Tuberculosis Control and Prevention 
REPORT OF THE 
VIRGINIA, ADVISORY LEGISLATIVE COUNCIL 
TO THE 
GOVERNOR 
AND THE 
GENERAL ASSEMBLY OF VIRGINIA 
HOUSE DOCUMENT No. 22 
Commonwealth of Virginia 
Division of Purchase and Printing 
Richmond 
1946 MEMBERS OF THE COUNCIL 
Edward L. Breeden, Jr., Chairman 
Edward O. McCue, Jr., Vice-Chairman 
Willis E. Cohoon 
Charles R. Fenwick 
Garland Gray 
E. Glenn Jordan 
E. Blackburn Moore 
John B. Spiers 
Robert C. Vaden 
Cassius M. Chichester, Secretary 
John B. Boatwright, Jr., Recording Secretary Tuberculosis Control and Prevention 
A REPORT OF THE VIRGINIA ADVISORY 
LEGISLATIVE COUNCIL 
Richmond, Virginia, December 15, 1945. 
To: 
Honorable Colgate W. Darden, Jr., Governor of Virginia 
AND 
The General Assembly of Virginia: 
The General Assembly at the extra session in 1945 directed the 
Virginia Advisory Legislative Council to make a study and report 
upon the problem of the prevention and control of tuberculosis in 
Virginia. 
House Joint Resolution No. 37 is as follows 
HOUSE JOINT RESOLUTION No. 37 
Directing the Virginia Advisory Legislative Council to make a study 
and report on the problem of the prevention and control of tuber- 
culosis in Virginia. 
Whereas, the prevalence of tuberculosis in the State of Virginia, 
due in part at least to the failure of existing facilities and methods 
of prevention and control, makes it advisable that the whole 
problem be given further study before any substantial changes 
are made in such facilities and methods; Now, Therefore, 
Be it resolved by the House of Delegates of Virginia, the 
Senate concurring, as follows: 
Section 1. The Virginia Advisory Legislative Council is 
authorized and directed to make a thorough investigation and 
study of the problem of the prevention and control of tuberculosis 
in the State of Virginia, and the contribution which the State 
and its political subdivisions should make to the solution of this 
problem, giving particular attention to the adequacy of existing 
law with respect to isolation and quarantine. In its study the 
Council shall avail itself of the assistance of the Department of 
Health, and of any Federal, State or local agency or private organ- 
ization concerned with the problem. 
Section 2. The Council shall submit to the Governor and 
the General Assembly at least sixty days prior to the next regular 4 
House Document No. 22 
session of the General Assembly a report of its findings and recom- 
mendations, together with any proposed legislation necessary to 
carry such recommendations into effect. 
The Council referred this study to E. O. McCue, Jr., Charlottes- 
ville, Member, House of Delegates, as Chairman of the Committee to 
make the preliminary study and report. The following served on the 
Committee with the Chairman: Dr. I. C. Riggin, State Health Com- 
missioner; Frank C. Hanrahan, County Manager, Arlington County, 
Arlington; Dr. Frank B. Stafford, Superintendent and Medical Direc- 
tor, Blue Ridge Sanatorium, Charlottesville; and Thomas C. Boushall, 
President, Morris Plan Bank, Richmond. 
The Committee organized and appointed Cassius M. Chichester 
and John B. Boatwright, Jr., as Secretary and Recording Secretary, 
respectively to the Committee. 
The Committee gathered and studied all available data from the 
files of the Health Department and other sources, made personal 
examination of certain of the facilities at the tuberculosis sanatoria, 
studied the laws of this and other states and practices thereunder and 
after careful consideration of same, reported to the Council. 
The Council studied the report and accompanying data and now 
makes its report. 
The tuberculosis picture in the State is as follows. 
In 1915, which was the first year the vital statistics law in Virginia 
was in operation requiring the physicians to report births and deaths, 
it was found that 4,003 people (white, 1,765 and colored, 2,238) had 
died of tuberculosis. No doubt there were many more deaths from 
tuberculosis not reported, because many of the physicians were indiffer- 
ent and careless and did not understand their responsibilities in the 
matter. Also many mistakes in diagnosis must have been made, 
when we consider the poor facilities available for this purpose at that 
time. In contrast to the high death rate in 1915, we find last year 
(1944) the Bureau of Vital Statistics of Virginia reports 1,287 deaths 
from all forms of tuberculosis in Virginia, both white and colored. 
