miss Helen C. Corner,
Roland Park, Md.
Mrs. L. J. Cherry •... _. .
. .. Baltimore, Md.
Miss Anne F. Maddox,.
. . . . .•....
. . . . . •.. . . . Breathedaville,
Md.
Mrs. Henry Hertel,...
.................
. . Baltimore, Md.
Mrs. Martha Startt,...........................
. Baltimore, Md.

44

MARYLAND TUBERCULOSIS

SANATORIUM

:Miss Mabel Reese, (Kenwood Rug),.
Miss \V. Carey, (Blanket),
.
Mrs. Samuel Theobald,
.

...........

Baltimore. Md.
. Princess Anne, Md.
. ... Baltimore, :Md.

MONEY

Mr. R. M. Coulbourn,.
Mr. S. K. Dennis,........
Miss Mabel Reese,..... . ..
...
..
Mrs. Francis E. Waters,
The Quarter Club of Maryland furnished
a fund lo provide a Work-shop.
BOOKS

.
.

. .. Baltimore,
Baltimore,
Baltimore,
Baltimore,

Md.
l\Id.
Md.
Md.

AND l\tIAGAZINES

Church Periodical Club,_ ... _. _..
. .. Baltimore, l\Icl.
Rev. F. \\T. Meyer.. . .
. . . . . . .. . .
.Baltimore, l'\:ld.
l\Iiss Anne 1-1. Rolando.. . . . . . . . .
. .. Baltimore, Me!.
Mrs. Cruickshank,....
. . .. . .
.
Baltimore, Mel.
Mrs. R. H. Bland,... ... ... .
..
.
Catonsville, Md.
Mr. Robert C. White,..
. ..
.Ballimore,1'vId.
Mr. Victor G. Bloede,...........
. .... Baltimore, Md.
Miss Diehnan,.
.
New Windsor, Md.
Miss Ayres,...
. .. ..
.
New Windsor, Md.
Rev. G. Lawrence Allbull,... .
. . . . . . . . . . .. . . . . .
. Baltimore, Md.
Mrs. Elizabeth \\T. Handall., .
. Baltimore, Md.
Mr. Charles Halter,..
.. .. .. .. ....
.Baltimore, Md.
Miss C. B. Fornshil, .. . . . . . .
........
.Baltimore, Md.
Mrs. A. Brune..
.Baltimore, Md.
Miss Emma I-Iough,... . . . . . . . . . .
. Baltimore, Md.
Mrs. Wm. H. Stem bler.. . . . . . . . .
. Baltimore, Md.
Miss Emma A. Yeisley..
. .. Baltimore, IVId.
Mr. Tench Tilghman,.....
.
. Norfolk, Vn.
Toys
Mrs. Samuel Theobald, .....
Mrs. A. Brune, .....

AND

GAMES

. Baltimore,
. Baltimore,

:i\ld .
Md.

lItAHYI.AKD

TUBERCULOSIS

SUPERINTENDENT'S
I.-MOVEMENT
Number
Number
Number
Number

45

SANATORIUl\1

REPORT IN DETAIL
OF POPULATION

Patients
Males
remaining January 1, 1916.
. __
218
admitted within the 21 months __
1,015
treated during the 21 months_. __
1,233
remaining September 30, 1917
_
227

Females

196
773
969
191


'"<
Q

p::
W
;>-

-<
Q

Z

"'!::; ~-OOOOo:-.:t'-.::I'C'l

~C'>

-""l"
-M

COCOCXlO">l.'--CXlOOC'J

.::;:'"'

...................-co

E-~~g;~~~~~gg~~f6:75~
-

.......

Ci'

tl!::: MMMMMM<:::r""l"U":l
C'?' .... cc r-c co e,.,OOOOC'!

.,t":l
-It":l
-M

-c

.....0:


Q

~e:;~~~~~~~~~;;~g~
~
"

-c

--

W

p::

~;:::0

"l~
o;uO'>

M-.::I'OOM
...... "' L')"'<;l'''''l"I.!)-.:;;'lnU":ll.!)l
.....
-

~~

.

-0">

-r-..
--::r

5

""" ... _O:C\l
.... ("";:O_ooo--.::I"_OO>
~~
-.::r1:'1~-o:::!'.t":l-.::r-.::rf'-.-o:::!'-.:;:<<:::rMc<:l~

Q

"';;; co ec eo r.... OCONOOO
~ ... O>f'-.OOOOoooo:::oo~

ui

0<0


r-,

_

., ....
:~

Z ~ h;;;oo;::::~g~~~~:£g;s$~::g
_......
C7:
o ·0z ~"~ .......

O>COMC'lOOU":l"'
~ ~ "§~ -::rC"MMMM-.::r-.::rln
5~ O>O">Mm_MOC'!
~ ~ ~C'>C'JNMM-::rc<:l~C'?-,:v_NC'l
Q -<
~
e,

-<

>-..l

r::Z

o
e-

I
c-i

:~
,nN

"' ... l.... -.:t'l .... vOOOOI .... -e rU":l-.:t'-.:t'U":l<:::r-:::r'<:o<:::r<:O
~...

"':::0'>
~~
~

I.!)-.:t'N

"
-0:0

.r-..
--o::r<

C"IC'l __
U":lO">O':>OO,,",:,U":l-.::rO'l
U":l""!'Cl?CO""!'M<:OL(";l\{";I-.:t'C'lM:R

Totals
414
1,788
2,202
418

46

MARSLAND

3.-HESIDENCE

TUBEIl,CULOSIS

BY COUNTIES

Counties
Baltimore Cltv.
Baltimore County
Alleghany ....
Anne Aruudel .

S,\KATORJUM

OF DISCHAHGED
111ales
702

77
42

.

22
:3
5

Calvert.

Carroll.
Caroline.
Cecil.

10

Garrell.

501
38

Totals
1203
115

19

91

13

35
5

2
)]

16
16

6
.

14

15

29

I

6
9

.

5
;;
8
5
6
6
7
I

2
4
.

T Iarlord ....
Howard ..
Kent .
Montgomery.
Prince George.

Females

6
3
3
3

Charles.

Dorchester.
Frederick

PATIENTS

5
7
9

·1
-I
2

12

13
10

19
16

2
7

9
11

29
26

9

16
17
18
13

7

5

22
12

1008

780

1788

87
299
722

60
229
·i91

147
528
1213

1008

no

1788

Years

Males

08

Females
10
61
93
291

Totals

5-10.
1..0-15
..
15-20.
20-30.

