Dispensary at Johns Hopkins' Hospital, and the University of Maryland Hospital Tuberculosis Dispensary.

The problems which chiefly concern the Tuberculosis Division in its efforts to control the spread of tuberculosis in Baltimore are the failure of physicians to report cases to the Department of Health until the patient is in a dying condition, and the inadequate provision for hospital care of advanced cases. These conditions are particularly marked in the case of colored patients, who are found going in and out of homes, restaurants, and laundries, as cooks, waitresses and servants of various kinds, as long as they are able to drag themselves about.

The nurses of the Tuberculosis Division are graduate nurses and are registered. They are paid $75 a month, with car fare and telephone expenses, and are allowed two weeks' vacation with pay. They are not required to take a Civil Service examination, but are carefully selected with a view to obtaining women of a high grade of efficiency. They wear uniforms of blue denim with simple hats and coats, but not of uniform design. Each nurse wears under the lapel of her coat a badge reading "Nurse—Baltimore Health Department," which she uses on occasions. The nurses report to the Superintendent each morning at 8:30 to hand in reports of the previous day's work, to stock their bags, and to receive new work for the day. At noon each nurse reports at her branch office, of which there are seven, each situated on border lines of adjoining districts. An hour is spent at the branch office for lunch and rest, for receiving telephone calls and for restocking the bags for afternoon rounds. The nurse leaves her district at four o'clock to attend to about an hour's clerical work, which is usually done at home.

The average number of patients per nurse is 212, about four per cent of whom are bed cases. These bed patients are visited two or three times a week, while ambulatory cases are visited on an average of twice a month. During the year 1912 the sixteen nurses made 72,058 visits for instruction and nursing care.

The oldest tuberculosis clinic in New York City is connected with the New York Nose, Throat and Lung Hospital; it was established

in 1894. In 1895, the Presbyterian Hospital established a special tuberculosis clinic. In 1902, the Vanderbilt Clinic organized a special class for the treatment of tuberculosis. In 1903, Gouverneur and Bellevue Hospitals and, in 1904, Harlem Hospital added Tuberculosis Clinics. These were followed during the next few years by the establishment of many others. In 1906, when the Tuberculosis Relief Committee of the New York Charity Organization Society began its work among the tuberculous poor of the city, it met at every turn instances of overlapping and duplication in the work done by the various clinics. This lack of co-operation, with the resulting difficulties encountered by the Committee in its endeavor to efficiently administer its special tuberculosis fund, demonstrated the advisability of forming an organization having as its object the co-ordination of the work of the various tuberculosis clinics. In 1908, nine of these clinics and several allied philanthropic agencies were organized into the Association of Tuberculosis Clinics. Today there are 29 clinics, 14 philanthropic institutions and organizations, five departments of municipal and state government, six tuberculosis institutions, and numerous other institutions and organizations having special interest in tuberculosis work. Of the 29 clinics, eleven are under the supervision of the Department of Health, three are connected with city hospitals, and the remainder are operated by private institutions. This voluntary association of private and municipal dispensaries, sharing equal responsibilities and acknowledging equal obligations, is a striking feature of tuberculosis work in New York and presents a unique example of co-operation.

The task of standardizing the clinics was a difficult one. One clinic had ten rooms with every convenience. Another had one room and no conveniences. Some clinics made no provision for sputum beyond a cuspidor; others provided gauze or paper napkins when patients entered the room. Two clinics provided no drinking water; two had a metal water cooler in the waiting room; one provided sanitary drinking cups; and another had two enamel drinking cups chained to the wall. Some clinics had sanitary fountains; in others the nurse kept a glass on hand for the patients. Neither was there any uniformity in matters of dress. Nurses and doctors at some clinics wore ordinary street clothes. At other clinics, gowns or aprons, with or without sleeves, were worn. Three clinics occupied separate buildings of their own. Four clinics provided separate waiting-rooms for tuberculous patients. At one dispensary the tuberculous patients had the use of the general waiting room, there being no other clinics held at that time; other clinics made no distinction,

tuberculous patients using the general waiting room in company with patients attending other clinics. After studying the conditions existing in the various clinics, it was decided that to belong to the association each clinic must subscribe to and comply with the following regulations:

Early in the history of the Association objection was made to this last rule by teachers of medicine, who held that it tended to deprive them of teaching material; but they soon fell in line with the other dispensaries when they saw the advantage it afforded them of improving their methods without loss of teaching material, and the further opportunity of securing home supervision.

From time to time it has been necessary for the Association to adopt certain methods of procedure in the administration of the various clinics. The general policy of the Association is as follows: