THE TREATMENT OE PHTHISIS IN 
SANITARIA NEAR OUR HOMES. 
By VINCENT Y. BOW DITCH, M.I). 
OF BOSTON. THE TREATMENT OF PHTHISIS IN 
SANITARIA NEAR OUR HOMES. 
By VINCENT Y. BOWDITCH, M.D. 
OF BOSTON. 
Head at the Annual Meeting of the Massachusetts Medical Society, 
June 10,1896. THE TREATMENT OF PHTHISIS IN 
SANITARIA NEAR OUR HOMES. 
When requested to address you upon the " Home 
Treatment of Phthisis,” I asked permission to change 
the subject, feeling that I could, perhaps, give you 
something of greater interest if I attempted to show 
you the results obtained by the sanitarium treatment of 
phthisis near our own city, as illustrated by five years’ 
experience at the Sharon Sanitarium for Pulmonary 
Diseases in Sharon, Mass. In presenting the results of the 
work there, it is with the hope that the idea of establishing 
sanitaria for treating tuberculosis may grow steadily in 
favor, so that instead of small isolated institutions here and 
there in the United States, we may have in the immediate 
vicinity of our large cities in every State suitable establish- 
ments where people of limited means, who are showing the 
first signs of consumption, can be sent with the hope of ar- 
resting the disease in its early stages, even in insalubrious 
climates. In Europe, much more rapid advance has been 
made than in America in the past few years in these mat- 
ters. Of late, the French government, convinced of the 
usefulness of such establishments, has taken steps to found 
sanitaria for consumptives in various parts of the country. 
Brelnner, the father of the idea of sanitarium treatment for 
consumption, has left behind him his now great and cele- 
brated sanitarium at Gorbersdorf as a proof of the correct- 
ness of his views advanced nearly forty years agp. Ilia 4 
THE TREATMENT OF PHTHISIS 
pupil, Dettweiler, later established the sanitarium at 
Falkenstein, near Frankfort, and his name is now as well 
known throughout the medical world as that of his great 
predecessor. 
Numerous similar institutions in later years have been 
founded in various parts of Germany, and their results are 
showing already how much can be done even in the harsh 
cold winters of North Germany. 
In England, Scotland and Ireland also, they are follow- 
ing the example of the Germans. Even in the damp, 
chilly climate of eastern Scotland favorable results are being 
reported at the Craigleith Sanitarium for the consumptive 
poor near Edinburgh. 
The Adirondac Cottage Sanitarium at Saranac Lake, 
N. V., and the Winyah at Asheville, N. C., are now well 
known in America, the former only, however* being in- 
tended for people of very moderate means. Others exist 
in Colorado, Southern California and in the South, but, so 
far as I know, the Sharon Sanitarium is the only one in 
New England which is intended exclusively for people of 
very limited means. 
The people of New York city, however, have within the 
past year founded an institution at Liberty, N. Y., intended 
for eases of incipient phthisis in connection with consumptive 
hospitals in the city. 
The Rush Hospital for Consumptives in Philadelphia, 
Pa., and another similar institution near Baltimore, Md., 
should be mentioned, but I do not understand them to be 
devoted especially to eases of consumption in its early 
stages. 
As I review the records of the Sanitarium and recall the 
cases of those in whom arrest of the morbid process has 
been accomplished, it is gratifying to find that my former 
belief in the efficacy of such treatment for a good percentage 
of cases even in our own harsh climate was not unfounded. IN SANITARIA NEAR OUR HOMES. 
5 
In presenting to you these records of five years’ ex- 
perience, I should not he so foolish, of course, as to claim 
results equal to those coming from a radical change of 
climate such as is possible for the wealthier classes, hut I 
merely wish to show, if I can, that what has been accom- 
plished at Sharon is vastly more satisfactory than any 
attempt, in my experience at least, to treat patients in their 
homes or at the office in this part of the country. 
The reason for this would seem to he obvious. A bright, 
cheerful home is provided at very slight cost to the patients, 
where in addition to <rood food and the excellent air of a 
healthy country town, medical supervision is kept up at a 
period of the disease when it is of vital importance that the 
patient should not be allowed to follow his own inclinations 
as to exercise, food or general mode of life.* 
Contrast this with the usual method of treating the poor 
or even the wealthier class of patients at one’s office. It 
is impossible under such conditions to control as one should 
the actions of even the most intelligent, and, in such a 
climate as ours, the results are discouraging to the last 
degree. 
