a French physician, belongs the immortal fame of being the first to show the essential distinction in tuberculosis

between the virus causing the disease and the lesion produced by it. By inoculating animals, he demonstrated that tuberculosis is a specific disease caused by a specific agent. His paper presented in 1865 before the Academy of Medicine in France contained a detailed account of his experimental investigations. This was a most remarkable contribution to scientific medicine.

It remained for Robert Koch in 1882, after years of painstaking investigation, to announce to the world the discovery of a definite bacillus as the causative agent in all forms of tuberculous lesions. Koch isolated, cultivated outside the body, described and differentiated the infective organism of tuberculosis and proved that it could continue to produce the same lesions indefinitely. He showed the presence of the bacilli in all known tuberculous lesions and in tuberculous expectoration, and demonstrated the virulence in sputum which had been dried for eight weeks.

Following directly upon the knowledge of the cause of tuberculosis came the recognition of its curability, and the proper means of its prevention. Although good food and fresh air have always been considered of importance in the treatment of the disease, it was not until the middle of the nineteenth century that anything like systematic treatment was undertaken.

Dr. George Bodingon of Sutton Coldfield, England, wrote an essay in 1840 advocating fresh air treatment. He denounced the common hospital in large towns as a most unfit place for consumptive patients, and established a home for their care, but met with so much opposition that it was soon closed.

In 1856, Hermann Brehmer wrote a thesis on the subject which has been the foundation of our modern treatment. He opened a small sanatorium in 1864. Five years later he established the sanatorium at Goerbersdorf, in Silesia, which eventually became the largest in the world. He advocated life in the open air, abundant dietary and constant medical supervision. He believed that the heart of the large majority of consumptives is small and undeveloped, and that this predisposes them to the disease. In accordance with this theory he put a great deal of emphasis on exercise in the treatment of his patients. He built walks of various grades on the grounds of his sanatorium and installed a system of walking exercise. Patients began with the lowest grade, gradually accustoming themselves to ascend to the highest. Brehmer was himself a consumptive, and was cured by the method he so firmly believed in.

Dr. Dettweiler, who opened the second sanatorium in Germany, at Falkenstein, near Frankfort, was also a consumptive, having developed

tuberculosis during the arduous campaign in the Franco-Prussian War in 1871. He entered the Goerbersdorf Sanatorium as a patient, becoming later an assistant of Brehmer. Dr. Dettweiler laid great emphasis upon rest in treatment.

In 1888, Dr. Otto Walther opened his famous sanatorium at Nordrach in the Black Forest, in Germany.

The first sanatorium for the care of the consumptive in the United States was opened at Saranac Lake by Dr. Edward L. Trudeau in 1884. He was the pioneer of the sanatorium treatment in this country, and an example of what a man, although tuberculous himself, can do for his fellow men. In 1874, a seemingly helpless invalid, he made his home in the Adirondack Mountains. A little more than twenty-five years ago he became the founder of a village now crowded with tuberculous patients. The Saranac Lake institution, which began with one small cottage, has since developed into the best known sanatorium in this country.

In 1891, Dr. Herman Biggs posted the first anti-spitting ordinance in the street railway cars of New York.

Dr. Lawrence Flick brought about the formation of the first anti-tuberculosis society in 1892, and in 1894 the City of New York adopted a law to enforce notification and registration.

Dr. Philip of Edinburgh was the first to systematically and completely organize the anti-tuberculosis campaign. In 1887 he inaugurated that new institution, the anti-tuberculosis dispensary, which has since rendered such inestimable service. The fundamental principle of the Edinburgh system is that the disease should be sought out in its haunts.

The first dispensary in the United States was opened in New York in 1904, modeled after the Edinburgh system. About the same time came the Open Air Schools—Charlottenburg establishing one in 1904 and Providence, R. I., following in 1908. The first Day Camp in the United States was opened in 1905 in Boston. New Jersey established the first Preventorium for Children at Farmingdale in 1909. All this naturally led to better provision for advanced cases; sanatoria for hopeful cases at small cost; factory inspection; and, in some countries, industrial colonies for arrested cases.

The tuberculosis patient of today presents a hopefulness previously undreamt of. The outlook is brighter with promise than ever before, and we have every reason to look forward to a steady reduction in the mortality rate from this dread disease; but the extinction of tuberculosis will be achieved only when the social and economic problems have been solved.

VISITING TUBERCULOSIS NURSING IN VARIOUS CITIES OF THE UNITED STATES

In 1903, the first visiting tuberculosis nurse was assigned in Baltimore to follow up patients of the Johns Hopkins Hospital Out-patient Department. Her duties were varied as are the duties of the present day tuberculosis nurse. She was to instruct patients in the use of sunlight and fresh air and was allowed to furnish them with special diet in the shape of milk and eggs. She investigated home conditions and helped improve sleeping quarters. She placed patients in sanatoria, or brought them back to the dispensary for treatment. She gave bedside care to advanced cases, if she could not get them into hospitals, and applied to relief organizations for help in solving the problems of the family. From time to time other nurses of the Baltimore Visiting Nurse Association were assigned to the work, other dispensaries and agencies began referring cases to be followed up, and the work grew to such proportions as to be almost unmanageable for a private organization.

In 1910, the Tuberculosis Division of the Baltimore Health Department was organized. It began its activities with a corps of fifteen nurses and a visiting list of 1,617 patients turned over to it by the Baltimore Visiting Nurse Association. The object of the Tuberculosis Division was to bring under the supervision of the Health Department all persons in the city suffering with pulmonary tuberculosis. Ambulatory cases were to be given advice and instruction; advanced cases, bedside care, if needed, or hospital care, if available. At present, it is upon the advanced cases, as well as those who are in contact with them, that the nurses of the Tuberculosis Division concentrate their efforts. The Staff at present consists of a Superintendent and sixteen Field Nurses. The city is

divided into sixteen districts, a nurse being assigned to each district. Each nurse is responsible for the care of all cases of tuberculosis in her district.

In 1912, the Tuberculosis Division opened two municipal tuberculosis dispensaries. These dispensaries receive patients on alternate days from 3 to 5 p. m., nurses in districts nearest the dispensaries alternating for clinic duty. Other dispensaries are the Phipps Tuberculosis