We find many ventilating engineers who claim that by carefully adjusted apparatus, with forced draughts through apertures whose capacity has been arranged by close calculation, a better quality of air can be provided than by any system of open windows. These claims are based on the supposition that the prime requisite is to supply a calculated amount of unused and fresh air and to remove air that has been used. Their test of the quality of the air in a room is the proportion of CO,.

Unfortunately very little is known as to those characteristics of air which make it wholesome and stimulating. We know that temperature, humidity, and motion have much effect in determining whether air is agreeable and healthful. We know, too, that the amount of CO, in air is not an unfailing guide as to its quality in these respects.

Out of the obscurity which clouds this subject one fact emerges with tolerable clearness, and that is that outof-door air has a healthful quality which confined air never has, no matter how carefully compounded. A man who has been living out of doors notices a stuffiness in the air of a room with all the windows open. There is some quality of freshness and stimulation in the open that is lost in confined spaces. On a summer's evening, after a hot day, compare the air on an open piazza with that inside the house, and consider the length of time it takes for the cool evening air to penetrate and displace the hot stagnant air within a house with every window open.

By such a comparison as the above we shall be convinced that an out-ofdoor school has advantages over a room with all the windows open, and that we should aim at a thoroughly out-of-door arrangement, one which can be protected from violent wind and

rain, but the leeward sides of which shall at all times be fully open. When the best arrangement cannot be provided, rooms with all of the windows open should be used. Such rooms will be of little use, however, unless they are in charge of teachers who are intelligent advocates of open air, for otherwise the slightest severity of the weather brings a closing of the windows.

The open-air-school will act as a strong preventive measure against tuberculosis, and, by improving the health of the under-nourished, will check the development of many cases. It will thus cut down the numbers of the other class we have now to consider; namely the active, open,' contagious class.

It is quite clear that the children with open communicable tuberculosis should be separated from the healthy children, for two reasons. First, because the community is responsible for the reasonable protection of the children whom it forces to attend school. With our present knowledge of tuberculosis it is almost criminal disregard of this responsibility to allow tuberculous cases to herd with well children in our school-rooms.

Secondly, these children should be segregated on their own account. They need an even more rigidly conducted open-air treatment than do the debilitated children. They need extra feeding. They need a careful regulation of their work and rest-hours under the guidance of a physician, and the constant care of trained nurses experienced in tuberculosis. They must be carefully taught the precautions needed to prevent their giving the disease to others. In short, they need hospital care and treatment, and their teaching and study must be regarded as of secondary importance.

How can this care and supervision

be most effectively and, at the same time, most economically provided?

Here we come to a point in our problem where the human element must be considered. It is quite plain that if all of these children could be collected in hospitals this would give the best sort of isolation of the disease. Unhappily, however, the parents, as a rule, will not send their children away from home, and without their coöperation this kind of quarantine is impossible.

Facing a problem of this kind, the Boston Association for the Relief and Control of Tuberculosis established an outdoor camp, where the children. pursued their studies, and at the same time were under the care of doctors and nurses. From this beginning was gradually evolved the Boston Hospital School, which, through the help of the Park Commission, was comfortably housed in Franklin Park. The experiment proved so successful that (through the combined action of its School Committee and its Consumptives' Hospital Trustees) the City of Boston presently took the school under its charge and placed the responsibility for its management in the hands of the Consumptives' Hospital Trustees, thus recognizing that this institution was a hospital rather than a school.

I do not purpose here to consider the details of treatment at this hospital school. It was practically a day-camp, at which the children were occupied with study only so far as was thought good for their health. Many parents approved the plan and sent their children, so that, although the school was situated on the outskirts of the city, the attendance was satisfactory. The children did well. The nurses, trained in tuberculosis work, followed them to their homes, and were able in this way to exert some influence upon their home surroundings, obtaining for them better care and diminishing as far as

possible the infection of those around them.1

On the 31st of January, 1911, the Boston Consumptives' Hospital Trustees closed the school, thus putting an end to this pioneer work which had met with the approval of competent persons in all parts of the country, and which had taken a large number of tuberculous patients out of the public schools and had cared for them under conditions which reduced the risk of infection in the community to a mini

mum.

The chairman of the board, who cast the deciding vote which closed the school, when asked how these patients were to be cared for after the closure of the school, said, 'At daycamps and hospitals,' and declared that it was the intention of his trusttees so to provide for them. Under these circumstances it is interesting to know what became of these patients after they were turned out of the Hospital School. Drs. Locke and Murphy made an investigation and were able to trace one hundred and fifty-six out of the one hundred and seventy-four cases treated at the school during the year previous to its closure. Of these cases just nineteen, or 10.91 per cent, went to day-camps or hospitals; ninety-one, or 58.33 per cent, went back into the public schools; four, or 2.56 per cent, had died; and the remaining forty-two patients, or 26.92 per cent, had gone back into the community.

These figures give a striking illustration of the far greater usefulness to the community of a hospital school

1 An excellent account of the work in this School is contained in the paper by Dr. James J. Minot and Miss Hyams, published in the Fifth Annual Report of the American Association for the Study and Prevention of Tuberculosis. Later, in the Boston Medical and Surgical Journal, August, 1911, Dr. Edwin A. Locke and Dr. Timothy J. Murphy published a very careful study of the work and its results.

then of a day-camp or hospital. Only a little more than 10 per cent of the children whose parents are willing to have them attend a hospital school are willing to let them go to day-camps and hospitals. The large proportion of these cases which went back into the public schools, at the risk of infecting well children, is sufficient basis for a serious indictment of the city government that subjects well children, put under its care, to such unnecessary risks. The results of this experience should convince any fair observer that the hospital school is the most efficient means as yet discovered for safely handling tuberculous schoolchildren. In a large city several hospitals of this type should be supplied and so placed as to be accessible to the school population.

We have hitherto considered the means at our disposal of caring for the children threatened or affected with tuberculosis, after they have been discovered. Obviously, any plan to this end must have its foundation in a thoroughly satisfactory system of school inspection.

I cannot here discuss the details of school inspection, for these must vary according to local conditions. In large cities the task is a large one, and since a large proportion of the children belong to a class in the community who do not employ a family physician, school physicians must play a considerable part in any complete scheme. Even, however, in large places it has been found by increasing experience that more and more of the work can safely be delegated to nurses. So far as this work has to do with the early discovery of tuberculous children many experienced physicians, expert in this class of work, feel a greater reliance upon the school nurse than upon the school physician. While the final decision as

to the existence of tuberculosis must be made by a physician, it is the watchful nurse, constantly among the children, who usually first discovers that the child is out of health and needs attention, and so brings the case to the physician for thorough examination. Many of the cases which come under the head of anæmic, debilitated children show no signs of definite disease, and the close watchfulness of the nurse is more likely to discover children in this class than the cursory observation of a school physician passing his eye rapidly over many children.

In conclusion, then, it appears that a safe system of care for tuberculous children in the schools is a duty that the public assumed when it made school attendance compulsory. That duty the school authorities cannot evade. They should face it squarely.

Any proper plan for handling tuberculosis must rest on a thorough and efficient system of school inspection. Every school should have provision for out-of-door study for all of its debilitated children. These children should have extra feeding. This is a medical necessity of the case. Whether this food should be supplied by the parents, by some outside charitable source, or by the town, is a question which must be settled according to the circumstances of each case, but the settlement should not be shirked.

Children having active tuberculosis should be separated from the other children, and should be cared for as sick children.

The most efficient plan for accomplishing this last-named object in cities of considerable size is the hospital school, and in a large city such schools should be provided in different sections of the city so that the children shall not have far to go from their homes.

It was eleven o'clock when Mother and Thomas and Sister hurried up the steps and into the church. The bell was tolling, and the town-clock was striking. The two jangled together high above the quiet street. The organist was late. She walked up the aisle very quickly, on her little high-heeled shoes. She slipped her plump bare arms out of her coat and took her place at the organ, just as Mother knelt on the hassock in her pew and bowed her head.

Mother tried to recall what most needed her prayer. She shook off the details of her household, which had reached elastic arms and little hooked ends after her, and had kept pulling her up, all the way down the street. There was a child sick in the village. Heaven send angels to help him and help his mother. There was a prayer of thankfulness and humility that her children were well. She started to rise; but wait, there was another prayer. God send pain to all doctors. Let them suffer pain that they may truly know what it is. She rose from her knees.

