Publication No. 6$ 
December, 1944 
CONTROL OF TUBERCULOSIS 
BY THE STATE 
Report Pursuant to Proposal No. 162, 
Sponsored by Representative William F. Gibbs 
and Senator Nicholas L, Hubbard, and to 
Proposal No. 190, Sponsored by 
Representative William Vicars 
Research Department 
ILLINOIS LEGISLATIVE COUNCIL . ILLINOIS LEGISLATIVE COUNCIL 
Representative Edward P. Saltiel, Chicago, Chairman 
Senator John W, Fribley, Pana, Vice-Chairman 
Representative Elroy C. Sandquist, Chicago, Secretary 
Representative Robert H. Allison, Pekin 
Senator Richard J. Barr, Joliet 
Senator Merman C. Barry, Chicago 
Senator Louis E. Beckman, Kankakee 
Senator Arnold P. Benson, Batavia 
Senator 0, E. Benson, Ottawa 
Senator R. G. Crisenberry, Murphyshore 
Senator Richard J. Daley, Chicago 
Representative Abner Field, Golconda 
Representative Lillian F, Gibbs, Quincy 
Representative Stanley A. Halick, Chicago 
Senator Nicholas L. Hubbard, Kt. Pulaski 
Representative Edward J. McCabe, Chicago 
Representative Ben S. Rhodes, Normal 
Representative Henry F. Scarborough, Payson 
Representative T.arren L, Wood, Plainfield 
Members Ex-Officio 
Lieutenant Governor Hugh W. Cross 
Speaker Elmer J. Schnackenberg 
Research Department 
J. F. Isakoff, Director (on military leave) 
Richard G. Browne, Acting Director 
Orville Alexander, Assistant Director 
G, F. D. Zimmerman, Research Associate 
Charles M. Kneier, Consultant (on military leave) 
- # - 
This report in intended to provide a factual source of 
information with regard to problems concerning which the 
General Assembly may be called upon to act. The research 
department of the Legislative Council is engaged in objec- 
tive fact-finding under the general supervision of members 
of the Council, who also serve in the General Assembly, 
No recommendations for consideration of proposed legisla- 
tion or particular policies are made by the research 
department. CONTENTS 
Page 
Extent of the Tuberculosis Problem and Possibilities of Control .... 1 
Extent , , 1 
Techniques of Control . . , . 2 
Agencies of Control 4 
State Programs for Tuberculosis Control 5 
Comparisons by Groups 6 
Group A - The 12 States With the Lowest Mortality Rate 6 
Group B - The 12 States With Next to the Lowest Mortality Rate . . 8 
Group C - The 12 States With Next to the Highest Mortality Rate , . B 
Group D - The 12 States With the Highest Mortality Rate 8 
Wisconsin , 17 
Michigan 19 
Connecticut , . . , , 20 
Massachusetts 20 
Indiana 21 
Ohio 21 
Pennsylvania 22 
New Jersey . , 22 
Missouri , . , . , 23 
Mew York 24 
California .......... 25 
Summary 25 
Tuberculosis Control in Illinois . 26 
Features of the Illinois Program 26 
Glackin Laws 2? 
State Tuberculosis Sanatoria for Illinois? ....... 28 
Penal and Welfare Institutions 39 CONTROL OF TUBERCULOSIS BY THE STATE 
Tuberculosis in the fairly recent past has held the questionable 
honor of having caused more deaths among mankind than any other disease. Even 
today, after great progress has been made in controlling the disease, some 
60,000 persons die each year in the United States from this cause. Among 
persons from 15 to 35 years of age it is the leading cause of death. 
The scientific attack on tuberculosis is quite recent and, on the 
basis of its achievements thus far, offers hope of complete control, if not 
elimination of the disease in the not too distant future. The tubercle 
bacillus was discovered only 62 years ago and the first sanatorium in America 
was not established until 1885. The first state sanatorium was established in 
Massachusetts in 1898. 
In 1900 tuberculosis was causing 194.4 deaths per 100,000 population 
and ranked first among all causes of death in the United States, By 1940 the 
death rate from tuberculosis had been reduced to 45.9 per 100,000 population 
and had fallen to seventh place. 
Extent of the Tuberculosis Problem 
and Possibilities of Control 
The very substantial gains in combatting tuberculosis that occurred 
during the first four decades of the present century have stimulated the 
movement to establish ultimate control of this disease. It is believed possible 
that further substantial reductions in the prevalence of this disease can be 
achieved. As one experienced worker expressed it, the eradication of tubercu- 
losis is absurdly simple. "Find all the cases of tuberculosis and isolate them 
until they are dead or non-infectious and there will be no more tuberculosis,"! 
Extent 
In 1940, there were 60,428 deaths from tuberculosis in the United 
States.2 This represents 4.3$ of all deaths. Since rather widespread 
experience indicates that there are several active cases for every tuberculosis 
death, it may be concluded that perhaps 500,000 persons in the country suffer 
from this dread disease. The majority of these cases have never been reported 
and many victims are totally unaware that they have contracted the disease. 
1. Past and Present Trends in the Tuberculosis Movement;. a Symposium of 
Historical Papers Presented at the 3&th Annual Meeting in Philadelphia of the 
National Tuberculosis Association, p. 42. 
2. In some vital statistics, tuberculosis of the respiratory system, which 
accounts for the overwhelming proportion of tuberculosis deaths, is separated 
from the nine other forms. To avoid complexity all forms are grouped together 
in the figures used in this report. 2 
The prevalence of tuberculosis differs widely in different areas 
and among different groups of people. Among the factors that seem-to be res- 
ponsible for these variations are urbanization, race, economic status, and 
adequacy of state and local programs of control. Only the latter falls within 
the scope of this report. However, the others must never be ignored. They 
show themselves in the relatively high death rates of the cities, among 
Negroes, Indians, and Spanish-speaking peoples, and in all areas characterized 
by poor housing, congestion, inadequate recreational facilities, and improper 
nutrition. 
Tuberculosis, during the 12-year period from 1932 to 1943, inclusive, 
caused 45,619 deaths in Illinois. The yearly figures, however, show a steady 
decline in tuberculosis mortality.3 In spite of this, tuberculosis today 
causes more deaths than any other communicable disease. 
Table 1 
Tuberculosis Deaths in Illinois, 
1932-1943 
Tuberculosis 
Rate Per 
Year 
Deaths 
100,000 Population 
1932 
4,291 
55.8 
1933 
4,174 
54.1 
1934 
4,124 
53.3 
1935 
4,075 
52.4 
1936 
4,050 
51.9 
1937 
3,995 
51.1 
1938 
3,686 
47 *0 
1939 
3,608 
45.8 
1940 
3,65 1 
16.2 
1941 
3,474 
43.7 
1942 
3,249 
41.1 
1943* 
3,239 
42.7 
* Provisional figures. 
The death rate from tuberculosis in Illinois has ordinarily been 
slightly above the national rate. This may be explained, in part, by the 
fundamental factors, referred to above, which affect tuberculosis prevalence, 
such as the relatively high degree of urbanization in Illinois. Part of the 
problem in Illinois, however, has undoubtedly been due to inadequate provi- 
sions for control. 
Techniques of Control 
Tuberculosis can be prevented. When discovery and treatment of the 
disease is made in the minimal or early stages, recovery can almost be 
assured. On the other hand, advanced tuberculosis is serious, and the chances 
3. See Table 1, The downward trend has slackened, however, and stopped 
entirely in 1943* 3 
for recovery are not favorable. Early diagnosis is important, and the 
greater the delay in making a diagnosis after the appearance of the first 
symptoms, the more likely it is that the disease will be far advanced. 
In 1938, a study was made of 6,906 patients who had been discharged 
alive from 75 public sanatoria in 1933* Of those who had been diagnosed 
minimal on admission to the sanatoria, 73$ were still alive in 1938 while 8$ 
were dead. The remaining 19$ were not traced. For those who were far 
advanced on admission, only A0$ were still alive in 1938 while 47$ were dead. 
The remaining 13$ were not traced. For those who were in the intermediate 
stage of tuberculosis upon admission, that is, the moderately advanced cases, 
59$ were still alive in 1938, 20$ were dead, and 21$ were not traced.A 
Intensive case-finding, carried out among supposedly healthly people 
as well as those who have been exposed to open cases of tuberculosis, is but 
one step in breaking the chain of infection that is spread by the tubercle 
bacillus germ. Once a case of tuberculosis is found, care must be given to 
■ the patient, and the public must be protected from infection. Tuberculosis is 
not like other communicable diseases for which reasonable quarantine regula- 
tions can be established. In tuberculosis the incubation period cannot be 
determined and the time when infectiousness begins or ends is not predictable. 
The sanatorium is the answer to this administrative problem. In a sanatorium 
the patient is given the best chance of cure and a comfortable place for 
voluntary segregation where he may prevent the spread of infection among his 
family and friends. "The care until death of the incurable cases and the 
treatment of the others until they are non-infectious and taught to live 
within their physical limitations are the true functions of a sanatorium."5 
The specific techniques for control are already numerous and new ones 
are constantly being developed. It is not necessary for the purposes of this 
report to examine them in detail. It may be useful, however, to consider them 
under three major headings, (1) Case-finding, (2) Sanatorium care, and (3) 
Education to prevent tuberculosis. 
The finding of tuberculosis cases is of great importance both to the 
individual victim and to his fellows. Early diagnosis greatly enhances the 
likelihood of achieving a cure; it also, if followed by proper measures, re- 
duces the chances of the infection being spread to others. Some medical tests 
for the presence of active tuberculosis are highly reliable but relatively 
expensive. Others are less expensive to administer. All of the tests serve 
particular purposes. Expanding their use would improve case-finding and, if 
followed by suitable measures, reduce the prevalence of the disease. The 
private physician occupies a strategic position in case-finding and great im- 
provement could be secured by greater cooperation in reporting known and 
suspected cases. The public health nurse has great value in case-finding. In 
addition, such agencies as state and local health departments, school health 
services, industrial health agencies, special clinics, and publicity campaigns 
serve to expand and improve the finding of tuberculosis cases. While some 
A, A Study of Patients Discharged Alive from Tuberculosis Sanatoria in 1933* 
published by the National Tuberculosis Association, Social Research Series, 
No, 8, p. 18. 
5. The Modem Attack on Tuberculosis by Henry D. Chadwick, M.D., and 
Alton S. Pope, M. D., p. A2. progress has been made in case-finding, much more remains to be done. 
Sanatorium care is a major technique in controlling tuberculosis. 
Not all cases need sanatorium care. At some stages in treatment, proper care 
at home can sometimes provide an acceptable substitute for sanatorium care 
provided the patient has learned the necessary techniques and follows them 
rigorously. Some general hospitals have special provision for tuberculosis 
patients. However, the specialized tuberculosis sanatorium has proved to be 
an indispensable part of the whole problem. Most patients need this care, at 
least for a time. The sanatorium serves to prevent infection and reduce the 
spread of the disease. It serves to educate the patient in how to care for 
himself and to protect others. In many cases it effects a cure or, at least, 
it succeeds in arresting the disease. It is often the center of training and 
research in dealing with tuberculosis as well as a diagnostic center and 
clinic. Its staff usually assists in case-finding and educational services. 
Education has been the keynote in the tuberculosis campaign since 
its beginning. It is still of vital importance in the program. If all 
persons could learn the main facts relating to the transmission of tubercu- 
losis much infection would be prevented. Instruction in personal hygiene, 
the development of good health habits, higher standards of nutrition, and 
other desirable attitudes and practices would tend to alleviate the disease. 
Constant cooperation of all agencies concerned with education and good health 
is most useful. 