When this is broken down into the two races, it is revealed that 625 
deaths occurred in white and 664 in colored. This compared to 1943 
shows reduction of 110 deaths, or 7.8 per cent, and is 30 less deaths 
in the white and 80 less in the colored. 
It is well to compare Virginia’s death rate from tuberculosis with 
that of other states in the Union. Miss Mary Dempsey, Statistician 
for the National Tuberculosis Association, has collected reports from 
Health Departments in the 48 states and District of Columbia for 
the 1943 death rate from tuberculosis for the continental United States 
(the death rate for the last year (1944) by states is not yet available), 
and it was-found to be 41.9 per 100,000 population. This is in contrast 
to 43.1 for the year 1942. Several states have been selected from Miss 
Dempsey’s publication and compiled in table 1 listed below. In addi- 
tion to showing the total number of deaths and the rate per 100,000 
population for the states, there is included the total number of new Tuverculosis Control and Prevention 
5 
cases reported and the ratio existing between these and the deaths 
which occurred. For many years it has been felt that there should be 
a given number of new cases of tuberculosis discovered and reported on 
a ratio basis to the number of deaths. It was not until recently that 
this ratio was fixed by the American Public Health Association at 
two. Last year this same Association raised the standard to three new 
cases per annual death. 
TABLE y 
New Cases Reported, Deaths and Death Rates From 
Tuberculosis, by States—1943 
STATE 
New 
Cases 
Reported 
Number 
of Deaths 
(Recorded) 
Cases 
Per 
Death 
Rate 
Per 
100,000 
United States 
118,042 
56,178 
2.10 
41.9 
California 
7,879 
3,809 
2.07 
45.0 
Connecticut 
1,280 
599 
2.14 
33.7 
Florida 
1,211 
834 
1.45 
35.2 
Georgia 
2,409 
1,285 
1.87 
39.8 
Illinois 
8,756 
3,240 
2.70 
42.1 
Iowa 
729 
380 
1.92 
16.4 
Kentucky 
2,356 
1,748 
1.35 
64.0 
Maryland 
3,522 
1,204 
2.93 
57.6 
Massachusetts 
2,960 
1,802 
1.64 
42.3 
Michigan 
• 6,546 
1.802 
3.63 
33.2 
Minnesota. . 
1,928 
753 
2.56 
29.2 
Mississippi 
1,637 
786 
2.08 
35.2 
New York 
14,744 
6,417 
2.30 
49.9 
North Carolina 
1,583 
1,444 
1.10 
39.7 
South Carolina 
635 
645 
0.98 
33.1 
Tennessee 
3,793 
l-,883 
2.01 
63.6 
Virginia 
3,771 
1,397 
2.97 
45.4 
West Virginia 
1.643 
765 
2.15 
43.6 
It will be seen from the states included in this tabulation that 
Kentucky heads the list as having the highest death rate with 64.0 per 
100,000 while Tennessee is a close second with 63.6. It is interesting 
to know that Tennessee, as far as known, does not yet have a State 
Sanatorium for the treatment of tuberculosis, while Kentucky has only 
had one a few years. As for the low states, it is seen that Iowa heads 
the list with a death rate of only 16.4 per 100,000, while the other low 
state is Minnesota with 29.2. 
Rates of New Cases Reported: 
As to the new cases reported compared to the deaths which took 
place, we find Michigan heads the list with 3.63 and Virginia stands 
second with 2.97. As to the low states we find that South Carolina 6 
House Document No. 22 
Source; Virginia Bureau of Vital Statistics 
VIRGINIA COUNTIES HAVING AN AVERAGE ANNUAL TUBERCULOSIS DEATH RATE HIGHER THAN 
THE STATE RATE OF 57.8 PER 100,000-1939-1943 
MAP 1 
Tuberculosis Death Rate Between 
57.8-100.0 per 100,000 
Tuberculosis Death Rate Above 
100.0 per 100,000 Tuberculosis Control and Prevention 
7 
was at the bottom of the list with 0.98 cases, next is North Carolina 
with 1.10; Kentucky with 1.35 and Florida with 1.46. This comparison 
shows that Virginia is well out in front in diagnosis and case finding, 
and that recommendation speaks well for the results which have been 
accomplished by the State Department of Health in its industrial sur- 
veys and tuberculosis clinic work in general throughout the State. 
