While Dr. Trudeau was pioneering the study of tuberculosis and the sanatorium movement in the United States, a new public health reform movement was growing in the cities. In an effort to stop the spread of the disease, anti-tuberculosis societies were formed to educate the public about contagion and contamination. Visiting nurses and social workers in city tenements sought to improve the living conditions of the poor and to educate those confined to institutions. Broadsides were distributed discouraging such common practices as spitting and listing other rules for healthy conduct:
In New York and other cities departments of health advocated laws requiring doctors and health officials to register all persons diagnosed with TB. While these laws were made for the public good, insurance companies began to use the registry to deny benefits to those ill with TB. By 1908, eighty-four cities required registration of people with tuberculosis and disinfection of their lodgings. These procedures also led to discrimination when landlords refused to rent to the tubercular and employers refused to hire them.
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Another way to stop the spread of the disease was wholesale confinement - of the poor, especially. By the turn of the nineteenth century, sanatoriums had multiplied, and while the "worthy" poor might be able to take the cure in Saranac, others not so lucky were sent to institutions in cities, more often than not against their will. Riverside, in New York City, took in "undesirable patients" and others who were "sources of danger to their family" or lived in "unfavorable...sanitary conditions."
Still, sanatoriums were charitable institutions, and well into the 1920s, applicants outnumbered beds. These institutions reflected various ethnic and economic groups: in Denver and New York, sanatoriums were funded by the United Hebrew Charities; Gabriels (1897) in the Adirondacks was the first to admit black patients; Stony Wold Sanitorium near Saranac Lake "was opened by a Trudeau admirer to treat working girls in the initial stages of tuberculosis." Other facilities, however, tried to "screen out those who were friendless, single or homeless, or who had a criminal record or physical disability." Some of the poor were sent to Otisville in the Catskills for a "work cure," with a three month time limit. For many of the afflicted, a public sanatorium was a place of last resort, and they left as soon as they could - most against medical advice.