Agencies of Control 
This report is concerned with the control of tuberculosis by the 
state. It is well to note, however, that not only the state but the federal 
government, the local governments, and many private organizations serve as 
agencies of tuberculosis control. 
The federal government provides care for a considerable number of 
veterans, Indians, and other "wards” and, in addition, maintains a program of 
research and education on the whole problem. There are 19 tuberculosis 
sanatoria operated by the federal government within the United States. These 
sanatoria have a total of 4,681 beds. In addition, 45 federal hospitals pro- 
vide 4,699 beds in facilities which make definite provision for tuberculosis 
patients. Besides these the federal government is responsible for sanatoria 
located in the District of Columbia, Alaska, the Philippine Islands, and 
Puerto Rico. All told the U, S, government provides 12,838 beds for the care 
of persons suffering from tuberculosis. 
In addition, the federal government provides national leadership 
through the work of the Public Health Service, a part of the Federal Security 
Agency, For many years the Public Health Service has conducted research on 
tuberculosis and other health problems, cooperated with state and local health 
agencies, and disseminated health information. It recently established a 
Division of Tuberculosis Control which is today the central agency in the 
federal tuberculosis program. Congress has authorized an appropriation for 
this office amounting to $10,000,000 for the fiscal year 1944-45, but no funds 
have yet been made available. The oulk of this authorized appropriation and 
similar appropriati|ns thereafter will be available for allotments to states 
on a matching basis. Such funds will probably be used chiefly for 5 
case-finding, the operation of clinics, and other field control services 
rather than for sanatorium care. 
In practically every state the county is an important agency in 
tuberculosis control. Some states, including Illinois, have relied chiefly 
on the county to provide sanatorium care and such other services as are 
offered. The city, also, to a lesser degree, has been concerned with 
tuberculosis control and most of the larger cities maintain municipal 
sanatoria. In a few cases, there has been joint city-county control. 
I'uch of the campaign against tuberculosis has been conducted by 
private agencies. Out of the total of 699 institutions in the country with 
facilities for sanatorium or hospital care of tuberculosis patients, 181 
institutions are private or semi-private. They provide a total of 16,169 
beds, approximately one-sixth of the nation’s tuberculosis beds. 
The National Tuberculosis Association, organized in 1901, is an 
organization of physicians and laymen engaged in conducting a constant cam- 
paign against tuberculosis. It coordinates the activities of the 18 state 
tuberculosis associations, the 1600 county and city associations, and the 800 
smaller committees. Its functions are: (1) Research, (2) Education and 
publicity, (3) Standard-making, (l) publishing, (5) Cooperation and coordina- 
tion, (6) Training and placement of personnel, and (7) Field service. Its 
activities are financed chiefly through the sale of Christmas Seals, although 
some income is obtained from memberships and donations. It operates in 
practically all states through state organizations, such as the Illinois 
Tuberculosis Association, founded in 1905. 
The American Trudeau Society was formed in 1905 under the name of 
the American Sanatorium Association. This organization concentrates its 
attention on the problem of sanatorium care. There are many societies in the 
general field of health which devote part of their energies to the tuberculosis 
control program. 
All of the various agencies which share in the program serve to aid 
and encourage the campaign. The remainder of this report will deal with the 
particular part of the tuberculosis program which is filled by the state. 
State Programs for Tuberculosis Control 
"Public health is purchasable. Within natural limitations a 
community can determine its own death-rate.” This dictum of the man, 
Dr, Herman M. Biggs, who in 1893 laid the ground-work for the administrative 
control of tuberculosis by health departments, is often quoted. The truth of 
the statement is adequately borne out by the death-rate of the various states 
when aligned with state expenditures for tuberculosis activities. To find 
this alignment, and as a matter of convenience in discussing the tuberculosis 
programs of the various states, the states have been grouped into four groups 
of 12 states each, according to the lowness of the state’s mortality rate. 
Group A contains those states with the lowest mortality rates while Group D 
includes those with the highest death-rate. Comparisons By Groups 
Table 2 gives a recapitulation of the detailed information which is 
contained in Tables 3 and 4. There were 60,426 deaths from all forms of 
tuberculosis in the entire United States in 1940 out of a population of 
131,669,275. This meant a national mortality rate of 45.9 deaths per 100,000 
population. In relation to these 60,426 deaths, there were 86,346 beds for 
tuberculosis patients in the entire country for 1942. This number of beds 
includes all beds, state, county, city, private and semi-private, with the 
exception of the federal beds. This gives a ratio of 1.46 beds per tubercu- 
losis death in 1940, Medical authorities and tuberculosis workers have set 
a standard of two beds per tuberculosis death, as a minimum requirement. By 
this standard, the country as a whole lags in providing for its tuberculosis 
patients. Even when the federal beds are considered, the ratio is only 1.62 
beds per death. 
The states spent approximately $24,122,600 for tuberculosis 
activities in 1939. This produces an average annual expenditure of $390 per 
tuberculosis death (based on 61,809 deaths in 1939). 
Group A - The 12 States With the Lowest Mortality Rates 
Group A of the states, populated by 12.0$ of the country’s 
inhabitants, has only 6.0$ of ell tuberculosis deaths. The average mortality 
rate for this group is 23.0 deaths per 100,000 population in contrast t© the 
national mortality rate of 45.9 deaths. Group A has an average ratio of 2.24 
beds per death which is above the standard of 2,0 beds per tuberculosis 
death. Five of the 12 states in Group A have 2,0 beds or more while one state 
has more than the national average of 1,46 beds but under 2,0 beds. The 
other six states have less than 1,46 beds, Most of the states in this group 
have a relatively high proportion of rural residents which leads one to 
expect a low tuberculosis rate. 
Group A of the states spend almost two and one-third as much per 
tuberculosis death as the national average of $390, Group A spent $903 per 
death with 11 of the 12 states spending more than the national average. 
Despite the relatively low incidence of tuberculosis in this group of states, 
the expenditures for tuberculosis control are at a relatively high level. Per Cent Distribution of Deaths, Beds, and State Expenditures 
(Recapitulation of Tables 3 and 4) 
Per Cent 
of Total 
Per Cent 
Mortality 
Rate Per 
Ratio of 
Number 
of States Having; 
Annual 
State Ex- 
Number of 
States Spending 
Popula- 
tion 
of Total 
Deaths 
100,000 
Population 
Beds Per 
Death 
2,00 Beds 
or More 
1.46 to Less than 
1.99 Beds I.46 Beds 
penditure Over $390 Under $390 
Per Death Per Death Per Death 
Group 
A 12.0$ 
6.0$ 
23.0 
2.24 
6 
1 6 
$903 
11 
1 
Group 
B 30.3$ 
26.Q$ 
39.4 
1.90 
6 
2 4 
66? 
9 
3 
Group 
C 33.6$ 
34.7% 
47.3 
1.39 
2 
0 10 
263 
3 
9 
Group 
D 23.6$ 
32.6% 
63.4 
1.02 
2 
0 10 
176 
2 
9* 
Note: 
The totals of several of the above columns are just short of 100$. The remaining small percentages 
amounts for the District of Columbia whose figures were included in the national totals but are not 
represented in any of the group amounts. 
are the 
The twelfth state in this 
separate activity. 
group is Nevada for which there was no record of expenditures for tuberculosis 
as a 
Table 2 8 
Group E - The 12 States With the Next to the Lowest Mortality Rates 
The second group of states, designated as Group B, includes a 
number of the larger, urban ones. They make up 30.3$ of the population of 
the country and have 26.0$ of the nation’s deaths from tuberculosis. The 
average mortality rate from tuberculosis is 39.4 deaths per 100,000 population 
and the ratio of beds per death is 1.90. Only four states in the group have 
fewer beds per death than the national average and such highly urban states as 
Rhode Island, Michigan, Connecticut, Massachusetts, and New Jersey have more 
than 2.0 beds per tuberculosis death. 
The states in Group E spend an average of $66? per tuberculosis 
death with all but three of them spending more than the national average of 
1390. The states in this group make the heaviest outlays of any of the four 
groups for both state sanatoria and state subsidies to local sanatoria. 
Group C - The 12 States With the Next to the Highest Mortality Rate 
The third group of states, designated as Group C, includes 
one-third (33.6$) of the nation’s population. Illinois is in this group, 
ranking 27th among the states. This group has slightly more than its share 
of the nation’s deaths from tuberculosis, 34.7$ of the total. Its ratio of 
beds to deaths is 1.39 beds with nine states, including Illinois, failing to 
reach the national ratio of 1.46 beds. The states in this group spend $263 
per tuberculosis death. 
Group D - The 12 States With the Highest Mortality Rate 
Group D of the states, with 23.6$ of the nation’s population, had 
32.6$ of the nation’s deaths from tuberculosis. In these states the mortality 
rate is 63.4 deaths per 100,000 population. 
The tuberculosis beds provided by this group of states average 
1.02 per death, seven states providing less than 1.0 bed per death. Group D, 
with nearly one-fourth of the country’s population, provides 17.8$ of the 
nation’s state beds, 20.4$ of the local beds, and 14.5$ of the total state 
expenditures for tuberculosis control.  
Tuberculosis Mortality Rates in Relation 
to Sanatorium Facilities 
and State Expenditures 
Beds 
Exclusive 
Approximate State Expenditures for 
of 
Federal 
Tuberculosis 
Activities 
Mortality 
Rate Per 
Number 
Ratio Per 
Annual Annual Expenditures Per 
Population 
Deaths in 
100,000 
in 
Death in 
Amount Tuberculosis Death in 
State 
in 1940 
1940 
Population 
1942 
1940 
in 1939 
1939 
United States 
131,669,275 
60,428 
45.9 
88,346 
1.46 
124,122,600 
$ 390 
Group 
A - First 12 
States Ranked 
According to Lowness of Mortality Rate 
Utah 
550,310 
89 
16.2 
106 
1.19 
78,200(a) 
823(a) 
Wyoming 
250,742 
42 
16.8 
33 
0.79 
37,100 
675 
Iowa 
2,538,268 
435 
17.1 
813 
1.87 
294,100 
605 
Nebraska 
1,315,834 
223 
17.1 
280 
1.24 
90,200 
412 
Idaho 
524,873 
95 
18.1 
43 
0.45 
24,600 
248 
North Dakota 
641,935 
124 
19.3 
368 
2.97 
227,700 
1,604 
New Hampshire 
491,524 
104 
21.2 
240 
2.31 
156,700 
1,127 
Kansas 
1,801,028 
448 
24.9 
626 
1.40 
319,300 
764 
Wisconsin 
3,137,587 
832 
26.5 
2,379 
2.86 
958,400 
1,111 
Minnesota 
2,792,300 
756 
27.1 
2,380 
3.15 
762,700 
943 
Oregon 
1,089,684 
297 
27.3 
681 
2.29 
334,600 
1,036 
South Dakota 
642,961 
189 
29.4 
192 
1.02 
182,900 
963 
Group A Totals 
and Averages 
15,777,046 
3,636 
23.0 
8,141 
2.24 
$ 3,466,500 
$ 903 
Table 3  
Tuberculosis Mortality Rates in Relation 
to Sanatorium Facilities and State Expenditures 
Population 
Deaths in 
Mortality 
Rate Per 
100,000 
Beds 
of 
Number 
in 
Exclusive 
Federal 
Ratio Per 
Death in 
Approximate State Expenditures for 
Tuberculosis Activities 
Annual Annual Expenditures, fer 
Amount Tuberculosis Death in 
State 
in 1940 
1940 
Population 
1942 
1940 
in 1939 
1939 
Group B - Second 
12 States Ranked According to Lowness 
of Mortality Rate 
Maine 
847,226 
253 
29.9 
542 
2.14 
1 485,500 
§1,728 
Rhode Island 
713,346 
236 
33.1 
783 
3.32 
462,000 
1,737 
Michigan 
5,256,106 
1,767 
33.6 
5,043 
2.85 
2,724,600 
1,429 
Connecticut 
1,709,242 
597 
34.9 
1,876 
3.14 
1,541,500 
2,573 
Massachusetts 
4,316,721 
1,629 
37.7 
4,069 
2.50 
1,995,100 
1,210 
Indiana 
3,427,796 
1,378 
40.2 
1,839 
1.33 
178,200 
126 
Montana 
559,456 
225 
40.2 
272 
1.21 
182,000 
734 
Ohio 
6,907,612 
2,792 
40.4 
4,082 
1.46 
122,800 
42 
Washington 
1,736,191 
707 
40.7 
1,061 
1.50 
401,500 
566 
V ermvnt 
359,231 
149 
41.5 
176 
1.18 
122,900 
897 
Pennsylvania 
9,900,180 
4,213 
42.6 
5,881 
1.40 
1,420,800 
335 
New Jersey 
4,160,166 
1,787 
43.0 
4,203 
2.35 
1,281,400 
643 
Group B Totals 
and Averages 
39,893,272 
15,733 
39.4 
29,827 
1.90 
110,918,300 
$ 667 
Table 3 (continued)  
Tuberculosis 
Mortality Rates in Relation to Sanatorium Facilities and State Expenditures 
Beds 
Exclusive 
Approximate 
State Expenditures for 
of 
Federal 
Tuberculosis Activities 
Mortality 
Rate Per 
Number 
Ratio Per 
Annual 
Annual Expenditures Per 
Population 
Deaths in 100,000 
in 
Death in 
Amount 
Tuberculosis Death in 
State 
in 1940 
1940 
Population 
1942 
1940 
in 1939 
1939 
Group C - Third 
12 States Ranked 
According to Lowness cf 
Mortality Rate 
Missouri 
3,73/,,664 
1,704 
45.0 
178 
1.28 
I 659,100 
$ 373. 
