Tuberculosis Preventorium for Children in Lakewood Township, New Jersey was the first preventorium in the United States. It opened in July 1909, as an expression of Nathan Straus' desire to prevent the spread of tuberculosis among children. The children were selected mainly by the Association of Tuberculosis Clinics and were passed upon by the Department of Health of New York City. There were 32 of these clinics, to the nearest of which the parents applied. No discrimination was made as to race or creed, and there was no charge for transportation or board.
In 1910, the institution was removed to Farmingdale, New Jersey. What marked the buildings here were the dormitories, which were made without sash or glass, so that the children at night were sleeping practically in the open air, even in the winter. In 1914, there were at one time 200 children in the preventorium; these children represented 120 families. The executive committee of the preventorium, at first with some hesitation, determined to help the general tuberculosis campaign by giving employment by preference to tuberculous patients with the arrested disease—those who had been discharged from the various sanatoriums. In 1917, there were at Farmingdale 15 people in this class. Occasionally, one of these cases relapsed. The plan on the whole was successful, and the preventorium felt encouraged in what was called its auxiliary work.
One could become a member of the preventorium by payment of to per annum. The municipality of New York City contributed liberally.
This preventorium was a precursor of other similar institutions founded throughout the U.S. in connection with the larger municipalities. A number of them were subsequently established. The Tuberculosis Preventorium for Children closed in 1970, its services no longer being needed.
Background In the spring of 1909, it was decided to organize an institution for poorly nourished children exposed to tuberculous infection in their homes. At that time no such institution existed in the U.S.
Tests, by means of tuberculin reactions, which had been simplified and extensively used just previous to this time, had shown that in the U.S., as well as abroad, a large number of children of school age gave a positive tuberculin reaction. Furthermore, it became generally known that in large cities, such as New York, there were thousands of children far below average in physical development and slightly infected with tuberculosis, who were living under miserable hygienic conditions with members of the family suffering from communicable tuberculosis. There was no place to send these children to; in the summer, some could be sheltered for a few weeks in fresh-air homes; in the winter, a very few could be sent out of the city by unusual effort; but there was no institution in New York or the U.S. which had as its chief aim the care of this large group of afflicted children. Such was the basic social condition that led to the foundation of this preventorium.
The preventorium movement was not only part of the general tuberculosis campaign, a link in a long chain, of which other links are the various sanatoria for the tuberculous, the tuberculosis dispensaries, the boats, and the camps, but it was also a link in general child welfare work. Straus realized that there were thousands of children living in the tenements surrounded by tuberculous adults. Dr. Hermann Biggs, later the president of the Preventorium, estimated that New York City had 40,000 of these young children. It seemed that if any group of poorly nourished children was to get sick, it was these children who were not only predisposed to tuberculosis but also exposed to this disease.
In March 1909, Straus offered his interest in the Lakewood Hotel property for the care of poorly nourished children who were exposed to tuberculosis in their homes. He felt convinced that if these children became more physically fit by a visit to the countryside, with good food, fresh air, and a proper amount of rest and exercise, they would develop a definite resistance to this disease.
In order to start this work, Straus asked Marcus M. Marks to undertake the organization of such an institution for the prevention instead of the cure of disease, a preventorium rather than a sanatorium. Marks accepted the challenge and organized a board of directors composed of leading physicians, as well as active civic-minded women and men, and they all set to work to develop such an institution, to be viewed not only as a tuberculosis activity but also as a part of the child welfare work.
Establishment in Lakewood, New Jersey (1909)
The Preventorium had its beginning in May 1909, when possession was taken of the Grover Cleveland Cottage, in the Lakewood Hotel grounds. It was named after President Grover Cleveland who had passed some of the last weeks of his life here.
The cottage was adapted, under the personal direction of Frances Cleveland, widow of the President, the porch being arranged for six beds and the house for fourteen, these quarters being for girls. An open-air camp, about long was built to accommodate twenty boys.
The Preventorium began on a very small scale when it opened its doors in July 1909, to children at the Cleveland Cottage. There was at once a great demand for admission and a long waiting list of children anxious to be taken from their crowded homes to the healthy, free surroundings of the country, and the directors were soon nonplussed anew with the need for a large institution.
