In planning these buildings the purpose was to secure an ar-
rangement embodying all the salient features which are so impor-
tant in a hospital of this kind, and also to make it homelike as well.
This result was attained, as will be seen by the plan, by placing the
various wards on the southern side of the main corridor, which
runs the entire length of the building, and connecting them by
laree slidine-doOrs with a recreation hall in the centre, which is
open to the third floor. Here concerts are given once a week by
the different district committees which compose the Young Ladies'
Charitable Association, thus affording those patients who are unable
to be about an opportunity of sharing the enjoyment with their
more fortunate companions.

The dining-hall, serving-kitchen, toilet-rooms, reading-rooms,



IMPORTANT SANATORIA AND SPECIAL HOSPITALS. I71

linen-rooms, and rooms for patients' clothing, are located on the
north side of the corridor. At the extreme end of the main cor-
ridor are grouped the wards for isolated patients, which are shut
off from the rest of the building, and are fitted up with toilet-
rooms, etc., for their use.

The front entrance, which is used for visitors, is through a vesti-
bule into a large, central hall, which is finished and paneled in
quartered oak, and is made attractive by a large, open fireplace,
and a spacious staircase which leads to the second and third floors.
Grouped about this hall are the reception-room, nurses' parlor, and
the throat- and consulting-room, which is also easy of access from
the administration building, adjoining it on the left. The consult-
ing-room is fitted with toilet, etc., for the use of the doctors, and it
also has an open fireplace, which gives it a cheerful appearance and
affords an excellent means of ventilation. In the basement are
located the laundry, drying-room, inhalation-room, fumigating-
room, kitchen, etc. The second floor is arranged in much the
same manner as the first floor, with the exception that on the south-
west front are two additional wards, accommodating eight beds
each, and a small chapel over the first entrance.

The building is finished in brown ash and quartered oak, and the
floors throughout, except the rooms in the basement, are laid out
with rift hard pine. As a protection against fire, brick walls have
been introduced every fifty feet, which run clear across the build-
ing, in the openings of which are hung metal, fireproof doors, so
that in case of fire the doors may be closed and the fire confined
to any particular section. The plumbing has been arranged
according to modern sanitary principles. The heating and ventilat-
ing system is known as the plenum or fan system. The air is
introduced at a central point and passed over tempering coils, and
heated to a temperature varying from 60° to 70° F., as may be
required, and then forced by a seven-foot fan through the various
galvanized-iron ducts to the heat-flues, at the base of which are
supplementary coils, which bring the temperature up to any degree
desired. Dampers are placed at the base of each heat-duct, which
are controlled by the nurse in each ward or room, and can be
manipulated so as to give any temperature desired in any room or
ward. The ventilation is extended to all the rooms throughout
the building, including kitchen, bakery, laundry, toilet-rooms, and



1/2



PULMONARY TUBERCULOSIS.




IMPORTANT SANATORIA AND SPECIAL HOSPITALS. 1 73

also corridors. The air-supply is on a basis of seventy cubic feet per
minute for each cot, and for each of four additional occupants.

The medical staff is composed of Drs. E. O. Otis, R. M. Merrick,
and H. M. R. Watts as visiting physicians, and ten consulting phy-
sicians, with Dr. Frederick I. Knight as chairman.



THE WINYAH SANITARIUM.

This institution was founded a number of years ago by Dr. J. W.
Gleitsmann, of New York, for the purpose of giving to the wealthier
class of consumptives the benefit of the hygienic and dietetic treat-
ment in a sanatorium, combined with the climatic advantages which
North Carolina offers. This sanatorium, which I visited in 1897,
is located at Asheville, and is now under the direction of Dr. Karl
von Ruck. It consists of a large building with verandas, accom-
modating about one hundred patients. Very interesting to me
was the well-equipped laboratory for bacteriological research
attached to Dr. von Ruck's institution.

Since my visit to Asheville I learn that plans for a new and much
larger institution have been decided upon. The new sanatorium
will be located in a grove of oak and pines, twenty acres in extent,
adjoining the city. The buildings are to consist of a main building
with the necessary public rooms, baths, hydropathic-treatment
rooms, and twenty-four private rooms for patients, together with
several suits of rooms with private baths. The construction will
be modern and in compliance with the most advanced principles
of sanitary science, but with special reference to its occupation by
phthisical patients. The heating will be with open fires in all pub-
lic and private rooms, but steam-heat will also be supplied by indi-
rect radiation, thus heating the outside air and delivering it into
the different apartments. Abundance of sunlight is to be secured
for all rooms, corridors, etc.

In addition there will be two cottages, one of four and another
of seven rooms, which will be constructed and equipped the same
as the main building. Additions to the capacity of the institution
will be made by the erection of new cottages as the patronage may
justify. Besides these, there will be a laboratory of six rooms,
with perfect equipment for the study of tuberculosis.

No advanced or hopeless cases will be admitted.



174



PULMONARY TUBERCULOSIS.



THE ASHEVILLE SANATORIUM FOR DISEASES OF THE CHEST

AND THROAT.

On the summit of a large, wooded eminence known as "Oakland
Heights," overlooking Asheville and one mile to the south of it,
arises a second sanatorium, recently built in that city. It is under
the medical management of S. Westrey Battle, M.D.,U.S.N., and
John W. Ross, M.D., U. S. N.

The view from the sanatorium is one of surprising loveliness — a
panorama of city, rivers, valleys, forests, and distant mountains.
The building is a substantial and ornamental structure, of three
stories and basement, designed for sanatorium purposes, and con-
tains eighty rooms. The appointments are modern, with elevator,




Fig. 57. — Asheville Sanatorium.



electric lights, etc. The basement, which is on the level of the
ground, is devoted to the bath establishment and gymnasium, in-
cluding a swimming-pool. The house is provided above and below
with numerous sunny, sheltered verandas and porches.

The capacity of the sanatorium is seventy-five patients.

The advantages of having all the patients under one extensive
roof are obvious, the chief one being that they can be more easily
and constantly watched over.

The grounds consist of fifteen acres of park land covered with
an open growth of handsome oaks, interspersed with pines. The
adjacent territory is especially suited for exercise on foot or horse-
back, mountain-climbing, etc.



IMPORTANT SANATORIA AND SPECIAL HOSPITALS.



175



The sanatorium was opened on the ist of March, 1898. The
treatment in the sanatorium is, of course, the hygienic and dietetic,
with all its various adjuncts (hydrotherapy, massage, etc.). The
sanatorium is bountifully supplied with remarkably pure water
for drinking and all other purposes, from its own spring, the
large stream from which does not vary perceptibly in quality or
quantity during wet or dry weather. In addition, the perfect
system of sewerage will be flushed with water from the city water-
works, and all sewage, after having been disinfected, will be dis-
charged into the French Broad River, one mile away.

One of the medical directors resides permanently in the sanato-
rium.




-Main Building of the Sanatorium Hygeia at Citronelle.



THE HYGEIA.
Two years ago there was founded at Citronelle, Ala., by Dr. A.
C. Klebs, son of Professor Edwin Klebs, of Chicago, a sanatorium
for consumptives. It is now under the management of Dr. J. G.



1/6



PULMONARY TUBERCULOSIS.



Michael, with Dr. Keith Fonde as house-physician, and has become
an institution open all the year.

Citronelle is situated almost in the centre of the high pine-forest
of South Alabama, sixty-two miles from the Gulf of Mexico, and
thirty-three hiiles north of Mobile. It has an elevation of 360
feet above the level of Mobile Bay. It is the highest point, within
this distance of the coast, between Boston and Galveston, and the
highest point on the Mobile and Ohio Railroad between Mobile




Fig. 59.— Cottages of the Sanatorium Hygeia at Citronelle.



and St. Louis. The elevation and the surrounding pine-covered
hills give to Citronelle perfect drainage and pure water. The warm
waters of the Gulf of Mexico modify the winter temperature, and
the height at which the sanatorium is built protects it from too
much moisture from the sea. It is also sufficiently removed from
the neighborhood of malarial swamps.

The United States weather reports for each of the months of
December, January, February, and March show that, at Citronelle,
the minimum temperatures average fifteen degrees higher than at



IMPORTANT SANATORIA AND SPECIAL HOSPITALS. I//

Asheville, North Carolina. The average maximum for the same
period shows seven degrees warmer here.

The " Hygeia " includes three large buildings and five cottages.
The main building contains dining-room, parlors, reading-room, and
business office, and a number of comfortable bedrooms for guests.
In the fall of 1898 all the buildings were repainted inside and out ;
new bedding and furniture were placed in all sleeping-apartments;
electric bells and modern sanitary appliances have been added.
Most of the bedrooms are supplied with open fireplaces, thus insur-
ing good ventilation and warmth.

For the entertainment of the guests and patients there are
a billiard- room and bowling-alley; also beautiful grounds for
croquet, lawn-tennis courts, and golf links. Besides this there are
well-kept walks and roads, which give ample opportunity for
beneficial exercise. There is, during the winter, excellent quail-
shooting.

To judge from a recent announcement which Dr. Fonde kindly
sent me, the " Hygeia " is as much a hotel as a sanatorium, and thus
I do not think we can class it as a closed establishment in the
strict sense of the word. The fact, however, that the institution
consists of large pavilions should make a division and strict sani-
tary supervision easy. There are appliances for inhalation, mas-
sage, bath, and electricity. There is a special railroad-station
immediately in front of the hotel.



"THE HOME" AT DENVER, COLORADO.

With a well-meant purpose, the Protestant Episcopal Church
has created, near the beautiful city of Denver, a large institution for
consumptives of the middle classes. It is called " The Home,"
and can be reached in fifteen minutes from the centre of Denver ;
three car-lines pass the institution. From the Home one has a
commanding view over the entire city, the plains for hundreds of
miles, and the Rockies for 150 miles, with an uninterrupted view
of Pike's Peak, Grey's Peak, and Long's Peak.

The institution has a southern exposure, and comprises three
buildings in colonial style : " St. Andrew's House " for men,
" Grace House " for mother and son, or husband and wife, and the
" Emily House" for women. These cover an entire block of land,
and are connected by a glass and covered porch called the




178



IMPORTANT SANATORIA AND SPECIAL HOSPITALS. 1 79

" Cloister." There are covered and uncovered porches front and
back, up-stairs and down-stairs ; a music-room ; a library containing
2000 volumes ; a gymnasium containing billiard-tables, chest-
weights, Indian clubs, dumb-bells, etc. There are parlors in each
of the buildings. In one hangs a very valuable oil picture, an old
copy of one of the Holy Families, painted by Raphael. Bath-
rooms, lavatories, and closets are in great abundance. There are
accommodations for eighty people. Each room is separated from
the adjoining rooms by a brick partition. The walls are hard
finish and the floors are hard wood. There is a large, attractive
dining-room.

The Rev. Frederick W. Oakes is the superintendent of the
institution. It is calculated to be self-supporting. Patients pay
one dollar per day and receive for this board and room. They
have the right to choose their medical attendant.

When I visited this beautiful institution, my first disappointment
was to learn that the Home had no house-physician. I passed
through the corridors, library, and dining-room, and looked at
the many cheerful and bright bedrooms. The air outside was
brisk and clear, and the sun shone ; but not one window was open,
and the atmosphere inside of the institution was far too warm, and
certainly not fresh enough to be of any benefit to the patients, who
were nearly all indoors. While I have no doubt that every pre-
caution is taken on the part of the management in regard to
the sputum, to supervise constantly eighty-odd tuberculous
patients and see that there should never be any violation of
the sanitary rules and regulations of the house, requires more
than the gentle hand of a minister or matron. Aside from this, it
is my firm conviction that, in the interest of the patients, as well
as in the interest of the community-at-large, there should never
be so great a number of tuberculous invalids without the constant
presence of a medical attendant. At no period in the course of
the disease should the tuberculous patient be "kept"; he should
always be treated. I make this criticism in the spirit of kindness,
for I think it just as essential to describe existing defects as to
emphasize the advantages which the various institutions I visited
had to offer.

The beautiful photograph which I reproduce here will give a
good idea of the institution, which is the result of the efforts of
noble-minded men and women. Their aims cannot be praised too



l8o PULMONARY TUBERCULOSIS.

highly, but if the institution would be transformed into a sana-
torium, as understood by modern phthisio-therapeutists, the good
which would be done would far exceed the work accomplished by
the Home in its present state.



GLOCKNER SANITARIUM.

