THE SANATORIUM 
OR CLOSED TREATMENT 
OF PHTHISIS. 
BY 
EDWAKD 0. OTIS, M.D., 
BOSTON. 
REPRINTED PROM THE 
Wcto ¥otfc J&ebtcal Journal 
for June IS, 1896. Reprinted from the New YorTc Medical Journal 
for June 13, 1896. 
THE SANATORIUM 
OE CLOSED TEEATMENT OF PHTHISIS.* 
By EDWARD O. OTIS, M. D., 
BOSTON. 
The open and the closed or sanatorium treatment of 
phthisis may not inaptly be compared, I think, to the treat- 
ment of a private patient before and after the advent of the 
trained nurse. With the accurate, intelligent, and skillful 
ministrations of the nurse, the prognosis for the patient is 
appreciably improved, other things being equal. In like 
manner, with the resources and expert service of a sanatori- 
um the percentage of recoveries has been found to be con- 
siderably greater than under the most favorable conditions in 
the open resorts. Besides this chief advantage of better re- 
sults in the closed treatment there are others which are not 
inconsiderable, and to them I shall refer directly. All of 
us who see and treat many cases of phthisis, either in the 
large centres of population or at the various health resorts, 
must, it seems to me, have become profoundly impressed, 
not to say depressed, by the fact that the results obtained 
* Read before the American Climatological Association, at Lake- 
wood, N. J., May 13, 1896. 
Copyright, 1896, by D. Appleton and Company. 2 
TIIE SANATORIUM OR 
by the open treatment, so called, even under the most 
favorable environment, are greatly inferior to those pro- 
duced by the closed treatment, as illustrated by the best 
sanatoriums abroad and the few existing in this country. 
Of one thousand and twenty-two cases treated by Dett- 
weiler, at Falkenstein, from 1876 to 1886, there were 24‘2 
per cent, of complete and relative cures—and by relative 
cure is meant an appearance of good health, with good 
action of all the organs, especially the heart and lungs, but 
where there are some physical signs still remaining in the 
lungs. 
Meissen, in his sanatorium at Hohenhonnef, gives 
twenty-seven per cent, of cures. In Dr. Trudeau’s last 
report of the Adirondack Cottage Sanatorium, of ninety- 
one patients who remained from three to forty-four months, 
nineteen incipient and advanced cases were apparently cured, 
and twenty-six incipient and advanced cases arrested; in 
reports of other years he exhibits equally good results. 
Rompler, at Gorbersdorf, gives twenty-five to twenty-seven 
per cent, of cures. Von Ruck, at Asheville, reports thirty- 
five per cent, cured or permanently arrested; forty-six per 
cent, improved. Turban, at Davos, reports forty per cent. 
Knopf gives statistics from fifteen sanatoriums, either 
visited or communicated with by him, representing forty- 
five hundred patients; six hundred and thirty, or fourteen 
per cent., were absolute cures; six hundred and thirty, 
or fourteen per cent., relative; and eighteen hundred and 
ninety, or forty-two per cent., improved. The more inti- 
mate our knowledge of the disease and the multiplicity of 
its pathological conditions, and of the character of the aver- 
age phthisical individual himself, the more hopeless seems 
the task of properly treating him, under however favorable 
a climate, without absolute control both of his body and of 
his mind. “ It is upon a multitude of small details most CLOSED TREATMENT OF PHTHISIS. 
3 
frequently that the cure depends. In appearance they may 
seem trifling, but in reality they are of capital importance.” 
The treatment, in a large measure, must consist in causing 
the patient to give up his bad hygienic habits and replac- 
ing them by good ones. The phthisical patient is a sick 
entity, sick in body and mind. He distorts the true rela- 
tions of things, and when left to himself frequently acts 
disastrously from this distorted point of view. His moral 
and mental condition requires a vast deal of study and ob- 
servation, which is only possible when he is immediately 
and constantly under his physician’s eye. You, who prac- 
tise in health resorts, I think, will corroborate these state- 
ments, and could doubtless adduce many cases in your own 
experience as illustrative of them. “A consumptive,” says 
Leon-Petit, “ given up to the care of those about him will 
be at the mercy of anything that may happen. In spite 
of the frequent visits of his physician, he will have to con- 
tend with his own peculiar weakness; he will commit with 
the best of intentions the gravest faults. His establish- 
ment may be perfect and the climate irreproachable, but 
he lacks the principal factor of treatment, without which 
all the others are rendered powerless—namely, the guide 
which he feels watches him constantly, in whom he has 
confidence, and who knows how to remove from his path 
the obstacles which can cause him to stumble.” It is em- 
phatically the case, as Dettweiler says, that the individual 
in toto has to be treated, and the moral education is quite 
as important as the bodily treatment. A consumptive 
is in a peculiar mental condition as a rule, possibly not 
different from that which is the concomitant of any 
chronic depressing disease, but which renders constant 
supervision and inspiration necessary. He lacks persever- 
ance and power to concentrate the mind and will upon a 
definite object. In brief, as some one has said, a typical 4 
THE SANATORIUM OR 
case of phthisis embraces little less than the whole field of 
pathology. 
Moreover, with our present knowledge of the conta- 
giousness of the disease, we must all agree, I am sure, that 
the sanatoria or special hospitals are the best means of pro- 
tecting the non tuberculous. We must reckon with the fact 
that the people are becoming educated to this new truth, 
and it will become more and more difficult to properly care 
for our consumptive patients, either at home or in the health 
resorts, where both non-tuberculous and tuberculous patients 
have been in the habit of congregating, as at Aiken, at Ashe- 
ville, in southern California, and in various other stations 
south and west. Those who, simply for a change, or for other 
maladies than phthisis, resort to these various stations will, 
as well as the inhabitants themselves of these places, de- 
mand that they be protected from the danger of contagion, 
which is ever present when tuberculous patients are allowed 
to go free among them. Already hotel proprietors are rec- 
ognizing this fact and closing their doors to the consump- 
tive. Besides, then, all the other advantages of sanatorium 
treatment, there will be this other impelling motive of 
necessity to provide establishments in the health resorts of 
known reputation for the unfortunate consumptive. The 
physicians themselves in these resorts, I am sure, realize 
this necessity, as well as the unsatisfactory condition under 
which they are now compelled to treat their patients by the 
open method, and it is to them especially that we of the 
cities and portions of the country wffiere phthisis so largely 
prevails must look to inaugurate the era of sanatoriums. 
We, on our part, must convince our patients of the much 
greater chances of recovery they have in a well-equipped 
and conducted sanatorium, and disabuse them of the erro- 
neous ideas they may hold of the life in such institutions. 
Whereas climate is a most valuable factor in the treat- CLOSED TREATMENT OF PHTHISIS. 
5 
ment of phthisis, as we would all oonfess, yet I believe 
that, both by the profession and the laity, its influence has 
been, if not entirely overrated, at least quite misunder- 
stood. We have been trying to make it do the whole work 
rather than its own appropriate part. We have looked 
upon it too much as a specific. A study of the sanatoria 
abroad makes it evident, I think, that it is not a peculiar 
variety or even excellence of climate which has produced 
the favorable results, but rather the admirable regime of the 
sanatorium itself, and the exact precision with which the 
whole life of the invalid is governed. It is the perfect 
hygienic environment. All sources of help, climate among 
them, are made use of, each according to its value. Knopf 
says, and I think he is right, that if he had the choice of 
sending a patient who had some prospect of recovery to an 
ideal climate and altitude in an open station where he 
would be left free to act as he pleased, or to send him to a 
closed institution where all the conditions of climate were 
those of the lowlands, he would send him to the latter, 
convinced that his chance of cure in a relatively unfavor- 
able climate, with the regime, hygiene, and constant super- 
vision of the physician, was greater than in an ideal clima e 
without these advantages which a sanatorium offers. Our 
medical journals are constantly publishing communications 
upon the various so-called climatic resorts which, in my 
opinion, still further promote this misconception of climate 
—namely, exaggerating its power and influence, and ignor- 
ing the vastly greater value of the hygienic treatment in 
its largest and fullest sense. It seems to me that it is time 
to make an emphatic protest against this one-sided view of 
the influence of climate per se, and an equally vigorous plea 
for the advantages of the hygienic treatment of phthisis 
as represented by the best sanatoriums. I do not wish to 
be understood as in any sense depreciating the value of cli- 6 
THE SANATORIUM OR 
mate, inestimable as it is. It is only that I believe in it so 
firmly that I desire to see it properly used and not abused 
through a misconception of its value. The consensus of 
opinion of all the experts in the treatment of this disease 
is that hygiene and dietetics come first, and after that cli- 
mate, altitude, and medication. 
