In England, and particularly in London and Liverpool, the necessity for this form of nursing among the poor was recognized some years ago, and in 1868 the East London Nursing Society was founded; in 1874 another society was created, the Metropolitan and National Nursing Association. In the original plan a central home and training school for nurses in district work was established, and after the work was thoroughly well under way it was increased and more patients were cared for by opening branch homes in suitable localities. The number of visits made by a nurse each day varies in proportion to the care required by each patient and the distance to be travelled, but the average is from eight to ten per day. All nursing is done strictly under medical direction. The association supplies nothing beyond the nursing and medical appliances.