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The second class consists of porch cases -- those which have progressed so far as to go to the dining room for meals and look after themselves, spending the day on reclining chairs in the open air. In addition to the occupations permitted the infirmary cases, porch patients may take up reed basketry, stenography, and penmanship as their strength increases -- but always under careful surveillance. On the first indication of trouble, they are immediately returned to the former classification until all danger is passed.

Class three is subdivided into six groups, according as the time prescribed for exercise and vocational therapy varies from fifteen minutes to two hours daily. As soon as a patient has progressed to the point where he can be permitted half an hour's exercise a day, he is given the opportunity of spending half this time in the workshop. Class three patients are offered the choice of instruction in basketry, carving, clay modelling, metal work, picture framing, illuminating, engraving, or, in the school building, of instruction in French, English, and in subjects preparatory for civil service positions. In the summer, the more favorable cases take up a little gardening. As in the second class, these patients are constantly watched for dangerous symptoms; as soon as any appear, the patient is returned to a less advanced category.

The workshop and the school are very simple structures designed to afford the maximum of fresh air and comfort. The classes are well-attended, and relapses are rare. Twenty-nine out of thirty-two patients who prepared for civil service positions have since passed their examinations with good averages.

The great defect of sanatorium treatment has hitherto been the fact that a large number of cases discharged with the disease apparently arrested sooner or later suffer a relapse. This has been true particularly of those patients who must support themselves, usually at some manual trade. The chief reason for this condition is doubtless the fact that the sudden change from perfectly hygienic surroundings with plenty of good food and fresh air and medical attention to the conditions under which the less well-off must so frequently live and work is a strain which many patients cannot withstand. It is therefore important that the period after discharge be wisely considered and planned for.

With this fact in mind, the army medical authorities in the various belligerent countries both at home and abroad have taken a number of preventive and precautionary measures with regard to this critical period. One of the obvious steps was the consideration of vocational possibilities. All occupations involving severe physical exertion or prolonged stay in a dust-laden atmosphere are impossible. The best seem to be outdoor and semi-outdoor occupations ranging from farmer to chauffeur, from policeman to ticket-collector and traveling salesman, and the like. Most patients seem to prefer, however, to return to their original vocations; and whenever the working conditions permit it the authorities make no objection. Even the best occupations have features that are not ideal for the worker with a tubercular history. Indeed, the factors that enter into the problem are so many and varied that almost every case must be judged on its own merits. Nevertheless, it Is most important that it be so judged, and that steps be taken in each case to eliminate as many objectionable features obtaining under the former working and living conditions as possible. In Germany the organized cooperation of the employer in this direction is asked for.

Recognizing the vital importance of the post-sanatorium period, the Surgeon General of the United States Army has approved a plan for "after-care" which involves the cooperation of various civilian agencies. Cooperation is secured through the National Tuberculosis Association. This body forwards the names of all soldiers invalided because of lung-disease, and of all civilians rejected for army service for the same reason, to such local organizations as public health boards, state anti-tuberculosis societies, and the local agencies of civilian relief of the Red Cross. These agencies share the work of supplying the War Risk Insurance Bureau with the required data concerning the economic and social circumstances of the disabled soldier and his family, of providing such medical examination, attendance, and other care as may be needed, the Red Cross assuming the burden of supplying the family with any necessary financial relief during the period before this duty is taken over by the proper community relief organization.

Another step in the direction of "after-care" that seems to have been taken simultaneously in the United States, in England, in Germany, and perhaps elsewhere, is the development of an institution that is to serve as an intermediate step between release from the sanatorium and return to complete economic usefulness. In England these institutions are called "farm colonies," in Germany, "convalescent work-homes"; in the United States they have as yet received no generic designation. But the purpose of them all is very much the same -- to take up the treatment where the sanatorium must properly drop it.