1 :-:'i I 1 I11|1|1'!|!||P d n t/cr ?TY AN L*»t : t NEW YORK J!i!ii|!l!!liliii!!!i™i:i i'..in.:ii:iiinniiiiininunuii- .i:tiiaii:iii. llllih. 111,...-iiiii lull.II If Uli WilUIllllUJ. . '....-i. :»,..iiiiiiiiiiiiaii MtOICINE NLM Q0032TbS b SURGEON GENERAL'S OFFICE LIBRARY. Section STATISTICAL SECTION N). 113, W.I>. S. G.O. No. *?/£?. -(&- £?. o *f A Presented to the Statistical Division, Surgeon-General's Library, United States Army Washington, D. C. The Prudential Insurance Co. of America Newark, New Jertey UNTIL TENEMENT HOMES LIKE THIS ARE WIPED OUT TUBERCULOSIS WILL SPREAD. In these three rooms a family of five contracted the disease. The two inside bed-rooms are indirectly ventilated from an air shaft kitchen. TWO YEARS OF THE HOME HOSPITAL EXPERIMENT METHODS RESULTS AND COMPARATIVE COST OF THE COMBINED HOME AND HOSPITAL TREATMENT OF FAMILIES MADE DEPENDENT BY TUBERCULOSIS 1912-14 NEW YORK ASSOCIATION ' FOR IMPROVING THE CONDITION OF THE POOR. 105 EAST 22ND STREET, NEW YORK Publication No. 84 v. -. 3fO NSl \b\- ''(..::r^ictlr INTRODUCTION The New York Association for Improving the Condition of the Poor has completed two years of the Home Hospital experi- ment. The questions which it set out to answer in the course of this experiment were: i. Is it possible to treat families in which one or more members are afflicted with tuberculosis by keeping the family together, in their own individual home, without danger to other members of the family? 2. Do the results of treating patients in their own homes under satisfactory conditions of living, with adequate medical supervision, compare favorably with results secured by remov- ing the patient from his home and treating him in a sanatorium or other special institution for tuberculosis? 3. In the case of a family in which there is combined tuber- culosis and poverty, which costs more: to treat the family as a unit, as is done in the Home Hospital experiment; or to break up the family, as is done under other methods of treating families with tuberculosis? This report endeavors to state the results of two years of serious effort to answer these questions. As planned, the experi- ment was to extend over a period of three years. While at the end of that time we shall have more complete and more con- clusive proof than is now available, yet we believe the evidence presented in this report points unmistakably to the fact that it is perfectly practicable to treat families in which there is tuber- culosis, as a family unit, without apparent danger of spreading the infection to well members of the family. Indeed, our results thus far indicate that it is the most practical way to prevent other members of the family from contracting tuberculosis. This is accomplished by careful medical and nursing supervision, by proper segregation of the patient from other members of his 3 family and by the correction of any hygienic or physical defects that in any way are detrimental to good health. Just as a super- abundance of fresh air and sunshine, good food and proper sani- tary surroundings are vital to the care of tuberculosis, so are these same fundamentals of hygienic living the essentials for pre- venting the spread and the development of the disease. We believe that the evidence in this report also points con- vincingly to the fact that the results secured during these two years by the treatment of patients in the Home Hospital compare very favorably with the results obtained in the best sanitoria and hospitals. These results are presented in detail in this re- port for the fullest and freest criticism. They have, however, been more satisfactory than it had even been hoped when the in- stitution was first planned. No small factor in securing these results, we believe, is the very important one of the mental effect on the patient. Modern therapeutics is recognizing more and more the importance of the psychological factor in the treatment and cure of certain diseases. This is particularly true of tuber- culosis. Take a man or a woman away from his home and his family—the maintenance of which is the one thing for which he lives—and immediately an unfavorable mental situation is cre- ated. Change this situation by providing for his treatment in his home, with his loved ones near him, and the unfavorable environment is changed to a favorable one—a retarding mental condition is transformed into one making rapidly for his im- provement. The results are what might be expected. The report also includes a full discussion of the relative cost of treating tuberculosis by the Home Hospital method as compared with other ways of treating families in which one or more members have this disease. The experiment has demon- strated that the cost of doing an adequate piece of work in treating combined poverty and tuberculosis by the Home Hospital method is less in each case than adequate treatment of both by any other method. One year remains before the full three-year experiment will have been completed. So convincing are the results, however, at the end of two years that the Association feels its main prot> lem from now on is to secure the continuation and extension of 4 the Home Hospital. It is even now no small institution. It has an average of approximately 130 patients, and of over 200 in- dividuals. Considering the patients alone, it is over one-half as large as either the New York Hospital or the Presbyterian Hos- pital, and is nearly one-half as large as Roosevelt Hospital or St. Luke's Hospital. It has about the same average number of patients as Fordham Hospital. Its average number of patients is greater than that of Trudeau Sanatorium at Saranac Lake, N. Y. It will be seen, therefore, that it is, in spite of its brief history, a considerable hospital. The demand is so great, how- ever, that we are convinced it should be not only made permanent but rapidly extended in size. Every effort will be made to add at least another staircase of twenty families before the completion of the three years. After all, the Home Hospital idea is only that of a decently constructed house with a decent budget available to provide ade- quate nourishment, together with provision for constant medical and nursing supervision of the family. Even less expensive tenements, with provision for the maximum of light and air, can be used for the extension of the Home Hospital idea. With these three items—a decent home, an adequate budget and proper super- vision—families afflicted with the ills flowing from tuberculosis and poverty combined can be rehabilitated. The inescapable con- clusion is, moreover, that with decently constructed homes, with adequate nourishment and with proper instruction and help, the spread of tuberculosis can practically be prevented. The Home Hospital is at once a demonstration of successful treatment of combined tuberculosis and poverty and an illustration of how society must regulate its housing conditions and the wages of its families if it seriously contemplates the prevention of tuber- culosis. One of the greatest difficulties with which the Home Hos- pital experiment has been confronted is a difficulty common to it and to hospitals and sanatoria, that is, the very great difficulty of securing suitable work with adequate remuneration for patients able to work. This difficulty has been aggravated during the past winter because of the large amount of unemployment. Even were this difficulty removed it would still be true that industrial 5 opportunities for the suitable employment of ex-patients are very unsatisfactory. The data in this report shows that treat- ment at the Home Hospital does much to increase the ability of patients for work. In many instances, however, it is unwise for arrested cases to return to the same kind of work they have per- formed and in some cases it is undesirable for them to work full days at hard labor. Add to this the difficulty through frequently not being able to find any kind of employment and it is readily seen how serious this problem is. An imperative next step in the problem of the successful treatment of tuberculosis is a serious consideration of this difficulty. It may be necessary to organize work with these cases particularly in mind. The reader of this report will be impressed, I am sure, that at the Home Hospital we are doing for the health of the family much more than to arrest tuberculosis and prevent its spread. It treats all cases of sickness that occur in these families but more than that it prevents the development of diseases other than tuberculosis through improving the resistance and general health of each member of the family. Furthermore, keeping the family together in wholesome surroundings promotes not only the health conditions of the family but also its moral and social value. The supervision is more than medical—it is moral also. Any measure of the value of the Home Hospital treatment must recognize these essential factors. This report would not be complete did it not recognize Mr. John A. Kingsbury who conceived the idea of the Home Hos- pital and actually organized it. and to the first Chairman of the Home Hospital Committee, Dr. Linsly R. Williams, whose medi- cal advice and help ensured a stable foundation. These men, the former now Commissioner of Public Charities in New York City, the latter the Deputy State Commissioner of Public Health, although in larger fields of public usefulness are still directly interested in the work of the Home Hospital. To the painstaking interest of its administrative and medical staff the success of the experiment is also in no small measure due. Bailey B. Burritt, General Director. 6 THE PROBLEM When a disease in a single city shows an annual death roll of eighty-five hundred human lives,* seizes yearly upon more than twenty-two thousand new victims and has constantly more than fifty thousand unfortunates marked for death, it creates an imperative problem. When that disease is involved with poverty in the family and consequent economic and social deterioration, the problem becomes exceedingly complex, difficult and baffling. In our congested tenement districts this problem is most pressing for it is there that the disease—tuberculosis—and pov- erty, combined and singly, are found most frequently. According to conservative estimates there are over 30,000 cases of tuber- culosis in the tenements of New York City. When people, huddled together, mingle freely with germ-spreading tuberculous men, women and children, who are either ignorant of their con- dition or careless; and when these well people at the same time are subject to the same inimical influence of tenement housing and living conditions that were responsible for the disease in their own or their neighbor's family, it is not surprising that the tenements are great breeding places of tuberculosis and the poverty that results therefrom. In dark, dirty, unventilated, overcrowded rooms lives many a family, of which one or both parents have consumption. Fre- quently several of the children also are tuberculous and all are inevitably predisposed to the disease. Not infrequently the con- sumptive mother is nursing an ill-fated babe. In the germ- charged atmosphere, incipient tuberculosis is developing, un- recognized and unchecked. The infected, absolutely unsegregated *The Department of Health of the City of New York reports 8,6oi deaths from pulmonary tuberculosis during the year 1913; that 22,671 new cases were registered that year and that 31,212 cases of tuberculosis were carried over from the preceding year. 7 in this close-knit family life, and opposed to separation from their loved ones, constitute a deadly menace to their family and neighbors. Other physical ailments abound. The home itself is in disorder, the family in partial or utter dependency. Formerly self-respecting and independent, they have now lost the hope and often the capacity for self-support. Standards of living and of morals have either deteriorated or utterly vanished. This description is literally true of hundreds of families among the tenement poor. To relieve these conditions various agencies are at work. Among these, and attaining a valuable measure of success, are the dispensary with its clinic and visiting nurses, who in most in- stances co-operate with relief agencies; the preventorium for the treatment of children over four years of age and predisposed to tuberculosis; the sanatorium for the cure of incipient patients; and the hospital for the segregation and care of advanced cases. These agencies, excepting in part the dispensary, treat the patient apart from his home, are concerned with the individual rather than with the family as a unit, and deal almost entirely with the physical rather than with the social and economic needs. But tuberculosis is not merely a human disease. It is a social disorder, and the real problem is not alone the patient, but the family and the conditions under which they live. For con- sumption is a house disease and the logical way to combat it is to attack the fundamental, predisposing cause, namely, the home and working conditions. As these were basic in causing the disease, so their correction is vital to the permanent cure of the patient and to the future welfare of his family. To treat the social ills, therefore, is quite as important as to cure the disease, for without social rehabilitation the disease is most liable to recur in the patient and to continue in his family. Based upon such convictions as these the Home Hospital experiment was established by the Association on March 18, 1912, for the combined treatment of tuberculosis and poverty among the tenement poor of New York City. More specifically, the object sought is to demonstrate by a three-year experiment that if sanitary housing with ample sunshine and fresh air, adequate relief, including good and abundant nourishment, free- 8 TAKING THE REST CURE PATIENTS SPEND DAYS AND EVENINGS ON THE ROOF OF THE HOME HOSPITAL. X-LJ-1J LHt rs NOT EVEN WINTER WEATHER KEEPS THEM INDOORS. dom from undue work and worry, reasonable segregation, skilful medical care and constant nursing supervision be provided, it is possible: i. To prevent the spread of tuberculosis from the sick to the well members of the family and particularly to protect the children from infection; 2. To cure many who are in the early stages of the disease; 3. To secure improved health and larger earning capacity to patients whose cases are moderately advanced; and 4. To complete, at least in instances, the rehabilitation of the family, physically, economically and socially. In this there is no intent or desire to supplant, or to provide a substitute for these other much-needed agencies, but rather to supplement their noble work, in a field that is still far too large for any and all adequately to compass, by proving the feasibility of effective treatment for "hundreds now on waiting lists and for thousands now spreading contagion in dark, dirty tenements." 9 THE EXPERIMENT The Home Hospital, ideally located at 78th Street and John Jay Park, occupies two entire sections of the East River Homes. One section was opened March 18, 1912, when the experiment was established, the second one was leased last year and was occupied on November 24. Two open staircases lead to the forty- eight apartments, consisting of from two to four rooms each, including one or more bed-chambers with open-air sleeping bal- conies. From a sanitary standpoint these apartments far excel the most exclusive apartments in New York City. No expense has been spared to provide a maximum amount of sunlight and ventilation for each room. Even the windows, extending from ceiling to floor, are arranged in three sashes, so that when open two-thirds of the space is unobstructed. On the roof is a spacious solarium, with hedges of privet and geraniums. A part of this solarium is reserved for the patients. Here in reclining chairs they take the cure. Another part of the roof is a children's play- ground, where there is no premium on fresh air and sunshine. There they play and make merry, remote from the danger of infection. Still another part of the roof is occupied by a fresh- air school. Four of the apartments are used for administrative pur- poses. Two comprise the office and clinic. A third apartment on the top floor has been equipped as a general kitchen and dining- room. The diet kitchen is also used for a class-room, where cooking lessons are given to mothers and the relative values of foodstuffs explained. In selecting families to participate in this experiment, prefer- ence has been given: 1st, to families in which both poverty and tuberculosis are more or less incipient; 2nd, to families believed to possess sufficient intelligence to co-operate in the experiment; 3rd, to families in which dependency is due to tuberculosis of the 10 wage-earner; and 4th, to families in which tuberculosis of the mother renders it inadvisable to keep the home together under ordinary circumstances; in general, to poor families of any nationality and religion made or kept dependent by tuberculosis and in which there is a reasonable hope of restoring the patient to health and at least partial earning capacity. It is to be noted that treatment is provided in this way for children too young to be admitted to preventoria, for patients unwilling or unable to leave their families, and especially for the largest and, because of its irresponsibility, most dangerous class of sufferers, namely, the more or less chronic second stage, but able-to-be-about cases, almost entirely unprovided for by other institutions. The selection of families is made in the following manner: A relief visitor of the Association visits and carefully investigates the home conditions, and if she decides that the family is suitable, all members report to the Home Hospital Clinic for examination. If the case is one which gives fair promise of being cured in a reasonable length of time, or even of such improvement as to restore partial earning capacity of the patient, the family is admitted. It will be readily seen by examining the cases in the appendix that the selection of patients has not been confined to favorable early-stage cases. Before a family is admitted its members understand definitely just what will be expected of them, and what they in turn may expect from the Association. All able-bodied members, for example, must work and account to the hospital for the expendi- ture of their incomes. Intemperance is not tolerated. All in- struction and advice must be faithfully followed, and supervision of the home by the resident staff and attending physicians must be permitted. On the other hand, the Association supplies or supplements in each family everything that is necessary for the maintenance of the normal standard of living and for the medical treatment of the patients. 11 SUPERVISION AND INSTRUCTION As its name implies, one of the purposes of the Hospital is to preserve the home. Therefore, so far as possible, each family is permitted and helped to live a normal home life. Every- thing, however, that relates to the welfare of the patient and the family is closely supervised by the hospital staff. Many of the families before coming to the hospital lived in dark and squalid tenements, strangers to comforts, conveniences and in some cases even the decencies of life. Having been accustomed to sleep in inside bedrooms, to bathe in water carried in small quantities with difficulty from three flights below, perchance to share a common drinking cup, they come with little and in some instances no knowledge of sanitation, personal hygiene and the precautions necessary to prevent the spread of tuberculosis. Painstaking, patient instruction becomes, therefore, a first neces- sity before these families are prepared for healthful living at the Home Hospital. To each family on admission is given careful and oft-repeated instruction in precautions necessary to prevent the spread of consumption to the well members. Individual toilet articles are given to each member of the family and all necessary furniture, clothing and household supplies are provided. Countless minor details in respect to prophylaxis and sanitation of the home are carefully explained, and particular emphasis is laid on the value of fresh air and personal hygiene as preventives not only of tuberculosis but also of other diseases. To care for the patients and to supervise and educate both the sick and the well members of the families, the Association has a staff of fourteen persons at the hospital. This consists of a superintendent, a medical director, an attending physician, two nurses, a nurses' helper, a mothers' helper, two clerks, a cook and four cleaners. The medical director acts in an advisory 12 capacity and is the only unsalaried member of the staff. The services rendered by the attending physician are described else- where in this report. The two clerks keep the social and economic records of the families and do the other necessary clerical work. The mothers' helper bathes the children in the families in which the mothers are the patients or are temporarily incapacitated for some other reason. She also makes them ready for school and does other light household work. The four cleaners do the washing and other heavy household work in the homes where the mothers are patients. The cook devotes her entire time to the diet kitchen. Although the family unit is preserved, the patient is so closely supervised as practically to prevent infecting the well members of the household. Each adult patient has a separate room and his individual dishes are sterilized. There is strict insistence upon such precautions as refraining from kissing and protecting the mouth when coughing. Special classes are held weekly at which the mothers and older girls receive instruction in food values, the preparation of food, and in sewing. These classes are much needed as many of the women have absolutely no knowledge of the value of proper preparation of food stuffs. Sewing and mending are also almost unknown to them. Some have never even sewed a button on their clothing. Naturally, such mothers as these are quite proud when for the first time they have cooked an appetizing dish or made a pair of rompers for baby. The nursing staff visits each family daily. While chatting with the patient or some member of the family the nurse has an opportunity to observe wherein a particular family has failed to follow instructions and to call attention to the omissions. Some- times only a suggestion is needed. At other times it is necessary to speak plainly and forcibly. One of the families last year seemed to be most anxious to do everything that the nurses re- quired. Casual inspections of the windows of the apartment in which they were living always showed the two bedroom windows open, but the nurse on visiting the home invariably found the whole family sitting in the kitchen with every door and window closed. Remonstrance always brought the reply, "but the bed- 13 room windows are open!" It was days before that family learned the kitchen windows must also be open, and that the tuber- culous father must not use his own fork or spoon to serve the children at meal time. Windows are carefully inspected every night during the winter months. If any is found closed the apartment is visited and the famiy is instructed to open it. As a rule, however, it is not difficult to teach the people to live in the open air. Rarely do the families object to the supervision to which they are sujected. Indeed, they usually welcome visits to their homes and when once they have learned just what is expected of them at least most of them try to fulfill the Home Hospital re- quirements. r4 METHODS OF TREATMENT The medical regime adopted is that of the best sanatoria and hospitals. All positive and suspected cases are examined every six weeks, healthy children every three months, and healthy adults every six months. The results of each exami- nation are recorded on a separate chart. After each exami- nation the patient is advised as to his condition, and is given instructions accordingly. If the patient has active sym- toms, with cough, sputum, elevation of pulse and temperature, etc., he is ordered to remain in bed. He sleeps out of doors on the balcony, is carefully fed, and isolated as far as possible from the well members of the family. The children are not allowed in the patient's bed-chamber or in close contact with him. The family is encouraged to spend the day on the roof, and to return to the apartments only to eat and sleep. With improvement, the patient spends the day on the roof, reclining in a steamer chair. Extra nourishment is given him at 10 A. M., at 3 P. M., and just before retiring. Arrested cases are at first allowed to do light work for a few hours each day, care being taken that the temperature, pulse, weight, and physical signs and symptoms remain satisfactory. A daily morning and afternoon temperature and pulse record is kept of all positive and suspected cases. Each week sputum examinations are made and weights are recorded. Each patient is provided with a notebook, in which answers to the following questions are entered daily: How many hours sleep ? How many sections window open at night? Head or feet to open window? Amount cough, sweat, or expectoration (during both day and night? Hour of arising? Morning tub ? 