With 2.97 cases reported, Virginia’s rate is almost up to that recom- 
mended by the American Public Health Association. 
The over-all picture as regards incidence of tuberculosis has been 
shown. Now the picture in its component parts will be given. 
Population Groups (Race)—The census figures for 1940 show a 
white population of 2,016,324 and a Negro population of 661,449 in 
Virginia. Total deaths for white were 626 and for colored, 661, or 
rates of 29.5, white, 97.7, Negro, for the year 1944. The high death 
rate in the Negro race is a dominant factor in the tuberculosis program 
and must be given careful and, serious consideration. The inter- 
relation of races is such that a high death rate in either race reacts 
unfavorably upon the other. The changing economic status of the 
Negro that has promoted him from domestic and agrarian to public 
work and industry removes a possible focus of infection from white 
homes, but in no sense benefits the Negro race. 
Map 1 shows the incidence of the disease, by counties, among the 
Negro race. 
1940 
1941 
1942 
1943 
1944 
No. 
Rates 
No. 
Rates 
No. 
Rates 
No. 
Rates 
No. 
Rates 
White 
732 
36.2 
746 
35.9 
743 
34.9 
686 
31.4 
626 
29.5 
Colored 
828 
124.6 
892 
130.1 
849 
125.1 
760 
110.8 
661 
97.7 
Tuberculosis Deaths, Five-Year Period, by Race 
Age Distribution.—A study of Table 2 indicates marked differences 
between the white and Negro races. In the white race, there is an 
increase after the age of 60, and in Negroes, the rate abruptly rises in 
the age group 15-19 and continues high throughout life. This presents a 
definite problem in control of a group for which no adequate provisions 
of hospitalization or isolation are available outside the home. For the 
colored group where the rate is highest in the most productive years of 
life and frequently it is the wage earner affected and presents a more 
serious family problem both socially, economically and medically. 
(See attached Table 2.) 8 
House Document No. 22 
TABLE 2 
Deaths From Pulmonary Tuberculosis—1943. 
AGE 
White 
Colored 
Popu- 
lation 
Deaths 
Deaths 
Per 
100,000 
Popu- 
lation 
Popu- 
lation 
Deaths 
Deaths 
Per 
100,000 
Popu- 
lation 
1-4 
194,273 
4 
2.1 
67,576 
9 
13.3 
5-9 
197,535 
0 
0.0 
72,035 
3 
4.2 
10-14 
212,813 
0 
0.0 
76,838 
21 
27.3 
15-19 
223,749 
17 
7.6 
77,523 
76 
98,0 
20-24 
206,288 
40 
19.4 
66,203 
97 
146.5 
25-29 
189,885 
51 
26.9 
56,255 
78 
138.7 
30-34 
170,242 
57 
33.5 
45,279 
84 
185.5 
35-39 
150,577 
49 
32.5 
43,908 
60 
136.6 
40-44 
132,055 
50 
37.9 
39,449 
59 
149.6 
45-49 
117,860 
44 
37.3 
35,332 
48 
135.9 
50-54 
102,582 
53 
51.7 
30,872 
39 
126.3 
55-59 
84,019 
42 
50.0 
22,296 
39 
174.9 
60-64 
72,004 
51 
70.8 
18,523 
16 
86.4 
65-69 
57,827 
53 
91.7 
16,121 
18 
111.7 
70-74 
37.105 
44 
118.6 
9,604 
11 
114.5 
75 and over 
35,980 
45 
125.1 
9,604 
10 
104.1 
Unknown 
1 
1 
Total 
2,184,774 
601 
27.5 
687,418 
669 
97.3 
Having seen the problem both in its entirety and in its phases the 
question arises as to the present facilities offered by the State to combat 
this menace. 
