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remain quite well, and will continue well so long as they live within the bounds of reason. I have been back at work three years, and feel better now than when I returned.
I was formerly always thin and delicate, subject to constant colds and ill-health. During the last three years I have not been absent from business a single day through illness, and my general health is completely restored.
I emphatically affirm that consumption is not a fatal disease, that not a single life should be lost through it, if only the proper means of grappling with it were employed.
It is not for me to enter into the scientific aspect of the disease. An excellent paper on Nordrach is contributed by Dr. R. Mander Smyth, himself a patient cured there, to the British Medical Journal of the 1st of October. I shall, however, give a rough outline of the treatment as carried out by Dr. Otto Walther, and to a great extent originated and perfected by him, at Nordrach, in the Baden Black Forest, Germany. The results he obtains are so much better than are got at any other sanatorium that Nordrach is the best place to take as a pattern when erecting sanatoria in this country.
The three outstanding features of Dr. Walther's treatment are :
(1) Over-feeding.–Dr. Walther holds that there can be no cure without weight-gaining. He carries this to its logical conclusion, and stuffs his patients to their utmost capacity. It is amazing the amount one can eat when forced to it; twice or three times as much as one would feel inclined to eat. There is no harshness used, but somehow the Doctor is able to make every one eat the amount necessary. The food is of ordinary kind, but consists of plenty of milk, fats of all kinds, meats, potatoes, vegetables, butter, bread, cheese, fruits, sweets, &c. The gain in weight is often enormous. I have known a patient to gain 8 lb. in one week, and another to double his weight while at Nordrach. Every one gains weight. Each patient is weighed every week; and as there is a friendly rivalry as to who will gain the most, there is a stimulus to good eating. This over-feeding causes no ill effects ; indeed girls come there who have taken very little solid or nourishing food for months, and start at once on this heroic treatment, showing signs of immediate improvement. We used to say amongst ourselves, or when impressing on a newcomer the necessity for eating largely, that we had to eat three times the ordinary amount of food ; one portion to replace natural waste; a second portion to replace the extra waste from the disease ; and a third portion to put on weight so that the system might be strengthened and finally get the better of the disease. As the weight increases the patient begins to feel more fit, and to realise that at last he has stumbled on the right treatment. The cough leaves him after the first few weeks. This irritating cough is nothing but an ordinary cold which the patient has all along been too weak to throw off. But now he is able to master it, and as a consequence his lungs get more rest and he himself more sleep. The chest begins to expand, the lungs to heal, and little by little, unconsciously and without effort, the patient's bent shoulders begin to straighten. Every fresh sign of returning health is of untold encouragement and good to him; and besides he sees others getting cured and leaving for home. There are three good meals a day. I am sure there is no place where there is so much food consumed per head as at Nordrach. And that by dying consumptives who are generally supposed to have no appetite! The meals are at long intervals, and there are no snacks allowed between whiles. Breakfast at 8, dinner at 1, and supper at 7 o'clock. Patients are required to be in their rooms to rest on their couches for an hour before each meal. Immediately after a walk one is too tired to eat well, but when an hour's rest has been taken one has as much of an appetite as it is ever possible at Nordrach to have. Resting is always to be taken stretched out at full length on a couch, as in that way the maximum amount of rest is obtained. No medicines are ever given, as they can do no good, and only upset the stomach.
(2) Regulation of the amount of ecertion and rest.-Doctors at home little realise that this is such an important matter. Certainly there is nothing so harmful to a consumptive patient as over-exertion in any form, mental or bodily. Even too great intentness in reading a novel, or, let us say, the excitement and engrossedness of listening to a concert, are injurious. Dr. Walther gives great attention to this matter of regulating the amount of exertion, for he says that more consumptives kill themselves by doing too much than in any other way.
