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It is of great importance to build the most suitable form of sanatorium. Much money may be uselessly wasted on buildings which, let us hope, in ten, fifteen, twenty, or twenty-five years will no longer be needed. Every shilling available should as far as possible be spent on the patients, and not on the buildings. To read Sanatoria for Consumptives one would think that the building and the site were everything, and that the treatment and the doctor were merely secondary considerations. Walther's sanatorium consists of four buildings, two of which were old dwelling-houses, and another was a little factory, while the fourth is the only one he has built specially as a sanatorium. (This latter building I will describe afterwards.) It is a fact that he gets just the same results in the converted dwelling-houses and factory-the rooms of which look in all directions, north, south, east, and west, and into some of which sunshine often does not enter for months-as he gets in his specially built Anstalt. This shows that the house is practically of no importance. Patients are in their rooms only two hours a day, and sunshine, which is not of much moment, they get outside.
First, as to a site for the sanatorium. Go to the highlands of Scotland, the lowlands of England, or to the bogs of Ireland, and plant your sanatoria there, it is of little consequence where. I see many doctors, leaders of public thought on matters of health, still coquetting with climate. Climate has nothing to do with the matter. All that is absolutely necessary is (1) a spot in the country where pure air is to be had, (2) well away from smoke, dust, traffic, and excitement, where the patients may lead the quiet unconventional lives so necessary to their well-being ; (3) the proper treatment, and (4) (but most important) the man to honestly carry it out. These four things are indispensable, nothing else is. It matters little whether the sanatorium be at the sea-level or on a mountain ; whether there be little or no wind; whether the walk be uphill first or downhill first (these two latter are only of importance in so far as they fatigue or do not fatigue the patients); whether there be much or little sunshine; whether the rainfall be high or low, or whether the soil be porous or otherwise. All these things are to be considered, not from the standpoint of healthfulness or unhealthfulness--for in the British Isles all places in the country where pure air is to be had are equally healthful—but from that of the patient's comfort. It is of course advisable to have as many helping factors and favourable conditions as possible, but I am so emphatic on this point because I wish it to be understood that these accessories are not absolutely necessary. The ideal place for a sanatorium is a site in the country, five or six miles at least from the nearest town, village, or public works, with an elevation of from 500 to 1,000 feet, protected on N.E. or N.W. by hills and open to S.W. or S.E., with plenty of trees which will afford protection for the patients from wind and sun, near and with a good expanse of country-over which the patients may have full liberty to roam, without fear of much outside interference--around.
Having selected the site, what is the best form of sanatorium ? The cheapest certainly, so that every possible pound may be spent on the patients. There must be no stinting in the matter of food, or in the salary necessary to secure a first-rate doctor. I would suggest that 1,000l. a year at least should be given to the doctor. The best men possible should be selected for the work-men of iron will, of great tenderness of heart, of unflagging perseverance and of inexhaustible patience. They should learn the treatment by practical experience for six months or so while the sanatoria are abuilding. It must be made worth the while of these doctors to devote their whole lives to this work, and to this alone. In this way only, by raising up a school of specialists in consumption from the best brains, hearts, and heads in the country, will consumption finally be overcome; for in the end everything depends upon the man who has charge of the sanatorium. I understand that a limited company has lately been formed to start a sanatorium, and that they are advertising for a doctor at a salary of 801. a year. To think of putting the lives of hundreds of people into the hands of a man who would accept such a salary! It is simply courting failure.
The following is the most perfect-because the simplest and cheapest-sanatorium that can be built. It is Walther's Anstalt. It consists of a long straight building of three stories, facing southeast or south-south-east, so that although the front gets most sunshine, yet the back is not altogether deprived of it. The lower story consists of the 'cellars’ (all above ground) for storage of coal, and for the plant necessary to heat water for baths, &c. Electric-lighting machinery would also be put in here, unless water-power were convenient, as gas (and fire) in the consumptive's room is very objectionable. There is no connection between these cellars' and the two upper stories, which are the bedrooms of the patients. The entrance to the cellars' can be from the back or front. The entrance to the two upper stories would be from the north-east and south-west ends by stairs. The second story would consist of a long line of rooms, say twenty, all facing to the front and opening on to a corridor behind. This corridor should be about six or eight feet in width, and should run the whole length of the building, ending in large casement windows, and having in its entire length a casement window opposite the door of each room. The third story is a duplicate of the second. Two w.c.8, servants' scullery, &c., would be built for each of these two stories, out from, and at the back of, the sanatorium ; one tier at the north-east corner, and the other near the centre of the building. Each patient's room would be about 14 x 14 x 12 feet, with the front almost full of window space—two casement windows, each about 5 x 5 feet, and above each a fanlight pivoted window reaching nearly to the ceiling. The floor of each room should be covered with linoleum, and the walls and ceiling sheeted with well-varnished wood, all of which could be washed as often as necessary. The furniture and fittings of each room should consist of the following: bed, dressing or writing table, two chairs, spitting-cup, &c., stand, wardrobe or chest of drawers, couch, douche-bath (hot and cold), coil of steam or hot-water pipes (which should be used for tempering the cold only in the depth of winter, and then but on the very coldest days) and electric-light pendant which should be movable, so as to be hung above table, couch, or bed. Each room should have bell communicating with servants' rooms; and the sanatorium should be connected by telephone with the doctor's house. The executive buildings-kitchen, servants' house, office, doctor's house, and dining hall-should be together, situated three or four hundred yards from the sanatorium proper, and should all be built as plainly and cheaply as possible. It may be here said that the doctor should lead the same Spartan life as the patients, if he is to command their respect and keep his necessary vigour of mind and body. The dining-hall should be a long, one-storied erection literally full of windows on each side-windows that could be taken quite out of the frames for a considerable part of the year, for where forty or fifty consumptive patients are in one room, for as long, often, as two hours at a time, it is necessary to have a superabundance of pure air. There should be no lying-out verandahs built on a sanatorium; they only conduce to lazy habits in the patients, and they do anything but put them ‘in the condition of athletes in training. Common sitting or meeting rooms are also a mistake, for they lead to loitering, talking, and excitement.
