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National Tuberculosis Association.

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Adirondack Cottage Sanitariam, Trudeau, N. Y. The Original One-room Cottage witere
Dr. Edward L. Tkudeau began his Experiment with the Open-air Treatment

OF Tuberculosis.



Tuberculosis

Hospital and Sanatorium

Construction



WRITTEN FOR

THE NATIONAL ASSOCIATION FOR

THE SVUDY AND PREVENTION OF

TUBERCULOSIS



BY
THOMAS SPEES CARRINGTON, M.D.



ASSISTANT SECRETARY




NEW YORK
105 EAST TWENTY-SECOND STREET

1911



rLLT.



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:i>ti!vnv



Prefa



ce



The present work is an expansion of the pamphlet issued two years ago by
the National Association for the Study and Prevention of Tuberculosis in response
to a pressing demand for information and advice in the establishment of sanatoria
and hospitals.

During this period the emphasis of the campaign has been laid particularly
upon the importance of increasing our equipment for the institutional care of tu-
berculous patients. The response has exceeded expectation and has been par-
ticularly encouraging in the degree to which local and state governments have
accepted responsibility for the situation. Under these conditions the problem of
tuberculosis from the institutional point of view is to care for the largest possible
number of patients at the lowest possible cost compatible with efficient results.

While it is true that institutional expense is much more a matter of main-
tenance than of original cost of construction it is equally true that careful prelim-
inary planning is the chief factor in subsequent economy of. operation. It is with
this end in view that the following study has been prepared.

It is hoped that the book will prove of service to those charged with the
responsibility of dealing with the institutional problem in their several communities.

Livingston Farr.\nd,

Executive Secretary.

May ijlli, iQii



2HU0H



Contents



Introduction
Section I.



II.



III.



IV



V.



VI.



Site and Grouping ........

Sanatorium Sites; Transportation Facilities; Extent and Nature of the Land;
Lighting, Water and Sewage; Meterological Conditions; Natural Beauty; Ex-
amination of the Land; Farm Buildings; Grouping; Cleaning and Apportioning
Grounds; Railroad Station; Buildings and Improvements for Block Plan; Sites
for Hospitals to House Advanced Cases; Examples of Grouping and Sites.

Administration Buildings .......

Methods of Sanatorium Administration; Planning Administration Buildings;
Class and Number of Patients; Staff and Servants' Housing; Staff and Ser-
vants' Salaries; Service Buildings; Amusement Pavilions; Industrial Buildings;
Water Supplies; Light, Heat and Power; Laundries; Sterilizing Rooms; Vacuum
Cleaning Plants; Ice Houses and Cold Storage Plants; Carpenter and Paint
Shops; Store Houses, Bakeries and Scale Houses; Green Houses, Forcing Beds,
Vegetable Cellars; Garages, Barns and Stables; Farm Outfits; Cow-barns; Silos;
Milk Houses; Chicken and Hog Houses; Sewage Disposal Plants; Examples
of Administration Buildings; Examples of Service Buildings.

Administration Buildings and Patients' Quarters Combined

Suggestions for Planning Buildings; Examples of Complete Institutions under
One Roof.

Hospitals for Advanced Cases. Infirmaries and Reception
Hospitals .........

Description of Hospitals for Advanced Cases; Description of Infirmaries; De-
scription of Reception Hospitals; Examples of the Buildings at Various Institu-
tions.

Patients' Quarters. Lean-to Type of Building

Origin of These Buildings; Material; Finish; Excavation; Exposure; Arrange-
ment of Floor Plans; Porch Space; Porch Protection; \'cntilation; Fixtures;
Plumbing; Examples of Lean-tos.

Patients' Quarters. Cottage Type of Building.

Origin of These Buildings; Points to be Considered in Designing Cottages; E.\-
amples of Cottages.



PAGE

17



37



69



89



117



147



Illustrations



Frontispiece — Dr. Trudeau's Original Cottage.



No.



3

4
5
6

7

8

9

lO

II

12



SECTION I

Site and Grouping

Loomis Sanatorium, Liberty, N. Y.,

Views of a Farmhouse before and aftei: Remodeling
Mews of Land Showing Natural Features

of Value on Sites for Sanatoria
Maryland State Sanatorium, Sabillasville, Md.,

Bird's-eye View .....
Georgia State Sanatorium, Alto. Ga.,

Block Plan

Waverly Hill Sanatorium, Waverly Hill, Ky.,

Front Elevation and Block Plan .
Agnes Memorial Sanatorium, Denver, Colo.,

Front Elevation and Block Plan .
Indiana State Hospital, Rockville, Ind.,

Bird's-eye View and Block Plan
Portland Open Air Sanatorium, Portland, Ore.,

Block Plan . . ,

\'ermont State Sanatorium, Pittsford, Vt.,

View of Front Elevation and Block Plan
Esse.x County Tuberculosis Hospital, Soho, N. J.,

\'iew of Buildings and Block Plan
Maine State Sanatorium, Hebron, Me.,

Block Plan . .

Preventorium for Children, Farmingdale, N. J.,

Bird's-eye View of Building and Block Plan



PAGE
20
22
26
27
28
29

30
31
32

33
34
35



SECTION II

Administr.ation Buildings

13 Adirondack Cottage Sanitarium, Saranac Lake, N. Y.,

Amusement Pavihon; Views and Plans. . . . .

14 Municipal Sanatorium, Otisville, N. Y.,

Servants' Open .\ir Sleeping Pavilion .....

15 An Open Air Dining Room ........

16 Portland Open Air Sanatorium, Portland, Ore.,

Amusement Pavilion; Interior ......

17 Catawba Sanatorium, Catawba, \'a.,

A Method of Storing Water .......

18 Waverly Hill Sanatorium, Wavc^-ly Hill, Ky.,

View from Rear of Buildings Showing Power House

19 Preventorium for Children, Farmingdale, N. J.,

Power House and Laundry; Elevations and Floor Plans.