West Virginia 
1,901,974 
876 
46.1 
1,226 
1.40 
610,900 
693. 
Illinois 
7,897,241 
3,654 
46.3 
4,690 
1.29 
1,600 
0.44 
New York 
13,479,142 
6*259 
46.4 
13,357 
2.13 
1,701,800 
263. 
Delaware 
266,505 
125 
46.9 
250 
2.00 
197,600 
1,275. 
South Carolina 
1,899,804 
900 
47.4 
927 
1.03 
252,000 
296. 
Oklahoma 
2,336,434 
1,126 
48.2 
768 
0.68 
295,200 
274. 
Mississippi 
2,183,796 
1*066 
48.8 
516 
0.48 
198,200 
184. 
Georgia 
3,123,723 
1,530 
49.0 
1,039 
0.68 
213,400 
141. 
North Carolina 
3,571,623 
1,783 
49.9 
1,901 
1.07 
459,400 
255. 
Arkansas 
1,949,387 
987 
50.6 
1,401 
1.42 
648,200 
652. 
Florida 
1,897,414 
960 
50.6 
878 
0.91 
332,100 
360. 
Group C Totals 
and Averages 
44,291,707 
20,970 
47.3 
29,131 
1.39 
$5,569,500 
$ 263. 
11 
Table 3 (continued)  
Tuberculosis Mortality Rates in Relation 
to Sanatorium Facilities and State Expenditures 
Beds 
Exclusive 
Approximate State Expenditures for ' 
of 
Federal 
Tuberculosis 
Activities 
Mortality 
Rate Per 
Number 
Ratio Per 
Annual Annual Expenditures Per 
Population 
Deaths in 
100,000 
in 
Death in 
Amount Tuberculosis Death in 
State 
in 1940 
1940 
Population 
1942 
1940 
in 1939 
1939 
Group D - Fourth 
12 States Ranked According to Lowness of Mortality Rate 
Alabama 
2,832,961 
1,499 
$2.9 
502 
0.33 
$ 122,100 
$ 79 
Colorado 
1,123,296 
600 
53.4 
1,748 
2.91 
64,900 
98 
California 
6,907,387 
3,38? 
56.3 
7,900 
2,03 
751,300 
. 192 
Virginia 
2,677,773 
1,557 
$8.1 
1,682 
* 1.08 
798,300 
494 
Louisiana 
2,363,880 
1,391 
58.8 
959 
0.69 
140,400 
101 
Texas 
6,414,324 
3,797 
59.2 
2,331 
0.61 
546,200 
140 
Kentucky 
2,845,627 
1,982 
69.7 
752 
0.38 
150,000 
75 
Nevada 
110,247 
79 
71.7 
12 
0.1$ 
(b) 
(b) 
Tennessee 
2,913,841 
2,184 
74.9 
1,279 
0.59 
81,400 
35 
New Mexico 
$31,818 
401 
75.4 
424 
1.06 
52,100 
122 
Maryland 
1,821,244 
1,441 
79.1 
1,819 
1.26 
723,700 
$61 
Arizona 
499,261 
853 
170.9 
632 
0.74 
73.500 
82 
Group D Totals 
and Averages 
31,044,159 
19,671 
63.4 20,040 
1.02 
13,503,900 
$ 175 
Table 3 (continued) Footnotes to Table 3 
Source and Explanation of Certain Figures: U. S. Department of 
Commerce, Bureau of the Census, Vital Statistics Rates in the United States 
1900-1940, p. 856 (for the population figures) and p. 330 (for the mortality 
rates); and Vital Statistics of the United States 1940, Part I, p. 416 (for 
the total deaths). Tuberculosis Sanatorium Directory, 1942, compiled by the 
National Tuberculosis Association, p. 176 (for number of beds and ratio per 
death). Public Health Reports, January 16, 1942, Vol. 37, No. 3, Tuberculosis 
Control by State Agencies by Joseph W. LIountin and Evelyn Flook, United States 
Public Health Service, p, 83 (for state expenditures). 
Because there is usually a slight variation in mortality rates as 
reported by various sources, evidently due to a time lag in reporting and 
recording deaths, the Illinois mortality rates and the number of deaths as 
shown in this table have been taken from A Statistical Review of Recent 
Mortality and Morbidity Trends, Educational Health Circular No. 59 revised 
June 1, 1942, Illinois Department of Public Health, p, 10. This has been 
done in order to avoid confusion when the Illinois tuberculosis situation is 
discussed. In discussing the Illinois situation, the Illinois Department of 
Public Health figures are used. 
The source from which the state expenditures have been taken is 
indefinite as to the year for which the annual anounts are reported. Since 
it will facilitate matters to have seme year to refer to in discussing these 
amounts, the year 1939 has been arbitrarily selected. The source has used the 
deaths for the year 1939 in computing the annual expenditures per death. 
However, it may be that the annual amount for some of the states is for the 
fiscal year 1940 or 1939, or it may be for the calendar year 1940 or 1939. 
The source states in regard to the expenditure figures which it shows: 
’•Expenditures for the services considered represent index rather than absolute 
amounts and include only expenditures allocated specifically to tuberculosis 
activities as such.” 
(a) ’’New program just getting under way. Expenditure reported 
represents only a fraction of a complete year.” 
(b) ”Ntf record of expenditures for tuberculosis as a separate 
activity." x The ranking of states used in the above classification should be 
interpreted with caution. Certain states, including such states as Colorado, 
California, Arizona, and New Mexico, probably have tuberculosis death rates 
that are affected by population mobility. Many tuberculosis patients have 
sought to find relief in the climate of these and other states. This has the 
effect of making the death rate in such states higher than would otherwise 
be the case. 
Another caution should be noted regarding the ratio of beds, and 
expenditures, to tuberculosis deaths. These ratios are widely used and 
represent the best known method of indicating the provisions for tuberculosis 
control. However, it should be remembered that any factor which operates to 
affect the number of deaths will affect these ratios inversely. Thus a 
state, even with an extensive program of tuberculosis control, will appear 
to have a much less extensive program if, for any reason, the deaths suddenly 
increase. More careful reporting of the cause of death may produce this 
result if it results in more deaths being classed as due to tuberculosis. 
It would doubtless be better if the ratios were related to the number of 
tuberculosis cases but, in the absence of any approach to comprehensive 
case-finding, this would be ever more distorted. 
The most striking conclusion from the classification of the states 
on the basis of tuberculosis deaths, beds, and expenditures is that, as 
stated above, "Public health is purchasable." The states with low death 
rates are, as a group, those which provide generously for tuberculosis 
control. It is true that, of these, the lowest mortality is found among the 
states with a high proportion of rural, white population. The various 
factors which determine the incidence of tuberculosis have been mentioned 
above. The comparison of the four groups of states demonstrates the part 
that tuberculosis control by the state plays in the situation. The tubercu- 
losis control programs of a few; states most likely to throw light on 
Illinois’ problem will be analyzed, Table U 
Beds 
and State Expenditures Specified by Type 
Beds According to Type 
Approximate Annual State Expen- 
of Control (1942) 
diture by Type of Service 
County, 
Maintenance 
State Sub- 
City & 
Private 
& Operation 
sidy of 
City- 
& Semi- 
of State 
Local 
Field 
State 
Federal 
State 
County 
Private 
Sanatoria 
Sanatoria 
Control 
Total 
9,380 
25,63/, 
16,243 
16,469 
$16,764,486 
16,407,573 
$950,541 
(9-6%) (26,2%) (47.3$) 
(16.9%) 
(69.5*) 
(26. bt) 
0.9$) 
Group A - 
First 12 
States Ranked According to lowness 
of Mortality 
Rate 
Utah 
- — 
106 
• — 
— — 
$ 78.200(a) 
$ - - 
$ (b) 
Wyo. 
— 
33 
- - 
— 
37,100 
- - 
(b) 
Iowa 
70 
424 
389 
- - 
263,220 
- - 
30,880 
Nebr. 
- - 
200 
80 
- - 
77,572 
- - 
12,628 
Idaho 
132 
- - 
- - 
43 
- - 
21,697 
2,903 
N. D. 
— 
368 
- - 
- - 
227,700 
- - 
(b) 
N. H. 
— 
140 
- - 
100 
85,872 
70,828 
(b) 
Kans. 
63 
492 
134 
- - 
310,360 
- - 
8,940 
Wise. 
204 
33i( 
c)l,929 
116 
263,560 
694,840 
(b) 
Minn. 
168 
498 
1,842 
40(d) 
312,707 
435,502 
14,491 
Ore. 
14 
600 
41 
40 
334,600 
(b) 
S. D. 
166 
192 
- - 
- - 
182.900 
- - 
(b) 
Total 
817 
3,387 
4,415 
339 
$ 2,173,791 
$1,222,867 
$ 69,842 
Group B - 
Second 12 States Ranked According to Lowness 
of Mortality 
■ Rate 
Maine 
6 
481 
_ _ 
61 
$ 431,610 
$ 53,890 
$ (b) 
R. I. 
— 
618 
65 
100 
447,216 
14,784 
(b) 
Mich. 
44 
704 
2,975 
1,364 
471,356 
2,250,520 
2,724 
Conn. 
_ _ 
1,657 
74 
145 
1,458,259 
40,079 
43,162 
Mass. 
304 
1,309 
2,463 
297(e;f) 1,398,565 
482,814 
113,721 
Ind. 
- - 
402 
1,437 
— 
178,200 
- - 
(b) 
Mont • 
- - 
258 
9 
5 
182,000 
_ - 
(b) 
Ohio 
238 
254 
3,196 
632 
122,800 
- - 
(b) 
Wash. 
676 
~ - 
886 
175 
- - 
399,894 
1,606 
Vt. 