Even at the Sanitarium we inevitably meet with certain 
cases, of course, which in spite of every effort steadily and 
surely lose ground ; but there are others which after a stay 
of many months, possibly, at Sharon, have remained in 
apparent perfect health, and it is these cases which have 
proved to me how much can be done with comparatively 
simple means, and how much more can he accomplished 
with increased facilities for the treatment of consumption 
when patients are kept under the close supervision of a 
sanitarium not far from home. You will notice that I have 
in no case used the word "cure,” but have confined myself 
to the term " arrest of disease,” simply because I do not 
* The price of board at the Sanitarium is $5.00 a week, which includes 
medical attendance, medicines, and everything else but washing. Only 
women are received at present. 6 
THE TREATMENT OF FIITIIISIS 
feel that the former term is justifiable until after a number 
ot years in which the patient shows no signs of relapse. 
If the general appearance, however, of the patient can be 
taken as an indication of his condition, the term " cure ” 
might certainly have been used in many of the cases which 
I have reported as " arrested.” In some, moreover, who 
have been away from Sharon for two or three years and report 
themselves as in perfect health, we should be justified in 
saying that they stand as good a chance of living long lives 
as anyone, but I have thought it best to adhere to the less 
absolute term. 
In a paper entitled " Three Years Experience with the 
Sanitarium Treatment of Phthisis near Boston,” I gave to 
the American Climatological Association at Washington in 
1894 the results of forty cases of consumption treated at 
Sharon. Ten of these were reported as "arrested,” and 
later in this paper I shall hope to give their succeeding 
histories. The full accounts can be found in the Transac- 
tions of the Climatological Association for 1894, or in the 
Boston Medical and Surgical Journal of July 12 and 19, 
1894. 
In the past two years, up to March 1, 1896, twenty-six 
cases have been admitted to the Sanitarium. Two of these 
remained less than five weeks and are, therefore, not in- 
cluded. Of twenty-four cases treated in the past two 
years, seven who have left the Sanitarium were called 
" arrested cases,” the details of which will be published 
with this paper. Of the remaining seventeen, one (No. 
64) was a suspicious case without very definite signs except 
anaemia, a si ight cough without expectoration, and a ques- 
tionable dry crepitation near the spine of the left scapula. 
She left at the end of four months perfectly well, and has 
remained so since, " never better in her life ” at last ac- 
counts. This case, however, was not classed with the 
"arrested” ones, because of the doubtful nature of the 
trouble. IN SANITARIA NEAR OUR HOMES. 
7 
Twelve others (Nos. 55, 57, 60, 61, 62, 66, 67, 69, 71, 
73, 74, 75) were all cases of more or less advanced 
phthisis in one or both lungs, several of whom were ad- 
mitted merely as an endeavor to better their condition, 
with little or no hope of cure. Eight of these showed a 
greater or less degree of improvement in their general con- 
dition ; four of them were not benefited. Four others were 
really incipient cases (Nos. 58, 68, 72, 76), two of whom 
having opportunities to live in Colorado left Sharon after a 
stay of three and one-half and six months respectively, with 
decided improvement in general symptoms, but with no 
change or a slight increase of local symptoms ; one other 
left after two months, decidedly improved, and one is still 
at the Sanitarium, the picture of health, with little or no 
cough, the bacilli having disappeared from the sputa since 
the early winter. 
In addition to the ten " arrested cases ” recorded in my 
paper before the Climatological Association, five who were 
then under treatment and classed as " much improved ” have 
since been discharged as "arrested cases,” the last one 
having left Sharon a year ago. Of these, four are very 
well (Nos. 31, 33, 36 and 48), no symptom of return of 
the disease having yet appeared ; one (No. 42), after a stay 
of nearly two years at the Sanitarium (with the exception 
of short intervals, during which she had to undergo serious 
operations at the hospital for uterine disease of unknown 
nature), left Sharon with the signs of the original lesion in 
the left lung quite healed, and finally died at the City Hos- 
pital following a severe operation for a uterine tumor. Just 
previous to her death I was able to carefully examine her 
lungs, and the only trace of her original trouble was a faint 
dry click occasionally heard in the left supra-clavicular 
space upon respiration. This result was corroborated by a 
member of the staff. Most unfortunately, no autopsy was 
allowed upon this most interesting case, and the nature of 8 
THE TREATMENT OF PHTHISIS 
the abdominal tumor was never known. The details of 
these cases will also be published with this paper. 
It is, of course, impossible in any paper to convey the 
impression made upon the observer by individual cases, and 
any attempt to recite in detail the results of each case would 
only weary, without convincing the listener probably. In 
giving percentages, moreover, there must inevitably arise 
small sources of error, but in publishing results I have 
tried to avoid the " personal equation ” in the description of 
cases, and can only emphasize what I have earlier stated, 
that the number of patients whom I have seen improve or 
in whom the symptoms of disease have disappeared at the 
Sanitarium is much greater than I have ever seen by ordi- 
nary methods of so-called " home-treatment ” in Boston. 