15 Cold water to chest? Breakfast menu? Morning temperature? Hour started for roof? Dinner menu? Hour returning from the roof? Nourishment at 10 A. M. Temperature at 3 P. M.? Supper menu? Nourishment at 9 P. M. ? Hour of retiring? Amount exercise or work during day ? Amount of sleep during day? Chills, day or night? Total hours spent in the open during day? Total amount of milk and eggs during day? Condition of bowels? Gain or loss in weight each weighing day? Amount of earnings, if any? General remarks? The records, besides being exteremely interesting, keep al- ways before the patient the essentials of the cure, and there has gradually developed a friendly rivalry among the patients, for each desires to excel in improvement. The hygienic-dietetic form of treatment has been followed. No special drugs have been employed. Tuberculin was administered in suitable cases during the second year of the experiment. The attending physician visits and holds clinics at the hospital on Monday, Wednesday, Friday, and Saturday of each week. One evening each month he meets all the patients in class conference. These gatherings are informal, the patients being encouraged to discuss their condition and ask questions. The first meetings are devoted chiefly to talks on etiology, prophy- laxis, and treatment of tuberculosis. Great stress is laid on how to prevent infecting others. The salient features of the treat- ment, viz., plenty of fresh air, sunshine, good food, rest and free- dom from worry, and hearty co-operation with their medical advisers are strongly emphasized. It is astonishing how readily the patients grasp these cardinal points. At each meeting, patients who have not gained are chosen as typical for discussion. After reviewing the daily program of these persons the class 16 REST PERIOD AT THE OPEN AIR SCHOOL ON THE ROOF OF THE HOME HOSPITAL. "THE PALE AND PUNY, WITH SUNKEN EYES AND FORLORN EXPRES- SIONS, HAVE CHANGED TO WHOLESOME, BRIGHT-EYED, HAPPY BOYS AND GIRLS." promptly explains why the patient in question has not gained. These informal talks are of great educational value, and the dis- semination of the principles of correct living among neighbor- hood families is already evidenced by the frequent visits to the clinic of these mothers living near by. The patients or members of their families have told them how they should live "to be healthy," and they come for further guidance. At the same time that the patients are being treated for tuberculosis, the other members of the family are treated for any physical defects they may have. They are also taught how to live properly and how to preserve their health. To the mothers instruction is given regularly in cooking, sewing, nursing, care and feeding of infants, personal cleanliness, hygiene and sanita- tion. The children attend regularly a fresh air school on the roof. The schedue of this is similar to that in the best open air schools. The session begins at 9 A. M. At 10 A. M. hot milk, broth or gruel is served. At 12 o'clock the children eat a hot lunch and then have a recess until 1 P. M. Following this is a forty-five minute rest period during which they recline on cots in the open air. Before dismissal at 3 o'clock extra nourishment is again provided. As the patients improve, they are encouraged to work on tasks proportioned to their increasing strength, and are thus prepared for a return to normal activity and to complete resump- tion of family responsibility. When the family is about to be discharged, the securing of employment and a sanitary home complete the care provided. The advantages claimed for this method are: (1) the direct- ness of its attack upon the home conditions as a crucial, under- lying cause of tuberculosis and its consequent poverty, (2) the readiness with which unsuspected, incipient cases may be detected and checked, (3) the exceptional opportunity it affords for ade- quate control of the disease and family, (4) its avoidance of the opposition, deterent influence, worry and other hardships in- evitably occasioned by the separation of the sick from the well members of the family, (5) its preservation of the integrity of the home, (6) its care of classes of patients who either could not or would not go to institutions, (7) its fostering an increase of 17 earning capacity in the wage-earner and a gradual return to normal conditions, (8) its provision against a return of either the patient or family to the inimical environment where the dis- ease was contracted and is likely to recur, and (9) in its care not only for the physical but for the economic and social ills not merely of the patient but of the entire family. Such a work aims at causes, seeks not only the cure of the individual but the protection of society, is concerned with the patient, his family and evironment and deals with fundamental questions of ideals, of livelihood and of life. 18 MEDICAL RESULTS The results obtained during the first year of the Home Hospital experiment were highly presumptive evidence of the medical practicability of treating combined poverty and tuber- culosis in the home. The study of this most important sociologi- cal problem was undertaken with twenty-seven families, con- taining fifty-four patients and twenty-five suspects. Such marked success attended the work with this small group that on Novem- ber 24, 1913, eighteen months after the establishment of the hospital, twenty-four apartments were added, thus doubling the capacity of the institution. Accordingly, during the past year we have been able to care for fifty-three families, containing 120 patients and sixty-four suspects. Of these families, seventeen were under care at the close of the first year of the experiment. During the first year eleven families were discharged, six having been rehabilitated physically, socially and economically. The other five were dismissed for intemperance or refusal to co-operate. During the past year fourteen families were dis- charged, eleven having been restored to health and earning capacity. Three refused to follow advice and were dismissed. The permanency of the cures since these families left the hos- pital has been equally as satisfactory as was the progress of the patients while under treatment. Only one of the nine positive cases and two suspects in the six families discharged as rehabili- tated during the first year has relapsed. This relapse was due to overwork rather than to a disreard of hygienic precautions, the patient being one of the chronic relapsing types. This is his third relapse, the former two following sanitarium treatment. All other members of his family have gained steadily since discharge. Of the twenty-seven positive and eight suspect cases in the eleven rehabilitated families discharged during the second year, only one patient, an adolescent, has relapsed. The recurrence of the 19 disease in this patient resulted from poor food and late hours. She promptly gained after readmission and is now almost ready for discharge. Thus of a total of thirty-six positive patients and ten suspects discharged during the two years of the experi- ment, only two cases have relapsed. It is most gratifying to visit the homes of these discharged families and to find sanitary and prophylactic measures observed. The children continue to gain in health and strength and the mothers frequently express their gratitude for all the good and happiness the Home Hospital has brought them. In no instance has a well member of a family developed symptoms of tuberculosis, either while at the Home Hospital or since discharge. This is convincing proof that, although the adult patient remains at home, there is little danger of infect- ing others if prophylactic measures are maintained. It also in- dicates that the degree of tuberculosis in any community, like the incidence of typhoid fever, is a fair index of that com- munity's hygienic status. Teach people to live properly and tuberculosis will rapidly wane. Classification and Progress of Patients The following table shows the physical condition of the 315 individuals comprising the sixty-two families under care during the past two years: Physical Condition of Persons in Hospitals Pati Positive ENTS Suspects Non-Patients Totals 72 4 44 16 4 54 13 36 8 43 21 112 12 141 50 136 71 108 315* *N. B.—Readmissions do not appear in these figures. Eight indi- viduals comprise the families of the two readmitted patients. 20 Positive cases Adults .................................. 2 Non-Patients Adults.................................. I Children ................................ 4 Suspects Children ................................ 1 8 Total patients under care........................ 207 Average number of individuals in family........ 6 Average number of patients in family............ 3.98 The complete report of each adult and child patient and sus- pect will be found in the appendix.* The Adult Patients Inasmuch as some of our adult patients are of a somewhat different type from those treated at sanatoria, it has seemed wise to classify them under the following groups: Group A: Cases with definite physical signs of pulmonary tuberculosis and with tubercle bacilli in their sputa. Group B: Cases with definite physical signs of pulmonary tubercuosis, but without tubercle bacilli in their sputa. Group C: Inactive cases with evidence of slight healed lesions. Group D: Cases which have been in the hospital insufficient time to have their disease arrested. GROUP A (Definite physical signs of pulmonary tuberculosis with positive sputa) Condition on Admission! First stage active.... First stage arrested.. Second stage active.. Second stage arrested Third stage active... Third stage arrested. Totals 1 1 14 2 3 I Present Condition Apparent- Ar- Im- Not Im- ly cured rested proved proved 0 1 0 0 0 0 1 0 4 8 1 1 1 0 0 1 0 0 2 1 died 0 0 1 0 5 9 5 3 *See page 57. ..... tThe terms first, second and third stages, correspond respectively with those of incipient, moderately advanced and far advanced cases of the nomenclature of the National Association for the Study and Prevention of Tuberculosis. 21 In the above table the one first stage active case was consid- ered a suspect (adolescent) in the first year's report. She soon developed a rapidly advancing tuberculosis. After several months of treatment her disease became arrested. Her weight is now twelve and three-quarter pounds above that on admission. The one first stage arrested case upon admission and tabu- lated as improved has-been at the hospital only 138 days and is doing well. Of the fourteen second stage active cases the one tabulated "not improved" was discharged as "arrested" in May, 1913. Dis- regarding advice, he overworked and relapsed, being readmitted in November, 1913. He is of the chronic relapsing type, having twice previously relapsed following sanatorium treatment.* Of the eight cases whose disease became arrested under the Home Hospital treatment, two were discharged for failure to follow advice and direction. Excluding these two dismissed cases, we have twelve second stage active cases of whom four, or 33 1/3%, have become ap- parently cured, while six, or 50%, have had their disease ar- rested. One who has been at the hospital 114 days is rapidly improving. Only one, who failed to follow advice after dis- charge, has not improved. Of the two second stage arrested cases upon admission, one was dismissed for inebriety. The remaining one has become apparently cured. Of the three third stage active cases, one died. Of the remaining two, one, who was admitted in a most critical condition, showed marked improvement, having gained eleven pounds in 288 days. Her disease was almost arrested when she had to be dismissed because of her husband's inebriety. The third case, a far advanced one, has gained eleven and a quarter pounds with marked constitutional improvement. Her condition was most unpromising upon admission. The one third stage arrested case has been at the hospital only 114 days and has gained one and a quarter pounds. The average gain in weight for each patient in Group A has been nine pounds during an average residence of 357 days. ♦See F. S. in Appendix, Group A, Page 62. 22 Seven of these patients are men who have returned to full- time work. GROUP B (Definite signs of pulmonary tuberculosis with negative sputa) Present Condition Condition on Admission Apparent-ly cured Ar-rested Im-proved Not Im-proved First stage arrested___ Second stage active.... Second stage arrested.. n 2 12 3 6 2 7 I 5 0 2 0 0 0 2 I 0 0 I i Totals .............. 28 16 7 3 2 Of the eleven first stage active cases six, or 54.5%, have become apparenty cured and five, or 45.5% have had their disease arrested. These five cases whose disease has been arrested have been at the hospital an average of only 135 days and yet have made an average gain in this short period of 9.2 pounds. One patient, about four weeks pregnant upon admission, was rapidly losing weight and raising blood-streaked sputum. During 115 days she has gained 11 and three-quarter pounds and has scarcely any cough or sputum. The two first stage arrested cases have both become appar- ently cured (100%). Of the twelve second stage active cases, the one tabulated "unimproved" was dismissed for failure to follow advice. Thus of eleven second stage active cases, seven, or 63.6% have become apparent cures. Of the two who have had their disease arrested, one has been at the hospital only 113 days and has gained three and one-quarter pounds; the other has gained ten and one-half pounds in 203 days. Of the two tabulated as "improved," one has gained five and one-half pounds in 252 days, the other three and three-quarter pounds in 114 days. Of the three second stage arrested cases, the one tabulated as "unimproved" was dismissed for habitual inebriety. Thus of two cases who followed advice, one has become apparently cured, and the other has gained seven and one-half pounds in 114 days. The average gain in weight for each patient in Group B. has been 10.54 pounds during an average residence of 310 days. 23 GROUP C (Inactive cases—signs of slight healed lesions) Present Condition Condition on Admission Apparent-ly cured Ar-rested Im-proved Not Im-proved Healed apical lesion---1 10 i 10 i 0 0 0 0 0 0 n 0 0 0 This group is a particularly interesting one. Prior to admission at least six of these patients became infected through the other adult member of the family. It is just this type of patient, with but slight healed lesions, who rapidly becomes an open case through environmental hardship. Up to the present time there has been no means of caring for such patients. In this respect the Home Hospital fills a unique and long felt want. Two of the patients in this group have been dismissed for failure to follow advice. One died of an acute illness several months after discharge. All the rest are working full time and remain in good condition. The average residence at the hospital of each patient has been 319 days and the average gain in weight 3.91 pounds. GROUP D (Under care but a few months—four have positive sputa) Condition on Admission First stage active--- First stage arrested... Second stage active... Second stage arrested. Totals 15 Present Condition Improved 14 Not Improved The one case tabulated "not improved" remained at the hos- pital only eight days and was dismissed for failure to follow advice. Two others have just been admitted (one and two days residence) and will be disregarded in this summary. The remain- ing twelve have made an average gain of 5.27 pounds during an average residence of 50.9 days. One patient (first stage active) six months pregnant upon admission, was losing weight, due to 24 her advancing tuberculosis and complicating pregnancy. In ninety days she has gained twenty-two pounds, rarely coughs and her disease has become arrested. The generous gains in weight of all these patients is convinc- ing testimony of the efficicacy of the Home Hospital method of treatment. Suspects Four adults comprise this group. One case is no longer under care, having been dismissed for failure to follow instruc- tions. The remaining three have been at the hospital only a short time and already show improvement. Their chest condi- tions remain satisfactory, showing no evidence of activity. These are probably very early cases of tuberculosis. If unrescued from their tenement environment they might fall an easy prey to the disease. A composite of groups A and B would give the following: Condition on Admission First stage active.... First stage arrested... Second stage active... Second stage arrested. Third stage active.... Third stage arrested.. Totals 12 3 26 5 3 1 Present Condition Apparent- ly cured 2 11 2 0 0 Ar- rested 6 0 10 0 0 0 Im- proved Not Im- proved 0 0 2 2 (died) 0 50 16 Of the five cases tabulated "not improved," one died and one (F. S.) relapsed because of failure to follow advice after dis- charge. The remaining three were dismissed, two for inebriety and one for failure to follow instructions. Thus of the forty- five remaining patients, twenty-two of whom had positive sputa, twenty-one, or 46.6%, have become apparently cured, sixteen or 35.5%, have had their disease arrested and eight, or 17.7%, have become much improved. It is to be noted that several cases in these groups have been under care a comparatively short time due to the enlargement of the hospital. Not a single patient who has followed advice has failed to improve. In no instance has a well member of a family developed 25 symptoms of tuberculosis while a resident at the Home Hospital. This is highly presumptive evidence that with proper supervision of patients under hygienic surroundings, there is little danger of infecting others. The Children The greatest good obtained is not the mere restoration of the adult member of the family to health and earning capacity. He has the disease and perchance may some day succumb to it, for it is well recognized that tuberculosis is a chronic relapsing disease. It is the children who are of vital importance. These frail, under-developed little ones, living in dark and squalid tene- ments, fall ready prey to infection. Our statistics prove that many of them contract the disease in infancy and early childhood. It would seem that the fundamental causes of the wide-spread prevalence of the disease among tenement children unquestionably are parental ignorance of hygiene and close contact with the infected members of the family. If we can give these children a good start in life, teach the mothers the proper hygiene of the home, and train the patient so to live as not to infect his children or other members of society, then we shall have struck a telling blow in preventing the spread of a plague which in the United States alone claims annually a death roll of about 200,000 indi- viduals and costs the country a greater sum than the Civil War debt. To-day's anaemic child of the tenement is the coughing, germ-spreading adult of to-morrow. Left unrescued in their inimical environment, many never reach maturity. The children have, therefore, claimed our special attention. Upon admission over 75% were underdeveloped, pale misfits—excellent candi- dates for the so-called latent or pre-tubercular class. During their residence at the hospital they are practically isolated from the infected adults and are given every hygienic advantage. They are well fed, receiving extra nourishment twice daily. They spend the entire day in the fresh air, and at night sleep in rooms with the windows wide open. The children of school age attend an open air school on an adjoining roof. Realizing the great difficulty of diagnosing tuberculosis in children, and also the difference of opinions of pediatricians as 26 to what syndrome constitutes active pulmonary tuberculosis, we have adopted the expedient of classifying our suspected children under two groups: Group A: Those under 12 years of age who present the following symptoms: 1. Under weight for age. 2. Constant or frequent cough. 3. Occasional or constant temperature of undiscov- erable origin. 4. Rales (near one or both nipples) (constant or inconstant), interscapular dulness. 5. Positive Von Pirquet reaction (under 4 years). Group B: Those who are delicate and present some of the above symptoms and physical signs. For purpose of description, we shall term those in Group A cases of probably active tuberculosis (pulmonary or bronchial glands), and classify them as patients. Those in Group B will be termed suspects. According to this classification we find sixty patients and sixty-seven suspects among the 189 infant-children under care. In other words 31.7% of the children of tubercular parentage already have thoracic tuberculosis, and another 34.4% are excel- lent candidates for the disease. It is probable that a similar appaling percentage holds true in thousands of tenement children. Most of the children presented pathological conditions* such as enlarged tonsils, adenoids, enlarged glands, dental caries, dis- charging ears, etc., which contributed to their poor physical con- dition. The treatment of enlarged tonsils and adenoids has proven most interesting. Many of the children are mouth breathers, have poorly developed chests and give a history of repeated colds, sore throats, nasal discharge, inflammation of the middle ear, etc. We believe this obstruction to the upper air passages is a vital predisposing cause of tubercular infection. Followng the removal of the diseased tonsils and obstructing adenoid tissue, these children show remarkable improvement within a few months. They breathe naturally, their chests en- large, they cease having colds and ear troubles, and gain in weight. One child recently operated upon gained seven pounds *See page 111. 27 in ten days following the operation. Even the parents them- seleves, have noticed the marked improvement in the children and several have come to the office to ask when their children may have their tonsils and adenoids removed. During the last two years ninety-two tonsillectomies and ninety-five adenoidectomies have been successfully performed at the hospital without a single complication. Dental hygiene is likewise a most important consideration. There have been 595 visits to dental clinics. This work at dis- pensaries has been highly unsatisfactory and during the ensuing year we plan to have an attending dentist who will be responsible for the oral hygiene of the patients. Gains in Weight The results obtained with the children have been so gratify- ing that we believe the experiment would be well worth while even had the adult cases shown no improvement. A study of the weight charts of the positive and suspect children is most interesting. When admitted most of the children are under weight and underdeveloped. At the end of six months of treatment at the Home Hospital their gain in weight, accord- ing to their respective ages, not only equals that of a normal healthy child but in most cases is considerably in excess as shown in the following chart: 100 35 90 55 80 73 S70 ID60 °55 ^50 45 40 35 30 25 ao t 2 3 4 45 6YETR- ^ ■>" t. 15 L_ 28 The next chart is a comparative study of the gain in weight according to age of healthy normal chidren and of those at the Home Hospital for a period of six months. The white columns represent the average gain in weight for a normal healthy child, and the black columns those of the patient and suspect children under our care. It will be noted that the underdeveloped children have made a gain not only comparable to but considerably in excess of that of healthy children so that at the end of six months many have reached a weight normal for their age. Comparative Weight Chart* White columns represent the average gain in weight in six months of a healthy normal child, ages three to fourteen (Holt). Black columns represent the gains of the children at the Home Hospital. *The chart (black columns) is based on the following number of children according to respective ages: Ages 3 to 4 years 4 to 5 5 to 6 6 to 7 7 to 8 8 to g No. Children ii 13 n n 13 9 Ages 9 to io years io to II n to 12 12 to 13 13 to 14 No. Children 10 7 6 5 5 29 These generous gains in weight are but a mild index of the marked general improvement in the childrens appearance. The pale, puny types with sunken eyes and forlorn expressions soon after admission to the hospital change to wholesome, bright- eyed happy boys and girls. Cases Illustrating Effects of Treatment Marie W., a patient ten years of age, was a pale, underde- veloped, sickly mouth-breathing child. She had enlarged glands, large tonsils and adenoids, constant cough, temperature, signs in chest, and a strongly positive Von Pirquet reaction. After two months of preventorium treatment just prior to admission, she was still in wretched condition. The child attended the open air school, had adenoids and tonsils removed, received extra nourishment and much dental attention and was provided with glasses. During 228 days' treatment she has gained thirteen pounds and is a plump, rosy-cheeked, wholesome child; breathes with mouth closed, has no cough or temperature, lungs are clear and glands small. Marie's sister, Katherine, 9 years, and her brother, John, 2*/2 years, both patients, when admitted, were likewise in very poor general condition, although Katherine had just returned from two months of preventorium treatment. Under the Home Hospital regime they have gained respectively eleven and five- eighths and seven and one-quarter pounds and are now the pic- ture of health. Alice B., a patient, eleven years of age, on admission was underdeveloped, frail and very anaemic, with deep circles under eyes, enlarged glands, large tonsils and adenoids, dental caries, and signs in chest. She also had a constant cough, a temperature (100.20) and positive Von Pirquet reaction. Alice attended the open air school, received a tonic, extra nourishment and much dental attention, and had adenoids and tonsils removed. Although at the Home Hospital only 138 days her appearance has improved wonderfully. She has excellent color, good nasal breathing, only a slight cough and occasional temperature and has gained six and three-quarter pounds. Treatment of Infants Of forty-eight infants under care, sixteen, or 33 1/3%, are considered patients and thirteen, or 27%, suspects. It is interest- ing to note that these percentages correspond closely with those 30 of the children patients and suspects. These high percentages of patient and suspect infants are conclusive evidence of how early in life these children become infected with tuberculosis. As an illustration, two infants, each four months old, gave strongly positive Von Pirquet reaction in twenty-four hours. The improvement of the infants quite rivaled that of the children. The babies are placed in cribs on the roof, where dur- ing the summer there is aways a cool breeze. Careful formula feeding, good nursing, "patience and hope" have had their reward. Each week has brought results. The average gain in weight for the infant patients has been 3.78 pounds in 180 days, average residence and the suspect infants have gained an average of 3.4 pounds in a similar time. One marasmic infant, Kathleen C, weighed six pounds and fifteen ounces at nine months. Her normal weight at this age should have been 17.5 pounds. This baby had been at a good city hospital and the mother was told it could not live. Shortly after admission to the Home Hospital the infant gained one pound and seven ounces in one week and has continued to gain at the rate of nine and three-quarter ounces a week. The excellent results obtained with the infants and children indicate, we believe, the real value of the experiment. These children of to-day are but the adults of to-morrow. Left un- rescued in their tenement environment, many would have suc- cumbed to the disease or would have reached maturity as weak- lings, their health undermined with tuberculosis and a menace and burden to society as their parents now are. Two "Control" Experiments In order that the results of the experiment may have greater weight and be truly comparable with other forms of treatment, two "controls" have been in progress. One of these experimental groups consists of twenty tenement families under good dispen- say supervision. The patients regularly visit the dispensary, are examined, treated, medicated, and given advice, and their homes visited by the district nurse. The second "control" group con- sists of a like number of families, the patients in which have been sent to sanatoria or hospitals. The remaining members are cared 31 for at home, visiting the clinics from time to time for examina- tion. These families, containing 212 individuals, have been sys- tematically visited and examined during the past two years by the Home Hospital staff. Three patients of these two groups have died and three more are rapidly progressive. Some of the children are in poor condition. Present indications are that at the end of another year a comparative study of these groups with the Home Hospital families will demonstrate the great advantages of the Home Hospital method of treatment! Medical Results of Two Years A summary of the medical results during the first two years of the experiment shows that seventeen families have been re- habilitated physically, and that eight others have been dismissed either for frequent intoxication or persistent refusal to follow advice and direction. The results obtained with the adult cases compare very favorably with those of the leading sanatoria, 46.6% having been apparently cured, 35.5% having had their disease arrested and 17.7% having been much improved. Every patient who has followed advice with the exception of one, a far advanced case who died 198 days after admission, has improved. To complete the success not one well member of any family has shown symptoms of the disease. 