191

458

Queen Anne ...

St. Mary's ..
Somerset
.
Talbot.
.
Washington ..
Wicomico
.
Worcester

13
9
23
.

Totals.

7

41

4.-HELlGIONS
Llcbrew .
Catholic ....
Protestants.

'" .

Tolals

.
5.-AGES

43

81
335
267
158
64

30-40.
40-50 ...

50-60.
60-80.
Totals ...

.

......
6.-CIVIL

78
104
174
626

65

223

22

30
9

94
31

1008

780

1,788

CONDITIONS
Males

Females

Totals

Single....

...•. ........................ 501

396

897

Marr-ed.

. . . .. . .. .. . . . . . . . . . . . . . . ... . ..

476

346

822

Widowed. ...........................•....

28

32

60

Divorced.

3

6

9

T otals..........•...... ............ 1008

780

1,788

..

r

A

Z

>

•,

m

"oz

•

o,

s

<
c

MAHYLAND

TUBERCULOSIS

47

SANATOHIU~t

7.-0CCUPATLONS

Actors
Agents (Adv.)

.
.

Agents (Insurance).
Agents (Real Estate).
Agents (Freight).
Bakers
.
Barbers
.
Bartenders .
Basket Makers.
Ben Boys
.
Blacksmiths
.
Boiler Makers.
Bookkeepers.
Box Makers.
Bot.tlers .
.. .
Bookbinders .
Boatmen.
Bootblack.
Brakemen ..
Bricklayers.
Brush Makers.
.
.
Broker
.
Broom Makers.
Builders ....
Butchers.
Candy Makers
Cabinet Makers.
Canvassers
.
Carpenters.
.
Car-repairers. . . . . . . . .. .
.
Cashiers
.
Chauffeurs
.
Cigar Makers.
Chemists
.
Clergymen
.
Clerks
.
Conductors (R. R.)
.
Conductors (Street-Car).
Contractors. . . . . . .. . ..
.
Cooks.
.
.
Coopers.
.
Crauerneu .
.
Collectors. . . . . . . . . . . . . . . . . . .. .
Dairymen.
.
' ..
Dentists.
.
Drapers
.
Draughtsmen.
Drivers.
.
.
Drug Clerks.
.
Electricians.
Editors
.
Engineers (Mechanical) .
Engineers (Civil).
Engineers (Railroad) ....
Factory hands.
Fanners.
.
Firemen
.

Males

Females

o

1

1

8
3
I

7

~
16
2
2
5
2

I:,
2

.

2
1

3
I

3
6
1

o
1

2
'I

.

3
1

4

27

.

9

o
9

4
1

4
101
I

.
.
.
.
.

11
1
2
1
1
2
2
1
I
1

22
.

.

2
4
1
I
2
9
22

47
6

o

o
o
o
o
o
o
o
o

o
o

!j

o
o
o
o
o
o
o

I
I

o

o
o
1
o
I
o
o
1
o

2

I

o
o

14

o
o
I
o
o
o
o
o
o

o
o

o
o
o
o
o

o
52
o
o

Totals
1
1
8
3
1
7
9
16

2
2
5
2
18
2
2
1
3
1
3
6
2
I

1
2
4
4
I

5

27
9
I

9
6
2
4

115
1
11
1
3
1
I

2
2
1
1
1

22
2
4
I
1

2
9

74
47
6

MARYLAND

TUBERCULOSIS

Fire-alarm Operator. . . .
.
Fishermen ...
Foremen.
Furniture Makers.
Glassblowers.
Grocers. .. . ..
.
.
Glass-cullers.
.
.
Governess.
.
.
Grinders.
. . . . . . . . .. .
.
Hairdressers.
...
.
.
Harness Makers ..
Housewives.
Hostlers ....
Housekeepers.
Hotel Keepers.
Housemaids.
Hucksters. '" .
Inspectors (Meter). . . .
.
Inspectors (Street)
.
Iron Moulders
.
Janitors .. ,.
Jewelers ....
Kitchen Helpers ..
Laborers.
. ...
Laundry Workers.
Laboratories
(Chemical) ..
Lawyers ...
Leller Carriers.
Linemen
.
Lithographers ..
Machinists
.
Marble Polishers.
Matrons ....
Marble Cullers.
.
.
Medical Students.
.
.
Merchants
.
Milliners.
Metal Workers.
Milk Men.
Motormen.
Mill Hands
.
Miners
.
Messenger Boys
.
Moving Picture Operators
.
1\1 usicians
.
None.
. .. ;.
Nurses (Graduate)
, .. .
.
Nurses (in training)..
.
.
Nurses (untrained) ..
Nurses (Childs') ..
Oilers ....
Organ-Builders
.
Orderlies (Hospital) ..
Oystermen
.
Painters.
.
.
.
Paper Carriers. . .
.
.
Paper-hangers
.
Peddlers.
.
.
Pharmacists . ..
.
.
'1'

•••••••••.••••••••

SANATORIUM

Males

Females

1

o

4
7
2
3
1

2

o

1

o

1

o

2

o
1
o

2
1
4

10
1
4

1

103
2
2
7
4
2
3

37
1

o

3
2
21

o

3
1

10
2
5
1

o

Totals
1
4

o
o
o

2
3
1

o

1
1

o

1

o
318
o
84
o
6
o
o
o
o
o
o
o
o
3

o

o
o
o

o
o
o
1
o
1

o
3
o
o
o

o
o
o
o

7

3
1

1
1

1

318
2
84
1

6
2
1
4

10
1
4
1

103
5
2
7
4

2

3
37
1
1

3
3
21
3
3
1

10
2
5
1
1

1
1
5

2
36

3
41

o
o
o

12
8
1
7

12
8
1
7
1
2
2
1

o

1

2
2
1

10
1
7

o
3

o
o
o
o

o
o
o
1
o

10
1
7
1
3

MARYLAND

TUBERCULOSIS

Piano Repairers.
Physicians
.
Plumbers
.
Photographers
.
Policemen.
Pipefltters ....
Poultrvmen.
Pressers ...
Porlers.
Printers.
.
.
Reporters
.
Restaurant Keepers.
Roofers.
Sailors. ..
. .
Salesmen and Salesladies
.
Saloon Keepers.
. Sawyers
.
School Children.
School Teachers.
Shoemakers.
Seams tresses.
Sexlon ....
Silver-smiths
Servants
.
Spongers
Steel Workers.
Steam-fil.tcrs .
Solicitors ....
Stenographers
Stone Cullers
.
Stevedores.
Street Cleaners ..
Students
.
Switchmen
.
Tailors
.
Teachers. '"
.
Telegraph Operators ..
Telephone Operators.
Tinners .
Typists ...
Undertakers.
Upholsters.
Wagon-Builders.
Waiters
.
Walchmen.......
.
Wa termen
.
Window Cleaners ..
Weavers .
Yard Musters
.
Totals

lYlafes
1

3
6
1

6
1

o

1

16
1

2
1
:l
:17

s
1

01

o

,[

o

.
.

