THE WORK of the Edward Sanatorium Naperville, Illinois JANUARY 15, 1907 TO JANUARY 1, 1911 INCLUDING THE ANNUAL REPORT for 1910 Founded January 15, 1907 DEPARTMENT CHICAGO TUBERCULOSIS INSTITUTE THE WORK OF THE Edward Sanatorium An Institution for the Treatment of Incipient Pulmonary Tuberculosis JANUARY 15, 1907 TO JANUARY 1, 1911 INCLUDING THE ANNUAL REPORT FOR 1910 Founded January 15, 1907 NAPERVILLE, ILLINOIS Staff Theodore B. Sachs, M. D., Medical Director. VISITING LARYNGOLOGISTS Elmer L. Kenyon, M. D. George A. Torrison, M. D. CONSULTING STAFF Special Departments Surgery— Arthur Dean Bevan, M. D. L. L. McArthur, M. D. Diseases of Women— E. C. Dudley, M. D. Diseases of Skin— Oliver S. Ormsby, M. D. Orthopedic Surgery•— John Ridlon, M. D. Edwin W. Ryerson, M. D. John L. Porter, M. D. Nose and Throat— G. E. Shambaugh, M. D. Laboratory— Edward C. Rosenow, M. D. Diseases of the Eye Cassius D. Wescott, M. D. Winnifred McEdward, R. N., Superintendent. Anne I. Murphy, M. D., House Physicians. J. B. Rogers, M. D., Cora Sommers, R. N. Georgia Rice, R. N. Stena Wellman, R. N. Edna Ruff. INTRODUCTION. It is opportune, at this stage of the development of the Sanatorium movement in the State of Illinois, to present to the medical profession and the community at large an analysis of results of sanatorium treatment of tuberculosis in our home climate. This report embodies the results obtained and the lessons learned during the first four years of operation of the Edward Sanatorium, at Naperville, Illinois, the first institution, under Chicago auspices, for the treatment of incipient pulmonary tuberculosis. The various features of the sanatorium regime and the arrangement of buildings are treated in detail in special chap- ters, and space is given to the architectural plans of the Medical Building, of the Infirmary and of the sleeping and recreation shacks. In presenting this information to the public, we hope that (in connection with Reports of other Sanatoria and the valuable publication on “Housing of Consumptives” by the National Asso- ciation for the Study and Prevention of Tuberculosis) it may be of assistance to those who contemplate the establishment of similar institutions. Step by step, the city of Chicago as well as the State at large are gradually developing a widespread public interest in the tuberculosis problem and its proper solution and it is hoped that the experiences of the Edward Sanatorium shall further develop and strengthen the conviction of the public as well as of the official bodies that tuberculosis can be successfully treated in our home climate, if treated in a proper way and at a proper time. Theodore B. Sachs, M. D. 1. Service Building (originally Administration Building.) 2. Medical Building and Infirmary. Gift of Mrs. Keith Spalding, the original donor of the Sanatorium to the Chicago Tuberculosis Institute. For description of these buildings see pages 56 to 58. For plans of Medical Building and Infirmary see page 54. CONTENTS PAGE REPORT OF THE MEDICAL DIRECTOR ? to 68 Analysis of cases and results of treatment at the Edward Sanatorium, January 15, 1907 to January 1, 1911. Chapters: Admissions. Summary 7 Admissions classified according to stage of disease 8 Admissions classified according to sex ,. v. 9 Admissions classified according to social status ....;. 9 Admissions classified according to age 10 Admissions classified according to nativity 10 Admissions classified according to residence . ... 11 Admissions classified according to occupation... 11 Admissions classified according to financial status 12 Supported beds. ; 13 Average duration of treatment 14 Schema of classification of cases and results of treatment adopted by the National Association for the Study and Prevention of Tuberculosis... 15 Results of Treatment at the Edward Sanatorium classified according to stage of disease on admission 17 Results of Treatment classified according to stage of disease and length of stay 18 Subsequent course of cases discharged from the Sanatorium since its opening on January 15, 1907.—Their present working capacity 19 Method of observation of discharged cases. The subsequent history record 22 Conditions of admission to the Sanatorium. Class of Cases. Method of applying for admission. Application blank. Necessary clothing.. 23 Ear, nose and throat service 26 Laboratory 26 Tuberculin treatment 27 Tabulation of individual cases discharged from the Sanatorium from January 1, 1910 to January 1, 1911 28 The Sanatorium regime: Rest. Exercise. Restoration of the working capacity 37 The daily regime 39 Preventive measures 41 Rules governing the patients 42 Outdoor sleeping during winter months. 1 Arranging the bed. 2 How to dress 45 Diet 47 Social Life at the Sanatorium 49 Observation of National Holidays 50 Entertainments. Concerts ,.. 51 Lectures. 52 Patients' reading circle 52 History and general description of the Institution 55 5 PAGE Individual description of buildings 56 Service Building 56 Medical Building and Infirmary 57 Patients’ sleeping quarters 59 Day rest or recreation shacks 62 The farm 65 Acknowledgments 66 The needs of the Institution 67 The Outlook 68 FINANCIAL REPORT. January 1, 1910 to December 31, 1910 69 New Medical Building Fund. Detailed statement of total contribution and disbursement 73 Average cost of maintenance of patients in 1907, 1908, 1909 and 1910 74 Comparative statement of cost of maintenance in same years 75 ADMISSIONS AND DISCHARGES 1907-1910 76 FORMS FOR DONATIONS AND BEQUESTS 77 ILLUSTRATIONS Phases of Sanatorium Life. The regime of the new patient 36 A group of convalescents 36 Convalescents on the lawn of the Sanatorium 38 Playing Croquet 39 On a drive through the country 40 Gardening 40 Working on the lawn 40 A quiet evening. Assembly Hall 49 Celebration of the Fourth of July 51 Patients’ Reading Circle 53 Types of Buildings. Illustrations and Plans. Service Building (originally Administration Building) 4 Medical Building and Infirmary 4 Sleeping Shacks. Women’s Section 45 Sleeping Shacks. Men’s Section 46 Plans of the Medical Building and Infirmary 54 Medical Building. Superintendent’s Office 57 Medical Building. Infirmary Sleeping Porches 57 Medical Building. Laboratory 58 Medical Building. Nose and Throat Room 59 Plans of a sleeping shack for ten patients 60 Plans of a sleeping shack for six patients 61 Day Rest or Recreation Shack 63 Plans of Day Rest Shack 64 The Farm. General View 65 A corner of the chicken farm 65 6 Report of the Medical Director. Four years have passed since the establishment of the Ed- ward Sanatorium, at Naperville, Illinois, the first permanent institution of its kind, near Chicago, for the treatment of in- cipient pulmonary tuberculosis. The time is opportune for an analysis of the results so far accomplished, not only in reference to the condition of the patients at the time of their discharge but also in reference to the main- tenance of their condition and their working capacity, with the progress of time. The results obtained at the Edward Sanatorium were freely quoted in the last three years’ campaign for ample institutional provision for the tuberculous sufferer in our home climate. In the successful fight for the establishment of the Chicago Munici- pal Sanitarium, the medical statistics of the Naperville Institution, as well as similar institutions in other States, were made the basis of a strong appeal to the community. Fully cognizant of our duty to the medical profession and the laity, who by studying the results of treatment of tubercu- losis under varying conditions, strive at formulation of effective methods of dealing with this disease, we have endeavored to present in this report a conservative estimate of the results ob- tained at the Edward Sanatorium, from the day of its opening, January 15th, 1907, up to January 1st, 1911. ADM ISSIONS-SUM MARY. Patients in residence, January 1, 1911 50 Admitted, from January 15, 1907, to January 1, 1911.... 406* Discharged in same period 356 In residence less than one month (results of treatment not classified) 45 Discharged cases, with results of treatment classified in this report 311 Average period of treatment of the 311 classified cases, weeks 16.8 Cases classified for the year 1910 (individual tabulation). 123 Present capacity of the Sanatorium 60 Prospective capacity, with the erection of additional shacks 100 * Of this number three patients were twice at the Sanatorium. 7 ADMISSIONS CLASSIFIED ACCORDING TO STAGE OF DISEASE. Discharged. In Residence Total. Per Cent. Incipient 225 26 251 61.8 I Moderately Advanced 112 22 134 33. Far Advanced 19 2 ' 21 5.2 Total 356 50 406 100. The Edward Sanatorium was established for the treatment of tuberculous patients in the incipient stages of the disease. This policy was adhered to in two-thirds of the entire num- ber of cases admitted to the institution in the last four years. Of the 406 admitted cases, 33 per cent were moderately advanced, presenting on their admission a reasonable prospect of ultimate “arrest.” Under the present conditions, a strict limitation of admissions to the “incipient” class is impossible and unjust for the following obvious reasons: (1) Preponderance of moderately advanced cases among applicants for admission to sanatoria. The general practitioner is frequently criticised for his fail- ure to detect tuberculosis in the incipient stages and thus fur- nish sanatoria with the "most favorable class of cases. Experience, however, shows that in a large percentage of cases, with a timely diagnosis made by the attending physician, treatment is delayed by (a) the involved deprivation of the family of the earnings of the afflicted member or (b) the unwillingness of the patient and the family to accept the diagnosis of tuberculosis at a time when the general appearance is not markedly suggestive of any serious disturbance of health. The first mentioned condition is one of the chief obstacles to timely treatment of tuberculosis among the working classes. Further education on the subject of tuberculosis is necessary to make the laitv an ally of the medical profession in the pres- ent fight against this disease; the absolute necessity of early treatment must become common knowledge; institutional pro- vision must be ample to meet the existing situation in every com- munity; during the period of treatment of their breadwinner, the 8 family must be provided for out of Workingmen’s Insurance or State funds. (2) Institutional provision for tuberculosis cases in Chicago and in Illinois, is so markedly inadequate that, for a great many years to come, the rules of admission of any existing institution must necessarily be interpreted in a liberal spirit and always in favor of the patient. A stricter grouping of various stages of the disease, in separate institutions, can be made possible only by the gradual development of a chain of state, city and private sanatoria. (3) While it is true that the prospect of ultimate recovery and restoration of working capacity diminishes with the progress of the disease, a large percentage of moderately advanced cases, particularly the class characterized by slow progress and good general condition, respond readily to treatment. The reports of the majority of sanatoria for incipient cases, in this country, show a population consisting of about two- thirds incipient cases and one-third moderately advanced. ADMISSIONS CLASSIFIED ACCORDING TO SEX. Male Female Total Discharged .... 145 211 356 In Residence September 1. 1910 . . . . . . . . 18 32 50 Total .... 163 243- 406 Per cent .... 40.1 59.9 100. It is interesting to note that the female sex predominates among the applicants for admission to sanatoria for incipient cases. An explanation of this fact is suggested by the present economic conditions as affecting both sexes; comparatively less hardship being caused by withdrawal of the earnings of a female member of a family, the available family resources frequently re- maining sufficient for partial or full support of the afflicted mem- ber in an institution. SOCIAL STATUS Single 257 or 63.3 per cent Married 125 or 30.8 per cent Widowed 24 or 5.9 per cent Less difficulty is encountered in arranging sanatorium treat- ment for single people. Family responsibilities, in the case of married men and women, frequently delay institution of treat- ment until the case is hopeless; the difficulty increases in propor- 9 tion to the size of the family in need of mother’s care or de- pendent upon the support of the afflicted breadwinner. Prompt, adequate provision; for the dependent family in such cases is very essential to timely institution of treatment and prevention of further infection. Discharged. In Residence Total. Per Cent. 5 to 10 years 3 0 3 0.7 10 to 15 years 15 0 15 3.7 15 to 20 years 61 6 67 16.5 20 to 30 years 148 27 175 43.1 30 to 40 years 92 11 103 25.4 40 to 50 years 29 5 34 8.4 50 to 60 years 6 1 7 1.7 Over 60 years 2 0 2 0.5 Total 356 50 406 100 AGES. 85 per cent of the total number of patients admitted to the Edward Sanatorium . were between 15 and 40 years of age ; 68.5 per cent between 20 and 40 years; 64 per cent under 30 years of age. Treatment of tuberculous children calls for separate hous- ing and modified regime, with provision for out-door schooling. This is to be borne in mind in the further extension of the pres- ent facilities of the Institution. NATIVITY. About two-thirds of the patients admitted to the Edward Sanatorium were native born. United States 262 Germany 29 Sweden 23 Ireland 21 Russia 17 Austria-Hungary 15 England 9 Canada 10 Denmark 7 Norway 5 Scotland 2 France 1 Finland 2 Roumania 1 Iceland 1 Japan 1 Total 406 Native born 64.5 per cent Foreign born 35.5 per cent Countries represented 16 10 RESIDENCE. Chicago furnished 88.9 per cent of the total number of cases; 53.5 per cent of Chicago cases came from the West Side, the industrial section of the City. No. of Patients Per cent Chicago, North Side... 57 15.8 j South Side... Ill 30.7 Per cent total West Side... 193 53.5 r 88.9 361 100.0 J Illinois (outside of Chi- 6.2 cago) 25 Kentucky 1 j Michigan 12 Indiana 3 Wisconsin 2 Nebraska 1 Pennsvlvania 1 J 4.9 Total 406 100. OCCUPATION. Actor 2 Agent 3 Artist 4 Baker 3 Bartender 1 Bed Enameler .... 1 Book Binder 2 Bricklayer 1 Carpenter 1 Carriage Maker ... 1 Car Repairer 1 Cement Finisher .. 1 Cigarmaker 1 Clerk, Bank 1 Clerk, Store 25 Clerk, Office .... 43 Conductor 2 Detective 1 Domestic 20 Draughtsman 1 Driver 2 Electrician 2 Elevator Starter ... 2 Engineer 1 Errand Boy 1 Factory—'Sundry .. 8 Farmer 3 Fencemaker 1 Fireman 1 Furrier 1 Gardener 1 Governess 1 Home, working at.. 16 Housewife 64 Ironworker 4 Janitor 2 Laborer 6 Laundress 4 Lawyer 1 Machinist 7 Matron 1 Metal Polisher .. 1 Meter Repairer .. 1 Milliner 5 Missionary 1 Motorman 1 Nurse, Practical ... 2 Nurse, Pupil 1 Nurse, Trained.. 11 Packer 3 Painter 3 Patternmaker 1 Penmaker 1 Pharmacist 2 Photo Engraver.. 1 Photographer .... 2 Physician 1 Plumber 1 Policeman 1 Post Office Clerk... 3 Printer 8 School 31 Shoe Operator 1 Social Worker .... 1 Steel Worker 1 Stone Carver 1 Store Keeper 4 Surveyor 1 Stenographer .... 23 Switchman 1 Tailor 19 Teacher 6 Telephone Operator 7 Telegraph Operator. 1 Upholsterer 1 Waiter 7 Winemaker 1 Woodworker 1 No Occupation .. 5 Total 406 11 SUMMARY OF OCCUPATIONS. A. Number Per cent Housewife . .641 81 20. Working at home Office ..171 74 18.2] Factory 76 18.7 [45.3 Store 34 8.41 School 31 7.6 Profession 33 8,1 Sundry 72 17.8 No Occupation 5 1.2 Total 406 100. B. Number Per cent Indoor Occupations 255 62.8 Outdoor Occupations . .. 34 8.4 Housewife or working home at 81 20. School 31 7.6 No Occupation 5 1.2 Total 406 100. Thus 45.3 per cent of the total number of patients admitted to the Edward Sanatorium, came from offices, stores and factories of the city; the housewives and those working at home constituted 20 per cent; school children 7.6 per cent. Indoor occupations, as it would be expected, predominate, representing 62.8 per cent of the total number. FINANCIAL STATUS OF THE 406 PATIENTS. The Edward Sanatorium was established for the treatment of tuberculous patients in moderate circumstances. During the four years of its operation, the number of applications for ad- mission was out of all proportion to the available facilities of the institution. With the absolute lack of provision by the municipality of Chicago and State of Illinois for their tubercu- lous population, a large number of applicants were of the class, unable, or but partially able, to pay for their maintenance. With liberal support from various individuals and organ- 12 izations, a proportion of patients at the Sanatorium were main- tained, during the last four years, free or semi-free, as shown in the appended table: • Jan. 15. 1907 to Jan. 15. 1911. No. of Per Patients I otal Cent Pay Patients 161 39.7 Free Patients. 10 beds at the disposal of the VisitingNurse Association. Maintained by Mrs. Keith Spalding . . 131 1 Children’s Bed. Maintained by Elizabeth McCormick Memorial Fund 7 3 Beds. Maintained by Sears, Roebuck & Co., for their employes 12 1 Bed for Nurses. Maintained by the Nurses’ Auxiliary of the Chicago Tuberculosis Institute .... 4 1 Bed. Maintained bv the Women’s Trade Union League of Chicago 1 Patients maintained by various organiza- dons, United Charities of Chicago, Fraternal Orders, etc 28 Patients maintained by various individuals 25 Total 208 51.2 Semi-Free. Assisted by various organizations, United Charities, Fraternal Orders, etc 12 Assisted by individuals 8 Assisted through Sanatorium Relief Fund, (Mrs. Louise DeKoven Bowen and Miss Smith of Hull House, chief con- tributors; contributions from various individuals; fees for special examina- tions on admission of patients are placed in this fund) 17 Total 37 9.1 Total 406 100. 13 The facilities p£ the institution will be gradually extended to accommodate a larger number of patients able to pay a moderate compensation for their maintenance. A larger number of endowed and supported beds is greatly needed. DURATION OF TREATMENT. A modern Sanatorium lias a twofold object to accomplish in each individual ca>e: (1) “cure” or “arrest” of the tuberculous process, (2) restoration of the working capacity. Absolute rest until subsidence of constitutional disturb- ance, followed by carefully graduated exercise in the period of convalescence, require a variable number of months, according to the progress of the case. Individual cases, even belonging to the same group (as “incipient”, “moderately advanced”, etc.) vary in their response to the same regime. The required period of treatment can be determined only by gradual developments in each individual case. Unfortunately, various outside factors frequently tend to terminate abruptly a course of treatment that would have other- wise resulted in the ultimate arrest of the disease. Of these, the financial inability to pay the cost of maintenance in a Sanatorium for a long period is a frequent cause of the premature return home; worry over family left to their own resources, home- sickness, utter inability of adjustment to a strict regime, etc., are other causes. The effect of these factors is minimized by an adequate provision for the dependent family and a sanatorium regime producing an atmosphere of contentment. No applicant for admission to a Sanatorium can be told in advance the required period of treatment in his case. The duration of treatment of 356 patients, discharged from the Sanatorium since January 15th, 1907, was as follows: 133 patients or 37.3 per cent of the total num- ber 3 months or less 145 patients or 40.8 per cent of the total num- ber 3 to 6 months 30 patients or 8.4 per cent of the total num- ber 6 to 9 months 14 3 patients or .9 per cent of the total num- ber 9 to 12 months 45 patients or 12.6 per cent (unclassified less than 1 month Average period of treatment of 356 discharged cases 15. weeks Average period of treatment of 311 classified cases. .16.8 weeks Average period of treatment of 199 incipient cases. .15.6 weeks Average period of treatment of 101 moderately ad- vanced cases 19.7 weeks Average period of treatment of 11 far advanced cases 19.6 weeks Average period of treatment of 45 unclassified cases. 2.4 weeks SUMMARY. SCHEMA OF CLASSIFICATION OF CASES AND RE- SULTS OF TREATMENT ADOPTED BY THE NATIONAL ASSOCIATION FOR THE STUDY AND PREVENTION OF TUBERCULOSIS. A. Incipient. Slight initial lesion in the form of infiltration limited to the apex of one or both lungs or a small part of one lobe. No tuberculous complications. Slight or no constitutional symptoms (particularly including gastric or intestinal disturbance or rapid loss of weight.) Slight or no elevation of temperature or accel- eration of pulse at any time during the twenty four hours, es- pecially after rest. Expectoration usually small in amount or absent. Tubercle bacilli may be present or absent. Moderately Advanced. No marked impairment of function either local or consti- tutional. Localized consolidation moderate in extent with l'ttle or no evidence of destruction of tissue; or disseminated fibroid deposits. No serious complications. Far Advanced. Marked impairment of function, local and constitutional. Localized consolidation intense; or disseminated areas of soft- ening; or serious complications. Acute Miliary Tuberculosis. STAGES. 15 DEFINITION OF THE EXTENT OF DISEASE IN LUNGS, ACCORDING TO TURBAN.* B. I— Slight lesion extending at most to the volume of one lobe or two half lobes. II— Slight lesion extending further than I, but at most to the volume of two lobes; or severe lesion extending at most to the volume of one lobe. III— All lesions which in extent of the parts affected ex- ceed II. “Slight Lesion”—disseminated centres of disease which manifest themselves physically by slight dullness, by harsh, feeble, or broncho-vesicular breathing, and by rales. “Severe Lesion”—cases of consolidation and excavation such as betray themselves by marked dullness, by tympanitic sounds, by very feeble broncho-vesicular, bronchial, or amphoric breathing, by rales of various kinds. Purely pleuritic dullness, unless marked, is to be left out of account; if it is serious, the pleurisy must be specially men- tioned under the head of “tuberculous complications.” The volume of a single lobe is always regarded as equiv- alent to the volume of two half lobes, etc. C. CLASSIFICATION OF RESULTS OF TREATMENT. Unimproved:—All essential symptoms and signs unabated or increased. Improved:—Constitutional symptoms lessened or entirely ab- sent ; physical signs improved or unchanged; cough and expectoration with bacilli usually present. Arrested:—Absence of all constitutional symptoms; expectora- tion and bacilli may or may not be present; physical signs stationary or retrogressive; the foregoing conditions to have existed for at least two months. Apparently Cured:—All constitutional symptoms and expectora- tion with bacilli absent for a period of three months; the physical signs to be those of a healed lesion. Cured:—All constitutional symptoms and expectoration with bacilli absent for a period of two years under ordinary conditions of life. *This is used in tabulation of individual cases. See pages 28 to 35 16 RESULTS OF TREATMENT ATTHE EDWARD SANA- TORIUM, CLASSIFIED ACCORDING TO STAGE OF DISEASE. (January 15, 1907 to January 1, 1911.) The stage of disease on admission determines to a great extent the result of treatment in each individual case admitted to a Sanatorium. The table below shows that 79.9 per cent of all incipient cases, admitted to the Edward Sanatorium in the last four years, were considered either “apparently cured” or “arrested” at the time of their discharge from the institution. Of the moderately advanced cases, 39.6 per cent were considered “arrested.” Of the total number of 311 cases, regardless of stage (“incipient” class predominating), 64 per cent were either “apparently cured” or “arrested.” Stage of Disease Apparently Cured. Arrested. Improved. Unimproved. Died. Not Classified. In residence i less than one month. Total. Incipient 67 92 v 79.9% J 37 2 1* 199 Moderately Advanced .. | 40 39.6% ' 52 9 101 Far Advanced .. 8 3 11 Total (Classified) 67 132 64% —' 97 14 1 311 Not Classified. In residence less than one month 45 Total 356 The length of stay in a Sanatorium is another important factor influencing the result of treatment in each individual case. The table below shows, that of 94 incipient cases treated at the Edward Sanatorium, for a period of 3 months or less, 63.8 per cent were either “apparently cured'’ or “arrested” at the time of their discharge; while of the 90 incipient cases, treated for a period of 3 to 6 months, “apparent cure” or “arrest” resulted in 94.4 per cent. *Cause of death: Malignant Endocarditis 17 The effect of the same factor is shown in the moderately advanced cases; of the 35 cases, with the length of stay of 3 months or less, 17.1 per cent were “arrested”; in the 49 cases, treated from 3 to 6 months, arrest of the tubercular process resulted in 61.2 per cent. RESULTS OF TREATMENT CLASSIFIED ACCORD- ING TO STAGE OF DISEASE AND LENGTH OF STAY. Months of Treatment. Apparently Cured. Arrested. Improved. Unimproved. Died. Total. 3 months or less 6 54 6.4% 57.4% 63.8% 31 2 1* 94 3 to 6 months . 54 60% 94. 31 34.4% 4% 5 90 Over G months . 7 7 i • • 15 Total 67 92 37 2 1 199 a. Incipient. *Cause of death: Malignant Endocarditis b. Moderately Advanced. Months of Treatment. Apparently Cured. Arrested. Improved. Unimproved. Died. ' Total. 3 months or less 6 or 17.1% 22 7 35 3 to 6 months . 30 or 61.2% 17 2 49 Over 6 months . 4 13 ... i 17 | Total 40 52 9 101 c. Far Advanced. Months of Treatment. Apparently Cured. Arrested. Improved. Unimproved. Died. Total. 3 months or less 3 1 4 3 to G months . 4 2 6 Over 6 months . 1 1 Total 8 3 11 18 THE SUBSEQUENT COURSE OF CASES DIS- CHARGED FROM THE SANATORIUM SINCE ITS OPENING ON JANUARY 15, 1907— THEIR PRESENT WORKING CAPACITY. The results of sanatorium treatment of tuberculous pa- tients, as shown by their condition, at the time of discharge, are of great value in determining the effect of sanatorium regime; the final judgment, however, rests on the study of “subsequent” results, as shown in the “permanency” of cure or arrest of the disease and in the maintenance of the working capacity. The majority of patients at the Edward Sanatorium are men and women earning their livelihood by office, clerical, fac- tory or professional work. The terms “apparent cure” or “arrest”, in their instance, must embrace restoration of the working power, as well as disappearance or subsidence of symp- toms and physical signs. A permanent loss or a considerable diminution of the earn- ing capacity, in case of a wage-earner, means a standard of life incompatible with future maintenance of health; hence the rapid decline in a large number of such cases on their discharge from a sanatorium. Early diagnosis and immediate treatment of tuberculosis among working people offers the only chance of permanent “cure” combined with a restored working power. The subsequent course of cases discharged from the Ed- ward Sanatorium, since its opening on January 15th, 1907, is treated in the following table from the standpoint of their pre- sent working capacity. 19 Stage of Disease on Admission Condition on Discharge. Working Capacity Maintained. Partial Working Capacity. Condition Stationary or Progressive. Patient at Home or in an Institution.- Does not Work. t a Total. Incipient Ap. Cured 67 67 Arrested 82 4 2 92 Improved 28 7 2 37 Unimprov. 2 2 Dead 1 Total 177 13 4 5 199 Per Cent 89 6.5 2 2.5 100 Moderately Advanced Arrested 24 7 3 6 40 Improved 9 10 17 16 52 Unimprov. 1 4 4 9 Total 33 18 24 26 101 Per Cent 32.7 17.8 23.8 25.7 100 Far Advanced Improved 1 3 3 1 8 Unimprov. 3 3 Total 1 3 6 1 11 Subsequent Results Regardless of Stage on Admission 211 34 34 32 311 Per Cent 67.9 10.9 10.9 10.3 100 *Cause of death in one case—chronic endocarditis; pulmonary tuberculo- sis—cause of death in three. **Cause of death—malignant endocarditis. These 311 cases were kept under observation for a time varying from a few months to three years and nine months, from the date of their discharge from the Institution. 20 The following table gives the periods of observation of the discharged incipient and moderately advanced cases, in which the working capacity was fully restored and is at present main- tained. Discharged Incipient Cases With Full Working Capacity at Present, Classified According to the Period of Time Since Their Discharge. Total—177 patients or 89% of treated incipient cases. 9 Patients under observation 3 years and over. 46 Patients under observation 2 to 3 years. 