CHARITIES THE OFFICIAL ORGAN OF THE CHARITY ORGANIZATION SOCIETY OF THE CITY OF NEW YORK. ENTERED AS SECOND-CLASS MATTER AT THE NEW YORK, N. Y., POST-OFFICE. Issued every Saturday. Five cents a copy. Subscription price, one dollar a year, in advance. Three dollars a hundred. ADVERTISING RATES. Classified advertisements, 5 cents a line, eight words to the line, agate measure. Display, 5 cents a line, 14 lines to the inch. Full page, 200 agate lines, $10. Half page, 100 agate lines, $5. Quarter page, 50 agate lines, $2.50. Special position, twenty-five per cent additional. EDWARD T. DEVINE, Editor. PUBLICATION OFFICE: NEW YORK, OCTOBER 6, 1900. We publish this week a suggestive article from Dr. S. A. Knopf, who is the author of a valuable work on the Prophylaxis and Treatment of Pulmonary Tuberculosis, and whose name has often appeared before in our columns. The paper read by Dr. Knopf on Tuberculosis and the Tenements, at the conference held by the Tenement House Committee in February, has been republished by more than half a dozen medical periodicals. It may seem slightly ungracious to suggest that money given for a particular charitable purpose might better be spent for another and quite distinct purpose. The alternative is seldom really presented. It frequently happens that the contribution, if not made for the special object which has appealed to the imagination and sympathy of the donor, would not be devoted to charitable objects at all, although there are no doubt some who are so conscientious and broadminded that they would be open to conviction as to the relative importance of different needs. Any attentive reader of CHARITIES will understand our entire acquiescence in the views expressed by Dr. Knopf as to the need for suitable hospital provision for consumptives. With increasing frequency demands which can not be ignored are now made at the offices of all charitable societies, for the relief of patients in the incipient stages of consumption, who can be cured only by prolonged hospital care, or by residence with medical treatment in a climate suitable for recovery. We also take pleasure in publishing a letter from Rev. David H. Greer, D. D., the rector of St. Bartholomew's Church, which is in part an indorsement to Dr. Knopf's article and in part a rejoinder. Dr. Greer is doubtless justified in his strictures upon some of the dispensary statistics that have been published, and upon the possibility of exaggeration in current statements as to persons of large means who apply for free treatment. For the first of these errors the dispensaries are themselves chiefly responsible. It has been a frequent practice to publish the total number of applications as if this indicated the number of beneficiaries. We believe, nevertheless, that there has been in the past a serious abuse of such free treatment, and that the greatest precautions are necessary to prevent such abuse, not in the interests of struggling physicians, but in the interests of the masses of the people for whom Dr. Greer especially pleads. If at the present time we were in position to influence any considerable contribution as between the two needs, we would unhesitatingly advise increased provision for consumptives, as we believe that this is the more urgent need. * We print on another page the estimates of the Department of Charities for the coming year with some interesting explanations from. the commissioner. From a printed statement, submitted to the Board of Estimate and Apportionment by the State Charities Aid Association, we are gratified to learn on so good an authority that there have been noticeable improvements in the administration of the public charities during the past year; that in all the institutions higher standards of administration have been observed, and that cleanliness and good order have been general. The association recommends larger salaties in several instances in order to secure a proper grade of service. For example, the female helpers in Bellevue Hospital are now paid $10 to $12 a month, while the corre sponding grade of service in private hospitals commands $14 to $16 per month. Add to the low wages, the dismal and forbidding character of the sleeping quarters provided, and it is easy to understand, as is pointed out in the pamphlet, that the female helpers in Bellevue Hospital are largely of an inefficient and undesir able type, and that every pay day there are large numbers of vacancies. Among the recommendations made by the association not included in the estimates submitted by the commissioner, are the erection of nurses' homes at the City Hospital, at the Almshouse, and on Randall's Island; several alterations in the various hospitals; and, at the Almshouse, better bathing facilities, rooms for storing men's and women's clothing, a new tailor shop, and dining rooms on the ground floor of the pavilion for the blind. A PROTEST AGAINST THE ERECTION OF ANOTHER DISPENSARY AND A PLEA FOR SHELTER AND TREATMENT FOR THE CONSUMPTIVE POOR. S. A. KNOPF, M. D. During the last weeks the medical and lay papers of this country, and particularly of the city of New York, told us of the magnificent gift from Mrs. Caroline Hoagland to the St. Bartholomew's Church, Madison. avenue and Forty-fourth street, of which the Rev. Dr. David H. Greer is rector. It is stated that a sixstory building will be erected which is to serve as a medical dispensary and clinic, and for which not less than $200,000 is to be expended. The dispensary is to be built on the 50 by 100-foot plot