1
2

o

1
1

o
.

1
J1
2

o

1
10
1
67
1
2

o
2

Females

o

o
o
o
o
o
o
o
o
o
o
o

o
o
20
o
o

Totals
1
3
6
t
6

1
5
1
16
1
2
1
3

57

70

5
1
121

9

9

20

20

o

1
2

o
o
o
o
20
o

1
1
5
1
31

1

II

o
o

:1

o
o

o

12
1
2
7

o
o
o
o


3

2
5
1
1
79
2
4
7

2

o




2
2

1
2
1
6
8

1
2
1
.

49

SANATORIUM

6

2

3

o
o
o

1

o

1,008

780


2

3
1
1788

50

MAHYLAND

8.~PJlYS1CAL

TUHEHCULOSIS

CONDITION ON ADMISSION
Males

1916
51

lnc~)icnl. ................
Mo crately Advanced ..... 134
Far Advanced. . . . .
. .. 229
Unclassified.
8
Non Tubercular. ,_,
2
Tolals ......

....

9.-PHYSICAL

Females

1917
65

1917

I

I
1

11
4

1917
136
395
475
3
2

584

353

427

777

1,011

228

288
2

.424

Totals

1916
46
141
161
3
2

71

167
187

1916
0
5
13
63
...174

Totals

55
205

1916
0
5
15
88
351

121

22-4

42
I

83
11

1917
0
4
13
212
398
2iO
111
3

427

777

1,011

1917
0
2
1

8

1916
0
0
2
25
177
116
30
3

.......424

584

353

NOTE.-195

390

Females

1917
0
2
12
157
193
149
69
2

Apparently Cured.
Arrested ...
Apparently Arrested ..
Quiescent. .....
Improved ..........
Unimproved .... ..........
Died .......
Unclassified ...

1916
97
275

CONDITION ON DiSCHARGE
Males

Totals.

SANATORIUM

108

... 53

Children Included in Tables 8 and 9.

Io-CLASS
265 NUMBER

OF PATIENTS

\\'LlO REMAINED

1.-1916

LESS THAN 90 DAYS.

AVERAGE

RESIDENCE

40.7 DAYS.

Apparently
Arrested
Arrested
Quiescent
Improved
Unimproved
Died
Condilion of Patient When
~
~
~
Admitted
No. Per Cent.No. Per Cent.No. Per Cent.No. Per Cent.No. Per Cent.No. Per Cent.No. Per Cent.
Incipient.
15
5.6
0
0
0
0
2
13.3 11
73.3
2
13.3
0
0
Mod. Advanced...........
76
28.6
0
0
0
2
2.6 '19
64.4 25
32.8
0
0
FarAdvanced
163
61.5
0
0
0
0
0
0
26
15.9 85
52.1 52
3\.9
Unclassified..... .. ..
8
3.0
0
0
0
0
0
0
0
0
0
0
0
0
Non-Tubercular..
..
3
1.1
0
0
0
0
0
0
3
100.
0
0
0
0

----

Totals...

.. ........

265

---

0

----

0

4

lOA-CLASS
22 CHILDREN

Condition of Patient When
Admitted
Incipient. ...................
Mod. Advanced. ..............
Far Advanced ................
Unclassified ... 1...............
Totals.

..............

WHO REMAINED
No.
17
I
I
3
22

Apparently
Arrested
0
0
0
0
0

LESS THAN

---

89

----

112

52

1.
90 DAYS.

AVERAGE

STAY 41.8 DAYS.

Arrested
0
0
0
0

Quiescent
2
0
0
0

Improved
13
I
0
0

Unimproved
2
0
0
0

0

2

I-I

2

Died
0
0
I
0

10-CLASS
HEMAl NED

291 WIIO

1-1917
LESS THAN

90 DAYS

Apparently

Arrested

Condition oj Patient When
Admilled
1 ncipient . .
Mod. Advanced
. .......
Far Advanced ..

No.
19
96
172

.

----

.........

287

0

.........

3
1

0
0

Tolal. . - . . . . . .. . .

. .. . . . . . . .. . .

15 CHILDHEN

291

WHO

-

----

Unimproved

Died

Per Cent.No. Per Cent.No. Per Cent.No. Per Cent.
10.5
9
47.3
7
36.8
1
05.2
49
51.0
42
43.7
05.2
0
0
17.4 78
0
30
45.3
64
37.2
----

----

----

0
0
0

0

0

7

0

89

0

127

0

65

0

0
0

0
0

0
1

0
0

0
1

0
0

0
0

0
0

0
0

0
0

0

0

0

7

0

90

0

127

0

65

0

----

0

Improved

Quiescent

No. Per Cent.No. Per Cent. No.
2
0
0
0
0
0
0
0
5
0
0
0
0
0
0
-

Total. .
Unclassified ...
Non-Tubercular.

Arrested

~

----

10.'1. CLASS I
HEMAINED
LESS THAN

----

----

----

90 DAYS

Apparen[{y

Arrested

Arrested

~

Condition of Patient When
Admitted
Incipient.
.
Mod. Advanced
.
Far Advanced ..

No.

Total.
.
Non-Tubercular ...

14

Total.

10

o
4

Quirscenl

Improved

Unimproved

~

Died

No. Pcr Cent. No. Per Cent.No. Per Cent.No. Per Cenl.No. Per Cent.No. Per Cent.
0
10
100.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
:J
0
.750
1
0
0
0
0
0
0
.250
0

----

I

0
0

15

0

0
0

0
0

0

0

----

----

----

----

----

0
0

0
0

0

0

----

0
0

10
1

0

II

----

0
0

3
3

0

3

----

0
0

0
0

.0

0

----

"132 NUMBEH

ll-CLASS
11-1916
WHO REMAINED
OVER 90 DAYS.

PATIENTS

AVERAGE

RESIDENCE

217.4 DAYS.

Apparently
A/Tested

~

Condition of Patienl When
Admitted

No. Per Cent.No.

IncipienL.... .. ..
Mod. Advanced . .
Far Advanced
Non Tubercular.
Totals.

25
188
218
0
1

.

Tolols.

5.7
43.5
50.5
0
.2

----

.432

58 CHILDREN

Arrested

Per Cent.No.
2
2
1

8.0
1.06
0.45

a

a

0

0

----

Per Cent.No.
8
6
I

a
a

WHO REMAINED

Improved

20.0
24.4
3.6

10
121
86

40.0
64.3
39.1

----

----

0

1

100

a
a

a

a

OVER 90 DAYS.

a

a

218

59

Unimproved

~

Died

PfT Cent.No. Per Cent.No. Per Cent.

Per Cent.No.

32.0
5
3.19 46
0.45 8
0

15

5

Quiescent

0
13
93

a
a

0
6.9
42.6
0
0

----

a
a

0

a
29
a
a

13.3
0

a

29

106

AVERAGE

STAY 263.5 DAYS

Apparently

Condition of Patient When
Admitted
Inc~ienl. .........
Mo . Advanced ... ........
Far Advanced ..
Totals.

No.

Arrested

Arrested

Quiescent

Improved

Unimproved

Died

40
10
8

a

22
1
0

18
8
4

0
3

0
0
1

58

a

a
0
a
a

23

30

4

0
0

I

ll-CLASS
605 WHO HEMAINED
Condition of Patient When
Admilled

r ncipient.

.

Mod. Advanced ...
Far Advanced.
Total. ....

...........

~

NQ.
29
287
289

11.-1917
OVEH 90 DAYS

Apparently
A rrested

Arrested

----

605

3

ClllLDHEN

~

Tot al .........

No.
78
12
10
100

Improved

Unimproved

Died

No. Per Cent.No. Per Cent .No, Per Cent.No, Per c-a.r:« Per Cent.No. Per Cent.
2
6.8
4
13.7
17
58.6
17.2
1
5
3.4
0
0
1
.34 9
38 6 134
31 111
46.6 31
10.8
1
.31
0
0
0
0
21
7.2 126
43.5 101
34.9 41
14.1

----

13

I1A-CLASS

Condition on Admission
I ncipient.. ., ....
Mod. Advanced.
Far Advanced ...

Quiescent

Apparently
.A rrested

~

----

----

265

133

42

I r.

WHO REMAINED
Arrested

----

149

OVEH 90 DAVS
Quiescent

Improoed

Unimproved

Died

No. Per Cent.No. Per Cent.No. Per Cent.Ne. Per Cent.No. Per Cent.No. Per Cent.
1
1.2
0
67.922
0
53
28.2 2
2.5 0
0
0
0
0
0
3
25.0 8
66.6
1
8.3 0
0
0
0
0
0
0
0
3
30.0 4
'10.0 3
30.0
56

33

7

;j

lIB~TABLE
265 ADULTS
Gain
104
Average Gain

s

REMAINING

REMAINING

Gain

Loss

13

3

OVEr;

Cain
10

Gain
55

Average Loss 2% Lb5.
TOTAL-ADULTS

REMAINING

UNDER

Nol Weighl

In

nl

Average Loss ll}1 Lbs.
REMAINING

Loss
1
Average Gain 37'2 Lb5.
Totals.

UNDER

Same
1
A vcragc LO!:.s 2 Lbs.

90 DAYS
Not Weigh!
3

OVER

Loss 8.3 Lb5.
OVER

no DAYS

Same Wt.

No/ WI.
1

Average Gain 9.2 Lbs.
AND CHILDHEN-777

no DAYS
Same "'t.
7

Not 'Wt.
41

I1J':MAINING

Loss
0

2

Loss 0

OF WEIGIITS-1917
605 ADULTS

no DAYS

Same

Gain
Loss
112
69
Average Gai n 6 M Lbs.
15 CHILDREN

58 CHILDHEN

Same WI.
2

UB-TABLE

REMAINING

Gain
Loss
312
72
Average Gain 12.32 Lbs .

90 DAYS

Not \\'1.
4

Average Gain 5.8 Lbs.

291 ADULTS

432 ADULTS

no DAYS

Not lVt.
Same \\'f.
18
87
Avet-age Loss 5 A Lbs.

Loss
56
7lbs.

22 CHILDHEN

UNDEH

OF \YElGHTS-InI6

REMAINING

Gain
Loss
437
106
Average Gain 12% Lbs.
100 CIlILDREN
Gain
85
Average

Loss
7
Gain 8.J;2 Lbs.

OVER

Same
11

90 DAYS
Not Weigh!
51

Average Loss 7 Lb5.
REMAINING

OVER

90 DAYS

Not Wei,qhl
Same
4
4
Average Loss 10 Lb5.
.896 Adults
115 Children

ioi:

12-EFFECT

OF TREATMENT

ON PROMINENT

On
Number
Number

of Patients
of Patients

whose expectoration
whose expectoration

contained
contained

.

who had Hernorrages ... . . . . . . .
who had no Hemorrages . ....... - ....

. .........

Total.

EFFECT

Discharge
218
272

Prior 1'0
Admission
173
317

. .490

490

490

490

...........

0
0

0
0

174
316

69
421

........ .

0

0

490

190

ON PROMINENT

SYMPTOMS

Prior To

During Slay In
Sanatorium
367
72
9
42

T. B ....
no T, B..

. .......

OF TREATMENT

On
Number of Patients who gained weight.
Numfer of Patients who lost weight. ... - . . . . . . . .
Number whose weight remained the same ...
.......... ....... ,-.
N umber not weighed.

........

Note.

On

Admission
0
0
0
0

Discharge

0

0

........

Tolal.

On

Admission
.263
.227

Total.
Patients
Patients

SYMPTOMS-j9j6

58 children in Luis lable-3

0

o0
0

with positive sputum.

Admission
0
0
0
0
0

During Stau In
Sanatorium
262
228

<190

CHILDREN
EFFECT

OVER

OF TREATMENT

ON PROMINENT

contained T. B ..
contained no T. B.

Number of Patients whose expectoration
Number of Patients whose expectoration
Total ...
Number
Number
Number
Number

of Patients who gained weight.
of Patients who lost weight. .. . . . . . . . .
whose weight remained the same.
. . . ... .
not weighed ..

ToLal.

Patients who had Hemorrahges ...
Patients who had no Hemorrhages.

. . ...........
.

..

. . . . . . .

..........

. .......

........

........

.

.

Total.

llEMORRAIIAGES

90 DAYS

IN PATIENTS

.

Oil

Admission

I

Discharge
2

57

56

57

56

58

58

58

58

0
0
0
0

0
0
0
0

0
0
0

55
0

a
a
a
a

a
a
a
a

REMAINING

LESS TIIAN
Previous

8/1

.
.

During Slay Jn
Sanatorium
2

On
Admission

Hemorrahages
265 Adults. . .
22 Children

SYMPTOMS

a

Prior '1'0
1

2
I

a
a

58

3

2

55

56

58

58

so DAYS
Hemorrhages During Slay
11
II

12-EFFECT

OF TREATMEJ'T

Number of Patients whose expectoration
Number of Patients whose expectoration

ON PROMINENT

contained T. B.
contained no T. B ..

Totals
Patients who had Hemorrhages ....
Patients who had no Hemorrhages.
Tol.als ..
Number
Number
Number
Number

of Patients who gained weight
.
of Patients who lost weight.
.
.
of Patients whose weight remained Lhe same
of Patients not weighed.

Total ...

.
.

SYMPTOMS-1917-ADULTS
During

Stay In

319
286

Prior To
Admission
298
307

.605

605

605

605

o
o

0
0

237
368

86
519

o

0

605

605

On
Admission
.390
.215

On

Disctiarqe

Sanaforium

301
304

437
106
11
51
605

12-EFFECT OF THEATMENT ON PHOMINENT SYMPTOMS-CfIILDHEN
On
Number of Patients whose expectoration
Number of Patients whose expectoration
Total ...

.............

Patients who had Hemorrhages
Patients who had no Hemorrhages.

.
.

.

Totals ...
Number
Number
Number
Number

of Patients who gained weight.
of Patients who lost weight.
whose weight remained the same
not weighed.

Total

, ..

.
.

.

Prior To
Admission
6

92

On
Discharge
8
92

100

100

100

100

o
o

0
0

11
89

5
95

o

0

100

100

o

0
0
0
0

0
0
0
0

85
7

0

0

100

Admission
8

contained T. B.
contained no T. B. ....

o
o

o
o

94

During Slay In
Sanatorium
9
91

<[

4

60

!I'IARVLAND

TUBERCULOSIS

SAKATontUM

DEFINITION OF TERMS EMPLOYED

Below is given the classification of the National Association
for the Study and Prevention of Tuberculosis, as modified and
interpreted by the American Sanatol'imTI Association.
l.-ON

ADMISSION

These definitions indicate the Iurtheet extent of disease and
the greatest severity of symptoms that a patient can present and
still belong to the stage defined. All patients beyond the incipient stage fall under the moderately advanced stage unless the
physical signs and symptoms exceed those of the moderately
advanced stage, when they should be classified as far advanced.

Incipient-Slight
or no constitutional symptoms (including particularly gastric or intestinal distmbance or rapid loss of
weight). Slight or no clevation of temperature or acceleration of pulse at any time during the twenty-four hours.
Expectoration usually small in amount 01' absent. Tubercle
bicilli may be present or absent.
Slight. infiltration limited to the apex of one or both lungs or
a small part of one lobe.
No tuberculous complications.

AloderateZyAdvanced.-No marked ·mpairmcnt of function, either
local or constitutional.
Localized consolidation moderate in sxtent., with little or no
evidence of cavity formation, or infiltration more extensive
than under incipient.
No serious complications.

For Advanced.-Markcd

impairment of function, local and con-

stitutional.
Marked consolidation of an entire lobe.
Or disseminated areas of beginning cavity formation.
Or serious complications.

111
iliary T1lberculosis.

"IARYLAND

TUBERCULOSIS

2.-0N

Apparently Cured.-All

SANATORIUM

61

DISCHARGJ'

constitutional syml(toms and expectora-

tion with bacilli absent for a period of twO years under ordinary conditions of 1i rc.
A rresled.-All

constitutional

symptoms

and expectoration

with

bacilli absent for a period of six months, the physical signs
to be those of a healed lesion.
Apparently Arrested.-All constitutional symptoms and expectoration with bacilli absent for a period of three months; the
physical signs to be those of a healed lesion.
Quiescent.-Absence of all constitutional symptoms; expectoration and bacilli mayor 111ay not be present j physical signs
stationary or retrogressive j the foregoing conditions to have

existed for at least two months.
Im]lroved.-Constitutional

symptoms lessened or entirely absent;

physical signs improved

01'

unchanged;

cough and expecto-

ration with bacilli usually present.
Unimproved.-All essential symptoms and signs unabated or illcreased.

Died.
TERMS USED IN DEFINITION

OF ((INCIPIENT"

1.

Slight Constitutional Disturbance.-Slight loss of appetite, of
strength, of weight; lassitude; possibly slight acceleration
of pulse or possibly slight elevation of temperature. The
impairment of health may be so slight that the patient
does not look or feel sick in the ordinary sense of the word.

2.

Slight Elevation of Temperature.-Maximum
temperature
after rest for one hom, never over 99.5 to 100 F. by mouth
(or 100.5 per rectnm).

62

l\lAnYI~o\ND

3.

•

TUBERCULOSIS

SANATORlUl\l

Slight Acceleration of Pulse.-Maximum
pulse rate not over
90 after rest for one hour, sitting or lying, except when
due to causes other than tuberculosis.
I

4. Absence of Tttbercle Bacilli.-Each monthly examination
(if the sputum be negative) to consist of a careful microscopic examination, with a mechanical stage, of two smears
devoting at least three minutes to each smear, made from

selected particles (at least six from different parts) of the
sputum on each of three successive days. Tho morning
sputum should always be obtained, or, better, the minute
bits that some arrested patients raise at very infrequent intervals. It is not yet deemed wise to insist on digestion
and centrifugalization

5.

InfiUrat-ion.-Physieal

01'

on innoculation

of guinea pigs.

signs of slight prominence to the

clavicle, lessened movement of chest, narrowing of apical resonance with lessened movement of base of lung,
slight or no change in resonance, distant 01' loud and

harsh breathing, with or without some change in the
rhythm (i. e., prolonged expiration), vocal resonance possibly slightly increased; or fine or moderately coarse rales
present or absent. If sputum contain tubercle bacilli, any
one of these.
6. Apex.- That portion of the lung situated above the clavicle
and the third vertebral spine.
7. A Small Part of One Lobe.-An area of one or two intercostal spaces, or an area not exceeding 60 to 80 sq. ern. ill
extent, according to the size of the patient.
TERMS

USED

IN

DEFINITION

OF

HMoDERA1'ELY

ADVANCED."

