below zero, the snow blowing in on the beds, no heat whatever and hot water bottles freezing by morning. This was surely a most strenuous life and had President Roosevelt ever seen such conditions he would have certainly referred to it in his famous book, for never were there a braver little band of men than those eighteen who faced our first winter at White Haven. In spite of these conditions the patients. contracted no colds, pleurisy or pneumonia and never since have our results quite equalled those obtained under these conditions, and the majority of those eighteen are well and working to-day. The example is a strong point in favor of the tent theory for all winter, but personally I would hardly advise anyone to try it, for looking back now it is difficult to understand just how they did pull through such a vigorous life. The system of treatment at White Haven is a combination of the best ideas gathered abroad, together with original ideas of Dr. Flick, and combined we have proven beyond a doubt that our recoveries and improvements cannot be equalled by any Sanatorium we have any knowledge of to-day, in the same length of time, and this is in spite of conditions that are still crude owing to lack of funds, and if we are successful in ever raising the necessary money, we purpose showing the public the largest and most complete Sanatorium in the world to-day. At present we have 100 beds with a large waiting list, but if the funds can be had we purpose increasing this to 200 or 300 this coming summer. With all these patients we have a staff of but eight employees with one resident physician, and a weekly maintenance averaging but $4.70 for the past fiscal year, yet we give our patients from 4 to 6 quarts of milk and from 6 to 12 fresh eggs daily. I know of but few institutions that are so economically conducted, and yet our food is invariably of the best quality and the quantity is never limited. As to fresh air, we insist on all whose temperature permits staying out doors from 8 to 12 hours daily. All are provided with reclining chairs placed on porches or protected from the winds and wrapped in warm blankets and given foot warmers when needed. If properly wrapped up the patient can be made comfortable in spite of all elements and it is this sitting out that hardens the patient, gives them the appetite to take our forced feeding and makes them sleep well at night. On forced feeding every patient is compelled to take not less than 4 quarts of milk and 6 fresh raw eggs daily and many take 6 quarts of milk and 12 eggs daily, a few even more. On the question of taking milk, I would like to say that I have seen many patients abroad and in Colorado refuse milk because it "upset them" as they said, and so prominent a physician as Dr. Knopf says many are unable to take it, but of nearly 400 cases treated at White Haven we have never had a case whom we did not ultimately induce to take the milk diet and yet a big percentage had never drank it before coming, proving that if given properly and of the right quality, which is the essential point, anyone can take it. To keep our milk right we insist on the dairies supplying us conducting them according to our orders and we personally inspect them to see that our instructions are carried out. To our minds no patient has much chance of recovery who cannot take forced feeding, and to make this possible it necessitates the best of food, the highest grade of cooking and a carefully selected menu. At 9 Our breakfast is a light meal served at 7 o'clock, consisting of fruit, cereal, coffee, milk, raw eggs and rolls. o'clock a lunch of milk and eggs is served and at 12 o'clock dinner, which is the only heavy meal of the day. Dinner consists of soup, with beef steak or roast beef, with lamb and mutton occasionally merely for a change; those vegetables such as potatoes, stewed onions, macaroni and cheese, rice, carrots, turnips, beans, etc., and in summer fresh vegetables. A dessert is served of some plain pudding containing milk and eggs and on Sundays and occasionally during the week, ice cream. No fancy pastries or pork or veal are served, but cabbage we find safe if boiled not less than four hours. At 4 o'clock lunch is served of milk and eggs and soda crackers, and at 7 o'clock, supper, which consists of either boiled rice, mush and milk or Irish stews, etc., with milk and eggs, tea and cream cheese, crackers. Butter is always served in abundance and all are encouraged to eat as much as possible of it. We only limit the minimum quantity, never the maximum and we insist on the patient eating his dinner whether disposed to do so or not. Temperatures are taken at rising and bed time, also pulse rate, and a careful record chart is kept of these with quantity of eggs taken, hours at cure, bowel movement, etc. The patients are divided in three squads, each under a captain who has lieutenants to assist him. They eat at separate tables, do all their own work as to housekeeping, etc., except of course cooking. They are divided into three classes: the first class doing the heavier work, the second class light work, the third class complete rest. The work therefore is divided to suit each class and each patient, unless in the third class, must do his or her share of the work. After breakfast each patient is seen personally and his record chart scanned, and if there is a rise in temperature or pulse he is put in the third class for that day, and if temperature is above 100 degrees is put to bed. By carefully watching the record chart, colds can be checked at the start and the patient is guarded against any serious development; upset stomachs are carefully looked after and the smallest detail receives careful attention. None are allowed to move about with a temperature above 992 and above 100 they go to bed until temperature becomes normal. All our patients rest in bed not less than 10 hours. All windows are kept wide open. No attention is paid to draughts. All are weighed weekly and weight recorded. Some of the weights are remarkable-many gain over 20 lbs. the first onth and one man has gained 231⁄2 lbs. in 25 days. I distinctly remember a case at Falkenstein who gained 12 lbs. in a month and he was the show patient of the institution and all wanted to see him. At White Haven we have had the same gain in one week. Dr. Walther at Nordnack always has the largest gains in Europe, but they have never yet reached records we have made. The secret of our success is our method of feeding and the careful individual attention the patient receives, and our rigid rules to which there is no unbending and to which all must adhere or leave. The patient soon falls into this routine when they realize it must be done and after the first few days find it far from a hardship. The medication used is Europhen in all cases, and varying tonics to aid digestion in most all cases. Expectorants when having a cold, and creosote in all cases with mixed infection. Whisky is never given. With this treatment the cough and night sweat disappear and the patient gains weight. For hemorrhages nitro-glycerine is used and as a precaution against them it is also given where there is an accentuation of a pulmonary second sound of the heart. With this practice we have been very free from hemorrhages, probably six cases being all we have had. The sanitary regulations are most exacting. All are provided with sputum cups which hold a paper cup into which they must expectorate. They also have paper napkins to use when the cup is not at hand and the paper is put in a bag, all of which is burnt twice daily. Spitting on the ground is made a cause for expulsion. The work at White Haven teaches us some valuable lessons, and proves one need not leave home and friends to effect a cure, and I can honestly state that in all the resorts I have lived I never saw such results as obtained at White Haven. It proves that tuberculosis is curable under the poorest surroundings if given the proper food and plenty of fresh air, and proper supervision and no one except those who have visited the institution and studied it can appreciate the wonderful work being done there, and physicians should feel gratified that they have a place so near home that they may send their consumptive patients. The accompanying photographs will give a fair idea of the appearance of our patients and instead of their lives being hard as one would believe, they are a wonderfully happy little colony living a unique life, making as hard and brave a fight as mortal ever did and deserving the help and sympathy of all. THE HOME TREATMENT OF TUBERCULOSIS. BY DR. WALTER DAVIS, WILKES-BARRE, PA. This means treatment not in some famous foreign climate nor at a sanatorium; and the fact that here is a treatment dignified by this name indicates that experience and reason show there is some hope and success in it. Now this is a welcome fact, because however much one might prefer for his patient, the climate of Florida, New Mexico, the Alps or Egypt, or the special advantages of sanatorium life, the fact remains. that about ninety consumptives in every hundred must live or die by the treatment they receive at home. The fact that climatic and sanatorium treatment, though available to so small a percentage of sufferers, has been so prominent in our minds, registers the pessimism that has prevailed regarding the prognosis when treatment was conducted in the same environment in which the disease is contracted. This pessimism was well founded, for in the same environment, living the same kind of life, they could only occasionally re cover. Therefore we sent them West for change of air and to sanatoria for change of air plus change in the way of living, but the conclusion has been reached by many eminent men that we may often gain good results by keeping them at home, provided we change the environment to one unfavorable for the growth of the germ and change the way of living to one favorable to the growth of the man. The advantages of climatic and sanatorium treatment may be imitated at home. If the air is pure outside the window or back yard in Wilkes-Barre, it is as healing to sick lungs as pure air when it flows from the Rocky Mountains. Of course we know that it is not always pure in Wilkes-Barre. The valley is not as well ventilated as the mountains and there is apt to be some dust in the air. It is apt to be too foggy in the early spring and late autumn and too warm in July and August, but in the winter and for many weeks and months throughout the |