followed years ago, that I have lost more or less my dread of pneumonia as a hospital disease. True, these cases have good nursing, good care and every possible attention, but still they are cases of pneumonia in hospital practice and they do remarkably well.

In another similar room in the same hospital, during the same period of time, I have been treating my typhoids. Occasionally, I have a typhoid under two years of age, most of them are over three, and the average age about six years. The typhoid cases come from the same class of patients as the pneumonias, and they do so much better in the fresh air that nothing could persuade me to return to the old method of treatment, similar in every way to the present, but minus the fresh air. The rooms where the typhoids and pneumonias are kept have large windows on two sides, and an open door on a third side; these are kept open day and night; a distinct effort is made to keep the hands. and feet of these children warm by gloves, stockings and hotwater bags, but the rooms are always cold, except for a few minutes every two or three hours, when the windows are closed and all the children carefully examined as to cleanliness, etc.

The few cases of tuberculosis are kept in a special portion of one of the porches, living practically in the open air. Arrangements are just being made for a special pavilion for these cases. In the Jefferson Hospital the pneumonia and typhoid cases are treated by the fresh air method and do infinitely better than formerly, when the fresh air treatment was not employed.

In private practice for five years I have treated all infants and children, sick and well, with fresh air; in fact, on my first visit to the child, I, if possible, instill into the mother the principle that fresh air differs from impure air as much as fresh milk from impure milk. Once gain her consent, and the treatment is an assured fact. I am more than surprised to see the willingness with which most mothers, no matter what their social status may be, enter into the treatment. The physician must be enthusiastic; the mother is, in my experience, easy to convince. It would be easy for me to give the histories of cases, but the time allotted to me is brief. Suffice it to say, that in many cases during the winters and summers of the past five years, I have kept numerous infants out of doors all day long, except bringing them in occasionally to the house for the purpose of removing soiled clothing, and I have never in all that time seen a single injurious symptom

result, and I am positive it has been the means of saving many lives. Rickets, scrofulosis, gastrointestinal disease, any and all conditions are benefited by the treatment. Measles, in hospital cases, I treat in separate rooms, each room opening upon a common porch, surrounded by glass. During the first few days the children are kept in the cool, darkened rooms, then moved to cribs on the porch, and the windows on the porch opened more or less, insuring an abundance of fresh air. The influence of climate associated with rest in the treatment of nephritis and cardiac disease is now so well recognized that comment is unnecessary.

It is an interesting question, which experience alone can decide, as to what arrangement will, in the future, be made to control the degree of temperature in which these children are kept when in the fresh air. In hospital practice it has been my custom to keep infants under three months for a few days in the cool air of the ward before putting them outdoors-the temperature of the ward usually being near 60°F. in the cooler months. In private practice, where the temperature can be more absolutely controlled for each individual case, I gradually but rapidly lower the temperature of the room to 60°F., then dressing the child. exactly as if it were to be taken outdoors, gradually lower the temperature of the room for a few hours each day until it approximates the degree of temperature in the fresh outside air. Indifferent temperature feels neither warm nor cold (Wachenheim), and is most restful. In children, indifferent temperature is above 75°F. in summer in summer clothing, and above 65°F. in winter in winter clothing, and varies with age and vitality. Temperatures above indifferent are not sedative, but cause a continuous stimulation that is harmful if prolonged, ending in exhaustion. The same author says that, "Young children stand severe cold badly." This is not my experience, if by "severe cold" is meant the ordinary winter weather in Philadelphia. True it is, that these children are bundled up from head to foot, lie in a comfortable baby coach, and have thick gloves, stockings, veil and perhaps a hot-water bag, but they do breathe the cool air, and they all do well. Two or three rainy or snowy days will convince any one; the children are kept indoors in a warm room and they fuss and cry; out of doors they are quiet.

Humidity has an influence by checking or increasing the evaporation from the body and further studies along this line will be of value.

The distance above sea level exerts a certain distinct influence upon the skin, kidneys and blood, and induces metabolic changes of importance. The influence of a few months of camp life on growing boys is appreciated by every one. "Camp life" is fresh air treatment.