The total number of beds in the State Sanatoria at the present time 
are as follows: 
SANATORIUM 
Number Beds 
Infirmary 
Pavilion 
Total 
Catawba 
134 
266 
400 
Blue Ridge 
137 
233 
370 
Piedmont 
172 
97 
269 
Total 
443 
596 
1,039 
Tabel 3 shows the distribution in the fiscal year 1945 of the patients 
at the sanatoria. Tuberculosis Control and Prevention 
9 
Distribution of Sanatoria Patients by Counties 
TABLE 3 
July 1, 1944, to June 30, 1945 
COUNTIES 
Catawba 
Blue Ridge 
Piedmont 
Total 
Accomack 
2 
9 
6 
17 
Albemarle 
1 
19 
6 
26 
Alleghany 
10 
2 
2 
14 
Amelia 
1 
0 
1 
2 
Amherst 
1 
0 
0 
1 
Appomattox 
0 
1 
0 
1 
Arlington 
10 
32 
10 
52 
Augusta 
2 
27 
2 
31 
Bath ■ ... 
2 
2 
1 
5 
Bedford 
3 
1 
3 
7 
Bland 
1 
0 
0 
1 
Botetourt 
6 
0 
0 
6 
Brunswick 
0 
0 
10 
10 
Buchanan 
8 
4 
0 
12 
Buckingham. 
0 
2 
3 
5 
Campbell 
8 
9 
5 
22 
Caroline 
0 
1 
5 • 
6 
Carroll 
6 
0 
0 
6 
Charles City 
0 
0 
1 
1 
Charlotte 
2 
1 
2 
5 
Chesterfield 
2 
5 
3 
10 
Clarke 
0 
1 
0 
1 
Craig 
0 
0 
0 
0 
Culpeper 
0 
3 
3 
6 
Cumberland 
0 
0 
1 
. 1 
Dickinson 
9 
1 
0 
10 
Dinwiddie 
3 
9 
9 
21 
Elizabeth City 
2 
12 
3 
17 
Essex 
0 
1 
0 
1 
Fairfax 
1 
12 
1 
14 
Fauquier 
0 
6 
1 
7 
Floyd 
2 
0 
0 
2 
Fluvanna 
0 
2 
2 
4 
Franklin 
1 
1 
1 
3 
Frederick 
1 
7 
2 
10 
Giles 
4 
5 
0 
9 
Gloucester 
0 
1 
1 
2 
Goochland 
0 
2 
1 
3 
Grayson 
5 
0 
0 
5 
Greene 
0 
1 
0 
1 
Greensville 
1 
2 
4 
7 
Halifax 
7 
3 
8 
18 
Hanover 
2 
3 
4 
9 
Henrico 
5 
29 
3 
37 
Henry 
17 
0 
5 
22 
Highland 
0 
1 
0 
1 
Isle of Wight 
2 
0 
1 
3 
James City 
1 
3 
1 
5 
King and Queen 
0 
0 
1 
1 
King George 
0 
0 
0 
0 
King William 
0 
0 
2 
2 
Lancaster 
0 
0 
3 
3 
Lee 
11 
1 
0 
12 10 
House Document No. 22 
COUNTIES 
Catawba 
Blue Ridge 
Piedmont 
Total 
Loudoun 
0 
3 
0 
3 
Louisa 
1 
3 
3 
7 
Lunenburg 
1 
1 
1 
3 
Madison 
0 
3 
1 
4 
Mathews 
0 
2 
0 
2 
Mecklenburg 
3 
4 
6 
13 
Middlesex 
0 
1 
2 
3 
Montgomery 
17 
2 
0 
19 
N ansemond 
2 
4 
9 
15 
Nelson 
0 
2 
0 
2 
New Kent 
0 
1 
0 
1 
Norfolk 
17 
52 
16 
85 
N orthampton 
2 
0 
11 
13 
N orthumberland 
0 
1 
1 
2 
Nottoway 
0 
1 
4 
5 
()range 
0 
1 
1 
2 
Page 
1 
5 
0 
6 
Patrick 
2 
0 
0 
2 
Pittsylvania 
4 
12 
11 
27 
Powhatan 
0 
0 
0 
0 
Prince Edward 
2 
1 
4 
7 
Prince George 
3 
7 
5 
15 
Prince William 
1 
0 
0 
1 
Princess Anne 
1 
3 
0 
4 
Pulaski 
7 
1 
0 
8 
Rappahannock 
0 
1 
0 
1 
Richmond 
0 
2 
0 
2 
Roanoke 
31 
0 
0 
31 
Rockbridge 
8 
2 
0 
10 
Rockingham 
3 
14 
2 
19 
Russell 
7 
2 
0 
9 
Scott 
14 
0 
0 
14 
Shenandoah 
1 
4 
1 
6 
Smyth 
10 
2 
2 
14 
Southampton 
0 
5 
2 
7 
Spotsylvania 
0 
11 
3 
14 
Stafford 
0 
6 
2 
8 
Surry 
0 
0 
1 
1 
Sussex 
0 
1 
7 
8 
Tazewell 
20 
1 
3 
24 
Warren 
1 
7 
0 
8 
Warwick 
2 
19 
12 
33 
Washington 
12 
0 
0 
12 
Westmoreland 
0 
3 
1 
4 
Wise 
28 
0 
1 
29 
Wythe 
6 
1 
1 
8 
York 
0 
1 
2 
3 
346 
413 
232 
991 
TABLE 3—Continued 
In addition there are 585 beds at the Municipal Sanatoria which 
are as follows: Pine Camp Hospital, Richmond; Granby Sanatorium, 
Norfolk; Hilltop Sanatorium, Danville; and Roanoke City Sanatorium, 
Roanoke. Tuberculosis Control and Prevention 
11 
Of the total of 1,624 beds, 1,039 are owned and operated by the 
State, the remaining 585 being owned and operated by the municipali- 
