The new basis of the visiting-nurse service which we thus inaugurated reacted almost immediately upon the relationship of the nurse to the patient, reversing the position the nurse had formerly held. Chagrin at having the neighbors see in her an agent whose presence proclaimed the family’s poverty or its failure to give adequate care to its sick member was changed to the gratifying consciousness that her presence, in conjunction with that of the doctor, “private” or “Lodge,”[1] proclaimed the family’s liberality and anxiety to do everything possible for the sufferer. For the exposure of poverty is a great humiliation to people who are trying to maintain a foothold in society for themselves and their families. My colleague and I realized that there were large numbers of people who could not, or would not, avail themselves of the hospitals. It was estimated that ninety per cent. of the sick people in cities were sick at home,—an estimate which has been corroborated (1913-14) by the investigation of the Committee of Inquiry into the Departments of Health, Charities, and Bellevue and Allied Hospitals of New York,—and a humanitarian civilization demanded that something of the nursing care given in hospitals should be accorded to sick people in their homes. [Illustration: THE NURSE IN THE TENEMENT Ninety per cent. of the sick of the city remain at home] We decided that fees should be charged when people could pay. It was interesting to discover that, although nominal in amount compared with the cost of the service, these fees represented a much larger proportion of the wage in the case of the ordinary worker who paid for the hourly service than did the fee paid by a man with a salary of $5,000, who engaged the full time of the nurse. Our plan, we reasoned, was analogous to the custom of “private” hospitals, which give free treatment or charge according to the resources of the ward patients. Both private hospitals and visiting nursing are thereby lifted out of “charity” as comprehended by the people. [Illustration] We felt that for economic reasons valuable and expensive hospital space should be saved for those for whom the hospital treatment is necessary; and an obvious social consideration was that many people, particularly women, cannot leave their homes without imperiling, or sometimes destroying, the home itself. * * * * * Almost immediately we found patients who needed care, and doctors ready to accept our services with probably the least amount of friction possible under the circumstances; for those doctors who had not been internes in the hospitals were unfamiliar with the trained nurse, whose work was little known at that time outside the hospitals and the homes of the well-to-do.