at 215 and 217 East Forty-second street, which adjoins the mission house of the church. This is truly a magnificent gift, and the noble woman who is the donor has certainly been guided by the best motives in stipulating the conditions of the disposition of the donations. But on reading the details of this announcement, one familiar with charity and dispensary work in New York can not but feel painfully impressed by this projected enterprise. There is not a city in the world where there is so much dispensary abuse as there is in the city of New York. From the latest very carefully compiled report of the New York State Board of Charities I quote the following (page 45): "It is practically agreed among those versed in the true principles of philanthropy that beneficence is lacking in any form of charitable assistance which works material injustice to the interests of those who do not seek charity, or which is not so safeguarded as to prevent the continued dispensation of relief to those who do not require aid. Most of the dispensaries of New York violate both of these principles, and their managers apparently are not (and never have been) in the temper to come to some mutual understand ing whereby better conditions shall prevail. In a large degree and for various reasons they have become competitors for business to such an extent that it is probable that nearly one-half of the inhabitants of New York are now receiving practically free medical treatment. That this is a wrongful state of affairs and produces an unfair competition with physicians who (unlike the dispensaries) are not partially supported by charitable donations, admits of no question. That it is also extremely pauperizing in its tendencies is equally true." The far too large number of already existing dispensaries has made such conditions possible. Our statesmen in Albany have realized that this evil should be remedied, or at least not be allowed to increase, and a Dispensary bill was passed recently whereby it will no longer be possible to conduct a dispensary with out having obtained a license from the proper authorities. There will probably be no difficulty for so honorable an institution as St. Bartholomew's Church to receive this license. The building will not only be elegant, but it will be equipped with all the latest improvements and implements, assuring a thorough hygienic and scientific working. Furthermore, I have no doubt that only most competent physicians will be engaged to give their services to the institution. Thus the convenient location, the ele gance of the building, and the excellent medical and surgical care will attract a selected clientèle. Perhaps the majority of the patients of the future St. Bartholomew's Dispensary will be able to pay, and would pay could they not get valuable advice so conveniently for nothing. On the other hand, the sufferers truly in need will often be crowded out by this so-called better class of dispensary patients. But there is really no need in New York for another free dispensary and clinic for general medical and surgical diseases. Let those interested in this new enterprise consult a number of our best known physicians and workers of the organized charities as to the need of the contemplated institution. I am sure the answer to the inquiry will be: No more dispensaries, no more clinics. We have already too many of them. In the description of this projected institution "for the relief of human suffering," it is distinctly stated that "there will be a small room for the detention of patients having infectious disease who got into the dispensary by mistake." And it is just for the patients having an infectious disease, particularly those suffering from tuberculosis, that a shelter is needed, not to speak of a proper sanatorium, where these people, suffering from a preventable and curable disease, should have been taken before their cases became hopeless. For the more than ten thousand consumptive poor living in the tenement districts of New York there is virtually nothing done. The public hospitals are crowded with patients suffering from acute diseases or accidents. What spare beds they have are always occupied by the few consumptives to whom admittance had been promised so long. Cases like the one of Dennis Kenney, a consumptive in the last stage of the disease, who was discharged from the Metropolitan Hospital on September 7 and was found the next day in a very precarious condition at Forty-fifth street and First avenue, are more numerous than one would think possible. The only difference between this case and the majority lies in the fact that Kenney had been in a hospital, while hundreds of consumptives applying for admission in general hospitals have never been received in any. Yet we should not always blame the authorities of the public hospitals for their unwillingness to take chronic consumptives into their wards. They know that a general hospital is ill adapted to the care and treatment of consumptives. Only specially arranged institutions for such cases can do effectual work. Furthermore, experience has taught that it is very unsafe to put a consumptive in the same ward with patients suffering from typhoid fever, pneumonia, or other acute diseases. No one is more in danger of taking tuberculosis from his consumptive neighbor in the ward than a patient suffering, or even recovering, from typhoid fever or some other debilitating disease. There is an urgent need for a large city hospital for the exclusive treatment of the