ties as listed above. Of these beds 1,163 are for white and 461 for 
colored. It will be seen from these figures that Virginia has only 
1.25 beds, State and Municipal, for every annual death as compared 
to the quota recommended by the National Tuberculosis Association 
as referred to above, that is, a ratio of one to two or three. When 
these figures are broken down between the two races there is for white 
1.8 beds per annual death, while for colored there is only 0.7 of a bed 
available. 
The table showing the distribution of beds in the State Sanatoria 
reveals that Catawba and Blue Ridge have only about one-third of 
their beds located on the Infirmary and the remaining two-thirds on 
pavilions, while Piedmont has just the reverse. 
Map 2 shows the distribution of sanatoria and pneumothorax 
stations. 
Central Register.—Since 1914, a central register has been main- 
tained where all positive cases reported, as required by Section 1515 
of the Code, by private physicians, clinics, sanatoria, Selective Service 
and Veterans’ Facilities are recorded. The recorded cases, as of Jan- 
uary 1, 1945, were 38,534; in 1920, there were 18,489 on the register. 
Clinic Service.—Two mobile x-ray units furnished diagnostic and 
consultation service throughout the rural areas of Virginia. Early in 
1942, a staff clinician entering the army created a vacancy which has 
not been filled. However, the clinic has continued to function with the 
exception of discontinuing the physical examinations. General prac- 
titioners in many small and rural areas are dependent on this service 
for x-ray examinations of their patients because of the lack of x-ray 
facilities and trained physicians to operate these facilities. 
Permanent x-ray clinics have been established in Martinsville, 
Hampton and in the counties of Fairfax, Prince William and Nanse- 
mond during 1945. 
Special Study.—In cooperation with the Bureau of Maternal and 
Child Health, a tuberculosis study has been in operation for the past 
five years on prenatal and postnatal cases. These are unselected cases 
attending the State Maternal and Child Health Clinics who are brought 
into the mobile x-ray clinics. Over a period of five years, 1,110 women 
have been x-rayed, 65 or 5.8 per cent having been found to have active 
tuberculosis. This is a high percentage to find in an unselected group. 
Nursing Service.—The nursing service comprises a staff of eight 
nurses and one supervisor. These tuberculosis field nurses carry on 
an active case finding program among adult, adolescent and child 
contacts; home visits to establish tuberculosis control measures; organi- 
zation and assistance in clinics; and follow-up of clinicians’ and family 
physicians’ recommendations in the forty-nine counties without local 
health departments. Due to war time shortages, there have been only 12 
House Document No. 22 
Source: Slat* Health Department 
VIRGINIA STATE AND MUNICIPAL FACILITIES FOR TREATING TUBERCULOSIS, OCTOBER 1945 
MAP 2 
Tuberculosis Sanatoria 
Pneumothorax Stations Tuberculosis Control and Prevention 
13 
five field nurses on duty. These five nurses made 612 visits to patients 
discharged from the sanatoria and a total of 5,262 home visits during 
1945. 
