The Advantages of Sanatoria in the Treatment of Phthisis.

By J. H. L. Allen, M.D. Univ. Dub.

My object in supplementing the remarks contained in Spencer's pamphlet is to draw attention to the advisability of establishing a Sanatorium in Napier for the reception and treatment of patients suffering from pulmonary consumption.

Dr. Spencer's statements are based on a long-continued and careful observation of the climate and its influences in modifying disease, and they prove how suitable Napier must be, as a residence for the pulmonary invalid.

Napier is, in point of fact, one of, Nature's Sanatoria, its peculiar semi-insular position, the dryness of its soil, the purity of the air from mountain and sea, and the abundance of sunshine, render it admirably adapted for a health resort.

The medical profession in New Zealand have long recognized the value of the climate, as is amply testified by the number of consumptive patients who are sent to Napier. The wonder is that a greater number of invalids from other parts of the world do not take advantage of this beautiful climate. The reason perhaps may be, that although Napier's claims in this respect are so generally acknowledged by visitors and residents, no one has hitherto taken the trouble to advocate these claims in such a manner as to bring them under the notice of the outside world.

Dr. Spencer, as he remarks in his pamphlet, wrote an article on the subject of the Napier climate some years ago, but this was published in England, side by side with descriptions by various authors of many other climates, so much page 4 more within reach, that it is little wonder the article did not attract the attention it deserved; and to the invalid seeking change of climate, the long and weary voyage of that time, with its dangers and possible privations, would put New Zealand out of the question.

Dr. Spencer's pamphlet deals fully with the special advantages of Napier as a health resort, but the points to which I would wish to direct attention here are, the aid which may be given to many sufferers by the establishment of a special institution for their reception and treatment; and also the responsibility which rests with the patients themselves, and how materially they may by their own voluntary actions either advance or retard their own recovery.

It may seem unnecessary to advance any arguments in favor of Sanatoria for the special treatment of pulmonary invalids, the advantages of these establishments being so generally recognized by the public, and so gratefully acknowledged by the many who have benefited by them. But, in the rapid growth of the Colony, the consideration of this important matter has apparently been forgotten, and notwithstanding that the increase in population is necessarily accompanied by greater prevalence of the disease, a special establishment for its treatment has not yet been erected in New Zealand.

A suitable climate is universally regarded as important in the treatment of chronic pulmonary disease, and justly so, for taken alone there is perhaps no other agent which tends so much to promote a cure. It should, however, be remembered that climate, however excellent, is not a specific for disease; the patient is hereby placed in the position most favorable for recovery, but other remedies, and general precautions, are indispensable.

A careful attention to the proper performance of the various functions of the body is necessary for the maintenance of health as well as its re-establishment in disease, and in no class of diseases is a recognition of this fact of more vital importance, than in chronic affections of the lungs. Patients at health resorts are apt to forget this, and to imagine they have nothing more to do in order to obtain the maximum amount of benefit from the climate, than to submit themselves passively to its benign influence. They trouble themselves little in regard to matters which they do page 5 not seem to have direct connexion with the diseased organs; and rules of diet, regulated exercise, healthy occupation of mind, and sanitary matters in general, are hardly considered at all by many patients.

This state of things, obtaining so generally, has neutralized to a great extent the benefical effects which change of climate might otherwise have produced in many instances, and has led to the establishment at health resorts, of Sanatoria and special hospitals for consumption, where patients are kept under constant medical supervision, and in which all hygienic arrangements are carefully carried out.

It has been proved by experience, that the diseases under consideration are to be cured, not so much by medicine, as by general management, and patients should submit themselves unreservedly to this management, if they wish to secure to the full, the beneficial effects of this system of treatment.

The necessity for constant medical supervision in order to ensure a thorough observance of hygienic rules, was forcibly brought home to my mind by the varying and apparently contradictory results of many cases which I have noted since my arrival in Napier.

