The Latest Methods of Dealing with Consumption
By Lawrence F. Flick
It is not surprising that the employment of the elements of nature, such as pure air and sunshine, should be beneficial in the treatment of pulmonary diseases, but perhaps only in recent years has their importance been fully appreciated. In former years patients suffering from a variety of diseases were believed to be at least aided by proper ventilation of the sick chamber, if not by the sun’s rays. It has been recognized, however, and especially by physicians who have devoted their attention to a careful study of the disease, that tuberculosis can be cured by what is popularly termed the “open air treatment,” provided it has not reached a stage which is too far advanced. I believe I am justified in making this assertion by the results which have thus far been obtained in institutions especially constructed and equipped to aid nature in her work of restoring health. Some of the sanatoriums of this class, intended especially to receive sufferers from pulmonary complaints, have been in existence long enough to prove that the method is no longer an experiment, and the man or woman who takes advantage of it before the system is too seriously affected has far more a fighting chance for complete recovery. Perhaps an outline of what has been accomplished at the White Haven Sanatorium may be of interest in this connection. When White Haven was opened on the Pennsylvania hillside, the buildings consisted of a tumble-down old barn and a very dilapidated small farmhouse located on a tract of two hundred and fifteen acres of mountain land. The Free Hospital for Poor Consumptives, which established it, had no money on14hand with which to begin a well-equipped sanatorium, and there was no prospect of getting any in the near future; so it was decided to begin in the humblest way, and depend upon Providence for the financial resources as the work developed. A few comfortable single beds of ordinary hospital pattern and make-up were put on the barn floor for the patients; a little room in the farmhouse was plainly furnished for the superintendent, and another for the cook; a small kitchen range was secured, and placed in a very primitive kitchen; a table and a few benches were made out of old boards for dining-room furniture, and a few dollars were expended for kitchen and dining-room utensils. This was practically the entire equipment, and the cost was but a trifle. When the board of managers talked over the matter of opening the sanatorium, it was thought that under no circumstances could the capacity of the institution be increased beyond twenty-five beds during the first year. It was soon found, however, that this limitation could not be adhered to. The most urgent appeals came from everywhere, and as it was possible to pay the bills at the end of each month, a few beds were added from time to time. At the end of the first fiscal year, there was a capacity of eighty beds, but in spite of this increase there was a waiting list of over one hundred patients, and the pressure for admission was greater than it had been at any time. During the first year there were one hundred and fifty-six admissions. Of these, sixteen remained less than a week, and eighteen more less than a month, making a total of thirty-four who remained less than a month. Some left because the place was too primitive, some because the weather was too cold, or because they were afraid to sleep in a draft, some because the associations were not good enough, and a few had to be discharged for breach of discipline. The results which were obtained, however, during the first year were far beyond expectation. A majority of the patients who remained over three months either recovered their health sufficiently to return to their avocations or are making rapid progress toward that condition. Quite a large percentage of the patients left as soon as they were well enough to go to work, promising to keep up their treatment at home. Some of these have done well, and it is quite possible that, with the knowledge they have gained at the sanatorium and the habits of life which they have formed, they will progress to recovery while pursuing their callings. In age the patients ranged between nine and sixty years. The majority were of the age of greatest activity and usefulness in life; namely, between twenty and fifty years. The treatment at the White Haven Sanatorium has been outdoor life, a carefully selected diet, regulation of exercise, and medication for the improvement of nutrition. The patients practically are kept in the open air for the twenty-four hours, irrespective of weather. At night all the windows in the pavilion are kept open, so that the air circulates freely throughout the sleeping apartments. Drafts are disregarded. Ample bed-covering is supplied to keep the body warm, and in cold weather bed-warmers are furnished the patients. In daytime the patients either sit out of doors or work. The camp life is one of the unique features, but thoroughly enjoyed by the patients. The summer camps amid the trees are near enough to the buildings to allow the latter to be easily reached when the dinner hour comes round. In them congenial groups pass most of the day in chatting, reading, or with games, the women often busying themselves with needlework of some sort. Each camp represents a little social club, where it is easy to forget one’s ills amid the cheerful surroundings. Very simple structures are they. Any material available is used for the roofs and walls. Planks or boughs fastened to convenient forest trees may form the sides, the trees being used for posts. Usually the southern side is left open; for they are merely intended as shelters in inclement weather, so that the inmates are to all intents and purposes in the open air. If warmth is required to make the camp comfortable, a small wood stove or perhaps an open fireplace is provided. During the winter months it must not be supposed that the camps are deserted, nor is outdoor recreation abandoned. Patients whose condition will allow them to go into the woods spend much of the time in these shelters, wearing sufficient clothing and wraps to prevent becoming chilled. The exposed side of the huts is not closed in winter, and it is often necessary to make a path through the snow to reach them. While the camps, as already stated, are very popular during the period between May and December, a large number of those who are members of the community live under canvas; for tents are put up about the permanent buildings, and inhabited until the snow comes. As to the “winter” camps, not a few have been constructed by patients, with such tools as were available. They have used not only axes and saws, but even their penknives, and have gladly performed the labor in order to secure these resorts, where they may receive not only the benefit of nature, but enjoy the society of friends. . . . When patients contract colds, as they occasionally do when some one comes into the sanatorium with a cold, they are at once put to bed, and kept there until they are over the acute stage. Colds always come in epidemics, passing through the entire sanatorium. As a precautionary measure the sanatorium has printed notices at the entrances to the grounds requesting people with colds to remain off the premises. The pulse and temperature of each patient are taken and recorded night and morning, and the weight is taken and recorded once a week. These records give an indication for the regulation of diet and exercise, and are carefully studied for that purpose. Patients who have rise of temperature and disturbed pulse-rate are not permitted to take any exercise. Unless a patient gains weight, his diet is incorrect, and an effort is made to correct it. The sanatorium was opened ostensibly for incipient cases. It was impossible, however, to limit admissions to this class; first, because not enough of such cases could be secured, and second, because the pressure for the admission of other cases was too great to be withstood. Advanced cases were cautiously admitted, and upon it being found that they did well, the doors were thrown open to all subjects who did not show a rapid downward tendency. Of one hundred and fifty-six admissions in one year, there were only fifteen who might be termed incipient cases. Sixty-three had both lungs involved, and about ten per cent of the entire number had at least one other organ or tissue involved besides the lung. A study of these and other patients, however, taught some valuable lessons: (1) that tuberculosis is curable under the most primitive conditions, provided the patient is kept out of doors and given plenty of the right kind of food. The comforts of life are of secondary consideration, and exposure to weather and cold may be disregarded; (2) that for successful sanatorium work patients should be carefully classified and kept apart according to the stage of the disease; (3) that tuberculosis is seldom recognized until it is far advanced, and that many patients continue to work when they have more than one important organ of the body involved; (4) that incipient cases recover in a very short time, and advanced cases require a long time for complete recovery.—Lawrence F. Flick, M. D., in The Independent.