for the comparative failure in their treatment. For certainly we must all admit that, of our patients with limited means who have been treated for recognized phthisis at their homes, in our more thickly settled communities (no matter how early in the disease they may have been seen), very few have recovered; the great majority even of incipient cases going from bad to worse before our very eyes. I doubt if any one will controvert this statement, unless it be the man who, during a large practice of thirty or forty years' duration, has never lost a case of pneumonia, or of diphtheria either, before or after the discovery of antitoxin. Consumption is a terrible disease and cannot, for many years at least, if ever, be robbed of all its terrors, in spite of the best medicinal, hygienic, and climatic treatment, in spite of all actual or possible new discoveries in science; nevertheless, those who have observed and are in a position to know, whether in this country or in Europe, feel confident of the superior efficacy of the modern sanatorium in the treatment of phthisis. Now, in what does this superiority consist? Surely not in the medicines used, for they are the same as those used by practitioners in all of our cities and towns. The dietetic treatment in sanatoria is important, but, except as the digestion and assimilation of food are more or less dependent upon the conjoined measures employed there, it can be carried out anywhere, as can also the baths and other hydropathic measures and massage, as well as the breathing and other exercises,-if only people would do it. The regulation of a consumptive's exercise and rest according to well-defined principles is a matter of vital moment, and yet on this point much ignorance prevails among the medical profession, in consequence of which many lives are undoubtedly lost. Still, if the physician realizes its importance and will give enough time to it, it can be utilized for the patient, wherever he may live. Yet more important, but more difficult to manage at the patient's home, is the effort to procure an unbounded supply of pure fresh air direct from nature's laboratory, by day and by night, in winter and in summer, in spring and in fall, in season and out of season. Satisfac tory arrangements for this are hard to obtain in our cities and large towns. Even if their environments were not particularly unfavorable, -as they would be from bleak east winds just off the ocean, from density of population, with accompanying abundance of noxious germs of various kinds, from volumes of smoke and dust, from dampness of soil, etc.,it is not easy to provide proper piazza space for day reclining, with the best sun exposure and sheltered from the worst winds; nor indeed do such patients often have sufficiently large sleeping rooms. Still, these obstacles are sometimes and to some extent surmountable; although in comparison with the deliciously pure and bracing, germ-free, elevated air of Rutland and some other localities, the air of such places is at best second or third or fourth class. Contrary to the opinion of some, even such city air, by night or by day, is vastly superior to the bad air breathed and rebreathed, over and over again, in which so many people seem to revel. In what has already been presented, a part of the advantages of the sanatorium treatment (which sometimes can also be obtained at home) has been hinted at; but by far the most important benefit to be derived from a sanatorium is the opportunity there provided to regulate the patient's conduct and life by the discipline of the place. Even if the physician finds that all of the benefits above referred to, and others as well, can be secured to his patient at home (as rarely happens), yet he never knows whether or not his prescriptions are followed in detail. In many cases the patient uses his own judgment, and frequently makes exceptions for what seems to him good and sufficient reasons. The will power in this disease is often weakened as well as the body, and he finds it easy to make excuses to himself for neglecting the plain path of duty. If any one doubts this tendency, let him look back on his own life and try to recollect how often, not only on January 1, but on many other days, without even the pretext of will power weakened from tuberculosis, he has made good resolutions, and promised himself to pull those chest weights and swing those Indian clubs in his bedroom so many times a day, for the development of his own muscle or for the relief of his own sedentary infirmities. On the other hand, in a sanatorium a certain amount of military discipline prevails. The patient's life is a regular one, his duties are those of an established routine, and he does them the more easily because others by his side are doing the same things. Indeed, the keynote to the whole situation is the fact that, instead of being left to use his own judgment, he is practically under the thumb of the physician and his assistants, though not in an offensive sense; for he is a willing captive, and gives his cordial coöperation in all the