REPORT 
ON THE 
TUBERCULOSIS WORK 
OF 
Bellevue Hospital and 
Dispensary Presented to the 
Statistical Division, Surgeon-General’s 
Library, United States Army 
Washington, D. C. 
BY 
The Prudential Insurance Co. of America 
Newark, New Jeraey DAY CAMP SOUTHFIELD, BELLEVUE HOSPITAL As short a space of time as five years ago the 
scourge of consumption in the City of New York 
was looked upon as a thing cpiite incapable of com- 
bating. There were at a low estimate twenty thou- 
sand persons affected with the disease filling the 
tenements, contaminating workrooms and factories, 
and endangering the health of society by daily and 
unrestricted intercourse in street and public car- 
riages. Tuberculosis was looked upon as incur- 
able, and there was a possibility within as few as 
the five years of the number of cases of tubercu- 
losis being doubled, possibly trebled, while the city 
felt itself powerless to check the contagion. 
But the knowledge having come to the medical 
world that tuberculosis is curable in its early stages, 
that the curative measures, fresh air, sunlight and 
nourishing food are at hand, first through organ- 
ized charities and tljen through its great city clinics, 
New York began five years ago its organized cam- 
paign against tbe disease. 
From the first it seemed that the campaign must 
be one of education. In some way the instruction 
of patients, often foreigners, ignorant members of 
the social unit and widely separated from dispen- 
saries and clinics must be effected. The method by 
which such education has been carried on, and the 
death rate from the disease materially reduced 
through co-operation of physicians, hospitals, and 
charitable organizations forms a social phenomenon 
of wide-spread interest. 
Public lectures, mainly stereopticon, with models, 
charts and photographs, are being given by the 
2 Committee on the Prevention of Tuberculosis of 
the Charity Organization Society reaching prob- 
ably half a million people in New York, but the 
more important work of the campaign has been 
done through the establishment of ten special tu- 
berculosis clinics, and the organizing of a system 
of dispensaries by which the city is divided into 
tuberculosis districts, and the work is co-ordinated 
and simplified by the division, and the overlapping 
or duplication of effort is prevented. 
The work of the several dispensaries is similar, 
but a large city hospital naturally reaching a larger 
number of patients, the methods employed by the 
Bellevue Tuberculosis Clinic may be cited as rep- 
resentative of New York’s crusade against the 
Great White Plague. 
In 1904 the special tuberculosis clinic was formed 
at Bellevue Hospital by the disintegration of pa- 
tients who had formerly been referred to and treat- 
ed in the general medical clinic. One visiting 
nurse was employed at first, and the number of 
cases treated during the first year was 604. From 
September, 1907, to September, 1908, 1,313 new 
patients were admitted. 
At the present time four graduate nurses are 
employed in the tuberculosis department, while one 
pupil nurse is assigned each six weeks for the 
training. 
Over one hundred new patients in addition to 
the regular monthly average of over four hundred 
patients come each month to Bellevue Clinic for 
treatment for tuberculosis. 
The active work of the clinic consists in the care- 
3 fill medical examination of the patient after which 
the case is referred to the visiting nurse. 
The seat of the disease is the crowded city tene- 
ment with its filth, its dirt, air-shaft room and its 
poverty; and to the tenement Bellevue directs its 
work of education. 
Within a week of his time of reporting at the 
dispensary and subsequently once a month each pa- 
tient is visited in his home by a trained nurse. 
Housing conditions, including character of rooms 
whether light or dark, ventilation and general 
cleanliness are carefully noted. The character of 
industry done in the apartment, the habits of pa- 
tients and the available roof, pier or park space for 
fresh air treatment are noted in the nurse’s report, 
and the nurse endeavors to ascertain if the patient 
is carrying out in his home the instructions received 
at the Clinic. General instructions as to the per- 
sonal cleanliness and care of sputum are given. 