I am aware that possibly the diagnosis in some of the 
published cases may be challenged, because of the failure 
to discover bacilli in the sputa, when the physical signs 
were very slight. I can only say in reply to this, what we 
all surely know, that the absence of bacilli is no proof of 
the absence of tubercular disease ; that in many cases which 
show undoubted evidences of phthisis, upon physical ex- 
amination we may fail for months to find bacilli in the 
sputa, and for myself there are certain evidences of in- 
cipient trouble, e.g. a change in the character of the per- 
cussion note or the respiratory murmur in the apex of a 
lung in conjupction with general signs of departure from 
health, like fever, malaise, loss of flesh, etc., that mean 
infinitely more to me than the mere evidence of the micro- 
scope alone, whether positive or negative. 
With these remarks as a preface, then, let me state that 
out of sixty-four cases of phthisis treated in the Sanitarium 
in the last five years, twenty-two have been classed as 
"arrested cases,” a little more than 33\°Jo. Of these, four 
(Nos. 3, 37, 41 and 4.2) have since died, and in two others 
(Nos. 1 and 63) the symptoms of disease again appeared 9 
IN SANITARIA NEAR OUR HOMES. 
not many months after leaving Sharon, but they are still 
living. Of those who died, however, one showed no evi- 
dence of return of pulmonary trouble, but died after a 
uterine operation ; two others resumed, against advice, the 
same mode of life as before, and pulmonary disease again 
developed. Another died from some rectal disease, the 
nature of which could not be known as the patient was lost 
sight of. Good accounts are obtained of all of the others, 
as far as pulmonary symptoms are concerned, the majority 
having left the Sanitarium more than two years ago. 
Granting that phthisis in a number of cases is a self- 
limited disease, and that such cases get well under any con- 
ditions (Austin Flint having claimed that about 11% are 
probably self-limited), and granting that evidences of tuber- 
cular processes are found in the lungs of numbers of people 
who have died of non-tubercular disease, yet I feel 1 am 
justified in maintaining that the results in this comparatively 
limited number of cases rest on something much more than 
mere self-limitation of disease, and that they are such as to 
warrant the establishment of similar institutions near every 
large city or town. 
The work at the Sanitarium has been greatly aided by 
the almost daily presence of a medical assistant, and of a 
most efficient matron, a former trained nurse, to whose un- 
remitting care those of the patients who have regained their 
health largely owe their lives. That still better results can 
be accomplished by the presence of a resident physician I 
have no doubt, and it is my earnest desire that at no far 
distant date, with increased funds, this, with other necessary 
improvements, will be accomplished. 
METHODS OF TREATMENT AT THE SANITARIUM. 
After many trials of various remedies, I am still convineed 
that fresh air, sunlight, good food, with judicious exercise, 
whether in the form of pulmonary gymnastics or otherwise, 10 
THE TREATMENT OF PHTHISIS 
are the chief factors in whatever good results have thus far 
been obtained. The so-called "peppermint cure” has been 
faithfully tried with negative results as far as any curative 
action is concerned, although it seemed in certain cases to 
ameliorate some of the symptoms, especially the cough. It 
should be said that it was impossible to use the mixture 
recommended by Curasso, to be taken by the mouth, as the 
amount of alcohol caused marked symptoms of intoxication, 
and a modified form was given, the chief ingredients being 
creosote and oil of peppermint, but the other details of his 
treatment were closely followed. 
Klebs’s " Antiphthisine ” has been used also in several 
cases, and I regret to say that the results in my hands have 
not convinced me of its curative power. It has been given 
carefully in accordance with the recommendations as far as 
possible, and in one or two cases improvement was noticed, 
but not more than I have noticed by different methods. 
Creosote alone has been tried, but without positive proof of 
its special value in my experience, except as a corrective to 
the digestion at times. I have never succeeded in giving the 
large doses recommended by some on account of the in- 
tolerance of the stomach for such amounts. 
Tuberculin has never been used at Sharon, my exper- 
ience at the Carney Hospital in South Boston, previous to 
the opening of the Sanitarium, having convinced me that 
it was wiser to wait until we have heard more upon the 
subject from Koch before making further experiments. 
The methods pursued have been chiefly these: — regular 
hours of sleep ; rest in the open air, even in the coldest 
winter weather, on the piazza in the sunshine; exercise by 
walking, regulated according to the condition of the patient; 
pulmonary gymnastics in the form of ordinary calisthenics, 
to develop the chest muscles, or by means of the pneumatic 
cabinet, regular treatment with which has a markedly 
beneficial effect upon the expansion of the chest. AVhen IN SANITARIA NEAR OUR HOMES. 
11 
used judiciously I have never seen harmful results from 
this treatment, and the patients almost universally speak of 
the sense of freedom in breathing after its use. At times 
the combination of a medicated vapor with the cabinet has 
a soothing effect, especially if a general bronchitis is present, 
but 1 have no faith in the germicidal effect of any vapor 
used in this way as sometimes recommended. Pulmonary 
gymnastics, then, in some form, hold in my opinion a very 
important place in all methods of cure of consumption, and 
chief among them stands the pneumatic cabinet or some 
equally efficacious substitute. 
