To the historian of the future the name Otisville will be associated with one of the great sanitary advances made in this country, namely, the establishment, by a municipality, of a tuberculosis sanatorium outside the political limits of that municipality. The establishment of such a sanatorium was first suggested in 1889. At that time, however, not even a medical sentiment was ripe for such a movement. In the succeeding fifteen years, little progress was made toward a realization of these plans, and it was not until Dr. Thomas Darlington became commissioner of health that any tangible results were achieved. He proved an aggressive and resourceful champion. With political, corporate, and private interests leagued together to prevent the city from acquiring a site, it was largely owing to the indefatigable labors of Dr. Darlington that the most determined opposition to the plan was overcome. After carefully examining many sites, it was finally determined to establish the sanatorium at Otisville, a little village lying in the Shawangunk Mountains, and about seventy-five miles from New York City. As a southern exposure was desired, the grounds, covering an area of over 1,400 acres, were selected on the southeastern slope of one of the most picturesque and most favorably situated mountains of the entire range. The grounds have an altitude varying from about 800 feet to 1,500 feet above sea level. The sanatorium property consists of what were formerly thirteen separate farms, which were purchased at different times during the years 1905 and 1906, the health department first taking possession for the city of New York on December 1, 1905. To avoid delay in establishing the institution on a working basis, it was deemed best to renovate and remodel the buildings on the property, and use them until such time as the needs of the sanatorium would require the erection of new ones. By July, 1906, the institution was ready to receive its first patients, and a year after that date had accommodations for about 100. Since the sanatorium is designed for the treatment of those ill with tuberculosis in the early stages of the disease, there is only a small building for hospital accommodations. The rest of the buildings, in which the patients practically live outdoors, are portable houses and shacks. All the frills and ruffles so universally connected with the construction of public buildings have been omitted; everything has been subordinated to that which is best for the patients.