On November 9, after 92 children had been cared for, and all had shown steady improvement, Marks made the announcement that the institution was in successful operation. He said:—
Opposition in Lakewood In the winter of 1909–10, organized and determined opposition among the residents and property holders of Lakewood developed to the presence of the Preventorium, even though it was known that the institution did not admit any children who were tuberculous and who could in any way be a source of danger to their neighbors. The opposition was probably more because the encroachment of an institution in a residential section might lower property values rather than any fear of infection.
The efforts to thwart the Preventorium's existence began within a fortnight with the arrest of the Preventorium's superintendent on a charge of "bringing dependent children into the State of New Jersey". The next week, one of the trustees was arrested on the same charge. All possible means were resorted to in the effort to abolish the institution. Throughout the long and bitter fight, Straus gave unflagging support to the trustees but kept silent except on one occasion. He felt that the opposition was so ill-founded and so inhuman that it would soon defeat itself, but it was represented to him by a newspaperman that, as the originator of the plan to save children of tuberculous families from the harm that threatened them, the public desired from him some expression of his views upon the effort that was being made to throttle the Preventorium. He replied:
Relocation to Farmingdale, New Jersey (1910-1970)
At this point, Arthur Brisbane came to the rescue with a gift of a farm at Farmingdale, New Jersey north of Lakewood, with a beautiful hilltop as a building site. Straus made it possible to construct a new and model institution by the generous gift of for a building fund. With this money, together with other contributions, the new Preventorium was built. The 1910 construction had a capacity for 128 children, and cost, including water supply and sewage disposal, . The Board of Health Auxiliary subscribed to build an additional open shack, for which they would select the children.
A small farmhouse situated on this property was remodeled for temporary use, and the children transferred from Lakewood to Farmingdale on April 28, 1910.
The Farmingdale plant consisted of open-air dormitories for children, an administration building, a power plant, two open-air schools, and several other smaller buildings. All children were quarantined during their first three weeks at the Preventorium in a reception pavilion in order to prevent infection of the large group.
The children were admitted to the Preventorium through the Tuberculosis Clinics in New York City, and remained at the Preventorium for a period of three to six months. They gained weight rapidly, with an average of ten pounds. Initially, only children between the ages of four and fourteen were admitted. Extension of the work to include younger children was very important, as infants were particularly susceptible to tuberculosis. If newborn babies were taken away from a tuberculous mother immediately, before they became infected, their lives would probably be saved.
The work of the Farmingdale Preventorium was intimately connected with that of the many tuberculosis clinics of New York. During the stay of the children at the preventorium, the conditions in their homes were investigated. This was one of the most difficult problems encountered in the work. Some homes could not be improved. Others could be bettered by sending the tuberculous member to a sanatorium, by giving instruction in cleanliness and hygiene and the proper disposal of sputum, and by considering needs with relief organizations and obtaining aid or additional assistance. Every six months after discharge, the children were to be revisited in the home and their physical condition and surroundings were noted.
Admission
Applicants must be examined by a physician, preferably at one of the tuberculosis clinics, who would fill out and sign the medical report blanks, which were obtained upon written or personal application to the Hospital Admission Bureau. Blanks were filled out in duplicate and sent to the Bureau. The applicants were then placed on a waiting list from which they were drawn for a final examination by the Medical Examiner for Admission to the Preventorium to determine their acceptance or rejection.
A tuberculin test was made in every case, and a report of the result was entered upon the application blank. No child was admitted who had tuberculosis in an infectious stage. No children who were known to have been exposed to any of the acute contagious diseases within three weeks of the date of their final examination for the Preventorium were eligible at that time. The presence in the house in which the children live, of any acute contagious disease at the time of the final examination, also temporarily disqualified them. Moreover, the presence of hypertrophied tonsils, adenoids, carious teeth, or pediculi or nits in the hair could be a cause of non-acceptance until such conditions are corrected. In order to save time and labor for all parties concerned, it is, therefore, requested that nurses have these conditions remedied before bringing the children for examination.
Clinic nurses were notified of the date of the final examination which was held at the Hospital Admission Bureau. Children who were accepted went to the Preventorium within two or three weeks of the date of their acceptance. Nurses were notified five days in advance whenever possible, of the date of departure for the Preventorium. At the appointed hour they had to have their charges at the Hospital Admission Bureau. From here, the children were taken across the ferry by the nurse from the Hospital Admission Bureau to meet the Preventorium nurse. Children who did not appear for the final examination when directed were placed in the rejected list unless the reason for such non-appearance was promptly furnished.