Tonics, in the form of the preparations of the hypophos- 
phites, bitters, malt and iron, are frequently used, and 
special attention is paid to the condition of the stomach and 
bowels. Three regular meals in the day, with lunches, 
usually of egg and milk in the middle of the morning and 
afternoon, are prescribed, and are varied according to the 
patients’ needs. If patients are found to be feverish, quiet 
is recommended rather than exercise, but, if in their rooms, 
the windows are always open in degrees varying with the 
temperature, that the advantages of fresh air treatment may 
not be lost. 
The strictest attention is paid to the care of the sputa, 
expectoration being allowed only into certain receptacles 
which are provided for this purpose and are destroyed by 
fire later. When on the grounds of the Sanitarium the 
patients are provided with small rubber pouches containing 
sheets of Japanese paper, which are destroyed after use. 
Table napkins are of the same material, and the china 
utensils, spoons and forks are boiled after use at every 
meal. Dusting and sweeping in the Sanitarium are never 
allowed, but the floors and walls are wiped frequently with 
damp cloths, which are afterwards burned or boiled, by all 
of which means chances of infection are reduced to a 
minimum. 12 
THE TREATMENT OF PHTHISIS 
Special endeavors are made to procure employment which 
will enable the patients after they leave Sharon to be more 
in the open air than in their previous occupations, and it 
has been gratifying to find how many continue to practise 
the hygienic methods and gymnastic exercises which have 
been taught them in the Sanitarium. 
It may be well for me to refer to what I have alluded to 
in previous papers, viz :—the idea that the presence of 
others who are ill in the same institution has a deleterious 
mental effect upon the patients. As a matter of fact, this 
objection, which doubtless exists in the minds of many, 
amounts, not only in my experience but in that of every 
physician who has had control of a properly regulated sani- 
tarium, to practically nothing when compared with the 
advantage to be gained. It has surprised me frequently to 
see how soon patients become wonted to their changed 
method of life after the first inevitable sense of strangeness 
and homesickness wears off, and how quickly they become 
cheerful and often happy in their surroundings. Depression 
comes usually from some outside source or from a cause 
other than the mere presence of other invalids. 
As to the danger of infection in institutions where proper 
precautions are used, I believe it to be very slight, and the 
lately published paper of Dr. IrwinW. Hance, entitled" Study 
of the Infectiousness of Dust in the Adirondac Cottage 
Sanitarium,” shows in a most interesting way how little we 
have to fear on that ground in such establishments where 
absolute cleanliness of the patient and his surroundings is 
insisted upon. 
In conclusion let me say, that I should regret it very 
much if in my scepticism as to the curative power of any of 
the so-called specific treatments for phthisis thus far in- 
vented I were to give a false impression as to my own hope 
and belief. I cannot help feeling that we are on the eve of 
a new epoch in the history of tuberculosis. Steadily and 13 
IN SANITARIA NEAR OUR HOMES. 
surely, although slowly, I believe we are approaching the 
time when phthisis may he regarded as we now regard the 
plague and small-pox, diseases which once w'ere the terror 
of the human race, but which are now either unknown in 
civilized communities, or so far under control that they are 
no longer so much dreaded. 
Preventive medicine, with its teachings of proper hygienic 
surroundings for those wdio show a tendency to weakened 
constitutions, either acquired or inherited, has played a 
most important part in the already noticeable decrease in 
the mortality from consumption, and to bacteriology we owe 
the great advance which has been made in our ability of late 
years to recognize the signs of incipient disease and to 
grapple successfully with them. 
Let us, therefore, hopefully, cautiously and patiently 
w'ork in the lines that experience teaches us will give the 
best results. If I shall have been able to convince you 
that the sanitarium treatment of Consumption, even in harsh 
climates, takes a very high rank among the methods of 
combating this disease, and if in so doing I can induce you 
to promulgate the idea, not only among the medical pro- 
fession but in the community generally, the object of this 
paper will have been accomplished. 
DISCUSSION. 
I)r. F. I. Knight, of Boston:—The subject which I 
was asked to discuss was a little different from this ; it was 
the home treatment of tuberculosis. I am not sorry that 
the subject was changed, because I think it very important 
that the sanitarium treatment of tuberculosis should be en- 
forced upon the profession. I fully endorse all that Dr. 
Bowditch has said. As long as the treatment of tuber- 
culosis is a treatment of the condition of the patient and 
not a treatment of the disease specifically, the closer super- 
vision and regulation of the patient the physician has, the 14 
THE TREATMENT OF PHTHISIS 
better it is going to be for the patient. After years and 
centuries of experience with searching for specifics, in our 
time we have fallen back pretty much upon the rational 
treatment, as we have called it, of the condition of the pa- 
tient. Very few specifics are known, and although, as l)r. 
Bowditch has said, we have hopes, very few have been dis- 
covered, and I agree with him that as yet we have not found a 
specific for tuberculosis upon which we can rely, disregarding 
the general treatment of the patient, which is, in the present 
state of our knowledge, in my opinion far more important. 
It is possible that even now specifics so-called may exist 
which help out in the cure, but the main thing yet is the 
treatment of the general condition of the patient. Now, 
that holds good in Colorado just as much as it does here. 
The Colorado climate may be looked at in the light of a 
specific in a certain sense, but the patient there with good 
general treatment is much better off than the patient with- 
out it. It is one of the temptations to young people in 
Colorado to disregard medical supervision and fall into social 
pleasures, which I am sorry to say even some of the physi- 
cians offer to their patients. I once sent a bright young 
man there, whose father came to me on one of his vacations 
and said : "I don’t want my son to go back to Dr. So-and- 
so’s family, because he gives a dinner party every night and 
they sit up very late talking and smoking.” 
The effect upon the patient of knowing his condition and 
of being with others in that condition is not depressing, as 
Dr. Bowditch says. It is curious perhaps that it is not, 
but patients in sanitaria and health resorts where there are 
other patients of the same kind are very apt to be cheerful in 
talking over1 their symptoms. Everyone seems to think he is 
a little better than his neighbor, and they realize the serious- 
ness of the condition and the prolonged fight necessary to 
overcome it. That is impressed in a sanitarium better than 
anywhere else, that it is a long, hard fight, and the patients 
realize it and are willing to submit to regulations. The 
difference between the health-resort treatment and the sani- 
tarium treatment is beautifully illustrated to my mind by 
the two mottoes, one of which was to be seen a few years 
ago, and perhaps now, in the recreation hall in the largest 
hotel in Davos, one of the fashionable sanitary resorts, 
where people generally live in the hotels and do as they IN SANITARIA NEAR OUR HOMES. 
15 
please to a great extent. The motto there is "Hilares mox 
sani” (Be merry, and you will soon he well). In the hall 
at Gorbersdorf the motto is "Die Patientcn kommen nichtum 
sich zu amiisiren, sondcrn um geheilt zu werden” (Patients 
do not come here to he amused, but to be cured). See a 
patient from each of those places and you will appreciate the 
difference. Patients from sanitaria appreciate the seriousness 
of the thing, realize that a day’s pleasure may destroy the 
improvement of a year. Yesterday a young girl came into 
my office, twenty years old, in whom the disease had been 
arrested so that she had no noticeable cough for nine or 
ten months and felt perfectly well. Without consulting 
me she went back to employment in a factory, and in two 
months there was a fresh invasion of tubercular disease, and 
I fear now that she is beyond recovery. If that young 
woman had ever been in a sanitarium and got the morale 
of it, she never would have thought of g;oing; to work with- 
out finding; out whether she oug;ht to have done so. In con- 
elusion, as far as the results go in New England, I feel sure 
that anybody who can be treated in a sanitarium is going 
to be better off than if treated at home. Of course if they 
can be treated in Colorado in a sanitarium, or under strict 
medical supervision, it is better than being treated it a sani- 
tarium here, but I have no doubt that many of the patients 
who go West and roam about without medical supervision 
and guidance would be better off in a sanitarium at home. 
RECORDS OF SEVEN CASES OF "ARRESTED DISEASES” SINCE 
THE PREVIOUS REPORT IN 1894. 
Case I.—(No. 51). American. Married. Age 31. 
Entered January 31, 1894. Mother died of phthisis. 
Pneumonia four years before, and "congestion of lungs” 
eighteen months previous to entrance. Slight cough and 
occasional haemoptysis since. Loss of flesh, malaise, slight 
fever. 
Physi cal Examination.—Dulness in upper portion of 
right lung, with crumpling rales varying in intensity over 
most of the lung. A little later, a few rales in top of left 
lung. Bacilli in sputa. Cough persisted, although lessen- 
ing, for six months, after which it practically ceased. Tem- 16 
THE TREATMENT OF PHTHISIS 
perature became normal. Gain of twenty-five pounds in 
weight. Left the Sanitarium one year and a half after en- 
trance. 
Synopsis.—Catarrhal phthisis of both lungs. Arrest of 
disease after a stay of one and a half years at the Sanitarium. 
Patient at this time, eleven months after departure, to all 
appearances well; the last examination showing dry rales 
in the apices and in lower part of right chest, but the per- 
cussion in both of good character. No cough. 
o o 
Case II. — (No. 53). Entered May 14, 1894. Ameri- 
can. Married. Age 33. Very phthisical family history. 
Has for several years had a pain in lower right chest, and 
a cough. For eight months previous to entrance cough was 
severe, with a good deal of sputa, occasionally bloody. 
Loss of flesh and strength. 