47 Patients under observation 1 to 2 years. 75 Patients under observation up to 1 year. Discharged Moderately Advanced Cases With Full Working Capacity at Present, Classified According to the Period of Time Since Their Discharge. Total—33 cases or 32.1% of treated moderately advanced cases. 4 Patients under observation 3 years and over. 8 Patients under observation 2 to 3 years. 10 Patients under observation 1 to 2 years. 11 Patients under observation up to 1 year. The figures bearing on the present working capacity of the 311 discharged patients, are presented with the full appreciation of the fact that (1) recurrence or extension of the tuberculous process, due to preventable or unpreventable conditions, is bound to undermine eventually the working capacity in a varying num- ber of cases, and (2) subsequent supervision and regulation is very essential to maintenance of the condition in which a patient is discharged from the institution. With the progress of time and the gradual impairment of condition in a certain percentage of cases, particularly the more advanced, a rearrangement of figures in the foregoing table will become necessary. The observations up to the present date fully illustrate, how- ever, the well known fact that the working capacity of a dis- charged patient, with an arrested moderately advanced tuber- culosis, is more frequently limited than that of an arrested incip- ient case. An analysis of the 311 classified cases discharged from the Edward Sanatorium in the last four years shows that of the total number of 199 incipient cases, apparent cure or arrest took 21 place in 159, or 79.9 per cent, improvement in 37 or 18.6 per cent, while full working capacity is maintained at present in 89 per cent and partial in 6.5 per cent. Of 101 moderately advanced cases, arrest of the tubercu- lous process resulted in 40, or 39.6 per cent, improvement in 52, or 51.5 per cent, while full working capacity is maintained at present in only 32.7 per cent and partial in 17.8 per cent of the total. From the standpoint of medical results as well as the reestablishment of working power of the tuberculous patient, early diagnosis is of utmost importance in each individual case. As previously stated, the permanency of “cure” or “arrest” of tuberculosis cases depends to a considerable extent on their subsequent effective supervision and regulation. This task natur- ally falls within the province of the family physician to whom the discharged patient is directed for further advice. Recognizing the great importance of the family physician as a factor in the crusade against tuberculosis as well as the in- timate relation existing between him and the patient, the Edward Sanatorium, since its establishment, had strictly adhered to the following policy: 1. The family physician is urged to visit the Sanatorium during the period of stay of his patient at the insti- tution, to observe the progress of the case and study the sana- torium methods of treatment, the subsequent application of which is so essential to the maintenance of health of the dis- charged patient; 2, the patient is instructed before leaving the Sanatorium, to consult his family physician from time to time; 3, the medical profession at large is urged to visit the institution and study the system. OBSERVATION OF DISCHARGED CASES. EDWARD SANATORIUM Naperville, Illinois. SUBSEQUENT HISTORY. No. Date Vol. Name Address Describe your sleeping quarters (3 lines) Are you employed? State nature of employment,. number of working hours and hygienic surroundings (clean- liness, light, purity of air, method of ventilation, etc.)—4 lines.. 22 Number of hours spent daily in the open air In what way are they spent? (Describe in detail) 2 lines Hours of arising and retiring Weight Strength (lf4 lines) Fever Cough (2 lines) ; Expectoration (character and amount) Hemorrhages Chills. Night-sweats Appetite Digestion Pain Food, kind and amount in 24 hours (4 lines) Additional Information (4 lines) Answers received from the former sanatorium patients are supplemented by additional information available through the family physician and the visiting tuberculosis nurse. With further growth of the Institution and corresponding increase in the number of discharged cases requiring observation, the present cooperation between the Sanatorium and the munic- ipal tuberculosis nursing force will be made more comprehen- sive in detail. CONDITIONS OF ADMISSION TO THE SANA- TORIUM. CLASS OF CASES. As stated in a previous chapter, two-thirds of all cases ad- mitted to the Edward Sanatorium, in the last four years, were in the incipient stages of the disease. Exceptions were made in a number of moderately advanced cases, in good general con- dition and running a chronic course. A certain number of febrile cases presenting a favorable outlook were admitted on trial to the Infirmary. The policy of the Institution is to admit chiefly incipient cases. METHOD OF APPLYING FOR ADMISSION Applications for admission should be made to the Chicago Tuberculosis Institute, 157 West Adams Street, Chicago. Tele- phone Main 1466. All applications are passed upon in Chicago by the Medical Director of the Sanatorium. Physicians are requested to furnish information in the fol- lowing blank which is mailed on request: 23 EDWARD SANATORIUM Naperville, Iilinois. APPLICATION FOR ADMISSION Name Address Age. ... Sex Social Status Race Birthplace Occupation . . .Duration of Sickness. . .Unable to work since. .. Financial Status Family History (incidence of tuberculosis) 3 lines Personal History (previous illness, habits, etc.) 3 lines History of Present Illness (5 lines) Examination. General Condition Weight—present average highest Height Temperature (lowest and highest in the last 7 days) Pulse—same Cough—character, frequency, etc Sputum—character and amount in 24 hours Shortness of breath Hoarseness Pain on swallowing Chills Sweats Hemorrhages—amount, dates Examination of the heart Examination of the Larynx Complications Examination of the Sputum Urinalysis Extent of involvement and physical signs. Right Lung (3 lines) Left Lung (3 lines) Diagnosis. Stage of Disease. Prognosis. (3 lines) M. D. Address Date The physical signs should also be recorded on the diagram (see other side). Mail the application to the Chicago Tubercu- losis Institute, 157 West Adams St., Chicago. Admission to the Sanatorium is dependent on the final exam- ination in Chicago. If the case is admissible, all arrangements for transportation, etc., are made by the Central Office, 157 West Adams St., Chicago. Applicants for admission should under no circumstances undertake the trip to the Sanatorium without the preliminary examination in Chicago. 24 For information concerning free or semi-free beds see page 13. The uniform charge to all pay patients is ten dollars a week. In some pay cases requiring special attention an additional fee of five dollars a week is charged. All patients are on the same basis regardless of financial arrangements. NECESSARY CLOTHING The clothing needed by the patient is stated in the following printed list furnished to applicants for admission: EDWARD SANATORIUM Naperville, Illinois NECESSARY CLOTHING. Bear in mind that you will spend your time out of doors, day and night, while at the Sanatorium. Clothing Necessary for Both Sexes: Four sets of warm underwear, heavy sweater, stout high shoes, arctic overshoes, warm mittens or gloves, two flannelette night caps, two pairs bed socks, lambs wool bed shoes, heavy bath robe, two heavy horse blankets, 6 pair woolen stockings; comb, brush and tooth brush. Heavy fleece lined shirts and drawers (men's wear) will be more satisfactory for night wear than gowns or pajamas (for either men or women). Additional for women: Short heavy skirt, heavy long coat, fascinator or stocking cap, bloomers or tights, warm colored waists, hot water bag. Additional for men : Heavy suit, heavy overcoat, cap, flan- nel negligee shirts, hot water bag, shaving outfit. Please have mustache and beard shaved. Naperville is thirty miles from Chicago, on the line of the Chicago, Burlington and Quincy Railway. A convenient train leaves the Union Station, corner Adams and Canal Streets, Chi- cago, at 11 a. m. The Sanatorium is one and one half miles from the Naperville Station. Transportation from the Station to the Sanatorium will be arranged, on application, by the Chi- cago Tuberculosis Institute. 25 EAR, NOSE AND THROAT SERVICE. Periodical examinations of the ear, nose and throat of all patients are an important feature of the medical work of the Institution. The service was established in 1908, with Drs. Elmer L. Kenyon and Daniel B. Hayden of Chicago, in charge of it. From the latter part of 1909 until September 1, 1910, the work was under the supervision of Dr. Elmer L. Kenyon, under whose direction the special Nose and Throat Depart- ment in the new Medical Building was arranged and equipped. At present the service is divided between Dr. Kenyon and Dr. George A. Torrison, each visiting the Institution, alternately, once a week. Local treatment necessary in a certain percentage of cases is administered during the week by the Resident Phy- sician, in accordance with the instructions of the Visiting Laryn- gologist. The work has three ends in view: (1) Immediate treat- ment of disease when it is required, and when immediate treat- ment is likely to be helpful to the general condition of the pa- tient; (2) Instruction of the patient in the hygiene of the nose and throat, and in the need of nose or throat treatment (if any) after active symptoms of tuberculosis have ceased; and (3) the study of certain abnormal conditions of the nose and throat in their relationship to pulmonary tuberculosis. Later a detailed report of the work in this department will be made. Tbe whole number of patients studied in this manner thus far is 225. LABORATORY. With the installation of a well equipped laboratory in the Medical Building, a systematic laboratory investigation of each individual case was made a part of the medical routine of the Institution. In the arrangement of the Laboratory the medical management adhered closely to the plans of Dr. Edward C. Rose- now, the Consulting Pathologist of the Sanatorium. No effort was spared to make the laboratory complete in every detail. In examination of sputum, urine and blood,- the following rules are in effect at present: 1. Sputum is examined on admission and once a month during the period of residence. If after three successive ex- aminations at the time of admission, no tubercle bacilli are found, by the sedimentation method, the examination is not re- 26 peated until the time of discharge or any time during residence when there is indication for it. In cases running an afternoon or evening temperature above 100CF, and with a leucocyte count above ten thousand, plate cultures are made from washed sputum for the purpose of identifying any secondary infection that may be present. 2. Urine examined on admission and discharge. Special examinations during residence if indicated. 3. Blood examined in all cases where indicated. The present arrangement will gradually be made more com- prehensive in detail. Dr. Anne J. Murphy, formerly House Physician of the New England Hospital in Boston, has charge of the work. Dr. Edward C. Rosenow is the Consulting Pathologist. It is the desire of the Medical Management of the Sana- torium to develop the Laboratory Department in the direction of thorough study of each individual case as well as special research work. The Laboratory is a recipient of an annual contribution of five hundred dollars from Mr. Julius Rosenwald of Chicago. TUBERCULIN TREATMENT. Patients treated in 1907 12 Patients treated in 1908 32 Patients treated in 1909-10 57 Total TlOi Tuberculin R was used in 19 cases; Bacillen Emulsion in 27; Tuberculin Denys (Bouillon Filtrate) in 55. Of the 101 patients, 63 were in the incipient stage of the disease, 37 moderately advanced. Tuberculin was administered by the clinical method (as outlined by Trudeau), with .0000001 cc. as the initial dose and gradual increase, regulated by close observation of temperature and other symptoms. Only such cases of chronic type were selected as had the benefit of a sufficient period of outdoor treatment; no further improvement taking place, tuberculin was used to supplement the general measures of the Sanatorium regime. Introduction of tuberculin resulted in further improvement in a certain per- centage of these cases. With further observation and accumulation of additional material, an analysis of the tuberculin treated cases will be presented in the annual report of the Institution. 27 TABULATION OF INDIVIDUAL CASES DISCHARGED FROM EDWARD SANATORIUM JAN. 1, 1910, TO JAN. 1, 1911 (Prepared in accordance with the suggestion of the National Association for the Study and Prevention of Tuberculosis) No. Duration of Treatment. Condition. Amt. of Involve- ment (Turban). Side. Duration of Disease. General Condition. Digestion. Range of Pulse 7 days on admis’n & [ 7 d’ys on Disch’ge Av. Max. Temp. 7 days on admis’n 7 days on Disch’ge T.B. Complications. Tuberculin Treatment. Weight. Non-Tuberculous. Tuberculous. 194 36 2/7 weeks On Admis’n Mod. Adv. II RL 3 years Unfavorable Unimpaired 96-110 101 + O O 138 On Disch’rge Arrested I RL 3 years 9 months Favorable Unimpaired 84- 96 99 O O 16834 213 32 4/7 weeks A Mod. Adv. II L 4 months Favorable Unimpaired 98-120 100.6 + O O 10634 D Arrested II L 1134 months Favorable Unimpaired 88-108 99.2 — 0 0 13634 215 34 weeks A Mod. Adv. II R 10 years Favorable Unimpaired 72-100 99 + O O 9834 D Arrested 11 R 10 years 8 34 mos. Favorable Unimpaired 74- 96 99.2 + 0 0 121*4 218 22 weeks A Incipient I L 8 months Favorable Unimpaired 88-100 99.4 + Chronic Endocarditis 0 12634 D Ap. Cured 1 year 2 months Favorable Unimpaired 90- 96 99.2 Chronic Endocarditis 0 136 219 24 6/7 weeks A Incipient I RL 6 months Favorable Unimpaired 84-100 99.8 — O 0 125 D Ap. Cured 1 year Favorable Unimpaired 84- 96 98.6 — O 0 14134 222 26 3/7 weeks A Incipient I RL 7 months Favorable Unimpaired 68-104 99 + 0 0 117 D Ap. Cured 1 year 1 month Favorable Unimpaired 72- 96 98.6 — 0 0 154 225 46 1/7 weeks A Far Adv. 