Collapse Therapy.—The collapse therapy program was inaugurated 
July 1, 1938. Forty-seven private practitioners were employed on a 
part-time basis to operate the pneumothorax stations established 
throughout the State. The majority of these stations are located in 
small hospitals where the necessary fluoroscopic and sterilizing equip- 
ment is available. 
Major chest surgery is performed in the two State-owned hospitals 
and four other general hospitals. Only patients lacking necessary 
funds are eligible for treatment and chest surgery under this program. 
Industrial and School Surveys— 
Industry: These x-ray surveys are carried on jointly with the 
Bureau of Industrial Hygiene. The two 35MM. photo-fluorographic 
units have x-rayed a total of 253,408 workers as of August 1, 1945, the 
majority of these being employed in war work during the past four 
years. The following table of tuberculosis discovered indicates this 
is an important and essential piece of work. Few of these workers 
had any suspicion that they might have any pulmonary tuberculosis 
prior to survey. 
Re-infection, Active 2,396 
Re-infection, Healed 534 
Suspicious 1,124 
School Surveys.—The need for an inexpensive rapid method of 
x-raying large groups of college students, high school groups, school 
teachers, bus drivers, and school cafeteria workers has been met by 
plans worked out in cooperation with the Virginia Tuberculosis Asso- 
ciation. The Association assumed the responsibility of arranging 
and holding the clinics, and the local health departments and the 
Tuberculosis Out-Patient Service provided the follow-up on all persons 
with positive and suspicious findings. 
1944-194^ 
No. x-rayed 59,898 
Re-infection Tuberculosis, Active 380 
Re-infection Tuberculosis, Healed 1,123 
Selective Service.—Since January, 1941, Selective Service rejectee 
tuberculosis reports from the Armed Forces Induction Stations are 
received almost daily. Those with positive disease are registered 
and the information is relayed to the local health departments for the 
necessary investigation and follow-up. Over the four-year period, 
2,660 positive reports have been received from Selective Service. 
Rehabilitation.—The rehabilitation of the tuberculous is an inte- 
gral part of the treatment of tuberculosis and therefore a part of any 
control program. It is usually considered best for any ex-tubercular 14 
House Document No. 22 
to return to his former occupation providing it is not one of the so- 
called “dangerous trades”. For those who cannot resume their former 
occupations, it becomes necessary to assist this person in planning for 
vocational training. These persons are referred to the Division of 
Rehabilitation of the State Board of Education for guidance and 
retraining. 
Education.—An educational program serves to emphasize the 
necessity of early diagnosis and regular medical attention. The methods 
utilized for informing the public by instruction and propaganda include 
clinics, news articles, radio talks, lectures, moving pictures, special 
posters, spot maps and distribution of health literature. 
The foregoing shows what is available mostly in the way of case 
finding in tuberculosis, if personnel and funds permit. What is actually 
available? 
Next we turn to the hospitalization of cases and to a discussion 
of the limited facilities for caring for them in our State sanatoria which 
includes a comparison of these with sanatoria of other states. Seven 
sanatoria in other States, believed to be as good as any in this country, 
were sent inquiries to obtain this information. 
Sanatorium Personnel: 
The normal ratio of employees to patients in out of state sanatoria 
ranges from approximately one employee to every one and one-half 
to two and one-half patients. At Catawba and Blue Ridge Sanatorium 
the normal ratio has, in the past, been one employee to approximately 
two patients. At the present time the out of state sanatoria are main- 
taining approximately their usual normal ratio between their number 
of employees and patients. However, at Catawba and Blue Ridge 
there is now only one employee for every 2.5 to 3 patients. 
In the out of state sanatoria the normal nurse-patient ratio is 
considerably lower than the normal nurse-patient ratio in the three 
Virginia State sanatoria. The normal ratio at Blue Ridge and Catawba 
Sanatorium has in the past averaged one nurse to every 4.8 patients, 
while at Piedmont the ratio has been one nurse to six patients. At 
the present time in the out of state sanatoria one nurse is taking care 
of from three to ten patients whereas in Virginia one nurse is taking 
care of approximately seven to eleven patients. This would certainly 
indicate that there is a very acute shortage of nursing personnel in 
our Virginia Sanatoria. 