The nurse becomes familiar with the family needs, 
and cases of extreme destitution are reported to the 
proper charitable society. The necessary diet is 
arranged through the co-operation of the several 
diet kitchens which distribute milk and eggs at the 
nurse’s order. 
To the visiting nurse belongs also the work of 
referring to a special children’s clinic at Bellevue 
the children of tuberculous parents. 
The Children's Clinic, held twice a week at Belle- 
vue dispensary has within the year of its inception, 
examined and treated over two hundred children, 
many of whom were found to be in the incipient 
stage of tuberculosis; some of the children were sent 
4 CHILDREN’S TUBERCULOSIS CLINIC, BELLEVUE HOSPITAL to sanatoria, others were sent to the country, and 
in this treatment of children predisposed to tuber- 
culosis lies the city’s hope of preventing the spread 
of the disease in the next generation. 
In the spring of 1907 the Committee on the Pre- 
vention of Tuberculosis of the Charity Organization 
Society decided to establish a day camp for the 
tuberculosis patients under treatment at the dis- 
pensaries of the Association of Tuberculosis Clinics. 
The problem of securing a land site in New York 
•seemed more difficult than in almost any other city 
Tecause of the overcrowded condition of the public 
parks and roofs and the impossibility of obtaining 
transportation to any out of town site which might 
be secured. A floating day camp seemed to be the 
Test solution and in June of the same year. Mr. John 
A. Bensel Commissioner of Docks of the City of 
New York placed at the disposal of the Committee 
the Southfield, an old Staten Island ferry boat. The 
boat was moored at the end of West 16th street 
pier and a corps of workers with soap, scrubbing 
brushes and paint soon effected its thorough clean- 
ing and renovating. Under the direction of the 
committee the boat was then furnished with the 
necessary equipment for a day camp. 
Patients were referred to the boat from the As- 
sociated City Clinics. Three patients came for 
treatment on June 17th, 1907, the date when the 
boat was given over for active use and within a 
comparatively short space of time this number had 
increased to sixty a day with many new appli- 
cants. 
The floating camp, having proved its efficiency, 
6 is this year under the support of Bellevue Hospital 
in conjunction with the Tuberculosis Clinic and is 
moored in the East River directly back of the hos- 
pital. 
Added improvements in the way of painting and 
plumbing have been made, and the work is similar 
to that of last year except that it has grown to 
much larger proportion. 
The central section of the lower deck is used as 
a store room, bunks having been torn out and 
shelves built in where dishes and food supplies 
are kept. In the passage way leading to the stairs 
a kitchen is located. Two cabins are furnished 
as dining rooms, and two as bath rooms for men 
and women respectively, while the gangway has 
been converted into a rest room by curtaining it 
off from the main entrance to the boat. An upper 
cabin is used as an office for doctors and nurses, 
cupboards being built in for medicines and work- 
ing supplies. 
The large upper decks are left open so that pa- 
tients may recline in steamer chairs or lie in ham- 
mocks and breathe the life giving sea air. 
A trained nurse with a corps of workers consist- 
ing of an assistant, two orderlies, a kitchen helper 
and a waitress is in charge of the camp. The 
routine work begins at nine in the morning with 
the arrival of patients and the taking of temper- 
atures, pulse and weight by the nurse in charge. 
Patients are then served with all the eggs and 
milk they can take, the amount varying from three 
to eight eggs a day and as many glasses of milk. 
At noon a warm dinner consisting of a soup, 
7 CHILDREN'S DEPARTMENT, DAY CAMP SOUTHFIELD meat and vegetables with an occasional dessert 
course is given, and the day ends at five. 
There is a special place on the boat for the chil- 
dren who are under observation at the Children’s 
Clinic. 
To a visitor the children’s deck seems like a 
large, beautiful outdoor play room with the con- 
stantly changing panorama of sea craft on the river 
for a background. There are toys, games and 
picture books, and blocks to amuse the children, 
and the babies have one corner of the deck fenced 
ofif with a soft rag rug, and furnished with tiny 
chairs for their own special use. 