Of these cases, sent here for health's sake, some having comfortable homes, have made recoveries more or less perfect, while other of a similar nature, notwithstanding having page 6 had the best medical advice and constant cave on the part of their attendants, have derived no benefit, and have gone from bad to worse.

This discrepancy of result, where the same advantages of climate have been enjoyed by all alike, seems to be in great measure due to the varying amount of attention which the patients pay to the ordinary rules of health. Some individuals are possessed of more intelligence than others in these matters; but it is the difference in the domestic surroundings which chiefly influences the result in such cases.

Some invalids, having the means to do so, come to a health resort accompanied by members of their families, and taking up their abode permanently, simply transfer their home with its comforts from one locality to another; others, being fortunate enough to obtain permanent employment of a light sort, thus connect themselves with the place, and make it their home. These two classes frequently do well, as the lawyer's clerk instanced by Dr. Spencer, and others who have come under my own observation here.

Another class of patients—and the class is a large one—regarding the health resort merely as a temporary residence, never dream of making it a home, or in other words of associating with it those comforts, and the many little indescribable accessories which help to make up the idea. By these individuals the time spent at a health resort is regarded as a period of banishment; they take up their abode at hotels or boarding-houses, which, however excellent and comfortable, are not meant for the residence of invalids, nor do the proprietors of these establishments as a rule care to undertake the responsibility of such cases. These patients, looking forward to relief more or less speedy, and not thinking it worthwhile to collect around them any permanent sources of amusement or comfort, pine for those they have left behind. They perhaps have limited their stay to a definite period, and as the months pass, and they notice no improvement in their state of health, they become nervous, and in their endeavors to do more than they have hitherto done in aid of their condition, they are fighting against time; the result of this being a constant mental anxiety which inevitably retards their recovery.

It may be thought that a needless amount of stress is laid on these matters—and that a patient having been sent to a page 7 suitable climate, and placed under the care of a skilful physician, all that is really necessary has been done—and that these subordinate matters are unimportant. But results prove the importance of these little things.

As the largest bodies in their entirety and perfection are composed of numberless apparently insignificant atoms, thus a complete course of treatment includes attention to many details and little matters, which to the invalid and his friends may appear of very slight importance, yet each contributing, however imperceptibly, to the successful result. On the other hand, slight omissions and indiscretions, however trivial they may appear at the time, may make all the difference in the ultimate issue of cases in which the prospects of recovery or the reverse are at all evenly balanced. Dietetic errors, for instance, are frequent, and the ensuing slight attack of indigestion being as often as not attributed to the wrong cause, the offending article of food may be persevered in, while really useful and harmless articles are suspected and shunned; the result being dyspepsia more or less permanent, whereby the changes necessary for its assimilation being prevented, the food either does no good, or becomes an actual source of irritation. The sudden cutting off of supplies—temporary though it may be—causes an interference with the nutrition of the body generally, and consequently of the lungs, which in their delicate state, sympathize with the slightest derangement of the system. A progress hitherto uninterrupted may thus be checked, and retrograde changes initiated—and from this very point it may happen that a loss of weight will be observed.

Regularity in the time for taking meals will also probably have been enjoined by the physician, and for a time the patient will observe these directions with tolerable accuracy—so that the stomach comes as it were to expect its supplies at these hours—and is ready for them. Some unforeseen circumstance, some arrangement of business or pleasure, may however cause a postponement of the dinner hour—and the consequence is, that the appointment with the stomach being broken, when the meal appears, the appetite for it is lost, and the digestive energy gone, and if, through a sense of duty, the food be forced down, it probably does as much harm as good.

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The invalid may hesitate to consult the physician about such a trival matter as this fit of indigestion, or temporary loss of appetite, or motives of economy may prevent him from doing so—and the same feeling may lead to results equally unfortunate, by inducing the patient to deny himself many little comforts which are really necessary for him.