requirements, knowing full well that every one concerned is anxious with him for his recovery. If he cannot take the discipline he leaves the institution. The night nurse, acting under instructions, keeps the windows open just so wide, no matter what the judgment of the patient may dictate. The latter lies abed, reclines in his steamer chair in the sun room or on the veranda, and takes walks or other exercises according to directions, and there are those near by whose duty it is to see that these directions are carried out. The nearer he gets to becoming a well man, the more liberty he has to regulate his own affairs. That this routine and discipline are not onerously irksome, and that the aggregation and close association of a large number of consumptives in one institution are not mentally depressing, as many people without experience theoretically imagine, can be easily proved by a visit to Rutland on any day, when demonstration will be forthcoming that it is one of the happiest communities in the world, at least to all external appearances. That our new State hospital (or sanatorium, as we like to call it) will in the years to come save many lives and return them to their dear ones; that it will, from a pecuniary standpoint, restore many wage-earners to the support of their families, thereby adding also to the productive labor of their towns, counties, and State; that it will so arrest the disease in its graduates as to enable them to live right here where they want to live, instead of in Colorado or Arizona, where their disease might have been arrested, but where they might not care permanently to reside; and that, where lives cannot be saved, they may be prolonged by such treatment, is our fond hope and belief. But we are not satisfied merely with these closely related benefits. We like to consider our hospital not merely a sanatorium, but also a great Normal School, whose graduates, having there learned how to live, will become teachers in the communities in which they may settleteachers of the laws of hygiene and healthy living, demonstrators of the importance of the destruction of tuberculous sputum, and apostles of the gospel of pure, fresh air, especially to consumptives, and more especially still to those of consumptive tendency; for it is far easier and far better to prevent than to cure. That there is need of missionary work in this direction, not only foreign, but also (we must confess) home missionary work, is beyond question. The air in our steam cars, where some of us spend so much time, is often vile beyond description. Our public halls, churches, lecture rooms, libraries, theatres, steamboats, and many other places are sometimes unbearable, and the air in all of them has often been proved to contain tubercle bacilli in abundance and of such virulence as to cause tuberculosis when injected into Guinea pigs, rabbits, etc. Our graduates have been so thoroughly soaked in pure, delicious, fresh air that they learn to love it as the hunter loves camp life. Some of them may learn to teach something about dietetics, some to teach hygiene, but all can learn to preach the virtues of fresh air; and if they become cranks upon this subject, so much the better chance they have of drawing the people up, somewhere near the proper line. It may be said that it is not necessary to take a course in a consumptives' hospital, to be able to teach the virtues of fresh air; but I have an idea that a man who has become a thorough master of the bicycle can better instruct another in riding than one who has never been on the machine him self, but who teaches it from theory only. Almost every man claims to believe in ventilation, and has done so for years; and yet many places all around us continue to reek with foulness. It is the hardest thing in the world to persuade many consumptives at home to furnish themselves with fresh air. They are constantly afraid of taking cold. I have often thought how nice it would be if foul air could be seen, like smoke, as well as smelled, especially by those whose olfactories are not very acute. Probably, however, this sight would not be enough, as smoke does not always intimidate. Better might be the effect if the foulness showed itself as large particles of visible dust, or if it took to itself wings and hung in the air as innumerable living bugs, each intent upon mischief, the patient not having imbibed! Would that each consumptive might learn to dread the smell of bad air, as some people now dread the smell of ether on account of a suggested surgical operation, or of carbolic acid or other disinfectant on account of a suggested contagious disease. If they lack everything else, yet give them a longing for plenty of fresh air, such a longing as had Arabella Willson more than a generation ago, expressed in her classic poem which I quote, showing that then as now, and now as then, a bad environment often attaches to a so-called good place. O Sextant of the meetin'-house, which sweeps And lites the gass, and sometimes leaves a screw loose, But, O Sextant, in our church it's scarce as beauty, |