8. Marked Impairment of Function, Either Local or Consiitu»
tional.-Local:
Marked dyspnea on exertion, limiting seriously the patient's activity.
Constitutional:

9.

Marked weakness, anorexia, tachycardia.

Moderate Extent of Localized Consolidation.-An

area of one-

MAIIYLAKD

TUBEHCULOSI$

SANATOflIUl\[

63

half lobe or less, but may involve both apices; marked dullness, bronchial
or decidedly broncho-vesicular
breathing;
markedly increased vocal resonance; rales usually preeent.
These signs are to be sharply limited as to area, instead
of gradually shading into normal physical signs"
10,

Evidence of Destruction of Tisslle.-Pl'esencc
of tubercle
bacilli or elastic fibers in the sputum, or the presence of
the physical signs of a cavity.
There are no absolutely
certain physical signs of cavity, but a combination of any
four of the following signs is to be taken as indicative of a
cavity:
(1) Cracked-pot
note; (2) amphoric
breathing;
(3) intense whispered pectoriloquy;
(4) a veiled puff or
post-tussive suction; (5) bubbling or resonant rales.
"Physical signs of softening" do not admit of any definition apart
from that of cavity forrnatiom, and the term. should not he
used.

1].

Disseminated Fibroid Deposils,-Morc
or less localized areas
of fibrous tissue, producing on physical examination some
change 01' dullness in the percussion note, more or less increase of vocal resonance, harsh, suppressed or bronehovesicular breathing, rales sibilant 01' sonorous usually, but
at times fine and moderately coarse.

12.

Serious CompUcations.-These
should be limited to tuberculous complications, such as meningitis, pharyngitis, laryngitis (except thickening in the posterior interary-tenoid
space and superficial ulceration of a vocal chord), enteritis,
peritonitis,
nephritis,
cystitis,
orchitis, adenitis
(unless
very slight), etc.

~rEHMS USED IN DEFINITION

OF uFAR ADVANCED."

13. Intense LocalizedConsolidation.- The term should be replaced
by "marked consolidation of an entire lobe." "Marked
consolidation"
indicates dullness into flatness, bronchial
or tubular breathing and other signs of consolidation as
defined in paragraph 10.

",IAIWLAND

TERMS

14.

TUBEHCULOSIS

USED IN DEFINITION

SANATORIUM

OF IIApPARENTLY

CURED"

Constitutional Sympto11ls.-Thesc
include elevation of temperature, Joss of weight, loss of strength, night sweats, chills,

tachycardia, cyanosis, loss of appetite, amenorrhea, etc.
15.

Physical Signs of a Healed Lesion.-These
may embrace every
physical sign of infiltration or consolidation (see paragraphs
6,10), with the exception of rales, which must be permanently
absent, cxcept possibly a fcw fine rales at the base, probably atelectatic in origin, and at aIle apex or over a small
part of one lobe. Rales in the latter two places are to be
heard only during the cough,. at the end of a prolonged
expiration, or during the inspiration which follows the congh.
TERMS USED

16.

Constitutional

IN DEFINITION

Symptoms

Lessened

or {(IMPROVED"
or Entirely

Absent.-By

this is meant an improvement in the general condition, as
shown

either

by a gain in both weight

reduction of previous febrile t.emperature

and strength

or by

to nor tal with-

out loss of strength.
TERMS

USED

IN DEF1NlTION

OF ((UNll\fPROVED

OR PnOGRESS1VE"

17. Essential Symptom.sand S'igns.-These include, among others,
weight, strength, appetite, night sweats, hemoptysis, pleurisy,
dyspnea, temperature, pulse-rate, dullness, change in vocal
resonance and respiratory movement, rales.

SUMMARY
HYGIENIC-DIETETIC

TREATMENT.

PATIENTS

STAYJNG

OVER 90 DAYS-J916

\VITH TUBERCULIN
Extent of
Physical
Sign
(Tur an) T.B.

CLASS

Incipient.
Incipient. .. . . . . . . . . . . . . .
Incipient. .
.. . . .. . . .
Inctient. .......
Mo(. Advanced.
Mod. Advanced. ............
.Mod. Advanced.
1\10d. Advanced. ...........
Mod.Advanced.
Mod. Advanced.
Far Advanced.
Far Advanced.
Far Advanced.
.............
Far Advanced.
.. .. . . . . .
Far Advanced. .. -, .....
Far Advanced.

.
.

.

ToL::d.

. .........

I
I
11
II

I
I
11
11
111
III
I
]

11
II
11l
III

0

+
0
+
0
+
0
+
0
+
0
+
0
+
0
+

Apparently
Arrested

Arrested

Quiescent

Improved

Cases
8
2

No.
2

Per Cent, No.
25. I
2

Per Cent. No.
12.5 3
100.

....
2

7
1
7

28.5
I
]

57.1
16.6

]

3
1
3
5

42 8
100.
42.8
83.3

1

100.

2
1

100.
100.
100.
100:

100.

].

2
1
]

]

2

2

39

Per Cent.
25.

..

28.5 2

6

Per Cent. No.
37.5 2

~-2

6

--10

21

SUMMARY
CIIILDREI':
IIYGIE:\IC-DIETETIC

TREATMENT.

PATIENTS

\\'ITII

(Turban)

Incipient.
.............
Incipient. ..
........
Incipient.
. . . . . . . ..
Incipient. .......
.............
Mod. Advanced.
Mod. Advanced. ... - .........
Mod. Advanced. . . . . . . . . . . . . . .
Mod. Advanced. ............
Mod. Advanced.
. . . . . . . .
Mod. Advanced. ... ,.,
Far Advanced.
Far Advanced.
Far Advanced.
Fnr Advauced .
Far Advanced.

......

Far Advnnced .

Total.

.

I
I
11
II
I
I
II
II
III
III
I
I
II
II
lIT
III

T. B.
0

+
0
+
0
+
0
+
0
+
0
+
0
+
0
+

..... - ......

Arrested

Cases

~

O\'ER

~O DAYS-1916

Apparently
Arrested

Quiesce.nl

TUBERCULIX

'Extent of
Physical
Sign

CLASS

STAYING

No.

Per Cenl. No.

Per Cent. No.
6

2

Per Cent.

