=Failure because of the Nature of Tuberculosis.= Let us first consider the nature of the disease. Tuberculosis is a prolonged, chronic disease, which may be drawn out over a period of months or years. The patient has many ups and downs, being sometimes so ill that he places himself under the care of a physician, sometimes so much better that he does not see a doctor for months. We have known patients who have not been to a physician for years, yet during that time they were infectious cases, as proved by sputum examination. During a hiatus of this kind, how can we possibly hold the doctor responsible for the tuberculous patient? How can we hold him responsible for the conduct, training, and surroundings of a case he never sees? Undoubtedly a very large number of patients pass completely from under the observation of their physicians, and are utterly lost to them. With the best intentions in the world, the private practitioner cannot follow and supervise a disease of this character, not acute, but chronic and ambulatory in nature. If he attempted this, it would leave him little time for anything else. Nor can we assume that the patient who closes his account with one doctor necessarily places himself in the hands of another. He frequently drifts along without any medical advice whatsoever, and only seeks it again when his symptoms become alarming. These facts alone, exclusive of all other considerations, show the necessity for centralized control of these ambulatory patients. Tuberculosis is largely a disease of the poor, as we have remarked before. A poor consumptive must consider the spending of every dollar, and the doctor’s fee is a matter of grave importance. For this reason, the patient will pay just as few visits to the physician as he possibly can. A doctor who sees a case only once or twice may well hesitate to pronounce it tuberculosis, and may wish to keep the patient under observation for a time, but the poverty of the patient prevents this.