The theory upon which this system is based is:

1st. Most patients are benefited by a certain amount of exercise in the form of work, because it tends to keep the various organs of the body functionating in a proper manner.

2d. It keeps the mind occupied, and thus prevents patients from thinking of the condition of their lungs.

3d. The fact that patients are able to work tends to give them a contented spirit, which is an essential factor in the treatment of tuberculosis.

Patients at the Municipal Sanatorium are expected to do from two to four hours' work daily, always providing their physical condition permits; the amount depending on the judgment of the Resident Physician. If they perform four hours' work, it is so arranged that they do two hours in the morning and two in the afternoon. This work consists of the various activities necessary to the conduct of the Sanatorium. The tasks assigned them will be shown in detail later in chart form. In this connection, it should be mentioned that, with few exceptions, the class of patients received at this sanatorium are those who are dependent upon manual labor for a livelihood.

When an employee's condition improves to such an extent that he feels able to take a paid position, he makes application to the Resident Physician who examines him, and if, in the latter's opinion, the patient is physically fit, he puts his name on his list of applicants for paid positions. When a vacancy occurs, the Resident Physician submits this list to the Physician-in-Charge, who looks up the history of each applicant, on Chart No. 4, and makes his choice accordingly.

The advantages derived by patients having paid positions are:

1st. His economic rehabilitation before his return home, the idea being to pay a nominal salary, which enables the patient to supply his various needs while at the Sanatorium. If he works long enough, he should have a surplus remaining which will support him on his return to the city until he is able to secure the kind of employment he is best suited for. He would otherwise be compelled to take the first position offered, owing to urgent need of funds.

2d. The fact that he has been working during his stay at the Sanatorium will make it infinitely easier for him to take up his work, on his return to the city, than it would otherwise have been if he had spent all his time in resting, and in addition, the weight he has gained will be much more apt to remain with him.

The advantage the Sanatorium derives from its patient employees is one of economy, as it is enabled to avail itself of labor at very much less cost than if regular city employees were used, thus reducing running expenses by thousands of dollars a year.

When patients are admitted to the Sanatorium they are expected to rest for the first sixteen days, during which time those who do not develop elevation of temperature, rapid pulse or other adverse symptoms, make their own beds, and during the second week do light shack work. On the eleventh day they begin their daily walks, accompanied by a walking captain. These walks are 10 minutes in duration, morning and afternoon, on the first day, and increase 10 minutes each day, until they walk one hour morning and afternoon. On the sixteenth day, at the completion of their afternoon's walk of one hour, they are inspected by the resident physicians, who take note of how they react to it in regard to pallor, rapid pulse, dyspnoea, etc.

During their stay in the reception shacks, the resident physicians have an excellent opportunity to observe the patients and become thoroughly familiar not only with their physical condition, but also their temperament, which helps greatly in making work and shack assignments.

The frequent changes in the staff personnel, which was much depleted during the period of the war, in addition to the handicap of a falling census and the admission of a poorer type of case, made it necessary to classify the patients so that their selection for work assignments would be simplified and placed on a scientific basis. As there are over 300 positions in the Sanatorium filled by patients, both paid and nonpaid, it can be seen how important it is to have the patients classified.

The advantages of this classification are as follows:

1st. It gives the Physician-in-Charge the opportunity to find out quickly the condition of all the patients, and puts him in a position where he can select the patients for paid positions, and advise, when called upon, in the selection of patients for regular work assignments.

2d. It also puts him in a position where he can quickly decide if a patient who complains of his work assignment has a legitimate reason for complaint.

3d. It helps the resident physician immeasurably in making their work assignments, and is of great aid to their chief clerks, who occasionally have to make a change in assignment at the last moment, in the absence of the resident physician, owing to the sudden illness of a patient, previously assigned.

The first step found necessary in classifying the patients, upon the basis of work assignment, was to revise the present accepted classification of tuberculosis to meet immediate requirements. To render it more simple, we classified Incipient A as 1A; Moderately Advanced A as 2A; Far Advanced A as 3A; etc. All patients were then divided into four classes:

The class A cases we consider the ideal patients for the great majority of our paid positions, and for some non-paid positions, where the work is fairly hardsuch as maids in the patient-nurses' home, and the maids who clean the dining hall.

The class B cases we consider to be well enough to fill easy, paid positions when we are unable to obtain class A cases-such as clerk in linen room, postmistress or postmaster, bath attendant, etc., as the hours in these positions are short, and the work not hard-and for non-paid positions where the work is much easier than that done by class A cases.

The class C cases have been rarely used, except when we were unable to obtain class B cases, and then only in positions such as librarians, temperature clerks, and weather clerk, where the work attached to the position was practically nil, and they had plenty of time to sit down and rest.

Class D was put in to complete the classification. The patients coming under this class are bed cases, and should be under care in tuberculosis hospitals and not in a sanatorium, although we have had quite a number of this type of case.

In making out this classification of patients, it was found convenient to make up four charts as follows:

No. 1. Work classification.

No. 2. Work assignments.

No. 3. Weekly census, and stage of disease.

No. 4. Patients' history and past work assignments.

Chart No. 1-Work Classification. On this chart is shown the four classes, A, B, C, and D, under which are placed all the positions filled by patients in the Sanatorium under the headings, Class A, Class A or B, Class B, Class B or C. Under Class A