32 FROM WHINES TO SMILES IN TWELVE WEEKS Kathleen's parents and sisters, all tuberculous. As "Chubby" looked when admitted to the Hospital. Weight 7 pounds, 1(1 pounds under normal. 'Chubby" twelve weeks later. Weight 14 pounds, an average gain of nearly 10 ounces a week. FAMILY EARNING POWER INCREASED To treat tuberculosis and to prevent the spread of infection in the family is only a part of the Home Hospital plan. Every family which has entered the hospital during the last two years was forced into poverty by the disease, some being partially dependent, others wholly destitute. To treat the social ills, there- fore, has been quite as important as to cure the disease, for with- out rehabilitation the family would continue to live an abnormal life, economically and socially, and consequently the disease would be more liable to recur. The Home Hospital seeks to round out the family life by raising the social standards of every member and developing the earning powers of those who are physically fit and old enough to work. In addition to being a hospital it is a school. While the patient is treated for tuberculosis, both he and the other members of the family are taught to live decently and to develop their earning powers, so that by the time the disease is cured the family is equipped to resume its normal place in society. If the family were broken up and temporarily cared for in institutions, or if the patient were sent to a hospital or sanatorium and the well members remained at home, the period of social and economic rehabilitation would have to be postponed, if it occurred at all, until either the home had been re-established or all mem- bers were reunited. Each of the eleven families discharged as rehabilitated last year had when it entered the hospital an average income of $6.34 a week. Five were absolutely destitute and another, earn- ing $18.00 a week, whose occupation was very detrimental to the health of the wage-earner, at the request of the Home Hospital staff, sought and secured more suitable but less remunerative employment. Another family whose income on admission was 33 $10.25 a week had its earnings cut off entirely after a few weeks residence at the hospital, as the husband, who was a patient, was put on the rest cure and not permitted to work. The hus- band and wife in still another family were working when the family moved to the hospital. Soon the husband was put on the rest cure and the income was reduced from $17.00 to $7.00 a week. When discharged the average income of each of these eleven families was $10.75. On admission to the hospital the average income of each of the seventeen families discharged as rehabilitated during the two years of the experiment was $6.37 a week. When these were discharged the average weekly earnings per family were $12.41. In other words, the average income of each was doubled. The fol- lowing table gives the income on admission of each family either discharged or dismissed during the last two years and the earn- ings of each when it left the hospital. Families Discharged as Rehabilitated 1912-13 Weekly Earnings Weekly Earnings when on Admission. Discharged. K.— ................. $4.50 $16.50 Sa.— ................. 6.00 12.00 G.— .................. 16.00 St.— ................. 7.50 17.00 W.— ................. 10.00 14.00 Se.— ................. 10.50 12.50 Total .....................$38.50........................$88.00 Average.................. 6.42........................ 14-67 Families Discharged as Rehabilitated 1913-14 Weekly Earnings Weekly Earnings when on Admission. Discharged. R.— .................. $9-5° C— .................. 6.50 W.— ................. 4.00 S.— .................. 12.00 Se.— .................*$i8.oo 14.00 O'K—................ 10.00 P.—.................. 10.00 10.00 G.— .................. 10.00 10.00 Ga— ................. 10.25 1500 F— .................. 4-5° I5-00 D—.................. 17.00 1700 Total .....................$69.75......................$123.00 Average .................. 6.34...................... n.17 *Gave up unsuitable occupation at request of Home Hospital. 34 Discharged for Intemperance or as Not Amendable to Advice and Direction 1912-13 Weekly Earnings on Admission. McG — ................ $6.00 D'A.—................. 6.00 F.— ................... 2.50 L.—................... 4-5° O'G.— ................. 6.50 Total......................$25.50........ Average ................... 5.10........ Weekly Earnings when Discharged. $17.50 12.00 2.50 20.00 17.00 569.00 13-80 1913-14 Weekly Earnings on Admission. B.—...................$11.00 K.—................... 18.00 M.— ................... Total ......................$29.00. Average ................... 9.66. Weekly Earnings when Discharged. $11.00 9.00 14.00 .$34-00 . 10.33 The following table gives the income of each family in residence at the close of the second year and at the time of admission: Under Care at End of Year Weekly Earnings Weekly Earnings on Admission. at End of Year. Wy.— .................$10.00 $10.00 Co.—.................. 1300 R.— ................... 12.00 Man.— ................ 10.00 B.— ................... 10.00 Giam— ............... 15.00 15.00 L— ................... 7-50 2.50 Be.— .................. 10.00 Bo.— .................. 5-00 500 M. L.— ............... 8.00 C— ................... H.— ................... 5-oo Cu.— .................. CI. J.—................ 12.00 CI. P.— ............... 15-00 15-00 D—................... 15.00 1500 Gu.— .................. 9.00 900 S.— ................... 12.50 12.50 M.— ................... Cam.— ................ 7-00 14-OQ 35 Li.— .................. St.— ................... 12.50 Mo.— ................. 14-00 FL— .................. De G.—................ Br.— .................. Re.— .................. 2.50 5-00 K.— ................... 5-00 Ko.— ................. 6o° Me.— ................. 10.00 10.00 Car.— ................. Mi.— ................. 10.50 10.50 Je-- .................. Par.— ................. Miz................... Sa.— .................. 111.— .................. Hen.— ................. El.— .................. Total .....................$i3i-50......................$228.50 Average .................. 3-37...................... 5-80 The experience of three typical families illustrates what the Home Hospital has done socially for those who have been dis- charged and what we hope to do for those now under care. Before moving to the Home Hospital the P. family—hus- band, wife and four children—and a lodger lived in two sunless rooms in a rear tenement in Mott Street. The wall paper was torn and dirty, the plaster broken in many places and the floors rickety and filled with wide cracks. There was no hot water and the supply of cold water was very inadequate. The halls reeked with foul odors, which filled the rooms whenever the doors were opened. The lodger and two of the children slept in the kitchen, the parents and the other two children in an inside bedroom, the entire floor space of which was occupied by a bed and a crib. The four children, from three to nine years of age, slept in two cribs, "a big one and a little one in one crib, and a big one and a little one in the other crib," as the mother aptly described the sleeping arrangements. *This small increase is due to the installation of the second staircase late in the Fall of 1913. Most of the breadwinners in this new group were put on the rest cure, thus noticeably reducing the average income of all breadwinners. 36 When admitted to the Home Hospital the family moved into a sunny four room apartment with balconies and was supplied with much needed furniture, bedding and clothing. During their residence Mrs. P. and three of the children were treated for tuberculosis. All of the children had tonsils and adenoids removed and received dental attention. One was provided with glasses. The two older children attended the open- air school. The father secured permanent work and the mother received instruction in personal hygiene, cooking, sewing and the care of her home and children. Anyone who had known the family before it was admitted to the Home Hospital would not have recognized it when dis- charged. Mrs. P. had gained thirteen pounds, was apparently cured of tuberculosis and able to care intelligently for her family. The children were well and strong, having gained six, nine, ten and thirteen pounds respectively. None showed any definite signs of the disease. At the present time this family is living in the East River Homes and all members are carefully observing all that they learned at the Home Hospital. All come to the office each week to be weighed. The O'K. family when admitted was dependent upon charity except for $2.00 a week that Mrs. O'K. earned in a laundry. The widowed mother and her three children were infected with the disease. Mrs. O'K. was melancholy and had given up all hope of ever being well again and able to care for her children. After a residence of a few months at the hospital the whole family showed marked improvement. Convinced at last that she could be cured, the woman began to take a new interest in life. All the children had tonsils and adenoids removed, the mother and two older children received much needed dental attention and Mrs. O'K. was also provided with glasses. Agnes was sent to the open-air school. To those who knew the mother before she went to the hospital it is a pleasure to see her now. She is bright, cheerful and happy and devoted to her work and family. As a nurses' helper she is earning $45.00 a month and is providing adequately for her children. Before admission the parents and three children of the F. 37 family, all tuberculosis, lived in three rooms which, during the rainy seasons, were constantly damp and musty. During the winter the wind whistled through the cracks and broken window panes, stuffed with old clothing, in a vain effort to keep out the cold. The rooms reeked with odor and were infested with ver- min. All water had to be carried through a dark hall from three flights below. When the Association's visitor went to see the family she found them shivering with the cold, as they had very little clothing. The few pieces of furniture and dishes were badly broken. At night all slept huddled together in one bed with very little clothing to cover them. They were penniless and unable to work, tuberculosis having sapped their strength. The family lived for a year in a sanitary three-room apart- ment at the Home Hospital. All were apparently cured during that time. The mother, who gained fifty-eight and a half pounds in weight, became an efficient homemaker. Grace, the twelve year old little drudge of the family, was relieved of her house- hold responsibilities and sent to the open-air school. With tonsils and adenoids removed and other physical defects cor- rected she has developed into a bright and attractive child. The two other children were also sent to the open-air school and received much needed dental attention and had tonsils and adenoids removed. None showed any definite signs of tubercu- losis at the end of the year. The father after having been apparently cured was able to resume his occupation as a barber and provide for his family, who now live in a comfortable home in the country. Thus by restoring to health wage-earners and other mem- bers of dependent families and by teaching each properly to live and to manage a home efficiently, the Home Hospital has increased not only the earning powers of those admitted but also has raised the standard of living in each home. While the aver- age increase in family income was a trifle less in the eleven fam- ilies discharged last year than in the six who moved away dur- ing the first year, this decrease in the larger number was so small that it does not appreciably affect the general results. Un- doubtedly the unsettled condition of the labor market last year had something to do with this decrease. The social and eco- 38 nomic results during the two years of the experiment strengthen our belief that completely to rehabilitate families either made dependent by tuberculosis, or whose physical breakdown has resulted from destitution, the treatment of the physical and social ills must be combined. 39 ■fc Cost of Home Hospital Treatment Days' Care: 1912-13 Adults—Non-patients.................................................................. 3734 Children—Non-patients................................................................ 9334 Total Non-patients........... 13068 Adults—Patients...................................................................... 8869 Children—Patients.................................................................... 9568 Total Patients............... 18437 Total Days' Care............ 31505 Cost: Chargeable Directly to Families. Living Expenses.................................................... .................. $15,776.99 Administration and Supervision......................................................... 6,553.40 Total .................. $22,330.39 General: Rent (A).............................................................................. $2,539-27 Miscellaneous (B)..................................................................... 261.96 Capital Expenditures (C)............................................................... 1,577.08 Total .................. $4,378.31 Grand Total........... $26,708.70 Expenditures by Home Hospital......................................................... 21,359.74 Earnings : ....................... $5,348.96 Per Family............................................................................ $198.11 Per Individual........................................................................ 39.62 Per Actual Workers.................................................................... 121.56 Per Actual Worker Weekly............................................................. 3.65 Per Actual Worker Weekly on Admission............................................... 3.44 Per Actual Worker Weekly Now........................................................ 7.00 (A) Rent not charged to families as it was incurred before opening or for vacancies during the year. (B) Includes Annual Report, conference expenses, etc. (C) Includes such items as furniture, equipment, etc., necessary for administration and for families. 13-14 1912-14 6679 10413 8845 18179 15524 11204 22047 $3,331-33 $35,244.26 28,260.16 $6,964.10 28592 20073 31615 33251 48775 51688 80280 $22,932.64 8,960.29 $38,709.63 15,513-69 $31,892.93 $54,223.32 $673.38 867.88 1,790.07 $3,212.65 1,129.84 3,367.15 $7,709.64 $61,932.96 49,619.90 $12,313.06 131.39 $153-91 25-79 30.41 116.07 118.39 4-49 4.086+ 4-68 4.16 5-69 6.24 Day Week Year Average ... Individual .$2.50 17.50 912.50 Average ... Individual . .500 3.50 182.50 Patient ... Individual . .564 3-95 205.86 Non-patient . .411 2.87 150.01 Living Expenses 1912-13 1913-14 Day Week Year 2.392 16.74 873.08 .470 3.29 171.55 •479 3-35 I74-83 .451 3-I5I 164-61 Administration & Supervision 1912-13 1913-14 Totals Day Week Year 1.04 7.28 379-6o .208 1.456 75.92 .208 1.456 75-92 .208 1.456 75-92 Day Week Year ■93 6.51 339-45 .183 1.28 66.79 .183 1.28 .183 1.28 66.79 66.79 1912-13 Day Week Year 3.54 24.78 1294.10 .708 4.956 258.42 .772 5.404 281.78 .619 4.33 225.93 1913-14 Day Week Year 3.32 23.25 1221.80 .653 4-57 238.34 .662 4.63 241.63 .634 4437 231.40 Cost of Care of Patients* 1912-13 Male Patient Female Patient Rent................ Food............... Clothing ... :....... Fuel ............... Lunch ............ Dues .............. Medicine .......... Ice ................ Carfare ............ Household Supplies. Miscellaneous ...... Adult .241 •325 .058 .009 .039 .013 .016 .003 .013 .013 .019 ■749 Adult .241 .260 .040 .009 .031 013 .016 .003 .013 .013 .019 .658 Child Patient Average Age 8 Yrs. .163 .162 .032 .009 .013 .016 .003 .013 .013 .019 1913-14 Male Patient Female Patient Rent............... Food .............. Clothing ........... Fuel ............... Lunch ............. Dues .............. Medicine........... Ice ................ Carfare ............ Household Supplies. Miscellaneous ...... Adult .252 .292 .068 .010 .028 .010 .013 .002 .008 .011 .018 16 male patients at .749............... 11.98 22 female patients at .658............. 14-47 41 children and infant patients at .443.. 18.16 -443 Adult .252 ■233 .047 .010 .022 .010 .013 .002 .008 .011 .018 .626 Child Patient Average Age 6 Yrs. .127 .146 .03*7 .010 .010 .013 .002 .008 .011 .018 .712 26 male patients at .712............... 18.51 38 female patients at .626............. 23.78 120 children (average6years) at .382... 45.84 .382 79 patients 44-6i per diem Average patient per diem.._.............564 Average non-patient per diem..........411 184 patients £ Average patient cost..........479 per diem Average non-patient cost.....451 per diem .13 per diem *Adult patients separate room, children share with others. Food basis of unit consumption and special nourishment. Clothing according to Chapin standard a family with $1,000 income. Other things shared equally except lunch, which is divided equally among the patient wage earners in each family woman expending but .8 amount of that expended by man—as per Chapin. No children wage earners. No lunch charged to them. COST OF HOME TREATMENT The whole story of the cost of treatment at the Home Hos- pital is told in the table on the preceding page. Sixty-four families have been admitted to the Hospital during the past two years. Twenty-seven families were treated during the first year, and fifty-three families during the second year. The average number of individuals per family was 5 during the first year, and 5.09 during the second year. The total days' care, including both pa- tients and non-patients, during the first year was 31,505, and dur- ing the second year, 48,775. The per diem cost per family during the first year was $3.54; during the second year it was $3.32. Similarly, the per capita per diem cost (patients and non-patients) was 7.08 cents the first year, and 65.3 cents during the second year. Exclusive of administration, the per capita per diem cost during the first year was 50 cents; and during the second year, 47 cents. It is found impracticable completely to separate the cost of caring for patients and non-patients in the accounting of the institution. A very detailed and, we believe, a very accurate esti- mate of the cost of care of patients as distinguished from non- patients has, however, been made. This was done by distribut- ing each of the items of expense on a basis of known differences in the cost of caring for patients and non-patients. This estimate is based on the fact that each adult patient is allowed a separate room and is charged accordingly for it in the rent item. Children patients share their rooms with the rest of the family. The dis- tribution of the food item is made on the basis of the Chapin unit of consumption and special nourishment allowed to patients. The clothing is distributed according to the Chapin standard of a fami- 42 ly with $1,000 income. Other items are shared equally, except the item for lunch which was divided equally among the patient wage earners in each family, the women expending but eight-tenths of the amount expended by the men—as per Chapin. During the year 1912-13, the average cost per diem per male adult patient, exclusive of supervision and administration, was 74.9 cents; for female adult patients, 65.8 cents; and for child patients, 44.3 cents. The average cost per patient, regardless of age or sex, was 56.4 cents per diem. During the year 1913-14, this average cost was 47.9 cents per diem per patient. If we include administration and supervision, the per capita cost per patient for 1912-13 was 77.2 cents, and during the year 1913-14, 66.2 cents. This per capita per diem cost of caring for patients in the Home Hospital, it will be observed, is exceptionally low as compared with that of any existing sanitorium or hospital. The total cost of the care of all the families in the Home Hos- pital during the two years has been $61,932.96. Living expenses made up over $38,000 of this; administration and supervision $15,000; and general expenses, chargeable to neither, made up the balance. Of this total expense $12,313.06 was contributed by the earnings of families receiving care, making a total expenditure by the Home Hospital of $49,619.90. By doubling the capacity of the Home Hospital the Associa- tion last year was able to reduce the cost of supervision and ad- ministration. Distributed equally among all members in the Hos- pital, the sick and the well, the per capita cost of this service in 1912-13 amounted to 20.8 cents a day. Charging this cost to the patients only, the average cost per patient was 35 cents a day. As more families were cared for last year and the staff and over- head charges were not increased materially, the daily per capita cost of administration and supervision, distributed equally among all persons, amounted to only .183 cent a day. The total expense of supervision and administration, if charged to the patients only, would amount to only .269 cent a day. Our experience has demonstrated that the non-patients re- quire as much care as the patients, that the children demand fully as much attention as the adults, hence the cost of supervision and administration should be pro-rated by individual. 43 Below is an itemized statement of the amounts, distribution and percentages of the living expenses of the families in the hos- pital during the years 1912-14: Living Expenses of Families at Home Hospital Average Daily Expense Per Family. Per Cent. 1912-13 I9I3-I4 1912-13 I9I3-M Rent ..................... $0,846* $0,792* 33.9* 33-i6* Food......................927 .929 37.1 38.9 Clothing...................201 .233 8.0 9.75 Fuel ......................045 .050 1.8 2.09 Lunch.....................089 .051 3-6 2.13 Dues......................068 .055 2.7 2.30 Medical and Surgical Sup- plies .....................079f .07if 3-2f 2.97f Ice........................017 .012 .6 .50 Carfare ...................065 .045 2.6 1.88 House Supplies.............065 .056 2.6 2.34 Miscellaneous .............097 .094 3.9 3-93 Totals.............. $2-499 $2,388 100.0 99-95 *Includes expense of heat and light. f Includes expense of paper napkins, sputum boxes and all medical and surgical supplies. As shown by the above table living expense of the twenty- seven families under care at the Home Hospital during the year 1912-13 amounted to $2,499 a day. The average daily living ex- pense of the fifty-three families under care during the year 1913- 14 was $2.38 or nine cents less than the cost in the year 1912-13. A diet kitchen has been opened in order that properly cooked meals may be sent to the homes in which the mother is too ill to prepare them. Later it seemed advisable to have certain patients —usually children with poor appetites—come directly to the diet kitchen dining room to eat under the immediate supervision of a nurse. The results obtained were most gratifying as their weight charts soon showed. Incidentally both children and adult patients were instructed in table etiquette. The nourishment for the open air school classes is also prepared in this kitchen so that it is a valuable adjunct to the Home Hospital activities. By increasing the capacity of the Home Hospital there was a noticeable reduction in the cost of meals served in the diet kitchen. During the first of the experiment from October 1, 44 1912 to March 18, 1913, an average of 305 individual meals or 172.2 unit meals from a varied dietary, were served every week from the diet kitchen under the supervision of a graduate nurse. The total number of persons served was 6,690 which, according to the scale used by the United States Department of Agriculture (Farmers' Bulletin 142) is the equivalent of 4,150.1 units. The average cost of the diet kitchen per week, including overhead charges, was $27.56. Of this amount $15.13 was spent for food. The average cost of food alone per meal per unit or per male adult was $.087. Including the expense of supervision, rent, fuel, etc., the diet kitchen provided meals at an average cost of $.16 per unit or per male adult. Last year, March 18, 1913, to March 18, 1914, a weekly average of 530.7 individual meals or 334.4 unit meals from a dietary similar to that used in 1912-13 were served from this diet kitchen under the supervision of a graduate nurse. The total number of persons served was 885 adults and 18,744 children, which is the equivalent of 17,393 units. The average cost of the diet kitchen per week including all overhead charges was $40.52. Of this amount $28.57 was spent for food. The average cost of food alone per unit or per adult male was $.085, a slight decrease from that of the previous year. Including the expense of supervision, rent, fuel, etc., the kitchen has provided meals at an everage cost of $.12 per unit, or per male adult, a reduction of $.04 over the cost in 1912-13. 45 COMPARATIVE COST OF HOME HOSPITAL AND INSTITUTIONAL TREATMENT For the purpose of comparing the cost of Home Hospital treatment with that of institutional care, we have ascertained the average weekly cost of caring for families living in the Home Hospital and have compared this amount with the estimated aver- age weekly cost of caring for the sick in a hospital or sanatorium plus the relief of the well members of these families either in their homes or in institutions. The families selected are typical of those relief agencies are usually called upon to aid, viz: (i) Both parents (chief wage-earners) and usually one or more children afflicted. (2) The father (principal wage-earner) and perhaps one or more of the children having tuberculosis. (3) The mother (housekeeper) and probably one or more of the children tubercu- lous. In making the study for this report we have again used the same families that were selected for a similar study for the 1912-13 report, as all were under care at the hospital for several months last year. It has been necessary for us, however, in comparing for the last two years the cost of the two methods of treatment this year to reduce in some instances and to increase in others the expense of institutional care, as the per capita cost has changed since 1912-13. We too, have had to take into con- sideration the reduced cost of living per family at the hospital last year, also the reduction in the per capita cost of administra- tion and supervision. Two of the families were moved during the year to larger apartments and, therefore, paid more rent than they did during the previous year. This accounts for the in- crease in the item of rent in the budget of these families in this report. We have assumed that a relief agency having the family in its care would send patients afflicted with incipient tuberculosis 46 to such a sanatorium as Ray Brook or Otisville, where the weekly cost for the last two years has been $8.96 and $9.52 respectively. More advanced cases would be sent to some hospital such as the municipal institution at Riverside, or to Seton or St. Joseph's. It is very difficult to get the exact cost of maintenance of patients at institutions of this kind. While the city pays eighty cents a day for each dependent patient it sends to Seton and St. Joseph's, the actual cost of maintenance is much more if allowance is made for administration and supervision, which must be taken into consideration if a true comparison is to be obtained. The National Association for the Study and Prevention of Tuberculosis ascer- tained in 1912 that the average per capita cost of maintenance of twenty-five second stage advanced case hospitals in New York, Philadelphia, Boston and Chicago was at that time $1.49 a day. The average per capita cost of seventeen tuberculosis institutions in New York State, according to a table* compiled last year by the State Charities Aid Association, is $1.40 a day. In 1912 the average per capita cost of nineteen New York State institutions was $1.56 a day. We have, therefore, conservatively estimated that the average cost of maintenance of an advanced stage patient in an institution is now $1.40 a day, or $9.80 a week. The weekly per capita cost of $2.75 for children over two years of age and $3.15 for children under two years of age are the rates the City of New York now allows orphan asylums for the care of those committed by its Department of Charities. At the time our first report was published the city was paying orphan asylums only $2.25 and $2.35. It would be very difficult to get hospital care for babies suffering from tuberculosis. The Metropolitan Hospital admits such cases, and the per capita cost of maintenance is $1.02 a day. This has been increased from eighty-eight cents since our first report. Preventorium care at Farmingdale for children from four to fourteen years of age costs the City of New York eighty cents a day. We have, therefore, allowed the amounts at present paid by the city to orphan asylums as a con- servative basis for the comparisons in this report. In computing the cost of administration and supervision for the families at the Home Hospital we have distributed the entire amount among all the members equally, the sick and the well. *See page in. 47 This amounts to $.183 a day per person. We believe that this is the only fair method. Those who are not afflicted with tuber- culosis have received much medical supervision.