Staff Physicians: 
In the out of state sanatoria in normal times, one physician has 
cared for from 46 to 104 patients, while in Virginia Sanatoria in normal 
times one physician has cared for from 53 to 66 patients. At present 
in the out of state sanatoria one physician cares for from 43 to 119 
patients, whereas in Virginia one physician is caring for from 103 to 
154 patients. These figures would certainly indicate an acute shortage 
of staff physicians, and an effort should be made to correct this. The Tuberculosis Control and Prevention 
15 
present number of physicians is inadequate to give proper service to 
such a large number of patients, particularly when so many of these 
patients are of the sicker type. 
From what has been set out the following matters are apparent: 
a. Tuberculosis can in time be eradicated. 
b. Tuberculosis kills more people between the ages of 15 and 45 
than any other disease. 
c. Eradication of tuberculosis among the colored population is 
an urgent need. 
d. More sanatoria are needed together with personnel; salaries 
sufficient to attract and hold such personnel must be paid. 
e. A correlated attack on tuberculosis through case finding, 
sanatoria care and surgical procedure will in time repay the 
State many times over the initial outlay. One case taken in 
time can be cured at less than one-fifth the cost of caring for a 
terminal or hopeless case. 
1. Piedmont Sanatorium should be expanded from its present 
capacity of 269 beds to approximately 500 beds; the additions 
should be of the infirmary type. 
Piedmont Sanatorium is for Negro patients. The need for more 
beds to meet the incidence of the disease among the race has been 
shown. The increase from a capacity of 269 to approximately 500 
beds will greatly aid in the control of the disease. 
The new facilities should be of the infirmary type because the 
so-called pavilion facility is not suitable for complete bed care, dis- 
cipline is more difficult, and because the infirmary facility can be used 
for all purposes whereas the pavilion type is suitable for only one 
type of case. 
The conclusions and recommendations follow. 
2. An additional sanatorium with a 500-bed capacity should 
be established for Negroes suffering from tuberculosis; this 
institution should be located in the area of highest incidence 
and will cost $2,000,000 at $4,000 per bed. 
In order to meet the minimum of two beds for each death from 
tuberculosis among the Negro race (which has been shown to have the 
highest death rate) a new sanatorium should be provided. This should 
be located in the area of highest incidence. For the reasons hereto- 
fore set out the new facilities should be of the infirmary type. 
3. Blue Ridge Sanatorium should be expanded from a capacity 
of 370 beds to 500 beds; the additional facilities should be 
of the infirmary type. 
In order to bring the facilities for the white race to the necessary 
level the Blue Ridge Sanatorium should be expanded from a capacity 16 
House Document No. 22 
of 370 beds to 500 beds; this will bring the number of beds for the 
white race up to minimum requirements. For reasons previously set 
out the new facilities should be of the infirmary type. 
4. The facilities of Catawba Sanatorium should be improved and 
modernized through the replacement of obsolete buildings. 
Catawba Sanatorium which serves largely the western area of the 
State should be modernized and the facilities improved through the 
replacement of obsolete buildings. The present buildings in some 
cases are outmoded and beyond repair. This will lead to more efficient 
service. Catawba Sanatorium, just as Blue Ridge, draws from all over 
the State though more people in the western part of the State go there 
because it is closer home. 
5. A 500-bed hospital should be established for the hospital- 
ization of persons suffering from chronic diseases or illnesses; 
this institution should have appropriate facilities to house 
incorrigible patients of the two races and the two sexes; this 
will cost approximately $1,500,000 at $3,000 per bed. 
One of the problems which taxes the sanatoria facilities is the care 
of persons suffering from chronic and incurable illnesses. This type 
of case needs mostly custodial care. Such patients occupy beds in the 
sanatoria or hospitals which could be used for patients with incipient 
disease. The care of chronically ill persons of this kind in institutions 
is less expensive than that of other types of cases often capable of 
being cured. 
Another problem is the institutional care of incorrigible patients. 
They cannot and should not be housed with well behaved patients. 
In the past some have been cared for at the State Farm (for men), 
but there, they cannot obtain needed care. There is no place to house 
incorrigible female patients. 
It is the recommendation of the Council that a 500-bed isolation 
hospital be provided with separate facilities for the chronically ill 
and the incorrigible. Such an institution should have proper quarters 
for the two groups referred to and also house separately the two races 
and sexes. This will take a load from the sanatoria and hospitals, 
lead to more efficient use of the sanatoria, and provide adequate care 
for the groups referred to at considerable saving. 