Physical Examination.—Thin and pale. Right clavicle 
prominent. Tenderness upon percussion. Respiration 
jerky there. Percussion slightly dull, also in middle third 
of right back. No special rales detected. Pulse 108. 
Temperature 100. Bacilli could not be found. Condi- 
tion slowly improved. Cough and expectoration ceased. 
Gain of twenty-two pounds in weight. Left the Sanitarium 
thirteen months after entrance, feeling well and stronger 
than for many years before. , 
Synopsis.—Incipient phthisis of right lung. Arrest of 
disease after thirteen months stay at the Sanitarium. 
Case III.—(No. 56). Entered June 27, 1894. Nova 
Scotian. Single. Age 24. Domestic. Two maternal 
aunts died of phthisis. Never very strong. Following an 
attack of tonsillitis a year before entrance, a slight cough 
with profuse expectoration, occasionally bloody, developed. 
Occasional night sweats. Pain in left side for two months. 
Catarrh troublesome. 
Physical Examination.—Slight dulness in right apex, 
a " squeak ” heard there once, with broncho-vesicular res- 
piration and a questionable "crumple.” Nothing over seat 
of pain. Temperature 99.3. Pulse 100. Barring a slight 
hemorrhage soon after entrance, there was steady improve- 
ment in all symptoms. Cough and expectoration ceased 
and catarrhal symptoms greatly improved. JSTo bacilli 
found. Patient left the Sanitarium against advice after a IN SANITARIA NEAR OUR HOMES. 
17 
two months’ stay, feeling very well; the percussion in the 
right apex being normal and no evidence of rale there. 
Synopsis.—Incipient phthisis at right apex. Disap- 
pearance of signs after two months’ stay at Sharon. 
Case IV.—(No. 59). Entered July 30, 1894. Sent 
by Dr. J. J. Minot. American. Single. Age 19. 
Mother and one sister died of phthisis; later, a brother de- 
veloped phthisis. Two years previously had taken care of 
a sick sister, and later, in winter preceding entrance, took 
cold and began to cough, which became less in the spring. 
Loss of flesh. Occasional pain in the right subscapular 
region. 
Physical Examination.—Dull in upper right back with 
faint "squeak,” and after cough an explosion of rales. 
Slight tubular respiration. Respiration decidedly broncho- 
vesicular in both apices. Voice increased in both apices. 
Pulse 100. Temperature 99.3. Bacilli in sputa. There 
was marked improvement from the outset. At the end of 
six months there was a cessation of cough and the bacilli 
had disappeared from the sputa when any could be obtained. 
The temperature became normal, and for the past year the 
patient has been the picture of health, and remained at the 
Sanitarium merely as a matter of precaution previous to 
living in the West. Gain of nineteen pounds in weight. 
At the last examination the percussion in the apices had 
greatly improved, and although the respiration was broncho- 
vesicular in both tops, and after cough a few rides could be 
heard, yet the whole sound was of a dry character. The 
general signs had been those of an arrested process for a 
year previous to departure. 
Synopsis.—Incipient phthisis in both apices. Arrest of 
disease at the end of six months, the patient remaining in 
the Sanitarium twenty-one months. 
Case V.—(No. 63). Entered November 7,1894. Ameri- 
can. Married. Age 23. One aunt died of phthisis. 
Two and a half months previous to entrance developed a 
cough, with profuse expectoration. Some loss of flesh, 
chilliness, malaise. 
Physical Examination.—Lack of tone in apices and 
faulty expansion of the chest. Slightly higher-pitched note 
in left apex behind. Suspicion of a dry n\le about spine of 18 
TIIE TREATMENT OF FIITHISIS 
left scapula. Slight elevation of temperature. Sputa 
negative. The cough and expectoration rapidly diminished 
and finally ceased. The expansion of chest and percussion 
greatly improved by the use of pulmonary gymnastics. 
Patient left against advice, feeling very well, at the end of 
three months, as a doubtful case of incipient phthisis. 
Gain of nine pounds. 
Synopsis.—Probable incipient phthisis at the top of left 
lung. Arrest of morbid signs at the end of three months’ 
stay. 
Subsequent History.—Patient returned to hard work in 
unhygienic surroundings. Had whooping cough later, and 
in June, 1895, was re-admitted, with evident signs of 
phthisis at the top of the left lung. Bacilli in the sjmta. 
Owing to disobedience of rules and refusal of treatment 
the patient was discharged at the end of three months, with 
only slight improvement of general symptoms. 
This case is shown as illustrating how the absence of 
bacilli in the early history was no proof of the non-existence 
of tubercular disease, and yet the physical signs pointed 
towards the existence of phthisis, which was proved several 
months later when the patient reentered the Sanitarium. 
Case VI.—(No. 65). Entered January 8th, 1895. 