— - 
132 
- - 
44 
115,034 
(g) 
7,866 
Penn. 
93 
3,186 
1,349 
1,346 
1,344,077 
- - 
76,723 
N. J. 
- — 
494 
2,965 
744 
452,334 
813,689 
15.377 
Total 
1,361 
9,495 
15,419 
4,913 
t 6,601,451 
$4,055,670 
$261,179 Table 4 (continued) 
Beds and State Expenditures 
i Specified by 
Type 
Beds According to Type 
Approximate 
Annual State 
Expendi- 
of Control (1942) 
ture by Type of Service 
County, 
Maintenance 
State Sub- 
City & 
Private 
M Operation 
sidy of 
City- 
& Semi- 
of State 
Local 
Field 
State 
Federal State 
County 
Private 
Sanatoria 
Sanatoria 
Control 
Cxroup C 
- Third 12 States Ranked According to Lowness 
of Mortality 
Rate 
M o. 
7 
780 
1,166 
232 
$ 578,690 
f 80,410 
5 (b) 
W. Va. 
- - 
1,109 
65 
52 
577,301 
23,825 
9,774 
111. 
184 
- - 
3,882 
808 
- - 
- - 
1,600 
N. Y. 
' 1,242 
1,035 
8,695 
3.627(h) 
1,635,430 
(b) 
66,370 
Dela. 
- - 
228 
- - 
22 
197,600 
- - 
(b) 
S. C. 
- - 
550 
295 
82 
252,000 
- - 
(b) 
Okla. 
291 
733 
- - 
35 
286,344 
- - 
8,856 
Miss. 
- _ 
425 
33 
58 
187,695 
- - 
10,505 
Ga • 
12 
637 
387 
15 
177,976 
_ ~ 
35,424 
N. C. 
850 
950(f) 
793 
158 
459,400 
- - 
(g) 
Ark. 
- - 
1,351 
50 
_ - 
636,532 
- - 
11,668 
Fla. 
6 
400 
435 
43 
313,502 
- - 
18,598 
Total 
2,592 
8,198 
15,801 
5,132 
$5,302,470 
$ 104,235 
$162,795 
Group D 
- Fourth 12 States Ranked According to Lowness of Mortality 
Rate 
Ala. 
35 
- — 
317 
185 
«* 
V 
e 74,969 
t 47,131 
Colo. 
750 
- - 
68 
1,680 
- - 
49,973 
14,927 
Calif. 
1,025 
- - 
5,707 
2,193 
- - 
731,766 
19,534 
Va. 
88 
1,053 
519 
110 
672,967 
50,293 
75,040 
La. 
181 
746 
49 
164 
121,586 
- - 
18,814 
Tex. 
419 
1,171 
734 
426 
529,814 
- _ 
16,386 
*ry« 
385 
120 
632 
- - 
113,550 
31,800 
4,650 
Nev. 
- - 
- 
12 
- - 
- - 
_ _ 
(b) 
Tenn. 
9 
- - 
902 
377 
- - 
10,012(a) 
71,388 
N. Y. 
791 
86 
- - 
338 
52,100 
- - 
(b) 
Md. 
10 
1,283 
280 
256 
502,972 
75,988 
144,740 
Ariz. 
917 
95 
192 
345 
46,591 
- - 
6,909 
Total 
4,610 
4,554 
9,412 
4,074 
#2,059,580 
$1,024,801 
$419,519 
Source 
: Tuberculosis Sanatorium Directory, 1942, compiled 
by National Tubercu- 
losis 
Association, p, 172, 
Public Health Reports, January 
16, 1942, vol. 
57, 
No. 3, 
Tuberculosis Control by State 
Agencies 
by Joseph A. 
fountin and Evelyn 
Flook, 
United 
States Public 
Health Service, p. 
87. For an 
explanation regarding 
(continued on next page) 17 
the state expenditures, see the footnotes under Table 3* The article on 
tuberculosis control also stated in regard to state expenditures: "State 
appropriations constitute the major item, but about one-fourth of the amount 
expended for field services is derived from Federal grants, whereas approxi- 
mately 10 percent of the cost of hospitalizing tuberculous patients in State 
sanatoria is borne by local taxing bodies." 
The total or national figures include the following for the District 
of Columbia: 1,196 county, city, and city-county beds; 11 private and 
semi-private beds; $627,194 for maintenance and operation of state sanatoria; 
and $37,206 for field control* 
(a) "New program just getting under way. Expenditure reported represents only 
a fraction of a complete year," 
(b) "No record of expenditures for tuberculosis as a separate activity." 
(c) "Includes 48 beds in a rehabilitation camp for adult male convalescents." 
(d) "Includes 18 beds in one institution which serves as a temporary home for 
arrested cases of tuberculosis during the period of their economic 
rehabilitation," 
(e) "Includes 50 beds in one institution providing vocational training for 
those with arrested tuberculosis." 
(f) "Also Orthopedic hospital; no specific number of beds for tuberculosis." 
(g) "Included in the figure reported for State sanatoria," 
(h) "Includes 54 beds in one institution for the rehabilitation of tubercu- 
losis patients and 18 oeds in a resident home for the temporary care of girls 
and women needing rehabilitation after the arrest of tuberculosis." 
Wisconsin 
Wisconsin has a state law establishing state tuberculosis sanatoria 
and a state tuberculosis camp and authorizing every county to establish a 
county sanatorium. The state and county sanatoria are under the supervision 
•f the State Board of Health. The law further provides for an allocation of 
expenses between state and county for those patients who are unable to pay the 
cost of their maintenance, whether they are treated in a state #r a county 
sanatorium. 
A patient in ''isconsin who is unable to pay the cost of his care, 
either in a state institution or a county sanatorium, applies to the county 
judge of the county where he has a legal settlement. The county judge, upon 
report of the examining physician and a statement from the superintendent of 
the sanatorium that the applicant is eligible and can be received, shall hold 
a hearing to determine the legal settlement of the applicant, his general financial ability, and the chargeability for the support of such person. If 
£ person can pay the county charges but is unable to pay the full cost of 
maintenance in a sanatorium, he may receive care without a hearing before a 
county judge if, upon investigation by the State Board of Health, it is found 
that the patient has truly represented his circumstances. 
For a patient at public charge in a state sanatorium in Wisconsin, 
the state pays all expenses but charges over to the county, in which such 
patient has his legal settlement, one-half the cost of his maintenance and 
the entire amount of all other expenses. For a patient at public charge in a 
county sanatorium, the state credits the county with $7 per week for each 
patient vhose support is chargeable abainst the county; but if the patient’s 
support is chargeable against some other county, then the state credits the 
county maintaining the patient with the total cost of the patient's maintenance 
and charges over to the other county the difference between the total cost and 
the 47 per week provided through state aid. Annual statements, by means of 
which accounts are settled between the state and the county, are prepared 
every July 1 by the State Board of Health and the superintendents of each 
county sanatorium.^ 
The Wisconsin law providing for tuberculosis sanatoria and other 
sections pertaining to the management of county institutions do not limit the 
amount of tax which a county may levy for the construction and maintenance of 
« tuberculosis sanatorium as is done by the Illinois Glackin Act. However, 
there is the Wisconsin general maximum county tax rate of one per cent of the 
total valuation of the county. This limitation does not apply to bonded 
indebtedness and to taxes, levied in counties having a population of 250,000 
or more, for purposes of consolidation of municipal services. 
Out of an expenditure of £958,400 spent for tuberculosis activities 
in 1939, Wisconsin spent 72.5$ of this, or £694,840, as a "state subsidy of 
local sanatoria." The remaining 27.5$, or £263,560, was spent in maintaining 
and operating the state sanatoria. Wisconsin spent approximately Cl,111 per 
tuberculosis death in 1939, which is nearly three times the national average. 
Wisconsin achieved a 49.1$ drop in its mortality rate during the ten-year 
period from 1930 to 1940, The state’s tuberculosis death rate in 1940 was 
26.5 deaths per 100,000 population. 
There are in Wisconsin 334 state beds which are distributed in a 
state sanatorium with a capacity of 241, in a state rehabilitation camp pro- 
viding for 48 adult male convalescents, and in the Wisconsin General Hospital 
which provides for 45 tuberculosis patients. The weekly rate charged in 1942 
by the Wisconsin State Sanatorium was £18.68, based on per capita cost while 
the weekly rate in the rehabilitation camp was £16.69 or per capita cost. 
The rate in the Wisconsin General Hospital was higher, with state-county 
patients paying £4.90 per day, inclusive; clinic patients, £6.00 per day; 
and private patients paying for room and care.? 
6. Wisconsin Statutes, 1943, Chap. 50, Chap 46, Secs. 46.18, 46.19, 46.20, 
and 46.21; Chap. 70, See. 70.62. 
7. Tuberculosis Sanatorium Directory, 1942, compiled by the National 
Tuberculosis Association, pp, 155-161. 19 
Wisconsin has a total of 1,929 county, city, and city-county beds. 
The weekly rates for county beds in 1942 ranged from $13,40 to $21.95, per 
capita cost. All beds in Wisconsin, exclusive of federal, give the state a 
ratio of 2,86 beds per tuberculosis death. 
Wisconsin, which ranks 9th in the lowness of its tuberculosis death 
rate, has made sanatorium care the central activity in its program. It pro- 
vides rather extensive facilities through a state subsidy granted to local 
sanatoria as well as providing state sanatoria. The expenditures of the 
state government on tuberculosis total almost a million dollars annually, a 
total exceeded by only six states, all of which, vjith the exception of 
Connecticut, have a considerably larger population. 
L'ichigan 
The state of Michigan has provided ooth state and county sanatoria 
for tuberculosis patients.8 There are two state sanatoria with a capacity of 
506 beds and a tuberculosis department with 98 beds in the University of 
Michigan Hospital. Fifteen county sanatoria and hospitals provide 2,975 beds. 
The state sanatoria are under the control of the state Tuberculosis 
Sanatorium Commission, consisting of the State Health Commissioner and nine 
appointed members of whom at least five must be licensed physicians. In these 
sanatoria patients are admitted as private patients at a charge of $3.00 per 
day. If a patient is admitted as a charge of the county the state pays $2 
per day with the county paying the balance (now $1 a day). The rate per day 
is fixed by the Sanatorium Commission. If the residence of the patient is in 
dispute, the State Department of Social Welfare is authorized to decide the 
issue. 
Counties are authorized to establish sanatoria singly or in 
multiple-county units, and levy a tax not exceeding 1 mill for this purpose. 
While boards of trustees in such counties control the sanatoria therein, the 
State Commissioner of Health is empowered to establish standards to which they 
must conform. The state pays a subsidy of $2 per day for each free patient 
cared for in county sanatoria. Private patients pay for their own care. 
County sanatoria may accept outside patients and counties net maintaining 
sanatoria may levy a tax to pay their share of the care of indigent patients 
in state and county sanatoria. 
Michigan spent $2,724,600 in 1942 on tuberculosis control with 
$2,250,520, or 82.95s, going as state subsidy to local sanatoria. Practically 
all the rest was spent on maintaining the state sanatoria, less then one-tenth 
of 1% going to field control. The state provided a total of 5,043 beds or 
2.85 beds per tuberculosis death. Expenditures totalled $1,429 per tubercu- 
losis death, far above the national average. The death rate from tuberculosis 
in richigan was 33-6 deaths per 100,000 persons giving the state a rank of 
15th in lowness of mortality rate. The rate in 1930 had been 61.1 deaths per 
100,000 persons. 
