The 1,901 patients traced in 1914 included 394 admitted to the Sanatorium as incipient and of whom 387, or 98 per cent., were still alive at the last inspection; 846 moderately advanced cases of which 760, or 89 per cent., were still alive; and 661 far advanced cases with a survival of 375, or 57 per cent.

The returns made for these 1,901 former patients are not complete. In the tables 210 persons are noted as having "no data." This means that the tracing nurse has not turned in enough information to make possible a conclusion regarding the present status of these patients. This is not necessarily any reflection on the nurses but it is in very many cases due to the difficulty of getting intelligible replies from those to whom English, or whatever other language the nurse happens to know, is a foreign tongue. Some patients who were traced were unwilling to give any information whatever. The result is that among our 1,901 persons there are 210, or 11 per cent., concerning whom we know only that they were alive at the last visit. Statistically these cases are otherwise of no value at all as we are unable to place them in any attempt to compare the present condition and that on leaving the Sanatorium.

In former discussions of the upfollow of 1912 and 1913, it has been proposed to consider those who left the Sanatorium as "apparently cured," "arrested," or "improved" as discharged with a "favorable prognosis" because such persons might be expected to remain well or yet further to gain, provided they followed at home the instructions already given them as to the proper way to live. On the other hand a discharge as "progressive" was to be considered as a discharge with an "unfavorable prognosis" because these patients are likely to decline, and to decline rapidly when at home again. Even some of those do well, as a study of the tables will show.

The time that had elapsed at the last visit reported appears in the subdivision of the tables. As that Sanatorium was opened at the beginning of 1913 the intervals since discharge from Cresson are small. Only nine are in the column under "18-24 months," and for them the interval is probably not over twenty months. For Mont Alto the reports are spread over much longer intervals. In both tabulations a certain number, more exactly 172, and all dead, have an interval "less than six months," but most of these are persons who left the Sanatoria with little hope and died soon; a much smaller number evidently relapsed speedily at home although discharged with an outlook which was not unfavorable.

As in the other upfollows the returns are classified, and the present status of each patient is determined and tabulated as "improved," "stationary," "progressive," or "dead." These conditions have been grouped by putting the first two together as showing the

patients to be doing well or at least to be no worse after the interval in question; for the last two it suffices to say that these patients are not doing well.

On the basis of these terms, and combining the tables of Mont Alto and Cresson, it appears from the reports of 1914, that:

Of 347 cases admitted as incipient and discharged with a favorable prognosis in the sense above explained, 309, or eighty-nine per cent., after various periods ranging from less than six months to more than forty-two months were doing well or showed no retrogression; while of eight cases of this class discharged with an unfavorable prognosis, seven, or slightly over eighty-seven per cent., showed improvement

or were no worse.

Of 638 cases admitted as moderately advanced and discharged with a favorable prognosis, 472, or seventy-four per cent., were still in good condition after similar intervals; and of 102 cases of this class discharged with an unfavorable prognosis, twenty-five, a little over twenty-four per cent., showed improvement or were no worse.

And in the third class, or among the far advanced cases, of 336 persons who left the Sanatoria with a favorable prognosis, 158, or forty-seven per cent., were reported to be doing well or to be no worse after the same series of intervals as in the other two classes; while of 259 persons of this class with an unfavorable prognosis, twenty, or nearly eight per cent., showed improvement or were no worse.

In the table below these results are set forth more fully and with the elaboration that the cases discharged as "apparently cured" or "arrested" are put together (A), apart from those discharged as "improved" (B), or "progressive" (C). The classification on admission is indicated by Roman numerals.

COMBINATION OF THE UPFOLLOWS FOR MONT ALTO AND CRESSON. Found to be

Cases.

The upfollow classification "stationary" will seem to some to present a difficulty in the interpretation of the reports, and such criticism is just. As we cannot compel a former patient to come to the

Dispensary again for a new examination and a more precise determination of his condition we must do the best we can with such information as the nurses are able to gather. As the reports indicate, some of these patients do return and enable us to perfect the record but these are few. Any effort further to individualize the records would probably only add to the difficulty of interpretation. The term "improved," although somewhat elastic, is sufficiently definite for our purpose and no objection can be made to "progressive" and least of all to "dead," except that it would be desirable to know whether the deaths were really due to tuberculosis, but such knowledge is not easy to get.