consumptive poor. Hospitals supported by private con tributions will but very rarely take a tuberculous case. The few existing institutions which receive consumptives can scarcely accommodate 500 of these invalids. What becomes of the rest? Those who desire to know I would advise to visit a few of these sufferers in their tenement homes. The visitor will see more misery caused by this one disease than by all others combined. In dingy, dark rooms the poor consumptive lives often without medical attendance, but nearly always without the proper food and supply of fresh air so essential in the combat of this disease. Some faithful member of the family remains at home to nurse the sufferer, and in the majority of cases contracts the disease as a result of this devotion. We will see the faithful wife nursing a consumptive husband in the last stage of the disease, and on examining her we will discover that she suffers already from incipient tuberculosis. tuberculosis. If there are children, they, too, may fall victims to the malady owing to the ignorance or carelessness of the sufferer and to the receptivity to disease of badly housed and underfed humanity. Yet could we take this invalid, hopelessly ill, away from the dreary tenement home to a special hospital, where he could be made comfortable, we would do away with a center of infection which constantly endangers the lives of his own family, neighbors and friends, and thus indirectly save, perhaps, many valuable lives. But not only a shelter, that is to say, a special hospital for the advanced cases of pulmonary tuberculosis, is needed in or near our city, but of equal urgency is the creation of a country sanatorium at not too great a distance from the city, where patients suffering from incipient consumption could be taken and cured. The reports of European sanatoria and of the very few of our own country, which treat early cases of pulmonary consumption, are indeed highly encouraging. Some have fifty, some seventy, and some even ninety per cent of cures, and this after a relatively short sojourn in such an institution. These sanatoria are not only healing institutions, but they are schools of public hygiene. Patients remaining a few months in such a sanatorium will receive lessons in proper living, in sobriety, and, above all, will learn how to take care of themselves and how not to propagate the disease by their expectoration. Had we such a sanatorium near the city of New York, we could take away the poor woman who contracted tuberculosis in the perform ance of her duty as wife and nurse of her consumptive husband, and give her from sixty to ninety per cent chances of becoming cured, while under existing conditions she is almost certain to follow her husband ere long, and the children will become a public charge. Tuberculosis among the poor is a very serious problem, and the misery. caused by the disease, which could be prevented, and in many instances cured, is beyond description. But strange as it may seem (in our country at least), there is less done for these unfortunate ones than for any other class of sufferers. We have palaces for the insane, hospitals and sanatoria for the habitual drunkards -the consumptive poor alone has no shelter. I trust that these lines may not only reach the noble woman who is about to give $200,000 for the relief of suffering mankind, but also her advisers and many other philanthropists who are willing to help, and help in the right direction. I repeat there is nothing more urgently needed in the city of New York than a large special hospital for the care of the more advanced cases of consumption and a spacious sanatorium where men and women suffering from the earlier stages of the disease can be cured and be made useful members of the community and breadwinners of their families. May this plea to the noble-hearted and generous American philanthropists not be in vain. A REJOINDER TO DR. KNOPF. OCTOBER 2, 1900. To the Editor of Charities: With much that Dr. Knopf says I am in full agreement. We not only need a home for consumptives, but also a home or homes for persons who are afflicted with nervous disorders. We are constantly meeting, in our work on the east side, a number of young women who are breaking down under the strain of their work, and who ought to go to some sanatorium for treatment; but there are not very many places where they can go, except at a very high charge. We are In regard to what Dr. Knopf says about dispensaries, and incidentally about St. Bartholomew's, I have nothing to say except what I have so often said before. The statement which he quotes, and which has been time and again repeated, about one-half the people of New York receiving free medical treatment, is not based in my judgment upon exact statistical information. reported, for instance, as having treated over 25,000 cases last year at St. Bartholomew's. The fact is, however, we only treated about 6,000, many of whom were treated three or four times; and even these 6,000 were not all new cases, but came to the dispensary at intervals of several months, and yet every time they came they were counted, and counted too in every depart ment of the dispensary in which they made application. What is true of our dispensary is doubtless true of many others. I think, too, that there has been a great deal of cheap and superficial statement about persons coming to dispensaries who are able to pay. As far as I have been able to observe, and I have looked into the matter very closely, such cases are |