20 District Tuberculosis Hospital, Lima, Ohio,

Floor Plan of Basement Showing Arrangement of Power Plant

21 A Rectangular Steam Disinfecting Chamber .....

22 Eudowood Sanatorium, Towson, Md.,

.\dministration Building; View and Floor Plans

23 Maine State Sanatorium, Hebron, Me.,

.\dministration Building; View and Floor I'lans

24 Iowa Stale Sanatorium, Oakdale, la..

Administration Building; View and Floor Plans

25 Manit()l)a Sanatorium, Ninette, Manitoba, Canada,

.\(hninistrali()n iiuilding; \'iews and Floor Plans

26 Indiana State H()s])ilal. Roikville, Ind.,

.\dministration Building; \'iew and Floor Plans

27 Preventorium for Children, Farmin'j;dale, N. J.,

.Administration Building; Elevation and Floor I'lans



40

41
42

43
44
46

47

48
50

55
57
58

59
61
62



10



Illustrations

No. PAGE

28 Municipal Sanatorium, Otisville, N. Y.,

Service Building; View and Floor Plans ........ 64

29 Iowa State Sanatorium, Oakdale, la.,

Service Building; \'iews and Floor Plans ........ 65

30 Catawba Sanatorium, Catawba, \'a.,

Sersice Building; Elevation and Floor Plan ........ 66

31 New Haven County State Sanatorium, Meriden, Conn.,

Ser\-ice Building; \'iew and Floor Plans ........ 67

SECTION III
Administration Buildings and Patients' Quarters Combined

32 Eastern Maine Hospital, Bangor, Me.,

Method of Protecting Sleeping Porch with Wire Netting. . . . . 71

^■^ U. S. Hospital for Insane, Washington, D. C,

Method of Enclosing Porch, with Swinging Sash Frames. . . -71

34 Sharon Sanatorium, Sharon, Mass.,

View and Floor Plan . . . . . . . .72

^^ Tuberculosis Hospital, Washington, D. C,

\'iew of F"ront Elevation ........... 74

36 Tuberculosis Hospital, Washington, D. C,

Floor Plans ............. 75

37 Lady Grey Hospital, Ottawa, Canada,

\'iew and Floor Plans . . . . . . . . . . -77

38 Lake Edward Sanatorium, Lake Edward, Quebec, Canada,

\'iew and Floor Plans ............ 79

39 Franklin County Tuberculosis Hospital, Columbus, Ohio,

Elevation and Floor Plans . . ■ . . . . . .81

40 Hartford County Tuberculosis Sanatorium, Hartford, Conn.,

\'iew and Floor Plans ............ 83

41 Cuenca Sanatorium, Bass Lake, ]\Iinn.,

Elevation and Floor Plans ........... 84

42 Association Sanatorium, Colorado Springs, Colo.,

Elevation and Floor Plans ........... 85

43 District Tuberculosis Hospital, Lima, Ohio,

Mews and Floor Plan ............ 86

44 .\ Design for a Small Town or Village Hospital,

Ele\'ation and Floor Plan ........... 88

SECTION IV
Hospitals for .Advanced Cases — Infirmaries .\nd Reception Hospitals

45 Comparison of the Floor Plans of Infirmaries, Reception Hospitals, and

Buildings Hou.sing .Vch^anced Cases ......... 90

46 Indiana State Hospital, Rockville. Ind..

.V Method of Connecting Rooms with Open Porches ...... 92

47 Isolation Hospital, Pater.son, N. J.,

.\ Method of Heating Porches for .\dvanced Cases. ...... 93

48 Riverside Hospital, New York City.

Concrete Pa\ilion; Elevation and Floor Plans ....... 05

49 Jewish Hosjjital for Consumptives, Reisterstown. Md.,

PaNdlion for Advanced Cases; Views of Elevations ....... 96

50 Jewish Hospital for Consiunptives, Reisterstown, Md.,

Pavilion for Ach'anced Cases; I'"loor Plans . . . .97

51 Indiana State Hospital, Rockville, Ind.,

Pavilion for .Vihanced Cases; \'iew and Floor Plans ...... 98

52 Isolation Hospital, Paterson, N. J.,

Pa\ilion for .\d\anced Cases; \'iew and Floor Plans ...... 99

53 LTnited States .\rmy General Hospital, Ft. Bayard, N. M.,

Officers' Quarters; \'iew and Floor Plan ........ 100

54 United States .\rmy General Hospital, Ft. Bayard, N. M..

Enlisted Men's Ward No. 2; \'iew and Floor Plan. ...... loi

55 United Stales .Vrmy General Hospital, Ft. Bayard, N. M.,

Enlisted Men's Ward No. 2; View of Inner Court ...... 102

56 Lakeville Tuberculosis Hospital. Middleboro. Mass.,

Pa\ilion for .\d\anced Cases; \"iew and Floor Plan ...... 103

57 Boston Consumptives Hosjiital, Maltajian, Mass.,

Ward for Advanced Cases; \'iew and Floor Plan . . . . .104

58 Maine State Sanatorium, Hebron, Me.,

Inlirmary; \'iew and Floor Plan .......... 105

II



Illustrations



No.

59 Municipal Sanatorium. Otisvillo. N. Y.,

Infirmary; \ic\vs of Front and Rear Elevations

60 Municipal Sanatorium, Otisville, N. Y.,

Infirmary; Floor Plans ......

61 Eudowood Sanatorium, Tovvson, Md.,

Infirmary; \'ie\vs and Floor Plan

62 Edward Sanatorium, Xai)or\ille, 111.,

Infirmar>- and Medical Building; Yiew and Floor Plans

63 Adirondack Cottage Sanitarium, Saranac Lake, N. Y.,

Infirmary and Medical Building; Yiew and Floor Pliins

64 Maryland State Sanatorium, Sabillas\ille, Md.,

Infirmary; Yiew and Floor Plans

65 Georgia State Sanatorium, .Vlto, (la..

Infirmary; \'iew and Floor Plan ....

66 Danvers State Hospital, Hawthorne, Mass.,

Pavilion; \'iew of Elevation and Floor Plan .

67 Ohio State Sanatorium, Mt. Yernon, Ohio,

Reception Hospital; View and Floor Plan . .



106



. 107


108


. no


III


112


. 113


. 114


. IIS



SECTION V

Patients' Quarters — Lean-to Type of Building for Incipient Cases

68 Comparison of Floor Plans of the Lean-to Type of Buildings

for Housing Incipient Cases ....

69 Catawba Sanatorium, Catawba, Va.,

An Open Porch Illustrating Simplicity of Construction

70 North Reading State Sanatorium, North Reading, Mass.,

An Open Porch Illustrating a Method of Protection

71 Virginia State Farm, Richmond, \'a..

Open Porch, Illustrating a Method of Protection .

72 Loomis Sanatorium, Liberty, N. Y.,

Open Porch, Showing a Method of Interior Finish .

73 Loomis Sanatorium, Liberty, N. Y.,

Lean-to; Yiew and Floor Plan ....

74 Michigan State Sanatorium, Howell, Mich.,

Lean-to; View and Floor Plan ....

75 Maryland State Sanatorium, Sabillasville, Md.,

Lean-to; View, Cross-Section and Floor Plan

76 Delaware State Sanatorium, Wilmington, Dela.,

Lean-to; Yiew and Floor Plan ....

77 Ohio State Sanatorium, Mt. Vernon, Ohio,

Lean-to; View and Floor Plan ....

78 Georgia State Sanatorium, .\lto, Ga.,

Design for a Lean-to ......

79 New Haven County State Sanatorium, Meriden, Conn.,

Lean-to; View and Floor Plans ....

80 Catawba Sanatorium, Catawba, Va.,

Lean-to; View and Floor Plan ....

81 Manitoba Sanatorium, Ninette, Manitoba, Canada,

Lean-to; View and Floor Plan ....

82 Edward Sanatorium, Naperville, 111.,

Lean-to; View and Floor Plan ....

83 Eudowood Sanatorium, Towson, Md.,

Lean-to; Yiew and Floor Plans ....

84 Iowa State Sanatorium, Oakdale, la..

Lean-to; \'iew and Floor Plan ....

85 Municipal Sanatorium, Otisville, N. Y.,

Lean-to; View and Floor Plan ....

86 Association Sanatorium, Louisville, Ky.,

Lean-to; View and Floor Plan ....

87 North Reading State Sanatorium, North Reading, Mass.,

Lean-to; View, Cross-Section and Floor Plan

88 Edward Sanatorium, Naperville, 111.,

Lean-to; View and Floor Plan ....

89 Iowa State Hospital, Mt. Pleasant, la..

Lean-to; Elevation and Floor Plan

90 Rush Hosfiital, Country Branch, Malvern, Pa.,

Lean-to; \'icw and Floor Plans ....

91 Loomis Sanatorium, Liberty, N. Y.,

Lean-to; View and Floor Plan ....



118
120
121
122
123
124

125
126
127
128
129
130

131
132

133
134

13s
136

137
138

139
140

141
142



12



Illustrations



No.
92

93
94
95



96

97
98

99

100

lOI

102

103
104

105
106
107
108
109
no



Michigan State Sanatorium, Howell. Mich.,

Design for a Lean-to ....
New York State Hospital, Raybrook, N. Y.,

Design for a Lean-to ....
Municipal Sanatorium, Otisville, X. Y.,

Lean-to; \'iew and Floor Plans
Preventorium for Children, Farmingdale, X. J..

Lean-to; Elevation and Floor Plans



SECTIOX VI
P.vTiENTs' Quarters — Cott.\ge Type of Building



Millet Sanatorium, East Bridgewater, Mass.,

Cottage; View, Cross-Sections and Plans
Rush Hospital, Country Branch, Malvern, Pa.,

Cottage; \'iew and Floor Plan
Adirondack Cottage Sanitarium. Saranac Lake, X'^. Y.,

Cottage; \'iew and Floor Plan
Association Sanatorium, Louisville, Ky.,

Cottage; View and Floor Plan
White Haven Sanatorium, White Haven, Pa.,

Cottage; \'iew and Floor Plan
Municipal Sanatorium, Otisville, X'. Y..

Cottage; \'iew and Floor Plan
Plainfield General Hospital, Plainfield, X. J.,

Cottage; Mew and Floor Plan
Iowa State Sanatorium, Oakdale, la..

Cottage; Mew and Floor Plan
Adirondack Cottage Sanitarium, Saranac Lake, X. Y.,

Wheeler Cottage; \'iew and Floor Plan
Gaylord Farm, Wallingford, Conn.,

Connected Cottages; View and Floor Plans
Barlow Sanatorium, Los .\ngeles, Cal.,

Cottage; \'iew and Floor Plan
Portland Open Air Sanatorium, Portland, Ore.,

Cottage; \'iews .....
Loomis Sanatorium, Liberty, X. Y.,

Orchard Cottage; \'icw and Floor Plan
Adirondack Cottage Sanitarium, Saranac Lake, X. Y.,

Xathan Cottage; \'ie\v and Floor Plan.
River Pines Sanatorium, Stevens Point, Wis.,

Cottage; Mew and Floor Plan



143
143
144

145



149
150
151

15^
153
154
155
156
157
158
159
160
162
163
164



13



Introduction



It is hoped that this work will be found useful by those who desire to design and
construct hospital and sanatorium buildings for the care of tuberculous patients.

