424  Sanatorium  Treatment  of  Consumption.  {^ptSbe^iloe.1, 
have  been  on  the  whole  unsatisfactory  is  due  to  the  lack  of  the 
careful  supervision,  and  the  lack  of  the  strict  discipline  maintained 
in  sanatoria.  The  tuberculosis  dispensaries  have  been  a  potent 
factor  in  preventing  the  spread  of  the  disease,  and  in  educating  the 
patients  and  the  general  public.  But,  I  believe,  relatively  few  cases 
treated  by  dispensary  methods  have  been  cured.  This  has  certainly 
been  the  experience  of  my  colleagues  and  myself  in  the  out-patient 
department  of  the  Massachusetts  General  Hospital,  where  the  dis- 
pensary methods  with  the  aid  of  the  District  Nursing  Association 
have  been  employed  for  several  years.  The  difference  between  our 
method  and  that  of  the  tuberculosis  dispensary  is  essentially  this : 
that  the  tuberculosis  dispensary  gives  a  relatively  small  amount  of 
care  to  a  large  number  of  patients,  while  we  give  a  large  amount  of 
care  to  a  small  number  of  patients. 
Our  organization  is  known  as  the  Emmanuel  Church  Tubercu- 
losis Class.  We  sometimes  speak  of  it  as  a  "  home  sanatorium," 
and  it  bears  much  the  same  relation  to  a  sanatorium  that  a  corre- 
spondence course  does  to  a  college  course.  Every  detail  of  the 
daily  life  is  supervised  and  strict  discipline  maintained.  A  nurse 
is  employed  who  devotes  her  time  to  visiting  the  members  of 
the  class.  I  prefer  the  term  "  friendly  visitor  "  to  nurse,  because  it 
describes  more  exactly  the  nature  of  her  duties.  She  should  be  the 
family's  wise  counsellor,  kindly  and  tactful,  yet  a  good  disciplinarian. 
The  class  should  number  but  a  few  members ;  I  think  the  maxi- 
mum limit  should  be  twenty-five. 
It  should  never  be  forgotten  that  it  is  the  individual,  not  the 
disease,  that  needs  treatment.  We  have  been  fortunate  in  having  a 
small  class,  and  so  we  have  come  to  know  our  patients  not  simply 
as  "  this  case  of  fibroid  phthisis,"  and  t(  that  of  pyopneumothorax," 
but  as  "  Elmer  "  and  "  Patrick." 
The  class  was  organized  the  first  of  July,  1905.  Most  of  the 
applicants  for  membership  were  referred  to  us  by  the  Out-patient. 
Department  of  the  Massachusetts  General  Hospital. 
The  rule  was  established  that  no  one  would  be  accepted  until  the 
clinical  diagnosis  was  confirmed  either  by  finding  the  tubercle 
bacilli  or  by  a  positive  tuberculin  test.  There  has  been,  however, 
no  difficulty  in  demonstrating  tubercle  bacilli  in  the  sputum  of  all 
our  patients  on  admission  to  the  class. 
Our  aid  has  been  refused  to  none.    Those  who  were  too  ill  for 
