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Since the health departments of large cities have begun to classify tuberculosis as a communicable disease and to require all cases of tuberculosis coming to the notice of physicians or hospitals to be reported to such departments, a new question has arisen as to whether the management of the hospitals for tuberculosis should be placed under the Department of Health, as is the case with hospitals for smallpox, diphtheria, scarlet fever, and measles. As a matter of fact, many of the diseases which contribute most largely to the census of municipal hospitals are being found to be communicable, though not in the ordinary sense contagious. Pneumonia, influenza, typhoid fever, and many other diseases would fall within this latter classification, as also leprosy, certain skin diseases, certain eye diseases, and the venereal diseases. It has never been suggested that all these diseases should be transferred to the Department of Health, and it is the opinion of the writer that it is not desirable that they should be. Their proper care and treatment does not demand the unusual precautions which are requisite in hospitals for the treatment of the strictly contagious diseases. There is also, in the writer's opinion, grave danger that the burdening of the Health Department with the administration of large series of hospitals for infectious diseases would almost inevitably result in impairing the efficiency of the work of that department in those important lines that directly affect the health of the entire community, such as the protection of food supplies, especially milk and fruit, the protection of the water supply, the medical examination of school children, etc.

It is very important, however, that the Health and Charities Departments should work in complete co-operation and harmony, and that the Health Department should always be able to refer to the Department of Charities, for care in its hospital, cases of tuberculosis which come to its notice and whose circumstances and habits are such as to conduce to the spread of the disease. It may be that the Health Department should exercise its jurisdiction to the extent of requiring the retention at the hospital of the Charities Department of cases of tuberculosis who may wish to be discharged but whose circumstances are such that proper home care is out of the question, and who would spread the disease by frequenting lodging-houses, parks, and other public places, particularly those who cannot be made to take proper measures for the destruction of their sputum.

While the question of change of climate and change to a great altitude is considered much less important than formerly, it is likely that but few cities can find within their limits the proper location for a sanatorium for incipient or only moderately advanced cases of tuberculosis. Pure air, attractive surroundings, and opportunity for moderate exercise in suitable cases are not likely to be found in or in the immediate neighborhood of large cities. These municipalities should therefore be given statutory authority to locate sanatoria for consumptives outside their corporate limits. Such authority was conferred upon cities of the first class in the State of New York several years ago, but later legislation so hampered the exercise of this power, by requiring the consents of so many local authorities, that it is doubtful whether such sanatoria can be established without change of legislation. The authorities of New York City have the matter under consideration, and considerable examination as to available sites has already been made. If the city makes reasonable effort to proceed and finds itself unable to secure a suitable site by reason of local opposition, it cannot be doubted that the law will be changed.

VI.

Municipal charity administration, in common with other branches of municipal action, has always before it the problem as to what constitutes the most effective method of administration, an unpaid board whose membership changes but slowly, or a salaried commissioner, with definite term or subject to removal by the mayor. History is being made rapidly on this question. In 1897 the city institutions of Boston were removed from the jurisdiction of one paid officer, and placed under the jurisdiction of three boards of trustees, each board consisting of seven members, serving without salary. The best-known municipal hospital in New York City, -- Bellevue, -- with its three tributary institutions, was placed on February 1, 1902, under a newly appointed board of trustees, seven in number, serving without salary, the term of one member expiring each year. The objects sought to be obtained by this change were the elimination of partisan influences in the hospital, the establishment of continuity of policy in its management, and the securing of higher standards of efficiency in all branches of its service than had theretofore obtained. It was not claimed that such a board would be more effective than one official giving his entire time to his duties if that official were in all respects qualified for his position and assured of a reasonable tenure of office, but it was contended that the mutations of municipal politics in New York City were such that an appointment of the right kind of person for commissioner was to be regarded as a happy accident which might happen once in a great while, rather than as the usual type of municipal administration of this department.