Cleveland Medical and Surgical Reporter.

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Vol. XIII.

JULY, 1905.

No. 7.

Original Articles.

THE CLIMATIC AND SANATORIUM TREATMENT OF TUBERCULOSIS.*

By Dr. John E. White, Nordrach Ranch, Colorado Springs, Colorado.

Allow me to thank you in advance for the honor which you have conferred upon me, by the invitation to present this paper to your Society to-night. The subject of Tuberculosis is creating a widespread interest both in and out of the profession, and this Society deserves. credit for inviting a discussion of this most interesting subject.

Twenty-three years after the discovery of the Bacillus we are just beginning to realize its significance. It is needless for me to expatiate upon the etiology of Tuberculosis, its prevalence, history or medical treatment, as these phases of the question are familiar to you all. The question to-day is, how to manage and care for the consumptive. We have tried to doctor the consumptive for years and under this method of drugging we consider the disease incurable. No one has found a specific which it is possible to use in general practice, and we usually consider those, who make such claims, irresponsible. Fortunately there is a cure, although it cannot be bottled and sold. This cure has been a gradual development of the experience of ages, and is generally spoken of as the open air treatment.

It is nothing more or less than placing patients in favorable hygienic and dietetic surroundings, utilizing to the fullest extent natural agencies, which should have been recognized centuries ago. It is simply another instance in which history repeats itself over and over again; by consuming the largest amount of time in discovering the simple, logical solution of its problems. The Cure began its gradual development even before the discovery of the Bacillus which has not influenced the method of cure except to strengthen our faith. Possibly at some future time we may have some form of specific medication, but it will not do away with the sanatorium as a basis of cure. Tuberculosis is a natural consequence of civilization, a result of too

* Read before the Cleveland Homeopathic Medical Society, June 21, 1905.

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much crowding, a direct result of in-door living, a house disease, and its cure is in removing the cause, by making patients lead simple lives in the open air. A large percentage of medical men still think that Tuberculosis can be cured with medicine. They do not appreciate the advantages offered by fresh air and sunshine, rest and nourishing food.

In connection with our work at Nordrach Ranch, we recently sent out over ten thousand letters to physicians of our school, enclosing postal cards inviting remarks.

Twenty-three per cent. of these cards came back to us, covered with comments of all kinds, some even writing long letters. While many indorsed the open air treatment, it was lamentable to observe the sublime confidence with which the larger number expatiated at length upon their indicated remedies. In Colorado we see the fatal endings of such confidence. I would like to say just here that I am a Homeopath, and I believe in the law of Similia; but when it comes to curing tuberculosis neither Homeopathy, Allopathy, or any other pathy has influence, and the sooner we acknowledge these facts the better for our patients. I have been requested by your secretary to confine my remarks to "The Effect of Climate and Sanatorium Treatment on Tuberculosis;" laying stress upon the kind of cases which should be sent away and the complications which forbid the same. am very partial to Colorado climate for the reason that I recovered my own health in Colorado and have seen many others do the same. I am fully aware of the fact that climate is being depreciated in somequarters, owing to great enthusiasm over the sanatorium movement. I will gladly admit that a certain percentage of cases do make cures in their home climate, but is the percentage flattering? I can do no better than to quote from Dr. E. L. Trudeau, whom we all know to be a most excellent and perhaps the very best authority upon this subject in this country. He stated in his recent address, at the Henry Phipps Institute of Philadelphia, that, "Climate to those who can afford it, is a most valuable aid." The answer is in a nut shell. In the present state of affairs can we afford to disregard "a most valuable aid"? According to Dr. Trudeau's report of over fifteen hundred cases treated from two to twenty years ago at Saranac Lake, approximately one-third of the cases heard from have made apparent cures. I will say, without fear of contradiction, that these results can be doubled in Colorado. From the earliest times climate has been thought to have marked influence over Pulmonary Tuberculosis. The most essential feature of our climate is its altitude; as we rise above sea level there is a decrease in atmospheric pressure and the quantity

of oxygen; the higher the altitude, the faster and deeper one has to breathe to get the same amount of oxygen. Pulmonary Tuberculosis is an implantation of tubercle bacilli within the lung, which produces a low type of pneumonia; in other words, at first, it is a solidification, a hepatization or occlusion of the small air vesicles and bronchioles by the deposit of inflammatory dèbris due to the local effect of bacilli.

At sea level one has more lung surface than is needed; there are dead air spaces, as it were, within the lungs, usually found at the apices and along the interlobar septa posteriorly. Bacilli are hunting for just such out of the way, dark unventilated corners and when once a tubercle has developed in such a place, has ripened or gone to seed and ruptured, the seed find other unventilated areas which in turn produce their tubercles and in this way a large area is formed. At. sea-level in the majority of cases, there is not a tendency on the part of nature to arrest such a development or growth of a tubercular area. In an altitude of from five to six thousand feet, one is compelled to use every single available air vesicle. A consumptive begins to clear up tubercular deposits; he begins to cough out more than before and often encysted bacilli are discovered for the first time. Many cases go to an altitude with a slight cough and high temperature, as the cough and expectoration increase in an altitude the temperature begins to lower. Bacilli do not thrive in the presence of pure air; ventilate a tubercular lung and you cure the condition by drainage; let in air with altitude and you let out pus with its billions upon billions of bacilli. Examining patients upon arrival in Colorado, we usually find very slight chest expansion, perhaps not more than one to one and one-half inches. The ear can hardly detect air entering certain portions of one or both lungs. There are no moist rales to speak of, because there is not enough air entering the air vesicles, to peel them apart and produce crepitant rales. Examine these patients even one month later, and in many cases the chest expansion has increased to three or three and one-half inches and crepitant rales are everywhere present over the diseased area. Is not this increased expansion and rale condition favorable? It is simply nature's way of clearing up a diseased area by ventilation. By the forcing in of air into diseased pulmonic areas bacilli are crowded out. In low altitudes there is not that tendency to clear up and diminish the disease, but on the contrary, there is a marked tendency to an increase of the diseased area, by confining bacilli. Another effect of altitude is in the increase of red blood corpuscles; by actual count the number is doubled in curable cases in three months' time. With the increase of red blood corpuscles and the disappearance of anæmia comes the increase of appe

tite, weight and general improvement. For thirty-five years Colorado has enjoyed an enviable reputation as a health resort, thousands have been sent to our State from all parts of the world, especially from England. Colorado Springs is often called "Little London" on account of the fact that so many cured tubercular English people are residing within its limits.

The climate and altitude throughout the State are most excellent; but the best all-round conditions are to be found in the vicinity of Colorado Springs.

Denver is a big, dirty city, and no place for a consumptive, if he wishes to escape the smoke and temptations of a city. Consumptives must get away from civilization into the pure air and quiet surroundings of the country. Colorado Springs is a beautiful little city of cottages. There are about thirty thousand inhabitants, and there are no smelters or manufactories to contaminate the pure air. We all appreciate the advantages of out-door life for a consumptive, in all seasons of the year. It is very easy to live in the open air in Colorado every hour of the day and every day of the year. We have an almost perpetual sunshine; in fact, we hail a cloudy day with delight as a diversion. Our air is dry and antiseptic. It must be antiseptic, otherwise meat exposed to the air would decompose or rot, however, it dries up and remains untainted for many months. As for moisture many of your Eastern cities have a greater precipitation in one month than we have in an entire year. The annual average percipitation is fourteen and one-half inches as contrasted with thirty-nine in the Adirondacks; forty-five at Ashville, forty-eight at Aiken, and eighteen at Santa Barbara. The bulk of the precipitation falls between the middle of April and the middle of September; the rest of the year there is practically no rain and very little snow. Certainly this dryness has an influence on Bronchial Catarrh, and contrary to the teachings of a few years ago, we have learned that cold air has an advantage over warm air, in helping to reduce temperature and as a general tonic. Eastern physicians now prefer the cold, sharp, dry winters of Colorado to the hot enervating climates of Florida, California, Arizona or New Mexico. Many patients are still sent south for the winter and they flock by the hundreds to Colorado in the summer. We find them incurable, they are by far the worst class of cases we have to deal with. They have lost their opportunity of a cure. Winter of all times is the time par excellence for a consumptive in Colorado. It is generally understood in Colorado that one winter is as good as two summers, and we have most excellent summers. No matter how ideal or beneficial a climate may be, it will not do all that

is required.

Comparing the results of a ten years' experience in handling consumptives in private practice, both in Cleveland and in Colorado Springs, with a four ears' experience in conducting a sanatorium, I find that there is no comparison. In practice a cure is rare, in a sanatorium it is frequent. The modern sanatorium has taught us that there is a cure, and some enthusiasts even go so far as to predict the time of a complete extermination of the disease. The whole world seems to be up in arms against this terrible foe of human life. Let us hope that the victory is not far distant.

The sanatorium life is just as essential in Colorado as it is in New York or Ohio, even more so, to educate patients how to take advantage of the climate and escape the dangers of altitude. The combination of Colorado climate and the sanatorium life are productive of the greatest possible good. There is nothing more fatal in Colorado, for a consumptive, than drifting from one place to another and from one physician to another. He is constantly making mistakes and everlastingly doing the wrong thing.

Consumption is a disease of relapses and of re-infections, and every single relapse is due to some indiscretion, or mistake on the part of the patient. These relapses can be forseen and prevented in a well regulated sanatorium. Where the medical director is supreme, a patient can not deviate very far from the straight and only path.

Sanatoria are needed everywhere. In low altitudes to accommodeat the vast number of cases that can not afford to go away, a certain per cent of cures, can be made in a sanatorium in a bad climate, while in the same locality cures are very rare in private practice. Sanatoria should be established in altitudes especially in Colorado, where those who can afford the advantages of climate, can be taught how to live and make the most of their chances of a cure. There is no question as to the advantages of a sanatorium in a good climate, over one in a bad climate, as Professor Edward O. Otis, the eminent Boston authority, recently states: "I have felt convinced and so stated in some of my published articles, that a sanatorium, of proper construction and under skilled management, located in the altitudes of Colorado with its unapproachable climate, ought to produce better results than have yet been obtained in any climate or any existing sanatorium.” Dr. Williams, of London, another authority upon the location of sanatoria, in a recent oration upon sanatorium treatment, after furnishing statistics of the comparative results of the treatment in sanatoria. in climates of low altitude, Germany for instance, and in climates of high altitude like Switzerland, writes thus:

"The superiority of the Swiss, over the German results, confirms