There are certain facts and misconceptions regarding 
sanatoriums which it seems to me well to consider a little 
more closely. In the first place, there is a fear abroad that 
sanatoriums may be a source of contagion not only to the 
inhabitants of the localities where they are situated, hut to 
the inmates as well. As to the fear that sanatoriums tend 
to spread the disease, we have the evidence to the contrary 
from both Gorbersdorf and Falkenstein, two of the oldest 
and largest sanatoriums in Germany. Gorbersdorf has been 
visited by twenty-five thousand patients during forty years, 
and the mortality from phthisis among the inhabitants has 
never passed the ordinary average, but, on the contrary, 
has diminished.* During the period of twenty years pre- 
ceding the establishment of the Falkenstein Sanatorium an 
average of four per cent, of the inhabitants died annually 
of consumption, and 18'9 per cent, of the total mortality 
was attributed to that disease. After the institution was 
opened, during the period from 1877 to 1894, the average 
annual mortality from phthisis fell to 2-4 per cent., and the 
proportion of deaths from consumption to those from all 
causes sank to 119 per cent.f On the contrary, there is 
reason to believe that in the open resorts consumption has 
increased among the inhabitants since the advent of phthis- 
ical patients. This has been observed at Nice, Cannes, 
Monte Carlo, Mentone, southern California, and, I doubt 
* Rompler. Beitrage zur Lehre von der chronischen Lungenschwind- 
sucht. 
f Quoted in the New York Medical Journal, February 22, 1896. CLOSED TREATMENT OF PHTHISIS. 
7 
not, other open resorts. Says the mayor of Nice, in a 
letter to Dr. Knopf: “ It is of public notoriety that at Nice, 
and especially Mentone, tuberculosis has increased enor- 
mously since consumptives have frequented this station.” 
Knowing, as we do now, the contagiousness of the disease 
and the carelessness of the average consumptive, how could 
this be otherwise, for among large numbers of consump- 
tives allowed to go free there will inevitably be some who 
will scatter their sputum about, and then the danger begins. 
As to the danger of contagion in the sanatorium itself, we 
have the experience of Gorbersdorf, Saranac, Brompton, 
and others. At the latter hospital, Williams says that dur- 
ing a long service he has observed only three or four cases 
of contagion among the 'personnel of the hospital. In the 
three great closed establishments at Gorbersdorf, among 
the attendants, who are taken almost exclusively from the 
indigenous population—that is, from an outdoor to an in- 
door life—the mortality is very low in spite of very exhaust- 
ing work. In an examination of the dust at the City of 
London Hospital for Diseases of the Chest and the Adiron- 
dack Cottage Sanitarium, by Heron and Hance, it was 
found to be practically free from bacilli. The first and last 
and constant care in a sanatorium is the proper disposal of 
the sputum; patients and attendants are taught to realize 
its danger and the way to protect themselves and others 
from it; this accomplished, contagion vanishes. 
Another common objection to sanatoriums is the de- 
pressing effect upon one shut up with so many consump- 
tives. If you suggest sanatorium to your patient or his 
friends it is not unlikely that they will consider the propo- 
sition as an impertinence on your part, and shudder at the 
mention of such an institution as a sort of Inferno, with 
“ Abandon hope, all ye who enter here,” written over it. 
This attitude of mind comes from the erroneous conception 8 
THE SANATORIUM OR 
of a sanatorium, and ignorance of the life within it, together 
with the desire, perhaps natural enough to average human 
nature, to conceal from themselves or friends the fact that 
they have a desperate disease which demands a long and 
unremitting struggle, aided by the best resources known, to 
combat it. Those of us who have visited sanatoriums in 
this country or abroad will agree, I think, that the at- 
mosphere in these institutions is a cheerful one, the pa- 
tients are generally happy and contented, and the “ hope 
that springs eternal in the human breast ” is fanned into a 
bright and constant flame. One encourages another and is 
encouraged by seeing others recover, and, if the director or 
physician is the man for the place and possesses something 
of the personality which makes the success of the faith- 
cure doctor, he is a constant inspiration to all. The repose 
of mind engendered in a sanatorium is most helpful. The 
patient is made to feel that he is wasting no opportunity, 
and, what is of inestimable value to a sick man, he is en- 
couraged to give himself up entirely to the guidance of the 
physician and renounce all responsibility of his case. lie 
is only to follow out from day to day the routine of life 
which is arranged for him, to do blindly, so to speak, what 
is told him to do, like school children or athletes training 
for a contest, a most favorable condition of mind for im- 
provement and recovery. Petit gives the impressions of 
one of his own countrymen in a German sanatorium. At 
first it is a sad one, he says, but this is very fleeting, and is 
replaced by one which is quite the opposite—a deep 
serenity of mind begotten by the hope of cure. Thanks 
to this serenity, the invalids joke and laugh the entire day. 
“ It is hope,” adds Petit, “which enters the sanatorium, 
and it is hope which lodges there.” 
The educative value of a sanatorium is an important 
part of its influence. It is no small advantage to train the CLOSED TREATMENT OF PHTHISIS. 
9 
patient in proper methods of personal hygiene, so that 
when he enters the common life again he may be able to 
so care for himself as to avoid the dangers he once fell 
into by his faulty hygiene. And further, he will also he a 
teacher to others by precept and example, and show them 
how to avoid the conditions conducive to phthisis. Upon 
the consumptive at large and his entourage he will impress 
the danger of carelessness in disposing of the sputum. 