8. Compiled Laws, 1929, Secs. 6641, 6992, 6996, ?014ff; 1940 Supplement, 
Secs. 7024, 7043- 20 
The Michigan program, like that of Wisconsin, relies chiefly on 
sanatorium care as a measure of control. The state provides a generous sub- 
sidy to local sanatoria, spending more than a third of the national total for 
this purpose and more than any other three states combined. This subsidy is 
combined with the setting of standards by the state health commissioner. 
Connecticut 
The state of Connecticut has five state sanatoria with a total of 
1,657 beds.9 There are no county sanatoria but three local tax-supported 
hospitals have facilities for a total of 74 tuberculosis patients. In all, the 
state has 3*14 beds per tuberculosis death. The sanatoria are controlled by 
the state Tuberculosis Commission, Patients are expected to pay for their 
care, which averages about $30 per week, if they, or their relatives, are able 
to do so. If not able to pay the full amount, they are expected to pay what 
they can, at least $4 a week. If unable to pay this minimum amount the town 
or city of the patient’s residence must supply a sum to assure the receipt of 
the $4 a week minimum. If the patient is a resident of Connecticut, but his 
legal residence in a town or city is not determined, the state will assume 
the cost of his care. 
The Tuberculosis Commission conducts case-finding, clinical service, 
rehabilitation, health education and all other phases of the tuberculosis 
program. The expenditures total $1,541,500, of which $1,458,259, or 95.8$, 
is devoted to maintaining the state sanatoria. A small subsidy is given to 
local hospitals. 
Connecticut in 1940, had a tuberculosis mortality rate of 34.9 
deaths per 100,000 persons compared to a rate of 61,2 in 1930. The state 
ranks loth in lowness of its mortality rate. The distinctive feature of the 
program is the fact that state sanatoria are relied upon almost exclusively 
to provide tuberculosis care. 
Massachusetts 
The state of Massachusetts maintains a state sanatorium program in 
addition to providing a subsidy for local sanatoria.Today there are five 
state institutions capable of caring for 1,309 patients and 16 local tax- 
supported sanatoria and hospitals with 1,994 beds for tuberculosis patients. 
This provides 2,50 beds for each tuberculosis death. 
The state sanatoria are controlled by the Division of Tuberculosis 
in the Department of Public Health. Patients are charged $7 per week and, if 
not financially able, this sum is charged to the city or town of residence. 
9. General Statutes of Connecticut, 1930* Secs, 2626ff; Supplement, 
Secs. 1004-1006c; 938e; 447ff. 
10. Annotated Laws of Massachusetts, vol. 3, ch, 111, secs. 57ff. 21 
Massachusetts further requires by statute that all counties and 
cities of 50,000 population or over must provide and operate tuberculosis 
sanatoria or contract with other counties or with the state for the care of 
persons in need of hospitalization. The state pays a subsidy amounting to $5 
per week for each patient cared for in a local sanatorium which meets the 
standards of the Department of Public Health. 
The cost of the subsidy paid in 1942 was $482,814 while the cost of 
operating the state sanatoria was $1,39B,565. In addition, Massachusetts 
spent $113,721 on field control, the next to the highest amount spent by any 
state. 
Massachusetts is one of the most highly urbanized states in the 
country. Despite this handicap its death rate from tuberculosis in 1940 was 
37.7 deaths per 100,000 persons, somewhat below the national figure. The rate 
in 1930 was 64.2 deaths per 100,000 population. The expenditures for tubercu- 
losis control amount to $1,210 per death. The whole program is characterized 
by the balance between the various types of tuberculosis expenditures. 
Indiana 
In Indiana there are two state sanatoria, nine county sanatoria, 
and one city hospital with special provision for tuberculosis patients.H 
The number of beds totals 1,839, with 402 in the state sanatoria and 1,437 in 
the local institutions. This is a ratio of 1.33 beds per death, slightly 
below the national average. 
The state sanatoria are controlled by a board of trustees. The 
state provides no subsidy to local sanatoria nor does it make any specific 
appropriation for field control. The total state expenditures for tuberculosis 
control amount to $178,200, an average of $126 per death. 
The mortality rate from tuberculosis was, in 1940, 40.2 deaths per 
100,000 persons. In 1930 it had been 68.2 deaths per 100,000 persons. 
The Indiana program is an example of the use of both state and local 
sanatoria with the local sanatoria being maintained without a state subsidy. 
Ohio 
Ohio has one state sanatorium, fifteen county sanatoria, three 
district sanatoria serving a total of thirteen counties, and two city hospitals 
with special facilities for tuberculosis patients.12 The state sanatorium pro- 
vides 254 beds, the tax-supported local institutions provide 3*196 beds, and, 
in addition, private sanatoria supply 632 beds making a. total of 4,082 beds, a 
ratio of 1,46 beds per death. 
11. Burns1 Indiana Statutes, Annotated, 1943 Supplement, Title 22, Chs. 33, 
%, 35 , 37. 
12. Baldwin1s Ohio Code, 1936, Secs. 1835 , 2052-72 , 3139ffJ 1943 Supplement, 
Sec. 3139. 22 
The state sanatorium provides only for minimal or ambulatory 
patients. The patient, if able, is required to pay not less than $5 per week 
and not more than $25 per week for his care. If the patient is not able to 
pay the minimum, this amount is charged to the county of his residence. The 
state sanatorium is managed by the Department of Public Welfare, 
The expenditure of $122,000 in 1942 for the state sanatorium 
represented Ohio’s entire state appropriation to tuberculosis control. The 
local sanatoria receive no state subsidy, nor are any funds specifically 
allocated to field control. The state expenditures amount to $42 per 
tuberculosis death. 
The mortality rate in Ohio fell from 64.1 deaths per 100,000 persons 
in 1930 to 40.4 deaths per 100,000 persons in 1940, The state’s program is 
similar to that of Indiana except that it provides fewer beds in the state 
sanatoria. 
Pennsylvania 
There are three state sanatoria in Pennsylvania having a total 
capacity of 3,186 beds.13 This represents the most extensive state sanatorium 
program in the United States, In addition there are eight county and city 
institutions providing a total of 1,349 beds, and 19 private institutions 
with a total of 1,346 beds. The state total is 5,881 beds, or 1,40 beds per 
tuberculosis death. 
The state sanatoria is controlled by the Bureau of Tuberculosis 
Control within the Department of Health. A special Division of Sanatoria 
within the Bureau has immediate supervision of the sanatoria. Only "indigent 
citizens" of the state are admitted to the state sanatoria, the term 
"indigent" being construed to mean citizens unable to pay for treatment in 
private sanatoria. No payment is received from any patient. The state 
expended in 1942, the sum of $1,344,077 in these institutions. No state 
subsidy is paid to local institutions, but $76,723 was spent for a comprehen- 
sive program of field control. Some 90 clinics are in operation throughout 
the state and approximately 50,000 persons are examined annually. 
Pennsylvania’s mortality rate from tuberculosis fell during the 
decade of 1930-40 from 61.5 to 42,6 deaths per 100,000 persons. The expendi- 
tures average $335 per tuberculosis death. The characteristics of the 
Pennsylvania program are the extensive provisions for state sanatoria, the 
absence of a state subsidy to local sanatoria, and the comprehensive program 
of field control. 
New Jerse; 
New Jersey has one state sanatorium of 494 beds, fourteen county 
and city institutions with a total of 2,965 beds, and nine private institutions 
13. Purdon’s Statutes, Title 16, sec. 442, Title 35, sec. 381, Title 62, 
secs. 1200ff., 1701ff., Title 72, sec. 3461. with a total of 744 The total number of beds is 4,203, or 2,35 beds 
per tuberculosis death. 
The New Jersey statutes make the counties responsible for the care 
of their tuberculosis patients. Each county is required to erect and maintain 
a sanatorium or to contract with the state or other counties for the care of 
their patients. Patients in any case pay for their care if able to do so. If 
not, they are admitted as "indigents." The state pays a subsidy of $6 per 
week for each "county indigent patient" and $12 per week for each "state 
indigent patient," cared for in a local hospital. A "county indigent patient" 
is one who has resided in the county at least 5 years; a "state indigent 
patient" has lived in the state a year but has not resided in a county for 
5 years. 
The subsidy involves an annual expense of $813,689, while the cost 
of maintaining the state sanatorium amounts to $452,334* In addition, $15,337 
is spent on field control services. Total expenditures are $1,281,400 «r $643 
per tuberculosis death. 
The death rate fell during 1930-40 from 67,8 to 43*0 deaths per 
100,000 persons. The program is similar to Massachusetts in its balanced 
character although in New Jersey the local sanatoria are emphasized while in 
Massachusetts the largest expenditure is for the state institutions. 
Missouri 
There is one state sanatorium of 780 beds in the state of 
Missouri.15 In addition there are six county and city institutions with a 
total of 1,166 beds. Three private sanatoria with a total of 232 beds bring 
the state1s total facilities to 2,178 beds or 1,28 beds per tuberculosis death. 
The state sanatorium is under the control of the Board of Managers 
which controls various other state institutions. The annual expenditures 
amount to $578,690. The state grants a small subsidy, amounting to $80,410 to 
local institutions. No funds are specifically allotted to field contrcl. 
Total expenditures amount to $659,100 or $373 per tuberculosis death. 
The tuberculosis death rate fell from 70,6 deaths per 100,000 
persons to 45.0 deaths per 100,000 during the decade 1930-40. The Missouri 
program is, so far as the state is concerned, one that emphasizes the state 
sanatorium. 
11. Revised Statutes, 1937» Title 30, Ch. 1, secs. 7, H, Oh, 1, secs. 23ff., 
Ch, 9, secs. 55ff. 
15. Revised Statutes. 1939» Secs. 9258, 9379-86, 15172ff. 24 
New York 
The New York program for tuberculosis control has developed under a 
series of statutes, which make a confused pattern.16 However, the statutes 
represent an attempt to meet different needs of different areas in ways that 
are most appropriate. 
One of the four existing state sanatoria was established in 1904. 
A few years later counties were authorized to establish sanatoria and still 
later, those with a population of 35,000 or m#re were required to construct 
sanatoria or make other provision for tuberculosis patients. Still later, 
after a health survey had revealed the need for additional sanatoria in a 
number of counties with relatively small populations, three additional state 
sanatoria were constructed. Special legislation for New York City had mean- 
while been enacted and, in addition, three counties located near the 
metropolitan districts, were granted special legislation. The result, 
necessarily, involves some complexity. 
The four state sanatoria are, in reality, district institutions 
serving the less populous counties. Each serves a district of seven or eight 
counties and, while any resident of the state may be admitted, preference is 
given to residents of the sanatorium district.17 Three of these sanatoria 
charge $17.50 per week which must be paid by the county if the patient is 
unable to do so.18 The four sanatoria supply a total of 1,035 beds and cost 
$1,635,430 per year for maintenance. 
The 41 county and municipal sanatoria provide a total of 8,695 beds 
of which 3,949 are in New York City, There is no state subsidy for their 
support but, until 1944, the patient was required to pay for his care if able 
to do so. In 1944, an act was passed which eliminated this requirement in 23 
out of the 27 counties supporting county sanatoria. Any patient may be allowed 
to pay for his treatment in whole or in part if the patient wishes to do so. 
In all. New York has 13,357 beds for tuberculosis patients, a rati© 
of 2,13 beds per death. The sum of $66,370 was spent in 1939 on field control. 
The total state expenditures amounted to $1,701,800, or $263 per tuberculosis 
death. The death rate from tuberculosis was 46.4 deaths per 100,000 persons 
in 1940, a reduction from 71.6 deaths per 100,000 persons 10 years earlier. 
The New York program is one in which responsibility for care rests chiefly on 
the local governments without subsidy, but with the state providing for the 
less populous counties. 