I may here relate a case in point, which recently occurred in my practice. A young man in good circumstances, and with fine prospects, had come to Napier suffering from delicacy of the chest—he had been feeling rather worse than usual of late, but attributed his sensations to having caught cold; and until I saw him, he had had no medical advice since his arrival some weeks before. I found that in addition to the chest affection, he was suffering from disease of the kidneys, of the existence of which disease he was utterly unaware. The affection had been advancing insidiously, and had reached such a stage that all treatment proved useless, and he rapidly sank. Now had this young man been under constant medical supervision, the kidney affection must have been detected long before, and life might have been much prolonged.

This case serves to exemplify the disastrous results which may occur when patients far from home and friends trust to their own sensations as a criterion of progress—it shows, too, not only the necessity for medical supervision, but also that this supervision should be constant, and not limited to the occasional advice of a doctor, just when the patient may consider he requires it.

Such careful medical supervision is only to be secured to its full extent in a special hospital, or well ordered Sanatorium, under the superintendence of a resident physician.

One of the greatest advantages of the Sanatorium is the fact that the medical man possesses an accurate knowledge of the doings of his patients—he institutes a certain method of treatment, and having the patient constantly under his eye, can see that his instructions are carried out to the letter, and the most minute details strictly observed—the effect of medicines, of various kinds of food, and of treatment in general, can be watched and noted to an extent quite impossible in ordinary private practice; and the change from one remedy or article of food to another can immediately be made when such change becomes necessary, so that the page 9 physician holds as it were the hand of his patient constantly within his own, and can at once perceive any backward slip, while guiding his progress towards recovery.

But the necessity for Sanatoria is evident to any thinking mind, and the large number of such institutions which are now established on the southern shores of England, and on the Continent, sufficiently attest their value, and the successful results which in many cases are found to follow the treatment conducted in them.

On the other hand, how unfortunate are the results in many cases, such as that which I have related above, where the patient—sent to a health resort without having friends to guide him—trusts to his own judgment, he is like a ship without a rudder, he probably meets with others in like case, and the blind lead the blind; he visits a medical man, and is presumably under his care—but the credulity with which he listens to stories of cure by other remedies, will as likely as not lead to a want of confidence in his physician, and a half-hearted acquiesence in the rules prescribed;—while promising obedience, he probably makes a mental reservation that he will also try this or that new remedy, or "infallible cure," which has just been so strongly recommended to him, and thus the best efforts of the medical man are often frustrated.

As a drowning man, in his ineffectual straggles, may seriously hamper his preserver, and may defeat the most strenuous efforts put forth on his behalf—thus the patient, unaware of the importance; of perfect acquiesence in the advice of his physician in matters small and great, may forget, or neglect this advice; or, alarmed at the prospect of danger, he may overreach himself in his anxiety, and feverish efforts to promote his recovery.

How often we see the consumptive patient drifting about, eagerly listening to, and vainly endeavoring to follow the various, and generally contradictory advice, which in such cases is readily and confidently given—the disease unfortunately being so wide-spread that almost everyone has seen something of it, and therefore thinks he or she knows something about it. One specific after another is recommended to the bewildered invalid, and the many half empty bottles which litter his room bear testimony to the utter inefficacy of them all. Meanwhile golden time is lost, and the invalid page 10 goes steadily down the hill. What a haven of security is the well-ordered Sanatorium for such a case as this!

I may here quote some remarks from a course of lectures delivered in March last, at the Royal College of Physicians, London, by Dr. Hermann Weber, Physician to the German Hospital. Dr. Weber is one of the highest authorities on the subject of pulmonary disease, and in these lectures draws special attention to what may be called the common-sense treatment of consumption. He lays great stress on the necessity for the intelligent co-operation of the patient with his physician, so that both may earnestly work together with a common object in view.

Speaking of the relation which should exist between physician and patient, he says:—"Shall the physician frankly tell the patient that his disease is phthisis. It is still the opinion of many eminent medical men that we should not do so. As long as phthisis was considered an incurable disease, there may have been some reason for such concealment, but now, as we know, and can tell our patient, that phthisis is a curable disease, I think the patient ought to be informed of his condition, more or less according to the individuality; and as far as my experience goes, this has a salutary effect. The patient is more ready to co-operate with the physician, and to bear the great and long continued sacrifices, for he becomes aware of his own large share of responsibility. I have already alluded to the circumstance that intelligence on the part of the patient and his friends is a great help towards recovery in phthisis; and that want of judgment or insight into the nature of the illness, and of the manifold dangers, and into the means of cure, renders the prognosis less hopeful unless we are able to place the patient under the strictest superintendence of a judicious physician, or still better, in a health establishment under the control of a resident medical man and his assistants, or in a well arranged special hospital. Every consumptive patient ought to be under the constant guidance of his doctor."

Speaking of the importance of diet, he says:—"All those who have been successful in the treatment of phthisis have paid much attention to the question of food . . . . It ought to be varied as far as possible, and the cooking and serving of meals ought to be nice. The example of others is mostly very useful, and this is one point in favor of page 11 special establishments and health resorts for phthisis. I have seen at Davos and St. Moritz, patients in company with other patients, eat and drink with regard to quantity and quality what they would never eat in their own homes. Though it is impossible to lay down fixed rules for all cases, one rule is almost general—namely that those suffering from active consumption, ought to take the amount of food required in frequent small meals, and not in only two large meals as in French, and in three meals, as in German and Swiss hotels. This is one of the reasons why ordinary hotels are in general not adapted to the treatment of active phthisis.

Dr. Weber's remarks on exercise are most instructive, but I can only quote a few sentences here:—"Without exercise I should not like to treat phthisis—to take exercise properly, however, requires the guiding hand of the physician—there are judicious persons who can be taught . . . . to do neither too much nor too little, but such persons are rare among consumptive invalids. In many of them the nutrition of the brain has suffered as much as that of the stomach and lungs and other systems, and their judgment with regard to their own state and their wants is impaired. We ought therefore to bear in mind that the majority of those suffering from phthisis require to be held by 'leading reins' and must be told what kind of exercise to take, how much, and at what time, walking on level, climbing gently, etc."

Remarking on air and ventilation, he says:—"Fear of the inclemency of the weather is far too great amongst the public, as well as the profession. Patients affected with chronic consumption . . . . . ought to spend the greater part of most days in the open air, and ought not to be deterred by a little rain, or mud, or low temperature, or by the fact that they begin to cough when they come out of the close house into the open air . . . . . . As however the greater part of the twenty-four hours is spent indoors, the arrangements of the house, and of the rooms, are of the utmost importance.

Speaking of the habits of invalids at the continental health resorts, Dr. Weber says:—"The majority of invalids are in the habit of acting almost independently of their medical advisers, and many perish, who, under strict guidance; might have been saved . . . . . but the whole page 12 system of this looseness of tie between medical man and consumptive patient is deplorable, and the results obtained are very inferior to those which might be obtained by judiciously arranged health establishments under strict medical supervision in every point of general hygiene. This, however, is by many invalids, not yet regarded as the principal sphere of the physician's work, but more or less as everybody's business, for which no medical man is required, and which each individual must find out for himself."

In quoting from these lectures I have only selected some points which bear more directly on the necessity for medical supervision, and on the advantages of treatment in Sanatoria, but Dr. Hermann Weber's lectures are worthy of most careful perusal, not only by medical men, but by all who may be brought into contact with the class of cases under consideration; for the more that is known on the subject of the general management of consumptives, the better will it be for this large class of sufferers.

The failure of one remedy after another having disheartened both patient and physician, consumption was formerly looked upon as beyond the reach of treatment and unfortunately this is still the case in too many instances; but now "we can tell our patients that phthisis is a curable disease," and can face it more boldly having hope on our side. But it is only by rallying all our forces that the march of the disease can be arrested.

Recent researches have thrown much light on the nature of the disease, and seem to point out more clearly the directions in which our efforts may meet with success, but all experience points to the futility of the exclusive employment of any one remedy—and it is in an institution furnished with facilities for the simultaneous employment of the many measures, medicinal and general, which are found to conduce to the one end, that the highest degree of success at present possible, is to be achieved.

In coming to Napier the invalid need not fear ennui. The town is the capital of the province, and is full of busy life; the best society can be enjoyed by those strong enough to take advantage of it, and the scenery is varied and charming.

From the seaward hills the view is particularly fine. The luxuriant growth of trees and shrubs, with their vary page 13 ing tints of green, and the bright flowers blooming in semi-tropical profusion in the well-kept gardens, form a singularly beautiful foreground, contrasting in richness of coloring with the delicate tints of the distant hills which bound the bay, and the soft deep blue of the Pacific which rolls its waves on the beach below.

Extending to the southward in a gentle curve, is a level beach of sand and shingle, on which the children may be seen playing all the year round; the town has extended much in this direction, and a long line of houses follows the curve of the shore—the sunlight on walls and roofs contrasting with the deep shade beneath their verandahs. The broad blue bay, fringed by a line of white foam extending unbroken for miles along the curving shore, reminds the beholder of the bay of Naples, and the brilliancy and abundance of the sunshine renders the resemblance still more complete.

Arrangements are now in progress for the establishment of a Sanitarium on modern principles in Napier. The site is not yet definitely fixed, but it is the intention of the promoters to build on one of the hills, so as to have the advantage of an uninterrupted view of the bay, and the benefit of the sea breeze.

Pending the erection of the building, it seems a pity that any time should be lost—time so invaluable in many cases. A large and commodious house in an elevated position, has therefore been taken. The proprietor has spared no expense in rendering the hygienic arrangements complete—and a limited number of patients can now be temporarily received under medical care.

In thus endeavoring to secure the advantages of sustained medical treatment, and the curative influence of the climate, while obviating the drawbacks which so often mar the beneficial results of the latter, we can look back on the records of successful treatment in health establishments, and on lives preserved by their means, and may confidently look forward to equally successful results.

It may perhaps be thought that such matters as the foregoing should be relegated to the province of the physician, and that it can serve no useful purpose thus to call general attention to them; but when we look around and on all sides see the baneful effects of this disease—so page 14 many useful lives cut short, so much rising talent doomed to early extinction, and our fairest flowers so often blighted just as they are opening into bloom—surely the consideration of consumption should be looked upon not merely as a question of medical interest, but so far as regards its general management and prevention as of vital importance to the community at large, and universal support should be accorded to those institutions in which all the resources of medical science can be collected together and concentrated to combat the disease.

Medical men, having devoted their lives to such subjects, will always be the guides of the public in matters relating to health; but they will ever welcome intelligent co-operation in their efforts for the prevention and cure of disease.

Many invalids are fully alive to the drawbacks which in their case attend the usual temporary residence at health resorts they desire to spare no expense in order to secure suitable accommodation and the advantages of constant medical care, and they enter the pay ward of the hospital. But the general hospital for many reasons is not well adapted to the treatment of phthisis, and there are many who shrink from the idea of a hospital, and from propinquity to disease in so many forms. To these individuals the comforts and privacy of the Sanatorium are an inestimable boon.

The great benefit of health establishments being so generally recognized, and so many of these institutions having proved their value in inferior climates,—surely it is time that with a climate so pre-eminently suitable, Napier should possess a Sanatorium—and that invalids should no longer be debarred from the restorative influence of the climate by want of suitable accommodation.

Let the inducements offered by nature be enhanced by the advantages of an establishment as perfect in hygienic arrangements as modern science can make it; in which the invalid can confidently place himself under medical care, and yet enjoy the comforts of home with amusement and relaxation of mind, and we may anticipate finding Napier in the near future the favorite health resort of the colonies.