* Besides this much attention has been given to the well members to prevent the spread of infection in each family. It is obvious, therefore, that all persons participating in the experiment should share the ex- pense of administration. If, however, the cost of administration and supervision were charged to the patients only, the per capita cost per patient would amount to $.269 a day. In the following tables showing the cost of institutional care we have used the figures furnished us by the city officials and institutions as the per capita cost of caring for patients last year. A Family of the First Type.—The G---- family is a good example of the first type. If institutional care had been pro- vided the family would have been cared for as follows: The father (a moderately advanced case) would have been sent to a hospital and the mother (an incipient case) to Ray Brook. Until the recovery of the parents the children would have been cared for in an orphan asylum. In this family group is a complica- tion which under ordinary circumstances would receive no spe- cial attention. William, two and one-half years old, a suspect, is too young to send to a preventorium and certainly he is unfit to mingle with healthy children in an orphan asylum. The Home Hospital ideally solves this problen. The following gives the average weekly cost of the family in institutions and the average amount it has cost to keep all the members in the Home Hospital for one week: PLAN 1—Entire Family in Institutions Weekly Age. Health. per capita. Institution. Joseph (father)---34 yrs. Tuberculous $9.80 Hospital. Margaret (mother) 32 " 8.96 Ray Brook. Joseph.............10 " 2.75 Orphan Asylum. John ............. 6 " 2.75 Eleanor............ 4 " 2.75 William............ 2^ yrs. Suspect 2.75 " " Helen ............14 mos. 3.15 " " Total cost of family per week in institutions.$32.9i Shown in the tables on page in. 48 THE PROBLEM Eighteen of the Twenty-six Members of These Four Families are Tuberculous. The Bread-winner in Every Home is a Patient. Four members tuberculous: father and three children. Father permanently incapacitated by injury. Mother (bread-winner) and three children tuberculous. Kvcry member of this family, including the father, i^ tuberculous. Source of infection: wife's mother. PLAN 2—All in Home Hospital Weekly per Family. Rent ............................... ................ $7.00* Food Clothing ...................... Fuel .......................... Lunch ........................ Dues ......................... Medical ....................... Ice ........................... Carefare ...................... House Supplies................ Supervision and administration. 15 26 44 48 74 49 10 059 37 967 Total cost per family per week in Home Hospital___$28,056 In the Home Hospital the weekly expense has been $28,056. If the home had been broken up and the members sent to institu- tions the weekly cost would have been $32.91. The weekly saving under the Home Hospital plan, therefore, has been $4,854. To keep the family in institutions for a year would cost $252.40 more than in the Home Hospital. Consideration must be given to the fact that this patient was able to do light work much sooner than if he had been in a regular hospital, for at the Home Hos- pital he was earning something while still under all the super- vision that was necessary after his convalescence had progressed somewhat. After being on partial rest cure for six months, he began to work part time, earning an average of $6 a week for two months. For eleven months prior to the family's discharge from the hospital, the husband worked full time, earning an aver- age of $12 a week. It must also be remembered that the relief given to the entire family is much more adequate than that usually given by a relief agency, and that the treatment is comparable with that of the best sanatoria. Tuberculous families falling in the second class, where the father and one or more of the children have the disease, are far more numerous among those aided by relief agencies than the afflicted families in either the first or third class. There are three possible plans of treatment for a family in the second class, viz: (1) The family broken up, man and all children except one sent to institutions, mother at work and supporting herself and *Heat and light included. 49 the one child with her; (2) man in hospital or sanatorium, family at home supported by a relief agency; (3) entire family in Home Hospital. The B---- family is typical of this group. Here is what it would cost to keep this family under plans 1 and 2, and what it has cost to keep them in the Home Hospital. PLAN 1.—All Except Mother and One Child in Institu- tions Age. Health Institution. Cost. James (father).. .30 Tuberculous Hospital $9.80 per wk. Isabella (mother).29 At Work John............. 4 Suspect Preventorium 5.60 ' James ........... 3 " Orphan Asylum 2.75 "( "^ Joseph........... 2 Tuberculous Hospital 7.15 Helen............ 4 mos. (With mother) Total weekly cost of institutional care, mother supporting herself and one child..................................$2530 PLAN 2—Family at Home and Patients in Institutions Man's care ........................................... $9-8o Joseph's care ......................................... 7-15 John's care.......................................... 5.60 Family's Care. Food................................................ 3-15 Rent ................................................. 2.00 Fuel ..................................................50 Light.................................................25 Clothing ............................................. 1.40 Incidentals .........................................'.. .50 Total weekly cost...................................$30.35 PLAN 3—Entire Family in Home Hospital Rent ................................................. $6.00* Food ................................................ 5.78 Clothing ............................................. 2.39 Fuel ..................................................42 Lunch ................................................20 Dues .................................................31 Medical ...............................................5! Ice ...................................................I0 Carfare •30 House Supplies .......................................36 Miscellaneous ........................................ i.oi Supervision and administration........................ 7.686 Total cost in Home Hospital........................$25,066 Tight and heat included in rental. 50 It is more difficult with this type of family than with the other two to compare the merits of the three plans of treatment in relation to the cost of each. The estimated cost of caring for all except the mother and one child in institutions is $25.30 a week. The cost of keeping the well members at home and the sick members in institutions is estimated to be $30.35. The actual cost of caring for the entire family in the Home Hospital was $25,066. The cost of the Home Hospital plan is, therefore, twenty-three cents a week cheaper than that under Plan 1, and $5,284 less a week than under Plan 2. One child, James, who is thought to be infected with tuber- culosis, is too young to be sent to a preventorium. In an orphan asylum he probably would be a source of danger to the other children. While at home with his mother he would require nurs- ing supervision, the expense of which the relief agency would have to pay. In Plan 1 we have assumed that the mother can work in a place where she can keep Helen with her. Her earnings would pay their board and lodging and about $3.00 a week additional. which would just defray necessary expenses. The budget for the family in Plan 2 is based on the amounts the Bureau of Relief and Rehabilitation of the Association ordinarily would allow a dependent family of the same size. It should be noted that in the cost of treatment under the second plan nothing is charged for the expense of supervision, which the relief agency would have to give through one of its trained visitors and one of its visiting nurses. This expense is included in the cost of treatment under the Home Hospital plan. The advantages of the Home Hospital plan of treatment over either of the other two are many. If the mother were left to support herself and one child while the father and three chil- dren were in institutions, no attempt could be made to rehabili- tate the family socially or to put them on their feet again until the family had been reunited. Undoubtedly the relief agency would have had to supplement the family income for some time after the home had been re-established, or at least until the hus- band had been able to find suitable work. If the well members of 5i the family were left at home the father and one child sent to tuberculosis hospitals and the boy to a preventorium, the economic rehabilitation would be delayed until after the father secured work that he could do. With the entire family living a normal home life in the Home Hospital, all of the untoward conditions that must necessarily exist under either of the other two plans of treatment are elim- inated. The family is being rehabilitated physically, socially and economically at the same time, so that by the time the patients are cured the family can take its place in society again and lead a normal life. The mother is kept with the children where she should be, the husband begins to contribute toward the support of the family as soon as he is able and without having to wait until the entire period of convalescence has passed, and during the temporary misfortune the family standards have not de- teriorated, but in many instances have been raised, but usually not beyond the family's own possibilities. Under Plans I and 2 there is always the element of uncertainty, while under the Home Hospital plan all members of the family are certain of decent living conditions and instructions that will benefit them in the future. A family in the third class, in which the mother and one or more of the children have tuberculosis, must either be broken up and all except the father sent to institutions, or all cared for under some such plan of treatment as the Home Hospital offers. In the S---- family four of the six members of the family have tuberculosis, the father and one son being the only ones in health. If institutional care had been provided, the mother and baby would have been sent to hospitals, two girls to a prevent- orium, and the boy to an orphan asylum. The father would have been able to support himself and pay for the baby's hos- pital care. The cost of institutional care and the average weekly expenses of this family at the Home Hospital are as follows: 52 PLAN i—Entire Family Except Father in Institutions Age. Health. Frederick (father)..40 yrs. Blanche (mother) .. .29 " Tuberculous Edgar...............10 " Ruth................ 7 " Incipient Geraldine........... 4 " Dorothy............. 2 " Weekly per capita. $9.80 wk. 2-75 " 5-6o " 5.60 " 7.15 " Institution. Hospital. Orphan Asylum. Preventorium. Hospital Total cost in institutions..................$30.90 Less part of father's earnings.......... 7.15 Net cost, less part of father's earnings___$23.75 PLAN 2—In Home Hospital Rent ................................................. $8.00* Food .............• •................................. 7.89 Clothing ............................................. 2.39 Fuel..................................................47 Lunch .................................................49 Dues.................................................46 Medical and Surgical ..................................55 Ice ....................................................10 House Supplies...................................... 1.12 Carfare .......„.......................................38 Miscellaneous ........................................ 1.07 Administration and Supervision....................... 7.686 Total cost to Home Hospital.......................$30.61 Less father's earnings............................ 13.00 Net cost in Home Hospital......................... 17.61 The average weekly expense of this family during the sec- ond year of residence at the Home Hospital was $17.61. It would have cost $23.75 a week to keep the four patients and the well boy in institutions, the father supporting himself and paying for the hospital care of the baby. The Home Hospital treat- ment, with all its extra advantage to the social well being of the family, was $6.14 a week cheaper. The saving in the year would be $319.28. The economy of the Home Hospital method over institu- tional care may be established in another way that will indicate a saving quite as striking as that in the individual family. Assuming that adults, adolescents and children over five years of age who are classed as positive cases of tuberculosis, *Light and heat included in rental. 53 were sent to hospitals where the weekly cost of treatment for the last two years has averaged $10.02*; that children under five years of age were sent to the Metropolitan Hospital where the weekly per capita cost of maintenance averaged $6.65*, or to some similar institution; that the cost of saatorium treatment of adults and adolescents is no greater than that at Ray Brook, $8.96 per week, and that children from four to fourteen years of age suffering from incipient tuberculosis were sent to preventoria where the weekly per capita cost is $5.60—the total expense for the institutional care of the eighty adult and adolescent patients and the 127 children patients who have been at the Home Hos- pital during the last two years would be $118,995.76, itemized as follows: Cost of Institutional Care 24 adults, positive cases, hospital care ($10.02 per week)..........$240.48 41 adults and 4 adolescents, incipient cases, sanatorium treatment (Ray Brook) ($8.96 per week) ............................. 403.20 2 infants (under 2 years) suspects, hospital care ($6.65^2 per week) ..................................................... 13.31 87 children 4-14 years, preventorium treatment ($5.60 per week)___ 487.20 Total weekly cost..................................... $1,144.19 Total cost for two years ..............................$118,995.76 That the cost of treating these same patients at the Home Hospital for two years, based on the average weekly per capita cost for that period, charging the entire expense of supervision and administration (1) to the patients themselves would amount only to $96,447.52, or (2) if distributed among all the members of the family would be further reduced to $83,294.64 is apparent from the following table: *As the per capita cost of caring for patients in institutions changed during the two_ years and as'the living expenses and cost of supervision and administration at the Home Hospital were higher during the first year of the experiment than last year, we have averaged the cost for the two years. For example, in the first Report we estimated that the weekly cost for hospital care per patient was $10.25. Last year the average daily per capita cost of seventeen institutions in New York State was reduced to w °l ThlS caused us this year t0 reduce our estimate to $9.80 a week We have, therefore, allowed $10.02 as the estimated weekly per capita cost in hospitals for the two years. 54 Cost of Home Hospital Weekly Expense Weekly Expense Charged to Distributed Patients. Among Family. 30 male patients ($7,273* per wk.) . .$218.19 ($6,475* per wk.) .. .$194.25 36 adult and 3 adolescent female pa- tients ($6,667* per wk.)....... 260.01 ($5,859* per wk.)... 228.501 89 children, including positive cases and suspects (average age 8 years) ($5,047* per wk.)......449-183 ($4,249* per wk.)... 378.16 Total weekly cost...........$927.38 .....................$800.91 Total cost for two years. .$96,447.52 ................$83,294.64 Thus it will be seen that for the same period of time and the same number and classes of patients the cost of institutional care would be $22,548.24 more than the cost of the Home Hospital method, when under the latter the entire expense of administra- tion and supervision is charged to the patients only, or $35,701.12 more if this charge be distributed equally among all members of the families who have received care. In the number of patients given above are not counted the eleven cases of adults classified as inactive under Group Cf. These would probably have been treated at dispensaries. It is a well known fact that such persons rarely heed advice and frequently suffer relapse due to their own neglect. We have also omitted thirty-eight children ranging in age from five months to three and a half years who are classified as suspects and positive cases. These would not be eligible for hospital care and would prob- ably be sent to an orphan asylum. Thus by comparing the actual cost of caring for tuberculous families in the Home Hospital for the year with the estimated cost of institutional care, the expense of the former method is found to be less. The total cost of treatment and maintenance of the patients at the Home Hospital during the two years has been less than the estimated cost of caring for the same persons in institutions. Therefore, the economy of the new method is apparently well established. *Average weekly cost for two years. tSee page 24. 55 APPENDIX. MEDICAL STATISTICS ADULT PATIENTS—CLASS "A" Description of Patient Family patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days IN II.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain in W'ght Remarks Family consists of Frank and Lizzie R., aged respective-ly 26 and 22 yrs., and child 17 mos. (All patients.) F. R. U. S. Prot. Episco-pal. 26 yrs. Mar. 20, '12. 198 Third stage ac-tive ; antrum 10 cm. in diameter. Extensive infilt. both chests. + Progressively worse. Max. temp, on admis-s i o n 100°. Range of pulse 120-104. Max. t. 6 mos. after admission 100.6°. Range of pulse 140-118. Rest cure 150 days. Deceased. Family admitted as wife and child, both patients, seemed suitable cases. John and Katherine K., aged 42 and 43 jrrs., and 4 chil-dren, aged respec-tively 16, 12, 9 and 7 yrs. J. K. U. S. R. C. 43 yrs. Dec. 7, '12. 225 Second stage ac-tive. Cough 2 yrs. Much spu-tum. Right up-per dulness, rales, & bron. voice. Left apex dulness & rales. + Progressive im-provement. Max. temp, on admis. 99.2°. Range of pulse 96-68. Rest cure pre-scribed but not fol-lowed. Ex-tra nourish-ment; tonic. Arrested. Negative sputum. Lost ^4 lb. Patient would have gained and shown greater im-provement except for fam-ily troubles. Woman preg-nant upon admission. Ut-terly disregarded advice and lost 25 }4 lbs. Child-ren all showed marked im-provement. Gertrude 10 yrs., gained 4J^ lbs. Ed-ward 12 yrs., gained 8H lbs. Adenoids and tonsils removed. Loretta 9 yrs. gained 3f£ lbs. Tonsils and adenoids removed; dentistry. Margaret 7 yrs., \Yi lbs. Baby born Feb. 24; puny, premature child (6 lbs.); had no rectum; operated upon at Home Hospital 30 hours after de-livery. New rectal canal established. Baby made perfect recovery from op-eration. Death 56 his. later. Autopsy revealed cause of death to be eon-genital pyloric stenosis. Adult Patients—Class "A"—(Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days IN H.H. Condition on Admission Spu-tum + General Progress Treatment Present Condition 1 Gain IN W'ght Remarks Family consists of Fred and Blanche S., aged 40 and 28 yrs., and 4 chil-dren, aged respec-tively 10, 6, 3 yrs. and 8 mos. B. S. U. S. R. C. 28 yrs. May 17, '12. 671 Second stage ac-tive. Cough much (sputum copious), 6 mos. hemopt. Dulness & rales right up-per lobe & left apex, anterior & posterior. Improvement. Max. temp, on adm.1010. Range of pulse 108-96. Max. temp, past 2 mos. 99.6°. Range of pulse 96-72. Rest cure and partial rest. Extra nour-ishment. Tonics; den-tistry. Arrested Sputum oc-casionally positive. 23 lbs. Patient was reported as ap-parently cured in 1st year's report. Has disobeyed ad-vice, has had self induced gynecological complication that caused her relapse. Is now steadily improving. Husband has lost 2% lbs. Is working very hard. Ed-gar 11 yrs., has gained ]8}4 lbs. Dentistry; glasses; adenoids and ton-sils removed; open air school. Ruth 7 yrs., has gained 16J^ lbs. Adenoids and tonsils re-moved; open air school; dentistry. Geraldine 4 yrs., has gained 17J4 lbs.; adenoids and tonsils re-moved. Dorothy 2 yrs., has gained 18M lbs. de-spite loss from mastoid operation. Was considered hopeless when admitted. Family consists of James and Isabelle B., aged 28 and 29 yrs., and 4 chil-dren, aged respec-tively 3 yrs., 2 yrs., 4 mos., and Isa-bella, born 1 yr. later at H. H. J. B. Scot. R. C. 2!) yrs. 4-11-12 707 Second stage ac-tive. One yr. cough & loss of weight. Dulness it. apex; rales ant. & post. + Progressive im-provement. Max. temp, on admis. 98.6°. Range of pulse 100-72. Temp., pulse and respiration normal for sev-eral months. Rest cure 47 days. Full time work past year. Apparently cured. Sputum negative; no cough; dulness same; no rales; gen-eral condi-tion excel-lent. 5*4 lbs. lias done exceedingly well. Earning capacity on admis-sion O. During past year $40 per month. Wife has gained 9yi lbs.; has had much dentistry (false teeth provided). Children have all shown great improve-ment. John, 5 yrs., (sus-pect) has gained 8^4 lbs.; tonsils and _ adenoids removed; circumcision. James, 4 yrs., (suspect) 9 1 mos. in hospital recovering Family consists of Martin and Mary, aged respectively 25 and 35 yrs., and 2 children, aged respectively 9 and S yr^ M.McG. U. S. R. C. 35 yrs. 3-28-12 155 Second stage ac-tive; chr. pro-cess. Infilt. & softening both upper and right middle lobes. History of many relapses. Michael and Frances D., aged 36 and 34 yrs., and 3 chil-dren, aged respec-tively 12, 10 and 5 yrs. M. D. Irish R. C. 36 yrs. 12-11-12 463 Second stage ar-icsted. Cough moderate for 2 yrs. Sputum bloody. Right upper dulness with moist rales; scat. sono. sib. rales. Andrew and Mary C, aged 41 and 43 yrs., and 2 chil-dren, aged respec-tively 11 and 4 yrs. A. C. u. s. Prot. 41 yrs. 11-25-13 114 Third stage ar-rested. Cough & sputum moderate. Gen-eral infilt. left chest with an-trum 4 cm. in-filt. R. apex. Progressive im- Rest cure 39 provemcnt. Max. days. temp, on admis. Worked, 116 99.4°. Range of days. p. 104-76. Max. temp. past 2 mos. 98.6°. Range of p. I 76. Progressive im- provement. Max. temp, on admis. 98.2°. Range of p. 92-80. Past year pulse and temp, normal. Rest _ cure. Working a year. Progressive im- Working. Ex- provement. Max. tra nourish- temp. on admis.i ment; sleeps 99.5°. Range ofi in open air. p. 100-76. Disease ar- rested. Rap- id improve- ment. Gen- eral condi- tion excel- lent. Dul- ness same; few rales. Cough slight. Sputum scant. Apparently cured. Cough very slight; spu- tum occa- sionally; negative 13 mos. No rales. 6 lbs. 10J4 lbs. Improved. 1'4 Cough and lbs. sputum less. Sputum po- sitive. S lgns in chest from severe burns; plastic operation and circumcision. Has gained 7^2 lbs. Jo- seph, 2 yrs. (suspect) ton- sils and adenoids removed; circumcision. Has gained 18^4 lbs. Isabella, 9 months, healthy normal baby, no evidence of tuber- culosis. Patient's earning capacity was $8.25 per week on ad- mission and $17.50 on dis- charge. Discharged Au- gust 28, '12. "Not amen- able to advice and direc- tion." Eight mos. after discharge from H. H. pa- tient is working and look- ing well. Children 9 and 8 yrs., suspects, gained Yi and 1^4 lbs. Refused ton- sillectomy. Patient markedly improved by H.. H. treatment. Sick for years before admission; filthy habits; undoubtedly a public menace. Wife healthy. Mary 14 yrs. (suspect), tonsils and ade- noids removed; much den- tistry; gained 8^ lbs. Nora 11 yrs. (suspect), tonsils and adenoids removed; dentistry; gained 9yi lbs. Michael 6 yrs. (patient), tonsils and adenoids re- moved; gained 5^4 lbs. Old sanitarium and hospital case. Tuberculosis for 15 yrs. Wife healthy; gained 2 lbs. Grace 10 yrs. (sus- pect) had tonsils and ade- noids removed; lost '/i lb. (Recovering from opera- tion.) Aurora 4 yrs. (pa- Adult Patients—Class "A"—(Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days in H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain IN W'ght Remarks Andrew and Mary C. (Con't.) 22! 4 lbs. tient), tonsils and ade-noids removed; myringot-omy. Lost % lb. (Re-covering from operation.) Amedeo and Erminia G., each aged 35 yrs., and 4 chil-dren, aged respec-tively 6, 4, 3 and 1J4 yrs. E. G. Italian R. C. 35 yrs. 10-15-13 155 Second stage ac-tive. Cough & sputum moder-ate. Fibrosis left apex & R. base. Infiltra-tion R. apex & apex of left lower lobe. Pregnant. + Marked progres-sive improve-m e n t. Max. temp. 98.6°. P. range 112-76. Now normal. Partial rest cure 155 days. Arrested. Cough very slight; scant sputum; no rales; nega-tive sputum for 3 months. This gain includes that of concomitant pregnancy. De-spite this complication pa-tient's general condition has markedly improved. Signs in chest have become inactive and sputum nega-tive. Husband, a suspect, has gained V/2 lbs. Car-mella 6 yrs. (suspect), has had adenoids and tonsils removed; gained 5% lbs. Maria 4 yrs. (patient), tonsils and adenoids re-moved; gained 3 lbs. Jo-sephine 3 yrs. (suspect), adenoids and tonsils re-moved; gained 2% lbs. Dominick V/2 yrs. (pa-tient), gained 5^4 lbs. Marion C, widow, 49 yrs., Winifred, 19 yrs., Helen, 6 yrs. W. C. IT. S. R. C. 19 yrs. 4-5-13 348 Second stage ac-tive. Cough & sputum moder-ate. Infilt. R. upper lobe & apex of R. lower. Cervical adenitis. + Progressive im-provement. Max. tem. 99.6-100.2°. Range of p 112-72. Rest cure & partial rest cure. Arrested. Cough and sputum less. Dulness R. V. lobe; dry rales. Sputum po-sitive; cerv-ical glands greatly sub-sided. 