16. Thompson’s Laws, 1939. County, secs, 45ff, 330; Public Health, secs. 3a, 
337ff, Public Welfare, sec. 86, General City, secs. 140ff; 1941 Supplement, 
p. 709; 1942 Supplement, p. 848, 
17. In Ray Brook Hospital, the first sanatorium established, all residents 
are admitted without preference. In addition, unlike the other sanatoria, the 
care is free. However, only minimal cases are admitted. 
18. A bill to make admission to all state sanatoria free except to patients 
offering to pay was passed by the one house of the State Assembly in 1944 but 
failed to pass the other. 25 
California 
California is, like Illinois, one of the small group of states which 
does not maintain one or more state sanatoria.19 However, the state does pro- 
vide a substantial subsidy to county institutions of which there are 37, 
providing a total of 5,70? beds.20 Four of these institutions are formed by 
the consolidation of the tuberculosis functions of two or more counties, one 
institution serving 13 counties. Most of the local sanatoria provide free care 
although some charge for the care of the patients able to pay. The state sub- 
sidy amounts to $3 per week per patient, an expenditure amounting to 
$731,766 in 1939. 
Private sanatoria provide 2,193 beds giving a total for the state 
of 2,03 beds per death. Expenditures by the state amount to $192 per death. 
The death rate in California is doubtless affected by the movement 
of tuberculous persons from other states into California. In 1940 the rate 
was 56,3 deaths per 100,000 persons having fallen from 99.1 deaths per 
100,000 in 1930. The state control program, except for small sums spent on 
field control, is exclusively a subsidy to local institutions. 
Summary 
The examination of state programs for the control of tuberculosis 
leads to an appreciation of the importance of an adequate state program. 
Except for the variations produced by the factors of urbanization, racial 
differences, and economic status, the state’s death rate from tuberculosis is 
closely related to the adequacy of the state’s tuberculosis control program. 
The provision of proper sanatorium care for patients, and the existence of an 
adequate program of field control, are major factors in determining the death 
rate. 
State sanatoria are maintained in 41 states; county, city, and 
city-county sanatoria exist in 37. There are private sanatoria in 37 states 
also. Exactly half the states have all three types. Illinois is one of seven 
states which have only local sanatoria. It is the only one of this group 
which fails to subsidize the local institutions. 
In all, 21 of the 37 states which have local publicly-supported 
sanatoria, provide subsidies from state funds. In many instances the subsidy 
is an instrument of control which permits the state to enforce its standards 
of proper sanatorium care. 
All states maintain some degree of field control activity although 
only 30 list it as a separate appropriation item. Amounts spend on field 
control varied, in 1939, from $1,600, in Illinois, to $144,740 spent in 
Maryland,21 
19. There are only 7 states in this group now. The others are Alabama, 
Colorado, Nevada, Tennessee, and Washington, 
20. General Laws, 1937, Act. 6255, 6258; Codes of California, 1939, Health 
and Safety Code, secs. 3099-3342. 
21. Illinois did not establish a Division of Tuberculosis Control until 1942. 
Its appropriations for the 1943-45 biennium total $44,960, 26 
Tuberculosis Control in Illinois 
The early efforts to establish tuberculosis control in Illinois 
centered very largely in Chicago. In 1891, a pavilion to segregate tubercu- 
losis patients was established in the Cook County Poorhouse. Shortly 
afterward some provision was made for special types of tuberculosis patients 
in two or three Chicago hospitals. In 1900 a tuberculosis clinic was founded 
in Chicago. 
The first hospital provision for patients in downstate Illinois, 
and the first sanatorium in the state, was a tent colony opened at Ottawa in 
1904, The following year a camp was established at Glencoe, 
In 189B the secretary of the Illinois State Board of Health had 
proposed the establishment of a state sanatoria. This recommendation failed 
of adoption. During the following decade there was a steadily growing demand 
for legislation to aid the fight against the disease. In Chicago the 
Tuberculosis Committee of the Visiting Nurses Association, established in 1903, 
was instrumental in founding the Chicago Tuberculosis Institute (1906). The 
Illinois Society for the Prevention of Tuberculosis (now the Illinois Tubercu- 
losis Association) was established in 1905 and, in that year, began to finance 
tuberculosis control activity through the sale of seals. In 1908 and in 1915 
the legislature passed the Glackin Acts, still the cornerstone of our state 
control program. 
eatures of the Illinois Program 
labile the state of Illinois is one of the few states which have not 
established state sanatoria, and is the only state which has not provided 
either state sanatoria or state subsidy of local sanatoria, certain features 
of the Illinois program deserve mention. 
In the first place the responsibility in the Illinois system has 
rested on the county and, in the case of the larger cities, on the city. While 
this responsibility has been voluntary, a total of 82 counties and 3 cities 
have accepted the task of providing for tuberculosis patients at public ex- 
pense. In each case this has been done by means of a popular referendum, 
indicating that the citizens are aware of the problem £nd concerned with its 
solution. 
In the second place, the Illinois program has been based on the 
willingness of the tuberculosis patient to voluntarily enter a sanatorium for 
treatment. No compulsory or "quarantine” provisions have been made which 
would require the confinement of patients against their consent. The evidence 
of many sanatoria is that the unwilling patient is a great detriment to the 
proper functioning of the sanatorium. He does not cooperate in the regimen of 
living necessary for his own recovery; instead he endangers the recovery of 
other patients and lowers the morale of the whole institution. 
Thirdly, Illinois has always recognized tuberculosis as a public 
health problem. Treatment in all public sanatoria is free to the patient, 
although the Glackin Laws permit the sanatorium boards to receive donations. 27 
Since tuberculosis is of extended duration, it always places a financial 
burden on the patient and his family. To require them to pay for his care 
would, in many cases, make such care impossible. 
In the fourth place, the Illinois program has been greatly aided by 
the work of voluntary, private organizations. The Illinois Tuberculosis 
Association, The Illinois Trudeau Society, The Tuberculosis Institute of 
Chicago and Cook County, The Illinois Medical Society, and other organizations 
have worked consistently and intelligently in strengthening the program. Tuch 
of the success in securing favorable votes on the county referenda, has been 
due to their efforts. 
Finally, the Illinois Department of Public Health has always dealt 
with this problem and recently has expanded its activities in the field most 
successfully. While the Department always performed many field services in 
tuberculosis control, a separate Division of Tuberculosis Control was not 
established until 1942. This was partially the result of the report on 
"Public Health in Illinois" published following a study made by the American 
Public Hehlth Association. This same study the so-called "Ruck Report", also 
recommended the construction of state sanatoria. 
Glackin Laws 
The General Assembly has adopted a number of statutes to provide 
sanatorium care for tuberculosis patients. They are usually called the 
Glackin Laws, after the original sponsor of the statutes. The laws provide 
for the following types of sanatoria: 22 
(1) Any county may levy a tuberculosis control tax by vote 
of the people and use the proceeds either to maintain a sanatorium 
or otherwise to care for persons suffering from tuberculosis. 
(Ch. 34, sec. I64ff.) 
a. Such tax, designated '’Sanatorium Tax," may 
be within the statutory tax limit. 
b. By vote of the people, such levy, called 
an "Excess Tax," may be in addition to the 
statutory limit. 
In either case the rate shall not exceed lg mills. 
This provision has been adopted by 82 counties of which 
group 6? have voted the "Excess Tax". However, only 18-of 
these counties actually operate county sanatoria.23 
22. The location of these sanatoria, and the tax basis of the various 
counties are shown in ■ aps A and 3 which appear in the appendix. See also 
Tables 5 and 4. 
23. See Table 5 and Tap A. The tax basis is shown in ?'ap D and the taxes 
collected in Table 6. (2) Any city may maintain a tuberculosis sanatorium and levy 
a special tax therefor, (Ch. 24, sec. 72). 
Chicago, Peoria, and Rockford have taken advantage of this 
statute, 
(3) That portion of any county lying outside a city main- 
taining a sanatorium may be organized into a tuberculosis 
district, (Ch. 23, sec, l?7a). 
This has been done in Peoria County, It would be 
applicable to Cook County outside Chicago. 
(4) Any two or more contiguous counties may form a 
tuberculosis sanatorium district. (Ch, 34, sec. 175). 
This has never been used. 
The 21 county and municipal sanatoria set up under the Glackin Acts 
and the facilities of the 9 private institutions in Illinois provide a total 
of 4,725 tuberculosis beds. The standards of care, and the cost, vary 
considerably in the different institutions. The Division of Tuberculosis 
Control of the Illinois Department of Public Health has recently attempted to 
secure voluntary adherence to approved standards of care in the various 
sanatoria. This has been only partially successful. 
State Tuberculosis Sanatoria for Illinois? 
While the state of Illinois is one of the seven states which have 
not established state tuberculosis sanatoria, the plan has been frequently 
under consideration. The study made by the American Public Health Association 
in 194224 included as one of its 12 "Fajor Recommendations" that the state 
construct and maintain one or more tuberculosis sanatoria. In 1944, an 
advisory committee of the Department of Public Health brought in a similar 
recommendation, 
The Department of Public Health has recommended to the Illinois 
Post-War Planning Commission the following: (1) Four state tuberculosis 
sanatoria of 150 to 200 beds each to be located "approximately" in Union, 
Wayne, Coles, Carroll or Whiteside Counties. (2) A Cook County Tuberculosis 
Sanatorium of 1,500 to 2,000 beds. 
The Executive Board of the Illinois Statewide Public Health 
Committee on August 30, 1914, adopted a motion "that the Executive Board 
recommend the construction of state owned and operated tuberculosis sanatoria 
as follows: Four sanatoria of 200 beds each for the State outside of Cook 
County, one sanatorium of 2,000 beds for Cook County." 
Dr, E. F, Steinkopff,F.D., former head of the Illinois Division of 
Tuberculosis Control, recommended, in a letter of larch 30, 1944, to the 
Illinois Legislative Council, the construction of "several state owned 
24. Published under the title "Public Health in Illinois,” N. y., 1942. Table 5 
Illinois Counties Showing Cases Reported and Deaths from 
in 1943, and also Sanatorium Facilities 
Tuberculosis 
Cases 
Cases Report- 
Tuberculosis 
Reported 
, ed in Highest 
Number of 
Total Beds for 
County 
Deaths, 1943* 
> 1943s 
Year, 1932-43* 
*■ Sanatoria 
Tuberculosis 
Adams 
10 
45 
68 
1 
50 
Alexander 
18 
38 
132 
1 
100 
.Bond 
3 
4 
15 
0 
0 
Boone 
3 
1 
12 
0 
0 
Brown 
2 
4 
11 
0 
0 
Bureau 
7 
22 
37 
0 
0 
Calhoun 
3 
4 
9 
0 
0 
Carroll 
2 
7 
31 
0 
0 
Cass 
5 
8 
24 
0 
0 
Champaign 
6 
33 
67 
1 
40 
Christian 
13 
32 
52 
0 
0 
Clark 
3 
3 
23 
0 
0 
Clay 
9 
16 
28 
0 
0 
Clinton 
3 
5 
15 
0 
0 
Coles 
4 
16 
44 
0 
0 
Cook 
2,082 
5,882 
6,492 
8 
2,653 
Crawford 
3 
19 
23 
0 
0 
Cumberland 
3 
4 
12 
0 
0 
De Kalb 
4 
20 
28 
1 
33 
De Witt 
3 
7 
19 
0 
0 
Douglas 
4 
13 
14 
0 
0 
Du Page 
19 
49 
90 
2 
186 
Edgar 
4 
10 
43 
0 
0 
Edwards 
2 
4 
6 
0 
0 
Effingham 
3 
10 
20 
0 
0 
Fayette 
6 
8 
24 
0 
0 
Fo rd 
1 
5 
24 
0 
0 
Franklin 
22 
31 
53 
0 
0 
Fulton 
7 
41 
60 
0 
0 
Gallatin 
U 
11 
17 
0 
0 
Greene 
2 
5 
16 
0 
0 
Grundy 
6 
8 
21 
0 
0 
Hamilton 
8 
11 
15 
0 
0 
Hancock 
3 
8 
17 
0 
0 
Hardin 
8 
14 
15 
0 
0 Table 5 (continued) 
Illinois Counties Showing Cases Reported and Deaths from 
in 1%3, and also Sanatorium Facilities 
Tuberculosis 
Tuberculosis 
County Deaths, 1943* 
Cases 
Reported, 
1943* 
Cases Report- 
ed in Highest 
Year, 1932-43* 
Number of 
Sanatoria 
Total Beds for 
Tuberculosis 
Henderson 
2 
3 
5 
0 
0 
Henry 
5 
13 
45 
0 
0 
Iroquois 
4 
18 
24 
0 
0 
Jackson 
13 
17 
54 
0 
0 
Jasper 
3 
4 
17 
0 
0 
Jefferson 
6 
20 
30 
0 
0 
Jersey 
3 
3 
8 
0 
0 
Jo Daviess 
1 
1 
10 
0 
0 
Johnson 
3 
1 
11 
0 
0 
Kane 
51 
77 
284 
1 
85 
Kankakee 
114 
139 
327 
0 
0 
K endall 
2 
2 
8 
0 
0 
Knox 
6 
14 
37 
0 
0 
Lake 
30 
101 
179 
1 
100 
La Salle 
21 
44 
91 
2 
208 
Lawrence 
2 
5 
24 
0 
0 
Lee 
35 
76 
76 
0 
} 
Livingston 
5 
12 
52 
1 
50 
Logan 
19 
56 
56 
0 
0 
Me Donough 
5 
12 
32 
1 
36 
Me Henry 
3 
15 
28 
0 
0 
Me Lean 
11 
39 
73 
1 
56 
Macon 
13 
56 
170 
1 
80 
Macoupin 
10 
24 
40 
0 
0 
Madison 
50 
155 
279 
1 
99 
Marion 
13 
29 
36 
0 
0 
Marshall 
1 
7 
7 
0 
0 
Mason 
5 
11 
15 
0 
0 
Massac 
19 
27 
27 
0 
0 
Menard 
5 
4 
11 
0 
0 
Mercer 
1 
2 
23 
0 
0 
Monroe 
2 
2 
6 
0 
0 
Montgomery 
8 
29 
41 
0 
0 
Morgan 
24 
41 
96 
1 
40 
Moultrie 
2 
5 
10 
0 
0 Table 5 (continued) 
Illinois Counties Showing Cases Reported and Deaths from 
in 1943> and also Sanatorium Facilities 
Tuberculosis 
County 
Tuberculosis 
Deaths, 1943*' 
Cases 
Reported, 
1943* 
Cases Report- 
ed in Highest 
Year, 1932-43* 
Number of 
Sanatoria 
Total Beds for 
Tuberculosis 
Ogle 
2 
12 
35 
0 
0 
Peoria 
48 
191 
435 
1 
103 
Perry 
1 
3 
23 
0 
0 
Piatt 
1 
3 
11 
0 
0 
Pike 
4 
14 
23 
0 
0 
Pope 
4 
4 
14 
0 
0 
Pulaski 
9 
14 
32 
0 
0 
Putnam 
1 
4 
4 
0 
0 
Randolph 
14 
11 
46 
0 
0 
Richland 
5 
7 
12 
0 
0 
Rock Island 
39 
62 
158 
1 
76 
St. Clair 
65 
145 
188 
1 
103 
Saline 
7 
23 
43 
0 
0 
Sangamon 
25 
93 
175 
2 
285 
Schuyler 
1 
5 
10 
0 
0 
Scott 
—— 
2 
8 
0 
0 
Shelby 
6 
7 
57 
0 
0 
Stark 
1 
2 
12 
0 
0 
Stephenson 
2 
10 
35 
0 
0 
Tazewell 
9 
23 
73 
1 
45 
Union 
21 
26 
128 
0 
0 
Vermilion 
30 
88 
127 
1 
54 
Wabash 
5 
9 
12 
0 
0 
Warren 
4 
9 
18 
0 
0 
Washington 
3 
11 
11 
0 
0 
Wayne 
4 
17 
17 
0 
0 
White 
7 
23 
23 
0 
0 
Whiteside 
6 
12 
47 - 
0 
0 
Will 
36 
107 
141 
1 
89 
Williamson 
17 
47 
65 
0 
0 
Winnebago 
21 
218 
321 
1 
124 
Woodford 
3 
19 
1 
15 
* As reported to the Illinois Department of Public Health, Statistical Office. 
The data for 1943 are "provisional" 
, Cases are reported according to county of 
"residence 
", It should be noted that inmates of various state institutions are 
listed as 
"residents" of 
the county in which the institution is 
located. 32 
tuberculosis sanatoria As a beginning it is believed that two should 
be erected in southern Illinois, one in the vicinity of Randolph, Perry or 
Jackson counties and the other in the vicinity of Wayne, Hamilton, or White 
counties. In addition to these, another institution, perhaps of two hundred 
beds is needed in the northwest corner of the state. Cook County should have 
more beds available," 
These recommendations, and those of other groups, have been based on 
two major facts: (1) the inadequate geographical distribution of facilities 
with some sections of the state almost without tuberculosis beds, and (2) the 
fact that the state, as a whole, does not have enough beds to meet the 
standard of two beds per tuberculosis death. 
The geographical areas of the state which show the greatest lack of 
sanatorium facilities are the counties in the north-western part of the state, 
those in the central-western part, and those in the southern third.25 in the 
first group are the counties of Jo Daviess, Stephenson, Carroll, Ogle, 
Whiteside, Lee, Henry, Bureau, Putnam, Marshall, Stark, Knox, Mercer, Warren, 
Henderson, and Hancock. In these 16 counties there were, in 1913? a total of 
202 cases of tuberculosis reported and there were 79 tuberculosis deaths.26 
The patients requiring sanatorium care from this group of counties were cared 
for, so far as possible, in sanatoria located in near-by counties. Eleven 
of the 16 counties levied the sanatorium tax to provide funds for this 
purpose. Only Jo Daviess, Putnam, Marshall, Warren, and Hancock, with a total 
of 29 cases and 10 deaths made no public provision for sanatorium care. 
In the centrsl-western part of the state there is a group of 11 
counties without sanatorium facilities. These are Fulton, Mason, Schuyler, 
Cass, Menard, Brown, Scott, Pike, Greene, Calhoun, and Jersey, In 1913? this 
group had a total of 101 cases reported and 37 deaths. It is likely that the 
sanatoria in neighboring counties took care of most of these patients except, 
of course, in Brown, Calhoun, and Jersey counties where the sanatorium tax is 
not levied. These counties had a total of 11 cases reported and 8 deaths. 
The greatest need for sanatorium facilities is clearly, in the 
southern tier of counties. In the entire state south of Decatur, Springfield, 
and Jacksonville, only 3 sanatoria exist. These are in Madison, St, Clair, 
and Alexander counties. Forty-one other counties have no tuberculosis 
facilities, and the situation is further affected because the sanatoria in 
Madison and St, Clair counties are not able to accept out-of-county patients. 
25 . See Table 5. 
26, It should be noted that something over one-third of the cases and 
deaths occurred in Lee County and many of these were inmates of the Dixon 
State Hospital, Table 6 
Tuberculosis 
Taxes in 
Illinois Counties, 1942 and 1943* 
1940 Population 
Taxes for Tuberculosis Sanatorium 
Population Under 10,000 
1-942 
1913 
Putnam 
. 5,289 
$ • • • 4 
$ . . . 
Hardin 
. 7,759 
• • • 
• • • 
Pope ..... 
. 7,999 
4 4 4 
• ♦ • 
Brown 
. 8,053 
4 4 4 
• • f 
Scott ......... 
. 8,176 
797 
880 
Calhoun 
. 8,207 
• • 0 
• • • 
Stark . 
. 8,881 
1,621 
4,797 
Henderson ....... 
. 8,949 
• • f 
4,312 
Edwards 
. 8,974 
4 t 4 
• O* 
Population 10,000 to 15,000 
Menard . 
. 10,663 
• • • 
• 4 4 
Johnson 
. 10,727 
• . . 
• 4 4 
I endall 
. 11,105 
2,729 
2,888 
Gallatin . 
. 11,414 
5,854 
6,780 
Schuyler . 
. 11,430 
8,957 
9,440 
Cumberland 
. 11,698 
10,789 
Monroe 
. 12,754 
♦ • • 
• 4 4 
Marshall 
. 13,179 
• • • 
4 4 4 
Jasper 
. 13,431 
• • • 
4 4 4 
Hamilton ........ 
. 13,454 
13,110 
13,182 
Moultrie ... 
. 13,477 
20,534 
24,183 
Jersey 
. 13,636 
444 
444 
Wabash . . 
. 13,724 
f • • 
444 
Bond .......... 
. 14,540 
17,621 
19,701 
Piatt 
. 11,659 
7,335 
6,500 
Massac ......... 
. 14,937 
• 0 • 
444 
* As compiled by the Taxpayers1 Federation of Illinois. Municipal taxes f«r 
sanatoria, in effect in Chicago, Peoria, and Rockford, are not included. 
Sixteen counties, viz: Menard, Jasper, Carroll, Douglas, Crawford, Ogle, 
Randolph, Jefferson, McHenry, Jackson, Stephenson, Whiteside, Henry, Knox, 
Tazewell, and Peoria, have adopted sanatorium tax provisions but levied no taxes 
during 1942 and 1943 for this purpose. In some cases these counties have 
operated on balances from previous years and in other cases the charges for 
sanatorium care have been paid from the general fund of the oeunty. Table 6 (continued) 
Tuberculosis 
Taxes in 
Illinois Counties, 1942 end 
1943 
1940 Population 
Taxes for Tuberculosis 
Sanatorium 
Population 15,000 to 20,000 
1942 
..mi 
Ford 
15,00? 
1 9,631 
$ 9,850 
Boone 
15,202 
14,630 
15,291 
Kason 
15,35 B 
« • • 
18,171 
Washington , . . . 
15,801 
14,498 
7,528 
Pulaski 
15,875 
• • • 
Cass ............ 
16,425 
21,687 
22,972 
Richland 
17,137 
18,746 
12,576 
Douglas . . . . 
17,590 
• • • 
• • * 
Fercer .... 
17,701 
9,126 
8,324 
Carroll , . 
17,987 
• • * 
• * • 
DeWitt 
18,244 
3,531 
4,021 
Grundy 
18,398 
• • • 
25,580 
Clark 
18,642 
1,040 
1,061 
Clay , . 
18,947 
15,000 
17,267 
Woodford 
19,124 
32.486 
22,415 
Jo Daviess 
19,989 
♦ • • 
• • • 
Population 20,06® to 25,000 
White 
20,027 
18,131 
17,963 
Greene ..... . 
20,292 
• • • 
2,453 
Lawrence 
21,075 
• • • 
• • • 
Warren 
21,286 
• • • 
• • • 
Crawf ord . 
21,294 
12,729 
16,791 
Union 
21,528 
• • • 
• • • 
Effingham 
22,034 
• • • 
22,846 
Wayne 
22,092 
21,076 
19,169 
Clinton 
22,912 
• • • 
• • • 
Perry . . 
23,438 
• ♦ • 
• • « 
Edgar ... 