6. Existing laws should be amended to provide for the compulsory 
isolation of persons suffering from tuberculosis. 
The present statutes for the isolation of tubercular persons are 
inadequate. The Council recommends that they be amended to provide 
for such compulsory isolation for the very good reasons that such 
persons are a menace to the health of the general public, they endanger 
their own lives, and they can be treated and cured much less expen- 
sively in the early than in the late stages of the disease. 
7. The surgical facilities in the sanatoria should be placed into 
operation again when conditions and personnel permit; these Tuberculosis Control and Prevention 
17 
facilities should be expanded by increasing the appropriation 
for indigent cases from $50,000 to $100,000. 
In the last few years one of the most important advances in the 
cure of tuberculosis has been the use of surgical techniques involving 
collapse of the affected lung or, in severe cases, excision of a badly 
damaged lung. The benefits have been many; the length of stay in the 
institution is reduced, the patient is more quickly returned to health, 
and time and funds—both that of State personnel and revenues and 
that of the patient—are saved. The sanatoria in this State have 
adopted and made wide use of surgery in this field. An expansion of 
this program will greatly benefit the public and the State by making 
more efficient use of sanatoria and reducing ultimately, public outlays. 
The patients can also benefit very materially. To this end, the Council 
recommends that this program be expanded from an outlay of $50,000 
to one of $100,000 per annum as soon as needed personnel and facilities 
can be obtained. 
8. Sufficient funds should be appropriated to the Health Depart- 
ment so that it can appoint a Director of Tuberculosis Work 
who can devote his full time to complete coordination of the 
tuberculosis control program in the State. 
The State Health Department has done well in coordinating the 
work of the sanatoria, field workers, local health departments and 
other persons and agencies in this field despite the lack of adequate 
funds and a shortage of personnel. It is the opinion of the Council 
that in order for the Department to do the best work it should be 
given the necessary funds to employ a full time director of tuberculosis 
control work with other necessary personnel. Such a director could 
give his full time to this work. The Department, if given the money, 
will do the work; it is the recommendation that the money be given. 
CONCLUSION 
The Council wishes to express its appreciation for the assistance 
rendered by the Virginia Tuberculosis Association, and the members of 
the Committee who so generously gave of their best to the preparation 
and formulation of this report. The Council is indebted to them for 
their most excellent services. 
A bill is attached to effectuate the one recommendation requiring 
legislation. 
Respectfully submitted, 
Edward L. Breeden, Jr., Chairman 
Edward 0. McCue, Jr., Vice-Chairman 
Willis E. Cohoon 
Charles R. Fenwick 
Garland Gray 
E. Glenn Jordan 
E. Blackburn Moore 
John B. Spiers 
Robert C. Vaden 18 
House Document No. 22 
A BILL 
To amend and re-enact Section 1516 of the Code of Virginia, relating to control 
of tuberculosis. 
Be it enacted by the General Assembly of Virginia: 
1. That section fifteen hundred sixteen of the Code of Virginia 
be amended and re-enacted, as follows; 
Section 1516. * Unlawful for persons having tuberculosis to en- 
danger health of others: how restrained.—It shall be unlawful for any * 
person suffering from tuberculosis * to violate the laws prohibiting 
expectoration in public places and vehicles, or * to deliberately and 
continuously place the health of any person in danger of infection with 
such disease *. Any person violating any of the provisions of this section 
shall be deemed guilty of a misdemeanor and punished accordingly. 
Any person violating the provisions of this section may, in lieu of 
prosecution hereunder, upon motion of any member of the board of 
health of any county or city of the Commonwealth, * be summoned 
to appear before * the circuit * or corporation court of such city or 
county to answer such charge, and if, after hearing, it be found that 
such person is guilty of the conduct charged and is a menace to the 
health of the public, or is unnecessarily exposing other persons to 
infection with tuberculosis, the court may order such person to be 
restrained and detained for a period not exceeding twelve months in 
some suitable place, or be required to give bond in a penalty to be 
determined by the court conditioned upon a cessation of the practices 
complained of for such period, not exceeding twelve months, as the 
court may determine. The court may at any time, for good cause 
shown, rescind or modify such order, or make such other disposition 
of such person as is authorized by existing laws.