10 lbs. Patient is of chronic relaps-ing type. Would be pub-lic menace if under dispen-sary control. Mother healthy. Gained 21 lbs. Helen, 6 yrs., gained 9Ji lbs. Family consists of Joseph and Mar-garet G., 34 and 32 yrs., and children 10, 6, 4, 2 y2 and 1 yr., respectively. J. G. Gen-many R. C. 34 yrs. 8-10-12 573 Second stage ac-tive. Much Cough 1 year. Much sputum. Dulness, retrac-tion, rales, right apex. Dulness left apex, an-terior & pos-terior. Family consists of William and An-nie F., aged 46 and 42 yrs., and 2 children, 13J4 yrs. and 11J4 yrs. W. F. U. S. Prot. 46 yrs. 4-11-12 108 Second stage ar-rested. Cough C mos. Sputum. Dulness over right apex post. Bronchovesic. breathing right apex post, and apex right lower lobe. Patrick and Cath-erine O'G., each 31 yrs. of age, and 2 children, 7 and4H yrs., respectively. C. O'G. u. s. R. C. 31 yrs. 4-22-12 288 Third stage ac-tive. Chills, fever, sweats, rapid loss in weight. Dulness, rales, br. voice & breathing, right upper lobe; dulness, rales left upper Progressive im-provement. Max. temp. 98.2. Range of p. 88-76. Past year normal. Rest cure & partial rest cure. Work-ing most of past year. Apparently cured. No cough, no sputum. No rales in chest. Spu-tum negative for past year. 10 lbs. Family discharged March 4, 1914, rehabilitated physi-cally, socially and econ-omically. Wife (patient) —see classification B, gained 12 lbs. Joseph 10 yrs., dentistry, glasses, gained 9J4 lbs. John, 6 yrs., dentistry; tonsils and adenoids removed; gained 9J4 lbs. William, 4 yrs. (suspect), gained 8l/t lbs. Eleanor, 4 yrs., tonsils and adenoids removed; gained 8}4 lbs. Helen, in-fant, gained 12J4 lbs. and is a wholesome baby. Unimproved. Max. temp, on admis. 99°. Range of p. 96-70. Max. temp. on dis-charge 99.4°. Range of p. 106-72. Rest cure 108 days. Disease ac-tive. Cough and sputum persist. Signs over same area with rales. Lost lbs. Patient did well for first 2 months and gained 4 lbs. Then began to drink heavi-ly and lost 3 lbs. in 2 weeks, while disease be-came slightly active. Dis-charged for marked in-temperance. Wife sent to country for 1 week; also provided with glasses; gained V/2 lbs. Margaret (135^ yrs.), suspect, lost % lb. Given glasses. An-nie 11 lA yrs., gained 6 lbs. then lost 2% lbs. when father began drinking. Af-ter family left it devel-oped that father took money, given for food, for drink, and children went hungry. Marked progres-sive improve-ment. Max. tem. on adm. 103.2°. Range of p. 128-88. Max. temp. 2 mos. before discharge 100.4°. Range of p. 104-! 88. Rest cure, in bed, 105 days; _ in open air on balcony, in r e c 1 i n ing chair and bed on bal-cony 183 days. Forced Third stage active (mostly ar-rested). 11 lbs. Patient did remarkably well. On admission temperature 103, pulse 128, respiration 40. Marked cyanosis. Pa-tient seemed doomed. In-cessant cough. Copious sputum. Put to bed and kept there. Marked im-provement. On discharge only slight activity, slight Adult Patients—Class "A"—(Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days IN H.H. Condition on Admission Spu- iGeneral Progress tum Treatment Present Condition Gain in W'ght Remarks & right middle; infilt. extensive; softening. feedings (4 to 6 eggs and 2 qts. milk.) temp., slight cough, mod-erate amount of sputum, good appetite; looks like different woman. Dis-charged because of in-ebriety of husband. Re-fused to go to hospital for completion of cure. Hus-band lost 5 lbs. Chronic alcoholic. Family was kept in H. H. in hope man would reform as wife made such marked im-provement. Family consists of Frederick and An-nie S., aged 39 and 35 yrs., and 5 chil-dren, aged respec-tively 12, 10, 8, 5 and 2 yrs. F. S. U. S. Prot. 38 yrs. 3-19-12 480 Second stage ac-tive. Infilt. both upper lobes; fib-rosis left base post. + Max. temp. on adm. 99.4°. P. 112-84. Patient showed progres-sive improve-ment and was discharged ar-rested on May 8, 1913. Failed to follow advice and was read-mitted second stage active Nov. 24, 1913. Rest cure 90 days on first admis-sion. Com-plete rest cure since readmission. Second stage active. Mod-erate cough and sputum (positive). Gastro-intestinal complica-tions. Chest signs same as on first admission. Considerable emphysema. Lost 16}* lbs. Patient is a chronic relaps-ing type. Long history. Previous hospital and sanitarium treatment. Will probably not recover. Re-admitted for children's sake. Wife remains healthy. Mary 12 yrs., dentistry; has gained lllA lbs. Annie, 12 yrs. (suspect), den-tistry; gained 16 lbs. Freddie, 10 yrs., dentistry; gained 11 lbs. Charles 6 yrs., much dentistry; ton-sils and adenoids removed; gained 9 lbs. Lillie 4 yrs.. gained 8 Y\ lbs. Family consists of Patrick and Mary R., both aged 35, and 3 children, 6 yrs., 5 yrs., and 3 yrs., respectively. P. R. Irish. R. c 35 yrs. 9-12-13 189 1st stage arrested Infiltration right upper lobe; dry rales. + Progressive im-provement. Max. temp, on admis. 99.6°. P. range 92-70. Pulse and temp, nor-mal past 2 mos. Working. Sleeping on open bal-cony. Extra n|ourish-ment. Arrested. No rales. Cough and sputum slight. (Sputum +.) 5 lbs. Patient feels much stronger and is gaining steadily though at work. Wife is healthy (pregnant). John, 6 yrs. (suspect), has had adenoids and tonsils re-moved; has gained 4J4 lbs, 1 1 Family consists of Patrick and Annie B., aged 44 and 41 yrs., and 5 chil-dren, 14, 12, 9, 5, and 3 yrs., respec-tively. P. B. Irish. R. C. 44 yrs. 42 yrs. 11-1-13 138 235 2nd stage active. Infilt. both up-per lobes; moist rales; moderate cough & moder-ate sputum (pos-itive just prior to admission) ; loosing weight. Family consists of Wm. and Annie S., aged 42 and 41 yrs., and 4 chil-dren, aged respec-tively 13, 11, 7 and 5 yrs. W. S. U. s. R. C. 4-22-12 Second stage ac-tive. Cough 17 yrs. Dulness & rales, left upper & apex of left lower, infilt. ex-tensive. Some softenin'g. Signs bronchitis & asthma. Family consists of John and Char-lotte C, aged 31 and 24 yrs., and 3 children, aged re-spectively 8, 3 and y2 yrs. J. C. u. s. R. C. 37 yrs. 11-26-13 400 Second stage ac-tive. Cough 7 yrs. Right up-per dulness & rales; increased voice & breath-ing; left apex dulness & rales. Patrick, 5 yrs. (patient), gained \y2 lbs. Elizabeth, 3 yrs. (suspect), gained 5 Progressive im-provement. Max. temp, on admis. 99.2°. Range of p. 96-72. Rest cure 138 days. Treat-ment for Otitis Me-dia and lumbago. Arrested. Oc-casional dry rale. Cough very slight. Spu tum ver\ slight. (negative.) 13^ lbs. Patient is greatly improved. Rapid gain in weight since admission. Was losing prior to admission. Annie, 41yrs., is a 1st stage active case (see Class B). Ed-ward, 14 yrs., adenoids and tonsils removed; much den-tistry; has gained 4f£ lbs. Alice, 12 yrs. (patient), tonsils and adenoids re-moved; much dentistry; has gained Qji lbs. Pat-rick, 9 yrs. (suspect), ton-sils and adenoids removed, has gained 3% lbs. Kather-ine, 3 yrs. (suspect), ade-noids and tonsils removed; has gained 2% lbs. Progressive im-provement. Max. temp, on admis. 100.8°. Range of p. 104-72. Max. temp, for past 2 mos. 98.4°. Range of p. 80-76. Partial rest cure 235 days. Extra milk and eggs. Apparently cured. Spu-tum nega-tive. Son-orous sib. rales. Nc fine rales. QY4 lbs. Disease complicated by ma-laria and asthma. Patient not amenable to advice and direction; condition arrested when discharged. Much dentistry. Earning capacity on admission $30 per month; earning capacity on discharge, ready to start work at $17.50 per week. Four months later couple at work managing nicely; "never felt better." Progressive im-provement. Blood streaked sputum for 3 mos. Max. temp. 99.2°. Range of pulse 104-70. Rest cure 111 days. Full time work past 4 mos. Apparently cured. lib. Patient chronic relapsing type. Left hospital _ in good physical condition with earning capacity com-pletely restored. Wife healthy woman; gained 30J4 lbs. Alexander, 8 yrs. (patient), tonsils and ade-noids removed and den-tistry; gained 8^2 lbs. Charlotte, 3 yrs., mastoid-ectomy; gained &/2 lbs. Adult Patients—Class "A"—(Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days in H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain in W'ght Remarks John and Charlotte C. (Con't.) Marie, lyi yrs., maistoid-ectomy; tonsils and ade-noids removed; gained 1 lb. Family consists oi Edward & Lillian M., aged 37 and 34 yrs., and 5 children aged re-spectively 11, 10, 8, 6 and 3 yrs. E. M. U. S. R. C. 37 yrs. 11-26-13 113 Second stage ac-tive. Cough 6 mos. Sputum moderate _ ( + ) ; very rapid loss of weight; infil-tration left up-per lobe, right apex & apex of left lower. + Marked progres-sive improve-ment. Max. temp. 100.6°. Range of pulse 108-72. Complete rest cure 50 days; graded exercises 63. Arrested. No sputum; practically no cough; no rales. 29J4 lbs. This rapid gain in weight has been made despite a severe complicating ma-laria. On admission pa-tient was very sick and seemed a bad risk. After 113 days looks and feels like new man. Wife (sus-pect) with gynecological complications has lost iy2 lbs. Lillian, 11 yrs. (sus-pect), tonsils and adenoids removed; dentistry; has gained 8J4 lbs. Kathleen, 10 yrs. (patient), adenoids and tonsils removed; den-tistry; has gained 3J£ lbs. Grace, 8 yrs. (suspect), bad cardiac case. Has gained 2J4 lbs. Edward, 6 yrs. (patient), tonsils and adenoids removed; has gained 1% lbs. Marie, 3 yrs. (patient), adenoids and tonsils removed; has gained 2 $4 lbs. Josephine McL., wid-ow, aged 36 yrs., and 5 children aged respectively 16, 13, 11, 7 and 4 yrs. L. McL. U. s. R. C. 16 yrs. 9-20-12 545 Incipient lesion rapidly advanced involving rt. up-per lobe & left apex. + General improve-ment past 8 mos. Complete rest cure 4 mos. Max. temp. 104.8°. R. of pulse 120-76. Graded ex-e r c i s e s since. Arrested. Slight cough and sputum ( + ) ; rales. dry; no temp, in 3 mos. 12 Y4 lbs. See description of mother (Class B) and children. Family consists of John and Louise L., aged respec- tively 38 and 31 yrs., and 3 child- ren 13, 10 and yrs. respectively. Family consists of Mary M., widow, 25 yrs., and child 4 yrs. Family consists of Joseph and Made- line P., agel 27 and 21 yrs., and 2 children 2 yrs. and 4 mos. respective- ly. J. L. M. M. U. S. Prot. Austria. R. C. J-P- Italian R. C. 38 10-23-12 513 yrs. 25 5-15-13 308 yrs. 27 11-25-13 114 yrs. Second stage ac- tive. Much cough & much sputum 3 yrs. Sputum blood streaked. Dul- ness and rales both apices. Tbc. laryngitis. Third stage ac- tive. Much cough & spu- tum; moderate cyanosis. Tbc. laryngitis (?) Gen'l infilt. left chest with an- trum 6 cm. in L.L. lobe. In- filt. R. upper lobe. Second stage ac- tive. Infilt. both upper lobes & left lower. Old Pott's dis- ease; asthma. Cough & spu- tum moderate, latter blood streaked. + + Progressive im- provement. Max. temp, on admis. 100°. Range of p. 92-70. cure Rest Part work. Tub- erculin. Progressive im- provement. Max. temp, on admis. 102.5°. Pulse range 116-72. Progressive im- provement. Max. temp, on admis. 99.6°. Range of p. 120-88. Complete rest cure 308 days. Complete rest cure 114 days. Tuber- culin. Arrested. Cough and sputum mod erate. Spu- tum nega tive for 4 mos. Scant dry rales Working part-time. Improved. Cough and sputum much less; only occa- sional slight temperature. Chest signs show less activity. Improved. Cough and sputum less; fewer rales. Past 2 mos. sputum negative. 5*4 lbs. HJ4 lbs. lbs. Patient is chronic relapsing type and typical spreader of infection. Wife, 31 yrs., has gained 6% lbs. Eve- line, 13 yrs., much den- tistry; has gained 24 }4 lbs. John, 10 yrs., dentistry; adenoids and tonsils re- moved; gained 10 Y± lbs. Raymond, 8 yrs., dentis- try; tonsils and adenoids removed; gained 11 }i lbs. Patient bad prognosis on ad- mission. Family admitted on account of child who is a patient. Has had ade- noids and tonsils removed and has gained 6J4 lbs. He is now in excellent condition. Patient discontented; trou- bled much with asthma. Wife, healthy; much den- tistry; has gained 5 lbs. Joseph, 2 yrs., has gained 2 lbs. Jennie, 4 mos., has gained 4}i lbs. ADULT PATIENTS—CLASS "B" Description of Family Patient 'amily consists of Angelina M., wid- ow with 3 children aged respectively 8, 7 and 5 yrs. Family consists of Rocco and Mary P., aged 50 yrs and 30 yrs., and 5 children, aged spcctively 10, 7, 4 and 2 yrs. (Child horn 6 mos. after admission.) Nativity and Re- ligion A. M. M. P. Italian R. C. Italian R. C. Age on Ad- mis- sion 42 yrs. 31 yrs. Date of Ad- mission 11-19-12 4-13-12 No Days H.H 485 668 Condition on Admission Spu- General Progress tum i Second stage ; tive. Cough. chills, sweats. Dull right apex; dulness with rales; 3-4 space, right ant. Second stage ac- tive. Cough; ex- pectoration; dul- ness right apex, ant. & post.; dull post. to base. Left up- per, rales 2-3 spaces. Progressive im- provement. Max. temp, on admis. 99°. Range of p. 92-68. Progressive im provement. Max temp, on admis 99°. Pulse range 92-72. Treatment Partial cure days. Partial rest cure 6 mos Present Condition Apparently cured. Very slight cough; occa- sional spu- tum; no rales. Apparently cured. No cough, sputum no rales in 14 mos. Gain IN W'ght 30^ lbs. 12/2 lbs. Remarks Excellent general condition. Rehabilitated. About to be discharged. Earning ca- pacity on admission O now $40 per month. Ma tilda, 8 yrs. (suspect), ade noids and tonsils removed dentistry; gained 4^5 lbs Nora, 7 yrs. (suspect), ade noids and tonsils removed dentistry; gained 11 lbs Rose, 5 yrs. (patient), ade noids and tonsils removed gained 6 lbs. Family discharged in Feb., 1914, rehabilitated physi- cally, socially and econ- omically. Present earning capacity JJ410 per week. All members show remarkable improvement under H. H. treatment. Mother, though pregnant upon admission, and with active tb._ was able to arrest her disease during her pregnancy. Rocco, 10 yrs., tonsils and adenoids removed; glasses; dentistry; gained 9$4, lbs. Angelina, 7 yrs. (patient), adenoids and tonsils # re- moved; dentistry; gained 13 lbs. Salvatore, 4 yrs. (patient), adenoids and tonsils removed; circumci- sion; gained 6}4 lbs. Ellen, 2 yrs. (patient), adenoids and tonsils removed; myr- ingotomy; gained 10 lbs. Tony, born at H. H. very marasmic type; died soon after birth. Tamily consists ofl Josephine M., wid-| ow, and 5 child-ren, aged respec-tively 15, 12, 10, 6, and 4 yrs. J. M. U. S. R. C. 35 yrs. 9-20-12 546 First stage ac-tive. Cough 9 mos.; sputum moderate. Dul-ness & rales right apex. Family consists of John and Mary S., aged 36 and 34 yrs., and 4 child-ren aged respec-tively 9, 7, 5 and 3 yrs. J. S. Ger-many. R. C. 30 yrs. 11-24-13 115 First stage ar-rested. Fibrosis R. apex. Dis-charged 3 mos. from sanitar-ium. Cough & loss of 10 lbs. since. Theresa C, single 19 yrs. (adoles-cent). T. C. Ireland. R. C. 19 yrs. 10-19-12 316 First stage ac-tive. Cough much—2 yrs.; sputum slight. Dulness & rales right apex, ant. & post. Progressive im- provement. Max. temp, on admis. 99.4°. Pulse range 92-72. Progressive im- provement. Max. temp. 98.6°. Pulse 100-60. Progressive im- provement. Up- on first admis. max. temp. 100°. Range of pulse 116-88. Dis- charged app. cured May 29, 1913. Readmit- ted Dec. 16, 1913. Max. t. 100.4°. Pulse range 100-80. Partial rest cure 50 days. Housework since. Working times. Rest cure 79 days. Par- tial rest cure 41 days. Then h o u sework until dis- charge. Since readmission partial rest cure. Apparently cured. No cough, no sputum, no temperature in 8 mos. Apparently cured. Cough slight; spu- tum scant. Apparently cured (Mar., 1913). Arrested March 19, 1914. Lost lbs. lbs. Lost 9 lbs. Mother is in excellent physi- cal condition except for gynecological complica- tions. Family being kept at H. H. on account of adolescent daugher (see (Class A). Joseph, 13 yrs. (suspect), dentistry; endo- carditis; has gained 13 J4 lbs. Edward, 11 yrs. (sus- pect), dentistry; rinj? worm; gained 3% lbs. Frances, 8 yrs. (patient), dentistry; adenoids and tonsils removed; gained 10 lbs. Harry, 6 yrs. (pa- tient), tonsils and ade- noids removed; gained 8 lbs. Patient has done well but will have to be dis- charged (dipsomaniac). Wife, healthy; gained 8J4 lbs. May, 9 yrs. (suspect), adenoids and tonsils re- moved; gained 1 lb. Will- iam, 7 yrs. (suspect), ade- noids and tonsils removed; gained 2 lbs. George, 5 yrs. (patient), adenoids and tonsils removed; gained 2 lbs. Kathleen, 3 yrs. (patient), adenoids and tonsils removed; gained H lb. (Just re- covering from operation.) Patient discharged apparent- ly cured March 29, 1913. Failed to follow advice and direction. Readmitted as a 1st stage (active) Dec. 16, 1913. Chest condition now arrested. Chief trouble at present is tb. salpingitis. Adult Patients—Class "B"— (Continued) \ Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days in H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain in W'ght Remarks Family consists of Lizzie K., aged 36 yrs., insane hus-band (committed), and 4 children aged respectively 18, 16, 13, and 9 yrs. L. K. Ireland. R. C. 36 yrs. 3-19-12 354 Second stage ac-tive. Cough al-most incessant. • Sputum copious. Infilt. right up-per, left lower; many rales. Marked dulness. Progressive im-provement. Max. temp, on admis. 99.6°. Range of p. 104-62. Max. temp, past 2 mos. 98.8°. Range of p 96-76. Rest cure 205 days. Housework past 3 mos. Apparently cured. Gen-eral condi-tion excel-lent; cough scant; much sputum; no bacilli. Slight dul-ness right upper; few dry rales; rales scant, right base post. QYa lbs. All children have done well; have gained respectively iyit \\y2, 9J4 and 6 lbs. Family earning capicity in-creased from $4.50 per wk. on admission to $16.50 on discharge. Rehabilitation complete. Family consists of Eugene and Fan-nie G., each 24 yrs. old; and 2 children aged re-spectively 2yi yrs. and 5 mos. E.G. Rus-sian. R. C. 25 yrs. 3-29-12 355 First stage ac-tive. Much cough & much sputum. Right apex dulness; retr. bron.— vesic breathing; incr. fremitus; no rales. Progressive im-provement. Max. temp, on admis. 99°. Range of p. 100-72. Max. temp. 2 mos. before disch. 98.6°. Range of p. 88-72. Rest cure 97 days. Work-ing 227 uays. Disease ap-parently cured Cough very slight; _ ex-pectoration very slight. General condition excellent. 28 lbs. Patient's income on admis-sion O. Present, $13.00. Bobbie, 3 yrs., patient, gained 5]4 lbs. and had tonsillectomy; Theodore, 5 mos. and suspect, gained iy4 lbs. Family consists of John and Virginia D., each 24 yrs. of age, and 1 child, 4 mos. J. D. Italy. R. C. 24 y2 yrs. 4-12-12 145 Second stage ac-tive. Right up-per dull; many rales; left up-per rales incon-stant above clav., left lower post. Rales. Condition unim-proved. Max. temp, on admis. 98.8°. Range of p. 92-72. Max. temp, on disch. 98.6°. Range of p. 88-24. Did not fol-low orders. Took in boarders. Unchanged upon dis-charge. Signs same. Lost 4 lbs. Patient not amenable to ad-vice. Earning capacity up-on admission 0. Earning capacity upon discharge $12 week. Family consists of John and Mary L., aged 48 and 41 yrs., and 5 child-ren, aged respec-tively 15, 12, 8, 6, and 3 yrs. J.L. Ireland. Prot. 48 yrs. 4-11-12 161 Second stage ar-rested. Cough 2 yrs. Dull right apex, ant. and post. Dull left apex. No rales. Unimproved. Max. temp, on adm. 98.8°. Range of p. 96-76. Max. temp. on disch. 98.4°. Range of p. 84-74. None (nevci could be found). Second stage arrested. Signs same Inactive. Lost 1/a lbs. Patient, a wandering drunk-ard, absented himself for 87 days to test prison rest cure (Conn.). Lost 12 lbs. Upon return gained 9J4 lbs. in 9 days. Again dis-appeared. Family dis-charged as patient did mot return for treatment. Nm. and Louisa W., aged 34 and 27 yrs., infant of 3 mos. L. W. U. S. Prot. 27 yrs. 7-13-12 242 First stage ac-tive. Cough moderate 7 mos. Sputum moder-ate. Right apex dull & rales, ant. & post. Family consists of Raphael and Jen-nie G., aged 45 and 40 yrs., and 5 children, aged re-spectively 14, 13, 8, 4 and 2 yrs. J. G. Italian. R. C. 40 yrs. 4-3-13 349 First stage ac-tive. Infilt. L. apex; rales to 2nd rib; moder-ate cough & sputum. Family consists of widow, Annie, 28 yrs., and 3 child-ren, aged respec-tively G, 4, and 1 yr. A. O'K. Irish. R. C. 28 yrs. 4-2-12 554 Second stage ac-tive. Right apex, dull harsh breathing; scanty rales. Apex right lower lobe dull and rales. Left apex, dulness. Max. temp, on adm. 99°. Range of p. 92-80. Max. temp. 2 mos. before disch.98°. Range of p. 88-76. Partial rest cure 218 days. Extra milk and eggs. Apparently cured. No cough or sputum. Slight dul-ness; no rales. 10}* lbs. Patient is markedly in proved. Has had salvai san and neosalvarsan; als salicylate of mercurj William (luetic) lost, 8} lbs. soon after admissior After 2 injections of nee salvarsan gained 7J4 lbs Present condition good Evelyn (baby), distinct! syphilitic, puny wail Weight on admission (3y mos.), 5 lbs. 3 oz. Ha gained 9 lbs. 6 oz. Se classification of Children. Max. temp. 99°. Pulse range 96-64. Partial rest cure 8 mos. House* work since. Apparently cured. No rales; no cough or sputum. 15 X lbs. Patient in excellent condi tion and ready for dis charge. Husband healthy gained 10y2 lbs. Daniel 14 yrs., dentistry; gainei 9Y2 lbs. Gaetano, 13 yrs., suspect, dentistry; gained 4Y2 lbs. Emma, 8 yrs., pa-tient, adenoids and tonsils removed; gained_ 6J4 lbs. Olga, 4 yrs., patient, ade-noids and tonsils removed; gained 4f4 lbs. Ida, 2 yrs., patient, gained 4 lbs. Progressive im-provement. Max. temp, on admis. 99°. Pulse range 100-72. House work for 1 yr. Attendant at H. H. for past year. Disease ap-parently cured. Dul-ness only; no rales. 10M lbs. Patient a forlorn melancholy woman on admission. Now changed to a bright happy "worth-while" type. Past year has been staircase at-tendant. Earning capacity on admission O. Now $45.00 per month. Agnes, 6 yrs., suspect, adenoids and tonsils removed; den-tistry; gained 8 lbs. Florence, 4 yrs., adenoids and tonsils removed; den-tistry; gained 9 !/i lbs. James, 1 yr., adenoids and tonsils removed; circum-cision; gained 12 $4 lbs. Adult Patients—Class "B"—(Continued) Description of Family Patient Nativity and Re-ligion Age ON Ad-mis-sion Date of Ad-mission No Days IN H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain in W'ght Remarks Family consists of Michael and Mar-garet C, both 33 yrs., and 3 child-ren, aged respec-tively 7, 2 yrs. and 9 mos. (Wife of above.) M. C. M. C. Irish. R. C. Irish. R. C. 33 yrs. 33 yrs. 12-9-14 12-9-14 100 100 F"irst stage ac-tive. Infilt. R. apex; rales to 2nd space. Cough & sputum moderate. Loos-ing weight. First stage ac-tive. Infilt. L. U. lobe; rales to 2nd sp. Some fibrosis. Slight cough & expec-toration. — Progressive im-provement. Max. temp. 98.6°. Pulse range 92-GS. Progressive im-provement. Max. temp. 99.4°. Pulse range 100-76. Partial rest cure. Partial rest cure. Arrested. Oc-casional rale above clav-icle. Cough and sputum only occa-sionally. Arrested. No rales. Oc-casional sputum. 754 lbs. 154 lbs. Patient had rectal complica-tion causing loss of much blood. Hemorrhoidectomy at H. II. Since opera-tion has rapidly improved. Woman has shown marked general improvement since admission to II. IT. Lillie, 7 yrs., patient, adenoids and tonsils removed; gained 1% lbs. Rose, 2 yrs., patient, adenoids and tonsils removed; gained 2JA lbs. Katherine, 9 mos., suspect, gained 654 lbs. Annie B. (wife of Patrick B. See Class A.) A. B. Irish. R. C. 41 yrs. 11-1-14 138 First stage ac-tive. Infilt. R. apex; rales to 1st space; slight cough & sputum. .Max. temp. 99.4°. Pulse range 92-72. Partial rest cure. Arrested. No rales. Occa-sional cough and sputum. 1354 lbs. Patient probably contractei disease from husband jus prior to admission. Pa tient has gained 13J/2 lbs despite pelvic complica tions. Family consists of Sarah W., widow, aged 45 yrs., and 3 children aged respectively 13, 9, and 5 yrs. S. W. Irish. Prot. 45 yrs. 4-8-12 477 Second stage ac-tive. Cough & expectoration. Both upper lobes; dulness with many rales. Progressive im-provement. Max. temp, on admis. 98.4°. Range of p. 92-72. Partial rest cure for 6 mos. Then housework. Apparently cured. Dis-charged from H. H. 9 mos. ago. lbs. Patient has remained ii good condition since dis charge. John, 13 yrs., den tistry and glasses; gainec liy2 lbs. Marion, 8 yrs. suspect, adenoids and ton sils removed; dentistry gained 4J4 lbs. Charlotte 5 yrs., suspect, adenoid: and tonsils removed; den tistry; gained 6^4 lbs. Nellie B., 30 yrs.,l widow with 3 children, aged re-spectively 7, 5, and 3 yrs. N. B. Polish. R. C. 30 yrs. 10-16-12 519 Second stage ar-rested. Cough; much sputum; dulness, apices; no rales; pleu-risy at right base. Progressive im-provement. Max. temp, on admis. 99.6°. Range of p. 100-72. Rest cure 30 days. Par-tial rest cure 90 days. Since then full time work. Apparently cured. No rales; no cough; no sputum. Ex-cellent gen-eral condi-tion. lbs. Since discharge has become a staircase helper and has continued to gain. Earn-ing capacity on admission O. Present $40.00 per month. Mary, 7 yrs., sus-pect, adenoids and tonsils removed; dentistry; gained 12J4 lbs. Frances, 5 yrs., suspect, adenoids and ton-sils removed; gained 954 lbs. Stephanie, 3 yrs., pa-tient, adenoids and tonsils removed; gained 105*4 lbs. Salvatore and Jose-phine F., aged 43 and 33 yrs., and 3 children, aged re-spectively 12, 9 and 5 yrs. J.F. Italian. K. C. 33 yrs. 12-19-12 43S Second stage ac-tive. Cough 0 yrs. Sputum moderate. Right upper, dulness & rales; left up-per, dulness & rales. Progressive im-provement. Max. temp, on admis. 100°. Range of p. 96-72. Rest cure 59 days. Housework. Apparently cured. No cough, no sputum, no rales in 9 mos. 58^ lbs. Marked general improve-ment. Looks like different woman. Grace, 12 yrs., pa-tient, adenoids and tonsils removed; much dentistry; gained 11 lbs. Raymond, 9 yrs., patient, adenoids and tonsils removed; dentistry; gained 10^4 lbs. Michael, 5 yrs., patient, adenoids and tonsils removed; den-tistry; gained 9J-6 lbs. Josepli and Margaret G. (family de-scribed in Class A.) M. G. English. R. C. 31 yrs. 8-10-12 573 First stage ac-tive. Cough moderate—2 yrs. Sputum slight. Rales & dulness above left clav. --- Progressive im-provement. Max. temp, on admis. 99.2°. Range of p. 100-70. Partial rest cure for 14 mos. Apparently cured. No cough, no sputum, no rales in 8 mos. 12 lbs. Family recently discharged, rehabilitated. Family consists of Robert and Nettie G., aged 37 and 35 yrs., and 3 chil-dren, aged respec-tively 13, 12, and i yr. N. G. U. S. R. C. • 35 yrs. 5-22-13 274 Second stage ac-tive. Infilt. both apices, with rales on R. side to 2nd rib. Moderate cough and sputum. Progressive im-provement. Max. temp. 99.4°. Pulse range 90-68. Partial rest cure. Apparently cured. No cough, no sputum, no rales in 6 mos. 9J4 lbs. Family discharged Feb. 21, 1914, rehabilitated. Rob-ert, husband, gained 5 lbs. Lena, 13 yrs., dentistry; gained 14 lbs. Amelia, 12 yrs., dentistry; gained 4J4 lbs. Gertrude, 1 yr., sus-pect, gained 6 lbs. Family consists of Frank and Jose-phine O, aged 41 and 45 yrs., and (i children aged re-spectively 15. 12. F. C. Italian. R. C. 41 yrs. 11-20-13! 113 Second stage nc tive. General in-filt. right upper and R. middle lobes. (Con-siderable fibro- Progressive im-provement. Max. temp, on admis. 