24,430 
• • • 
• • '• 
Population 25,000 to 30,000 
Pike 
25,340 
10,613 
17,980 
Alexander , . 
25,496 
20,927 
21,147 
Shelby 
26,290 
13,013 
15,992 
Hancock 
26,297 
• ♦ ♦ 
• • f 
McDonough ......... 
26,944 
9,349 
11,374 
Fayette 
29,159 
14,614 
14,384 
Logan ........... 
29,438 
6,931 
7,709 
Ogle 
29,869 
• • 0 Table 6 (continued) 
Tuberculosis 
Taxes in Illinois Counties, 1942 and 1943 
1940 Population 
Taxes for Tuberculosis 
Sanatorium 
Population 
30,000 to 35,000 
1942 
1943 
Iroquois , 
. . 32,496 
$29,536 
$31,178 
Randolph . 
♦ • • 
• • • 
Jefferson 
• • ♦ 
• • f 
DeKalb . . 
29,809 
28,935 
ontgomery 
35,147 
38,467 
Lee . . . 
19,241 
24,519 
Population 
35,000 to 40,000 
"'organ , . 
. 36,378 
15,266 
16,076 
KcKenry 
• • • 
• • P 
Bureau . . 
25,691 
• • • 
Jackson . 
• • t 
• ♦ • 
Saline . . 
16,646 
18,520 
Coles . . 
■ • 38,470 
31,882 
33,836 
Christian 
. 38,564 
32,979 
34,862 
Livingston 
• • • 
32,659 
Population 40,000 to 50,000 
Stephenson 
♦ • • 
• • • 
Whiteside 
• • 43,338 
• ♦ • 
• • • 
Henry . , 
* 1 • 
« . . 
Fulton . . 
. . 44,627 
41,028 
47,011 
1 'a coup in . 
. . 46,304 
34,917 
38,917 
Farion . , 
21,046 
40,303 
Population 50,000 to 60,000 
Williamson 
. . 51,424 
• • • 
• • ♦ 
Knox . . 
• • t 
• • • 
Franklin . 
2.6,510 
29,443 
Tazewell . 
♦ • • 
• • ♦ Table £ (continued) 
Tuberculosis Taxes in 
Illinois Counties, 1942 
and 1943 
1940 Populati 
on 
Taxes for Tuberculo 
sis Sanatorium 
Population 60,000 to 75?000 
1942 
1943' 
Kankakee 
$ 29,199 
$ 34,647 
Adams 
43,910 
44,064 
Champaign . . . . 
. . . . 70,578 
56,732 
58,962 
McLean 
. • . . 73,930 
57,850 
64,672 
Population 75,000 
to 
100,000 
K'acon 
61,851 
65,737 
Vermilion . . . , 
82,566 
82,200 
LaSalle 
. . . . 97,801 
96,799 
103,931 
Population 100,000 
to 
125,000 
DuPage 
92,113 
92,682 
Rock Island . . . 
68,524 
72,794 
Will 
87,648 
107,744 
‘Sangamon 
. . . . 117,912 
90,387 
96,583 
Lake 
127,202 
133,311 
Winnebago . . t . 
18,355 
20,150 
Population 125,000 
to 
175,000 
Kane , 
69,744 
73,985 
Kadison 
. . . . 149,349 
89,881 
101,226 
Peoria 
. . . . 153,374 
• • • 
• • • 
St, Clair . . . . 
173,389 
181,006 
Downstate Totals 
t 
3,833,899 
1,955,387 
2,184,938 
Cook 
4,063,342 
• • • • 
• • • • 
State Totals 
7,897,241 
$1,955,387 
12,184,938 37 
In the 41 southern Illinois counties without tuberculosis facilities 
there were, in 1943, a total of 576 cases reported and 286 deaths. Twenty- 
eight of these counties levied a tax and attempted to find accomodations for 
their patients in other Fany patients did not obtain sanatorium 
care. In 13 counties of this area, no tax was levied. These counties had a 
total of 160 reported cases and 92 deaths, 
In most of these southern Illinois counties, as well as in many 
counties throughout the state, the number of patients in a single county is 
too small to justify the construction and maintenance of a sanatorium. It was 
with this in mind that the General Assembly provided, in 1939, for a sanatorium 
district to be formed by two or more contiguous counties. This provision, 
however, has not been used to date. 
Beside the inadequacy of the facilities in certain areas, the state 
as a whole lacks sufficient tuberculosis beds. There are now provided some 
4,725 beds in the state, 2,653 in Cook County and 2,072 in the 
rest of the state. In 1943 there were 8,666 reported cases and deaths. 
The number of cases reported exceeded the total number of beds by nearly 
4,000.^8 
In Cook County the cases reported totalled 5,882 and the deaths 
2,082 compared with the number of beds which was 2,653* This has led the 
Department of Public Health to recommend that the state construct and maintain 
a sanatorium with 1,500 to 2,000 beds in Cook County as well as four smaller 
sanatoria downstate. The American Public Health Association recommended, in 
1942, that a Cook County sanatorium of 2,000 beds be constructed but suggested 
that it be a county, rather than a state, institution. 
The recommendation of an institution of 2,000 beds has been seriously 
questioned. Dr. E, K. Steinkopff, former Chief of the Division of Tuberculosis 
Control, believes that no institution should have more than 500 beds.29 phe 
Illinois Tuberculosis Association that, instead of a 2,000 bed 
institution, it would be better to have several sanatorium units of 150 to 200 
beds each. 
The control program in Chicago and Cook County is, at present, most 
extensive. The Chicago Municipal Sanitarium, established in 1915 under the 
Glackin Act, consists of the Sanatarium proper (capacity 1,200 beds), the North 
Riverside Branch (capacity 256 beds), and seven dispensaries, (registration 
46,250, including; contacts and observation cases). The case-finding techniques 
include the use of the chest x-ray which, since 1940, has been used in examin- 
ing 170,119 persons, with a yield of 5,331 new cases. The value of this 
techniques is shown by the fact that 2,820 cases, or 55.6$, were minimal and 
likely to result in cures. 
2?. Two additional counties in this group voted in November, 1914, to levy- 
such tax beginning in 1945. 
2B. Of course, not all cases require sanatorium care. In addition, the state 
provides some facilities in the penal and welfare institutions. On the other 
hand, there are a very large number of cases that are not discovered and are 
not reported. In some counties the deaths exceed the cases indicating the 
inadequacy of case-finding and reporting, 
29. Letter to the Illinois Legislative Council, Larch 30, 1944. 
30, Editorial in Contact. October, 1944* 38 
The Cook County Tuberculosis Hospital at Oak Forest has a capacity 
of 598 and maintains a staff which renders considerable out-patient service. 
The Cook County Hospital in Chicago has a separate building for tuberculosis 
patients with a capacity of 377* Besides these there are several private 
sanatoria with some 250 additional beds. Neighboring counties also provide 
some facilities for private patients. 
There are certain administrative problems which occur because of the 
peculiar character of the Cook County program. Some attempts to secure 
coordination of the activities of the various agencies in the County are at 
present underway. In addition, the Chicago Medical Society and the U. S. 
Public Health Service are studying the nature of an over-all county-city 
program. The Executive Board of the Illinois State-wide Public Health 
Committee, meeting August 30, 1944, voted to 11 throw the weight of its 
influence on the coordination of tuberculosis work in Cook County.” 
Whatever the nature of the administration, the need for additional 
beds in Cook County is clear. 
The A.P.H.A. report, and the recommendations of the Illinois Depart- 
ment of Public Health, agree that state sanatoria should be administered 
through the State Department of Public Health, In the 41 states which have 
state sanatoria the administration is lodged with the health department in 15 
states, in the welfare department in 7 states, in special sanatorium boards in 
8 states, and in various other agencies in the other 11, . 
If state sanatoria should be established the question arises con- 
cerning the method of financing the care of patients, Illinois, from the date 
of the Glackin Act, has followed the principle of free treatment of patients. 
This was based on the belief that a comprehensive program of care was much 
more likely to be secured if tuberculosis care was available to all patients 
regardless of their financial ability. All of the county and municipal 
sanatoria have always been free. The statutes permit their boards to accept 
gifts and donations but they are not permitted to charge for care. 
Since the Illinois program has always been based on the county, it 
has been suggested that the state sanatoria be fitted into the picture on a 
similar financial basis. This would entail charging the cost of care to the 
county of the patient’s residence. Such charges, sometimes fixed by statute, 
are in effect in many of the states having state sanatoria. In some cases the 
full cost, which'averages from $18 to $30 per patient per week, is assessed 
against the county of residence; in other cases the county pays only a part of 
the cost and the state assumes the rest. 
Under such provisions, it is essential that the statute provide 
clearly for a method of determining the county of residence. In some states 
this power is lodged with the Director of the Department of Public Health, 
Other states state a county residence qualification but provide that those who 
do not meet the requirements in any county shall be cared for at state expense. 
The argument has been advancedll that the need for beds is greatest 
in counties which can least afford to pay for the care of their patients. On 
31. H, V, Hullerman, F.D., "Control of Tuberculosis", Illinois Medical 
Journal, Vol. 79, No, 2, pp. 126-132. (February, 1944). ether hand, the Illinois Tuberculosis Association has assembled data to show 
that any county which votes the taxes authorized by the Glackin Acts would 
be able to pay for the care of their patients if facilities were available. 
It may be that a system by which the state and the county share the cost 
would be most satisfactory. If such plan should be adopted, it would follow 
logically that the state should pay a similar share of the cost of caring for 
patients in established sanatoria. This would be a subsidy system such as is 
used in many states. One advantage accruing to such a plan is that it would 
permit the State to establish standards for sanatorium care by denying the 
subsidy to institutions which are below standard. 
Penal and Welfare Institutions 
One aspect of the problem which is of some importance concerns the 
provisions made for tuberculosis patients in the state penal and welfare 
institutions, Illinois, in common with 10 other states, has provided special 
facilities of this nature. All eleven of the state mental hospitals provide 
beds for tuberculosis patients. These beds total about 1,500, varying all the 
way from 25 to nearly 600. At the Manteno hospital, where between 550 and 600 
tuberculosis patients are cared for, special facilities have been provided. 
When possible, patients from other institutions are transferred there. How- 
ever, the Illinois Department of Public V<elfare feels its facilities are 
inadequate and has requested the Illinois Post-Far Planning Commission to 
approve the construction of a special 1,000 bed tuberculosis sanatorium for 
the Kankakee hospital and a 600 bed sanatorium for the Alton Hospital. If 
this were done, the Department would transfer practically all tuberculous 
patients from the other hospitals to these two maintaining only small provi- 
sions for observations and preliminary treatment. In its program the 
Department of Public Welfare has consistently sought the advice and assistance 
of the Department of Public Health, 
In the Illinois prisons special provision for tuberculous inmates 
has also been made. Some facilities are provided at Menard and Stateville 
but, in 1938, a central tuberculosis hospital for penitentiary inmates was 
constructed at Pontiac, This hospital is equipped for all modern diagnostic 
and collapse therapy procedures. Most of the tuberculosis patients among the 
inmates of all Illinois penitentiaries are now cared for there. MAP A. TUBERCULOSIS SANATORIA IN ILLINOIS. 1944 
*14 (74659) 
C - County Sanatorium 
M - Municipal Sanatorium 
P - Private Sanatorium 
Figures show number of beds MAP B. TAX BASIS FOR TUBERCULOSIS CONTROL. 1944 
(74659) 
[1 Municipal Tax 
Excess Tax 
and Glackin 
Law 
Glackin Law Only- 
No Tax Funds For Care 
of Tuberculosis Patients 
Note: There is a municipal tax in Chicago but no special tax in the remainder of 
Cook County. Some money is appropriated from the General Fund.