Each patient has to take his temperature, by the rectum, four times every day, and to note it on a chart. The Doctor visits him three times a day, and can tell at a glance from the temperature chart if the patient is doing as he ought, and instructs him accordingly; whether he is to be in bed, to lie on his couch, to sit outside, or to go a long or a short walk. When there is fever the patient is required to be in bed until such time as the temperature becomes normal. In old-standing and obstinate cases this is sometimes for months. When in bed the patient is expected to eat quite as much as when going about. Walking is generally uphill, and always at a snail's pace, so that the lungs are exercised without being exerted, and are thus strengthened and healed. These walks are increased in length as the patient grows stronger, until by the time he is quite cured he is allowed to walk long distances, say ten miles, and is so thoroughly hardened and confirmed in health that he is able on his return home to at once resume work. When cured, the erstwhile patient is sent back to this country as readily in mid-winter as in midsummer. Winter in fact is the best time for consumptives under the Nordrach
treatment, as then they eat more and gain weight more rapidly. Ten hours' sleep every night for each patient; to bed at nine and up at seven o'clock. Though one may not be sleeping all the time, yet one is resting. The Doctor is very much displeased when any one disregards his instructions on these matters. Indeed the patient soon finds out for himself that the laws laid down are for his good. Over-exertion to the length of fatigue results in return of cough or fever, or tells a tale in some other unpleasant way.
(3) Pure air.-From the moment of arrival until leaving Nordrach the patient never breathes one breath of any but the purest air, as Nordrach is in the Black Forest at an elevation of 1,500 feet, surrounded by trees, and a long way off from a town or even a village. The casement windows of the sanatoria are kept wide open day and night, winter and summer, and in some instances the windows are taken completely out of the frames. Thus it is practically an outdoor life the patient lives continuously.
There is therefore no danger of chills on going out in any kind of weather or at any hour, as the temperature within and without is equal. So pleasant does this living in the open become, and so hardy is the patient made, and so invigorated, that on his return to this country it is the greatest misery for him to have to remain in a room with closed windows. Being at such a considerable height~1,500 feet, with a rise in the longer walks of another 1,500 feet—the patient, to get the same amount of oxygen into the system, must breathe relatively more of the rarefied air, and thus expand the lungs. In this way the lungs are completely flooded with pure air; all the odd corners and crannies, which he has hardly used for years, are ventilated, which the easy walking uphill is eminently calculated to effect, while at the same time the almost absolute rest the patient enjoys allows the lungs to be practically undisturbed, and so permits the healing process to proceed. The climate is much the same as at home. There is quite as high a rainfall, and in winter it is much colder. But it has been demonstrated beyond a doubt that climate has absolutely nothing
There the patients, who go out regularly, day after day, in all kinds of weather, sometimes walk for hours at a time in the rain, without ever thinking of changing their wet clothes afterwards. This course I still adopt, and find that such a wetting -sometimes twice in one day-never does me any harm whatever. I asked Dr. Walther if he thought his system could be carried on with bope of success in this country. He said that it could be worked here quite as well as at Nordrach, or as in the balmiest clime; that all that was required was a place where pure air was to be had, situated well away from a town, at a fair elevation, and the man to see that the system was properly carried out. I am now convinced that this is perfectly true. Absolutely nothing else is needed. Freedom from
a high average of sunshine, dry climate, and all such other
to do with the case.
Vol. XLV-No. 263
things as are generally supposed to be so necessary, go for nothing. Aad this is the crux of the whole matter. It is possible to cure here, on the spot, almost all the people of this country who are ill of phthisis! Why, then, are sanatoria not erected at once to cure the hundreds of thousands of those who are ill, and who have not the means to go abroad-hundre s of thousands who are as certainly doomed to death as if they were already under the sod, if some such steps be not at once taken ? It is sad to think that all these people must die, when they might easily be saved.