'I I R 6 months Unfavorable Unimpaired 96-124 99.6 + 0 0 10334 D Improved 11 It 1 year 5 months Favorable Unimpaired 70- 82 99.6 + 0 0 10534 226 27 weeks A Incipient I R 4 months Favorable Unimpaired 94-124 101.8 + 0 0 138 D Improved 1 Jt 1034 months Favorable Unimpaired 96-118 101 (Multiple Neuritis) 0 15534 229 26 5/7 weeks A Mod. Adv. I I RL 5 months Unfavorable Impaired 80-126 100.8 + O 0 10034 D Improved 11 R L 11J4 months Favorable Unimpaired 96-108 100 + 0 0 11234 234 38 3/7 weeks A Mod. Adv. II RL 2 years Unfavorable Unimpaired 80-108 101 + 0 0 120 D Improved 1 I RL 2 years 9 months Favorable Unimpaired 78-100 100 + 0 0 133 235 27 weeks A Incipient I R 1 year Favorable Unimpaired 88-100 100 — 0 0 102 D Ap. Cured 1 year 6 months Favorable Unimpaired 82- 96 99.2 — 0 0 11534 239 21 4/7 weeks A Mod. Adv. II R 3J4 months Favorable Unimpaired 94-120 99.8 + 0 0 10934 D Improved I 1 R 834 months Favorable Unimpaired 96-120 100.4 + 0 0 13434 240 23 6/7 weeks A Mod. Adv. 11 L 6 months Favorable Unimpaired 60-100 99 + 0 0 13834 D Arrested 11 L 1 year Favorable Unimpaired 72- 96 99 + 0 0 15434 241 21 4/7 weeks A Mod. Adv. II LR 6 months Unfavorable Unimpaired 96-130 102 + 0 0 103 D Improved 11 LR 11 months Unfavorable Unimpaired 96-110 100.4 + 0 0 11434 28 242 21 3/7 weeks A Incipient I R 6 months Favorable Unimpaired 80-100 99.6 — O 0 112 D Ap. Cured 11 months Favorable Unimpaired 84- 96 99 — 0 0 13134 244 18 weeks A Incipient I R 6 years F’avorable Unimpaired 76-100 99.6 — 0 Cervical Glands 4834 D Arrested I R 6 years 4 months Favorable Unimpaired 84-104 99.2 — 0 Cervical Glands 52 245 35 1/7 weeks A Mod. Adv. II L 3 years Unfavorable Unimpaired 84-120 100 + 0 Laryngitis + 10134 D I mpro ved II L 3 years 8 months Unfavorable Unimpaired 82-100 99.6 + 0 Laryngitis 114 246 17 4/7 weeks A Incipient I L 2 months Favorable Unimpaired 88-112 99.2 — 0 O + 126L€ D Arrested I L 6 months Favorable Unimpaired 80- 96 98.6 — 0 0 151 247 23 2/7 weeks A Incipient I RL 10 months Favorable Unimpaired 96-108 100 + 0 0 115 D Improved 1 RL 1 year 4 months Favorable Unimpaired 84-108 99.8 + 0 0 126 34 248 28 3/7 weeks A Incipient I RL 234 months Favorable Unimpaired 96-112 99.6 — 0 0 12934 D Ap. Cured 934 months Favorable Unimpaired 80- 90 98.8 — 0 0 157 250 20 6/7 weeks A Far Adv. III LR 1 year 7 months Favorable Impaired 96-134 101.4 + O 0 147 D Improved III Lll 2 years Favorable Unimpaired 94-104 98.6 + 0 0 169M 251 24 1/7 weeks A Mod. Adv. I I T, 6 months Favorable Unimpaired 80-124 99.6 + 0 0 1443,4' D Arrested II L 1034 months Favorable Unimpaired 76-104 99 + 0 0 145 252 16 5/7 weeks A Incipient I R 2 months Favorable Unimpaired 60-120 99 _ 0 0 12434 D Ap. Cured 6 months Favorable Unimpaired 78- 96 99 — 0 0 14034 253 14 3/7 weeks A Incipient I LR 2 years Favorable Unimpaired 76-100 99.6 — 0 0 137 D Arrested I L 2 years 334 mos. Favorable Unimpaired 76- 96 99.2 — 0 0 165 254 25 weeks A Incipient I L 3 months Favorable Unimpaired 64- 88 98.8 — 0 0 14834 D Ap. Cured 9 months Favorable Unimpaired 70- 80 98.8 — 0 0 167 255 36 5/7 weeks A Mod. Adv. 11 R 1 year Favorable Unimpaired 76-100 99.6 + 0 0 + 16234 D Improved II It 1 year 834 mos. Favorable Unimpaired 76- 92 100 + 0 0 15634 259 10 1/7 weeks A Mod. Adv. 11 R 1 year 6 months Favorable Unimpaired 96-120 99.8 + 0 0 + 12534 D Unimproved 11 R 1 year 8 34mos. Favorable Unimpaired 96-124 100.2 + 0 0 12134 261 20 weeks A Mod. Adv. I I R 1 year Unfavorable Unimpaired 108-120 101.4 + 0 0 913* D Arrested 11 R 1 year 5 months Favorable Unimpaired 80-100 99.2 + 0 0 103 262 27 weeks A Far Adv. I I I RL 1 year 6 months Unfavorable Unimpaired 94-110 100 + 0 0 + 12334 D Improved III RL 2 years 34 mo. Favorable Unimpaired 80- 90 99.8 + 0 0 141 263 25 6/7 weeks A Incipient I RL 3 months Favorable Unimpaired 84-104 98.8 _ 0 0 10734 D Ap. Cured 9 months Favorable Unimpaired 70- 80 98.8 — 0 0 13234 264 19 6/7 weeks A Far Adv. I 11 LR lyear 10 months Unfavorable Impaired 92-124 101 + 0 Peritoneum + 118 D Improved 1 I 1 LIt 2 years 3 months Unfavorable Impaired 88-124 100 + 0 Peritoneum 111 29 No. Duration of Treatment. Condition. Amt. of Involve- ment (Turban). Side. Duration of Disease. General Condition. Digestion. Range of Pulse 7 days on admis’n & 7 d’ys on Disch’ge Av. Max. Temp. 7 days on admis’n 7 days on Disch'ge T.B. Complications. Tuberculin Treatment. Weight. Non-Tuberculous. Tuberculous 265 36 1/7 weeks A Incipient I R 1 year Favorable Unimpaired 72-100 98.8 — O Intestino-Ves. Fis 151 D Ap. Cured 1 year 8 months Favorable Unimpaired 80-100 99.4 — O Improved 19034 266 14 6/7 weeks A Incipient I R 1 year Favorable Unimpaired 84- 96 99.2 — O O 8334 D Arrested 1 R 1 year 3 months Favorable Unimpaired 72- 96 99 — O O 90 267 21 2/7 weeks A Incipient I R 8 months Favorable Unimpaired 84-106 99.8 _ O O 122 D Ap. Cured 13 months Favorable Unimpaired 84- 90 99.6 — O O 136 268 22 6/7 weeks A Mod. Adv. I I LR 3 years Favorable Unimpaired 76- 90 99.2 _ O O 10834 D Arrested 1 1 LR 3 years 534 mos. Favorable Unimpaired 80- 90 99 — 0 O 140 269 33 4/7 weeks A I I I, R 84-120 102.4 + 0 112 D improved II LR 1 year Favorable Unimpaired 80-120 99.4 + 0 0 112 34 270 13 4/7 weeks A Incipient I LR 11 months Favorable Unimpaired 84- 96 99.6 — 0 0 my D Arrested 1 LR 1 year 2 months Favorable Unimpaired 70- 96 99.2 — 0 0 nay 271 24 weeks A Mod. Adv. I I LR 11 months Unfavorable Unimpaired 96-108 99.4 + 0 0 sm D Improved 11 L R 1 year 3 months Favorable Unimpaired 112-122 99 2 + 0 0 8934 272 26 weeks A Incipient I L 1 year Favorable Unimpaired 84-108 99.4 0 0 my D Ap. Cured 1 year 6 months Favorable Unimpaired 74-100 99.2 — 0 0 118“/4 273 12 5/7 weeks A Incipient I L 3 months Favorable Unimpaired 80- 96 99 - 0 0 114 D Arrested 1 L 7 months Favorable Unimpaired 68- 88 98.6 — 0 0 142 274 23 weeks A Incipient I RL 2 years Favorable Unimpaired 84-106 99 — 0 0 108 D Ap. Cured 2 years 5X mos. Favorable Unimpaired 72-110 99.6 — 0 0 122 275 20 4/7 weeks A Incipient I LR 3 years Favorable Unimpaired 84-120 99.4 — 0 0 107 D Ap. Cured 3 years 534 mos. Favorable Unimpaired 80-110 99.6 0 0 11034 276 12 4/7 weeks A Incipient I L 9 months Favorable Unimpaired 84-100 99 0 0 150 D Arrested 1 L 1 year Favorable Unimpaired 80- 96 98.8 — 0 0 168 277 12 weeks A Incipient I LR 1 year 2 months Favorable Unimpaired 92-108 100 + 0 0 141J4 D Arrested I L 1 year 5 months Favorable Unimpaired 78-100 98.8 0 0 161 278 34 5/7 weeks A Mod. Adv. II L R. 6 months Favorable Unimpaired 72-108 99 + 0 0 11734 D Improved I I LR 1 year 6 months Favorable Unimpaired 84-92 98.6 4* 0 0 13634 30 279 17 3/7 weeks A Incipient I H L 4 months Unfavorable Unimpaired 84- 96 98.6 0 0 100)4 D Ap. Cured 8 months Favorable Unimpaired 72-100 98.6 — 0 0 111 280 16 3/7 weeks A Incipient I R L 3 months Favorable Unimpaired 72- 84 99 O 0 144)4 D Ap. Cured 7 months Favorable Unimpaired 78- 84 99 — 0 0 168 *281 2 5/7 weeks A Mod. Adv. I I * D 4 282 7 5/7 weeks A Incipient I R L 1 year Favorable Unimpaired 68- 98 98.6 0 0 140'-. I) Arrested I R L 1 year 2 months Favorable U nimpaired 80- 90 99 — 0 0 145 283 16 weeks A Far Adv. I I 1 R I. 1 year 4 months Unfavorable Unimpaired 80-108 101.2 + 0 0 120)4 D Unimproved I I 1 R I. 1 year 8 months Unfavorable U nimpaired 100-130 101 + 0 Pleurisy with Lit. 108)4 284 20 6/7 weeks A Incipient I R 6 months Favorable Unimpaired 96-112 100.2 — 0 0 93)4 D Improved I R 11 months Favorable Unimpaired 90-100 100.6 — 0 0 95 285 5 5/7 weeks A Incipient I R 1 year Favorable Unimpaired 72- 94 98.8 — 0 0 121)4 D Improved I R 1 year 1)4 mos. Favorable Unimpaired 72- 96 98.6 — 0 0 127^2 *286 3 3/7 weeks A Incipient I 1 D 287 9 0/7 weeks A Incipient I L 3 months Favorable Unimpaired 84- 96 100 — 0 0 115)4 D Arrested I L 5Yi months Favorable Unimpaired 68- 80 98.6 — 0 0 120)4 288 17 3/7 weeks A Incipient I L 2 months Favorable Unimpaired 84- 96 99.6 — 0 0 149 1) Ap. Cured 6 months Favorable Unimpaired 72- 84 98.8 0 0 170 289 9 6/7 weeks A Incipient I L 2 months Favorable Unimpaired 78- 96 99.6 0 0 107 D Arrested 1 L 4 months Favorable Unimpaired 78- 88 98.6 — 0 0 123)4 290 13 weeks A Mod. Adv. I I LR 5 months Unfavorable Unimpaired 96-108 100.4 + 0 0 93)4 D Improved I 1 LR 8 months Unfavorable Unimpaired 90-100 99 + 0 0 98 291 8 3/7 weeks A Incipient I R 2 months Favorable Unimpaired 72- 96 99 - 0 Empyema 150 11 Unimproved I R 4 months Unfavorable Unimpaired 92-110 101.4 0 Empyema 151)4 292 11 1/7 weeks A Mod. Adv. I I R L 5 months Unfavorable Unimpaired 96-108 100.6 + 0 O 104 11 Arrested I 1 R L 714 months Favorable Unimpaired 72-104 99.4 + 0 O 115 293 4 2/7 weeks A Incipient I L 1 month Favorable Unimpaired 84- 96 99 0 O 130 11 Improved I L 2 months Favorable Unimpaired 70- 80 98.8 — 0 O 133)4 294 10 6/7 weeks A Incipient 1 R L 3 months Favorable Unimpaired 84- 96 99.2 0 0 104)4 D Arrested I R L 5% months I^avorable Unimpaired 80- 90 99 — 0 O 120 295 15 weeks A Mod. Adv. I I LR 1 year Favorable Unimpaired 102-108 99.6: + 0 O 137)4 D Improved I I LR 1 year 4 months Favorable Unimpaired 80-108 100.4 + 0 O 138 ‘Unclassified. 31 No. Duration of Treatment. Condition. Amt. of Involve- ment (Turban). Side. Duration of Disease. General Condition'. Digestion. j Range of Pulse 7 | days on admis’n & | 7 d'ys on Disch’ge Av. Max. Temp. 7 days on admis’n 7 davs on Disch’ge T.B. Complications. Tuberculin Treatment. Weight. Non-Tuberculous. Tuberculous. | 296 A Incipient I R L 3 months Favorable Unimpaired 80- 90 99 + O 0 148 D Arrested I R 5)4 months Favorable Unimpaired 60- 94 98.6 — 0 0 166 297 12 2/7 weeks A Incipient I R. 6 months Favorable Unimpaired 62- 96 98.2 — 0 0 106) 2 D Arrested R 9 months Favorable Unimpaired 72- 82 98.2 — 0 0 118 298 A Incipient I R 3 months Favorable Unimpaired 96-140 100.6 + 0 0 107 D Arrested I R 6 months Favorable Unimpaired 74- 94 98.8 + 0 0 130j/2 299 A Mod. Adv. II L 1 year Favorable Unimpaired 84-108 99.6 + 0 0 139 D Unimproved II L 1 year 4 months Favorable Unimpaired 78-110 100.4 + 0 0 1*2 300 24 6/7 weeks A Incipient I R.L 1 year Favorable Unimpaired 72- 86 99.2 — 0 0 109)4 D Arrested I RL 1 year 6 months Favorable Unimpaired 94-106 99.6 — 0 0 116 301 A Mod. Adv. T I R 2 years Unfavorable Unimpaired 82-104 99.8 + 0 0 103 D Improved I I R 2 years 2 months Unfavorable Unimpaired 90-104 98.6 + 0 0 104)4 302 A Mod. Adv. I I R 1 year Favorable Unimpaired 80- 90 100 — 0 0 92)4 14 Improved I I It 1 year 3 mouths Favorable Unimpaired 74-100 99.6 — 0 0 93)i 303 A Incipient I R 3 months Favorable Unimpaired 88-104 99.4 — 0 0 117 I) Improved I R 4)4 months Favorable Unimpaired 78- 92 98.6 — 0 0 124)4 1 Tncir x l we D ' 303 13 5/7 weeks A Incipient I R 3 months Favorable Unimpaired 80- 96 99 — 0 0 132)4 D Arrested I R 6 months Favorable Unimpaired 74- 92 99.8 — 0 0 139 306 23 1/7 weeks A Incipient I R 3 months Favorable Unimpaired 80-100 98.6 — 0 0 125 D Ap. Cured 8)4 months Favorable U nimpaired 78-100 99.2 — 0 0 141 307 A Mod. Adv. 11 RL 5 years Unfavorable Unimpaired 80-120 100.8 — 0 0 156 D Improved 11 11L 5 years 3 months Unfavorable Unimpaired 78- 92 100 + 0 0 16012 308 A- Incipient I L 2)4 months Favorable Unimpaired 78- 96 99 — 0 0 122 D Ap. Cured 8 months Favorable Unimpaired 76- 96 99 — 0 0 137 A Mod. Adv. 11 R 1 year 2 months Favorable Unimpaired 80-100 100 + O 0 -f 101 D Improved 11 R 1 year 9 months Favorable Unimpaired 88-110 99 + 0 0 113)4 ‘Unclassified. 32 310 5 5/7 weeks! A Incipient I R 1 year 1 month Favorable Unimpaired 84-124 100 O O * 90)4 D Improved I R 1 year 2 months Favorable Unimpaired 78- 90 99 — O O 97 311 5 3/7 weeks A Incipient I L 1 year Favorable Unimpaired 82-100 98.8 _ 0 O 11534 Improved I L 1 year 1)4 mos. Favorable Impaired 80- 98 98.8 — 0 O 117 312 5 4/7 weeks A Incipient I 1 R 3 months Favorable Impaired 80- 90 100 _ 0 O 97 D Improved I 1 R *4} 2 months Favorable Impaired 76-112 99.2 — 0 O 99)4 314 28 3/7 weeks A Incipient I R L 6 months Favorable Unimpaired 66- 92 99 + 0. 0 12334 D Arrested I R L 1 year Favorable Unimpaired 80- 90 98.8 + 0 0 145)2 31i. 4 2/7 weeks A Incipient I R L 9 months Favorable Unimpaired 64- 86 98.6 — 0 0 117 D Improved 1 R L 10 months Favorable Unimpaired 76- 84 98.6 — 0 0 117 31C 14 1/7 weeks A Mod. Adv. I I R L 9 months Favorable Unimpaired 100-120 99 + 0 0 135 D Improved 1 I R L 1 year )4 month Favorable Unimpaired 88-106 101 + 0 0 145 *317 1/7 weeks A I I D 318 13 1/7 weeks A Incipient I L R 2 months Favorable Unimpaired 84-100 99 _ 0 0 75 D Arrested I LR 5 months Favorable Unimpaired 90-120 99.8 — 0 0 73)4 319 14 weeks A Mod. Adv. I I R 9 months Favorable Unimpaired 96-116 100.8 + 0 0 108 D Arrested 1 1 R 1 year 1 month Favorable Unimpaired 72-118 99 + 0 0 125 320 17 weeks A Mod. Adv. I I LR 5 months Unfavorable Unimpaired 90-100 100 + 0 0 107 D Arrested I I LR 9 months Favorable Unimpaired 70-100 99 + 0 0 132 321 20 3/7 weeks A Incipient I LR 4 months Favorable Unimpaired 80-106 100 0 0 107 11 Ap. Cured 9 months Favorable Unimpaired 76-100 99.4 — 0 0 126)4 323 5 weeks A Mod. Adv. I 1 R L 6 months Unfavorable Unimpaired 100-140 104.4 + O 110 D Unimproved I 1 R L 9 months Unfavorable Unimpaired 116-140 104 0 102 324 6 wreeks A Incipient I R 3 years Favorable Unimpaired 80- 92 98.8 0 0 132 11 Improved I II 3 years 1 month Favorable Impaired 70- 92 100 — 0 0 131 325 18 1/7 weeks A Incipient I LR 1 month Favorable Unimpaired 78- 98 98.8 — 0 0 101 11 Arrested 1 LR 5)4 months Favorable Unimpaired 72-112 98.6 — 0 0 111 326 8 5/7 wTeeks A Mod. Adv. I I RL 9 months Favorable Unimpaired 78-100 98.8 + 0 O 99)4 11 Improved I I RL 11 months Favorable Unimpaired 80-100 99 + 0 0 101 327 15 weeks A Incipient I R 2 years Favorable Unimpaired 84- 90 99.2 Bronchial Asthma 0 107 11 Arrested 1 R 2 years 3 months Favorable Unimpaired 90-110 99.6 Bronchial Asthma 0 119 328 21 4/7 weeks A Incipient I R 3 months Favorable Unimpaired 82-100 99.4 O O 126 11 Ap. Cured 7 months Favorable Unimpaired 70-100 99 — O 0 144)4 * Unclassified. 33 No. Duration of Treatment. Condition. Amt. of Involve- ment (Turban). Side. Duration of Disease. General Condition. Digestion. Range of J’ulse 7 days on admis’n & 7 d’ys on Disch’ge Av. Max. Temp. 7 days on admis’n 7 davs on Disch’ge T.B. Complications. Tuberculin Treatment. Weight. Non-Tuberculous. Tuberculous. 