be up and about in the street cars or in their homes, infecting you, me, our children, and everybody else if they have a chance to do so, but surely reinfecting themselves and retarding their

recovery.

Now, the object of the special tuberculosis dispensaries to which I allude is two-fold. It is to treat the ambulant cases: it is to teach them how to prevent infection of others and reinfecting themselves. Thus, they can have actually a chance of becoming well. The incipient tuberculous patient is one of the most curable of all patients in the world. Intelligently treated, taught how to live, particularly taught that alcohol is not a specific for tuberculosis, directed to the kind of work he can do, or told what he must do, and last but not least supplied with a sufficient amount of food, he has a chance to get well, even in New York.

I proposed the subject to Mr. Devine of the Charity Organization, and to Mr. Tucker of the A. I. C. P., and both gentlemen promised me that if we had a special tuberculosis dispensary in New York, they would see that the patients who were treated by it hygienically, medicinally and educationally, could receive meals through the societies they represent, and thus would be treated dietetically as well. I am convinced that with the help of these two societies and the diet kitchen we could cure many an ambulant tuberculosis patient, who now is doomed to become gradually worse and finally hopeless.

Now I venture to say that the average dispensary as it exists to-day is almost a farce for a tuberculous patient. I will tell you of a little experience I had in treating tuberculous patients. When I was attached to dispensary work and a tuberculous patient came in, I, of course, frequently prescribed a tonic, and it happended more than once that the patient came back after a week or so unimproved. Upon inquiry I ascertained that the patient had taken his tonic regularly and that his appetite had really improved. He had, however, not enough to eat, having had a

square meal only at rare occasions, and the tonic had only increased his desire for more food, which, owing to his poverty, he could not obtain. These are the difficulties which make a successful treatment of tuberculous patients in existing dispensaries in the majority of cases an utter impossibility. I, therefore, appeal strongly to you to assert your influence for the creation of special tuberculosis dispensaries.

Mrs. HENRY VILLARD.- I welcome this opportunity to bring before the Conference the work of the New York Diet Kitchen Association, of which I have the honor to be the President. All the more, because no mention of this charity has been made in your program nor has any speaker, who has preceded me, referred to it; yet it certainly is a subject of vital importance.

Perhaps the name Diet Kitchen - does not quite express the character of our work, but we have found it very difficult to designate it so plainly, that it will not be misunderstood. It has for its object, simply, the furnishing of nourishing food to the sick poor in their homes. An incalculable amount of good is done for sick babies and old people, especially during the hot weather.

We have only five kitchens and the doctors tell us that twenty would not suffice for the needs of this great city. They are run most economically. Some are given to us free of rent and for the others but a small sum is paid. The salaries of the matrons are not large and all the rest of the money, every cent of it, goes for the food which consists mostly of pure milk, beaf tea, rice, bread and eggs when they are donated.

The matron dispenses the milk from nine to one o'clock, in the morning, upon the presentation of requisitions given by house and visiting physicians. In the afternoon, she visits the patients, putting them in touch with other charities and acting as a good Samaritan in many ways. We are so fortunate as to have, in one kitchen, a trained nurse.

Let me beg every one of you to remember the needs of this Association. It is a pity that such a charity should not be adequately supported. We find it difficult to carry on five kitchens and we feel that the nature of the work is not understood therefore, we wish, that in all future Conferences, we shall not be forgotten. We constantly supplement the efforts of the doctors who rely, more and more, upon milk and other nourishing food as important factors in the saving of human life.

During the year 1900, we gave out 308,090 pints of milk; 296,012 portions of rice; 1,454 portions of broth; 95 dozens of eggs; 3,109 loaves of bread and 24,683 rolls. Twenty-one thousand five hundred and seventy-four patients have been assisted, the total expenditure being $9,253.40, of which $6,167.55 was paid for milk alone.

We have an endowment fund of $29,886.26, and greatly need to increase it.

Dr. STEPHEN SMITH.- I am very familiar with the work of the New York Diet Kitchen in connection with the dispensaries of this city. One of the most active and efficient persons in founding this charity was its first President, Mrs. Abby Hopper Gibbons, to whom the city and the State are indebted for the existence of some of their most useful charitable and reformatory institutions. The Diet Kitchen formerly received a small annual appropriation from the Actors' Fund. Its good work among the sick poor who visit the dispensaries for medical relief commends it to the liberal support of the community.

Mr. C. C. SAVAGE. I commend this Diet Kitchen as a side issue, because we have found the benefit of it in the Demilt Dispensary.

I commend your report with two exceptions. The first exception is to the giving of power to the medical board instead of giving the power already existing in the trustees. I have had an ex

perience of sixteen years in hospital management, and I am able to judge from that whether the trustees should be ignored as they are in this report, or not. I believe the trustees should have more power and their staff can do the work better under direction of the medical board than they can if the medical board do it alone. It frees the medical board from many jealousies which would otherwise exist.

Dr. SMITH. Mr. Savage, I would like to correct you. I think that the report states that the managers are supreme in their authority and the board is subordinate to it. There is no such position taken.

Mr. SAVAGE.—I understand the report to be that the medical board should have all the authority.

Dr. SMITH.No. They should do all the work; the managers supervising it.

Mr. SAVAGE. The managers have to do a great deal of the work.

The second point I want to make is, you recommend the matron should have charge of the nurses. I think in a large hospital that would be found impracticable. The directress of nurses, if she has a large hospital, has all she can do and all that she ought to do in instructing, in watching, in caring for and seeing the nurses do their duty. The matron has sufficient to do in looking after the help, in mending and things of that kind. Those are the two points to which I take exception.

Dr. SMITH. I think your second exception is not well taken. The matron is to be the superintendent of the school.

Mr. SAVAGE. Will you have any directress of nurses?

Dr. SMITH.No. The medical board governs the school, organizes the school. The superintendent is appointed by recom

mendation of the board by the trustees, and she is to be the matron of the school. That has been the case in Bellevue Hospital now for about twenty-five years, and it has worked admirably there.

Mr. SAVAGE. They have a directress of nurses there, independent?

Dr. SMITH.- No. She is matron and superintendent.

Mr. SAVAGE. Well, my experience shows that the directress of nurses should have the charge and management and instruction, under the direction of the physicians, of the education of the nurses. I have watched that question very closely, and I think I am right.

Dr. SMITH.-To what hospital do you refer?

Mr. SAVAGE. Roosevelt Hospital. We have a matron also.

Dr. SMITH.- The Bellevue School was the first one established in this country and has been a great success. It has a superintendent of nurses who is matron too.

Mr. SAVAGE. The medical board will not give the attention that is required. The nurses must be assigned; they must be watched to see that they do right, and this cannot be done if the matron has to attend to other duties.

In regard to Dr. Chapin's paper, it is very commendable, and I want to emphazise one point more in that; and that is, trained nurses that go into these homes. A trained nurse with tact and a level head can do an immense amount of good.

The balance of the session was devoted to the Committee on Sanatoria for Consumptives (Division B), the Chairman of which, Dr. John H. Pryor, of Buffalo, presided throughout the remainder of the session.

Dr. PRYOR.— Before reading the report of the Committee on Sanatoria for Consumptives, I want to seize this opportunity