The Glockner Sanitarium is situated at Colorado Springs, Col.
The climate of the region has been studied and described by
Weber, Denison, and Solly. The latter says, in his comparative
merits of American resorts, that " Colorado Springs, 6000 feet
above the sea, has about the same winter temperature as Denver;
is slightly drier; has less snow, but rather more wind. It was
laid out as a health resort upon a mesa, near to, but sufficiently
removed from, the shadow of Pike's Peak. It is a handsome resi-
dential town, without manufactories and with first-class resources
of all kinds and beautiful suburbs." ^

Colorado Springs is situated on a vast plateau, and, though
inclosed by the Rockies and foot-hills, it receives, nevertheless, its
full share of insolation and is free from excessive heat and intense
cold. The Glockner institution is situated at the northern end of
the city and is easily accessible by^electric cars in fifteen minutes.

From the circular the Sister Superior very kindly handed me, on
my recent visit to the institution, I give the following extract, which
describes the institution and its aims :

"The house was designed and built for the special care of pul-
monary complaints, though it welcomes other invalids also. It is
supplied with every modern convenience and appliance. It is so
constructed that every room receives the sun. It is furnished, on
every story, with ample porches, some entirely open, so as to
receive all the influence of the air and sun ; some -covered, for exer-
cise and air in inclement weather; some completely inclosed in
glass, giving all the benefit of the sun, while sheltered from the air.
An electric elevator reaches every floor. Electric lights are in
every room and hall. Elegant sitting- and reading-rooms afford
opportunity for social enjoyment. Spacious grounds and lawns
relieve the eye and furnish pleasant walks. In order to facilitate
life in the open air, so beneficial in pulmonary disorders, a number

^ " Transactions of the Amer. Climat. Assoc," vol. xni, p. 181.



IMPORTANT SANATORIA AND SPECIAL HOSPITALS, l8l

of tents have been erected on the grounds, in which patients may
spend both day and night, if so disposed. It has been made a
point to keep a table of the highest grade, in which the dishes are
of a variety to suit every taste, and are prepared and served with
the greatest care. The house is owned and managed by the Sisters
of Charity."

This speaks for itself as to, how far the institution is from a sana-
torium — or closed establishment — in the meaning of the word as
now interpreted. There is no house-physician, and the hygienic
and sanitary supervision is in the hands of the Sisters of Charity.

THE BROOKLYN HOME FOR CONSUMPTIVES.

With an object similar to the institution just described, the Brook-
lyn Home for Consumptives was founded in i88i. It is, however,
non-sectarian, and nearly all the churches of Brooklyn are contrib-
utors.

The " Home " is a large, comfortable building, situated at the
corner of Butler and Douglass Streets, in the borough of Brook-
lyn. It can accommodate ninety-two patients. The institution is
under the energetic management of Mrs. S. V. White, its president,
with a number of ladies to aid her. The last annual announce-
ment, which the matron-in-charge had the courtesy to give me
when I visited the institution, speaks of a report of " allopathic
physicians " and of a report of " homoeopathic physicians." The
former states that the number of —

Patients treated during the year was 152

Died during the year, 5^

Left, improved, 22

Left with permission, 7

Left without permission, 3

Discharged, 3

Sent to hospital, I

Remaining in Home, 5^

The homoeopathic physicians gave the following statement :

Patients treated during the year, 84

Died during the year, 27

Left, improved, 17

Left, unimproved, 6

Left without permission, 6

Sent to hospital, I

Remaining in Home . 27



1 82 PULMONARY TUBERCULOSIS,

The institution is entirely free to the poor, and thus, no doubt,
doing good work by accepting even the advanced cases. But the
same criticism which I made in regard to the Denver Home is
apphcable to the Brooklyn Home. There is not a sufficient hygi-
enic supervision, and no medical attendant resides in the house.



CANADA.

THE MUSKOKA COTTAGE SANATORIUM.

This institution, situated at Gravenhurst, Ont., was opened on the
1st of September, 1897. It is the first of a number of Canadian
sanatoria which are to be erected by the National Sanatorium As-
sociation — an association founded by a number of philanthropists,
and incorporated by special act of the Parliament of Canada, with
an object " to establish public institutions for the isolation, treat-
ment, and cure of persons affected with pulmonary disease."