331 13 weeks A Incipient I R 2 years Favorable Unimpaired 86-108 100 — O O 103 D Arrested I R 2 years 3 months Favorable Unimpaired 80-100 98.8 — 0 O 116 332 A Mod. Adv. I T RL 6 months Favorable Unimpaired 74-112 99.6 + O O 155 D Arrested I RL 10 months Favorable Unimpaired 76- 90 99 + 0 O 167% 333 A Incipient I L 1 year 6 months Favorable Unimpaired 96-108 100.4 — 0 O 222 D Improved I L 1 year 7% mos. Favorable Unimpaired 72-100 100.4 — 0 0 225% 334 5 6/7 weeks A Incipient I R 1% months Favorable Unimpaired 74- 90 98.8 — 0 0 112% D Improved I R 3 months Favorable Unimpaired 72-100 99 — 0 0 119 336 13 1/7 weeks A Incipient I L 2 years Favorable Unimpaired 66- 84 99.6 — 0 0 105 D Arrested I L 2 years 3 months Favorable Unimpaired 78-100 99 — 0 0 118 337 4 3/7 weeks A Incipient I R 6% months Favorable Unimpaired 68- 88 99 — 0 O 110% D Improved I R 7months Favorable Unimpaired 76- 96 99 — 0 0 116 338 A Mod. Adv. 11 L 1 month Favorable Unimpaired 90-124 100 + 0 0 139 D Unimproved 1 I L 4% months Favorable Unimpaired 88-110 100.4 + 0 0 140 343 18 5/7 weeks A Incipient I LR 2 years Favorable Unimpaired 80-100 100 — 0 0 120% D Ap. Cured 2 years 5 months Favorable Unimpaired 86-100 98.6 — 0 0 129% 344 A Incipient I R 2 months Favorable Unimpaired 56- 76 98.8 — 0 0 141% D Improved 1 R 4 months Favorable Unimpaired 60- 84 100.8 — 0 0 146% 349 11 weeks A Far Adv. I I I RL 1 month Unfavorable Unimpaired 108-120 100 — 0 0 67% D Improved I I I RL 4 months Favorable Unimpaired 96-120 98.6 0 0 88% 350 A Incipient I LR 2 years Favorable Unimpaired 74- 90 99.4 _ 0 0 113% D Arrested I LR 2 years 2 months Favorable Unimpaired 70- 90 99.2 — 0 0 125% 351 A Incipient I L 6 months Favorable Unimpaired 70-104 99.2 — 0 0 87% D Ap. Cured 10% months Favorable Unimpaired 80- 90 98.8 — 0 0 114% 352 A Incipient I RL 8 months Favorable Impaired 78-100 99.4 — Chronic Gastritis 0 117 D Arrested I RL 1 year 1 month Favorable Impaired 84-96 99.2 Chronic Gastritis 0 119% *353 4 weeks A Mod. Adv. II # D .... * Unclassified. 34 *357 4 weeks A Mod. Adv. II D 359 13 weeks A Incipient I R 1 year Favorable Unimpaired 110-136 99.4 Chronic Endocarditis O 48 D Arrested I R 1 year 3 months Favorable Unimpaired 88-104 99.2 — Chronic Endocarditis 0 52% 362 12 weeks A Mod. Adv. I I U R, 3 months Favorable Unimpaired 80-100 99.4 + O 0 104% D Arrested I I L 6 months Favorable Unimpaired 80-110 99.6 + O 0 121 364 7 weeks A Mod. Adv. I I L R 1 year 6 months Favorable Unimpaired 76- 98 99 + O 0 97 D Improved I I LR 1 year 7 months Favorable Unimpaired 72-100 99 + O 0 107% 366 13 3/7 weeks A Incipient I LR 1 month Favorable Unimpaired 66-100 99.6 _ O 0 98 D Arrested I UR 4% months Favorable Unimpaired 60- 94 98.6 — O 0 117 *367 3 1/7 weeks A Mod. Adv. I I D *369 1 5/7 weeks A Incipient I D 372 7 weeks A Incipient I L 5 months Favorable Unimpaired 74-100 99.2 O 0 115% D Improved I L 7 months Favorable Unimpaired 74-108 98.6 o 0 122 374 13 5/7 weeks A Incipient I L 3 years Favorable Unimpaired 64-110 99.4 — Gall Stones 0 110% 1) Arrested I U 3 years 3% mos. Favorable Unimpaired 90-112 98.8 — Gall Stones 0 126 *376 3 weeks A Mod. Adv. II D .. *379 4 weeks A Incipient I D 384 7 2/7 weeks A Incipient I R 6. months Favorable Unimpaired 74-100 99.4 — Mitral Insufficiency 0 87 1) Improved I R 8 months Favorable Unimpaired 88-102 98.6 — Mitral Insufficiency 0 95 387 8 weeks A Incipient I L 2 months Favorable Unimpaired 60- 90 98.6 — O 0 138% D Arrested I L 4 months Favorable Unimpaired 78-118 99 — O 0 156% *391 1 week A Incipient I » D i .... *392 3 5/7 weeks A Incipient I D *401 3/7 weeks A Incipient I D ’Unclassified. 35 The Regime of the New Patients. A Group of Convalescents. 36 The Sanatorium Regime. REST. EXERCISE. RESTORATION OF THE WORK- ING CAPACITY. In the treatment of the individual cases of tuberculosis the Sanatorium adheres closely to the essentials of the modern sanatorium regime, the aim of which is (1) improvement of the general condition of the patient, (2) arrest of the tuber- culous process and (3) restoration of the working capacity. Absolute rest is enforced in all new cases for periods of time dependent upon the condition of the patient. Febrile patients or those manifesting serious symptoms are kept in the Infirmary which is a part of the Medical Building. The method of treatment in each individual case is decided upon after a preliminary medical and laboratory investigation. The general supervision of the routine is in the hands of the Medical Director and the Resident Staff consisting of the Superintendent, Blouse Physician and a corps of trained nurses. With the full establishment of convalescence, exercise and work, individually suited, is gradually introduced into the regime of each case. It is always borne in mind that the average patient, having passed through full period of treatment, expects to leave the institution adequately prepared to resume the work before him. This is just as essential to him as to the community at large, whose support of the sanatorium movement is largely based on the expected restoration of the working power in a large percentage of curable cases. A careful introduction of graduated work into the regime of the convalescent patient, while reducing superfluous weight in a few cases, does not interfere with the improved general concl’tion of the majority of the convalescents, stimulates it in many, and gives all of them the opportunity to learn the extent of their working power and the proper way of preserving it. The ultimate result is much superior to that in patients overburdened with superfluous flesh, incapable-of the least exer- tion and with no experience in the utilization and preservation of their strength. 37 Convalescents on the Lawn of the Sanatorium, To have an efficient working- program for patients in a Sanatorium, it is very important that a comprehensive provision should be made for various kinds of work suited to individual cases and that the stay at the Institution be long enough to permit a gradual increase of exercise up to about 8 hours a day. The fulfillment of the second condition is a difficult task in case of wage earners who are anxious to resume their family responsibilities as soon as considerable improvement takes place in their condition. Up to January 1st, 1911, the plan of keeping patients at the Sanatorium until they do a full day’s work was successful in a considerable number of cases; the average extent of work, for the 199 “arrested” and “apparently cured” cases, at the time of their discharge, was three hours a day; it is expected that this average will increase with the further development of the Institution. The “working program” at the Edward Sanatorium is being gradually developed; at present the activities of the Insti- tution furnish the following kinds of employment to< the con- valescent patient: care of the lawn, gardening, less laborious part of the farm work for the more robust patient accustomed to this kind of labor, driving, assistance in some of the outdoor work of the institution, office work under open air conditions, the lighter details of housekeeping, etc. The work is as far as possible individualized; as for example, the office worker is assigned tasks suited to his general 38 makeup and training; the convalescent trained nurse takes part in medical record keeping, etc. The Institution is striving in this matter to accomplish its function in fitting the patient for the life work ahead of him. Rising Hour, 7 A. M. Morning bath, dressing, morning temperature, 7 to 8 A. M. Breakfast, 8 A. M. Forenoon Rest in Recreation Shacks, 9 to 12. Luncheon, 10:30 A. M. Dinner, 12:45 P. M. Afternoon Rest in Recreation Shacks, 1:30 P. M. to 5 :30 P. M. Afternoon Luncheon, 3 :00 P. M. Supper, 5 :30 P. M. Evening Social Hour, 6:30 P. M. to 8:30 P. M. Retiring Hour, 7 :00 P. M. to 8 :30 P. M., according to the condition of the patient. Temperature taken in all new cases four times daily, or more frequently; with full establishment of convalescence— twice a day. On admission the patient is kept at rest for a period of observation necessary to establish a clinical and laboratory diagnosis. The febrile patients are placed at absolute rest in the Outdoor Infirmary Quarters. THE DAILY REGIME. Playing Croquet. 39 On a Drive Through the Country. Gardening. Working oil tlie Lawn, 40 The schedule above has reference to febrile cases, or those with very slight afternoon rises. With the progress of conval- escence the general daily regime is gradually modified in each case by the introduction of exercise and a later retiring hour (from 7 P. M. to 8:30 P. M.) All lights in patients’ quarters are out at 9 P. M. Rounds of the men’s and women’s sections are made by Nurses in charge, between 7 P. M. and 9 P. M., while various groups of patients, with retiring hour defined for each, are on the way to their sleeping quarters. The Superintendent and the Resident Physician make rounds of the Institution twice daily. The medical force at the Sanatorium is in easy reach of the patients during the night hours, several nurses occupying a specially constructed Nurses’ Shack. PREVENTIVE MEASURES. Utmost care is exercised to prevent dissemination of infec- tion during the acts of coughing and expectoration. The first lesson taught the new patient is control by will- power of all the unnecessary, unproductive cough. In the act of coughing the patient covers his mouth com- pletely with the paper handkerchief held in the palm of his hand; a similar handkerchief is also used for the collection of sputum; this is folded and deposited in a paper bag which, when full, is destroyed in the crematory. Two-thirds of the patients at the Edward Sanatorium are in the incipient stages of the disease; the Institution includes but a few with frequent cough and profuse expectoration; these use pasteboard boxes carried in a metal holder; sputum collected in these boxes is destroyed in the crematory and the holders are disinfected every day in a special room set aside in the Medical Building. A large proportion of the patients have no expectoration. Of all the rules of the Sanatorium, those pertaining to cough and expectoration are most stringently observed. All incipient cases are, as a rule, quartered in the open air shacks, while those beyond the incipient stage are kept in the Infirmary until all excessive cough and expectoration subside. 41 Cough is seldom heard on the grounds or in the assembly rooms and is prohibited in the dining room. If an attack of cough is anticipated by a patient, he immediately leaves the room and does not return until the attack has completely sub- sided. With the continuous supervision by nurses and cooperation on the part of patients, infrequency of cough in every well regulated sanatorium is a feature familiar to all visitors. The crematory for destruction of all infected material is at the west end of the farm; another is soon to be erected in the sputum room in the basement of the Medical Building. All clothes before sent to the laundry are thoroughly aired and fumigated with formaldehyde gas in the disinfecting room. Lavatories and bathrooms are disinfected with formaldehyde once a week. No dry sweeping or dusting is permitted in the Institution. RULES GOVERNING THE PATIENTS. On entering the Sanatorium, the new patient is given a small folder containing the rules of the Institution. These rules are read and explained to the patient by the Resident Physician or Nurse in Charge. Framed copies of the Sanatorium rules are displayed on the walls of all assembly rooms and sleeping apartments. Edward Sanatorium, Naperville, Illinois. Rules Governing Patients. Respect the Rights of Your Neighbor and You Will Benefit Thereby. 1. Sanatorium Buildings must be kept immaculately clean. Do your utmost to make this possible. Receptacles are provided in the buildings and on the grounds for waste paper. Keep the chairs, blankets, etc., in an orderly fashion in the manner directed by the Superintendent. 2. Quietude is an essential condition in the treatment of any disease, tuberculosis included. Keep quiet; avoid all unnecessary conversations; they are as much of a strain as any other exercise. SET OF RULES DISPLAYED IN ALL ASSEMBLY ROOMS. 42 Loud talking is absolutely prohibited in the institution; this applies to all—patients, employes, visitors. This rule is to be strictly enforced in the buildings as well as on the grounds. 3. Never fail to cover your mouth, when coughing, with a paper handkerchief provided for that purpose. Dispose of your sputum in the manner directed in the rules of the Institution. Spitting on the grounds will be followed by immediate dis- missal. Visitors are requested to abide by this rule A Sanatorium must be freer from germs than any ordinary dwelling. Remember that failure to comply with this rule is an im- position on your neighbor. 4. Cooperate in the maintenance of discipline. It is to your advantage. The most effective sanatorium regime is a result of coop- eration of the management and the patients. Remember that we are all working toward the same end— to get you well. SET OF RULES DISPLAYED IN ALL SLEEPING DEPARTMENTS. Edward Sanatorium, Naperville, Illinois. Rules Governing Patients. 1. Be careful with your sputum; expectorate into paper napkins or sputum cups provided for that purpose. Do not expectorate on the floor or grounds—into the wash bowls or toilets. Always cover your mouth with the paper handkerchief while coughing. Do not swallow your sputum. Do not cough needlessly; you can control it to a great ex- tent by will power. Coughing or expectorating in the dining room is strictly prohibited; patients must leave the room for that purpose. Sputum cups must not be taken into the dining room. Table napkins are not to be used as handkerchiefs. In final disposition of paper napkins, emptying and disin- fection of cups, follow closely the instructions of the nurse in charge. 2. Patients are not permitted to take any medicines except those ordered by the attending physician. 43 Use of liquor, tobacco, and chewing gum is prohibited. No food is to be kept in the lockers. 3. Gambling or games of chance are strictly prohibited. 4. Patients are not permitted to visit in each other’s shacks without permission. Patients are not permitted to go down town without per- mission, nor take any exercise, even for a short period, except that prescribed by the Medical Director. 5. Patients are forbidden to discuss their condition and symptoms with the other patients. Report any new symptoms to the nurse in charge. 6. Loud talk, argument, controversy, etc., between patients, is not permitted. 7. Patients must wash their hands before meals and lunch- eons ; also clean their teeth after meals. 