every 100 patients on the clinic register.

That the Association found it necessary to make so many recommendations for the administration of the various clinics is evidence of the diverse systems, and in some instances, the entire lack of system, in vogue in some dispensaries. The salary of nurses in privately operated tuberculosis dispensaries averages about $75 per month; no standard uniform is in use.

The first tuberculosis visiting nurse of the New York Department of Health was appointed March 1st, 1903. By January, 1910, the staff had grown to 158, the Health Department becoming practically responsible for the home supervision of every registered case of tuberculosis in New York not under the care of a private physician or in an institution.

The organization of the work of the new Health Department tuberculosis nurses has been based upon the district system in force among the Associated Clinics. In each clinic district a staff of Health Department nurses is maintained, charged with the sanitary supervision of cases of pulmonary tuberculosis in that district. They visit at least once a month all "at home" cases; that is, cases not regularly attending clinics, not in an institution, or not under a private physician's care. These nurses report daily at the tuberculosis clinic, which is used as a district headquarters, and there receive assignments. One nurse is detailed as Captain, or supervising nurse of the district, and acts as official intermediary between the clinic and the Department of Health. Each morning the nurse telephones to the Department of Health the daily report of her staff and

of the clinic, and obtains information received at the Department regarding cases in the district. In case of death or removal of tuberculous patients from a home the district nurses order disinfection of the premises and bedding; they make arrangements for admission of patients to hospitals or sanatoria, investigate complaints made by citizens, see that regulations of the Department of Health regarding expectoration are observed, and use their authority to induce delinquent cases to resume attendance at the proper clinic. They also visit families of patients in hospitals at intervals. Each nurse keeps a complete index of all cases of pulmonary tuberculosis in her district, which is at all times accessible to nurses and physicians at the clinic.

In the Department of Health clinics, the plan is as follows: a supervising nurse who does no district work, and several field nurses, each assigned to special duties on clinic days, such as registration room, throat room, examining rooms, etc. Field nurses are also responsible for the care of patients in their sub-districts, each nurse carrying an average of about 125 patients on her visiting list at one time.

A staff of twenty-five nurses, working from the Out-patient Department of the Boston Consumptives' Hospital, has the supervision of all tuberculosis cases in their homes, and the follow-up work on all discharged sanatorium and hospital cases in the city of Boston.

All cases of tuberculosis reported to the Health Department, whether under the care of a private physician or not, are visited at least once by a nurse from this staff, to see that they are carrying out a proper plan of isolation.

The Boston Consumptives' Hospital Dispensary, centrally located, is open every morning and one or two evenings a week. Three or four nurses are on duty in the clinic each morning, taking histories, attending nose and throat room and preparing patients for examination. At the dispensary only a medical history of new patients is taken, the social history being obtained by the nurse on her first visit to the home. Pulse, temperature and weight are also taken at the dispensary, after which the patient waits his turn for examination. Each new patient is given an examination in the nose and throat room; old patients also, if necessary. After examination or treatment, all patients return to the general waiting room. From here each patient is called before the Chief of Clinic, who notes the general progress of the patient, the results of the last examination

or any remarks recorded by the physician, and the report of home conditions as reported by the nurse. The Chief of Clinic advises the patient in accordance with the needs indicated. He makes no examinations, but sees each patient every time he comes to the clinic and is thus able to follow very carefully the progress of each patient and to advise such changes in treatment as may seem necessary.

The city is divided into twenty-two districts, each nurse being responsible for the care of all tuberculous patients in her district. The number of patients cared for by each nurse is from 100 to 180. A very small percentage of bedside care is given; far advanced patients as a rule are sent to hospitals.

Boston tuberculosis nurses do not wear uniforms. They are paid $900 a year, with no increase for length of service or efficiency.

The purpose of the Buffalo Association for the Relief and Control of Tuberculosis has been to stimulate progress in fighting tuberculosis. It very modestly shares with the city officials and with private charities the credit for the work accomplished. All it claims for itself is that it has been able, and will continue, to "point the way." How thoroughly it has succeeded in this may be seen by the progress made since 1909 when the Buffalo Association made its first appeal for funds. At that time Buffalo had:

The present facilities are: