CROMWELL HALL HEALTH SCHOOL AND PRIVATE ESTABLISHMENT FOR THE Medical and Hygienic Treatment of Invalids. OrOMWELL, middletown, CONNECTICUT. Founded in 1877 WINTHROP B. HALLOCK,"M. D. FRANK K. HALLOCK, M. D., - Medical Director. CLARA M. DeHART, M. D., Assistant Physician. WILLIAM P. COUCH, ------ Business Manager. NOT mean, nor base. But of Heaven's best upbuilding is this House fashioned for man: The City of nine gates,— Wonderful, subtle, sacredto be kept Jair and avell garnished; Graced voith ornament Outside and in, and hardened voorthily. That, in its ordered precincts, angels' voings May float and fold, and Body help the Soul, As Soul helps Body. Edwin Arnold. CONTENTS. Location, 7 PAGE. Railroad Connections, - - - -■ - - - - - - 9 Buildings and Equipment, ---------- 9 Character and Scope, - - - - - - - - - - - 11 Class of Patients Treated, ---------- 13 ■Outline of Treatment, ----------- 15 General Principles, ------ 15 The Hygienic Method, - -- -- -- -- -- 17 Special Features and Methods,— The Program, ------------ 19 The Rest Cure, ---------- - - 2i Massage, Electricity, Hydrotherapy, - - - - - - - 23 Heliotherapy, ----23 Physical Culture, ------------- 25 The Principle of Relaxation, - - - - - - - 27 Deep Breathing, - -- -- -- ..-29 Tone and Speech, ---------- 31 Body Attitudes, - - - - - 31 Diet, - 31 Physical Deficiencies, -.--------3! Diversion, - ------33 The River, - -- -- -- -- -- -- -35 The Out-Door Fife, ------------ 35 The Winter Season, ----------- .35 Terms and Conditions, ----------- 39 The Summer Season, ----------- 37 RAND AVERY SUPPLY CO., FNGR'S, BOSTON CROMWELL’S CONNECTIONS CROMWELL HALL. Cromweu Hau occupies an elevated situation on the southern slope of ProspeCt r „ Hill, in the Town of Cromwell, formerly called Upper Middletown, or Middletown Upper Houses. It is pleas- antly located one mile from the Connecticut river, at the head of the village park and conveniently removed from neighboring houses. The site of the institution is noted for commanding extensive views of the Connecticut river valley. David Dudley Field, in an address at the Second Centennial Anniversary of Middletown, in 1850, said: “The elder President Adams, in a journey in the month of June, 1771, struck the Connecticut river at Enfield, and passed down through Windsor and Hartford to Weth- ersfield, admiring the valley on the way and saying when at the last place: ‘This is the finest ride in America, I believe; nothing can exceed the beauty and fertility of the country.’ But when he had passed on to ProspeCt Hill in Upper Middletown, and the river for miles opened before him, with the intervals and improvements on both sides, with the luxuriant crops ripening for harvest, the body of this town, and the mountains in the distance, he was enraptured, and said: ‘ Middletown, I think, is the most beautiful of all! ’ ” Cromwell Hall-Main Building. 9 Railroad Connections Cromwell is easy of access several divisions of the New York, New Haven and Hartford Railroad, or by carriage from Middletown, two and one-half miles distant. Express trains from New York and Boston via Air Line reach Middletown in two and one-half hours. The Valley Division passing through Cromwell makes direCt connections with points north at Hartford, with the Air Line Division and Berlin Branch at Middletown, and with the Shore Line Division at Saybrook. During the navigable season of the Connecticut river, the Hart- ford and New York steamers make daily landings at Mid- dletown. A public conveyance is always at the Cronrwell and Middletown stations. These INCLUDE the original Hall now called the Main Building, and an East and West Cottage. The first floor of the Main Building, Che Buildings and Equipment with the exception of the administration quarters, is for the general use of patients, and consists of a sun-room, a sitting-room or library, and dining-room with conservatory adjoining. The chief treatment and examination room is also in this building, and there is an additional sitting-room on the upper floor with windows looking toward the river, the Portland hills, and Cobalt mountain. This sitting- room and the bed-rooms are reserved for female patients. 'Che CClest Cottage is also occupied by women. It is attractively situated a few rods from the Main Building. The bath-room is fully appointed for hydrotherapeutic treatment. A veranda, glass-enclosed in winter, extends along the entire west and south sides of the house. West Cottage. Che Bast Cottage is reserved solely for male patients. An amusement, or general meeting-room, containing a bil- liard table, piano, and the simpler gymnastic apparatus, occupies the entire ground floor of one portion of the build- ings. The various buiedings together furnish accom- modation for thirty patients. During the camping-out season, June ist to November ist, by means of tents and permanent cabins, ten additional patients can be received. Character and Scope The institution is provided with all prac- tical arrangements and detail of equipment common tke larger sanatoria, and offers in addition the advantage of individualized medical attention under more natural and favorable sur- roundings. A very distindl effort is made to maintain a wholesome, home-like atmosphere. In order to attain this end and preserve harmony, patients with noticeable depression or any disturbing characteristics, temperamental or acquired, cannot be received. The establishment is not a home for the care of incur- able invalids. Every patient is under adtive treatment and any case that cannot be truly and progressively helped is not retained. Also, it is not a sanatorium in the sense that is usually meant by this term. The same medical and hygienic methods are employed, but its scope is wider than this. Two features tend to differentiate Cromwell Hall from a simple sanatorium: one, is the specially developed out- of-door system of living, comparable to certain of the Nature-Cures and Health-Resorts of Continental Europe; the other, is the educational method of treatment. This latter feature makes the name of “Health School” not at all inappropriate. Ui O < I- \— o o I— co < Ul ClaB9 of patients Created The specialty of the institu- tion is the treatment of nervous diseases, both acute and chronic. Cases of nervous prostration in all its forms naturally represent the chief class of patients treated. Individuals suffering from severe nervous dis- ease, such as epilepsy, insanity, etc., cannot be admitted. Invalids in general, convalescents, and all medical cases such as rheumatism, affeCtions of the heart, disorders of digestion, exophthalmic goitre, etc., requiring treatment away from home, are received. Business and professional men on the verge of exhaus- tion from the stress and anxiety of work can here find opportunity to rest and recuperate under most favorable ■conditions. Such men, as well as those younger who are prostrated by the strain of severe study and preparation for their professional life, can frequently gain time and are most benefited by immediately subjecting themselves to medical guidance in the regulation of rest, exercise, diet, and their entire daily life. Foreign travel, so com- monly prescribed for patients of this class, too often re- sults, by reason of its unavoidable worries, in a failure to find the necessary rest and acquire the desired strength. Under the regime of this institution all personal responsi- bility is relieved, the tastes of the individual are consid- ered, and with a careful study of the requirements of each case the effort is made not only to remedy the pres- ent weakness but also to teach the patient the way to avoid a future breakdown. Another class of patients which the educational methods here practiced are calculated to benefit are the semi-invalid young women without definite aim in life. Capricious health and not having to work for a living are generally the initial fathers in developing these cases. At the same time high ideals are not wanting and society or the or- dinary duties of home do not satisfy. The feeling of accomplishing so little in the life of each day torments the individual into a restless, discontented state of mind which after a time reaCts unfavorably on the general health. Such young persons drift along, misunderstood perhaps by their parents and not knowing themselves what is the matter. The life here led and the natural and wholesome influences to which they are exposed are often most helpful to this class, who, as the phrase well describes, “have not found themselves.” Speaking comprehensively, it may be said that the distinctive feature of the treatment here pursued has for its un- derlying principle the education or train- OutUne of {Treatment ing of the individual, both physically and mentally, to correCt habits of living. Medical teaching and praCtice tend too often to limit the attention solely to the disease, the individual as a whole is not studied or treated. The real problem is not merely to make a correct diagnosis of the specific disorder or condition, but it also calls for a thorough study of the general physiological and psycho- logical characteristics of the patient. This analysis of the temperament, the physical and mental habits, the charac- ter of the will power and the nature of the emotional reactions, all contributes to the complete understanding of each case. The method of treatment therefore must consist of two parallel lines of effort: one is the improvement of the physical condition; the other is the improvement of the mental attitude of the patient. Summarized: I. Improvement of the physical condi- tion is accomplished by both medical and hygienic treat- ment and embraces: i. The regulation of diet, of rest, of exercise, and of the entire daily condudt; 2, treatment of the adtual phys- ical condition and elimination of individual symptoms by the various remedial agents and methods. Providing a suitable schedule for each individual in- volves a careful study and examination of each case. In connedtion, therefore, with the routine physical and neu- rological examination, special attention is given to deter- mining the condition of the nutritional and metabolic processes in the organism. To attain this knowledge exadt laboratory methods are followed in examining the blood, urine, stomach, and digestive fundtions, secretions and excretions. 11. The improvement of the mental attitude or psycho- therapeutic part of the treatment, embraces: I. Giving patients an intelligent, working conception of their own cases; 2, the explanation of the nature and significance of symptoms; 3, the eradication of fear and erroneous fixed belief; 4, the corredtion of faulty habits in thought and adtion; 5, the interpretation of all phe- nomena from the optimistic point of view, that is, teach- ing a philosophy which makes optimism the duty as well the guiding principle of life. Che Rygiemc )Method The treatment of invalidism by the natural or hygienic method means sub- jecting the body to all the forces and agents existing in nature which can in any renovate and build it up. Chief among such agencies at our command are the following: fresh air, supplying oxygen to the blood; proper food, for the nutrition of the body; water, internally, for use in the tissues and as flushing agent, externally, for both its local and systemic effedts; and exposure to sunlight, for its stimulating and life-giving properties. Combined with these, two other fadtors must be included: exercise and rest. The former applied in graded measure from massage and passive motions to adlual muscle building, and the latter regulated in amount according to the needs of the indi- vidual. It follows that if a person comes under these agencies or influences, and allows them to operate with full force, progress towards health must result, provided any recuperative power exists in the organism. These influences represent the fundamental elements or sources of health. Certainly they are in no wise artificial, and the degree of health gained by their means is of the most solid and permanent charadter. These fadls are so simple and self-evident that no mention of them were necessary did not the success and benefit of the hygienic method of treatment depend upon its adaptation and corredl applica- tion to the individual. It is easy to tell a patient to take fresh air and rest, but this advice is valueless unless the proper manner of doing these things is taught. It is an art of the greatest advantage to know how to rest, and often a nervous person will require a number of weeks to learn the secret. The practical carrying out of the sys- tem of treatment for each patient is accom- plished by the program method. By this is meant that each case is given a written Zh e program program prescribing exactly what shall be done for, or by the patient, throughout the entire day from the call to arise to the final bath or massage at bedtime. The chief advantage of this method lies in the endeavor to turn to more profitable account what are too often waste intervals between prescribed exercises. Each hour has its item of business, not only as to adtive treatment, but also in regard to the disposal of the intervening time as to resting, reading, playing games, and the outdoor life; in short, the program is a prescription for the best possible daily life for each individual patient to lead. Under the headings that follow, mention will be briefly made of some of the special features and methods incor- porated into the life and treatment at this establishment. Whether conducted stridlly as origin- ally taught by Weir Mitchell, or on some modified plan, this method represents an ideal program treatment. It stands low- Che Rest Cure est, however, in the scale of required cooperation on the part of the patient. That is, the patient is negative— does nothing, simply relaxes as completely as possible and allows the nurse to do everything. On this account the Rest Cure is found to be the most serviceable as a form of treatment in cases of nervous exhaustion of com- paratively recent development rather than in cases of long standing, unless in this latter class the degree of prostra- tion is extreme. With some patients, although the nerv- ous exhaustion is well marked, the quiet, isolation, and forced feeding do not succeed. In such cases the prac- tice is to map out a careful schedule involving alternate rest and exercise. Whatever the patient does, or has done, is followed by a stated period of rest, which, accord- ing to the given case, is always proportioned to the amount of energy expended. Gradually the interest is awakened to change the ratio between the amount of work done and rest required, and so by one step a day, the growth in strength begins. When the degree of prostration is de- termined, the utmost care is taken to keep the amount of rest in excess, and by this precaution the process of in- creasing the amount of work is always from behind for- ward, and hence advancement is inevitable. Swedish JMowmcnts, JMassage, electricity, hydrotherapy In some form, one or all of these well-known therapeu- tic agents and methods are always included in the daily life of the patients. Nurses with the requisite natural qualifications of strength and temperament are trained to give massage and Swed- ish movements under the supervision of a graduate and experienced masseuse. Kledtricity in its different forms is employed whenever the administration of this remedial agent is medically indicated. Hydrotherapy in its many methods of application is perhaps the most important single agent in the treat- ment of invalidism. The tonic or sedative effedts of heat and cold, applied locally or systemically through the medium of water, are obtained the various packs, compresses, fomentations, douches, sprays, vapor and tub baths. Treatments by the Schott-Nauheim method and by dry heat of very high temperature are also given. No other institution in this coun- try, so far as known, has emphasized the value of sunlight as a therapeutic Heliotherapy agent to the extent that has been done here. The importance of fresh air, of water treatment, of electricity, have been fully recognized, but light, funda- mentally the most important of all forces in nature, has not been adequately considered as a curative agent. Sun Baths at the West Cottage. The weakening effect of present day civilization has led physicians to urge long vacations and a freer, more nat- ural life out-of-doors. It would seem that the advice should be to return completely to nature. But seldom is the individual actually told to copy his primitive ancestors and go mother-naked in the sun. This sounds extreme and unnecessary. It is not. On the contrary, it is really the most logical advice that can be given, for it means subjecting the organism diredtly to the most powerful re- storative and developing influence in the universe. Rheumatic, catarrhal, and many skin affections are es- pecially benefited by exposure of the whole or part of the body diredtly to the sun’s rays. In anaemia and kindred disorders of the blood, results can be obtained by the sun treatment which are not pos- sible by the ordinary methods. In the process of developing body energy and hardening the physique no other single procedure can be compared in value to the practice of exposing the body direCtly to the sun and air. The cold of winter and the heat of summer are more comfortably borne; fewer and lighter garments can be worn and the tendency to catch cold is greatly reduced. To carrjr out this treatment, glass-enclosed compart- ments are arranged for use during the winter season and ■during the summer months, board fence and hedge enclos- ures provide the necessary privacy for both the sun and air baths. Under the leadership of a competent and experienced teacher, aided by nurses instructed to assist in the work, special at- tention is paid to this department. physical Culture The general principle of the physical culture here followed is represented by the combination of two lines of effort; one Outdoor Resting in Winter, is the teaching of the principle of relaxing, the other is the teaching of the correct method of energizing the muscles; the result aimed at being to establish a normal personal balance in which the harmonious relation between mind and muscle is made manifest by perfedt body movements executed with ease and power, yet with truest economy of nerve force. The true method of energizing, the positive side of the work, so to speak, is taught the women chiefly by means of a series of exercises adapted from the best features of the Delsarte and other allied systems. In the case of men gymnastic apparatus is employed to a relatively greater extent. On account of its therapeutic value in dealing with pain, insomnia, and a variety of perplexing nervous symp- toms, the principle of relaxation de- Che principle of Relaxation serves special mention. Among the chief causes of nervous breakdown is the inability to do one’s work easily. Even if the sphere of activity is small we are apt to feel under a certain strain. We may not be diredtly conscious of this, but the chances are that if we carefully study the particular manner in which we do even simple things, we will find that a superfluous amount of energy is expended. In listening to music or ledtures, or engaged in an interesting conver- sation, we will often note that our feet press hard on the floor, that the hands clutch the chair or squeeze some objedt firmly; in short, that throughout the body numer- ous muscle groups are in an adtive state of tension when they could just as well be at rest. In ordinary talking too frequently the voice becomes raised and high pitched 29 and unimportant words and sentences are emphasized en- tirely out of proportion to their significance. In many other ways this waste of nerve force goes on, and it will be readily seen that if it could be checked a great saving of body power would result. A strong, well-balanced organization under normal conditions does not usually display such excess of nervous strength, nevertheless the tendency of all civilized life is to create a feeling of pres- sure and to develop a habit of exaggerated tension which may easily become characteristic of every aCt of the indi- vidual. With the majority of nervous invalids it is not any one particular strain which exhausts, but it is the long continued misuse and overexpenditure of nervous force. They have never learned how to live in correCt nervous adjustment to their environment. With this hint at the meaning of the term “ relaxation,’" it will be sufficient to state that the teaching of this prin- ciple of “ letting go,” or avoiding all unnecessary intensity of adtion, involves not only the presentation of the intel- lectual conception of what should be done, but also the suggestion to the patient of some definite plan, or method of practice, by which the body can be trained to exercise its powers with effective, but not wasteful, accomplish- ment of purpose. In the department of physical culture, attention is called to such special features as deep breathing, use of the voice, body attitudes, and physical deficiencies. Deep Breathing, The value of deep and correCt breath- ing, not only as a body exercise, but also as a means of oxidizing the blood and promoting change of tissue, is in general only partially appreciated. It is here made a definite exercise and its importance is emphasized by 31 instruction in the correct use of the diaphragm, abdomi- nal and intercostal muscles, and the appointment of stated times to practice the breathing movements. Cone and Speech* Closely allied with the function of breathing is the production of proper tone and the use of the voice. The art of speaking correctly, that is expres- sively, yet without strain, is one of the most important parts of physical education. It is a well-known fact that social intercourse is apt to be exhausting to most invalids. Several factors contribute to this result, but if the voice is managed properly, one of the principal means of avoid- ing fatigue will have been taken. correct manner of standing, walking, sitting, and holding the body in all its various attitudes and movements. The practice of control movements as well as those of expres- sion is of both diagnostic and psychological value, and forms a most important part of this department of the physical training. Body Httitudcs. Each patient is instructed in the physical Deficiencies. The character and amount of physical work to be done each patient is prescribed after examination, measurement, and test of the muscu- lar strength. In case of deficiency of development in part or as a whole, e.g., chest capacity, also when actual deformity exists, e.g., spinal curvature, the proper series of exercises are instituted for building up the body to its full capacity of strength and symmetry. Diet The subject of dietetics is very naturally of supreme importance in the treatment of invalids. The general table is conducted on a generous plan, the aim being to provide food of the highest grade and in abundant variety. The Kursaae, Except as necessity requires, the common plan of feed- ing invalids almost exclusively on the highty nutritious and easily assimilated foods is not followed. The contin- uance of this practice results frequently in an inactive condition of the alimentary tradt from too little functional exercise. Gradually, but as fast as may be, new articles are introduced into the diet. Patients are also constantly encouraged to expand their dietary, to overcome bigotry and cultivate a taste for arti- cles of food not previously enjoyed. Diet suitable to the varied diatheses and the different digestive disorders as determined by examination, test meals, etc., are planned and prepared according to the requirements of each case. As far AS practicable, physical exercise is prescribed in the form of outdoor games. Croquet, tennis, tether-ball, golf, driving, Diversion skating, easy grade tobogganing, rowing, sailing, and swimming are some of the most available sports. Of these, golf, by reason of the nature of the game and the ability to grade the dosage, is the most valuable. The links covering one mile in extent are near at hand and the game is played throughout the summer and winter. 'Swimming is regarded as one of the most desirable exer- cises for the uniform, all-around development of the body. It is taught to such convalescents as are able to go fre- quently to the river. The patients are constantly encouraged to study and develop an interest in nature. The institution is located in a sedtion of country which is most favorable for this purpose, and possesses a nature library of several hun- dred volumes. The library was started by patients and represents their contribution as a memorial to Dr. Winthrop B. Hallock, founder of the establishment. The boat-house, three-quarters of a mile distant, stands somewhat secluded in a belt of cotton-wood trees and com- Cbe River mands fine views up and down the Connecticut River. The men patients who are able frequently spend a part and sometimes a whole day here on the river bank. The spot is sufficiently retired to allow dispensing with all clothing except the bathing suit. Thus meagerly attired, in wind and air and alternate sun and shade, the body is free to acquire a degree of strength and hardihood not obtainable in any other way. The time thus spent is not passed in a desultory manner. The boating, swimming, reading, resting, and all exercises are done according to program, with reasonable latitude, under the direction of a competent nurse. A neighboring island with sandy beach and shade trees, still more secluded and safe from public intrusion pro- vides the female patients with opportunity to enjoy sim- ilar privileges. "Che CCltnter Season*—During the cold weather season the outdoor life of the patients is naturally restricted. The water, sun and air baths are given €he Outdoor Life indoors and for the weaker patients only a limited number of body exercises can be carried on out of doors. The chief feature of the winter fresh air training is the resting upon cots during the intervals between the more active events of the day. Blankets and wraps are sup- plied in abundance, and when carefully tucked in by the Camp Life on The Hill, nurse, the patient can rest warm and comfortable in quite severe winter weather. With the fear of cold once abated it is always a pleasant surprise to the delicate, nervous invalid to find acftual sleep is possible under these condi- tions. The wholesome stimulation and refreshment of outdoor resting produces a gratifying effedt upon the appetite, digestion, and sleep at night. The more pros- trate invalids have to be content with resting in their rooms by the open window or with the freest fresh air ventilation possible. Che Summer Season,—ln the warm months of the year the weaker patients are gradually weaned from their rooms and supplied with a cot on the veranda, or lawn, near the Hall. Later, as their strength increases, they are transported by carriage to the hill back of the insti- tution. Here each patient is assigned a particular tree under which the cot is placed, with other conveniences for resting and spending the day. Each tree is consid- ered as private as a room in the house, and promiscuous visiting between patients is not allowed. The view from the hill is very extensive in all directions, peculiarly rest- ful in character and altogether one of the most beautiful in the whole Connecticut Valley. The effect of such an outlook and the life here led is the most striking feature of a patient’s summer visit to this institution. Means are at hand for supplying the patients readily with light refreshments. Regular meals and lunches for those un- able to go to the Hall are brought diredt from the main kitchen. Tight board fence enclosures represent the arrangement for giving sun and air baths. Another compartment with water supply leading to it, provides the means of giving the various sprays, douches, and other hydrotherapeutic measures. All forms of physical exercise from relaxation move- ments to adtive g3Tranastic drill are given in the open air in the Kursaal. The patients usually have their first exercising alone under their own trees, and when they are stronger join a class in regular body training. Permanent cabins and tents are provided for a limited number of patients to live constantly on the hill. Each •cabin is supplied with suitable conveniences, and the free open-air life, day and night, corresponds to camping out at the seashore or in the mountains, with the additional advantage of close medical surveillance and the diet and comforts of home. Nurses and a night watchman are in attendance, and patients can be as safe as in rooms in the house. “ Now I see the secret of the making of the best persons, It is to grow in the open air, and eat and sleep with the earth.” The weekly charge is from twenty- five dollars up, depending upon the nature of the case and the accommo- dations desired. Ordinarily the rate stated includes room, board, medicine, 39 Ccrms and Conditions general nursing, and the requisite medical attention. Extra nursing is ten dollars, and special nursing is twenty dollars a week additional. The rate for a nurse attending a patient away from the Hall is twenty-five dollars per week and expenses. No rebate is allowed for absence of less than one week. Half rate is charged for rooms retained but not occu- pied one week or more. Personal laundry is an extra charge. Except by special agreement no case is received for less than one month. The rates are payable monthly, four weeks constituting a month. Address letters to Cromwell, Connecticut. To insure prompt deliver}7, direCl telegrams to Dr. Hallock, Middle- town, Connecticut. Long distance telephone connections via Middletown Division, Southern New England Telephone Company. Dr. Rallock may be consulted from October to July, in JNew York at No. 819 Madison Avenue, from 2 to 4 p. M. on the first Tuesday of each month; in Boston at Hotel Vendome, from 2 to 4 p. m. on the third Tuesday of each month. Dr* Deßart may be consulted in JNcw York at No. 30 East 57th Street, Lester Studio, Room 4, from 2 to 4 p. M. on the third Thursday of each month except July and August.