A trained kindergartner has been employed as 
an assistant to the nurse in charge, and she con- 
ducts games, tells stories, and does a little teaching 
along the line of language and hand work that 
the children may be kept busy and happy in addi- 
tion to being cared for physically. 
It is hoped that in the near future the problem 
of the daily occupation of adult patients will be 
solved. 
The above report shows that Bellevue has been 
doing its share in the crusade against tuberculosis, 
but there comes a point where a large city machine 
is powerless to help the tenements to bear their 
burden of disease. Public finance cannot furnish 
the comforts of life which make illness less terrible. 
It cannot give its charges a season in the country. 
It cannot provide warm clothing. It cannot send 
an armful of flowers to a patient who perhaps has 
not seen a rose for a year. It cannot pay the 
salary of a kintergartner and furnish her with ma- 
9 terial for amusing the sick little folks on the boat. 
At this point, where the city is obliged to confess 
the inadequacy of its resources, private charity has 
taken up the work, and in May of the present year, 
through the efforts of Dr. James Alexander Miller, 
in charge of the tuberculosis work, at Bellevue Hos- 
pital, the Woman’s Auxiliary to the Tuberculosis 
Clinic, was formed. It is composed of a body of 
New York women deeply interested in the move- 
ment. Active members hold weekly meetings at 
Bellevue Dispensary, their committees caring re- 
spectively for the Day Camp, the Clinic and the 
Tuberculosis Wards, and through this organized ef- 
fort, the sum of over three hundred dollars a month 
is distributed for social relief. 
The work of the Auxiliary is new, but it has al- 
ready placed many patients in the country and in 
sanatoria. It has relieved cases of destitution in the 
tenements which no other means could have reached, 
and its semi-weekly boxes of flowers, have made 
the Tuberculosis Clinic, a most attractive spot for 
the colorless eyes of the sick man. 
Down in a two-room, dark tenement in the vi- 
cinity of one of the City Wards, there lives a man 
who has been a day laborer in New York for his 
whole lifetime. One child has died of tuberculosis, 
another has the disease, as has his wife also, and the 
man himself is in an advanced stage. He is not an 
object of charity, at least not in his own eyes, al- 
though the family often suffers for food. He is pos- 
sessed of a wonderful pride, which makes the most 
tactful efforts of the nurse to assist the family, often 
fruitless. It seems nearly incredible, that in all 
10 his long years in this city, Williams had never seen 
Central Park. 
Of course he had heard of it, a place of enchant- 
ment, of green grass, of automobiles, of all the 
things that he had never had time for. And one day 
one of the visiting members of the Auxiliary per- 
suaded him to accept the wherewithal to provide 
car fare, lunch and everything for a day in the park. 
The whole family went and the children sat by the 
edge of the road and were quite sure that every car- 
riage which whirled by was going to stop and take 
them all inside. Why else should there be car- 
riages ! They all had their first sight of a squirrel. 
If they did have to go back to their dark home and 
their lives of lamp light, the glimpse of the other 
world which lays so near them, but which they have 
never stepped inside before made up in a measure 
of the darkness. 
The work of organized charity will grow, and in 
co-operation with the regular preventive measures of 
the hospital, it is hoped that a few years will show 
a marked decrease in the spread of tuberculosis in 
New York City. 
Genevieve Wilson, 
Nurse in Charge Tuberculosis Clinic, 
Bellevue Hospital, Out Patient Department. 
11 EXPENSES OF DAY CAMP FOR 94 DAYS 
From June 13th to Sept. 14th. 
Equipment $558.58 
Running Expenses. 
Wages $444-37 
Supplies 262.95 
Medical supplies 3I-5I 
Contingent 25.60 
Milk and eggs 526.29 
Washing IO-75 
Car fares 93-4° 
Total $i,395-87 
Total number of attendances 3,781 
Average attendance per day 40.2 
Total cost per day $14.23 
Total cost per patient 34.23 
Total cost per patient per day 0.369 
12