The information presented has been collected during a series of investigations into
the methods and materials used in the construction of buildings at various institutions
where patients are treated for all varieties and stages of tuberculous disease. This book
is a development and expansion of the original pamphlet on construction, "Some Plans
and Suggestions for Housing Consumptives," published in 1909 by the National Associa-
tion for the Study and Prevention of Tuberculosis, and includes the results of studies made
on the question of sites, in order to determine in some degree the effect of location and
surroundings from both the clinical and economic points of view. During the past
two years, in a number of states, legislation has been enacted authorizing counties to
establish institutions for the treatment of tuberculous patients. The rapid growth of this
movement has brought about many new problems in the construction and maintenance of
hospitals and sanatoria, and it has been the aim to embody in this work such material as
might help in the solution of these difficulties.

Cost of Construction

It is the opinion of the majority of those who have had experience in constructing
and administering tuberculosis hospitals and sanatoria, that it is \nse to build in a compara-
tively inexpensive manner. Excellent results have been obtained by the open-air method
of treating tuberculous patients in institutions built on simple and economical plans; and
further, this class of institutions returns patients to their homes \\'ithout making them un-
duly discontented with the environment and life to which they belong. It may therefore
be said that those who adhere to simplicity and economy in sanatorium construction and
furnishing, and who supply patients with good wholesome food, cleanliness, light employ-
ment, and a happy, friendly atmosphere, are operating along modern and approved lines.

One of the first questions asked when the establishment of either a sanatorium for
incipient cases or a hospital for advanced cases is proposed in a community, is, "What
funds will be needed for constructing and maintaining the institution?" In general terms
it may be stated:

A Sanatorium for Incipient Cases, having a capacity of fifty patients, will cost to
build and equip (exclusive of the land) 825,000 and upward.

A Hospital for Advanced Cases, haNing a capacity of fifty patients, will cost to
build and equip (exclusive of land) 850,000 and upward.

A Hospital for Both Classes of Cases, ha\'ing a capacity of fifty patients, will cost
to build and equip (exclusive of land) $35,000 and upward.

In other words, it will cost to build and equip a complete institution for Incipient
Cases about S500 per bed; for Advanced Cases Si, 000 per bed; and for Both Classes of
Cases in the same institution S750 per bed.

14



Introduction



Cost of Administration Buildings

Administration buildings for an institution housing fifty patients can be constructed
for $12,000 and upward, the cost depending upon the material used and the exterior and
interior finish.

Cost of Infirmaries and Pavilions for Advanced Cases

Infirmaries and pa\dlions for advanced cases, having a capacity of twenty patients,
housed in single rooms, can be constructed for $10,000 and upward.

Cost of Lean-tos

Lean-tos ha\dng a capacity of sixteen incipient cases can be constructed for $800
and upward.

Examples of Appropriations

The following list is given in order to show how, in an actual case, $100,000 was
expended for the construction of a State Sanatorium housing one hundred and fifty patients
of all classes except the very far advanced cases.

Administration Building $31,500

Four Lean-tos (each $3,500) 14,000

Two Wards for Advanced Cases (each $7,000) 14,000

Power House and Heating Plant 5,000

Sewage Disposal Plant 2,000

Water Pumping and Supply Plant 5,ooo

Boilers and Machinery 3^300

Furnishings 7,000

Laundry 1,200

Land (Site) 5>5oo

Expenses of Building Commission ii»5oo

Total $100,000

The following is cited in order to show the distribution of an appropriation for the
construction of a County Hospital having a capacity for fifty patients, of all classes.

