DISSOLUTE, DISSIPATED, and vicious consumptives... [who] are likely to be most dangerous to the community," according to old records of the New York (NY) City Department of Health, were confined to Riverside, a special hospital on a harbor island, in the early years of this century. Although it was set up with good intentions, "the facility was chaotic," says a present-day historian, and few of the proposed treatment plans could be accomplished. The terms used today to describe most of the estimated 6000 to 7000 persons in New York City with active tuberculosis (TB)—"usually poor and minority members, often homeless, sometimes mentally ill, frequently substance abusers"— are less contemptuous, but issues of how to care for them have become more complex. Some of the problems, as well as the solutions, are old: William Osler, MD, said decades ago that the way to get rid of TB was to "eliminate poverty,