Little Sister who had knelt in sweet imitation of Mother, now shot a glance out of the corner of her eye, and seeing that Mother had raised her head, proceeded to raise her own fat self from the hassock to the seat of the pew. It was uncushioned, and Sister was much occupied in finding herself a comfortable position. The organ pealed out the hymn, and Thomas found the place in the beautiful new prayer-book his godmother had given him. They were all standing, and Sister stepped up on the

hassock, slipped off it, and her little feet made a clatter. She giggled out loud. Thomas frowned and looked at his mother. Mother smiled at Thomas and smiled at Sister. Their pew was the very last one in the church, and they were behind everybody else.

Two girls came in and went into the second seat in front. They had hurried and had been blown about in the wind. One of them was soft and plump, and her hair had been curled with a curlingiron. The wind had blown out a few straight locks which mixed oddly with the fluffy ones. They lay round her ears in little tails.

At the opposite end of their pew sat Mrs. Hammond. Mother did not know her, but knew she came from Dummer. She wore a hat with a big bunch of cherries on it, and a veil that had got caught on the stem of a cherry and did not lie quite straight. Her coat had two fat wrinkles over the shoulders, and the skirts to it were crumpled. She had come to church squeezed into a buggy beside her sun-browned son. Mother looked at the cherries and could see the hills of Dummer. A white farmhouse standing back from the road, in a prosperous lawn; another farm-house near, on another hill like Rome, Dummer was built on seven hills. All round the hamlet was the June embroidery of incredibly thick foliage, and grass and daisies and late buttercups; and among the orchards were trees crimson with cherries. The air was keen from the hill-winds and sweet with hayfields.

The rector's voice began, 'Let the words of my mouth and the meditation of my heart be alway acceptable in thy sight, O Lord, my strength and my redeemer.' Mother glanced quickly at the altar. There was no display of Communion silver or linen. The Order for Daily Morning Prayer was so much more simple for Thomas, who was just learning to find the places in his prayerbook. Communion Sunday was always such a bewilderment to him. But Mother could not remember to tell him, before they came to church, about the Sentences of Scripture, and whenever she tried to show him, the rector read so fast that Thomas could not follow, with his deliberate little mind. But with 'Dearly Beloved Brethren' the frown on the forehead of Thomas disappeared. From that point it was plain sailing.

While the choir was singing the Te Deum a young man and woman and a little boy came into the next pew. They were good Episcopalians. They uttered the responses in the tones of people to whom the responses had become a habit. All but the little boy: he sat leaning against his mother's arm; and he kept his head turned to gaze at Sister. Sister gazed back. The little boy's mother kept trying to turn his head to look at the rector. She had a face with no softness in it. Her cheeks were straight instead of round, and her mouth was a straight line. She looked young and healthy, and very energetic. She gave up trying to turn the little boy's head. She lifted him and placed him on her other side, so that she could, with herself, shut off his view of Sister's rosy face in its frame of lace and ribbons. The little boy's father reached out an arm and snuggled the little boy up to him. He was a very tall thin man. His hair was getting gray at the temples. His mouth was very clear-cut and smiling, and he

smiled down at the little boy, and his long fingers patted the little white blouse ever so softly. He had several horizontal lines on his forehead. The boy was thin, and he breathed with his mouth open. His eyes were too big. They were brown and had thick curling lashes. Mother looked away, up to the stained-glass window. She was thinking, 'I wish they would make him eat more bread and butter, and let him eat more sugar.'

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Nearer the chancel sat a woman who wore a large white hat. She sat up very straight and the light, from the window near her, fell on her lovely gray hair gray hair whitening at the ends, and shading in the shadows to the darkest gray. Here it blended into the facing of her hat which was dark velvet, curving up and away from her head, and her pretty little sea-shell ears. Along the front and side lay folds of white satin, also catching the light, creased and crumpled into the right size and shape to turn the head and hat into a delightful composition of light and shade. Except for that one, the church was full of freak hats. Right in front of Mother was one on a tall girl. It was black, and its crown was completely round like a man's derby. It was pushed down flat on the girl's head, and there was not a spear of decoration, nor anything in front to turn it into a composition. At the back a bunch of aigrettes was perched on it like a feather-duster. The brim lay on the girl's shoulders. You could not see her hair. She looked shapeless and like

a scarecrow.

'Finally we commend to thy fatherly goodness all those who are any ways afflicted or distressed in mind, body, or estate.' Mother's thoughts flew guiltily away from hats and out over the world. She looked down at the little boy. She did not like to think of their taking him to the hospital, to be