Site, Water Supply and Sewage Disposal $10,000

Administration Building 16,000

Ad\anced Case Pavilion (Twenty Beds) 10,000

Two Incipient Case Pa\ilions ($2,500 each) 5,000

Total $41 ,000

Arrangement of the Floor Plans for Administration Buildings

Many Administration Buildings constructed for Tuberculosis Hospitals or Sanatoria
have been designed on general hospital lines. This has not pro\-en to be the most satis-
factory type of building for administrati\-e purposes, as the medical stafY, nurses and ser-
vants are often arrested or cured cases of tuberculosis. Administration buildings that
seem best adapted for institutions of this class, are those constructed so that all persons
housed in them may haA-e, if desired, individual open-air sleeping porches. For this reason,
it is the opinion of many authorities that all buildings for tuberculosis institutions should be
of the open t\pe; that is to say, with walls pierced by as many windows reaching from the
floors to the ceiling as possible, and all apartments arranged so that they may be thrown



I







Introduction



open on at least two sides. Amusement halls, reading, dining and sitting rooms, which are
constructed as small individual buildings, and arranged to be opened on all sides when the
weather permits, arc being erected in greater numbers, and prove satisfactory. Buildings
used by the administrative departments, except in cities or towns where land is valuable,
are said to give better service when entirely separated from the patients' quarters. Where
sites are large enough, one-story buildings, even for administrative purposes, are becoming
popular.

Arrangement of Floor Plans for Pavilions for Advanced Cases

Pavilions for advanced tuberculous cases have also, in the past, been constructed in
the same manner as general hospital wards, but as it has been found that many advanced
tuberculous patients, with proper care, quickly improve under the open-air treatment, these
buildings are now being planned so that open porch space may be allotted to all the inmates,
and indi\ddual rooms pro\dded for all far advanced cases.

Arrangement of Floor Plans for Lean-tos

The only changes of importance, during the past months, made in designing the
lean-to type of building, have been in the pro\ision of larger lockers for each patient, and
in placing transverse partitions on the open sleeping porches in order to house the patients
in smaller groups. It may be said that practically all new designs call for lockers which are
large enough to be used as private dressing rooms, and in many instances fitted with a
chest of drawers, a mirror, racks for toilet articles, and other conveniences.

Transportation

The importance of keeping down the cost of maintaining an institution after it is
erected, should be always before those selecting the site and planning the buildings. Trans-
portation expense is one of the larger factors in this problem, and it is becoming clearer that
public institutions must be placed on or near good transportation facilities. In a number
of instances, railroad companies ha\'e willingly put in spurs or sicUngs free of charge, as the
sites chosen were near their right-of-way, and it is advisable that authorities, considering
the establishment of a sanatorium or hospital, consider this question with care before pur-
chasing an otherwise desirable property.

T. S. C.



i6



SECTION I
Site and Grouping



SECTION I
Site and Grouping



Sanatorium Sites

In selecting a site in the open country for a tuberculosis sanatorium, to house in-
cipient and moderately advanced cases, a decision must be made as to whether the advan-
tage of having the patients near at hand and accessible to their friends overweighs the
possible benefit to be obtained by placing the institution in a region more favorable from a
climatic point of view, but far from the patients' homes. It is now generally agreed that
in the treatment of tuberculosis excellent results can be obtained in practically any section
of the country and the desirability of local institutional pro\ision can be accepted as an
established fact. Within a short distance of almost every city and town, land can be
obtained where tuberculous patients will do well.

Transportation Facilities

Transportation facilities should always be carefully considered, as a long haul from
the railroad or landing adds expense both in building and maintenance. Probably in the
near future most of the institutions founded with the intention of housing over one hundred
patients, will be placed upon land that can be reached without great expense by a private
branch or spur from the nearest railroad, or by some other means of public transportation.
A site on a direct trolley line is very desirable in order to make it accessible to the patients'
friends. It is often hard to hold consumptives in a sanatorium, for the very sick do not
like to leave their families, and many incipient patients become restless when first com-
pelled to drop their regular occupations. If a sanatorium is close to the towns from which
most of the patients are drawn and where by a short trolley trip visitors can reach it easily,
the location will help very largely in making the patients contented.

Extent and Nature of the Land

The site should be a tract of land from twenty to two hundred acres in extent and
it will be more valuable for its purpose if it includes forest, orchard and land that can be
cultivated. It is now generally conceded that incipient patients improve faster when they


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Online LibraryNational Tuberculosis AssociationTuberculosis hospital and sanatorium construction, written for the National Association for the Study and Prevention of Tuberculosis → online text (page 1 of 12)