8. Patients must sponge chest and back with cool water morning and evening, unless exempted by the Medical Director or Resident Physician. A cleansing bath must be taken at least once a week. The temperature of water used in sponging and bathing is to be determined by the medical management. 9. Patients on full rest must not play the piano or indulge in any kind of games. 10. Patients must not go to bed during the day without per- mission. In case of sickness patients must notify the nurse and she will notify the physician. 11. Patients must be prompt to meals. Patients must not go into or through the kitchen or laundry without permission. Patients must get their own laundry ready for fumigation; clothes must be hung up on clothes lines Sunday night and re- placed in hamper immediately after breakfast Monday morning. No clothes will be washed unless previously disinfected. 12. Be careful with everything—chairs, dishes, etc., belong- ing to the Sanatorium; articles broken through carelessness must be replaced. Obey cheerfully the*instructions of the physician and nurse; they are for your benefit. 44 The tendency of the Institution is toward maintenance of strict discipline in the interest of the patient’s welfare. This is done in a kind and firm manner calculated to bring the full and enthusiastic cooperation of the patients, for whose welfare the sanatorium management stands responsible. Sleeping Shacks. Women’s Section. OUTDOOR SLEEPING DURING WINTER. I. Arranging the Bed. 1. Sew a layer of building paper on the springs and over it a strong piece of unbleached muslin or canvas. This not only prevents the cold from coming up underneath but also keeps the paper in place. 2. Place an unbleached muslin cover over the mattress and a pad on the top of it; then cover with a white cotton sheet, tucking it in at head and sides. 3. Cover three-fourths of the bed, lengthwise, with a heavy woolen blanket, with part of it extending over one side; put another one, in like manner, on the other side of the bed. Place pillow at the head. 4. Place a double flannelette sheet, or 6 yards in length, over the bed, with the closed end at the foot. Turn in the sides of this sheet (allowing enough room to sleep between) and letting the under part of the sheet to extend over and around the pillow. 5. Fold over the flaps of the two blankets and tuck them in. 6. Place one or two double blankets over all, tucking in 45 well at the sides and foot of the bed. Fold back the upper part of the flannelette sheet over the blankets. 7. Place a khaki or canvas cover over the entire bed. To get into this bed it is necessary to slide in at the top. The lower part of the blanket sheet can be drawn over tbe head and shoulders while the upper part can be tucked under the chin, so that only the face is exposed. II. To dress for outdoor sleeping during winter. 1. Put on a suit of underwear that fits comfortably; this may be either wool or fleece lined. Over this you may wear an additional larger suit of woolen underwear. 2. Wear a heavy pair of wool socks; over these lambs’ wool bed shoes or lumberman’s socks. The bed shoes are made of lamb skin with the wool on the inside and are laced like shoes. Sleeping Shacks. Men’s Section. 3. A heavy flannelette night gown or suit of pajamas comes next. Pajamas are better as they fit more comfortably. This is especially true when the patient must slide into bed start- ing at the head and going down feet first. 4. If the blanket sheet of the “Klondike Bed” is not suffi- cient protection for the head, a flannelette cap that fits over the forehead and under the chin is worn; one with a shoulder cape is desirable. 5. In extreme weather more underwear may be worn. The bed may be warmed with a soap stone or hot water can (one that holds a gallon of water will retain its heat all night, even in the coldest weather). A heavy eiderdown robe must be worn to and from the dressing room. 46 THE DIET. In arranging the diet for Sanatorium patients it is borne in mind that the defensive resources of the average patient grow with the improvement of his nutrition and that the reparative process is dependent upon a liberal, varied diet containing a sufficient amount of nitrogenous food and an abundance of easily assimilated fats. The diet must be well balanced, properly prepared and at- tractively served. The amount should be within the limits of digestion and assimilation of the individual patient; this is de- fined in a general way in each case and the patient is impressed with the importance of abundant food in the treatment of tuber- culosis ; stuffing, however, is avoided. Individualization is practiced as far as possible; the diet kitchen in the Medical Building is used for modifying the general diet for the Infirmary patients. Lunches of eggs, milk, crackers, bread and butter, are served twice a day, between meals, to all patients, unless con- traindicated ; this in continued in individual cases until normal weight is restored; then, the additional eggs and milk are grad- ually withdrawn and the patient eventually returns to normal diet. In addition to the three meals the patients get from three to six eggs and from one and a half to two quarts of milk daily. The following is a typical weekly menu: August 21st to 27th, 1910. Sunday— Breakfast: Grapes, Corn Flakes, Cream, Egg Omelet, Bread and Butter, Coffee, Milk, Raw Eggs. Dinner: Tomato Soup, Crackers, Fried Chicken, Gravy, Boiled Rice, Spinach with Hard Boiled Egg, Olives, Jelly, Radishes, Bread and Butter, Caramel Ice Cream, Sponge Cake, Milk. Supper: Cold Boiled Ham, Browned Potatoes, Combination Salad, Blackberries with Cream, Tea, Sponge Cake, Milk. Monday— Breakfast: Muskmelons, Malt Breakfast Food, Cream, Ba- con, Fried Eggs, Bread and Butter, Coffee, Milk, Raw Eggs. 47 Dinner: Roast Beef, Boiled Potatoes, String Beans, Cold Slaw, Olives, Bread and Butter, Cocoanut Pudding, Milk. Supper: Beef Tongue, Creamed Potatoes, Lettuce, Bread and Butter, Stewed Blackberries, Tea, Milk. T UESDAY-— Breakfast: Plums, Peaches, Puffed Rice, Cream, Soft Boiled Eggs, Bread and Butter, Coffee, Milk, Raw Eggs. Dinner: Macaroni Soup, Beef Steak, Mashed Potatoes, Lettuce, Bread and Butter, Watermelon, Milk. Supper: Creamed Dried Beef, Baked Potatoes, String Bean Salad, Bread and Butter, Buns, Stewed Prunes, Tea, Milk. W EDNESDAY Breakfast: Baked Apple, Oatmeal, Cream, Bacon, Fried Eggs, Bread and Butter, Coffee, Milk, Raw Eggs. Dinner: Roast Lamb, Boiled Potatoes, Boiled Beets, Suc- cotash, Green Onions, Bread and Butter, Lemon Jelly, Cream, Milk. Supper: Cold Boiled Ham, Baked Sweet Potatoes, Sliced Cucumbers, Bread and Butter, Peaches, Tea, Milk. Thursday— Breakfast: Sliced Oranges, Corn Flakes, Cream, Scram- bled Eggs, Bacon, Bread and Butter, Coffee, Milk, Raw Eggs. Dinner: Puree of Peas, Sirloin Steak, Gravy, Baked Pota- toes, Creamed Onions, Olives, Bread and Butter, Plum Ice, Milk. Supper: Veal Loaf, Fried Potatoes, Lettuce, Bread and Butter, Sliced Bananas, Tea, Milk. Friday— Breakfast: Apricots, Oatmeal, Cream, Soft Boiled Eggs, Bread and Butter, Coffee, Milk, Raw Eggs. Dinner-. Boiled Halibut, Egg Sauce, Beef Steak, Mashed Potatoes, Stewed Tomatoes, Cold Slaw, Bread and Butter, Apple Pie, Milk. Supper: Creamed Salmon, Baked Potatoes, Lettuce, Bread and Butter, Sliced Pineapple, Tea, Milk. Saturday— Breakfast: Grapes, Corn Flakes, Cream, Pancakes, Maple Syrup, Bread and Butter, Coffee, Milk, Raw Eggs. 48 Dinner: Roast Beef, Gravy, Boiled Potatoes, Stewed Corn, Tomatoes, Pickles, Bread and Butter, Tapioca, Cream, Milk. Supper: Beef Tongue, Fried Potatoes, Vegetable Salad, Bread and Butter, Stewed Pears, Tea, Milk. The effort is toward a liberal nutritious and varied diet. Fruit and vegetables are served according to season. A con- siderable variety of vegetables is produced on the farm. Changes in the diet are made from week to week. A Quiet Evening—Assembly Hail. A strict adherence by the patients to the various details of the Sanatorium regime is very essential to their satisfactory progress. Maintenance of discipline is facilitated by an atmos- phere of cheerfulness. The attractiveness of grounds, the gen- eral grouping of buildings, their simple and attractive exterior, walks laid through fields and lawns, the general appearance of an institution—all these are factors appealing to the eye of the patient. The relationship of the patients and the management should be such as to blend the patients, the physicians and the nurses SOCIAL LIFE AT THE SANATORIUM. 49 into a one well conducted happy family, all working to the same end: the general restoration of the health of the patient. The social side of the Sanatorium life is of great importance; without it, discipline becomes irksome and its enforcement diffi- cult. The social evening hour, with its quiet games, music, mutual exchange of experiences, lectures, etc., calls for an Assembly Room, sufficient to accommodate all the convalescent patients. Games requiring little exertion, as croquet, etc., are per- mitted during the daily hours of exercise, as well as walking trips into the country by various groups of patients, defined in their duration according to their condition. In addition to the general provision for pastime, the Edward Sanatorium is gradually developing the following social fea- tures : I.-OBSERVATION OF NATIONAL HOLIDAYS. During the last fourteen months the following days were appropriately observed : Fourth of July, 1909. Celebration arranged by the patients and the first three numbers on the program rendered by them. Introductory Remarks Air. Fred Streit Reading of the Declaration of Independence Airs. C. E. Hopkins Fourth of July Oration Air. J. E. Downs Vocal Solos Aliss Julia E. Clark of Chicago Baritone and Trombone Solos Air. J. Yender and Air. T. Becker, of Naperville Address... Prof. H. J. Kiekhofer of Northwestern College, Naperville. Concluding Remarks Aledical Director Orchestra—Carolus Orchestra of Naperville, Aliss Eger- mann, Leader. Refreshments. Fireworks. AIemorial Day Exercises, AIay 30, 1910. Chairman Aledical Director Address.... Air. Harlow N. Higinbotham, President Chi- cago Alunicipal Sanatorium. 50 Address. .Professor Kiekhofer, Northwestern College, Na- perville. Vocal Music Miss Julia H. Clark, Chicago Fourth of July, 1910. Presiding Medical Director Address Professor Kiekhofer, Naperville Clarinet and Piano Mr. and Mrs. Nietz, Naperville Orchestra—Naperville High School Band, Mr. Nietz, Leader. Fireworks. Celebration of the Fourth of July. II.-ENTERTAINMENTS, CONCERTS. August 28, 1909. Violin Solos Miss Kathleen Moore, Batavia, 111. Vocal Miss Julia Clark, Chicago October 31, 1909. Vocal Selections. Dr. Robert Hardie and Mr. Pence, Chicago Piano Mrs. Clyde D. Pence and Miss Pratt, Chicago November 13, 1909. Concert by the Orpheus Orchestra of Naperville; direction, Mr. Ralph Reiche. 51 Violin Solos Mr. Reiche, Naperville Piano Miss Ella Boettger, Naperville December 19, 1909. Concert by the Orpheus Orchestra of Naperville; direction, Mr. Ralph Reiche. Piano Miss Ella Boettger, Naperville Violin Mr. Ralph Reiche, Naperville Vocal Frederick Children, Naperville Readings Miss Louise Laird, Naperville Popular Melodies Mr. Unger, Naperville Hallowe’en, October 31, 1910. Appropriate program; decorations; souvenirs; games; re- freshments. Music by Orpheus Orchestra of Naperville, direction, Mr. Ralph Reiche. III.-LECTURES. Stereopticon Lectures on Tuberculosis by the Medical Director, May 22, 1909; September 5, 1909; December 12., 1909 ; April 12, 1910; August 7, 1910 ; December 18, 1910. Lectures on this subject are given at stated intervals. The Sanatorium is provided with a full set of slides depict- ing- various phases of tuberculosis movement and life in sanatoria in this country and Europe. By organization of a special Lecture Committee it is proposed to extend the Lecture Program of the Institution to various general subjects of interest, historical, hygienic, etc. IV.— PATIENTS’ READING CIRCLE. To establish a closer relationship between the patients as well as to give them a useful pastime, Reading Circles were introduced at the Sanatorium. Meetings of one hour's duration are held on an aver- age two or three times a week. Reading of a selected ar- ticle by one of the patients occupies about a half an hour,, and this is followed by general discussion. (a) The Tuberculosis Reading Circle devotes its time to selections from “Journal of the Outdoor Life’’ and various popu- lar treatises on the subject, viz.: “Tuberculosis, a Curable and Preventable Disease’’ by Dr. A. S. Knopf, “Consumption and Civilization” by Dr. J. B. Huber, etc. 52 Some of the selections follow: “Daily Outdoor Life,” from “Journal of the Outdoor Life.” “Truths about Tuberculosis,” from “Journal of the Outdoor Life.” “Rest and Exercise,” from “Journal of the Outdoor Life.” “The Nature of a Sanatorium,” from “Journal of the Out- door Life.” “Hints for Tuberculous Patients,” from “Journal of the Outdoor Life.” Selections from Knopf’s, Huber’s, etc. (b) The General Reading Circle takes up subjects of cur- rent or historical interest. Some of the selections: “The North Pole at Last,” from “The Outlook.” “Articles on Current Events,” from “The Outlook.” “Search for the North Pole,” from “American Review of Reviews.” “Early Struggle fori Liberty in the Colonies,” from “Eg- gleston’s History of the L'nited States.” “The Outlook of the Revolution and the Declaration of In- dependence,” from “Eggleston’s History of the United States.” and other similar articles on various topics in the standard periodicals and general literature. The Reading Circle. 53 ntiT rim fW /ItpCAL BVILftdC, PC# Tnt Hr>Wf»D SA^Tociyn /VreviLLf-- iLLl/toO • Plans of the Medical Building: and Infirmary. 1. First Floor. 2. Second Floor. 3. Basement. For description see page 57. 