When it is possible to select the kind of fresh air desired, certain broad lines may be followed. Increase of heat production, and, consequently, an augmented metabolism, are rendered necessary by cold, dry air of high altitudes. This is proven by the larger amount of carbonic acid gas given off by the lungs. It also, as a rule, increases the red blood cells during the first few weeks of treatment. High altitudes are useful in children with incipient tuberculosis, or an inherited tendency to tuberculosis.

Fresh seashore air is of decided benefit in infants and children convalescing from severe illnesses, especially gastrointestinal in type. It is of distinct benefit in the so-called strumous type.

Fresh country air is better than fresh city air. Rural districts are better than urban, but density of population, such as one sees often in large cities, does not necessarily imply lack of fresh air. The number of people living in a given area may be very large, but if they live in comfortable houses, keep the windows open and live under the best hygienic conditions, fresh air can be secured in abundance, and infants and children do well. If the same number of people living in the same area do not have an abundance of fresh air, the infants and children do badly. Density of population may have much or little to do with fresh air.

Statistics prove conclusively that in all countries where the mothers work in industrial plants, necessitating their absence from home a large portion of the day, that the infants and children show a much higher mortality rate, owing to the fact of their being kept indoors, than among the children of the same class of people living under exactly similar conditions except that the mothers live at home and have time to keep their children in the fresh air.

In Berlin, 1903, Newman investigated 2,701 infant deaths. Where the families were in one-room dwellings he found 1,792 deaths; in two-room dwellings, 754 deaths; in three-room dwellings, 122 deaths; in larger dwellings, 43 deaths. Can anything prove more conclusively than this, the power fresh air has to preserve life, or the rapidity with which bad or impure air can cause death? Unfortunately for the infant and young child, the

ignorance of many mothers, the superstitions and traditions of others, and the carelessness of a few, are the greatest barriers to the keeping the children in the fresh air. During the past few years comparatively little has been written upon the importance of fresh air for very young children, and yet the subject of fresh air as an aid in the treatment of disease is not of recent date. In the History of the Medical Society of the State of New York, as published in the New York State Journal of Medicine, it is shown that in the early part of the nineteenth century the dangers of dust laden air were recognized; the influence that certain occupations exerted upon the etiology of tuberculosis was appreciated, and even at that date "cold air" was used in the treatment of typhus fever.

In one of these essays upon "The Influence of Trades, Professions and Occupations in the United States on the Production of Disease," the author shows clearly how the crowding together of children in the tenement districts produces gastrointestinal disease and death, proving that at this distant period the virtue of fresh air was appreciated.

In 1850 to 1860 Dr. Clarke treated a very large number of cases of typhus fever in Bellevue Hospital by the fresh air method. The windows were removed; in winter stoves were placed before the open spaces to insure a slight heating of the air, but the patients were given the fresh air treatment, as we understand it in the fullest sense to-day. The results were vastly superior, the death rate very markedly lower than the mortality among the same class of patients in the same hospital at the same period in the hands of the other members of the staff where fresh air was not used. It is a well-known fact that in times of war patients treated with fresh air in tents always do better than those confined in hospitals.

The phenomena of child life have often occupied the attention of psychologists, and new theories are formed every day for children by educators. Theoretically, they are making the superchild, soon to be the father of the superman. We, however, should be quite content if parents can be taught to appreciate the advantages accruing to the child from correct feeding, combined with fresh air and the influence they exert upon the mental and physical development of the growing child.

Everyone should be made to understand how important it is for the very young to be taught how to stand, lie down and sit

properly, and that deep breathing is the proper and only sure way to secure full lung expansion.

Let us all join hands and preach fresh air; vote for open squares, endorse roof gardens, have adenoids and tonsils removed, and if we are willing as a society to endorse and work for the fresh air treatment with the same zeal and enthusiasm as we have worked for fresh and pure milk, our results will be as great a success as has been secured by our milk enthusiasts.