The sanatorium is situated on the shores of Lake Muskoka, 125
miles north of Toronto, Ontario. All the buildings have their
frontage to the south. The elevation is about 1000 feet. The air
is bracing, dry, and free from dust. The region is very rocky, there
being little farm land in the district. The formation is entirely
Laurentian ; the water is consequently free from lime, and is very
soft. To the north and west are rocky bluffs, and, except on the
south, the buildings are surrounded by a wood of beech, maple, and
balsamic trees. To the south a terraced lawn stretches from the
buildings to the shore of the lake. As the name indicates, the
cottage plan of treatment has been adopted. In the administration
building there are rooms for twenty patients. In it are also the
offices, reception- and music-room, reading-room, broad, spacious
hallways, kitchen, dining-room, and three solaria ; one solarium
faces the east; a second, southeast ; the third, southwest. Along
the front of the building is a broad piazza, on which the sun shines
from morning until night, and above this, on the second floor, an
open balcony of the same width.

None of the cottages accommodate more than six patients, some
being limited to four. Each cottage has a large sitting-room, in
which is an open fireplace. There is also a large piazza, so ar-
ranged that it may be partially inclosed with glass during the
winter. All the buildings are lighted by electricity. The main



IMPORTANT SANATORIA AND SPECIAL HOSPITALS.



183




1 84



PULMONARY TUBERCULOSIS.



building is heated by steam, the cottages by hot water. During
the cooler nights of early fall and late spring the fireplaces are
used. Only fifty patients can be accommodated at present, but the
number of cottages will be increased until there is room for about
ninety patients.

There are no wards ; each patient has a separate room. The
rooms are large and well ventilated ; each is so situated as to
receive the sun during some part of the day. The interior of the
building is finished in birch, with white walls above the wainscot.
The floors throughout are of hard wood.

Artificial paths of various gradients have been made throughout
the grounds. Although in such proximity to the water, the air is




Fig. 62. — A Cottage of Muskoka Cottage Sanatorium.



quite dry, and the patients can avail themselves of excellent boating
facilities and daily excursions up the lakes for a few hours or the
whole day.

The meals are at eight, one, and six, with lunches at eleven, four,
and nine ; all retire at ten.

The sanatorium is open throughout the year, the results in
winter being fully as satisfactory as in summer. The nights in
summer are quite cool. In winter there are no sudden changes in
temperature. Snow lies on the ground from December until March,
with steady frost. There is a maximum of sunshine. The patients
are able to live on the verandas six to eight hours a day through-
out the winter. The paths are kept clear of snow for walking.



IMPORTANT SANATORIA AND SPECIAL HOSPITALS. 1 85

Considerable driving is done during the sleighing season. Snow-
shoeing is also a favorite pastime and exercise for suitable cases.

The sanatorium is devoted to the treatment of pulmonary phthisis.
The cost to each patient is six dollars per week, including medi-
cine. The results for the first six months have been quite satis-
factory, though much better figures would be given did the finances
of the patients allow them to remain longer under treatment.
Only patients will be admitted who are in an early stage of con-
sumption, and to whom residence for a number of months in the
sanatorium promises either a complete cure, or such an improved
condition that they may be able to return to their homes to carry
on their work. The sanatorium reserves the right to dismiss a
patient at any time.

The physician-in-charge is Dr. J. H. Elliott; the examining
physician for Toronto is Dr. N. A. Powell, and for Montreal, Dr.
James Stewart.

THE LAURENTIAN SANATORIUM.

This Canadian establishment, with limited accommodation for
twenty-five patients, is situated in a small valley formed by the
chain of mountains bearing the name " Laurentian," at an elevation
of nearly two thousand feet. It is partially exposed to the north,
but principally to the southeast; in spite of this partial northern
exposure it is sufficiently well protected by distant hills. The dry
air in this region is particularly well adapted for the out-door life
which the patients are enjoined constantly to follow. During the
winter the typical Canadian cold weather does not offer any serious
objections to the outdoor life of the patients; owing to the lack of
moisture, the patients may be allowed to lounge in the open air for
hours in perfect comfort, provided they are well wrapped up in
woolen clothing.

This sanatorium is situated at about one mile from the village
of St. Agathe des Monts, and at about an equal distance from the
railway station. St. Agathe is sixty-four miles from Montreal,
and is reached by a branch line of the Canadian Pacific Railway.
This line was built some few years ago through a wild, mountainous
district, and now one sees here and there small villages on each
side of the railway. From the railway cars one is treated to natural