Many of these registration cards are duplicates, the case having already been registered by the attending physician, or the dispensary. If they are not duplicates, it is necessary to have the official registration in the handwriting of the physician himself—it is often needed when trouble arises over the fumigation of houses, and so forth. There is nothing official or authoritative about the nurse’s registration cards—these merely call attention to the fact that certain patients are under her supervision, attended by such and such a doctor. In most cases, the diagnosis given is a verbal one. Should any difficulty arise, this verbal diagnosis would not be valid, although it furnishes an excellent basis from which to instruct the patient and his family. Therefore the nurse’s registration card, if it is not a duplicate, serves to call attention to the fact that a certain physician is in charge of a case which he has not reported. The Health Department at once writes and asks him to report, and in this way the diagnosis is officially recorded. In Maryland, the law calling for the registration of tuberculosis had been on the statute books some years, but was generally disregarded. The physicians failed to report their cases, and it was therefore impossible to estimate the amount or distribution of tuberculosis. To do this was the object of the law. How generally this regulation had been ignored may be judged from the fact that in 1909, the year before the Baltimore municipal nurses went on duty, the number of cases of tuberculosis registered by physicians was only 919, while the deaths from tuberculosis for that same year were 1400. In 1910, the first year that the nurses were on duty, the cases registered jumped up to 3202, while the deaths fell to 1234. This sudden increase in the registrations—an increase of over three hundred per cent.—shows the stimulating effects of a staff of active public health nurses.