We should regard, I think, sanatoriums as most valuable 
allies to the conservators of public health in disseminating 
the knowledge of the danger of the sputum and the means 
of protection from it, and it is well for us to acknowledge 
our indebtedness to them. 
The educative value of the sanatorium upon the side of 
its material for clinical study and its laboratory for the 
investigation of problems in tuberculosis is highly im- 
portant. Consider the work of Brehmer and Williams, 
Dettweiler and Powell, Sabourin and Petit. In our own 
country we must all acknowledge our obligations to Dr. 
Trudeau for the work he has already accomplished in the 
Saranac Laboratory, and we have the new laboratory at the 
Winyah Sanatorium from which to expect valuable results. 
If special training is necessary for the physician who would 
direct a sanatorium or devote himself to the treatment of 
phthisis at large, the sanatorium is the natural school for 
such training. Dettweiler was a pupil of Brehmer’s and 
Meissen of Dettweiler’s. Moreover, many therapeutic 
problems, the testing of the value or worthlessness of any 
vaunted drug or method of treatment, can find in such an 
institution most favorable conditions for their solution. 
The advantages to the patient in the way of costly equip- 
ment the large plant of a sanatorium offers can not be so 
completely obtained in any other way, I believe ; the sani- 
tary arrangements, cleanliness, ventilation, preparation of 10 
THE SANATORIUM OR 
food, heating, facilities for various kinds of baths and mas- 
sage, means of physical culture and breathing exercises, 
location so as to command the greatest amount of sun- 
shine—all these and others, when dominated by an expert, 
produce a combination of favoring circumstances rarely if 
ever possible in an open resort. 
There are many details regarding the establishment of 
sanatoriums which it would be of interest to consider, had 
one time: the location, climate, altitude, capacity, method 
of housing, either in a number of small buildings, as at 
Saranac, or in one or two large ones, as at Gorbersdorf 
and Falkenstein; my thesis, however, is a plea for the 
greater advantages and better results of the closed treat- 
ment rather than a discussion and review of sanatorium 
location, construction, and management. 
I will, however, say a word or two regarding the ques- 
tion of climate in relation to the location of the sanatorium. 
With reasonable regard for other considerations, such as 
accessibility, facility for obtaining supplies, a near source 
of good and abundant water, etc., the next consideration 
should be given to climate, and that resort should be se- 
lected which offers the most favorable climatic conditions 
for the open-air treatment: a pure atmosphere, a majority 
of pleasant and sunny days, dryness of soil and air, and 
more or less equability of temperature. The medium and 
high altitudes have given the best results, and, other things 
being equal, are to be given the preference in the location 
of the sanatorium. All of those in Europe, with the ex- 
ception of the three at Davos, Leysin, and Arosa, in 
Switzerland, are of the medium altitude class—averaging 
about sixteen hundred and sixty-seven feet. Nearly all 
of them, however, are situated in the mountains, and 
possess a mountain air, rather dry, with no sudden or 
considerable changes in temperature, and fairly abundant CLOSED TREATMENT OF PHTHISIS. 
11 
sunshine. There are, however, I believe, cases enough 
more suitable for the lowland climate—Gedding’s “asep- 
tic climate without altitude ”—as well as those who would 
do as well there as anywhere, to warrant the construc- 
tion of sanatoriums in these localities, represented by such 
places as Lakewood, Aiken, Thomasville, and southern 
California. It is well to repeat in this connection that 
climate and altitude are only more or less favorable allies, 
only a part of the tout ensemble of the treatment of phthisis, 
and not the tout ensemble. Better results are to he ex- 
pected from sanatorium treatment in a mediocre climate 
than from the open or free treatment under the most per- 
fect climatic conditions. “ Wherever they are situated,” 
says Sahourin, “ analogous results are obtained. The 
tuberculous are cured as well in the temperate climates 
as the cold ones. Altitude plays only a secondary role in 
the cure. The best proof of this is that the most excel- 
lent results are perhaps obtained at Falkenstein, a station 
of only an elevation of thirteen hundred and seventy-eight 
feet, and whose atmosphere is a little misty or foggy. It 
has often been said,” he continues, “ and it is well to re- 
peat it, that a climate does not exist which cures phthisis, 
but there is a curative method which is applied in a more 
favorable manner perhaps in one climate than in another. 
The superb results obtained in the sanatoriums of medium 
altitudes show that they respond to the indications of a 
majority of the cases which present themselves.” 
Are there no cases, then, for which the open treatment 
is better adapted ? one naturally asks. Yes; if one could be 
psychologist enough to make the selection. Such patients 
should possess sufficient strength of will, tenacity of pur- 
pose, and mental acuteness to comprehend and faithfully 
and perseveringly carry out a regime carefully arranged and 
supervised for them by a skilled physician close at hand, 12 
THE SANATORIUM OR 
and further, their environment should be able to furnish 
the requisite means for accomplishing this. As a fact, 
however, I think most of us would agree that such a happy 
combination of traits and conditions was not frequent, and 
we can never be sure of knowing with any degree of confi- 
dence when it does exist. Consider a moment the require- 
ments: a pure and wholesome atmosphere and constant 
exposure to it; the best possible hygienic conditions; pro- 
tection from a new infection either by self-infection or 
from some other careless patient; good nourishment, with 
a wholesome, abundant, varied, and attractively served 
table, the food being especially prepared if the condition 
demands it, to be constantly under the eye of a specialist in 
this disease. Facilities for proper physical exercise, when 
allowable; also for hydrotherapy and massage. Conditions 
such as will excite hope and secure tranquillity of mind, 
and promote co-operation in the exertions made to bring 
about the favorable results. Can, now, these conditions be 
fulfilled with any degree of certainty or completeness in a 
free station t I doubt if they can. Fremy, quoted by 
Knopf, favors open resorts only for those who have no 
need of a rigorous supervision and a methodic treatment; 
the suspected cases—scrofulous, bronchitics, the predis- 
posed, or those who have hereditary tendencies—but, as 
Knopf says, for a patient with phthisis in evolution, who can 
aggravate his state by the least imprudence or fault; for 
one, the constant supervision of whom, and whose educa- 
tion, physical and moral, constitutes the principal treat- 
ment, a closed establishment is the only way in which he 
can hope for a cure. The treatment in a free station is 
illusory. 
There still remains the important question of sanatori- 
ums for the poor. This is being widely discussed abroad, 
and already with substantial results, as I shall show directly CLOSED TREATMENT OF PHTHISIS. 
13 
in presenting a list of the sanatoriums already established 
and proposed. For the poor consumptives of our cities— 
and the majority of them are found there—two classes of 
sanatoriums or special hospitals will be found necessary, I 
think : the one in or near the city, to receive the tubercu- 
lous of all stages ; the other in the country, under more 
favorable climatic conditions, to receive such cases from the 
former as are suitable for the climatic cure and who have 
the most need of its influences. When once the public 
realizes the value and economy as well as protection that 
such provision for the poor consumptives will effect, they 
will not be slow to follow the example of the only state 
which has, as yet, made such beneficent provision. 
Ultimately the state has to provide refuge in its gen- 
eral hospitals, poorhouses, and asylums for the consumptive 
when he is too ill to work longer. Here he is a menace to 
the other inmates, and receives little, if any, special treat- 
ment, although the expense per capita is probably larger 
than it would be in a special hospital. The favorable results 
are, moreover, almost nothing, while with the special treat- 
ment in sanatoriums many lives would be restored to the 
working community, which would mean a great economic 
gain. 
As illustrative of the subject, I have endeavored to col- 
lect a list of all the sanatoriums now existing in Europe 
and this country, with a few facts relating to them. I have 
a list of thirty-three—probably there are more at this 
writing—great and small, scattered throughout Europe, and 
most of them at a medium altitude. The three in Switzer- 
land are of high altitude, and those in London, at the Isle 
of Wight, and the little one in Scotland, are at sea level, as 
also, I suppose, those, or most of them, in Russia are. 
Twenty are paying more or less, and thirteen are charitable. 
Their capacity varies from two hundred and fifty to fifteen. THE SANATORIUM OR 
u 
Name. 
Situation. 
Elevation. 
Sanatorium of Brehmer 
Gorbersdorf in Silesia. 
1,840 feet. 
Sanatorium of Rompler 
a u 
1,840 “ 
Sanatorium of Countess Buckler 
1,840 “ 
1,378 “ 
Sanatorium of Falkenstein 
Falkenstein in the Taunus. 
Sanatorium for the Poor at Fal- 
u a a 
1,378 “ 
kenstein. 
Sanatorium of Davos 
Davos, Engadine Valley 
(Switzerland). 
5,159 “ 
Sanatorium of Hohenhonnef... 
In Honnef, between Linz 
and Bonn. 
774 “ 
Sanatorium of Reiboldsgriin ... 
Reiboldsgriin, between 
. 2,461 to 
Saxony and Bohemia. 
2,625 feet. 
Sanatorium of St. Blasien 
Black Forest. 
2,534 “ 
Sanatorium of Badenweiler.... 
U 
1,378 “ 
u 
Sanatorium of Schomberg 
u 
2,132 feet. 
Sanatorium of St. Andreasberg. 
Hartz Mountains. 
1,968 “ 
Sanatorium of Rehburg (two 
492 “ 
small sanatoriums). 
Sanatorium of Neu-Schmecks .. 
Austria-Hungary, Carpa- 
thian Mountains. 
3,293 “ 
Sanatorium of Tonsaasen 
Norway. 
1,968 “ 
4,756 “ 
Sanatorium of Ley sin 
Switzerland. 
Sanatorium of Arosa. . 
Engadine. 
6,188 “ 
Sanatorium of Weissenbourg... 
2,919 “ 
Sanatorium of Canigou 
France, Verne-les-Bains. 
2,132 “ 
Sanatorium of Craigleith 
Scotland, near Edinburgh. 
Sea-level. 
Royal National Hospital 
Ventnor, Isle of Wight. 
U 
Sanatorium of Brompton 
London. 
a 
Sanatorium of Victoria Park... 
U 
“ 
Royal Hospital for Diseases of 
U 
the Lungs. 
North London Hospital for Con- 
u 
Sea-level. 
sumption. 
Sanatorium of Alexandra 
Russia, St. Petersburg. 
u a 
Sanatorium of Obouchowsky... 
Sanatorium of Alexandrina.... 
Sanatorium of Finland 
Halila, Finland. 
Russia. 
Sanatorium of Slavonta 
Sanatorium of Ialta 
Crimea, Russia. 
Near Warsaw, Poland. 
Hospital de Wola 
Sanatoriums for CLOSED TREATMENT OF PHTHISIS. 
Phthisis in Europe. 
15 
Director. 
Paying or 
non-paying. 
Treatment. 
Capacity. 
Achtermann. 
Paving. 
Brehmer. 
250 
Rom pier. 
a 
100 
Weicker. 
Small ain’t. 
u 
30 
Dettweiler. 
Paying. 
Brehmer-Dettweiler. 
150 
U 
Non-paying. 
U 
28 
Turban. 
Paying. 
u 
60 rooms. 
Meissen. 
U 
u 
Largest in 
Germany. 
Wolff. 
u 
100 
Haufe. 
u 
u 
60 
Leiser. 
u 
Not exclusively for 
phthisis. 
Walther. 
u 
» 
34 
Bandach. 
u 
Jacubash. 
u 
Brehmer. 
Michaelis, 
u 
U 
15-20 
Kaatzer. 
Scontagh. 
u 
Cure (Pair and hydropath- 
ic; open only in summer. 
Anvord. 
u 
90 
Burnier. 
u 
Usual hygienic. 
130 
Ewart. 
u 
Brehmer-Dettweiler. 
40 
u 
Cure (Pair only; hydro- 
Mixed. 
pathic; summer. 
Sabourin. 
u 
Hygienic: cure d Vombre. 
Does not lodge patients. 
Non-paying. 
Cure d Pair libre. 
15 
Dr. Philip. 
Partly char- 
Eclectic. 
134 beds. 
itable. 
Non-paying. 
U 
m 
U 
U 
164 
Dr. Buchanan. 
u 
u 
u 
“ 
84 
il 
100 
u 
150 
u 
50 
Dr. Gabrlowitch. 
“ 
100 
phthisis. 16 
THE SANATORIUM OR 
So far as the results are attainable, they are about the 
same for all—of absolute and relative cures, from twenty- 
five to thirty per cent.; of improved, forty per cent, or 
more; or the total minimum of absolute and relative cures 
and improved, seventy per cent., as calculated by Knopf 
from forty-five hundred cases. The average duration of 
residence was from seventy to ninety days. 
Besides the sanatoriums already established in Europe, 
which I have enumerated, there are numerous others, either 
in process of construction or contemplated, principally for 
the poor. Switzerland has been especially active in this 
work. The Canton of Bern has quite or nearly completed 
one in the village of Schevendi, overlooking Lake Thun, 
with a capacity of fifty. The Canton Glarus has one pro- 
jected near Braunwald, with a capacity of twelve to fifteen 
beds; Bale, two proposed, one of sixty beds near the city, 
and the other at Davos-Dorfli; Zurich, one of eighty to one 
hundred beds, the situation not yet selected. At Leysin, 
in the Cantons of St. Gallen, Aargau, and in other portions 
of the country, like establishments are under consideration. 
In Germany a number of special hospitals for consumptives 
have recently been established or proposed at Bremen, 
Breslau, Dresden, Hanover, Cologne, Frankfort on the Main, 
Worms, and Stettin, and two in Berlin. At Ruppertskain, 
near Konigstein, one, with a capacity of eighty, is nearly or 
quite completed. In the neighborhood of Vienna a hospi- 
tal is to be erected for poor consumptives, with a capacity 
of a hundred beds. In France, at Agincourt and Magny, 
sanatoriums are projected, or in process of construction. 
Some years ago a Mr. M. 0. Motschoutkovsky * first ad- 
vocated the provision of floating sanatoria for people threat- 
ened with tuberculous disease, or suffering from its incip- 
ient forms, and quite lately he has taken up the subject 
* The Lancet, April 4, 1896, p. 939. CLOSED TREATMENT OF PtITHISIS. 
17 
again with renewed enthusiasm. This zealous hygienist is 
of the opinion that, sooner or later, his scheme will prove 
a triumphant success, for, according to his plan, the isola- 
tion of a dangerous class can be effectively carried out 
with very little discomfort to its members, for, by a judi- 
cious timing of moves, the sufferers will be afforded an ex- 
cellent chance of recovery under the best and most favor- 
able climatic conditions. The various anchorages planned 
have one and all their special seasons, and, as these seasons 
by no means correspond with each other chronologically, a 
speedy vessel could easily transport the passengers from 
one to another, thereby gaining the best results from all. 
The ships for this service are to be specially constructed, and 
are to be in employment only during eight or nine months 
in the year, the remaining time being used to clean and 
thoroughly disinfect them. Mr. Motschoutkovsky is con 
vinced that no sanatorium in the world could surpass his 
floating palaces in comfort or salubrity, while, as regards 
variety and change of scene, there can be no comparison. 
At the present time the well-known shipowning association, 
the Austrian Lloyds, is having a large steamer constructed, 
especially adapted and fitted for the accommodation of in- 
valids in need of fresh air and favorable climate, and the 
anchorages that so far have been selected are at Corfu, 
Alexandria, Palermo, Messina, Naples, Tunis, and Malta. 
There are also various hospitals or sanatoriums in Eu- 
rope for scrofulous or tuberculous children, most of them 
on the seashore. 
Belgium has two—one at Middelkerke, with a capacity 
of three hundred, and the other at Venduyne, of two hun- 
dred capacity. Holland, three—at Zandvort, the Hague, 
and Wyk-sur-Mer. Italy has thirteen sanatoriums of this 
kind on the shores of the Mediterranean and seven on the 
Adriatic. Each of these hospitals takes in a year, on an 18 
THE SANATORIUM OR 
average, from fifty to three hundred patients. Denmark 
has the hospital of Refsnaes, which can receive one hundred 
and thirty sick children. Austria has a marine asylum at 
Rovigno, near Trieste. Germany, and quite recently Rus- 
sia, have followed the example of the other countries of Eu- 
rope. England has the oldest marine hospital for children 
at Margate, founded in 1796. France has many hospitals 
for children on the coast; at Cette, Berck-sur Mer, Cannes, 
Pen Bron, Arcachon, Banyuls-sur-Mer, Cape Breton, 
Ilyeres-Giens, Saint Pol sur Mer, Ver-sur Mer; and in the 
mountains, that of Ormesson, one hundred beds; Yilliers- 
sur Marne, eighty beds; and Forges les-Bains; also one at 
Peyraube in process of construction. At Davos, in Switz- 
erland, the Sanatorium Fredericianum for young boys with 
tuberculous tendencies was founded in 1878. 
Progress in this country in the recognition of the value 
and importance of the sanatorium, treatment for its con- 
sumptives is slow, and but comparatively little has as yet 
been accomplished. A wider knowledge, however, of the 
contagiousness of tuberculosis and of the valuable means 
of protection which sanatoriums offer is influencing the 
public mind to a greater and greater extent, so that we 
may confidently expect in the near future that, either 
through selfishness from fear of infection or from philan- 
thropic motives, both the national and State governments, 
as well as individual beneficence, will be active in promot- 
ing the establishment of such institutions. In order to 
obtain as accurate information as I could, I addressed com- 
munications to the State hoards of health of all the States, 
and from a majority of them I have received replies. I 
find that Massachusetts is the only State that has made any 
public provision for its poor consumptives, having appro- 
priated last year by legislative enactment $150,000 for a 
special hospital, which has been located at Rutland, Worces- CLOSED TREATMENT OF PHTHISIS. 
19 
ter County, one of the highest points in the State. Of the 
sanatoriums established by private means as business en- 
terprises or by philanthropy, there are hut a few that can 
he strictly so called. The Adirondack Cottage Sanitarium 
at Saranac Lake, in the Adirondack Mountains, New York, 
is a monument to the indefatigable exertions and skill of 
Dr. E. L. Trudeau, who is its director. This is partly 
charitable, and is within the reach of persons of moderate 
means. It has a capacity of about seventy-five. The 
Winyah, at Asheville, N. C., under Dr. Yon Ruck and 
Professor Klebs, for paying patients, has a capacity of 
about a hundred. The Sharon Sanitarium, at Sharon, 
Mass., under the direction of Dr. Y. Y. Bowditch, has a 
capacity of nine beds. It has as yet no resident physician. 