Such is a complete sanatorium for forty patients. It should not cost more than 5,000l, or 6,000l, at the outside. If there is not so much money as that available, any house in a suitable place will do to convert into a sanatorium in which to carry out the treatment thoroughly.
The Committee of the proposed West Kirby Sanatorium—the building of which the generosity of Mr. W. P. Hartley and Lady Willox has made practicable—appointed a deputation to take the advice of Sir William Broadbent and Sir Douglas Galton as to the plan on which it should be built. At the request of one of their number I met the deputation in London and placed the above plans before them. Plans of a · Pavilion 'sanatorium on much the same lines as Ventnor had been drawn out. It was to cost 15,0001. and to have accommodation for about thirty-five patients. The deputation unanimously accepted the plans here set forth, provided that Sir William Broadbent and Sir Douglas Galton concurred. Next day we waited on Sir William and Sir Douglas, who heartily approved of these plans and condemned those on the Ventnor principle. Instead of 15,0001. their sanatorium should cost them only 5,0001. or 6,0001., so that the West Kirby Committee will have a good few thousands in hand and a more suitable sanatorium) with which to buy a better site—as the site selected is anything but the ideal one-or, if that be found impracticable, to carry on the work at West Kirby and even to build a second sanatorium.
When it has been proved beyond doubt that consumption is quite as curable at home, on these lines, as it is abroad, it will be the duty of the State to undertake such measures as may be
for the cure, prevention, and final eradication of this disease. Private and philanthropic effort are of little use to check the fearful ravages of consumption. While it is being attacked in one place, it is spreading and flourishing in a hundred others. It must be attacked at all places at the same time, as in this way it will be the more easily, quickly, and economically overcome. Sooner or later the State will have to take the matter up, for it cannot be thought that an enlightened and civilised community could stand by and see hundreds of thousands of its members perishing (and hundreds of thousands will perish, needlessly, if private effort alone be trusted to) when a remedy lay to hand.
JAMES ARTHUR GIBSON.
* The object of chemistry,' Lavoisier wrote in the last century, ‘is to decompose substances and to examine separately the divers elements which enter into their composition. . . . Chemistry advances towards its goal by division, subdivision, and subdivision again.' Only step by step did chemists come to the idea that the reverse operation also belongs to their domain; that after having learned of what elements a body is composed, and in what proportions, they must strive to reconstitute that body out of its elements; that synthesis, in a word, must follow analysis.
With inorganic bodies synthesis rapidly became of everyday application ; but until the year 1828, or practically until the end of the first half of our century, it was considered that to build up organic bodies, such as are produced by vital processes in plants or animals, lies beyond the reasonable ambition of a chemist. Taking a lemon as an instance, when the chemist had shown that it contains an acid and some sugar in its juice, some colouring matter and an aromatic oil in its peel, and some woody substance in its inner peel, and when he had determined that the acid, the sugar, the oil, and so on consist each of so many atoms of carbon, oxygen, and hydrogen, he considered his task accomplished. The possibility of building up the acid, the sugar, or the oil in the laboratory, out of their elements, must have haunted his mind, but he dismissed it as unrealisable. The intervention of a vital force' was considered of absolute necessity for that end.
The news that Wöhler had obtained, in 1828, out of inorganic stuffs, a certain substance, urea, which occurs in nature as a distinct product of vital activity in animals, came, however, to upset the then current ideas. Then, later on, Liebig in Germany and Frankland in this country made several important syntheses, and in 1860 Berthelot published his epoch-making work, Organic Chemistry
| Professor Meldola, in a very suggestive address delivered before the British Association in 1895, pointed out that Henry Hennell had made in this country, in 1826, the synthesis of alcohol from coal-gas; but this important discovery passed then unnoticed.