9 p.m. Glass of milk with two or three tea-spoonfuls of cognac.
Of course the diet varies in different sana toria, according to the custom of the country. It must also be adjusted to each individual, and be cooked in the best possible way, not only from the point of view of digestion but also from the point of view of its appetizing quality. Milk bulks largely in it; and at the beginning of treatment, in cases attended by fever, may be the exclusive diet. Four or five glasses a day should be regularly taken by the patient able to take full meals.
It is not necessary to enter into other details as to the treatment in sanatoria. It is suffi cient to say that, for each patient, each day the amount of rest or exercise is laid down, and that, as the patient improves, his exercise is gradually increased, by graduated mountain climbing and in other ways, till becomes fit to return to his home.
It is also needless to emphasize the fact that in a properly-equipped institution every con trivance and arrangement exist to prevent contamination by the organisms of the disease. Promiscuous spitting is rigorously put down. Each patient must carry a specially-constructed flask for spitting into,' and these are regularly disinfected. There is probably, therefore, less risk of infection in a properly-managed sana torium than in most places of public resort.
There are now many sanatoria in Germany, Austria, France, America, and the British Isles. The general tendency of opinion at present is towards the view that success depends more on the situation and construction of the sana torium, the general management of the institu tion, and the methodical and constant medical control and supervision of each individual case than on the climate. There are many suitable situations in the British Isles, and numerous Home Sanatoria are already established, or in course of construction, where the treatment may be carried out as successfully as in the foreign establishments. The treatment is thus being brought within the reach of very many to whom a long journey to a foreign sanatorium would be an insuperable obstacle.
A list of the chief institutions at home and on the continent of Europe follows.
Too much must not be expected of sana torium treatment. A sanatorium is not to be regarded as a last resort, as a place to be kept in view "if things come to the worst." It is to be the place of first resort, if success is to be looked for.
In spite of the success of sanatorium treat ment, it may yet be said with perfect truth that there are cases of advanced consumption beyond the power of any treatment to arrest. Indeed many sanatoria authorities recognize this and refuse to accept such cases, or admit them only for a short time, and if no distinct improvement occurs within a few weeks, send them away. Thus statistics published regard ing 5032 patients treated at Goerbersdorf showed that of 1390 patients in the first stage of the disease nearly 59 per cent were cured or nearly cured, while of 2225 in the second stage only 21i per cent were cured or nearly so, while of 1517 in the third stage only 3 per cent de rived benefit. Again, the statistics published from time to time regarding Falkenstein, where advanced cases are not taken, show the number cured or nearly so do not exceed 30 per cent. These are absolutely reliable facts. Yet in judicious people, who happen to belong to the happy band of the cured, have written to the lay press in terms suggesting that an absolute cure is in all cases obtainable. Such an ex pectation could be encouraged only by those who are so ignorant of the true character and varieties of the disease as to assume that, be cause they have been cured, every other case may be also, provided of course they go through an identical course of treatment. Such an ex pectation is not to be encouraged. The lesson of the statistics is that "delay is dangerous," and that the sooner a patient suffering from consumption repairs to a sanatorium the more hopeful may hd be of success, and the longer he delays the smaller becomes his chance.