54 HISTORY AND GENERAL DESCRIPTION OF THE INSTITUTION. The Edward Sanatorium at Naperville, Illinois, for the treat- ment of incipient pulmonary tuberculosis, was founded by Mrs. Keith Spalding of Chicago. The cornerstone was laid in the spring of 1906 and on the 15th of January, 1907, the doors of the Sanatorium were opened for admission of patients. The initial accommodations of the Institution were for 16 patients; the present capacity is 60 beds, which will be gradually increased by further extension of the administration facilities and the erection of additional sleeping shacks. On May 27, 1907, the Sanatorium was presented by Mrs. Spalding to the Chicago Tuberculosis Institute. The Edward Sanatorium is located just outside of the city limits of Naperville, Du Page County, Illinois. Communication from Chicago is by Chicago, Burlington & Quincy Railway suburban trains, leaving the Union depot every two to three hours, and reaching Naperville in fifty to sixty minutes. The site is a farm of 40 acres. The ground is elevated, af- fording an unobstructed view of picturesque scenery for miles around. Across the roadway is the Du Page River, with numer- ous groves of trees east of it; south and west of the institution is the boundless stretch of sloping ground and fertile farm land. The east section of the ground is occupied by an orchard and a large lawn; around it in a semi-circle are the medical building with the infirmary, the service building and the day shacks so placed that the patients are under the constant observation of the central office. West of this group of buildings are two rows of sleeping shacks (one for men and one for women), with a large lawn between them; several hundred evergreens were placed around this part of the grounds for protection from the prevailing winds. Cement walks connect the various buildings of the institu- tion and lead to the main entrance of the Sanatorium. About 30 acres of rich soil, lying west of the Sanatorium proper comprise the farm. The group of buildings, situated here, consists of a farmhouse, several barns, three poultry houses, water tower, engine house, refuse crematory and ice house. 55 Pure water is supplied to the institution from an artesian well driven in the rear of the grounds. Sewerage is thoroughly treated in two septic tanks of ample dimensions. INDIVIDUAL DESCRIPTION OF BUILDINGS. The general plan for buildings, as gradually developed by a four years’ experience, includes a provision for— (1) Service Building, with dining hall, kitchen, laundry, and rooms for employes. (2) Medical Building, including central office, all the medi- cal facilities, infirmary and rooms for medical and nursing staff. (3) Sleeping shacks, accommodating six to ten patients; a number of tent cottages, two beds each. (4) Day Rest or Recreation Shacks. (5) A central heating plant and laundry to be erected later. (6) Gradual extension of the present facilities. The arrangement of day rest in shacks separate from the sleeping quarters affords the patients a daily variation of sur- roundings conducive to general contentment; at the Edward Sanatorium these day shacks and rest verandas are so placed as to be within close observation of the Central Office. In the general plans of the Institution as well as the indivi- dual arrangement of various buildings, the medical manage- ment of the Sanatorium, during the last four years, worked to- gether with Architect W. A. Otis of Chicago (W. A. Otis and E. H. Clark). SERVICE BUILDING The Service Building- is a two story frame structure, with basement, of an attractive, simplified colonial design, with the main portion about 61x32 and an L 57 feet long-, at the rear; the south and east sides are surrounded by open air verandas. The basement contains the heating- plant for this building, fumigating rooms, store rooms, and bath and toilet facilities for male patients. A hall runs through the center of the first floor, with the assembly room on the north and patients’ dining room on the south. To the north of the west end of this hall is the Nurses’ office. 56 The extension attached to the main building- includes the kitchen, butler’s pantry, store and refrigerator room, and laundry. The second floor is divided into sleeping rooms for the housekeeper, one of the nurses, clerk and employes, bathroom, linen room, etc. This structure is the original Administration Building erected by Mrs. Spalding, the founder of the Institution. MEDICAL BUILDING AND INFIRMARY A great deal of time and effort were spent by the Medical Management and Architect W. A. Otis in planning the New Medical Building and Infirmary. This spa- cious two-story build- ing, with basement and unfinished attic that can be utilized for eight additional rooms, was occupied in January, 1910. Entire cost of building and equipment was furnished by Mrs. Keith Spalding. The necessary sanitary requirements were met in the sim- plicity of design, proper arrangement of rooms, large windows, rounded corners, smoothness of sur- face, tile and cement floors and enameled walls in certain sec- tions. The basement in- cludes the toilet and bath rooms for wo- men patients, shower baths, fumigating room, disinfecting room, heating plant with its accessories,etc. Medical Building. Superintendent’s Office. Medical Building-. Infirmary Sleeping Porclies, 57 A hall runs south and north through the center of the first floor, with the following rooms arranged on each side: labo- ratory, nose and throat room, patients’ waiting room, examin- ing room and drug room. The main entrance of the building leads to an entrance hall, with the large central office on the north and visitors’ waiting room on the south of it. The general arrangement of the second floor is approx- imately the same, with rooms for the Superintendent, Resident Physician, Nurse, Linen Room, Room for the Medical Director and visitors, toilet and bath rooms. Two rooms, on the south, with bath and toilet room, are reserved for isolation of patients. The Infirmary occupies the south section of the Medical Building, the lower floor for men, the upper for women. Each section, with accommodation for six patients, is provided with a spacious sleeping porch, locker and dining room, and toilet and bath facilities. The outlook from the sleeping porches is over the vast undulating country. The Medical Building is so arranged as to permit of future additions. The cost of construction was $21,435.62. >Ie HEW OMO.TGKJVH - ffEPT- Flans of a Sleeping Shack for Ten Patients (modeled after Dr. King’s Lean-to.) For description see page 59. The shack recently erected for the employes of Sears, Roebuck & Company, is a structure 18x53 feet, with the west section including the recreation and dressing room; this part projects 6 feet beyond the front line. The sleeping porch is 37 feet long, a continuous line of windows extending over the entire north wall; the entire front facing southeast is open, canvas curtains being used in stormy weather; a large door, occupying one-half of the east wall, affords additional ventila- tion. The roof is provided with two skylight ventilators. The dressing room is 12x15 feet; a section of it is given to individual lockers, toilet and lavatory facilities. The recreation room is 11 xl5 feet, with large windows extending along the south and north sides and glass doors leading to the porch and dressing room. The porch is large enough to accommodate the beds and the reclining chairs. 60 A Sleeping; Shack for Six Patients. (For Sears, Roebuck & Co. Employes.) atAut- V'i:cr <* EjrVW-H-tLWCK-AfTCKTa tpifrlWtcT- thitABO-lu.- CaTTACt-inAO^ ETVAm) uVArOKlVn-/tejtViUi~lLL IHICMO- TvrEmLOito-lflSri I v/Tt- J7Z -THZ.CXKXr.~P- -CAZX& HEAP i>rtvrnRtwi~Fn>-T~ Plans of Sleeping Shack for Six Patients. For description see page 60. 61 The main points of improvement in this shack, in reference to ventilation, are: (1) widely open front, open railing, (2) suspended, movable half of the east wall of the shack, (3) con- tinuous line of windows in the rear wall. Cost of construction, $1,287.00. The Infirmary Porches are 18x31 feet. They face south and are protected from northwest winds by windows on the west and the wall of the medical building on the north. The south and east sides are provided with canvas curtains. A line of transoms extends on the west, south and east sides. The bathing and toilet facilities as well as the dressing and dining rooms connected with the infirmary porches are heated with steam; large windows furnish necessary ventilation All arrangements are of improved sanitary type and of a char- acter designed to give all the necessary comfort to patients tem- porarily confined to bed. DAY REST OR RECREATION SHACKS. Day rest is taken by the majority of the patients in re- clining chairs in especially constructed day shacks; those in need of close observation are kept on porches connected with the old administration and the recently erected medical build- ings. Canvas reclining chairs were used exclusively until now; these are being replaced gradually by Adirondack Recliners. Two day rest shacks accommodate approximately 30 pa- tients, one for ten, another for twenty. The larger shack, recently erected, is a structure 80 feet long and 12 feet wide. The south front is entirely open, with an open railing along its entire length. The central portion of the shack piojects slightly beyond the front line. A continuous line of windows extends over the north wall and one-half of the east and west sides are suspended and movable, contributing considerably to ventilation necessary in ordinary weather. Awnings extend over the entire front of the shack. Cost of construction, $520.00. 62 Day Kest or Kecreation Sliack. 63 TltCttATIOM- an Ac* * T-0®- TT1L tDUAU i/AMATOUUn - ILL* 5t.'. «. o rian of Day Rest or Recreation Shack. For description see page 62. rtOTLTtt tLtYATlOM 64 THE FARM. The land owned by the Sanatorium comprises forty acres; about two-thirds of it, west of the Sanatorium buildings, is under cultivation. The group of farm build- ings consists of the farmer’s cottage, several barns and three poultry houses. The lat- est addition is a modern poul- try house, 16x82 feet, modeled after the plans of the U. S. Department of Agriculture. The chief products of the farm at present are eggs, vege- tables, hay, wheat, oats, and corn. Four horses are kept for farm work and driving. On January 1st, 1911, the poultry yard contained 500 Wyandottes and Barred Plymouth Rocks. Incubators are used for hatching the chickens. From January 1st, 1910, to January 1st, 1911, 6,342 dozen egss (total value $1,678.15) were used at the Sanatorium; of this the farm produced 1,663 dozen (total value $410.49). The output was growing steadily since January 1st, 1911: January, 110 dozen; February, 102 dozen; March, 447 dozen. With its gradual development the poultry farm is expected to yield the entire egg supply needed at the Institution. A Corner of the Chicken Farm. General View of the Farm. 65 The output of the farm in 1910 is represented by the fol- lowing figures: Vegetables, $200.00; eggs, $399.95; poultry for table, $150.03; hay, $210.00; oats, $78.98; wheat, $75.62; corn, $150.00; pigs, $177.80. Total, $1,442.38. An effort is being made at present to develop the full ca- pacity of the farm. With the purchase of additional land the installation of a model dairy may become possible; at present all milk is fur- nished by a herd of tuberculin tested cows on a neighboring farm. ACKNOWLEDGMENTS We are indebted to the President and the Board of Directors of the Chicago Tuberculosis Institute for their support and en- couragement; to people of Naperville for their uniformly kind attitude and ever ready cooperation; to Mrs. Keith Spalding of Chicago, the founder of the Sanatorium, for her numerous ben- efactions and unremitting support in advancing the interests of the Institution; to Mr. and Mrs. Cyrus H. McCormick for the maintenance of the Elizabeth McCormick Memorial Bed for children; to Mrs. Louise de Koven Bowen, Miss Mary Rozet Smith and others for their liberal contributions to the patients’ relief fund; to Mr. Julius Rosenwald of Chicago for his annual contribution of five hundred dollars to the Laboratory Lund; to the Nurses’ Auxiliary of the Chicago Tuberculosis Institute for the maintenance of a bed for nurses; to Sears, Roe- buck & Company for the gift of a six bed cottage and the main- tenance of three beds for their employes; to the Women’s Trade Union League of Chicago for the maintenance of a bed for their members; and all others who have contributed from time to time to the Institution. We gratefully acknowledge the valuable services rendered by our Architect, Mr. W. A. Otis of Chicago. Appreciation is due to the Superintendent of the Chicago Tuberculosis Institute, Mr. Lrank E. Wing, for his ever ready cooperation in various matters pertaining to the Sanatorium; to Dr. Elmer L. Kenyon, the Visiting Laryngologist, for his valuable services in the development of the Nose and Throat Department; to Dr. Edward R. Rosenow, the Consulting Pathol- 66 ogist, for similar services in the development of the Laboratory; to Dr. James A. Britton, the Associate Visiting Physician, for his valuable assistance; to Dr. George A. Torrison, the Visiting Laryngologist, for his valuable services since his appointment on September 1, 1910; and to Dr. Anne J. Murphy, for faithful and efficient performance of duty, as House Physician. The able and faithful services, extending over three years, of the Superintendent of the Sanatorium, Miss Winnifred Mc- Edward, can not be too highly commended; as well as the en- thusiastic and efficient services of the Sanatorium Nurses, Miss Julia Ristell, Miss Alice Buckland and Miss Annie Stephens, and the clerk, Miss Eunice Aikman. The valuable services rendered, by Mrs. Theodore B. Sachs, in connection with systematic investigation of economic purchase of supplies, are gratefully acknowledged. THE NEEDS OF THE INSTITUTION. The Sanatorium is in need of funds for further extension of its facilities. By enlargement of the present service building and erection of additional sleeping shacks the present capacity of the Insti- tution can be doubled. Construction of a central heating plant would result in a greater economy of service. Purchase of additional land for future uses is very- desir- able. To provide for a larger number of tuberculous patients of moderate means, an increase in the number of supported and endowed beds is greatly needed. An annual contribution of five hundred dollars will support one bed, taking care of two to three patients yearly (at the pre- sent rate of the average duration of treatment) ; an annual con- tribution of two hundred and fifty dollars will reduce the weekly charge in the same number of cases to five dollars a week. Endowment of beds can be arranged by contribution yield- ing an annual income as above stated. The special “patients’ relief fund” is used to cover the difference between the reduced charge allowed in a certain per- centage of cases and the weekly cost of maintenance. Liberal 67 contributions to this fund would minimize the burden resting upon the patients of limited means. The Sanatorium appeals to the public for generous sup- port ; the appeal is based on the record of work so far accom- plished and the determination to develop in every way the effi- ciency of the Institution. Checks specified “for the Edward Sanatorium, Naperville, Illinois’" should be sent to Mr. David R. Forgan, Treasurer, Chicago Tuberculosis Institute, 158 Adams St., Chicago. THE OUTLOOK. When the Edward Sanatorium opened its doors on Jan- uary 15, 1907, it was the first institution of its kind under Chi- cago auspices. During the last four years it has been the exponent of sanatorium treatment of tuberculosis in our home climate. The results obtained at the Edward Sanatorium have served as a basis of appeal for the establishment of similar private and municipal institutions. Since the opening of the Sanatorium up to the present time, the aim has been (1.) to develop tbe medical and laboratory facilities of the Institution, so essential to a thorough study of each Individual case and (2.) to perfect a sanatorium regime in- suring a strict supervision of cases and close observance of all the essentials of the modern treatment of tuberculosis. i. A continuous eff-ort was directed to the development of the proper spirit and enthusiasm among the patients whose cooper- ation is indispensable to a successful treatment of this disease. The plan for the future of the Edward Sanatorium is fur- ther development and increased efficiency; to achieve this object the Institution needs the generous support of the public. Theodore B. Sachs, M. D. Medical Director. 