American. Single. Age 24. Lives at home. Sent by 
Dr. George G. Sears. Family history negative, with ex- 
ception of asthma in father’s family. Seven years before 
had been anamiic. A year and a half previous to entrance 
had la grippe, and continued to lose flesh, and had a slight 
cough without much sputa. Malaise and anorexia, dysp- 
noea and palpitation. Just before entrance Dr. Sears had 
found some moist rales at the left apex. 
Physical Examination.—Anaemic. Rather high-pitched 
percussion note in apices and sub-clavicular spaces, more 
noticeable in apices in the back. Respiration decidedly 
broncho-vesicular in both apices, most marked behind, with 
increased voice sounds. Later, diminution of respiratory 
murmur in lower left chest. Temperature 100. Pulse 88. 
Examination of sputa negative. The patient remained 
four months, gained twenty-one pounds, looked the picture 
of health ; cough and expectoration ceased entirely, and 
temperature became normal. Although the respiration re- 19 
IN SANITARIA NEAR OUR HOMES. 
mained broncho-vesicular in the apices, yet all other signs 
pointed to a complete cessation of any morbid process. 
She was advised to stay longer, but was obliged to leave. 
Synopsis.—Case of incipient phthisis in one apex at 
least. Complete cessation of all morbid symptoms after 
four months. Gain of twenty-one pounds in weight. 
Subsequent history excellent. 
Case VII.—(No. 70). Entered June 22, 1895. Ameri- 
can. Single. Age 1(1. Mother and sister died of phthisis. 
Dry hacking cough nine months previous to entrance. 
Slight amount of blood. Other symptoms not marked. 
Physical Examination.—Slight dullness in right supra- 
clavicular space, and lacking in tone in both apices. Ex- 
plosion of moist rales in both tops to second ribs. Less 
marked in back. Respiration faintly bronchial. Voice 
slightly increased. Temperature 100.8. Pulse 112. Ex- 
amination for bacilli negative. Steady improvement 
from the outset. Cessation of cough and sputa. Gain of 
fifteen and one fourth pounds in weight. The physical 
signs became dry in character, although they persisted at 
the apices after entire cessation of cough and expectoration. 
Patient left against advice in three months. 
Synopsis.—Incipient phthisis at both apices. Patient 
was discharged as " greatly improved ” at the end of three 
months, although the cessation of cough and expectoration, 
the normal temperature and the general appearance of 
health justified the term " arrest of disease.” 
RECORDS OF FIVE CASES PREVIOUSLY RECORDED IN AN 
EARLIER PAPER AS "MUCH IMPROVED,” SINCE 
DISCHARGED AS "ARRESTED CASES.” 
Case L — (No. 31). Entered May 31, 1892. Sent by 
Dr. C. Ellery Stedman. American. Age 17. Family 
history bad : father, one sister, one adopted sister, and later 
a brother, died of phthisis. Perfectly well until one month 
previous to entrance, then took cold and a cough with 
little or no sputa persisted. Loss of flesh and strength, 
pain in chest and soreness. 
Physical Examination.—Pale, dark under the eyes. 
Slight dulness down to the third rib in left top, also in left 
apex behind. Respiration a little jerky in this region, no 20 
TIIE TREATMENT OF PHTHISIS 
definite r:\le, but in the supra-clavicular space a faint 
"crumple” with full breath. Voice a little "nearer” in 
right apex. Temperature 99.8. Pulse 98. One month 
later the " crumple ” had disappeared, but the jerky res- 
piration continued. Respiration in right apex broncho- 
vesicular and voice faintly bronchophonic. In the lower 
right back, especially between the scapula and vertebral 
column, moist rales. During her stay of a little over two 
years she expectorated blood once, and the respiration in 
the lower right back became in a circumscribed area rather 
bronchial, but upon the last examination only faint dry 
rales could be heard after cough, with obscurity of respira- 
tion, but the percussion note had everywhere improved 
greatly. The temperature and pulse fluctuated from time 
to time, but at the last became normal. Wo bacilli were 
found at any time. Gain of twenty-seven pounds in 
weight. 
Subsequent History.—For two years has felt perfectly 
well. One brother has since died of acute tuberculosis, 
but she has had no return of abnormal symptoms. 
Case II.—(No. 33). Entered July 23, 1892. Ameri- 
can. Age 19. Single. Worker in box factory. Family 
history negative. For some months weakness, cough with 
whitish starchy sputa, three times slight amount of blood ; 
severe headache; night sweats, loss of flesh, dyspnoea upon 
exertion; occasionally feverish. 
Physical Examination.—Except for slight increase in 
the expiratory murmur in the right apex in front, and 
broncho-vesicular respiration in the upper right back, little 
to be found in chest. Anaemia present, and sclerotics very 
clear. Temperature slightly elevated. Pulse rapid. 
Later, slight dullness developed in the right apex, and res- 
piration was jerky. Bacilli in sputa. Occasional slight 
haemoptysis occurred, but patient steadily improved, and at 
the end of two years left the hospital and is now very well. 