98. Pulse range 100-64. Working part of time. Arrested. No rales. Spu-tum and cough very seldom. 354 lbs. Beginning to show decided improvement though work-ing. Wife, 45 yrs., healthy; gained 3^4 lbs. Tony, 15 yrs., patient, not amenable to advice, has lost 5^4 lbs. Adult Patients—Class "B"—(Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days in H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain in W'ght Remarks 10, 8, 3 yrs., and 6 mos. sis.) Moderate cough, copious expectoration. Caroline, 12 yrs., den-tistry; gained 6 lbs. Nello, 10 yrs., suspect, bone and skin tuberculosis (?); has gained 4J4 lbs. Katie, 8 yrs., suspect, dentistry; and tonsils removed; has gained 1 lb. Antoinette, 3 yrs.,_ patient, adenoids and tonsils removed; has gained 1354 lbs. Carmella, 6 mos., has gained 5*4 lbs. Family consists of Andrew and Mary I., 25 and 24 yrs., and 2 children aged respectively 3 and 2 yrs. A.I. Hun-garian, R. C. 25 yrs. 7-9-13 252 Second stage ac-tive. Infiltration both lower lobes posteriorly. Much cough; profuse expec-toration. Progressive im-provement. Max. temp, on admis. 100.2°. Pulse range 100-68. Rest cure 252 days. Tuber-culin. Improved. No cough; nu sputum; no rales; runs an occasion-al slight temperature. 5^4 lbs. Much improved by tubercu-lin. Wife, healthy, has gained 954 lbs. (pregnant 2 mos.) John, 3 yrs., ade-noids and tonsils removed; has gained 454 lbs. Marie, 2 yrs., suspect, has gained 354 lbs. Family consists of Jennie DeG., wid-ow, aged 45 yrs., and 5 children aged respectively 14, 12, 11, 7 and 5 yrs. J. DeG. Italian. R. C. 45 yrs. 11-25-13 114 Second stage ac-tive. Infiltration right and left upper lobes and apex of left lower lobe. Moderate cough and expectora-tion. Progressive im-provement. Max. temp. 99°. Pulse range 86-72. Partial rest cure. Improved. Cough and sputum less. Signs about the same. No tempera-ture for 2 mos. 3*4 lbs. General appearance much improved. Rose, 14 yrs., mitral insufficiency; den-tistry; gained 954 lbs. Thomas, 12 yrs., adenoids and tonsils removed fol-lowing which he gained 7 lbs. in w days. Mary, 11 yrs., patient, dentistry; tonsils and adenoids re-moved; gained 1*4 lbs. Louie, 7 yrs., suspect, ton-sils and adenoids removed: gained 254 lbs. Susie, 5 yrs., patient, tonsils and adenoids removed; gained 154 lbs. ?amily consists ofi Albina F., widow, 36 yrs., and 5 children, aged re-spectively 13, 9, 7, 3 yrs., and 4 mos. A. F. Italian. R. C. 36 yrs. 11-25-13 114 Second stage ar-rested. Infilt. R. upper lobe and 1. apex (fib-rosis). Moder-ate cough; scant expectoration. Family consists of Daniel and Agnes J., 30 and 26 yrs., and 2 children aged respectively 2 yrs., and 4 mos. A.J. Irish. R. C. 26 yrs. 11-24-13 115 First stage ac-tive (Incipient). Infilt. R. apex. Moderate cough, copious sputum. at times blood streaked. Rapid loss of weight and strength. Pregnant three weeks. Family consists of Antonio & Jennie L., aged 38 and 30 yrs., and 5 children aged re-spectively 12, 10 6, 3, and 1 yr. A. L. Italian. R. C. 3S yrs. 11-28-13 111 First stage ar-rested. Infilt. R. apex (dry). Hemoptysis 4 mos. before adm. Moderate cough and expectora-tion. Family consists ol Cornelius and An-nie M., aged 40 and 35 yrs., and 5 children aged re- A. M. i Irish. R. C. 35 yrs. 8-28-13 203 Second stage active. Infilt. R. upper and R. middle lobes and apex ofL.upper lobe. ' Moderate cough Progressive im-provement. Max. temp. 98.8°. Pulse range 96-72. Partial rest cure. Arrested. Very slight cough. No sputum. 754 lbs. Melancholy and despondent on admission. Now bright and cheerful. Mary, 13 yrs., suspect, dentistry; glasses; gained 754 lbs. Avanti, 9 yrs., suspect, tonsils and _ adenoids re-moved; dentistry; no gain or less. Rose, 7 yrs., pa-tient, tonsils and adenoids removed; dentistry; gained 54 lb. Ribella, 3 yrs., ton-sils and adenoids removed; gained 154 lbs. Andrew, 4 mos., normal baby born at H. H. Progressive im-provement. Max. temp. 98.6°. Pulse range 96-64. Complete rest cure 1 mo. Partial rest cure 1 mo. House work at present. Arrested; in-constant rales. Cough only occa-sional. No sputum. 11 J* lbs. Despite pregnancy patient has become arrested. Have had several similar cases at the H. H. Husband, healthy, has gained 1J4 lbs. John, 2 yrs., suspect, gained 4 lbs. Andrew, 4 mos., gained 454 lbs. Progressive im-provement. Max. temp. 98.6°. Pulse range 92-68. Partial rest cure. Apparently cured. Only occasional cough and expectora-tion. 5J4 lbs. Patient is in excellent gen-eral condition and soon to be discharged. Jennie, healthy, has gained 1154 lbs. Frank, 12 yrs., sus-pect, gained 4 54 lbs. Jo-seph, 10 yrs., suspect, lost l/2 lb. (recovering from adenoid and tonsil opera-tion). Josephine, 6 yrs., adenoids and tonsils re-moved; lost Y2 lb. Jennie, 3 yrs., adenoids and ton-sils removed; gained }/2 lb. Rose, 1 yr., gained 154 lbs. — Progressive im-provement. Max. temp. 99.8°. Pulse range" 112-72. Partial rest cure. Arrested. No rales. Slight cough and expec-toration. 1054 lbs. Marked general improve-ment in patient. Was los-ing rapidly prior to admis-sion. Husband healthy. Philip 11 yrs., suspect, Adult Patients—Class "B"— (Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days IN H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain IN W'ght Remarks spectively 11, 10, S, 3, and 1 yr. and sputum. Recent loss of weight. adenoids and tonsils re-moved; gained 6;s lbs. William, 10 yrs., suspect, adenoids and tonsils re-moved; double herniotomy; plastic for undescended testes; gained 4>4 lbs. Lil-lie, 8 yrs., suspect adenoids and tonsils removed; den-tistry; gained 8 lbs. Ger-trude, 3 yrs., suspect, ade-noids and tonsils removed; has gained 454 lbs. Minnie, 1 yr., patient, gained 11 >4 lbs. Family consists of Michael and Delia W., aged 33 and 34 yrs., and 4 children, aged re-spectively 11, 9, 3, and 15^ yrs. D. W. Irish. R. C. 34 yrs. 7-24-13 228 First stage ac-tive. Infiltration right upper (rales to 2nd space). Moder-ate cough and sputum. Loosing weight rapidly. Progressive im-provement. Max. temp. 100°. Pulse range 96-72. Partial rest cure. First stage arrested. No rales, no cough, no sputum. 1254 lbs. Patient very forlorn on ad-mission. Now happy and bright; glasses provided. Husband, healthy, gained 2354 lbs. Marie, 11 yrs., suspect, adenoids and ton-sils removed; glasses; den-tistry; has gained 13 lbs. Katharine, 9 yrs., adenoids and tonsils removed; den-tistry; gained 11J£ lbs. John, 3 yrs., patient, ade-noids and tonsils removed; gained 754 lbs. George, 154 yrs., suspect, gained 754 lbs. ADULT PATIENTS—CLASS "C Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days IN H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain IN W'ght Remarks Family consists of Frank and Lizzie R., aged respec-tively 26 and 22, and child 17 mos. old (all pa-tients). L. R. U. S. Prot. Episco-pal. 22 yrs. 3-20-12 430 Slight cough; no sputum. Fibro-sis right apex. Good, especially since death of husband. None. Apparently cured. Em-ployed as housemaid. 154 lbs. Patient discharged in e> cellent condition and ha remained so. Ethel, 2 yrs (see children patients). Family consists of Patrick and Kath-arine S., and 4 children, aged re-spectively 7, 4, 2 yrs., and 354 mos. P. S. Irish. R. C 48 yrs. 3-27-12 479 T. B. pleurisy; pleuritic rales left base. Progressive im-provement. Temp, normal. Pulse normal. Has been working since admis-sion. Disease ap-parently cured. Gen-eral condi-tion excel-lent. Signs same as on admission. 054 lbs. Patient's earning capacit; on discharge #40 per mc Ralph, 7 yrs., suspect, ade-noids and tonsils removed; circumcision; gained 8J4 lbs. Ella, 4 yrs., patient, gained 'iy lbs. Stella, 2 yrs., gained 5' 4 lbs. How-ard, marasmic, hopeless on admission, gained 19T4 lbs. Katharine, wife of Patrick S. (above). K. S. Irish. R. C. 27 yrs. 3-27-12 479 Dulness right up-per. No rales. Hist. of old tuberculosis. Pelvic peritonitis soon after ad., probably tuber-culous. Re-covery without operation. Pro-gressive im-provement since. Temp. and p. normal. Rest cure 89 days. Light house work 359 days. Apparently cured; dul-ness same; no constitu-tional symp-toms. 54 1b. Woman is like a different person since recovery from peritonitis. Formerly for-lorn and haggard; now bright and wholesome. Mary McG., wife of Martin McG. See Class A. M.McG. u. s. R. C. 25 yrs. 3-28-12 155 No active sym-toms. Mitral stenosis. Right apex slightly dull; retraction; increased fremi-tus and voice; broncho-vesic. breathing; no rales. Healed lesion. Improvement progressive at first. Loss later due to dissatis-faction. Temp. normal. Pulse normal. Housework. Disease ap-parently cured. Phy-sical signs unchanged. y ib. Had gained 6 lbs. Mental equilibrium un-stable (tnsanity in family). Not tractable. Adult Patients—Class "C"—(Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days in H.H. Condition on Admission Fannie G., wife of Eugene G. See Class B. F. G. Rus-sian. R. C. 24 yrs. 3-29-12 355 Healed lesion at apex, dulness retraction. Voice and_ breathing in-creased. No cough; no spu-tum. Family consists of Leonard and An-nie S., aged 21 and 23 yrs., and child of 13 mos. A. S. Ireland. R. C. 23 yrs. 4-3-12 183 Slight retr. left apex; incr. voice and breathing. No rales. Mary L., wife of 'John L. See Class B. M. L. Ireland. R. C. 41 yrs. 4-11-12 161 No definite sym-ptoms. Right apex dull; retr. Spu-tum General Progress Unchanged. Stationary. Max. temp, on admis. 98.8°. Range of p. 108-84. Max. temp. 2 mos. before dis-charge 98.4°. Range of pulse 92-72. Improved gene-ral condition. Max. temp, on adm. 98.2°. Range of p. 84-76. Max. temp. on discharge 98.6°. Range of p. 80-72. Treatment Housework. Housework. Housework. (Hard- working woman.) Present Condition Gain IN W'ght Remarks Disease ap- parently cured. Signs same. 54lb. Disease ap- parently cured. Signs same. None. Apparently cured. Signs same. 2*4 Patient not tractable. Men- tal equilibrium labile. For description ot children see Class B (Eugene G.). Patient 3 mos. pregnant on admission. Kept at hospi- tal until after confinement in order to care properly for mother and produce a healthy child. Baby weighed 8 lbs. at birth. Very well nourished. Nurs- ing when discharged, and in 21 days gained 2 lbs. 4 ozs. Husband gained 554 lbs. while working steadily, Helen gained 1J4 lbs. Dis charged as not needing further treatment. Familj all in good condition. Worked hard and worrier] much about husband. Pro vided with glasses. Re- lieved of incessant head- ache. Sent to country foi 1 wk. Tom, 15 yrs., lost 2J4 lbs. Worried mucl over father. James, 15 yrs., gained 154 lbs. (in corrigible). Mary, 8 yrs., gained 54 lb. Dental wort done. Ellen, 6 yrs., gainec 154 lbs. Had teeth attend ed to. William, 3 yrs. gained Y\ lb. Annie S., wife of 1 William S. See Class A. A. S. U. S. R. C. 41 yrs. 4-22-12 235 Four yrs. slight symptoms; dul-ness right apex. Dulness ana rales at left apex. Progressive im-provement. Max. temp, on admis. 99°. Range of p. 90-76. Max. temp. 2 mos. before discharge 98.8°. Range of p. 88-80. 97 days' rest cure. House-work en-tirely 138 days. Extra milk and eggs. Apparently cured. Dul-ness less marked. No rales. 14*4 lbs. Mental equilibrium labile; much dental attention; glasses and abdominal belt. For description of children see Class A. (Wm. S.). Salvatore and Jose-phine F., aged 43 and 33 yrs., and 3 children aged re-spectively 12, 9, and 5 yrs. S. F. Italian. R. C. 43 yrs. 12-19-12 448 Fibrosis R. apex. Improved. Non - resident at H. H. ex-cept for week-ends. Apparently cured. Signs same. 854 lbs. Man working in country town. For description of children see Children pa-tients and suspects. Family consists of John and Julia S., aged 31 and 26 yrs., and 2 child-ren aged respec-tively 6 and 1 yr. Julia S. Aus-trian. R. C. 26 yrs. 4-11-13 148 Fibrosis of L. apex. Improved. Housework. Apparently cured. Signs same. 1054 lbs. General appearance much improved. Husband healthy. John, 6 yrs., pa-tient, dentistry; glasses; gained J4 lb. William, 1 yr., suspect, gained 254 lbs. Tony C, aged 15 yrs. (adolescent). T. C. Italian. R. C. 15 yrs. 11-26-13 113 Fibrosis R. apex. (puestionable rales.) — Improved. Does not fol-low advice. Same signs. Lost 5*4 lbs. Patient has failed to fol-low advice and direction. ADULT PATIENTS—CLASS "D" Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days in H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain IN W'ght Remarks Family consists of Florence B., age 38 yrs., widow and 1 child, 4 yrs., and Florence D.. niece. F. B. Irish. R. C. 38 yrs. 5-27-13 8 Second stage ac-tive. General infilt. and par-tial consolida-tion L. chest; infilt. R. apex. Unimproved. Failed to fol-low advice. Unimproved. ? Discharged for failure to follow advice and direc-tion. Family consists of Jeremiah and An-nie M.. both aged 24 yrs., and 3 children aged re-spectively 6, 3 yrs., and 9 mos. J. M. A. M. U. S. R. C. U. S. R. C. 24 yrs. 24 yrs. 8-8-13 8-8-13 75 75 First stage ar-rested. Dulness R. apex; rales to 1st space. Second stage ac-tive. Infilt. R. apex and R. lower lobe. Pregrant half mo. — Improved. Max. temp. 98.6°. Pulse range 80-60. Improved. Max. temp. 100. Pulse range 100-72. Partial rest cure. Rest cure. Arrested. No cough; no sputum; no rales. Second stage active (al-most ar-rested). 1*4 lbs. 1454 lbs. Patient much improved by short residence but un-worthy type. James, Jr., 6 yrs., suspect; adenoids and tonsils removed; gained 254 lbs. Matthew, 3 yrs., ade-noids and tonsils removed; gained *4 lb. _ Jerry, 9 mos., patient, gained 15 oz. (Swallowed safety pin— gastroenterostomy.) Despite complicating preg-nancy patient's pulmonary condition steadily im-proved. Patient not tract-able. Family consists of Frederick and Rose H., aged 36 and 31 yrs., and 4 children aged re-spectively 11, 9, 7, and 2 yrs. F. H. U. s. R. C. 36 yrs.- 3-17-14 1 Third stage ac-tive. General infilt. and_ par-tial consolida-tion of R. chest with antrum 6 cm. in R. U. L. Infilt. L. upper lobe. + Just admitted. Rest cure. Third stage active. 0 Family just admitted. Wife healthy. Eldest three child-ren are suspects. The youngest, aged 2 yrs., is a patient. Family consists of Thomas and Marv R., aged 48 and 39 yrs., and 1 child 6 yrs. r. R. Irish. R. C. 48 yrs. 1-12-14 65 Second stage ac-tive. Diffuse infilt. R. chest, infilt. L. apex. Much cough; + Progressive im-provement. Max. temp. 100.2° Range of p. 96-68. Rest cure. 2nd stage ac-tive. Cough much im proved. Spu tum scant. 6*4 lbs. This initial gain occurs in many oi trie H. H. pa-tients sUowing the inimical influence of tenement housing. Mary, 39 yrs., | moderate spu-tum. suspect. Frank, 6 yrs., suspect, adenoids and ton-sils removed; gained 2 lbs. Family consists of William and Milli-cent E., aged 34 and 32 yrs., and 3 children 8, 6, and 254 yrs. respec-tively. W. E. U. S. Prot. Presb. 34 yrs. 3-18-14 1 25 Third stage ac-tive. General in-filt. L. chest with small an-trum in L. lower lobe. In-filt. R. upper. Moderate cough and sputum. + J ust admitted. Temp, on adm-99.8°. Pulse 100. Respira-tion 32. Rest cure. Third stage active. 0 Family just admitted. Alice, 8 yrs., suspect. Walter, 6 yrs., suspect. Millicent, 2 yrs., patient. Wife, sus-pect. Family consists of Lizzie H., widow, aged 33 yrs., and 2 children aged re-spectively 16 and 8 yrs., and wo-man's niece, Irene D., 18 yrs. L. H. Aus-trian. R. C. 33 yrs. 2-21-14 First stage ac-tive. Infilt. R. apex (rales to 2nd rib). Ques-tion of infilt. of L. apex. Cough and sputum moderate for 2 mos. Beginning to im-prove. Max. temp, on admis. 99°. Pulse 100-82. Partial rest cure. First stage active. Cough and sputum slight. 2/2 lbs. Patient beginning to im-prove, also illustrating initial gain in weight soon after admission. Irene, 18 yrs., gained 54 lb. Alex-ander, 16 yrs., lost V/2 lbs. (.Tonsillitis). Helen, 8 yrs., patient, gained 1*4 lbs. Family consists of James and Lillian D., aged 36 and 31 yrs., and one child 13 yrs. L. D. English. R. C. 31 yrs. 3-5-14 13 Second stage ac-tive. Infilt. L. upper lobe & R. apex. Moderate cough; very slight sputum. Beginning to im-prove. Partial rest cure. Second stage active. 2y2 lbs. Another illustration of tne initial gain in weight soon after admission. Patient has pelvic complications. Husband healthy. Lillian, 13 yrs., suspect. Family consists of Patrick and Eva C, aged 44 and 31 yrs. Sister Kath-erine C, aged 48 yrs., and 2 child-ren aged respec-tively 6 and 4 yrs. E. C. K. C. u. s. R. C. u. S. R. C. 81 yrs. 48 yrs. 2-19-14 2-19-14 27 27 Second stage ac-tive. Infilt. L. upper lobe— fibrosis R. apex. Old sanitarium case with re-lapse. Second stage ac-tive. Infilt. R. upper lobe. Questionable rales L. apex. Slight cough and sputum. - Beginning to im-prove. Beginning to im-prove. Partial rest cure. Partial rest cure. Second stage active. Second stage active. 0 lib. Sister, K. C. did not know she had tuberculosis until examined at H. H. Un-doubtedly infected from sister. Husband healthy. Lawrence, 6 yrs., suspect, lost 54 lb. Lillian, 4 yrs., patient, gained *4 lb. Adult Patients—Class "D"—(Continued) Description of Family Patient Nativity and Re-ligion Age on Ad-mis-sion Date of Ad-mission No Days in H.H. Condition on Admission Spu-tum General Progress Treatment Present Condition Gain IN W'ght Remarks Family consists oi Daniel and Mary K., aged 46 and 45 yrs., and 6 child-ren aged respec-tively 14, 13, 10, 8, 6, and 4 yrs. M. K. Irish. R. C. 45 yrs. 1-5-14 72 Second stage ac-tive. Infilt. of L. chest, Infilt. R. U. lobe. Much cough and sputum. Progressive im-provement. Max. temp. 98.8°. Pulse range 96-76. Partial rest cure. Much dentistry. Second stage active. Signs same. Cough and sputum less. lbs. Patient demonstrates initial gain in weight soon after adm. Husband healthy, gained 1*4 lbs. John 14 yrs., gained 3*4 lbs. Helen 13 yrs., suspect, gained 1*6 lbs. Mary 10 yrs., suspect, dentistry; gained 154 lbs. Katherine, 8 yrs., suspect, glasses; gained 2*jj lbs. Anna 6 yrs., suspect, ade-noids & tonsils removed; gained 2l/2 lbs. Julia 4 yrs., gained 1 lb. Family consists of Joseph and Mary K., both 30 yrs., and 4 children aged respectively S, 6, 4, and 2 yrs. M. K. Bo-hemian. R. C. 30 yrs. 12-18-14 90 First stage ac-tive. R. upper infiltration (rales to 2nd space). Ques-tion of L. apex. Cough and spu-tum 3 mos. Pregnant 6 mos. Progressive im-provement. Max. temp. 98.8°. Pulse range 100-80. Partial rest cure. Arrested. No rales. Cough and sputum only occasionally. 22 lbs. Gain in weight includes that due to pregnancy. Despite this condition patient's dis-ease became arrested. Marked general improve-ment. Husband healthy. Amelia, 8 yrs. suspect, ade-noids and tonsils removed; lost 1*4 lbs. Rudolph, 6 yrs., patient, gained 154 lbs. Joseph, 4 yrs., pa-tient, gained 1 lb. Olga, 2 yrs., patient, gained 154 lbs. Family consists of Raphael and Fan-nie M., aged 32 and 29 yrs., and 4 children aged re-spectively 7 and 3 yrs., and twins 4 mos. R. M. Italian. R. C. 32 yrs. 1-10-14 67 First stage ar-rested. Dulness R. apex to 3rd rib. Slight cough and ex-pectoration. Progressive im-provement. Max. temp. 98.8°. Pulse range 92-72. Partial rest cure. Arrested. Cough and sputum only occasionally. 9*4 lbs. Patient gaining rapidly since admission. Wife, healthy. Willian, 7 yrs., suspect, adenoids and tonsils re-moved; gained 1*4 lbs. Al-fonso, 3 yrs., adenoids and tonsils removed; gained 354 lbs. Maria and Lena, 4 mos. (twins), are both patients. These cases demonstrate how early the children may become in-fected. Family consists of Elias and Jennie M., aged 37 and 36 yrs., and 4 children aged re-spectively 12, 10, 9, and 2 yrs. J. M. Aus-trian. Hebrew. 36 yrs. 2-11-14 36 First stage ac-tive. Infilt. R. lower lobe. Much cough and sputum. Beginning to im-prove. Max. temp. 102.5°. Pulse range 116-80. Partial rest cure. First stage ar-rested. (?) Cough and sputum less. Lost 2 lbs. Husband healthy. Sarah. 7 yrs., suspect, lost 1*4 lbs. Benjamin, 12 yrs., suspect, lost 2 lbs. Millicent, 9 yrs., patient, lost 2J4 lbs. Isador, 2 yrs., patient, gained 1 lb. Family consists of Michael and Rose B., aged 34 and 31 yrs., and 3 child-ren aged respec-tively 11, 5, and 4 yrs. M. B. Hun-garian. 31 yrs. 2-9-14 37 Second stage ac-tive. Scattered infilt. both chests. + Beginning to im-prove. Max. temp. 99.4°. Pulse range 100-80. Partial rest cure. Second stage active. Cough and sputum im-proving. lib. Wife healthy. Alexander. 11 yrs., suspect, gained J4 lb. Irene, 5 yrs., patient, adenoids and tonsils re-moved; gained 54 lb. Mar-garet, 4 yrs., patient, ade-noids and tonsils removed; recovering from operation. ADULT SUSPECTS Family consists of Thos. and Mary R., aged 48 and 39 yrs., and 1 child 6 yrs. M. R. U. S. R. C. 39 yrs. 1-12-14 65 Questionable rales above R. clavicle. Coughing; slight temp. Improving. No elevation of pulse or temp. Housework. Improved. ? See description of family under Thos. R. (Class D). Family consists of Edward & Lillie M., aged 37 and 34_ yrs., and 5 children aged re-spectively 11, 10, 8, 6, and 3 yrs. L. M. U. S. R. C. 34 yrs. 11-26-13 113 Inconstant rales R. apex to 2nd rib. Coughing; no sputum. Pel-vic complica-tion. Very ner-vous. Improving. No elevation of pulse or temp. Partial rest cure. Improved. No rales. Coughing only occa-sionally. No sputum. Lost 2y2 lbs. Loss of weight due to gyne-cological complicatioriiS. (see Edward M., Class A). Family consists of Amedeo and Er-minia G., each aged 35 yrs., and 4 children aged re-spectively 6, 4, 3, and lyi yrs. E.G. Italian. R. C. 35 yrs. 10-15-13 155 Questionable rales both apices poster-iorly. Coughing. No temp. Improving. Cough slight. No elevation of temp or pulse. Working. Improved. IDS. Working steadily. Family consists of John & Virginia D'A., each 24J4 yrs. of age, and 1 child 4 mos. V. D'A. Italian. R. C. 2454 yrs. 4-12-12 145 Suspect. No defi-nite signs. Condition unim-proved. Temp. 98.4-97.2°. Pulse 88-76. Did not fol-low advice and direc-tion. Unchanged on dis-charge. Lost 7 lbs. Mother nursing infant. Both husband and wife caroused late at night. Retained at H. H. 145 days chiefly to give baby good start. Baby gained 4 lbs. 15 oz. (See John D., Class B.) CHILDREN PATIENTS Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Reaction Treatment Progress Present Condition Gain in W'ght Remarks Gertrude G. lyr. Anaemic pasty baby; fretful; coughing; signs in chest; enlarged glands; running a tem-perature. 274 Positive after 24 hours. On roof; careful feed-ing. Progressive im-provement. Tern]). range 100.2°-97° (rec-tal). General im-provement; no cough; chest clear; glands smaller; tonsils en-larged. 6 lbs. Mother indifferent to _ ad-vice. Refused tonsillec-tomy. John S. 6 yrs. Pale, anaemic, round shouldered, flat chested child; adenoid facies; mouth breather; large tonsils; huge glands; facial eczema; cough-ing; running a tempera-ture; signs in chest; dental caries; ametrop-ia; discharging ear. 148 Refused V. P. Special nour-ishment; open air school; den-tistry; glasses; ade-noids and tonsils re-moved. Marked general improvement. Temp. range 100°-90°. No temp.; no signs in chest; no cough; glands sub-sided; breathes with closed mouth; ec-zema cured; teeth in re-pair; good color. Lost 54 lb. Hoy quite transformed from dull, ashen, mouth breath-ing type to bright happy child. Jeremiah M. 9 mos. Anaemic; facial acne; en-larged tonsils; ade-noids; enlarged glands; phimosis. 75 Positive reaction after 24 hours. Part of time in German Hospital. Range of temp. 100°-97° (rec-tal). Unimproved. 15 oz. Gained 1 pound in first month at II. H. Swal-lowed a safety pin and was operated on at Ger-man Hosp. Family not amenable to advice and Margaret K. 7 yrs. Fairly well nourished; very pale; adenoid fa-cies; glands much en-larged; adenoids and tonsils enlarged; dental caries; signs in chest; running a temperature. 122 Suggestive after 24 hours. Fresh air; extra nour-ishment; dentistry; adenoids and tonsils removed. Progressive im-provement. Temp. range 99.4°-97°. Marked gen-eral im-provement; mucous membranes excellent color; glands sub siding; slight tem-perature Lost 1H lbs. General condition improved. Breathes with mouth closed. Ethel R. 15 mos. Ella S. Florence O'K. 00 4 2/3 yrs. 4 yrs. Pale, fretful child; coughing much; signs in chest; enlarged glands; running a tem- perature. Pasty anaemic child; looks chronically ill: coughing; enlarged glands; running a tem- perature. Pale, pudgy child; en- larged, glands; running a temperature; mouth breather. 420 479 554 Strongly positive after 24 hours Positive after 60 hours. Positive after 24 hours. On roof; ex- tra nourish- ment; sleeps out. Extra nour- ishment; tonic; den- tistry. Roof; _ extra nourish- ment; ade noids and tonsils moved; vac- cinated. Marked sive ment. range 98.6°. progres improve Temp 101.4° Progressive provement. Temp. range 100.6°-97A'. Marked improve ment. Temp. range 102.2°-98.4°. Excellent Rosy cheeks; bright healthy ap- pearance; no temp. cough in 6 months; glands sub- siding. Excellent col- or; no cough; glands sub- siding; still runs slight temp, of deg. Excellent; rosy cheeks; bright eyes; glands small; no temp. 75* lbs. 3 lbs. 9*4 lbs. This child was transformed from a fretful, sickly baby to a wholesome, bright healthy child. Fractured skull shortly before disch. Perfect recovery. Child continues to gain and is in excellent condition at pres- ent. Patient was picture of chronic illness; eyes sunk- en; pasty appearance; apa- thetic; now bright-eyed, smiling; red cheeks. Child completely changed; wholesome looking; much improved by removel of adenoids and tonsils; breathes with mouth closed; child continues> in excellent condition since discharge. James O'K. (Omitted from report of 1st year) lyr. Pale, flabby child; mu- cous membranes color- less; enlarged tonsils and adenoids; signs in chest; running a tem- perature; mouth breath- er; always sick; phim- osis; eczema. 554 Positive after 36 hours. Roof; extra nourish- mentj cir- cumcision; vaccination. Marked general improvement. Temp. range 99.4. Child should be greatly im-proved by operation as she had much naso-pharyngeal obstruction. Michael D. 5 yrs. 6 mos. Pale, anaemic misfit, half-starved; scabies; large glands; large ton-sils and adenoids; cough; signs in chest; running a temperature; no vitality. 463 Very suggestive after 24 hours. Roof; extra nourish-ment; ade-noids and tonsils re-moved. Progressive im-provement. Temp. range 99.4°-96°. E.xeellent con-dition ; fine color; no cough; no temp.; no signs in chest; glands small. 4*4 lbs. Marked general improve-ment. Child upon admis sion presented miserable appearance; dull; listless; no vitality. Has been transformed to bright, hap-py, wholesome appearance. Aurora C. 4 yrs. 9 mos. Just returned from Pre-ventorium; had en-larged glands; large tonsils and typical ade-noid expression; cough; running a temperature; scabies. 114 Positive after 48 hours. Roof; _ extra nourish-ment; ade-noids and tonsils re-moved. Progressive im-provement. Temp. range 100.8°-97.4°. Just recovered from opera-tion for ade-noids and tonsils. Lost % lb. Family had to be discharged for failure to follow ad-vice and direction. Child showed general improve-ment and relief of nasal obstruction. Scabies cured. Dominick G. lyr. Pale, pasty, pudgy, an-aemic type; adenoid fa-cies; enlarged glands; large tonsils; running a temperature. 155 Positive after 48 hours. Roof; careful feeding. Progressive im-provement. Temp. range 102.2°-98° (rec-tal). Much im-proved ; has good color; glands but slightly en-larged; no tempera-ture in 2 months. 