68 Financial Report, Edward Sanatorium. January 1st to December 31st, 1910. Balances of cash on hand January, 1st, 1910: General Fund $ 773.85 Petty Cash 50.00 Sanatorium Building Fund 18,131.01 $18,954.86 ~ , RECEIPTS. General Fund: Contributions, Mrs. Keith Spalding . .$ 7,000.00 Contributions, additional 20.00 Board of Patients 17,606.37 Sears, Roebuck & Co. (for Shack).... 1,410.47 Special Patients’ Board Fund 385.00 Elizabeth McCormick Memorial Fund. 600.00 Nurses’ Auxiliary Bed 600.00 Women’s Trade Union League Fund. . 250.00 Laboratory Fund 500.00 Sales and Refunds 408.71 Sanatorium Building Fund: Interest on Bank Deposits $ 124.51 $28,904.06 Total $47,858.92 DISBURSEMENTS. General Administrative Expenses: Salaries (Superintendent, etc.) $ 866.00 Printing-, Stationery and Office Supplies 46.07 Postage 21.00 Telephone 177.81 Railroad Expenses 208.10 Livery Expenses 12.00 Legal Expenses 178.79 Photographs, Prints, Cuts, etc. . . ,r .. . 41.90 Library 9.63 Miscellaneous 109.78 $ 1,671.08 Professional Care of Patients: House Physician and Nurses $ 1,438.85 69 Transportation 122.86 Medical Supplies 103.88 Surgical Supplies 63.02 General Supplies ' 332.46 Miscellaneous 22.84 $ 2,083.91 Housekeeping (Including Laundry): Salaries and Wages $ 1,173.84 Beds and Bedding 1,165.41 Linen and other Dry Goods 184.02 Furnishings 157.83 Crockery, Hardware and Kitchen Uten- sils 193.49 Cleaning and Laundry Supplies...... 339.68 Miscellaneous 96.68 $ 2,310.95 Steward’s Department: Salaries and Wages $ 1,118.38 Milk and Cream..... 2,024.66 Butter and Cheese 731.99 Eggs 1,267.66 Groceries, Vegetables and Fruits 2,329.03 Meat, Poultry and Fish 2,577.63 Flour, Bread and Crackers 263.61 Coffee, Tea, Cocoa, etc 108.41 Miscellaneous 77.71 $10,499.04 General House and Property Expenses: Salaries and Wages ; $ 385.01 Coal 773.09 Oil and Gasoline 181.37 Electricity 185.94 Taxes 4.29 Insurance (3 years) 959.00 Renewals and Repairs: To Grounds 197.85 To Buildings 795.17 To Machinery and Tools 205.31 Miscellaneous 172.31 $ 3,859.34 70 Farm: Labor $ 625.87 Hay, Grain and Feed 274.72 Poultry Supplies' 81.55 Seeds 27.82 Other Farm Supplies 81.51 Miscellaneous 35.80 $ 1,127.27 Laboratory: Laboratory Supplies $ 47.24 Miscellaneous .25 $ 47.49 Total Operating Expenses $21,599.08 Other Current Expenses: New Equipment: Buildings $ 1,558.32 Grounds 568.66 Beds and Bedding 127.90 Furniture and Furnishings 1,018.38 Apparatus 309.00 Farming Machinery 10.45 Laboratory Equipment 6.31 Miscellaneous 81.98 $ 3,681.00 Other Expenses: Board Refunded to Patients $ 154.95 Articles chargeable to Patients’ Account 208.27 Miscellaneous 277.20 $ 640.42 Miscellaneous $ 1,291.72 $ 1,291.72 Total Current Expenses $27,212.22 Sanatorium Building Fund: Construction $14,529.49 Equipment 3,633.53 Insurance 62.50 $18,255.52 Grand Total All Disbursements $45,467.74 71 Balance of Cash on Hand December 31st, 1910: General Account 2,391.18 $47,858.92 Distribution of Balance: Maintenance $ 1,467.17 Petty Cash 200.00 Special Board Fund 121.37 Elizabeth McCormick Memorial Fund 6.35 Nurses’ Auxiliary Bed 65.78 Health Committee Fund, Woman’s Trade Union League 84.31 Laboratory Fund 446.20 , $ 2,391.18 72 COMPLETE FINANCIAL STATEMENT SANATORIUM BUILDING FUND. RECEIPTS. Contributions (Mrs. Keith Spalding) $25,047.50 Accrued Interest on Deposits 564.52 $25,612.02 DISBURSEMENTS. On Account of Medical Building: Construction: General Contractor $19,990.28 Architect’s Fees 999.96 Clerk of Works 420.75 Coal during construction 24.63 $21,435.62 Insurance $ 437.50 $ 437.50 Equipment: Furniture and Furnishings $ 634.40 Rugs 191.10 Beds and Mattresses 221.40 Blankets and Bedding 313.35 Towels and Dry Goods 85.67 Dining Room Supplies 270.19 Medical and Laboratory Supplies.... 531.73 Electrical Fixtures and Labor 189.68 Cork Flooring and Supplies 124.75 Curtain Rods and Shades 121.84 $ 2,684.11 Ground Improvements: Septic Tank $ 550.00 Gas Mains 100.00 Labor, etc. on grounds 404.79 $ 1,054.79 $25,61202 73 June July August September October November Per Patient Totals Per Week Gen. Administrative Exp $ 58.90 $ 49.52 $ 26.06 $ 22.45 $ 81.50 $ 64.63 $ 303.06 $ .72 Salaries 201.00 204.08 201.28 196.50 210.28 257.49 1,270.63 3.01 Food Supplies .... 286.12 274.09 322.13 321.65 568.98 444.64 2,217.61 5.25 Heat, Light and Water .... 31.18 33.44 80.68 320.13 36.23 61.77 563.43 1.33 Medical Supplies 35 32.56 26.00 29.41 39.20 65.44 192.96 .47 Dry Goods and Household Supplies .... 55.23 16.16 35.46 34.54 3.74 74.78 219.91 .50 Farm 78.79 73.25 83.35 61.45 45.50 83.45 428.79 1.02 Renewals and Repairs .... 4.00 10.12 8.68 39.90 51.62 94.52 208.84 .49 Totals ....$715.57 $693.22 $783.64 $1,029.03 $1,037.05 $1,146.72 $5,405.23 $12.79 Total number of days of treatment 424 457 487 451 496 642 2957 Average patients in residence... 14 15 16 15 16 21 16 Average cost per patient per week ... $11.81 $10.62 $11.26 $15.97 $14.63 $12.33 $12.79 ‘Payments on December accounts made in January and therefore included in statement of following year. COST OF MAINTENANCE—EDWARD SANATORIUM- DECEMBER 1, 1907 TO DECEMBER 1, 1908 Dec., '07 January February March April May June July August September October November Totals Per Pa- tient per Week Gen. Administrative Exp $66.48 $51.98 $52.77 $51.35 $45.95 $34.70 $56.67 $43.49 $26.27 $56.38 $46.52 $41.20 $573.76 .428 Salaries 377.20 250.00 274.48 280.40 307.00 276.66 281.46 314.09 320.00 310.00 303.96 305.00 3600.25 2.685 Food Supplies 610.76 374.50 521.98 522.51 388.24 408.34 425.77 564.87 451.44 568.05 589.76 641.02 6067.24 4.525 Dry G. and H-H Sup 83.26 158.97 30.75 42.07 10.25 98.47 1.16 56.22 4.18 14.26 114.25 80.03 693.87 .519 Heat, Light and Water 93.27 39.59 52.21 107.37 105.10 53.99 65.07 311.34 32.18 36.83 24.35 13.36 934.66 .697 Medical Supplies 24.42 15.23 52.33 52.98 16.48 26.67 42.27 43.44 10.19 56.77 37.71 66.53 445.02 .331 Farm 45.75 40.65 130.79 148.30 121.13 85.25 108.91 93.39 112.25 79.10 57.45 61.02 1083.99 .808 Renewals and Repairs 37.06 31.62 40.22 48.98 49.98 106.30 144.50 169.54 8.76 13.75 36.73 34.68 731.12 .545 TOTALS $1338.20 $962.54 $1164.53 $1253.96 $1044.13 $1090.38 $1125.81 $1596.38 $965.27 $1135.14 $1210.73 $1242.84 $14129.91 $10.54 Total number of days of treat- ment 751 77S 740 745 763 815 792 853 799 712 751 886 9385 Average patients in residence.. 24.2 25.1 25.5 24.03 25.4 26.3 26.4 27.5 25.8 23.7 24.2 29.5 25.6 Average cost per patient per week $12.47 $8.66 $11.01 $11.78 $9.48 $9.36 $9.95 $13.10 $8.46 $11.16 $11.28 S'J-71 $10.54 COST OF MAINTENANCE—EDWARD SANATORIUM—JUNE 1, 1907 TO DECEMBER 1, 1907.* 74 Dee. '08 January February March April May June July August September October November Per Patient Totals Per Week Gen. Administrative Exp $ 60.65 $ 17.95 $ 57.87 $ 28.29 $ 69.86 $ 72.85 $ 60.37 $ 52.55 $ 79.56 $ 55.11 $ 29.90 $ 71.70 $ 656.66 .399 Salaries 305.00 305.00 324.25 315.00 316.90 321.00 255.88 284.90 280.00 308.62 284.92 285.50 3586.97 2.180 Food Supplies 465.74 507.34 563.18 467.42 464.06 536.63 497.04 618.46 646.10 601.53 599.45 592.83 6559.78 3.989 Dry Goods & Household Sup... 5.35 30.05 .50 28.14 73.52 52.39 24.13 40.52 35.10 46.72 19.58 20.92 376.92 .229 Heat, Light & Water 159.78 167.03 39.95 107.50 91.60 60.19 22.16 393.29 49.56 431.85 6.85 15.10 1544.86 .939 Medical Supplies 26.50 9.03 59.40 40.52 22.81 39.18 49.74 36.96 36.94 53.25 18.19 30.42 422.94 .257 Farm 127.20 55.00 51.80 57.10 111.88 105.38 138.98 126.66 121.05 89.06 94.80 121.30 1200.21 .729 Renewals and Repairs 255.99 50.86 111.99 63.28 41.25 110.77 83.53 445.78 97.95 17.13 7.43 12.03 1297.99 .788 Totals $1406.21 $1142.26 $1208.94 $1107.25 $1191.88 $1298.39 $1131.83 $1999.12 $1346.26 $1603.27 $1061.12 $1149.80 $15646.33 $9.51 Total number of days of treat- ment 899 882 860 906 910 996 946 1055 1057 966 1009 1030 11516 Av. patients in residence 29. 28. 31. 29. 30. 32. 32. 34. 34. 32. 33. 34. 32. Av. cost per patient per week.. $11.06 $9,065 $9.84 $8.55 $9,278 $9,125 $8,375 $13.26 $8,915 $11,726 $7.36 $7.81 $9.51 Dec. '09 Jan. TO February March April May June July August September October November Totals Per Patient Per Week Gen. Administrative Exp. . . $ 123.15 $ 297.84 $ 120.50 $ 126.79 $ 137.35 $ 143.23 $ 109.74 $ 132.26 $ 97.88 $ 139.89 $ 174.10 $ 138.35 $ 1741.08 .760 Professional care of Patients. 141.12 119.23 96.57 107.80 187.54 146.61 279.44 198.34 199.38 199.58 212.97 275.33 2163.91 .944 Housekeeping 247.49 122.24 135.51 133.21 129.61 183.61 134.61 286.35 293.57 218.33 288.76 210.66 2383.95 1.040 Steward's Department 777.41 655.67 663.25 657.92 799.25 734.70 864.39 1042.80 1059.48 1314.20 1091.71 925.26 10586.04 4.622 Gen’l House & Property Exp. 152.11 260.61 229.80 75.13 374.31 320.48 310.89 777.98 119.12 134.30 249.78 245.50 3250.01 1.419 Farm 77.20 76.20 146.63 70.83 905.38 77.40 121.00 103.65 139.65 57.50 80.92 130.91 1177.27 .514 Laboratory Supplies 7.95 14.34 16.74 1.91 .35 3.67 2.53 47.49 .020 Totals $1518.48 $1531.79 $1392.26 $1171.68 $1723.44 $1613.98 $1834.41 $2558.12 $1910.99 $2064.15 $2101.91 $1928.54 $21349.75 $9.32 Total number of days of treat- ment 1033 1095 1042 1162 1217 1357 1464 1523 1551 1578 1532 1478 16032 Average patients in residence 33. 35. 37. 41. 41. 44. 49. 49. 50. 52. 49. 49. 43.9 Av. cost per patient per week $10,289 $9,792 $9,353 $7,058 $9,912 $8,325 $8,777 $11,757 $8,812 $9,156 $9,669 $9,837 $9.32 COST OF MAINTENANCE—EDWARD SANATORIUM—DECEMBER 1, 1909 TO DECEMBER 1, 1910. COST OF MAINTENANCE—EDWARD SANATORIUM—DECEMBER 1, 1908 TO DECEMBER 1, 1909. 75 EDWARD SANATORIUM—COMPARATIVE STATEMENT Showing increasing service and decreasing operating expense for periods ending December 1, 1907; December 1, 1908; December 1, 1909; and December 1, 1910. 1907 June 1 to Dec. 1st (6 months) 1908 Dec. 1,1907 to Dec. 1,1908 (1 year) 1909 Dec. 1,1908 to Dec. 1,1909 (1 year) 1910 Dec.1,1909 to Dec. 1,1910 (1 year) Total operating expense. ... $5,405.23 $14,129.91 $15,646.33 $21,349.75 Number of patient days. . .. 2957 9385 11516 16032 Average patients in resi- dence 16 26 32 43 Average cost per patient per day $1,827 $1,506 $1,360 $1,331 Average cost per patient per week $12.79 $10.54 $9.51 $9.32 ADMISSIONS AND DISCHARGES 1907—1910 1907 1908 1909 1910 TOTAL! Admitted 59 102 102 143 406 | Discharged 35 98 100 123 356 76 FORM OF BEQUEST I give and bequeath to the EDWARD SANATORIUM, Naperville, 111., a department of the CHICAGO TUBER- CULOSIS INSTITUTE, a corporation organized under the laws of the State of Illinois, the sum of dollars. In contributing to the Sanatorium follow the form below: DAVID R. FORGAN, Treasurer, Chicago Tuberculosis Institute, 157 West Adams Street, Chicago, 111. Please find enclosed $ ;, a contribution to the general funds of the Edward Sanatorium, Naper- ville, Illinois, Department of the Chicago Tuberculosis Institute. Please state address to facilitate acknowledgement. In contributing to any special fund of the Sanatorium or for any specific purpose, please specify same. The special funds of the Sanatorium are as follows: Sanatorium Building Fund, Endowed Beds, Laboratory Fund, Patients’ Board Fund, Supported Beds, Library Fund. See chapter on the needs of the Sanatorium page 67- 77 The Chicago Tuberculosis Institute The Central Headquarters of the Anti -Tuberculosis Propaganda in Chicago BOARD OF DIRECTORS 1910 Henry B. Favill, M. D., President; Frank Billings, M. D., First Vice- President; Robert H. Babcock, M. D., Second Vice-President; David R. Forgan, Treasurer; Sherman C. Kingsley, Secretary. Miss Jane Addams Charles L. Allen John V. Clarice N. S. Davis, M. D. Mrs. E. C. Dudley Wm. A. Evans, M. D. Miss Harriet Fulmer Ethan A. Gray, M. D. Mrs. J. L. Houghteling F. S. Johnson, M. D. John Koelling Hon. Julian W. Mack Charles L. Mix, M. D. Mrs. Jesse L. Moss O. W. McMichael,M.D. Rev. P. F. O’Callaghan George W. Perkins John A. Robison, M. D. E, W. Ryerson, M. D. Theo. B. Sachs, M. D. Miss Laura Shedd Geo. W. Webster, M.D. Sanatorium Department: Theodore B. Sachs, M. D., Head of the Department, Edward Sanatorium, Naperville, 111. Theodore B. Sachs, M. D., Medical Director. Winifred McEdward, R. N., Superintendent. Dispensary Department: Ethan A. Gray, M. D., Head of the Depart- ment. Edna L. Foley, R. N., Supervising Nurse. Educational Department: O. W. McMiciiael, M. D., Head of the Department. Central Office: Room 411, Rand-McNally Bldg., 157 West Adams St. Telephone Main 1466. Frank E. Wing, Superintendent. 78 «r*C*NIA, HICK El t COn MtWTtW, « FIFTH AWt