It is perhaps worth while to inquire what our tables show and if we count only "improved" as indicating a satisfactory condition of the person traced. This is of course making about the worst possible interpretation of the figures since the "stationary" cases of certain groups really denote a most excellent outcome of the treatment. For some of the tables the exclusion of the interval "under six months" is desirable because here are noted many persons for whom an early death was clearly probable when they went home. Limiting our tables in this fashion the results are as follows:

FOR THE UPFOLLOW OF 1914, MONT ALTO AND CRESSON.

In the reports many other details concerning these patients will be found. Particular interest attaches to the figures which give general information as to the extent to which these persons were found to be at work, but with no details as to the kind or change of occupation. This information for the two Sanatoria may be summarized thus:

Of 105 men of occupational age, 81, or 77%, are occupied.
Of 129 women of occupational age, 88, or 66%, are occupied.

43

17

86

71 (828)

Of 292 men of occupational age, 187, or 64%, are occupied.
Of 317 women of occupational age, 190, or 60%, are occupied.

Of 169 men of occupational age, 66, or 39%, are occupied.
Of 133 women of occupational age, 62, or 47%, are occupied.

It appears then that of the persons here traced and found to be still alive after sanatorial treatment as incipient or moderately advanced cases, 76% of the men and 86% of the women have been able to resume their occupations or to be otherwise employed. And for these two classes, 55% of the men and 36% of the women not formerly occupied, although of occupational age, are now occupied. The proportions for those of the far advanced group are shown in the sum mary above.

The report of the Medical Inspector of the Tuberculosis Dispensaries gives many particulars concerning this important work of the Department. At the beginning of the year the roll of the Dispensaries carried 8,252 patients under treatment for tuberculosis. The admissions were 11,102, and 9,716 persons were discharged, so that at the end of the year the enrollment included 9,638 persons.

A new Dispensary was established at Ardmore in Montgomery County, and another was opened in connection with the Sanatorium at Hamburg. Late in the year the Dispensary at Tioga was transferred to Wellsboro in the same county.

The biological products of the tubercle bacillus were increasingly used in the treatment of selected cases, and with pronounced success. Some details regarding the doses administered in various Dispensaries are presented in extensive tabulations.

Much interest attaches to a special report of the Medical Inspector of Dispensaries on the endeavor to trace former patients of the Dispensaries that have not entered our Sanatoria, and to determine their present condition. This upfollow is the result of directions given by me some time ago that all such patients should be traced at in

tervals of six months for two years after discharge. This is no small undertaking in view of the size of the territory covered and the limited number of nurses available for this work. This year the tracers were able to pick up some information about 5,463 such persons, some times, to be sure, merely the information that the patient sought was still alive or already dead. This is, of course, only a small part of the patients who have been "discharged" after treatment in the Dispensaries, but no marked increase in this upfollow work is to be expected with the force of tracers which we are now able to provide.

The cases traced have been out of the Dispensaries for various lengths of time and are tabulated according to the six-month intervals since discharge as the cases from the Sanatoria are tabulated in their upfollow. The Dispensary cases are grouped according to the nature of the discharge which is also an indication of the opportunity which the patients had to derive benefit from their treatment. Thus, the cases discharged because of progress towards recovery, going away as "apparently cured" or "arrested" form one group; those which removed beyond the district of the Dispensary form another group; and yet other groups contain patients who went to "institutions" in great variety outside the supervision of the Department of Health, patients who were able to put themselves in care of a family physician, and finally such patients as were dropped because of nonattendance or were excluded because of unwillingness to follow the directions given by the Dispensary physician as good discipline requires. Each of these groups is worthy of study and their tables illuminate various phases of the dispensary treatment of tuberculosis.

In the group of patients discharged as apparently cured or arrested the nurses reported concerning 1,181 persons for whom the interval since discharge ranged from less than six months to fortytwo months and over. Of these, fifteen were dead, or one and threetenths per cent., all being arrested cases, and three of them having been out over forty-two months. For 113 cases, rather less than ten per cent., the data were insufficient for a final estimate of their condition beyond the fact that these persons were still alive, some of them as much as two years and a half after discharge. We have then in this series 1,068 persons whose present status is so tabulated that comparisons are possible.