At the last examination there was little or nothing abnormal 
to find in the chest. Gain of thirty-four pounds in weight. 
Synopsis.—Incipient phthisis at top of right lung. The 
patient was of very nervous disposition and, although the 
temperature never rose very high, it always was slightly 
elevated, and was just above normal towards the last. IN SANITARIA NEAR OUR HOMES. 
21 
Arrest of disease after a stay of two years. Patient has 
remained well since. 
Case III.—(No. 3G). Entered October 5,1892. Ameri- 
can. Age 22. Single. Clerk. Family history: mother, 
two aunts and two uncles died of phthisis. Never.vigorous. 
Two months previous to entrance about a half cup full of 
blood was expectorated. Slight hacking cough with slight 
yellow expectoration. Loss of twenty pounds of flesh. 
Physical Examination.—No dullness, but in both 
apices, in front and behind, rather coarse " clicks ” with 
inspiration. No bronchial respiration. In left back, near 
spine of scapula, circumscribed area of slight broncho- 
vesicular respiration with increase of voice sounds. Tem- 
perature 100. Pulse 100. Bacilli were found in the 
sputa. The patient had occasional haemoptysis, and the 
cough persisted for months, but at the end of two and one 
half years she left Sharon looking and feeling well and 
strong, the cough and bloody expectoration having disap- 
peared ; faint snapping rales in the apices still being noticed. 
Gain of seventeen pounds. 
Synopsis.—Incipient phthisis at apices. Arrest of 
disease after two years’ stay at Sharon. Patient has re- 
mained very well since, with no symptom of return of 
trouble (one year). 
Case IV.—(No. 42). Entered January 25,1893. Irish. 
Single. Age 25. Domestic. Never was strong. Family 
history: one sister died of' phthisis, otherwise negative. 
Previous history of uterine trouble for which she was treated 
at the City Hospital; malarial fever and "la grippe” six 
months before entrance. Six months previously caught a 
severe cold ; bad cough for four mouths, with muco-puru- 
lent sputa; pain in upper left chest and shoulder ; palpi- 
tation ; much loss of flesh, anorexia, dyspepsia; irregular 
and painful menstruation. 
Physical Examination.—Slight dullness in right apex, 
lack of tone in both apices. Respiration obscure in apices, 
and a questionable " crumple ” in the right top front and 
bock. The patient, during her stay of nearly two years, 
improved greatly in general conditions ; had one or two 
attacks of general bronchitis. At one time faint clicks 
could be heard in both apices, and whispered voice was in- 22 
TIIE TREATMENT OF PHTHISIS. 
creased at these points. On account of the uterine condi- 
tion, however, she was obliged to go to the New England 
Hospital, and later to the City Hospital, but previous to 
her departure all signs had cleared from the chest; the per- 
cussion was good throughout, and only an occasional dry 
" click ” could be heard at the supra-clavicular space. Tem- 
perature 99.8. Pulse 94. Bacilli were found in the 
sputa. Gain of five pounds in weight. 
Synopsis.—Incipient phthisis at both apices, with inter- 
current attacks of acute bronchitis and complicated with 
severe uterine trouble requiring operations. Complete 
cessation of cough and expectoration and clearing of morbid 
pulmonary signs after a nearly two years’ stay at the Sani- 
tarium. No recurrence of pulmonary disease. Death 
following uterine operation about one year later. 
Case V.—(No. 49). Entered July 27, 1890. Irish. 
Age 28. Single. Domestic. Family history bad; two 
brothers, two sisters and father died of pulmonary disease. 
History of illness five years before, with pain in the right 
side, but no cough, and was not in bed. Was told at the 
time by a doctor in Ireland that she had consumption and 
would not get well. Came to America three years before 
entrance and was well until two months previous when she 
had a hemorrhage without previous warning. Short cough 
with scanty sputa, malaise, loss of flesh, anorexia, pain in 
right chest. 
Physical Examination.—Large frame. Tenderness at 
right apex. In middle of right back, slight dullness; res- 
piration not so free as on left. Two months later moist 
rales developed over point of dullness in right back. Tem- 
perature 100. Pulse 88. Bacilli and elastic fibres in 
the sputa. Fourteen months later the patient left Sharon, 
having had no cough or expectoration for several months, 
and having been well, as far as general appearance goes, for 
six months. Splendid specimen of health. Gain of twenty- 
six and one half pounds in weight. The slight dullness in 
right back persisted, but the rales disappeared. 
Synopsis.—Case of incipient phthisis in right lung with 
hemorrhages. Complete arrest of disease after fourteen 
months stay at Sharon. Patient perfectly well and strong 
up to the present time ; "never so well in her life befoi'e.” 
No sign of cough or ill health since leaving Sharon. 
50G Beacon Street.