The Ilygeia Sanitarium, at Citronelle, Ala., open from Oc- 
tober to May, under Dr. J. 0. Michael and Dr. A. C. Klebs, 
for paying patients, has a capacity of about fifty. There 
are several other institutions scattered about the country 
for the reception of phthisical patients, but which can not 
be strictly classed as sanatoriums: the so-called Home in 
Denver, established by the Rev. F. W. Oakes; the Glockner 
and Bellevue, at Colorado Springs ; the Lyndhurst Sanitary 
Homes, near Denver; a small private institution at Boerne, 
Texas, not exclusively, however, for consumptives ; a Home 
for Consumptives at Chestnut Hill, near Philadelphia ; the 
Rush Hospital for Consumptives and Allied Diseases, in 
Philadelphia. The House of Rest for Consumptives, forty 
beds; St. Joseph’s Hospital, three hundred beds; the Dis- 
pensary for Consumptives, twelve beds—all in New York 
city. The Seton Hospital, Spuyten Duyvil, New York city, 
has one hundred and twenty beds and thirty private rooms. 
The Free Home for Consumptives, twenty-seven beds, 
and soon to be enlarged to one hundred beds, is in Dor- 
chester, Mass. One at Liberty, Sullivan County, N. Y., is 20 
THE SANATORIUM OR 
soon to be opened, and one near Paul Smith’s, Adirondack 
Mountains, under the charge of the Sisters of Charity, is to 
be opened within a few months. In Canada one is pro- 
jected in the Laurentian Mountains ; it is to be a national 
sanitarium and to be built upon the cottage plan. 
Through the efforts of the Invalid Aid Society of Bos 
ton a hill was introduced into the United States Senate by 
Senator Gallinger, of New Hampshire, granting to the 
Society the abandoned Fort Marcy military reservation in 
New Mexico, for the purpose of a national sanitarium for 
the treatment of pulmonary disease. Senator Gallinger 
writes me that the bill is now under consideration by the 
Committee on Public Lands of the House of Representa- 
tives, having passed the Senate ; he adds that he has strong 
hopes that it will become a law. Fort Marcy is about 
seven thousand feet in altitude, contains seventeen acres, 
and has good buildings. Fort Union reservation in the 
same State has also been obtained for a private sanatorium 
for the exclusive treatment of phthisis. In the report of 
the Governor of New Mexico for the year ending June 30, 
1895, Dr. Francis Crosson, who makes the special report 
upon the climate of that region, states that plans are now 
almost complete for the erection of a large sanatorium, to 
be located either at Santa Fe, Las Vegas, or Ojo Caliente, 
by a syndicate of physicians of St. Louis, to carry out Dr. 
Paul Paquin’s new treatment of consumption by “ im- 
munized serum.” He also adds that establishments of a 
similar character are now in contemplation by the Masonic 
and Odd Fellows’ fraternities. 
It seems to me that it is to be deplored that the main 
object of all sanatorium treatment—namely, the hygienic— 
should in any way be obscured in these laudable attempts 
to establish special institutions for the treatment of con- 
sumption by the more specious claims of special methods CLOSED TREATMENT OF PHTHISIS. 
21 
of treatment or specifics. It is well to again repeat that 
up to the present time there has been discovered no specific 
which will cure consumption, and the best results have 
been, and are now, obtained by the hygienic, open-air 
treatment, as illustrated in the best equipped and con- 
ducted sanatoriums. The extraordinary and unexpected, 
like the X rays, may at any time happen in the discovery 
of the devoutly desired specific or immunized serum; but 
when it does come, if ever, there will still be as great a 
need of sanatoriums as at present, where the damage left in 
the wake of the dislodged and routed bacillus and his con- 
freres can be repaired, and the battered body gently and 
skillfully restored for further service. 
Bibliography. 
Leon-Petit. Le Phtisique et son traitement hygienique. 
Paris, 1895. 
Knopf, S. A. Les Sanatoria. Traitement et prophylaxie de 
la phtisie pulmonaire. Paris, 1895. 
Sabourin, Ch. Traitement rationnel de la phtisie. Paris, 
1896. 
Thorne, W. Bezlv. The Open-air Treatment of Phthisis. 
London, 1894. 
Yon Ziemssen. Treatment of Disease by Climate. Hand- 
book of General Therapeutics, vol. iv. 
Hance, Irwin H. A Study of the Infectiousness of the 
Dust in the Adirondack Cottage Sanitarium. Reprint from 
the Medical Record, New York, 1896. 
Yon Ruck, Karl. The Climate of Western North Carolina. 
1896. 
Reports of the Adirondack Cottage Sanitarium. 
Reports of the Glockner and Sharon Sanitariums. The New York Medical Journal. 
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