=Outdoor Work.= Another favourite fallacy is the advantage of outdoor work for the returned patient. The sole value of outdoor work lies in the opportunity to breathe fresh air, but this benefit may be more than offset by the strain of long hours, exposure to heat, cold, and rain, the lifting of heavy weights, and so forth. All these objections apply to farm-work, driving delivery or freight waggons, the occupation of motorman, conductor, and so forth. Now and then, patients undertake work of this character and do well at it, but we cannot but believe that this is in spite, of, rather than because of, their occupation. In summing up the nurse’s value to these discharged cases, we find her able to give immense assistance at a most crucial period in the patient’s life. By this help and advice, she can often prevent his relapse, or at least delay it for a long time. Her supervision provides incentive and encouragement, and her careful watchfulness, both of the patient and his household, is of value in detecting further danger signals. If, as too often happens, he is eventually swept under by currents too strong for him, she is still on the spot, tried counsellor and friend, to make safer and easier the downward path. CHAPTER XVI Hospitals for Advanced Cases—The Careful Consumptive—Chief Duty of the Nurse—Responsibility of the Institution—Home Care of the Advanced Case—Exceptions to Institutional Care—Compulsory Segregation. =Hospitals for the Advanced Case.= The crux of the tuberculosis problem lies in the segregation of the advanced case. Until the distributor is removed from his family, and separated from the intimate circle surrounding him, we can make but little progress in the fight against this disease. No community can protect itself from the ravages of tuberculosis until it provides a place to which these advanced cases may be sent. Not only do we need large special hospitals for these patients, but we need special wards for consumptives in connection with every general hospital which receives either city or State appropriations. These special wards would be of even greater benefit to the community than large special hospitals situated in the environs of a city, since it would be easier to persuade a patient to enter an institution just “round the corner” than to go to one far distant from his home. A dying man dreads being separated from his family, and his family is equally reluctant to part from him; furthermore, if a hospital is remote from the city, his family can afford neither time nor carfare for frequent visits. These facts play an important part in influencing a patient’s decision, and due consideration should be accorded them.