66.6

Improved

No,
:l

Per Cent,
33.3

~

ioo

I

100.

100.

13

6

7

SUMMARY
HYGIENIC

DIETETIC

STAYING

PATIENTS

TREATMENT.

OVER

90 DAYS-1916

'VITHOUT TUBERCULIN

CLASS

Oca f::
d'~61$ T.B.
~;.;;

I-.

~-"

0

U

cijp., t::.
Incipient
Incipient. ..
Incipient. ....
Inc~ient. ........
Mo . Advanced ..
Mod. Advanced ..
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced ....
Far Advanced ......
Far Advanced ....
Far Advanced ....
Far Advanced ...
Far Advanced .....
Far Advanced.
Non Tubercular.

1
1

0

[[
[[

1
I
II
[[

III
III
1
I
11

II
III
III

+0
+
0
+
0
+
0
+
0
+
0
+
0
+

With Tuberculin.
Total. ..

~
~
~
~

........

14
I
57
10
40
55
1
4
1
1
11
62
4
131
1

Arrested

Apparently
Arrested

Quiescent

~

Improved

~

Unimproved

~

Died

No. Per Cent. No. Per Cent, No. Per Cent. No. Per Cent. No. PerCent. No. Per Cent.
14.2
7
50.
35.7
2
5
1
100.
I
1

.77

3

2.5

5.2

9
2

2.5

14

13
1

15.7
20.
35.
23 6
100.

39
8
23
36

68.4
80.
57.5

3

75.
100.
100.
81.8

1

1
2
2
3

.76

393
39

3
2

432

5

-~--

9
6
15

----

49
10
59

9.09
3.2
50.

2.29

----

1
9
28
I
39
1
197
21
218

65.4

45.1

25.
29.7

5

8.7

I
6

2.5
10.9
25.

1
24
I
67

9.09
38.7
25.

8

12.9

51.1

21

16.

106

29

106

29

----

SUMMARY
CHILDREN
llYGIENIC

DIETETIC

TREATMENT.

PATIENTS

STAYING

OVER 90 DAYS-1916

\VITIIOUT TUBEHCULIN

O"@

-t:

-'Ud@

CLASS

Incipient ....
Incipient ...
Incipient ....
InC~)ient. ..... : .
Mo . Advanced.
Mod. Advanced.
Mod. Advanced ..
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Far Advanced .....
Far Advanced ......
Far Advanced ...
Far Advanced .....
Far Advanced ...
Far Advanced .....
With Tuberculin ...

e-e tlJl,.Q
1-0 T. B.
-;::t...::: c/l ;:I
UlA. t;.
I
I
II
II
I
I
II
11
III
III
I
I
Il
[]

1lI
III

...........

Tolal. ...................

a
+
a
+
a
+
a
+
a
+
a
+
a
+
a
+

~
~
~
~

U

Apparently

Arrested

~

No.
31

PCI'

Arrested

Quiescent

6

16.6

I

100.

1
1
3
I
,

58

~

Died

Cent. No. Per Cent, No. Per Cent. No. Per Cent. No. Pcr Cent. No. Per Cent.
16
51. 6 15
483

I

45
13

Unimproved

Improved

~

1

100.

4

666

1
1

100.
333

I

16.6

100.
2

666
100.

17
6

23
7

4

23

30

4

-

SUMMAHY
IlYGIENIC

DIETETIC

THEATMENT.

PATIENTS

'VITI[

0(;;
CLASS

c

~.::l 5h..d

Cl.1 ~'-l-<
"'K,J:::::(/)
;:::l

C

~o..
Incipient .
lncipient .
Incipient.
Incipient. ...
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Far Advanced.
Far Advanced.
Far Advanced.
Far Advanced.
Far Advanced.
Far Advanced.
Tctnl . ..

m

T.B.

1
I

n
ir
I
I
JI
Il
JII
lIT
I
I

n

II
III
111
.........

0

+
0
+
0
+
0
+
0
+
0
+
0
+
0
+

"~
•

u

STAYING

TUBEHCULTN

Apparenlly

Unimproved
Died
Quiescent
Improved
~~
~
No. Per Cent. No. Per Cent. No. Per Cenl. No. Per Cent. No. Prr Cent. No. Per Cent.

Arrested

Arrested

3

I

33.3

9
7
6
8

2

22.22

2
5
4
'I

22.22
71.43
66.67
50.00

1
5

2

40.00

2

1

5000

. . 41

OVEH ~O DAYS-J917

2

66.7

5
2
2

~

50.56
28.57
33.33
00.00

1

100.00

3

60.00
1

50.00

SUMMARY
HYGIENIC

DIETETIC

TREATMRNT.

PATIENTS

WITHOUT

CLASS

'0"; ?
-;;.:=~

~~,",T.B.
~.c ~

~~ eIncipient.
Incipient.
Incipient.
Incipient ......
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced ..
Far Advanced.
Far Advanced.
Far Advanced.
Far Advanced.
Far Advanced.
Fnr Advanced.

I
I
II
II

I
I
II

II
III
III

I
I
II
Il
III
[II

Total ...
With Tuberculin ..
Tolal No. Cases.

0

+
0
+
0
+
0
+
0
+
0
+
0
+
0
+

..~
"
0

OVEH ~O DAYS-1917

STAYING

TUBERCULIN

Apparently

Arrested

Quiescent

Arrested

Improved

U

102
1
1
76
39
58
86

Unimproved

~

Died

No. Per Cent. No. Per Cent, No. Per Cent. No. Per Cent. No. Per Cent. No. Per Cent.
3
2.943
2.94 68
66.67 25
24.51 3
2.94

I
I

26
20
24
28

34.21 40
51.28 17

10
3

:,

I
1
2

9
92
11
173

9

5

1.72

----

I
I

6 58
2 .57

100.00
100.00

I

.n

----

6

32.56 46

';2.63
43.58 1
'13.11 7
5:,.49 11

658
2.57
12.07
12.79

10.00 I
33.33 2
66.67 I
5
9.78 43
11
:1.47 63
----

10.00 8
66.67
33.33
55.!'"l6 3
16.74 28
100.00
36.42 7:l
----

80.00

ai.sa 25

~)

.....664
41

...705
100 children included in this table with separate results in next table.

I.16

33.33 I
30.44 12

II.11
13.01

'12.19 31
---

17.92

SUMMARY OF CHILDREN
HYGIENIC-DIETIC TREATMENT.