4 lbs. Soon to have adenoids re-moved. Children Patients—(Continued) Name Age on Admission Condition on Adm. Days IN H. H. Von Pirquet Reaction Treatment Progress Present Condition Gain IN W'ght Remarks Maria G. ■ 3 yrs. 8 mos. Same as above. 155 Strongly positive after 48 hours. Roof; _ extra nourish-ment; ade-noids and tonsils re-moved. Progressive im-provement. Temp. range y9.2°-97°. Color much improved; glands sub-siding; no tempera-ture in 2 months. 4 lbs. Much improved by removal of adenoids and tonsils. Angelina P. 7 yrs. Poorly nourished and de-veloped; very pale; sunken eyes; huge glands; enlarged tonsils and adenoids; cough; signs in chest; run-ning a temperature. GGS Negative after 24 hours. Fresh air; open air school; ex-tra nourish-ment; tonic; adenoids and tonsils removed; dentistry. Progressive im-provement. Temp. range 100.6°-96.4°. Rosy cheeks; bright and happy; no cough; no tempera-ture; no signs in chest; good nasal breathing; teeth in re-pair. 13^4 lbs. Has continued to gain since discharge. Ellen P. 3 yrs. Pale, quiet, dull child; signs in chest; cough; enlarged glands; run-ning a temperature. 668 Positive after 60 hours. Roof; ex*ra nourish-ment; ton-ic; adenoids and tonsils removed. Marked progres-sive improve-Temp. range 101.4°-90.2°. Very whole-some; plump, rosy cheeks; no cough; no tempera-ture; no signs in chest; nasal respira-tion; glands subsided. 9/2 lbs. Transformed from stupid sickly child to bright, wholesome, attractive type. Harry McL. 4J4 yrs. Fairly well developed; anaemic; mouth-breath-er; rachitic chest; en-larged glands; en-larged tonsils and ade-noids; cough; running a temperature. 546 Negative after 48 hours. Open air school; ton-ic; ade-noids and tonsils re-moved; den-tistry. Progressive im-provement. Temp. range 100°-96.6°. On rest cure in bed. Was considered a suspect at first; then developed definite signs in chest; now 5*4 lbs. This is the second member of the family who upon ad-mission was considered a suspect and later found to be a positive case. Frances McL. 6 yrs. Fairly well nourished: anaemic; glands en-larged; tonsils en-larged; dental caries; signs in chest; running a temperature. Ring-worm of scalp. 546 Positive after 48 hours. Same as above. Progressive im-provement. Temp. range 99.6°-96.6°. Excellent gen-eral condi-tion; plump, rosy cheeks; glands small; teeth in repair; no signs in chest; no cough; no temperature. 10 lbs. Had a month of complete rest in bed with marked general improvement. Ring-worm cured. Rose M. 5 yrs. Fairly well nourished; underdeveloped; fair color; all glands en-larged; adenoids en-larged; dental caries; signs in chest; running a temperature. 485 Positive after 24 hours. Fresh air; ex-tra nourish-ment ; tonic; adenoids and tonsils removed. Progressive im-provement. Temp. range 101.2°-97.4°. Picture of health. Is chubby, rosy cheeks, bright eyed and happy; glands small; no cough; no signs in chest; no tempera-ture. 5^4 lbs. Present condition is in marked contrast to that on admission. Patrick R. 4y2 yrs. Admitted to H. IT. after 4 months in Preven-torium. Fairly well nourished; fairly good color; glands enlarged; tonsils huge; adenoids; dental caries; coughing; running a temperature. 189 Positive after 48 hours. Open air; tonic; ex-tra nourish-ment; ade-noids and tonsils re-moved; den-tistry. Progressive im-provement. Temp. range 100°-97°. Excellent gen-eral condi-tion; glands small; nasal breathing; no cough; no tempera-ture. 1J4 lbs. Healthy looking little boy. Alice B. 11 yrs. 10 mos. Under-developed; frail; very anaemic; circles under eyes; enlarged glands; large tonsils and adenoids; dental caries; cough; signs in chest; running a tem-perature. 138 Von Pirquet po-sitive before admission. Open air school; ton-ic; extra nourish-ment; ade-noids and tonsils re-moved; den-tistry. Progressive im-provement. Temp. range 100.2°-97°. Still coughing and running a tempera-ture# but gaining rap-idly. 6*4 lbs. It is just this type of child for whom the H. H. can do so much. Antoinette C. 3 yrs. 1 mo. Pasty and pudgy with adenoid facies; en-larged glands, large tonsils and adenoids and signs in chest. 113 Positive after 48 hours. Roof; extra nourish-ment; ade-noids and tonsils re-moved. Marked progres-sive improve-ment. Temp. range 99.4°-96°. Much im-proved; ex-cellent col-or; _ glands subsiding; nasal breath-ing. 4^4 lbs. Now has a bright, happy, wholesome expression. Children Patients—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet ., Progress Treatment Progress Present Condition Gain in W'ght Remarks Susie DeG. 5 yrs. 4 mos. Forlorn; frail with the physical development of a child of 3 yrs. List-less expression with adenoid facies; enlarged glands; large tonsils and adenoids; signs in chest; coughing; run-ning a temperature; dental caries. 114 Positive after 48 hours. Roof; tonic; extra nour-ishment; adenoids and tonsils removed. Progressive im-provement. Tem]). range 100°-90.4°. Beginning to improve from recent operation for adenoids and tonsils. 1 lb. One of the worst tenement types. Such a child shows to a marked degree the inimical effects of tene-ment housing. Rose F. 7 yrs. 2 mos. Poorly nourished and de-veloped; circles under eyes; pale mucous mem-branes; enlarged glands; large tonsils and adenoids; signs in chest; coughing; run-ning a temperature; dental caries. 114 Suggestive after 24 hours. Roof; tonic; extra nour-ishment; adenoids and tonsils removed; dentistry. Progressive im-provement. Temp. range l(K).8°-9()°. Color much improved; still running a tempera-ture; con-valescing from opera-tion for ade-noids and tonsils. % lb. These children usually begin to gain progressively after initial loss from operation for tonsils and adenoids. Walter H. 2 yrs. 6 mos. Fairly well nourished and developed; fair col-or; enlarged glands; huge tonsils and ade-noids; running a tem-perature. 2 Positive in 24 hours. Roof. Temp. range 100.4°-99° (rec-tal). Just admitted. To have tonsils and ade-noid removed. George S. 5 yrs. 3 mos. Fairly well nourished; very anaemic; eye-lid disease; enlarged glands; large tonsils and adenoids; caries; signs in chest; running a temperature; cough-ing. 115 Positive after 48 hours. Roof; tonic; extra nour-ment; ade-noids and tonsils re moved. Progressive im-provement. Temp. range 99.6°-97.2°. Good color; nasal breath-ing; glands subsiding. 154 lbs. Father a dipsomaniac. Minnie M. 11 % mos. Baby had physical de-velopment of 4 mos. child. Pale and pasty with adenoid facies; drooling; deep circles under eyes; eczema; huge tonsils; enlarged 203 Positive after 24 hours. Roof; careful feeding. Progressive im-provement. Temp. range 100.4°-98.2°. Well nour-nished; weight nor-mal for age; excellent color; glands sub- 11 lbs. 14 oz. Child on admission was markedly under weight for age. In 7 months has reached normal weight and development. birth; signs in chest. siding; bright and happy. Isidor M. 2Y2 yrs. Fair development; en-larged glands; huge tonsils—adenoids. 36 Positive after 24 hours. Roof. Temp. range 99.6°-98°. (rec-tal). Condition about same as on admis-sion. 0 Child will soon have ade-noids and tonsils removed. Millicent M. 9 yrs. 9 mos. Just returned from Pre-ventorium. Poorly nourished and devel-oped; enlarged glands; large tonsils and ade-noids; signs in chest; coughing; running a temperature. 36 Positive after 24 hours. Roof; tonic; extra nour-ment. Temp. range 100.4°-97.4°. Same# as on admission; has had poor appe-tite. Lost 2^4 lbs. Adenoids and tonsils soon to be removed. Louis M. 3 yrs. Well nourished and de-veloped; appears healthy; enlarged glands; large tonsils and adenoids. 308 Positive after 48 hours. Roof; extra nourish-ment; ton-sils and adenoids re-moved. Progressive im-provement. Temp. range 99.4°-96°. Very whole-some big boy; glands subsided; nasal breath-ing. 6^8 lbs. Mother a far advanced bed ridden patient since admis-sion. Kathleen S. 3 yrs. 4 mos. Under-developed and un-der-nourished. Rachitic; adenoid facies; circles under eyes; very pale; enlarged glands; large tonsils and adenoids; signs in chest; cough-ing; running a tempera-ture. 115 Positive after 48 hours. Roof; tonic; extra nour-ishment; adenoids and tonsils removed. Progressive im-provement. Temp. range 102.8°-97°. Considerable general im-provement. *4 lb. Father a dipsomaniac. Edward M. 5 yrs. 11 mos. Poorly nourished and de-veloped; forlorn ex-pression; deep circles under eyes; round shouldered; enlarged glands; huge tonsils; signs in chest; cough-ing. 113 Positive after 24 'hours. Roof; tonic; extra nour-ishment; adenoids and tonsils removed; dentistry. Progressive im-provement. Temp. range 96.6°-96°. Much general improve-ment; color better; up-per air pas-sages clear; glands sub-siding. l'/4 lbs. This child and the next 2 demonstrate to a marked degree the evil effects of tenement life. Marie M. 2 yrs. 10 mos. Fairly well nourished and developed; adenoid facies; all glands en-larged; large tonsils; coughing; forlorn, list-less expression. 113 Positive after 24 hours. Roof; tonic; extra nour-ishment; adenoids and tonsils removed. Progressive im-provement. Temp. range 99.6°-97.2°. General con-dition much better. Col-or improved; nasal breath-ing; glands subsiding; no cough. 1/2 lis. Same as above. Children Patients—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Reaction Treatment Progress Present Gain Condition in W'ght Remarks Katherine M. 9 yrs. 10 mos. Very poorly nourished and aeveloped. Life-less expression; ade-noid facies; very pale; hollow chested; en-larged glands; large tonsils and adenoids; signs in chest; running a temperature; cough-ing; dental caries. 113 Negative after 24 hours. Roof; extra nourish-ment; ton-ic; tonsils and ade-noids re-moved; den-tistry. Progressive im-provement. Temp. range 100°-96.8°. Much im-proved. Col-or better; has more life;_ glands subsiding still cough-ing; occa-sional tem-perature. 1*4 lbs. Rudolph K. 5 yrs. 8 mos. Poorly nourished and de-veloped; very anaemic; circles under eyes; glands much enlarged; large tonsils and ade-noids; signs in chest; coughing; running a temperature. 90 Positive after 24 hours. Roof; tonic; extra nour-ishment; myringot-omy. Progressive im-provement. Temp. range 99.6°-96.8°. Color im-proved ; coughs less. 154 lbs. Tonsils and adenoids to be removed. Olga K. 2 yrs. 6 mos. Fairly well nourished and developed; very pale; circles under eyes; enlarged glands; large tonsils and ade-noids; coughing; run-ning _ a temperature; signs in chest. 90 Positive after 24 hours. Roof; tonic; extra nour-ishment. Progressive im-provement. Temp. range 100.8°-98.6°. Steadily im-proving. Color much better; coughs less. 154 lbs. To have tonsils and ade-noids removed. Grace F. 12 yrs. Fairly well nourished; anaemic; large glands; large tonsils and ade-noids; cough; sputum; signs in chest; chronic appendicitis; rheumat-ism; teeth bad; running a temperature. 448 No. Von Pirquet. Open air school; ton-ic; _ extra nourish-ment; ton-sils and adenoids re-moved; den-tistry. Marked improve-ment. Temp. range 99.4°-96°. Excellent physical condition. Wholesome, bright and happy. Ex-cellent col-or; no cough; no tempera-ture; no ac-tivity in chest; glands small;; teeth in repair. 11 lbs. This child is a great credit to the Home Hospital. Raymond F. 9 yrs. 4 mos. (Omitted from 1st year's report.) Fairly well nourished and developed. Pale; adenoid facies; flat nose; all glands enlarged; huge tonsils; cough; sputum; signs in chest; running a temperature. 448 Positive after 24 hours. Same as above. Temp. range 99.4°-96°. Plump; whole-some; excel-lent color, glands sub-sided; no cough; no tempera-ture; chest clear. 1054 lbs. Much improved by Home Hospital environment. Michael F. 5 yrs. 6 mos. Typical pretuberculai type; pale, pudgy ap-pearance; mouth-breather; large glands; large tonsils and ade-noids; cough; signs in chest; running a tem-perature. 448 Positive after 24 hours. Same as above. Temp. range 99.6°-96°. Excellent gen-eral condi-tion. Fine color; glands subsided; good nasal respiration; no cough; no tempera-ture; chest clear. 9H lbs. Very attractive wholesome child quite in contrast with his picture on admission. Lena M. 4 mos. Healthy, happy baby. 68 Positive after 24 hours. Roof. Temp. range 99.2°-97.6° (rec-tal). Doing well. 3 lbs. 1 oz. Positive Van Pirquet reac-tion, indicating how early in life children may be-come infected with tuber-culosis. Marie M. 4 mos. Same. 68 Positive after 24 hours. Temp. range 99.4°-97.6° (rec-tal). Doing well. 3 lbs. 1 oz. Same. Mary DeG. 11 yrs. Undersized; fairly well nourished; mucous membranes pale; huge tonsils and adenoids; enlarged glands; signs in chest; coughing; running a temperature. 114 None. Open aii-school; ton-ic; extra nourish-ment; ton-sils and adenoids re-moved; glasses. Temp. range 99.6°-97°. Much im-proved; good _ nasal breathing; glands sub-siding; cough bet-ter; still slight tem-perature. 1J* lbs. Gained after admission. Then fractured leg and lost some while convales-cing. Children Patients—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Reaction Treatment Progress Present Condition Gain IN W'ght Remarks Bobbie G. 2Y2 yrs. Puny, pale child; run-ning _ a temperature; adenoids and tonsils enlarged; _ enlarged glands; signs of bron-chitis; cough; mouth-breather; running a temperature. 355 Strongly positive after 60 hours. On roof; ex-tra nour-ishment; adenoids and tonsils removed. Marked progres-sive improve-ment. Temp. range 100.8°-98.6°. Excellent; plump, rosy cheeks; glands smaller; no tempera-ture. 5J4 lbs. Child sickly on admission; although 2yi yrs. old was just about able to totter about; mouth - breather. Now wholesome, active boy. Marked improvement following tonsillectomy and adenoidectomy. Evelyn W. 3 mos. Whining, marasmic, apish, cyanotic; skin in folds; scaphoid abdo-men _ with umbilical hernia; enlarged glands; signs of heredi-tary syphilis; snuffles and fissures. 242 Negative. Roof; form-ula feeding; gray pow-der. Wonderful im-provement. Temp. range 100°-97° (rec-tal). Plump, rosy, pouting cheeks; hap-py and bright; strong arms and legs; able to sit up. Glands small; hernia dis-appeared ; no evidence of lues. 9 lbs. 6 oz. Upon admission child seemed doomed. Cried continu-ously; refused feedings; weighed but 5 lbs. 3 ozs. (normal child at 3 mos. weighs 12^4 lbs.) The baby has gained 9 lbs. 6 ozs. in the same length of time that a normal child gains %Yi lbs. Josephine O'G. 4 yrs. Wretched appearance; pale, puny; facial ec-zema and herpes; huge glands; enlarged ade-noids and tonsils; cough; signs in chest; mouth-breather; run-ning a temperature. 288 Strongly positive in 48 hours. On roof ex-tra nour-ishment; tonic; ade-noids and tonsils re-moved. Marked progres-sive improve-ment. Temp. range 101.2°-96°. excellent. condition; well nourished; good color; plump, rosy cheeks; ec-zema and herpes cured; glands smaller; no cough; no tempera-ture ; chest improved; breathes with mouth closed. 6 lbs. It is interesting to compare this child with her brother Morris, aged 6 yrs., who lives out with an aunt un-der good hygienic condi-tions. Josephine, on dis-charge, well nourished; plump rosy cheeks; weight 3954 lbs.; tonsils and ade-noids removed; glands small; very wholesome ap-pearance. _ Morris, 2 years older, weighed but 2 lbs. more; thin, anaemic child; adenoids and tonsils en-larged; big glands; typical pretubercular type. This will illustrate what 9 mos. treatment at the H. H. can accomplish. CHILDREN SUSPECTS Age on Name Admission Days Condition on Adm. in H. H. Von Pirquet Reaction Treatment Progress Present Gain Condition in W'ght Remarks William G. 1 lyr. 6 mos. Fairly well nourished; pasty appearance; glands enlarged; facial acne; croupy; running temperature. 573 Suggestive after 48 hours. Roof; tonic. Progressive im-provement. Temp. range 100.6°-97.4°. Excellent con-dition. Plump, rosy cheeks; bright and happy; glands not enlarged. 8'/2 lbs. Very wholesome child. Charlotte W. 4 yrs. 6 mos. Fair color and nutrition; pasty, non-resistant type; dental caries; en-larged adenoids and tonsils; enlarged glands; ring-worm. 477 Positive after 48 hours. Roof; tonic; extra nour-ishment; tonsils and adenoids re-moved; den-tistry. Progressive im-provement. Temp. range 99°-96.8°. Excellent gen-eral condi-tion. 0^4 lbs. Very active, restless type. Marion W. 9 yrs. Admitted after 3 mos. at preventorium; well nourished and devel-oped; good color; gland enlarged; tonsils en-larged; dental caries. 477 Positive after 48 hours. Open air school; ton-ic; extra nourish-ment; ton-sils and adenoids re-moved. Progressive im-provement. Temp. range 99.6°-95.8° Excellent ap-pearance. Good nasal breathing; no cough; no tempera-ture; chest clear. 4*4 lbs. Healthy, normal child. William S. lyr. 3 mos. Well nourished; fair col-or; adenoid facies; en-larged glands; large tonsils; signs in chest; coughing. 148 Refused. Roof; care-ful feeding. Progressive im-provement. Temp. range 100.6°-97°. Good color. Still run-ning slight tempera-ture; gen-eral condi-tion im-proved; glands smaller. Lost 2Ya lbs. Family not amenable to ad-vice. James M. 6 yrs. 9 mos. Poorly nourished; verj pale; enlarged glands large tonsils and ade noids; dental caries. 75 Positive after 6C hours. Open air school; ex-tra nour-ishment; ment; ton sils anc adenoids re moved. Progressive im provement. Temp. range 99.6°-97°. Good color, nasal breathing; throat clear glands sub siding. 2% lbs. Much general improvement. Children Suspects—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Reaction Treatment Reaction Present Condition Gain in W'ght Remarks Ralph S. 7 yrs. Pale, underfed, poorly developed boy; en-larged tonsils and ade-noids; enlarged glands; dental caries; phimosis; running slight tempera-ture on admission. 479 Suggestive after 24 hours. Open air school; ton-ic ; extra nourish-ment; ton-sils _ and adenoids re-moved. Progressive im-provement. Temp. range 99.2°-97.2°. Good color; glands sub-siding; throat clear; no signs in chest; no tempera-ture. 954 lbs. Child had always been very delicate and sickly. Agnes O'K. 6 yrs. Fair nutrition; poor col-or, enlarged glands; enlarged tonsils and adenoids; coryza; run-ning a temperature. 554 Positive after 24 hours. Open air school; ton-ic; extra nourish-ment; ton-sils and ade-noids re-moved ; den-tistry. Marked progres-sive improve-ment. Temp. range 99.6°-96.6°. Very plump, rosy cheeks; cheeks; breathes with closed mouth; glands sub-sided; throat clear. 8 lbs. Picture of health and happi-ness. Gaetano G. 13 yrs. 2 mos. Very poorly nourished and developed. Very pale, pasty, peaked ap-pearance. Enlarged glands; dental caries; trachoma. 349 None. Open air; ex-tra nourish-ment; den-tistry; treat-ment for trachoma. Progressive im-provement. Temp. range 98.6°-97°. Rugged, stur-dylittle boy. Bright and happy. 4^ lbs. Markedly improved by Home Hospital treatment. Lillian D. 13 yrs. 9 mos. Under-developed; good color; enlarged glands; enlarged tonsils; signs in chest; coughing. 14 None. Tonic;_ extra nourish-ment. Temp. range 98°-97°. Just admitted. Ya lb. Frances B. 5 yrs. Very pale; poorly nour-ished and developed; circles under eyes; ton-sils enlarged; glands much enlarged; dental caries. 519 Positive after 48 hours. Open air; ton-ic; extra nourish-ment. Marked progres-sive improve-ment. Temp. range 100.8°-96.8°. Very _ well nourished; good color; glands sub-sided; throat clear; nasal breath-ing; no cough; no tempera- 054 lbs. Looks like a different child. Mary B. 7 yrs. Fairly well nourished and developed; pasty, pale and anaemic; circles under eyes; glands enlarged; erup-tion on skin; enlarged tonsils; dental caries; running a temperature. 519 Suggestive after 48 hours. Open air school; ton-ic; extra nourish-ment; den-tistry. Marked progres-sive improve-ment Temp. range 99.4°-96.2°. Well nour-ished; ex-cellent col-or; glands small; throat clear; no cough; no tempera-ture. 12 % lbs. Sanie as above. George W. %Y2 mos. Pale, peaked, puny, rach-itic child. Enlarged glands; huge tonsils and adenoids; cough-ing; running a tempera-ture; signs in chest. 228 Negative after 24 hours. Roof; careful feeding; myringot-omy. Marked progres-sive improve-ment. Temp. range 100.2°-97.2°. Fairly well nourished; excellent color; glands still en-larged; no cough; no tempera-ture. 754 lbs. Tonsils and adenoids soon to be removed; shows marked improvement. Cathleen C. Sy mos. Whining, apish, extreme mavasmic type. Wrinkled forehead; sunken eyes; veins dis-tended; ears excoriated; all glands enlarged; skin hangs in folds; partial facial palsy. 100 Negative after 24 hours. Roof; careful formula feeding. Remarkable pro-gressive im-provement. Temp. range 101.2°-98°. Chubby; wholesome; rosy cheeks; bright and happy; nor-mal child; palsy dis-appeared. 6 lbs. 8 oz. Seemed hopeless on admis-sion. Joseph B. 4 mos. Pasty, pale, cyanotic baby; _ coughing much; signs in chest; running a temperature; enlarged adenoids and tonsils; phimosis. 707 Negative after 24 hours. Roof; careful feeding; adenoids and tonsils removed. Marked progres-sive improve-ment. Temp. range l03.2°-98.6°. Stout, sturdy, wholesome child. 1854 lbs. Picture of health. John B. 3 yrs. Well nourished and de-veloped; poor color; huge glands; enlarged adenoids and tonsils; running a temperature. 707 Negative after 24 hours. Fresh air; ex-tra nourish-ment; ton-sils and ade-noids re-moved. Temp. range 100.8°-96°. Rugged, rough youngster. Picture of health. 834 lbs. Looks anything but a sus-pect. James P>. 2 yrs. Well nourished and de-veloped; glands en-larged; adenoids and tonsils enlarged; signs in chest; cough; run-ning a temperature. 707 Negative after ?4 hours. Open air; ton-ic ; extra nourish-ment; ton-sils and ade-noids re-moved; cir-cumcision; plastic Progressive im-provement. Temp. range 101°-97.2°. Marked im-provement. Has been invalided most of year due to sev-ere burns. Now happy and bright. IY2 lbs. Child had bad contractures from burn scars. These have been corrected by operations and he now walks with a normal gait. Children Suspects—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Reaction Treatment Reaction Present Condition Gain in W'ght Remarks James B. (Con't.) operation for burn cicatrices. Lawrence C. 6 yrs. 5 mos. Fair development and color but sickly; glands enlarged; nasal ob-struction; large tonsils and adenoids. 28 Positive after 48 hours. Open air. Progressive im-provement. Temp. range 101.6°-97°. Has been at Home Hos-pital but 4 weeks. 134 lbs. Soon to have tonsils and adenoids removed. Alexander B. 11 yrs. 9 mos. Fairly nourished; very pale; circles under eyes; large glands; huge tonsils and ade-noids; dental caries. 37 Positive after 48 hours. Open air school; ton-ic; extra nourish-ment; ton-sils and ade-noids re-moved. Progressive im-provement. Temp. range 99°-96.8°. Much im-proved by tonsils and adenoid operation. Color bet-ter. y2 ib. Just recovered from diph-theria. Mary D. 12 yrs. Poorly nourished and de-veloped; anaemic; ade-noid facies; glands en-larged; adenoids and tonsils enlarged; den-tal caries; scabies; fever. 463 Positive after 36 hours. Open air; ex-tra nourish-ment; ton-ic; tonsils and ade-noids re-moved; den-tistry. Progressive im-provement. Temp. range 99.2°-95.4°. Excellent col-lor. Breathes with closed mouth; glands small; throat clear. 8J4 lbs. Child changed from a list-less, mouth breathing chil to a bright, wholesome gir Nora D. 10 yrs. Thin, pale; mouth-breather glands much enlarged; dental caries; enlarged tonsils and adenoids; cough; signs in chest; scabies. 463 Negative after 24 hours. Same as above. Progressive im-provement. Temp. range 98.4°-95.2°. Very well nourished; excellent color; glands small; throat clear; nasal breath-ing. 956 lbs. Same as above. Grace C. 10 yrs. 9 mos. Plump; good color; en-larged glands; large tonsils and adenoids; coughing; just home from Preventorium. 114 Positive after 48 hours. Open air school; ex-tra nour-ishment; tonsils and adenoids re-moved. Progressive im-provement. Temp. range 98.8°-96°. Improved by removal of tonsils and adenoids. No cough. 1 lb. Child was in good conditio on admission. Josephine G. 2 yrs. 7 mos. Poorly nourished; poor-ly developed; very an-aemic; adenoid facies; glands much enlarged; large tonsils and ade-noids; coughing; run-ning a temperature. 155 Negative after 24 hours. Open air; ton-ic; tonsils and ade-noids re-moved. Progressive im-provement. Temp. range 104°-97.8° (rec-tal). Much im-proved; good color; better nour-ished ; breathes with mouth closed; glands sub-siding. 3 lbs. Child is a great credit to the Home Hospital. Carmella G. 6 yrs. 4 mos. Wan; hollow-eyed; for-lorn; adenoid facies; nasal obstruction; en-larged glands; huge tonsils and adenoids; coughing; running a temperature. 155 Positive after 24 hours. Open air school; ton-ic; extra nourish-ment; ton-sils and adenoids re-moved. Progressive im-provement. Temp. range 99.6°-96.6°. Markedly im-proved; good color; bright ap-pearance; breathes with closed mouth; glands sub-siding; cough bet-ter; no tempera-ture. 4 lbs. Same as above. Salvatore F. 5 yrs. Poorly developed, anae-mic child; cough; en-larged tonsils and ade-noids; glands en-larged; phimosis; fever. 668 Positive after 60 hours. Roof; tonic; extra nour-ishment; tonsils and adenoids re-moved. Progressive im-provement. Temp. range 99.4<97°. Very good physical condition; hardy and rugged; ex-cellent col-or. 4 lbs. Changed from a puny deli-cate child to a wholesome hardy boy. Tony P. Born in H. H. Apish, marasmic; whin-ing; sunken eyes; skin in folds; scaphoid ab-domen; sunken fontan-elles; unable to move; weight 5 lbs. 8 oz. 344 None. Roof; spet-cial feeding with medi-cine drop-per; sent to Babies' Hosp. for wet nurse. Unimproved. Temp. range 103.4°-97.8°. Deceased. De-ceased. Child a hopeless marasmic type. Could not nurse and was fed with medicine dropper. Mother had no milk. Obtained mother's milk from Bellevue Hosp. Mother pregnant on ad-mission. Baby showed slight improvement until hot weather and then fad-ed away. Joseph McL. 12 yrs. Just home from Preven-torium. Looked well; had good color; en-larged glands; large tonsils and adenoids. 546 Positive after 60 hours. Fresh air; ex-tra nourish-ment; tonic; anti-rheu-matic treat-ment; treat- Progressive im-provement. Temp. range 98.4°-95°. Very much improved; well nour-ished; ex-cellent col-or ; teeth in 954 lbs. Child not considered a sus-pect in last report. This boy and his brother now suspects. The mother, 2 sisters and one brother are patients. Children Suspects—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Reaction Treatment Progress Present Condition Gain in W'ght Remarks Joseph McL. (Con't.) ment for ap-pendicitis; dentistry. repair; free from rheu-matism. Edward McL. 10 yrs. Just home from Preven-torium. Well nour-ished; good color; en-larged glands; large tonsils and adenoids; dental caries. 546 Positive after 60 hours. Open air school; ton-ic; extra nourish-ment; den-tistry; ton-sils and ade-noids re-moved. Progressive im-provement. Temp. range 98.6°-95.8°. Very good oolor; looks strong; and muscular. 1*4 lbs. Brother of above suspect. Matilda M. 8 yrs. Fairly well nourished; poorly _ developed anae-mic; rings under eyes; adenoids and tonsils enlarged; dental caries; ring-worm of scalp; fever. 485 Positive after 24 hours. Open air school; ton-ic; extra nourish-ment; ton-sils and ade-noids re-moved; den-tistry. Progressive im-provement. Temp. range 101.2°-97.4°. Markedly im-proved. Rosy cheeks; plump and wholesome; glands small; still has occa-sional slight tem-perature. 454 lbs. Now a very attractive child. Nora M. 7 yrs. Poorly nourished; fair development; anaemic; adenoid facies; en-larged glands; dental caries; fever. 