These are the three features of the cure : nourishment, rest, and fresh air.? Of course there are details in the treatment. Every patient is examined once a month, both as to his lungs and sputum. Each month the symptoms of disease become less and less evident, until there comes a time when the Doctor, after examining the patient's chest, will say, 'I can hear absolutely nothing. That indeed is a happy moment for the patient. The lungs
The lungs are quite healed, and the sputum likely to be free from bacilli. After assurance is made doubly sure by injecting the sputum into a guinea-pig, and waiting a few weeks to see that there is no unfavourable result, the happy patient—now a patient no longer-is free to leave Nordrach and go whithersoever he listeth. As a matter of fact, their most intimate friends often do not recognise in the stalwart, broad-chested fellows the dying consumptives they knew but a few months before.
Only forty to fifty patients are taken at Nordrach. Dr. Walther says it is impossible to properly overlook more, and it can be easily understood that he is besieged with applications for rooms long before he is able to accommodate the applicants. It is in the matter of this effective supervision that the results got at Nordrach are so much better than can be obtained elsewhere. If one thinks for a moment this will not seem strange. At Davos and such places friends of the patients and others unite with them in having a good time, and render it almost an impossibility for a cure to be effected. Nordrach, as far as I can discover, is the only sanatorium where this thorough, constant, personal supervision is exercised, and it tells in a marvellous way in the results. Instead of twenty-five to thirty per cent. cured at other sanatoria, and those only the most favourable cases, ninety per cent. I should say are cured at Nordrach, and many of those would be cases of the very worst type and of the longest standing, that had most likely come from other sanatoria to Nordrach as a last resort.
Taking all cases---favourable and unfavourable--the average time necessary to effect a cure is five to six months. Some are cured in
: Of the three the over-feeding is by far the most important, for it is conceivable that a cure might be effected by this means alone, which could never be accomplished by fresh air and rest only.
two months, others (a few) need as many years.
As to what is a hopeless case there is no saying. I think Dr. Walther never gives up hope. Certainly he has cured cases that were considered absolutely hopeless by every other authority. But it is to be hoped that, with increasing knowledge and better precautionary measures, such cases as are almost beyond all hope will no longer be met with, so that soon there should be no doubt as to every one being cured, if only we set about establishing a rational system of treatment on a
The advance in our knowledge of tuberculosis of late years has been immense. It is now no longer considered, in the bestinformed circles, as incurable, and it has been proved beyond doubt that it is not hereditary. There is never disease, active or latent, in the offspring unless the womb itself of the mother is diseased-a very rare occurrence. In the case of cattle, as veterinarians know, it has been proved that it is not an hereditary disease by the experiments conducted by Sir Thomas Gibson-Carmichael, M.P., in his pedigree herd at Castlecraig, some of the soundest and best-known animals of which have been bred off tuberculous parents. The idea that it was an hereditary disease got abroad no doubt in somewhat the following way. In a family in which one or both of the parents are consumptive the children are constantly in contact with an infectious disease. The fact of the parents having fallen victims to the malady is an indication that they were weakly constituted. The children are naturally weakly constituted also, and are therefore liable to take this or any other infectious disease. That is all. To begin with there is certainly no disease in the children's systems. But living in the same unhealthy surroundings and bad circumstances as their parents, and being badly nourished, either from necessity or through a constitutional distaste for proper nourishing food, they naturally sooner or later most likely contract the disease. This gave rise to the idea that consumption runs in families. But if the children were taken away from those bad surroundings, and brought up rationally and healthfully, they would be quite as free and immune from the disease as the children of the healthiest parents. On the other hand the very healthiest people, with the best possible · family histories,' become afflicted with phthisis through disregard of the laws which make for health. So long as the body is in health, well nourished and well cared for, there is no danger from infection. One may then, without any danger, commit the generally considered suicidal act of going out in rain for hours without overcoat or other protection, and without afterwards having a change of clothing, and do many other such terrible things without any other result than an increased belief in the wisdom of keeping strong in order to defy disease. It is only when the system gets below par, through some of the hundred and one agencies that