PATIENTS STAYING OVER 90 DAYS-1917

\VITHOUT

CLASS

0"'; '2
.... uOllo:\l
~..... :::;,:

$ ~.!?! ~ T.B.

K..cv::lE-t_
~P<

Incipient. ......
... I
Incipient. '" ...
I
Incipient. .......
. . . . . II
Incipient. ... '" .. · .. 11
Mod. Advanced ..
I
Mod. Advanced.
... [
Mod. Advanced ..
I
Mod. Advanced.
· .. II
Mod. Advanced.
.III
Mod. Advanced.
·..III
Far Advanced .... .... I
Far Advanced ....
I
Far Advanced ..... ... 11
Far Advanced .... .... II
Far Advanced.
.III
Far Advanced ..... ...III
Tolal. ...

0

+
0
+
0
+
0
+
0
+
0
+
0
+
0
+

~
~
~
~

U

77

~

Arrested

TUBERCULIN

Apparently
Arrested

Quiescent

Improved

~

Unimproved

Died

No. Per Cent. No. Per Cent. No. Per Cent. No. Per Cent. No. Per Cent. No. Per Cent.
I
1.30
52
67.53 22
28.57 2
2.60 ..

100.00
5

2

5
2

20.00

4

80.00

40.00

2
2

40.00 I
100.00

20.00

1
50.00 1
100.00
20.00 2
----

5000 1

2
2
1
5

.. .. 100

I

----

---

----

1
1

50.00

....

50.00

..

40.00 2
---

40.00

HESULTS

Class
1 uoipient. ..
l ncipient .
Incipient ......
Incitcnl. .......
Mo . Advanced.
Mod. Advanced.
Mod. Advanced.
J'vrod. Advanced.

Mod. Advanced.
Mod. Advanced.
Far Advanced ...
Far Advanced ..
Far Advanced ..
Far Advanced ..
Far Advanced ...
Far Advanced ..
Sub. Total
Unclassified ......
Non Tubercular.
Totals ..

l

1
II
II
I
I
II
II

[II
III
I
T
I[

u
III

111

or- SPUTUM

Total
No.

Treatrnent

77

Without Tuberculin ..

A n D
+ + +

"

762

11
[

777

A H D
+ + 0

A H D
+ 0 0

PATlENTS-1916

A R D
0 + 0

A F\ 0
0 0 0

A H D
0 + +

A R D
+ 0 +

PARD
+000

Per Ct. r« Per Ct. No. Per Ct.
No. Per 0. No. Per CI. No. Per Ct. No. Per Ct. No. Per Ct. No.
1.30
1

2
1

20 With Tuberculin ..

With Tuberculin ....
Without Tuberculin ..
104 Without Tuberculin ..
10 With Tuberculin ..
136 \Vithoul Tuberculin ..
15 With Tuberculin .....
10 Without Tuberculin ..
With Tuberculin ..
Tuberculin ..
;) Without
3 With Tuberculin ..
127 Without Tuberculin ..
With Tuberculin .....
248 Without Tuberculin ..
:l Wit.h Turberculin ...

OF ABOYE

EXAMINATION

3 .8.,

:,
I

8
34 25.
2
2 1:l.:l:l
1
3 30

82
1

2 60
'10

2.88 4
10.
588 17
1:l.:l:l1
I
10.

20

20.

6-1.57 :l

2 36

0_0.

193 77.82 1'1

5.

1
;)

5.64 8

:, .85
12.50 4
6.67
10.
33.3:l
3.93
3.22 2

74
18

96.10
90.

87
8
2.9364
7
2
10.

83.65 2
80.
47. 05 3
16 67 1
1
20.

2
2
27
3
0.80 13
1

40.
6667

.73

2.21

6.67
10.

3

2 se

20.

21.26

7

5 .52

75.
5.27

1/1

:J 6\

33.33

"21

3 85
10.
3.68
13.33
10.

·1
1

.92

1.61
2

66.67

A
Class
Incipient.
Incipient. .
Incipient.
Incipient.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Mod. Advanced.
Far Advanced ..
Far Advanced ..
Far Advanced ..
Far Advanced ..
Far Advanced ..
Far Advanced.
Sub. Total.
Unclassified ....
Non- Tubercular
Totals ..

Tolal
No.
I

.I

[J

[

I
II
I[

III
III
I
I
II
II

III
III

145
[2

207
20
11

Without

H D

+ + +

132 Without Tuberculin ..
3 With Tuberculin .....

11
1

Treatment

Tuberculin ..

With Tuberculin ..
Without Tuberculin ..
With Tuberculin ..
Without Tuberculin ..
With Tuberculin ....
Without Tuberculin ..

A

H

D

+ + 0

I{ D

A

H D

A

+ 0 0

0

+ 0

0 0 0

A

H

0

A

No. Per Ct. No. Per Ct. No. Per Ct. No. Per CI. No. Per Ct. No.
I
0.76
13[ 99.24
3 100.0
1 100.0
16
3
60
9
8

[ 1 .03 6
25.00
28.9917

45.00

3

4. 14 2[

14.·18

3
8.21 17

25.00

15.00

5.00

[

8.21

069
2

0.97

98
6
96
7

67.59

0

H

0 + +

n

0

PAHD

+ 0

+

+000

A

Pa CI. No. Per a. No. Per Ct.

2

1 .:18

8

:3.86

3

27.27

0.69

5000
4638

0.48

6

2.HO

1

7.6\l

5

3 '\5

5

J .61

'3500

72.73

With Tuberculin ..

13 Without
[

Tuberculin

..

145 'Without Tuberculin ..
,I \Vith Tuberculin .....
311 Without Tuberculin.
1 With Tuberculin ..

.1006

2

15.38

23.08

7

5385

I [00.00

99
2
247

68.28

5
1
79.42 13
I 100.00

50.00

NOTE~O

3
2
. .. . lOI 1

3

'With Tuberculin ..

Included

3.45

2
1
1.18 13

25.00

138
25.00
1.18

2

1.38

20 \3.79

3

0.96

18

[0

689

5 79 12

3.86

tubercle bacilli absent.
A on admission.
D on discharge.
in this table 115 children,

Note-s-Where 1916 is used the results are tabulated
Where 1917 is used the results are tabulated

..
2

1. :,8

-l-Lubercle bacilli present.
R during residence.
P previous to admission.
10\ with negative

from Jan. 1, 1916~to
from Oct. 1, 1916~lo

sputum

and 11 with positive sputum .

Del. 1, 1916.
Oct. 1, 1917.