485 Positive after 24 hours. Open air school; ton-ic; extra nourish-ment; ton-sils and ade-noids re-moved; den-tistry. Progressive im-provement. Temp. range 100.2°-97°. Well nour-ished; good color; glands small; throat clear; no tempera-ture. 11 lbs Has shown remarkable im-provement. Elizabeth R. 3 yrs. Fairly well nourished; under-developed; fair color; circles under eyes; enlarged glands; cough; running a tem-perature. 189 Negative after 48 hours. Roof; tonic; extra nour-ishment. Progressive im-provement. Temp. range 104.3°-97°. Good color; well nour-ished; glands sub-siding; no cough. 454 lbs. Family has gone to Ireland to live on a farm. ohn R. 6 yrs. 4 mos. Returned from Preven-torium. Poorly devel-oped; very poor color; enlarged glands; large tonsils and adenoids; coughing; runnng a temperature. 189 Positive after 60 hours. Open air school; ton-ic ; extra ishment; tonsils and adenoids re-moved. Progressive im-provement. Temp. range 101.2°-97°. Much im-proved. Ex-cellent col-or; well nourished; throat clear; no cough. 4Y* lbs. Family have gone to Ireland to live on a farm. Kathleen B. 3 yrs. 1 mo. Pale; pudgy; mouth breather; typical ade-noid tacies; circles un-der eyes; enlarged glands; large tonsils and adenoids; signs in chest; coughing; run-ning a temperature. 138 Negative after 24 hours. Roof; tonic; extra nour-ishment; tonsils and adenoids re-moved. Progressive im-provement. Temp. range 101.8°-97°. Excellent col-or; breathes with closed mouth; throat clear; glands sub-siding; still "wheezy"; no tempera-ture. 3 lbs. Markedly improved in gen-eral appearance. Thaddius B. 5 yrs. 3 mos. Fairly well nourished but pale; enlarged glands; diseased tonsils; ade-noids; coughing; run-ning a temperature. 138 Negative after 24 hours. Roof; tonic; extra nour-ishment; tonsils and adenoids re-moved. Progressive im-provement. Temp. range 100.2°-96.4°. Color excel-lent; throat clear; glands sub-siding no cough; no temperature. 2 lbs. Sturdy looking boy. Edward B. 14 yrs. 4 mos. Under-nourished and un-der-developed; pale; coughing; running a temperature; dental caries. 138 None. Fresh air; tonic; extra nourish-ment; much dentistry. Progressive im-provement. Temp. range 100°-97.4°. No cough; no temperature; excellent color; teeth in repair. 4J4 lbs. Beginning to look rugged. Patrick B. 8 yrs. 9 mos. Poorly nourished; pale; circles under eyes; har-row chest; round shouldered; enlarged glands; large tonsils and adenoids; cough-ing; slight temperature; signs in chest. 138 Negative after 24 hours. Fresh air; tonic; ex-tra nour-ishment. Progressive im-provement. Temp. range 99.6° -96°. Plump; good color; rosy cheeks; bright eyes; glands sub-siding; no cough; no tempera-ture; ques-tionable signs in chest. 6 lbs Has gained rapidly; looks well and strong. Children Suspects—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Progress Treatment Progress Present Condition Gain in W'ght Remarks Nello C. 10 yrs. 1 mo. Fairly well nourished; small stature; mouth breather; enlarged ade-noids; old osteomyelitis of left hand; probable tuberculides on foot. 113 None. Fresh air; tonic; ex-tra nour-ishment; adenoids re-moved ; or-thopedic treatment. Progressive im-provement. Temp. range 99.6°-98°. Color better; beginning to gain weight; nasal breath-ing; glands subsiding. 1 lb. Beginning to improve. Katie C. 7 yrs. 5 mos. Poorly nourished and de-veloped; pale, peaked appearance; enlarged glands; large tonsils and adenoids; umbilical hernia; coughing; run-ning a temperature. 113 Negative after 24 hours. Fresh air; tonic; ex-tra nour-ishment ; tonsils and adenoids re-moved. Progressive im-provement. Temp. range 99.4°-97°. Excellent col-lor; breathes with closed mouth: 354 lbs. Gaining rapidly since re-moval of tonsils and ade--noids. Louis DeG. 7 yrs. 3 mos. Pale, pasty expression: rachitic head and chest; enlarged glands; huge tonsils, adenoids; caries; coughing; run-ning a temperature; questionable signs in chest; tonsillitis. 114 None. Open air school; ton-ic; extra nourish-ment; ton-sils and ade-noids re-moved; den-tistry. Progressive im-provement. Temp. range 99.8°-96.2°. Appearance much im-proved. Good color; breathes with closed mouth. 354 lbs. No_ temperature nor cough since removal of _ tonsils and adenoids. Quite con-stant before operation. Mary F. 13 yrs. 1 mo. Fairly well nourished and developed; anae-mic; melancholy ex-pression; coughing; running a temperature; caries. 114 None. Open air school; ton-ic; < extra nourish-ment; den-tistry; glasses. Progressive im-provement. Temp. range 99.4°-96.8°. Marked im-provement; excellent color; cough less; no tem-perature. 754 lbs. Appearance completely changed to that of a_ bright, happy, wholesome girl. Marie I. 2 yrs. 9 mos. Pale, pasty child; en-larged glands; large tonsils and adenoids; coughing; running a temperature. 247 Negative after 48 hours. Fresh air; special nour-ishment. Progressive im-provement. Temp. range 100.8°-98.2°. Color much improved; cough very slight; still running slight tem-perature. 254 lbs. Looks quite healthy. Tohn J. 1 yr. 11 mos. Soft pudgy type; mu-cous membranes poor color; enlarged glands; tonsils and adenoids; cough; running a tem-perature. 115 Negative after 48 hours. Fresh air; special nour-ment; treatment for ring worm. Progressive im-provement. Temp. range 100.4°-98.4°. General condi-tion excel-lent; good color; cough less; occa-sional tem-perature. 354 lbs. Markedly improved. Helen K. 13 yrs. Under-nourished and de-veloped. Pinched ex-pression ; narrow chested; enlarged glands; huge tonsils; dental caries; question-able signs in chest; slight temperature. 73 None. Fresh air; ex-tra nourish-ment; tonic; glasses; den-tistry. Progressive im-provement. Temp. range 99.4°-96°. Beginning _ to show im-provement. Lost H lb. Tonsils about to be removed. Loss of weight from recur-rent attacks of tonsillitis. Anna K. 6 yrs. 3 mos. Well nourished but pasty and anaemic; adenoid facies; enlarged glands; huge tonsils; adenoids; coughing; slight tem perature; questionable signs in chest. 73 Positive after 24 hours. Fresh air; tonic; ex-tra nourish-ment. Progressive im-provement. Temp. range 99.6°-97°. Color much better; gen-eral appear-ance more wholesome. 254 lbs. About to have tonsils and adenoids removed. Katherine K. 8 yrs. 6 mos. Pale, peaked, with ade-noids facies, rachitic chest, enlarged glands; large tonsils and ade-noids; caries. 73 Positive after 24 hours. Fresh air; tonic; extra nourish-ment; glasses. Progressive im-provement. Temp. range 98.9°-96°. Markedly im-proved in color and weight. 454 lbs. Same as above. Mary K. 10 yrs. 7 mos. Very anaemic, round shouldered, under-nour-ished and under-devel-oped girl. Deep circles under eyes; narrow chest; enlarged glands; large tonsils and ade-noids; caries; cough-ing. 73 Positive after 24 hours. Fresh air; tonic; extra nourish-ment; den-tistry. Progressive im-provement. Temp. range 98.6°-96.8°. Beginning to improve. Color much better. 54 lb. Soon to have tonsils and adenoids removed. Amelia K. 8 yrs. 3 mos. Well nourished; fairly good color; mouth breather; enlarged glands; large tonsils and adenoids^ caries and tartar. 90 Positive after 48 hours. Fresh air; tonic; extra nourish-ment; ton-sils and adenoids re-moved. Progressive im-provement. Temp. range 98.8°-97°. General con-dition much improved. Breathes with closed mouth; glands sub-siding. % lb. Just recovering from ie-moval of tonsils and .lde-noids. Children Suspects—(Continued) Name Age on Admission Condition on Adm. Days in H.H. Von Pirquet Reaction Treatment Progress Present Condition Gain in W'ght Remarks Joseph K. 4 yrs. 9 mos. Pale, peaked, pinched ex-pression; circles under eyes; enlarged glands; large tonsils and ade-noids; nasal discharge; coughing; running a temperature. 90 Positive after 24 hours. Fresh air; tonic; extra nourish-ment. Progressive im-provement. Temp. range 99.6°-96.4°. Beginning to show marked im-provement. Color better; glands sub-siding; no tempera-ture. 1 lb. Soon to have tonsils and adenoids remov;!. Frank L. 12 yrs. 3 mos. Poorly nourished; anae-mic; circles under eyes; enlarged glands; huge tonsils and adenoids; ringworm of scalp; ton-sillitis. 111 Positive after 48 hours. Fresh air; tonic; extra nourish-ment; treat-ment for ring worm of scalp. Progressive im-provement. Temp. range 99°-96.4°. Well nour-ished; excel-lent color; glands sub-siding; no temperature. 63,4 lbs. Same as above. Joseph L. 9 yrs. 10 mos. Poorly nourished and de-veloped; anaemic; cir-cles under eyes; mouth breather; enlarged glands; large tonsils and adenoids; cleft uvula. 111 Positive after 48 hours. Fresh air; tonic; extra nourish-ment; den-tistry; re-moval of tonsils and adenoids; staphylorr-haphy. Progressive im-provement. Temp. range 99°-95.6°. Excellent col-lor; breathes with closed mouth; be-ginning to gain. 1J4 lbs. Much general improvement. Philip M. 11 yrs. 10 mos. Just returned from Pre-ventorium. Under-de-veloped; fair color; en-larged glands; large tonsils and adenoids; running a temperature. 203 Negative after 48 hours. Open air school; ton-ic; extra nourish-ment; ton-sils and ade-noids re-moved. Temp. range 100°-96°. Markedly im-proved ; sturdy; good color; breathes with closed mouth; looks whole-some. 8 lbs. Transformed from sickly delicate child to a whole-some hardy appearance. Lillie M. 7 yrs. 7 mos. Wretched, pale, puny child; sunken watery eyes; enlarged glands; large tonsils and ade-noids; dental caries; running a temperature; coughing. 203 Negative after -18 hours. Fresh air; tonic; ex-tra nour-ishment; tonsils and adenoids re-moved; den-tistry. Progressive im-provement. Temp. range 99.8°-90.2°. Plump; rosy cheeks; breathes with closed mouth; glands sub-siding; still occasional 8 lbs. Same as above. slight tem- perature. William M. 9 yrs. 10 mos. Pale, forlorn, poorly de-veloped boy. Enlarged glands; large tonsils and adenoids; cough-ing; questionable signs in chest; running a temperature; double in-guinal hernia and un-descended testes; trach-oma. 203 Positive after 48 hours. Open air school; ton-ic; _ extra nourish-ment; ton-sils and adenoids re-moved; transplan-tation of both testes; double her-niotomy. Progressive im-provement. Temp. range 100.2°-96°. Plump rosy cheeks; hap-py expres-sion ; gain-ing rapidly; glands sub-sided; no cough; no signs in chest. 554 lbs. Both inguinal operations very successful. Gertrude M. 3 yrs. 10 mos. Very poorly nourished; pasty appearance; ade-noid lacies; nasal dis-charge; enlarged glands; large tonsils and adenoids; croupy. 203 Suggestive after 24 hours. Progressive im-provement. Temp. range 100.4°-96.6°. Very much improved; excellent col-or; good nasal respi-ration ; glands sub-siding; no temperature. 454 lbs. No cough since removal of tonsils and adenoids. Roof; tonic; extra nour-ishment; tonsils and adenoids re-moved. William Mon. 7 yrs. 8 mos. Poorly nourished and developed; pale; circles under eyes; adenoid fa-cies; enlarged glands; huge tonsils and ade-noids; coughing; run-ning _ a temperature; questionable signs in chest. 68 Negative after 48 hours. Fresh air; tonic; ex-tra nourish-ment; ton-sils and ade-noids re-moved. Progressive im-provement. Temp. range 100°-96°. Marked gen-eral im-provement. Excellent color; grow-ing plump; breathes with closed mouth; glapds sub-siding; no cough; occa-sional slight temperature. \Va lbs. Much improved by removal of tonsils and adenoids. Benjamin M. 12 yrs. 2 mos. Just home from 3 months in Preventorium; well nourished; very pale; circles under eyes; en-larged glands; tonsils and adenoids; nasal ob-struction. 36 None. Fresh air; ex-tra nourish-ment; tonic. Unimproved. Temp. range 99°-96.4°. Same as on admission. Lost 254 lbs. Soon to have tonsils and adenoids removed. Sarah M. 7 yrs. 4 mos. Just home from 3 months in Preventorium; fairly well nourished and de-veloped but very pale; enlarged glands; en-larged tonsils and ade-noids. 36 Positive after 24 hours. Fresh air; ex-tra nourish-ment; tonic. Unimproved. Temp. range 100.4°-96.4°. Same as on admission. Lost 254 lbs. Soon to have tonsils and adenoids removed. Children Susfects—(Continued) Name Age on Admission Condition on Adm. Days in H. H. Von Pirquet Reaction Treatment Progress Present Condition Gain in W'ght Remarks Mary St. 9 yrs. 5 mos. Poorly nourished and de-veloped; pale; circles under eyes; adenoid facies; enlarged glands; enlarged tonsils and adenoids. 115 Positive after 48 hours. Fresh air; ex-tra nourish-ment; tonic; open air school; ton-sils and ade-noids re-moved. Progressive im-provement. Temp. range 99.6°-96.6°. Color much improved; good _ nasal breathing; glands sub-siding; no temperature. 2/2 lbs. Marked general improve-ment after removal of ton-sils and adenoids. William S. 7 yrs. Poorly nourished and de-veloped; anaemic; cir-cles under eyes; round shouldered; much en-larged glands; large tonsils and adenoids; dental caries—tartar. 115 Positive after 48 hours. Fresh air; ex-tra nourish-ment; open air school; adenoids and tonsils removed. Progressive im-provement. Temp. range 99.6°-96.6°. Good color; appearance wholesome; nasal breath-ing. 354 lbs. Marked general improvement after removal of tonsi's and adenoids. Annie S. 10 yrs. Readmitted in excellent condition. See last year's report. 480 Positive after 48 hours. Fresh air; special nour-ishment; tonic. Progressive im-provement. Temp. range 99.4°-96°. Excellent gen-eral condi-tion. 16 lbs. Picture of health. Frank R. 6 yrs. 9 mos. Fairly well nourished and developed; pasty appearance; adenoid fa-cies; enlarged glands; huge tonsils and ade-noids; cough; running a temperature. 69 Positive after 48 hours. Fresh air; tonic; ex-tra nourish-ment; ton-sils and ade-noids re-moved; open air school. Progressive im-provement. Temp. range 99.6°-96°. Color much improved; gaining in weight; nasal respiration; glands sub-siding; oc-casional tem-perature. 2 lbs. Cough improved since re-moval of tonsils and ade-noids. Grace M. 8 yrs. Very pale, pinched, for-lorn appearance. En-larged glands; huge tonsils and _ adenoids; cough; running a tem-perature; valvula heart disease. 113 Positive after 48 nours. Fresh air; tonic; extra nourish-ment. Progressive im-provement. Temp. range 100.2°-96.2°. Color much improved; _ gaining in weight; gen-eral condi-tion some-what im-proved. 3 lbs. Typical child of tenement. Removed from school be-cause of cardiac condition. Lillian M. 11 yrs. Forlorn, sickly, puny child. Very poorly de-veloped; anaemic; round shoulders; en-larged glands, tonsils and adenoids. 113 Positive after 4S hours. Fresh air; tonic; extra nourish-ment. Progressive im-provement. Temp. range 99.6°-96°. Marked gen-eral im-provement. Color very good; throat clear; glands sub-siding. 4 lbs. No ear trouble since re-moval of tonsils and ade-noids. Margaret F. 13 yrs. Pale, _ anaemic, poorly nourished; under-devel-oped; enlarged ton-sils and adenoids; en-larged glands; chronic nasal catarrh; cough; slight temperature. 108 Strongly positive after 48 hours. Fresh air; extra milk and eggs; glasses pro-vided. Unimproved. Temp. range 99.2°-98°. Unchanged. Lost Va lb. After discharge of family for intemperance it was learned that money given parents for food was used for liquor. Mamie McG. 9 yrs. Poorly nourished and de-veloped; anaemic; en-larged tonsils and ade-noids; enlarged glands; dental caries; question-able signs in chest; run-ning slight temperature. 155 Strongly positive after 24 hours. Extra milk and eggs; fresh air; dentistry. Improved. Temp. range 99.6°-97.6°. On discharge had better color; teeth in repair; no tempera-ture in 2 months. 54 lb. Parents refused advice as to care of child; refused operation for tonsils and adenoids. Katherine McG. 8 yrs. Pale, frail child; en-larged tonsils and ade-noids; enlarged glands; running slight tem-perature. 155 Strongly positive after 24 hours. Extra milk and eggs; fresh air; dentistry. Improved. Temp. range 99.2°-96.2°. Color _ and nutrition much im-proved; no temperature for several weeks. 254 lbs. Had repeated attacks of ton-sillitis; parents refused operation. Theodore G. 5 mos. Fairly well nourished child; pale, pasty type. 355 Suggestive after 24 hours. On roof; formula feeding; tonic. Improved in last few months. Fairly well nourished and devel-oped; can walk. 754 lbs. Child has had several acute illnesses; bronchopneumon-ia twice; colitis twice; ton-sillitis. Has received very poor attention from erratic mother. Avanti F. 9 yrs. Poorly nourished and de-veloped. Circles under eyes; very anaemic; en-larged glands; large tonsils and adenoids. Caries. 114 Positive after 24 hours. Open air school; den-tistry; ade-noids and tonsils re-moved. Progressive im-provement. General ap-pearance much im-proved. 54 lb. Child just convalescing from operation. Had gained 4 lbs. before operation. HOME STATEMENT OF RECEIPTS Year Ended RECEIPTS >ns, per following list: Anonymous................................$2,000.00 M l .................................... 1,000.00 Anderson^ Mrs.' A.' A.'.'.'.'.'.'.................... 2,000.00 Barbey, Henry G............................. 5oo.oo Beatty, A. Chester........................... 50-00 Bliss, Cornelius N., Jr........................ 1,500.00 Bliss, Mrs. Cornelius N., Jr.................. 500.00 Bliss, Mrs. Cornelius N...................... 500.00 Bliss, Miss L. P.............................. 500.00 Brewster, Mrs. Benjamin..................... 500.00 Brewster, George S.......................... 1,000.00 Burlingham, Charles C........................ 200.00 Cobb, Miss Elizabeth C....................... S0.00 Cutting, R. Fulton........................... 3,008.00 Delano, Eugene.............................. 1,000.00 Dodge, Cleveland H.......................... 1,000.00 Douglas, James.............................. 250.00 East River Homes............................ 9,500.00 Ellis, William D.............................. 10.00 Harkness, Edward S......................... 5,000.00 Knauth, Nachod & Kuhne..................... 10.00 Milbank, Albert G............................ 250.00 New York Foundation........................ 750-00 Oelrichs & Company........................ 100.00 Pyne, Percy R............................... 4,000.00 Stetson, Francis L............................ 250.00 Stillman, Mrs. Ernest G...................... 1500 Ward, John Seely............................. 250.00 Total Donations........................ $35,693-00 Earnings of Families................................ 6,964.10 Total Receipts............................. $42^57.10 Balance on Hand March 19, 1913: Cash.......................................$ 496.27 Inventory................................... 255.99 -------- 752.26 Total.................................. $43,409.36 108 HOSPITAL AND DISBURSEMENTS March, 1914 DISBURSEMENTS Maintenance and Operation : Salaries : Local Administration........................$ 2,059.92 Clerical................................... 961.76 Professional............................... 732.50 Nurses..................................... 2,152.00 Domestic Service............................ 1,96279 Total Salaries......................... $ 7,868.97 Expenses : Appeals...................................$ 19.55 Rent...................................... 7,365.87 Food...................................... 7,783-78 Clothing.................................. 888.56 Medical Supplies............................ 576.43 Ice and Water............................... 222.65 House Supplies.............................. 1,395.22 Repairs.................................... 12.09 Telephone & Telegraph...................... 83.98 Postage.................................... 17.06 Stationery & Office Supplies.................. 79-23 Moving Expenses............................ 30.25 Trans. Employees........................... 34-78 Trans. Beneficiaries.......................... 88.82 Expressage and Cartage...................... 3.10 Toys, Games & Entertainment................ 170.86 Light & Power.............................. 165.00 Dues...................................... 47-21 Annual Report..........................___ 454-00 Miscellaneous.............................. 212.18 Total Expenses......................... $19,650.62 Total Maintenance & Operation........... $27,519.59 Expended by Families........................... 6,964.10 Capital Expenditures : Hospital Furniture & Fixtures................$ 665.83 Office Furniture & Fixtures.................. 62.74 Hospital Equipment & Instruments........... 12.00 --------- 740.57 Total Disbursements................... $35,224.26 Balance March 18th, 1914: Cash......................................$ 7,631.18 Inventory................................. 553-92 --------- 8,185.10 Total................................. $43,409.36 109 INDIVIDUAL STATISTICS 1912—1914 UNDER TREATMENT DISCHARGED DECEASED TOTALS Posi-tive Sus-pects Not Pati-ents Total For Inebriety Not Amendable Rehabilitated Posi-tive Sus-pects Not Pati-ents Posi-tive Sus-pects - Posi-tive Sus-pects Not Pati-ents Posi-tive Sus-pects Not Pati-ents Posi-tive Sus-pects Not Pati-ents Not Pati-ents 1-1 Adults—Adolescents .. 5 Children............... 44 32 11 3 44 8 29 24 10 76 100 29 4 1 0 0 1 0 3 4 1 7 1 1 1 3 0 3 4 1 22 10 4 0 7 4 10 15 7 1 0 0 0 0 1 0 0 2 34 12 5 1 11 5 16 11 Total................ 87 55 63 205 5 I 8 9 4 8 36 11 32 1 1 2 51 17 50 31 3 9 43 2 0 1 5 0 0 12 0 5 1 0 0 51 3 15 N. B. In group "under treatment" are eight individuals comprising the families of the (2) patients discharged during the first year and readmitted during the second year. GRAND TOTAL Positive Adults—Adolescents..........78 Children.......................44 Infants........................16 138 42.7% Suspects 4 55 13 72 21.3% Not Patients 45 47 21 113 34.9% Total 127 146 50 323 Average 39.3% 45.2% 15.4% 9.99% PER CAPITA COST OF MAINTENANCE The following table gives the per capita cost of maintenance and capacity of some of the prominent tuberculosis hospitals and sanatoria in New York State: Per Capita Cost Name of Institution. Capacity. Maintenance. Summit View Tuberculosis Hospital, Fulton Co. 17 $1.87 Iola Sanatorium, Monroe Co.................. 250 1.22 Montgomery County Tuberculosis Hospital___ 20 1.71 Oakmount Sanatorium, Ontario Co............ 30 1.15 Estelle & Walter Odell Memorial Hospital, Orange Co................................ 40 1.59 Lakeview Sanatorium, Rensselaer Co.......... 51 1.14 Glen Ridge Sanatorium, Schenectady Co....... 72 1.30 Ulster County Tuberculosis Hospital........... 26 1.34 Albany Hospital ............................. 90 1.28 Albany Federation of Labor Pavilion......... 15 1.10 Elmira Tuberculosis Hospital.................. 30 1.60 Poughkeepsie Tuberculosis Hospital........... 100 1.16 Auburn Municipal Sanatorium................ 25 1.50 New York City Hospital for Incipient Cases, Otisville, New York...................... 465 1.36 Yonkers Municipal Hospital for Advanced Cases 40 1.75 Yonkers Sprain Ridge Hospital............... 25 1.50 State Hospital for Incipient Tuberculosis, Ray Brook.................................. 300 1.28 Average daily per capita cost of maintenance..........$1.40 MEDICAL AND SURGICAL TREATMENT AT HOME HOSPITAL, 1912-1914 Operations performed at Home Hospital, 1912-1914: Operation for Imperforate Anus....................... 1 Tonsillectomy......................................... 92 Adenoidectomy....................................... 95 Mastoidectomy....................................... 3 Myringotomy......................................... 7 Hemorrhoidectomy................................... 1 Hernia............................................... 2 Undescended Testes................................... 2 Plastic................................................ 1 Staphylorraphy....................................... 1 Administration Salvarsan.............................. 1 Administration of Neosalvarsan......................... 5 Injestion of Salicylate of Mercury....................... 4 Illnesses treated at Home Hospital: Pertussis.............................................. 3 Chicken Pox.......................................... 2 Conjunctivitis........................................ 8 Tonsilitis............................................. 35 Confinements......................................... 6 III Illnesses treated at Home Hospital (Continued) : Grippe............................................... 17 Croup............................................... 2 Bronchitis............................................ 4° Malaria.............................................. 3 Ileocolitis............................................. 19 Hysteria............................................. I Pleurisy.............................................. 3 Pelvic Peritonitis..................................... 1 Retropharyngeal Abscess............................. 2 Mastoiditis........................................... 7 Asthma............................................. 4 Trachoma............................................ 3 Rheumatism.......................................... 6 Purulent Discharges.................................. 9 Lumbago............................................. i Pneumonia........................................... 6 Pulmonary Hemorrhage............................... 13 Diphthera............................................ i Appendicitis.......................................... 4 Eczema.............................................. 9 Mumps...........................................'--- 2 Gastro Intestinal..................................... 20 Laryngitis............................................ 1 Discharging Ears..................................... i5 Minor Lacerations Innumerable. Gastritis............................................. 5° Burn of 3rd Degree (temporarily treated).............. 1 Fracture of Skull with Concussion..................... 1 Fracture of Leg....................................... 1 Members of the families in the hospital were sent to the following special clinics for treatment. As a result of these visits the Home Hospital provided twenty-nine pairs of glasses, two pairs of elastic stockings and one abdominal belt. Eye and Ear........................................... 185 Nose and Throat....................................... 35 Dental............................................... 595 Gynecological........................................ 103 Maternity............................................ 33 Accidents............................................. 66 Miscellaneous........................................ 104 The following hospitals admitted members of the families for special treatment: Babies' Hospital...................................... 3 Bresbyterian......................................... 2 St. Lukes............................................ 1 Bellevue............................................. 8 Metropolitan......................................... 3 German......................................1....... 3 Manhattan Eye and Ear................................ 9 General Memorial.................................... 1 Reception Hospital................................... 3 112 NATIONAL LIBRARY OF MEDICINF NLM QDQ32TbS b .,:;„,ii;^nv.:^nnnia}iitt ii, Wijrtffifiwm,.... rH^.,rw^ij^,7r;-^7nnifr^)irnintrn)?mTTil^PTtTn'h .u..,i.7i»^»i,.i;,.».Tiim;Tr,r,-,..,iu-^)Ijii1wljl)iii)jlhi1rti ^,-«~.iit.. ,r,.,,-ft.-T;mtn7i^?h;f{i}(nhimmiHT?TnTi |h>, i!':!ii!!i|,ii;ii!!l ■.■''''!ii'i,iill (|1 iii'i-- i!;!:"'; 1:1"' il;!i ' li^'Hi! 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