Open-Air Treatment.—This has already been referred to in discussing the prophylaxis of the disease, and it must be accepted as the most potent factor in the treatment of the established affection, though not mentioned first on the list. The poorer class of patient, who must needs work at his daily toil during the earlier stages of the disease, should be induced to spend every available moment in the open air, and never, when possible, even to take his meals under cover. His occupation should be changed for one which gives him the maximum of fresh air and sunshine when this can be accomplished, and when it is impossible he must have the freest possible ventilation in his workshop.
His sitting and sleeping apartment must be constantly flushed with fresh air, and he must be taught that the danger of " draughts " whilst he lies warmly clad in bed is a fanciful one. Legislation has placed the advan tages of sanatorium treatment within the reach of the poor, and indirectly enormous benefits will arise from this, since it will inculcate habits of open air living amongst a class of the community which dreads pure air and ventilation as deadly dangers.
The ordinary routine open-air life of the sanatorium should be enforced from the start with those who can give themselves entirely up to treatment. In the daytime the patient should spend every moment in the open air regardless of cough, pyrexia or other complication. When unable to take exercise he should be upon a couch in the most open type of shelter, whether the sun is shining or a drizzling rain is falling or the atmosphere is fog-laden, winter and summer alike, provided suitable protection by warm clothing and wraps is afforded. By the use of the rotatory shelter he avoids the direct effects of the wind and rain, and when this is not available a temporary screen may be utilised for the same purpose. Soon the patient becomes able to sleep entirely out of doors in his shelter, and after a short time he refuses to spend his night in any other way, though he may find occasionally some snow on his coverlet in the mornings.
It is, however, a constant difficulty to get patients to carry out this radical change in their mode of living at home, and the practice of the writer is to insist upon all cases going for a time to a well-regulated sanatorium in order to get acclimatised and thoroughly introduced to the routine of open-air life, which they afterwards carry out enthusiastically upon their return to the homestead. One of the first effects noticeable
by this treatment is the great stimulus to the appetite and the improvement in the digestive power, which soon shows itself by a marked increase in weight; cough, sweating and pyrexia diminish, though often little change may be noticeable in the physical signs in the lung.
Rest and Regulated Exercises.—The effects of these valuable therapeutic agents and the indications for their employment will be discussed when dealing with the treatment of pyrexia in a subsequent page.
Climatic Treatment.—Since the establishment of the various open-air sanatoria in different parts of Great Britain, climatic treatment may be said to have been relegated to a lower place on the list of therapeutic agents. This is not to be wondered at, because there are good grounds for believing that often better results can be obtained by means of the superior equipment and the scientific knowledge which guides the routine of these establishments than can be procured in foreign climates where the patient is permitted to eat and drink, live and sleep under sanitary conditions often much less satisfactory than those which prevail in his own home where the disease has been contracted. Even in our own climate the locality in which the sanatorium is situated is believed to be a much less important matter than the nature of the supervision, feeding and routine maintained within it. A dry sandy is, however, prefer able to a moist clay soil, and exposure to east and north winds is not desirable.
In the earlier editions of the present volume issued before sanatoria were established, the writer, in discussing the relative value of the various climates in the treatment of phthisis, laid down the following law— that there being no region on the globe free from tuberculosis, no climate could be regarded as possessing a specific action on the growth of the bacillus, and that the climate which afforded the greatest facilities for spending the largest amount of the patient's time in the open air was the one from which the best results were to be expected.
Though bright sunshine and the so-called " sun-bath " are desiderata which can only he enjoyed for a brief portion of the total year at home, nevertheless their absence is fully compensated for by the greater home comforts and the avoidance of the fatigue and dangers which a long journey entails upon patients in a pyretic condition.